Clinical

Question 1

Diarrhoea definition

Answer 1

SUBJECTIVE

increased fluidity and frequency of stools

Question 2

Gastro-enteritis clinical definition

Answer 2

OBJECTIVE

3 or more loose stools / day
Accompanying features

(a clinical diagnosis)

Question 3

Dysentery definition

Answer 3

Large bowel inflammation

Bloody stools

Question 4

Outbreak! definition

Answer 4

2 or more cases of an infection linked in time and place

Question 5

The chain of infection

Answer 5

Infectious agent
Reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host

Question 6

Droplet + Airborne (aerosol) transmission based precautions (TBPs)

Answer 6

Gloves
Apron
Mask
Eye protection
Hand hygiene
Keep door closed

Question 7

Contact transmission based precautions (TBPs)

Answer 7

Contact
Gloves
Apron
Hand hygiene 
Keep door closed

Question 8

difference between droplet and aerosol

Answer 8

DROPLET:
>5micrometres
spread about 1m
drop to ground

AEROSOL:
<5micrometres
much wider spread
remain suspended in the air

Question 9

Cleaning, disinfection and sterilisation

definitions

Answer 9

CLEANING:
= physical removal of organic material and decrease in microbial load (essential prior to disinfection/sterilisation

DISINFECTION
= large reduction in microbe numbers (spores mat remain)

STERILISATION
= removal/destruction of ALL microbes and spores

Question 10

Methods of disinfection

Answer 10

Heat (pasteurisation, boiling)

Chemical

Question 11

Methods of sterilisation

Answer 11

Steam under pressure (autoclave)

Hot air oven
Gas (ethylene dioxide)
Ionising radiation

Question 12

Zoonoses definition

Answer 12

Infections that pass from living animals to humans

That do NOT depend on the human host for part of their lifecycle

Question 13

Human infections that can be transmitted to animal are called

Answer 13

Anthroponoses

e.g influenza - birds/pigs
strep throat (dogs)

Question 14

Production of recombinant vaccines (e.g. for Hep B)

a type of subunit vaccine

Answer 14

The DNA segment coding for HBsAg is removed, purified and mixed with plasmids
–>
This is inserted into yeasts and fermented
–>
HBsAg produced

Question 15

The “6 in 1” vaccine

Answer 15

Purified Bordetella pertussis (aP)
Inactivated polio virus (IPV)
Purified component of Haemophilus influenzae b (Hib)
Purified tetanus toxoid (T)
Hepatitis B rDNA (HBV)
Purified diphtheria toxoid (D)

Question 16

The BCG vaccine protects against…

Answer 16

TB

Question 17

The BCG vaccine is given in the UK to…

Answer 17

Some infants

• areas with annual incidence of TB >40/100,000
• parents/ grandparents born in a country with annual incidence > 40/100,000

Children at high risk (screened at school for risk-factors)
New immigrants from high prevalence countries
Contacts (<35yrs) of TB patients
Healthcare workers

Question 18

Indications for the influenza vaccine

Answer 18

65 years (Nursing home residents)
Healthcare workers
Immunodeficiency/immunosuppression
     - Asplenia/ hyposplenism
     -  DM
     - pregnancy
Chronic liver, renal, cardiac or lung disease

Question 19

The hepatitis B vaccine is given to…

Answer 19

All new-borns from 2018 (6-in-1)
Children at high risk of exposure
Healthcare workers
PWID
MSM
Prisoners
Chronic liver/ kidney disease

Question 20

Varicella-zoster vaccine is given to…

Answer 20

Immunosuppression
Children in contact with those at risk of severe vzv
Healthcare workers (if sero-neg and in contact with cases)

Question 21

The VZV vaccine

type + regime

Answer 21

Live attenuated virus

2 doses, 4-8 weeks apart

Question 22

Herpes-zoster (shingles) vaccine

name, type + indication

Answer 22

Zostavax
A live attenuated virus
Given to all elderly patients (70-80 years) - boosts existing immunity

Question 23

Human normal immunoglobulin

uses

Answer 23

[Contains antibodies against hepatitis A, rubella and measles]

Used in immunoglobulin deficiencies
Used in the treatment of some autoimmune disorders (e.g. myasthenia gravis)

Question 24

Disease specific (post-exposure) immunoglobulins exist for…

Answer 24

Hepatitis B Ig
Rabies Ig
Varicella zoster (chickenpox) Ig
Tetanus anti-toxin Ig
Diphtheria anti-toxin Ig
Botulinum anti-toxin Ig

Question 25

Sources of information on changing international travel health advice

Answer 25

British national formulary (BNF) | Immunization against infectious diseases (green book)

Question 26

Common immunisations for travellers

Answer 26

``` Tetanus Polio Typhoid Hepatitis A Yellow fever Cholera ``` RARER (for special circumstances): meningococcus ACWY, rabies, diphtheria, Japanese B encephalitis, Tick borne encephalitis

Question 27

Natural passive immunity is acquired...

Answer 27

maternally

Question 28

Natural active immunity is acquired...

Answer 28

post infection

Question 29

Artificial passive immunity is acquired...

Answer 29

Through immunoglobulins

Question 30

Artificial active immunity is acquired...

Answer 30

Through immunisations

Question 31

Vaccinations given at 2 months

Answer 31

6-in-1 Pneumococcal conjugate Men B Rotavirus

Question 32

Vaccinations given at 3 months

Answer 32

6-in-1 | Rotavirus

Question 33

Vaccinations given at 4 months

Answer 33

6-in-1 Pneumococcal conjugate Men B

Question 34

Vaccinations given at 1 year

Answer 34

``` Haemophilus influenzae B (Hib) Men C Men B Pneumococcal conjugate MMR ```

Question 35

Vaccinations given at 2 - 8 years

Answer 35

Influenza nasal

Question 36

Vaccinations given at 3-5 years

Answer 36

4-in-1 booster (DTaP/IPV) | MMR

Question 37

HPV vaccine is given to...

Answer 37

Girls | 12 - 13 years

Question 38

Vaccinations given at 14 years

Answer 38

3-in-1 booster (dT/IPV) | Men AWCY

Question 39

Steps to be taken after percutaneous exposure to blood/body fluids (needlestick injury)...

Answer 39

1. Encourage bleeding 2. Wash injury with warm water + soap 3. Cover with a waterproof plaster 4. Report immediately to supervisor 5. Approach the source and request testing for blood-borne viruses 6. The victim's immunisation history should be assessed as active or active/passive immunisation may be appropriate 7. offer the victim testing for blood-borne viruses after 3 + 6 months

Question 40

Investigations to be carried out in a traveller returning from abroad with fever

Answer 40

``` o FBC o Malaria films o LFTs o Stool microscopy and culture o Urine analysis and culture o Blood cultures o CXR o + any other specific tests if indicated ```

Question 41

Antifungal agents to treat invasive fungal infections that works by ergosterol (maintains cell membrane) lysis treats cryptococcal meningitis...

Answer 41

Amphotericin B formulations (IV) | (broad spectrum against most fungal pathogens)

Question 42

Antifungal agents to treat invasive fungal infections that inhibit ergosterol (maintain cell membrane) syntesis treat cryptococcal meningitis, invasive candidiasis...

Answer 42

Azoles (IV/Oral) - fluconazole - voriconazole - isavuconazole ...etc

Question 43

Antifungal agents to treat invasive fungal infections that inhibit glucan synthesis treats invasive candidiasis...

Answer 43

Echinocandins (IV)

Question 44

Antifungal agent to treat invasive fungal infections that inhibit fungal DNA synthesis treat cryptococcal meningitis...

Answer 44

Flucytosine

Question 45

Diagnosis of wound infections

Answer 45

culture of pus/ infected tissues | aim for deeper structures

Question 46

Risks of transmission (following significant percutaneous exposure to a positive source) if no preventative action taken for Hep B, Hep C + HIV

Answer 46

Hepatitis B – 30% Hepatitis C – 3% HIV – 0.3%

Question 47

Post-exposure prophylaxis for HIV

Answer 47

Combination anti-retroviral therapy (CART) Ideally started within 1 hour of exposure (still worthwhile up to 72 hours post exposure)

Question 48

Post-exposure prophylaxis for Hep B/C

Answer 48

Hep B - active recombinant vaccination or... - passive hep B immunoglobulin vaccination Hep C - no PEP available