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conditions Flashcards

1
Q

what is septic shock?

A

severe sepsis + hypotension

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2
Q

what percentage of scottish patients are affected by a HAI

A

4.9%

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3
Q

what is the treatment of lyme disease

A

21 days oral doxycycline or amoxicillin

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4
Q

Which drug is given to pregnant women with influenza

A

oseltamivir

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5
Q

what cancer is particularly seen in HIV

A

Kaposi’s sarcoma (skin)

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6
Q

how is lyme disease diagnosed

A

mostly clinical

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7
Q

what symptoms may be seen in a primary HIV infection

A

flu like symptoms with erythematous/ maculopapular rash

fever, rash, mylagia, lymphadenopathy, pharyngitis

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8
Q

what is the main cause of fever in returning travellers

A

malaria

hepatitis, respiratory, UTI, dengue

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9
Q

how is zika virus transmitted

A

bites from daytime aedes mosquitos

sexual contact, blood transfusion

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10
Q

how may typhoid fever present in the 1st week

A

(non specific) fever, headache, abdo pain, constipation, dry cough

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11
Q

what is in the 6 in 1 vaccine

A

diphtheria, tetanus, whooping cough (bordetella pertussis), polio, h.influenza B, hepatitis B

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12
Q

how may sepsis present differently in the very young and old and immunocompromised

A

hypothermia <36

leucopenia WCC <4,000/ ml

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13
Q

what is your differential for a returning traveller with a fever who has a history of arthralgia

A

SLE, infective endocarditis, lyme disease, brucellosis, Tb, IBD

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14
Q

what signs are classic of a pulmonary aspegilloma on a chest X-ray

A

halo sign

air crescent sign

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15
Q

what are high risk items that need sterilisation

A

surgical instruments

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16
Q

what is the most common organism in IV catheter associated infection

A

staph aureus (MRSA, MSSA)

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17
Q

what organism causes lyme disease

A

borrelia burgdorferi

ixodes genus vector - i.ricinus (europe), i,scapularis/ pacificus (N america) i.persulcatus (asia)

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18
Q

what are the 3 species of brucella

A

melitensis - goats, sheep and camels
suis - pigs (america,SE asia)
abortus - cattle (not man)

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19
Q

how do patients with sepsis have features consistent with immunosuppression

A

loss of delayed hypersensitivity, inability to clear infection, predisposition to nosocomial infection

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20
Q

what is the difference between antigenic drift and shift

A

drift - mechanism of genetic variation within the virus, occurs over time
shift - abrupt change in virus resulting in new H/N combo

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21
Q

how does rabies present with an acute encephalitis

A

malaise, headache, fever, odd behaviour

death by respiratory failure

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22
Q

what are medium risk items that need disinfecting

A

mucous membrane contact - bedpans, vaginal specula, endoscopes

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23
Q

what are the boys defences against sepsis

A

physical - skin, mucosa, epithelial lining
innate - IgA, dendrites, macrophages
adaptive - lymphocytes, immunoglobulins

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24
Q

name some bacteria that are zoonoses

A

salmonella, campylobacter, shigella, brucella, leptospirosis, Q fever (coxiella burnetti), psittacosis

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25
Q

which virus used to be known as the winter vomiting disease

A

norovirus

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26
Q

how can natural colonised bacteria change to cause infection

A

break in skin - surgical site
vascular devices - BSI
catheters - catheter associated UTI
ventilators - ventilator associated pneumonia

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27
Q

what is is seen in sub acute invasive pulmonary aspergillosis

A

non angioinvasive, limited fungal growth
pyogranulomatous infiltrates, tissue necrosis, excessive inflammation
non specific clinical signs and symptoms

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28
Q

what are predisposing factors to necrotising fasciitis

A

diabetes, surgery, trauma
peripheral vascular disease
skin popping

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29
Q

what is the triad of neuroboreliosis in severe lyme disease

A

facial nerve palsy, radicular pain (worse at night), lymphocytic meningitis

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30
Q

what may be seen in HIV clinical stage IV

A 
toxoplasmosis of brain
HIV encephalopathy 
HIV wasting syndrome
cytomegalovirus (MCV) 
herpes simplex 
progressive multifocal leukoencelopathy (PML)
candidas - oral, oesophagus, trachea, lungs
extra- pulmonary Tb
Kaposi sarcoma
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31
Q

what organisms cause toxin mediated syndromes

A

staph aureus

streptococcus pyrogens

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32
Q

at what point does HIV become symptomatic

A

HIV RNA > CD4

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33
Q

what vaccine is given to >65

A

influenza, varicella zoster

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34
Q

give some examples of detoxified exotoxin vaccinations

A

diphtheria, tetanus

toxin treated with formalin

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35
Q

in what cases would a persons body not be able to fight sepsis as well

A

immunosuppressed - HIV, drugs (steroids, chemo, biologics), congenital
co-mornid - COPD, DM (immunoparesis), malignancy

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36
Q

what are compilation of campylobacter infection

A

guillain barre syndrome, reactive arthritis, pancreatitis

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37
Q

why does erysipelas have a high recurrence rate (30% within 3 years)

A

damage to lymphatic system - never fully regains function

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38
Q

what is an AIDs defining dermatology disease

A

Kaposis sarcoma

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39
Q

what is acrodermatitis chronic atroficans (ACA) a sign of

A

lyme disease- chronic

blusih red discolouration , extensor surfaces of digital extremities

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40
Q

what pathogen caused the most hospital admissions for gastroenteritis each year

A

salmonella

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41
Q

how is cellulitis and erysipelastreated?

A

combo of anti-staph (fluclozacillin) and ant strep (benzylpenicillin)
extensive disease - admit with IV antibiotics and rest

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42
Q

what is Katayama fever (complication of schistosomiasis)

A

fever, urticaria, diarrhoea, lymphadenopathy, splenomegaly, eosinophilia

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43
Q

how is staphylococcal scalded skin syndrome characterised

A

widepsread bull and skin exfoliation

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44
Q

how is noravirus diagnosed

A

PCR - stool sample reverse transcriptase

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45
Q

why is CD4 count measured in HIV

A

monitor immune system function and disease progression

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46
Q

what are side effects of non nucleoside reverse transcriptase inhibitor (rilpivirine)

A

skin rashes, GI disturbance, drug interaction (major PPI)

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47
Q

what immunoglobulins are specific in chronic/ allergic pulmonary aspergillosis

A

aspergillosis specific IgG and IgE

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48
Q

what disease is is cryptococcus neoformans a major killer in

A

HIV associated cryptococcal meningitis

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49
Q

how does blackwater fever present (complication of malaria)

A

profound anemia, haemoglobinuria, acute renal failure, dark urine
severe intravascular haemolysis, high parasitaemia

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50
Q

name some viruses that are zoonoses

A

rabies, avian influenza, ebola, west nile fever, yellow fever

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51
Q

what type of bacteria is vibrio cholera

A

gram -ve, aerobic

comma shaped flagellated swarming rod

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52
Q

how may shigella present

A

watery/ bloody diarrhoea, pain, tenesmus, fever

1-2 days after exposure, lasts 5-7 days

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53
Q

what are the main differences between seasonal and pandemic influenza

A

seasonal - annual, 10-15% populations, not life-threatening

pandemic - sporadic, +25% population, more serious complications

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54
Q

which skin and soft tissue infections need urgent attention

A 
necrotising fasciitis 
toxic shock syndrome
pyomositis
PVL infection
venflon- associated infenction
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55
Q

what group usually cause toxin mediated syndromes

A

superantigens (pyrogenic exotoxins)
bypass immune system and attach directly to T cell receptors
massive cytokine release

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56
Q

how may rickettsiosis present

A

incubation 1-2 weeks

abrupt onset swinging fever, headache, confusion, myalgia, rash (macular, petechial)

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57
Q

what patients is neutropenic PUO diagnosed in

A

neutrophils <500/mm3 - haematology, chemotherapy

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58
Q

how is c. difficile diagnosed

A

need diarrhoea symptoms
immunoassay for glutamate dehydrogenase
positive toxin test

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59
Q

what problems with the host may lead to a more serious skin infection

A 
diabetes - nuropahty
immunosuppressed -hiv, chemo, steroids
renal failure
milroys disease - non pitting oedema
predisposing skin conditions eg atop dermatitis
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60
Q

how does infectious tenosynovitis present

A

erythematous fusiform swelling of finger and pain with extension of finger

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61
Q

what is the treatment of IV associated infections

A

remove cannula and express any pus from the thrombophlebitis

antibiotics 14 days

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62
Q

does a bacterial infection have high neutrophils or lymphocytes?

A

neutrophils

viral = high lymphocytes

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63
Q

how do antifungal azoles work

A

inhibit ergosterol synthesis
fluconazole - candidas
voriconazole/ issavaconazole - aspergillosis
itraconazole/ posaconazole - antifungal propylaxis

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64
Q

whats are low risk items that need cleaning

A

intact skin contact - stethoscope, mattress, cot

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65
Q

what 3 things are given in sepsis 6

A

oxygen, IV antibiotics, IV fluids

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66
Q

what is the aim of HIV treatment

A

to reduce HIV viral load to a level undetectable by standard laboratory techniques leading to immunological recovery, reduced clinical progression and reduced mortality, with at least possible side effects

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67
Q

what are the most common isolates of the salmonella species

A

salmonella enteritidis

salmonella typhimurium

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68
Q

what are the body’s main defences against enteric infections

A

hygiene
normal gut flora
stomach acid

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69
Q

what do HIV and AIDS stand for

A

human immunodeficiency virus

acquired immune deficiency syndrome

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70
Q

how is malaria diagnosed

A

thick and thin blood films - giemsa/ fields stain (microscopy)
quantitative buffy coat (QBC)
rapid antigen test - optiMal, ParaSight F

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71
Q

how may septic bursitis present

A

pain, swelling, warmth , fever

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72
Q

which imaging techniques can be done to investigate pyrexia

A

CT contrast, radio labelled white cell scan, PET scan, Flurodeoxyglucose (FDG) - not diabetics

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73
Q

how may brucellosis present sub-acutely (1-6 months)

A

fever and joint pain

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74
Q

how would you assess a patient with diarrhoea hydration status

A

postural BP, skin turgor, pulse

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75
Q

what is a anthroponosis and give some examples

A

a disease from humans that affects animals
influenza - birds, pigs
strep throat - dogs
leishmaniasis - dogs

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76
Q

what are complications of typhoid fever (3rd week)

A

intestinal bleeding, perforation, peritoneum, GI complications form peyers patches

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77
Q

what are clinical characteristics of Clostridium difficile infections

A

watery diarrhoea - cahracteristic odour
abdominal pain, fever, high WCC
pseudomembranous colitis - on endoscopy

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78
Q

list some bacterial toxins released in stage 1 of sepsis

A

gram -ve - lipopolysaccharide (LPS
gram +ve - MAMP microbial associated molecular pattern (lipoteichoic acid LTA, muramyl dipeptides), super antigens (streptococcal exotoxin, staphylococcal toxic shock syndrome toxin)

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79
Q

what are some control measures for preventing an outbreak of HAI

A

single room isolation
ward closure
cohorting cases
staff exclusion

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80
Q

how long does the influenza virus survive

A

24-48 hours on non-porous surfaces

8-12 on porous e.g. tissue

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81
Q

what is a fabricated fever

A

self induced - eat soap, inject focal products
microbiology negative
psychiatric expertise

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82
Q

give some examples of live attenuated vaccinations

A

measles, mumps, rubella (MMR)
varicella zoster virus (shingles)
yellow fever, typhoid

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83
Q

what is the natural history of HIV

A

acute infection –> seroconversion to asymptomatic –> HIV related illness –> AIDs defining illness –> Death

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84
Q

what HIV test be done at point of care

A

immunoassay kit - finger prick or mouth swab

needs serological confirmation

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85
Q

how is a carbuncle treated compared to folliculitis and furunculosis

A

admission, surgery and IV antibiotics compared to no treatment

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86
Q

where may IV catheter associated infections spread

A

heart valve - endocarditis

bones - osteomyelitis

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87
Q

what are some means of transmission of healthcare associated infections

A

direct contact - staph aureus
respiratory / droplet - neisseria meningitis, mycobacteria tuberculosis
faecal-oral - clostridium difficile, salmonella
penetrating injury - group A streptococcus, bloodbourne virus

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88
Q

what is severe sepsis?

A

sepsis + end organ damage

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89
Q

what are the 3 layers of skin

A

epidermis, dermis, subcutaneous fat

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90
Q

which bacteria causes food posioning from re-fried rice

A

bacillus cereus

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91
Q

how is the seasonal flu vaccine given?

A

single 0.5ml intramuscular injection (SE sore arm)

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92
Q

how does chronic pulmonary aspergillosis present

A

> 3 months of declining lung function

increased respiratory symptoms - cough, dyspnoea, decreased exercise tolerance

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93
Q

why do people with severe secretory diarrhoea need fluid replacement with hypotonic solutions

A

secreterory diarrhoea can lead to sever electrolyte loss - hyponatraemia, hypokalaemia

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94
Q

if you suspected temporal arteritis, vasculitis or other connective tissue disorders in someone with pyrexia how would you treat them

A

steroids

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95
Q

what did brucellosis used to be an occupational hazard of (now rare in UK)

A

farmers, vets, slaughterhouse workers

orgnaisms are excreted in milk, placenta and aborted foetus

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96
Q

how is typhoid fever caused

A

poor sanitation and unclean drinking water

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97
Q

what does cART therapy mean

A

combination anteretrovirals - at least 3 drugs from 2 groups

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98
Q

how is rotavirus diagnosed

A

stool antigen - wheel like appearance

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99
Q

after contact with the HIV virus how long do symptoms take to develop for the primary HIV infection

A

2-4 weeks

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100
Q

where is the incidence of malaria highest

A

sub-Saharan africa - 88% of cases, 90% of deaths, most <5 years old

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101
Q

how can c.diff infections be prevented

A

reduce 4Cs and broad spectrum antibiotics
local antibiotic policy
isolate symptomatic patients
wash hands between patents

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102
Q

what are risk factors for an IV catheter associated infection

A

continus infusion >24hrs, cannula in situ >72hrs
cannula in lower limbs
patient with neurological problem

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103
Q

what is the general presentation of sepsis

A 
fever >38
hypotension 
tachycardia >90bpm
Tacypnoea >20/ min 
altered mental state
oedema
hyperglycaemia >8 (not diabetic)
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104
Q

how would you investigate pyomyosists

A

CT/ MRI

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105
Q

what percentage of people is primary HIV infection symptomatic in

A

80%
2-4 weeks after exposure
self limiting 1-2 weeks

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106
Q

what is the classical skin sign of lyme disease

A

erythema migrans - bullseye rash, not painful/ itchy

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107
Q

what is the mortality for necrotising fasciitis?

A

17-40%

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108
Q

when are antibiotics indicated in the treatment of gastroenteritis

A

normally not

immunocompromised, severe sepsis, valvular heart disease, chronic illness, diabetes

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109
Q

what diseases do mosquitos carry

A

malaria, dengue fever, yellow fever , zika virus

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110
Q

how would you diagnose influenza

A

clinical - acute + cough + fever
viral N&T swab
blood - U&E, FBC, CRP (pneumonia recovery - halve in 4 days)

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111
Q

what is the difference in the type of influenza of antigenic shift and drift

A

shift - pandemic

drift - worse than normal epidemics (seasonal influenza)

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112
Q

what is the difference between cleaning and sterilisation

A

cleaning - physical removal of organic material and decrease microbial load
sterilisation - removal and destruction of ALL microbes and spores

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113
Q

how would you investigate PUO if you suspected Tb contact

A

sputum smear - ZN
bone marrow
mantoux screen

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114
Q

list some classes of antifungal drugs

A

amphotericin B
azoles
echinocandins
flucytosine

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115
Q

how do you determine if the same strain of bacteria is present (typing)

A 
antiobiogram - antibiotic sensitivity pattern
phage typing 
pyocin typing
serotyping 
molecular typing (DNA)
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116
Q

what vaccine is given to girls aged 12-13

A

human papilloma virus (HPV 6, 1, 16, 18)

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117
Q

what enzyme converts HIV RNA to DNA

A

reverse transcriptase

error prone - diverse virus

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118
Q

give some 20th century pandemic influenzas

A

1918-19 - spanish flu (A/H1N1)
1957-58 - asian flu (A/H2N2)
1968-9 - hong kong flu (A/H3N2)
2009-10 - swine flu (A/H1N1)

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119
Q

what travel related infections may present with a rash

A

typhoid, typhus, dengue

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120
Q

what percentage of the population have staph aureus colonised in their nose

A

30%

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121
Q

what is the diagnostic criteria for staphylococcal toxic shock syndrome

A

fever, hypotension
diffuse macular rah - pink, leaves finger imprint
3+ organs - liver, blood, renal, GI, CNS, MSK
isolation of staph aureus from normal sterile site

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122
Q

list some ways to avoid exposure to BBV at work

A

good hand hygiene
cover wounds with waterproof dressing
protect eyes/nose/ mouth from blood splashes
avoid sharps usage where possible
dispose of sharps safely
clear up blood/ disinfect
procedure for safe disposal of contaminated waste

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123
Q

who is the seasonal flu vaccine contraindicated in

A

egg allergy

grown in allantoic cavity of chick embryo then chemically inactivated and purified

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124
Q

what are methods of sterilisation

A

steam under pressure (autoclave)
hot air oven
gas (ethylene dioxide)
ionising radiation

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125
Q

how are humans infected with brucella

A

milking infected animals, birthing animals, handling carcasses of infected animals, consumption of unpasteurised dairy products

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126
Q

where does erysipelas tend to occur

A

70-80% occur on lower limbs - can’t weight bear

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127
Q

what travel related infections have a long incubation period >21d

A

malaria, HIV, Tb, viral hepatitis, schistosomiasis,

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128
Q

what are the 3 phases in the pathogenesis of sepsis

A
  1. release of bacterial toxins
  2. release of mediators in response to infection
  3. Effects of specific excessive mediators (pro/anti inflammatory)
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129
Q

how is crytococcus neoformans transmitted

A

inhalation - bark of trees, bird faeces

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130
Q

which 4 antibiotics are known to give clostridium difficile diarrhoea

A

cephalosporin, co-amoxiclav, clindamycin, clarithromycin

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131
Q

why does the incidence of lyme disease spike in summer

A

increased human activity , tics are active above 4 degress

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132
Q

how does a quantitative buffy coat diagnose malaria

A

spin blood overnight - red cells on bottom, serum on top, buffy coat in middle look at under stain (acridine orange)

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133
Q

what causes the acute disease of schistosomiasis

A

eggs deposited in bowel (dysentry) or bladder (haematuria)

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134
Q

how is the c. difficile infection caused

A

imbalance in gut flora from an endogenous or exogenous source

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135
Q

what vaccines are given within the first few months of life

A

6 un 1, pneumococcus, rotavirus, men B

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136
Q

what are adverse effects of oseltaemivir (tamiflu) - 1st line influenza drug

A

N&V, abdominal pain, diarrhoea
less common - headache, hallucinations, insomnia, rash
caution with renal

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137
Q

what is your differential for a returning traveller with a fever who has a history of animal contact

A

brucellosis, toxoplasmosis, leptospirosis, Q fever

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138
Q

what is seasonal influenza

A

acute viral infection of the lungs and airways

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139
Q

how would you diagnose a pulmonary aspergilloma in a neutropenic and non- neutropenic patient

A

non- neutropenic - cultures of sputum and or BAL or biopsy

neutropenic - CT chest - halo sign air cresent sign, galactomannan, PCR aspergillus

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140
Q

how is cholera treated

A

oral rehydration salts , fluids if severely dehydrated

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141
Q

how does organ dysfunction present in sepsis

A

arterial hypoxaemia
renal - oliguria, creatinine increase,
gut - ileus (absent bowel sounds)
liver - coagulation abnormal, hyperbilirubinaemia

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142
Q

in sepsis pathogenesis, mediators TH1 and Th2 cause which inflammatory reaction

A

TH1 - pro-inflammatory - causes sepsis reactions
Th2 - anti-inflammatory - compensatory reaction
(balance to survive)

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143
Q

what is an AIDs defining gynaecology disease

A

cervical cancer

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144
Q

how is aspergillosis transmitted

A

sporulation, hydrophobic conidia, airborne/ inhalation

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145
Q

what is considered in a risk assessment for travelleres

A

own health, previous immunisation, area visiting, duration of visit, activities , accommodation, remote areas

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146
Q

what are side effects of doxycycline

A

not for <12, can stain teeth and bones, photosensitivity

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147
Q

how are fungal pathogens opportunistic

A

affect patients with an impaired immune system/ HIV/ malignancies/ COPD & lung diseases, ICU

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148
Q

what are aspects of the malaria control programme

A

site - drainage of standing water
killing spray - DDT
human behaviour - bed nets, mesh windows

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149
Q

how many folliculitis present

A

circumscribed pustular infection of a single hair follicle
small red papule with a centre area of pus
typically on head, bum, back and limbs

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150
Q

when does influenza hit the north and southern hemispheres

A

north - dec-feb

south - jun-aug

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151
Q

how is invasive candidiasis diagnosed

A

blood culture form normal sterile site

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152
Q

what is an AIDs defining oncology disease

A

non- hodgkins lymphoma

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153
Q

why are malaria, schistosomiasis (snail fever), onchocerciasis (river blindness) and elephantiasis (lymphatic filariasis) not zoonoses

A

although their are transmitted from animals they depend on the human host for part of their life cycle

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154
Q

how is cryptococcal disease diagnosed

A

CSF - indian ink preparation (80%), culture, high protein/ low glucose,
blood - culture crytococcus antigen

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155
Q

what is a pulmonary aspergilloma

A

fungal mass that usually grows in pre-exisitng lung cavities (Tb, sarcoid, bronchiectasis, bronchial cysts/ bullae)

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156
Q

how may early disseminated lyme disease present (weeks- months)

A

borrelial lympocytoma, neuroborreliosis

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157
Q

what is a diagnostic window and what is it for HIV

A

period of time during which markers of infection are not detectable - can get false negatives
roughly 3 months

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158
Q

what are the 4 classes of HIV drug

A

nucleoside reverse transcriptase inhibitor
non nucleoside reverse transcriptiase inhibitor
integrase inhibitor
protease inhibitor

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159
Q

how do nucleoside reverse transcriptase inhibitors work (tenofovir, emtricitabine)

A

inhibit reverse transcriptase and the conversion of RNA -> DNA

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160
Q

give an example of a recombinant vaccination and how it works

A

hep B

remove active part (DNA segment coding for HBsAg) > mixed with plasmids > fermented in yeast > produce surface antigen

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161
Q

what are the 3 main groups of influenza virus

A

A - birds and mammals
B - humans
C - humans, less serious/ short lived

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162
Q

how is typhoif fever treated

A

oral azithromycin

IV ceftriaxone if complicated (c. diff)

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163
Q

what is an AIDs defining neurology disease

A

cerebral toxoplasmosis
primary cerebral lymphoma
cryptococcal meningitis
progressive multifocal leukoencephalopathy (PML)

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164
Q

what is the differential diagnosis of malaria

A

dengue, typhoid, hepatitis, viral haemorrhagic fever

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165
Q

what are the main causes of gastroenteritis

A

contaminated foodstuff- poultry
poor storage of produce - bacteria proliferates at room temp
travel related
person-person spread e.g. noravirus

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166
Q

what is pyomyositis

A

purulent infection deep within the strained muscle often manifesting as an abscess
often secondary to seeding

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167
Q

what is complicated influenza

A

influenza requiring hospital admission
and/or with symptoms and signs of lower respiratory tract infection (hyperaemia, dyspnoea, lung infiltrate)
and/ or CNS involvement
and/ or significant exacerbation of an underlying medical condition

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168
Q

how should health care staff protect themselves from the flu

A

face mask, apron, gloves
hand hygiene
face fit respirator masks (FFP 3) when patient receiving nebuliser

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169
Q

how do you break the chain of infection (source of microbe > transmission > host)

A

risk awareness
standard infection prevention and control precautions (SICPs)
Hand hygiene
appropriate PPE - gloves, aprons, masks
Personal - bare below elbows, hair back, scrubs
vaccination
strict aseptic techniques

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170
Q

when is nosocomial PUO diagnosed

A

develops in hospital and still undiagnosed after 3 days

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171
Q

why must HIV adherence be >90%

A

prevent viral mutation and resistance

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172
Q

what age is the MMR vaccine given at

A

3-5 years

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173
Q

what disease used to be common in NE Scotland fish workers

A

leptospirosis / rat fever/ Weil’s disease

L. icterohaemorrhagica

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174
Q

how is giardia lamblia treated

A

metronidazole

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175
Q

what must all patients be asked before a HIV test?

A

consent

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176
Q

what is the definition of a zoonoses

A

infections that are naturally transmitted between vertebrae animals and humans
(approx 61% of known pathogens are zoonotic)

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177
Q

what does impetigo look like

A

multiple vesicular lesions on an erythematous base
golden crust (honey comb)
normally on face, scalp and arm

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178
Q

what is moderate risk criteria for sepsis

A

reports of altered mental state
RR 21-24
SBP - 91-100 mmHg
HR - 91- 130
urine output - nil 12-18hrs, 0.5-1ml if catheter
local signs of infection - redness, swelling
recent surgery/ trauma

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179
Q

what is an Influenza like illness (ILU)

A

fever >38 AND cough with onset within 10 days

if needs hospital - severe acute respiratory infection

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180
Q

how do you treat uncomplicated (p. falciparum) malaria

A 
??
3 compounds 
3 days - raiment, eurartesim, malarone
7 days - quinine 
plus oral doxycycline
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181
Q

what are possible outcomes of HAI

A

extended length of stay, pain, discomfort
increased cost
litigations
loss of public confidence

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182
Q

what is the gold standard test for HIV

A

4ht generation ELISA assay - for HIV antibody and antigen(1 month diagnostic window)

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183
Q

what illnesses does panton-valentine leucocidin toxin lead to

A

haemorrhagic pneumonia

skin and soft tissue infection

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184
Q

what patients is allergic pulmonaryaspergillosis seen in

A

CF and asthma

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185
Q

how may late disseminated lyme disease present (months- years)

A

acrodermatitis chronic atrophicans, lyme arthritis

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186
Q

what is the treatment of staphylococcal toxic shock syndrome

A

remove any offending objects
IV fluids
antibiotics - flucloxacillin if staph
IV immunoglobulins

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187
Q

what bacteria commonly causes outbreaks in nurseries

A

shigella sonnei (gram -ve)

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188
Q

give some examples of sub unit vaccinations

A

purified microbial products stimulate immune response

h. infleunzae B, meningococcus C, pneumococcus

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189
Q

how may brucellosis present acutely (1-3 weeks)

A

high PUO, weakness, headaches, drenching sweats, splenomegaly

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190
Q

name some parasites that are zoonoses

A

toxoplasmosis, crysticercosis, ehinococcosis

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191
Q

what syndrome can E.coli 0157 toxin cause

A

haemolytic uraemia syndrome (HUS) - haemolytic anaemia, renal failure, thrombocytopenia

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192
Q

in sepsis pathogenesis, what happens if the anti and pro inflammatory responses are not balanced

A

pro > anti - septic shock with multi-organ failure and death

anti > pro - immunoparalysis with uncontrolled infection - multi-organ failure

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193
Q

what is the sepsis 6

A

TAKE 3 - blood cultures, blood lactate, urine output

GIVE - oxygen, fluids, antibiotics

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194
Q

how is noravirus transmitted

A

contact with infected people, environment and food

common cause of outbreaks in community, hospital and cruise ship

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195
Q

how are surgical site infections classed

A

I - clean wounds (no respiratory, GI, genital, urinary)
II - clean - contaminated wound
III - contaminated wound (open, fresh )
IV - infected wound

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196
Q

how is complicated malaria assessed

A

1 or more of - impaired consciousness , hypoglycaemia, low haemoglobin, parasite count >2%, spontaneous bleeding, haemoglobulinuria, AKI,

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197
Q

what are the 2 types of lactate taken in sepsis 6

A

type A - marker of generalised hypo perfusion

type B - mitochondrial toxins, alcohol metabolism errors

198
Q

why should patients with flu symptoms and fever >4 days have an urgent CXR

A

suspect secondary bacterial pneumonia

199
Q

what are the surface proteins of the influenza virus

A

Haemaglutinin (H) (1-3)

Neuraminidase (N) 11

200
Q

what diseases can cryptococcus neoformans cause

A

meningitis and pneumonia

201
Q

what must be ruled out when diagnosing septic bursitis

A

Septic arthritis - needs emergency surgery to wash out

- no ability to flex/ bend knee

202
Q

how would you investigate unilateral headaches with a fever

A

temporal artery biopsy - high ESR

203
Q

how is seasonal infleunza spread

A

person - person by air droplets and contact (direct or indirect)
rapid

204
Q

why did the incidence of staphylococcal toxic shock syndrome increase in 1980s

A

high absorbency tampons during menses

205
Q

what sats of O2 should you aim for in sepsis

A

94-98% (88-92% if COPD/ risk of CO2 retention)

206
Q

what may predispose someone to pymoyositis

A

diabetes, HIV/ immunocompromised, malignancy
rheumatoid disease - SLE, rheumatic arthritis
IV drug use

207
Q

how is shigella diagnosed

A

stool culture

PCR/ enzyme immunoassay

208
Q

what does the Neuraminidase (N) influenza surface protein do

A

enables new virion to be released from host cell

209
Q

what is the term for when someone with in malaria is in shock

A

algid malaria - gram negative septicaemia

210
Q

what are borreliallymphocytomas and what are they a sign of

A

bluish solitary nodules - earlobe, nipple, genital

lyme disease

211
Q

what bacteria is the most common cause of gastroenteritis

A

campylobacter

212
Q

what are the most common zoonoses in the UK

A 
salmonella
campylobacter
toxoplasma
Q-fever (coxiella burnetti) 
psittacosis (chlamydia - birds)
ringworm/ dermatophytosis
213
Q

which bacteria causes food poisoning from re-fried rice

A

bacillus cereus

214
Q

how is eColi 0157 diagnosed

A

stool culture

PCR/ enzyme immunoassy - shiga-toxin

215
Q

how would you investigate PUO in someone with tropical travel

A

bloods - malaria,a dengue, HIV, bone marrow for leishmaniasis

216
Q

what are healthcare associated infections

A

infections that were not present in the pre-syymptomatic phase at the time of admission to hospital
or
arise >48h after admission or with 48h of discharge

217
Q

how is schistosomiasis treated

A

praziquantel 20mg/kg - 2 doses 6 hours apart

prednisolone if sever katakana fever

218
Q

name 3 hair associated infection s

A

folliculitis, furunculosis, carbuncle

219
Q

where does E.coli infection come from

A

food - contaminated meat

220
Q

what is a carbuncle

A

multiseptated abscessed involving multiple furuncles
often locate back of neck, posterior trunk or thigh
purulent material may be expressed

221
Q

how long is seasonal influenza infective for

A

1 day prior to 7 days after symptoms

222
Q

what is the incubation period of seasonal influenza

A

2-4 days (1-7 range)

223
Q

what are the symptoms of salmonella poisoning and when do they occur

A

<48h of exposure

diarrhoea with cramps and fever

224
Q

how do protease inhibitors work (atazanavir, darunavir)

A

inhibit protease, the enzyme involved in the maturation of virus particles (can’t infect other cells)

225
Q

how may erysipelas present

A

infection of the upper dermis with a painful well defined red area
associated with fever +systemic symptoms
can’t weight bear
lymphadenopathy

226
Q

what is skin popping? risk factor for necrotising fasciitis

A

after injecting drugs for a number of years and run out of veins they begin to inject into subcutaneous fat

227
Q

what is streptococcal toxic shock syndrome associated with

A

presence of streptococci in deep seated infections such as erysipelas or necrotising fasciitis

228
Q

what SOFA score represents a 10% mortality risk of sepsis

A

> 2

229
Q

describe the lifestyle of schistosomiasis

A

parasite in water enters snails > replicates and enter water > humans paddle in water > parasite enters skin and spreads in the bloodstream to gut/ bladder/ lymph > replicates to produce eggs which are excreted in faeces or urine

230
Q

how may typhoid fever present in the 2nd week

A

fever peaks at 7-10 days

rose spots, diarrhoea (no vomiting - distinguish salmonella)

231
Q

how is the diagnosis of rabies made

A

potential exposure + progressive signs of myelitis and encephalitis
PCR for lyssaviras of saliva/ CSF
often confirmed post mortem brain biopsy

232
Q

what is PEPSE in HIV therapy

A

short term use of anteretroviral therapy after potential HIV exposure - emergency method of HIV prevention
up to 72h but ideally <24 hours

233
Q

in sepsis pathogenesis does LPS (-ve) or LTA (+ve) need a protein to bind to macropahges

A

LPS

234
Q

why are antibiotics given in sepsis

A

to reduce to pro-inflammatory response

if too much is given/ diabetics this can lead to anti> pro and death

235
Q

what are the 2 most common organisms to cause HIV associated PUO

A

mycobacterium tuberculoses and mycobacterium ovum

more than 3 days inpatient or 4 weeks as outpatient

236
Q

how do integrase strand transfer inhibitors work (dolutegravir, elvitegravir, raltegravir)

A

inhibit integrates and prevent HIV DNA integration into nuclear genome via nucleus

237
Q

what is the difference between natural and artificial adaptive immunity

A

natural - body adaptation to environment and infectious stimuli
artificial - given immunoglobulins to fight off infection

238
Q

how is the diagnosis of brucellosis made

A

culture with prolonged incubation due to slow doubling time

can spread in library - give warning

239
Q

what features may be seen in necrotising fasciitis?

A

erythema, extensive oedema, severe unremitting pain
haemorrhagic bull, skin necrosis
systemic - fever, hypotension, tachycardia, delirium, multi-organ failure

240
Q

who is indicated for the hep B vaccine

A

children at high risk, health care workers, PWID, MSM, prisoners, chronic liver/ kidney disease

241
Q

which layer of skin does impetigo affect?

A

epidermis - superficila

242
Q

if rabies is symptomatic or treated what happens

A

death

100% fatal once reached CNS

243
Q

list some investigations you would do for PUO and why

A

bloods - 3x at time of fever
CXR - tb, lung cancer
urinalysis - UTI, renal tumour, vasculitis
FBC- differential WCC (lymphocytes vs neutrophils)
CRP/ ESR
U&E
LFT

244
Q

how do patients with panton-valentine leucocidin toxin present

A

recurrent boils that are hard to treat

245
Q

what are bursae and what is their function

A

small sac like cavities that contain fluid and are lined by synovial membrane, they are located subcutaneously between bony prominences or tendons, they facilitate movement with reduced friction

246
Q

in sepsis pathogenesis , what is the pro-inflammatory response

A 
leukocyte adhesion - WC to site of infection 
arachidonic acid metabolites released
vasodialte blood vessels (NO)
increase coagulation 
TNF-a causes temperature
247
Q

what is the most important predisposing factor to skin infections

A

breach in the skin - trauma, infection, dermatitis, psoriasis

248
Q

what are side effects of nucleoside reverse transcriptase inhibitor (tenofovir, emtricitabine)

A

lipodystrophy (fat distributer) , marrow toxicity, neuropathy, GI disturbance/ pancreatitis

249
Q

what drug cures tick typhus

A

tetracycline

250
Q

how can the presentation of c.diff range

A

mild diarrhoea to severe colitis

251
Q

are you born with innate or adaptive immune system

A

innate

252
Q

what are common sites for pyomyositis

A

lower limbs - thigh, calf , gluteal region , psoas

arma, chest wall, psoas

253
Q

give some reasons for poor uptake of vaccinations

A

infrastructure, staffing problem, heath scare, parental belief

254
Q

how should antibiotics be given in sepsis? type and rate

A

IV crystalloids with Na, 500ml over 15 mins in bolus

255
Q

what animal transmits lyme disease

A

tick

256
Q

what are methods of disinfection

A

heat - pasteurisation / boiling

chemical - alcohol, hydrogen peroxide

257
Q

what are high risk criteria for sepsis

A

objective evidence of altered mental state
high RR >24
SBP <90 mmHg
HR > 130 bpm
urine output - nil for 18h , <0.5ml if catheter
mottled/ cyanotic skin

258
Q

how is salmonella investigated

A

blood cultures - <5% positive, screen out lactose-non fermenters

259
Q

what is a common complication of salmonella

A

irritable bowel syndrome

260
Q

what travel related infections have a short incubation period <10d

A

dengue, gastroenteritis, rickettsiae

261
Q

what is rabies

A

viral infection (lyssavirus) transmitted form the bite of an infected animal

262
Q

what is malaria

A

parastitic infection of RBC, spread by mosquitoes breeding in contaminated water to humans by biting
(only females take blood for egg development, male take sugar)

263
Q

what entities make up the SOFA score

A 
PaO2 -low
BP - low
platelets -low
bilirubin - high 
GCS - low
creatine - high 
urine output - low
264
Q

what are the 5 malaria parasites that cause human disease

A

plasmodium falciparum - most severe
plasmodium vivax - persistent liver stage
plasmodium ovale - persistent liver stage
plasmodium malariae
plasmodium knowlesi

265
Q

how do live attenuated vaccines work

A

live replicating DNA stimulates immune system to get response
minimises chance of infection , can only get the disease if immunocompromised

266
Q

how is HIV transmitted

A

blood, sexual fluid, breast milk (vertical), injection drug misuse, organ transplant

267
Q

what is an AIDs defining opthamology disease

A

cytomegalovirus retinitis

268
Q

what is the incubation fever of typhoid fever

A

7 days - 4 weeks

269
Q

what are predisposing factors of impetigo

A

skin abrasions, minor trauma, burns, insect bites, poor hygiene, chickenpox, eczema, atopic dermatitis

270
Q

give examples of natural adaptive immunity

A

passive - maternal

active - infection stopped if encounter same pathogen

271
Q

how do you differentiate between E.coli strains

A

you don’t - only 0157 and ordinary

272
Q

what is the most common organism in septic bursitis

A

staph aureus

273
Q

who is the BCG Bacile Calmette- gudrun vaccine (tb) indicated for

A

infants in Tb high incidence area or parents from a country of high incidence

274
Q

what diseases are caught from a tick bite

A

rickettsiosis, lyme disease

275
Q

how is folliculitis treated

A

no treatment - normally benign and asymptomatic

276
Q

how may malaria present

A

fever, rigors, aching bones/ myalgia, abdominal pain, headache, dysuria, diarrhoea, cough
signs - hepatosplenomegaly, tachycardia, mild jaundice if severe

277
Q

which 2 tests are done to monitor HIV

A

CD4 count
HIV viral load
on treatment CD4 will rise and viral load will fall

278
Q

how is campylobacter diagnosed

A

stool culture (-ve in 6weeks)
PCR enzyme immunoassay
special culture conditions for c.jejuni, c.coli

279
Q

give examples of prophylaxis that is given

A

travelers - malaira
post exposure - ciproflaxin for meningococcal disease
pre/ post HIV exposure
surgical

280
Q

what patients are likely to get chronic pulmonary aspergillosis

A

underlying chronic lung infections - asthma, CF, COPD

281
Q

name 2 fungi that are zoonoses

A

dermatophytoses (ringworm), sporotrichosis

282
Q

list some arthropod borne infections (arbovirus)

A

malaria, dengue, yellow fever (mosquitos)

rickettsial (tick thyphus), leishmaniasis

283
Q

what antibiotics mainly cause C. diff

A 
ceftiaxone &amp; cephalosporins
co-amoxiclav
clindamyin
ciprofloxacin 
also - metronidazole vancomycin used to treat
284
Q

define a fever

A

an elevation of body temperature above normal 37 degrees

up to 0.8 daily variation - low am , high pm

285
Q

in sepsis pathogenesis, what is the anti-inflammatory response

A

inhibit TNF-a (bring down temperature)
inhibit activation of coagulation system (thrombosis)
negative feedback to pro-inflammatory

286
Q

who is at high risk for complicated influenza

A 
chronic disease - cardiac, COPD, renal, neurones
diabetes mellitus
sever immunosuppression 
>65 years/ children <6 months
pregnancy
morbid obese >40
287
Q

what is your differential for a returning traveller with a fever who has a history of a cough

A

TB, PE, Q fever, enteric fever, sarcoidosis

288
Q

what is the 4th most common bloodstream infection in adults

A

invasive candidiasis - mortality up to 40%

289
Q

what is the treatment of pyomyositis

A

drainage with antibiotic coverage

290
Q

what organism commonly causes pyomyositis

A

staph aureus

291
Q

what is the most common form of brucella presentation

A

sub clinical - 50% have positive serology

292
Q

what is the difference between noravirus and rotavirus in terms of their RNA structure

A

rotavirus is double strange, nor virus is single stranded

293
Q

what are haemorrhagic signs of dengue fever

A

petechiae, purpura, positive tourniquet test

294
Q

what are the classifications of PUO

A

classical, nosocomial, neutropenic, HIV associated

295
Q

what are presenting symptoms of mucocutaneous candidiasis (moist areas)

A

fungal toenails, thrush mouth, oesophageal white patches on erythematous background, sore in inflamed areas, skin folds

296
Q

what are procedural associated factors for a surgical site infection

A 
shaving skin night before
improper prep skin preparation 
improper antimicrobial prophylaxis
break in sterile technique
inadequate theatre ventilation 
perioperative hypoxia
297
Q

what are the symptoms of classical dengue fever

A

incubation 3-14 days

sudden fever, severe headache, retro-orbital pain, myalgia/arthralgia, macular/ maculopapular rash

298
Q

what is now the most common form of rat fever/ weil’s disease

A

L. hardjo in cattle

11% dairy workers positive urology

299
Q

how is the seasonal flu vaccine trivalent

A

2 type A and 1 type B subtype viruses

300
Q

is HIV more severe with a high or low CD4 count

A

low

301
Q

when do immunocompetent adults become non infectious

A

24 hours after last fly symptoms (fever and cough) or when antiviral therapy complete

302
Q

what does the Haemaglutinin (H) influenza surface protein do

A

facilitates viral attachment and entry to host cell

303
Q

what is the ABCD of malaria prevention

A

A - aware of risk (stagnant water)
B - bite prevention (cover up, DEET, nets)
C- chemoprophylaxis - malarone, doxycyline
D - diagnose and treat

304
Q

how may a cryptococcus infection present

A

headache, confusion, focal neurological signs, altered behaviour, visual disturbances, pleuritic pain, coma (raised ICP)

305
Q

what class of drugs is used to treat complicated influenza

A

neuraminidase inhibitors - oseltamivir, zanamivir

306
Q

what is PrEP in HIV therapy

A

use of SRT in those at high risk of acquiring HIV (MSM, condomless, relationship with no suppression of viral load)
lowers risk by 70-80%

307
Q

how may you prevent lyme disease

A

keep limbs covered, insect repellant, inspect skin, remove ticks

308
Q

what substances cause a fever and where do they act

A

pyrogens - act on hypothalamic thermoregulatory centres to cause reduced heat loss, leading to fever

309
Q

which tendons are more commonly associated with infectioustenosynovitis

A

flexor muscle associated tendons

tendon sheaths in the hand

310
Q

what are side effects of protease inhibitors (atazanavir, darunavir)

A

lipodystrophy, drug interactions, diarrhoea, hyperlipidaemia and hyperglycaemia

311
Q

What CD4 count defines aids

A

<200 cells per mL

312
Q

what may be seen in HIV clinical stage II

A

recurrent upper respiratory tract infection
herpes zoster
minor mucucutaneous manifestations - seborrheic dermatitis, fungal nail infection, recurrent oral ulcerations

313
Q

how does furunculosis present (boils)

A

inflammatory nodule in dermis and subcutaneous tissue - painful to pressure
usually affect moist, hairy, friction prone areas - face, axilla, neck, bum

314
Q

how is schistosomiasis diagnosed o

A

clinical diagnosis

serology/ antibody test, ova in stools and urine, bowe/bladder hystol

315
Q

what is pyrexia of unknown origin defined as

A

pyrexia > 3 weeks with no identifiable cause after;

3 outpatient visits or 3 days in hospital or 3 days of outpatient investigation

316
Q

how many blood cultures should you take for sepsis 6

A

2 anaerobic and 2 aerobic for microbiological diagnosis

317
Q

by what and how is dengue fever transmitted

A

mosquito - aedes aegypti

bites during the day

318
Q

who is contraindicated for the influenza vaccine

A

egg allergy (chicken embryo)

319
Q

what are microbial factors that lead to infection

A

resistnace, virulence, transmissibility, ability to evade host defences

320
Q

how is invasive candidiasis treated

A

echinocandins, fluconazole

321
Q

what is HIV viral load done for (range of 40- >10 mil genome copies/ ml blood)

A

monitor effectiveness of treatment

diagnosis in presence of maternal antibody

322
Q

are endogenous pyrogens from inside or outside the body

A

inside - cytokines

exogenous are outside - endotoxins form gram -ve bacteria

323
Q

what is the mortality rate of acute pulmonary aspergillosis

A

50% - rapid and extensive why-hal growth, thrombus and haemorrhage

324
Q

what percentage of UTIs are associated with urinary catheters

A

50%

325
Q

what is an AIDs defining respiratory disease

A

tuberculosis

pneumocystis jirovecii

326
Q

how is zanamivir (relents) taken - 2nd line influenza drug

A

inhaled

rare - bronchospasm

327
Q

how may cerebral malaria( encephalopathy) present as a complication of malaria

A

hypoglycaemia, convulsions, hypoxia, drowsiness

coma, death

328
Q

who is likely to be infected with acute pulmonary aspergillosis

A

neutropenic patient - leukaemia
post transplant
invasive steroid therapy

329
Q

what is the difference between furious and paralytic rabies

A

furious - hyperactivity (saliva and tears), terror, unable to swallow
paralytic - flacid paralysis in bitten limb –> coma —> death

330
Q

how does the antifungal flucytosine work

A

inhibits fungal DNA synthesis - not monotherapy

amB+ flucytosine for cryptococcal meningitis

331
Q

what is candida albicans and what infection does it cause

A

commensal in mouth, vagina nd GI tract

yeast infection, smooth/ light/ yellow colonies

332
Q

what treatment is recommended for HIV

A

ateretrovirals for everyone

333
Q

how much bacteria lives in a human

A

x10^14
>1kg in gut
10x bacteria to human cells

334
Q

how does giardia lamblia presents

A

diarrhoea, malapsorption, failure to thrive

335
Q

describe the life cycle of malaria

A

mosquito bites and sporozoites are transferred to the host > travel in bloodstream to liver > mature to form schizonts with merozoite offspring > schizonts rypture and release merozoites to enter RBCs > form larger trophozoites and erythrocytic schizonts > rupture of erythrocytic schizonts causes clinical manifestation

336
Q

what is the difference between folliculitis, furunculosis and carbuncles in terms of where they affect

A

folliculitis - single follicle (up to 5mm)
furunculosis - follicle associated inflammatory nodule in dermis + subcutaneous fat
carbuncle - infection spreads to multiple furuncles

337
Q

how does cholera manifest clinically

A 
incubation 2-5hrs (75% asymptomatic) 
profuse diarrhoea (rice water stool), vomiting, dehydration 
leads to metabolic acidosis, circulatory collapse and death
338
Q

with is anaesthesia at site highly suggestive of necrotising fasciitis?

A

deep infection to nerve endings

339
Q

what is contained in the human normal immunoglobulin (passive immunisation)

A

antibodies agianst hep A, rubella, measles

used in immunoglobulin deficiencies , some autoimmune disorders

340
Q

what are predisposing factors to septic bursitis

A

adjacent skin infection

diabetes, rheumatoid arthritis, IV drug use , immunosuppressed

341
Q

how would you treat uncomplicated influenza

A

symptomatic e.g. paracetamol

342
Q

what is the spectrum of sepsis

A

systemic inflammatory response syndrome > sepsis > severe sepsis > septic shock

343
Q

if you suspect a mycobacterial infection in someone with pyrexia how would you treat them

A

ant- tb therapy

if no response in 2 sees it is unlikely

344
Q

which is the first antibody to rise to infection

A

Ig M , then Ig G

345
Q

how is crytpoccal disease treated

A

amphotericin B + flucytosine and fluconazole for maintenance

346
Q

how is brucellosis treated

A

doxyxyclien 2-3 months + rifampicin & im gentamicin for first week
cos disease - add co-trimoxazole

347
Q

what are symptoms of primary immunodeficiency disorders characterised by

A

neutropenia, low CD4+ T helper cells, impaired IL-17 immunity, Hyper IgE syndrome, CARD 9 deficiency

348
Q

how would you diagnoses a protozoa/ helminth (parasite) infection

A

microscopy - send stools with PCO (parasites cysts an ova)

349
Q

what are the 3 main pathogens studied in this block

A

aspergillosis - aspergillu fumigatus
candidiasis - candida albicans
cryptococcosis- cryptococcus neoformans

350
Q

what is a positive tourniquet test for dengue fever

A

inflate BP cuff midway between systolic and diastolic for 5 mins - >10 petechiae / inch

351
Q

what new drug has been introduced to treat uncomplicated influenza

A

peramivir - IV infusions

not usually treated

352
Q

what are the most likely organism in cellulitis

A

staph aureus and strep pyrogens

353
Q

what happens to the HIV viral load when the CD4 count declines

A

increases

354
Q

how is the severity of secondary bacterial pneumonia assessed

A

CURB 65

confusion, urea >7, respiratory rate >30, BP <90, age

355
Q

what is PGL in HIV stage 1

A

persisten generalised lymphadenopathy - swollen/ enlarged nodes > 3 months
(>1cm in >2 non contagious sites)

356
Q

which of the 2 toxin strain of c.difficile causes the disease

A

toxin positive strain

357
Q

how is enteric fever diagnosed

A

serology - blood culture, urine, stool

culture bone marrow

358
Q

what are respiratory complications of influenza

A

acute bronchitis
secondary bacterial pneumonia (20%) - 4-5 days after
(strep. pneumonia, staph aureus, H influenza)

359
Q

what is a HAI outbreak defined as

A

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

360
Q

what are the 3 points to the qSOFA score

A

hypotension - systolic <100
altered mental status
tachypnea - RR > 22/ min

361
Q

how would you investigate a new murmur

A

echocardiography- trans-oesophageal

362
Q

what may be seen in HIV clinical stage III

A

unexplained chronic diarrhoea/ prolonged fever
oral candidiasis, hairy leukoplakia
pulmonary Tb
severe bacterial infections

363
Q

what rash appears when infected by schistosomiasis

A

swimmers itch - pruritic papular rash , clears 24-48 hours

364
Q

list some water related infections

A

shistosomiasis, leptospirosis, liver flukes

365
Q

what re host factors that lead to infection

A 
devices - catheter, PVC, ventilation
borad spectrum antibiotics
break in skin surface
foreign body 
immunosuppression
age extremes
366
Q

how would you diagnose complicated malaria

A

IV artesunate, IV quinine station

plus doxycycline

367
Q

list some emerging infectious diseases

A

Zika, ebola, avian flu, west nile virus

368
Q

how would you treat complicated influenza

A 
antivirals ASAP (<2 days) 
need hospital admission
369
Q

what are predisposing factors to cellulitis

A

diabetes, tinea pedis (athletes foot) , lymphoedema

370
Q

what organisms are involved in a type 1 necrotising fasciitis

A

aerobic and anaerobic (polymicrobial)

diabetic foot, fournier gangrene)

371
Q

list some features of sepsis

CNS, pulmonary, blood vessel, liver, cardiac, renal

A

CNS - altered consciousness, confusion
pulmonary - tachypnoea, PaO2 <70, sats <90%
blood vessel - low platelet, low CRP, high D dimer
liver - jaundice, high LFTs, low albumin
cardiac - tachycardia, hypotension, reduced capillary refill
renal - oliguria, anuria, high creatine

372
Q

how are rotavirus and noravirus treated

A

supportive

may need anti -motility

373
Q

what makes hospital patietns more vulnerable to microbial colonisation and infection

A

broad spectrum antibiotics, immunosuppressed, compromised barriers (catheter, ventilator, surgery)

374
Q

give examples of artificial adaptive immunity

A

passive - antibody transfer

active - immunisation

375
Q

how does invasive candidiasis present

A

febrile with no microbiological evidence of infection, new murmur, muscle tenderness, skin nodules

376
Q

what is your differential for a returning traveller with a fever who has a history of weight loss

A

malignancy, vasculitis, Tb, HIV, IBD, thyrotoxicosis

377
Q

what antibiotics should be given for necrotising fasciitis

A

broad spectrum antibiotics - flucloxacilllin, gentamycin, clindamycin
surgical review mandatory

378
Q

what is an IV catheter associated infection

A

nosocomial associated infection , normally starts a local skin/ soft tissue inflammation progressing to cellulitis or tissue necrosis

379
Q

what are cardiac and CNS complications of influenza

A

cardiac - myocarditis, pericarditis
CNS -transvere myelitis, guillain-barre, myositis
rare - encephalitis lethargica (Fever, headache, lethargy)

380
Q

what travel related infections have a medium incubation period 10-21d

A

malaria, HIV, enteric fever, Q fever

381
Q

what is the concept of herd immunity

A

vaccination uptake 90-95% to break the cycle of infection and eradicate disease

382
Q

at what cut offs of CD4 is HIV treatment recommended

A

recommednder for all
<350 - start treatment
<200 need treatment ASAP
all pregnant women before 3rd trimester

383
Q

how do you treat impetigo

A

small - topical antibiotics

large - topical and oral antibiotics (flucloxacillin)

384
Q

give some examples of inactivated vaccinations

A

Polio, hep A, cholera, rabies

385
Q

how is panton-valentine leucocidin toxin typically spread

A

swimming pool towels, walking bare foot

386
Q

what is cellulitis

A

diffuse skin infection involving deep dermis and subcutaneous fat

387
Q

what are complications of dengue fever

A

dengue haemorrhagic fever , dengue shock syndrome

388
Q

why are travellers more vulnerable to infections

A 
take more risks - food water sex
different epidemiology of disease
stress of travel
don't understand health hazards
refugees - malnutrition, deprivation
389
Q

how does leptospirosis infect humans

A

highly mobile spirochetes penetrate abraded skin or mucous membranes and cause systemic illness

390
Q

what is a panton-valentine leucocidin toxin

A

gamma haemolysin that can be transferred from one strain of staph aureus to another

391
Q

where is cholera found

A

faecally contaminated water - rare in UK

392
Q

list some clinical signs of lyme disease

A 
erythema migrans
acrodermatitis chronic atroficans
borrelial lymphocytoma
neuroborreliosis 
arthritis of large joints
393
Q

how is giardia lamblia diagnosed

A

vegetative form in duodenal biopsy

string test / cysts seen on microscopy

394
Q

who is indicated for the influenza vaccination

A

age >65, nursing home, immunodeficiceny, hyposplenia, diabetes, coeliac, pregnant, chronic disease (heart/ lung/ liver/ renal)

395
Q

how is schistosomiasis spread

A

fresh water snails

396
Q

how may aspergillosis present as a primary immunodeficiency

A

congenital neutropenia, chronic granulomatous disease (phagocytes disorder), hyper IgE syndrome, CAR-9 deficiency

397
Q

how may allergic aspergillosis present

A

acute deterioration of lung function and respiratory symptoms , new abnormalities on chest X-ray , elevates IgE and positive specific IgG/ IgE

398
Q

what genus species does malaria belong to

A

plasmodium - only 5 cause human disease

399
Q

what invasive investigations may be done for pyrexia and why

A

bone marrow and liver biopsy - tissue for culture and histology
malignancy, Tb, lymphoma

400
Q

what are risk factors for developing invasive candidiasis

A

immunocompromised, co-morbidities, ITU

broad spectrum antibiotics, IV catheters, total parental nutrition, abdominal surgery

401
Q

how does campylobacter present

A

up to 7 day incubation

bloody diarrhoea, abode pain, fever, headache

402
Q

what is persistent diarrhoea

A

acutely starting diarrhoea lasting >14d

403
Q

what percentage of bloodstream infections are associated with intravascular devices (PVC, CVC)

A

60%
higher risk with cvc
switch to oral ASAP

404
Q

how do non nucleoside reverse transcriptase inhibitor work (rilpivirine)

A

inhibit reverse transcriptase and the conversion of RNA -> DNA

405
Q

how is dengue fever treated

A

not - fluid balance (IV crystalloid)

406
Q

what organisms cause infectious tenosynovitis

A

staph aureus and streptococci

chronic - mycobacteria, fungi

407
Q

what are risk factors for developing furunculosis (boils)

A

obesity, diabetes, atopic dermatitis, CKD, steroid use, shaving

408
Q

how many chronic brucellosis present (months-years)

A

flu-like symptoms, malaise, depression
chronic arthritis, endocarditis, spondylitis
difficult to treat

409
Q

what organism and where does type II necrotising fasciitis usually affect

A 
strep pyrogens (mono microbial)
limbs
410
Q

whta is seen on blood films to diagnose malaria

A

red cells with parasites in them

sygnet rings - multiple parasites

411
Q

what are symptoms of rat fever/ leptospirosis

A

incubation 10-14 days (2-30)

undifferentiated fever, myalgia, headache, abdominal pain

412
Q

list some methods of HIV preventions

A
  • condom use
  • prevent vertical transmission by maternal cART by 24wks
  • PrEP - pre-exposure prophylaxis
  • PEPSE - post exposure prophylaxis
413
Q

how do you treat malaria that is not cause by p. flaciparum

A

chloroquine , riamet 3 days

414
Q

what is HIV (the virus)

A

retrovirus that infects and replicates in human lymphocytes (CD 4 + T helper cell ) , monocytes macrophages

415
Q

what is the most important blood investigation in sepsis?

A

lactate

416
Q

how is zika virus teratogenic

A

microcephaly, eye pathology, intracranial calcification

417
Q

how does avian flu spread

A

direct contact with infected birds (dead/alive)

418
Q

what is cytomegalovirus (MCV) in HIV

A

disease of an organ other than liver, spleen or lymph nodes

419
Q

what are clinical features an inflammatory/ shigella diarrhoea illness

A

diarrhoea with pain and fever

mucosal destruction from inflammation

420
Q

is it HIV1 or HIV 2 that causes the disease

A

HIV 1 (group M)

421
Q

what bacteria cause typhoid (enteric) fever

A

salmonella typhi or salmonella paratyphoid

gram -ve

422
Q

what is staphylococcal scalded skin syndrome due to

A

strain of staph aureus producing exfoliative toxin A or B

423
Q

how is a c.diff infection treated

A

oral metronidazole if not severe

oral vancomycin if sever

424
Q

how does acute pulmonary aspergillosis respond to antibiotics

A

doesn’t - persistent febrile neutropenia

425
Q

how is rat fever/ leptospirosis/ Weils disease treated

A

mild - doxycycline

severe - IV penicillin for sever, prompt dialysis and mechanical ventilation

426
Q

what happens to the immune system with impaired function of CD4 cells

A 
decreases function 
(increases risk of infections and tumours)
427
Q

what are methods of cleaning

A

detergent and water

428
Q

what is primary viral pneumonia a rare complication on

A

human cases of avian flu (H5N1) - rapid respiratory failure within 2 days

429
Q

what is the hospital mortality of septic shock

A

40% - multi-organ failure

mortality increases 7.6% per hour

430
Q

what animals most common transmit rabies

A

dogs 97%, bats in N europe

also monkeys, foxes, racoons, wolves

431
Q

what physiological things happen as part of the systemic inflammatory response syndrome (SIRS)

A

fever, pulse rate rises, respiratory rate rises

432
Q

what type of bacteria is c. difficile

A

gram -ve , anerobic bacillus

433
Q

what are the clinical features on zika virus

A

80% subclinical

headache, fever, rash, malaise, conjunctivitis, joint pain

434
Q

what are the 3 criteria for a pandemic influenza

A

human pathogenicity
new virus (antigenic shift)
efficient person- person transmission

435
Q

what is gastroenteritis

A

diarrhoea (3+ loose stools/day) +/- vomiting due to enteric infection with bacteria, viruses or parasites

436
Q

what is infectious tenosynovitis

A

infection of synovial sheaths that surround tendons

437
Q

how may lyme disease present in the early stage (3-30d after bite)

A

erythema migrans, lymphadenopathy, fever, malaise, headache

438
Q

what is the triad of Weil’s disease (severe leptospirosis)

A

jaundice, AKI, bleeding

splenomegaly, pulmonary haemorrhage, CNS

439
Q

is imaging good at differentiating between infection and inflammation

A

nope

440
Q

how does ventilator associated pneumonia (VAP) occur

A

endotracheal tube interferes with protective upper airway reflexes and facilitates microaspiration

441
Q

how is a surgical site infection diagnosed

A

pus/ infected tissue sent for cultures

442
Q

what is the most virulent species of brucella

A

brucella melitensis

small gram negative coccobacilli

443
Q

in the UK what 2 parasites are caught from contaminated water

A

giardia lamblia, cryptosporidium parvum

differentiate by cysts seen on stool microscopy

444
Q

which bursae most commonly become septic

A

patellar, olecranon

445
Q

how is rickettsiosis diagnosed

A

clinical features + rash + history

446
Q

what are side effects of quinines (malaria drug)

A

nausea, tinnitus, deafness, rash

IV - cardiac depression, cerebral irr

447
Q

what is an AIDs defining gastroenterology disease

A

persistent cryptosporidiosis

448
Q

which has a higher mortality rate staphylococcal TSS or streptococcal TSS

A

streptococcal - 50% vs 5%

449
Q

what do toxin mediated syndromes cause in the body

A

endotehlial leakage, hypotension, haemodynamic shock, multi-organ failure, death

450
Q

how may you investigate gastroenteritis

A

stool culture - 3 days
blood culture
FBC - neutrophilic, haemolysis
abdominal Xray - distended or tender

451
Q

how does noravirus present

A

12-48 hour after exposure, lasts 1-3 days

acute vomiting, watery diarrhoea, cramps, nausea

452
Q

what is sepsis

A

multi-organ dysfunction caused by microbial invasion of normal sterile parts of the body

453
Q

what is the treatemtn of streptococcal toxic shock syndrome

A

urgent surgical debridement

454
Q

what are patient associated factors for a surgical site infection

A

diabetes, smoking, obesity, malnutrition

concurrent steroid use

455
Q

what is the clinical presentation of seasonal influenza (lasts 1-5 days)

A

abrupt fever
2+ - cough, myalgia, headache, malaise
less common - N&V, diarrhoea, limb/joint pain, photophobia

456
Q

how would you diagnose septic arthritis

A

aspirate fluid

457
Q

what are clinical features of the invasive stage schistosomiasis

A

cough, abdominal discomfort, splenomegaly

458
Q

what diseases must be excluded form a returning traveller with a fever

A

malaria, HIV

459
Q

what is dysentry

A

infectious gastroenteritis with bloody diarrhoea and large bowel inflammation

460
Q

what is the point in the qSOFA score in sepsis

A

quickly identifies people who are likely to have a prolonged ICU stay or die in hospital

461
Q

how long does malaria take to become symptomatic

A

live phase lasts 7 days

462
Q

how does the the HIV bind to lymphocytes (Thelper cells), monocytes and macrophages

A

via its GP120 envelope glycoprotein to CD4 receptors on these cells
(CD4 cells migrate to lymphoid tissue and virus is replicated)

463
Q

what is acute diarrhoea defined as

A

> 3 episodes of partially formed or watery stools/ day for <14 days

464
Q

which 2 bacteria cause impetigo

A

staph aureus

strep pyogenes

465
Q

how does the antifungal echinocandins work

A

inhibit gluten synthesis

used in invasive candidas

466
Q

how does rotavirus present

A

2 days incubation

watery diarrhoea, vomiting 3-8 days, fever and abdo pain

467
Q

what is the main treatment for gastroenteritis

A

oral rehydration with sugar/salt solution

468
Q

how many doses of killed vaccines are given

A

3 doses, 2nd to build respond, 3rd for adequate

469
Q

what is the difference between immunisation and prophylaxis

A

immunisation - induction of immunity to fight infection

prophylaxis - prevention of infection

470
Q

how are IV catheter associated infections prevented

A 
don't leave old cannula in 
only insert necessary cannulas 
change cannula every 72 hours
monitor for thrombophlebitis
aseptic technique when inserting
471
Q

how is rat fever (leptospirosis) diagnosed

A

MAT (microscopic agglutination test)

ELISA serology, blood/ CSF culture (takes 1 week)

472
Q

what are side effects of ntegrase strand transfer inhibitors (dolutegravir, elvitegravir, raltegravir)

A

rashes, GI disturbance, insomnia

473
Q

what investigations would you do in a returning traveller with a fever

A

FBC, malaria films, LFT, stool microscopy&culture, urine analysis, blood cultures
specific tests if indicated - dengue, tick typhus, hepatitis

474
Q

what 3 things are taken in sepsis 6

A

lactate, blood culture, urine

475
Q

how may pyomyosists present

A

fever, pain and woody induration of affected muscle

476
Q

what are clinical features on a non-inflammatory/ secretory diarrhoea illness

A

frequent watery stools with little abdominal pain

secretary toxin mediates e.coli/ cholera

477
Q

what history would you take in a returnign traveller with a fever

A

where and when were they (incubation risk)

precautions, activities, events

478
Q

what test diagnoses erysipelas

A

ASO titre - goes up

479
Q

what is the most common cause of bacterial food poisoning in the UK

A

campylobacter gastroenteritis

480
Q

what should you do immediately after a bite from an animal that may have rabies

A

post exposure prophylaxis; human rabies immunoglobulin (HRIG), infiltrated round bite
+ 4 doses of rabies vaccine over 14 days

481
Q

list some complications of malaria

A

cerebral malaria (encephalopathy), blackwater fever, pulmonary oedema, jaundice, sever anaemia, algid malaria

482
Q

how is dengue fever diagnosed

A

clinical - +ve tourniquet test, thrombocytopenia, leucopenia, elevated transaminases

483
Q

how is the composition of the seasonal flu vaccine decided

A

using viruses considered most likely to be circulating that winter

484
Q

how is zika virus diagnosed

A

PCR of viral DNA in blood/ body fluid

485
Q

what type of bacteria is campylobacter

A

gram -ve, spiral rod shaped

486
Q

what are the most common site of healthcare associated infections

A 
UTI (catheter) (22.6%)
surgical site infection (18.6%)
respiratory tract  (intubation) (17.5%)
bloodstream (10,8%)
GI (6.8%) skin and soft tissue (4%)
487
Q

what is the broadest antifungal therapy available

A

amphotericin B formulations (IV only)

488
Q

what is HIV resistance testing used for (sequencing of polymerase and protease genes)

A 
test identifies specific mutation that confer resistance to antiretroviral drugs; 
baseline at diagnosis
suboptimal treatment response
treatment failing
want to change treatment
489
Q

how does cellulitis present

A

spreading erythematous with no distinct border

fever, pain, no weight pair, lymphadenopathy

490
Q

what is the most common organism in hair associated infections

A

staph aureus

491
Q

what percentage of people does influenza infect each year

A

5-10% adults

20-30% children

infection (1 decks)

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