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Year 3 Conditions > ID and Immunology > Flashcards

ID and Immunology Flashcards

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1
Q

What is sjogrens

A

Autoimmune condition affecting exocrine glands mainly the tear and salivary glands

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2
Q

Risk factors for sjogrens

A

Middle aged women
Rheumatoid and SLE associated
Infections of glands

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3
Q

Aetiology of sjogrens

A

Genetic- HLA associations

Environment- infection of glands

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4
Q

Specific ABs tested for in sjogrens

A

Anti-SS-A (Ro)
Anti-SS-B (La)
these are ribonuclear proetins found in gland cells

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5
Q

Symptoms of sjogrens

A 
Keratoconjunctivits
Xerostomia
Dry skin
Dryness in vagina leading to pain
Difficulty talking as larynx affected
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6
Q

What are symptoms associated with xerostomia

A

Dry mouth
Difficulty tasting and swallowing
Cracks and fissures in mouth

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7
Q

Symptoms of keratoconjunctivitis

A

Dry and itchy eyes
Blurred vision
Burning eye pain

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8
Q

Investigations for sjogrens

A 
Test exocrine function
- saliometry
- schirmers test
Confirmatory
- anti-SS-A
- anti-SS-B
- lip biopsy will show T cell infiltration, macrophages and thickening of inner duct wall
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9
Q

What is most likely diagnosis of someone returning from africa with a fever

A

Malaria

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10
Q

How does malaria present

A 
Cyclical fever
Malaise
Headache
Vomiting
Diarrorhoea
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11
Q

First line treatment of malaria

A

Quinines

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12
Q

What is confirmatory test for malaria

A

Thick and thin blood films

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13
Q

What is main test for infective mononucelosis

A

Paul Bunnell

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14
Q

Other than malaria what else can you get from mosquitos

A

Dengue fever

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15
Q

Presentation of dengue fever

A

Quick onset fever
Facial flushing
Retrobulbar pain
Maculopapular rash

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16
Q

What is primary TB

A

Initial infection post exposure that is normally asymptomatic

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17
Q

What is post primaryTB

A

Happens a few weeks post exposure and presents with pulmonary symptoms

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18
Q

How does reinfection with TB occur

A

Latent TB can lie in granulomas

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19
Q

What infective agent causes pneumocystic pneumonia

A

Pneumocystic jerovecii- fungal

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20
Q

What is common lung complication of HIV

A

PCP

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21
Q

How does PCP present

A

Dry cough
Fevers
Night sweats

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22
Q

How does PCP appear on CXR

A

Widespread infiltrates

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23
Q

How does mycoplasma atypical pneumonia present

A

Dry cough
Myalgia
Arthralgia

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24
Q

Most common cause of infective exacerbated COPD

A

Haemophillus influenzae

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25
Who does klebsiella penemoniae present in
Elderly Immunocompromised Alcoholics
26
How does klebsiella pneumoniae present
Cavitating lesion causing haemoptysis and prurulent sputum
27
When does staph aureus infection most commonly happen
After influenza infection
28
What is problem of staph aureus infection
Life threatening as causes cavitating lesion
29
How does cholera present
Normally mild diarrorhoea but sometimes can be profuse "rice water stools"
30
What organism causes typhoid
Salmonella typhi
31
Early presentation of typhoid
``` Fever Headache Malaise Diarrorhoea or constipation Maculopapular rash on trunks-> rose spots ```
32
What infection presents with rose spots
Salmonella typhi
33
Most common cause of travellers diarrorhoea
Enterotoxigenic E.Coli
34
Which infection is common in transplant patients
CMV
35
Who does CMV occur in
Immunocompromised transplant patients- opportunistic virus
36
How does varicella zoster virus present
Prodromal illness of malaise, headache, fever then vesicular rash all over face and scalp- sometimes the trunk
37
Most common outbreak of diarrorhoea in children
Rotavirus
38
How are vasculitis' split up
Small vessel Medium Large
39
How does mechanism for small vessel vasculitis differ from that for large and medium
In lage and medium immune system attacks endothelium directly due to molecular mimicry whereas in small is indirect
40
What happens physiologically in vasculitis
Damage to vessel walls leading to weaker walls within which aneurysms develop, fibrin deposited and clots form thus making the vessels narrower leading to ischaemia
41
Generalised sx of vasculitidies
Fever Weight loss Lethargy
42
2 large vessel vasculitidies
GCA | Takayasu
43
What is affected in takayasu
Aortic arch | Sx depend on branch- carotid ->neuro sx. Subclavian->reduced pulses
44
Who does Takayasu normally occur in
Asian women under the age of 40
45
Investigations and findings of Takayasu
ESR raised | Biopsy showing granulomas
46
1 medium sized vasculitidies need to know and 1 dont
Polyarteritis nodosa Kawasaki
47
What vessels are affected in kawasakis
Coronary arteries
48
What condition is associated with polyarteritis nodosa
Hep B
49
Organs affected in polyarteritis nodosa and their effect
``` Kidney- HTN Brain- TIA Coronary arteries Gut- mesenteric ischaemia Skin- lesions Nerves ```
50
What are particularly common to polyarteritis nodosa
Aneurysms- see beaded appearance on angio
51
What do you see on angio of polyarteritis nodosa
Beaded appearance due to aneurysms
52
Pathophysiology of Wegners
Ig CANCA produced against protein of neutrophils
53
What is proper name of Wegners
Granulomatosis with polyangiitis
54
Who does Wegners normally occur in
Middle aged men
55
Which organs are affected in Wegners and their affects
Nasopharynx- chronic pain from sinusitis, bloody mucus, saddle nose deformity Lung- SOB, haemoptysis Kidney- oligouria, HTN
56
Are relapses common in Wegners
Yes
57
Small vessel vasculitides need to know
Microscopic polyangiitis Henoch schonlein purpura Eosinophillic granulomatosis with polyangiitis
58
Antibody in Wegners
C-ANCA IgG
59
Antibody in microscopic polyangiitis
P-ANCA
60
Differences between Wegners and microscopic polyangiitis
Wegners affects nose Granulomas in wegners Wegners C-ANCA vs P-ANCA in MP
61
What is name given to shape of nose in Wegners
Saddle nose deformity
62
What is the other name for Eosinophillic granulomatosis with polyangiitis
Churg strauss syndrome
63
What organs does churg strauss syndrome affect
``` Wegners one GI Skin Nerve Heart ```
64
What is churg strauss often confused with
Asthma and allergies
65
Antibody for churg strauss
P-ANCA
66
Blood finding for churg strauss
Increased eospinophils
67
Biopsy finding for Churg strauss syndrome
Granulomas
68
What are risk factors for churg strauss syndrome
Asthma Allergies Which already have eosinophilia
69
What are checklists for tonsilitis
Centor | Feverpain
70
Investigations for EBV
FBC Blood film Monospots to look for heterophile antibodies Be more specific can do EBV specific ABs
71
What happens when give amoxicillin to EBV patient
Maculopapular rash
72
Treatment for tonsilitis
Penicillin | If allergic give erithomycin
73
Blood findings of EBV
Lymphocytosis Anaemia Thrmobocytopenia
74
Examination findings of EBV
Hepatosplenomegaly Posterior cervical ymphadenopathy Tonsillar exudates
75
Management of EBV after treatment of cause
Let sexual partners know Avoid contact Avoid contact sports within 6 weeks
76
How does EBV present on blood film
Atypical activated lymphocytes
77
How does SLE normally present
``` Malar rash Athritis Glomerulonephritis Alopecia Pericarditis Pleurisy ```
78
What is shared with myositis, SLE, sjogrens and systemic sclerosis
ANA
79
What is problem with ANA use
Common in titres up to 1/80 in older women
80
How do titre results work
Denominator is the number of titres done until the ABs arent present
81
What is elevated in SLE
``` ESR not CRP niche ANA Anti DsDNA Anti Ro Anti smith RF pos C3 (complement) ```
82
What does it mean if C3 elevated in SLE
Disease well progressed
83
Examination findings sjogrens
Red eyes Fissures in mouth Dry skin Swollen parotid glands
84
What does sjogrens increase risk of
Lymphoma
85
What are associated symptoms of myositis'
ILD Calcinosis Raynauds
86
Derm changes seen in dermatomyositis
Helioptrope Gattrons papules Shawl sign Mechanics hand
87
What is a heliotrope rash
Red/purple rash under eyes or on eyelids
88
Where are gottrons nodules found
On the knuckles
89
What is shawl sign
Extreme reddening of chest area or on back
90
What are mecahnics hands
Blisters of the hands that make look like have lived a mechanics life
91
Difference in skin presentation of limited vs diffuse scleroderma
Limited affects distal limbs and face | Diffuse all over
92
What is a halo on US indicative of
GCA
93
Antibodies found in systemic sclerosis
Anti- centromere | Anti-Scl70
94
Antibody in diffuse vs limited scleroderma
Limited-anti centromere | Diffuse- anti Scl70
95
Complications of diffuse scelorderma
ILD | Kidney problems
96
Complication of limited scleroderma
Pulmonary HTN
97
CREST symptoms
``` Calcinosis Raynauds Eosophageal dysmobility Sclerodactyly Telengiectasia ```
98
Limb symptoms of Takayasu
Limb claudication
99
What is presentation of PMR
Shoulder and hip pain, tenderness and stiffness | Reduced mobility
100
What is danger of PMR
Can develop to GCA with artery involvement
101
What inflammation do you get with PMR
Bursitis and synovitis
102
Where is bursitis in PMR
Subacromial | Trochanteric
103
Where is synovitis in PMR
Shoulder Hip Other joints
104
What triggers HSP
URTI
105
Who does HSP occur in
Children
106
What happens in HSP physiological
IgA deposits
107
How is HSV 1 transmitted
Resp | Saliva
108
How is HSV 2 transmitted
Sex | Perinatal
109
How is Varicella transmitted
Resp
110
How is HHV-8 transmitted
Sex
111
How is EBV transmitted
Saliva
112
What are the 5 human herpes viruses we need to know
``` HSV 1 HSV2 EBV Varicella HHV 8 ```
113
What does HHV 8 cause
Kaposi sarcoma in immunocompromised patients
114
What can HSV 1 cause as complications
Temporal enchephalitis Keratoconjunctivits Menigitis Systemic infection
115
What is gingivostomatitis
Cold sores
116
What are cold sores also known as
gingivostomatitis | Herpes labialis
117
What is vesicular lesion on hands called caused by HSV-1
Herpetic whitlow
118
How does neonatal herpes present
Eczema herpeticum- red spots all over face mainly around mouth
119
Presentation of HSV 2
Flu like prodrome | Vesicles and papules around anus and genitals
120
Features of HSV2 skin changes
Dysuria Shallow ulcers Discharge Fever
121
Infectious course of HSV
Following primary infection the virus will remain dormant in the sacral or trigeminal root ganglia called LATENT phase where asymptomatic. Then a stress or immunocompromised will cause it reactivate and go to skin in LYTIC phase. Will have it for whole life
122
How is herpes investigated
Diagnosis made clincally but can do viral culture and HSV PCR
123
How is HSV treated
Topical, oral or IV acyclovir
124
What happens when varicella reactivated
Causes shingles after being dormant in dorsal root ganglia
125
When does shingles most commonly present
After age of 50 post a stress on body or immunocompromised
126
Peak incidence for chicken pox
4-10
127
When is a chicken pox patient no longer contagious
When vesicles have crusted over
128
Presentation of shingles
Occurs due to stress- get tingling in dermatomal distribution then painful skin lesions lasting 10-14 days
129
How is Varicella investigated
Purely off clinical diagnosis
130
How is chicken pox managed in children
Calamine lotion Analgesia Antihistamines
131
How is chicken pox managed in adults
Acyclovir if within 24hr of rash onset
132
How is shingles treated
1st line valaciclovir or famciclovir 2nd line acyclovir But only if within 72 hrs of rash
133
What is only time give VZIG
Immunosuppressed | Pregnant women exposed to Varicella zoster as likely to get shingles
134
What is complications of varicella
Bacterial sepsis Widespread rash Pneumonia
135
Main complication of shingles
Postherpetic shingles
136
What cells does EBV infect
B lymphocytes
137
Presentation of EBV
Fever Pharyngitis Swollen lymph nodes Jaundice
138
Which lymph nodes does EBV affect
Posterior cervical
139
Management of EBV
Paracetamol | Corticosteroids in severe cases where obstructive pharyngitis, haemolytic anaemia, or really swollen glands
140
What are 3 components to EBV specific antibodies
EBV VCA (viral capsular antigen) IgM EBV VCA IgG EBNA( epstein barr nuclear antigen) IgG
141
When is only time get EBNA IgG
6-12 weeks post infection | Will also have VCA IgG
142
What ABS do you have at these stages of EBV infection Early primary infection Acute primary infection Past infection
Early primary infection- VCA IgM Acute primary infection- VCA IgG, VCA IgM Past infection- VCA IgG, EBNA IgG
143
What is vesicular whitlow
HSV 1 blister on hand
144
What lymphadenopathy is seen in strep pyogenes
Anterior
145
How is HIV transmitted
``` Sex Vertical IV injections Trnasfusion or organ donation Occupational ```
146
4 stages of untreated HIV
Flu like Feeling fine Falling count Final crisis
147
What is hairy leukoplakia
Irregular white painless plaques that cant be scraped off the tongue
148
Which organism causes hairy leukoplakia directly
EBV
149
Who does hairy leukoplakia occur in
HIV Immunocompromised Organ transplant
150
What is candidiasis
Fungal infection caused by candida albicans causing thrush
151
Conditions caused by candidiasis
``` Oral and oesophageal candidiasis Vulvovaginits Diaper rash Infective endocarditis Disseminated candidiasis ```
152
Who does disseminated candidiasis occur in
Neutropenic
153
What causes vulvovaginitis
Diabetes | Abx
154
Symptoms of oral candidiasis
Dysphagia | White exudate can scrape off
155
Symptoms of vulvovaginitis
Thick discharge Itching Sore Red
156
Symptoms of disseminated candidiasis
Lymphocytosis Fever Hypotension
157
Investigations for candidiasis
``` Swabs Invesitgations mainly rule out others Urinalysis for UTI Vaginal pH to exclude other STIs HIV test Diabetes ```
158
What does kaposi sarcoma look like
Pink or purple patch on skin or mouth
159
If have kaposi sarcoma what does this suggest
Have AIDS- is defining
160
What are cancers associated with HIV
Kaposi sarcoma Squamous cell carcinoma of cervix or anus due to HPV Lymphoma
161
Confirm HIV
Elisa | Then confirm with WESTERN BLOT
162
Other disease tests needed for HIV
Hep B, Hep C Syphilis test Tuberculin
163
Most common viral causes of tonsilitis
Rhinovirus Coronaviruses Adenovirus
164
Most common bacterial causes of tonsilitis
Group A strep Mycoplasma pneumonia Neisseria gonorrhoea
165
Investigations for tonsilitis
Rapid strep antigen test | Throat culture
166
Symptoms of tonsilitis
Pain on swallowing Fever Sore throat sudden onset
167
Signs on examination of tonsilitis
Tonsillar exudate Tonsillar erythema and enlargement Anterior cervical enlargement
168
What is under centor criteria
Tonsilar exudates Fever Anterior lymphadenopathy No cough
169
How does centor criteria work in terms of investigations
If 2 or less probably viral so do nothing | If 3 or more do rapid strep antigen test
170
Symptoms of cold
Viral URTI with nasal stuffiness, discharge, sore throat, headache and cough
171
Investigations for cold
Clincal diagnosis
172
Management of cold
Anticongestants Hydration Analgesia
173
3 most common causes of cold
Rhinovirus Coronavirus Influenza
174
How to define abscess
Collection of pus within tissue or walled off by fibrosis
175
Most common cause of external abscess
S aureus
176
How do external abscess present
``` Erythema Hot Pain Oedema Loss of function ```
177
Who are perianal abscesses common in
IBD | Diabetes
178
How do internal abscess present
Vety unwell Pain Fever
179
Management of uncomplicated abscesses
Aspiration | Incision and drainage
180
Management of severe abscess and rapid disease progression
Antibiotics Incision and drainage Excision in some cases
181
Which abscesses do you only give Abx in
Severe
182
What causes multiple ring enhancing lesions in HIV pts
Toxoplasmosis
183
How to differentiate between viral and bacterial tonsilits
Do centor 2 or less viral 3 or more bacterial
184
Cause of meningitis if long pregnancy
Group B strep
185
Cause of meningitis if infection in previous pregnancy
Group b strep
186
Cause of meningitis if late neonatal infection
Ecoli
187
Cause of meningitis if gram -ve diplococci
Neisseria meningitidis
188
Cause of meningitis if unvaccinated teenager
Haemophilus influenzae
189
Cause of meningitis if gram +ve cocci
Strep pneumoniae
190
Cause of meningitis if elderly
Listeria monocytogenes
191
Cause of meningitis if eaten cheese or unpasteurised milk
Listeria monocytogenes
192
Cause of meningitis if alcoholic
Listeria monocytogenes
193
What does skin rash in meningitis imply
Meningococcal septicaemia
194
If has signs of meningococcal septicaemia what is drug give
IV benzylpenicillin
195
Management of non meningococcal septicaemia
IV ceftriaxone Consider dexamethasone Consider IV acyclovir if LOC to cover encephalitis
196
What can be given to close contacts of people with meningitis
Rifampicin or ciprofloxacin
197
If listeria indicated what is treatment meningitis
Ampicillin
198
What separates protein and glucose in bacterial meningitis from others
Protein extremely high | Glucose extremely low
199
What are risk factors for streptococci endocarditis
Abnormal valves ie from calcification, degeneration, rheumatic fever. Is quite a weak bacteria so struggles in healthy tissues
200
What are risk factors for staphyloccocus endocarditis
IV drug user | Prosthetic valve
201
3 most common causes of endocarditis
Streptococci Staphyloccocus Enterococci Other organisms that give negative blood cultures
202
Risk factors for endocarditis in general
``` Abnormal valves ie from calcification, degeneration, rheumatic fever IV drug user Prosthetic valve Dental work Turbulent flow Indwelling catheter ```
203
Frequency with which endocarditis affects vavles
Mitral Aortic Tricuspid Pulmonary
204
Non hand signs on examination of endocarditis
``` Pyrexia Clubbing New murmur Splenomegaly Vasculitis lesions Roth spots ```
205
Investigations for endocarditis
FBC- high neutrophils, anaemia CRP and ESR up U&Es Rheumatoid factor- positve in some cases as can cause endocarditis 3 blood cultures 1 hour apart within 24hrs Urgent echo Duke criteria
206
Complications of endocarditis
``` CHF Valve incompetence Aneurysm formatin Systemic emoli Renal failure Glomerulonephritis ```
207
General management of endocarditis
Abx for 6 weeks
208
If have prosthetic valves what antibiotics do you give in endocarditis
Flucloxacillin Rifampicin Gentamicin
209
If have native valves what antibiotics are given for strep viridans if penicillin sensitive
Benzylpenicillin | Gentamicin
210
Treatment for staph aureus endocarditis in native valves
Flucloxacillin
211
What would be given if endocarditis bacteria resistant to penicillin or allergic
Vancomycin
212
What diarrorhoea comes from leafy vedgetables
E.coli and haemorrhagic e coli
213
What diarrorhoea comes from reheated rice
Bacillus cereus
214
What diarrorhoea can cause cerebral abscess
Bacillus cereus
215
What diarrorhoea comes from eggs and poultry
Salmonella
216
What diarrorhoea comes from uncooked poultry
Campylobacter
217
Which organism causes diarrorhoea following poor sanitation and tropical places
Entamoeba histolytica
218
Management of gastroenteritis dependant upon
Depends on systemic signs like prolonged visible blood, fever over 39 and dehydration
219
Treatment for gastroenteritis when no systemic signs
Supportive therapy- bed rest, oral hydration, electrolyte replacement NO stool culture needed
220
Treatment for systemic gastroenteritis
Admit and oral fluids If severe dehydration give IV Antibiotics if organism identified
221
When is only time give antibiotics in gastroenteritis
Infective organism idenitified
222
Acute hepatitis investigations
``` FBC LFTS Clotting US scan Viral serology and PCR Biopsy maybe ```
223
How is Hep A and E transmitted
Faeco oral
224
Where do people normally pick Hep A up
Travel history from contaminated water
225
How does Hep A normally present
Asymptomatic
226
Who normally presents with Hep E
Pregnant Immunocompromised Travel history to endemic area
227
Management of Hep A and E
Supportive | Avoid alcohol
228
How is Hep B transmitted
Sex Needles Vertical
229
Managment of Hep B acute
Symptom support
230
Management of Hep B chronic
Tenofovir | Peginterferon alpha
231
How is Hep D transmitted
Must have Hep B infection
232
What is management of Hep C
Antiretrovirals are now curative | For example sofosbuvir, Ledipasvir
233
Presentation of cystitis
FUD Haematuria Foul smelling and cloudy urine Suprabubic or loin pain
234
Presentation of pyelonephritis
``` Rigors Pyrexia Nausea and vomiting Confusion in elderly Flank pain to back ```
235
Most common causes of UTI
Ecoli Proteus mirabilis Klebsiella Enterococcci
236
What are nitrates specific to
E coli
237
Investigations UTI
Urinalysis MC and S USS to rule out obstruction
238
What are 2 rashes seen in SLE
Malar | Discoid
239
What is main common and pathogmonic feature of discoid and malar rashes
Photosensitive
240
What does malar rash look like and what does it spare
Erythematous and photosensitive covering cheek and nasal bridge Spares the nasolabial fold
241
How does discoid rash appear
Erthematous plaques that look like discs | Photosensitive
242
Where are discoid rashes seen
Scalp Face Ears
243
Diagnosis criteria for SLE
``` DOPAMINERASH Discoid rash Oral ulcers Photosensitivity Arthritis Malar rash Immunological criteria Neurological sx ESR Renal disease ANA Serosities Haem abnormalities ```
244
What are serosities seen in lupus
Pleural effusion | Pericardial effusion
245
How can SLE renal disease present
Nephrotic syndrome Nephritis syndrome Rapid glomerulonephritis
246
How does SLE joint disease present
Symmetrical polyarthritis affecting hands just like RA with early morning stiffness
247
How does SLE joint disease present on examination and Xray
Normal
248
How can neurological SLE present
Seizures | Psychosis
249
Haem presentation of SLE
Warm AIHA
250
Most specific AB for SLE
Anti smith
251
Inflammatory markers in SLE
CRP normal | ESR elevated
252
What are C3 and C4 in normal SLE disease
Low
253
DDx for nephrotic syndrome
``` minimal change disease membranous focal segmented glomerulosclerosis diabetic myeloma ```
254
What causes membranous change nephrotic syndrome
Secondary to cancer, lupus, viral hepatitis B/C
255
What causes focal segmented glomerulosclerosis
HIV | Heroine
256
Microscopy finding of membranous change disease
Thickened basement membrane | Subepithelial deposits of immune complexes

Year 3 Conditions (33 decks)

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