Immunology

Question 1

When is chloramphenicol not okay to use?

Answer 1

In newborn babies, inadequately metabolised so causes Grey baby syndrome

Question 2

What can be causes of infective pathological change in vaginal discharge?

Answer 2

-Fungal
-Protozoal (TV) yellow/green discharge, foul smell (STI), GP for ab
-Bacterial (BV) grey discharge, fishy smell, GP for ab
-Viral (HIV, warts) Fluid filled vesicles, bumps

Question 3

What are the clinical symptoms of thrush in men?

Answer 3

Vary from none to itching, burning and redness of glands on foreskin
Thick yellowish discharge
Penile shaft, scrotum, and groin occasionally involved

Question 4

What are OTC topical treatments to vaginal thrush and describe them:

Answer 4

Topical imidazoles:
Clotrimazole, econazole., miconazole
External cream (2%)
Internal cream (10%)
Pessary (500mg)
Use internal preparations at night as absorbs better
Can be used in combination
May affect latex condoms

Question 5

What are OTC oral treatments to vaginal thrush and describe them:

Answer 5

Fluconazole
150mg single dose
Can be combined with external cream
12-24 hour improvement, 3 days max
Interactions:
-Anticoagulants -Ciclosporins -Phenytoin

Question 6

What are POM treatments for vaginal thrush and describe them:

Answer 6

Oral itraconazole- 200mg BD for 1 day
Oral ketoconazole- 400mg OD cc for 5 days
^ POM as less specific for fungal and used for resistant/chronic cases
Topical nystatin- 14 day treatment, stains clothes yellow, for resistant cases
Topical provide- iodine (rare)

Question 7

What is the advice for vaginal thrush medication to give to pregnant women?

Answer 7

Not a danger to foetus
Topical azoles preffered

Question 8

Is oral thrush common in babies and describe why?

Answer 8

1in 7 babies develop oral thrush in week 4
Clears up in 3-8 weeks

Question 9

What are symptoms of oral thrush?

Answer 9

Milk curds in mouth, when wiped away leave red sore lesions, similar to vaginal thrush but in mouth

Question 10

What are the POM treatment for oral thrush and describe it:

Answer 10

Nystatin and amphoteracin
- lozenge or oral suspension
Fluconazole and itraconazole (reserved)
- 7-14 days treatment

Question 11

What is the general structure of a fungal skin infection ?

Answer 11

Raised edge, angular defined shape, usually itches, red and angry

Question 12

What are lifestyle managements for athletes foot?

Answer 12

Clean, dry feet
Appropriate footwear and socks
Put socks on before underwear
Wear footwear in the gym/ changing room
Antifungal powder for shoe

Question 13

What are OTC treatments for athletes foot?

Answer 13

Azoles- BD, TDS for 14 days from resolved
Terbinafine- OD-BD 7-14 days

Question 14

What are referral signs in athletes foot?

Answer 14

Severe infections (large parts of foot)
Secondary bacterial infections -from itching, yellow crust
Diabetic (impaired circulation)
Treatment failure after 2 weeks

Question 15

What are POM treatments for athletes foot and describe them:

Answer 15

Only necessary for severe/ extensive infections
Oral terbinafine (can affect liver so liver function tests)
-250mg OD for 4-6 weeks for tinea pedis
-250mg OD for 3-6 months for nail infections
Intraconazole, griseofulvin, fluconazole

Question 16

What is OTC treatment for a fungal nail infection?

Answer 16

Amorolfine nail lacquer (curanail)
Used to treat proximal and distal onychomycosis - proximal (nail bed) may be more resistant
Weekly application for up to 12 months, because it’s a slow-growing nail, often little difference in the first three months

Question 17

What are the referral red flags in a fungal nail infection?

Answer 17

Nail plates destroyed
More than 2 nails affected
Proximal onychomycosis
Pregnancy/ breastfeeding
Under 18 years old

Question 18

What does R and S mean on a resistance microbiology report chart?

Answer 18

R= resistant, can’t be used
S= sensitive, can be used

Question 19

What are four investigations used to demonstrate the presence of an infection and their recovery?

Answer 19

1. Haematology results
2. Biochemistry results
3. Body temp
   ^MAIN ONES
4. Scanning techniques (X-rays)

Question 20

How is haematology used to demonstrate infections?

Answer 20

White cell count (WCC)
Reference range= 4-11 x10^9/L = no infection
A raised WCC indicates the presence of infection
In less acute infections WCC may remain in reference range

Question 21

How is biochemistry used to demonstrate infections?

Answer 21

-Used in combo with WCC
-C Reactive Protein (CRP)
-Reference range= 0-10
-Non specific indicator of infection but is also affected by other conditions e.g can rise in post surgery, inflammation
-Creatinine can be raised by UTIs/ sepsis
-Liver function tests may be raised in certain infections e.g viral hep

Question 22

How is body temperature used to demonstrate infections?

Answer 22

Used in combo
Normally raised in an infection
Can also be a sign of other diseases such as neoplasms, acute MI and pulmonary embolism

Question 23

How are scanning techniques used to demonstrate infections?

Answer 23

E.g shadowing on a chest x ray for a chest infection
Ultrasound and X ray
In extreme cases when unsure:
- White cell scan, white cells are extracted, radio-labeled and re-injected if source of infection unclear, under X ray shows the cells accumulating at the site of infection

Question 24

When would you switch an antibiotic from IV to oral administration?

Answer 24

Review after 48 hours If patient: -haemodynamically stable with no signs of fever -clinically improving -able to take oral meds -functional GI tract with no malabsorption -no other interactions

Question 25

Why is oral route of administration better than IV?

Answer 25

Less time consuming Less chance of infections no canulla

Question 26

What should be the duration for the course of antibiotics and give examples:

Answer 26

Duration not well defined Usually less than 14 days 3 days for female uncomplicated UTI, 7 days for male 6 weeks or more for endocarditis or osteomyelitis 5 days adequate for most infections

Question 27

What are the four main groups of bacteria and which part of the body do these bacteria normally affect?

Answer 27

1. Gram-positive- Gut and mouth 2. Gram-negative- Skin and mucous membranes 3. Anaerobes- GI tract, 4. Atypical- Chest, GI and genitourinary

Question 28

What are symptoms of community acquired pneumonia?

Answer 28

Cough, chest pain, dyspnoea, increased in sputum

Question 29

What are the treatments for community acquired pneumonia?

Answer 29

Non severe (5-7 days) Amoxicillin (doxycycline if allergic) +/- clarithromycin Severe (7-10 days) Benzylpenicillin (IV) + clarithromycin

Question 30

When shouldn't you dipstick to test for a UTI and why?

Answer 30

Over 65 due to them already containing the bacteria naturally

Question 31

What are the treatments for UTI?

Answer 31

Simple UTI: women (3 days) men (7 days), trimethoprim, niturfuratoin, co-amoxiclav Penicillin allergy, fosfomycin instead of co-amoxiclav

Question 32

When should you not prescribe nitufuratoin for a UTI?

Answer 32

If there is poor renal function, under 30ml/min

Question 33

How can you tell if an antibiotic treatment is working in cellulitis?

Answer 33

Draw around the redness and the redness should shrink when taking an Ab

Question 34

What is the first line treatment for cellulitis?

Answer 34

7-14 days: flucoxacillin If allergy, clarithromycin +/- metronidazole

Question 35

What is MRSA?

Answer 35

Methicillin-resistant Staphylococcus aureus Usually confined in hospital, can be treated by vancomycin (drug is toxic, expensive, has to be given by IV)

Question 36

What are the clinical symptoms of Hep A?

Answer 36

-Fever, fatigue, nausea, loss of appetite, abdominal pain -Jaundice in 70-80% adults, 10% children -Fulminant hep occurs in 1-3/1000 people, 80% mortality

Question 37

What are the treatment/ preventative measures for Hep A?

Answer 37

Prophylaxis with immune serum globulin 80-90% effective Killed HAV vaccine approved

Question 38

What are the ways of transmission for Hep B virus?

Answer 38

Blood By injection into the blood stream Also found in saliva, semen and milk So by sexual contact and birth

Question 39

What is the treatment and prophylaxis of acute HBV?

Answer 39

No treatment HBV immune globulin may be administered within a week of exposure or to newborn babies to prevent disease

Question 40

How can syphilis be treated?

Answer 40

Chloramphenicol and penicillin in the first stages 3rd stage can't really get rid of the damage

Question 41

What are the clinical symptoms of chlamydia in men and which complications can this lead to if untreated?

Answer 41

Urethritis Epididymitis- tube in testicle becomes swollen Proctitis- inflammation of anus Conjunctivitis Can lead to- systemic spread, Reiters syndrome

Question 42

Are the clinical symptoms of chlamydia in women and which complications can this lead to if untreated?

Answer 42

Urethritis Conjunctivitis Cervicitis Can lead to- Ectopic pregnancy, infertility, dermatitis, systemic spread, arthritis