Infectious disease

Question 1

Examples of inactivated vaccines

Answer 1

Polio
Flu
Hepatitis A
Rabies

Question 2

Examples of conjugate vaccines

Answer 2

Pneumococcus
Menigococcus
Hepatitis B
Pertussis - whooping cough
Haemophilus influenza
HPV
Shingles

Question 3

Examples of live attenuated vaccines

Answer 3

MMR
BCG
Chicken pox
Nasal influenza
Rotavirus

Question 4

Clinical signs of sepsis

Answer 4

Deranged physical observations
Prolonged capillary refill time
Fever or hypothermia
Deranged behaviour
Poor feeding
Inconsolable or high pitched weak cry
Reduced consciousness
Reduced tone - floppy
Skin colour changes - cyanosis, mottled, ashen

Question 5

Immediate management of sepsis

Answer 5

Oxygen
IV access
Blood cultures
Bloods - FBC, UE, CRP, Clotting, gas lactate acidosis
Urine dip and culture
Antibiotics -
IV fluids 20ml/kg bolus

Question 6

Prolonged management of sepsis

Answer 6

CXR
Abdo and pelvic ultra sound
Lumbar puncture
Meningococcal PCR
Serum cortisol

Question 7

Define meningitis

Answer 7

Inflammation of the meninges

Question 8

Common organism in meningitis

Answer 8

Neisseria meningitidis
Streptoccus pneumoniae
Group B strep - neonates

Question 9

Presentation of meningitis

Answer 9

Fever
Neck stiffness
Vomiting
Headache
Photophobia
Altered consciousness
Seizures
Non blanching rash
Hypotonia
Poor feeding
Lethargy
Hypothermia
Bulging fontanelle

Question 10

Investigation in meningitis

Answer 10

LP
Kernig’s test
Brudzinski’s

Question 11

Define Kernig’s test

Answer 11

Patient lying on back, flex hip and knee to 90 then slowly extend knee
Stretches meninges - pain or reduced movement

Question 12

Define Brudzinski’s test

Answer 12

Lie patient on back and lift head and neck off the bed - flex chin to chest
Positive test will demonstrate flexion at the hips and knees

Question 13

Community management of meningitis

Answer 13

Benzylpenicillin IM

Question 14

Management of meningitis

Answer 14

LP
Menigoncoccal PCR
<3 months - cefotaxime plus amoxicillin
>3 months - ceftriaxone
Steroids

Question 15

Management of meningitis close contacts

Answer 15

Single dose Ciprofloxacin within 24 hours

Question 16

LP appearance in bacterial meningitis

Answer 16

Cloudy
High protein
low glucose
High white cells
Culture +ve bacteria

Question 17

CSF appearance in viral meningitis

Answer 17

Clear
Normal proein
Normal glucose
High white cells
Negative culture

Question 18

Define encephalitis

Answer 18

Inflammation of the brain!
Most commonly viral infection but can be anything

Question 19

Presentation of encephalitis

Answer 19

Altered consciousness
Altered cognition
Unusual behaviour
Acute onset
Focal neurological symptoms
Focal seizure
Fever

Question 20

Investigations in encephalitis

Answer 20

LP - PCR testing
CT scan
MRI
EEG
Swabs
HIV testing

Question 21

Management of encephalitis

Answer 21

Acivlovir - herpes simplex virus
Ganciclovir - CMV
Repeat LP

Question 22

Define infectious mononucleosis

Answer 22

Condition caused by infection with EBV - kissing disease, glandular fever, mono - dound in saliva of infected individuals spread by kissing sharing cups toothbrushes

Question 23

Features of infectious mononucleosis

Answer 23

Fever
Sore throat
Fatigue
Lymphadenopathy
Tonsillar enlargement
Splenomegaly - rupture!

Question 24

Investigations in infectious mononucleosis

Answer 24

Monospot test
Paul-Bunnell test
Antibody tests - viral capsid antigen

Question 25

Management of infectious mononucleosis

Answer 25

Self limiting Supportive care Avoid alcohol Avoid contact sports

Question 26

Define mumps

Answer 26

Viral infection spread by respiratory droplets -

Question 27

Presentation of mumps

Answer 27

Flu like prodrome Parotid swelling Fever Muscle ahces Lethargy Reduced appetite Headache Dry mouth Abdo pain - pancreatitis Testicular pain - orchitis Confusion - meningitis, encephalitis

Question 28

Management of mumps

Answer 28

PCR and antibody testing Notifiable Supportive management

Question 29

Complications of mumps

Answer 29

Pancreatitis Orchitis Meningitis Sensorineural hearing loss

Question 30

Define HIV

Answer 30

Human immunodeficiency virus - causes infection that makes someone immunocompromised. Leads to the sundrome AIDS

Question 31

When is HIV spread

Answer 31

Unprotected anal, vaginal or oral sexual activity Mther to child at any stage of pregnancy, birth or breast feeding Mucous membranes - sharing needles, blood contact

Question 32

HIV prevention during birth

Answer 32

Viral load <50 copies/ml - normal vaginal delivery > 50 - consider caesarean >400 - caesarean >10000 - IV zidovudine

Question 33

When to test for HIV

Answer 33

Babies to HIV +ve parents - tested at 3 and 24 month Immunodeficiency is suspected - unusual severe or frequent infection Young people who are sexually active and concerned Other risk factors - needle stick, sexual abuse, IVDU

Question 34

Management of HIV

Answer 34

Antiretroviral therapy Vaccines Prophylactic co-trimoxazole Treat infections

Question 35

Define Hepatitis B

Answer 35

DNA virus transmitted by contact with blood or bodily fluids

Question 36

What does HBsAg suggest

Answer 36

Active infection

Question 37

What does HBeAg suggest

Answer 37

Marker of viral replication and implies high infectivity

Question 38

What does HBcAb suggest

Answer 38

Implies past or current infection

Question 39

What does HBsAb suggest

Answer 39

Vaccination or past or current infection

Question 40

What does HBV DNA suggest

Answer 40

Direct count of viral load

Question 41

When to test for hepatitis

Answer 41

Children of hep B +ve mums Migrants from endemic areas Close contacts

Question 42

Management of hep B

Answer 42

Often asymptomatic Regular monitoring Antivirals?

Question 43

Define Hep C

Answer 43

RNA virus spread by blood and body fluids