MP321 week 1 Flashcards
(209 cards)
1
Q
name the six services provided by community pharmacies under the NHS
A
-dispensing
- minor ailment/ pharmacy first
-medicines care review (aka chronic medication service)
-prescribing
-patient counselling
-polypharmacy reviews
2
Q
name 5 signs and symptoms of infection
A
-redness/ change in skin colour (inflammation)
-pain
-heat
-swelling
-loss of function
3
Q
clinical assessment for infection (7)
A
-temperature
-tachycardia
-tachypnoea
-white cell count (below 4, above 11)
-hypotension
-hyperglycaemia
-swollen lymph nodes
4
Q
define tachycardia
A
raised heart rate (over 100bpm)
5
Q
define tachypnoea
A
rapid breathing over 20 breaths per minute
6
Q
define hyperglycaemia
A
high blood sugar
7
Q
define hypotension
A
low blood pressure (less than 90/60)
8
Q
clinical signs related to specific infections (7)
A
-increased sputum volume/ increased sputum purulence
-pus/ exudates
-rashes
-cough
-pain on urination
-nasal congestion
-sore throat
9
Q
define SIRS
A
systemic inflammatory response syndrome
10
Q
SIRS criteria (4)
A
- temperature below 36 or above 38
-pulse greater than 90 bpm
-respiratory rate greater than 20 breaths per min
-white cell count less than 4 or greater than 11
11
Q
sepsis
A
one SIRS criteria
documented infection
12
Q
documented infection (7)
A
- a host response to the presence of micro-organisms or tissue invasion by microorganisms
-cellulitis
-purulent sputum
-x-ray changes in the lung
-redness
-swelling
-heat
13
Q
patient factors for infection
A
-age (extremes, very old and very young are more susceptible to infection)
-other conditions or illnesses
-nutritional status
-compromised immune system
-medications (some meds can mimic signs of infection)
14
Q
exogenous source of infection
A
(outside the body)
via host or from environment- food, water, soil, coughing and sneezing
15
Q
endogenous source of infection
A
normal flora from another part of the body- skin pathogens, gut pathogens
16
Q
blood cultures
A
- different sites
-taken while patient is pyrexial (high temperature)
17
Q
urine sample
A
should be taken mid stream
18
Q
swab samples
A
-wounds
-eyes
-throat
-nose
19
Q
what happens to samples at the lab
A
-agar plates
-stains (gram stain, Ziehl-Neelsen)
-confirmatory tests (oxidase/catalase)
-selective media
-viral cultures
-PCR
-ELISA tests
20
Q
sensitivity testing
A
tests for sensitivity or resistance to a selection of potential treatments
-guides the continuing therapy for treating the patient
-national and local sensitivity/ resistance patterns
-guides the development of local formularies
21
Q
modified early warning system (MEWS)
A
a scoring system to help determine if a patient has infection or not (used in hospital)
a score of 0 is good, no infection likely
if a score of 4 or more, the ward doctor is informed- this is concerning- infection serious
22
Q
SEWS
A
MEWS but for surgical ward
score of 4 or more - contact doctor for review
score of 6 or more- urgent review
23
Q
what is CURB-65
A
assessment of pneumonia
how likely the patient is to die of this pneumonia
24
Q
monitoring infection
A
all diagnostic parameters are used for monitoring
frequency of monitoring depends on the severity of infection
25
ectoparasites- live where?
outside the body
26
large complex multicellular organism. parasites as they attach to the body and take a blood meal. rely on humans to get nutrients and survive and reproduce
ectoparasites
27
example of ectoparasite
-head lice (pedicures humanus capitis)
-scabies (sarcoptes scabei)
-body lice (pediculus corporals)
-pubic lice (phthirus pubis)
-dust mites (Dermatophagoides pteronyssinus)
-ticks
fleas
28
pedicures humanus capitis
head lice
29
head lice
-wingless insects, very common in school ages children
-transferred by hair to hair contact (they don't jump)
-female cement pinhead-sized eggs to the hairs near the root- scalp keeps them warm
-hatch ~9 days (white 'nit' stage) but initially remain attached to hair, later begin feeding by biting scalp + drawing blood (causes inflammation)
- in another 9-10 days they are fully matured- females can lay more eggs
30
head lice treatment
0.2-0.3 comb
lotion
31
scarcoptes scabei
scabies
32
scabies
- small mites which burrow into skin
-contagious skin infestation
-symptoms- result of allergic reaction
-most common symptom- itchy pimple-like rash
33
scabies treatment
-ivermectin
-permithrin
34
ectoparasites can be vectors for infection eg
-mosquitoes (malaria, dengue, yellow fever, zika)
-ticks (Lyme disease, typhus, encephalitis)
-fleas (typhus)
-sandfly (leishmania - protozoal infection)
-tsetse fly (sleeping sickness)
-reduvid bug (chagas disease)
-simulum fly (onchocerciasis)
35
endoparasites- live where
inside the body
36
helminth worms
-many types of worms, only a few are parasitic in humans
- worms are heard to treat and cause great suffering (global)
-3 classes- roundworms (most common), tapeworms, trematodes (least common)
- tend to go under a sexual cycle- outside the human body
-they depend on the human body to provide nutrients
37
ascaris roundworm- live stages
-adult stage in the gut
-shed eggs into faeces
-fertilised outside body
-as it forms larvae it is re-ingested the hatches in the gut
-break into gut wall
-imbed and migrate through the bloodstream
-can move to lungs, where they are coughed up and re swallowed then go to gut and grow to full size
38
intestinal nematodes
often cause diarrhoea, rich and anaemia
usually acquired orally or through skin, transmitted but faeces
39
roundworms (nematode)
-Strongyloides (threadworm) can migrate to lungs
-Trichuris (whipworm)
-Ascaris (roundworm) migrates to liver, heart, lung and back to gut. Some patients carry 1000+ worms, females worms can lay 200,000 eggs daily
-Enterobius (pinworm)
-Necator and Ancylostoma (hookworms)
-Trichostrongylus: mild intestinal symptoms but very common
40
extra intestinal nematodes
-Trichinella (trichinosis) – present in infected meat, cysts in muscle.
-Dracunculus (guinea worm) can grow up to 1 metre long in the skin
-Larva migrans (disease eruption can occur in a variety of tissues when invaded by larvae of roundworms )
41
causes of transmission of roundworms
sharing water - bathing/ drinking
42
tapeworms- cestodes
flat segmented worms containing both male and female organs
43
tapeworms- Epinococcus granulosus:
Adult worms are found in gut of dogs.
There they produce eggs (excreted in faeces) which can remain viable for up to a year.
Found in dog fur, dog leads and on tongues of infected dogs
- Ingested eggs release larvae when in the gut, and larval (hydatid) cysts can then be found in liver and other tissues in humans and sheep. The cysts can be very large (litres of fluid) and contain many immature larvae, causing major problems when they burst.
44
Taenia solium (pork tapeworm)
Pigs become infected by swallowing eggs present in human faeces.
-Humans then ingest uncooked pork meat (or through not washing hands) and in the duodenum the ingested eggs release larvae.
-The larvae are carried in blood to muscle, CNS and the eye where they get encysted and cause pain and neurological problems such as epilepsy
45
cysticercosis
-tissue infection- caused by young form of pork tapeworm
-acquired by eating contaminated food or water
-transmitted through oral-faecal route
-eggs enter intestine and develop into larvae
-larvae enters bloodstream and invade tissues & develop into cysts
-1000 hospitalisations per year (USA)
-taenia solium tapeworm- lives in human tissues like brain and muscles
-larval castes found in uncooked pork
46
guinea worm
-among longest nematode infecting humans
-on target to be second infection disease of humans to be eradicated
-endemic in only 5 countries in Africa
47
filarial (extra intestinal) nematodes
-Thread like worms, 200- 300 microns long when adult and about one red blood cell wide transmitted by an insect vector (fly or mosquito) takes a blood meal.
-Usually have an insect stage in which the larvae develops
-Injected larvae migrate to specific tissues, e.g. skin, lungs lymphatics – matures to adults (forming skin nodules) and after a sexual stage produce microfilariae.
-The microfilariae migrate to particular tissues depending upon the species involved, giving rise to pathogenesis as they mature to microlarval stage.
-Wuchereria bancroft : microfilarial blockage of lymphatic ducts leading to elephantiasis. Affects over 120 million people throughout the tropics and subtropics
-Onchocerca volvulus: larval migration to the eye causing river blindness. 300 million at risk in Sub-Saharan Africa, parts of Arabia and S. America. 37 million cases annually, 300,000 cases of permanent blindness.
-These diseases are on the list of neglected diseases and more research is needed.
-so small can be injected by insects taking a blood meal
-as insects take a blood meal they inject anticoagulants and the parasite
48
Flukes (Multicellular Trematodes)
-Adult flukes mainly reside in blood (veins), gut or lungs.
-They have complex life cycles, but essentially, adult flukes produce eggs which become encysted when present in the liver or other tissues such as bladder, lung, CNS. Reaction to the presence of the eggs causes pathological changes in the infected tissues.
-In Schistosomiasis, Eggs are also released via faeces or urine into water, where the parasite is taken up by snails. The snail then releases a form of larva (cercaria) which can penetrate skin and thus infect persons coming into contact with infected water.
Examples:
Schistostoma mansoni:
-encysted eggs present in the liver can cause fatal cirrhosis.
-transmitted in water
-prevalent in agriculture and fishing communities
-infestation causes gut and urogenital issues
-immune response causes inflammation in infected tissues
Fasciola hepatica: (Sheep liver fluke – can also infect humans)
49
liver fluke (fasciola hepatica)
-penetrate through the colon wall and go to the liver via hepatic portal vein
-causes cirrhosis (liver damage) - jaundice among other complications
50
protozoal infections
-single cell organisms that infest inside the body
-can be extracellular/ intracellular
-very successful at evading Immune system
-
Single cell eukaryote -cellular organelles and membraned bound nucleus. More complex than bacteria which don’t have nuclear membrane
Sexual and asexual reproduction
Can be ingested or transmitted by blood transfusion, open wound in an aqueous environment or injected by ectoparasites in a blood meal
-Able to hide from the immune system (red blood cells like in malaria). Can change surface coat at a fast rate to evade the immune system. Therefore it is hard to develop vaccines, particularly against malaria
51
waterborne protozoal infections
-giardia lamblia
-entamoeba histolytica
-trichomonas
52
giardia lamblia
-causes diarrhoea and dysentery (diarrhoea with blood/mucous
-can be in reservoirs in UK
-usually spread from animal source
-causes GI upset
53
entamoeba histolytica
-causes amoebic dysentery
-can be asymptomatic but may cause severe bloody diarrhoea
-can gain entry to other tissues-abscesses in the brain
54
trichomonas
-infect urinogenital tract
-can cause vaginitis
-is a sexually transmitted disease
-only 30% of patients have symptoms of itching or burning with urnination
55
insect borne protozoal infections
-Trypanosoma
-Leishmania
-Toxoplasmosis
-Plasmodium
56
Trypanosoma
-transmitted by tsetse fly vector
-sleeping sickness
-extracellular in blood first, then CNS or heart depending on species
-brain infection causes neuronal damage and sleeping sickness
57
Leishmania
-transmitted by sand fly
-resides intracellularly in macrophages (evasion of immune system)
-causes skin sores
-may also cause lysis of WBC, more immunodeficient
-can be fatal
58
Toxoplasmosis
-very common
-cat faeces is major source
-some people tolerate well, lots have antibodies by
-may also cause foetal damage and schizophrenia
59
Plasmodium
-cause of malaria
-intracellular
-spread by mosquitos
60
malaria
-protozoal infection
-potentially fatal
-belongs to plasmodium group
-untreated- results in cyclic fever and chills, destruction of RBCs and sometimes blockage of cerebral blood vessels (can cause disability and death)
-1.5-3 million deaths annually
61
sporozoite (malaria)
- the form that is injected from mosquito
-thread like
-reside in mosquito salivary gland
62
malaria life cycles
-rapidly move to liver and form a cyst, other go into liver cells and divide rapidly
-burst open from hepatocytes
-merozoites are enow ready to infect RBCs
-release secretory granules and processed haemoglobin- thesis cause fever
-merozoites can reinfect RBCs- thesis are then ingested in mosquito blood meal and cycle continues
63
viruses
-parasites
-non-living
-obligate intracellular parasites
-hijack cellular processed to produce virally encoded proteins and replicate genetic material
-possess own genetic info
-no metabolism
-infect all types of cellular organisms
-can be associated with increased risk of cancer
-cannot reproduce themselves (rely on host machinery)
-
64
RNA viruses
needs to be reverse transcribed into DNA for tar virus to reproduce in the cell
65
examples of human viruses as their transmission routes
Polio, Hepatitis A: faecal-oral route (human faeces used as fertiliser, poor hand washing. Shed in faeces, getting into food or drink to gain entry into the body)
Rabies: Bite of infected animal
Human Papilloma virus (warts): skin contact
Herpes 1&2, HPV, Hepatitis B, HIV : Sexual transmission
Ebola: All body fluids and tissues (many strains- a few associated with increased risk of cervical cancer)
Influenza, colds, measles, mumps, rubella: Respiratory
Yellow Fever, Dengue Fever, Chikungunya Virus: Insect vectors
COVID-19 (SARS-CoV-2): A Corona virus which can cause Severe Acute Respiratory Syndrome
66
viral structure
-diverse sizes, shapes and chemical composition
-nucleic acid surrounded by a protein coat
-mainly rod shaped with helical nucleic acid or icosahedral with spherical nucleic acids
-Core-genetic material, can be DNA or RNA. If RNA it is a retrovirus because to needs to be reverse transcribed to DNA for replication
Most viruses are encapsulated- capsid
-Glycoprotein spikes- are important for binging/docking onto the target on cell surface to invade the cell. Good targets for vaccines
Can contain viral enzymes to help viruses replicate
67
viral genome
- DNA or RNA
-single or double stranded
-linear or circular
-genome is very small
-encodes functions required for replication once within the host cell
-RNA genome is associated with. higher mutation rater
68
RBD
receptor binding domain of the spike protein which engages the ACE 2 receptor target
69
viral replication
-attachment
-penetration
-synthesis of nucleic acid and protein
-RNA viruses use a reverse transcriptase (retro virus)
-assembly and packaging (maturation)
-release
70
prion protein diseases
-transmissible spongiform encephalopathies (TSEs)
-rare, fatal neurodegenerative diseases belonging to amyloid group
-affecting humans, agricultural, zoo and wild animals
-Genetic, sporadic and infectious aetiologies
-Can have lengthy incubation periods (> 40 years!)
-Clinically characterised by dementia and ataxia
-Pathology characterised by neuronal loss, gliosis and spongiform change in the brain.
-No classical host immune response
71
a protein only infectious agent
“Prions are transmissible particles that are devoid of nucleic acid and seem to be composed entirely of a modified protein (PrPSc).”
“The normal, cellular PrP (PrPC) is converted into PrPSc through a post-translational process during which it acquires a high b-sheet content.”
“In contrast to pathogens carrying a nucleic acid genome, prions appear to encipher strain-specific properties in the tertiary structure of PrPSc.”
72
structure of PrPc
-normal cellular isoform
-3% beta sheet
-monomeric and soluble
-protease sensitive (PrPsin)
-neuroprotective
-easy to breakdown into amino acids to clear excess protein
-protective against oxidative stress
73
structure of PrPsc
-disease-associated isoform
-43% beta sheet
-aggregated and insoluble
-partially protease resistant (PrPres)
-more beta pleated sheet
-becomes hard to break down the misfiled protein so it accumulates as an aggregate
-kills the cells
-not only toxic by themselves but recruit normal protein an act as template to fold them into abnormal shape
74
characteristic TSE neuropathology
-haematoxylin (nuclei) and eosin (cytoplasm) (HE) (healthy neutron with some white matter tissue)(gaps/holes in the tissue where cells have died)
-glial fibrillary acidic protein (a marker of astrocytic gliosis) (GFAP)(astrocyte marker)(cells present in areas of cell loss)
-PrP prion protein- detected by antibody (brown)(accumulation of prion protein in the holes)
75
are fungi eukaryote or prokaryote
eukaryote
76
large cell, organelles present, multiple linear chromosomes
eukaryotes
77
small cells, with no organelles and only one circular chromosome/ plasmid
prokaryote
78
what helps a bacterium to move around and be mobile
flagellum
79
what do pili do on bacteria
help them adhere to surfaces
80
why do you need a medium when culturing microbes
to has nutrients etc which are essential to the growth of microbes
81
define CFU (in culturing microbes)
colony forming units
82
why are colony forming units (CFUs) important
help determine if it is a bacteria or fungi
83
what type of growth media inhibits some microbes
selective
84
what type of growth media contains pH indicators / dyes
differential
85
what colour will bacteria that use lactose be
red
86
what colour will bacteria that do not use lactose be
yellow
87
latin for round cell
coccus
88
chain like bacteria
streptococcus
89
clump like bacteria
staphylococcus
90
what colour is gram positive
purple
Positive Purple
91
what colour is gram negative
pink
Negative piNk
92
rectangle shaped bacteria are called
rod
93
what dye is used in grams bacteria staining
crystal violet
94
steps of gram staining (3)
-crystal violet stain is put on
-alcohol is used to remove stain from gram negative cells
-a second (pink) dye is applied and this only coats gram negative cells
95
what is the layer called which gram positive bacteria have that traps the dye
peptidoglycan
96
what is a peptidoglycan layer made of
peptides and sugars
97
how many cytoplasmic membranes do gram negative bacteria have
2
98
what are the small holes in gram negative bacterias outer membrane called
porins
99
what type of molecule do porins let through
small hydrophilic molecule
100
name 3 gram positive cocci
Staphylococcus aureus
Streptococcus pyogenes
Enterococcus faecalis
101
name 2 gram negative cocci
Neisseria gonorrhoeae
Neisseria meningitidis
102
name 4 gram positive rods
Clostridium botulinum
Clostridium difficile Clostridium perfringens
Clostridium tetani
103
name 4 gram negative rods
Escherichia coli Pseudomonas aeruginosa
Klebsiella pneumoniae
Haemophilus influenzae
104
what has a very unique cell wall, rod shaped and will appear pink under microscope
mycobacteria
105
name two examples of mycobacteria
tuberculosis
leprae (causes leprosy)
106
what cell part do some bacteria have to help protect them against drugs, disinfectants etc
capsule
107
what are bacteria capsules made of
sugars
108
name 4 gram negative bacteria that have capsules
E.coli
Klebsiella pneumoniae
Haemophilus influenzae
Neisseria meningitidis
109
name 4 gram positive bacteria with capsules
Streptococcus pyogenes,
S. pneumoniae,
S. agalactiae,
S. mutans
110
name one fungi with a capsule
Cryptococcus neoformans
111
what is it called when bacteria go into dormancy when conditions are not favourable for them
endospore
112
name 3 bacteria with endospores
All Clostridium species
Bacillus anthracis
Bacillus cereus
113
name the 2 categories of fungi
yeast and mould
114
are yeasts unicellular or multicellular
unicellular
115
are moulds unicellular or multicellular
multicellular
116
define mycelium
large spread of mould- circular spread with noticeable centre
117
what connects spores to hyphae
philalide
118
define sporangium
pack of spores
119
what yeast can cause oral/genital infections
Candida albicans
120
what mould can cause aspergillosis
Aspergillus
121
define HAI
healthcare associated infection
122
name the 3 most common HAIs
UTI
respiratory tract infection
surgical site infection
123
name the 3 most common pathogens associated with HAIs
Enterobacteriaceae e.g. E. coli
Staphylococcus aureus
Clostridium difficile
124
what is the location where possible pathogens may live and multiply called
reservoir
125
name some exits from reservoir (10)
ear wax
broken or infected skin
skin flakes
anus (faeces)
semen
urine
vaginal secretions
breast milk
nose secretions
eyes (tears)
126
portal of entry into body (8)
-broken skin
-insect bites
-anus
-vagina
-penis
-mouth
-nose
-conjunctiva of eyes
127
one downfall of common alcohol disinfectants
limited contact time due to rapid evaporation
128
name a common skin disinfectant
iodine
129
QACs
benzalkonium chloride
cetrimide
cetylpyridinium chloride
130
how do QACs work
absorb and penetrate the cytoplasmic membrane
131
name 6 factors that increase a persons risk of infection
age
immune status
genetics
concurrent co-morbidities
nutritional status
behaviours
132
name 6 societal barriers to disease
clean water
waste disposal
hygienic food prep (refrigeration)
hand washing
condoms
social distancing
133
name 6 physical barriers to infection (first line)
skin
mucous membranes( mouth, nose)
eyes (lysosome)
respiratory tract (mucous)
urogenital tract (flushing)
microbiome (normal bacteria on or in the body)
134
name 3 chemical barrier to infection (first line)
stomach acid
urogenital tract (acidity)
digestive tract (stomach acid, pancreatic enzymes, bile)
135
name 3 ways of defeating external defences
water borne
injury
insect bite
136
what are pyrogens
peptides secreted by leukocytes
137
where do pyrogens act
hypothalamus - causing fever which may inhibit iron uptake by some bacteria
138
what are interferons
proteins which interfere with viral replication
chemical mediator of inflammation
139
what are complements
non specific plasma proteins that destroy cells
an integral part of specific immune response
140
what are phagocytes
omnivorous scavengers
detect foreign material and digest it
141
what are neutrophils
first responder at site of infection
142
where are neutrophils found
in blood and tissues
143
what are monocytes
roaming mononuclear phagocytes in the blood
differentiate into macrophages in connective tissue
144
what are 'fixed' phagocytes
organ specific phagocytes which do not roam
145
give 2 examples of 'fixed phagocytes and where they are found
osteoclasts- bone marrow
microglia- CNS (maintain homeostasis)
146
what are dendritic cells
derived from monocytes
early warning cells
digest trapped antigens and present them to other cells in the immune system in the context of MHC (major histocompatibility complex)
147
name the 5 types of amoeboid-like phagocytes
neutrophils
monocytes
'fixed' phagocytes
microglia
dendritic cells
148
what are the 2 stages of antimicrobial function of phagocytosis
neutrophils engulf the microbes
microbes are internalised in phagosomes and broken down in phagolysosomes
149
define chemotaxis
chemical attractants from invading bacteria and tissue leukocytes attract local neutrophils and monocytes from the bloodstream
150
define diapedesis
mast cells and basophils release histamine making the blood vessel permeable and allowing cells through
151
state the 5 steps of diapedesis in local infection
pathogen enters tissue
resident immune cells cause inflammation
mast cells release histamine (makes endothelium more permeable)
circulating monocytes attracted by chemotaxis
monocytes enter tissue by diapedesis and differentiate into macrophages
152
define antigen
substances recognised by the immune system as being 'non-self' and which provoke an immune response
153
define epitope
one molecule may have several antigenic determinant sites, each individual one is called an epitope
154
define hapten
some low molecular weight compounds are able to bind to antibodies but done cause an immune response unless bound to a carrier molecule like a protein
155
state 2 examples of haptens
urushiol (poison ivy)
penicillin
156
name 2 methods of specific antigen elimination
humoral
cell-mediated
157
humoral antigen elimination
antibody mediated
act indirectly
see lecture 6 slides for more info
158
name the 5 antibody classifications
IgM
IgD
IgG
IgA
IgE
(MADGE)- see lecture 6 slides for more info
159
name the 3 ways antibodies eliminate antigens
opsonisation
neutralisation
complement activation
160
define opsonin
a protein which promotes opsonisation
161
define opsonisation
promotion of phagocytosis
162
define neutralisation
the neutralisation of a pathogen by an antibody
163
complement proteins and activation
can be activated :
-in response to antigen-antibody complexes
or
-in the presence of bacterial surface molecules
each complement protein in the cascade cleaves its successor
the products of each cleavage either embed in the membrane or go off to activate other systems
components assemble together to form a pore
the pore allows high concentration of calcium to accumulate in the cells and destroy them
look at lecture 6 slides for more info
163
complement proteins and activation
can be activated :
-in response to antigen-antibody complexes
or
-in the presence of bacterial surface molecules
each complement protein in the cascade cleaves its successor
the products of each cleavage either embed in the membrane or go off to activate other systems
components assemble together to form a pore
the pore allows high concentration of calcium to accumulate in the cells and destroy them
look at lecture 6 slides for more info
164
cell mediated specific antigen elimination
cells are ultimately responsible fora antigen elimination
requires cell to cell contact
three main types of lymphocytes involved - B-cells, T-cells and natural killer (NK cells)
165
B-cells
mature in bone marrow
when stimulated produce antibodies
can differentiate into plasma cells
plasma B produce antibodies
memory B lead secondary immune response
activated when free antigens bind to immunoglobulin receptors on B cell surface
166
T-cells
mature in thymus
2 important subtypes- cytotoxic and helper
167
natural killer cells
kill virus infected / cancerous cells
168
clonal proliferation
1- a specific antigen binds to a naive B cell via Ig-R activating it
2- T cell moves to the B cell and activates it
3- activated B cell proliferates
4- most differentiate into antibody producing plasma cells
5- some into memory cells
169
what do helper T cells do
release interleukins and activate macrophages and cytotoxic T cells, activate B cells and help recruit neutrophils and macrophages
170
what do regulatory T cells do
act to dampen immune response
171
what do memory T cells do
increase longevity of immunity
172
what do cytotoxic 'killer' T cells (and NK cells) do
directly kill infected cells
173
T cell activation
-required peptide antigens to be presented to the 'Ig-like' T cell receptors (TCRs) on the T cell surface
-this is done by an antigen presenting cell in the context of major histocompatibility complex (MHC) proteins
-class 1 MHC proteins activate CD8 and cytotoxic T cells
-class 2 MHC proteins activate CD4 and helper T cells
174
Th- cell and B-cell interaction
-activated Th cell seeks out a B cell (in lymph nodes) which recognises the same antigen
-when activated Th cell finds a B cell that also recognises its peptide antigen, they dock together forming an immunological synapse
-the Th cell releases cytokines which stimulate further B cell production of antibodies (IgE)
-the two cells also differentiate and secrete interleukins proliferating the B-cell population
175
describe the difference between cellular and humeral immunity
The major difference between humoral and cell-mediated immunity is that humoral immunity produces antigen-specific antibodies, whereas cell-mediated immunity does not.
176
define apyrexial
without fever (over 37, under 38)
177
define hypertensive
high blood pressure over 120/100
178
define hypotension
low blood pressure below 90/60
179
define neutropenia
low neutrophils (white blood cells) less than 2, normal range is 4-11
180
define pyrexia
fever, temp over 38
181
define rigours
a sudden feeling of cold and shivering with a fever- hot and cold feelings alternating rapidly
182
define tachycardia
heart rate over 100bpm
183
define tachypnoea
rapid breathing - normal is 12-14, above 20 is tachypnoeic
184
define erythema
redness of the skin- important to consider skin colour, the lighter the skin the easier to see redness
185
normal haemoglobin range for men
14-17 grams per deciliter
186
normal haemoglobin rangefor women
12-15 grams per deciliter
187
what is pyelonephritis
kidney infection
188
what is the colon doing or not doing when diarrhoea occurs
the colon is not removing enough water from the faecal matter
189
give an example of a common colon bacteria
E.coli
190
nappy rash treatment
- keep area clean and dry
-apply nappy rash ointment like sudocrem or metanium
191
1. A parent brings in their 13 month old child to your community pharmacy to ask if you would look at a severe rash that developed on the buttocks of the child has developed after 36 hours of diarrhoea. You take them into the consultation room to inspect the affected skin but have to use baby wipes to cleanse the skin of diarrhoeal residue prior to inspection.
diarrhoea and nappy rash
192
2. A 79 year old lady presents at your pharmacy stating that a painful unilateral (relating to only one area) rash with blisters has developed across her upper torso over a 48hr period and asks if you could inspect the affected area.
shingles
193
shingles treatment
acyclovir 800mg tablets 5x daily for 5 days
194
3. An 18year old male presents complaining of an uncomfortable itchy red, scaly, flaky rash with small blisters that appears to be restricted to the skin surfaces between toes. He is a keen amateur footballer.
athletes foot
195
athletes foot treatment
miconazole cream twice daily
keep feet clean and dry
196
4. A 32yr old female presents with atopic eczema presents at the pharmacy with very inflamed skins folds on her left elbow with signs of excoriations and fissures and visible golden crusting, oozing, pustulation and appreciable erythema of the surrounding normal skin. She confesses that her eczema has flared up over the past few days and that she has been scratching the area very frequently due to the severe itch.
staphylococcus aureus infection via broken skin from itching
197
staphylococcus aureus skin infection treatment
flucloxacililin 500mg 4x daily for 5 days
maybe also steroid cream to help with inflammation
198
what can flucloxacillin cause
cholestatic jaundice
199
good antihistamine for itching? and dose
chlorphenamine 4mg every 4-6 hours, max 24mg per day
200
5. An 85yr old male was admitted into hospital with severe community acquired pneumonia. He has been treated with intravenous antibiotic therapy (clarithromycin 500 mg 12 hourly and co-amoxiclav 1.2 g 8 hourly) for the past 72hrs but has started to experience painful abdominal cramps with watery diarrhoea.
c.difficle infection
201
what kind of medication causes a higher risk of C.difficle
PPI ie omeprazole
202
the 4 Cs of antibiotics
clindamycin
co-amoxiclav
cephalosporins
ciprofloxacin
203
what do the 4Cs increase the risk of
c. difficle infection
204
what age group is more likely to get C.difficle infection
over 60
205
treatment for C.difficle infection
vancomycin 125mg every 6 hours for 10 days
206
streptococcus: shape?, how long can it survive?, gram?
coccus- round
can survive on dry surfaces for 3 days to 6.5 months
gram positive
207
escherichia coli: shape?, how long can it survive?
rod
can survive for up to 16 months on dry, inanimate surfaces
gram negative
208
name 4 disinfectants, what they target and how they work
ethanol- active against negative forms of bacteria, fungi and coated viruses,
hypochlorus acid- active against bacteria, fungi and coated and uncoated viruses
iodine - active against bacteria, fungi, spores and viruses
hydrogen peroxide- active against bacteria, fungi and viruses, inactivated by organic matter, exert antimicrobial effects through generation of hydroxyl free radicals
