Pathology Flashcards
(690 cards)
1
Q
What is sepsis
A
Life threatening organ dysfunction caused by dysregulated host response to infection
2
Q
What is septic shock
A
Clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain MAP >66mmHg despite adequate vol. resuscitation
Or having serum lactate >2mmol/l
3
Q
What are the early signs of sepsis?
A
Oliguria (<0.5ml/kg/hr)
Increased blood glucose
4
Q
What are general signs of sepsis
A
Fever >38 Chills Rigors Flushes Cold sweats Nights sweats Hypothermia (especially in elderly and very young children) Tachycardia Tachypnoea Altered mental state (esp. elderly) Confusion Hyperglycaemia (>8mmol/L in absence of DM)
5
Q
What are the 3 components of the qSOFA score
A
- Hypotension systolic <100mg
- Tachypnoea >22/min
- Altered mental status
6
Q
What qSOFA score suggests the greater risk of poorer outcomes?
A
2 or more
7
Q
What is the qsofa score?
A
Bedside prompt investigation which identifies patients who are at greater risk for poorer outcomes outwith ICU
8
Q
Name Sepsis 6
A
Take 3:
Take blood cultures
Measure urine output
Take Blood lactate
Give 3:
Give high flow O2
Give IV abx.
Give IV fluids
9
Q
When is septic shock diagnoses
A
When hypoperfusion persists even after appropriate fluid challenge
10
Q
Why is sepsis so important?
A
Because it is associated with very high morbidity and very high mortality
11
Q
What is impetigo
A
Superficial skin acute infection
12
Q
Who is impetigo common in?
A
2-5yrs old
13
Q
Is impetigo contagious
A
Yes
Highly contagious
14
Q
What is the most common organism to cause impetigo
A
Staph. Aureus
15
Q
What is a lesser common organism to cause impetigo?
A
Strep. Pyogenes
16
Q
Describe the appearance of impetigo
A
Golden crusted appearance Pustules and honey coloured crusted erosions
Well defined borders
Cornflake appearance
17
Q
Where does impetigo usually occur?
A
Exposed body parts Face Nose Extremities Scalp
18
Q
Ix for impetigo
A
Clinical Dx
Can send bacterial swabs
19
Q
Rx for impetigo
A
Small areas: topical Abx
Large areas: Topical and oral Abx
20
Q
What is the most common skin infection seen in young children
A
Impetigo
21
Q
What is cellulitis
A
Acute skin infection involving the dermis and sub. cut fat
22
Q
What are predispositions to impetigo?
A
DM Immunocompromised CKD Obesity Pregnancy Previous cellulitis
23
Q
What are the most common organism causes of cellulitis?
A
Staph. Aureus
Strep. Pyogenes
24
Q
What are the cardinal features of cellulitis?
A
Red (erythema) Warm Painful Swollen skin Fever With systemic symptoms
25
Ix for cellulitis
```
Clinical examination
Blood cultures
ESR
CRP
WCC
```
26
Rx for cellulitis
Oral abx.
If severe: Admission, IV abx
Analgesia
Elevate affected part
27
Which abx should be used to treat cellulitis
Penicillin (Benzylpenicillin)
| If allergic: Erythromycin
28
What are potential complications of cellulitis
Sepsis
Endocarditis
Necrotising fasciitis
29
Who does necrotising fascitiis require urgent review by?
URGENT surgical review
30
What is folliculitis
Infection/inflammation of hair follicles
31
What is the most common organism cause of folliculitis
Staph aureus
32
Appearance of folliculitis
Small red papules
33
What is the difference between folliculitus and furunculosis
Furunculosis is usually deeper infection with only 1 hair follicle affected
Bacterial folliculitis is more superficial papules
34
Rx for furunculosis
No Rx
Keep skin clean
Sometimes topical Rx
35
What is the size of folliculitis
up to 5mm in diameter
36
Risk factors for furuncolosis
```
Obesity
DM
Atopic dermatitis
CKD
Corticosteroid use
```
37
What is carbuncle
Multiple headed boil
| Collection of boils all connected under the skin
38
Common organism in carbuncle
Staph. Aureus
39
Appearance of carbuncle
Swollen area with accumulation of pus and death tissue
| Multiseptated abscess
40
Where is a carbuncle typically found?
Back of neck
Posterior trunk
thigh
41
Rx for carbuncle
Admission
Surgery
IV abx.
42
What is necrotising fasciitis?
Infectious disease emergency
| Rapidly progressive infection of deep fascia causing necrosis of tissue
43
Predisposing factors for Necrotising fasciitis
DM
HIV/ Immunocompromised
Malignancy
Liver cirrhosis
44
Typical organisms for necrotising fasciitis
```
Staphylococci
Streptococci
Enterococci
Gram -ve bacilli
Clostridium
```
45
What is type 1 necrotising fasciitis
Mixed aerobic and anarobic infective organisms causing the disease
46
What is type 2 necrotising fasciitis
Monomicorbial
| Usually associated with strep. pyogenes
47
Clinical features of necrotising fasciitis
```
Rapid onset
Haemorrhagic bullae
Skin necrosis
Crepitus
Anaesthesia at site
Erythema
Severe pain
```
48
What is mandatory in necrotising fasciitis
Urgent surgical review
49
Rx for necrotising fasciitis
IV Abx.
| Radical debridement +/- amputation
50
Abx. to use for necrotising fasciitis
Broad spectrum
Flucloxacillin
Gentamicin
Clindamycin
51
Does necrotising fasciitis have a high or low mortality
High mortality
52
What is pyomyositis
Purulent infection deep within striated (skeletal) m.
53
Predisposing factors to pyomyositis
DM
HIV/ Immunocompromised
Malignancy
Liver cirrhosis
54
Common sites of pyomyositis
```
Thigh
Calf
Arms
Gluteal region
Chest wall
Psoas muscle
```
55
Commonest organism for pyomyositis
Staph. Aureus
56
Clinical signs of pyomyositis
Fever
Pain
Myalgia
Woody induration of affected muscle
57
Ix for pyomyositis
CT/MRI
| Culture of surgical drainage
58
Rx pyomyositis
Surgical drainage
| Abx. depending on microbiology results
59
What is erysipelas
Infection of the upper dermis
| Essentially superficial form of cellulitis
60
What is the most common organism for erysipelas
Strep. Pyogenes
61
Appearance of erysipelas
```
Red painful area
Distinct elevated borders
Associated fever
Regional lymphadenopathy
Regional lymphangitis
```
62
Common area for erysipelas
Lower limbs in 70%
| 5-20% affect face
63
Rx for erysipelas
Abx.
Analgesia
Elevate affected part
64
Does erysipelas have a high or low recurrence rate
High
65
What does HSV1 typically cause
Cold sores
66
What does HSV2 typically cause
Genital herpes
67
What is genital herpes classed as
STI
68
Is HSV1 and HSV2 causing cold sores and genital herpes a set rule?
No
HSV1 can cause genital herpes
HSV2 can cause cold sores
69
Describe primary infection in HSV
```
Can go unnoticed (be asymptomatic)
or
Subclinical or sensroy nerve tingling prodrome
Vesicles
Burst to give shallow ulcers
```
70
Can you cure HSV?
No
| Infection is lifelong
71
When HSV recurs is it typically more or less severe
Symptoms usually the same
| but usually less severe
72
Ix for HSV
Usually clinical O/E
PCR viral
PCR swab
73
What IX is required in HSV encephalitis
PCR CSF
74
Rx for HSV infection
Aciclovir
75
Rx for HSV encephalitis
Empirical Aciclovir
76
Where does the HSV virus remain latent
In dorsal root ganglion
77
Where does HSV 2 typically remain dormant
Sacral ganglion
78
How is HSV2 typically spread
Sexual contact
79
How is HSV1 typically spread
Kissing
| Sharing utensils
80
What is septic bursitis
Infection of the bursae
81
Predisposing factor to septic bursitis
```
RA
Alcoholism
DM
IV drug abuse
Immunosuppression
HIV/AIDS
```
82
Where does septic bursitis most commonly affect
Patellar (knee)
| Olecranon (elbow)
83
Clinical features of septic bursitis
```
Pain
Fever
Pain on joint movement
Warms
Swelling
Redness
```
84
What are bursae?
Small sac like cavities that contain lubricating fluid and are surrounded by a synovial membrane
85
How is septic bursitis Dx?
Aspiration of fluid
| Need to differentiate between septic and aseptic infection
86
Rx for septic bursitis?
Abx. (oral or IV depending)
| Analgesia
87
Most common organism to cause septic bursitis
Staph. Aureus
88
What is infectious tenosynovitis
Infection of synovial sheets that surround tendons
89
Where is most commonly affected in infectious tenosynovitis
Flexor muscle associated tendons and tendon sheaths of hand are most commonly involved
90
Organism cause of infectious tenosynovitis
Most commonly staph. aureus
| Streptococci
91
Clinical features of infectious tenosynovitis
Erythematous fusiform swelling finger
Held in semi-flexed position
Tenderness over length of tendon
Pain with finger extension
92
What sign is seen in infectious tenosynovitis
Kanavel's Sign
93
Rx for infectious tenosynovitis
Empiric abx
| Urgent hand surgeon review
94
What is staphylococcal scalded syndrome?
Infection due to particular stain of Staph. Aureus producing exfoliative toxin A or B
95
Who is Staph. Scalded Syndrome common in ?
Children
96
Is Staph. Scalded syndrome common in adults?
Far less common in adults compared to children
97
Which organism causes Staph. Scalded Syndrome?
Staph. Aureus
| Particular strain producing exfoliative toxins A or B
98
Clinical features of Staph Scalded Syndrome
```
Widespread bullae
Skin exfoliation
Tissue paper wrinkling of skin
Red blistering of skin
Irritability
```
99
Ix Staph. Scalded Syndrome
```
Hx and O/E
Tzanck smear
Skin biopsy
Bacterial culture:
Skin
Blood
Urine
Umbilical cord
```
100
Rx Staph. Scalded Syndrome
IV fluids
| IV Abx. (flucloxacillin
101
What is the most common cause of gastroenteritis in the UK
Camplyobacter
102
What is the most common cause of hospitalised gastroenteritis in the UK
Salmonella
103
Define actue diarrhoea:
>3 episodes of watery/partially formed stools/day for <14 days
104
Define dysentery
Infectious diarrhoea + bloody diarrhoea
105
Define persistent diarrhoea
Acute beginning then persisting >14 days
106
Define travellers diarrhoea
Starting during or shortly after foreign travel
107
Define food poisoning
Disease caused by consumption of food/water
| Notifiable in UK
108
If diarrhoea lasts >2 weeks is it likely to be gastroenteritis
no
109
Ix for gastroenteritis
Stool culture (except C.difficile)
110
What is the general Rx for gastroenteritis
Often supportive
REHYDRATION!!
Abx. not indicated for in healthy patients
111
Are abx indicated for in healthy patients with gastroenteritis?
No
112
Differential Dx for gastroenteritis when diarrhoea persists >2/52
IBD (CD, UC)
Spurious diarrhoea
Carcinoma
113
When would you be indicated to give abx. in gastroenteritis?
Immunocompromised patients
Severe sepsis from invasive infection
Valvular heart disease
DM
114
What is the name of the stool chart used to classify stools?
Bristol Stool Chart
115
What is the commonest bacterial cause of diarrhoea in the UK
Campylobacter gastro-enteritis
116
What is the common organism in campylobacter gastroenteritis?
Campylobacter jejuni
117
Sources of campylobacter
Chicken
Contaminated milk
Puppies
118
Clinical features of campylobacter gastroenteritis
```
Fever
Headache
Nausea
Vomiting
Diarrhoea
Abdo. pain
```
119
Ix camplyobacter
Stool culture
120
Rx for campylobacter
Supportive
Oral rehydration
IV saline
Abx. not indicated in healthy patient
121
Post -infection sequelae in Campylobacter
Guillian-Barre Syndrome
| Reactive arthritis
122
What is the most common cause of hospitalised diarrhoea in UK
Salmonella
123
Describe salmonella bacteria
Gram -ve
Anaerobic bacilli
Motile with flagella
124
Clinical features of salmonella
```
Fever
Headache
Nausea
Vomiting
Diarrhoea
Abdo. pain
```
125
Ix for salmonella
Stool culture
FBC
Blood culture
126
Rx for salmonella
Supportive
Rehydration (oral if possible)
Abx. not indicated in health patient
127
Is there a link with Guillian Barre and salmonella?
No there has been no link identified
128
Complications of invasive salmonella infection
```
Meningitis
Osteomyelitis
Septic arthritis
Sepsis
Bacteraemia
```
129
What is common post infection in salmonella gastroenteritis
Post infectious irritable bowel
130
What % of patients still have +ve stools 20/52 later after salmonella gastroenteritis
20%
131
How is infection with E.coli O157 commonly acquired
Contaminated meat or
| Person to Person
132
In E.coli O157 which part of the bacteria usually enters the blood?
E.coli stays in the gut but the toxin enters the blood
133
Clinical features of E.coli O157
```
Diarrhoea
Abdo. pain
Fever
Nausea
Vomiting
Bloody stools
```
134
Ix of E.coli O157
Stool culture
Blood culture
Renal function
FBC
135
Rx of E.coli O157
Supportive - do not give Abx.
136
Why should you not give Abx. in E.coli O157?
It increases the risk of HUS
137
What does HUS stand for?
Haemoltyic Uraemic Syndrome
138
What 3 things are characteristic of HUS
Haemolytic Anaemia
Renal failure
Thrombocytopenia
139
What is the mainstay Rx for HUS
Supportive!!
Do not gie abx.
Sometimes supportive dialysis is required
140
What is the commonest cause of traveller's diarrhoea
Enterotoxigenic E.coli
141
Describe the pathophysiology of enterotoxigenic E.coli
Produce heat labile enterotoxins which stimulate the inflow of Cl- and Na+ into the gut lumen
Dragging water with it
142
Ix of enterotoxigenic E.coli
Stool culture
| Toxin from stool
143
Clinical features of enterotoxigenic E.coli
```
Abdo. pain
Nausea
Vomiting
Headache
Diarrhoea
Fever
```
144
Rx for enterotoxigenic E.coli
Supportive
Rehydration
Abx. usually not indicated
145
What is C.diff Diarrhoea heavily associated with?
Broad spectrum bx. use
146
Which toxins does C.Difficile produce
Enterotoxin A
| Cytotoxin B
147
How is C.difficile Dx
Not by culture
148
Rx for mild C.difficile
Stop any current abx. courses
Oral Metronidazole
Rehydration
149
Rx for severe C.Difficile
Stop any current Abx. courses
| Oral vancomycin
150
Rx for Rx resistant C.Difficile
High dose oral vancomycin + IV Metronidazole
Stool Tx
Surgery in worst cae
151
Prevention of C.Difficile
Hand hygiene
Isolate patients
Cleaning of hospital surfaces
Reduce in broad spectrum abx use
152
What are the 4 broad spectrum abx. associated with C.Difficile infection
```
Avoid 4Cs
Cephalosporins
Co-amoxiclav
Clarithromycin
Clindamycni
```
153
Complications of C.Difficle
```
Pseudomembranous colitis
Toxic megacolon
Perforation of the colon
Sepsis
Death
```
154
What is the commonest cause of viral gastroenteritis outbreak on a cruise ship
Norovirus
155
Risk factors for C.Difficile infection
```
Abx therapy
Have been in a long term healthcare setting
Age >65
Immunocompromised
On PPI
Underlying conditions e.g
```
156
Name 3 parasites which can cause gastroenteritis
Giardia Lamblia
Cryptosporidium
Amoebiasis
157
Is the norovirus infectious?
Yes
| Highly infectious
158
Prevention of norovirus
Hand Hygiene
Isolation of patients
Supportive
159
Why are abx. not indicated for norovirus
As it is a viral cause not bacterial
160
What is the transmission route of HAV
Faecal-oral
161
Where is HAV prevalence high
Areas with poor sanitation
162
Is HAV more often chronic or acute
Almost always acute
163
What does high IgM indicate about HAV infection
Active infection
164
What does high IgG indicate about HAV infection
Chronic infection
165
What type of vaccine is the HAV vaccine
Inactivated vaccine
166
Why is HAV prevalence decreasing
Due to improved sanitation
167
Clinical features of HAV infection
High liver enzymes
Fever
Anorexia
Nausea
168
Is there a vaccination for HCV?
No
169
What is the transmission route for HCV?
Blood-blood transmission
Blood transfusion
IV drug abuse
Sexually transmitted
170
Risk factors for progression of HCV to Cirrhosis
M
Increased age
Already has HIV or HBV
171
What % of infected HCV patient go onto develop chronic infection
85%
172
What % of chronic HCV patients go onto develop cirrhosis
20%
| 1/5
173
Ix for HCV
HCV RNA
Anti-HCV antibodies
LFTs
174
Rx for HV
Pegylated interferon
Ribavirin
Alcohol cessation
Liver Tx
175
What is the main difference between HBV and HCV infection
HCV majority (85%) will go onto develop chronic infection
176
Why type of virus is HDV
Incomplete RNA virus
177
Which virus is HDV a parasite of?
HBV
178
Which virus does HDV require for infection to occur
HBV
179
What is co-infection with HDV
When infection of HBV and HDV occur simultaneously
180
What is super-infection with HDV?
When HDV infects someone who already has chronic HBV
181
Ix for HDV?
Antibody and blood tests
| Anti-HDV antibody
182
Would you test HDV is HBVsAG was negative
No
| Only ask for HDV testing if HBVsAg is +ve
183
Rx for HDV
HDV +HBV is notoriously difficult to treat
Liver Tx may be required
184
What is the transmission route for HEV?
Faecal oral route
185
Who is HEV infection very dangerous for?
Pregnant women
186
Is there a vaccination for HEV in the UK?
No
187
Who should be immunised against HAV?
```
Travellers
Chronic liver disease patients
Haemophiliacs
Lab workers
Men who have sex with men
```
188
Is HCV symptomatic?
It is fairly asymptomatic until potential end stage liver disease/cirrhosis has occurred
189
What is the transmission of influenza?
Airborne
190
Who is influenza potentially complicating in?
```
Elderly
Young children
Pregnant women
Those with chronic neurological conditions
DM
Severely immunocompromised
BMI>40
```
191
Compare population affected in Seasonal to pandemic flu
Seasonal flu - 10-15%
| Pandemic flu 25% +
192
When does seasonal flu typically occur
Winter
Dec-Feb in Northern Hemishpere
Jun-Aug in Southern Hemisphere
193
When does Pandemic flu usually occur?
No specific time
| Occurs sporadically
194
What are the 3 types of influenza virus?
A B C
195
What are the two surface proteins of the influenza virus
H (haemaglutinin)
| N (neuroaminidase)
196
What do H surface proteins do in influenza virus?
Facilitates viral attachment and entry to the host cell
197
How many different types of H surface proteins are there for the influenza virus?
18
198
What do N surface proteins do in influenza?
Enables new viron to be release from host cell
199
How many different types of N surface proteins are there?
11 different N proteins
200
What is antigenic drift?
Small ongoing mutations in genetic coding for antibody binding sites
201
What is antigenic drift?
Abrupt major changes in virus resulting in new H/N combinations
202
Clinical features of influenza
```
Abrupt feverDry cough
Sore throat
Rhinorrhoea
Myalagia
Headache
Malaise
Conjunctivitis
Eye pain +/- photophobia
```
203
Ix for influenza
Often clinical Dx
204
Rx for uncomplicated and previously healthy patient with influenza
No Rx
Paracetamol
Give Oseltamivir if concerned they will develop severe complications
205
Rx for uncomplicated influenza in an at risk patient
Oseltamavir
206
Rx for complicated influenza in a patient who is NOT immunocompromised
Oseltamavir
| Zanamivir
207
What is the Rx of influenza in a pregnant patient
Oseltamivir remains 1st line
208
Who is the annual influenza vaccine CI in ?
Those with egg allergy
209
Who is the influenza annual vaccination recommended in?
High risk groups (elderly, young, immunocompromised, DM, chronic conditions)
Healthcare workers
210
How is the influenza vaccination given/
Given each year using predicted virus for that year
| Single 0.5IM injection
211
What is a potential side effect of the influenza vaccination
Sore arm
212
Common name for influenza
Flu
213
What are common complications of influenza
Acute bronchitis
| Secondary bacterial pneumonia
214
Less common complications of infleuza
```
Primary viral pneumonia
Myocarditis
Pericarditis
Guillian Barre
Transverse myelitis
```
215
To which family does the influenza virus belong to
Orthromyxoviridae
216
What are the 3 requirements for pandemic flu?
Human pathogenicity
New virus (antigenic shift) - vulnerable population
Efficient person to person transmission
217
What is the Rx for influenza when breastfeeding
Oral Oseltamavir
218
How can healthcare professionals protect themselves from the flu?
```
Hand hygiene
Protective equipment (face mask, apron gloves)
```
219
Why should healthcare workers receive the influenza vaccine?
to protect themselves and their patients
reduce the risk to at risk patients
reduce absence from work during influenza surge
220
How does HIV infect a patient
RNA Retrovirus
| Encodes reverse transcriptase allowing DNA copies to be produced from viral RNA
221
What is the most common type of HIV
HIV 1 Group M
222
Describe the pathophysiology of HIV infectin
HIV infects and destroys cells of the immune system
Binds to CD4 receptors on T helper cells, monocytes and macrophages
These ‘CD4 cells’ migrate to lymphoid tissue where the virus replicates
Infecting loads of new CD4 cells
As disease progresses depletion and impaired function of CD4+ cells
CD4+ cells decreases
Viral Load increases
immune function decreases
223
What happens to CD4+ cell count in HIV
It decreases
224
What happens to immune function in HIV
It decreases
225
How is HIV transmitted
Sexual
Injection drug misuse
Blood products
Vertical transmission
226
What is the Dx window in HIV
Length varies between individuals
| But generally considered to be 1 month
227
Do you need permission to give a patient HIV testing?
Yes
| Test unconscious patient if it is believed to be in their best interests
228
Ix to Dx HIV
ELISA for HIV antigen/antibody testing
229
What are the 2 types of HIV
HIV 1
| HIV 2
230
What are symptoms of seroconversion in HIV
```
Flu like
Fever
Malaise
Lethargy
Pharyngitis
Mucosal ulceration
Headache
Rash
```
231
Define persistent lymphadenopathy
Swollen/enlarged LN >1cm in 2 or more non-contigous sites
| Persisting >3 months
232
Which Ix should you use to manage HIV
Viral load
Viral resistance testing CD4 count
Tropism levels
Drug levels
233
When should you consider commencing ART in HIV
Consider commencing at Dx regardless of CD4 count
234
When is ART Rx more encouraged in HIV patients
When CD4 count is <350
235
At which CD4 level should you commence ART ASAP
CD4 <200
236
How many ART drugs should be used in combination to treat HIV?
3 drug combination
237
How long does a patient with HIV need Rx
Lifelong
238
Name ways in which HIV can be prevented
Correct use of condoms/barrier contraception
Behaviour change
Circumcision
239
What is the post exposure prophylaxis steps for HIV
Short term use of ART after potential exposure
Can be given up to 72hr
Preferably <24hr
1st line: Tenovir
Test for HIV infection 8-12 weeks after exposure
240
Who could be given pre-exosure prophylaxis for HIV infection
Serodifferent relationships
| Condomless anal sex in MSM
241
When should Rx be commenced in pregnant ladies with HIV
Start Rx <3rd trimester (by 24 weeks)
242
How should mothers with HIV deliver their babies?
C-section indicated if viral load>50
243
Which body fluids need to be handled with care for risk of HIV?
```
CSF
Pleural fluid
Peritoneal fluid
Pericardial fluid
Vaginal fluids
Breast milk
```
244
What should immediate actions after exposure with HIV be?
Wash (soap and running water)
Encourage bleeding
Wash out splashes in eyes, nose or mouth
245
Name some aims of ART in HIV
Reduce HIV loads to undetectable by standard laboratory techniques
Reduce clinical progression
Reduce mortality
246
Name the classes of HIV drugs
```
Nucleoside (NRTIs)
Non-nucleoside (NNRTIs)
Proteas inhibitors
Integrase inhibitors
CCR5 antagonists
```
247
What is the action of nucleoside drugs
Reverse transcriptase inhibitors
Inhibit conversion of HIV RNA to HIV DNA
Competitively inhibit reverse transcriptase
248
Side effects of nucleoside drugs
Marrow toxicity
Neuropathy
Lipodystrophy
249
Action of non-nucleoside drugs
Reverse transcriptase inhibitors
Inhibit conversion of HIV RNA to HIV DNA
Work by directly binding to reverse transcriptase
Non-competitie inhibition
250
Side effects of non-nucleoside drugs
Skin rashes
Hypersensitivity
Drug interactions
251
Action of protease inhibitors
Inhibits protease
| Protease = enzyme involved in maturation of virus particles
252
Side effects of proteas inhibitors
Drug interactions
Diarrhoea
Lipodystrophy
Hyperlipidaemi
253
Action of integrase inhibitors
Inhibit integrase and prevent HIV DNA integrating into the nucleus
254
Action of CCR5 antagonists
Inhibit entry of virus into the cell
| Block CCR5 receptor
255
Give 2 examples of nucleoside drugs
Abacavir
| Lamivudine
256
Give 2 examples of non-nucleoside drugs
Delaviridine
| Efavirenz
257
Give 2 examples of Protease Inhibitors
Raltegravir
| Elvitegravir
258
Give an example of a CCR5 antagonist
Maraviroc
259
Why is malaria so important
Because it is a serious global health problem
260
How is malaria transmitted?
Mosquito bite most common
261
What is the vector in malaria
Female anopheles mosquito
262
What type of organism is malaria
Parasitee
263
What are the 5 species of malaria
```
Plasmodium Falciparum
Plasmodium Vivas
Plasmodium Ovale
Plasmodium Malariae
Plasmodium Knowlesi
```
264
Which is the most severe species of malaria
Plasmodium Falciparum
265
Which 2 species of malaria commonly lie dormant in the liver
Vivax
| Ovale
266
Which species of malaria is very rare
Plasmodium Knowlesi
267
Which features would Dx complicated malaria
```
1 or more of
Impaired consciousness /seizures
Hypoglycaemia (<2.2 mmol/l)
Parasite count >2%
Haemoglobin <8mg/Dl
Spontaneous bleeding
Haemoglobinuria
Renal impairment or pH <7.3 (acidosis)
Pulmonary oedema or ARDS
Shock
```
268
Symptoms of malaria
```
Fever
Rigors
Night sweats
Myalgia Arching bones
Abdo. pain
Headache
Dysuria
Frequency
Sore throat
Cough
Diarrhoea
Nausea
Vomiting
```
269
Signs of malaria
None
Splenomegaly
Hepatomegaly
Jaundice
270
Ix for malaria
Immediate blood testing mandatory in the UK
Thick and thin blood films
Quantity buffy coat
Rapid antigen tests
271
Rx for uncomplicated P.Falciparum
Riamet ® (artemether-lumefantrine) 3 days
Eurartesim ® (dihydroartemisinin-piperaquine 3 days
Malarone ® (atovaquone-proguanil) 3 days
Quinine 7 days
plus oral doxycycline (or clindamycin)
272
For which species of malaria is chloroquine not used as Rx
Falciparum
273
Rx for complicated/severe P.Falciparum
IV Artesunate
| IV Quinine + oral doxycycline
274
Rx for P.Vivax/Ovale/Malariae/Knowlesi
Chloroquine 3 days
| Riamet 3 days
275
Additional Rx for P.Vivax and P.Ovale to eradicate hypnozoites from liver
Primaquine
276
Who is malaria notificale to?
Public health
277
To which species of malaria is Sickle Cell anaemia protective against?
P.Vivax
278
Give examples of prevention of malaria by mosquito control programmes?
```
Drainage of standing water
Bed nets
Mesh windows
Sterile Male
Mosquito Release
```
279
Which malaria treatment is CI in pregnancy and which abx should be given as an alternative
Oral doxycycline CI
| so give Clindamycin instead
280
Where does maturation of malaria parasites occur in the body?
Liver
281
Which species of malaria go dormant in the liver?
P. Vivax and P.Ovales
282
Once matured in the liver where do merozoites enter?
RBC
283
Which process produces clinical manifestations of malaria
Rupture of erythrocytic schizonts
284
Which virus causes Zika Fever?
Zika virus
285
Transmission routes for zika virus
Daytime biting aedes mosquitos
Sexual contact
Blood transfusion
Vertical (mother to baby)
286
Rx for zika virus
No antiviral therapy
| Prevention is key
287
Who is the zika virus particularly bad in?
Pregnant women
288
What can the zika virus cause in pregnancy?
Fetal microcephaly
| Other neurological problems
289
Prevention of zika virus?
Mosquito control measures
Avoid non-essential travel in pregnancy
Condoms
290
Complications of Zika Virus
Strong association with Guillian Barre
291
Ix for Zika virus
Zika virus RNA in :
Blood
Urine
Saliva
292
Incubation perdio for rabies
2 weeks to several years
293
Where does the Rabies virus travel from and to
Travels from the peripheral nervous system to the central nervous system
294
Transmission of Rabies
Bite from infected animal
| Saliva
295
Main transmitters of rabies virus
Dogs (97%)
Bats
Mokeys
296
When was the last UK death from Rabies?
2012
297
Is rabies a viral or bacterial infection?
Viral
298
Once symptomatic what is the prognosis for rabies?
Death virtually inevitable
299
Post exposure prophylaxis of rabies
Wound cleaned
Human Rabies Immunoglobulin
4 doses Rabies vaccination
300
Ix for rabies
PCR saliva
PCR CSF
Often confirmed by post mortem bran biopsy
301
Prophylaxis for rabies
Human diploid strain vaccine
302
Clinical features of rabies
```
Malaise
Headache
Agitation
Paraesthesia (at wound site)
Fever
Mania
Lethargy
Coma
Overproduction of saliva and tears
Inability to swallow
Hydrophobia
Death by resp. failure
Convulsions
```
303
Name some potential complications of malaria
```
Cerebral malaria (encephalopathy)
Blackwater fever
Pulmonary Oedema
Jaundice
Severe anaemia
Algid Malaria
```
304
What is meningitis?
Inflammation of the meninges usually as a result of infection
305
Common bacteria causes of meningitis in adults
Neisseria Meningitidis (Meningococcal)
Strep. Pneumoniae
(Pneumococcal)
Haemophilus Influenzae
306
Common bacterial causes of meningitis in neonates
E.coli
| Group B streptococci
307
What does meningism refer to?
A symptomatic complex
308
Name the symptoms included in meningism
Headache
Photophobia
Neck Stiffness
Vomiting
309
Does meningism only occur in meningitis?
No meningism can occur in the absence of meningitis
| I.e there can be many other causes of meningism
310
Clinical featues of meningitis
```
Neck stiffness
Photophobia
Vomiting
Headache
Fever
Cold hands and feet
Non-blanching petechial rash
```
311
What is the hallmark of meningococcal meningitis
Non-blanching petecial rash
312
Which test can be done to determine if a rash is non blanching
Tumbler test
313
Ix for meningitis
Blood cultures
| LP (CSF culture)
314
When is LP CI
In suspected raised ICP or space occupying lesion
315
If suspected raised ICP which Ix would need to be done first to rule this out before LP
CT
316
Rx for meningitis
IV high dose Ceftriaxone preferably before hospital admission
317
When should blood cultures be done in meningitis
Preferably before abx. have been given
318
Who does meningococcal meningitis typically affect?
Children and young adults
319
Which organism causes meningococcal meningitis
Neisseria Meningitis
320
Which abx should be given to close contacts of meningococcal meningitis as prophylaxis?
Rifampicin or ciprofloxacin
321
What is the hallmark of meningococcal meningitis
Non-blanching petechial rash
322
Who should all cases of meningococcal meningitis be notified to?
Consultant in public health
323
Why have cases of meningococcal group C decreases
Due to introduction of MEN C vaccine
324
What is Waterhouse Freidrichsen Syndrome:
Adrenal gland failure due to bleeding into the adrenal glands
325
What % of patients die within 24hrs of fulminant meningococcal septicaemia
50%
326
What does autopsy reveal in Waterhouse Friedrichsen syndrome
Bilateral adrenal haemorrhages with adrenal ablation/hypoadrenalism
327
What sign is characteristic of Waterhouse Friedrichsen Syndrome/Fulminant infection
Purpurice rash
328
Describe CSF in fulminant meningococcal septicaemia
CSF is terile with little or no increase in WCC
329
What is the commonest cause of bacterial meningitis in adults
Pneumococcal
330
Which 2 vaccines prevent against Pneumococcal meningitis
Pneumovax
| Prevenar
331
Who is given the Pneumovax vaccine
Recommended in those >65yr Scotland
332
Who is given the Prevenar vaccination
Now part of childhood immunisation programme
333
Predisposing factors to pneumococcal meningitis
```
Pneumonia
Sinusitis
Endocarditis
Head trauma
Alcoholism
Splenectomy
```
334
What should you look for in pneumococcal meningitis
Concurrent sinus or ear infection
335
Is petechiae common or uncommon in pneumococcal meningitis?
Uncommon
336
Rx for pneumococcal meningitis
High dose IV Ceftriaxone
| Before blood cultures ideally
337
Chronic complications of pneumococcal meningitis
```
Loss of hearing
CN deficits
Hemiparesis
Hydrocephalus
Seizures
```
338
Which type of haemophilia influenza is meningitis normally associated with
Type b
339
Rx for haemophilus meningitis
Ceftriaxone high dose IV
340
Symptoms of haemophilus meningitis
```
Fever
Nausea
Photophobia
Headache
Neck stiffness
```
Clinical picture often:
Mid URTI followed by rapid deterioration
341
What is tuberculosis meningitis
Mycobacterium tuberculosis infection of the meninges
342
Is TB meningitis common or uncommon in the UK
Uncommon
343
Where does TB meningitis remain a problem
In the developing world
344
When is Tb meningitis considered
In someone with meningism
Low grade fever
And Extra-meningeal TB known
345
Ix for TB meningitis
LP (CSF analysis)
ZN stai n
CXR thorax (chest TB)
346
Why might a CT head be useful in TB meningitis
Potential presence of meningioma
347
Poor prognostic factors for TB meningitis
Extremes of age
Ie very old and very young
Presence of neurological deficits
Resistant organisms
348
Organisms causing lyme disease
Borrelia Burgdoferi
349
How is lyme disease predominantly spread
By ticks
350
Organism causing leptospirosis
Leptospira Interrogans
351
How is leptospirosis transmitted
in animal urine
352
What is the most common initial sign of lyme disease
Erythema migrans rash
353
Most common UK causes of viral meningitis
```
Echo virus
Coxsackie virus
Enteroviruses ]HSV
HZV
EBV
```
354
Ix for suspected viral meningitis
PCR of CSF
355
CSF findings in viral meningitis
Normal glucose
| increased lymphocytes
356
Treatment for HSV meningitis
IV acyclovir
357
Why has mumps meningitis incidence decreased
Due to MMR vaccine
358
Who is at the most risk of viral meningitis
Young
| Immunocompromised
359
What is the main outcome of viral meningitis
Majority will recover within 72hrs
360
Can abx treat viral meningitis
No because it is not a bacterial infection
361
Symptoms of viral meningitis
```
Low grade fever
Headache
Photophobia
Neck stiffness
Lethargy
Nausea/Vomiting
```
362
Prevention of viral meningitis
Good hand
| Encourage MMR vaccination
363
Prognosis for viral meningitis
Majority make complete recovery with no long term sequelae
364
What is the most important cause of meningitis in HIV patient
Cryptococcus Neoformans
365
Ix for fungal meningitis
LP
| CSF analysis
366
Where is cryptococcus neoformans organisms found
Bird droppings
367
Rx for fungal meningitis
Parenteral Amphotercin
| High dose Fluconazole
368
In what 2 ways does neonatal meningitis differ from adult meningitis
Symptoms and signs are usually non-specific or not well localised
Bacteria involved are commonly different to that of adult meningitis
369
Common organisms neonatal meningitis
Group B streptococci
E.coli
L. Monocytogenes
370
Risk factors for neonatal meningitis
Preterm (<37 weeks)
Prolonged interval between membrane rupture and delivery
Previous infant with group B streptococcal disease
371
2 types of neonatal meningitis
Early onset
| Late onset
372
Describe early onset neonatal meningitis
Within 3 days brith
Associated with premature or prolonged delivery
Marked resp. distress, bacteraemia
Increased mortality (50%)
Organism has usually been acquired at birth from female genital tract
373
Describe late onset neonatal meningitis
>1 week after birth
Infection gained from outside world
Pulmonary involvement is rare
Mortality less 10-20%
374
How is bacterial neonatal meningitis Dx
Neonatal CSF cultures
| Neonatal blood cultures
375
Viral Dx of neonatal meningitis
CSF PCR
| EDTA blood, faeces, and nasopharyngeal secretions
376
Rx for neonatal meningitis
For bacterial:
IV ampicillin + gentamicin/ceftriaxone
for viral:
IV immunoglobulin may be helpful
377
Why is E.coli and L. Monocytogenes a common cause for neonatal meningitis
Because they are commensals of the female genital tract
378
Prevention of neonatal meningitis for high risk mothers
Chemoprophylaxis during delivery
Amoxicillin
Co-amoxiclav
379
What is the most common fungal infection
Candidiasis
380
What is the most common candidiasis organism
Candida Albicans
381
Risk factors for candidiasis infection
```
Very young
elderly
Immunosuppressed/steroid
Abx therapy
Inhalation steroids (asthmatics)
```
382
where is candidiasis infection typically seen
Moist areas
Oral
Vaginal
383
Symptoms of vaginal candidiasis
Thick cottage cheese like discharge
Severe itching
Burning sensation
384
Main symptom oesophageal candidiasis
Painful dysphagia
385
Symptoms of oral thrush
White/yellow patches on tongue/ cheeks/roof mouth
Redness in mouth
Pain in mouth
386
What is invasive candidiasis infection
When the candidiasis infection enters the blood
| Can spread to bones, eyes, brain, heart
387
Ix for invasive candidiasis infection
Blood cultures
| CSF culture
388
Rx for invasive candidiasis
Parental therapy with antifungals:
Amphotericin B
Fluconazole
Voriconazole
389
Ix for superficial fungal infection
Fungal swabs
| Scraping from infected lesions/tissue secretions
390
What is pneumonia
Lower respiratory tract infection
391
Define community acquired pneumonia
Infections in a person who has not recently been hospitalise
392
Common organisms community acquired pneumonia
Strep. Pneumonia
Haemophilus influenza
Moraxella catarrhalis
393
Define hospital acquired pneumonia
New infection >48hrs after hospital admission
394
Common organisms hospital acquired pneumonia
Gram -ve enterobacteria
Staph Aureus
Klebsiella
395
Define aspiration pneumonia
When inhalation of oropharyngeal contents into the lower airways leads to lung injury and subsequently bacterial infection
396
Define immunocompromised pneumonia
```
Occurs in immunocompromised patients
E.g HIV/AIDS
Malignancy
Organ Tx
Long term steroid medications
Often caused by opportunistic organisms
```
397
What is an opportunistic organism?
An organism that infects someone who has a weak immune system
Would not normally cause disease in a healthy individual with normal immune system
398
what does CURB 65 stand for
```
Confusion
Urea >7mmol
RR >30
BP <60/<90 mmHg
Age 65
```
1 point for each
399
What does the CURB score determine
30 days survival score
400
When would you worry about a CURB score
When 3 or more
401
Organisms causing pneumonia
```
Strep Pneumonia
Haemophilus influenza
Legionella
Staph. Aureus
Mycoplasma Pneumonia
```
402
Signs of pneumonia
```
Dullness to percussion
Inspiratory crepitations
Increased vocal resonance Pyrexia
Tachypnoea
Central cyanosis
bronchial breathing sounds
```
403
Rx for CURB 0-1
Amoxicillin OR Clarithromycin
404
Rx for CURB 2
Amoxicillin AND Clarithromycin
405
Rx for CURB 3-5
Co-amoxiclav
| And Clarithromycin
406
In pneumonia Rx what should amoxicillin be replaced for in penicillin allergic patients
Levofloxacin
407
Supportive Rx in Pneumonia
```
Analgesia
O2
IV fluids
CPAP
Intubation and ventilation in worst case
```
408
Complications Pneumonia
```
Empyema
Abscess
AKI
Septicaemia
ARDS
Haemolytic anaemia
```
409
DDX for pneumonia
```
TB
Lung cancer
PE
Cardiac failure
Pulmonary vasculitis (Wegner Granulomatosis)
```
410
Symptoms pneumonia
```
Chest pain
Cough
Purulent sputum
Dyspnoea
Malaise
Fever
```
411
Rx for TB
```
RIPE
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
```
All for 2 months
Then R and I for further 2 months
Overall 6 months Rx
412
What is TB
Granulomatous disease that can affect any organ
| But typically the lungs
413
Which organ does TB typically affect
Lungs
414
Risk factors for TB
```
HIV
Overcrowding
Malnutrition
Smoking
Alcoholism
DM
```
415
Most common organism of TB
Mycobacterium Tuberculosis
416
How is TB transmitted
Via aerosal droplets
417
What can TB in CNS cause
TB meningitis
| Tuberculoma
418
Describe natural history of TB
Infection
5-10% will get primary/early disease
>90% it will be contained and go straight to latent infection
Reactivation of latent TB <10%
Chronic latent infection >90%
419
What happens to the majority of people infected with TB
Immune system fights off the infection
No active TB
Goes straight to latents TB
420
What happens to <5% of those infected with TB?
There is active infection
| Where you develop symptoms
421
Symptoms of active Tb
```
Cough
Haemoptysis
Weight loss
Night sweats
Fever
Fatigue
Lymphadenopathy
```
422
What can skin TB cause?
Lupus vulgarise
| Erythema Nodusum
423
What can liver TB cause
Hepatitis
424
What can lumbar vertebrae Tb cause
Potts Disease
425
Prevention vaccine for TB
BCG
426
Ix TB
```
Mantoux test
IGRA (interferon gamma release assay)
ZN stain
Sputum culture
Trans-bronchiol biopsy
Pleural fluid analysis and biopsy
Radiological:
X-ray
LP
CT
```
427
How often is latent TB reactivated to secondary TB
up to 10%
428
What is secondary TB
Reactivation of previous infection
429
what can TB in kidneys cause
Sterile pyuria
430
What can adrenal Tb cause
Addisons disease
431
what can Tb in the female reproductive system cause
Infertility
| Damage to fallopian tubes
432
Do TB cases need to be notified
Yes
433
What is a UTI
Infection of the urinary tract
434
What is bacteriuria
Bacteria in the urine
| This is not a disease
435
What is pyelonephritis
Kidney infection
436
What is Cystitis
Bladder infection
437
What is prostatitis
Infection of the prostate
438
Risk factors for UTI
```
Female
Sexually active
Congenital
Catheterisation
DM
Pregnancy
Bladder instrumentation
Kidney stones
Immunosuppression
```
439
Describe uncomplicated UTI
Normal renal tract structure and unction
Young sexually active females
Typically E.coli
440
Describe complicated UTi
Structural/functional abnormality of the urinary tract is present
Children
Males
441
In children what is a UTI likely to be cause by?
```
Structural deformity
E.g
Horseshoe kidney
Vesicoureteric reflux
Duplex kidney
```
442
Typical organisms of uncomplicated UTI
E.coli
Klebsiella
Proteus species
443
Ix for UTI
MSSU
444
What is the MSSU cut off for UTI infection
MSSU >10 to 5
445
Symptoms of UTI
```
Dysuria
Frequency
Haematuria
Suprapubic opain
Polyuria
Urgency
```
446
What should you rule out in young sexually active males with recurrent UTI?
Chlamydia
447
What is the tolerance for UTI and pregnant women
Lower tolerance
| >10 to 2
448
Common complication of UTI
Pyelonephritis
449
Rx for uncomplicated UTI
3d course Trimethoprim
or
Nitrofurantoin
450
Rx for UTI in men
7d course
| Trimethoprim or Nitrofurantoin
451
Which UTI abx is CI in pregnancy
Trimethoprim
452
Rx for child with UTI
Refer to paediatrician
453
Why is UTI more common in pregnancy
Due to stasis of urine
454
Rx for UTI in pregnancy
Nitrofuranotin
| NOT trimethoprim as CI in pregnancy
455
Why does UTI incidence increase unman with age
Due to BPH
456
Ix fo UTI
Urine dipstick
Urine culture
potentially bloods
457
Ix for complicated UTI
USS
CT
Cystoscopy
458
What is UTI in pregnancy associated with
Increased risk of preterm labour
| And intrauterine growth restriction
459
When collecting urine for culture in catheterised patients where should the urine be collected from
Sampling port
| NOT catheter bag
460
What does rotavirus cause
Viral gastroenteritis
461
Who is most commonly affected by rotavirus
Children
462
Symptoms of rotavirus gastroenteritis
Watery diarrhoea
Vomiting
fever
Abdominal pain
463
Rx for rotavirus gastroenteritis
Supportive Rx
| Abx will not do anything
464
What is the main prevention for rotavirus gastroenteritis
Routine oral vaccination UK
| Babies 8-12 weeks
465
Name parasites which can cause gastroenteritis
Giardia Lamblia
Cryptosporidium
Amoebiasis
466
Rx for parasitic gastroenteritis
Metronidazole
467
Organism in Q fever
Coxiella Burntii
468
Sources of Q fever
Sheep
Goats
Cattle
469
What is the most common for of chronic Q fever
Endocarditis
470
Symptoms of Q fever
```
Majority asymptomatic
Symptomatic:
Flu like symptoms
Fever
Nausea
Fatigue
Headache
```
471
Typhoid organism
Salmonella typhi
472
Parathyphoid organism
Salmonella Paratyphi
473
Transmission of typhoid fever
Faecal-oral route
474
Causes of typhoid fever
Poor sanitation
Poor hygiene
Unclean drinking water
Contaminated food and water
475
2 vaccines against typhoid
Oral Ty21a vaccine
| Vi vaccine
476
Who is Oral Ty21a (against typhoid) vaccine Ci in
Pregnancy
| Immunosuppression
477
Limitation of Vi vaccine (typhoid fever)
No protection against para-typhoid
478
1st week symptoms of typhoid
```
Fever
Headaches
Abo. discomfort
Dry cough
Bradycardia
Neutrophilia
Confusion
```
479
2nd week symptoms of typhoid
```
Fever peaks
Rose spots
Diarrhoea begins
Tachycardia
Neutropenia
Hepatosplenomegaly
```
480
3rd week clinical features of typhoid
intestinal bleeding
Perforation
Peritonism
Metastatic infections
481
4th week clinical features of typhoid
Recovery
Characterised by gradual improvement
10-15% relapse
482
Ix for typhoid
Blood cultures
Urine and stool cultures
Cultue bone marrow
Clinical Dx is not easy
483
Rx of typhoid
Oral Azithromycin
Now drug of choice for Asian-acquired uncomplicated enteric fever
IV Ceftrixone
If complicated or concerned regarding absorption of drug orally
484
Examples of viral haemorrhage fevers
Ebola
Congo-Crimea
Lassa Fever
Marburg Disease
485
Hows is dengue fever transmitted
Aedes Aegypti Mosquito
486
Clinical features of classical Dengue Fever
```
Sudden fever
Severe headaches
Sudden malaise
Retro-orbital pain
Severe myalgia
Severe arthralgia
Macular/Maculopapular rash
```
487
Signs of Dengue fever
```
Thrombocytopenia
Leukopenia
Elevated transaminases
Positive tourniquets test
Sp
```
488
Ix for Dengue fever
Viral PCR
489
Complications of Dengue fever
Dengue haemorrhagic fever
| Dengue shock syndrome
490
Rx for Dengue fever
No specific therapeutic agents
Supportive
analgesia
Fluids
491
Prevention of Dengue fever
Prevent bites:
Insect repellant
Mosquito nets
492
Describe Dengue Haemorrhagic Fever
```
Serious complication of dengue fever
Characterised by:
Capillary leak syndrome
Thrombocytopenia
Haemorrhage
```
493
Describe Dengue Shock Syndrome
```
Serious complication of dengue fever
Abrupt onset hypotension
Haemorrhage into skin
Epistaxis
Haematemesis
Melaena
```
494
Rx for Dengue haemorrhagic fever and shock syndrome
IV fluids
Fresh frozen plasma
Platelets
495
What causes Schistosomiasis?
Parasitic flat worms (Trematode) Schistosomes
496
How do humans become infected with Schistosomiasis
Through contact with contaminated fresh water containing the parasites
497
Describe the lifecycle of Schistosomiasis
1. Snails release infectious Schistosomes cercariae into fresh water
2. Cercariae penetrate human skin
3. Immature schistosomes migrate through the body
4. can cause acute fever (Katayma fever)
5. Schistosome maturation
6. Adult worms mature and produce eggs
7. Eggs released in fresh water
9. infect snails
498
Where do schistosomes mature in humans
In the liver
499
How are schistosome eggs released from humans
Faeces
| Urine
500
Symptoms of cercarial (schistosomiasis) penetration through skin
Local dermatitis
| Swimmers itch
501
What is Katayma Fever?
Acute schistosomiasis
502
Rx for Schistosomiaias
2 doses Praziquantel
| Prednisolone if severe
503
Katayma fever symptoms
```
Fever
Cough
Bloody diarrhoea
Malaise
Headache
Rash (urticaria)
Abdominal pain
Splenomegaly
```
504
Species of Schistosomiasis
S. haematobium
S. mansoni
S. japonicum
505
Ix for Schistosomiasis
Ova in urine
Ova in Faeces
Bowel/bladder histology
506
What is long term schistosomiasis infection of the bladder associated with?
Squamous cell carcinoma of the bladder
507
Treatment for viral haemorrhagic fevers
High security infection unit
| SUPPORTIVE!
508
Where does S.Mansoni usually affect
Large bowel
| Schistosomiasis
509
Which species of Schistosomiasis is most likely to affect the urinary system
S.Haemotobium
510
How do you contract Psittacosis
From infected birds
511
Organism of Psittacosis
Chlamydia Psittaci
512
How does Psittacosis typically present?
As atypical pneumonia with flu like symptoms
513
Who should you consider Psittacosis in?
Rare
So Consider Hx of bird exposure
Pet bird ownership
Pigeon fancying
514
Is psittacosis rare or common?
Rare
515
What is Psittacosis commonly called?
Parrot fever
516
Rx for Psittacosis
Doxycycline
| Clarithromycin
517
Organism of Toxoplasmosis
Toxoplasma Gondii
| Parasite
518
Host of Toxoplasmosis
Cat
519
Which disease may trigger reactivation of toxoplasmosis
HIV
520
What is congenital toxoplasmosis
Where the baby is infected through the placenta from an infected mother
521
Symptoms of toxoplasmosis
Asymptomatic in 90%
Normal immune system:
Low grade fever
Swollen LN
Headaches
522
What makes you most at risk during toxoplasmosis infection
Immunosuppressed
| Pregnant
523
What can toxoplasmosis cause in pregnancy
```
Miscarriage
Neurocognitive deficits in fetus:
Microcephaly
Hydrocephalus
Encephalitis
Retinal damage
Choroidoretinitis
```
524
Complications of toxoplasmosis in immunocompromised
```
Cerebral abscess
Encephalitis
Choriodoretinitis
Myocarditis
Myositis
Pneumonitis
Hepatitis
```
525
Rx toxoplasmosis
Pyrimethamine + Sulfadizaine + Folinic Acid
526
What is Dermatophytoses also known as
Ring worm
527
What does Tinea Media cause
Athletes foot
528
What does tine cruris cause
Jocks itch
529
What is Oncychomycosis
Infection of the nail
530
What does Tinea Capititis cause
Infection of the scalp and hair
Can cause alopecia
Scalp scaling
531
What does Tinea Faciei cause
Fungal infection of the face
532
What does Tinea Manuum cause
Infection of hands and palm area
533
What type of infection is ringworm E.g Bacteria, viral or fungal?
Fungal infection
534
Risk factors for dermatophytoses
```
Public showers
Contact sports
Excessive sweating
Contact with animals
decreased immune function
```
535
Ix for dermatophytoses
Clinical
O/E
Fungal swab in some cases
536
Rx for dermatophytoses
Topical anti fungal agents:
Miconazole
Terbinafine
Oral in more severe cases
537
What does dermatophytoses infect?
Skin and keratinised structures
538
How is lyme disease contracted
Via a tick bite
539
Lyme disease organism
Borrelia Burgodorferi
540
Early localised lyme disease infection clinical features
```
Erythema migrans (bulls eye rash)
Begins at site of tick bite
Note: 1/3 do not have this rash
```
541
Dx of lyme disease
Clinical features and epidemiological considerations are usually strongly suggestive
Sometimes erythema migrans
Antibodies to lyme disease (difficult to isolate organism)
542
Rx of lyme disease
Oral amoxicillin
Or
Oral Doxycycline
543
Rx for disseminated Lyme disease
IV Ceftriaxone
544
Clinical feature of early disseminated lyme disease infection
```
Widespread rash
Headache
Fever
Malaise
Pain/pruritis
Lymphadenopathy
Numbness
Tingling
Bells Palsy
Some: cardiac and neurological involvement
```
545
Clinical features of late disseminated lyme disease
```
Rare
Chronic arthritis
Encephalopmyelitis
Acrodermatitis
Chronic Atrophicans
Chronic neurological symptoms
Memory loss
Cardiac arrhythmias
```
546
What is a borrelial lymphocytoma?
```
Bluish solitary painless nodule
On
Earlobe or areola
Common in
Children > Adults
```
Caused by lyme disease
547
What is Allergic Bronchopulmonary Aspergillosis
Rare disease
| Hypersensitivity type I & III reaction to Aspergillus Fumigatus
548
What can Allergic Bronchopulmonary Aspergillosis complicate?
Asthma
CF
Patients with bronchieactsis
549
Clinical features of allergic bronchopulmonary aspergillosis
```
Episodes of:
Wheeze
SOB
Cough
Fever
Malaise
"recurrent pneumonia"
```
550
Rx for acute attacks allergic bronchopulmonary aspergillosis
Prednisolone
551
Rx for long term allergic bronchopulmonary aspergillosis
Itraconazole (anti fungal)
| Oral, long term steroids
552
What is an aspergilloma
Fungus ball within pre-existing cavity
| Most commonly lung
553
What is a pre-existing cavity in the lung aspergilloma usually caused by
TB infection
Sarcoidosis
CF
Bronchiectasis
554
Rx for aspergilloma
Only symptomatic require Rx
Surgical excision for solitary symptomatic OR severe haemoptysis caused by aspergilloma
Voriconazole
Local instillation amphotericin paste under CT guidance
555
Ix for aspergilloma
CXR
| Sputum culture
556
What is the most common symptoms associated with aspergilloma
Mainly asymptomatic
| But most common associated symptom is haemoptysis
557
What is infective endocarditis
Infection of the endocardium
| Inner layer of the heart
558
Risk factors for IE
```
IV drug abuse
Cardiac lesions
Rheumatic heart disease
Dental treatment
Prosthetic valves
Immunosuppression
DM
```
559
What are the HACEK organisms
Group of fastidious gram -ve bacilli causing IE
560
Common bacterial causes IE
Strep. Viridans
Staph. Aureus
Strep. Bovis
Enterococci
561
What type of infection is brucellosis
Bacterial zoonoses
562
3 species of Brucellosis
B. Melitensis
B.Suis
B.Abortus
563
Which brucellosis species has the highest virulence in men
B.Melitensis
564
Transmission methods of brucellosis
Unpasteurised milk
Undercooked eat
Unpasteurised dairy products
565
Types of brucellosis infection
Subclinical (most common)
Acute
Subacute
Chronic
566
How long does chronic brucellosis last
>6 months
567
Rx for Brucellosis
Long acting Doxycycline 2-3 months + Rifampicin or + IM Gentamycin for first weeks
568
Which antibiotic should be added in CNS brucellosis disease
Co-trimoxazole
569
What is subclinical Brucellosis
Brucellosis as asymptomatic
| Most common form
570
Symptoms of acute brucellosis
```
1-3 weeks
High undulant fever
Weakness
Headaches
Drenching sweats
Splenomegaly
Malaise
```
571
Which animal does brucellosis abortus come from
Cattle
572
Which animal does brucellosis melitensis come from?
Goats and sheep
573
Is brucellosis a rare or common disease in the UK
Rare
574
Dx of brucellosis
Blood cultures
575
What is the main risk food/drink for contracting brucellosis
Unpasteurised milk/dairy products
576
Which animals carries leptospirosis
Rats
Cows
Pigs
Dogs
577
Triad of Weil's disease
Jaundice
AKI
Bleeding
578
How is leptospirosis contracted?
```
Extracted in animal urine
Urine contaminated soil
Food contaminated by infected urine
Direct contact with the animal
When the person has open wounds or a route for entry
```
579
1st/acute phase symptoms of leptospirosis
Fever
| Non-specific flu like symptoms
580
2nd/immune phase symptoms of leptospirosis
```
Myalgia
Jaundice
Meningitis
Uveitis
AKI
ARDS
Pulmonary haemorrhage
```
581
Dx of Leptospirosis
Think of it:
Fever in cattle farmer
Exposure to water or rats
DX in UK via National Leptospirosis Service
PCR
Blood culture (takes 1 week on special media)
582
Rx for leptospirosis
Doxycycline mild disease
Penicillin severe disease
Supportive:
Prompt dialysis
Mechanical ventilation
583
Do steroids help leptospirosis
No
584
2 main species of Cryptococcus
C.Neoformans
| C.Gattii
585
Who does cryptococcus disease usually affect?
```
HIV patients (AIDS defining illness)
Sarcoid
Hodgkins
Haematological malignancy
Post Tx
```
586
How is cryptococcus transmitted
Inhalaiton
587
Ix of cryptococcus
CSF analysis:
Indian Ink Preparation
Blood culture
Blood crytpococcus antigen analysis
588
Typical CSF findings in cryptococcus infection
High protein
Low glucose
Cryptococcus antigen
589
Who does meningoencephalitis cryptococcosis infection usually affect
HIV/AIDS patients
590
Symptoms of brain cryptococcus
```
Confusion
Headaches
Altered behaviour Visual disturbances
Nausea
Vomiting
Neck stiffness
```
591
Rx for cryptococcus
Amphotericin + Flucytosine
| Fluconazole
592
Main method of HBV prevention
HBV vaccination
593
Who is active HBV vaccination recommended for?
```
Health care workers
Travelling to endemic areas
Renal dialysis
PWID
Close contacts to those who have chronic HBV
```
594
How is HBV diagnosed
Blood tests
595
What do hepatitis surface antigens suggest
Presence of HBV virus
HBV infection present
Need to differentiate acute and chronic
596
When does seroconversion occur in HBV
When patient recovers after infection
Or
When the patient responds to HBV vaccination
597
High risk groups HBV
```
Injection drug users
Multiple sexual partners
Immigration from areas of high endemnicitiy
Haemodialysis
Babies born to mothers at risk
Healthcare workers
```
598
Routes of transmission HBV
Sexual
Perinatal (mother to baby)
Needlestick injury
Blood borns - transmission
599
What does Anti-HBs mean (HBV)
Protection against HBV virus
| Either from vaccination or recovery from virus
600
What does IgM Anti-HBC mean (HBV)
Acute HBV infection
601
What does IgG Anti-HBC mean (HBV)
Chronic HBV infection
602
What does Anti-HBe mean (HBV)
inactive virus
603
What does HBV DNA mean
Viral replication
604
What does HBV e antigen mean
Active replication
605
```
Example 1:
Interpret these bloods
HBsAg negative
Anti-HBc negative
Anti HBs negative
```
No infection
Not immunised
Susceptible
606
Interpret:
HBsAg negative
Anti HBc positive
Anti - HBs positive
Resolved HBV infection
| Now immune
607
Interpret:
HBsAg negative
Anti HBc negative
nti HBs positive
Vaccinated against HBV
608
Interpret:
HBsAg positive
Anti-HBC positive
Anti- HBs
Active HBV infection
609
How many HBV infected patients go on to develop acute infection:
5-10%
610
Potential outcomes of chronic HBV infection
Asymptomatic chronic infection
Chronic persistent hepatitis
Chronic active hepatitis
611
What can chronic active HBV lead to
Cirrhosis
| Or primary liver cancer
612
What can cirrhosis in chronic HBV lead to
Primary Liver Cancer
Require Liver Tx
Or lead to death
613
Post vaccine Anti-HBs level >100
| Interpret
Responder to vaccine
Not further antibody check
Booster in 5 years
614
Post vaccine Anti-HBs level 10-<100
| Interpret
Responder (but with poor response)
Booster now and in 5 years
No further antibody check required
615
Post vaccine Anti-HBs level <10
| Interpret
No response to vaccine
Repeat course of vaccine
Recheck antibody level 3 months after last dose
616
What percentage of HBV acutely infected recover and do not progress to chronic infection
90-95%
617
Who is considered for antiviral therapy in HBV
```
Asymptomatic with increased ALT
HBeAg +ve
Cirrhosis present
Evidence of ongoing viral replication
Sig. liver inflammation or fibrosis
```
618
Rx for HBV
Long acting Pegylated Interferon
Nucleoside analogues
Liver Tx
619
Who is Liver Tx for in HBV
Advanced cirrhosis patients
620
Nucleoside analogue drugs used to treat HBV
Lamivudine
Adefovir
Dipivoxil
Entecavir
621
Vague symptoms of acute HBV infection
```
Fatigue
Fever
Loss of appetite
Nausea
Diarrhoea
Abdominal pain
Jaundice
```
622
Which 2 distinct diseases does the herpes zoster virus produce
Chicken pox
| shingles
623
What is chicken pox
Initial infection with Varicella virus
624
What is shingles
Reactivation of latent varicella virus
625
When does chicken pox usually occur
In childhood
626
Transmission of chicken pox
Throat
Fresh skin lesions
Air borne transmission
Direct contact
627
Where does the varicella virus lie dormant
In the dorsal route ganglion
628
Symptoms of chicken pox
```
Initial exposure to VZV
Fever
Headache
Malaise
Rash
```
629
Describe the rash in chicken pox
Rapid progression of macule to papule to vesicles to pustules in a matter of hours
Pruritis (itchy)
Eventually pustules and healing without scars
630
Symptoms of shingles
Reactivation of VZV
Rash
Painful
631
Describe the rash in shingles
Macular to vesicular rash
Dermatomal pattern
Unilateral
Painful
632
A patient presents with a unilateral painful rash with has a dermatomal distribution what is the likely infection
Shingles
633
Dx of chicken pox and shingles
Clinical
| O/E
634
Rx for shingles
Analgesia
Antivirals:
Aciclovir
Valaciclovir
635
Rx for pregnant women with shingles
IV Aciclovir
636
Rx for chicken pox
Usually self-limiting
637
What is the most common complication of Q fever
Endocarditis
638
What are the 3 types of polio virus
Polio 1,2,3
639
Where does the poliovirus have a propensity for
Nervous system
| Particularly anterior horn cells of LMN
640
Transmission of polio
Faecal-oral
641
Outcome of majority polio cases
Asymptomatic seroconversion
642
Describe paralytic poliomyelitis
Meningeal irritation (headache, fever, neck stiffness, vomiting)
Asymmetric onset flaccid paralysis
No sensory involvement
643
Prevention of polio
Vaccination
644
How does polio differ from guillain barre
No sensory involvement
| Asymmetric natura of paralysis
645
Rx of polio
No cure only supportive measures
Best rest
respiratory support if muscles of wh are involved
646
What type of virus is polio
Enterovirus
647
Who does polio typically affect
Children
648
In what % of polio does it cause paralytic disease
1%
649
Which disease are tampon use associated with?
Toxic Shock Syndrome
650
Common organisms of TSS
Strep. Pyogenes
| Staph. Aureus
651
What is produced by the organisms in TSS
Super antigens
652
Diagnostic Criteria for TSS
Fever
Hypotension
Diffuse macular rash
Three of the following organs involved
Liver, blood, renal, gatrointestinal, CNS, muscular
Isolation of Staph aureus from mucosal or normally sterile sites
Production of TSST1 by isolate
Development of antibody to toxin during convalescence
653
Rx TSS
```
Remove offending agent (e.g tampon)
IV fluids
Ionotropes
Abx.
IV immunoglobulins
```
654
What type of infection is an IV catheter infection
Nosocomial
655
What is meant by nosocomial infection
Acquired in hospital
656
Risk factors for IV catheter infection
Continuous infusion >24hrs
Cannula in situ >72hrs
Cannula in LL
Patients with neurological/ neurosurgical problems
657
Most common organisms IV catheter infections
Staph. Aureus
MSSA
MRSA
658
Ix to Dx IV catheter infection
Clinically
| or by +ve blood cultures
659
Rx for of IV catheter infection
Remove cannula
Express any pus from thrombophlebitis
Abx. for 14 days
660
Prevention of IV catheter infections
Do not leave in unused cannula
Do not insert cannula unless using it
Change cannula every 72hrs
Use aseptic technique when inserting cannula
661
Common complication of IV catheter infection
Infective Endocarditis
| Hence do an ECHO
662
Describe Class I surgical site infection
Clean wounds (resp. alimentary, genital or infected urinary systems not entered)
663
Describe Class II surgical site infections
Clean contaminated wound (open, fresh accidental wounds or gross spillage from GI tract)
664
Describe Class III surgical site infections
Contaminated wound (open, fresh accidental wounds or gross spillage from GI tract)
665
Describe Class IV surgical site infections
Infected wounds (existing clinical infection/infection present before operation)
666
Organisms surgical site infections
```
Staph. Aureus (incl. MSSA and MRSA)
Coagulase negative Staphylococci
Enterococcus
Escherichia coli
Pseudomonas Aeruginosa
Enterobacter
Streptococci
Fungi
```
667
Ix for Surgical site infection
Send pus/infected tissue for cutter
Avoid superficial swabs
Aim for deep structures
668
Rx for Surgical site infections
Abx. to target likely organisms
669
Risk factors for surgical site infections
```
DM
Smoking
Obesity
Malnutrition
Concurrent steroid use
```
670
What does MRSA stand for
Meticillin Resistant Staphylococcus Aureus
671
What type of infection is MRSA
Hospital acquired infection
672
What is VISA (hospital acquired infection)
Vancomycin intermediate staph. aureus
673
What is VRSA (hospital acquired infection)?
Vancomycin Resistant Staph Aureus
674
Where does MRSA commonly live
On 1/3 of peoples skin
675
Why are hospital patients susceptible to MRSA
They have, open wounds/ catheters/drips (easier entry for MRSA)
They may be immunocompromised
They are in close contact with a lot of people (easier for MRSA to spread)
676
What is required fro infection of MRSA to occur
Needs to be able to enter the tissue, blood and allowed to multiple
677
Ix for MRSA
Blood sample
Urine sample
Swab from site
678
Rx for MRSA infection
IV Vancomycin
| Teicoplanin
679
Rx for removing MRSA from skin
Antibacterial cream inside nose 2-5d
Antibacterial shampoo everyday (5d)
Changing laundry every day
680
Risk factors for MRSA infection
Abx. exposure
Hospital stay
Surgery
Nursing home
681
Prevention of MRSA
Surveillance
Barrier precautions
Hand hygiene
682
Describe surveillance for MRSA
Sometimes pre-admission for overnight hospital stay
Asked for a swab off the skin
683
Where does aspergillosis commonly affect?
Lungs
684
Transmission of aspergillosis
Sporulation
| Airborne/inhalation
685
What type of infection is aspergillosis
d Fungal infection
686
In what patients does aspergillosis mainly occur
Those with underlying lung pathology:
| E.g COPD, TB
687
Who does invasive pulmonary aspergillosis normally occurs in
Patients who are severely immunocompromised
688
Risk Factors for Invasive pulmonary aspergillosis
```
Immunocompromised (e.g HIV)
Leukaemia
Wegner's
SLE
After broad spectrum Abx.
```
689
Mortality rate of acute invasive pulmonary aspergillosis
50%
690
Ix for invasive pulmonary aspergillosis
IV Anti-fungals
