Sýklafræði II

Question 1

Shigella líkist helst hvaða bakteríu?

Answer 1

E coli - báðar gram negativar og virka svipað.

Question 2

Hvernig smitast Shigella?

Answer 2

Með vatni og mat.

Question 3

Sjúkdómsgangur Shigellu og einkenni.

Answer 3

• Sársaukafullur niðurgangur
• “Dysentery” - large bowel diarrhea, blóðugur.
• Invades colonic epithelial frumur.
• Töluvert mortalitet á heimsvísu.

Question 4

Í hvernig kjöti er Campylobacter helst?

Answer 4

Fuglakjöti

Question 5

Algengasta niðurgangsBAKTERÍA í UK, framar en Salmonella?

Answer 5

Campylobacter

Question 6

Einkenni Campylobacter:

Answer 6

• Niðurgangur
• Kviðverkir
• Blóðugur niðurgangur í börnum undir 5 ára aldri

Question 7

Meðferð Campylobacter:

Answer 7

Clarithromycin (macrolide) ef greinist snemma en gengur annars yfirleitt yfir af sjálfu sér.

Question 8

Meðferð meningococcal meningitidis? (empirisk, skammtar líka)

Answer 8

• In the hospital setting IV ceftriaxone (2 g adult; 80 mg/kg child) or IV cefotaxime (2 g adult; 80 mg/kg child) are the preferred agents.
• IM benzylpenicillin can be given as an alternative in the pre-hospital setting and chloramphenicol is a suitable alternative if there is a history of anaphylaxis to cephalosporins.

Question 9

Hvað er reactive arthritis? (áður kallað Reiter´s disease)

Answer 9

Klassiskur triad:

• arthritis (yfirleitt 1-2 liðir, geta verið allt að 4-5)
• conjunctivitis
• urethritis

(getur líka fengið iritis, circinate balanitis og keratoderma blennorhagicum á iljar)

Question 10

Hvaða serologiu tengist reactive arthritis?

Answer 10

HLA B27

Question 11

Orsakir reactive arthritis:

Answer 11

• Niðurgangur (t.d. salmonella, campylobacter, shigella)

- STD: chlamydia og gonorrhea

Question 12

Hversu mörg börn fá rotavirus?

Answer 12

ÖLL börn fengu rotavirus fyrir 5 ára aldur áður en bólusetningar hófust 2013. Hefur minnkað um 75% síðan þá.

Question 13

Einkenni rotavirus:

Answer 13

• Mikill niðurgangur, oft þurrkur og þarf oft innlögn til vökvagjafar
• Færð immunity eftir á

Question 14

Hvenær er noro algengast?

Answer 14

Á veturna (winter vomiting)

Question 15

Hversu lengi endist ónæmið fyrir noro eftir sýkingu?

Answer 15

Frekar stutt, 2 mánuði uþb

Question 16

Hvernig drepum við Norovirus t.d. eftir að komið er út úr einangrun?

Answer 16

Drepst við handþvott og sprittun.

Question 17

Neisseria gonorrhea - hvernig baktería, gram neg/pos og útlit, incubation tími?

Answer 17

• Gram neg diplococcus

- Incubation tími er 4-6 dagar

Question 18

Einkenni N. gonorrhoea:

Answer 18

Um 50% kvenna eru einkennalausar.

Kk fá oft týpísk UTI einkenni.

Question 19

Meðferð N. gonorrhoea:

Answer 19

Ónæmt fyrir mörgu.

Ceftriaxone 500mg im PLÚS azithromycin 1g per os (macrolide)

Question 20

Hvað gerist ef N. gonorrhea er ekki meðhöndluð? (4)

Answer 20

Getur orðið krónísk og getur þá fengið:

• septic arthritis
• epididymo-orchitis
• bacterial endocarditis
• PID í konum

Question 21

Chlamydia trachomatis - incubation tími og einkenni:

Answer 21

• Incubation tími oft margar vikur
• 50-70% kvenna eru einkennalausar en um helmingur einkennalausu kvennanna fá PID í framhaldinu
• KK fá oft klístraða útferð og urethritis
• Getur orðið krónískt

Question 22

Greining klamydíu

Answer 22

NAATs (t.d. PCR)

Question 23

Meðferð klamydíu:

Answer 23

doxycycline eða macrolide

Question 24

Mislingar: hvernig veira er það, hvernig smitast hún og incubation tími.

Answer 24

• Measles belongs to the paramyxoviridae group of viruses.

- The incubation period is 7-18 days (average 10) and it is spread by airborne or droplet transmission.

Question 25

Einkenni mislinga:

Answer 25

- The classical presentation is of a high fever with coryzal symptoms and photophobia with conjunctivitis often being present. - The rash that is associated is a widespread erythematous maculopapular rash. - Koplik spots are pathognomonic for measles, and are the presence of white lesions on the buccal mucosa.

Question 26

Greining mislinga:

Answer 26

- Salivary swab for measles specific IgM - Serum sample for measles specific IgM - Salivary swab for RNA detection

Question 27

Dæmi um 3 kríp sem smitast með aerosol smiti:

Answer 27

Mycobacterium tuberculosis Varicella zoster virus Measles virus

Question 28

Hvað eru aerosol smit? Hvernig verst maður slíku smiti?

Answer 28

- Aerosols are airborne particles that are less than 5 µm in size, such as droplet nuclei (residue from evaporated droplets) containing infective organisms. They typically cause infection of the upper or lower respiratory tract. - These organisms can survive outside the body and remain suspended in the air for long periods of time. They can be spread over large distances and transmitted via ventilation systems. For this reason masks and negative pressure rooms are required to prevent spread.

Question 29

5 kríp sem smitast sem Droplet (airborne particle > 5 µm)?

Answer 29

``` Neisseria meningitidis Bordatella pertussis Influenza virus Parainfluenza virus Respiratory syncytial virus ```

Question 30

7 kríp sem smitast faeco-oral?

Answer 30

``` Salmonella enteritidis Escherichia coli Vibrio cholerae Ascaris lumbricoides Hepatitis A Poliovirus Rotavirus ```

Question 31

4 kríp sem smitast með direct contact:

Answer 31

Staphylococcus aureus Streptococcus pyogenes Trichophyton rubrum Human papillomavirus

Question 32

3 kríp sem smitast verticalt:

Answer 32

Trepenoma pallidum HIV Hepatitis B

Question 33

5 kríp sem eru vector-borne smit:

Answer 33

``` Plasmodium falciparum Borrelia burgdorferi Trypanosoma cruzi Coxiella burnetti Leishmania donovani ```

Question 34

Hvaða skor á að nota í mati á akút hálsbólgu?

Answer 34

FEVERpain skorið: - Fever in last 24 hours - Purulence - Attended rapidly in under 3 days - Inflamed tonsils - No cough or coyza - Score 0-1 = Unlikely streptococcal infection (13-18% isolation of streptococcus) antibiotics not recommended - Score 2-3 = 34-40% isolation of streptococcus, consider delayed prescribing of antibiotics (3-day ‘back-up prescription’) - Score ≥4 = 62-65% isolation of streptococcus, use immediate antibiotic if severe, or 48-hour short back-up prescription

Question 35

Empirisk meðferð streptokokka:

Answer 35

- Prescribe phenoxymethylpenicillin as the first-choice antibiotic. - If there is a true penicillin allergy, clarithromycin is an alternative. - Prescribe erythromycin for a pregnant woman with penicillin allergy.

Question 36

Hvað er Hutchinson´s sign og hvers vegna birtist það?

Answer 36

Hutchinson’s sign is the presence of herpes vesicles on the tip, side, or root of the nose. It typically precedes the development of ophthalmic herpes zoster. This occurs because branches of the nasociliary nerve (a branch of the ophthalmic division of the trigeminal nerve) innervate both the cornea and the dorsum and tip of the nose.

Question 37

Hvað eru facultative bacteria?

Answer 37

Facultative anaerobic bacteria make ATP via aerobic respiration and are also capable of switching to fermentation.

Question 38

4 dæmi um obligate anaerobe bacteríur:

Answer 38

Bacteroides spp. Clostridium spp. Treponema spp. Actinomyces spp.

Question 39

Hvers konar baktería er Neisseria gonorrhea?

Answer 39

Gram-negative non-spore-forming diplococcus

Question 40

Hvað er post-primary tuberculosis?

Answer 40

Post-primary tuberculosis, also known as reactivation tuberculosis, usually occurs a year or two after the primary infection. Reactivation often occurs in the setting of a decreased immune status and commonly involves the lung apex. It can affect all organs and body systems. The presentation of post-primary tuberculosis is highly variable.

Question 41

Hver er algengasta presentasjón post-primary tuberculosis í UK?

Answer 41

Pulmonary tuberculosis is the most common presentation, accounting for 60% of cases in the UK. General symptoms are common and include fever, night sweats, weight loss, anorexia and malaise. Patients commonly have a chronic, productive cough and/or haemoptysis. It can result in pneumonia, lobar collapse, bronchiectasis and pleural effusion.

Question 42

Í post-primary tuberculosis, hver er algengasta EXTRAPULMONARY presentasjónin?

Answer 42

- Extrapulmonary tuberculosis is more common in children and the immunosuppressed. Around 15-20% of cases spread to extrapulmonary sites such as the pleura, central nervous system, lymphatics, bones, joints, and genitourinary system: - Genitourinary tuberculosis is the most common site outside the lungs and often presents with ‘sterile’ pyuria. It can also cause salpingitis, abscesses, renal lesions and infertility in women.

Question 43

Hvað er Pott´s disease?

Answer 43

Pott’s disease is extrapulmonary tuberculosis that affects the spine. It primarily affects the lower thoracic and upper lumbar vertebrae. It can also affect other parts of the musculoskeletal system, causing isolated bone and joint lesions.

Question 44

Hvað er miliary tuberculosis?

Answer 44

Miliary tuberculosis (disseminated tuberculosis) refers to tuberculosis that has widely disseminated to other organs via blood or lymphatics.

Question 45

Hvað er scrofula?

Answer 45

Scrofula refers to cervical tuberculous lymphadenopathy. Scrofula is also referred to as a cold abscess due to the absence of erythema and warmth.

Question 46

Hversu stórar eru loftbornar partiklur og dæmi um slíkar partiklur (hvernig þær verða til).

Answer 46

Aerosols are airborne particles that are less than 5 µm in size, such as droplet nuclei (residue from evaporated droplets) containing infective organisms. They typically cause infection of the upper or lower respiratory tract.

Question 47

3 dæmi um sjúkdóma sem smitast með aerosol smiti:

Answer 47

Mycobacterium tuberculosis Varicella-zoster virus Measles virus

Question 48

Hvað sjáum við með direct light microscopy?

Answer 48

- Direct light microscopy – stool parasites

Question 49

Hvað sjáum við með Ziehl-Nielson stain light microscopy?

Answer 49

Ziehl-Nielson (Z-N) stain light microscopy – sputum for tuberculosis

Question 50

Hvað sjáum við með Giemsa stain light microscopy?

Answer 50

- Giemsa stain light microscopy – blood for malaria

Question 51

Hvað sjáum við með fluorescent microscopy?

Answer 51

- Fluorescent microscopy – nasopharyngeal aspirate for respiratory syncytial virus (RSV)

Question 52

Hvað er obligate pathogen og 2 dæmi um slíkt:

Answer 52

Obligate pathogens are organisms that are almost always associated with disease. They usually cannot survive outside of the body for long periods of time. Examples include Trepenoma pallidum and HIV.

Question 53

Hvað er conditional pathogen og 2 dæmi um slíkt:

Answer 53

Conditional pathogens are organisms that can usually only cause disease if certain conditions are met. A classic example is Staphylococcus aureus, which is often a normal commensal but can cause disease if inoculated into a wound. Another example is Bacteroides fragilis, which is a normal commensal of the gut but can cause abscesses if it reaches the peritoneal cavity.

Question 54

Hvað eru opportunistic pathogens og 2 dæmi um slíkt:

Answer 54

Opportunistic pathogens are organisms that can only cause disease in an immunocompromised host or under other unusual circumstances. Examples include Pneumocystis jiroveci, which can only cause disease if the host is immunocompromised, and Pseudomonas aeruginosa, which typically only causes skin infection when the normal skin microbiota is disrupted.

Question 55

Hvernig smitast impetigo (kossageit)?

Answer 55

Impetigo is most commonly spread by direct person-to-person contact and can spread rapidly through families and school classes. It can also, less commonly, be spread by indirect contact.

Question 56

2 algengustu orsakavaldar impetigo?

Answer 56

The commonest causative organism is Staphylococcus aureus. Streptococcus pyogenes is the second commonest and causes fewer cases, either alone or in combination with Staphylococcus aureus. The streptococcal form tends to be commoner in warmer, more humid climates.

Question 57

2 algengustu orsakavaldar impetigo?

Answer 57

The commonest causative organism is Staphylococcus aureus. Streptococcus pyogenes is the second commonest and causes fewer cases, either alone or in combination with Staphylococcus aureus. The streptococcal form tends to be commoner in warmer, more humid climates.

Question 58

Hvaða tvær týpur eru til af impetigo/kossageit?

Answer 58

- Non-bullous impetigo – lesions usually start as tiny pustules or vesicles that evolve rapidly into honey-crusted plaques that tend to be under 2 cm in diameter. These can be itchy but are rarely painful. - Bullous impetigo – lesions have a thin roof and tend to rupture spontaneously. This type is more likely to be painful and may be associated with systemic upset.

Question 59

Hvernig breytist ónæmiskerfið ef miltað er fjarlægt?

Answer 59

Following splenectomy, patients have defective macrophage function and a diminished ability to remove capsulated organisms from the blood. Splenectomy, therefore, results in an increased risk of sepsis due to encapsulated organisms, and the risk is greatest with the most virulent pathogens in this group.

Question 60

Hvaða hjúp bakteríur eru mikilvægastar þegar kemur að því að verja sjúklinga sem ekki hafa milta? (3)

Answer 60

The most important encapsulated pathogen is Streptococcus pneumoniae. In one notable study, reporting 349 episodes of sepsis in patients with asplenia, 57% of infections and 59% of deaths were caused by Streptococcus pneumoniae. Approximately 6% of infections were caused by Haemophilus influenzae, and 3.7% of infections were caused by Neisseria meningitidis.

Question 61

Hvaða 3 bóluefni þurfa allir sjúklingar án milta að fá?

Answer 61

All patients that have undergone splenectomy should receive the pneumococcal conjugate vaccine, Haemophilus influenzae type B vaccine and the meningococcal vaccine.

Question 62

3 mismunandi leiðir til að testa fyrir HIV:

Answer 62

p24 antigen tests Nucleic acid tests (NAT) HIV antibody tests

Question 63

Hvernig virka/til hvers eru p24 antigen test fyrir HIV?

Answer 63

p24 is the viral protein that makes up most of the core of the human immunodeficiency virus (HIV). Serum concentrations of the p24 antigen are typically high in the first few weeks after infection. They can usually detect HIV infection 18-45 days after exposure. The p24 antigen test is, therefore, a useful way of diagnosing very early infection, such as during a seroconversion illness.

Question 64

Til hvers eru PCR (NAAT) próf fyrir HIV nytsamleg?

Answer 64

These amplify and detect one or more of several target sequences located in specific HIV genes. They can detect HIV sooner than the other types of tests (between 10-33 days after exposure) but are very expensive and are not used routinely. They are usually reserved for use under very specific circumstances, such as a recent high-risk exposure.

Question 65

Til hvers eru HIV antibody test?

Answer 65

These include ELISA and western blot tests. They are a very sensitive way of detecting the presence of HIV but cannot be used in the early stages of the disease. There is typically a window period of 6-12 weeks before antibodies are produced, and these tests will be negative during a seroconversion illness. The 'rapid HIV test' is an example of an HIV antibody test. It is called the 'rapid test' as it can detect antibodies in blood or saliva much quicker than the other antibody tests, and results are often back within 20 minutes.

Question 66

Legionella pneumophilia: 1 sýklalyf sem hún er resistant við og 2 sýklalyf sem virka yfirleitt:

Answer 66

Legionella pneumophila infections are resistant to amoxicillin but can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used.

Question 67

Hvernig bakteríur eru Salmonellurnar?

Answer 67

Salmonella spp. are Gram-negative, rod-shaped, non-spore-forming bacteria. They are predominantly motile organisms and are also facultative anaerobes, capable of surviving with or without oxygen.

Question 68

Hversu stórar eru droplet partiklur og hvernig berast þær á milli?

Answer 68

Droplets are airborne particles that are more than 5 µm in size. Droplet transmission occurs when respiratory droplets are generated via coughing, sneezing, or talking.

Question 69

Dæmi um 5 bakteríur eða veirur sem berast með droplet smiti:

Answer 69

``` Neisseria meningitidis Bordatella pertussis Influenza virus Parainfluenza virus Respiratory syncytial virus ```

Question 70

2 sveppir sem geta valdið septiskum arthritis:

Answer 70

Fungi can also be causative agents, notably Histoplasmosa and Blastomyces.

Question 71

6 dæmi um veirur sem geta valdið liðsýkingum:

Answer 71

Viruses can also cause septic arthritis, and these include hepatitis A, B and C, coxsackie virus, adenovirus and parvovirus.

Question 72

5 algengustu bakteríurnar sem valda liðsýkingum:

Answer 72

- Staphylococcus aureus (langalgengast) - H. influenzae (dregið úr með bólusetningum) - Streptococcus spp.. - Neisseria gonorrhoea (typically sexually active young adults, macules or vesicles frequently seen on the trunk) - Escherichia coli (seen in IVDUs, the elderly and seriously ill)