Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GORGAS > Tetanus And Rabies > Flashcards

Tetanus And Rabies Flashcards

1
Q

Mimics of Tetanus?

A

Strychnine poisoning
Rabies
Hypocalcaemic tetany

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What kind of bacteria is tetanus?

A

Clostridium Tetani
Anaerobic gram positive bacilli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is tetanospasmin?

A

A neurotropic toxin
Travels to spinal cord and disrupts inhibitory neurotransmitters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is risus sardonicus? Opisthotonus?

A

Lock jaw smile
Extensive back spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does WHO define tetanus?

A

It is a clinical diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do you Dx tetanus?

A

Spatula test, they bite down
Clinical diagnosis!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the clinical course?

A

Injury
7 days later get trismus, dysphagia and back pain
Period of onset is time until spasms which occur around day 10
Typically occur in face, nack, back and rigidity
After day 10, CVS, GI/renal and pyrexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the types of tetanus?

A

Cephalic tetanus– most rare, lower cranial nerve muscles
Localised tetanus– spasms around muscle of wound, weakness in that leg
Neonatal tetanus

Both progress to generalised tetanus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Treatment?

A

Minimise light and any stimulus
1st Benzodiazepines , titrate IV benzos such as diazepam and lorazepam
2nd Chlorpromazine
3rd Vecuronium (neuromuscular blockade)

Then use human antitoxin can also use equine
Surgical debridement and metronidazole

Use really short acting beta blockers such as esmolol and morphine, clonidine and magnesium sulphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Complications of tetanus?

A

Bone fractures
Rhabdomyolysis
PE
Pressure sores
Muscle rigidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the vaccine?

A

Need full course of vaccination
You can Never get natural immunity to tetanus!
3 doses followed by 3 boosters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you prevent neonatal tetanus?

A

Clean delivery practice
Vaccinate women of reproductive age
In Jun-immunised pregnant women give them 2 doses of tetanus toxoid one month apart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is elimination of tetanus defined as?

A

Elimination defined as <1 NNT case per 1000 live births in every district per year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Is there any reduction in GCS during tetanus, if a patient is confused with muscular spasms is it tetanus?

A

No!
There is never a reduction in GCS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What causes nocturnal onset of chest discomfort, breathlessness, abdo pain or early morning paralysis?

A

Caused by Burngarus bites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the two main families of snakes?

A

Viperidae: Relatively short, thich body, short tail and strike like lightening
Elapidae: Relatively long thin body, long tail uniformly coloured

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the vector of African Tryp?

A

Glossina Spp.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the two species of African Tryp?

A

T.B. Gambiense is central and West Africa
T.B. Rhodesiense in East Africa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the main cause of African sleeping sickness?

A

Gambiense

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the most endemic Country of T B Gambiense?

A

DRC
Gabon
Congo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which country has both TB Gambiense and TB Rhodiense?

A

Uganda

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Compare clinical features of Rhodesiense with Gambiense

A

Rhodesiense has trypanosomal chancre ++, can be absent in Gambiense
Haemo-lymphatic stage in Gambiense is low grade fever, no neurological symptoms, typically Posterior Cervical lymphadenopathy
The Haemo-lymphatic stage in Rhodesiense is high fever, lymphadenopathy, rash on legs, multi-organ failure
Meningo-encephalitis stage is seen more in Gambiense compared to rhodesiense as rhodesiense is severe and therefore is diagnosed beforehand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is time between bite and onset of symptoms in rhodesiense?

A

10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is winterbottom sign?

A

Painless poster or Cervical lymphadenopathy in TB Gambiense

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is criteria for diagnosis of Meningo-encephalitis stage?

A

Presence of tryps in CSF
>5 Leukocytes
(presence of Mott cells)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How do you diagnose gambiense?

A

CATT (card agglutination test)
LFT

Then go on to do a blood film, lymph node aspiration and use centrifugation methods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Hat in the non endemic setting, who gets rhodesiense vs Gambiense?

A

Rhodesiense seen almost excludively in tourists from Tanzania, Malawi, Zambia
Mostly diagnosed by blood smear and most are in stage 1, diagnosed within 3 weeks of exposure

Gambiense mostly in migrants
DRC, Gabon and Angola
39% diagnosed by blood smear, 77% diagnosed in stage 2 and diagnostic delay 3-12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How do you treat Gambiense?

A

Fexinidazole for stage 1 and
2nd Stage: Fexinidazole

Except if advanced disease/presence of >100 WBC in CSF where NECT is preferred

Need f/u for 2 years and LP every 6 months if had 2nd Stage Gambiense

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How do you treat TB Rhodesiense?

A

First Stage: Suramin (risk of proteninuria, exfoliative dermatitis, Mazotti test if onchocerciasis)
Second Stage: Suramin and Melarsoprol (Very toxic causes polyneuropathy, hepatitis, haemolysis and encephalitis)

30
Q

What spreads Ebola?

A

Pteropodidae fruit bad

31
Q

How does Ebola spread? incubation time?

A

Contact with bodily fluids, not aersolised
Incubate 2-21 days

32
Q

How does Ebola present?

A

Fever
Bleeding
Bloody diarrhoea

33
Q

Dx of Ebola?

A

PCR

34
Q

Clinica stages of Ebola?

A

Dry followed by wet (diarrhoea, vomiting) and then stage 3 which is coma, hiccups, haemorrage and seizures

35
Q

Type of virus Marburg and main reservoir?

A

Filo virus

36
Q

Reservoir of lasa virus? Type of virus?

A

Mastomys natalensis
Arena virus

37
Q

Signs of lasa?

A

High fever, sore throat, vomiting, chest pain sensorineural hearing loss

38
Q

What does hanta virus cause in old world?

A

Causes haemorrhagic renal failure

39
Q

What does new world hanta virus cause?

A

Influenza like illness which causes rapidly progressing pulmonary disease

40
Q

How is CCHF transmitted?

A

Ticks are the main vectors
Associated with cattle slaughtering

41
Q

Clinical signs of scorpion sting? How does envenoming work?

A

Localised agonising pain
Ion channels block Na, K and Ca channels

Initial parasympathetic signs; vomiting, secretions, sweating, priaprism
Neurotoxic signs; fasiculations, tonic-colonic spasms

42
Q

Tx initially of scorpion sting?

A

Digital block of lidocaine or tetracaine
Need ICU tx

43
Q

Brown recluse spiders also known as? Clinical presentation?

A

Loxoceles spp
Initial discomfort, erythema
Develops blue/red/white sign
Becomes necrotic eschar

44
Q

What is a severe complication of loxoceles?

A

Fever, hemolytic Anaemia, jaundice and AKI
Only 4-19% will develop visceral complications

45
Q

What spiders cause Neurotoxic araneism?

A

Lactrodectus spiders (brown and black widow)
Latin American banana spiders (Phoneutria), and
Sydney/Australian funnel-web spiders (Atrax, Hadronyche)

46
Q

What symptoms do Neurotoxic spiders cause?

A

Local: immediate pain, sweating, gooseflesh/goose bumps
• Systemic: rapidly-evolving headache, nausea, vomiting, profuse
generalized sweating, fever, priapism, painful muscle spasms,
tremors, rigidity that may cause respiratory distress or simulate an
acute abdomen

47
Q

Types of fish poisoning?

A

Ciguatera
Scombroid
Tetrodotoxic

48
Q

Where is ciguatera fish poisoning and what is it?

A

Ciguatoxins caused by
Typically round tropical countries
Caused by psuedomonas bacteria

49
Q

What fish are ciguatoxic?

A

Grouper
Barracuda
Parrotfish
Moray eel
Trigger fish
red bass

50
Q

What are the clinical features of ciguatera toxin?

A

GI symptoms which become parastehsiae, paradoxical dysasthesia, pruritus, numbness and weakness

51
Q

What type of fish have scombroid poisoning?

A

Mackerel
Albacore
Yellow fin tuna
Bonito

52
Q

What are the immediate symptoms of scombroid?

A

Immediate peri-oral tingling
Histaminic anapylactic reaction
Case fatality is low
Urticaria like rash with throbbing headache, dizziness and syncope

53
Q

What does Pufferfish poisoning lead to?

A

Tetrodotoxic poisonings derviced from psuedomonas bacteria

54
Q

What does shellfish poisoning do?

A

Diarrheal is due to okadaic acid
Neurotoxic is due to brevetoxin
Paralytic is caused by tetrahydropurine
Domoic acid causes amnesia
Rapid onset parastehsiae, but no paralysis

55
Q

How do you treat marine poisoning?

A

Elimante gut contents
-ciguatera poisoning need IV mannitol and restore fluids
-Scombroid poisoning give adrenaline and histamine H1 and H2 receptor blockers

56
Q

What is important to note seafood toxins?

A

They are heat and acid resistant!
Prevent eating large tropical sea fish and eat only fresh fish to prevent scombroid poisoning

57
Q

Tx of amatoxin mushroom poisoning?

A

Silibinin
N-acetyl cysteine
High dose benzyl penicillin

58
Q

What are species of rabies and what predominates? What kind of virus is rabies?

A

Mainly type 1 rabies
Lyssa virus

59
Q

Where is most rabies worldwide?

A

India

60
Q

Two types of presentations in dogs?

A

Dumb (60%) and furious (40%)

61
Q

How long does rabies incubate for?

A

20-90 days
Can be years

62
Q

What is the clinica picture of rabies?

A

Earliest symptom is itching
Encephalomyelitis can be furious such as hydrophobic spasms, rapid deterioration into coma, die from cardiac and respiratory arrest
Paralytic ‘dumb’ rabies which is ascending flaccid paralysis. This has a longer survival

63
Q

How does Paralytic rabies present?

A

Prodromal fever, headache, parastehsiae at bite site
Pain, flaccid paralysis, Sensory abnormalities in limb.
No hydrophobia, excitation or convulsions.
Death from bulbar and resp paralysis or cardiac arrhythmias

64
Q

How do you diagnose rabies?

A

PCR of bodily fluids such as CSF, tears, skin biopsy.
Can immunofluorescence antigen seen in skin biopsy of hairy area
Autopsy/post-mortem needle autopsy

65
Q

What is post exposure prophylaxsis?

A

Throughourly clean the wound
Vaccine (x5) and RIG
0, 3, 7, 14 and 28 days is the vaccine regimen
Void suturing the wound
Abx and tetanus if required

66
Q

What are the categories of rabies post exposure

A

Cat 1: touching or being licked/intact skin
Cat 2: nibbles without breaking skin
Cat 3: Bites or scratches with breaking skin causing bleeding, contact of saliva with broken skin/mucous membranes and ANY contact with bats

67
Q

How do you manage CAT 1-3 when not vaccinated?

A

Cat 1- clean wound and no PEP
Cat 2- clean wound, Vaccinate immediately only give RIG if immunocompromised
Cat 3- clean wound, Vaccinate immediately and RIG

68
Q

What do you do with immunosuppressed patients for PEP?

A

Need 5 doses of vaccine irrespective of PREP
Need RIG for category 2 and 3 cases

69
Q

How else can you give PEP?

A

4 doses IM over 21-28 days OR give 3 or 2 dose mutli-site ID over 7 days

For those with PrEP either give 2 doses IM over 3 days or give mutli-site ID on 1 day

70
Q

When is it too late to give PEP?
Too late to give RIG?
When is it too late to give RIG after starting vaccine?

A

There is no time limit for giving PEP due to long incubation exposure
Too late to give RIG if exposure was more than 1 year ago
Do not give RIG >7 days after starting vaccination process and do not give RIG to immunocompetent people with PrEP

GORGAS (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions