Trauma Flashcards
(128 cards)
1
Q
Signs of tension pneumothorax and Mx?
A
Respiratory distress, raised JVP with low BP, hyper resonant
Mx = large bore cannula 2ICS MCL
2
Q
NEXUS criteria for clearing C-spine?
A
Fully alert No abnormal neurology No head injury / neck pain no drugs / alcohol No distracting injury
3
Q
Massive transfusion - definition, Mx, criteria for end points?
A
Transfusion of whole blood volume within 24 hours
CRASH study = tranexamic acid
Ratio of 1:1:1 for FFP, platelets and RBC
Therapeutic endpoints: Hb 8-10 Platelets >100 INR < 1.5 Ca > 1 pH normal range
4
Q
Thorax trauma:
Reduced BP, reduced chest expansion and breath sound on one side.
Stony dull to percuss
Cause, Mx?
A
Massive haemothorax
> 1.5L of blood in chest
Large bore chest drain ± thoracotomy
5
Q
Thorax trauma:
Reduced sats, abnormal chest movements, crushing injury to chest
Cause, Ix, Mx?
A
Flail chest = anterior/lateral #’s of >2 adjacent ribs in > 2 places
Also will have pulmonary contusion
CXR + serial ABGS
Mx: Analgesia and oxygen
6
Q
Thorax trauma:
Patient on mechanical ventilation
SOB, dropping BP ad JVP raised
Cause, Mx?
A
Tension pneumothorax
Large bore cannula, 2ICS, MCL
7
Q
Thorax trauma:
CXR shows 2cm pneumothorax - Mx?
A
Aspirate anything > 2cm or symptomatic
8
Q
Thorax trauma:
Patient in shock, muffled heart sounds.
JVP raised
Name of this triad, cause, Mx?
A
Becks triad
Cardiac tamponade
Pericardiocentesis = spinal needle in R subxiphoid space aiming for R tip of left scapula
9
Q
Thorax trauma:
What symptoms might you see in blunt cardiac injury?
A
Can mimic MI
Also see arrhythmias, hypotension
10
Q
Thorax trauma:
Deceleration injury, persistent hypotension
Likely cause, Ix, Mx?
A
Aortic disruption
Most die at scene
CXR = widened mediastinum and depression of L amino bronchus Diagnosis = CT angio
Mx = surgical repair
11
Q
Thorax trauma:
CXR shows small bowel loops in lower semi-diaphragm?
A
Diaphragmatic rupture
Mx = surgical repair
12
Q
Investigations for abdominal trauma?
A
Normotensive:
- USS to identify free fluid. But operator dependant and can miss retroperitoneal stuff
- CT abdo - most specific for identifying visceral injury, but time consuming and need contrast
- Hypotensive = diagnostic lavage to identify bleed. VERY sensitive but very invasive
13
Q
Abdominal trauma:
Urine dip shows haematuria
Cause?
A
Kidney injury
14
Q
Abdominal trauma:
Indications for laparotomy
A
Persistent unexplained hypotension Peritonitic Gunshot wound Evisceration Radiological evidence of free gas or diaphragmatic rupture
15
Q
Abdominal trauma:
Liver trauma?
A
Suture lacération / partial hepatectomy
16
Q
Abdominal trauma:
Bowel trauma?
A
Resection
17
Q
Abdominal trauma:
Bladder trauma?
A
Intraperitoenal = laparoscopic repair and urethral and suprapubic drainage
Retroperitoneal = conservative with urethral drainage
18
Q
Abdominal trauma:
what is Kehrs sign?
A
Shoulder tip pain, if on left side = ruptured spleen
19
Q
Abdominal trauma:
Splenic tear classification?
A
1 = capsular tear 2 = + parenchymal damage 3 = tear up to hilum 4 = complete rupture
20
Q
Abdominal trauma:
Splenic injury - when to Mx conservatively, preservative surgery and splenectomy?
A
conservatively = small sub-capsular haematoma, minor bleeding, no hilar involvement
Laparoscopic and conservation:
Increased intra-abdominal bleed
Moderate haemodynamic compromise
Tear / laceration affecting > 50%
Splenectomy:
Hilar involvement, major haemorrhage, major associated injury
21
Q
What is the Monroe-Kelly doctrine?
A
Cranium is a box, contents must remain for ICP to remain. the same
If volume goes up somewhere, must go down elsewhere
22
Q
Extra dural - where is the bleed, common artery (+nerve) affected + features?
A
Between dura mater and skull
Middle meningeal artery
Auriculotemporal nerve closely related to middle meningeal = supplies external ear and outermost tympanic membrane
Raised ICP, Lucid interval
23
Q
Subdural - layer affected and lobes commonly affected, RF’s and onset?
A
Innermost meningeal layer
Parietal and frontal
Risk factors = old age and alcoholism
Slow onset
24
Q
SAH - What is it, PC?
A
Spontaneous ruptured cerebral aneurysm
Sudden onset, severe headache
25
Basal skull # - common features?
CSF rhinorrhoea and otorrhoea
Battle sign = mastoid busing
Panda sign = bilateral orbital bruising
26
Intraventricular haemorrhage - who gets it, Mx?
Spontaneously In neonates
Mx conservative unless raised ICP/hydrocephalus = shunt
27
Criteria for performing a CT?
```
GCS <13
GCS <15 2 hours after injury
Open or depressed skull #
>1 episode of vomiting
Focal neurology
Any signs of basal skull #
Post-traumatic seizure
```
28
When to contact neurosurgeon in head injury?
```
GCS persistently <8
Ongoing worsening confusion > 4 hours
Progressive neurology
CSF rhinorrhoea
Reducing GCS post-admission
```
29
When do we need to be measuring ICP?
GCS 3-8 with abnormal CT = mandatory
| GCS 3-8 with normal CT = appropriate
30
Minimum cerebral perfusion In adults?
70mmHg
31
What is bushings reflex and what does it mean?
Bradycardia, HTN + irregular breathing
Means imminent herniation
32
Pupillary finings In head injury:
1. Unilaterally dilated, sluggish
2. Bilaterally dilated, sluggish
3. Marcus Gunn
4. Bilat constricted
1. 3rd nerve palsy (down and out), secondary to tectorial herniation
Mx = temporal-parietal craniotomy on ipsilateral side
2. Bilateral 3rd nerve, OR reduced CNS perfusion
3. When swing light from normal to affected eye, it does not constrict as well = APPARENT dilation
Due to a defect inn the afferent pathway
So light in the normal eye still constricts both okay
Cause = Optic nerve lesion or severe retinal disease
4. Opiates or pontine lesion
33
Criteria for paediatric head CT?
LOC or amnesia > 5 mins
>3 episodes of vomiting
Focal neurology / abnormal confusion + drowsiness
Suspected NAI or traumatic cause e.g. RTA
GCS <14, or if under 1 <15
Signs of basal skull #, or depressed / open #
If < 1 any bruise, swelling or laceration >5cm
34
Stroke Oxford classification - TACS?
Region involved
Symptoms
what else can it cause
Highest mortality
Region involving carotid / MCA and ACA
All 3 of: Contralateral motor / sensory deficit, contralateral homonymous hemianopia + higher dysfunction
Can get cerebral oedema = raised ICP. Will need neurosurgical review for ? hemi-craniectomy
Indications - <60, MCA territory, reduced consciousness + >50% infarct territory
35
Stroke Oxford classification - PACS?
2/3 of TACS ones
Usually higher dysfunction and motor/sensory loss
36
Stroke Oxford classification - Posteiror circulation storke?
Area affected
Symptoms
Vertebrobasillar territory
```
Any of:
Cerebellar syndrome
Brainstem syndrome
LOC
Contralateral homonymous hemianopia
```
37
Stroke Oxford classification - Lacunar strokes?
Where are the infarcts?
What infarct location corresponds to which symptoms
Small infarcts around basal ganglia, internal capsule, thalamus and pons
Pure motor = posteiror internal capsule
Pure sensory = Thalamus
Mixed = internal capsule
Ataxic hemiparesis = Anterior limb of internal capsule
38
Stroke dysphasia - which region is it always?
MCA
39
Stroke dysphasia Brocas vs Wernickes?
Wernickes is receptive
- Speak fluently, but doesn't make sense and word substitution / new words
superior frontal gyrus
Brocas is expressive
Can understand, but have halted laboured speech
40
ACA vs MCA motor and sensory signs?
ACA = Legs > arms, face spared
MCA = arms and face > legs
41
```
Brainstem infarcts:
Paresis
Gaze palsies
Facial weakness (LMN)
Vertigo and nystagmus
Dysphagia and dysarthria
```
```
Paresis = Corticospinal tract
Gaze palsies = CN6
Facial weakness (LMN) = CN7
Vertigo and nystagmus = CN8
Dysphagia and dysarthria = CN9/10
```
42
Lateral medullary syndrome / Wallenbergs - area affected and symptoms?
PICA or vertebral artery = lateral medulla
```
A-HAND
Ataxia
Horners
Anaesthesia:
Ipsilateral face pain and heat loss
Contralateral in body
Nystagmus + vertigo
Dysphagia
```
43
Webers syndrome - area affected and signs?
Branches of posterior cerebral artery to midbrain
Ipsilateral CN3 + contralateral hemiparesis
44
Millard-Gubler syndrome:
Where is the infarct
Symptoms?
```
Pons infarct
C6+7 and corticospinal tracts affected
- Diplopia
- LMN facial palsy
- loss of corneal reflex
- Contralateral hemiplegia
```
45
Locked in syndrome - Causes, clinical picture?
Vental pons infarct = Basilar artery, central pontine demyelinosis
Patient is aware and cognitively intact but completely paralysed except from upwards gaze and upper eyelids
These are preserved as midbrain tectum is spared
46
Cerebellopontine angle syndrome - causes, symptoms?
Acoustic neuroma, mets, meningioma, cerebellar astrocytoma
Cerebellar signs + CN5/6/7/8
= absent corneal reflex, gaze palsies, LMN facial, hearing problems + DANISH
47
Le Fort # - grade 1?
starts at nasal septum, extending to pyriform rim
Travels horizontally across apices of teeth, and crosses BELOW the zygomaticofacial junction
Traverses the pterygomaxillary junction
48
Le Fort # - Grade 2 + symptoms?
From nasal bridge not septum this time, extends through the frontal process of maxilla
Travels inferolaterally involving the lacrimal does and is near the inferior orbital fissure
Travels under the zygoma, across the pterygomaxillary fissure and through pterygoid plates
```
Features:
Infraorbital paraesthesia
Palatal mobility
Malocclusion of teeth
If severe = enophthalmos
```
49
Le Fort # - grade 3 + classical features
Dish pan / flattened face
Starts at nasofrontal junction, extends posteriorly along medial orbit wall and through ethmoid bones
(Thicker sphenoid bones prevent fracture into orbital canal)
Fracture continues along floor of orbit, through inferior orbital fissure + through lateral orbital wall
Then through zygomatic arch
50
Superior orbital fissure syndrome?
Severe force to lateral wall = compression of neurovascular
Features:
complete ophthalmoplegia and ptosis = CN3,4,6 and nerve to levator palpebrae superioris
RAPD
Dilation of pupil and loss of accommodation + corneal reflex
Altered sensation
51
Orbital blow out?
Bone fragment displaced downwards, attached to periosteum still though
Periorbital fat may herniate through defect = interfere with oblique and inferior rectus = Diplopia on upwards gaze
Mx = orbital floor reconstruction
52
In nasal fracture what does CNS rhinorrhoea imply?
Cribiform plate has been breached = need antibiotics
53
Retrobulbar haemorrhage - symptoms + Mx?
4 P's and a V
Proptosis, pain, pupil reaction loss, paralysis
Vision loss - colour first
Mx = osmotic diuretic, steroids, acetazolamide
Likely need cantholysis prior to definitive surgery
54
Pathology of burns?
Haemolysis - due to damage of erythrocytes
Loss of capillary membrane = plasma leakage into interstitial space
Oedema = Due to Protein loss
Shock = due to Extravasation of fluids up to 48 h after
55
Pathology of burns healing?
Superficial = keratinocytes form new layer over bur site = epithelial migration
Deep burns = Dermal scarring
- need keratinocytes from skin graft to provide optimal coverage
56
Burns classification - Superficial?
Just epidermis
Erythema and painful e.g. sunburn
Blanching
57
Burns classification - Partial thickness?
Epidermis and part of papillary dermis
Dry white skin, blanching
If deep = loss of dermis too, but adnexae remain = very painful
Usually nil surgical Mx
58
Burns classification - Deep partial thickness?
Epidermis and whole papillary dermis
Mottled red, non-blanching
needs surgical Mx usually
59
Burns classification - full thickness?
Complete loss of dermis, and subcut. tissue affected
Charry waxed, leathery skin
non-blanching
Heals from the edge in = scar
Management in burns centre
60
Complications of burns - early, intermediate and late?
Early = infection, shock, compartment syndrome, curling ulcers in kids, metabolic disturbances
Intermediate = Pressure sores, oedema, VTE
Late = Scarring, contractures and psych
61
Mapping out burns %?
What to use in kids?
```
Wallace rule of 9's:
Head and neck = 9%
Each arm = 9%
Back and front torso 18% EACH
Each leg = 18%
Perineum and palm = 1% each
```
In kids use a Lund Browder chart
62
Management of burns?
A - consider early intubation
B - 100% 02
- watch out for signs of carbon monoxide poisoning:
Headache, nausea, cherry red appearance
C - massive fluid losses
Parkland formula = 4 x weight x % burns
= ml of Hartman's in first 24 hours. Give half of this within 8 hours
Referral to burns centre if needed
63
When do we refer to a burns centre?
```
Any deep dermal / full thickness
Adults >10%, kids >5%
Any burns to face or perineum
Inhalation injury
Electrical / chemical / NAI
```
64
When do we use escharotomies In burns?
If full thickness circumferential burns to torso / limbs
Aim is to either help ventilation, or relieve compartment syndrome
65
What is ARDS?
Increased permeability of alveolar capillaries, leading to fluid accumulation in alveoli
Non-cardiogenic pulmonary oedema
66
What happens to surfactant and elastase in ARDS?
Reduced surfactant
Increased elastase from neutrophils
67
Criteria for ARDS?
3 of:
Onset with 1 week, on background of pneumonia
Bilateral opacities on CXR
Pa02:Fi02 < 200 (basically low sats despite oxygen)
Pulmonary oedema excluded. = clinically or CVP < 18mmHg
68
2 stages of ARDS?
Early = exudative phase, oedema
Late = reparative fibroproliferative stage ± scarring
69
causes of ARDS?
```
Sepsis (chest infection commonest)
DIC
Massive blood transfusion
Burns / trauma / inhalation injury
Aspiration
Pancreatitis
```
70
ARDS - clinical features and Mx?
Dyspnoea and hypoxic
RR raised
Bilateral crackles
CXR = bilateral infiltrate
```
Mx:
ITU - mortality 40%
Ventilation, PEEP 5-10mmHg, low tidal volume
Inotropes
Treat cause
```
71
What is compartment syndrome?
Raised pressure within. closed anatomical compartment
| Often following a fracture
72
What are the classical injuries leading to compartment syndrome?
Supracondylar and tibial shaft #'s
73
Clinical features and diagnosis of compartment syndrome?
Pain, paraesthsia, pallor and paralysis
Arterial pulsate felt
Dx = compartment pressure > 40mmHg
> 20 is abnormal
74
Compartment syndrome Mx?
Prompt and extensive fasciotomies
Lower limb deep muscle - small incisions will not suffice
Post-fasciotomy = myoglobinuria > renal failure
= need aggressive IV fluids
If notable necrosis already = amputate
75
Hypothermia stages?
1 / mild = 35-32
Shivering, tachycardia, vasoconstricted
Stage 2 / moderate = 32-28
Not shivering, J-waves on ECG, hypotensive, bradycardia, dysrhythmias
Reduced GCS and reflexes
Stage 3 / severe = 28-20
Unconscious, not shivering.
Cardiogenic shock, oliguria, coagulopathy, apnoea, no-reactive pupils
Stage 4/ severe = <20
No vital signs
76
Hypothermia Mx?
Mild = rewarm with external devices
>moderate = warmed intraperitoneal fluid / haemodialysis
Slowly rewarm. 0.5 degrees / hour
77
what is shock?
Insufficient output to meet tissue perfusion needs
78
Sepsis and septic shock definitions?
Sepsis = life threatening organ dysfunction, due to host dysregulated response to infection
Septic shock = persisting hypotension requiring vasopressors to maintain MAP 65mmHg, and serum lactate >2 despite adequate fluid resuscitation
79
SVR and CO in sepsis?
SVR decreased
| CO normal / raised
80
categories of the SOFA score?
```
Lungs = Pa02:Fi02
coag = platelets
Liver = bilirubin
neuro = GCS
CVS = MAP
Kidneys = Creatinine
```
> 2 = 10% mortality in hopsital
81
Resuscitation goals in sepsis?
```
CVP 8-12
UO > 0.5ml/kg/hour
SVC sats >70%
MAP > 65mmHg
Lactate normal
```
82
SVR and CO in haemorrhage shock?
How does it affect urine specific gravity?
SVR increased, CO low
Increased
83
What is cardiac index?
numerical value for the tissue oxygen delivery
CO divided by total body surface area
84
neurogenic shock - cause, SVR and CO, Mx?
Spinal cord transection, usually high
Causes decreased sympathetic / increased parasympathetic. = decreased peripheral vascular tone = LOW SVR
Because of this you have reduced pre-load > Low CO
Mx unlike most shock is with peripheral vasoconstrictors to return normal vascular tone
85
Mian causes of cardiogenic shock?
IHD
If trauma - blunt trauma usually affects right side of heart = needs surgery
86
Doses used in anaphylaxis - adrenaline, hydrocortisone then chlorphenamine
<6 months = 0.15mg/ml of 1/1000, 25, 250mcg/kg
6 months - 6 years = 0.15mg, 50mg, 2.5mg
6-12 years = 0.3mg, 100mg, 5mg
>12 years = 0.5mg, 200mg, 10mg
87
How can the arterial trace against the ventilation phase be useful?
If systolic pressure varies with intrathoracic pressure = need more IV fluids
88
Where does CVP sit, what does it measure.
| If adequate fluid volume what happens with a fluid challenge?
Sits in SVC, via IJV
Measures right atrial filling pressure
Adequate intra-vascular volume, fluid challenge should raise CVP by 6-8mmHg for a prolonged period
89
How do you monitor cardiac output?
How does it work?
What else can it measure?
Swan Ganz catheter
Demonstrates left atrial pressure , via inflations of ball distally = PAOP
```
Can calculate:
Stroke volume
SVR
Pulmonary artery resistance
Oxygen delivery and consumption
```
90
Inotropes: Receptor affecting and action?
1. Noradrenaline
2. Adrenaline
3. Dopamine
4. Dobutamine
5. Milrinone
1. Alpha agonist
Vasopressor, minimal effect on CO
2. Alpha and B
Increases CO and PVR
3. B1 = contractility and rate
4. B1 and B2 = Increase cardiac output and decrease SVR
5. Phosphodiesterase inhibitor
Elevates cAMP levels = increases muscle contractility
Vasodilator
91
Staphylococcus aureus:
Key features
What exo vs enterotoxins cause
How are they resistant to penicillins
Anaerobe, G+ve
Haemolysis on blood agar
Catalase +ve
```
Exotoxins = Toxi shock syndrome
Enterotoxins = Gastroenteritis
```
Mec operon
92
Streptococcus pyogenes:
Key features
what proteins it releases
G+ve, chain like colonies
Group A strep
Beta haemolysis on blood agar
Catalase negative
Proteins released = hyaluronidase and streptokinase = rapid tissue destruction
93
E. coli:
Key features
3 types and what they cause
G-ve rod, anaerobe, non spore-forming
1. Enterotoxic = large volumes of fluid into the gut via cAMP
Small intestine affected, travellers diarrhoea
2. Enteroinvasive = dysentry, large bowel necrosis and ulcers
3. Enterohaemorrhagic = 0157
HUS, TTP + haemorrhage colitis
94
Campylobacter jejuni:
Key features
PC
Mx?
curved G-ve, non spore forming
Diffuse and bloody enteritis
RIF + bloody diarrhoea
Self limiting = no Abx
95
H. Pylori:
Key features
Gene for duodenal ulcers
How it neutralises acid
G-ve, helical rod.
Microaerophilic
Flagellated and mobile
If carry Cag A gene = duodenal ulcers
Secretes urease = breaks down gastric urea to CO2 and ammonia > Ammonium > bicarb = neutralises acid
96
Whats streptococcus bovis associated with?
Bowel cancer and infective endocarditis
97
Gastroenteritis:
| Staph aureus?
no fever or abdo pain
Severe vomiting
Incubation = 6 hours
98
Gastroenteritis:
| B. Cereus
Vomiting first, then diarrhoea
| NO FEVER
99
Gastroenteritis:
Salmonella
How does typhoid fever present?
nausea, vomiting and fever
Relative bradycardia
Typhoid = constipation, splenomegaly and rose spots
Typhoid needs ceftriaxone
100
Gastroenteritis:
| E Coli
Watery stools and cramps
| No fever
101
Gastroenteritis:
| Listeria - key features and PC
B-hameolyticc, aesculin +ve with tumbling motility
Fever
Watery diarrhoea, cramps and headaches
Little vomiting
102
Gastroenteritis:
| Shigella
Kids at nursery
Watery diarrhoea > Bloody mucoid
Vomiting + abdo pain
Fever
103
Gastroenteritis:
Campylobacter
Resevoir and complications?
Severe RIF abdo pain
Bloody diarrhoea
Birds are a recognised resevoir
Complications = GBS
104
Gastroenteritis:
Giardiasis
Key features and PC
Pear shaped trophozoite, Africa / Eastern Europe
Resistant to chlorination = swimming pools
Prolonged steatorrhoea
Flatulence and cramps
NO FEVER
105
Gastroenteritis:
| Amoebiasis
Mobile trophozoite, Flask shape ulcers
Gradual onset bloody diarrhoea, abdo pain
Can last for weeks
106
```
C. diff:
Associated Abx
PC
severe progression?
Mx
```
Cephalosporin, ciprofloxacin, also co-amoxiclav and tazocin
Mild diarrhoea
Pseudomembranous colitis = severe systemic features such as dehydration and fever
Abdo pain, bloody mucoid diarrhoea
Can even. become paralytic ileus
Mx = Metro then vancomycin
If toxic megacolon, raised LDH or clinically worsening = colectomy
107
GI parasitic infections:
| Threadworm - parasite name, PC, Dx and Mx?
Enterobius vermicularis
Pruritus ani
Dx = scotch tape at anus over night
Mx = mebendazole
108
GI parasitic infections:
| Hookworm - parasite name, life cycle, PC, Dx and Mx?
Ancylostoma duodenale
- hookworm that attaches to proximal small bowel
Skin penetration > lungs > coughed up > swallowed
Most asymptomatic, although can cause iron deficiency
Larvae can be seen in stool left at ambient temperature... although hard to diagnose
Mx = mebendazole
109
GI parasitic infections:
| Strongyloidiasis - parasite name, life cycle, PC, Dx and Mx?
Strongyloidiasis stercoralis
nematode living in duodenum
Skin penetration > lungs > coughed up > swallowed
Asymptomatic generally
```
Dx = stool microscopy
Mx = mebendazole
```
110
GI parasitic infections:
| Roundnworm - parasite name, life cycle, PC, Dx and Mx?
Ascariasis lumbricoides
begins in gut + penetrates duodenal wall > lungs > coughed up > swallowed
Dx = identify worms / eggs in faeces
Mx = mebendazole
111
```
Hepatitis A:
Type of virus
Course
PC
Immunisation?
```
RNA virus
Benign self limiting course
Faeco-oral transmission
Prodromal flu like features, then jaundice and hepatomegaly
Immunisation available
112
Hep A long term marker in blood following infection?
IgG
113
Hepatitis LFT pattern?
ALT>AST
AST:ALT <2
114
```
Hepatitis B:
Type of virus
Course
PC
Mx
```
Double strand DNA virus
Can be acute or chronic
PC = Fever, jaundice and hepatomegaly
Mx = antivirals e.g. tenofovir
115
Hepatitis B - complications?
10% get chronic infection
5% get cirrhosis
Hepatocellular carcinoma
Fulminant disease
116
Hepatitis B - Vaccine course and PEP?
HbsAg - given over three doses
>100 = adequate
10-100 = suboptimal = 1 further dose
<10 = check for previous infection /. current infection
PEP:
If know responder give booster
Known non-responder = vaccine course and HBIG
current course ongoing = accelerate and HBIG
117
Hepatitis B - serology?
Surface antigen appears first (HBsAg) = Anti-HBs production
HbsAg = acute infection
HbeAg results from breakdown of core antigen, seen in early infection only = HIGHLY INFECTIVE
Anti-HBc =. previous or current infection
- IgM is only in acute infection
- IgG persists
Anti-Hbs = immunity (from exposure or vaccine). -ve in chronic disease
118
Hep B + C transmission?
Bodily fluids, vertical transmission too
| Breastfeeding ok
119
Hep C - Virus type, P, complications and Mx?
RNA flavivirus
PC = most asymptomatic
30% get jaundice, arthralgia and fatigue
- Complications 60-80% get chronic disease. = cirrhosis and rheumatological manifestations
- IFN. related depression
- Hepatocellular carcinoma
Mx = Protease inhibitor e.g. ribavirin + IFN alpha
120
Hep C - treatment SE's?
Ribavirin = haemolytic anaemia + cough
IFN-alpha = depression, flu-like symptoms, leucopenia, thrombocytopaenia
121
Hepatitis D - type of virus, what it needs to replicate, two types and Mx?
Single stranded RNA virus
needs Hep B surface antigen to replicate
1. co-infection = get the at the same time
2. Superinfection = Get D whilst already have hep B = big risk of cirrhosis, chronic disease and fulminant disease
122
Liver flukes / Fasciola hepatica - Classic resevoir, two phases, Ix and Mx?
Water cress
1 = immature worm penetrates gut:
- Fever, nausea
- severe. abdominal pain
- Hepatomegaly
- Rash
2 = Worm matures in bile duct
- Jaundice
- intermittent pain
- anaemia
Ix = hyper echoic on USS within middle dilated bile ducts
Mx = Triclabendazole
123
What bacteria might you see in severe peritoneal infections, pungent pus
Bacteroides fragilis
124
An example of alpha haemolytic strep?
| What it causes?
Strep pneumoniae
| Pneumonia, meningitis and otitis media
125
Example of Beta haemolytic strep group A and what it causes
Strep pyogenes = impetigo, cellulitis, type 2 nec fac, tonsillitis / pharyngitis
Immune reaction can cause post-strep glomerulonephritis
126
Example of Group B, beta haemolytic strep?
Agalacticae = neonatal meningitis + septicaemia
127
Which bug. colonises plastic implants and forms a biofilm?
Staph epidermidis
128
MRSA screen. - who and where, what happens if positive?
All elective and emergency admissions
Nose and skin swabs
Nose +ve = Mupirocin 2% TDS for 5 days
Skin +ve = chlorhexidine solution OD for 5 days
