14. Infection Formative Flashcards

1
Q

What is the most likely cause of an outbreak of nausea and vomiting on a cruise ship?

A
Adenovirus
Enterovirus
Epstein Barr virus
Norovirus
Rotavirus
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2
Q

What is the most likely cause of an outbreak of nausea and vomiting on a cruise ship?

(answers explained)

A

Adenovirus- again more common in babies

Enterovirus- GI bug doesn’t cause diarrhoea

Epstein Barr virus- kissing disease doesn’t cause diorrhea

Norovirus- correct answer, common cause of outbreaks

Rotavirus- common in children under 5, common in winter

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3
Q

What is the commonest cause of travellers diarrhoea?

A
Campylobacter
Cryptosporidium
E Coli 0157
Enterotoxigenic E. coli
Giardia
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4
Q

What is the commonest cause of travellers diarrhoea?

why is each answer that answer

A

Campylobacter- most common foodborne diarrhoeal pathogen

Cryptosporidium- parasite that cuases watery diorrhea, not common

E Coli 0157- frequent bloody stools, characterised by renal failure, haemolytic anaemia, thrombocytopenia

Enterotoxigenic E. coli- correct answer, traveller’s diarrhoea

Giardia-microscopic parasite that causes diarrhoea, not as common

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5
Q

A 22 year old man presents to A&E with a rash which extends in patches over his chest, abdomen and legs. It develops over 6 hours. He is hypotensive (80/50) and pyrexial

What is your next course of action

A
Call for senior help
Get fast IV fluids
IV high dose cephalosporin
Blood cultures
All of the above- correct answer

qSOFA criteria- RR>22, BP<100, altered mental status. 2 or more oh no

Sepsis 6 (give fluids, antibiotics oxygen)
Take- blood cultures, urine lactate, urine output
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6
Q

A 22 year old man presents to A&E with a rash which extends in patches over his chest, abdomen and legs. It develops over 6 hours. He is hypotensive (80/50) and pyrexial

What is your next course of action

A
Call for senior help
Get fast IV fluids
IV high dose cephalosporin
Blood cultures
All of the above
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7
Q

A 22 year old man presents to A&E with a rash which extends in patches over his chest, abdomen and legs. It develops over 6 hours. He is hypotensive (80/50) and pyrexial

What is your next course of action

(Answers explained)

A
Call for senior help
Get fast IV fluids
IV high dose cephalosporin
Blood cultures
All of the above- correct answer

qSOFA criteria- RR>22, BP<100, altered mental status. 2 or more oh no

Sepsis 6 (give fluids, antibiotics oxygen)
Take- blood cultures, urine lactate, urine output
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8
Q

A 22 year old man presents to A&E with a rash which extends in patches over his chest, abdomen and legs. It develops over 6 hours. He is hypotensive (80/50) and pyrexial

What should his family be given?

A
Amoxicillin or chloramphenicol
Rifampicin or Ciprofloxacin
Chloramphicol or Cefalexin
Cefalexin or Trimethoprim
None of the above
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9
Q

A 22 year old man presents to A&E with a rash which extends in patches over his chest, abdomen and legs. It develops over 6 hours. He is hypotensive (80/50) and pyrexial

What should his family be given?
(answer explained) (ask the boy or tutor)

A
Amoxicillin or chloramphenicol
Rifampicin or Ciprofloxacin- correct answer, antibiotic prophylaxis for sepsis
Chloramphicol or Cefalexin
Cefalexin or Trimethoprim
None of the above
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10
Q

A 22 year old man presents to A&E with a rash which extends in patches over his chest, abdomen and legs. It develops over 6 hours. He is hypotensive (80/50) and pyrexial

Four days later he becomes hypotensive and is noted to have low sodium and high potassium. What is the most likely cause?

A
Too little saline in his fluid regime
Syndrome of inappropriate ADH
Adrenal insufficiency
Renal failure
Antibiotic associated diarrhoea
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11
Q

A 22 year old man presents to A&E with a rash which extends in patches over his chest, abdomen and legs. It develops over 6 hours. He is hypotensive (80/50) and pyrexial

Four days later he becomes hypotensive and is noted to have low sodium and high potassium. What is the most likely cause?

A
Too little saline in his fluid regime
Syndrome of inappropriate ADH
Adrenal insufficiency
Renal failure- correct answer, tissues are unable to be perfused so due to septic shock kidneys fail
Antibiotic associated diarrhoea
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12
Q

What component of Neisseria Meningitidis causes septic shock?

A
Capsule
Fimbriae
Lipo-polysaccharide
Peptidoglycan
Superantigens
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13
Q

What component of Neisseria Meningitidis causes septic shock?

Answer explained

A

Capsule

Fimbriae

Lipo-polysaccharide- also known as endotoxins, activate over 20% of the bodies T cells leading to septic shock

Peptidoglycan

Superantigens

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14
Q

A 30 year old IV drug user is admitted with jaundice

HBV surface antigen -ve
HBV core antibody -ve
HBV surface antibody +ve
HAV IgM antibody +ve

Which of the following is true?

A

He has acute hepatitis B infection
He has acute hepatitis A infection
He has previously had hepatitis B infection
He has not been immunised against hepatitis B

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15
Q

A 30 year old IV drug user is admitted with jaundice

HBV surface antigen -ve
HBV core antibody -ve
HBV surface antibody +ve
HAV IgM antibody +ve

Which of the following is true? (answer explained)

A

He has acute hepatitis B infection

He has acute hepatitis A infection- correct answer

He has previously had hepatitis B infection

He has not been immunised against hepatitis B

To understand we must look at what marker is indicative of

HBV surface antigen (sAg)- indicatess current hep B infection

HBV core antibody (anti-HBc or HBcAb) - indicates past or current hep B infection

HBV surface antibody (anti-HBs)- immune to hep B

HAV IgM antibody- indicates current HIV infection

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16
Q

For which of the following infections is there no vaccine?

A
Hep A
Hep C
Polio
Typhoid
Yellow fever
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17
Q

For which of the following infections is there no vaccine?

answer explained

A
Hep A
Hep C- no current vaccine (just need to know)
Polio
Typhoid
Yellow fever
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18
Q

Which of the following is true of active immunisation?

A

Always contains a live organism
Contains immunoglobulin
Gives immediate protection against infection
Stimulates the host immune response

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19
Q

Which of the following is true of active immunisation?

answer explained

A

Always contains a live organism
Contains immunoglobulin
Gives immediate protection against infection
Stimulates the host immune response- correct answer

Active vaccine stimulates the host response by exposing them to different pathogens whether they be live or recombinant

20
Q

A 28 year old man presents with a 3 week history of swallowing difficulties. He has white plaques on the roof of his mouth and down his throat

What is the most likely organism to cause this appearance?

A
Epstein- barr virus
Human immunodeficiency virus
Herpes Zoster virus
Candida albicans- 
Group A streptococcus
21
Q

A 28 year old man presents with a 3 week history of swallowing difficulties. He has white plaques on the roof of his mouth and down his throat

He is found to be HIV positive, the candida is treated with fluconazole. His further treatment should be

A

Beetroot
Immunise with BCG as he has a great risk of developing TB
Commence at least three antivirals
Wait until he has aids and then give antivirals
Immunotherapy with an HIV vaccine

22
Q

A 28 year old man presents with a 3 week history of swallowing difficulties. He has white plaques on the roof of his mouth and down his throat

He is found to be HIV positive, the candida is treated with fluconazole. His further treatment should be

Answer explained

A

Beetroot
Immunise with BCG as he has a great risk of developing TB
Commence at least three antivirals- correct answer
Wait until he has aids and then give antivirals
Immunotherapy with an HIV vaccine

23
Q

When taking blood from a man who is HIV positive you stab yourself with a needle. What do you do?

A

Phone the on-call occupational health doctor
Call the registrar
Wash the wound and encourage bleeding
Phone my mbchb office

24
Q

When taking blood from a man who is HIV positive you stab yourself with a needle. What do you do?

Answer explained

A

Phone the on-call occupational health doctor
Call the registrar
Wash the wound and encourage bleeding
Phone my mbchb office

25
Q

When taking blood from a man who is HIV positive you stab yourself with a needle. What do you do?

Answer explained

A

Phone the on-call occupational health doctor
Call the registrar
Wash the wound and encourage bleeding
Phone my mbchb office

26
Q

What infection has the highest risk of BBV transmission?

A

HIV risk is the highest
Hep C
Hep B

27
Q

What infection has the highest risk of BBV transmission?

Unsure ask the boys/tutor)

A

HIV risk is the highest
Hep C
Hep B

28
Q

What is the commonest cause of bacterial infective diorrhoea in Britain?

A

Salmonella
E.coli 0157
Camplyobacter
Entamoeba histolytics

29
Q

What is the commonest cause of bacterial infective diarrhoea in Britain?

(answers explained)

A

Salmonella
E.coli 0157
Camplyobacter- jus tis, learn it
Entamoeba histolytics

30
Q

a 27 year old woman presents with a history of a 6 week dry cough, weight loss and fevers. 3 months after returning from working in a bolivian orphanage

What is the most liekly diagnosis?

Answer explained

A

Pulmonary TB

31
Q

How do you confirm a diagnosis for TB

Answer explained

A

Ziehl Neelson (ZN) stain/ Auramine stain

32
Q

How do you treat someone with TB?

A

Rifampicin- 4 for two months then 2 for four months
Isoniazid- 4 for two months then 2 for four months
Pyrazinamide 4 for two months
Ethambutol 4 for two months

33
Q

50 y/o male returns from Spain, smoker. cough 2 weeks, dyspnoea, sputum, diarrhoea

HR 120, BP100/50, RR30 T-38.5
Cyanosed
Dehydrated
Bilateral basal consolidation
WCC-15, Na 115, ALT 300, CRP 300

What is the most likely causative organism?

A
Influenza A
E. coli
Strep pneumoniae
Mycoplasma
Legionella
34
Q

50 y/o male returns from Spain, smoker. cough 2 weeks, dyspnoea, sputum, diarrhoea

HR 120, BP100/50, RR30 T-38.5
Cyanosed
Dehydrated
Bilateral basal consolidation
WCC-15, Na 115, ALT 300, CRP 300

What is the most likely causative organism?

Answer explained (no idea)

A
Influenza A
E. coli
Strep pneumoniae
Mycoplasma
Legionella
35
Q

50 y/o male returns from Spain, smoker. cough 2 weeks, dyspnoea, sputum, diarrhoea

HR 120, BP100/50, RR30 T-38.5
Cyanosed
Dehydrated
Bilateral basal consolidation
WCC-15, Na 115, ALT 300, CRP 300

How do you diagnose the causative organism?

A

Blood culture
Serology
Sputum culture
Urinary antigen

36
Q

50 y/o male returns from Spain, smoker. cough 2 weeks, dyspnoea, sputum, diarrhoea

HR 120, BP100/50, RR30 T-38.5
Cyanosed
Dehydrated
Bilateral basal consolidation
WCC-15, Na 115, ALT 300, CRP 300

How do you diagnose the causative organism?

A

Blood culture
Serology
Sputum culture- seems sensible, not sure
Urinary antigen

37
Q

5 year old farmer’s daughter, history developed diarrhoea, worsened 2 days ago. Blood PR for 24 hours. Abdo pain. Reduced urine output, HR-84, BP150/95, Temperature 36.5, tender abdomen

Low heamoglobin
Raised white blood cells
Low platelets
High urea
High creatine

What is the most likely infecting organism?

A

Campylobacter
Shigella dysentry
Cryptosporidium
E.coli 0157

38
Q

5 year old farmer’s daughter, history developed diarrhoea, worsened 2 days ago. Blood PR for 24 hours. Abdo pain. Reduced urine output, HR-84, BP150/95, Temperature 36.5, tender abdomen

Low heamoglobin
Raised white blood cells
Low platelets
High urea
High creatine

What is the most likely infecting organism?

(answer explained)

A

Campylobacter
Shigella dysentry
Cryptosporidium
E.coli 0157- causes abdominal pain, bloody diarrhoea, fever, seizures, lethargy, thrombocytopenia, renal failure, microanglopathic hemolytic anemia.

39
Q

What antibiotics do you give for e. coli 0157 infection?

answer explained

A

None, not indicated

40
Q

28 year old oil worker returns from a month working offshore in Nigeria. He is febrile, vomiting unwell. Most important investigation is?

A
CXR
Blood cultures
Stool microspoy and culture for typhoid
Malaria film +- antigen test
Urgent HIV test
41
Q

28 year old oil worker returns from a month working offshore in Nigeria. He is febrile, vomiting unwell. Most important investigation is?

(answers explained)

A
CXR
Blood cultures
Stool microscopy and culture for typhoid
Malaria film +- antigen test- important as malaria can be serious if missed.
Urgent HIV test
42
Q

28 year old oil worker returns from a month working offshore in Nigeria. He is febrile, vomiting unwell. Blood film confirms plasmodium falciparm with a parasitaemia of 6%

A
Artemether/lemefantrine (ACT)
Intravenous Artesunate
Intravenous Ciprofloxacin
Oral quinine unless parasitaemia increases
Chloroquine IV or orally if tolerated
43
Q

28 year old oil worker returns from a month working offshore in Nigeria. He is febrile, vomiting unwell. Blood film confirms plasmodium falciparm with a parasitaemia of 6%

A

Artemether/lemefantrine (ACT)
Intravenous Artesunate- indicated for complicated plasmodium falciparum
Intravenous Ciprofloxacin
Oral quinine unless parasitaemia increases- for unsevere infection
Chloroquine IV or orally if tolerated

44
Q

47 year old lady with a background of mild asthma presents to hospital with 5 day history of coryzal symptoms. Followed by fever, productive cough and shortness of breath. She was alert and orientated on examinantion O2 sats 90%, 38.5, 110/60, 110bpm, RR32, WCC 31.9, Urea 8, CRp 344

What is the CURB 65 scoring system and therefore what is her score?

(answers explained)

A

C- confusion
U- urea above 7mmol
R- respiratory rate >30
B- Bp <91 diastolic or <61 systolic

3- treat as severe

45
Q

47 year old lady with a background of mild asthma presents to hospital with 5 day history of coryzal symptoms. Followed by fever, productive cough and shortness of breath. She was alert and orientated on examinantion O2 sats 90%, 38.5, 110/60, 110bpm, RR32, WCC 31.9, Urea 8, CRp 344

Most likely causative organism?

(answers explained
)

A

Streptococcus pneumoniae

46
Q

47 year old lady with a background of mild asthma presents to hospital with 5 day history of coryzal symptoms. Followed by fever, productive cough and shortness of breath. She was alert and orientated on examination O2 sats 90%, 38.5, 110/60, 110bpm, RR32, WCC 31.9, Urea 8, CRp 344

What antibiotics should be started

(answers explained) (not sure ask the boys)

A

yes

47
Q

40 year ol dman with a background hisotry of alcohol excess was admiitedd to hospital with 3 month histry of weight loss, non productive cough and SOB. Travels infrequently with work. Chest auscultation reveals basal , sats were 92% on air. Bloods -3.9 WCC, platelets 100, CRP 23

What investigations would you do

(answers expaliend

A
bronchoalveolar lavage/ induced sputum for microsopy and culture
AAFB and cultures
Viral PCR
PJP PCR
fUNGAL cULTURES
HRCT