201 International Health

Question 0

What is Brock’s syndrome?

Answer 0

Right middle lobe atelectasis (collapse) in TB secondary to lymphadenopathy. It causes the middle bronchus to become ‘slit-like’ in appearance

Question 1

What is erythema nodosum a clinical sign of?

Answer 1

TB

Question 2

What are the 3 main symptoms of TB?

Answer 2

Fever and night sweats (50%)
Cough (50%)
Weight loss (50%)

Question 3

What type of bacteria is mycobacterium tuberculosis?

Answer 3

Obligate aerobe

Question 4

In which cells do M. Tuberculosis proliferate in?

Answer 4

Macrophages

Question 5

Where is the primary infection of M. tuberculosis commonly found?

Answer 5

Sub pleural in the mid to upper zones

Question 6

What are the radiological features of a pt with TB?

Answer 6

Necrosing granulomas
Hilar lymphadenopathy

I.e. Ghon complex

Question 7

What are the drugs of choice for the 1st 2 months of a primary TB infection?

Answer 7

Rifater (Rifampicin, isoniazid, pyrazinamide)

Ethambutol

Question 8

What is the treatment following 4 months of the 6 month treatment of primary TB?

Answer 8

Rifinah (Rifampicin and isoniazid)

Question 9

Why should LFTs be monitored in patients with TB on treatment?

Answer 9

S/E of treatment drugs cause hepatotoxicity

Question 10

What are the side effects of Ethambutol in the treatment of TB?

Answer 10

Visual effects - loss of vision, eye pain, red-green colour blindness

Should perform regular visual acuity testing etc

Question 11

How long should a meningitis TB pt be treated for?

Answer 11

12 months - add in steroids

Question 12

How much of the population of sub Saharan Africa are thought to be exposed to TB?

Answer 12

100%

Question 13

Which type of TB is the neonatal vaccination of TB effective against?

Answer 13

Meningitis TB

Question 14

What could be detected in a sputum AFB?

Answer 14

Mycobacterium tuberculosis

Non TB mycobacterium

Question 15

What is auromine rhodamine staining used to visualise?

Answer 15

Mycobacterium

Question 16

What is injected in a Mantoux test?

Answer 16

PPD - purified protein derivative of tuberculin

Question 17

What is IGRA used to test for?

Answer 17

Latent TB infection - measures the interferon gamma released by T-cells.
Highly sensitive

Question 18

What is the lifetime risk of reactivation of TB?

Answer 18

10%

Question 19

What is the lifetime risk of contracting TB?

Answer 19

0.1%

Question 20

What is miliary TB?

Answer 20

Uncontrolled dissemination of M. tuberculosis throughout blood stream

Question 21

What is Bedaquiline used to treat?

Answer 21

MDRTB

Question 22

Which nucleus is disinhibited in decorticating posture?

Answer 22

Red nucleus in rostral midbrain - supplying flexor muscle of the upper limb - therefore pts have disinhibited flexion of the arms

Question 23

Protein synthesis of which chromosomes makes haemoglobin?

Answer 23

α genes = chromosome 16

β genes = chromosome 11

Question 24

Why is there microcytic anaemia in low Hb?

Answer 24

Hb conc involved with cell division, when less Hb, more division and smaller cells

Question 25

What is the inheritance of sickle cell?

Answer 25

AR

Question 26

What are the features of sickle cell?

Answer 26

Obstruction of microvasculature, tissue infarction leading to acute pain, chest syndrome, stroke...

Question 27

Where is the mutation in sickle cell?

Answer 27

Point mutation of β chain of Hb

Question 28

Why is splenomegaly a feature of thalassaemia?

Answer 28

Point mutation of the β and α chains of Hb so solubility of haemoglobin affected. Increased end cell fragility - spleen tries to compensate with increase haematopoesis

Question 29

What is the estimated concentration of Hb if the packed cell volume (PCV) is 21%?

Answer 29

Estimated Hb = PCV x10 / 3 = 70g/L

Question 30

Definition: | The organism in which the adult or sexually mature stage of the parasite

Answer 30

Definitive host

Question 31

Definition: | The organism in which the parasite lives during a period of its development

Answer 31

Intermediate host

Question 32

How do amoebas mobilise?

Answer 32

Extend cytoplasmic projections - pseudopodia

Question 34

Definition: | Organism which transmit pathogens rom one infected animal to another

Answer 34

Vectors

Question 35

What is the vector for Chagas disease?

Answer 35

Triatomine bug

Question 36

Which disease does Yersinia pestis cause?

Answer 36

Bubonic plague

Question 37

Which vector carries Onchocerca volvulus?

Answer 37

Black fly

Question 38

Which disease is caused by Trypanosoma brucei and what is the vector?

Answer 38

Sleeping sickness - tsetse fly

Question 39

Which of the following affects blood and tissues? 1. Cryptosporidium spp 2. Trichuris trichuria 3. Trypanosoma cruzi 4. Enterobius vermicularis

Answer 39

23. Trypanosoma cruzi - Chagas disease

Question 40

What type of microorganism causes African sleeping sickness?

Answer 40

Protozoa - Tichomonas brucei

Question 41

What are the initial S&S of African sleeping sickness? | 4 listed

Answer 41

1. Fever 2. HA 3. HA 4. Itching

Question 42

What are the later S&S of African sleeping sickness - once the protozoa has crossed the BBB? (5 listed)

Answer 42

1. Changes in behaviour 2. Confusion 3. Sensory disturbance 4. Poor coordination 5. Disturbance of sleep cycle

Question 43

What investigation is performed to determine disease progression?

Answer 43

LP

Question 44

Which stage of African sleeping sickness is treated by: Pentamidine (for gambiense) Suramin (for rhodisiense)

Answer 44

1st stage - i.e. lower toxicity

Question 45

Why are Melarsoprol, Eflorinthine , Nufurtimox + eflorinthine used to treat the 2nd stage of African sleeping sickness?

Answer 45

They are able to cross the BBB

Question 46

How is Trypanosoma cruzi transported into the host blood stream?

Answer 46

Triatomine bug bites skin of human and defaecates close by. Bite is scratched by the host and protozoa are able to enter in through the broken skin.

Question 47

What percentage of people are chronically affected by African sleeping sickness?

Answer 47

30%

Question 48

How long does the acute phase of Chagas disease last?

Answer 48

~ 2 months

Question 49

Where do the parasites of Chagas disease reside in during the chronic phase?

Answer 49

Heart myocardium

Question 50

What is the long term consequences of a Trypanosoma cruzi infection?

Answer 50

Sudden death or HF caused by progressive destruction of the heart muscle

Question 51

What are Benznidazole and Nifurtimox used to treat?

Answer 51

Chagas disease