Case 9 Flashcards
1
Q
Respiratory syncytial virus (summer flu)
- virus
- family
- genus
- genome
- clinical manifestation & complications
- incubation period
- contagiousness
- transmission
- reservoir
- diagnosis
- treatment
- prevention
- reinfection?
A
- Enveloped RNA virus
- Paramyxoviridae - 1 serotype (variation)
- Pneumovirus
- ss (-) RNA circular
- Mainly harmless rhinitis (runny nose/ sneezing/ nasal congestion)
Cough, shortness of breath, fever, lethargy and decreased appetite.
Symptoms can progress to croup, bronchiolitis and acute lower respiratory tract infection.
Complications: Otitis media, bronchitis, pneumonia - 2-8 days
- Very contagious
- Spread from respiratory secretions through close contact with infected persons via respiratory droplets or contact with contaminated surfaces or objects
- Humans only known reservoir
- Serology to differentiate between IgG (past infection) & IgM (ongoing infection)
- No therapy
- No vaccine
- Previous infection by RSV may only confer partial immunity to RSV and so individuals may be infected repeatedly with the same or different strains of RSV
2
Q
Influenza
- virus
- family
- genus
- genome
- clinical manifestation & complications
- incubation period
- contagiousness
- transmission
- reservoir
- diagnosis
- treatment
- prevention
- reinfection?
A
- Segmented RNA packaged in nucleoprotein
- Orthomyxoviridae
- A/ B/ C
- Sudden onset of fever, chills, headache, myalgia and extreme fatigue.
Other common symptoms include a dry cough, sore throat and stuffy nose.
Recovery usually within 2-7 days.
Complications: bronchitis, secondary bacterial pneumonia or, in children, otitis media, more unusually: meningitis, encephalitis or meningoencephalitis - 1-3 days
- Very contagious
- Droplets, aerosol, or through direct contact with respiratory secretions of someone with the infection
Most cases during 8-10 week period in winter - Lakes/ birds/ pigs/ horses
- Not commonly done
- Neuraminidase inhibitor (not v effective)
- IM inactivated vaccine/ nasal live attenuated spray
13.
3
Q
Rubella (german measles)
- virus
- family
- genus
- genome
- clinical manifestation & complications
- incubation period
- contagiousness
- transmission
- reservoir
- diagnosis
- treatment
- prevention
- reinfection?
A
- Togaviridae
3. - mild prodromal illness involving a low-grade fever, malaise, coryza and mild conjunctivitis.
Lymphadenopathy involving post-auricular and sub-occipital glands may precede the rash.
Rash usually transitory, erythematous and mostly seen behind the ears and on the face and neck appears 14-17 days after exposure
Complications: thrombocytopaenia and post-infectious encephalitis. In adults, arthritis and arthralgia may occasionally be seen after rubella infection. - 14-21 day, infectious from 1 week before symptoms appear to 4 days after the onset of the rash
- Droplet transmission
4
Q
7 examples of live vaccines
A
MMR BCG Nasal flu Oral rotavirus Oral typhoid Varicella zoster Yellow fever
5
Q
8 examples of killed vaccines
A
DTaP (diphtheria/ tetanus/ attenuated pertussis) Hib (haemophilus influenza B) Men B/C Hep A/B Intramuscular flu Pneumococcal IM typhoid HPV
6
Q
What does the little black triangle symbol mean?
A
New vaccine
7
Q
Which 3 vaccines to babies receive at 2, 3 and 4 months in one single injection?
A
DTaP
IPV (inactivated polio virus)
Hib (haemophilus influenza B)
8
Q
Other than the 3 given at 2, 3, 4 months
which 2 other vaccines are given at 2 months?
A
Men B
Oral rotavirus
9
Q
Other than the 3 given at 2, 3, 4 months
which 2 other vaccines are given at 3 months?
A
Men C
Oral rotavirus
10
Q
Other than the 3 given at 2, 3, 4 months
which 2 other vaccines are given at 4 months?
A
Men B
PCV (pneumococcal conjugate vaccine)
11
Q
Which 5 vaccines are given at 12-13 months?
A
Hib (haemophilus influenza B) Men B Men C PCV (pneumococcal conjugate vaccine) MMR
12
Q
Which 3 vaccines are given at 40 months?
A
DTaP
IPV (inactivated polio virus)
MMR
13
Q
Who is vaccinated against flu?
A
2-7yo 65 and over Pregnant women Carers Long stay care Those in risk group for over 6 months: diabetes/ chronic disease/ weak immunity
14
Q
What is the commonest cause of community-aquired pneumonia?
A
Pneumococcal infection
15
Q
What does pneumococcal infection cause?
A
Otitis media
Pneumonia
Septicaemia
Meningitis
16
Q
Who is recommended to have the pneumococcal vaccine?
A
65yo Asplenia Sickle cell disease Severe coeliac disease Cochlear implant CSF leakage
17
Q
What causes chicken pox and shingles?
A
Varicella zoster virus
from a-herpesvirus family
18
Q
How can someone get shingles?
A
Primary infection of acute varicella (chickenpox)
Establishes lifelong latency in cranial nerve/ dorsal root ganglia
Reactivate as herpes zoster/ shingles
19
Q
Who is recommended to have the Hep B vaccine?
A
Contact with HBV carrier (sexual partner/ house/ carer Babies of HBV carrier Injecting drug users Multiple sexual partners Chronic renal/ liver failure Receiving regular blood products Foster carers HCW Learning difficulties Prisoners and staff Morticians and embalmers
20
Q
Which vaccines do pregnant women need to get?
A
Influenza
Pertussis to protect baby as cannot immunise
21
Q
What are the 6 links in the chain of infection?
A
Infectious agent Reservoir Portal of exit Mode of transmission Portal of entry Susceptible host
22
Q
What is virulence?
A
Ability to multiply and grow
23
Q
What is pathogenicity?
A
Ability to cause disease
24
Q
When is there potential for eradication?
A
When the reservoir is non-human e.g. polio/ smallpox
25
What is a fomite?
An object likely to carry infection e.g. clothes
| Norovirus can spread by fomites
26
Are HIV and STIs classed as notifiable disease?
No
27
When assessing growth, what height would be expected?
Height within 2 SD of parents average height centile
28
Prenatal stages
Embryonic conception - 8 weeks
| Fetal 8 weeks - birth
29
Stages of infancy and early childhood
Neonate birth - 1 month
Infancy 1 month - 1 year
Toddler 1 - 3 years
30
What are the 4 modalities of development to be assessed?
Gross motor
Fine motor
Hearing/ vision
Communication
31
What are the normal fluctuations in weight of baby after birth?
weight loss by 5-10% by day 3-4
| weight gain by day 10
32
When do the primitive reflexes disappear?
Month 4-6
33
What's the average weight, occipitofrontal circumference and length of a newborn?
Weight: 3.5kg (10kg when 1yo)
OFC: 35cm
Length: 50cm
34
What are the primitive reflexes?
Lower motor neurone responses
Step reflex (walking movement when held up on feet)
Asymmetric tonic neck movement (superman - arm and leg on side that head is turned to extend, opposite side flex)
Root and suck response (turns and opens mouth when cheek stroked, suckles on anything in mouth)
35
What would be classed as an extremely preterm baby?
Before 28 weeks
36
What is the normal birth weight?
More than or equal to
| 2.5kg
37
What 5 domains does the apgar score describe?
| How are they scored?
```
Tone
Colour
Breathing
Heart rate
Response to stimulation
Each scores 0-2 so max of 10 points
```
38
What is concerning with apgar scores?
A decreasing score
| Low score at 10 mins = death/ later disability
39
When does a baby show a social smile?
by week 8
40
When can a baby fix on their mother's face?
6-8 weeks
41
When does a baby begin to respond to "no" and names?
9 months
42
When does a baby develop stranger anxiety?
9 months
43
When do babies develop palmar grasp?
9 months
44
When do babies begin to know the function of objects?
12 months
45
Name the 3 neurotropic alpha herpes viruses
HSV 1 - cold sores
HSV 2
Varicella zoster virus (HHV 3) - chicken pox/ shingles
46
Name the 3 lymphotropic beta herpes viruses
Cytomegalovirus/ CMV (HHV 5)
HHV 6
HHV 7
47
Name the 2 lymphotropic gamma herpes viruses
Epstein Barr virus (HHV 4) - infectious mononucleosis
| HHV 8 - Kaposi's sarcoma
48
Is food poisoning a notifiable disease?
Yes
49
What's the average age an infant/ toddler begins to walk?
13 months
50
When can a toddler begin to recognise faces in photos?
2 years old
51
What is a virus?
Filterable agent (some filters impermeable to bacteria)
Do not have metabolic activity outside living cell
Small: 20-300 nm
Only seen with a scanning electron microscope
52
Arrange these in order of increasing magnification:
| nmr, electron microscope, light microscope, x-ray
light, electron, x-ray, nmr
53
Describe the constituents of a virus
```
Genome - no nucleic acids = not a virus
Protein capsid/ core
Lipoprotein envelope (not all viruses have one)
```
54
What is a virion?
A mature virus particle
55
What is the main function of a virion?
To deliver its DNA/ RNA genome into the host cell so that the genome can be expressed (transcribed and translated) by the host cell
56
What's a nucleocapsid?
The nucleic acid-associated protein, called nucleoprotein, together with the genome
57
What's a bacteriophage?
A virus which parasitises a bacterium by infecting it & reproducing inside it
58
What is peplomer?
A viral glycoprotein
59
The Baltimore classification system separates viruses into 7 different groups depending on what?
How they make their mRNA
60
Why do RNA viruses mutate more often than DNA viruses?
Errors in nucleic acid copying occur at a higher rate for RNA than DNA viruses
61
Name 2 viruses that speed by horizontal spread
Leukaemia viruses
| Congenital rubella
62
Which baltimore classes are enveloped as a rule of thumb?
V, VI and VII
63
What are the needle colours in order of length?
Brown 10mm
Orange 16mm
Blue 1.25"
Green 1.5"
64
What does a centile represent in child growth charts?
The % of children expected to be below that line
65
How many children are expected to be between the 25th & 75th centile?
50%
66
What does a z score measure?
The number of SDs a value is above/ below the mean
| To see how common/ rare an observation is
67
How would the z score of a child's weight be calculated?
z= child's weight - mean of all children's weights / SD of all children's weights
68
How can a z score be converted into centile?
Look up the probability of the z score in the table
| P(z) usually given as decimal so x100 to convert into a %
69
Equation for BMI
BMI = weight / height^2
70
What BMI is classed as underweight?
BMI below 2nd centile
71
What BMI is classed as healthy weight?
BMI on 2nd centile or above
| That's less than 85th centile
72
What BMI is classed as overweight?
BMI on 85th centile or above
| That's less than 95th centile
73
What BMI is classed as obese?
BMI on 95th centile or above
74
If a data set is positively skewed, where do most of the values lie?
Most values are greater than the value of the peak
75
If a data set is negatively skewed, where do most of the values lie?
Most values are smaller than the value of the peak
76
For normal distributions, how much of the data lies within 1 SD of the mean?
About 68%
77
For normal distributions, how much of the data lies within 2 SDs of the mean?
95%
78
As 95% of data lie within 2SD of the mean, how would a 95% reference range be calculated?
(mean -2SD, mean +2SD)
very similar to
(2.5th centile, 97.5th centile)
79
What is the difference between a pandemic and an epidemic?
Epidemic: disease outbreak that is concentrated in a particular region Pandemic: disease outbreak that occurs over a wide geographic area and affects a very high proportion of the population
80
What may cause antigenic DRIFT that leads to an epidemic?
Mutation
81
What may cause antigenic SHIFT that leads to an pandemic?
Reassortment (mixing of genetic material into new combinations)
82
What is a serious complication of measles?
Subacute sclerosing panencephalitis (SSPE)
83
What are the symptoms of measles?
Koplick spots (white spots inside cheeks) 2-3 days before
Makulopapulous exanthema (rash - flat, red area with small confluent bumps) starting on head/ neck, moving down to chest and spreading to rest of body
Fever
Laryngitis
Tracheobronchitis
84
What may the measles component of the MMR vaccine cause?
Malaise, fever and/or a rash may occur, most commonly about a week after immunisation, and last about two to three days
85
What may the mumps component of the MMR vaccine cause?
Swollen lymph nodes 3 weeks after jab
86
What may the rubella component of the MMR vaccine cause?
Joint symptoms 1-3 weeks after vaccination
87
What should a child be fully immunised against by
| 3 years 4 months?
MMR
DTaP
IPV
88
What should a child be fully immunised against by
| 12 months?
Hib
PCV
MenB
MenC
89
What should a child be fully immunised against by
| 3 months?
Rotavirus
90
How do the risks of congenital rubella syndrome alter with time of infection during gestation?
Infection in the first 8-10 weeks of pregnancy = damage in up to 90% of surviving infants
10-20% risk of damage with infection at 11-16 weeks gestation
Damage rare with infection after 16 weeks of pregnancy
91
How are measles, mumps and rubella spread?
airborne
92
What are the 3 C's of the measles symptoms?
Cough
Coryza (head cold, fever, sneezing)
Conjunctivitis
93
GLUT?
The glucose passes through glut 1 to get to the fetus across the placenta.
Glut 2 is found on the liver and pancreas and is used for detecting high glucose levels
Glut 3 is found on neurones
Glut 4 is insulin dependent and is found on skeletal muscle and adipose tissue and takes up glucose in response to insulin
Glut 5 is a fructose transporter
94
Which HPV type is the most common in cases of cervical carcinoma?
HPV -16
95
What may hand preference before 12 months be an indicator of?
cerebral palsy
96
What are the complications of mumps?
```
Meningitis
Encephalitis
Pancreatitis
Oophoritis/ orchitis
Sensorineural deafness
```
97
What are the complications of rubella?
Thrombocytopaenia
| Encephalitis
98
What are the symptoms of rubella?
Maculopapular rash starts behind the ears before spreading around the head and neck
Swollen lymph glands
