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Year 2 > Case 9 > Flashcards

Case 9 Flashcards

1
Q

Respiratory syncytial virus (summer flu)

  1. virus
  2. family
  3. genus
  4. genome
  5. clinical manifestation & complications
  6. incubation period
  7. contagiousness
  8. transmission
  9. reservoir
  10. diagnosis
  11. treatment
  12. prevention
  13. reinfection?
A
  1. Enveloped RNA virus
  2. Paramyxoviridae - 1 serotype (variation)
  3. Pneumovirus
  4. ss (-) RNA circular
  5. 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
  6. 2-8 days
  7. Very contagious
  8. Spread from respiratory secretions through close contact with infected persons via respiratory droplets or contact with contaminated surfaces or objects
  9. Humans only known reservoir
  10. Serology to differentiate between IgG (past infection) & IgM (ongoing infection)
  11. No therapy
  12. No vaccine
  13. 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
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2
Q

Influenza

  1. virus
  2. family
  3. genus
  4. genome
  5. clinical manifestation & complications
  6. incubation period
  7. contagiousness
  8. transmission
  9. reservoir
  10. diagnosis
  11. treatment
  12. prevention
  13. reinfection?
A
  1. Segmented RNA packaged in nucleoprotein
  2. Orthomyxoviridae
  3. A/ B/ C
  5. 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
  6. 1-3 days
  7. Very contagious
  8. Droplets, aerosol, or through direct contact with respiratory secretions of someone with the infection
    Most cases during 8-10 week period in winter
  9. Lakes/ birds/ pigs/ horses
  10. Not commonly done
  11. Neuraminidase inhibitor (not v effective)
  12. IM inactivated vaccine/ nasal live attenuated spray
    13.
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3
Q

Rubella (german measles)

  1. virus
  2. family
  3. genus
  4. genome
  5. clinical manifestation & complications
  6. incubation period
  7. contagiousness
  8. transmission
  9. reservoir
  10. diagnosis
  11. treatment
  12. prevention
  13. reinfection?
A
  2. Togaviridae
    3.
  4. 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.
  5. 14-21 day, infectious from 1 week before symptoms appear to 4 days after the onset of the rash
  6. Droplet transmission
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4
Q

7 examples of live vaccines

A 
MMR
BCG
Nasal flu 
Oral rotavirus
Oral typhoid
Varicella zoster 
Yellow fever
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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
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6
Q

What does the little black triangle symbol mean?

A

New vaccine

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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)

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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

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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

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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)

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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
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12
Q

Which 3 vaccines are given at 40 months?

A

DTaP
IPV (inactivated polio virus)
MMR

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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
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14
Q

What is the commonest cause of community-aquired pneumonia?

A

Pneumococcal infection

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15
Q

What does pneumococcal infection cause?

A

Otitis media
Pneumonia
Septicaemia
Meningitis

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16
Q

Who is recommended to have the pneumococcal vaccine?

A 
65yo
Asplenia
Sickle cell disease
Severe coeliac disease
Cochlear implant 
CSF leakage
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17
Q

What causes chicken pox and shingles?

A

Varicella zoster virus

from a-herpesvirus family

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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

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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
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20
Q

Which vaccines do pregnant women need to get?

A

Influenza

Pertussis to protect baby as cannot immunise

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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
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22
Q

What is virulence?

A

Ability to multiply and grow

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23
Q

What is pathogenicity?

A

Ability to cause disease

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24
Q

When is there potential for eradication?

A

When the reservoir is non-human e.g. polio/ smallpox

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25
Q

What is a fomite?

A

An object likely to carry infection e.g. clothes

Norovirus can spread by fomites

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26
Q

Are HIV and STIs classed as notifiable disease?

A

No

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27
Q

When assessing growth, what height would be expected?

A

Height within 2 SD of parents average height centile

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28
Q

Prenatal stages

A

Embryonic conception - 8 weeks

Fetal 8 weeks - birth

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29
Q

Stages of infancy and early childhood

A

Neonate birth - 1 month
Infancy 1 month - 1 year
Toddler 1 - 3 years

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30
Q

What are the 4 modalities of development to be assessed?

A

Gross motor
Fine motor
Hearing/ vision
Communication

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31
Q

What are the normal fluctuations in weight of baby after birth?

A

weight loss by 5-10% by day 3-4

weight gain by day 10

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32
Q

When do the primitive reflexes disappear?

A

Month 4-6

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33
Q

What’s the average weight, occipitofrontal circumference and length of a newborn?

A

Weight: 3.5kg (10kg when 1yo)
OFC: 35cm
Length: 50cm

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34
Q

What are the primitive reflexes?

A

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)

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35
Q

What would be classed as an extremely preterm baby?

A

Before 28 weeks

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36
Q

What is the normal birth weight?

A

More than or equal to

2.5kg

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37
Q

What 5 domains does the apgar score describe?

How are they scored?

A 
Tone
Colour
Breathing
Heart rate
Response to stimulation
Each scores 0-2 so max of 10 points
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38
Q

What is concerning with apgar scores?

A

A decreasing score

Low score at 10 mins = death/ later disability

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39
Q

When does a baby show a social smile?

A

by week 8

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40
Q

When can a baby fix on their mother’s face?

A

6-8 weeks

41
Q

When does a baby begin to respond to “no” and names?

A

9 months

42
Q

When does a baby develop stranger anxiety?

A

9 months

43
Q

When do babies develop palmar grasp?

A

9 months

44
Q

When do babies begin to know the function of objects?

A

12 months

45
Q

Name the 3 neurotropic alpha herpes viruses

A

HSV 1 - cold sores
HSV 2
Varicella zoster virus (HHV 3) - chicken pox/ shingles

46
Q

Name the 3 lymphotropic beta herpes viruses

A

Cytomegalovirus/ CMV (HHV 5)
HHV 6
HHV 7

47
Q

Name the 2 lymphotropic gamma herpes viruses

A

Epstein Barr virus (HHV 4) - infectious mononucleosis

HHV 8 - Kaposi’s sarcoma

48
Q

Is food poisoning a notifiable disease?

A

Yes

49
Q

What’s the average age an infant/ toddler begins to walk?

A

13 months

50
Q

When can a toddler begin to recognise faces in photos?

A

2 years old

51
Q

What is a virus?

A

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
Q

Arrange these in order of increasing magnification:

nmr, electron microscope, light microscope, x-ray

A

light, electron, x-ray, nmr

53
Q

Describe the constituents of a virus

A 
Genome - no nucleic acids = not a virus
Protein capsid/ core
Lipoprotein envelope (not all viruses have one)
54
Q

What is a virion?

A

A mature virus particle

55
Q

What is the main function of a virion?

A

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
Q

What’s a nucleocapsid?

A

The nucleic acid-associated protein, called nucleoprotein, together with the genome

57
Q

What’s a bacteriophage?

A

A virus which parasitises a bacterium by infecting it & reproducing inside it

58
Q

What is peplomer?

A

A viral glycoprotein

59
Q

The Baltimore classification system separates viruses into 7 different groups depending on what?

A

How they make their mRNA

60
Q

Why do RNA viruses mutate more often than DNA viruses?

A

Errors in nucleic acid copying occur at a higher rate for RNA than DNA viruses

61
Q

Name 2 viruses that speed by horizontal spread

A

Leukaemia viruses

Congenital rubella

62
Q

Which baltimore classes are enveloped as a rule of thumb?

A

V, VI and VII

63
Q

What are the needle colours in order of length?

A

Brown 10mm
Orange 16mm
Blue 1.25”
Green 1.5”

64
Q

What does a centile represent in child growth charts?

A

The % of children expected to be below that line

65
Q

How many children are expected to be between the 25th & 75th centile?

A

50%

66
Q

What does a z score measure?

A

The number of SDs a value is above/ below the mean

To see how common/ rare an observation is

67
Q

How would the z score of a child’s weight be calculated?

A

z= child’s weight - mean of all children’s weights / SD of all children’s weights

68
Q

How can a z score be converted into centile?

A

Look up the probability of the z score in the table

P(z) usually given as decimal so x100 to convert into a %

69
Q

Equation for BMI

A

BMI = weight / height^2

70
Q

What BMI is classed as underweight?

A

BMI below 2nd centile

71
Q

What BMI is classed as healthy weight?

A

BMI on 2nd centile or above

That’s less than 85th centile

72
Q

What BMI is classed as overweight?

A

BMI on 85th centile or above

That’s less than 95th centile

73
Q

What BMI is classed as obese?

A

BMI on 95th centile or above

74
Q

If a data set is positively skewed, where do most of the values lie?

A

Most values are greater than the value of the peak

75
Q

If a data set is negatively skewed, where do most of the values lie?

A

Most values are smaller than the value of the peak

76
Q

For normal distributions, how much of the data lies within 1 SD of the mean?

A

About 68%

77
Q

For normal distributions, how much of the data lies within 2 SDs of the mean?

A

95%

78
Q

As 95% of data lie within 2SD of the mean, how would a 95% reference range be calculated?

A

(mean -2SD, mean +2SD)
very similar to
(2.5th centile, 97.5th centile)

79
Q

What is the difference between a pandemic and an epidemic?

A

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
Q

What may cause antigenic DRIFT that leads to an epidemic?

A

Mutation

81
Q

What may cause antigenic SHIFT that leads to an pandemic?

A

Reassortment (mixing of genetic material into new combinations)

82
Q

What is a serious complication of measles?

A

Subacute sclerosing panencephalitis (SSPE)

83
Q

What are the symptoms of measles?

A

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
Q

What may the measles component of the MMR vaccine cause?

A

Malaise, fever and/or a rash may occur, most commonly about a week after immunisation, and last about two to three days

85
Q

What may the mumps component of the MMR vaccine cause?

A

Swollen lymph nodes 3 weeks after jab

86
Q

What may the rubella component of the MMR vaccine cause?

A

Joint symptoms 1-3 weeks after vaccination

87
Q

What should a child be fully immunised against by

3 years 4 months?

A

MMR
DTaP
IPV

88
Q

What should a child be fully immunised against by

12 months?

A

Hib
PCV
MenB
MenC

89
Q

What should a child be fully immunised against by

3 months?

A

Rotavirus

90
Q

How do the risks of congenital rubella syndrome alter with time of infection during gestation?

A

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
Q

How are measles, mumps and rubella spread?

A

airborne

92
Q

What are the 3 C’s of the measles symptoms?

A

Cough
Coryza (head cold, fever, sneezing)
Conjunctivitis

93
Q

GLUT?

A

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
Q

Which HPV type is the most common in cases of cervical carcinoma?

A

HPV -16

95
Q

What may hand preference before 12 months be an indicator of?

A

cerebral palsy

96
Q

What are the complications of mumps?

A 
Meningitis 
Encephalitis
Pancreatitis 
Oophoritis/ orchitis
Sensorineural deafness
97
Q

What are the complications of rubella?

A

Thrombocytopaenia

Encephalitis

98
Q

What are the symptoms of rubella?

A

Maculopapular rash starts behind the ears before spreading around the head and neck
Swollen lymph glands

Year 2 (13 decks)

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