Clincal Conditions Flashcards
1
Q
What is the presentation of someone with Neisseria meningitidus
A
Fatigue, fever, headache, stiff neck, non-blanching rash
2
Q
What type of swab would you do for a suspected Neisseria meningitidus
A
Nasopharyngeal swab
3
Q
What is the gram stain for Neisseria Meningitidsu
A
Gram negative diplococcus
4
Q
What is the treatment of Neisseria Meningitidus
A
Ceftriaxone
5
Q
What are the most common causative organisms of meningitis in newborns, children and adults
A
Newborns - E. coli, Group B streptococcus
Children - Haemophilius influenzae, Group B strep, Neisseria meningitidus
Adults - Neisseria menignitidus and Strep pneumoniae
6
Q
What 2 things can E. coli present as
A
- gastroenteritis
- UTI
7
Q
How is E. coli spread?
A
- perforated bowel
- feacal oral
8
Q
What is the gram stain for E. coli?
A
Gram negative bacilli
9
Q
What tests would you do to identify E. coli
A
Nitrites, leukocyte ester as expected, dipstick test, CRP, lactate
10
Q
What is the treatment for E. coli and how does this antibiotic work?
A
Trimethoprim - inhibits folic acid synthesis
11
Q
How does Haemophilius influenzae Present
A
- as a URTI
- as meningitis
12
Q
Where is Haemophilius influenzae found as part of the normal flora
A
Nasopharynx
13
Q
What can staphylococcus aureus cause
A
- skin infections
- pneumonia
- abscess
- prosthetic infections
14
Q
Where is staph aureus found as part of the normal flora
A
Skin and respiratory tract
15
Q
What are the exotoxins for staph aureus
A
- superantigens
- coagulase enzymes
- hyaluronidase
- haemolysins
16
Q
What is the gram stain for staphylococci
A
Gram positive cocci in clusters
17
Q
What is the treatment for staph aureus and what do they do?
A
Penicillin but flucoxacillin if unsure it its strep - these are beta lactams which prevent cell wall synthesis
18
Q
What microbes commonly cause prosthetic infections after surgery
A
Under 1 year - coagulase negative staphylococcus
Over 1 year - staph aureus or viridans streptococcus
19
Q
What is used to treat MRSA
A
Vancomycin
20
Q
How can you prevent biofilms forming on IV lines
A
Make silver coated IV lines
21
Q
What can Staphlococcus epidermis cause?
A
Biofilm formations on equipment such as catheters
22
Q
What are the 3 types of haemolysis for streptococci
A
Alpha - partially break down the RBCs
Beta - fully break down RBCs
Gamma - dont break down the RBCs
23
Q
What are the 2 types of alpha streptococcus
A
- strep pneumoniae
- viridans streptococcus
24
Q
How does strep pneumoniae interact with the host
A
Enters the alveoli and stimulates an immune response so the alveoli fill with an exudate/pus. It may then infect the blood and cause complications.
25
What is the gram stain for streptococci
Gram positive cocci in chains
26
What commonly causes infective endocarditis
Viridans streptococcus
27
What are the features of infective endocarditis
Fever, heart murmur, janeway lesions, Osler nodes
28
Why must you look at dental hygiene with suspected infective endocarditis
As viridans streptococcus is naturally found in the mouth so could be able to enter the blood through poor dental hygiene
29
What type of beta streptococci are there
Streptococcus pyogenes
30
What are the virulence factors of streptococcus pyogenes
- M protein
- hyaluronic acid capsule
- streptokinase
- Exotoxins which cleave IgG
31
What is the presentation of strep pharyngitis
Sore throat, headache, pus exudate on tonsils
32
How do you treat strep throat
Initially only supportive to try and develop M protein specific antibodies
33
What are the complications of strep throat
- peritonsillar abscess
- post streptococcal glomerulonephritis
- scarlet fever
- rheumatic fever
34
What skin infections can strep pyogenes cause
Impetigo, erysipelas, cellulitis, necrotising fasciitis
35
How does strep pyogenes cause toxic shock syndrome
It invades into the blood stream and their superantigens cause the proliferation of T cells, releasing lots of cytokines leading to organ failure and vascular collapse
36
What is the gram stain for c diff
Gram positive bacilli
37
What is the treatment for c diff
Metronidazole
38
Why is c diff so hard to remove
It replicates using spores which are resistant to boiling water, chemical and UV so are very hard to remove
39
What are the exotoxins for c diff
Exotoxins A - causing inflammation
| Exotoxins B - kills healthy gut cells by preventing protein synthesis
40
Why is using antibiotics a risk factor for developing a c diff infection
Antibiotics deplete the normal flora meaning there is reduced competition for the c diff
41
Describe the formation of a biofilm
The bacteria adhere to a surface
They begin to multiple and create a slime coating
Nutrients and other bacteria can move through this slime capsule into the biofilm
42
What are the advantages to the bacteria of a biofilm
Prevents competition from other bacteria, prevents complement and phagocytosis and prevents antibiotics
43
What is a vegetation
A collection of bacteria on heart valves
44
Where is E. coli found as part of the normal flora
Intestines
45
Where is h pylori found as part of the normal flora
Stomach
46
What is the grain stain for h pylori
Gram negative
47
What is the treatment for h pylori
Amoxicillin
48
What are you at risk of developing from h pylori and why
Gastric ulcers, gastric adenocarcinoma and lymphoma of the MALT tissue. This is because the irritation/inflammation means the cells there regenerate so there's more chances for mutation
49
What are the signs of sepsis
High heart rate, high RR, low BP, high temperature, low oxygen saturation
50
What is the sepsis sexist bundle
- oxygen
- fluids
- antibiotics (e.g. Gentamicin)
- measure urine output
- measure lactate
- blood culture
51
How does an infection with candida present
Thrush - sore throat, white patches
52
What puts you at risk of developing an infection with candida
Taking antibiotics as this depletes the normal flora
53
When does candida only being infectious
When it overgrows
54
What does aspergillosis cause
Fever, cough, chest pain, breathlessness
55
Where is aspergillosis usually found
In dust in building
56
What would the chest CT look. Like in aspergillosis
White patches with well defined edges
57
Why may blood tests appear negative for aspergillosis
As the fungi stay localised and don't travel around the blood and so a biopsy must be taken
58
How does Adenovirus present
Fever, sore throat, enlarged lymph nodes, inflamed pharynx, no white patches on the throat
Can also cause gastroenteritis, conjunctivitis, pneumoniae
59
What is the virus structure for adenovirus
Double stranded DNA, non enveloped
60
How does Norovirus present
Vomiting, diarrhoea, dehydration
61
What is the virus structure for norovirus
SsRNA, non enveloped
62
How does EBV present
Fever, fatigue, swollen lymph nodes, enlarged spleen, rash (infectious mononucleosis)
63
What does EBV do to lymphocytes
- 50% increase in T cells of which 10% are abnormal
| - stays latent in B cells
64
What family of viruses is EBV part of
Herpes viruses
65
What are the symptoms of hep b
Nausea, vomiting, jaundice, headache, abdominal pain
66
What type of jaundice is seen in hepatitis
Intracellular-hepatic - where the liver cant conjugate the bilirubin
67
What are the 3 types of hepatitis
Pre hepatic = increase in RBC breakdown
Intra hepatic = liver cant conjugate the bilirubin
Extra hepatic = blockage of the bile duct.
68
What does hepatitis do to the liver
Causes inflammation as the virus replicates and kills hepatocytes
69
How likely is it for hep b aand c to become chronic
More likely in hep c resulting in hepatocellular carcinoma, cirrhosis, liver disease
70
What is the treatment for hep b
No treatment, only prevention. Therefore lifelong antivirals
71
Give an example of an antiviral
Acyclovir
72
What serology results are seen in hep b
- increase in HbsAg
- increase in HBeAG
- increase in IgM
- increase in HbeAb
- increase in HbsAb
- increase in IgG
73
What would the liver function tests show in hepatitis
High ALT, AST and possibly ALP
| Low albumin and coagulation factors
74
What is the virus structure for hep b
DsDNA enveloped
75
What is the serology like in hep c
Increase in anti-hepatitis C antibody
76
What antigen must be present for chronic hep b - and how long must it persist for
HbsAg for over 6 months
77
What is the virus structure of hep c
SsRNA enveloped
78
What are the risks of needlestick for hep b, hep c and HIV
Hep b = 1/3
Hep c = 1/30
HIV = 1/300
79
How does the primary stage of HIV present and what are the CD4 levels
Presents as a flu with a rash
| CD4 levels are normal depsite lots of virus replicating
80
What is the latent stage of HIV infection
CD4 starts to drop as virus continues to increase. No symptoms
81
What is the somatic stage of HIV infection
CD4 drops below 350. Start to get opportunistic diseases
82
What is the AIDS stage of HIV
CD4 below 200. Get opportunistic infections
83
What opportunistic infections are likely in HIV
```
Kaposi's sarcoma
PCP
CMV
TB
Meningitis
Oral candidiasis
```
84
How does the virus interact with the host
Binds to CD4 receptors and empties its contents into the cell. Reverse transcriptase converts ssRNA into dsDNA and integrase adds this to host DNA. The host then produces viral proteins which cause inflammation and destroy the cell.
85
What is the treatment for HIV
2 x reverse transcriptase inhibitors
| 1 of either an integrase inhibitor or a protease inhibitor
86
Why are 3 drugs given in HIV
To prevent the chance of resistance
87
What is the serology for HIV
HIV antigen and antibody tests
88
What is the virus structure of HIV
SsRNA. Enveloped
89
What can herpes zoster cause
Chicken pox and shingles
90
How does shingles present
Pain, blistered rash which doesn't cross the midline and affects a single dermatome
91
Where does herpes zoster remain dormant
Root ganglion
92
What is the virus structure of herpes zoster
DsDNA enveloped
93
How does malaria present
Fever, sweating, chills, spleen enlargement, vomiting, cough, fatigue
94
What is the incubation period of malaria
6 days
95
What are the causative organisms of malaria
Plasmodium falciparum/ ovale/ vivax/ malariae
96
What are the complication of plasmodium falciparum
Hypoglycaemia, renal failure, tachycardia, hypotension, cerebral problems, DIC
97
What does malaria interact with the host
When the sporozites enter they goes via the blood to the liver where the enter the hepatocytes becoming merozoites. They replicate inside the cells eventually causing them to burst. They them travel in the blood to RBCs and will cause them to burst
98
What is the vector of malaria
Female anopheles mosquito
99
What tests do you do in malaria
3 blood films, FBC, coagulation, U+E, CXR
100
What is the treatment for malaria
```
Falciparum = artesunate (as its still in the liver)
Viva/ovale = primoquine and chloroquine
```
101
What is the prevention for malaria
Preventing biting through nets, clothing, repellent
| Antimalarials
102
What is the risk of antimalarials
They deplete NADPH levels
103
What is the presentation of typhoid
Fever, headache, abdominal discomfort, cough, Bradycardia
104
What organism causes typhoid
Salmonella enterica
105
What are the virulence factors for typhoid
Lipopolysaccharide
Fimbriae
Invasin
106
What is the treatment of typhoid
Ceftriaxone
107
What are the complication of re-infection of typhoid
Intestinal haemorrhage and perforation
108
How does typoid spread
Fecal oral
109
How can typoid be prevented
Better sanitation
110
What causes dengue fever
Dengue virus - an arbovirus
111
What is an arbovirus
A virus spread by mosquitoes
112
How does dengue fever present
Rash, fever
113
What type of organism is schistosomiasis
Helmith/ worm
114
What consequences are there of schistosomiasis
Bladder cancer
115
What are the symtoms of infection by schistosomiasis
Swimmers rash, fever, aching, general feeling of unwell
