Clinical skills - Infection & Immunity

Question 1

Are urine dipsticks necessary to diagnose UTI’s in women

Answer 1

No

Question 2

Key urinary symptoms

Answer 2

Dysuria
Nocturia
Cloudy urine

Question 3

If a woman has 2 key urinary symptoms

Answer 3

Urine culture –> start abx

Question 4

If a woman has 1 key urinary symptoms

Answer 4

Urinalysis

Question 5

When are urine dipsticks unreliable

Answer 5

In men
Those over 65
Those w/ a catheter - colonised bacteria

Question 6

Causes of red urine

Answer 6

Haematuria
Rifampicin
Food e.g. beetroot

Question 7

Causes of brown urine

Answer 7

Jaundice
Rhabdomyolysis
Drugs e.g levodopa

Question 8

Causes of green urine

Answer 8

Pseudomonas UTI

Drugs e.g amitriptyline, indomethacin

Question 9

Causes of frothy urine

Answer 9

Proteinuria

Question 10

Most prominent protein in blood plasma

Answer 10

Albumin (58%)

Question 11

Buffy coat

Answer 11

Made up of leucocytes - mainly neutrophils

Question 12

Production of CRP

Answer 12

IL -1, IL-6 and TNF-alpha stimulate hepatocytes to produce CRP

Question 13

As the production of acute phase proteins increases ..

Answer 13

Albumin levels reduce

Question 14

Three main complement pathways

Answer 14

Lectin pathway
Classical pathway
Alternative pathway

Question 15

What is C3 activated by

Answer 15

Classic and Alternative pathways

Question 16

What does C3 activate

Answer 16

Membrane Attack Complex: C5b, C6, C7, C8, C9

Question 17

How does C3 directly act in the process of infl

Answer 17

Dilating arterioles
Stimulating mast cells to release histamine
Cause chemotaxis of phagocytes
Opsoninisation

Question 18

Opsonination

Answer 18

Acting as a marker to attract macrophages

Question 19

Sepsis 6

Answer 19

Take 3: bloods, measure urine output, check serial lactates (venous lactate)
Give 3: IV fluids, abx, oxygen

Question 20

Presentation of scarlet fever

Answer 20

High fever (38 degrees)
White coated tongue that peels –> red and swollen
Red rash on chest and back which branches w/ gentle pressure

Question 21

Examples of notifiable diseases

Answer 21

Scarlet fever 
Malaria 
Measles 
Meningitis 
Leprosy

Question 22

Epstein-Barr virus

Answer 22

One of 8 diff types of human herpes viruses - causes glandular fever (infectious mononucleosis)

Question 23

Diseases caused by EBV

Answer 23

Infectious mononucleosis 
Burkitt lymphoma 
Nasopharyngeal carcinoma 
CNS lymphoma 
Lymoproliferative disease

Question 24

Using vision in general observation

Answer 24

Position 
Shape/ size 
Colour 
Texture 
Comparison between L and R

Question 25

Using Hearing in general observation

Answer 25

Voice, speech

Stethoscope - things that move e.g blood (heart, vessels), air (lungs), gut contents (bowel sounds)

Question 26

Using Touch in general observation

Answer 26

Temp
Texture
Pain
Attachment

Question 27

Using smell in general observation

Answer 27

Smoke 
Alcohol 
Stale sweat or urine 
Infections (e.g gangrene)
Ketosis 
Diarrhoea die to blood (melaena) or infection

Question 28

Colours of blood

Answer 28

Fresh, oxygenated is bright red
Increased blood in vessels (injected/ vascular) or diffusely (erythema)
Decreased blood = pallor/ anaemia
Breakdown products (bruise) –> purple –> green –> yellow (jaundice)
Deoxygenated blood is a deep red purple (cyanosis)

Question 29

Abdominal distension

Answer 29

6 F’s

Flatus (air)
Faeces 
Foetus 
Fat 
Fluid 
Fatal (tumours)

Question 30

Ascites

Answer 30

Build up of fluid

Question 31

Test for oedema

Answer 31

Gradually increasing pressure over a bony site - cold for at least 15 secs
Shiny, stretched, blistered, weeping or ulcerated skin

Question 32

Presentation of septic arthritis

Answer 32

Unable to weight bear 
Unable to flex joint 
Swelling is in soft tissue, extra-articular 
Joint is red, swollen and warm 
Pain on all active and passive movements

Question 33

Risk factors for developing septic arthritis

Answer 33

Age >80yrs
Any pre-existing joint disease (e.g. rheumatoid arthritis)
Diabetes mellitus or immunosuppression
Chronic renal failure
Hip or knee joint prosthesis
Intravenous drug use

Question 34

Complications of IVDU

Answer 34

Spinal epidural abscess 
False aneurysm 
DVT 
Infective endocarditis 
Hepatic cirrhosis