Corrections - Vaccinations, Infections & ENT Flashcards
Mx of wound if tetanus vaccination history is incomplete or unknown?
Regardless of wound severity –> booster dose of vaccine.
Tetanus prone & high risk wounds –> booster dose of vaccine + tetanus immunoglobulin
What are 7 examples of live attenuated vaccines?
1) BCG
2) MMR
3) Influenza (intranasal)
4) Oral rotavirus
5) Oral polio
6) Yellow fever
7) Oral typhoid
What is included in the ‘6 in 1’ vaccine?
Diptheria
Tetanus
Hep B
Polio
Pertussis
Hib
Where in the childhood immunisation schedule is the Meningitis B vaccine given?
2 months
4 months
12 months
When is the HPV vaccine offered?
Boys and girls aged 12-13 y/o
What is the most suitable management option for epistaxis where the bleed site is difficult to localise?
Anterior packing
(Note - cautery with silver nitrate requires bleeding vessels to be visible).
Mx of bleeding 5-10 days post tonsillectomy?
Admit for IV Abx as usually due to wound infection.
Who should all post-tonsillectomy haemorrhages be assessed by?
ENT
Who should be vaccinated against Hep A?
1) people travelling to or going to reside in areas of high or intermediate prevalence, if aged > 1 year old
2) people with chronic liver disease
3) patients with haemophilia
4) MSM
5) IVDU
6) individuals at occupational risk: laboratory worker; staff of large residential institutions; sewage workers; people who work with primates
Is oral polio a live vaccine?
Yes
Why is Little’s area in the nasal septum a common site for epistaxis to originate?
As it is the confluence of 4 arteries.
Is there a hep C vaccine?
No
Describe a ‘clean’ wound in regards to tetanus
- Wounds less than 6 hours old
- Non-penetrating with negligible tissue damage
Describe a ‘tetanus prone’ wound
- puncture-type injuries acquired in a contaminated environment e.g. gardening injuries
- wounds containing foreign bodies
- compound fractures
- wounds or burns with systemic sepsis
- certain animal bites and scratches
Describe a ‘high risk’ tetanus prone wound
- heavy contamination with material likely to contain tetanus spores e.g. soil, manure
- wounds or burns that show extensive devitalised tissue
- wounds or burns that require surgical intervention
In epistaxis that has failed all management (e.g. cautery, and anterior and posterior packing), what is the next step?
Ligation of the sphenopalatine artery in theatre.
When is the first dose of the MMR vaccine typically administered?
Around 12 months of age
Mx of quinsy?
IV Abx + surgical drainage
Tonsillectomy should be considered in 6 weeks
What vaccine do people receive between the ages of 13 and 18?
3 in 1 teenage booster (tetanus, diptheria and polio)
Men ACWY
When is the BCG vaccine given at birth?
If the baby is deemed at risk of tuberculosis (e.g. Tuberculosis in the family in the past 6 months).
When is a bone marrow biopsy indicated in ITP?
If there are atypical features e.g.
- lymph node enlargement/splenomegaly, high/low white cells
- failure to resolve/respond to treatment
What does the BCG vaccine provide the most protection against?
TB meningitis in children
Note –> the BCG vaccine is unreliable in protecting against pulmonary TB.
When is the rotavirus given?
2 months and 3 months
What type of vaccine is the rotavirus vaccine?
Oral, live attenuated
Initial management of epistaxis?
Pinch the nasal ala (nostrils) firmly and lean forward for 20 minutes
Mx of tetanus wound if patient has had 5 doses of tetanus vaccine, with the last dose < 10 years ago?
No booster vaccine nor immunoglobulins required, regardless of how severe the wound is.
How many tetanus vaccinations are there in the UK schedule?
5 –> 2 months, 3 months, 4 months, 3-5 years and 13-18 years.
When is the final tetanus dose given?
13-18 years
What type of vaccine is the influenza vaccine?
Inactivated
Which 2 vaccines are routinely offered to pregnant women in the UK?
Influenza + pertussis
How soon ago must patients have received their last tetanus dose to not require a booster vaccine nor immunoglobulins with a wound?
<10 years
Features of botulism (i.e. infection with clostridium botulinum)?
- patient usually fully conscious with no sensory disturbance
- FLACCID paralysis
- diplopia
- ataxia
- bulbar palsy
What vaccines should patients diagnosed with chronic hepatitis be offered?
Annual influenza + one off pneumococcal vaccine.
How is the influenza vaccine given in children?
Intranasally
When is the influenza vaccine in children given?
Dose at 2-3 years then annually
Contraindications for influenza vaccine in children?
1) immunocompromised
2) aged < 2 years
3) current febrile illness or blocked nose/rhinorrhoea
4) current wheeze (e.g. ongoing viral-induced wheeze/asthma) or history of severe asthma –> wait until child is better
5) egg allergy
6) pregnancy/breastfeeding
7) if the child is taking aspirin (e.g. for Kawasaki disease) due to a risk of Reye’s syndrome
What type of vaccine is the influenza vaccine in children?
Live
What is the most common infective cause of diarrhoea in HIV patients?
Cryptosporidium
What investigation may be indicated in Cryptosporidium diarrhoea in HIV?
Modified Ziehl-Neelsen stain (acid-fast stain)
What may a modified Ziehl-Neelsen stain (acid-fast stain) reveal in Cryptosporidium infection?
Characteristic red cysts of Cryptosporidium
Mx of Cryptosporidium infective diarrhoea in HIV?
Supportive therapy
What is the mainstay of treatment of PCP?
Co-trimoxazole (trimethoprim + sulfamethoxazole)
What organism causes typhoid?
Salmonella typhi
Features of typhoid?
- systemic upset: headache, fever, arthralgia
- relative bradycardia
- abdominal pain, distension
- constipation (although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid)
- rose spots: present on trunk in 40% of patients
What are 3 recognised medical benefits of circumcision?
1) reduces the risk of penile cancer
2) reduces the risk of UTI
3) reduces the risk of acquiring sexually transmitted infections including HIV
Give 4 medical indications for circumcision?
1) phimosis
2) recurrent balanitis
3) balanitis xerotica obliterans
4) paraphimosis
What is it important to exclude before circumcision?
Hypospadias (as the foreskin may be used in surgical repair)
What anaesthetic is circumcision performed under?
Local or GA
What is Ludwig’s angina?
A life-threatening cellulitis which occurs on the floor of the mouth.
Infection is rapidly progressive and can cause potential airway obstruction.
Risk factors for Ludwig’s angina?
1) Recent infection or injury to area
2) Diabetes
3) Oral malignancy
4) Alcoholism
5) Malnutrition
6) Immunocompromised status
What type of pneumonia does a peripheral blood smear showing red blood cell agglutination indicate?
Mycoplasma pneumoniae
What childhood infection is characterised by a prodrome of irritability, conjunctivitis & fever?
Measles
What childhood infection is characterised by white spots (‘grain of salt’) on buccal mucosa (Koplik spots)?
Measles
Which childhood infection can cause vesicles in the mouth and on the palms and soles of the feet?
Hand, foot and mouth disease (coxsackie A16 virus)
What virus is hand, foot and mouth disease caused by?
coxsackie A16 virus
What condition are Koplik spots pathognomonic of?
Measles
When do Koplik spots in measles appear?
Appear 1 to 2 days before the onset of the rash and may persist for a further one to two days.
Where does rash typically begin in measles?
starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
Where does rash typically begin in rubella?
Pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
What is known as ‘slapped cheek syndrome’?
Erythema infectiosum caused by parvovirus B19
What condition does large swollen tonsils together with a palpable mass in the left hypochondriac region indicate?
Infectious mononucleosis
Is Scarlet fever a notifiable disease?
Yes
Features of Hep A?
- flu-like prodrome
- abdominal pain: typically right upper quadrant
- tender hepatomegaly
- jaundice
- deranged liver function tests
What is Kaposi’s sarcoma caused by?
HHV-8
How does Kaposi’s sarcoma present?
Purple papules or plaques on the skin or mucosa (e.g. GI and respiratory tract).
Skin lesions may later ulcerate.
Note - respiratory involvement may cause massive haemoptysis and pleural effusion
What is the 1st line HIV screening of asymptomatic individuals or patients with signs and symptoms of chronic infection?
Combined HIV antibody/antigen tests e.g. HIV-1/2 Ab/Ag Immunoassay
Why is shellfish a common source of hep A?
as the virus is transmitted via the faecal-oral route
Cirrhosis, malignancy & RHF are 3 common causes of hepatomegaly.
How does the liver feel in RHF?
Rirm, smooth, tender liver edge. May be pulsatile.
What can acute toxoplasmosis in the immunocompetent patient mimic?
Acute EBV infection (low-grade fever, generalised lymphadenopathy with prominent cervical lymph nodes and malaise).
What accounts for around 50% of cerebral lesions in patients with HIV?
Cerebral toxoplasmosis
What is oral hair leukoplakia associated with?
EBV infection
Is oral hairy leukoplakia malignant?
No
What is acute epididymo-orchitis in sexually active younger adults most commonly caused by?
Chlamydia trachomatis
What lymph nodes are typically affected in rubella infection?
1) Suboccipital
2) Postauricular
What is the strongest risk factor for anal cancer?
HPV infection
What does triple antiretroviral therapy consist of in HIV?
2x nucleoside reverse transcriptase inhibitors (NRTI) + 1x protease inhibitor
How often is CD4 count checked in HIV?
First diagnosis
Every 3-6 months
What is the most common and important viral infection in solid organ transplant recipients?
Cytomegalovirus
Mx of cytomegalovirus infection in solid organ transplant recipients?
Ganciclovir
When is the decision made to start Abx without a LP in meningitis?
If the LP cannot be done within the first HOUR, give IV Abx after blood cultures have been taken.
CSF findings in viral meningitis?
Raised lymphocytes & raised proteins
What is the steroid of choice in bacterial meningitis?
Dexamethasone
When should steroids be avoided in bacterial meningitis?
- Septic shock
- Meningococcal septicaemia
- Immunocompromised
- Meningitis following surgery
What 2 vaccines are pregnant women offered?
Whooping cough (pertussis) + injectable influenza (not nasal - this is a live vaccine)
What is the most common cause of viral meningitis in adults?
Enteroviruses e.g. Coxsackie B virus
If SAH is suspected but a CT head done >6 hours after symptom onset is normal, what should be done next?
LP to confirm or exclude the diagnosis
What is used as prophylaxis for contacts of patients with meningococcal meningitis?
Oral ciprofloxacin (or rifampicin)
But ciprofloxacin is 1st line
Fontanelle in meningitis in neonates?
Typicall bulging
Fontanelle in sepsis in neonates?
Typically sunken
What condition do Koplik spots indicate?
Measles
What is the most common complication of measles?
Otitis media
(as the respiratory virus can easily spread to the ear canals).
What is pituitary apoplexy?
Sudden enlargement of a pituitary tumour (usually non-functioning macroadenoma) 2ary to haemorrhage or infarction.
What are some precipitating factors for pituitary apoplexy?
- HTN
- Pregnancy
- Trauma
- Anticoagulation
features of pituitary apoplexy?
1) Sudden onset headache (similar to that seen in SAH)
2) Vomiting
3) Neck stiffness
4) Visual field defects: classically bitemporal superior quadrantic defect
5) Extraocular nerve palsies
6) Features of pituitary insufficiency e.g. hypotension/hyponatraemia 2ary to hypoadrenalism
What investigation is diagnostic for pituitary apoplexy?
MRI
Mx of pituitary apoplexy?
1) Urgent steroid replacement due to loss of ACTH
2) Careful fluid balance
3) Surgery
What is a dendritic ulcer?
An ulcer or inflammation on the cornea caused by HSV-1.
Complication of eczema herpeticum.
How can herpetic keratitis be diagnosed?
Fluorescein stain –> stained dendritic ulcer.
