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1
Q

notifyable diseases from this years knowledge

A
  • acute encephalitis
  • acute meningitis
  • cholera
  • food poisoning
  • HUS
  • infective bloody diarrhoea
  • meningococcal septicaemia
  • MMR
  • SARS
  • whooping cough
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2
Q

causes of candidaemia

A
  • translocation from gut into blood stream (sepsis, perforation, obstruction, necrosis of bowel)
  • central/Arterial lines
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3
Q

how to diagnose candidal infection

A
  • blood culture: appears like large gram pos cocci

- beta-D-glucagon (v senstivie but not specific)

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4
Q

types of herpes viruses

A
  • herpes simplex virus 1 and 2
  • Epstein Barr virus (glandular fever and burkitt’s lymphoma)
  • cytomegalovirus
  • varicella zoster virus
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5
Q

pathogens found in infective endocarditis (different groups)

A
  • streptococcus viridans (normal variant)
  • staphylococcus aureus (IVDU)
  • staphylococcus epidermis (prostetic valves)
  • streptococcus bovis (colorectal cancer)
  • streptococcus mitis (dental work)
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6
Q

investigations for meningitis

A
  • viral and bacterial troat swabs
  • blood culture
  • penumococcal urinary antigen
  • meningococcal PCR
  • lumbar puncture
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7
Q

viral skin pathogens

A 
herpes simplex 
papilomavirus 
molluscum 
orf
varicella
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8
Q

bacterial skin pathogens and syndrome

A
  • S aureus (impetigo, furunculosis, boils, toxic epidermal necrolysis, acute paronychia)
  • S pyrogenes (cellulitis, eryipelas, impetigo)
  • C diphteriae (cutaenous diphteria)
  • M tuberculosis (lupus vulgaris)
  • M marinum (chronic ulcerative disease)
  • M ulcerans (destructive ulcer)
  • pseudomonas aerinosa (colonises burns)
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9
Q

fungal skin pathogens

A

epidemophyton

  • microsporum
  • trichophyton
  • candida
  • malassezia furfur
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10
Q

causes of necrotizing fasciitis

A
  • group 1: mixed aerobic and anerobic bacteria

- group 2: group A streptococci

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11
Q

presentation of necrotizing fasciitis

A
  • pain at site of infection out of proportion with skin findings
  • fever, confusion, weakness, diarrhoea
  • shock
  • discoloured or infected area
  • erythema rapidly spreading
  • woody induration and crepitus
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12
Q

treatment of necrotizing fasciitis

A

EMERGENCY

  • antibiotics
  • surgical eploration, debriement and amputation if necessary)
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13
Q

def necrotizing fasciitis

A

rapidly spreading infection of deep fascia, with inflammation leading to necrosis of subcutaneous tissue planes

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14
Q

different types of necrotizing fasciitis

A

type 1:

  • 1+ anaerobic species AND enterobacteria
  • ususally associated with diabetes or peripheral vascular disease

type 2:

  • group 1 streptococcus (isolated alone or with otheer bacteria: staph aureus)
  • haemolytic streptococcal gangrene
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15
Q

differentials for necrotizing fasciitis

A

cellulitis
pyomyositis
gas gangrene

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16
Q

causes of cellulitis

A

S aureus
S pyrogenes
pasteurella multocida
Psudomonas aeruginosa

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17
Q

risk factors for cellulitis

A
  • venous status/lymphoedema
  • obesity
  • diabetes
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18
Q

differentials for cellulitis

A
  • DVT
  • lymphoedema
  • venous insufficiency
  • venous eczema
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19
Q

treatment of cellulitis

A

Uncomplicated:

  • flucloxacillin (first line)
  • co-amoxiclav (mammal bites)
  • piperacillin with tazobactam
  • clindamycin (if penicillin allergic)

MRSA:
- vancomycin

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20
Q

risk factors for MRSA

A
  • recent course of antibiotics
  • hospital admissions
  • open wounds
  • contact with someone with MRSA
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21
Q

different treatments available for MRSA

A
  • vancomycin
  • doxycycline
  • linezolid
  • teicoplanin
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22
Q

warts pathogen

A

HPV

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23
Q

def verrucae

A

plantar warts: direct contact under wet conditions

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24
Q

warts management

A
  • resolve spontaneously

consider treatment if: painful, consmetically unsightly, persisting wart

  • cryptotherapy
  • topical salicylic acid
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25
cause of gas gangrene
costridium perfingens
26
symptoms of gas gangrene
infected would foul discharge tender on palpation crepitus felt
27
management of gas gangrene
rapidly progressive and life threatening - surgical debriement - antibiotics
28
common causes of CAP
- strep pneumonia - haemophilus influenza - myycoplasm pneumonia (atypical pneumonia)
29
def atypical pneumonia
inflammation of interstitium not alveoli: CXR will be clear
30
aspiration pneumonia features and pathogen associated
red current jelly | Klabsiella pneumonia
31
assessment in CAP
- ABCDE - bloods: normal, clotting and glucose - CXR - Sepsis screen + VCURB65 - sputum culture - throat swab for viral OCR - urine for pneumococcal and legionella - BBV screen
32
management of CAP
CURB 0-1: amoxicillin CURB 2: amoxicillin and clarythromycin CURB 3+: co-amoxiclav and doxy or clarythromycin
33
types of influenza and which is most common? most serious?
A, B and C most common: A and B most serious A>B
34
what classes of surface antigen do you find on influenza
H and N
35
symptoms of uncomplicated influenza
fever coryza headaches, malaise, myalgia, arthralgia GI symptoms
36
presentation of complicated influenza
requires hospital admission and/or symptoms and signs of LRTI (primary viral pneumonia or bacteria pneumonia) CNS involvement (encephalitis, myelitis, GBS, aseptic meningitis) or/and significant exacerbation of underlying medical condition
37
how do you manage severe acute respiratory infections
discuss with infection specialist side room with resp precautions make sure hydration and oxygen levels are managed
38
investigations for SARI
- blood cultures (x2) - sputum culrues (bacterial and legionella) - legionella urine antigen - nasopharyngeal swab for viral PCR - chlamydiaphilia/mycoplasma PCR - bacterial throat swab
39
common viral causes of SARI
- influenza - adenovirus - parainfluenza virus - respiratory syncytial virus - SARS - MERS - COVID
40
risk factors for SARI
??
41
who is at increased risk for infective diarrhoea
- recent travellers - immunosuppresed - care home/hospiral patients
42
diarrhoea in immunocompromised patient
- salmonella, campylobacter, C diff, shigella, mycobacterium tuberculosis, cytomegalovirus, fungal/parasitic infections, norovirus, gardia
43
how does diarrhoea preseenation different in immunocompromised
more severe and longer course of infection
44
investigations for diarrhoea in immunocompromised patient
- normal bloods + clotting and lactate - blood cultures (if septic) - faecal sample CS&M: must tell lab patient immunocompromised - ABG - sigmoidoscopy
45
management of immunocompromised patient with diarrhoea
- in post transplant: must contact transplant team - fluids resucue (ORS or IV fluids) - consider empiric antibiotics - urgent sigmoidoscopy to exclude colitis - HIV test
46
management of fungal infection (investigations and treatment)
- serum fungal antigen test (beta-D-glucan) - IV antifungals (2 weeks) - remove lines and send for culture - fungal culture for urine - echo
47
causes of glandular fever
EBV | CMV
48
spread of glandular fever
- not very contagious - spread through contact with saliva, sex, blood transfusions, organ tranplantations and intrauterine - during incubation time (4-7 weeks) and while symptoms are present
49
lifelong effect of glandular fever infectopn
- latent carrier state | - reactivation more likely in immunocompromised
50
management of glandular fever
- self limiting (2-4 weeks) - analgesia - encourage people to go about normal activities ASAP - advice to avoid heacy lifting/contact sport for the first month (splenic rupture) - advise on spread of disease - arrange hospital admission if serious complications suspected
51
complications of glandular fever
- upper airway obstruction - splenic rupture - neutropaenia - malignant disease (in immunocompromised)
52
presentation of glandular fever
sore throat pyrexia lymphadenopathy malaise, anorexia, headache splenomegaly
53
diagnosis of glandular fever
Monospot test (heterophil antibody test) in second week of illness
54
different parasitic infections
- schisctosomiasis - strongyloidiasis - filariasis - malaria
55
risk factors for parasitic infections
- HIV/immunocompromised - eating raw foods - walking barefoor in areas endemic for soil transmitted helminths - living in close proximity with animals - swimming in waters endemic areas - travel
56
schistosomiasis def
parasitic flatworm infection present in bowels or bladder
57
route of inf schitosomiasis
freshwater, penetrate through skin
58
route inf of strongyloidiasis
soil
59
presentation of malaria
- fever - headache - chills/sweating - fatigue/pain - back pain - enlarged spleen - nausea and vomiting
60
spread of giardiasis and what type of pathogen
faecal oral | flagellate protozoan
61
features of giardiasis
- often asymptomaticc - lethargy, bloating, abdo pain - flatulence - non bloody diarrhoea
62
treatment for giardiasis
metronidazole
63
what test to do if suspect parasitic gastroenteritis
stool microscopy for trophoite and cysts
64
diagnosis of malaria
Blood smear normochromic normocytic anaemia - thrombocytopaaenia - elevate lactated dehydrogenase (haemolysis)
65
treatment of malarai
- chemoprophylaxis | - post infection treatment
66
amoebic liver abscess pathogens
- entamoeba histolytica parasite
67
amoebic liver abscess transmission route
feacal oral
68
pathogenesis of amoebic liver abscess
colonises small intestine and invade colonic mucosa | spread to liver via portal circulation
69
clinical features of amoebic liver abscess
- R upper quadrant pain - fever - recent Hx of diarrhoea and dysentry - jaundice (rare)
70
investigations for amoiebic liver abscess
- bloods (not associated with oesinophilia unlike other parasitic infections) - abdominal ultrasound - aspiration: think, brown fluid (anchovy pasteà - BBV screen (if indicated)
71
treatment of amoebic liver abscess
- metronidazole for 7-10 dzyd - lumen actuve agent - abcess drainage if significant complications
72
hepatitis B serology
- acute: early rise in anti core IgM - HbAg neg, HBVab positive: previous infection - HbAg pos and HbAb pos: chronic infection
73
hepatitis C serology
- HCV ab pos and HCV RNA neg: prior exposure | - HCV Ab pos and HCV RNA pos: chronic infection
74
hepatits B spread
blood (IVDU, medical) sex vertical
75
hep C transmission
blood (IVDU, medical) | sexual, vertical
76
treatment of hep B
- immunisation - acute: none - chronic: antivirals and interferon
77
treatment hep C
- interferon - ribavirin - protease inhibitors
78
complications of hepatitis
- liver cirrhosis | - hepatocellular carcinoma
79
indications for HIV testing
- chronic unexplained diarrhoea - oral candiditis - TB, pneumocystis - cerebral taxoplasmosis, primary cerebral lymphoma, cryptococcal meningitis - Kaposi's sarcoma - oral candidasis, hep B or C inf, salmonella, shigela or campylobacter inf - cervical cancer - chronic lympadenopathy, fever
80
if pregnant woman has HIV managemenr
babies: - test them at birth, 6, 12 weeks (HIV DNA PCR) - test them 18 months w/ HIV ab breast feeding: - small risk of infection - safety triangle: no virus (U), hppy tums (of baby) and healthy breast (of mums)
81
BBV testing
HIV antibody HBV: HBsAg, antiHBs HBC antibody
82
HIV treatment
- HAART (highly active antiretroviral therapy) IRIS: starting treatment can start Immune reconstitution inflammatory syndrome: pospone treatment in patient with serous opportunistic infections)
83
side effects of HAART
D&V, nausea headache tiredness rash lessens with time
84
HAART interactions
- nasal sprays inhalors herbal remedies (johns wort) recreational drugs
85
exposure to HIV manageemnt
Post exposure prophylaxis (PEP) | - start within 72h of exposure, take for 28 days
86
pre- exposure prophylaxis (PrEP)
for high risk individuals (sex or IVDU: partner with HIV, sharing needles with HIV person, keep using PEP, wanting to get pregnant and partner has HIV)

Year 4 (13 decks)

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