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3B > ID > Flashcards

ID Flashcards

1
Q

What cancers are associated with EBV?

A

Hodgkins, Burkits and gastric

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2
Q

What are the complications of a congenital CMV infection?

A

Prematurity, low birth weight, jaundice, enlarged liver, microcephaly, rash, pneumonia and seizures

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3
Q

Hep B serology:

What are the 3 antigens that Hep B has?

A

HBsAG (hep B surface antigen)
HBcAG (hep B core antigen)
HBeAG (hep B e antigen - a secreted protein with unknown function)

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4
Q

Hep B serology:

What Hep B serology marker would be +ve if they have an infection?

A

HBsAg would be positive if they have a an active infection

Surface antigen is the first thing seen in the serum 4w–>12wks and then is replaced by anti-HBs

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5
Q

Hep B serology:

Which Hep B serum marker tests if they have some immunity (regardless if it is from vaccine or from past infection)?

A

HB surface antibody

Tests for immunity +ve for vaccination or if they have had a past infection

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6
Q

Anti-HBc determines if they have got their immunity from a past infection or if it has just been from the vaccine. What would the following results mean?
Anti-HBc: IgG +ve and IgM -ve

A

They have got their immunity from the vaccine

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7
Q

Anti-HBc determines if they have got their immunity from a past infection or if it has just been from the vaccine. What would the following results mean?
Anti-HBc: IgG +ve and IgM +ve

A

They have had a past infection and cleared it

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8
Q

When do you vaccinate against Hep B?

A
  • HBsAG given at 0, 1 & 6/12 with boosters every 5 years
  • Anti HBV immunoglobulins
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9
Q

What are the symptoms of Hep B?

A

Fever, Jaundice and elevated liver transaminases

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10
Q

What are the complications of Hep B infection?

A

Chronic hepatitis
Fulminant liver failure
HCC
Glomerular nephritis

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11
Q

How would you diagnose Hep C?

A

Serum test for: HCV RNA

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12
Q

Do the majority of people with Hep C go onto clear the virus or to have chronic disease?

A

15-45% clear

55-85% go onto have chronic hepatitis

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13
Q

What defines chronic hep c?

A

When they have had HCV RNA in the blood for >6m

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14
Q

What are the potential complications for Hep C?

A

HCC
Cirrhosis
Rhuem: arthralgia and arthritis
Eye: Sjogrens

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15
Q

What does the management of Hep C depend on?

A

Their viral genotype which should be tested for before starting treatment

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16
Q

How would you treat a chronic hep C infection?

A

1) Protease inhibitors (telaprivir, daclatasvir)
2) Antiviral - nucleoside inhibitor (Ribavirin)
3) Peg INF alpha

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17
Q 
Protease inhibitors are a class of drug used to treat Hep C. 
How do they work?
Give 2 examples
A

Protease inhibitors are anti-virals that prevent viral replication by selectively binding to proteases + blocking proteolytic cleavage of proteins
E.g Telaprevir + Beceprevir

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18
Q

How does PEG INF alpha work to treat Hep C?

A

PEG INF alpha acts as a multifunctional immuno-regulatory cytokine which stimulates B cells

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19
Q

What are the SE of PEG INF alpha?

A

Headache, fatigue, N + hairless
Flu-like symptoms, leukopenia and thrombocytopenia
Depression and fatigue

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20
Q

How does Ribavirin work?

A

It is an anti-viral that reduces the viral load as it is a nucleoside inhibitor

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21
Q

What are the SE of the specialist treatment of Hep C infection?

A

SE of the specialist Hep C treatment:

  • Flu-like symptoms
  • Haemolytic anaemia and other blood dyscrasias
  • Depression
  • Dry skin, eczema and itch
  • Hypo/hyperthyroidism
  • Sleep disturbances
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22
Q

What are the 4 types of malaria parasite?

A

Plasmodium falciparum
Plasmodium viva
Plasmodium malaria
Plasmodium ovale

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23
Q

Briefly explain the life-cycle of malaria

A

When an infected mosquito bits a human the sporozoites travel to the human liver where they mature. Mature organisms (merozoites) can rupture to release more organisms into the blood. Merozoites invade RBC and reproduce to make more sporozoites which can be transmitted/picked up by more mosquitos when they have a blood meal.
Infection of RBC –> haemolysis

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24
Q

A 26yr old has just returned from Africa. He is unwell with SOB, fits, hypoglycaemia and AKI and is bleeding. You suspect that he has a severe malaria infection - but what would your differentials be?

A 
Typhoid 
Hepatits 
Dengue fever 
Influenza 
HIV 
Viral haemorrhage fevers
25
Q

What is the gold standard test to dx malaria?

A

Thick and thin blood smears stained with giemsa

26
Q

How can you dx malaria?

A

1) Thick and thin blood smears stained with giemsa

2) Rapid diagnostic tests (RDTS) - dipstick based investigations

27
Q

How do you treat non-fallciparum malaria?

A

1) Chloroquine

Or if resistant:
- Malarone (atovaquone-proguanil)
//
- Riamet (artemether w. lumefantrine)

28
Q

How do you treat non-complicated Fallciparum malaria?

A 
Qunine + doxycyline 
or// 
Malarone  
or//
Riamet
29
Q

How do you treat complicated Fallciparum malaria?

A

Iv Quinine dihydrochloride with doxycycline

30
Q

What are the possible complications of malaria?

A 
LOC/siezures 
Renal impairment 
Acidosis 
Hypoglycaemia 
Anaemia 
Splenic rupture 
DIC 
Multiple organ failure 
Death
31
Q

What cells are most affected by HIV?

A

Helper T lymphocytes

other CD4 cells: monocytes+ macrophages

32
Q

What is HIV seroconversion?

A

HIV seroconversion is the time during which the HIV abs become detectable.
It is symptomatic in 60% of patients and they experience a glandular fever type illness

33
Q

What are some of the symptoms that someone experiencing the HIV seroconversion illness may experience?

A 
Sore throat 
Lymphadenopathy 
Malaise, myalgia and arthralgia 
Diarrhoea 
Maculopapular rash
34
Q

The window period of HIV is 1-3 weeks

How can you dx HIV during this time?

A

1) HIV RNA PCR

2) Core p24 antigen (detectable <4wks when there is very high viral replication)

35
Q

How do you diagnose HIV?

A

2 ab test:

1) ELISA
2) Western blot

+ serum CD4 count and HIV RNA PCR (for viral load)

36
Q

What are the stages of HIV?

A 
1 = Seroconversion (2-6 weeks) 
2 = asymptomatic/clinical latency 
3 = AIDs related complex (constitutional symptoms - fever, night sweats, D, weight loss + minor opportunistic infections) 
4 = AIDS 
(HIV + indicator disease)
37
Q

How do you treat HIV?

A

HAART = highly active anti retroviral therapy

> 3 different drugs are used to reduce the cross resistance

2x NRTI + 1x NNRTI

2x NRTI + 1x PI

38
Q

Give examples of the types of drugs used to treat HIV

A
  • Nucleoside reverse transcriptase inhibitors
  • Nucleotide reverse transcriptase inhibitors
  • Non-nucleoside reverse trancriptase inhibitors
  • Protease inhibitors
  • Fusion inhibitors
  • Integrase inhibitors
39
Q

What is PEP?

A

Post exposure prophylaxis
Start immediately if there has been significant exposure
- 4 week course usually of Truvada (NRTI) + Raltegravir (Integrase inhibitor)

40
Q

What is AIDs related complex?

A

It is a prodromal infection in a person with HIV which they can have before they develop AIDS
Pyrexia, fever, night sweats, D and weight loss
It is differentiated between AIDS with serology markers (b lymphocytes levels ect…)
Not used as much now

41
Q

Define AIDS

A

Acquired immune deficiency syndrome
It is defined by the occurrence of any of more than 20 opportunistic infections or HIV-related cancers in a person who is HIV +ve

42
Q

Give examples of the AIDS defining illnesses

A 
CMV - cytomegalovirus 
PCP - pneumocystis jirovecii 
TB 
Cancers - Karposi's sarcoma + lymphoma 
Candidiasis 
HSV 
VZV - at multiple dermatomes
43
Q

What abx are used to treat MRSA?

A

1st line = vancomycin

2nd line = linezolid

44
Q

How would you treat a HIV patient who was also suffering with PCP chest infection?

A

co-trimoxazole

45
Q

What can cause headaches in a person with HIV who is not being treated?

A

Toxoplasmosis

Crytococcal meningitis

46
Q

What should you do if you get a needle stick injury?

A

Encourage it to bleed and run it under water and soap

47
Q

How would you treat a CMV infection in a person with HIV?

A

Ganciclovir

48
Q

What class of anti-retrovirals does Lamivudine belong to?

A

Nucleoside reverse transcriptase inhibitors

49
Q

What are the SE of the Nucleoside reverse transcriptase inhibitors

A

Haemolytic anaemia and hypersensitivity reactions

50
Q

What class of anti-retrovirals does raltegravir belong to?

A

Integrase inhibitors

51
Q

What class of anti-retrovirals does efavirenz belong to?

A

Non-nucleoside reverse transcriptase inhibitors

52
Q

What are the SE of Non-nucleoside reverse transcriptase inhibitors?

A

Rash, liver toxicity, drug interactions and sleep disturbance

53
Q

Which out of HIV, Hep B or Hep C is the most infectious?

A

Hep B

54
Q

There is no indication for treatment of acute Hep B infection however it can rarely go into fulminant hepatic failure which may need a liver transplant.
What blood test is used as a marker for this?

A

Increasing INR

55
Q

Hep C is the 3rd most common cause of liver failure in the UK.
What are the most common causes?

A

Alcohol and non-alcoholic fatty liver disease

56
Q

How do patients with Hep C get assessed for the severity of their liver disease?

A

They undergo a baseline liver fibrosis scan - Firboscan looking at the liver transient elastography (liver stiffness)

57
Q

How are patients with Hep C and evidence of cirrhosis screened for HCC?

A

6mly AFP and liver USS

[if there is evidence of portal HTN they are screened for gastric and oesophageal varies with an OGD]

58
Q

What factors reduce the efficacy of Hep C treatment?

A 
Male sex 
High HCV RNA 
Age >40 
Obesity 
HIV + Hep B co-infection
Degree of liver damage 
Black ethnicity

3B (21 decks)

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