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UKMLA Prep > Infection 🦠 > Flashcards

Infection 🦠 Flashcards

Conditions and Presentation

1
Q

What is the most common cause of encephalitis

A

Herpes simplex virus

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2
Q

Melanoma ABCDE

A
  • Asymmetry
  • irregular Borders
  • Colour variegation
  • Diameter >6mm
  • Elevation/evolution of a skin lesion.
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3
Q

Fitzpatrick skin scale

A
  • 6 scales of skin
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4
Q

What is the most common type of melanoma that has a long radial phase?

A

Superficial spreading melanoma (Pagetoid)

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5
Q

Which melanoma type has a very long radial phase and exists as lentigo maligna before it starts invading the basement membrane?

A

Lentigo maligna melanoma (Hutchinson’s melanotic freckle)

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6
Q

What is the most aggressive type of melanoma that has no radial phase?

A

Nodular melanoma (ab initio)

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7
Q

Which melanoma type has a short radial phase, occurs more frequently in patients with darker skin tones, and involves the palms or soles?

A

Acral lentiginous melanoma

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8
Q

What type of melanoma grows under the nail?

A

Subungual melanoma

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9
Q

What type of melanoma lacks pigmentation?

A

Amelanotic melanoma

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10
Q

Max amount of units of alcohol per week

A

14 units

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11
Q

How to calculate units of alcohol

A

Units = strength (ABV) x volume (ml) ÷ 1000

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12
Q

Medical managment of smoking cessation- NRT

A
  • NRT (patches and oral for 8 weeks)
  • Start on quit day
  • Should not be used with varenicline or bupropion
  • contra-indicated in severe cardiovascular disease
  • SIDE EFFECTS: nausea, dizziness, vivid dreams and palpitations.
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13
Q

Bupropion

A
  • originally an anti-depressant
    *inhibits reuptake of dopamine, noradrenaline and serotonin in the brain. Helps with cessation
  • start 7-14 days before quit date
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14
Q

Contradiction of Bupropion (5)

A
  • Epilepsy (decreases seizure threshold)
  • Eating disorders and bipolar disorder
  • CNS tumours
  • Those experiencing current benzodiazepine or alcohol withdrawal
  • Pregnancy and breast-feeding
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15
Q

Varenicline (Champix)

A
  • partial nicotinic acetylcholine receptor agonist.
  • 7-14 days before the quit date; needs to be titred
  • contradicted in pregnancy
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16
Q

Who can’t use POP

A
  • women who smoke >15 cigarettes a day
  • over 35 years old
  • migraines with auras
  • breast-feeding women
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17
Q

Asthma exaccebation signs and symptoms

A
  • Tachypnoea
  • Increased work of breathing
  • Hyperinflated chest
  • Expiratory polyphonic wheeze throughout the lung fields
  • Decreased air entry (if severe)
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18
Q

Death verification procedure

A
  • Confirming the patients identity
  • Checking for any obvious signs of life
  • Checking response to verbal and painful stimuli
  • Assessing pupils - they should be fixed and dilated
  • Feeling a central pulse
  • Listening for heart sounds and respiratory sounds for a total of 5 minutes.
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19
Q

LUTI managment

A
  • 3 days oral nitrofurantoin or trimethoprim
  • conservative measures (e.g fluids)
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20
Q

UTI in Men managment

A
  • trimethoprim or nitrofurantoin for 7 days
  • Refer to urology if repeating symptoms
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21
Q

UTI during Pregnancy (with no haematuria) managment

A
  • nitrofurantoin (but avoid at term), for 7 days.
  • 2nd line: amoxicillin/cefelexin for 7 days.
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22
Q

Managment of pylonephritis

A
  • hospital admission
  • IV broad-spectrum cephalosporin, a quinolone, or gentamicin
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23
Q

Stem cell factor

A

Pluripotent cells

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24
Q

IL-3

A

CFU-GEMM

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25
Q

G-CSF

A

Granulocyte precursor

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26
Q

M-CSF

A

Monocyte precursor

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27
Q

IL-5

A

Eosinophil progenitors

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28
Q

Erythropoietin

A

Erythrocytes progenitors

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29
Q

Thrombopoietin

A

Megakaryocyte progenitor

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30
Q

IL6

A

B cell precursor

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31
Q

IL 2

A

T cell precursor

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32
Q

IL-1 and TNF

A

Stormal cells

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33
Q

Spleen blood supply

A

Splenic artery

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34
Q

Spleen blood drainage

A

Splenic veins - SMV to portal vein

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35
Q

Structures anterior to the spleen

A
  • stomach
  • tail of pancreas
  • left colic flexors
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36
Q

Medial to spleen

A

Left kidney

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37
Q

Posterior to spleen

A

Diaphragm
Ribs 9-11

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38
Q

Felty’s triad.

A

Rheumatoid arthritis (usually severe, longstanding RA).
Splenomegaly.
Neutropenia (low white blood cell count, specifically neutrophils).

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39
Q

What is whooping cough also known as?

A

‘Cough of 100 days’

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40
Q

What bacterium causes whooping cough?

A

Bordetella pertussis

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41
Q

At what ages are infants routinely immunised against whooping cough in the UK?

A

2, 3, 4 months and 3-5 years

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42
Q

What phase of whooping cough lasts around 1-2 weeks and has symptoms similar to a viral upper respiratory infection?

A

Catarrhal phase

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43
Q

What is a key feature of the paroxysmal phase of whooping cough?

A

Coughing bouts increase in severity

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44
Q

True or False: The inspiratory whoop is always present in whooping cough.

A

False

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45
Q

What are some complications of whooping cough? (4)

A
  • Subconjunctival haemorrhage
  • Pneumonia
  • Bronchiectasis
  • Seizures
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46
Q

What diagnostic criteria should raise suspicion for whooping cough?

A
  • Acute cough lasting 14 days or more
  • Paroxysmal cough
  • Inspiratory whoop
  • Post-tussive vomiting
  • Undiagnosed apnoeic attacks in infants
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47
Q

What type of swab is used to culture Bordetella pertussis?

A

Per nasal swab

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48
Q

What is the recommended antibiotic for infants under 6 months suspected of having whooping cough?

A

Oral macrolide (e.g. clarithromycin, azithromycin, erythromycin)

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49
Q

What is the school exclusion period for whooping cough after starting antibiotics?

A

48 hours after commencing antibiotics

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50
Q

What vaccination program was introduced for pregnant women in 2012?

A

Whooping cough vaccination program

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51
Q

What are the common symptoms of viral gastroenteritis?

A
  • Diarrhoea
  • Nausea and vomiting
  • Abdominal pain
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52
Q

What percentage of vaginal candidiasis cases are caused by Candida albicans?

A

80%

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53
Q

What are some predisposing factors for vaginal candidiasis?

A
  • Diabetes mellitus
  • Antibiotics
  • Steroids
  • Pregnancy
  • Immunosuppression (e.g., HIV)
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54
Q

What is a characteristic feature of vaginal candidiasis discharge?

A

‘Cottage cheese’, non-offensive discharge

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55
Q

What is the first-line treatment for vaginal candidiasis?

A

Oral fluconazole 150 mg as a single dose

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56
Q

What defines recurrent vaginal candidiasis according to BASHH?

A

4 or more episodes per year

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57
Q

What should be considered in the management of recurrent vaginal candidiasis?

A
  • Confirm diagnosis
  • High vaginal swab for microscopy and culture
  • Blood glucose test to exclude diabetes
  • Induction-maintenance regime
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58
Q

What should be used for treatment if a pregnant woman has vaginal candidiasis?

A

Only local treatments (e.g. cream or pessaries)

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59
Q

What is ascending cholangitis?

A

A bacterial infection of the biliary tree, typically caused by E. coli

Most common predisposing factor is gallstones.

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60
Q

What are the components of Charcot’s triad?

A
  • Right upper quadrant pain
  • Fever
  • Jaundice
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61
Q

What additional features are included in Reynolds’ pentad?

A
  • Hypotension
  • Confusion
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62
Q

What is the first-line investigation for suspected ascending cholangitis?

A

Ultrasound to look for bile duct dilation and bile duct stones

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63
Q

What is the initial management for ascending cholangitis?

A
  • Intravenous antibiotics
  • ERCP after 24-48 hours to relieve obstruction
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64
Q

What are common causes of brain abscesses?

A
  • Extension of sepsis from middle ear or sinuses
  • Trauma or surgery to the scalp
  • Penetrating head injuries
  • Embolic events from endocarditis
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65
Q

What are the presenting symptoms of a brain abscess? (6)

A
  • Headache
  • Fever
  • Focal neurology
  • Nausea
  • Papilloedema
  • Seizures
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66
Q

What is the typical management for a brain abscess?

A
  • Surgery (craniotomy and debridement)
  • IV antibiotics (3rd-generation cephalosporin + metronidazole)
  • Intracranial pressure management (e.g., dexamethasone)
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67
Q

What virus causes measles?

A

RNA paramyxovirus

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68
Q

What are the key features of measles?

A
  • Prodromal phase (irritability, conjunctivitis, fever)
  • Koplik spots
  • Maculopapular rash
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69
Q

What is the most common complication of measles?

A

Otitis media

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70
Q

What is reactive arthritis?

A

Arthritis that develops following an infection where the organism cannot be recovered from the joint

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71
Q

What are the typical symptoms of reactive arthritis?

A
  • Asymmetrical oligoarthritis of lower limbs
  • Dactylitis
  • Urethritis symptoms
  • Conjunctivitis (10-30%)
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72
Q

What is the common presentation of COVID-19?

A
  • Fever
  • Cough
  • Fatigue
  • Loss of taste or smell
  • Myalgia
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73
Q

What is the gold standard test for diagnosing COVID-19?

A

Reverse transcription polymerase chain reaction (RT-PCR)

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74
Q

What are the common management strategies for COVID-19?

A
  • Isolation
  • Supportive care (hydration, antipyretics, oxygen therapy)
  • Antivirals (e.g., Remdesivir)
  • Corticosteroids (e.g., Dexamethasone)
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75
Q

What is the typical age range for peak incidence of croup?

A

6 months to 3 years

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76
Q

What characterizes the cough in croup?

A

Barking, seal-like cough

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77
Q

What is the recommended management for mild croup?

A

Single dose of oral dexamethasone (0.15mg/kg)

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78
Q

What is herpes simplex (HSV) encephalitis commonly associated with?

A

Temporal lobe involvement

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79
Q

What is the treatment for herpes simplex encephalitis?

A

Intravenous aciclovir

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80
Q

What are common causes of diarrhoea in HIV patients? (4)

A
  • Cryptosporidium
  • Cytomegalovirus
  • Mycobacterium avium intracellulare
  • Giardia
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81
Q

What is the mainstay of management for Cryptosporidium infection in HIV patients?

A

Supportive therapy

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82
Q

What are the strains of herpes simplex virus in humans?

A
  • HSV-1
  • HSV-2
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83
Q

What is advised for pregnant women with a primary attack of herpes?

A

Elective caesarean section at term if it occurs after 28 weeks gestation

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84
Q

What is the most common infective cause of diarrhoea in HIV patients?

A

Cryptosporidium

Cryptosporidium is an intracellular protozoa with an incubation period of 7 days.

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85
Q

What type of stain may reveal the characteristic red cysts of Cryptosporidium?

A

Modified Ziehl-Neelsen stain

This is an acid-fast stain used for identifying certain pathogens.

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86
Q

What are the typical features of Mycobacterium avium intracellulare in HIV patients?

A
  • Fever
  • Sweats
  • Abdominal pain
  • Diarrhoea
  • Hepatomegaly
  • Deranged LFTs

Diagnosis is made by blood cultures and bone marrow examination.

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87
Q

What virus causes Kaposi’s sarcoma?

A

HHV-8 (human herpes virus 8)

Kaposi’s sarcoma presents as purple papules or plaques on the skin or mucosa.

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88
Q

What is the recommended ART regimen for HIV patients?

A

A combination of at least three drugs, typically two NRTIs and either a PI or NNRTI.

This combination decreases viral replication and reduces the risk of viral resistance.

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89
Q

What are the two types of entry inhibitors used in HIV therapy?

A
  • Maraviroc
  • Enfuvirtide

Maraviroc binds to CCR5, preventing interaction with gp41; enfuvirtide binds to gp41.

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90
Q

What are examples of NRTIs? (8)

A
  • Zidovudine (AZT)
  • Abacavir
  • Emtricitabine
  • Didanosine
  • Lamivudine
  • Stavudine
  • Zalcitabine
  • Tenofovir

NRTIs are associated with peripheral neuropathy and specific adverse effects.

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91
Q

What are common side effects of NNRTIs?

A
  • P450 enzyme interaction
  • Rashes

Nevirapine induces P450 enzyme.

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92
Q

What are the side effects of protease inhibitors (PI)?

A
  • Diabetes
  • Hyperlipidaemia
  • Buffalo hump
  • Central obesity
  • P450 enzyme inhibition

Indinavir can cause renal stones and ritonavir is a potent inhibitor of the P450 system.

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93
Q

What are the symptoms of Toxoplasmosis in HIV patients? (4)

A
  • Constitutional symptoms
  • Headache
  • Confusion
  • Drowsiness

It accounts for around 50% of cerebral lesions in patients with HIV.

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94
Q

What distinguishes primary CNS lymphoma from toxoplasmosis on a CT scan?

A

Primary CNS lymphoma typically shows single or multiple homogenous enhancing lesions, while toxoplasmosis shows multiple ring-enhancing lesions.

This differentiation is important due to vastly different treatment strategies.

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95
Q

What is the most common fungal infection of the CNS?

A

Cryptococcus

Symptoms include headache, fever, malaise, nausea/vomiting, seizures, and focal neurological deficit.

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96
Q

What condition accounts for up to 10% of end-stage renal failure cases in the United States related to HIV?

A

HIV-associated nephropathy (HIVAN)

Antiretroviral therapy is the treatment of choice for HIVAN.

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97
Q

What are the five key features of HIVAN?

A
  • Massive proteinuria resulting in nephrotic syndrome
  • Normal or large kidneys
  • Focal segmental glomerulosclerosis
  • Elevated urea and creatinine
  • Normotension

Focal or global capillary collapse may be observed on renal biopsy.

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98
Q

What are common symptoms of HIV seroconversion?

A
  • Sore throat
  • Lymphadenopathy
  • Malaise
  • Myalgia
  • Arthralgia
  • Diarrhoea
  • Maculopapular rash
  • Mouth ulcers

Rarely, it may present as meningoencephalitis.

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99
Q

What is the typical timeline for HIV antibodies to develop post-infection?

A

4-6 weeks, with 99% developing antibodies by 3 months

Testing typically involves both ELISA and confirmatory Western Blot Assay.

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100
Q

What is the purpose of the p24 antigen test in HIV diagnosis?

A

To detect the viral core protein that appears early in the blood after infection.

It is usually positive from about 1 week to 3-4 weeks after infection.

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101
Q

What is the first-line test for HIV screening of asymptomatic individuals?

A

Fourth-generation tests (HIV antibody and p24 antigen)

These tests have a sensitivity approaching 100% for chronic HIV infection.

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102
Q

What is polymyalgia rheumatica (PMR)?

A

A condition in older people characterized by muscle stiffness and raised inflammatory markers

PMR is closely related to temporal arteritis but does not appear to be a vasculitic process.

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103
Q

What are the typical features of PMR?

A
  • Typically patients are > 60 years old
  • Usually rapid onset (e.g. < 1 month)
  • Aching, morning stiffness in proximal limb muscles
  • Mild polyarthralgia, lethargy, depression, low-grade fever, anorexia, night sweats

Weakness is not considered a symptom of PMR.

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104
Q

What investigations are used for PMR?

A
  • Raised inflammatory markers (e.g. ESR > 40 mm/hr)
  • Normal creatine kinase and EMG

ESR stands for Erythrocyte Sedimentation Rate.

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105
Q

What is the first-line treatment for PMR?

A

Prednisolone (e.g. 15mg/od)

Patients typically respond dramatically to steroids.

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106
Q

What is pneumonia?

A

An inflammatory condition affecting the alveoli in the lungs caused by pathogens

Pathogens can include bacteria, viruses, and fungi.

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107
Q

What is the most common cause of community acquired pneumonia (CAP)?

A

Streptococcus pneumoniae

This is a bacterial pathogen.

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108
Q

What are the risk factors for pneumonia?

A
  • Aged under 5 or over 65 years
  • Smoking
  • Recent viral respiratory tract infection
  • Chronic respiratory diseases (e.g. cystic fibrosis, COPD)
  • Immunosuppression (e.g. cytotoxic drug therapy, HIV)
  • Aspiration risk (e.g. neurological diseases, oesophageal obstruction)
  • IV drug users
  • Other non-respiratory comorbidities (e.g. diabetes, cardiovascular disease)
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109
Q

What are the common symptoms of pneumonia? (5)

A
  • Cough with purulent sputum (rust colored/bloodstained)
  • Dyspnoea
  • Chest pain (may be pleuritic)
  • Fever
  • Malaise
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110
Q

What signs may indicate pneumonia?

A
  • High temperature
  • Tachycardia
  • Hypotension
  • Confusion
  • Tachypnoea
  • Low oxygen saturation
  • Reduced breath sounds, bronchial breathing, crepitations/crackles
  • Dullness on percussion
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111
Q

What is the CRB65 criteria used for?

A

To assess pneumonia patients’ risk of death in a primary care setting

The CRB65 criteria include confusion, respiration rate, blood pressure, and age.

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112
Q

What does a CRB65 score of 0 indicate?

A

Low risk (less than 1% mortality risk)

Home-based care is recommended for patients with a CRB65 score of 0.

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113
Q

What is the CURB65 criteria used for?

A

To assess pneumonia patients’ risk of death in a secondary care setting

The CURB65 includes an additional criterion of urea > 7 mmol/L.

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114
Q

What is pulmonary tuberculosis (TB)?

A

An infectious disease caused by Mycobacterium tuberculosis

TB can remain dormant before progressing to its active form.

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115
Q

What are the primary infection symptoms of TB?

A
  • Fever
  • Pleuritic or retrosternal pain
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116
Q

What are the secondary infection features of TB? (6)

A
  • Cough becoming productive
  • Haemoptysis (in a minority)
  • Weight loss
  • Fatigue
  • Night sweats
  • Low-grade fever
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117
Q

What is MRSA?

A

Methicillin-resistant Staphylococcus aureus, a dangerous hospital-acquired infection

MRSA was one of the first organisms to highlight the dangers of hospital-acquired infections.

118
Q

Who should be screened for MRSA?

A

All patients awaiting elective admissions and all emergency admissions

Exceptions include day patients having terminations of pregnancy and ophthalmic surgery.

119
Q

What is the treatment for MRSA infections?

A
  • Vancomycin
  • Teicoplanin
  • Linezolid

Some strains may also be sensitive to rifampicin, macrolides, tetracyclines, aminoglycosides, and clindamycin but should not be used alone.

120
Q

What causes giardiasis?

A

The flagellate protozoan Giardia lamblia

It is spread by the faeco-oral route.

121
Q

What are the common features of giardiasis?

A
  • Often asymptomatic
  • Non-bloody diarrhoea
  • Steatorrhoea
  • Bloating
  • Abdominal pain
  • Lethargy
  • Weight loss
122
Q

What is the treatment for giardiasis?

A

Metronidazole

123
Q

What are the symptoms of viral gastroenteritis?

A
  • Diarrhoea
  • Nausea and vomiting
  • Abdominal pain
124
Q

What causes Lyme disease?

A

The spirochaete Borrelia burgdorferi, spread by ticks

125
Q

What is the characteristic rash associated with Lyme disease?

A

Erythema migrans, a ‘bull’s-eye’ rash at the site of the tick bite

Typically develops 1-4 weeks after the initial bite.

126
Q

What is the management for suspected/confirmed Lyme disease?

A

Doxycycline if early disease; Amoxicillin is an alternative if doxycycline is contraindicated

Ceftriaxone is used for disseminated disease.

127
Q

What are notifiable diseases in the UK? (33)

A
  • Acute encephalitis
  • Acute infectious hepatitis
  • Acute meningitis
  • Acute poliomyelitis
  • Anthrax
  • Botulism
  • Brucellosis
  • Cholera
  • COVID-19
  • Diphtheria
  • Enteric fever
  • Food poisoning
  • Haemolytic uraemic syndrome
  • Infectious bloody diarrhoea
  • Invasive group A streptococcal disease
  • Legionnaires Disease
  • Leprosy
  • Malaria
  • Measles
  • Meningococcal septicaemia
  • Mumps
  • Plague
  • Rabies
  • Rubella
  • Severe Acute Respiratory Syndrome
  • Scarlet fever
  • Smallpox
  • Tetanus
  • Tuberculosis
  • Typhus
  • Viral haemorrhagic fever
  • Whooping cough
  • Yellow fever
128
Q

What is osteomyelitis?

A

An infection of the bone

It may be subclassified into haematogenous and non-haematogenous osteomyelitis.

129
Q

What is the most common cause of haematogenous osteomyelitis?

A

Staphylococcus aureus, except in patients with sickle-cell anaemia where Salmonella species predominate

130
Q

What is the management for osteomyelitis?

A

Flucloxacillin for 6 weeks; clindamycin if penicillin-allergic

131
Q

What causes chickenpox?

A

Primary infection with varicella zoster virus

132
Q

What are the clinical features of chickenpox?

A
  • Fever initially
  • Itchy rash starting on head/trunk before spreading
  • Rash transitions from macular to papular to vesicular
133
Q

What is the incubation period for chickenpox?

A

10-21 days

134
Q

What is the management for chickenpox?

A

Supportive care, keep cool, trim nails, calamine lotion

Immunocompromised patients and newborns with peripartum exposure should receive varicella zoster immunoglobulin (VZIG).

135
Q

What is the common manifestation of invasive group A streptococcal soft tissue infections?

A

Necrotizing fasciitis

This occurs in a small number of patients and may result in serious complications.

136
Q

List rare complications associated with infections.
(6)

A
  • Pneumonia
  • Encephalitis (cerebellar involvement)
  • Disseminated haemorrhagic chickenpox
  • Arthritis
  • Nephritis
  • Pancreatitis
137
Q

What are the initial symptoms of Chickenpox?

A
  • Fever
  • Itchy rash starting on head/trunk
  • Systemic upset usually mild
138
Q

What are the key features of Measles?

A
  • Prodrome: irritable, conjunctivitis, fever
  • Koplik spots: white spots on buccal mucosa
  • Rash: starts behind ears, becomes blotchy & confluent
139
Q

What is the incubation period for Measles?

A

10-14 days

140
Q

What causes Erythema infectiosum?

A

Parvovirus B19

141
Q

What is a characteristic rash of Erythema infectiosum?

A

‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces

142
Q

What is the main cause of Scarlet fever?

A

Erythrogenic toxins produced by Group A haemolytic streptococci

143
Q

What are the clinical features of Hand, foot and mouth disease?

A
  • Mild systemic upset: sore throat, fever
  • Oral ulcers
  • Vesicles on palms and soles
144
Q

What is the treatment for Scarlet fever?

A

Oral penicillin V for 10 days

Azithromycin for those with penicillin allergy.

145
Q

What are Koplik spots and when do they appear?

A

White spots (‘grain of salt’) on the buccal mucosa, typically develop before the rash

146
Q

What is the common age range affected by Roseola infantum?

A

6 months to 2 years

147
Q

What is a notable feature of the rash in Roseola infantum?

A

Maculopapular rash following high fever

148
Q

What are the complications of Measles? (6)

A
  • Otitis media
  • Pneumonia
  • Encephalitis
  • Subacute sclerosing panencephalitis (rare)
  • Febrile convulsions
  • Diarrhoea
149
Q

What is the infectious period for Rubella?

A

7 days before symptoms to 4 days after rash onset

150
Q

What is the typical rash appearance in Rubella?

A

Pink maculopapular rash, initially on face before spreading

151
Q

What is the incubation period for Rubella?

A

14-21 days

152
Q

What characterizes the rash of Scarlet fever?

A

Fine punctate erythema sparing the palms and soles

153
Q

True or False: Children with Hand, foot and mouth disease need to be excluded from school.

A

False

154
Q

What should be done if an unimmunized child comes into contact with Measles?

A

Offer MMR vaccine within 72 hours

155
Q

What are Nagayama spots associated with?

A

Roseola infantum

156
Q

What is the main management approach for Measles?

A

Supportive care

157
Q

What is a common complication of Scarlet fever?

A

Otitis media

158
Q

What is the typical age group for Scarlet fever incidence?

A

2 - 6 years, peak at 4 years

159
Q

What is the recommendation for annual influenza vaccination?

A

Recommended for people older than 65 years and those with certain chronic conditions

Chronic conditions include respiratory, heart, kidney, liver, neurological diseases, diabetes, immunosuppression, asplenia, and pregnant women.

160
Q

Who are considered at-risk individuals for influenza vaccination?

A

Includes health and social care staff, residents in care homes, and carers of at-risk individuals

At-risk groups are determined at the GP’s discretion.

161
Q

What are the main types of vaccines? (6)

A
  • Live attenuated
  • Inactivated preparations
  • Toxoid
  • Subunit and conjugate
  • Messenger RNA (mRNA)
  • Viral vector vaccines

Each type has unique characteristics and examples.

162
Q

What is a live attenuated vaccine?

A

Utilizes a weakened form of the pathogen to stimulate an immune response

Not recommended for individuals with compromised immune systems.

163
Q

What is the difference between monovalent and multivalent vaccines?

A
  • Monovalent: Contains a singular antigenic component
  • Multivalent: Comprises multiple antigenic components

Example of monovalent is the measles vaccine; quadrivalent influenza vaccine is multivalent.

164
Q

How many doses of tetanus vaccine are provided in the UK immunisation schedule?

A

Five doses

Administered at 2 months, 3 months, 4 months, 3-5 years, and 13-18 years.

165
Q

What is the first step in managing a wound?

A

Classify the wound

Categories include clean wound, tetanus prone wound, and high-risk tetanus prone wound.

166
Q

What is the recommendation for immunocompromised individuals regarding live vaccines?

A

They should not receive live attenuated vaccines

Examples include BCG, MMR, and oral rotavirus vaccines.

167
Q

What is the effectiveness of the influenza vaccine in adults?

A

Around 75% effective

Effectiveness may decrease in the elderly.

168
Q

What is the recommended age for the first dose of the oral rotavirus vaccine?

A

2 months

A second dose is required at 3 months.

169
Q

What are the contraindications for the MMR vaccine? (4)

A
  • Severe immunosuppression
  • Allergy to neomycin
  • Recent live vaccine within 4 weeks
  • Pregnancy (avoid for 1 month post-vaccination)
  • Immunoglobulin therapy within 3 months

These contraindications ensure safety and efficacy of the vaccine.

170
Q

What is the storage requirement for the influenza vaccine?

A

Stored between +2 and +8ºC and shielded from light

Proper storage is crucial for vaccine efficacy.

171
Q

What is the recommended vaccination schedule for children in the UK?

A

Includes BCG, 6-in-1 vaccine, oral rotavirus, Men B, MMR, and flu vaccine

Specific ages for vaccines include at birth, 2 months, 3 months, 4 months, and 12-13 months.

172
Q

True or False: The Men C vaccine is still offered to babies at 12 weeks of age.

A

False

The Men C vaccine has been discontinued from the NHS childhood vaccination programme.

173
Q

What is the purpose of the pneumococcal conjugate vaccine?

A

To protect against pneumococcal infections

It is recommended for certain at-risk populations.

174
Q

Fill in the blank: The rotavirus vaccine is a _______ vaccine.

A

live attenuated

175
Q

What adverse effects may occur after the first dose of the MMR vaccine?

A
  • Malaise
  • Fever
  • Rash

These typically occur 5-10 days post-vaccination and last around 2-3 days.

176
Q

When was the Men C vaccine discontinued from the NHS childhood vaccination programme?

A

July 1, 2016

177
Q

What is the result of the success of the Men C vaccination programme?

A

Almost no cases of Men C disease in babies or young children in the UK

178
Q

What vaccine is offered to children at one year of age?

A

Hib/Men C vaccine

179
Q

What vaccine is offered to children at 14 years of age?

A

Men ACWY vaccine

180
Q

What are the general contraindications to immunisation?

A
  • Confirmed anaphylactic reaction to a previous dose of a vaccine containing the same antigens
  • Confirmed anaphylactic reaction to another component in the relevant vaccine (e.g. egg protein)
181
Q

Under what conditions should vaccines be delayed?

A

Febrile illness/intercurrent infection

182
Q

What are the contraindications to live vaccines?

A
  • Pregnancy
  • Immunosuppression
183
Q

In which situation should DTP vaccination be deferred?

A

Children with an evolving or unstable neurological condition

184
Q

Which conditions are NOT contraindications to immunisation? (9)

A
  • Asthma or eczema
  • History of seizures (if associated with fever then advice should be given regarding antipyretics)
  • Breastfed child
  • Previous history of natural pertussis, measles, mumps or rubella infection
  • History of neonatal jaundice
  • Family history of autism
  • Neurological conditions such as Down’s or cerebral palsy
  • Low birth weight or prematurity
  • Patients on replacement steroids (e.g. CAH)
185
Q

What is the carcinogenic virus that infects keratinocytes?

A

Human papillomavirus (HPV)

186
Q

Which HPV strains are most important and what do they cause?

A
  • 6 & 11: causes genital warts
  • 16 & 18: linked to various cancers, notably cervical cancer
187
Q

What percentage of cervical cancers is HPV infection linked to?

A

Over 99.7%

188
Q

What is the role of HPV testing in cervical cancer screening?

A

Samples are first tested for HPV; if positive, cytology is then performed

189
Q

What other cancers is HPV linked to?

A
  • Around 85% of anal cancers
  • Around 50% of vulval and vaginal cancers
  • Around 20-30% of mouth and throat cancers
190
Q

What are other risk factors for developing cervical cancer?

A
  • Smoking
  • Combined oral contraceptive pill use
  • High parity
191
Q

What is the primary target group for the UK HPV immunisation programme?

A

12-13 years olds, both girls and boys

192
Q

Since when is the HPV vaccine now given as a single dose instead of two?

A

September 2023

193
Q

Who else is offered the HPV vaccine apart from school-aged children?

A
  • Gay, bisexual, and other men who have sex with men (GBMSM)
  • Eligible GBMSM under the age of 25
  • Eligible GBMSM aged 25 to 45 years
  • Immunosuppressed individuals or those known to be HIV-positive
194
Q

What does the Bacille Calmette-Guerin (BCG) vaccine protect against?

A

Tuberculosis (TB)

195
Q

Who is advised to receive the BCG vaccine in the UK? (8)

A
  • All infants (0 to 12 months) in high TB incidence areas
  • Infants with a parent/grandparent from high TB incidence countries
  • Tuberculin-negative contacts of respiratory TB cases
  • Tuberculin-negative new entrants under 16 from high TB incidence countries
  • Healthcare workers
  • Prison staff
  • Care home staff
  • Workers with homeless people
196
Q

What is the route of administration for the BCG vaccine?

A

Intradermally, normally to the lateral aspect of the left upper arm

197
Q

What are the contraindications for receiving the BCG vaccine?

A
  • Previous BCG vaccination
  • Past history of tuberculosis
  • HIV
  • Pregnancy
  • Positive tuberculin test
198
Q

What age group is not given the BCG vaccine and why?

A

Anyone over the age of 35, as there is no evidence it works for that age group

199
Q

What is the common outcome for warts?

A

Most resolve spontaneously within months or at most within 2 years

200
Q

What causes Giardiasis?

A

Flagellate protozoan Giardia lamblia

201
Q

What are the risk factors for Giardiasis? (3)

A
  • Foreign travel
  • Swimming/drinking water from rivers or lakes
  • Male-male sexual contact
202
Q

What are the common features of Giardiasis? (8)

A
  • Often asymptomatic
  • Non-bloody diarrhoea
  • Steatorrhoea
  • Bloating, abdominal pain
  • Lethargy
  • Flatulence
  • Weight loss
  • Malabsorption and lactose intolerance
203
Q

What is the treatment for Giardiasis?

A

Metronidazole

204
Q

What is viral gastroenteritis?

A

One of the most common conditions seen in medicine

205
Q

What are the common features of viral gastroenteritis?

A
  • Diarrhoea
  • Nausea and vomiting
  • Abdominal pain
206
Q

What is the most common cause of acute pyelonephritis?

A

Ascending infection, typically E. coli from the lower urinary tract

207
Q

List three clinical features of acute pyelonephritis.

A
  • Fever
  • Loin pain
  • Nausea/vomiting
208
Q

What symptoms of cystitis may be present in acute pyelonephritis?

A
  • Dysuria
  • Urinary frequency
209
Q

What type of urine sample should all patients have sent before starting antibiotics?

A

Mid-stream urine (MSU)

210
Q

For how long should broad-spectrum cephalosporin or a quinolone be prescribed for acute pyelonephritis?

A

7-10 days

211
Q

What are the clinical features of a lower urinary tract infection (UTI)?

A
  • Dysuria
  • Urinary frequency
  • Urinary urgency
  • Cloudy/offensive smelling urine
  • Lower abdominal pain
  • Fever
  • Malaise
212
Q

True or False: Urine dipsticks should be used for diagnosing UTI in men.

A

False

213
Q

In which patients should urine cultures be sent?

A
  • Women aged > 65 years
  • Recurrent UTI
  • Pregnant women
  • Men
  • Visible or non-visible haematuria
214
Q

What antibiotics are recommended for non-pregnant women with lower UTIs?

A
  • Trimethoprim
  • Nitrofurantoin
215
Q

What is the first-line antibiotic treatment for symptomatic pregnant women with a UTI?

A

Nitrofurantoin

216
Q

What is the recommended duration of antibiotic treatment for pregnant women with a UTI?

A

7 days

217
Q

Fill in the blank: Asymptomatic bacteriuria in pregnant women should be treated to prevent progression to _______.

A

acute pyelonephritis

218
Q

When should catheterized patients be treated for asymptomatic bacteria?

A

They should not be treated

219
Q

What should be done if a catheter has been in place for more than 7 days in symptomatic patients?

A

Consider removing or changing the catheter

220
Q

What is the primary causative organism of UTIs in children?

A

E. coli

221
Q

What are the symptoms of UTI in infants?

A
  • Poor feeding
  • Vomiting
  • Irritability
222
Q

What urine collection method is preferable for children?

A

Clean catch

223
Q

What should be done for infants less than 3 months old with a UTI?

A

Refer immediately to a paediatrician

224
Q

When should imaging of the urinary tract be performed in infants with a first UTI?

A

Within 6 weeks

225
Q

What is a common adverse effect of bisphosphonates?

A

Oesophageal reactions

226
Q

What is the clinical use of bisphosphonates? (4)

A
  • Prevention and treatment of osteoporosis
  • Hypercalcaemia
  • Paget’s disease
  • Pain from bone metastases
227
Q

What should be corrected before giving bisphosphonates?

A

Hypocalcemia/vitamin D deficiency

228
Q

What is the recommended duration for bisphosphonate treatment in low-risk patients?

A

Stop at 5 years

229
Q

What should be done for patients >= 75 years with a fragility fracture?

A

Start first-line therapy without needing a DEXA scan

230
Q

What is the threshold age for assessing osteoporosis risk in women according to NICE?

A

65 years

231
Q

What is the significance of a DEXA scan in patients under 75 years of age?

A

To assess ongoing fracture risk

232
Q

What does FRAX assess?

A

10-year risk of developing a fracture

233
Q

What should be done if a patient’s calculated fracture risk is in the orange zone?

A

Arrange a DEXA scan

234
Q

What are some secondary causes of osteoporosis? (4)

A
  • Hormonal disorders
  • Chronic kidney disease
  • Gastrointestinal disorders
  • Malabsorption
235
Q

Fill in the blank: Advancing age and _______ are significant risk factors for osteoporosis.

A

female sex

236
Q

What is a major risk factor for osteoporosis?

A

Corticosteroid use

The use of corticosteroids significantly increases the risk of developing osteoporosis.

237
Q

What T-score range indicates osteopaenia?

A

-1.0 to -2.5

T-scores are used to assess bone mineral density in relation to a young reference population.

238
Q

What is the definition of osteoporosis according to the World Health Organization?

A

Presence of bone mineral density (BMD) of less than 2.5 standard deviations (SD) below the young adult mean density

Osteoporosis is characterized by a significant decrease in bone mass.

239
Q

Which medication is the first-line treatment for osteoporosis?

A

Alendronate

Oral bisphosphonates like alendronate are commonly used for osteoporosis management.

240
Q

What is the recommended follow-up period for prescribing oral bisphosphonates?

A

At least 5 years

Regular reassessment of fracture risk is necessary after this period.

241
Q

What is the significance of a T-score less than -2.5?

A

Indicates osteoporosis

This threshold is used to diagnose osteoporosis via bone mineral density assessment.

242
Q

Fill in the blank: The major risk factors for osteoporosis include _______.

A

Age, female gender, corticosteroid use, smoking, alcohol, low body mass index, family history

These factors increase the likelihood of developing osteoporosis.

243
Q

What is the purpose of using screening tools like FRAX or QFracture?

A

To assess the 10-year risk of developing a fragility fracture

These tools help identify patients who may require further evaluation for osteoporosis.

244
Q

True or False: Osteoporosis is usually symptomatic until a fracture occurs.

A

True

Many patients remain asymptomatic until they experience a fragility fracture.

245
Q

What investigations are recommended by NOGG for secondary causes of osteoporosis?

A

History and physical examination, blood tests, thyroid function tests, bone densitometry (DXA)

These tests help identify underlying conditions contributing to osteoporosis.

246
Q

What are the common side effects of bisphosphonates?

A

Gastrointestinal discomfort, oesophagitis, hypocalcaemia

Serious risks include atypical femoral fractures and osteonecrosis of the jaw.

247
Q

What is the management recommendation for patients over 65 years or with previous fragility fractures?

A

They should be offered bone protection

This is based on guidelines to prevent further fractures.

248
Q

What are the classical symptoms of falciparum malaria?

A

Paroxysms of fever, chills, sweating

These symptoms correspond to the erythrocytic cycle of the Plasmodium falciparum parasite.

249
Q

Fill in the blank: The primary vector for malaria is the _______ mosquito.

A

Female Anopheles

Understanding the vector is crucial for malaria prevention strategies.

250
Q

What is the first-line therapy for uncomplicated falciparum malaria?

A

Artemisinin-based combination therapies (ACTs)

WHO guidelines recommend ACTs as they are effective against resistant strains.

251
Q

What complication can occur in post-pubertal males with mumps?

A

Orchitis

This complication occurs in 25-35% of post-pubertal males following parotitis.

252
Q

What condition is characterized by a significant decrease in bone mass?

A

Osteoporosis

It is a skeletal disorder that increases the risk of fragility fractures.

253
Q

What is the most common cause of non-falciparum malaria?

A

Plasmodium vivax

Other causes include Plasmodium ovale and Plasmodium malariae.

254
Q

Which malaria species is predominantly found in Central America and the Indian Subcontinent?

A

Plasmodium vivax

255
Q

What is the recommended first-line therapy for uncomplicated falciparum malaria according to the 2010 WHO guidelines?

A

Artemisinin-based combination therapies (ACTs)

Examples include artemether plus lumefantrine and artesunate plus amodiaquine.

256
Q

What treatment is preferred by WHO for severe falciparum malaria?

A

Intravenous artesunate

257
Q

What parasite count typically necessitates parenteral treatment for severe falciparum malaria?

A

More than 2%

258
Q

What should be considered if the parasite count exceeds 10% in severe falciparum malaria?

A

Exchange transfusion

259
Q

What are the general features of malaria?

A

Fever, headache, splenomegaly

260
Q

What is the cyclical fever pattern for Plasmodium vivax and Plasmodium ovale?

A

Every 48 hours

261
Q

What is the cyclical fever pattern for Plasmodium malariae?

A

Every 72 hours

262
Q

What condition is associated with Plasmodium malariae?

A

Nephrotic syndrome

263
Q

What is a hypnozoite stage in malaria?

A

A dormant stage that may cause relapse following treatment

264
Q

In areas where chloroquine is sensitive, what does WHO recommend for treatment?

A

Either an ACT or chloroquine

265
Q

What should be given to patients with ovale or vivax malaria after acute treatment with chloroquine?

A

Primaquine

266
Q

What is Teriparatide?

A

Recombinant form of parathyroid hormone

267
Q

What is the role of Teriparatide in osteoporosis management?

A

Not yet clearly defined

268
Q

What is Romosozumab?

A

A monoclonal antibody that inhibits sclerostin

269
Q

How does Romosozumab affect bone health?

A

Increases bone formation and decreases bone resorption

270
Q

What common imaging finding is associated with osteoporosis?

A

Fractures of the thoracic vertebrae

271
Q

What are contraindications to lumbar puncture?

A

Signs of raised ICP, focal neurological signs, papilloedema, significant bulging of the fontanelle, disseminated intravascular coagulation, signs of cerebral herniation

272
Q

What should be obtained instead of a lumbar puncture for patients with meningococcal septicaemia?

A

Blood cultures and PCR for meningococcus

273
Q

What is the initial antibiotic treatment for patients under 3 months?

A

IV amoxicillin (or ampicillin) + IV cefotaxime

274
Q

What is the initial antibiotic treatment for patients over 3 months?

A

IV cefotaxime (or ceftriaxone)

275
Q

When should dexamethasone be considered in meningitis management?

A

If lumbar puncture reveals frankly purulent CSF, CSF white blood cell count > 1000/microlitre, raised CSF white blood cell count with protein concentration > 1 g/litre, or bacteria on Gram stain

276
Q

What is the most common cause of meningitis in neonates?

A

Group B Streptococcus

277
Q

What are the CSF findings in bacterial meningitis?

A
  • Appearance: Cloudy
  • Glucose: Low (< 1/2 plasma)
  • Protein: High (> 1 g/l)
  • White cells: 10 - 5,000 polymorphs/mm³
278
Q

What condition are patients with meningococcal meningitis at risk for?

A

Waterhouse-Friderichsen syndrome

279
Q

What is the role of the ABC approach in meningitis management?

A

Airway, Breathing, Circulation, Disability (GCS, focal neurological signs, seizures, papilloedema)

280
Q

True or False: A lumbar puncture should be performed immediately in all cases of suspected meningitis.

A

False

281
Q

What tests should be performed on blood samples taken from suspected meningitis patients?

A
  • Full blood count
  • Renal function
  • Glucose
  • Lactate
  • Clotting profile
  • CRP
282
Q

What is the recommended prophylactic antibiotic for contacts of patients with meningococcal meningitis?

A

Ciprofloxacin

283
Q

What is the common clinical presentation of viral meningitis?

A
  • Headache
  • Neck stiffness
  • Photophobia
  • Confusion
  • Fevers
284
Q

What cerebrospinal fluid findings are characteristic of viral meningitis?

A
  • Opening Pressure: 10 - 20 cm³ H²O
  • Cell count: 10-300 cells/µL
  • Cell differential: Lymphocytes
  • Glucose: 2.8 - 4.2 mmol/L or 2/3 serum glucose
  • Protein: 0.5 - 1 g/dL
285
Q

What should be done while waiting for lumbar puncture results in suspected meningitis cases?

A

Supportive treatment and broad-spectrum antibiotics if bacterial meningitis is suspected

286
Q

What are the common viral causes of viral meningitis? (7)

A
  • Non-polio enteroviruses (e.g., coxsackie virus, echovirus)
  • Mumps
  • Herpes simplex virus (HSV)
  • Cytomegalovirus (CMV)
  • Herpes zoster viruses
  • HIV
  • Measles
287
Q

What is the preferred antibiotic for treating meningococcal meningitis?

A

IV benzylpenicillin or cefotaxime (or ceftriaxone)

288
Q

Fill in the blank: Meningitis is an inflammation of the _______ and the cerebrospinal fluid of the subarachnoid space.

A

leptomeninges

289
Q

What is the sensitivity of the Ziehl-Neelsen stain in detecting tuberculous meningitis?

A

20%

290
Q

What are some neurological sequelae of meningitis? (7)

A
  • Sensorineural hearing loss
  • Seizures
  • Focal neurological deficit
  • Sepsis
  • Intracerebral abscess
  • Brain herniation
  • Hydrocephalus

UKMLA Prep (46 decks)

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