Infection 🦠 Flashcards
Conditions and Presentation
1
Q
What is the most common cause of encephalitis
A
Herpes simplex virus
2
Q
Melanoma ABCDE
A
- Asymmetry
- irregular Borders
- Colour variegation
- Diameter >6mm
- Elevation/evolution of a skin lesion.
3
Q
Fitzpatrick skin scale
A
- 6 scales of skin
4
Q
What is the most common type of melanoma that has a long radial phase?
A
Superficial spreading melanoma (Pagetoid)
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)
6
Q
What is the most aggressive type of melanoma that has no radial phase?
A
Nodular melanoma (ab initio)
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
8
Q
What type of melanoma grows under the nail?
A
Subungual melanoma
9
Q
What type of melanoma lacks pigmentation?
A
Amelanotic melanoma
10
Q
Max amount of units of alcohol per week
A
14 units
11
Q
How to calculate units of alcohol
A
Units = strength (ABV) x volume (ml) ÷ 1000
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.
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
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
15
Q
Varenicline (Champix)
A
- partial nicotinic acetylcholine receptor agonist.
- 7-14 days before the quit date; needs to be titred
- contradicted in pregnancy
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
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)
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.
19
Q
LUTI managment
A
- 3 days oral nitrofurantoin or trimethoprim
- conservative measures (e.g fluids)
20
Q
UTI in Men managment
A
- trimethoprim or nitrofurantoin for 7 days
- Refer to urology if repeating symptoms
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.
22
Q
Managment of pylonephritis
A
- hospital admission
- IV broad-spectrum cephalosporin, a quinolone, or gentamicin
23
Q
Stem cell factor
A
Pluripotent cells
24
Q
IL-3
A
CFU-GEMM
25
G-CSF
Granulocyte precursor
26
M-CSF
Monocyte precursor
27
IL-5
Eosinophil progenitors
28
Erythropoietin
Erythrocytes progenitors
29
Thrombopoietin
Megakaryocyte progenitor
30
IL6
B cell precursor
31
IL 2
T cell precursor
32
IL-1 and TNF
Stormal cells
33
Spleen blood supply
Splenic artery
34
Spleen blood drainage
Splenic veins - SMV to portal vein
35
Structures anterior to the spleen
* stomach
* tail of pancreas
* left colic flexors
36
Medial to spleen
Left kidney
37
Posterior to spleen
Diaphragm
Ribs 9-11
38
Felty’s triad.
Rheumatoid arthritis (usually severe, longstanding RA).
Splenomegaly.
Neutropenia (low white blood cell count, specifically neutrophils).
39
What is whooping cough also known as?
'Cough of 100 days'
40
What bacterium causes whooping cough?
Bordetella pertussis
41
At what ages are infants routinely immunised against whooping cough in the UK?
2, 3, 4 months and 3-5 years
42
What phase of whooping cough lasts around 1-2 weeks and has symptoms similar to a viral upper respiratory infection?
Catarrhal phase
43
What is a key feature of the paroxysmal phase of whooping cough?
Coughing bouts increase in severity
44
True or False: The inspiratory whoop is always present in whooping cough.
False
45
What are some complications of whooping cough? (4)
* Subconjunctival haemorrhage
* Pneumonia
* Bronchiectasis
* Seizures
46
What diagnostic criteria should raise suspicion for whooping cough?
* Acute cough lasting 14 days or more
* Paroxysmal cough
* Inspiratory whoop
* Post-tussive vomiting
* Undiagnosed apnoeic attacks in infants
47
What type of swab is used to culture Bordetella pertussis?
Per nasal swab
48
What is the recommended antibiotic for infants under 6 months suspected of having whooping cough?
Oral macrolide (e.g. clarithromycin, azithromycin, erythromycin)
49
What is the school exclusion period for whooping cough after starting antibiotics?
48 hours after commencing antibiotics
50
What vaccination program was introduced for pregnant women in 2012?
Whooping cough vaccination program
51
What are the common symptoms of viral gastroenteritis?
* Diarrhoea
* Nausea and vomiting
* Abdominal pain
52
What percentage of vaginal candidiasis cases are caused by Candida albicans?
80%
53
What are some predisposing factors for vaginal candidiasis?
* Diabetes mellitus
* Antibiotics
* Steroids
* Pregnancy
* Immunosuppression (e.g., HIV)
54
What is a characteristic feature of vaginal candidiasis discharge?
'Cottage cheese', non-offensive discharge
55
What is the first-line treatment for vaginal candidiasis?
Oral fluconazole 150 mg as a single dose
56
What defines recurrent vaginal candidiasis according to BASHH?
4 or more episodes per year
57
What should be considered in the management of recurrent vaginal candidiasis?
* Confirm diagnosis
* High vaginal swab for microscopy and culture
* Blood glucose test to exclude diabetes
* Induction-maintenance regime
58
What should be used for treatment if a pregnant woman has vaginal candidiasis?
Only local treatments (e.g. cream or pessaries)
59
What is ascending cholangitis?
A bacterial infection of the biliary tree, typically caused by E. coli
## Footnote
Most common predisposing factor is gallstones.
60
What are the components of Charcot's triad?
* Right upper quadrant pain
* Fever
* Jaundice
61
What additional features are included in Reynolds' pentad?
* Hypotension
* Confusion
62
What is the first-line investigation for suspected ascending cholangitis?
Ultrasound to look for bile duct dilation and bile duct stones
63
What is the initial management for ascending cholangitis?
* Intravenous antibiotics
* ERCP after 24-48 hours to relieve obstruction
64
What are common causes of brain abscesses?
* Extension of sepsis from middle ear or sinuses
* Trauma or surgery to the scalp
* Penetrating head injuries
* Embolic events from endocarditis
65
What are the presenting symptoms of a brain abscess? (6)
* Headache
* Fever
* Focal neurology
* Nausea
* Papilloedema
* Seizures
66
What is the typical management for a brain abscess?
* Surgery (craniotomy and debridement)
* IV antibiotics (3rd-generation cephalosporin + metronidazole)
* Intracranial pressure management (e.g., dexamethasone)
67
What virus causes measles?
RNA paramyxovirus
68
What are the key features of measles?
* Prodromal phase (irritability, conjunctivitis, fever)
* Koplik spots
* Maculopapular rash
69
What is the most common complication of measles?
Otitis media
70
What is reactive arthritis?
Arthritis that develops following an infection where the organism cannot be recovered from the joint
71
What are the typical symptoms of reactive arthritis?
* Asymmetrical oligoarthritis of lower limbs
* Dactylitis
* Urethritis symptoms
* Conjunctivitis (10-30%)
72
What is the common presentation of COVID-19?
* Fever
* Cough
* Fatigue
* Loss of taste or smell
* Myalgia
73
What is the gold standard test for diagnosing COVID-19?
Reverse transcription polymerase chain reaction (RT-PCR)
74
What are the common management strategies for COVID-19?
* Isolation
* Supportive care (hydration, antipyretics, oxygen therapy)
* Antivirals (e.g., Remdesivir)
* Corticosteroids (e.g., Dexamethasone)
75
What is the typical age range for peak incidence of croup?
6 months to 3 years
76
What characterizes the cough in croup?
Barking, seal-like cough
77
What is the recommended management for mild croup?
Single dose of oral dexamethasone (0.15mg/kg)
78
What is herpes simplex (HSV) encephalitis commonly associated with?
Temporal lobe involvement
79
What is the treatment for herpes simplex encephalitis?
Intravenous aciclovir
80
What are common causes of diarrhoea in HIV patients? (4)
* Cryptosporidium
* Cytomegalovirus
* Mycobacterium avium intracellulare
* Giardia
81
What is the mainstay of management for Cryptosporidium infection in HIV patients?
Supportive therapy
82
What are the strains of herpes simplex virus in humans?
* HSV-1
* HSV-2
83
What is advised for pregnant women with a primary attack of herpes?
Elective caesarean section at term if it occurs after 28 weeks gestation
84
What is the most common infective cause of diarrhoea in HIV patients?
Cryptosporidium
## Footnote
Cryptosporidium is an intracellular protozoa with an incubation period of 7 days.
85
What type of stain may reveal the characteristic red cysts of Cryptosporidium?
Modified Ziehl-Neelsen stain
## Footnote
This is an acid-fast stain used for identifying certain pathogens.
86
What are the typical features of Mycobacterium avium intracellulare in HIV patients?
* Fever
* Sweats
* Abdominal pain
* Diarrhoea
* Hepatomegaly
* Deranged LFTs
## Footnote
Diagnosis is made by blood cultures and bone marrow examination.
87
What virus causes Kaposi's sarcoma?
HHV-8 (human herpes virus 8)
## Footnote
Kaposi's sarcoma presents as purple papules or plaques on the skin or mucosa.
88
What is the recommended ART regimen for HIV patients?
A combination of at least three drugs, typically two NRTIs and either a PI or NNRTI.
## Footnote
This combination decreases viral replication and reduces the risk of viral resistance.
89
What are the two types of entry inhibitors used in HIV therapy?
* Maraviroc
* Enfuvirtide
## Footnote
Maraviroc binds to CCR5, preventing interaction with gp41; enfuvirtide binds to gp41.
90
What are examples of NRTIs? (8)
* Zidovudine (AZT)
* Abacavir
* Emtricitabine
* Didanosine
* Lamivudine
* Stavudine
* Zalcitabine
* Tenofovir
## Footnote
NRTIs are associated with peripheral neuropathy and specific adverse effects.
91
What are common side effects of NNRTIs?
* P450 enzyme interaction
* Rashes
## Footnote
Nevirapine induces P450 enzyme.
92
What are the side effects of protease inhibitors (PI)?
* Diabetes
* Hyperlipidaemia
* Buffalo hump
* Central obesity
* P450 enzyme inhibition
## Footnote
Indinavir can cause renal stones and ritonavir is a potent inhibitor of the P450 system.
93
What are the symptoms of Toxoplasmosis in HIV patients? (4)
* Constitutional symptoms
* Headache
* Confusion
* Drowsiness
## Footnote
It accounts for around 50% of cerebral lesions in patients with HIV.
94
What distinguishes primary CNS lymphoma from toxoplasmosis on a CT scan?
Primary CNS lymphoma typically shows single or multiple homogenous enhancing lesions, while toxoplasmosis shows multiple ring-enhancing lesions.
## Footnote
This differentiation is important due to vastly different treatment strategies.
95
What is the most common fungal infection of the CNS?
Cryptococcus
## Footnote
Symptoms include headache, fever, malaise, nausea/vomiting, seizures, and focal neurological deficit.
96
What condition accounts for up to 10% of end-stage renal failure cases in the United States related to HIV?
HIV-associated nephropathy (HIVAN)
## Footnote
Antiretroviral therapy is the treatment of choice for HIVAN.
97
What are the five key features of HIVAN?
* Massive proteinuria resulting in nephrotic syndrome
* Normal or large kidneys
* Focal segmental glomerulosclerosis
* Elevated urea and creatinine
* Normotension
## Footnote
Focal or global capillary collapse may be observed on renal biopsy.
98
What are common symptoms of HIV seroconversion?
* Sore throat
* Lymphadenopathy
* Malaise
* Myalgia
* Arthralgia
* Diarrhoea
* Maculopapular rash
* Mouth ulcers
## Footnote
Rarely, it may present as meningoencephalitis.
99
What is the typical timeline for HIV antibodies to develop post-infection?
4-6 weeks, with 99% developing antibodies by 3 months
## Footnote
Testing typically involves both ELISA and confirmatory Western Blot Assay.
100
What is the purpose of the p24 antigen test in HIV diagnosis?
To detect the viral core protein that appears early in the blood after infection.
## Footnote
It is usually positive from about 1 week to 3-4 weeks after infection.
101
What is the first-line test for HIV screening of asymptomatic individuals?
Fourth-generation tests (HIV antibody and p24 antigen)
## Footnote
These tests have a sensitivity approaching 100% for chronic HIV infection.
102
What is polymyalgia rheumatica (PMR)?
A condition in older people characterized by muscle stiffness and raised inflammatory markers
## Footnote
PMR is closely related to temporal arteritis but does not appear to be a vasculitic process.
103
What are the typical features of PMR?
* 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
## Footnote
Weakness is not considered a symptom of PMR.
104
What investigations are used for PMR?
* Raised inflammatory markers (e.g. ESR > 40 mm/hr)
* Normal creatine kinase and EMG
## Footnote
ESR stands for Erythrocyte Sedimentation Rate.
105
What is the first-line treatment for PMR?
Prednisolone (e.g. 15mg/od)
## Footnote
Patients typically respond dramatically to steroids.
106
What is pneumonia?
An inflammatory condition affecting the alveoli in the lungs caused by pathogens
## Footnote
Pathogens can include bacteria, viruses, and fungi.
107
What is the most common cause of community acquired pneumonia (CAP)?
Streptococcus pneumoniae
## Footnote
This is a bacterial pathogen.
108
What are the risk factors for pneumonia?
* 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)
109
What are the common symptoms of pneumonia? (5)
* Cough with purulent sputum (rust colored/bloodstained)
* Dyspnoea
* Chest pain (may be pleuritic)
* Fever
* Malaise
110
What signs may indicate pneumonia?
* High temperature
* Tachycardia
* Hypotension
* Confusion
* Tachypnoea
* Low oxygen saturation
* Reduced breath sounds, bronchial breathing, crepitations/crackles
* Dullness on percussion
111
What is the CRB65 criteria used for?
To assess pneumonia patients' risk of death in a primary care setting
## Footnote
The CRB65 criteria include confusion, respiration rate, blood pressure, and age.
112
What does a CRB65 score of 0 indicate?
Low risk (less than 1% mortality risk)
## Footnote
Home-based care is recommended for patients with a CRB65 score of 0.
113
What is the CURB65 criteria used for?
To assess pneumonia patients' risk of death in a secondary care setting
## Footnote
The CURB65 includes an additional criterion of urea > 7 mmol/L.
114
What is pulmonary tuberculosis (TB)?
An infectious disease caused by Mycobacterium tuberculosis
## Footnote
TB can remain dormant before progressing to its active form.
115
What are the primary infection symptoms of TB?
* Fever
* Pleuritic or retrosternal pain
116
What are the secondary infection features of TB? (6)
* Cough becoming productive
* Haemoptysis (in a minority)
* Weight loss
* Fatigue
* Night sweats
* Low-grade fever
117
What is MRSA?
Methicillin-resistant Staphylococcus aureus, a dangerous hospital-acquired infection
## Footnote
MRSA was one of the first organisms to highlight the dangers of hospital-acquired infections.
118
Who should be screened for MRSA?
All patients awaiting elective admissions and all emergency admissions
## Footnote
Exceptions include day patients having terminations of pregnancy and ophthalmic surgery.
119
What is the treatment for MRSA infections?
* Vancomycin
* Teicoplanin
* Linezolid
## Footnote
Some strains may also be sensitive to rifampicin, macrolides, tetracyclines, aminoglycosides, and clindamycin but should not be used alone.
120
What causes giardiasis?
The flagellate protozoan Giardia lamblia
## Footnote
It is spread by the faeco-oral route.
121
What are the common features of giardiasis?
* Often asymptomatic
* Non-bloody diarrhoea
* Steatorrhoea
* Bloating
* Abdominal pain
* Lethargy
* Weight loss
122
What is the treatment for giardiasis?
Metronidazole
123
What are the symptoms of viral gastroenteritis?
* Diarrhoea
* Nausea and vomiting
* Abdominal pain
124
What causes Lyme disease?
The spirochaete Borrelia burgdorferi, spread by ticks
125
What is the characteristic rash associated with Lyme disease?
Erythema migrans, a 'bull's-eye' rash at the site of the tick bite
## Footnote
Typically develops 1-4 weeks after the initial bite.
126
What is the management for suspected/confirmed Lyme disease?
Doxycycline if early disease; Amoxicillin is an alternative if doxycycline is contraindicated
## Footnote
Ceftriaxone is used for disseminated disease.
127
What are notifiable diseases in the UK? (33)
* 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
What is osteomyelitis?
An infection of the bone
## Footnote
It may be subclassified into haematogenous and non-haematogenous osteomyelitis.
129
What is the most common cause of haematogenous osteomyelitis?
Staphylococcus aureus, except in patients with sickle-cell anaemia where Salmonella species predominate
130
What is the management for osteomyelitis?
Flucloxacillin for 6 weeks; clindamycin if penicillin-allergic
131
What causes chickenpox?
Primary infection with varicella zoster virus
132
What are the clinical features of chickenpox?
* Fever initially
* Itchy rash starting on head/trunk before spreading
* Rash transitions from macular to papular to vesicular
133
What is the incubation period for chickenpox?
10-21 days
134
What is the management for chickenpox?
Supportive care, keep cool, trim nails, calamine lotion
## Footnote
Immunocompromised patients and newborns with peripartum exposure should receive varicella zoster immunoglobulin (VZIG).
135
What is the common manifestation of invasive group A streptococcal soft tissue infections?
Necrotizing fasciitis
## Footnote
This occurs in a small number of patients and may result in serious complications.
136
List rare complications associated with infections.
(6)
* Pneumonia
* Encephalitis (cerebellar involvement)
* Disseminated haemorrhagic chickenpox
* Arthritis
* Nephritis
* Pancreatitis
137
What are the initial symptoms of Chickenpox?
* Fever
* Itchy rash starting on head/trunk
* Systemic upset usually mild
138
What are the key features of Measles?
* Prodrome: irritable, conjunctivitis, fever
* Koplik spots: white spots on buccal mucosa
* Rash: starts behind ears, becomes blotchy & confluent
139
What is the incubation period for Measles?
10-14 days
140
What causes Erythema infectiosum?
Parvovirus B19
141
What is a characteristic rash of Erythema infectiosum?
'Slapped-cheek' rash spreading to proximal arms and extensor surfaces
142
What is the main cause of Scarlet fever?
Erythrogenic toxins produced by Group A haemolytic streptococci
143
What are the clinical features of Hand, foot and mouth disease?
* Mild systemic upset: sore throat, fever
* Oral ulcers
* Vesicles on palms and soles
144
What is the treatment for Scarlet fever?
Oral penicillin V for 10 days
## Footnote
Azithromycin for those with penicillin allergy.
145
What are Koplik spots and when do they appear?
White spots ('grain of salt') on the buccal mucosa, typically develop before the rash
146
What is the common age range affected by Roseola infantum?
6 months to 2 years
147
What is a notable feature of the rash in Roseola infantum?
Maculopapular rash following high fever
148
What are the complications of Measles? (6)
* Otitis media
* Pneumonia
* Encephalitis
* Subacute sclerosing panencephalitis (rare)
* Febrile convulsions
* Diarrhoea
149
What is the infectious period for Rubella?
7 days before symptoms to 4 days after rash onset
150
What is the typical rash appearance in Rubella?
Pink maculopapular rash, initially on face before spreading
151
What is the incubation period for Rubella?
14-21 days
152
What characterizes the rash of Scarlet fever?
Fine punctate erythema sparing the palms and soles
153
True or False: Children with Hand, foot and mouth disease need to be excluded from school.
False
154
What should be done if an unimmunized child comes into contact with Measles?
Offer MMR vaccine within 72 hours
155
What are Nagayama spots associated with?
Roseola infantum
156
What is the main management approach for Measles?
Supportive care
157
What is a common complication of Scarlet fever?
Otitis media
158
What is the typical age group for Scarlet fever incidence?
2 - 6 years, peak at 4 years
159
What is the recommendation for annual influenza vaccination?
Recommended for people older than 65 years and those with certain chronic conditions
## Footnote
Chronic conditions include respiratory, heart, kidney, liver, neurological diseases, diabetes, immunosuppression, asplenia, and pregnant women.
160
Who are considered at-risk individuals for influenza vaccination?
Includes health and social care staff, residents in care homes, and carers of at-risk individuals
## Footnote
At-risk groups are determined at the GP's discretion.
161
What are the main types of vaccines? (6)
* Live attenuated
* Inactivated preparations
* Toxoid
* Subunit and conjugate
* Messenger RNA (mRNA)
* Viral vector vaccines
## Footnote
Each type has unique characteristics and examples.
162
What is a live attenuated vaccine?
Utilizes a weakened form of the pathogen to stimulate an immune response
## Footnote
Not recommended for individuals with compromised immune systems.
163
What is the difference between monovalent and multivalent vaccines?
* Monovalent: Contains a singular antigenic component
* Multivalent: Comprises multiple antigenic components
## Footnote
Example of monovalent is the measles vaccine; quadrivalent influenza vaccine is multivalent.
164
How many doses of tetanus vaccine are provided in the UK immunisation schedule?
Five doses
## Footnote
Administered at 2 months, 3 months, 4 months, 3-5 years, and 13-18 years.
165
What is the first step in managing a wound?
Classify the wound
## Footnote
Categories include clean wound, tetanus prone wound, and high-risk tetanus prone wound.
166
What is the recommendation for immunocompromised individuals regarding live vaccines?
They should not receive live attenuated vaccines
## Footnote
Examples include BCG, MMR, and oral rotavirus vaccines.
167
What is the effectiveness of the influenza vaccine in adults?
Around 75% effective
## Footnote
Effectiveness may decrease in the elderly.
168
What is the recommended age for the first dose of the oral rotavirus vaccine?
2 months
## Footnote
A second dose is required at 3 months.
169
What are the contraindications for the MMR vaccine? (4)
* Severe immunosuppression
* Allergy to neomycin
* Recent live vaccine within 4 weeks
* Pregnancy (avoid for 1 month post-vaccination)
* Immunoglobulin therapy within 3 months
## Footnote
These contraindications ensure safety and efficacy of the vaccine.
170
What is the storage requirement for the influenza vaccine?
Stored between +2 and +8ºC and shielded from light
## Footnote
Proper storage is crucial for vaccine efficacy.
171
What is the recommended vaccination schedule for children in the UK?
Includes BCG, 6-in-1 vaccine, oral rotavirus, Men B, MMR, and flu vaccine
## Footnote
Specific ages for vaccines include at birth, 2 months, 3 months, 4 months, and 12-13 months.
172
True or False: The Men C vaccine is still offered to babies at 12 weeks of age.
False
## Footnote
The Men C vaccine has been discontinued from the NHS childhood vaccination programme.
173
What is the purpose of the pneumococcal conjugate vaccine?
To protect against pneumococcal infections
## Footnote
It is recommended for certain at-risk populations.
174
Fill in the blank: The rotavirus vaccine is a _______ vaccine.
live attenuated
175
What adverse effects may occur after the first dose of the MMR vaccine?
* Malaise
* Fever
* Rash
## Footnote
These typically occur 5-10 days post-vaccination and last around 2-3 days.
176
When was the Men C vaccine discontinued from the NHS childhood vaccination programme?
July 1, 2016
177
What is the result of the success of the Men C vaccination programme?
Almost no cases of Men C disease in babies or young children in the UK
178
What vaccine is offered to children at one year of age?
Hib/Men C vaccine
179
What vaccine is offered to children at 14 years of age?
Men ACWY vaccine
180
What are the general contraindications to immunisation?
* 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
Under what conditions should vaccines be delayed?
Febrile illness/intercurrent infection
182
What are the contraindications to live vaccines?
* Pregnancy
* Immunosuppression
183
In which situation should DTP vaccination be deferred?
Children with an evolving or unstable neurological condition
184
Which conditions are NOT contraindications to immunisation? (9)
* 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
What is the carcinogenic virus that infects keratinocytes?
Human papillomavirus (HPV)
186
Which HPV strains are most important and what do they cause?
* 6 & 11: causes genital warts
* 16 & 18: linked to various cancers, notably cervical cancer
187
What percentage of cervical cancers is HPV infection linked to?
Over 99.7%
188
What is the role of HPV testing in cervical cancer screening?
Samples are first tested for HPV; if positive, cytology is then performed
189
What other cancers is HPV linked to?
* Around 85% of anal cancers
* Around 50% of vulval and vaginal cancers
* Around 20-30% of mouth and throat cancers
190
What are other risk factors for developing cervical cancer?
* Smoking
* Combined oral contraceptive pill use
* High parity
191
What is the primary target group for the UK HPV immunisation programme?
12-13 years olds, both girls and boys
192
Since when is the HPV vaccine now given as a single dose instead of two?
September 2023
193
Who else is offered the HPV vaccine apart from school-aged children?
* 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
What does the Bacille Calmette-Guerin (BCG) vaccine protect against?
Tuberculosis (TB)
195
Who is advised to receive the BCG vaccine in the UK? (8)
* 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
What is the route of administration for the BCG vaccine?
Intradermally, normally to the lateral aspect of the left upper arm
197
What are the contraindications for receiving the BCG vaccine?
* Previous BCG vaccination
* Past history of tuberculosis
* HIV
* Pregnancy
* Positive tuberculin test
198
What age group is not given the BCG vaccine and why?
Anyone over the age of 35, as there is no evidence it works for that age group
199
What is the common outcome for warts?
Most resolve spontaneously within months or at most within 2 years
200
What causes Giardiasis?
Flagellate protozoan Giardia lamblia
201
What are the risk factors for Giardiasis? (3)
* Foreign travel
* Swimming/drinking water from rivers or lakes
* Male-male sexual contact
202
What are the common features of Giardiasis? (8)
* Often asymptomatic
* Non-bloody diarrhoea
* Steatorrhoea
* Bloating, abdominal pain
* Lethargy
* Flatulence
* Weight loss
* Malabsorption and lactose intolerance
203
What is the treatment for Giardiasis?
Metronidazole
204
What is viral gastroenteritis?
One of the most common conditions seen in medicine
205
What are the common features of viral gastroenteritis?
* Diarrhoea
* Nausea and vomiting
* Abdominal pain
206
What is the most common cause of acute pyelonephritis?
Ascending infection, typically E. coli from the lower urinary tract
207
List three clinical features of acute pyelonephritis.
* Fever
* Loin pain
* Nausea/vomiting
208
What symptoms of cystitis may be present in acute pyelonephritis?
* Dysuria
* Urinary frequency
209
What type of urine sample should all patients have sent before starting antibiotics?
Mid-stream urine (MSU)
210
For how long should broad-spectrum cephalosporin or a quinolone be prescribed for acute pyelonephritis?
7-10 days
211
What are the clinical features of a lower urinary tract infection (UTI)?
* Dysuria
* Urinary frequency
* Urinary urgency
* Cloudy/offensive smelling urine
* Lower abdominal pain
* Fever
* Malaise
212
True or False: Urine dipsticks should be used for diagnosing UTI in men.
False
213
In which patients should urine cultures be sent?
* Women aged > 65 years
* Recurrent UTI
* Pregnant women
* Men
* Visible or non-visible haematuria
214
What antibiotics are recommended for non-pregnant women with lower UTIs?
* Trimethoprim
* Nitrofurantoin
215
What is the first-line antibiotic treatment for symptomatic pregnant women with a UTI?
Nitrofurantoin
216
What is the recommended duration of antibiotic treatment for pregnant women with a UTI?
7 days
217
Fill in the blank: Asymptomatic bacteriuria in pregnant women should be treated to prevent progression to _______.
acute pyelonephritis
218
When should catheterized patients be treated for asymptomatic bacteria?
They should not be treated
219
What should be done if a catheter has been in place for more than 7 days in symptomatic patients?
Consider removing or changing the catheter
220
What is the primary causative organism of UTIs in children?
E. coli
221
What are the symptoms of UTI in infants?
* Poor feeding
* Vomiting
* Irritability
222
What urine collection method is preferable for children?
Clean catch
223
What should be done for infants less than 3 months old with a UTI?
Refer immediately to a paediatrician
224
When should imaging of the urinary tract be performed in infants with a first UTI?
Within 6 weeks
225
What is a common adverse effect of bisphosphonates?
Oesophageal reactions
226
What is the clinical use of bisphosphonates? (4)
* Prevention and treatment of osteoporosis
* Hypercalcaemia
* Paget's disease
* Pain from bone metastases
227
What should be corrected before giving bisphosphonates?
Hypocalcemia/vitamin D deficiency
228
What is the recommended duration for bisphosphonate treatment in low-risk patients?
Stop at 5 years
229
What should be done for patients >= 75 years with a fragility fracture?
Start first-line therapy without needing a DEXA scan
230
What is the threshold age for assessing osteoporosis risk in women according to NICE?
65 years
231
What is the significance of a DEXA scan in patients under 75 years of age?
To assess ongoing fracture risk
232
What does FRAX assess?
10-year risk of developing a fracture
233
What should be done if a patient's calculated fracture risk is in the orange zone?
Arrange a DEXA scan
234
What are some secondary causes of osteoporosis? (4)
* Hormonal disorders
* Chronic kidney disease
* Gastrointestinal disorders
* Malabsorption
235
Fill in the blank: Advancing age and _______ are significant risk factors for osteoporosis.
female sex
236
What is a major risk factor for osteoporosis?
Corticosteroid use
## Footnote
The use of corticosteroids significantly increases the risk of developing osteoporosis.
237
What T-score range indicates osteopaenia?
-1.0 to -2.5
## Footnote
T-scores are used to assess bone mineral density in relation to a young reference population.
238
What is the definition of osteoporosis according to the World Health Organization?
Presence of bone mineral density (BMD) of less than 2.5 standard deviations (SD) below the young adult mean density
## Footnote
Osteoporosis is characterized by a significant decrease in bone mass.
239
Which medication is the first-line treatment for osteoporosis?
Alendronate
## Footnote
Oral bisphosphonates like alendronate are commonly used for osteoporosis management.
240
What is the recommended follow-up period for prescribing oral bisphosphonates?
At least 5 years
## Footnote
Regular reassessment of fracture risk is necessary after this period.
241
What is the significance of a T-score less than -2.5?
Indicates osteoporosis
## Footnote
This threshold is used to diagnose osteoporosis via bone mineral density assessment.
242
Fill in the blank: The major risk factors for osteoporosis include _______.
Age, female gender, corticosteroid use, smoking, alcohol, low body mass index, family history
## Footnote
These factors increase the likelihood of developing osteoporosis.
243
What is the purpose of using screening tools like FRAX or QFracture?
To assess the 10-year risk of developing a fragility fracture
## Footnote
These tools help identify patients who may require further evaluation for osteoporosis.
244
True or False: Osteoporosis is usually symptomatic until a fracture occurs.
True
## Footnote
Many patients remain asymptomatic until they experience a fragility fracture.
245
What investigations are recommended by NOGG for secondary causes of osteoporosis?
History and physical examination, blood tests, thyroid function tests, bone densitometry (DXA)
## Footnote
These tests help identify underlying conditions contributing to osteoporosis.
246
What are the common side effects of bisphosphonates?
Gastrointestinal discomfort, oesophagitis, hypocalcaemia
## Footnote
Serious risks include atypical femoral fractures and osteonecrosis of the jaw.
247
What is the management recommendation for patients over 65 years or with previous fragility fractures?
They should be offered bone protection
## Footnote
This is based on guidelines to prevent further fractures.
248
What are the classical symptoms of falciparum malaria?
Paroxysms of fever, chills, sweating
## Footnote
These symptoms correspond to the erythrocytic cycle of the Plasmodium falciparum parasite.
249
Fill in the blank: The primary vector for malaria is the _______ mosquito.
Female Anopheles
## Footnote
Understanding the vector is crucial for malaria prevention strategies.
250
What is the first-line therapy for uncomplicated falciparum malaria?
Artemisinin-based combination therapies (ACTs)
## Footnote
WHO guidelines recommend ACTs as they are effective against resistant strains.
251
What complication can occur in post-pubertal males with mumps?
Orchitis
## Footnote
This complication occurs in 25-35% of post-pubertal males following parotitis.
252
What condition is characterized by a significant decrease in bone mass?
Osteoporosis
## Footnote
It is a skeletal disorder that increases the risk of fragility fractures.
253
What is the most common cause of non-falciparum malaria?
Plasmodium vivax
## Footnote
Other causes include Plasmodium ovale and Plasmodium malariae.
254
Which malaria species is predominantly found in Central America and the Indian Subcontinent?
Plasmodium vivax
255
What is the recommended first-line therapy for uncomplicated falciparum malaria according to the 2010 WHO guidelines?
Artemisinin-based combination therapies (ACTs)
## Footnote
Examples include artemether plus lumefantrine and artesunate plus amodiaquine.
256
What treatment is preferred by WHO for severe falciparum malaria?
Intravenous artesunate
257
What parasite count typically necessitates parenteral treatment for severe falciparum malaria?
More than 2%
258
What should be considered if the parasite count exceeds 10% in severe falciparum malaria?
Exchange transfusion
259
What are the general features of malaria?
Fever, headache, splenomegaly
260
What is the cyclical fever pattern for Plasmodium vivax and Plasmodium ovale?
Every 48 hours
261
What is the cyclical fever pattern for Plasmodium malariae?
Every 72 hours
262
What condition is associated with Plasmodium malariae?
Nephrotic syndrome
263
What is a hypnozoite stage in malaria?
A dormant stage that may cause relapse following treatment
264
In areas where chloroquine is sensitive, what does WHO recommend for treatment?
Either an ACT or chloroquine
265
What should be given to patients with ovale or vivax malaria after acute treatment with chloroquine?
Primaquine
266
What is Teriparatide?
Recombinant form of parathyroid hormone
267
What is the role of Teriparatide in osteoporosis management?
Not yet clearly defined
268
What is Romosozumab?
A monoclonal antibody that inhibits sclerostin
269
How does Romosozumab affect bone health?
Increases bone formation and decreases bone resorption
270
What common imaging finding is associated with osteoporosis?
Fractures of the thoracic vertebrae
271
What are contraindications to lumbar puncture?
Signs of raised ICP, focal neurological signs, papilloedema, significant bulging of the fontanelle, disseminated intravascular coagulation, signs of cerebral herniation
272
What should be obtained instead of a lumbar puncture for patients with meningococcal septicaemia?
Blood cultures and PCR for meningococcus
273
What is the initial antibiotic treatment for patients under 3 months?
IV amoxicillin (or ampicillin) + IV cefotaxime
274
What is the initial antibiotic treatment for patients over 3 months?
IV cefotaxime (or ceftriaxone)
275
When should dexamethasone be considered in meningitis management?
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
What is the most common cause of meningitis in neonates?
Group B Streptococcus
277
What are the CSF findings in bacterial meningitis?
* Appearance: Cloudy
* Glucose: Low (< 1/2 plasma)
* Protein: High (> 1 g/l)
* White cells: 10 - 5,000 polymorphs/mm³
278
What condition are patients with meningococcal meningitis at risk for?
Waterhouse-Friderichsen syndrome
279
What is the role of the ABC approach in meningitis management?
Airway, Breathing, Circulation, Disability (GCS, focal neurological signs, seizures, papilloedema)
280
True or False: A lumbar puncture should be performed immediately in all cases of suspected meningitis.
False
281
What tests should be performed on blood samples taken from suspected meningitis patients?
* Full blood count
* Renal function
* Glucose
* Lactate
* Clotting profile
* CRP
282
What is the recommended prophylactic antibiotic for contacts of patients with meningococcal meningitis?
Ciprofloxacin
283
What is the common clinical presentation of viral meningitis?
* Headache
* Neck stiffness
* Photophobia
* Confusion
* Fevers
284
What cerebrospinal fluid findings are characteristic of viral meningitis?
* 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
What should be done while waiting for lumbar puncture results in suspected meningitis cases?
Supportive treatment and broad-spectrum antibiotics if bacterial meningitis is suspected
286
What are the common viral causes of viral meningitis? (7)
* Non-polio enteroviruses (e.g., coxsackie virus, echovirus)
* Mumps
* Herpes simplex virus (HSV)
* Cytomegalovirus (CMV)
* Herpes zoster viruses
* HIV
* Measles
287
What is the preferred antibiotic for treating meningococcal meningitis?
IV benzylpenicillin or cefotaxime (or ceftriaxone)
288
Fill in the blank: Meningitis is an inflammation of the _______ and the cerebrospinal fluid of the subarachnoid space.
leptomeninges
289
What is the sensitivity of the Ziehl-Neelsen stain in detecting tuberculous meningitis?
20%
290
What are some neurological sequelae of meningitis? (7)
* Sensorineural hearing loss
* Seizures
* Focal neurological deficit
* Sepsis
* Intracerebral abscess
* Brain herniation
* Hydrocephalus
