Infection 🦠 Flashcards
Conditions and Presentation
What is the most common cause of encephalitis
Herpes simplex virus
Melanoma ABCDE
- Asymmetry
- irregular Borders
- Colour variegation
- Diameter >6mm
- Elevation/evolution of a skin lesion.
Fitzpatrick skin scale
- 6 scales of skin
What is the most common type of melanoma that has a long radial phase?
Superficial spreading melanoma (Pagetoid)
Which melanoma type has a very long radial phase and exists as lentigo maligna before it starts invading the basement membrane?
Lentigo maligna melanoma (Hutchinson’s melanotic freckle)
What is the most aggressive type of melanoma that has no radial phase?
Nodular melanoma (ab initio)
Which melanoma type has a short radial phase, occurs more frequently in patients with darker skin tones, and involves the palms or soles?
Acral lentiginous melanoma
What type of melanoma grows under the nail?
Subungual melanoma
What type of melanoma lacks pigmentation?
Amelanotic melanoma
Max amount of units of alcohol per week
14 units
How to calculate units of alcohol
Units = strength (ABV) x volume (ml) ÷ 1000
Medical managment of smoking cessation- NRT
- 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.
Bupropion
- originally an anti-depressant
*inhibits reuptake of dopamine, noradrenaline and serotonin in the brain. Helps with cessation - start 7-14 days before quit date
Contradiction of Bupropion (5)
- Epilepsy (decreases seizure threshold)
- Eating disorders and bipolar disorder
- CNS tumours
- Those experiencing current benzodiazepine or alcohol withdrawal
- Pregnancy and breast-feeding
Varenicline (Champix)
- partial nicotinic acetylcholine receptor agonist.
- 7-14 days before the quit date; needs to be titred
- contradicted in pregnancy
Who can’t use POP
- women who smoke >15 cigarettes a day
- over 35 years old
- migraines with auras
- breast-feeding women
Asthma exaccebation signs and symptoms
- Tachypnoea
- Increased work of breathing
- Hyperinflated chest
- Expiratory polyphonic wheeze throughout the lung fields
- Decreased air entry (if severe)
Death verification procedure
- 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.
LUTI managment
- 3 days oral nitrofurantoin or trimethoprim
- conservative measures (e.g fluids)
UTI in Men managment
- trimethoprim or nitrofurantoin for 7 days
- Refer to urology if repeating symptoms
UTI during Pregnancy (with no haematuria) managment
- nitrofurantoin (but avoid at term), for 7 days.
- 2nd line: amoxicillin/cefelexin for 7 days.
Managment of pylonephritis
- hospital admission
- IV broad-spectrum cephalosporin, a quinolone, or gentamicin
Stem cell factor
Pluripotent cells
IL-3
CFU-GEMM
G-CSF
Granulocyte precursor
M-CSF
Monocyte precursor
IL-5
Eosinophil progenitors
Erythropoietin
Erythrocytes progenitors
Thrombopoietin
Megakaryocyte progenitor
IL6
B cell precursor
IL 2
T cell precursor
IL-1 and TNF
Stormal cells
Spleen blood supply
Splenic artery
Spleen blood drainage
Splenic veins - SMV to portal vein
Structures anterior to the spleen
- stomach
- tail of pancreas
- left colic flexors
Medial to spleen
Left kidney
Posterior to spleen
Diaphragm
Ribs 9-11
Felty’s triad.
Rheumatoid arthritis (usually severe, longstanding RA).
Splenomegaly.
Neutropenia (low white blood cell count, specifically neutrophils).
What is whooping cough also known as?
‘Cough of 100 days’
What bacterium causes whooping cough?
Bordetella pertussis
At what ages are infants routinely immunised against whooping cough in the UK?
2, 3, 4 months and 3-5 years
What phase of whooping cough lasts around 1-2 weeks and has symptoms similar to a viral upper respiratory infection?
Catarrhal phase
What is a key feature of the paroxysmal phase of whooping cough?
Coughing bouts increase in severity
True or False: The inspiratory whoop is always present in whooping cough.
False
What are some complications of whooping cough? (4)
- Subconjunctival haemorrhage
- Pneumonia
- Bronchiectasis
- Seizures
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
What type of swab is used to culture Bordetella pertussis?
Per nasal swab
What is the recommended antibiotic for infants under 6 months suspected of having whooping cough?
Oral macrolide (e.g. clarithromycin, azithromycin, erythromycin)
What is the school exclusion period for whooping cough after starting antibiotics?
48 hours after commencing antibiotics
What vaccination program was introduced for pregnant women in 2012?
Whooping cough vaccination program
What are the common symptoms of viral gastroenteritis?
- Diarrhoea
- Nausea and vomiting
- Abdominal pain
What percentage of vaginal candidiasis cases are caused by Candida albicans?
80%
What are some predisposing factors for vaginal candidiasis?
- Diabetes mellitus
- Antibiotics
- Steroids
- Pregnancy
- Immunosuppression (e.g., HIV)
What is a characteristic feature of vaginal candidiasis discharge?
‘Cottage cheese’, non-offensive discharge
What is the first-line treatment for vaginal candidiasis?
Oral fluconazole 150 mg as a single dose
What defines recurrent vaginal candidiasis according to BASHH?
4 or more episodes per year
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
What should be used for treatment if a pregnant woman has vaginal candidiasis?
Only local treatments (e.g. cream or pessaries)
What is ascending cholangitis?
A bacterial infection of the biliary tree, typically caused by E. coli
Most common predisposing factor is gallstones.
What are the components of Charcot’s triad?
- Right upper quadrant pain
- Fever
- Jaundice
What additional features are included in Reynolds’ pentad?
- Hypotension
- Confusion
What is the first-line investigation for suspected ascending cholangitis?
Ultrasound to look for bile duct dilation and bile duct stones
What is the initial management for ascending cholangitis?
- Intravenous antibiotics
- ERCP after 24-48 hours to relieve obstruction
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
What are the presenting symptoms of a brain abscess? (6)
- Headache
- Fever
- Focal neurology
- Nausea
- Papilloedema
- Seizures
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)
What virus causes measles?
RNA paramyxovirus
What are the key features of measles?
- Prodromal phase (irritability, conjunctivitis, fever)
- Koplik spots
- Maculopapular rash
What is the most common complication of measles?
Otitis media
What is reactive arthritis?
Arthritis that develops following an infection where the organism cannot be recovered from the joint
What are the typical symptoms of reactive arthritis?
- Asymmetrical oligoarthritis of lower limbs
- Dactylitis
- Urethritis symptoms
- Conjunctivitis (10-30%)
What is the common presentation of COVID-19?
- Fever
- Cough
- Fatigue
- Loss of taste or smell
- Myalgia
What is the gold standard test for diagnosing COVID-19?
Reverse transcription polymerase chain reaction (RT-PCR)
What are the common management strategies for COVID-19?
- Isolation
- Supportive care (hydration, antipyretics, oxygen therapy)
- Antivirals (e.g., Remdesivir)
- Corticosteroids (e.g., Dexamethasone)
What is the typical age range for peak incidence of croup?
6 months to 3 years
What characterizes the cough in croup?
Barking, seal-like cough
What is the recommended management for mild croup?
Single dose of oral dexamethasone (0.15mg/kg)
What is herpes simplex (HSV) encephalitis commonly associated with?
Temporal lobe involvement
What is the treatment for herpes simplex encephalitis?
Intravenous aciclovir
What are common causes of diarrhoea in HIV patients? (4)
- Cryptosporidium
- Cytomegalovirus
- Mycobacterium avium intracellulare
- Giardia
What is the mainstay of management for Cryptosporidium infection in HIV patients?
Supportive therapy
What are the strains of herpes simplex virus in humans?
- HSV-1
- HSV-2
What is advised for pregnant women with a primary attack of herpes?
Elective caesarean section at term if it occurs after 28 weeks gestation
What is the most common infective cause of diarrhoea in HIV patients?
Cryptosporidium
Cryptosporidium is an intracellular protozoa with an incubation period of 7 days.
What type of stain may reveal the characteristic red cysts of Cryptosporidium?
Modified Ziehl-Neelsen stain
This is an acid-fast stain used for identifying certain pathogens.
What are the typical features of Mycobacterium avium intracellulare in HIV patients?
- Fever
- Sweats
- Abdominal pain
- Diarrhoea
- Hepatomegaly
- Deranged LFTs
Diagnosis is made by blood cultures and bone marrow examination.
What virus causes Kaposi’s sarcoma?
HHV-8 (human herpes virus 8)
Kaposi’s sarcoma presents as purple papules or plaques on the skin or mucosa.
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.
This combination decreases viral replication and reduces the risk of viral resistance.
What are the two types of entry inhibitors used in HIV therapy?
- Maraviroc
- Enfuvirtide
Maraviroc binds to CCR5, preventing interaction with gp41; enfuvirtide binds to gp41.
What are examples of NRTIs? (8)
- Zidovudine (AZT)
- Abacavir
- Emtricitabine
- Didanosine
- Lamivudine
- Stavudine
- Zalcitabine
- Tenofovir
NRTIs are associated with peripheral neuropathy and specific adverse effects.
What are common side effects of NNRTIs?
- P450 enzyme interaction
- Rashes
Nevirapine induces P450 enzyme.
What are the side effects of protease inhibitors (PI)?
- Diabetes
- Hyperlipidaemia
- Buffalo hump
- Central obesity
- P450 enzyme inhibition
Indinavir can cause renal stones and ritonavir is a potent inhibitor of the P450 system.
What are the symptoms of Toxoplasmosis in HIV patients? (4)
- Constitutional symptoms
- Headache
- Confusion
- Drowsiness
It accounts for around 50% of cerebral lesions in patients with HIV.
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.
This differentiation is important due to vastly different treatment strategies.
What is the most common fungal infection of the CNS?
Cryptococcus
Symptoms include headache, fever, malaise, nausea/vomiting, seizures, and focal neurological deficit.
What condition accounts for up to 10% of end-stage renal failure cases in the United States related to HIV?
HIV-associated nephropathy (HIVAN)
Antiretroviral therapy is the treatment of choice for HIVAN.
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
Focal or global capillary collapse may be observed on renal biopsy.
What are common symptoms of HIV seroconversion?
- Sore throat
- Lymphadenopathy
- Malaise
- Myalgia
- Arthralgia
- Diarrhoea
- Maculopapular rash
- Mouth ulcers
Rarely, it may present as meningoencephalitis.
What is the typical timeline for HIV antibodies to develop post-infection?
4-6 weeks, with 99% developing antibodies by 3 months
Testing typically involves both ELISA and confirmatory Western Blot Assay.
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.
It is usually positive from about 1 week to 3-4 weeks after infection.
What is the first-line test for HIV screening of asymptomatic individuals?
Fourth-generation tests (HIV antibody and p24 antigen)
These tests have a sensitivity approaching 100% for chronic HIV infection.
What is polymyalgia rheumatica (PMR)?
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.
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
Weakness is not considered a symptom of PMR.
What investigations are used for PMR?
- Raised inflammatory markers (e.g. ESR > 40 mm/hr)
- Normal creatine kinase and EMG
ESR stands for Erythrocyte Sedimentation Rate.
What is the first-line treatment for PMR?
Prednisolone (e.g. 15mg/od)
Patients typically respond dramatically to steroids.
What is pneumonia?
An inflammatory condition affecting the alveoli in the lungs caused by pathogens
Pathogens can include bacteria, viruses, and fungi.
What is the most common cause of community acquired pneumonia (CAP)?
Streptococcus pneumoniae
This is a bacterial pathogen.
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)
What are the common symptoms of pneumonia? (5)
- Cough with purulent sputum (rust colored/bloodstained)
- Dyspnoea
- Chest pain (may be pleuritic)
- Fever
- Malaise
What signs may indicate pneumonia?
- High temperature
- Tachycardia
- Hypotension
- Confusion
- Tachypnoea
- Low oxygen saturation
- Reduced breath sounds, bronchial breathing, crepitations/crackles
- Dullness on percussion
What is the CRB65 criteria used for?
To assess pneumonia patients’ risk of death in a primary care setting
The CRB65 criteria include confusion, respiration rate, blood pressure, and age.
What does a CRB65 score of 0 indicate?
Low risk (less than 1% mortality risk)
Home-based care is recommended for patients with a CRB65 score of 0.
What is the CURB65 criteria used for?
To assess pneumonia patients’ risk of death in a secondary care setting
The CURB65 includes an additional criterion of urea > 7 mmol/L.
What is pulmonary tuberculosis (TB)?
An infectious disease caused by Mycobacterium tuberculosis
TB can remain dormant before progressing to its active form.
What are the primary infection symptoms of TB?
- Fever
- Pleuritic or retrosternal pain
What are the secondary infection features of TB? (6)
- Cough becoming productive
- Haemoptysis (in a minority)
- Weight loss
- Fatigue
- Night sweats
- Low-grade fever
What is MRSA?
Methicillin-resistant Staphylococcus aureus, a dangerous hospital-acquired infection
MRSA was one of the first organisms to highlight the dangers of hospital-acquired infections.
Who should be screened for MRSA?
All patients awaiting elective admissions and all emergency admissions
Exceptions include day patients having terminations of pregnancy and ophthalmic surgery.
What is the treatment for MRSA infections?
- Vancomycin
- Teicoplanin
- Linezolid
Some strains may also be sensitive to rifampicin, macrolides, tetracyclines, aminoglycosides, and clindamycin but should not be used alone.
What causes giardiasis?
The flagellate protozoan Giardia lamblia
It is spread by the faeco-oral route.
What are the common features of giardiasis?
- Often asymptomatic
- Non-bloody diarrhoea
- Steatorrhoea
- Bloating
- Abdominal pain
- Lethargy
- Weight loss
What is the treatment for giardiasis?
Metronidazole
What are the symptoms of viral gastroenteritis?
- Diarrhoea
- Nausea and vomiting
- Abdominal pain
What causes Lyme disease?
The spirochaete Borrelia burgdorferi, spread by ticks
What is the characteristic rash associated with Lyme disease?
Erythema migrans, a ‘bull’s-eye’ rash at the site of the tick bite
Typically develops 1-4 weeks after the initial bite.
What is the management for suspected/confirmed Lyme disease?
Doxycycline if early disease; Amoxicillin is an alternative if doxycycline is contraindicated
Ceftriaxone is used for disseminated disease.
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
What is osteomyelitis?
An infection of the bone
It may be subclassified into haematogenous and non-haematogenous osteomyelitis.
What is the most common cause of haematogenous osteomyelitis?
Staphylococcus aureus, except in patients with sickle-cell anaemia where Salmonella species predominate
What is the management for osteomyelitis?
Flucloxacillin for 6 weeks; clindamycin if penicillin-allergic
What causes chickenpox?
Primary infection with varicella zoster virus
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
What is the incubation period for chickenpox?
10-21 days
What is the management for chickenpox?
Supportive care, keep cool, trim nails, calamine lotion
Immunocompromised patients and newborns with peripartum exposure should receive varicella zoster immunoglobulin (VZIG).
What is the common manifestation of invasive group A streptococcal soft tissue infections?
Necrotizing fasciitis
This occurs in a small number of patients and may result in serious complications.
List rare complications associated with infections.
(6)
- Pneumonia
- Encephalitis (cerebellar involvement)
- Disseminated haemorrhagic chickenpox
- Arthritis
- Nephritis
- Pancreatitis
What are the initial symptoms of Chickenpox?
- Fever
- Itchy rash starting on head/trunk
- Systemic upset usually mild
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
What is the incubation period for Measles?
10-14 days
What causes Erythema infectiosum?
Parvovirus B19
What is a characteristic rash of Erythema infectiosum?
‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces
What is the main cause of Scarlet fever?
Erythrogenic toxins produced by Group A haemolytic streptococci
What are the clinical features of Hand, foot and mouth disease?
- Mild systemic upset: sore throat, fever
- Oral ulcers
- Vesicles on palms and soles
What is the treatment for Scarlet fever?
Oral penicillin V for 10 days
Azithromycin for those with penicillin allergy.
What are Koplik spots and when do they appear?
White spots (‘grain of salt’) on the buccal mucosa, typically develop before the rash
What is the common age range affected by Roseola infantum?
6 months to 2 years
What is a notable feature of the rash in Roseola infantum?
Maculopapular rash following high fever
What are the complications of Measles? (6)
- Otitis media
- Pneumonia
- Encephalitis
- Subacute sclerosing panencephalitis (rare)
- Febrile convulsions
- Diarrhoea
What is the infectious period for Rubella?
7 days before symptoms to 4 days after rash onset
What is the typical rash appearance in Rubella?
Pink maculopapular rash, initially on face before spreading
What is the incubation period for Rubella?
14-21 days
What characterizes the rash of Scarlet fever?
Fine punctate erythema sparing the palms and soles
True or False: Children with Hand, foot and mouth disease need to be excluded from school.
False
What should be done if an unimmunized child comes into contact with Measles?
Offer MMR vaccine within 72 hours
What are Nagayama spots associated with?
Roseola infantum
What is the main management approach for Measles?
Supportive care
What is a common complication of Scarlet fever?
Otitis media
What is the typical age group for Scarlet fever incidence?
2 - 6 years, peak at 4 years
What is the recommendation for annual influenza vaccination?
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.
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
At-risk groups are determined at the GP’s discretion.
What are the main types of vaccines? (6)
- Live attenuated
- Inactivated preparations
- Toxoid
- Subunit and conjugate
- Messenger RNA (mRNA)
- Viral vector vaccines
Each type has unique characteristics and examples.
What is a live attenuated vaccine?
Utilizes a weakened form of the pathogen to stimulate an immune response
Not recommended for individuals with compromised immune systems.
What is the difference between monovalent and multivalent vaccines?
- Monovalent: Contains a singular antigenic component
- Multivalent: Comprises multiple antigenic components
Example of monovalent is the measles vaccine; quadrivalent influenza vaccine is multivalent.
How many doses of tetanus vaccine are provided in the UK immunisation schedule?
Five doses
Administered at 2 months, 3 months, 4 months, 3-5 years, and 13-18 years.
What is the first step in managing a wound?
Classify the wound
Categories include clean wound, tetanus prone wound, and high-risk tetanus prone wound.
What is the recommendation for immunocompromised individuals regarding live vaccines?
They should not receive live attenuated vaccines
Examples include BCG, MMR, and oral rotavirus vaccines.
What is the effectiveness of the influenza vaccine in adults?
Around 75% effective
Effectiveness may decrease in the elderly.
What is the recommended age for the first dose of the oral rotavirus vaccine?
2 months
A second dose is required at 3 months.
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
These contraindications ensure safety and efficacy of the vaccine.
What is the storage requirement for the influenza vaccine?
Stored between +2 and +8ºC and shielded from light
Proper storage is crucial for vaccine efficacy.
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
Specific ages for vaccines include at birth, 2 months, 3 months, 4 months, and 12-13 months.
True or False: The Men C vaccine is still offered to babies at 12 weeks of age.
False
The Men C vaccine has been discontinued from the NHS childhood vaccination programme.
What is the purpose of the pneumococcal conjugate vaccine?
To protect against pneumococcal infections
It is recommended for certain at-risk populations.
Fill in the blank: The rotavirus vaccine is a _______ vaccine.
live attenuated
What adverse effects may occur after the first dose of the MMR vaccine?
- Malaise
- Fever
- Rash
These typically occur 5-10 days post-vaccination and last around 2-3 days.
When was the Men C vaccine discontinued from the NHS childhood vaccination programme?
July 1, 2016
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
What vaccine is offered to children at one year of age?
Hib/Men C vaccine
What vaccine is offered to children at 14 years of age?
Men ACWY vaccine
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)
Under what conditions should vaccines be delayed?
Febrile illness/intercurrent infection
What are the contraindications to live vaccines?
- Pregnancy
- Immunosuppression
In which situation should DTP vaccination be deferred?
Children with an evolving or unstable neurological condition
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)
What is the carcinogenic virus that infects keratinocytes?
Human papillomavirus (HPV)
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
What percentage of cervical cancers is HPV infection linked to?
Over 99.7%
What is the role of HPV testing in cervical cancer screening?
Samples are first tested for HPV; if positive, cytology is then performed
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
What are other risk factors for developing cervical cancer?
- Smoking
- Combined oral contraceptive pill use
- High parity
What is the primary target group for the UK HPV immunisation programme?
12-13 years olds, both girls and boys
Since when is the HPV vaccine now given as a single dose instead of two?
September 2023
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
What does the Bacille Calmette-Guerin (BCG) vaccine protect against?
Tuberculosis (TB)
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
What is the route of administration for the BCG vaccine?
Intradermally, normally to the lateral aspect of the left upper arm
What are the contraindications for receiving the BCG vaccine?
- Previous BCG vaccination
- Past history of tuberculosis
- HIV
- Pregnancy
- Positive tuberculin test
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
What is the common outcome for warts?
Most resolve spontaneously within months or at most within 2 years
What causes Giardiasis?
Flagellate protozoan Giardia lamblia
What are the risk factors for Giardiasis? (3)
- Foreign travel
- Swimming/drinking water from rivers or lakes
- Male-male sexual contact
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
What is the treatment for Giardiasis?
Metronidazole
What is viral gastroenteritis?
One of the most common conditions seen in medicine
What are the common features of viral gastroenteritis?
- Diarrhoea
- Nausea and vomiting
- Abdominal pain
What is the most common cause of acute pyelonephritis?
Ascending infection, typically E. coli from the lower urinary tract
List three clinical features of acute pyelonephritis.
- Fever
- Loin pain
- Nausea/vomiting
What symptoms of cystitis may be present in acute pyelonephritis?
- Dysuria
- Urinary frequency
What type of urine sample should all patients have sent before starting antibiotics?
Mid-stream urine (MSU)
For how long should broad-spectrum cephalosporin or a quinolone be prescribed for acute pyelonephritis?
7-10 days
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
True or False: Urine dipsticks should be used for diagnosing UTI in men.
False
In which patients should urine cultures be sent?
- Women aged > 65 years
- Recurrent UTI
- Pregnant women
- Men
- Visible or non-visible haematuria
What antibiotics are recommended for non-pregnant women with lower UTIs?
- Trimethoprim
- Nitrofurantoin
What is the first-line antibiotic treatment for symptomatic pregnant women with a UTI?
Nitrofurantoin
What is the recommended duration of antibiotic treatment for pregnant women with a UTI?
7 days
Fill in the blank: Asymptomatic bacteriuria in pregnant women should be treated to prevent progression to _______.
acute pyelonephritis
When should catheterized patients be treated for asymptomatic bacteria?
They should not be treated
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
What is the primary causative organism of UTIs in children?
E. coli
What are the symptoms of UTI in infants?
- Poor feeding
- Vomiting
- Irritability
What urine collection method is preferable for children?
Clean catch
What should be done for infants less than 3 months old with a UTI?
Refer immediately to a paediatrician
When should imaging of the urinary tract be performed in infants with a first UTI?
Within 6 weeks
What is a common adverse effect of bisphosphonates?
Oesophageal reactions
What is the clinical use of bisphosphonates? (4)
- Prevention and treatment of osteoporosis
- Hypercalcaemia
- Paget’s disease
- Pain from bone metastases
What should be corrected before giving bisphosphonates?
Hypocalcemia/vitamin D deficiency
What is the recommended duration for bisphosphonate treatment in low-risk patients?
Stop at 5 years
What should be done for patients >= 75 years with a fragility fracture?
Start first-line therapy without needing a DEXA scan
What is the threshold age for assessing osteoporosis risk in women according to NICE?
65 years
What is the significance of a DEXA scan in patients under 75 years of age?
To assess ongoing fracture risk
What does FRAX assess?
10-year risk of developing a fracture
What should be done if a patient’s calculated fracture risk is in the orange zone?
Arrange a DEXA scan
What are some secondary causes of osteoporosis? (4)
- Hormonal disorders
- Chronic kidney disease
- Gastrointestinal disorders
- Malabsorption
Fill in the blank: Advancing age and _______ are significant risk factors for osteoporosis.
female sex
What is a major risk factor for osteoporosis?
Corticosteroid use
The use of corticosteroids significantly increases the risk of developing osteoporosis.
What T-score range indicates osteopaenia?
-1.0 to -2.5
T-scores are used to assess bone mineral density in relation to a young reference population.
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
Osteoporosis is characterized by a significant decrease in bone mass.
Which medication is the first-line treatment for osteoporosis?
Alendronate
Oral bisphosphonates like alendronate are commonly used for osteoporosis management.
What is the recommended follow-up period for prescribing oral bisphosphonates?
At least 5 years
Regular reassessment of fracture risk is necessary after this period.
What is the significance of a T-score less than -2.5?
Indicates osteoporosis
This threshold is used to diagnose osteoporosis via bone mineral density assessment.
Fill in the blank: The major risk factors for osteoporosis include _______.
Age, female gender, corticosteroid use, smoking, alcohol, low body mass index, family history
These factors increase the likelihood of developing osteoporosis.
What is the purpose of using screening tools like FRAX or QFracture?
To assess the 10-year risk of developing a fragility fracture
These tools help identify patients who may require further evaluation for osteoporosis.
True or False: Osteoporosis is usually symptomatic until a fracture occurs.
True
Many patients remain asymptomatic until they experience a fragility fracture.
What investigations are recommended by NOGG for secondary causes of osteoporosis?
History and physical examination, blood tests, thyroid function tests, bone densitometry (DXA)
These tests help identify underlying conditions contributing to osteoporosis.
What are the common side effects of bisphosphonates?
Gastrointestinal discomfort, oesophagitis, hypocalcaemia
Serious risks include atypical femoral fractures and osteonecrosis of the jaw.
What is the management recommendation for patients over 65 years or with previous fragility fractures?
They should be offered bone protection
This is based on guidelines to prevent further fractures.
What are the classical symptoms of falciparum malaria?
Paroxysms of fever, chills, sweating
These symptoms correspond to the erythrocytic cycle of the Plasmodium falciparum parasite.
Fill in the blank: The primary vector for malaria is the _______ mosquito.
Female Anopheles
Understanding the vector is crucial for malaria prevention strategies.
What is the first-line therapy for uncomplicated falciparum malaria?
Artemisinin-based combination therapies (ACTs)
WHO guidelines recommend ACTs as they are effective against resistant strains.
What complication can occur in post-pubertal males with mumps?
Orchitis
This complication occurs in 25-35% of post-pubertal males following parotitis.
What condition is characterized by a significant decrease in bone mass?
Osteoporosis
It is a skeletal disorder that increases the risk of fragility fractures.
What is the most common cause of non-falciparum malaria?
Plasmodium vivax
Other causes include Plasmodium ovale and Plasmodium malariae.
Which malaria species is predominantly found in Central America and the Indian Subcontinent?
Plasmodium vivax
What is the recommended first-line therapy for uncomplicated falciparum malaria according to the 2010 WHO guidelines?
Artemisinin-based combination therapies (ACTs)
Examples include artemether plus lumefantrine and artesunate plus amodiaquine.
What treatment is preferred by WHO for severe falciparum malaria?
Intravenous artesunate
What parasite count typically necessitates parenteral treatment for severe falciparum malaria?
More than 2%
What should be considered if the parasite count exceeds 10% in severe falciparum malaria?
Exchange transfusion
What are the general features of malaria?
Fever, headache, splenomegaly
What is the cyclical fever pattern for Plasmodium vivax and Plasmodium ovale?
Every 48 hours
What is the cyclical fever pattern for Plasmodium malariae?
Every 72 hours
What condition is associated with Plasmodium malariae?
Nephrotic syndrome
What is a hypnozoite stage in malaria?
A dormant stage that may cause relapse following treatment
In areas where chloroquine is sensitive, what does WHO recommend for treatment?
Either an ACT or chloroquine
What should be given to patients with ovale or vivax malaria after acute treatment with chloroquine?
Primaquine
What is Teriparatide?
Recombinant form of parathyroid hormone
What is the role of Teriparatide in osteoporosis management?
Not yet clearly defined
What is Romosozumab?
A monoclonal antibody that inhibits sclerostin
How does Romosozumab affect bone health?
Increases bone formation and decreases bone resorption
What common imaging finding is associated with osteoporosis?
Fractures of the thoracic vertebrae
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
What should be obtained instead of a lumbar puncture for patients with meningococcal septicaemia?
Blood cultures and PCR for meningococcus
What is the initial antibiotic treatment for patients under 3 months?
IV amoxicillin (or ampicillin) + IV cefotaxime
What is the initial antibiotic treatment for patients over 3 months?
IV cefotaxime (or ceftriaxone)
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
What is the most common cause of meningitis in neonates?
Group B Streptococcus
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
What condition are patients with meningococcal meningitis at risk for?
Waterhouse-Friderichsen syndrome
What is the role of the ABC approach in meningitis management?
Airway, Breathing, Circulation, Disability (GCS, focal neurological signs, seizures, papilloedema)
True or False: A lumbar puncture should be performed immediately in all cases of suspected meningitis.
False
What tests should be performed on blood samples taken from suspected meningitis patients?
- Full blood count
- Renal function
- Glucose
- Lactate
- Clotting profile
- CRP
What is the recommended prophylactic antibiotic for contacts of patients with meningococcal meningitis?
Ciprofloxacin
What is the common clinical presentation of viral meningitis?
- Headache
- Neck stiffness
- Photophobia
- Confusion
- Fevers
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
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
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
What is the preferred antibiotic for treating meningococcal meningitis?
IV benzylpenicillin or cefotaxime (or ceftriaxone)
Fill in the blank: Meningitis is an inflammation of the _______ and the cerebrospinal fluid of the subarachnoid space.
leptomeninges
What is the sensitivity of the Ziehl-Neelsen stain in detecting tuberculous meningitis?
20%
What are some neurological sequelae of meningitis? (7)
- Sensorineural hearing loss
- Seizures
- Focal neurological deficit
- Sepsis
- Intracerebral abscess
- Brain herniation
- Hydrocephalus