Infection and Immunology Flashcards

Question 1

Q

Define autoimmune hepatitis.

Answer

A

Autoimmune hepatitis (AIH) is a chronic inflammatory disease of the liver of unknown aetiology. It is characterised by the presence of circulating auto-antibodies with a high serum globulin concentration, inflammatory changes on liver histology, and a favourable response to immunosuppressive treatment.

Question 2

Q

Explain the aetiology/risk factors of autoimmune hepatitis.

Answer

A

Female gender Genetic predisposition Immune dysregulation

Question 3

Q

Summarise the epidemiology of autoimmune hepatitis.

Answer

A

All ethnicities are susceptible to the disease, but prevalence is greatest among people with northern European ancestry who have a high frequency of human leukocyte antigen (HLA)-DR3 and HLA-DR4 markers.

Question 4

Q

Recognise the presenting symptoms of autoimmune hepatitis. Recognise the signs of autoimmune hepatitis on physical examination.

Answer

A

Fatigue/malaise Anorexia Abdominal discomfort Hepatomegaly Jaundice Pruritus Arthralgia Nausea Fever Spider angiomata Splenomegaly

Question 5

Q

Identify appropriate investigations for autoimmune hepatitis and interpret the results.

Answer

A

Aspartate transaminase Alanine transaminase Bilirubin Gamma-GT Alkaline phosphatase Serum globulin Serum albumin Prothrombin time

Question 6

Q

Generate a management plan for autoimmune hepatitis.

Answer

A

Observation and monitoring Corticosteroid monotherapy e.g. prednisolone

Question 7

Q

Identify the possible complications of autoimmune hepatitis and its management.

Answer

A

Osteoporosis, diabetes mellitus, hypertension, truncal obesity, cataracts due to corticosteroid therapy. Hepatocellular carcinoma, end-stage liver disease due to progression of AIH. Bone marrow suppression, cholestatic hepatitis, pancreatitis, skin rash due to azathioprine therapy.

Question 8

Q

Summarise the prognosis for patients with autoimmune hepatitis.

Answer

A

The natural history of AIH reveals that untreated AIH has a poor prognosis with a 5-year survival rate of 50% and 10-year survival rate of 10%. Immunosuppressive therapy significantly improves survival.

Question 9

Q

Define Behçet’s disease.

Answer

A

A systemic vasculitis which can cause skin and mucosal lesions, uveitis, major arterial and venous vessel disease, and GI and neurological manifestations.

Question 10

Q

Explain the aetiology/risk factors of Behçet’s disease.

Answer

A

Age 20 to 40 years Family history of Behçet’s syndrome Genetic predisposition

Question 11

Q

Summarise the epidemiology of Behçet’s disease.

Answer

A

Patients are most commonly from the Middle East, the Mediterranean region, and eastern Asia, with Japan and South Korea leading the list. Behçet’s syndrome is rare in northern Europe and Africa. The prevalence in Turkey is 1 in 250 of the adult population.

Question 12

Q

Recognise the signs of Behçet’s disease on physical examination. Recognise the presenting symptoms of Behçet’s disease.

Answer

A

Increased predisposition in certain ethnic/geographic groups Oral ulcers Genital ulcers Uveitis Acne lesions Erythema nodosum

Question 13

Q

Identify appropriate investigations for Behçet’s disease and interpret the results.

Answer

A

Pathergy testing RF ANA Anti-neutrophil cytoplasmic antibodies HLA-B51 MRI brain with contrast Colonoscopy Upper GI endoscopy High-resolution chest CT CT angiography of chest Pulmonary angiography

Question 14

Q

Define candidiasis.

Answer

A

Oral candidiasis involves an infection of oral tissues by yeasts of the genus Candida, mostly C albicans. It is the most common oral fungal infection and is commonly seen in infants and older adults, and also with states of local and systemic immunological suppression.

Question 15

Q

Explain the aetiology/risk factors of candidiasis.

Answer

A

Hyposalivation/xerostomia Poor oral hygiene, especially among denture wearers Malabsorption and malnutrition Advanced malignancy Cancer chemotherapy and radiotherapy HIV infection Endocrine disturbance (e.g., diabetes mellitus, hypoparathyroidism, pregnancy, hypoadrenalism) Immunosuppressive agents (e.g., systemic corticosteroid therapy) Current or recent past use of broad-spectrum or multiple narrow-spectrum antibiotics

Question 16

Q

Summarise the epidemiology of candidiasis.

Answer

A

Oral candidal colonisation has been reported to range from approximately 40% to 70% of healthy children and adults, with higher rates observed among children with carious teeth and older adults wearing dentures.

Question 17

Q

Recognise the presenting symptoms of candidiasis. Recognise the signs of candidiasis on physical examination.

Answer

A

Creamy white or yellowish plaques, fairly adherent to oral mucosa Cracks, ulcers, or crusted fissures radiating from angles of the mouth Lesions on any part of the oral mucosa Atrophic, fiery red, flat lesions on the palate Patchy areas of loss of filiform papillae on the dorsum of the tongue Spotty red areas on the buccal mucosa Lesions confined to the outline of a dental prosthesis Burning oral pain

Question 18

Q

Identify appropriate investigations for candidiasis and interpret the results.

Answer

A

Superficial smear of lesion for microscopy

Question 19

Q

Define encephalitis.

Answer

A

Encephalitis is defined as inflammation of the brain parenchyma associated with neurological dysfunction such as altered state of consciousness, seizures, personality changes, cranial nerve palsies, speech problems, and motor and sensory deficits.

Question 20

Q

Explain the aetiology/risk factors of encephalitis.

Answer

A

Age <1 or >65 years Immunodeficiency Post-infection Blood/body fluid exposure Organ transplantation Animal or insect bites Location Season Swimming or diving in warm freshwater or nasal/sinus irrigation

Question 21

Q

Summarise the epidemiology of encephalitis.

Answer

A

Around 2500 cases of encephalitis occur in England each year. Globally, the incidence of encephalitis is around 7 per 100,000 population per year.

Question 22

Q

Recognise the presenting symptoms of encephalitis. Recognise the signs of encephalitis on physical examination.

Answer

A

Fever Rash Altered mental state Focal neurological deficit Meningismus Parotitis Lymphadenopathy Optic neuritis Acute flaccid paralysis Movement disorder Cough Gastrointestinal infection Seizures

Question 23

Q

Identify appropriate investigations for encephalitis and interpret the results.

Answer

A

FBC Peripheral blood smear Serum electrolytes Liver function tests Blood cultures Throat swab Nasopharyngeal aspirate Sputum culture Chest radiography CT brain MRI brain Electroencephalogram (EEG) Cerebrospinal fluid (CSF) analysis, culture, serology andpolymerase chain reaction (PCR)

Question 24

Q

Define human immunodeficiency virus (HIV).

Answer

A

HIV is caused by a retrovirus that infects and replicates in human lymphocytes and macrophages, eroding the integrity of the human immune system over a number of years, culminating in immune deficiency and a susceptibility to a series of opportunistic and other infections as well as the development of certain malignancies.

Question 25

Q

Explain the aetiology/risk factors of human immunodeficiency virus (HIV).

Answer

A

Needle sharing with intravenous drug use Unprotected receptive anal intercourse Unprotected receptive penile-vaginal sexual intercourse Percutaneous needle stick injury High maternal viral load (mother to child transmission)

Question 26

Q

Summarise the epidemiology of human immunodeficiency virus (HIV).

Answer

A

Globally, there were 37.9 million people living with HIV worldwide at the end of 2018, with approximately 1.7 million becoming newly infected in 2018. Approximately 70% of people living with HIV are in sub-Saharan Africa.

Question 27

Q

Recognise the presenting symptoms of human immunodeficiency virus (HIV). Recognise the signs of human immunodeficiency virus (HIV) on physical examination.

Answer

A

Fevers and night sweats Weight loss Skin rashes and post-inflammatory scars Oral ulcers, angular cheilitis, oral thrush, or oral hairy leukoplakia Diarrhoea Wasting syndrome Changes in mental status or neuropsychiatric function Recent hospital admissions Tuberculosis (TB) Generalised lymphadenopathy Kaposi's sarcoma Genital STIs Chronic vaginal candidiasis Shingles

Question 28

Q

Identify appropriate investigations for human immunodeficiency virus (HIV) and interpret the results.

Answer

A

Serum HIV enzyme-linked immunosorbent assay (ELISA) Serum HIV rapid test HIV non-invasive tests Serum Western blot Serum p24 antigen Serum HIV DNA polymerase chain reaction (PCR) CD4 count Serum viral load (HIV RNA) Serum hepatitis B serology Serum hepatitis C serology Serum electrolytes Serum creatinine Urinalysis

Question 29

Q

Define malaria.

Answer

A

Malaria is a parasitic infection caused by protozoa of the genus Plasmodium. Five species are known to infect humans; Plasmodium falciparum is the most life-threatening.

Question 30

Q

Explain the aetiology/risk factors of malaria.

Answer

A

Travel to endemic area Inadequate or absent chemoprophylaxis Insecticide-treated bed net not used in endemic area Settled migrants returning from travel to endemic area of origin Low host immunity Pregnancy Age <5 years Immunocompromised Older age

Question 31

Q

Summarise the epidemiology of malaria.

Answer

A

There were an estimated 219 million malaria cases worldwide (in 87 countries) in 2017, resulting in an estimated 435,000 deaths. Approximately 92% of all malaria cases and 93% of all malaria deaths occurred in the African region, and the majority of deaths were due to Plasmodium falciparum infection.

Question 32

Q

Recognise the presenting symptoms of malaria. Recognise the signs of malaria on physical examination.

Answer

A

Fever Headache Myalgia Arthralgia Diarrhoea Nausea and vomiting Abdominal pain Pallor Hepatosplenomegaly, jaundice Altered level of consciousness Hypotension Anuria/oliguria

Question 33

Q

Identify appropriate investigations for malaria and interpret the results.

Answer

A

Giemsa-stained thick and thin blood smears Rapid diagnostic tests (RDTs) FBC Serum electrolytes, urea and creatinine Serum LFTs Serum blood glucose Urinalysis Arterial blood gas

Question 34

Q

Define mastitis and breast abscesses.

Answer

A

Mastitis is inflammation of the breast with or without infection. Mastitis with infection may be lactational (puerperal) or non-lactational (e.g., duct ectasia). A breast abscess is a localised area of infection with a walled-off collection of pus. It may or may not be associated with mastitis.

Question 35

Q

Explain the aetiology/risk factors of mastitis and breast abscesses.

Answer

A

Female sex Women aged >30 years Poor breastfeeding technique Lactation Milk stasis Nipple injury Shaving or plucking areola hair Anatomical breast defect, mammoplasty, or scar Other underlying breast condition Staphylococcus aureus carrier Immunosuppression

Question 36

Q

Summarise the epidemiology of mastitis and breast abscesses.

Answer

A

The global prevalence of mastitis in lactating women is approximately 1% to 10% but may be higher. Breast abscess develops in 3% to 11% of women with mastitis with a reported incidence of 0.1% to 3.0% in breastfeeding women.

Question 37

Q

Recognise the presenting symptoms of mastitis and breast abscesses. Recognise the signs of mastitis and breast abscesses on physical examination.

Answer

A

Flu-like symptoms, malaise, and myalgia Fever Breast pain Decreased milk outflow Breast warmth, tenderness, erythema and swelling Breast firmness Breast mass Nipple discharge Nipple inversion/retraction

Question 38

Q

Identify appropriate investigations for mastitis and breast abscesses and interpret the results.

Answer

A

Breast ultrasound Diagnostic needle aspiration drainage Cytology of nipple discharge or sample from fine-needle aspiration Milk, aspirate, discharge, or biopsy tissue for culture and sensitivity Histopathological examination of biopsy tissue

Question 39

Q

Generate a management plan for mastitis and breast abscesses.

Answer

A

Antibiotic therapy e.g. Flucloxacillin Effective milk removal and supportive care e.g. paracetamol

Question 40

Q

Identify the possible complications of mastitis and breast abscesses and its management.

Answer

A

Cessation of breastfeeding Abscess (complicating mastitis) Sepsis Scarring Functional mastectomy Breast hypoplasia Necrotising fasciitis

Question 41

Q

Summarise the prognosis for patients with mastitis and breast abscesses.

Answer

A

When treated promptly and appropriately, most breast infections, including abscess, will resolve without serious complications. Resolution of mastitis after 2-3 days of appropriate antibiotic therapy is expected among most patients.

Question 42

Q

Define necrotising fasciitis.

Answer

A

Necrotising fasciitis is a life-threatening subcutaneous soft-tissue infection that may extend to the deep fascia, but not into the underlying muscle.

Question 43

Q

Explain the aetiology/risk factors of necrotising fasciitis.

Answer

A

Inpatient contact with index case Varicella zoster infection Cutaneous injury, surgery, trauma Non-traumatic skin lesions Intravenous drug use

Question 44

Q

Summarise the epidemiology of necrotising fasciitis.

Answer

A

Absolute data for the incidence and prevalence of necrotising fasciitis are lacking. There is no trend towards an increase or decrease in the prevalence or incidence of necrotising fasciitis, or evidence of global differences in epidemiology.

Question 45

Q

Recognise the presenting symptoms of necrotising fasciitis. Recognise the signs of necrotising fasciitis on physical examination.

Answer

A

Anaesthesia or severe pain over site of cellulitis Fever Palpitations, tachycardia, tachypnoea, hypotension, and lightheadedness Nausea and vomiting Delirium Crepitus Vesicles or bullae Grey discoloration of skin Oedema or induration

Question 46

Q

Identify appropriate investigations for necrotising fasciitis and interpret the results.

Answer

A

Full blood count and differential Serum electrolytes Serum urea and creatinine CRP CK Serum lactate Blood and tissue cultures Gram stain ABG CT/MRI Surgical exploration

Question 47

Q

Define neutropenic sepsis.

Answer

A

Neutropenic sepsis is a potentially life-threatening complication of neutropenia (low neutrophil count). It is defined as a temperature of greater than 38°C or any symptoms and/or signs of sepsis, in a person with an absolute neutrophil count of 0.5 x 10^9/L or lower.

Question 48

Q

Explain the aetiology/risk factors of neutropenic sepsis.

Answer

A

Characteristics of neutropenia Rapid rate of decline of the neutrophil count increases infection risk Age (infants and >60) Chemotherapy Corticosteroids Antibiotics Advanced malignancy History of previous febrile neutropenia Prolonged hospital admission Previous surgery Comorbidities

Question 49

Q

Summarise the epidemiology of neutropenic sepsis.

Answer

A

The incidence of neutropenic sepsis is increasing over time, possibly reflecting the increasing use of anticancer and other immunosuppressive drug therapies The incidence of neutropenic sepsis among people with cancer ranges from three cases a month in general hospitals in the UK to over 20 cases a month in specialist haematology/oncology units.

Question 50

Q

Recognise the presenting symptoms of neutropenic sepsis. Recognise the signs of neutropenic sepsis on physical examination.

Answer

A

Dysuria Diarrhoea Productive cough Rapid decline Chills, shivers, rigors Febrile >38°C (may also present with hypothermia)

Question 51

Q

Identify appropriate investigations for neutropenic sepsis and interpret the results.

Answer

A

FBC CRP Temperature Urinalysis Blood culture Lactate

Question 52

Q

Define osteomyelitis.

Answer

A

Osteomyelitis is an inflammatory condition of bone caused by an infecting organism, most commonly Staphylococcus aureus. It usually involves a single bone but may rarely affect multiple sites.

Question 53

Q

Explain the aetiology/risk factors of osteomyelitis.

Answer

A

Penetrating injuries Surgical contamination Intravenous drug misuse Diabetes mellitus Periodontitis

Question 54

Q

Summarise the epidemiology of osteomyelitis.

Answer

A

A study in the US showed that the overall age- and sex-adjusted annual incidence of osteomyelitis was 21.8 cases per 100,000 person-years between 1969 and 2009. The annual incidence was higher for men than for women and increased with age.

Question 55

Q

Recognise the presenting symptoms of osteomyelitis. Recognise the signs of osteomyelitis on physical examination.

Answer

A

Non-specific pain at site of infection Malaise and fatigue Local inflammation, erythema, or swelling Low-grade fever Wound drainage Scars, previous flaps Reduced range of movement Reduced sensation in diabetic foot ulcer

Question 56

Q

Identify appropriate investigations for osteomyelitis and interpret the results.

Answer

A

WBC count ESR CRP Plain x-rays of affected area

Question 57

Q

Define pneumonia.

Answer

A

Pneumonia is inflammation of the lungs with consolidation or interstitial lung infiltrates, most often categorised according to the causative organism.

Question 58

Q

Explain the aetiology/risk factors of pneumonia.

Answer

A

Age >65 years Residence in a healthcare setting COPD Exposure to cigarette smoke Alcohol abuse Poor oral hygiene Use of acid-reducing drugs, inhaled corticosteroids, antipsychotics, antidiabetic drugs Contact with children HIV infection Aspiration risk

Question 59

Q

Summarise the epidemiology of pneumonia.

Answer

A

The global burden of diseases, injuries, and risk factors (GDB) study showed that lower respiratory tract infections affected over 336 million people all over the world. HAP and ventilator-associated pneumonia (VAP) are now the most common nosocomial infections (accounting for 22% of the total). In the UK, between 0.5% and 1% of adults will have CAP every year.

Question 60

Q

Recognise the presenting symptoms of pneumonia. Recognise the signs of pneumonia on physical examination.

Answer

A

Dyspnoea Productive cough Fever Chest pain Asymmetrical expansion of the chest Diminished resonance

Question 61

Q

Identify appropriate investigations for pneumonia and interpret the results.

Answer

A

Chest x-ray FBC Serum electrolytes, urea Liver function tests Blood glucose Arterial blood gases/oximetry Blood culture Sputum culture

Question 62

Q

Generate a management plan for pneumonia.

Answer

A

Oral antibiotics e.g. amoxicillin, doxycycline, macrolide Supportive care

Question 63

Q

Identify the possible complications of pneumonia and its management.

Answer

A

Septic shock Acute respiratory distress syndrome (ARDS) Antibiotic-associated Clostridium difficile colitis Heart failure Acute coronary syndrome Cardiac arrhythmias Necrotising pneumonia Pleural effusion Lung abscess

Question 64

Q

Summarise the prognosis for patients with pneumonia.

Answer

A

Prognosis is determined by 3 major factors: age of the patient, general state of health (presence of comorbidities), and the setting where antibiotic treatment is given.

The all-cause mortality for HAP is 30% to 70%, while the attributable mortality is approximately 10%. Many people with HAP die of their underlying cause. Readmission rates in patients with CAP range from 7% to 12%.

Answer 65

A

Septic arthritis is defined as the infection of 1 or more joints caused by pathogenic inoculation of microbes. It occurs either by direct inoculation or via haematogenous spread.

Answer 66

A

Underlying joint disease Joint prostheses Intravenous drug abuse Diabetes Presence of cutaneous ulcers

Answer 67

A

The estimated incidence of septic arthritis in developed countries is 6 cases per 100,000 population per year. In patients with underlying joint disease or with prosthetic joints the incidence increases approximately 10-fold, to 70 cases per 100,000 of the population.

Answer 68

A

Hot, swollen, tender, restricted joint Fever

Answer 69

A

Synovial fluid Gram stain and culture Synovial fluid white cell count Blood culture White cell count Erythrocyte sedimentation rate CRP Plain radiograph Ultrasound

Answer 70

A

Sjögren's syndrome is a systemic auto-immune disorder characterised by the presence of dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia) as a consequence of lymphocytic infiltration into the lacrimal and salivary glands.

Answer 71

A

Female Systemic lupus erythematosus (SLE) Rheumatoid arthritis Systemic sclerosis (scleroderma) HLA class II markers Age peaks in 20s to 30s and after the menopause

Answer 72

A

Possibly the most common of all systemic auto-immune rheumatic diseases, Sjögren's syndrome is a systemic auto-immune disorder with a female-to-male ratio of 9:1 and a population prevalence of between 0.5% and 1.56%, depending on the diagnostic criteria used.

Answer 73

A

Fatigue Dry eyes Dry mouth Vasculitis Dental caries Increased oral fungal and bacterial infections Arthralgia Myalgia

Answer 74

A

Schirmer's test Anti-60 kD (SS-A) Ro and anti-La (SS-B)

Answer 75

A

Quantitatively measures tears. A filter paper is placed in the lower conjunctival sac. The test is positive if less than 5 mm of paper is wetted after 5 minutes.

Answer 76

A

Spontaneous bacterial peritonitis (SBP) is an infection of ascitic fluid that cannot be attributed to any intra-abdominal, ongoing inflammatory, or surgically correctable condition. It is one of the most frequently encountered bacterial infections in patients with cirrhosis.

Answer 77

A

Decompensated hepatic state (usually cirrhosis) Low ascitic protein/complement GI bleeding Sclerosis of oesophageal varices

Answer 78

A

Studies have demonstrated a SBP prevalence of 12% in patients with ascites admitted for decompensated cirrhosis, 18% in those admitted for hepatic encephalopathy, and 10% to 14% in those admitted with acute GI haemorrhage.

Answer 79

A

Abdominal pain or tenderness Signs of ascites Fever Nausea/vomiting Diarrhoea Altered mental status GI bleed Hypothermia Hypotension Tachycardia

Answer 80

A

FBC Serum creatinine Ascitic fluid appearance Ascitic fluid absolute neutrophil count (ANC) Ascitic fluid Gram stain Ascitic fluid culture Highly-sensitive leukocyte esterase reagent strip testing of ascitic fluid (Periscreen) Bedside (standard urine) leukocyte esterase reagent strip testing of ascitic fluid Blood cultures LFT PT/INR Ascitic fluid pH and arterial blood pH

Answer 81

A

Antibiotics Antibiotic and beta-blocker prophylaxis

Answer 82

A

Sepsis/septic shock Tense ascites Bleeding after paracentesis Bowel perforation after paracentesis Leakage from paracentesis puncture site Renal failure

Answer 83

A

One-year SBP recurrence rates as high as 69% have been reported. Randomised controlled trials comparing antibiotic regimens have described an in-hospital mortality rate of 10% to 28%.

Answer 84

A

Systemic lupus erythematosus (SLE) is a chronic multisystem disorder that most commonly affects women during their reproductive years. It is characterised by the presence of antinuclear antibodies.

Answer 85

A

Female sex Age 15 to 45 years African/Asian descent in Europe and US Drugs

Answer 86

A

Methods applied to study the epidemiology of SLE have limitations. Common to all studies is that the disease occurs most frequently between the ages of 15 and 45 years, when it is 12 times more common in females than in males.

Answer 87

A

Malar (butterfly) rash Photosensitive rash Discoid rash Fatigue Weight loss Fever Oral ulcers Alopecia Arthralgia/arthritis Fibromyalgia Raynaud's phenomenon

Answer 88

A

Anti-DSDNA ANA FBC and differential Activated PTT Urea and electrolytes Erythrocyte sedimentation rate (ESR) and CRP Urinalysis Chest x-ray ECG

Answer 89

A

Systemic sclerosis (SSc), also known as scleroderma, is a multi-system, autoimmune disease, characterised by functional and structural abnormalities of small blood vessels, fibrosis of skin and internal organs, and production of auto-antibodies.

Answer 90

A

FHx of scleroderma Immune dysregulation (e.g., positive ANA)

Answer 91

A

There are different prevalence estimates for scleroderma among different world populations, with higher population estimates in the US than in Europe or Asia. The prevalence of scleroderma is estimated at 88 per million in England.

Answer 92

A

Raynaud's phenomenon Digital pits or ulcers Swelling of the hands and feet Skin thickening Loss of function of hands Sclerodactyly Heartburn, reflux, and dysphagia Bloating Faecal incontinence Arthralgias and myalgias

Answer 93

A

Serum auto-antibodies FBC Urea and serum creatinine ESR C-reactive protein (CRP) Urine microscopy Complete PFTs (spirometry, lung volumes, and diffusing capacity measurement) ECG Echocardiogra CXR Barium swallow

Answer 94

A

Acute tonsillitis is an acute infection of the parenchyma of the palatine tonsils. The clinical distinction between tonsillitis and pharyngitis is unclear in the literature, and the condition is often referred to simply as 'acute sore throat'.

Answer 95

A

Age between 5 and 15 years Contact with infected people in enclosed spaces (e.g., child care centres, schools, prison)

Answer 96

A

In UK general practice, recurrent sore throat has an annual incidence of 100 in 1000 population. Acute tonsillitis is more common in children between the ages of 5-15 years.

Answer 97

A

Pain on swallowing Fever (>38°C) Tonsillar exudate Sudden onset of sore throat Headache Abdominal pain Nausea and vomiting Presence of cough or runny nose Tonsillar erythema and enlargement Enlarged anterior cervical lymph nodes

Answer 98

A

Throat culture Rapid streptococcal antigen test

Answer 99

A

When TB occurs in organ systems other than the lungs, it is referred to as extrapulmonary TB (EPTB).

Answer 100

A

Exposure to TB Born in Asia, Latin America, or Africa HIV infection Immunosuppressive medicines Haematological or head/neck malignancy End stage renal disease (ESRD) Apical fibrosis Very young age

Answer 101

A

Of the 9272 reported cases of active TB in the US in 2016, 20% had EPTB disease alone. Patients born outside the US accounted for 68.5% of the total cases of TB in 2016.

Answer 102

A

Enlarged lymph node Pleuritic chest pain Skeletal pain Urinary symptoms Abdominal swelling Abdominal pain Cough Hepatomegaly Fever Night sweats

Answer 103

A

Chest x-ray Sputum smear Sputum culture Tuberculin skin testing (TST) FBC Fine-needle aspiration (FNA) Pleural fluid analysis Ascitic fluid analysis Bone films CSF analysis Urinalysis Nucleic acid amplification test (NAAT)

Answer 104

A

Pulmonary tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. In many cases, M tuberculosis becomes dormant before it progresses to active TB. This is a notifiable disease.

Answer 105

A

Exposure to infection Birth in an endemic country HIV infection Immunosuppressive medicines Silicosis Apical fibrosis

Answer 106

A

According to WHO data, TB is the ninth leading cause of death worldwide, and is the leading cause of death from a single infectious agent.

Answer 107

A

Cough Fever Anorexia Weight loss Malaise Night sweats Pleuritic chest pain Haemoptysis

Answer 108

A

CXR Sputum acid-fast bacilli (AFB) smear Sputum culture FBC Nucleic acid amplification tests (NAAT)

Answer 109

A

Eosinophilic granulomatosis with polyangiitis (EGPA) is a form of primary systemic autoimmune vasculitis characterised by inflammation of blood vessels. In EGPA, vasculitis is associated with asthma and eosinophilia. EGPA is also known as Churg-Strauss syndrome (CSS).

Answer 110

A

History of asthma, allergic rhinitis, or sinusitis Use of certain medications

Answer 111

A

EGPA is the most rare of the three anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides, with an estimated annual incidence of between 1 and 3 cases per million people. Among asthma patients, the incidence is as high as 67 per million asthma patients.

Answer 112

A

Focal numbness or weakness Nasal discharge or stuffiness, or facial pain Palpable purpura and petechiae Wheeze Haemoptysis Skin nodules Fatigue, arthralgias, myalgias Shortness of breath or cough Abdominal pain

Answer 113

A

FBC with differential Serum anti-neutrophil cytoplasmic antibodies (ANCA) Serum CRP Erythrocyte sedimentation rate Serum urea and creatinine Urinalysis Pulmonary function test Chest x-ray Echocardiogram

Answer 114

A

Granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis) is a systemic vasculitis that typically involves small and medium vessels. Although any organ may be targeted, the classic triad consists of upper and lower respiratory tract involvement and pauci-immune glomerulonephritis.

Answer 115

A

Genetic predisposition Infection Environmental exposures All of these have a weak association, though.

Answer 116

A

The incidence and prevalence of granulomatosis with polyangiitis (GPA) (formerly known as Wegener's granulomatosis) varies considerably between countries. GPA can occur at any age. The mean age of onset in most series is between 40 and 60 years of age, with an approximately equal gender distribution. It is most commonly seen in white people, but can also occur in other racial and ethnic groups.

Answer 117

A

Upper and lower respiratory tract involvement Renal involvement Constitutional features Ocular manifestations Cutaneous manifestations Musculoskeletal manifestations Neurological manifestations

Answer 118

A

Urinalysis and microscopy CT chest Anti-neutrophil cytoplasmic antibody (ANCA) FBC and differential Serum creatinine Erythrocyte sedimentation rate (ESR)

Answer 119

A

Polyarteritis nodosa (PAN) is a rare disease that results from blood vessel inflammation ("vasculitis") causing injury to organ systems. The areas most commonly affected by PAN include the nerves, intestinal tract, heart, and joints.

Answer 120

A

Hepatitis B virus (HBV) infection Age 40 to 60 years

Answer 121

A

Over time, polyarteritis nodosa (PAN) has become progressively less common, largely owing to effective hepatitis B virus (HBV) immunisation programmes and improved blood screening for HBV, as well as to major alterations in the definition and classification of vasculitis.

Answer 122

A

Age 40 to 60 years Fever Weight loss Myalgia or arthralgia Mononeuritis multiplex Paraesthesia Muscle tenderness Abdominal pain Skin manifestations Diastolic blood pressure >90 mmHg

Answer 123

A

CRP ESR FBC Complement Serum creatinine Midstream urine analysis Liver function tests HBV serology Hepatitis C virus (HCV) serology ANCA, ANA, Anti-DSDNA

Answer 124

A

Takayasu arteritis is a chronic granulomatous vasculitis affecting large arteries: primarily the aorta and its main branches. Vascular inflammation can cause stenosis, occlusion, and aneurysm formation.

Answer 125

A

Genetic predisposition Female sex Age <40 Asian ethnicity

Answer 126

A

Takayasu arteritis is a rare disease. Its distribution is worldwide, although most cases are reported in Asian populations. Women in Japan affected about 8 times more frequently than men, whereas in India, men and women are equally represented.

Answer 127

A

Upper or lower limb claudication Absent pulse(s) Unequal blood pressures Vascular bruits Low-grade fever Transient ischaemic attack (TIA) Myalgia/arthralgia Weight loss Fatigue

Answer 128

A

ESR CRP Computerised tomography angiography (CTA) Magnetic resonance imaging angiography (MRA)

Brainscape's Knowledge GenomeTM

Infection and Immunology Flashcards

Brainscape's Knowledge Genome^TM