Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSRA Content > Infection - Level 2 > Flashcards

Infection - Level 2 Flashcards

1
Q

Epidemiology of HIV?

A
  • 110,000 people living with HIV in the UK.
  • 5% MSM living in the UK has HIV.
  • Black African people make up 36% of all people living with HIV in UK
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is HIV and how does it progress?

A

o Retrovirus which infects and replicates in human lymphocytes (CD4 + T-Cells) and macrophages
 Retrovirus encodes reverse transcriptase, allowing DNA copes to be produced from viral RNA, it is error prone
o Leads to progressive immune system dysfunction, opportunistic infection and malignancy=AIDS
o Subtypes include HIV1 (global epidemic) and HIV2 (low pathogenic, West Africa)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Transmission of HIV?

A

Blood, sexual fluids and vertically (pregnancy, childbirth, breastfeeding)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Risk Factors of HIV?

A
  • Partner infected or from high risk area of HIV
  • MSM
  • Female sexual contacts of MSM
  • Multiple partners
  • History of STIs, Hep B, Hep C
  • Migration from high prevalence countries (particularly sub-saharan Africa)
  • Failure to use barrier contraception.
  • IVDU
  • Needle-stick injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pathophysiology of HIV?

A

o HIV binds, via its GP120 envelope glycoprotein, to CD4 receptors on helper-T-cells, monocytes and macrophages
o CD4 cells migrate to lymphoid tissue where virus replicates, producing new virions
o Released and infect new CD4 cells
o As infection progresses, depletion or impaired function of CD4 cells leads to decreased immunity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When is HIV most infective?

A
  • Acute primary HIV infection is the time of highest infectivity.
  • The risk of transmission per exposure via sex is relatively low (~0.1-3%).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Symptoms and signs of primary HIV?

A

Primary HIV infection (seroconversion illness)

  • Symptomatic in 80%, typically 2-4 weeks after infection
  • Flu-like symptoms
    o Fever
    o Malaise
    o Myalgia
    o Lymphadenopathy
    o Pharyngitis
  • Erythematous/Maculopapular rash
  • Headache/Aseptic meningitis
  • Unusual signs: oral thrush, recurrent shingles, leukopenia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Symptoms and signs of asymptomatic HIV?

A

Asymptomatic infection (clinical latency)

  • After seroconversion, virus levels low as replication continues
  • CD4 and CD8 normal and may persist for many years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Symptoms and signs of persistent generalised lymphadenopathy HIV?

A
  • Swollen/Enlarged lymph nodes >1cm in 2 or more non-contiguous sites (not inguinal) persisting >3 months
  • Due to follicular hyperplasia caused by HIV
  • Exclude TB, infection and malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Symptoms of infections in HIV?

A
  • Non-Specific symptoms
    o Fever, night sweats, diarrhoea, weight loss
  • Minor opportunistic infection
    o Oral thrush, oral hairy leukoplakia, HZV, recurrent shingles, tinea infection, seborrheic dermatitis
    o Lymphopenia, thrombocytopenia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

WHO clinical stage 1 of HIV?

A

o Asymptomatic

o Persistent generalised lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

WHO clinical stage 2 of HIV?

A

o Moderate unexplained weight loss (<10% presumed or measured body weight)
o Recurrent respiratory tract infections  sinusitis, tonsillitis, otitis media and pharyngitis.
o Herpres zoster
o Recurrent oral ulceration
o Papular puritic eruptions
o Seborrhoeic dermatitis
o Fungal nail infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

WHO clinical stage 3 of HIV?

A

o Unexplained severe weight loss (>10% of presumed or measured body weight), chronic diarrhoea for longer than 1-month, persistent fever (>37.6 degrees intermittent or constant, longer than 1 month).
o Persistent oral candidiasis
o Oral hairy leukoplakia
o Pulmonary tuberculosis
o Severe bacterial infections (pneumonia, empyema, pyomyositis, bone/joint infections, meningitis or bacteraemia).
o Acute necrotising ulcerative stomatitis, gingivitis or periodontitis.
o Unexplained anaemia (<8g/dL), neutropenia (<0.5 x 109/L) or chronic thrombocytopenia (<50 x 109/L)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

WHO clinical stage 4 of HIV?

A

o HIV wasting syndrome (weight loss with diarrhoea or weakness and fever)
o Pneumocystis jirovecii pneumonia, recurrent severe bacterial pneumonia
o Chronic HSV (orolabial, genital or anorectal for more than one month or visceral at any site).
o Oesophageal candidiasis (or candidiasis of trachea, bronchi or lungs).
o Extrapulmonary tuberculosis
o Kaposi’s sarcoma
o CMV (retinitis or infection of other organs)
o CNS toxoplasmosis
o HIV encephalopathy
o Extrapulmonary cryptococcosis including meningitis
o Disseminated non-tuberculous mycobacterial infection
o Progressive multifocal leukoencephalopathy
o Chronic cryptosporidiosis (with diarrhoea)
o Chronic isoporiasis
o Disseminated myocisis (coccidomycosis or histoplasmosis)
o Recurrent non-typhoidal Salmonella bacteraemia.
o Lymphoma (cerebral or B-cell non-Hodgkin) or other solid HIV associated tumours.
o Invasive cervical carcinoma
o Atypical disseminated leishmaniasis
o Symptomatic HIV-associated nephropathy or symptomatic HIV associated cardiomyopathy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When should HIV testing be offered?

A 
o	All at risk patients
	Anyone with STI
	MSM
	Buying/Selling sex
	From countries of high HIV prevalence
	IVDU
	Any sexual partner of the above
o	Blood or organ donation
o	Opt out screening – attendees of sexual health clinics, antenatal screening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Benefits of HIV testing?

A

 Negative - Reassurance, motivation to maintain behaviours

 Positive – Effective treatment to reduce morbidity, better prognosis, reduce risk of inadvertent transmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What 2 tests are offered to diagnose HIV? Describe process of diagnosing HIV?

A

o ELISA + Western Blotting for HIV antibody and p24 antigen
 Assays for HIV1, HIV2 and HIVp24 antigen
 Send 10mls of clotted blood to virology, marked HIV test
 Window period up to 12 weeks
 If positive, diagnosis confirmed by confirmatory assay
 If negative, reassuring but repeat at 3 months
 If at risk – 3-6 monthly testing

o Point-of-care Tests
 Finger-prick or mouth samples used in some GUM clinics, results within 1 hour (can be used in acute setting)
 If positive, lab test done

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Other tests used in HIV monitoring? and their uses?

A

o CD4 Count
 Used to monitor immune system function and disease progression (<200 cells/microlitre is AIDS)

o Viral Load
 Quantification of HIV RNA
 Used to monitor response to ART
 Not diagnostic so care of use in symptomatic window period – need confirmation of seroconversion

o Nucleic Acid Testing/Viral PCR
 Test for viral RNA, used in vertical transmission in neonates

o Routine Bloods
 FBC, U&E, LFT, lipid/bone profile, glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Prevention and management of needle stick injury in patient with HIV?

A
  • Risk of HIV transmission from single needle-stick exposure from person with HIV not on ART is 1 in 300
  • Prevent
    o Use safer sharps (mechanism to minimise injury)
    o Do not recap medical sharps
    o When using sharps, ensure disposal container near
  • Manage
    o Encourage wound to bleed, ideally under running water (do not suck)
    o Wash with soap and running water, do not scrub
    o Contact OH/infection control (or A&E outside working hours) regarding testing and post-exposure prophylaxis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Monitoring in HIV infection?

A
  • Clinical assessment
  • CD4 count
  • Plasma HIV RNA levels
  • 6-monthly review at GP
  • Annual full sexual health screen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Management of new diagnosis of HIV - referral?

A
  • Refer urgently (within 48 hours, no later than 2 weeks) to GUM or HIV specialist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Management of new diagnosis of HIV - general measures?

A

Sex safe promotion (barrier contraception, dangers of multiple partners)

Needle exchange schemes

Vaccine for HepB, pneumococcal and Hib, influenza and swine flu

Partner notification
 Speak to GUM if not willing
 Estimate date when infection occurred, all contacts within 90 days prior to infection
 If estimate cannot be made, all prior partners should be informed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Management of new diagnosis of HIV - follow up?

A
  • Follow Up in 1-2 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Contact tracing in new diagnosis of HIV?

A

 Speak to GUM if not willing
 Estimate date when infection occurred, all contacts within 90 days prior to infection
 If estimate cannot be made, all prior partners should be informed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is ART management?

A
  • Antiretroviral therapy (ART) used in everyone with HIV
  • Aims to reduce HIV viral load to undetectable level leading to immunological recovery, reduced clinical progression and reduced mortality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Mechanism of HAART - NRTI/NNRTI?

A

o Nuclotide/Non-nucleoside reverse transcriptase inhibitors (NRTI/NNRTI)
 Inhibit reverse transcriptase and conversion of viral RNA into DNA
• NRTI – Zidovudine, abacavir, didanosine, lamivudine
• NNRTI – Efavirenz, etravirine, nevirapine, rilpivirine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Mechanism of HAART - Protease inhibitors?

A

o Protease Inhibitors
 Inhibit HIV enzymes required to produce mature infectious particles by cleaving structural proteins and enzymes
 Atazanavir, darunavir, fosamprenavir, indinavir, lopinavir, ritonavir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Mechanism of HAART - CCR5 antagonist?

A

o CCR5 Antagonist
 Inhibit entry of virus into cell by blocking CCR5 co-receptor
 Maraviroc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Mechanism of HAART - Integrase inhibitor?

A

o Integrase inhibitor
 Dolutegravir, elvitegravir, raltegravir
 Used in HIV infection resistant to 1st line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Investigations to perform when starting HAART?

A

o Counselling – health promotion, not a cure and lifelong therapy, side effects of treatment
o Screen for infections and malignancy (TB and HepB&C)
o Baseline tests – CD4, viral load, FBC, LFT, U&E, pregnancy test, viral genotype

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

1st line drug regimen in HAART in HIV?

A

o 2 NRTIs + one of:
 Ritonavir-boosted protease inhibitor
 NNRTI
 Integrase inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

1st line NRTIs used in HAART for HIV?

A

 Tenofovir + Emtricitabine (Truvada), abacavir + lamivudine (Kivexa)
 SE: GI disturbance, anorexia, pancreatitis, lactic acidosis, low bone density

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

1st line Protease inhibitors used in HAART for HIV?

A

 Atazanavir, darunavir, fosamprenavir, indinavir, lopinavir, ritonavir
 SE: hyperglycaemia, insulin resistance, dyslipidaemia, jaundice, hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

1st line NNRTIs used in HAART for HIV?

A

 Rilpivirine (give with food), efavirenz (CNS toxicity, care in depression, adverse lipids, rash)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

1st line Integrase inhibitors used in HAART for HIV?

A

 Dolutegravir, elvitegravir, raltegravir

 SE: rash, GI disturbance, insomnia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

1st line regimen choice in HAART for HIV?

A

o Tenofovir + emtricitabine (Truvada) + efavirenz/atazanavir/darunavir

o Abacavir + lamivudine (Kivexa) + lopinavir with ritonavir/fosamprenavir/nevirapine/rilprivirine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Aims of HAART treatment in HIV?

A

o Reduce viral load to <50copies/ml within 4-6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Primary prevention of infections used in HIV?

A
  • PCP – co-trimoxazole if CD4 <200
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is Post-exposure prophylaxis in HIV?

A
  • Short-term use of ART recommended ASAP after potential sexual or occupational exposure (up to 72h, ideally <24h)
  • Need to assess level of risk with OH or specialist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

1st line PEP in HIV?

A 
o	Truvada (tenofovir +emtricitabine) and raltegravir for 28 days
o	Test for HIV 8-12 weeks after exposure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is Pre-exposure prophylaxis in HIV?

A
  • Used in HIV-negative patients with high risk of acquiring HIV including serodifferent relationships without suppression of viral load, condomless anal in MSM
  • Taken before, during and after – daily or around sexual activities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Drug used in PrEP in HIV?

A
  • Truvada used (Emtricitabine + Tenofovir)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Is HIV tested in pregnancy?

A

• HIV blood test as part of the routine antenatal screening.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Contraception counselling advice in HIV?

A
  • Where the mother is positive and the partner negative, self-insemination with the partner’s sperm is recommended.
  • If the male is positive and the female is negative, sperm washing is recommended (alternatively, donor insemination is an option).
  • IVF should take account of the parents’ viral load, CD4 counts and any AIDS defining illness.
  • Consideration should be given to current therapy (HAART) as there is the possibility of teratogenicity with some drug combinations of taking folate antagonists for PCP prophylaxis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Testing in patient with HIV and pregnant?

A

o HIV test at booking
 Testing of other children is recommended.
o Check for Hep B, Hep C, VZV, measles and toxoplasmosis antibodies
o Offer Hep B, pneumococcal and influenza vaccine
o Screening for STI’s should be performed at booking and 28 weeks
o Treat asymptomatic infections
o Viral load and CD4 count should be repeated every 3 months and specifically at 36 weeks to inform neonatal therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

HAART management during pregnancy for patient with HIV?

A

o Continue in pregnancy if needed for mothers’ health
o If not needed, start HAART by 24 weeks until delivery
 cART
 If viral load <10000 and elective CS – ZDV monotherapy between 20-28 weeks, then IV ZDV 4 hours before CS until cord clamped
o Warm about risk of GDM and premature labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

How to prevention vertical transmission of HIV in pregnancy?

A
  • Antenatal HAART (highly active antiretroviral therapy)
  • Delivery by CS
  • Avoidance of breast feeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Delivery in patient with HIV - premature labour?

A

o If membranes rupture >34 weeks, expedite
o If membranes rupture <34 weeks, give steroids, erythromycin, HAART regimen and seek HIV specialist review
o If no membrane rupture, manage as if HIV negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Delivery in patient with HIV - C-section?

A
  • 38 weeks
  • If viral load >50 (>400 on HAART), or co-infected with Hep C and not on HAART
  • If viral load <50 – plan for 39+ weeks
  • Performed within 4 hours of SROM.
  • HAART needed if not on medication
  • Early clamping of the cord is recommended
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Delivery in patient with HIV - vaginal delivery?

A
  • Viral loads <50 (<400 if on HAART)
  • Continue HAART in labour
  • Avoid foetal blood sampling/scalp electrodes/amniotomy unless delivery imminent
  • Oxytocin augmentation can be used
  • Low cavity forceps preferred (avoid mid -cavity or rotational)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Delivery in patient with HIV -HAART?

A

cART for advanced disease

  • ART initiated by 24th week and discontinued at delivery
  • If viral load <10000 and elective CS – ZDV monotherapy between 20-28 weeks, then IV ZDV 4 hours before CS until cord clamped
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Neonatal treatment to baby born to HIV positive mother?

A

cART for advanced disease

  • ART initiated by 24th week and discontinued at delivery
  • If viral load <10000 and elective CS – ZDV monotherapy between 20-28 weeks, then IV ZDV 4 hours before CS until cord clamped
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

When to test neonate after birth to HIV positive mother?

A

o HIV DNA PCR (or HIV RNA testing):
o Day 1, 6 weeks and 12 weeks
o Confirmatory HIV antibody testing at 18 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Definition of AIDS?

A

• The development of opportunistic infections or malignancy (including cervical carcinoma) or a CD4 count <200 cells/mm3 are diagnostic of AIDS.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Common AIDs defining diseases?

A

 Pneumocystitis pneumonia
 Oesophageal candida
 Non-Hodgkin’s lymphoma
 Tuberculosis (pulmonary and extra pulmonary)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Side effects of HAART medications?

A
  • Common side effects include: collection of fat on the back (buffalo hump) and abdomen, diarrhoea, malaise, headache, nausea, weakness, high glucose, high cholesterol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Definition of influenza?

A
  • Acute respiratory illness caused by RNA viruses of Orthomyxoviridae (influenza viruses)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Types of influenza?

A

o Influenza A – more frequent and more virulent, responsible for local outbreaks, large epidemics and pandemics
o Influenza B – co-circulates with influenza A during yearly outbreaks, less severe
o Influenza C – mild or asymptomatic infection similar to common cold
- Seasonal outbreaks divided by H and N antigens on virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is uncomplicated influenza?

A

o Acute infection usually self-limiting in general population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is complicated influenza?

A

o More severe, usually Influenza A

o Symptoms that require hospital admission, involve LRT, exacerbated pre-existing medical condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Epidemiology of influenza?

A
  • Occurs during winter months, typically between December and March
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Symptoms of uncomplicated influenza?

A 
o	Coryza, nasal discharge
o	Cough
o	Fever
o	GI upset
o	Headache, malaise, myalgia, arthralgia
o	Photophobia, conjunctivitis
o	Sore throat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Symptoms of complicated influenza

A

o Signs and symptoms that require hospital admission
o LRTI
o CNS involvement
o Exacerbation of underlying medical condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Management of influenza - general advice?

A

o Drink adequate fluids
o PRN paracetamol and ibuprofen
o Bed rest
o Stay off work until feel able to attend
o Symptoms usually resolve within 1 week, may be up to 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Management of influenza - safety net?

A

o Warn about complicated symptoms
 Signs and symptoms that require hospital admission
 LRTI
 CNS involvement
 Exacerbation of underlying medical condition
o If develop SOB, CP or haemoptysis or no improvement within 1 week – follow up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Management of influenza - admission?

A

 Complication of influenza – pneumonia
 Co-existing medical condition that puts them at high risk
 Under 2 years old and in high risk group

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Management of influenza - antiviral therapy - when to give?

A

Antiviral (oral oseltamivir or inhaled zanamivir) if:

 National survery indicates influenza is circulating
 Person is ‘at risk’
• >65 years, <6 months, pregnant women and 2 weeks post-partum
• Asplenia
• COPD, bronchiectasis, CF, Asthma (continuous or repeated use of corticosteroids)
• CHD, CHF, IHD,
• CKD,
• Cirrhosis, biliary atresia, hepatitis,
• TIA, stroke,
• T1DM, T2DM, Immunosuppression,
• BMI >40
 Person can start treatment within 48 hours of onset of symptoms (36 in zanamivir)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Management of influenza - post exposure prophylaxis?

A

o DO NOT consider in at-risk groups if vaccinated >14 days before exposure
o Only prescribe if:
 National surveillance indicates influenza circulating
 Person exposed (in same household)
 At risk group and not adequately protected by vaccine
 Able to start treatment within 48 hours of contact (oseltamivir) or 36 (zanamivir)
o Arrange flu jab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Management of influenza - prevention?

A

Vaccination (quadrivalent – 2 types of A & B)
o How to give:
 Adults – IM injection in deltoid
 Children 2-10 - Intranasal spray in each nostril

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Management of influenza - when to give vaccine?

A

All people aged >65 (adjusted trivalent or quadrivalent)

All people aged 6 months to 65 years in clinical risk group:
• Respiratory – COPD, bronchiectasis, CF, IPF, BPD, asthma (continuous or repeated corticosteroids or previous hospital admission)
• Cardiac – congenital HD, hypertension with cardiac complications, CHF, IHD
• CKD
• Liver – Hepatitis, cirrhosis, biliary atresia
• Neurological – TIA, stroke, cerebral palsy, Parkinson’s, MS, MND, polio
• T1DM, T2DM
• Immunosuppressed – chemo, bone marrow transplant, myeloma, HIV/AIDs, DMARDs, systemic corticosteroids (>1 month)
• Asplenia
• Pregnant women
• BMI >40

Children aged 2-10 (LAIV)

People in long-stay residential and nursing homes

Close contacts of immunocompromised people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Management of influenza - contraindications to influenza vaccine?

A

 Allergy (if true egg allergy – may need admission for it)

 Acutely unwell (febrile, systemic infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Management of influenza - adverse effects of influenza vaccine?

A

 Pain, swelling, redness at site
 Low-grade fever, malaise, fatigue
 Headache, myalgia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Complications of influenza?

A

o Respiratory - Acute bronchitis, exacerbation of asthma or COPD, otitis media, pneumonia, sinusitis
o Cardiac - Myocarditis, pericarditis
o Febrile convulsions
o Myalgia, myositis
o Neurological – Reyes syndrome, encephalomyelitis, GBS, aseptic meningitis
o Toxic shock syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Definition of measles? Transmission? Incubation?

A
  • RNA paramyoxyviridae virus
  • Highly infectious
  • Transmitted by droplets / direct contact
  • Incubation period: 7-14 days
  • Infectious 4d before symptoms and 4d after onset of rash
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Epidemiology of measles?

A
  • Peak age= <1 year (before immunisation) or older children that are not immunised
  • Occurs typically in preschool children - peak in winter/spring
  • Commonest in developing countries
  • Rare due to MMR vaccine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Risk factors of measles?

A
  • Not immunised, immunocompromised, contact
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Symptoms of measles?

A
  • Prodrome (2-4 days) of:
    o Fever 39oC
    o Conjunctivitis, coryza, cough, lymphadenopathy
    o Koplik’s spots (grain like spots opposite lower molars and buccal mucosa)
  • Rash appears 3-4 days later usually on face & behind ear and spreads to whole body
    o Initially erythematous and maculopapular but then blotchy and conflueunt, may desquamate in 2’ wk.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Diagnosis of measles?

A
  • Clinical diagnosis confirmed by serology &/ or viral culture (oral fluid sample)
  • Blood Film
    o Leucopenia, lymphopenia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Management of measles - general advice?

A
  • Notifiable disease to Health Board
    o Testing kit – oral fluid sample for IgG/IgM and/or RNA testing
    o Seek advice from HPT about immunosuppressed, pregnant and infants <1
  • Supportive – Antipyretics, ibuprofen and fluids
  • Stay off school/work for 4 days after development of rash
  • Avoid contact with people not vaccinated, infants, pregnant women or immunocompromised
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Management of measles - if susceptible and >1, pregnant or immunosuppressed?

A

o Give immediate MMR vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Management of measles - if immunocompromised?

A

o Ribavirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Prognosis of measles?

A

o Most people with measles make full recovery after a week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Complications of measles?

A 
-	Common
o	Otitis Media
o	Pneumonia
o	Tracheobronchitis
o	Diarrhoea
  • Rare
    o Convulsions
    o Encephalitis
    o Subacute Sclerosing Panencephalitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Definition of mumps? Incubation time? Infective?

A
  • Acute infection caused by RNA paramyoxavirus
  • Droplet/Saliva spread and replicates in upper respiratory mucosa
  • Incubation time - 14-21 days
  • Infective – 7 days before and 9 days after parotid swelling starts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Epidemiology of mumps?

A
  • Introduction of MMR has reduced rates of mumps
  • 90% in people >15
  • Rare in children <1 due to passive immunity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Risk factors of mumps?

A
  • Likely in unimmunised, recent contact or outbreak of mumps in local area
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Symptoms of mumps?

A

o Prodromal malaise
o High temperature
o Painful parotid swelling (typically one side first, then bilateral in 70%)
 Ear lobe deflected upwards and outwards
 Angle of mandible obscured
 Pain when chewing, speaking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Investigations of mumps?

A
  • Clinical Diagnosis

- Confirmed by saliva sample to detect presence of IgM mumps antibody

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Management of mumps - notify public health?

A

o Arrange testing kit through saliva swab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Management of mumps -general advice?

A

o Self-limiting – resolves over 1-2 weeks
o Bed Rest
o Drink adequate fluids
o PRN paracetamol and ibuprofen
o Warm/Cold packs to parotid gland
o OFF SCHOOL/WORK FOR 5 DAYS AFTER INITIAL DEVELOPMENT OF PAROTIDITIS
o 1-week follow up to check symptoms resolving and immunised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Management of mumps -contacts?

A

o Offer MMR if not fully immunised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Management of mumps -pregnant women?

A

o Manage in same way, MMR is CI in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Management of mumps -if epididymo-orchitis diagnosed?

A

o Symptomatic relief
o Symptoms should resolve in 2 weeks
o If concerned about fertility issues, offer semen analysis 3 months after mumps resolved
 If abnormal then refer to fertility specialist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Management of mumps -admission?

A

o Mumps encephalitis or meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Prognosis of mumps?

A

o Self-limiting disease that resolves within 1-2 weeks and most recover without any long-term complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Complications of mumps?

A 
o	Usually none
o	Parotiditis
o	Epididymo-orchitis (+/- infertility)
o	Oophoritis
o	Arthritis
o	Meningitis
o	Pancreatitis
o	Myocarditis
o	Deafness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Definition of rubella? Transmission? Incubation period? Infectivity?

A
  • Infectious RNA togaviridae viral illness, Rubella virus spread via air-droplets
  • Known as German measles or three-day measles
  • Transmitted by droplet spread or via placenta to foetus
  • Incubation period = 14-21 days
  • Infectious: most infectious when rash erupting but 7 days before to 7 days after rash appears
  • Prevention of Spread – MMR vaccine at 12-15 months, booster at 4-6 years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Epidemiology of rubella?

A
  • 1/25,000

- Peak age: >15 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Risk Factors of rubella?

A
  • Malnutrition, not immunised, immunocompromised, contact with Rubella
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Symptoms if caught during pregnancy of rubella? ?

A

o Teratogen during pregnancy
 Infection before 8 weeks leads to cataracts, congenital heart defects and deafness
• Congenital Rubella Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Symptoms of rubella?

A
  • Clinical Features 2-3 weeks after exposure and include:
    o Rash – Pink or light red maculopapular rash starts on face which spreads to chest, upper arms, abdomen and thighs
    o Lymphadenopathy (suboccipital, postauricular and cervical lymph nodes)
    o Arthralgia and arthritis
    o Malaise
    o Low-grade Fever
    o Headache
    o Coryza
    o Non-purulent conjunctivitis
102
Q

Investigations of rubella?

A
  • Clinical diagnosis

- Confirmed by serology &/ or viral culture

103
Q

Management of rubella - notifying HPT?

A

o Notifiable disease – inform HPT
o Discuss need for testing
 Immediate oral fluid sample for serology and PCR may be requested – if positive then further testing needed
 May need to test for other infections

104
Q

Management of rubella - general advice?

A

 Normally self-limiting – resolve within 1 week
 Supportive – Antipyretics, keep hydrated
 Avoid school for 5 days after development of rash
 Avoid contact with pregnant women

105
Q

Management of rubella - pregnant women - if confirmed and <20 weeks?

A

 Refer urgently to obstetrics for risk-assessment (lower gestation, the higher risk of CRS)

106
Q

Management of rubella - pregnant women - if confirmed and >20 weeks?

A

 Reassure that no reported cases of CRS after this age

 Give rubella vaccine post-partum only

107
Q

Complications of rubella in healthy people?

A

o Arthritis and arthralgia

o Encephalitis rare

108
Q

Complications of rubella in pregnant women?

A

Miscarriage, stillbirth and Congenital Rubella Syndrome
o Cataracts, hearing impairment, PDA and pulmonary artery stenosis, microencephaly, mental retardation, IUGR, autism, DM and thyroid dysfunction

109
Q

Definition of Chicken Pox?

A
  • Highly infectious disease caused by herpes virus transmitted by air droplets
  • VZV infection between 1-6yrs commonly —winter/spring
110
Q

Transmission of Chicken Pox?

A
  • Transmission is by personal contact or droplet spread, with an incubation period (the time from becoming infected until symptoms appear) of 1-3 weeks
111
Q

Infectivity of Chicken Pox?

A
  • Chickenpox is infectious from 1-2 days before the rash appears until the vesicles are dry or have crusted over, usually 5 days after the onset of the rash
112
Q

What is Herpes Zoster Virus?

A
  • Herpes Zoster (shingles)
    o a reactivation of the latent infection may occur -> vesicular lesions in the distribution of the sensory nerve. Increased risk in immunosuppressed
113
Q

Epidemiology of Chicken Pox?

A
  • Incidence is highest before 10 years of age
  • > 90% of people older than 15 years of age UK are immune
  • Peak incidence from March-May
114
Q

Cause of Chicken Pox?

A
  • Caused by varicella-zoster virus (VZV)
115
Q

Symptoms of Chicken Pox?

A

Prodrome:

  • Infection begins 2 days before vesicles appear
  • Infection ends when last vesicle crusts over

Rash:

  • Head and trunk rest of body.
  • Red macules papulevesiclepustulecrusting
  • Crusting within 5 days and fall off after 1-2 weeks

Other features: headache, anorexia, URTI (sore throat, coryza, cough), fever and itching

116
Q

Investigations of Chicken Pox?

A

Ex: Characteristic rash, its distribution and progression

Laboratory tests, rarely required

117
Q

Management of Chicken Pox - general advice?

A

o Usually self-limiting
o Encourage fluid intake
o Wear smooth, cotton fabrics
o Keep nails short to minimise damage from scratching
o Avoid contact with immunocompromised, pregnant women and infants <4 weeks until 5 days after rash
o School/nursery exclusion until all lesions crusted over

118
Q

Management of Chicken Pox - symptomatic advice?

A

o Paracetamol
o Calamine lotion
o Chlorphenamine

119
Q

Management of Chicken Pox - if >14, presenting within 24 hours of rash and severe or risk of complications (smoker)?

A

o Consider Aciclovir PO 800mg 5x/day

120
Q

Management of Chicken Pox -admission?

A
  • Admit if severe complications (pneumonia, encephalitis, dehydration)
121
Q

Management of Chicken Pox - pregnant women - admission?

A
  • Admit to hospital if pregnant woman has:
    o Respiratory symptoms, neurological symptoms, haemorrhagic rash or bleeding, dense rash with mucosal lesions, immunosuppressed
  • All other women:
    o Seek specialist advice from obstetrician
122
Q

Management of Chicken Pox - pregnant women - drug management?

A

o Oral aciclovir

o Symptomatic Treatment
 Paracetamol
 Calamine lotion

123
Q

Management of Chicken Pox - pregnant women - general advice?

A

 Usually self-limiting
 Encourage fluid intake
 Wear smooth, cotton fabrics
 Keep nails short to minimise damage from scratching
 Avoid contact with immunocompromised, pregnant women and infants <4 weeks until 5 days after rash
 School/nursery exclusion until all lesions crusted over

124
Q

Manageemnt of exposure to chicken pox?

A
  • Significant exposure if mother, continuous home contact, contact in same room for 15 minutes, face to face contact
  • If pregnant woman and never had chicken pox – Test for IgG VZV and if negative seek specialist advice
  • If immunocompromised or neonate – immediate specialist advice
125
Q

Complications of Chicken Pox in pregnancy?

A
  • Varicella in pregnancy can result in severe chickenpox
  • Infection during 1st 28 weeks of pregnancy can lead to intrauterine infection and foetal varicella syndrome
    o Skin scarring in dermatomal distribution, microphthalmia, chorioretinitis, cataracts, hypoplastic limbs, microcephaly
126
Q

Complications of Chicken Pox?

A
  • Secondary bacterial infection
    o Due to staphylococcal/streptococcal leading to toxic shock syndrome or necrotising fasciitis
  • Encephalitis
    o Cerebellitis, meningitis
  • Purpura fulminans
    o Vasculitis in the skin due to cross-reactivity of antiviral antibodies
  • Immunocompromised can disseminate causing pneumonitis/DIC – fatal 20%
127
Q

Definition of whooping cough?

A
  • Pertussis - a highly infectious form of bronchitis
128
Q

Epidemiology of whooping cough?

A
  • Usually epidemics every 3-4 years

- Incidence is increasing

129
Q

Risk factors of whooping cough?

A

o Young Infants
o Unvaccinated children
o Immunocompromised

130
Q

Cause of whooping cough?

A
  • Caused by Bordetella pertussis

- Spread with close contact of air-born droplets

131
Q

Symptoms of whooping cough - catarrhal phase?

A 
	Nasal discharge
	Conunctivitis
	Malaise
	Sore throat
	Low-grade fevfer
	Dry, unproductive cough
132
Q

Symptoms of whooping cough - paroxysmal phase?

A

o Paroxysmal Phase (1-6 weeks)
 Coughing fits (paroxysms)
 Short expiratory burst followed by inspiratory gasp, causing whoop sound
 More common at night and triggered by stimulus (cold, noise)
 Can cause cyanosis, post-tussive vomiting

133
Q

Symptoms of whooping cough - convalescent phase?

A

o Convalescent Phase (3 months)

 Gradual improvement in cough

134
Q

Signs of whooping cough?

A

o During paroxysm child goes red or blue in face
o Whoop may be absent in infants
o Apnoeas common in infants
o Epistaxis and sub-conjunctival haemorrhages can occur after vigorous coughing
o Exhausted by coughing

135
Q

Diagnosis of whooping cough?

A 
-	Clinical Diagnosis
o	If acute cough >14 days without cause and has:
	Paroxysmal cough
	Inspiratory whoop
	Post-tussive vomiting
	Undiagnosed apnoeic attack in infants
136
Q

Management of whooping cough - notification and testing?

A
  • Notify local Public Health England centre within 3 days

o If cough <2 weeks – culture nasopharyngeal aspirate or swabs

o If <3 weeks duration – PCR testing of nasopharyngeal/throat swabs

o If cough >2 weeks – anti-pertussis toxin IgG detection in serology (over 16) or oral fluid (children 5-16 years)

137
Q

Management of whooping cough - when is diagnosis confirmed?

A

Bordetella pertussis on aspirate/swab, PCR detection of pertussis or anti-pertussis toxin IgG in serum/oral fluid in abscnece of vaccine within the last year

138
Q

Management of whooping cough - admit?

A

o <6 months and acutely unwell
o Apnoeas/Severe paroxysms/Cyanosis
o Complication (seizures, pneumonia)

139
Q

Management of whooping cough - general measures?

A

o Rest
o Adequate fluid intake
o Paracetamol and ibuprofen
o Avoid school/work/nursery until 48 hours of antibiotics or 21 days after onset of cough

140
Q

Management of whooping cough - antibiotic therapy?

A 
o	If onset of cough within 21 days:
	Clarithromycin if <1 month of age
	Clarithromycin or azithromycin if >1 month old
	Erythromycin in pregnant women
•	Alternative – co-trimoxazole
141
Q

Management of whooping cough - antibiotic prophylaxis - who?

A

When case within 21 days and close contacts in one of these groups:

 Group 1 – unimmunised infant born <32w <2m, unimmunised infant born >32w and <2m if mother did not have pertussis vaccine, infant >2m who are unimmunised
 Group 2 – Pregnant woman >32 weeks, healthcare worker with infants or pregnant women, people sharing household with infant too young to vaccinated

142
Q

Management of whooping cough - antibiotic prophylaxis - what?

A

 Clarithromycin if <1 month of age
 Clarithromycin or azithromycin if >1 month old
 Erythromycin in pregnant women
• Alternative – co-trimoxazole

143
Q

Definition of gastro-enteritis?

A
  • Decreased stool consistency from water, fat or inflammatory discharge
144
Q

Classification of gastro-enteritis?

A
  • Acute <2 weeks

- Persistent >2 weeks

145
Q

Definition of dysentery?

A

o Loose stools with blood and mucus
o Organisms that cause bloody diarrhoea include campylobacter, entamoeba histolytica, E.coli, salmonella serotypes and Shigella

146
Q

Definition of Traveller’s Diarrhoea?

A

o Diarrhoea starting during or shortly after foreign travel

o Organism most commonly E.coli, Salmonella, Viruses, Cryptosporidium, Giardia

147
Q

Common causes of diarrhoea?

A 
-	Common Causes
o	Gastroenteritis
o	Parasites/protozoa
o	IBS
o	Colorectal cancer
o	IBD
-	Drugs
o	Antibiotics, PPI, NSAIDs, laxative, alcohol, cytotoxics
-	Rarer Causes
o	Chronic pancreatitis, laxative abuse, lactose intolerance, overflow diarrhoea, ileal resection, thyrotoxicosis, Ischaemic colitis
148
Q

Cause of gastro-enteritis?

A

o Often contaminated food, usually meat, egg or milk products which been prepared inadequately

149
Q

Types of diarrhoea and their cause?

A

o Bloody Diarrhoea
 Campylobacter, Shigella/Salmonella, E.coli, amoebiasis
 IBD, colorectal cancer, colonic polyps, colitis
o Mucous
 IBS, colorectal cancer, polyps
o Frank Pus
 IBD, diverticulitis, abscess or fistula
o Explosive
 Cholera, giardia, rotavirus

150
Q

Important history questions in gastro-enteritis?

A

o Important questions – duration, frequency, food and water intake, cooking method, time until onset, other diners affected, any swimming or canoeing

151
Q

Assessment of dehydration in gastro-enteritis?

A

o Mild – anorexia, nausea, light headedness, postural hypotension

o Moderate – tiredness, dizziness, nausea, headache, muscle cramps, dry tongue, sunken eyes, reduced skin turgor, tachycardia, oliguria

o Severe – Profound apathy, weakness, confusion, shock, tachycardia, peripheral vasoconstriction, low BP, anuria/oliguria

152
Q

Investigations in gastro-enteritis?

A

o FBC, ESR/CRP, U&E, TSH, coeliac serology

153
Q

When to do stool culture in gastro-enteritis?

A

o Only used if patient has been abroad, severely ill, prolonged symptoms or works as food-handler

154
Q

Food associated with S.aureus?

A

Meat

155
Q

Food associated with Bacillus Cereus?

A

Rice

156
Q

Food associated with Salmonella?

A

Meat, eggs, poultry

157
Q

Food associated with C.botulinum?

A

Processed food

158
Q

Food associated with V.cholerae?

A

Water

159
Q

Associated with C.diff?

A

Abx associated

160
Q

Food associated with Campylobacter?

A

Milk, poultry, water

161
Q

Food associated with Listeria?

A

Cheese, pate

162
Q

Associated with E.coli 0157?

A

HUS

163
Q

Associated with norovirus?

A

Faecal oral spread, very contagious

164
Q

Food associated with Shigella?

A

Any Food

165
Q

Management of gastroenteritis - prevention?

A

o Hygiene (hand, water sources, no ice cubes, salads)
o Eat only freshly prepared hot food
o Food handlers – no work until stool samples negative

166
Q

Management of gastroenteritis - symptomatic treatment?

A

 Usually self-limiting
 Maintain oral intake
 ORT (Dioralyte) – contains glucose, Na, K, Cl
 Loperamide if mild-to-moderate traveller’s diarrhoea
• Avoid in bloody or inflammatory dysentery and significant abdominal pain

167
Q

Management of gastroenteritis - when to admit?

A

seriously ill, dehydrated >5%, high fever, infants

168
Q

Management of gastroenteritis - Fluid therapy if shocked?

A

IV saline bolus 500ml (in children 20ml/kg)

169
Q

Management of gastroenteritis - Fluid therapy if not shocked?

A

Encourage oral intake (in children – ORS 50ml/kg, continue breastfeeding, avoid fruit jucie and carbonated drinks)

170
Q

Management of gastroenteritis - IV Fluid therapy if adult?

A

IV fluids 0.9% saline + 20mmol/L K/L IVI

171
Q

Management of gastroenteritis - IV Fluid therapy if child?

A

Deficit 0.9% NaCl (100ml/kg if shocked, 50ml/kg if not),

Maintenance (100ml/kg/day for 1st 10kg, 50ml/kg/day for 2nd 10kg, 20ml/kg/day for subsequent kg)

172
Q

Management of gastroenteritis - antibiotic therapy?

A

• Ciprofloxacin

o If systemically unwell, elderly, immunosuppressed, Salmonella, shigella or campylobacter

173
Q

Definition of malaria?

A
  • Infection of RBCs by plasmodium parasites including:

o P.falciparum, P.vivax, P.ovale, P.malariae

174
Q

Transmission of malaria?

A
  • Transmission through bite of infected female Anopheles mosquito
    o Sporozoite inoculated into humans in saliva of mosquito
    o Travels in blood stream to the liver, enter liver cells and mature into schizonts which rupture and release thousands of merozoites
    o Each merozoite infects a RBC where they divide and reupture
  • Found in tropical and subtropical area
175
Q

Causes of malaria and their distribution?

A

.falciparum – African continent, most common, incubation 7-10 days and symptoms recur 36-48 hourly
o P.vivax – Asia, Latin America, Africa, incubation period 10-17d and can remain dormant for months
o P.ovale – Africa, western Pacific, dormant for months
o P.malariae – South America, Asia, Africa, chronic infection, incubation 18-40d, recurs 72 hourly
o P.knowlesi – from monkeys in Asia, can be fatal

176
Q

Features of malaria?

A

o Usually present within 6 months of exposure

177
Q

Symptoms of malaria?

A 
o	Fever (often >39o, and spikes), sweat, chills
	Shivering <1h
	Hot, fever 2-6h
	Sweats as temperature falls
o	Headache
o	Malaise, lethargy, fatigue
o	Anorexia, nausea, vomiting, diarrhoea
o	Myalgia, arthralgia
o	Sore throat, cough
178
Q

Symptoms of severe malaria?

A 
o	Cerebral – GCS <11 or seizures
o	Renal impairment
o	Acidosis
o	Hypoglycaemia
o	RDS
o	Anaemia
o	Bleeding
o	Shock, sepsis
179
Q

Bloods taken in malaria?

A

o Thick and thin blood film microscopy

o Antigen Detection Test

180
Q

Management of malaria - prevention?

A

Avoid travel if high risk (pregnant, child, age >70, immunosuppression)

Avoid risk factors:
 Outside between dusk and dawn, unscreened accommodation

PPE: insect repellent (20% DEET or icardin), protective clothing, insecticide impregnated bed nets

Chemoprophylaxis
 Start 1 week before travel, for 4 weeks
 Chloroquine, mefloquine, proguanil hydrochloride

Standby emergency medication if remote areas without medical facilities for 24 hours

Upon return - if develop any illness within 1st 3 months to see doctor immediately

181
Q

Management of malaria -admission of acute infection?

A

o Admit any person with suspected severe or complicated malaria, falciparum malaria, pregnant, child or >65

182
Q

Management of malaria - discussion in anyone with suspected malaria?

A

o Urgently discuss all other patients with ID specialist with view to admission for rapid blood testing
o Notify PHE

183
Q

Management of malaria - general advice?

A

 Warn that if family members get symptoms to see doctor
 Notified to PHE
 Relapses can occur
 Excluded from blood donation

184
Q

Management of malaria -immediate referral to ID or MAU for blood testing?

A
  • Severe, complicated or falciparum malaria
  • Pregnant
  • Child
  • > 65 years
185
Q

Management of malaria - testing in ID or MAU?

A

• Thick and thin blood films
o If negative, further blood test 12-24 hours later and again after 24 hours
o Calculate percentage of RBC parasitized

  • Antigen Detection Test if blood films not available
  • FBC (anaemia, thrombocytopenia), Clotting (DIC). Glucose (low), U&E (renal failure)
  • ABG (lactic acidosis)
  • Urinalysis (protein, blood, casts)
  • Blood Culture – rule out sepsis
186
Q

Management of malaria - drug management - if species not known?

A

o Artemether with lumefantrine (ACT)
o Quinine
o Atovaquone with proguanil

187
Q

Management of malaria - drug management -if uncomplicated falciparum malaria?

A

 Artemether with lumefantrine (ACT)
 Atovaquone with proguanil
 Quinine (IV if severe)
• Oral given for 5-7 days, with or followed by oral doxycycline for 7 days

188
Q

Management of malaria - drug management - if complicated falciparum malaria?

A

 IV Artesunate or Quinine

189
Q

Management of malaria - drug management - if non-falciparum malaria (P.v, P.o, P.m, P.k)?

A

o Chloroquine
o If resistant then use artemether-lumefantrine
o If P.v or P.o – use chloroquine + primaquine after for 14 days

190
Q

Management of malaria - drug management - cerebral malaria?

A

 Manage fluids
 Haemofiltration
 Ventilation
 Exchange transfusion if severe

191
Q

Prognosis of malaria?

A

o If identified, appropriate treatment is given and no organ dysfunction – most people make rapid recovery
o If delayed – severe or fatal malaria can develop
o Death more likely in >65
o In pregnancy – pulmonary oedema and hypoglycaemias

192
Q

Complications of malaria?

A 
o	Cerebral malaria
o	ARDS
o	Coagulopathy
o	Sepsis
o	Severe anaemia
o	Hypoglycaemia
o	Metabolic acidosis
o	AKI
o	Nephrotic syndrome
193
Q

Symptoms pointing towards diagnosis in febrile traveller - jaundice?

A 
	Viral hepatitis
	Cholangitis
	Liver abscess
	Leptospirosis
	Typhoid
	Malaria
	Dengue fever
	Yellow fever
194
Q

Symptoms pointing towards diagnosis in febrile traveller - splenomegaly?

A

 Malaria

 Leishmaniasis

195
Q

Symptoms pointing towards diagnosis in febrile traveller - D&V?

A 
	E.coli (Travellers)
	Salmonella
	Shigella
	Campylobacter
	Vibrio cholerae
196
Q

Symptoms pointing towards diagnosis in febrile traveller - hepatosplenomegaly??

A

 Malaria
 Typhoid
 Brucella

197
Q

Symptoms pointing towards diagnosis in febrile traveller - anaemia?

A

 Hookworm
 Malaria
 Haemolysis

198
Q

Symptoms pointing towards diagnosis in febrile traveller - bleeding?

A

 Viral haemorrhagic fevers

199
Q

Cause, incubation and spread of typhoid?

A
  • Caused by Salmonella typhi (typhoid) and S.paratyphi (types A, B, C) (paratypod)
  • Incubation – 3-21 day
  • Spread – Faecal-oral route
200
Q

Epidemiology of typhoid?

A
  • Type A most common

- S.typhi 10:1 S.paratyphi

201
Q

Risk factors of typhoid?

A

o H2RA, PPIs – reduced stomach acidity
o Immunosuppression
o Other infections
o SCD

202
Q

Symptoms of typhoid?

A

o Week One
 Diarrhoea after first week
 Malaise, headache, high fever, cough
 Relative Bradycardia – pulse slower than expected from temperature
 CNS signs (delirium, meningism, cerebellar signs, fits, coma)
 Rose spots – on trunk
 Epistaxis, bruising and splenomegaly

Week Two
 Sustained pyrexia, high fever, malaise and weakness
 Confusional state
 Rose spots – crops of macules in diameter that blanch on pressure
 Pea soup diarrhoea

203
Q

Investigations of typhoid?

A 
-	Bloods
o	LFTs raised
-	Blood culture – positive for 10 days
-	Stool culture
-	Bone marrow aspirate
-	Serology – Widal’s Test (measures agglutinating antibodies against antigens)
204
Q

Management of typhoid?

A
  • Notifiable in UK
  • IV fluids
  • Ciprofloxacin PO 500m BD for 10 days (Alternatives if Asia: ceftriaxone, azithromycin)
    o In severe give IV ceftriaxone + ciprofloxacin
  • In encephalopathy – dexamethasone
205
Q

Testing clearance of typhoid?

A

o 6 consecutive negative cultures of urine + faeces

o Treat with ciprofloxacin 500mg BD for 6 weeks if chronic carrier

206
Q

Complications of typhoid?

A 
o	Osteomyelitis
o	GI bleed
o	Cholecystitis
o	Myocarditis
o	Pyelonephritis
o	Meningitis
o	DVT
207
Q

Definition of Dengue Fever?

A
  • Mosquito-borne viral haemorrhagic fever, transmitted by female mosquitos (Aedes aegypti)
  • Most common self-limiting flu-like illness
  • RNA flavivirus
208
Q

Epidemiology of Dengue Fever?

A
  • Endemic in Africa, Americas, Southeast Asia

- 90% of severe dengue in <15 years old

209
Q

Risk factors of Dengue Fever?

A

o High population density
o Urban living
o Poor public hygiene
o Exposure to mosquitoes

210
Q

Symptoms of Dengue Fever?

A

o Flushes (neck, face, chest)
o Centrifugal maculopapular rash, progresses to confluent petechiae with pale areas of normal skin
o Headache
o Arthralgia
o Hepatosplenomegaly
o Haemorrhagic signs
 Petechiae, GI/gum/nose bleeds, haematuria, menorrhagia

211
Q

Monitoring of Dengue Fever?

A

o BP, urine output
o Bloods
 Prolonged APTT, WCC low, platelets low
o Tourniquet Test - >20 petechiae/inch2

212
Q

When is Dengue fever excluded?

A

o Symptoms start >2 weeks after leaving dengue area or if fever lasts >2 weeks, dengue ruled out

213
Q

Management of Dengue Fever?

A
  • IV resuscitation if needed
  • Paracetamol
  • Notifiable disease
214
Q

Cause of amoebiasis?

A
  • Caused by entamoeba histolytica

- Spread faecal-oral route

215
Q

Symptoms of amoebiasis?

A
  • Ameobic dysentery:
    o Starts slowly, becoming profuse and bloody
    o May remit and relapse
  • Amoebic colonic abscesses – may perforate causing peritonitis
-	Amoebic liver abscess
o	Single mass in right lobe containing ‘anchovy-sauce’ pus
o	High-swinging fevers, sweats, RUQ pain
o	Ix – High WCC, LFTs
o	Dx – PCR, Liver US/CT +/- aspiration
216
Q

Investigations of amoebiasis?

A
  • Stool microscopy – trophozoites, blood, pus cells

- Faecal antigen detection

217
Q

Management of acute of amoebiasis?

A

o Metronidazole 800mg TDS PO for 5 days

o Then diloxanide furoate 500mg TDS for 10 days to destroy gut cysts

218
Q

Management of amoebic liver abscess?

A

o Tinidazole for 5 days

o US guided aspiration if not improving

219
Q

Definition of Traveller’s Diarrhoea?

A
  • Diarrhoea in travellers usually in first week or two of stay in foreign country
220
Q

Epidemiology of Traveller’s Diarrhoea?

A
  • High risk – Africa, Latin America, Middle East and Asia

- 20-60% of travellers

221
Q

Causative organism of Traveller’s Diarrhoea?

A
  • E.coli
222
Q

Symptoms of Traveller’s Diarrhoea?

A
  • Self-limiting diarrhoea for <72 hours usually

- Longer than 14 days suggests Giardia, Entameoba, Cryptosporidium

223
Q

Management of Traveller’s Diarrhoea?

A

o Often last a few days
o Keep hydrated – ORS good
o Avoid alcohol, coffee, tea
o Loperamide/Bismuth subsalicylate used for symptomatic relief

224
Q

Prevention of Traveller’s Diarrhoea?

A

o Boil water if in doubt
 Chlorination okay but does not kill amoebic cysts
o Avoid ice
o Avoid salads, peel your own fruit
o If cannot wash hands, discard food you are holding
o If Crohn’s or immunosuppressed – prophylactic antibiotics - ciprofloxacin

225
Q

Definition of Lyme Disease?

A
  • Tick-bourne infection caused by Borrelia burgdorferi
226
Q

Epidemiology of Lyme Disease?

A
  • Found in grassy, wooded area

- Increase in prevalence in April-June

227
Q

Symptoms of Lyme Disease?

A

o Folowing tick bite
o Erythema migrans – circular rash occurring at site of rash and can expand
 Bull’s eye/Target sign appearance – centre may clear
o Fatigue, chills, fever, headache, muscle and joint pain, lymphadenopathy

228
Q

Complications of Lyme Disease?

A

o Myocarditis, heart block, meningitis, neuropathy

229
Q

Diagnosis of Lyme Disease?

A
  • Clinical diagnosis
  • If Lyme Disease suspected without erythema migrans – offer ELISA test for Lyme Disease
    o If positive – perform immunoblot
230
Q

Prevention of Lyme Disease?

A

o Keep limbs covered, use insect repellent
o Remove ticks using fine tweezers to grasp tick very close to skin and pull body away
o Clean with soap and water

231
Q

Management of skin rash in Lyme Disease?

A

o Doxycycline 100mg BD for 21 days

 Alternative: Amoxcillin 1000mg TDS for 21 days, azithromycin 500mg for 17 days

232
Q

Management of severe Lyme Disease?

A

o IV benzylpenicillin or ceftriaxone

233
Q

Cause of cholera? Incubation and spread?

A
  • Cause – Vibrio cholerae (Gram-negative comma-shaped flagellated mobile rods) 01 and 0139
  • Incubation – few hours to 5 days
  • Spread – faecal-oral route
234
Q

Epidemiology of cholera?

A
  • Endemic in Africa, Asia, Middle East, South America
235
Q

Symptoms and signs of cholera?

A
  • Profuse rice-water diarrhoea, fever, vomiting and rapid dehydration
  • Sunken eyes, impaired consciousness, dry skin, reduced skin turgor, tachycardia, low BP
236
Q

Investigations of cholera?

A
  • Stool microscopy (+/- dark ground) and culture
  • Bloods
    o U&E, FBC
237
Q

Management of cholera - general measures?

A 
o	Notifiable Disease
o	Strict barrier measures
o	Rehydration
	ORS if mild
	IV saline if severe
238
Q

Management of cholera - Antibiotics?

A

o Oral erythromycin or ciprofloxacin stat may reduce fluid loss

239
Q

Management of cholera - prevention?

A 
o	Good hygiene methods
o	Only drink boiled or treated water
o	Cook all food well, eat hot
o	Avoid shellfish
o	Peel all vegetables
240
Q

Causes of schistosomiasis?

A
  • Caused by blood-dwelling schistosoma worms
241
Q

Life cycle of schistosomiasis?

A

o Snails release cercariae tjhat penetrate skin (during paddling), causes itchy popular rash
o Cercariae shed tails to become schistosomules, migrating via lungs to liver where they grow
o In 8 weeks, flukes mature and migrate to bladder and mesenteric veins, releasing eggs and causing granulomas and scarring

242
Q

Symptoms of schistosomiasis?

A
  • 2 weeks after incubation period

o Fever, urticaria, diarrhoea, cough, wheeze, hepatosplenomegaly

243
Q

Investigations of schistosomiasis?

A
  • Eggs in urine or faeces

- Antibody testing

244
Q

Management of schistosomiasis?

A
  • Praziquantel with food into 2 divided doses
245
Q

Complications of schistosomiasis?

A
  • Hydronephrosis

- SCC of bladder

246
Q

Antibiotic therapy used in gastroenteritis - Entamoeba histiolytica?

A

Mild to moderate - Metronidazole 400mg TDS for 5-10 days, followed by diloxanide 500mg TDS for 10 days

Amoebic dysentery - Metronidazole 800mg TDS for 5 days, followed by diloxanide 500mg TDS for 10 days

Alternative to Metronidazole is Tinidazole

247
Q

Antibiotic therapy used in gastroenteritis - Campylobacter?

A

Consider is severe, immunocompromised, symptoms worsening or >1 week

Erythromycin 250mg-500mg QDS for 5-7 days

Ciprofloxacin 500mg BD for 5-7 days - if macrolides cannot be taken

248
Q

Antibiotic therapy used in gastroenteritis - Cryptosporidium?

A

None

249
Q

Antibiotic therapy used in gastroenteritis - Giardia Intestinalis?

A

Metronidazole 400mg TDS for 5 days

Tinidazole is alternative

250
Q

Antibiotic therapy used in gastroenteritis - Salmonella & Shigella?

A

Consider if severe, elderly, immunocompromised, valve problems

Ciprofloxacin 500mg BD for 1 day (5 days if Shigella Dysenteriae)

Alternatives - azithromycin 500mg OD for 3 days

MSRA Content (87 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions