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year 3 conditions > infections + A&E > Flashcards

infections + A&E Flashcards

1
Q

contrast the mode of transmission and the main differentiating symptoms of HSV1 vs HSV2

A

HSV1
- spread in childhood via saliva
- herpes labials, HSV encephalitis

HSV2
- spread via genital contact
- genital herpes (ulcers)

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2
Q

2 main risk factors for HSV

A

HIV
immunosuppressive medications

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3
Q

describe the symptoms of genital herpes

A

ulcers
painful
dysuria
pruritus

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4
Q

describe the symptoms of herpes labials

A

cold sores on/around lips
tingling sensation first, then the lesion develops

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5
Q

describe skin manifestations of HSV

A

erythema multiform - target lesions
erythema herpeticum - punched out erosions, rapidly progressive painful rash, seen in children with atopic eczema, life threateing –> Tx = IV acyclovir

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6
Q

what type of lymphadenopathy is seen in HSV

A

Tender Inguinal Lymphadenopathy

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7
Q

list some symptoms for HSV

A

genital ulcers
cold sores
tender inguinal lymphadenopathy
erythema multiform
eczema herpeticum
severe gingivostomatitis (erythema and painful ulcerations on the perioral skin and oral mucosa)

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8
Q

Ix for HSV

A

Viral PCR
→ order when lesions are present

Genital Herpes
→ nucleic acid amplification tests (NAAT)
(after obtaining swab of the base of the ulcer)

Viral Culture

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9
Q

Tx for HSV

A

oral acyclovir

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10
Q

what is the pathological mechanism of HIV

A

it is a retrovirus, so infects and replicates inside of CD4+ T cells and macrophages

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11
Q

incubation period of HIV

A

symptoms start 3-12 weeks after infection

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12
Q

signs and symptoms of HIV

A

fatigue
weight loss
night sweats
lymphadenopathy
shingles
recurrent candidiasis
TB
maculopapular rash
sore throat
oral ulcers
diarrhoea
genital STIs

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13
Q

which appears first, HIV p24 antigen or HIV antibodies?

A

HIV p24 antigens

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14
Q

what test can be used for staging in HIV

A

CD4 count

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15
Q

Ix for HIV

A

Combination Test (standard for diagnosis and screening)
→ HIV p24 Antigen + HIV antibody Test

Serum HIV Enzyme-Linked Immunosorbent Assay (ELISA)
→ positive for HIV antibodies
(however antibodies may not be present in early infection)

CD4 Count
→ indicates immune status and helps in staging process.

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16
Q

medication for HIV? and when should it be started

A

1st Line
→ antiretroviral therapy (ART) = two NRTIs and one PI/NNRTI
(should be started as soon as HIV diagnosed)

NRTI’s (AToZ)
⇒ zidovudine,
abacavir,
tenofovir

NNRTI’s
⇒ nevirapine,
efavirenz

Protease Inhibitors (all end in -navir)
⇒ indinavir,
nelfinavir,
ritonavir

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17
Q

PrEP vs PeP

A

HIV Preexposure Prophylaxis (PrEP) for individuals at high risk of contracting HIV

HIV Postexposure Prophylaxis (PEP) which is a short course of ART taken by patients after potential exposure to HIV

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18
Q

when should PEP be started and how long should it be taken for

A

started 72 hrs after exposure
taken for 4 weeks

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19
Q

what should be given to HIV pt if their CD4 count is <200

A

co-trimoxazole
prophylaxis against Pneumocystis jiroveci pneumonia

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20
Q

how do you asses for deeper collections or necrotising fasciitis in a surgical site infection

A

cross sectional imaging

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21
Q

preoperative prevention steps against surgical site infection

A

Don’t remove body hair routinely
(if you do, use electrical clippers instead of razors)

Antibiotic Prophylaxis
→ if placement of prosthesis or valve

Patient Advice
→ encourage weight loss,
smoking cessation,
optimise nutrition,
ensure good diabetic control

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22
Q

intraoperative prevention steps against surgical site infection

A

Prepare skin with alcoholic chlorhexidine

Cover surgical site with dressing

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23
Q

risk factors for surgical site infection (pt factors and operative factors)

A

pt factors
- obesity
- poor glucose control
- age
- smoking
- renal failure
- immunosuppression

operative factors
- preoperative shaving
- length of operation
use of antimicrobial prophylaxis
- skin protection
appropriate gown and sterile equipment

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24
Q

how to manage surgical site infection

A

remove any sutures and clips and allow pus to drain
empirical abx therapy

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25
incubation period of HSV3 aka VSV
14 days
26
difference between shingles and herpes
shingles - caused by VSV (aka HSV3) only flares up once in lifetime herpes - caused by HSV1/2 - can have recurrent flare ups
27
after primary infection with VSV (chicken pox0, where can it remain latent in body
trigemina ganglia dorsal root ganglia
28
in which 2 groups of ppl does VSV often reactivate to produce shingles
HIV immunocompromised
29
how can VSV be spread
direct contact with lesions airborne spread from resp particles
30
what type of rash is caused by VSV and how does it spread
vesicular rash appears centrally, then spreads to extremities
31
describe presentation of shingles
acute, unilateral, painful blistering rash. Prodromal period with burning pain over affected dermatome for 2-3 days. Erythematous, macular rash → vesicular rash. Patients are infectious until vesicles have crusted over Should avoid pregnant women and immunocompromised whilst infectious.
32
tx for shingles
Tx = paracetamol and NSAIDs. Can also give antivirals within 72 hrs.
33
VSV ix
PCR
34
VSV tx: supportive care, risk of moderate disease, risk of severe disease
Supportive Care → paracetamol Risk of moderate-severe disease → oral antiviral therapy (aciclovir) Risk of severe disease → IV antiviral therapy
35
Ramsay hunt syndrome cause and presentation
cause is VSV ion the geniculate ganglion of the facial nerve LMN facial nerve palsy Auricular pain is first feature, followed by unilateral facial nerve palsy and vesicular rash around the ear (may also get blisters on anterior 2/3 of tongue).
36
Ramsay hunt syndrome tx
oral acyclovir and prednisolone
37
cause and presentation of Herpes zoster opthalmicus
reactivation of the varicella-zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve. Causes vesicular rash around the eye and hutchinson’s sign (rash on the tip or side of nose). Requires urgent opthalmology review
38
tx of herpes zoster opthalmicus
Requires urgent opthalmology review and oral antivirals for 7-10 days.
39
common 2 pathogens for surgical site infections
e coli staph aureus
40
common 2 pathogens for nosocomial pneumonia
staph aureus p aeruginosa
41
common pathogens for VAP (ventilator acquired pneumonia)
gram negative bacilli - e coli - klebsiella pneumonia - p aeruginosa - acinobacter gram positive cocci - stash aureus
42
most common pathogen for nosocomial UTIs
e coli
43
most common pathogen for nosocomial bloodstream infections
staph aureus
44
most common pathogen for nosocomial GI infections
c difficile
45
the protozoa of which genus causes malaria
plasmodium
46
which protozoan parasite causes the most deadly malaria
plasmodium falciparum
47
method of transmission of malaria
bite by an infected female anopheles mosquito or by blood transfusion / organ transplantation
48
give 2 protective conditions against malaria
sickle cell anaemia G6PD deficiency
49
symptoms of malaria
Cyclical Fevers with chills and rigors (shivering) Haemolytic Anaemia → causes jaundice and may turn urine dark Splenomegaly Headache Weakness Myalgia Arthralgia Anorexia Diarrhoea
50
give some investigations for malaria
Giemsa-stained thick and thin blood smears (Thick detects parasites present. Thin detects species.) RDTs (rapid diagnostic tests) detect antigen, quick so useful in health resource-limited areas FBC (shows anaemia)
51
tx for malaria
chloroquine or hydroxychloroquine
52
what news score indicates sepsis
NEWS2 ≥5
53
when should blood cultures be taken in sepsis
immediately, before antibiotics are started
54
what is dos serum lactate level in sepsis indicate
determines severity of the sepsis
55
what does METABOLIC ACIDOSIS WITH RAISED LACTATE indicate
sepsis
56
how does sepsis affect urine output
decreased urine output
57
describe the fluid resuscitation used in sepsis
500mL of crystalloid fluid
58
which 3 drugs can be used for sepsis
Vasopressor + Ionotrope + Corticosteroid
59
what is the most common causative agent of candidiasis
Candida albicans (a type od dimorphic fungi)
60
describe the effect of candidiasis on the mouth
Oral Thrush → oropharyngeal region affected White plaque in the oral cavity that can be scraped off, leading to inflamed areas. Cottony feeling in the mouth. Fissuring at mouth corners. May be caused by ICS (beclamethasone) use in asthmatics
61
what manifestation of candidiasis is considered an AIDS defining illness
oesophageal candidiasis - causes odynophagia (retrosternal pain on swallowing)
62
'Cottage cheese’, non-offensive discharge from vagina diagnosis
vulvovaginitis (vaginal yeast infection)
63
what is vulvitis and what are the main symptoms
yeast infection if the outer part (vulva) dysuria, dyspareunia
64
vulvitis vs vaginitis vs vulvovaginitis
vulvitis = affect outer part (vulva) vaginitis = affects inner part (vagina) vulvovaginitis = affects both
65
candidiasis investigation
Superficial Smear of Lesion for Microscopy
66
tx for vaginl candidiasis
oral fluconazole
67
list some topical antifungals
clotrimazole, miconazole, nystatin
68
which antifungal can be used for systemic antifungal testament in severe candidiasis disease
fluconazole
69
which 2 causative agents of dysentry have a short incubation period of 1-6 hrs
s aureus bacillus cereus
70
which 2 causative agents of dysentry have a long incubation period of 7 days
giardiasis amoebiasis
71
which causative agent of dysentry is common amongst travellers
e coli
72
which causative agent of dysentry can cause steatorrhea, and lactose intolerance afterwards
giardiasis
73
which causative agent of dysentry can cause GBS
campylobacter
74
which causative agent of dysentry can cause profuse watery diarrhoea, severe dehydration and weight loss
cholera
75
which causative agent of dysentry can cause HUS
haemolytic e coli
76
which causative agents of dysentry can cause severe/projectile vomiting
s aureus - severe vomiting bacillus cereus - vomiting within 6 hrs, diarrhoea after 6 hrs norovirus - projectile vomiting
77
which antibiotic can be used for severe campylobacter
clarithromycin
78
which anabiotics can be used for moderate vs severe c diff
moderate - oral vanconycin severe - IV metronidazole
79
is HIV a notifiable disease
no
80
process of reporting notifiable diseases
medical practitioner --> proper office at local health protection team --> health protection agency report immediately, dont wait for lab confirmation report within 3 days via form, or if urgent verbally within 24 hrs
81
which antivirals can be used for hep c, and also for chronic hep b
interferon alpha rivibarin
82
what ix can be done to asses degree of cirrhosis in chronic hep c
liver biopsy
83
which heps are RNA and which are DNA
RNA virus - A, C, D, E DNA virus - B
84
what type of virus is hep A
picarnovirus
85
what type of virus is hep E
calcivirus
86
what type of virus is hep B
hepadnovirus
87
common cause of a chronic hep B pt having a super flare up
hep D infection
88
which pts can hep D infect and why
is coated with HBsAg so can only co-infect with hep B, or infect someone who already has hep B
89
what does anti HBsAg antibodies indicate
immunisation either from - recovery of infection --> if with IgG anti HBcAg - vaccination ---> if just alone, no HBcAg (only comes with an actual infection)
90
which hep b antigen indicates high infectivity if present
HBeAg
91
3 types of Hep b antigens
HBsAg --> surface (always present, antibodies don't form against it until immunisation is reached either from recovery or vaccination) HBcAg --> core (always present, antibodies form against it from start of infection, IgM indicates acute, IgG indicates chronic) HBeAg --> envelope (not always present, but indicates high infectivity)
92
which of IgG and IgM indicate chronic vs acute infections
IgM - acute IgG - chronic
93
most common cause of hepatocellular carcinoma worldwide vs UK
worldwide = chronic hep b UK = chronic hep c
94
main risk factors for hepatocellular carcinoma
liver cirrhosis secondary to hep B and C alcohol NAFLD α-1-antitrypsin deficiency Haemachromatosis
95
raised 'X' is a useful diagnostic marker for hepatocellular carcinoma
AFP
96
what 2 things are used for screening for hepatocellular carcinoma in ppl with hep b/c, haemochromatosis, alcohol abuse etc
USS AFP levels
97
which hep is particularly associated with travellers
hep A
98
which hep is particularly associated with pregnancy
hep E
99
incubation period of hep b / d
3 - 6 months
100
incubation period of hep a / e
3 - 6 weeks
101
which heps have vaccinations
hep A hep B
102
symptoms of acute vs chronic hep c
acute - asymptomatic chronic - arthritis, arthralgia, eye problems (sjogren’s syndrome), cirrhosis, hepatocellular cancer, cryglobulinaemia (vasculitis) membranoproliferative glomerulonephritis (leading to renal dysfunction)
103
what type of hypersensitivity is anaphylaxis
type 1 hypersensitivity reaction due to IgE-mediated mast cell activation
104
describe the steps that lead up to an anaphylactic shock
Degranulation of Mast Cells → Massive Histamine Release → Systemic Vasodilation → Increased Capillary Leakage → Anaphylactic Shock
105
list symptoms of anaphylaxis
Airway Swelling (Angio-Oedema) Stridor, Dyspnoea, Wheezing, Respiratory Arrest Pale, Clammy skin, Hypotension, Tachycardia, Confusion Urticaria, Erythema, Pruritus
106
what can we look for in blood the indicates an anaphylactic shock
Mast-Cell Tryptase → may remain elevated for up to 12hrs after acute episode
107
steps in managing anaphylactic shock
1. remove trigger and call for help 2. IM adrenaline + ABCDE + High flow oxygen (15L/min non-rebreathe mask) 3. IV chlorphenamine 10mg + IV hydrocortisone 200mg ALWAYS GIVE ADRENALINE IM EVEN IF PT HAS IV ACCESS (unless have refractory anaphylaxis)
108
what are the adrenaline doses for different ages
< 6months = 100-150 mcg 6m - 6yrs = 150 mcg 6 - 12 yrs = 300 mcg 12yrs + = 500 mcg
109
what is refractory Anaphylaxis and how is it treated
Refractory Anaphylaxis ⇒ persists despite 2 doses of IM adrenaline (Tx with IV adrenaline and IV fluid bolus)
110
what type of bleed is extradural, from which vessel and where on skull
arterial bleed from middle meningel artery pterion (thinnest part of skull)
111
between which 2 layers is an extradural haemorrhage
dura skull
112
which layer is subdural haemorrhage in
outermost meningeal layer
113
which lobes do subdural haemorrhages most commonly occur around
frontal parietal
114
2 main risk factors for subdural haemorrhage
old age alcoholism
115
onset of symptoms in subdural vs extradural haemorrhage
slower onset in subdural
116
causes of subarachnoid haemorrhage
spontaneous due to cerebral aneurysm rupture vs traumatic brain injury
117
classical presentation of extradural haemorrhage in terms of consciousness, neurological deficits and eyes
1) initial loss of consciousness following head injury 2) temporary recovery of consciousness with return to normal neurological function (lucid interval) 3) neurological status declines again due to haematoma expansion contralateral focal neurological deficits Signs of raised ICP Compression of Occulomotor Nerve (CN3) → Fixed, dilated pupil
118
which imaging is used for extradural haemorrhage and what does it show
Non-Contrast CT Scan - biconvex lesion, - hyperdense in appearance (brighter), - limited by suture lines - midline shift eXtradural is conveX
119
how can extradural haemorrhage lead to death
haematoma expansion --> raised ICP --> coning --> death
120
management of extradural haemorrhage
craniotomy and haematoma evacuation ICP management anticoagulants reversal
121
what is resp arrest definition
cessation of breathing pt has pulse
122
extrapulmonary causes of resp arrest
CNS depression (opioid intoxication), respiratory muscle weakness (myasthenia gravis, ALS), airway obstruction (aspiration), drowning, Trauma
123
pulmonary causes of resp arrest
airway obstruction (bronchospasm in asthma/COPD patients), impaired alveolar diffusion(pulmonary oedema, pneumonia)
124
resp arrets main symptoms
cyanosis tachycardia diaphoresis altered mental state
125
2 main ix for resp arrest
ABG → reduced oxygen, increased carbon dioxide Pulse Oximetry
126
management of resp arrest
Intubation Mechanical Ventilation
127
define unstable angina
Myocardial ischaemia at rest or on minimal exertion in the absence of acute cardiomyocyte injury/necrosis
128
sx of unstable angina
chest pain dyspnoea sweating syncope
129
ECG and troponin in unstable angina
ECG = normal troponin = not elevated
130
1st line for unstable angina
300 mg aspirin
131
describe the steps from infection to MODS
SIRS + infection --> sepsis --> severe sepsis --> MODS
132
what is MODS defined as
development of progressive and potentially reversible physiologic dysfunction of 2 or more organs or organ systems that is induced by a variety of insults, including sepsis
133
stage 1 of MODS
- increased volume and insulin requirements, mild respiratory alkalosis, oliguria, hyperglycaemia,
134
stage 2 of MODS
- tachypnoea, hypocapnia, hypoxaemia, moderate liver dysfunction haematologic abnormalities
135
stage 3 of MODS
- shock, azotaemia (high nitrogenous waste/creatinine/waste products in the blood), acid-base disturbance, significant coagulation abnormalities
136
stage 4 of MODS
- vasopressor dependent, oliguria or anuria, development of ischaemic colitis and lactic acidosis
137
Mx of MODS
IV fluids abx vasopressor meds blood transfusions O2 therapy technical ventilation dialysis ECMO (+ surgeries needed etc)
138
how to vasopressors affect bp
used to increase bp

year 3 conditions (17 decks)

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