Infectious disease Flashcards
1
Q
What colour do Gram negative bacteria stain?
A
Pink
2
Q
What colour do Gram negative bacteria stain?
A
Purple
3
Q
List some gram positive cocci
A
Staphylococcus
Streptococcus
Enterococcus
4
Q
List some gram positive bacilli
A
Corneybacterium Mycobacterium Listeria Bacillus Nocardia
5
Q
List some gram positive anaerobes
A
Clostridium
Lactobacillus
Actinomycyes
Propionibacterium
6
Q
List some gram negative bacteria
A
Neisseria meningitis Neisseria gonorrhoea Haemophilus influenza E.col Klebsiella Pseudomonas aeruginosa Moraxella catarrhalis
7
Q
What is the difference between gram positive and gram negative bacteria?
A
Gram positive - have thick peptidoglycan cell walls whereas gram negative do not
8
Q
What are atypical bacteria?
A
Bacteria which cant be cultured in the normal way or gram stained - most often implicated in pneumonia
9
Q
List some atypical bacteria
A
Legionella pneumophila Chlamydia psittaci Mycoplasma pneumoniae Chlamydophila pneumoniae Q fever
10
Q
What is MRSA
A
Methicillin resistant staphylococcus aureus
Resistant to beta lactam antibiotics
Problem in healthcare settings
Patients are swabbed before surgery/treatment in groin and nose
Eradication by chlorhexidine body was and antibacterial nasal cream
Doxycyline, clindamycin, vancomycin, teicoplanin, linezolid
11
Q
What are extended spectrum beta lactamase bacteria (ESBLs)
A
Produce beta lactamase enzymes that destroy the beta lactam ring on the antibiotics - resistant to broad spectrum antibiotics
E.coli or Klebisella - cause UTI or pneumonia
Sensitive to carbopenams (meropenam or imipenem)
12
Q
List the antibiotics which inhibit the cell wall synthesis
A
Antibiotics with a beta-lactam ring
- Penicillin
- Carbopenam such as meropenam
- Cephalosporins
Antibiotics without a beta lactam ring
- Vancomycin
- Teicoplanin
13
Q
List the antibiotics which inhibit folic acid metabolism
A
Sulfamethoxazole
Trimethoprim
Co-trimoxaole - combination of sulfamethoxole and trimethoprim
14
Q
Which bacteria does metronidazole work in?
A
Anaerobic cells - partially reduced metronidazole inhibits nucleic acid synthesis and only reduced in anaerobic cells
15
Q
List the antibiotics which inhibit protein synthesis by targeting the ribosome
A
Macrolides - erythromycin, clarithromycin, azithromycin Clindamycin Tetracyclines - doxycycline Gentamicin Chloramaphenicol
16
Q
Which antibiotics will a proportion of penicillin allergic patients also cross react to?
A
Cephalosporin and carbopenams
17
Q
What scoring system is used to pick up sepsis
A
NEWS
- HR
- BP
- O2 sats
- RR
- Conscious level
18
Q
What signs on examination may indicate sepsis
A
Tachypneoa (often first sign) New onset AF Signs of potential sources - cellulitis, wound, cough or dysuria Non blanching rash - meningococcal septicaemia Mottled skin Reduced urine output Cyanosis Elderly - confused or off legs Neutropenic may have normal obs
19
Q
List some investigations for sepsis
A
FBC - WCC, neutrophils and platelets U&Es - AKI LFT - source and liver failuree CRP Clotting - DIC Blood culture LP - meningitis and encephalitis Urine dipstick and culture CXR CT scan abdomen if abscess
20
Q
Describe the sepsis 6
A
Take
- blood cultures
- urine output
- Blood lactate
Give
- O2 (94-98% or 88-92% in COPD)
- Empirical broad spectrum antibiotics until culture results
- IV fluids
21
Q
What causes neutropenia
A
Chemotherapy Clozapine Hydroxychloraquine Sulfasalazine Carbimaxole# Methotrexate Quinine Infliximab Rituximab
22
Q
What is neutropenic sepsis
A
Sepsis and neutrophils <1
23
Q
How do you treat neutropenic sepsis?
A
Piperacillin with tazobactam (tazocin)
Other aspects are the same for sepsis
24
Q
How long do you have to treat sepsis?
A
golden hour
25
Describe the pathophysiology of sepsis
Pathogens recognised by immune cells. Cytokines (IL and TNF) produced. Vasodilation and fluid leaking into extracellular space, reduction in intracellular volume. Oedema reduces oxygen delivery to tissue.
Activation of the coagulation system reduces perfusion - thrombocytopenia, haemorrhage and DIC
Blood lactate rises due to hypoperfusion of tissues - anaerobic respiration
26
Define septic shock
Arterial blood pressure and result in organ hypoperfusion
Rise in blood lactate - anaerobic respiration
SBP <90
Hyperlactaemia >4
Treat with aggressive IV fluids and inotropes (noradrenalin) if not responding to fluids
27
List some signs of severe sepsis
```
Hypoxia
Oliguria
AKI
Thrombocytopenia
Coagulation dysfunction
Hypotension
Hyperlactaemia
```
28
List some risk factors for sepsis
```
Very young or old
Chronic conditions - COPD and DM
Chemotherapy, immunosuppressants
Surgery
Recent trauma or burns
Pregnancy or post partum
Indwelling medical devices
```
29
Who does Pseudomonas aeruginosa present in?
Cystic fibrosis and bronchiectasis
30
What do cystic fibrosis patients take to prevent Staphylococcus pneumonia
Flucloxacillin
31
Which antibiotics can be used to treat atypical pneumonias
Macrolides - clarithromycin
Quinolones - levofloxacin
Tetracylines - doxycycline
32
Give some symptoms of lower urinary tract infection
```
Dysuria - pain, stingin, burning when passing urine
Suprapubic pain or discomfort
Frequency
Urgency
Incontinence #
Confusion - elderly
```
33
Give some sympotm sof pylenephritis
```
Fever
Loin, suprapubic or back pain - bilateral or unilateral
Looking and feeling generally unwell
Vomiting
Loss of appetite
Haematuria
Renal angle tenderness
```
34
What are nitrites a sign of in urine
Gram negative bacteria break down nitrates to nitrites
35
What type of sample is sent to lab to test the sensitivities of UTI
Midstream urine
36
Describe E.coli
Gram negative anaerobic bacilli
37
List some other bacteria which can be present in urine
```
Klebsiella pneumoniae
Enterococcus
Pseudomonas aerginosa
Staphylococcus saprophyticus
Candida albicans (fungal)
```
38
How long should you give antibiotics for in UTIs
3 days in simple LUTI in women
5-10 days in immuncompromised, abnormal anatomy or impaired kidney function women
7 days in men, pregnant women and catheter related UTI
39
What is the complication of UTI in pregnant
Increased risk of pyelonephritis, premature rupture of membranes and pre-term labour
40
Which antibiotics are avoided in pregnancy
Trimethoprim - avoid in 1st trimester due to anti folate effect
Nitrofuratoin - avoid in 3rd trimester - haemolytic anaemia in newborn
41
Describe the management of pyelonephritis
Refer to hospital if signs of sepsis
| 7-10 days of cefalexin, co-amoxiclav, trimethroprim or ciprofloxacin depending on local sensitivity
42
Describe the presentation of cellulitis
```
Erythema
Warm or hot to touch
Tense
Thickened
Oedematous
Bullae (fluid flilled blisters)
Golden yellow crust - impetigo - staph aureus infection
```
43
List the causes of cellulitis
Staphyloccous aureus
Group A streptococcus - strep pyogenes
Group C strep - strep dysgalactiae
MRSA
44
Describe the Eron classification
1) no systemic toxicity or comorbidity
2) systemic toxicity or comorbidity
3) significant toxicity or significant comorbidity
4) sepsis or life threatening
Admit patients if class 3 or 4 or old, very young or immunocompromised - IV Abx
45
How is cellulitis treated?
Flucloxacillin - gram positive cocci - PO/IV
Clarithromycin
Clindamycin
Co-amoxiclav
46
Which organism commonly causes bacterial tonsillitis
Group A streptococcus - Streptococcus pyogenes
47
WHich organism commonly causes otitis media and sinusisits and tonisitis not caused by GAS
Streptococcus pneumoniae
Haemophilus influenza
Moraxella catarrhalis
Staphylococcus aureus
48
Describe the Centor criteria
Fever >38
Tonsillar exudates
Abscence of cough
Tender anterior cervical lymph nodes
The more points, the greater likelihood of bacteria so give Abx if score >3
49
Which antibiotic is given to treat bacterial tonsillitis
Penicillin V for 10 days
Co-amoxiclav
Clarithromycin
Doxycyline
50
What is otitis media
Infection in middle ear
Bulging red tympanic membrane, may have pus if perforated
Resolves 3-5 days without antibiotics but give antibiotic if systemically unwell
51
What antibiotic should be given for otitis media
Amoxicillin (clarithromycin/erythromycin in allergy)
Co-amoxiclav 2nd line
52
Describe sinusitis and its treatment
2-3 weeks and resolves without management
<10 days - self care
2 weeks of high dose steroid nasal spray
Bacterial cause - consider delayed or immediate prescription of penicillin V for 5 day course (clarithromycin/erythromycin (pregnancy), doxycycline if allergy) or co-amoxiclav if not responding.
53
Which antibiotics can cause C.difficile infection?
Cephalosporin
54
What is spontaneous bacterial peritonitis and how is it treated?
Piperacillin/tazobactam - 1st line
Cephalosporin - cefotaxime
Levofloxacin plus metronidazole - in penicillin allergy
55
Which antibiotic is bactericidal to gram negative bacteria and so often given as a STAT dose in severe intra-abdominal infection
Gentamicin
56
How does septic arthritis present
Single joint - most often knee
Hot, red, swollen and painful joint
Stiffness and reduced range of motion
Systemic symptoms - fever, lethargy and sepsis
57
What increases the risk of septic arthritis
Joint replacement - particularly revision
58
List the bacteria causing septic arthritis
Staphylococcus aureus
Neisseria gonorrhoea (gonococcus - gram negative gonoccus) in sexually active individuals - gonoococcal septic arthritis is different to reactive arthritis
Group A streptococcus - streptococcus pyogenes
Haemophilus influenza
E.coli
59
What are the differentials of a acutely hot and swollen joint?
Gout
Pseudogout
Reactive arthtitis
Haemoarthosis
60
Describe the management of septic arthritis
Aspirate the joint - gram staining, crystal microscopy, culture and antibiotic sensitivities
Empirical IV antibiotics given until sensitives known - continue for 3-6 weeks - Flucloxacillin plus rifampicin is often 1st line, vancomycin plus rifampicin for penicillin allergy, MRSA or prosthetic joint, clindamycin is an alternative
61
What type of virus is influenza
RNA virus
62
What is H1N1 influenza
Swine flu
63
What is H5N1 influenza
Avian flu
64
Who is eligible for free flu jab?
```
>65 yo
Young children
Pregnant women
Chronic health conditions - asthma, COPD, HF, DM
Healthcare workers and carers
```
65
Which drugs can be given to people at risk of complications who develop influenza
Oral oseltamivir (tamiflu) 75mg BD for 5 days or
Inhaled zanamivir 10mg BD for 5 days
Start treatment <48hrs of symptoms
Post exposure prophylaxis to high risk groups <48hrs of exposure - half the treatment dose for double the treatment time (10 days)
66
List the viruses which can cause viral gastroenteritis
Rotavirus
Norovirus
Adenovirus
67
Which bacteria can cause gastroenteritis
E.coli - shiga toxin E.coli 0157. Haemolytic uraemic syndrome due to shiga toxin which destroys blood cells. Antibiotics can increase risk of HUS
Campylobacter jejuni - travellers diarrhoea, most common worldwide, curved bacteria, gram negative spiral shaped bacteria, raw poultry, untreated water and unpasterised milk. 2-5 day incubation. 3-6 day symptom resolution. Antibiotics - azithromycin and ciprofloxacin
Shigella - produces shiga toxin and cause HUS. Symptoms for 1 week and resolve without treatment. Can be treasted with antibiotics in severe cases - azithromycin and ciprofloxacin
Salmonella - raw egg/poultry, incubation period 12hrs-3 days. Symptoms resolve within 1 week. Watery diarrhoea and mucus or blood, abdo pain and vomiting. Antibiotics only in severe cases and guided by stool culture
Bacillus cereus - gram positive rod spread by inadequately cooked food. Cerelide toxin causing vomiting within 5hrs, watery diarrhoea >8hrs, symptoms resolve within 24hrs. IVDU endocarditis also.
Yersinia enterocolitica - gram negative bacillus, raw pork can cause infection, young children, watery/bloody diarrhoea, lymphadenopathy, fever, abdo cramps. 4-7days incubation and long symptoms >3 weeks. Right sided abdo pain and fever in adults. Antibiotics dependent on stool culture
68
Give an example of a parasite which causes gastroenteritis
Giardia lamblia - small intestine of mammals - release cysts in the stools of infected mammals which are transmitted by faecal-oral route. Chronic diarrhoea, diagnosis by stool microscopy. Treat with metronidazole
69
How is gastroenteritis prevented
Isolation
| Barrier nursing
70
How is gastroenteritis managed
Stool culture
Assess for dehydration - fluid challenge
Rehydration solution - dioralyte
Slowly introduce light diet once oral intake tolerated
Stay off work or school for 48hrs after symptoms stop
Anti-diarrhoeal and anti-emetics avoided
Antibiotics only after stool culture and if risk of complications
71
List some post-gastroenteritis complications
Lactose intolerance
IBS
Reactive arthritis
Guillian Barre syndrome
72
Describe Neisseria meningitidis (meningococcus)
Gram negative diplococcus
73
What is the significance of a non-blanching rash in meningitis
Meningococcal septicaemia
Bacteria in the blood
DIC
74
Describe meningitis
Bacteria in meninges (layer round brain and spinal cord)
75
What are the common causes of bacterial meningitis
```
Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)
Neonates - group B streptococcus - contracted in birth from vagina
```
76
Describe the presentation of meningitis
```
Headache#
Fever
Neck stiffness
Vomiting
Photophobia
Altered consciousness
Seizures
```
Neonates and babies - hypotonia, poor feeding, hypothermia, poor feeding, bulging anterior fontanelle - LP for <1month with fever, <3 months if fever and unwell
77
Describe the presentation of meningococcal septicaemia
Non-blanching rash
78
What special tests can be done to test for meningitis
Kernigs test - lie patient on back, flex one hip and knee to 90 degrees then slowly straighten knee whilst keeping hip flexed at 90 degrees - slight stretch in meninges and produces spinal pain or resistance
Brudzinskis test - lying the patient flat on their back and gently using your hands to lift their head and neck off the bed and flex their chin to their chest - positive test is when this causes the patient to involuntarily flex their knees and hips
79
How is meningitis managed?
Primary care - IM/IV benzylpenicillin prior to hospital transfer
SEcondary care - LP to identify the bacteria for CSF, blood test for meningococcal PCR, cefotaxime plus amoxicillin if <3months and ceftriaxone if >3months
Vancomycin added if penicillin resistance - recent travel or prolonged antibiotic exposure
Steroids used to reduce frequency and severity of hearing loss and neurological damage - dexamethasone 4 times a day for 4 days
Notifiable disease
80
Describe post exposure prophylaxis in meningitis
Risk is highest for people who had close prolonged contact within 7 days prior to illness
Guided by public health - single dose ciprofloxacin orally within 24hrs of inital diagnosis
81
Which viruses can cause viral meningitis
Herpes simplex virus (HSV)
Enterovirus
Varicella zoster virus
82
How is viral meningitis managed
Viral PCR testing
| Aciclovir and supportive care
83
Describe lumbar puncture
Inserting a needle in lower back (L3-L4 intervertebral space to avoid spinal cord )
Bacterial culutre, viral PCR, protein and glucose. Sample of blood glucose sent at the same time.
84
Describe bacteria in the CSF
```
Cloudy appearance
Low glucose
High protein
High neutrophils
Bacteria
```
85
Describe viruses in the CSF
```
Clear fluid
Mildly raised or normal protein
Normal glucose
High lymphocytes
Negative for bacterial culture
```
86
List the complications of meningitis
Hearing loss
Seizures and epilepsy
Cognitive impairment and learning disability and memory loss
Focal neurological problems
87
Describe the bacterium which causes TB
Mycobacterium tuberculosis
Rod shaped bacteria
Resistant to acids used in staining procedure - Acid fastness - waxy coating
88
How is mycobacterium tuberculosis diagnosed
Zeihl-Neelsen stain - red against blue background
89
Who is TB more common in
```
Close contacts of TB
Asia
HIV
Homeless
IVDU
Alcoholics
Immunocompromised
Recent travel to prevalent areas
```
90
What are multi drug reistant TB
Resistant to more than 1 drug
91
Why are Tb hard to culture and treat
Slow growing
| High oxygen demand
92
How is Tb spread
Droplet infection
Then spread through lymphatics and blood
Granulomas form in the body
93
What is active TB
Active infection
94
What is latent TB
Immune system encapsulates the TB
95
What is secondary TB
When the latent TB reacticates
96
What is miliary TB
Disseminated severe disease
97
Where is TB found in body
```
LUngs
Lymph node - cold abscess (firm painless abscess caused by TB in neck)
Pleura
CNS
Pericardium
GI system
GU system
Bones and joints
Cutaneous - skin
```
98
Describe the BCG vaccine
Intradermal injection of live attenuated TB
| Protection against severe and complicated TB but less effective at preventing pulmonary TB
99
Who is the BCG vaccine given to
Only those with negative mantoux test
| High risk of contact with TB - people in high TB prevalence areas, family history of TB, healthcare workers
100
Describe the presentation of TB
```
Lethargy
Fever or night sweats
Weight loss
Cough with or without haemoptysis
Lymphadenopathy
Erythema nodosum
Spinal pain in spinal TB - Potts disease
```
101
How is TB diagnosed
Ziehl Neelsen stain
Mantoux test ( previous immune response to TB suggesting vaccination, latent or active TB, inject tuberculin into intradermal space on forearm which creates a bleb under the skin, an induration of 5mm or more 72hrs later is positive) and Interferon gamma release assay (sample of blood mixed with TB antigens, WCC will be sensitised and release Interferon gamma if already had contact - positive)
CXR and cultures (3 sputum cultures/ bronchoscopy with lavage, mycobacterium blood cultures, lymph node aspiration and biopsy)
Nuclear acid amplicfication test - DNA of TB sputum or lymph node
102
What are the chest Xray signs of primary TB
Patchy consolidation, pleural effusions and hilar lymphadenopathy
103
What are the CXR signs of latent TB
Patchy or nodular consolidation with cavitation (gas filled spaces in lungs) typically upper zone
104
What are the CXR signs of miliary TB
Millet seeds uniformly distributed throughout the lung fields
105
Describe the management of latent TB
Isoniazid and rifampicin for 3 months
| Isoniazid for 6 months
106
Describe the management of active TB
```
RIPE
Rifampicin for 6 months
Isoniazid for 6 months
Pyrazinamide for 2 months
Ethambutol for 2 months
```
107
What side effect does isoniazid cause
Peripheral neuropathy
108
Which drug do you give alongside isoniazid to prevent peripheral neuropathy
Pyridoxine (vitamin B6)
| Im so numbazid
109
What are the side effects of rifampicin
Red/orange discolouration of urine and tears - red and orange pissin
Potent inducer of the cyctochrome P450 - reduces effects of drugs metabolised by this system
110
What are the side effects of Ethambutol
Colour blindness and visual acuity
| Hepatotoxicity
111
What are the side effects of pyazinamide
Hyperuricaemia - gout
| Hepatotoxity
112
What type of virus is HIV
RNA retrovirus
113
Which cells does HIV affect
CD4 T helper cells
114
Describe the seroconversion of HIV
Flu like illness a few weeks after infection
115
How is HIV spread
Unprotected sexual activity
Vertical transmission at any stage of pregnancy and breast feeding
Needles
Blood splashed in eye
116
List some AIDs defining illnesses
```
Kaposis sarcoma
Pneumocystis jirovecii pneumonia
CMV infection
Candidiasis - oesophageal and bronchial
Lymphoma
TB
```
117
How long does it take for HIV to be detected on antibody tests
3 months
118
Describe the investigations for HIV
Antibody blood test
P24 antigen - earlier diagnosis
PCR testing for the HIV RNA levels test directly for the quantity of the HIV virus in the blood and gives a viral load
CD4 count monitoring - <200 - end stage
Viral load - number of HIV RNA per ml of blood
119
Define undetectable for HIV
Viral load <50-100 copies per ml
120
How is HIV treated
```
Antiviral therapy medications
2 NRTIs (nuceloside reverse transcriptase inhibitors) - tenofovir and emtricitabine plus a third agent (protease inhibitors, integrase inhibitors, non-nucleoside reverse transcriptase inhibitors, entry inhibitors)
```
Prophylatic septrin (co-trimoxazole) for PCP
Statins as HIV increases CVD
Yearly cervical smears - HPV and cervical cancer
Vaccinations - but avoid live vaccines
121
What treatment should babies be given following birth from HIV mother
4 weeks ART to reduce risk of vertical transmission
122
Describe post exposure prophylaxis
Used after exposure to HIV and reduce risk of transmission
Must be started within 72hrs
ART - truvada (emtriciabine and tenofovir) and raltegravir -
HIV test minimum 3 months after and abstain from unprotected sex for 3 months
123
What causes malaria
Plasmodium family of protozoan (single celled organism) parasites
Plasmodium falciparum - female anopheles mosquitor
124
Describe the life cycle of malaria
Spread by female anopheles mosquitoes
Infected blood reproduces in the gut of mosquito producing thousandds of sporozoites
Sporozorites injected into human blood which travel to liver of person and lie dormant as hypnozites for severeal years in P vivax and P ovale. Mature into merozoites which enter blood and infect RBC which mature for 48hrs which then rupturee and cause haemolytic anaemia and release of lots more merozoites
Fever spikes every 48hrs
125
List the four types of malaria
Plasmodium falciparum - most common and severe
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae
126
Describe the presentation of malaria
```
1-4 week incubation
Travelled to high prevalence area
Fever, sweats and rigors, malaise, myalgia, headache and vomiting
Pallor- anaemia
Hepatosplenomegaly
Jaundice - haemolysis
```
127
How is malaria diagnosed
Malaria blood film - sent in an EDTA bottle (red top used for FBC)
Parasites
3 samples sent over 3 consequtive days to exclude malaria due to 48hr cycle of malaria being release into blood
128
Describe the management of malaria
Artemether with lumefantrine (riamet)
Proguanil and atovaquone (malarone)
Quinine sulphate
Doxycycline
Artesunate - IV
Quinine dihydrochloride - IV
129
List the complications of falciparum
```
Cerebral malaria
Seizures
GCS reduction
AKI
Pulmonary oedema
DIC
Haemolytic anaemia
Multi-organ failure and death
```
130
Describe malaria prophylaxisis
Antimalarial medications
- proguanil and atovaquone (malarone) - taken daily 2 days before and 1 week after being in endemic area, expensive, best side effect profile
- Mefloquine
Taken once weekly 2 weeks before, during and 4 weeks after being in endemic area - dreams and psychotic disorders
- Doxycyline - diarrhorea and candidal and sun sentiviities
Mosquito spray
Mosquito nets and barriers
131
List some antibiotics which cover anaerobes
Doxycycline
Metronidazole
Piptaz
Co-amoxiclav
132
What is amoxicillin and doxycyline used to treat
CAP
133
What is ceftriaxone used to treat
Bacterial meningitis
| Skin/soft tissue infection in penicillin allergic
134
What is co-amoxiclav used to treat
Pyelonephritis and gut stuff
135
What is piperacillin/tazobactam and gentamicin used to treat
Neutropenic sepsis
136
What are vancomycin, gentamicin and metronidazole used to treat
Sepsis and in severe penicillin allergic cases
137
List some reasons to avoid broad spectrum Ab
Risk of C.difficile
| Risk of resistant organism
138
List some reasons not to use narrow spectrum Ab
Patient too sick
| Risk of the bacteria not being targeted
139
What specific bacteria do pip/taz and gent cover
Pseudomonas
140
What is the most common complication of C.diff despite best medical management
Relapse - 1/3
| Restart treatment early
141
What is ascending lymphangitis
Tracking up the lymphatic system - ascending up the lymph
142
What non-pharmacological interventions can be useful in cellulitis
Mark the area and elevate the leg
143
What would be the antibiotic choice for someone with cellulitis and penicillin allergy
Teicoplanin
144
List some features of necrotising fascitis
Pain out of proportion
| Rapidly spreading
145
What is the commonest cause of viral meningitis in the UK
Enterovirus
146
What is the commonest bacteria causing meningitis in a patient >60
S.pneumoniae
147
Describe mumps
```
Long incubation perior 16-18days
Aseptic meningitis in up to 15 %
Most common symptom is parotitis
Epididymo-orchitis in 25%
Sensorineural deafness also well recognised Highly infectious - respiratory droplets and direct contact
```
148
List the 4 Cs of measles
Cough
Conjunctivitis
Coryza
Koplik spots
