Transfusion related acute lung injury vs Transfusion associated circulatory overload - too much transfusion in a px with a heart failure causing pulmonary oedema LIKE TRALI except the px will be hypertensive not hypotensive

Infectious disease Flashcards by Zohaa Qaisar

Fine needle vs core needle aspirate?

Fine needle = cytological info

Core needle = histological info*

done for breast tissue histological analysis for breast lesions

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Family hx of breast cancer conditions for referral to secondary care?

BC in first degree male relative!

BC in first degree relative under 40

Bilateral BC in first degree relative under 50

BC in 2 first degree relatives

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What is a triple assessment of the breast for BC?

Clinical exam
Mammography
Core needle biopsy

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Ductal carcinoma mammogram findings

areas of calcification

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which Breast cancer causes pagets disease of breast (eczema like feeling of nipple with lump behind it)

Ductal carcinoma in situ

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if someone has HER2 receptor positive breast cancer?

Can treat with a biologic
= trastuzumab

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if someone is on trastuzumab for breast cancer what needs to be monitered?

Cardiac function

cardiotoxicity causing drug

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TNM for breast cancer?

Small tumours under 2cm in size score T1.

If cancerous cells are found in 4-9 local lymph nodes (axillary or internal mammary), an N2 score is given. If fewer than 4 are affected, then the score is N1. If more than 9, or it has spread to supra- or infra-clavicular lymph nodes, the score will be N3.

If no metastasis is found, the score will be M0. If there is metastasis, the score will be M1.

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every px who has a wide local excision of breast cancer should be offered wat?

adjuvant radiotherapy

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How does candida albicans affect the skin?

Itchy rash in folds e.g. sub-mammary, groin, axilla

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How can a baby get congenital herpes simplex virus?

transmission through vaginal birth within 6 weeks that the mother had infection, mum should do a c section and take intra-partum IV acyclovir

Baby will have vesicular lesions around skin, eyes, oral mucosa, can have encephalititis and sepsis

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Most common cause of encephalitis

Herpes simplex virus (1)

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Baby with well defined circular papules, target shaped lesions of 3 concentric rings of different colours

starts at palms and spreads out, what is it

Erythema multiforme (allergic reaction to infection), caused by HSV

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px has painful ulcers on vulva, but swabs and PCR for HSV are both negative

what next?

probable diagnosis is still genital HSV so

if it is negative PCR and swab (e.g. atypical ulcers) do anti-HSV antibodies to confirm diagnosis

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pregnancy and HSV?

Offer patient acyclovir and elective C section

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young patient with hx of eczema is pyrexic, fluid filled blisters which break open to leave shallow sores on skin?

Herpes simplex virus caused Eczema herpeticum

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an USS of a px showing fluid and air accumulating between fascia in their right thigh?

necrotising fasciitis

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How does fourniers gangrene present?

e.g. presented with severe testicular pain, a day ago, dramatically worsened

very unwell, with hx of diabetes/HIV etc

oedematous testicle, erythema with poorly defined margins

palpation impossible due to pain

cremasteric reflex is fine

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px with pneumonia and shingles?

Primary HIV infection (leads to recurrent shingles/molluscum contagiosum/pneumocystis jirovecii pneumonia)

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hiv diagnosis/screening

combination test

tests for P24 antigen +
antibodies against HIV

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hiv diagnosis/screening

combination test

tests for P24 antigen +
antibodies against HIV

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TRALI acute transfusion reaction?

Transfusion related acute lung injury

basically non cardiogenic pulmonary oedema

due to stuff in new blood activating neutrophils in pulmonary vascualture increasing permeability = oedema

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TRALI vs TACO?

Transfusion related acute lung injury

Transfusion associated circulatory overload

too much transfusion in a px with a heart failure causing pulmonary oedema LIKE TRALI except the px will be hypertensive not hypotensive

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breast mastitis organisms

Staph A

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mastitis risk factors?

Smoking breast feeding

breast mastitis ix?

USS Diagnostic needle aspiration drainage = prurulent fluid indicates abscess

breast cyst and cancer link\?

there is one, a complex cyst can develop

most common breast cancer?

Invasive lobular carcinoma

BRCA1 gene?

on chromosome 17 70% will develop breast cancer by aged 80 50% will develop ovarian cancer Increased risk of bowel and prostate cancer

BRCA2 gene?

on chromosome 1 60% will develop breast cancer by aged 80 Around 20% will develop ovarian cancer

NHS screening programme breast cancer?

mammogram every 3 years for women 50-70 yrs old

mx for candidiasis?

Topical antifungal e.g. clotrimazole, miconazole, nystatin only for severe systemic or vaginal - oral fluconazole

genital herpes caused by HSV2 sx?

dysuria + pruritus ulcers

what is gingivostomitis|?

primary infection of herpes erythema and painful ulcers on perioral skin and oral mucosa

what conditions are linked to HIV?

May present with maculopapular rash oral ulcers TB Candidiasis shingles

what is oesophaheal candidiasis?

an aids defining illness

what does oral thrush present as? (candidiasis)

White plaques that can be scrapped off and a cottony feeling

How does HIV seroconversion time present?

Glandular fever like, 3-12 weeks after the infection can get maculopapular rash

how to investigate HIV?

combination test HIV p24 + HIV antibody - the p24 shows up earlier in disease

When to give co-trimoxazole for HIV?

CD4 tells immune status, if <200

Necrotising fasciitis summary?

2 types type 2 = strep pyogenes will present like worsening cellulitis with extreme pain do surgical exploration before cultures

What is the sepsis 6 OBAFLU

administer Oxygen take Blood culture give broad spec Abx give iv Fluid measure serum Lactate measure hourly Urine

where can varicella zoster become dormant in the body after chicken pox?

basal root ganglia trigeminal ganglia

chicken pox skin affects?

vesicular rash 1st appearing centrally then to limbs vesicles on mucous membranes in nasopharynx itchy

ramsay hunt syndrome - varicella zoster - summary

reactivation occurs in the geniculate ganglion of the facial nerve causes ear pain first, then unilateral facial palsy + vesicular rash around ear Mx with oral aciclovir and corticosteroids (prednisolone).

Herpes Zoster Ophthalmicus

Reactivation of varicella zoster in ophthalmic division of the trigeminal nerve resulting in vesicular rash around eye and hutchinson's sign - rash on tip of nose urgent opthal review + oral antivirals

which viral illnesses does viral exanthema present in?

Chicken pox Rubella measles usually on trunk can give emollients to reduce itch

Where does multi-organ dysfunction syndrome come in?

sepsis -> severe sepsis -> MODS

What primary causes can result in MODS?

Infection injury hypoperfusion hypermetabolism

multi organ dysfunction can come in 4 stages each with worsening features which are?

Stage 1 - mild resp alkalosis, oliguria, hyperglycaemia stage 2 = tachypnoea, hypoxaemia, liver dysfunction, haem abnormalities stage 3 - shock, high nitrogen in blood, acid base, significant coagulation abnormalities stage 4 = vasopressor dependent, oliguria, anuria, development of ischaemic colitis and lactic acidosis

Hospital acquired infection (nosocomial infection contracted 48 hrs after hospitalisation) surgical site infection? nosocomial pneumonia? nosocomial UTIs? bloodstream infections? GI infections? multidrug resistant

surgical site infection? = E-coli + S.A nosocomial pneumonia? = S.A + P.aeruginosa nosocomial UTIs? = E-coli bloodstream infections? = S.A GI infections? = C. difficle multidrug resistant = MRSA

candida albicans, the fungi that causes candidiasis features?

Dimorphic fungi low numbers on healthy skin, in oropharyngeal cavity, GI, GU, disease in high risk patients

does vaginal candidiasis cause an offensive discharge

No, just a cottage cheese looking type + dysuria + dyspareunia

tender inguinal lymph seen in?

genital ulcers - HSV2

1st line for HIV is starting ART - antiretroviral therapy this includes two NRTIs* and one PI**/NNRTI *** give examples * 'TAZ' ** '-navir' *** 'vir'

NRTI = Tenofovir, abacavir, zidovudine PI = indinavir, nelfinavir, ritonavir NNRTI = nevirapine, efavirenz

abx for breast mastitis as needed?

Flucloxacillin as main organism if staph A

which breast lump changes with menstruation/pregnancy which breast lump changes around menopause

fibroadenoma breast cyst

describe a breast cyst vs breast fibroadenoma

cyst = fluid collection, soft fluctuable, may be multiple, may be painful, can be complex and cause malignancy - halo appaerance on mammography mobile mass, smooth lump, rubbery and non tender - popcorn calcification on mammography

when to excise cyst when to excise fibroadenoma

blood stained / persistently refill cysts 3cm+ - excise

tumour marker in breast cancer?

CA 15-3

who to send for 2WW for triple assessment in breast clinic?

>30 with unexplained breast mass >50 with nipple discharge, retraction, other concerning features

if breast cancer presents with palpable axillary lymphadenopathy what to do?

lymph node clearance - can cause lymphoedema /functional arm impairment

Hormonal therapy breast cancer if eostrogen receptor positive?

in pre-menopause : tamoxifen in post-menopause : anastrazole * may cause osteoporotic fractures