Measles Flashcards
Measles, also called Rubeola is an infection caused by the measles virus. What was the number of confirmed cases in 2019?
1 - 810
2 - 1000
3 - 2032
4 - 3450
1 - 810
Was 2032 in 2012
Is Measles a notifiable disease?
- Yes
Notify UK Health Security Agency (UKHSA).
Measles is an airborne virus and can be transmitted via droplets or through the surface that it lands upon. How long can it survive once outside of the human host?
1 - 2 minutes
2 - 2 hours
3 - 2 days
4 - 2 weeks
2 - 2 hours
If someone inhales, or touches a surface and then touches their eyes, nose or mouth they will become infected
Is measles contagious?
- incredibly contagious
Measles is incredibly contagious, what % of non-immune people will become infected if they contract the virus?
1 - 9%
2 - 19%
3 - 39%
4 - 90%
4 - 90%
Once a patient has the measles virus on a mucosal surface, like the eyes, nose or mouth, what protein do they use to bind to epithelial cells in the trachea or bronchi?
1 - hemagglutinin (H protein)
2 - neuraminidase (N protein)
3 - GP41 protein
4 - Fusion (F protein)
1 - hemagglutinin (H protein)
H protein binds:
- CD46
- signalling lymphocyte activation molecule (SLAM)
- nectin-4
Once a patient has the measles virus on a mucosal surface, like the eyes, nose or mouth, the virus uses the H protein to bind to epithelial cells in the trachea or bronchi. Which protein does the measles virus then use to gain entry into the epithelial cells?
1 - NEF protein
2 - neuraminidase (N protein)
3 - GP41 protein
4 - Fusion (F protein)
4 - Fusion (F protein)
- single stranded RNA (ssRNA) then needs to be copied by RNA polymerase of the host cells after this the virus can be copied
Once infected with the measles virus, how long is it before the patient begin presenting with symptoms, termed the incubation period?
1 - 24h
2 - 72h
3 - 14-21 days
4 - 21-24 days
3 - 14-21 days
Infectious time period is 4 days before the rash and 4 days after
Following the 10-14 days of incubation, a patient then enters the prodromal phase, lasting typically 3 days where they will present with a fever. They will also present with all of the following, EXCEPT which one?
1 - candidiasis
2 - cough
3 - conjunctivitis
4 - coryzal symptoms
1 - candidiasis
- Not one of the 3 Cs
Coryza = swelling in the mucous membrane of the nose, essentially a stuffy nose.
In addition to a fever, cough, conjunctivitis and coryza in the prodromal phase, patients typically present with is a rash (small spots) on the mucous membranes, typically of the mouth. What is this rash called?
1 - erythema nodosum
2 - enanthem
3 - erythema multiforme
4 - induratum
2 - enanthem
- also called Koplick spots (small red spots with bluish-white centre)
In measles, do immunocompromised patients develop the textbook rash of measles?
- No
Following the prodromal phase, a patient infected with the measles virus will enter the exanthem phase. What is this characterised by?
1 - skin becomes infected
2 - recovery phase begins
3 - large, painful sores (ulcers) develop on the skin
4 - red, blotchy, maculopapular rash spreads in a cephalocaudal progression
4 - red, blotchy, maculopapular rash spreads in a cephalocaudal progression
Rash starts at the head (cephalo), specifically behind the ears, and spreads to the extremities or ends of the body (caudal)
Following the exanthem phase (red rash), patients typically enter the recovery phase which can last 10-14 days. What do patients infected with measles typically have throughout this period?
1 - persistent cough
2 - persistent fever
3 - persistently blocked nose
4 - persistent conjunctivitis
1 - persistent cough
Measles is very contagious. Which of the following is the most contagious time point?
1 - from initial infection to recovery phase
2 - from initial infection to end of prodromal phase
3 - end of incubation to the end of the exanthem phase
4 - end of exanthem phase to end of recovery phase
3 - end of incubation to the end of the exanthem phase
Typically:
- 4 days before the rash
- 4 days of having the rash
If someone has been infected with measles before, are patients able to becone infected again?
- no
- lifelong immunity
Measles can affect multiple tissues and lead to all of the following complications EXCEPT which one?
1 - renal failure
2 - pneumonia
3 - diarrhoea
4 - encephalitis
1 - renal failure
Lungs, GIT and brain are commonly affected and their complications can cause death
Of all the following complication of measles infection, which is the most common?
1 - otitis media
2 - pneumonia
3 - encephalitis
4 - subacute sclerosing panencephalitis
5 - febrile convulsions
6 - keratoconjunctivitis, corneal ulceration
7 - diarrhoea
8 - increased incidence of appendicitis
9 - myocarditis
1 - otitis media
Closely followed by diarrhoea
Of all the following complication of measles infection, otitis media is the most common. Which is the most common cause of death?
1 - otitis media
2 - pneumonia
3 - encephalitis
4 - subacute sclerosing panencephalitis
5 - febrile convulsions
6 - keratoconjunctivitis, corneal ulceration
7 - diarrhoea
8 - increased incidence of appendicitis
9 - myocarditis
2 - pneumonia
Measles is able to suppress the immune system that can increase the risk of super bacterial infections, like otitis media and bacterial pneumonia. How long can the immune system typically be suppressed for?
1 - 72h
2 - 1 week
3 - 6 weeks
4 - 12 weeks
3 - 6 weeks
Which age group are at the highest risk of the complications associated with measles such as pneumonia, diarrhoea, encephalitis, meningitis and bacterial superinfections, and even death?
1 - infants
2 - teenagers
3 - middle aged adults
4 - older patients
1 - infants
- highest levels of mortality
There is a serious complication that can occur in children <2 y/o that can occur 7-10 years following the initial measles infection. This can lead to inflammation of the entire brain. What is this called?
1 - meningococcal meningitis
2 - meningoencephalitis
3 - subacute sclerosing panencephalitis
4 - any of the above
3 - subacute sclerosing panencephalitis
- SSPE
Presents with:
- subtle initially with mood changes
- eventually rapid with seizures, coma and even death
Do all patients who become infected with measles develop the textbook symptoms, such as ananthem (rash on mucosal membranes) and exanthem (red rash)?
- no
- immunocompromised patients will NOT
- BUT they develop more pneumonia and encephalitis
- have a higher mortality
Which 2 of the following can be used to diagnosis patients with measles?
1 - ELISA
2 - serology for measles antibodies PCR
3 - chest X-ray
4 - FBC and chest X-ray
1 - ELISA
2 - serology for measles antibodies PCR
Oral of urine sample - Green top swab
- IgM = acute infection(<5 days)
- IgG = immunity testing
PCR = viral load from swabs (throat, urine, EDTA blood)
What is the treatment of choice for measles?
1 - anti-virals
2 - immunosuppressants
3 - corticosteroids
4 - vaccination
4 - vaccination
Given as a live attenuated vaccine with a 95% vaccine efficacy rate
In the UK, what 2 times will children receive the live attenuated measles vaccine?
1 - 12-13 weeks
2 - 16 weeks
3 - 12 months
4 - 3 years and 4 months
3 - 12 months
4 - 3 years and 4 months
MMR vaccine - Measles, mumps and rubella
In addition to vaccines, what else can protect the baby until they receive their first dose of the vaccine for measles?
1 - anti-virals
2 - immunosuppressants
3 - mothers anti-measles antibodies (immunoglobulin’s)
4 - corticosteroids
3 - mothers anti-measles antibodies (immunoglobulin’s)
Typically lasts around 9 months
If a patient becomes infected with measles, is there any specific anti-viral treatments?
- no
In severe cases can give Ribavirin
If a patient becomes infected with measles, there is no specific anti-viral treatments. Therefore, which of the following are patients advised to do?
1 - isolate
2 - stay hydrated
3 - analgesia for pain and fever
4 - treat superinfection as appropriate
5 - vitamin A (immuno-modulator)
6 - all of the above
6 - all of the above
Vitamin A given in 2 doses, 24h apart to help reduce risk of eye complications
In an outbreak setting, can patients within the same household be offered measles vaccine if they have not previously had it?
- yes
- should be given within 72h
In an outbreak setting, would pregnant women and young infants be offered the measles vaccine or measles immunoglobulins?
- measles immunoglobulins
In pregnant women and immunocompromised patients, would they receive the same conservative management, or would they be considered for hospital admission due to the risks associated with measles?
- consider hospital admission
Measles is more severe during pregnancy
It can cause miscarriage and still births
