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MedEd Path > MedEd Micro 2 > Flashcards

MedEd Micro 2 Flashcards

1
Q

causes of immunocompromise

A

immunodeficiency syndromes
acquired - HIV, iatrogenic, lymphopaenia, malnutrition, DM
organ specific - structural lung disease (COPD, CF), splenectomy

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2
Q

what organisms are people with no spleen at risk of

A

encapsulated bacteria
ie NHS
neisseria
hamophilus
strep

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3
Q

consequences of immunocompromise

A

unusual organism infections
unusual site infections

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4
Q

HIV specific infections

A

PCP
JC virus
toxoplasmosis
microsporidium
MAC
(TB & CMV more severe)

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5
Q

CF specific infections

A

burkolderia cepacia

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6
Q

anti TNFa specific infections

A

JC virus

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7
Q

HIV pts can get common infections in weird places - 2 examples of the bug with location

A

CMV colitis
oesophageal candidiasis

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8
Q

what weird site infection do sickle cell pts get and from what bug

A

salmonella septic arthritis

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9
Q

prophylaxis for HIV / splenectomy pts

A

vaccination (splenectomy)
ABx - co-trimoxazole (HIV)

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10
Q

what feature of influenza allows antigenic shift

A

multi segmented genome

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11
Q

types of influenza

A

A and B
technically 4 types but C and D aren’t that clinically relevant

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12
Q

which type of influenza is worse

A

A
(its the pandemic one)

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13
Q

what 3 features of influenza allow it to have pandemic risk

A

novel antigenicity
efficient replication in airways
efficient transmission between people

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14
Q

2 processes that allow novel antigenicity

A

antigenic shift
antigenic drift

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15
Q

what is antigenic drift

A

accumulation of errors over time

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16
Q

what is antigenic shift

A

organism infected with 2 strains of influenza at the same time –> RNA from both strains mix in the same cell –> genome of virus changes

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17
Q

problem with antigenic drift

A

pre formed ABs from previous infection are no longer effective against current strain

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18
Q

how many chunks of RNA does influenza have

A

8

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19
Q

how common is antigenic shift vs drift

A

drift is common, shift is very rare - esp to cause a functional virus as often the mix produces nonsense virus

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20
Q

2 most important genes in influenza

A

neuraminidase
haemagglutinin

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21
Q

what does neuraminidase do

A

cleaves sialic acid, facilitating viral release from cells

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22
Q

what does haemagglutinin do

A

binds to sialic acid, facilitating viral entry

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23
Q

key pandemic feature of haemagglutinin

A

prone to antigenic drift

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24
Q

key pandemic feature of neuraminidase

A

prone to antigenic shift

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25
Q

how do you determine strain of influenza

A

RT - PCR

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26
Q

where are haemagglutinin and neuraminidase found

A

cell SURFACE

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27
Q

influenza antivirals

A

PO oseltamivir (tamiflu) ** key one
inhaled zanamivir
IV peramivir
oral baloxavir
oral amantadine

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28
Q

how does oseltamivir work

A

neuraminidase inhibitor

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29
Q

how does baloxavir work & when is it used

A

endonuclease inhibitor
only in first 2 days of infection

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30
Q

how does amantadine work

A

m2 antagonist

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31
Q

problem with amantadine

A

easy to become resistant to it - most influenza strains are resistant to it, so not used anymore

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32
Q

what herpes presentation indicates uncontrolled HIV infection

A

herpes oesophagitis

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33
Q

JC virus causes what presentation

A

progressive multifocal leucoencephalopathy (PMLE)

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34
Q

what is this persons Hep B status
HBsAg +
HBsAB -
HBcAB IgM +
HBeAg +
HBeAB -

A

acute hep B infection

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35
Q

what does val infront of an antiviral indicate & clinical indication

A

increases bioavailability + less effected by first pass metabolism
easier to take orally

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36
Q

tx ladder of human herpes viruses

A

aciclovir or ganciclovir
foscarnet
cidofovir

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37
Q

usual first line Tx for non herpes viruses

A

cidofovir 1st line

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38
Q

why do we not just treat everyone with cidofovir if its 3rd line HHV and 1st line non HHV

A

dirty drug - nephrotoxic, ocular toxicity, BM suppression

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39
Q

what are herpes simplex in terms of HHV

A

HHV 1 & 2

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40
Q

brain manifestations of HSV1 vs HSV2

A

1 = HSV encephalitis
2 = HSV meningitis

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41
Q

PCs of HSV1

A

herpes labialis (oral ulcers)
HSV encephalitis

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42
Q

PCs of HSV2

A

genital herpes ulcers
HSV meningitis

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43
Q

rarer presentations of HSV

A

HSV oesophagitis / colitis - HIV!!!!
eczema herpeticum
herpetic whitlow
disseminated cutaneous herpes - imm comp

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44
Q

what is herpetic whitlow

A

herpes on the finger

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45
Q

who gets herpetic whitlow

A

healthcare workers !!

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46
Q

1st line tx of HSV

A

aciclovir

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47
Q

what can initial enoculation with HSV look like (more commonly than in reactivation)

A

herpes gingivostomatitis - ulcers around mouth

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48
Q

what HHV is VZV

A

HHV3

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49
Q

PC of VZV

A

chicken pox and shingles

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50
Q

who gets more serious chickenpox infections

A

adults - esp imm supp / foetus

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51
Q

aka shingles

A

herpes zoster

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52
Q

2 key risks of shingles

A

opthalmic herpes zoster
ramsay hunt syndrome

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53
Q

what is ophthalmic herpes zoster

A

shingles of v1 –> damage of retina

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54
Q

sign of opthalmic herpes zoster and what this actually is

A

hutchinson sign
vesicles on the nose tip

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55
Q

what is ramsay hunt syndrome

A

facial nerve shingles
can get bells palsy, ear pain + vesicles in ear

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56
Q

what is not part of the VZV tx esp in children & why

A

ibuprofen
- increases secondary skin infections esp nec fasc

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57
Q

complication post shingles

A

post herpeticum neuralgia
- pain in distribution of dermatome

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58
Q

what is HHV4

A

EBV

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59
Q

PC of EBV

A

infectious mononucleosis
- fever, pharyngitis, lymphadenopathy
- hepatosplenomegaly

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60
Q

how can the lymphadenopathy picture differentiate EBV from tonsilitis

A

EBV affects posterior cervical chain
tonsilitis affects anterior cervical chain

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61
Q

what else can cause infectious mononucelosis

A

CMV
toxoplasmosis

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62
Q

what else can cause a similar picture to infectious mononucleosis

A

HIV seroconversion !

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63
Q

what lab findings strengthen a Dx of EBV

A

monospot test
atypical lymphocytes on smear

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64
Q

how is EBV usually diagnosed now

A

EBV serology

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65
Q

tx of EBV

A

usually supportive
gancyclovir if really bad

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66
Q

2 pieces of advice for patient with mono

A

avoid contact sports - splenic rupture risk
avoid alcohol - can give hepatitis

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67
Q

3 associated diseases after EBV

A

burkitts lymphoma
post transplant lymphoproliferative disorder
nasopharyngeal carcinoma

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68
Q

what is HHV5

A

CMV

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69
Q

2 potential PCs of CMV

A

asymptomatic or mononucelosis picture

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70
Q

buzzword of CMV

A

owl’s eye inclusion bodies

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71
Q

4 PCs reactivation of CMV in imm supp

A

pneumonitis
retinitis
colitis
encephalitis

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72
Q

tx of CMV

A

gancyclovir / valgancyclovir

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73
Q

CT of CMV pneumonitis

A

ground glass widespread appearance

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74
Q

what does CMV retinitis look like

A

widespread cotton wool spots

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75
Q

what does CMV colitis look like

A

like HSV oesophagitis - hard to differentiate
owls eye inclusion body !

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76
Q

name 3 other HHV and what they cause

A

HHV6 & 7 - roseola
HHV8 - karposi’s sarcoma

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77
Q

complication of roseola

A

encephalitis (rare) –> causes lots of febrile seizures

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78
Q

association of HHV8

A

castleman disease
primary effusion lymphoma

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79
Q

what is primary effusion lymphoma

A

very poor prognosis diffuse large B cell lymphoma

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80
Q

what is castlemann’s lymphoma

A

lymphoproliferative disorder

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81
Q

what is karposi’s sarcoma

A

lymphatic endothelium proliferation

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82
Q

what is the problem with karposi’s sarcoma

A

lesions on the skin are fine ish
but often associated with lesions internally which can haemorrhage massively

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83
Q

what do adenoviruses cause in imm comp

A

pneumonitis
haemorrhagic cystitis
meningioencephalitis
colitis

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84
Q

what does JC virus cause in helathy vs imm comp ppl

A

healthy = nothing
imm comp = PML

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85
Q

who is most susceptible to JC virus

A

monoclonal ABs pts
HIV

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86
Q

Tx of JC virus

A

no antivirals really
treat imm supp

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87
Q

what does BK virus cause & who do we worry about it in

A

transplant pts !!
nephropathy - kidney transplant pts
haemorrhagic cystitis - BM transplant pts

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88
Q

which hepatitis viruses cause acute infection

A

A and E

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89
Q

common things between hep A and E

A

both cause acute infection
both faecal-oral
both seen in travellers
similar clinical presentations
can be STIs esp in MSM !!
rarely cause chronic infection, just acute

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90
Q

progression of PC of hep A/E
- inc incubation period and resolution period

A

incubation period 2-6 weeks
prodromal malaise
jaundice, hepatitis, cholestasis
resolution ~ 2 months

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91
Q

what complication is rare in hep A and E

A

fulminant hepatitis (can happen but v v v rare)

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92
Q

who would get fulminant hepatitis in hep A / E

A

A = elderly
E = pregnant women *** buzzword

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93
Q

tx of hep A / E

A

none - symptomatic

94
Q

which hep has a vaccine

A

hep A and B

95
Q

how is hep B transmitted

A

contaminated blood / fluids
vertically

96
Q

how does hep B present & for how long

A

acutely with hepatitis
can last up to 6 months

97
Q

is hep B fulminant

A

rarely

98
Q

what % of people fail to clear hep B and what happens then

A

5-10%
- become chronically infected

99
Q

what can uncontrolled hep b cause

A

cirrhosis
HCC

100
Q

what is the RF of hep B becoming chronic

A

younger age !!

101
Q

what does hep B sAg + indicate

A

have the virus present

102
Q

what does hep B sAB + indicate

A

you are immune (have neutralising ABs)

103
Q

what does hep B cAB + indicate

A

you have / had hep B

104
Q

which hep B cAB is present in acute vs chronic response

A

IgM = acute
IgG = chronic

105
Q

do hep B cAB confer immunity

A

NO - just shows you have seen the virus. its HBsAB that shows immunity

106
Q

what is the hep B eAg a marker of

A

infectivity (present = highly infectious)

107
Q

what does hep B eAB indicate

A

not very infectious

108
Q

pt with only hep B cAB + only

A

either JUST cleared the infection
infected AGES ago

109
Q

hep b tx

A

tenofovir 1st line
entecavir can be used
looooads of others that aren’t as relevant for path

110
Q

follow up of hep b

A

6 monthly screening for HCC - USS / AFP

111
Q

how can hep B be prevented

A

vaccination !!

112
Q

when do you get hep D

A

only if you have hep B too

113
Q

3 manifestations of hep D with PC

A

coinfection at the same time with hep B –> ++++ severe acute hep B
superinfection (flare of hep B then get hep D) –> exacerbation of chronic hep B
aggressive, difficult to treat chronic hep B

114
Q

Ix for hep D

A

anti HDV ABs

115
Q

prognosis and tx of hep D

A

very very bad - get cirrhosis quickly
IFNa but not that good

116
Q

how is hep C transmitted

A

bodily fluids
vertically

117
Q

what is hep C the opposite of and why

A

hep B
- rarely get acute hepatitis, sometimes coryza
- very common to get chronic 60-80%

118
Q

how does chronic hep C present

A

cirrhosis (dont get initial hepatitis so dont know you have it)

119
Q

unusual presentations of hep c

A

glomerulonephritis
cryoglobulinaemia
vasculitis

120
Q

Ix of HCV

A

viral load
serology less useful

121
Q

hep c tx

A

direct acting antivirals (target parts of hep c genome)

122
Q

how is tx for hep c judged and what is this

A

sustained virologic response (SVR)
- at 12 weeks, do you have a detectable viral load

123
Q

is there a vaccine for hep c

A

no

124
Q

define pyrexia of unknown origin

A

> 38.3 degrees
+
3 weeks
+
no known cause
+
one week of Ix

125
Q

3 specific situations of PUO

A

nosocomial
neutropaenic
HIV assoicated

126
Q

3 specific situations of PUO

A

nosocomial
neutropaenic
HIV associated

127
Q

what can cause a fever

A

infection - classical or weird ones / weird foci
cancer - haem ones esp
AID
rare familial diseases - eg FMF, immunodefs

128
Q

weird foci infections

A

IE
psoas abscess
epidural abscess

129
Q

which AIDs can cause fever

A

rheumatology ones
vasculitis
still’s disease **buzzword

130
Q

buzzwords of typhoid fever PC

A

rose spots
nosebleeds
constipation
fagets sign

131
Q

what ABx is usually used to treat weird infections

A

doxycycline

132
Q

cause of typhoid

A

salmonella typhi or paratyphi
NOT the other salmonella

133
Q

who gets typhoid and how

A

travellers from India
foecal - oral

134
Q

what is fagets sign

A

relative bradycardia (usually HR increases if fever)

135
Q

incubation of typhoid

A

1-2 weeks

136
Q

gold standard Ix for typhoid

A

BM culture

137
Q

actual tests for typhoid

A

cultures
serology (widal test)

138
Q

tx of typhoid

A

ceftriaxone

139
Q

where does typhoid live

A

peyers patch

140
Q

complication of typhoid

A

haemorrhage from ruptured peyers patch

141
Q

where is the dengue traveller coming back from

A

SE asia - thailand / cambodia

142
Q

transmission of dengue

A

mosquitoes

143
Q

how many serovars are there of dengue

A

4

144
Q

2 buzzwords of dengue

A

retro-orbital headache
suburn rash

145
Q

incubation of dengue

A

2 weeks

146
Q

tx of dengue

A

supportive tx as they will get better on their own usually

147
Q

2 serious ways dengue can present

A

dengue shock syndrome
dengue haemorrhagic fever

148
Q

why do people get the more serious dengue presentations

A

previously infected with dengue (more common in people who live in these countries)

149
Q

cause of malaria

A

plasmodium spp

150
Q

where do you travel to to get malaria

A

africa / south asia / se asia / central or south america

151
Q

how does malaria present

A

paroxysms (episodes) of fever and rigors
anaemia, jaundice, hepatosplenomegaly, haemaglobinuria

152
Q

incubation of malaria

A

depends on species infected with

153
Q

fatal complications of malaria

A

shock
ARDS
cerebral malaria
blackwater fever
DIC

154
Q

what is blackwater fever & classical sign of it

A

pronounced haemolysis –> kidney damage
get BLACK urine

155
Q

how is malaria Dx

A

thick and thin blood film

156
Q

name the species of malaria

A

plasmodium:
falciparum
vivax
ovale
knowlesi
malariae

157
Q

which species of malaria causes the fatal disease

A

fallciparum

158
Q

which species of malaria requires treatment of hypnozoites (bcos they are the only ones to produce hypnozoites)

A

vivax and ovale

159
Q

which species of malaria have tertian pattern with 48hr paroxysms

A

falciparum, ovale, vivax

160
Q

which species of malaria have quotidian patterns and how long are the paroxysms

A

knowlesi - 24hrs
malariae - 72hrs

161
Q

what is schizont and where do they form

A

big ball of developing malaria
- in liver / RBC

162
Q

describe malaria lifecycle

A

mosquito bites you
releases sporozoites
travels to liver and forms schizont
schizont ruptures - releasing immature parasites to blood stream
each invades a RBC
forms schizont in RBC which ruptures and releases again
continues cycle

163
Q

which bit of the cycle is responsible for periods of fever

A

schizont in RBC rupturing

164
Q

which malarias can present 6-7 years after exposure in acute phase and why

A

ovale and vivax
- make hypnozoites which can lay dormant in liver then randomly make schizont later

165
Q

tx of severe malaria

A

IV artesunate

166
Q

indications for IV artesunate in malaria

A

severe
parasitaemia >2%
hypoglycaemia
metabolic / lactic acidosis
severe anaemia (70/80ish)

167
Q

tx of less severe malaria

A

artemesin combo tx or chloroquine

168
Q

what other tx does vivax / ovale need

A

primaquine

169
Q

buzzwords of brucellosis RFs

A

raw dairy / unpasteurised milk
cattle / farms

170
Q

buzzwords of brucellosis PC

A

lower back pain (epidural abscess)
epididymo-orchitis

171
Q

dx of brucellosis

A

cultures

172
Q

tx of brucellosis

A

doxycycline

173
Q

buzzwords of rabies RFs

A

dogs / bats bites

174
Q

what causes rabies

A

lyssavirus

175
Q

buzzwords of rabies PC

A

hydrophobia
excessive salivation
furious / dumb encephalitis (angry or sedated)

176
Q

incubation of rabies

A

1-3 months

177
Q

tx of rabies & time frame

A

rabies Ig / vaccine
only BEFORE they are sx - otherwise dead

178
Q

what CSF PCR result is pathognomonic for rabies

A

negri bodies
** buzzword

179
Q

potential dx of rabies

A

biopsy from nape of neck
usually just clinically tho as its so rapidly progressing

180
Q

buzzwords for RFs for plague

A

rats esp fleas on rats

181
Q

buzzwords for PC of bubonic plague

A

buboes - massive lymph nodes which when aspirated show a dense BLACK fluid

182
Q

cause of plague

A

yersinia pestis

183
Q

tx of plague

A

doxycycline

184
Q

how can bubonic / septicaemic plague also present

A

peripheral gangrene

185
Q

buzzwords for RFs for leptospirosis

A

rat urine - outdoor water activities

186
Q

buzzwords for PC of leptospirosis

A

jaundice
conjunctival suffusion (dry, no exudate)

187
Q

incubation of leptospirosis

A

1 week

188
Q

tx of leptospirosis

A

doxycycline
ceftriaxone if severe

189
Q

buzzwords for bartonellosis RFs

A

kittens
“cat scratch fever”

190
Q

buzzwords for bartonellosis PC

A

lymphadenopathy proximal to scratch
papule where scratch
parinaud oculoglandular syndrome

191
Q

what is parinaud oculoglandular syndrome

A

conjunctivitis
big lymph nodes infront of ear

192
Q

tx of bartonellosis

A

doxycycline

193
Q

buzzwords of lyme disease RFs

A

ticks (ixodes tick) - usually been outdoors in woods etc

194
Q

buzzwords of lyme disease PC

A

bullseye rash (erythma migrans)
–> Dx of lyme if present

195
Q

complications of lyme disease

A

arthralgia
heart blocks

196
Q

tx of lyme disease

A

doxycycline

197
Q

buzzwords of leishmaniasis RFs

A

sandflies

198
Q

buzzwords of leishmaniasis PCs

A

visceral - hepatosplenomegaly, pancytopaenia
cutaneous - well demarcated lesion at site of bite. can be very destructive ulcers
mucocutaenous - VERY destructive of mouth / nose

199
Q

dx of leishmaniasis

A

microscopy

200
Q

tx of visceral leishamniasis

A

liposomal amphoterocin B

201
Q

buzzwords of anthrax RFs

A

wild animals - spores in hairs

202
Q

buzzwords of anthrax PC

A

eschars (boil on skin –> painless necrotic skin lesion)
widened mediastinum (pulmonary anthrax)

203
Q

dx of anthrax

A

microscopy or culture

204
Q

tx of anthrax

A

doxycycline

205
Q

classical superficial fungal infections

A

dermatophytoses (tinea / ringworm)
pityriasis versicolor

206
Q

cause of tinea

A

trycophytum rubera

207
Q

which tinea can be treated with topical antifungals

A

tinea pedis (athletes foot)
tinea cruris (groin)
tinea corporis (body)
tinea manuum (hands / palms)

208
Q

which tinea can’t be cleared with topical antifungals, and require systemic antifungals

A

tinea capitis (scalp / hair)
tinea unguium (nails)

209
Q

PC of pityriasis versicolor

A

multiple tan/brown lesions across trunk (hypopigmented in darker skin), abdo, face

210
Q

tx of pityriasis versicolor

A

antifungal shampoos / topical azoles

211
Q

PC of candida

A

oral thrush
vaginal thrush
disseminated
oesophageal

212
Q

who gets the following candida:
oral
oesophageal
dissemninated

A

asthmatics bcos of steroid inhaler
severe imm supp
central access lines

213
Q

2 specifc blood tests for candida & results

A

beta D glucan +
galactomannan -

214
Q

tx of severe candida

A

amphoterocin B
echinocandins

215
Q

3 PC of aspergillus

A

aspergilloma
invasive aspergillosis
ABPA

216
Q

blood test result for aspergillus

A

beta D glucan +
galactomanna + (candida in comparison in negative)

217
Q

who gets aspergilloma

A

pre existing cavity in lung eg abscess

218
Q

who gets invasive aspergillosis

A

imm supp

219
Q

what is ABPA

A

hypersensitivity reaction to colonisation
- NOT an infection

220
Q

tx of aspergillus

A

amphoterocin B
(NOT ABPA - not an infection - give steroid)
if aspergilloma - surgical removal of the fungi

221
Q

buzzword of sporotrichosis (RFs and Sx)

A

contracted from rose thorns - gardeners / farmers
necrotic patchy rash spreading proximally

222
Q

buzzword for mucormycosis

A

DM pts following COVID
gets rhinocerebral infection (big necrosis on face)

223
Q

what is a prion

A

misfolded PrPc protein (should be alpha helix –> now beta pleated sheet which can’t be broken down)

224
Q

what do prions do to the normal PrPc proteins

A

make the normal ones misfold to form prions

225
Q

PC of prion disease

A

rapid neurodegeneration

226
Q

most common prion diseases

A

creutzfeldt jakob disease

227
Q

3 forms of CJD and prevelance

A

sporadic 85%
familial 5-15%
acquired <1% eg iatrogenic. inc variant !!

228
Q

what causes variant CJD

A

eaten beef with mad cow disease

229
Q

dx of CJD

A

clinically
biopsy PM
in variant –> can do tonsillar biopsy

230
Q

buzzwords of kuru

A

papau new guinea
ritual cannibalism

231
Q

2 familial prions

A

fatal familial insomnia
gerstmann-straussler-scheinker (better prog)

MedEd Path (10 decks)

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