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Infection Erin > Pathology > Flashcards

Pathology Flashcards

1
Q

What is sepsis

A

Life threatening organ dysfunction caused by dysregulated host response to infection

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2
Q

What is septic shock

A

Clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain MAP >66mmHg despite adequate vol. resuscitation

Or having serum lactate >2mmol/l

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3
Q

What are the early signs of sepsis?

A

Oliguria (<0.5ml/kg/hr)

Increased blood glucose

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4
Q

What are general signs of sepsis

A 
Fever >38 
Chills
Rigors 
Flushes
Cold sweats
Nights sweats
Hypothermia (especially in elderly and very young children)
Tachycardia 
Tachypnoea 
Altered mental state (esp. elderly)
Confusion 
Hyperglycaemia (>8mmol/L in absence of DM)
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5
Q

What are the 3 components of the qSOFA score

A
  1. Hypotension systolic <100mg
  2. Tachypnoea >22/min
  3. Altered mental status
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6
Q

What qSOFA score suggests the greater risk of poorer outcomes?

A

2 or more

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7
Q

What is the qsofa score?

A

Bedside prompt investigation which identifies patients who are at greater risk for poorer outcomes outwith ICU

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8
Q

Name Sepsis 6

A

Take 3:
Take blood cultures
Measure urine output
Take Blood lactate

Give 3:
Give high flow O2
Give IV abx.
Give IV fluids

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9
Q

When is septic shock diagnoses

A

When hypoperfusion persists even after appropriate fluid challenge

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10
Q

Why is sepsis so important?

A

Because it is associated with very high morbidity and very high mortality

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11
Q

What is impetigo

A

Superficial skin acute infection

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12
Q

Who is impetigo common in?

A

2-5yrs old

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13
Q

Is impetigo contagious

A

Yes

Highly contagious

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14
Q

What is the most common organism to cause impetigo

A

Staph. Aureus

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15
Q

What is a lesser common organism to cause impetigo?

A

Strep. Pyogenes

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16
Q

Describe the appearance of impetigo

A

Golden crusted appearance Pustules and honey coloured crusted erosions
Well defined borders
Cornflake appearance

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17
Q

Where does impetigo usually occur?

A 
Exposed body parts 
Face
Nose 
Extremities 
Scalp
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18
Q

Ix for impetigo

A

Clinical Dx

Can send bacterial swabs

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19
Q

Rx for impetigo

A

Small areas: topical Abx

Large areas: Topical and oral Abx

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20
Q

What is the most common skin infection seen in young children

A

Impetigo

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21
Q

What is cellulitis

A

Acute skin infection involving the dermis and sub. cut fat

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22
Q

What are predispositions to impetigo?

A 
DM 
Immunocompromised 
CKD 
Obesity 
Pregnancy 
Previous cellulitis
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23
Q

What are the most common organism causes of cellulitis?

A

Staph. Aureus

Strep. Pyogenes

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24
Q

What are the cardinal features of cellulitis?

A 
Red (erythema)
Warm
Painful 
Swollen skin 
Fever 
With systemic symptoms
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25
Q

Ix for cellulitis

A 
Clinical examination 
Blood cultures 
ESR 
CRP 
WCC
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26
Q

Rx for cellulitis

A

Oral abx.

If severe: Admission, IV abx

Analgesia

Elevate affected part

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27
Q

Which abx should be used to treat cellulitis

A

Penicillin (Benzylpenicillin)

If allergic: Erythromycin

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28
Q

What are potential complications of cellulitis

A

Sepsis
Endocarditis
Necrotising fasciitis

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29
Q

Who does necrotising fascitiis require urgent review by?

A

URGENT surgical review

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30
Q

What is folliculitis

A

Infection/inflammation of hair follicles

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31
Q

What is the most common organism cause of folliculitis

A

Staph aureus

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32
Q

Appearance of folliculitis

A

Small red papules

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33
Q

What is the difference between folliculitus and furunculosis

A

Furunculosis is usually deeper infection with only 1 hair follicle affected

Bacterial folliculitis is more superficial papules

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34
Q

Rx for furunculosis

A

No Rx
Keep skin clean
Sometimes topical Rx

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35
Q

What is the size of folliculitis

A

up to 5mm in diameter

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36
Q

Risk factors for furuncolosis

A 
Obesity 
DM 
Atopic dermatitis 
CKD 
Corticosteroid use
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37
Q

What is carbuncle

A

Multiple headed boil

Collection of boils all connected under the skin

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38
Q

Common organism in carbuncle

A

Staph. Aureus

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39
Q

Appearance of carbuncle

A

Swollen area with accumulation of pus and death tissue

Multiseptated abscess

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40
Q

Where is a carbuncle typically found?

A

Back of neck
Posterior trunk
thigh

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41
Q

Rx for carbuncle

A

Admission
Surgery
IV abx.

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42
Q

What is necrotising fasciitis?

A

Infectious disease emergency

Rapidly progressive infection of deep fascia causing necrosis of tissue

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43
Q

Predisposing factors for Necrotising fasciitis

A

DM
HIV/ Immunocompromised
Malignancy
Liver cirrhosis

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44
Q

Typical organisms for necrotising fasciitis

A 
Staphylococci 
Streptococci 
Enterococci 
Gram -ve bacilli 
Clostridium
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45
Q

What is type 1 necrotising fasciitis

A

Mixed aerobic and anarobic infective organisms causing the disease

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46
Q

What is type 2 necrotising fasciitis

A

Monomicorbial

Usually associated with strep. pyogenes

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47
Q

Clinical features of necrotising fasciitis

A 
Rapid onset
Haemorrhagic bullae 
Skin necrosis 
Crepitus 
Anaesthesia at site
Erythema 
Severe pain
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48
Q

What is mandatory in necrotising fasciitis

A

Urgent surgical review

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49
Q

Rx for necrotising fasciitis

A

IV Abx.

Radical debridement +/- amputation

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50
Q

Abx. to use for necrotising fasciitis

A

Broad spectrum
Flucloxacillin
Gentamicin
Clindamycin

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51
Q

Does necrotising fasciitis have a high or low mortality

A

High mortality

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52
Q

What is pyomyositis

A

Purulent infection deep within striated (skeletal) m.

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53
Q

Predisposing factors to pyomyositis

A

DM
HIV/ Immunocompromised
Malignancy
Liver cirrhosis

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54
Q

Common sites of pyomyositis

A 
Thigh 
Calf 
Arms 
Gluteal region 
Chest wall 
Psoas muscle
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55
Q

Commonest organism for pyomyositis

A

Staph. Aureus

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56
Q

Clinical signs of pyomyositis

A

Fever
Pain
Myalgia
Woody induration of affected muscle

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57
Q

Ix for pyomyositis

A

CT/MRI

Culture of surgical drainage

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58
Q

Rx pyomyositis

A

Surgical drainage

Abx. depending on microbiology results

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59
Q

What is erysipelas

A

Infection of the upper dermis

Essentially superficial form of cellulitis

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60
Q

What is the most common organism for erysipelas

A

Strep. Pyogenes

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61
Q

Appearance of erysipelas

A 
Red painful area 
Distinct elevated borders 
Associated fever 
Regional lymphadenopathy 
Regional lymphangitis
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62
Q

Common area for erysipelas

A

Lower limbs in 70%

5-20% affect face

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63
Q

Rx for erysipelas

A

Abx.
Analgesia
Elevate affected part

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64
Q

Does erysipelas have a high or low recurrence rate

A

High

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65
Q

What does HSV1 typically cause

A

Cold sores

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66
Q

What does HSV2 typically cause

A

Genital herpes

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67
Q

What is genital herpes classed as

A

STI

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68
Q

Is HSV1 and HSV2 causing cold sores and genital herpes a set rule?

A

No
HSV1 can cause genital herpes
HSV2 can cause cold sores

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69
Q

Describe primary infection in HSV

A 
Can go unnoticed (be asymptomatic)
or 
Subclinical or sensroy nerve tingling prodrome 
Vesicles 
Burst to give shallow ulcers
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70
Q

Can you cure HSV?

A

No

Infection is lifelong

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71
Q

When HSV recurs is it typically more or less severe

A

Symptoms usually the same

but usually less severe

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72
Q

Ix for HSV

A

Usually clinical O/E
PCR viral
PCR swab

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73
Q

What IX is required in HSV encephalitis

A

PCR CSF

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74
Q

Rx for HSV infection

A

Aciclovir

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75
Q

Rx for HSV encephalitis

A

Empirical Aciclovir

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76
Q

Where does the HSV virus remain latent

A

In dorsal root ganglion

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77
Q

Where does HSV 2 typically remain dormant

A

Sacral ganglion

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78
Q

How is HSV2 typically spread

A

Sexual contact

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79
Q

How is HSV1 typically spread

A

Kissing

Sharing utensils

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80
Q

What is septic bursitis

A

Infection of the bursae

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81
Q

Predisposing factor to septic bursitis

A 
RA
Alcoholism 
DM 
IV drug abuse
Immunosuppression 
HIV/AIDS
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82
Q

Where does septic bursitis most commonly affect

A

Patellar (knee)

Olecranon (elbow)

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83
Q

Clinical features of septic bursitis

A 
Pain 
Fever 
Pain on joint movement 
Warms 
Swelling 
Redness
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84
Q

What are bursae?

A

Small sac like cavities that contain lubricating fluid and are surrounded by a synovial membrane

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85
Q

How is septic bursitis Dx?

A

Aspiration of fluid

Need to differentiate between septic and aseptic infection

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86
Q

Rx for septic bursitis?

A

Abx. (oral or IV depending)

Analgesia

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87
Q

Most common organism to cause septic bursitis

A

Staph. Aureus

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88
Q

What is infectious tenosynovitis

A

Infection of synovial sheets that surround tendons

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89
Q

Where is most commonly affected in infectious tenosynovitis

A

Flexor muscle associated tendons and tendon sheaths of hand are most commonly involved

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90
Q

Organism cause of infectious tenosynovitis

A

Most commonly staph. aureus

Streptococci

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91
Q

Clinical features of infectious tenosynovitis

A

Erythematous fusiform swelling finger
Held in semi-flexed position
Tenderness over length of tendon
Pain with finger extension

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92
Q

What sign is seen in infectious tenosynovitis

A

Kanavel’s Sign

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93
Q

Rx for infectious tenosynovitis

A

Empiric abx

Urgent hand surgeon review

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94
Q

What is staphylococcal scalded syndrome?

A

Infection due to particular stain of Staph. Aureus producing exfoliative toxin A or B

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95
Q

Who is Staph. Scalded Syndrome common in ?

A

Children

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96
Q

Is Staph. Scalded syndrome common in adults?

A

Far less common in adults compared to children

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97
Q

Which organism causes Staph. Scalded Syndrome?

A

Staph. Aureus

Particular strain producing exfoliative toxins A or B

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98
Q

Clinical features of Staph Scalded Syndrome

A 
Widespread bullae 
Skin exfoliation 
Tissue paper wrinkling of skin 
Red blistering of skin
Irritability
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99
Q

Ix Staph. Scalded Syndrome

A 
Hx and O/E
Tzanck smear
Skin biopsy 
Bacterial culture:
Skin 
Blood 
Urine 
Umbilical cord
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100
Q

Rx Staph. Scalded Syndrome

A

IV fluids

IV Abx. (flucloxacillin

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101
Q

What is the most common cause of gastroenteritis in the UK

A

Camplyobacter

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102
Q

What is the most common cause of hospitalised gastroenteritis in the UK

A

Salmonella

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103
Q

Define actue diarrhoea:

A

> 3 episodes of watery/partially formed stools/day for <14 days

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104
Q

Define dysentery

A

Infectious diarrhoea + bloody diarrhoea

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105
Q

Define persistent diarrhoea

A

Acute beginning then persisting >14 days

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106
Q

Define travellers diarrhoea

A

Starting during or shortly after foreign travel

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107
Q

Define food poisoning

A

Disease caused by consumption of food/water

Notifiable in UK

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108
Q

If diarrhoea lasts >2 weeks is it likely to be gastroenteritis

A

no

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109
Q

Ix for gastroenteritis

A

Stool culture (except C.difficile)

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110
Q

What is the general Rx for gastroenteritis

A

Often supportive
REHYDRATION!!
Abx. not indicated for in healthy patients

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111
Q

Are abx indicated for in healthy patients with gastroenteritis?

A

No

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112
Q

Differential Dx for gastroenteritis when diarrhoea persists >2/52

A

IBD (CD, UC)
Spurious diarrhoea
Carcinoma

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113
Q

When would you be indicated to give abx. in gastroenteritis?

A

Immunocompromised patients
Severe sepsis from invasive infection
Valvular heart disease
DM

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114
Q

What is the name of the stool chart used to classify stools?

A

Bristol Stool Chart

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115
Q

What is the commonest bacterial cause of diarrhoea in the UK

A

Campylobacter gastro-enteritis

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116
Q

What is the common organism in campylobacter gastroenteritis?

A

Campylobacter jejuni

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117
Q

Sources of campylobacter

A

Chicken
Contaminated milk
Puppies

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118
Q

Clinical features of campylobacter gastroenteritis

A 
Fever
Headache 
Nausea 
Vomiting 
Diarrhoea 
Abdo. pain
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119
Q

Ix camplyobacter

A

Stool culture

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120
Q

Rx for campylobacter

A

Supportive
Oral rehydration
IV saline

Abx. not indicated in healthy patient

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121
Q

Post -infection sequelae in Campylobacter

A

Guillian-Barre Syndrome

Reactive arthritis

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122
Q

What is the most common cause of hospitalised diarrhoea in UK

A

Salmonella

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123
Q

Describe salmonella bacteria

A

Gram -ve
Anaerobic bacilli
Motile with flagella

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124
Q

Clinical features of salmonella

A 
Fever
Headache 
Nausea 
Vomiting 
Diarrhoea 
Abdo. pain
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125
Q

Ix for salmonella

A

Stool culture
FBC
Blood culture

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126
Q

Rx for salmonella

A

Supportive
Rehydration (oral if possible)
Abx. not indicated in health patient

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127
Q

Is there a link with Guillian Barre and salmonella?

A

No there has been no link identified

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128
Q

Complications of invasive salmonella infection

A 
Meningitis 
Osteomyelitis 
Septic arthritis 
Sepsis 
Bacteraemia
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129
Q

What is common post infection in salmonella gastroenteritis

A

Post infectious irritable bowel

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130
Q

What % of patients still have +ve stools 20/52 later after salmonella gastroenteritis

A

20%

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131
Q

How is infection with E.coli O157 commonly acquired

A

Contaminated meat or

Person to Person

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132
Q

In E.coli O157 which part of the bacteria usually enters the blood?

A

E.coli stays in the gut but the toxin enters the blood

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133
Q

Clinical features of E.coli O157

A 
Diarrhoea 
Abdo. pain 
Fever 
Nausea 
Vomiting 
Bloody stools
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134
Q

Ix of E.coli O157

A

Stool culture
Blood culture
Renal function
FBC

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135
Q

Rx of E.coli O157

A

Supportive - do not give Abx.

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136
Q

Why should you not give Abx. in E.coli O157?

A

It increases the risk of HUS

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137
Q

What does HUS stand for?

A

Haemoltyic Uraemic Syndrome

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138
Q

What 3 things are characteristic of HUS

A

Haemolytic Anaemia
Renal failure
Thrombocytopenia

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139
Q

What is the mainstay Rx for HUS

A

Supportive!!
Do not gie abx.

Sometimes supportive dialysis is required

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140
Q

What is the commonest cause of traveller’s diarrhoea

A

Enterotoxigenic E.coli

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141
Q

Describe the pathophysiology of enterotoxigenic E.coli

A

Produce heat labile enterotoxins which stimulate the inflow of Cl- and Na+ into the gut lumen
Dragging water with it

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142
Q

Ix of enterotoxigenic E.coli

A

Stool culture

Toxin from stool

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143
Q

Clinical features of enterotoxigenic E.coli

A 
Abdo. pain 
Nausea
Vomiting 
Headache 
Diarrhoea
Fever
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144
Q

Rx for enterotoxigenic E.coli

A

Supportive
Rehydration
Abx. usually not indicated

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145
Q

What is C.diff Diarrhoea heavily associated with?

A

Broad spectrum bx. use

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146
Q

Which toxins does C.Difficile produce

A

Enterotoxin A

Cytotoxin B

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147
Q

How is C.difficile Dx

A

Not by culture

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148
Q

Rx for mild C.difficile

A

Stop any current abx. courses
Oral Metronidazole
Rehydration

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149
Q

Rx for severe C.Difficile

A

Stop any current Abx. courses

Oral vancomycin

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150
Q

Rx for Rx resistant C.Difficile

A

High dose oral vancomycin + IV Metronidazole
Stool Tx
Surgery in worst cae

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151
Q

Prevention of C.Difficile

A

Hand hygiene
Isolate patients
Cleaning of hospital surfaces
Reduce in broad spectrum abx use

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152
Q

What are the 4 broad spectrum abx. associated with C.Difficile infection

A 
Avoid 4Cs
Cephalosporins 
Co-amoxiclav 
Clarithromycin 
Clindamycni
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153
Q

Complications of C.Difficle

A 
Pseudomembranous colitis 
Toxic megacolon 
Perforation of the colon 
Sepsis 
Death
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154
Q

What is the commonest cause of viral gastroenteritis outbreak on a cruise ship

A

Norovirus

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155
Q

Risk factors for C.Difficile infection

A 
Abx therapy
Have been in a long term healthcare setting 
Age >65
Immunocompromised 
On PPI 
Underlying conditions e.g
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156
Q

Name 3 parasites which can cause gastroenteritis

A

Giardia Lamblia
Cryptosporidium
Amoebiasis

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157
Q

Is the norovirus infectious?

A

Yes

Highly infectious

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158
Q

Prevention of norovirus

A

Hand Hygiene
Isolation of patients
Supportive

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159
Q

Why are abx. not indicated for norovirus

A

As it is a viral cause not bacterial

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160
Q

What is the transmission route of HAV

A

Faecal-oral

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161
Q

Where is HAV prevalence high

A

Areas with poor sanitation

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162
Q

Is HAV more often chronic or acute

A

Almost always acute

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163
Q

What does high IgM indicate about HAV infection

A

Active infection

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164
Q

What does high IgG indicate about HAV infection

A

Chronic infection

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165
Q

What type of vaccine is the HAV vaccine

A

Inactivated vaccine

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166
Q

Why is HAV prevalence decreasing

A

Due to improved sanitation

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167
Q

Clinical features of HAV infection

A

High liver enzymes
Fever
Anorexia
Nausea

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168
Q

Is there a vaccination for HCV?

A

No

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169
Q

What is the transmission route for HCV?

A

Blood-blood transmission
Blood transfusion
IV drug abuse
Sexually transmitted

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170
Q

Risk factors for progression of HCV to Cirrhosis

A

M
Increased age
Already has HIV or HBV

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171
Q

What % of infected HCV patient go onto develop chronic infection

A

85%

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172
Q

What % of chronic HCV patients go onto develop cirrhosis

A

20%

1/5

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173
Q

Ix for HCV

A

HCV RNA

Anti-HCV antibodies

LFTs

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174
Q

Rx for HV

A

Pegylated interferon
Ribavirin
Alcohol cessation
Liver Tx

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175
Q

What is the main difference between HBV and HCV infection

A

HCV majority (85%) will go onto develop chronic infection

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176
Q

Why type of virus is HDV

A

Incomplete RNA virus

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177
Q

Which virus is HDV a parasite of?

A

HBV

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178
Q

Which virus does HDV require for infection to occur

A

HBV

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179
Q

What is co-infection with HDV

A

When infection of HBV and HDV occur simultaneously

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180
Q

What is super-infection with HDV?

A

When HDV infects someone who already has chronic HBV

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181
Q

Ix for HDV?

A

Antibody and blood tests

Anti-HDV antibody

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182
Q

Would you test HDV is HBVsAG was negative

A

No

Only ask for HDV testing if HBVsAg is +ve

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183
Q

Rx for HDV

A

HDV +HBV is notoriously difficult to treat

Liver Tx may be required

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184
Q

What is the transmission route for HEV?

A

Faecal oral route

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185
Q

Who is HEV infection very dangerous for?

A

Pregnant women

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186
Q

Is there a vaccination for HEV in the UK?

A

No

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187
Q

Who should be immunised against HAV?

A 
Travellers 
Chronic liver disease patients 
Haemophiliacs 
Lab workers 
Men who have sex with men
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188
Q

Is HCV symptomatic?

A

It is fairly asymptomatic until potential end stage liver disease/cirrhosis has occurred

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189
Q

What is the transmission of influenza?

A

Airborne

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190
Q

Who is influenza potentially complicating in?

A 
Elderly 
Young children 
Pregnant women 
Those with chronic neurological conditions
DM
Severely immunocompromised 
BMI>40
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191
Q

Compare population affected in Seasonal to pandemic flu

A

Seasonal flu - 10-15%

Pandemic flu 25% +

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192
Q

When does seasonal flu typically occur

A

Winter
Dec-Feb in Northern Hemishpere
Jun-Aug in Southern Hemisphere

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193
Q

When does Pandemic flu usually occur?

A

No specific time

Occurs sporadically

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194
Q

What are the 3 types of influenza virus?

A

A B C

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195
Q

What are the two surface proteins of the influenza virus

A

H (haemaglutinin)

N (neuroaminidase)

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196
Q

What do H surface proteins do in influenza virus?

A

Facilitates viral attachment and entry to the host cell

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197
Q

How many different types of H surface proteins are there for the influenza virus?

A

18

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198
Q

What do N surface proteins do in influenza?

A

Enables new viron to be release from host cell

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199
Q

How many different types of N surface proteins are there?

A

11 different N proteins

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200
Q

What is antigenic drift?

A

Small ongoing mutations in genetic coding for antibody binding sites

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201
Q

What is antigenic drift?

A

Abrupt major changes in virus resulting in new H/N combinations

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202
Q

Clinical features of influenza

A 
Abrupt feverDry cough 
Sore throat
Rhinorrhoea 
Myalagia 
Headache 
Malaise 
Conjunctivitis
Eye pain +/- photophobia
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203
Q

Ix for influenza

A

Often clinical Dx

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204
Q

Rx for uncomplicated and previously healthy patient with influenza

A

No Rx
Paracetamol

Give Oseltamivir if concerned they will develop severe complications

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205
Q

Rx for uncomplicated influenza in an at risk patient

A

Oseltamavir

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206
Q

Rx for complicated influenza in a patient who is NOT immunocompromised

A

Oseltamavir

Zanamivir

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207
Q

What is the Rx of influenza in a pregnant patient

A

Oseltamivir remains 1st line

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208
Q

Who is the annual influenza vaccine CI in ?

A

Those with egg allergy

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209
Q

Who is the influenza annual vaccination recommended in?

A

High risk groups (elderly, young, immunocompromised, DM, chronic conditions)
Healthcare workers

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210
Q

How is the influenza vaccination given/

A

Given each year using predicted virus for that year

Single 0.5IM injection

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211
Q

What is a potential side effect of the influenza vaccination

A

Sore arm

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212
Q

Common name for influenza

A

Flu

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213
Q

What are common complications of influenza

A

Acute bronchitis

Secondary bacterial pneumonia

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214
Q

Less common complications of infleuza

A 
Primary viral pneumonia 
Myocarditis 
Pericarditis 
Guillian Barre
Transverse myelitis
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215
Q

To which family does the influenza virus belong to

A

Orthromyxoviridae

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216
Q

What are the 3 requirements for pandemic flu?

A

Human pathogenicity
New virus (antigenic shift) - vulnerable population
Efficient person to person transmission

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217
Q

What is the Rx for influenza when breastfeeding

A

Oral Oseltamavir

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218
Q

How can healthcare professionals protect themselves from the flu?

A 
Hand hygiene 
Protective equipment (face mask, apron gloves)
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219
Q

Why should healthcare workers receive the influenza vaccine?

A

to protect themselves and their patients
reduce the risk to at risk patients
reduce absence from work during influenza surge

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220
Q

How does HIV infect a patient

A

RNA Retrovirus

Encodes reverse transcriptase allowing DNA copies to be produced from viral RNA

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221
Q

What is the most common type of HIV

A

HIV 1 Group M

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222
Q

Describe the pathophysiology of HIV infectin

A

HIV infects and destroys cells of the immune system
Binds to CD4 receptors on T helper cells, monocytes and macrophages
These ‘CD4 cells’ migrate to lymphoid tissue where the virus replicates
Infecting loads of new CD4 cells
As disease progresses depletion and impaired function of CD4+ cells
CD4+ cells decreases
Viral Load increases
immune function decreases

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223
Q

What happens to CD4+ cell count in HIV

A

It decreases

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224
Q

What happens to immune function in HIV

A

It decreases

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225
Q

How is HIV transmitted

A

Sexual
Injection drug misuse
Blood products
Vertical transmission

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226
Q

What is the Dx window in HIV

A

Length varies between individuals

But generally considered to be 1 month

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227
Q

Do you need permission to give a patient HIV testing?

A

Yes

Test unconscious patient if it is believed to be in their best interests

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228
Q

Ix to Dx HIV

A

ELISA for HIV antigen/antibody testing

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229
Q

What are the 2 types of HIV

A

HIV 1

HIV 2

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230
Q

What are symptoms of seroconversion in HIV

A 
Flu like 
Fever
Malaise 
Lethargy 
Pharyngitis 
Mucosal ulceration 
Headache 
Rash
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231
Q

Define persistent lymphadenopathy

A

Swollen/enlarged LN >1cm in 2 or more non-contigous sites

Persisting >3 months

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232
Q

Which Ix should you use to manage HIV

A

Viral load
Viral resistance testing CD4 count
Tropism levels
Drug levels

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233
Q

When should you consider commencing ART in HIV

A

Consider commencing at Dx regardless of CD4 count

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234
Q

When is ART Rx more encouraged in HIV patients

A

When CD4 count is <350

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235
Q

At which CD4 level should you commence ART ASAP

A

CD4 <200

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236
Q

How many ART drugs should be used in combination to treat HIV?

A

3 drug combination

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237
Q

How long does a patient with HIV need Rx

A

Lifelong

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238
Q

Name ways in which HIV can be prevented

A

Correct use of condoms/barrier contraception
Behaviour change
Circumcision

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239
Q

What is the post exposure prophylaxis steps for HIV

A

Short term use of ART after potential exposure
Can be given up to 72hr
Preferably <24hr
1st line: Tenovir
Test for HIV infection 8-12 weeks after exposure

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240
Q

Who could be given pre-exosure prophylaxis for HIV infection

A

Serodifferent relationships

Condomless anal sex in MSM

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241
Q

When should Rx be commenced in pregnant ladies with HIV

A

Start Rx <3rd trimester (by 24 weeks)

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242
Q

How should mothers with HIV deliver their babies?

A

C-section indicated if viral load>50

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243
Q

Which body fluids need to be handled with care for risk of HIV?

A 
CSF 
Pleural fluid 
Peritoneal fluid 
Pericardial fluid 
Vaginal fluids 
Breast milk
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244
Q

What should immediate actions after exposure with HIV be?

A

Wash (soap and running water)
Encourage bleeding
Wash out splashes in eyes, nose or mouth

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245
Q

Name some aims of ART in HIV

A

Reduce HIV loads to undetectable by standard laboratory techniques
Reduce clinical progression
Reduce mortality

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246
Q

Name the classes of HIV drugs

A 
Nucleoside (NRTIs)
Non-nucleoside (NNRTIs)
Proteas inhibitors 
Integrase inhibitors 
CCR5 antagonists
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247
Q

What is the action of nucleoside drugs

A

Reverse transcriptase inhibitors
Inhibit conversion of HIV RNA to HIV DNA
Competitively inhibit reverse transcriptase

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248
Q

Side effects of nucleoside drugs

A

Marrow toxicity
Neuropathy
Lipodystrophy

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249
Q

Action of non-nucleoside drugs

A

Reverse transcriptase inhibitors
Inhibit conversion of HIV RNA to HIV DNA
Work by directly binding to reverse transcriptase
Non-competitie inhibition

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250
Q

Side effects of non-nucleoside drugs

A

Skin rashes
Hypersensitivity
Drug interactions

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251
Q

Action of protease inhibitors

A

Inhibits protease

Protease = enzyme involved in maturation of virus particles

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252
Q

Side effects of proteas inhibitors

A

Drug interactions
Diarrhoea
Lipodystrophy
Hyperlipidaemi

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253
Q

Action of integrase inhibitors

A

Inhibit integrase and prevent HIV DNA integrating into the nucleus

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254
Q

Action of CCR5 antagonists

A

Inhibit entry of virus into the cell

Block CCR5 receptor

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255
Q

Give 2 examples of nucleoside drugs

A

Abacavir

Lamivudine

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256
Q

Give 2 examples of non-nucleoside drugs

A

Delaviridine

Efavirenz

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257
Q

Give 2 examples of Protease Inhibitors

A

Raltegravir

Elvitegravir

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258
Q

Give an example of a CCR5 antagonist

A

Maraviroc

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259
Q

Why is malaria so important

A

Because it is a serious global health problem

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260
Q

How is malaria transmitted?

A

Mosquito bite most common

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261
Q

What is the vector in malaria

A

Female anopheles mosquito

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262
Q

What type of organism is malaria

A

Parasitee

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263
Q

What are the 5 species of malaria

A 
Plasmodium Falciparum 
Plasmodium Vivas 
Plasmodium Ovale 
Plasmodium Malariae
Plasmodium Knowlesi
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264
Q

Which is the most severe species of malaria

A

Plasmodium Falciparum

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265
Q

Which 2 species of malaria commonly lie dormant in the liver

A

Vivax

Ovale

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266
Q

Which species of malaria is very rare

A

Plasmodium Knowlesi

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267
Q

Which features would Dx complicated malaria

A 
1 or more of 
Impaired consciousness /seizures
Hypoglycaemia (<2.2 mmol/l)
Parasite count >2% 
Haemoglobin <8mg/Dl
Spontaneous bleeding 
Haemoglobinuria
Renal impairment or pH <7.3 (acidosis)
Pulmonary oedema or ARDS 
Shock
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268
Q

Symptoms of malaria

A 
Fever 
Rigors 
Night sweats 
Myalgia Arching bones 
Abdo. pain 
Headache 
Dysuria 
Frequency 
Sore throat 
Cough 
Diarrhoea 
Nausea 
Vomiting
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269
Q

Signs of malaria

A

None
Splenomegaly
Hepatomegaly
Jaundice

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270
Q

Ix for malaria

A

Immediate blood testing mandatory in the UK
Thick and thin blood films
Quantity buffy coat
Rapid antigen tests

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271
Q

Rx for uncomplicated P.Falciparum

A

Riamet ® (artemether-lumefantrine) 3 days

Eurartesim ® (dihydroartemisinin-piperaquine 3 days 


Malarone ® (atovaquone-proguanil) 3 days


Quinine 7 days

plus oral doxycycline (or clindamycin)


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272
Q

For which species of malaria is chloroquine not used as Rx

A

Falciparum

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273
Q

Rx for complicated/severe P.Falciparum

A

IV Artesunate

IV Quinine + oral doxycycline

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274
Q

Rx for P.Vivax/Ovale/Malariae/Knowlesi

A

Chloroquine 3 days

Riamet 3 days

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275
Q

Additional Rx for P.Vivax and P.Ovale to eradicate hypnozoites from liver

A

Primaquine

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276
Q

Who is malaria notificale to?

A

Public health

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277
Q

To which species of malaria is Sickle Cell anaemia protective against?

A

P.Vivax

278
Q

Give examples of prevention of malaria by mosquito control programmes?

A 
Drainage of standing water
Bed nets 
Mesh windows 
Sterile Male
Mosquito Release
279
Q

Which malaria treatment is CI in pregnancy and which abx should be given as an alternative

A

Oral doxycycline CI

so give Clindamycin instead

280
Q

Where does maturation of malaria parasites occur in the body?

A

Liver

281
Q

Which species of malaria go dormant in the liver?

A

P. Vivax and P.Ovales

282
Q

Once matured in the liver where do merozoites enter?

A

RBC

283
Q

Which process produces clinical manifestations of malaria

A

Rupture of erythrocytic schizonts

284
Q

Which virus causes Zika Fever?

A

Zika virus

285
Q

Transmission routes for zika virus

A

Daytime biting aedes mosquitos
Sexual contact
Blood transfusion
Vertical (mother to baby)

286
Q

Rx for zika virus

A

No antiviral therapy

Prevention is key

287
Q

Who is the zika virus particularly bad in?

A

Pregnant women

288
Q

What can the zika virus cause in pregnancy?

A

Fetal microcephaly

Other neurological problems

289
Q

Prevention of zika virus?

A

Mosquito control measures
Avoid non-essential travel in pregnancy
Condoms

290
Q

Complications of Zika Virus

A

Strong association with Guillian Barre

291
Q

Ix for Zika virus

A

Zika virus RNA in :
Blood
Urine
Saliva

292
Q

Incubation perdio for rabies

A

2 weeks to several years

293
Q

Where does the Rabies virus travel from and to

A

Travels from the peripheral nervous system to the central nervous system

294
Q

Transmission of Rabies

A

Bite from infected animal

Saliva

295
Q

Main transmitters of rabies virus

A

Dogs (97%)
Bats
Mokeys

296
Q

When was the last UK death from Rabies?

A

2012

297
Q

Is rabies a viral or bacterial infection?

A

Viral

298
Q

Once symptomatic what is the prognosis for rabies?

A

Death virtually inevitable

299
Q

Post exposure prophylaxis of rabies

A

Wound cleaned
Human Rabies Immunoglobulin
4 doses Rabies vaccination

300
Q

Ix for rabies

A

PCR saliva
PCR CSF
Often confirmed by post mortem bran biopsy

301
Q

Prophylaxis for rabies

A

Human diploid strain vaccine

302
Q

Clinical features of rabies

A 
Malaise 
Headache 
Agitation 
Paraesthesia (at wound site)
Fever
Mania 
Lethargy 
Coma
Overproduction of saliva and tears
Inability to swallow 
Hydrophobia 
Death by resp. failure 
Convulsions
303
Q

Name some potential complications of malaria

A 
Cerebral malaria (encephalopathy)
Blackwater fever
Pulmonary Oedema 
Jaundice 
Severe anaemia 
Algid Malaria
304
Q

What is meningitis?

A

Inflammation of the meninges usually as a result of infection

305
Q

Common bacteria causes of meningitis in adults

A

Neisseria Meningitidis (Meningococcal)

Strep. Pneumoniae
(Pneumococcal)

Haemophilus Influenzae

306
Q

Common bacterial causes of meningitis in neonates

A

E.coli

Group B streptococci

307
Q

What does meningism refer to?

A

A symptomatic complex

308
Q

Name the symptoms included in meningism

A

Headache
Photophobia
Neck Stiffness
Vomiting

309
Q

Does meningism only occur in meningitis?

A

No meningism can occur in the absence of meningitis

I.e there can be many other causes of meningism

310
Q

Clinical featues of meningitis

A 
Neck stiffness 
Photophobia 
Vomiting 
Headache 
Fever
Cold hands and feet
Non-blanching petechial rash
311
Q

What is the hallmark of meningococcal meningitis

A

Non-blanching petecial rash

312
Q

Which test can be done to determine if a rash is non blanching

A

Tumbler test

313
Q

Ix for meningitis

A

Blood cultures

LP (CSF culture)

314
Q

When is LP CI

A

In suspected raised ICP or space occupying lesion

315
Q

If suspected raised ICP which Ix would need to be done first to rule this out before LP

A

CT

316
Q

Rx for meningitis

A

IV high dose Ceftriaxone preferably before hospital admission

317
Q

When should blood cultures be done in meningitis

A

Preferably before abx. have been given

318
Q

Who does meningococcal meningitis typically affect?

A

Children and young adults

319
Q

Which organism causes meningococcal meningitis

A

Neisseria Meningitis

320
Q

Which abx should be given to close contacts of meningococcal meningitis as prophylaxis?

A

Rifampicin or ciprofloxacin

321
Q

What is the hallmark of meningococcal meningitis

A

Non-blanching petechial rash

322
Q

Who should all cases of meningococcal meningitis be notified to?

A

Consultant in public health

323
Q

Why have cases of meningococcal group C decreases

A

Due to introduction of MEN C vaccine

324
Q

What is Waterhouse Freidrichsen Syndrome:

A

Adrenal gland failure due to bleeding into the adrenal glands

325
Q

What % of patients die within 24hrs of fulminant meningococcal septicaemia

A

50%

326
Q

What does autopsy reveal in Waterhouse Friedrichsen syndrome

A

Bilateral adrenal haemorrhages with adrenal ablation/hypoadrenalism

327
Q

What sign is characteristic of Waterhouse Friedrichsen Syndrome/Fulminant infection

A

Purpurice rash

328
Q

Describe CSF in fulminant meningococcal septicaemia

A

CSF is terile with little or no increase in WCC

329
Q

What is the commonest cause of bacterial meningitis in adults

A

Pneumococcal

330
Q

Which 2 vaccines prevent against Pneumococcal meningitis

A

Pneumovax

Prevenar

331
Q

Who is given the Pneumovax vaccine

A

Recommended in those >65yr Scotland

332
Q

Who is given the Prevenar vaccination

A

Now part of childhood immunisation programme

333
Q

Predisposing factors to pneumococcal meningitis

A 
Pneumonia 
Sinusitis 
Endocarditis 
Head trauma 
Alcoholism
Splenectomy
334
Q

What should you look for in pneumococcal meningitis

A

Concurrent sinus or ear infection

335
Q

Is petechiae common or uncommon in pneumococcal meningitis?

A

Uncommon

336
Q

Rx for pneumococcal meningitis

A

High dose IV Ceftriaxone

Before blood cultures ideally

337
Q

Chronic complications of pneumococcal meningitis

A 
Loss of hearing 
CN deficits 
Hemiparesis 
Hydrocephalus 
Seizures
338
Q

Which type of haemophilia influenza is meningitis normally associated with

A

Type b

339
Q

Rx for haemophilus meningitis

A

Ceftriaxone high dose IV

340
Q

Symptoms of haemophilus meningitis

A 
Fever
Nausea
Photophobia 
Headache 
Neck stiffness

Clinical picture often:
Mid URTI followed by rapid deterioration

341
Q

What is tuberculosis meningitis

A

Mycobacterium tuberculosis infection of the meninges

342
Q

Is TB meningitis common or uncommon in the UK

A

Uncommon

343
Q

Where does TB meningitis remain a problem

A

In the developing world

344
Q

When is Tb meningitis considered

A

In someone with meningism
Low grade fever
And Extra-meningeal TB known

345
Q

Ix for TB meningitis

A

LP (CSF analysis)
ZN stai n
CXR thorax (chest TB)

346
Q

Why might a CT head be useful in TB meningitis

A

Potential presence of meningioma

347
Q

Poor prognostic factors for TB meningitis

A

Extremes of age
Ie very old and very young
Presence of neurological deficits
Resistant organisms

348
Q

Organisms causing lyme disease

A

Borrelia Burgdoferi

349
Q

How is lyme disease predominantly spread

A

By ticks

350
Q

Organism causing leptospirosis

A

Leptospira Interrogans

351
Q

How is leptospirosis transmitted

A

in animal urine

352
Q

What is the most common initial sign of lyme disease

A

Erythema migrans rash

353
Q

Most common UK causes of viral meningitis

A 
Echo virus
Coxsackie virus 
Enteroviruses ]HSV 
HZV 
EBV
354
Q

Ix for suspected viral meningitis

A

PCR of CSF

355
Q

CSF findings in viral meningitis

A

Normal glucose

increased lymphocytes

356
Q

Treatment for HSV meningitis

A

IV acyclovir

357
Q

Why has mumps meningitis incidence decreased

A

Due to MMR vaccine

358
Q

Who is at the most risk of viral meningitis

A

Young

Immunocompromised

359
Q

What is the main outcome of viral meningitis

A

Majority will recover within 72hrs

360
Q

Can abx treat viral meningitis

A

No because it is not a bacterial infection

361
Q

Symptoms of viral meningitis

A 
Low grade fever
Headache 
Photophobia 
Neck stiffness 
Lethargy 
Nausea/Vomiting
362
Q

Prevention of viral meningitis

A

Good hand

Encourage MMR vaccination

363
Q

Prognosis for viral meningitis

A

Majority make complete recovery with no long term sequelae

364
Q

What is the most important cause of meningitis in HIV patient

A

Cryptococcus Neoformans

365
Q

Ix for fungal meningitis

A

LP

CSF analysis

366
Q

Where is cryptococcus neoformans organisms found

A

Bird droppings

367
Q

Rx for fungal meningitis

A

Parenteral Amphotercin

High dose Fluconazole

368
Q

In what 2 ways does neonatal meningitis differ from adult meningitis

A

Symptoms and signs are usually non-specific or not well localised
Bacteria involved are commonly different to that of adult meningitis

369
Q

Common organisms neonatal meningitis

A

Group B streptococci
E.coli
L. Monocytogenes

370
Q

Risk factors for neonatal meningitis

A

Preterm (<37 weeks)
Prolonged interval between membrane rupture and delivery
Previous infant with group B streptococcal disease

371
Q

2 types of neonatal meningitis

A

Early onset

Late onset

372
Q

Describe early onset neonatal meningitis

A

Within 3 days brith
Associated with premature or prolonged delivery
Marked resp. distress, bacteraemia
Increased mortality (50%)
Organism has usually been acquired at birth from female genital tract

373
Q

Describe late onset neonatal meningitis

A

> 1 week after birth
Infection gained from outside world
Pulmonary involvement is rare
Mortality less 10-20%

374
Q

How is bacterial neonatal meningitis Dx

A

Neonatal CSF cultures

Neonatal blood cultures

375
Q

Viral Dx of neonatal meningitis

A

CSF PCR

EDTA blood, faeces, and nasopharyngeal secretions

376
Q

Rx for neonatal meningitis

A

For bacterial:
IV ampicillin + gentamicin/ceftriaxone

for viral:
IV immunoglobulin may be helpful

377
Q

Why is E.coli and L. Monocytogenes a common cause for neonatal meningitis

A

Because they are commensals of the female genital tract

378
Q

Prevention of neonatal meningitis for high risk mothers

A

Chemoprophylaxis during delivery
Amoxicillin
Co-amoxiclav

379
Q

What is the most common fungal infection

A

Candidiasis

380
Q

What is the most common candidiasis organism

A

Candida Albicans

381
Q

Risk factors for candidiasis infection

A 
Very young 
elderly 
Immunosuppressed/steroid 
Abx therapy 
Inhalation steroids (asthmatics)
382
Q

where is candidiasis infection typically seen

A

Moist areas
Oral
Vaginal

383
Q

Symptoms of vaginal candidiasis

A

Thick cottage cheese like discharge
Severe itching
Burning sensation

384
Q

Main symptom oesophageal candidiasis

A

Painful dysphagia

385
Q

Symptoms of oral thrush

A

White/yellow patches on tongue/ cheeks/roof mouth
Redness in mouth
Pain in mouth

386
Q

What is invasive candidiasis infection

A

When the candidiasis infection enters the blood

Can spread to bones, eyes, brain, heart

387
Q

Ix for invasive candidiasis infection

A

Blood cultures

CSF culture

388
Q

Rx for invasive candidiasis

A

Parental therapy with antifungals:
Amphotericin B
Fluconazole
Voriconazole

389
Q

Ix for superficial fungal infection

A

Fungal swabs

Scraping from infected lesions/tissue secretions

390
Q

What is pneumonia

A

Lower respiratory tract infection

391
Q

Define community acquired pneumonia

A

Infections in a person who has not recently been hospitalise

392
Q

Common organisms community acquired pneumonia

A

Strep. Pneumonia
Haemophilus influenza
Moraxella catarrhalis

393
Q

Define hospital acquired pneumonia

A

New infection >48hrs after hospital admission

394
Q

Common organisms hospital acquired pneumonia

A

Gram -ve enterobacteria
Staph Aureus
Klebsiella

395
Q

Define aspiration pneumonia

A

When inhalation of oropharyngeal contents into the lower airways leads to lung injury and subsequently bacterial infection

396
Q

Define immunocompromised pneumonia

A 
Occurs in immunocompromised patients
E.g HIV/AIDS 
Malignancy 
Organ Tx 
Long term steroid medications 
Often caused by opportunistic organisms
397
Q

What is an opportunistic organism?

A

An organism that infects someone who has a weak immune system
Would not normally cause disease in a healthy individual with normal immune system

398
Q

what does CURB 65 stand for

A 
Confusion 
Urea >7mmol 
RR >30 
BP  <60/<90 mmHg
Age 65

1 point for each

399
Q

What does the CURB score determine

A

30 days survival score

400
Q

When would you worry about a CURB score

A

When 3 or more

401
Q

Organisms causing pneumonia

A 
Strep Pneumonia 
Haemophilus influenza 
Legionella 
Staph. Aureus 
Mycoplasma Pneumonia
402
Q

Signs of pneumonia

A 
Dullness to percussion 
Inspiratory crepitations 
Increased vocal resonance Pyrexia 
Tachypnoea 
Central cyanosis 
bronchial breathing sounds
403
Q

Rx for CURB 0-1

A

Amoxicillin OR Clarithromycin

404
Q

Rx for CURB 2

A

Amoxicillin AND Clarithromycin

405
Q

Rx for CURB 3-5

A

Co-amoxiclav

And Clarithromycin

406
Q

In pneumonia Rx what should amoxicillin be replaced for in penicillin allergic patients

A

Levofloxacin

407
Q

Supportive Rx in Pneumonia

A 
Analgesia  
O2 
IV fluids 
CPAP 
Intubation and ventilation in worst case
408
Q

Complications Pneumonia

A 
Empyema 
Abscess 
AKI
Septicaemia 
ARDS 
Haemolytic anaemia
409
Q

DDX for pneumonia

A 
TB 
Lung cancer 
PE 
Cardiac failure 
Pulmonary vasculitis (Wegner Granulomatosis)
410
Q

Symptoms pneumonia

A 
Chest pain 
Cough 
Purulent sputum 
Dyspnoea 
Malaise 
Fever
411
Q

Rx for TB

A 
RIPE 
Rifampicin 
Isoniazid 
Pyrazinamide
Ethambutol

All for 2 months
Then R and I for further 2 months
Overall 6 months Rx

412
Q

What is TB

A

Granulomatous disease that can affect any organ

But typically the lungs

413
Q

Which organ does TB typically affect

A

Lungs

414
Q

Risk factors for TB

A 
HIV 
Overcrowding 
Malnutrition 
Smoking 
Alcoholism 
DM
415
Q

Most common organism of TB

A

Mycobacterium Tuberculosis

416
Q

How is TB transmitted

A

Via aerosal droplets

417
Q

What can TB in CNS cause

A

TB meningitis

Tuberculoma

418
Q

Describe natural history of TB

A

Infection
5-10% will get primary/early disease
>90% it will be contained and go straight to latent infection

Reactivation of latent TB <10%
Chronic latent infection >90%

419
Q

What happens to the majority of people infected with TB

A

Immune system fights off the infection
No active TB
Goes straight to latents TB

420
Q

What happens to <5% of those infected with TB?

A

There is active infection

Where you develop symptoms

421
Q

Symptoms of active Tb

A 
Cough 
Haemoptysis 
Weight loss 
Night sweats 
Fever
Fatigue 
Lymphadenopathy
422
Q

What can skin TB cause?

A

Lupus vulgarise

Erythema Nodusum

423
Q

What can liver TB cause

A

Hepatitis

424
Q

What can lumbar vertebrae Tb cause

A

Potts Disease

425
Q

Prevention vaccine for TB

A

BCG

426
Q

Ix TB

A 
Mantoux test 
IGRA (interferon gamma release assay)
ZN stain 
Sputum culture 
Trans-bronchiol biopsy 
Pleural fluid analysis and biopsy 
Radiological:
X-ray
LP 
CT
427
Q

How often is latent TB reactivated to secondary TB

A

up to 10%

428
Q

What is secondary TB

A

Reactivation of previous infection

429
Q

what can TB in kidneys cause

A

Sterile pyuria

430
Q

What can adrenal Tb cause

A

Addisons disease

431
Q

what can Tb in the female reproductive system cause

A

Infertility

Damage to fallopian tubes

432
Q

Do TB cases need to be notified

A

Yes

433
Q

What is a UTI

A

Infection of the urinary tract

434
Q

What is bacteriuria

A

Bacteria in the urine

This is not a disease

435
Q

What is pyelonephritis

A

Kidney infection

436
Q

What is Cystitis

A

Bladder infection

437
Q

What is prostatitis

A

Infection of the prostate

438
Q

Risk factors for UTI

A 
Female 
Sexually active 
Congenital 
Catheterisation 
DM 
Pregnancy 
Bladder instrumentation 
Kidney stones 
Immunosuppression
439
Q

Describe uncomplicated UTI

A

Normal renal tract structure and unction
Young sexually active females
Typically E.coli

440
Q

Describe complicated UTi

A

Structural/functional abnormality of the urinary tract is present
Children
Males

441
Q

In children what is a UTI likely to be cause by?

A 
Structural deformity 
E.g 
Horseshoe kidney 
Vesicoureteric reflux 
Duplex kidney
442
Q

Typical organisms of uncomplicated UTI

A

E.coli
Klebsiella
Proteus species

443
Q

Ix for UTI

A

MSSU

444
Q

What is the MSSU cut off for UTI infection

A

MSSU >10 to 5

445
Q

Symptoms of UTI

A 
Dysuria 
Frequency 
Haematuria 
Suprapubic opain 
Polyuria 
Urgency
446
Q

What should you rule out in young sexually active males with recurrent UTI?

A

Chlamydia

447
Q

What is the tolerance for UTI and pregnant women

A

Lower tolerance

>10 to 2

448
Q

Common complication of UTI

A

Pyelonephritis

449
Q

Rx for uncomplicated UTI

A

3d course Trimethoprim
or
Nitrofurantoin

450
Q

Rx for UTI in men

A

7d course

Trimethoprim or Nitrofurantoin

451
Q

Which UTI abx is CI in pregnancy

A

Trimethoprim

452
Q

Rx for child with UTI

A

Refer to paediatrician

453
Q

Why is UTI more common in pregnancy

A

Due to stasis of urine

454
Q

Rx for UTI in pregnancy

A

Nitrofuranotin

NOT trimethoprim as CI in pregnancy

455
Q

Why does UTI incidence increase unman with age

A

Due to BPH

456
Q

Ix fo UTI

A

Urine dipstick
Urine culture
potentially bloods

457
Q

Ix for complicated UTI

A

USS
CT
Cystoscopy

458
Q

What is UTI in pregnancy associated with

A

Increased risk of preterm labour

And intrauterine growth restriction

459
Q

When collecting urine for culture in catheterised patients where should the urine be collected from

A

Sampling port

NOT catheter bag

460
Q

What does rotavirus cause

A

Viral gastroenteritis

461
Q

Who is most commonly affected by rotavirus

A

Children

462
Q

Symptoms of rotavirus gastroenteritis

A

Watery diarrhoea
Vomiting
fever
Abdominal pain

463
Q

Rx for rotavirus gastroenteritis

A

Supportive Rx

Abx will not do anything

464
Q

What is the main prevention for rotavirus gastroenteritis

A

Routine oral vaccination UK

Babies 8-12 weeks

465
Q

Name parasites which can cause gastroenteritis

A

Giardia Lamblia
Cryptosporidium
Amoebiasis

466
Q

Rx for parasitic gastroenteritis

A

Metronidazole

467
Q

Organism in Q fever

A

Coxiella Burntii

468
Q

Sources of Q fever

A

Sheep
Goats
Cattle

469
Q

What is the most common for of chronic Q fever

A

Endocarditis

470
Q

Symptoms of Q fever

A 
Majority asymptomatic 
Symptomatic:
Flu like symptoms 
Fever 
Nausea 
Fatigue 
Headache
471
Q

Typhoid organism

A

Salmonella typhi

472
Q

Parathyphoid organism

A

Salmonella Paratyphi

473
Q

Transmission of typhoid fever

A

Faecal-oral route

474
Q

Causes of typhoid fever

A

Poor sanitation
Poor hygiene
Unclean drinking water
Contaminated food and water

475
Q

2 vaccines against typhoid

A

Oral Ty21a vaccine

Vi vaccine

476
Q

Who is Oral Ty21a (against typhoid) vaccine Ci in

A

Pregnancy

Immunosuppression

477
Q

Limitation of Vi vaccine (typhoid fever)

A

No protection against para-typhoid

478
Q

1st week symptoms of typhoid

A 
Fever 
Headaches 
Abo. discomfort 
Dry cough 
Bradycardia 
Neutrophilia 
Confusion
479
Q

2nd week symptoms of typhoid

A 
Fever peaks 
Rose spots 
Diarrhoea begins 
Tachycardia 
Neutropenia 
Hepatosplenomegaly
480
Q

3rd week clinical features of typhoid

A

intestinal bleeding
Perforation
Peritonism
Metastatic infections

481
Q

4th week clinical features of typhoid

A

Recovery
Characterised by gradual improvement
10-15% relapse

482
Q

Ix for typhoid

A

Blood cultures
Urine and stool cultures
Cultue bone marrow

Clinical Dx is not easy

483
Q

Rx of typhoid

A

Oral Azithromycin
Now drug of choice for Asian-acquired uncomplicated enteric fever

IV Ceftrixone
If complicated or concerned regarding absorption of drug orally

484
Q

Examples of viral haemorrhage fevers

A

Ebola
Congo-Crimea
Lassa Fever
Marburg Disease

485
Q

Hows is dengue fever transmitted

A

Aedes Aegypti Mosquito

486
Q

Clinical features of classical Dengue Fever

A 
Sudden fever
Severe headaches 
Sudden malaise 
Retro-orbital pain 
Severe myalgia 
Severe arthralgia
Macular/Maculopapular rash
487
Q

Signs of Dengue fever

A 
Thrombocytopenia 
Leukopenia 
Elevated transaminases 
Positive tourniquets test 
Sp
488
Q

Ix for Dengue fever

A

Viral PCR

489
Q

Complications of Dengue fever

A

Dengue haemorrhagic fever

Dengue shock syndrome

490
Q

Rx for Dengue fever

A

No specific therapeutic agents
Supportive
analgesia
Fluids

491
Q

Prevention of Dengue fever

A

Prevent bites:
Insect repellant
Mosquito nets

492
Q

Describe Dengue Haemorrhagic Fever

A 
Serious complication of dengue fever 
Characterised by:
Capillary leak syndrome 
Thrombocytopenia
Haemorrhage
493
Q

Describe Dengue Shock Syndrome

A 
Serious complication of dengue fever 
Abrupt onset hypotension 
Haemorrhage into skin 
Epistaxis 
Haematemesis 
Melaena
494
Q

Rx for Dengue haemorrhagic fever and shock syndrome

A

IV fluids
Fresh frozen plasma
Platelets

495
Q

What causes Schistosomiasis?

A

Parasitic flat worms (Trematode) Schistosomes

496
Q

How do humans become infected with Schistosomiasis

A

Through contact with contaminated fresh water containing the parasites

497
Q

Describe the lifecycle of Schistosomiasis

A
  1. Snails release infectious Schistosomes cercariae into fresh water
  2. Cercariae penetrate human skin
  3. Immature schistosomes migrate through the body
  4. can cause acute fever (Katayma fever)
  5. Schistosome maturation
  6. Adult worms mature and produce eggs
  7. Eggs released in fresh water
  8. infect snails
498
Q

Where do schistosomes mature in humans

A

In the liver

499
Q

How are schistosome eggs released from humans

A

Faeces

Urine

500
Q

Symptoms of cercarial (schistosomiasis) penetration through skin

A

Local dermatitis

Swimmers itch

501
Q

What is Katayma Fever?

A

Acute schistosomiasis

502
Q

Rx for Schistosomiaias

A

2 doses Praziquantel

Prednisolone if severe

503
Q

Katayma fever symptoms

A 
Fever 
Cough 
Bloody diarrhoea 
Malaise 
Headache 
Rash (urticaria)
Abdominal pain 
Splenomegaly
504
Q

Species of Schistosomiasis

A

S. haematobium
S. mansoni
S. japonicum

505
Q

Ix for Schistosomiasis

A

Ova in urine
Ova in Faeces
Bowel/bladder histology

506
Q

What is long term schistosomiasis infection of the bladder associated with?

A

Squamous cell carcinoma of the bladder

507
Q

Treatment for viral haemorrhagic fevers

A

High security infection unit

SUPPORTIVE!

508
Q

Where does S.Mansoni usually affect

A

Large bowel

Schistosomiasis

509
Q

Which species of Schistosomiasis is most likely to affect the urinary system

A

S.Haemotobium

510
Q

How do you contract Psittacosis

A

From infected birds

511
Q

Organism of Psittacosis

A

Chlamydia Psittaci

512
Q

How does Psittacosis typically present?

A

As atypical pneumonia with flu like symptoms

513
Q

Who should you consider Psittacosis in?

A

Rare
So Consider Hx of bird exposure
Pet bird ownership
Pigeon fancying

514
Q

Is psittacosis rare or common?

A

Rare

515
Q

What is Psittacosis commonly called?

A

Parrot fever

516
Q

Rx for Psittacosis

A

Doxycycline

Clarithromycin

517
Q

Organism of Toxoplasmosis

A

Toxoplasma Gondii

Parasite

518
Q

Host of Toxoplasmosis

A

Cat

519
Q

Which disease may trigger reactivation of toxoplasmosis

A

HIV

520
Q

What is congenital toxoplasmosis

A

Where the baby is infected through the placenta from an infected mother

521
Q

Symptoms of toxoplasmosis

A

Asymptomatic in 90%

Normal immune system:
Low grade fever
Swollen LN
Headaches

522
Q

What makes you most at risk during toxoplasmosis infection

A

Immunosuppressed

Pregnant

523
Q

What can toxoplasmosis cause in pregnancy

A 
Miscarriage 
Neurocognitive deficits in fetus:
Microcephaly 
Hydrocephalus 
Encephalitis 
Retinal damage
Choroidoretinitis
524
Q

Complications of toxoplasmosis in immunocompromised

A 
Cerebral abscess
Encephalitis 
Choriodoretinitis 
Myocarditis 
Myositis 
Pneumonitis 
Hepatitis
525
Q

Rx toxoplasmosis

A

Pyrimethamine + Sulfadizaine + Folinic Acid

526
Q

What is Dermatophytoses also known as

A

Ring worm

527
Q

What does Tinea Media cause

A

Athletes foot

528
Q

What does tine cruris cause

A

Jocks itch

529
Q

What is Oncychomycosis

A

Infection of the nail

530
Q

What does Tinea Capititis cause

A

Infection of the scalp and hair
Can cause alopecia
Scalp scaling

531
Q

What does Tinea Faciei cause

A

Fungal infection of the face

532
Q

What does Tinea Manuum cause

A

Infection of hands and palm area

533
Q

What type of infection is ringworm E.g Bacteria, viral or fungal?

A

Fungal infection

534
Q

Risk factors for dermatophytoses

A 
Public showers 
Contact sports 
Excessive sweating 
Contact with animals 
decreased immune function
535
Q

Ix for dermatophytoses

A

Clinical
O/E
Fungal swab in some cases

536
Q

Rx for dermatophytoses

A

Topical anti fungal agents:
Miconazole
Terbinafine

Oral in more severe cases

537
Q

What does dermatophytoses infect?

A

Skin and keratinised structures

538
Q

How is lyme disease contracted

A

Via a tick bite

539
Q

Lyme disease organism

A

Borrelia Burgodorferi

540
Q

Early localised lyme disease infection clinical features

A 
Erythema migrans (bulls eye rash)
Begins at site of tick bite 
Note: 1/3 do not have this rash
541
Q

Dx of lyme disease

A

Clinical features and epidemiological considerations are usually strongly suggestive

Sometimes erythema migrans
Antibodies to lyme disease (difficult to isolate organism)

542
Q

Rx of lyme disease

A

Oral amoxicillin
Or
Oral Doxycycline

543
Q

Rx for disseminated Lyme disease

A

IV Ceftriaxone

544
Q

Clinical feature of early disseminated lyme disease infection

A 
Widespread rash 
Headache 
Fever
Malaise 
Pain/pruritis 
Lymphadenopathy
Numbness 
Tingling 
Bells Palsy
Some: cardiac and neurological involvement
545
Q

Clinical features of late disseminated lyme disease

A 
Rare 
Chronic arthritis 
Encephalopmyelitis 
Acrodermatitis 
Chronic Atrophicans
Chronic neurological symptoms
Memory loss
Cardiac arrhythmias
546
Q

What is a borrelial lymphocytoma?

A 
Bluish solitary painless nodule
On
Earlobe or areola
Common in 
Children > Adults

Caused by lyme disease

547
Q

What is Allergic Bronchopulmonary Aspergillosis

A

Rare disease

Hypersensitivity type I & III reaction to Aspergillus Fumigatus

548
Q

What can Allergic Bronchopulmonary Aspergillosis complicate?

A

Asthma
CF
Patients with bronchieactsis

549
Q

Clinical features of allergic bronchopulmonary aspergillosis

A 
Episodes of:
Wheeze
SOB 
Cough 
Fever 
Malaise 
"recurrent pneumonia"
550
Q

Rx for acute attacks allergic bronchopulmonary aspergillosis

A

Prednisolone

551
Q

Rx for long term allergic bronchopulmonary aspergillosis

A

Itraconazole (anti fungal)

Oral, long term steroids

552
Q

What is an aspergilloma

A

Fungus ball within pre-existing cavity

Most commonly lung

553
Q

What is a pre-existing cavity in the lung aspergilloma usually caused by

A

TB infection
Sarcoidosis
CF
Bronchiectasis

554
Q

Rx for aspergilloma

A

Only symptomatic require Rx
Surgical excision for solitary symptomatic OR severe haemoptysis caused by aspergilloma

Voriconazole
Local instillation amphotericin paste under CT guidance

555
Q

Ix for aspergilloma

A

CXR

Sputum culture

556
Q

What is the most common symptoms associated with aspergilloma

A

Mainly asymptomatic

But most common associated symptom is haemoptysis

557
Q

What is infective endocarditis

A

Infection of the endocardium

Inner layer of the heart

558
Q

Risk factors for IE

A 
IV drug abuse 
Cardiac lesions 
Rheumatic heart disease
Dental treatment 
Prosthetic valves 
Immunosuppression 
DM
559
Q

What are the HACEK organisms

A

Group of fastidious gram -ve bacilli causing IE

560
Q

Common bacterial causes IE

A

Strep. Viridans
Staph. Aureus
Strep. Bovis
Enterococci

561
Q

What type of infection is brucellosis

A

Bacterial zoonoses

562
Q

3 species of Brucellosis

A

B. Melitensis
B.Suis
B.Abortus

563
Q

Which brucellosis species has the highest virulence in men

A

B.Melitensis

564
Q

Transmission methods of brucellosis

A

Unpasteurised milk
Undercooked eat
Unpasteurised dairy products

565
Q

Types of brucellosis infection

A

Subclinical (most common)
Acute
Subacute
Chronic

566
Q

How long does chronic brucellosis last

A

> 6 months

567
Q

Rx for Brucellosis

A

Long acting Doxycycline 2-3 months + Rifampicin or + IM Gentamycin for first weeks

568
Q

Which antibiotic should be added in CNS brucellosis disease

A

Co-trimoxazole

569
Q

What is subclinical Brucellosis

A

Brucellosis as asymptomatic

Most common form

570
Q

Symptoms of acute brucellosis

A 
1-3 weeks 
High undulant fever
Weakness 
Headaches 
Drenching sweats
Splenomegaly 
Malaise
571
Q

Which animal does brucellosis abortus come from

A

Cattle

572
Q

Which animal does brucellosis melitensis come from?

A

Goats and sheep

573
Q

Is brucellosis a rare or common disease in the UK

A

Rare

574
Q

Dx of brucellosis

A

Blood cultures

575
Q

What is the main risk food/drink for contracting brucellosis

A

Unpasteurised milk/dairy products

576
Q

Which animals carries leptospirosis

A

Rats
Cows
Pigs
Dogs

577
Q

Triad of Weil’s disease

A

Jaundice
AKI
Bleeding

578
Q

How is leptospirosis contracted?

A 
Extracted in animal urine 
Urine contaminated soil 
Food contaminated by infected urine 
Direct contact with the animal 
When the person has open wounds or a route for entry
579
Q

1st/acute phase symptoms of leptospirosis

A

Fever

Non-specific flu like symptoms

580
Q

2nd/immune phase symptoms of leptospirosis

A 
Myalgia 
Jaundice 
Meningitis
Uveitis
AKI 
ARDS 
Pulmonary haemorrhage
581
Q

Dx of Leptospirosis

A

Think of it:
Fever in cattle farmer
Exposure to water or rats

DX in UK via National Leptospirosis Service
PCR
Blood culture (takes 1 week on special media)

582
Q

Rx for leptospirosis

A

Doxycycline mild disease
Penicillin severe disease

Supportive:
Prompt dialysis
Mechanical ventilation

583
Q

Do steroids help leptospirosis

A

No

584
Q

2 main species of Cryptococcus

A

C.Neoformans

C.Gattii

585
Q

Who does cryptococcus disease usually affect?

A 
HIV patients (AIDS defining illness)
Sarcoid 
Hodgkins
Haematological malignancy 
Post Tx
586
Q

How is cryptococcus transmitted

A

Inhalaiton

587
Q

Ix of cryptococcus

A

CSF analysis:
Indian Ink Preparation

Blood culture
Blood crytpococcus antigen analysis

588
Q

Typical CSF findings in cryptococcus infection

A

High protein
Low glucose
Cryptococcus antigen

589
Q

Who does meningoencephalitis cryptococcosis infection usually affect

A

HIV/AIDS patients

590
Q

Symptoms of brain cryptococcus

A 
Confusion 
Headaches 
Altered behaviour Visual disturbances 
Nausea 
Vomiting 
Neck stiffness
591
Q

Rx for cryptococcus

A

Amphotericin + Flucytosine

Fluconazole

592
Q

Main method of HBV prevention

A

HBV vaccination

593
Q

Who is active HBV vaccination recommended for?

A 
Health care workers 
Travelling to endemic areas
Renal dialysis 
PWID 
Close contacts to those who have chronic HBV
594
Q

How is HBV diagnosed

A

Blood tests

595
Q

What do hepatitis surface antigens suggest

A

Presence of HBV virus
HBV infection present
Need to differentiate acute and chronic

596
Q

When does seroconversion occur in HBV

A

When patient recovers after infection
Or
When the patient responds to HBV vaccination

597
Q

High risk groups HBV

A 
Injection drug users
Multiple sexual partners
Immigration from areas of high endemnicitiy 
Haemodialysis 
Babies born to mothers at risk 
Healthcare workers
598
Q

Routes of transmission HBV

A

Sexual
Perinatal (mother to baby)
Needlestick injury
Blood borns - transmission

599
Q

What does Anti-HBs mean (HBV)

A

Protection against HBV virus

Either from vaccination or recovery from virus

600
Q

What does IgM Anti-HBC mean (HBV)

A

Acute HBV infection

601
Q

What does IgG Anti-HBC mean (HBV)

A

Chronic HBV infection

602
Q

What does Anti-HBe mean (HBV)

A

inactive virus

603
Q

What does HBV DNA mean

A

Viral replication

604
Q

What does HBV e antigen mean

A

Active replication

605
Q 
Example 1:
Interpret these bloods 
HBsAg negative 
Anti-HBc negative 
Anti HBs negative
A

No infection
Not immunised
Susceptible

606
Q

Interpret:
HBsAg negative
Anti HBc positive
Anti - HBs positive

A

Resolved HBV infection

Now immune

607
Q

Interpret:
HBsAg negative
Anti HBc negative
nti HBs positive

A

Vaccinated against HBV

608
Q

Interpret:
HBsAg positive
Anti-HBC positive
Anti- HBs

A

Active HBV infection

609
Q

How many HBV infected patients go on to develop acute infection:

A

5-10%

610
Q

Potential outcomes of chronic HBV infection

A

Asymptomatic chronic infection
Chronic persistent hepatitis
Chronic active hepatitis

611
Q

What can chronic active HBV lead to

A

Cirrhosis

Or primary liver cancer

612
Q

What can cirrhosis in chronic HBV lead to

A

Primary Liver Cancer
Require Liver Tx
Or lead to death

613
Q

Post vaccine Anti-HBs level >100

Interpret

A

Responder to vaccine
Not further antibody check
Booster in 5 years

614
Q

Post vaccine Anti-HBs level 10-<100

Interpret

A

Responder (but with poor response)
Booster now and in 5 years
No further antibody check required

615
Q

Post vaccine Anti-HBs level <10

Interpret

A

No response to vaccine
Repeat course of vaccine
Recheck antibody level 3 months after last dose

616
Q

What percentage of HBV acutely infected recover and do not progress to chronic infection

A

90-95%

617
Q

Who is considered for antiviral therapy in HBV

A 
Asymptomatic with increased ALT 
HBeAg +ve
Cirrhosis present 
Evidence of ongoing viral replication 
Sig. liver inflammation or fibrosis
618
Q

Rx for HBV

A

Long acting Pegylated Interferon
Nucleoside analogues
Liver Tx

619
Q

Who is Liver Tx for in HBV

A

Advanced cirrhosis patients

620
Q

Nucleoside analogue drugs used to treat HBV

A

Lamivudine
Adefovir
Dipivoxil
Entecavir

621
Q

Vague symptoms of acute HBV infection

A 
Fatigue 
Fever
Loss of appetite
Nausea
Diarrhoea 
Abdominal pain 
Jaundice
622
Q

Which 2 distinct diseases does the herpes zoster virus produce

A

Chicken pox

shingles

623
Q

What is chicken pox

A

Initial infection with Varicella virus

624
Q

What is shingles

A

Reactivation of latent varicella virus

625
Q

When does chicken pox usually occur

A

In childhood

626
Q

Transmission of chicken pox

A

Throat
Fresh skin lesions
Air borne transmission
Direct contact

627
Q

Where does the varicella virus lie dormant

A

In the dorsal route ganglion

628
Q

Symptoms of chicken pox

A 
Initial exposure to VZV 
Fever
Headache 
Malaise 
Rash
629
Q

Describe the rash in chicken pox

A

Rapid progression of macule to papule to vesicles to pustules in a matter of hours
Pruritis (itchy)
Eventually pustules and healing without scars

630
Q

Symptoms of shingles

A

Reactivation of VZV
Rash
Painful

631
Q

Describe the rash in shingles

A

Macular to vesicular rash
Dermatomal pattern
Unilateral
Painful

632
Q

A patient presents with a unilateral painful rash with has a dermatomal distribution what is the likely infection

A

Shingles

633
Q

Dx of chicken pox and shingles

A

Clinical

O/E

634
Q

Rx for shingles

A

Analgesia
Antivirals:
Aciclovir
Valaciclovir

635
Q

Rx for pregnant women with shingles

A

IV Aciclovir

636
Q

Rx for chicken pox

A

Usually self-limiting

637
Q

What is the most common complication of Q fever

A

Endocarditis

638
Q

What are the 3 types of polio virus

A

Polio 1,2,3

639
Q

Where does the poliovirus have a propensity for

A

Nervous system

Particularly anterior horn cells of LMN

640
Q

Transmission of polio

A

Faecal-oral

641
Q

Outcome of majority polio cases

A

Asymptomatic seroconversion

642
Q

Describe paralytic poliomyelitis

A

Meningeal irritation (headache, fever, neck stiffness, vomiting)
Asymmetric onset flaccid paralysis
No sensory involvement

643
Q

Prevention of polio

A

Vaccination

644
Q

How does polio differ from guillain barre

A

No sensory involvement

Asymmetric natura of paralysis

645
Q

Rx of polio

A

No cure only supportive measures
Best rest
respiratory support if muscles of wh are involved

646
Q

What type of virus is polio

A

Enterovirus

647
Q

Who does polio typically affect

A

Children

648
Q

In what % of polio does it cause paralytic disease

A

1%

649
Q

Which disease are tampon use associated with?

A

Toxic Shock Syndrome

650
Q

Common organisms of TSS

A

Strep. Pyogenes

Staph. Aureus

651
Q

What is produced by the organisms in TSS

A

Super antigens

652
Q

Diagnostic Criteria for TSS

A

Fever
Hypotension
Diffuse macular rash

Three of the following organs involved
Liver, blood, renal, gatrointestinal, CNS, muscular

Isolation of Staph aureus from mucosal or normally sterile sites

Production of TSST1 by isolate

Development of antibody to toxin during convalescence

653
Q

Rx TSS

A 
Remove offending agent (e.g tampon)
IV fluids 
Ionotropes 
Abx. 
IV immunoglobulins
654
Q

What type of infection is an IV catheter infection

A

Nosocomial

655
Q

What is meant by nosocomial infection

A

Acquired in hospital

656
Q

Risk factors for IV catheter infection

A

Continuous infusion >24hrs
Cannula in situ >72hrs
Cannula in LL
Patients with neurological/ neurosurgical problems

657
Q

Most common organisms IV catheter infections

A

Staph. Aureus
MSSA
MRSA

658
Q

Ix to Dx IV catheter infection

A

Clinically

or by +ve blood cultures

659
Q

Rx for of IV catheter infection

A

Remove cannula
Express any pus from thrombophlebitis
Abx. for 14 days

660
Q

Prevention of IV catheter infections

A

Do not leave in unused cannula
Do not insert cannula unless using it
Change cannula every 72hrs
Use aseptic technique when inserting cannula

661
Q

Common complication of IV catheter infection

A

Infective Endocarditis

Hence do an ECHO

662
Q

Describe Class I surgical site infection

A

Clean wounds (resp. alimentary, genital or infected urinary systems not entered)

663
Q

Describe Class II surgical site infections

A

Clean contaminated wound (open, fresh accidental wounds or gross spillage from GI tract)

664
Q

Describe Class III surgical site infections

A

Contaminated wound (open, fresh accidental wounds or gross spillage from GI tract)

665
Q

Describe Class IV surgical site infections

A

Infected wounds (existing clinical infection/infection present before operation)

666
Q

Organisms surgical site infections

A 
Staph. Aureus (incl. MSSA and MRSA)
Coagulase negative Staphylococci 
Enterococcus 
Escherichia coli 
Pseudomonas Aeruginosa 
Enterobacter
Streptococci 
Fungi
667
Q

Ix for Surgical site infection

A

Send pus/infected tissue for cutter

Avoid superficial swabs
Aim for deep structures

668
Q

Rx for Surgical site infections

A

Abx. to target likely organisms

669
Q

Risk factors for surgical site infections

A 
DM 
Smoking 
Obesity 
Malnutrition 
Concurrent steroid use
670
Q

What does MRSA stand for

A

Meticillin Resistant Staphylococcus Aureus

671
Q

What type of infection is MRSA

A

Hospital acquired infection

672
Q

What is VISA (hospital acquired infection)

A

Vancomycin intermediate staph. aureus

673
Q

What is VRSA (hospital acquired infection)?

A

Vancomycin Resistant Staph Aureus

674
Q

Where does MRSA commonly live

A

On 1/3 of peoples skin

675
Q

Why are hospital patients susceptible to MRSA

A

They have, open wounds/ catheters/drips (easier entry for MRSA)

They may be immunocompromised

They are in close contact with a lot of people (easier for MRSA to spread)

676
Q

What is required fro infection of MRSA to occur

A

Needs to be able to enter the tissue, blood and allowed to multiple

677
Q

Ix for MRSA

A

Blood sample
Urine sample
Swab from site

678
Q

Rx for MRSA infection

A

IV Vancomycin

Teicoplanin

679
Q

Rx for removing MRSA from skin

A

Antibacterial cream inside nose 2-5d
Antibacterial shampoo everyday (5d)
Changing laundry every day

680
Q

Risk factors for MRSA infection

A

Abx. exposure
Hospital stay
Surgery
Nursing home

681
Q

Prevention of MRSA

A

Surveillance
Barrier precautions
Hand hygiene

682
Q

Describe surveillance for MRSA

A

Sometimes pre-admission for overnight hospital stay

Asked for a swab off the skin

683
Q

Where does aspergillosis commonly affect?

A

Lungs

684
Q

Transmission of aspergillosis

A

Sporulation

Airborne/inhalation

685
Q

What type of infection is aspergillosis

A

d Fungal infection

686
Q

In what patients does aspergillosis mainly occur

A

Those with underlying lung pathology:

E.g COPD, TB

687
Q

Who does invasive pulmonary aspergillosis normally occurs in

A

Patients who are severely immunocompromised

688
Q

Risk Factors for Invasive pulmonary aspergillosis

A 
Immunocompromised (e.g HIV)
Leukaemia 
Wegner's 
SLE 
After broad spectrum Abx.
689
Q

Mortality rate of acute invasive pulmonary aspergillosis

A

50%

690
Q

Ix for invasive pulmonary aspergillosis

A

IV Anti-fungals

Infection Erin (10 decks)

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