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PSM MBBS > Rabies, STDs, RTI, ADIs > Flashcards

Rabies, STDs, RTI, ADIs Flashcards

1
Q

Animal bite category

A 
I. Licks:
 No tissue injury
 πŸ€, 🐿, domestic animal bites
 Wound management
II. Abrasion/laceration:
 Wound management + ARV
III. Wild animal bite:
 Wound management + ARV + rabies immunoglobulin
πŸ¦‡ bite no Anti Rabies Vaccine ARV
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2
Q

Within 15 minutes of animal bite

A 
1. Local wound management: 
 Continue for 25-20 min
 Wash it with running water and soap
2. ARV/ RIG:
 vaccine/Ig 
 depends on class of bite 
3. Antibiotics:
 depends on class of bite 
4. Td vaccine
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3
Q

Rabies

A 
Hydrophobia
Agent: rhabdovirus (bullet shaped lyssavirus)
Street virus or fixed virus 🦠 
Host: warm blooded animals (carnivores usually)
100% fatal
Affecting CNS
Bats are the M/C reservoir
Dogs are the M/C source
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4
Q

Prevention of rabies

A
  1. Post exposure prophylaxis
  2. Post exposure prophylaxis for vaccinated persons:
    0,3 or 4 site (0.1 ml)
  3. Pre-exposure prophylaxis PrEP:
    0, 7, 21/28
  4. Rabies in πŸ•
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5
Q

Post exposure prophylaxis of rabies

A
  1. Site of bite affects rate of progression
  2. Category of contact
  3. Washing with alcohol (only scenario)
  4. No suturing
  5. Anti tetanus prophylaxis
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6
Q

Immunisation for rabies

A
  1. Essen regimen: 0,3,7,14,28
  2. Zagreb regimen: 0+0, 7, 21
  3. Intradermal: 0+0, 3+3 ,7+7, 28+28
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7
Q

Occurrence of symptomatic STI patients vs asymptomatic STI patients

A

Symptomatic STI patients are commonly male
Asymptomatic patients are commonly female
Morbidity is more in men but more severe in females

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8
Q

High risk populations for STDs

A 
CSWs
Drug addicts
Truck drivers
Army
Factory workers
Tourists
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9
Q

Social and behavioural factors affecting STDs

A 
Poverty
Broken family
Marital disharmony 
Urban migration
Commercial sex work
Easy money
Lack of awareness
Social stigma
Changing behaviour
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10
Q

Advantages of syndromic case management of STIs

A
  1. Identified and treated by signs and symptoms
  2. Syndromes easily recognised clinically
  3. Small number of clinical syndrome
  4. Rx given for majority of organisms
  5. Simple and cost-effective
  6. Valid, feasibility, immediate Rx
  7. Risk assessment πŸ”Ό performance
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11
Q

Disadvantages of syndromic case management of STIs

A
  1. Tendency to overtreat: justifiable in high prevalence areas
  2. Decreased specificity
  3. Overuse of expensive drugs
  4. Asymptomatic cases not fully addressed even with risk assessment
  5. Management of cervical infections problematic
  6. Vagina discharge algorithm performs poorly on low prevalence areas
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12
Q

Requirements of syndromic case management of STIs

A
  1. Adequate medical history
  2. Good sexual history
  3. Complete STI clinical examination
  4. Management guidelines
  5. Good supply of effective drugs
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13
Q

Common syndromes and sequelae STD

A

Male urethritis
Low genital infections in women: vaginitis, cervicitis, urethritis
Genital ulcers
Proctitis/colitis

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14
Q

Treatment of STIs

basic features

A 
Contact tracing 
Compliance
Confidentiality
Condom use
Counselling
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15
Q

Control and prevention of STI

A
  1. STD clinic
  2. Laboratory services
  3. PHC
  4. Information system
  5. Legislation
  6. Social welfare measures
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16
Q

Circulating influenza viruses which are a pandemic threat

A

H1N1
H3N2
H1N5
B

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17
Q

Phenomena shown by influenza

A 
1. Antigenic shift:
 Sudden, big changes 
 Due to genetic reassortment
2. Antigenic drift:
 Subtle slow small changes
 Due to point mutations
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18
Q

Host and environmental factors of influenza

A 
Host: affects all
 Most severe in ages <1 years and >60 year
Environmental:
 N. Hemisphere: mostly ❄️ season
 S. Hemisphere: ❄️, spring, 🌧
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19
Q

Influenza
incubation period
period of communicability

A

Incubation: 1-3 days
Period of communicability:
1-3 days before onset of disease to 2-3 days after

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20
Q

Influenza

clinical features

A 
1. Category A:
 Mild πŸ€’(<38Β°C, <48 hr) w/o sore throat w/o cough/coryza
2. Category B:
 High πŸ€’ (>38Β°C, <48 hr), should be tested for influenza
3. Category C:
Category A/B + red flag symptoms:
β€’ Adults: breathlessness >48 hr
  hypotension
  cyanosis/ hemoptysis
β€’ Children: shortness of breath
  convulsions, inability to feed
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21
Q

Influenza treatment

A

Oseltamivir 75 mg BD5 days
β€’ in case of persistent πŸ€’ on day 6, it is extended for 10 days
β€’ in case of RTI:
Oseltamivir 150 mg BD10 days + steps (low dose hydrocortisone) + mucolytic agent + bronchodilator + antibiotic
Prophylaxis: amoxicillin/ampicillin
Piperacilin (ventilator support)

22
Q

Vaccines for influenza

A 
A. Live
B. Killed:
 1. πŸ₯š based:
  β€’ Trivalent:
    Michigan, Colorado, Switzerland strain 
  β€’ Quadrivalent:
    Trivalent stains + Phuket stain
 2. Non-πŸ₯š based:
    Singapore strain 
FLAV - Flu Live attenuated vaccine
 nasal spray 
 CI: >50 yr, 🀰, HIV,…
23
Q

Baloxavir, Marboxil

A 
Approved drug for influenza
Cap-dependent endonuclease inhibitor
Prevents viral replication within host cell
Indication: age >12 yr
 πŸ€’ <48 hr
24
Q

Acute Respiratory Illness

examples

A 
Children:
 Measles, influenza, diphtheria, pertussis, H. influenzae
Adults:
 Klebsiella, Legionella
No age distribution:
 Streptococcus : M/C cause of community acquired pneumonia
 Staphylococcus: nosocomial pneumonia
 Rhino virus, Corona virus
25
Q

Classification of pneumonia

2 months-5 year

A 
1. No pneumonia:
 Cough, cold, πŸ€’ 
2. Pneumonia:
 πŸ€’ + cough/cold + tachypnea 
 (RR>60 ➑️ age <2 months
  RR>50 ➑️ 2 months-1 year
  RR>40 ➑️ >1 year)
3. Severe pneumonia:
 Chest indrawing + tachypnea + nasal flaring)
4. Very severe pneumonia:
 Inability to feed, convulsion, somnolence, strider
26
Q

Classification of pneumonia

<2 months

A 
1. No pneumonia:
 Fever + cough/cold
2. Severe pneumonia:
 Chest indrawing + tachypnea 
3. Very severe pneumonia:
 Inability to feed, convulsion, stridor, wheeze
27
Q

Treatment of pneumonia

A 
DoC: cotrimoxazole 
For severe: injectable antibiotics
1. Benzyl penicillin
2. Ampicillin
3. Gentamycin 
4. Chloramphenicol
28
Q

GAPPD
Integrated global action plan for prevention and control of pneumonia and diarrhea
objectives

A
  1. πŸ”½ pneumonia mortality by <3/1000 live births
  2. πŸ”½ diarrhea mortality by <1/1000 live births
  3. Decrease incidence is pneumonia and diarrhea by <75%
  4. Decrease prevalence of stunting by <40%
29
Q

Immunization recommend in respiratory infections

A
  1. Measles
  2. HiB
  3. PPV23 / PCV13
    Pneumococcal polysaccharide vaccine 23 / pneumococcal conjugate vaccine 13
30
Q

Diarrhea definition

A

Change on consistency/frequency of stools >3 times a day

31
Q

Types of diarrhea

A 
1. Acute watery diarrhea:
 Cholera, rotavirus, E. coli 
2. Persistent diarrhea:
 Diarrhea >14 days
3. Bloody diarrhea:
 Shigella
32
Q

Diarrhea

agent factors

A 
25-30%: cause unidentified
Enterotoxigenic E. coli: 10-20%
Rotavirus: 15-25%
Campylobacter: 10-25%
Shigella: 5-15%
V. cholerae: 5-10%
33
Q

Diarrhea

environmental and host factors

A

Environmental: all seasons
Rotavirus- after summer/early winter
Host: 6 month - 2 years of age (predominant)

34
Q

Control of diarrhea

A
  1. Short term:
    ORS, clinical management, of severe dehydration ➑️IV
  2. Long term:
    πŸ”Ό maternal and child health care
    πŸ”½ outbreak of diarrhea by- πŸ”Ό health education and sanitation
35
Q

Types of oral rehydration therapy

A 
1. Reduced osmolarity ORS:
 245 mmol/L
2. Super ORS:
 ORS with energy providing food products
3. Resomal: 
 Rehydration solution for severely malnourished children
4. Home based ORS:
 Salt: sugar::1:6
36
Q

Composition of reduced osmolarity ORS

A

Na: 75 mmol/L
Glucose: 75 mmol/L
Cl: 20 mmol/L
Citrate: 10 mmol/L

37
Q

Super ORS

A 
ORS with:
β€’ starch (rice 🍚) 
β€’ starch-free (glycine/glucose polymer)
Advantage:
1. πŸ”½ dehydration
2. πŸ”½ stool frequency
3. Provides 180 kcal/L
38
Q

Resomal

A 
Rehydration solution for severely malnourished children
Composition: 
1. ORS pack
2. 2 L water
3. 50gm sugar
4. Mineral electrolyte solution
 K, Cl, Mg, Zn, Cu
39
Q

Treatment of diarrhea using ORS

A

75 ml/kg + for every stool episode add 100 ml

40
Q

Cholera

bacterial load

A

Carriers: 10^2-10^5 vibrio/gm stool
Case: 10^7-10^9 vibrio/gm stool
75% of cases of cholera are asymptomatic

41
Q

Carriers of cholera and their infective period

A
  1. Health carriers and chronic carriers: months to years
  2. Incubatory carriers: 1-5 days
  3. Convalescent carriers: 2-3 weeks
  4. Contact carrier: 8-10 days
  5. Case of cholera: 8-10 days
42
Q

Stages of cholera

A 
1. Stage of evacuation: 
 Persistent profuse diarrhea
2. Stage of collapse:
 Intense diarrhea + dehydration
3. Stage of recovery
43
Q

Cholera pathogenesis

A

In gut V. cholerae secretes mucinase which helps the bacteria enter gut mucosa and secrete adherence factor.
This helps them to bind to gut epithelium and secrete toxins

44
Q

Cholera treatment

A 
For age:
1. <1 yr: 30 ml within 1st hour
 70 ml in next 5 hr
2. >1 yr: 30 ml in 30 min 
 70 ml in next 150 min
β€’ In severe dehydration, prefer IV rehydration
β€’ πŸ”Ό feeding
β€’ chemoprophylaxis (doxycycline)
β€’ oral zinc supplement at 20 mg * 14 days
45
Q

Vibrio cholera (physical) properties

A 
Can be killed within 30 mins of heating
Destroyed by dryness and sunshine
Destroyed by chlorine, bleaching powder (6mg/L)
Humans are the only reservoir
High attack rate in children
46
Q

Cholera toxins

A
  1. L toxic:
    Combines with ganglioside in cell membrane and helps its attachment to cell membrane
  2. H toxin:
    Helps in activating adenyl cyclase and cAMP ➑️ secretory diarrhea
47
Q

Cholera

diagnosis

A
  1. Hanging dropπŸ’§ method
  2. Dark field illumination
  3. Holding media- Venkat Raman media
  4. Sample collectors:
    Mc Cartney water bottles
48
Q

Cholera

treatment

A

DoC: doxycycline
Other: tetracycline, ciprofloxacin

49
Q

Cholera

vaccines

A 
1. Dukoral: 
 Whole cell recombinant vaccine
2. Shanchol: 
 Oral cholera vaccine
3. Bivalent Shanchol:
 Used now
4. Euvichol:
 More stable and efficacious
50
Q

Dukoral vaccine

A

For cholera
Whole cell-recombinant vaccine with Ξ² subunit to be taken with buffer
2 doses, 7 days apart
CI in ages <2 years

51
Q

Shanchol vaccine

A 
For cholera
2 doses, 10-14 days apart
Oral cholera vaccine mORCVAX 
No Ξ² subunit
No buffer required
Can be given in age >1 yr
Bivalent Shanchol:
 Used now
 Has both OI & OI39

PSM MBBS (5 decks)

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