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MRCEM Primary Exam > Sýklafræði II > Flashcards

Sýklafræði II Flashcards

1
Q

Shigella líkist helst hvaða bakteríu?

A

E coli - báðar gram negativar og virka svipað.

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2
Q

Hvernig smitast Shigella?

A

Með vatni og mat.

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3
Q

Sjúkdómsgangur Shigellu og einkenni.

A
  • Sársaukafullur niðurgangur
  • “Dysentery” - large bowel diarrhea, blóðugur.
  • Invades colonic epithelial frumur.
  • Töluvert mortalitet á heimsvísu.
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4
Q

Í hvernig kjöti er Campylobacter helst?

A

Fuglakjöti

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5
Q

Algengasta niðurgangsBAKTERÍA í UK, framar en Salmonella?

A

Campylobacter

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6
Q

Einkenni Campylobacter:

A
  • Niðurgangur
  • Kviðverkir
  • Blóðugur niðurgangur í börnum undir 5 ára aldri
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7
Q

Meðferð Campylobacter:

A

Clarithromycin (macrolide) ef greinist snemma en gengur annars yfirleitt yfir af sjálfu sér.

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8
Q

Meðferð meningococcal meningitidis? (empirisk, skammtar líka)

A
  • In the hospital setting IV ceftriaxone (2 g adult; 80 mg/kg child) or IV cefotaxime (2 g adult; 80 mg/kg child) are the preferred agents.
  • IM benzylpenicillin can be given as an alternative in the pre-hospital setting and chloramphenicol is a suitable alternative if there is a history of anaphylaxis to cephalosporins.
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9
Q

Hvað er reactive arthritis? (áður kallað Reiter´s disease)

A

Klassiskur triad:

  • arthritis (yfirleitt 1-2 liðir, geta verið allt að 4-5)
  • conjunctivitis
  • urethritis

(getur líka fengið iritis, circinate balanitis og keratoderma blennorhagicum á iljar)

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10
Q

Hvaða serologiu tengist reactive arthritis?

A

HLA B27

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11
Q

Orsakir reactive arthritis:

A
  • Niðurgangur (t.d. salmonella, campylobacter, shigella)

- STD: chlamydia og gonorrhea

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12
Q

Hversu mörg börn fá rotavirus?

A

ÖLL börn fengu rotavirus fyrir 5 ára aldur áður en bólusetningar hófust 2013. Hefur minnkað um 75% síðan þá.

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13
Q

Einkenni rotavirus:

A
  • Mikill niðurgangur, oft þurrkur og þarf oft innlögn til vökvagjafar
  • Færð immunity eftir á
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14
Q

Hvenær er noro algengast?

A

Á veturna (winter vomiting)

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15
Q

Hversu lengi endist ónæmið fyrir noro eftir sýkingu?

A

Frekar stutt, 2 mánuði uþb

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16
Q

Hvernig drepum við Norovirus t.d. eftir að komið er út úr einangrun?

A

Drepst við handþvott og sprittun.

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17
Q

Neisseria gonorrhea - hvernig baktería, gram neg/pos og útlit, incubation tími?

A
  • Gram neg diplococcus

- Incubation tími er 4-6 dagar

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18
Q

Einkenni N. gonorrhoea:

A

Um 50% kvenna eru einkennalausar.

Kk fá oft týpísk UTI einkenni.

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19
Q

Meðferð N. gonorrhoea:

A

Ónæmt fyrir mörgu.

Ceftriaxone 500mg im PLÚS azithromycin 1g per os (macrolide)

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20
Q

Hvað gerist ef N. gonorrhea er ekki meðhöndluð? (4)

A

Getur orðið krónísk og getur þá fengið:

  • septic arthritis
  • epididymo-orchitis
  • bacterial endocarditis
  • PID í konum
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21
Q

Chlamydia trachomatis - incubation tími og einkenni:

A
  • Incubation tími oft margar vikur
  • 50-70% kvenna eru einkennalausar en um helmingur einkennalausu kvennanna fá PID í framhaldinu
  • KK fá oft klístraða útferð og urethritis
  • Getur orðið krónískt
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22
Q

Greining klamydíu

A

NAATs (t.d. PCR)

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23
Q

Meðferð klamydíu:

A

doxycycline eða macrolide

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24
Q

Mislingar: hvernig veira er það, hvernig smitast hún og incubation tími.

A
  • Measles belongs to the paramyxoviridae group of viruses.

- The incubation period is 7-18 days (average 10) and it is spread by airborne or droplet transmission.

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25
Q

Einkenni mislinga:

A
  • The classical presentation is of a high fever with coryzal symptoms and photophobia with conjunctivitis often being present.
  • The rash that is associated is a widespread erythematous maculopapular rash.
  • Koplik spots are pathognomonic for measles, and are the presence of white lesions on the buccal mucosa.
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26
Q

Greining mislinga:

A
  • Salivary swab for measles specific IgM
  • Serum sample for measles specific IgM
  • Salivary swab for RNA detection
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27
Q

Dæmi um 3 kríp sem smitast með aerosol smiti:

A

Mycobacterium tuberculosis
Varicella zoster virus
Measles virus

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28
Q

Hvað eru aerosol smit? Hvernig verst maður slíku smiti?

A
  • Aerosols are airborne particles that are less than 5 µm in size, such as droplet nuclei (residue from evaporated droplets) containing infective organisms. They typically cause infection of the upper or lower respiratory tract.
  • These organisms can survive outside the body and remain suspended in the air for long periods of time. They can be spread over large distances and transmitted via ventilation systems. For this reason masks and negative pressure rooms are required to prevent spread.
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29
Q

5 kríp sem smitast sem Droplet (airborne particle > 5 µm)?

A 
Neisseria meningitidis
Bordatella pertussis
Influenza virus
Parainfluenza virus
Respiratory syncytial virus
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30
Q

7 kríp sem smitast faeco-oral?

A 
Salmonella enteritidis
Escherichia coli
Vibrio cholerae
Ascaris lumbricoides
Hepatitis A
Poliovirus
Rotavirus
31
Q

4 kríp sem smitast með direct contact:

A

Staphylococcus aureus
Streptococcus pyogenes
Trichophyton rubrum
Human papillomavirus

32
Q

3 kríp sem smitast verticalt:

A

Trepenoma pallidum
HIV
Hepatitis B

33
Q

5 kríp sem eru vector-borne smit:

A 
Plasmodium falciparum
Borrelia burgdorferi
Trypanosoma cruzi
Coxiella burnetti
Leishmania donovani
34
Q

Hvaða skor á að nota í mati á akút hálsbólgu?

A

FEVERpain skorið:

  • Fever in last 24 hours
  • Purulence
  • Attended rapidly in under 3 days
  • Inflamed tonsils
  • No cough or coyza
  • Score 0-1 = Unlikely streptococcal infection (13-18% isolation of streptococcus) antibiotics not recommended
  • Score 2-3 = 34-40% isolation of streptococcus, consider delayed prescribing of antibiotics (3-day ‘back-up prescription’)
  • Score ≥4 = 62-65% isolation of streptococcus, use immediate antibiotic if severe, or 48-hour short back-up prescription
35
Q

Empirisk meðferð streptokokka:

A
  • Prescribe phenoxymethylpenicillin as the first-choice antibiotic.
  • If there is a true penicillin allergy, clarithromycin is an alternative.
  • Prescribe erythromycin for a pregnant woman with penicillin allergy.
36
Q

Hvað er Hutchinson´s sign og hvers vegna birtist það?

A

Hutchinson’s sign is the presence of herpes vesicles on the tip, side, or root of the nose. It typically precedes the development of ophthalmic herpes zoster.

This occurs because branches of the nasociliary nerve (a branch of the ophthalmic division of the trigeminal nerve) innervate both the cornea and the dorsum and tip of the nose.

37
Q

Hvað eru facultative bacteria?

A

Facultative anaerobic bacteria make ATP via aerobic respiration and are also capable of switching to fermentation.

38
Q

4 dæmi um obligate anaerobe bacteríur:

A

Bacteroides spp.
Clostridium spp.
Treponema spp.
Actinomyces spp.

39
Q

Hvers konar baktería er Neisseria gonorrhea?

A

Gram-negative non-spore-forming diplococcus

40
Q

Hvað er post-primary tuberculosis?

A

Post-primary tuberculosis, also known as reactivation tuberculosis, usually occurs a year or two after the primary infection. Reactivation often occurs in the setting of a decreased immune status and commonly involves the lung apex. It can affect all organs and body systems. The presentation of post-primary tuberculosis is highly variable.

41
Q

Hver er algengasta presentasjón post-primary tuberculosis í UK?

A

Pulmonary tuberculosis is the most common presentation, accounting for 60% of cases in the UK. General symptoms are common and include fever, night sweats, weight loss, anorexia and malaise. Patients commonly have a chronic, productive cough and/or haemoptysis. It can result in pneumonia, lobar collapse, bronchiectasis and pleural effusion.

42
Q

Í post-primary tuberculosis, hver er algengasta EXTRAPULMONARY presentasjónin?

A
  • Extrapulmonary tuberculosis is more common in children and the immunosuppressed. Around 15-20% of cases spread to extrapulmonary sites such as the pleura, central nervous system, lymphatics, bones, joints, and genitourinary system:
  • Genitourinary tuberculosis is the most common site outside the lungs and often presents with ‘sterile’ pyuria. It can also cause salpingitis, abscesses, renal lesions and infertility in women.
43
Q

Hvað er Pott´s disease?

A

Pott’s disease is extrapulmonary tuberculosis that affects the spine. It primarily affects the lower thoracic and upper lumbar vertebrae. It can also affect other parts of the musculoskeletal system, causing isolated bone and joint lesions.

44
Q

Hvað er miliary tuberculosis?

A

Miliary tuberculosis (disseminated tuberculosis) refers to tuberculosis that has widely disseminated to other organs via blood or lymphatics.

45
Q

Hvað er scrofula?

A

Scrofula refers to cervical tuberculous lymphadenopathy. Scrofula is also referred to as a cold abscess due to the absence of erythema and warmth.

46
Q

Hversu stórar eru loftbornar partiklur og dæmi um slíkar partiklur (hvernig þær verða til).

A

Aerosols are airborne particles that are less than 5 µm in size, such as droplet nuclei (residue from evaporated droplets) containing infective organisms. They typically cause infection of the upper or lower respiratory tract.

47
Q

3 dæmi um sjúkdóma sem smitast með aerosol smiti:

A

Mycobacterium tuberculosis
Varicella-zoster virus
Measles virus

48
Q

Hvað sjáum við með direct light microscopy?

A
  • Direct light microscopy – stool parasites
49
Q

Hvað sjáum við með Ziehl-Nielson stain light microscopy?

A

Ziehl-Nielson (Z-N) stain light microscopy – sputum for tuberculosis

50
Q

Hvað sjáum við með Giemsa stain light microscopy?

A
  • Giemsa stain light microscopy – blood for malaria
51
Q

Hvað sjáum við með fluorescent microscopy?

A
  • Fluorescent microscopy – nasopharyngeal aspirate for respiratory syncytial virus (RSV)
52
Q

Hvað er obligate pathogen og 2 dæmi um slíkt:

A

Obligate pathogens are organisms that are almost always associated with disease. They usually cannot survive outside of the body for long periods of time. Examples include Trepenoma pallidum and HIV.

53
Q

Hvað er conditional pathogen og 2 dæmi um slíkt:

A

Conditional pathogens are organisms that can usually only cause disease if certain conditions are met. A classic example is Staphylococcus aureus, which is often a normal commensal but can cause disease if inoculated into a wound. Another example is Bacteroides fragilis, which is a normal commensal of the gut but can cause abscesses if it reaches the peritoneal cavity.

54
Q

Hvað eru opportunistic pathogens og 2 dæmi um slíkt:

A

Opportunistic pathogens are organisms that can only cause disease in an immunocompromised host or under other unusual circumstances. Examples include Pneumocystis jiroveci, which can only cause disease if the host is immunocompromised, and Pseudomonas aeruginosa, which typically only causes skin infection when the normal skin microbiota is disrupted.

55
Q

Hvernig smitast impetigo (kossageit)?

A

Impetigo is most commonly spread by direct person-to-person contact and can spread rapidly through families and school classes. It can also, less commonly, be spread by indirect contact.

56
Q

2 algengustu orsakavaldar impetigo?

A

The commonest causative organism is Staphylococcus aureus. Streptococcus pyogenes is the second commonest and causes fewer cases, either alone or in combination with Staphylococcus aureus. The streptococcal form tends to be commoner in warmer, more humid climates.

57
Q

2 algengustu orsakavaldar impetigo?

A

The commonest causative organism is Staphylococcus aureus. Streptococcus pyogenes is the second commonest and causes fewer cases, either alone or in combination with Staphylococcus aureus. The streptococcal form tends to be commoner in warmer, more humid climates.

58
Q

Hvaða tvær týpur eru til af impetigo/kossageit?

A
  • Non-bullous impetigo – lesions usually start as tiny pustules or vesicles that evolve rapidly into honey-crusted plaques that tend to be under 2 cm in diameter. These can be itchy but are rarely painful.
  • Bullous impetigo – lesions have a thin roof and tend to rupture spontaneously. This type is more likely to be painful and may be associated with systemic upset.
59
Q

Hvernig breytist ónæmiskerfið ef miltað er fjarlægt?

A

Following splenectomy, patients have defective macrophage function and a diminished ability to remove capsulated organisms from the blood. Splenectomy, therefore, results in an increased risk of sepsis due to encapsulated organisms, and the risk is greatest with the most virulent pathogens in this group.

60
Q

Hvaða hjúp bakteríur eru mikilvægastar þegar kemur að því að verja sjúklinga sem ekki hafa milta? (3)

A

The most important encapsulated pathogen is Streptococcus pneumoniae. In one notable study, reporting 349 episodes of sepsis in patients with asplenia, 57% of infections and 59% of deaths were caused by Streptococcus pneumoniae. Approximately 6% of infections were caused by Haemophilus influenzae, and 3.7% of infections were caused by Neisseria meningitidis.

61
Q

Hvaða 3 bóluefni þurfa allir sjúklingar án milta að fá?

A

All patients that have undergone splenectomy should receive the pneumococcal conjugate vaccine, Haemophilus influenzae type B vaccine and the meningococcal vaccine.

62
Q

3 mismunandi leiðir til að testa fyrir HIV:

A

p24 antigen tests
Nucleic acid tests (NAT)
HIV antibody tests

63
Q

Hvernig virka/til hvers eru p24 antigen test fyrir HIV?

A

p24 is the viral protein that makes up most of the core of the human immunodeficiency virus (HIV). Serum concentrations of the p24 antigen are typically high in the first few weeks after infection. They can usually detect HIV infection 18-45 days after exposure. The p24 antigen test is, therefore, a useful way of diagnosing very early infection, such as during a seroconversion illness.

64
Q

Til hvers eru PCR (NAAT) próf fyrir HIV nytsamleg?

A

These amplify and detect one or more of several target sequences located in specific HIV genes. They can detect HIV sooner than the other types of tests (between 10-33 days after exposure) but are very expensive and are not used routinely. They are usually reserved for use under very specific circumstances, such as a recent high-risk exposure.

65
Q

Til hvers eru HIV antibody test?

A

These include ELISA and western blot tests. They are a very sensitive way of detecting the presence of HIV but cannot be used in the early stages of the disease. There is typically a window period of 6-12 weeks before antibodies are produced, and these tests will be negative during a seroconversion illness. The ‘rapid HIV test’ is an example of an HIV antibody test. It is called the ‘rapid test’ as it can detect antibodies in blood or saliva much quicker than the other antibody tests, and results are often back within 20 minutes.

66
Q

Legionella pneumophilia: 1 sýklalyf sem hún er resistant við og 2 sýklalyf sem virka yfirleitt:

A

Legionella pneumophila infections are resistant to amoxicillin but can be successfully treated with macrolide antibiotics, such as erythromycin, or quinolones, such as ciprofloxacin. Tetracyclines, such as doxycycline, can also be used.

67
Q

Hvernig bakteríur eru Salmonellurnar?

A

Salmonella spp. are Gram-negative, rod-shaped, non-spore-forming bacteria. They are predominantly motile organisms and are also facultative anaerobes, capable of surviving with or without oxygen.

68
Q

Hversu stórar eru droplet partiklur og hvernig berast þær á milli?

A

Droplets are airborne particles that are more than 5 µm in size. Droplet transmission occurs when respiratory droplets are generated via coughing, sneezing, or talking.

69
Q

Dæmi um 5 bakteríur eða veirur sem berast með droplet smiti:

A 
Neisseria meningitidis
Bordatella pertussis
Influenza virus
Parainfluenza virus
Respiratory syncytial virus
70
Q

2 sveppir sem geta valdið septiskum arthritis:

A

Fungi can also be causative agents, notably Histoplasmosa and Blastomyces.

71
Q

6 dæmi um veirur sem geta valdið liðsýkingum:

A

Viruses can also cause septic arthritis, and these include hepatitis A, B and C, coxsackie virus, adenovirus and parvovirus.

72
Q

5 algengustu bakteríurnar sem valda liðsýkingum:

A
  • Staphylococcus aureus (langalgengast)
  • H. influenzae (dregið úr með bólusetningum)
  • Streptococcus spp..
  • Neisseria gonorrhoea (typically sexually active young adults, macules or vesicles frequently seen on the trunk)
  • Escherichia coli (seen in IVDUs, the elderly and seriously ill)
73
Q
A
74
Q
A

MRCEM Primary Exam (21 decks)

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