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MRCS A - Clinical > Trauma > Flashcards

Trauma Flashcards

1
Q

Signs of tension pneumothorax and Mx?

A

Respiratory distress, raised JVP with low BP, hyper resonant

Mx = large bore cannula 2ICS MCL

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2
Q

NEXUS criteria for clearing C-spine?

A 
Fully alert
No abnormal neurology 
No head injury / neck pain
no drugs / alcohol 
No distracting injury
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3
Q

Massive transfusion - definition, Mx, criteria for end points?

A

Transfusion of whole blood volume within 24 hours

CRASH study = tranexamic acid
Ratio of 1:1:1 for FFP, platelets and RBC

Therapeutic endpoints:
Hb 8-10
Platelets >100
INR < 1.5
Ca > 1
pH normal range
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4
Q

Thorax trauma:
Reduced BP, reduced chest expansion and breath sound on one side.
Stony dull to percuss
Cause, Mx?

A

Massive haemothorax
> 1.5L of blood in chest

Large bore chest drain ± thoracotomy

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5
Q

Thorax trauma:

Reduced sats, abnormal chest movements, crushing injury to chest

Cause, Ix, Mx?

A

Flail chest = anterior/lateral #’s of >2 adjacent ribs in > 2 places
Also will have pulmonary contusion

CXR + serial ABGS

Mx: Analgesia and oxygen

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6
Q

Thorax trauma:
Patient on mechanical ventilation
SOB, dropping BP ad JVP raised

Cause, Mx?

A

Tension pneumothorax

Large bore cannula, 2ICS, MCL

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7
Q

Thorax trauma:

CXR shows 2cm pneumothorax - Mx?

A

Aspirate anything > 2cm or symptomatic

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8
Q

Thorax trauma:
Patient in shock, muffled heart sounds.
JVP raised

Name of this triad, cause, Mx?

A

Becks triad
Cardiac tamponade

Pericardiocentesis = spinal needle in R subxiphoid space aiming for R tip of left scapula

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9
Q

Thorax trauma:

What symptoms might you see in blunt cardiac injury?

A

Can mimic MI

Also see arrhythmias, hypotension

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10
Q

Thorax trauma:
Deceleration injury, persistent hypotension

Likely cause, Ix, Mx?

A

Aortic disruption
Most die at scene

CXR = widened mediastinum and depression of L amino bronchus 
Diagnosis = CT angio

Mx = surgical repair

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11
Q

Thorax trauma:

CXR shows small bowel loops in lower semi-diaphragm?

A

Diaphragmatic rupture

Mx = surgical repair

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12
Q

Investigations for abdominal trauma?

A

Normotensive:

  1. USS to identify free fluid. But operator dependant and can miss retroperitoneal stuff
  2. CT abdo - most specific for identifying visceral injury, but time consuming and need contrast
  3. Hypotensive = diagnostic lavage to identify bleed. VERY sensitive but very invasive
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13
Q

Abdominal trauma:
Urine dip shows haematuria

Cause?

A

Kidney injury

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14
Q

Abdominal trauma:

Indications for laparotomy

A 
Persistent unexplained hypotension
Peritonitic 
Gunshot wound 
Evisceration
Radiological evidence of free gas or diaphragmatic rupture
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15
Q

Abdominal trauma:

Liver trauma?

A

Suture lacération / partial hepatectomy

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16
Q

Abdominal trauma:

Bowel trauma?

A

Resection

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17
Q

Abdominal trauma:

Bladder trauma?

A

Intraperitoenal = laparoscopic repair and urethral and suprapubic drainage

Retroperitoneal = conservative with urethral drainage

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18
Q

Abdominal trauma:

what is Kehrs sign?

A

Shoulder tip pain, if on left side = ruptured spleen

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19
Q

Abdominal trauma:

Splenic tear classification?

A 
1 = capsular tear
2 = + parenchymal damage 
3 = tear up to hilum 
4 = complete rupture
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20
Q

Abdominal trauma:

Splenic injury - when to Mx conservatively, preservative surgery and splenectomy?

A

conservatively = small sub-capsular haematoma, minor bleeding, no hilar involvement

Laparoscopic and conservation:
Increased intra-abdominal bleed
Moderate haemodynamic compromise
Tear / laceration affecting > 50%

Splenectomy:
Hilar involvement, major haemorrhage, major associated injury

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21
Q

What is the Monroe-Kelly doctrine?

A

Cranium is a box, contents must remain for ICP to remain. the same

If volume goes up somewhere, must go down elsewhere

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22
Q

Extra dural - where is the bleed, common artery (+nerve) affected + features?

A

Between dura mater and skull

Middle meningeal artery
Auriculotemporal nerve closely related to middle meningeal = supplies external ear and outermost tympanic membrane

Raised ICP, Lucid interval

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23
Q

Subdural - layer affected and lobes commonly affected, RF’s and onset?

A

Innermost meningeal layer

Parietal and frontal

Risk factors = old age and alcoholism

Slow onset

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24
Q

SAH - What is it, PC?

A

Spontaneous ruptured cerebral aneurysm

Sudden onset, severe headache

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25
Q

Basal skull # - common features?

A

CSF rhinorrhoea and otorrhoea

Battle sign = mastoid busing
Panda sign = bilateral orbital bruising

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26
Q

Intraventricular haemorrhage - who gets it, Mx?

A

Spontaneously In neonates

Mx conservative unless raised ICP/hydrocephalus = shunt

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27
Q

Criteria for performing a CT?

A 
GCS <13
GCS <15 2 hours after injury
Open or depressed skull #
>1 episode of vomiting 
Focal neurology 
Any signs of basal skull #
Post-traumatic seizure
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28
Q

When to contact neurosurgeon in head injury?

A 
GCS persistently <8 
Ongoing worsening confusion > 4 hours
Progressive neurology 
CSF rhinorrhoea 
Reducing GCS post-admission
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29
Q

When do we need to be measuring ICP?

A

GCS 3-8 with abnormal CT = mandatory

GCS 3-8 with normal CT = appropriate

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30
Q

Minimum cerebral perfusion In adults?

A

70mmHg

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31
Q

What is bushings reflex and what does it mean?

A

Bradycardia, HTN + irregular breathing

Means imminent herniation

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32
Q

Pupillary finings In head injury:

  1. Unilaterally dilated, sluggish
  2. Bilaterally dilated, sluggish
  3. Marcus Gunn
  4. Bilat constricted
A
  1. 3rd nerve palsy (down and out), secondary to tectorial herniation
    Mx = temporal-parietal craniotomy on ipsilateral side
  2. Bilateral 3rd nerve, OR reduced CNS perfusion
  3. When swing light from normal to affected eye, it does not constrict as well = APPARENT dilation
    Due to a defect inn the afferent pathway
    So light in the normal eye still constricts both okay
    Cause = Optic nerve lesion or severe retinal disease
  4. Opiates or pontine lesion
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33
Q

Criteria for paediatric head CT?

A

LOC or amnesia > 5 mins
>3 episodes of vomiting
Focal neurology / abnormal confusion + drowsiness
Suspected NAI or traumatic cause e.g. RTA
GCS <14, or if under 1 <15
Signs of basal skull #, or depressed / open #

If < 1 any bruise, swelling or laceration >5cm

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34
Q

Stroke Oxford classification - TACS?

Region involved
Symptoms
what else can it cause

A

Highest mortality
Region involving carotid / MCA and ACA

All 3 of: Contralateral motor / sensory deficit, contralateral homonymous hemianopia + higher dysfunction

Can get cerebral oedema = raised ICP. Will need neurosurgical review for ? hemi-craniectomy
Indications - <60, MCA territory, reduced consciousness + >50% infarct territory

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35
Q

Stroke Oxford classification - PACS?

A

2/3 of TACS ones

Usually higher dysfunction and motor/sensory loss

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36
Q

Stroke Oxford classification - Posteiror circulation storke?

Area affected
Symptoms

A

Vertebrobasillar territory

Any of:
Cerebellar syndrome
Brainstem syndrome
LOC
Contralateral homonymous hemianopia
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37
Q

Stroke Oxford classification - Lacunar strokes?

Where are the infarcts?
What infarct location corresponds to which symptoms

A

Small infarcts around basal ganglia, internal capsule, thalamus and pons

Pure motor = posteiror internal capsule
Pure sensory = Thalamus
Mixed = internal capsule
Ataxic hemiparesis = Anterior limb of internal capsule

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38
Q

Stroke dysphasia - which region is it always?

A

MCA

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39
Q

Stroke dysphasia Brocas vs Wernickes?

A

Wernickes is receptive
- Speak fluently, but doesn’t make sense and word substitution / new words
superior frontal gyrus

Brocas is expressive
Can understand, but have halted laboured speech

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40
Q

ACA vs MCA motor and sensory signs?

A

ACA = Legs > arms, face spared

MCA = arms and face > legs

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41
Q 
Brainstem infarcts:
Paresis
Gaze palsies
Facial weakness (LMN)
Vertigo and nystagmus
Dysphagia and dysarthria
A 
Paresis  = Corticospinal tract
Gaze palsies = CN6
Facial weakness (LMN) = CN7
Vertigo and nystagmus = CN8
Dysphagia and dysarthria = CN9/10
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42
Q

Lateral medullary syndrome / Wallenbergs - area affected and symptoms?

A

PICA or vertebral artery = lateral medulla

A-HAND
Ataxia
Horners
Anaesthesia:
Ipsilateral face pain and heat loss
Contralateral in body
Nystagmus + vertigo 
Dysphagia
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43
Q

Webers syndrome - area affected and signs?

A

Branches of posterior cerebral artery to midbrain

Ipsilateral CN3 + contralateral hemiparesis

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44
Q

Millard-Gubler syndrome:

Where is the infarct
Symptoms?

A 
Pons infarct 
C6+7 and corticospinal tracts affected 
- Diplopia
- LMN facial palsy 
- loss of corneal reflex 
- Contralateral hemiplegia
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45
Q

Locked in syndrome - Causes, clinical picture?

A

Vental pons infarct = Basilar artery, central pontine demyelinosis

Patient is aware and cognitively intact but completely paralysed except from upwards gaze and upper eyelids

These are preserved as midbrain tectum is spared

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46
Q

Cerebellopontine angle syndrome - causes, symptoms?

A

Acoustic neuroma, mets, meningioma, cerebellar astrocytoma

Cerebellar signs + CN5/6/7/8
= absent corneal reflex, gaze palsies, LMN facial, hearing problems + DANISH

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47
Q

Le Fort # - grade 1?

A

starts at nasal septum, extending to pyriform rim
Travels horizontally across apices of teeth, and crosses BELOW the zygomaticofacial junction
Traverses the pterygomaxillary junction

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48
Q

Le Fort # - Grade 2 + symptoms?

A

From nasal bridge not septum this time, extends through the frontal process of maxilla
Travels inferolaterally involving the lacrimal does and is near the inferior orbital fissure

Travels under the zygoma, across the pterygomaxillary fissure and through pterygoid plates

Features:
Infraorbital paraesthesia 
Palatal mobility 
Malocclusion of teeth
If severe = enophthalmos
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49
Q

Le Fort # - grade 3 + classical features

A

Dish pan / flattened face

Starts at nasofrontal junction, extends posteriorly along medial orbit wall and through ethmoid bones
(Thicker sphenoid bones prevent fracture into orbital canal)
Fracture continues along floor of orbit, through inferior orbital fissure + through lateral orbital wall
Then through zygomatic arch

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50
Q

Superior orbital fissure syndrome?

A

Severe force to lateral wall = compression of neurovascular

Features:
complete ophthalmoplegia and ptosis = CN3,4,6 and nerve to levator palpebrae superioris
RAPD
Dilation of pupil and loss of accommodation + corneal reflex
Altered sensation

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51
Q

Orbital blow out?

A

Bone fragment displaced downwards, attached to periosteum still though
Periorbital fat may herniate through defect = interfere with oblique and inferior rectus = Diplopia on upwards gaze

Mx = orbital floor reconstruction

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52
Q

In nasal fracture what does CNS rhinorrhoea imply?

A

Cribiform plate has been breached = need antibiotics

53
Q

Retrobulbar haemorrhage - symptoms + Mx?

A

4 P’s and a V
Proptosis, pain, pupil reaction loss, paralysis
Vision loss - colour first

Mx = osmotic diuretic, steroids, acetazolamide
Likely need cantholysis prior to definitive surgery

54
Q

Pathology of burns?

A

Haemolysis - due to damage of erythrocytes
Loss of capillary membrane = plasma leakage into interstitial space
Oedema = Due to Protein loss

Shock = due to Extravasation of fluids up to 48 h after

55
Q

Pathology of burns healing?

A

Superficial = keratinocytes form new layer over bur site = epithelial migration

Deep burns = Dermal scarring
- need keratinocytes from skin graft to provide optimal coverage

56
Q

Burns classification - Superficial?

A

Just epidermis

Erythema and painful e.g. sunburn
Blanching

57
Q

Burns classification - Partial thickness?

A

Epidermis and part of papillary dermis

Dry white skin, blanching
If deep = loss of dermis too, but adnexae remain = very painful

Usually nil surgical Mx

58
Q

Burns classification - Deep partial thickness?

A

Epidermis and whole papillary dermis
Mottled red, non-blanching

needs surgical Mx usually

59
Q

Burns classification - full thickness?

A

Complete loss of dermis, and subcut. tissue affected

Charry waxed, leathery skin
non-blanching
Heals from the edge in = scar

Management in burns centre

60
Q

Complications of burns - early, intermediate and late?

A

Early = infection, shock, compartment syndrome, curling ulcers in kids, metabolic disturbances

Intermediate = Pressure sores, oedema, VTE

Late = Scarring, contractures and psych

61
Q

Mapping out burns %?

What to use in kids?

A 
Wallace rule of 9's:
Head and neck = 9%
Each arm = 9%
Back and front torso 18% EACH
Each leg = 18%
Perineum and palm = 1% each

In kids use a Lund Browder chart

62
Q

Management of burns?

A

A - consider early intubation

B - 100% 02
- watch out for signs of carbon monoxide poisoning:
Headache, nausea, cherry red appearance

C - massive fluid losses
Parkland formula = 4 x weight x % burns
= ml of Hartman’s in first 24 hours. Give half of this within 8 hours

Referral to burns centre if needed

63
Q

When do we refer to a burns centre?

A 
Any deep dermal / full thickness 
Adults >10%, kids >5%
Any burns to face or perineum 
Inhalation injury 
Electrical / chemical / NAI
64
Q

When do we use escharotomies In burns?

A

If full thickness circumferential burns to torso / limbs

Aim is to either help ventilation, or relieve compartment syndrome

65
Q

What is ARDS?

A

Increased permeability of alveolar capillaries, leading to fluid accumulation in alveoli

Non-cardiogenic pulmonary oedema

66
Q

What happens to surfactant and elastase in ARDS?

A

Reduced surfactant

Increased elastase from neutrophils

67
Q

Criteria for ARDS?

A

3 of:
Onset with 1 week, on background of pneumonia
Bilateral opacities on CXR
Pa02:Fi02 < 200 (basically low sats despite oxygen)
Pulmonary oedema excluded. = clinically or CVP < 18mmHg

68
Q

2 stages of ARDS?

A

Early = exudative phase, oedema

Late = reparative fibroproliferative stage ± scarring

69
Q

causes of ARDS?

A 
Sepsis (chest infection commonest) 
DIC
Massive blood transfusion 
Burns / trauma / inhalation injury 
Aspiration
Pancreatitis
70
Q

ARDS - clinical features and Mx?

A

Dyspnoea and hypoxic
RR raised
Bilateral crackles
CXR = bilateral infiltrate

Mx:
ITU - mortality 40%
Ventilation, PEEP 5-10mmHg, low tidal volume 
Inotropes
Treat cause
71
Q

What is compartment syndrome?

A

Raised pressure within. closed anatomical compartment

Often following a fracture

72
Q

What are the classical injuries leading to compartment syndrome?

A

Supracondylar and tibial shaft #’s

73
Q

Clinical features and diagnosis of compartment syndrome?

A

Pain, paraesthsia, pallor and paralysis
Arterial pulsate felt

Dx = compartment pressure > 40mmHg
> 20 is abnormal

74
Q

Compartment syndrome Mx?

A

Prompt and extensive fasciotomies
Lower limb deep muscle - small incisions will not suffice

Post-fasciotomy = myoglobinuria > renal failure
= need aggressive IV fluids

If notable necrosis already = amputate

75
Q

Hypothermia stages?

A

1 / mild = 35-32
Shivering, tachycardia, vasoconstricted

Stage 2 / moderate = 32-28
Not shivering, J-waves on ECG, hypotensive, bradycardia, dysrhythmias
Reduced GCS and reflexes

Stage 3 / severe = 28-20
Unconscious, not shivering.
Cardiogenic shock, oliguria, coagulopathy, apnoea, no-reactive pupils

Stage 4/ severe = <20
No vital signs

76
Q

Hypothermia Mx?

A

Mild = rewarm with external devices

> moderate = warmed intraperitoneal fluid / haemodialysis

Slowly rewarm. 0.5 degrees / hour

77
Q

what is shock?

A

Insufficient output to meet tissue perfusion needs

78
Q

Sepsis and septic shock definitions?

A

Sepsis = life threatening organ dysfunction, due to host dysregulated response to infection

Septic shock = persisting hypotension requiring vasopressors to maintain MAP 65mmHg, and serum lactate >2 despite adequate fluid resuscitation

79
Q

SVR and CO in sepsis?

A

SVR decreased

CO normal / raised

80
Q

categories of the SOFA score?

A 
Lungs = Pa02:Fi02
coag = platelets
Liver = bilirubin 
neuro = GCS
CVS = MAP
Kidneys = Creatinine

> 2 = 10% mortality in hopsital

81
Q

Resuscitation goals in sepsis?

A 
CVP 8-12
UO > 0.5ml/kg/hour
SVC sats >70%
MAP > 65mmHg
Lactate normal
82
Q

SVR and CO in haemorrhage shock?

How does it affect urine specific gravity?

A

SVR increased, CO low

Increased

83
Q

What is cardiac index?

A

numerical value for the tissue oxygen delivery

CO divided by total body surface area

84
Q

neurogenic shock - cause, SVR and CO, Mx?

A

Spinal cord transection, usually high

Causes decreased sympathetic / increased parasympathetic. = decreased peripheral vascular tone = LOW SVR
Because of this you have reduced pre-load > Low CO

Mx unlike most shock is with peripheral vasoconstrictors to return normal vascular tone

85
Q

Mian causes of cardiogenic shock?

A

IHD

If trauma - blunt trauma usually affects right side of heart = needs surgery

86
Q

Doses used in anaphylaxis - adrenaline, hydrocortisone then chlorphenamine

A

<6 months = 0.15mg/ml of 1/1000, 25, 250mcg/kg

6 months - 6 years = 0.15mg, 50mg, 2.5mg

6-12 years = 0.3mg, 100mg, 5mg

> 12 years = 0.5mg, 200mg, 10mg

87
Q

How can the arterial trace against the ventilation phase be useful?

A

If systolic pressure varies with intrathoracic pressure = need more IV fluids

88
Q

Where does CVP sit, what does it measure.

If adequate fluid volume what happens with a fluid challenge?

A

Sits in SVC, via IJV
Measures right atrial filling pressure
Adequate intra-vascular volume, fluid challenge should raise CVP by 6-8mmHg for a prolonged period

89
Q

How do you monitor cardiac output?
How does it work?
What else can it measure?

A

Swan Ganz catheter

Demonstrates left atrial pressure , via inflations of ball distally = PAOP

Can calculate:
Stroke volume
SVR
Pulmonary artery resistance
Oxygen delivery and consumption
90
Q

Inotropes: Receptor affecting and action?

  1. Noradrenaline
  2. Adrenaline
  3. Dopamine
  4. Dobutamine
  5. Milrinone
A
  1. Alpha agonist
    Vasopressor, minimal effect on CO
  2. Alpha and B
    Increases CO and PVR
  3. B1 = contractility and rate
  4. B1 and B2 = Increase cardiac output and decrease SVR
  5. Phosphodiesterase inhibitor
    Elevates cAMP levels = increases muscle contractility
    Vasodilator
91
Q

Staphylococcus aureus:
Key features
What exo vs enterotoxins cause
How are they resistant to penicillins

A

Anaerobe, G+ve
Haemolysis on blood agar
Catalase +ve

Exotoxins = Toxi shock syndrome
Enterotoxins = Gastroenteritis

Mec operon

92
Q

Streptococcus pyogenes:
Key features
what proteins it releases

A

G+ve, chain like colonies
Group A strep
Beta haemolysis on blood agar
Catalase negative

Proteins released = hyaluronidase and streptokinase = rapid tissue destruction

93
Q

E. coli:
Key features
3 types and what they cause

A

G-ve rod, anaerobe, non spore-forming

  1. Enterotoxic = large volumes of fluid into the gut via cAMP
    Small intestine affected, travellers diarrhoea
  2. Enteroinvasive = dysentry, large bowel necrosis and ulcers
  3. Enterohaemorrhagic = 0157
    HUS, TTP + haemorrhage colitis
94
Q

Campylobacter jejuni:
Key features
PC
Mx?

A

curved G-ve, non spore forming
Diffuse and bloody enteritis
RIF + bloody diarrhoea

Self limiting = no Abx

95
Q

H. Pylori:
Key features
Gene for duodenal ulcers
How it neutralises acid

A

G-ve, helical rod.
Microaerophilic
Flagellated and mobile

If carry Cag A gene = duodenal ulcers

Secretes urease = breaks down gastric urea to CO2 and ammonia > Ammonium > bicarb = neutralises acid

96
Q

Whats streptococcus bovis associated with?

A

Bowel cancer and infective endocarditis

97
Q

Gastroenteritis:

Staph aureus?

A

no fever or abdo pain
Severe vomiting

Incubation = 6 hours

98
Q

Gastroenteritis:

B. Cereus

A

Vomiting first, then diarrhoea

NO FEVER

99
Q

Gastroenteritis:
Salmonella

How does typhoid fever present?

A

nausea, vomiting and fever
Relative bradycardia

Typhoid = constipation, splenomegaly and rose spots
Typhoid needs ceftriaxone

100
Q

Gastroenteritis:

E Coli

A

Watery stools and cramps

No fever

101
Q

Gastroenteritis:

Listeria - key features and PC

A

B-hameolyticc, aesculin +ve with tumbling motility

Fever
Watery diarrhoea, cramps and headaches
Little vomiting

102
Q

Gastroenteritis:

Shigella

A

Kids at nursery

Watery diarrhoea > Bloody mucoid
Vomiting + abdo pain
Fever

103
Q

Gastroenteritis:
Campylobacter
Resevoir and complications?

A

Severe RIF abdo pain
Bloody diarrhoea

Birds are a recognised resevoir

Complications = GBS

104
Q

Gastroenteritis:
Giardiasis
Key features and PC

A

Pear shaped trophozoite, Africa / Eastern Europe
Resistant to chlorination = swimming pools

Prolonged steatorrhoea
Flatulence and cramps
NO FEVER

105
Q

Gastroenteritis:

Amoebiasis

A

Mobile trophozoite, Flask shape ulcers

Gradual onset bloody diarrhoea, abdo pain
Can last for weeks

106
Q 
C. diff:
Associated Abx
PC
severe progression?
Mx
A

Cephalosporin, ciprofloxacin, also co-amoxiclav and tazocin

Mild diarrhoea

Pseudomembranous colitis = severe systemic features such as dehydration and fever
Abdo pain, bloody mucoid diarrhoea
Can even. become paralytic ileus

Mx = Metro then vancomycin
If toxic megacolon, raised LDH or clinically worsening = colectomy

107
Q

GI parasitic infections:

Threadworm - parasite name, PC, Dx and Mx?

A

Enterobius vermicularis
Pruritus ani
Dx = scotch tape at anus over night

Mx = mebendazole

108
Q

GI parasitic infections:

Hookworm - parasite name, life cycle, PC, Dx and Mx?

A

Ancylostoma duodenale
- hookworm that attaches to proximal small bowel

Skin penetration > lungs > coughed up > swallowed

Most asymptomatic, although can cause iron deficiency

Larvae can be seen in stool left at ambient temperature… although hard to diagnose

Mx = mebendazole

109
Q

GI parasitic infections:

Strongyloidiasis - parasite name, life cycle, PC, Dx and Mx?

A

Strongyloidiasis stercoralis
nematode living in duodenum

Skin penetration > lungs > coughed up > swallowed

Asymptomatic generally

Dx = stool microscopy
Mx = mebendazole
110
Q

GI parasitic infections:

Roundnworm - parasite name, life cycle, PC, Dx and Mx?

A

Ascariasis lumbricoides

begins in gut + penetrates duodenal wall > lungs > coughed up > swallowed

Dx = identify worms / eggs in faeces

Mx = mebendazole

111
Q 
Hepatitis A:
Type of virus
Course
PC
Immunisation?
A

RNA virus
Benign self limiting course

Faeco-oral transmission
Prodromal flu like features, then jaundice and hepatomegaly

Immunisation available

112
Q

Hep A long term marker in blood following infection?

A

IgG

113
Q

Hepatitis LFT pattern?

A

ALT>AST

AST:ALT <2

114
Q 
Hepatitis B:
Type of virus
Course
PC
Mx
A

Double strand DNA virus

Can be acute or chronic

PC = Fever, jaundice and hepatomegaly

Mx = antivirals e.g. tenofovir

115
Q

Hepatitis B - complications?

A

10% get chronic infection
5% get cirrhosis
Hepatocellular carcinoma
Fulminant disease

116
Q

Hepatitis B - Vaccine course and PEP?

A

HbsAg - given over three doses
>100 = adequate
10-100 = suboptimal = 1 further dose
<10 = check for previous infection /. current infection

PEP:
If know responder give booster
Known non-responder = vaccine course and HBIG
current course ongoing = accelerate and HBIG

117
Q

Hepatitis B - serology?

A

Surface antigen appears first (HBsAg) = Anti-HBs production
HbsAg = acute infection

HbeAg results from breakdown of core antigen, seen in early infection only = HIGHLY INFECTIVE

Anti-HBc =. previous or current infection

  • IgM is only in acute infection
  • IgG persists

Anti-Hbs = immunity (from exposure or vaccine). -ve in chronic disease

118
Q

Hep B + C transmission?

A

Bodily fluids, vertical transmission too

Breastfeeding ok

119
Q

Hep C - Virus type, P, complications and Mx?

A

RNA flavivirus
PC = most asymptomatic
30% get jaundice, arthralgia and fatigue

  • Complications 60-80% get chronic disease. = cirrhosis and rheumatological manifestations
  • IFN. related depression
  • Hepatocellular carcinoma

Mx = Protease inhibitor e.g. ribavirin + IFN alpha

120
Q

Hep C - treatment SE’s?

A

Ribavirin = haemolytic anaemia + cough

IFN-alpha = depression, flu-like symptoms, leucopenia, thrombocytopaenia

121
Q

Hepatitis D - type of virus, what it needs to replicate, two types and Mx?

A

Single stranded RNA virus
needs Hep B surface antigen to replicate

  1. co-infection = get the at the same time
  2. Superinfection = Get D whilst already have hep B = big risk of cirrhosis, chronic disease and fulminant disease
122
Q

Liver flukes / Fasciola hepatica - Classic resevoir, two phases, Ix and Mx?

A

Water cress

1 = immature worm penetrates gut:

  • Fever, nausea
  • severe. abdominal pain
  • Hepatomegaly
  • Rash

2 = Worm matures in bile duct

  • Jaundice
  • intermittent pain
  • anaemia

Ix = hyper echoic on USS within middle dilated bile ducts

Mx = Triclabendazole

123
Q

What bacteria might you see in severe peritoneal infections, pungent pus

A

Bacteroides fragilis

124
Q

An example of alpha haemolytic strep?

What it causes?

A

Strep pneumoniae

Pneumonia, meningitis and otitis media

125
Q

Example of Beta haemolytic strep group A and what it causes

A

Strep pyogenes = impetigo, cellulitis, type 2 nec fac, tonsillitis / pharyngitis

Immune reaction can cause post-strep glomerulonephritis

126
Q

Example of Group B, beta haemolytic strep?

A

Agalacticae = neonatal meningitis + septicaemia

127
Q

Which bug. colonises plastic implants and forms a biofilm?

A

Staph epidermidis

128
Q

MRSA screen. - who and where, what happens if positive?

A

All elective and emergency admissions
Nose and skin swabs

Nose +ve = Mupirocin 2% TDS for 5 days
Skin +ve = chlorhexidine solution OD for 5 days

MRCS A - Clinical (4 decks)

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