Week 1 Flashcards
which gender gets infective endocarditis more
male
most common bacterial cause of infective endocarditis
streptococcus viridans
what is infective endocarditis
inflammation of the endocardium due to bacterial colonisation, commonly on valves with vegetation
why are valves more prone to bacterial colonisation
poor blood supply
which valve is most prone to infective endocarditis
mitral valve
who gets right sided infective endocarditis
IVDU
3 most common bacterial causes of infective endocarditis
streptococcus viridans
strptococcus faecalis
staph aureus
who are more prone to getting infective endocarditis caused by the HACEK organisms
IVDU
poor dental hygiene
pre-existing valvular disease
what fungal causes of infective endocarditis are there
candida albicans
aspergillus
what are 4 bacterial causes of infective endocarditis that will not culture
mycoplasma
brucella
legionella
chalmydia
risk factors of infective endocarditis
immunocompromised artificial heart valves valvular conditions hx of infective endocarditis IVDU people at risk of bacteraemia
why is prior dental procedure a risk factor for infective endocarditis
because streptococcus viridans lives in the mouth and throat and procedures can cause skin punctures and introduction of bacteria into the blood
systemic symptoms of infective endocarditis
fever flu like illness night sweats rigors weight loss malaise fatigue
signs of infective endocarditis
murmur
finger clubbing
splenomegaly
what does FROM JANE stand for
Fever
Roth’s spots
Osler’s Nodes
Murmur
Janeway lesions
Anaemia
Nail haemorrhages
Embolus
what 2 types of symptoms are found in infective endocarditis
vasculitic symptoms and immunologic symptoms
describe janeway lesions and oslers nodes
oslers nodes are painful, found on finger and toes
janeway lesions are not painful, found on palms and soles of feet
why is haematuria a sign of infective endocarditis
immunologic symptom of infective endocarditis causing glomerulonephritis
investigations of infective endocarditis
ECG, urine dipstick
Bloods and culture
imaging - CXR and ECHO
how should blood cultures be taken in infective endocarditis
3 cultures 6 hours apart
what is the diagnostic requirement for Dukes criteria
2 major
1 major 3 minor
5 minor
what are the major criteria in dukes criteria
blood culture findings
echo findings
what are the minor criteria in dukes criteria
Fever Echo findings (not major) Vasculitic symptoms Evidence from microbiology Risk factors
important questions to ask in suspected malaria case
travel history
malaria prophylaxis compliance
past history of malaria
symptoms of malaria
fever night sweats rigors headache fatigue splenomegaly
complications of malaria
renal dysfunction iron deficiency hypoglycaemia hypotension jaundice hepatosplonomegaly shock
difference between thick and thin blood films in malaria investigation
thick tells you if there is a parasite
thin tells you the species
ABCD of malaria prevention
awareness
bite prevention
chemoprophylaxis
Diagnosis
what are some typical malarial chemoprophylaxis
doxycyline
chloroquine
malarone
treatment for malaria
quinine
doxycycline
artemisinin combination therapy
what is dengue fever caused by
Flavivirus - RNA virus with 5 subtypes
which mosquito transmits malaria
anopheles
which mosquito transmits dengue
aedes egptyi
what time of the day are the malaria and dengue mosquitoes most active
malaria - morning/night
dengue - day time
symptoms of dengue fever
fever rash arthralgia retroorbital pain photophobia lymphadenopathy
what can dengue fever progress to
dengue haemorrhagic fever or dengue shock syndrome
treatment for dengue fever
supportive, fluids, blood
causative organism of typhoid?
salmonella typhii
transmission route of typhid
faecal oral, food
most common areas in the world affected by typhoid
india, SEA, africa
clinical features of typhoid
malaise, aches, anorexia
abdominal pain
bloody diarrhea
rashes
FBC features of typhoid
neutrophillia, leukopaenia, thrombocytopaenia
typhoid can be a chronic carrier status - T or F
true - treat with 28 days ciprofloxacin
5 ‘P’s of sexual history taking
sexual practices partners past sti history protection pregnancy
when to examine a person with suspected STI
only if symptomatic
what position should a female be in an STI examination
lithotomy position
4 major complaints of STI presentations
urethritis/discharge
ulcers
lumps and bumps
vaginal discharge
what STIs can cause urethritis
gonorrhea chlamydia HSV trichomonas vaginalis mycoplasma genitalium
what is the 2nd most common STI in UK
gonorrhea
which group of the population have the highest incidence of gonorrhea
males 20-24
clinical features of gonorrhea
purulent discharge urethritis inflammation at contact point depending on sexual practice systemic sysmptoms (fever sweats)
2 possible male complications of gonorrhea
epididymo-orchitis
prostatits
2 possible female complications of gonorrhea
PID
bartholinits
what can neonates get in vertical gonorrhea infections
gonococcal conjunctivities
investigation of gonorrhea
microscopy
blood cultures
what would gonorrhea look like on a microscope
gram negative intracellular diplococci
there is only 1 strain of chlamydia - T or F
F
serotypes D-K are most common of chlamydial STIs
most chlamydia infections are asymptomatic - T or F
true
clinical features of chlamydia
urethritis
cervicitis
proctitis
what STIs can cause genital ulceration
HSV
sphillis
scabies
tropical STIs like chancroid LGV
where does HSV1 and HSV2 usually infect
HSV1 usually mouth
HSV2 usually genitals
which group of the population have the highest rates of HSV infections
females 20-24
stages of HSV STI
primary infection
latent phase
reactivation
how does primary infection of HSV present
itchy, painful ulcerate genitalia
vesicles
regional painful lymphadenopathy
systemic features - fever, headache myalgia
where does the HS virus remain latent
dorsal ganglia
how does HSV reactivation look like
genital cold sores
how to diagnosis HSV STI
clinical appearance
blood tests are useful in HSV investigation - T or F
F - many people are asymptomatic carriers
treatment for HSV STI
aciclovir
which strains of HPV are most responsible for genital warts
6 and 11
how does HPV warts look like
painless genital warts
what is the primary causative organism of bacterial vaginosis
gardenerella vaginalis
which 2 groups of females are more prone to bacterial vaginalis
IUCD and WSW
symptoms of bacterial vaginalis
discharge
foul smelling - like fish
describe the discharge in bacterial vaginalis
thin, homogenous grey vaginal discharge (NOT purulent)
how to diagnose bacterial vaginosis
wet film, gram smear
look for clue cells and mixed flora
symptoms of candidiasis
itchy, dry yeasty smell vaginal discharge
microscopy features of candidiasis
spores and pseudohyphae
what causes trichomoniasis
bacteria - trichomoniasis vaginalis
symptoms of trichominiasis
offensive vaginal discharge - green or yellow
microscopy features of trichomoniasis
motile trichomonads
what route is hepatitis A spread by
faecal oral
symptoms of hepatitis A
systemic - fever, malaise, ruq pain, anorexia, arthralgia
jaundice
complications of hepatitis A
fuliminant liver failuer
encephalopathy
investigations of hepatitis A
FBC - lymphocytic LFTs - hepatitic piture Clotting - raised PT Bilirubin - raised if jaundiced ESR: raised
which viral hepatitis infections have vaccines
Hep A and B
transmission of hepatitis B via?
blood, bodily fluids
symptoms of Hepatitis B
generalised malaise, arthralgia, anorexia, mild fever, RUQ pain, jaundice
what are the different possibilities after infection with Hepatitis B virus
active infection resolution chronic hepatits B infection fulminant liver failure hepatocellular carcinoma
which blood protein is sensitive for hepatocellular carcinoma
alpha-fetoprotein
6 types of serological markers in hepatitis B
HBsAg HBeAG antiHB C IgM antiHB C IgG HBe AB HBs AB
serological markers in hepatitis B of
active infection
HBs Ag
HBe Ag
HBC IgM
HBV DNA
serological markers in hepatitis B of
chronic infection
HBs Ag
HBe Ag
HBC IgG
HBV DNA
serological markers in hepatitis B of
resolved infection
Anti HBs Ab
Anti HBc IgG
Anti HBe Ab
-ve HBV DNA
serological markers in hepatitis B of
immunity from vaccination
anti HBs Ab
which hepatitis B serological marker is a sign of infectivity
HBe Ag
how does hepatitis D happen
co-infection (same time) or superinfection (after) with hepatitis B
which is worse with hepatitis D co infection or superinfection?
superinfection
what risk is increased in hepatitis D superinfection
liver cirrhosis, failure and HCC
there is a vaccine for hepatitis C T or F?
F
most hepatitis C cases resolve within a month and never appear again - T or F
False- 75% of acute cases become chronic
hepatitis C or B which is more likely to cause cirrhosis and HCC
C
why is hep C more likely to cause long term damage?
because it can exist for decades before becoming detectable
