Week 7 - Clinical Microbiology 2 Flashcards

Question

Describe the 3F's transmission of GI infections?

Answer 1

1. Food- contamination (farm to fork), cross-contamination (distribution chain or domestic kitchen) 2. Fluids- water, contaminated juices etc 3. Fingers- importance of washing hands (after toileting, before & after preparing or consuming food and drinks)

Answer 2

- Infectious dose | - Ability to contaminate & persist in the environment

Answer 3

Vomiting, abdominal pain, diarrhoea, frequency & nature of symptoms, travel history, food history, other affected individuals, speed of onset of illness, blood in stools

Answer 4

Contains nutrients that promote preferential growth of the pathogen

Answer 5

Suppress growth of background flora while allowing growth of the pathogen

Answer 6

Antibiotic treatment reserved for severe/prolonged symptoms

Answer 7

1. May prolong symptom duration 2. May exacerbate symptoms 3. Promotes emergence of antibiotic resistance 4. May actually be harmful e.g. STEC infection

Answer 8

1. Adequate public health measures 2. Education in hygienic food preparation 3. Pasteurisation of milk & dairy products 4. Sensible travel food practices

Answer 9

- Microaerophilic and thermophilic (42oC) | - Culture on Campylobacter selective agar

Answer 10

Curved Gram-negative bacilli

Answer 11

Campylobacter 1

Answer 12

- Large animal reservoir (poultry, cattle, sheep, rodents & wild birds) - Marked seasonal peaks of infection in May & September - Large point source outbreaks uncommon (doesn’t multiply in food)

Answer 13

- Via contaminated food (esp. poultry), milk or water | - Person-to person spread rare

Answer 14

- Inflammation, ulceration & bleeding in small & large bowel - Bacteraemia can occur (extremes of age, immunocompromised)

Answer 15

Post-infectious demyelination syndrome (Guillain-Barre), | characterised by ascending paralysis

Answer 16

1. Bloody diarrhoea 2. Cramping abdominal pain 3. Vomiting is not usually a feature 4. Fever

Answer 17

- Fluid replacement - Clarithromycin for severe/persistent disease - Quinolone (e.g. ciprofloxacin) or aminoglycoside (e.g. gentamicin) for invasive disease

Answer 18

1. Reduction of contamination in raw, retail poultry meat | 2. Adequate cooking

Answer 19

Gram-negative bacilli

Answer 20

- Member of the Enterobacteriaceae - Non-lactose fermenters - XLD plates most commonly used in clinical labs

Answer 21

- Found in a wide range of warm & cold blooded animals - Secondary spread via person-to-person transmission may be a feature - Seasonal peaks in summer and autumn

Answer 22

Salmonella Typhi & Salmonella Paratyphi

Answer 23

- Via contaminated food, especially pork, poultry & other meat & milk/dairy products - Waterborne infection less common

Answer 24

- Diarrhoea - Bacteraemia can occur (extremes of age, immunocompromised) - Distant organs may become seeded to establish metastatic infection e.g. osteomyelitis, septic arthritis, meningitis etc.

Answer 25

Due to invasion of epithelial cells in the distal small intestine, & subsequent inflammation

Answer 26

1. Watery diarrhoea 2. Vomiting is common 3. Fever can occur, & is usually associated with more invasive disease

Answer 27

- Fluid replacement - Antibiotics reserved for severe infections & bacteraemia - Antibiotics & antimotility agents prolong excretion of salmonellae in the faeces

Answer 28

1. Beta-lactams 2. Quinolones 3. Aminoglycoside

Answer 29

The introduction of immunisation of poultry flocks lead to a dramatic reduction in S.Enteritidis in the UK

Answer 30

Gram-negative bacilli

Answer 31

- Member of the Enterobacteriaceae - 4 species - Non-lactose fermenters (useful in differential media) - XLD plates most commonly used in clinical labs

Answer 32

1. Shigella sonnei associated with milder infections 2. Shigella boydii & S. flexneri associated with more severe disease 3. Shigella dysenteriae associated with most severe disease

Answer 33

- S.dysenteriae in developing world - Large outbreaks can occur - Does not persist in the environment (unlike V. cholerae) - Contaminated food and water less important - Recent outbreaks associated with MSM

Answer 34

Diarrhoeal disease in children

Answer 35

Person-to-person spread via faecal-oral route is most important- associated with low infectious dose

Answer 36

- Organisms attach to & colonise mucosal epithelium of terminal ileum & colon - Systemic invasion is not a feature

Answer 37

Produces a potent protein exotoxin (Shiga toxin) which not only damages intestinal epithelium, but in some patients targets glomerular endothelium causing renal failure as part of haemolytic-uraemic syndrome (HUS)

Answer 38

1. Dysentery 2. Initially watery diarrhoea followed by bloody diarhoea 3. Marked, cramping abdominal pain 4. Vomiting is uncommon 5. Fever is usually present

Answer 39

- Usually self-limiting | - Fluid replacement is usually sufficient

Answer 40

Treatment of renal failure

Answer 41

Only found in humans, so good standards of sanitation & personal hygiene are key measures

Answer 42

Comma-shaped Gram-negative bacilli

Answer 43

- Serotypes defined on basis of “O” antigens - Sucrose-fermenter - Thiosulphate-bile sucrose selective/differential medium

Answer 44

1. SerotypeO1- Classical, El Tor (less severe disease, more carriage, better persistence in environment) 2. SerotypeO139

Answer 45

- Spreads via contaminated food or water | - Direct person-to-person transmission uncommon

Answer 46

- Flagellae & mucinase facilitate penetration of intestinal mucous - Attachment to mucosa by specific receptors - Diarrhoea due to production of a potent protein exotoxin

Answer 47

Severe, profuse, non-bloody, watery diarrhoea (rice water stool)

Answer 48

1. Hypokalaemia 2. Metabolic acidosis 3. Hypovolaemic shock 4. Cardiac failure

Answer 49

- Prompt oral or IV rehydration is lifesaving (mortality reduced to <1%) - Tetracycline antibiotics may shorten duration of shedding

Answer 50

1. No animal reservoir | 2. Clean drinking water supply & proper sanitation are key preventative measures

Answer 51

Gram-negative bacilli

Answer 52

Enterobacteriaceae

Answer 53

Gut flora of man & animals

Answer 54

1. Enteropathogenic E. coli (EPEC) 2. Enterotoxigenic E. coli (ETEC) 3. Enterohaemorrhagic E. coli (EHEC) 4. Enteroinvasive E.coli (EIEC) 5. Entero-aggregative E.coli (EAEC) 6. Diffuse aggregative E.coli (DAEC)

Answer 55

Virulence factors which enable them to cause infections

Answer 56

- No differential media available - Test selection of colonies using polyvalent antisera for common EPEC 􏱠"O􏰅" types - Not routinely done

Answer 57

- Sporadic cases & outbreaks of diarrhoea in infants & children - Cause of some cases of 􏱠traveller􏰎s􏰅 diarrhoea

Answer 58

Initial adherence via pili, followed by formation of characteristic 􏱠attatching & effacing􏰅 lesion mediated by intimin protein and Tir (translocated intimin receptor) with disruption of intestinal microvilli

Answer 59

1. Watery diarrhoea 2. Abdominal pain 3. Vomiting 4. Often accompanied by fever

Answer 60

1. Heat-labile (LT)- Structural & functional analogue of cholera toxin 2. Heat-stable (ST)- Produced in addition to or instead of LT, similar mode of action

Answer 61

- No differential media available - Test liquid cultures for production of toxins by immunoassays - Not routinely done

Answer 62

1. Watery diarrhoea 2. Abdominal pain 3. Vomiting 4. No associated fever

Answer 63

- More than 100 serotypes - Best known is E.coli O157:H7 - O157 is a non-sorbitol fermenter. Sorbitol MacConkey agar (SMAC)

Answer 64

- Outbreaks & sporadic cases worldwide (~250 cases/year in Scotland) - Large animal reservoirs (esp. cattle & sheep) - Persistent in environment - Secondary person-to-person spread important (associated with low infectious dose)

Answer 65

- Consumption of contaminated food, water & dairy products - Direct environmental contact with animal faeces e.g. petting zoos

Answer 66

- Attaching & effacing lesion (similar to EPEC) | - Production of Shiga-like toxins

Answer 67

Structural & functional analogue of Shigella dysenteriae toxin, sometimes strains called STEC (shiga-toxin producing EC) or VTEC (verotoxin- producing EC) because toxins are toxic for cultured vero cells

Answer 68

1. Bloody diarrhoea 2. Abdominal pain 3. Vomiting 4. No associated fever

Answer 69

Haemolytic uraemic syndrome (5-10% of cases) - Microangiopathic haemolytic anaemia - Thrombocytopaenia - Acute renal failure

Answer 70

Enterohaemorrhagic E. coli (EHEC)

Answer 71

1. EPEC | 2. ETEC

Answer 72

- Adequate rehydration - Antibiotics not indicated, & in the case of EHEC may increase risk of HUS - Antimotility agents also increase HUS risk

Answer 73

Gram-positive cocci

Answer 74

Enterotoxins (types A-E)

Answer 75

- Food is contaminated by human carriers - Especially cooked meats, cakes and pastries - Bacteria multiply at room temperature & produce toxins

Answer 76

Heat stable & acid-resistant protein toxins

Answer 77

30 mins- 6hrs

Answer 78

1. Profuse vomiting 2. Abdominal cramps 3. No fever & no diarrhoea

Answer 79

Self-limiting disease

Answer 80

1. Hygienic food preparation to minimise contamination | 2. Refrigerated storage

Answer 81

Aerobic, spore-forming Gram-positive bacilli

Answer 82

Spores & vegetative cells contaminate wide range of foodstuffs

Answer 83

1. Emetic disease | 2. Diarrhoeal disease

Answer 84

- Typically associated with fried rice - Spores survive initial boiling - If rice is bulk cooled & stored prior to frying, the spores germinate, multiply and re-sporulate - Protein enterotoxin produced during sporulation - Heat stable toxin survives further frying

Answer 85

- Spores in food survive cooking, germinate & organisms multiply in food - Ingested organisms produce a heat-labile toxin in the gut with similar mode of action to cholera toxin

Answer 86

1. Profuse vomiting 2. Abdominal cramps 3. Watery diarrhoea 4. No fever

Answer 87

1. Watery diarrhoea 2. Cramping abdominal pain 3. No vomiting 4. No fever

Answer 88

Self-limiting disease

Answer 89

Anaerobic, spore-forming Gram-positive bacilli

Answer 90

- Spores & vegetative cells ubiquitous in soil & animal gut - Contaminated foodstuff (usually meat products) - Often involves bulk-cooking of stews, meat pies

Answer 91

- Spores survive cooking, germinate & organisms multiply in cooling food - Food inadequately re-heated to kill organisms - Organisms ingested & sporulate in large intestine with production of enterotoxin

Answer 92

1. Watery diarrhoea 2. Abdominal cramps 3. No fever & no vomiting

Answer 93

Self-limiting disease

Answer 94

1. Rapid chilling/freezing of bulk-cooked foods | 2. Thorough re-heating before consumption

Answer 95

Anaerobic, spore-forming Gram-positive bacilli

Answer 96

Laboratory diagnosis based upon toxin detection

Answer 97

- Spores & vegetative cells ubiquitous in soil & animal GIT - Produces powerful heat-labile protein neurotoxin (types A, B & E cause human disease) - Absorbed toxins spread via bloodstream & enter peripheral nerves where they cause neuromuscular blockade at the synapses

Answer 98

1. Foodborne botulism- pre-formed toxin in food. Commonly associated with improperly processed canned foods 2. Infant botulism- organisms germinate in gut of babies fed honey containing spores, & toxins are produced in gut 3. Wound botulism- organisms implanted in wound produce toxin

Answer 99

- Neuromuscular blockade results in flaccid paralysis & progressive muscle weakness - Involvement of muscles of chest/diaphragm causes respiratory failure - High mortality if untreated

Answer 100

- Urgent intensive supportive care due to difficulties breathing and swallowing - Antitoxin

Answer 101

1. Proper manufacturing controls in canning industry 2. Hygienic food preparation 3. Proper cooking 4. Refrigerated storage

Answer 102

Anaerobic, spore-forming Gram-positive bacilli

Answer 103

- Spores resistant to heat, drying, disinfection, alcohol | - Clinical features due to production of potent toxins (A+B)

Answer 104

- Spores & vegetative cells ubiquitous in environment - Infection requires disruption of the normal “protective” gut flora - Major cause of healthcare associated infections

Answer 105

- Mild to severe with abdominal pain | - Relapses are common & may be multiple

Answer 106

Pseudomembranous colitis (may be fatal)

Answer 107

Colonic dilatation & perforation

Answer 108

- Stop precipitating antibiotics - Oral metronidazole (mild [0 severity markers]) - Oral vancomycin (severe [≥ 1 severity markers or no improvement after 5 days metronidazole])

Answer 109

Faecal transplant

Answer 110

1. Antimicrobial stewardship 2. Infection Prevention & Control measures (source isolation, hand hygiene, PPE) 3. Cleaning/disinfection with hypochlorite disinfectants

Answer 111

Gram-positive coccobacilli

Answer 112

- Selective culture media available for culture from suspect foods - Standard laboratory for blood & CSF samples

Answer 113

- Widespread among animals & environment - Pregnant women, elderly & immunocompromised - Mortality high - Can multiply at 4oC - Invasive infection from GIT results in systemic spread via bloodstream

Answer 114

Contaminated foods, especially unpasteurised milk and soft cheeses, pate, cooked meats, smoked fish & coleslaw

Answer 115

Initial flu-like illness, with or without diarrhoea

Answer 116

Severe systemic infection ie. septicaemia, meningitis

Answer 117

IV antibiotics (usually Ampicillin & synergistic gentamicin)

Answer 118

1. Susceptible groups should avoid high risk foods 2. Observe use by dates 3. Wash raw fruit & vegetables & avoid cross contamination

Answer 119

Gram-negative spiral shaped bacilli

Answer 120

- Microaerophilic | - Urease-positive

Answer 121

- Detection of faecal antigen or urea “breath test” | - Serum antibody tests mainly of use in epidemiological surveys of past or current infection

Answer 122

- Faecal-oral or oral-oral - Humans are the only reservoir - Infection acquired in childhood & persists life long unless treated

Answer 123

Complex & involving cytotoxin production, & a range of factors to promote adhesion and colonisation

Answer 124

- Infection is asymptomatic unless peptic ulceration develops - Now established as cause of >90% of duodenal ulcers & 70-80% of gastric ulcers - Gastric cancer risk

Answer 125

Combined treatment with a proton pump inhibitor & combinations of antibiotics (clarithromycin & metronidazole) eradicates carriage & facilitates ulcer healing

Answer 126

1. Bacteriophages 2. Plasmids 3. Transposons

Answer 127

- Even if a stool sample is sent diagnostic yield is <50% - Reliant on differential/selective media - Lack sensitivity - Not available for may organisms/pathotypes - Expensive, demanding & slow

Answer 128

- Rapid expansion of molecular diagnostics - Target 􏰎generic􏱠 pathogen groups & pathogenicity genes - Rapidly screen for range of pathogens simultaneously (Bacteria, Viruses, Protozoa) - Transform ability to understand & control GI infections

Answer 129

Inflammation of the stomach & intestines cases by virus(es)

Answer 130

1. Children under age 5 2. Old age people especially in nursing home 3. Immunocompromised

Answer 131

1. Norovirus (Norwalk virus) 2. Sapovirus 3. Rotavirus 4. Adenovirus 40 & 41 5. Astrovirus

Answer 132

Can affect all ages & healthy individuals but often most serious in young & elderly

Answer 133

Affects mainly children under 2 years, elderly & immunocompromised

Answer 134

- Non enveloped, single stranded RNA virus | - 5 genotypes, only 3 affect humans (GI, GII and GIV)

Answer 135

GII-4 strain

Answer 136

1. Person to Person (faecal-oral, aerosolised e.g. by toilet flush, fomites) 2. Food-borne 3. Water

Answer 137

- Infectious dose very small (10-100 virions) - Can affect all ages - Very stable & may remain viable for long periods of time in the environment

Answer 138

24-48 hour

Answer 139

Up to 3 weeks after infection

Answer 140

1. Can be asymptomatic 2. Vomiting 3. Diarrhoea 4. Nausea 5. Abdominal cramps 6. Headache, muscle aches 7. Fever (minority) 8. Dehydration in young & elderly

Answer 141

Usually lasts 12-60 hours

Answer 142

1. Significant proportion of childhood hospitalisation 2. Hospital outbreaks lasts longer with an increased risk of mortality 3. In elderly increased post infection complications 4. Chronic diarrhoea & virus shedding in both solid organ transplant patients & bone marrow transplant patients

Answer 143

1. Oral &/or IV fluids 2. Antispasmodics 3. Analgesics 4. Antipyretics

Answer 144

6-14 weeks

Answer 145

Incomplete understanding of immunity & the fact norovirus can’t be cultured

Answer 146

Expression of human histo-blood group antigens (HBGAs) & the susceptibility to norovirus infection

Answer 147

- Isolation or cohorting - Exclude symptomatic staff until symptom free for 48 hours - Do not move patients - Do not admit new patients - Thorough cleaning of ward/hotel/cruise ship/bus 48hrs after last case symptomatic - Patient/visitor/passenger/guest awareness

Answer 148

Contaminated hands

Answer 149

- Double stranded, non enveloped RNA virus - 5 predominant strains G1-4, G9 - 11 strands of RNA so potential for much antigenic variation

Answer 150

>70% infections

Answer 151

- Low infectious dose (10-100 virus particles) - Mainly person to person via feaco-oral or fomites - Food & water borne spread is possible - Spread via respiratory droplets is speculated

Answer 152

If it is the 1st infection or reinfection

Answer 153

1. Watery diarrhoea 2. Abdominal pain 3. Vomiting 4. Loss of electrolytes leading to dehydration

Answer 154

- 1st infection after age 3 months is usually the most severe - Re-infection can occur at any age - Hospital outbreaks in paediatric wards common

Answer 155

1. Severe chronic diarrhoea 2. Dehydration 3. Electrolyte imbalance 4. Metabolic acidosis 5. Immunodeficient children may have more severe or persistent disease

Answer 156

- 1st Infection doesn't lead to permanent immunity - By age 3, 90% of children have serum antibodies to 1 or more types - Young children may suffer up to 5 re-infections by age 2 years of age

Answer 157

Rotarix® (came out in July 2013)

Answer 158

Over 85% effective at protecting against severe rotavirus gastroenteritis in the first 2 years of life

Answer 159

- Double stranded DNA virus | - >50 serotypes causing range of illnesses

Answer 160

Adenovirus 40 & 41

Answer 161

1. Fever | 2. Watery diarrhoea

Answer 162

Supportive

Answer 163

No vaccine

Answer 164

Single stranded, non enveloped RNA virus

Answer 165

- Less severe gastroenteritis than other enteric pathogens | - Infection usually as sporadic cases but can be outbreaks, usually in young children

Answer 166

Polymerase chain reaction (PCR) which detects the DNA or RNA, Testing done at Virology lab, GRI

Answer 167

Vomit or stool

Answer 168

1. Poliovirus (& all other enteroviruses) 2. Adenoviruses OTHER THAN types 40 & 41 3. Hepatitis A/E

Answer 169

1. Loss of cartilage --> Osteoarthritis in later life | 2. Severe sepsis --> Septic shock

Answer 170

- Single hot joint: Knee 50%, Hip 20% - Polyarticular involvement in 10-20% of patients - Loss of movement - Pain

Answer 171

1. Blood cultures 2. Joint Aspirate (Gram, microscopy for crystals and culture) 3. FBC 4. CRP 5. Imaging

Answer 172

1. MSSA/MRSA 2. Streptococci (S. pyogenes, Group G Strep, pneumococcus) 3. H. influenzae 4. Kingella 5. N. meningitidis 6. N. gonorrhoeae 7. E.coli 8. P. aeruginosa 9. Salmonella species

Answer 173

- At least 2 weeks IV antibiotics | - Often 3 weeks IV antibiotics followed by 3 weeks oral

Answer 174

CRP & clinical

Answer 175

Putting in an artificial joint

Answer 176

Taking the diseased | joint out & putting in an artificial one

Answer 177

Re-operating on an artificial joint

Answer 178

Fusing 2 bones together

Answer 179

Allowing 2 bones to articulate against 1 another but without a joint e.g. Girdlestone

Answer 180

1. Rheumatoid arthritis 2. Diabetes mellitus 3. Poor nutritional status 4. Obesity 5. Concurrent UTI 6. Steroids 7. Malignancy

Answer 181

1. Prior joint surgery 2. Prolonged operating room time 3. Pre-op infection (teeth, skin, UTI)

Answer 182

1. S. aureus 2. Coagulase-negative staphylococci 3. Streptococci 4. Gram-negative bacilli 5. Anaerobic organisms

Answer 183

1. Haematogenous Spread (20-40%) | 2. Local Spread (60-80%)

Answer 184

- Mostly organisms from skin surface - Direct communication between skin surface & prosthesis while fascial planes heal - Usually manifests in immediate post-op period (acute <4 weeks)

Answer 185

2 or more years after surgery (delayed/late >4 weeks)

Answer 186

- Presents later - Intact surrounding connective tissue often limits infection to bone/cement interface - Can be any organism

Answer 187

Ability to infect

Answer 188

Low grade indolent infections which are tenacious e.g. coagulase negative staphylococci

Answer 189

Fulminant infection or septic shock e.g. MSSA, MRSA, Group A or G Beta Haemolytic Streptococcus

Answer 190

Avascular surface allow survival of bacteria as protects from circulating immunological defences & most antibiotics

Answer 191

Inhibit phagocytosis & lymphocyte/ complement function

Answer 192

1. Pain 2. Effusion 3. Warm joint 4. Fever & systemic symptoms 5. Prosthetic joint- Loosening on Xray, Discharging sinus, Mechanical dysfunction

Answer 193

- Single pre-op dose cephalosporin reduces risk of deep wound infection by 1.8% (3% to 1.2%) - Single pre-op dose & 2 post op doses reduce risk of deep wound infection by 2.9% (4.3% to 1.4%) - Evidence supports use of cephalosporin (+ vancomycin/teicoplanin if MRSA) in prevention of PJI (but not C. difficile)

Answer 194

Debride, Antibiotics, Implant Retained

Answer 195

If prosthesis infection is acute (<30 days since insertion), then it is still mechanically functional & can be kept in but infected tissues should be debrided & the joint washed out to reduce the burden of infection then IV antibiotics started for 4-6 weeks

Answer 196

- If the infection occurs over 30 days since surgery then it may no longer be fully functional & may need removed - Removal involves taking out the prosthesis & all cement (can􏰎t heal if foreign body retained)

Answer 197

1. Girdlestone procedure 2. 1 stage revision (put a new one in during the same operation as removing the infected one) 3. 2 stage revision (delay putting in a new 1 until treated the existing infection for 4-6 weeks)

Answer 198

Chances of success & cure of infection reduce dramatically due to anatomical distortion & infection becomes harder to suppress making amputation a possibility

Answer 199

Tissue or pus or fluid is always preferable to a surface swab

Answer 200

1. Macroscopic appearance 2. Histopathology 3. Microbiology

Answer 201

1. Bacteria present in very small numbers & require longer time to grow 2. Bacteria died in transit if there was delay reaching the lab/if it was a fastidious organism e.g.anaerobes 3. Antibiotics given pre-op (rarely necessary before revision surgery & 2 days to 2 weeks antibiotic free pre-op is ideal)

Answer 202

Needs to penetrate to bone (cephalosporins, tazocin, carbapenems, fusidic acid, doxycycline, rifampicin, linezolid, trimethoprim, ciprofloxacin,clindamycin)

Answer 203

Oral antibiotics are unlikely to suppress infection if a prolonged course of IV therapy has not already been given & the CRP hasn'􏰎t begun to normalise or treating a virulent organism

Answer 204

Combination therapies which include rifampicin (rifampicin & ciprofloxacin)

Answer 205

If they have a life threatening infection

Answer 206

- Multiple intra-operative specimens to microbiology from at least 5 different sites - Debrided tissue to a histopathologist

Answer 207

1. Start antibiotics rationally based on antibiograms & using drugs that penetrate bone 2. Do not stop IV antibiotics immediately post-operatively 3. Measure CRP regularly

Answer 208

Progressive infection of bone characterised by death of bone & the formation of sequestra (piece of dead bone tissue formed within a diseased or injured bone)

Answer 209

1. Haematogenous spread | 2. Contiguous spread- overlying infection (e.g. cellulitic ulcer), trauma (compound fracture), surgical inoculation

Answer 210

Children than adults

Answer 211

- Often undertreated with oral antibiotics & so may recur - Causative bacteria similar to septic arthritis but also include anaerobes

Answer 212

1. Debulk infection back to healthy bone & manage dead space that remains (e.g. with muscle flaps) 2. Stabilise infected fractures (external fixation often used) & debride sinuses & close wounds

Answer 213

- Antibiotic choice is determined by what grows from debrided bone - May require long term antibiotic treatment (4- 6 weeks IV)

Answer 214

- More complex than septic arthritis | - Usually involves bone (osteomyelitis) but can also involve joints

Answer 215

Need to optimise diabetic control as well as treat infection so should involve a diabetologist

Answer 216

- Infection of a disc space & adjacent vertebral end plates - Similar organisms to septic arthritis & osteomyelitis

Answer 217

Can be very destructive with deformity, spinal instability risking cord compression, paraplegia & disability

Answer 218

Tuberculosis

Answer 219

- Host defense defect - Large innoculum - Increased virulence

Answer 220

1. Streptococcus pneumoniae (most common) 2. Haemophilus influenzae 3. Moraxella catharralis

Answer 221

1. Mycoplasma pneumoniae 2. Legionella pneumoniae 3. Chlamydophila pneumoniae 4. Chlamydophila psittaci

Answer 222

S. pneumoniae

Answer 223

1. Decreased immune function from disease or drugs (HIV, flu) 2. Smoking 3. Lung disease, asthma 4. Alcohol 5. Cancer 6. Heart disease

Answer 224

1. Abrupt Onset 2. Cough 3. Fever 4. Pleuritic chest pain

Answer 225

1. Dull percussion 2. Coarse crepitations 3. Increased vocal resonance

Answer 226

1. Macrolides (clarithromycin) | 2. Tetracyclines (doxycycline)

Answer 227

1. Older people | 2. Underlying lung disease

Answer 228

Type B (does not cause pneumonia)

Answer 229

Colonisation of upper respiratory tract

Answer 230

1. Abrupt Onset 2. Cough 3. Fever 4. Pleuritic chest pain

Answer 231

1. Dull percussion 2. Coarse crepitations 3. Increased vocal resonance

Answer 232

Some Haemophilus influenzae produce β-Lactamase

Answer 233

1. Co-amoxiclav 2. Macrolides (clarithromycin) 3. Tetracyclines (doxycicline)

Answer 234

- Smallest free living bacterium - Lack of cell wall - Very difficult to grow

Answer 235

- Spreads person-person | - Autumn & winter have the highest rates

Answer 236

Atypical, may have flu-like illness with a cough

Answer 237

1. Haemolysis (cold agglutinins) 2. Guillain-Barre 3. Erythema multiforme 4. Cardiac 5. Arthritis

Answer 238

- Can't culture - Serology - PCR (sputum/throat swab) most common

Answer 239

Beta lactams (penicillins/cephalosporins)

Answer 240

1. Macrolides (clarithromycin) 2. Tetracyclines (doxycycline) 3. Quinolones (ciprofloxacin)

Answer 241

- Humans inhale it from sources & it infects macrophages which get into the lungs - Organisms exist in the environment as amoeba's - Outbreaks in hotels through air-con & water systems (hot tubs)

Answer 242

Atypical (tired, fever etc)

Answer 243

- Culture (rare) - Serology - Urinary antigen test (most common)

Answer 244

Beta lactams (penicillins/cephalosporins)

Answer 245

1. Macrolides (clarithromycin) 2. Quinolones (ciprofloxacin) 3. Tetracyclines (doxycicline)

Answer 246

1. Fever 2. Cough/sputum 3. Chest pain 4. Insidious/abrupt onset 5. Non respiratory symptoms

Answer 247

1. Underlying lung disease | 2. Immunosupression

Answer 248

1. Ill contacts 2. Travel 3. Water exposure

Answer 249

1. CURB65 score | 2. Sepsis - qSOFA

Answer 250

``` C - Confusion U- Urea>7 R- Respiratory rate ≥ 30 B- BP, diastolic<60 or systolic <90 65- Age over 65 years ```

Answer 251

- Systolic BP< 100mmHg - Altered mental status - Respiratory rate > 22 breaths/min

Answer 252

Multilobar consolidation on CXR &/or Hypoxia on room air

Answer 253

1. FBC 2. U&Es 3. ABGs/Oxygen sats

Answer 254

1. Blood cultures 2. Sputum culture 3. Throat swab 4. Urine Legionella antigen

Answer 255

1. Chest X-ray | 2. ECG

Answer 256

A- Airway (Conscious level?) B- Breathing (Oxygen, ITU) C- Circulation (shock-fluids)

Answer 257

1. CURB65- mortality increase with score 2 or more 2. Sepsis qSOFA score 3. Hypoxia

Answer 258

Acute respiratory viruses

Answer 259

1. Rhinovirus | 2. Coronavirus

Answer 260

1. Adenovirus (12-23%) 2. Rhinovirus 3. Influenza 4. Parainfluenza

Answer 261

Parainfluenza virus (1-4)

Answer 262

1. Influenza | 2. RSV

Answer 263

- Usually self-diagnosed - Sore “scratchy” throat - Rhinorrhoea - Nasal obstruction - Persists ~ 1 week

Answer 264

1-3 days after viral infection

Answer 265

1. Otitis media | 2. Sinusitis

Answer 266

1. Elderly 2. Immunocompromised 3. Asthma 4. COPD 5. CF

Answer 267

- ssRNA - 3 species RV-A, RV-B, RV-C - >100 types

Answer 268

- ssRNA - Largest RNA virus genome - Enveloped

Answer 269

- Sore throat & pharyngeal inflammation - Viral infections 25-45% - 82% occurrence in infectious mononucleosis ie. Epstein Barr Virus (EBV), Saliva spread - HIV seroconversion illness - Herpes simplex virus

Answer 270

Viral cause (monitor at home, gargle with salt water)

Answer 271

Bacterial cause (come to health centre)

Answer 272

- Commonly encountered childhood infectious syndrome - Distinctive cough - Mostly mild but responsible for significant emergency visits (rapid onset, difficult breathing)

Answer 273

Supportive

Answer 274

- Lower respiratory tract infection of young children - Leading cause hospitalisation in infants - Most children infected by 2 yrs of age - Reinfections are common but less severe

Answer 275

- Wheezing, tachycardia | - Persistent cough for up to 3 weeks

Answer 276

Development of asthma

Answer 277

1. Immunocompromised 2. Adults with chronic lung disease 3. Elderly

Answer 278

- Ribavirin (oral, IV, aerosolised) has been used but benefit unclear - It has numerous side-effects

Answer 279

A prophylatic monoclonal antibody is available (Palivizumab/Synagis) given IM monthly

Answer 280

Annual epidemics & occasional pandemics

Answer 281

3 types (A-C)

Answer 282

1. Headache 2. Fever 3. Tiredness 4. Aches 5. Vomiting 6. Coughing 7. Runny nose 8. Sore throat

Answer 283

1. Acute otitis media (children) 2. Sinusitis 3. Pneumonia 4. Exacerbation of underlying diseases 5. Dehydration (infants)

Answer 284

1. Encephalopathy 2. Reye syndrome (children) 3. Myositis 4. Myocarditis 5. Febrile seizures

Answer 285

1. Neurological 2. Hepatic 3. Renal 4. Pulmonary 5. Chronic cardiac 6. Diabetes mellitus 7. Severe immunosuppression 8. Age >65 years 9. Children <6 months 10. Pregnancy (inc. up to 2 weeks post partum) 11. Morbid obesity (BMI≥40)

Answer 286

1. M2 Inhibitors 2. IMP dehydrogenase inhibitors 3. RNA polymerase inhibitors 4. Neuraminidase inhibitors

Answer 287

1. Amantadine | 2. Rimantadine

Answer 288

1. Favipiravir | 2. Baloxavir

Answer 289

1. Oseltamivir 2. Zanamivir 3. Peramivir 4. Laninamivir

Answer 290

Humans, swine, birds

Answer 291

Humans only

Answer 292

Antigenic drift (point mutations of HA & NA genes)

Answer 293

- Live & inactivated influenza vaccines - Offered to risk groups: healthcare workers & children - Manufactured annually - Reduces severity, hospitalisations & death

Answer 294

1. Trivalent vaccine 2. Adjuvanted trivalent vaccine (given to >65yrs) 3. Quadrivalent vaccine

Answer 295

Live attenuated intranasal influenza vaccine

Answer 296

- 2 influenza A types & 2 influenza B types - Manufactured annually - 83% effective

Answer 297

- Worldwide epidemics of a newly emerged strain of influenza | - New virus spreads widely, easily, and causes more serious illness

Answer 298

Antigenic shift

Answer 299

Avian Influenza outbreak in Asia & Middle East

Answer 300

Acute respiratory distress syndrome

Answer 301

Oseltamivir

Answer 302

Coronaviruses more than the common cold

Answer 303

- Fatality rate 9.5% - Contained in 2003 - 3 cases accidental release lab stored strain in May 2004 - NO NEW CASES REPORTED SINCE 2004

Answer 304

Flu-like illness (transmission unlikely)

Answer 305

1. Dyspnoea 2. Vomiting 3. Diarrhoea 4. Chest pain 5. Cough (transmission)

Answer 306

1. ARDS 2. Renal failure 3. Multi-organ failure (transmission)

Answer 307

1. Electron microscopy | 2. Tissue culture

Answer 308

1. Improves the diagnosis of previously under diagnosed infections 2. Rapid 3. Rapidly developed to detect new pathogens 4. Monitoring of the effectiveness of treatment 5. Reduces unnecessary antibiotic treatment 6. Informs public health 7. Vaccine effectiveness 8. New treatments

Answer 309

Point of Care Testing

Answer 310

- Gargle - 20 min for positive test - Distinguish between Flu A, Flu B & RSV

Answer 311

1. Resistance 2. Epidemiology 3. Outbreak investigation

Answer 312

Mycobacterium tuberculosis

Answer 313

1. Ziehl Neelsen Stain | 2. Auramine stain (not specific)

Answer 314

1. M. tb 2. M. bovis 3. M. kansasii 4. M. chelonae 5. M. abscessus 6. M. fortuitum 7. M. leprae

Answer 315

- M. Tuberculosis inhaled & goes into the lungs - Taken up by macrophages - Can form a TB lesion in lungs - Haematogenous spread in 90-95% - 5-10% progress to cavitary TB

Answer 316

In situ PCR

Answer 317

1. Immunosuppression 2. HIV infection 3. Smoking

Answer 318

Cavities open into the bronchi, allowing spread of M. tuberculosis through coughing

Answer 319

Ghon complex (calcified areas)

Answer 320

- Healing, Calcification & dormant organisms | - This can lead to reactivation or reinfection --> Secondary (cavitary) TB

Answer 321

Goes on to be progressive primary TB

Answer 322

1. Certain racial groups 2. Children 3. Immunocompromised hosts

Answer 323

Apical destruction

Answer 324

Miliary TB (potentially fatal)

Answer 325

1. CNS | 2. Renal

Answer 326

- Contains mostly blood-derived macrophages, epithelioid cells (differentiated macrophages) & multinucleated giant cells surrounded by T lymphocytes - Caseous granulomas are typical of TB

Answer 327

- Cell mediated immunity crucial - Macrophages key controlling cell - T cell production of interferon gamma - Cytokines involved in this process all key

Answer 328

Mantoux Reaction

Answer 329

T spot test- single-visit blood tests, also known as an interferon gamma release assay (IGRA).

Answer 330

- Rifampicin - Isonizid - Pyrazinamide - Ethambutol

Answer 331

If senstive to Rifampicin & isoniazid

Answer 332

After 2 months

Answer 333

Pyridoxine

Answer 334

- Induces cytochrome P450 & alters metabolism of many drugs e.g. steroids - Metabolized in liver: potential for toxicity - Turns urine reddish

Answer 335

1. Fitter 2. Lower rates of depression 3. Better cardiovascular health

Answer 336

1. Non-consensual sex 2. Exploitative sex 3. Sexual dysfunction 4. Unwanted conception 5. Infection

Answer 337

1. Diagnosis before treatment (antibiotic use) 2. Screen for accompanying STIs 3. Simple treatment regimens 4. Follow-up after treatment +/- TOC 5. Partner notification 6. Non-judgemental patient support, counselling, education

Answer 338

Technology (apps ie. tinder)

Answer 339

Cities with higher populations

Answer 340

1. Last time ANY type of sex 2. Who that was with: Gender & Location 3. Type of sex e.g. receptive anal sex 4. Condom use or not

Answer 341

Gonorrhoea

Answer 342

Mycoplasma genitalia/ Chlamydia

Answer 343

Gram negative diplococci & white cells

Answer 344

Ulcers, skin changes, dysuria & urethral exudate discharge

Answer 345

- NAAT test - Male urine sample acceptable +/- rectal/throat (MSM) - Vulvovaginal swab (self-taken is fine)

Answer 346

1. Skin pustules | 2. Joint infections

Answer 347

Its turning drug resistant

Answer 348

1. Ceftriaxone 500 mg IM 2. Azithromycin 1g stat 3. Partner notification

Answer 349

1. Penicillin- 9.9% 2. Tetracycline- 29.4% 3. Ciprofloxacin- 31.4% 4. Cefixime- 0.1% (susceptible to ceftriaxone) 5. Azithromycin- 3% had reduced susceptibility (46% of these had HL-AziR)

Answer 350

Asymptomatic

Answer 351

Tubal damage / infertility: - About 16% of women infected will develop PID - No current evidence that screening programme has reduced prevalence or PID or infertility

Answer 352

1. Extra-genital testing in women | 2. Is single-dose treatment adequate?

Answer 353

1. Doxycycline 100 mg BD x 1 week (3 weeks for LGV) | 2. Azithromycin 1g oral stat, followed by 500mg od 2 days (recent change to BASHH guidance)

Answer 354

- Lymphotropic chlamydia - Severe proctitis causing constipation , rectal bleeding - Looks like cancer or Crohn’s - Inguinal ‘bubos’

Answer 355

Exposure --> 1° lesion (chancre) --> 2° lesion (rash) --> Latent syphilis (+ve serology only) --> 3° syphilis --> Gumma, Cardiovascular, Neurological

Answer 356

Men who have sex with men (MSM)

Answer 357

- Highly infectious - Can be confused with many other medical conditions or ignored by patient - Blood tests always strongly positive - Not universal: many patients have no secondary stage

Answer 358

1. Aortic dilatation | 2. Neurosyphilis- hearing loss, visual disturbances

Answer 359

Benzathine penicillin injection in butt cheeks

Answer 360

1. Human Papilloma Virus 2. Molluscum contagiosum 3. Herpes Simplex Virus 4. HIV 5. Hepatitis B 6. Hepatitis C

Answer 361

HPV-6 & 11

Answer 362

HPV 16 & 18

Answer 363

- Gardasil: HPV strains 6/11/16/18 - School aged girls - MSM attending sexual health/HIV clinics <45y - Soon to be school aged boys

Answer 364

1. Cream form- direct toxin effect on skin cells 2. Immunomodulation 3. Cryotherapy- toxic effect to skin

Answer 365

- Pox virus - Sexual transmission - Pubic area/groin - Extensive/Face may indicate immunosuppression in adults - Usually self limiting

Answer 366

- May be asymptomatic but may cause ulcers - Flu-like symptoms - Pain in genitalia - Dysuria

Answer 367

Diagnoses decreases with age & is more common in women

Answer 368

1. Aciclovir 400mg TDS 5 days- 1st episode 2. Aciclovir 800mg TDS 2 days- recurrence 3. Aciclovir 400mg BD 6-12 months- suppression

Answer 369

1. Trichomonas vaginalis- 2% prevalence in Glasgow. Vaginal discharge & pain in women but asymptomatic in men. Presents as bacterial vaginosis 2. Mycoplasma genitalium- NO test, 1 week Doxycycline 3. Donovanosis 4. Chancroid- Rare in UK

Answer 370

Seminal fluid

Answer 371

Pneumocystis carinii infection

Answer 372

1. Related to sexually activity 2. CMV related 3. Drug use 4. Environmental- sauna related

Answer 373

Sex-linked, inherited disorder characterized by a deficiency in Factor VIII activity

Answer 374

IV administration of exogenous Factor VIII as either cryoprecipitate made from fresh frozen plasma or lyophilized Factor VIII concentrate manufactured from plasma pools collected from thousand+ donors

Answer 375

- “Bush meat” theory: a hunter was bitten or cut while butchering an animal - How SIV transformed into HIV in the human & became capable of replicating in humans is not known

Answer 376

1. Social changes & urbanization 2. Unsterile injections: vaccines, antibiotics, sleeping sickness 3. Genital ulcer diseases & sexual promiscuity

Answer 377

- Was introduced to Haiti by unknown individual/individuals who contracted it in the Democratic Republic of the Congo - Mini-epidemic followed, & ≈ 1969, another individual brought HIV from Haiti to the United States - Vast majority of cases of AIDS outside sub-Saharan Africa can be traced back to that single unknown person

Answer 378

Long incubation period before illness

Answer 379

One of the most demonised patients in history - Gaetan Dugas - has been convincingly cleared of claims he spread HIV to the US, say scientists

Answer 380

- Almost always acquired sexually - Successful needle exchange programmes limiting the injecting drug use transmission seen in the early 80s - MSM most infections occur in Scotland - Infected heterosexually acquire HIV either overseas/ through sexual contact here with someone from high-prevalence country

Answer 381

Enters the body through open cuts, sores or breaks in the skin, through mucous membranes, such as those inside the anus or vagina, or through direct injection

Answer 382

1. Anal or vaginal intercourse (oral sex not an efficient route) 2. Injecting drugs + sharing equipment 3. Mother-to-child (before / during birth, or through breast milk) 4. Health care settings 5. Via donated blood or blood clotting factors

Answer 383

1. Saliva 2. Tears 3. Urine

Answer 384

1. Shaking hands 2. Hugging 3. Casual kissing 4. Sharing food/ eating utensils 5. Toilet seats 6. Drinking fountain

Answer 385

1. Blood (including menstrual blood) 2. Semen 3. Vaginal secretions 4. Breast milk

Answer 386

Blood followed by semen followed by vaginal fluids then followed by breast milk

Answer 387

- Infects cells in the immune system such as T helper Cells, macrophages & dendritic cells - All these cells carry CD4 receptors which allow HIV entry - Causes depletion of CD4 T helper cells - Abnormal B cell activation resulting in excess / inappropriate immunoglobulin production

Answer 388

The person is at risk of opportunistic infections & some cancers

Answer 389

1. Direct viral killing of cells 2. Apoptosis of uninfected “bystander cells” 3. CD8+ cytotoxic T cell killing of infected CD4+cells

Answer 390

- Spherical - Diameter of ~120 nm - 2 copies of positive single-stranded RNA codes for the virus's 9 genes enclosed by conical capsid composed of copies of viral protein p24 - Single-stranded RNA is tightly bound to nucleocapsid proteins, p7, & enzymes needed for the development of the virion - Matrix composed of the viral protein p17 surrounds the capsid - Surrounded by the viral envelope of 2 layers of phospholipids

Answer 391

1. Reverse transcriptase 2. Proteases 3. Ribonuclease 4. Integrase

Answer 392

Proteins from the host cell & about 70 copies of a complex HIV protein (Enz) that protrudes through the surface of the virus particle

Answer 393

1. Fusion inhibitor, R5 inhibitor 2. Protease inhibitor 3. NRTI, NNRTI 4. Integrase inhibitor

Answer 394

Enables the virus to attach to & fuse with target cells to initiate the infectious cycle

Answer 395

- At least 7 structural landmarks (LTR, TAR, RRE, PE, SLIP, CRS, & INS) - 9 genes (gag, pol, env, tat, rev, nef, vif, vpr, vpu) encoding 19 proteins

Answer 396

Gag, pol & env

Answer 397

Regulatory genes for proteins that control the ability of HIV to infect cells, produce new copies of virus (replicate), or cause disease

Answer 398

A state of reversibly non-productive infection of individual cells

Answer 399

Generally used to describe the long asymptomatic period between initial infection & advanced HIV (AIDS)

Answer 400

HIV replicates actively throughout the course of the infection even during the asymptomatic period

Answer 401

There is no cure as no way to remove it

Answer 402

- HIV multiplies in the body, the virus sometimes mutates (changes form) & produces variations of itself - Variations of HIV can develop while a person is taking HIV medicines

Answer 403

A person can initially be infected with drug-resistant HIV or develop drug-resistant HIV after starting HIV medicines

Answer 404

- Which, if any, HIV medicines won’t be effective against a person’s HIV - Drug-resistance testing results help determine which HIV medicines to include in an HIV treatment regimen

Answer 405

Medication adherence- taking HIV medicines every day & exactly as prescribed

Answer 406

1. CD4 cell count (T-helper lymphocyte count) 2. HIV-1 plasma RNA (Viral load test) 3. HIV-1 subtypes (Clade typing) 4. Genotypic & phenotypic resistance tests 5. Tropism tests (CCR5 status) 6. HLA-B*5701 to predict Abacavir reactions

Answer 407

From total lymphocyte count

Answer 408

- HIV-negative: 600-1200 per mm3 | - Risk of opportunistic infection increases sharply below 200/mm3

Answer 409

Using log 10 scale

Answer 410

- “Set point” lower the better - Below 10,000 (104) low - Above 100,000 high - “Undetectable” means below 40 copies/ml

Answer 411

- Primary infection - +/- acute HIV syndrome: wide dissemination of virus, seeding of lymphoid organs - Clinical latency - Constitutional symptoms - Opportunistic diseases - Death

Answer 412

1. Thrush 2. TB 3. Pneumocystis carinii pneumonia 4. Cytomagalovirus disease (CMV) 5. Mycobacterium avium complex disease

Answer 413

1. Systemic- fever, weight loss 2. Pharyngitis 3. Mouth- sores, thrush 4. Oesophageal- sores 5. Muscles- myalgia 6. Liver & spleen- enlargement 7. Gastric- nausea, vomiting 8. Skin- rash 9. Lymphadenopathy 10. Central- malaise, headache, neuropathy

Answer 414

Maculopapular rash

Answer 415

1. Infectious mononucleosis 2. Secondary syphilis 3. Drug rash 4. Viral infections- CMV, Rubella, Influenza, Parvovirus

Answer 416

1. Increase testing levels in primary care settings 2. Increase testing levels among non-HIV specialists in secondary care 3. HIV testing routine in secondary care settings where HIV indicator conditions are present

Answer 417

1. These prompt HIV testing 2. It’s the condition not the behaviour 3. Just like any other medical investigation 4. You get it done & give the result 5. Diagnose HIV & you will save that person’s life

Answer 418

An ambitious treatment target to help end the AIDS epidemic (90% diagnosed, 90% on treatment & 90% virally suppressed)

Answer 419

- Moved from CD4 count of 200 to 350 - START (When to start) - SPARTAC (seroconversion) - NOW: Test & Treat (prevention)

Answer 420

Improvement in mortality/morbidity & complications of HAART

Answer 421

Highly Active AntiRetroviral Treatment

Answer 422

- ‘Triple therapy’ (cART) - 2 nucleosides + 1 drug from another class - Aim to suppress viral load to undetectable - CD4 recovery - Combination pills available

Answer 423

1. Good adherence (>95%) essential 2. Psychological impact 3. Short term side-effects 4. Drug-drug interactions 5. Emerging longer term toxicities

Answer 424

1. Rash 2. Hypersensitivity (Abacavir & Nevirapine) 3. CNS side effects (Efavirenz)- sleep disturbance, vivid dreams, mood changes 4. GI side effects 5. Renal 6. Hepatic

Answer 425

CYP450 (induction/inhibition)

Answer 426

1. PPIs 2. Statins 3. Antipsychotics- QTc

Answer 427

1. Body shape changes- lipoatrophy or lipodystrophy (particularly older drugs) 2. Renal – Tenofovir disoproxil 3. Hepatic 4. Lipid 5. Bone

Answer 428

Fallen from 20-25% to under 0.1%

Answer 429

1. Treat mother during pregnancy 2. Minimise risk at delivery 3. Treat baby early on 4. Avoid breast feeding 5. Universal antenatal HIV screening

Answer 430

- Highly cost-effective - Major impact on morbidity & mortality - Prevents HIV transmission - BUT can’t treat HIV if it is undiagnosed

Answer 431

1. HIV is a treatable long-term condition 2. Essential to test if the symptoms could be HIV 3. Don’t let absence of a “risk group” put you off 4. Can prevent transmission if HIV is diagnosed

Answer 432

- 25 % remain undiagnosed (as UK wide) - 93% of diagnosed attending for monitoring - 97% of attenders on treatment

Answer 433

Needle Exchange Surveillance Initiative

Answer 434

- Despite good IEP provision - Change of service model to adapt to need - Challenges of providing care to vulnerable group - Over 100 diagnoses in past 3 years

Answer 435

1. HIV testing 2. HIV PEPSE 3. TasP 4. HIV PrEP?

Answer 436

1. Vulnerable populations- further marginalisation 2. Access to healthcare- HIV & associated infections/illnesses 3. Provision of ARVs- Lifelong, Management of ARV complications 4. Single parent families/orphaned children 5. Disabilities 6. STIGMA

Answer 437

1. Pneumonia 2. Malaria 3. Diarrhoea

Answer 438

Faster in children aged 1-59 months than they were in neonates (2.9% per year vs 2.1% per year)

Answer 439

Sub-Saharan Africa

Answer 440

U5MR of no more than 25 per 1000 live births in every country of the world by 2030

Answer 441

Can halve the number of episodes of clinical | malaria and reduce all-cause mortality in children younger than 5 years of age

Answer 442

Substantial reductions in low birthweight, placental parasitaemia, stillbirths & miscarriages

Answer 443

Protection for all people in a community, including those who do not sleep under a net themselves

Answer 444

Lady health workers (LHWs) in Pakistan were able to satisfactorily diagnose & treat severe pneumonia at home

Answer 445

1. Insecticide-treated bednets (25%) 2. Improvements in nutritional status (19%) 3. Vitamin A supplementation (9%) 4. Treatment of diarrhoea with oral rehydration salts and zinc & careseeking for fever, malaria, or childhood pneumonia (22%) 5. Vaccinations (11%)

Answer 446

- Immunodeficient at birth | - Move from sterile environment to pathogenic

Answer 447

- Mother needs to ignore foetal alloantigens (half of antigens being of paternal i.e. foreign origin) - ‘Immunosuppressive’ environment of womb moving to ‘dampened’ responsiveness to avoid inflammatory responses to benign/harmless antigens

Answer 448

Balance of Th1 (cell-mediated immunity) & Th2 (humoral immunity) cytokines is characterized by an initial prevalence of Th2 cytokines, followed by a progressive shift toward Th1 predominance

Answer 449

Increased susceptibility to pathogens & reduced responses to vaccines

Answer 450

- Immunoglobulin (IgG) predom in third trimester | - Breast feeding

Answer 451

1. Grp B Strep 2. E coli 3. Resp viruses 4. Enteroviruses

Answer 452

1. Resp viruses 2. Enteroviruses 3. Chylamydia

Answer 453

1. Strep pneumonia | 2. Resp viruses

Answer 454

1. Mycoplasma pneumonae 2. Strep. Pneumonia 3. Resp viruses

Answer 455

1. Grp B Strep 2. E coli 3. Haemophilus Type B (Hib) 4. Meningiococcus 5. Strep Pneumonia 6. Listeria

Answer 456

1. Meningiococcus 2. Strep Pneumonia 3. Hib 4. Listeria

Answer 457

1. Meningiococcus 2. Strep Pneumonia 3. Hib (rare)

Answer 458

1. Meningiococcus | 2. Strep Pneumonia

Answer 459

Generally involves cellular responses, serum antibodies or a combination acting against one or more antigens on the infecting organism

Answer 460

Antibody mediated or cell mediated components

Answer 461

- B cell encounters an antigen that it recognises, it's stimulated to proliferate & produce large numbers of lymphocytes secreting an antibody to this antigen - Replication & differentiation of B cells into plasma cells is regulated by contact with the antigen & by interactions with T cells

Answer 462

- T cells mediate 3 principal functions: help, suppression & cytotoxicity - T-helper cells stimulate immune response of other cells (stimulate B cells to produce antibodies) - T-suppressor cells play an inhibitory role & control level & quality of the immune response - Cytotoxic T cells recognise & destroy infected cells & activate phagocytes to destroy pathogens they have taken up

Answer 463

Induce active immunity & immunological memory

Answer 464

Inactivated (killed) or attenuated live organisms, secreted products, recombinant components or the constituents of cell walls

Answer 465

Inactivated bacteria/virus

Answer 466

Inactivated toxins

Answer 467

Capsular polysaccharide

Answer 468

- IgM mediated followed by IgG - Commonly need 2 or more injections to elicit response in young infants (primary or priming course) - Further injections lead to accelerated response lead by IgG (secondary reponse)

Answer 469

Adjuvants which are substances that enhance the antibody response

Answer 470

- They do not stimulate the immune system as broadly as protein antigens such as tetanus, diphtheria or influenza - Protection is not long-lasting & response in infants & young children is poor

Answer 471

By conjugation- the polysaccharide antigen is attached to a protein carrier (e.g. Hib & MenC vaccines) giving better immunological memory

Answer 472

The live organism must replicate (grow) in the vaccinated individual over a period of time (days or weeks)

Answer 473

- Usually promote a full, long lasting immune response after 1-2 doses - Vaccine virus is weakened or ‘attenuated ‘ but a mild form of the disease may rarely occur - Not to be given to immunocompromised individuals

Answer 474

1. MMR 2. VZV (rotavirus) 3. Intranasal influenza

Answer 475

- Vaccinated individuals not only less likely to get disease but also less likely to be a source of infection to others - Unvaccinated individuals are therefore protected - Interrupts cycle of infection & reservoirs e.g. Small pox

Answer 476

At least 95% of children to receive a first vaccination MMR vaccine before age 2 years & a booster before 5 years to achieve herd immunity & prevent outbreaks

Answer 477

1. DTaP/IPV/HiB/HepB 2. Pneumococcal vaccine 3. Rotavirus vaccine 4. Men B vaccine

Answer 478

1. DTaP/IPV/HiB/HepB (2nd dose) | 2. Rotavirus vaccine (2nd dose)

Answer 479

1. DTaP/IPV/HiB/HepB (3rd dose) 2. Pneumococcal vaccine (2nd dose) 3. Men B vaccine (2nd dose)

Answer 480

1. MMR vaccine 2. Hib/Men C booster vaccine 3. Pneumococcal vaccine (3rd dose) 4. Men B vaccine (3rd dose)

Answer 481

Children's annual flu vaccine

Answer 482

1. DTaP/IPV | 2. MMR vaccine (2nd dose)

Answer 483

HPV vaccine

Answer 484

1. Td/IPV | 2. Men ACWY vaccine

Answer 485

Diptheria, tetanus, acellular pertussis & inactivated polio virus

Answer 486

- Capsule: major virulence factor - Over 90 different capsular types have been characterised - Prior to PCV 80% of invasive infections in children were caused by 8-10 capsular types

Answer 487

May be carried in the nasopharynx without symptoms, with disease occurring in a small proportion of infected individuals

Answer 488

Bacteraemia (community acq) & meningitis (major cause of morbidity & mortality)

Answer 489

1. Under 2s 2. Immunocompromised 3. Asplenics

Answer 490

Prenevar13

Answer 491

Meningitis

Answer 492

1. Bacteraemia 60% 2. Epiglottis 15% 3. Pneumonia 4. Cellulitis

Answer 493

Either meningitis or septicaemia, or a combination of both

Answer 494

1. Poor responses to vaccines 2. Unable to communicate/localise 3. Unable to tolerate oral meds 4. Correct dose of meds ‘the younger the age, the more cautious the approach’

Answer 495

1. Wider range of pathogens | 2. Infections disseminate more easily

Answer 496

- Take a good history - Fever duration & measurement - Assessment of severity - Localising systems - Causation (pathogen) - Is the patient well/unwell? - Should I be acting now or do I have time to observe?

Answer 497

1. Feeding/vomiting 2. Crying 3. Sleeping 4. Smiling

Answer 498

1. Feeding 2. Activity levels 3. Drowsiness

Answer 499

1. Localising symptoms- cough, coryza, vomiting, diarrhoea, rash, dysuria, headache, sore ears/throat 2. Causation- nursery contacts etc.