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|The following are common causes of urinary tract infections: | |
| |
|A | | |
|Proteus | | |
| | | |
|B | | |
|Klebsiella | | |
| | | |
|C | | |
|Enterobacter | | |
| | | |
|D | | |
|Chlamydia | | |
| | | |
|E | | |
|Candida | | |
| | | |
|Comments: | |
|Eschericha coli accounts for 80% of urinary tract infections. Enterobacter and Klebsiella spp. tend to be hospital acquired | |
|infections. Pseudomonas and Candida spp. are opportunistic infections, which affect immunosuppressed patients. Proteus spp. | |
|are often associated with urinary calculi. Chlamydia rarely causes UTI's but is associated with pelvic inflammatory disease.| |
|The following are examples of DNA viruses: | |
|A | | |
|herpes simplex virus | | |
| | | |
|B | | |
|papilloma virus | | |
| | | |
|C | | |
|influenza virus | | |
| | | |
|D | | |
|enteroviruses | | |
| | | |
|E | | |
|Epstein-Barr virus | | |
| | | |
|[pic] | |
|Comments: | |
|The Herpesviridae family of viruses are dsDNA viruses that include herpes simplex, varicella zoster, CMV and EBV. The | |
|papilloma virus, a member of the Papovavius, is a small dsDNA virus. The influenza virus belongs to the Othomyxoviridae | |
|family, and enteroviruses belong to the Picornaviridae family. Both are ssRNA viruses. | |
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|The germination of tetanus spores in a wound is inhibited by: | |
| |
|A | | |
|Tissue trauma | | |
| | | |
|B | | |
|Oxgen | | |
| | | |
|C | | |
|Injection of anti-toxin | | |
| | | |
|D | | |
|Injection of toxoid | | |
| | | |
|E | | |
|Removal of devitalized tissue | | |
| | | |
|[pic] | |
|Comments: | |
|Germination occurs in damaged tissue where damage to the blood supply has reduced the supply of oxygen. Careful debridement | |
|of devitalised tissue and removal of foreign bodies is a useful preventative measure. Antitoxin should be promptly | |
|administered in all cases of suspected tetanus. It is ineffective when the toxin is already fixed in the CNS. Because spores| |
|of C. tetani are so widely distributed, the only effective way to control tetanus is by prophylactic immunisation with | |
|Tetanus toxoid. | |
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|Escherichia coli 0157 / H7: | |
| |
|A | | |
|is a bowel commensal | | |
| | | |
|B | | |
|causes haemorrhagic colitis | | |
| | | |
|C | | |
|is an important cause of cholera-like illness | | |
| | | |
|D | | |
|is a recognised cause of the haemolytic uraemic syndrome | | |
| | | |
|E | | |
|can be prevented from causing clinical illness by vaccination | | |
| | | |
|[pic] | |
|Comments: | |
|Escherichia coli 0157 / H7 characteristically causes a haemorrhagic colitis with abdominal pain but little or no fever. An | |
|outbreak of 500 cases in the USA was described in 1993. This outbreak was associated with the consumption of hamburgers. | |
|There were over 50 cases of haemolytic uraemic syndrome and 4 fatalities. The source of an outbreak in Wishaw, Scotland in | |
|1996 was a butcher's. There were over 500 cases and 18 fatalities. | |
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|Staphylococcus epidermidis: | |
| |
|A |false [pic] | |
|is coagulase positive | | |
| | | |
|B |false [pic] | |
|on microscopy are Gram positive cocci in chains | | |
| | | |
|C |true [pic] | |
|are usually sensitive to penicillin | | |
| | | |
|D |false [pic] | |
|grown in blood cultures are due to contamination and should be ignored | | |
| | | |
|E |true [pic] | |
|are destroyed by povodine iodine | | |
| | | |
|[pic] | |
|Comments: | |
|Staph. epidermidis is part of the normal skin flora. As for Staph. aureus, Gram positive cocci in bunches are seen on | |
|microscopy. | |
|It is usually insensitive to penicillin. | |
|Although it is often a contaminant in blood cultures, it is associated with line infections. Central venous catheters are an| |
|especially likely site of infection even in the absence of overt exit site sepsis. They should not be ignored but | |
|interpreted in the clinical context, and usually the blood cultures should be repeated. In patients with central lines, | |
|blood cultures should be taken both peripherally and from the central line as semi-quantitative microbiological techniques | |
|are available that may point to the central line as the principle site of infection. | |
[pic]
|Blood cultures: | |
| |
|A |false [pic] | |
|Are usually negative. | | |
| | | |
|B |true [pic] | |
|Are best obtained when the patient is febrile or complains of chills. | | |
| | | |
|C |true [pic] | |
|Require two culture (aerobic and anaerobic) specimens obtained from the arm. | | |
| | | |
|D |true [pic] | |
|Are unreliable if the patient has already been commenced on antibiotics. | | |
| | | |
|E |false [pic] | |
|Grow and identify organisms within 24 hours. | | |
| | | |
|[pic] | |
|Comments: | |
|Blood cultures are frequently negative or grow commensal organisms. Bacteraemia can be intermittent and transient. Episodes | |
|of bacteraemia are usually associated with chills and fever. Two culture specimens (one aerobic one anaerobic) should be | |
|obtained from at least two different sites. Ideally, blood cultures should be obtained before commencing antibiotic therapy.| |
|A preliminary report can be issued at 24 hrs, however, 48 – 72 hrs are required for growth and identification of the | |
|organism. | |
[pic]
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|Bacterial capsules: | |
| |
|A | | |
|are typical of pseudomonas aeroginose | | |
| | | |
|B | | |
|can transfer antibiotic reisistance to other bacteria | | |
| | | |
|C | | |
|enhance bacterial resistance to dehydration and phagocystosis | | |
| | | |
|D | | |
|are associated with endotoxic shock | | |
| | | |
|E | | |
|enhance bacterial resistance to antibiotics | | |
| | | |
|[pic] | |
|Comments: | |
|Bacterial capsules are usually composed of polysaccharide and may be associated with mucoid colonial morphology. The slimy | |
|material functions as an anti-phagocytic agent and also protects the bacterial cell from the environment, (eg dehydration), | |
|including antibiotics which may be present. However many important bacterial pathogens do NOT rely on capsules e.g. | |
|M.tuberculosis or Salmonella. Endotoxic shock is associated with the biological activity of lipopolysaccharide (LPS), not | |
|capsules. Endotoxic shock is associated with the biological activity of Gram negative cell wall lipopolysaccharide. | |
|Capsulated bacteria include Streptococcus pneumoniae and pseudomonas. Although capsule may help to protect against | |
|antibiotics they do not transfer antibiotic resistance. | |
[pic]
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|Toxoplasma gondii: | |
| |
|A | | |
|Is a rickettsia | | |
| | | |
|B | | |
|Proliferates in the central nervous system | | |
| | | |
|C | | |
|Is identified by Gram staining | | |
| | | |
|D | | |
|Is a cause of congenital hydrocephalus | | |
| | | |
|E | | |
|Is transmitted by ingestion of raw meat | | |
| | | |
|[pic] | |
|Comments: | |
|Toxoplasma gondii is an obligate intacellular parasite of the Apicomplexa family. The life cycle of the T. gondii parasite | |
|has three stages: cyst, oocyst, or tachyzoite. The latter can proliferate in the CNS forming cysts. This is particularly the| |
|case in the immunocompromised host and infection is a serious problem in pregnancy with fetal infection associated with | |
|stillbirth, prematurity, IUGR and neurological and ophthalmological abnormalities. The organism is identified with the | |
|Giemsa stain. It is usually transmitted through fecal contamination (most often cats) but can be acquired through consuming | |
|uncooked meats (this is how the cats get the disease). | |
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|Proteolytic enzymes are released by the following organisms: | |
| |
|A | | |
|Neisseria meningitides | | |
| | | |
|B | | |
|Salmonella typhi | | |
| | | |
|C | | |
|Streptococcus pyogenes | | |
| | | |
|D | | |
|Mycobacterium tuberculosis | | |
| | | |
|E | | |
|Clostridium perfringens (welchii) | | |
| | | |
|[pic] | |
|Comments: | |
|Virulence factors are important in the bacterial survival in vivo. In this sense bacterial extracellular proteolytic enzymes| |
|can be recognized as the legitimate target for this approach since they are involved either in direct or indirect | |
|destruction of an infected/colonized tissue and in dysregulation of many host defense pathways. The best example of the last| |
|is an effect of bacterial proteinases on fibrinolytic, kallikrein-kinin and complement cascades, as well as degradation of | |
|immunoglobulins, inactivation of endogenous proteinase inhibitors, and dysregulation of cytokine network system. Proteolytic| |
|enzymes are responsible for the virulence and activity of organisms such as Strep Pyogenes, Staphylococcus aureus, E coli | |
|and Clostridium welchii enabling the necrolytic effects on the skin in cellulitis and gangrene. | |
[pic]
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|Features of tetanus includes | |
| |
|A | | |
|A rigid abdomen | | |
| | | |
|B | | |
|Hypomagnesaemia | | |
| | | |
|C | | |
|Hypocalcaemia | | |
| | | |
|D | | |
|Carpopedal spasm | | |
| | | |
|E | | |
|Clouding of conciousness | | |
| | | |
|[pic] | |
|Comments: | |
|Tetanus is caused by the gram positive bacillus Clostridium tetani and is associated with tetanic contractions due to | |
|neuromuscular blockade by the tetanus toxin. Tetanic contractions and respiratory arrest are seen but the level of | |
|conciousness is typically unimpaired. | |
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|Prevention of infection in joint replacement includes | |
| |
|A | | |
|Covering all open wounds with an occlusive dressing | | |
| | | |
|B | | |
|Cessation of smoking pre-operatively | | |
| | | |
|C | | |
|The patient should shave the operation site the day before surgery | | |
| | | |
|D | | |
|Laminar air flow in theatre | | |
| | | |
|E | | |
|Antibiotic impregnated cement | | |
| | | |
|[pic] | |
|Comments: | |
|Joint replacement surgery should not be considered in patients with open wounds. Cessation of smoking at least 2 weeks | |
|before surgery reduces prosthesis and wound infection rates. The operation site should be shaved immediately before surgery,| |
|shaving the day before surgery causes an increased release of skin commensals. Laminar flow air hoods reduce the number of | |
|bacteria in the air above the wound. The antibiotic impregnated cement reduces the rate of deep infection. | |
[pic]
|The following are correctly paired | |
| |
|A | | |
|erythema nodosum tuberculosis | | |
| | | |
|B | | |
|erythema marginatum Lyme disease | | |
| | | |
|C | | |
|erythema multiforme orf | | |
| | | |
|D | | |
|erythema induratum syphilis | | |
| | | |
|E | | |
|erythema infectiosum parvovirus B19 | | |
| | | |
|[pic] | |
|Comments: | |
|Erythema nodosum. This is characterised by tender red swellings usually over the shins. The most common cause is | |
|streptococcal infection. Tuberculosis, sarcoidosis, leprosy, sulphonamides and inflammatory bowel disease are other | |
|important causes. | |
|Erythema marginatum. This is a non-itchy, pale red, macular eruption. It is a major criterion for the diagnosis of rheumatic| |
|fever but is also seen in acute glomerulonephritis and drug reactions. | |
|Erythema multiforme. This is characterised by cutaneous "target" lesions and mucosal involvement. Children and young adults | |
|are more commonly affected. Orf, mycoplasma, and herpes simplex are among the known causes. | |
|Erythema induratum. Cutaneous tuberculosis. Otherwise known as Bazin's disease. | |
|Erythema infectiosum. "Slapped cheeks", caused by parvovirus B19. | |
|Erythema chronicum migrans. An expanding annular lesion occurring in Lyme disease. | |
|Erythema gyratum repens. Erythema forming repeated concentric rings. Often there is an underlying malignancy. | |
|Clostridium tetani | |
| |
|A | | |
|causes gas gangrene | | |
| | | |
|B | | |
|produces an exotoxin | | |
| | | |
|C | | |
|has a terminal spore | | |
| | | |
|D | | |
|is an obligatory anaerobe | | |
| | | |
|E | | |
|is non-motile | | |
| | | |
|[pic] | |
|Comments: | |
|Gas gangrene is a Clostridium perfringens myositis. | |
|Clostridium tetani produces a potent neurotoxin called tetanospasmin. Tetanospasmin acts on both the motor systems at | |
|synapses, resulting in disinhibition. | |
|Most clostridia are normal commensals of human and animal gastrointestinal tracts, and are widely distributed in soil where,| |
|as spores, they may survive for years in adverse conditions. | |
|Clostridia are Gram-positive, spore-forming, obligatory anaerobic bacilli. | |
|Clostridium tetani is motile but non-invasive. | |
[pic]
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|Bacterial endotoxins: | |
| |
|A | | |
|are proteins | | |
| | | |
|B | | |
|are lipopolysaccharides | | |
| | | |
|C | | |
|induce fever | | |
| | | |
|D | | |
|are components of the cell wall in gram negative bacteria | | |
| | | |
|E | | |
|are destroyed by heat such as boiling for 5 minutes | | |
| | | |
|[pic] | |
|Comments: | |
|Enodotoxins are lipopolysaccharides of the cell walls of gram negative bacteria and released following cell death. Typically| |
|larger amounts are required to produce effect compared with exotoxins. They are responsible for producing numerous effects | |
|of the infection (eg E Coli 0157) including fever, DIC, Myolysis etc. They are often heat resistant. | |
[pic]
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|Typical diseases caused by Haemophilus influezae include: | |
| |
|A | | |
|Bronchopneumonia | | |
| | | |
|B | | |
|Meningitis | | |
| | | |
|C | | |
|Cellulitis | | |
| | | |
|D | | |
|Septic arthritis | | |
| | | |
|E | | |
|Epiglottitis | | |
| | | |
|[pic] | |
|Comments: | |
|H Influenzae may also cause osteomyelitis, pericarditis and sepsis. Appropraite therapy includes penicillin based antibiotic| |
|and third generation cephalosporins. | |
[pic]
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|Exotoxins: | |
| |
|A | | |
|Are derived from Gram negative bacteria | | |
| | | |
|B | | |
|Have a specific action | | |
| | | |
|C | | |
|Are more toxic than endotoxins | | |
| | | |
|D | | |
|Are neutralized by their homologous antitoxin | | |
| | | |
|E | | |
|Can be converted to a toxoid | | |
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|[pic] | |
|Comments: | |
|Toxigenesis, or the ability to produce toxins, is an underlying mechanism by which many bacterial pathogens produce disease.| |
|At a chemical level, there are two types of bacterial toxins, lipopolysaccharides, which are associated with the cell walls | |
|of Gram-negative bacteria, and proteins, which are released from bacterial cells and may act at tissue sites removed from | |
|the site of bacterial growth. The lipoplysaccharide toxins are referred to as endotoxins and the extracellular diffusible | |
|toxins are referred to as exotoxins. Exotoxins are soluble proteins produced by the living bacteria and are generally | |
|specific for the pathogenic bacteria involved (Can be produced by both gram positive and gram negative bacteria -eg | |
|enterotoxigenic E coli). Bacterial protein toxins are the most powerful human poisons known and retain high activity at very| |
|high dilutions. Their effect may be neutralized by the antitoxin and this is used as a treatment (toxoid). | |
[pic]
|Micro-organisms that can cause latent infection include: | |
| |
|A | | |
|Mycobacterium tuberculosis | | |
| | | |
|B | | |
|varicella-zoster virus | | |
| | | |
|C | [pic] | |
|cytomegalovirus (CMV) | | |
| | | |
|D | | |
|hepatitis A | | |
| | | |
|E | | |
|chlamydia trachoma | | |
| | | |
|[pic] | |
|Comments: | |
|Most commonly clinical tuberculosis represents delayed reactivation.Varicella-zoster virus remains dormant in the dorsal | |
|root ganglia and can cause latent infections such as shingles.Over 50% of the adult population have serological evidence of | |
|latent infection with CMV, although infection is generally symptomless.Hepatitis A is self-limiting and usually over in 3-6 | |
|weeks.Chlamydia trachomatis can remain latent for years but can later cause blindness, infertility, and ischaemic heart | |
|disease. | |
[pic]
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|Which of the following antibiotics are considered bactericidal? | |
| |
|A | | |
|Clindamycin | | |
| | | |
|B | | |
|Amoxicillin | | |
| | | |
|C | | |
|Erythromycin | | |
| | | |
|D | | |
|Tetracycline | | |
| | | |
|E | | |
|Gentamicin | | |
| | | |
|[pic] | |
|Comments: | |
|Both penicillins and the aminoglycosides such as gentamicin are bactericidal whereas the others are bacteriostatic. | |
[pic]
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|Which of the following may constitute a vaccine? | |
| |
|A | | |
|prion | | |
| | | |
|B | | |
|live attenuated | | |
| | | |
|C | | |
|toxoid | | |
| | | |
|D |[pic] | |
|inactivated | | |
| | | |
|E |true [pic] | |
|DNA recombinant | | |
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|[pic] | |
|Comments: | |
|A prion is a proteinaceous infective material believed to be responsible for Creutzfeldt-Jacob Disease. You have probably | |
|received all of these yourself, with the possible exception of D. (B = polio, measles, BCG; C = diphtheria and tetanus | |
|toxoids; D = inactivated bacteria - pertussis[whooping cough], or viruses – hepatitis A, rabies; E = hepatitis B surface | |
|antigen, produced in yeasts ). | |
[pic]
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|Human immunodeficiency virus | |
| |
|A | | |
|Is a single stranded DNA retrovirus | | |
| | | |
|B | | |
|Induces a fall in CD4 lymphocytes, monocytes and antigen-presenting cells | | |
| | | |
|C | | |
|Increases the risk of opportunistic infection | | |
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|D | | |
|Patients can be infective prior to seroconversion illness at about three months | | |
| | | |
|E | | |
|The median survival with AIDS is greater than 10 years | | |
| | | |
|[pic] | |
|Comments: | |
|HIV is a single stranded RNA retrovirus. It induces immunodeficeincy and increases the risk of opportunitsic infection (e.g.| |
|histoplasmosis, Pneumocystis carinii) and malignancy (e.g. Kaposi's sarcoma). Patients may have asymptomatic or symptomatic | |
|disease for several years before developing AIDS. The median survival with full AIDS is less than two years | |
[pic]
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|The following is true regarding Hydradenitis suppurativa: | |
| |
|A | | |
|Represents an infection of the paracrine sweat glands | | |
| | | |
|B | | |
|Due to an antigen-antibody reaction | | |
| | | |
|C | | |
|Occurs more often in overweight women | | |
| | | |
|D | | |
|Can result in sterile abscesses | | |
| | | |
|E | | |
|Complete excision of the affected tissue down to the deep fascia can be curative | | |
| | | |
|[pic] | |
|Comments: | |
|This is a condition of the apocrine sweat glands. It is thought that it is an antigen-antibody complex clump that blocks | |
|excretion from the gland. The condition affects the axillae and perineum most often in overweight women. | |
|Abscesses are commonly sterile and when pathogens are present, they may represent commensal organisms. The surgery can often| |
|be extensive and debilitating. | |
[pic]
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|Regarding multiple organ dysfunction syndrome (MODS). | |
| |
|A | | |
|The renal system often deteriorates first. | | |
| | | |
|B | | |
|Sequence of organ dysfunction is not associated by the site of the original insult. | | |
| | | |
|C | | |
|Mortality is up to 80%. | | |
| | | |
|D | | |
|Is a reversible phenomenon. | | |
| | | |
|E | | |
|Secondary MODS occurs when organ dysfunction is a consequence of the hosts response. | | |
| | | |
|[pic] | |
|Comments: | |
|The respiratory system often deteriorates first. The organs involved and the sequence of their dysfunction is determined by | |
|the original insult. Mortality increases with the number of organ systems affected and with the severity of physiological | |
|disturbance at onset. Prompt intervention can reverse organ dysfunction. Primary MODS is a direct consequence of a specific | |
|insult that causes early dysfunction of the organs involved. | |
[pic]
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|The following are true about Pseudomonas aeruginosa: | |
| |
|A | | |
|it is the most common cause of contact lens acquired infection | | |
| | | |
|B | | |
|it is a Gram negative bacteria | | |
| | | |
|C | | |
|it can cause osteomyelitis | | |
| | | |
|D | | |
|it is sensitive to chloramphenicol | | |
| | | |
|E | | |
|it is sensitive to ciprofloxacin | | |
| | | |
|[pic] | |
|Comments: | |
|Infection rates can be reduced by wearing the contact lens for 10 hours or less.It is a gram-negative aerobic bacilli.The | |
|most common organisms that cause osteomyelitis are Staphylococcus, Haemophilus influenzae, and Salmonella, although | |
|P.Aeruginosa can cause osteomyelitis.Chloramphenicol has good activity against Haemophilus influenzae but not | |
|P.Aeruginosa.P.Aeruginosa is sensitive to quinolones, which inhibit DNA Topoisomerase. | |
[pic]
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|The following are suitable antibiotics for treating Escherichia coli: | |
| |
|A |false [pic] | |
|Ampicillin | | |
| | | |
|B |false [pic] | |
|Amoxicillin | | |
| | | |
|C |true [pic] | |
|Ciprofloxacin | | |
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|D |true [pic] | |
|Co-amoxiclav | | |
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|E |true [pic] | |
|Cefuroxime | | |
| | | |
|[pic] | |
|Comments: | |
|Escherichia coli is a Gram-negative bacillus which produces penicillinases, but it remains sensitive to numerous | |
|antibiotics. Bacterial resistance to antibiotics is a major problem and where possible sensitivities should be checked | |
|before blind treatment of infections is commenced. Ampicillin and amoxicillin are broad spectrum antibiotics active against | |
|non-beta lactamase producing Gram-positive and Gram-negative organisms. They are inactivated by penicillinases and since up | |
|to 50% of Escherichia coli strains are now resistant, they would be an unsuitable choice. Co-amoxiclav consists of | |
|amoxicillin and the beta-lactamase inhibitor clavulanic acid. Thus it is active against beta-lactamase producing bacteria | |
|that are resistant to amoxicillin, including strains of Escherichia coli. Cefuroxime is a cephalosporin that is resistant to| |
|inactivation by bacterial beta-lactamases and so may be used against Escherichia coli. Ciprofloxacin has a 6-fluoro | |
|substituents which confers enhanced antibacterial potency against both Gram positive and Gram negative organisms, including | |
|Escherichia coli. | |
[pic]
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|The following definitions regarding the sepsis sequelae are correct. | |
| |
|A | | |
|Systemic inflammatory response syndrome (SIRS) is the alteration of organ function in acute illness such | | |
|that homeostasis cannot be maintained without intervention. | | |
| | | |
|B | | |
|Sepsis is an inflammatory response to microorganisms or their invasion of normal sterile host tissue. | | |
| | | |
|C | | |
|Septicaemia is a clinically symptomatic endoxaemia or bacteraemia. | | |
| | | |
|D | | |
|Septic shock is sepsis with hypotension and hypoperfusion despite adequate fluid resuscitation. | | |
| | | |
|E | | |
|Severe sepsis is the systemic inflammatory response syndrome (SIRS) plus a confirmed infective process. | | |
| | | |
|[pic] | |
|Comments: | |
|SIRS is defined by the presence of 2 or more of the following; Temp > 38OC, or < 36OC. Pulse > 90 beats/min. Respiratory | |
|rate > 20 per min or an arterial partial pressure of oxygen (PaC02) 12, or < 4. B - The described definition | |
|is of infection. Sepsis is defined as SIRS plus a confirmed infective process. C - This is a dated term rarely used today. D| |
|- ie sepsis associated with a shocked state. Severe sepsis is defined as SIRS plus organ dysfunction, hypoperfusion or | |
|hypotension. | |
[pic]
|Sepsis | |
| |
|A | | |
|Systemic Inflammatory Response Syndrome (SIRS) is defined as three or more of the following; tachycardia, tachypnoea, pyrexia,| | |
|hypothermia, WCC >12 or 1.2mmol/l or systemic vascular resistance of 12 or 1.2mmol/l or a SVR of 38OC, or < 36OC. Pulse > 90 beats/min. Respiratory | |
|rate > 20 per min or an arterial partial pressure of oxygen (PaC02) 12, or < 4. B - The described definition | |
|is of infection. Sepsis is defined as SIRS plus a confirmed infective process. C - This is a dated term rarely used today. D| |
|- ie sepsis associated with a shocked state. Severe sepsis is defined as SIRS plus organ dysfunction, hypoperfusion or | |
|hypotension. | |
[pic]
| | |
|Bacterial plasmids: | |
| |
|A | | |
|may be transferred by conjugation between different strains | | |
| | | |
|B | | |
|are responsible for endotoxaemic shock | | |
| | | |
|C | | |
|always contain genes for enzymes that modify antibiotics | | |
| | | |
|D | | |
|are responsible for transferring resistance to penicillins | | |
| | | |
|E | | |
|may consist of a circular molecule of double-stranded RNA | | |
| | | |
|[pic] | |
|Comments: | |
|Plasmids comprise a group of extra-chromosomal, usually circular, molecules of double-stranded DNA, and may contain genetic | |
|information for various bacterial characteristics e.g. toxin production, adhesins etc as well as enzymes. They can replicate| |
|autonomously (ie independently from the bacterial chromosome), and larger plasmids are transferred naturally by conjugation | |
|between bacterial strains. DNA transferred between bacteria can be integrated into the recipient host chromosome or | |
|maintained as a plasmid. Plasmids may contain genetic information for various bacterial characteristics e.g. toxin | |
|production, adhesins etc. Plasmids comprise a circular molecule of double-stranded DNA. | |
[pic]
| | |
| | |
| | |
| | |
| | |
| | |
|Regarding perianal abscesses: | |
| |
|A | | |
|Abscess position is predicted by Goodsall's rule | | |
| | | |
|B | | |
|The presence of aerobic bacteria in the pus implies a fistula | | |
| | | |
|C | | |
|Are relatively common in children | | |
| | | |
|D | | |
|Are more common in ulcerative colitis than in Crohn's disease | | |
| | | |
|E | | |
|5% of patients presenting with a perianal abscess are diabetic | | |
| | | |
|[pic] | |
|Comments: | |
|Goodsall's rule predicts the position of the internal opening of a perianal fistula. The presence of bowel flora is | |
|associated with a fistula, aerobic bacteria would imply that the sepsis was derived from the skin. The incidence is less | |
|than 0.1% with boys less than 2 years being affected more often. Crohn's patients present more often with perianal sepsis | |
|and maybe the presenting symptom. All non-diabetic patients therefore need to be screened for diabetes. | |
[pic]
| | |
| | |
| | |
| | |
|The following are true about Pseudomonas aeruginosa: | |
| |
|A | | |
|it is the most common cause of contact lens acquired infection | | |
| | | |
|B | | |
|it is a Gram negative bacteria | | |
| | | |
|C | | |
|it can cause osteomyelitis | | |
| | | |
|D | | |
|it is sensitive to chloramphenicol | | |
| | | |
|E | | |
|it is sensitive to ciprofloxacin | | |
| | | |
|[pic] | |
|Comments: | |
|Infection rates can be reduced by wearing the contact lens for 10 hours or less.It is a gram-negative aerobic bacilli.The | |
|most common organisms that cause osteomyelitis are Staphylococcus, Haemophilus influenzae, and Salmonella, although | |
|P.Aeruginosa can cause osteomyelitis.Chloramphenicol has good activity against Haemophilus influenzae but not | |
|P.Aeruginosa.P.Aeruginosa is sensitive to quinolones, which inhibit DNA Topoisomerase. | |
[pic]
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
|Pseudomonas infections are associated with: | |
| |
|A | | |
|Urea - like odour | | |
| | | |
|B | | |
|Grape - like odour | | |
| | | |
|C | | |
|Faeculent - like odour | | |
| | | |
|D | | |
|Sloughy exudate | | |
| | | |
|E | | |
|Green exudate | | |
| | | |
|[pic] | |
|Comments: | |
|Pseudomonas spp. is a ubiquitous facultative anaerobe. Proteus infections are associated with urea-like odours. Bacteroides,| |
|Fusobacteria and Clostridia infections produce a faeculent odour. | |
[pic]
|Staphylococcus aureus | |
| |
|A | | |
|is a gram positive motile organism | | |
| | | |
|B | | |
|produces a coagulase | | |
| | | |
|C | | |
|produces enterotoxin | | |
| | | |
|D | | |
|is typically anaerobic | | |
| | | |
|E | [pic] | |
|is arranged in chains | | |
| | | |
|[pic] | |
|Comments: | |
|Staphylococcus aureus is a gram positive non-motile, aerobic coccus whose colonies are arranged in grape-like clusters. | |
|Strains are responsible for food poisoning through the production of an enterotoxin and pathogenicity is also associated | |
|with coagulase positivity. | |
[pic]
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
|A 69-year-old smoker is to undergo a left fem-pop bypass due to atheromatous arterial disease. Which of | |
|the following would be regarded as appropriate antibacterial prophylaxis for this patient? | |
| |
|A | | |
|Cefotaxime | | |
| | | |
|B | | |
|Erythromycin | | |
| | | |
|C | | |
|Gentamicin | | |
| | | |
|D | | |
|Metronidazole | | |
| | | |
|E | | |
|Flucloxacillin | | |
| | | |
|[pic] | |
|Comments: | |
|Appropriate prophylactic antibacterials for a relatively clean procedure such as arterial surgery includes 2nd or 3rd | |
|generation caphalosporins or Co-Amoxiclav as the drugs of choice for these procedures. Bacteriostatic agents such as | |
|erythromycin are inappropriate. Metronidazole would be effective where anaerobic agents would be considered problematic and | |
|would be used adjunctively in diabetic wounds etc. Flucloxacillin would not have a broad enough spectrum of activity to be | |
|considered appropriate. In those suspected high risk of MRSA - previous infection- or units where MRSA is a problem - | |
|vancomycin would be an appropriate agent. | |
[pic]
|The following are normal flora found in the particular anatomical site | |
| |
|A | | |
|Nasopharynx – Haemophilus spp | | |
| | | |
|B | | |
|Skin – Propionbacteria | | |
| | | |
|C | | |
|Stomach – sterile | | |
| | | |
|D | | |
|Female genital tract – Enterococci | | |
| | | |
|E | | |
|Urinary tract – Escherichia coli | | |
| | | |
|[pic] | |
|Comments: | |
|The normal flora found are | |
|Nasopharynx: Staphylococci, streptococci (including pneumococci), haemophilus spp., anaerobes | |
|Skin: Staphylococci, streptococci, propionbacteria | |
|Stomach: The acid content reduces the bacterial load, however, organisms can persist e.g. Helicobacter pylori | |
|Female genital tract: Flora of the large bowel plus staphylococci, streptococci, haemophilus spp. | |
|Urinary tract: Normally sterile | |
[pic]
| | |
| | |
| | |
| | |
| | |
|Features of tetanus includes | |
| |
|A | | |
|A rigid abdomen | | |
| | | |
|B | | |
|Hypomagnesaemia | | |
| | | |
|C | | |
|Hypocalcaemia | | |
| | | |
|D | | |
|Carpopedal spasm | | |
| | | |
|E | | |
|Clouding of conciousness | | |
| | | |
|[pic] | |
|Comments: | |
|Tetanus is caused by the gram positive bacillus Clostridium tetani and is associated with tetanic contractions due to | |
|neuromuscular blockade by the tetanus toxin. Tetanic contractions and respiratory arrest are seen but the level of | |
|conciousness is typically unimpaired. | |
[pic]
| | |
| | |
| | |
|Pelvic abscesses | |
| |
|A |false [pic] | |
|Are an uncommon cause of intra-abdominal abscess/ | | |
| | | |
|B |true [pic] | |
|Can be associated with a perforated peptic ulcer | | |
| | | |
|C |false [pic] | |
|Commonly present with nocturia | | |
| | | |
|D |true [pic] | |
|Frequently drain spontaneously into the rectum | | |
| | | |
|E |false [pic] | |
|Can only be identified on CT if there is a full bladder | | |
| | | |
|[pic] | |
|Comments: | |
|Pelvic abscess is the commonest variety of intraperitoneal abscess. Pus can track down the peritoneal cavity to form a | |
|pelvic abscess. The abscess can irritate the bladder causing urinary frequency/nocturia. If an abscess drains spontaneously | |
|via the rectum, they rarely require any further treatment. Ultrasound imaging requires a full urinary bladder to identify | |
|the pelvic organs and any abscesses present. | |
[pic]
| | |
| | |
| | |
| | |
| | |
| | |
| | |
|Bacterial capsules: | |
| |
|A |false [pic] | |
|are typical of pseudomonas aeroginose | | |
| | | |
|B |false [pic] | |
|can transfer antibiotic reisistance to other bacteria | | |
| | | |
|C |true [pic] | |
|enhance bacterial resistance to dehydration and phagocystosis | | |
| | | |
|D |false [pic] | |
|are associated with endotoxic shock | | |
| | | |
|E |true [pic] | |
|enhance bacterial resistance to antibiotics | | |
| | | |
|[pic] | |
|Comments: | |
|Bacterial capsules are usually composed of polysaccharide and may be associated with mucoid colonial morphology. The slimy | |
|material functions as an anti-phagocytic agent and also protects the bacterial cell from the environment, (eg dehydration), | |
|including antibiotics which may be present. However many important bacterial pathogens do NOT rely on capsules e.g. | |
|M.tuberculosis or Salmonella. Endotoxic shock is associated with the biological activity of lipopolysaccharide (LPS), not | |
|capsules. Endotoxic shock is associated with the biological activity of Gram negative cell wall lipopolysaccharide. | |
|Capsulated bacteria include Streptococcus pneumoniae and pseudomonas. Although capsule may help to protect against | |
|antibiotics they do not transfer antibiotic resistance. | |
[pic]
| |
| |
| |
| |
| |
| |
|A middle-aged woman presents with recent changes in bowel habit. She is investigated as a case of sporadic colonic carcinoma.|
|What is the mechanism of its tumorogenesis? |
| |
| |
|1 ) |APC gene mutation |[pic] | | |
|2 ) |β-catenin suppression |[pic] | | |
|3 ) |Down-regulation of p27 |[pic] | | |
|4 ) |K-ras suppression |[pic] | | |
|5 ) |p53 upregulation |[pic] | | |
| |
|[pic] |
|Comments: |
|The cyclin-dependent kinase inhibitor p27 is a negative regulator of the cell cycle and a potential tumour suppressor gene. |
|Its down-regulation is associated with occurrence of sporadic colon cancer. β-catenin accumulation, not suppression, |
|initiates adenoma formation. p53 is a tumour suppressor gene. Activation of K-ras oncogene is seen in sporadic colon cancer. |
[pic]
| |
| |
| |
| |
|A 17-year-old girl underwent emergency splenectomy after a domestic accident. Which one of the following organisms is most |
|likely to cause life-threatening infection in the future? |
| |
| |
|1 ) |Actinomycosis | | | |
|2 ) |Haemophilus influenzae | | | |
|3 ) |Pseudomonas aeruginosa | | | |
|4 ) |Staphylococcus aureus | | | |
|5 ) |Streptococcus pneumoniae | | | |
| |
|[pic] |
|Comments: |
|Following splenectomy a person is at risk of Streptococcus pneumoniae , Haemophilus influenzae, Nesseria meningitidis, |
|Escherichia coli and Pseudomonas aeruginosa. |
|By far the most common is Streptococcus pneumoniae- which can cause life threatening infection. |
[pic]
| |
| |
| |
| |
| |
| |
| |
| |
|A 33-year-old type 1 diabetic male presents with a two day history of pain in his left hand, fever and a rash. This began |
|after he pricked his finger in the garden whilst pruning a bush. His diabetic control has been quite reasonable with a HbA1c |
|of 7.1% on basal bolus insulin consisting of Lispro tds and Humulin I in the evenings. On examination he has a painful, red |
|and swollen middle finger with the redness extending to the metacaropophalangeal joint. He is diagnosed with cellulites and |
|is prescribed antibiotics. What is the most likely infective organism? |
| |
| |
|1 ) |Escherichia coli |[pic] | | |
|2 ) |Klebsiella |[pic] | | |
|3 ) |MRSA |[pic] | | |
|4 ) |Pseudomonas aeruginosa |[pic] | | |
|5 ) |Streptococcus pyogenes |[pic] |[pic] | |
| |
|[pic] |
|Comments: |
|This patient has a community-acquired cellulitis which is most likely due to either strep or Staphylococcus aureus (not MRSA |
|which is more of a hospital pathogen and tends not to cause cellultis). Understanding the likely infective organism can |
|therefore dictate appropriate antibiotic therapy. In this case oral flucloxacillin and Pencillin V are appropriate. If the |
|cellultis does not quickly improve then intravenous antibiotics may be required. |
|Which of the following micro-organisms is the commonest cause of haematogenous osteomyelitis? |
| |
| |
|1 ) |Streptococcus |[pic] | | |
|2 ) |Salmonella |[pic] | | |
|3 ) |H.influenza |[pic] | | |
|4 ) |Staphylococcus aureus |[pic] |[pic] | |
| |
|[pic] |
|Comments: |
|In persons with haematogenous osteomyelitis, when infection penetrates the periosteal membrane, a cloaca may form and extend |
|into the adjacent soft tissues. Cortical sequestration can subsequently appear. In infants and young children, a suppurative |
|process of the metaphysis may extend into the epiphysis and also lead to involucrum formation. Other abnormalities include |
|single or multiple Brodies abscess usually of staphylococcal origin. On radiographs these abscesses appear as areas of |
|radiolucency with adjacent sclerosis. In the metaphysis, the lucent region may connect with the growth plate by a tortuous |
|channel (i.e. channel or tract sign); in the diaphysis, the radiolucent abscess cavity can be located in central or |
|subcortical areas or in the cortex itself and may contain a central sequestrum; in an epiphysis, a circular, well-defined |
|osteolytic lesion is seen. A cortical abscess simulates the appearance of an osteoid osteoma or a stress fracture. |
[pic]
|A 47-year-old man presents with progressive right hand swelling 2 days after being bitten by a dog. On examination there is a|
|punture wound with pus over the dorsum of the hand, cellulitis, ascending lymphangitis and tender axillary lymphadenopathy. |
|What is the most appropriate antibiotics therapy in this case? |
| |
| |
|1 ) |Benzylpenicillin and flucloxacillin |[pic] | | |
|2 ) |Ceftriaxone |[pic] | | |
|3 ) |Ciprofloxacin |[pic] | | |
|4 ) |Co-amoxiclav |[pic] | | |
|5 ) |Erythromycin |[pic] | | |
| |
|[pic] |
|Comments: |
|Only 15-20% of dog bites become infected and providing the wound is appropriately cleaned and not considered at risk (eg |
|crush or deep wounds) then antibiotic prophylaxis may not be required. Hiwever, this patient has an infected wound and |
|infective organisms include pastuerella spp, Staph aureua and anaerobes like corynebacterium. The most appropriate antibiotic|
|therapy in dog bites associated with cellulites would be co-amoxiclav. |
[pic]
|A 21-year-old man with non-Hodgkin’s lymphoma and haemolytic anaemia is assessed for splenectomy. When should Pneumovax vaccine be administered? |
| |
| |
|1 ) |one month before surgery |[pic] |[pic] | |
|2 ) |one week before surgery |[pic] | | |
|3 ) |one week after surgery |[pic] | | |
|4 ) |one month after surgery |[pic] | | |
|5 ) |perioperatively |[pic] | | |
| |
|[pic] |
|Comments: |
|The vaccine should be given a minimum of two weeks before elective splenectomy in order to ensure an optimal antibody response. In emergency splenectomy|
|the patient should be immunized as soon as possible after recovery from the operation and before discharge from hospital. Unvaccinated patients |
|splenectomized some time earlier should be vaccinated at the first opportunity. Vaccination is delayed for at least six months after immunosuppressive |
|chemotherapy or radiotherapy, during which time prophylactic antibiotics should be given. |
[pic]
|A 12-year-old girl presents with left ear pain and fever, worsening over the past 3 days. Today mother has noted a whitish |
|creamy discharge from the ear canal. She was born at 38/40 gestation weighing 3.8kg and there were no neonatal problems. She |
|is fully immunised. She trains regularly in a swimming team. |
|On examination she has a temperature of 38.2°C and has a red left tragus. This is exquisitely tender, and examination of the |
|drum is impossible because of the pain and creamy thin discharge. She has shotty tender posterior cervical glands. |
|What is the most likely diagnosis? |
| |
| |
|1 ) |Group A streptococcal pharyngitis |[pic] | | |
|2 ) |Mastoiditis |[pic] | | |
|3 ) |Otitis externa |[pic] | | |
|4 ) |Otitis media, acute |[pic] |[pic] | |
|5 ) |Otitis media, recurrent |[pic] | | |
| |
|[pic] |
|Comments: |
|The history suggests an acute otitis externa. The tight adherance of skin to the underlying perichondrium and periostium make|
|the pain worse than the degree of inflammation would suggest. An ear swab culture should be sent and neomycin and |
|colistin/polymixin ear drops commenced. This covers the common gram positive and gram negative usually responsible. |
[pic]
|A 5-year-old boy presents to Accident and Emergency complaining of acute pain over his upper tibia. He is febrile and he |
|refuses to move his leg. A diagnosis of osteomyelitis is suspected |
|The likely infecting organism is? |
| |
| |
|1 ) |Clostridium difficile | | | |
|2 ) |Haemophilus influenzae | | | |
|3 ) |Pseudomonas | | | |
|4 ) |Salmonella | | | |
|5 ) |Staphylococcus aureus | | | |
| |
|[pic] |
|Comments: |
|The commonest infecting organism in acute osteomyelitis in children over the age of 4 years is Staphilococcus aureus. With |
|immuniozation cases of haemtogenous osteomyelitis due to Haemophilus influenzae have almost been eradicated. Salmonella is |
|the characteristic organism inm sickle cell anaemia. Pseudomonas infection is a common organism in haemodyalisis patients and|
|intravenous drug addicts. |
[pic]
|A 7-year-old girl presents with right ear pain and fever, worsening over the past few days. Symptoms began 7d ago with severe|
|ear pain and fever, which was treated with paracetamol. The following morning the pain resolved and a purulent discharge |
|mixed with blood was noted on her pillow. 4d later the pain is throbbing and her ear is tender. She was born at term weighing|
|3.68kg and there were no neonatal problems. She is fully immunised, and there is no FH/SH of note. |
|On examination she has a fever to 39.7C, and her right ear is displaced downwards and forwards. She is extremely tender |
|behind the right ear, and has a purulent discharge from the ear canal. Her pulse is 100/min and respiratory rate is 15/min. |
|What is the most likely diagnosis? |
| |
| |
|1 ) |Cholesteatoma |[pic] | | |
|2 ) |Mastoiditis |[pic] | | |
|3 ) |Otitis media with effusion |[pic] | | |
|4 ) |Otitis media, acute |[pic] | | |
|5 ) |Otitis media, recurrent |[pic] | | |
| |
|[pic] |
|Comments: |
|The history suggests acute otitis media with perforation, followed by acute mastoiditis (acute mastoid osteitis). This can be|
|confirmed by CT scan of the mastoid. Pneumococcus and H. influenzae are the commonest cause. Most resolve with antibiotics, |
|but some require surgical drainage. |
|Regarding antibiotic prophylaxis: | |
| |
|A | | |
|The dose of antibiotic should reflect the degree of sepsis found | | |
| | | |
|B | | |
|Requires a second dose if the procedure exceeds 4 hrs | | |
| | | |
|C | | |
|Should only be given on induction of anaesthetic | | |
| | | |
|D | | |
|Usually only require a single dose | | |
| | | |
|E | | |
|Are not required in 'clean' procedures | | |
| | | |
|[pic] | |
|Comments: | |
|In adults, the full dose of the chosen antibiotic should be administered unless there is a concern regarding excretion e.g. | |
|renal failure. In prolonged procedures, a second dose is advised. Otherwise, single-dose prophylaxis is effective in most | |
|clinical situations. Clean procedures were synthetic material is implanted require antibiotic prophylaxis. | |
[pic]
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
|The following statements regarding anastomotic leakage are correct: | |
| |
|A | | |
|Colorectal anastomotic leakage results in a three-fold increase in post-operative mortality. | | |
| | | |
|B | | |
|Anastomoses below the peritoneal reflection have a reduced risk of leakage. | | |
| | | |
|C | | |
|Clinically detected leaks are roughly equal to radiologically detected leaks. | | |
| | | |
|D | | |
|Excessive tension in the ligatures reduces the leak rate. | | |
| | | |
|E | | |
|Barium enema is the investigation of choice to confirm the diagnosis. | | |
| | | |
|[pic] | |
|Comments: | |
|Most colorectal anastomotic leaks present late (after the patient has recommenced oral feeding). Low anastomoses have a | |
|higher leak rate therefore, most surgeons divert the faecal flow with a temporary proximal stoma. | |
|The clinical leak rate underestimates the true incidence of leakage. Excessive tension leads to tissue necrosis and leakage | |
|of the anastomosis. | |
|Barium is toxic in the peritoneal cavity therefore the investigation of choice is a gastrograffin enema. | |
[pic]
| | |
| | |
| | |
| | |
|Regarding surgical infection: | |
| |
|A | | |
|Primary refers to a planned surgical trauma. | | |
| | | |
|B | | |
|Always have a focus of infection. | | |
| | | |
|C | | |
|Are always associated with tissue necrosis. | | |
| | | |
|D | | |
|Inflammation is the response to tissue necrosis. | | |
| | | |
|E | | |
|Antibiotics are advised once a septic focus has been drained. | | |
| | | |
|[pic] | |
|Comments: | |
|Primary surgical infections refer to surgical wounds which appear spontaneously e.g. a skin abscess. | |
|Surgical wounds differ from non-surgical wounds in that they always have a source of infection, which can be drained | |
|surgically. | |
|Tissue necrosis results from trauma or through a pathophysiological process. Inflammation leads to the events visible at the| |
|surface. Once the source of infection has been drained, antibiotics are usually unnecessary unless the surrounding tissues | |
|are infected. | |
[pic]
| | |
| | |
| | |
| | |
| | |
| | |
| | |
|The following can be used for skin disinfection: | |
| |
|A | | |
|quaternary ammonium compounds | | |
| | | |
|B | | |
|phenol | | |
| | | |
|C | | |
|glutaraldehyde | | |
| | | |
|D | | |
|alcoholic solution of chlorhexidine | | |
| | | |
|E | | |
|povidone-iodine solution | | |
| | | |
|[pic] | |
|Comments: | |
|Quaternary ammonium compounds are powerful disinfectants with additional detergent action, not to be used on skin. Phenol is| |
|famous as the disinfectant first used by Joseph Lister in the l880's in antiseptic surgery. It is however very corrosive to | |
|human tissues and today is usually the starting point for the synthesis of derivatives. Glutaraldehyde is a compound used | |
|especially in tanning leather and in the fixation of biological tissues. Although not a phenol compound, chlorohexidine is | |
|similar in structure and function and has no reported toxic effects. It is often used as an alternative in soaps, and on | |
|skin and mucous membranes. Iodine is most commonly used in alcoholic solution known as tinctures of iodine. It is a common | |
|skin disinfectant used for cuts and abrasions as well as a skin preparation in surgery. | |
[pic]
| | |
| | |
| | |
| | |
| | |
|The following are recognised cause of toxic megacolon: | |
| |
|A | | |
|pneumatosis cystoides intestinalis | | |
| | | |
|B | | |
|amoebic dysentry | | |
| | | |
|C | | |
|salmonella gastroenteritis | | |
| | | |
|D | | |
|Strongyloides infection | | |
| | | |
|E | | |
|pseudomembranous colitis | | |
| | | |
|[pic] | |
|Comments: | |
|Complications of amoebiasis include fulminant colitis, stricture formation, haemorrahge, amoeboma and amoebic liver abscess.| |
|Pseudomembranous colitis caused by Clostridium difficile and associated with antibiotic use. Symptoms vary from mild | |
|diarrhoea to fulminating toxic megacolon. Samonella is also a recognised cause, particularly in children. Pneumatosis | |
|cystoides intestinalis associated with chronic bronchitis - multiple gas filled cysts in sub-mucosa of colon. Mainly | |
|asymptomatic, but can cause abdominal pain, diarrhoea and rupture to produce pneumoperitoneum. Salmonella enterocolitis | |
|produces colitis, acute appendicitis in young and mesenteric thrombosis in the elderly. Strongyloides stercoralis causes | |
|malabsorption with steatorrhoea. | |
[pic]
| | |
| | |
| | |
| | |
| | |
|In a young man with a four day history of bloody diarrhoea: | |
| |
|A | | |
|shigellosis is a likely diagnosis | | |
| | | |
|B | | |
|the finding of cysts to Entamoeba histolytica in the stools confirms a diagnosis of acute amoebic | | |
|dysentry | | |
| | | |
|C | | |
|cholera is a likely diagnosis | | |
| | | |
|D | | |
|a negative amoebic fluorescent antibody test excludes a diagnosis of acute amoebic dysentry | | |
| | | |
|E | | |
|giardiasis is a likely diagnosis | | |
| | | |
|[pic] | |
|Comments: | |
|Infective causes plus inflammatory bowel disease should be considered in the differential diagnosis of a young man with | |
|bloody diarrhoea. Shigellosis is a possible cause. b-trophozoites seen in acute dysentry. Cysts for E. Histolitica are not | |
|100% sensitive for amoebic dysentery. c+e-watery diarrhoea | |
[pic]
| | |
| | |
| | |
| | |
|Sterilization: | |
| |
|A | | |
|Hot air sterilization is the preferred method to treat surgical instruments with fine cutting edges. | | |
| | | |
|B | | |
|Sterilization by ethylene oxide has a broad-spectrum static action against bacteria, spores and viruses. | | |
| | | |
|C | | |
|Ethylene oxide should only be used when heat sterilization of an item is not possible. | | |
| | | |
|D | | |
|Flash autoclaving at 147°C and 40 lb/square inch is the preferred method of sterilization by steam. | | |
| | | |
|E | | |
|Unwrapped instruments may be sterilized in theatre using a portable steam sterilizer. | | |
| | | |
|[pic] | |
|Comments: | |
|Hot-air ovens have the benefit of not causing corrosion in non-stainless metals and not damaging fine cutting edges in | |
|delicate instruments. | |
|Under optimal conditions of concentration, temperature and exposure time, ethylene oxide has a broad spectrum cidal action. | |
|Ethylene oxide is toxic, irritant, mutagenic and carcinogenic, therefore its use requires extreme caution. | |
|Flash autoclaving is no longer recommended or available for safety reasons, the preferred setting is 132°C (30 lb in-2) held| |
|for 3 minutes. This method is a convenient way to deal with dropped instruments. | |
[pic]
| | |
| | |
| | |
| | |
| | |
|The following wound classification are correct: | |
| |
|A | | |
|Emergency femoral hernia repair – clean | | |
| | | |
|B | | |
|Open cholecystectomy for a mucocele of the gallbladder – potentially contaminated. | | |
| | | |
|C | | |
|Emergency abdominal aortic aneurysm repair – contaminated. | | |
| | | |
|D | | |
|Girdlestone's procedure – clean. | | |
| | | |
|E | | |
|Hartmann's procedure performed for peritonitis - dirty. | | |
| | | |
|[pic] | |
|Comments: | |
|While the femoral hernia repair is being performed, as an emergency there is a high risk of strangulation and possible perforation; therefore, this| |
|wound should be considered as potentially contaminated. | |
|There is always a risk of bile/mucus spillage during the procedure. | |
|Emergency and elective abdominal aortic aneurysm should be considered clean procedures. | |
|Girdlestone's procedure (excision of the femoral head and arthrodesis) is usually performed for infection and should be considered to be | |
|potentially contaminated. | |
|An emergency Hartmann's procedure is usually performed for a sigmoid colon perforation or secondary to diverticular disease or cancer. | |
[pic]
|T | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
|he following is/are true of the Hepatitis C virus | |
| |
|A | | |
|Can be prevented by vaccination | | |
| | | |
|B | | |
|Usually resolves following an acute illness | | |
| | | |
|C | | |
|The prevalence in the UK is ................
................
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