Kidney Functions and Processes
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Questions and Answers

What percentage of liquid is reabsorbed by the kidneys?

  • 95%
  • 99% (correct)
  • 90%
  • 80%

    • What are the two main risk factors for kidney disease?

  • Hypertension and Diabetes (correct)
  • Obesity and Family history
  • Diabetes and Heart problems
  • Tobacco use and 60+ years old

    • What is the normal urine production rate for the kidneys?

  • 3.5 - 4.5 ml/kg/hr
  • 1.5 - 2.5 ml/kg/hr
  • 2.5 - 3.5 ml/kg/hr
  • 0.5 - 1.5 ml/kg/hr (correct)

    • What is the glomerular filtration rate (GFR) for the kidneys?

    <p>100ml / min</p> Signup and view all the answers

    What percentage of people with kidney disease are unaware?

    <p>40%</p> Signup and view all the answers

    How long are kidney disease patients usually asymptomatic?

    <p>Until advanced disease</p> Signup and view all the answers

    What stages of kidney disease are considered risks for dental treatment?

    <p>Stages 4 and 5</p> Signup and view all the answers

    What is a consequence of kidney disease?

    <p>Build up of toxins</p> Signup and view all the answers

    What is a dental implication of kidney disease?

    <p>Bone abnormalities</p> Signup and view all the answers

    What is the mechanism that causes jaw bone changes in chronic kidney disease?

    <p>Increased parathormone release due to low Vitamin D levels</p> Signup and view all the answers

    What drug does not require alteration if the patient has chronic kidney disease?

    <p>Lignocaine</p> Signup and view all the answers

    What type of dialysis is necessary when the kidney function is no longer able to meet demand?

    <p>Both Haemodialysis and Peritoneal dialysis</p> Signup and view all the answers

    What is the consequence of kidney disease that affects the cardiovascular system?

    <p>Increased cardiovascular risk</p> Signup and view all the answers

    What is the dental implication of kidney disease that is related to nutrition and preparation for transplant?

    <p>Good oral health supports nutrition/preparation for transplant</p> Signup and view all the answers

    What is the result of increased parathormone release in chronic kidney disease?

    <p>Increased osteoclastic activity</p> Signup and view all the answers

    What is the condition that requires alteration of Amoxycillin dosage in chronic kidney disease patients?

    <p>GFR under 10</p> Signup and view all the answers

    Why should NSAID’s be avoided in chronic kidney disease patients?

    <p>If GFR is under 10 or they have diabetes</p> Signup and view all the answers

    When is Haemodialysis or Peritoneal dialysis necessary in kidney disease patients?

    <p>When function is no longer able to meet demand</p> Signup and view all the answers

    What is the primary function of the kidneys in terms of waste removal?

    <p>Excrete waste including dental drugs</p> Signup and view all the answers

    What hormone is involved in vitamin D metabolism and calcium homeostasis?

    <p>1.25 cholecalciferol</p> Signup and view all the answers

    What is the target organ for parathormone, aldosterone, and ADH?

    <p>Kidneys</p> Signup and view all the answers

    What are the two ethnicities most at risk of developing kidney disease?

    <p>Asian and Black Caribbean</p> Signup and view all the answers

    What is the final stage of kidney disease?

    <p>Kidney failure requiring treatment to live</p> Signup and view all the answers

    What is a risk factor for chronic kidney disease?

    <p>Family history of kidney disease</p> Signup and view all the answers

    What is the primary focus of the concept of pathogenicity?

    <p>The ability to cause disease</p> Signup and view all the answers

    What is the primary purpose of Koch's postulates?

    <p>To determine if a microbe is pathogenic</p> Signup and view all the answers

    What is the limitation of Koch's postulates in relation to HIV?

    <p>HIV cannot be grown in culture</p> Signup and view all the answers

    What is the name given to the redefined version of Koch's postulates?

    <p>Molecular Koch's postulates</p> Signup and view all the answers

    What is the first postulate of Molecular Koch's postulates?

    <p>The phenotype should be associated significantly more often with a pathogenic organism than with a non-pathogenic one</p> Signup and view all the answers

    What is the function of a virulence factor or gene?

    <p>To drive the pathogenesis of an organism</p> Signup and view all the answers

    What is the purpose of inactivating a gene associated with a suspected virulence trait?

    <p>To measure the decrease in virulence</p> Signup and view all the answers

    What is the primary function of adhesin genes?

    <p>To provide a product that enables the microbe to bind more easily</p> Signup and view all the answers

    What is the difference between colonization and infection?

    <p>Colonization is the presence of microbes without disease, while infection is the presence of microbes resulting in disease</p> Signup and view all the answers

    What are the three origins of virulence genes?

    <p>Plasmids, bacteriophages, and pathogenicity islands</p> Signup and view all the answers

    What is the function of M proteins in group A streptococci?

    <p>To prevent Fc binding to antibodies</p> Signup and view all the answers

    What is the difference between facultative and obligate intracellular pathogens?

    <p>Facultative pathogens are not dependent on the host, while obligate pathogens are</p> Signup and view all the answers

    How do microbes adhere to the host cells?

    <p>Through the use of flagellae and fimbriae</p> Signup and view all the answers

    What are the three stages of bacterial burden?

    <p>Contamination, colonization, and critical colonization</p> Signup and view all the answers

    What is the function of antiphagocytic capsules?

    <p>To prevent the take-up of the microbe by host cells</p> Signup and view all the answers

    What type of bacteria is Rickettsiae?

    <p>Obligate intracellular bacteria</p> Signup and view all the answers

    What is the mechanism of Rickettsiae and therefore obligate intracellular bacteria?

    <p>Entry in cell, escapes phagosomes, grows and replicates, grows actin tail, and escapes through cell membrane</p> Signup and view all the answers

    Why do obligate intracellular pathogens have a low number of Open Reading Frames (ORFs)?

    <p>They lose a lot of genetic material as they do not need to grow in an external environment</p> Signup and view all the answers

    What is the advantage of intracellular infection for bacteria?

    <p>Immune evasion, carriage around the body via the host cell, obtaining nutrients from the host, and smaller genome size</p> Signup and view all the answers

    What is pyogenic inflammation caused by?

    <p>A lipopolysaccaride known as Pathogen Associated Molecular Pattern (PAMPs)</p> Signup and view all the answers

    What are the two negative consequences of pyogenic inflammation?

    <p>Blocking of capillaries and major organ failure</p> Signup and view all the answers

    What is granulomatous inflammation caused by and what is its purpose?

    <p>Mycobacterium tuberculosis, to 'sequester' the pathogen</p> Signup and view all the answers

    What causes a cytokine storm?

    <p>Over-activation of a healthy immune system</p> Signup and view all the answers

    What are the two cytokines involved in a cytokine storm?

    <p>TNF alpha and IL-6</p> Signup and view all the answers

    What is mimicry in the context of microbial infection?

    <p>When the microbe mimics the host</p> Signup and view all the answers

    What is the primary mode of transmission of Herpes Simplex Virus 2?

    <p>Sexual contact</p> Signup and view all the answers

    What is the typical incubation period of Herpes Simplex Virus?

    <p>2-12 days</p> Signup and view all the answers

    What is a common complication of Herpes Simplex Virus in newborns?

    <p>Neonatal mortality</p> Signup and view all the answers

    Which of the following is NOT a clinical feature of Herpes Simplex Virus?

    <p>Rash on hands and feet</p> Signup and view all the answers

    What is the mechanism by which Herpes Zoster occurs?

    <p>Reactivation of the varicella zoster virus</p> Signup and view all the answers

    What is the primary purpose of Acyclovir in the treatment of Herpes Simplex Virus?

    <p>To suppress viral replication</p> Signup and view all the answers

    What is a characteristic of Pseudomembranous candidiasis?

    <p>Thin yellow membrane</p> Signup and view all the answers

    What type of parasite is Leishmania?

    <p>Systemic</p> Signup and view all the answers

    How is a local parasite such as Trichomonas tenax treated?

    <p>With Metronidazole</p> Signup and view all the answers

    What is the name of the parasite that affects the oral cavity and causes granulomatous growth on the mouth and nose?

    <p>Leishmania</p> Signup and view all the answers

    What is the term for the red, swollen patches that occur in the corners of the mouth?

    <p>Angular Chelitis</p> Signup and view all the answers

    What is the term for the smooth, red, flat or raised nodular area on the top part of the tongue?

    <p>Median rhomboid glossitis</p> Signup and view all the answers

    Which of the following is a complication of Herpes zoster?

    <p>Post-herpetic neuralgia</p> Signup and view all the answers

    What is the type of transmission that occurs when an individual never develops symptoms?

    <p>Asymptomatic transmission</p> Signup and view all the answers

    What is the incubation period of infectious mononucleosis?

    <p>4-14 days</p> Signup and view all the answers

    What is the causative agent of chicken pox?

    <p>Varicella zoster virus</p> Signup and view all the answers

    What is the virus that causes Hand-Foot-and-Mouth disease?

    <p>Coxsackie virus B</p> Signup and view all the answers

    What is the type of immunity that involves the transmission of antibodies from a mother to a fetus?

    <p>Passive immunity</p> Signup and view all the answers

    What is the primary portal of entry for the SARS-CoV-2 virus?

    <p>Mucosal membrane of the oral cavity</p> Signup and view all the answers

    What is the mechanism of Rickettsiae and why are they obligate intracellular bacteria?

    <p>They use the host cell's membrane to penetrate</p> Signup and view all the answers

    What is the type of virus that Hepatitis B is?

    <p>DNA virus</p> Signup and view all the answers

    What is the complication associated with measles?

    <p>Gingivostomatitis</p> Signup and view all the answers

    What is the incubation period for Hepatitis B?

    <p>45-180 days</p> Signup and view all the answers

    What is the clinical feature of Erythema infectiosum?

    <p>Livid erythema of the cheeks</p> Signup and view all the answers

    What is the virus that causes COVID-19?

    <p>SARS-CoV-2</p> Signup and view all the answers

    What is the causative agent of Whooping cough?

    <p>Bordetella pertussis</p> Signup and view all the answers

    What is the primary purpose of Monospot test?

    <p>To diagnose Infectious mononucleosis</p> Signup and view all the answers

    What is the common complication of Mumps?

    <p>All of the above</p> Signup and view all the answers

    What is the complication of Whooping cough?

    <p>All of the above</p> Signup and view all the answers

    What is the primary function of the ACE2 receptor in the context of SARS-CoV-2?

    <p>To facilitate the entry of the virus into the host cell</p> Signup and view all the answers

    What is the type of virus that Hepatitis C is?

    <p>RNA virus</p> Signup and view all the answers

    What is the disease that is strongly associated with HIV infection?

    <p>All of the above</p> Signup and view all the answers

    What is the primary function of basophils in the immune system?

    <p>Antibody-dependent damage to parasites and immediate hypersensitivity reactions</p> Signup and view all the answers

    What is the normal haemoglobin level for adult females?

    <p>120-155 g/L</p> Signup and view all the answers

    What dictates the symptoms and signs of anaemia?

    <p>The rate at which anaemia develops</p> Signup and view all the answers

    What is the function of monocytes and macrophages?

    <p>Chemotaxis, phagocytosis, killing of micro-organisms, antigen presentation and release of IL-1 and TNF</p> Signup and view all the answers

    What is the result of a reduction in haemoglobin levels below the reference range for age and sex?

    <p>Anaemia</p> Signup and view all the answers

    What is the function of neutrophils in the immune system?

    <p>Chemotaxis, phagocytosis, and killing of phagocytosed cells</p> Signup and view all the answers

    What is the primary function of Haemoglobin?

    <p>Oxygen transportation</p> Signup and view all the answers

    What is the most common congenital cause of haemolytic anaemia?

    <p>Membrane defects (Hereditary spherocytosis)</p> Signup and view all the answers

    What is the term for the enlargement of the spleen?

    <p>Splenomegaly</p> Signup and view all the answers

    What type of defect is Glucose-6-phosphate dehydrogenase (G6DP) deficiency?

    <p>Enzyme defects</p> Signup and view all the answers

    What is the term for the expansion of erythropoiesis leading to bone deformities?

    <p>Frontal bossing</p> Signup and view all the answers

    What is the normal composition of adult Haemoglobin?

    <p>2 alpha and 2 beta chains</p> Signup and view all the answers

    What is the primary mechanism of iron deficiency anaemia?

    <p>Inadequate dietary intake</p> Signup and view all the answers

    What is the root cause of megaloblastic anaemia?

    <p>Vitamin B12 deficiency</p> Signup and view all the answers

    What is the typical presentation of iron deficiency anaemia?

    <p>All of the above</p> Signup and view all the answers

    What is the primary treatment for megaloblastic anaemia?

    <p>Addressing underlying cause and dietary modification</p> Signup and view all the answers

    What is the primary mechanism of normocytic anaemia?

    <p>Chronic disease and inflammation</p> Signup and view all the answers

    What is the typical cause of microcytic anaemia?

    <p>All of the above</p> Signup and view all the answers

    What is the primary mechanism of macrocytic anaemia?

    <p>Megaloblastic erythropoiesis</p> Signup and view all the answers

    What is the typical presentation of vitamin B12 deficiency?

    <p>Peripheral neuropathy and demyelination</p> Signup and view all the answers

    What is the primary cause of anaemia of chronic disease?

    <p>All of the above</p> Signup and view all the answers

    What is the primary treatment for iron deficiency anaemia?

    <p>Addressing underlying cause and dietary modification</p> Signup and view all the answers

    Study Notes

    Kidney Function

    • Kidneys excrete waste, including dental drugs
    • Regulate fluid volume and acid/base
    • Maintain blood pressure
    • Synthesize erythropoietin, renin, and 1.25 cholecalciferol
    • Act as a target organ for parathormone, aldosterone, and ADH

    Glomerular Filtration Rate (GFR)

    • Normal GFR: 100ml/min (150L/day)
    • Reabsorption rate: 99% of liquid

    Urine Production

    • Normal urine production rate: 0.5-1.5 ml/kg/hr
    • Unreabsorbed liquid contains: urea, creatinine, K+, NH4, H+, PO4, hormones, and drugs

    Kidney Disease

    • Patients are often asymptomatic until advanced disease
    • 40% of people with kidney disease are unaware
    • Risk factors: hypertension, diabetes, Asian and Black Caribbean ethnicity

    Chronic Kidney Disease Risk Factors

    • Diabetes
    • High blood pressure
    • Heart problems or stroke
    • Obesity
    • Family history
    • Tobacco use
    • 60+ years old

    Kidney Disease Stages

    • Stage 1: Kidney damage, normal function
    • Stage 2: Kidney damage, mild loss of function
    • Stage 3: Moderate to severe loss of function
    • Stage 4: Severe loss of function
    • Stage 5: Kidney failure, requiring treatment to live

    Risks for Dental Treatment

    • Stages 4 and 5 pose a risk for dental treatment
    • GFR < 30 in these stages

    Consequences of Kidney Disease

    • Increased cardiovascular risk
    • Anaemia and reduced immunity due to high urate levels
    • Increased risk of bleeding
    • Fluid imbalance
    • Decreased bone health
    • Buildup of toxins
    • Reduced drug excretion

    Dental Implications of Kidney Disease

    • Increased periodontal disease
    • Oral signs of anaemia (e.g., angular chelitis, esophageal web)
    • Bone abnormalities
    • Potential increased bleeding tendency
    • Care with ibuprofen (NSAIDs)
    • Good oral health supports nutrition/preparation for transplant

    Jaw Bone Changes in Chronic Kidney Disease

    • Failure to excrete PO4 and low levels of active Vitamin D
    • Low free Ca2+ levels
    • Increased parathormone release
    • Osteoclastic activity
    • Formation of a central giant cell granuloma

    Drug Alterations in Chronic Kidney Disease

    • No alteration required: lignocaine, articaine
    • Dose alteration required: amoxycillin (reduce dose if GFR < 10), NSAIDs (avoid if GFR < 10 or with diabetes), erythromycin (avoid due to drug interactions), midazolam (use with caution if stage 4+, GFR < 30)

    Dialysis

    • Types: haemodialysis, peritoneal dialysis
    • Necessary introduction: when function is no longer able to meet demand (GFR < 30)

    Kidney Function

    • Kidneys excrete waste, including dental drugs
    • Regulate fluid volume and acid/base
    • Maintain blood pressure
    • Synthesize erythropoietin, renin, and 1.25 cholecalciferol
    • Act as a target organ for parathormone, aldosterone, and ADH

    Glomerular Filtration Rate (GFR)

    • Normal GFR: 100ml/min (150L/day)
    • Reabsorption rate: 99% of liquid

    Urine Production

    • Normal urine production rate: 0.5-1.5 ml/kg/hr
    • Unreabsorbed liquid contains: urea, creatinine, K+, NH4, H+, PO4, hormones, and drugs

    Kidney Disease

    • Patients are often asymptomatic until advanced disease
    • 40% of people with kidney disease are unaware
    • Risk factors: hypertension, diabetes, Asian and Black Caribbean ethnicity

    Chronic Kidney Disease Risk Factors

    • Diabetes
    • High blood pressure
    • Heart problems or stroke
    • Obesity
    • Family history
    • Tobacco use
    • 60+ years old

    Kidney Disease Stages

    • Stage 1: Kidney damage, normal function
    • Stage 2: Kidney damage, mild loss of function
    • Stage 3: Moderate to severe loss of function
    • Stage 4: Severe loss of function
    • Stage 5: Kidney failure, requiring treatment to live

    Risks for Dental Treatment

    • Stages 4 and 5 pose a risk for dental treatment
    • GFR < 30 in these stages

    Consequences of Kidney Disease

    • Increased cardiovascular risk
    • Anaemia and reduced immunity due to high urate levels
    • Increased risk of bleeding
    • Fluid imbalance
    • Decreased bone health
    • Buildup of toxins
    • Reduced drug excretion

    Dental Implications of Kidney Disease

    • Increased periodontal disease
    • Oral signs of anaemia (e.g., angular chelitis, esophageal web)
    • Bone abnormalities
    • Potential increased bleeding tendency
    • Care with ibuprofen (NSAIDs)
    • Good oral health supports nutrition/preparation for transplant

    Jaw Bone Changes in Chronic Kidney Disease

    • Failure to excrete PO4 and low levels of active Vitamin D
    • Low free Ca2+ levels
    • Increased parathormone release
    • Osteoclastic activity
    • Formation of a central giant cell granuloma

    Drug Alterations in Chronic Kidney Disease

    • No alteration required: lignocaine, articaine
    • Dose alteration required: amoxycillin (reduce dose if GFR < 10), NSAIDs (avoid if GFR < 10 or with diabetes), erythromycin (avoid due to drug interactions), midazolam (use with caution if stage 4+, GFR < 30)

    Dialysis

    • Types: haemodialysis, peritoneal dialysis
    • Necessary introduction: when function is no longer able to meet demand (GFR < 30)

    Pathogenicity and Virulence

    • Pathogenicity: The ability to cause disease
    • Virulence: The degree of pathogenicity
    • Virulence factor/gene: A gene that drives the pathogenesis of an organism
    • Housekeeping gene: A gene involved in all aspects of a bacterium's life, such as metabolism, protein synthesis

    Koch's Postulates

    • Determine if a microbe is pathogenic
    • 3 Postulates:
        1. Pathogen occurs in every case of the disease and distribution corresponds to that of lesions observed
        1. Pathogen does not occur in healthy subjects
        1. After isolation and repeated growth in pure culture, pathogen can induce disease in susceptible animals

    Anomalies to Koch's Postulates

    • HIV: Can't grow in culture, poor animal model
    • Helicobacter pylori: Carriage doesn't necessarily mean disease, no good animal model
    • Streptococcus mutans: Not the only cause of caries, sometimes no disease
    • Chlamydia: Can't grow in separate culture
    • Cholera: Poor animal models, but eventually shown
    • Diptheria: Disease throughout body, but bacteria only in throat
    • TB: Carried asymptomatically in 1/3 people

    Molecular Koch's Postulates

    • 3 Postulates:
        1. Phenotype should be associated significantly more often with pathogenic organism than with non-pathogenic member or strain
        1. Specific inactivation of gene associated with the suspected virulence trait should lead to a measurable decrease in virulence
        1. Restoration of full pathogenicity should accompany replacement of the mutated gene with the wild type original

    Virulence Genes and Pathogenicity Factors

    • Virulence gene: Causes disease, often encoded on mobile genetic elements
    • Origins of virulence genes:
        1. Plasmids (adhesin genes, antibiotic resistance genes, toxin genes)
        1. Bacteriophages (toxin genes)
        1. Pathogenicity islands (toxin gene systems)
    • 4 Bacterial pathogenicity factors:
        1. Transmission
        1. Adherence (epithelium, skin, etc.)
        1. Invasiveness (sometimes into cells)
        1. Ability to cause damage (cause pathology)

    Transmission and Adherence

    • 3 Methods of transmission:
        1. Inhalation
        1. Ingestion (faecal contamination)
        1. Inoculation (contaminated needles and blood transfusions, skin contact, insects, sexual contact)
    • 3 Ways microbes adhere:
        1. Flagellae (also for motility)
        1. Fimbriae (pili) - enable microbes to bind to the cell wall
        1. Specialised surface proteins (direct attachment, signalling to the eukaryotic cell)

    Bacterial Burden and Colonization

    • Difference between colonization and infection:
      • Colonization: Presence of microbes without accompanying disease
      • Infection: Presence of microbes resulting in disease
    • 4 Stages of bacterial burden:
        1. Contamination
        1. Colonization
        1. Critical colonization
        1. Infection

    Microbial Survival

    • 3 Ways microbes survive:
        1. Affect host function
        1. Immune evasion (antigenic shift, e.g. Neisseria, Borrelia)
        1. Oppose immune function (e.g. superoxide dismutase - inactivates immune cells)

    Invasion and Intracellular Pathogens

    • How microbes invade the body:
        1. Bind to surface
        1. Invade and go through tissues to get to underlying surfaces and penetrate the mucosal layer
    • 3 Properties aid invasion:
        1. Secreted bacterial enzymes (disrupt and destroy tissues and protein structures)
        1. Antiphagocytic capsule (prevents uptake)
        1. Toxins that control uptake mechanisms
    • 2 Ways intracellular bacteria carry out invasion:
        1. Phagocytosis (gets into cell, then escapes phagosome)
        1. Induces uptake by macropinocytosis or endocytosis (complex interactions)

    Facultative and Obligate Intracellular Pathogens

    • Facultative pathogens: Can survive in multiple niches, including the host
    • Obligate pathogens: Require a host to fulfill their life cycle
    • Examples of facultative intracellular pathogens:
        1. Mycobacterium tuberculosis
        1. Legionella pneumophila
        1. Listeria monocytogenes
        1. Salmonella typhimurium
        1. Shigella flexneri (dysentery)
        1. Brucella abortus (congenital fever)
    • Examples of obligate intracellular bacterial pathogens:
        1. Mycobacterium leprae (leprosy)
        1. Chlamydiaceae (common STD)
        1. Rickettsia prowazekii (typhus)

    Chlamydia

    • Dimorphic: Exists in 2 forms:
      • Elementary body (EB) - infectious, but inert
      • Reticulate body (RB) - not infectious, metabolically active
    • How the 2 forms of chlamydia work:
        1. EB attaches to phagocyte and is ingested
        1. Phagosome fusion occurs with the EB
        1. The EB reorganises to RB
        1. RB multiplies as it is metabolically active
        1. Condensation of RB to EB occurs (as this is infectious)
        1. Infectious EB is released

    Rickettsiae

    • Obligate intracellular bacteria
    • Mechanism of Rickettsiae:
        1. Entry into cell
        1. Escapes phagosomes
        1. Into cellular environment
        1. Grows and replicates
        1. Grows actin tail
        1. Escapes through cell membrane with use of actin tail provided by the host

    Obligate Intracellular Bacteria

    • 9 Features:
        1. Long generation time
        1. Small size with small genome
        1. Requires exogenous energy supply
        1. May infect non-phagocytic cells
        1. Protected from lysosomal degradation
        1. Uses own expression and replication mechanisms
        1. No environmental reservoir
        1. Cannot be grown by standard bacterial culture techniques
        1. Difficult to study

    Advantages of Intracellular Infection

    • Immune evasion
    • Carriage around body via the host cell
    • Obtain nutrients from host
    • Smaller genome size

    Pyogenic Inflammation

    • Rapid inflammation leading to:
        1. Cytokine induction
        1. Recruitment of neutrophils and macrophages
        1. Opsonisation and bacterial killing
    • Caused by lipopolysaccharide (Pathogen Associated Molecular Pattern - PAMPs)
    • Examples of bacteria that can cause pyogenic inflammation:
        1. Streptococcus pyogenes
        1. S. pneumoniae
        1. Staphylcoccus aureus

    Granulomatous Inflammation

    • Macrophage and T cell response to Mycobacterium tuberculosis
    • A granuloma is formed to 'sequester' the pathogen, which limits spread

    Infections

    • An infection is a process of tissue invasion by microorganisms, where they multiply in the body of the host to cause disease.
    • There are 4 types of infections:
      • Bacterial
      • Fungal
      • Viral
      • Parasitic
    • Cross-infection is the transmission of infection between patients and healthcare professionals.

    Viral Infections

    • Examples of viral infections:
      • CMV
      • Hepatitis virus
      • HSV1 and 2
      • HIV
      • Measles
      • Mumps
      • Influenza
      • Rubella
      • Adenovirus

    Herpes Simplex (HSV)

    • HSV1 is spread by infected saliva.
    • HSV2 is spread by sexual contact.
    • Incubation period of HSV: 2-12 days.
    • Clinical features of HSV:
      • Orolabialis infection (oral herpes)
      • Sore throat, fever
      • Vesicles on pharynx, buccal mucosa, gingiva, and tongue
      • Lymphadenopathy (enlargement of lymph nodes)
      • Recurrence
    • Infections associated with HSV1 and HSV2:
      • HSV-1 and HSV-2: skin infections, herpetic whitlow
      • HSV-1: eye infections, blindness can occur
      • HSV-2: genital/anal infections
    • Complications of HSV:
      • Encephalitis (affects temporal lobes)
      • Neonatal (mortality rate is 60% for newborns, c-section may be needed)
      • Erythema multiforme (skin reaction)
      • Eczema herpeticum (virus affects a large part of the skin)
    • Treatment of HSV:
      • Acyclovir
      • Valacyclovir

    Herpes Zoster

    • Herpes zoster is caused by the reactivation of the varicella zoster virus.
    • Clinical features of Herpes zoster:
      • Radicular pain (pain that radiates from your back and hip into your legs through the spine)
      • Hyperaesthesia (increase of sensitivity) of overlying skin
      • Rash
      • Erythema caused by inflamed blood capillaries
      • Oral, palatal, or pharyngeal involvement if the Trigeminal nerve is affected
    • Complications of Herpes zoster:
      • Post-herpetic neuralgia
      • Meningitis (neurological)
    • Treatment of Herpes zoster:
      • Acyclovir
    • Complication that treatment has no effect on:
      • Post-herpetic neuralgia

    Infectious Mononucleosis

    • Infectious mononucleosis is caused by the Epstein-Barr virus.
    • Incubation period: 4-14 days.
    • Clinical features of infectious mononucleosis:
      • Anorexia, malaise, fever
      • Sore throat
      • Cervical lymphadenopathy (swelling of lymph nodes)
      • Macular rash due to ampicillin
      • Palatal petechiae
      • Palpable spleen
      • Jaundice in 10% of cases
    • Complications of infectious mononucleosis:
      • Hepatitis
      • Respiratory obstruction
      • Ruptured spleen
    • Diagnosis of infectious mononucleosis:
      • Monospot test

    Chicken Pox

    • Chicken pox is caused by the varicella zoster virus.
    • Incubation period: 14-16 days.
    • Clinical features of chicken pox:
      • Rash that starts on scalp/trunk then spreads to limbs and face
      • Vesicles dry and crust
      • Pruritis (itchiness)
      • Shallow ulcers on mucous membranes
    • Complications of chicken pox:
      • Cellulitis/impetigo
      • Pneumonia
      • Acute cerebellar ataxia, Reye's syndrome (neurological)
      • Congenital abnormalities
    • Treatment of chicken pox:
      • Antihistamines
      • Acyclovir (for severe cases/complications)

    Mumps

    • Mumps is caused by the paramyxovirus (RNA).
    • Incubation period: 16-21 days.
    • Clinical features of mumps:
      • Asymptomatic in 40%
      • Fever, malaise
      • Enlargement of 1/both parotids
      • Earache and displacement of earlobe
      • Partoid papillae inflamed
      • Difficulty in swallowing
      • Submandibular glands may be affected
    • Complications of mumps:
      • Neurological: aseptic meningitis, encephalitis
      • Orchitis (common in post-puberty, 20-25%)
      • Non-parotid mumps: ovaries, thyroid, pancreas, breasts
    • Treatment of mumps:
      • Good oral hygiene
      • Bed rest

    Haematopoiesis and Cell Lines

    • 7 cell lines arise from haematopoiesis:
      • Red blood cells: transport O2 from lungs to tissues
      • Neutrophils: chemotaxis, phagocytosis, killing of phagocytosed cells
      • Eosinophils: neutrophil functions + antibody-dependent damage to parasites, immediate hypersensitivity
      • Basophils: immediate hypersensitivity, modulate inflammatory response via proteases and heparin
      • Monocytes and macrophages: chemotaxis, phagocytosis, killing of micro-organisms, antigen presentation and release of IL-1 and TNF
      • Platelets: primary haemostasis (adhere to subendothelial connective tissue)
      • Lymphocytes: immune response and haemopoietic growth factors

    Haemoglobin Levels and Anaemia

    • Haemoglobin levels:
      • Children (6 months-6 years): 110-145 g/L
      • Children (6 years-14 years): 120-155 g/L
      • Adult males: 130-170 g/L
      • Adult females: 120-155 g/L
      • Pregnant females: 110-140 g/L
    • Anaemia: reduction in haemoglobin levels below the reference range for age and sex of the individual
    • Rate at which anaemia develops dictates symptoms and signs

    Symptoms and Signs of Anaemia

    • Symptoms:
      • Lassitude
      • Fatigue
      • Dyspnoea on exertion
      • Palpitations
      • Headache
      • Chest pain
    • Signs:
      • Pallor
      • Tachycardia
      • Wide pulse pressures
      • Systolic flow murmurs
      • Congestive cardiac failure

    Mechanisms of Anaemia Development

    • 5 mechanisms:
      • Blood loss
      • Decreased red cell lifespan (haemolytic)
      • Impairment of red cell formation
      • Pooling and destruction of RBCs in spleen
      • Increased plasma volume (pregnancy)

    Morphology of Anaemia

    • 3 types:
      • Microcytic (small): Iron deficiency, Thalassaemias
      • Normocytic (normal): Acute blood loss, Anaemia of chronic disease, Chronic renal failure
      • Macrocytic (big): Alcoholism, Folate deficiency, Vitamin B12 deficiency, Drugs

    Iron Deficiency Anaemia

    • Most common cause of microcytic anaemia worldwide
    • Iron tightly managed in the body due to toxicity
    • 3 mechanisms of iron deficiency development:
      • Poor dietary intake
      • Malabsorption
      • Increased loss of iron
    • 6 manifestations of iron deficiency:
      • Koilonychia
      • Angular chelitis
      • Atrophic glossitis
      • Recurrent oral ulceration
      • Burning mouth
      • Oesophageal web (Plummer-Vinson / Patterson-Brown Kelly syndrome)

    Management of Iron Deficiency Anaemia

    • Blood film and iron studies
    • Address underlying cause
    • Oral supplementation (ferrous sulphate 200mg x3 a day for 3 months)
    • Parenteral available (fever, arthropathy, anaphylaxis)
    • Blood transfusion (only in severe compromise)

    Other Causes of Microcytic Anaemia

    • Thalassaemias: inherited blood disorder, less haemoglobin than normal

    Normocytic Anaemia

    • Associated with:
      • Chronic inflammatory/connective tissue (rheumatoid arthritis)
      • Chronic infections (tuberculosis)
      • Chronic renal disease (due to reduction in erythropoietin)
      • Malignancies (bone marrow infiltration)

    Macrocytic Anaemia

    • 2 divisions:
      • Megaloblastic erythropoiesis: abnormal red cell development due to disordered DNA synthesis
      • Normoblastic erythropoiesis: normal red cell maturation
    • Megaloblastic anaemia: Macrocytic anaemia due to:
      • Folate (vitamin B9) deficiency
      • Vitamin B12 deficiency

    Folate and Vitamin B12 Deficiencies

    • Causes of deficiencies:
      • Folate: inadequate intake, malabsorption, increased requirement, increased loss, drugs
      • Vitamin B12: inadequate intake, inadequate secretion of intrinsic factor, inadequate release from food, diversion of dietary B12, malabsorption
    • Clinical features:
      • Generic symptoms and signs of anaemia
      • Occasional mild jaundice
      • Glossitis
      • Oral ulceration
      • Peripheral neuropathy (loss of proprioception and vibration sense) (Vitamin B12 only)
      • Demyelination with subacute combined degeneration of spinal cord (Vitamin B12 only)
      • Dementia (Vitamin B12 only)

    Management of Megaloblastic Anaemia

    • Investigations: Blood film, Serum folate and B12
    • Address underlying cause
    • Oral supplementation (never folate only if B12 level not known)
    • Parenteral vitamin B12 (IM) required in pernicious anaemia

    Normoblastic Macrocytosis

    • 4 causes:
      • Alcohol excess
      • Liver dysfunction
      • Hypothyroidism
      • Drugs (methotrexate, azathioprine)

    Haemolytic Anaemia

    • 2 types:
      • Congenital
      • Acquired
    • Congenital haemolytic anaemia:
      • Membrane defects
      • Enzyme defects (G6DP deficiency)
      • Globin defects
    • Acquired haemolytic anaemia:
      • Immune (IgG coated red cells)
      • Non-immune (mechanical trauma, infections, drugs)

    Clinical Features of Haemolytic Anaemia

    • Pallor
    • Jaundice (due to elevated bilirubin)
    • Splenomegaly (enlargement of the spleen)
    • Expansion of erythropoiesis leading to bone deformities (frontal bossing) and pathological features

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    This quiz covers the functions of the kidneys, including waste excretion, fluid regulation, blood pressure maintenance, and hormone synthesis. It also explores the glomerular filtration rate and reabsorption of liquids by the kidneys.

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