Medical-Surgical Nursing Prelims Review: Infectious Diseases, Hepatitis, Neurological Infections, Autoimmune & GI/Urologic Conditions

A comprehensive set of practice flashcards covering infectious disease transmission, TB, pneumonia, hepatitis and liver diseases, meningitis, HIV/AIDS, STIs, arboviral diseases, autoimmune disorders, GI and GU disorders, and related nursing management and preventive measures.

What are the main modes of transmission of infectious diseases listed in the notes?

Direct contact (skin contact, kissing), droplet, airborne, vehicle-borne (fomites like phones, utensils, clothing), inoculation (sharps, needles); horizontal (direct/indirect) and vertical (mother to baby) transmission; negative pressure rooms and HEPA filters are used for certain airborne diseases.

How do droplet and airborne transmission differ according to the notes?

Droplet transmission involves larger droplets that travel about 3 feet and are heavier; airborne transmission involves smaller droplet nuclei that remain suspended in air and can spread more extensively.

What is vehicle-borne transmission?

Transmission via inanimate objects or non-living things (fomites) such as cellphones, utensils, clothes; includes inoculation with sharps.

Differentiate horizontal and vertical transmission.

Horizontal: direct and indirect contact between individuals. Vertical: mother-to-baby transmission.

What do 'negative pressure' and 'HEPA filter' refer to in infection control?

Negative pressure refers to rooms that prevent pathogen escape (e.g., TB); HEPA filters provide high-efficiency particulate air filtration to reduce airborne contaminants.

Name the 4 host types described.

Patient (infected with signs/symptoms; isolates and precautions), Carrier (harbors microorganisms without signs; potential source), Contact (close exposure), Suspect (history and symptoms suggest infectious disease).

What are the key virus characteristics noted?

Viruses replicate only in living organisms, can pass through filters, are self-limited, and are treated symptomatically with potential for permanent immunity; rely on host for reproduction.

What are the key bacteria characteristics noted?

Bacteria can multiply in living and non-living matter, are generally larger than viruses, and can be self-limiting depending on infection; some require specific antibiotics.

What is the difference between TB Infection (Latent TB) and TB Disease (Active TB) as described?

Latent TB: bacteria live in the body without causing illness and are not contagious; Active TB: bacteria are multiplying, patients are sick and can spread the bacteria to others.

List the first-line anti-TB drugs mentioned.

Isoniazid (INH), Rifampin (Rifadin), Ethambutol, Pyrazinamide (PZA); also rifamycins like Rifabutin and Rifapentin are noted as related agents.

List some second-line anti-TB drugs mentioned.

Cycloserine, Ethionamide, Streptomycin, Capreomycin, Kanamycin, PAS (para-aminosalicylic acid), and fluoroquinolones (e.g., Levofloxacin, Moxifloxacin).

What hospital precautions are appropriate for TB patients?

Negative airflow room; use N95 respirators or HEPA for staff; airborne precautions; client may need a mask during transport; discourage spread with proper disposal of secretions and drug adherence.

What is DOTS in TB management?

Directly Observed Treatment, Short-course—a program to ensure drug adherence and reduce transmission.

What diagnostic tests are used for TB?

Mantoux tuberculin skin test (PPD), Interferon-Gamma Release Assays (IGRAs), Chest X-ray, Sputum smear for AFB, Sputum culture; GeneXpert/CBNAAT for rapid detection and rifampicin resistance.

What are some extrapulmonary TB complications listed?

Miliary TB with systemic spread; meningitis, pericarditis; CNS, bone/joint TB; involvement of kidneys, adrenals, lymph nodes, and genital tracts.

What pneumonia categories are defined in the notes and how are they distinguished?

CAP (Community-Acquired Pneumonia) occurs in the community; HAP (Hospital-Acquired Pneumonia) occurs 48 hours after admission; VAP (Ventilator-Associated Pneumonia) occurs after 48-72 hours of ventilation; HCAP (Healthcare-Associated Pneumonia) includes patients with new pneumonia in healthcare settings.

Which organism is the most common cause of bacterial pneumonia?

Streptococcus pneumoniae.

What are common pneumonia-related pleural conditions?

Pleurisy (inflammation of pleura); Pleural effusion (fluid in the pleural space); Atelectasis (collapsed alveoli).

What test should be done before starting antibiotics for pneumonia as per the notes?

Blood tests are often done; in the notes, a blood test is mentioned before antibiotics; sputum culture may also be obtained.

What are key signs of pneumonia described?

Shortness of breath, fatigue, crackles/wheezes; tachypnea; fever; cough with sputum may be present.

Describe Hepatitis A (transmission, incubation, and typical source).

Transmission: fecal-oral; incubation about 2-6 weeks; common in children and food handlers; acquired via contaminated food or water.

Describe Hepatitis B transmission routes and typical incubation period.

Parenteral (blood, sharps), sexual contact, vertical (mother to child) and oral contact; incubation about 6-24 weeks.

Describe Hepatitis C transmission and incubation.

Primarily parenteral exposure (blood products, IV drug use); incubation about 5-10 weeks.

What is unique about Hepatitis D (Delta virus)?

Dormant type that cannot multiply without Hepatitis B; requires HBV for its replication.

What is unique about Hepatitis E transmission and incubation?

Transmission fecal-oral; incubation about 3-6 weeks; similar to Hepatitis A in route and illness pattern.

What is unique about Hepatitis G?

Caused by Hepatitis G virus; transmission similar to Hepatitis C; IP unknown; does not cause disease on its own.

What are the three phases of acute hepatitis described?

Pre-icteric (early flu-like symptoms), Icteric (jaundice with elevated bilirubin/enzyme levels), Post-icteric (recovery Phase with improving symptoms).

Which liver enzymes are commonly evaluated and what do they indicate?

ALT and AST indicate hepatocellular injury; ALP indicates cholestasis; GGT indicates hepatobiliary disease; LDH indicates tissue damage; levels help assess liver injury and recovery.

What vaccination schedule is described for Hepatitis B?

HBV vaccination: at birth, 1-2 months, and 6-8 months with intramuscular injections (0.5 mL).

What would indicate an active Hepatitis B infection serologically?

HBsAg (HBV surface antigen) present in the serum indicates infection or carrier state.

What are common therapy approaches for chronic Hepatitis B and C?

HBV: pegylated interferon with or without nucleoside analogs (e.g., lamivudine, entecavir, tenofovir); HCV: pegylated interferon with ribavirin (older regimens); newer DAAs have replaced these in many settings.

What are key signs of meningitis?

Fever, severe headache, photophobia, vomiting; nuchal rigidity; positive Kernig and Brudzinski signs; altered mental status; increased ICP in bacterial meningitis.

What CSF findings differentiate bacterial vs viral meningitis?

Bacterial: cloudy/yellow, high WBC with neutrophils, high protein, low glucose; Viral: clear or mildly turbid, lymphocytic predominance, normal or mildly reduced glucose, normal or slightly elevated protein.

What are hallmark signs of meningitis on physical exam?

Nuchal rigidity, positive Kernig sign (pain with knee extension when hip is flexed), and positive Brudzinski sign (neck flexion causes hip/knee flexion).

What organism most commonly causes bacterial meningitis in adults?

Streptococcus pneumoniae and Neisseria meningitidis.

What are common interventions for meningitis to prevent complications?

Respiratory precautions (droplet precautions as needed), IV antibiotics after cultures, dexamethasone to reduce inflammation, seizure precautions, monitoring ICP, analgesia, hydration.

What are typical signs of Chlamydial infection in women and men?

Women: vaginal discharge, spotting, cervicitis; Men: urethritis with dysuria; often asymptomatic or mild symptoms.

What is the standard treatment for gonorrhea and what additional considerations are noted for pregnancy?

Ceftriaxone is a treatment; alternative options include cefixime, ciprofloxacin, or ofloxacin; if allergic to penicillin, doxycycline or tetracycline may be used; newborns may have conjunctivitis prophylaxis.

What are the stages of syphilis and their major manifestations?

Primary: chancre at entry site; Secondary: generalized rash and lymphadenopathy; Latent: asymptomatic; Tertiary: gummas, cardiovascular and neurologic complications.

What are key HIV testing components and what indicates AIDS progression?

ELISA screening with confirmatory Western blot; CD4 count (healthy range ~500-1600 cells/mm3; <200 indicates AIDS); viral load indicates amount of HIV RNA in blood; ART aims to suppress viral load.

What immunoassays confirm HIV infection and what counseling is recommended?

Western blot confirms HIV antibodies; pre- and post-test counseling recommended; maintain confidentiality and informed consent; negative or indeterminate results require confirmatory testing as needed.

Name the vaccines and schedule for MMR (measles-mumps-rubella).

MMR vaccine given in infancy with doses at 12-15 months; can be given earlier (6-11 months) in outbreak situations with revaccination at 12-15 months; MMR reflects immunity against measles, mumps, rubella.

What are key features of Dengue fever and DHF grading?

Dengue transmitted by Aedes mosquitoes; four serotypes; Grade 1: fever with mild symptoms; Grade 2: spontaneous bleeding; Grade 3: circulatory failure; Tourniquet test helps aid diagnosis; management is supportive.

What is the clinical profile of Chikungunya compared to dengue hemorrhagic fever (DHF) in terms of severity?

Chikungunya is generally milder than DHF; both are arboviral infections transmitted by mosquitoes and cause arthralgia and fever; management is supportive.

What are ulcerative colitis and Crohn's disease summarized as in the notes?

Ulcerative colitis: inflammation of the colon/rectum with continuous mucosal involvement; Crohn's disease: transmural, can affect any part of the GI tract with cobblestone appearance; different treatments include 5-ASA/Azulfidine, steroids, immunosuppressants, and possible surgery.

What are common signs of appendicitis and key signs used in diagnosis?

Symptoms include acute periumbilical pain migrating to the right lower quadrant; McBurney's point tenderness; rebound tenderness; Rovsing's sign; Dunphy's sign (pain with coughing); objective signs include rigid abdomen.

What are the major complications and management priorities for peritonitis and paralytic ileus?

Peritonitis: inflammation with fluid shift into peritoneal cavity; abdominal pain/tenderness; fever; management includes NPO, IV fluids, antibiotics, pain control, possible drainage; Paralytic ileus: decreased/absent bowel sounds due to neural or inflammatory processes; management includes rest, NPO, NG tube if distention, and supportive care.

What are common gallbladder diseases and their key signs?

Cholecystitis (gallbladder inflammation) and cholelithiasis (gallstones); RUQ pain, Murphy's sign; risk factors 5Fs (female, fat, fair, fertile, forty); imaging often with HIDA scan for biliary function.

What are typical managements for acute pancreatitis?

Relieve pain, IV fluids, NPO, manage electrolytes, digestive enzyme supplementation if needed; monitor amylase/lipase; avoid alcohol and fat; consider cause (gallstones, hypertriglyceridemia).

What is the difference between ulcerative colitis and Crohn's disease regarding disease location and depth of involvement?

Ulcerative colitis: mucosal and submucosal involvement of the colon/rectum with continuous lesions; Crohn's disease: transmural, can affect any part of GI tract with skip lesions and potential cobblestone appearance.

What non-GI autoimmune disease discussed involves demyelination and CNS symptoms, with potential relapses and remissions?

Multiple Sclerosis (MS); onset typically 20-40 years; unknown cause; demyelination of CNS white matter; management includes disease-modifying therapies and symptomatic management (steroids, muscle relaxants, energy conservation, OT/PT).

What neuromuscular autoimmune disorder involves antibodies blocking neuromuscular transmission and presents with ptosis and diplopia that worsen with use?

Myasthenia Gravis (MG); Tensilon (edrophonium) can transiently improve strength; treated with acetylcholinesterase inhibitors (pyridostigmine, neostigmine) and supportive care; cholinergic crisis is a potential complication.

What syndrome is characterized by rapidly progressive, symmetrical ascending paralysis and may require plasmapheresis or ventilation support?

Guillain-Barré Syndrome (GBS); progression from legs upward, possible facial weakness; management includes respiratory support, plasmapheresis, IVIG, and ROM exercises.

Why is HIV viral load important and when should it be measured?

Viral load measures HIV RNA copies in blood; used to monitor effectiveness of ART; measured initially, then every 3-6 months or after changing therapy until suppressed.

What is the significance of CD4 counts in HIV, and what count indicates AIDS?

CD4 count reflects immune function; a count below 200 cells/mm3 is a criterion for AIDS; regular monitoring (every 3-6 months) helps guide therapy and prognosis.

What is the purpose of a lumbar puncture and what precautions are noted?

To obtain CSF for analysis, determine pressure, or administer meds; contraindicated with increased intracranial pressure; perform with asepsis, patient positioning, post-procedure bilirubin hydration? (Note: maintain strict asepsis, monitor vitals and neuro status, and encourage fluids).

What test explanations are given for the sputum sample collection in diagnosing respiratory infections?

Sputum culture helps identify causative organisms; collection should be early in the morning; patient should be hydrated to produce sputum; for TB, sputum AFB smear/culture is essential.

What is standardized guidance for TB exposure in families and healthcare workers?

Exposed family members should be tested; proper hand hygiene; cover mouth when coughing; newborns may require prophylaxis; health care workers should use airborne precautions when indicated.

What is the standard exam approach for assessing potential TB exposure and infection?

Mantoux tuberculin skin test (PPD), IGRA like QuantiFERON; read induration after 48-72 hours; results vary by risk category; two-step testing may be used for initial negative screens.

What is the role of HBsAg testing in blood donors?

HBsAg presence in donor blood indicates hepatitis B infection; affected units should be discarded to prevent transmission.

What are key points about lumbar puncture procedure safety and patient preparation?

Obtain informed consent, have patient void bladder, position properly, maintain asepsis, monitor vital signs and neuro status, encourage fluids post-procedure, monitor for complications.

What diagnostic tool is used to assess gallbladder function and is more accurate than ultrasound in some cases?

HIDA scan (hepatobiliary iminodiacetic acid scan) to assess gallbladder function; non-filling of GB indicates acute cholecystitis; tracer in CBD or small bowel indicates different findings.

What are major clinical signs of rheumatoid arthritis (RA) and standard approaches to management?

Chronic inflammatory arthritis with joint pain, morning stiffness; management includes NSAIDs, corticosteroids, DMARDs (e.g., methotrexate), lifestyle changes, physical therapy, and surgery in severe cases.

What are common autoimmune conditions noted and their general management strategies?

SLE (systemic lupus erythematosus): ANA, dsDNA; managed with corticosteroids and DMARDs; MS: disease-modifying therapies; MG: cholinesterase inhibitors; GBS: supportive care and plasmapheresis; RA: NSAIDs and DMARDs.

What basic precautions and lifestyle recommendations are given for patients with autoimmune and inflammatory diseases?

Avoid excessive sun exposure, quit smoking, manage stress, maintain healthy lifestyle, adhere to meds, attend regular check-ups, and monitor disease activity.

What is the role of diet and exercise in managing Crohn’s disease and ulcerative colitis?

Dietary modifications (low-residue or specific tolerances), high-calorie and high-protein intake during flares, nutrition support like TPN as needed; regular exercise helps maintain general health; avoid triggers and smoking; some patients require surgery.

What are common signs of urinary tract infections and kidney stones described?

UTI symptoms: dysuria, frequency, urgency, suprapubic pain; kidney stones: colicky flank or groin pain, hematuria, possible nausea; management includes hydration, analgesia, antibiotics for infection, and potential lithotripsy or surgical removal.

What is the 5F risk factor for gallbladder disease and how does it relate to clinical signs?

5Fs: female, fat, fair, fertile, forty; increases risk for gallstones (cholelithiasis) and gallbladder disease; signs include RUQ pain, Murphy’s sign, and potential jaundice.