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1. Critically discuss the economic impacts that infectious diseases can have - both positive, and negative impacts. Use specific disease examples to support your arguments.  500-600 words
2. Discuss, drawing on a range of examples, how surveillance is used to control diseases? 400-500 words
3. Explain, using a range of bacterial/disease examples, why the formation of biofilm can be clinically problematic. 400-500 words
4.  Critically discuss strategies that could be used to treat biofilm infections. 400-500 words
5. Using examples, explain what a prion is and how prions can cause infectious diseases. 400-500 words
6. Discuss how infectious prion diseases can spread and make recommendations for effective prevention of prion diseases in the future. 400-500 words
7. What is the current global impact of the HIV epidemic and what is being done to control it? 400-500 words
8. Describe in detail, the process of diagnosis of infective endocarditis, in a patient with native valve infective endocarditis.  You should comment on the clinical signs and symptoms, the role of the microbiology laboratory and the treatment options available. 400-500 words
9. Explain, with reference to antigenic drift and shift, how influenza seasonal epidemics and pandemics occur. 400-500 words
10. Discuss prevention and control of influenza. 400-500 words
11. Discuss, with named examples, how organisms have been controlled with vaccination and how vaccination has impacted on the health of the population. 400-500 words
12. Compare and contrast these two common vaginal infections – Candida (thrush) and Chlamydia. Your answer should include information about the causative organism, transmission, disease caused, diagnosis and treatment? 400-500 words
13. Explain, with specific examples, the differences between passive and active immunisation. 400-500 words
14. Compare and contrast whole cell and subunit vaccines. 400-500 words
15. Explain, with specific examples, the differences between live attenuated and whole cell inactivated vaccines. 400-500 words
16. What is the “vaccination gap” and what is being done to address it globally? 400-500 words
17. Discuss the global impact of neglected tropical diseases, using specific examples. You should also explain why these diseases have been “neglected” in the past and what the strategy is now to control them. 400-500 words
18. Explain, with reference to the lifecycle, how (hookworm disease OR guinea worm disease OR trypanosomiasis) can be controlled and prevented. 400-500 words
19. Epidemiology is a useful tool in the control of infectious diseases, discuss (Epidemiology, HIV, Influenza, STI’s Polio/Diphtheria/Whooping cough). 400-500 words
20. How are infectious diseases controlled and prevented (Vaccines, Antibiotics, HIV, Influenza, STI’s, Prions, TB, Mycoses, Polio,/Diphtheria/Whooping Cough). 400-500 words
21. Discuss the importance of Biofilms (Biofilms, Infective Endocarditis) . 400-500 words
22. Describe how infectious diseases are diagnosed within a clinical microbiology laboratory (Influenza, HIV, STI, Biofilms, Infective Endocarditis, TB, Fungal, Polio/Diptheria/Whooping Cough, Typhoid/Cholera). 400-500 words
23. Give examples of the different classes of antibiotics, their mode of action and which bacteria they are active against (Antibiotics). 400-500 words
24. Describe the importance of fungal infections (Mycoses) 400-500 words
25. Describe, with named examples, how vaccination has been used to control and eradicate infectious diseases (Vaccination). 400-500 words
26. Using named examples, give the clinical symptoms, complications, treatment and prevention of sexually transmitted infections (STI). 400-500 words
27. Discuss the 3 main types of prion infection, examining their pathogenicity factors, laboratory diagnosis and prevention (Prion). 400-500 words
28. Bacteria use various methods to avoid host defences and cause disease. Discuss these different types of bacterial pathogenicity factors (Pathogenicity). 400-500 words
29. Role of BMS and their importance given along with the disciplines in Pathology that BMS’s can work. 400-500 words
30. 5 functions of clinical microbiology given (Diagnosis of disease, Infection control, outbreak identification, epidemiology and antimicrobial stewardship. 400-500 words
31. Roles of Medical Laboratory Assistants, Associate Practitioners, BMS’s, Clinical Scientists and Consultant microbiologists given. 400-500 words
32. Diagnosis of disease in microbiology discussed. 400-500 words
33. How microbiology fits into the patient pathway was demonstrated using example case studies. 400-500 words
34. Infection control discussed using Hospital Acquired MRSA as an example – discussed MRSA screening and screening for other organisms. 400-500 words
35. Outbreak control and antimicrobial stewardship discussed. 400-500 words
36. discuss what role the host has in the pathology caused by an aspergillus infection 500-600 words

1.   Case Study Example 1

Important information from request form

Female patient suffering heavy periods and pain on sexual intercourse and urination. Past history of ectopic pregnancy. Patient has had multiple sexual partners but is on the contraceptive pill. Routine bacterial screen for STI’s was negative. Patient given a pack to take home for them to obtain their own specimen.

 

a)      What specimens would you take from this patient and what organisms would you look for? (2 marks).

As this was a home test given for the patient to take at home and send to the lab, the correct answer is Self Taken Vaginal Swab. (1 mark). If the student just mentions ‘vaginal swab; as the specimen to take, then they can get ½ mark (in the clinical setting, cervical swabs would be taken and not vaginal swabs)

As the sample was bacterial culture negative (ruling out gonorrhoea which has similar symptoms), the correct answer for this is Chlamydia trachomatis. (1 mark)

b)      What type of test would the lab perform on this sample? (1 mark).

The lab would perform a Nucleic Acid Amplification Technique test (NAAT). (1 mark).

c)      Why would this organism not have been grown on routine bacterial culture? (1 mark).

Because the organism is an Obligate Intracellular bacterium. (1 mark).

d)      What type of antibiotics could be used to treat this infection? (5 marks) – 1 for each correct antibiotic named).

azithromycin or doxycycline are drugs of choice (95% sensitivity). (2 marks – one for each named). Amoxycillin, erythromycin and levofloxacin can also be used. (3 marks – one for each named.) Antibiotic resistance is rare.

 

e)      What are the names for the infective but metabolically inactive stage and actively replicating stages of this organism lifecycle? (2 marks).

Infectious and metabolically inactive stage = Elementary body (1 mark).

Actively replicating stage = Reticulate body (1 mark).

f)       Name up to 4 complications associated with this infection? (2 marks) - ½ mark per correct complication listed.)

Complications include:

Pelvic inflammatory disease. (½ mark)

Infertility. (½ mark)

Ectopic pregnancy. (½ mark)

Chronic pelvic pain. (½ mark)

 

2.   Case Study Example 2 

Important information from request form

Male patient that is bisexual and has had multiple partners. Condoms not used during bisexual intercourse. Patient has had previous history of a flu like illness. Patient now suffering with weight loss, night sweats and has oral thrush. Bacterial STI screen negative. Viral illness now suspected by the doctor.

 

a)      What specimens would you take from this patient and what organism would you look for? (2 marks).

Main organism to look for would be HIV (1 mark).

For new diagnosis, would take Serum (1/2 mark) and plasma (1/2 mark) samples.

b)      What tests would you perform and what elements would they look to identify when looking for this organism? (3 marks)  - ½ mark for giving correct technology used for screening test, ½ mark for naming what 2 elements in the blood the screening test looks for, ½ mark for correct identification of the generation of test used and ½ mark given for naming each of the two confirmatory tests used on a positive screening test.

The initial test for HIV is an ELISA(1/2 mark) looking for HIV antibodies (1/2 mark) and p24 antigen (1/2 mark)(4^th Generation test)(1/2 mark). Better answers will indicate that, if positive, and first diagnosis, then serum sample would be re-tested using another technique and the plasma sample would have genotype to distinguish between HIV1 and HIV2 (1/2 mark) and a viral load (to determine levels of virus in the blood (1/2 mark) performed on it.

c)      What natural factors and drug inhibitors could be used to treat this organism and what are their modes of action? (7 marks).

Half a mark for each cellular factor/drug inhibitor and correct mode of action(upto a maximum of 7 marks).

Natural cellular factors

TRIM5 = tripartite motif containing protein 5. Its a retrovirus restriction factor blocking retrovirus infection – detects proteins in viral coat and prevents virus uncoating.​

SAMHD1 = SAM and HD domain containing proteins. Blocks replication. Converts deoxyribonucleotide triphosphates (dNTP’s) to inorganic phosphate and 2’ deoxynucleoside without phosphate – depletes availability of dNTP’s available to reverse transcriptase to prevent replication​

Tetherin = produced by cell to prevent virus budding by forming dimers, one in the viral membrane and one in the host membrane.​

Drug inhibitors

CCR5 = C chemokine receptor type 5 blocks CCR5 receptor and prevents entry.​

Fusion Inhibitors = Binds to envelope protein on virus and blocks structural changes needed for the virus to fuse with the host cell.​

NRTI and NNRTI = Non and nucleoside reverse transcriptase inhibitors – Analogues of deoxynucleotides lacking 3’ hydroxyl group so next nucleotide to come along the growing chain can not form bond and nucleic acid growth halted.​

INSTI’s = Integrase inhibitors prevents integration of viral genetic material into host genetic material.​

Protease Inhibitors – blocks viral proteases and prevents cleavage of protein precursors in proviral cell thus preventing the cell from becoming infective.