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Infectious Disease and Travel Medicine Flashcards

1
Q

As per Nice, how should temperature be measured in a child?

A

Axilla in under 4 weeks age
4 weeks to 5 years - axilla (electronic or chemical dot), or infrared tympanic

NOT routinely with oral or rectal thermometers

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2
Q

As per NICE, how should fevers/perception of fever reported by a parent be considered?

A

It should be taken seriously and considered valid

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3
Q

What should be assessed first on assessment of a child with a fever?

A

Are there any life threatening signs present?

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4
Q

What life threatening signs may be present on initial assessment of a child with a fever?

A

Think ABC:
Airway collapse/compromise
Impaired breathing
Circulatory collapse
Decreased level of consciousness

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5
Q

What system can be used to predict the risk of serious illness in children?

A

Traffic light system

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6
Q

What are the signs in children looked for in the skin to help risk stratify for traffic light system for fevers?

A

Pale, mottled, ashen, blue skin, lips of tongue would be red

Pallor detected by parent/carer but perhaps less convincing objectively to clinician may be amber

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7
Q

What are the social signs in children looked for to help risk stratify for traffic light system for fevers?

A

No response to social cues, not smiling could be red or amber depending on the situation

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8
Q

What are the signs in children looked for in the chest/respiratory system to help risk stratify for traffic light system for fevers?

A

RED:
Weak/high pitched cry
Grunting
Recessions
Resp rate greater than 60

AMBER:
Nasal flaring

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9
Q

Other than social cues, skin appearance, and respiratory symptoms, what other signs in children do we look for to help risk stratify for traffic light system for fevers?

A

RED:
Not waking or if roused does not stay awake
Appearing unwell
Reduced skin turgor
Bulging fontanelle

AMBER:
Dry mucous membranes
Rigours
Reduced urine output
Poor feeding in infants

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10
Q

Under what age is a temperature of 38C or more considered a high risk sign on its own?

A

Under 3 months

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11
Q

What should be assessed for in a child who has had a fever for 5 days or more?

A

Kawasaki disease

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12
Q

In whom should meningococcal disease be considered?

A

Anyone with fever, non blanching rash, neck stiffness, signs of severe illness

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13
Q

In whom should bacterial meningitis be considered?

A

Any child with fever, and any of neck stiffness, bulging fontanelle,decreased LoC, or convulsive status epilepticus

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14
Q

How might herpes simplex encephalitis present?

A

Child with fever, focal neurology, focal seizures, and/or decreased level of consciousness

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15
Q

What other symptoms/signs may present in a child with pneumonia?

A

Tachypnoea
Crackles in chest
Nasal flaring
Recessions
Cyanosis
Oxygen sats 95% or less on air

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16
Q

How might a UTI present in a child?

A

Dysuria
Frequency of urination
New bed wetting
Malodorous urine
Dark/cloudy urine
Frank haematuria
Abdo/loin pain

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17
Q

A child is brought in by their mother with acute onset swelling to right knee, with new inability to weightbear through it due to pain, and fevers.

What is the most concerning diagnosis?

A

Septic arthritis or osteomyelitis

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18
Q

A child is brought in with a non specific fever lasting over 1 week. What other features should you check for in the mouth and what are they looking to rule out?

A

Kawasaki disease

Bilateral conjunctival injection without exudate
Strawberry tongue or erythema/cracking of lips

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19
Q

A child with a week long history or non specific fever and new strawberry tongue is brought in. What cutaneous features should you look for in this condition?

A

Kawasaki disease

Oedema and erythema to hands and feet
Polymorphous rash
Cervical lymphadenopathy

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20
Q

What is the risk associated with Kawasaki disease?

A

Coronary artery disease

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21
Q

When taking an infection history, what category should not be missed?

A

Travel history

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22
Q

A mother calls in about their child who has had a fever, appears mottled, and is difficult to rouse, although appears to be breathing well and has normal responses when spoken to.

How quickly should they be assessed as per NICE face to face?

A

Within 2 hours for any child with red features who does not have any immediately life threatening signs

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23
Q

Do antipyretics prevent febrile convulsions?

A

No

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24
Q

When should antipyretics be used in children?

A

To reduce a fever in a child who is distressed by the fever - d not give with sole aim to reduce temperature

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25
Q

What general advice can be given to parents to manage a feverish child at home?

A

Encourage fluids and hydration
How to detect dehydration
How to identify non-blanching rash
Check on child in night
Avoid nursery/school while unwell ad inform

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26
Q

If a UTI is suspected in a baby under 3 months, what should happen?

A

Send urine sample for urgent MC&S
Refer to paediatric specialist care

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27
Q

When should a urine sample be sent for UTI?

A

Prior to commencing antibiotics, as soon as possible

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28
Q

What results on urine dip in symptomatic children would warrant treatment with antibiotics, and what else should be done?

A

Either leukocytes or nitrites or both positive
Send for MC&S

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29
Q

A child with a non-specific fever is assessed in clinic. The urine dip is positive for leukocytes but not nitrites.
What should be done here?

A

Send urine for culture but do not treat as UTI yet as leukocytes could be present from another source of infection which should be checked for, and the child has no specific clinical features of UTI

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30
Q

What congenital features increase risk of UTI in children?

A

Antenatally diagnosed renal disease
Spinal lesions

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31
Q

What physical issues can increase risk of UTIs in children?

A

Constipation
Abdominal mass
Spinal lesion
Poor growth
High BP

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32
Q

Which children with UTIs should be referred for imaging?

A

Those with atypical UTIs or recurrent UTIs

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33
Q

You are referring a child with recurrent UTIs to specialist care for investigation. What element of clinical assessment will be useful for diagnosis of renal parenchymal defects?

A

Proteinuria
Blood pressure

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34
Q

What is bronchiolitis?

A

A respiratory illness caught in the first 2 years of life

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35
Q

When is bronchiolitis most commonly caught?

A

Between 3 and 6 months of age, although can be up to age 2

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36
Q

A 5 month old is brought in by dad, who is concerned due to new fevers for 2 days with runny nose, persistent cough, and sounding wheezy.

What is the likely diagnosis?

A

Bronchiolitis

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37
Q

A child aged 3 comes in with fevers for 2 days with runny nose, persistent cough, and sounding wheezy.

What are the top differentials, and what is less likely?

A

Viral induced wheeze
Pneumonia

Bronchiolitis less likely due to age

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38
Q

Why do insect bites/stings cause a reaction?

A

Insects inject substances such as anticoagulants and vasodilators, as well as antigenic components pare often present

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39
Q

If bites seen are suspected to be due to bed bugs, what should you advise the patient regarding eradication?

A

They should contact pest control as these are difficult to eradicate

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40
Q

If bites seen are suspected to be due to fleas, what should you advise the patient regarding eradication?

A

Advise these are usually due to pets (cats/dogs) being infested, so pets should be examined and treated

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41
Q

A patient presents with flea bites from their dog, who is being treated.
The bites are very itchy and keeping the patient awake at night. What can you advise?

A

-The itching will improve with time
-Try not to scratch as this may introduce infection
-Not a lot of evidence for medical management of itching in this case but oral antihistamines may help short term

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42
Q

What is scabies?

A

An intensely itchy skin infestation caused by human parasite Sarcoptes scabiei, a mite that burrows in the stratum corneum

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43
Q

How long is the life-cycle of scabies mite?

A

4-6 weeks

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44
Q

A patient attends with signs of scabies. Who else may need to be informed given mode of transmission?

A

Any sexual partners
Anyone who shares clothing or bedding (or in extreme cases soft furnishings) with the patient

Casual contact is unlikely to lead to transmission

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45
Q

What are the risk factors for catching scabies?

A

-Poverty and social deprivation
-Crowded living conditions and institutionalisation
-Winter months

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46
Q

What are the potential complications of scabies?

A

Generally good prognosis, but can cause:
-secondary bacterial infection
-secondary eczematization
-nodular scabies

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47
Q

What is nodular scabies?

A

Pruritic nodules of the axillae, groin, and male genitalia which can persist for weeks or months following treatment due to a prolonged immune response to mite antigens.

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48
Q

A patient presents with an intense generalised itch, worse at night, with erythematous papules across hands (including in between fingers), extensor aspects of limbs, and a few other areas.

Which area of the body may be spared in this condition?

A

Scabies

The back is usually spared, and the head except in children.

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49
Q

How can a diagnosis of scabies be confirmed?

A

Skin scrapings and/or ink test if suitable expertise is available

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50
Q

How should scabies be managed in an immune-compromised person?

A

Usually needs hospitalisation as generally causes crusted scabies (more severe and widespread)

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51
Q

How should scabies be managed?

A

Permethrin 5% cream of the patient and household members/sexual partners

Decontaminate bedding/clothing/towels at 60 degrees at least then hot drying, or sealing in a plastic bag for 72 hours

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52
Q

Which of the following are notifiable diseases?

a. acute encephalitis
b. rubella
c. tuberculosis

A

All of them

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53
Q

Which of the following are notifiable diseases?

a. Malaria
b. Diphtheria
c. Candidiasis

A

a and b

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54
Q

Which of the following are notifiable diseases?

a. Acute meningitis
b. CJD
c. MRSA

A

a and b

55
Q

Which of the following are notifiable diseases?

a. acute infectious hepatitis
b. lyme disease
c. leprosy

A

a and c

56
Q

Which of the following are notifiable diseases?

a. Shingles
b. Acute poliomyelitis
c. Typhus

A

b and c

57
Q

Which of the following are notifiable diseases?

a. SARS
b. COVID-19
c. Infectious bloody diarrhoea

A

All of the above

58
Q

Which of the following are notifiable diseases?

a. Legionnaire’s disease
b. Scarlet fever
c. Anthrax

A

All of the above

59
Q

Which of the following are notifiable diseases?

a. Streptococcal pneumonia
b. Chronic Hepatitis C
c. Pseudomonas aeruginosa

A

None of the above

60
Q

Which of the following are notifiable diseases?

a. Herpes simplex
b. Yellow fever
c. Botulism

A

b & c

61
Q

Which of the following are notifiable diseases?

a. Measles
b. Cholera
c. Food poisoning

A

All of the above

62
Q

Which of the following are notifiable diseases?

a. Bronchiolitis
b. Haemolytic uraemic syndrome
c. Whooping cough

A

b and c

63
Q

Which of the following are notifiable diseases?

a. Infectious diarrhoea
b. Infectious bloody diarrhoea
c. Impetigo

A

b

64
Q

Which of the following are notifiable diseases?

a. Invasive group A streptococcal disease
b. Meningococcal septicaemia
c. Chlamydia

A

a and b

65
Q

Which of the following are notifiable diseases?

a. Measles
b. Mumps
c. Rubella

A

All of the above

66
Q

Which of the following are notifiable diseases?

a. Smallpox
b. Plague
c. Toxoplasmosis

A

a and b

67
Q

Under which law do certain diseases become notifiable?

A

Public Health Act 1984 and Health Protection Regulations 2010

68
Q

How can a notifiable disease be reported?

A

Online via the proper officer of the local authority

69
Q

A woman presents to her GP with a single target shaped erythematous rash on her thigh, present for a few days since a walking holiday. She has been feeling fatigued and feverish since it appeared.

What is the causative organism?

A

Borrelia bacteria carried by ticks

70
Q

A woman presents to her GP with a single target shaped erythematous rash on her thigh, present for a few days since a walking holiday. She has been feeling fatigued and feverish since it appeared.

What is the name of this rash?

A

Erythema migrans

71
Q

A woman presents to her GP with a single target shaped erythematous rash on her thigh, present for a few days since a walking holiday. She has been feeling fatigued and feverish since it appeared.

Does this patient need testing for the causative organism?

A

No - the erythema migrans with clear history is diagnostic

72
Q

A woman presents to her GP a few days after a walking holiday. She has been feeling fatigued and feverish, with aches in her joints.

How should this be investigated?

A

Immunological testing for potential Lyme disease

73
Q

A woman presents to her GP with a single target shaped erythematous rash on her thigh, present for a few days since a walking holiday. She has been feeling fatigued and feverish since it appeared.

How should this be managed?

A

Doxycycline (oral) for 3 weeks

74
Q

A woman presents to her GP with a single target shaped erythematous rash on her thigh, present for a few days since a walking holiday. She has been feeling fatigued and feverish since it appeared.

After 2 course of antibiotics, the patient feels no better and has ongoing symptoms. What should be done now?

A

Specialist input is recommended for cases of Lyme disease that do not improve after 2 x 3 week course of antibiotics

75
Q

A woman presents to her GP with a single target shaped erythematous rash on her thigh, present for a few days since a walking holiday. She has been feeling fatigued and feverish since it appeared.

What is the prognosis for this disease?

A

Lyme disease

Generally good - most people recover completely especially with prompt diagnosis and treatment

76
Q

A woman presents to her GP with a single target shaped erythematous rash on her thigh, present for a few days since a walking holiday. She has been feeling fatigued and feverish since it appeared.

Given the likely diagnosis, is this rash usually itchy?

A

No - erythema migrans in Lyme disease is not usually itchy, painful, or hot.

77
Q

A woman presents to her GP with a single target shaped erythematous rash on her thigh, present for a few days since a walking holiday. She has been feeling fatigued and feverish since it appeared.

If the patient has contracted Lyme disease, when does this rash usually appear?

A

From around 1 to 4 weeks after the tick bite

78
Q

A woman presents to her GP with a single target shaped erythematous rash on her thigh, present for a few days since a walking holiday. She has been feeling fatigued and feverish since it appeared.

How long can this rash be present for?

A

Lyme disease/erythema migrans

Several weeks

79
Q

A woman presents to her GP with a single target shaped erythematous rash on her thigh, present for a few days since a walking holiday. She has been feeling fatigued and feverish since it appeared.

What other symptoms might this patient report, given the likely diagnosis?

A

Lyme Disease

-Swollen glands
-Malaise
-Neck pain/stiffness
-Cognitive impairment
-Headache
-Parasthesia

80
Q

A woman presents to her GP with a single target shaped erythematous rash on her thigh, present for a few days since a walking holiday. She has been feeling fatigued and feverish since it appeared.

What uncommon neurological signs may be present with more advanced/complicated cases?

A

Facial palsy or other CN palsy

Meningitis

Radiculopathies

81
Q

A woman presents to her GP with a single target shaped erythematous rash on her thigh, present for a few days since a walking holiday. She has been feeling fatigued and feverish since it appeared.

What uncommon MSK signs may be present with more advanced/complicated cases?

A

Inflammatory arthritis - polyarticular, migratory, fluctuating

82
Q

A woman presents to her GP with a single target shaped erythematous rash on her thigh, present for a few days since a walking holiday. She has been feeling fatigued and feverish since it appeared.

What uncommon cardiac signs may be present with more advanced/complicated cases?

A

Lyme carditis

Heart block

83
Q

A woman presents to her GP with a single target shaped erythematous rash on her thigh, present for a few days since a walking holiday. She has been feeling fatigued and feverish since it appeared.

What uncommon ophthalmological signs may be present with more advanced/complicated cases?

A

Uveitis
Keratitis

84
Q

How are false positives minimised when testing for Lyme disease?

A

2 tier testing strategy - sensitive ELISA followed by immunoblot to be sure

85
Q

A woman presents to her GP with a single target shaped erythematous rash on her thigh, present for a few days since a walking holiday. She has been feeling fatigued and feverish since it appeared.

Her 14yo child also has the same rash and some symptoms. How should the child be managed differently?

A

Children under 18 with suspected Lyme disease should have specialist advice input

86
Q

A woman presents to her GP with a single target shaped erythematous rash on her thigh, present for a few days since a walking holiday. She has been feeling fatigued and feverish since it appeared.

If this patient also complains of polyarticular joint pain, how should this be managed in GP land?

A

Doxycycline for 4 weeks in the case of Lyme disease with Lyme arthritis

87
Q

A woman presents to her GP with a single target shaped erythematous rash on her thigh, present for a few days since a walking holiday. She has been feeling fatigued and feverish since it appeared.

What are the 1st, 2nd, and 3rd line treatments for this if uncomplicated?

A

Lyme disease

1st - Doxycycline
2nd - Amoxicillin
3rd - Azithromycin

88
Q

A woman presents to her GP with a single target shaped erythematous rash on her thigh, present for a few days since a walking holiday. She has been feeling fatigued and feverish since it appeared.

The patient then develops signs of meningitis. How should this be managed?

A

Needs enhanced dose IV ceftriaxone for Lyme disease affecting the CNS

89
Q

Can the symptoms of lyme disease continue after the infection has been treated?

A

Yes - they can be ongoing for months to years, this does not necessarily mean there is ongoing infection

90
Q

If a woman is pregnant and contracts Lyme disease, can she pass the infection to the baby?

A

It is unlikely - the treatment course should be completed in full

91
Q

Can the tests for Lyme disease distinguish between active and orevious infection?

A

No

92
Q

What is sepsis?

A

Life-threatening organ dysfunction caused by dysregulated host response to an infection

93
Q

What age groups are most high risk for sepsis?

A

Under 1 year and over 75 years

94
Q

What immunosuppressed states increase risk for sepsis?

A

-Current chemotherapy
-Steroids
-Immunosuppressant drugs
-Asplenic/hyposplenic
-Sickle cell
-Diabetes

95
Q

A patient returning from a trip abroad complains of symptoms of infection.

What important history do we need to ask?

A

-Symptoms
-Area and duration of travel
-Immunisations and prophylaxis
-Other people travelling with the patient
-Sexual contact while abroad
-Medical treatment while abroad

96
Q

Why can malaria be easily missed?

A

Presents with vague and varying symptoms

97
Q

What are some of the common symptoms of malaria?

A

Headache
Malaise
Myalgia
Anorexia
Recurrent high fevers
Drenching sweat

98
Q

A patient returning from a trip to central Africa complains of feeling tired, headaches and muscle aches, and becoming feverish the last few days causing drenching sweats.

Given the likely diagnosis, what blood tests should be sent?

A

Thick and thin blood film for malaria

Depends on symptoms for other bloods but inc. LFTs, FBC, viral serology

99
Q

A patient returning from a trip to central Africa complains of feeling tired, headaches and muscle aches, and becoming feverish the last few days causing drenching sweats. They feel and look very unwell.

Given the likely diagnosis, what is your advice in GP land?

A

Malaria

Go to hospital urgently to commence treatment

If not unwell can await blood films before referral

100
Q

A patient returning from a trip to central Africa complains of feeling tired, headaches and muscle aches, and becoming feverish the last few days causing drenching sweats. They feel otherwise ok, and observations are stable.

Given the likely diagnosis, what is your advice in GP land?

A

Malaria

Should be discussed with infectious diseases specialist to arrange for treatment and monitoring based on local protocols

Notification of Infectious Disease

101
Q

What organisms cause typhoid and paratyphoid?

A

Salmonella typhi and Salmonella paratyphi

102
Q

How are typhoid and paratyphoid spread?

A

Faeco-oral route

103
Q

How long is the incubation period of typhoid/paratyphoid?

A

3 days to 3 weeks

104
Q

A patient returning from a rural area of South-East Asia presents with malaise, fever, headache, cough, and nosebleeds.

What skin sign would increase likelihood of diagnosis of typhoid fever?

A

Rose-coloured spot on abdomen

105
Q

A patient returning from a rural area of South-East Asia presents with malaise, fever, headache, cough, and nosebleeds.

What cardiovascular finding might there be for typhoid infection?

A

Relative bradycardia

106
Q

A patient returning from a rural area of South-East Asia presents with malaise, fever, headache, cough, and nosebleeds.

What abdominal symptoms might there be for typhoid infection?

A

Splenomegaly

107
Q

A patient returning from a rural area of South-East Asia presents with malaise, fever, headache, cough, and nosebleeds.

On examination you find rose-coloured spots on the abdomen, splenomegaly, a fever, and HR of 56.

What are next steps given the likely diagnosis?

A

Potentially typhoid fever

Admit to hospital for antibiotics and further investigations

108
Q

What kind of infection if Dengue fever?

A

Viral

109
Q

A patient comes to the GP having just returned from a trip to a tropical region complaining of flu-like symptoms, high fever, and later a red maculopapular rash.

How is the likely diagnosis managed?

A

Dengue fever

Supportively, in hospital

110
Q

A patient comes to the GP having just returned from a trip to a tropical region complaining of flu-like symptoms, high fever, and later a red maculopapular rash.

They sustain a small cut while in the waiting room and it won’t stop bleeding. What is the concern here?

A

Dengue haemorrhagic fever

Very rare form of Dengue fever with poor prognosis

111
Q

A patient presents to GP land with diarrhoea after coming back from a trip abroad.

What features can help distinguish between various causes?

A

Fever
Blood in stool

112
Q

A patient presents to GP land with diarrhoea after coming back from a trip abroad.

What test should be sent?

A

Stool MC&S with details of the area travelled to.

113
Q

A patient presents to GP land with diarrhoea after coming back from a trip abroad.

There is no fever with this diarrhoea. Which infective agent is more likely to have caused this?

A

Giardiasis

Cholera and amoebic dysentery usually come with fever

114
Q

A patient presents to GP land with diarrhoea after coming back from a trip abroad.

The stool has slowly become looser and more profuse, and there is blood present. What is the most likely causative organism?

A

Amoebic dysentery due to presence of blood

115
Q

What is the definition of neutropenic sepsis?

A

Fever of over 38 degrees for more than 2 hours when neutrophil count is less than 1

116
Q

What are the main causes of neutropenic sepsis?

A

-Chemotherapy
-Radiotherapy to large volumes of bone marrow
-Malignant infiltration of bone marrow

117
Q

What additional signs to fever in a high risk group can suggest neutropenia?

A

Mouth ulcers
Increased fatigue

118
Q

What is an opportunistic infection?

A

Infection from an endogenous microflora that are non-pathogenic or from ordinarily harmless organisms when host defence mechanism has been altered

119
Q

Name some common opportunistic infections?

A

-E. coli
-CMV
-Pneumocystis
-Candida
-Herpes simplex
-Toxoplasmosis
-Mycobacteria
-Non-pathogenic streptococci
-Cryptococcal infection

120
Q

What can cause functional asplenism?

A

Sickle cell disease

121
Q

What is the risk of asplenism?

A

Increased risk of bacterial infection

122
Q

What 4 things should an asplenic patient have?

A
  1. Alert card
  2. Vaccinations
  3. Prophylactic antibiotics
  4. Stand-by amoxicillin
123
Q

What kind of vaccine is the MMR vaccine?

A

Live attenuated viruses

124
Q

When are MMR vaccines offered?

A

Age 1 and pre-school

125
Q

What can be offered to children over 18 months if they have not had MMR vaccine?

A

2 doses of MMR vaccine, or a booster dose if a single dose was had previously

126
Q

Which virus in MMR is important to vaccinate women of child-bearing age against if they are not already vaccinated?

A

Rubella

127
Q

Can a pregnant woman without rubella immunity be given the MMR vaccine?

A

No - not proven to be harmful however should be avoided, also avoid pregnancy 1 month after having the vaccine

128
Q

Who is the chickenpox immunisation offered to?

A

Healthcare workers who are not immune with direct patient contact

Susceptible close contacts of immune compromised patients

129
Q

A pregnant woman who has never had chickenpox is exposed via her 4 year old son. What should be offered?

A

Varicella zoster immunoglobulin <3days after initial contact

130
Q

What is shingles?

A

Reactivation of latent chickenpox virus

131
Q

A patient with diabetes presents with pain across left shoulder for a few days, followed by vesicular rash in the same area.

What is the likely diagnosis?

A

Shingles

132
Q

A patient with diabetes presents with pain across left shoulder for a few days, followed by vesicular rash in the same area.

How is this condition managed?

A

Shingles

Oral antivirals need to be given within 48hrs of rash appearing

IV antivirals if immune compromised

133
Q

Which population group is offered shingles vaccine?

A

Over 70s

134
Q

A patient with diabetes presents with pain across left shoulder for a few days, followed by vesicular rash in the same area.

What complications can arise from this condition?

A

Shingles

-Post-herpetic neuralgia
-Dissemination to other areas
-Eye involvement

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