Infections

Question 1

Eczema herpeticum

Answer 1

Cause: Hepes simplex virus
Management: aciclovir

Question 2

Necrotising fasciitis

Answer 2

Cause: Hroup A haemolytic strep (S. pyogenes) or C. perfringens
Management: debridement + IV antibiotics

Question 3

Cellulitis

Answer 3

Cause: S. pyogenes or S. aureus
Management: flucloxacillin or doycycline (if penicillin allergic) or teicoplanin (if severely ill)

Question 4

Pre-septal cellulitis (MILD)

Answer 4

Cause: S. pyogenes, S. aureus, S. pneumoniae + H. influenzae
Management: co-amoxiclav

Question 5

Pre-septal cellulitis (SEV) or orbital cellulitis

Answer 5

Cause: S. pyogenes, S. aureus, S. pneumoniae + H. influenzae
Management: ceftriaxone (cefotaxime if <1 month) +/- metronidazole and xylometazaline (if sinus involvement)

Question 6

Fungal infections

Answer 6

Cause: tinea, candida, mallassezia, aspergillus, etc
Management: manage risk factors + antifungals (topical/PO)

Question 7

Otitis externa

Answer 7

Cause: pseudomonas + S. aureus
Management: analgesics, ear drops (acetic acid) +/- abx eardrops (ciprofloxacin)

Question 8

Otomycosis

Answer 8

Cause: candida (rice-pudding exudate) + aspergillus (black spots)
Management: fundal specific drops (canestan)

Question 9

Otitis media

Answer 9

Cause: H. influenzae, S. penumoniae, M. catarrhalis + S. pyogenes
Management: analgesia + little role for abx (amoxicillin or clarithromycin)

Question 10

Ramsey hunt syndrome

Answer 10

Cause: Herpes simplex virus
Management: aciclovir, prednisolone, omeprazole, analgesia, fake tears + eye protection

Question 11

Tonsilitis

Answer 11

Cause: viral (rhinovirus, coronavirus, parainfluenzavirus, HSV, influenza A/B + EBV) + bacterial (Group A beta-haemolytic strep = S. pyogenes)
Management: treat if F-PAIN >4 phenoxymethylpenicillin/benzylpenicillin or clarithromycin

Question 12

Scarlet fever

Answer 12

Cause: S. pyogenes
Management: Phenoxymethylpenicillin

Question 13

Blepharitis

Answer 13

Cause: staph
Management: eye hygiene, warm compress +/- topic abx (chloramphenicol)

Question 14

Stye/Hordeolum

Answer 14

Cause: staph
Management: eye hygiene, warm compress, manage pre-existing conditions +/- topical abx or drainage (eyelash plucking/surgical drainage)

Question 15

Conjunctivitis

Answer 15

Cause: viral (adenovirus), bacterial (S. pneumoniae, S, aureus + H. influenzae), chlamydia + gonococcus
Management: eye hygiene, cool compress, topical abx (chloramphenicol if bacterial or ofloxacin + ceftriaxone if gonococcal)

Question 16

Splenectomy prophylaxis

Answer 16

Cause: S.pneumoniae, H. influenzae B + N. meningitidis
Management: 12 months phenoxymethylpenicillin or erythromycin (penicillin allergic) then review

Question 17

Meningitis

Answer 17

Cause: Birth to 12 weeks (Group B strep, E.coli [+ other gram -ve] + listeria), 3 months to 4 years (N. meningitidis, S. pneumoniae, H. influenza B + TB [rare]) + over 4 years (N. meningitides, S. pneumoniae + TB)
Management: [ANY febrile child should be given stat dose of benzylpenicillin in primary care but should not hinder transfer for hospital] under 28 days (cefotaxime, amoxicillin + gentamicin), 1 to 3 months (cetriaxone + amoxicillin) + older than 3 months (ceftriaxone [or meropenem if sev. penicillin allergy] +/- listeria). Also give steroids + PPI early.

Question 18

Encephalitis

Answer 18

Cause: HSV, enterovirus, VZV, RSV, adenovirus + M. pneumoniae
Management: 28 days to 3 months (aciclovir, cetfriaxone + amoxicillin), 3 months and beyond (aciclovir + ceftriaxone)
[Basically just add on aciclovir to the meningitis management]

Question 19

Sepsis

Answer 19

Cause: Neonates (group B strep + E coli), infants (CoNS, S. aureus + S. pneumoniae) + adults (depends on site of origin)
Management: under 1 month (cefotaxime, amoxicillin + gentamicin), 1 to 3 months (ceftriaxone + amoxicillin), over 3 months (ceftriaxone) + adult (gentamicin 1g IV)

Question 20

Bronchiolitis

Answer 20

Cause: RSV, parainfluenza, influenza, rhinovirus + adenovirus
Management: O2 therapy +/- steroids or NG feeds

Question 21

Croup

Answer 21

Causes: parainfluenza (1 + 3), RSV, rhinovirus + influenza
Management: mild (single PO dose of dexamethasone), moderate (inhaled budesonide + IM dexamethasone) + severe (as with moderate +/- inhaled adrenaline).
Consider hospital admission if chronic lung disease, congenital heart defect, NMD, immunodeficiency, <3 months, poor fluid intake, inability to care for child at home + longer distance to healthcare

Question 22

Pneumonia

Answer 22

Causes: neonates (group B strep, gram negative enterococci + bacilli), infants (RSV, S. pneumoniae, H. influenzae, B. pertussis, C. trachomatis + S. aureus), over 5s (M. pneumoniae, S. pneumonia + C. trachomatis) + adults (S. pneumoniae, H. influenzae, M. catarrhalis, M. pneumoinae + B. pertussis)
Management: paeds (mild = amoxicillin or clarithromycin. Severe = co-amox + clarithromycin OR cefuroxime + clarithromycin) + adults (score 0-1 = PO amoxicillin, score 2 = PO amoxicillin + doxycycline + score 3-5 = IV co-amox + doxy)

Question 23

Gastroenteritis

Answer 23

Viral: rotavirus, norovirus, adenovirus, astrovirus + CMV
Bacterial: salmonella, campylobactor, shigella, E. coli, C. difficile, V. cholera + Y. enterocolita
Parasite: giardia + cryptosporidium

Question 24

Septic arthritis + osteomyelitis

Answer 24

Causes: S. aureus, group A strep + H. influenzae

Question 25

Group B strep in pregnancy

Answer 25

If found before labour/birth = amoxicillin 7 days
High risk for GBS women should be given prophylaxis once in active labour = benzylpenicillin IV stat + every 4 hours OR cefuroxime IV stat then every 8 hours
Prelabour (from 34+0 weeks onwards) rupture of membranes in known GBS carrier = abx as above and induction with oxytocin
Preterm (24-33+6 weeks) prelabour rupture of membranes = erythromycin for 10 days or until labour (aim for >34 weeks)

Question 26

Urinary tract infections

Answer 26

PAEDIATRIC
Causes: E. coli, proteus, klebsiella, pseudomonas + strep. faecalis
For children >3 years:
- Both +ve –> abx + culture
- Nitrite +ve –> abx + culture
- LE +ve –> culture +/- abx
- Both -ve –> small possibility of UTI
LUTI: 3 months to 12 years (cefalexin or nitrofurantoin) or 12-17 years (nitrofurantoin or cefalexin)
UUTI: >3 months (cefalexin or co-amoxiclav)
Followup:
- <6 months: USS in 6 weeks if responding well + if not, USS during infection, DMSA 4-6 months later + MCUG
- 6 months to 3 years: responding well (no followup) OR atypical UTI (urgent USS + DMSA in 4-6 months) OR recurrent (USS in 6 weeks + DMSA 4-6 months after infection)
- >3 years: responding well (no followup) OR atypical (USS during infection) OR recurrent UTI (6 week USS + DMSA at 4-6 months)

ADULT
Causes: E. coli, S. saprophyticusm, P. mirabilis + K. pneumoniae
Non-pregnant woman + men: trimethoprim (3 days in women + 7 days in men or anyone with catheter) OR fosfomycin (single stat dose) OR pivmecillinam (stat dose then 3 days in women + 7 days in men or anyone with catheter)
Pregnant women: cefalexin 7 days OR fosfomycin STAT or trimethoprim 7 days
If needing IV: non pregnent (co-amox), pregnant (cefuroxime) + penicillin allergy (gentamicin)

Question 27

Vaginal candidiasis

Answer 27

Cause: Candida species
Management: avoid local irritants (perfumed soaps)/douching/daily panty-liners, use emollients, manage DM better +/- antifungals = fluconazole (avoid in pregnancy) + clotrimazole

Question 28

Bacterial vaginosis

Answer 28

Cause: loss of lactobacilli + increase in Gardnerella vaginalis, Prevotella species, mycoplasma hominis + mobiluncus spp
Management: avoid douching, shower gel or antiseptic agents in the bath +/- abx (for symptomatic cases + undergoing surgery) metronidazole stat or 5-7 days or intravaginal cream for 5 days

Question 29

Trichomonas vaginalis

Answer 29

Cause: T. vaginalis (flagelated protozoa)
Management: metronidazole (stat or BD 5-7 days) OR tinidazole

Question 30

Gonorrhoea

Answer 30

Cause: N. gonorrhoea (gram -ve diplococci)
Management: if sensitivity not known (ceftriaxone) or if sensitivity known (ceiprofloxacin)

Question 31

Chlamydia

Answer 31

Cause: C. trachomatis
Management: chlamydia 7days OR azithromycin stat OR erythromycin 10-14 days OR ofloxacin 7 days

Question 32

Mycoplasma genitalum

Answer 32

Cause: M. genitalum
Management: uncomplicated (urethritis/cervicitis = doxycycline 7 days OR moxifloxacin 10 days) OR uncomplicated (PID/epidiymoorchitis = moxifloxacin 14 days)

Question 33

Non-gonococcal urethritis

Answer 33

Cause: [only in males + cases that no cause can be found after gonorrhoea has been ruled out] C. trachomatis, M. genitalium, ureaplasmas, T. vaginalis, adenovirus, HSV, etc
Management: 1st occurrence (doxycycline 7 days OR azithromycin stat + 2 days OR ofloxacin 7 days) OR persistent episode (doxy first = azithromycin stat + 2 days + started within 2 weeks of finishing doxy OR azithromycin first = moxifloxacin 10 days OR doxycycline 7 days)

Question 34

Herpes simplex genital ulcers

Answer 34

Cause: HSV 1 + 2 (commonest for genital ulcers)
Management: non-pregnant (start within 5 days of symptom onset + continue for 5 days - aciclovir/valaciclovir)

DURING PREGNANCY (Mother):

• First occurrence: if <28+0 (give suppressive aciclovir from 36+0 + expect vaginal delivery) OR if >28+0 (give suppressive therapy until delivery, test for HSV IgG + recommend C/S)
• Recurrent episode: consider suppressive therapy + vaginal delivery should be fine
• Episode during labour: recommend C/S but leave it up to mother if recurrent

NEONATAL MANAGEMENT:

• If born by C/S + recurrence in mother during 3rd trimester = no management needed but signpost to parents
• If born by PV delivery + primary infection within last 6 weeks = baby well (swab, NO LP, start aciclovir, infection prevention + maintain breastfeeding) OR baby NOT well (weab, LP (even if no neuro symptoms) + start aciclovir)

Question 35

Anogenital warts

Answer 35

Cause: HPV types 6 + 11 (90%)
Management: STI screen, condoms, stop smoking. Podophylotoxin + imiquimod are teratogenic. Cryotherapy, excision + electrocautery are safe in pregnancy.

Question 36

Syphilis

Answer 36

Cause: T. pallidum
Management: primary or secondary (benzathine penicillin IM stat), late latent (benzathine penicillin IM once weekly for 3 weeks + tertiary/neurosyphilis (procaine penicillin OD + probenecid for 14 days OR benzylpenicillin IV every 4 hours for 14 days)

Question 37

Lymphogranuloma venerum

Answer 37

Cause: C. trachomatis L1, L2 + L3
Management: Doxycycline 21 days OR erythromycin 21 days OR consider azithromycin stat

Question 38

Pelvic inflammatory disease

Answer 38

Cause: chlamydia, gonorrhoea + commensals (anaerobes, g. vaginosis + M genitalum)
Management: rest, analgesia, abstention + consider admission. Outpatient (IM ceftriaxone STAT, oral doxycycline 14 days + oral metronidazole 14 days) or inpatient (IV centriaxone daily + IV doxycycline AND continue until managing PO meds)