Resp and Skin infections

Question 1

what is the clinical presentation of croup?

Answer 1

seal-like barking cough
Stridor
Voice Hoarness
respiratory distress

symptoms result from upper airway obstruction due to inflammation of the airways

typically caused by parainfluenza viruses

Question 2

How is croup treated?

Answer 2

dexamethasone

nebulised adrenaline and o2 in severe

Question 3

what virus causes bronchiolitis?

Answer 3

Respiratory synctyial virus

Question 4

what are the S&S and InV for bronchiolitis?

Answer 4

cough, tachyapnoea, wheezing, grunting and nasal flaring. fever and fatigue

pulse oximetry, ELISA rapid antigen detection, CXR and RT-PCR

Question 5

what is the treatment of bronchiolitis?

Answer 5

ribavirin
prednisolone
o2 support

Question 6

what are the types of influenza and how are they subdivided?

Answer 6

Type A and B

Subcategorised according to H and N antigens

Question 7

what are the symptoms of the flu?

Answer 7

fever 
runny/blocked nose 
sore throat 
cough 
headache 
joint pain 
fatigue 
vomiting

Question 8

what are the InV for the flu? what are complications?

Answer 8

viral culture
immunofluorescent antibody staining
RT-PCR

Acute ottitis media 
sinusitis 
pneumonia 
ARDS 
myocarditis 
reye syndrome

Question 9

what drugs are available to treat flu?

Answer 9

neuraminidase inhibitors

• oseltamivir
• zanamivir

M2 inhibitors

• amantadine
• rimantadine

IMP dehydrogenase inhibitors
- ribavirin

RNA polymerase inhibitors

• favipiravir
• baloxivir

analgesia and antipyretics

Question 10

what pathogens are commonly implicated in cellulitis?

Answer 10

Group A streptococci e.g strep pyogenes

Staph aureus

Question 11

what are the S&S of cellulitis?

Answer 11

acute onset of red, painful, hot, swollen skin

Well demarcated, bright red raised skin

fever and malaise

lymphangitis - red line that spreads proximally along lymphatics to the lymph nodes

Question 12

what InV are done for cellulitis?

Answer 12

FBC, ESR and CRP
- leucocytosis and elevated CRP and ESR

Blood culture and skin swab

Question 13

what is the treatment options for cellulitis?

Answer 13

oral/IV flucloxacillin
- clarithromycin if penicillin allergic

Supportive care

• fluids
• wound management
• mark boundaries and assess spread
• analgesia

Question 14

what is necrotising fasciitis?

Answer 14

a life threatening subcutaneous soft tissue infection that may extend to the deep fascia but not into the underlying muscle

Question 15

what is type 1 nec fasc?

Answer 15

polymicrobial infection of subcutaneous tissue with an anaerobe and faculative anaerobic

• bacteriodes
• E. Coli
• Klebsiella

Question 16

what is type 2 nec fasc?

Answer 16

monomicrobial infection of subcutaneous tissue most commonly by streptococcus pyogenes

Question 17

what are the S&S of nec fasc?

Answer 17

disproportionate pain at site or possible numbness

fever, N&V

tachycardia, tachyapnoea, hypotension

delirium

Vesicles or bullae, oedema and darkening of skin

Crepitus of skin overlying cellulitis

Question 18

what InV are done in Nec Fasc?

Answer 18

FBC, CRP and ESR
- leucocytosis and elevated CRP/ESR

U&E’s

• hyponatraemia
• urea and creatinine markedly increased

Lactate
- elevated

blood and tissue cultures

Radiography - CT/MRI or US

• oedema extending along fascial plane
• soft tissue gas

Question 19

How is Nec Fasc managed?

Answer 19

surgical debridement and haemodynamic support

Flucloxacillin 
Benzylpenicilin 
Gentamicin 
Metronidazole 
Clindamycin 

Funny Boys Get More Cunt

Question 20

what are the S&S of MRSA infection

Answer 20

erythematous skin lesions or pustules in single or multiple forms

• commonly mistaken for insect bites or follicutlitis
• central ulceration may be present

irritation or pain at indwelling catheter site

fever chills, malaise

abscess

nodular, abscessed or ulcerated lesion with sharp pain

Question 21

which gene infers methicillin resistance in MRSA?

Answer 21

mecA

Question 22

what InV are done for MRSA?

Answer 22

FBC - leucocytosis

Blood and tissue culture - MRSA

indwelling catheter tip culture

Echo - endocarditis

CXR - pneumonia

PCR - detect mecA gene

Question 23

what are risk factors for MRSA?

Answer 23

older age
recent hospitalisation
Previous ABx
Crowded living conditions

Question 24

what is the treatment of MRSA?

Answer 24

abscess incison and drainage
debridement
IV Vancomycin

Question 25

How can herpes simplex virus infection manifest?

Answer 25

oral, genital or ocular ulcers

Question 26

what are the InV for HSV?

Answer 26

viral culture
HSV PCR
Glycoprotein G-based type-specific serology
- positive antibody to HSV 1 or 2

Question 27

what is the treatment of HSV?

Answer 27

Aciclovir
analgesia
IV foscarnet if aciclovir fails

Question 28

what are the complications of HSV?

Answer 28

recurrence as it establishes latency in neuronal ganglia

• oesophagitis
• erythema multiforme
• meningitis
• encephalitis
• Bells palsy