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Conditions Flashcards

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1
Q

Ramsay Hunt syndrome mx

A

Prednisolone 1mg/kg (max 75mg) 5/7
Aciclovir 800mg TDS 7/7
Eye patch/artificial tears
Referral to neurologist
Simple analgesia
Avoid contact with immunocompromised

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2
Q

Mx bite/clenched fist injuries

A

If Abx needed; Augmentin 875+125mg (child >=2mo 22.5+3.2mg/kg) BD 5/7
Irrigate wound
Remove foreign bodies
Analgesia - panadol/iburorfen
Elevated/immobilise extremity for 48-72hrs
Advise for early review if signs of infection develop
Apply dressing
Tetanus

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3
Q

Ix for latent TB

A

Tuberculin skin test: good if child <2yo or doesn’t want venepuncture
- not reliable if had previous BCG vaccine
Interferon gamma release assay (IGRA) blood test
If either is positive -> exclude active TB and refer to specialist for mx

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4
Q

Ix for active TB

A

Consider testing if suspicious symptoms
Must do CXR
3x early morning sputums 8hrs apart for acid-fast bacilli culture, MCS
- can do TB PCR with advice from ID (more sensitive and rapid)

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5
Q

Ix of contact of TB

A

Asymp with hx of TB/LTBI -> CXR +/- TST/IGRA +/- sputum
Symptoms -> as above
Nil sx or hx of TB/LTBI -> TST/IGRA -> if negative repeat at 8 weeks
- if <5yo or vulnerable -> consider prophylaxis

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6
Q

Tx latent TB

A

Isoniazid 10mg/kg daily 9/12
ADR; GIT upset, acne, hepatotoxicity, peripheral neuropathy

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7
Q

Tx active TB

A

Isoniazid
Rifampicin
Pyrazinamide
Ethambutol
Above can cause hepatotoxicity

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8
Q

Pertussis sx

A

Persistent cough >2/52 with one or more of;
- paroxysms of coughing
- inspiratory whoop
- post-tussive emesis
Cyanosis/apnoea
Older children/adults may present atypically - isolated cough

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9
Q

Pertussis Ix

A

Pertussis PCR NP swab - best in first 3/52 of illness
Pertussis serology; low sens - use if >2/52 illness
Culture; only accurate early on disease - takes 2/52 for result
Leucocytosis and lymphocytosis

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10
Q

Mx of pertussis

A

Isolate until finish 5/7 therapy of >3/52 of cough (no longer infectious)
Azithromycin 500mg day 1 -> 250mg 4/7 (child 10mg/kg day 1, 5mg/kg 4/7)

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11
Q

Indication for prophylactic Abx for pertussis in contacts

A

Contact; F2F within 1min for >=1hr
Indicated; close contact whilst infectious (<3/52 cough or <5/7 of Abx)
- Child; <6/12, household member <6/12, <3 doses vaccine, attends childcare in same room as infant <6/12
- Adult; expectant parents in last 1/12 pregnancy, healthcare worker in maternity/nursery, childcare worker with contact with <6/12, household member <6/12
Isolation of contacts
- Unimmunised household and childcare contacts <7yo to isolate for 14 days post exposure or until 5 days of ABx

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12
Q

Mx pneumocystic jirovecii pneumonia (PJP)

A

Trimethoprim + sulfamethoxazole 5+25mg/kg TDS 21/7

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13
Q

Legionella pneumonia

A

Legionella longbeachae - commonly in potting mix
Assoc with contamination of water in hospitals, hotels, apartments
Sea water, hot springs, creeks, soil
Sx
- 2-10/7 IP
- T up to 40C
- Dry cough
- Diarrhoea
Ix
CXR; lower zone patchy consolidation, effusion
Hyponatraemia
Elevated transaminases
CRP >100
PCR sputum is gold standard
- if can’t - do urinary antigen Legionella
Tx
- Azithromycin 500mg PO 7/7

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14
Q

Psittacosis (Chlamydia psittaci)

A

From infected birds
- inhaled dust from dried droppings, resp droplets from birds
Sx
- URTI
- abrupt fever
- headache
- myalgia
Ix
- Pharyngeal PCR
Tx
- Doxycycline 100mg BD 7/7

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15
Q

Causes of pneumonia

A

Strep pneumonia
Legionella
Chlamydia psittaci
Mycoplasma pneumonia
H influenza
K pneumonia
Influenza/RSV/adenovirus

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16
Q

Risk factors pneumonia

A

Nil pneumococcal vax
>65yo
Chronic lung disease
Immunocompromised
Malnutrition
Recurrent aspiration
Alcohol
Smoking

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17
Q

CRB-65 for severity of CAP

A

Confusion = 1
RR >=30 = 1
BP <90 / 60 = 1
Age >=65 = 1
Score 1-2 may need referral to hospital

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18
Q

CAP mx

A

Tx 5/7 if good response, otherwise full 7/7
Child; amoxicillin 30mg/kg TDS 3-5/7
Low severity
- Amoxicillin 1g TDS
- Allergic; doxycycline 100mg BD or clarithromycin 500mg BD
Combination therapy
- Indication; if nil improvement after 48hrs, or poor f/u start straight away
- Amoxicillin 1g TDS PLUS doxycycline 100mg BD
- Allergic; cefuroxime 500mg BD PLUS doxy 100mg BD (use clarithromycin 500mg BD as alternative to doxy if pregnancy

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19
Q

Indications for hospital referral for CAP

A

RR >=22
HR >100
Hypotension
Confusion
O2 <92%
Multilobar involvement

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20
Q

Meningitis sx, exam, tx

A

Sx
- Triad; fever, nuchal rigidity, changed mental status
- Headache
- GCS <14
- Nausea
- Rash
Exam
- Brudzinski sign; spontaneous hip flexion with passive neck flexion
- Kernig; inability to fully extend knee with hip flexed at 90deg
Tx
- If can’t do LP within 60min - then tx with empirical ABx
- Ceftriaxone 2g (child >1/12 50mg/kg) IV/IM
- OR benzylpenicillin 2.4g (child 60mg/kg) IV/IM

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21
Q

Indications for PEP rabies

A

Indication; nibbling of uncovered skin, scratches/abrasion, bites, contamination of mucous membrane/broken skin with saliva
- If immunised; 2 doses IM on day 0 and 3
- Non-immune; 4 doses IM day 0,3,7,14, 1 dose HRIG (Human Rabies immunoglobulin) ASAP and prior to day 7!

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22
Q

Listeriosis

A

Cause
- listeria monocytogenes bacteria in fresh foods, unpasteurised dairy, processed meats, seafood
Sx
- influenza like illness
- food poisoning sx
- Meningitis in elderly / infants
- Sepsis / pneumonia
Ix
- Listeriosis PCR of blood/any bodily fluids
- MCS from infected site/blood
- Serology

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23
Q

Leptospirosis

A

Cause; leptospira infected urine from animals into open skin/mucous membranes
- farmers, meat workers
Sx
- Fever, chills, myalgia
- Severe headache
- Macular rash
- conjunctivitis
Ix
- Takes weeks for seroconversion - if clinically suspect then tx
- Leptospirosis blood culture and PCR
Tx
- Doxycycline 100mg BD 7/7

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24
Q

Q fever

A

Cause
- Coxiella burnetti bacteria from cattle/sheep/dogs/cats
- Inhaled droplets or dust contaminated with faeces/ urine
Risk; meatworkers, farmers, vets
Sx
- asymp
- Severe flu-like illness; fever, headache, myalgia
- Atypical pneumonia/hepatitis
- Lead to endocarditis/osteomyelitis
- Post Q fever fatigue syndrome
- Chronic fatigue
Ix
- Rickettsial serology then repeat in 6/12 to see if chronic
- PCR blood but must be within 1 week of disease
- Raised AST/ALT
- Lymphopenia, low platelet
- Test results can take weeks - so start tx anyway
Tx
- doxycycline 100mg BD 2/52
Prevention
- Q fever vaccine; >15yo and high risk occupation
- Hand hygiene
- Respiratory
- Removal of animal waste
- Insect repellents

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25
Scrub typhus
Cause - Mite bite with Gram negative - Asia, Pacific/Indian Ocean Island, Northern Aus Sx - 21/7 IP - Fever - Eschar at bite site - LN - Splenomegaly Ix - Serology - PCR on blood/tissue specimens - Low WCC/plt - Elevated AST/ALT Tx - Doxycycline 100mg BD 7/7
26
Queensland tick typhus
Cause - Rickettsia Australia G-ve bacteria via tick bite Sx - 14/7 IP - Eschar at bite site - Fever - headache - erythematous eruption Ix - Serology - takes 6/7 for result - PCR if within 1-5 days post bite Tx - Doxycycline 100mg BD 7/7
27
Dengue
Dengue virus Sx - Classic; fever, headache, retro-orbital pain, myalgia - Fever 5-7/7 - Arthralgia - Fine macular rash - Positive tourniquet test - Dengue haemorrhagic fever; low plt, bleeding Ix - Serum PCR within 1-5/7 of sx onset Tx - Public health notification - Urgent prevention measures; tell pt to stay indoors, insect repellent - supportive tx - Avoid NSAID (bleeding risk) - Hospital; pregnant, chronic medical condition, extreme of age - observation and fluid replacement
28
Ross River virus
Cause - Infected mosquito, Aus, NG, Indonesia Sx - 14/7 IP - Fever, polyarthritis (symmetrical), rash! - Myalgia - Rare to contract it again Ix - RR serology within 7/7 sx onset -> repeat 14/7 later (4x fold increase IgG confirms dx) Tx- supportive
29
Sexual history
Number of partners Gender of partners Type of sex Prev hx STI Have you paid to have sex or been paid by someone else Tattoos / IVDU Previous incarceration Immigrant ATSI
30
History to establish risk of STI from encounter
Type of sex Use of condoms Was it with a sex worker Did your partner have signs of STI - ulcers, discharge Vaccination status - hepatitis B Does pt have STI sx
31
Standard asymptomatic STD screening
Bloods - HIV - Syphilis - Hepatitis B; HbsAg, Anti-HBs, Anti-HBc Chlamydia/gonorrhoea - Urethral FPU PCR - Self collected PV swab is preferred ATSI <30yo; chlam/gon/syph/HIV/trichomoniasis if endem MSM; 3/12ly - Oropharyngeal/rectal PCR chlam/gon - FPU PCR chlam/gon - Blood; HIV, syph, Hep C, Hep A, Hep B - Only test Hep C annual if HIV, PrEP or IVDU
32
Indications to screen for HepC in STD check
HIV positive IVUD Anal sex with partner with HCV Incarceration Non-professional tattoos/piercings Organ/blood recipient prior 1990
33
STD contact tracing
Chlamydia - 6/12 Hep A; 50 days from sx onset Hep B: 6/12 prior to acute sx Hep C; 6/12 prior to acute sx HIV; recent sexual/needle-sharing partners Syphilis - Primary; 3/12 plus duration of sx - Secondary; 6/12 plus duration of sx - Early latent; 12/12
34
Anogenital warts
Cause; HPV Sx; peri-anal itch, rectal bleeding, warty growths on skin, Can lead to malignancy Tx - avoid shaving/waxing to prevent spread - Offer HPV vaccine - Podophyllotoxin paint BD 3 days on / 4 days off -> 6 cycles - Imiquimod 5% cream 3x weekly bedtime, wash off in morning 16/52 - Specialist for excision/ablative therapy under GA
35
Types of chlamydia
A/C; ocular trachoma D-K; conjunctivitis, genital infection L1-3; lymphogranuloma venerum
36
Complications of chlamydia
Epididymo-orchitis PID Infertility Ectopic pregnancy, PROM, Reactive arthritis Cervicitis Conjunctivitis Perihepatitis
37
Chlamydia Ix
FPU PCR; male or unable to do PV swab Self-collected PV swab or endocervical swab Anorectal swab; if sx or homo Pharyngeal swab; if homo
38
Chlamydia mx
Non-pharm - Nil sex 7/7 after tx - Contact tracing 6/12 - Nil sex with partner from last 6/12 until all tested and tx - Provide fact sheet about illness Partner delivered therapy Offer presumptive tx of sexual contacts Uncomplicated genital/pharyngeal; doxycycline 100mg BD 7/7 OR Azithromycin 1g PO STAT Anorectal - Asymp; doxy 100mg BD 7/7 - Symp; Doxy 100mg BD 21/7 or Azi 1g PO and repeat at 24hrs Conjunctivitis - Azithromycin 1g stat
39
Chlamydia f/u
Confirm adherence Confirm contact tracing Sexual health education + counselling TOC: only if pregnant or anorectal infection tx with azi -> 4/52 post tx TOC Test reinfection; 3/12
40
Lymphogranuloma venereum
Cause- C trachomatis L1-3 Sx - Primary; ulcer/nodule, proctitis - Secondary; inguinal LN swelling/discharge/erythema - Tertiary; chronic proctitis, fistula, strictures, scarring Dx - Rectal swab Chlamydia PCR + write on request LGV testing - test if proctitis sx or homosexual men - LGV very uncommon vaginal - should refer to specialist if suspect Tx - Nil sex 21/7 - Nil sex partners from last 3/12 - Contact tracing - Doxycycline 100mg BD 21/7 - Inguinal buboes- may need drainage F/u - 1/52 - results, adherence, sx, contact tracing, sexual health counselling - TOC: PCR 3/52 after finish tx - Test reinfection; 3/12
41
Donovanosis
Cause; rare - genital ulcer by Klebsiella granulomatis - PNG, South Africa, South America, India Sx - painless ulcer, offensive odour - Can spread to uterus/tubes/long bones/psoas muscles - Neoplastic transformation - Increased HIV transmission risk Ix - Dry swab or punch biopsy for PCR Tx - Nil sex 7/7, contact tracing 6/12, nil sex prev partners 6/12, notify - Specialist referral! - Azithromycin 500mg 7/7 or azithromycin 1g weekly 4/52
42
Pubic lice
Genital itch, rash, debris in underwear (crabs), fever, lethargy Mx - Pyrethrin 0.165% + piperonyl butoxide 1.65% foam to hair and other areas -> wash after 10min -> repeat 1/52
43
Genital scabies
Sx - genital papulonodule + visualisation of silvery skin burrows - fever, pain, secondary infection Mx - Permethrin 5% neck down for 8hrs - repeat in 1 week
44
Oral HSV mx
Primary oral - Minor; analgesia, fluid, lidocaine 2% 15ml 3hrly - Severe; aciclovir 200mg 5x daily 7/7 Recurrent oral - Minor recurrence; aciclovir 5% cream 5x daily 5/7 - Severe; aciclovir 400mg 5x daily 5/7 Long-term suppression - Famciclovir 250mg BD 6/12
45
Genital HSV clinical features
Sx - Anogenital, lower back, buttocks, thighs ulcer - Cervicitis +/- ulcers/blisters +/- PV discharge - Proctitis - Urethritis DDx; Behcet's syndrome (vasculitis - mouth Ulcer + genital ulcer + uveitis) Ix - HSV PCR - swab base of deroofed vesicle or ulcer
46
Genital HSV mx
Non-pharm - Fluids - Hand hygiene to avoid autoinoculation - Nil sex until lesions healed Pain - NSAID - Lignocaine 2% topical - Saline baths Initial episode; aciclovir 400mg PO TDS 10/7 Recurrence; aciclovir 800mg TDS 2/7 Suppression; aciclovir 400mg BD 6/12 Suppression in pregnancy; aciclovir 400mg TDS from K36
47
Gonorrhoea sx
Urethritis sx Cervicitis sx Conjunctivitis; purulent, sight-threatening Anorectal sx; discharge, tenesmus Complications; epididymo-orchitis, prostatitis, PID, disseminated disease (rash, septic arthritis), meningitis, endocarditis
48
Gonorrhoea Ix
FPU PCR; males and if can't do PV/cervical swab Gonococcal culture; good for Abx sens - take it prior to starting Abx Homo; anorectal + pharyngeal swab regardless of sx
49
Gonorrhoea mx
Nil sex until 7 days after tx Nil sex with partners for last 2/12 Contact tracing Notify state department Consider HIV PreEP Uncomplicated genital/anorectal - Ceftriaxone 500mg IMI 2ml 1% lignocaine PLUS Azithromycin 1g PO stat Uncomplicated pharyngeal - As above but Azi 2g Conjunctivitis - Ceftriaxone 1g IM 2ml 1% lignocaine PLUS Azi 1g stat F/u - 1/52; adherence, sx, contact tracing, sexual counselling, discuss HIV PrEP - TOC: PCR swab each site 2/52 post tx - Reinfection; 3/12
50
Hepatitis A
Cause; contaminated food/water, faeco-oral transmission during sex Lifelong immunity after infection Prevention; Hep A vaccine for homo, IVDU, ATSI, custodial worker, sex workers Ix - Positive anti-HAV IgM Mx - Supportive - No sex for 1 week post onset of jaundice - Avoid preparing food/drink - Contact tracing - Notify state - Specialist; pregnant - Contact tracing; 50 days from onset of sx - PEP; Hep A vaccine or immunoglobulin for contacts;
51
Hep B Ix
Chronic Hep B - HbsAg and Anti-Hbc positive - Anti-Hbs negative Acute - HbsAg, Anti-Hbc, Anti-Hbc IgM POSITIVE, anti-Hbs negative Immune from vax - anti-Hbs POSITIVE - HbsAg/anti-Hbc negative Immune from resolved infection - HbsAg neg - antiHBc and antiHBs positive
52
Indications to tx Hep B
HBV DNA >20,000 Elevated ALT HbeAg positive or anti-HbeAg positive
53
Acute hep B mx
Refer S100 prescriber if tx indicated No sex until partner is immune Avoid sharing toothbrush/razors Screen household contacts +/- vaccinate Hep A vaccine Contact tracing; sexual, household, close family and vaccinate for last 6/12 before onset of sx Consider other STI screening Ix for fibrosis with fibroscan PoEP with HbIG; sexual, IVDU, occupational
54
Hep B f/u
Contact tracing Monitor until HbsAg neg Chronic infection - 6-12/12 monitor, annual viral load, LFT - HCC screening with USS/AFP - check Hep A/C status
55
HIV sx
Acute infection; 2/52 for seroconversion - Fever, rash of whole body, LN, pharyngitis, myalgia Immune deficiency; thrush, diarrhoea, weight loss, skin infections, herpes zoster Complications; AIDs (PJP, candidiasis, Kaposi sarcoma, non-Hodgkin lymphoma), increased risk CVD/CKD/oesteoporosis
56
HIV Ix
HIV serology; repeat 6/52 later
57
HIV diagnosis counselling
Explain a disease that is controllable and can achieve normal life expectancy Explain can tx with PO meds Refer to sexual health clinic to start anti-retrovirals Use condoms with any sexual partner and must disclose his HIV status Refer to HIV support services / psychologist Explain this is notifiable Explain need to test his CD4 count and viral load
58
HIV post-exposure prophylaxix
Within 72hrs
59
PrEP HIV steps
Suitability - Test HIV, assess sx - Confirm normal eGFR 60 and exclude nephrotoxics / interactions - Ensure not candidate for post-exposure prophylaxis Testing - Assess for other STI, Hep B/C, pregnancy test, renal function Prescribing - Tenofovir 300mg / emtricitabine 200mg daily dosing -> 7 days until protection for males, 20 days for females -> continue 28days post exposure -> ADR; nausea, headache - safe in pregnancy/breastfeeding Monitor - HIV testing + STI; day 30, 90 and every 90days on PrEP - Hep B/C; baseline, Hep C annually - Pregnancy test every visit
60
Mycoplasma genitalium
Sx - urethral discharge - PID/cervicitis - Post-coital bleeding - Pelvic pain - preterm, abortion, proctitis, reactive arthritis Ix; test if acute/persistent/recurrent urethritis, cervicitis, PID, post-coital bleeding - FPU CR - Anorectal swab if sx Mx - Condoms until TOC - TOC 21 days after tx - No sex in untested partners - Fact sheet - Susceptible; doxy 100mg BD 7/7 then azi 1g immediately then 500mg daily 3/7 - Resistant; doxy 100mg BD 7/7 then moxifloxacin 400mg 7/7
61
Stages of syphilis
Early; primary, secondary, early latent Late latent Tertiary
62
Primary syphilis clinical features
Genital/anal/oral ulcer (chancre) Painless, well defined IP 3/52 Inguinal LN large, nontender Highly infectious
63
Secondary syphilis clinical features
Occurs <6/52 post infection Fever, malaise, headache, LN Generalised rash trunk/palms/soles Alopecia Neurological; vision change, tinnitus, meningitis Highly infectious
64
Early latent syphilis clinical features
<2years infection Nil sx Positive serology Highly infectious
65
Late latent syphilis clinical features
>2 years infection Nil sx No longer infectious - can be transmitted vertically
66
Tertiary syphilis clinical features
Late sx and complications CNS/CVS disease Destructive skin lesions - gummas
67
Early neurosyphilis clinical features
Vision change Tinnitus Deafness Meningitis Needs IVAbx
68
Syphilis Ix
Syphilis serology - if positive - Rapid plasma reagin positive -> if nil hx = early / late syphilis = treat -> if had prev tx and now RPR increase -> possible reinfection = treat -> if had prev tx and now RPR lower -> past treated syphilis = don't treat Venereal disease research lab (VDLR) confirmatory testing Treponema-specific assay (TPHA/TPPA); remains positive for life Swab ulcer PCR
69
Syphilis mx
Must have RPR repeated on same day of tx for accurate baseline Primary/secondary; benzathine benzylpenicillin 1.8mg IMI as 2 injections All other cases - benzathine benzylpenicillin 1.8g IMI as 2 doses weekly for 3 weeks Non-pharm - nil sex for 7 days after tx - Nil sex with partners from last 3/12 (primary,), 6/12 (secondary), 12/12 (early latent) - Contact tracing - Notify - Syphilis register
70
Jarisch-Herxheimer reaction
Reaction to treatment in primary/secondary syphilis Occurs 6-12hrs after tx Fever, headache, rigors, joint pain Tx conservatively
71
Mx of syphilis contacts
Partners from last 3/12 should have tx for primary/secondary syphilis regardless of serology
72
F/U syphilis
TOC; RPR 3/12, 6/12, 12/12 post tx - 4x drop RPR = adequate response MSM; screen HIV/STI every 3-12/12
73
Trichomoniasis
Cause; trichomonas vaginalis protozoa Risk; older, regional/remote, ATSI, sex workers Sx - Urethritis - Malodourous PV discharge - Prostatitis, PROM, preterm, Ix - High PV swab PCR or FPU PCR Tx - Nil sex 7/7 after tx - Tx partner - Contact tracing - Metronidazole 400mg BD 7/7 (avoid etoh) - Specialist; pregnant, breast-feeding, HIV F/u - 1/52; usual - Nil TOC - Retest at 4/52 if ongoing sx
74
Bacterial vaginosis
Cause; Gardnerella vaginalis Sx - thin white/grey PV discharge - asymp 50% Ix - Amsel criteria; 3/4 of; -> Thin white/grey discharge -> pH >4.5 -> Whiff test; malodour with K hydroxide or on exam -> clue cells on microscopy Tx - Wear condoms - Avoid douching - Metronidazole 400mg BDD 7/7 OR Metronidazole 0.75% gel intravag 5/7 F/u - nil needed
75
Hep C risk factors
IVDU Incarceration Sexual partner of pt w/ Hep C Hep B or HIV infection Needlestick injury Tattoos / body piercings Blood/organ recipient before 1990
76
Hep C Ix
Hep C Ab; indicates prior or current infection HCV RNA; viral load = active infection HCV genotype - can guide antiviral therapy FBC U+E LFT INR bHCG Hep A/B + HIV serology Liver elastography FPG
77
Evaluate for fibrosis in chronic hep C
Fibroscan OR AST to platelet Ratio index (APRI) if <1.0 = exclude cirrhosis
78
Ix prior to tx chronic hep C
FBC/LFT/UE/eGFR/INR BHCG Fibrosis ax Liver USS to rule out HCC
79
Direct-acting antiviral regimen (DAAT) for hep C
Sofosbuvir Plus velpatasvir combination 12/52 course All pt with hep C can have this ADR; fatigue, headache, nausea, insomnia Repeat HCV RNA 12/52 after tx
80
Monitor of tx hep C DAAT
12/52 HCV RNA + LFT Annual RNA if risk factors for reinfection
81
Patient education hep C tx
Cure rate >90% with current treatment Minimise alcohol – abstinence in cirrhosis can still work in healthcare as long as she uses precautions Contraception whilst on antivirals PPI interact with antivirals
82
Cause of anogenital lumps
HPV Molluscum contagiosum HSV Syphilis IEC Fordyce spots Folliculitis Papillae
83
Causes of anogenital ulcers
HSV Syphilis Donovanosis Lymphogranuloma venreum Aphthous ulcer IEC Behcet syndrome Varicella zoster
84
Anorectal syndrome sx + mx
Sx; discharge, pain, fever, tenesmus Tx empirically - Doxycycline 100mg BD 21/7 PLUS ceftriaxone 500mg in 2ml 1% lignocaine IM PLUS valaciclovir 500mg BD 10/7
85
Cervicitis sx, Ix, mx
Sx; discharge, intermenstrual/postcoital bleed, irritation, pelvic pain Ix; PCR chlam/gon/M genitalium/T vaginalis via high PV swab Mx; tx for chlam + gonorrhoea
86
Urethritis Ix, mx
Ix; FPU PCR chlam/gon/M genitalium Mx - NGU likely; doxy 100mg BD 7/7 - Gon likely; ceftriaxone 500mg IMI 2ml 1% lignocaine PLUS azi 1g stat OR doxy 100mg BD 7/7
87
PID sx
PV discharge PV bleeding Fever, nausea, vomiting Dyspareunia Cervical motion tenderness
88
PID Ix
urine pregnancy Endocervical PCR chlam/gon/M genitalium Urinalysis
89
PID tx
Abx - Ceftriaxone 500mg 2ml 1% lignocaine - PLUS metro 400mg PO BD 14/7 - PLUS doxy 100mg BD 14/7 IUD - leave insitu if respond to tx within 72hr - otherwise remove Admission - Pregnant, intolerant to PO, severe, not responding to POAbx
90
Sexual assault mx
First aid Offer forensic evidence collection in ED Assess for strangulation HIV PoEP for 30 days Check HBsAb, HbcAb, HbsAg and offer vaccination to non=-immune or HBIG if assailant in known Hep B +ve Emergency contraception Psychosocial support Chlamydia/gonorrhoea swab at each orifice of penetration
91
EBV Ix, mx
Ix - Serology - Infectious mononucleosis monospot test - repeat after 1/52 Mx - No contact sports 4/52 - Avoid saliva contact with partner - Analgesia - Bed rest - Throat lozenges, prednisolone for severe throat pain - Avoid penicillin - Educate - may extend for 1 year
92
EBV prevention
Hand hygiene Avoid sharing cups Washing toys of children
93
EBV complications
Rash w/ penicillin Jaundice, hepatitis and liver failure Splenic rupture Encephalitis/meningitis Haemolytic anaemia GBS Chronic active EBV Burkitt Lymphoma
94
Head lice mx
Pyrethrin 0.165% + piperonyl butoxide 1.65% for 10min - repeat 1/52 Refractory; ivermectin 200mcg/kg stat dose - repeat 7/7
95
Staphylococcal scalded skin syndrome
Neonates/young children S aureus toxin Skin tenderness, erythema, desquamation Nikolsky sign; pressure exfoliates skin Fever Irritability Tx; IVF, Abx, analgesia
96
Eczema herpeticum
Dermatologist emergency Widespread HSV complicating skin disease like eczema Sx; fever, widespread HSV rash, severe morbidity/mortality Tx; swab HSV PCR, prompt oral antivirals, consider admission if moderate-severe sx and immunocompromised
97
Lyme disease
Borrelia species - tick bite Europe, North America Sx - erythema migrans -> disseminated disease, neuro/cardiac sx -> arthritis/encephalopathy/polyneuropathy Tx - Doxycycline 100mg BD
98
Scabies risk factors
RACF Prison Refugee camps ATSI remote Overcrowded hygiene
99
Scabies mx
Wash clothing 60C or place in bag for 8 days Vacuum house Permethrin 5% cream neck down - wash off after 8hrs - repeat in 1/52 - if central/northern Aus and infant/eldelry - apply to face and scalp Ivermectin 200mcg/kg stat dose and repeat in 7/7 - avoid if <5yo, pregnant, breast-feeding Steroid for itch
100
Tetanus prone wound
Compound fracture Bite Deep penetration Foreign bodies Pyogenic infection Burns Contaminated wounds w/ soil/dust
101
Tetanus prophylaxis indications
<5yrs since last dose - nil 5-10 yrs since last dose - give if dirty/major wound >10 years since last dose - give for all wounds If <3 doses tetanus or unknown hx - Give for clean minor wounds - All other wounds - vaccine + tetanus immunoglobulin
102
Herpes zoster mx
Antiviral - Indication; rash <72hrs, immunocompromised, HZ opthalmicus - Aciclovir 800mg (child 20mg/kg) 5x daily for 7/7 Pain; oxycodone, prednisolone 50mg 7/7, lidocaine 5% patch 12hrs (healed rash) Remove crusts with saline bath - apply vaseline and cover Avoid contact children, pregnant, immunocompromised Infective until lesions dry
103
Mx postherpetic neuralgia
TCA Pregabalin Topical capsaicin Lidocaine 5% patch Psychological
104
Cellulitis IVAbx indication
Two or more of; - T >38 - HR >90 - RR >20 - WCC >12x10 or <4x10
105
Erysipelas of S pyogenes cellulitis (non purulent, recurrent, spontaneous or rapidly growing)
Phenoxymethylpenicillin 500mg QID 5/7 (child 12.5mg/kg) - Non severe allergy; keflex 500mg QID 5/7 - Severe allergy; clindamycin 450mg TDS 5/7
106
Purulent cellulitis or S Aureus suspected
Flucloxacillin 500mg (child 12.5mg/kg) QID 5/7 - keflex in child as tasty - MRSA/allergy; bactrim 160_800mg BD 5/7
107
Water immersion for cellulitis
Doxy + fluclox
108
Spinal epidural abscess Ix
MRI + contrast 2x BC Aspiration for culture Mx - vancomycin, cephalosporin together for 8/52
109
Empirical tx acute infectious diarrhoea
Ciprofloxacin 500mg BD 3/7
110
Campylobacter enteritis mx
Conservative Abx; if severe, 3rd trim preg, infants, frail, immunocompromised Ciprofloxacin 500mg BD 3/7
111
C difficile mx
Metronidazole 400mg TDS 10/7
112
Giardiasis mx
Metronidazole 400mg TDS 5/7 (child 10mg/kg)
113
Ddx of cystitis sx with negative culture
Urethritis STD Cervicitis Atrophic vaginitis Lichen sclerosis Stones Bladder cancer Endometriosis
114
Acute cystitis mx
Non-pregnant women - trimethoprim 300mg 3/7 Pregnancy - Nitrofurantoin 100mg QID 5/7 Men - Trimethoprim 300mg 7/7 Children - Bactrim 4+20mg/kg BD 3/7 (10/7 if systemic features / pyelo)
115
Recurrent UTI mx
Trimethoprim 150mg nocte 6/12 Topical vaginal oestrogen for postmenopausal women Methenamine hippurate; good for UTI abnormalities or neuropathic bladder
116
Typhoid vaccine
Indication; travellers >=2yo to endemic region, lab workers who work with Salmonella typhi, military Endemic region; Africa, Central/South America, Middle East, East/South Asia ViCPS injection 1 dose 2 weeks prior to travel - booster every 2 years
117
Yellow fever vaccine
>=9mo travelling to risk area Booster if last dose >10 years ago
118
Prevention of altitude illness
Medication - Acetazolamide 250mg Slow ascent; 500m ascent per day once higher than 3km Spend >=2 nights at each location
119
Clinical conditions of high altitude
High-altitude headache; tx with NSAID High-altitude cerebral oedema; develops 24-36hrs post arrival -> impaired mental state, ataxia!!! -> tx with immediate reduction in altitude, oxygen, IV dexamethasone High-altitude pulmonary oedema Acute mountain sickness; nausea, vomiting, weakness, headache
120
Rash in returned travellers ddx
Dengue Measles HIV Rickettsial infection Ross River virus Barmah forest virus Typhoid
121
Fever in traveller history
Location Timing - seasons Exposure - Animals - Insect bites - Water / food - Activities; sex, tattoos, drug - Sick contacts Immunisation hx Prophylaxis used - medications - mosquito nets Sx onset and duration Healthcare received overseas
122
Malaria sx
Fever - paroxysms at irregular intervals Malaise Nausea/vomiting/diarrhoea abdo pain myalgia anaemia
123
Malaria prevention
Doxycycline 100mg 1-2 prior to entry and for 4/52 after leaving Insect repellent Bed netting Long clothes Avoid dusk/dawn Avoid perfume/aftershave
124
Typhoid fever
Salmonella typhi via contaminated water/food of faeces from humans Dx; stepladder fever PLUS abdo pain PLUS relative bradycardia Sx - headache, dry cough, fever that increases in stepladder manner over 4 days, abdo pain, diarrhoea (pea soup) - Rash - rose spots - Splenomegaly Mx - Azithromycin 1g 7/7
125
Empirical mx of traveller's diarrhoea
Azithromycin 1g stat dose
126
Pre-travel advice
Insurance Food/drink precautions First aid kit Avoid sex/tattoos Insect avoidance / prophylaxis Avoid swimming in fresh water Hand hygiene

Infectious disease and Travel medicine (1 decks)

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