Emergency medicine: Infection

Question 1

What are the symptoms of cellulitis and how may you differentiate from DVT clinically?

Answer 1

• Acute onset swelling of leg
• Severe pain
• Red, shiny, inflamed
• oedematous - blends with rest of leg, makes border indiscriminate
• U/L (usually)
• Fever, rigors, malaise and nausea* typically present in cellulitis not DVT

Question 2

What is the classification system for cellulitis? When would you admit a patient

Answer 2

Eron

- grade ≥ 3 = admission

Question 3

What are the primary antibiotic management of cellulitis?

Answer 3

1. phenoxymethylpenicillin + high dose flucloxacillin

2. Clarith/clind/vanc if pen allergic

Question 4

What is the common causes of tonsillitis?

Answer 4

Viral (common) - EBV, HSV1, adenovirus

Bacterial (rare) - Group A B-haemolytic strep

Question 5

What is the system used to determine risk of bacterial tonsillitis?

Answer 5

Centor criteria:

1. Fever > 38
2. White exudate on tonsils or swelling
3. Cervical lymphadenopathy
4. Cough absent
5. Age 3-14 (1), ≥ 45 (-1)

Question 6

What is the treatment for bacterial tonsillitis?

Answer 6

Benzylpenicillin (1st line)

Clarithromycin (if pen allergic)

Question 7

What are the symptoms of acute OM?

Answer 7

Presents at 6-12 months usually

• Painful ear
• Red, bright bulging tympanic membrane
• Loss of light reflex
• Pain subsides when TM bursts –> effusion
• Fever and irritable

Question 8

What are the symptoms of chronic secretory OM?

Answer 8

Presents at 2-7yo

• no pain
• chronic effusion
• appears inattentive
• often does badly in school (mistaken)
• Dull retracted and opaque tympanic membrane

Question 9

What is the treatment for OM?

Answer 9

1. Analgesia and temperature
   - Paracetamol
2. Antibiotics
   - Amoxicillin or Co-amoxiclav
3. Tympanostomy tubes