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Year 3 Infection > Infection > Flashcards

Infection Flashcards

(90 cards)

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1
Q

What is Cellulitis?

A

Inflammation of the skin and subcutaneous tissues, typically due to infection by Streptococcus pyogenes or Staphylcoccus aureus

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2
Q

What are the main presenting features of cellulitis?

A 
Shins
Erythema
Pain
Swelling
Systemic e.g. fever
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3
Q

How is cellulitis diagnosed?

A

Clinically

Bloods + culture might be requested if septicaemia is suspected

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4
Q

When would you consider admitting a patients with cellulitis?

A 
Significant systemic upset
Unstable co-morbidities 
Limb threatening infection (vascular compromise) 
Sepsis
Necrotising fasciitis
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5
Q

What is the first line treatment for mild/moderate cellulitis?

A

Flucloxacillin

Clarithromycin if allergic

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6
Q

What is the first line treatment for severe cellulitis?

A

Co-amoxiclav
Cefuroxime
Clindamycin

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7
Q

What are some RFs for cellulitis?

A

Breaks in skin e.g.
Eczema
Leg ulcers

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8
Q

What do you look for in someone presenting fever unrelated to travel?

A 
CAP, UTI, Cellulitis
VIral
Infective endocarditis 
Osteomyelitis
Abscess
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9
Q

What are causes of fever in the returning traveller?

A

Viral (Dengue)
Bacterial (Salmonella, typhi/paratyhi)
Parasites (Malaria)

Respiratory (COVID, Flu,)
GI/GU (Schistosomiasis)

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10
Q

What should you consider when trying to diagnose fever in a returning traveller?

A

Location of travel
Incubation period
Exposures e.g. bites/sexual contact/contaminate food water

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11
Q

What are differentials for a non-infective fever?

A

Immunological inflammatory e.g. SLE, Vasculitis

Malignancy

Endocrinology e.g. thyrotoxicosis, adrenal insufficiency

Metabolic e.g. gout

Tissue destruction e.g. rhabdomyolysis

Misc e.g. drug induced, incompatible transfusion

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12
Q

What blood smears can be used to identify plasmodium falciparum?

A

Giesma stain thick/thing smears

Also can use rapid diagnostic tests

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13
Q

What is the management of malaria?

A

Admission and infectious disease specialist

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14
Q

What would be the aims of treatment of infections?

A
  • eradicate infection
  • reduce risk of complications
  • avoid selecting resistance by using multiple agents
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15
Q

What is complicated malaria?

A

Organ failure

Needs admission for IV fluid treatment

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16
Q

What is the management for complicated falciparum malaria?

A

IV artesunate
Strict fluid balance
Involve ITU early

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17
Q

What is the management for non-complicated falciparum malaria?

A

Artemether with lumefantrine for 3 days

OR

Artenimol with piperquine phosopate

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18
Q

What is the management for non-complicated non-falciparum malaria?

A

Artemether with lumefantrine for 3 days

14 day course of primaquine to prevent relapse

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19
Q

What should you consider before prescribing quinines?

A

Think about G6PD deficiency

Common in west africa

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20
Q

How is malaria monitored?

A

Daily blood films until parasites are undertaken until parasite no longer detected

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21
Q

What are features of severe malaria?

A 
schizonts on a blood film
parasitaemia > 2%
hypoglycaemia
acidosis
temperature > 39 °C
severe anaemia
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22
Q

What are potential complications of malaria?

A

cerebral malaria: seizures, coma
acute renal failure
acute respiratory distress syndrome (ARDS)
hypoglycaemia
disseminated intravascular coagulation (DIC)

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23
Q

What are the symptoms of acute conjunctivitis?

A

Irritated red eye
Watery or purulent discharge
Mucoid discharge
Swollen eyelids

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24
Q

What causes conjuctivitis?

A 
Allergy
Bacterial/Viral infection
Mechanical stress
Irritation by toxic chemicals or medication
Exposure to infected person
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25
What is the diagnostic test for conjuctivitis?
Rapid adenovirus immunoassay | Tear fluid sample
26
What is the management for allergic conjunctivitis?
first-line: topical or systemic antihistamines second-line: topical mast-cell stabilisers, e.g. Sodium cromoglicate and nedocromil
27
What is the management for infective conjunctivitis?
Usually self-limiting Topical ABs e.g. chloramphenicol drops or fusidic acid Do not wear contact lenses
28
Define COVID-19
potentially severe acute respiratory infection caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
29
What are the presenting features of COVID infection?
``` Respiratory infection: Fever Cough Dyspnoea Loss of taste/smell ``` Complications: Multi-organ failure Septic shock Venous thromboembolism
30
What investigations are done for COVID?
real-time reverse transcription PCR
31
What is the management for mild covid?
Home isolation Monitoring Supportive care Anti-pyretic/analgesia
32
What is the management for severe covid?
``` Admission O2 therapy VTE prophylaxis ABs Anti-viral ```
33
What is the management for critical covid?
``` ITU High flow nasal O2 or NIV Manage sepsis Corticosteroid IL-6 inhibitors JAK inhibitor Palliative? ```
34
What is the classic clinical presentation of herpes simplex virus infection?
Vesicles progressing to painful ulcers | But is unusual
35
What are symptoms of oral herpes?
Tingling/burning Vesicular to ulcerative lesions Oropharynx and perioral mucosa HSV-1
36
What causes genital herpes?
HSV-1 | HSV-2
37
What are RFs for HSV infection?
HIV Immunosuppressive medications High-risk sexual behaviour
38
What investigations are ordered in HSV infection?
``` HSV PCR Viral culture (swab ulcer/vessicles) ```
39
What is the treatment for cold sores in HSV infection?
Topical aciclovir
40
What is the treatment for genital herpes?
Oral aciclovir
41
What is advised to pregnant women with herpes infection?
Elective C-section at term if HSV infection is after 28 weeks Women with recurrent herpes should be treated with suppressive therapy
42
Define HIV
retrovirus that infects and replicates in human lymphocytes and macrophages, eroding the integrity of the human immune system
43
What are RFs for HIV?
Blood transfusion IV drug use Unprotected sex Needle prick injury
44
What are some presenting features of HIV?
``` FLAWS Rashes Ulcers Diarrhoea Mental state changes TB STIs Shingles ```
45
What investigations confirm HIV infection?
HIV ELISA Serum HIV rapid test Serum Western blot
46
What is the management for newly confirmed HIV?
Anti-retroviral therapy 3x drugs usually: 2x Nucleoside reverse transcriptase inhbitor 1x Protease inhibitor Reduces risk of viral resistance and replication
47
What is PEP?
Post-exposure prophylaxis is the administration of antiretroviral therapy to HIV-negative people who may have been occupationally or sexually exposed to HIV
48
Give an example of a nucleoside reverse transcriptase inhibitor
Zidovudine
49
Give an example of a protease inhibitor
Darunivir
50
Give an example of a non-nucleoside reverse transcriptase inhibitor
Nevirapine
51
What are some lower respiratory tract infections?
Bronchitis Bronchiolitis Chest infection Pneumonia
52
What are some upper respiratory tract infections?
Common cold Sinusitis Tonsilitis Laryngitis
53
Define bronchiolitis
Viral bronchiolitis is an acute viral infection of the lower respiratory tract Most common in infants caused by RSV
54
Define tonsilitis
nflammation of the tonsils; specifically it is an infection of the parenchyma of the palatine tonsils
55
What are the presenting features of tonsolitis?
Pain on swelling Fever > 38 Tonsillar exudate
56
What investigations are done for tonsillitis?
Throat culuture | Rapid streptococcal antigen test
57
What is the management for tonsillitis not due to strep infection?
Analgesia
58
What is the management for tonsillitis due to strep infection?
Analgesia ABs Corticosteroids
59
What is the management for recurrent tonsillitis?
Tonsillectomy if 5 or more episodes a year At least a year Symptoms are disabling
60
What should a doctor do if a notifiable disease is suspected in your healthcare setting?
Statutory duty to notify the local health protection team Complete notification form on govt website List of disease found here too
61
What is varicella-zoster?
Chicken pox | Human alpha herpes virus
62
What are the presenting features of varicella-zoster infection?
``` Fever Malaise Generalised pruritic rash Vesicular rash Usually self-limiting ```
63
How is varicella-zoster diagnosed?
Clinically | Can do PCR/Viral culture
64
What is the treatment for children with increased risk?
Oral antivrial Aciclovir Increased risks include atopic dermiatitis, pulmonary disease or on corticosteroids
65
How can chickenpox be caught?
spread via the respiratory route | can be caught from someone with shingles
66
What is supportive management for chickenpox?
Keep cool Trim nails Calamine lotion School exclusion
67
What is shingles?
acute, unilateral, painful blistering rash caused by reactivation of the varicella-zoster virus dermatomal as virus lies dormant in dorsal root ganglion or cranial nerve ganglia
68
Who is eligible for a primary (chickenpox) varicella infection?
Healthcare workers not already immune | Contacts of immunocompromised pts
69
Who is offered a shingles vaccine?
70-79 year olds
70
What are the features of shingles?
``` Prodromal period: Burning pain over affected dermatome Fever Headache Lethargy Rash ```
71
What are the features of rash in shingles?
Erythematous, macular initially Becomes vesicular Dermatomal
72
What is the management of shingles?
Remind they are potentially infectious need to avoid pregnancy and immunocompromised Analgesia - paracetamol and NSAIDS Antivirals - aciclovir
73
What can a maculopapular rash also be known as?
Exanthem | Morbilliform eruption
74
What can cause viral exanthema?
``` Enterovirus Echovirus EBV Rubella Acute Hep B/C infection Ebola Zika Dengue ```
75
What is viral exanthem?
non-specific viral rash caused by a viral infection
76
How does viral exanthem present?
``` Widespread rash Pink-red spots or bumps Primarily trunk, arms and legs May or may not be itchy Might have systemic symptoms ```
77
Define viral gastroenteritis
acute inflammation of the lining of the stomach and intestines caused by enteropathogenic viruses
78
What is the typical presentation of viral gastroenteritis?
``` Increased defacation frequency <14 days Nausea Vomiting Anorexia Abdominal cramps Fever ```
79
What are some RFs for viral gastroenteritis?
Exposure to contaminated food or water sources Close contact with infected people Poor hygeine HIV
80
What viruses are most commonly associated with gastroenteritis?
Norovirus Sapovirus Rotavirus
81
How can you diagnose viral gastroenteritis?
Clinical history | Stool viral PCR
82
What is the management for viral gastroenteritis?
Self-limiting so supportive Hydration Correct electrolyte imbalances
83
Define peri-orbital cellulitis
Inflammation and infection of the superficial eyelid Confined to soft-tissue layers Occular function remains intact
84
Define orbital cellulitis
Infection within the orbital soft tissues with associated ocular dysfunction and is usually due to underlying bacterial sinusitis Serious and warrants hospital admission
85
What are some presenting features of peri/orbital cellulitis?
``` Redness and swelling of the eye Ocular pain Decreased vision Eyelid oedema Exopthalmos ```
86
What are some RFs for peri/orbital cellulitis?
Sinusitis Young age Male sex Lack of Hib vaccine
87
How do you diagnose peri/orbital cellulitis?
Clinical examination CT sinus and orbits with contrast WCC
88
What is the management for orbital cellulitis?
Hospitalisation for IV ABs
89
What are night sweats?
Profuse sweating at night soaking the bed despite cool environement
90
What causes night sweats?
``` Menopause Anxiety Medications Hypoglycaemia Alcohol/Drug use Malignancy ```

Year 3 Infection (3 decks)

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