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Year 3 Infection > Infection > Flashcards

Infection Flashcards

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
Q

What is the diagnostic test for conjuctivitis?

A

Rapid adenovirus immunoassay

Tear fluid sample

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26
Q

What is the management for allergic conjunctivitis?

A

first-line: topical or systemic antihistamines

second-line: topical mast-cell stabilisers, e.g. Sodium cromoglicate and nedocromil

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27
Q

What is the management for infective conjunctivitis?

A

Usually self-limiting
Topical ABs e.g. chloramphenicol drops or fusidic acid
Do not wear contact lenses

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28
Q

Define COVID-19

A

potentially severe acute respiratory infection caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

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29
Q

What are the presenting features of COVID infection?

A 
Respiratory infection:
Fever
Cough
Dyspnoea
Loss of taste/smell

Complications:
Multi-organ failure
Septic shock
Venous thromboembolism

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30
Q

What investigations are done for COVID?

A

real-time reverse transcription PCR

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31
Q

What is the management for mild covid?

A

Home isolation
Monitoring
Supportive care
Anti-pyretic/analgesia

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32
Q

What is the management for severe covid?

A 
Admission
O2 therapy
VTE prophylaxis 
ABs
Anti-viral
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33
Q

What is the management for critical covid?

A 
ITU
High flow nasal O2 or NIV
Manage sepsis
Corticosteroid
IL-6 inhibitors
JAK inhibitor
Palliative?
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34
Q

What is the classic clinical presentation of herpes simplex virus infection?

A

Vesicles progressing to painful ulcers

But is unusual

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35
Q

What are symptoms of oral herpes?

A

Tingling/burning
Vesicular to ulcerative lesions
Oropharynx and perioral mucosa
HSV-1

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36
Q

What causes genital herpes?

A

HSV-1

HSV-2

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37
Q

What are RFs for HSV infection?

A

HIV
Immunosuppressive medications
High-risk sexual behaviour

38
Q

What investigations are ordered in HSV infection?

A 
HSV PCR
Viral culture (swab ulcer/vessicles)
39
Q

What is the treatment for cold sores in HSV infection?

A

Topical aciclovir

40
Q

What is the treatment for genital herpes?

A

Oral aciclovir

41
Q

What is advised to pregnant women with herpes infection?

A

Elective C-section at term if HSV infection is after 28 weeks

Women with recurrent herpes should be treated with suppressive therapy

42
Q

Define HIV

A

retrovirus that infects and replicates in human lymphocytes and macrophages, eroding the integrity of the human immune system

43
Q

What are RFs for HIV?

A

Blood transfusion
IV drug use
Unprotected sex
Needle prick injury

44
Q

What are some presenting features of HIV?

A 
FLAWS
Rashes
Ulcers
Diarrhoea
Mental state changes
TB
STIs
Shingles
45
Q

What investigations confirm HIV infection?

A

HIV ELISA
Serum HIV rapid test
Serum Western blot

46
Q

What is the management for newly confirmed HIV?

A

Anti-retroviral therapy
3x drugs usually:
2x Nucleoside reverse transcriptase inhbitor
1x Protease inhibitor

Reduces risk of viral resistance and replication

47
Q

What is PEP?

A

Post-exposure prophylaxis is the administration of antiretroviral therapy to HIV-negative people who may have been occupationally or sexually exposed to HIV

48
Q

Give an example of a nucleoside reverse transcriptase inhibitor

A

Zidovudine

49
Q

Give an example of a protease inhibitor

A

Darunivir

50
Q

Give an example of a non-nucleoside reverse transcriptase inhibitor

A

Nevirapine

51
Q

What are some lower respiratory tract infections?

A

Bronchitis
Bronchiolitis
Chest infection
Pneumonia

52
Q

What are some upper respiratory tract infections?

A

Common cold
Sinusitis
Tonsilitis
Laryngitis

53
Q

Define bronchiolitis

A

Viral bronchiolitis is an acute viral infection of the lower respiratory tract
Most common in infants caused by RSV

54
Q

Define tonsilitis

A

nflammation of the tonsils; specifically it is an infection of the parenchyma of the palatine tonsils

55
Q

What are the presenting features of tonsolitis?

A

Pain on swelling
Fever > 38
Tonsillar exudate

56
Q

What investigations are done for tonsillitis?

A

Throat culuture

Rapid streptococcal antigen test

57
Q

What is the management for tonsillitis not due to strep infection?

A

Analgesia

58
Q

What is the management for tonsillitis due to strep infection?

A

Analgesia
ABs
Corticosteroids

59
Q

What is the management for recurrent tonsillitis?

A

Tonsillectomy if 5 or more episodes a year
At least a year
Symptoms are disabling

60
Q

What should a doctor do if a notifiable disease is suspected in your healthcare setting?

A

Statutory duty to notify the local health protection team
Complete notification form on govt website
List of disease found here too

61
Q

What is varicella-zoster?

A

Chicken pox

Human alpha herpes virus

62
Q

What are the presenting features of varicella-zoster infection?

A 
Fever
Malaise
Generalised pruritic rash 
Vesicular rash 
Usually self-limiting
63
Q

How is varicella-zoster diagnosed?

A

Clinically

Can do PCR/Viral culture

64
Q

What is the treatment for children with increased risk?

A

Oral antivrial
Aciclovir

Increased risks include atopic dermiatitis, pulmonary disease or on corticosteroids

65
Q

How can chickenpox be caught?

A

spread via the respiratory route

can be caught from someone with shingles

66
Q

What is supportive management for chickenpox?

A

Keep cool
Trim nails
Calamine lotion
School exclusion

67
Q

What is shingles?

A

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
Q

Who is eligible for a primary (chickenpox) varicella infection?

A

Healthcare workers not already immune

Contacts of immunocompromised pts

69
Q

Who is offered a shingles vaccine?

A

70-79 year olds

70
Q

What are the features of shingles?

A 
Prodromal period:
Burning pain over affected dermatome
Fever
Headache
Lethargy
Rash
71
Q

What are the features of rash in shingles?

A

Erythematous, macular initially
Becomes vesicular
Dermatomal

72
Q

What is the management of shingles?

A

Remind they are potentially infectious need to avoid pregnancy and immunocompromised

Analgesia - paracetamol and NSAIDS
Antivirals - aciclovir

73
Q

What can a maculopapular rash also be known as?

A

Exanthem

Morbilliform eruption

74
Q

What can cause viral exanthema?

A 
Enterovirus
Echovirus 
EBV
Rubella
Acute Hep B/C infection
Ebola
Zika
Dengue
75
Q

What is viral exanthem?

A

non-specific viral rash caused by a viral infection

76
Q

How does viral exanthem present?

A 
Widespread rash
Pink-red spots or bumps 
Primarily trunk, arms and legs
May or may not be itchy
Might have systemic symptoms
77
Q

Define viral gastroenteritis

A

acute inflammation of the lining of the stomach and intestines caused by enteropathogenic viruses

78
Q

What is the typical presentation of viral gastroenteritis?

A 
Increased defacation frequency <14 days
Nausea
Vomiting
Anorexia
Abdominal cramps
Fever
79
Q

What are some RFs for viral gastroenteritis?

A

Exposure to contaminated food or water sources
Close contact with infected people
Poor hygeine
HIV

80
Q

What viruses are most commonly associated with gastroenteritis?

A

Norovirus
Sapovirus
Rotavirus

81
Q

How can you diagnose viral gastroenteritis?

A

Clinical history

Stool viral PCR

82
Q

What is the management for viral gastroenteritis?

A

Self-limiting so supportive
Hydration
Correct electrolyte imbalances

83
Q

Define peri-orbital cellulitis

A

Inflammation and infection of the superficial eyelid
Confined to soft-tissue layers
Occular function remains intact

84
Q

Define orbital cellulitis

A

Infection within the orbital soft tissues with associated ocular dysfunction and is usually due to underlying bacterial sinusitis

Serious and warrants hospital admission

85
Q

What are some presenting features of peri/orbital cellulitis?

A 
Redness and swelling of the eye
Ocular pain
Decreased vision
Eyelid oedema
Exopthalmos
86
Q

What are some RFs for peri/orbital cellulitis?

A

Sinusitis
Young age
Male sex
Lack of Hib vaccine

87
Q

How do you diagnose peri/orbital cellulitis?

A

Clinical examination
CT sinus and orbits with contrast
WCC

88
Q

What is the management for orbital cellulitis?

A

Hospitalisation for IV ABs

89
Q

What are night sweats?

A

Profuse sweating at night soaking the bed despite cool environement

90
Q

What causes night sweats?

A 
Menopause
Anxiety
Medications
Hypoglycaemia
Alcohol/Drug use
Malignancy

Year 3 Infection (3 decks)

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