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Infection conditions Flashcards

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1
Q

What symptoms will someone with meningitis classically present with?

A 
Headache 
Neck stiffness 
Photophobia
Confusion
Fever
Lethargy
Drowsiness
Lack of appetite
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2
Q

Who is more at risk of meningitis? Why?

A 
Old people (over 60)
Young people (under 2) 
Due to immune system compromise
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3
Q

What are the first line investigations you should do if you suspect someone has meningitis? Explain why they are done

A

Bloods: FBC, PCR meningitis screen, WCC
Lumbar puncture- don’t do this if someone is hypotensive or has raised ICP
Venous blood gas- to check for lactate to see if they are septic

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4
Q

How is meningitis managed?

A

Hospitalise the patient and give antibiotics
Supportive treatment eg IV fluids, oxygen
Possibly give corticosteroids but not if they are under 3

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5
Q

What are other names for infectious mononucleosis?

A

Glandular fever, EBV (epstein barr virus), kissing disease, mono

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6
Q

What symptoms will some with glandular fever present with?

A 
Sore throat
Fever
Swollen tonsils 
White exudate on tonsils
Chills
Sweats 
Rash- may be macropapular after treatment with amoxicillin 
Splenomegaly
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7
Q

What age group is glandular fever common in?

A

15-24 years old

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8
Q

How is glandular fever spread?

A

Via contact or sexual contact eg kissing, sharing utensils/ food and drink

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9
Q

What is the first line investigation for glandular fever? What will they show to confirm diagnosis

A

Bloods- check FBC (WCC- lymphocytes will make up more than 50% total or there will be 10-20% that are atypical)
Monospot test

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10
Q

What symptoms will someone with herpes simplex virus classically present with?

A 
Oral/ mouth/ genital ulcers
Lymphadenopathy
Fever
Malaise 
Dysuria in women
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11
Q

What is the first line investigation for herpes simplex virus?

A

Viral screen or PCR (done by taking a swab)

Ideally done in a GUM clinic

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12
Q

How is herpes simplex virus infection managed?

A

First line antibiotics:
Start them as as soon as possible
Aciclovir, if not valciclovir or famciclovir
200mg 5 times daily
If they have neurological symptoms admit them and give these abx via IV
Topical lidocaine can be given to reduce pain from ulcers
The antibiotics will be needed again when they have flare ups

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13
Q

Who is more at risk of herpes simplex virus infection?

A

Immunocompromised patients
Those who have HIV
Those who undertake high risk sexual behaviour

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14
Q

What are the main strains of herpes simplex virus? Describe how they are transmitted and how they differ in terms of symptoms etc

A

HSV1- transmitted through vaginal or anal intercourse

HSV2- transmitted through oro-genital sex, is usually more severe in terms of number of flare ups after first exposure

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15
Q

How is herpes simplex virus transmitted? What are some things it is important to tell the patient?

A

It is transmitted via shedding- this can be though lesions or mucosal surfaces
The person will always have the virus so they should know they can transmit it if they have sex- for advice on how to not transmit tell them this is possible with correct use of condoms however they can still spread it during foreplay or from other mucosal linings and lesions so the condoms won;t prevent transmission completely

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16
Q

What symptoms will someone with oral candida classically present with?

A

White/ creamy/ yellow plaques on the mucosal surfaces of their mouth
Lesions anywhere in the mouth
Burning oral pain

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17
Q

What is the first line investigation for oral candidiasis?

A

None, diagnosis is clinical and after examination

Swabs are not useful and most people have candidiasis in their mouth already

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18
Q

How is oral candidiasis managed?

A

Topical antifungals first line eg miconazole
If severe or genital then oral flucazone
They may also need topical corticosteroids if particularly complicated

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19
Q

What is gangrene?

A

A complication of necrosis

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20
Q

What are the 2 types of gangrene?

A

Ischaemic and infectious

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21
Q

What is wet gangrene?

A

Infectious gangrene

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22
Q

What is dry gangrene?

A

Ischaemic gangrene

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23
Q

What are the 2 types of infectious gangrene?

A

Gas gangrene

Necrotising fasciitis

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24
Q

Why does ischaemic gangrene arise?

A

Due to compromised arterial or venous supply

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25
What symptoms will someone with gangrene present with?
A painful joint/area- if the pain is acute then it suggests infectious gangrene Crepitus may be heard on light palpation if there is gas gangrene (crunching or crackling noises) Oedema Heaviness of the joint
26
Who is more likely to get gangrene?
``` Diabetes mellitus Alcohol misuse Athersclerosis Malignancy Long term smokers Renal disease ```
27
What investigations would you do if you suspect gangrene? What will you expect to see
Full set of bloods- LFTs, U+Es, FBC (look for leukocytosis and anaemia) Blood culture- look for infectious organism Metabolic profile- look for acidosis etc CRP- raised X ray of joint- high specificity for gas gangrene but will not usually be visible on admission CT- look for abcess/ oedema etc
28
How is gangrene managed?
IV antibiotics (vancomycin plus one more), surgical debridement (completely remove the necrotic area and the incision should extend past it)
29
What are some complications of gangrene?
``` Amputation Haemolysis Shock Sepsis DIC Acute renal failure ```
30
What sign might you see in ischaemic gangrene due to arterial insufficiency?
Diminished pulses
31
What is influenza infection?
An acute respiratory infection
32
What respiratory tracts does influenza affect?
Both upper and lower
33
What symptoms will someone with influenza classically present with?
``` Runny nose Cough Sore throat Fever Malaise May have some GI symptoms May have some ocular symptoms eg lacrimation, pain on eye movement ```
34
Who is more likely to get infleunza?
``` Overall more likely in the winter season Immunocompromised people Chronic kidney disease Pregnant women Those with longstanding cardiovascular and respiratory conditions Those with diabetes Those who aren't vaccinated ```
35
What is the first line investigation for influenza? What would you expect to see?
None, diagnosis is usually clinical If you want to confirm the agent or believe they are at risk of developing complications you can do a viral culture or rapid test
36
How is influenza managed?
Usually management is not needed- just tell the patient to drink lots of water, rest and take antipyretics if needed If you believe they are at risk of developing complications give them antivirals- most commonly oral oseltamivir
37
What are some complications of influenza
``` Bacterial pneumonia (when caused by bacteria) Otitis media ```
38
How many strains of influenza are there and what are they called?
2- they are called influenza A and B
39
What is infectious mononucleosis?
An infection most often by the epstein barr virus
40
What are some other names for infectious mononucleosis?
``` EBV Epstein barr virus Infectious mono Glandular fever Kissing disease ```
41
What will someone with infectious mononucleosis classically present with?
``` Sore throat Enlarged lymph nodes Fever White exudate on tonsils Malaise Fatigue Macropapular rash (after treatment with amoxicillin) Splenomegaly ```
42
Who is more likely to get infectious mononucleosis?
Young adults and teenagers
43
What is the first line investigation for infectious mononucleosis? What would you expect to see
If they are under 12 or immunocompromised and have been ill for 7 days then first line viral serology If they are above 12 and not immunocompromised then first line bloods- you will see high WCC with more than 50% of white cells being lymphocytes (they may possibly also be abnormal). Then also do a monospot test in the 2nd week of illness
44
What will you see specifically in bloods in someone with infectious mononucleosis?
Raised WCC | More than 50% of them will be lymphocytes and may be abnormal
45
How is infectious mononucleosis managed?
Symptomatic relief with paracetamol | If they deteriorate eg resp rate is high, they are unable to swallow increasing risk of dehydration then admit them
46
What 2 things must you advise those with infectious mononucleosis to do?
1) don't lift heavy weights to reduce risk of splenic rupture 2) avoid spreading by not sharing utensils/food and not kissing etc (spreads via saliva)
47
What are some complications of infectious mononucleosis?
Splenic rupture | Dehydration
48
How might older patients with infectious mono present?
Atypically- they may be jaundiced, there may not be a sore throat etc
49
After what with you see a macropapular rash in someone with infectious mono?
After the use of amoxicillin
50
What symptoms will someone with HIV classically present with?
``` Flu like symptoms- sore throat, fever, malaise, myalgia, lymphadenopathy Pyrexia Weight loss Night sweats Shingles Oral candidiasis Oral, genital or perianal ulcers (apthous ulcers in the mouth) Macropapular rash ```
51
Who is more likely to get HIV?
Needle sharing IV drug use High risk sexual behaviour Receptive anal sex Receptive penile vaginal sexual intercourse Percutaneous needle stick injury Those who live in sub saharan or southern africa
52
What are the first line investigations for HIV? What would you see?
``` HIV ELISA (enzyme linked immunosorbant assay) HIV rapid test ``` Do baseline FBC, serum electrolytes, urinalysis, creatinine and monitor these with treatment
53
How is HIV managed?
First line ART (anti retroviral therapy)- this stops the virus replicating Refer them to an HIV clinically for the next 48 hrs- 2 weeks and they can go home if they aren't clinically unwell ART regimen: 3 drugs 2 x NRTI (nucleoside reverse transcriptase inhibitors)- most commonly tenofovir and emitricitabine 1 x NNRTI or INI or PI (non nucleoside... or integrase inhibitor or boosted protease inhibitor)
54
What 2 tests are done to monitor HIV? What do they show
Viral load- shows how much virus is in the blood | CD4 count- shows how much HIV is suppressing the immune system
55
What symptoms might you get in HIV initially due to immunosupression?
Shingles | Oral candidiasis
56
What illnesses is HIV associated with?
``` PCP (pneumocystic pneumonia) Kaposi's sarcoma Lymphoma Bacterial LRTI Tuberculosis ```
57
What are some complications of HIV?
Everything- it increases risk of disease to most systems, cancer, diabetes, infections etc etc
58
What classes of drugs are used for HIV?
Antiretroviral therapy which includes: 2 x NRTI (nucleoside reverse transcriptase inhibitors)- most commonly tenofovir and emitricitabine 1 x NNRTI or INI or PI (non nucleoside... or integrase inhibitor or boosted protease inhibitor)
59
What symptoms will someone with with tuberculosis classically present with?
Chronic cough- initially dry and later productive Anorexia Weight loss Low grade fever- not as common in older people Malaise Night sweats
60
Who is more likely to get TB?
``` Those born in an endemic country HIV Immunosupressive medication Silicosis Malignancy ```
61
What is the first line investigation for tuberculosis? What would you see?
Chest x ray- you would see cavitation, pleural effusion and lymphadenopathy in the upper lobes Sputum pot- for culture and microscopy if chest x ray supports pathology
62
How is tuberculosis managed?
4 abx first line: RIPE rifampicin and isonizide for 6 months first 2 months pyrazinamide and ethambutol Give vitamin B6 supplements as isonazide will reduce levels
63
Why does TB mostly affect the upper lung lobes most?
It is an aerobic bacteria and the upper lobes are most well perfused so have the most oxygen
64
What must you warn patients with TB when prescribing them antibiotics for treatment?
Their urine will turn orange | The OCP will be less effective so they should use condoms or other contraception
65
What is encephalitis?
Inflammation of the brain parenchyma
66
What symptoms will someone with encephalitis classically present with?
Neurological dysfunction- paresis, abulia, paralysis, cognitive decline Fever Rash Altered mental state Seizures May have a cough and a GI infection to precede
67
Who is more likely to get encephalitis?
``` Those who have a viral infection Immunodeficiency Under 1 Over 65 Organ transplant ```
68
What are some investigations for encephalitis? What might you see?
``` CT head Lumbar puncture FBC- WCC raised Serum electrolytes- hyponatraemia LFTs- raised EEG ```
69
What are some common viruses that cause encephalitis?
Herpes simplex virus Enterovirus (causes GI infection) Varicella zoster virus
70
How is encephalitis managed?
First line IV aciclovir | Supportive treatment eg mechanical ventilation, ulcer therapy, DVT prophylaxis, electrolytes etc
71
What are some complications of encephalitis?
Seizure Death Neurological deficit

Year 3 (104 decks)

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