Infectious diz Flashcards by amany soliman

Fever initially
Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
Systemic upset is usually mild

Chickenpox

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Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots (‘grain of salt’) on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy &confluent

Measles

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Fever, malaise, muscular pain

Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%

Mumps

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Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular

Rubella

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Caused by parvovirus B19
Lethargy, fever, headache
‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces

Erythema infectiosum

Also known as fifth disease or ‘slapped-cheek syndrome’

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Fever, malaise, tonsillitis
‘Strawberry’ tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)

Scarlet fever

Reaction to erythrogenic toxins produced by Group A haemolytic streptococci

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Mild systemic upset: sore throat, fever

Vesicles in the mouth and on the palms and soles of the feet

Hand, foot and mouth disease

Caused by the coxsackie A16 virus

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Common amongst travellers
Watery stools
Abdominal cramps and nausea

E.coli

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Prolonged, non-bloody diarrhoea

Giardiasis

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Bloody diarrhoea

Vomiting and abdominal pain

Shigella

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Profuse, watery diarrhoea
Severe dehydration resulting in weight loss
Not common amongst travellers

cholera

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Severe vomiting

Short incubation period

Staph.aures

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A flu-like prodrome is usually followed by crampy abdominal pains, fever and diarrhoea which may be bloody
May mimic appendicitis
Complications include Guillain-Barre syndrome

Campylobacter……….>clarithromycin

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Two types of illness are seen
vomiting within 6 hours, stereotypically due to rice
diarrhoeal illness occurring after 6 hours

Bacillus cereus

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Gradual onset bloody diarrhoea, abdominal pain and tenderness which may last for several weeks

Amoebiasis

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Child recovered from bacterial meningitis

Further next invest.??

Hearing test to exclude sensourneural hearing loss

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Prophylaxis in case of exposure to meningitis ?

Rifampcin or ciprofloxacin

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Multiple painful blisters on vulva + flu-like $ +inguinal LN swelling
Invest.?
Most appropriate ttt?

Dx genital herpes (HSV type 2)
Invest: Anti_HSV abs
Ttt :acyclovir

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Hodgkin lymphoma on chemo + temp 39.5 + Lt sided abd. pain + blood sent for culture
What is the next step ?

Dx : neutropenic sepsis
#causes of neutropenia :
1lymphocytosis replase neutrophils
2SE:chemo kill also healthy cells .
🤔suspect neutropenia in { chemo,BM transplant}
Ttt:
1st Immediate AB { piperacillin + tazobactam}
2nd_alternative AB meropenum +/- Vancomycin
3rd add antifungal +invest for fungus

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Deep penetrating wound + not remember if vaccinated when was a child

Tetanus IG &amp;tetanus vaccine 
*Notes : tetanus schedule 
2m,3m,4m,3_5y,13_18y
* if high risk wounds : give IG
High risk wounds ;
1_ wounds contaminated with soil 
2_ compound fr.
3_ wounds containing FB 
4_ burn 
*if incomplete or unknown vaccination >> give complete course of tetanus vaccine

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Sudden onset of pain around the ear &loss of hearing in Lt ear + tinnitus+vertigo + painful vesicular rash around the ear on the auditory canal + ipslateral facial nerve palsy.
Dx?
Ttt?

Ramsy Hunt $
(Herpes zoster oticus )
Caused dt reactivation of HZV in there 7th nerve
Ttt :
1oral a cyclovir &steroid
2 for herptic neuralgia give amitriptyline

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Hx of travel to Zimbabwe +and pain + bladder calcification on xray + evidence of obstructive uropathy .
Dx?
Most common complication ?

Schistosomiasis haematobium
Complication:
*Squamous cell carcinoma
* bladder calcification &ulceration

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(Nursing home)* + rashes on her finger webs +axillary folds + itching severe at night
Dx?
Ttt?

Scabies 
*5% topical permethrin  1st line 
*0.5 malathion 3nd line 
Note :severe form of scabies called { Norwegian scabies} 
In immunocompromised

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Liner tracks on the wrist + (nursing home )* + itching

Allergic reaction to eggs &faces

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Pain + swelling at the angle of mandible + temp 38.5+ dry mouth +orchitis Dx? Organism? Ttt?

Mumps * paramyxovirus * reassurance & supportive ttt

``` Sore throat + follicular tonsillitis +cervical lymphadenpathy +may splenomegly +after amoxicillin develop prurtic rash Dx Organism Invest ? Ttt? ```

Infectious mononucleosis (glandular fever) * EBV (also know as HHV_4 ) * heterophil ABs test {monospot test } (Paul bunnell) * lymphocytosis * supportive ttt

Hx of travel to India or already from India + cough + fever + enlarged cervical LN + histology revealed caseating granuloma Dx ?

Tuberculous lymphadentis

Clean wound + never immunised

Full course (DTP)

Widespread maculopapular rash over the sole& plan + mouth ulcers + penile ulcer which healed 6w Dx? Organism ?

Syphilis | * treponema pallidum

HIV +ve (CD count< 50)+ complains of worsing headache + visual disturbance+ facial weakness + MRI (multiple ring shaped contrast enhancing lesion)* Dx? Organism ?

Toxoplasmosis * toxoplasma gondii * pyrimethamine + sulphadiazine

HIV +ve (CD count 350) + cough + temp 38.1 + dysnea + xray show lobar consolidation Most likely caustive organism ?

Streptococcus pneumonia | Exclude Pneumocystitis carnii jiroveci (more if CD < 200)

Immunocompromised + dysphagia+ pain on swallowing + fissuring & soreness at the angle of the mouth

* Angular cheiltis | * Caustive organis : candida.

Headache + neck stiffness+is ceftriaxone started + lp done showed listeria monocytogenes Most appropraite ttt?;

Change to IV ampicillin +gentamicin

8y +Itchy rash on his abd., faces,legs turned into fluid blisters +crusted few days later . Main mode of transmission?

*mainly by Airborne infection *maybe through direct contact with fluid filled vesicle of chicken pox or herpes sister Dx chicken pox

Invest .of meningitis

* CSF analysis | * blood culture in case of presence of rash as u should suspect nesseria meningitis

40y travelled to Sudan since 5w + dark urine +rigors + tender hepatomegly Most likely dx?

Malaria (blackwater) * exclude S.hematombium as dark urine will appear after at least (10w_12w) &WO hepatomegly * S.mansoni cause hepatomegly and not dark urine .

Jejunal biopsy show deposition of macrophages in the lamina propria _containing granules which stain +ve for PAS ( periodic acid Schiff) + git $

Whipple's diz | Caused by tropheryma whippelii in immunocompromised

Hx of camping + no allergy hx + Erythematous patch on thigh Dx? Invest? Ttt?

*Lyme diz *invest: antibodies to borrelia burgdorferi *ttt: doxycyclin *In pregnancy : amoxicillin "Ceftriaxone if disseminated

(Jewish or mediterrian man )* +Multiple purple popular lesions on his face not painful not itchy + upper trunk

Kaposi's sarcoma | *human herpes virus 8

Meningitis | Most appropriate empirical ABs to be started?

* Prehospital sitting +suspect meningitis= IM benzylpenicilline * hospital sitting +suspect meningitis = iv ceftriaxone * meningitis caused by listeria = Iv amoxicilline +gentamicin * hypersensitivity reaction to penicillin or cephalosporn = chloraphenicol. * prophylaxis to close contact = cipro or rifampcin

IV abuser + flu_like $ + dydnea + temp. cough + cxr show bilateral cavitation

Staphylococcus pneumonia

Hx of travel to India + grey membranes on the tonsils &uvula (may cause resp. Obstruction) + enlarged cervical LNs +

Diphtheria

Hx of immunocompromised or smoking or steroid inhaler + white patches in the mouth +wiped off leaving painless red base + cracks at the corner Dx? Ttt?

Pseudomembranous oral candidiasis {oral thrush } | *oral fluconazole

Hx of smoking + raised edges of white patches +sharply defined + can't rubbed out Dx ?

Leukoplakia | Ttt: stop smoking

Hx of travel to Bangkok + don't have any malaria prophylaxis +fever +generalised macular rash +retro orbitalbpain + tender &swollen cervical Lymphadenopathy

Dengue fever

Hx of travel to (Africa)* | + fever ,chills ,rigors

Malaria

Hx of travel to far East Asia | +generalised rash +biphasic fever + retro_orbital pain

Dengue Fever

Hx of travel to South america + severe headache + andabd .pain

typhoid

Hx of travel to South america + severe headache + and.pain

typhoid

5y child + $ of meningism + inc intra cranial pressure +hx of travel to Ghana (Africa)*+ started malaria prophylaxis +FBC show anaemia

Cerebral malaria | Note : malaria prophylaxis not provide full protection against all type of malaria l parasites

5y child + $ of meningism + inc intra cranial pressure +hx of travel to Ghana (Africa)*+ started malaria prophylaxis +FBC show anaemia

Cerebral malaria

Rigors + blood film show ring form of plasmodium with schuffner's dots in RBCs. Most appropriate drug to eradicate this infection ? 🤔

Primaquine *Dx ? Plasmodium oval or vivax *Both can cause replase by re infection from latent hypnozoite in the liver . Ttt : * chloroquine * if resistant give Quinine * primaquine is used to destroy liver stage .

13y +hoarseness of voice + dry cough + FAHM + laryngscope show grossly edematous vocal cord .

* Dx common cold | * reassurance

Pregnenant with resp. Tb . | Med. Should not used in pregnancy ?

Streptomycin (teratogenic)

Painful hard lump of rt breast + temp.38.1 + breast abscess suspected *most likely organism ?

Staphylococcus aureus . Dx? Infectious mastitis complicated by abscess Ttt: incision &drainage +flucloxacillin

33y +IV drug abuser + swelling erythema at the site of injection + toxic look + bullae seen on his arm + not responded to IV flucloxacillin Dx ?

Necrotising fascitis | *organism: group A beta hemolytic strept.

(Homeless)* smoker+ wt loss + cervical LNs swelling + crackles in her rt upperlobe + CXR show cavitation in rt upper lobe Dx?

``` TB #$ of TB : *wt loss *night sweat * chronic productive cough * looks of appetite. #diagnosis : * CXR ;upper lobe infiltration with cavitation { GHons Focus} * AFB staining *culture most specific but take time 🇦🇱 don't use man to us to diagnosis acute TB ```

(Homeless)* smoker+ et loss + cervical LNs swelling + crackled in her rt upperlobe + CXR show cavitation in rt upper lobe Dx?

Screening & management of TB ?

``` 1_ mantoux testing : to diagnosis latent TB infection like co_worker، school contact . 2_interferon gamma testing used in case of BCG vaccination as BCG vaccinated pt will be man to ux +ve #ttt: 1) 1st 2m (RIPE) * rifampcin *isonizid *pyrazinamide *ethambutol 2_ 4m *Rifampcin *isonizid ```

HIV +ve | Appropriate vaccination ?

Proceed with all vaccines as schedualed expect BCG vaccine . | 🇦🇱MMRbnot given if CD < 200

Diabetic women +heavy smoker+ red swelling over rt foot+ foot is erythematous glossybwarm tender Possible complication ?

Gangrene

Hiv +ve + CD count >200

Proceed with administration of MMR vaccination

XY with urethral discharge+ dysuria + sexual active with 4 partners + swab +ve for chylamidia. Most likely complication? 🤔

Epididymo_orchitis

20w pregnant + intermittent fever + rigors + headache+ got upset+ splenomegly + hepatomegly+ yellowish tinge skin + on chemoprophylaxis for malaria {chloroquine + proguanil}

Malaria | 🇦🇱😠 {chloroquine+ proguanil} safe in pregnancy but not effective against most areas

Generalised skin rash lesion + lesions are macular papukar &vesicles &concentrated more in the back &chest . Pinkish fluid secreted from lesion + (temp.39.1 )* Most appropriate ttt?

Oral Antibiotics | If chicken pox rash complicated with bacteria

Generalised skin rash lesion + lesions are macular papukar &vesicles &concentrated more in the back &chest . Pinkish fluid secreted from lesion + temp.39.1

Oral Antibiotics

Infectious diz Flashcards

(66 cards)