26. Infections 1

Question 1

What is HIV and how does it transmit?

Answer 1

Chronic, single-stranded retrovirus

Sexual intercourse
Vertical (placenta, breast milk, birth)
Needlestick, blood transfusion

Question 2

How do we diagnose HIV?

Answer 2

Response to HIV - IgG and IgM, 15-45 days positive
Presence of HIV protein
Presence of HIV genome

Question 3

How do we treat HIV?

Answer 3

Regime of 2-3 or more agents

Question 4

What does CD4 mean in HIV?

Answer 4

This is checked to see the level of illness. The fewer the CD4 cells, the worse the prognosis.

Question 5

HSV transmission?

Answer 5

Sexual transmission
Vertical (mother to baby)
Muscosal/skin breaks

Two types of HSV

Question 6

Two stages of HSV?

Answer 6

Latency

Reactivation (cold sore stuff)

Question 7

Presentation of HSV?

Answer 7

Herpes labialis (on lip)
Genital herpes
Dissemeinated disease when immunosuppessed

Question 8

How do we treat HSV?

Answer 8

Antivirals - acyclovir (oral, topical, IV, prophylaxis in pregnancy)

Question 9

Varicella zoster virus transmission?

Answer 9

Droplets or direct contact with lesions.

Infectious until all lesions have crusted.

Question 10

What is shingles?

Answer 10

Reactivation of the VZV, often in older patients

Question 11

How do we treat VZV?

Answer 11

Self-limiting
Paracetamol
Calamine lotion
Anti-virals

Question 12

How does VZV present in shingles?

Answer 12

Painful vesicles
Can cause ramsay hunt syndrome
Post-herpetic neuralgia
Herpes zoster ophthalmicus

Question 13

How does epstein barr virus transmit?

Answer 13

Mononucleosis/glandular fever/kissing disease
Sexual contact

Initially attacks epithelial cells and then B cells after

Question 14

Presentation of epstein barr?

Answer 14

Mild flu-like sx
Triad of - fever, sore throat, lymphadenopathy
Hepatosplenomegaly
Often presents after abx is given to patients due to sore throat, and they get a rash

Can cause splenic rupture (avoid contact sport)
Lymphomas

Question 15

Diagnosing epstein barr virus?

Answer 15

Atypical lymphocytes on blood film
Lymphocytosis
Positive heterophile antibodies on monospot
LFTs - raised transaminases with hepatosplenomegaly
Direct viral detection

Question 16

How to treat EBV?

Answer 16

Analgesia (not aspirin)
Anti-pyretic
Corticosteroids for any swelling

Question 17

Candidiasis presentation?

Answer 17

Pseudomembranous - white plaques can be scraped off with erythematous base
Atrophic (dentures) - red lesions
Hyperplastic - non-scrapable plaques

Odd feeling, odd taste, cotton feeling, pain/tenderness

Thick white discharge from vulvar

Question 18

How do we diagnose candidiasis?

Answer 18

Branched pseudohyphae on microscopy

Potassium hydroxide test to see candida (differentiate between psoriasis, eczema and candida)

Question 19

How would we treat candidiasis?

Answer 19

Oral - topical or systemic (never if pregnant) antifungal

Vaginal - fluconazole

Question 20

Tonsilitis presentation viral vs bacteria?

Answer 20

Viral - low grade fever, cough, rhinorrhoea

Bacterial - high grade fever, sore throat, odynophagia/dysphagia

Question 21

What is the fever pain score?

Answer 21

Fever last 24hr
Pus
rApid onset
Inflammed tonsils 
No cough
1pt each

Higher the more likely bacterial

Question 22

How do we treat tonsilitis?

Answer 22

Phenoxymethylpenicillin
OR clarithromycin if pen allergic
Erythromycin if allergic and pregnant

Do a strep test if immunocompromised

Question 23

How do we diagnose and treat abscesses?

Answer 23

USS
CT
MRI
– all seem to show a ring of fluid

USS guided aspiration for culture
Abx
Incision, drainage