Clinical Reasoning In Infection

Question 1

Key components of ‘one liner’ statement for infection cases

Answer 1

Who is the patient? (Pertinent demographics, risk factors, ethnicity?)
What is the temporal pattern of the illness?
What is the clinical syndrome? Signs + symptoms
An effective summary statement includes discriminating features (eg rash) and excludes nonspecific ones (e.g. malaise)

Question 2

History emphasis in acute FEVER

Answer 2

Fever details
Exposure (inc travel)
Vulnerability (tendency, predisposition)
Systemic enquiry
Drugs

Question 3

Fever details

Answer 3

How high?
Have they measured it?
Single/recurrent/persistent?
Any pattern?
Were they aware of it? ESP inpatients?
Any associated symptoms? Eg rigours, rash, sweats
Have they taken any paracetamol?

Question 4

Exposure + contact history

Answer 4

Household
Animals
Children
Social events
Sexual
Occupation
Travel

Question 5

Household infections

Answer 5

Covid-19, influenza, common cold, meningococcus, GAS, VSV, TB, Enteroviruses

Question 6

Animal infections

Answer 6

Cats and toxoplasmosis, puppies and worms, mammals and rabies, petting zoos and E. coli 0157

Question 7

Social events - infection spread

Answer 7

Campylobacter from BBQs, salmonella from mayonnaise, norovirus from cruise ships

Question 8

Travel - the five Ws of the Wanderer

Answer 8

Where - exactly
When - exactly
Doing What?
With Whom? (What has happened to them?
Waccination (prophylaxis)

Question 9

The five Ws of the Wanderer

Answer 9

Where - exactly
When - exactly
Doing what?
With whom?
Waccination (prophylaxis)

Question 10

Vulnerability to infection - Iatrogenic causes

Answer 10

Chemotherapy
Steroids
Immunosuppression
T cell (mycophenolate)
B cell (rituximab)

Question 11

Vulnerability to infection - underlying disease

Answer 11

HIV
Alcohol
Diabetes
Old age
Infancy
Pregnancy
Malnutrition

Question 12

Vulnerability to infection - Hyposplenism

Answer 12

Sickle cell Trauma

Question 13

Vulnerability to infection - Autoimmune

Answer 13

Lupus
Rheumatoid
T cell
Antibody
Neutropenia

Question 14

Examination in infections

Answer 14

How sick is your patient?
What is the diagnosis?
Is this an infection?
Where is the focus?
What is the likely pathogen?
Must include: lymph nodes, spleen, liver, skin, neuro inc MTS

Question 15

Travel history - specifics to remember

Answer 15

Geographical restriction Vectors / transmission routes Incubation periods
Main syndromes to consider – fever, rash, diarrhoea, eosinophilia, neuro