Clinical skills - Viral diseases Flashcards
Common NSAIDs
Ibuprofen Aspirin Neproxin Diclofenac Indomethacin
Dysphagia
Difficulty breathing e.g stroke
Dysepsis
Indigestion
What can increased stomach acid lead to
Gastric ulcers - can also be caused by smoking
How do you treat impetigo
Flucloxacillin 250-500mg QDS/ 7 days
Topical fusidic acid
What is Staphylococcus resistant to
Amoxicillin
How can Staphylococcus be treated by
Macrolides
Examples of macrolides
Clarithromycin
Erythromycin
Why is clarithromycin the preferred macrolide
BDS vs QDS in erythromycin
Less side effects
Which surfaces does psoriasis present on
Flaky, silvery rash on extensor surfaces
Which surfaces does eczema present on
Flexor surfaces
Nerves in the hand
Median
Ulna
Radial
RhA in heart
Endocarditis
RhA in lung
Pleuritis
Sero-ve spondyloarthropy
W/ out serum RhF
What can long term use of NSAID’s lead to
Kidney issues - drugs metabolised in kidney
Osgood - Schlatter
Infl of patellar ligament at the tibial tuberosity
Common viruses in primary care
Hand, foot, mouth disease in children
Chickenpox
Shingles
Conjuctivitis
Incubation of chicken pox
2 weeks
PHN
Post hepatic neuralgia
How to avoid PHN
Treating shingles with 2 days
Types of conjuctivitis
Allergic
Viral
Bacterial
Co-amoxicillin
Type of penicillin used when amoxicillin isn’t appropriate
Dose of co-amoxicillin
250/ 125 mg very 8 hrs increased to 500/ 250 mg for severe infection
Can also be given intravenously in adults, 1.2g/ 8 hrs
Hep A vs B
A is transmitted by oral-faecal route
B is blood borne or sexually transmitted
Can also be caused by drugs and alcohol
When is tonsillectomy required
If you have tonsillitis 7 times in 2 years
Problems w/ abcess
Abx can’t get into it - no blood supply
Ulceration
Break in mucosa
Treating genital warts
Cauterized
Freezed off
Verucca
Ingrowing wart on foot
Determining likelihood of streptococcal infection
FeverPAIN
Centor clinical prediction
What is GAS pharyngitis/ tonsillitis common in
Children and adolescents aged 5-15
More common in winter
What is streptococcal infection suggested by
Fever > 38.5 degrees
Exudate on the pharynx/ tonsils
Anterior neck lymphadenopathy
Absence of cough
What is hand, foot and mouth disease caused by
Coxsackievirus A16
Enterovirus 71
Oral lesions associated w/ hand, foot and mouth disease
Develop anywhere inside the mouth but most frequently appear on the hard palate, tongue, cheeks and gums
Begin as erythematous macule and papules
What do the erythematous macule and poapules progress into in h,f,m disease
Thin-walled vesicles that burst and form painful ulcers surrounded by red halo
Heal w/ out treatment over 5-10 days
Macules
Blisters
Papules
Flat, inflamed red spots
Chickenpox
Varicellar-zoster virus
Charcterized by vesicular rash, often preceded by fever and malaise
Px for chickenpox
Aciclovir 800mg 5x/ day for a week in those who are immunocompromised
What should you avoid in chickenpox
Giving NSAIDs
Paracetomol is fine if pain and fever is causing distressing
Rhinovirus
Brings on all the familiar symptoms of a cold
Can cause mild fever and lead to ear or sinus infections in some people
Familiar symptoms of cold
Runny nose Sneezing Sore throat Headache Cough Body aches
Epstein Barr Virus
V high temp or you feel hot and shivery Severe sore throat Swelling either side of your neck - swollen glands Extreme tiredness or exhaustion Tonsillitis that isn't getting better
Post viral syndrome
Chronic fatigue syndorme or myalgic encophalomyelitis (CFS/ME)
Symptoms of CFS/ME
Sleep problems Muscle or joint pain Headaches Sore throat or sore glands w. no swelling Flu like symptoms
Bronchitis vs bronchiolitis
Infl of URT vs LRT
Can affect any age vs infants < 2yrs
Same symptoms but cyanosis and vomiting is also seen in bronchiolitis
Diagnose w/ exam and X-ray but also RSV antigen test in bronchiolitis
Common respiratory viral infections
Adenovirus Coronavirus Influenza A/B Parainfluenza Rhinovirus RSV
Risk factors for complicated influenza
Diabetes mellitus
Severe immunosuppression
65 yrs>
Morbid obesity (BMI 40 +)
What has a significant impact in reducing the spread of respiratory viral illnesses
Hand washing
How do serotypes 1 & 4 of HPV present
As common foot warts
How do serotypes 2, 3 and 10 of HPV present
Warts on the fingers
Low risk serotypes of HPV
1 4 2 3 10
What can high risk serotypes of HPV cause
Malignancy e.g Cervical cancer Some head and neck cancers Penile cancer Anal cancer Vulval and vaginal cancer
HPV vaccine
Gardasil protects against 4 serotypes: 6, 11, 16 and 18
Which serotypes of HPV cause 90% of genital warts
6
11
Human Herpes Viruses
Herpes Simples type 1 and 2 Cytomegalovirus (CMV) VZV (chickenpox and shingles) EBV HHV types 6, 6A, 7 and 8
Can you ever get rid of HHV
No
Once you have the infection, you keep it for life, usually in a dormant form
Reactivation can occur
What can CMV cause
Infection similar to EBV (but usually less pharyngitis or tonsillitis)
Congenital infections
Serious infection in immunocompromised
Infectious mononucleosis
EBV causing glandular fever
Initial infection of oral epithelial cells w/ subsequent spread to B lymphocytes
Clinical disease caused by EBV
Infectious mononucleosis Burkitt lymphoma Lymphoproliferative diocese Nasopharyngeal carcinoma CNS lymphoma
Human Herpes virus type 6
Can be isolated from the saliva of about 85% of adults
Causes roseola infants in children
Common viral rashes
Hand, foot and mouth disease
Parvovirus B19
Molluscum contageosum
Parvovirus B19
Causes a relatively mild infection in children but. ay have v serious effects if contracted in pregnancy
May cause arthritis in adults
Molluscum contageosum
Caused by a pox virus
Multiple lesions can occur, mainly in children
Clear spontaneously w/ out treatment but thus can take several years
Why might parents refuse consent for immunisations
Fear of side effects Misinformation spread by social media
Religious concerns
Concern that it might increase promiscuity / Concern that it might discourage safe sex practices
Lack of health literacy
Lack of confidence in Health services
Examples of wrong ideas about immunisations
Polio (a Western plot to make African women infertile)
HPV (a cause of promiscuity in teenagers)
Evidence demonstrating effectiveness of HPV vaccine
Scotland, Australia & Denmark have seen a significant (at least a 50-70% in studies) reduction in cervical pre-cancer since immunisation has been introduced
Cause of impetigo
Bacterial skin infection caused by Staph or Strep
Spread by direct contact with discharges from scab of infected person
Presentation of impetigo
‘Golden’, crusted skin lesions typically around mouth
Lesions tend to be found on face, flexures and limbs not covered by clothing
