Common Presentations Flashcards
Diarrhoea with severe abdominal pain, low fever
Recent chicken consumption in past couple of days
Give most likely diagnosis (and other likely), diagnostic test, and treatment
Campylobacter most likely, also salmonella
Stool culture + microscopy
Supportive treatment
Diarrhoea, no fever
From care home
Give most likely diagnosis (and other likely), diagnostic test, and treatment
Norovirus
Clinical or PCR
Supportive
Diarrhoea, no fever
Child
Give most likely diagnosis (and other likely), diagnostic test, and treatment
Rotavirus
Clinical or PCR
Supportive
Diarrhoea, severe abdominal pain
Recent travel
Give most likely diagnosis (and other likely), diagnostic test, and treatment
E. Coli (toxigenic)
Stool culture for serotyping
Supportive or Abx in severe
Bloody diarrhoea with fever and nausea
Farmer
Give most likely diagnosis (and other likely), diagnostic test, and treatment
E. Coli O157
Stool culture
Supportive - DO NOT GIVE antibiotics
Diarrhoea with abdominal pain and fever
Recent antibiotic use
Give most likely diagnosis (and other likely), diagnostic test, and treatment
C. Diff
Sigmoidoscopy
Stool culture and toxin
Metronidazole OR Vancomycin OR Fidaxomicin
2-day fever with cough, headache, myalgia and malaise
Give most likely diagnosis (and other likely), diagnostic test, and treatment
Flu
Especially if during winter months/outbreak
Swab nose/throat and CXR if pneumonia possible
Oseltamivir/zanamivir if onset <48 hours previous or severe
Fever with reduced mental state
Tachycardia and low BP
Give most likely diagnosis (and other likely), diagnostic test, and treatment
?Sepsis?
Lactate + Blood Culture + Urine output
O2 + IV Abx + IV fluids
Fever, malaise
Lymphadenopathy
Oral thrush
Give most likely diagnosis (and other likely), diagnostic test, and treatment
HIV
P24 antigen and HIV antibodies
CD4 count and viral load
HAART - 3+ drugs from 2+ classes
Fever, headache
Reduced mental state, nausea
Neck stiffness
Give most likely diagnosis (and other likely), diagnostic test, and treatment
Meningitis
LP - CSF testing
Blood cultures
Benzylpenicillin and ceftriaxone in unconfirmed/bacterial
Supportive in viral
Jaundice
Hepatic tenderness
Fever, nausea
Recent travel to developing country and MSM
Give most likely diagnosis (and other likely), diagnostic test, and treatment
Hep A
Serology for IgM
Supportive
Jaundice
Hepatic tenderness
MSM and IVDU
Give most likely diagnosis (and other likely), diagnostic test, and treatment
Hep B (or possibly C if not transmitted sexually)
Serology:
Hep B surface antigen > core ABs > surface ABs
or Hep C antibodies
Supportive
Antivirals in cirrhotic Hep B or chronic Hep C
Intermittent fever with chills
Headache and myalgia
Give most likely diagnosis (and other likely), diagnostic test, and treatment
Malaria
Thick and thin giemsa-stained blood films
Quinine/chloroquine/artemether+lumefantrine
Persistent febrile illness
No white cell changes
Give most likely diagnosis (and other likely), diagnostic test, and treatment
Possible typhoid
Blood/stool/urine culture
Ceftriaxone
Azithromycin
Fever
Flushed skin
Aches
Give most likely diagnosis (and other likely), diagnostic test, and treatment
Haemorrhagic fever (e.g. Dengue)
Serology/PCR for viral antigen
Supportive treatment
Groin itch
Abdominal pain
Haematuria
Schistosomiasis
Stool/urine microscopy
Praziquantel
Small bite with surrounding maculopapular rash
- no erythema migrans
Rickettsiosis
Serology
Tetracycline
Headache, fever
Lethargy, mania/coma
Animal bite
Rabies
Saliva/CSF PCR
Human rabies IG + 4 doses of vaccine over 14 days
Fever, headache
Myalgia
Farmer
Leptospirosis (or Brucellosis)
Serology/PCR
Antibiotics (doxycycline/rifampicin in brucellosis)
Fever, malaise, headache
Erythema migrans
Lyme disease
Clinical or serology
Doxycycline/amoxicillin/ceftriaxone for 3-4 weeks
Look for Acrodermatitis Chronica Atrophicans on distal extensor surfaces
Fever, cough and pleuritic pain
History of COPD
Aspergillosis
Cultures/biopsy
Voriconazole and isauconazole
Unexplained fever
Recent broad-spectrum antibiotic use
Possible invasive candidiasis
Echinocandins and fluconazole
Headache and pneumonia-like symptoms in person with known HIV
Possible cryptococcal infection, also cryptococcal meningitis
Blood culture (or CSF)
Amphotericin B + flucytosine and fluconazole
Facial vesicles with erythema and golden crust
Give most likely diagnosis (and other likely), most likely organism, and treatment
Impetigo
Likely SA
Topical antibiotics
Add IV if large areas
Painful red area with elevated borders
Fever
Give most likely diagnosis (and other likely), most likely organism, and treatment
Erysipelas
Likely strep pyogenes
Antibiotics
Spreading area of erythema
Fever
Cellulitis
Strep pyogenes or SA
Antibiotics
Consider in Diabetes
Rapid onset of erythema with following oedema and pain
Anaesthesia at site of infection
Necrotising fasciitis
Type I - mixed aerobe/anaerobe (staph, strep, entero, gram negs)
Type II - mono (usually strep pyogenes)
Broad spectrum ABx and surgical review
