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Infectious disease and Travel medicine > Conditions > Flashcards

Conditions Flashcards

1
Q

Ramsay Hunt syndrome mx

A

Prednisolone 1mg/kg (max 75mg) 5/7
Aciclovir 800mg TDS 7/7
Eye patch/artificial tears
Referral to neurologist
Simple analgesia
Avoid contact with immunocompromised

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2
Q

Mx bite/clenched fist injuries

A

If Abx needed; Augmentin 875+125mg (child >=2mo 22.5+3.2mg/kg) BD 5/7
Irrigate wound
Remove foreign bodies
Analgesia - panadol/iburorfen
Elevated/immobilise extremity for 48-72hrs
Advise for early review if signs of infection develop
Apply dressing
Tetanus

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3
Q

Ix for latent TB

A

Tuberculin skin test: good if child <2yo or doesn’t want venepuncture
- not reliable if had previous BCG vaccine
Interferon gamma release assay (IGRA) blood test
If either is positive -> exclude active TB and refer to specialist for mx

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4
Q

Ix for active TB

A

Consider testing if suspicious symptoms
Must do CXR
3x early morning sputums 8hrs apart for acid-fast bacilli culture, MCS
- can do TB PCR with advice from ID (more sensitive and rapid)

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5
Q

Ix of contact of TB

A

Asymp with hx of TB/LTBI -> CXR +/- TST/IGRA +/- sputum
Symptoms -> as above
Nil sx or hx of TB/LTBI -> TST/IGRA -> if negative repeat at 8 weeks
- if <5yo or vulnerable -> consider prophylaxis

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6
Q

Tx latent TB

A

Isoniazid 10mg/kg daily 9/12
ADR; GIT upset, acne, hepatotoxicity, peripheral neuropathy

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7
Q

Tx active TB

A

Isoniazid
Rifampicin
Pyrazinamide
Ethambutol
Above can cause hepatotoxicity

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8
Q

Pertussis sx

A

Persistent cough >2/52 with one or more of;
- paroxysms of coughing
- inspiratory whoop
- post-tussive emesis
Cyanosis/apnoea
Older children/adults may present atypically - isolated cough

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9
Q

Pertussis Ix

A

Pertussis PCR NP swab - best in first 3/52 of illness
Pertussis serology; low sens - use if >2/52 illness
Culture; only accurate early on disease - takes 2/52 for result
Leucocytosis and lymphocytosis

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10
Q

Mx of pertussis

A

Isolate until finish 5/7 therapy of >3/52 of cough (no longer infectious)
Azithromycin 500mg day 1 -> 250mg 4/7 (child 10mg/kg day 1, 5mg/kg 4/7)

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11
Q

Indication for prophylactic Abx for pertussis in contacts

A

Contact; F2F within 1min for >=1hr
Indicated; close contact whilst infectious (<3/52 cough or <5/7 of Abx)
- Child; <6/12, household member <6/12, <3 doses vaccine, attends childcare in same room as infant <6/12
- Adult; expectant parents in last 1/12 pregnancy, healthcare worker in maternity/nursery, childcare worker with contact with <6/12, household member <6/12
Isolation of contacts
- Unimmunised household and childcare contacts <7yo to isolate for 14 days post exposure or until 5 days of ABx

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12
Q

Mx pneumocystic jirovecii pneumonia (PJP)

A

Trimethoprim + sulfamethoxazole 5+25mg/kg TDS 21/7

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13
Q

Legionella pneumonia

A

Legionella longbeachae - commonly in potting mix
Assoc with contamination of water in hospitals, hotels, apartments
Sea water, hot springs, creeks, soil
Sx
- 2-10/7 IP
- T up to 40C
- Dry cough
- Diarrhoea
Ix
CXR; lower zone patchy consolidation, effusion
Hyponatraemia
Elevated transaminases
CRP >100
PCR sputum is gold standard
- if can’t - do urinary antigen Legionella
Tx
- Azithromycin 500mg PO 7/7

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14
Q

Psittacosis (Chlamydia psittaci)

A

From infected birds
- inhaled dust from dried droppings, resp droplets from birds
Sx
- URTI
- abrupt fever
- headache
- myalgia
Ix
- Pharyngeal PCR
Tx
- Doxycycline 100mg BD 7/7

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15
Q

Causes of pneumonia

A

Strep pneumonia
Legionella
Chlamydia psittaci
Mycoplasma pneumonia
H influenza
K pneumonia
Influenza/RSV/adenovirus

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16
Q

Risk factors pneumonia

A

Nil pneumococcal vax
>65yo
Chronic lung disease
Immunocompromised
Malnutrition
Recurrent aspiration
Alcohol
Smoking

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17
Q

CRB-65 for severity of CAP

A

Confusion = 1
RR >=30 = 1
BP <90 / 60 = 1
Age >=65 = 1
Score 1-2 may need referral to hospital

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18
Q

CAP mx

A

Tx 5/7 if good response, otherwise full 7/7
Child; amoxicillin 30mg/kg TDS 3-5/7
Low severity
- Amoxicillin 1g TDS
- Allergic; doxycycline 100mg BD or clarithromycin 500mg BD
Combination therapy
- Indication; if nil improvement after 48hrs, or poor f/u start straight away
- Amoxicillin 1g TDS PLUS doxycycline 100mg BD
- Allergic; cefuroxime 500mg BD PLUS doxy 100mg BD (use clarithromycin 500mg BD as alternative to doxy if pregnancy

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19
Q

Indications for hospital referral for CAP

A

RR >=22
HR >100
Hypotension
Confusion
O2 <92%
Multilobar involvement

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20
Q

Meningitis sx, exam, tx

A

Sx
- Triad; fever, nuchal rigidity, changed mental status
- Headache
- GCS <14
- Nausea
- Rash
Exam
- Brudzinski sign; spontaneous hip flexion with passive neck flexion
- Kernig; inability to fully extend knee with hip flexed at 90deg
Tx
- If can’t do LP within 60min - then tx with empirical ABx
- Ceftriaxone 2g (child >1/12 50mg/kg) IV/IM
- OR benzylpenicillin 2.4g (child 60mg/kg) IV/IM

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21
Q

Indications for PEP rabies

A

Indication; nibbling of uncovered skin, scratches/abrasion, bites, contamination of mucous membrane/broken skin with saliva
- If immunised; 2 doses IM on day 0 and 3
- Non-immune; 4 doses IM day 0,3,7,14, 1 dose HRIG (Human Rabies immunoglobulin) ASAP and prior to day 7!

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22
Q

Listeriosis

A

Cause
- listeria monocytogenes bacteria in fresh foods, unpasteurised dairy, processed meats, seafood
Sx
- influenza like illness
- food poisoning sx
- Meningitis in elderly / infants
- Sepsis / pneumonia
Ix
- Listeriosis PCR of blood/any bodily fluids
- MCS from infected site/blood
- Serology

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23
Q

Leptospirosis

A

Cause; leptospira infected urine from animals into open skin/mucous membranes
- farmers, meat workers
Sx
- Fever, chills, myalgia
- Severe headache
- Macular rash
- conjunctivitis
Ix
- Takes weeks for seroconversion - if clinically suspect then tx
- Leptospirosis blood culture and PCR
Tx
- Doxycycline 100mg BD 7/7

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24
Q

Q fever

A

Cause
- Coxiella burnetti bacteria from cattle/sheep/dogs/cats
- Inhaled droplets or dust contaminated with faeces/ urine
Risk; meatworkers, farmers, vets
Sx
- asymp
- Severe flu-like illness; fever, headache, myalgia
- Atypical pneumonia/hepatitis
- Lead to endocarditis/osteomyelitis
- Post Q fever fatigue syndrome
- Chronic fatigue
Ix
- Rickettsial serology then repeat in 6/12 to see if chronic
- PCR blood but must be within 1 week of disease
- Raised AST/ALT
- Lymphopenia, low platelet
- Test results can take weeks - so start tx anyway
Tx
- doxycycline 100mg BD 2/52
Prevention
- Q fever vaccine; >15yo and high risk occupation
- Hand hygiene
- Respiratory
- Removal of animal waste
- Insect repellents

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25
Q

Scrub typhus

A

Cause
- Mite bite with Gram negative - Asia, Pacific/Indian Ocean Island, Northern Aus
Sx
- 21/7 IP
- Fever
- Eschar at bite site
- LN
- Splenomegaly
Ix
- Serology
- PCR on blood/tissue specimens
- Low WCC/plt
- Elevated AST/ALT
Tx
- Doxycycline 100mg BD 7/7

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26
Q

Queensland tick typhus

A

Cause
- Rickettsia Australia G-ve bacteria via tick bite
Sx
- 14/7 IP
- Eschar at bite site
- Fever
- headache
- erythematous eruption
Ix
- Serology - takes 6/7 for result
- PCR if within 1-5 days post bite
Tx
- Doxycycline 100mg BD 7/7

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27
Q

Dengue

A

Dengue virus
Sx
- Classic; fever, headache, retro-orbital pain, myalgia
- Fever 5-7/7
- Arthralgia
- Fine macular rash
- Positive tourniquet test
- Dengue haemorrhagic fever; low plt, bleeding
Ix
- Serum PCR within 1-5/7 of sx onset
Tx
- Public health notification
- Urgent prevention measures; tell pt to stay indoors, insect repellent
- supportive tx
- Avoid NSAID (bleeding risk)
- Hospital; pregnant, chronic medical condition, extreme of age - observation and fluid replacement

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28
Q

Ross River virus

A

Cause
- Infected mosquito, Aus, NG, Indonesia
Sx
- 14/7 IP
- Fever, polyarthritis (symmetrical), rash!
- Myalgia
- Rare to contract it again
Ix
- RR serology within 7/7 sx onset -> repeat 14/7 later (4x fold increase IgG confirms dx)
Tx- supportive

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29
Q

Sexual history

A

Number of partners
Gender of partners
Type of sex
Prev hx STI
Have you paid to have sex or been paid by someone else
Tattoos / IVDU
Previous incarceration
Immigrant
ATSI

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30
Q

History to establish risk of STI from encounter

A

Type of sex
Use of condoms
Was it with a sex worker
Did your partner have signs of STI - ulcers, discharge
Vaccination status - hepatitis B
Does pt have STI sx

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31
Q

Standard asymptomatic STD screening

A

Bloods
- HIV
- Syphilis
- Hepatitis B; HbsAg, Anti-HBs, Anti-HBc
Chlamydia/gonorrhoea
- Urethral FPU PCR
- Self collected PV swab is preferred
ATSI <30yo; chlam/gon/syph/HIV/trichomoniasis if endem
MSM; 3/12ly
- Oropharyngeal/rectal PCR chlam/gon
- FPU PCR chlam/gon
- Blood; HIV, syph, Hep C, Hep A, Hep B
- Only test Hep C annual if HIV, PrEP or IVDU

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32
Q

Indications to screen for HepC in STD check

A

HIV positive
IVUD
Anal sex with partner with HCV
Incarceration
Non-professional tattoos/piercings
Organ/blood recipient prior 1990

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33
Q

STD contact tracing

A

Chlamydia - 6/12
Hep A; 50 days from sx onset
Hep B: 6/12 prior to acute sx
Hep C; 6/12 prior to acute sx
HIV; recent sexual/needle-sharing partners
Syphilis
- Primary; 3/12 plus duration of sx
- Secondary; 6/12 plus duration of sx
- Early latent; 12/12

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34
Q

Anogenital warts

A

Cause; HPV
Sx; peri-anal itch, rectal bleeding, warty growths on skin,
Can lead to malignancy
Tx
- avoid shaving/waxing to prevent spread
- Offer HPV vaccine
- Podophyllotoxin paint BD 3 days on / 4 days off -> 6 cycles
- Imiquimod 5% cream 3x weekly bedtime, wash off in morning 16/52
- Specialist for excision/ablative therapy under GA

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35
Q

Types of chlamydia

A

A/C; ocular trachoma
D-K; conjunctivitis, genital infection
L1-3; lymphogranuloma venerum

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36
Q

Complications of chlamydia

A

Epididymo-orchitis
PID
Infertility
Ectopic pregnancy, PROM,
Reactive arthritis
Cervicitis
Conjunctivitis
Perihepatitis

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37
Q

Chlamydia Ix

A

FPU PCR; male or unable to do PV swab
Self-collected PV swab or endocervical swab
Anorectal swab; if sx or homo
Pharyngeal swab; if homo

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38
Q

Chlamydia mx

A

Non-pharm
- Nil sex 7/7 after tx
- Contact tracing 6/12
- Nil sex with partner from last 6/12 until all tested and tx
- Provide fact sheet about illness
Partner delivered therapy
Offer presumptive tx of sexual contacts
Uncomplicated genital/pharyngeal; doxycycline 100mg BD 7/7 OR Azithromycin 1g PO STAT
Anorectal
- Asymp; doxy 100mg BD 7/7
- Symp; Doxy 100mg BD 21/7 or Azi 1g PO and repeat at 24hrs
Conjunctivitis
- Azithromycin 1g stat

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39
Q

Chlamydia f/u

A

Confirm adherence
Confirm contact tracing
Sexual health education + counselling
TOC: only if pregnant or anorectal infection tx with azi -> 4/52 post tx TOC
Test reinfection; 3/12

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40
Q

Lymphogranuloma venereum

A

Cause- C trachomatis L1-3
Sx
- Primary; ulcer/nodule, proctitis
- Secondary; inguinal LN swelling/discharge/erythema
- Tertiary; chronic proctitis, fistula, strictures, scarring
Dx
- Rectal swab Chlamydia PCR + write on request LGV testing - test if proctitis sx or homosexual men
- LGV very uncommon vaginal - should refer to specialist if suspect
Tx
- Nil sex 21/7
- Nil sex partners from last 3/12
- Contact tracing
- Doxycycline 100mg BD 21/7
- Inguinal buboes- may need drainage
F/u
- 1/52 - results, adherence, sx, contact tracing, sexual health counselling
- TOC: PCR 3/52 after finish tx
- Test reinfection; 3/12

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41
Q

Donovanosis

A

Cause; rare - genital ulcer by Klebsiella granulomatis
- PNG, South Africa, South America, India
Sx
- painless ulcer, offensive odour
- Can spread to uterus/tubes/long bones/psoas muscles
- Neoplastic transformation
- Increased HIV transmission risk
Ix
- Dry swab or punch biopsy for PCR
Tx
- Nil sex 7/7, contact tracing 6/12, nil sex prev partners 6/12, notify
- Specialist referral!
- Azithromycin 500mg 7/7 or azithromycin 1g weekly 4/52

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42
Q

Pubic lice

A

Genital itch, rash, debris in underwear (crabs), fever, lethargy
Mx
- Pyrethrin 0.165% + piperonyl butoxide 1.65% foam to hair and other areas -> wash after 10min -> repeat 1/52

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43
Q

Genital scabies

A

Sx
- genital papulonodule + visualisation of silvery skin burrows
- fever, pain, secondary infection
Mx
- Permethrin 5% neck down for 8hrs - repeat in 1 week

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44
Q

Oral HSV mx

A

Primary oral
- Minor; analgesia, fluid, lidocaine 2% 15ml 3hrly
- Severe; aciclovir 200mg 5x daily 7/7
Recurrent oral
- Minor recurrence; aciclovir 5% cream 5x daily 5/7
- Severe; aciclovir 400mg 5x daily 5/7
Long-term suppression
- Famciclovir 250mg BD 6/12

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45
Q

Genital HSV clinical features

A

Sx
- Anogenital, lower back, buttocks, thighs ulcer
- Cervicitis +/- ulcers/blisters +/- PV discharge
- Proctitis
- Urethritis
DDx; Behcet’s syndrome (vasculitis - mouth Ulcer + genital ulcer + uveitis)
Ix
- HSV PCR - swab base of deroofed vesicle or ulcer

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46
Q

Genital HSV mx

A

Non-pharm
- Fluids
- Hand hygiene to avoid autoinoculation
- Nil sex until lesions healed
Pain
- NSAID
- Lignocaine 2% topical
- Saline baths
Initial episode; aciclovir 400mg PO TDS 10/7
Recurrence; aciclovir 800mg TDS 2/7
Suppression; aciclovir 400mg BD 6/12
Suppression in pregnancy; aciclovir 400mg TDS from K36

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47
Q

Gonorrhoea sx

A

Urethritis sx
Cervicitis sx
Conjunctivitis; purulent, sight-threatening
Anorectal sx; discharge, tenesmus
Complications; epididymo-orchitis, prostatitis, PID, disseminated disease (rash, septic arthritis), meningitis, endocarditis

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48
Q

Gonorrhoea Ix

A

FPU PCR; males and if can’t do PV/cervical swab
Gonococcal culture; good for Abx sens - take it prior to starting Abx
Homo; anorectal + pharyngeal swab regardless of sx

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49
Q

Gonorrhoea mx

A

Nil sex until 7 days after tx
Nil sex with partners for last 2/12
Contact tracing
Notify state department
Consider HIV PreEP
Uncomplicated genital/anorectal
- Ceftriaxone 500mg IMI 2ml 1% lignocaine PLUS Azithromycin 1g PO stat
Uncomplicated pharyngeal
- As above but Azi 2g
Conjunctivitis
- Ceftriaxone 1g IM 2ml 1% lignocaine PLUS Azi 1g stat
F/u
- 1/52; adherence, sx, contact tracing, sexual counselling, discuss HIV PrEP
- TOC: PCR swab each site 2/52 post tx
- Reinfection; 3/12

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50
Q

Hepatitis A

A

Cause; contaminated food/water, faeco-oral transmission during sex
Lifelong immunity after infection
Prevention; Hep A vaccine for homo, IVDU, ATSI, custodial worker, sex workers
Ix
- Positive anti-HAV IgM
Mx
- Supportive
- No sex for 1 week post onset of jaundice
- Avoid preparing food/drink
- Contact tracing
- Notify state
- Specialist; pregnant
- Contact tracing; 50 days from onset of sx
- PEP; Hep A vaccine or immunoglobulin for contacts;

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51
Q

Hep B Ix

A

Chronic Hep B
- HbsAg and Anti-Hbc positive
- Anti-Hbs negative
Acute
- HbsAg, Anti-Hbc, Anti-Hbc IgM POSITIVE, anti-Hbs negative
Immune from vax
- anti-Hbs POSITIVE
- HbsAg/anti-Hbc negative
Immune from resolved infection
- HbsAg neg
- antiHBc and antiHBs positive

52
Q

Indications to tx Hep B

A

HBV DNA >20,000
Elevated ALT
HbeAg positive or anti-HbeAg positive

53
Q

Acute hep B mx

A

Refer S100 prescriber if tx indicated
No sex until partner is immune
Avoid sharing toothbrush/razors
Screen household contacts +/- vaccinate
Hep A vaccine
Contact tracing; sexual, household, close family and vaccinate for last 6/12 before onset of sx
Consider other STI screening
Ix for fibrosis with fibroscan
PoEP with HbIG; sexual, IVDU, occupational

54
Q

Hep B f/u

A

Contact tracing
Monitor until HbsAg neg
Chronic infection
- 6-12/12 monitor, annual viral load, LFT
- HCC screening with USS/AFP
- check Hep A/C status

55
Q

HIV sx

A

Acute infection; 2/52 for seroconversion
- Fever, rash of whole body, LN, pharyngitis, myalgia
Immune deficiency; thrush, diarrhoea, weight loss, skin infections, herpes zoster
Complications; AIDs (PJP, candidiasis, Kaposi sarcoma, non-Hodgkin lymphoma), increased risk CVD/CKD/oesteoporosis

56
Q

HIV Ix

A

HIV serology; repeat 6/52 later

57
Q

HIV diagnosis counselling

A

Explain a disease that is controllable and can achieve normal life expectancy
Explain can tx with PO meds
Refer to sexual health clinic to start anti-retrovirals
Use condoms with any sexual partner and must disclose his HIV status
Refer to HIV support services / psychologist
Explain this is notifiable
Explain need to test his CD4 count and viral load

58
Q

HIV post-exposure prophylaxix

A

Within 72hrs

59
Q

PrEP HIV steps

A

Suitability
- Test HIV, assess sx
- Confirm normal eGFR 60 and exclude nephrotoxics / interactions
- Ensure not candidate for post-exposure prophylaxis
Testing
- Assess for other STI, Hep B/C, pregnancy test, renal function
Prescribing
- Tenofovir 300mg / emtricitabine 200mg daily dosing
-> 7 days until protection for males, 20 days for females -> continue 28days post exposure
-> ADR; nausea, headache
- safe in pregnancy/breastfeeding
Monitor
- HIV testing + STI; day 30, 90 and every 90days on PrEP
- Hep B/C; baseline, Hep C annually
- Pregnancy test every visit

60
Q

Mycoplasma genitalium

A

Sx
- urethral discharge
- PID/cervicitis
- Post-coital bleeding
- Pelvic pain
- preterm, abortion, proctitis, reactive arthritis
Ix; test if acute/persistent/recurrent urethritis, cervicitis, PID, post-coital bleeding
- FPU CR
- Anorectal swab if sx
Mx
- Condoms until TOC
- TOC 21 days after tx
- No sex in untested partners
- Fact sheet
- Susceptible; doxy 100mg BD 7/7 then azi 1g immediately then 500mg daily 3/7
- Resistant; doxy 100mg BD 7/7 then moxifloxacin 400mg 7/7

61
Q

Stages of syphilis

A

Early; primary, secondary, early latent
Late latent
Tertiary

62
Q

Primary syphilis clinical features

A

Genital/anal/oral ulcer (chancre)
Painless, well defined
IP 3/52
Inguinal LN large, nontender
Highly infectious

63
Q

Secondary syphilis clinical features

A

Occurs <6/52 post infection
Fever, malaise, headache, LN
Generalised rash trunk/palms/soles
Alopecia
Neurological; vision change, tinnitus, meningitis
Highly infectious

64
Q

Early latent syphilis clinical features

A

<2years infection
Nil sx
Positive serology
Highly infectious

65
Q

Late latent syphilis clinical features

A

> 2 years infection
Nil sx
No longer infectious - can be transmitted vertically

66
Q

Tertiary syphilis clinical features

A

Late sx and complications
CNS/CVS disease
Destructive skin lesions - gummas

67
Q

Early neurosyphilis clinical features

A

Vision change
Tinnitus
Deafness
Meningitis
Needs IVAbx

68
Q

Syphilis Ix

A

Syphilis serology - if positive
- Rapid plasma reagin positive
-> if nil hx = early / late syphilis = treat
-> if had prev tx and now RPR increase -> possible reinfection = treat
-> if had prev tx and now RPR lower -> past treated syphilis = don’t treat
Venereal disease research lab (VDLR) confirmatory testing
Treponema-specific assay (TPHA/TPPA); remains positive for life
Swab ulcer PCR

69
Q

Syphilis mx

A

Must have RPR repeated on same day of tx for accurate baseline
Primary/secondary; benzathine benzylpenicillin 1.8mg IMI as 2 injections
All other cases
- benzathine benzylpenicillin 1.8g IMI as 2 doses weekly for 3 weeks
Non-pharm
- nil sex for 7 days after tx
- Nil sex with partners from last 3/12 (primary,), 6/12 (secondary), 12/12 (early latent)
- Contact tracing
- Notify
- Syphilis register

70
Q

Jarisch-Herxheimer reaction

A

Reaction to treatment in primary/secondary syphilis
Occurs 6-12hrs after tx
Fever, headache, rigors, joint pain
Tx conservatively

71
Q

Mx of syphilis contacts

A

Partners from last 3/12 should have tx for primary/secondary syphilis regardless of serology

72
Q

F/U syphilis

A

TOC; RPR 3/12, 6/12, 12/12 post tx
- 4x drop RPR = adequate response
MSM; screen HIV/STI every 3-12/12

73
Q

Trichomoniasis

A

Cause; trichomonas vaginalis protozoa
Risk; older, regional/remote, ATSI, sex workers
Sx
- Urethritis
- Malodourous PV discharge
- Prostatitis, PROM, preterm,
Ix
- High PV swab PCR or FPU PCR
Tx
- Nil sex 7/7 after tx
- Tx partner
- Contact tracing
- Metronidazole 400mg BD 7/7 (avoid etoh)
- Specialist; pregnant, breast-feeding, HIV
F/u
- 1/52; usual
- Nil TOC
- Retest at 4/52 if ongoing sx

74
Q

Bacterial vaginosis

A

Cause; Gardnerella vaginalis
Sx
- thin white/grey PV discharge
- asymp 50%
Ix
- Amsel criteria; 3/4 of;
-> Thin white/grey discharge
-> pH >4.5
-> Whiff test; malodour with K hydroxide or on exam
-> clue cells on microscopy
Tx
- Wear condoms
- Avoid douching
- Metronidazole 400mg BDD 7/7 OR Metronidazole 0.75% gel intravag 5/7
F/u
- nil needed

75
Q

Hep C risk factors

A

IVDU
Incarceration
Sexual partner of pt w/ Hep C
Hep B or HIV infection
Needlestick injury
Tattoos / body piercings
Blood/organ recipient before 1990

76
Q

Hep C Ix

A

Hep C Ab; indicates prior or current infection
HCV RNA; viral load = active infection
HCV genotype - can guide antiviral therapy
FBC
U+E
LFT
INR
bHCG
Hep A/B + HIV serology
Liver elastography
FPG

77
Q

Evaluate for fibrosis in chronic hep C

A

Fibroscan
OR
AST to platelet Ratio index (APRI)
if <1.0 = exclude cirrhosis

78
Q

Ix prior to tx chronic hep C

A

FBC/LFT/UE/eGFR/INR
BHCG
Fibrosis ax
Liver USS to rule out HCC

79
Q

Direct-acting antiviral regimen (DAAT) for hep C

A

Sofosbuvir Plus velpatasvir combination 12/52 course
All pt with hep C can have this
ADR; fatigue, headache, nausea, insomnia
Repeat HCV RNA 12/52 after tx

80
Q

Monitor of tx hep C DAAT

A

12/52 HCV RNA + LFT
Annual RNA if risk factors for reinfection

81
Q

Patient education hep C tx

A

Cure rate >90% with current treatment
Minimise alcohol – abstinence in cirrhosis
can still work in healthcare as long as she uses precautions
Contraception whilst on antivirals
PPI interact with antivirals

82
Q

Cause of anogenital lumps

A

HPV
Molluscum contagiosum
HSV
Syphilis
IEC
Fordyce spots
Folliculitis
Papillae

83
Q

Causes of anogenital ulcers

A

HSV
Syphilis
Donovanosis
Lymphogranuloma venreum
Aphthous ulcer
IEC
Behcet syndrome
Varicella zoster

84
Q

Anorectal syndrome sx + mx

A

Sx; discharge, pain, fever, tenesmus
Tx empirically
- Doxycycline 100mg BD 21/7 PLUS ceftriaxone 500mg in 2ml 1% lignocaine IM PLUS valaciclovir 500mg BD 10/7

85
Q

Cervicitis sx, Ix, mx

A

Sx; discharge, intermenstrual/postcoital bleed, irritation, pelvic pain
Ix; PCR chlam/gon/M genitalium/T vaginalis via high PV swab
Mx; tx for chlam + gonorrhoea

86
Q

Urethritis Ix, mx

A

Ix; FPU PCR chlam/gon/M genitalium
Mx
- NGU likely; doxy 100mg BD 7/7
- Gon likely; ceftriaxone 500mg IMI 2ml 1% lignocaine PLUS azi 1g stat OR doxy 100mg BD 7/7

87
Q

PID sx

A

PV discharge
PV bleeding
Fever, nausea, vomiting
Dyspareunia
Cervical motion tenderness

88
Q

PID Ix

A

urine pregnancy
Endocervical PCR chlam/gon/M genitalium
Urinalysis

89
Q

PID tx

A

Abx
- Ceftriaxone 500mg 2ml 1% lignocaine
- PLUS metro 400mg PO BD 14/7
- PLUS doxy 100mg BD 14/7
IUD
- leave insitu if respond to tx within 72hr - otherwise remove
Admission
- Pregnant, intolerant to PO, severe, not responding to POAbx

90
Q

Sexual assault mx

A

First aid
Offer forensic evidence collection in ED
Assess for strangulation
HIV PoEP for 30 days
Check HBsAb, HbcAb, HbsAg and offer vaccination to non=-immune or HBIG if assailant in known Hep B +ve
Emergency contraception
Psychosocial support
Chlamydia/gonorrhoea swab at each orifice of penetration

91
Q

EBV Ix, mx

A

Ix
- Serology
- Infectious mononucleosis monospot test - repeat after 1/52
Mx
- No contact sports 4/52
- Avoid saliva contact with partner
- Analgesia
- Bed rest
- Throat lozenges, prednisolone for severe throat pain
- Avoid penicillin
- Educate - may extend for 1 year

92
Q

EBV prevention

A

Hand hygiene
Avoid sharing cups
Washing toys of children

93
Q

EBV complications

A

Rash w/ penicillin
Jaundice, hepatitis and liver failure
Splenic rupture
Encephalitis/meningitis
Haemolytic anaemia
GBS
Chronic active EBV
Burkitt Lymphoma

94
Q

Head lice mx

A

Pyrethrin 0.165% + piperonyl butoxide 1.65% for 10min - repeat 1/52
Refractory; ivermectin 200mcg/kg stat dose - repeat 7/7

95
Q

Staphylococcal scalded skin syndrome

A

Neonates/young children
S aureus toxin
Skin tenderness, erythema, desquamation
Nikolsky sign; pressure exfoliates skin
Fever
Irritability
Tx; IVF, Abx, analgesia

96
Q

Eczema herpeticum

A

Dermatologist emergency
Widespread HSV complicating skin disease like eczema
Sx; fever, widespread HSV rash, severe morbidity/mortality
Tx; swab HSV PCR, prompt oral antivirals, consider admission if moderate-severe sx and immunocompromised

97
Q

Lyme disease

A

Borrelia species - tick bite
Europe, North America
Sx
- erythema migrans -> disseminated disease, neuro/cardiac sx -> arthritis/encephalopathy/polyneuropathy
Tx
- Doxycycline 100mg BD

98
Q

Scabies risk factors

A

RACF
Prison
Refugee camps
ATSI remote
Overcrowded hygiene

99
Q

Scabies mx

A

Wash clothing 60C or place in bag for 8 days
Vacuum house
Permethrin 5% cream neck down - wash off after 8hrs - repeat in 1/52
- if central/northern Aus and infant/eldelry - apply to face and scalp
Ivermectin 200mcg/kg stat dose and repeat in 7/7
- avoid if <5yo, pregnant, breast-feeding
Steroid for itch

100
Q

Tetanus prone wound

A

Compound fracture
Bite
Deep penetration
Foreign bodies
Pyogenic infection
Burns
Contaminated wounds w/ soil/dust

101
Q

Tetanus prophylaxis indications

A

<5yrs since last dose - nil
5-10 yrs since last dose
- give if dirty/major wound
>10 years since last dose
- give for all wounds
If <3 doses tetanus or unknown hx
- Give for clean minor wounds
- All other wounds - vaccine + tetanus immunoglobulin

102
Q

Herpes zoster mx

A

Antiviral
- Indication; rash <72hrs, immunocompromised, HZ opthalmicus
- Aciclovir 800mg (child 20mg/kg) 5x daily for 7/7
Pain; oxycodone, prednisolone 50mg 7/7, lidocaine 5% patch 12hrs (healed rash)
Remove crusts with saline bath - apply vaseline and cover
Avoid contact children, pregnant, immunocompromised
Infective until lesions dry

103
Q

Mx postherpetic neuralgia

A

TCA
Pregabalin
Topical capsaicin
Lidocaine 5% patch
Psychological

104
Q

Cellulitis IVAbx indication

A

Two or more of;
- T >38
- HR >90
- RR >20
- WCC >12x10 or <4x10

105
Q

Erysipelas of S pyogenes cellulitis (non purulent, recurrent, spontaneous or rapidly growing)

A

Phenoxymethylpenicillin 500mg QID 5/7 (child 12.5mg/kg)
- Non severe allergy; keflex 500mg QID 5/7
- Severe allergy; clindamycin 450mg TDS 5/7

106
Q

Purulent cellulitis or S Aureus suspected

A

Flucloxacillin 500mg (child 12.5mg/kg) QID 5/7
- keflex in child as tasty
- MRSA/allergy; bactrim 160_800mg BD 5/7

107
Q

Water immersion for cellulitis

A

Doxy + fluclox

108
Q

Spinal epidural abscess Ix

A

MRI + contrast
2x BC
Aspiration for culture
Mx
- vancomycin, cephalosporin together for 8/52

109
Q

Empirical tx acute infectious diarrhoea

A

Ciprofloxacin 500mg BD 3/7

110
Q

Campylobacter enteritis mx

A

Conservative
Abx; if severe, 3rd trim preg, infants, frail, immunocompromised
Ciprofloxacin 500mg BD 3/7

111
Q

C difficile mx

A

Metronidazole 400mg TDS 10/7

112
Q

Giardiasis mx

A

Metronidazole 400mg TDS 5/7 (child 10mg/kg)

113
Q

Ddx of cystitis sx with negative culture

A

Urethritis
STD
Cervicitis
Atrophic vaginitis
Lichen sclerosis
Stones
Bladder cancer
Endometriosis

114
Q

Acute cystitis mx

A

Non-pregnant women
- trimethoprim 300mg 3/7
Pregnancy
- Nitrofurantoin 100mg QID 5/7
Men
- Trimethoprim 300mg 7/7
Children
- Bactrim 4+20mg/kg BD 3/7 (10/7 if systemic features / pyelo)

115
Q

Recurrent UTI mx

A

Trimethoprim 150mg nocte 6/12
Topical vaginal oestrogen for postmenopausal women
Methenamine hippurate; good for UTI abnormalities or neuropathic bladder

116
Q

Typhoid vaccine

A

Indication; travellers >=2yo to endemic region, lab workers who work with Salmonella typhi, military
Endemic region; Africa, Central/South America, Middle East, East/South Asia
ViCPS injection 1 dose 2 weeks prior to travel
- booster every 2 years

117
Q

Yellow fever vaccine

A

> =9mo travelling to risk area
Booster if last dose >10 years ago

118
Q

Prevention of altitude illness

A

Medication
- Acetazolamide 250mg
Slow ascent; 500m ascent per day once higher than 3km
Spend >=2 nights at each location

119
Q

Clinical conditions of high altitude

A

High-altitude headache; tx with NSAID
High-altitude cerebral oedema; develops 24-36hrs post arrival -> impaired mental state, ataxia!!! -> tx with immediate reduction in altitude, oxygen, IV dexamethasone
High-altitude pulmonary oedema
Acute mountain sickness; nausea, vomiting, weakness, headache

120
Q

Rash in returned travellers ddx

A

Dengue
Measles
HIV
Rickettsial infection
Ross River virus
Barmah forest virus
Typhoid

121
Q

Fever in traveller history

A

Location
Timing - seasons
Exposure
- Animals
- Insect bites
- Water / food
- Activities; sex, tattoos, drug
- Sick contacts
Immunisation hx
Prophylaxis used
- medications
- mosquito nets
Sx onset and duration
Healthcare received overseas

122
Q

Malaria sx

A

Fever - paroxysms at irregular intervals
Malaise
Nausea/vomiting/diarrhoea
abdo pain
myalgia
anaemia

123
Q

Malaria prevention

A

Doxycycline 100mg 1-2 prior to entry and for 4/52 after leaving
Insect repellent
Bed netting
Long clothes
Avoid dusk/dawn
Avoid perfume/aftershave

124
Q

Typhoid fever

A

Salmonella typhi via contaminated water/food of faeces from humans
Dx; stepladder fever PLUS abdo pain PLUS relative bradycardia
Sx
- headache, dry cough, fever that increases in stepladder manner over 4 days, abdo pain, diarrhoea (pea soup)
- Rash - rose spots
- Splenomegaly
Mx
- Azithromycin 1g 7/7

125
Q

Empirical mx of traveller’s diarrhoea

A

Azithromycin 1g stat dose

126
Q

Pre-travel advice

A

Insurance
Food/drink precautions
First aid kit
Avoid sex/tattoos
Insect avoidance / prophylaxis
Avoid swimming in fresh water
Hand hygiene

Infectious disease and Travel medicine (1 decks)

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