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GP > GP Infections and Paeds > Flashcards

GP Infections and Paeds Flashcards

1
Q

Measles is what type of virus?

A

type of paramyxovirus
highly contagious

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2
Q

Presentation of Measles?

A
  • Prodromal cough, conjunctivitis and coryza (cold like symptoms)
  • Also get characteristic Koplik spots (white spots on a reddened background that occur on the inside of cheeks early in the course of measles)
  • Eruptive Exanthem phase – red blotchy maculopapular rash that spreads from the head downwards to eventually involve the whole body
  • Recovery phase- final symptom persistent cough
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3
Q

What are Koplik spots and which infection are they characteristic of?

A

white spots on a reddened background that occur on the inside of cheeks early in the course of measles

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4
Q

Management of measles?

A

management is supportive
prevention with vaccine

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5
Q

Diagnosis of measles?

A

Most cases are diagnosed clinically but detection of measles specific IgM in blood or oral fluid or genome or antigen detection from nasopharyngeal aspirates or throat swabs can be used to confirm the diagnosis

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6
Q

Complications of measles?

A
  • Most worrying complication in an immunocompetent person is risk of encephalitis
  • Other complications include pneumonia and risk of super infections as the virus suppresses the immune system
  • Complications worse amongst young infants
  • In children under 2 there is the risk of rare subacute sclerosing panencephalitis which occurs 7-10 years after initial infection where there is persistence of the virus, reactivation and progressive mental deterioration with a fatal outcome
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7
Q

Mumps is what type of virus?

A

paramyxovirus

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8
Q

How is mumps spread?

A
  • Spread by droplet infection, direct contact or through fomites
  • Humans are the only known natural hosts
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9
Q

Presentation of mumps?

A
  • Prodromal symptoms are fever, malaise, headache and loss of appetite
  • Usually followed by severe pain over the parotid glands with either unilateral or bilateral parotid swelling
  • Side note: the parotid glands sit just in front of the ears on each side of the face
  • These enlarged glands obscure the angle of the mandible and may elevate the ear lobe (differentiate from cervical lymph node enlargement as that wouldn’t elevate the ear lobe)
  • Trismus is common at this stage (restriction of the range of motion of the jaw, can be painful)
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10
Q

Complications of mumps?

A
  • Can cause meningitis and encephalitis
  • Can infect the testicles and epididymis in males, and then cause inflammation resulting in testicular atrophy, decreased sperm count and motility, although rarely issues are large enough to cause infertility
  • Glomerulonephritis, arthritis, myocarditis, hepatitis, pancreatitis and polyarthritis can also occur
  • Should note that mumps in pregnancy does not increase the risk of congenital defects
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11
Q

Diagnosis of mumps?

A
  • Diagnosis is on basis of clinical features but can be confirmed using serology and swabs (usually buccal swab)
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12
Q

Management of mumps?

A
  • Treatment is supportive
  • Prevention should be mainstay with vaccine available for all children in UK
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13
Q

What is the hallmark of herpes viruses?

A

the ability of the viruses to establish latent infections that then persist for the life of the individual

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14
Q

What are the 2 types of herpes simplex viruses and what types of infection do they cause?

A
  • HSV-1 is the major causes of herpetic stomatitis, herpes labialis (cold sore), keratoconjunctivitis and encephalitis
  • HSV-2 causes genital herpes and may be responsible for systemic infection in the immunocompromised host
  • Although there is the distinction there is some overlap where HSV-1 can cause genital and vice versa
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15
Q

Presentation of HSV-1?

A
  • Primary infection may go unnoticed or may produce a severe inflammatory reaction with vesicle formation leading to painful ulcers
  • Virus may be reactivated from the trigeminal ganglion by stress, trauma, febrile illness, UV radiation
  • Approximately 70% of the population is infected with HSV-1 and recurrent infections occur in one third of individuals
  • Reactivation often produces localised paraesthesiae in the lip before the appearance of a cold sore
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16
Q

Complications of HSV-1?

A

transfer to eye (dendritic ulceration / keratitis), acute encephalitis, nail bed infections (herpetic whitlow) and erythema multiforme

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17
Q

Presentation of HSV-2?

A
  • This is a STI
  • It is the most common cause of genital ulceration worldwide
  • Transmission occurs via genital to genital contact from someone shedding the virus who may be asymptomatic
  • Primary infection occurs when someone has never been in contact with HSV 1 or 2 and can result in blistering and ulceration of external genitalia, pain, external dysuria, vaginal or urethral discharge, local lymphadenopathy, fever and myalgia
  • Fever and myalgia are sometimes the prodrome to the illness
  • Primary infection usually lasts 14-21 days
  • Recurrent herpes is due to reactivation and usually there are only a few ulcers confined to a small area, systemic symptoms are rare but the person is still infectious as viral shedding can occur
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18
Q

What is the risk of primary infection in pregnancy with HSV?

A

can cause neonatal HSV which can be very serious

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19
Q

Diagnosis of HSV?

A
  • Diagnosis is by swab in virus transport medium of deroofed blister for PCR
  • Serology IgG is not useful as it just tells you if the patient has ever been in contact with HSV in their life (which a lot of us have) rather than that the current problem is herpes
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20
Q

Management of HSV?

A
  • For some supportive treatment can be fine and will clear up
  • Other options are antiviral treatment with acyclovir
  • In genital may consider topical lidocaine if very painful as well as saline bathing and analgesia for primary episode
  • In recurrent episodes may do episodic antiviral therapy or suppressive treatment if recurrences are very frequent with aciclovir
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21
Q

Influenza is _____ viruses of the _______ family

A
  • RNA viruses of the orthomyxoviridae family
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22
Q

Explain the differences between the 3 influenza types?

A
  • Influenza A occurs more frequently and is more virulent, it is responsible for local outbreaks, larger epidemics and pandemics
  • Influenza B often co-circulates with A during the outbreaks but generally causes less severe clinical illness but can still cause outbreaks
  • Influenza C usually causes a mild or asymptomatic infection similar to the common cold
23
Q

When does influenza tend to occur?

A

in the winter months

24
Q

Presentation of influenza?

A
  • Coryza (inflammation of mucus membranes in nose)
  • Nasal discharge
  • Cough
  • Fever
  • GI symptoms
  • Headache
  • Malaise
  • Myalgia
  • Arthralgia
  • Ocular symptoms (conjunctivitis)
  • Sore throat
25
Q

Complications of influenza?

A
  • Acute bronchitis
  • Pneumonia
  • Exacerbations of asthma and COPD
  • Otitis media
  • Sinusitis
26
Q

Management of influenza?

A
  • For otherwise healthy people antiviral drugs are not usually recommended unless they are at risk of developing serious complications
  • Supportive management: drink adequate fluids, take paracetamol or ibuprofen to relieve symptoms, rest and stay off until symptoms resolved
  • For people in at risk groups antivirals (oseltamivir or zanamivir) should be prescribed
  • At risks groups include chronic diseases, immunosuppressed, those over 65, pregnant women, children under 6 months
  • Prevention with yearly vaccine is important (vaccine is different every year with protection against the 3 strains predicted to dominate in the coming season
27
Q

What is the varicella zoster virus?

A
  • Double stranded, linear DNA virus, causes chickenpox as primary infection and shingles as secondary infection
28
Q

How is chickenpox spread?

A

highly infectious and spread by respiratory droplets and direct contact

29
Q

Presentation of chickenpox?

A
  • Prodromal symptoms include nausea, myalgia, anorexia, headache, general malaise and loss of appetite
  • Then get a centripetal rash (appearing initially on the extremities and spreading to back, torso, and face, but sparing palms, soles, genitalia, and mucous membranes)
30
Q

Chickenpox is more likely to be serious if infected as _____

A

an adult

31
Q

Complications of chicken pox?

A
  • Complications include secondary bacterial infection, haemorrhagic rash, scarring, encephalitis, or pneumonitis (chickenpox pneumonia, note it’s technically not pneumonia as there is no consolidation on X-ray!)
  • Neonatal VZV can occur secondary to chickenpox in a mother in late pregnancy, this has a higher mortality so prevention with VZV immunoglobulins or acyclovir in women exposed to VZV in late pregnancy is recommended
32
Q

Management of chickenpox?

A
  • Trim children’s finger nails to avoid scratching, hot baths and moisturiser, paracetamol to reduce fever and pain, calamine or oral antihistamines may help with itching, oral acyclovir may be considered in those over 12
  • Vaccination is available for chickenpox (although you have to pay for it in UK)
33
Q

Explain what causes shingles?

A
  • The varicella zoster virus (chickenpox) remains dormant in sensory ganglia after infection
  • It may reactivate in a specific dorsal root ganglion resulting in dermatomal distribution of the disease
  • This usually occurs in old age
34
Q

Shingles usually occurs in ______

A

old age

35
Q

Most common complication of shingles ?

A

post herpetic neuralgia

36
Q

When can shingles cause problems?

A

is associated with motor nerves or ophthalmic division of trigeminal

37
Q

Shingles vaccine programme?

A
  • Although vaccination against the chickenpox in the UK is not routine, there is a high dose chickenpox vaccine given to those over 70 in the hope it reduces the chance of shingles developing
38
Q

What is Lyme Disease?

A
  • This is caused by a bacterial infection by Borrelia burgdorferi (spirochete bacteria)
  • Transmitted to humans following a bite from an infected tick
39
Q

Risk factors for Lyme disease?

A
  • Occupational and recreational exposure to woodlands and fields, particularly in areas with high incidences of infection
40
Q

Presentation of Lyme disease?

A
  • Early localised phase – days to weeks after initial infection – bullseye shape rash – erythema migrans – maybe also vague flu like symptoms
  • Early dissemination phase – weeks to months – spread through bloodstream – severe immune reaction – carditis, meningitis, arthritis, facial nerve palsy, fever, fatigue, flu like symptoms
  • Late dissemination – chronic arthritis
41
Q

Diagnosis of Lyme disease?

A
  • Diagnosis can be made in those with erythema migrans rash as this only occurs in Lyme disease
  • If Lyme disease is suspected in people without erythema migrans an ELISA for Lyme disease can be offered
42
Q

Management of Lyme disease?

A

Antibiotics – usually doxycycline or amoxicillin or ceftriaxone depending on what complications are present

43
Q

What is croup and what is it most commonly caused by?

A

Laryngotracheobronchitis
generally viral caused by parainfluenza

44
Q

What age groups are generally affected by croup?

A

children 6 months to 3 years

45
Q

Presentation of croup?

A
  • Characterised by a sudden onset of a seal-like barking cough, which may be accompanied by voice hoarseness, stridor and/or respiratory distress
  • Symptoms are typically worse at night and increase with agitation
  • Prodromal, non-specific upper respiratory tract symptoms e.g. cough, rhinorrhoea, coryza and fever may have been present between 12 and 72 hours
  • Buzzword: steeple sign on XR
46
Q

Seal like barking cough?

A

croup

47
Q

Steeple sign on XR?

A

croup

48
Q

Bronchiolitis vs croup?

A

bronchiolitis is lower resp and cause expiratory wheeze
croup is upper rest so cause inspiratory stridor

49
Q

Diagnosis of croup?

A

can usually be diagnosed on clinical history, investigations rarely helpful

50
Q

What is bronchiolitis? What group does it tend to occur in?

A
  • Lower respiratory illness that involves acute inflammatory injury of the bronchioles usually due to infection with RSV
  • Occurs in babies under 18 months old
51
Q

Presentation of bronchiolitis?

A

NICE guidelines advise it should be considered in children under the age of 2 presenting with:
* Persistent cough and
* Either tachypnoea or chest recession (or both) and
* Either wheeze or crackles on chest auscultation (or both)

Other features – wet cough, fever, poor feeding, very young babies may present solely with apnoea

52
Q

Investigations for bronchiolitis?

A
  • Pulse oximetry
  • Viral throat swabs for respiratory viruses
  • CXR and bloods are not advised for routine management unless there is evidence of deterioration and worsening respiratory distress
53
Q

Management of bronchiolitis?

A
  • Most infants have mild self limiting illness that can be managed at home
  • Mainstay of treatment is supportive
  • Anti-pyretics only needed if temperature causing distress to the child
  • In secondary care supportive is still mainstay, high flow nasal oxygen or CPAP may be used
  • Most children make a full recovery in a week

GP (9 decks)

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