ID Flashcards
What are the potential complications of traveller’s diarrhoea?
Dehydration
Post-infective IBS
Reactive arthritis/uveitis/urethritis = Reiter’s syndrome
GBS
How does chicken pox usually present?
Prodrome of fever and lethargy
Itchy vesicular rash which starts on face & chest, then spreads throughout the body
What are the potential complications of chicken pox infection?
Infected skin lesions Pneumonitis Encephalitis Myocarditis Hepatitis
Increased risk of the above in the immunocompromised and pregnant populations
What should you do if a pregnant woman is exposed to chicken pox and is unsure of her immunity status?
- Test for VZV IgG
- If not immune, give VZIG if <10d of exposure
- If symptomatic, give oral acyclovir
How long should people with chicken pox avoid contact with others?
Until lesions have all crusted over (usually about 5 days after rash appears)
How does shingles usually present?
In those who have already been exposed to VZV (due to reactivation in dorsal root ganglia)
Usually painful/itchy prodrome
Painful vesicular rash in dermatomal distribution
No crossing of the midline of the body
How is shingles treated?
Oral acyclovir
How does measles usually present?
Prodrome of fever, malaise, conjunctivitis, cough
Development of koplik spots in the mouth
Development of rash: mobiliform maculopapular rash which starts on the face and moves down the body
Rash lesions can merge together and become confluent
What are potential complications of measles?
Otitis media
Diarrhoea
Bacterial Pneumonia
Acute encephalitis
Pregnancy complications
What are symptoms of primary HIV infection?
Pharyngitis Lymphadenopathy Headache Mouth ulcers Flu-like symptoms
May present like glandular fever or flu
Which type of herpes is involved with oral ulcers, cold sores, eye and URT symptoms?
HSV 1
Which type of herpes is responsible for genital ulceration?
HSV2
Which antibiotic can precipitate a rash in glandular fever?
Amoxicillin
What is the recommended chemoprophylaxis of malaria?
Doxycycline
What are the typical symptoms of malaria?
Fluctuating temperature Headache Fever Fatigue Dry cough N+V Splenomegaly
Travel to endemic area
What is the treatment for threadworm?
Mebendazole
Whole family should be treated
What are symptoms of giardiasis?
Watery diarrhoea
Excessive flatulence
Generally picked up from contaminated water
What is the treatment for scabies?
Permethrin
What are symptoms of schistosomiasis?
Bloody diarrhoea
Haematuria
Hepatic fibrosis and portal hypertension
Pulmonary fibrosis
Space occupying lesion and seizures
How would you diagnose and treat candidaemia?
May grow in standard blood culture bottle
Presence of B-d-glucan in the blood
MEDICAL EMERGENCY
RX micafungin treatment until 2 weeks after cultures become negative
What are the most common bacterial causes of infective endocarditis?
Streptococcus viridans
Staphylococcus aureus in IVDUs
How is infective endocarditis diagnosed?
Blood cultures from 3 different sites at different times
Echocardiogram = gold standard diagnostic test
What tests should be ordered in suspected meningitis?
Blood cultures LP: culture + sensitivity, microscopy, gram stain, PCR, cells/protein/glucose/pressures Pneumococcal urinary antigen Viral and bacterial throat swabs Meningococcal PCR of blood or CSF
What are the most common bacterial and viral causes of meningitis?
Bacterial: Staphylococcus pneumoniae, neisseria meningitidis
Viral: herpes viruses (HSV 2), enteroviruses e.g. coxsackie
What is the most common bacterial cause of cellulitis?
Staphylococcus aureus
What is the first-line management of cellulitis?
Flucloxacillin
Clarithromycin if penicillin allergic
Where in particular do we worry about the development of cellulitis?
Hands
- > very small spaces which can cause neuromuscular compromise if swollen
- > orthopaedic emergency which warrants admission for antibiotics and decompression/debridement
What antibiotic is first line for the treatment of animal bites?
Co-amoxiclav
What are the antibiotics of choice in MRSA?
Doxycycline in mild infections
Vancomycin in severe infections
What is the treatment for necrotising fasciitis?
Surgical debridement
Supportive IV antibioticss
What is the most common cause of secondary bacterial pneumonia following flu?
Staphylococcus aureus
What are the differential diagnoses for a hypoechoic lesion on liver ultrasound?
Hepatocellular carcinoma Liver metastases Pyogenic liver abscess Hyatid cyst Amoebic liver abscess
How are amoebic liver abscesses best treated?
Metronidazole
Drainage if complicated
What are the symptoms of amoebic liver abscess?
RUQ pain Fever (Jaundice is RARE) May have recent diarrhoea Travel to: India, America, Mexico, Central/South America
Disproportionately high ALP
What is the most common cause of infective mononucleosis?
Epstein-Barr Virus
What are the symptoms of mononucleosis?
Symptoms may last >1 month
Fever, malaise and fatigue
Lymphadenopathy, pharyngitis, tonsilitis, splenomegaly
How is mononucleosis diagnosed?
Often a clinical diagnosis
Monospot test: detects EBV antibodies
How is mononucleosis managed?
Supportive care: analgesia, fluids, antipyretics
No need to exclude from school/work but avoid sharing saliva
Avoid contact sport due to risk of splenic rupture
What are potential complications of mononucleosis?
GBS Meningitis/encephalitis CN7 palsy Splenic rupture Airway obstruction Burkitt lymphoma
Which HIV test results are always repeated?
Positive results are always repeated
Negatives are only repeated if <4 weeks from potential exposure
When are babies of HIV positive mothers tested?
birth, 6 weeks, 12 weeks
18 months
What is the advise regarding breastfeeding in HIV-positive mothers?
Generally advised to avoid
If adamant: viral load should be undetectable, no diarrhoea in either and no nipple lesions
What are the three most common classes of HAART therapy?
Reverse transcriptase inhibitors
Integrase inhibitors
Protease inhibitors
At what CD4 count should antibiotic prophylaxis against PJP be given?
What medication is used?
CD4 <200
Co-trimoxazole
How long after a potential exposure can PEP be given?
< 72 hours
Use condoms until confident this has been effective and no infection
What medication is used at PrEP in the UK?
Truvada
How is PJP diagnosed?
Sputum/BAL PCR
CXR- diffuse pulmonary infiltrates
CT- diffuse ground-glass opacities
B-d-glucan testing
