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Medicine MBBS year 3 > Infection > Flashcards

Infection Flashcards

1
Q

Symptoms of vaginal candidiasis?

Management?

A

Vaginal itching or soreness
Abnormal vaginal discharge - cottage cheese appearance
Pain during sexual intercourse
Pain or discomfort when urinating

Antifungal topical cream, single dose of oral fluconazole

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2
Q

Oral candidiais treatment?

Complication of oral candidiasis?

A

Topical antifungal e.g. clotrimazole

Complications include esophageal candidiasis(dysphagia, odynophagia),

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3
Q

Symptoms of systemic candidiasis?
Risk factors?
Management?

A

Ranges from mild Fever to signs of sepsis e.g. hypotension.
Atypical findings= skin lesions and bisual changes

central venous catheters, exposure to broad-spectrum antibiotics, surgery, and immunosuppressant therapy, parenteral nutrition

Caspofungin 1st line. Amphotericin B second line
Remove central venous catheter, ophthalmological exam required

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4
Q

Differentiate between the types of necrotising fasciitis

A

Type I necrotising fasciitis is a polymicrobial infection. Occurs in diabetics, immunocompromised, vascular disease, following surgery. Fourniers gangrene = subtype in perinuem

Type II = a monomicrobial infection with Streptococcus pyogenes. Occurs in healthy people following skin injury

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5
Q

Necrotising fasciitis symptoms and management?

A

Anaesthesia or severe pain over the site of cellulitis indicates necrotising fasciitis.
Hypotension, fever

URGENT surgical debridement +/- amputation, IV antibiotics/antifungal e.g. benzylpenicillin and clindamycin

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6
Q

Brain abscess symptoms investigations and management

A

Headache, fever, focal neurological sign e.g cranial nerve palsy
Raised ICP signs - siezures, nausea, papilloedema

RF: ear infection, sinus infection, head trauma

1ST line = MRI with contrast - shows one or more ring enhancing lesions

IV vancomycin, metronidazole and Ceftriaxone
Craniotomy
If parasitic = antiparasitic
If fungal = antifungal

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7
Q

Mastitis symptoms and subtypes

A

Inflammation of breast with or without infection

ERYTHEMA
FLU LIKE SYMPTOMS
FEVER
PAIN

lactational or non-lactational mastitis which has subtypes

lactational mastitis:

  • first line is continue breastfeeding, analgesia
  • if no improvement in 24 hours, nipple fissure, systemically unwell, second line is oral flucloxacillin

Co-amoxiclav for non lactational mastitis

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8
Q

Symptoms of conjuctivitis and management

A

Allergic - itchy eyes, bilateral
Bacterial - pus - e.g. chlamydia trachomatis - eyelashes may eventually press into globe
Viral - Most Common - often adenovirus - sparse and watery mucous discharge,

Tender preauricular lymphadenopathy (viral>bacterial)

Allergic = topical mast cell stabilisers, antihistamines 
Bacterial = topical antibiotics - azithromycin opthalmic 
Viral = topical antihistamine
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9
Q

COVID-19 symptoms, investigation and management

A

fever, cough, dyspnoea, and loss of taste/smell

RT-PCR

Mild = home isolation 
Severe = enoxaparin thromboembolsim prophylaxis 
Critical = mechanical ventilation

Dexamethasone and tocilizumab used in the uk. Remdesivir, Ronapreve

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10
Q

Encephalitis symtoms, investigation and management?

A

rash, ALTERED MENTAL STATE (more common than in meningitis) motor or sensory deficits
Focal neurological deficit (altered behaviour and personality changes, speech or movement disorders)
Usually caused by viruses, HSV-1 most common cause

EEG shows background slowing, brain MRI>CT

CSF - will have increase in WBC and protein, low/normal glucose if it is a viral cause. elevated RBC

IV aciclovir, IV fluids

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11
Q

Hepes simplex virus investigations and management?

A

Viral culture
HSV polymerase chain reaction (PCR)
Serology gG1 and gG2

Oral acyclovir
IV if disseminated

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12
Q

MRSA infection presentation and management

A

MRSA infections can include syndromes of bacteraemia, pneumonia, endocarditis, joint infections, and skin or soft-tissue infections.

Common finding = pain at catheter site-> UTI, abcess

Blood, urine, tissue, sputum culture

Management = antibiotics

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13
Q

How is HIV treated?

A

HIV antibody testing
Bronchoalveolar lavage to diagnose PCP which occurs when CD4 count falls below 200

Antiretroviral therapy - consists of 3 drugs, 2 NRTIs and preferably an integrase inhibitor.
Other drugs include protease inhibitors, NNRTIs, entry inhibitors

Co-trimoxazole for PCP prophylaxis

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14
Q

Symptoms, investigations and management for C. Diff?

Complications?

A

New onset diarrhea, abdominal pain, leukocytosis

Stool polymerase chain reaction - looking for the toxin - positive

Treatment is to discontinue the inciting antimicrobial agent and start therapy with oral fidaxomicin or vancomycin or metronidazole.

Ileus, peritonitis, toxic megacolon = complications

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15
Q

Glandular Fever symptoms investigations and management

A

triad of fever, pharyngitis(sore throat, difficulty swallowing, petechiae may be present on soft palate), and generalised or cervical lymphadenopathy (tender, most commonly posterior chain)
Hepatosplenomagaly and hepatitis may occur

heterophile antibody test and serological test for antibodies against EBV
Throat swab to rule out strep.
Paul bunnel test - for EBV virus - not specific

Give painkillers
Avoid alcohol, contact sports, avoid amoxicillin

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16
Q

Malaria symptoms investigation and management?

A

Fevers, chills, sweats, Headache, weakness, myalgia
Anorexia, diarrhea
RF = travel history/endemic region

Giemsa-stained blood film = 1st line = ring form trophozoites or gametocytes seen

Uncomplicated disease, not pregnant = chloroquine, hydroxychloroquine
Sever disease or pregnant = artesunate,

17
Q

Meningitis symptoms investigation amd management

A

Viral meningitis usually due to entoroviruses (coxsackieviruses, echoviruses, and polioviruses)

Headache, neck stiffness, fever, photophobia, seizures

Brudzinskis sign - patient’s hips and knees to flex when the neck is flexed.

Kernigs sign - flexing the thighs at the hip, and the knees, at 90 degree angles, and assessing whether subsequent extension of the knee is painful

Lumbar puncture/ spinal tap = 1st line

bacterial meningitis = Ceftriaxone (+amoxicillin if 60 or older or immunocompromised)..
Viral = supportive care

Bacterial meningitis w non-blanching rash or menigococcal scepticemia
IV/ IM benzylpenicillin

18
Q

CSF intepretation: viral vs fungal vs bacterial meningitis

A

Bacterial - protein markedly increased, glucose decreased, PMNs high

Viral - glucose normal, wcc really high

Fungal -

19
Q

Symptoms of meningococcal disease?

Management?

A

Meningism + purpuric/ petechial rash

100% oxygen + IV/IM benzylpenicillin.

20
Q

Orbital and periorbital cellulitis findings investigations and management

A

Redness, SWELlING and painful eye

orbital cellulitis only= occular dysfunction - reduced visual acuity, proptosis, painful eye movements

RF = bacterial sinusitis, insect bite, chalazion, ear or face infection

CT sinus and orbits with contrast - mainstay for orbital cellulitis diagnosis
Opthalmological examination

IV antibiotics or oral for orbital cellulitis only

21
Q

Symptoms of peritonitis?

What investigations are carried out for the different subtypes and what are the findings?

A

Abdominal pain, tenderness, ascites, nausea, fever,
Guarding, rebound tenderness, abdominal tenderness on examiation

SBP - common bacterial infection in patients with cirrhosis and ascites. Usually gram -ve bacteria like ecoli.
Paracentesis -> absolute neutrophil count (ANC) >250 is diagnostic. Ascitic fluid may be hazy, cloudy, bloody. First line treatment is a 3rd generation cepholosporin like cefotaxime

Tuberculous peritonitis - CT scan may show enlarged abdominal lymph nodes. Adenosine deaminase level >39 units/L is highly suggestive

Secondary peritonitis - Polymicrobial growth, increased protein and LDH with decreased glucose in ascitic fluid culture = secondary peritonitis

22
Q

Signs of sepsis?

Management?

A

fever, tachycardia and hypotension are common

Oliguria, poor cap refill, altered mental status may also occur

Give oxygen and take blood cultures
IV fluid challenge
IV antibiotics - Anti-pseudomonal cover is important for people with suspected Neutropenic sepsis, so a first-line choice may be monotherapy with piperacillin/tazobactam

23
Q

Surgical site infection symptoms and management

A

redness, delayed healing, fever, pain, tenderness, warmth, or swelling.

Superficial SSI
Deep SSI
Organ or space SSI

Antibiotics +/- surgery

24
Q

Varicella Zoster restults in what conditions? How do you manage this?

A

Herpes zoster, also known as shingles, is caused by the reactivation of varicella zoster virus in already infected individuals. is characterised by a single dermatomal pain and papular rash. The pain typically precedes the rash by several days and can persist for several months after the rash resolves. Common complication is postherpetic neuralgia. Ophthalmic zoster can also occur

Chicken pox

Neonates and children 1-3 months = IV acyclovir

People at risk of moderate to severe disease (E.g. healthy patients age 13 or over) = Oral acyclovir

Children at low risk of severe disease = paracetamol, oral and topical diphenhydramine

25
Q

Viral gastroenteritis symptoms and management

A

Diarrhea <14 days, non-bloody
Vomiting, nausea, abdominal pain

usually norovirus

Oral rehydration therapy. Iv fluids if severe

26
Q 
Viral hepatitis A 
Mode of transmission 
Symptoms 
Investigation 
Management
A

Faecal oral mode

Abrupt onset fever, abdominal pain, malaise and jaundice (can be seen in all hepatitis virus subtypes)

Hepatomegaly and clay coloured stools can occur

IgM anti-hepatitis A virus serology is the test of choice for diagnosis.
Serum transaminases and bilirubin = elevated

Supportive care. Liver transplant if worsening jaundice

27
Q 
Viral hepatitis b
Mode of transmission 
Symptoms 
Investigation 
Management
A

Blood, sexual contact

Usually asymptomatic

VIRAL SEROLOGY - Hep B antibodies

Antiviral therapy - entecavir

28
Q

Hepatitis _ cause fulminant hepatitis in pregnant women

A

E

29
Q

Hepatitis _ only infects cells infected with Hep B

A

D

30
Q

Key causes of bloody diarrhea can be remembered using the acronym SSYCEE
Which stands for?

A

Salmonella, shigella, yersinia, campylobacter, EIEC and EHEC

31
Q

Name some causes of watery diarrhea

A

Cholera - rice water diarrhea (mostly water with flakes of mucus) - stool culture 1st line. Oral rehydration
ETEC - common cause of travellers diarrhea
Cdiff
Rotavirus - most important cause of infantile gastroenteritis - no testing needed - vaccine recommended
Norovirus
Giardia lamblia - watery foul smelling steatorrhea. stool microscopy (ova and parasite): positive for trophozoites. stool enzyme immunoassay:positive for Giardia antigen. Metronidazole treatment
Cryptosporidium - mild watery diarrhea, severe in AIDS

32
Q

Breast abscess treatment?

A

Drainage via needle aspiration or surgical drainage

Doxycycline

33
Q

How does dry gangrene present?

A

Necrotic/black area WELL demarcated from surrounding tissue. No signs of infection. Can auto-amputate

Ischeamic causes such as peripheral arterial disease, thrombosis eg hypercoagulable states, and vasospasm

34
Q

How does wet gangrene present?

A

Necrotic area is POORLY demarcated from surrounding tissue.

Patients are pyrexial/septic.

Surgical debridement/amputation/ IV antibiotics

35
Q

Viral Gastroenteritis

  • Symptoms and risk factors
  • common organisms and their classifications
A

Most COMMON = Norovirus
Gram negative CURVED ROD- Campylobacter(undercooked poultry, meat, unpasteurised milk)

Gram negative Bacilli - ecoli, salmonella, shigella, yersinia

Symptoms = diarrhoea (may be bloody), nausea/vomiting, abdominal pain

RFs: contaminated food/water, close contacts

Medicine MBBS year 3 (12 decks)

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