Infections

Question 1

Describe the causes of encephalitis

Answer 1

Infections:

• Viral: HSV 1 (most common), CMV, VZV
• Non-viral: any bacterial meningitis, TB, Lyme

Inflammatory:
-Autoimmune

Question 2

Describe the presentation of encephalitis

Answer 2

• Headache
• Confusion, reduced GCS
• Fever, tachycardia
• Focal neurology
• Seizures

Question 3

Describe the investigations for encephalitis

Answer 3

• History and examination + obs
• Urine dip
• Bloods: FBC, CRP, U+Es, LFTs, TFTs, clotting, B12, glucose, VBG, culture
• CT head
• LP

Question 4

Describe the management of encephalitis

Answer 4

A to E 
Call for senior help, neuro referral. HDU/ITU bed
1. IV fluids
2. IV aciclovir 10mg/kg every 8 hours 
Seizure Mx eg phenytoin

Question 5

Describe the differential diagnoses for encephalitis

Answer 5

Causes of encephalopathy/confusion:

• Infections/inflammation- encephalitis, sepsis
• Vascular/trauma: stroke, bleeds
• Metabolic: hypoxia, uraemia, liver failure, electrolytes, alcohol, glucose, B12
• Neoplasms
• Drugs
• Endocrine: Cushing’s, hypothyroidism

Question 6

Describe the causes of meningitis

Answer 6

Bacterial: N meningitidis, Strep pneumo, HiB, Listeria, E coli, GBS
Viral: Coxsackie, echovirus
TB

Question 7

Describe the presentation of meningitis

Answer 7

Acute constant severe headache
Neck stiffness
Photophobia 
Fever
Kernig's + (bending knees), Brudzinski's (lift head)
\+/- non-blanching purpuric rash

Question 8

Describe the investigations for meningitis

Answer 8

• History, examination, obs
• Bloods: FBC, CRP, U+Es, clotting, VBG, culture
• CT head
• LP

Question 9

Describe the LP results in meningitis

Answer 9

Bacterial: low glucose, high protein, high neutrophils
Viral: N glucose, high protein, high lymphocytes
TB: low glucose, high protein, high lymphocytes

Question 10

Describe the management of meningitis (in hospital)

Answer 10

A to E 
Admit
-IV BS antibiotics eg ceftriaxone 2g +/- ampicillin (if old)
-IV fluids
-Analgesia
*Dex if bacterial

Question 11

Which pathogen is responsible for epiglottitis?

Answer 11

Haemophilus influenzae B

Question 12

Describe the presentation of epiglottitis

Answer 12

Usually children, unvaxed

• Acutely unwell with fever
• Difficulty swallowing + drooling
• Stridor

Question 13

Describe the management of epiglottitis

Answer 13

A to E

• Essential to secure airway. Call anaesthetics
• Nebulised adrenaline
• IV/IM steroids
• IV cefotaxime

Question 14

Describe the management of meningitis in primary care

Answer 14

If signs of meningococcal disease, call 999
Give IM benpen
Otherwise, refer to ED urgently

Question 15

Describe the pathophysiology of toxic shock syndrome

Answer 15

Exotoxin mediated illness caused by Staph or Strep
Staph TSS is assoc with tampons + post-partum infections
-> immune system activation + release of cytokines
-> multi-organ dysfunction

Question 16

Describe the presentation of toxic shock syndrome

Answer 16

Non-specific: fever, aches, malaise, pain
-Vomiting, diarrhoea
-Rashes
-Shock 
-Difficulty breathing, hypoxia
etc

Question 17

Describe the investigations for TSS

Answer 17

• Urine dip, MCS
• Swab any wounds, sputum
• Bloods: FBC, CRP, U+Es, LFTs, clotting, glucose, VBG, culture
• CXR
• Consider imaging + LP if indicated (meningitic)

Question 18

Describe the management of TSS

Answer 18

A to E
Call for help. ITU needed
IV fluids, high flow O2 etc
IV antibiotics - clindamycin + Taz/vanc/carbapenem

Question 19

What is necrotising fasciitis? Describe the types

Answer 19

A life-threatening soft tissue infection
Type I: mixed anaerobic
Type II: monobacterial, usually Grp A Strep

Question 20

Describe the presentation of necrotising fasciitis

Answer 20

Rapidly progressive soft tissue infection (eg cellulitis): redness, swelling, warmth
+ Pain disproportionate to clinical findings
Fever
May very quickly become systemically unwell

Question 21

Describe the investigations for necrotising fasciitis

Answer 21

• Swabs
• Urine
• Bloods: FBC, CRP, U+Es, LFTs, clotting, glucose, G&S, VBG, culture
• CXR if indicated. ECG pre-op
• Imaging: CT

Question 22

Describe the management of necrotising fasciitis

Answer 22

A to E: supportive
Immediate surgical referral- do not wait for Ix
-IV fluids
-Analgesia
-IV BS Abx eg. Taz/ cef
-Urgent surgical debridement -> re-exploration

Question 23

What is the difference between per-orbital and orbital cellulitis?

Answer 23

Peri-orbital is superficial to septum (in the eyelid) and normal ocular function
Orbital is deep to septum, affects muscles + fat in the orbit. Usually arises from sinusitis. Compromises ocular function. Emergency

Question 24

Describe the presentation of pre-orbital and orbital cellulitis

Answer 24

Pre-orbital: redness of the eyelid, with minimal swelling/pain/fever. No ocular symptoms
Orbital: redness, swelling, pain, fever. Proptosis, ophthalmoplegia, visual loss

Question 25

Describe the investigations for orbital cellulitis

Answer 25

• Swab
• Bloods: FBC, CRP, U+Es, VBG, culture
• Imaging: CT, MRI

Question 26

Describe the management of pre-orbital and orbital cellulitis

Answer 26

Pre-orbital: oral ABx (adults), IV (kids)
Orbital:
-Refer to ED urgently to be seen by head + neck
-IV BS ABx +/- surgical drainage of abscess/orbital decompression