Infections Flashcards
Describe the most common cause of meningitis in children
Strep. Pneumonia
What is the most important sign in meningitis?
Neck stiffness
What is the first test in a child suspected of having meningitis with not rash?
Blood culture
If rash - antibiotics
What is the first-line treatment for viral meningitis?
Supportive care
Define the main line of treatment for herpes encephalitis
IV acyclovir
How do you manage TB meningitis?
Steroids and antituberculous drugs
Describe the most common neurological sequelae after meningitis
Deafness
What is the main symptom of herpes encephalitis?
Confusion
What does the CSF analysis of herpes encephalitis typically show?
++ lymphocytes & ++ RBCs
What is the treatment for acute adrenal crisis?
Steroids
Management** of adrenal crisis is with parenteral administration of corticosteroids. Hydrocortisone is the drug of choice for patients with known diagnosis of adrenal insufficiency, while dexamethaosne is the preferred medication for those without a previous diagnosis of adrenal insufficiency, because it is not measured in serum cortisol assays.
Do you give Rifampin or Ciprofloxacin as the first-line prophylaxis to close contacts of meningitis cases?
Rifampin
Describe the presentation of a child with acute sinusitis
Fever, headache, pain, and tenderness at the sinus
Describe the treatment for bacterial pharyngitis with strep pneumonia as the causative agent.
Treatment of choice is amoxicillin-clavulanate for 10 days.
What is the most common cause of bacterial pharyngitis?
Strep pneumonia is the most common cause.
How is a peri-tonsillar abscess diagnosed in a patient with bacterial URTI?
Presence of a deviated uvula during examination.
Define the first step in the treatment of a peri-tonsillar abscess.
Aspiration is the initial step, followed by tonsillectomy after 4 months if needed.
What is the recommended treatment for PCP pneumonia in an HIV patient?
Trimethoprim-sulfamethoxazole (TMP-SMX) is the treatment of choice.
Pneumocystis pneumonia (PCP) is characterized by several distinct symptoms. Here are the key ones:
- Cough: Usually dry and non-productive.
- Shortness of breath: Gradually worsening over days to weeks.
- Fever: Often low-grade but persistent.
- Chest discomfort: May be mild or severe.
- Fatigue: A significant drop in energy levels.
- Weight loss: Unintentional and noticeable over time.
- Night sweats: Common, especially in severe cases.
In severe cases, patients might experience hypoxemia (low blood oxygen levels) and require oxygen therapy, as depicted in the illustration.
Describe the management of HIV during pregnancy.
Antiretroviral therapy is taken by the mother during pregnancy, a cesarean section is performed during labor, and the baby is given zidovudine for 6 weeks after birth. Breastfeeding is not recommended.
How can perinatal transmission of HIV be most effectively prevented?
By ensuring the mother receives antiretroviral therapy during pregnancy.
What is the second most common route of HIV transmission?
Perinatal transmission.
What is the best screening test for HIV?
ELISA (Enzyme-Linked Immunosorbent Assay).
Describe the treatment for Influenza after the first 48 hours of symptom onset.
Only symptomatic treatment is recommended after 48 hours.
What is the first step in managing a peri-tonsillar abscess in a patient with severe respiratory distress?
Intubation is the initial step.
How is a diagnosis of viral pharyngitis confirmed?
Based on good general condition with a red, swollen throat and tonsils.
What is the most common cause of a false positive ELISA test for HIV?
False positive ELISA results are most commonly caused by other conditions.
Describe the best confirmatory test for HIV after a positive ELISA result.
Western Blot is the best confirmatory test for HIV.
What is the recommended test for confirming influenza infection?
Fast test followed by nasopharyngeal swab or viral culture for confirmation.
What is the first step in treating a peri-tonsillar abscess?
Aspiration is the initial treatment step.
How is bacterial pharyngitis differentiated from viral pharyngitis based on symptoms?
Bacterial pharyngitis presents with bad general condition, red swollen throat and tonsils with white spots, and cervical lymphadenopathy.
What is the management approach for a child suspected of having influenza after 48 hours of symptom onset?
Testing for influenza is recommended; medications are only effective within the first 48 hours.
Describe the post-exposure prophylaxis for HIV.
Post-exposure prophylaxis should be initiated promptly after potential exposure.
What is the treatment of choice for HIV-positive pregnant women during labor?
Cesarean section is recommended during labor for HIV-positive pregnant women.
How is a diagnosis of bacterial pharyngitis confirmed?
Rapid strep test is the best initial investigation, followed by throat culture for confirmation.
Describe the most common route of HIV transmission in Australia.
Sex
Do anal sex or oral sex pose a higher risk for HIV transmission?
Anal sex followed by oral sex
What is the hardest type of sex to transmit HIV through?
Vaginal sex
Can HIV be transmitted through kissing?
No
What is the likely diagnosis if a patient develops rash, sore throat, and lymphadenopathy with atypical lymphocytosis after traveling to Thailand?
HIV
What is the recommended treatment for primary syphilis?
IV penicillin single dose
What is the organism responsible for syphilis?
Treponema pallidum
What is the investigation of choice for primary syphilis?
In general practice, serological testing is essential for the diagnosis of all stages of syphilis. There are two types of serological tests available: treponemal and nontre- ponemal. Combinations of both are required for diagnosis and staging of disease (Table 2, Figure 3).
https://www.racgp.org.au › …PDF
Syphilis - Diagnosis and management in general practice - RACGP test)
What is the key word associated with primary syphilis?
Chancre
What is the treatment of choice for herpes simplex?
Oral acyclovir even in pregnancy
What is the characteristic symptom of cystitis?
Suprapubic pain with no fever
What is the most common organism causing UTIs?
E. coli
What is the Jarisch-Herxheimer reaction?
Fever and headache after giving penicillin
What is the treatment of choice for syphilis in patients with penicillin allergy?
Doxycycline
What is the difference between condyloma lata and condyloma acuminata?
Condyloma lata is associated with syphilis, while condyloma acuminata is caused by HPV
Describe the symptoms of a UTI
Very high fever, chills, flank pain
What does a urine analysis show in a UTI?
WBCs more than 10
In diagnosing a urinary tract infection (UTI), specific values in a urine analysis are important indicators. According to the RACGP guidelines and other medical sources:
- Leukocyte Esterase: A positive test indicates pyuria. The presence of any leukocyte esterase typically suggests a UTI.
- Nitrites: A positive nitrite test is a strong indicator of a bacterial UTI, as many gram-negative bacteria (e.g., E. coli) reduce urinary nitrates to nitrites. This test has a specificity of about 90-95% for UTIs.
- White Blood Cells (Pyuria): More than 10 white blood cells per high-power field (WBCs/HPF) in centrifuged urine is generally considered significant pyuria, indicating an infection.
- Bacteria: Significant bacteriuria is defined as the presence of more than 100,000 colony-forming units (CFUs) per milliliter (mL) of a single type of organism in a clean-catch urine sample.
- Red Blood Cells (Hematuria): The presence of more than 3 red blood cells per high-power field (RBCs/HPF) can indicate hematuria, which may be associated with UTIs, although it’s not specific to UTIs alone.
- Cloudiness: Cloudy urine due to the presence of bacteria, white blood cells, and pus.
These markers collectively help in diagnosing UTIs and guiding treatment decisions oai_citation:1,www.racgp.org.au oai_citation:2,RACGP - What to do about recurrent urinary tract infections oai_citation:3,RACGP - Paediatric urinary tract infections: Diagnosis and treatment. For further information, please refer to the RACGP guidelines on recurrent urinary tract infections.
What does a urine culture show in a UTI?
E. coli more than 100,000
Why are females at a higher risk of UTIs?
Due to having a short urethra
Why are pregnant individuals at a higher risk of UTIs?
Progesterone relaxes ligaments
How should urine samples be collected in adults?
Mid-stream collection
How should urine samples be collected in pediatrics under 1 year?
Suprapubic aspiration
What is the next step if urine sample collection fails in pediatrics?
Catheterization
When is a urine sample considered positive for a UTI based on WBC count?
More than 10 WBCs
When is a urine sample considered positive for a UTI based on E. coli count?
More than 100,000 E. coli
What is the recommended further investigation for children with UTIs?
Ultrasound is a must
What is the recommended treatment for cystitis as the first line?
TMP-SMX
What is the second-line treatment for cystitis?
Amoxicillin
What is the treatment for pyelonephritis with Ceftriaxone?
Ceftriaxone
What is the treatment for pyelonephritis with Amoxicillin and Gentamicin?
Amoxicillin and Gentamicin
What is the treatment for UTI in patients with end-stage renal disease as the first line?
Ciprofloxacin
What is the second-line treatment for UTI in patients with end-stage renal disease?
Cephalosporin
What is the third-line treatment for UTI in patients with end-stage renal disease?
TMP-SMX
What is the first-line treatment for cystitis in pregnancy?
Nitrofurantoin
What is the second-line treatment for cystitis in pregnancy?
Cephalexin
What is the third-line treatment for cystitis in pregnancy?
Amoxicillin-clavulanate
What is the first-line treatment for asymptomatic bacteriuria?
Nitrofurantoin
What is the treatment for pyelonephritis in pregnancy with IV cephalosporin?
IV cephalosporin
What is the most common cause of fever after a urological procedure?
Bacteremia
What is the treatment for fever post-urological procedure with amoxicillin and gentamicin?
Amoxicillin and gentamicin
If a patient develops a rash after taking ampicillin for URTI, what is the likely diagnosis?
Infectious Mononucleosis (IMN)
What is the causative agent of Infectious Mononucleosis (IMN)?
Epstein-Barr Virus (EBV)
What is the diagnosis for a patient with URTI, HSM, atypical lymphocytes, and negative heterophil antibody test?
Cytomegalovirus (CMV)
What is the most important investigation for Epstein-Barr Virus (EBV)?
Atypical lymphocytes and positive heterophil antibody test
What is the most specific investigation for Infectious Mononucleosis (IMN)?
EBV antigen
What is the recommended treatment for Infectious Mononucleosis (IMN)?
Supportive care
What is the most important advice for a patient with Infectious Mononucleosis (IMN)?
Avoid contact sports for 3-4 weeks
What is the likely diagnosis for a patient with chronic fatigue not related to exertion or relieved by rest after a recent URTI?
Chronic fatigue syndrome
Describe the presentation and diagnosis of a patient with dengue fever after returning from Thailand.
Headache, rash, joint and muscle pain, low platelets; diagnosed with dengue fever.
Describe the presentation and diagnosis of a patient with malaria after returning from Thailand.
Headache, rash, jaundice, joint and muscle pain, normal platelets, low RBCs; diagnosed with malaria.
What is the difference in platelet levels between malaria and dengue fever infections?
Malaria presents with normal platelets, while dengue fever shows decreased platelets.
What is the common causative agent of malignant otitis externa in diabetic patients?
Pseudomonas aeruginosa.
Describe the presentation and diagnosis of a diabetic patient with facial palsy and painful vesicular rash in and around the ear.
Painful vesicular rash in and around the ear, facial palsy; diagnosed with Ramsay Hunt syndrome.
What virus is commonly associated with Ramsay Hunt syndrome?
Herpes Zoster Virus (Varicella-Zoster Virus).
What is the likely diagnosis for a patient who returned from abroad with respiratory and hepatic symptoms?
Q-fever.
What is the probable diagnosis for a patient who returned from camping in West Australia with fever and rash? Joint pain
Ross River fever.
How is Lyme disease typically transmitted to humans?
Through a tick bite.
