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ICP EJR > Infections > Flashcards

Infections Flashcards

1
Q

What are the two most common causative pathogens in Infective Endocarditis?

A
  1. a-Haemolytic Streptococcus

2. Staph. Aureus

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2
Q

What are the risk factors for Infective Endocarditis?

A
  1. Prosthetic valves
  2. Rheumatic fever (damaged valves)
  3. IVDU (needles contaminated with bacteria- primarily affects tricuspid valve as users inject into venous system)
  4. History of endocarditis
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3
Q

Which valves are most commonly affected by Infective Endocarditis?

A

Aortic and Mitral valves

Tricuspid in IVDU as they inject into venous system

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4
Q

What causes Non-bacterial Thrombotic Endocarditis and what is its clinical importance?

A

Occurs in a hypercoagulable state:

  1. Cancer (advanced malignancy)
  2. DIC
  3. Sepsis

Clinically important as it results in emboli.

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5
Q

What are the symptoms of Infective Endocarditis?

A 
Fever
Chills
Night sweats
Headaches
SoB on exertion
Tiredness
Heart failure symptoms can be caused by a regurgitant valve.
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6
Q

What are the signs of Infective Endocarditis?

A

Murmurs
Tachycardia
Splenomegaly
Skin: Splinter Haemorrhages, Petechiae, Janeway lesions (5%), Osler’s nodes (15%)
Roth Spots
Renal: Microscopic heamaturia, renal impairment
Clubbing (in longstanding disease only)

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7
Q

What is the diagnostic criteria for Infective Endocarditis?

A

DUKES Classification:

  • Major criteria:
    1) +ve blood culture of typical organism from two separate tests.
    2) +ve echocardiogram showing evidence of endocardial involvement via vegetation, an abscess, or new valve regurgitation.
  • Minor criteria (5/6 if no major criteria):
    1) Predisposing condition or IVDU
    2) Fever
    3) Vascular phenomena- emboli etc.
    4) Immunological phenomena- osler’s nodes etc.
    5) Microbiological evidence= +ve culture
    6) Endocardiogram not quite meeting major criteria
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8
Q

Infective Endocarditis investigations and results?

A 
WCC increased
Urea and Creatinine increased
ESR raised, high
CRP raised
Urine: Proteinuria, microscopic haematuria (50%)
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9
Q

Infective endocarditis treatment?

A

Abx for 4-6 weeks.

  1. Gradual onset- unlikely staph- Benzylpenicillin + Gentamicin
  2. Acute onset/ skin trauma- Flucloxacillin + Gentamicin
  3. Resistance/ staph (recent valve replacement or IVDU)- Vancomycin + Gentamicin
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10
Q

What are the possible complications of Infective Endocarditis?

A

Myocardial abscess- suppurative pericarditis
Valve rupture
Systemic emboli- Left side= kidney infarct, irght side= PE

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11
Q

What are the common causative organisms for an infection of the nasopharynx?

A

Rhinovirus
Coronavirus
Staph. Aureus

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12
Q

What are the common causative organisms for an infection of the oropharynx?

A

Group A strep.
Diptheriae
Epstein-Barr virus
Adenovirus

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13
Q

What is the most common causative organism for an epiglottitis infection?

A

Haemophilus influenza type B

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14
Q

What are the common causative organisms for an infection of the middle ear (otitis media)?

A

Haemophilus influenza
Strep. Pneumoniae
Staph. Aureus

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15
Q

What are the common causative organisms for an infection of the sinuses?

A

Haemophilus influenza

Staph. Aureus

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16
Q

What is the most common causative organism for an infection of the pharynx?

A

Strep. Pyogenes

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17
Q

What is the presentation of acute bronchitis?

A

Cough
SoB
Wheeze
Pyrexial

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18
Q

What is the cause of acute bronchitis, and does it require treatment?

A

Most commonly viral (Will present with purulent sputum if bacterial)
Usually self-limiting

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19
Q

What is the presentation of pneumonia?

A

Productive cough with purulent sputum (if bacterial, which it usually is) and possibly haemoptysis
Pleuritic chest pain
SoB
Fever
Malaise
Anorexia
May be: Confused, tachypnoeic, tachycardic, hypotensive

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20
Q

What are the chest signs in pneumonia?

A 
Expansion reduced
Percussion dull
Vocal resonance increased
Bronchial breathing
Pleural rub
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21
Q

How is a pneumonia diagnosis confirmed?

A

CXR

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22
Q

What are the common causative organisms for CAP?

A
  1. Strep pneumoniae (gram +ve) (rust coloured sputum)
  2. Haempohilus influenzae (gram -ve)
  3. Moraxella catarrhalis (gram -ve)
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23
Q

What is the scoring system used to gauge the severity of a CAP infection and what are its components?

A 
Confusion (AMT < 8)
Urea > 7 mmol/L
Resp. rate >30 bpm
Blood pressure < 90mmHG sys/ < 60mmHg dias
65 years old or greater 
(Score correlated to mortality and used for admission)
0-1 = outpatient
2 = inpatient
3 or more = consider ICU
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24
Q

What is the definition of a HAP?

A

Pneumonia acquired 48hrs after admission

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25
Q

What are the most common causative organisms of a HAP?

A 
Most commonly gram -ve enterobacteriae:
E. Coli
Klebsiella pneumoniae
Pseudomonas aeruginosa (CF)
Staph. Aureus
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26
Q

What is the most common cause of tuberculosis?

A 
Mycobacterium Tuberculosis (large non-motile rod shaped gram +ve bacterium)
Obligate aerobe therefore found in the well ventilated upper lobes
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27
Q

How does TB spread?

A

Via airborne droplet nuclei

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28
Q

What it the pathogenesis of TB?

A

Droplet nuclei inhaled, travel to alveoli (not v infectious, need 8 hrs/ day contact)
2-8 weeks: Macrophages ingest/ surround the bacilli, forming granulomatous inflammation.
If the immune system cannot contain the bacilli they multiply rapdily causing active TB (which is infectious)

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29
Q

What are the symptoms of TB?

A 
Persistent cough >3 weeks with sputum/ heamoptysis (gradual onset)
Dyspnoea
Weight loss
Drenching night sweats
Fever
Lethargy
Unexplained pain
Extra-pulmonary TB (usually non-infectious): Swollen lymph nodes, weakened bones, abdo pain, vomiting, diarrhoea, rectal bleeding, headache, confusion, blurred vision
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30
Q

What are the clinical signs of TB?

A 
Pleural effusion
Cervical lymphadenopathy 
Mediastinal/ hilar lymphadenopathy 
Cachexia
Ascites
Mono-arthritis
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31
Q

What investigations are used to diagnose TB?

A

Interferon Gamma release assays
Mantoux test (false +ve if BCG vaccinated, false -ve if very recent infection)
Multiple sputum samples
CXR- consolidation + cavities in mid/upper zones
CT scan- ‘tree in bud’ sign- airway obstruction due to infection

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32
Q

How does the BCG vaccine work?

A

Made from attenuated mycobacterium bovis.

70-80% effective

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33
Q

How is TB treated and what are the side effects?

A 
2 months of:
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
4 further months of :
Rifampicin Isoniazid
Side effects: Itching, rashes, nausea &amp; vomiting, peripheral neuropathy, colour blindness, hepatitis
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34
Q

What is the most common cause of Acute Cholecystitis?

A

Gallstones blocking the cystic duct.

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35
Q

What are the symptoms of Acute Cholecystitis?

A

Biliary colic- RUQ pain/epigastrium pain- radiates towards the right scapula (Boas’ sign- right phrenic nerve irritation)
Tender/ swollen/ hot
Worse on breathing/ moving
Worse on eating fatty foods (gall bladder stimulated to contract by CCK from the pancreas)
Nausea+ vomiting
Diarrhoea

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36
Q

What are the clinical signs of Acute Cholecystitis?

A

Murphy’s sign +ve: Place hand below right costal margin and ask patient to breath in. They will catch their breath as their gallbladder hits your fingers.
Fever
*Courvoisier’s law: Painless enlarged gallbladder + jaundice is unlikely to be gallstones, more likely cancer of lower biliary tree.

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37
Q

What investigations give abnormal results in Acute Cholecystitis?

A

WCC increased
AST raised
ALT raised

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38
Q

How is Acute Cholecystitis managed?

A

Broad spectrum abx

Cholecystectomy (if symptomatic)

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39
Q

Which organisms can cause complications in an inflammed gallbladder?

A 
*KEEP* (infectious organisms of the gut)
Klebsiella pneumoniae
E. Coli
Enterococcus
Pseudomonas legionella
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40
Q

What are the symptoms of Ascending Cholangitis?

A

Charcot’s Triad:

  1. RUQ pain
  2. Fever (rigors)
  3. Jaundice (due to obstruction of common bile duct)
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41
Q

What are the symptoms and signs of meningitis?

A

Headache
Pyrexia
Photophobia
Non-blanching rash (if meningococcal)
Neck stiffness
Focal Signs (hemiparesis/ opthalmoparesis)
+ve Kernig’s sign (inability to straighten leg when hip flexed to 90 degrees and neck/back pain when attempted)

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42
Q

How does a meningitis history proceed?

A

Prodrome (fever, lethargy etc.)
Meningism (headache, photophobia, neck stiffness etc.)
Raised ICP (drowsiness, irritability etc.)
Sepsis

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43
Q

What are the main bacterial causes of Meningitis?

A 
Neisseria meningitides (meningococcus)
Strep. pneumonia (pneumococcus)
Listeria monocytogenes
Haemophilus influenza
Mycobacterium tuberculosis (insidious onset 1-9 months)
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44
Q

What are the main viral causes of meningitis?

A 
Cytomegalovirus
Herpes simplex 
Varicella zoster
Enterovirus
HIV
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45
Q

What are the other causes of meningitis?

A

Fungal: cryptococcus neoformans
IV Amphotericin B 14 days then PO Fluconazole 8 weeks

Protozoa
Helminths (worm)
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46
Q

What changes to WBCs, Protein and Glucose would be seen on LP for meningitis caused by:

  1. Bacteria
  2. Virus
  3. TB
  4. Malignancy
A 
Bacteria= WBC markedly raised, Protein usually elevated, Glucose reduced
Viral= WBC raised, Protein often elevated, Glucose normal
TB= WBC elevated, Protein usually elevated, Glucose reduced
Malignant= WBC elevated, Protein elevated, Glucose reduced
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47
Q

How is meningitis managed?

A

Pre-hospital:
1.2g Benzylpenicillin IV/IM (1g cefotaxime if allergic)
1L IV fluid over 15 mins
Oxygen

Hospital:
ABC- 100% Oxygen, IV fluid, 2g cefotaxime
(If elderly/ suspected listeria also give 2g/hr ampicillin/ amoxicillin)
*If septic, don’t LP and instead give 2g cefotaxime and contact the critical care team.

Viral= aciclovir 10mg/Kg TDS

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48
Q

What are the signs and symptoms of Encephalitis?

A 
Focal neurology e.g. dysphagia
Seizures
Headache
Fever
(High mortality if untreated- 70%)
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49
Q

What’s the most common cause of Encephalitis?

A

Viral e.g varicella

TB, autoimmune can also be responsible

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50
Q

What is Status Epilepticus?

A

30 min continuous seizure/ multiple seizures over 30 mins without regaining consciousness

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51
Q

How do you manage Status Epilepticus?

A

ABC
Lorazepam 1-2mg IV
Phenytoin 15-30mg/kg loading dose then 100mg TDS
Fosphenytoin
Thiopentone/ propofol infusion- paralyse and ventilate (ITU)

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52
Q

What are the components of the GCS?

A

E(4)
Normal, Pain, Speech, None
V(5)
Normal, Confused, Words, Sounds, None
M(6)
Normal, localises to pain, withdraws, abnormal flexion, abnormal extension, none
3= deep coma, <8= Severe consciousness impairment

53
Q

How does a Septic Arthritis present and what are the risk factors?

A

Red, hot swollen joint

Often post-injury, in pre-existing disease, immunocompromised patients, diabetes, renal failure, prosthetic joints

54
Q

How do you investigate Septic Arthritis?

A

Joint aspiration (urgently) and culture
CRP may be normal
X-ray may be normal

55
Q

What are the common causative organisms of Septic Arthritis?

A

Staph Aureus (therefore treat empirically with flucloxacillin IV)
Strep
Neisseria gonococcus
Gram -ve bacilli (treat with cefotaxime)

56
Q

What is Sepsis?

A 
SIRS + suspected infective cause.
SIRS= 2 or more of:
Respiratory rate > 30bpm
Heart rate > 90 bpm
Temperature <36 or >38
WBC <4x10^9 or >12x10^9
57
Q

What is neutropenic sepsis?

A

Sepsis + ANC<1 (<1000 Neutrophils/mm3)

58
Q

What are the signs and symptoms of bacterial vaginosis?

A

50% asymptomatic
Offensive (fishy smelling) vaginal discharge
Vaginal irritation
Thin grey/white discharge

59
Q

What causes Bacterial Vaginosis?

A

Reduction in lactobacilli, overgrowth of anaerobic organisms in the vagina, an increase in pH.
(Gardnerella vaginalis, Provetella spp, Mycoplasma hominis, Mobiluncus spp)
Can arise and remit spontaneously regardless of sexual activity.

60
Q

What are the diagnosis criteria of Bacterial Vaginosis?

A 
Amsel's criteria (3 needed):
Thin grey/white discharge
\+ve amine test (fishy odour when alkali (10% KOH) added)
Clue cells on microscopy
pH of vaginal fluid > 4.5

Hay-Ison score can also be used to grade BV.

61
Q

How is Bacterial Vaginosis treated?

A 
Metronidazole 400mg BD 5 days or 2g stat.
Treat if:
Persistent symptoms
Pregnant
Pre-hysterectomy
62
Q

What are the complications of Bacterial Vaginosis?

A

Post TOP endometritis/PID

Recurrent late miscarriages

63
Q

What causes Candida (Thrush) infections and how common are they?

A

Candida albicans (fungal)

Majority of women will have minimum one symptomatic episode.

64
Q

What are the symptoms and signs of a Candida infection?

A 
Symptoms:
Itching
Vulval soreness
Superficial dyspareunia
Discharge

Signs:
Swelling
Linear fissures
Satellite lesions

65
Q

How are Candida infections diagnosed?

A 
Primary care:
Clinical diagnosis 
pH > 5
High vaginal swab +ve 
(Worth noting that 10-20% of women are asymptomatic vaginal carriers)
66
Q

How are Candida infections treated?

A

Don’t treat if asymptomatic

Antifungal pessary Clotrimazole (Canesten) +/- cream for external areas
or
Fluconazole 150mg stat. (avoid in pregnancy)

67
Q

What are the risk factors for a Candida infection?

A 
Diabetes 
Thyroid disease
Iron deficiency
Immunodeficiency
Corticosteroid use
Frequent abx use
68
Q

How does candida infection present in men and how is it managed?

A

Balanitis (mild) with pruritus
May be first sign of diabetes

Avoid irritants
Emolient +/- azole cream

69
Q

How does Trichomonas Vaginalis present in men and women?

A

Women- found in vagina and urethra- 50% asymptomatic
Vaginal discharge- offensive, yellow, thin, frothy
Vulval irritation
Superficial dyspareunia
Dysuria
Cervicitis with contact bleeding

Men- Infection of urethra- usually asymptomatic
Dysuria
Urethritis/ balanitis

70
Q

How is Trichomonas Vaginalis diagnosed and treated?

A

Diagnosis:
High vaginal swab
Visibly moving protozoa on a wet slide

Treatment:
Metronidazole 400mg BD 5 days

71
Q

What type of bacteria are Chlamydia Trachomatis?

A

Gram -ve

Obligate intracellular parasites

72
Q

What does perinatal transmission of Chlamydia Trachomatis cause?

A

Neonatal conjunctivitis in 30-50% of exposed babies, presenting in 2nd week of life
Less commonly pneumonitis between 4-12 wks of age

73
Q

What is the presentation of Chlamydia Trachomatis in women?

A 
80% asymptomatic
PMB/IMBO
Purulent discharge
Low abdo pain
Can cause proctitis
Tubal damage
74
Q

What is the presentation of Chlamydia Trachomatis in men?

A 
50% asymptomatic
Urethral discharge
Dysuria
Testicular/epididymal pain
Can cause proctitis
75
Q

How is Chlamydia Trachomatis diagnosed?

A

Nucleic Acid Amplification Tests (NAATs)
Usually with ‘First Void Urine’ (FVU)
CANNOT be diagnosed on genital swabs

76
Q

How is Chlamydia Trachomatis treated?

A

Azythromicin 1g stat
Doxycycline 100mg BD 7 days (not in pregancy/ breast feeding)

Alternatives:
Erythromicin 500mg BD 14 days (if poss. pregnancy/ breast feeding)
Erythromicin 500mg QDS 7 dyas
Ofloxacin 200mg BD/ 400mg OD 7 days
Women must be retested to make sure they are cured if erythromicin is used

Sexual partners should be treated even if tests are -ve.

77
Q

What are the possible complications of Chlamydial infection in pregnancy?

A

Low birth weight
Post-partum endometriosis
Neonatal conjunctivitis and pnuemonitis

78
Q

Which areas does Neisseria Gonorrhoea most commonly affect?

A

Mucosal surfaces of the genital tract, rectum, oropharynx and eye

79
Q

How is Gonorrhoea transmitted?

A

Sexually transmitted in adults

Perinatally transmitted resulting in eye infection in neonates

80
Q

What are the symptoms of Gonorrhoea?

A 
Urethral discharge/dysuria- mucoid and purulent
Vaginal discharge
Low abdo/pelvic pain
Rectal pain/discharge
Pharyngeal exudate
81
Q

How is Gonorrhoea diagnosed?

A

Men:
Urethral swab, gram stain + microscopy of discharge
Confirmed with culture/ NAAT
(If asymptomatic: NAATs)

Women:
Endocervical swab for culture and NAAT +/- a urethral culture
(If asymptomatic: Dual NAATs via vulvo-vaginal swab (also tests for chlamydia))

82
Q

How is Gonorrhoea treated?

A

Ceftriaxone 500mg IM stat + Azithromycin 1g PO stat (as 30% of patients are also infected with Chlamydia)

83
Q

Which organisms are commonly responsible for Epididymitis?

A

N. Gonorrhoea - 30-50% also have Chlamydia
Chlamydia Trachomatis - most common <35yo
E.coli, enterobacteria - usually > 35yo and/ or urinary tract abnormality
M. tuberculosis (Rare)

84
Q

What is the presentation of Epididymitis?

A

Usually unilateral
Scrotal swelling/pain
Erythema of overlying skin

85
Q

How is Epididymitis treated?

A

<35 and no urinary symptoms:
Doxycycline 100mg BD 14 days and review

> 35 and significant urinary symptoms, treat as complicated UTI

86
Q

Which types of the Herpesviridae family commonly cause infections in humans?

A 
HSV 1 (most cold sores)
HSV 2 (most genital herpes)
Varicella Zoster
EBV
CMV
87
Q

How is HSV transmitted?

A

Close physical contact when an infected individual is ‘shedding’ the virus. This is sporadic and not necessarily at the time of symptoms.

88
Q

How does HSV infection present?

A

70% asymptomatic
Can present with severe primary attack (fever, dysuria, lymphadenopathy, neuropathic pain in genital area, genital blisters)
Some develop minor lesions
Recurrent episodes usually mild:
Neuropathic prodrome, erythema and blisters
Resolves in 3-4 days

89
Q

Who is at risk of symptomatic recurrences of HSV?

A 
<20 years old
Severe first episode
Within 3 months of first episode
Genital HSV type 2 infection
HIV/ immunodeficiency
90
Q

How is HSV infection diagnosed?

A

Swabs taken from lesions for culture/PCR

91
Q

How is HSV infection treated?

A

Primary episode:
Aciclovir 400mg TDS 5 days/ 200mg 5x a day 5 days
Analgesics and bathing in dilute saline

Recurrent episode:
Antiviral not usually used
Analgesics and saline baths

Prolonged recurrence/ frequent (>6/year):
Aciclovir 400mg BD 6 months

92
Q

How is Hepatitis B transmitted?

A

Sexual transmission
Parenteral
Vertical (mother to infant)
(100 times more infectious than HIV)

93
Q

What is the incubation period of Hepatitis B?

A

1-6 months

94
Q

What is the presentation of Hepatitis B?

A 
(Most infants/children are asymptomatic)
Tiredness
Aches
Fever
Abdo pain
Jaundice
Dark urine
(Women more severe than men)
95
Q

What does a positive Hep B Surface Antigen (SAg) mean?

A

Positive in acute and chronic infection, appearing within 3 months and disappearing when resolved.

96
Q

What does Hep B Core Antibody (cAb) show?

A

+ve in both active and resolved infection.

-ve if vaccinated.

97
Q

What does Hep B Surface Antibody (sAb) show?

A

If alone, it is a marker of successful vaccination.

If accompanied by Hep B cAb it is a marker of resolved Hep B infection.

98
Q

What does Hep B Envelope Antigen (eAg) show?

A

High viral activity therefore a higher risk of complications.

99
Q

What are the symptoms of PID?

A 
Pelvic pain
Vaginal discharge
Deep dyspareunia
Heavy menses
IMB/PCB
100
Q

What are the signs of PID?

A

Uterine tenderness
Cervical excitation
Adnexal tenderness
Pyrexia

101
Q

What are the likely differentials of PID?

A 
Ectopic pregnancy
IBS
Endometriosis
Appendicitis
Ovarian cysts
Uterine cramps
102
Q

How is PID managed?

A

Ofloxacin 400mg 14 days + Metronidazole 400mg BD 14 days

103
Q

What is the organism responsible for Syphilis infections and how does it spread?

A 
Treponema pallidum (Spirochete)
Spreads through sexual contact, most infectious during primary and secondary phases
104
Q

How does primary Syphilis present?

A

Chancre (painless ulcer, clean base, discharging clear serum)
Regional lymphadenopathy

105
Q

How does secondary Syphilis present?

A 
Within 2 years of infection
Multisystem involvement:
Polymorphic rash (non-itchy)
Condylomata lata (warts on genitals)
Generalised lymphadenopathy
Mucocutaneous lesions
Also:
Alopecia, anterior uveitis, meningitis, cranial nerve palsies, hepatitis, splenomegaly, glomerulonephritis
106
Q

What are early and late latent syphilis?

A

Early Latent Syphilis:
+ve serological tests yet no clinical evidence of infection within the first 2 years of infection

Late Latent Syphilis:
+ve serological tests and more than 2 years duration/ symptoms or signs of late manifestation

107
Q

What are the three major clinical manifestations of symptomatic Late Syphilis?

A
  1. Neurosyphilis- dorsal column loss/ dementia
  2. Cardiovascular syphilis- aortitis leading to aortic regurg, aortic aneurysm and angina
  3. Gummata- inflammatory fibrous nodules and plaques, commonly in skin and bone
108
Q

How is Syphilis diagnosed?

A

Serological testing (normally +ve 4 weeks after infection, but can take up to 3 months. -ve in 15% with a chancre)

  1. Venereal Disease Research Laboratory (VDRL)
    - ve in old treated syphilis, false +ve <1%
  2. T. Pallidum Particle Assay (TPPA)
  3. Enzyme Immunoassay (EIA)
  4. IgM
    - ve in late latent syphilis and old treated syphilis
109
Q

How is Syphilis treated?

A

Early:
IM Benzathine Benzylpenicillin or IM Procaine
Benzylpenicillin 600mg 10 days

Late:
3 doses IM Benzathine Benzylpenicillin or IM Procaine over two weeks
Benzylpenicillin 600mg 17 daily

Oral doxycycline if allergic
Consider steroid to avoid acute febrile illness in conjunction with abx treatment (Jarisch-Herxheimer Reaction)

110
Q

What are the symptoms of urethritis?

A

Urethral discharge
Dysuria
(Women commonly asymptomatic)

111
Q

What are the signs of urethritis?

A

Urethral discharge

Meatitis (erythema of urethral meatus)

112
Q

What are the common pathogens responsible for urethritis?

A 
M. Gonorrhoea
C. Trachomatis
Mycoplasma Genitalium
HSV
Trichomonas Vaginalis (TV)
113
Q

How is urethritis investigated?

A

Symptomatic: Urethral swab for gram stain

Asymptomatic: Urine for dual NAATs test for C. Trachomatis and N. Gonorrhoea +/- urethral swab for N. gonorrhoea culture
MSU sample should be sent to rule out UTI

114
Q

How is urethritis treated?

A

Azithromycin 1g stat Doxycycline 100mg BD 7 days

115
Q

What causes external genital warts?

A

HPV (types 6 and 11)

Types 16, 18 = cervical cancer

116
Q

What are the symptoms and signs of a genital wart infection?

A 
Genital lumps, can be hard or soft
Bleeding, mainly urethral
Occasionally:
Itchy
Hyperpigmented
117
Q

How are genital warts treated?

A

Podophyllotoxin Warticon 0.15% cream 1 month (3 days on, 4 off- avoid in pregnancy/ nut allergy)
or
Weekly cryotherapy
or
Aldara (Imiquimod 5%- immune modulator- alternate days 1 month)

118
Q

Who tends to be affected by Acute Otitis Media (AOM)?

A

Children, typically 6-12 months, all by 5
Will affect 60% of children
(Due to short and horizontal ear canal)

119
Q

What are the symptoms and signs of Acute Otitis Media (AOM)?

A 
(Often bilateral)
Otalgia
Discharge
Deafness/ altered hearing
Pyrexia
Mastoid tenderness
Tympanic membrane (Can vary depending on severity):
Loss of light reflex/ lustre
Injection of small vessles
Redness/ fullness of drum
Bulging drum (possible with pus)
Perforation:
Through tympanic membrane- ottorhoea
Occasionally into mastoid sinus- mastoiditis- risk of meningitis
120
Q

What causes Acute Otitis Media?

A

Often follows URTI (virus travels up Eustachian tube)
Always viral AND bacterial:
V= rhinovirus, RSV, influenza
B= S. pneumoniae 30%, Branhamella Catarrhalis 20%, Group A haemolytic strep, H. influenza

121
Q

How is Acute Otitis Media managed?

A 
80% resolve in 48hrs
Abx:
(Reduce duration of pain, do not change risk of perforation)
Amoxicillin
Cephalosporin 2nd line
122
Q

What are the complications of Acute Otitis Media?

A

Perforation
Acute mastoiditis
Meningitis
Facial palsy

123
Q

What is HIV and what are the different types?

A

Single-stranded RNA retrovirus

HIV-1 Highly virulent/ transmittable- global
HIV-2 Less virulent/ transmittable- mostly West Africa and Portugal

124
Q

How do viral load values relate to detectability?

A 
< 50/ml            = Undetectable
< 500/ml          = Very low
< 5,000/ml       = Low
~ 50,000/ml     = Moderatley high
> 500,000/ml   = High
125
Q

How do CD4 counts correlate with the level of immune suppression?

A

800-1200/mm3 = Normal
> 500/mm3 = Minimal immune suppression
~ 350/mm3 = Moderate immune suppression
< 200/mm3 = Advanced immune suppression
(most AIDS diagnoses occur at <200/mm3)
< 50/mm3 = Very severe immune suppression

126
Q

What are the symptoms and signs of HIV infection?

A 
Non specific:
Fever, fatigue, rash, lympahdenopathy etc.
Opportunistic infections:
Pneumocystis jiroveci pneumonia (PCP)
Oesophageal candidiasis
etc.
127
Q

What are the components of HAART?

A

At least 3 antiretroviral drugs
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Protease inhibitors (PIs)

128
Q

What are the side effects of HAART?

A

Metabolic disturbance (raised LDL, insulin resistance etc.)
Peripheral neuropathy
Hepatitis

ICP EJR (1 decks)

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