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Phase 1c: Conditions > Infections and Immunology > Flashcards

Infections and Immunology Flashcards

1
Q

How does varicella zoster present?

A

Fever
Itch
General fatigue and malaise
Widespread, erythematous, raised, vesicular (fluid filled), blistering lesions - stop being contagious when they scab over

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2
Q

What are the complications of varicella zoster?

A

Bacterial superinfection
Dehydration
Conjunctival lesions
Pneumonia
Encephalitis (presenting as ataxia)
Ramsay Hunt syndrome
Shingles

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3
Q

How is chickenpox managed?

A

Usually does not require treatment
Aciclovir in immunocompromised patients
Calamine lotion

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4
Q

what are the features of shingles?

A

unilateral vesicular rash that follows dermatomal distribution
painful rash that does not cross the midline

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5
Q

how is shingles managed?

A

paracetamol and NSAIDs
oral aciclovir

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6
Q

What is Ramsay Hunt syndrome?

A

Reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve

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7
Q

What are the features of Ramsay Hunt syndrome?

A

Auricular pain
Facial nerve palsy
Vesicular rash around the ear
Vertigo and tinnitus

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8
Q

How is Ramsay Hunt syndrome managed?

A

Oral aciclovir
Corticosteroids

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9
Q

What causes infectious mononucleosis?

A

Epstein-Barr Virus

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10
Q

What are the symptoms of infectious mononucleosis?

A

Symptoms usually resolve after 2-4 weeks
Sore throat
Lymphadenopathy
Fever and malaise
Transient macular rash
Mild hepatosplenomegaly

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11
Q

How is infectious mononucleosis investigated?

A

Heterophil antibody test (Monospot test) - 2nd week of illness, repeat if negative after 5-7 days
FBC (raised lymphocytes)

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12
Q

How is infectious mononucleosis managed

A

Conservative management
Analgesia
Avoid ampicillin and amoxicillin - can cause an itchy maculopapular rash
Avoid contact sports for at least 3 weeks (due to risk of splenic trauma)

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13
Q

What is the first and second most common cause of tonsillitis in children?

A

Streptococcus pyogenes is most common
Streptococcus pneumoniae is second most common

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14
Q

What are the symptoms of tonsillitis?

A

Sore throat
Fever (above 38°C)
Pain on swallowing
Anterior cervical lymphadenopathy

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15
Q

How is the cause of tonsillitis determined?

A

Centaur score will determine bacterial vs viral - give antibiotics if score 3 or more
Fever over 38ºC
Tonsillar exudates
Absence of cough
Tender anterior cervical lymph nodes (lymphadenopathy)

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16
Q

How is tonsillitis treated?

A

Phenoxymethylpenicillin for 10-day course
Clarithromycin if allergic
ONLY IF BACTERIAL TONSILLITIS

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17
Q

What is anaphylaxis?

A

Type 1 IgE-mediated hypersensitivity reaction to certain triggers

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18
Q

What are the symptoms of anaphylaxis?

A

Widespread urticaria, itching and flushing
Angio-oedema
Sneezing
Wheeze
Abdominal pain, nausea, vomiting, diarrhoea
Tachycardia and hypotension

19
Q

How is anaphylaxis managed?

A

IM adrenaline (500 mcg in adults, in thigh)
Antihistamines, e.g. oral chlorphenamine or cetirizine
Steroids, e.g. IV hydrocortisone
Lie patient flat and raise legs
IV fluids if hypotensive

20
Q

What are the symptoms of HIV?

A

Initial flu-like illness 3-12 weeks after infection
Fevers, night sweats, weight loss
Maculopapular rash
Lymphadenopathy
Sore throat
Mouth ulcers
Diarrhoea
TB
Genital STIs

21
Q

How is HIV investigated?

A

HIV p24 antigen and HIV antibody test (IgG, IgM)
ELISA
CD4 count

22
Q

How is HIV managed?

A

2 nucleoside reverse transcriptase inhibitors (NRTIs) and one protease inhibitor (PI) or non-nucleoside reverse transcriptase inhibitor (NNRTI)
If CD4 <200, give co-trimoxazole as prophylaxis against Pneumocystis jiroveci pneumonia

23
Q

How is HSV transmitted?

A

Via direct contact with mucosal tissue or secretions of another infected person
HSV-1: usually in childhood via saliva
HSV-2: through genital contact

24
Q

How does genital herpes present?

A

Painful genital ulcers
Neuropathic pain
Dysuria and pruritis
Fever
Inguinal lymphadenopathy
Constipation, rectal pain, tenesmus, proctitis

25
Q

How does herpes labialis present?

A

Painful oral ulcers
High fever
Sore throat
Pharyngeal oedema
Myalgia
Cervical lymphadenopathy

26
Q

What are the risk factors for recurrence of HSV?

A

Menstruation
Stress
Minor trauma
Sun exposure

27
Q

How is genital herpes treated?

A

Oral aciclovir for 5 days
Topical lidocaine for symptomatic relief

28
Q

What are the types of necrotising fasciiitis?

A

Type 1: polymicrobial infection caused by mix of aerobes and anaerobes - more common, occurs post-surgery in diabetics
Type 2: streptococcus pyogenes

29
Q

What are the risk factors for necrotising fasciiitis?

A

Diabetes mellitus (particularly if treated with SGLT-2 inhibitors)
CKD
Alcohol excess
Increasing age or frailty
Malnutrition
Metastatic cancer
Immunocompromised

30
Q

What are the features of necrotising fasciitis?

A

acute onset
pain, swelling, erythema at the affected site
pain out of keeping with clinical signs
fever and tachycardia

31
Q

How is necrotising fasciiitis treated?

A

urgent surgical referral debridement
intravenous antibiotics

32
Q

what are the features of peritonsillar abscess?

A

severe throat pain, which lateralises to one side
deviation of uvula to unaffected side
trismus (difficulty opening mouth)
reduced neck mobility
fever, chills, malaise

33
Q

how is peritonsillar abscess treated?

A

needle aspiration or incision and drainage and IV antibiotics
consider tonsillectomy

34
Q

what are the features of measles?

A

prodromal phase: fever, irritable, conjunctivitis
Koplik spots: white spots on the buccal mucosa (pathognomic)
discrete maculopapular rash - begins behind ears and spreads to rest of body

35
Q

how is measles investigated?

A

IgM antibodies can be detected a few days from disease onset

36
Q

what are the complications of measles?

A

otitis media (most common complication)
pneumonia (most common cause of death)
encephalitis
subacute sclerosing panencephalitis
keratoconjunctivitis
febrile convulsions
diarrhoea
myocarditis

37
Q

how is measles managed?

A

self-resolving after 7-10 days of symptoms
isolate until 4 days after onset of symptoms
notifiable disease

38
Q

what organism causes scarlet fever?

A

scarlet fever is a reaction to erythrogenic toxins produced by Group A haemolytic streptococci - usually Streptococcus pyogenes

39
Q

what are the features of scarlet fever?

A

red-pink, blotchy macular rash with rough ‘sandpaper’ skin - starts on the trunk and spreads outwards
red, flushed cheeks
fever
lethargy, headache, nausea, vomiting
sore throat
‘strawberry’ tongue
cervical lymphadenopathy

40
Q

how is scarlet fever investigated?

A

throat swab - commence antibiotics immediately

41
Q

how is scarlet fever managed?

A

oral penicillin V for 10 days - azithromycin if allergic
children can return to school 24 hours after starting antibiotics
notifiable disease

42
Q

what are the features of rubella?

A

caused by togavirus
prodrome, e.g. low-grade fever
maculopapular rash - initially on face, spreads to rest of the body (lasts 3 days)
lymphadenopathy

43
Q

what are the complications of rubella?

A

arthritis
thrombocytopaenia
encephalitis
myocarditis

Phase 1c: Conditions (18 decks)

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