Infections in Primary Care

Question 1

Presentation of mastitis?

Answer 1

Painful, red, hot, tender breast.
May have fever and malaise.

Question 2

Management of mastitis?

Answer 2

First line - continue breast feeding and use analgesia and warm compress.
If systemically unwell, nipple fissures present or symptoms not improved in 12-24hr of milk removal then start abx - flucloxacillin for 10-14 days.

Question 3

What are the different types of conjunctivitis and how do they present?

Answer 3

Bacterial - purulent discharge. Eyes may be stuck together in the morning.
Viral - serous discharge, recent URI and preauricular lymphadenopathy

Question 4

What is the management of infective conjunctivitis?

Answer 4

Normally self limiting condition which settles without treatment in 1-2 weeks.
Topical chlorampenicol can be given, fusidic acid is an alternative for pregnant women.
Avoid contact lens during infection.
Do not share towels.
School exclusion not needed

Question 5

What is croup and what is the most common cause?

Answer 5

URTI of toddlers and infants. Characterised by stridor (caused by laryngeal oedema and secretions).
Parainfluenza virus is the most common cause.

Question 6

What are the presenting features for croup?

Answer 6

Cough - barking, seal-like cough which is worse at night.
Stridor - avoid throat examination due to risk of precipitating obstruction.
Fever,
Coryzal symptoms.
Increased work of breathing.

Question 7

What are the features of mild croup?

Answer 7

Occasional barking cough

No audible stridor at rest (no extra sounds)

No or mild suprasternal and/or intercostal recession (no effort)

The child is happy and is prepared to eat, drink, and play (alert)

Question 8

What are the features of moderate croup?

Answer 8

Frequent barking cough

Easily audible stridor at rest (intermittent)

Suprasternal and sternal wall retraction at rest (increased effort)

No or little distress or agitation

The child can be placated and is interested in its surroundings (uninterested)

Answer 9

Frequent barking cough

Prominent inspiratory (and occasionally, expiratory) stridor at rest

Marked sternal wall retractions

Significant distress and agitation, or lethargy or restlessness (a sign of hypoxaemia)

Tachycardia occurs with more severe obstructive symptoms and hypoxaemia

Question 10

When should you admit a child with croup?

Answer 10

If moderate or severe.
If < 3 months of age.
If they have known upper airway abnormalities.
Uncertainty about diagnosis.

Question 11

What are the investigations for croup?

Answer 11

Clinical diagnosis but can do CXR:
Steeple sign in PA view (subglottic narrowing).
Thumb sign in lateral view (swelling of epiglottis).

Question 12

What is the management of croup?

Answer 12

Single dose of dexamethasone to all children regardless of severity. Observe for 30mins after.
Emergency - high flow oxygen and nebulised adrenaline.

Question 13

Describe features of pityriasis versicolor

Answer 13

Malassezia furfur infection which presents with scaley patches of hypopigmentation, pink or brown and mild pruritis.
Management - topical ketoconazole. If fails to respond then skin scrapings and oral itraconazole.

Question 14

Describe features of tinea capitis?

Answer 14

Presentation - hair loss, scaling. Less commonly itching and pain. If untreated can present with kerion (boggy mass of inflammatory tissue).
Ix - Skin scrapings.
Rx - Oral antifungals (terbinafine) and ketoconazole shampoo.

Question 15

Describe features of tinea corporis

Answer 15

Also known as ringworm.
Present with annular, erythematous lesions with papules and pustules.
Treat with fluconazole

Question 16

Describe features of tinea pedia

Answer 16

Athletes foot
Characterised by itchy, peeling skin between the toes.

Question 17

Describe features of folliculitis

Answer 17

S.aureus infection of hair follicles.
It results in papules and pustules anywhere on the body except for palms and soles of feet.

Question 18

What is the management of folliculitis?

Answer 18

Topical antibiotics and an antibacterial soap (chlorhexadine solution).
Oral antibiotics can be used in severe cases or those which do not respond to topical abx.

Question 19

Presentation and treatment for impetigo?

Answer 19

Golden crusted lesions typically around the mouth. Very contagious and typically caused by S. aureus of s.pyogens.
Treatment:
1. Hydrogen peroxide cream
2. Topical fusidic acid or mupirocin.
3. If extensive then oral fluclox or erythromycin.

Question 20

Impetigo and school exclusion?

Answer 20

Until all lesions have crusted and healed or 48 hours after commencing abx treatment

Question 21

Presentation of infectious mononucleosis

Answer 21

Triad: sore throat, pyrexia and lymphadenopathy (both anterior and posterior chains)
Palatal petechiae,
Splenomegaly (50%),
Hepatitis (rise in ALT),
Lymphocytosis
Haemolytic anaemia
Maculopapular rash if take amoxicillin.

Question 22

Investigations for infectious mononucleosis

Answer 22

Heterophile antibody test (monospot test).
Recommended in the 2nd week of illness.

Question 23

Management of infectious mononucleosis?

Answer 23

Supportive - rest, analgesia, fluids.
Avoid contact sports for 4 weeks.

Question 24

What are the clinical features of influenza?

Answer 24

Fever > 37.8
Nonproductive cough,
Myalgia,
Headache,
Malaise,
Sore throat,
Rhinitis

Question 25

What are the complications of influenza?

Answer 25

Pulmonary - secondary bacterial pneumonia, worsening of chronic conditions.
Cardiovascular - Myocarditis, heart failure.
Neurological - encephalopathy.
GI - Anorexia and vomiting