Infectious disease

Question 1

Malaria

Answer 1

Is the diagnosis until proved otherwise if there is a travel Hx in an endemic area (basically Africa, Middle East, Asia)

Fever, malaise, headache, vomiting, diarrhoea, paroxysmal fever

Confirmed with THICK AND THIN BLOOD FILMS

Faliparium = QUININE

Question 2

Malaria and fever timings

Answer 2

48 h for FALCIPARUM, VIVAX, and OVALE

72 h for MALARIAE

Question 3

Cholera

Answer 3

VIBRIO CHOLERAE (faeco-oral)

Mild diarrhoea OR profuse ‘rice-water’ diarrhoea, fever, vomiting

Question 4

Typhoid

Answer 4

SALMONELLA TYPHI )faeco-oral)

Gradual onset fever, headache, malaise, constipation/diarrhoea

maculopapular rash (rose spots over trunk)

Question 5

What is the Sepsis Six?

Answer 5

1) Administer high flow O2 to sats >94%
2) Take blood cultures
3) Administer IV antibiotics
4) Start IV fluid resus
5) Check lactate
6) Catheterise and monitor hourly urine output

Question 6

Molluscum contagiosum

Answer 6

Poxvirus (DNA virus)

Bowl-shaepd, umbilicated lesions

Common in KIDS

Think HIV / STI in adults

Question 7

Syphilis

Answer 7

Treponema pallidum (STD)

1) Painless ulcer on glans penis, vulva vaginalis, lips
2) Malaise, fever, pathognomic rash
3) CNS involvement (focal neurology/neurosyphilis), tabes dorsalis (incredible pain +/- gait ataxia)

****VDRL test apparently?

Treat with PENICILLIN –> Jarisch-Herxheimer reaction (anti-pyretics)

Question 8

Pregnant lady comes in with a UTI - which antibiotic do you prescribe?

Answer 8

Co-amoxiclav

Question 9

Which antibiotics are INHIBITORS of the cytochrome P450 system?

Answer 9

Quinolones (e.g. ciprofloxacin)

Macrolides (e.g. clarithromycin)

Metronidazole

Question 10

Which antibiotics are INDUCERS of the cytochrome P450 system?

Answer 10

Aminoglycosides (e.g. gentamicin)

Question 11

What constitutes SIRS?

Answer 11

2+ of:

Body temp >38 or <36
HR >90
RR >20 or PaCO2 <4.3
WCC >12 or <4

Question 12

What constitutes sepsis?

Answer 12

Features of SIRS

SOURCE OF INFECTION suspected/confirmed

Question 13

What constitutes severe sepsis?

Answer 13

Features of sepsis

BP <90 or drop of 40+ OR lactic acidosis

Question 14

What constitutes septic shock?

Answer 14

Features of severe sepsis

Organ hypoperfusion –> BP does not respond to fluid resus

Question 15

Gas gangrene

Answer 15

Muscle necrosis, gas production, sepsis

Caused by CLOSTRIDIUM PERFRINGENS

****BEST = x-ray may show gas under soft tissue

***Blood culture = clostridium species