Infectious diseases

Question 1

Describe the management of septic arthritis

Answer 1

If in doubt, start empirical IV antibiotics (after aspiration) until sensitivities are known
Antibiotics are required for a prolonged period, conventionally ~2 weeks IV, then if patient improves 2-4 weeks PO
Consider orthopod review – arthrocentesis, washout & debridement

Question 2

Describe the symptoms, investigations & management of osteomyelitis

Answer 2

Fever, local pain & erythema
CT/MRI/bone scan
Blood cultures, as well as bone cultures & biopsy -> identify the organism & sensitivities
Treatment = flucloxacillin & fusidic acid for at least 4-6 weeks, starting IV

Question 3

List clinical features of spondylodiscitis

Answer 3

Back/neck pain
Constant pain, more worse at night
Radicular pain radiating to chest or abdomen
Fever

Question 4

Describe the management of spondylodiscitis

Answer 4

Conservative – antibiotics & immobilisation of the spine
Surgery – radical surgical debridement, stable reconstruction

Question 5

List the clinical features of cellulitis

Answer 5

Erythema in the involved area, with poorly demarcated margins, swelling, warmth & tenderness
May be low-grade fever

Question 6

Describe the management of cellulitis

Answer 6

Flucloxacillin

Question 7

Define necrotising fasciitis

Answer 7

Rapidly progressive
Infection of the deep fascia causing necrosis of subcutaneous tissue

Question 8

Describe the management of necrotising fasciitis

Answer 8

Radical debridement +/- amputation
IV antibiotics – benzylpenicillin and clindamycin

Question 9

List the clinical features of cystitis

Answer 9

Frequency
Dysuria
Urgency
Suprapubic pain
Polyuria
Haematuria

Question 10

List the clinical features of pyelonephritis

Answer 10

Fever
Rigor
Vomiting
Loin pain/tenderness
Costovertebral pain
Associated cystitis
Septic shock

Question 11

List the clinical features of clostridium difficile

Answer 11

Watery diarrhoea
Mild -> fulminant colitis
Ileus
Toxic megacolon

Question 12

Describe the management of clostridium difficile

Answer 12

SIGHT – suspect, isolate within 2 hours, gloves and aprons, hand wash with soap, test immediately
Metronidazole PO
Severe – vancomycin PO

Question 13

Describe the management of meningitis

Answer 13

Start treatment immediately if suspected
Urgent abx treatment – benzylpenicillin, ceftriaxone

Question 14

List clinical features of encephalitis

Answer 14

Bizarre encephalopathic behaviour/consolidation
Decreased GCS/coma
Fever
Headache
Focal neurological signs
Seizures
History of travel or animal bite

Question 15

List investigations to do for suspected encephalitis

Answer 15

Bloods
Contrast-enhanced CT
LP
EEG

Question 16

Describe the management of encephalitis

Answer 16

Start aciclovir within 30min of the patient arriving
Supportive therapy – in high-dependency unit/ICU environment
Symptomatic treatment – phenytoin for seizures

Question 17

List investigations for fever in the returned traveller

Answer 17

Bloods – FBC, LFTs, U&Es
Malaria smears +/- antigen detection dipstick
Blood cultures x2
Urinalysis
Stool cultures +/- stool for ova, cysts and parasites
CXR
HIV, hep B, hep C and syphilis serology

Question 18

List clinical features of malaria

Answer 18

Abrupt onset of rigors followed by high fevers, malaise, severe headache & myalgia, vague abdominal pain, N&V
Diarrhoea
Jaundice and hepatosplenomegaly
Bloods – anaemia, thrombocytopenia, leukopenia & abnormal LFTs

Question 19

Describe the management for malaria

Answer 19

Uncomplicated falciparum – artemisinin combination therapies, if ACT unavailable -> atovaquone-proguanil, oral quinine sulphate plus doxycycline
Non-falciparum – chloroquine, primaquine (risk of haemolysis in G6PD deficiency so screen prior to use)

Question 20

List the clinical features of typhoid fever

Answer 20

Sustained fever
Anorexia
Malaise
Vague abdominal discomfort
Constipation/diarrhoea
Dry cough

Question 21

Describe the management of typhoid fever

Answer 21

IV ceftriaxone
Once sensitivities known, switch to PO ciprofloxacin or PO azithromycin

Question 22

Describe pyrexia of unknown origin

Answer 22

Temperature > 38 degrees on multiple occasions
Illness > 3 weeks duration
No diagnosis despite >1 week’s worth of inpatient

Question 23

Describe the management of patients with pyrexia of unknown origin

Answer 23

Aim to establish diagnosis, rather than treated blindly
Try and stay up to date on what tests have been done
Stable patients can be managed as outpatients following a period of observation in hospital