infectious diseases Flashcards
what does RILE stand for with regards to the heart
right murmurs loudest on inspiration, left murmurs loudest on expiration
Which valve does the patient lean forward for
Aortic
Which valve does the patient lean to the side for
mitral
Features of atypical pneumonia
dry cough, malaise, fever, joint pain, longer history
key things in cardiology exam
parasternal heave LHS, check for thrills over each valve
What does stoney dull indicate
pleural effusion
Things to remember from cardio exam that you need in resp
JVP and apex beat
Ptosis on respiratory exam
Horners syndrome, pancoast tumour
fever definitions
Continuous fever - fluctuates within 1 degree but remains high
Intermittent - fluctuates between baseline and high
Remittent - there is fluctuation but always 1 degree above baseline at least
systems review
CNS headache, seizures, neck stiffness, photophobia, vision changes. Skin - colour changes, rash, pruritis, tenderness. MSK - joint pain or mobility issues. GI- stool problems, abdominal pain. Resp- cough, SOB. Cardiac - chest pain, palpiatation, SOB. Urinary - dysuria, anuria, discharge, flank pain. Red flags- lumps and bumps, malignancy, fever, rash, weight loss, sweats. Metabolic - heat or cold intolerance, mood changes.
In general examination always mention
pulses
Jaundice associations -
changes in colour of urine and stools, itching of skin, dull achy pain in right hypochondrium, vomiting
Haemolysis history
= chills and back pain, blood problems, sickle cell, G6PH etc
Liver disease stigmata =
rectal varices, skin
investigation for TB patient
CXR and bronchoscopy
pyelonephritis treatment
co-amox IV
treatment for line infection with coagulating neg staph (neutropenic sepsis)
IV tazocin
What does this show
gametocyte = malaria
What does this show
Area of consolidation could be pneumonia in apex of right upper zone with effusion of horizontal fissure
organism and treatment
Group A streptococcus - gram positive cocci chains
IV benzylpenicillin/Flucloxacillin would be the appropriate choice
response to penicillin allergic reaction anaphylaxis
Allergic reaction - anaphylaxis to antibiotic
IM adrenaline 0.5mg in 500ml
Antihistamine, salbutamol nebulised, steroid treatment e.g. hydrocortisone
Stop antibiotic treatment
Falciparum malaria =
headphones on blood film (treatment is artemisinin (IV artesunate and PO Riamet)
Dengue features
Dengue = classically presents with rash
* Lasts 1-5 days
* Improves 3-4 days after rash
* Supportive treatment only
* Re infection can be dangerous
Fever, headache +/- abdo pain (dry cough) =
Fever, headache +/- abdo pain (dry cough) = Typhoid and paratyphoid/enteric fever (most common in Leic), faecal-oral (salmonella typhi)
* Invades Payer’s patches not mucosa (hence not necessarily diarrhoea)
* Low infectious dose, survives gastric acid, reside within macrophages
* Incubation 7-14 days
* 10% mortality
* +tive blood culture
* Treat with IV ceftriaxone or azithromycin (Meropenem if Ceftriaxone resistance)
* Takes 7-10 days to settle even with antibiotics
Difference between meningitis and encephalitis
Meningitis is inflammation of the meninges surrounding brain and spinal cord, encephalitis is inflammation of the brain itself
Meningitis: fever, headache, vomiting, photophobia, stiff neck
Encephalitis: altered consciousness, seizures and focal deficits
Immediate management of meningitis
Single dose of parenteral benzylpenicillin IV/IM
Corticosteroids
Paracetamol for temperature
Oxygen/fluids/pain relief if indicated
Investigations to confirm meningitis diagnosis
Blood culture
CT scan
Spinal tap - cerebrospinal fluid culture
Examples of notifiable diseases
Botulism, legionnaires disease, measles, TB
CSF result in meningitis that is bacterial
CSF results: Increased opening pressure, high protein, high WBC count between 10-10,000, decreased glucose concentration <45 mg/dL, cloudy
What infectious disease are associated with patients travelling to sub saharan africa
HIV, TB, malaria, schistosomiasis
Most likely parasitic infection from sub saharan africa
Schistosomiasis - microscopic visualisation of eggs in stools or urine, or serological testing of affected tissues for detection
Treat with praziquantel
Types of TB
TB meningitis/CNS TB, pericardial TB, Miliary TB, pulmonary TB
TB meningitis key points
TB meningitis. MRI would show leptomeningeal enhancement. LP will show high protein, low glucose and lymphocytosis
Given steroids when starting treatment and treatment is longer (12 months)
