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Phase 4 - GI, MSK, Infectious Diseases > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

What is head lice also known as and what is the causative organism

A

Pediculosis
Nits

Pediculus capitis - parasite

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2
Q

Pathophysiology of head lice

A

Head lice are small insects that live only on humans, they feed on our blood. Eggs are grey or brown and about the size of a pinhead. The eggs are glued to the hair, close to the scalp and hatch in 7 to 10 days. Nits are the empty egg shells and are white and shiny. They are found further along the hair shaft as they grow out.

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3
Q

How are head lice spread

A

Head-to-head contact

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4
Q

Symptoms of head lice

A

Most cases have no symptoms but some complain of:
Itching and scratching on the scalp up to 2-3 weeks after infection

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5
Q

How to diagnose head lice

A

Fine-toothed combing of wet or dry hair

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6
Q

Management of head lice

A

Treatment is only indicated if living lice are found
Wet combing with fine combs
Physical insecticide - Dimeticone 4% lotion left on for 8 hours
Chemical insecticide - Malathion

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7
Q

When should household contacts of head lice be treated

A

Household contacts of patients with head lice do not need to be treated unless they are also affected

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8
Q

What are the two types of herpes simplex virus

A

HSV-1 and HSV-2

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9
Q

What are the two sensory nerve ganglion that herpes simplex virus infect most commonly

A

Trigeminal nerve
Sacral nerve

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10
Q

How is genital herpes caused by HSV-1 spread? What about HSV-2?

A

HSV-1: Oro-genital sex
HSV-2: STI

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11
Q

What are the symptoms of genital herpes

A

Initial presnetation:
Ulcers or blistering lesions around the genital area
Neuropathic pain (tingling, burning or shooting)
Flu-like symptoms
Dysuria
Inguinal lymphadenopathy

Recurrent episodes usually have more mild symptoms

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12
Q

Investigations for genital herpes

A

Full history - ask about sexual contacts to establish source of infection
Clinical diagnosis
Viral PCR swab

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13
Q

Management of genital herpes

A

Oral Acyclovir (valaciclovir or famciclovir as alternatives)
Topical lidocaine 2%
Cleaning with warm salt water
Topical Vaseline
Wear loose clothing
Avoid intercourse with symptoms

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14
Q

Guidelines on treating pregnant women who have genital herpes

A

Primary attack before 28 weeks gestation = acyclovir followed by prophylactic acyclovir starting from 36 weeks onwards (prevents transmission to baby)
- Caesarean recommended if symptoms are present to avoid spread

Primary attack after 28 weeks = acyclovir followed by regular prophylactic acyclovir
- Caesarean is recommended

If recurrent genital herpes then prophylactic acyclovir from 36 weeks gestation onwards

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15
Q

Symptoms of oral herpes

A

Prodrome of:
Fever
Malaise
Sore throat
Cervical and submandibular lymphadenopathy
Painful vesicles on a red swollen base in the oral mucosa

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16
Q

Management of oral herpes

A

Oral acyclovir
Chlorhexidine mouthwash

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17
Q

Pathophysiology of HIV

A

HIV is a RNA retrovirus
Enters and destroys CD4 T-helper cells
An initial seroconversion flu-like illness occurs within a few weeks of infection

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18
Q

What are the symptoms of HIV seroconversion

A

Sore throat
Lymphadenopathy
Malaise, myalgia and arthralgia
Diarrhoea
Maculopapular rash
Mouth ulcer

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19
Q

Investigations for HIV seroconversion

A

HIV antibody and HIV antigen testing - AKA fourth generation testing (first line)

HIV antibodies
- Usually develop 4-6 weeks after infection (99% by 3 months)

p24 antigen
- Viral core protein present 1-3/4 weeks after infection

Combination tests (p24 and HIV antibodies)
- If positive repeat to confirm diagnosis

HIV RNA load

HIV testing in asymptomatic patients should be done 4 weeks after possible infection
- If first test is negative then repeat at 12 weeks

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20
Q

How is HIV monitored?

A

Testing CD4 count - lower = higher risk of opportunistic infections
Normal range = 500-1200
High risk of opportunistic infections = under 200

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21
Q

Management of HIV

A

Treatment started as soon as diagnosed
Antiretroviral therapy (ART) = involves at least three drugs:
- 2 nucleoside reverse transcriptase inhibitors (NRTI)
- e.g. tenofovir and emtricitabine
+
- Protease inhibitor
- e.g. indinavir
or
- Non-nucleoside reverse transcriptase inhibitor (NNRTI)
- e.g. nevirapine

AIM = normal CD4 count and undetectable viral load

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22
Q

What are the five features of HIV-associated nephropathy

A

Massive proteinuria = nephrotic syndrome
Normal or large kidneys
Focal segmental glomerulosclerosis with focal or global capillary collapse on renal biopsy
Elevated urea and creatinine
Normotension

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23
Q

What is the most common opportunistic infection in AIDS

A

Pneumocystis jiroveci
All patients with CD4 count < 200 should receive PCP prophylaxis

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24
Q

Symptoms of Pneumocystis jiroveci

A

Dyspnoea
Dry cough
Fever
Very few chest signs
May cause:
Hepatosplenomegaly
Lymphadenopathy
Choroid lesions

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25
Q

Investigations for Pneumocystis jiroveci

A

CXR: bilateral interstitial pulmonary infiltrates
Exercise induced desaturation
Bronchoalveolar lavage shows pneumocystis jiroveci

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26
Q

Management of pneumocystis jiroveci

A

Co-trimoxazole
Severe: IV pentamidine
If hypoxic: steroids

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27
Q

What is the most common cause of oesophagitis in patients with HIV

A

Oesophageal candidiasis
(seen in patients with a CD4 count > 100)

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28
Q

Symptoms of oesophageal candidiasis

A

Dysphagia
Odynophagia

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29
Q

Treatment for oesophageal candidiasis

A

Fluconazole
or
Itraconazole

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30
Q

What conditions can patients with a CD4 count (HIV) between 200 and 500 have?

A

Oral thrush
Shingles
Hairy leucoplakia
Kaposi sarcoma

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31
Q

What conditions can patients with a CD4 count (HIV) between 100 and 200 have?

A

Pneumocystis jiroveci pneumonia
Cerebral toxoplasmosis
HIV dementia
Cryptosporidiosis

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32
Q

What conditions can patients with a CD4 count (HIV) between 50 and 100 have?

A

Aspergiliosis
Oesophageal candidiasis
Cryptococcal meningitis
Primary CNS lymphoma

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33
Q

What conditions can patients with a CD4 count (HIV) less than 50?

A

Cytomegalovirus retinitis

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34
Q

What organism causes Kaposi sarcoma in patients with HIV?

A

HHV-8

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35
Q

How does Kaposi sarcoma present in patients with HIV

A

purple papules or plaques on the skin or mucosa
Haemoptysis if respiratory involvement

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36
Q

Treatment of Kaposi sarcoma in HIV

A

Radiotherapy and resection

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37
Q

Most common cause of diarrhoea in HIV patients

A

Cryptosporidium - intracellular protazoa

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38
Q

Treatment of diarrhoea in HIV patients

A

Supportive

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39
Q

How to prevent STI spread of HIV

A

Condoms
ART therapy

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40
Q

What monitoring should patients with HIV undergo

A

Monitoring of cardiovascular risk factors - blood lipids
Yearly cervical smears - increased risk of HPV infection and cervical cancer

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41
Q

Can a mother breastfeed if she has HIV

A

Yes, if mother is adamant and viral load is undetectable
Otherwise, advise not to

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42
Q

What is the mode of delivery if a woman has a HIV viral load of >50, <50 and <400?

A

<50 = normal vaginal
>50 = consider a pre-labour caesarean
>400 = pre-labour caesarean

IV zidovudine should be started 4 hours prior to c-section

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43
Q

If the viral load of HIV is unknown or >1000 what should be done?

A

IV zidovudine given during labour and delivery

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44
Q

What are neonates given if the mother has a HIV viral load of <50 and >50?

A

<50 = oral zidovudine for 2-4 weeks
>50 = Triple ART for 4-6 weeks

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45
Q

What should HIV positive pregnant women be offered during pregnancy

A

ART - whether they were taking it before or not

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46
Q

What factors reduce vertical transmission of HIV

A

Maternal ART
C-section
Neonatal ART
Bottle feeding

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47
Q

What is post-exposure prophylaxis (in the context of HIV)? What drugs are used?

A

Can be used after exposure to reduce the risk of transmission

emtricitabine/tenofovir (Truvada) and raltegravir for 28 days.

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48
Q

What patients should be screened for MRSA?

A

All patients awaiting elective admission
All emergency admissions

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49
Q

How should a person be screened for MRSA

A

Nasal swab and skin lesions/wounds

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50
Q

One a carrier of MRSA is identified, what should be done?

A

Suppressive therapy:
Nose: mupirocin 2% in white soft paraffin, tds for 5 days
Skin: chlorhexidine gluconate, od for 5 days, apply all over but especially in axilla, groin and perineum

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51
Q

What antibiotics are commonly used for MRSA

A

1st line = vancomycin or teicoplanin
then
Linezolid - reserved for resistant cases

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52
Q

What is the causative agent in Lyme disease and what is it spread by

A

Borrelia burgdorferi - spread by ticks

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53
Q

What are the symptoms of Lyme disease

A

Erythema migrans - ‘bulls eye’ rash seen at the site of the bite
- Typically develops 1-4 weeks after initial bite
- Painless and more than 5cm in diameter
Systemic features:
Fever
Headache
Lethargy
Arthralgia

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54
Q

What are the later features (after 30 days) of Lyme disease

A

Cardiovascular:
Heart block
Peri/myocarditis
Neurological:
Facial nerve palsy
Radicular pain
Meningitis

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55
Q

Investigations for Lyme disease

A

Clinical if erythema migrans present
Enzyme Linked Immunosorbent Assay (ELISA) antibodies to Borrelia burgdorferi = 1st LINE

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56
Q

Management for Lyme disease

A

Asymptomatic:
- If tick present then remove with tweezer as close to skin as possible

Symptomatic:
Doxycycline (amoxicillin alternative)
Ceftriaxone if disseminated disease

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57
Q

What is the Jarisch-Herxheimer reaction?

A

Seen after initiating antibiotics. symptoms are:
Fever
Rash
Tachycardia

58
Q

What are the different classifications of necrotising fasciitis

A

Classified according to the causative organism:
Type 1 - caused by mixed anaerobes and aerobes (often occurs post-surgery in diabetics)
Type 2 - caused by streptococcus pyogenes

59
Q

What are the risk factors for developing necrotising fasciitis

A

Recent trauma
Burns
Soft tissue infections
Diabetes - particularly if patient is on SGLT-2 inhibitors
IV drug users
Immunosuppression

60
Q

What is the most commonly affected site for necrotising fasciitis

A

Perineum - Fournier’s gangrene

61
Q

What are the features of necrotising fasciitis

A

Acute onset
Pain, swelling and erythema at affected site
Extremely tender over infected tissue with hypoesthesia to light touch
Skin necrosis and crepitus/gas gangrene are late signs
Fever
Tachycardia

62
Q

What is staphylococcal toxic shock syndrome

A

Severe systemic reaction to staphylococcal exotoxins, the TSST-1 superantigen toxin

63
Q

What is the main cause of staphylococcal toxic shock syndrome

A

Infected tampons

64
Q

Symptoms of staphylococcal toxic shock syndrome

A

Fever > 38.9
Hypotension - systolic < 90
Diffuse erythematous rash
Desquamation of rash - especially of the palms and soles
GI symptoms - diarrhoea and vomiting, hepatitis
Renal failure
Thrombocytopenia
Mucus membrane erythema
CNS involvement - confusion

65
Q

Management of staphylococcal toxic shock syndrome

A

Removal of infection focus - retained tampon
IV fluids
IV antibiotics

66
Q

What is a perianal abscess

A

Collection of pus within the subcutaneous tissue of the anus that has tracked from the tissue surrounding the anal sphincter.

67
Q

Risk factors for perianal abscess

A

Male
Over 40
Crohn’s disease
Diabetes
Malignancy

68
Q

Cause of perianal abscess

A

Generally colonised by gut flora such as E.coli

69
Q

Symptoms of perianal abscess

A

Pain around the anus made worse by sitting
Hardened tissue in the anal region
Pus like discharge from the anus
May have features of systemic infection if long standing

70
Q

Investigations for perianal abscess

A

Clinical
MRI is gold standard

71
Q

Treatment of perianal abscess

A

Surgical incision and drainage under local anaesthetic
Antibiotics if features of systemic infection

72
Q

What diseases are the most common cause of abdominal cavity fistula

A

Diverticular disease
Crohn’s disease

73
Q

What are the four types of fistula

A

Enterocutaneous
Enteroenteric/enterocolic
Enterovaginal
Enterovesicular

74
Q

What is chicken pox cause by

A

Varicella zoster virus

75
Q

How is chicken pox spread

A

Via respiratory route

76
Q

How long are people with chicken pox infectious for

A

4 days prior to rash
5 days after rash

77
Q

Symptoms of chicken pox

A

Fever initially
Itchy rash starting on head/trunk before spreading
Initially macular then papular then vesicular

78
Q

Management of chicken pox

A

Supportive
Trim nails
Calamine lotion

79
Q

What is the school exclusion guidelines for chicken pox

A

Until lesions have crusted over
(usually 5 days after rash appeared)

80
Q

What is a complication of chicken pox and what increases the chance of this complication

A

Secondary bacterial infection of the lesions
NSAIDs increase the chance
Group A streptococcal soft tissue infection may occur resulting in necrotising fasciitis

81
Q

Complications of chicken pox

A

Pneumonia
Encephalitis
Disseminated haemorrhagic chicken pox
Arthritis, Nephritis, Pancreatitis

82
Q

What type of organism is Clostridium difficile

A

gram-positive, rod shaped, anaerobic bacteria

83
Q

What are the causes of C.diff infection

A

PPIs and Antibiotics (begin with letter C):
Clindamycin
Ciprofloxacin
Cephalosporins
Carbapenems (meropenem)

84
Q

What toxins does C.diff produce

A

toxin A
toxin B

85
Q

Mode of transmission of C.diff

A

Faecal-oral

86
Q

Symptoms of C.diff infection

A

Diarrhoea
Abdominal pain
Severe:
Dehydration
Fever, tachycardia and hypotension (systemic symptoms)

87
Q

How do we differentiate between mild, moderate, severe and life threatening C.diff infection

A

Mild: Normal WCC
Moderate: raised WCC & typically 3-5 loose stools a day
Severe: raised WCC or acutely raised creatinine, temp above 38.5 or severe colitis
Life threatening: Hypotension, ileus or toxic megacolon

88
Q

Investigations for C.diff infection

A

Stool sample and test for:
C.diff antigen (glutamate dehydrogenase) –> if positive does not necessarily mean it is producing toxins
A and B toxins - by PCR or enzyme immunoassay

89
Q

How to manage C.diff infection

A

First episode:
Oral vancomycin (fidaxomicin 2nd line)
Recurrent episode:
Within 12 weeks of initial - oral fidaxomicin
After 12 weeks - oral vancomycin OR fidaxomicin

Life threatening:
Oral vancomycin AND IV metronidazole

90
Q

Define sepsis

A

Where the body launches a large immune response to an infection causing systemic inflammation and organ dysfunction

91
Q

What is the difference between sepsis and septic shock

A

Septic shock is when the arterial blood pressure drops despite adequate fluid resuscitation resulting in organ hypoperfusion

92
Q

Define shock

A

Insufficient tissue perfusion

93
Q

What are the different types of shock

A

Septic shock
Hemorrhagic shock
Neurogenic shock - most commonly after a spinal cord transection - peripheral vasoconstrictor can be used to return vascular tone to normal
Cardiogenic shock - the main cause is ischaemic heart disease
Anaphylactic shock - from nuts, drugs or venom (wasp sting)

94
Q

How is septic shock diagnosed

A

Low mean arterial pressure (below 65mmHg) despite fluid resuscitation (requiring vasopressors - noradrenaline)
Rasided serum lactate - more than 2mmol/L

95
Q

What is the SOFA score used for? What does it take into account

A

Sepsis-related organ failure assessment (SOFA)
Can be used to assess the severity of organ dysfunction in sepsis, takes into account:
Hypoxia
Increased O2 requirements
Requiring mechanical ventilation
Low platelets (thrombocytopenia)
Reduced GCS
Raised bilirubin
Reduced BP
Raised creatinine

96
Q

Risk factors for developing sepsis?

A

Anything that causes immune dysfunction, frailty, or a predisposition to infection:
Very young or old patient s(under 1 or over 75)
Chronic conditions such as COPD or diabetes
Chemotherapy, immunosuppressants or steroids
Surgery, trauma, or burns
Pregnancy and childbirth
Indwelling medical devices - catheter or central lines

97
Q

How is sepsis identified?

A

Using the National Early Warning Score (NEWS2) score, six things are measured:
Temperature
Blood pressure
Heart rate
Respiratory rate
Oxygen sats
Consciousness level

Additional signs of infection also checked for:
Signs of sources - cellulitis, cough, dysuria, wound
Reduced urine output
Mottled skin
Cyanosis
New onset arrhythmias
Non-blanching rash (meningococcal septicemia)

98
Q

What is often an early sign of sepsis

A

Tachypnoea

99
Q

How can elderly patients present with sepsis

A

Confusion
Drowsiness

100
Q

When would patients with sepsis have normal observations despite being life-threateningly unwell

A

Neutropenic or immunocompromised patients

101
Q

Investigations for sepsis

A

Sepsis 6:
Take 3:
Serum lactate
Blood cultures
Urine output - measure hourly
Give 3:
Oxygen to maintain O2 sats 94-98% (88-92% for COPD patients)
Empirical broad-spectrum antibiotics
IV fluids

Blood tests
FBC
U&Es - check for AKI
LFTs - check for the source of infection
CRP
Blood glucose - for hypo/hyperglycemia
Blood cultures - assess for bacteremia
Blood gas - for lactate

Urine dipstick and culture
CXR
CT scan if intra-abdominal infection/abscess is suspected
LP for meningitis or encephalitis

102
Q

Treatment for sepsis

A

Administer O2 - aim for 92-94% (88-92% in COPD)
IV fluids - bolus of 500ml crystalloid over less than 15 mins
Broad-spectrum antibiotics

103
Q

What are the red flag criteria to initiate sepsis 6 immediately

A

Respons to voice or pain only/unresponsive
Acute confusional state (low GCS)
Systolic BP <= 90mmHg (or drop of 40 from normal)
HR > 130
RR >= 25
Need oxygen to keep SpO2 >= 92
Non-blanching rash/mottled/ashe/cyanotic
Not passed urine in last 18 hours or urine output <0.5ml/kg/hr
Lactate > 2mmol/L
Recent chemotherapy

104
Q

What is neutropenic sepsis

A

Refers to sepsis in someone with an absolute neutrophil count below 0.5 x 109/L (or likely to fall to this level)

105
Q

What can cause neutropenic sepsis

A

Immunosuppressants or anti-cancer treatment:
Methotrexate
Sulfasalazine
Chemo
Carbimazole
Hydroxychloroquine
Infliximab
Rituximab
Clozapine

106
Q

What is the treatment of neutropenic sepsis

A

Tazocin (piperacillin with tazobactam)

107
Q

What is the causative organism of mumps

A

RNA paramyxovirus

108
Q

How is mumps spread

A

Droplets

109
Q

How long are patients with mumps infective for

A

7 days before and 9 days after parotid swelling starts

110
Q

What are the symptoms of mumps

A

Fever
Malaise
Muscular pain
Parotitis - presents as earache or pain on eating - unilateral then becomes bilateral in 70% of patients

111
Q

How to prevent mumps

A

MMR vaccine

112
Q

Management of mumps

A

Rest
Paracetamol for high fever/discomfort
Notifiable disease

113
Q

Complications of mumps

A

Orchitis
Hearing loss
Meningoencephalitis
Pancreatitis

114
Q

What type of virus is the influenza virus

A

RNA virus

115
Q

Who is the influenza vaccine free to?

A

Aged 65 or over
Young children
Pregnant women
Chronic health conditions - COPD, HF, DM
Healthcare workers and carers

116
Q

What are the symptoms of influenza

A

Fever
Lethargy and fatigue
Anorexia - loss of appetite
Muscle and joint aches
Headache
Dry cough
Sore throat
Coryzal symptoms

117
Q

How do you differentiate between the common cold and a flu

A

Flu = abrupt onset, fever and muscle aches and lethargy
Common cold - gradual onset, no fever

118
Q

How to diagnose influenza

A

Viral nasal or throat swabs aresent for PCR analysis

119
Q

In which patients do you treat influenza

A

Chronic disease of respiratory, cardiac, renal, hepatic, or neurological nature
Diabetes
Immunosuppression
Morbid obesity

120
Q

What is the management of influenza

A

1st line = oseltamivir
2nd line = zanamivir
Needs to be started within 48 hours of onset

121
Q

What si the post-exposure prophylaxis options for influenza? Which patients can receive this

A

Oral oseltamavir 75mg OD for 10 days
Inhaled zanamivir 10mg OD for 10 days
Given if:
Initial treatment started within 48 hours
Increased risk - chronic disease or immunosuppression
Not vaccinated

122
Q

Complications of influenza

A

Viral pneumonia
Sinusitis, otitis media and bronchitis
Worsening of chronic condition
Febrile convulsions
Encephalitis

123
Q

What measures can be put into place pre-operatively to reduce the risk of surgical site infections

A

Use electric clippers to remove bodily hair
Antibiotic prophylaxis if placement of prosthesis or valve, contaminated surgery or clean-contaminated surgery
Give single dose IV antibiotics on anesthesia (give earlier if tourniquet used)

124
Q

What measures can be put into place intra-operatively to reduce the risk of surgical site infections

A

Prepare skin with chlorhexidine
Cover the surgical site with a dressing

125
Q

What measures can be put into place post-operatively to reduce the risk of surgical site infections?

A

Tissue viability advice for management of surgical wounds healing by secondary intention

126
Q

What is gangrene

A

A serious medical condition characterised by the death of body tissue due to a lack of blood supply, infection, or both

127
Q

What are the causes of gangrene

A

Interruption of blood supply leading to tissue ischemia and necrosis. Can occur due to:
Arterial occlusion - Atherosclerosis, thrombosis, or embolism can obstruct blood flow
Infection
Trauma - can compromise blood supply and introduce pathogens
Chronic conditions - diabtetes

128
Q

What are the three types of gangrene

A

Dry
Wet
Gas

129
Q

What is dry gangrene usually caused by? What is the appearance?

A

Chronic ischemia (usually due to PAD)
Characterized by:
Dry, shrivelled and blackened tissue
Clear demarcation between necrotic and live tissue
Typically painless due to nerve damage

130
Q

What is wet gangrene usually caused by? What is the appearance?

A

Sudden lack of blood supply combined with infection
Characterised by:
Swollen,moist and blistered tissue
Foul odour
Systemic symptoms - fever and malaise
Severe pain and erythema of affected area
Can lead to sepsis

131
Q

What is gas gangrene usually caused by? What is the appearance?

A

Caused by infection with Clostridium bacteria - which produces gas and toxins
Characterised by:
Severe pain and swelling
Crepitus due to gas production
Rapid onset of systemic symptoms - tachycardia, hypotension and shock

132
Q

Management of gangrene

A

Surgical intervention - debridement, amputation (if necessary) and revascularization
Antibiotics - empirical broad-spectrum
Supportive - IV fluids, analgesia
Hyperbaric oxygen therapy - used in some cases of gas gangrene to enhance O2 delivery to tissue and inhibit anaerobic bacterial growth

133
Q

What antibiotics are recommended for gas gangrene

A

High-dose penicillin and clindamycin

134
Q

What is the causative agent in Covid-19

A

SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2)

135
Q

How is Covid-19 spread

A

Respiratory droplets
Contact with contaminated surfaces

136
Q

Symptoms of Covid-19

A

Fever
Cough
Fatigue
Loss of taste or smell
Myalgia
Nausea
Diarrhoea
If severe:
SOB
Chest pain
Confusion
Cyanosis

137
Q

Investigation for Covid-19

A

Reverse transcription PCR (RT-PCR)
Antigen test
Serological test - detect antibodies

Imaging:
CXR - may show bilateral infiltrates
CT scan - can reveal ground glass opacities and consolidation

138
Q

Management of Covid-19

A

General:
Isolation
Supportive - hydrations, antipyretics, oxygen

Pharmacological:
Antivirals - remdesivir
Corticosteroids - dexamethasone

Supportive:
Oxygen therapy

139
Q

How to prevent Covid-19

A

Vaccine
Mask-wearing
Hand hygiene
Social distancing

140
Q
A

Phase 4 - GI, MSK, Infectious Diseases (3 decks)

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