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FINALS > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

When taking a travel history what is important to include?

A

Exactly what area they visited/prophylaxis for malaria or other disease/N vaccinations they had pre-travel such as hepatitis A typhoid and Assyria and the general vaccine schedule/the use of bug repellent or sleeping nets

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2
Q

what are farmworkers susceptible to getting?

A

Leptospirosis, coxiella, Orf

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3
Q

what are sewerworkers susceptible to getting?

A

Leptospirosis, hepatitis A, gastroenteritis

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4
Q

what are sex workers susceptible to getting?

A

HIV hepatitis B HSV gonoccocus syphilis chlamydia

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5
Q

what infectious disease are pet shop owners susceptible to getting?

A

psittacosis

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6
Q

what are abbatoir workers succeptable to getting?

A

anthrax

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7
Q

what are canoeists susceptible to getting?

A

Leptospirosis gastroenteritis

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8
Q

what are swimmers susceptible to getting?

A

Fungal infection pox viruses leptospirosis gastroenteritis

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9
Q

what are cavers susceptible to getting?

A

histoprirosis and Marburg

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10
Q

What are trekkers susceptible to getting?

A

Lyme disease and other tickborne diseases

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11
Q

what are rugby players susceptible to getting?

A

HSV (from the scrum) fungal infections

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12
Q

what causes leptospirosis?

A

infected urine - namely from rats but can be from other pets such as dogs, rabbits, cows and sheep (bacteria)

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13
Q

what causes histoplasmosis?

A

stoplasma capsulatum fungal spores. These spores are found in soil and in the droppings of bats and birds.

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14
Q

What causes a Coxiella?

A

Coxiella burnetii is most frequently found in ruminants (cattle, sheep!!, and goats) is a bacteria

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15
Q

What causes Orf?

A

Orf is a viral skin disease that can be spread to humans by handling infected sheep and goats. The disease – caused by a parapoxvirus

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16
Q

what does the following picture show?

A

orf (nb its self limiting mostly)

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17
Q

What infections are IV drug users susceptible to?

A

Hepatitis C hepatitis B HIV endocarditis skin and soft tissue infection including antharax , Aspergillus

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18
Q

what infections are alcohol abusers predisposed to?

A

TB pneumonia HIV

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19
Q

what infections are cannabis users susceptible to?

A

Pneumonia early COPD lung abscesses

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20
Q

what is Marburg?

A

Marburg virus is a hemorrhagic fever virus of the Filoviridae family of viruses - transmitted by bats

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21
Q

What infections can dogs transmit?

A

Campylobacter Toxocara rabies

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22
Q

what infection can cats Transmit?

A

toxoplasma Bartonella pasteurella

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23
Q

what infection can rodents transmit?

A

Rat bite fever salmonella

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24
Q

what infections can terrapins and reptiles transmit?

A

salmonella

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25
Q

what infection can psittacine birds transmit?

A

chlamydia psittaci

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26
Q

what infection can tropical fish transmit?

A

Mycobacterium marinum

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27
Q

What infection can wild and domestic fowl transmit?

A

Avian influenza

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28
Q

what’s infection can agricultural animals transmit?

A

Coxiella SPP and Salmonella E. coli

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29
Q

what type of virus is the HIV virus and what cells does it target?

A

retrovirus destroying CD4 + cells

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30
Q

what are the two strains of HIV?

A

HIV-1 – responsible for the global pandemic HIV two – is less pathogenic mostly limited to West Africa

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31
Q

what are the stages of HIV?

A

stage I CD4 over 500 well with no symptoms/ stage II CD4 350 – 500 minus symptoms/ stage III CD4 200 – 250 major symptoms with opportunistic diseases/ stage 4 CD4 less than 200 AIDS

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32
Q

what CD4 count is considered a late diagnosis in HIV?

A

CD4 count less than 350

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33
Q

what are the consequences of a late diagnosis in HIV?

A

10 times higher death rate within the first year

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34
Q

what is the definition of a viral load?

A

the actual quantity of the virus per millilitres of patient’s serum

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35
Q

how does the viral load in HIV differ in untreated versus treated patients?

A

Untreated viral load is greater than 500,000 treated viral load is undetectable

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36
Q

what is the meaning of an undetectable viral load in HIV?

A

the virus cannot be spread

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37
Q

what is the definition of AIDS?

A

CD4 count less than 200 or the presence of an AIDS defining illness and any HIV patient ( PCP TB CMV sentinel tumours)

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38
Q

when is HIV detectable post infection?

A

After four weeks

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39
Q

what is the diagnosis/testing of HIV?

A

IgG ELISA or serum HIV rapid test (both serological) if those are positive confirm with Western blot test or 4th generation serum test (P 24 antigen)

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40
Q

in a non-HIV person what is the CD4 count?

A

480 – 1600

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41
Q

what are stage 2/ minor symptoms of HIV?

A

Weight loss/shingles and other rashes (seborrhoeic dermatitis pruritic papular eruptions inea corporum or ungium) oral ulcers angular chelitis generalised lymphadenopathy

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42
Q

what is the definition of generalised lymphadenopathy?

A

Painless enlarged nodes in two or more non-contiguous sites > 1cm)

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43
Q

what symptoms are present in stage 3/major symptoms of HIV?

A

Fever and night sweats for more than one month diarrhoea for more than one month oral Canada oral hairy leukopenia chronic vaginal candidiasis

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44
Q

what are AIDS defining opportunistic infections?

A

Sentinel tumours (couples Q sarcoma or lymphoma) TB PCP toxoplasmosis P.jiroveci, CMV

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45
Q

what feature would indicate a toxoplasmosis infection in an AIDS patient?

A

Changing mental state

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46
Q

what is the management of HIV?

A

Usually using 2 NRTIs plus and other agent of (integrase inhibitor NNRTR PI) - usually preparations are made with a once-daily tablet containing all three medications

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47
Q

what level of compliance is required in HIV patients?

A

95%

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48
Q

what are NRTIs? How do they work?

A

nucleoside reverse transcriptase inhibitor / Prevent the elongation of DNA chains from viral RNA transcriptase

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49
Q

what are NNRTIs? And how do they work?

A

non-nucleoside reverse transcriptase inhibitor Act near the active site of reverse transcriptase blocking viral replication

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50
Q

what are Pis? And how do they work?

A

Protease inhibitors/blocks the cleavage of active proteins from poly protein formed by viral transcription

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51
Q

what are fusion inhibitors? (HIV)

A

Drugs which block viruses from entering the CD4 cells

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52
Q

what are integrase inhibitors? (HIV)

A

prevents insertion of viral DNA into host DNA

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53
Q

what are side effects of N RTIs?

A

haemolytic anaemia is all hypersensitivity reactions

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54
Q

what are side effects of NN RT I?

A

rash liver toxicity drug interactions and sleep disturbances

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55
Q

what is post exposure prophylactic?

A

drugs given to 0 negative patients who have a high risk of exposure

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56
Q

how do you prescribe postexposure prophylaxis?

A

A four-week course is given and subsequent testing should be provided

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57
Q

when would you give prophylaxis to patients with HIV?

A

In patients who have a CD4 count less than 200 prophylaxis is usually needed at the start of treatment in severe patients but once immune system has improved prophylaxis stop

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58
Q

when would you prescribe co-trimoxone?

A

prophylaxis for PCP and toxoplasma

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59
Q

what are side effects of co-trimoxone?

A

bone marrow suppression rash

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60
Q

when would you prescribe a nebulised Pentamidine?

A

PCP prophylaxis

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61
Q

what are side effects of Pentamidine?

A

highly Tetrogenic and has to be given in a negative pressure side room in case other patients may be pregnant

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62
Q

when would you prescribe azithromycin for prophylaxis in HIV?

A

for protection against Mycobacterium avarium

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63
Q

when would you prescribe glancyclovir in HIV

A

it is a treatment and the secondary prophylaxis of CMV

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64
Q

what is important to assure patients with HIV when they find out their diagnosis?

A

With good compliance of treatment life expectancy is normal

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65
Q

what is vertical transmission?

A

Transmission of infection from mother to child

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66
Q

what is vertical transmission in untreated HIV?

A

25 to 40%

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67
Q

what are modes of delivery of vertical transmission?

A

Breastmilk and at delivery

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68
Q

what is the management of HIV if it is detected antenatal screening?

A

HAART is started at the end of the first trimester and viral load is measured every two weeks after 30 weeks gestation

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69
Q

can the agile delivery occur in HIV-positive patient?

A

Yes if the viral load is undetectable otherwise the section is required

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70
Q

what is the management of a neonate who was born with HIV positive mother?

A

Infant is given an RTI monotherapy for four weeks and only bottle-fed - this is regardless of if viral load is detectable or not

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71
Q

with compliance delivery modifications and neonatal monotherapy what is the risk of transmission of HIV to a neonate?

A

less than 1%

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72
Q

what virus causes mumps?

A

An RNA paramyoxyvirus

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73
Q

how is mumps spread?

A

Respiratory droplets direct contact or contaminated surfaces

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74
Q

what is the incubation period of Mumps?

A

14 – 18 days

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75
Q

when is mumps most contagious?

A

1/2 days before the onset of symptoms

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76
Q

a patient presents with: fever and malaise started about three days ago today they noticed that their neck on one side is very swollen what is the most likely diagnosis

A

mumps

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77
Q

what is the presentation of mumps?

A

parotitis which can be bilateral – hallmarks in term constitutional symptoms usually proceed peritonitis orchitis commonly occurs in males which can be painful?

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78
Q

what are more severe symptoms which can occur in mumps?

A

aseptic meningitis – symptoms of meninges am in a 25% of patients whose varieties in 7% of females presenting with fever and abdominal back loin pain

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79
Q

what complications can occur due to mumps?

A

Infertility mastitis encephalitis and deafness

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80
Q

what are risk factors for mumpd?

A

and vaccinated either primary vaccine or secondary vaccine close contact living such as uni prisons and soldiers healthcare workers international travellers

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81
Q

what test is required in mumps?

A

s library at our AGM collected with swab

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82
Q

what is the management of mumps?

A

supportive with isolation give paracetamol fibre pro then and isolation for five days after the onset of parotitis

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83
Q

what does the following images show?

A

koplick spots

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84
Q

a patient presents with fever, which has now gone, course and horizon their parent states that they noticed a rash starting on the head which then spread to the trunks and limbs - what is the most likely diagnosis?

A

measles

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85
Q

what does the following images show?

A

Measles rash – maculopapular

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86
Q

what is a presentation of measles?

A

Fever cask arise conjunctivitis koplick spots all appear before the rash a maculopapular rash then starts on the head and spreads to the trunk and extremities

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87
Q

when do complications occur in measles?

A

Usually only in immunocompromised or malnourished groups children under five (the younger the worse it is) adults over 20 pregnant women

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88
Q

what are complications of measles?

A

Pneumonialaryngotrachitis otitis media which can lead to deafness and encephalitis

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89
Q

how do you diagnose measles?

A

Serology IgM and IgG however RNA PCR can also be used

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90
Q

what is the management of measles?

A

Supportive and vitamin a supplementation in severe cases- in severe cases also treats complications such as pneumonia and encephalitis

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91
Q

what are the consequences of measles in pregnancy?

A

Stillbirth miscarriage I u GR

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92
Q

what does the following image show?

A

Rubella maculopapular rash

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93
Q

what is a presentation of rubella

A

in half of cases it is asymptomatic rash starts behind ears and moves centrifuge elite round the body maculopapular error scimitars discreet and sometimes itchy low-grade fever lymphadenopathy can proceed to the rash by one week (auricular cerviacle occipital) arthralgia can occur in older women

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94
Q

how do you diagnose rubella?

A

Serum IgM or viral culture with PCR

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95
Q

when is rubella testing necessary?

A

In pregnancy or if there are complications

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96
Q

what can show on FBC in rubella?

A

thrombocytopenic

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97
Q

what are complications of rubella (non-congenital)?

A

arthritis encephalitis thrombocytopenia myocarditis chorio retinitis

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98
Q

what complications can occur in congenital rubella?

A

deafness congenital heart disease (like PDA) cataracts - less than 8 w impaired hearing - less than 16 w intracerebral calcification ans IUGR and neurological disability can also occur

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99
Q

or what is the management of rubella?

A

If contracted in pregnancy refer to specialist as termination may be indicated otherwise Ig’s can be given MMR is not safe in pregnancy but wil be given immediately after birth- otherwise supportive

100
Q

what is the management of a neonate with congenital rubella?

A

pyramethamine + sulfadiazine For one year

101
Q

when would you test for rubella immunity?

A

Prenatal visit routine

102
Q

What are the most common areas which can get septic?

A

Lungs abdomen the bloodstream renal/GU

103
Q

what are the most common pathogens which cause sepsis?

A

Either gram-negative – pseudomonas or E. coli

or

gram-positive staphylococcus

104
Q

describe the pathophysiology of sepsis

A

Immune system is activated and there is the release of inflammatory mediators as well as the release of reactive oxygen is such as Nitrous oxide/endothelium is activated and becomes porous/the coagulation system becomes pro clear regulation/vasodilation, oedema, formation of micro-ember like causes a decrease in oxygenation of organs leading to organ failure and dysfunction

105
Q

what is the definition of septic shock?

A

A septic patient with persistent hypotension not responding to fluids and requiring vasopressor’s. Have a mean arterial pressure of less than 65 and a lactate of over two

106
Q

what are the features of a news 2 score?

A

tachypnoea/hyper- or hypovolaemia/tachycardias/acutely altered mental state/low oxygen saturations/hypotension/oliguria/mottled or ashen skin – poor Refill/cyanosis INSERT PICTURE

107
Q

what initial investigations should you perform if you suspect sepsis?

A

Do buffalo six INSERT PICTURE

108
Q

what bloods are included in the Buffalo six?

A

Cultures glucose lactate full blood count renal function tests CRP clotting

109
Q

what additional investigations apart from the Buffalo six are useful in ? Sepsis?

A

ECG / liver function tests/venous blood gas check acidosis and lactate/chest x-ray (pulmonary origin) urinealysis (urinary origin) CT (GI origin)

110
Q

what is the management of sepsis?

A

IV broad-spectrum antibiotics oxygen if required and more targeted antibiotic therapy once pathogen found

111
Q

what are symptoms of meningism?

A

Headache neck stiffness photophobia nausea vomiting fever

112
Q

what is the most common cause of aseptic meningitis?

A

enteroviruses – Coxsackie virus echo virus poliovirus and herpesviruses – HSV two (HSV-1 more commonly causes encephalitis), varicella

113
Q

which group of people are most likely to get viral meningitis?

A

Infants and young children young adults older people those who had exposure to insect vectors

114
Q

apart from symptoms of meninges them what other symptoms would coxsackie a cause?

A

herpangia - insert picture

115
Q

apart from symptoms of meninges them what other symptoms would echovirus - 9 a cause?

A

Maculopapular rash

116
Q

apart from symptoms of meninges them what other symptoms would HSV 2 a cause?

A

genital herpes

117
Q

what investigations should you perform in a patient with meningism?

A

bacterial Gram stain and culture of bloods / csf ulture + stain viral culture (blood, csf) PCR head CT/MRI, glucose, VBG, FBC, LFT, coag, lactate - septic screen Serum HIV

118
Q

what is the management of aseptic meningitis?

A

initially it is really hard to distinguish between viral and bacterial meningitis so broad-spectrum antibiotics should be used until causative agent is found. Treatment from viral meningitis is supportive unless HSP VZV (acyclovir) or CMV (gancyclovir) is found

119
Q

you do a lumbar puncture the CSF appears clear has a normal opening pressure white blood cell count of less than eight a normal protein level and a normal glucose level how would you consider this CSF?

A

normal

120
Q

you do a lumbar puncture the CSF appears turbid has a high opening pressure white blood cell count >1000 a high protein level and a low glucose level how would you consider this CSF?

A

bacterial

121
Q

you do a lumbar puncture the CSF appears clear has a normal opening pressure white blood cell count <300 with predominantly lymphocyted a moderately raised protein level and a normal glucose level how would you consider this CSF?

A

viral

122
Q

you do a lumbar puncture the CSF appears clear has a slightly high opening pressure white blood cell count of <500 a high protein level and a slightly low glucose level how would you consider this CSF?

A

fungal

123
Q

describe how different pathogens affect CSF?

A

Insert picture

124
Q

what are the most common causes of bacterial meningitis?

A

Streptococcus pneumoniae nisseria meningitidis haemophilus influenza B

125
Q

patient has all the classic symptoms of meningitis along with confusion and has started having seizures what does this indicate about the meningitis

A

serious bacterial

126
Q

what is the initial management of bacterial meningitis?

A

Until the causative agent is found to give broad-spectrum antibiotics with dexamethasone then give targeted therapy

127
Q

who is most at risk of fungal meningitis?

A

Immunosuppressed HIV infants and neonates people exposed to disturbed soil bat caves neurosurgery patients neutropenic patients

128
Q

which fungal agents usually cause meningitis?

A

Cryptococcal histoplasma coccidioal candida

129
Q

what is the typical presentation of fungal meningitis?

A

is a much more progressive chronic/subacute presentation of progressive headaches slowly becoming more severe symptoms of meningitis them personality and behavioural changes decrease visual acuity and papilloedema/symptoms of increased ICP typically in cryptococcal infections

130
Q

when word symptoms of hydrocephalus present in fungal meningitis? And what are the symptoms?

A

coccidioal infections/ impaired cognitive function confusion in coordination gait disturbances urinary incontinence

131
Q

what is the management of fungal meningitis?

A

IV fluconazole with PO therapy for maintenance afterwards if there is hydrocephalus CSF drainage

132
Q

what is required in the diagnosis of fungal meningitis?

A

three fungal cultures as well as CT/MRI CSF studies including antigen/antibody tests

133
Q

how is hepatitis B transmitted?

A

Vertical – mother to baby 90% transmission without preventative measures horizontal – sexual blood transfusions needles or sharp injuries household transmission from shared razors or toothbrushes

134
Q

how do you diagnose hepatitis B?

A

Surface antigen test or IgM (not current Infection)

135
Q

what antibody is used for evidence of an immune response in hepatitis B?

A

HBe AB

136
Q

what is the definition of a chronic infection in hepatitis B?

A

infection lasting more than six months

137
Q

what is the management of acute hepatitis B?

A

nothing it is usually self-limiting and treatment is not usually indicated

138
Q

what is a complication of acute hepatitis B?

A

Fulminant liver failure

139
Q

How would you check for fulminant liver failure in the patient with hepatitis B?

A

checking INR this is the main marker

140
Q

when is a chronic hepatitis B most likely to occur?

A

Acquired from vertical transmission in adult hood the chance of it becoming chronic is 5%

141
Q

what is usually done to prevent vertically acquired hepatitis B from becoming chronic?

A

IG’s and HBV immunisation given in pregnancy and towards the end of pregnancy antivirals are given

142
Q

one should treatment be given in hepatitis B?

A

In chronic infections during the clearance phase or the reactivation phase

143
Q

described the phases of hepatitis B infection?

A

Tolerant phase: HBV has high levels in the body liver remains unaffected and there is no indication for treatment / clearance phase: there is an immune response with inflammation which can cause cirrhosis liver enzymes (a LT) are elevated there is indication for treatment inactive phase: there is immune control patients liver is usually fine but may require cirrhosis monitoring there is no indication for treatment reactivation phase: the immune system cannot control the hepatitis B and there is a more rapid progression of fibrosis ALT is deranged and there is indication for treatment

144
Q

what are the treatments for hepatitis B?

A

Pegylated interferon alpha injected weekly for 48 weeks (mainstay of Mx used for patients who have good LF) and Tenevofir or entecavir PO daily long terms (for patients who cant handle interferon)

145
Q

what is the impact of hepatitis C in terms of public health?

A

The third largest cause of end-stage liver disease

146
Q

what is the main mode of transition for hepatitis C?

A

historic patients may have gotten hepatitis C from blood transfusions as virus was recognised in the 1980s more current infections through IV drug use parenterally

147
Q

what is the presentation of hepatitis C in its acute infection?

A

Most patients are asymptomatic or have very minor symptoms 15% will have a typical hepatic illness with malaise nausea right upper quadrant pain and subsequent jaundice

148
Q

what is the significance of being asymptomatic in the acute phase of hepatitis C?

A

if you are completely asymptomatic you have a much higher chance of developing a chronic infection

149
Q

what is the presentation of hepatitis C in a patient with chronic infection?

A

until there is cirrhosis the infection is mainly asymptomatic with intermittent right upper quadrant pain and as it worsens malaise and fatigue

150
Q

how do you diagnose hepatitis C?

A

Serologic enzyme immunoassay and confirmation with immunoblot assay if those two tests are positive then do HCVRNA PCR to check for current infection

151
Q

apart from diagnostic viral tests what other investigations are required in chronic hepatitis C?

A

Baseline and serial LFT and liver fibrosis assessment using a fibre scan this negates the need for a biopsy in advanced fibrosis/cirrhosis six monthly hepatocellular carcinoma screening using ultrasound scan and alpha-fetoprotein levels any evidence of portal hypertension do regular ODD to screen for varicies

152
Q

what is a liver fibroscan?

A

Transient elastography which looks at liver stiffness in cirrhosis it will be way more thick

153
Q

what are some extrahepatic manifestations of chronic hepatitis C?

A

Essential mixed cryoglobuminea membranoproliferative glomerulonephritis porphyria cutanea tardia atuoimmune thyroid disease

154
Q

what is a treatment for hepatitis C?

A

The aim of treatment is curative unlike with hepatitis B (undetectable viral load 12 weeks after the end of treatment = curative) direct acting antiviral drugs are used mixing to or more the AAS drug classes

155
Q

what are some examples of DAAS used in hepatitis C?

A

ledip-ASVIR sofo-BUVIR Grazo-PREVIR

156
Q

What are some side effects of Ribavarin?

A

anaemia and associated symptoms insomnia agitation and anxiety

157
Q

when is ribavarin indicated in Hep C?

A

in decompensated cirrhosis

158
Q

what is drug induced fever?

A

Drugs that cause fever due to effects of pharmacological activity or altered thermoregulation or contaminants or indirect induction or hypersensitivity reactions

159
Q

what drugs cause fever due to pharmacological activity?

A

Antibiotics: penicillin, Pan Am’s cephalosporin error through Myerson nitrofurantoin isoniazid or cytotoxic agents

160
Q

what drugs cause fever due to altered thermoregulation?

A

Atropine catecholamines(decrease sweating) thyroxine drugs

161
Q

what drugs cause fever indirectly?

A

anticoagulants heparin

162
Q

what drugs most commonly cause fever?

A

Antihistamine barbiturates me thou doper penicillin phenytoin salycates

163
Q

which common drugs cause fever?

A

ibruprophen allopurinol heparin penicillins nitrofurantoin or through myosin, penance cephalosporin me thou doper nifedipine coltopril

164
Q

what is malaria caused by?

A

a parasitic infection caused by Plasmodium most importantly Plasmodium falciparum - most severe

165
Q

what are the symptoms of malaria?

A

Weakness myalgia arthralgia anorexia more severe symptoms of diarrhoea seizures and altered mental state jaundice anuria/oliguria suggest falsiparum

166
Q

described the life-cycle of Plasmodium?

A

Mosquito takes a blood meal and injects sporozoites these travel to the liver cell which gets infected and many parasites again to develop forming a schizont which eventually raptures and enters the bloodstream a trophozite forms which either forms a gametocyte which then gets transferred to mosquite when it bites you or reforms schizont

167
Q

how do you diagnose malaria?

A

Geima stained Thick and thin blood smears identifying parasite rapid diagnostic tests of antigen or enzyme and PCR are also used as well as a normal blood tests for baselines

168
Q

how do you treat malaria?

A

Chloroquine or hydroxychloroquine

169
Q

what drug is used for malaria prophylaxis?

A

Doxycycline

170
Q

What are the notifiable diseases?

A

insert picture

171
Q

Who do you report notifiable diseases to?

A

Public health England and also the office for standards in education if the patient is under eight and there is a case of any notifiable disease in a school or nursery or two or more cases of food poisoning plus the consultant for communicable diseases control this is under the health protection notifications act of 2010

172
Q

What pathogenic causes Legionella?

A

gram-negative bacteria Legionella

173
Q

How is the Legionella infection contracted?

A

Contaminated water either aerosols such as contaminated air-conditioning or from aspiration when drinking

174
Q

what is the presentation of Legionella?

A

Typical pneumonia symptoms (productive cough to snow. Hypoxaemia tachycardia fever headache crackles) history of recent residential plumbing repair use of whirlpool spas use of non-municipal water supply

175
Q

how do you diagnose Legionella?

A

sputum culture and Gram stain

176
Q

how do you manage Legionella?

A

flurochloroquines or macrolides - both if severe

177
Q

what causes typhoid disease and how is it contracted?

A

Salmonella typhi transmitted feco orally - most commonly in the Indian subcontinent

178
Q

what is the presentation of typhoid?

A

prolonged febrile illness – High-grade with normal white blood count bradycardia rose spots (see picture below) generalised flulike symptoms with GI symptoms

179
Q

how do you diagnose typhoid?

A

blood cultures

180
Q

what is the management of typhoid?

A

If you suspect typhoid to treat with broad-spectrum antibiotics such as ceftriaxone and azithromycin then targeted antibiotics should be used

181
Q

what is a complication of typhoid? And how do you treat it?

A

encephalopathy treated with high-dose dexamethasone

182
Q

what is most common mode of transmission of HIV in children?

A

At birth in the birth canal through breastfeeding and can occur and utero but this is the most uncommon

183
Q

How do you diagnose HIV in children?

A

DNA PCR is diagnostic if over 18 months of age/before 18 months you cannot diagnose HIV you can only assess for negative diagnosis/and negative diagnosis: completion of an antenatal antiviral is too negative PCR is one negative PCR after 18 months - the reason for this is that maternal antibodies are still present before 18 months and so positive results may occur

184
Q

how quickly can HIV develop into AIDs in an untreated child?

A

one year

185
Q

what are mild symptoms of HIV in children?

A

lymphadenopathy parotitis hepatosplenomegaly thrombocytopenia

186
Q

what are moderate symptoms of HIV in children?

A

Recurrent bacterial infections candidiasis chronic diarrhoea lymphocytic interstitial pneumonitis

187
Q

what are severe symptoms of HIV in childhood?

A

opportunistic infections severe failure to thrive encephalopathy malignancy

188
Q

what is the management of HIV in children with a CD4 count between 200 and 350?

A

2 NRTI + 1 NNRTI

189
Q

what is the management of HIV in children with the CD4 counts over 350?

A

2 NRTI + one protease inhibitor

190
Q

what vaccinations should be given to HIV patients?

A

All normal Vaccinations should be given and PCP vaccination should be given over the age of four but no BCG vaccination

191
Q

a child presents with a lacy reticular exanmem on their extremities and torso and face, their parents say that in the week prior they had a slight fever and cold like symptoms what is the most likely diagnosis?

A

slapped cheek syndrome (insert picture)

192
Q

what pathogen causes slapped cheek syndrome?

A

parvovirus B19

193
Q

apart from prodromal symptoms and slapped cheek/rash what other symptoms can be presence in slapped cheek syndromes?

A

Self-limiting arthralgia of the small joints of the hands wrists knees or ankles

194
Q

what causes the slapped cheek appearance and what does this mean for immunocompromised patients?

A

Immune complexes are what causes the red cheek appearance so in immune deficient patients the classic symptoms of a slapped cheek are not present

195
Q

what are complications which can arise from parvovirus B19 infection?

A

Persistent parvovirus B19 causes severe anaemia due to chronic red-cell aplasia

196
Q

what can happen if a pregnant woman contracts parvovirus B19?

A

Fatal anaemia which can be so severe it is fatal to the foetus

197
Q

what can happen if patients who has haematological disorders contracts parvovirus B19?

A

in patients with increased red blood cell turnover aplastic crises can occur

198
Q

what investigations are required in parvovirus B19 infection?

A

FBC and reticulocytes counts especially if they are immunosuppressed or pregnant / serology for IgM in anyone presenting with complicated parvovirus infection

199
Q

what is the management of parvovirus B19?

A

Usually supportive care with simple analgesia rest and hydration in complicated parvovirus haematological referral is required and may receive IVIG and red blood cell transfusions

200
Q

what causes toxic shock syndrome?

A

streptococci either Streptococcus pyogenes MRSA or Streptococcus aureus

201
Q

what other two types of toxic shock syndrome?

A

menstrual toxic shock non-menstrual toxic shock

202
Q

what are the causes of menstrual toxic shock?

A

during menstruation there is extended use of a single tampon or use of highly absorbable tampons

203
Q

what causes non-menstrual toxic shock?

A

postpartum, associated with infections such as mastitis associated with abortion episiotomy endomitritis infected abdominal wounds

204
Q

what are symptoms of toxic shock syndrome?

A

non-specific symptoms of severe infection can become life-threatening within 24 to 72 hours can have a diffuse erythematous rash in Streptococcus and the desquamation rash on hands and feet in staphylococcus

205
Q

how do you diagnose toxic shock syndrome?

A

Assess for sepsis microscopy and culture of blood CSF and throat you can also include pleural or peritoneal fluid if they have symptoms of myocarditis or peritonitis

206
Q

apart from sepsis what is a complication of toxic shock syndrome?

A

diffuse bilateral infiltrates consistent with RDS seen on chest x-ray

207
Q

what is the diagnostic test for toxic shock syndrome

A

staphylococcus antibody or streptococcal endotoxin

208
Q

what is the management of toxic shock syndrome?

A

Aggressive fluid resuscitation empirical antibiotic therapy vasopressor support if there is refractory hypo gastric protection with PPI and H2 agonist DVT prophylaxis regular insulin and glucose control transfer to ICU surgical depriving may be necessary targeted antibiotic therapy with or without IVIG if streptococcal infectiontension

209
Q

how is poliovirus transmitted?

A

gastrointestinal faecal oral transmission

210
Q

what is the presentation of poliovirus?

A

Usually asymptomatic or manifests as a minor GI symptoms (lasting no longer than 5 days) , may also present with meningitis symptoms, however it can present as a major illness

211
Q

what symptoms of a major illness of the poliovirus?

A

acute flaccid paralysis proceeding to asymmetrical lower limb weakness and flaccidity the maximum extent of paralysis is reached within a week some patients progress to life-threatening bulbar polite paralysis and respiratory compromise - will also have the accompnying GI symptoms

212
Q

what is post poliomyelitis syndrome?

A

develops years or even decades following acute poliomyelitis

213
Q

what is the presentation of post-poliomyelitis syndrome?

A

fatigue weakness wasting of the muscles usually involving muscles previously affected by the original illness

214
Q

what are risk factors for polio?

A

Lack of vaccination for sanitisation endemic areas immunosuppressant patients (may get polio from the vaccine as it is live attenuated vaccine)

215
Q

what signs will you find on a child with progressive acute flaccid paralysis?

A

decreased sensation decreased deep tendon reflexes atrophy of the muscles of the affected limb which can lead to deformity

216
Q

how do you diagnose polio?

A

Clinical initial diagnosis confirmed by the isolation of poliovirus from stools NB specimen collection will be handled by local health authorities

217
Q

how would you investigate child who had acute flaccid paralysis from poliovirus?

A

Spinal-cord MRI electromyography or nerve conduction studies - used to rule out other causes of paralysis

218
Q

what is the management of poliovirus?

A

Simple: oral rehydration or IV fluids and monitor for acute flaccid paralysis acute flaccid paralysis: early mobilisation and physiotherapy monitoring for bulbar poliomyelitis bulbar polio: intubation and ventilation

219
Q

how do you manage

poliomyelitis?

A

ongoing physiotherapy and mobilisation

220
Q

What is Kawasaki disease?

A

and acute febrile self-limiting systemic vasculitis

221
Q

what is the diagnostic criteria for Kawasaki disease?

A

Five days of fever that is refractory to antibiotic therapy and 4/5 following symptoms: bilateral conjunctiva will infection polymorphous rash mucous membrane changes extremity changes cervical lymphadenopathy

222
Q

describes the classic mucous membrane changes that occur in Kawasaki disease?

A

Strawberry tongue read it dry for assuring injected lips injected pharynx

223
Q

described the characteristic extremity changes that occur in Kawasaki disease?

A

Desquamation of fingers and toes

224
Q

what is a serious complication of Kawasaki disease?

A

cardiac involvement with myocarditis pericarditis and aneurysms

225
Q

what occurs in week one of Kawasaki disease?

A

fever conjunctivitis mucous membrane changes lymphadenopathy and rash

226
Q

what occurs in week two of Kawasaki disease?

A

red oedematous palms and soles of feel + desquamation

227
Q

what occurs in weeks 3 to 8 Kawasaki disease?

A

Cardiovascular signs/gallop rhythm plus myocarditis pericarditis and the formation of aneurysms

228
Q

how do you investigate Kawasaki disease?

A

Clinical signs and symptoms with high level of suspicion plus SBC: raised WCC raised PLT anaemia raised CRP ESR echocardiogram to check for coronary artery aneurysm

229
Q

what is the management of Kawasaki disease presenting within less than 10 days or with high risk factors the complications?

A

IV I and high-dose aspirin, if there is no response to 2 doses of IVIG try corticosteroids or infliximab

230
Q

what is the management of Kawasaki disease presenting over 10 days from onset or without any high risk for complications?

A

low dose asprin

231
Q

what is the ongoing management of Kawasaki disease?

A

is low risk of complications discontinue low-dose aspirin and provide follow-up there are aneurysms give antiplatelet if there is a large aneurysm give antiplatelet with anticoagulant and beta-blocker

232
Q

a patient presents the sore throat and low-grade fever they’re having dysphasia dysphonia a creepy cough and this Nokia on examination of the throat you find that there is a grey membrane covering their tonsils and pharynx what is most likely diagnosis?

A

Diphtheria

233
Q

what does the image below show?

A

Classic bull neck appearance caused by severe lymphadenopathy which occurs because of the grey pseudo-membrane forming over the tonsils and pharynx which thickens and spreads

234
Q

what causes the pseudo-membrane in diphtheria?

A

diphtheria toxin’s cause necrosis of tissue forming the grey pseudo-membrane

235
Q

how do you diagnose diphtheria?

A

Culture and microscopy (antibody levels can aid the diagnosis)

236
Q

what does the image below show?

A

cutaneous diphtheria shallow painful tender erythematous skin lesion which is often ulcerated which is also covered by a grey brown pseudo-membrane

237
Q

how do you get cutaneous diphtheria?

A

when there has been a cut in the skin which then gets infected by the diphtheria it is more common in people their skin conditions such as eczema or in the extremities such as hands or feet

238
Q

what is the management of diphtheria?

A

Requires hospitalisation in isolation administered diphtheria antitoxin and antibiotic therapy if severe consider airway protection and ventilation cutaneous diphtheria can be treated as an outpatient everyone has been exposed to diphtheria requires diphtheria toxoid immunisation

239
Q

what is hand foot and mouth disease?

A

A common childhood bacterial infection commonly associated by Coxsackie virus usually occurring in children younger than 10

240
Q

what is the presentation of hands and mouth disease?

A

Low-grade fever loss of appetite sore throat cough abdominal pain diarrhoea general malaise occasionally arthralgia sores appearing around the mouth then on the palms of hands and soles of feet and buttocks lesions healing within one week

241
Q

what is the management of hand foot and mouth disease?

A

analgesia and antipyretic’s, topical anaesthetics such as Lidocaine and adequate fluid and nutritional support

242
Q

what is scarlet fever?

A

a bacterial illness that develops in some people who have strep throat most commonly children 5 to 15 years old

243
Q

child presents with a red rash appeared on their face and neck which is now spread to their trunk arms and legs looks a lot like sunburn and feels like some paper which is flashed around the Facebook pale around the mouth you also notice a strawberry tongue (most common in early disease) red lines in the folds of skin in the groins armpit et cetera you notice that their skin has started to peel (occurs about after one week of unfettered symptoms) there are also general malaise symptoms such as high-grade fever sore red throat Uetc - what is the most likely diagnosis?

A

scarlet fever

244
Q

What does the image below show?

A

scarlet fever of the face

245
Q

What does image below show?

A

strawberry tongue with white membrane of scarlet fever

246
Q

how do you investigate scarlet fever?

A

throat swab with culture

247
Q

What is the management of scarlet fever?

A

Antibiotics and children can return to school after 24-hour is of taking antibiotics

FINALS (24 decks)

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