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Medicine block > Infectious diseases block > Flashcards

Infectious diseases block Flashcards

1
Q

What are the common signs and sx associated w fever in a returned traveller?

A
  • Febrile
  • Resp sx
  • GI sx - D+V
  • Lymphadenopathy
  • Hepatosplenomegaly
  • Rash
  • Jaundice
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2
Q

What are the common causes of fever in a returned traveller?

A
  • Malaria
  • Dengue fever
  • Thyphoid fever
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3
Q

What are some important things to ask about in a hx of a returned traveller?

A
  • Travel in last 12 months, travel date and duration of stay
  • Accom - urban or rural, staying w fam and friends
  • Sexual exposure - sex worker, unprotected sex
  • Activities and exposure - freshwater swimming, insects and animals
  • Food and water
  • PMH and predisposition to infection
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4
Q

What protection can pt have to travel related disease?

A

Vaccines - childhood vaccines, Hep A and B, rabies, typhoid, tetanus, yellow fever
Malaria chemoprophylaxis or insect spray and malaria nets.

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5
Q

What are the time frames for different diseases causing fever in returned traveller?

A

0-10 days - dengue fever, GI, viral
10-21 days - malaria, typhoid, primary HIV infection
>21 days - malaria, TB, parasites, chronic bacterial infection

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6
Q

What signs could be found on exam of a returned traveller w fever?

A
  • Maculopapular rash - dengue, CMV, EBV, rubella, primary HIV
  • Low pulse w high fever = typhoid
  • Splenomegaly - mono, malaria, typhoid
  • Haemorrhagic lesions - haemorrhagic and dengue fever, meningitis
  • Fever + alt mental state in returned traveller could = meningo encephalitis from cerebral malaria or Japanese encephalitis
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7
Q

What are the ix into fever in returned traveller?

A
  • Bloods - FBC, LFT, U&E, culture, malaria smear
  • Urinanalysis and culture
  • CXR
  • Stool culture
  • Serology of HIV, Hep B and C, syphilisis
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8
Q

What is malaria?

A

Disease transmitted by female Anopheles mosquitos at night. P falciparum is the most extreme and most from Africa. Can also get P vivax and P ovale from SE Asia.

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9
Q

What is the presentation of malaria?

A
  • Abrupt onset rigors
  • Then high fevers, malaise, headache, N+V, myalgia, vague abdo pain
  • Jaundice and hepatosplenomegaly
  • Can get diarrhoea
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10
Q

What is found in bloods of a pt w malaria?

A

Anaemia, thrombocytopenia, leukopenia and derranged LFTs.

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11
Q

What happens if malaria is left untreated?

A

Hypoglycaemia, pulm oedema, renal fail, neuro deterioration and death.

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12
Q

What are the sx of typhoid fever?

A
  • Diarrhoea or constipation
  • Vague abdo pain
  • Sustained fever
  • Anorexia and malaise
  • Dry cough
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13
Q

What are the findings on a pt w typhoid fever?

A
  • Pulse temp dissociation
  • Hepatosplenomegaly
  • Rose spots
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14
Q

What are the ix into typhoid and how is it diagnosed?

A

Ix - leukopenia, lymphopenia, raised CRP

Dx - blood, stool and urine cultures, DM and duodenal aspirates

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15
Q

What is the treatment of typhoid?

A
  • IV ceftriaxone

- Once know sensitivities = PO ciprofloxacin or azithromycine

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16
Q

What is PUO and what are the classic characteristics?

A

Pyrexia of unknown origin:

  • 38 degrees multiple occasions
  • > 3 weeks illness
  • No dx >1 week in hospital
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17
Q

What are the possible causes of PUO?

A

Infective - IE, TB, abscess
Autoimmune - Wegner’s granuloma, GCA
Neoplastic - lymphoma, leukaemia, RCC
Drugs, VTE, hyperthyroidism.

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18
Q

What is the management of PUO?

A
  • Establish dx and don’t start abx until spoken to a senior

- Might be able to manage a stable pt outpt after a period of inpt observation

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19
Q

Give an overview of TB

A
  • Caused by mycobacterium tuberculosis
  • Aerosol infection that causes pulm infection and then haematogenous spread to anywhere else in body
  • Reactivation risk ~10-15%
20
Q

Who is at risk of latent TB reactivation?

A
  • Often happens in people who have emigrated to the UK from endemic areas
  • Immunocompromised pt
  • Pt on immunosuppressants
21
Q

What is latent TB?

A

Asymptomatic TB and has to be identified on screening. Can lie dormant for years w/o causing sx and then reactivate to cause sx.

22
Q

How do you screen for latent TB and who is screened? What are the downsides of the tests?

A

Interferon gamma and quantiferon.
Downsides - don’t differentiate between active and latent TB, can get false neg and positives.
Screen - health care workers, immigrants from high prevelance countries, HIV +ve, pt about to start immunosuppressants.

23
Q

What is the treatment for latent TB?

A

3 months rifampicin and isoniazid or 6 months just rifampicin.

24
Q

What are the common sx of active TB?

A
  • Drenching night sweats
  • Weight loss
  • Non resolving cough
  • Persistant unexplained fever
25
Q

What are the signs of active TB?

A
  • Clubbing
  • Lymphadenopathy
  • Cachexia
  • Hepatosplenomgealy
  • Erythema nodosum
26
Q

What are the ix into active TB?

A
  • Culture is the gold standard
  • Imaging = lymphadenopathy, cavitating pneumonia
  • Biopsy = caseating/necrotising granulomata
27
Q

What is a paradoxial reaction in TB?

A

TB sx get worse as bacteria die, usually when a pt starts treatment.
If the new sx are really bad pt may need steroids for the duration of their treatment.

28
Q

What is TB meningitis and what are the sx?

A

TB in CSF - all pt w miliary TB need LP to exclude.

Sx - personality change, headaches, meningitis sx then comatose, more insidious onset than viral and bacterial

29
Q

What are the ix results for TB meningitis?

A

LP - high protein, low glucose and lymphocytosis

MRI - leptomeningeal enhancement

30
Q

How is TB meningitis treated?

A

The paradoxial reaction can be fatal so need steroids when start treatment and for 12 months.

31
Q

What is pericardial TB and treatment?

A

Causes pericardial effusion and paradoxial reaction = cardiac tamponade, need 6 months treatment and steroids

32
Q

What is miliary TB and how is it treated?

A

Disseminated TB, TB in multipe sites. Need CT/MRI head and LP to exclude CNS involvement and then can start treatment.

33
Q

What are the RF for MDR TB and what protective measures are used against it?

A

RF - incomplete TB treatment, pt from abroad

Protective measures - infection control = neg pressure rooms and PPE

34
Q

What is the treatment for TB (not for CNS TB)? How do you monitor ATT?

A

Intense phase = 2 months rifampicin, isoniazid, ethambutol, pyrazinamide + pyridoxine (vit B)
Continuation phase = 4 months rifampicin and isoniazid +pyridoxine (vit B)

Monitoring - LFTs and visual acuity before and LFTs throughout

35
Q

What are the SE of the ATT drugs?

A

Rifampicin - orange tears and urine, hepatitis
Ethambutol - retrobulbar neuritis, hepatitis
Isoniazid - hepatitis, peripheral neuropathy, hepatitis
Pyrazinamide - hepatitis

36
Q

What are the infection control measures surrounding TB?

A

Pt needs to be isolated/in side room and wear mask when leaving room for first 2 weeks of treatment. After 2 weeks pt consider non infectious to immunocompetent individuals.

37
Q

What STI testing is available for an asymptomatic pt?

A
  • Vulvo-vaginal, rectal and pharyngeal swab

- First pass urine in men

38
Q

What STI testing is available for a symptomatic pt?

A
  • Urethral, vaginal, rectal discharge = charcoal swab to microbiology for gonorrhoea, BV and thrush
  • Conjunctivitis swab for gonorrhoea
  • Oral/genital swab = viral swab for HSV
39
Q

What pt should bacterial STI screening be offered to?

A
  • Pt who already have a sexually transmitted infection
  • Pt who ask for it
  • Pt w RF for STI in their hx
40
Q

What are the ix into HIV?

A
  • HIV test to confirm
  • CD4 count
  • HIV viral load and resistance profile
  • Serology for syphilis, Hep B, A, C
  • Bloods = FBC, U&E, LFT, bone and lipid profile
41
Q

What drugs are used to treat HIV and what are the important things to note about them?

A

Anti retro virals eg. emtricitabine. Need to avoid drug resistance by using the right meds and being compliant.
They have many DDI esp OTC prescriptions and inhaled therapy.

42
Q

What does a CD4 count of <200 mean and how should a pt be treated?

A

AIDs. Highly at risk for opportunistic infections. Treat w co-trimoxazole as prophylaxis for PCP.

43
Q

How should a pt w a CD4 count of <50 be treated?

A

High dose azithromicin against MAI. Need to be ix for intra ocular infection eg. CMV retinitis.

44
Q

What vaccinations should HIV pt receive?

A
  • Hep B
  • Pneumococcals
  • Annual flu jab
45
Q

PrEP vs PEP

A

PrEP - for pt who are at risk of becoming HIV +ve to prevent this, 90% effective
PEP - stops pt w exposure getting HIV, emergency situation and start w/i 72 hr of exposure

46
Q

How do you treat life threatening C diff?

A

IV metronidazole and oral vancomycin

47
Q

What are the live attenuated vaccines?

A

BOOMY
BCG
Oral polio
Oral typhoid
Mumps
Yellow fever

Medicine block (8 decks)

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