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Medicine - Year 1 > Viral Diseases - Clinical medicine > Flashcards

Viral Diseases - Clinical medicine Flashcards

1
Q

List the most common respiratory viral infections that are seen in primary care

A
  • Adenovirus
  • Coronavirus
  • Influenzas A/ B
  • Parainfluenza
  • Rhinovirus
  • Respiratory syncytial virus (RSV)
  • Human metapneumovirus
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2
Q

What are the risk factors for complicated influenza

A
  • Neurological, hepatic, renal, pulmonary and chronic cardiac disease
  • Diabetes mellitus
  • Severe immunosuppression
  • Age >65 yrs.
  • Pregnancy (including up to 2 weeks post-partum)
  • Children <6 months
  • Morbid obesity (BMI 40+)
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3
Q

What hygiene technique has the most significant impact in reducing the spread of respiratory viral illness?

A

Hand washing

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4
Q

What is the human papilloma virus (HPV)

A

A viral infection that’s passed between people through skin-to-skin contact and causes a range of human disease

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5
Q

What does humn papilloma virus commonly cause?

A

Hand and foot warts

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6
Q

Which HPV serotypes ( a serologically distinguishable strain) are considered low risk in feet and hand/fingers?

A

1 & 4 for feet

2, 3 & 10 for hand/fingers

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7
Q

a) What can high risk HPV serotypes cause?
b) Provide examples

A

a) Malignancy

b)

  • Cervical cancer
  • Some head and neck cancers
  • Penile cancer
  • Anal cancer
  • Vulval and vaginal cancer
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8
Q

a) What is the HPV vaccine called?
b) How may serotypes does it protect against and which ones are they?

A

a) Gardasil
b) 4 serotypes: 6, 11, 16 & 18

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9
Q

a) Which two HPV serotypes caues 90% of genital warts?
b) Which HPV serotype causes about 60% of cervical cancer in Europe?
c) Which HPV serotype causes 15% of cervical cancer in Europe?

A

a) Type 6 and 11
b) Type 16
c) Type 18

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10
Q

a) What HPV vaccine will the UK switch to for routine immunisation?
b) Which additional HPV serotypes will it cover?
c) What do these additional HPV serotypes cause?

A

a) Gardasil 9
b) 31, 33, 45 and 52
c) Cause an additional 15% of cervical cancers

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11
Q

What are the types of human herpes virus (HHV)?

A
  • Herpes Simplex type 1 and 2
  • Cytomegalovirus (CMV)
  • Varicella zoster virus (VZV) (chicken pox and shingles)
  • Epstein-Barr virus (EBV)
  • Human Herpes virus types 6, 6A, 7 & 8
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12
Q

What do herpes simplex type 1 and 2 commonly cause?

A

Cold sores and genital herpes (mainly type 2)

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13
Q

a) What happens once you are infected with a human herpes virus?
b) What can occur later in life? Provide examples

A

a) Once you have an infection, you keep it for life, usually in dormant form
b) Reactivation can occur e.g. shingles in V2V and pityriasis rosea in human herpes virus 6 & 7

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14
Q

What can cytomegalovirus cause?

A
  • Can cause infection similar to EBV (but usually less pharyngits or tonsilitis)
  • Can cause congenital infection (affect unborn fetus/newborn infant)
  • Can cause serious infection in the immunocompromised including interstitial pneumonia in bone marrow ttansplant patient
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15
Q

What type of infection are 70% of sore throats caused by?

A

Viral infections

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16
Q

a) What does Epstein-Barrvirus cause (EBV)?
b) Where does the initial infection of EBV start? and where does it spread to?
c) Where can it be cultured from?

A

a) glandular fever (infectious mononucleosis)
b) Initial infection of oral epithelial cells with subsequent spread to B-lymphocytes

17
Q

a) Where can human herpes virus type 6 be isolated from in adults?
b) What can it cause in children? and why?

A

a) Saliva
b) Roseola infantum (common infection that causes high temperature and rash) because of reactivation of human herpes virus 6 & 7

18
Q

What are the common rashes you see in primary care?

A
  • Hand, foot, and mouth disease
  • Parvovirus
  • Molluscum contageosum
19
Q

What virus is hand, foot, and mouth disease caused by?

A

Coxsackie virus A1

20
Q

a) What virus causes Mollusucm contageosum?
b) What clinical presentation is mainly found in children from molluscum contageosum?
c) Can it clear spontaenously by itself?

A

a) Pox virus
b) Multiple lesions
c) Yes but this can take several years

21
Q

What should you ask during a consultation history of an acute infection?

A
  • What are the symptoms? e.g., Cough, coryza, sore throat, otalgia, rash, headache, pyrexia, dysuria, diarrhoea, and vomiting
  • Duration and time course
  • Severity and progression
  • Risk factors for more severe infection e.g., pregnancy, immunosuppression
  • Travel hx and contacts
  • What has the patient tried already?
  • What does the patient think it is? What are their concerns? What are they expecting? What is the impact e.g., on work, caring for others?
22
Q

What should you look for/examine during a consultation of an acute infection?

A
  1. Do they look sick?
  2. Temperature, heart rate, BP, respiratory rate, O2 sats -> NEWS score
  3. Capillary refill Mucous membranes -> Hydration status
  • Press on nail bed for 5 seconds, until turns white
  • Should take less than 2 seconds to refill
  • If it takes longer, it suggests they’re dehydrated
  1. Rash
  • Flat/ raised
  • Vesicular (Small fluid filled blisters)
  • Pruritic (itchy)
  • Widespread
  • Localised
  1. Relevant examination: Look at ears/ throat
  2. Relevant examination: Listen to chest
23
Q

What should you consider during a consultation of an acute infection?

A
  • SEPSIS – 999
  • What is the type of infection e.g., upper, or lower respiratory tract, gastrointestinal or urinary tracts, skin etc?
  • What is the causative organism? Viral/ bacterial/ fungal
  • Can I make the diagnosis from the history and examination, or do I need further investigations?
  • How unwell is this patient?
  • What are their risk factors?
  • Can I safely manage in primary care?
  • Do I need to give a specific treatment e.g., an antibiotic? Pros and cons
  • Self-help advice
  • Fitness to work certificate
  • Safety netting (e.g., if it gets worse, to come back)
  • Have I fully considered and met the patient’s ideas, concerns, and expectations?
24
Q

What investigations can be undertaken in primary care to diagnose an acute infection?

A
  • Blood tests: FBC and CRP
  • Swabs – bacterial and viral
  • Urine dipstick and culture (MC&S)
  • Chest X-ray (CXR)
25
Q

a) What are the differential diagnosis?
b) If it is tonsilitis what treatment will you give?
c) What should you consider?

A

a)

  • Tonsilitis (bacterial/viral)
  • Glandular fever (viral)
  • Streptoccocus meningitis (bacteria)

b) Antibiotics
c) Make sure patient not taking immunosuppressants, as contradicts with antibiotics

26
Q

a) What are the differential diagnosis
b) If it is flu what treatment would you give?
c) What advice would you give?

A

a)

  • COVID-19 - Do a PCR test to confirm
  • Flu
  • Malaria - ask about travel

b) Symptomatic relief: rest and NSAIDs

c)

  • If temeperature raises/coughing up sputum to come back to hospital
  • Keep distance from mother
  • Mother can be given tenofovir or prophylaxis antiviral
27
Q

a) What are the differential diagnosis?
b) If it is streptococcus pneumonia what treatment would you give?
c) What advice would you give?

A

a)

  • Sepsis
  • Streptococcus pneumonia

b)

  • Amoxicillin (antibiotic - penicillin)
  • If allergic use: clarithromycin (antibiotic)

c)

  • Send straight to hospital due to high NEWS score
  • Tell her to come back if crepitations continue
28
Q

a) What are the differential diagnosis?
b) If it is an ear infection what treatment would you give?
c) What advice would you give?

A

a)

  • Mastoiditis – document mastoid isn’t tender as it’s a bacterial infection common in children
  • Ear infection - majority of red inflamed ear drums are bacterial

b)

  • Carry on NSAIDs
  • Burst ear drum is body’s reaction of getting ride of puss à heals up on own
  • If condition gets worse give antibiotics

c)

  • Do not go swimming/put head underwater
  • Come back for a check up
29
Q

a) What are the differential diagnosis?
b) If it is chicken pox what treatment will you give?
c) What advice will you give?

A

a)

  • Chicken pox
  • Hand, foot, and mouth disease

b)

  • No antiviral
  • Cool showers
  • Moisturising
  • No NSAIDs as can lead to secondary bacteria
  • No aspirin for U16’s unless heart disease
  • Give paracetamol

c)

  • Ask mum if she’s had chicken pox before because risk to mum as she’s immunocompromised and risk to baby
  • Do blood tests for lgM and lgG in mum and if she does not have any then give immunoglobulins
30
Q

What questions would you ask to gain more information?

A
  • More details about the symptoms, is there muscle pain, sore throat, fatigue?
  • Onset of the symptoms?
  • Did he get any mosquito bites?
  • Was he taking malarial prophylaxis?
  • Was anyone else unwell in the group?
  • Has he other symptoms such as diarrhoea or vomiting?
  • Is anyone else unwell at home?
  • How is his asthma doing?
31
Q

What physical examinations would you perform?

A
  • Pulse, temperature, BP, respiratory rate and oximeter reading.
  • Look for general findings such as pallor (pale) or rash. Does he look unwell?
  • Check for important findings such a neck stiffness and photophobia (meningism) - Is bright light hard to look at
  • Ear, nose and throat.
  • Listen to his chest
  • Examine his abdomen
  • Check for any subtle signs of a change in his cognitive function
32
Q

What investigations would you consider?

A

Blood tests

  • FBC
  • CRP
  • Urea and electrolytes (U&Es)
  • Liver function tests (LFTS)
  • Blood film for malarial parasites.

If findigs suggest a lower repiratory tract infection:

  • Might need to also consider chest x-ray
33
Q

What sort of symptoms might indicate a need for hospital admission?

A
  • Meningism (clinical syndrome of headache, neck stiffness, and photophobia, often with nausea and vomiting) or petechial rash (doesn’t branch or fade away when pressure is applied/glass test for it)
  • Suspicion of sepsis
  • Symptoms such as rigors (high fever with associated shaking as body set temp at higher temperature) - found in serious infections
  • Change in cognitive level or confusion (think of encephalitis - inflammation of brain or viral meningitis inflammation of membrane protecting brain)
  • Acute exacerbation of his asthma
34
Q

a) What is spesis?
b) What are the signs of sepsis

A

a) S-erious complication of an infection
b) E-xtreme shivering or muscle pain

P- assing no urine (in a day)

S-evere breathlessness

I-t feels like you are going to die

S-kin mottled or discoloured

Medicine - Year 1 (61 decks)

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