Viral Diseases - Clinical medicine Flashcards
List the most common respiratory viral infections that are seen in primary care
- Adenovirus
- Coronavirus
- Influenzas A/ B
- Parainfluenza
- Rhinovirus
- Respiratory syncytial virus (RSV)
- Human metapneumovirus
What are the risk factors for complicated influenza
- 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+)
What hygiene technique has the most significant impact in reducing the spread of respiratory viral illness?
Hand washing
What is the human papilloma virus (HPV)
A viral infection that’s passed between people through skin-to-skin contact and causes a range of human disease
What does humn papilloma virus commonly cause?
Hand and foot warts
Which HPV serotypes ( a serologically distinguishable strain) are considered low risk in feet and hand/fingers?
1 & 4 for feet
2, 3 & 10 for hand/fingers
a) What can high risk HPV serotypes cause?
b) Provide examples
a) Malignancy
b)
- Cervical cancer
- Some head and neck cancers
- Penile cancer
- Anal cancer
- Vulval and vaginal cancer
a) What is the HPV vaccine called?
b) How may serotypes does it protect against and which ones are they?
a) Gardasil
b) 4 serotypes: 6, 11, 16 & 18
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) Type 6 and 11
b) Type 16
c) Type 18
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) Gardasil 9
b) 31, 33, 45 and 52
c) Cause an additional 15% of cervical cancers
What are the types of human herpes virus (HHV)?
- 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
What do herpes simplex type 1 and 2 commonly cause?
Cold sores and genital herpes (mainly type 2)
a) What happens once you are infected with a human herpes virus?
b) What can occur later in life? Provide examples
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
What can cytomegalovirus cause?
- 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
What type of infection are 70% of sore throats caused by?
Viral infections
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) glandular fever (infectious mononucleosis)
b) Initial infection of oral epithelial cells with subsequent spread to B-lymphocytes
a) Where can human herpes virus type 6 be isolated from in adults?
b) What can it cause in children? and why?
a) Saliva
b) Roseola infantum (common infection that causes high temperature and rash) because of reactivation of human herpes virus 6 & 7
What are the common rashes you see in primary care?
- Hand, foot, and mouth disease
- Parvovirus
- Molluscum contageosum
What virus is hand, foot, and mouth disease caused by?
Coxsackie virus A1
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) Pox virus
b) Multiple lesions
c) Yes but this can take several years
What should you ask during a consultation history of an acute infection?
- 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?
What should you look for/examine during a consultation of an acute infection?
- Do they look sick?
- Temperature, heart rate, BP, respiratory rate, O2 sats -> NEWS score
- 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
- Rash
- Flat/ raised
- Vesicular (Small fluid filled blisters)
- Pruritic (itchy)
- Widespread
- Localised
- Relevant examination: Look at ears/ throat
- Relevant examination: Listen to chest
What should you consider during a consultation of an acute infection?
- 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?
What investigations can be undertaken in primary care to diagnose an acute infection?
- Blood tests: FBC and CRP
- Swabs – bacterial and viral
- Urine dipstick and culture (MC&S)
- Chest X-ray (CXR)
a) What are the differential diagnosis?
b) If it is tonsilitis what treatment will you give?
c) What should you consider?
a)
- Tonsilitis (bacterial/viral)
- Glandular fever (viral)
- Streptoccocus meningitis (bacteria)
b) Antibiotics
c) Make sure patient not taking immunosuppressants, as contradicts with antibiotics
a) What are the differential diagnosis
b) If it is flu what treatment would you give?
c) What advice would you give?
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
a) What are the differential diagnosis?
b) If it is streptococcus pneumonia what treatment would you give?
c) What advice would you give?
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
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)
- 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
a) What are the differential diagnosis?
b) If it is chicken pox what treatment will you give?
c) What advice will you give?
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
What questions would you ask to gain more information?
- 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?
What physical examinations would you perform?
- 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
What investigations would you consider?
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
What sort of symptoms might indicate a need for hospital admission?
- 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
a) What is spesis?
b) What are the signs of sepsis
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
