1 Gp - Seco 2

Front 1

Gastroenteritis - types of hx that need to be covered

Back 1

-occupational hx
-travel hx
-contact hx

Front 2

Symptoms & signs of Gastroenteritis

Back 2

-diarrhea
-nausea
-abd cramp
-fever
-myalgia
-headache
-incr'd bowel sounds

Front 3

Management of gastroenteritis

Back 3

-fluid - severe->IV fluid
-diet - simple sugars avoided; probiotic or fermented milk may be beneficial; zinc can treat&prevent diarrhea
-anti-diarrhea medicine
--loperamide not recommended in children due crossing immature BBB to cause toxicity
-limited role of antibiotics (if used, then macrolide) - due major pathogen being viral (child: rotavirus; adult: norovirus); less common are bacteria and parasites

regardless of being food handler, pat needs to reduce further spread by diligent personal hygiene

Front 4

A food handler with campylobacteriosis...

Back 4

should not return to work until symptom-free for 48hr with one negative stool culture
-if pat tests +ve for salmonella, then 3 -ve stool cultures before return to work; some just 2 -ve cultures

-inform pat of the process and the possibility of a health protection officer contacting the pat

Front 5

Influenza symptoms

Back 5

Symptoms characterized by rapid onset of systemic&respiratory symptoms incl (fammhtc gd):
-fever (may be absent in elderly)
-anorexia
-malaise
-myalgia
-headache (retro-orbital)
-sore throat
-cough (non-productive)
-minority: GI symptoms
-drowsiness: children age<4 (50%); age4-15 (10%; )adult (rare)

-acute symptoms typically last for days, but cough, tiredness & malaise may last for wks

Front 6

Influeza occurs in...

Back 6

-Peak time: May-September in Southern hemisphere
-up to 15% can develop seasonal influenza anytime of year

Front 7

Other illnesses with influenza-like symptoms include:

Back 7

-other viral URTI
-acute pharyngitis
-CMV
-EBV (glandular fever)
-lower RTI
Serious infections:
-Pneumonia
-Meningitis
-Malaria or Dengue fever in returnign travelers
-Acute HIV seroconversion illness

Front 8

4 Qu's to distinguish between influenza and influenza-like illness

Back 8

1) Area: are influenza viruses known to be circulating in this area?
2) Onset: is it sudden onset of symptoms?
3) Temp: is the temp sig'ly raised (38degC+)
4) Symptoms: both systemic & respiratory symptoms, esp. cough

If 4 Yeses then influenza is likely dx

Front 9

Management of Influenza

Back 9

self-management incl.:
-rest
-incr fluid intake
-analgesic & antipyretics e.g. paracetamol 1g qds
--asthmatic: take care with NSAID/aspirin - can cause exacerbation
-Represent if acute symptoms not settling after a few days or new symptoms develop e.g. pleuritic chest pain

Written note on red flag symptoms of meningococcal disease:
EARLIER:
-leg pain
-cold hands & feet
-abnormal skin color
LATER:
-classic meningism:
--headache
--photophobia
--neck stiffness
-feature of raised ICP:
--irritability
--drowsiness
-septicemia:
--arthralgia
--hemorrhagic rash

Prevention:
-vaccination
--70-90% effective when vaccine strains match the current circulating strains well
--free for age65+ and age 6mo-65 with chronic illness, including asthma if on preventive therapy

Front 10

Chlamydia infection should be considered when...

Back 10

-women at risk of STIs
-Urine sample shows sterile pyuria

Front 11

Appropriate sample for Chlamydia trachomatis urethritis is...

If tested +ve...

Back 11

FVU
-if tested +ve, complete STI evaluation is recommended to exclude co-infection with other STI (bacteria, protozoa & viruses)

Front 12

UTI: urine dipstick analysis

Back 12

Nitrate
-high predictive value for UTI (80%)
--Chlamydia does not produce nitrates

-ve dipstick (no nitrates/ leukocytes): doesn't rule out UTI

+ve nitrates: doesn't rule out concomitant Chlamydia infection

Front 13

Complicating features of UTI in women requiring urinary culture

Back 13

-abN urinary tract e.g. stone, reflux, catheter
-impaired host defences e.g. pregnancy, diabetes, immunosuppression
-impaired renal function
-suspicion of pyelonephritis
-more than 3 UTIs in one year
-UTI recurrence within 2 wks

Front 14

Management of upper UTI

Back 14

Tx as outpatient for mild symptoms (cf. if severe or vomiting, refer for IV antibiotics):

First line: trimethoprim 300mg od, 10-14d

Alternatives:
-co-trimoxazole 400+80mg 2 tablets bid for 10-14d
-augmentin 500/125mg tds for 10-14d
-cefaclor 500mg tds for 10-14d

Local tx of choice is: cefaclor, augmentin, or ciprofloxacin

Follow up:
-Review at 48hr to assess tx response, and ensure she is taking the right antibiotics based on the culture&sensitivity results
-needs to return urgently if gets worse
-1-2wk after completing tx, post-tx cultures are recommended to check infection has cleared