Case report + case series
Description of pts complete medical history
series compiles multiple pts to identify common patterns
Cross sectional study
Measures prevalence of a disease + gathers exposure data
e.g. HTN in the community; then collect data on sex, weight, smoking etc.
Case control study
Compares those with & without a disease
e.g. with and without cancer; then collect data on smoking
Cohort study (prospective vs retrospective)
Follows a group over time to investigate exposure and outcome
Prospective - do not have disease, measure exposure, monitor outcome
Retrospective - already exposed, check if outcome occurred
Most common cause of gastroenteritis
Viral - rotavirus, norovirus, adenovirus
E.coli infection gi - incubation, what, sx/complication.
12-48 hrs incubation
gram -ve rods lactose fermenting bacilli
0157 strain produces shiga toxin => cramps, bloody diarrhoea, vomiting
Can lead to haemolytic uraemic syndrome; worsened by abx
Common in travellers
Campylobacter jejuni infection
gram -ve bacilli
Poultry, milk and untreated water
2-5 incubation, 2-6 days of sx; prodrome: headache malaise
diarrhoea: often bloody
abdominal pain: may mimic appendicitis
Clarithromycin if severe sx
Shigella infection
gram -ve rod
Shiga toxin
1-2 day incubation period, 1 week sx
Can lead to haemolytic uraemic syndrome; worsened by abx
Azithromycin if severe
Salmonella infection
Poultry, raw egg
12hrs-3 days incubation, sx 1 week
Bacillus Cercus infection
+ve rod
unrefrigerated food after cooking e.g. rice reheated kills bacteria but not toxin
vomiting within 5 hours, watery diarrhoea after 8, resolution within 24
Yersinia Enterocolitica infection
-ve bacilli
Pork
typically children; watery/bloody diarrhoea, pain, fever
adults can present with R abdo pain from mesenteric adenitis
4-7 incubation, 3 weeks sx
Staph aureus GI infection
eggs, dairy, meat
sx within hours, settles within 24
Giardiasis infection
Parasite
days-years incubation
can be no sx -> often asymptomatic
non-bloody diarrhoea
steatorrhoea
bloating, abdominal pain
lethargy
flatulence
weight loss
malabsorption and lactose intolerance can occur
-ve on cultures. Microscopy or antigen
Cryptosporium infection
Parasite
7-10days incubation
GI symptoms
Leptospirosis
Rodent urine
Underlying vasculitis
Sudden onset fever, headache, myalgia, conjunctival suffusion
=> Weil’s disease - jaundice, thrombocytopaenia, AKI, aseptic meningitis
Malaria
Parasite; Plasmodium falciparum - most common and most severe
Fever, fatigue, myalgia, headache, N+V, pallor, hepatosplenomegaly, jaundice
Falciparum fever spikes often, p. ovale and p. vivax rupture every 48 hours and fever spike every 48 hours
Incubation 1-4 weeks
Blood film diagnosis
3 -ve samples in 3 days needed for exclusion
Treatment:
Artemether with lumefantrine 1st line, quinine also
Artesunate if severe (can give haemolysis)
Complications
cerebral malaria, seizures, decreased GCS, AKI, DIC
Prophylaxis
proguanil/atovaquone for 2 days prior, 7 days after
doxy 2 days, 4 weeks
mefloquine 2 weeks, 4 weeks (can give psych side effects)
Enteric fever / typhoid - presentation, investigations, management
salmonella typhi
week 1: headache, cough , weak, fever, abdo discomfort
2: ‘toxic’; sustained fever, rose spots, pain, constipation* or diarrhoea, hepatosplenomegaly, bradycardia
3: sx settle or complications; GI perf, haemorrhage, shock
Blood cultures
Supportive care +- iv abx
Trypanosomiasis - types, presentation, management
African trypanosomiasis/sleeping sickness:
Trypanosoma chancre - painless subcutaneous nodule at site of infection
intermittent fever
enlargement of posterior cervical lymph nodes
later: central nervous system involvement e.g. somnolence, headaches, mood changes, meningoencephalitis
Management
early disease: IV pentamidine or suramin
later disease or central nervous system involvement: IV melarsoprol
American trypanosomiasis, or Chagas’ disease: The vast majority of patients (95%) are asymptomatic in the acute phase although a chagoma (an erythematous nodule at site of infection) and periorbital oedema are sometimes seen. Chronic Chagas’ disease mainly affects the heart and gastrointestinal tract; myocarditis may lead to dilated cardiomyopathy, complete heart block is common in late stages
gastrointestinal features includes megaoesophagus and megacolon causing dysphagia and constipation
Management
treatment is most effective in the acute phase using azole or nitroderivatives such as benznidazole or nifurtimox
chronic disease management involves treating the complications e.g., heart failure
Dengue fever - cause, presentation, management
viral infection
fever
headache (often retro-orbital)
myalgia, bone pain and arthralgia (‘break-bone fever’)
pleuritic pain
facial flushing (dengue)
maculopapular rash
haemorrhagic manifestations e.g. positive tourniquet test, petechiae, purpura/ecchymosis, epistaxis
‘warning signs’ include:
abdominal pain
hepatomegaly
persistent vomiting
clinical fluid accumulation (ascites, pleural effusion)
dengue haemorrhagic fever: DIC
Supportive management
Blood transfusion indications
20% blood loss
pre operative Hb <90g/L with increased risk of blood loss
Hb <80 in active MI
Hb <70
Hb 70-90 if symptomatic or co-morbid: SOB, angina, syncope, ST depression, tachy
Q: What is an acute haemolytic transfusion reaction, and how is it managed?
Due to ABO incompatibility (IgM antibodies to transfused blood)
Occurs within minutes
Symptoms: fever, abdo pain, hypotension, haemoglobinuria, anxiety
Can lead to DIC and renal failure
Management:
Stop transfusion
Send blood for Coombs test
Give fluid resuscitation
What is transfusion-related acute lung injury (TRALI), and how is it managed?
Cause: Donor antibodies (Ab) to neutrophils + HLA
Onset: Within 6 hours
Symptoms: Dyspnoea, severe hypoxaemia, hypotension
Management:
Stop transfusion
Provide oxygen and supportive care
What is a febrile non-haemolytic transfusion reaction, and how is it managed?
Cause: Antibodies against donor HLA
Symptoms: Fever, chills, no haemolysis
Management:
Slow or stop transfusion
Monitor the patient
What causes anaphylaxis during a transfusion, and how is it managed?
Cause: Usually caused by IgA deficiency and anti-IgA antibodies
Management:
Stop transfusion
Give IM adrenaline
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Drugs166
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Module 1 Structure, function & defence284
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Module 1 revision of Bacteria, infections and antibiotics30
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Module 2 Respiratory339
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Module 3 Cardiovascular277
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Module 4 Limbs and Back353
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Module 5 Alimentary System137
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Module 6 Endocrine122
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Module 7 Urogenital497
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Module 8 Neurosciences367
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Module 9 Integrative124
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OSCE20
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Surgery FFP204
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FFP Medicine234
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Patient Clinical Signs18
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Clinical phase OSCE25
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FFP Mental Health104
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FFP Specialty Skills120
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Extra areas29
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Obs and gynae140
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Paeds153
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Integrated + HCOLL122
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Senior med68
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Senior Surgery7
