29. Infections 2

Question 1

What is infective endocarditis and what are the main causative organisms?

Answer 1

Infection of endocardial structures

Staphylococci
Streptococci (likes prosthetic valves)
Enterococci

Question 2

Signs and symptoms of infective endocarditis?

Answer 2

Fever
Malaise
Arthralgia, myalgia, confusion

Pyrexia, tachy, anaemia
Clubbing
New murmur
Splenomegaly
Vasculitic lesions

Question 3

Investigations for infective endocarditis?

Answer 3

Bloods - FBC for anaemia, ESR, CRP, U&Es, rheumatoid factor positive
3 blood cultures an hour apart
Urgent echo

Dukes classification

Question 4

How do we manage infective endocarditis?

Answer 4

Empirical ABx
Targeted ABx after sensitivity results (2-6 weeks)
Anticoagulation may be needed in prosthetic valve endocarditis to prevent stroke/pe

Question 5

What are the main three UTIs?

Answer 5

Cystitis - bladder
Pyelonephritis - kidney
Prostate - prostatitis

Question 6

What are the signs and symptoms of pyelonephritis?

Answer 6

Rigors
Flank and back pain
Pyrexia
N&V
Confusion (elderly)

Question 7

Signs and symptoms of cystitis?

Answer 7

Frequency
Urgency
Dysuria
Haematuria
Foul-smelling cloudy urine
Suprapubic/loin pain

Question 8

How do we investigate UTIs?

Answer 8

Assess RF (complicated or no)
Dipstick urinalysis (positive nitrites, leukocytes, blood)
Urine MC&S
Abdo USS to exclude urinary tract obstruction/renal stones

Question 9

How do we manage UTIs?

Answer 9

Cefalexin first like for pyelonephritis

Trimethoprim/nitrofurantoin

Question 10

What is malaria?

Answer 10

Infection with protozoan plasmodium

Question 11

Signs and symptoms of malaria?

Answer 11

Headache
Weakness
Myalgia
Fevers
Splenomegaly
Anaemia
DIC

Question 12

Investigations and management for malaria?

Answer 12

Giemsa-stained thick and thin blood smears

Artesunate

Question 13

Symptoms of viral hepatitis?

Answer 13

Initial flu-like symptoms, malaise, joint pain etc.
Icteric phase - jaundice, pale stools, dark urine, pruritus
Recovery - up to 6 months (or not at all if in chronic, B, C, D)

Question 14

How do we manage viral hepatitis?

Answer 14

Supportive - rest, avoid alcohol, paracetamol, anti-emetics etc.
Minimise risk to others - not sharing toothbrushes, razors, sex, needles

Question 15

What is gastroenteritis and what are the common pathogens?

Answer 15

Inflammation of the GI tract
Norovirus
Rotavirus
Campylobacter
E.coli

Question 16

Symptoms of gastroenteritis?

Answer 16

Sudden onset diarrhoea
Blood or mucus in the stool
Faecal urgency
N&V
Fever/malaise
Abdo pain/cramps

Question 17

Gastroenteritis investigations?

Answer 17

Assess fluid status
HR, BP, temp for shock
Bloods (deranged K in severe dehy)
Stool MC&S - bacteria, ova, parasites

Question 18

Management of gastroenteritis?

Answer 18

Supportive therapy (bed rest, fluids)
If systemic illness then admit with oral fluids
ABx

Question 19

Main causes of meningitis?

Answer 19

Neisseria meningitidis

Strep pneumoniae

Question 20

Sign and symptoms of meningitis?

Answer 20

Classic triad -
Fever
Tachy
Hypotension

Altered mental state
Skin rash
N&V
Focal neurological signs
Brudzinski's and kernig's sign

Question 21

Investigations for meningitis?

Answer 21

Two sets blood culture
CT scan to exclude raised ICP
Lumbar puncture for CSF and gram staining

Question 22

How do we treat meningitis?

Answer 22

Non-blanching rash or septicaemia - call an ambulance and give IV benzylpenicillin

Bacterial meningitis - IV ceftriaxone
Consider corticosteroids
Consider IV acyclovir for encephalitis

Rifampicin for prophylaxis of close contacts