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302 > Case of the collapsed traveller > Flashcards

Case of the collapsed traveller Flashcards

1
Q

gram positive colour and negative?

A

positive purple, negative pink

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2
Q

gram positive?

A

thick peptiodglycan layer hold onto purple dye

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3
Q

gram postive circular?

A

staphylcoccus

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4
Q

grampositive diplococci

A

streptococcus pneumoniae

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5
Q

gram negative rods or bacilli?

A

ecoli, escherichia

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6
Q

gram negative coccus?

A

neisseria gonorrhoea

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7
Q

streptococci species haemolysis on blood agar?

A

alpha- partial green
beta- complete so translucent
gamma- no haemolysis

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8
Q

e.coli 0157:H7 causes?

A

food poisoning

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9
Q

staphylcoccus aureus…?

A

commensal of nose 60%

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10
Q

s.aureus is special because?

A

coagulase positive

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11
Q

example of coagulase negative

A

staphycoccus epidermis

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12
Q

cellulitis cause

A

strep pyogenes, staph aureus

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13
Q

3 ways to classify streptocci?

A
  1. haemolysis
  2. lancefield groups- surface carbohydrate antigens
  3. true species name
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14
Q

which organisms cause alpha haemolysis?

A

viridans type streptococci, common comensals of mouth,
s.pneumoniae, s.milleri, s.mitis, s.sanguis

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15
Q

necrotising fasciitis?

A

s.pyogenes infection of deep tissues, producing tissue destructive enzymes in stationary phase

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16
Q

signs of necrotising fascitis?

A

pain out of proportion to physical signs
bruising and blistering
generalised toxaemia
renal impairment
high crp
raised CK

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17
Q

streptococcus pyogenes levels?

A

superficial- pharyngitis, cellulitis
deep- necrotising fascitis/ myoitis
autoimmune sequelae- rheumatic fever, glomerulonephritis

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18
Q

gram negative bacteria?

A

nesisseria meningitidis

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19
Q

n.meningitidis blebbing?

A

lipopolysaccharide shedding (endotoxin)

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20
Q

why are you likely to grow staph epidermis in someones blood?

A

someone didnt clean the skin before they took the blood

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21
Q

endpoint of sepsis

A

purpura fulminans (bruising that comes on like lightening)

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22
Q

concept of sepsis?

A

infection, host tries to contain and cures, dissemination can lead to cellular and organ damage

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23
Q

SIRS definition?

A

fever more than 38, less than 36
tachypnoea more than 20
tachycardia more than 90bpm
leucocytosis/leucopenia more than 12000 or less than 4000

more than 2 out of 4 required

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24
Q

proinflammatory cytokines cause?

A

increased vascular permeability and decreased vascular resistance

decreased cardiac contractility
fever diarrhoea, metabolic changes- insulin resistance(hyperglycaemic), protein catabolism

raised neutrophil, migration, adhesion, first high then low

increase coagulation

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25
Q

sepsis shock?

A

early distributive shock- warm peripheries, peripheral vasolidilation
hypovolaemic shock- cold peripheries
cardiogenic shock

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26
Q

LPS is recognised by?

A

TLR4, but can be macrophage scavenger receptor

27
Q

other PAMPS?

A

lipopolypeptides, peptidoglycans, flagellin microbial DNA/RNA

28
Q

other pattern recognition receptors?

A

CD15, TLRs1-11, NOD1/2, beta integrins

29
Q

gram positive bacteria can cause sepsis through?

A

lipotechoic acid, peptidoglycans

30
Q

superantigen exotoxins are released by?

A

staph aureus, streptococcus pyogenes- toxic shock syndrome

31
Q

toxic shock syndrome result?

A

skin desquamation

32
Q

superantigens cause?

A

huge t cell responses

33
Q

organ dysfunction score?

A

SOFA- six organ symptoms
resp, coagulation, liver, cardiovascular, cns, kidney

34
Q

initial antibiotic treatment of sepsis

A

initate treatment in 1 hour
iv antimicrobial from agreed local formulary

35
Q

deadliest malaria parasite in africa?

A

p.falciparum

36
Q

most dominant malaria parasite in sub saharan africa?

A

p.vivax

37
Q

what is injected into bloodstream?

A

sporozoites

38
Q

from liver stage what is released?

A

merozoite

39
Q

what happens in red blood cell?

A

ring- trophozoitem schizont, which bursts and release merozoites which infect more rbcs

40
Q

what is taken up by mosquito?

A

gametocytes

41
Q

why is there no malaria in UK?

A

parasite multiplication affected by temp, less than 16 no replication

42
Q

how can we control malaria?

A

insecticide treated nets
indoor residual spraying
malaria vaccination
treatment
prophylaxis

43
Q

prompts diagnosis of malaria?

A

fever, visited malaria endemic area,

44
Q

how do you test for malaria?

A

giema-stained blood film
rapid diagnostic tests

45
Q

falciparum look like

A

ring trophozoite

46
Q

what does microscopy tell you

A

species, parasitemia, parasite stage

47
Q

presentation of malaria?

A

myalgia, headache, fever, abdominal pain, lethargy diarrhoea and vomiting

48
Q

severe malaria?

A

parasitaemia more than 2%

or less than 2 but schizonts present or complications

49
Q

how does malaria affect rbcs?

A
  1. malaria parasites inserts proteins PfEMP1 onto infected rbc surface
  2. form adhesive knobs which
50
Q

how many var genes does malaria have?

A

60

51
Q

how to treat malaria?

A

drug susceptibility
type of plasmodium
prophylaxis
how severe

52
Q

iv quinine side effects?

A

arrhythmias,
hypoglycaemia
potentially lethal hypotension

53
Q

treatment of severe malaria?

A

iv artesunate- kills circulating ring stage parasites as well as schizonts

54
Q

hypnozoites living in liver are due to?

A

p.vivax, p.ovale

55
Q

how to treat p.vivax and p.ovale?

A

primaquine

56
Q

activated charcoal should be given?

A

1st hour

57
Q

cocaine and amphetamine neutransmitters?

A

dopamine and noradrenaline

58
Q

diagnostic tests for cocaine/results?

A

ECG tachyarrhythmia
metabolic acidosis
increased creatnine kinase

59
Q

how to treat prolonged QRS?

A

iv sodium bicarbonate

60
Q

morphine toxicity sign?

A

pinpoint pupils, accumulating co2, bradycardia

61
Q

naloxone has?

A

short half life compared to the opiate you are giving it for

62
Q

benzodiazepine antagonist- reversal

A

flumazenil- can give seizure

63
Q

methylene blue

A
64
Q

aspirin overdose?

A

metabolic acidosis and respiratory alkalosis

302 (24 decks)

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