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3/4: YX - OSCE > Infection Station > Flashcards

Infection Station Flashcards

1
Q

What is the main iatrogenic precipitant of C.diff?

A

Antibiotic use (particularly broad spec)

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2
Q

Which antibiotic is the main culprit for C.diff?

A

Ceftriaxone

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3
Q

How is C.diff transmitted?

A

As spores

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4
Q

What hygiene precaution is important with C.diff?

A

Wash hands WITH SOAP AND WATER

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5
Q

What gives C.diff its unique hygiene rule?

A

Ability of spores to survive alcohol gel

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6
Q

Is C.diff always pathological?

A

No - 3% of the population have it as normal gut flora

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7
Q

How does C.diff cause illness?

A

Releases toxins that cause cytokine release and cell damage and death

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8
Q

What is the name given to C.diff’s effect in the bowel?

A

Pseudomembranous colitis

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9
Q

What symptoms present in C.diff?

A 
Diarrhoea
Abdo pain
Fever
Malaise
Nausea
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10
Q

What investigations should be done in C.diff?

A

NEWS

Stool sample

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11
Q

What effect can C.diff have in peristalsis?

A

Stop it

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12
Q

What does the cessation of peristalsis in C.diff risk?

A

Bowel perforation

Sepsis

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13
Q

What is looked for on stool sample in C.diff?

A

Antigens

Toxins

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14
Q

What stool sample result means that C.diff is at a pathological level?

A

Toxin positive

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15
Q

Why is NEWS important in C.diff?

A

Look for early warning signs of sepsis

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16
Q

What medication is used to treat C.diff?

A

Metronidazole

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17
Q

What other management steps (besides antibiotics) should be taken in C.diff?

A

Isolate patient
Stop previous antibiotics
Ensure good hand hygiene
Use PPE

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18
Q

What should be remembered about metronidazole?

A

It is a CYP450 inhibitor

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19
Q

What are the common 3 organisms causing CA pneumonia?

A

Strep pneumoniae
Klebsiella pneumoniae
Haemophilus influenzae

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20
Q

What type of organisms most commonly cause HA pneumonia?

A

Mostly gram-ve rods

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21
Q

What antibiotic used to treat first line mild CAP?

A

Amoxicillin

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22
Q

Second lines in mild CAP?

A

Macrolide

Tetracycline

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23
Q

What are some symptoms of pneumonia?

A 
SoB
Rigors
Fever
Cough +/- sputum
Pleuritic chest pain
Malaise
N+V
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24
Q

What are two rarer causes of CAP?

A

Mycoplasma

Staph aureus

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25
Q

What score is used to assess CAP?

A

CURB65

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26
Q

What does C mean in CURB65?

A

New onset Confusion

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27
Q

What does U mean in CURB65?

A

Urea >7

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28
Q

What does R mean in CURB65?

A

RR≥30

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29
Q

What does B mean in CURB65?

A

SBP ≤90 or DBP ≤60

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30
Q

What does 65 mean in CURB65?

A

Age >65

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31
Q

What does each aspect of CURB65 score?

A

1 point

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32
Q

A score of what should lead to admission to hospital?

A

≥2

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33
Q

What antibiotics are used for mild HAP?

A

Amoxicillin

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34
Q

What antibiotic should be used for Moderate-Severe HAP?

A

Ceftriaxone

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35
Q

Why is Ceftriaxone used in more severe HAP?

A

It is more effective against Gram -ve bacteria (the most common cause of HAP)

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36
Q

Why is tetracycline (+amoxicillin) used in severe CAP?

A

Broad spectrum to cover the Gram +ve/-ve organisms that can commonly cause CAP

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37
Q

What investigations should always be done in pneumonia?

A 
FBC
U&E
CRP
ABG
CXR
Sputum culture
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38
Q

What tests can be added if you fancy for pneumonia?

A

Blood culture
Lavage
Serum antibody
Nose and throat swabs

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39
Q

What are some possible examination findings of pneumonia?

A 
Tachycardia
Tachypnoea
Pyrexia
Cyanosis
Dull percussion
Increased tactile vocal fremitus/resonance
Bronchial breathing
Crackles
40
Q

After what time period is onset of pneumonia post-hospital admission consider HAP?

A

> 48 hours

41
Q

What is bacteriuria?

A

Bacteria in urine (a/symptoamtic)

42
Q

What is a UTI?

A

Symptomatic w/ +ve culture or dipstick

43
Q

What is urethral syndrome?

A

Symptomatic but no bacteriuria

44
Q

What is an uncomplicated UTI?

A

UTI in normal GU tract and function

45
Q

What is a complicated UTI?

A

UTI in abnormal GU tract/function

and all men sometimes

46
Q

What are the 3 presentations of UTI’s?

A

Pyelonephritis
Cystitis
Prostatitis

47
Q

How does pyelonephritis present?

A

Fever
Loin pain
Vomiting
Potentially oliguria if AKI

48
Q

How does cystitis present?

A 
Frequency
Urgency
Polyuria
Dysuria
Suprapubic tenderness
Foul smelling urine
49
Q

How does prostatitis present?

A

Flu-like symptoms
Low back ache
Dysuria
Tender prostate on PR

50
Q

What are the risk factors for UTI?

A 
Female
Sexual activity
Pregnancy
Menopause
DM
Abnormal tract
51
Q

What can constitute an abnormal urinary tract?

A

Stones
Obstructions
Catheter
Malformation

52
Q

What is the most common organism causing UTI?

A

E. coli

53
Q

What less organisms can cause UTI?

A

Staphylococcus Saprophyticus
Proteus
Klebsiella

54
Q

What investigations should be done for UTI?

A

Dipstick
MSU for MCS
Bloods
USS in children, men, recurrent or pyelonephritis

55
Q

How can UTI be managed non-pharmacologically?

A

Drink plenty

Urinate often

56
Q

What is the first line for cystitis?

A

Nitrofurantoin

57
Q

What is second line for cystitis?

A

Trimethoprim

58
Q

What can contra-indicate use of nitrofurantoin?

A

eGFR <45

59
Q

What can be used to treat pyelonephritis?

A

Cefotaxime

60
Q

How should UTI’s be prevented?

A

Drink more
Abx prophylaxis (in serious recurrent cases)
Drink cranberry juice (caution with drug interactions)
Wipe front to back

61
Q

When should septic arthritis be suspected?

A

Any acutely inflamed joint

62
Q

Why is it important to be highly suspicious of septic arthritis?

A

Can destroy a joint in <24 hours

63
Q

What is the mortality rate of septic arthritis?

A

11%

64
Q

What is the most commonly affected joint in septic arthritis?

A

Knee

65
Q

How should septic arthritis be investigated?

A

Joint aspiration for microscopy and culture

Blood cultures

66
Q

When must aspiration and blood cultures be taken?

A

Before starting empirical antibiotics

67
Q

What are some major risk factors for septic arthritis?

A

Immunosuppression
DM
Prosthetic joints
Recent joint surgery

68
Q

When is septic arthritis particularly difficult to treat?

A

In prosthetic joints

69
Q

What is the main differential for septic arthritis?

A

Crystal arhtopathies

70
Q

What are the main crystal arthropathies?

A

Gout

Pseudo-gout

71
Q

What will be seen on microscopy of joint aspirate in septic arthritis?

A

Increased WCC

72
Q

What will be seen on microscopy of joint aspirate in gout?

A

Needle shaped urate crystals

73
Q

What will be seen microscopy of joint aspirate in pseudo-gout?

A

Rhomboid shaped crystals

74
Q

What colour is joint aspirate in septic and crystal arthropathies?

A

Turbid yellow

75
Q

How can a joint become septic?

A

Direct introduction of bacteria

Deposition of bacteria via systemic spread

76
Q

What are the most common causative organisms of septic arthritis?

A

Staph aureus

Strep

77
Q

What is a good empirical antibiotic to use in septic arthritis?

A

IV flucloxacillin

78
Q

How long are antibiotics used in septic arthritis?

A

2-4 weeks

79
Q

What antibiotic should be used if there is a suspected gram -ve cause of septic arthritis?

A

IV ceftriaxone

80
Q

Where does appendicitis pain begin?

A

Umbilical region

81
Q

Where does appendicitis pain localise?

A

RIF

82
Q

What are the symptoms of appendicitis?

A

Abdo pain
Nausea and vomiting
Diarrhoea
Lost appetitie

83
Q

How is appendicitis treated?

A

Mostly with removal of the appendix

84
Q

How is an appendectomy performed?

A

Laparoscopy

85
Q

What antibiotic used for cellulitis?

A

Flucloxacillin

86
Q

How can the symptoms of meningitis be classified?

A

Meningitic
Neurological
Septic

87
Q

What are the meningitic symptoms of meningitis?

A

Headache
Neck stiffness
Photophobia
N&V

88
Q

What are the neurological features of meningitis?

A

Decreased GCS
Seizures
Focal neurological signs

89
Q

What are the septic features of meningitis?

A

Sepsis

90
Q

What organisms can cause meningitis?

A 
HSV2
Meningococcus
Pneumococcus
Haemophilus
TB
Cryptococcus
91
Q

What investigations are required for meningitis?

A

Bloods
Blood cultures
Lumbar puncture*

92
Q

When should LP not be performed in meningitis?

A

When the patient is mainly septic

93
Q

When should LP be performed in meningitis?

A

When the patient is mainly meningitic

94
Q

If a meningitis patient is mainly septic what medication should be given?

A

Ceftriaxone

95
Q

If a patient is mainly meningitic what medications should be given?

A

Ceftriaxone

Dexamethasone

96
Q

What supportive therapies should be given in meningitis?

A

Oxygen

Fluids

97
Q

What can be given as prophylaxis to household contacts of patients with meningitis?

A

Rifampicin

3/4: YX - OSCE (19 decks)

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