CLASP - sepsis (micro) Flashcards
(183 cards)
1
Q
Tx for C.diff
A
1st: Oral vancomycin
2nd: Fidaxomicin
3rd: Oral vancyomycin +/- IV metronidazole
In life-threatening toxic megacolon, a subtotal colectomy may be required
2
Q
T or F: alcohol-based hand rubs are not effective in removing C. difficile spores
A
True - use water and soap
3
Q
Fever, rash, relative bradycardia and abdominal pain plus leukopaenia and raised transaminases in a returning traveller
A
Salmonella typhi
4
Q
When is vaginal therapy indicated in a pregnant woman with HIV?
A
Viral load <50 at 36 weeks
5
Q
Rapid onset vomiting after having home-made foods and dairy products + non-bloody diarrhoea
A
Staphylococcus aureus
6
Q
Serious side effect of the use of penicillins?
A
Anaphylactic shock
7
Q
Spectrum of activity of penicillin
A
Covers gram-positive (S. aureus, S. pneumoniae, S. viridans, ß-haemolytic Streptococci, Bacillus anthracis, Clostridium tetani); spectrum increased with ß-lactamase inhibition
8
Q
Spectrum of activity of flucloxacillin
A
Penicillinase resistant
9
Q
Spectrum of activity of amoxicillin
A
Similar to penicillin + gram-negative cover (E. coli, Brucella spp., H. influenzae)
10
Q
Spectrum of activity of Glycopeptides
A
Gram-positive coverage (aerobic and anaerobic)
11
Q
Spectrum of activity of Linezolid
A
Gram-positive infection (including MRSA)
12
Q
Spectrum of activity of Aminoglycosides
A
Broad-spectrum gram-negative cover e.g. E. coli, P. aeruginosa
13
Q
Spectrum of activity of Fluoroquinolones
A
Broad-spectrum antibiotic coverage
14
Q
Spectrum of activity of Tetracyclines
A
Broad-spectrum gram-positive, gram-negative and intracellular cover; some gram-positive cocci resistance
15
Q
Spectrum of activity of Macrolides
A
Similar to penicillins with cover for multiple causes of atypical pneumonia
16
Q
Spectrum of activity of Metronidazole
A
Significant anaerobic cover and protozoan cover
17
Q
Aerobic, haemolytic gram-positive bacillus
A
Listeria
18
Q
Spore-forming, toxin-producing gram-positive bacillus; found in cattle and sheep
A
Bacillus anthracis
19
Q
Toxin-producing gram-positive bacillus. Causes gastroenteritis. Found in re-heated takeaway food (typically rice); re-heating kills bacteria but not toxins
A
Bacillus cereus
20
Q
Anaerobic, spore-forming gram-positive bacilli; typically found in soil and dust
A
Clostridium
21
Q
Rod-shaped, a nonmotile, non-encapsulated obligate aerobe
A
Mycobacterium tuberculosis/bovis
22
Q
Mechanism of trimethoprim?
A
Inhibits the folic acid synthesis pathway
23
Q
Contraindication to the use of trimethoprim?
A
Pregnancy
24
Q
Adverse effect of quinolone antibiotics?
A
C. difficile superinfection
25
Haematogenous osteomyelitis, causative agent likely to be..
Staphylococcus aureus
26
What does the following gram stain show?
Staphylococcus aureus/Staph epidermis if coag positive
Gram positive clusters
27
What is strep pneumonia?
Gram-positive, α-hemolytic, lancet-shaped diplococci
28
Blue-green pigment is noted on the agar plate
Pseudomonas aeruginosa
29
8 year old with sore throat and fever
Anterior cervical lymphadenopathy
Blood agar, which shows growth of colonies surrounded by a clear zone
Strep throat - Strep pyogens (GAS - beta haemolytic)
30
History of cystic fibrosis. Blood culture shows gram negative rods
Pseudomonas aeruginosa
31
Abx for Pseudomonas aeruginosa
Erythromycin
32
Gram positive coccus that generally exists in pairs, or in chains
Streptococcus pyogenes
Streptococcus pneumoniae
33
Gram negative diplococci
Neisseria meningitidis
34
Gram positive cocci in clusters
Staphylococcus aureus
35
Drug to give if penicillin allergic
Macrolides - Clarithromycin, zithromycin and erythromycin
36
Drug to give if penicillin resistant
Vancomycin
37
Gram negative bacilli/rods
Shigella spp
Salmonella spp
Escherichia coli
Vibrio cholerae
38
Gram negative bacilli/rods:
K. pneumonia/E- coli if lactase positive
H. pylori/V. cholerae/ P. aeruginose if lactase negative
39
Which condition is an absolute contraindication to treatment with nitrofurantoin?
G6PD
40
Gram negative curved/spiral bacillus
Vibrio cholerae
Campylobacter jejuni
H. pylori
41
Which lab test would be most useful to identify strep pyogenes?
Anti-streptolysion O
42
Which lab test would be most useful to identify strep pneumoniae?
Quellung reaction
43
Abx for Campylobacter
Clarithromycin
Alt. ciprofloxacin
44
Abx for Salmonella
Ciprofloxacin
45
Abx for Shigellosis
Ciprofloxacin
46
Ix for Clostridioides difficile
CDT in the stool
47
Tx for UTIs
48
Ix for legionella
Urinary antigen
49
Tx for legionella
Erythromycin/clarithromycin
50
Fever, myalgia and fatigue 1 week after returning from Kenya
Mild jaundice and splenomegaly
Malaria
51
What type of bacteria is Campylobacter?
Gram-negative bacillus
52
Causes skin infections (e.g. cellulitis), abscesses, osteomyelitis, toxic shock syndrome
Coagulase-positive Staphylococcus aureus
53
Cause of central line infections and infective endocarditis
Coagulase-negative Staphylococcus epidermidis
54
Gram positive cocci
Staphylococci + streptococci (including enterococci)
55
Gram-negative cocci
Neisseria meningitidis + Neisseria gonorrhoeae, also Moraxella catarrhalis
56
Gram-positive rods (bacilli)
ABCD L
Actinomyces
Bacillus anthracis (anthrax)
Clostridium
Diphtheria: Corynebacterium diphtheriae
Listeria monocytogenes
57
Gram-negative rods (bacilli)
Escherichia coli
Haemophilus influenzae
Pseudomonas aeruginosa
Salmonella sp.
Shigella sp.
Campylobacter jejuni
58
Alternative to PO metronidazole in BV?
Topical metronidazole/clindamycin
59
Milk, cheese and eggs
Salmonella Typhimurium/Entereditis
60
BBQs
Campylobacter jejuni
61
Reheated rice
Bacillus cereus
62
Contaminated milk products and foods contaminated through contact with food workers who carry the bacteria
Food that require no cooking, including puddings, pastries, sandwiches and sliced meat
Staph aureus
63
Red meat
Clostridium perfringens
64
Improperly cooked or cheap cuts of meat and petting zoos or farms
E. coli
65
Tx for gastroenteritis
Ciprofloxacin/azithromycin
66
CURB 65
Confusion +/-
Urea >7
Respiratory Rate >30
Blood pressure: systolic < 90 or diastolic <60
More than 65 years old
67
Mx if CURB 65 is 0/1
Home-based care, give oral amoxicillin for 5 days (macrolide e.g. clarithromycin, doxycycline or tetracycline if penicillin allergic)
68
Mx if CURB 65 is 2
Hospital-based care, 7-10 day course of dual antibiotic therapy with amoxicillin (IV or oral) and a macrolide
69
Mx if CURB 65 is 3
Hospital/ITU-based care, 7-10 day course of dual antibiotic therapy with IV co-amoxiclav/ceftriaxone/tazocin and a macrolide.
70
Mx if HAP within 5 days of admission
Co-amoxicillin or cephalosporin (e.g cefuroxime)
71
Mx if HAP 5 days after admission
Tazocin or cephalosporin (e.g. ceftazidime) or quinolone
72
_____ is characteristic of haemolytic anaemia, thrombocytopenia and acute renal failure
E. coli 0157
73
Most common bacterial organism implicated in infections affecting the urinary tract
E coli
74
ESBL enzyme means the bacteria has resistance to..
All penicillins, third-generation cephalosporins, plus monobactam (aztreonam) and beta-lactam
75
_______ is the most common cause of travellers' diarrhoea
E. coli
76
What does the gram stain show?
Corynebacterium
Clostridium
Listeria
Bacillus
Gram positive bacilli
77
What does the agar plate show?
Beta haemolysis: strep pyogens, GAS
78
What does the agar plate show?
Alpha haemolysis: s. viridians/pneumonia
79
What does the agar plate show?
Gamma haemolysis: Enterococcus faecalis (Group D Strep), staph epidermis
80
Role of lab diagnosis
81
What does the gram stain show?
N. gonorrhoea/meningitidis
Gram negative cocci
82
What does the gram stain show?
H influenza
B pertussis
M catarrhalis
Gram negative coccobacilli
83
Abx in non-neutropenic sepsis
IV Amoxicillin + Metronidazole + Gentamicin
84
Abx in non-neutropenic sepsis if penicillin allergic
IV Vancomycin + Metronidazole + Gentamicin
85
IV ________ is more effective than vancomycin in methicillin-sensitive staphylococcus aureus (MSSA)
Flucloxacillin
86
What tests are done if suspecting endocarditis?
Refer to cardio for TTE
If negative/equivocal/ongoing suspicion then TOE
87
How often are blood cultures repeated in endocarditis?
48 hours after starting IV abx and at 48 hour intervals until negative cultures
88
Abx in maternal sepsis
IV co-amoxiclav +/- IV gentamicin
In allergic then clindamycin + gentamycin
89
Abx in maternal septic shock
IV piperacillin tazobactam + IV clindamycin + IV gentamicin
If allergic then clindamycin + gentamycin
90
Abx in sepsis/septic shock for IVOST/post-partum
PO co-amoxiclav
If allergic for IVOST antenatal then PO ceftixime + clindamycin
If allergic for IVOST postpartum then PO co-trimoxazole + metronidazole
91
Tx for meningitis
If in the community then benzylpenicillin
If hospital then IV ceftriaxone followed by Dexamethasone
92
Who should you NOT dipstick in?
>65
Catheters
93
Tx for orbital cellulitis
Admission to hospital for IV antibiotics
94
Most common bacterial causes of orbital cellulitis
Streptococcus, Staphylococcus aureus
Haemophilus influenzae B
95
Moost frequently causative organisms of preseptal cellulitis
Staph. aureus
Staph. epidermidis
Streptococci
Anaerobic bacteria
96
Tx of preseptal cellulitis
Co-amoxiclav
97
Tx of allergic conjunctivitis
First-line: topical or systemic antihistamines
Second-line: topical mast-cell stabilisers, e.g. Sodium cromoglicate and nedocromil
98
Tx of infective conjunctivitis
Self limiting but if doesn't resolve then:
Topical Chloramphenicol
If pregnant/alt: Topical fusidic acid
No contact lens (Ix: topical fluoresceins), sharing towels, can still go to school
99
Tx for ophthalmic shingles
Aciclovir or valaciclovir + lubricating eye drops if lesions near eyelid
100
Tx for dental abscess
Refere to dentist
Phenoxymethylpenicillin (clarithromycin is allergic)
101
Tx for tonsillitis
Phenoxymethylpenicillin (erythromycin if the patient is penicillin allergic)
102
Scoring systems for tonsillitis
103
Most common causes of sinusitis
Streptococcus pneumoniae, Haemophilus influenzae and rhinoviruses
104
Mx of acute sinusitis
If more than 10 days symptoms: intranasal corticosteroids
If severe: phenoxymethylpenicillin (co-amoxiclav)
105
Mx of epiglottitis
ET
Don't examine the throat
O2
IV Abx
106
Most common cause of epiglottitis
Haemophilus influenzae type B
107
Most common cause of acute otitis media
Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis
108
Mx of acute otitis media
5-7 day course of amoxicillin is first-line
If allergy then erythromycin or clarithromycin
109
Abx are only prescribed in acute otitis media if..
>4 days or not improving
Systemically unwell
Immunocompromise or high risk of complications secondary to heart, lung, kidney, liver, or neuromuscular disease
<2 years with bilateral otitis media
Perforation and/or discharge in the canal
110
Causes of otitis externa
Bacterial (Staphylococcus aureus, Pseudomonas aeruginosa) or fungal
Seborrhoeic dermatitis
111
Mx of otitis externa
1st: Topical antibiotic or a combined topical antibiotic with a steroid
2nd: Flucloxacillin (erythromycin if penicillin-allergic). Empirical use of an antifungal agent
112
Mx of oral candidiasis
1st: Nystatin suspension, miconazole gel
2nd: Oral fluconazole
113
The most common infective causes of COPD exacerbations are..
Haemophilus influenzae
114
Mx of acute exacerbation of COPD if sputum is purulent or there are clinical signs of pneumonia
Amoxicillin or clarithromycin or doxycycline
115
Mx of acute bronchitis if systemically unwell, have pre-existing co-morbidities, CRP of 20-100mg/L, r a CRP >100mg/L
Doxycycline
If pregnant/children then amoxicillin
116
Mx of diverticulitis
Metronidazole + Co-trimoxazole 5 days (or co-amoxiclav if unable to take cotrimoxazole)
117
Most common cause of cellulitis
Streptococcus pyogenes
Staph aureus is less common
118
Tx of cellulitis
Flucloxacillin (clarithromycin, erythromycin or doxycycline if penicillin-allergic)
119
Tx of facial cellulitis
Co-amoxiclav
120
Tx of athlete's foot
Terrbinafine cream
121
Tx of scalp infection
Oral terbinafin for 2-4 weeks + ketoconazole shampoo twice
weekly for first 2 weeks
122
Tx of fungal nail infection
Oral terbinafine 6 weeks (fingers) or 12 weeks (toes)
If non dermatophyte or candida use itraconazole for 1 week out of 4. 2 cycles (fingers) or 3 cycles (toes)
123
Tx for diabetic foot disease
Mild: Flucloxacillin or Doxycycline
Moderate: Flucloxacillin + Metronidazole or Doxycycline
+ Metronidazole
124
Most common cause of impetigo
Staphylcoccus aureus or Streptococcus pyogenes
125
Tx for mild impetigo
Hydrogen peroxide 1% cream
Topical fusidic acid. If resistant then topical mupirocin
126
Tx for extensive impetigo
Oral flucloxacillin
Oral erythromycin if penicillin-allergic
127
Tx for chickenpox
Aciclovir if patient presents within 24 hours of onset of rash or immunocompromised
128
Tx for shingles
Acicolvir or valaciclovir
Immunocompromised should be referred to hospital for IV antiviral treatment
129
Tx for bites
Co-amoxiclav (doxycycline + metronidazole if penicillin-allergic)
130
Most common organism in bites
Pasteurella multocida
131
Most common cause of pyelonephritis
E. coli
132
Tx of pyelonephritis
Broad-spectrum cephalosporin or a quinolone (for non-pregnant women) for 7-10 days
133
Most common cause of prostatitis
E. coli
134
Tx of prostatitis
Quinolone or trimethoprim
135
Most common cause of epididymo-orchitis
Chlamydia trachomatis and Neisseria gonorrhoeae in younger
E. coli in older adults with a low-risk sexual history
136
Mx of epididymo-orchitis
If organism unknown then: ceftriaxone IM plus doxycycline PO twice daily for 10-14 days
If organism known then: MSU + oral quinolone for 2 weeks (e.g. ofloxacin)
137
Causes of viral conjunctivitis
Adenovirus
Herpes simplex
Herpes zoster
138
Cavitating lesions in pneumonia
Staphylococcus aureus
Haemophilus influenzae type A
139
Pneumonia + erythema multiforme or erythema nodosum
Mycoplasma pneumoniae
140
_______ pneumoniae is more likely in patients with alcohol abuse
Klebsiella
141
_____________ is the most common cause of community-acquired pneumonia
Streptococcus pneumoniae
142
People who have been exposed to a patient with confirmed bacterial meningitis should be given prophylactic antibiotics if they have close contact within the 7 days before onset. This includes..
Oral ciprofloxacin or rifampici
143
Abx used in the treatment of mRSA infections
Vancomycin
Teicoplanin
Linezolid
144
Non-bloody diarrhoea + malabsorption (floating stools in the toilet)
Giardiasis
145
What type of influenza vaccine is given to pregnant women/immunocompormised/adults?
Injection form = inactive virus
Only children get the nasal form (live weakened virus)
146
Tx for Jarisch-Herxheimer reaction
Antipyretics and supportive treatment
147
Latent tuberculosis treatment options
3 months of isoniazid (with pyridoxine) and rifampicin, or
6 months of isoniazid (with pyridoxine)
148
Tx for exacerbations of chronic bronchitis
Amoxicillin or tetracycline or clarithromycin
149
Tx for uncomplicated community-acquired pneumonia
Amoxicillin (Doxycycline or clarithromycin in penicillin allergic, add flucloxacillin if staphylococci suspected e.g. In influenza)
150
Tx for pneumonia possibly caused by atypical pathogens
Clarithromycin
151
Tx for Hospital-acquired pneumonia
pneumonia Within 5 days of admission: co-amoxiclav or cefuroxime
More than 5 days after admission: piperacillin with tazobactam OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin)
152
Tx for impetigo
Topical hydrogen peroxide
Oral flucloxacillin or erythromycin if widespread
153
Tx for Erysipelas
Flucloxacillin (clarithromycin, erythromycin or doxycycline if penicillin-allergic)
154
Tx of Gingivitis
Metronidazole
155
Tx for Shigellosis
Ciprofloxacin
156
Tx for Salmonella
Ciprofloxacin
157
BNF antibiotic guidelines (revision card)
158
Periods of sudden coldness (cold stage) then a hot stage with fever, vomiting, and flushing, and finally a sweating stage before returning to normal
Malaria
159
Mosquitos. Headache (often retro-orbital), fever, muscle aches, facial flushing, and a maculopapular rash
Dengue fever
160
Mild fever, diarrhoea, myalgia, and headache
Typhoid
161
Tx of meningitis if there is diagnostic delay
IV ceftriaxone
IV amoxicillin if immunocompromises, <6 months, >60 years, due to a need to cover for Listeria monocytogenes
162
Most common organism in osteomyelitis
Staph. aureus
If sickle-cell anaemia: Salmonella species
163
Mx of osteomyelitis
Flucloxacillin for 6 weeks
Clindamycin if penicillin-allergic
164
Urethritis + arthritis +/- conjunctivitis
Reactive arthritis
165
Tx for a pregnant women with a UTI if she is near term
Amoxicillin for 7 days
166
HIV seroconversion lasts..
3-12 weeks after infection
167
For HIV, what's the next step if the combined test is positive?
It should be repeated to confirm the diagnosis
168
After an initial negative result when testing for HIV in an asymptomatic patient, offer a repeat test at..
12 weeks
169
Flu-like symptoms including fever (present in > 95% of patients)
Dry cough
Relative bradycardia
Confusion
Lymphopaenia
Hyponatraemia
Deranged liver function tests
Legionella pneumophilia
170
What part of the bone is most commonly affected in osteomyelitis?
Children = M inors = M etaphysis
Adults = E lders = E piphysis
171
Dengue: Retro-orbital headache, fever, maculopapular rash and thrombocytopenia
Enteric fever: First stage lasts for approximately the first week and often precedes the classical 'pea green diarrhoea' of typhoid. Headache, fever, arthralgia, rose spots. Later on, it is accompanied by relative bradycardia, abdominal pain, distension and constipation
Malaria: Cyclical fever, tiredness, vomiting, anaemia and headaches, jaundice
172
Incubation period
1-6 hrs: Staphylococcus aureus, Bacillus cereus*
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis
173
Notifiable diseases
174
Tenosynovitis
Migratory polyarthritis
Dermatitis (lesions can be maculopapular or vesicular)
Disseminated gonococcal infection
175
Stippled appearance of vaginal epithelial cells
Bacterial vaginosis
176
Genital ulcers
painful: herpes much more common than chancroid
painless: syphilis more common than lymphogranuloma venereum
177
presents with a penile ulcer. It initially started as a papule which later progressed to become a painful ulcer 15mm in diameter with an undermined ragged edge
Chancroid
178
Severe hepatitis in a pregnant woman - think hepatitis E
This patient has presented with hepatitis with reduced GCS, a flapping tremor, and a clotting screen consistent with disseminated intravascular coagulation. Fulminant liver failure in a pregnant woman who has recently returned from Mexico is consistent with hepatitis E
179
Tertiary syphilis = 4 Ds
4 D's:
Destructive gumma
Dorsal columns (tabes dorsalis)
Dilated aortic root
Dementia
180
Common cause of meningitis in 0-3 months
Group B Streptococcus (most common cause in neonates)
E. coli
Listeria monocytogenes
181
Common cause of meningitis in 3 months - 6 years
Neisseria meningitidis
Streptococcus pneumoniae
182
Common cause of meningitis in > 60 years
Streptococcus pneumoniae
Neisseria meningitidis
Listeria monocytogenes
183
Common cause of meningitis in immunosuppressed
Listeria monocytogenes
