Common infections Flashcards

1
Q

Classical presentation of acute pneumonia

A

Fever - due to inflammation Shortness of breath Increased sputum production Pleuretic chest pain Dullness to percussion Bronchial breathing

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2
Q

CURB65

A

Used for estimating prognosis of pneumonia. Score over 2 = hospital, over 3=ITU

Confusion

Urea >7mmol/l

Respiratory rate >30/min

Blood pressure SBP>90 or DBP <60

Age over 65

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3
Q

Organisms that cause acute pneumonia

A

Typical:
Streptococcus pneumoniae
Haemophilus influenzae
Staphylococcus aureus

Atypical:
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Legionella sp.
Respiratory viruses
TB

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4
Q

Atypical pneumonia

A

Pneumonia caused by organisms which do not respond to penicillin or are non-culturable e.g. leigionella, M. pneumoniae, viruses.

Can’t differentiate clinically

Detect with serology (rising Ab levels or urine antigen detection)

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5
Q

What investigations would you carry out in a patient with suspected pneumonia

A

Blood cultures, sputum if productive cough

Serology (2 samples, 7 days apart, may confirm atypical infection, useful in outbreaks)

Antigen testing (urine)

Pleural fluid sampling (to differentiate other causes of lung disease)

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6
Q

Why would you test a sputum sample in a patient with suspected pneumonia?

A

If the suspected cause was not a normal commensal of the body e.g. M. pneumoniae, Mtb, Pneumocytis,

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7
Q

Parapneumonic effusion

A

Pleural effusion associated with bacterial pneumonia, lung abscesses or trauma which introduces organisms into the chest wall.

Pleural inflammation results in exudate forming in the pleural cavity. This has a high neutrophil content.

Pleural effusions are normally sterile but if the bacteria invade the pleural space, inflamation and fibrogenesis result in abscess formation.

Fluid is resorbed and fibroblasts proliferate forming a scar.

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8
Q

Treatment of acute pneumonia

A

Increased survival if antibiotics given <4hrs

Amoxycillin for mild infection

Clarithromycin for atypical/hospital infection

Severe pneumonia broad spectrum (co-amoxiclav) + clarithromycin

Oxygen, IV fluids (treatment for sepsis)

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9
Q

Gastroenteritis

A

Inflammation of the stomach and intestinal epithelium

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10
Q

Diarrhoea

A

passage of liquid stool or frequent passage of normal stool

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11
Q

Food poisioning

A

vomiting/diarrhoea caused by eating food contaminated with bacteria, bacterial toxins or other substances

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12
Q

Dysentery

A

Bloody diarrhoea with mucus, tenesmus, pain and fever

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13
Q

Signs of hypovolemia

A

thirst, dry mucus membranes

low venous pressure

tachcardia

hypotension

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14
Q

Signs of colitis

A

Abdominal tenderness

bowel sounds

distension

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15
Q

In what patients would investigation of diarrhoea be indicated?

A

Bloody diarrhoea

Dehydrated patients

If diarrhoea is persistent

Abdominal pain

Fever

Immunocompromised

Risk of C.diff (>60, recent admission, antibiotics)

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16
Q

What investigations would you do in a patient with diarrhoea?

A

Blood tests

Stool sample (selective agar, grown in selective conditions)

17
Q

Causes of non-inflammatory diarrhoea

A

Enteroadherent E. coli
Staph aureus
Bacillus cereus
Clostridium perfringens
Cholera

normally due to the relsease of toxin, rapid onset

18
Q

Causes of inflammatory diarrhoea

A

Clostridium difficile (antibiotic related)
Shigella
E. coli
Salmonella
Campylobacter

19
Q

Common food-borne causes of diarrhoea

A

Salmonella (poulty/eggs)

Campylobacter (poultry)

E.coli (faecall contaminated food)

20
Q

Characteristic of cholera

A

Rice water stool

Rapid loss of fluid

21
Q

Common causes of viral gastroenteritis

A

Norovirus

Rotavirus

Detected by EM, Elisa or PCR

22
Q

Giardia

A

Caused by giardia lamblia

Causes diarrhoea due to fat malabsorption, atrophy of intestinal villi and loss of disaccharides

Diagnosis my microscopy for cysts or immunoassay

Treat with metronidazole

23
Q

Subacute endocarditis

A

Slow progressing endocarditis caused by bacteria from the mouth and GI tract

Progression is subtle

Vasculitic lesions are normally first indication e.g. splinter haemorrhages

24
Q

Acute endocarditis

A

Caused by S. aureus

Rapid deterioration, results in valve failure

25
Q

Investigations for a patient with endocarditis

A

Blood culture

Echocardiogram (valve lesion or vegetation)

Duke criteria for assessing severity