CP3-6 investigations of specific infections Flashcards

(53 cards)

1
Q

What are three CNS infections?

A

Meningitis
Encephalitis
Brain abscess

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2
Q

Who should be offered HIV testing?

A

Those with an infection presenting upon acute medical admission and upon registration with a new GP

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3
Q

What is meningitis?

A

Inflammation of meninges in the brain

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4
Q

Which is the main test required to investigate meningitis?

How are the results interpreted?

A

Lumbar puncture to collect cerebral spinal fluid

The opening pressure, appearance, WBC count, cell differentiation, protein and glucose levels to determine if normal or viral, bacterial or fungal meningitis or TB

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5
Q

How does CSF opening pressure vary between bacterial and viral meningitis?

A

Viral = normal (5-20cm H2O)/slightly elevated opening pressure
Bacterial = >30 cm H2O opening pressure

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6
Q

How does the appearance of CSF vary between normal and bacterial and viral meningitis?

A

Normal = clear
Viral = clear
Bacterial = turbid

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7
Q

What is the WBC count of CSF when normal, with bacterial or viral meningitis?

A

Normal = <3 x10^6/L
Viral = <1000
Bacterial = >500

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8
Q

What is the glucose level in CSF compared to blood glucose in normal, viral or bacterial meningitis?

A

Normal = 0.6
Viral = >0.6
Bacterial = <0.4

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9
Q

When are procalcitonin levels important in distinguishing an infection?

A

Determining bacterial vs viral infection

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10
Q

What other tests can be done to investigate meningitis?

A

2 sets of blood cultures
Blood test for bacterial PCR
Blood test for FBC, clotting, U&Es, glucose and CRP
Throat swab

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11
Q

What additional tests for meningitis are needed in immunosuppressed patients?

A

serum/CSF cryptococcal antigen
10ml of CSF for TB culture/PCR if suspect TB meningitis

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12
Q

What additional tests are important in investigating encephalitis?

A

Lumbar puncture
Viral PCR on CSF

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13
Q

What is encephalitis? What is the most common cause?

A

Inflammation of the brain - usually caused by herpes virus

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14
Q

What test is used to investigate brain abscesses?

A

NO lumbar puncture
Local sampling of pus for gram, culture, and sensitivity/PCR testing
Blood cultures

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15
Q

What are two common ear infection?

A

Acute otitis media
Otitis externa

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16
Q

What is a common nose infection?

A

Sinusitis

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17
Q

What are two common throat infections?

A

Pharyngitis
Diptheria

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18
Q

What test is used to investigate ear infection?

A

Can swab pus

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19
Q

What tests are used to investigate chronic sinusitis?

A

Take sample of pus
Check FBC
Take blood cultures

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20
Q

What is sinusitis?

A

Inflammation of the sinuses due to infection (usually viral) caused by a secondary bacterial infection from upper respiratory flora

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21
Q

What tests are used to investigate throat infections?

A

Throat swab for bacterial infection e.g. strep a
EBV serology
Swab for diptheria
Swab for pus if suspect quinsy abscess

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22
Q

What causes pus on tonsils?

A

Both bacterial and viral infections

23
Q

Who needs to be tested for influenza?

A

those who may require treatment
Those at risk of transmitting

24
Q

What tests are used to investigate influenza?

A

Lateral flow test/POC
PCR

25
What is the sensitivity and specificity of influenza PCR?
Sensitivity >90% Specificity 99%
26
What tests are done to investigate pneumonia with a CURB score between 2-5?
Sputum sampling Blood culturing Atypical screening including urine for legionella antigen, nose and throat mycoplasma PCR and sometimes serum
27
What tests after chest XR are needed to investigate a pneumonia with a CURB score of 0-1?
No further investigations
28
What tests are used to investigate TB?
Exposure testing e.g. mantoux (skin prick) but more commonly IGRA (interferon G releasing assay) 3 sputum samples (including early morning sample) for AAFB and microscopy and culture PCR testing
29
What tests are done to investigate atypical respiratory infections?
Viral PCR Culture for fungal infections and test for aspergillus antigens
30
What tests are used to investigate pneumocystis jirovecii?
PCR Serum B-d glucan
31
What samples are best for investigating atypical respiratory infections?
Deep respiratory samples
32
What are three localised skin infections?
Impetigo Erysipelas Cellulitis
33
What is an example of a severe skin infection?
Necrotising fasciitis
34
What skin infection are diabetics at risk of?
Diabetic foot infection
35
What tests are used to investigate localised skin infections?
Wound swabs of blister fluid or abscess pus Blood cultures
36
What tests are done to investigate necrotising fasciitis?
Two sets of blood cultures FBC, U&Es, LFTs, CRP
37
What tests are done to investigate diabetic foot infection?
Wound swab If severe infection = bone or tissue sample
38
What tests are done to investigate lower and upper UTIs? How should they be interpreted?
Urine sample for WBC, RBC, epithelial cells, bacterial growth and sensitivities kass criteria used to assess if significant bacteriuria
39
Fill in the blank. Urine from a catheter is ________ beneficial than collecting mid stream urine excreted naturally.
Less
40
What tests are used to investigate prostatitis?
Urine after a post prostatic massage
41
What tests are used to investigate epididymo-orchitis?
Send urine for culture Test for chlamydia and gonorrhoea Bloods and blood cultures if severe
42
What tests are used to investigate GI infectious diarrhoea?
(Primarily) Stool sample - 3 samples to pick up parasites Further investigations: Bloods - FBC, clotting, U&Es, LFTs, CRP Blood cultures Abdominal imaging
43
What test are used to investigate h. Pylori infection?
Stool test for h. Pylori antigen Urea breath test (less common) Biopsy urease test Endoscopy
44
What must be stopped before testing for H. Pylori?
Protein pump inhibitors
45
What test are done to investigate a liver abscess?
Blood culture FBC, U&Es, LFTs, CRP Sample pus if safe to drain Serology Imaging - ultrasound and CT
46
What tests are used to investigate cholangitis/cholecystitis?
Bloods: FBC, U&Es, LFTs, clotting, amylase Blood cultures Ultrasound or CT If aspirated/drained a bile fluid or pus sample
47
What tests are used to investigate diverticulitis?
Pus from abscess if complicated diverticulitis Blood cultures Bloods: FBC, U&Es, LFTs, clotting, amylase CT
48
What tests are used to investigate endocarditis?
Blood cultures - 3 sets taken at different times during first 24 hours of admission Echocardiogram FBC, CRP, U&Es, LFTs Serology for coxiella and brucella
49
What tests are done to investigate vascular graft infection?
Three sets of blood cultures at different times over 24 hours Imaging e.g. CT PCR or culture tissue/fluid around the graft site
50
What tests are done to investigate hepatitis A?
Serology +/- PCR Antibody testing - IgM
51
What tests are done to investigate hepatitis B infection?
Serology +/- PCR
52
What test are used to investigate hepatitis C infection?
serology +/- PCR
53
What tests are used to investigate syphilis?
Swab if have a lesion Blood tests