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5thyr > Infection > Flashcards

Infection Flashcards

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1
Q

What is the 1st line antibiotic for perioperative antibiotic prophylaxis?

Allergy?

A

First-line treatment: intravenous cefazolin

In patients with beta-lactam allergy: clindamycin or vancomycin

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2
Q

Which patients may require IV metronidazole in addition to IV cefalozin for perioperative prophylaxis?

A

Small intestinal obstruction
Appendectomy
Colorectal surgery

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3
Q

What are the most common causes of a post op fever?

A 
Surgical site infections
Pneumonia 
Catheter related UTI 
Primary blood stream infections 
Febrile drug reaction
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4
Q

What types of pnuemonia are surgical patients at risk of?

A

Ventilator associated
HAP
Aspiration

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5
Q

What bacteria causes necrotising fasciitis?

How does it present?

A

Group A strep most commonly (strep pyogenes)

Cloudy grey discharge +/- crepitus (gas in subcutaneous tissue)

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6
Q

How does c diff present?

What is the complication?

A
  • Watery diarrhoea (can be blood stained)
  • Colicky abdominal cramps
  • Fever w/ Rigors
  • Raised WCC

Complication: Risk of toxic megacolon (do AXR)

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7
Q

What type of bacteria is C diff? How does it cause disease?

A
  • ANAEROBIC gram +ve rod
  • forms toxins that are cytotoxic to mucosal cels
  • causes pseudomembranous colitis (PMC)
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8
Q

What antibiotics cause C diff?

A
  • CEPHALOSPORINS MOST COMMON (spores)

also: Clindamycin/ciprofloxin/penicillins

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9
Q

What is the management of c diff?

A

PO metronidazole for 10-14 days

PO vancomycin if severe / unresponsive

(combine both if life threatening)

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10
Q

What is the diagnostic test for C diff?

A

Stool sample

-PCR for protein followed by ELISA for toxins

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11
Q

What would you see in C diff on sigmoid/colonoscopy

A

pseudomembranous yellow plaques

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12
Q

Treatment for toxic megaolon?

A

May need urgent colectomy

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13
Q

Define pyrexia of unknown origin

A

Fever >38 for >3 weeks which cannot be diagnosed after a week in hostpiral

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14
Q

List some causes of pyrexia of unknown origin

A

Neoplasia

  • Lymphoma
  • Hypernephroma
  • Preleukaemia
  • Atrial myxoma

Infections

  • Abscess
  • TB

Connective tissue disorders

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15
Q

Criteria for HAP diagnosis?

A

HAP

  • Pneumonia if been admitted with 5 days
  • If sent home and get pnuemonia within 4-6 weeks
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16
Q

What bacteria are more likely to cause HAP

A

Different profile of organism compared with CAP

  1. Gram negative enterobacteria
  2. Staphylococcus aureus
  3. Pseudomonas
  4. Klebsiella pneumoniae
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17
Q

Treatment for HAP?

A

HAP

- IV aminoglycoside e.g. gentamicin (gram neg cover) and IV piperacillin Tazocin

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18
Q

What are the three types of influenza virus? Which cause most cases?

A

A, B, C

A and B are majority

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19
Q

How are children given the flu vaccine?

Study These Flashcards
A

Intra-nassally
At 2-3yrs then annually
Live vaccine

20
Q

How does flu present?

Study These Flashcards
A 
Most asymptomatic
Sudden onset high fever 
Headache 
Muscle / joint aches 
Non productive cough 
Severe malaise
21
Q

If someone with flu develops a productive cough or raised inflammatory markers?

Study These Flashcards
A

Bacterial superinfection over influenza

Most commonly s aureus or strep pneumoniae

22
Q

Management of flu?

Study These Flashcards
A

Supportive

Antiviral if high risk (neuraminidase inhibitors eg zanamivir / oselatamivir)

23
Q

Complications of flu?

Study These Flashcards
A

Primary influenza pneumonia

  • Haemorrhagic pneumonia
  • Can progress to ARDS

Secondary bacterial pneominia

  • Febrile and productive cough after flu symptoms have improved
  • Most common pneumoniae

URTI eg AOM, sinusitis, croup
Myositis and rahbdomyolyis
Myocarditis
Encephalitis

24
Q

How does mumps present?

Study These Flashcards
A

MUMPS

  • Prodrome of fever, malaise, myalgia
  • Then parotitis -U/L → B/L
    • causes earache and pain on eating
    • dry mouth because salivary glands blocked

Clinical diagnosis is often adequate ☺

25
How is mumps spread?
Resp droplets taken into parotid gland then spreads to other tissues (kissing) NB notifiable disease
26
What is the incubation period and when is mumps infective?
Infective 7 days before and 9 days after parotid swelling starts Incubation period = 14-21 days
27
What are some complications of mumps?
Orchitis → infertility:50% of POSTpubertal males, - Usually 4/5 days after start of parotitis Hearing loss - usually unilateral and transient Meningitis (15%) -mild and self limiting Acute pancreatitis
28
What causes malaria?
Plasmodium protozoa Spread by female Anopheles mosquito
29
What are the different types of plasmodium?
1) Plasmodium falciparum (most common cause of malaria) 2) Plasmodium vivax 3) Plasmodium ovale 4) Plasmodium malariae
30
What are some protective factors for malaria?
Sickle cell trait | G6PD deficiency
31
How does malaria present?
- Flu like symptoms - Headache - Excessive sweating (diaphoresis) - High fever - Haemolytic anaemia - weakness, paleness, dizziness - D&V - Confusion/seizures if sever Note can present up to a year post travel ``` Sx may occur from 6 d of infection → many months later Phase 1 (≤ 1hr) Shivering Phase 2 (2-6hr) Fever (HIGH temp > 41), flushed, dry skin, nausea + vomiting, headache Phase 3 (3hr) – Cold Sweats as temp falls ```
32
When do you get spikes in fever with Malaria?
Falciparum + Vivax + ovale = EVERY OTHER DAY (tertian) Malariae = Every 3rd day (quatrtan)
33
What signs do you get with malaria?
Spleno/hepatomegaly ± abdominal tenderness Jaundice Myalgia
34
What is the diagnostic investigation for malaria?
d
35
What is the diagnostic investigation for malaria?
THICK AND THIN BLOOD SMEAR
36
What other bloods would you do in malaria and what would you see?
FBC: - anemia - thrombocytopenia (may cause bleeding) Creatinine (AKI picture) Clotting (can get DIC) ABG/lactate -acidosis Urinalysis -heamaglobinuria (nephritic) Glucose -hypoglyceamia
37
How does severe malaira (usually falciparum) cause severe organ dysfunction?
Infected erythrocytes deform and stick to endothelial vessels This prevents them from being removed by the spleen These occlude capillaries causing microinfarcts
38
What organ damage can occur in severe malaria?
Kidneys - Flank Pain - Oliguria - Hemoglobinuria Cerebral - Hallucinations - Confusion - LOC / coma HF Pulmonary oedema Shock
39
What is the treatment for uncomplicated falciparum malaria?
UNCOMPLICATED falciparum malaria - Artemisinin combination therapy (ACT) e. g. artemether with lumefantrine If not available: - Quinine - AtovaQUONE with proguanil
40
What are features of severe malaria?
SEVERE MALARIA FEATURES - ↓GCS/siezures - AKI/ haemaglobinuria (from acute tubular necrosis) - Shock - Hypoglycaemia - Pulmonary odema/ARDS - Anemia - DIC/spont bleeding - Acidosis (pH <7.3)
41
What is the treatment for severe malaria?
Treatment for severe malaria | -IV Artesunate
42
What is the treatment of choice for non falciparum malaria?
Non falciparum malaria=Chloroquine (can cause blindness) | this is because falciparum is resistant to chloroquinine
43
Fever following fresh water exposure?
Schistosomiasis (snails | Leptopirosis (rats-weil disease)
44
Fever following contaminated food and water / raw meat / fish
``` Enteric fever Shigella Salmonella Campylobacter Amoebiasis Helminth infection Hep A and E ```
45
What does eosinophilia in a returning traveller indicate?
Parasitic infection
46
Describe symtpoms of Campylobacter infection? | Complication?
Campylobacter - A flu-like prodrome - Followed by crampy abdominal pains, fever + diarrhoea (may be bloody) - Complications include Guillain-Barre syndrome
47
Which antibiotics have a beta lactam ring?
``` Penicillins Cephalosporins Monobactam Carbapenems Carbacephems ```

5thyr (18 decks)

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