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3rd yr clinical > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

What is DIC

A

Disseminated intravascular coagulopathy - low platelets - thrombocytopaniea due to blood clots forming and taking all the platelets and clotting factors- this will cause haemorrhage

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2
Q

How is septic shock diagnosed

A

Low mean arterial blood pressure (below 65) despite fluid rhesus (need vasopressors)

Raised serum lactate above 2

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3
Q

What is SOFA

A

Sepsis related organ failure assessment
-Assess severity of organ dysfunction
-Hypoxia, O2 requirements, mechanical ventilation, thrombocytopenia, reduced GCS, raised bile, reduced BP and raised creatinine

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4
Q

What does the NEWS2 look at

A

Temp, HR, RR, O2 sats, BP, Conciousness

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5
Q

What is the management of sepsis

A

Sepsis 6
3 in
Oxygen
Empirical broad spectrum abx
IV fluids

3 out
Serum lactate
Blood cultures
Urine output

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6
Q

When should you suspect neutropenic sepsis and what causes it

A

Fever in any immunocompromised patient is a medical emergency

Chemo meds, clozapine (schizophrenia), hydroxychloroquinine, methotrexate, sulfasalazine, carbimazole (hyperthyroid), quinine, infliximab, rutuximab

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7
Q

What antibiotics are used in sepsis

A

Piperacillin with tazobactam - tazocin

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8
Q

What are the main organisms that cause UTIS

A

Usually E.coli
Klebsiella pneumoniae
Enterococcus
Pseudomonas aeruginosa

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9
Q

What are the various findings on a urine dipstick and what do they indicate

A

Nitrates- Gram negative bacteria- E.Coli break down nitrates
Leukocytes- infection inflam
RBCs- microscopic haematuria- infection, bladder cancer, nephritis

Nitrates are best indication of infection

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10
Q

What is the management of of LUTI

A

Nitrofuratonin (unless eGFR <45) then trimethoprim
3 days abs for simple UTI

5-10 days if immunosupressed/ impaired kidney function

7 days men, pregnancy women and catheter related UTIS

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11
Q

What is the management of pyelonephritis

A

7-10 days of cefalexin
Co-amoxiclav or trimethoprim if culture results available
Ciprofloxacin

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12
Q

What antibiotics are used in a pregnancy UTI

A

Cefalexin typically used
Nitrofuratonin can use in 1st and 2nd trimester but not 3rd
Amoxicillin if sensitivities are known

Avoid trimethoprim in first trimester- folate antagonist

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13
Q

What are the main organisms that cause cellulitis

A

Staphylococcus aureus
Strep group A (strep pyogenes)
Strep group C (strep dysgalactinae)

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14
Q

What is the management for Cellulitis

A

ERON classes 3 and 4 need hospital admission and IV abx

Flucloxacillin is first line oral or IV

If cellulitis is around the eyes or nose use co-amoxiclav first line

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15
Q

What is the main bacteria that causes bacterial tonsillitis

A

Group 1 strep -strep pyrogenes

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16
Q

What are the main organisms that cause ottitis media and sinusitis

A

Strep pneumonia
Haemophilus influenza
Staph aureus
Morazella catarrhalis

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17
Q

What scores are used for tonsillitis

A

CENTOR
over 3 needs abx
Points for
Fever, tonsillar exudates, no cough, tender anterior cervical lymph nodes

Fever pain can also be used
3 days of onset, fever, purulence, inflammed tonsils, no cough

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18
Q

What is the treatment for tonsillitis

A

Phenoxymethylpenicillin for 10 days (penicillin V)

Clarithromycin second choice is pen allergy

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19
Q

What are the complications of tonsillitis

A

Peritonsillar abscess- quincy
Ottits media-
Scarlet fever
Rheumatic fever
Post strep glomerulonephritis
Post strep reactive arthritis

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20
Q

What is the treatment for ottitis media

A

resolves 3-7 days without abx but if unwell 5-7 days abx
Clarithromycin or erythromycin

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21
Q

What is the treatment for sinusitis

A

Viral usually
If symptoms don’t improve after 10 days- high dose nasal steroid for 14 days
-Can give phenoxymethypenicicillin if not improving or worsening after 7 days

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22
Q

What is the treatment for chronic sinusitis

A

Saline nasal irrigation
Steroid nasal drops
Functional endoscopy sinus surgery

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23
Q

What are the main bacteria that cause intraabdominal infections

A

Anaerobes - bactericides and clostridium
E.Coli
Klebsiella
Enterococcus
Streptococcus

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24
Q

What is the treatment for intraabdominal infections

A

Broad spectrum antibiotics until cultures are available

Co-Amoxiclav
Quinolones (ciprofloxacin/levofloxacin) - good but don’t cover anaerobes so can be paired with metronidazole
Gentamicin
Vancomycin

Avoid cephalosporins due to risk of C.Diff

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25
Q

What are the main causes of septic arthritis

A

Group A strep
Heamophilus influenza
Neisseria gonorrhoea
E.Coli

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26
Q

What is the treatment for septic arthritis

A

Joint fluid aspiration and examination before abx or
Empirical abx given until sensitivities are known

Continue abx for 4-6 weeks
Flucloxacillin 1st line
Clindamycin if penicillin allergy
Vancomycin if MRSA expected

For gonorrhoea - ceftriaxone

27
Q

What is the treatment for influenza in high risk patients

A

Oral oseltamivir (2x5 days)
Inhaled zanamivir (2x5 days)
Treatment needed within 48 hrs of infection

28
Q

What are the features of E.Coli

A

From infected faeces, unwashed salads, contaminated water
Shiga toxin- haemolytic uraemia syndrome

Don’t give abx- increases risk of haemolytic uraemic syndrome

29
Q

What are the features of Campylobacter jejune

A

Traveller’s diarrhoea- most common
Incubation 2-5 days symptoms after 3-6 days
Antibiotics considered in severe symptoms - clarithromycin

30
Q

What are the features of Shigella

A

Period is 1-2 days and symptoms resolve in 1 week
Siga toxin - haemolytic uraemic syndrome
Severe cases can give azithromycin/ciprofloxacin

31
Q

What are the features of Bacillus cereus

A

Not refrigerated food after cooking- rice
Mom within 5 hrs and diarrhoea within 8 - resolves in 24 hrs

This can also cause infective endocarditis in IV drug users

32
Q

What are the features of yersinia entercolitica

A

Pork - affects children
Incubation period 4-7 days symptoms can last 3 weeks
Older children and adults can show mesenteric lymphadenitis and fever

33
Q

What are the features of Giardiasis

A

Parasite in small intestines or mammals, faecal oral transmission
Chronic diarrhoea or no symptoms
Stool microscopy for diagnosis
Metronidazole for treatment

34
Q

What antibiotics cause C diff

A

Most that start with C
Clindamycin, ciprofloxacin (other flurorquinolones), cephalosporins, carbapenems

35
Q

What investigations are done for C.DIFF

A

C diff antigen (glutamate dehydrogenase)
A and B toxins
all in stool samples

36
Q

What is the management for C.Diff

A

Normal- Oral vancomycin and oral findaxomicin

Life threatening
Oral vancomycin with IV metronidazole

37
Q

What are the complications of C.Diff

A

Pseudomemebraneous colitis- inflam of large intestine with yellow and white plaques on bowel wall

Toxic megacolon- risk of bowel rupture

38
Q

What are the main organisms that cause bacterial meningitis

A

Neisseria meningitis
Strep pneumonia
Haemophilus influenza
Group b strep
Listeria Monocyogenes

39
Q

What are the main viral causes of meningitis

A

Enteroviruses (coxsackie)
HSV
VZV

40
Q

What are the two special tests for meningitis

A

Kernig’s test- lie patient on back flex hip and knee to 90 degrees, straighten knee and keep hip flexed at 90 - stretch in meninges will cause pain

Brudzinki’s test- Lie patient on bacterial and lift head and neck off bed with chin to chest- if hips and knees flex- meningitis

41
Q

Where is a lumbar puncture done

A

L3-L4 or L4-L5 intervertebral spaces

42
Q

What is found in a bacterial meningitis lumbar puncture

A

High protein, low glucose, cloudy, high WCC (neutrophils), culture bacteria

43
Q

What is found in a viral meningitis lumbar puncture

A

Mildly raised or normal protein, normal glucose, WCC high (lymphocytes), clear colour, negative culture

44
Q

What is the management of meningitis

A
  1. In children with non blanching rash - urgent dose of benzylpenicillin IM or IV whilst waiting transfer to hosp under 1 300mg, 1-9- 600mg over 10- 1200mg

Antibiotics- in babies under 3 months - cefotaxime and amoxicillin
Above 3 months ceftriaxone

Post exposure prophylaxis- single dose ciprofloxacin

45
Q

What are the investigations for TB

A
  1. Mantoux test - skin induration >5mm - positive
  2. Interferon gamma release assay - blood sample mixed with antigens
46
Q

What will a CXR show for primary TB and miliary TB and latent TB

A

Primary- patchy consolidation, pleural effusions, hilar lymphadenopathy

Disseminated miliary TB- millet seeds across lung fields - small nodules

Latent TB- a calcified Ghon complex - single calcified nodule

47
Q

What is the treatment for latent TB

A

Isoniazid and rifampicin for 3 months then isoniazid for 6 months

48
Q

What is the treatment for active TB

A

RIPE
Rifampicin 6 months - red tears, urine
Isoniazid 6 months- peripheral neuropathy so give B6 with it
Pyrazinamide 2 months- gout
Ethambutol 2 months- colour blind

49
Q

What CD4 count is high risk for opportunistic infections

A

under 200 cells/mm3

50
Q

What is the treatment for HIV

A

Two NRTI’s Nucelotide reverse transcriptase inhibitors (tenofovir and emtricitabine) and a third agent (bictegravir)

Can give prophylactic co-trimoxazole if CD4 under 200cells/mm3

51
Q

How is a baby protected during labour and birth when mother is HIV positive

A

IV zidovudine given infusion during labour and delivery if viral load over 1000 or unknown

Recommended C-section if viral load is over 50 copies

No breastfeeding

Babies given prophylaxis
Low risk- Ziovudine 2-4 weeks
High risk- zidovudine and nevirapine for 4 weeks

52
Q

What medications are used for PEP

A

ART combination - emtricitabine/ tenofovir and raltegravir for 28 days

53
Q

What medication is used for PreP

A

Emtricitabine/ tenofovir

54
Q

What is the treatment for malaria orally

A

Artmether and lumefantirine first line

Quinine and doxycycline/ clindamycin

55
Q

What are the features of Dengue fever

A

Mosquitos
Headache, fever, facial flushing, widespread maculopapular rash

THROMBOCYTOPENIA AND LEUKOPENIA - it causes bone marrow suppression

56
Q

How is lyme disease diagnosed

A

Erythema migrans (target rash) can diagnose clinically
Antibodies to borrelia burgdorferi within 4 weeks of first symptoms and repeat this 4-6 weeks after

Treat with doxycycline
Ceftriaxone in disseminated disease

57
Q

What are the features of latent TB

A

Positive Mantoux and Interferon gamma but negative sputum culture and normal chest xray

Patients treated with
3 months isoniazid and rifampicin
or 6 months isoniazid

They cannot pass the disease onto others

58
Q

What are the features of glandular fever

A

Sore throat
Lympadenopathy
Pyrexia
Splenomegaly
Palatal petechiae
Hepatitis, haemolytic anaemia, maculopapular pruritic rash if patients take amoxicillin

Symptoms resolve in 2-4 weeks
Avoid contact spots fir 4 weeks

EBV

59
Q

What are the features of Legionella

A

Water tanks- air conditioning/ holidays

Flu like symptoms
Dry cough, brady
Confusion
Lymphopaneia, hyponatraemia, deranged LFTs

Urinary antigen for diagnosis
Mid to lower zone consolidation on Xray

Treat with erythromycin/ clarithromycin

60
Q

What are the features of mycoplasma pneumonia

A

Atypical pneumonia that affects younger patients
Erythema multiform and cold haemolytic anaemia
Bilateral consolidation on xray
Flu symptoms and cough
Red blood cell agglutination

Treat with doxy or a macrolide (clarith)

61
Q

What are the features of pneumocystis jiroveci

A

HIV pneumonia
Desaturations on exertion and CXR looks normal
Fever, SOB
Pneumothroax can be a complication

Management
Co-trimoxazole

62
Q

What are the features of toxoplasmosis gondii

A

Oocysts from cat usually
Similar infection to glandular fever presentation

Immunocompetant patients don’t need treatment

Immunocompromised patients need Treated with Pyrimethamine and sulphadiazine

They can get cerebral toxoplasmosis- multiple ring enhancing lesions

63
Q
A

3rd yr clinical (22 decks)

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