Infectious Diseases Flashcards

1
Q

which classes of antibiotic have a beta-lactam ring?

A
  • penicillins
  • carbapenems
  • cephalosporins
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2
Q

stepwise approach to picking ABx in hospital?

A
  • start empirically with amoxicillin (covers streptococcus, listeria and enterococcus)
  • switch to co-amoxiclav (all of above plus staphylococcus, haemophilus and e. coli)
  • switch to tazocin (plus pseudomonas)
  • switch to meropenem (plus ESBLs)
  • add on teicoplanin / vancomycin (covers MRSA)
  • add clarithromycin / doxycycline (covers atypical bacteria)
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3
Q

pathophysiology of sepsis?

A
  • cytokines trigger a huge immune response
  • nitrous oxide gives vasodilation
  • coagulation system gets activated, causes DIC
  • hypoxia occurs, causing anaerobic respiration and blood lactate rises
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4
Q

what are the 2 ways in which septic shock can be defined?

A

either of these:

  • systolic BP <90 despite fluid resus
  • lactate >4 mmol/l
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5
Q

management of septic shock?

A
  • aggressive fluid resus
  • ICU admission
  • inotropes (noradrenalin)
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6
Q

features of severe sepsis?

A
  • hypoxaemia
  • oliguria
  • AKI
  • thrombocytopenia
  • coagulation dysfunction
  • hypotension
  • lactate >2 mmol/l
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7
Q

risk factors for sepsis?

A
  • extremes of age
  • chronic disease (e.g. COPD, DM)
  • surgery
  • recent trauma / burns
  • pregnancy / peripartum
  • indwelling catheter / central line
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8
Q

which signs make up the NEWS?

A
  • temp
  • HR
  • RR
  • O2
  • BP
  • GCS
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9
Q

signs O/E in sepsis?

A
  • signs of source of infection (cellulitis, wound discharge, cough, dysuria)
  • non-blanching rash
  • reduced UO
  • mottled skin
  • cyanosis
  • arrhythmias (e.g. new AF)
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10
Q

what is often the first sign of sepsis?

A

high RR (tachypnoea)

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11
Q

how might elderly patients present with sepsis?

A
  • confused
  • drowsy
  • “off legs”
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12
Q

which pts might have normal obs even if they are severely septic?

A
  • neutropenic pts

- immunosuppressed pts

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13
Q

investigations for sepsis?

A

a bunch of bloods:

  • FBC
  • UEs
  • LFTs
  • CRP
  • clotting (DIC)
  • blood cultures
  • blood gas (lactate)
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14
Q

which additional, non-blood test investigations can be helpful in sepsis?

A
  • urine dip and culture
  • CXR
  • CT (look for source of infection)
  • LP (if meningitis / encephalitis)
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15
Q

management of sepsis?

A
  • follow local protocol
  • assess and treat within 1 hour
  • do sepsis 6 / BUFALO
  • O2
  • empirical broad-spec ABx
  • IV fluids
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16
Q

what does BUFALO stand for?

A
  • blood cultures (take)
  • urine output (take)
  • fluids (give)
  • ABx (give)
  • lactate (take)
  • O2 (give)
17
Q

define neutropenic sepsis

A

sepsis in a pt with a neutrophil count less than 1 * 10^9 /L

18
Q

drugs which cause neutropenia? give an indication for each of them

A
  • chemotherapy (Ca)
  • clozapine (schizophrenia)
  • hydroxychloroquine (RA)
  • methotrexate (RA)
  • sulfasalazine (RA)
  • carbimazole (hyperthyroidism)
  • quinine (malaria)
  • infliximab (immunosuppression)
  • rituximab (immunosuppression)
19
Q

when should you suspect neutropenic sepsis?

A
  • have a high index of suspicion

- any fever >38C is neutropenic sepsis until proven otherwise

20
Q

ABx of choice in neutropenic sepsis?

A

tazocin (piperacillin with tazobactam)

21
Q

what is the difference between meningitis and meningococcal septicaemia?

A
  • meningitis is inflammation of the meninges

- meningococcal septicaemia is when the meningococcus bacteria is in the blood stream

22
Q

unique feature of meningococcal septicaemia? what causes this?

A
  • non-blanching rash

- it is the result of DIC and subcut haemorrhages

23
Q

what are the most common causative organisms of bacterial meningitis in non-neonates?

A
  • n. meningitidis (meningococcus)

- strep. pneumoniae (pneumococcus)

24
Q

what is the most common causative organism in neonatal bacterial meningitis?

A

group B streptococcus (GBS)

25
Q

presentation of meningitis?

A
  • fever
  • neck stiffness
  • vomiting
  • headache
  • photophobia
  • altered consciousness
  • seizures