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Infectious Diseases Flashcards

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1
Q

what is septic shock

A
  • arterial blood pressure drops despite adequate fluid resuscitation, resulting in organ hypoperfusion.
  • Anaerobic respiration begins, and lactate level rises.
    It is diagnosed with:
  • Low mean arterial pressure (below 65 mmHg) despite fluid resuscitation (requiring vasopressors)
  • Raised serum lactate (above 2 mmol/L)
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2
Q

Mx of septic shock

A
  • aggressive IV fluids
  • HDU
  • vasopressors e.g. noradrenaline (cause vasoconstriction)
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3
Q

Rf for sepsis

A
  • immune dysfunction
  • frailty and very young
  • chronic conditions (COPD, diabetes)
  • chemo, immunosuppressants
  • surgery, trauma, burns
  • pregnancy
  • catheter, central lines
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4
Q

Bloods for sepsis

A
  • FBC for WCC + neutrophils
  • U&Es for kidney function + AKI
  • LFTs for liver function and a possible source of infection
  • CRP for inflammation
  • Blood glucose for hyper/hypoglycaemia
  • Clotting to assess for disseminated intravascular coagulopathy (DIC)
  • Blood cultures to assess for bacteraemia
  • Blood gas for lactate, pH and glucose
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5
Q

additional test for sepsis to locate source

A
  • urine dipstick
  • chest XR
  • CT abdo
  • LP
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6
Q

what is neutropenic sepsis

A

absolute neutrophil count below 0.5 x 109/L (or likely to fall to this level). It is a life-threatening medical emergency

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7
Q

Mx of neutropenic sepsis

A

immediate broad-spectrum antibiotics, such as piperacillin with tazobactam (tazocin)

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8
Q

Pyelonephritis sx

A

LUTI sx + triad
- loin to groin/back pain
- fever
- N&V
(renal angle tenderness)

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9
Q

when is MSU important in UTI

A
  • pregnancy
  • recurrent UTI
  • atypical sx
  • sx not improving on abx
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10
Q

Mx of LUTI

A
  • Nitrofurantoin (avoided in patients with an eGFR <45)
  • Trimethoprim (often associated with high rates of bacterial resistance)

can also go amoxicillin, cefalexin

3 days simple, 7 if man/pregnant, 5-10 days kidneys/immunosuppressed

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11
Q

Mx of pyelonephritis

A

first-line abx 7-10 days when treating in the community:
- Cefalexin
- Co-amoxiclav (if culture results are available)
- Trimethoprim (if culture results are available)
- Ciprofloxacin (keep tendon damage and lower seizure threshold in mind)

SEPSIS 6 if in hospital

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12
Q

what to consider if pyelonephritis not improving

A
  • renal abscess
  • kidney stone
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13
Q

Mx of UTI in pregnancy

A

7 days + MSU
- Nitrofurantoin (avoided in the third trimester due to neonatal haemolysis)
- Cefalexin
- Amoxicillin (only after sensitivities are known)

avoid trimeth in 1st as folate antagonist (neural tube)

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14
Q

causes of cellulitis

A
  • Staphylococcus aureus
  • Group A streptococcus (mainly streptococcus pyogenes)
  • Group C streptococcus (mainly streptococcus dysgalactiae)
  • consider MRSA
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15
Q

Mx of cellulitis

A
  • flucloxacillin 1st line
  • clarithromycin
  • clindamycin
  • co-amoxiclav if near eyes/nose
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16
Q

common bacterial causes of intra-abdominal infections

A
  • Anaerobes (e.g. Bacteroides and Clostridium)
  • E. coli (gram-negative)
  • Klebsiella (gram-negative)
  • Enterococcus (gram +ve)
  • Streptococcus (gram +ve)
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17
Q

Mx of intra-andominal infections

A

need broad spectrum e.g.
- co-amoxiclav
- quinolones
- metronidazole
- gentamicin
- vancomycin
- cephalosporins
- tazocin

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18
Q

Mx of septic arthritis

A
  • joint aspiration
  • empirical IV abx for 4-6 wks
    e.g. fluclox, clinda, vanc, ceftriaxone (gonorrhoea)
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19
Q

Mx for influenza in people at risk

A
  • Oral oseltamivir (BD for 5 days)
  • Inhaled zanamivir (BD for 5 days)
    start within 48hrs of sx onset
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20
Q

causes of viral gastroenteritis

A
  • rotavirus
  • norovirus
  • adenovirus
  • E coli 0157 (bloody)
  • campylobacter jejuni (MC worldwide, raw poultry)
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21
Q

Shigella

A
  • spread by faeces or contaminated water/food
  • incubation 1-2 days
  • Mx: azithromycin
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22
Q

Salmonella

A
  • raw eggs, poultry
  • incubation 12hrs-3days
  • sx resolve within 1 week
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23
Q

Bacillus cereus

A
  • gram +ve rod
  • reheated rice
  • watery dirahhoea
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24
Q

how to diagnose C.diff

A

Stools can be tested for:
- C. difficile antigen (specifically glutamate dehydrogenase)
- A and B toxins (by PCR or enzyme immunoassay)

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25
Mx of c.diff
- oral vancomycin (1st) - oral fidaxomicin (2nd) if serious oral van and IV metronidazole? If recurrence <12 weeks oral fidaxomicin if >12 weeks van
26
complications of c.diff
- pseudomembranous colitis: inflam of large intestine with yellow/white plaques that form pseudomembranes on the inner surface of the bowel wall - toxic megacolon
27
causes of meningitis
- Neisseria meningitidis - Strep pneumoniae (pneumococcus) - Haemophilus influenzae - Group B streptococcus (GBS) (particularly in neonates) - Listeria monocytogenes (particularly in neonates)
28
what is meningococcal septicaemia
non-blanching rash
29
tests for meningeal infection
- kernig's test - Brudzinski's test
30
LP in bacterial and viral meningitis
Bacterial: cloudy, high protein, low glucose, high neutrophils Viral: clear, mildly raised/normal protein, normal glucose, high lymphocytes
31
complication of meningitis
- hearing loss - seizures and epilepsy - cognitive impairment
32
staining for TB
Zeihl-Neelsen stain, which turns them bright red against a blue background.
33
Ix for TB
- Mantoux test - Interferon‑gamma release assay (IGRA) - 3 sputum cultures
34
Mx of TB
Rifampicin 6 months Isoniazid 6 months Pyrazinamide 2 months Ethambutol 2 months
35
side effects of TB treatment
- Rifampicin: red/orange secretions - Isoniazid: peripheral neuropathy (prescribe pyridoxine (vit b6) to reduce risk) - Pyrazinamide: hyperuricaemia resulting in gout and kidney stones - Ethambutol: colour blindness, reduced visual acuity RIP all assoc with hepatotoxicity
36
examples of AIDS defining illnesses
when CD4 is low - Kaposi’s sarcoma - Pneumocystis jirovecii pneumonia (PCP) - Cytomegalovirus infection - Candidiasis (oesophageal or bronchial) - Lymphomas - Tuberculosis
37
classes of antiretroviral therapy for HIV
- Protease inhibitors (PI) - Integrase inhibitors (II) - Nucleoside reverse transcriptase inhibitors (NRTI) - Non-nucleoside reverse transcriptase inhibitors (NNRTI) - Entry inhibitors (EI) usually 2NRTIs + third agent
38
additional mx of HIV
- prophylactic co-trimoxazole when CD4 <200 to protect against PCP
39
presentation of malaria
- cyclic fever up to 41, sweats and rigors - myalgia - N/V, fatigue, headache - hepatosplenomegaly - jaundice - pallor
40
how to diagnose malaria
blood film
41
mx of malaria
- Artemether with lumefantrine (Riamet) is the usual first choice - Quinine plus doxycycline - Quinine plus clindamycin - Proguanil with atovaquone (Malarone) - Chloroquine - Primaquine (can cause severe haemolysis in patients with G6PD deficiency) - severe: artesunate
42
cryptosporidium parvum features
- protozoan parasite - cause diarrhoea in immunocompromised patients - found in contaminated water sources - test: modified Ziehl–Neelsen stain/ Kinyoun Acid Fast stain - Mx: Paromomycin
43
Abx for MRSA +ve cellulitis
vancomycin
44
late stage HIV presentation
- folliculitis on chest - also fauces are red and there are two small aphthous ulcers on his left buccal mucosa. He also has a maculopapular erythematous rash on his upper trunk, red hands
45
gram +ve bacteria
- pair: strep pneumoniae - clusters: staph aureus
46
how does herpes simplex virus present
- hsv1: cold sore - hsv 2: multiple tender ulcers on the preputial skin
47
hepatitis B presentation
most commonly presents with anorexia, nausea and right upper quadrant pain
48
typhoid fever presentation
- Salmonella typhi g-ve rods - faeco-oral transmission - headache, fever, arthralgia - constipation - rose spots
49
mx of typhoid
IV ceftriaxone then PO azithromycin
50
which organism causes erythema multiforme (target lesions)
mycoplasma pneumoniae
51
campylobacter jejuni presentation and mx
- undercooked poultry - bloody diarrhoea - mx erythromycin
52
giardia presentation and mx
- watery foul smelling stool - swimming in lake - pear shaped trophozoite - mx metronidazole
53
C difficile mx
- oral vancomycin 10 days - 2nd line fidaxomicin - severe: oral vancomycin + IV metronidazole recurrence <12 weeks: oral fidaxomicin >12 weeks: oral vanc or fidax
54
who should receive hepatitis A vaccine
- MSM - Close contacts of infected persons - Travellers to common countries - People with chronic liver disease - Injecting drug users - People with haemophilia - High-risk of occupational hepatitis A exposure e.g. sewage workers, people who work for organisations where personal hygiene may be poor (e.g. homeless shelters), and people working with primates
55
lyme disease features
- tick (Borrelia burgdoferi) - erythema chronicum migrans (bullseye rash - flu like sx - Late persistent: focal neurology, neuropsychiatric, arthritis - Mx doxycycline - if ticket removed and well no prophylactic abx needed
56
infectious mononucleosis presentation
Triad of: - sore throat, pyrexia and lymphadenopathy Also - palatal petechiae - malaise - a maculopapular, pruritic rash if pts take ampicillin/amoxicillin whilst they have infectious mononucleosis
57
Diagnosis of infectious mononucleosis
monospot test
58
mx of infectious mononucleosis
- rest and analgesia - avoid contact sport for 4 weeks
59
chlamydia features
asymptomatic in around 70% of women and 50% of men women: cervicitis (discharge, bleeding), dysuria men: urethral discharge, dysuria
60
complications of chlamydia
epididymitis pelvic inflammatory disease endometritis increased incidence of ectopic pregnancies infertility reactive arthritis perihepatitis (Fitz-Hugh-Curtis syndrome)
61
ix for chlamydia
NAAT for women: the vulvovaginal swab is first-line for men: the urine test is first-line do 2 weeks post exposure
62
Mx of chlamydia
doxycycline 7 days if pregnant then azithromycin, erythromycin or amoxicillin
63
Presentation of gonorrhoea
- Gram-negative diplococcus - males: urethral discharge, dysuria - females: cervicitis e.g. leading to vaginal discharge - rectal and pharyngeal infection is usually asymptomatic
64
complications of gonorrhoea
- urethral strictures - epididymitis - salpingitis- may lead to infertility - Disseminated infection may occur
65
mx of gonorrhoea
- single dose of IM ceftriaxone 1g - if can't take give azithromycin

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