Infectious diseases 2 Flashcards
(114 cards)
1
Q
Define meningitis
A
Inflammation of leptomeningeal (pia mater and arachnoid) coverings of the brain
2
Q
Which meningeal layers are inflamed in meningitis
A
Pia and arachnoid
3
Q
Define encephalitis
A
Inflammation of brain parenchyma
4
Q
Bacterial causative agents in meningitis (3)
A
Streptococcus pneumoniae,
Neisseria meningitidis
Haemophilus influenzae type B
5
Q
Most common cause of aseptic meningitis
A
Enterovirus
6
Q
Main cause of encephalitis
A
Herpes virus
7
Q
Main symptoms of meningitis (4)
A
Photophobia
Neck stiffness
Headache
Fever
8
Q
Symptoms of encephalitis (7)
A
Altered state of consciousness, seizures, personality change, cranial nerve palsies, speech problems, motor and sensory deficit
9
Q
Ix for meningitis
A
lumbar puncture to obtain CSF
10
Q
Ix for encephalitis (3)
A
Blood cultures, neuroimaging (MRI), CSF analysis
11
Q
What organisms commonly infect neonates (3)
A
Group B streptococcus
E coli
Listeria monocytogenes
12
Q
Which gram -ve diplococci often infects children and teenagers
A
Neisseria meningitides
13
Q
Which bacteria often infects unvaccinated children and teenagers
A
Haemophilus influenzae
14
Q
Which gram +ve cocci often infects adults and the elderly
A
Strep pneumonia
15
Q
Which bacteria often infects the elderly, alcoholics and cheese/unpasteurised milk
A
Listeria monocytogenes
16
Q
Which organism infects neonates with an extended delivery
A
Group B strep
17
Q
Which organism infects neonates that have had an infection in a previous pregnancy
A
Group B strep
18
Q
Which organism causes a late neonatal infection
A
E coli
19
Q
What buzzword guides you to Group B strep infection in a neonate (2)
A
Extended labour, infection in previous pregnancy
20
Q
What buzzword guides you to E coli infection in a neonate
A
Late neonatal infection
21
Q
What buzzword guides you to neisseria meningitides infection in children and teenagers
A
grame -ve diplococci
22
Q
What buzzword guides you to haemophilia influenzae infection in children and teenagers
A
Unvaccinated
23
Q
What buzzword guides you to strep pneumoniae infection in adults and elderly
A
grame +ve cocci
24
Q
What buzzword guides you to Listeria monocytogenes infection in adults and elderly (4)
A
Elderly, unpasteurised milk, cheese, alcoholics
25
What is Brudsinkins sign
Flexing the neck causes the patient s hips and knees to flex (meningitis)
26
What is Kernigs sign
Inability to straighten the leg when the hip is flexed to 90 degrees
27
Signs of meningitis infection (5)
```
Fever
Tachycardia
Hypotension
Skin rash – petechiae meningococcal septicaemia
Altered mental state.
```
28
Ix for meningitis (3)
Blood: Two sets of blood cultures
Imaging: CT scan to exclude intracranial pressure.
Lumbar puncture: Send CSF for MC&S and Gram staining
29
When do you avoid LP (3)
Neurological signs suggesting raised ICP
Superficial infection over LP site
Coagulopathy
30
```
CSF normally:
Appearance
WCC
Protein
Glucose
Gram stain
```
```
Clear
Very low
Normal
Normal
Normal
```
31
```
CSF in bacterial meningitis:
Appearance
WCC and which cell
Protein
Glucose
Gram stain
```
```
Turbid
Very high - neutrophils
Very very very high
Very very very low
Positive
```
32
```
CSF in viral meningitis:
Appearance
WCC and which cell
Protein
Glucose
Gram stain
```
```
Clear/cloudy
High - lymphocytes
Increased
Normal
Normal
```
33
```
CSF in fungal/TB meningitis:
Appearance
WCC and which cell
Protein
Glucose
Gram stain
```
Clear/cloudy
High lymphocytes
Increased protein
Decreased glucose
34
Mx of meningococcal septicaemia
Admit
| Give single dose IV benzylpenicillin
35
Mx of bacterial meningitis
IV Ceftriaxone (3rd generation cephalosporin)
Consider corticosteroids – Dexamethasone for bacterial meningitis BUT not if meningococcal septicaemia is suspected
(cover Listeria with ampicillin)
If consciousness affected, consider IV acyclovir to cover encephalitis
Prophylaxis to close contacts: Rifampicin or ciprofloxacin
36
Viral causes of encephalitis (6)
(HSV-1, HSV-2, VZV, CMV, EBV, Human herpes virus)
37
Bacterial causes of encephalitis (4)
Neisseria meningitides
TB
Syphilis
Listeria
38
What type of encephalitis does neisseria meningitides cause
Meningo-encephalitis
39
Fungal causes of encephalitis (2)
Cryptococcus
| Candida
40
Parasitic causes of encephalitis (2)
Toxoplasma Gondii, malaria
41
Which three organisms (and subtypes) are the main causes of infective endocarditis
Group A Streptococci (viridian's or Boris)
Staphylococci aureus or epidermis
Enterococci faecalis
42
What are the RF of IE
```
Abnormal valves
Prosthetic valves
IV drug use
Turbulent flow
Recent dental work
```
43
What are 4 causes of abnormal valves
congenital, post-rheumatic, calcification/ degeneration
44
What organism does a case of infective endocarditis with abnormal valves suggest
Strep viridian's or strep bovis
45
What organism does a case of infective endocarditis with prosthetic heart valves suggest
Staph a or epidermis
46
What organism does a case of infective endocarditis with IV drug use suggest
Staph A or staph epidermis
47
Symptoms of infective endocarditis (5)
Fever with sweats/chills/rigors
| Malaise, arthralgia, myalgia, confusion
48
Signs of infective endocarditis
```
Pyrexia, tachycardia, signs of anaemia.
Clubbing
New murmur
Splenomegaly.
Vasculitic lesions
```
49
Order of which valves are most likely to get infective endocarditis
Frequency: Mitral > aortic > tricuspid > pulmonary.
50
What does right sided infective endocarditis suggest
Drug use
51
Mnemonic to help remember signs of infective endocarditis
```
Fever
Roth spots
Osler nodes
Murmur
Janeway lesions
Anaemia
Nail-bed splinter haemorrhage
Emboli
```
52
Buzzwords for infective endocarditis (6)
```
Prosthetic valve
Dental procedure
New onset murmur
Vegetation on echo
Right heart
Indwelling catheter
```
53
Ix for endocarditis
```
Bloods
3 blood cultures, 1 h apart, within 24 hs
Urgent echo
Dukes classification
Broad spectrum
```
54
What do you look for in the bloods of infective endocarditis (5)
Bloods: FBC (high neutrophils, normocytic anaemia), ESR and CRP, U&Es, rheumatoid factor positive
55
Complications of infective endocarditis (6)
```
Congestive heart failure
Valve incompetence
Aneurysm formation
Systemic embolization
Renal failure
Glomerulonephritis.
```
56
Mx of infective endocarditis
Dependent upon organism.
On clinical suspicion benzylpenicillin or vancomycin if allergic until confirmed.
Then switch to targeted antibiotics
Penicillin-sensitive Streptococcus viridans = Benzylpenicillin + gentamicin
S. aureus = Flucloxacillin
Prosthetic Valves
Staphylococci = Flucloxacillin/Vancomycin + rifampicin + gentamicin
57
Common causes of dysentry (6 mnemonic)
CCHESS
```
Campylobacter / Clostridium difficile
Haemorrhagic E. coli
Entamoeba histolytica
Shigella
Salmonella
```
58
Common causes of diarrhoea (6)
```
Campylobacter / Clostridium difficile
Staph aureus
Vibrio cholera
E. coli
Bacillus cereus
Salmonella
```
59
History clues to suggest gastroenteritis due to C diff (4)
>70 yo, past C. diff, use of antibiotics, antiperistaltic drugs
60
History clues to suggest gastroenteritis due to staph A (3)
food, 1-6 hours after eating, short lived
61
History clues to suggest gastroenteritis due to vibrio cholera (3)
rice water diarrhoea, poor sanitation, shock
62
History clues to suggest gastroenteritis due to e coli
leafy vegetables
63
History clues to suggest gastroenteritis due to bacillus cereus (2)
reheated rice, can cause cerebral abscess
64
History clues to suggest gastroenteritis due to salmonella (3)
eggs, poultry may present with constipation, multiplies in Payer’s patches of the intestine
65
Which diarrhoea causing organism can cause a cerebral abscess
Bacillus cereus
66
History clues to suggest dysentry due to campylobacter (31
Uncooked poultry
67
History clues to suggest dysentry due to HEC (1)
Leafy vegetables
68
What follows bloody diarrhoea in HEC
Haemolytic uraemia syndrome
69
History clues to suggest dysentry due to entamoeba histolytica (2)
poor sanitation, tropical places
70
History clues to suggest dysentry due to entamoeba histolytica (2)
person-to-person contact, poor sanitation
71
History clues to suggest dysentry due to salmonella (2)
eggs
72
Examinations for gastroenteritis (3)
Mucous membranes, skin turgor, cap refill dehydration?
HR, BP shock?
Temperature
73
Ix for gastroenteritis
```
Bloods: FBC, ESR/CRP, U&Es - deranged (low K in severe D&V)
Stool MC&S
Bacterial pathogens
Ova cysts (eggs)
Parasites
```
74
Mx of gastroenteritis
No systemic signs - bed rest, fluids and electrolyte replacement with oral rehydration and no stool culture
Systemic signs:
Admit
Oral fluids/IV if severe vomiting
Direct faecal smear then culture
75
What counts as systemic signs in gastroenteritis
>39C or dehydration
| Visible blood or >2wks
76
baby girl born 1 day ago born after a prolonged vaginal delivery, becomes drowsy. On examination, T: 38.9, HR: 170bpm, RR: 30. Which is the most likely causative agent?
Group B streptococcus
77
Non-blanching rash in meningitis indicates what viral/bacterial/fungal meningitis?
Bacterial
78
A 72-year-old patient with a new onset murmur, fever and clubbing presents with blood in his stools, diarrhoea and weight loss over the past 5 months. Which is the most likely causative agent?
Strep bovis as it is suggestive of infective endocarditis with colorectal cancer
79
A 15-year-old boy with DiGeorge syndrome had a dental tooth extraction 2 weeks ago, visits his GP who on auscultation finds a new murmur on the left sternal edge. Basic observations: BP 110/80, HR: 95, Temperature: 38.5, SaO2 98% on air. What is the most likely causative agent?
Strep viridans due to congenital heart defect
80
A 24 year old medical student comes back from their holiday and presents to A&E with profuse diarrhoea of rice water appearance. There is no blood. What is the most likely causative agent?
Vibrio cholera
81
A 40 year old woman presents to A&E with bloody, foul smelling diarrhoea. She went to a barbeque yesterday where she suspects she ate undercooked chicken. She has a fever and severe abdominal pain. What is the most likely causative agent?
Campylobacter
| Salmonella is more associated with raw eggs
82
A 67 year old male has been in hospital for the past two weeks for severe pneumonia. He develops bloody diarrhoea, colitis and reduced urine output. He has raised CRP, WCC and low albumin. What is the most likely causative organism?
C. Difficile
| Due to likelihood of having broad spectrum antibiotics with the pneumonia
83
3 key features of hepatitis
Fever
Jaundice
Raised ALT, raised AST
84
3 key causes of hepatitis
Viral (ABCDE)
Alcohol
Autoimmune
85
Hep A transmission route
Faeco-oral
| vowels = bowels
86
Hep B transmission route
Sexual
Contaminated needles
(also infected tears and saliva)
87
Hep C transmission route
Blood to blood
88
Hep D transmission route
Resides inside B
89
Hep E transmission route
Faeco-oral
90
Which hepatic virus' are chronic and which %
B 10% is chronic
| C 80% is chronic
91
Mx for HCV
Antiretrovirals are now curative
e.g. NS5A inhibitors,
NS3/4 protease inhibitors
92
Symptoms of acute HBV (4)
Antiretrovirals are now curative
e.g. NS5A inhibitors,
NS3/4 protease inhibitors
93
Hep A symptoms (5)
```
Usually asymptomatic 90% but can get:
Nausea
Vomiting (+ Diarrhoea)
Fever
Jaundice
Abdominal pain (particularly RUQ)
```
94
Hep E RF: (4)
Enteric
Epidemics (water)
Expectant mothers
E- immunocompromised
95
Hep B transmission (3)
Baby making Unprotected sex, MSM,
Blood (transfusion, IVDU)
Birthing (perinatal)
96
Which hepatic viruses causes liver cancer/cirrhosis
B and C
97
Most common cause of UTI
E coli
98
Mx of UTI
Trimethoprim
99
Ix for UTI (4)
Assess RF
Dipstick urinalysis: positive nitrites +/- leukocytes
Urine MC&S
(Abdo USS – exclude urinary tract obstruction or renal stones)
100
Ix for viral hepatitis (8)
Blood:
FBC
LFTs (bilirubin, albumin, AlkPhos, GGT).
U&E
Clotting: Prolonged PT is a sensitive marker of significant liver damage.
Ultrasound scan: For other causes of liver impairment (e.g. malignancies).
Viral serology
Viral PCR
Liver biopsy: To assess degree of inflammation and liver damage (useful in diagnosing cirrhosis as patients)
101
Which is chronic which is acute IgG or IgM
IgG – Gone
| IgM – Now
102
Symptoms of malaria (5)
```
Headache
Weakness
Myalgia/ Arthralgia
Anorexia
Fever - Characteristic paroxysms of severe cold / rigors followed by severing sweating
```
103
Signs of malaria (3)
Pyrexia
Anaemia
Splenomegaly
104
Ix for malaria
Giemsa-stained thick and thin blood smears
Thick – detects parasites present
Thin – identifies species
Other: FBC (Hb, platelets), Clotting profile, U+E, LFTs, blood glucose, Urinalysis, ABG
105
A 37-year-old bride-to-be returned from Jamaica 3 days ago, where she partied and explored the local cuisine with her best friends. She presents to her GP complaining of being jaundiced with right upper quadrant pain and fever. What is the most likely cause of her symptoms?
Hep A due to faeco-oral transmission
106
How long does Hep E last 4
2-8
107
How long does hep A last for
6 weeks
108
Differences between hep A and E
A: loss of appetite, diarrhoea, fever, malaise, not chronic
E: chronic, risk of fulminant liver failure
109
A 37-year-old bride-to-be returned from Jamaica 3 days ago, where she partied and explored the local cuisine with her best friends. She presents to her GP complaining of being jaundiced with right upper quadrant pain and fever. What is the most likely cause of her symptoms?
Hep A
110
A 64-year-old male with thalassaemia is investigated under the two-week wait for jaundice, hepatomegaly and weight loss. His blood tests show a raised αFP. Which chronic infection is he most likely to have?
Hep C
| Recurrent blood transfusions due to thalassaemia which is a major risk factor for HCV
111
27-year-old promiscuous man returns from a trip to Thailand with a right upper quadrant pain, fever and raised ALP and AST. Which is the most likely causative agent?
HBV due to sexual transmission
112
A 35-year-old woman presenting to her GP with increased urinary frequency and lower back pain. On examination her BP is 130/90, HR: 83bpm, RR: 17bpm and T: 38.3. Which is the most likely finding on her urine dip stick and MC&S?
Positive nitrites and gram-negative bacilli
113
E. coli is what type of bacteria
Gram -ve bacillus
114
A 45-year old man presented to his GP with cyclical fevers. He returned from Ethiopia 10 days ago. What is the most likely causative agent?
Plasmodium falciparum
