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Infectious Diseases Flashcards

(72 cards)

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1
Q

How may cellulitis present?

A 
Erythema
Warm or hot to the touch 
Tense
Thickened
Oedematous
Bullae
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2
Q

What sign can be indicative of a S.aureus cellulitis?

A

Golden-yellow crust

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3
Q

What are the most common causes of cellulitis?

A

S.aureus
Group A Strept (S.pyogenes)
Group C Strept (S.dysgalactiae)

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4
Q

What classification can be used to assess the severity of cellulitis?

A

Eron Classification

Class 1 - no systemic toxicity or comorbidities

Class 2 - systemic toxicity or comorbidity

Class 3 - Significant systemic toxicity or significant comorbidity

Class 4 - Sepsis or life-threatening infection

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5
Q

When should a patient be admitted for IV antibiotics in cellulitis?

A

Class 3 or 4

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6
Q

What is the first line antibiotic for cellulitis?

A

Flucloxacillin

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7
Q

If a patient has a penicillin allergy, what antibiotic should be given if they have cellulitis?

A

Clarithromycin

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8
Q

What type of organism is Neisseria meningitidis?

A

Gram negative diploccocus

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9
Q

What type of meningitis is associated with a non-blanching rash?

A

Meningococcal septicaemia

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10
Q

What does the non-blanching rash in meningococcal septicaemia indicate?

A

DIC

Subcutaneous haemorrhage

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11
Q

In children and adults, what are the most common cause of bacterial meningitis?

A

Neisseria meningitidis

Streptococcus pneumoniae

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12
Q

In neonates, what is the most common cause of bacterial meningitis?

A

Group B Streptococcus

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13
Q

How can meningitis present?

A 
Fever
Neck stiffness
Photophobia
Vomiting
Headache 
Altered consciousness
Seizures
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14
Q

What are the two special tests that can be used to assess for meningism?

A

Kernig’s test

Brudzinski test

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15
Q

In the community, what antibiotic should be given prior to transfer to hospital?

A

Benzylpenicillin (IM/IV)

Under 1: 300mg
1-9 years: 600mg
>10 years: 1200mg

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16
Q

Once admitted to hospital, what two investigations should be performed, ideally before initiating antibiotics in a patient with suspected meningitis?

A

Blood cultures

Lumber puncture

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17
Q

If meningococcal disease is suspected, what specific blood test should be performed?

A

Meningococcal PCR

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18
Q

What antibiotic regimen should be commenced in neonates under 3 months if they have bacterial meningitis?

A

Cefotraxime

Amoxicillin

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19
Q

In people over 3 months old, what antibiotic should be commenced if they have bacterial meningitis?

A

Cefotriaxone

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20
Q

Along with antibiotics, what other medication should be started in patients with bacterial meningitis and why?

A

Dexamethasone (QDS for 4 days)

Reduce frequency and severity of hearing loss and neurological damage

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21
Q

What can be used as a prophylaxis treatment in close contacts of a patient with bacterial meningitis?

A

Single dose of ciprofloxacin

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22
Q

What are the most common causes of viral meningitis?

A

Herpes simplex virus
Enterovirus
Varicella zoster virus

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23
Q

What drug can be used to treat viral meningitis caused by herpes simplex virus?

A

Acyclovir

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24
Q

When sending a LP for suspected meningitis, what tests should be requested?

A 
Bacterial culture
Viral PCR
Cell count
Protein
Glucose

(Paired serum glucose sample)

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25
What are the complications of meningitis?
``` Hearing loss Seizures and epilepsy Cognitive impairment and learning disability Memory loss Focal neurological deficits ```
26
What bacteria causes tuberculosis?
mycobacterium tuberculosis
27
What type of bacteria is mycobacterium tuberculosis?
Bacillus
28
What type of staining is used in the assessment of tuberculosis and how is it described?
Ziehl-Neeson Staining Acid-fast bacillus
29
How does TB spread through the body?
Through the lymphatics and blood
30
What is latent TB?
Immune system encapsulates sites of TB infection and stops the disease progression
31
How is it described if latent TB becomes reactivated
Secondary TB
32
How is it described if the immune system is unable to control the TB causing disseminating, severe disease?
Miliary TB
33
Give some sites of extrapulmonary TB
``` Lymph nodes - cold abscess Pleura CNS and spine (Pott's disease) Pericardium GI system GU system Bones and joints Cutaneous TB ```
34
Describe the BCG vaccine
Interdermal infection of live attenuated TB
35
Prior to the BCG vaccine, what test needs to be performed?
Mantoux test (get the vaccine if it is negative)
36
How can TB present?
Chronic, gradually worsening symptoms ``` Lethargy Fever Night sweats Cough ± haemoptysis Lymphadenopathy Erythema nodosum Spinal pain - in spinal TB (Potts disease) ```
37
What are the two tests to assess for an immune response to TB?
Mantoux test | Interferon Gamma Release Assay
38
What does the Mantoux test look for? What does it indicate?
Previous immune response to TB Previous vaccination Latent TB Active TB
39
Describe how a Mantoux test is performed
Tuberculin is injected into the transdermal space Causes a bleb to form If >5mm after 72 hours = positive Need to assess for active disease
40
Describe how an Interferon-Gamma Release Assay is performed
Sample of blood is mixed with antigens from TB | Previous contract with TB = WBC sensitised to antigens --> release interferon-gamma
41
What is the role of IGRA test in patients who have a positive Mantoux test with no active disease?
Latent TB
42
What are the potential CXR appearances in primary TB
Patchy consolidation Pleural effusions Hilar lymphadenopathy
43
What are the potential CXR appearances in reactivated TB?
Patchy/nodular consolidations with cavitation
44
How might miliary TB look on CXR
Millet seeds
45
What are the three ways to collect culture samples in the investigation of TB?
1. Sputum 2. Mycobacterium blood culture 3. Lymph node aspiration or biopsy
46
How can Latent TB be managed in an otherwise healthy patient?
No treatment
47
How can Latent TB be managed in patients who are at risk of reactivation?
Isoniazid and rifampicin for 3 months OR Isoniazid for 6 months
48
What drugs are used in the management of active TB?
Rifampicin - 6 months Isoniazid - 6 months Pyrazinamide - 2 months Ethambutol - 2 months
49
Alongside, Rifampicin, Isoniazid, Pyrazinamide and Ethambutol, what other drug should be prescribed and why?
Pyridoxine (prophylaxis against the peripheral neuropathy caused by isoniazid)
50
What are some side effects of Rifampicin?
Red/orange secretions Potent induce of cytochrome p450 Hepatotoxicity
51
What is the side effects of Isoniazid?
``` Peripheral neuropathy (co-prescribe pyridoxine) Hepatotoxicity ```
52
What is the side effect of pyrazinamide?
Hyperuraemic --> gout | Hepatotoxicity
53
What is the side effect of ethambutol?
Reduced visual acuity | Colour blindness
54
What type of virus is HIV?
RNA Retrovirus
55
Give some examples of AIDS defining illnesses
``` Kaposi's Sarcoma PCP Cytomegalovirus infection Candiadiasis (bronchial, oesophageal) Lymphomas TB ```
56
How long may an antibody test for HIV be negative after a potential exposure?
3 months
57
How is HIV screened for in hospital?
Antibody blood test
58
In HIV PCR testing, what antigen is tested for?
p24 antigen
59
What type of testing gives the viral load of HIV?
HIV RNA PCR testing
60
What is the normal range for CD4 cells?
500-1200 cells/mm3
61
What CD4 count is considered as end stage HIV/AIDS?
<200 cells/mm3
62
Define viral load in regards tro HIV
Number of copies of HIV RNA per ml of blood
63
Who is offered ART?
Anyone with a diagnosis of HIV regardless of CD4 levels or viral load
64
What is the aim of treatment in HIV?
Achieve a normal CD4 count and an undetectable viral load
65
What is the recommended starting regimen in HIV treatment?
``` 2 NRTIs (nuclease reverse transcriptase inhibitors) - tenofovir, emtricitabine 1 other agent ```
66
What are the classes of HIV ARTs?
Protease inhibitors Integrase inhibitors Nuclease reverse transcriptase inhibitors Non-nucleoside reverse transcriptase inhibitors Entry inhibitors
67
What should be given as prophylaxis against PCP and at what CD4 count should this be initiated?
Co-trimoxazole CD4 <200/mm3
68
How often should a female patient with HIV attend cervical screening?
Every year
69
What vaccinations should a person living with HIV have?
``` annual influenza pneumococcal (5-10y) Hep A and B Tetanus Diphtheria Polio ```
70
What type of vaccines should be avoided in people living with HIV?
Live
71
How long should a newborn be given ART if they are born to a HIV positive mother?
4 weeks
72
How long post-exposure can post-exposure prophylaxis to HIV be given?
Within 72 hours | combination ART for 28 days

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