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Year 4 Medical specialties > Infectious diseases > Flashcards

Infectious diseases Flashcards

(128 cards)

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1
Q

define colonisation

A

presence of a microbe in the human body without an inflammatory response

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2
Q

define infection

A

inflammation due to a microbe

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3
Q

define bacteraemia

A

presence of viable bacteria in the blood

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4
Q

define sepsis

A

life threatening organ dysfunction caused by a dysregulated host response to infection

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5
Q

define septic shock

A

sepsis AND (despite adequate fluid resuscitation + vasopressors) persistent hypotension AND lactate >=2

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6
Q

what is SIRS

A 
NON-specific clinical response including >=2 of the following:
temp >38 <36 
HR >90
RR >20 
WBC >12000
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7
Q

causes of SIRS

A 
infection 
burns 
trauma 
pancreatitis 
and other insults
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8
Q

What is the term for SIRS with a presumed/confirmed infectious process

A

sepsis

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9
Q

list the organ dysfunction that can occur due to sepsis

A 
renal 
CNS 
haematological - DIC 
CVS
hepatic 
respiratory 
metabolic acidosis
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10
Q

what is the qSOFA score

A 
screening for outcome rather than diagnosis 
(see slide)
RR >22
sBP <100 
Altered GCS
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11
Q

NEWS of ?, think sepsis

A

NEWS of >=5 with a known infection, think sepsis

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12
Q

RF for sepsis

A 
age: <1yr or >75yr 
frail people 
recent trauma / invasive procedure 
immunocompromised
- DM, hyposplenism, Coeliac
- steroids, chemo, DMARDs, biologics
Indwelling lines - catheters, cannulas
PWID 
breach in skin integrity - burns, ulcers, wounds,  infections 
pregnancy/puerperium, PPROM
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13
Q

What is the sepsis 6 bundle

A 
Cultures: blood, sputum, urine, stool, wound
Lactate 
Urine output 
Oxygen 
IV fluids 
IV antibiotics 
WITHIN 1 HOUR!!!
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14
Q

principles in fluid resuscitation in sepsis

A

250-500ml 0.9% saline/Hartmanns over 15 min
aim for MAP >65mmHg
aim for 30ml/kg over first 3 hours

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15
Q

if BP is unresponsive after fluid resuscitation, what should you do

A

consider transfer to HDU for vasopressors via CVC e.g. noradrenaline, vasopressin

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16
Q

what is a high lactate a sign of

A

ischaemia and hypoperfusion

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17
Q

minimal target for urine output in sepsis

A

0.5ml/kg/hour

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18
Q

signs of infection in someone with a NEWS >5

A 
new onset confusion 
cough 
UTI - dysuria 
abdo pain 
abnormal bloods
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19
Q

skin colonisers/commensals

A

staphylococcus aureus, epidermidis

corynebacterium - diphtheroids

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20
Q

what are potential contaminants of cultures

A

staph epi

diphtheroids

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21
Q

what is a pathogen

A

any bug that has the potential to cause disease

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22
Q

Gram positive bacteria have a thick/thin peptidoglycan wall

A

thick

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23
Q

Gram negative bacteria have a thick/thin peptidoglycan wall and an additional __ layer

A

thin wall

additional lipopolysaccharide layer

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24
Q

what do the following severity scoring systems assess:
CURB65
Dukes

A

CURB65 - CAP

Dukes - IE

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25
oral cavity colonisers
strep viridans group
26
vagina colonisers
enterobactereriaceae lactobacillus candida staph aureus
27
large bowel colonisers
enterobactereriaceae - E.coli, klebsiella, enterobacter, proteus enterococci - E.faecalis / faecium
28
what is IVOST
IV to oral switch
29
List B lactam antibiotics
``` penicillin flucloxacillin amoxicillin co-amoxiclav cephalosporins pipercillin / tazobactam carbepenems ```
30
what is the allergy causing part in some antibiotics
B lactam ring
31
Penicillin G is IV/PO?
penicillin G = IV = benzylpenicillin
32
Penicillin V is IV/PO?
penicillin V = PO = phenoxymethylpenicillin
33
which is more effective PO penicillin or amoxicillin
PO amoxicillin > penicillin
34
describe the haemolysis in the following for strep: alpha beta gamma
alpha - partial / green tinge beta - complete / golden gamma - none
35
what is the antibiotic of choice for Gm + bacteria
1. amoxicillin | 2. vancomycin
36
what is VRE
vancomycin resistant enterococcus
37
antibiotic of choice for staph. Aureus
FLUCLOXACILLIN
38
antibiotic of choice for MRSA or penicillin allergy
vancomycin
39
RF for C. diff infection
``` elderly 4 Cs antibiotics PPIs prolonged hospital stay surgical procedure immunocompromised ```
40
4 Cs for C.diff
``` cephalosporins ciprofloxacin (and all quinolones) clindamycin co-amoxiclav NOT clarithromycin ```
41
what is used to assess severity of C.diff infection
severity assessment
42
management of non-severe c.diff infection
PO metronidazole
43
management of severe c.diff infection
PO vancomycin +- IV metronidazole
44
C.diff requires isolation?
yes
45
in a case of intra-abdominal sepsis, which antibiotics cover the following: enterococci anaerobes gram negative coliforms
enterococci - amoxicillin anaerobes - metronidazole gram negative coliforms - gentamicin
46
side effects of quinolone antibiotics
``` tendon rupture lower seizure threshold c.diff infection psychosis aortic rupture ```
47
the pathogenicity of gram negative bacteria is associated with what
LPS layer of the outer membrane
48
antibiotics that may be active against Gm-
``` B lactams monobactam - aztreonam aminoglycosides - gentamicin macrolides tetracyclines chloramphenicol co-trimoxazole ```
49
aztreonam is only effective against Gm + or -
Gm -ves
50
RF for Gm - infection
``` HAP vs CAP ventilated vs not time of year immunosuppressed chronic lung disease travel epidemiological exposures ```
51
what is HiB
gram negative coccobacillus
52
examples of microbes causing atypical pneumonia and what is the management
``` legionella mycoplasma coxiella C. psittaci macrolides, tetracyclines, quinolones ```
53
RF for legionella
``` lukewarm aerosolised water smokers males COPD immunocompromised malignancy DM dialysis hot tubs ```
54
test for legionella (serotype 1)
urinary antigen
55
antibiotics for legionella
levofloxacin
56
what are coliforms
Gm - rods
57
which microbes cause Gm - sepsis
``` E.coli Klebsiella Pseudomonas Enterobacter N. meningitides ```
58
what are ESBLs
extended spectrum B lactamases | bacteria that are resistant to B lactam antibiotics i.e. resistant Gm -ves
59
side effects of gentamicin
otoxicity | nephrotoxicity
60
max duration of gentamicin therapy
72 hours
61
CVS dysfunction in sepsis
hypotension due to vasodilatation | distributive shock
62
pulmonary dysfunction in sepsis
ARDS | resp failure
63
renal dysfunction in sepsis
AKI
64
hepatic dysfunction in sepsis
transaminitis due to hypoperfusion | jaundice
65
CNS dysfunction in sepsis
delirium / acute confusional state drowsy altered GCS
66
what is lactic acidosis
diffuse tissue hypoxia and hypoperfusion leads to anaerobic metabolism and therefore lactic acid production --> met acidosis
67
haemtological dysfunction in sepsis
DIC = imbalance between clotting and bleeding from endothelial dysfunction thrombocytopaenia, prolonged PTT/APTT, low fibrinogen, raised d dimers
68
allergy to 1 B lactam = allergy to all?
yes
69
examples of quinolones
ciprofloxacin levofloxacin oflaxacin moxifloxacin
70
B lactams are bactericidal/bacteriostatic
bactericidal
71
side effects of tetracyclines
photosensitivity | teeth staining in kids
72
which antibiotic does NOT cover strep pneumoniae
ciprofloxacin
73
what does clindamycin cover
Gm + and anaerobes
74
what infections can listeria cause
meningitis in immunosuppressed | gastroenteritis
75
vancomycin works against Gm -, true or false
FALSE | only Gm +
76
which antibiotic should never be prescribed on its own
rifampicin
77
side effects of antibiotics in general
N+V diarrhoea rashes candida
78
side effects of penicillins
hypersensitivity | skin reactions
79
what antibiotics can cause cholestatic jaundice
flucloxacillin | co-amoxiclav
80
side effects of macrolides
N+V GI upset hepatotoxicity long QT
81
side effects of quinolones
long QT lower seizure threshold tendonitis and rupture AAA
82
side effects of aminoglycosides
nephrotoxicity | ototoxicity
83
side effect of vancomycin
red man syndrome
84
side effects of tetracyclines
photosensitivity hepatotoxicity teeth staining dysphagia
85
side effects of nitrofurantoin
peripheral neuropathy | pulmonary fibrosis
86
side effects of sulphonamides
SJS | haematological
87
side effect of trimethoprim
blood dyscrasias
88
side effects of chloramphenicol
aplastic anaemia | grey baby syndrome
89
aztreonam does not cause a penicillin associated allergy
true
90
how many blood cultures should you take for suspected IE
3
91
Criteria for IVOST
``` HOME Haemodynamically stable Oral route available Markers of inflammation improving Exclude deep seated infection ```
92
what is a SAB
Staph Aureus Bacteraemia
93
which antibiotics cover Gm+ bacteria?
``` Penicillins: flucloxacillin, amoxicillin, co-amoxiclav Vancomycin Cephalosporins Rifamipicin Fusidic acid Co-trimoxazole Clindamycin Carbepenems ```
94
which antibiotics cover anaerobic bacteria?
``` Metronidazole Clindamycin Vancomycin Co-trimoxazole Carbepenems ```
95
which antibiotics cover Gm- bacteria?
``` Gentamicin Co-trimoxazole Amoxicillin Carbepenems Quinolones ```
96
why is nitrofurantoin never used for pyelonephritis
only penetrates the bladder | not effective in the kidneys - poor tissue penetration
97
antibiotics for pyelonephritis
amoxicillin and gentamicin
98
how do you make a diagnosis of pneumonia
consolidation on a CXR
99
in someone with a UTI/pyelonephritis what else should you ask in the history
PV discharge / symptoms | recent STI
100
another differential you should consider in pyelonephritis
renal calculi
101
what are possible infectious causes of diffuse generalised abdominal pain in e.g. elderly patients
UTI
102
what strain of Staph A can cause multiple boils in the skin
PVL producing Staph
103
what toxin does E.coli 0157 release that causes HUS
shiga toxin
104
types of infections that PWID are at increased risk of
``` cellulitis - repetitive breach into the skin Infective endocarditis phlebitis / DVT abscess bacteraemia pseudoaneurysm from arterial puncture ```
105
what side of the heart are PWID more likely to get IE
right sided because of venous access | but technically can get vegetations at any part
106
what is required to have IE
bacteraemia
107
what bug specifically causes IE in prosthetic valves
staph epi
108
what is the most common bug cause of IE
staph aureus
109
causes of acute IE
staph A strep viridans MRSA
110
causes of subacute IE
enterococci | strep viridans
111
where are you most likely to get MRSA IE
repeated hospital admissions
112
what is the logic behind prescribing gentamicin for IE
it has a synergistic effect when given with amoxicillin / vancomycin, against strep normally 7mg/kg but in IE, 1mg/kg
113
differential diagnoses of fevers, weight loss
``` subacute IE TB malignancy abscess osteomyelitis deep seated infection ```
114
investigations for TB swab
PCR - faster and more sensitive | acid fast bacilli - needs a large number of bacteria
115
treatment for TB
``` 2 RIPE 4 RI rifampicin isoniazid pyrazinamide ethambutol ```
116
side effect of TB drugs
rifampicin - orange urine, hepatitis isoniazid - peripheral neuropathy, hepatitis, P450 inhibitor pyrazinamide - gout ethambutol - loss of colour vision
117
N. meningitides is a commensal of ??
the throat in some people
118
causes of meningitis in adults
``` N. meningitides - younger HiB strep pneumoniae - older (NHS) enteroviruses HSV2 ```
119
which virus commonly causes encephalitis
HSV1
120
imaging for encephalitis
CT - to rule out mass lesions... | MRI - better to look at brain parenchyma
121
why do you do a CT for some people with meningitis | what are the indications
to exclude risk of brain herniation in those with signs to carry out LP safely - focal neurology - low GCS <12 - seizures - papilloedema
122
ICP will be raised in all causes of neuro infection?
true
123
when doing a LP, where will you send the sample?
microbiology - gram stain and culture, viral PCR microscopy - white cells biochemistry - glucose, protein
124
causes of liver abscesses
portal venous system - carrying blood from other areas in the abdomen which may have disease e.g. diverticular abscess, CRC hepatobiliary - cholecystitis, cholangitis haematogenous seeding external - surgery, biopsy
125
in severe C.diff infection, why would you add IV met to PO vanc
IV metronidzaole in those with ileus to help vancomycin reach the gut better
126
indications for IVOST
exclude deep seated infection safe oral route available with good choice of antibiotic resolution of inflammation and improvement seen
127
in those with febrile neutropaenia, what is the most common bug
gram negatives e.g. pseudomonas | treat with pip/taz
128
rapid diagnostic test for C.diff
stool toxin

Year 4 Medical specialties (3 decks)

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