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Infectious disease, Oncology, & Urology > Meningitis, Malaria, Pneumonia > Flashcards

Meningitis, Malaria, Pneumonia Flashcards

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1
Q

You’re working in a GP practice. A patient comes in with signs suggestive of meningitis. What should you do?

A

Call an ambulance

Give Benzyl Penicillin IM or IV

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2
Q

You’re working in a GP practice. A patient comes in with signs suggestive of meningitis. They have a penicillin allergy. What should you do?

A

Call an ambulance

If they’ve anaphylaxis to penicillin you can give cefuroxime if there is any.

If the allergy is minor give BenPen anyway

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3
Q

A patient is referred from their GP with suspected meningococcal septicaemia.

What should your immediate investigations and treatment be?

A

BUFALO

Blood cultures
Urine output
Fluids
Antibiotics (a 3rd gen. cephalosporin)
Lactate
Oxygen
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4
Q

What antibiotics should you give to a patient with suspected meningitis?

A

3rd gen cephalosporin: cefotaxime

If over 50 or under 3 months also give amoxicillin for listeria cover

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5
Q

What sort of rash would you see in meningococcal septicaemia?

A

Petechiae
Purpura
Ecchymosis

Non-blanching

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6
Q

Investigations for meningitis?

A

BUFALO

Bedside

  • Obs
  • BM
  • ABG/VBG

Routine

  • Bloods: FBC, U+E, CRP, Clotting, LFTs
  • Cultures
  • LP

Specialist
- CT head

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7
Q

How do you know if it is safe to do an LP?

A

If they have signs of raised ICP then you should do a CT head before doing an LP

Papilloedema
Reduced GCS
Seizures
Focal neurology
Previous malignancy
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8
Q

What are signs of raised ICP?

A 
Papilloedema
Reduced GCS
Seizures
Focal neurology
Previous malignancy
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9
Q

In CSF…

What are glucose and protein levels like in bacterial, viral and TB meningitis?

What leukocytes are present?

What colour is the CSF?

A

Glucose

  • viral = normal
  • bacterial = low
  • TB = low

Protein

  • viral = normal
  • bacteria = high
  • TB = high

Leukocytes

  • viral = lymphocytes
  • bacterial = neutrophils
  • TB = lymphocytes

Colour

  • viral = clear
  • bacterial = turbid
  • TB = opalescent
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10
Q

Which organisms cause meningitis in:

  1. neonates
  2. children
  3. adults
  4. elderly
A
  1. Group B strep, E. coli, S. pneumoniae, Listeria
  2. N. meningitidis, S. pneumoniae, H. influenzae
  3. N. meningitidis, S. pneumoniae
  4. N. meningitidis, S. pneumoniae, Listeria, H. influenza
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11
Q

Which viruses cause meningitis?

Management?

A

Enteroviruses
Herpes virus
Mumps

Supportive, usually self resolving

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12
Q

Which bugs cause encephalitis?

Management?

A

Herpes simplex
EBV
CMV
Varicella zoster

Aciclovir

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13
Q

What are contacts of meningitis patients given as prophylaxis?

A

Ciprofloxacin

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14
Q

What are the neuro signs of meningitis?

A

Kernig’s: unable to extend knee with hip flexed

Brudzinski’s: unable to lift head and legs off bed

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15
Q

What are the clinical features of meningitis and meningococcal septicaemia?

A 
Stiff neck
Photophobia
Malaise
Fever
N + V
Headache
Reduced consciousness

Septicaemia:

  • low BP
  • tachycardia
  • purpuric rash
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16
Q

Clinical features of malaria?

Study These Flashcards
A 
Fever, rigors
Myalgia
Malaise
Headache
Vomiting + diarrhoea
17
Q

Investigations for malaria?

Study These Flashcards
A

BUFALO if they look septic

Bedside:

  • obs
  • BM
  • ABG, VBG

Routine:

  • Bloods: FBC, U+E, CRP, Clotting, LFTs, lactate
  • Blood film
  • CXR

Specialist:
- MRI if concerned about cerebral malaria

18
Q

What special blood test identifies malaria?

Study These Flashcards
A

Blood film
Thick and thin

Thick is best to see parasites

Also, antigen assay

19
Q

What’s the incubation period for malaria?

Study These Flashcards
A

Depends on type:
- falciparum 9-14 days

Others can be up to a year

20
Q

List the types of malaria?

What’s the basic difference between them?

Study These Flashcards
A

Falciparum (main, most severe)

Ovale
Vivax
Malariae
Knowlesi
(These all are less severe and don't cause cerebral malaria, they also have a liver stage)
21
Q

What would make a case of malaria ‘complicated malaria’?

Study These Flashcards
A 
Impaired consciousness, seizures
Renal impairment
Acidosis
Hypoglycaemia
Hb < 80
DIC or bleeding
Shock
Haemoglobinuria
Parasite count >2%
22
Q

Management of falciparum malaria?

Study These Flashcards
A

UNCOMPLICATED:

1st line: Riamet (PO equivalent of artesunate)

2nd line: malarone, quinine + doxy

COMPLICATED:

1st line: IV artesunate

2nd line: IV quinine + PO doxy

23
Q

Management of non-falciparum malaria?

Study These Flashcards
A

Chloroquinine
Riamet

The malaria can go dormant in the liver, so treatment must include ‘eradication of liver stage’ with primaquine

24
Q

What are the possible complications of malaria?

Study These Flashcards
A

Splenomegaly
Cerebral malaria
Renal and liver impairment

25
What are the clinical features of cerebral malaria?
``` Stroke Oedema Seizures Reducing GCS Coma Death ```
26
Which drugs are used as malaria prophylaxis?
Chloroquine Doxycycline Proguanil
27
Investigations of pneumonia?
BUFALO if he looks septic Bedside: - obs - BM - ABG, VBG Routine: - bloods: FBC, UE, CRP, lactate, LFT, clotting - CXR - sputum sample - blood cultures Specialist - CT - MRI - bronchoscopy + lavage
28
What are the markers of clinical severity and increased risk of death in pneumonia? How would you manage based on these?
CURB65 Confusion Urea > 7 mmol/L Resp rate > 30 BP < 90/60 ``` 0-1 = low risk, manage in community, amoxicillin 2 = moderate risk, admit, amox + clarithromycin 3+ = high risk, consider ITU, co-amox + clari ```
29
Management of pneumonia?
Supportive Oxygen Antibiotics: low risk: amoxicillin moderate risk: amox + clari high risk: co-amox + clari If Pen allergic: use macrolide (clari) or tetracycline
30
What is the most common bug that causes pneumonia? What others cause it?
Strep pneumoniae ``` Legionella pnuemophila H. influenzae Mycoplasma pneumonia Klebsiella Pseudomonas ```
31
What's the full name of: - legionella - listeria
Legionella pneumophila Listeria monocytogenes
32
What would make you consider legionella pneumonia? How can you test for it? What antibiotic treats it?
Exposure to poorly maintained air conditioning No improvement with amoxicillin Deranged renal and liver function tests Makes young and fit people very unwell Urinary antigen Macrolide (clari)
33
Complications of pneumonia?
``` Sepsis Lung abscess AKI Extra-thoracic infection Effusions Multi-organ failure Death ```
34
Clinical features of pneumonia?
SOB Cough + sputum Fever Malaise Low oxygen sats Crepitations Dull to percussion
35
What test do you do to test vocal resonance? What does it help you with?
Patient says 99 while you auscultate It should sound muffled Increased vocal resonance - it sounds clearer: consolidation Decreased or absent vocal resonance - pleural effusion or collapse

Infectious disease, Oncology, & Urology (11 decks)

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