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PUO / Influenza / HAI Flashcards

(68 cards)

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1
Q

What is a PUO

A

> 3 febrile episodes

1 week of investigation

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2
Q

What is a fever

A

Elevation of temp above 37

Clinical cut off = 38

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3
Q

What causes a PUO

A 
Infection 
Malignancy
Inflammatory
Drugs
Venous thrombosis 
Neutropenia 
HIV associated
Tropical disease
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4
Q

What infections tend to cause

A

Abscess

TB

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5
Q

What are inflammatory causes of PUO

A

SLE
Vasculitis
IBD

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6
Q

What is a neutropenic fever

A

Undiagnosed fever in patient with low neutrophils <500

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7
Q

What is HIV associated fever caused by

A

Commonly mycobacterium TB / avium

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8
Q

When is tropical disease unlikely

A

If fever <21 days

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9
Q

What tropical diseases cause fever

A

Malaria
Tyhpoid
Dengue

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10
Q

What is important in the Hx of fever

A 
Pattern
Travel
Contact
Food
Sexual 
FH - age on onset
Occupation
PMH / drug / surgery
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11
Q

What do you ask in travel HX

A 
Location 
Risk activities
Purpose of trip
Accommodation
Vaccine
Malaria prophylaxis - always 
Sexual contacts
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12
Q

What investigation should you do for fever

A 
EXAM - REPEAT 
FBC, U+E, LFT, CRP
Blood film
Blood culture 
Urine / stool
Urinanalysis
CXR
USS abdo
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13
Q

When do you do cultures

A

At time of fever

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14
Q

What are further tests that can be done if Dx still unknown

A 
Blood culture / serology for tropical disease
Bone marrow 
ECHO 
Biopsy - if headache 
TB test
BBV
Renal biopsy / USS
Auto Ab 
CT PET
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15
Q

When do you do ECHO

A

New murmur

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16
Q

When do you do bone marrow

A

Malignancy

Leishmaniosis

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17
Q

When do you do renal biopsy

A

Haematuria

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18
Q

How do you treat PUO

A

Steroids if suspect vasculitis
Anti-TB
Steroids / NSAIDs - may respond even if no Dx

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19
Q

When is TB unlikely

A

If no response after 2 weeks of chemo

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20
Q

What is a fabricated fever

A

Fever is real but self induced

Multiple organisms on blood culture

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21
Q

What is a pyrogen

A

Substance which causes fever
Endogenous - cytokine
Exogenous - endotoxin

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22
Q

What do pyrogens do

A 
Act on hypothalamic thermoregulatory centre
Increases set point
Vasoconstriction
Decreased heat loss 
Causes fever
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23
Q

What is a HAI

A

Infection arise >48 hours after admission or discharge

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24
Q

What are common sources of HAI

A 
Catheter
Surgical site
Intubation
Central lines
Break in skin
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25
What does HAI transmit
``` Direct contact Respiratory Faecal - oral Penetrating injury Disruption bacteria / host = most common ```
26
Microbial RF in hospital
Increased resistance | Increased transmission
27
What are host RF
``` Devices Ax Wounds Immunosuppression Age Overcrowding ```
28
What are common HAI
``` Resp Blood GI SSTI UTI ```
29
What does HAI lead too
``` Increased stay Death Cost Litigation Loss of public confidence ```
30
How is surveillance carried out
Lab Ward National
31
What is an outbreak
2+ cases linked in time and space
32
How do you deal with an outbreak
Single room isolation Clinical ara closure Re-inforce IPC Staff exclsuion
33
How do you decrease risk
``` IPC Risk awareness Hand hygiene PPE Vaccination PEP ```
34
What is influenza
RNA virus
35
What does influenza have
H antigen - attachment | N antigen - Virion release
36
What type of influenza cause disease
A+B
37
How is influenza spread
Airborne - resp droplet | Contact
38
What is the inc
1-4 days
39
What are the symptoms of influenza
``` Fever 3 days + 2+ Cough Myalgia Sore throat Rhinorhoea / coryzal symptoms Headache Malaise Increased RR Low sats N+V+D NO PNEUMONIA SX ```
40
When are you non-infectious
24 hours after symptoms or when anti-viral completed
41
Who is high risk and what do they get
``` Chronic disease - renal ,heart, lung, liver - hep B+C, neuro DM Immunosuppression Asplenia >65 <6 months Pregnnant Obesity BMI >40 Healthcare ``` FLU vaccine annually
42
How do you Dx flu
PCR nose / throat swab
43
What other investigations can be done
Bloods Blood culture ABG if low sats
44
What do bloods show
Low platelet, WCC | Raised sera protein
45
What should CRP do
1/2 when recovering from pneumonia
46
When do you do a CXR
If >4 days
47
What are complications
``` Reyes Acute bronchitis Sinusitis Exacerbation of chronic lung disease Otitis media ```
48
What is Reyes
``` Rash Vomiting Increased LFT Fatty liver failure Encpehalopathy ```
49
What is another common complication
Secondary bacterial pneumonia S.Aureus = common H. influenza S.pneumonia
50
When does it occur
4-5 days after
51
What are less common complications
``` Myocarditis GBS Myoglobinuria Encephaitis Primary viral pnuemonia Rapid resp failure ```
52
When do you give an anti-viral
``` If within 48 hours At high risk Complications Immuosuppressed Pregnant ```
53
What antiviral do you do
Oseltamivir (oral) = 1st line
54
SE
``` N+V+D Pain Headache Hallucination Renal ```
55
What are other options
Zanamivir (inhaled)
56
CI
Bronchospasm
57
What do you give if severe
Prophylaxis cipro / co-amoxiclav to prevent pneumonia
58
What other flu
Avian flu H5N1 / H7N9 Infected birds High mortality
59
What is seasonal flu
Every winter
60
What is pandemic flu
New virus due to antigenic shift Sporadic More serious complications
61
What is the seasonal flu vaccine
Inactivated vaccine Prepare each year Type A+B IM
62
What are SE
Sore arm Malaise Fever
63
Who gets
At risk
64
What do children get
Live intranasal vaccine
65
When is it CI
``` Immunocompromised Current febrile Current wheeze/ severe asthma <2 Egg allergy Aspirin as risk of Reye's ```
66
What are SE
Blocked nose Headache Anorexia
67
What is antigenic drift
Small point mutations | Cause epidemics and vaccine mismatch
68
What is antigenic shift
Abrupt amor change resulting in H/N combinations | Cause pandemics

Infection (14 decks)

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