Sepsis

Question 1

Define septic shock

Answer 1

Where despite fluid resuscitation there is still hypotension (despite vasopressin to maintain MAP at 60) AND lactate >2mmol/l

Question 2

Define sepsis

Answer 2

Life threatening organ dysfunction caused by dysregulated host response to a pathogen. Where evidence of infection plus organ dysfunction

Question 3

Define virulence

Answer 3

Likelihood of causing disease

Question 4

What news score plus infection is required to diagnose sepsis

Answer 4

> 5

Question 5

You diagnose sepsis what do you need to do within the next hour?

Answer 5

SEPSIS 6

• blood cultures (and any other relevant cultures)
• urine output
• IV fluids (250-500ml saline in 15 minutes)
• IV antibiotics (best guess)
• lactate (if >4 repeat in 4-6hrs)
• oxygen (if o2 <94% )

Question 6

What is the type of organism is staph aureus?

Answer 6

Gram positive cocci that is coagulase +

Question 7

What is the antibiotic choice for staph aureus?

Answer 7

Flucloxacillin

Vancomycin if allergic to penicillin

Question 8

What is the type of organism is staph epidermis?

Answer 8

Gram positive cocci clusters coagulase negative

Question 9

You culture an organism that is a purple cocci in chains, and it is has a yellow tinge on blood agar. The patient has a sore throat. Likely organism?

Answer 9

Group A strep

• gram positive cocci, beta haemolytic

Question 10

Women with prosthetic mitral valve presents with malaise, fatigue and dysponea on exertion. Shes been intermittently febrile for a few wks. 3 blood cultures show a gram film organism isolated from all 6 bottles. It is a gram positive cocci and when grown on blood agar shows a green tinge. What is the likely organism?

Answer 10

Strep viridans (endocarditis)

Question 11

What is the usual source of strep viridans ?

Answer 11

GI tract

Question 12

What is the duke criteria?

Answer 12

For diagnosing endocarditis;
Major; blood cultures +endocarditis, echocardiogram showing involvement of heart

Minor; drug user, fever, vascular phenomena, osler node/roth spots/ RF,

Question 13

Karen is 46yrs with 2days of RUQ pain, nausea, vomiting and rigors. She has a NEWs of 9. You make the diagnosis of sepsis. What is the likely pathogens?

Answer 13

Coliforms, enterococci and anaerobes

Question 14

When there is little idea what antibiotics/ microbe involvement there is, what antibiotic combination would you prescribe?

Answer 14

Amoxicillin, gentamicin and metronidazole IV.

Question 15

Culture an organism that are purple clusters of spheres. On blood agar it shows no haemolysis. The patient has been having diarrhoea. What is the likely organism

Answer 15

Enterococcus faecalis

Staphylococci that is non- haemolytic

Question 16

What is the likely causitive organsim of a diabetic foot ulcer that becomes infected

Answer 16

Staph aureus

Question 17

Man reheats rice and then has protracted vomiting and nausea hours after. What is the likely organism?

Answer 17

Bacilli=us cereus (gram +)

Question 18

What are the 4C antibioitsc?

Answer 18

Ciprofloxacin, co-amoxiclav, cephalosporins, clindamycin

Question 19

If you give antibiotics in a ecoli 0157 likely infection what could happen?

Answer 19

Haemolytic uremic syndrome

Question 20

What would you treat a c. Difficile infection with ?

Answer 20

Oral vancomycin

Question 21

What is the mechanism of penicillin bacteriostatic or bacteriocidial?

Answer 21

Bacteriocidal

Question 22

What are some of the side effects of quinolones

Answer 22

Worsening epileptic control, psychiatric side effects, AAA rupture, diffuse tendonitis, achilles ruputure

Question 23

Tertacyclines are used to treat children <12 yrs T/f?

Answer 23

False

Question 24

Koplik spots are associated with what condition

Answer 24

Measles

Question 25

What is the transmission of measles?

Answer 25

Droplets by sneezing

Question 26

Kingella kingae, bartonella henselae, enterococcus faecalis, staph aureus and strep viridans all have what in common?

Answer 26

Major criteria on dukes for endocarditis

Question 27

What types of pathogens are people who are hyposplenic likely to get?

Answer 27

Strep pneumonia Haemophilius influenzae Neisseria meningitis

Question 28

What types of pathogens are people who are HIV positive likely to get?

Answer 28

``` Pneumococal pneumoviae mycobacterium TB candidias pneumocystic jirovecci cytomegalovirus toxoplasma gondii ```

Question 29

Man presents with a C difficile infection what do you prescribe

Answer 29

Vancomycin orally

Question 30

``` Which antibioitc carries highest risk of C diff? A. Clarithromycin b. Ofloxacin C. Trimethoprim D. Amoxicillin ```

Answer 30

Ofloxacin- quinolone

Question 31

``` Regarding penicillin’s which of the following is false? A. They inhibit cell wall synthesis B. They are bacteriostatic C. Some are not absorbed orally D. Allergy to 1= allergy to all ```

Answer 31

B. They are bacteriostatic

Question 32

``` Which of the following is most likely to cause photosensitivity ? A. Doxycycline B. Clarithromycin C. Co-amoxiclav D. Ciprofloxacin ```

Answer 32

A. Doxycycline

Question 33

``` Which of the following can worsen epileptic control ? A. Doxycyline Clarithromycin Co amoxiclav Levofloxacin ```

Answer 33

Levofloxacin (all quinolones)

Question 34

``` Which would provide inadequate cover for respiratory strep pneumoniae? Doxycyline Clarithromycin Co-amoxiclav Ciprofloxacin Amoxicillin ```

Answer 34

Ciprofloxacin

Question 35

What is the main side effect of doxycyline?

Answer 35

Photosensitivity