sepsis

Question 1

colonisation

Answer 1

the presence of a microbe in the human body without inflammation (staph aureus on skin)

Question 2

infection

Answer 2

inflammation due to a microbe

Question 3

bacteraemia

Answer 3

presence of a viable bacteria in the blood

Question 4

sepsis

Answer 4

life threatening organ dysfunction caused by dysregulated host repsonse to infection

Question 5

septic shock

Answer 5

circulatory and cellular/ metabolic dysfunction associated with high risk mortailty
-attempt made at volume resus but still hypotensive
(due to low TPR and due to vasodilation)

Question 6

pathogen

Answer 6

any microorganisms that has the potential to cause disease

Question 7

virulence

Answer 7

likelihood of causing a disease

Question 8

prodome

Answer 8

little bit ill before proper illness

Question 9

what is SIRS?

Answer 9

Systemic inflammatory response syndrome

Question 10

SIRS criteria?

Answer 10

temp >38 or < 36
HR>90
RR>20
WCC>12000 or <4000

Question 11

what is SOFA?

Answer 11

sequential organ function assessment score

Question 12

qSOFA criteria?

Answer 12

RR>22
sBP<100
altered GCS

Question 13

What news score indicates infection?

Answer 13

5

Question 14

what is infection?

Answer 14

invasion and multiplication of micro organisms within the body

Question 15

symptoms of infection?

Answer 15

• cough
• dysuria
• abdo pain
• pain
• ab bloods
• confusion

Question 16

septic shock?

Answer 16

hypotension despite fluid resus (30ml/kg) and vasoopressors (adrenaline and noradrenaline)

Question 17

What is the sepsis 6?

Answer 17

GIVE 3 TAKE 3
give O2- aiming for 94-98%, if concerned measure ABG
give fluids- 0.9% NaCl saline solution (hartmanns) aiming for MAP >65mmHg
give antibiotics- broad spec, amoxicillin, metronidazole and gentamicin
take lactate- high lactate= sign of hypoperfusion
take urine output- marker of organ perfusion
take blood- for culture

Question 18

what do you do if MAP <65mmHg after resus?

Answer 18

add vasopressors (noradrenaline) via CVC

Question 19

How many blood cultures do you take?

Answer 19

1 (3 if suspected endocarditis)

Question 20

what do you do it there is an abscess present?

Answer 20

Drain it

Question 21

what is empirical management?

Answer 21

very educated guess

Question 22

how do you assess pnuemonia?

Answer 22

curb 65

Question 23

how do you assess endocarditis?

Answer 23

dukes criteria

Question 24

what do toxins from bacteria cause?

Answer 24

vasodilation

Question 25

what is ascites a sign of?

Answer 25

peritonitis

Question 26

what indicated secondary bacterial peritonitis

Answer 26

history of trauma/perforated bowel

Question 27

what is amoxicillin used for?

Answer 27

gram +ve (enterococci)

Question 28

what is gentamicin used for?

Answer 28

gram -ve (coliforms)

Question 29

what is metronidazole used for?

Answer 29

anaerobes

Question 30

where are anaerobes most likely to be found?

Answer 30

in places with little o2 (ie bowel)

Question 31

what grows on Mckonkey agar?

Answer 31

E.coli

Question 32

vibro shaped?

Answer 32

cholera

Question 33

what colonises in the mouth?

Answer 33

strep virdans neisseria anaerobes

Question 34

what colonises in the colon?

Answer 34

e.coli klebsiella enterobacter (coliforms)

Question 35

what colonises in the colon?

Answer 35

e.coli klebsiella enterobacter (coliforms)

Question 36

what colonises on the skin?

Answer 36

staph. aureus

Question 37

describe gram +ve bacteria wall

Answer 37

thick peptiglycan layer (purple)

Question 38

describe gram -ve bacteria wall

Answer 38

thin peptiglycan layer (pink)

Question 39

what to phagocytes target?

Answer 39

bacteria | fungi

Question 40

what do T lymphocytes target?

Answer 40

viruses | parasites

Question 41

what do antibodies and B lymphocytes target?

Answer 41

viruses

Question 42

what do eosinophils target?

Answer 42

fungi parasites worms

Question 43

what do mast cells target?

Answer 43

worms

Question 44

what cells does HIV target?

Answer 44

CD4+ CELLS

Question 45

describe alpha haemolysis?

Answer 45

partial green -virdans pneumoniae

Question 46

describe beta haemolysis?

Answer 46

complete white -GAS -strep pyrogenes

Question 47

describe gamma haemolysis?

Answer 47

no haemolysis red -enterococci

Question 48

what do sebaceous glands secrete?

Answer 48

antimicrobial peptides

Question 49

what are the main APC of the body?

Answer 49

langerhan cells

Question 50

Staphlcocci

Answer 50

catalase positive - staph epidermis - staph aureus

Question 51

Staphylcocci

Answer 51

catalase positive - staph epidermis (no haemolysis, coagulase -ve) - staph aureus (golden on blood agar)

Question 52

streptococci

Answer 52

strep virdans and strep pneumoniae (alpha haemolysis) GAS- strep pyrogenes (beta haemolysis) GBS-strep agalactaiae (beta haemolysis)

Question 53

Enterococci

Answer 53

``` often in pairs intestine commensals -e.faecalis -e.faecium VRE- vancomycin resistant enterococci ```

Question 54

Gram +ve bacilli organisms:

Answer 54

- listeria monocytogenes (GI, cheeses) - Clostridia (c.diff, c.perfringens- wound infections) - corynebacterium (diphtheroids) - bacillus cereus

Question 55

Enterococci

Answer 55

``` often in pairs intestine commensals -e.faecalis -e.faecium VRE- vancomycin resistant enterococci (Tx: linezolid, daptomycin, tigecycline) ```

Question 56

penicillin binds to step pneumoniae enzymes that are required to synthesis peptidoglycan layer- inhibits it

Answer 56

if recent travel to areas with penicillin resistant strep then IV vancomycin

Question 57

Strep Bovis

Answer 57

typical endocarditis pathogen | requires colonoscopy due to risk of colon cancer

Question 58

Enterococci- in GI tract, UTI, endocarditis, bacteriaemia | how is it Tx?

Answer 58

AmoxicillinIV - amoxicillin/ co-trimoxazole oral = step down - vancomycin if amoxicillin resistant

Question 59

Tx of staph aureus?

Answer 59

Flucloxicillin IV in sepsis | Vancomycin in allergy or MRSA

Question 60

C.diff

Answer 60

Faecal-oral transmission | must wash hands after being in contact as spore forming and gel = not effective

Question 61

4 C's

Answer 61

ciprofloxacin co-amoxiclav clindamycin cefrazidime

Question 62

Tx of c.diff

Answer 62

oral vancomycin

Question 63

Tx of c.diff

Answer 63

oral vancomycin

Question 64

Gram -ve bacterias are mostly which shape?

Answer 64

bacilli

Question 65

what are antibiotics for Gram -ve bacteria?

Answer 65

beta lactams - azatreonam (monobactam) purely active against gram -ve aminogllycosides -gentamicin (only if kindeys are ok) macrolides, tetracyclines, chloramphenicol, cotrimoxazole, polumixins

Question 66

what are gram -ve cocci

Answer 66

neiserrria | gonorrhoea

Question 67

H.influenzae

Answer 67

``` gram -ve coccobacillus aerobic will not grow on chocolate agar vitro growth factors required (x factor- hemin and v factor) Tx: amoxicillin and doxycycline TYPE B CAPSULAR ANTIGEN ```

Question 68

What are some atypical pnuemonias?

Answer 68

all except strep.pnuemonia

Question 69

Tx of atypical pneumonias?

Answer 69

doxycyline or tetracycline or clarithromycin | levofloxacin if penicillin allergic

Question 70

Tx of atypical pneumonias?

Answer 70

doxycyline or tetracycline or clarithromycin | levofloxacin if penicillin allergic

Question 71

Tx of legionella

Answer 71

co-amoxiclav and levofloxacin

Question 72

what is legionella assoc w/

Answer 72

luke warm water and aerosolised water (showers, aircon)

Question 73

how do you diagnose legionella

Answer 73

urine antigen

Question 74

what are coliforms?

Answer 74

gram -ve rods eg E.coli, klebsiella, enterobacter

Question 75

treatment for coliforms

Answer 75

Gentamicin

Question 76

what is the likely causitive organism in endocarditis after a prosthetic valve?

Answer 76

strep virdans