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MRCP: Infectious Diseases > Severe Infections > Flashcards

Severe Infections Flashcards

1
Q

What is a super antigen?

A

Antigens that results in excessive activation of the immune system

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2
Q

What is the antigen that provokes staphylococcal toxic shock syndrome?

A

TSST-1 antigen (toxic shock syndrome toxin)

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3
Q

What are features of TSS?

A

Extreme fever > 39.0
Septic shock
Diffuse erythematous rash
Desquamation of rash, especially of the palms and soles
Involvement of three or more organ systems: e.g. gastrointestinal (diarrhoea and vomiting), mucous membrane erythema, renal failure, hepatitis, thrombocytopenia, CNS involvement (e.g. confusion)

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4
Q

How do you treat TSS?

A

Remove source of antigen
Organ support

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5
Q

What is a positive kernig’s sign and what does it suggest?

A

Step 1. The patient is positioned in supine with hip and knee flexed to 90 degrees

Step 2. The knee is then slowly extended by the examiner (Repeat on both legs)

Step 3. Resistance or pain and the inability to extend the patient’s knee beyond 135 degrees, because of pain, bilaterally indicates a positive Kernig’s sign

Meningitis

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6
Q

How is meningitis empirically treated if < 3 months?

A

Cefotaxime + Amoxicillin

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7
Q

How is meningitis empirically treated if 3 months - 50 years?

A

Cefotaxime

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8
Q

How is meningitis empirically treated if > 50 years?

A

Cefotaxime + Amoxicillin

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9
Q

How is meningococcal meningitis treated?

A

Intravenous benzylpenicillin or cefotaxime (or ceftriaxone)

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10
Q

What is the indication for steroids in meningitis?

A

septic shock
meningococcal septicaemia
immunocompromised
meningitis following surgery

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11
Q

Who should be contact traced in meningitis?

A
  1. close contacts of patients affected with meningococcal meningitis.
  2. exposed to respiratory secretion, regardless of the closeness of contact
  3. exposed to a patient with confirmed bacterial meningitis should be given prophylactic antibiotics if they have close contact within the 7 days before onset
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12
Q

How should contact traced individuals be managed for meningitis?

A

Oral ciprofloxacin
or
Oral Rifampicin

plus:
meningococcal vaccination should be offered to close contacts when serotype results are available, including booster doses to those who had the vaccine in infancy

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13
Q

What causes viral meningitis?

A

non-polio enteroviruses e.g. coxsackie virus, echovirus
mumps
herpes simplex virus (HSV), cytomegalovirus (CMV), herpes zoster viruses
HIV
measles

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14
Q

What are the features of viral meningitis?

A

Headache
Nuchal rigidity
Photophobia (often milder than the photophobia experienced by a patient with bacterial meningitis)
Confusion
Fevers

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15
Q

If you are waiting on CSF result and suspect mengitis, even viral, how should it be treated?

A

IV ceftiraxone
IV acyclovir

While awaiting result

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16
Q

What are the features of a bacterial meningitis csf?

A

Appearance: Cloudy
Glucose: Low (less than half of plasma)
Protein: High (>1g/l)
White cells: 10-5000 (polymorphic)

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17
Q

What are the features of a viral meningitis csf?

A

Appearance: Cloudy / clear
Glucose: 60-80% of plasma
Protein: Normal / raised
White cells: 15-1000 Lymphocytes

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18
Q

What are the features of a tuberculosis meningitis csf?

A

Appearance: Cloudy / fibrin web
Glucose: Low (less than half of plasma)
Protein: High (>1g/l)
White cells: 30- 3000Lymphocytes

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19
Q

What would make you think a CSF fungus?

A

Low lymphocytes <30

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20
Q

What are typical causes of cellulitis?

A

Streptococcus pyogenes
Staph aureus

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21
Q

How should cellulitis be treated?

A

Flucloxacillin first line

Pen allergic: Doxycycline

Pregnant or penicillin allergic: Clarithromycin / erythromycin

Severe cellulitis:
co-amoxiclav, cefuroxime, clindamycin or ceftriaxone.

22
Q

What causes caveatting lung lesions?

A

Staph aureus (PVL staph)
Klebsiella
TB
squamous cell carcinoma - most common oncology cause

23
Q

How is listeria meningitis treated? How is general listeria infection treated?

A

General: Amoxillin / ampicillin
Meningitis: IV Amoxicillin and Gentamicin

24
Q

What are the features of a listeria infection

A

diarrhoea, flu-like illness
pneumonia
ataxia and seizures

meningoencephalitis

25
Q

Who are 20 times more likely to get a listeria infection?

A

Pregnant women

26
Q

What are the complications of listeria in pregnancy?

A

fetal/neonatal infection can occur both transplacentally and vertically during child birth
complications include miscarriage, premature labour, stillbirth and chorioamnionitis

27
Q

What is a risk factor for having anthrax?

A

Being a butcher

28
Q

What is Lemierre’s syndrome and what causes it?

A

Lemierre’s syndrome is an infectious thrombophlebitis of the internal jugular vein.

Fusobacterium necrophorum

29
Q

What is the pathophysiology of lemierre’s syndrome?

A

a bacterial sore throat caused by Fusobacterium necrophorum leading to a peritonsillar abscess. A combination of spread of the infection laterally from the abscess and compression lead to thrombosis of the IJV.

30
Q

Complications of lemierre’s ?

A

Septic pulmonary emboli

31
Q

Pneumonia + Alcoholic + Cavitation ?

A

Klebsiella

32
Q

Pneumonia + Prior Flu?

A

Staph pneumonia

33
Q

Pneumonia + Chicken Pox Rash?

A

Varicella

34
Q

Pneumoniae Pneumonia + Hemolytic Anemia?

A

Mycoplasma

35
Q

Pneumonia + Hyponatraemia + Travel History?

A

Legionella

36
Q

Pneumonia + Fleeting opacities?

A

Cryptogenic Pneumonia

37
Q

Pneumonia + Fits/LOC?

A

Aspiration pneumonia

38
Q

Pneumonia + HSV oral lesion?

A

Strep Pneumonia

39
Q

Pneumonia + parrot?

A

Chamlydia pittasci

40
Q

Pneumonia + farm animals?

A

Q fever - coxiella

41
Q

Pneumonia + HIV?

A

think pcp but if straight forward case strep pneumonia is still most common

42
Q

Pneumonia + Cystic fibrosis?

A

Consider pseudomonas/Burkholderia

43
Q

Pneumonia + COPD or exac ?

A

Haemophillus

44
Q

Commonest cause of CAP?

A

strep pneumonia

45
Q

What is the most likely cause of sepsis from a central line?

A

Staph epidermis - Cause of central line infections and infective endocarditis

46
Q

What should be given alongside antibiotics in bacterial menginitis?

A

Dexamethasone
Reduced neurological sequelae

47
Q

What is the treatment of tetanus?

A

Metronidazole

48
Q

Treatment of meningitis and penicillin allergic?

A

Chloramphenicol

49
Q

What is the cause of necrotising fascitis ?

A

type 1 is caused by mixed anaerobes and aerobes (often occurs post-surgery in diabetics). This is the most common type
type 2 is caused by Streptococcus pyogenes

50
Q

Risk factors for necrotising fascitis?

A

skin factors: recent trauma, burns or soft tissue infections
diabetes mellitus
the most common preexisting medical condition
particularly if the patient is treated with SGLT-2 inhibitors
intravenous drug use
immunosuppression

51
Q

Features of necrotising fascitis?

A

acute onset
pain, swelling, erythema at the affected site
often presents as rapidly worsening cellulitis with pain out of keeping with physical features
extremely tender over infected tissue with hypoaesthesia to light touch
skin necrosis and crepitus/gas gangrene are late signs
fever and tachycardia may be absent or occur late in the presentation

MRCP: Infectious Diseases (15 decks)

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