Treatments

Question 1

Simple CAP

Answer 1

Amoxicillin 500mg-1gTDS (alt. Clarithromycin)

Question 2

Severe CAP

Answer 2

IV Co-amoxiclav+ IV erythromycin/clarithromycin (if micro undefined 10 days Tx but if you culture Legionella, staph or gm -ve bac then extend to 14-21 days)Ch

Question 3

Chlamydia

Answer 3

one dose oral Azithromycin 1g// or Doxycycline 100mg bd 7 days alt. erythromycin
Avoid sex till finish Tx or 7 days after Azithro

Question 4

Gonnorhoea

Answer 4

Ceftriaxone 250mg IM (OR single cipro oral dose)- can also give single dose azithromycin alongside to cover chlamydia

Question 5

Vulvovaginal Candidiasis

Answer 5

Topical and oral Azole (not oral if preg)

Question 6

Appendicitis

Answer 6

IV cefuroxime+ metronidazole. Remove appendix.

Question 7

Ascending cholangitis (Charcot’s triad- fever with rigors, Abdo pain+ Jaundice). U/S shows dilated intrahepatic ducts+ gallstones in CBD,

Answer 7

Cefuroxime and Metronidazole IV. If anaphylaxis to penicillin in past then Ciprofloxacin. ERCP. If septic too- add gentamicin

Question 8

Pyogenic Liver abscess

Disprop increase ALP. U/S- large gas containing mass on liver U/S

Answer 8

Radiologically guided drain abscess. Tx Cefuroxime+ Metronidazole (Cont 4wks-3m)

Question 9

Spontaneous bacterial peritonitis

Answer 9

Ascitic tap on admx to see of SBP. (Clot screen 1st)- WCC>250cm3- consistent so Tx even if no org (Cefuroxime) - if ESBL prod E.coli then add Meropenem IV

Question 10

Acute pancreatitis (Blood amylase Increased)- - central dull abdo pain relived by sitting forwards. Tachy. Flank discol

Answer 10

Usually sterile process but infec of inflammed pancreas can occcur- so if >30% necrosis- meropenem+ fluconazole

Question 11

Abx prophylaxis for surgery

Answer 11

Cefuroxime+ Metronidazole IV 1 dose (within 30 min of inducing anaesthesia). - unless blood loss> 1500ml, haemodialysis or surgery prolonged (then add dose)

Question 12

What do you do if a patient is MRSA +ve coming in for an op?

Answer 12

Operate on them at the end of the theatre list+ add teicoplanin to standard prophylaxis

Question 13

Bacterial Vaginosis

Answer 13

Oral metronidazole/ clindamycin (if breastfeeding- intravag metronidazole gel)

Question 14

Pelvic Inflammatory Disease

Answer 14

IV ceftriaxone, Doxycycline, Metronidazole Combo

Question 15

Herpes Simplex

Answer 15

Saline baths; Analgesia; Topical anaesthetics when peeing- lidocaine; Aciclovir or famiciclovir, or valaciclovir- shortens and reduces severity )oral) -if recurrence can use chronic supressive Tx or episodic Tx

Question 16

Secondary Syphillis (VDRL blood test)

Answer 16

Penicillin IM (1 if 2 years)

Question 17

Genital warts

Answer 17

No specific Tx (use condoms)- Can try imiquimod, cryotherapy, laser therapy

Question 18

Molluscum contagiosum

Answer 18

Usually resolves. May do cutterage/ cryotherapy

Question 19

Falciparum Malaria (No dormant liver stage- so no recurrence except within that year)

Answer 19

Oral quinine+ Doxycycline (+/-cefuroxime/ metronidazole if added bac infec/ septicaemia). If severe–> ICU- IV quinine

Question 20

Vivax +Ovale Malaria- more benign but have dormant types so recur if not killed by Tx

Answer 20

Primaquine (14 days) kills hypnozoites

Question 21

Malariae malaria (benign + no hypnozoites) - but if not Tx- can recrudesce from blood + recurrent fevers ~50 yrs. Fevers every 3 days

Answer 21

Chloroquine

Question 22

Typhoid- Gm-ve rods.

Answer 22

Ceftriaxone

Question 23

Schistosomiasis (Bilharzia)- fresh water esp. lake malawi Cercaria- become worms + lay eggs in bowel/rectum–> liver (+ shed in stools). Serology at 6+ 12wk post exposure. Risk= transverse myelitis

Answer 23

Can Tx without test if v. worried- but no point in first 3 wks. Praziquantel- single dose

Question 24

Malaria prophylaxis

Answer 24

Mefloquine (vivid dreams/ neuropsych effects)- 1 a wk- start 3 wks before. Malarone (during and 1-2d before)/ Doxycycline- nausea + photosensitivity- daily- 1-2 before

Question 25

HIV Testing

Answer 25

HIV ab+ ag. Window is 6 wks- 3months

Question 26

Classes of ART

Answer 26

NRTI (Phosp inhibit HIV RT so can't replicate in CD4 cells); NNRTIs- act on another part of RT don't need phosp. PI- proteins produced by translation can't be spliced

Question 27

Predom meningococcal septicaemia

Answer 27

Don't attempt LP- IV cefotaxime or ceftriaxone

Question 28

If predom meningitis

Answer 28

If no signs increased ICP - LP unless will delay IV cefotaxime/ ceftriaxone by >30 mins (consider streroids) If increased LP signs- Defer LP, give the abx+ steroids

Question 29

Notifying public health

Answer 29

Meningococcal or Hib meningitis (rifampicin)

Question 30

Organisms on stain. Strep p; Staph; N. meningitidis; H. influenzae. L. monocytogenes

Answer 30

``` Strep p. Gm+ve cocci in pairs Staph- Gm+ve cocci in clusters Gm -ve diplococci- N.meningitidis H. influenzae- Gm -ve bacilli Gm+ve bacilli- L.monocytogenes ```

Question 31

Duration meningitis Tx

Answer 31

7day in meningococcal septicaemia+ meningitis if N. men or H. influenzae 10-14d- Strep pneumoniae 21d- Aerobic gm-ve bacilli/ L.monocytogenes.

Question 32

Cellulitis

Answer 32

Afebrile+ healthy look- Oral Flucloxacillin outpatient (if allergic- clindamycin) If febrile+ ill look but no other co-morb- short stay/outpatient IV Ceftriaxone--> Fluclox PO Toxic app/ 1 co-morb/limb threatening infec- IV fluclox-->Fluclox PO

Question 33

Necrotizing fasciitis (Clostridium perfringens; Strep pyogenes)

Answer 33

Meropenem+ clindamycin immed+ fluids--> urgent surgical debridement

Question 34

Animal bites (risk with dog-pastuerella)

Answer 34

Augmentin; Irrigate+ clean wound; Give tetanus jab if need

Question 35

Venflon ass. infections. Commonest HAI- Use aseptic technique+ change every 3d

Answer 35

Flucloxacillin (if MRSA in wound- vancomycin, teicoplanin, linezolid)

Question 36

UTI (lower, uncomplicated, cystitis)

Answer 36

Trimethoprim/ Nitrofurantoin for 3d

Question 37

Upper UTI

Answer 37

Meropenem or whatever hosp policy is- 7-14d IV if complicated+ bacteraemia

Question 38

Bacteruria in preg

Answer 38

7 day Amoxicillin if asymp. Trimethoprim 7d if symp

Question 39

UTI in males

Answer 39

Quinolone (or trimethoprim,)- 2 wks

Question 40

Catheter UTI

Answer 40

Don't give abx if asymp bacteruria

Question 41

Sepsis 6

Answer 41

1. Give 100% O2 via non-rebreathable bag 2. Take blood cultures 3. Give IV abx (co-amoxiclav+ gentamicin) 4. Start IV fluid rescuscitation 5. Check lactate 6. Monitor urine output

Question 42

Endocarditis

Answer 42

Benzyl+ gentamicin if natural valve | Vancomycin IV and gent if prosthetic

Question 43

Patient remains hypotensive despite adequate fluid

Answer 43

Insert CVP, IV adrenaline, IV noradrenaline (1st choice as vasopressor as increases BP by increasing CO whereas IV adrenaline does it by increasing TPVR)

Question 44

Aspergillosis (invasive)- halo sign of consolidation on CXR (mass surrounded by ground glass)

Answer 44

Bronchoalveolar lavage+ serum ag. IV voriconazole.