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Infection > 1 -4 Revision > Flashcards

1 -4 Revision Flashcards

1
Q

What are the 6 signs of sepsis?

A 
Slurred speech
Extreme shivering or muscle pain
Passing no urine
Severe breathlessness
I feel like i might die
Skin mottled/discoloured
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2
Q

What is sepsis?

A

A life threatening organ dysfunction due to dysregulated host response to infection.

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3
Q

What is the Sepsis 6 bundle?

A
  1. Give O2
  2. Take blood culture
  3. Give IV antibiotics
  4. Give fluid
  5. Measure lactate
  6. Measure urine output
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4
Q

How can sepsis be recognised early?

A

Raised EWS

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5
Q

What things are recognised as ‘red flags’ for sepsis?

A

RR > 25/min
SBP <91 mmHg
HR > 130/ min

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6
Q

How does sepsis lead to organ ischaemia?

A

Cytokines initiate the production of thrombin, promoting coagulation. Microvasculature thrombosis leads to organ ischeamia, dysfunction and failure.

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7
Q

What bacteria are most likely to cause sepsis?

A

Gram negative bacteria with potent LPS endotoxin

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8
Q

What antibiotic is commonly used to treat gram -ve sepsis?

A

Gentamicin

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9
Q

What type of antibiotic is gentamicin?

A

Aminoglyceride

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10
Q

How would you identify haemophilis influenza on a gram stain?

A

Gram negative

Pleomorphic - coccobacili to long filaments

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11
Q

Where is h.influenzae a commensal in the body?

A

Upper respiratory tract

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12
Q

How is H.influenzae spread?

A

Respiratory droplets

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13
Q

What can infection haemophilis influenzae cause in infants and young children?

A

Meningitis

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14
Q

What virulence factors does H.influenzae possess?

A

IgA protease that degrades IgA and allows colonisation of URT mucosa.

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15
Q

What antibiotic would you used to treat H. Influenzae?

A

Amoxicillin

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16
Q

How can H.influenzae infections be categorised?

A

Disseminated - via blood stream

Contiguous spread - site of colonisation in resp tract

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17
Q

What contagious spread infections can H.influenzae cause?

A

Sinusitis
Otitis media
Bronchopneumonia

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18
Q

What disseminated infections can H. influenzae cause?

A

** Bacterial meningitis mainly
Epiglottitis
Septic arthritis

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19
Q

How would you recognise E.coli on a gram stain?

A

Gram negative rod

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20
Q

Where is E.coli found in the body?

A

Normal flora in the colon

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21
Q

What virulence factors does E.coli have?

A
  1. Pili or fimbriae - adherence
  2. Generates energy by reducing nitrates to nitrites
  3. LPS
  4. Catalase-positive
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22
Q

How can a urine dipstick help to diagnose UTI caused by E.coli?

A

Nitrites positive - gram +ve uropathogens are nitrites negative.

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23
Q

How are E.coli UTI infections treated?

A

Trimethoprim

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24
Q

What is the mechanism of infection for E.coli?

A
  • Movement to sterile body site

- Facal/oral route, from contaminated food and water

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25
Q

What extra intestinal diseases can E.coli cause?

A

UTI
Neonatal meningitis
Sepsis, Pneumonia, Shock

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26
Q

What are the presenting signs of cellulitis?

A

Rubor, Calor, Dolor, Tumor, Fever

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27
Q

What patient factors increase risk of cellulitis?

A

Elderly
Skin breaks - wounds, catheters
Compromised immune function

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28
Q

How would you recognise staph aureus on a gram stain?

A

Gram +ve (purple) cocci clusters

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29
Q

What antibiotic is used to treat skin and soft tissue staph.aureus infections?

A

Flucloxacillin

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30
Q

How would you recognise neisseria meningitidis on a gram stain?

A

Gram negative, diplococcus

31
Q

Where does neisseria meningitis exist as a commensal in carriers?

A

Nasopharyngeal mucosa

32
Q

What virulence factors does Neisseria meningiditis have?

A
  1. Pili - aid attachment
  2. Polysaccharide capsule
  3. LOS released during autolysis -> toxic endotoxin which can cause sepsis
33
Q

What is the mode of transmission for Neisseria meningitidis?

A

Inhalation of respiratory droplets

34
Q

How would a patient with meningitis present?

A

Severe headache
Rigid neck
Sensitivity to light
Petechial rash -non blanching

35
Q

How would you treat meningitis caused by neisseria meningitis?

A

Ceftriaxone - beta lactam which is less susceptible to beta lactamases and accesses the CSF

36
Q

What type of antibacterial is ceftriaxone?

A

Cephalosporin beta lactam

37
Q

Which patients are more at risk of neisseria meningitidis infection?

A

Young, previously well patients
Smokers
Recent viral infection
Complement deficiency

38
Q

How would you recognise strep pneumonia on a gram stain?

A

Gram positive, lancet-shaped cocci

Can be in pairs or chains

39
Q

What 2 enzyme exotoxins are released from strep pneumoniae?

A

Autolysin

Pneumolysin

40
Q

What do autolysin and pneumolysin do?

A

Autolysin causes cell wall lysis and the release of intracellular exotoxin pneumolysin which attacks cell membrane.

41
Q

What bacteria is the most common cause of community-acquired pneumonia?

A

Strep. pneumonia

42
Q

What other infections does strep.pneumonia cause?

A

Otitis media
Meningitis
Bacteraemia/sepsis

43
Q

How would you treat mild and severe strep.pneumonia infections?

A

Beta lactam - amoxicillin

Co-amoxiclav if severe

44
Q

What are staph aureus virulence factors?

A
  1. Cell wall - protein A, fibrinonectin-binding protein
  2. Superantigen exotoxins - toxic shock
  3. Cytlytic exotoxins - hemolysins
  4. Enzymes - coagulase, hyaluronidase, catalase
  5. Slime production
45
Q

How does MRSA develop resistance to beta-lactam antibiotics?

A

Acquires modified PBP - PBP2a which has low affinity for all beta lactate antibiotics

46
Q

What infection does epstein-barr virus cause?

A

Infectious mononucleosis (glandular fever)

47
Q

What age group is infectious mononucleosis most common in?

A

15-19 year olds

48
Q

What is the classic triad of symptoms associated with glandular fever?

A

Fever
Pharyngitis
Lymphadenopathy
Others - rash, jaundice

49
Q

What is the structure of EBV?

A

Enveloped dsDNA virus

50
Q

What is the initial site of EBV infection?

A

Oropharyngeal epithelium

51
Q

How is EBV transmitted?

A

Saliva

52
Q

What malignancies is EBV infection associated with?

A

Burkitt lymphoma

Nasopharyngeal carcinoma

53
Q

Which cells does EBV infect?

A

B cells

54
Q

When would you use chocolate agar?

A

To grow Haemophilus influenza as it will only grow if blood cells are lysed

55
Q

What is the best way to diagnose a virus?

A

PCR

56
Q

What is the MOA of trimethoprim?

A

Inhibits folic acid synthesis by inhibiting bacterial dihydrofolate reductase

57
Q

What are the 4 P’s of infection control?

A

Place
Pathogen
Patient
Practice

58
Q

What neisseria virulence factor is part of the vaccine and protects against some, but not all serogroups?

A

Capsule

For some serogroups, the capsule is antigenic but for others (B) the capsule does not trigger a good response.

59
Q

Which response is likely to be activated by the flu virus?

A

Cytotoxic T lymphocytes
TH1 T cells
Antibodies

60
Q

What feature of staph epidermidis enables it to cause infections on surfaces?

A

Produces slime that facilitates adherence to prosthetic surfaces such as catheters

61
Q

Are fungi larger or small than bacteria?

A

Fungi are larger than bacteria.

Bacteria are larger than viruses.

62
Q

Where would you take a swab to check if a patient is an MRSA carrier?

A

Nose swab - MRSA colonises the nose

63
Q

What characteristic of clostridium allows it to survive outside the host for long periods?

A

Spore formation - dormant cell, resistant to heat, UV light and chemical agents

64
Q

What is acute HIV infection characterised by?

A

A flu-like illness with a mild rash

65
Q

Which blood cell would you expect to be raised in a viral infection?

A

T lymphocytes

66
Q

Which blood cell would you expect to be raised in a bacterial infection?

A

Neutrophil

67
Q

What is known as the ‘winter vomiting bug’?

A

Norovirus

68
Q

What is the endotoxin of neisseria meningitidis?

A

LPS on the outer membrane

69
Q

What bacteria is metronidazole active against?

A

Anaerobic bacteria - c.diff

70
Q

What 2 toxins does C.difficule produce?

A

Toxin A - enterotoxin that produces excessive fluid secretion and inflammation of lining of bowel wall
Toxin B - cytotoxin that affects protein synthesis in cells

71
Q

What gram negative bacilli is present in the colon?

A

Escherichia coli

72
Q

What personal protection methods can be used when dealing with patients with infections?

A

Wear gloves
Wear apron
Wash hands before and after consultation
Wash stethoscope

73
Q

List 4 causes of community-aquired pneumonia.

A

Strep pneumoniae
Haemiphilus influenzae
Influenza
Staph aureus

74
Q

What bedside tests can be done to check for UTI’s?

A

Dipstick

Nitrites - some gram negative bacteria reduce nitrates to nitrites

Infection (15 decks)

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