14. Infection Formative Flashcards
What is the most likely cause of an outbreak of nausea and vomiting on a cruise ship?
Adenovirus Enterovirus Epstein Barr virus Norovirus Rotavirus
What is the most likely cause of an outbreak of nausea and vomiting on a cruise ship?
(answers explained)
Adenovirus- again more common in babies
Enterovirus- GI bug doesn’t cause diarrhoea
Epstein Barr virus- kissing disease doesn’t cause diorrhea
Norovirus- correct answer, common cause of outbreaks
Rotavirus- common in children under 5, common in winter
What is the commonest cause of travellers diarrhoea?
Campylobacter Cryptosporidium E Coli 0157 Enterotoxigenic E. coli Giardia
What is the commonest cause of travellers diarrhoea?
why is each answer that answer
Campylobacter- most common foodborne diarrhoeal pathogen
Cryptosporidium- parasite that cuases watery diorrhea, not common
E Coli 0157- frequent bloody stools, characterised by renal failure, haemolytic anaemia, thrombocytopenia
Enterotoxigenic E. coli- correct answer, traveller’s diarrhoea
Giardia-microscopic parasite that causes diarrhoea, not as common
A 22 year old man presents to A&E with a rash which extends in patches over his chest, abdomen and legs. It develops over 6 hours. He is hypotensive (80/50) and pyrexial
What is your next course of action
Call for senior help Get fast IV fluids IV high dose cephalosporin Blood cultures All of the above- correct answer
qSOFA criteria- RR>22, BP<100, altered mental status. 2 or more oh no
Sepsis 6 (give fluids, antibiotics oxygen) Take- blood cultures, urine lactate, urine output
A 22 year old man presents to A&E with a rash which extends in patches over his chest, abdomen and legs. It develops over 6 hours. He is hypotensive (80/50) and pyrexial
What is your next course of action
Call for senior help Get fast IV fluids IV high dose cephalosporin Blood cultures All of the above
A 22 year old man presents to A&E with a rash which extends in patches over his chest, abdomen and legs. It develops over 6 hours. He is hypotensive (80/50) and pyrexial
What is your next course of action
(Answers explained)
Call for senior help Get fast IV fluids IV high dose cephalosporin Blood cultures All of the above- correct answer
qSOFA criteria- RR>22, BP<100, altered mental status. 2 or more oh no
Sepsis 6 (give fluids, antibiotics oxygen) Take- blood cultures, urine lactate, urine output
A 22 year old man presents to A&E with a rash which extends in patches over his chest, abdomen and legs. It develops over 6 hours. He is hypotensive (80/50) and pyrexial
What should his family be given?
Amoxicillin or chloramphenicol Rifampicin or Ciprofloxacin Chloramphicol or Cefalexin Cefalexin or Trimethoprim None of the above
A 22 year old man presents to A&E with a rash which extends in patches over his chest, abdomen and legs. It develops over 6 hours. He is hypotensive (80/50) and pyrexial
What should his family be given?
(answer explained) (ask the boy or tutor)
Amoxicillin or chloramphenicol Rifampicin or Ciprofloxacin- correct answer, antibiotic prophylaxis for sepsis Chloramphicol or Cefalexin Cefalexin or Trimethoprim None of the above
A 22 year old man presents to A&E with a rash which extends in patches over his chest, abdomen and legs. It develops over 6 hours. He is hypotensive (80/50) and pyrexial
Four days later he becomes hypotensive and is noted to have low sodium and high potassium. What is the most likely cause?
Too little saline in his fluid regime Syndrome of inappropriate ADH Adrenal insufficiency Renal failure Antibiotic associated diarrhoea
A 22 year old man presents to A&E with a rash which extends in patches over his chest, abdomen and legs. It develops over 6 hours. He is hypotensive (80/50) and pyrexial
Four days later he becomes hypotensive and is noted to have low sodium and high potassium. What is the most likely cause?
Too little saline in his fluid regime Syndrome of inappropriate ADH Adrenal insufficiency Renal failure- correct answer, tissues are unable to be perfused so due to septic shock kidneys fail Antibiotic associated diarrhoea
What component of Neisseria Meningitidis causes septic shock?
Capsule Fimbriae Lipo-polysaccharide Peptidoglycan Superantigens
What component of Neisseria Meningitidis causes septic shock?
Answer explained
Capsule
Fimbriae
Lipo-polysaccharide- also known as endotoxins, activate over 20% of the bodies T cells leading to septic shock
Peptidoglycan
Superantigens
A 30 year old IV drug user is admitted with jaundice
HBV surface antigen -ve
HBV core antibody -ve
HBV surface antibody +ve
HAV IgM antibody +ve
Which of the following is true?
He has acute hepatitis B infection
He has acute hepatitis A infection
He has previously had hepatitis B infection
He has not been immunised against hepatitis B
A 30 year old IV drug user is admitted with jaundice
HBV surface antigen -ve
HBV core antibody -ve
HBV surface antibody +ve
HAV IgM antibody +ve
Which of the following is true? (answer explained)
He has acute hepatitis B infection
He has acute hepatitis A infection- correct answer
He has previously had hepatitis B infection
He has not been immunised against hepatitis B
To understand we must look at what marker is indicative of
HBV surface antigen (sAg)- indicatess current hep B infection
HBV core antibody (anti-HBc or HBcAb) - indicates past or current hep B infection
HBV surface antibody (anti-HBs)- immune to hep B
HAV IgM antibody- indicates current HIV infection
For which of the following infections is there no vaccine?
Hep A Hep C Polio Typhoid Yellow fever
For which of the following infections is there no vaccine?
answer explained
Hep A Hep C- no current vaccine (just need to know) Polio Typhoid Yellow fever
Which of the following is true of active immunisation?
Always contains a live organism
Contains immunoglobulin
Gives immediate protection against infection
Stimulates the host immune response
Which of the following is true of active immunisation?
answer explained
Always contains a live organism
Contains immunoglobulin
Gives immediate protection against infection
Stimulates the host immune response- correct answer
Active vaccine stimulates the host response by exposing them to different pathogens whether they be live or recombinant
A 28 year old man presents with a 3 week history of swallowing difficulties. He has white plaques on the roof of his mouth and down his throat
What is the most likely organism to cause this appearance?
Epstein- barr virus Human immunodeficiency virus Herpes Zoster virus Candida albicans- Group A streptococcus
A 28 year old man presents with a 3 week history of swallowing difficulties. He has white plaques on the roof of his mouth and down his throat
He is found to be HIV positive, the candida is treated with fluconazole. His further treatment should be
Beetroot
Immunise with BCG as he has a great risk of developing TB
Commence at least three antivirals
Wait until he has aids and then give antivirals
Immunotherapy with an HIV vaccine
A 28 year old man presents with a 3 week history of swallowing difficulties. He has white plaques on the roof of his mouth and down his throat
He is found to be HIV positive, the candida is treated with fluconazole. His further treatment should be
Answer explained
Beetroot
Immunise with BCG as he has a great risk of developing TB
Commence at least three antivirals- correct answer
Wait until he has aids and then give antivirals
Immunotherapy with an HIV vaccine
When taking blood from a man who is HIV positive you stab yourself with a needle. What do you do?
Phone the on-call occupational health doctor
Call the registrar
Wash the wound and encourage bleeding
Phone my mbchb office
When taking blood from a man who is HIV positive you stab yourself with a needle. What do you do?
Answer explained
Phone the on-call occupational health doctor
Call the registrar
Wash the wound and encourage bleeding
Phone my mbchb office
When taking blood from a man who is HIV positive you stab yourself with a needle. What do you do?
Answer explained
Phone the on-call occupational health doctor
Call the registrar
Wash the wound and encourage bleeding
Phone my mbchb office
What infection has the highest risk of BBV transmission?
HIV risk is the highest
Hep C
Hep B
What infection has the highest risk of BBV transmission?
Unsure ask the boys/tutor)
HIV risk is the highest
Hep C
Hep B
What is the commonest cause of bacterial infective diorrhoea in Britain?
Salmonella
E.coli 0157
Camplyobacter
Entamoeba histolytics
What is the commonest cause of bacterial infective diarrhoea in Britain?
(answers explained)
Salmonella
E.coli 0157
Camplyobacter- jus tis, learn it
Entamoeba histolytics
a 27 year old woman presents with a history of a 6 week dry cough, weight loss and fevers. 3 months after returning from working in a bolivian orphanage
What is the most liekly diagnosis?
Answer explained
Pulmonary TB
How do you confirm a diagnosis for TB
Answer explained
Ziehl Neelson (ZN) stain/ Auramine stain
How do you treat someone with TB?
Rifampicin- 4 for two months then 2 for four months
Isoniazid- 4 for two months then 2 for four months
Pyrazinamide 4 for two months
Ethambutol 4 for two months
50 y/o male returns from Spain, smoker. cough 2 weeks, dyspnoea, sputum, diarrhoea
HR 120, BP100/50, RR30 T-38.5 Cyanosed Dehydrated Bilateral basal consolidation WCC-15, Na 115, ALT 300, CRP 300
What is the most likely causative organism?
Influenza A E. coli Strep pneumoniae Mycoplasma Legionella
50 y/o male returns from Spain, smoker. cough 2 weeks, dyspnoea, sputum, diarrhoea
HR 120, BP100/50, RR30 T-38.5 Cyanosed Dehydrated Bilateral basal consolidation WCC-15, Na 115, ALT 300, CRP 300
What is the most likely causative organism?
Answer explained (no idea)
Influenza A E. coli Strep pneumoniae Mycoplasma Legionella
50 y/o male returns from Spain, smoker. cough 2 weeks, dyspnoea, sputum, diarrhoea
HR 120, BP100/50, RR30 T-38.5 Cyanosed Dehydrated Bilateral basal consolidation WCC-15, Na 115, ALT 300, CRP 300
How do you diagnose the causative organism?
Blood culture
Serology
Sputum culture
Urinary antigen
50 y/o male returns from Spain, smoker. cough 2 weeks, dyspnoea, sputum, diarrhoea
HR 120, BP100/50, RR30 T-38.5 Cyanosed Dehydrated Bilateral basal consolidation WCC-15, Na 115, ALT 300, CRP 300
How do you diagnose the causative organism?
Blood culture
Serology
Sputum culture- seems sensible, not sure
Urinary antigen
5 year old farmer’s daughter, history developed diarrhoea, worsened 2 days ago. Blood PR for 24 hours. Abdo pain. Reduced urine output, HR-84, BP150/95, Temperature 36.5, tender abdomen
Low heamoglobin Raised white blood cells Low platelets High urea High creatine
What is the most likely infecting organism?
Campylobacter
Shigella dysentry
Cryptosporidium
E.coli 0157
5 year old farmer’s daughter, history developed diarrhoea, worsened 2 days ago. Blood PR for 24 hours. Abdo pain. Reduced urine output, HR-84, BP150/95, Temperature 36.5, tender abdomen
Low heamoglobin Raised white blood cells Low platelets High urea High creatine
What is the most likely infecting organism?
(answer explained)
Campylobacter
Shigella dysentry
Cryptosporidium
E.coli 0157- causes abdominal pain, bloody diarrhoea, fever, seizures, lethargy, thrombocytopenia, renal failure, microanglopathic hemolytic anemia.
What antibiotics do you give for e. coli 0157 infection?
answer explained
None, not indicated
28 year old oil worker returns from a month working offshore in Nigeria. He is febrile, vomiting unwell. Most important investigation is?
CXR Blood cultures Stool microspoy and culture for typhoid Malaria film +- antigen test Urgent HIV test
28 year old oil worker returns from a month working offshore in Nigeria. He is febrile, vomiting unwell. Most important investigation is?
(answers explained)
CXR Blood cultures Stool microscopy and culture for typhoid Malaria film +- antigen test- important as malaria can be serious if missed. Urgent HIV test
28 year old oil worker returns from a month working offshore in Nigeria. He is febrile, vomiting unwell. Blood film confirms plasmodium falciparm with a parasitaemia of 6%
Artemether/lemefantrine (ACT) Intravenous Artesunate Intravenous Ciprofloxacin Oral quinine unless parasitaemia increases Chloroquine IV or orally if tolerated
28 year old oil worker returns from a month working offshore in Nigeria. He is febrile, vomiting unwell. Blood film confirms plasmodium falciparm with a parasitaemia of 6%
Artemether/lemefantrine (ACT)
Intravenous Artesunate- indicated for complicated plasmodium falciparum
Intravenous Ciprofloxacin
Oral quinine unless parasitaemia increases- for unsevere infection
Chloroquine IV or orally if tolerated
47 year old lady with a background of mild asthma presents to hospital with 5 day history of coryzal symptoms. Followed by fever, productive cough and shortness of breath. She was alert and orientated on examinantion O2 sats 90%, 38.5, 110/60, 110bpm, RR32, WCC 31.9, Urea 8, CRp 344
What is the CURB 65 scoring system and therefore what is her score?
(answers explained)
C- confusion
U- urea above 7mmol
R- respiratory rate >30
B- Bp <91 diastolic or <61 systolic
3- treat as severe
47 year old lady with a background of mild asthma presents to hospital with 5 day history of coryzal symptoms. Followed by fever, productive cough and shortness of breath. She was alert and orientated on examinantion O2 sats 90%, 38.5, 110/60, 110bpm, RR32, WCC 31.9, Urea 8, CRp 344
Most likely causative organism?
(answers explained
)
Streptococcus pneumoniae
47 year old lady with a background of mild asthma presents to hospital with 5 day history of coryzal symptoms. Followed by fever, productive cough and shortness of breath. She was alert and orientated on examination O2 sats 90%, 38.5, 110/60, 110bpm, RR32, WCC 31.9, Urea 8, CRp 344
What antibiotics should be started
(answers explained) (not sure ask the boys)
yes
40 year ol dman with a background hisotry of alcohol excess was admiitedd to hospital with 3 month histry of weight loss, non productive cough and SOB. Travels infrequently with work. Chest auscultation reveals basal , sats were 92% on air. Bloods -3.9 WCC, platelets 100, CRP 23
What investigations would you do
(answers expaliend
bronchoalveolar lavage/ induced sputum for microsopy and culture AAFB and cultures Viral PCR PJP PCR fUNGAL cULTURES HRCT
