7 clinical scenarios Flashcards
1
Q
what are the 7 clinical scenarios?
A
- UTI
- Skin and Soft Tissue Infections (SSTIs)
- URTI and LRTI
- Red eye
- GI
- Meningitis
- STD
2
Q
what are Lower tract UTI symptoms
A
frequency, urgency, dysuria (painful urination), small volumes, lower abdominal pain
3
Q
what are Upper tract UTI symptoms
A
pyelonephritis with flank pain, high fever, sepsis
4
Q
what is the Empirical treatment for UTIs?
A
Co-amoxyclav (Augmentin) & cephalexin
5
Q
what organisms can cause UTI in a 24 year old woman for the first time?
A
Escherichia coli
Staphylococcus Saprophyticus
6
Q
E. coli morphology and lab test results
A
Gram negative rods, facultatively anaerobic, lactose-fermenting
normal GIT commensal bacteria (spread over from anus)
7
Q
what is the treatment for E. coli in a 24 year old woman for the first time
A
cephalexin
8
Q
Staphylococcus Saprophyticus morphology and lab test results
A
Gram positive cocci, facultatively anaerobic, catalase positive
Coagulase negative staphylococci (CNS)
9
Q
who is more prone to get Staphylococcus Saprophyticus?
A
sexually active young women, during reproductive years
10
Q
what is the treatment for Staphylococcus Saprophyticus in in a 24 year old woman for the first time
A
empirical treatment: cephalexin
if recurrent: co-trimoxazole
methicillin-resistant S. saprophyticus: vancomycin
11
Q
what organisms can cause UTI in a male baby
A
Escherichia coli
12
Q
what is the treatment for E. coli in a male baby
A
IV Gentamicin and oral cephalexin
13
Q
complications of E. coli
A
E. coli diarrheal disease
14
Q
what organisms can cause UTI in a male adult
A
if male adult has UTI, they are likely already immunocompromised
Hence, more susceptible to Proteus and Klebsiella
15
Q
Proteus morphology and lab test results
A
Gram-negative coliforms
Non-lactose fermenting
Urease positive
16
Q
Klebsiella morphology and lab test results
A
Gram-negative coliforms
Lactose-fermenting
Part of normal colonic flora but cause UTI
17
Q
what is the treatment for proteus or klebsiella in a male adult
A
co-trimoxazole or ciprofloxacin
18
Q
complications of Klebsiella
A
Severe form of pneumonia with abscess formation: Freidlander’s pneumonia
19
Q
what organisms can cause severe UTI or pyelonephritis
A
E. coli
Proteus
Klebsiella
Enterococci
20
Q
Enterococci morphology and lab test results
A
Gram-positive rod, Lancefield Group D cocci
21
Q
what is the treatment for severe UTI or pyelonephritis
A
IV: gentamicin and co-amoxyclav
22
Q
complications of enterococci
A
Endocarditis
23
Q
what organisms can cause post treatment recurrence or hospital acquired infection with catheter
A
E. coli
Proteus
Klebsiella
Enterococci
Enterobacter
Pseudomonas aeruginosa (PAE)
24
Q
PAE morphology and lab test results
A
Gram-negative rod, facultatively aerobic
Non lactose-fermenting
25
what is the treatment for hospital acquired or catheter UTI
Cefepime (anti-psuedomonal) +amikacin
26
complications of PAE
Septicaemia
27
why are males more unlikely to get UTIs than females
males have a longer urethra than females
28
investigations for UTIs
Urine microscopy and culture
29
main organisms that cause SSTIs
Staphylococcus aureus (has obvious wound)
Streptococcus pyogenes (no obvious wound)
30
staphylococcus aureus morphology and lab test results
Gram positive cocci, typically seen in clusters
Catalase & coagulation positive
31
Streptococcus pyogenes morphology and lab test results
Gram positive
β-haemolytic
Catalase negative
Group A streptococcus
32
what does staphylococcus aureus cause
Boils, carbuncles
HAI wound (definitely caused by MRSA)
33
what treatment for staphylococcus aureus
Incision and drainage of boils and carbuncles first
Cloxacillin
For penicillin allergic patients: Erythromycin
If MRSA → vancomycin
If HAI wound that is bowel associated: Vancomycin and add on Pip-tazo
34
complications of staphylococcus aureus
Toxic shock syndrome toxin-1(TSST-1)
Endocarditis
Osteomyelitis
35
what does Streptococcus pyogenes cause
leg cellulitis with no wound
36
complications of streptococcus pyogenes
scarlet fever
acute glomerulonephritis
37
what treatment for streptococcus pyogenes
IV benzylpenicillin (penicillin G)
38
what causes SSTI with water
S. aureus (most common)
Strep. Pyogenes (more common)
Pseudomonas aeruginosa (PAE)
Vibrio vulnificus
Aeromonas
39
Vibrio vulnificus morphology and lab test results
Gram negative, curved rods
40
Aeromonas morphology and lab test results
Gram-negative, facultative anaerobic rod
41
SSTI with water treatment
Aggressive wound debreidement/amputation
Empirical treatment: combination of
IV ciprofloxacin: quinolones
AND
IV cloxacillin: targets mainly Streptococcus & Staphylococcus
For gram negative bacteria (Pseudomonas aeruginosa (PAE), Vibrio vulnificus, Aeromonas):
Ceftazidime
42
Vibrio vulnificus complications
oedema, erythema & life-threatening necrosis
43
what organisms cause Diabetic foot ulcer
Mixed organisms (Gram positives plus Gram negatives infect together)
44
treatment for diabetic foot ulcer
Debridement
IV co-amoxyclav AND Metronidazole
45
what organisms cause necrotising fasciitis
Staphylococcus aureus
Streptococcus pyogenes
Synergistic infections (complex mixture of bacteria usually including anaerobes)
Vibrio vulnificus
46
how to treat necrotising fasciitis
Debridement +
cloxacillin +
benzylpenicillin +
clindamycin +
IVIG (IV immune globulin)
47
what organisms cause Necrotising fasciitis with water exposure
Staphylococcus aureus
Streptococcus pyogenes
Vibrio vulnificus
Aeromonas
48
what treats necrotising fasciitis with water
Debridement +
cefazolin +
ciprofloxacin
49
what organisms cause gas gangrene
Clostridium perfringens
50
Clostridium perfringens morphology
Sporing gram positive rods, obligate anaerobes
51
how to treat gas gangrene
Debridement+
benzylpenicillin +
clindamycin
52
what organism can cause a black lesion on a farm animal worker
Bacillus anthracis
53
Bacillus anthracis morphology
Large gram positive rods with spores & grow aerobically
54
how to treat bacillus anthracis
Ciprofloxacin + Benzylpenicillin
55
what organism can cause a red lesion with pus after an animal bite
Pasteurella
56
pasteurella morphology and lab test results
Gram-negative, facultatively anaerobic bacteria
Catalase & oxidase-positive
57
how to treat pasteurella
incision and drainage
58
investigations for SSTIs
Sample microscopy, culture & susceptibility test
59
what organisms cause acute pharyngitis
Viruses
Streptococcal pyogenes
60
what investigations for acute pharyngitis
Culture test for Group A Streptococcal
Respiratory viruses: rapid antigen detection
61
how to treat acute pharyngitis
Virus: NIL
Oral penicillin V for S. pyogenes
62
what organisms cause acute epiglottitis
-Haemophilus influenza
-Streptococcal pneumoniae
63
streptococcal pneumoniae morphology
Commensal throat flora: gram positive cocci, α-hemolytic,
64
Haemophilus influenza morphology
Gram-negative rods, some capsulated
65
investigations for acute epiglottitis
Blood culture
66
how to treat acute epiglottitis
IV ceftriaxone
67
what organisms cause community acquired typical pneumonia
Streptococcal pneumoniae
Haemophilus influenza
Moraxhella catarrhalis
68
how to treat community acquired typical pneumonia
penicillin or augmentin
Levofloxacin if allergic to penicillin
69
what organisms cause community acquired atypical pneumonia
Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella
70
how to treat community acquired atypical pneumonia
tetracycline
For Legionella: tetracycline + macrolide (azithromycin or erythromycin)
71
what virus causes community acquired pneumonia and how to treat it
Influenza virus
Treat with Oseltamivir (Tamiflu)
72
what causes hospital acquired pneumonia
PAE
MRSA
Gram negatives (Buckholderia pseudomallai, Klebsellia pneumoniae)
73
how to treat hospital acquired pneumonia
PAE: piptazo
MRSA: Vancomycin and tetracycline
Gram negatives: Gentamicin
74
what organisms cause conjunctivitis
Adenovirus
Strep. Pneumoniae
H. influenzae
75
how to treat conjunctivitis
Bacteria:Fluoroquinolone + Chloramphenicol + Fusidic acid
Adenovirus: NIL
76
what organism causes dendritic ulcer
what organism causes local zoster
dendritic ulcer: herpes simplex virus 1
Local zoster: varicella zoster virus
77
how to test for dendritic ulcer and local zoster
fluorescent stain
78
how to treat dendritic ulcer and local zoster
Acyclovir
79
what organism can cause red eye in a soft contact lens user
Pseudomonas aeruginosa (PAE)
80
how to investigate red eye in soft contact lens user
Corneal scrape for microscopy, culture & susceptibility test
81
how to treat red eye in soft contact lens user
Ciprofloxacin + gentamicin
82
complication of PAE in soft contact lens user
Pseudomonas keratitis: small corneal ulcer -> rapidly penetrate -> perforate cornea -> blindness
83
what organism can cause red eye in someone who swims with contact lenses
Acanthamoeba (causes occular pain)
84
how to treat red eye in someone who swims with contact lenses
corneal graft
85
what can cause Red eye with trauma
PAE
Bacillus cereus
Aspergillus
Candida
86
what can cause red eye in neonate (day 1-3)
Neisseria gonorrhoeae
87
Neisseria gonorrhoeae morphology
Gram -ve cocci, oxidase +ve, transport in charcoal medium, grow on chocolate agar
88
how to investigate red eye in neonate (day 1-3)
Smear or culture
Urine PCR for gonorrhoeae & chlamydia
89
how to treat red eye in neonate (day 1-3)
Ceftriaxone
90
what can cause red eye in neonate (day 3-10)
Chlamydia trachomatis
91
how to investigate red eye in neonate (day 3-10)
PCR for Chlamydia trachomatis
92
how to treat red eye in neonate (day 3-10)
erythromycin
93
what organisms can cause diarrhoea in children
rotavirus
94
how to manage and prevent rotavirus infection
management: oral rehydration
prevention: oral live attenuated vaccines (Rotateq and Rotarix)
once infected once, lifelong immunity
95
what can cause food related diarrhoea and vomiting
Milk: Staphylococcus aureus
Uncooked meat: Salmonella, Campylobacter
Water: Shigella
Fried rice: Bacillus cereus
Seafood: Norovirus
96
how to treat food related diarrhoea and vomiting
Staphylococcus aureus: NIL
Salmonella: Ceftriaxone
Campylobacter: Oral rehydration therapy, erythromycin or ciprofloxacin if severe
Shigella
Bacillus cereus: ciprofloxacin or azithromycin
Norovirus: Oral rehydration therapy
97
what can cause travel related diarrhoea and vomiting
E. coli
Two types:
Enteropathogenic (EPEC): in developing countries Enterotoxic (ETEC): toxin-producing, traveller’s diarrhoea
Vibrio cholerae
98
how to treat travel related diarrhoea and vomiting
E. coli: Ciprofloxacin
Vibrio cholerae: Doxicycline
99
what causes Bloody diarrhoea with HUS (hemolytic uremic syndrome)
Enterohaemorrhagic E. coli (EHEC)
100
what causes sudden explosive watery diarrhoea with bulky, frothy, greasy, foul-smelling stools
Giardia
101
how to treat giardia
Metranidazole
102
what causes antibiotic related diarrhea
Clostridium difficule
103
how to treat antibiotic related diarrhea
vancomycin
104
investigations for GI organisms
stool culture
105
what causes neonate to look blueish and lethargic + fever
Streptococcal agalactiae (infection from mother's birth canal)
E. coli
Listeria monocytogenes
106
how to treat neonate looking blueish and lethargic + fever
Ceftriaxone +
Penicillin +
Gentamycin
107
what causes infant looking blueish and lethargic + fever
Neisseria meningitidis (is life threatening)
H. influenzae
Strep. pneumoniae
108
how to treat infant looking blueish and lethargic + fever
ceftriaxone + vancomycin
IF confirmed Nesseria meningitidis, ceftriaxone + vancomycin + IV penicillin
109
how to test for acute meningitis and what are the expected results
CSF culture
High CSF WBC (in 1000s), Low CSF glucose
110
what causes acute meningitis in adults
Strep. pneumoniae
Neisseria meningitides
111
how to treat acute meningitis in adults
ceftriaxone + vancomycin
IF confirmed Nesseria meningitidis, ceftriaxone + vancomycin + IV penicillin
112
if CSF findings are CSF WBC (in 100s), Normal CSF glucose, what is causing it
Enterovirus
113
if CSF findings are high protein, low glucose, WBC in 100s, and patient has had a headache for 5 days, what is causing it
M. tuberculosis
114
how to treat m. tuberculosis
RIPE (rifampicin, isoniazid, pyrazinamide, ethambutol)
115
what causes blisters on genitals
Herpes Simplex Virus 2(most common)
Primary syphilis (Treponema pallidum)
116
how to investigate blisters on genitals
Swab wet blister/puncture blister to swab contents -> PCR (most sensitive)
117
how to treat genital blisters
For HSV2: oral acyclovir
For primary syphilis: IM benzylpenicillin
118
what causes Dysuria & urgency, thin discharge
Chlamydia trachomatis: commonest STD in SG
Mycoplasma genitalium
119
how to test for chlamydia
Morning urine PCR
120
how to treat Chlamydia trachomatis, Mycoplasma genitalium
Oral doxycycline + Oral azithromycin
121
complications of Chlamydia trachomatis
conjunctivitis
122
what causes Purulent urethral discharge
Nesseria gonorrhoea
123
how to treat nesseria gonorrhea
Ceftriaxone AND Azithromycin
124
what causes cheesy vaginal discharge + pruritus
Candida albicans yeast
125
how to treat candida albicans yeast
topical clotrimazole AND Systemic amphotericin B
126
what causes foul smelling vaginal discharge
Bacterial vaginosis
127
how to treat bacterial vaginosis
Oral metronidazole
128
what causes Copious, foamy, purulent, frothy, yellow-greenish vaginal discharge
Trichomonas vaginalis
129
how to treat Trichomonas vaginalis
Oral metronidazole
130
what causes genital warts
HPV
131
how to treat genital warts
Topical Podophyllotoxin
