Acute medicine and infectious diseases Flashcards

Question

describe asymptomatic bacteruria and UTIs in pregnancy

Answer 1

asymptomatic bacteruria; risk factor for pyelonephritis and premature labour UTIs; associated with developmental delay, cerebral palsy, foetal death treat after confirming with 2nd sample to exclude contamination

Answer 2

nitrofurantoin 100mg 6hrly PO with food or pivmecillinam 400mg PO loading dose, then 200mg PO 8hrly female 3 days, male 7 days

Answer 3

gentamicin 5mg/kg 24hrly IV or piperacillin-tazobactam 4.5mg 8hrly IV 7-10 days

Answer 4

piperacillin-tazobactam 4.5mg 8hrly IV + gentamicin 5mg/kg 24hrly IV

Answer 5

increasing fluid intake NSAIDs insufficient evidence for cranberry juice, herbal products, lactobacillus

Answer 6

haematogenous spread, direct contiguous spread, iatrogenic immune system activation cytokine production increased BBB permeability, altered cerebral blood flow, leukocyte adherence to capillary endothelium, increased reactive oxygen species changes in CSF flow and composition neuronal damage, increased ICP and cerebral oedema

Answer 7

``` fungal meningitis TB meningitis amoebic meningitis syphilis atypical infections in the immunocompromised vial meningitis/encephalitis inflammatory meningitis carcinomatous/lymphomatous meningitis SAH intracranial venous thrombosis tonsilitis ```

Answer 8

rash; neiserria meningiditis in adults, meningococcal meningitis in children children; kernig's sign, brudzinski's sign

Answer 9

``` bloods; FBC, U&E, creatinine, LFTs, coag procalcitonin meningococcal and pneumococcal PCR serology sample glucose throat swab; bacterial culture CSF; protein, glucose, lactate, meningococcal and pneumococcal PCR, microscopy, culture, sensitivity ```

Answer 10

``` signs of severe sepsis rapidly evolving rash respiratory/cardiac compromise anticoagulant therapy known thrombocytopenia infection at LP site focal neurological signs papilloedema continuous/uncontrolled seizures GCS <12 ```

Answer 11

``` accounts for 50-80% of total meningitis WCC and CRP often normal CSF used for PCR no treatment of proven benefit IV aciclovir; suspected HSV encephalitis, changes in personality, behaviour, cognition or altered conscious level ```

Answer 12

isolation until meningococcal disease excluded or 24hrs IV ceftriaxone antibiotic chemoprophylaxis for those exposed to respiratory secretions or droplets of meningococcal disease; during CPR or intubation

Answer 13

``` recent hospitalisation surgery vascular device IV drug use haemodialysis previous SAB ```

Answer 14

``` vascular device skin/soft tissue/wound septic arthritis osteomyelitis discitis endocarditis prosthesis infected DVT/septic thrombophlebitis pneumonia ```

Answer 15

minimum 2 weeks IV flucloxacillin

Answer 16

examine and investigate to find source source control; joint washout, remove IV device transthoracic echo (in all patients) repeat blood cultures 48-96hrs after starting IV antibiotics

Answer 17

``` fever chills poor appetite weight loss heart murmurs emboli to lung, spleen and brain ```

Answer 18

``` prosthetic valve native valve disease cardiac device male IV drug use recent dental procedure ```

Answer 19

``` streptococcus staph aureus coagulase negative staphylococci enterococcus HACEK ```

Answer 20

ampicillin 12g IV with flucloxacillin 12g IV with gentamicin 3mg/kg/day IV or vancomycin 30-60mg/kg/day IV with gentamicin 3mg/kg/day IV

Answer 21

any prosthetic valve previous episode of IE current CAD certain dental procedures (not all)

Answer 22

``` isolate in a side room urgent malaria investigation FBC, U&E, LFT, coagulation, CRP, glucose, blood cultures inform laboratory of possible VHF case blood cultures VHF screen ```

Answer 23

``` return from an exposed country fever headache myalgia abdominal pain tachycardia fever ```

Answer 24

IV artesunate IV meropenem; covered for fever stop if blood cultures return negative and patient improves improvement; switch to artemisinin-based combination therapy (ACT)

Answer 25

physical barriers; skin, mucous, GI and urinary tract flushing, normal microbiota innate immunity; phagocytes, complement system, NK cells adaptive immunity; B and T lymphocytes

Answer 26

tocilizumab and dexamethasone

Answer 27

tocilizumab; suppresses pyrexic response and CRP | dexamethasone; causes neutrophilia

Answer 28

``` weight loss exertional dyspnoea fever dry cough pleuritic chest pain immunosuppression ``` high dose co-trimoxazole 14 days

Answer 29

``` gradual onset time to respiratory failure 2 weeks to 2 months more PCP and less neutrophils less severe oxygen impairment diagnosis with clinical picture and PCR adjunctive corticosteroids in hypoxia high dose co-trimoxazole 21 days prophylaxis for CD4 <200 ```

Answer 30

time to respiratory failure 1 week less PCP and higher inflammatory markers in BAL suggests severe or dysregulated inflammatory response diagnosis more difficult; fewer organisms, upper respiratory samples frequently negative consider use of beta D glucan high dose co-trimoxazole 134 days

Answer 31

HIV infects CD4+ T cells normal CD4 count; evidence of immune dysregulation heavily immunocompromised once CD4 <200

Answer 32

IRIS occurs in patients with AIDS; CD4 <100mm3 preexisting infectious process that worsens paradoxically after initiation of highly active antiretroviral therapy

Answer 33

``` already in sepsis; altered conscious level or hypoxia; <94% or shock; SBP <90 ```

Answer 34

assume in all haematology/oncology patients within 6/52 SACT observations; temp, HR, BP, O2, AVPU commence NEWS IV access and blood; cultures, FBC, U&E, CRP, LFTs, venous lactate treatment; 1st line antibiotics immediately, consider need for IVF and supplemental O2 commence neutropenic sepsis care pathway

Answer 35

piperacillin 4g and tazobactam 500mg IV QDS or ciprofloxacin 600mg slow IV BD, gentamicin 5mg/kg IV BD after line flush and teicoplanin 10mk/kg IV (BC x 3 then OD)

Answer 36

HSV; acyclovir 400mg PO BD CMV; letemovir 280mg PO OD 100 days post-transplant PCP; co-trimozaxole once neutrophils and platelets recovered fungal; posaconazole, itraconazole, fluconazole

Answer 37

``` TB; CXR, IGRA (latent TB) hep B & C; HBsAg HIV VZV; VZV antibody test if they have no history of chickenpox leishmaniasis endemic mycoses ```

Answer 38

for those with HIV, <65 with evidence of latent TB and have been in contact with suspected/confirmed TB 3 months isoniazid and rifampicin or 6 months isoniazid

Answer 39

lower threshold for starting broad spectrum antibiotics only speak with team about potential for stopping/holding/decreasing dose of relevant drugs do not stop their anti-rejection transplant drugs hold any DMARDs for inflammatory conditions until infection resolved/resolving

Answer 40

inhibits bacterial growth | assumed to require phagocytic cells to definitely clear bacteria

Answer 41

kills bacteria preferred in serious infection and immunocompromsied e.g.; beta lactase, polymyxins, vancomycin, quinolone, rifampicin, chloramphenicol, aminoglycosides

Answer 42

flucloxacillin IV 2g QDS penicillin allergic alternative; vancomycin or clindamycin check weight, renal function and drug interactions before prescribing

Answer 43

look for; acute onset of illness life-threatening breathing/airway/circulation problems usually skin changes

Answer 44

IM adrenaline; 500mcg IV (>12yrs) IVF challenge; 500-1000ml stop IV colloid; may be the cause of anaphylaxis

Answer 45

allergy IgE mediated symptoms; urticaria, anaphylaxis

Answer 46

IgG and FC receptor mediated | symptoms; blood cell dyscrasia

Answer 47

IgG complement/FC receptor | symptoms; vasculitis

Answer 48

T-cell mediated | symptoms; eczema, exanthema, DRESS, TEN

Answer 49

severe; anaphylaxis, angioedema, urticarial rash, pruritus, wheezing/stridor usually within 1hr non-severe; maculopapular/morbilliform rash, serum sickness usually within 24hrs

Answer 50

no cultures back amoxicillin 1g 8hrly PO IV + clarithromycin 500mg 12hrly PO or doxycycline 100mg 12hrly PO

Answer 51

levofloxacin | alternative; in torsade de pointes, doxycycline

Answer 52

stop all drugs known to prolong the QT interval correct electrolyte abnormalities, especially hyperkalaemia magnesium sulphate 2g IV / 10mins adverse features; arrange immediate synchronised cardioversion pulseless; attempt defibrillation immediately stop levofloxacin; treatment with alternative (doxycycline)

Answer 53

antiarrhythmics antihistamines antipsychotics; haloperidol, chlorpromazine atypical antipsychotics; citalopram, zimelidine antibiotics; macrolides, fluoroquinolones, anti-malarials, pentamidine anti-emetics; ondansetron, domperidone

Answer 54

erythromycin clarithromycin azithromycin

Answer 55

ciprofloxacin levofloxacin moxifloxacin ofloxacin

Answer 56

``` tendon pain or swelling join pain swelling of the arms, shoulders, legs abnormal pain or sensations; pins and needles etc. weakness; in legs, arms, difficulty walking severe tiredness depressed mood anxiety problems with memory sleeping problems changes in vision, smell, taste, hearing ```

Answer 57

presence of hypotension, shock, ileus, toxic megacolon, colonic perforation

Answer 58

discontinue concomitant antibiotics stop any PPI treatment if unnecessary surgical review indicated vancomycin 500mg PO NG QDS + metronidazole 500mg IV TDS 10-14 days presence of ileus/NBM; intra-colonic vancomycin 500mg in 100ml NaCl 0.9% QDS + IV metronidazole 500mg TDS 10-14 days

Answer 59

``` clindamycin cephalosporins monobactams carbapenems fluoroquinolones penicillins tetracyclines ```

Answer 60

abrupt onset of severe sore throat with cervical lymphadenopathy or gradual onset of low-grade fever, malaise, arthralgia, myalgia acute, generalised maculopapular rash, non-itchy more intense and extensive cutaneous eruption appears in up to 90% 2-10 days after starting antibiotics

Answer 61

thorough drug allergy history antibiotic treatment within 1hr of diagnosis of severe sepsis or life-threatening infection comply with local antibiotic prescribing guidance document clinical indicate, dose and route include review/stop date obtain cultures prior to commencing therapy if possible but do not delay treatment

Answer 62

check microbiology; stop, IV to oral switch, change antibiotic, continue, OPAT document all decisions