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MBChB 3 > CLASP Sepsis > Flashcards

CLASP Sepsis Flashcards

1
Q

Describe gram negative

A

Pink with thin wall

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2
Q

Describe gram positive

A

Purple with thick wall

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3
Q

What organism is associated with heart valves in infective endocarditis?

A

Strep Viridans

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4
Q

Where is Strep Viridans usually found?

A

GI tract

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5
Q

What criteria is used to assess infective endocarditis?

A

Duke Criteria

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6
Q

What kind of haemolytic does Enterococcus Faecalis show?

A

Non-Haemolysis

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7
Q

What organisms are in the major criteria for diagnosing endocarditis?

A

Enterococcus faecalis, Strep Viridans, HAECK group, Staph Aureus

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8
Q

Is this patient septic ?

*72 year old patient, 2 weeks following a total hip replacement .On a proton pump inhibitor. Co-amoxyclav prophylaxis for their surgery.
*They have profuse green diarrhoea
*BP 90/60 , pulse 130, RR 30, confused
*Oxygen saturation 97% in room air
*Acute kidney injury ( creatinine double patient’s usual value)

A

Yes

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9
Q

Is this patient in septic shock ?

*72 year old patient, 2 weeks following a total hip replacement .On a proton pump inhibitor. Co-amoxyclav prophylaxis for their surgery. They have profuse diarrhoea.
*Profuse green diarrhoea
*BP 90/60 , pulse 130, RR 30, confused
*Oxygen saturation 97% in room air
*Acute kidney injury ( creatinine double patient’s usual value)

A

No

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10
Q

What is the most likely pathogen ?

*72 year old patient, 2 weeks following a total hip replacement .On a proton pump inhibitor. Co-amoxyclav prophylaxis for their surgery.
*10 (type 7) bowel motions per hour
*BP 90/60 , pulse 130, RR 30, confused
*Oxygen saturation 97% in room air
*Acute kidney injury ( creatinine double patient’s usual value)

A

Clostridium Difficile

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11
Q

How do you test for C Diff in Tayside?

A

Stool Toxin Test

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12
Q

What are risk factors for C Diff?

A
  • immunosuppression
  • hospitalisation
  • abx in past 3 months
  • PPI
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13
Q

What is the most likely pathogen?

*28 year old patient, 2 days after a visit to a petting zoo followed by a barbecue . She has a fever of 39 and new bloody diarrhoea
*No prior medical history
*BP 80/60 , pulse 130, RR 24, sats 97%
*She has acute kidney injury
Her blood pressure remains 80/60 despite adequate intravenous fluid

A

E Coli

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14
Q

What antibiotics would you give as part of Sepsis 6 ?

*28 year old patient, 2 days after a visit to a petting zoo followed by a barbecue . She has a fever of 39 and new bloody diarrhoea
*No prior medical history
*BP 80/60 , pulse 130, RR 24, sats 97%
*She has acute kidney injury
*Her blood pressure remains 80/60 despite adequate intravenous fluid

A

Avoid abx - HUS is a complication

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15
Q

What other samples would you send to the laboratory as part of Sepsis 6 ?

*28 year old patient, 2 days after a visit to a petting zoo followed by a barbecue . She has a fever of 39 and new bloody diarrhoea
*No prior medical history
*BP 80/60 , pulse 130, RR 24, sats 97%
*She has acute kidney injury
*Her blood pressure remains 80/60 despite adequate intravenous fluid
*Blood cultures have been sent

A

Stool cultures

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16
Q

What associated complication may occur and increase mortality in this condition

*28 year old patient, 2 days after a visit to a petting zoo followed by a barbecue . She has a fever of 39 and new bloody diarrhoea
*No prior medical history
*BP 80/60 , pulse 130, RR 24, sats 97%
*She has acute kidney injury
*Her blood pressure remains 80/60 despite adequate intravenous fluid
*

A

Haemolytic Uraemic Syndrome

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17
Q

What are the gram characteristics of the infecting organism

*28 year old patient, 2 days after a visit to a petting zoo followed by a barbecue . She has a fever of 39 and new bloody diarrhoea
*No prior medical history
*BP 80/60 , pulse 130, RR 24, sats 97%
*She has acute kidney injury
*Her blood pressure remains 80/60 despite adequate intravenous fluid

A

E Coli = gram negative rod/bacillus

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18
Q

Which of these is the likely responsible gram positive organism ?

*22 year old patient, No prior medical history
*Protracted vomiting and nausea a few hours after eating reheated rice
*BP 110/60 , pulse 90, RR 16, sats 97%
*She is unable to maintain oral intake

A

Bacillus Cereus

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19
Q

What antibiotic would you use?

*22 year old student, No prior medical history
*Protracted vomiting and nausea a few hours after eating reheated rice
*BP 110/60 , pulse 90, RR 16, sats 97%, her temperature is 37.5 C
*He is unable to maintain oral intake
*White cell count is normal as is renal function.

A

Supportive management only - vitals look fine.

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20
Q

What antibiotic has no activity against anaerobes?

A

Gentamicin

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21
Q

What antibiotic is active against gram positive only?

A

Vancomycin

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22
Q

What antibiotic is active against gram negative only?

A

Gentamicin

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23
Q

Give examples of quinolones

A

Levofloxacin, Moxifloxacin, Ciprofloxacin

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24
Q

What antibiotic is safe to use in penicillin type 1 allergy?

A

Aztreonam

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25
what pathogen is the most likely to cause all these symptoms? *Mark is admitted to hospital with fevers, a swollen thigh , a discharging right groin wound and a cough over the preceding 2 days. He last injected heroin in to his thigh . He always uses the needle exchange * He has a fever of 39 C , he has a blood pressure of 90/60 , his pulse is 130 beats per minute . He is confused but has no focal neurology. His respiratory rate is 28. *He has a newly raised creatinine
Staph Aureus
26
PWID , fever of 39 C , he has a blood pressure of 90/60 , his pulse is 130 beats per minute . He is confused but has no focal neurology. His respiratory rate is 28. Is this sepsis?
Yes
27
How many blood cultures are required before antibiotics are given?
3 sets over an hour
28
What is the next test you would like to request ? *Mark is admitted to hospital with fevers, a swollen thigh , a discharging right groin wound and a cough over the preceding 2 days. He last injected heroin in to his thigh . He always uses the needle exchange * He has a fever of 39 C , he has a blood pressure of 90/60 , his pulse is 130 beats per minute . He is confused but has no focal neurology. His respiratory rate is 28. *He has a newly raised creatinine
Echocardiography
29
What covers staph aureus in a penicillin allergy?
Doxycycline
30
What is the duration of abx in severe staph aureus infection cellulitis in a PWID?
6 weeks
31
What are screening tests for Sepsis?
SIRS, SOFA, QSOFA, SEWS, NEWS, NICE
32
What time frame should sepsis 6 be delivered in?
1 hour
33
How much 0.9% saline IV should be given initially to septic patients?
500ml bolus
34
What is the mortality of septic shock?
>40%
35
What are the most likely pathogens in sepsis caused by a diverticular abscess?
Coliforms and anaerobes
36
What is the best empiric antimicrobial cover for sepsis caused by a diverticular abscess?
Amoxicillin, gentamicin and metronidazole
37
What is the best oral abx to switch to following source control (drainage) of sepsis caused by a diverticular abscess?
Co-trimoxazole and metronidazole
38
What is the best abx for MRSA blood stream infection?
IV Vancomycin
39
What is the best abx for methicillin sensitive staph aureus blood stream infection?
IV flucloxacillin
40
What is the most reliably active abx in extended spectrum beta lactamase producing coliform in blood?
IV meropenem
41
What organism is gram positive clusters that grows in golden colonies?
Staph Aureus
42
Is staph aureus coagulase positive or negative?
Positive
43
Define colonisation
Presence of a microbe in the body without inflammatory response
44
Name different methods of sensitivity testing
Disc diffusion, E test and Vitek
45
Is an infection more likely to be bacterial, viral or fungal if the CRP is raised?
Bacterial (viral/fungal is lower)
46
Define pre-test probability
The likelihood of the patient having a diagnosis prior to the test
47
Define post-test probability
The likelihood of the patient having a diagnosis once the test result is available
48
Define sensitivity
The probability a test is positive if the disease is present (TP/TP+FN)
49
Define specificity
The probability a test is negative if the disease is absent (TN/FP+TN)
50
What organism is associated with CAP in alcoholics?
Klebsiella Pneumonia
51
What organism is associated with CAP in COPD?
Haemophilus influenza
52
What organism is associated with CAP in exposure to farm animals?
Coxiella burnetti
53
What organism is associated with CAP in early HIV?
H. influenza, M. tuberculosis, S. pneumoniae
54
What organism is associated with CAP in late HIV?
Aspergillus, Pneumocystis jiroveci
55
What organism is associated with CAP in recent cruise/hotel/travel?
Legionella
56
What organism is associated with CAP in IVDU?
Staph aureus
57
Treatment of malaria?
Artesunate, Quinine
58
What NEWS score would cause you to think sepsis?
>5
59
What parameters are used to define septic shock?
Sepsis with hypotension despite fluid resus and vasopressors, plus lactate >2
60
Describe sepsis 6 protocol
1. give high flow O2 2. take blood cultures 3. give IV abx 4. give fluid challenge 5. measure lactate 6. measure urine output (aim for 0.5ml/kg/hr)
61
What does a high lactate indicate in sepsis?
Hypoperfusion
62
What are the 4Cs of C Diff?
Co-amoxiclav, cephalosporins, clindamycin, ciprofloxacin
63
Penicillin side effects
allergy, skin reactions
64
Flucloxacillin/Co-amoxiclav side effects
Cholestatic jaundice
65
Macrolide side effects
GI disturbance, hepatitis, longer QT
66
Quinolones side effects
longer QT, convulsions, tendonitis
67
Gentamicin side effects
nephrotoxicity/ototoxicity
68
Vancomycin side effects
Red man syndrome
69
Tetracyclines side effects
Photosensitivity, hepatotoxicity
70
Nitrofurantoin side effects
Peripheral neuropathy, pulmonary fibrosis
71
Co-trimoxazole side effects
Stevens-Johnson syndrome
72
Trimethoprim side effects
Blood dyscrasias
73
Choramphenicol side effects
Aplastic anaemia
74
Which antibiotic is an enzyme inducer?
Rifampicin
75
What reduces absorption of tetracyclines and quinolones?
Antacids, calcium
76
What abx should be avoided when drinking alcohol?
Metronidazole
77
What abx have anti-toxin effects?
Linezolid and Clindamycin

MBChB 3 (3 decks)

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