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3MB Buzzwords > CLASP - sepsis (micro) > Flashcards

CLASP - sepsis (micro) Flashcards

1
Q

Tx for C.diff

A

1st: Oral vancomycin
2nd: Fidaxomicin
3rd: Oral vancyomycin +/- IV metronidazole
In life-threatening toxic megacolon, a subtotal colectomy may be required

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2
Q

T or F: alcohol-based hand rubs are not effective in removing C. difficile spores

A

True - use water and soap

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3
Q

Fever, rash, relative bradycardia and abdominal pain plus leukopaenia and raised transaminases in a returning traveller

A

Salmonella typhi

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4
Q

When is vaginal therapy indicated in a pregnant woman with HIV?

A

Viral load <50 at 36 weeks

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5
Q

Rapid onset vomiting after having home-made foods and dairy products + non-bloody diarrhoea

A

Staphylococcus aureus

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6
Q

Serious side effect of the use of penicillins?

A

Anaphylactic shock

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7
Q

Spectrum of activity of penicillin

A

Covers gram-positive (S. aureus, S. pneumoniae, S. viridans, ß-haemolytic Streptococci, Bacillus anthracis, Clostridium tetani); spectrum increased with ß-lactamase inhibition

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8
Q

Spectrum of activity of flucloxacillin

A

Penicillinase resistant

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9
Q

Spectrum of activity of amoxicillin

A

Similar to penicillin + gram-negative cover (E. coli, Brucella spp., H. influenzae)

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10
Q

Spectrum of activity of Glycopeptides

A

Gram-positive coverage (aerobic and anaerobic)

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11
Q

Spectrum of activity of Linezolid

A

Gram-positive infection (including MRSA)

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12
Q

Spectrum of activity of Aminoglycosides

A

Broad-spectrum gram-negative cover e.g. E. coli, P. aeruginosa

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13
Q

Spectrum of activity of Fluoroquinolones

A

Broad-spectrum antibiotic coverage

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14
Q

Spectrum of activity of Tetracyclines

A

Broad-spectrum gram-positive, gram-negative and intracellular cover; some gram-positive cocci resistance

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15
Q

Spectrum of activity of Macrolides

A

Similar to penicillins with cover for multiple causes of atypical pneumonia

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16
Q

Spectrum of activity of Metronidazole

A

Significant anaerobic cover and protozoan cover

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17
Q

Aerobic, haemolytic gram-positive bacillus

A

Listeria

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18
Q

Spore-forming, toxin-producing gram-positive bacillus; found in cattle and sheep

A

Bacillus anthracis

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19
Q

Toxin-producing gram-positive bacillus. Causes gastroenteritis. Found in re-heated takeaway food (typically rice); re-heating kills bacteria but not toxins

A

Bacillus cereus

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20
Q

Anaerobic, spore-forming gram-positive bacilli; typically found in soil and dust

A

Clostridium

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21
Q

Rod-shaped, a nonmotile, non-encapsulated obligate aerobe

A

Mycobacterium tuberculosis/bovis

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22
Q

Mechanism of trimethoprim?

A

Inhibits the folic acid synthesis pathway

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23
Q

Contraindication to the use of trimethoprim?

A

Pregnancy

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24
Q

Adverse effect of quinolone antibiotics?

A

C. difficile superinfection

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25
Q

Haematogenous osteomyelitis, causative agent likely to be..

A

Staphylococcus aureus

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26
Q

What does the following gram stain show?

A

Staphylococcus aureus/Staph epidermis if coag positive

Gram positive clusters

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27
Q

What is strep pneumonia?

A

Gram-positive, α-hemolytic, lancet-shaped diplococci

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28
Q

Blue-green pigment is noted on the agar plate

A

Pseudomonas aeruginosa

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29
Q

8 year old with sore throat and fever
Anterior cervical lymphadenopathy
Blood agar, which shows growth of colonies surrounded by a clear zone

A

Strep throat - Strep pyogens (GAS - beta haemolytic)

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30
Q

History of cystic fibrosis. Blood culture shows gram negative rods

A

Pseudomonas aeruginosa

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31
Q

Abx for Pseudomonas aeruginosa

A

Erythromycin

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32
Q

Gram positive coccus that generally exists in pairs, or in chains

A

Streptococcus pyogenes
Streptococcus pneumoniae

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33
Q

Gram negative diplococci

A

Neisseria meningitidis

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34
Q

Gram positive cocci in clusters

A

Staphylococcus aureus

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35
Q

Drug to give if penicillin allergic

A

Macrolides - Clarithromycin, zithromycin and erythromycin

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36
Q

Drug to give if penicillin resistant

A

Vancomycin

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37
Q

Gram negative bacilli/rods

A

Shigella spp
Salmonella spp
Escherichia coli
Vibrio cholerae

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38
Q
A

Gram negative bacilli/rods:

K. pneumonia/E- coli if lactase positive

H. pylori/V. cholerae/ P. aeruginose if lactase negative

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39
Q

Which condition is an absolute contraindication to treatment with nitrofurantoin?

A

G6PD

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40
Q

Gram negative curved/spiral bacillus

A

Vibrio cholerae
Campylobacter jejuni
H. pylori

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41
Q

Which lab test would be most useful to identify strep pyogenes?

A

Anti-streptolysion O

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42
Q

Which lab test would be most useful to identify strep pneumoniae?

A

Quellung reaction

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43
Q

Abx for Campylobacter

A

Clarithromycin

Alt. ciprofloxacin

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44
Q

Abx for Salmonella

A

Ciprofloxacin

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45
Q

Abx for Shigellosis

A

Ciprofloxacin

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46
Q

Ix for Clostridioides difficile

A

CDT in the stool

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47
Q

Tx for UTIs

A
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48
Q

Ix for legionella

A

Urinary antigen

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49
Q

Tx for legionella

A

Erythromycin/clarithromycin

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50
Q

Fever, myalgia and fatigue 1 week after returning from Kenya

Mild jaundice and splenomegaly

A

Malaria

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51
Q

What type of bacteria is Campylobacter?

A

Gram-negative bacillus

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52
Q

Causes skin infections (e.g. cellulitis), abscesses, osteomyelitis, toxic shock syndrome

A

Coagulase-positive Staphylococcus aureus

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53
Q

Cause of central line infections and infective endocarditis

A

Coagulase-negative Staphylococcus epidermidis

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54
Q

Gram positive cocci

A

Staphylococci + streptococci (including enterococci)

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55
Q

Gram-negative cocci

A

Neisseria meningitidis + Neisseria gonorrhoeae, also Moraxella catarrhalis

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56
Q

Gram-positive rods (bacilli)

A

ABCD L
Actinomyces
Bacillus anthracis (anthrax)
Clostridium
Diphtheria: Corynebacterium diphtheriae
Listeria monocytogenes

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57
Q

Gram-negative rods (bacilli)

A

Escherichia coli
Haemophilus influenzae
Pseudomonas aeruginosa
Salmonella sp.
Shigella sp.
Campylobacter jejuni

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58
Q

Alternative to PO metronidazole in BV?

A

Topical metronidazole/clindamycin

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59
Q

Milk, cheese and eggs

A

Salmonella Typhimurium/Entereditis

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60
Q

BBQs

A

Campylobacter jejuni

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61
Q

Reheated rice

A

Bacillus cereus

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62
Q

Contaminated milk products and foods contaminated through contact with food workers who carry the bacteria

Food that require no cooking, including puddings, pastries, sandwiches and sliced meat

A

Staph aureus

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63
Q

Red meat

A

Clostridium perfringens

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64
Q

Improperly cooked or cheap cuts of meat and petting zoos or farms

A

E. coli

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65
Q

Tx for gastroenteritis

A

Ciprofloxacin/azithromycin

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66
Q

CURB 65

A

Confusion +/-
Urea >7
Respiratory Rate >30
Blood pressure: systolic < 90 or diastolic <60
More than 65 years old

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67
Q

Mx if CURB 65 is 0/1

A

Home-based care, give oral amoxicillin for 5 days (macrolide e.g. clarithromycin, doxycycline or tetracycline if penicillin allergic)

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68
Q

Mx if CURB 65 is 2

A

Hospital-based care, 7-10 day course of dual antibiotic therapy with amoxicillin (IV or oral) and a macrolide

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69
Q

Mx if CURB 65 is 3

A

Hospital/ITU-based care, 7-10 day course of dual antibiotic therapy with IV co-amoxiclav/ceftriaxone/tazocin and a macrolide.

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70
Q

Mx if HAP within 5 days of admission

A

Co-amoxicillin or cephalosporin (e.g cefuroxime)

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71
Q

Mx if HAP 5 days after admission

A

Tazocin or cephalosporin (e.g. ceftazidime) or quinolone

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72
Q

_____ is characteristic of haemolytic anaemia, thrombocytopenia and acute renal failure

A

E. coli 0157

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73
Q

Most common bacterial organism implicated in infections affecting the urinary tract

A

E coli

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74
Q

ESBL enzyme means the bacteria has resistance to..

A

All penicillins, third-generation cephalosporins, plus monobactam (aztreonam) and beta-lactam

75
Q

_______ is the most common cause of travellers’ diarrhoea

A

E. coli

76
Q

What does the gram stain show?

A

Corynebacterium
Clostridium
Listeria
Bacillus

Gram positive bacilli

77
Q

What does the agar plate show?

A

Beta haemolysis: strep pyogens, GAS

78
Q

What does the agar plate show?

A

Alpha haemolysis: s. viridians/pneumonia

79
Q

What does the agar plate show?

A

Gamma haemolysis: Enterococcus faecalis (Group D Strep), staph epidermis

80
Q

Role of lab diagnosis

A
81
Q

What does the gram stain show?

A

N. gonorrhoea/meningitidis

Gram negative cocci

82
Q

What does the gram stain show?

A

H influenza
B pertussis
M catarrhalis

Gram negative coccobacilli

83
Q

Abx in non-neutropenic sepsis

A

IV Amoxicillin + Metronidazole + Gentamicin

84
Q

Abx in non-neutropenic sepsis if penicillin allergic

A

IV Vancomycin + Metronidazole + Gentamicin

85
Q

IV ________ is more effective than vancomycin in methicillin-sensitive staphylococcus aureus (MSSA)

A

Flucloxacillin

86
Q

What tests are done if suspecting endocarditis?

A

Refer to cardio for TTE
If negative/equivocal/ongoing suspicion then TOE

87
Q

How often are blood cultures repeated in endocarditis?

A

48 hours after starting IV abx and at 48 hour intervals until negative cultures

88
Q

Abx in maternal sepsis

A

IV co-amoxiclav +/- IV gentamicin

In allergic then clindamycin + gentamycin

89
Q

Abx in maternal septic shock

A

IV piperacillin tazobactam + IV clindamycin + IV gentamicin

If allergic then clindamycin + gentamycin

90
Q

Abx in sepsis/septic shock for IVOST/post-partum

A

PO co-amoxiclav

If allergic for IVOST antenatal then PO ceftixime + clindamycin

If allergic for IVOST postpartum then PO co-trimoxazole + metronidazole

91
Q

Tx for meningitis

A

If in the community then benzylpenicillin

If hospital then IV ceftriaxone followed by Dexamethasone

92
Q

Who should you NOT dipstick in?

A

> 65
Catheters

93
Q

Tx for orbital cellulitis

A

Admission to hospital for IV antibiotics

94
Q

Most common bacterial causes of orbital cellulitis

A

Streptococcus, Staphylococcus aureus
Haemophilus influenzae B

95
Q

Moost frequently causative organisms of preseptal cellulitis

A

Staph. aureus
Staph. epidermidis
Streptococci
Anaerobic bacteria

96
Q

Tx of preseptal cellulitis

A

Co-amoxiclav

97
Q

Tx of allergic conjunctivitis

A

First-line: topical or systemic antihistamines

Second-line: topical mast-cell stabilisers, e.g. Sodium cromoglicate and nedocromil

98
Q

Tx of infective conjunctivitis

A

Self limiting but if doesn’t resolve then:

Topical Chloramphenicol
If pregnant/alt: Topical fusidic acid
No contact lens (Ix: topical fluoresceins), sharing towels, can still go to school

99
Q

Tx for ophthalmic shingles

A

Aciclovir or valaciclovir + lubricating eye drops if lesions near eyelid

100
Q

Tx for dental abscess

A

Refere to dentist
Phenoxymethylpenicillin (clarithromycin is allergic)

101
Q

Tx for tonsillitis

A

Phenoxymethylpenicillin (erythromycin if the patient is penicillin allergic)

102
Q

Scoring systems for tonsillitis

A
103
Q

Most common causes of sinusitis

A

Streptococcus pneumoniae, Haemophilus influenzae and rhinoviruses

104
Q

Mx of acute sinusitis

A

If more than 10 days symptoms: intranasal corticosteroids

If severe: phenoxymethylpenicillin (co-amoxiclav)

105
Q

Mx of epiglottitis

A

ET
Don’t examine the throat
O2
IV Abx

106
Q

Most common cause of epiglottitis

A

Haemophilus influenzae type B

107
Q

Most common cause of acute otitis media

A

Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis

108
Q

Mx of acute otitis media

A

5-7 day course of amoxicillin is first-line

If allergy then erythromycin or clarithromycin

109
Q

Abx are only prescribed in acute otitis media if..

A

> 4 days or not improving
Systemically unwell
Immunocompromise or high risk of complications secondary to heart, lung, kidney, liver, or neuromuscular disease
<2 years with bilateral otitis media
Perforation and/or discharge in the canal

110
Q

Causes of otitis externa

A

Bacterial (Staphylococcus aureus, Pseudomonas aeruginosa) or fungal
Seborrhoeic dermatitis

111
Q

Mx of otitis externa

A

1st: Topical antibiotic or a combined topical antibiotic with a steroid

2nd: Flucloxacillin (erythromycin if penicillin-allergic). Empirical use of an antifungal agent

112
Q

Mx of oral candidiasis

A

1st: Nystatin suspension, miconazole gel

2nd: Oral fluconazole

113
Q

The most common infective causes of COPD exacerbations are..

A

Haemophilus influenzae

114
Q

Mx of acute exacerbation of COPD if sputum is purulent or there are clinical signs of pneumonia

A

Amoxicillin or clarithromycin or doxycycline

115
Q

Mx of acute bronchitis if systemically unwell, have pre-existing co-morbidities, CRP of 20-100mg/L, r a CRP >100mg/L

A

Doxycycline
If pregnant/children then amoxicillin

116
Q

Mx of diverticulitis

A

Metronidazole + Co-trimoxazole 5 days (or co-amoxiclav if unable to take cotrimoxazole)

117
Q

Most common cause of cellulitis

A

Streptococcus pyogenes
Staph aureus is less common

118
Q

Tx of cellulitis

A

Flucloxacillin (clarithromycin, erythromycin or doxycycline if penicillin-allergic)

119
Q

Tx of facial cellulitis

A

Co-amoxiclav

120
Q

Tx of athlete’s foot

A

Terrbinafine cream

121
Q

Tx of scalp infection

A

Oral terbinafin for 2-4 weeks + ketoconazole shampoo twice
weekly for first 2 weeks

122
Q

Tx of fungal nail infection

A

Oral terbinafine 6 weeks (fingers) or 12 weeks (toes)

If non dermatophyte or candida use itraconazole for 1 week out of 4. 2 cycles (fingers) or 3 cycles (toes)

123
Q

Tx for diabetic foot disease

A

Mild: Flucloxacillin or Doxycycline

Moderate: Flucloxacillin + Metronidazole or Doxycycline
+ Metronidazole

124
Q

Most common cause of impetigo

A

Staphylcoccus aureus or Streptococcus pyogenes

125
Q

Tx for mild impetigo

A

Hydrogen peroxide 1% cream
Topical fusidic acid. If resistant then topical mupirocin

126
Q

Tx for extensive impetigo

A

Oral flucloxacillin
Oral erythromycin if penicillin-allergic

127
Q

Tx for chickenpox

A

Aciclovir if patient presents within 24 hours of onset of rash or immunocompromised

128
Q

Tx for shingles

A

Acicolvir or valaciclovir

Immunocompromised should be referred to hospital for IV antiviral treatment

129
Q

Tx for bites

A

Co-amoxiclav (doxycycline + metronidazole if penicillin-allergic)

130
Q

Most common organism in bites

A

Pasteurella multocida

131
Q

Most common cause of pyelonephritis

A

E. coli

132
Q

Tx of pyelonephritis

A

Broad-spectrum cephalosporin or a quinolone (for non-pregnant women) for 7-10 days

133
Q

Most common cause of prostatitis

A

E. coli

134
Q

Tx of prostatitis

A

Quinolone or trimethoprim

135
Q

Most common cause of epididymo-orchitis

A

Chlamydia trachomatis and Neisseria gonorrhoeae in younger

E. coli in older adults with a low-risk sexual history

136
Q

Mx of epididymo-orchitis

A

If organism unknown then: ceftriaxone IM plus doxycycline PO twice daily for 10-14 days

If organism known then: MSU + oral quinolone for 2 weeks (e.g. ofloxacin)

137
Q

Causes of viral conjunctivitis

A

Adenovirus
Herpes simplex
Herpes zoster

138
Q

Cavitating lesions in pneumonia

A

Staphylococcus aureus
Haemophilus influenzae type A

139
Q

Pneumonia + erythema multiforme or erythema nodosum

A

Mycoplasma pneumoniae

140
Q

_______ pneumoniae is more likely in patients with alcohol abuse

A

Klebsiella

141
Q

_____________ is the most common cause of community-acquired pneumonia

A

Streptococcus pneumoniae

142
Q

People who have been exposed to a patient with confirmed bacterial meningitis should be given prophylactic antibiotics if they have close contact within the 7 days before onset. This includes..

A

Oral ciprofloxacin or rifampici

143
Q

Abx used in the treatment of mRSA infections

A

Vancomycin
Teicoplanin
Linezolid

144
Q

Non-bloody diarrhoea + malabsorption (floating stools in the toilet)

A

Giardiasis

145
Q

What type of influenza vaccine is given to pregnant women/immunocompormised/adults?

A

Injection form = inactive virus

Only children get the nasal form (live weakened virus)

146
Q

Tx for Jarisch-Herxheimer reaction

A

Antipyretics and supportive treatment

147
Q

Latent tuberculosis treatment options

A

3 months of isoniazid (with pyridoxine) and rifampicin, or
6 months of isoniazid (with pyridoxine)

148
Q

Tx for exacerbations of chronic bronchitis

A

Amoxicillin or tetracycline or clarithromycin

149
Q

Tx for uncomplicated community-acquired pneumonia

A

Amoxicillin (Doxycycline or clarithromycin in penicillin allergic, add flucloxacillin if staphylococci suspected e.g. In influenza)

150
Q

Tx for pneumonia possibly caused by atypical pathogens

A

Clarithromycin

151
Q

Tx for Hospital-acquired pneumonia

A

pneumonia Within 5 days of admission: co-amoxiclav or cefuroxime

More than 5 days after admission: piperacillin with tazobactam OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin)

152
Q

Tx for impetigo

A

Topical hydrogen peroxide

Oral flucloxacillin or erythromycin if widespread

153
Q

Tx for Erysipelas

A

Flucloxacillin (clarithromycin, erythromycin or doxycycline if penicillin-allergic)

154
Q

Tx of Gingivitis

A

Metronidazole

155
Q

Tx for Shigellosis

A

Ciprofloxacin

156
Q

Tx for Salmonella

A

Ciprofloxacin

157
Q

BNF antibiotic guidelines (revision card)

A
158
Q

Periods of sudden coldness (cold stage) then a hot stage with fever, vomiting, and flushing, and finally a sweating stage before returning to normal

A

Malaria

159
Q

Mosquitos. Headache (often retro-orbital), fever, muscle aches, facial flushing, and a maculopapular rash

A

Dengue fever

160
Q

Mild fever, diarrhoea, myalgia, and headache

A

Typhoid

161
Q

Tx of meningitis if there is diagnostic delay

A

IV ceftriaxone

IV amoxicillin if immunocompromises, <6 months, >60 years, due to a need to cover for Listeria monocytogenes

162
Q

Most common organism in osteomyelitis

A

Staph. aureus

If sickle-cell anaemia: Salmonella species

163
Q

Mx of osteomyelitis

A

Flucloxacillin for 6 weeks
Clindamycin if penicillin-allergic

164
Q

Urethritis + arthritis +/- conjunctivitis

A

Reactive arthritis

165
Q

Tx for a pregnant women with a UTI if she is near term

A

Amoxicillin for 7 days

166
Q

HIV seroconversion lasts..

A

3-12 weeks after infection

167
Q

For HIV, what’s the next step if the combined test is positive?

A

It should be repeated to confirm the diagnosis

168
Q

After an initial negative result when testing for HIV in an asymptomatic patient, offer a repeat test at..

A

12 weeks

169
Q

Flu-like symptoms including fever (present in > 95% of patients)
Dry cough
Relative bradycardia
Confusion
Lymphopaenia
Hyponatraemia
Deranged liver function tests

A

Legionella pneumophilia

170
Q

What part of the bone is most commonly affected in osteomyelitis?

A

Children = M inors = M etaphysis
Adults = E lders = E piphysis

171
Q

Dengue: Retro-orbital headache, fever, maculopapular rash and thrombocytopenia

Enteric fever: First stage lasts for approximately the first week and often precedes the classical ‘pea green diarrhoea’ of typhoid. Headache, fever, arthralgia, rose spots. Later on, it is accompanied by relative bradycardia, abdominal pain, distension and constipation

Malaria: Cyclical fever, tiredness, vomiting, anaemia and headaches, jaundice

A
172
Q

Incubation period
1-6 hrs: Staphylococcus aureus, Bacillus cereus*
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis

A
173
Q

Notifiable diseases

A
174
Q

Tenosynovitis
Migratory polyarthritis
Dermatitis (lesions can be maculopapular or vesicular)

A

Disseminated gonococcal infection

175
Q

Stippled appearance of vaginal epithelial cells

A

Bacterial vaginosis

176
Q

Genital ulcers
painful: herpes much more common than chancroid
painless: syphilis more common than lymphogranuloma venereum

A
177
Q

presents with a penile ulcer. It initially started as a papule which later progressed to become a painful ulcer 15mm in diameter with an undermined ragged edge

A

Chancroid

178
Q

Severe hepatitis in a pregnant woman - think hepatitis E

A

This patient has presented with hepatitis with reduced GCS, a flapping tremor, and a clotting screen consistent with disseminated intravascular coagulation. Fulminant liver failure in a pregnant woman who has recently returned from Mexico is consistent with hepatitis E

179
Q

Tertiary syphilis = 4 Ds

A

4 D’s:
Destructive gumma
Dorsal columns (tabes dorsalis)
Dilated aortic root
Dementia

180
Q

Common cause of meningitis in 0-3 months

A

Group B Streptococcus (most common cause in neonates)
E. coli
Listeria monocytogenes

181
Q

Common cause of meningitis in 3 months - 6 years

A

Neisseria meningitidis
Streptococcus pneumoniae

182
Q

Common cause of meningitis in > 60 years

A

Streptococcus pneumoniae
Neisseria meningitidis
Listeria monocytogenes

183
Q

Common cause of meningitis in immunosuppressed

A

Listeria monocytogenes

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