Clinical skills - Infection & Immunity Flashcards
Are urine dipsticks necessary to diagnose UTI’s in women
No
Key urinary symptoms
Dysuria
Nocturia
Cloudy urine
If a woman has 2 key urinary symptoms
Urine culture –> start abx
If a woman has 1 key urinary symptoms
Urinalysis
When are urine dipsticks unreliable
In men
Those over 65
Those w/ a catheter - colonised bacteria
Causes of red urine
Haematuria
Rifampicin
Food e.g. beetroot
Causes of brown urine
Jaundice
Rhabdomyolysis
Drugs e.g levodopa
Causes of green urine
Pseudomonas UTI
Drugs e.g amitriptyline, indomethacin
Causes of frothy urine
Proteinuria
Most prominent protein in blood plasma
Albumin (58%)
Buffy coat
Made up of leucocytes - mainly neutrophils
Production of CRP
IL -1, IL-6 and TNF-alpha stimulate hepatocytes to produce CRP
As the production of acute phase proteins increases ..
Albumin levels reduce
Three main complement pathways
Lectin pathway
Classical pathway
Alternative pathway
What is C3 activated by
Classic and Alternative pathways
What does C3 activate
Membrane Attack Complex: C5b, C6, C7, C8, C9
How does C3 directly act in the process of infl
Dilating arterioles
Stimulating mast cells to release histamine
Cause chemotaxis of phagocytes
Opsoninisation
Opsonination
Acting as a marker to attract macrophages
Sepsis 6
Take 3: bloods, measure urine output, check serial lactates (venous lactate)
Give 3: IV fluids, abx, oxygen
Presentation of scarlet fever
High fever (38 degrees)
White coated tongue that peels –> red and swollen
Red rash on chest and back which branches w/ gentle pressure
Examples of notifiable diseases
Scarlet fever Malaria Measles Meningitis Leprosy
Epstein-Barr virus
One of 8 diff types of human herpes viruses - causes glandular fever (infectious mononucleosis)
Diseases caused by EBV
Infectious mononucleosis Burkitt lymphoma Nasopharyngeal carcinoma CNS lymphoma Lymoproliferative disease
Using vision in general observation
Position Shape/ size Colour Texture Comparison between L and R
Using Hearing in general observation
Voice, speech
Stethoscope - things that move e.g blood (heart, vessels), air (lungs), gut contents (bowel sounds)
Using Touch in general observation
Temp
Texture
Pain
Attachment
Using smell in general observation
Smoke Alcohol Stale sweat or urine Infections (e.g gangrene) Ketosis Diarrhoea die to blood (melaena) or infection
Colours of blood
Fresh, oxygenated is bright red
Increased blood in vessels (injected/ vascular) or diffusely (erythema)
Decreased blood = pallor/ anaemia
Breakdown products (bruise) –> purple –> green –> yellow (jaundice)
Deoxygenated blood is a deep red purple (cyanosis)
Abdominal distension
6 F’s
Flatus (air) Faeces Foetus Fat Fluid Fatal (tumours)
Ascites
Build up of fluid
Test for oedema
Gradually increasing pressure over a bony site - cold for at least 15 secs
Shiny, stretched, blistered, weeping or ulcerated skin
Presentation of septic arthritis
Unable to weight bear Unable to flex joint Swelling is in soft tissue, extra-articular Joint is red, swollen and warm Pain on all active and passive movements
Risk factors for developing septic arthritis
Age >80yrs Any pre-existing joint disease (e.g. rheumatoid arthritis) Diabetes mellitus or immunosuppression Chronic renal failure Hip or knee joint prosthesis Intravenous drug use
Complications of IVDU
Spinal epidural abscess False aneurysm DVT Infective endocarditis Hepatic cirrhosis
