Core ID Conditions Flashcards
Strep pneumoniae is the the cause of meningitis in which age group?
> 21
Neisseria meningitidis is the the cause of meningitis in which age group?
10-21
Listeria is the the cause of meningitis in which age group?
(>60 years or immunocompromised or neonates (including alcohol dependency and diabetes)
Viral meningitis is most commonly caused by what?
Enterovirus
> 2000 white cells, glucose in the CSF being low compared to the blood & increased neutrophils indicates which type of meningitis?
Bacterial
primarily polymorphonuclear leukocytes (polymorphs) are found in what kind of meningitis?
Bacterial
Low WBC, minimally elevated protein and normal glucose would indicate which type of meningitis?
Aseptic (viral)
What antibiotic needs to be added to the standard treatment of meningitis (ceftriaxone + dexamethasone) when listeria cover is required?
Amoxicillin IV
What should replace ceftriaxone in the case of penicillin allergy when treating meningitis?
Chloramphemicol
Should you continue the dexamethasone if you discover the meningitis has a viral cause?
No - just give supportive treatment
What virus is the most common cause of encephalitis?
Herpes simplex
What is the most common causative organism in epiglottitis?
Haemophilus influenzae
What is the most common bacterial causative organism in tonsillitis & pharyngitis?
Group A beta haemolytic streptococci (mostly strep pyogenes)
What is the most common bacterial causative organism in sinusitis?
Pneumococcus
The treatment if a tonsillitis patient is scoring 0-1 on the centor criteria should be what?
No antibiotic
The treatment if a tonsillitis patient is scoring 2-3 on the centor criteria should be what?
Should receive an antibiotic (penicillin) if symptoms progress
The treatment if a tonsillitis patient is scoring 4-5 on the centor criteria should be what?
Treat empirically with an antibiotic
What number on the FeverPAIN score would make you consider immediate antibiotics for tonsillitis?
≥4
What would make you consider giving antibiotics in acute otitis media?
- <2 years and bilateral
- Bulging membrane and marked multiple
symptoms - Otorrhoea
When cellulitis is from a dental / mandibular / sinus source what antibiotic should be used instead of flucloxacillin?
Co-amoxiclav
What are the 5 components of the centor criteria?
1 point for each:
- History of fever
- Tonsillar exudates
- Tender anterior cervical adenopathy
- Absence of cough
Age <15 add 1 point
Age >44 subtract 1 point
What are the 5 components of CURB65
C = confusion U = urea (>7 mmol/L) R = RR (>30/min) B = Blood pressure (Systolic <90 or diastolic <60) 65 = >65 years
What CURB65 score is considered mild CAP?
0-1
What CURB65 score is considered moderate CAP?
2-3
What CURB65 score is considered severe CAP?
4-5
What is the most common cause of pneumonia?
Streptococcus pneumoniae - 80% of cases
What organism commonly causes pneumonia in COPD patients?
Haemophilus influenzae
What organism commonly causes pneumonia following an influenza infection?
Staphlococcus aureus
What organism commonly causes pneumonia that presents with a dry cough and atypical CXR findings +/- autoimmune haemolytic anaemia and erythema multiforme?
Mycoplasma pneumoniae
What organism commonly causes atypical pneumonia that often presents with hyponatraemia and lymphopenia
Legionella pneumophilia
What organism commonly causes pneumonia in alcoholics that classically presents with bloody or yellow sputum
Klebsiella pneumoniae
What organism typically causes pneumonia in patients with HIV
Pneumocystis jiroveci
Which are the 2 most like organisms to cause mild/moderate CAP?
Streptococcus pneumoniae / haemophilus influenzae
What organism is most likely to cause acute native valve endocarditis?
Staph aureus
What organisms are most likely to cause subacute native valve endocarditis?
Viridans streptococci or enterococci
What organisms are most likely to cause prosthetic valve or MRSA endocarditis
Coagulase negative staphylococci
How many blood culture sets should be taken in chronic/subacute endocarditis?
3
What are the severity markers for c.diff?
One or more of:
- Temperature >38.5
- Ileus, colonic dilatation or toxic megacolon
- WBC >15 cells x 10 to the power of 9 /L
- Rising serum creatinine >1.5 x baseline
- Remaining c.diff after 2 courses of therapy
Who needs to be contacted about suspected cases of r E coli O157?
Health Protection & Infection Control
How many days does it take on average to develop HUS caused by E coli O157?
6-8 days
What is the key symptom indicating HUS caused by E coli O157?
Bloody diarrhoea
What will the blood cells look like on the blood film in HUS?
Fragmented
When should blood and urine cultures be sent in UTI?
Complicated infection, or male
Should you ever send a urine sample from a catheter?
Only if you consider the catheter to be the source of infection
Why is ceftriaxone used for meningitis when pneumococci & meningococci are sensitive to penicillin?
Ceftriaxone is chosen because of the need for high CSF levels to be maintained & the ease of dosing (twice a day).
It also provides better cover for the rare strain that may have borderline sensitivity to penicillin
What age does Scottish guidance recommend testing for c.diff?
≥3 years
What are the major risk factors for contracting c.diff?
- Current or recent (within 3 months) use of antibiotics
- Increased age
- PPIs
- Prolonged hospital stay
- Serious underlying condition
- Surgical procedures (especially bowel procedures)
- Immunosurpression
Is severe c.diff always associated with diarrhoea?
No
What symptoms apart from diarrhoea can be present in c.diff infection?
- Abdo cramps
- Fever
- Frequent stool
- Raised WBC count
- Rarely pseudomembranous colitis, toxic megacolon and peritonitis
What transmission based precautions should be taken for c.diff patients?
Standard infection control + contact precautions:
- Hand washing with soap and water
- Gloves and aprons
- Patient isolated to a single room with en suite toilet
- Treat linen as infected
- Decontaminate room daily and clean immediate environment twice a day
What is the definition of diarrhoea?
The passage of three or more loose or liquid stool per day, or more frequently than normal for the individual
How is c.diff spread
Spores via the faecal oral route
When is treatment initiated in c.diff?
As soon as it is suspected without waiting for lab confirmation
When are c.diff patients considered to be clear of infection
When they are 48hrs symptom free
Clearance samples are required to be sent to the lab in c.diff infection. True or false?
False
What is severe sepsis?
Sepsis (SIRS + presumed/confirmed infection)
+
at least one acute organ dysfunction
What is septic shock?
Severe sepsis with hypotension refractory to adequate volume resuscitation
