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Clinical Pathology > CP3-6 investigations of specific infections > Flashcards

CP3-6 investigations of specific infections Flashcards

1
Q

What are three CNS infections?

A

Meningitis
Encephalitis
Brain abscess

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2
Q

Who should be offered HIV testing?

A

Those with an infection presenting upon acute medical admission and upon registration with a new GP

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3
Q

What is meningitis?

A

Inflammation of meninges in the brain

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4
Q

Which is the main test required to investigate meningitis?

How are the results interpreted?

A

Lumbar puncture to collect cerebral spinal fluid

The opening pressure, appearance, WBC count, cell differentiation, protein and glucose levels to determine if normal or viral, bacterial or fungal meningitis or TB

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5
Q

How does CSF opening pressure vary between bacterial and viral meningitis?

A

Viral = normal (5-20cm H2O)/slightly elevated opening pressure
Bacterial = >30 cm H2O opening pressure

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6
Q

How does the appearance of CSF vary between normal and bacterial and viral meningitis?

A

Normal = clear
Viral = clear
Bacterial = turbid

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7
Q

What is the WBC count of CSF when normal, with bacterial or viral meningitis?

A

Normal = <3 x10^6/L
Viral = <1000
Bacterial = >500

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8
Q

What is the glucose level in CSF compared to blood glucose in normal, viral or bacterial meningitis?

A

Normal = 0.6
Viral = >0.6
Bacterial = <0.4

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9
Q

When are procalcitonin levels important in distinguishing an infection?

A

Determining bacterial vs viral infection

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10
Q

What other tests can be done to investigate meningitis?

A

2 sets of blood cultures
Blood test for bacterial PCR
Blood test for FBC, clotting, U&Es, glucose and CRP
Throat swab

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11
Q

What additional tests for meningitis are needed in immunosuppressed patients?

A

serum/CSF cryptococcal antigen
10ml of CSF for TB culture/PCR if suspect TB meningitis

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12
Q

What additional tests are important in investigating encephalitis?

A

Lumbar puncture
Viral PCR on CSF

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13
Q

What is encephalitis? What is the most common cause?

A

Inflammation of the brain - usually caused by herpes virus

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14
Q

What test is used to investigate brain abscesses?

A

NO lumbar puncture
Local sampling of pus for gram, culture, and sensitivity/PCR testing
Blood cultures

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15
Q

What are two common ear infection?

A

Acute otitis media
Otitis externa

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16
Q

What is a common nose infection?

A

Sinusitis

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17
Q

What are two common throat infections?

A

Pharyngitis
Diptheria

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18
Q

What test is used to investigate ear infection?

A

Can swab pus

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19
Q

What tests are used to investigate chronic sinusitis?

A

Take sample of pus
Check FBC
Take blood cultures

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20
Q

What is sinusitis?

A

Inflammation of the sinuses due to infection (usually viral) caused by a secondary bacterial infection from upper respiratory flora

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21
Q

What tests are used to investigate throat infections?

A

Throat swab for bacterial infection e.g. strep a
EBV serology
Swab for diptheria
Swab for pus if suspect quinsy abscess

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22
Q

What causes pus on tonsils?

A

Both bacterial and viral infections

23
Q

Who needs to be tested for influenza?

A

those who may require treatment
Those at risk of transmitting

24
Q

What tests are used to investigate influenza?

A

Lateral flow test/POC
PCR

25
Q

What is the sensitivity and specificity of influenza PCR?

A

Sensitivity >90%
Specificity 99%

26
Q

What tests are done to investigate pneumonia with a CURB score between 2-5?

A

Sputum sampling
Blood culturing
Atypical screening including urine for legionella antigen, nose and throat mycoplasma PCR and sometimes serum

27
Q

What tests after chest XR are needed to investigate a pneumonia with a CURB score of 0-1?

A

No further investigations

28
Q

What tests are used to investigate TB?

A

Exposure testing e.g. mantoux (skin prick) but more commonly IGRA (interferon G releasing assay)
3 sputum samples (including early morning sample) for AAFB and microscopy and culture
PCR testing

29
Q

What tests are done to investigate atypical respiratory infections?

A

Viral PCR
Culture for fungal infections and test for aspergillus antigens

30
Q

What tests are used to investigate pneumocystis jirovecii?

A

PCR
Serum B-d glucan

31
Q

What samples are best for investigating atypical respiratory infections?

A

Deep respiratory samples

32
Q

What are three localised skin infections?

A

Impetigo
Erysipelas
Cellulitis

33
Q

What is an example of a severe skin infection?

A

Necrotising fasciitis

34
Q

What skin infection are diabetics at risk of?

A

Diabetic foot infection

35
Q

What tests are used to investigate localised skin infections?

A

Wound swabs of blister fluid or abscess pus
Blood cultures

36
Q

What tests are done to investigate necrotising fasciitis?

A

Two sets of blood cultures
FBC, U&Es, LFTs, CRP

37
Q

What tests are done to investigate diabetic foot infection?

A

Wound swab
If severe infection = bone or tissue sample

38
Q

What tests are done to investigate lower and upper UTIs?
How should they be interpreted?

A

Urine sample for WBC, RBC, epithelial cells, bacterial growth and sensitivities

kass criteria used to assess if significant bacteriuria

39
Q

Fill in the blank.

Urine from a catheter is ________ beneficial than collecting mid stream urine excreted naturally.

A

Less

40
Q

What tests are used to investigate prostatitis?

A

Urine after a post prostatic massage

41
Q

What tests are used to investigate epididymo-orchitis?

A

Send urine for culture
Test for chlamydia and gonorrhoea
Bloods and blood cultures if severe

42
Q

What tests are used to investigate GI infectious diarrhoea?

A

(Primarily) Stool sample - 3 samples to pick up parasites

Further investigations:
Bloods - FBC, clotting, U&Es, LFTs, CRP
Blood cultures
Abdominal imaging

43
Q

What test are used to investigate h. Pylori infection?

A

Stool test for h. Pylori antigen
Urea breath test (less common)
Biopsy urease test
Endoscopy

44
Q

What must be stopped before testing for H. Pylori?

A

Protein pump inhibitors

45
Q

What test are done to investigate a liver abscess?

A

Blood culture
FBC, U&Es, LFTs, CRP
Sample pus if safe to drain
Serology
Imaging - ultrasound and CT

46
Q

What tests are used to investigate cholangitis/cholecystitis?

A

Bloods: FBC, U&Es, LFTs, clotting, amylase
Blood cultures
Ultrasound or CT
If aspirated/drained a bile fluid or pus sample

47
Q

What tests are used to investigate diverticulitis?

A

Pus from abscess if complicated diverticulitis
Blood cultures
Bloods: FBC, U&Es, LFTs, clotting, amylase
CT

48
Q

What tests are used to investigate endocarditis?

A

Blood cultures - 3 sets taken at different times during first 24 hours of admission
Echocardiogram
FBC, CRP, U&Es, LFTs
Serology for coxiella and brucella

49
Q

What tests are done to investigate vascular graft infection?

A

Three sets of blood cultures at different times over 24 hours
Imaging e.g. CT
PCR or culture tissue/fluid around the graft site

50
Q

What tests are done to investigate hepatitis A?

A

Serology +/- PCR
Antibody testing - IgM

51
Q

What tests are done to investigate hepatitis B infection?

A

Serology +/- PCR

52
Q

What test are used to investigate hepatitis C infection?

A

serology +/- PCR

53
Q

What tests are used to investigate syphilis?

A

Swab if have a lesion
Blood tests

Clinical Pathology (65 decks)

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