Extra areas Flashcards
Case report + case series
Description of pts complete medical history
series compiles multiple pts to identify common patterns
Cross sectional study
Measures prevalence of a disease + gathers exposure data
e.g. HTN in the community; then collect data on sex, weight, smoking etc.
Case control study
Compares those with & without a disease
e.g. with and without cancer; then collect data on smoking
Cohort study (prospective vs retrospective)
Follows a group over time to investigate exposure and outcome
Prospective - do not have disease, measure exposure, monitor outcome
Retrospective - already exposed, check if outcome occurred
Most common cause of gastroenteritis
Viral - rotavirus, norovirus, adenovirus
E.coli infection gi
gram -ve rods lactose fermenting bacilli
0157 strain produces shiga toxin => cramps, bloody diarrhoea, vomiting
Can lead to haemolytic uraemic syndrome; worsened by abx
Common in travellers
Campylobacter jejuni infection
gram -ve bacilli
Poultry, milk and untreated water
2-5 incubation, 2-6 days of sx
Clarithromycin if severe sx
Shigella infection
gram -ve rod
Shiga toxin
1-2 day incubation period, 1 week sx
Can lead to haemolytic uraemic syndrome; worsened by abx
Azithromycin if severe
Salmonella infection
Poultry, raw egg
12hrs-3 days incubation, sx 1 week
Bacillus Cercus infection
+ve rod
unrefrigerated food after cooking e.g. rice reheated kills bacteria but not toxin
vomiting within 5 hours, watery diarrhoea after 8, resolution within 24
Yersinia Enterocolitica infection
-ve bacilli
Pork
typically children; watery/bloody diarrhoea, pain, fever
adults can present with R abdo pain from mesenteric adenitis
4-7 incubation, 3 weeks sx
Staph aureus GI infection
eggs, dairy, meat
sx within hours, settles within 24
Giardiasis infection
Parasite
days-years incubation
can be no sx -> fulminant colitis
Cryptosporium infection
Parasite
7-10days incubation
GI symptoms
Leptospirosis
Rodent urine
Underlying vasculitis
Sudden onset fever, headache, myalgia, conjunctival suffusion
=> Weil’s disease - jaundice, thrombocytopaenia, AKI, aseptic meningitis
Malaria
Parasite; Plasmodium falciparum - most common and most severe
Fever, fatigue, myalgia, headache, N+V, pallor, hepatosplenomegaly, jaundice
Falciparum fever spikes often, p. ovale and p. vivax rupture every 48 hours and fever spike every 48 hours
Incubation 1-4 weeks
Blood film diagnosis
3 -ve samples in 3 days needed for exclusion
Treatment:
Artemether with lumefantrine 1st line, quinine also
Artesunate if severe (can give haemolysis)
Complications
cerebral malaria, seizures, decreased GCS, AKI, DIC
Prophylaxis
proguanil/atovaquone for 2 days prior, 7 days after
doxy 2 days, 4 weeks
mefloquine 2 weeks, 4 weeks (can give psych side effects)
Enteric fever / typhoid
salmonella typhi
week 1: headache, cough , weak, fever, abdo discomfort
2: ‘toxic’; sustained fever, rose spots, pain, diarrhoea, hepatosplenomegaly
3: sx settle or complications; GI perf, haemorrhage, shock
Blood transfusion indications
20% blood loss
pre operative Hb <90g/L with increased risk of blood loss
Hb <80 in active MI
Hb <70
Hb 70-90 if symptomatic or co-morbid: SOB, angina, syncope, ST depression, tachy
Q: What is an acute haemolytic transfusion reaction, and how is it managed?
Due to ABO incompatibility (IgM antibodies to transfused blood)
Occurs within minutes
Symptoms: fever, abdo pain, hypotension, haemoglobinuria, anxiety
Can lead to DIC and renal failure
Management:
Stop transfusion
Send blood for Coombs test
Give fluid resuscitation
What is transfusion-related acute lung injury (TRALI), and how is it managed?
Cause: Donor antibodies (Ab) to neutrophils + HLA
Onset: Within 6 hours
Symptoms: Dyspnoea, severe hypoxaemia, hypotension
Management:
Stop transfusion
Provide oxygen and supportive care
What is a febrile non-haemolytic transfusion reaction, and how is it managed?
Cause: Antibodies against donor HLA
Symptoms: Fever, chills, no haemolysis
Management:
Slow or stop transfusion
Monitor the patient
What causes anaphylaxis during a transfusion, and how is it managed?
Cause: Usually caused by IgA deficiency and anti-IgA antibodies
Management:
Stop transfusion
Give IM adrenaline
Transfusion associated circulatory overload
dyspnoea, orthopnoea, tachypnoea, hypoxaemia, hypertensive
up to 12 hours post transfusion
Treat with O2 and diuretics
Delayed haemolytic transfusion reactions
Ab against rhesus or kidd
3-14 days post transfusion
jaundice, fever, decreased Hb, haemoglobinuria
