ICP Flashcards
What type of antibiotics work on the cell wall?
Any examples?
Penicillins - pen V, amoxicillin, flucloxacillin Cephalosporins - ceftriaxone, cefuroxime Carbapenems - meropenem, ertapenem Aztreonam (a monobactam) Glycopeptides - vancomycin, teicoplanin
Give examples of 1st, 2nd and 3rd generation cephalosporins
1st generation - cephalexin
2nd generation - cefuroxime
3rd generation - ceftriaxone, cefotaxime
Give examples of antibiotics that work on protein synthesis
Aminoglycosides - gentamicin, streptomycin
Macrolides - erythromycin, clarithromycin
Clindamycin (a lyncosamide)
Tetracyclines - doxycycline
Chloramphenicol
Fusidic acid
Antibiotics working on DNA
Fluroquinolones - ciprofloxacin
Metronidazole
Nitrofurantoin
Antibiotics working on RNA
Rifampicin
Antibiotics working on folate
Trimethoprim
Sulphonamides - sulfamethoxazole
Possible adverse events with antibiotics
- Allergy
- Side effects of antibiotics
- Interaction with medications
- Effect on normal flora - leading to diarrhoea, candidiasis (oral/vaginal), resistance
- Venflon / central line infection
- Increased antibiotic resistance
Which drug classes are beta lactams
Penicillins
Cephalosporins
Carbapenems
Monobactams (Aztreonam)
Give some examples of mechanisms of antibiotic resistance
Enzymatic inactivation - penicillinase e.g. MRSA Altered target site Decreased permeability Efflux pumps Utilising alternative metabolic pathway
What is the CURB-65 score for pneumonia?
Confusion - AMT <=8 Urea - >7mmol/L Respiratory rate - >=30/min Blood pressure - SBP <90, DBP <60 65 - or older age 1 point for each
Treatment for MRSA
Vancomycin Clindamycin -- Teicoplanin Linezolid Daptomycin Gentamicin Rifampicin/Fusidic acid (not alone)
Treatment for C. difficile
Metronidazole PO/IV
Vancomycin PO
Which antibiotics should not be used in any trimester of pregnancy?
Tetracyclines - can cause discolouration of the developing teeth
Which trimester should trimethoprim be avoided in?
First trimester - as it is an anti-folate
Which trimester should nitrofurantoin be avoided in?
3rd trimester
Structure + function of antibodies
IgM - pentamer, first antibody produced but it is short acting
IgG - monomer, crosses placenta, involved in long-term immunity
IgA - dimer, secreted into mucous, saliva, tears, colostrum (breast milk)
IgE - monomer, involved in allergy and antiparasitic
IgD - monomer, not much known about function
Why might eczema improve during pregnancy?
Immune system is dampened down during pregnancy
What types of bacteria are asplenic patients at risk of?
Encapsulated bacteria
- Neisseria meningidis
- Streptococcus pneumoniae
- Haemophilus influenzae
- E coli (some strains)
Risks of vaccinations?
Injection site pain and inflammation
Bleeding (can’t take aspirin before vaccination)
Fever
Flu-like symptoms
Major - anaphylaxis and guillian-barré syndrome
Contraindications for vaccination
Previous problems with vaccination Allergy Egg allergy Pregnancy - no live vaccinations allowed Immunocompromised - no live vaccinations
Which vaccinations are live?
Live flu vaccine Rotavirus Shingles BCG Oral typhoid Varicella Yellow fever MMR
Examples of quinolones
Ciprofloxacin
Contents of septrin?
Septrin is co-trimoxazole
- Sulfamethoxazole
- Trimethoprim
Side effects of gentamicin?
Ototoxic, nephrotoxic
UTI in pregnancy?
Cephalosporins e.g. cefalexin 1st line
Risk factors for pneumonia?
- Lung damage e.g. bronchiectasis
- Alcoholism
- Diabetes - klebsiella risk
- Smoking
- Travel
- ITU / VAP
- Occupational e.g. brucellosis in abertoirs
- COPD - haemophilus/moraxella
- Immunosuppresion
- Nursing home
- Age >65 or <5
- Air conditioning - Legionella
- Recent viral illness
Pneumonia organism more common in diabetics / alcohol dependent
Klebsiella
Most common organisms of pneumonia
S. pneumoniae - causes classic whiting out of lobe on CXR
H. influenzae
Klebsiella pneumoniae
Most common cause of pneumonia in COPD
Haemophilus influenzae
Treatment for pseudomonas pneumonia
Ciprofloxacin
Causes of atypical pneumonia
Mycoplasma pneumoniae
Legionella pneumophilia
Coxiella burnetii
Chlamydia pneumoniae (RF birds)
Viral causes of pneumonia
Influenzae
RSV
Adenovirus
Pathophysiology of aspiration pneumonia
Acid from stomach entering lungs causing a pneumonitis
Protozoal causes of pneumonia
Pneumocystis jirovecii
Toxoplasmosis
Classic feature of pneumocystis jirovecii pneumonia?
Put sats probe on, ask patient to walk and sats will rapidly drop
DECAF score
Dyspnoea - MRCD 1-4=0, 5a=1, 5b=2 Eosinophils <0.05 = 1 Consolidation = 1 Acidosis pH <7.3 = 1 Fibrillation (AF) =1
Antibiotic therapy for pneumonia with CURB score <=2 or CRB <=1
Amoxicillin
or
clarithromycin
Antibiotic therapy for pneumonia with CURB score >=3 or CRB >=2
Under 65:
Coamoxiclav IV plus clarithromycin
Over 65:
Piperacillin-tazobactam IV + clarithromycin PO
Why must a CXR be done 6 weeks post-pneumonia?
- Ensures clearance
Rules out other cause of shadowing e.g. malignancy
Complications of pneumonia
Parapneumonic effusion
EMpyema
Abscess
Appearance of neisseria gonorrhoea on microscopy?
Gram negative intracellular diplococci
Where to swab to test for gonorrhoea and chlamydia in men and women?
Women - vulvovaginal swab best
Men - first pass urine better
Treatment of gonorrhoea
Ceftriaxone IM once
or
Ciprofloxacin 500mg PO
Complications of gonorrhoea
- PID
- Infertility
- Neonatal conjunctivitis (ophthalmia neonatorum)
- Epididymo-orchitis
- Disseminated gonoccocal infection - rash like meningococcal septicaemia
Treatment for chlamydia
Doxycycline 100mg BD 1 week
or
Azithromycin for 2 days
Types of HSV sti
Type 1 - stomatitis
Type 2 - genitals
How to diagnose HSV ulcers?
Clinical diagnosis
Treatment for HSV STI infection
Aciclovir if diagnosed within 5 days, otherwise supportive
Stages of syphilis
Primary - up to 90 days, get chancre formation (painless ulcer)
Secondary - 4-10 weeks after chancre, get maculopapular rash on palms and soles, condylomata lata (raised plaques), fever headache myalgia
Tertiary - neurosyphilis. Argyll Robertson pupil - pupil constricted, not reactive to light but accomodates
Tabes dorsalis - infection of dorsal column so loss of proprioception
What is an argyll-roberton pupil
Complication of tertiary syphilis
Pupil constricted, not reacting to light but still accommodates
Treatment of syphilis
Benzylpenicilin injectio
or
doxycycline 100mgBD duration dep on stage
How long is syphilis infectious for?
It is infectious for up to 2yrs, usually until after the secondary phase
Treatment for genital warts
- Do nothing
- Immune modulation - imiquimod
- Cryotherapy
Characteristics of molloscum contagiosum
Round
Same colour as skin
Nodular
No inflammatory changes to skin
Causative agent of molloscum contagiousm
Molloscipoxvirus
Treatment for scabies
Permethrin 5% cream
Pathophysiology of bacterial vaginosis
Loss of usual lactobacilli, leading to proliferation of gram negative anaerobes e.g. garnerella vaginalis
Symptoms of bacterial vaginosis
Malodorous, grey/white discharge
Treatment for bacterial vaginosis
Metronidazole
Candidiasis clinical features
Itchy, dry, smelly discharge, white
Risk factors for candidiasis
Pregnancy
Anaemia
Diabetes
Recent antibiotics
Treatment for candidiasis
Fluconazole
Management of recurrent candidiasis
Investigate for immunosuppresion / underlying factors e.g. diabetes
Genital hygiene advice
Confirm diagnosis with swabs and find out type of candida
Trichomoniasis clinical features
Yellow, frothy, smelly discharge
Asymptomatic in men
Treatment for trichomoniasis
Metronidazole
