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ID Flashcards

1
Q

Antibiotic treatment options for MRSA are

A

Doxycycline
Clindamycin
Vancomycin
Teicoplanin
Linezolid

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2
Q

ESBL examples

A

E.coli

Klebsiella

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3
Q

ESBLs are usually sensitive to

A

Carbapenems such as meropenem or imipenem.

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4
Q

Amoxicillin covers

A

Streptococcus, listeria and enterococcus

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5
Q

Switch to co-amoxiclav to additionally cover

A

Staphylococcus, haemophilus and e. coli (UTIs)

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6
Q

Switch to tazocin to additionally cover

A

Pseudomonas

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7
Q

Switch to meropenem to additionally cover

A

ESBLs

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8
Q

For suspected C diff

A

Oral vancomycin and IV metronidazole

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9
Q

Add teicoplanin or vancomycin to cover

A

MRSA

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10
Q

Add clarithromycin or doxycycline to cover

A

Atypicals

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11
Q

Atypicals include

A

Legions – Legionella pneumophila
Psittaci – Chlamydia psittaci
M – Mycoplasma pneumoniae
C – Chlamydydophila pneumoniae
Qs – Q fever (coxiella burneti)

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12
Q

Staphylococcus aureus may cause chest infections in patients with

A

CF

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13
Q

Pseudomonas aeruginosa may cause chest infections in patients with

A

Cystic fibrosis or bronchiectasis

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14
Q

An appropriate initial antibiotic in the community for UTI would be

A

Trimethoprim
Nitrofurantoin

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15
Q

Nitrofurantoin and pregnancy

A

Generally avoided in the third trimester as it is linked with haemolytic anaemia in the newborn

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16
Q

Trimethoprim and pregnancy

A

Safe in pregnancy but avoided in the first trimester or if they are on another medication that affects folic acid (such as anti-epileptics) due to the anti-folate effects.

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17
Q

Antibiotic of choice for skin infections

A

Flucloxacillin

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18
Q

Bacterial tonsillitis is most commonly caused by

A

Group A Streptococcus (GAS) infections, mainly streptococcus pyogenes.

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19
Q

Otitis media, sinusitis and tonsillitis not caused by GAS are most commonly caused by

A

Streptococcus pneumoniae

Other causes of otitis media, sinusitis and tonsillitis:
Haemophilus influenzae
Morazella catarrhalis
Staphylococcus aureus

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20
Q

Centor criteria for tonsilitis

A

Centor Criteria are used to estimate the probability that tonsillitis is due to a bacteria infection, and therefore requires antibiotics.

A score of < 3 indicates they are unlikely to benefit from an antibiotic and antibiotics should not routinely be given.

A score of ≥ 3 gives a 40 – 60 % probability of bacterial tonsillitis and it is appropriate to offer antibiotics. One point is given for each of the following:

Fever > 38ºC
Tonsillar exudates
Absence of cough
Tender anterior cervical lymph nodes (lymphadenopathy)

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21
Q

First line antibiotics for tonsillitis

A

Penicillin V (also called phenoxymethylpenicillin) for a 10 day course is typically first line.

Alternatives antibiotics and for a broader spectrum of activity:
Co-amoxiclav
Clarithromycin
Doxycycline

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22
Q

Otitis media on examination

A

Examination will reveal a bulging red tympanic membrane. If the ear drum perforates there can be discharge from the ear.

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23
Q

Why are Cephalosporins avoided

A

High risk of C.diff development

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24
Q

First line for Spontaneous Bacterial Peritonitis

A

Pip Taz

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25
Q

What should be avoided if E Coli gastroenteritis is suspected?

A

The use of antibiotics increases the risk of haemolytic uraemic syndrome therefore antibiotics should be avoided if E. coli gastroenteritis is considered

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26
Q

Common cause of travellers diarrhoea

A

Campylobacter

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27
Q

The most common causes of bacterial meningitis in children and adults is

A

Neisseria meningitidis (meningococcus) and Streptococcus pneumoniae (pneumococcus).

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28
Q

Most common cause of bacterial meningitis in neonates

A

Group B Streptococcus (GBS). GBS is usually contracted during birth from the GBS bacteria that can often live harmlessly in the mothers vagina.

29
Q

Two special tests you can perform to look for meningeal irritation

A

Kernigs Test
Brudzinski’s Test

30
Q

Kernig’s test

A

Involves lying the patient on their back, flexing one hip and knee to 90 degrees and then slowly straightening the knee whilst keeping the hip flexed at 90 degrees. This creates a slight stretch in the meninges and where there is meningitis will produce spinal pain or resistance to this movement.

31
Q

Brudzinski’s test

A

Involves lying the patient flat on their back and gently using your hands to lift their head and neck off the bed and flex their chin to their chest. A positive test is when this causes the patient to involuntarily flex their hips and knees.

32
Q

Children seen in the primary care setting with suspected meningitis AND a non blanching rash should receive urgent

A

Injection (IM or IV) of benzylpenicillin prior to transfer to hospital as time is so important

33
Q

Antibiotic for meningitis

A

< 3 months – cefotaxime plus amoxicillin (the amoxicillin is to cover listeria contracted during pregnancy from the mother)

> 3 months – ceftriaxone

34
Q

Are bacteria meningitis and meningococcal infection are notifiable diseases?

A

Yes

35
Q

Complications of meningitis

A

Hearing loss is a key complication
Seizures and epilepsy
Cognitive impairment and learning disability
Memory loss
Focal neurological deficits such as limb weakness or spasticity

36
Q

Mantoux test indicates

A

Previous vaccination, latent or active TB.

37
Q

When is IGRA used

A

The IGRA test is used in patients that do not have features of active TB but do have a positive Mantoux test to confirm a diagnosis of latent TB.

38
Q

Management of latent TB

A

Otherwise healthy patients do not necessarily need treatment for latent TB. Patients at risk of reactivation of latent TB can be treated with either

Isoniazid and rifampicin for 3 months
Isoniazid for 6 months

39
Q

Management of active TB

A

RIPE is the mnemonic used to remember the treatment for TB. It involves a combination of 4 drugs used at the same time:

R – Rifampicin for 6 months
I – Isoniazid for 6 months
P – Pyrazinamide for 2 months
E – Ethambutol for 2 months

40
Q

Isoniazid side effect and therefore is prescribed alongside

A

Peripheral neuropathy

Vitamin B6 pyridoxine

41
Q

Rifampicin can cause

A

Red/orange discolouration of secretions like urine and tears.

It is a potent inducer of cytochrome P450 enzymes therefore reduces the effect of drugs metabolised by this system. This is important for medications such as the contraceptive pill.

42
Q

Ethambutol can cause

A

Colour blindness and reduced visual acuity.

43
Q

Pyrazinamide can cause

A

Hyperuricaemia (high uric acid levels) resulting in gout.

44
Q

First line treatment for Lyme disease

A

Doxycyline

45
Q

Second line treatment for Lyme disease (allergy)

A

Amoxicillin

46
Q

What should be added to antibiotic in treatment of meningitis and why

A

Steroid

Dexamethasone improves outcomes (by reducing neurological sequelae) in the treatment of bacterial meningitis

47
Q

Vaccine avoidance on azathioprine

A

If you are taking azathioprine or mercaptopurine you should not receive live vaccines, such as: polio, yellow fever, BCG (tuberculosis)

48
Q

Diagnosis for Chlamydia

A

Chlamydia is diagnosed using nucleic acid amplification tests (NAAT). Both urethral swab and first-catch urine samples can be used for NAAT.

As first catch urine is as sensitive and less invasive than a urethral swab, this is the investigation of choice.

49
Q

Common cause for non-specific urethritis (dysuria +/- urethral discharge)

A

Chlamydia trachomatis infection

50
Q

When is rash present in meningitis ?

A

When there is meningococcal septicaemia

51
Q

When is dexamethasone contradicted in meningitis treatment?

A

In meningococcal septicaemia - presence of a non-blanching purpuric rash.

52
Q

First line for N. gonorrhoea

A

IM Ceftriaxone (neisseria!)

53
Q

Second line for N. gonorrhoea

A

For patients with gonorrhoea, a combination of oral cefixime + oral azithromycin is used if the patient refuses IM ceftriaxone

54
Q

What is used to treat bacterial vaginosis and pelvic inflammatory disease.

A

Metronidazole

55
Q

Most common cause of oesophagitis in patients with HIV.

A

Oesophageal candidiasis

56
Q

Swabs for chlamydia and gonorrhoea in women should be taken from the

A

Vulvo-vaginal area (introitus)

57
Q

When is doxycycline contradicted?

A

Contraindicated in pregnancy due to its teratogenic effects on foetal long bone growth and potential to cause teeth discolouration in the baby.

58
Q

What antibiotics are used to treat chlamydia in pregnancy?

A

Azithromycin, erythromycin or amoxicillin

59
Q

First line for syphilis

A

IM benzathine penicillin

60
Q

Diagnosis of syphilis

A

Positive non-treponemal test and a positive treponemal-specific test.

61
Q

Non treponemal tests include

A

Non-treponemal tests include rapid plasma reagin and Venereal Disease Research Laboratory.

These tests will investigate the reactivity of serum from patients to a cardiolipin-cholesterol-lecithin antigen and will assess the number of antibodies produced.

62
Q

Treponemal specific tests include

A

Trepenomal-specific tests include T. pallidum enzyme immunoassay, T. pallidum HaemAgglutination test. These tests will investigate the number of antibodies such as IgM and igG produced by the body directed to the Treponema pallidum .

63
Q

Which type of test for syphilis indicates recovery from infection due to treatment?

A

When treatment is started, non-treponemal titres will decline.

Non-treponemal titres will reduce as these tests detect antibodies directed to specific antigens and damaged host cells. As there is subsequent bacterial death following antibiotic treatment, the damage to the host cells is reduced thus there will be reduced antibodies directed to these. A four-fold decline is considered adequate.

64
Q

Which bacteria causes syphilis ?

A

Treponema pallidum

65
Q

Perform stool microbiological investigations if

A

You suspect septicaemia

There is blood and/or mucus in the stool or

The child is immunocompromised

66
Q

Urethritis in a male, negative for Gonorrhoea and Chlamydia →

A

?Mycoplasma genitalium

67
Q

URTI symptoms + amoxicillin → rash

A

?glandular fever

68
Q

Disseminated gonococcal infection triad

A

Tenosynovitis, migratory polyarthritis, dermatitis

69
Q

Disseminated gonococcal infection pathogen

A

Neisseria gonorrhoeae

AKT (16 decks)

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