ID Flashcards
gram positive anaerobes
CLAP
clostridium
lactobacillus
actinomyces
propionibacterium
MRSA is trested with
doxycycline
clindamycin
vancomycin
teicoplanin
linezolid
what are ESBL
extended spectrum beta lactamase bacteria- they have become resistant to beta lactams
usually e coli or klebsiella
difference between gram pos and neg
pos= have a peptidoglycan cell wall
neg= no cell wall
gram positive rods
corny mikes list of basic cars
cornybacteria
mycobacteria
listeria
bacillus
nocardia
general escalation of hospital abx
amoxicillin- covers strep, listeria and enterococcus
co amoxiclav- covers staph, haem and e coli
piptaz- covers pseudomonas
meropenem- covers ESBLs
teicoplanin/vanc- covers MRSA
clarith/doxy- covers atypicals
what is septic shock
when blood pressure remains low despite fluid resus
this causes hypoperfusion and anaerobic respiration so lactate rises
how is septic shock diagnosed
low MAP despite fluid resus
raised lactate
NEWS2 components
blood pressure
heart rate
temp
o2 sats
resp rate
consciousness level
pyelonephritis triad
fever
loin pain
nausea/vomitting
urine dip UTI results
nirates or leukocytes plus RBC= likely UTI
only leukocytes= send to lab
only nitrates= treat as UTI
what type of bacteria is e coli
gram negative anaerobic rod
avoid nitrofurantoin in
patients with an eGFR <45
pregnant women near term
abx for pyelonephritis in community
cefalexin 7-10 days
what does use of nitrofurantoin in the 3rd trimester cause
neonatal haemolysis
what dopes use of trimethoprim in the 1st trimester cause
NTDs
in cellulitis what indicates a staph aureus infection
a golden yellow crust
common bacteria associated with cellulitis
staph aureus
group A strep
group C strep
abx for cellulitis near eyes or nose
co amoxiclav
bacterial tonsillitis common bacteria
group A strep (strep pyogenes)
if not then usually strep pnuemoniae
what centor score warrants use of abx
3 or more
centor score components
fever over 38 degrees
tender cervical lymphadenopathy
tonsillar exudates
absence of cough
first line abx tonsillitis
penicillin V for 10 days
clarithromycin if allergic to penicillin
complications of tonsillitis
quinsy
otitis media
scarlet fever
rheumatic fever
post strep glomerulonephritis
otitis media abx
amoxicillin 5-7 days 1st line
clarithromycin if allergic
erythromycin if pregnant and allergic
sinusitis mx
10 days conservative mx
high dose steroid nasal spray 14 days
back up abx if not improving
chronic sinusitis mx
saline nasal irrigation
steroid nasal spray
septic arthritis most common organism
staph aureus
nisseria gonorrhoea if young
pseudogout crystals are made of
calcium pyrophosphate
septic arthritis abx
empirical IV abx for 4-6 weeks
fluclox usually 1st line
what type of virus is influenza
RNA
medications for flu
olsetamivir
zanamivir
what medication increases risk of HUS
antibiotics- avoid use if e coli gastroenteritis is suspected
gastroentertitis stay off work/school rules
till 48 hrs after sx resolve
abx that cause c diff
clindamycin
cipro
cephalosporins
carbapenams
c diff recurrence rate
high
complications of c diff
toxic megacolon
pseudomembranous colitis
bowel perforation
sepsis
what type of bacteria is nisseria meningitis
gram negative diplococcus
most common cause of viral meningitis
enterovirus
how to test for kernigs sign
flex the hip and knee to 90 degrees
while keeping the hip flexed straighten the knee
pain or resistance to movement indicates meningitis
how to test for brudzinskis sign
lift head and neck off bed when patient is lying flat
involuntary flexion of hip and knees is positive
CSF protein in bacterial meningitis
high
CSF protein in viral meningitis
slightly raised or normal
high neutrophils in CSF indicates
bacterial cause
high lymphocytes in CSF indicates
viral cause
benzylpenicillin dosing in meningitis
under 1 yr- 300mg
1-9yrs- 600mg
over 10yrs- 1200mg
what test should be done if meningococcus is suspected in meningitis
meningococal PCR
what tests can be done when examining a patient with suspected meningitis
brudzinski
kernigs
meningitis abx
under 3 months- cefotaxime plus amoxicillin
over 3 months- ceftriaxone
what can reduce neurological complications and hearing loss in meningitis
steroids
post exposure prophylaxis for meningitis contacts
single dose cipro
complications of meningitis
hearing loss
seizures/epilpesy
cognitive impairment
focal neurological deficit eg limb weakness/spasticity
TB stain and result
zeihl neelsen
turns bright red on a blue background
are people with latent tuberculosis infectious
no
what is potts disease
spinal tuberculosis
tests for immune response to TB
mantoux test
IGRA (interferon gamma release assay)
mantoux test method and result
tuberculin is injected
after 72hrs the induration is measured
>5mm= positive
IGRA method and result
pt blood is mixed with TB antigens
release of interferon gamma is positive- leukocytes that have been sensitised will release it
miliary TB on CXR
millet seed appearance- small nodules disseminated through the lung field
latent TB mx
isoniazid 6 months
rifampicin and isoniazid for 3 months
what should be prescribed with isoniazid
pyroxidine/vitamin b6
this reduces peripheral neuropathy
what ventilation is used in rooms where patients are isolated with infectious disease that are aiborne
negative pressure
what enzyme does rifampicin affect and how
induces cytochrome p450
this enzyme metabolises medications like COCP so these become less effective
pyrazinamide side effects
gout
kidney stones
what cells does HIV destroy
CD4 T helper cells
AIDS defining illnesses
kaposi sarcoma
PCP
cytomegalovirus
candidiasis
lymphoma
TB
HIV blood test consent rules
in emergency departments there is assumed consent unless patients choose to opt out
lab test for HIV tests for
HIV antibodies
p24 antigen
lab test for HIV has a reliable result after how many days
45
what CD4 count in HIV is high risk
<200 cells/mm3
what is given to high risk HIV pts
prophylactic co trimox for PCP
cervical smear frequency in HIV pts
yearly
delivery plan for HIV pts
viral load <50= normal vaginal possible
viral load >400= c section recommended
50-400= consider c section
IV zidovudine during labour and delivery and to babies
PEP drugs and duration
truvada and raltegravir for 28 days
PrEP drugs
truvada
most common malaria type
plasmodium falciparum
most severe malaria type
plasmodium falciparum
what is tertian fever
fever every 48 hrs
associated w p vivax and o ovale
