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4th year OSCE > ID > Flashcards

ID Flashcards

1
Q

HACEK organisms cause…

Name them

A

Subacute endocarditis

Haemophilus, Acinetobacillus, Cardiobacterium, Eikenella, Kingella

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2
Q

ESCAPPM organisms are…

Name them

A

Extended beta-lactamase activity

Enterobacter, Serratia, Citrobacter, Acinetobacter, Proteus, Providencia, Morganella

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3
Q

What to use for ESCAPPM organisms

A

Carbapenem, Aminoglycoside

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4
Q

Clinicla features meningitis

A

Headache, fever, neck stiffness, photophobia, confusion

Spreading, non-blanching petechial rash in Meningococcal

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5
Q

Kernig’s sign

A

when hip is flexed, inability to extend knee

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6
Q

Brudzinski’s sign

A

When lifting head of patient lying flat, knees rise involuntarily

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7
Q

DDx meningitis

A

malaria, encephalitis, septicaemia, sub-arachnoid, dengue, tetanus

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8
Q

2 Commonest cause meningitis adults

A

Neisseria, Streptococcus

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9
Q

Most common cause meningitis non-vaccinated kids

A

HIB

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10
Q

Common causes vaccinated kids <3 of meningitis

A

Strep Agalacticae, E.Coli

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11
Q

Immunocompromised meningitis causes

A

Listeria, Cryptococcus

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12
Q

Rx cryptococcus

A

amphotericin B and fluconazole

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13
Q

Viral meningitis causes

A

Enteroviruses (echo and cocksackie), herpes, varicella, measles, mumps, arboviruses

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14
Q

Ix meningitis

A

Blood culture, Gram stain/NAT of skin swabs if present. CSF gram stain and NAT
LP if CT shows no evidence increased ICP

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15
Q

Viral vs bacterial meningitis CSF

A

Both have high protein. Bacterial has low glucose and polymorphonucleocytes dominating. Viral has mononuclear cells and normal glucose

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16
Q

empirical meningitis Rx

A

Dexamethasone + ceftriaxone

Benzylpen to cover listeria, consider vanc if strep pneumo

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17
Q

Neisseria meningiditis Rx

A

Benzylpenicillin

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18
Q

Meningitis prophylaxis pregnant women

A

Ceftriaxone

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19
Q

Meningitis prophylaxis adults

A

cipro

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20
Q

Meningitis prophylaxis kids

A

rifampcin

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21
Q

What drugs don’t penetrate CSF

A

aminoglycosides, early gen cephalosporins, clindamycin, erythromycin

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22
Q

Neisseria culture media

A

chocolate

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23
Q

Meningococcal rash means…

A

septicaemia caused by neisseria

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24
Q

Why is meningococcal dangerous

A

50% mortality, multi organ fail, DIC (endotoxin)

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25
Q

What is DIC?

A

Activation of coagulation mechanism results in small clots forming everywhere (affecting organs) and uses up clotting factors so bleeding occurs in skin

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26
Q

CAP common causes

A

Strep pneumo, Mycoplasma, chlamydophila, legionella (HIB only in kids/COPD)

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27
Q

Clinical features pneumonia

A

pleuritic chest pain, sudden onset, productive cough, fever, headache, dyspnoea

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28
Q

Ix pneumonia

A

CXR, FBC, UEC, LFT, O2 sats
Sputum gram stain and culture (before Abx)
Blood culture
Mycoplasma serology
Nose and throat swab NAT
Bronchoalveolar lavage consider in severly ill

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29
Q

Assessing pneumonia severity

A

PSI (assess for admission)
CORB- confusion, O230, BP2= admit
SMART-CRP for ICU

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30
Q

empirical Abx for moderate CAP

A

Benzylpen/amoxil (strep, HIB) + Azithro/Doxy (atypical)

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31
Q

In tropical regions empiral Abx moderate CAP

A

Ceftriaxone + gent

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32
Q

Outpatient Abx pneumonia

A

Amoxycillin

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33
Q

Severe CAP Abx

A

Ceftriaxone + Azithromycin

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34
Q

Aspiration pneumonia Rx

A

Benzylpen + Metronidazole

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35
Q

Nosocomial pneumonia organisms

A

MRSA, pseudomonas, strenotrophomonas maltophila

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36
Q

Rx Nosocomial pneumonia

A

Gent + benzylpen

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37
Q

Pneumocystis Abx

A

Trimethoprim, sulfamethoxazole

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38
Q

3 infections for the returned traveller

A

Malaria, Dengue, Enteric fever

pneumonia, meningitis, gastro

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39
Q

Mosquito for malaria

A

anopheles

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40
Q

Key features of dengue

A

short incubation (4-7 days), maculopapular rash, thrmobocytopenia, leukopenia

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41
Q

Places for malaria

A

West Africa, nigeria, solomon islands, papua new guinea

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42
Q

Sx of malaria

A

fever, chills, sweats, headache, myalgia

43
Q

Complications of malaria

A

anaemia, thrombocytopenia, splenomegaly

44
Q

Complications from falciparum

A

cerebral, blackwater fever, pulmonary oedema, anemia, bleeding

45
Q

Incubation fo falciparum

A

8-25 days. Presents within 6 weeks of infection

46
Q

Mortality for falciparum

A

48 hours, .5-3.5%

47
Q

Which forms can have liver relapse in malaria

A

vivax, ovale

48
Q

Parasitemia levels in falciparum vs others

A

falciparum up to 60%, others <1%

49
Q

Dx of malaria

A

thick and thin blood films, antigen detection, PCR

50
Q

Rx non-falciparum

A

chloroquine, primaquine (eradicate liver phase)

51
Q

Rx falciparum (non-severe)

A

Mefloquine (neuropsychiatric) , malarone (expensive)

52
Q

Rx severe falciparum

A

artemisin derivatives (not widely available)
Quinine (tolerance issue)
Doxycyline (last resort)

53
Q

Prophylaxis for malaria

A

doxy, chloroquine, mefloquine, malarone

54
Q

Dengue causing mozzie

A

aedes aegypti

55
Q

Features of dengue

A

severe myalgia, fever, retro-orbital headache, rash on trunk, THROMBOCYTOPENIA

56
Q

Major complication dengue

A

haemorrhagic fever

57
Q

Dx of dengue

A

PCR, serology

58
Q

Typhoid causative agents

A

Salmonella typhi and paratyphi

59
Q

Typhoid pathyphys

A

bacteraemic illness that causes inflammatory destruction of intestine and other organs. mainly ingested in food/water in sub-continent

60
Q

Typical rash of typhoid

A

rose spots

61
Q

Dx of typhoid

A

blood cultures, urine and stool cultures (usually not positive till second week though)

62
Q

Clinical features of typhoid

A

progress from week to week. 1st week quite non-specific, leading to diarrhoea and fever in second week. 3rd week septic shock, intestinal bleeding etc

63
Q

Rx Typhoid

A

Ciprofloxacin

64
Q

Abx chlamydia

A

Azithromycin

65
Q

Abx Neisseria gonnorhoea

A

Ceftriaxone

66
Q

Complications of chlamydia

A

PID, infertility,

67
Q

Tests for STIs

A

NAT on first void urine, discharge culture, PCR, genital swab MCS and PCR
Urethra, cervix, vagina MCS and PCR

68
Q

HIV screening blood test

A

ELISA to detect antibodies

69
Q

Syphillis investigation

A

dark ground microscopy

70
Q

HIV testing window period

71
Q

Vaginal discharge causes

A

bacterial vaginosis, candidiasis, trichomoniases

72
Q

Cervical discharge causes

A

chlamydia, gonorrhoea, carcinoma

73
Q

Bacterial vaginosis caused by… and symptoms and Rx

A

Trichomonas, grey white discharge, metronidazole

74
Q

UTI likely organisms

A

E.coli, Staph saprophyticus

75
Q

Rx UTI mild

A

Trimethoprim, cephalexin

76
Q

Rx UTI severe

A

gentamicin, amoxil

77
Q

Osteomyelitis DDx

A

gout, septic arthritis

78
Q

Causes of Osteomyelitis

A

S.aureus (80%), think TB and malignancy too. E.coli/pseudomonas in vertebral osteomyelitis in adults

79
Q

Sx osteomyelitis

A

pain, tender, warm, erythema, systemic infection

80
Q

RFs for osteomyelitis

A

diabetes, vascular disease, impaired immunity, surgery, open fractures

81
Q

Radiology bad for osteomyelitis why?

A

10-14 days to show changes

82
Q

Management approach OM

A

Drain abscess and give IV Fluclox (vanc if MRSA)

83
Q

RF septic arthritis

A

pre-existing joint disease (RA), diabetes, immunosupression, prosthetic joints

84
Q

Ix Septic arthritis

A

joint aspiration for synovial fluid microscopy and culture, blood cultures

85
Q

What level of CD4 cells do opporutnistic infecitons appear in HIV

86
Q

Name some opportunistic infections

A

Pneumocystis, toxoplasmosis, cryptococcus, CMV, MAI

87
Q

Name infections 200-500 CD4 counts

A

TB, HSV, VZV, oesophageal candida, Kaposi sarcoma

88
Q

TB treatment

A

Rifampcin, Isoniazid, Pyrazinamide, Ethanbutol

89
Q

Kaposi’s sarcoma= HHV?

90
Q

Neutrophil defects in HIV cause what infections…

A

bacteria and fungi

91
Q

CMI defects cause what type of infection…

A

parasite, virus, intracellular

92
Q

Febrile neutropenia dangeours bacterial organism and empirical therapy

A

Pseudomonas

Broad spectrum, meropenem+ aminoglycoside

93
Q

Common HAI

A

Staph Aureus, pseudomonas, klebsiella

94
Q

Precautions in hospital

A

hand hygeine, moment of hand washing, waste disposal, sterile environment, catheter and cannula management, infection control team

95
Q

HIV, Hep C and Hep B risk from needle stick

96
Q

Immune complex deposition signs of IE

A

Roth spots, osler nodes, glomerulonephritis

97
Q

Spetic emboli signs of IE

A

Janeway lesion, splinter haemorrhage, renal/splenic infarct

98
Q

Causative organisms of IE

A

Acute- Staph Aureus
Subacute- viridans strep, enterococcal
Rare- HACEK, fungal, coxiella (Q-fever)

99
Q

RFs for IE

A

IV injection, dental, operation, immunocompromised, Rheumatic fever

100
Q

Dukes criteria number required

A

2 major, 1 major 3 minor, 5 minor

101
Q

Major Dukes criteria

A

Vegetations/abscess on echo

Multiple positive blood cultures with endo suspective organisms

102
Q

Minor Dukes criteria

A

Fever, Janeway, Osler, Splinter, Roth spots, other emboli, pre-existing heart condition, blood culture or echo stuff that doesn’t meet major criteria

103
Q

Ix for IE

A

CXR, ECG, Blood culture, Echo

104
Q

Empirical treatment for IE

A

Benzylpen + fluclox + gent

4th year OSCE (7 decks)

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