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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
What is DIC?
Activation of coagulation mechanism results in small clots forming everywhere (affecting organs) and uses up clotting factors so bleeding occurs in skin
26
CAP common causes
Strep pneumo, Mycoplasma, chlamydophila, legionella (HIB only in kids/COPD)
27
Clinical features pneumonia
pleuritic chest pain, sudden onset, productive cough, fever, headache, dyspnoea
28
Ix pneumonia
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
29
Assessing pneumonia severity
PSI (assess for admission) CORB- confusion, O230, BP2= admit SMART-CRP for ICU
30
empirical Abx for moderate CAP
Benzylpen/amoxil (strep, HIB) + Azithro/Doxy (atypical)
31
In tropical regions empiral Abx moderate CAP
Ceftriaxone + gent
32
Outpatient Abx pneumonia
Amoxycillin
33
Severe CAP Abx
Ceftriaxone + Azithromycin
34
Aspiration pneumonia Rx
Benzylpen + Metronidazole
35
Nosocomial pneumonia organisms
MRSA, pseudomonas, strenotrophomonas maltophila
36
Rx Nosocomial pneumonia
Gent + benzylpen
37
Pneumocystis Abx
Trimethoprim, sulfamethoxazole
38
3 infections for the returned traveller
Malaria, Dengue, Enteric fever | pneumonia, meningitis, gastro
39
Mosquito for malaria
anopheles
40
Key features of dengue
short incubation (4-7 days), maculopapular rash, thrmobocytopenia, leukopenia
41
Places for malaria
West Africa, nigeria, solomon islands, papua new guinea
42
Sx of malaria
fever, chills, sweats, headache, myalgia
43
Complications of malaria
anaemia, thrombocytopenia, splenomegaly
44
Complications from falciparum
cerebral, blackwater fever, pulmonary oedema, anemia, bleeding
45
Incubation fo falciparum
8-25 days. Presents within 6 weeks of infection
46
Mortality for falciparum
48 hours, .5-3.5%
47
Which forms can have liver relapse in malaria
vivax, ovale
48
Parasitemia levels in falciparum vs others
falciparum up to 60%, others <1%
49
Dx of malaria
thick and thin blood films, antigen detection, PCR
50
Rx non-falciparum
chloroquine, primaquine (eradicate liver phase)
51
Rx falciparum (non-severe)
Mefloquine (neuropsychiatric) , malarone (expensive)
52
Rx severe falciparum
artemisin derivatives (not widely available) Quinine (tolerance issue) Doxycyline (last resort)
53
Prophylaxis for malaria
doxy, chloroquine, mefloquine, malarone
54
Dengue causing mozzie
aedes aegypti
55
Features of dengue
severe myalgia, fever, retro-orbital headache, rash on trunk, THROMBOCYTOPENIA
56
Major complication dengue
haemorrhagic fever
57
Dx of dengue
PCR, serology
58
Typhoid causative agents
Salmonella typhi and paratyphi
59
Typhoid pathyphys
bacteraemic illness that causes inflammatory destruction of intestine and other organs. mainly ingested in food/water in sub-continent
60
Typical rash of typhoid
rose spots
61
Dx of typhoid
blood cultures, urine and stool cultures (usually not positive till second week though)
62
Clinical features of typhoid
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
Rx Typhoid
Ciprofloxacin
64
Abx chlamydia
Azithromycin
65
Abx Neisseria gonnorhoea
Ceftriaxone
66
Complications of chlamydia
PID, infertility,
67
Tests for STIs
NAT on first void urine, discharge culture, PCR, genital swab MCS and PCR Urethra, cervix, vagina MCS and PCR
68
HIV screening blood test
ELISA to detect antibodies
69
Syphillis investigation
dark ground microscopy
70
HIV testing window period
6 months
71
Vaginal discharge causes
bacterial vaginosis, candidiasis, trichomoniases
72
Cervical discharge causes
chlamydia, gonorrhoea, carcinoma
73
Bacterial vaginosis caused by... and symptoms and Rx
Trichomonas, grey white discharge, metronidazole
74
UTI likely organisms
E.coli, Staph saprophyticus
75
Rx UTI mild
Trimethoprim, cephalexin
76
Rx UTI severe
gentamicin, amoxil
77
Osteomyelitis DDx
gout, septic arthritis
78
Causes of Osteomyelitis
S.aureus (80%), think TB and malignancy too. E.coli/pseudomonas in vertebral osteomyelitis in adults
79
Sx osteomyelitis
pain, tender, warm, erythema, systemic infection
80
RFs for osteomyelitis
diabetes, vascular disease, impaired immunity, surgery, open fractures
81
Radiology bad for osteomyelitis why?
10-14 days to show changes
82
Management approach OM
Drain abscess and give IV Fluclox (vanc if MRSA)
83
RF septic arthritis
pre-existing joint disease (RA), diabetes, immunosupression, prosthetic joints
84
Ix Septic arthritis
joint aspiration for synovial fluid microscopy and culture, blood cultures
85
What level of CD4 cells do opporutnistic infecitons appear in HIV
<200
86
Name some opportunistic infections
Pneumocystis, toxoplasmosis, cryptococcus, CMV, MAI
87
Name infections 200-500 CD4 counts
TB, HSV, VZV, oesophageal candida, Kaposi sarcoma
88
TB treatment
Rifampcin, Isoniazid, Pyrazinamide, Ethanbutol
89
Kaposi's sarcoma= HHV?
8
90
Neutrophil defects in HIV cause what infections...
bacteria and fungi
91
CMI defects cause what type of infection...
parasite, virus, intracellular
92
Febrile neutropenia dangeours bacterial organism and empirical therapy
Pseudomonas | Broad spectrum, meropenem+ aminoglycoside
93
Common HAI
Staph Aureus, pseudomonas, klebsiella
94
Precautions in hospital
hand hygeine, moment of hand washing, waste disposal, sterile environment, catheter and cannula management, infection control team
95
HIV, Hep C and Hep B risk from needle stick
.3, 3, 30
96
Immune complex deposition signs of IE
Roth spots, osler nodes, glomerulonephritis
97
Spetic emboli signs of IE
Janeway lesion, splinter haemorrhage, renal/splenic infarct
98
Causative organisms of IE
Acute- Staph Aureus Subacute- viridans strep, enterococcal Rare- HACEK, fungal, coxiella (Q-fever)
99
RFs for IE
IV injection, dental, operation, immunocompromised, Rheumatic fever
100
Dukes criteria number required
2 major, 1 major 3 minor, 5 minor
101
Major Dukes criteria
Vegetations/abscess on echo | Multiple positive blood cultures with endo suspective organisms
102
Minor Dukes criteria
Fever, Janeway, Osler, Splinter, Roth spots, other emboli, pre-existing heart condition, blood culture or echo stuff that doesn't meet major criteria
103
Ix for IE
CXR, ECG, Blood culture, Echo
104
Empirical treatment for IE
Benzylpen + fluclox + gent

4th year OSCE (7 decks)

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