I.D. Flashcards
28 year old woman is admitted via the Accident & Emergency department.
She had not gone to work due to feeling flu-like that morning.
Her boyfriend has brought her in to Accident & Emergency as she has become drowsy and has developed a rash.
She is febrile, hypotensive and confused with marked neck stiffness and purpuric rash
- diagnosis and bug?
meningitis
n. meningitis
72 year old, usually fit and well woman has been sent to the medical admissions unit with fever, headache and neck pain.
On admission she is unwell with fever, tachycardia, neck stiffness and confusion (MSQ 6/10).
LP = white blood cells 1000/mm3 (all neutrophils), red blood cells 3/mm3, and Gram positive cocci are seen
- bug?
Strep. Pneumonia
Ix for C. Diff
Stool toxin
Ix for E. Coli
Stool Culture
Ix for influenzae
Throat swab for viral PCR
Tayside empirical therapy for intra-abdominal sepsis
IV Amox + Met + Gent
Tayside empirical therapy for intra-abdominal sepsis - step down therapy
PO Co-Trimoxazole and Metronidazole
Tx for Pyelonephritis
IV Amox and Gent
Tx for Pyelonephritis - if pen allergic
IV Co-Trimoxazole and Gent
Tx for severe CAP
Co-Amox and Clarithromycin
cellulitis tx
flucloxacillin
cellulitis tx - if pen allergic
IV Vancomycin
c.diff tx - non-severe
PO Metronidazole
c.diff tx - severe
PO Vancomycin
A 26 year old woman presented with dysuria but no frequency. She was prescribed co-amoxiclav but has returned after three days saying her symptoms are no better and she now has vaginal discharge
- why has treatment failed?
The patients symptoms are probably caused by a fungal infection
i.e. thrush
vaginal discharge is not a symptom of UTI
An 86 year old resident of a nursing home has become more confused. A week ago the nurses noticed that her urine was smelly and a urine culture grew Escherichia coli sensitive to Trimethoprim. Her temperature was 37oC, pulse 76bpm, respiratory rate 18 per minute, BP 130/80 mmHg. She has no other symptoms. She was treated with Trimethoprim but after 5 days of treatment her confusion has not improved.
- why has treatmetn failed?
The patients symptoms are probably not caused by infection
bacteria in catheter bag not causing symptoms
preventative action required if MRSA found?
hand hygiene
preventative action required if Norovirus found?
isolation of the patients and/or cohort nursing, ward closure
preventative action for THR elective operation?
antibiotic prophylaxis
1st line treatment for MRSA
IV Vancomycin
1st line treatment for MSSA
Flucloxacillin
68 year old woman is admitted with sepsis secondary to E.coli urinary tract infection. She has no allergies and has been compliant with her treatment. She has been treated with Trimethoprim by her GP but has not responded.
- reason for treatment failure
Extrinsic resistance
A patient is admitted with a non-severe community acquired pneumonia. You treat with Amoxicillin. Serology confirms Mycoplasma pneumoniae and the patient is not improving.
- reason for treatment failure
Intrinsic resistance
Mycoplasma pneumoniae is one of the organisms that cause the atypical pneumonias
An 80 year old man required a central venous catheter following admission for a myocardial infarction and shock. Four days later his temperature is documented as 37.8oC and all other signs are normal. His WCC is 6.7 x 103 A blood culture taken through the central line reveals a growth Gram positive cocci in one bottle after 72 hours of incubation. Peripheral blood cultures taken at the same time are sterile.
- definition?
bacteraemia
A 91 year old woman with a long standing urinary catheter is admitted with smelly urine, mild confusion and fatigue. Her She has no other signs or symptoms. WCC is normal. Her catheter urine culture, taken by the residential home, has grown E.coli.
- definition
colonisation
Ix for TB if no productive cough
Bronchoscopy with lavage
A 38 year old labourer present to the gastroenterology clinic with 3 months of weight loss, recurrent oral thrush and fatigue. His full blood count reveals lymphopenia
- likely diagnosis
HIV
An intravenous drug user has been an inpatient on the liver unit for investigation and management of his chronic liver disease. A phlebotomist is carrying out a venesection and sustains a significant needle stick injury. The phlebotomist has previously been adequately vaccinated against blood borne virus infections. What infection is most likely to be acquired from exposure to this patient? .
Hep C
