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infection Flashcards

1
Q

dysuria
frequency
urgency
suprapubic pain

whats these symptoms of

A

UTI- that causes cystitis - inflammation of the bladder

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2
Q

whats often the only symptoms of a uti in the frail elderly

A

confusion

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3
Q

whats a sign of pyelonephritis

A

fever
loin/ supraoubic/ back pain
unwell/vomit
hameaturia
renal angle tenderness on examination- where the hilum of kideny is

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4
Q

what do you need to look for if the patient has pyelonephritis

A

signs of sepsis

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5
Q

what investigations do you do for suspected uti

A

urine dipstick = nitirites certain and leukocytes
if got either these then send midstream urine sample off to microbiology lab for culture and sensitivity

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6
Q

what in a urine dipstick prove uti

A

nitirites - treat as uti
nitirites and leukocytes = treat as uti
leukocytes byself= treat uti if got clinical signs

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7
Q

what investifation to do for uti suspect

A

urine dipstick
if nitiries/leukocytes present senf midstream sample to microbiology for sensitivity and culture

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8
Q

whats the main bacterial cause of uti

A

e.coli

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9
Q

what are risk facotrs for uti

A

woman
urinary catheter
women with incontinece/poor hygeine
sex - spreads bacteria from back around perineum

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10
Q

how do you. manage uti

A

woman = 3 days anitbiotics
5-10 days if immunosupressed woman, got abnormal anatomy or impaired kidney function
7 days if man, pregnant, catheter related uti

main abx= trimethoprim
or nitrofurantoin

others:
pivmecillinam
amoxicillin
cefalexin

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11
Q

what do you do for pregant women with uti

A

7 days abx of nitrfurantoin (not third trimester as cause haemolytic anemia in newborn)
or
2nd line = cefalexin/amoxicllin

trimethoprim = safe but not in first trimester or someone who has med that affect folic acid (anti epileptics)

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12
Q

how do you manage pyelonephritis

A

if signs sepis send to hosp
community =
7 days of either cefalexin, trimethoprim, co-amoxiclav, ciprofloxacin

if preg and not needed hosp then cefalexin

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13
Q

red hot or swollen
tight/ tense skin
oedematous
bullae formed
golden yellow crust
thickened skin

whats this signs of

A

cellulitis

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14
Q

whats golden yellow crust sign of

A

cellultitis
- staphycoccus aureus infection

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15
Q

whats differentials of cellulits presentation

A

acute gout
ruptured bakers cyst
dvt
septic arthritis

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16
Q

what the causes of cellultis

A

bacteria

staphycoccus aureus
group a streptococcus=> streptococcus pyogenes
group c streptococcus=> streptococcus dysgalactiae

consider mrsa if in nursing home/ in out hosp

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17
Q

how do you classify cellulits

A

eron classification
1= no systemic toxicity nor comorbidities

2= systemic toxicity or comorbididites

3= sign sustemic toxicity or sign. co morbidities

4= sepsis or life threatening infction

3 and 4 go to hosp or also if frail/ v young, immunocompromised

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18
Q

how treat cellulitis

A

flucloxacillin

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19
Q

when do you suspect that sinusitis is bacterial cause

A

lastsed for over 10 days
purulent nasal discharge
discoloured nasal dicharge
sevre loval pain
38 degrees over
deterioration after initally mid

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20
Q

whats the causes of sinusitis

A

bacterial or viral
usually tigfgered by a upper resp viral infection

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21
Q

nasal blockage
discolpured / purulent nasal discharge
facial pain
facial pressure
mucosal oedema
fever/ tender over sinuses

whats this

A

sinusitiss

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22
Q

what do you treat sinutisit with

A

get better over 2-3 weeks itself
symptoms less than 10 days no abx- offer paracetmaol/ibruprofen

symtpoms lasted over 10 days = give 2 weeks of nasal steroid spray hgih dose

symtoms last over 10 days and likely bacteral = offer antibitotcs= pehnoxymethylpenicillin first line for 5 days

if not improved after2-3 days give co-amoxiclav

if penicillin allergy consider:
clarithromycin
erythromycin = if preg
doxycyline

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23
Q

sinusitis, otis media and tonsillitis are commonly caused by viral or bacterial infection

A

viral

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24
Q

whats the bacterial casues of sinusitis, otis media and tonsillitis

A

group A streptoccocus - strep pyogenes

or if not then streptococcus penumoniae

others:
haemophilus influenzae
morazella catarrhalis
staphylcoccus aureus

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25
Q

how long does it take otis media to resolve

A

3-7 days byself

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26
Q

s and s of oitis media

A

buldging red tympanic membrane
if mebrane ruptured then discharge
tugging ear
ear pain
slight hearing loss
fatigue
fever

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27
Q

treatemnt for otis media

A

if systmeiccal unwell, more serious illness or high risk of getting comolications then give antibitocs
= amoxcillin first line for 5-7 days
not repsonded after 2 days give co-amoxiclav

or penicllin allergy give erythromycin- if preg
clarithromycin

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28
Q

s and s of tonsillitis

A

tonssilar exudate
fever
sore throat
hard to swalow
swollen tonsils
cough
headache
fatigue
earache
lymphadenopathy

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29
Q

tonsillits is commonly caused by viral or bacteira

A

viral

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30
Q

if bacterial tonsillits what most common cause

A

group a streptococcus- strep pyogenes

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31
Q

how do you know if the tonsillitis is likely to be bacterial of cause

A

centor crtieria
get a poijt for each and if over 3 then 40-60% likely bacteria and so give abx

absent cough
fever 38 or over
tonsillar exudate
tender anterior cervical lymph nodes

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32
Q

if suspect bacterial tonsillitis how do you treat

A

phenoxymethylpenicillin for 10 days

broader spectrum=
clarithromycin
erythromcin
doxycyline

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33
Q

what should you have a low threshold of suspicion for when inflammed joint

A

septic arthritis

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34
Q

rapid onset
often one joint- odten knee
red
swollen
hot joint
stiff and dec range of movement
systemic symtpoms- fatigue, fever, sepsis

whats these suggest

A

septic arthritis

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35
Q

what differentials are there of symtpms of septic arthriti

A

gout - urate crustals. negatively birefringent

pseudogout- calcium pyrophosphate crystals positively birefringent

reactive arthritis- triggered by uretritis and gastroenteritis and associated with conjunctivitis

haemarthrosis

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36
Q

what investigations do you do for septic artrhtisi

A

aspirate joint
may be purulent fluid

send off to lab for crystal microscopy, antibiotic sentivities, gram staining, culutre

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37
Q

what treatment give for septic arthrtis

A

empirical iv antibiotics to start
3-6 weeks on antibitocs
flucloxacillin and rifampicin
or vancomycin and rifampicin if penicillin allergy

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38
Q

whats the risk facotrs of septic arthritis

A

recent joint replacment
dog bite/ big cut
infection elsewhere in body and travleed to joint

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39
Q

what pathogen can casue septic arthrtis

A

staphylcoccus aureus - most common

neisseria gonhorrea
group a strep- strep pyogenes haemophilus influenzae
e coli

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40
Q

whats urinary tract infection

A

involves infection in bladder casuing inflam of bladder- cystitis and can spread to kindyes= pyelonephritits

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41
Q

risk factors of uti

A

women
catheter
poor hygein, incontinece women
sex

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42
Q

presentation of lower uti

A

dysuria= pain, burning, stinging when pass urine
suprapubic pain / discomfort
frequency
urgency
incontinence
confusion = esp elferly only sign sometomes

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43
Q

presentation of pyelonephritis

A

fever= more rpominen t
loin, suprapubic pain, back pain = bilateral and unilateral vomiting
loss appetite
haematuria
renal angle tenderness on examination

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44
Q

dipstick = nitrites

A

gram negative bacteria break down nitrates to nitrites
treat as uti

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45
Q

leukocytes and nitrites in dipstick

A

treat as uti

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46
Q

only leukocytes in dipstick

A

if clinical evidecne treat as uti

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47
Q

investigations for uti

A

send midstream urine sample to lab for culture and sensitivity testing

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48
Q

main cause of uti

A

e coli
gram negative aerobic rod shaped bacteria

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49
Q

what other organisms can cuase uti

A

e coli- most common
klebsiella pneumonia
enterococcus
psudomonas aeruginosa
staphylcoccus saprophyticus
candida albicans- fungal

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50
Q

antibiotics cna give for uti

A

trimethoprim
nitrofurantoin

pivmecillinam
amoxicillin
cefalexin

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51
Q

how long to give antibiotcs for uti

A

3 days= women simple lower uti
5-10 days, women immunospuressed, abnormal anatomy, impaired kidney function
7 days men and pregant women and cather uti

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52
Q

pt has uti and has catheter in. treatment

A

antibiotcs for 7 days
replace catheter

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53
Q

treatment for pregant women with uti

A

7 days antibiotics
even if asymptomatic
urine for culutre
1st= nitrofurantoin
2= cefalexin/amoxicillin

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54
Q

uti in pregnant women increases risk of what

A

increase risk of pyelonnephritits
premature rupture of membranes
pre term labour

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55
Q

what antibiotcs avoid when in pregnant women for uti

A

nitrofurantoin
avoid 3rd trimester
can casue haemolytic anemia of newborn

trmethoprim. avoid 1st trimester or throughout if on meds that affects folic acid

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56
Q

what antibiotic causes haemolytic anemia in newborn

A

nitrofurantoin - used first line uti ipregancy

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57
Q

whats sepsis

A

life threatening organ dysfunction caused by dysregulated host repsonse to infection
infection in blood

large immune repsonse to infection systemic inflammation
affects organ fucntio n

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58
Q

pahtolphysiology sepsis

A

macrophages, lymphocytes recognise pathogen= cytokines = activcate other parts immune system= no = vasodilation, inflam throughout body

endothelilal lining increase permeability= fluid into ecm= oedema = dec intravascualt volume and harder for o2 to get to tissues through fluid

active coagulation = fibrin block bv and so dec o to tissues
platelets get consumed= thrombocytopenia haemorrhages= disseminated inravascualr coagulapathy

blood lactate increase= anerobic resp

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59
Q

investigations for sepsis

A

fbc= wbc and neutrophila
u and e= aki
lft= see function and source infection
crp= show inflamm
clotting= may show DIC
blood culture= show if bacteraemia
blood gas= lactate, ph , glucos e

urine dipstick and culture possibly
cxr maybe
ct= intra abdo infection/absess
lumbar puncture - menigitis,encephalitis

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60
Q

risk factors for sepsis

A

patient prone to infection, on immune supresion
under 1 or over 75
chronic ocnditions- diabetes, copd
chemo, steroids, immunsupressants
surgery, recent truama, burns pregnancy, post partum
indwelling med device- catheter, central line

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61
Q

whats spetic shock

A

low bp so less ocygen to tissues

have systolic bp lower than 90 depsite having fluid resus hyperlactameia - lactate ore than 4

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62
Q

how to treat septic shock

A

iv fluid to increase bp and tissue perfusion

if dont work then inotropes= noradrenalin = to increase bp and stimulate cv system

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63
Q

what organ dysfucntion can occur in sevcere sepsos

A

hypoxia
oliguria
aki
thrombocytopenia
coagualtion dysfucntion
hypotension
hyperlactameia - more than 2

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64
Q

pt has lactate more than 4
infection present
oliguria
systolic bp 85
what is this

A

septic shock

lactate more than 4 and systolic bp less than 90

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65
Q

presentation of sepsis

A

high or low temp
tachycardia
tachypnoea!
low o sats
low bp
decreased consiousness
confusion/drowsy

o/e
signs of infection- cellulitis, cough, dysuria, discharge form owund
non blanching rash- menigiococcus septicaemia
low urine output
mottle skin
cyanosisis
arhtmia - new AF

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66
Q

management of sepsis

A

sepsis 6 give three
take three

treat pt wtihin an hour of presenting

blood test
urine output
blood culture

give
oxygen - sats want 94-98% or 88-92% in copd
broad spectrum antibiotcs
iv fluid

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67
Q

whats neutropenic spesosi

A

spesis and neutrophils count less than 1

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68
Q

ccauses of neutropenia

A

chemo
clozapine- schitophrenia
methotrexate- RA
hydroxychloroquine- RA
sulfasalazine -RA
carbimazole- hyperthyroid
quinine- malaria
infliximab and rituximab- monoclononal antibodies for immunosupression

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69
Q

treat neutropneia sepsis

A

any temp over 38 as neutropenic sepsis in anyone on meds that cause neutropenia / immunosupressed
]give broad spectrum antibiotcs= tazobactam and piperacillin= tazocin

other sepsis rx

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70
Q

what antibiotic use to treat neutropneic sepsis

A

tazocin= piperacillin and tazobactam

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71
Q

test for legionella

A

urinary antigen test

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72
Q

how is folic acid synthesisied in bacteria

A

PABA–> DHFA –> THFA –> folic acid

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73
Q

staphylcoccus gram stain

A

staphylcoccus = gram +ve cocci

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74
Q

enterococcus gram stain

A

enterococcus = gram +ve cocci

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75
Q

streptococcus gram stain

A

streptococcus = gram +ve coccic

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76
Q

gram +ve cocci

A

streptococcus
staphylcoccus
enterococcus

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77
Q

gram +v rods

A

corney mikes list of basica of cars

corneybacteria
mycobacteria
listeria
bacillus
nocardia

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78
Q

corney bacteria shape and gram stain

A

gram +ve rod

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79
Q

listeria shape and gram stain

A

gram +ve rod

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80
Q

mycobacteria shape and gram stain

A

gram +ve rod

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81
Q

bacillus shape and gram stain

A

gram +ve rod

82
Q

nocardia shape and gram stain

A

gram +ve rod

83
Q

gram +ve anerobes

A

CLAP
clostridium
lactobacillus
actinomyces
propionibacterium

84
Q

clostridium type and gram stain

A

gram +ve anerobe

85
Q

lactobacillus type and gram stain

A

gram +ve anerobe

86
Q

actinomyces type and gram stain

A

gram +ve anerobe

87
Q

propionibacterium type and gram stain

A

gram +ve anerobe

88
Q

casues of atypical pneumonaia

A

atypical- doesnt show up on gram stain or cant be cultured in normal way

legions of psittaci MCQ
legionella pneumophila
chlamydia pscittaci
mycoplasma pneumoniae
chlamydophila pneumoniae
Q fever- coxiella burneti

89
Q

legionella pneumonphila type bacteria

A

atypical-often a casue of atypical pneumonia

90
Q

chlamydia pscittaci type bacteria

A

atypical - often a casue of atypical pneumonia

91
Q

mycoplasma pneumonia type of bactiera

A

atypical - often a casue of atypical pneumonia

92
Q

chlyamydophila penumonia type of abcteira

A

atypical- often a casue of atypical pneumonia

93
Q

q fever- coxiella brunetti type of bactiera

A

atypica- often a casue of atypical penumonai

94
Q

common gram -ve bacteria

A

neiserria meningitidis
neiseria gonorrhea
haemophilus influenza
E coli
klebsiella
psudomonas aerguinosa
moraxella catarrhalis

95
Q

neiserria meingitidis type bactiera

A

gram -ve- coccus

96
Q

neisseria gonorrhea type of bactiera

A

gram -ve - diplococci

97
Q

klebsiella type bacteria

A

gram -ve - rod shaped

98
Q

e coli type of bactieria

A

gram -ve rod shaped

99
Q

hameophilus influenza type of abctieria

A

gram -ve aneorbic cocobaciullus

100
Q

pseudomonas aeruguinsosa type of bacteria

A

gram -ve rod shpaed

101
Q

moraxella catarrhalis type of bacteira

A

gram -ve
diplococcus

102
Q

whats MRSA

A

staphylcoccus aureus bactiera resistant to beta lactam abx- penicllins, carbapenems, cephalosporins

103
Q

how to eradict mrsa from body sruface and abx use if infected with it

A

if in hosp and got it on skin eradicate with chlorhexadine wash

abx:
doxycycline
clindamycin
vancomycin
teicoplanin
linezolid

104
Q

exteneded spectrum betal lactamase bacteria
typical bactiera and abx treat

A

bacteria developed reisistnace to beta lactam abx = produce beta lactamase

tend to be e coli and klebsilla - can typically casue uti and penumonia

abx: carbapenems- meropenem / imipenem

105
Q

common intra abdominal infections

A

appendicitits
acute diverticulitits
ascending cholangitits
cholecystitis- with 2 infection
spontaenous bacterial peritonitits
intra abdo abscess

106
Q

common casues of intra abdo infectins

A

e coli
enterococcus
streptococcus
anaerobes- clostridium bacteroides
klebsiella

107
Q

how to trat intra abdo infection

A

broad sprectum abx unless have culture
cover gram +ve and gram -ve and anaerobes

108
Q

co amoxiclav good for what and dont cover what

A

good: gram +ve
gram - ve
anaerobic

x pseudonomas
atypical bacteria

109
Q

quinolones good for what and dont cover what

A

good: gram +ve
gram -ve
atypical

x anaeroboes

usually pair with metroidazole cus that covers anaerobes when have intra abdo infection

110
Q

metronidazole good for what and dont cover what

A

anaerobes

x aerobic

111
Q

gentamicin good for what and dont cover what

A

gram -ve
some gram +ve- staphylcoccis

bactericidal so kill the bacteria andnot jus slow it down so often use stat dose of it if not in the regimes if pt is severely septic to provide strong gram -ve bactericidal action

112
Q

vancomycin good for what and dont cover what

A

gram +ve
MRSA

often with metroidazole + gentamicin in pen allergy

113
Q

cephalosporins good for what and dont cover what

A

broad spectrum gram +ve
gram -ve

x anaerobic
avoid due to risk of c diff infection

114
Q

tazocin and meropenem good for what and dont cover what

A

tazocin = piperacilllin + tazobactam

both tazocin and meropenem ar eheavy hitting abx
gram +ve
gram -ve
anaerobic

x atypical
MRSA
and tazocin also doesnt cover ESBLS

use for pts very ill and other abx havnt worked

115
Q

common regimes for itra bado infection

A

co amoxiclav by self
amoxicillin + gentamicin + metronidazole
metronidazole + vancomycin + gentamicicn = pen allergy
ciprofloxacin + metronidazole= pen allergy

116
Q

spontaenous bacterial periotinitis
abx treat

A

typically due to liver fdailure
1st line= tazocin
cephalosportins ( cefotaxime) often used
levofloxacin + metronidazole= pen allergy

117
Q

influenza =is what virus dna or rna

A

RNA
3 types A,B,C
A has H and N subtypes

H1N1= swine flu
H5N1= avian flu

118
Q

when can get a vaccination for influenza

A

yearly
65 and over
young children
pregnant women
health care workers and carer
chronic health conditions - asthma, copd, heart failure, diabetes

119
Q

presentation influenza

A

occur abrupttly - usally 2 days after exposrue
fever
corzyal symptoms
cough- can productive
fatigue and lethargy
muscle and joint aches
headache
sore throat
anorexia

gi symtpom
ocular symtpms- photophobia, pain on eye movmemnt

complcaited influenza= lrti, signs of exaserbation of underylting condition

120
Q

daingosis of influenza

A

treat based on hx, rf for complications and cloinical

cxan do viral nasal/throat swab pcr
DO WITH PEOPLEW ITH COMPLCIATED influenza

121
Q

treatment influenza

A

healthy pt wth not at risk of complcaitions- self care

if at risk of complciations: start treatment within 48hrs onset symtpoms to be effective:
oral oseltamivir 75mg BD 5 days
or
inhaled zanamivir 10mg BD 5 days

if pt high risk of complications (chronic disease/ immunosupression)
ca give post exposure prophylaxis- seen person with flu and then get this treatment to try reduce risk of developing flu and complciations :

given within 48hrs of close contact with influenza:
oral oseltamivir 75mg OD 10 days
or
inhaled zanamivir 10mg OD 10 days

122
Q

complcaition of influenza

A

exaserbation of health condition- copd, heart failure
febrile convulsions in young childnre
encephalitits
viral pneumonia
secondary bacterial pneumonia
otitis media, sinusitis, bronchitits

123
Q

HIV

A

human immunodeficency virus
RNA retrovirus
binds to CD4 cells and releases its RNA into and destorys CD4 T cells

124
Q

transmmission hiv

A

bodily secretions

sexual transmission - unprotected ana, vaginal, oral sex
mother - child- any point pregnancy, birth, breast feeding = vertical trasnmission
mucous membranes, blood, open wound expiresure to infected blood/bodily fluids= sharing needles, needle stick injury and blood splash in eye

125
Q

presentation of hiv

A

active HIV= acute seroconversion illness = like glandular fever - fever, swollen glands, muscle aches and tirdness

chronic infection: the immune system controls it and so CD4 recovers and viral load goes down- asymptomatic but cant get rid of it so chronic infection
then over time the hiv infects and kills cd4 and so cd4 decreases and viral load increases and then eventaually when CD4 below 200 have AIDS

126
Q

AIDS defining conditions
got any of these then think they are immunocompromised cus shouldnt be getting these infections normlaly

A

candidiasis- oesophageal, bronchial
PCP
kaposi sarcoma
cytomegalo virus
lymohpma
TB
toxoplasmosis
MAC disease
crytpococcal disease- fungal

127
Q

screenin HIV

A

any risk facotr then test for it
do it immediately then do in 3 months cus antibody test can be -ve for 3 months after exposure
need verbal consent to do it
HIV RNA= tests viral load
PCR for p24 antigen - can show postive before the ab
antivody blood test

128
Q

treatment for HIV

A

key mechanism is inhibiting reverse trasncriptase
3 drugs- at leas 2 diff classes
2 NRTIs + protease inhibitor/integrase inhibitor = eg. triumeq =Abacavir / Dolutegravir / Lamivudine

NRTI= nucelotide reverse transcriptase inhibitors eg tenofovir + emtrictiabine

on it for life long
give to anyone with HIV (not based off cd4 count)
once normal CD4 count and undetectable viral load trat any physical conditions as they are hiv negative

once undetectable viral load then wont pass it on

if CD4 below 200 = give prophylactic co-trimoxazole to prtoetec agasint PCP

monritor rf for cv as with hiv have increase risk of CVD

cervical smears yearly as increase risk HPV and cervical cancer

vaccines- keep up to date and dont use live vaccine

129
Q

pt has CD4 count below 200
what do

A

once CD4 count below 200 also give prophylactic co trimoxazole to protect agasint pcp

130
Q

what vaccines avoid with pt with HIV

A

dont give live vaccine

131
Q

what need to know about reproductive health if got HIV

A

use protection even if both +ve

if viral load undtectable transmission is vvvvv unliekly
partneers recommened to have regular hiv test

undetectable viral load then can consider unprotected sex and pregancy

caesaerean section fot pt with hIV - can consider vaginal birth if viral load undtetcable

if mum has hiv give the new born baby HAART for 4 weeks to prevent vertical trasnmission

only consider breast feeding if viral load is undetectable

132
Q

gastroentereitis

A

inflammation of stomach = vomiting
inflammation of intestines= diarrhoea

133
Q

most common casue of gastroenteritis

A

viral

134
Q

casues of viral gastroentertitis

A

norovirus
rotavirus
adenovirus- less common but more subacute diarrhoea

135
Q

which e.coli casues gstroentertisi (one to rmebeer there are other strains)

A

e.coli 0157 = produces shiga toxin

136
Q

tranmission of e.coli

A

contact with infected faces, unwashed salfs, contaminated water

137
Q

presentation of gastroenteritis casued by ecoli

A

abdo crams
vomiting
bloody diarrhoea
shiga toxin can aslo desotry blood cells and casue HUS

138
Q

treament of gastroenteritis casued by ecoli

A

no abx! - increases risk of HUS as releaseing the toxin into the blood more by destorying the bacterira

139
Q

key points on E COLI casuing gastroentertis

A

only certain strains
e coli 0157 produces shiga toxin
trnasmission via cotnact with infected faeces, unwashed saldas and contaminated water
presentation= vomiting, abdo cramps, blood diarrhoea
can casue HUS if its shiga toxin
dont give abx as increase risk HUS

140
Q

most comon casue of travellers diarrhoea

A

campylobacter jejuni

141
Q

most common casues of bacterial gastroenteritis

A

campylobacter jejuni

142
Q

campylobacter jejuni transmission and type of bacteria

A

gram -ve, spiral/curved
transmission: raw/uncooked pultry, untreated water, unpasterurised milk

143
Q

presentation of campylobacter jejuni

A

incubation 2-5 days
resolves 3-6 days
abdo cramps
diarrhoea- often with blood
vomiting
fever

144
Q

treat gastroenteritis caused by campylobacter jejuni

A

if severe and know its campylo abx or if have rf eg HIV, hearrt faiure
azithromycin/ciprofloxacin

145
Q

brief summary of campylobacter jejuni gastroenteritis

A

most common casue travellers diarhroea and most common casue bacterial gastroenteritis

transmission via raw/ uncooked pultyr, untreated water and unpasterusied milk

presentation:
incubation 2-5 days
resolved 3-6 days
abdocramps
diarrhoea offten bloody
fever
vomitin
treat
abx if severe/ rf- hiv heart failure
azithromycin/ciprofloxacin

146
Q

shigella transmission

A

faces contaminiating drinking water/ swimming pool/ food
prodduced shiga toxin

147
Q

presentation shigella

A

incubation 1-2 days
reoslvies 1 week without rx
bloody diarrhea
abdo crmaps
fever

148
Q

treat shigella

A

severe abx
ciprofloxacin/ azithromycin

149
Q

shigella breigf summary

A

prouduces shigella toxin
trnasmission faeces contaminating food, wter, swimmming pools

incubation 1-2 days
resovles 1 week
bloody diarrhoea
abdo cramps
fever

if severe abx azitrhomycin/ciprofloxacin

150
Q

salmonella transmission

A

raw eggs/ uncooked pultry and contaminated fiid with infected faeces

151
Q

presentation salonella

A

incubation 12 hrs-3 days
resovles 1 week
water diarrhia - can be assciated with blood/mucus
abdo pain
vomiting

152
Q

treat salmonella

A

if severe abx

153
Q

bacillus cereus type and transmission

A

gram +ve rod
transmission:
inadequately cooked food esp grows on food that been cooked and not immediately put in fridfge eg. rice left at room temp
produces toxin - cereulide

154
Q

presentation bacillus cereus

A

abdo cramp
vomiting within 5 hrs
diarrhoea after 8hrs
resolives within 24 hrs

can also be casue of infective endocarditis in drug users (staphylcoccus aureus most common casue in durg users)

155
Q

breife summary baciullus cereus casuing gastroenterisi

A

GRAM +VE ROD
produces toxin cereulide
most common due to food not put in frisge after cooking 0 eating rice
short incubation period
after ingestion vomit 5hrs afte
after 8hrs diarrhoea (the toxin got the the intestines)
resove 24 hrs

156
Q

pt vomit 5 hrs after eating some food.
then theyget dirahhoea 8 hrs after eating

A

bacillus cereus
5-8-24

157
Q

yersinia enterocolita type and transmission

A

gram -ve bacillus
PIGS- raw/ undercooked pork
contamination of urine/faeces from other mammabls

158
Q

presentation yersinia eneterocolita

A

incubation 4-7 days
lasts 3 weeks or more
watery/bloody diarrhoea
abdo pain
fevers
lymphadenopathy !! = adults and older children can present with r abdo pain due to meseneteric lymphadentitis = may present thereore similar to appendicitis

159
Q

pt fevers
abdo pain
r abdo pain
watery/bloody diarrhwa
ate pork

A

yersinia enterocolitia

160
Q

what gastroenteritis may present similar to appendicitis

A

yersinia enterocolitia- can casue mesenteric lymphadentitis

161
Q

which gastroenteritis cause can cause lyphadenopathy

A

yersinia enterocolitia

162
Q

staphycoccus aureus transmission gastroenteritis

A

produces enterotoxin - causes the issues
fiod- eggs, meat , diary

163
Q

presentation stapyloccus aruesus gastroenteritis

A

diarrhoea
profuse vomiting
abdo cramps
fever
occurs eithin hrs of ingestion
resolves 12-24 hrs

164
Q

giardiasis gastroenteritsi transmision and type

A

parasite
in mammals and they form cysyts with the parasite inthen they infect food etc= faeco oral transmission

165
Q

presentation giardiasis gastroenteritis

A

non
or
chronic diarrhoa

166
Q

diagnose giardiaisis

A

stool microscopy

167
Q

treat giardiasis gastroenteritis

A

metronidazole

168
Q

general treamtnet gastroentneritis

A

asses dehdration
if can oral fluids
if cant then iv fluids
small food
no school/work for 48 hrs after symptoms compellty resoves

try not to use antidiarhoa/ anti emetic

  • can if mild/ mod symptoms eg. loperamide/ metacloprmide

dont use antiemetics/ antidiarrhoal fro shiggella/ ecoli 0157 or if blood diarrhia / fever

169
Q

meningitis

A

inflammation of meninges

170
Q

whats meningiococcal septicaemia

A

casued by neisseria menigitis in the blood
neisseria meningitis is also called menigiococcus

mengioniococcus in the blood stream casues a non blanching rash - the rash means the infection has casues disseminated intravascualr coagulopathy and subcutaenous haameorrhage

neisseria menigitis/ menigiooccus can casue mengitis+/ mengiococcal septicaemia = both are med emergencies

menigiococcal menigitis = bacteria infectig the menginges and csf

171
Q

bacterial meningitis - casues

A

common casues are neisseria menigitis = mengiococcus
streptoccocus penumonia - pneumococcus

neonates= group B streptococcus

if got menigiococcal septicameia too then have the non blanching rash can poorer prognosis

172
Q

casue of non blanching rash

A

= DIC and subcutaenous haemorrhage
meningiococcal septicaemia
but loads other causes:

Conditions you are born with, such as:
Osler-Weber-Rendu syndrome.
Ehlers-Danlos syndrome.
Pseudoxanthoma elasticum (a condition affecting the elastic tissue of the blood vessels and other parts of the body).
Infections picked up during pregnancy whilst still in the womb, such as cytomegalovirus and rubella.
Conditions acquired after you were born, such as:
Severe bacterial infections such as sepsis, infection with one of the germs that cause meningitis (meningococcal disease).
Allergy-based conditions such as Henoch-Schönlein purpura.
Disorders of the connective tissue that connects and binds other bits of the body together, such as systemic lupus erythematosus and rheumatoid arthritis.
As a side-effect of medicines such as steroids and sulfonamides (antibiotics).
Other causes, such as ageing of the skin, injury (trauma), lack of vitamin C (scurvy) and poor blood supply, especially to the legs.
Conditions that cause increased pressure, such as coughing or vomiting.
Thrombocytopenic purpura
Conditions resulting from problems with platelet production, such as:
Bone marrow failure - for example:
Leukaemia.
Aplastic anaemia (anaemia caused by problems with production of the platelets and other blood cells by the bone marrow).
Myeloma.
Cancer deposits replacing the bone marrow.
Medicines such as co-trimoxazole (an antibiotic) and chemicals.
Conditions that increase the breakdown of platelets, such as:
Immune thrombocytopenia.
Systemic lupus erythematosus.
Viral infections.
Conditions affecting the blood clotting (coagulation) system, such as:
Disseminated intravascular coagulation which causes excessive blood clotting in small blood vessels).
Haemolytic uraemic syndrome (destruction of blood cells associated with kidney disease and kidney damage).
Enlarged spleen.
Conditions causing dilution of the platelets, such as rapid transfusion of large quantities of stored blood.

173
Q

presnetation menigitits

A

viral milder
fever
neck stiffness
vomiting
headache
non blanching rash= menigiococcal septicaemia
photophobia
altered consiosness
eizures

neonates and babies:
hypotonia
hypothermia
poor feeding
bulgding fontaelle
lethargy

174
Q

what the two tests can do for menigitis

A

kernigs test=
psotive then painful =>
pt on back, flex knee and hip 90 degrees. slowly straighten knee but keep hip flexes 90 degrees. = stretched meniges and if meningitis get spinal pain/ resistanc with movement

Brudzinskis test= on back, dr lifts the pts head and neck off the bed and flex their chin to chest- psotive test when casues pt to involutnaruly flex hips and knees

175
Q

investifation mengitits

A

LP for CSF- ahve bacterial culture, glucose, protein, cell count, viral PCR do before starting abx but if pt ancutely unwell then dont delay the abx

(do LP for all childrne uner 1 onth with fever. do for children 1-3 omths f fever and unwell. do for children unde r1 yr old if unexplaine dfever and serious illness)

blood culture
fbc
renal fucntion
coagualtion- esp ifDIC suspected
bloods for menigiococcoal PCR if susect meningiococcal disease
blood glucose- do same time LP glcuose so can compare

176
Q

management for bacterial meningitis

A

prior to hosp transfer give IV/IM benzylpenicillin
- do fot all children with suspected mingintis with non blanching rash
- do fot adults with severe spesi- low bp, altered consiousness, poor cap fill time/ hosp over 1hr away

under 1 yr=300mg
1-9yrs= 600mg
over 10 and adults 1200mg

abx=>
of under 3 months= cefotaxime + amxocillin (listeria)

over 3 months= ceftriaxone
+ vancomycin if at risk of penicillin ressitatn penumococcal eg. if recent forgein travel or proplonged abx exposure

+ give steroids- dexamethoasone 4 times day for 4 days tp reduce frequency and severity of hearing loss and neuro damage

notifable disease

177
Q

casues of viral meningitis

A

enterovirus
hepres simpplex virus
varicella zoster virus
= less severe viral compared to bacteria

178
Q

treament viral menigitis

A

supportive
if herpez simplex virus casue then can give aciclovir

179
Q

complcaitions menignits

A

HEARING LOSS
seizures + epilepsy
cognitive impairment and learning disability
memory loss
focal neruo defecit - limb weakness/ spastiticty

180
Q

what does LP show for mengitings

A

bacteria in csf they use up glucose and relase lots protien = low glucose, high prtoein
virus in csf they dont use glcuose but may release small amount protein

the immune system in repsonse to bacteria relase neutrophils
in response to virus release lymphoctyes

181
Q

bacterial LP menigitis

A

cloudy
hgih protein over 1.5 g/l
low glucose under 0.5
over 1000 white cell and neutrophils
psotive bacterial culture

182
Q

vrial LP mengitits

A

clear
mild raised/normal prtoein
normal glucose - 0.6-.08
over 1000 wcc lymphoctyes
negative culture

183
Q

cause of malaria

A

plasmodium family of protozoan parasite

spread by bite from female anopholes mosquiti that carries the disease

184
Q

types of malaria

A

p. falciparum = most severe
daily/contionous fever
subsaharan africa, tropics
present within 4 weeks of return but can present up to a year after
most common in uk pop

plasmodium vivax
india, s e asia, s america, e africa
less sevre
teritan fever
can present several months after
prophylaxis ineffective

p ovale
p malariae

185
Q

lifecycle of malaria

A

infected blood sucked by mosquito –> reproduce in gut of mosquito => sporozoites = malaria spores
–> bite human and inject sporozoites in
–> goes to liver
–> can lie dormant in liver as hypozonoites for severeal years in vivax and ovale
–> merozointes in liver and then enter blood and ifect rbc–>
merozoites reproduce in rbc - 48hrs ish (not falciparum its quicker for that)
–> rupture rbc= haemolytic anemia

186
Q

presentation malarai

A

fever- daily/continuous in falciparum/ tertian in vivax
headache
malasie
myalgia
sweats
rigors
vomiting
pallor-anemia
hepatosplenoemgaly
jaundice

incubation 1-4 weeks
can like dormant for years some types though
if fever within 1yr travel always consider malaria

187
Q

how to daongose malaria

A

blood film
3 samples over 3 consecuative days to exclude malaria- cus can be negative if the parasites not released from the rc that day

188
Q

managment of malaria

A

treat if falciparum
treat if vivax can

189
Q

treatment for malaria casued by falciparum

A

hosp
if uncomplciated malaria:
malarone= proguanil + atocaquone
riamet = artemether + limefantine
quinine sulphate
doxycyline

if severe / complicated:
artesunate = most efective but not lsicensed
quinine dihydrochloride

190
Q

treatment for vivax malaria

A

artemether and lumefantine/chorquine
then primaquine to eliminate hypozonite stage

check no G6PD deficiency before primaquine given- primaquine causes rbc burst

191
Q

complications of p falciparum malaria

A

seizures
AKI
pulmonary oedema
cerebral malaria
decreased consiousness
DIC
severe hameolytic anemia
multi organ failure and death

192
Q

malaril prophylaxis what used

A

nets, sprays, antimalraials

malarone = proguanil + atovaquone
- take daily- 2 days before, during and 1 week after
best se profile

mefloquine
- once weekly- 2 weeks before, during, 4 weeks after
se= bad dreams, psycotic disorders and seizures

doxycyline
-daily, 2 days before, during, 4 weeks after
se= cus broad spectrum abx can casue diarrhoea and thrush
can casue senstive to sun- rash and sunburn

193
Q

abx that inhibit cell wall synthetis
with beta lactam ring

A

penicillins- flucloxacillin, tazocin, Pen V, amoxicillin, co- amox, benzylpenicillin

carbapenems- meropenem
cephalosporins - ceftriaxon

194
Q

abx that inhibit cell wall sysnthesis and dont have a beta lactam ring

A

vancomycin
teircoplanin
- these are glycoprotiens

195
Q

abx that inibit folic acid metabolism

A

sulfamethoxaole = blocks DHFA => THFA
trimethorpim = blocks THFA=> folic acid

used in combo= co-trimoxazole

196
Q

metronidazole does what

A

inhibits nucelic acid synthesis but only in anearobes

197
Q

abx that inhibit protein syntheissi by targeting ribosomes

A

macrolides=> erythromycin, clarithromycin, aziathromycin
clindamycin= linosamide drug
tetracyclines= doxycyline
gentamicin
chloramphenicol

198
Q

erythromycin
clarithromycin
aziathromycin

what type abx

A

macrolides = inhibit protein syntheisis by targeting ribosomes

199
Q

meropenem what abx

A

carbapenems

200
Q

ceftriaxon what abx

A

cephlasporins

201
Q

ciprofloxacin
levofloxacin
moxifloxacin
nalidixic acid
what type abx

A

quinolones

Medicine (11 decks)

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