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Semester 3 - me > Infection > Flashcards

Infection Flashcards

1
Q

What does SIRS stand for?

A

Systemic Inflammatory Immune Response

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2
Q

What clinical features does SIRS consist of?

A 
You need 2 of the following:
HR >90bpm
Temp 38
WBC 12 
RR >20/min
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3
Q

Define bacteraemia

A

This is where there is bacteria in the blood but no clinical symptoms

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4
Q

Define septicaemia

A

This is where there is bacteraemia clincally

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5
Q

Define sepsis

A

This is clinical presentation + SIRS

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6
Q

Define severe sepsis

A

SIRS and organ dysfunction

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7
Q

Define septic shock

A

This is where the blood pressure does not increase despite IV fluids`

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8
Q

What investigations would you perform for sepsis?

A 
FBC
LFT
Urea and electrolytes 
Blood culture 
Blood sugar
Blood gases
CRP
Clotting factors
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9
Q

What is the sepsis 6 and when should you do it?

A

Within one hour

1) deliver high o2
2) take blood cultures
3) IV antibiotics
4) measure serum lactate
5) IV fluids
6) urine output measurement

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10
Q

What antibiotics are used for meningitis and why?

A

Ceftriaxone because it can cross the CSF

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11
Q

What are life threatening complications of sepsis?

A 
Liver failure
Irreversible hypotension
Kidney failure 
Raised intracranial pressure
Ischaemic necrosis of peripheries
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12
Q

How would you confirm the diagnosis of sepsis?

A

Blood culture
PCR
Lumbar puncture (turbidity, colour, microscopy)

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13
Q

What can sepsis lead to in terms of coagulation?

A

Cytokines promote thrombin and inhibit fibrinolysis

This can lead to necrosis, lack of perfusion, organ dysfunction and failure

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14
Q

Describe neisseria meningitidis

A 
This is a gram negative diplococcus 
More common in the winter or Africa
It's a normal oral commensal 
Antiphagocytotic capsule 
Lipopolysaccharide activates TLR4 - sepsis
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15
Q

What are the symptoms of meningitis?

A

Fever
Headaches
Stiff neck
Rash

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16
Q

Should treatment of meningitis wait conformation?

A

No!

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17
Q

How is neisseria meningitidis spread?

A

Direct aerosol

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18
Q

Describe streptococcus pneumoniae

A

Gram positive coccus
Causes pneumonia, meningitis, resp infection, endocarditis
Invades the blood
Susceptable to penicillin

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19
Q

Describe E. coli

A 
This is a normal flora in the GI tract 
Causes food poisoning/UTI
facultative 
faecal oral transmission or faecal perineal 
Gram negative bacilli
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20
Q

When is the onset of hospital infections?

A

At least 48 hours after transmission

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21
Q

What percentage of patients are hospital infections?

A

8%

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22
Q

Name some hospital acquired infections

A 
Pneumonia
GI
UTI
C diff
MRSA 
Surgical wounds 
Skin 
Bloodstream
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23
Q

Name some common hospital acquired viruses

A

Hep B
Norovirus
Influenza
Chicken pox

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24
Q

Name some common hospital acquired fungi

A

Aspergillus

Candida

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25
Q

Name a hospital acquired parasite

A

Malaria

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26
Q

Who is at risk of a hospital acquired infection?

A 
Extremes of age
Diabetes 
Immunocompromised
Chemotherapy
Obese 
Malnutrition 
Surgery
Smoker
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27
Q

How can you prevent hospital acquired infections?

A 
Stop smoking 
Diet
Diabetes control
Iodine
Handwashing 
Sterilisation
Pressure rooms 
Bed layout
Individual rooms 
Steam cleaning
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28
Q

How can antibiotic resistance occur?

A 
Increased efflux
Decreased influx
Altered target
Altered transcription 
Impermeability
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29
Q

Describe staph aureus

A 
Commensal in URT 
Gram positive bacilli 
Facultative 
Spreads by air 
MRSA
30
Q

What infections does staph aureus cause?

A 
Toxic Shock Syndrome
MRSA
Endocarditis 
Impetigo 
Surgical wounds
31
Q

What antibiotics are used to treat staph aureus?

A

Tetracycline, erythromycin, clindamycin

32
Q

Describe C difficile

A 
Watery, yellow, pale diarrhoea 
Endotoxins
Spore 
Anaerobe 
Gram positive bacilli 
Antibiotic associated
33
Q

What is diarrhoea defined as?

A

Over 3 loose stools per day

34
Q

What symptoms do you get with c diff?

A

Abdo pain
Nausea
Diarrhoea

35
Q

How do you treat c diff?

A

Stop antibiotics
Treat with metronidazole for 10 days
IV if severe

36
Q

Describe norovirus

A 
Infection common in winter 
D+V in hospitals 
Projectile
Diagnose by NAAT 
Ward closure
37
Q

What are the key aspects of a travel history?

A

Where, when, with who, what did you do, was it direct, where did you stay, how long for?

38
Q

What are common diagnoses of travel infections?

A 
Typhoid
Dengue
Malaria 
Yellow Fever
TB
39
Q

Where can you get information on outbreaks of where a patient has travelled?

A

NICE
WHO
Centre of disease control

40
Q

What organisms cause malaria?

A

Plasmodium falciforum (most fatal)
Plasmodium ovale
Plasmodium malariae
Plasmodium vivax

41
Q

How is malaria transmitted?

A

Bite of anopholes mosquito

42
Q

What symptoms are associated with malaria?

A

Headache, cough, malaise, fever every 3rd/4th day, arthralgia

43
Q

What is the incubation period of malaria?

A

3 weeks

44
Q

How would you investigate malaria?

A 
Infectious disease physician 
Blood smear 
urea, electrolytes, fb 
CT
Microscopy
45
Q

How do you treat malaria?

A

Quinine for falcifarum

Primiquine for the rest

46
Q

What is the pathway of events of malaria?

A 
Gets into blood
Liver
Multiplies 
Red cells
Another bite
47
Q

How do you prevent malaria?

A

Chemoprophylaxis

Spray, nets, clothing

48
Q

What is enteric fever?

A

Thyphoid and parathyphoid

Poor sanitation

49
Q

How does enteric fever spread?

A 
Faecal oral 
Invasion of intestine
Spread to lymph
Bacteraemia
Multiply in peyers patches
50
Q

What are the symptoms of enteric fever?

A 
Headache 
Diarrhoea
Vomitting 
Rosy rash on abdomen 
Hepatosplenomegaly
Cough
Bradycardia
51
Q

What investigations would you do for enteric fever?

A 
Anaemia 
Lymphopenia 
Culture
FBC
Serology
52
Q

What antibiotic would you use for enteric fever?

A

Ceftriaxone

53
Q

What is antigenic drift?

A

A minor change in the genome of a pathogen
Large number of people with no immunity
Epidemic results

54
Q

What is antigenic shift?

A

This is when there is a major change in the genome so noone is protected and causes a pandemic

55
Q

Describe influenza A and antigentic shift

A

Swine flu
Spanish flu
Bird flu

56
Q

What is a virion?

A

Genome and capsid

57
Q

What is the sequence of events of replication of a virus?

A 
Absorption
Entry
Uncoating
Transcription
Virion synthesis
Assembly
Replication
Release
58
Q

What investigations can you use for viruses?

A

Antibody detection
Viral Load
CD4
PCR

59
Q

Describe HIV

A

This is a lentivirus

RNA single stranded

60
Q

Describe the process of infection of HIV

A 
Attachment to host CD4
Reverse transcriptase
Integration into host cell
Reproduction of viral components 
Assembly of new viruses 
Release
61
Q

What happens when host CD4 drops?

A

Weirder infections

62
Q

What are the symptoms of primary HIV?

A 
Fever
Rash 
Flu like symptoms 
Pharyngitis
Lymphadenopathy
63
Q

How do you diagnose HIV?

A

Immunoassay
PCR
Viral load
Antibodies and antigens

64
Q

What investigations do you perform with HIV?

A

Full body
Chest x ray
Comorbidities

65
Q

How can you treat HIV?

A

3 antivirals to suppress but no cure

66
Q

Describe hepatitis B

A

This is a hepadnavirus
Double stranded DNA
6 month incubation
There is a vaccine

67
Q

What would you examine for with Hep B?

A 
Caput medusa
White nails 
Clubbing
Jaundice
Ascites
68
Q

How do you treat hep b?

A

monitor viral load and decide when to give antivirals

69
Q

Describe hep c

A

Flavavirus
IVDU main cause
High risk of chronic infection
There is a vaccine

70
Q

Explain the pros/cons of drugs used with hep c

A

They lower cancer and cirrhosis risk

Have horrible side effects

Semester 3 - me (8 decks)

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