Infection

Question 1

What is Mastitis?

Answer 1

Painful inflammatory condition of breast

Can lead to formation of breast abscess which is a complication

Question 2

What are the causes of Mastitis?

Answer 2

Infectious Causes :
- Lactational or duct ectasia (milk stasis)
- MC cause is Staph. aureus

Non-infectious causes :
- Idiopathic granulomatous Inflammation
- Foreign body reaction

Question 3

H&E of Mastitis

Answer 3

• Coryzal symptoms (common cold symptoms)
• Nipple discharge
• Redness
• Tenderness
• Abscess

Severe signs:
- Infected nipple fissure
- Not improving
- Positive breast milk culture

Question 4

Investigations for Mastitis

Answer 4

Breast milk culture and clinical diagnosis

Question 5

Management of Mastitis

Answer 5

Lactational / Non-severe :
- Continue breastfeeding
- Warm compress
- Analgesia

Severe or not improving after milk removal :
- Oral flucloxacillin for 10-14 days

Non-lactational :
- Co-amoxiclav 3x a day for 10-14 days

Question 6

Management of breast abscess

Answer 6

• Incision and drainage (+culture)
• IV/PO antibiotics (typically doxycycline)
• Analgesia

Question 7

What is Sepsis?

Answer 7

Life-threatening organ dysfunction caused by dysregulated host response to infection

Question 8

What is septic shock?

Answer 8

A more severe form of sepsis, technically defined as ‘in which circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone’

Question 9

How is the quickSOFA score used in sepsis?

Answer 9

qSOFA score

RR > 22/min
Altered mentation
Systolic BP < 100mmHg

Adults with suspected infection with qSOFA score >= 2 at heightened risk of mortality

Within ICU for SOFA score is used

Question 10

Red Flags for Sepsis

Answer 10

• Responds only to voice or pain/unresponsive
• Acute confusional state
• Systolic BP <= 90mmHg or drop >40 from normal
• HR > 130
• RR > 25
• Needs oxygen to keep SpO2 >= 92%
• Non-blanching rash, mottled/ashen/cyanotic
• Not passed urine in last 18h/ UO < 0.5ml/kg/hr
• Lactate >= 2mmol/L
• Recent Chemo

Question 11

Management of Sepsis

Answer 11

If any of the red flags are present the ‘sepsis six’ should be started straight away:

1. Administer oxygen : keep above 94% or 88-92% if at risk of CO2 retention
2. Take blood cultures
3. Give broad spectrum antibiotics
4. Give IV fluid challenges
5. Measure Serum Lactate
6. Measure accurate hourly urine output