Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Specialities > Infection > Flashcards

Infection Flashcards

1
Q

Presentation of non-inflammatory diarrhoea

A

Frequent watery stools with little abdo pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Acute causes of diarrhoea

A

Bacterial, viral, amoebic dyssentery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Main symptoms of gastroenteritis

A

Diarrhoea and vomiting caused by stomach and intestinal inflammation (viral or bacterial infection most common)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Bacterial diarrhoea organisms

A
  • E.coli is most common
  • Salmonella
  • Shigella
  • Campylobacter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the most common cause of diarrhoea

A

Rotavirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How would you assess hydration in a patient with diarrhoea

A

Postural BP, skin turgor and pulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Investigations of diarrhoea

A
  • Stool culture
  • Blood culture
  • Renal function
  • Blood count - neutrophilia, haemolysis
  • Abdominal X-ray if abdomen is distended and/or tender
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Differential diagnosis of diarrhoea

A
  • Inflammatory bowel disease
  • Spurious diarrhoea (secondary to constipation)
  • Carcinoma
  • Diarrhoea and fever can occur with SEPSIS OUTSIDE THE GUT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Treatment of gastro-enteritis

A

Rehydration - oral with salt/sugar solution or IV saline

Antimicrobials (in systemically unwell, immunosuppressed or elderly)

DONT GIVE ROUTINE ANTI-DIARRHOEALS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Drugs that cause diarrhoea

A

ANTIBIOTICS - clindamycin, erythromycin, penicillins, tetracyclin, neomycin

LAXITIVES

Digoxin, magnesium salts, omeprazole, cimetidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Chronic causes of diarrhoea

A

Metabolic disorders - thyrotoxicosis, hyperthyroidism, anxiety

Small bowel disease - crohn’s, coeliac

Large bowel disease - ulcerative colitis, colon cancer, IBS, spurious (with constipating drugs - cause impacted stools that only allow watery stools to exit bowel)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Presentation of e.coli 0157 infection

A

Frequent bloody stools

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Complications of e.coli 0157 infection

A

Toxin can cause haemolytic uraemic syndrome

–> haemolytic anaemia and renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Bacterial responsible for travellers diarrhoea

A

Enterotoxic e.coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When give antibiotics for gastroenteritis

A

Immunocompromised, severe sepsis or invasive infection, valvular heart disease, chronic illness, diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which bacteria is commonly responsible for diarrhoea after previous antibiotic treatment

A

Clostridium difficile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treatment of clostridium difficile diarrhoea

A

Metronidazole, oral vancomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which antibiotics have been blamed for c difficile infection

A

Broad spectrum - 4 Cs

Cephalosporins
Clindamycin
Clarythromycin
Co-amoxiclav

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Features indicating systemic illness

A
  • fever >39.5; dehydration

- diarrhoea and visible blood (= dysentery) for >2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Define sepsis

A

Systemic illness caused by microbial invasion of normally sterile parts of the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Features of systemic inflammatory response syndrome

A

Temperature >38 or 90

RR >20 or PaCO2 12,000 or 10% bands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Triggers of SIRS

A

Infection, surgery, trauma, burns, pancreatitis and malignancies (lymphoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Define sepsis

A

Systemic inflammatory response syndrome triggered by a primary localised infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Signs of sepsis

A

2 or more of SIRS features (tachycardia, hypothermia or hyperthermia, low or high WBC, tachypnoea or low PaCO2)

Resulting from infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Signs of severe sepsis

A

Sepsis (2 or more SIRS features and infection) alongside signs of organ hypoperfusion - hypoxemia, oliguria, lactic acidosis or acute alteration in mental state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Signs of septic shock

A

Severe sepsis with hypotension OR the requirement for vasoactive drugs DESPITE adequate fluid resuscitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Multi-organ complications of SIRS, sepsis and septic shock

A

Cardiac - hypotension and tachcardia
Respiratory- tachypnoa, hypoxaemia, respiratory alkalosis, ARDS
Renal - acute renal failure (cytokine mediated vasodilation and hypotension cause decreased renal prefusion)
Haematological - disseminated intravascular coagulation
Lactic acidosis caused by tissue hypoxia from tissue hypoperfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Investigations to identify trigger the trigger of SIRS or sepsis

A
  • chest Xray
  • blood culture
  • FBC, U&E, LFT
  • arterial blood gas
  • urine dipstick
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Sepsis 6 (give 3 and take 3)

A
  1. Give high flow oxygen
  2. Take blood cultures
  3. Give empirical antibiotics IV
  4. IV fluid resuscitation
  5. Check Hb and lactate (ABG or VBG)
  6. Monitor urine output accurately
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Patholophysiology of sepsis

A

Originates from breach of integrity of host barrier - physical or immunological –> organism enters blood stream causing septic state

  • -> uncontrolled inflammatory response
  • release of bacterial toxins
  • release of mediators (endotoxins, exotoxins…)
  • effects of specific excessive mediators (pro-inflammatory vs anti-inflammatory)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Effect of excessive pro-inflammatory mediators

A

Immunoparalysis with uncontrolled infection and multi-organ failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Effect of excessive compensatory anti-inflammatory mediators

A

Septic shock with multi-organ failure and death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Causes of high lactate

A

Hypoperfusion

Also - mitochondrial toxins, alcohol, malignancy, metabolism errors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Rule for fluid administration in patient with severe sepsis/septic shock

A

30ml/kg fluid challenge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the empiric antibiotic recommendation for severe pneumonia

A

IV amoxicillin 1g tds and clarythromycin 500mg bd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Spread of HIV

A
  • Sexual transmission
  • Injection drug misuse
  • blood products
  • vertical transmission (from mother to embryo, fetus, baby during pregnancy or childhood
  • organ transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Clinical stage 1 HIV

A

Asymptomatic
Persistent generalised lymphadenopathy
Normal activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Clinical stage 2 HIV

A

Weight loss (

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Clinical stage 3 HIV

A 
Weight loss (>10%)
Unexplained chronic diarrhoea 
Unexplained prolonged fever (intermittent or constant) >1 month
Oral candidiasis (thrush)
Oral hairy leukoplakia
Pulmonary TB, within past year 
Severe bacterial infections 
- performance scale 3: bedridden
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Clinical stage 4 HIV

A

HIV wasting syndrome
HIV encephalopathy
Performance - bedridden

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the difference between AIDS and HIV

A

Certain infections and tumours that develop due to a weakness in the immune system = AIDS illnesses. If you have no symptoms then you have a HIV infection only.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Immunology of HIV

A

HIV infects and destroys cells of the immune system especially CD4 positive T-helper cells. CD4 receptors are also present on the surface of macrophages and monocytes, cells in the bran and skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Natural history of HIV infection

A

Over course of infection, CD4 count declines and HIV viral load increases. As the CD4 count falls the risk of developing infections an tumours increases

Acute infection –> asymptomatic –> HIV related illnesses –> HIV defining illness –> death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Opportunistic infections that affect those with HIV

A
  • Pneumocystis jiroveci pneumonia
  • Candidiasis
  • Mycobacterium avium complex
  • Cryptosporidiosis
  • cerebral toxoplasmosis, TB, CMV disease REACTIVATION
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

AIDS defining conditions

A

TB, pneumocytis, kaposi’s sarcoma, cervical cancer, non-hodgin lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is seroconversion in relation to HIV

A

Approximately 30-60% of patients have a seroconversion illness - when HIV antibodies first develop

Abrupt onset 2-4 weeks post exposure, self limiting 1-2 weeks

Symptoms are generally non-specific and differential diagnosis includes wide range of common conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Symptoms of HIV seroconversion

A 
Flu like illness 
Fever 
Malaise and lethargy 
Pharyngitis
Lymphadenopathy 
Toxic exanthema

— Looks like glandular fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Treatment of HIV

A

Antiretroviral therapy - lifelong

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Side effects of anti-viral therapy for HIV

A
  • Lipodystrophy,
  • Hyperlipidaemia
  • Insulin resistance
  • Marrow toxicity,
  • Neuropathy
  • Rashes
  • Diarrhoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

HIV and pregnancy risk of transmission

A

Minimised by effective antivirals
Caesarean section reduces transmission where viral load is detectable
Give neonate antiretroviral therapy for 4 weeks
Need to avoid breast feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Tests to diagnose HIV infection

A

Antigen/antibody detection

–> ELISA assays allow simultaneous detection of antibody and antigen

Need to confirm with at lease one additional antibody/antigen test and determine whether HIV-1 or HIV-2

Avidity testing
–> indicates whether infection acquired in last 3-4 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How to determine the viral load in HIV

A

HIV genome detection - quantification of HIV RNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

How to monitor the effectiveness of HIV treatment

A

Viral load - HIV genome detection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How to diagnose an infant with HIV

A

Viral load quantifies HIV RNA - child will have passively acquired maternal antbody

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Define meningism

A

Symptom complex characterised by headache, photophobia and vomiting with muscle spasm leading to neck rigidity (stiffness on passive neck flexion)

MENINGISM MAY OCCUR IN ABSENCE OF MENINGITIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Causes of meningism

A

Meningitis, sub-arachnoid haemorrhage or infection accompanied by bacteraemia, some viral infections (influenza)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Define meningitis

A

Inflammation of the meninges due to infection - leads to signs of meningeal irritation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Pathogenesis of meningitis

A
  1. Attachment of mucosal epithelial cells
  2. Transgression of the mucosal barrier
  3. Survival in the blood stream
  4. Entry into the CSF
  5. Production of overt infection in the meninges with or without brain infection (encephalitis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Bacterial meningitis causative organisms

A 
Neisseria meningitidis (meningococcus); 
Streptococcus pneumoniae (pneumococcus)

E.coli and group B streptococci in neonates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Viral causative organisms of meningitis

A

Enteroviruses - echoviruses, parechoviruses, coxsackie viruses A and B
Mumps - rare due to MMR vaccine
Herpes simplex virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Non-infective causes of meningitis

A

Tumour cells in the CSF may produce an aseptic meningitis

Certain drugs or chemicals or by some diseases of unknown aetiology (sarcoidosis, SLE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Presentation of bacterial meningitis

A

Headache, photophobia, neck stiffness and vomiting
Fever (or recent fever) with clouding of consciousness

May be nerve palsies of CN VI, VII and VIII

Usually acute onset and rapid progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What skin change may be noticed in a patient with meningitis

A

Skin and conjunctival petichiae which occur in about 60% of patients with meningococcal infections but can also occur in other bacterial meningitides and with viral meningitis and endocarditis

Other rashes - vasculitis, macular/maculo-papular, purpuric, pruritic or vescicular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Kernig’s sign

A

Hip flexed, the patient cannot be straigthened due to hamstring spasm in meningism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

How would you demonstrate neck stiffness

A

Attempt to flex the neck to touch the chin to the chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Investigations for suspected meningitis

A

Blood cultures

Lumbar puncture - if there are focal neurological signs or papilloedema need to exclude a space occupying lesion with a CT

FBC

Routine urea and electrolytes for renal function

LFTs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

How long does it take for a blood culture result

A

It takes at least 6 hours and usually 12-48 hours incubation before an organism becomes detectable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

CSF microbiology tests for meningitis

A 
Gram stain (ZN if appropriate)
Differential cell count (neutrophil polymorphs or lymphocytes)
Antigen detection test
Bacterial culture 
PCR for viruses if appropriate 
PCR for bacteria if appropriate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

CSF biochemistry tests for meningitis

A

Glucose

Protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Examples of non-inflammatory diarrhoea

A

Secretory toxin mediated

  • cholera increases cAMP levels and Cl secretion
  • enterotoxigenic E.coli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Meningism

A

Neck stiffness
Photophobia
Vomiting
Headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Causes of meningism

A

Meningitis
Subarachnoid haemorrhage
Infection +/- bacteraemia - UTI, influenza, tonsilitis
Non-infective - tumour in CSF, sarcoid, SLE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Bacterial infective organisms for meningitis in infants

A

E.coli

Group B streptococcus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Bacterial meningitis organisms

A

Neiserria meningitidis

Strep. Pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Viral causes of meningitis

A

Enteroviruses

  • echoviruses
  • parexovirus
  • coxsackie A&B
  • polio (Rare)

Mumps

HSV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Investigations for suspected meningitis

A 
Blood culture 
Lumbar puncture 
PCR
FBC
UandE
LFT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

CSF findings in bacterial meningitis

A

Turbid (cloudy)
Neutrophils predominant cell type
Less glucose
More protein

78
Q

CSF findings in viral meningitis

A

Clear –> cloudy
Lymphocytes predominant cell type
Normal glucose
Moderate increase in protein

79
Q

CSF findings in TB meningitis

A

Clear –> turgid
Lymphocytes predominate or mixed
Less glucose
Large increase in protein

80
Q

What features may suggest a bacterial cause of meningitis

A

(Meningism)
FEVER
CLOUDING OF CONSCIOUSNESS
RASH

81
Q

Antibiotic therapy for bacterial meningitis

A

Benzylpenicillin - good at penetrating into the CSF

Possibly give dexamethasone to reduce likelihood of developing neuro sequelae

82
Q

Epidemiology of neisseria meningitidis

A

In scotland most are caused by groups B and C but C has reduced to menC vaccine

Outbreaks commonly occur where large numbers of young people mix

83
Q

Meningococcal infection presentation

A

Acute onset of meingism, systemic upset and a skin rash, usually petichial

84
Q

Fulminant meningococcal septicaemia is characterised by…

A

Rapid deterioration in consciousness, fever, septicaemic shock with renal failure and disseminated intravascular coagulation

85
Q

Mortality of meningococcal septicaemia

A

50% of patients die within the first 24 hours of illness

86
Q

What are the early symptoms of meningococcal sepsis

A

Cold hands and feet
Leg pains
Abnormal skin colour

Purpuric rash

87
Q

What to do if suspect meningococcal inection

A

Parenteral PENICILLIN 3-4 MU prior to transfer to hospital

If patient acutely unwell when arrive in hospital administer high dose CEFTRIAXONE prior to LP but after blood culture

BENZYLPENICILLIN has lower spectrum so consider after results of blood culture

When discharging RIFAMPICIN or CIPROFLOXACIN to eradicate carriage from nasopharynx

88
Q

Most common cause of meningitis in adults

A

Streptococcus pneumoniae

89
Q

Predisposing factor for pneumococcal meningitis

A 
Pneumonia
Sinusitis
Endocarditis 
Head trauma 
Alcoholism 
Splenectomy
90
Q

Microbiology of pneumococcal meningitis

A

Gram positive diplicocci and alpha haemolytic

91
Q

Treatment of pneumococcal meningitis

A

High dose ceftrioxone on admission

Benzylpenicillin is effective for pneumococcal meningitis
Ceftrioxone in benpen resistant

92
Q

Complications of pneumococcal meningitis

A

Death (30-50% mortality)

In those who survive: loss of hearing, hemiparesis, hydrocephalus, seizures - dexamethasone reduces likelihood of this occurring

93
Q

Prevention of pneumococcal meningitis

A

Pneumococcal vaccine - pneumovax
Covers 23 serotypes

Recommended for all >65
Splenectomy, diabetes, chronic renal disease, cardio-respiratory disease, HIV infection

Prevenar in childhood

94
Q

What does the hib vaccine work against

A

Haemophilus influenzae type B - causes meningitis, arthritis, epiglottitis

Given to all 2 months old+

— uncommon now

95
Q

Epidemiology of viral meningitis

A

Most cases young women or children

Enteroviruses - echoviruses and coxsackie most common cause in UK, occurring usually in late summer, early autumn

Mumps uncommon due to MMR, polio uncommon, HSV and EBV especially in immunocompromised

96
Q

Clinical presentation of viral meningitis

A

Non-specific prodromal illness followed by rapid onset of headache, photophobia, low grade fever and stiff neck

Usually lucid and alert

Encephalitis - lethargy, confusion, seizures, focal neurological signs

97
Q

Investigation for suspected viral meningitis

A

PCR of CSF for enterocytes, herpes simplex, mumps etc.

Enteroviruses can also be detected in throat swabs and faeces

Test for HIV if appropriate NB may be part of seroconversion so test would be negative

98
Q

Treatment of viral meningitis

A

Enteroviruses and parenchoviruses - symptomatic and will recover within 72 hours

If chronic infection occurs (e.g. Patient immunocompromised) need IV immunoglobulin

Give aciclovir IV for herpes simplex

99
Q

Prognosis of viral meningitis

A

Most make complete recovery without long term sequelae

Mumps could cause deafness, orchitis or testicular atrophy

100
Q

What is the most important cause of meningitis with HIV infection

A

Cryptococcus neoformans - found in bird droppings

101
Q

Presentation of fungal meningitis

A

More commonly is a sub-acute onset of symptoms with low grade fever, headache, nausea, lethargy, confusion and abdo pain

Meningism is less common

102
Q

Treatment of fungal meningitis

A

Parenteral amphoterecin sometimes in combo with flucytosine

Or high dose fluconazole

103
Q

Prevention of fungal meningitis in those with HIV

A

Secondary prevention: Long term chemoprophylaxis with fluconazole for all with HIV following an episode of cryptococcal meningitis

104
Q

What conditions predispose neonates to meningitis

A

Low birth weight

Prolonged rupture of membranes

Maternal diabetes mellitus

105
Q

What are the most common bacteria implicated in neonatal meningitis

A

Group B strep (gram +ve cocci)
E.coli
Listeria monocytogenes

106
Q

Presentation of neonatal meningitis

A

Early within 3 days of birth: marked respiratory distress, bacteraemia, and high mortality - organism acquired at birth from mother’s genital tract

Late >week after birth: bacteria and meningitis - spread by cross infection from other mothers, babies or health care workers

107
Q

Diagnosis of neonatal meningitis

A

Neonatal CSF and blood cultures; maternal blood cultures;

CSF, EDTA blood, faeces and nasopharyngeal secretions for viral

108
Q

Treatment for neonatal meningitis

A

Parenteral ampicillin and gentamycin or cefotaxime

109
Q

Prevention of neonatal meningitis

A

Chemoprophylaxis to prevent neonatal group B strep infection is given to high risk mothers during labour using amoxycillin or co-amxiclav

At risk: prolonged interval between membrane rupture and delivery (>18hours), intrapartum fever

110
Q

Bacterial causes of pneumonia

A 
Streptococcus pneumoniae
Staph aureus (post influenza) 
Mycoplasma pneumonia (common in young adults)
Chlamydia psittaci (bird owners!)
110
Q

How would you assess the severity of community acquired pneumonia

A 
CURB-65
Confusion 
Urea >7mmol/L
Respiratory rate >30
BP 65
2 = consider admit 
2-5 = severe pneumonia
111
Q

Complications of pneumonia

A 
Pleurisy, pleural effusion, empyema 
Lung abscess
Abnormal pulmonary fas exchage 
Bronchiectasis = permanent dilatation of bronchi that need physio to help clear sputum 
Aspiration pneumonia
112
Q

Risk factors for contracting tuberculosis

A 
HIV - screen for
Overcrowding 
Chronic lung disease
From S. Asia or Africa
Malnutrition
113
Q

Treatment of tuberculosis

A

Isoniazid and rifampicin for 6 months

Pyrazinamide and ethambutol for 1st 2 months

114
Q

Symptoms of tuberculosis

A

SOB
Cough and sputum
Haemoptysis
Crackles

Blood-borne spread - malaise, weight loss, fever, night sweats

115
Q

Side effects of the drugs used to treat tuberculosis

A

Pyrazinamide –> gout
Ethambutol –> optic neuropathy
Isoniazid –> hepatitis, peripheral neuropathy
Rifampacin –> orange/iron bru urine and tears; induces liver enzymes so changes effectiveness of prednisolone, anti-convulsants, oral contraceptives

116
Q

Define hospital acquired pneumonia

A

Pneumonia occuring greater than 48hours after admission to hospital

117
Q

Causative organisms for hospital acquired pneumonia

A

Usually gram negative and drug resistant:

  • klebsiella
  • serratia
  • enterobacter
  • pseudomonas
118
Q

Signs and symptoms of infective endocarditis

A 
Fever
Roth spots
Osler nodes
Murmur - new or changed
Janeway lesions 
Anorexia 
Nail haemorrhage 
Embolism

May have SOB and fatigue and chest pain

119
Q

Modified duke criteria for infective endocarditis

A

Major -
Blood cultures are positive for IE
Evidence of endocardial involvement - echocardiography, new valvular regurgitation

Minor -
Predisposition including heart condition or injecting drug use
Fever
Vascular phenomena
Immunologic phenomena - glomerulonephritis, osler’s nodes, roth’s spots, rheumatoid factor
Microbiological evidence

Need 2 major, 1 major and 3 minor or 5 minor criteria

120
Q

Causative organisms for infective endocarditis

A

Staph aureus - treat with gent and fluclox or vancomycin

Strep viridans - treat with benzylpenicillin and gentamycin

121
Q

Which organism is likely to be infecting a man with cystic fibrosis

A

Pseudomonas aeruginosa
Burkholderia cepacia
Staph aureus
Haemophilus influenzae

122
Q

Most common causative organism for lobar pneumonia

A

Streptococcus pneumoniae

123
Q

Organisms responsible for pneumonia in previously young and healthy person

A

Streptococcus pneumoniae
Mycoplasma pneumoniae
Legionella pneumonia
Chlamydia psittachi

124
Q

Signs of left lobar pneumonia

A 
Tachypnoea 
Tachycardia 
Fever
Cyanosis
Decreased chest expansion
Dullness to percussion 
Bronchial breathing at left base
125
Q

Investigations for suspected lobar pneumonia

A 
Sputum analysis for culture 
CRP and ESR 
Blood culture 
Chest xray 
Acute and convalescent serology
126
Q

Organisms which present with typical features of pneumonia

A

Strep pneumoniae
Haemophilus influenzae
Moraxella catarrhalis (smoking)
Klebsiella pneumonia (alcoholism)

127
Q

Gram +ve diplococci that causes acute lobar pneumonia

A

Strep. Pneumoniae

128
Q

Why is haemophilus not penicillin sensitive

A

Produce beta-lactamase that can break down penicillins

129
Q

Atypical pneumonia

A 
Legionella
Mycoplasma 
Coxiella burnitii
Chlamydia psittaci = psittacosis
Bordatella pertussis 
TB
130
Q

Legionella pneumonia

A

Aerosol spread

Severe systemic illness that may include abdominal pain and diarrhoea, lymphopenia and hyponatraemia

131
Q

Viral pneumonia

A

Influenza A and B

Varicella zoster and herpes zoster

132
Q

Which antibiotics should you use in a hospital acquired pneumonia

A

Cefrazidime - only cephalosporin active against pseudomonas
Gentamicin - good gram neg cover
Vancomycin - good gram pos cover

133
Q

Define pyrexia of unknown origin

A

Temperature persistently above 38 for more than 3 weeks, without diagnosis despite initial investigation during 3 days of inpatient care or after more than 2 outpatient visits

134
Q

Investigations for pyrexia of unknown origin

A

Sputum or other specimens for mycobacterial stains and culture
Antigen detection - in blood, CSF, nasopharyngeal aspirate, urine
Nucleic acid detection
Serological tests - antibody detection for viruses, dysmorphic fungi and some bacteria and protozoa
Imaging of the abdomen by ultrasonography or computed tomography
Echocardiography

135
Q

Differential diagnosis of acute diarrhoea and vomiting

A

Infectious - Gastroenteritis, C. Difficile, Acute diverticulitis, sepsis, pelvic inflammatory disease, pneumonia (atypical), malaria

Non-infectious:
GI - inflammatory bowel disease, bowel malignancy, overflow from constipation
Metabolic - diabetic ketoacidosis, thyrotoxicosis, uraemia
Drugs - NSAIDs, cytotoxic agents, antibiotics, PPI

136
Q

Investigations for pyrexia of unknown origin

A

Sputum or other specimens for mycobacterial stains and culture
Antigen detection - in blood, CSF, nasopharyngeal aspirate, urine
Nucleic acid detection
Serological tests - antibody detection for viruses, dysmorphic fungi and some bacteria and protozoa
Imaging of the abdomen by ultrasonography or computed tomography
Echocardiography

137
Q

Which foods are associated with transmission of salmonella spp and campylobacter

A

Raw eggs (salmonella only)
Undercooked meat or poultry
Unpasteurised milk or juice
Unpasteurised soft cheeses

138
Q

What is raw seafood likely to transmit

A

Norovirus
Vibrio spp
Hepatitis A

139
Q

First investigations for malaria

A

Think and thin blood film for malaria parasites, FBC, urinalysis

140
Q

What is topical sprue

A

Malabsorption syndrome with no defined aetiology; gardia lamblia infection may progress to a malabsorption syndrome that mimics topical sprue

141
Q

Which blood component is usually raised in parasitaemia

A

Oesinophilia - hookworm, schistosomiasis

142
Q

Presentation of schistosomiasis

A

Transient rash
Fever
Hepatosplenomegaly
Induces transient respiratory symptoms with infiltrates in the acute stages and, when eggs reach the pulmonary vasculature in chronic infection, can result in shortness of breath with features of right heart failure due to pulmonary hypertension

143
Q

Investigation of oesinophilia

A 
Stool microscopy 
Terminal urine 
Duodenal aspirate 
Slit lamp examination 
Serology
144
Q

Consequence of varicella zoster virus in pregnancy

A

Neonatal infection, congenital malformation and serious infection in the mother

145
Q

What is the effect of cytomegalovirus in pregnancy

A

Neonatal infection and congenital malformation

146
Q

Which maternal infections can cause neonatal conjunctivitis

A

Neisseria gonorrhoea

Chlamydia trachomatis

147
Q

Effect of maternal malaria

A

Fetal loss
Intrauterine growth retardation
Severe malaria in mother

148
Q

Clinical features of parvovirus B19

A

Small children –> slapped cheek followed by a maculopapular rash then resolution

Gloves and socks syndrome in young adults

Arthropathies in adults and children

Impaired erythropoeisis in adults with haematological disease or immunucompromised

HYDROPS FETALIS - CAN CAUSE SPONTANEOUS ABORTION

149
Q

What is the effect of cytomegalovirus

A

Congenital infection
Infectious mononucleosis
Hepatitis
Disease in immunocompromised patients - retinitis, encephalitis, pneumonitis, hepatitis, enteritis
Fever with abnormalities in haematological parameters

150
Q

What is the effect of epstein-barr virus

A 
Infectious mononucleosis 
Burkitt's lymphoma 
Nasopharyngeal carcinoma 
Oral hairy leucoplakia (AIDS) 
Other lymphoma
151
Q

Which herpes virus infection causes kaposi’s sarcoma

A

HHV-8

152
Q

Complications of mumps

A 
Encephalitis 
Transient hearing loss 
Encephalitis 
Labyrinthitis 
Electrocardiographic abnormalities 
Pancreatitis
Arthritis 
Infertility in males
153
Q

Infectious mononucleosis

A

Acute viral illness characterised by pharyngitis, cervical lymphadenopathy, fever and lymphocytosis most commonly caused by epstein barr virus

But CMV, HHV-6, HIV-1 and toxoplasmosis can produce a similar clinical syndrome

154
Q

Common complications of infectious mononucleosis

A 
Severe pharyngeal oedema 
Anti-biotic induced rash when use amoxicillin 
Prolonged post-viral fatigue 
Hepatitis 
Jaundice
155
Q

Uncommon complications of infectious mononucleosis

A

Neurological - cranial nerve palsies, meningoenchephalitis

Haematological - haemolytic anaemia, thrombocytopenia

Cardiac - myocarditis, ECG abnormalities, pericarditis

Ruptured spleen, respiratory obstruction, agranulocytosis

156
Q

Which malignancies are associated with EBV

A 
Nasopharyngeal carcinoma 
Burkitt's lymphoma 
Primary CNS lymphoma 
Hodgkin's disease
Lymphoproliferative disease in the immunocompromised
157
Q

How would you investigate for EBV

A

Monospot test - heterophile antibody is present during acute illness and convalescence

158
Q

Management of EBV

A

If a throat culture yields B-haemolytic strep then a course of penicillin should be administered

When pharyngeal oedema is severe, a short course of corticosteroids may help

Warn to avoid contact sports due to risk of splenic rupture

159
Q

Complications of cytomegalovirus

A

Meningoencephalitis, guillan barre syndrome, acute haemolytic anaemia, thrombocytopenia, myocarditis and amoxicillin induced rash

Immunocompromised - hepatitis, oesophagitis, colitis, pneumonitis, retinitis, encephalitis, polyradiculitis

160
Q

Which virus is associated with cruise ship outbreaks

A

Norovirus - vomiting is prominent symptom

161
Q

Infections caused by staph aureus

A

Repiratory - pneumonia, empyema, lung abscess

Cardiac - endocarditis, pericarditis

Blood stream - septicaemia and metastatic abscesses

CNS - meningitis, brain abscess

Bone and joint - osteomyelitis and septic arthritis

Enterocolitis

Toxic shock syndrome - toxic shock syndrome

Skin - wound infections, bullous impetigo, scalded skin syndrome

162
Q

Treatment of scarlet fever

A

Caused by strep pyogenase - benzylpen or orally available penicillin

163
Q

Organism responsible for food poisoning from rice

A

Bacillus cereus

164
Q

Most common cause of bacterial gastroenteritis

A

Campylobacter jejuni - nausea, vomiting, significant diarrhoea, frequently containing blood

165
Q

Complications of campylobacter jejuni

A

Reactive arthritis and guillian barre

166
Q

Usual antibiotic choice if you choose to treat bacterial gastroenteritis

A

Ciprofloxacin

167
Q

Malaria in humans is caused by

A

Plasmodium falciparum

168
Q

Presentation of plasmodium falciparum infection

A

Insidious onset with malaise, headache and vomiting; cough and mild diarrhoea are also common
Fever
Jaundice occurs due to haemolysis and hepatic dysfunction
The liver and spleen enlarge and may become tender
Anaemia and thrombocytopenia occur rapidly
Cerebral malaria is shown as confusion, seizures or coma

169
Q

Diagnosis of HIV

A

Detect HIV RNA in serum or immunoblot assay

170
Q

What is the differential diagnosis of primary HIV

A 
EBV
CMV
Streptococcal pharyngitis 
Toxoplasmosis 
Secondary syphilis
171
Q

AIDS-defining conditions

A 
Oesophageal candidiasis
Cryptococcal meningitis
Cerebral toxoplasmosis 
Chronic mucocutaneous herpes simplex 
Pulmonary or extrapulmonary tuberculosis 
Pneumocystis jirovecii 
Invasive cervical cancer 
Kaposi's sarcoma 
HIV associated dementia 
Non-hodgkin lymphoma
172
Q

Gram positive cocci in chains that causes infective endocarditis

A

Viridans streptococci

173
Q

Appearance of strep pyogenes

A

Gram positive cocci - 2 together and not in chains

174
Q

Appearance of e.coli under the microscope

A

Gram negative bacilli

175
Q

Which organism looks like bunch of grapes on stains

A

Staph aureus

176
Q

Treatment of strep viridans infective endocarditis

A

IV benzylpenicillin for 2 weeks

177
Q

Could you give someone with HIV a live vaccine

A

No

178
Q

Gram positive cocci in chains that causes infective endocarditis

A

Viridans streptococci

179
Q

Appearance of strep pyogenes

A

Gram positive cocci - 2 together and not in chains

180
Q

Appearance of e.coli under the microscope

A

Gram negative bacilli

181
Q

Which organism looks like bunch of grapes on stains

A

Staph aureus

182
Q

Treatment of strep viridans infective endocarditis

A

IV benzylpenicillin for 2 weeks

183
Q

Could you give someone with HIV a live vaccine

A

No

184
Q

Best antibiotic for gram negative sepsis with septic shock

A

Tazocin

185
Q

Best antibiotic for gram negative sepsis with septic shock

A

Tazocin

186
Q

Best antibiotic for gram negative sepsis with septic shock

A

Tazocin

187
Q

Best antibiotic for gram negative sepsis with septic shock

A

Tazocin

188
Q

Best antibiotic for gram negative sepsis with septic shock

A

Tazocin

189
Q

Best antibiotic for gram negative sepsis with septic shock

A

Tazocin

Specialities (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions