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CDM > Infection > Flashcards

Infection Flashcards

1
Q

What does crackles in the lung indicate?

A

Fluid build up and infection

Can be water/blood/pus

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2
Q

Why does fluid build up in the lungs cause SOB?

A

Can block air flow

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3
Q

What information do you need with a query chest infection patient?

A

> CRP, blood urea nitrogen, WBC

> Sputum and blood culture to identify microorganism

> If they have an existing respiratory condition, their lung function test

> 02 sats- do they need oxygen?

> Severity and type (especially in pneumonia)

> Acute or chronic onset?

> LFT and renal function

> Are they septic?

> Is it the flu?

> Can they swallow tablets/are they vomiting?

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4
Q

How would you determine if pneumonia is community acquired?

A

No hospital admissions in the last 6 months

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5
Q

What score can be used to determine pneumonia mortality risk and what does each factor mean?

A

CURB65

Confusion (mental test score 8 or less)

Urea nitrogen (>7 mmol/l)

Respiratory rate (30 breaths per min or more)

BP (Diastolic 60 or less, or systolic is less than 90)

65 years or more

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6
Q

What do the CURB65 scores mean (point ranges and risk)?

A

0 or 1 - low risk (<3%)

2- intermediate risk (3-15%)

3-5 - High risk (> 15%)

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7
Q

What does the CURB65 score determine?

A

Mortality risk %

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8
Q

What is 1st line for non severe CAP and what is the CURB65 score?

What if the patient can only have IV therapy?

A

< 2

Amoxicillin 500mg TDS PO/IV + doxycline 200mg OD PO for 5-7 days

If IV needed- change doxycycline to clarithromycin 250 mg BD IV

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9
Q

What is the treatment for a penicillin allergic non severe CAP?

What if IV is needed?

A

CURB65 < 2

Doxycycline 200 mg OD 5-7 days

If IV needed- change doxycycline to clarithromycin 250 mg BD IV

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10
Q

What is the 1st line treatment for severe CAP and what is the CURB65 score?

What if the patient can only have IV therapy?

A

CURB65 >2

Co-amoxiclav 1.2 g TDS IV and doxycyline 200mg OD PO for 5-7 days

If IV needed- change doxycycline to clarithromycin 500 mg BD IV

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11
Q

What is the treatment for a penicillin allergic severe CAP?

A

CURB65>2

Vancomycin (refer to dosing guidance) and ciprofloxacin 400mg BD for 5-7 days

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12
Q

How do you distinguish between early and late onset HAP?

A

Early onset is within 3 days of admission

Late onset if more than 3 days after admission

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13
Q

What is the 1st line treatment for early onset HAP?

A

Co-amoxiclav 625 mg TDS PO or 1.2G TDS IV for 5 days

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14
Q

What do NICE guidelines say about pneumonia treatment duration compared to local London hospital guidelines?

A

NICE guidelines recommend 7-10 day course of ABX (local hospital guidelines suggest 5-7)

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15
Q

What is the penicillin allergic treatment for early onset HAP?

What is the alternative if the patient can only have IV?

A

Doxycycline 200 mg OD 5-7 days

If IV needed- change doxycycline to clarithromycin 250-500 mg BD IV

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16
Q

What is the 1st line treatment for late onset HAP?

A

Co-amoxiclav PO or IV and gentamicin IV for 5-7 days

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17
Q

What is the penicillin allergic treatment for late onset HAP?

A

Vancomycin IV and gentamicin IV for 2 doses then review

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18
Q

What are the symptoms of cellulitis and what makes you more at risk?

A
  • Sometimes near toes if you have athletes foot
  • Lower legs affected
  • Swollen, painful, tender
  • More at risk if you have poor circulation e.g. diabetes or if you have broken skin around that area (easy for bacteria to get in)
  • Can be limb threatening
19
Q

What do you need to consider with query cellulitis?

What about if they are diabetic?

A
  • Where did it come from- e.g. a bite, fresh water expsoure, occupational exposure, pets?
  • WBC and CRP for signs of infection
  • LFT and renal function
  • If diabetic, look out for signs of necrotic tissue
20
Q

What are the likely organisms of cellulitis?

A
  • Streptococcus pyrogenes
  • Staph.aureus
  • Staph. Epidermidis
21
Q

How would you diagnose pneumonia?

A

Chest a ray

22
Q

How would you diagnose pneumonia?

A

Chest X ray

23
Q

If a patient comes in with pneumonia, how quick does treatment need to be started?

A

Within 4 hours of admission

24
Q

What does GCS score measure?

A

Level of consciousness

25
Q

What other treatment would you give a patient with pneumonia other than ABX?

What analgesics wouldn’t you use and why?

Why do you need to be careful if you are giving paracetamol to reduce temperature?

A
  • IV fluid increases BP
  • Vaccinate for flu and pneumonia
  • Would not use opioids due to respiratory depression risk
  • Paracetamol reduces temperature but may also mask infection
26
Q

What is 1st line treatment for cellulitis?

A

Flucloxacillin 500 mg QDS PO or 1g TDS IV for 7 days

May as well give IV if patient is an inpatient

27
Q

What is the penicillin allergic treatment for cellulitis?

A

Clarithromycin 500 mg BD PO for 7 days

28
Q

What score system do you use to measure severity of cellulitis?

A

ERON

29
Q

What are the ERON classes?

A

Class 1- No signs of systemic toxicity and the person has no uncontrolled co-morbidities

Class 2- The person has a comorbidity (e.g. peripheral arterial disease, morbid obesity)

Class 3- Signs of systemic upset e.g. acute confusion, tachycardia, hypotension or unstable comorbidities that may interfere with treatment response

Class 4 -Sepsis syndrome/life-threatening infection e.g. necrotizing fascitis

30
Q

What are the symptoms of meningitis?

A
  • Headache
  • Photophobia
  • Stiff neck
  • Fever- if they have taken paracetamol, fever could reduce
  • Rash
  • Life-threatening and needs to be treated ASAP
31
Q

What are the organisms that can cause meningitis?

A
  • Streptococcus pneumoniae (+ve)

* Neisseria meningitidis (-ve)

32
Q

What are the things to consider with bacterial meningitis?

A
  • How quickly has this come on?
  • Consider taking cerebral spinal fluid however sometimes you don’t get an organism growing there anyway
  • Monitor WBC, CRP, LFT and renal function
  • Are they pregnant/BF?
  • Have they got a rash?
  • Do they need oxygen? IV fluids?
  • How have they got the meningitis? From someone else? Transmitted it to others? Potential prophylaxis for those close to patient
  • Vaccination against meningitis
33
Q

What do you need to rule out with a query meningitis?

A
  • Rule out encephalitis- blood cultures via PCR test to confirm organism but important they gets IV ABX in the meantime
34
Q

What is the 1st line treatment for bacterial meningitis?

If they are immunocompromised/over 60 years, what would you add in?

A

Ceftriaxone 4g IV single immediate dose then 2g OD IV

for 5-10 days

Amoxicillin 2g QDS IV

35
Q

What would you add in with if a meningitis patient is suspected to have encephalitis?

A

Aciclovir 10 mg/kg TDS

36
Q

What is 1st line for C.Difficile?

What about in severe disease?

A

Metronidazole

In severe disease, use vancomycin

37
Q

What is 1st line for C. Difficile?

What about in severe disease?

A

Metronidazole

In severe disease, use vancomycin

38
Q

Prolonged unnecessary ABX treatment could lead to?

A

Resistance and healthcare associated infections

39
Q

What 7 physiological parameters do you look out for with sepsis?

A
  1. Respiratory rate
  2. 02 sats
  3. Supplemental oxygen?
  4. Systolic BP
  5. HR
  6. AVPU score
  7. temperature
40
Q

What class are cephalosporins and in what patient group should they be avoided if there is an alternative?

A

Beta lactams

Penicillin allergy patients

41
Q

What class is vancomycin?

A

Glycopeptide

42
Q

What class is gentamicin?

A

Aminoglycoside

43
Q

What class is doxycycline?

A

Tetracycline

CDM (17 decks)

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