Infection

Question 1

What type or organism is c.diff

Answer 1

Gram-positive, spore-forming, anaerobic, bacillus

Only toxin producing strains cause diarrhoea

Question 2

Recent hospital stay within the last _______ is a risk factor for c.diff

Answer 2

3 months

Question 3

Can C. difficile spores be inactivated by alcohol-based products

Answer 3

no

Question 4

antibiotics associated with c diff (4)

Answer 4

Clindamycin
Co-amox
Quinilones
Cephlasporins

Question 5

Can we give opioids in c. diff

Answer 5

Best not as they are constipating. Also avoid loperamide

Question 6

Is there are difference in treatment of c .diff in terms of effectiveness?

Answer 6

No - Fidaxomycin, Vanc and metronidazole are euqivilent.

Fidax is much more expensive and has less chance of recurrance.

Question 7

Treatment for non severe c. diff (WBC<15)

Answer 7

PO metronidazole 400mg TDS 10-14 days

Question 8

Treatment for severe c. diff

Answer 8

PO Vanc 125mg 6 hourly 10-14 days.

Consider fidaxomycin 200mg BD if comorbidities/receiving concomittent antibitoics

Question 9

Where do we tend to have gram +ve, -ve and anaerobic bacteria

Answer 9

+ve from the external environment
-ve gut or nosicomial
anaerobes are from the gut

Question 10

Diabetes cellulitus - why use a broader spec?

Answer 10

Need better penetration

Question 11

All betalactams have gram _______ activity

Answer 11

POSITIVE

But some are broader than others

Question 12

MRSA is gram ____

So usually treated with

Answer 12

positive

Vanc or Teic

Question 13

What is the only oral gram -ve agent

What IV options are there

Answer 13

Cipro (and other quinilones but cipro has the most -ve spectrum)

Gent
Amik

Question 14

Penicillins are bacteria cidal or static

Answer 14

Cidal

if its not related to penicillin it tents to be static e.g. clindamycin, tetracyclines and linezolid

Question 15

Which penetrates more vanoc or teic

Answer 15

Vanc

Question 16

Aspiration shows was what on x ray

Answer 16

Mid zone consolidation

Question 17

Why should we not use amik for HAP

Answer 17

Poor lung penetration

Question 18

Why do we give gent for pylonephritis?

Answer 18

to cover -ve organisms while we wait for MCS

Question 19

Treatment for ceullitis and causitive organisms (2)

Answer 19

Fluclox

covers staph and strep

Question 20

Cellulitis in pen allergy

Answer 20

Clarithromycin

Question 21

CAP pathogens

Answer 21

• Streptococcus pneumoniae
  
  • Mycoplasma pneumoniae
  • Haemophilus influenzae
  • Chlamydophila pneumoniae
  • Respiratory viruses.

Question 22

HAP pathogens

Answer 22

`Infections occurring during the first four days of the hospital stay is usually caused by Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis.
Onset more than four days after admission is more often caused by Gram-negative Pseudomonas aeruginosa, enterobacteria, S. aureus, Klebsiella pneumoniae or L. pneumophila.

Question 23

COPD exacerbation pathogens

Answer 23

• Streptococcus pneumoniaeand Haemophilus influenzaeand, less commonly,Moraxella catarrhalis.
  
  • Staphylococcus aureusmay be the cause during the influenza season. Infection with Pseudomonas aeruginosamay also cause exacerbations of COPD.

Question 24

In CAP if mycoplasma is suspected what would you recommend

Answer 24

Doxy + amox or doxy alone

Question 25

Pred dose for asthma

Answer 25

Prednisolone 40–50 mg by mouth for at least 5 days

Question 26

Pred dose in COPD

Answer 26

Pred 30mg po 7 – 14 days

Question 27

Treatment for COPD infection

Answer 27

Amoxicillin or tetracycline

Question 28

HAP treatment:

Answer 28

<5 days
Co-amoxiclav or cefuroxime

Late onset (<5 days)
Tazocin, cefetazadime

If MRSA - Vanc

Question 29

MRSA - why should rifampicin and fusidic acid not be used alone

Answer 29

Rifampicin or fusidic acid should not be used alone because resistance may develop rapidly

Question 30

MRSA treatment

Answer 30

tetracycline +/- combo of rifampicin and fusidic acid

OR

clindamycin

OR

Vancomycin can be used if severe