Infection

Question 1

Which WBC are key in fighting bacterial + fungal infections?

Answer 1

Neutrophils

Question 2

Which WBC are key in fighting fungal infections?

Answer 2

Neutrophils
Monocytes
T-lymphocytes

Question 3

Which WBC are key in fighting parasitic infections?

Answer 3

Eosinophils

Question 4

Which WBC are key in fighting bacterial infections?

Answer 4

B lymphocytes

Neutrophils

Question 5

Neutrophils are key in fighting what?

Answer 5

Bacteria

Fungi

Question 6

Monocytes are key in fighting what?

Answer 6

Fungi

Question 7

Eosinophils are key in fighting what?

Answer 7

Parasites

Question 8

T lymphocytes are key in fighting what?

Answer 8

Fungi (PJP)

Viruses

Question 9

B lymphocytes are key in fighting what?

Answer 9

Bacteria

Question 10

How is risk of sepsis managed in patients with Haematological malignancy?

Answer 10

Prophylaxis 
Growth factors
Stem cell transplant 
Protective environment 
IV Ig 
Vaccinations

Question 11

What antibiotic is used for prophylaxis against Pneumocystis jiroveci pneumonia?

Answer 11

Co-trimoxazole

Question 12

How is neutropenic risk assessed?

Answer 12

Cause of neutropenia
Degree of neutropenia
(<0.2x10^9/L = high risk)
Duration of neutropenia
(>7 days high risk)
Disrupted skin
Altered gut flora 
Lymphopenia 
Monocytopenia

Question 13

What is the common bacterial cause of Febrile neutropenia?

Answer 13

Gram +bacteria (70%)

Gram -ve bacilli (30-40%)

Question 14

What are the common gram +ve causes of febrile neutropenia?

Answer 14

MSSA, MRSA, Coagulase negative Staph
Streptococcus viridans
Enterococcus faecalis

Question 15

What are the common gram -ve causes of febrile neutropenia?

Answer 15

E. coli
Klebsiella spp
Pseudomonas aeruginosa

Question 16

What dysfunctions in immunocompromised patients contribute to risk of fungal infection?

Answer 16

Monocytopenia/monocyte dysfunction

Question 17

How does neutropenic sepsis present?

Answer 17

Fever with NO localised signs
Rigors 
Pneumonia 
Cellulitis 
UTI 
Septic shock

Question 18

What is the sepsis six?

Answer 18

Take 3:
Serum Lactate
Blood culture 
Urine output
Give 3
High flow Oxygen
IV fluids 
IV Antibiotics (within 1 hr)

Question 19

How should neutropenic fever be investigated?

Answer 19

History + examination
Blood & sputum cultures 
CXR
Throat swab 
FBC
Renal, LFTs

Question 20

How is neutropenic sepsis managed?

Answer 20

ABCDE
Broad spec antibiotics
CT chest/abdo/pelvis for source
Modify based on culture results

Question 21

Outline the antibiotic use in neutropenic sepsis

Answer 21

Broad spec:
Piperacillin/Tazobactam + Gentamicin
If gram +ve add:
Vancomycin or Teicoplanin
If no response after 72hrs add:
Caspofungin

Question 22

What are the main causes of lymphopenia?

Answer 22

Stem cell tranplants (allogenic++)
Total Body Irradiation 
Graft vs Host disease
Nucleoside analogues
Lymphoid malignancy

Question 23

What infections are seen in severely lymphopenic patients?

Answer 23

Atypical pneumonia 
Shingles
Mouth ulcers
EBV 
Fungi - candida, aspergillus
Atypical mycobacteria

Question 24

What are the causes of atypical pneumonia in lymphopenic patients?

Answer 24

Pneumocystis jiroveci
CMV
Respiratory syncytial virus