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YEAR 3 & 5 CORE CONDITIONS > Infection > Flashcards

Infection Flashcards

1
Q

What is the antibiotic of choice for perioperative abx prophylaxis?

A

IV Cefalozin (1st gen cephalosporin)

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2
Q

Cefalozin is used for perioperative prophylaxis, allergy to what may mean another abx must be used? Which may be used be used?

A

Beta lactam allergy

Use clindamycin or vancomycin

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3
Q

Which antibiotics have a beta lactam ring?

A 
Penicillins
Cephalosporins
Monobactam
Carbapenems
Carbacephems
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4
Q

In addition to IV Cefalozin, what other antibiotic may be used for perioperative prophylaxis?

A

IV metronidazole

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5
Q

Which patients may require IV metronidazole in addition to IV cefalozin for perioperative prophylaxis?

A

Small intestinal obstruction
Appendectomy
Colorectal surgery

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6
Q

What are the most common causes of a post op fever?

A 
Surgical site infections
Pneumonia
Catheter related UTI
Primary blood stream infections
Febrile drug reaction
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7
Q

Which types of pneumonia are post op patients vulnerable to?

A

Ventilator associated
HAP
Aspiration

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8
Q

Which bacteria are commonly indicated in surgical site infection?

A

First 4 days:

  • Group A strep = strep pyogenes
  • Clostridium perfringens

> 4 days
- s aureus

> 30 days:
- indolent organisms egs epidermis

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9
Q

What can clostridium perfringens infection lead to?

A

Necrotising fasciitis

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10
Q

How can surgical wounds be classified? (4)

A

1) Clean
2) Clean - contaminated
3) Contaminated
4) Dirty / infected

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11
Q

What criteria must be met for a surgical wound to be described as clean?

A

All of:

  • Noninflamed operative wound
  • The respiratory, GI, genital and urinary tracts have not been entered during surgery
  • Would is closed primary with / without a drain
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12
Q

What is a clean-contaminated surgical wound?

A

Non inflamed operative wound

The respiratory, GI, genital and urinary tracts have been entered during surgery

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13
Q

What is a contaminated surgical wound?

A

Fresh, open, accidental wound
Inflamed operative wound without purulent discharge

Clean or clean-contaminated wounds with a break in sterile technique during surgery

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14
Q

What is a dirty / infected surgical wound?

A

Inflamed operative wound

Purulent discharge

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15
Q

How does the surgical incision site appear necrotising fasciitis present?

A

Cloudy grey discharge

+/- crepitus (gas in subcutaneous tissue)

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16
Q

What is the abx of choice in clean surgical site infection?

A

Low risk MRSA = cefazolin

High risk MRSA / beta lactam allergic = vancomycin, daptomycin, or linezolid

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17
Q

What is the abx of choice if strep pygones or c. perfrigens is suspected?

A

Penicillin and clindamycin

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18
Q

Which antibiotics is associated with c diff development?

A

2nd and 3rd gen cephalopsorins eg cefuroxime

Historically clindamycin

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19
Q

How does c diff present?

A

DIarrhoea
Abdo pain
Raised WCC
Risk of toxic megacolon

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20
Q

How is c diff diagnosed?

A

Stool sample showing toxin

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21
Q

What is the management of c diff?

A

PO metronidazole for 10-14 days

PO vancomycin if severe / unresponsive

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22
Q

Define pyrexia of unknown origin

A

Fever >38 for >3 weeks which cannot be diagnosed after a week in hostpiral

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23
Q

List some causes of pyrexia of unknown origin

A

Neoplasia

  • Lymphoma
  • Hypernephroma
  • Preleukaemia
  • Atrial myxoma

Infections

  • Abscess
  • TB

Connective tissue disorders

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24
Q

What are the three types of influenza virus? Which cause most cases?

A

A, B, C

A and B are majority

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25
How are children given the flu vaccine?
Intranassally At 2-3yrs then annually Live vaccine
26
How does flu present?
``` Most asymptomatic Sudden onset high fever Headache Muscle / joint aches Non productive cough Severe malaise ```
27
If someone with flu develops a productive cough or raised inflammatory markers?
Bacterial superinfection over influenza Most commonly s aureus or strep pneumoniae
28
Whats the management of influenza?
Supportive | Antiviral if high risk (neuraminidase inhibitors eg zanamivir / oselatamivir)
29
List some complications of flu
Primary influenza pneumonia - Haemorrhagic pneumonia - Can progress to ARDS Secondary bacterial pneominia - Febrile and productive cough after flu symptoms have improved - Most pneumoniae URTI eg AOM, sinusitis, croup Myositis and rahbdomyolyis Myocarditis Encephalitis
30
How does mumps present?
Fever Malaisa Musclar pain Parotitis - usually initially unilateral but becomes bilateral
31
How does parotitis present?
Earache | Pain on eating
32
How is mumps spead?
Resp droplets taken into parotid gland then spreads to other tissues NB notifiable disease
33
What is the incubation period and when is mumps infective?
Infective 7 days before and 9 days after parotid swelling starts Incubation period = 14-21 days
34
What are some complications of mumps?
Orchitis (postpubertal) - Usually 4/5 days after start of parotitis Hearing loss - usually unilateral and transient Meningoencephalitis Pancreatitis
35
What is pertussis? What causes it?
Whooping cough Bordetella pertussis
36
How does whooping cough present?
2-3 days of coyza followed by: Coughing bouts worse at night and after feeding, may be ended by vomiting and associated central cyanosis Inspiratory whoop Undiagnosed apnoeic attacks in young infants
37
What causes an inspiratory whoop?
Forced inspiration against a closed glottis (opening between vocal cords)
38
What can a persistent cough cause / coughing really hard?
Subconjunctival haemorrhages | Anoxia - leadng to syncope and seizures
39
How long can symptoms of whooping cough last?
10-14 weeks
40
How is whooping cough diagnosed?
Nasal swab for bordetella pertussis
41
What is the management of whooping cough?
<6 months = admit PO macrolide eg calrithromycin if onset of cough is within the previous 21 days Offer prophylaxis to household School exclusion 48hrs after commencing abx or 21 days from onset of symtoms Pregnant women offered vaccine
42
What causes malaria?
Plasmodium protozoa Spread by female Anopheles mosquito
43
What are the different types of plasmodium?
1) Plasmodium falciparum 2) Plasmodium vivax 3) Plasmodium ovale 4) Plasmodium malariae
44
Which species of plasmodium causes nearly all of the cases of severe malaria?
Plasmodium falciparum Other 3 cause 'benign'
45
What are some protective factors for malaria?
Sickle cell trait G6PD deficiency HLA-B53 Absence of Duffy antigens
46
How does malaria present?
``` Flu like symptoms Headache Excessive sweating (diaphoresis) High fever Inc bleeding - thrombocytopenia Haemolytic anaemia - weakness, paleness, dizziness D&V Hepatosplenomagaly Discrete jaundice ``` Note can present up to a year post travel
47
Different species of plasmodium cause different diseases, what are these?
Vivax + ovale = Tertian Malariae = Quartan
48
What course does the fever take in
Tertian = fever spikes every 48hrs Quartan = spikes every 72hrs Falciparum = irregular fever spikes without a noticeable rhythm
49
How does severe malaira (usually falciparum) cause severe organ dysfunction?
Infected erythrocytes deform and stick to endothelial vessels This prevents them from being removed by the spleen These occlude capillaries causing microinfarcts
50
What organ damage can occur in severe malaria?
Kidneys - Flank Pain - Oliguria - Hemoglobinuria Cerebral - Hallucinations - Confusion - LOC / coma HF Pulmonary oedema Shock
51
How is malaria diagnosed?
Blood smear showing parasites Need at least 3 malaria tests over consecutive days to exclude the diagnosis
52
How is malaria treated?
Chloroquinine Quinine Falciparum = admit
53
Fever following hosptital work ddx
TB HIV Viral hemorrhagic fever (VHF) Typhus
54
Fever following sexual exposure ddx
HIV Hep B and C Syphillis Gonorrhoea
55
Fever following visit to African game park
Tick typhys
56
Fever following fresh water exposure
Schistosomiasis | Leptopirosis
57
Fever following caving
Histroplasmosis | Rabies
58
Fever following contaminated food and water / raw meat / fish
``` Enteric fever Shigella Salmonella Campylobacter Amoebiasis Helminth infection Hep A and E ```
59
Fever following ingestion of unpasteurised milk
Brucella Listeria Salmonella
60
Fever following animal contact
Brucella | Q fever
61
Fever following air conditioning systems / showers
Leigonella
62
What investigations are recommended for returning travellers with a fever?
Bloods - FBC, U&Es, LFTs At least 3 malaria blood films or rapid diagnostic tests over 2 days Blood cultures HIV test Urine and stool MC&S Serology +/- PCR for dengue, Q fever, Brucella CXR and US of liver and spleen
63
What does eosinophilia in a returning traveller indicate?
Parasitic infection

YEAR 3 & 5 CORE CONDITIONS (30 decks)

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