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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
Q

How are children given the flu vaccine?

A

Intranassally
At 2-3yrs then annually
Live vaccine

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26
Q

How does flu present?

A 
Most asymptomatic
Sudden onset high fever
Headache
Muscle / joint aches
Non productive cough
Severe malaise
27
Q

If someone with flu develops a productive cough or raised inflammatory markers?

A

Bacterial superinfection over influenza

Most commonly s aureus or strep pneumoniae

28
Q

Whats the management of influenza?

A

Supportive

Antiviral if high risk (neuraminidase inhibitors eg zanamivir / oselatamivir)

29
Q

List some complications of flu

A

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
Q

How does mumps present?

A

Fever
Malaisa
Musclar pain
Parotitis - usually initially unilateral but becomes bilateral

31
Q

How does parotitis present?

A

Earache

Pain on eating

32
Q

How is mumps spead?

A

Resp droplets taken into parotid gland then spreads to other tissues

NB notifiable disease

33
Q

What is the incubation period and when is mumps infective?

A

Infective 7 days before and 9 days after parotid swelling starts

Incubation period = 14-21 days

34
Q

What are some complications of mumps?

A

Orchitis (postpubertal)
- Usually 4/5 days after start of parotitis
Hearing loss - usually unilateral and transient
Meningoencephalitis
Pancreatitis

35
Q

What is pertussis? What causes it?

A

Whooping cough

Bordetella pertussis

36
Q

How does whooping cough present?

A

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
Q

What causes an inspiratory whoop?

A

Forced inspiration against a closed glottis (opening between vocal cords)

38
Q

What can a persistent cough cause / coughing really hard?

A

Subconjunctival haemorrhages

Anoxia - leadng to syncope and seizures

39
Q

How long can symptoms of whooping cough last?

A

10-14 weeks

40
Q

How is whooping cough diagnosed?

A

Nasal swab for bordetella pertussis

41
Q

What is the management of whooping cough?

A

<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
Q

What causes malaria?

A

Plasmodium protozoa

Spread by female Anopheles mosquito

43
Q

What are the different types of plasmodium?

A

1) Plasmodium falciparum
2) Plasmodium vivax
3) Plasmodium ovale
4) Plasmodium malariae

44
Q

Which species of plasmodium causes nearly all of the cases of severe malaria?

A

Plasmodium falciparum

Other 3 cause ‘benign’

45
Q

What are some protective factors for malaria?

A

Sickle cell trait
G6PD deficiency
HLA-B53
Absence of Duffy antigens

46
Q

How does malaria present?

A 
Flu like symptoms
Headache
Excessive sweating (diaphoresis)
High fever
Inc bleeding - thrombocytopenia
Haemolytic anaemia - weakness, paleness, dizziness
D&amp;V
Hepatosplenomagaly
Discrete jaundice

Note can present up to a year post travel

47
Q

Different species of plasmodium cause different diseases, what are these?

A

Vivax + ovale = Tertian

Malariae = Quartan

48
Q

What course does the fever take in

A

Tertian = fever spikes every 48hrs

Quartan = spikes every 72hrs

Falciparum = irregular fever spikes without a noticeable rhythm

49
Q

How does severe malaira (usually falciparum) cause severe organ dysfunction?

A

Infected erythrocytes deform and stick to endothelial vessels

This prevents them from being removed by the spleen

These occlude capillaries causing microinfarcts

50
Q

What organ damage can occur in severe malaria?

A

Kidneys

  • Flank Pain
  • Oliguria
  • Hemoglobinuria

Cerebral

  • Hallucinations
  • Confusion
  • LOC / coma

HF
Pulmonary oedema
Shock

51
Q

How is malaria diagnosed?

A

Blood smear showing parasites

Need at least 3 malaria tests over consecutive days to exclude the diagnosis

52
Q

How is malaria treated?

A

Chloroquinine
Quinine

Falciparum = admit

53
Q

Fever following hosptital work ddx

A

TB
HIV
Viral hemorrhagic fever (VHF)
Typhus

54
Q

Fever following sexual exposure ddx

A

HIV
Hep B and C
Syphillis
Gonorrhoea

55
Q

Fever following visit to African game park

A

Tick typhys

56
Q

Fever following fresh water exposure

A

Schistosomiasis

Leptopirosis

57
Q

Fever following caving

A

Histroplasmosis

Rabies

58
Q

Fever following contaminated food and water / raw meat / fish

A 
Enteric fever
Shigella
Salmonella
Campylobacter
Amoebiasis
Helminth infection
Hep A and E
59
Q

Fever following ingestion of unpasteurised milk

A

Brucella
Listeria
Salmonella

60
Q

Fever following animal contact

A

Brucella

Q fever

61
Q

Fever following air conditioning systems / showers

A

Leigonella

62
Q

What investigations are recommended for returning travellers with a fever?

A

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
Q

What does eosinophilia in a returning traveller indicate?

A

Parasitic infection

YEAR 3 & 5 CORE CONDITIONS (30 decks)

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