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5thyr > Infection > Flashcards

Infection Flashcards

1
Q

What is the 1st line antibiotic for perioperative antibiotic prophylaxis?

Allergy?

A

First-line treatment: intravenous cefazolin

In patients with beta-lactam allergy: clindamycin or vancomycin

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2
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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3
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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4
Q

What types of pnuemonia are surgical patients at risk of?

A

Ventilator associated
HAP
Aspiration

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5
Q

What bacteria causes necrotising fasciitis?

How does it present?

A

Group A strep most commonly (strep pyogenes)

Cloudy grey discharge +/- crepitus (gas in subcutaneous tissue)

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6
Q

How does c diff present?

What is the complication?

A
  • Watery diarrhoea (can be blood stained)
  • Colicky abdominal cramps
  • Fever w/ Rigors
  • Raised WCC

Complication: Risk of toxic megacolon (do AXR)

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7
Q

What type of bacteria is C diff? How does it cause disease?

A
  • ANAEROBIC gram +ve rod
  • forms toxins that are cytotoxic to mucosal cels
  • causes pseudomembranous colitis (PMC)
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8
Q

What antibiotics cause C diff?

A
  • CEPHALOSPORINS MOST COMMON (spores)

also: Clindamycin/ciprofloxin/penicillins

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9
Q

What is the management of c diff?

A

PO metronidazole for 10-14 days

PO vancomycin if severe / unresponsive

(combine both if life threatening)

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10
Q

What is the diagnostic test for C diff?

A

Stool sample

-PCR for protein followed by ELISA for toxins

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11
Q

What would you see in C diff on sigmoid/colonoscopy

A

pseudomembranous yellow plaques

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12
Q

Treatment for toxic megaolon?

A

May need urgent colectomy

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13
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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14
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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15
Q

Criteria for HAP diagnosis?

A

HAP

  • Pneumonia if been admitted with 5 days
  • If sent home and get pnuemonia within 4-6 weeks
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16
Q

What bacteria are more likely to cause HAP

A

Different profile of organism compared with CAP

  1. Gram negative enterobacteria
  2. Staphylococcus aureus
  3. Pseudomonas
  4. Klebsiella pneumoniae
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17
Q

Treatment for HAP?

A

HAP

- IV aminoglycoside e.g. gentamicin (gram neg cover) and IV piperacillin Tazocin

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18
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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19
Q

How are children given the flu vaccine?

A

Intra-nassally
At 2-3yrs then annually
Live vaccine

20
Q

How does flu present?

A 
Most asymptomatic
Sudden onset high fever 
Headache 
Muscle / joint aches 
Non productive cough 
Severe malaise
21
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

22
Q

Management of flu?

A

Supportive

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

23
Q

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 common pneumoniae

URTI eg AOM, sinusitis, croup
Myositis and rahbdomyolyis
Myocarditis
Encephalitis

24
Q

How does mumps present?

A

MUMPS

  • Prodrome of fever, malaise, myalgia
  • Then parotitis -U/L → B/L
    • causes earache and pain on eating
    • dry mouth because salivary glands blocked

Clinical diagnosis is often adequate ☺

25
Q

How is mumps spread?

A

Resp droplets taken into parotid gland then spreads to other tissues (kissing)

NB notifiable disease

26
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

27
Q

What are some complications of mumps?

A

Orchitis → infertility:50% of POSTpubertal males,
- Usually 4/5 days after start of parotitis
Hearing loss - usually unilateral and transient
Meningitis (15%) -mild and self limiting
Acute pancreatitis

28
Q

What causes malaria?

A

Plasmodium protozoa

Spread by female Anopheles mosquito

29
Q

What are the different types of plasmodium?

A

1) Plasmodium falciparum (most common cause of malaria)
2) Plasmodium vivax
3) Plasmodium ovale
4) Plasmodium malariae

30
Q

What are some protective factors for malaria?

A

Sickle cell trait

G6PD deficiency

31
Q

How does malaria present?

A
  • Flu like symptoms
  • Headache
  • Excessive sweating (diaphoresis)
  • High fever
  • Haemolytic anaemia - weakness, paleness, dizziness
  • D&V
  • Confusion/seizures if sever

Note can present up to a year post travel

Sx may occur from 6 d of infection → many months later  
Phase 1 (≤ 1hr) Shivering  
Phase 2 (2-6hr) Fever (HIGH temp > 41), flushed, dry skin, nausea + vomiting, headache  
Phase 3 (3hr) – Cold Sweats as temp falls
32
Q

When do you get spikes in fever with Malaria?

A

Falciparum + Vivax + ovale = EVERY OTHER DAY (tertian)

Malariae = Every 3rd day (quatrtan)

33
Q

What signs do you get with malaria?

A

Spleno/hepatomegaly ± abdominal tenderness
Jaundice
Myalgia

34
Q

What is the diagnostic investigation for malaria?

A

d

35
Q

What is the diagnostic investigation for malaria?

A

THICK AND THIN BLOOD SMEAR

36
Q

What other bloods would you do in malaria and what would you see?

A

FBC:

  • anemia
  • thrombocytopenia (may cause bleeding)

Creatinine
(AKI picture)

Clotting
(can get DIC)

ABG/lactate
-acidosis

Urinalysis
-heamaglobinuria (nephritic)

Glucose
-hypoglyceamia

37
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

38
Q

What organ damage can occur in severe malaria?

A

Kidneys

  • Flank Pain
  • Oliguria
  • Hemoglobinuria

Cerebral

  • Hallucinations
  • Confusion
  • LOC / coma

HF
Pulmonary oedema
Shock

39
Q

What is the treatment for uncomplicated falciparum malaria?

A

UNCOMPLICATED falciparum malaria

  • Artemisinin combination therapy (ACT)
    e. g. artemether with lumefantrine

If not available:

  • Quinine
  • AtovaQUONE with proguanil
40
Q

What are features of severe malaria?

A

SEVERE MALARIA FEATURES

  • ↓GCS/siezures
  • AKI/ haemaglobinuria (from acute tubular necrosis)
  • Shock
  • Hypoglycaemia
  • Pulmonary odema/ARDS
  • Anemia
  • DIC/spont bleeding
  • Acidosis (pH <7.3)
41
Q

What is the treatment for severe malaria?

A

Treatment for severe malaria

-IV Artesunate

42
Q

What is the treatment of choice for non falciparum malaria?

A

Non falciparum malaria=Chloroquine (can cause blindness)

this is because falciparum is resistant to chloroquinine

43
Q

Fever following fresh water exposure?

A

Schistosomiasis (snails

Leptopirosis (rats-weil disease)

44
Q

Fever following contaminated food and water / raw meat / fish

A 
Enteric fever
Shigella 
Salmonella 
Campylobacter 
Amoebiasis 
Helminth infection 
Hep A and E
45
Q

What does eosinophilia in a returning traveller indicate?

A

Parasitic infection

46
Q

Describe symtpoms of Campylobacter infection?

Complication?

A

Campylobacter

  • A flu-like prodrome
  • Followed by crampy abdominal pains, fever + diarrhoea (may be bloody)
  • Complications include Guillain-Barre syndrome
47
Q

Which antibiotics have a beta lactam ring?

A 
Penicillins
Cephalosporins 
Monobactam 
Carbapenems 
Carbacephems

5thyr (18 decks)

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