Infection and Immunology Flashcards
1
Q
What is the management plan for Abcess?
A
- Small asbcesses may be drained naturally or w/ warm compression
- If large or complicated or persistant = ABx
- Incision and drainage - inspect for foreign objects
- Done under LA –> pus drained and sample taken for testing
- Area covered w/ sterile saline and dressing
2
Q
What is the management for Anaphylaxis?
A
- ABCDE approach + stop suspected cause
- Position patient comfortably depending on Sx
- IM adrenaline (0.5mg) - anterolateral aspect of thigh
- Repeat dose if no change after 5 mins
- Secure airway and give 100% O2 (>10ml/min)
- Monitor vital signs regularly
- Nebulised salutomol if bronchoconstriction
- If no change consult cardiologist - consider IV atropine/glucagon
- After attack = admit to ward and carry further tests for cause
- 1st Line - IM/IV Antihistamine (chlorphenamine) + IM/IV hydrocortisone
- Monitor and review for biphasic reaction
- Precaution - 2X adrenaline auto-injectors always on hand
3
Q
What is the management plan for Cellulitis + Erysipelas?
A
- Upper and Lower limbs
- 1st line = oral flucloxacillin/cefalexin
- If MRSA suspected = + Vancomycin
- If severely ill - use parenteral ABx + MRSA cover
- 1st line = oral flucloxacillin/cefalexin
- Orbital - cephalosporin e.g. cefuroxime + metronidazole
- If abscess - inscision, drainage and culture
- 2nd Line = orbitotomy + drainage of abscess
Note - management can be more specific if organism identified
4
Q
What is the management plan for Epididymitis?
A
- 1st Line - Ceftriaxone IM + 14 day oral Doxycycline
- If >35 STI unlikely so use Oflaxacin
- NSAIDs + bed rest and scrotal elevation
- If induced by amiodorone, reduce or take off drug
- If abscess develops, consider drainage
5
Q
What is the management plan for Gastroenteritis?
A
In all patients
- Fluid and electrolyte rehydration + bed rest
- Consider Bismuth to reduce diarrhoea
- 2nd Line - severe vomiting or diarrhoea consider IV fluid rehydration therapy
If suspected enterotoxigenic
- Abx to non-self limiting causes if it will reduce recovery time
- If EHEC notify health authorities
- Treat botulinum toxin with botulinum antitoxin in ITU
- C diff. - Isolate + oral metronidazole (14 days) -> Vancomycin
6
Q
What is the management plan for infectious mononucleosis?
A
- 1st Line - paracetomal/ibuprofen
- + rest, fluids and anti-pyretics
- If upper aiway obstruction or haemolytic anaemia in severe cases –> + corticosteroids e.g. prednisolone
- If thrombocytopenia consider IV immunoglobulins
- Avoid sport for 2 weeks to avoid risk of splenic rupture
Note - aciclovir and antivirals are not indicated in decreasing Sx and complications
DO NOT GIVE AMPICILLIN OR AMOXICILLIN -> 100% of cases get maculopapular rash
7
Q
What is the management plan for Infective Endocarditis?
A
- 4 - 6 weeks of Abx always
- Suspected Abx - O2 + Resus and empirical broad spectrum Abx
- Blind native valve - Benzylpenicillin + low-dose gentamicin
- Blind prosthetic valve - vancomycin + rifampicin + LD gentamicin
- Staphylococci causing endocarditis
- Native valve - Flucloxacillin/ vancomycin (penicillin allergy)
- Prosthetic valve - Flucloxacillin + rifampicin + LD gentamicin
- Streptococci - Benzylpenicillin sodium
Surgery - urgent valve replacement if unresponsive to Abx
8
Q
What is the management plan for Mastitis/ breast abscess?
A
- Lactational Mastitis
- if not severe + not prolonged
- 1st Line = effective milk removal + simple analgesia
- if severe or prolonged
- 1st Line = 10-14 days oral flucloxacillin
- 2nd Line/MRSA confirmed = vancomycin
- if not severe + not prolonged
- Non-Lactational - same but go straight to ABx
- if Anaerobic consider cefalexin
- Breast abscess - surgical drainage + culture of fluid
- IV/Oral dicloxacillin or cefalexin
- Advice for relief - warm compress to aid milk flow and continue breast feeding to encourage milk removal
9
Q
What is the management plan for Meningitis?
A
Viral Meningitis - generally self-limiting
Bacterial Meningitis
- Acute - Immediately treat with IV Abx + IV dexamethasome (unless <1 month)
- <1 month - Ampicillin + Cefatoxime/Ceftriaxone
- >1 month - Vancomycin + Cefatoxime/Ceftriaxone
- >55 or immunocomprimised - Vancomycin + Cefatoxime/Ceftriaxone + Ampicillin
- For all patients supportive care - O2, Vasopressors, IV Fluid (careful in raised ICP)
- Once LP performed and bacterium confirmed
- Targeted Abx therapy and supportive care
- Strep Pneumoniae - Benzylpenicllin
- Targeted Abx therapy and supportive care
10
Q
What is the management plan for Pericarditis?
A
Initially the aim is to treat the cause, and restrict exercise
- Acute - pericardiocentesis performed
- If purulent consider Abx
- 1st Line - NSAIDs + PPI
- Consider Colchicine (anti-mitotic) if idiopathic/viral
- 2nd Line - Corticosteroids
- 3rd Line - Immunosuppression e.g. Azathioprine
- 4th Line - Surgical pericardiectomy for constrictive pericarditis
11
Q
What is the management plan for Peritonitis?
A
- Localised - depends on the cause:
- Appendicitis - surgery
- Salpingitis - Abx
- Generalised - medical emergency risk of sepsis or death
- Resus - IV fluids + IV abx
- Catheter, NG tube and central line
- Primary - should resolve with Abx
- Secondary - laparotomy may be indicated
- Spontaneous Bacterial Peritonitis
- 1st Line - ciprafloxacin + vancomycin
- Or cefuroxime + metronidazole
12
Q
What is the management plan for Pneumonia?
A
- ABCDE on presentation
- 02 - If <94% or <88% if at risk of hypercapnia
- IV fluid = assess patients for dehydration
- follow by vasopressors to maintain MABP >65mmHg
- VTE prophylaxis + nutritional support
- Simple analgesia should be sufficient
- ICU if necessary - avoid NIV
- Start empirical ABx
- Discharge - done if <2 features of clinical instability e.g. raised temp, HR, RR, or low BP
- Prevention - pneumococcal/ haemophilus/ Influenxa vaccine - usually given to at risk population
13
Q
What is the empirical Abx treatment for Pneumonia?
A
- Generally a 5 day treatment plan considered
- CURB 3-5 = IV Abx immediately after diagnossis
- Penicillin + Macrolide e.g. Amoxicillin + Clarithryomycin
- 2nd Line or legionella suspected = fluoroquinolone e.g. levofloxacin
- If unresponsive switch to pathogen targeted ABx
- CURB 2 = Oral amoxicillin + clarithryomycin
- if not responding or contraindicated –> IV ABx
- CURB 0-1 = Oral amoxicillin
- If not responding add clarithryomycin
- If HAP = Gram -ve cover e.g. Cefuroxime/ cefapime/ Caftazedine
- If MRSA suspected - + IV Vancomycin/gentamicin
- If aspiration pneumonia - IV cephalosporin + metronidazole
14
Q
Specific Pneumonia targeted treatments?
A
- Pneumococcal = amoxicillin +/- clarithromycin
- Staph non-MRSA = Flucloxacillin +/- rifampicin
- Staph MRSA = Vancomycin +/- rifampicin
- Mycoplasma = Clarithromycin (oral) or Doxycicline
- Chlamydia /coxiella = Doxycicline or Clarithromycin
- Legionella = Fluoroquinolone e.g. levofloxacin
- Haemophilus = Amoxicillin or Cefuroxime
- G-ve = Cefuroxime or Fluoroquinolone
- PCP = High dose co-trimoxazole
15
Q
What is the management plan for Thyroiditis?
A
Management changes depending on stage of thyroiditis
- In thyrotoxic (hyper stage) - 1st Line = monitor and observe TFTs
- Consider BB or CCB for elderly or CVS patients
- In hypo stage or Hashimotos
- 1st Line = daily oral levothyroxine if moderate to severe
- if mild just observe and monitor
- In recurrent thyroidits/ symptomatic goitre (e.g. very large)
- Surgical thyoidotomy or radioactive ablation
