Infection Incorrects Flashcards
A 76 year old man has nausea, fever and rigors. He has foul smelling urine. He was discharged 3 days ago after being treated for a PE. He has been having low molecular weight heparin injections twice daily since the diagnosis. He had a cholecystectomy 12 years ago.His temperature is 39.7°C, pulse rate 100 bpm and BP 92/41 mmHg.Investigations:
APTT 43 seconds (22–41) PT 18 seconds (10–12)
Which is the most likely cause of the prolonged prothrombin time?
A. Disseminated intravascular coagulation
B. Liver disease
C. Low molecular weight heparin
D. Lupus anticoagulant
E. Vitamin K deficiency
A = Sepsis causing DIC
chlamydia first line treatment?
doxycycline
A 24 year old woman has 1 week of watery diarrhoea and abdominal
cramping. She is a keen swimmer and there has been a recent outbreak of
diarrhoeal disease amongst her swimming club. She is otherwise well. A
stool sample shows oocysts of cryptosporidium.
Which is the most appropriate management?
no therapy required, self limiting illness
A child with scarlet fever can return to school x hours after commencing antibiotics?
24
Non-pregnant women with uncomplicated lower UTI, treatment with antibiotics for how many days?
3 days! of nitro
when would you send a urine culture/MSU for patients with a UTI?
women with a suspected UTI if associated with visible or non-visible haematuria
All men with a suspected UTI should have a urine culture sent before starting antibiotics
Do not treat asymptomatic bacteria in catheterised patients
UTI in a pregnant woman in the third trimester management?
amoxicillin or cefalexin for 7 days
A 41-year-old man with HIV attends his GP complaining of shortness of breath. He has a dry cough which has been present for the past 5 months and occasional symptoms of chest tightness and discomfort.
On examination his temperature is 36.7ºC, his heart rate is 69 bpm, his blood pressure is 131/86 mmHg and his oxygen saturations on air are 98%. Examination of his chest is normal but when he is asked to stand and walk 10m, upon returning to his chair his oxygen saturations on air are measured as 89%. A chest x-ray is subsequently performed which shows some patchy opacities in the right apex and bilateral hilar enlargement.
What is the most likely causative organism of this man’s symptoms?
Pneumocystis jiroveci pneumonia causes desaturation on exercise
ABG shows a metabolic acidosis and raised lactate which further points towards sepsis. Apyrexia does not rule out sepsis.
systolic blood pressure < 90mmHg or > 40mmHg fall from baseline
mean arterial pressure < 65mmHg
heart rate > 131 per minute
respiratory rate > 25 per minute
unresponsive or responsive only to voice or pain.
what type of swab is 1st line for chlamydia/ gonorrhea?
Vulvo-vaginal swab
trichomonas treatment?
meTronidazole
whooping cough management?
oral macrolide (e.g. clarithromycin, azithromycin or erythromycin)
Women who suffer regular urinary tract infection following sexual intercourse can be offered post-coital antibiotic prophylaxis
All patients with a CD4 count lower than 200/mm3 should receive prophylaxis against Pneumocystis jiroveci pneumonia with what medication addedd to their antivirals?
Co-trimoxazole
Antibiotic prohylaxis to prevent infective endocarditis is not routinely recommended in the UK for dental and other procedures
criteria for admission for croup?
in addition to oral dex
moderate or severe croup eg audible stridor at rest
< 3 months of age
moderate or severe croup
< 3 months of age
A 40-year-old patient is reviewed in the urgent neurology clinic after suffering a first seizure 3 days ago. They have a past medical history of HIV. As part of a series of investigations, a brain CT is performed which shows a single lesion with homogenous enhancement. A thallium SPECT scan later demonstrates increased uptake and is therefore reported as positive.
What is the most likely cause of the patient’s symptoms?
CNS lymphoma
Cryptococcus will show meningeal enhancement and cerebral oedema on CT scan.
In toxoplasmosis multiple lesions are often seen on CT scan and the thallium SPECT scan will be negative.
HIV test?
Combination HIV p24 antigen and HIV antibody test
viral antigen and antibody
A 55-year-old business man presents with a 15 day history of watery, non-bloody diarrhoea associated with anorexia and abdominal bloating. His symptoms started 4 days after returning from a trip to Pakistan. On examination he is apyrexial with dry mucous membranes but normal skin turgor. What is the most likely causative organism?
Although Escherichia coli is the most common cause of travellers’ diarrhoea, in this particular case the length of illness and nature of symptoms (bloating, watery diarrhoea) points to a diagnosis of Giardiasis!!!
which antibiotic should be avoided in the first trimester of pregnancy?
trimethoprim
criteria for MSU in women?
mid-stream urine sample should be sent for women with a suspected lower urinary tract infection to look for resistant or atypical organisms with the following indications:
Have symptoms that are persistent or do not resolve with antibiotic treatment.
Have recurrent UTI (2 episodes in 6 months or 3 in 12 months).
Have a urinary catheter in situ or have recently been catheterised.
Have risk factors for resistance or complicated UTI such as abnormalities of the genitourinary tract, renal impairment, residence in a long-term care facility, hospitalisation for more than 7 days in the last 6 months, recent travel to a country with increased resistance or previous resistant UTI.
Have atypical symptoms.
Have visible or non-visible (on urine dipstick) haematuria.
Pregnant
Age more than 65 years old.
Household contacts of patients with head lice do not need to be treated unless they are also affected
HIV seroconversion occurs from 3-12 weeks
ritonavir is what type of HIV drug?
protease inhibitor
‘Navir tease a pro’ - HIV drugs that end with -navir are protease inhibitors
which valve is most commonly affected in infective endocarditis?
mitral valve
HIV, neuro symptoms, widespread demyelination diagnosis
PML
most useful ix to diagnose infective endocarditis?
blood cultures
What finding is best in determining the severity of c difficile infection?
white blood cell count
A 38-year-old lady who smokes heavily presents with recurrent episodes of infection in the right breast. On examination, she has an indurated area at the lateral aspect of the nipple areolar complex. Imaging shows no mass lesions. What is the most likely diagnosis?
Periductal mastitis is common in smokers and may present with recurrent infections. Treatment is with co-amoxiclav.
Joint aspiration is performed and synovial fluid is sent to the lab. A Gram stain of the fluid shows Gram-positive cocci in clusters, which are coagulase positive. The following day they are shown to be resistant to flucloxacillin. The patient is scheduled for a joint washout on the same day.
What is the most appropriate next step with regard to antibiotics?
vancomycin! - this is mrsa
if effective removal of milk has not improved the symptoms of lactational mastitis after 12-24 hours flucloxacillin is the 1st line empirical treatment
A 35-year-old man who is known to have advanced HIV disease presents with dysphagia and odynophagia. What is the most likely cause of his problems?
Oesophageal candidiasis
chlamydia in pregnancyy treatment
Azithromycin, erythromycin or amoxicillin
not doxxyyy
Do not treat asymptomatic bacteria in catheterised patients
second line antibiotic to treat MRSA after vancomycin?
Linezolid
Toxic shock in a woman, most appropriate investigation?
speculum exam
The majority of patients with suspected shingles should be treated with antivirals within 72 hours of onset; aciclovir, famiciclovir etc
Most common cause of endocarditis:
Staphylococcus aureus iif > 2 months post valve surgery
Staphylococcus epidermidis if < 2 months post valve surgery
empirical treatment of choice in native valve endocarditis?
IV amoxicillin
