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Infection Station Flashcards

1
Q

What is the main iatrogenic precipitant of C.diff?

A

Antibiotic use (particularly broad spec)

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2
Q

Which antibiotic is the main culprit for C.diff?

A

Ceftriaxone

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3
Q

How is C.diff transmitted?

A

As spores

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4
Q

What hygiene precaution is important with C.diff?

A

Wash hands WITH SOAP AND WATER

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5
Q

What gives C.diff its unique hygiene rule?

A

Ability of spores to survive alcohol gel

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6
Q

Is C.diff always pathological?

A

No - 3% of the population have it as normal gut flora

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7
Q

How does C.diff cause illness?

A

Releases toxins that cause cytokine release and cell damage and death

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8
Q

What is the name given to C.diff’s effect in the bowel?

A

Pseudomembranous colitis

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9
Q

What symptoms present in C.diff?

A 
Diarrhoea
Abdo pain
Fever
Malaise
Nausea
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10
Q

What investigations should be done in C.diff?

A

NEWS

Stool sample

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11
Q

What effect can C.diff have in peristalsis?

A

Stop it

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12
Q

What does the cessation of peristalsis in C.diff risk?

A

Bowel perforation

Sepsis

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13
Q

What is looked for on stool sample in C.diff?

A

Antigens

Toxins

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14
Q

What stool sample result means that C.diff is at a pathological level?

A

Toxin positive

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15
Q

Why is NEWS important in C.diff?

A

Look for early warning signs of sepsis

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16
Q

What medication is used to treat C.diff?

A

Metronidazole

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17
Q

What other management steps (besides antibiotics) should be taken in C.diff?

A

Isolate patient
Stop previous antibiotics
Ensure good hand hygiene
Use PPE

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18
Q

What should be remembered about metronidazole?

A

It is a CYP450 inhibitor

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19
Q

What are the common 3 organisms causing CA pneumonia?

A

Strep pneumoniae
Klebsiella pneumoniae
Haemophilus influenzae

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20
Q

What type of organisms most commonly cause HA pneumonia?

A

Mostly gram-ve rods

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21
Q

What antibiotic used to treat first line mild CAP?

A

Amoxicillin

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22
Q

Second lines in mild CAP?

A

Macrolide

Tetracycline

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23
Q

What are some symptoms of pneumonia?

A 
SoB
Rigors
Fever
Cough +/- sputum
Pleuritic chest pain
Malaise
N+V
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24
Q

What are two rarer causes of CAP?

A

Mycoplasma

Staph aureus

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25
What score is used to assess CAP?
CURB65
26
What does C mean in CURB65?
New onset Confusion
27
What does U mean in CURB65?
Urea >7
28
What does R mean in CURB65?
RR≥30
29
What does B mean in CURB65?
SBP ≤90 or DBP ≤60
30
What does 65 mean in CURB65?
Age >65
31
What does each aspect of CURB65 score?
1 point
32
A score of what should lead to admission to hospital?
≥2
33
What antibiotics are used for mild HAP?
Amoxicillin
34
What antibiotic should be used for Moderate-Severe HAP?
Ceftriaxone
35
Why is Ceftriaxone used in more severe HAP?
It is more effective against Gram -ve bacteria (the most common cause of HAP)
36
Why is tetracycline (+amoxicillin) used in severe CAP?
Broad spectrum to cover the Gram +ve/-ve organisms that can commonly cause CAP
37
What investigations should always be done in pneumonia?
``` FBC U&E CRP ABG CXR Sputum culture ```
38
What tests can be added if you fancy for pneumonia?
Blood culture Lavage Serum antibody Nose and throat swabs
39
What are some possible examination findings of pneumonia?
``` Tachycardia Tachypnoea Pyrexia Cyanosis Dull percussion Increased tactile vocal fremitus/resonance Bronchial breathing Crackles ```
40
After what time period is onset of pneumonia post-hospital admission consider HAP?
>48 hours
41
What is bacteriuria?
Bacteria in urine (a/symptoamtic)
42
What is a UTI?
Symptomatic w/ +ve culture or dipstick
43
What is urethral syndrome?
Symptomatic but no bacteriuria
44
What is an uncomplicated UTI?
UTI in normal GU tract and function
45
What is a complicated UTI?
UTI in abnormal GU tract/function | and all men sometimes
46
What are the 3 presentations of UTI's?
Pyelonephritis Cystitis Prostatitis
47
How does pyelonephritis present?
Fever Loin pain Vomiting Potentially oliguria if AKI
48
How does cystitis present?
``` Frequency Urgency Polyuria Dysuria Suprapubic tenderness Foul smelling urine ```
49
How does prostatitis present?
Flu-like symptoms Low back ache Dysuria Tender prostate on PR
50
What are the risk factors for UTI?
``` Female Sexual activity Pregnancy Menopause DM Abnormal tract ```
51
What can constitute an abnormal urinary tract?
Stones Obstructions Catheter Malformation
52
What is the most common organism causing UTI?
E. coli
53
What less organisms can cause UTI?
Staphylococcus Saprophyticus Proteus Klebsiella
54
What investigations should be done for UTI?
Dipstick MSU for MCS Bloods USS in children, men, recurrent or pyelonephritis
55
How can UTI be managed non-pharmacologically?
Drink plenty | Urinate often
56
What is the first line for cystitis?
Nitrofurantoin
57
What is second line for cystitis?
Trimethoprim
58
What can contra-indicate use of nitrofurantoin?
eGFR <45
59
What can be used to treat pyelonephritis?
Cefotaxime
60
How should UTI's be prevented?
Drink more Abx prophylaxis (in serious recurrent cases) Drink cranberry juice (caution with drug interactions) Wipe front to back
61
When should septic arthritis be suspected?
Any acutely inflamed joint
62
Why is it important to be highly suspicious of septic arthritis?
Can destroy a joint in <24 hours
63
What is the mortality rate of septic arthritis?
11%
64
What is the most commonly affected joint in septic arthritis?
Knee
65
How should septic arthritis be investigated?
Joint aspiration for microscopy and culture | Blood cultures
66
When must aspiration and blood cultures be taken?
Before starting empirical antibiotics
67
What are some major risk factors for septic arthritis?
Immunosuppression DM Prosthetic joints Recent joint surgery
68
When is septic arthritis particularly difficult to treat?
In prosthetic joints
69
What is the main differential for septic arthritis?
Crystal arhtopathies
70
What are the main crystal arthropathies?
Gout | Pseudo-gout
71
What will be seen on microscopy of joint aspirate in septic arthritis?
Increased WCC
72
What will be seen on microscopy of joint aspirate in gout?
Needle shaped urate crystals
73
What will be seen microscopy of joint aspirate in pseudo-gout?
Rhomboid shaped crystals
74
What colour is joint aspirate in septic and crystal arthropathies?
Turbid yellow
75
How can a joint become septic?
Direct introduction of bacteria Deposition of bacteria via systemic spread
76
What are the most common causative organisms of septic arthritis?
Staph aureus | Strep
77
What is a good empirical antibiotic to use in septic arthritis?
IV flucloxacillin
78
How long are antibiotics used in septic arthritis?
2-4 weeks
79
What antibiotic should be used if there is a suspected gram -ve cause of septic arthritis?
IV ceftriaxone
80
Where does appendicitis pain begin?
Umbilical region
81
Where does appendicitis pain localise?
RIF
82
What are the symptoms of appendicitis?
Abdo pain Nausea and vomiting Diarrhoea Lost appetitie
83
How is appendicitis treated?
Mostly with removal of the appendix
84
How is an appendectomy performed?
Laparoscopy
85
What antibiotic used for cellulitis?
Flucloxacillin
86
How can the symptoms of meningitis be classified?
Meningitic Neurological Septic
87
What are the meningitic symptoms of meningitis?
Headache Neck stiffness Photophobia N&V
88
What are the neurological features of meningitis?
Decreased GCS Seizures Focal neurological signs
89
What are the septic features of meningitis?
Sepsis
90
What organisms can cause meningitis?
``` HSV2 Meningococcus Pneumococcus Haemophilus TB Cryptococcus ```
91
What investigations are required for meningitis?
Bloods Blood cultures Lumbar puncture*
92
When should LP not be performed in meningitis?
When the patient is mainly septic
93
When should LP be performed in meningitis?
When the patient is mainly meningitic
94
If a meningitis patient is mainly septic what medication should be given?
Ceftriaxone
95
If a patient is mainly meningitic what medications should be given?
Ceftriaxone | Dexamethasone
96
What supportive therapies should be given in meningitis?
Oxygen | Fluids
97
What can be given as prophylaxis to household contacts of patients with meningitis?
Rifampicin

OSCE (19 decks)

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