Infections Flashcards
What are some presenting features and signs of appendicitis?
Generalised abdominal pain that then localises to RIF as peritoneum becomes involved Profuse nausea and vomiting Anorexia Diarrhoea Guarding Rebound tenderness Fever Beware of signs of peritonitis or SHOCK if appendicitis's has ruptured
What would be some differentials for appendicitis?
Diverticulitis, Ectopic pregnancy, gastroenteritis, ovarian cyst
What makes appendicitis more difficult to diagnose?
Extremes of age and pregnancy
What investigations should you get in appendicitis?
FBC, U&E, LFT
- ESR, CRP and WCC will be raised
CT - highly sensitive and specific
USS - very commonly done
How should appendicitis be managed?
IV fluids Prophylactic Cef and Met Contact general surgery Slow IV metaclopramide Analgesia - opioid
What is cholecystitis?
Stones or sludge blocking neck of gall bladder leading to inflammation?
Gall stones is the most important cause
What are some symptoms and clinical signs of cholecystitis?
Pain in RUQ, tenderness (Murphy’s sign), Fever, Vomiting, peritonism,
Pain might be referred to right shoulder
Pain might be brought on by eating, particularly something fatty
What are some relevant investigations in cholecystitis?
High WCC
USS - thick walls of GB, might see stones, dilated CBD
LFTs - elevation of ALP, bili and ALT - only mild. If very high might suggest full obstruction of bile duct
ALP elevation suggestive of bile duct obstruction
What is the initial management of cholecystitis?
Keep them NBM
Give them opioid analgesics
give the IV fluids
Give them IV abx - consult trust guidelines ?Cefuroxime or tazocin
Management is surgical but often not emergency - wait for symptoms to settle
What is cholangitis?
This is all the features of cholecystitis PLUS jaundice - INFECTION IN GB.
What are the symptoms of cholangitis?
CHARCOT’S TRIAD
- RUQ pain
- Jaundice
- Fevers and Rigors
What increases the risk of cellulitis after a wound?
Retention of the foreign body Haematoma Devitalised tissue Poor nutrition and hence decreased immunity Diabetes
What is the most common organism to cause cellulitis?
Staph Aureus
What is the initial management for cellulitis and when should you consider admission?
Consider admission if patient is >38C, systemically unwell, regional lymphadenopathy or cellulitis is widespread
Consider - fluclox, BenPen or co-amox
Monitor vital signs for developing sepsis
What score do we use to grade croup?
Westley croup score:
STRIDOR: none=0, when agitated=1, at rest=2
RECESSIONS: mild=1, moderate=2, severe=3
AIR ENTRY: Normal=0, mild decrease=1, marked decrease=2
SpO2<92% on air: Non=0, with agitation=4, at rest=5
Level of consciousness: Normal =0, reduced=5
MODERATE = 3-5, SEVERE 6-11, IMPENDING RESP FAILURE >11
What is the initial management of croup?
Oral dexamethasone
Can give inhaled budesonide
adrenaline
Describe the scale of features of dehydration
MILD Thirst Decreased output (<4 wet nappies in 24h) Dry mouth MODERATE Sunken fontanelle Sunken eyes Tachypnoea - due to metabolic acidosis Tachycardia SEVERE Decreased skin turgor Drowsiness/irritability
What medications can we consider for severe diarrhoea?
Anti-emetics might help
ORAL REDHYDRATION: 200-400mL per loose stool
Loperamide
What antibiotic/pharmacological therapy should we consider in meningitis?
Refer to trust guidelines
Broad spectrum 2nd gen cephs (e.g. ceftriaxone, cefotaxime)
If it is occurring in adult >55 then might consider given AMPICILLIN as well to cover for listeria
Give IV dexamethasone with abx
What are some common pathogens that cause otitis media?
Streptococcus pneumoniae
Haemophilus influenza
How should we manage otitis media?
Oral analgesia (PCM) Might not need antibiotics but if you think they do consider amoxicillin 5 days
What is the CURB-65 score?
Score used to grade severity of CAP Confusion Urea >7 Resp rate >30 Blood pressure <90/<60 Age 65
***informs anti-microbial management
How should someone with CAP be managed?
Oxygen in hypoxic Iv fluids if hypotensive CXR Blood cultures and sputum cultures VTE prophylaxis Abx according to CURB65 Signs of SIRS (systemic inflammatory response syndrome)
How does CURB65 stratification affect antimicrobial management?
CURB mild - amoxicillin or clarithromycin
CURB moderate/severe - Amoxicillin/Co-amoxiclav + clarithromcyin (consider IV)
HAP -tazocin
What investigations are important to rule out septic arthritis?
Joint aspiration
Blood cultures
FBC, U&E
How should septic arthritis be managed?
IV fluclox + BenPen
Urgent referral to orthopaedics
What features within a tonsillitis history will help you decide if it is viral or bacterial?
Cough as a predominate symptom makes viral more likely
Exudate +++ on tonsils makes bacterial more likely
High FEVER also makes bacterial more likely
What are some common viral causes of tonsillitis?
Adenoviruses, EBV, HSV
What are some common bacterial causes of tonsillitis?
Group A beta-haemolytic strep, mycoplasma, corynebacterium
What antibiotic should you definitely not give unless you’ve completely ruled out EBV?
Amoxicillin
How should you manage a patient with tonsillitis?
Recommend PCM cover 1g QDS Ibuprofen 400mg PO TDS PRN IF BACTERIAL: - Penicillin 500mg PO QDS for 5 days OR - Clarithromycin 500mg PO BD
How should you manage an uncomplicated UTI?
3-6 day course of Trimethoprim or Nitrofurantoin and advise increased fluid intake
Amoxicillin for treatment of asx bacteriuria
MEN: 2 weeks ciprofloxacin, trimethoprim
CATHETER - 7 days cipro
