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Finals > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

what is sepsis?

A

it is a large immune response to systemic inflammation and affects the functioning of organs - cytokines affect the endothelial lining making it more permeable so there is a drop in intravascular volume, oedema and resultant hypoperfusion

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2
Q

what does hypoperfusion result in?

A

increased blood lactate leading to anaerobic respiration

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3
Q

what is the presentation of sepsis?

A

hypoxia, oliguria, AKI, thrombocytopenia, coagulation dysfunction, hypotension, high lactate, pyrexia, tachycardia, tachypnoea, low sats, rash, mottled skin, cyanosis, AF

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4
Q

what are the risk factors for sepsis?

A

extremes of age, chronic conditions, surgery, trauma, pregnancy, peri-partum, indwelling devices

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5
Q

how would you investigate sepsis?

A

FBC, U&Es, LFTs, CRP, clotting, cultures, ABG, dipstick, CXR, CT, LP

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6
Q

what is the management of sepsis?

A

within one hour - blood lactate, cultures, UO, IV fluids, IV ABx, O2

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7
Q

why is it important to look at clotting in sepsis?

A

activation of the coagulation system causes thrombocytopenia, haemorrhage and DIC

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8
Q

what is neutropenic sepsis?

A

it is when the neutrophils are less than 1x10^9/L. Caused by chemo, clozapine, methotrexate, carbimazole, infliximab, and usually treated with tazocin

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9
Q

what is the usual cause and some rarer causes of UTI?

A

E coli is usual
rare - Klebsiella, pseudomonas, staph, candida

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10
Q

how does UTI present?

A

dysuria, suprapubic pain, frequency, urgency, confusion, incontinence, loin or back pain, unwell, N&V, haematuria, renal angle tenderness, loss of appetite

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11
Q

what is the management of UTI?

A

LUTI women - 3d trimethoprim or nitrofurantoin
if immunocompromised, abnormal or impaired renal function - 5-10 days
male, pregnant or catheter - 7 days

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12
Q

how is UTI treated in pregnancy?

A

7d ABx, urine MC&S, nitro (avoid in third trimester), cefalexin, amoxicillin
avoid trimethoprim in first trimester

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13
Q

how is pyelonephritis treated?

A

refer if septic, 7-10d ABx, with cefalexin, co-amoxiclav, trimethoprim or ciprofloxacin

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14
Q

how does cellulitis present and what is the usual causes?

A

erythema, warmth, tense, oedematous, thickened, bullae, golden yellow indicates S Aureus - usual causes are S Aureus, GAS, GCS, MRSA

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15
Q

what is the Eron Classification?

A

severity of skin and soft tissue infections
I - no systemic symptoms
II - some systemic
III - significant systemic
IV - sepsis or life threatening
admit III and IV or if have comorbidities

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16
Q

what is the management of cellulitis?

A

flucloxacillin QDS PO if S Aureus, clarithromycin, clindamycin or co-amoxiclav

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17
Q

summarise bacterial tonsilitis?

A

usually caused by GAS or viral
CENTOR - bacterial - >3 give ABx - fever>38, tonsillar exudate, absence of cough, lymphadenopathy
treat with Pen V

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18
Q

summarise OM?

A

usually resolves in 3-7d without ABx - bulging red tympanic membrane, pain and then resolution means perforation, discharge - give amoxicillin, clari, erythro or coamox

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19
Q

summarise sinusitis?

A

self resolving in 2-3w without treatment - if >10d with no improvement then give 2w of high dose steroid nasal spray, if likely bacterial then pen V for 5 days

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20
Q

what is gastroenteritis?

A

it is inflammation of the stomach and intestines resulting in N,V&D - it is mostly viral and quickly spread (adeno, rota or noro)

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21
Q

describe the presentation of bacillus cereus?

A

it is a gram positive rod
from poor food hygiene
release cereulide toxin
cramping and vomiting within 5 hours and watery diarrhoea after eight hours - resolves in 24 hours

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22
Q

what gastroenteritis is azithromycin or ciprofloxacin used to treat?

A

campylobacter - travellers - 3-6d of abdo cramps, vomiting, some bloody diarrhoea, fever
shigella - bloody diarrhoea, abdo cramps

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23
Q

other than shigella what else releases the shiga toxin?

A

E coli - can result in HUS

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24
Q

how is giardiasis diagnosed and treated?

A

stool microscopy and treated with metronidazole

25
Q

general management of gastroenteritis?

A

M,C&S, ORS or dioralyte, ABx

26
Q

what are some differentials of septic arthritis?

A

gout, pseudogout, reactive arthritis, haemarthrosis

27
Q

what is the presentation of septic arthritis?

A

hot, swollen, tender, red, stiff joint, reduced ROM and systemic sx

28
Q

what is the management of septic arthritis?

A

joint aspiration, gram staining, crystal microscopy, culture and sensitives
washout or debridement
IV ABx for 3-6w (fluclox and rifampicin, vanco and rifampicin, clindamycin)

29
Q

when does SBP present and how is it treated?

A

typically in liver failure and treated with pip taz, cephalosporins, levofloxacin and metronidazole

30
Q

what is TB, how is it investigated and what are the risk factors?

A

it is a mycobacterium tuberculosis - small rod shaped
it is investigated with Ziehl Neelsen stain - bright red acid fast , Mantoux test, interferon gamma release assay, CXR, cultures (LN, sputum and mycobacterium)
risk factors - South Asian, immunocompromised, IVDU, known contact, immigrant, travel, homeless, alcoholic

31
Q

what is the natural progression of TB?

A

active - latent - secondary - miliary

32
Q

what is the presentation of TB?

A

lethargy, fever, night sweats, weight loss, cough and haemoptysis, erythema nodosum, lymphadenopathy, spinal pain

33
Q

what is seen on CXR for TB?

A

patchy consolidation, pleural effusions, hilar lymphadenopathy, cavitations and miliary seeds

34
Q

how is TB treated?

A

latent - isoniazid and rifampicin for 3m or isoniazid alone for 6m
acute - rifampicin 6m, isoniazid 6m, ethambutol 2m and pyrazinamide 2m

35
Q

what are some AIDS defining illnesses?

A

Kaposki’s sarcoma, cytomegalovirus, candidiasis, PCP, TB

36
Q

how is HIV screened and monitored?

A

screening - with any other infectious disease after 3m , antibody blood test, p24 antigen or PCR
monitoring - CD4 count (<200 is end stage), VL (<50 is undetectable)

37
Q

how is HIV managed?

A

ARTs - 2 NRTIs (tenovir and emtricitabine - combination is known as Truvada) and 3rd agent
HAART - protease inhibitors, integrase inhibitors, (non) nucleoside reverse transcriptase inhibitors, entry inhibitors
prophylactic ABx for PCP, cervical smear annually, avoid live vaccines, keep up to date with vaccines

38
Q

how does HIV impact birth?

A

usually a C section unless undetectable VL
baby to get 4weeks for ART and then tested

39
Q

what is post exposure prophylaxis for HIV?

A

commenced in 72 hours use ART - truvada

40
Q

what is post exposure prophylaxis for HIV?

A

commenced in 72 hours use ART - truvada and raltegravir for 28 days, test at presentation and at 3m and use protection until negative

41
Q

what is the pathophysiology of malaria?

A

plasmodium protozoan - sporozoites are transferred to liver, can lie dormant as hypnozoites (ovale and vivax), mature to merozoites, and infect RBCs - burst every 48 hours

42
Q

how does malaria present?

A

within 1-4 weeks for travel, spike fever every 48 hours, sweats, rigors, myalgia, malaise, headache, vomiting, pallor, hepatosplenomegaly, jaundice

43
Q

how is malaria diagnosed?

A

blood film (EDTA) 3 samples over 3 days

44
Q

what are the complications of malaria?

A

cerebral malaria, seizures, altered LOC, AKI, haemolytic anaemia, organ failure, death

45
Q

what is the prevention of malaria?

A

education, spray, nets, barriers, medical advice if sx, antimalarials:
proguanil and atovaquone - OD 2 days before, during and 1w after
mefloquine - once weekly, 2w before, during and 4 week after
doxycycline - OF 2d before, during and 4 week after - risk of UV

46
Q

how is malaria managed?

A

inform ID team
arthemeter and lumefantrine (riamet), proguanil and atovaquone (maladrone), quinine sulfate, doxycycline - all oral
IV - artesunate, quinine dihydrochloride

47
Q

what is the presentation of meningitis?

A

fever, neck stiffness, vomiting, headache, LOC reduced, seizures, photophobia

48
Q

how does meningitis present in neonates?

A

non specific
hypotonia, poor feeding, lethargy, bulging fontanelle, fever, unwell

49
Q

what are Kernig and Brudzinski’s signs?

A

Kernig’s - flex hip and knee to 90 degrees, straighten knee - painful or resistance
Brudzinskis - head and neck tilt to chest - involuntary hip and knee flexion

50
Q

what is the management of bacterial meningitis?

A

community - IM Ben Pen 1200mg adult
hospital - LP and CSF, PCR and DNA, <3m cefotaxime and amox, >3m ceftriaxone
if risk of resistance add vancomycin
steroids dex QDS 4d if needed

51
Q

how does CSF present in viral v bacterial meningitis?

A

viral - clear, normal protein, normal glucose, increased WCC with lymphocytes, negative culture
bacterial - cloudy, increased protein, low glucose, increased WCC with neutrophils, positive culture

52
Q

how is HSV meningitis managed?

A

supportive and acyclovir

53
Q

what is the prophylaxis for contacts of meningitis?

A

single dose ciprofloxacin

54
Q

what are complications of meningitis?

A

hearing loss, memory loss, seizures, CI

55
Q

who gets vaccinated against flu?

A

> 65, healthcare, pregnancy, chronic conditions, young children

56
Q

what are some complications of flu?

A

OM, sinusitis, bronchitis, viral / secondary bacterial pneumonia, febrile convulsions, worsening chronic conditions, encephalitis

57
Q

what is the post exposure prophylaxis for influenza?

A

if within 48h - oseltamivir OD for 10d 75mg

58
Q

how is influenza managed?

A

oral oseltamivir 75mg BD for 5 days, inhaled zanamivir 10mg BD for 5days within 48 hours of symptom onset

59
Q

how does influenza present and how is it diagnosed?

A

fever, coryzal sx, lethargy, fatigue, anorexia, muscle and joint pain, headache, dry cough, sore throat
viral or nasal swabs for PCR to diagnose

Finals (16 decks)

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