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Medicine > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

what is SIRS

A

systemic inflammatory response syndrome

systemic inflammatory response to an infectious insult or major systemic insult

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2
Q

what is SIRS criteria

A

2 or more of following
temp >38 or <36
HR >90
RR >20 or PCO2 <4.3 kPa
WCC >12k, <4k, or >10% bands

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3
Q

SIRS vs Sepsis vs Septic shock

A

Sepsis = SIRS + evi of infection
Septic shock = sepsis + tissue hypoperfusion or refractory hypotension

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4
Q

causal organisms of typical vs atypical pneumonia

A

typical pneumonia
strep pneumoniae
haemophilus influenza
moraxella catarrhalis
klebsiella
pseudomonas

atypical pneumonia
mycoplasma
legionella
coxiella burnetti
virus —- adenovirus, coronavirus, RSV, parainfluenza

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5
Q

Ix for CAP

A

vitals — increased RR & HR, reduced SpO2
+/- ABG depending on SpO2

bloods
FBC
lymphocytosis = viral
lymphopenia = covid-19
neutrophils = bacterial
U&Es
ESR, CRP — baseline
C&S

sputum C&S
urinary Ag — pneumococcus & legionella
+/- paired serum Ab — if suspect atypicals
+/- ABG — if SpO2 <95%

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6
Q

scoring system for pneumonia

A

CURB-65 or if in GP setting CRB65

criteria:
C: confusion — AMT-10 <8
U: Urea >7
R: RR >30
B: BP <90/60
65: Age >65 y/o

interpretation
0-1: home Tx
2: hospital Tx
3-5: consider HDU/ICU admission

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7
Q

is there any method for GP to decide whether to give Abx for CAP?

A

CRP POC if available
<20: no routine Abx
20-100: delayed Abx
>100: Abx

CRB65 can be used to guide referral to hospital

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8
Q

presentation of Covid-19

A

pulmonary
dry cough
SOB
fever
+/- sore throat

neuro: anosmia, stroke, headaches, dizziness
GI 25%: diarrhoea, N&V, abdo pain
VTE: DVT, PE

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9
Q

Ix for suspected covid-19

A

bloods
FBC — lymphopenia
U&Es
CRP
RT-PCR or rapid antigen test
pulse oximetry
ABG

CXR

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10
Q

Tx of covid-19

A

acc to severity + risk factors for severe covid-19 — home vs hospital management
if home management = safety net patient to monitor for progression of symptoms

symptomatic management
supplementary O2
cough — honey
adequate nutrition & rehydration
antipyretics + analgesia — paracetamol, ibuprofen

VTE prophylaxis
+/- empirical Abx – if ?superimposed bacterial infection
+/- corticosteroids
+/- antivirals — nirmatrelvir/ritonavir
+/- monoclonal Ab — if high risk progression

prevention of both disease & severe disease = covid-19 vaccine

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11
Q

20 y/o student — 2 day fever + severe sore throat + pain on swallowing
no cough
on exam: enlarged tonsils bilaterally + white exudate
ur DDx + why?

A

most likely tonisillitis — enlarged tonsils + white exudate + fever

other DDx
Quinsy = peritonsillar abscess — usually deviated uvula and one-sided

epiglottitis — if same presentation but in a young child + no white exudate on tonsils

glandular fever — adenopathy more posterior than in strep tonsillitis
if unsure = throat swab – check for strep + monospot (heterophile antibody test)

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12
Q

what is the most likely causal organism in tonsillitis

A

Grp A strep — ie strep pyogenes

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13
Q

what is the scoring system to help identify if Abx should be prescribed for tonsillitis

A

FeverPAIN scoring system (also used in pharyngitis)

criteria — 1 point each
fever
pus on tonsils
attendance within 3 days of symptom onset
(severely) inflamed tonsils
no cough & coryzal symptoms

interpretation
0-1: no Abx
2-3: offer deffered Abx
4-5: immediate Abx

Centor Criteria

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14
Q

Tx of tonsillitis in community

A

phenoxymethylpenicillin 666mg QDS 5 days
if pen allergic = clarithromycin 500mg BD 5 days

note: impt to prevent post-strep complications — post-strep GN, rheumatic fever, dehydration, quinsy, scarlet fever, sepsis

other Tx
paracetamol 1g QDS
ice cubes

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15
Q

causal organisms of acute OM

A

bacterial: strep pneumoniae, haemophilus influenza
viral: RSV, rhinovirus, adenovirus

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16
Q

Tx of otitis media in community

A

Abx — same as mild CAP
amoxicillin
if pen allergic = clarithromycin

analgesia — calpol (paracetamol) 15mg/kg per dose — every 4-6 hrs
dont exceed 4g daily

17
Q

complications of OM

A

perforation
impt to set appt 4 wks later to review TM tympanic membrane
presentation: discharge from ear
self-resolving

mastoiditis (rare)

18
Q

most likely causal organism of OE otitis externa

A

pseudomonas aeruginosa

19
Q

Tx of OE in community setting

A

if 100% sure TM tympanic membrane isnt perforated = topical aminoglycoside ear drops (eg. gentamicin)

if unsure if perforate = topical fluoroquinolone (eg. ofloxacin)

20
Q

presentation lower vs upper UTI

A

lower: dysuria + increased frequency

upper: dysuria + rigors + vomiting + renal angle tenderness

21
Q

most like causal organism of UTI

A

Escherichia Coli

22
Q

Tx of LUTI lower UTI vs pyelonephritis

A

LUTI Tx:

nitrofurantoin
capsule: 50mg QDS 3 days
or prolonged release: 100mg BD 3 days
C/I: severe renal impairment – eGFR<30

alternatives
cefalexin — but broad spectrum :(
trimethoprim — high level of R

duration differs acc to if male, child or pregnant F

safety net patient — if develop upper UTI symptoms = come back

Pyelonephritis:
cefalexin 500mg TDS 7-10 days
if pen allergic — may be allergic to cephalosporins

alternatives:
ciprofloxacin
co-amoxiclav

if no improvement after 24 hrs or if septic = admit

23
Q

presentation of conjunctivitis

A

unilateral + painless + red eye
purulent discharge

24
Q

most common causal organism of conjunctivitis

A

staph aureus
strep pneumoniae
haemophilus influenza

25
Q

Tx of conjunctivitis

A

deferred prescription of antibiotics — if suspect bacterial (eg. yellow-white mucopurulent discharge)
since usually self-limiting

1st line = chloramphenicol 0.5% drops — continue for 48 hrs after symptom resolution
C/I: <2 y/o

if <2 y/o = chloramphenicol 1% ointment

2nd line = fusidic acid 1% viscous eye drops suspension

if symptoms persist for >7-10 days = opth referral

26
Q

most likely causal organism of cellulitis

A

strep pyogenes (Grp A strep) — 2/3 cases
staph aureus — 1/3 cases

27
Q

Tx of cellulitis

A

1st line = flucloxacillin 500mg QDS 7-14 days
if pen allergic = clindamycin or clarithromycin or cefalexin
if facial cellulitis = co-amoxiclav

mark bounderies of cellulitis with a marker — to track progression
if febrile & ill = start IV
if has DM = clinical emergency!!! — risk of vascular compromise + ostoemyelitis

Medicine (18 decks)

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