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MRCP Part 1 > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

What is sepsis

A

Significant immune response causing widespread inflammation

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2
Q

In sepsis, what happens to the

Body fluid compartments

platelets

Blood lactate

A

Oedema due to increased capillary permeability

Thrombocytopaenia due to coag activation

Raised lactate due to hypoperfusion

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3
Q

What constitutes septic shock?

How is it treated

A

Systolic <90mmHg

AND/OR

Lactate >4mmol/L

Admin of inotropes in HDU (NOT FLUIDS)

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4
Q

Regarding observations in sepsis…

What is the first sign

How do they differ in neutropaenic sepsis?

A

Raised RR is the first sign

Neutropaenic patients have normal temperature

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5
Q

What are the take 3 give 3 of sepsis?

A

Take 3

Blood lactate

Blood culture

Urine output

Give 3

Oxygen

IV antibiotics

IV fluids

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6
Q

What lab finding would point towards neutropaenic sepsis?

A

Neutrophil count <1 x 10^9

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7
Q

What makes up the CURB65 score in pneumonia?

A

Confusion

Urea >7mmol

Resp rate >=30

Blood pressure <90 sys OR <=60 dia

65+

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8
Q

What are the two most commmon causes of CAP?

A
  1. Strep pneumoniae (G-ve, a-haem strep)
  2. H. Influenzae (G+ve, aerobic bacilli)
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9
Q

What are the 4 most common atypical CAP causes and their associations

A

Legions of psittaci MCQs

Legionella: cheap holiday, low sodium

Chlamydia psittaci: From birds

Mycoplasma pneumoniae: Target lesions, neuro features

Chlamydia pneumoniae: school aged kids with wheeze

Q-fever (coxiella burnetti): Farmer with flu symptoms

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10
Q

What pathogen is associated with pneumonia in…

Immunocompromised or chornic lung disease

Cystic fibrosis

Cystic fibrosis and bronchiectasis

A

M. Catarrhalis

S. Aureus

P. aeringuosa

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11
Q

What pneumonia bug do the following get

Immunocompromised patients

Alcoholics

A

Pneumocystis jiroveci

Klebsiella

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12
Q

How do you treat

Mild-mod CAP

Severe CAP

Non severe HAP

Severe HAP

Pneumocystic pneumoniae

A

5 days Amox (dox + macrolide)

PO Co-amox + dox (levofloxacin)

PO Amoxicillin (Doxycycline)

IV amox + gent (co-trimox + gent)

Co-trimoxazole, can be given prophylactically

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13
Q

How can you differentiate between lower and upper urinary tract infections?

A

Lower: Dysuria, incotinence; confusion in older patients

Upper: Fever, loin pain, haematuria

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14
Q

What testing should be performed in a suspected UTI?

A

Dipstick for nitrites and leukocytes

MSSU for culture

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15
Q

What is the most common cause of UTI?

A

E. Coli (G-ve, anerovic rod)

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16
Q

What is the management of the following UTIs

Lower UTI in

Males

Non-pregnant

Pregnant

Upper UTI

A

Males: Nitro/trimethoprim 7 days

Non-pregnant: Nitro/trimethoprim 3 days

Pregnant

asymp: nitro/amox/cefelexin 7 days
symp: 1. Nitro 2. Amox/cefaxelin 7 days

Upper: Co-amoxiclav/ Co-trimoxazole 10–14 days

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17
Q

When are the following antibiotics avoided in pregnancy for UTI and why?

Nitrofurantoin

Trimethoprim

A

3rd trimester due to haemolytic anaemia in newborns

First trimester to tue neural tube defects

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18
Q

What are the 3 most common causes of cellulitis?

What is the other cause to be aware of?

A

S. aureus

group A strep

Group C strep

MRSA

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19
Q

What antibioitic is given for cellulitis?

A

Flucloxicillin

20
Q

What is the most common cause of tonsilitis, otitis media and rhinosinusitis?

A

VIRAL

21
Q

What are the two most common bacterial causes of tonsilitis, otitis media, sinusitis?

A

Strep pyogenes

Strep Pneumoniae

22
Q

When is antibiotics given for tonsilitis?

What do you give?

A

CENTOR >=3 OR FeverPAIN >=4

Phenoxymethylpenicillin (Pen V) for 10 days (clarithromycin otherwise)

23
Q

What indicates otitis media and when would you consider antibiotics?

A

Painful ear with bulging tympanic membrane +/- discharge if perforation

If >3 days, under 2yrs, discharge or systemic infection

24
Q

What is the first line treatment for otitis media?

A

Amoxicillin PO 5 days (clarithromycin)

25
Q

How does duration of symptoms dictate sinusitis antibiotics?

A

<10 days: no therapy

>10 days: trial 2 weeks high dose nasal spray

+ if >10 days and likely bacterial cause: Pen V (clarithromycin)

26
Q

What are the two broad bacterial groups causing intra-abdominal infection

A

Coliforms (E. Coli, Klebsiella, enterobacter)

Anaerobes (bacterioides, clostridium)

27
Q

What regime is used in Tayside for intra-abdominal infection?

A

Amoxicillin (+ves) + Metronidazole (anarobes) + Gentamicin (-ves)

Replace amox with vanc if allergic

28
Q

In Tayside, what is used for the following SBP infections

Mild

Severe

A

Co-trimoxazole PO

Piperacillin/tazobactam then Co-trimoxazole

29
Q

What should you do for a red, hot, swollen joint with reduced mobility?

A

Aspirate to for microbiology to exclude septic arthritis

30
Q

What is the most common cause of septic arthritis?

A

S. aureus

31
Q

What should you suspect in younger patients with septic arthritis?

A

Gonococcal infection if sexually active

32
Q

What is the treatment of septic arthritis

A

Empirical until sensitivities back

Usually flucloxicillin

33
Q

What are the causes of viral gastroenteritis?

A

Rotavirus

Norovirus

Adenovirus

34
Q

Name the pathogen that fits the gastroenteritis history

Pork, 4-7 days incubation, children with lympahdenopathy

Uncooked rice, IVDUs, 8hr incubation; vomiting 5hrs, diarrhoea 8hrs, resolution 24hrs

Unwashed salad or water, antibiotic use, + blood

Water, pools and food, 1-2 days incubation

Raw eggs and poultry; 12hr-3d incubation, watery+/- mucus, blood

Travel, uncooked poultry, water; 2-5 days incubation, + blood

A

Yersinia

Bacillus Cereus

E. Coli

Shigella

Salmonella

Campylobacter jejuni

35
Q

What is the general approach for gastroenteritis?

A

Send stool for MCS

Fluid challenge +/- oral fluids

Generally avoid antidiarrhoeals and antiemetics

Isolate for 48 hours post-symptoms

36
Q

What are the common causes of bacterial meningitis in

Adults and children

Neonates

A

N. meningitidis, S. pneumoniae

GBS

37
Q

What can help clinically identify meningitis in

Adults and children

Newborns and infants

A

Straighten knee with flexed hip (Kernig) or put chin to chest (Brudzinkis sign), will cause resistance or pain

Perform LP…

<1 month + fever

1m-1yr: Fever + unwell

38
Q

What is the typical treatment for bacterial meningitis if

In community

Hospital

A

Community

IM benpen (<1yr: 300mg, <9yr: 600mg, >=10yr: 1200mg)

Hospital

<3 months: Cefotaxime + amoxicllin (cover listeria)

>3 months: Cetriaxone

+ Vanc if travel, long term therapy

+ Dexamethasone if >3 months 4 x 4 daily

39
Q

Who else gests treated following a suspected meningitis case and what is given?

A

Close contacts in past 7 days

Single dose ciprofloxacin

40
Q

What are the common causes of viral meningitis?

A

HSV

Enterovirus

VZV

41
Q

What is the most worrying form of malaria?

A

Plasmodium falciparum

42
Q

Outline malarial transmission

A

Infected blood –> Anopholes mosquito –> sporozites in gut –> infection to human –> travel to liver to infect RBCs

43
Q

Why do malaria patient have pallor, jaundice, hepatosplenomegaly and 48hr fevers

A

Travel to liver, infect RBCs, cause them to rupture then further infect

44
Q

How do you diagnose malaria?

A

3 samples over 3 days in EDTA for malaria blood film

45
Q

How do you treat the following malaria forms

Uncomplicated falciparum

Severe falciparum

Non falciparum

A

Uncomplicated: ACT combos -will be ‘arte’ plus another drug, Quinine + doxy/clinda

Severe: IV artesunate if >2% count, exchange transfusion if >10%

Non-falciparum: Chloroquine

MRCP Part 1 (32 decks)

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