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3rd yr clinical > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

What is DIC

A

Disseminated intravascular coagulopathy - low platelets - thrombocytopaniea due to blood clots forming and taking all the platelets and clotting factors- this will cause haemorrhage

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2
Q

How is septic shock diagnosed

A

Low mean arterial blood pressure (below 65) despite fluid rhesus (need vasopressors)

Raised serum lactate above 2

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3
Q

What is SOFA

A

Sepsis related organ failure assessment
-Assess severity of organ dysfunction
-Hypoxia, O2 requirements, mechanical ventilation, thrombocytopenia, reduced GCS, raised bile, reduced BP and raised creatinine

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4
Q

What does the NEWS2 look at

A

Temp, HR, RR, O2 sats, BP, Conciousness

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5
Q

What is the management of sepsis

A

Sepsis 6
3 in
Oxygen
Empirical broad spectrum abx
IV fluids

3 out
Serum lactate
Blood cultures
Urine output

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6
Q

When should you suspect neutropenic sepsis and what causes it

A

Fever in any immunocompromised patient is a medical emergency

Chemo meds, clozapine (schizophrenia), hydroxychloroquinine, methotrexate, sulfasalazine, carbimazole (hyperthyroid), quinine, infliximab, rutuximab

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7
Q

What antibiotics are used in sepsis

A

Piperacillin with tazobactam - tazocin

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8
Q

What are the main organisms that cause UTIS

A

Usually E.coli
Klebsiella pneumoniae
Enterococcus
Pseudomonas aeruginosa

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9
Q

What are the various findings on a urine dipstick and what do they indicate

A

Nitrates- Gram negative bacteria- E.Coli break down nitrates
Leukocytes- infection inflam
RBCs- microscopic haematuria- infection, bladder cancer, nephritis

Nitrates are best indication of infection

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10
Q

What is the management of of LUTI

A

Nitrofuratonin (unless eGFR <45) then trimethoprim
3 days abs for simple UTI

5-10 days if immunosupressed/ impaired kidney function

7 days men, pregnancy women and catheter related UTIS

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11
Q

What is the management of pyelonephritis

A

7-10 days of cefalexin
Co-amoxiclav or trimethoprim if culture results available
Ciprofloxacin

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12
Q

What antibiotics are used in a pregnancy UTI

A

Cefalexin typically used
Nitrofuratonin can use in 1st and 2nd trimester but not 3rd
Amoxicillin if sensitivities are known

Avoid trimethoprim in first trimester- folate antagonist

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13
Q

What are the main organisms that cause cellulitis

A

Staphylococcus aureus
Strep group A (strep pyogenes)
Strep group C (strep dysgalactinae)

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14
Q

What is the management for Cellulitis

A

ERON classes 3 and 4 need hospital admission and IV abx

Flucloxacillin is first line oral or IV

If cellulitis is around the eyes or nose use co-amoxiclav first line

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15
Q

What is the main bacteria that causes bacterial tonsillitis

A

Group 1 strep -strep pyrogenes

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16
Q

What are the main organisms that cause ottitis media and sinusitis

A

Strep pneumonia
Haemophilus influenza
Staph aureus
Morazella catarrhalis

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17
Q

What scores are used for tonsillitis

A

CENTOR
over 3 needs abx
Points for
Fever, tonsillar exudates, no cough, tender anterior cervical lymph nodes

Fever pain can also be used
3 days of onset, fever, purulence, inflammed tonsils, no cough

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18
Q

What is the treatment for tonsillitis

A

Phenoxymethylpenicillin for 10 days (penicillin V)

Clarithromycin second choice is pen allergy

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19
Q

What are the complications of tonsillitis

A

Peritonsillar abscess- quincy
Ottits media-
Scarlet fever
Rheumatic fever
Post strep glomerulonephritis
Post strep reactive arthritis

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20
Q

What is the treatment for ottitis media

A

resolves 3-7 days without abx but if unwell 5-7 days abx
Clarithromycin or erythromycin

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21
Q

What is the treatment for sinusitis

A

Viral usually
If symptoms don’t improve after 10 days- high dose nasal steroid for 14 days
-Can give phenoxymethypenicicillin if not improving or worsening after 7 days

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22
Q

What is the treatment for chronic sinusitis

A

Saline nasal irrigation
Steroid nasal drops
Functional endoscopy sinus surgery

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23
Q

What are the main bacteria that cause intraabdominal infections

A

Anaerobes - bactericides and clostridium
E.Coli
Klebsiella
Enterococcus
Streptococcus

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24
Q

What is the treatment for intraabdominal infections

A

Broad spectrum antibiotics until cultures are available

Co-Amoxiclav
Quinolones (ciprofloxacin/levofloxacin) - good but don’t cover anaerobes so can be paired with metronidazole
Gentamicin
Vancomycin

Avoid cephalosporins due to risk of C.Diff

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25
What are the main causes of septic arthritis
Group A strep Heamophilus influenza Neisseria gonorrhoea E.Coli
26
What is the treatment for septic arthritis
Joint fluid aspiration and examination before abx or Empirical abx given until sensitivities are known Continue abx for 4-6 weeks Flucloxacillin 1st line Clindamycin if penicillin allergy Vancomycin if MRSA expected For gonorrhoea - ceftriaxone
27
What is the treatment for influenza in high risk patients
Oral oseltamivir (2x5 days) Inhaled zanamivir (2x5 days) Treatment needed within 48 hrs of infection
28
What are the features of E.Coli
From infected faeces, unwashed salads, contaminated water Shiga toxin- haemolytic uraemia syndrome Don't give abx- increases risk of haemolytic uraemic syndrome
29
What are the features of Campylobacter jejune
Traveller's diarrhoea- most common Incubation 2-5 days symptoms after 3-6 days Antibiotics considered in severe symptoms - clarithromycin
30
What are the features of Shigella
Period is 1-2 days and symptoms resolve in 1 week Siga toxin - haemolytic uraemic syndrome Severe cases can give azithromycin/ciprofloxacin
31
What are the features of Bacillus cereus
Not refrigerated food after cooking- rice Mom within 5 hrs and diarrhoea within 8 - resolves in 24 hrs This can also cause infective endocarditis in IV drug users
32
What are the features of yersinia entercolitica
Pork - affects children Incubation period 4-7 days symptoms can last 3 weeks Older children and adults can show mesenteric lymphadenitis and fever
33
What are the features of Giardiasis
Parasite in small intestines or mammals, faecal oral transmission Chronic diarrhoea or no symptoms Stool microscopy for diagnosis Metronidazole for treatment
34
What antibiotics cause C diff
Most that start with C Clindamycin, ciprofloxacin (other flurorquinolones), cephalosporins, carbapenems
35
What investigations are done for C.DIFF
C diff antigen (glutamate dehydrogenase) A and B toxins all in stool samples
36
What is the management for C.Diff
Normal- Oral vancomycin and oral findaxomicin Life threatening Oral vancomycin with IV metronidazole
37
What are the complications of C.Diff
Pseudomemebraneous colitis- inflam of large intestine with yellow and white plaques on bowel wall Toxic megacolon- risk of bowel rupture
38
What are the main organisms that cause bacterial meningitis
Neisseria meningitis Strep pneumonia Haemophilus influenza Group b strep Listeria Monocyogenes
39
What are the main viral causes of meningitis
Enteroviruses (coxsackie) HSV VZV
40
What are the two special tests for meningitis
Kernig's test- lie patient on back flex hip and knee to 90 degrees, straighten knee and keep hip flexed at 90 - stretch in meninges will cause pain Brudzinki's test- Lie patient on bacterial and lift head and neck off bed with chin to chest- if hips and knees flex- meningitis
41
Where is a lumbar puncture done
L3-L4 or L4-L5 intervertebral spaces
42
What is found in a bacterial meningitis lumbar puncture
High protein, low glucose, cloudy, high WCC (neutrophils), culture bacteria
43
What is found in a viral meningitis lumbar puncture
Mildly raised or normal protein, normal glucose, WCC high (lymphocytes), clear colour, negative culture
44
What is the management of meningitis
1. In children with non blanching rash - urgent dose of benzylpenicillin IM or IV whilst waiting transfer to hosp under 1 300mg, 1-9- 600mg over 10- 1200mg Antibiotics- in babies under 3 months - cefotaxime and amoxicillin Above 3 months ceftriaxone Post exposure prophylaxis- single dose ciprofloxacin
45
What are the investigations for TB
1. Mantoux test - skin induration >5mm - positive 2. Interferon gamma release assay - blood sample mixed with antigens
46
What will a CXR show for primary TB and miliary TB and latent TB
Primary- patchy consolidation, pleural effusions, hilar lymphadenopathy Disseminated miliary TB- millet seeds across lung fields - small nodules Latent TB- a calcified Ghon complex - single calcified nodule
47
What is the treatment for latent TB
Isoniazid and rifampicin for 3 months then isoniazid for 6 months
48
What is the treatment for active TB
RIPE Rifampicin 6 months - red tears, urine Isoniazid 6 months- peripheral neuropathy so give B6 with it Pyrazinamide 2 months- gout Ethambutol 2 months- colour blind
49
What CD4 count is high risk for opportunistic infections
under 200 cells/mm3
50
What is the treatment for HIV
Two NRTI's Nucelotide reverse transcriptase inhibitors (tenofovir and emtricitabine) and a third agent (bictegravir) Can give prophylactic co-trimoxazole if CD4 under 200cells/mm3
51
How is a baby protected during labour and birth when mother is HIV positive
IV zidovudine given infusion during labour and delivery if viral load over 1000 or unknown Recommended C-section if viral load is over 50 copies No breastfeeding Babies given prophylaxis Low risk- Ziovudine 2-4 weeks High risk- zidovudine and nevirapine for 4 weeks
52
What medications are used for PEP
ART combination - emtricitabine/ tenofovir and raltegravir for 28 days
53
What medication is used for PreP
Emtricitabine/ tenofovir
54
What is the treatment for malaria orally
Artmether and lumefantirine first line Quinine and doxycycline/ clindamycin
55
What are the features of Dengue fever
Mosquitos Headache, fever, facial flushing, widespread maculopapular rash THROMBOCYTOPENIA AND LEUKOPENIA - it causes bone marrow suppression
56
How is lyme disease diagnosed
Erythema migrans (target rash) can diagnose clinically Antibodies to borrelia burgdorferi within 4 weeks of first symptoms and repeat this 4-6 weeks after Treat with doxycycline Ceftriaxone in disseminated disease
57
What are the features of latent TB
Positive Mantoux and Interferon gamma but negative sputum culture and normal chest xray Patients treated with 3 months isoniazid and rifampicin or 6 months isoniazid They cannot pass the disease onto others
58
What are the features of glandular fever
Sore throat Lympadenopathy Pyrexia Splenomegaly Palatal petechiae Hepatitis, haemolytic anaemia, maculopapular pruritic rash if patients take amoxicillin Symptoms resolve in 2-4 weeks Avoid contact spots fir 4 weeks EBV
59
What are the features of Legionella
Water tanks- air conditioning/ holidays Flu like symptoms Dry cough, brady Confusion Lymphopaneia, hyponatraemia, deranged LFTs Urinary antigen for diagnosis Mid to lower zone consolidation on Xray Treat with erythromycin/ clarithromycin
60
What are the features of mycoplasma pneumonia
Atypical pneumonia that affects younger patients Erythema multiform and cold haemolytic anaemia Bilateral consolidation on xray Flu symptoms and cough Red blood cell agglutination Treat with doxy or a macrolide (clarith)
61
What are the features of pneumocystis jiroveci
HIV pneumonia Desaturations on exertion and CXR looks normal Fever, SOB Pneumothroax can be a complication Management Co-trimoxazole
62
What are the features of toxoplasmosis gondii
Oocysts from cat usually Similar infection to glandular fever presentation Immunocompetant patients don't need treatment Immunocompromised patients need Treated with Pyrimethamine and sulphadiazine They can get cerebral toxoplasmosis- multiple ring enhancing lesions
63

3rd yr clinical (22 decks)

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