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CCE > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

What causes scarlet fever?

A

Streptococcus pyogenes

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2
Q

You are a surgical house officer and have been bleeped to see a 34 year old man who is post op day 1 following abdominal surgery. He complains of intense pain around his leg. On examination it is erythematous. His temperature is 38.3, HR 160, BP 135/96. He is a known diabetic and heavy drinker. What is the most appropriate management?

A

IV morphine and urgent referral for surgical debridement

This patient has necrotising fasciitis

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3
Q

What are risk factors for necrotising fasciitis?

A

Abdominal surgery
Diabetes
Alcoholism
Malignancy

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4
Q

What 4 drugs are used to treat TB?

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

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5
Q

What is a main side effect of ethambutol? What should be done before commencing treatment?

A

Toxic optic neuropathy

Test visual acuity and colour vision before treatment

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6
Q

What test should be performed prior to commencing rifampicin, isoniazid and pyrazinamide treatment?

A

LFTs as they can cause hepatitis

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7
Q

What type of bacteria is E.coli?

A

Gram negative bacilli

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8
Q

What is infectious mononucleosis?

A

Glandular fever
Self limiting infection due to Epstein Barr virus
Low grade fever, sore throat, lethargy

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9
Q

How do you diagnose glandular fever?

A

Monospot test

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10
Q

What happens if you prescribe amoxicillin to patients with glandular fever?

A

Severe rash

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11
Q

What is leptospirosis?

A

Weils disease
Infection caused by spirochaetes
Due to contact with infected urine, usually from rats
Mild flu like symptoms, jaundice, meningitis and renal failure in severe cases

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12
Q

How long after HIV exposure is post exposure prophylaxis effective for?

A

Most effective within an hour of infection

After 72 hours, effectiveness is very limited

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13
Q

What are the 3 most common chase of lung infection in people with cystic fibrosis?

A

Staph aureus
Haemophillus influenza
Pseudomonas aeruginosa: rusty coloured sputum

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14
Q

What sort of infections are people with a splenectomy susceptible to? And why

A

Encapsulated organisms for example h. Influenza and strep pneumoniae
Because spleen provides environment where encapsulated organisms are opsonised

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15
Q

What is antimicrobial stewardship?

A

Organisational approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness

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16
Q

What are the principles of antimicrobial stewardship?

A

How: Prescribe only when needed, Review need for abx in accordance with local formularies and guidelines
Why: Optimise therapy for individual patients, Prevent overuse, misuse, abuse, Minimise development of resistance at patient and
community levels

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17
Q

Who has responsibility for antimicrobial stewardship?

A

Clinicians
Society: Demand and supply
Politicians
Corporations

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18
Q

Why is antimicrobial stewardship important?

A

Optimise therapy for individual patients
Minimise side effects
Microbiome: all antibiotics, limit with narrower spectrum
Allergy and intolerance, specific contraindications and interactions
Prevent overuse, misuse, abuse
Minimise development of resistance at patient and community levels

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19
Q

How can we limit the need for antimicrobials?

A

Prevention and control of infection: No infection means no antibiotic needed, No multi-resistant organism means narrower spectrum antibiotic can be used

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20
Q

List resources available to aid optimal antimicrobial prescribing

A

TARGET antibiotics toolkit: treat antibiotics responsibly guidance, education and tools
NICE guidelines
Department of health antimicrobial stewardship guide
Local primary and secondary care guidance

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21
Q

What is contained in the TARGET toolkit?

A 
Commissioner resources
Information for patients
Audit tools
Training resources
Self assessment
National antibiotic management guidance
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22
Q

List the principal considerations required before commencing antibiotic therapy

A

Absorption (How can I get it into my patient?)
Distribution (does it get where I want it to?)
Predictably sensitive? (is resistance likely to be a problem before or after treatment?)
Adverse effects (common, particular patient group?)
Interaction with other drugs (prescribed or otherwise)
Metabolism and excretion (how does the drug get out? Is that a problem in my patient?)

23
Q

What are beta lactam antibiotics?

A

Penicillins and their derivatives
Cephalosporins (ceph/ cef….)
Carbapenems (-penems)
Monobactams (aztreonam)

24
Q

Describe the absorption profiles of the beta lactam antibiotics

A

Penicillins: Penicillin V/ phenoxymethylpenicillin low absorption from GI tract, Amoxicillin better, Penicillin G/ benzylpenicillin no absorption so given IV
Cephalosporins: Limited number available orally, generally good absorption for those that are (cefalexin), Most IV only e.g. ceftriaxone
Carbapenems: No oral formulation
Aztreonam: Also IV only

25
Q

Describe the distribution profile of beta lactam antibiotics

A

Generally good penetration to body tissues
Penicillins don’t cross the blood-brain barrier well unless the meninges are inflamed
Do not get inside individual host cells
Poor activity against bacteria that live intracellularly, Legionella is classic example

26
Q

Describe the mechanism of action of beta lactam antibiotics. What implication does this have?

A

Interruption of cell wall synthesis

So NO activity against bacteria without a cell wall (Mycoplasma, Chlamydia)

27
Q

What is the difference between a bacteriostatic and bacteriocidal antibiotics?

A

Bacteriostatic: inhibiting the growth of a bacterium
Bactericidal: killing the bacterium

28
Q

What is the minimum inhibitory concentration?

A

Lowest concentration of an antibiotic which inhibits visible growth of bacteria

29
Q

What is minimum Bactericidal concentration?

A

Lowest Concentration of an antibiotic that kills 99.9% of a population of bacteria

30
Q

What is the breakpoint in terms of antibiotic sensitivity?

A

Minimum inhibitory concentration cut-off which separates strains where there is a high likelihood of treatment succeeding from those where treatment is more likely to fail

31
Q

How does resistance to beta lactams occur?

A

Intrinsic: No cell wall, Strictly intracellular bacteria, No target for the specific drug
Acquired: Stop the drug getting in, Break it down, Change the target, Pump it out

32
Q

Describe the forms of acquired antibiotic resistance that occurs with beta lactams and what can be done about this

A

Enzyme which breaks the antibiotic down (e.g. Staphylococcal penicillinase), use an enzyme inhibitor to restore susceptibility (co-amoxiclav)
Alteration in target site (e.g. MRSA), need to find a new target for a different antimicrobial

33
Q

What are some adverse effects of beta lactam antibiotics?

A

Generally safe and well-tolerated: low rates renal of hepatotoxicity, neurotoxicity, Jaundice with flucloxacillin and co-amoxiclav
Diarrhoea with any, especially broad spectrum (C difficile particular association with cephalosporins)
IgE-mediated allergy in 5-10% patients

34
Q

Are beta lactam antibiotics teratogenic?

A

No

35
Q

Which drugs might interact with beta lactams?

A

Anticoagulants
Oral contraceptive (not contraindicated)
Anti-epileptics

36
Q

How are beta lactams excreted?

A

In urine
Excretion rates very rapid for older penicillins, so need to be given frequently
4-hourly for benzylpenicillin in severe infection
Pencillin V given qds

37
Q

At what level of renal function do you need to adjust the dose of beta lactams?

A

Only in very poor renal function

GFR less than 10

38
Q

What are potential complications of meningococcal disease?

A 
Septic shock 
Hypotension 
Acidosis 
DIC
Hearing loss
Motor and cognitive disability
Blindness
Ischaemic injury to skin/extremities
39
Q

What is Waterhouse friderichsens syndrome?

A

Bilateral adrenal haemorrhage typically caused by fulminant meningococcal infection

40
Q

What are risk factors for the development of meningococcal disease?

A 
Young age
Complement deficiency 
Asplenia or hyposplenia 
Residence in dormitory
Globulin deficiency 
Close contact with invasive meningococcal infection 
Household crowding
Travel to endemic area 
Lab worker
41
Q

What are risk factors for toxic shock syndrome?

A 
Diabetes mellitus 
Alcoholism
Trauma
Surgical procedures, particularly vaginal delivery, c section, hysterectomy 
Single tampon use for consecutive days
Highly absorbent tampons
42
Q

What are potential complications of toxic shock syndrome?

A 
Bacteraemia 
Acute respiratory distress syndrome 
DIC
Renal failure
Waterhouse friderichsen syndrome 
Wound sequelae requiring major surgery
43
Q

How many days pen V should be prescribed for streptococcal sore throat?

A

10 days

44
Q

A 23 year old with fever sore throat and swollen neck and groin nodes, what is the most likely diagnosis?

A

Glandular fever

45
Q

What is the test for glandular fever?

A

Monospot

Paul Bunnell

46
Q

A mum brings a 4 year old boy to GP with right earache and fever for 24 hours. This morning it has started to discharge pus, what is the most likely diagnosis?

A

Otitis media with perforation

47
Q

What tests can be done for streptococcal infection?

A

ASOT - antistreptolysin O titre

Anti DNAase B titre

48
Q

What can cause laryngitis?

A

Complication of URTI
Parainfluenza
Measles

49
Q

What should be done to treat acute laryngotracheobronchitis?

A

Nebulised adrenaline
Oral/IM corticosteroids
Oxygen
Fluids

50
Q

What should be done to treat acute epiglottitis?

A

Endotracheal intubation

IV ceftazidime

51
Q

In which patients is an inflenza vaccine recommended?

A 
Over 65s
CHD
Lung disease
CKD
Diabetes 
Immunosuppressed
52
Q

How do you treat sinusitis?

A

Nasal decongestant
Co amoxiclav
Fluticasone proprionate (corticosteroid) nasal spray
Steam inhalation

53
Q

What do you do to manage recurrent sinusitis or if there is an orbital cellulitis complication?

A

Refer to ENT for CT of paranasal sinuses

CCE (20 decks)

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