infectious disease

Question 1

Tests if you are suspicious of Epstein Barr virus

Answer 1

full blood count looking for leucocytosis and lymphocytosis
heterophil antibody tests: Paul Bunnell monospot test
limitation can happen because of infection in the early 2 weeks
blood film? atypical T lymph or lycocytosis.

Question 2

What not to prescribe in glandular fever

Answer 2

amoxicillin or ampicillin

Question 3

if you suspect a patient has TB what should you do?

Answer 3

1. call micro and double check that they look for acid fast bacilli (ziehl-Nielson)
2. TB is notifiable therefore contact public health services
3. place patient in isolation
4. test her for HIV
5. look for signs of spread to other organs, pain in the joints (potts fracture) genitourinary infection or ab pain
6. refer to TB service

Question 4

carbapenemase producing enterobacterales spread by

Answer 4

contact (hand)

Question 5

what are some of the resistant organisms?

Answer 5

gram neg
gram positive
MDRO

Question 6

CPE species

Answer 6

gram neg
bacilli= klebsiella spp.
e. coli
enterobacter spp

Question 7

CPe is resistant to what antibiotic?

Answer 7

meropenem

Question 8

exa,pales of enterobacterales

Answer 8

E.coli
k pneumoniae
k oxytocin
e cloacae

Question 9

treatment of CPE

Answer 9

amoxicillin
co-amoxiclav
ceftriaxone
ciprofloxacin

gentamicin

Question 10

what is the enzyme that predominate in this hospital with CPE resistance

Answer 10

OXA48

Question 11

why does the strain matter?

Answer 11

because if it is CPE different strains cannot be in contact… otherwise will produce vertical transmission

Question 12

when are the patients still considered contacts

Answer 12

before 4 negative fecal screen for CPE

Question 13

what infecting organism would you suspect in a women who traveled from Ghana and has diarrhoea with RIF pain?

Answer 13

Yersinia enterocolitica

Question 14

what is most important in the management of a patient with diarrhoea

Answer 14

fluid resus and oral rehydration salts

Question 15

what is a fluid challenge and what are the three possible outcomes of it?

Answer 15

A fluid challenge is 250-500 ml of crystalloid solution given Iv over 30 minutes to a patient who is hypovolemic (dry mucous membranes, increased skin turgor, and thirsty and tachycardia narrow pulse pressure or low blood pressure)

1. no improvement- patient is wither still hypovolemic or patient was not hypovolemic to begin with reassess to make sure hypo and then another fluid challenge.
2. transient response in blood pressure= patient is hypo but either not enough fluid given or they are haemorrhaging. give more fluids and think clinically about explanation
3. sustained response with increased blood pressure. YAY it worked

Question 16

what are maintenance fluids? How much fluids does a person lose a day?

Answer 16

2.5 L
100 microM Na
70 microM K
need to replace if a patient can’t drink or eat

Question 17

what are replacement fluids?

Answer 17

maintenance fluids are good, but what is the patient is losing more fluids than normal due to abnormally high fluid loss?
This is where replacement fluids come in

Question 18

How much replacement fluids does a patient with a fever need?

Answer 18

extra 500ml for every 1C over 37

Question 19

How much replacement fluid does a burns patient need?

Answer 19

use the Parkland formula

Question 20

How much replacement fluids do the stoma patients need?

Answer 20

measuring and recording the amount of excess fluid is being lost as the stoma bag is drained. Normal loss is only 200ml a day, so anything in excess needs to be replaced.

Question 21

How much fluid replacement does a patient with a third space need? What is a third space?

Answer 21

the third space is an area of the body that accumulates fluid only in disease, resulting in fluids draining from the first and second spaces. it is hard to calculate fluid lost, will have to fluid replace and then keep reassessing patient.

Question 22

signs of hypovolemia

Answer 22

dry mucous membranes, patient thirsty, increased skin turgor tachycardia, narrow pulse pressure, hypotension

Question 23

signs of fluid overload

Answer 23

oedematous face or legs
raised JVP
crep at the lung bases

Question 24

What must you always do in a patient receiving IV therapy for fluid resus

Answer 24

document fluid input and output

and take bloods for biochemistry (hyponatremic, hyperkalemia)

Question 25

what volume should a patient be getting a day?

Answer 25

25-30ml/kg/day

Question 26

how much e- should they be getting a day?

Answer 26

1mmol/ kg/day K Na CL

Question 27

how much glucose a day?

Answer 27

100 g/day to prevent starvation