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Medicine > Infectious Disease > Flashcards

Infectious Disease Flashcards

Respiratory infections Skin infections UTIs Intra-abdominal infection + hepatitis Gastroenteritis Meningitis Endocarditis Immunocompromise

1
Q

What are the sepsis 6?

A

Give 3: IV fluids, Abx, O2 Take 3: Blood cultures, urine output, lactate

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2
Q

What are the sepsis red flags?

A

RR >25

HR >130

BP <90 (or 40 below normal)

Temperature >38

Acutely altered mental state

Ashen/mottled appearance

Lactate >2

Anuric in last 18h/<0.5ml/kg/hr

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3
Q

What is the Centor score used for?

A

Score >=3 –> 50% of bacterial URTI –> give penicillin

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4
Q

What are the Centor criteria?

A

Can’t cough

Exudate on tonsils

Nodes enlarged

Temperature

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5
Q

What are the symptoms of pneumonia?

A

Fever

Breathlessness

Cough +/- purulent sputum/haemoptysis

Pleuritic pain (may radiate to flank DDx UTI) Confusion (esp in elderly, may be hypothermic, AMTS<8)

Malaise

Anorexia

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6
Q

What are the clinical signs of pneumonia?

A

Pyrexia

Tachycardia

Hypotension

Tachypnoea

Consolidation (CXR, bronchial breathing, dull to percussion, crackles, increased fremitus)

Cyanosis

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7
Q

How do you CURB-65 score?

A

1 point each for:

  • Confusion (AMTS <8)
  • Urea >7 (due to dehydration)
  • RR >30
  • BP <90
  • Age >65
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8
Q

How does CURB-65 influence management?

A

Indicator of mortality

0-1: PO home treatment

2: PO hospital treatment

3+: IV hospital treatment, consider ITU

Also consider: O2 sats, comorbidities, multilobar; underscores in young patients

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9
Q

How do you investigate pneumonia?

A

Bloods: CRP, FBC, U+Es, LFTs

Orifices: Urine dip (pneumococcal/legionella antigens), sputum if ?TB, swab for ?flu

X-rays: CXR + repeat in 6w

E: N/A

S: Consider atypical organisms if not improving with Abx

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10
Q

Who is at risk of influenza infection?

A

Extremes of age

Renal (dialysis pts)

Liver (cirrhosis)

Heart (IHD)

Diabetes, immunocompromised

Neuro patients (e.g. MS)

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11
Q

What are the common causes of CAP?

A

Streptococcus pneumoniae (rust-coloured)

Haemophilus influenzae

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12
Q

What is a HAP?

A

Pneumonia >48h after hospital admission

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13
Q

What are the common causative agents of a HAP?

A

Staph aureus

G-ve enterobacteria

Klebsiella

Pseudomonas

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14
Q

What are the common atypical agents?

A

Mycoplasma pneumoniae

Legionella

Chlamydia

Viral (flu commonly complicates MRSA pneumonia)

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15
Q

What are common causes of aspiration pneumonia?

A

Stroke, myasthenia, bulbar palsies, reduced consciousness

  • Klebsiella (currant jelly)
  • Other anaerobes
  • Strep pneumo
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16
Q

What are the causative agents of pneumonia in the immunocompromised?

A

Pneumocytis jirovecii

Aspergillus

Mycobacteria

Mycoplasma

Klebsiella

S. aureus,

S. pneumo

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17
Q

What are the common causes of pneumonia in neonates?

A

Group B strep, E. Coli (from vaginal canal)

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18
Q

What are the common causes of pneumonia in infants?

A

Chlamydia, S pneumoniae

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19
Q

What are the common causes of pneumonia in young adults?

A

Mycoplasma pneumoniae Chlamydia S pneumo

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20
Q

What are the common causes of pneumonia in the elderly?

A

S pneumo H influenzae

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21
Q

What makes you suspect IECOPD?

A

Increasing breathlessness/O2 requirement

Fevers

Change in volume/colour of sputum

Changes on CXR/crackles

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22
Q

Common cause of pneumonia in bronchiectasis/CF

A

Pseudomonas

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23
Q

Causes bilateral cavitating lesions on CXR

A

Staphylococcal (common post-influenza)

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24
Q

Cavitating pneumonia of upper lobes

A

Klebsiella (rare)

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25
Q

Flu-like symptoms followed by dry cough

A

Mycoplasma/Legionella

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26
Q

Reticular-nodular shadowing/patchy consolidation on CXR

A

Mycoplasma

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27
Q

Organism causing bi-basal consolidations on CXR

A

Legionella

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28
Q

Results with Legionella

A

Hyponatraemia, lymphopaenia, deranged LFTs, haematuria, early confusion

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29
Q

Biphasic illness: pharyngitis, hoarseness, otitis –> pneumonia

A

Chlamydia

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30
Q

Infective complications of pneumonia

A

Septicaemia

Empyema

Lung abscess

Endocarditis/myocarditis

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31
Q

Non-infective complications of pneumonia

A

Hypotension

Respiratory failure (commonly Type 1)

AF (treat w/ digoxin)

Jaundice (esp from Abx)

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32
Q

Common cause of bacterial tonsilitis in children?

A

Group A strep: scarlet fever (toxin) –> rheumatic fever (autoimmune) –> endocarditis risk/valvular disease

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33
Q

What layer of skin is affected in impetigo?

A

Epidermis

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34
Q

What is the appearance of impetigo?

A

Vesicles with honey-coloured crust (often on face of child)

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35
Q

Common causative agents of impetigo?

A

Staph aureus, Strep pyogenes

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36
Q

What is the appearance of eysipelas?

A

Painful, erythematous, RAISED + REGULAR border. well demarcated

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37
Q

What is the appearance of cellulitis?

A

Painful, erythematous, FLAT + IRREGULAR border, diffuse. May have lymphangitis track.

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38
Q

What layer of the skin is affected in erysipelas?

A

Superficial dermis

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39
Q

What layer of the skin is affected in cellulitis?

A

Deep dermis

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40
Q

What are the common causative agents of erysipelas and cellulitis?

A

Strep. pyogenes, Strep. agalactiae > S. aureus

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41
Q

What is the appearance of folliculitis?

A

Localised inflamed papules (no abx treatment necessary)

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42
Q

What is the appearance of a skin abscess?

A

Raised, tender nodule

Central purulence, initially firm then moveable

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43
Q

What agent commonly causes skin abscesses?

A

S. aureus

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44
Q

What are the early signs of necrotising fasciitis?

A

Pain out of proportion to patient appearance

Erythema spreading rapidly (hours-days),

flat + not sharply demarcated

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45
Q

What are necrotising fasciitis ‘red flags’?

A

Diabetes/cardiovascular comorbidity

Anaesthesia

Purplish/dusky appearance

Bullae/putrid discharge

Gas gangrene

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46
Q

What are the common causative agents of necrotising fasciitis?

A

Monomicrobial: S. pyogenes, C. perfringens (gas gangrene)

Polymicrobial: After abdominal surgery/perineal infection –> enteric bacteria/anaerobes

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47
Q

What are the common causative agents of UTIs?

A

E. Coli and other G-ve rods (e.g. Proteus)

Pseudomonas, Klebsiella for HAIs/CA-UTIs

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48
Q

What is the difference between complicated and uncomplicated UTI?

A

Uncomplicated: Normal renal structure/f(x)

Complicated: Structural/functional abnormality e.g. renal transplant, stones, catheter, obstruction

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49
Q

What are the risk factors for UTIs?

A

Bacterial inoculation: Sexual activity, urinary incontinence, faecal incontinence, constipation

Reduced urine flow: Obstruction, dehydration

Bacterial growth: Diabetes, immnosupression, pregnancy, stones, catheter

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50
Q

What are the infective causes of sterile pyuria?

A

Inadequately/recently treated UTI

TB/chlamydia/other STI

Appendicitis, prostatitis

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51
Q

What are the features of renal TB?

A

Sterile pyuria

Suprapubic pain

Loin pain

Night sweats/fevers/weight loss

Visible haematuria

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52
Q

What are the symptoms of cystitis?

A

Fever

Dysuria

Suprapubic pain

Frequency

Urgency

Haematuria

Polyuria

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53
Q

What are the symptoms of acute pyelonephritis?

A

Fever

Rigor

Loin pain (check tenderness, progresses rapidly!)

Vomiting

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54
Q

What are the symptoms of prostatitis?

A

Fever

Nausea

Perineal pain

Swollen/tender prostate on PR

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55
Q

When do you treat asymptomatic bacteriuria?

A

Pregnancy

Infants <1yo

Renal transplant patients

Remember 1/3 no UTI, 1/3 diff bacteria, 1/3 UTI

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56
Q

What are the noninfective causes of sterile pyuria?

A

Recent catheter

Drugs e.g. steroids

PKD

Renal tract tumour

Tubulointerstitial nephritis

SLE

Stones

Pregnancy

57
Q

How do you investigate a UTI?

A

Bloods: (systemically unwell) FBC, U+E, CRP, blood culture (low Sn)

Orifices: Urinalysis (-ve nitrites + leukocytes = 92% NPV);?urine culture

X: USS if complicated UTI, recurrent UTI, pyelonephritis, failure to respond to treatment

58
Q

What are the indications for a MSU culture?

A

Pregnancy

Elderly

Immunocompromised/diabetic

Recurrent/failed treatment

59
Q

What are the symptoms of epididymo-orchitis?

A

Erythema, oedema, urinary symptoms, fever, pain

Exclude testicular torsion!

60
Q

What are the symptoms of pelvic inflammatory disease?

A

Vaginal discharge, pelvic pain, possible abdominal/cervical tenderness

Risk: multiple sexual partners, unprotected intercourse, prev. PID

61
Q

What is the treatment of CA-UTI, pyelonephritis, prostatitis?

A

Co-amoxiclav

62
Q

What is the treatment of uncomplicated UTI?

A

Nitrofurantoin (concentrates in urine, 3-day for women and 7-day for men)

63
Q

What is the treatment of of mild CAP (CURB <2)?

A

Amoxicillin

64
Q

What is the treatment of severe CAP?

A

Amoxicillin + clarithromycin

65
Q

What is the treatment of septic CAP?

A

Co-amox + clarithromycin

66
Q

What organisms are asplenic patients most at risk from?

A

Encapsulated bacteria:

  • Strep pneumo
  • H. influenzae
  • N. meningiditis
  • Staphylococci
67
Q

What organisms commonly cause neutropaenic sepsis?

A

G-ve gut organisms (mucosal translocation):

  • E. Coli, anaerobes, pseudomonas (lines)

>

G+ve:

  • Enterococci, streptococci (nasopharynx)

>

Fungi:

  • Aspergillus (gram hyphae, halo sign), Candida
68
Q

What organism commonly causes infections in burns patients?

A

Pseudomonas

69
Q

Symptoms of empyema

A

Recurrent fever

Chest tenderness

Effusion on CXR

70
Q

Symptoms of a lung abscess

A

swinging fever

cavitating lesion on CXR (may be fluid filled)

purulent sputum cough

71
Q

What is gastroenteritis?

A

Diarrhoea +/- vomiting due to enteric infection

72
Q

What is the difference between diarrhoea and dysentery?

A

Diarrhoea: >3 episodes of semi-liquid stool per day

Dysentery: infectious gastroenteritis with bloody diarrhoea

73
Q

What are the common causes of dysentery?

A

2S, 2C, 2E:

  • Shigella, Salmonella
  • Campylobacter, C. diff
  • Enterohaemmorhagic E. Coli, Entamoebic histolytica (amoebic dysentery)
  • Yersinia
74
Q

What are the viral causes (50-60% of all gastroenteritis) of gastroenteritis?

A

Norovirus

Rotavirus

75
Q

What is the epidemiology of norovirus?

A

Causes epidemic outbreaks in institutions

76
Q

What is the epidemiology and symptoms of rotavirus?

A

Commonest cause of diarrhoea in children (universal infection by 5yo)

1-3d incubation, 3-8d gastroenteritis, fever, abdominal pain.

77
Q

What is the most common cause of traveller’s diarrhoea and what is the timecourse?

A

Enterotoxicogenic E. Coli

Incubation 1-3d

Usually <1 week (3-4d) watery diarrhoea.

78
Q

What is the epidemiology and symptoms for Campylobacter gastroenteritis?

A

Most common cause of dysentery.

Undercooked meat.

Dysentery, pain, fever, headache.

79
Q

What is the epidemiology, incubation, symptoms for Salmonella gastroenteritis?

A

Comes from undercooked eggs, poultry, meat.

Incubation 12-36h. Diarrhoea, cramps, fever.

80
Q

What do you suspect in persistent (>14d) traveller’s diarrhoea?

A

Giardia (Esp with upper GI symptoms: bloating, flatulence due to villous atrophy)

Entamoeba histolytica

Shigella

Malaria

HIV

81
Q

What is the epidemiology, incubation, symptoms of EHEC?

A

Shiga-toxin producing E. Coli ‘Petting zoo illness’ in children. ?meningism

Incubation 3-8d

82
Q

When would you suspect and how would you confirm C. diff infection?

A

Recent broad-spectrum abx in hospitalised pt

Watery diarrhoea, pseudomembranous colitis, ileus, toxic megacolon, neutrophilia.

Confirm with glutamate dehydrogenase or toxin immunoassay

83
Q

What are the common causes of toxin-mediated gastroenteritis?

A

Staph aureus: Sudden onset diarrhoea <6h after exposure to dairy, custard

Bacillus cereus: Vomiting (<6h) or diarrhoea (<16h) from leftover food, rice.

84
Q

What are the penicillin B-lactams?

A

Penicillin

Flucloxacillin

Amoxicillin/ampicillin

Co-amoxiclav (Augmentin)

Piperacillin-tazobactam (Tazocin)

85
Q

What are the cephalosporin B-lactams?

A

Ceftriaxone

Ceftazidime

86
Q

What antibiotic class is suitable against ESBLs?

A

Carbapenems

87
Q

What class of antibiotics is gentamicin and what are the common side effects?

A

Aminoglycoside

Oto (vestibular) and nephrotoxicity (not suitable for pregnancy)

88
Q

Which IV antibiotic is suitable against all gram positives but no gram negatives?

A

Vancomycin, glycopeptide

Nephrotoxic

89
Q

What class of antibiotics is ciprofloxacin? When is it contraindicated?

A

Fluoroquinolone. Teratogenic

90
Q

What class of antibiotic is clarithromycin?

A

Macrolide

91
Q

Which antibiotics are effective against Pseudomonas?

A

Ciprofloxacin

Meropenem

Ceftazidime

Tazocin

92
Q

Which antibiotics are effective against MRSA?

A

Vancomycin

Linezolid

Co-trimexazole (septrin)

93
Q

Risk factors for infective peritonitis?

A

Spontaneous: 2ry to ascites

Intra-op soiling

Bowel perforation:

  • IBD
  • ischaemia
  • diverticulitis
  • appendicitis
  • malignancy
  • ulceration

Peritoneal dialysis

94
Q

What are the signs of peritonitis?

A

Guarding

Rebound tenderness

+ve cough test

Absent bowel sounds

Pneumoperitoneum on erect CXR

NB: ALWAYS CHECK SERUM AMYLASE FOR PANCREATITIS

95
Q

What are the causes of a liver abscess?

A

Haematogenous spread of bacteria, esp post-dysentery

Cholangitis

Appendicitis

2ry infection of tumour/mets

96
Q

Presentation of liver abscess

A

RUQ tenderness

Malaise, anorexia, nausea

Hepatomegaly

Jaundice

Deranged LFTs

R-sided pleural effusion

97
Q

What is the difference between biliary colic, cholecystitis, and cholangitis?

A

Biliary colic: Colicky pain radiating to back due to gallstones in neck of gallbladder. RUQ pain.

Cholecystitis: Acute inflammation of gallbladder neck. Fever + raised WCC. RUQ pain.

Cholangitis: RUQ pain + rigors/fever + jaundice (Charcot’s triad). Due to stone blockage of CBD + infection

98
Q

What are the symptoms of acute viral hepatitis?

A

Malaise

Low-grade fever

Arthralgia

99
Q

What are the signs of acute viral hepatitis?

A

Jaundice

Hepatomegaly (mild)

Raise ALT and bilirubin

100
Q

What are the causative agents of acute hepatitis and any distinguishing features/incubation time?

A

Hep A/E (faeco-oral spread, incubation 2-6w)

CMV/EBV (lymphocytosis c.f. HepA/E)

HBV (incubation up to 75d)

101
Q

What are the causative agents of chronic hepatitis?

A

HBV

HCV

Both are blood-borne viruses

102
Q

How do you distinguish between acute and chronic HBV infection on serology?

A

Acute has IgM.

Both have sAg and eAg and DNA.

Chronic HBV has ground-glass hepatocytes. Increased risk of HCC.

103
Q

How do you distinguish between vaccinated and exposed individuals for HBV?

A

Vaccinees: HBsAb but no HBcAb

Exposed: HBsAb AND HBcAb

104
Q

What does HBeAg indicate for viral hepatitis?

A

Marker of replication (along with DNA), indicates early vs late chronic

105
Q

What are the clinical features of meningitis?

A

Fever (may be absent in elderly)

Neck stiffness (Examination finding)

Changes in mental status

Headache

Leg/joint pain

Photophobia

Non-blanching purpura (N. meningiditis)

Irritability/lethargy in infants

106
Q

What are the signs of raised ICP that contraindicate lumbar puncture?

A

Headache (worse on cough, leaning forward)

Vomiting

Reduced GCS

Papilloedema

Pupil constriction

Low HR and high BP

Hx of CNS lesion/seizures in past week

Focal neurology

107
Q

How would you investigate ?meningitis?

A

Lumbar puncture

HIV test (aseptic meningitis)

Blood cultures

FBC

Blood glucose

U+E

Coagulation (for DIC)

108
Q

What are the LP results in viral meningitis?

A

Lymphocytosis

Low protein

Normal glucose (>50% BG)

109
Q

What are the LP results in bacterial meningitis?

A

Neutrophilia

High protein

High CSF pressure

Low glucose (<50% BG)

110
Q

What are the LP results in TB meningitis?

A

Lymphocytosis

Very high protein

Very low (<33%) glucose

High CSF pressure

Clots on standing

111
Q

What may cause aseptic meningitis?

A

Viral (incl HIV)

Treated bacterial (culture -ve after 1h for NM, 4-6h for SP, PCR +ve still)

TB/fungal meningitis

112
Q

What are the risk factors for Listeria meningitis?

A

>55, neonate, immunocompromised, pregnant

113
Q

What commonly causes meningitis in children <5?

A

H influenzae

114
Q

What commonly causes meningitis in teens?

A

N. meningiditis (meningococcus)

115
Q

What commonly causes meningitis in adults?

A

Strep pneumo (pneumococcus)

116
Q

What are the features of meningo-encephalitis?

A

Seizures

Change in GCS

Neurological deficit

Abnormal speech/behaviour

117
Q

What are the clinical features of a brain abscess?

A

Early morning headache

Seizures

Fevers

False localising neurology

Papilloedema

118
Q

What are the causes of brain abscesses?

A

HIV: Toxoplasma

Otitis media/sinusitis/dental abscess: Streptococcus

Trauma/neurosurgery: Staph aureus

Neutropenia: GNRs

Endocarditis: Staph aureus, strep viridans

119
Q

What are the clinical features of infective endocarditis?

A

Symptoms:

  • Malaise
  • Weight loss/anorexia
  • Fevers
  • Septic emboli elsewhere

Signs:

  • New heart murmur
  • Osler nodes/Janeway lesions
  • Splinter haemmorhages
  • Clubbing
  • Heart failure
  • Heart block/arrhythmia
120
Q

What are the risk factors for endocarditis?

A

IVDU

Rheumatic fever

Prosthetic valve

Other valve disease (usually subacute course)

Previous endocarditis

Long lines/haemodialysis

Poor dentition

121
Q

What are the major Duke diagnostic criteria for endocarditis?

A

Blood culture +ve in 2 seperate cultures

Persistently +ve blood cultures (3 >12h apart)

Blood cultures +ve for Coxiella burnetti

Vegetations on echo/valvular lesions on CT

122
Q

What are the minor duke diagnostic criteria for endocarditis?

A

Fever >38

IVDU

predisposing heart condition

Vascular signs (emboli, Janeway lesions)

Immunologic signs (glomerulonephritis, Osler’s nodes, Roth spots, splinter haemmorhages)

123
Q

How do you diagnose endocarditis?

A

2 major or 1 major + 3 minor

Fever + new murmur = IE until proven otherwise

124
Q

How do you investigate endocarditis?

A

3x blood cultures at different times + sites

FBC: normocytic, normochromic anaemia

Urinalysis (microscopic haematuria)

Echo + ECG

125
Q

What are the common causative organisms for endocarditis?

A

Staph aureus

C-ve staph

Strep viridans

126
Q

What is the main concern with aminoglycosides (and give example of one)

A

Ototoxicity (vestibular symptoms)

Nephrotoxicity (check renal fx)

Gentamicin

127
Q

How do you treat neutropaenic sepsis?

A

Oxygen

Fluids - NOT HARTMANNS

Abx - Tazocin (interacts with hartmanns, also penicillin allergy)

128
Q

Symptoms of norovirus

A

Acute-onset vomiting, watery diarrhoea, cramps, nausea

129
Q

Timecourse of norovirus

A

1d incubation, 24-72h timecourse

130
Q

Complications of Campylobacter gastroenteritis?

A

Complications: septicaemia, G-B syndrome, hepatitis, pancreatitis

131
Q

Complications of Salmonella gastroenteritis?

A

Bactaraemia, meningitis, osteomyelitis, septic arthritis

132
Q

Dangerous complication of EHEC?

A

Do NOT give Abx –> increase risk of HUS due to toxin leak

Haemolytic-uraemic syndrome: haemolytic anaemia + thrombocytopaenia + high urea (AKI)

2-14d after onset of diarrhoea.

133
Q

First-line treatment for C. diff infection?

A

Metronidazole

134
Q

Signs of HIV causing meningitis

A

HIV: Lymphadenopathy, candidiasis, uveitis, dermatitis

135
Q

Signs of HSV causing meningitis

A

cold sores/genital vesicles

136
Q

Signs of EBV/CMV meningitis

A

Hx of glandular fever Sore throat, jaundice, lymphadenopathy

137
Q
A

Diffuse reticulo-nodular shadowing –> Mycoplasma pneumonia

138
Q
A

Bilateral consolidations - legionella

139
Q
A

Cavitating lesion - staphylococcal

Medicine (8 decks)

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