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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
Flu-like symptoms followed by dry cough
Mycoplasma/Legionella
26
Reticular-nodular shadowing/patchy consolidation on CXR
Mycoplasma
27
Organism causing bi-basal consolidations on CXR
Legionella
28
Results with Legionella
Hyponatraemia, lymphopaenia, deranged LFTs, haematuria, early confusion
29
Biphasic illness: pharyngitis, hoarseness, otitis --\> pneumonia
Chlamydia
30
Infective complications of pneumonia
Septicaemia Empyema Lung abscess Endocarditis/myocarditis
31
Non-infective complications of pneumonia
Hypotension Respiratory failure (commonly Type 1) AF (treat w/ digoxin) Jaundice (esp from Abx)
32
Common cause of bacterial tonsilitis in children?
Group A strep: scarlet fever (toxin) --\> rheumatic fever (autoimmune) --\> endocarditis risk/valvular disease
33
What layer of skin is affected in impetigo?
Epidermis
34
What is the appearance of impetigo?
Vesicles with honey-coloured crust (often on face of child)
35
Common causative agents of impetigo?
Staph aureus, Strep pyogenes
36
What is the appearance of eysipelas?
Painful, erythematous, RAISED + REGULAR border. well demarcated
37
What is the appearance of cellulitis?
Painful, erythematous, FLAT + IRREGULAR border, diffuse. May have lymphangitis track.
38
What layer of the skin is affected in erysipelas?
Superficial dermis
39
What layer of the skin is affected in cellulitis?
Deep dermis
40
What are the common causative agents of erysipelas and cellulitis?
Strep. pyogenes, Strep. agalactiae \> S. aureus
41
What is the appearance of folliculitis?
Localised inflamed papules (no abx treatment necessary)
42
What is the appearance of a skin abscess?
Raised, tender nodule Central purulence, initially firm then moveable
43
What agent commonly causes skin abscesses?
S. aureus
44
What are the early signs of necrotising fasciitis?
Pain out of proportion to patient appearance Erythema spreading rapidly (hours-days), flat + not sharply demarcated
45
What are necrotising fasciitis 'red flags'?
Diabetes/cardiovascular comorbidity Anaesthesia Purplish/dusky appearance Bullae/putrid discharge Gas gangrene
46
What are the common causative agents of necrotising fasciitis?
Monomicrobial: S. pyogenes, C. perfringens (gas gangrene) Polymicrobial: After abdominal surgery/perineal infection --\> enteric bacteria/anaerobes
47
What are the common causative agents of UTIs?
E. Coli and other G-ve rods (e.g. Proteus) Pseudomonas, Klebsiella for HAIs/CA-UTIs
48
What is the difference between complicated and uncomplicated UTI?
Uncomplicated: Normal renal structure/f(x) Complicated: Structural/functional abnormality e.g. renal transplant, stones, catheter, obstruction
49
What are the risk factors for UTIs?
Bacterial inoculation: Sexual activity, urinary incontinence, faecal incontinence, constipation Reduced urine flow: Obstruction, dehydration Bacterial growth: Diabetes, immnosupression, pregnancy, stones, catheter
50
What are the infective causes of sterile pyuria?
Inadequately/recently treated UTI TB/chlamydia/other STI Appendicitis, prostatitis
51
What are the features of renal TB?
Sterile pyuria Suprapubic pain Loin pain Night sweats/fevers/weight loss Visible haematuria
52
What are the symptoms of cystitis?
Fever Dysuria Suprapubic pain Frequency Urgency Haematuria Polyuria
53
What are the symptoms of acute pyelonephritis?
Fever Rigor Loin pain (check tenderness, progresses rapidly!) Vomiting
54
What are the symptoms of prostatitis?
Fever Nausea Perineal pain Swollen/tender prostate on PR
55
When do you treat asymptomatic bacteriuria?
Pregnancy Infants \<1yo Renal transplant patients Remember 1/3 no UTI, 1/3 diff bacteria, 1/3 UTI
56
What are the noninfective causes of sterile pyuria?
Recent catheter Drugs e.g. steroids PKD Renal tract tumour Tubulointerstitial nephritis SLE Stones Pregnancy
57
How do you investigate a UTI?
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
What are the indications for a MSU culture?
Pregnancy Elderly Immunocompromised/diabetic Recurrent/failed treatment
59
What are the symptoms of epididymo-orchitis?
Erythema, oedema, urinary symptoms, fever, pain Exclude testicular torsion!
60
What are the symptoms of pelvic inflammatory disease?
Vaginal discharge, pelvic pain, possible abdominal/cervical tenderness Risk: multiple sexual partners, unprotected intercourse, prev. PID
61
What is the treatment of CA-UTI, pyelonephritis, prostatitis?
Co-amoxiclav
62
What is the treatment of uncomplicated UTI?
Nitrofurantoin (concentrates in urine, 3-day for women and 7-day for men)
63
What is the treatment of of mild CAP (CURB \<2)?
Amoxicillin
64
What is the treatment of severe CAP?
Amoxicillin + clarithromycin
65
What is the treatment of septic CAP?
Co-amox + clarithromycin
66
What organisms are asplenic patients most at risk from?
Encapsulated bacteria: * Strep pneumo * H. influenzae * N. meningiditis * Staphylococci
67
What organisms commonly cause neutropaenic sepsis?
G-ve gut organisms (mucosal translocation): * E. Coli, anaerobes, pseudomonas (lines) \> G+ve: * Enterococci, streptococci (nasopharynx) \> Fungi: * Aspergillus (gram hyphae, halo sign), Candida
68
What organism commonly causes infections in burns patients?
Pseudomonas
69
Symptoms of empyema
Recurrent fever Chest tenderness Effusion on CXR
70
Symptoms of a lung abscess
swinging fever cavitating lesion on CXR (may be fluid filled) purulent sputum cough
71
What is gastroenteritis?
Diarrhoea +/- vomiting due to enteric infection
72
What is the difference between diarrhoea and dysentery?
Diarrhoea: \>3 episodes of semi-liquid stool per day Dysentery: infectious gastroenteritis with bloody diarrhoea
73
What are the common causes of dysentery?
2S, 2C, 2E: * Shigella, Salmonella * Campylobacter, C. diff * Enterohaemmorhagic E. Coli, Entamoebic histolytica (amoebic dysentery) * Yersinia
74
What are the viral causes (50-60% of all gastroenteritis) of gastroenteritis?
Norovirus Rotavirus
75
What is the epidemiology of norovirus?
Causes epidemic outbreaks in institutions
76
What is the epidemiology and symptoms of rotavirus?
Commonest cause of diarrhoea in children (universal infection by 5yo) 1-3d incubation, 3-8d gastroenteritis, fever, abdominal pain.
77
What is the most common cause of traveller's diarrhoea and what is the timecourse?
Enterotoxicogenic E. Coli Incubation 1-3d Usually \<1 week (3-4d) watery diarrhoea.
78
What is the epidemiology and symptoms for Campylobacter gastroenteritis?
Most common cause of dysentery. Undercooked meat. Dysentery, pain, fever, headache.
79
What is the epidemiology, incubation, symptoms for Salmonella gastroenteritis?
Comes from undercooked eggs, poultry, meat. Incubation 12-36h. Diarrhoea, cramps, fever.
80
What do you suspect in persistent (\>14d) traveller's diarrhoea?
Giardia (Esp with upper GI symptoms: bloating, flatulence due to villous atrophy) Entamoeba histolytica Shigella Malaria HIV
81
What is the epidemiology, incubation, symptoms of EHEC?
Shiga-toxin producing E. Coli 'Petting zoo illness' in children. ?meningism Incubation 3-8d
82
When would you suspect and how would you confirm C. diff infection?
Recent broad-spectrum abx in hospitalised pt Watery diarrhoea, pseudomembranous colitis, ileus, toxic megacolon, neutrophilia. Confirm with glutamate dehydrogenase or toxin immunoassay
83
What are the common causes of toxin-mediated gastroenteritis?
Staph aureus: Sudden onset diarrhoea \<6h after exposure to dairy, custard Bacillus cereus: Vomiting (\<6h) or diarrhoea (\<16h) from leftover food, rice.
84
What are the penicillin B-lactams?
Penicillin Flucloxacillin Amoxicillin/ampicillin Co-amoxiclav (Augmentin) Piperacillin-tazobactam (Tazocin)
85
What are the cephalosporin B-lactams?
Ceftriaxone Ceftazidime
86
What antibiotic class is suitable against ESBLs?
Carbapenems
87
What class of antibiotics is gentamicin and what are the common side effects?
Aminoglycoside Oto (vestibular) and nephrotoxicity (not suitable for pregnancy)
88
Which IV antibiotic is suitable against all gram positives but no gram negatives?
Vancomycin, glycopeptide Nephrotoxic
89
What class of antibiotics is ciprofloxacin? When is it contraindicated?
Fluoroquinolone. Teratogenic
90
What class of antibiotic is clarithromycin?
Macrolide
91
Which antibiotics are effective against Pseudomonas?
Ciprofloxacin Meropenem Ceftazidime Tazocin
92
Which antibiotics are effective against MRSA?
Vancomycin Linezolid Co-trimexazole (septrin)
93
Risk factors for infective peritonitis?
Spontaneous: 2ry to ascites Intra-op soiling Bowel perforation: * IBD * ischaemia * diverticulitis * appendicitis * malignancy * ulceration Peritoneal dialysis
94
What are the signs of peritonitis?
Guarding Rebound tenderness +ve cough test Absent bowel sounds Pneumoperitoneum on erect CXR NB: ALWAYS CHECK SERUM AMYLASE FOR PANCREATITIS
95
What are the causes of a liver abscess?
Haematogenous spread of bacteria, esp post-dysentery Cholangitis Appendicitis 2ry infection of tumour/mets
96
Presentation of liver abscess
RUQ tenderness Malaise, anorexia, nausea Hepatomegaly Jaundice Deranged LFTs R-sided pleural effusion
97
What is the difference between biliary colic, cholecystitis, and cholangitis?
**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
What are the symptoms of acute viral hepatitis?
Malaise Low-grade fever Arthralgia
99
What are the signs of acute viral hepatitis?
Jaundice Hepatomegaly (mild) Raise ALT and bilirubin
100
What are the causative agents of acute hepatitis and any distinguishing features/incubation time?
Hep A/E (faeco-oral spread, incubation 2-6w) CMV/EBV (lymphocytosis c.f. HepA/E) HBV (incubation up to 75d)
101
What are the causative agents of chronic hepatitis?
HBV HCV Both are blood-borne viruses
102
How do you distinguish between acute and chronic HBV infection on serology?
Acute has IgM. Both have sAg and eAg and DNA. Chronic HBV has ground-glass hepatocytes. Increased risk of HCC.
103
How do you distinguish between vaccinated and exposed individuals for HBV?
**Vaccinees**: HBsAb but no HBcAb **Exposed:** HBsAb AND HBcAb
104
What does HBeAg indicate for viral hepatitis?
Marker of replication (along with DNA), indicates early vs late chronic
105
What are the clinical features of meningitis?
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
What are the signs of raised ICP that contraindicate lumbar puncture?
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
How would you investigate ?meningitis?
Lumbar puncture HIV test (aseptic meningitis) Blood cultures FBC Blood glucose U+E Coagulation (for DIC)
108
What are the LP results in viral meningitis?
Lymphocytosis Low protein Normal glucose (\>50% BG)
109
What are the LP results in bacterial meningitis?
Neutrophilia High protein High CSF pressure Low glucose (\<50% BG)
110
What are the LP results in TB meningitis?
Lymphocytosis Very high protein Very low (\<33%) glucose High CSF pressure Clots on standing
111
What may cause aseptic meningitis?
Viral (incl HIV) Treated bacterial (culture -ve after 1h for NM, 4-6h for SP, PCR +ve still) TB/fungal meningitis
112
What are the risk factors for Listeria meningitis?
\>55, neonate, immunocompromised, pregnant
113
What commonly causes meningitis in children \<5?
H influenzae
114
What commonly causes meningitis in teens?
N. meningiditis (meningococcus)
115
What commonly causes meningitis in adults?
Strep pneumo (pneumococcus)
116
What are the features of meningo-encephalitis?
Seizures Change in GCS Neurological deficit Abnormal speech/behaviour
117
What are the clinical features of a brain abscess?
Early morning headache Seizures Fevers False localising neurology Papilloedema
118
What are the causes of brain abscesses?
**HIV:** Toxoplasma **Otitis media/sinusitis/dental abscess:** Streptococcus **Trauma/neurosurgery:** Staph aureus **Neutropenia:** GNRs **Endocarditis:** Staph aureus, strep viridans
119
What are the clinical features of infective endocarditis?
**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
What are the risk factors for endocarditis?
IVDU Rheumatic fever Prosthetic valve Other valve disease (usually subacute course) Previous endocarditis Long lines/haemodialysis Poor dentition
121
What are the major Duke diagnostic criteria for endocarditis?
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
What are the minor duke diagnostic criteria for endocarditis?
Fever \>38 IVDU predisposing heart condition Vascular signs (emboli, Janeway lesions) Immunologic signs (glomerulonephritis, Osler's nodes, Roth spots, splinter haemmorhages)
123
How do you diagnose endocarditis?
2 major or 1 major + 3 minor Fever + new murmur = IE until proven otherwise
124
How do you investigate endocarditis?
3x blood cultures at different times + sites FBC: normocytic, normochromic anaemia Urinalysis (microscopic haematuria) Echo + ECG
125
What are the common causative organisms for endocarditis?
Staph aureus C-ve staph Strep viridans
126
What is the main concern with aminoglycosides (and give example of one)
Ototoxicity (vestibular symptoms) Nephrotoxicity (check renal fx) Gentamicin
127
How do you treat neutropaenic sepsis?
Oxygen Fluids - NOT HARTMANNS Abx - Tazocin (interacts with hartmanns, also penicillin allergy)
128
Symptoms of norovirus
Acute-onset vomiting, watery diarrhoea, cramps, nausea
129
Timecourse of norovirus
1d incubation, 24-72h timecourse
130
Complications of Campylobacter gastroenteritis?
Complications: septicaemia, G-B syndrome, hepatitis, pancreatitis
131
Complications of Salmonella gastroenteritis?
Bactaraemia, meningitis, osteomyelitis, septic arthritis
132
Dangerous complication of EHEC?
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
First-line treatment for C. diff infection?
Metronidazole
134
Signs of HIV causing meningitis
HIV: Lymphadenopathy, candidiasis, uveitis, dermatitis
135
Signs of HSV causing meningitis
cold sores/genital vesicles
136
Signs of EBV/CMV meningitis
Hx of glandular fever Sore throat, jaundice, lymphadenopathy
137
Diffuse reticulo-nodular shadowing --\> Mycoplasma pneumonia
138
Bilateral consolidations - legionella
139
Cavitating lesion - staphylococcal

Medicine (8 decks)

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