infectious disease

Question 1

sepsis

Answer 1

clinical evidence of infection with 2 or more of these
resp rate greater 22 min
systolic BP greater than 100mm Hg

Question 2

septic shock

Answer 2

sepsis with hypotension
BP less than 90 or a fall greater than 40
persists despite fluid challenge

Question 3

if in septic shock

Answer 3

oxygen, fluid balance with isotonic crystalloids 
inotropic agents (adrenaline/ epinephrine infusions)

Question 4

loading dose in sepsis

Answer 4

loading dose is bigger in sepsis because of a high volume distribution due to leaky capillaries
so we get to therapeutic range quickly

Question 5

Assessing severity of pneumonia

Answer 5

CURB-65
CRB-65
Confusion
Urea elevated 
Resp rate greater than 30
Blood pressure low (less then 90 s and 60 d)
older than 65
0-1- outpatient therapy 
2- hospitalize 
3- more treat as CAP
CRB-65
0- outpatient therapy 
1-2 hospitalize 
3 or 4- treat as severe CAP

Question 6

pharmacokinetics changes in sepsis

Answer 6

A- poor drug absorption due to altered blood flow
increased cardiac index= increased clearance = low serum concentration
leaky capillaries and altered protein binding (due to inflammatory products)= increased volume distribution = low serum concentration
End organ dysfunction= reduced clearance = high serum concentrations

Question 7

Volume of distribution

Answer 7

amount of drug in body/plasma concentration

high vd means high in tissue than blood

Question 8

causes of CAP

Answer 8

atypical bacteria- legionella, chlamydophila pneumoniae, mycoplasma pneumoniae
conventional bacteria- strep pneumoniae, H influenzae, klebsiella pneumoniae, M catarrhalis, staph aureus

Question 9

managing CAP

Answer 9

broad spectrum beta lactam
macrolide for atypical bac
oxygen

Question 10

features of severe malaria

Answer 10

Decreased level of consciousness
Seizures
Prostration (inability to drink or sit unaided)
Shock
Acidosis
Severe anaemia (Hb <7 g/dL)
Visible jaundice 
Renal impairment
Parasitaemia ≥5% of red cells
Hypoglycaemia
Respiratory distress

Question 11

who is risk of severe malaria

Answer 11

Nearly always Plasmodium falciparum infection
In endemic areas (year-round transmission):
Young children
Pregnant
HIV+
All people from areas without malaria or with seasonal malaria

Question 12

treating malaria

Answer 12

IV therapy
drug: artesunate
cautious with fluids, do not overhydrate as it could cause resp failure

Question 13

treating bacterial meningitis

Answer 13

broad spectrum antibiotic intravenously

Question 14

inflammatory pathophysiology

Answer 14

check one note