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Finals Revision > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

Staph:

  • Catalase
  • Coagulase
A

Catalase +ve
Coagulase +ve = staph aureus
Coagulase -ve = epidermis

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2
Q

Strep:

  • Catalase
  • Haemolysis
A
  • Catalase -ve (streps are chains so think a chain is like a ‘-‘ sign
Alpha hameolysis = strept pneumoniae, viridans 
Beta haemolysis: 
Group A - pyogenes
B - aglactiae
D = enterococci
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3
Q

Gram positive cocci types

A

Staph & Strep

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4
Q

Gram positive rods

A 
ABCDL
Actinomyces ?
Bacillus cerus 
Clostridium 
Diphtheria 
Listeria
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5
Q

Gram negative cocci

A 
Neisseria 
N. meningitidus 
N.gonorrhoea (cocc-i !) 
Haemophilus 
Bordetella
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6
Q

Gram negative rod

A 
the ellas!! (basically all the stuff that causes food poisoning)  
Salmonella 
Klebsiella 
Bordetella 
Legionella 
Shigella 
\+ Campylobacter + E.coli + Proteus
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7
Q

Random organisms that don’t stain - atypical bacteria

A

Mycobacteria
Myocoplasma
Chlamydia
Spirochaetes - use dark field. –> Syphilis, Lyme

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8
Q

Pneumonia following an influenza - most causative organism

A

Staph aureus

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9
Q

Pneumonia in a COPD pt

A

Haemophilis influenza

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10
Q

Pneumonia in a younger pt with bilateral consolidation on XR and erythema multiforme

A

Mycoplasma pneumoniae

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11
Q

Pneumonia with derranged LFTs, dry cough, hyponatraemia after being on a mediterranian hol

A

Legionella

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12
Q

Pneumocystitis jivrocci

A

HIV/Immunosuppressed pt

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13
Q

Pneumonia in a bronchiectasis pt

A

Pseudomonas

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14
Q

CURB 65 results

A 
Confusion - y/n
Urea >7 mmol
RR >30 
BP <90/60 
65 yrs
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15
Q

CURB65 score of 2 - how to manage

A

Transfer to hosp
Give oral OR IV abx –> amox (doxy/clarithromycin if PA)
5 days

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16
Q

CURB65 score of 3+ how to manage

A

Transfer to ITU
IV co-amox + PO Doxy
OR (if NBM)
IV Co-amox + IV Clarithromycin

Step down to PO Doxy bd

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17
Q

Follow up pneumonia

A

Repeat CXR 4-6 weeks after to ensure consolidation resolved and no cancer

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18
Q

Investigations for meningitis

A

Bloods - FBC, CRP, culture, PCR, paired glucose (for LP), ABG
CT - to exclude raised ICP
LP

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19
Q

What is a normal LP interpretation:

  • Appearance
  • Opening pressure
  • WBCs
  • Protein
  • Glucose
A 
Clear appearance 
Pressure 7-18 
WBCs <4 lymphocytes, 0 polymorophs (a few in kids) 
Protein 0.15-0.4g 
Glucose >50% of serum glucose
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20
Q

What type of infection is:

  • Clear appearance
  • Normal opening pressure
  • Lymphocytosis
  • Normal-high protein
  • Normal glucose
A

Viral

*Note - partially treated bacterial infections can look viral-y

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21
Q

Mainstay characteristic features of LP

A

Bacterial - turbid looking appearnace
TB - Lymphocytosis + High proteins + <50% glucose
Viral - Normal glucose
Fungal - similar presentation to TB

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22
Q

Most common cause of meningitis

A

Most likely - viral

Enterovirus

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23
Q

Most common cause of BACTERIAL meningitis

A

0-3mnths –> Baby BEL

  • Group B strep
  • E.coli
  • Listeria

18mnths - 50yrs –> NHS

  • Neisseria
  • H.influenza
  • Strep pneumonia

> 50yrs
- NHS + Listeria

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24
Q

How is bacterial meningitis treated?

A

IV CEFOTAXIME + amox (for listeria cover)

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25
Q

If the patient has meningitis and you can’t get an urgent transfer into surgery - what do you give?

A

IM benzylpenicillin

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26
Q

If there are signs of encephalitis, what to give?

A

Aciclovir - 10 days Inf

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27
Q

What to give as meningococcal menigitis prophylaxis?

A

Give to close contacts
Oral ciprofloxacin or rifampicin
Meningococcal vaccine

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28
Q

Symptoms of encephalitis

A 
Meningial symptoms 
Altered behaviour 
Confusion 
Headache 
Drowsiness
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29
Q

Causes of encephalitis

A

Usually viral - HSV-1

If bacterial - usually a complication of menigitis from lyme disease or syphilis

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30
Q

Infections assoc. with Staph aureus bactereamia

A 
Osteomyelitis 
Septic arthrtitis 
Psoas abscess 
Discitis 
Endocarditis
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31
Q

Symtpoms of discitis

A

Back pain
Fever
Malaise
Focal neurology

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32
Q

Investigations of discitis

A

MRI spine

CT-giuded biopsy

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33
Q

If bacteraemia is uncomplicated or complicated, how many days do you treat with fluclox?

A

Uncomplicated - 14 days

Complicated - 28 days

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34
Q

Endocarditis signs - vascular and immunological

A

Due to septic emboli: (vascular)

  • Janeway lesions
  • Conjunctival haemorrhages
  • Splinter haemorrhages
  • Cerebral infarcts

Immunological:

  • Glomerulonephritis
  • Osler’s nodes
  • Roth spots
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35
Q

Infective endocarditis causative organisms

A
  • Staph aureus
  • Coagulase-negative staphs - S. epidermidis
  • Strep viridans
  • Enterococcus
  • HACEK –> Haemophilis….Kingella. Others inbetween, none sound familiar
36
Q

Diagnostic criteria for IE

A

Can be pathological or clinical:

Pathological: 1
- Autopsy, biopsy –> vegetations, embolic fragments

Clinical: 2 major or 1 major and 3 minor
Major:
- Blood culture +ve - 2 +ve cultures with characteristic organism or persistently +ve cultures with microorganisms that could be consistent with IE
- Echo positive for vegetation or abscess or dehiscence of prosthetic valve

Minor:

  • Pre-disposition e.g. heart condition or prosthetic valve
  • Fever >38
  • Immune complexes deposits
  • Embolic signs
  • +ve blood cultures not sufficient to meet major criteria
37
Q

When would you decide to do a surgical intervention for IE (otherwise medically treated with IV abx for 4-6wks)

A

Abx resistant
Persistent bactereamia
Myocardial abscess
Prevention of large emboli - if there are large vegetations

38
Q

Pathophysiology of TB

A

Primary disease - infected droplet inhaled gives a primary lung infected

Proliferates within alveolar macrophages - granulomatous tubercle

39
Q

Lung lesion + Lymphadenopathy

A

Ghon complex

40
Q

TB with bactereamia and disseminated infection

A

Miliary TB

41
Q

Reactivation of TB location

A

apex of lung

42
Q

RFs for reactivation

A 
Immunocompromised 
HIV
Steroid use 
TNFa inhibitors 
Renal failure
43
Q

Histology characteristic of TB

A

Langerhans multi-nucleated giant cells

44
Q

Invetsigations of TB if active

A

Sputum culutre (GOLD)

  • Assessed drug sensitivities
  • SLOW: takes several weeks

Sputum micorscopy

  • Commonest in practive
  • ZN stains acid fast bacilli
  • 3 samples needed

Nucleic acid amplication test (NAAT)

  • Rapid diagnosis <48hrs
  • Tests for rifampicin resistance
  • Less sensitive than culture

CXR

  • Upper lobe caviation (reactivated TB)
  • Bilateral hilar lymphadenopathy
45
Q

Investigations of latent TB

A

IGRA
- Detect T cells response

Tuberculin skin prick test (Mantoux)

  • Injected intradermally then wheal measured 72hrs later
  • <6mm negative
  • 6-14mm - maybe
  • <15 strongly suggestive of TB Infection
46
Q

4 medicines for TB

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

47
Q

S/E of 4 treatments for TB

A

Rifampicin - orange pee
Isoniazid - peripheral neuropathy - prevent this by adding pyridoxine (vit B6)
Pyrazinamide - gout
Ethambutol - optic neuritis (e for eye)

They also all can cause hepatitis

48
Q

Management time course

A

Active - 6 months total
2 RIPE
4 RI

Latent
3 mnths R&I
6 mnths I

Meningeal TB
- 12mnths antibitix + steroids

49
Q

Causative organism for:

  • Cellulitis
  • Nec fasc
  • Gas grangrene
A

cellulitis:

  • staph aureus
  • GAS

nec fasc
- GAS
Staph aureus

Gas gangrene
- clostridium perfringes

50
Q

info of nec fasc

A

Commonest site = perineum - “Founeirs gangrene”

Seen in IVDU, immunocompromised

Pain out of keeping with physical features

51
Q

tx of nec fasc

A

Emergency surgical debridement
Tazocin + Clindamycin

similar tx for gas grangrene

52
Q

tx of cellulitis

A

IV fluclox for 5-7 days

53
Q

Questions to ask for ID

A
  • Where specifically did they go?
  • Did they get any pre-travel vaccines
  • Sexual contact
  • Needle contact
  • Freshwater contact
  • Animal contact, insect bites
  • Accomadation - hostel/hotal/camping
  • Street food
  • Unsterilized water
54
Q

Symptoms of infectious mononucleosis

A

Sore throat
Fever
Lymphadenopathy

55
Q

Diagnosis of glandular fever

A

Heterophile antibody test

- Infected B cells produce IgM which agglutinate RCBs

56
Q

Mx glandular fever

A

supportive

57
Q

Early and late features of LYme disease

A

Early - erythema migricans rash, headache, lethargy

Late features - CARDIO heart block and NEURO facial nerve palsy

Suspect if patient has told you they have been out camping

58
Q

Ix of lyme disease

A

ELISA antibodies

59
Q

Mx of lyme disease

A

Doxy & amox if early

Late - ceftriaxone

60
Q

Pathophysiology of botulism

A

Botulinum toxin inhibits ACh release - causes flaccidness

61
Q

Pathophysiology of tetanus

A

tetanus exotoxin inhibits gaba release - causes rigidity

62
Q

Mx for botulinum and tetanus

A

Bot - anti-toxin

Tet - metronidazole also tetanus vaccine

63
Q

HIV diagnosis

A

You need explicit consent to test for HIV

Serology - antibodies to HIV antigens develop at 4-6 weeks. They can be detected by ELISA.
Get confirmatory western blot

Viral detection is not used in diagnosis, it is used to monitor treatment

64
Q

Most common infection of AIDS

A

Pneumocystis pneumonia

65
Q

Features of pneumocystis pneumonia

A

dyspnoea (SOB) , dry cough, fever, desaturation on walking

66
Q

Diagnosis of pneumocystis pneumonia

A

BAL - sputum

PCR of p. jirovecii

67
Q

Mx of penumocystis peumonia

A

High dose co-trimoxazole

IV pentamidine

68
Q

Mx of HIV

A

3 HAART drugs

2 nucleoside reverse transcriptase inhibitors (NRTI)
Either protease inhibitor or non-nucleotide reverse transcriptase inhibitor (NNRTI)

69
Q

Pregnant Tx of HIV

A

all women screened and offered antiretrovirals if +ve

Vaginal delivery : if viral load <50 at 36 wks, can deliver. If higher, must be C/S
Start Zidovudine before delivery

Neonatal - zidovudine if mother <50, otherwise give triple therapy

DON’T BREASTFEED

70
Q

Malaria - clinical features

A

48hr cyclical headache
Malaise
Headache

71
Q

Diagnosis

A

Blood smears
Detect LDH antigen
Blood findings - haemolysis, thrombocytopenia, ureamia, hyperbilirubinaemia, abnormal LFTs

History of travel to an endemic area

72
Q

Malaria mx

A

most common type of malaria = falciparum

  • Uncomplicated = oral ARTeminsin combo therapy
    (ARTemether + lumefantrine)

If severe or >2% parasited = give IV ARTesunate

73
Q

Malaria prophylaxis

A

Malarone - GI upset - 2 days prior + 7 days after
Don’t give to renal impairment

Chloroquine – headache - 1 week + 4 weeks after
Don’t give to epileptics

Doxy - photosensitivity - 2 days prior + 4 weeks after
Don’t give to pregnancy

Mefloquine - dizziness - 3 weeks prior + 4 weeks after
Don’t give to epilepsy or mental health

74
Q

Parasites:
1) Eggs in urine

2) Dilated cardiomyopathy + MEGA oesophagus + MEGA colon
3) Hepato + splenomegaly
4) CNS involvement

A

1) Scistomiasis
2) Chagas
3) Leischmamnn
4) Sleeping sickness

75
Q

Gatsroenteritis:
non-bloody diarrhoea, recent travel to spain

Tx?

A

Giardiasis

Metronidazole

76
Q

Causative drugs of C.diff

A

Clindamycin, cephalosporins, co-amox

77
Q

Ix of c.diff

A

WCC

C.diff toxin in STOOL

78
Q

Mx of c.diff

A 
1st line - oral metronidazole 
2nd line (if severe) - oral vancomycin
79
Q

What abx to give after an animal bite?

A

Cp-amox

80
Q

overgrowth of predominately Gardnerella vaginalisn is what condiiton

A

bacterial vaginosis

81
Q

Which gastroenteritis presents with constipation?

A

Typhoid fever i.e. salmonella

although note: classic salmonella can give diarrhoea

82
Q

Cellulitis is a PA pregnant person?

A

Erythromycin

Note: PA people with cellultis - give clarithromycin but because clarithromycin is inappropriate during pregnancy, give eryth

83
Q

What organism causes pneumonia that is assoc. with cold sores?

A

Strep. pneumonia (most common causative organism)

84
Q

Syphilis Mx

A

IM benzylpenicillin

85
Q

Stereotypical features of Legionella include?

A

dry cough, relative bradycardia and confusion. Blood tests may show hyponatraemia

86
Q

common cause of chronic wound infections

A

pseudomonas

Finals Revision (7 decks)

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