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Phase1c Medicine > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

What is the most common causative organism for infective endocarditis?

A

Staphylococcus aureus

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2
Q

Which pathogen is associated with poor dental hygiene in infective endocarditis?

A

Streptococcus viridans

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3
Q

Which pathogen is associated with prosthetic valves in infective endocarditis?

A

Staphylococcus epidermidis

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4
Q

Which pathogen is associated with colorectal cancer in infective endocarditis?

A

Streptococcus bovis

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5
Q

What are the risk factors of infective endocarditis?

A

Rheumatic valve disease (30%)

Prosthetic valves

Congenital heart defects

Intravenous drug users (IVDUs)

Dental work

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6
Q

Which valve is most commonly affected by infective endocarditis?

A

Mitral valve

Aortic > tricuspid > pulmonary

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7
Q

What are the symptoms of infective endocarditis?

A

Fever/sweats/chills/rigors

Malaise, arthralgia, myalgia, confusion, weight loss

Pyrexia, tachycardia, signs of anaemia

Clubbing

New valvular mumur

Haematuria

Vasculitis lesions

Splenomeagaly

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8
Q

What are the specific signs of infective endocarditis?

A

Roth spots
Osler nodes
Janeway lesions
Splinter haemorrhages

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9
Q

Which valve is affected in IVDU infective endocarditis?

A

Tricuspid

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10
Q

What investigations are performed in infective endocarditis?

A

Bloods -FBC, ESR, CRP

3 blood cultures 1 hour apart within 24 hours

Urgent transoeophageal echocardiogram

Dukes Classification

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11
Q

How many blood cultures are performed in the investigation of infective endocarditis?

A

3 blood cultures 1 hour apart within 24 hours

Aerobic bottle first before anaerobic

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12
Q

What is the initial blind therapy for infective endocarditis?

A

Native valve
amoxicillin, consider adding low-dose gentamicin

If penicillin allergic, MRSA or severe sepsis
vancomycin + low-dose gentamicin

If prosthetic valve
vancomycin + rifampicin + low-dose gentamicin

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13
Q

In addition to antibiotics what is added to management for infective endocarditis in prosthetic valve?

A

Anticoagulation

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14
Q

What are the complications of infective endocarditis?

A

Stroke (left-side)
PE (Right side)
Congestive heart failure

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15
Q

What are the features of UTIs?

A 
Features
dysuria
urinary frequency
urinary urgency
cloudy/offensive smelling urine
lower abdominal pain
fever: typically low-grade in lower UTI
malaise
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16
Q

What is the most common cause of UTI?

A

E.coli

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17
Q

Which pathogen can cause struvite stones in UTIs?

A

Proteus mirabilis

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18
Q

What are the risk factors for UTIs?

A

Age >50 years
Urine outflow obstruction -BPH, stones, strictures

Catheters

DM

Pregnancy

Immunosuppression

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19
Q

What are the signs and symptoms of pyelonephritis?

A 
Rigours
Flank pain 
Pyrexia
Nausea and vomiting 
Acute confusional state
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20
Q

What are the signs and symptoms of cystitis?

A 
Frequency, urgency
Dysuria
Haematuria
Foul-smelling + cloudy urine
Suprapubic pain or loin pain
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21
Q

What is the first-line investigation for urinary tract infections?

A

Dipstick urinalysis - positive nitrites/leukocytes/blood

Urine MC&S - via Mid-stream urine - DIAGNOSTIC

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22
Q

What do White cell casts in urine suggest?

A

Pyelonephritis

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23
Q

What ABx is prescribed in UTIs?

A

Trimethoprim (Avoid in pregnancy)

Nitrofurantoin

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24
Q

What is Malaria?

A

Infection with the protozoan plasmodium

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25
Q

What is the most common type of malaria?

A

Falciparum malaria

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26
Q

What are the symptoms of malaria?

A 
Headaches
Weakness
Myalgia/Arthralgia
Anorexia
Cyclical fevers - paroxysmal of severe cold rigors followed by severe sweating

Signs

  • Pyrexia
  • Splenomegaly
  • Haemolytic anaemia - dark urine
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27
Q

What are the investigations to diagnostically confirm Malaria?

A

Giemsa-stained thick and thin blood smears

Thick -detects parasites present

Thin - identifies species

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28
Q

What is the management of malaria?

A

Complicated/severe

  • Artensunate
  • Quinine
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29
Q

What are the main signs and symptoms of hepatitis?

A

Raised AST/ALT
Fever
Jaundice

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30
Q

What is the prodromal phase of viral hepatitis?

A 
General fatigue
Malaise
Joint/muscle pain 
Low-grade fever
GI upset- RUQ pain
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31
Q

What are the symptoms associated with the icteric phase of viral hepatitis?

A 
Jaundice
Pale stools
Dark urine
Pruritus
Hepatomegaly 
RUQ pain
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32
Q

Which hepatitis is associated with chronic hepatitis?

A

B,C,D

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33
Q

How is HepA-E transmitted?

A

Faeco-oral transmission

Shellfish and contaminated water.

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34
Q

How is Hep B and C transmitted?

A 
Sexual contact
Blood borne
Vertical transmission
Needle-stick injury 
Associated with HIV
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35
Q

What is the management of acute viral hepatitis B?

A

Acute- supportive

36
Q

What is the management for chronic viral hepatitis B?

A

Peginterferon Alpha-2-A

Antivirals (Tenofovir)

37
Q

What is the management of chronic hepatitis C?

A

Sofobuvir

Daclatasvir

38
Q

What do LFTs reveal in viral hepatitis?

A 
Increased bilirubin 
Decreased albumin 
Raised ALT/AST
Raised GGT
Raised ALP

Clotting - Prolonged PT (INR) - A sensitive marker of significant liver damage

39
Q

What radiological investigation is performed in diagnosing viral hepatitis?

A

Ultrasound scan

40
Q

Which antibodies raise first in hepatitis A?

A

IgM

41
Q

What investigation is performed to assess the degree of inflammation and liver damage in viral hepatitis?

A

Liver biopsy

42
Q

Which hepatitis antibodies are raised in vaccinated Hep B?

A

Anti-HepB Surface antigen

43
Q

Which hepatitis antibodies are raised in natural immune hepatitis B?

A

Anti-HbSAg

Anti HbC-Ag

44
Q

Which hepatitis antibodies are raised in acute infection of HepB?

A

IgM anti-HbCAg

HbSAg

45
Q

HbSAg + and Anti-HbCAg - suggests what?

A

Chronic infection

46
Q

Which antigen is associated with chronic and acute hepatitis B?

A

HbSAg

47
Q

What is gastroenteritis?

A

Inflammation of the gastrointestinal tract - caused by pathogens

48
Q

What are the common viruses associated with gastroenteritis?

A

Norovirus

Rotavirus

49
Q

What are the common bacteria associated with gastroenteritis?

A

Campylobacter Jejuni
E.coli
Salmonella

50
Q

What are the symptoms of gastroenteritis?

A 
Sudden onset diarrhoea 
Blood or mucous in the stool
Faecal urgency 
Nausea/vomiting
Fever + malaise
Abdominal pain or cramps

Associated symptoms: Headache, myalgia, bloating, flatulence, weight loss, malabsorption

51
Q

What is dysentery?

A

Blood in stool due to an infectious agent

52
Q

Which infectious agents are associated with secretory diarrhoea?

A 
Campylobacter
Staph aureus
Vibrio cholera
E.coli 
Salmonella Bacillus cereus
53
Q

What are the CHESS organisms responsible for causing dysentery (bloody diarrhoea)

A 
Campylobacter/Clostridium difficile
Haemorrhagic E.coli 
Entamoeba histolytica
Shigella
Salmonella
54
Q

Which agents can potentiate C difficile?

A

Antibiotics (Second and third-generation cephalosporins and clindamycin)

PPI

Anti-peristaltic drugs

55
Q

How is staph aureus diarrhoea caused?

A

Contaminated food 1-6 hours, short lived

56
Q

How is bacillus cereus transmitted?

A

Reheated rice

Can cause cerebral abscess

57
Q

How is E.coli caused?

A

Contaminated foods - associated with recent travel

58
Q

How is salmonella transmitted?

A

Eggs, poultry, associated with constipation, multiplies in Peyer’s patches

59
Q

What causative organism is associated with GBS?

A

Campylobacter

60
Q

What strain causes haemorrhagic E.coli?

A

EHEC 0157:H7

61
Q

What renal disorder is associated with ETEC?

A

Haemolytic uraemic syndrome

62
Q

How is shigella transmitted?

A

Person-to-person contact
Poor sanitation
MSM

63
Q

What examination findings are associated with gastreoenteritis?

A

Dry Mucous membranes, reduced skin turgor, cap

Reduced urine output - marker of dehydration

HR, BP - signs of shock
Temperature

64
Q

What is the management for gastroenteritis (no systemic signs)?

A

Supportive therapy, bed rest, and electrolyte replacement with oral rehydration solution.

65
Q

What is the management for gastroenteritis (systemic illness)?

A

Admit and give oral fluids

-Direct faecal smear, then culture

66
Q

Definition of meningitis?

A

Inflammation of leptomeningeal (pia mater and arachnoid) coverings of the brain

Affects extremes of age

67
Q

What are the most common bacterial causes of meningits?

A

Neisseria meningitidis

Streptococcus pneumoniae

68
Q

Which is the most common viral of meningitis?

A

Coxsackie virus, HSV, enteroviruses

69
Q

What type of bacteria is Neisseria meningitides?

A

Gram negative diplococci

70
Q

What type of bacteria is streptococcus pneumonia?

A

Gram positive cocci

71
Q

What is the classic triad of meningits?

A

Photophobia
Neck stiffness
Headache

72
Q

What is the presentation of meningits?

A 
Fever
Tachycardia
Hypotension
Photophobia
Neck stiffness
Headache
Non-blanching rash
N&V
73
Q

What does a non-blanching skin rash suggest in meningitis?

A

Meninogoccal stepicaemia

Neisseria meningitiidis

74
Q

What is Brudzinki’s sign?

A

Passively flex at neck - severe neck stifness

75
Q

What is Kernig’s sign?

A

Severe stiffness of the hamstrings and an inability to straighten the leg

76
Q

What does a lumbar puncture reveal in bacterial meningitis?

A

Gram-negative diplococci

Numerous segmented neutrophils

77
Q

What investigations are recommended in meningitis?

A

Two sets of blood cultures

-Imaging - CT to exclude intracranial pressure - to assess viability for lumbar puncture

78
Q

What is the diagnostic investigation for meningitis?

A

Lumbar puncture - send the CSF sampling for MC&S and gram staining to confirm

79
Q

What are the contraindications for a lumbar puncture?

A

Neurological signs suggested raised ICP

Superficial infection of the lP site

Coagulopathy

80
Q

What CSF features are associated with bacterial meningitis?

A

Turbid
Very high-neutrophils
Raised protein
Low glucose

81
Q

What features are associated with viral meningitIs (CSF)

A

Clear/cloudy appearance
High lymphocytes
Raised protein
Normal glucose

82
Q

What features are associated with TB/fungal meningits?

A

Clear cloudy appearance - high lymphocytes
Raised protein
Low glucose

83
Q

What is the first-line management for non-blanching rash/meningococcal septicaemia?

A

Admit/call an ambulance

Single-dose of IV benzylpenicillin

84
Q

What ABx is prescribed in bacterial meningitis?

A

IV ceftriaxone

Consider corticosteroids - dexamethasone for bacterial meningitis

85
Q

If the patient has affected consciousness in meningitis what should be given?

A

IV acyclovir (Suspect encephalitis)

86
Q

What is the prophylaxis of meningitis?

A

Rifampicin or ciprofloxacin

Phase1c Medicine (11 decks)

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