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Finals > Infectious diseases > Flashcards

Infectious diseases Flashcards

1
Q

Define sepsis

A

Large immune response to an infection, causing systemic inflammation and organ dysfunction

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2
Q

Define septic shock

A
  • When arterial BP drops despite adequate fluid resus
  • This causes organ hypoperfusion, leading to anaerobic respiration and lactate rises.
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3
Q

How is septic shock diagnosed ?

A
  • Low mean arterial pressure (below 65 mmHg) despite fluid resuscitation (requiring vasopressors)
  • Raised serum lactate (above 2 mmol/L)
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4
Q

How is septic shock managed on ITU when fluid resus is inadequate ?

A
  • Vasopressors (e.g. noradrenaline)
  • They cause vasoconstriction, increasing systemic vascular resistance and in turn MAP
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5
Q

what is an early sign of sepsis ?

A

Tachypnoea

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6
Q

what is the sepsis 6 done in anyone with suspected sepsis

A
  • > 3 treatments : oxygen, empirical broad-spectrum Abx, IV fluids

-> 3 tests : serum lactate, blood cultures, urine output

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7
Q

what are the target SATs for anyone on oxygen ?

A
  • 94-98%
  • 88-92% in COPD
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8
Q

Presentation of a lower UTI (7)

A
  • Dysuria
  • Suprapubic pain
  • Frequency
  • Urgency
  • Incontinence
  • Cloudy or foul-smelling urine
  • Confusion in older and frail patients
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9
Q

Most common cause of UTI

A

E. coli = gram-negative, anaerobic, rod shaped bacteria

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10
Q

When should a urine culture be sent over just a urine dipstick in UTI ? (5)

A
  • Women aged > 65 years
  • Recurrent UTI (2 episodes in 6 months or 3 in 12 months)
  • Pregnant women
  • Men
  • Visible or non-visible haematuria
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11
Q

What does the results of a urine dipstick suggest based on leukocytes / nitrites

A
  • Nitrities or leukocytes + RBCs = UTI
  • Nitrites + leukocytes = UTI
  • Nitrites only = UTI
  • Leukocytes only = culture
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12
Q

How is a UTI managed in non pregnant women ? ?

A
  • Check local Abx guideline
  • Trimethoprim or nitrofurantoin for 3 days
  • Send MSU culture if >65 yrs or visible / non visible haematuria
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13
Q

How is a UTI managed in a pregnanct woman ?

A
  • Send MSU culture
  • 7 day course !
  • 1st = nitrfurantoin UNLESS 3rd trimester
  • 2nd = cefalexin or amoxacillin (if sensitivities known)
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14
Q

what is the effect of nitrofurantoin and trimethoprim if given at the wrong time in pregnancy ?

A
  • Nitrofurantoin = avoid in 3rd trimester = neonatal haemolysis
  • Trimethoprim = avoid in 1st trimester = folate antagonist = neural tube defects
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15
Q

How is a UTI managed in man ?

A
  • 7 days of nitrofurantoin / trimethoprim
  • MSU culture
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16
Q

what is the management of asymptomatic bacteriuria in pregnancy women

A
  • 7 day course of Abx
  • MSU culture for test of cure
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17
Q

Clinical features of pyelonephritis (triad +3)

A
  • Triad : fever, loin pain, N&V
  • Loss of appeitite
  • Haematuria
  • Renal angle tenderness
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18
Q

how is pyelonephritis managed ?

A
  • Should have SMU sent before
    starting 7-10 days Abx
  • Cefalexin
  • Co-amoxiclav / trimethoprim if culture results available
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19
Q

what is cellulitis and its most common causes (2) ?

A
  • Infection of the skin and soft tissue
  • Streptococcus pyogenes (most common - inc in DM)
  • Staphylococcus aureus
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20
Q

How does cellulitis present ?

A
  • Erythema
  • Warm or hot to touch
  • Swelling
  • Systemically unwell : fever, malaise, nausea
  • Bullae in severe disease
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21
Q

What is the eron classification of cellulitis

A
  • Class 1 – no systemic toxicity or uncontrolled comorbidity
  • Class 2 – systemic toxicity or comorbidity
  • Class 3 – significant systemic toxicity or significant comorbidity
  • Class 4 – sepsis or life-threatening infection
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22
Q

Management of eron class I cellulitis

A
  • Oral flucloxacillin (Doxycycline if pen allergic)
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23
Q

Management of eron class III or IV cellulitis

A
  • Admit
  • Oral/IV co-amoxiclav, oral/IV clindamycin, IV cefuroxime or IV ceftriaxone
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24
Q

How is cellulitis managed in a pregnant woman ?

A
  • Oral erythromycin
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25
Q

what kind of bacteria are streptococci and when are they clinically important ?

A
  • Gram positive cocci
  • Alpha haemolytic = streptococcus pneumoniae (pneumonia)
  • Beta haemolytic = Group A streptococcus pyogenes -> cellulitis, impetigo, tonsilitis
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26
Q

what causes TB and what staining is required when culturing?

A
  • Mycobacterium tuberculosis = “rod shaped acid-fast bacilli”)
  • Zeihl-Neelsan staining = bright red against a blue background
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27
Q

Define the different outcomes when TB enters the body

A
  • Immediate clearance of the bacteria
  • Primary active tuberculosis = active infection after exposure
  • Latent tuberculosis = presence of the bacteria without being symptomatic or contagious
  • Secondary tuberculosis = reactivation of latent tuberculosis to active infection, usually occurs in the apex of the lungs when a pt becomes immunocomprimised
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28
Q

what are the 2 screening tests for latent TB ?

A

-> Mantoux test (>=6mm = +ve)
-> Interferon-gamma release assay (IGRA)

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29
Q

what is used to diagnose TB in active disease ?

A
  • CXR
  • Sputum smear : 3 samples and 50-80% sensitive
  • Sputum culture = gold standard (more sensitive) but takes 1-3 weeks. Used to assess drug sensitivites
  • NAAT - rapid diagnosis (1-2 days)
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30
Q

What are common findings on CXR in TB ?

A
  • Primary tuberculosis - bilateral hilar lymphadenopathy.
  • Reactivated tuberculosis = upper lobe cavitation (gas-filled spaces),
  • Disseminated miliary tuberculosis = millet seeds uniformly distributed across the lung fields.
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31
Q

How is active TB managed ?

A
  • R : Rifampicin for 6 mnths
  • I : Isoniazid for 6 mnths
  • P : Pyrazinamide for 2 mnths
  • E : Ethambutol for 2 mnths
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32
Q

what should be prescribed alongside isoniazid ?

A
  • Pyridoxine (vitamin B6) -> prevents peripheral neuropathy caused by isoniazid
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33
Q

How is latent TB managed ?

A

EITHER

  • Isoniazid and rifampicin for 3 months
  • Isoniazid for 6 months
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34
Q

Common SE of rifampicin

A
  • Red / orange discolouration of urine / tears
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35
Q

Common SE of Isoniazid

A

Peripheral neuropathy

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36
Q

Common SE of pyrazinamide

A
  • Hyperuricaemia = gout and kidney stones
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37
Q

Common SE of ethambutol

A
  • Optic neuritis
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38
Q

what is the typical presentation of TB ?

A
  • Usually causes pulmonary disease
  • Cough
  • Haemoptysis
  • Lethargy
  • Fever or night sweats
  • Weight loss
  • Lymphadenopathy
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39
Q

what is the typical presentation of malariua ?

A
  • Fever (up to 41) spiking every 48 hours.
  • Fatigue
  • Myalgia
  • Headache
  • N&V
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40
Q

what is seen on examination in malaria ?

A
  • Pallor due to the anaemia
  • Hepatosplenomegaly
  • Jaundice
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41
Q

What are the treatment options for severe or complicated malaria ?

A
  • IV Artesunate (1st choice)
42
Q

How is malaria tested for ?

A
  • 3 thick & thin blood films at least 24hrs apart should be sent
  • Thick films are used to calculate the parasitaemia
  • Parasitaemia >2% is associated with increased chance of developing severe disease
43
Q

what are the features of severe malaria in an adult (7)

A
  • Schizonts on blood fim
  • Parasitaemia >2%
  • Hypoglycaemia
  • Acidosis
  • Temp >39
  • Severe anaemia
44
Q

Causes of meningitis in 0-3 mnths

A
  • Group B Streptococcus (most common cause in neonates)
  • E. coli
  • Listeria monocytogenes
45
Q

Causes of meningitis in 3mnths - 6 yrs

A
  • Neisseria meningitidis
  • Streptococcus pneumoniae
  • Haemophilus influenzae
46
Q

Causes of meningitis in 6 yrs - 60 yrs

A
  • Neisseria meningitidis
  • Streptococcus pneumoniae
47
Q

Causes of meningitis in >60 yrs

A

Streptococcus pneumoniae
Neisseria meningitidis
Listeria monocytogenes

48
Q

Causes of pneumonia in the immunosuppressed

A

Listeria monocytogenes

49
Q

Define meningitis, meningococcal meningitis and meningococcal septicaemia

A
  • > Inflammation of the meninges
    -> Meningococcal meningitis : inflammation of meninges and CSF
    -> Meningococcal septicaemia : bacterial infection is in the bloodsteam -> can lead to non blanching rash.
50
Q

what are the common viral causes of meningitis ?

A

Enteroviruses (e.g., coxsackievirus)
Herpes simplex virus (HSV)
Varicella zoster virus (VZV)

HSV / VZV = aciclovir

51
Q

What is the usual presentation of meningitis

A
  • Fever
  • Neck stiffness
  • Vomiting
  • Headache
  • Photophobia
  • Altered consciousness
  • Seizures
52
Q

what 2 tests suggest meningeal irritation ?

A

-> Kernig’s : flex one hip and knee to 90 degrees, then straighten knee keeping hip flexed. +ve = pain or resisted movement
- > Brudzinski’s : flexing chin to chest whilst laying flat = hips and knees flex involuntarily

53
Q

CSF findings in bacterial meningitis

A
  • Appearance : cloudy
  • Protein : high
  • Glucose : low
  • WCC : high neutrophils
  • Culture : bacteria
54
Q

CSF findings in viral meningitis

A
  • Appearance : clear
  • Protein : normal or mildly raised
  • Glucose : normal
  • WCC : high lymphocytes
  • Culture : negative
55
Q

CSF findings in fungal meningitis

A
  • Appearance : cloudy
  • Glucose : low
  • Protein : high
  • WCC : high lymphocytes
56
Q

Management of suspected meningitis with non blanching rash in community

A

IM benzylpenicillin

  • <1yr = 300mg
  • 1-9 yrs = 600mg
  • > 10 yrs = 1200mg
57
Q

management of pt with suspected meningitis without indication for delayed LP

A
  • IV access → take bloods and blood cultures
  • LP within 1st hr. (CI in the presence of a rash)
  • IV antibiotics
  • IV dexamethasone
58
Q

Management of meningitis <3 mnths

A

Intravenous cefotaxime + amoxicillin (or ampicillin)

59
Q

Management of meningitis >3mnths - 50 yrs

A

IV 2g ceftriaxone (cephlasporin)

60
Q

Management of meningitis >50 yrs

A
  • IV ceftriaxone + amoxicillin (risk of listeria)
61
Q

what is deemed as a contact to someone with meningitis and what are they given ?

A
  • Prolonged contact within 7 days before illness onset
  • Single dose of ciproflaxacin (500mg)
62
Q

5 complications of meningitis

A
  • Hearing loss
  • Seizures and epilepsy
  • Cognitive impairment and learning disability
  • Memory loss
  • Focal neurological deficits, such as limb weakness or spasticity
63
Q

What should CSF be sent for after doing a LP for suspected meningitis ?

A
  • WCC
  • Red cell count
  • Protein
  • Gram stain & culture
  • Glucose
  • Viral PCR
  • Meningococcal & Pneumococcal PCR
64
Q

What antibodies are associated with increased risk of c.diff

A
  • Clindamycin
  • Ciprofloxacin (and other fluoroquinolones)
  • Cephalosporins
  • Carbapenems (e.g., meropenem)
65
Q

what are the features of c.diff

A
  • Diarrhoea, nausea and abdo pain
  • If severe = colitis = dehydration and systemic symptoms (tachycardia, hypotension).
66
Q

what 2 tests re used for c.diff diagnosis

A
  1. Present of c.difficile antigen in stool (c.diff PCR)
  2. Presence of c.diff toxin in stool = diagnostic
67
Q

what is first and second line management of c.diff

A
  • Oral vancomycin for 10 days
  • 2nd = oral fidaxomicin
68
Q

How is recurrent c.diff infection managed ?

A
  • within 12 weeks of symptom resolution: oral fidaxomicin
  • after 12 weeks of symptom resolution: oral vancomycin OR fidaxomicin
69
Q

how is life threatening c.diff managed

A

oral vancomycin AND IV metronidazole
(suggested by hypotension, ileus, toxic megacolon or CT evidence severe disease)

70
Q

What can be considered in patients who’ve had 2 or more previous episodes of c.diff infection ?

A

faecal microbiota transplant

71
Q

Give 4 complications of c.diff infection

A
  • Pseudomembranous colitis
  • Toxic megacolon
  • Bowel perforation
  • Sepsis
72
Q

Most common organism found in central lime infections and is it coagulase negative or positve

A
  • Staphylococcus epidermis
  • Gram +ve cocci but coagulsae negative
73
Q

Common presentation of bacillus cereus infection

A
  • Short incubation period (24 hrs)
  • Commonly caused by rice
  • Crampy abdo pain, vomiting and diarrhoea
74
Q

6 AIDs defining illnesses with underlying bacterual causes

A
  1. Gastreoenteritis caused by cryptosporidium parvum
  2. Pneumonia caused by pneumocystis jiroveci
  3. Loss of vision with cytomegalovirus retinitis
  4. HIV related encephalopathy
  5. Mycobacterium TB
  6. Invasive cervical cancer
75
Q

Presentation of yellow fever

A

Flu like illness -> brief remission -> jaundice and haematemesis

76
Q

What is the criteria for receiving varicella zoster immunoglobulin (VZIG) if exposed to chickenpox?

A
  1. Significant exposure to chickenpox or herpes zoster
  2. Clinical condition that increases the risk of severe varicella; this includes immunosuppressed patients, neonates and pregnant women
    e.g. long-term steroids, methotrexate and other common immunosuppressants
  3. No antibodies to the varicella virus
77
Q

Cause of lyme disease

A

Spirochaete Borrelia burgdorferi and is sread by ticks

78
Q

First line test for suspected lyme diease

A

ELISA antibodies to Borrelia burgorferi

79
Q

Management if early lyme disase

A

Doxycycline
Amoxicillin if pregnanct

80
Q

Management of disseminated lyme disease

A

Ceftriaxone

81
Q

Early features of lyme disease

A
  • Erythema migrans (bulls-eye rash)
  • Headache, lethargy, fever, arthralgia
82
Q

Late features of lyme disease

A
  • Cardivascular : heart block, peri/myocarditis
  • Neurological : facial nerve palsy, radicular pain, meningitis
83
Q

Diagnosis and management of influenza

A
  • Nasal / throat swab with PCR testing
  • Tx : Oseltamivir (TAMIFLU)
84
Q

2 viral causes of gastroenteritis

A

Rotavirus
Noravirus

85
Q

Each cause most associated with :

  1. Foreign travel
  2. Raw eggs / poultry
  3. Old fried rice
  4. Small intestines of mammals
  5. Undercooked pork
A
  1. Campylobacter jejuni
  2. Salmonella
  3. Bacillus
  4. Giardia
  5. Yersinia
86
Q

3 features of HUS

A

Anaemia
AKI
Low plts

87
Q

2 causes of HUS

A

Shigella
E.coli 0157

88
Q

4 complications of HUS

A
  1. Lactose intolerance
  2. GBS
  3. IBS
  4. Reactive arthritis
89
Q

5 complications of malaria that would also then classify as severe malaeia

A
  • Cerebral malaria (seizures, coma)
  • Acute renal failure
  • ARDS
  • Hypoglycaemia
  • DIC
90
Q

Cause of type 1 and 2 necrotising fascitis

A
  • 1 : Mixed anaerobes and aerobes (post surgery in diabetics) = most common
  • 2 : Caused by strep pyogenes
91
Q

Management of necrotising fascitis

A

IV ABx
Immediate surgical debridement

92
Q

do you treat asymptomatic bacteria in catherised pts

A

No

93
Q

what kind of vaccine is the BCG vaccine and what should be tested beforehand ?

A
  • Live attenuated
  • Tuberculin test
94
Q

cause of pneumonia with cavitating lesion

A

Staphylococcus aureus

95
Q

Who is affected by mycoplasma pneumoniae

A

younger people

96
Q

Complication of mycoplasma pneumoniae

A

Cold autoimmune haemolytic anaemia

97
Q

what antibiotics are used in animal and human bites

A

Co-amoxiclav
(doxycyline + metronidazole if pen allergic)

98
Q

Skin finding in mycoplasma pneumonia

A
  • Erythema multiforme = symmetrical target shaped rash with central blister
99
Q

what are sewage workers at risk of ?

A

Leptospirosis

100
Q

what kind of pneumonia does preceding influenza predispose to ?

A

Staphylococus aureus

101
Q

Renal transplant + infection. Presenting with fever, bilateral pneumonia, derranged LFTs and lymphadenopathy. Likely cause ?

A

Cytomegalovirus

102
Q
A

Finals (92 decks)

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