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Yr 3 MedEd > Infectious diseases 2 > Flashcards

Infectious diseases 2 Flashcards

1
Q

Give 4 causes of aseptic meningitis.

A
  • Enterovirus: mycobacteria, fungi
  • Autoimmune: Sarcoidosis, Behcet’s disease, SLE
  • Malignancy
  • Medication: NSAIDs, trimethoprim, azathioprine
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2
Q

How do investigations differ between meningitis and encephalitis?

Give 2 antibiotic managements for meningitis.

A
  • Meningitis: straight to lumbar puncture for CSF.
  • Encephalitis: blood cultures, MRI, CSF analysis.
  • Ceftriaxone, vancomycin
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3
Q 
Give the most likely bacteria for the following meningitis cases.
Neonates
- Extended labour, infection in previous pregnancy
- Late neonatal infection
- Other neonate
Children/ teens
- Gram -ve diplococci
- Unvaccinated
Adults/ elderly
- Gram +ve cocci
- Cheese/ unpasteurised milk, alcoholics
A 
Neonates
- Group B streptococcus
- E. Coli
- Listeria monocytogenes
Children/ teens
- Neisseria meningitides
- Haemophillus influenzae
Adults/ Elderly
- Streptococcus pneumoniae
- Listeria monocytogenes
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4
Q

What is Brudzinski’s sign?

What is Kernig’s sign?

A

Tests for meningitis
- Neck stiffness causes hips and knees to flex when neck is flexed.

  • Hamstring stiffness causes inability to straighten leg when hip is flexed 90 degrees.
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5
Q

What needs to be excluded on imaging when investigating meningitis.

A

Need CT to exclude raised intracranial pressure.

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6
Q

Differentiate the LP CSF results for bacterial/ viral meningitis:

  • Appearance
  • White cells
  • Protein
  • Glucose
  • Gram stain
A

Bacterial : Viral

  • Turbid: Clear/ cloudy
  • Very high neutrophils: High lymphocytes
  • Very high protein: High protein
  • Very low glucose: Normal glucose
  • Positive: no gram stain
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7
Q

Give 3 contraindications for Lumbar puncture.

A
  • Neurological signs suggesting raised ICP.
  • Superficial infection over LP site
  • Coagulopathy
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8
Q

What is the management for:

  • Non-blanching rash or meningococcal septicaemia
  • Bacterial meningitis
  • Bacterial meningitis with affected consciousness.

What medication is given as prophylaxis to close contacts?

A
  • Single does IV benzylpenicillin
  • Bacterial meningitis: IV Ceftriaxone (3rd generation cephalosporin). Consider corticosteroid: dexamethasone for bacterial meningitis.
    Do not give steroids if meningococcal septicaemia is suspected.
  • If consciousness affected, consider IV acyclovir to cover encephalitis.
  • Rifampicin or ciproflaxin for prophylaxis.
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9
Q

What is main cause of encephalitis?

- Give 3 bacterial causes of meningitis other than Neisseria mengititides

A
  • Herpes virus

- TB, Syphillis, Listeria

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10
Q

Give 3 most common pathogens causing infective endocarditis and their respective risk factors

Give 2 other risk factors for infective endocarditis.

Which pathogen causes IE with colorectal cancer

Which pathogen causes IE from dental tooth extraction?

A
  • Streptococci: Abnormal valves (congenital, post-rheumatic, calcification/ degeneration)
  • Staphylococci: Prosthetic heart valves
  • Enterococci: IV drug use.
  • Turbulent flow
  • Recent dental work.
  • Strep. Bovis
  • Strep. Viridian
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11
Q

What is the mnemonic for signs and symptoms of infective endocarditis.

A

From Jane with Love:

  • Fever (and tachycardia), malaise, arthralgia
  • Roth spots
  • Osler nodes
  • Murmur: Mitral> aortic> tricuspid> pulmonary
  • Janeway lesions
  • Anaemia- normocytic
  • Nail-bed (splinter) haemorrhage
  • Emboli.
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12
Q

Give 5 buzzwords for infective endocarditis

A
  • Prosthetic valve
  • Dental procedure
  • New onset murmur
  • Vegetation on echo
  • Indwelling catheter
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13
Q

How many blood cultures should be taken to investigate infective endocarditis?

What is the Duke’s classification for diagnosis of endocarditis?

A
  • 3 cultures, 1 hour apart.

Dukes:
- Major: positive blood culture in 2 samples. Positive echo.
Minor: High grade pyrexia, risk factors, vascular signs.

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14
Q

What are the initial antibiotic managements on suspicion of infective endocarditis?

What are the antibiotic regimes for the following IE pathogens:

  • Streptococci
  • Staphylococci
  • Enterococci

In penicillin allergy what is the alternative?

A
  • Benzylpenicillin + gentamicin
  • Strep; same as above
  • Staph: Flucloxacillin/ Vancomycin + gentamicin
  • Entero: Ampicillin + gentamicin.

Penicillin alternative is vancomycin

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15
Q

Give 6 complications of infective endocarditis

A
  • Congestive heart failure
  • Valve incompetence
  • Aneurysm formation
  • Systemic embolization
  • Renal failure
  • Glomerulonephritis
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16
Q

Give 2 viral and 3 bacterial causes of gastroenteritis.

A

Viral: rotavirus, adenovirus.
Bacterial: Campylobacter jejuni, Escheria Coli, salmonella (egg shell).

17
Q

Give 3 bacterial causes of diarrhoea
Give 3 bacterial causes of dysentery.
Give 2 bacterial causes of both

A 
Diarrhoea:
- Staph aureus
- Vibrio cholera
- E. Coli
Dysentery:
- Haemorrhagic E. Coli
- Entamoeba hystolytica
- Shigella
Both:
- Campylobacter/ clostridium difficile
- Salmonella
18
Q

Which bacterial causes of diarrhoea do the following relate to?:

  • > 70, use of antibiotics.
  • 1-6 hours after eating, short lived
  • Rice water diarrhoea, poor sanitation
  • Leafy vegetables
  • Reheated rice, can cause cerebral abscess
  • Eggs, poultry, constipation, Peyer’s patches
A
  • C. Diff
  • Staph aureus
  • Vibrio cholera
  • E. Coli
  • Bacillus Cereus
  • Salmonella
19
Q

Which pathogenic causes of dysentery are related to the following:

  • Uncooked poultry
  • Leafy vegetables, haemolytic uraemia
  • Poor sanitation, tropical places, MSM
  • Personal contact, poor sanitation, MSM
  • Eggs
A
  • Campylobacter
  • Haemorrhagic E. Coli
  • Entamoeba hystolytica
  • Shigella
  • Salmonella

Acronym CHESS for dysentery.

20
Q

Give management of gastroenteritis with no systemic signs.

Give 2 management steps for gastroenteritis with systemic illness, >39C temp, visible blood or ongoing for > 2 weeks.

A
  • Supportive therapy (electrolyte replacement, bed rest, fluids), no stool culture needed.
  • Admit and give oral fluids
  • Direct faecal smear, then culture.
21
Q

What are the 3 signs/ symptoms of hepatitis?

What clotting sign is marker of liver damage?

A
  • Fever, jaundice, raised ALT/ AST

- Prolonged PT is sensitive marker of significant liver damage.

22
Q

Give the transmission route of hepatitis A-E.

A

A- Faecal oral- no permanent damage to liver.
B- Sexual contact, body fluids, contaminated needles
C- Blood-blood transmission. Asymptomatic, flu-like.
D- Previous infection of Hep B (D resides in hep B). Liver failure risk greater.
E- Faecal oral route

23
Q

Give features of Hep A history.

Give 4 Es of Hep E

What is management of hepatitis A&E?

A
  • Acute travel history/ contaminated water.
  • Usually asymptomatic.
  • Can have nausea, vomiting, jaundice, RUQ abdominal pain.
  • Enteric
  • Epidemics (water)
  • Expectant mothers
  • E- immunocompromised.

Supportive, avoid alcohol.

24
Q

What percentage of Hep B infections are chronic?

What are the two medication options for chronic hepatitis B?

A
  • Chronic in 10% of cases.
  • Peginterferon alpha or Tenofovir.

Hep D needs Hep B surface antigen to enter hepatocytes.

25
Q

What percentage of Hep C infections are chronic?

What cancer is Hep C a risk factor for?
What marker indicates liver cancer?

Give 2 medication treatments for Hep C

A
  • 80%
  • Mainly asymptomatic.
  • Risk of hepatocellular carcinoma.
  • Alpha-fetoprotein (AFP)
  • NS5A inhibitors, NS3/4 protease inhibitors.
26
Q

What is most common causative organism of UTIs?

What is seen in urine dipstick for UTI?

What is the management for UTI.

A

E. Coli

  • Positive nitrites +/- leukocytes.

Trimethroptim.

27
Q

What is incubation time for Malaria?

Give 3 causative organisms of Malaria. Which is most common?

A
  • 1-2 weeks incubation but up to a year.
  • Plasmodium Falciparum is most common and most serious.
  • Plasmodium Vivax/ Ovale
  • Plasmodium Malaria
28
Q

Give 2 main symptoms of malaria infection.
Give 3 clinical signs of Malaria.

What blood smear is used in Malaria investigation?

A
  • Headache, fevers- cyclical, (also weakness, anorexia, myalgia).
  • Pyrexia, anaemia, splenomegaly.

Giemsa stained smear:

  • Thick smear: detects parasites
  • Thin smear: identifies species.

Yr 3 MedEd (31 decks)

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