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Y3 MedEd > Infectious diseases 2 > Flashcards

Infectious diseases 2 Flashcards

1
Q

Define meningitis

A

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

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2
Q

Which meningeal layers are inflamed in meningitis

A

Pia and arachnoid

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3
Q

Define encephalitis

A

Inflammation of brain parenchyma

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4
Q

Bacterial causative agents in meningitis (3)

A

Streptococcus pneumoniae,
Neisseria meningitidis
Haemophilus influenzae type B

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5
Q

Most common cause of aseptic meningitis

A

Enterovirus

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6
Q

Main cause of encephalitis

A

Herpes virus

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7
Q

Main symptoms of meningitis (4)

A

Photophobia
Neck stiffness
Headache
Fever

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8
Q

Symptoms of encephalitis (7)

A

Altered state of consciousness, seizures, personality change, cranial nerve palsies, speech problems, motor and sensory deficit

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9
Q

Ix for meningitis

A

lumbar puncture to obtain CSF

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10
Q

Ix for encephalitis (3)

A

Blood cultures, neuroimaging (MRI), CSF analysis

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11
Q

What organisms commonly infect neonates (3)

A

Group B streptococcus
E coli
Listeria monocytogenes

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12
Q

Which gram -ve diplococci often infects children and teenagers

A

Neisseria meningitides

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13
Q

Which bacteria often infects unvaccinated children and teenagers

A

Haemophilus influenzae

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14
Q

Which gram +ve cocci often infects adults and the elderly

A

Strep pneumonia

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15
Q

Which bacteria often infects the elderly, alcoholics and cheese/unpasteurised milk

A

Listeria monocytogenes

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16
Q

Which organism infects neonates with an extended delivery

A

Group B strep

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17
Q

Which organism infects neonates that have had an infection in a previous pregnancy

A

Group B strep

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18
Q

Which organism causes a late neonatal infection

A

E coli

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19
Q

What buzzword guides you to Group B strep infection in a neonate (2)

A

Extended labour, infection in previous pregnancy

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20
Q

What buzzword guides you to E coli infection in a neonate

A

Late neonatal infection

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21
Q

What buzzword guides you to neisseria meningitides infection in children and teenagers

A

grame -ve diplococci

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22
Q

What buzzword guides you to haemophilia influenzae infection in children and teenagers

A

Unvaccinated

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23
Q

What buzzword guides you to strep pneumoniae infection in adults and elderly

A

grame +ve cocci

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24
Q

What buzzword guides you to Listeria monocytogenes infection in adults and elderly (4)

A

Elderly, unpasteurised milk, cheese, alcoholics

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25
Q

What is Brudsinkins sign

A

Flexing the neck causes the patient s hips and knees to flex (meningitis)

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26
Q

What is Kernigs sign

A

Inability to straighten the leg when the hip is flexed to 90 degrees

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27
Q

Signs of meningitis infection (5)

A 
Fever
Tachycardia 
Hypotension
Skin rash – petechiae  meningococcal septicaemia
Altered mental state.
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28
Q

Ix for meningitis (3)

A

Blood: Two sets of blood cultures
Imaging: CT scan to exclude intracranial pressure.
Lumbar puncture: Send CSF for MC&S and Gram staining

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29
Q

When do you avoid LP (3)

A

Neurological signs suggesting raised ICP
Superficial infection over LP site
Coagulopathy

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30
Q 
CSF normally:
Appearance
WCC
Protein
Glucose
Gram stain
A 
Clear
Very low
Normal
Normal
Normal
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31
Q 
CSF in bacterial meningitis:
Appearance
WCC and which cell
Protein
Glucose
Gram stain
A 
Turbid
Very high - neutrophils
Very very very high
Very very very low
Positive
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32
Q 
CSF in viral meningitis:
Appearance
WCC and which cell
Protein
Glucose
Gram stain
A 
Clear/cloudy
High - lymphocytes
Increased
Normal
Normal
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33
Q 
CSF in fungal/TB meningitis:
Appearance
WCC and which cell
Protein
Glucose
Gram stain
A

Clear/cloudy
High lymphocytes
Increased protein
Decreased glucose

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34
Q

Mx of meningococcal septicaemia

A

Admit

Give single dose IV benzylpenicillin

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35
Q

Mx of bacterial meningitis

A

IV Ceftriaxone (3rd generation cephalosporin)
Consider corticosteroids – Dexamethasone for bacterial meningitis BUT not if meningococcal septicaemia is suspected
(cover Listeria with ampicillin)

If consciousness affected, consider IV acyclovir to cover encephalitis

Prophylaxis to close contacts: Rifampicin or ciprofloxacin

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36
Q

Viral causes of encephalitis (6)

A

(HSV-1, HSV-2, VZV, CMV, EBV, Human herpes virus)

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37
Q

Bacterial causes of encephalitis (4)

A

Neisseria meningitides
TB
Syphilis
Listeria

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38
Q

What type of encephalitis does neisseria meningitides cause

A

Meningo-encephalitis

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39
Q

Fungal causes of encephalitis (2)

A

Cryptococcus

Candida

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40
Q

Parasitic causes of encephalitis (2)

A

Toxoplasma Gondii, malaria

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41
Q

Which three organisms (and subtypes) are the main causes of infective endocarditis

A

Group A Streptococci (viridian’s or Boris)
Staphylococci aureus or epidermis
Enterococci faecalis

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42
Q

What are the RF of IE

A 
Abnormal valves
Prosthetic valves
IV drug use
Turbulent flow 
Recent dental work
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43
Q

What are 4 causes of abnormal valves

A

congenital, post-rheumatic, calcification/ degeneration

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44
Q

What organism does a case of infective endocarditis with abnormal valves suggest

A

Strep viridian’s or strep bovis

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45
Q

What organism does a case of infective endocarditis with prosthetic heart valves suggest

A

Staph a or epidermis

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46
Q

What organism does a case of infective endocarditis with IV drug use suggest

A

Staph A or staph epidermis

47
Q

Symptoms of infective endocarditis (5)

A

Fever with sweats/chills/rigors

Malaise, arthralgia, myalgia, confusion

48
Q

Signs of infective endocarditis

A 
Pyrexia, tachycardia, signs of anaemia.
Clubbing 
New murmur
Splenomegaly.
Vasculitic lesions
49
Q

Order of which valves are most likely to get infective endocarditis

A

Frequency: Mitral > aortic > tricuspid > pulmonary.

50
Q

What does right sided infective endocarditis suggest

A

Drug use

51
Q

Mnemonic to help remember signs of infective endocarditis

A 
Fever
Roth spots
Osler nodes
Murmur
Janeway lesions
Anaemia
Nail-bed splinter haemorrhage
Emboli
52
Q

Buzzwords for infective endocarditis (6)

A 
Prosthetic valve
Dental procedure
New onset murmur
Vegetation on echo
Right heart
Indwelling catheter
53
Q

Ix for endocarditis

A 
Bloods
3 blood cultures, 1 h apart, within 24 hs
Urgent echo
Dukes classification 
Broad spectrum
54
Q

What do you look for in the bloods of infective endocarditis (5)

A

Bloods: FBC (high neutrophils, normocytic anaemia), ESR and CRP, U&Es, rheumatoid factor positive

55
Q

Complications of infective endocarditis (6)

A 
Congestive heart failure
Valve incompetence
Aneurysm formation
Systemic embolization 
Renal failure
Glomerulonephritis.
56
Q

Mx of infective endocarditis

A

Dependent upon organism.
On clinical suspicion benzylpenicillin or vancomycin if allergic until confirmed.
Then switch to targeted antibiotics

Penicillin-sensitive Streptococcus viridans = Benzylpenicillin + gentamicin
S. aureus = Flucloxacillin

Prosthetic Valves
Staphylococci = Flucloxacillin/Vancomycin + rifampicin + gentamicin

57
Q

Common causes of dysentry (6 mnemonic)

A

CCHESS

Campylobacter / Clostridium difficile 
Haemorrhagic E. coli 
Entamoeba histolytica
Shigella
Salmonella
58
Q

Common causes of diarrhoea (6)

A 
Campylobacter / Clostridium difficile 
Staph aureus 
Vibrio cholera
E. coli 
Bacillus cereus 
Salmonella
59
Q

History clues to suggest gastroenteritis due to C diff (4)

A

> 70 yo, past C. diff, use of antibiotics, antiperistaltic drugs

60
Q

History clues to suggest gastroenteritis due to staph A (3)

A

food, 1-6 hours after eating, short lived

61
Q

History clues to suggest gastroenteritis due to vibrio cholera (3)

A

rice water diarrhoea, poor sanitation, shock

62
Q

History clues to suggest gastroenteritis due to e coli

A

leafy vegetables

63
Q

History clues to suggest gastroenteritis due to bacillus cereus (2)

A

reheated rice, can cause cerebral abscess

64
Q

History clues to suggest gastroenteritis due to salmonella (3)

A

eggs, poultry may present with constipation, multiplies in Payer’s patches of the intestine

65
Q

Which diarrhoea causing organism can cause a cerebral abscess

A

Bacillus cereus

66
Q

History clues to suggest dysentry due to campylobacter (31

A

Uncooked poultry

67
Q

History clues to suggest dysentry due to HEC (1)

A

Leafy vegetables

68
Q

What follows bloody diarrhoea in HEC

A

Haemolytic uraemia syndrome

69
Q

History clues to suggest dysentry due to entamoeba histolytica (2)

A

poor sanitation, tropical places

70
Q

History clues to suggest dysentry due to entamoeba histolytica (2)

A

person-to-person contact, poor sanitation

71
Q

History clues to suggest dysentry due to salmonella (2)

A

eggs

72
Q

Examinations for gastroenteritis (3)

A

Mucous membranes, skin turgor, cap refill  dehydration?
HR, BP  shock?
Temperature

73
Q

Ix for gastroenteritis

A 
Bloods: FBC, ESR/CRP, U&Es - deranged (low K in severe D&V)
Stool MC&S
Bacterial pathogens
Ova cysts (eggs)
Parasites
74
Q

Mx of gastroenteritis

A

No systemic signs - bed rest, fluids and electrolyte replacement with oral rehydration and no stool culture

Systemic signs:
Admit
Oral fluids/IV if severe vomiting

Direct faecal smear then culture

75
Q

What counts as systemic signs in gastroenteritis

A

> 39C or dehydration

Visible blood or >2wks

76
Q

baby girl born 1 day ago born after a prolonged vaginal delivery, becomes drowsy. On examination, T: 38.9, HR: 170bpm, RR: 30. Which is the most likely causative agent?

A

Group B streptococcus

77
Q

Non-blanching rash in meningitis indicates what viral/bacterial/fungal meningitis?

A

Bacterial

78
Q

A 72-year-old patient with a new onset murmur, fever and clubbing presents with blood in his stools, diarrhoea and weight loss over the past 5 months. Which is the most likely causative agent?

A

Strep bovis as it is suggestive of infective endocarditis with colorectal cancer

79
Q

A 15-year-old boy with DiGeorge syndrome had a dental tooth extraction 2 weeks ago, visits his GP who on auscultation finds a new murmur on the left sternal edge. Basic observations: BP 110/80, HR: 95, Temperature: 38.5, SaO2 98% on air. What is the most likely causative agent?

A

Strep viridans due to congenital heart defect

80
Q

A 24 year old medical student comes back from their holiday and presents to A&E with profuse diarrhoea of rice water appearance. There is no blood. What is the most likely causative agent?

A

Vibrio cholera

81
Q

A 40 year old woman presents to A&E with bloody, foul smelling diarrhoea. She went to a barbeque yesterday where she suspects she ate undercooked chicken. She has a fever and severe abdominal pain. What is the most likely causative agent?

A

Campylobacter

Salmonella is more associated with raw eggs

82
Q

A 67 year old male has been in hospital for the past two weeks for severe pneumonia. He develops bloody diarrhoea, colitis and reduced urine output. He has raised CRP, WCC and low albumin. What is the most likely causative organism?

A

C. Difficile

Due to likelihood of having broad spectrum antibiotics with the pneumonia

83
Q

3 key features of hepatitis

A

Fever
Jaundice
Raised ALT, raised AST

84
Q

3 key causes of hepatitis

A

Viral (ABCDE)
Alcohol
Autoimmune

85
Q

Hep A transmission route

A

Faeco-oral

vowels = bowels

86
Q

Hep B transmission route

A

Sexual
Contaminated needles
(also infected tears and saliva)

87
Q

Hep C transmission route

A

Blood to blood

88
Q

Hep D transmission route

A

Resides inside B

89
Q

Hep E transmission route

A

Faeco-oral

90
Q

Which hepatic virus’ are chronic and which %

A

B 10% is chronic

C 80% is chronic

91
Q

Mx for HCV

A

Antiretrovirals are now curative
e.g. NS5A inhibitors,
NS3/4 protease inhibitors

92
Q

Symptoms of acute HBV (4)

A

Antiretrovirals are now curative
e.g. NS5A inhibitors,
NS3/4 protease inhibitors

93
Q

Hep A symptoms (5)

A 
Usually asymptomatic 90% but can get:
Nausea
Vomiting (+ Diarrhoea)
Fever
Jaundice
Abdominal pain (particularly RUQ)
94
Q

Hep E RF: (4)

A

Enteric
Epidemics (water)
Expectant mothers
E- immunocompromised

95
Q

Hep B transmission (3)

A

Baby making  Unprotected sex, MSM,
Blood (transfusion, IVDU)
Birthing (perinatal)

96
Q

Which hepatic viruses causes liver cancer/cirrhosis

A

B and C

97
Q

Most common cause of UTI

A

E coli

98
Q

Mx of UTI

A

Trimethoprim

99
Q

Ix for UTI (4)

A

Assess RF
Dipstick urinalysis: positive nitrites +/- leukocytes
Urine MC&S
(Abdo USS – exclude urinary tract obstruction or renal stones)

100
Q

Ix for viral hepatitis (8)

A

Blood:
FBC
LFTs (bilirubin, albumin, AlkPhos, GGT).
U&E
Clotting: Prolonged PT is a sensitive marker of significant liver damage.
Ultrasound scan: For other causes of liver impairment (e.g. malignancies).
Viral serology
Viral PCR
Liver biopsy: To assess degree of inflammation and liver damage (useful in diagnosing cirrhosis as patients)

101
Q

Which is chronic which is acute IgG or IgM

A

IgG – Gone

IgM – Now

102
Q

Symptoms of malaria (5)

A 
Headache
Weakness
Myalgia/ Arthralgia
Anorexia
Fever - Characteristic paroxysms of severe cold / rigors followed by severing sweating
103
Q

Signs of malaria (3)

A

Pyrexia
Anaemia
Splenomegaly

104
Q

Ix for malaria

A

Giemsa-stained thick and thin blood smears

Thick – detects parasites present
Thin – identifies species

Other: FBC (Hb, platelets), Clotting profile, U+E, LFTs, blood glucose, Urinalysis, ABG

105
Q

A 37-year-old bride-to-be returned from Jamaica 3 days ago, where she partied and explored the local cuisine with her best friends. She presents to her GP complaining of being jaundiced with right upper quadrant pain and fever. What is the most likely cause of her symptoms?

A

Hep A due to faeco-oral transmission

106
Q

How long does Hep E last 4

A

2-8

107
Q

How long does hep A last for

A

6 weeks

108
Q

Differences between hep A and E

A

A: loss of appetite, diarrhoea, fever, malaise, not chronic

E: chronic, risk of fulminant liver failure

109
Q

A 37-year-old bride-to-be returned from Jamaica 3 days ago, where she partied and explored the local cuisine with her best friends. She presents to her GP complaining of being jaundiced with right upper quadrant pain and fever. What is the most likely cause of her symptoms?

A

Hep A

110
Q

A 64-year-old male with thalassaemia is investigated under the two-week wait for jaundice, hepatomegaly and weight loss. His blood tests show a raised αFP. Which chronic infection is he most likely to have?

A

Hep C

Recurrent blood transfusions due to thalassaemia which is a major risk factor for HCV

111
Q

27-year-old promiscuous man returns from a trip to Thailand with a right upper quadrant pain, fever and raised ALP and AST. Which is the most likely causative agent?

A

HBV due to sexual transmission

112
Q

A 35-year-old woman presenting to her GP with increased urinary frequency and lower back pain. On examination her BP is 130/90, HR: 83bpm, RR: 17bpm and T: 38.3. Which is the most likely finding on her urine dip stick and MC&S?

A

Positive nitrites and gram-negative bacilli

113
Q

E. coli is what type of bacteria

A

Gram -ve bacillus

114
Q

A 45-year old man presented to his GP with cyclical fevers. He returned from Ethiopia 10 days ago. What is the most likely causative agent?

A

Plasmodium falciparum

Y3 MedEd (34 decks)

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