Infectious diseases Flashcards
1
Q
What is cellulitis?
A
Nonnecrotizing inflammation of the skin and subcutaeous tissue
2
Q
What usually precedes cellulitis?
A
Breach in the skin
3
Q
What are the signs and symptoms of cellulitis?
A
Erythema,pain, swelling, warmth
4
Q
What is the most likely cause of a skin infection without underlying drainage, penetrating trauma, eschar or abscess?
A
Strep, Staph A, MrSA
5
Q
What does skin infection with violaceous colour and bulae suggest in terms of causing pathogen?
A
Bibrio vulnificus, strep pneumoniae
6
Q
What signs suggest severe infection in cellulitis?
A
Malaise, chills, fever, toxicity, lymphangitic spread, circumferetntial cellulitis, pain disproportionate to exam findings
7
Q
What is lymphangitic spread?
A
Red lines streaking away from the area of infection
8
Q
What are the indications for surgical evaluation in cellulitis?
A
Rapid progression, hypotension, violasceous bullae, skin sloughing, skin anaesthesia, cutaneous haemorrhage, gas in the tissue
9
Q
What are the indications for a blood culture in a case of cellulitis?
A
Moderate to severe disease, cellulitis of specific anatomic sights, history of contact with contaminated water, animal bites, immunodeficiency
10
Q
How should cellulitis with signs of systemic toxicity be investigated?
A
Blood culture, fbc, U and Es, CRP, creatinine, bicarb, creatine phosphokinase
11
Q
When shoould needle aspiraiton be used in patients with cellulitis?
A
Bullae, diabetes, immunocompromise, neutropenic, not responding to therapy, animal bites
12
Q
What is the most common cause of nonpurulent cellulitis?
A
Strep
13
Q
What is the most common cause of purulent cellulitis?
A
S. A
14
Q
What host factors predispose the host to severe infection due to cellulitis?
A
Lymphatic obstruction, DM, immunodeficiency, venous stasis, chronic liverdisease, venous stasis, peripheral arterial diseasechronic kidney disease
15
Q
What can immunocompromised hosts be infected with that cause cellulitis?
A
Pseudomonas, proteus, serratia, Enterobacter, citrobactor, anaerobes, helicobacter cinaedi, fusarium
16
Q
What are the hospital acquired forms of cellilitis?
A
beta haemolytic streptococcus, clostrididium perfringens,acinebacter baumannii, group A strep,
17
Q
How can varicella affect cellulitis
A
Complicate
18
Q
How ca cellulitis with varicella be identified?
A
Larger margins of erythema surroundings cvesicles
19
Q
What can cause cellulitis with animal bites?
A
Capnoctophaga canimorsus (dog), Eikenella corrodens (human), Pasteurella corrodens (hdog/cat) streptobacillus moniliformis (rat)
20
Q
What are the signs and symptoms of bacterial gastroentritis?
A
Diarrhoea, vomiting, fever, abdo pain, ingestion of particular food, exposure to water, travel, animals, dehydration, malnutrition, borborygmi, perianal erythema
21
Q
How are diagnosis of gastroentritis made?
A
Presence or absence of symptoms, stool pH, stool culture, presence of pseudomembranes in the stool, faecal leukocytes, reducing substances, antisteriolysin O, selective culture to identify cause
22
Q
What does the presenc3e of pseudomembranes in the stool suggest?
A
C. Diff
23
Q
What is the management of bacterial gastroentritis
A
Since diarrhoea is mostly self limiting, oral rehydration, IV rehydation. monitoring for complication
24
Q
What are the top three causes of bacterial gastroentritis world wide?
A
Salmonella, shigella, campylobacter
25
What are the characteristics of small bowel diarrhoea?
Watery, large volumes with increased frequency, pH<5.5, can have reding substances
26
What can cause small bowel diarrhoea?
Bacillus, s A, E coli, cholera, vibrio, listeria, C. perfringens,rota virus, adenovirus, astrovirus, calicivirus, norwalk virus, giardia, cryptosporidium
27
What are the characteristics of large bowel diarrhoea
Mucus and bloody, small volume with incresed frequency, pH>5.5, leukcytes present
28
What is the mechanism that causes small bowel diarrhoea?
Preformed toxins
29
What agents can cause large bowel diarrhoea?
e coli, shigella, salmonella, campylobacter, yersinia, aeromonas, plesiomonas, c difficile, entamoeba
30
Patient has had no incubation, sickness lasts 0-2 weeks, can have vomiting, fever, no abdopain, scuba diver, ate seafood, meat, vegetables, recently travelled, or went to mexico
Aeromonas
| Associated with marine contact
31
Patient has incubation of 2-4 days, sickness lasts 5-7 days, fever, abdopain, ate uncooked dairy, poultry, meat. tenesmus.
Campylobacter
32
Patient has incubation of 1-16 hours, sickness lasts 1-2 days, vomiting, abdopain, eaten fried rice
Bacillus
33
Patient has had variable incubation, sickness is variable, mild fever and abdo pain, was hospitalized for pneumonia. Anorexic, malaise, crampy abdo pain, mild to moderate watery diarrhoea
C. diff
34
Patient has had 0-1 day incubation, sickness lasts 1 day, can have mild vomiting,abdopain, eating meat, vegetables, travelled to the tropics
C. perfringes
35
Patient has had 1-8 days incubation, sickness lasts 3-6 days, can have some fever, abdopain, eaten ground beef, alfaalfa sprouts
Enterohaemorrhagic e coli
36
Patient has had 1-3 days incubation, sickness lasts 3-5 days, can have vomiting, low fever, abdopain, recently travelled
Enterotoxic e coli
37
Patient has had 20 hours incubation, sickness lasts 2 days, can have some vomiting, fever, some abdopain, eaten diary
Listeria
38
Patient has had no incubation, sickness lasts 0-2 weeks, can have some vomiting, fever, abdopain, recently travelled to mexico, has liver cancer
Plesiomonas
| Associated with liver probs or malignancy
39
Patient has had 0-3 days incubation, sickness lasts 2-7 days , can have vomiting, fever, abdopain, eaten dairy, eggs, meats, alphaalpha sprouts, recently travelled
Salmonella
40
Patient has had 0-2 days incubation, sickness lasts 2-7, high fever, abdopain, competitive swimmer, bloody diarrhoea, passage of mucus, crampy abdo pain, tenesmus
Shigella
| associated with swimming pools
41
Patient has had 2-6 hours incubation, sickness lasts 1 day, can have vomiting, abdopain,
S A
42
Patient has had 0-1 day incubation, sickness lasts 5-7 days, can have vomiting, abdopain, eaten seafood, recently travelled to africa, asia
Vibrio
43
Patient has had 1-6 days incubation, sickness lasts 1-46 days, can have vomiting, fever,abdopain, eaten chicken, travelled to Australia, canada, europe or mexico
Y enterocolitis
44
How does viral gastroentritis typically spread?
Faecal oral route through contamniated food and water, can be through airborne route
45
How does rotavirus cause diarrhoea?
Causes maldigestion of carbs, and carb accumulation, secretes enterotoxin
46
What is the typical presentation of viral gastroentritis?
Short prodrome, mild fever, vomiting, 1-4 days of nonbloody, watery diarrhea, usually self limited
47
What are the warning sign of a bacterial gastroentritis?
Increased frequency, bloody diarrhoea, high fever, severe abdo pain, travel, sexual practice, antibiotic use
48
What should be done during the examination of a patient with diarrhoea
Assess hydration
49
What are the causes of infantile viral gastroentritis?
Group A rotavirus, astrovirus, calicivirus, adenovirus, sapovirus, norovirus
50
What are the causes of epidemic viral gastroentritis?
Norovirus, sapovirus, rota virus, astrovirus
51
What are the causes of sporadic adult viral gastroentritis?
Calicivirus, rotavirus, astrovirus, adenovirus
52
what is the most common cause of community acquired inflammatory enteritis?
Campylobactor jejuni
53
What does diarrhoea, malaise, weakness, abdo distension, malodorous greasy stool, abdo cramps, flatulence, nausea, anorexia, weight loss, low grade fever and urticaria suggest?
Giardiasis
54
What are the signs and symptoms of viral nasopharyngitis?
Common cold. Literally this.
| Nasal mucosal erythema (red nose), oedema (nose swelling), nasal discharge (profuse discharge), foul breath, fever
55
What suggests bacterial nasopharyngitis?
Nasal discharge becomes cloudy white, yellow or green over several days
56
What are the signs and symptoms of group A streptococcal pharyngitis
Tender cervical lymphnodes, exudates, swelling or tenderness of tonsils or harynx, temp>38.3, Absence of [Conjunctivitis, cough, rhinorrhea]
57
What are the signs and symptoms of acute bacterial rhinosinusitis in children
Persistent nasal discharge, cough > 10 days severe fever > 3 days, worsening cough
58
What are the signs and symptoms of epiglottitis?
Cherry red epiglottis, sore throat, drooling, difficulty/pain swallowing, muffled dysphonia, fever, fatigue, malaise, dry cough, dypnea, tripod posture
59
When is testing of nasopharyngeal specimen required?
Immunocompromise, when treatment is specific
60
What is the management of epiglottis?
Hospitalization, monitoring, O2, avoid instrumentation, IV antibiotics
61
What are the physical and mechanical barries to prevent URTIs
Hair lining, mucus, ciliated cells, humoral immunity, inflammtory cytokines
62
What are the more common causes of nassopharyngitis?
Rhinoviruses, coronaviruses, enteroviruses, adenoviruses, orthomysoviruses, paramyxoviruses, RSV, EBV, human metapneumovirus, boca virus
63
What are the most common viral causes of pharyngitis?
Adenovirus, influenza, coxsackie, HSV, EBV, CMV
64
What are the most common bacterial causes of pharyngitis?
Group A strep, N. gonorrhea, anaerobes, diptheria, corynebacter
65
What are the viral causes of rhinosinovitis?
Adenovirus, enterovius, Enterovirus, RSV, whinovirus, coronavirus, influenza
66
What are the bacterial causes of rhinosinivitis?
Strep. pneumoniae, H. influ. B, SA, mooraxella
67
What are the bacterial causes for laryngitis?
SA, strep pneumonia, Chlamydia, mycoplasma, morexella, diphteria, group A strep, TB
68
What are the viral causes of laryngitis?
Rhinovirus, coronavirus, RSV, adenovirus, influenza, parainfluenza
69
What are the RF for URTIs?
Contact, , anatomical cahnges, smokiing, travel, inflammation, immunocompromise
70
What are the complications of URTIs?
Otitis media, meningitis, bronghitis, brain abscess, sepsis, pneumonia
71
What is bacterial sepsis?
Symptomatic bacteraemia, with or without organ dysfunction
72
What are the signs and symptoms of bacterial sepsis?
Fever, impaired mental status, tachypnea, rigors, warm or cold skin, abdopain, abnormalities on rectal exam, gaurding, fatigue, malaise, nausea, vomiting
73
What can cause sepsis from the GI tract?
Liver disease, gallbladder disease, perforation, peritonitis, obstruction, colon disease
74
What can cause sepsis from the GU tract?
Pyelonephritis, perineprhric abscess, renal calculi, obstruction, renal insufficiency, pelvic abscess
75
What can cause sepsis from LRTI?
Pneumonia, abscess, empyema
76
What can cause sepsis from the CV system?
Infected prosthetic, IV line, acute endocarditis, myocardial or perivalvular ring abscess
77
What tests are used to diagnose sepsis?
FBC, blood culture, urine studies, gram staining, ECG, CXR, US, CT, MRI
78
What are the sepsis 6?
Give: High flow O2, IV antibiotics, IV fluids
Take: blood, urine output, lactate levels
79
What is SIRS?
Systemis inflammatory response syndrome
80
What is the criteria for SIRS?
```
Two or the following
High fever (>8)
Tachycardia (>90)
Tachypnea (>20)
Raised or reduced WBC count
```
81
What organisms can cayse septic shock from LRTIs?
Strep. pneumoniae, klebsiella, legionella, E coli, SA, Haemophilus, pseudomoonas, anaerobes, gram -ve bacteria, fungi
82
What organisms can cause septic shock from GI infections?
Ecoli, enterococcus, salmonella, klebsiella, pseudomonas, bacteriodes fragilis, aceinebacter, enterobacter, anaerobes
83
What can cause septic shock from UTIs?
E coli, proteus, enterococcus, candida, klebsiella, serratia, enterobacter, serratia
84
What can cause septic shock from GTIs?
N. gonorrhea, gram -ve bacteria, streptococci, anaerobes
85
What can cause septic shock from soft tissue infections?
S A, strep epidermidis, fungi, gram -ve bacteria, streptococci, anaerobes, fungi
86
What can cause septic shock from foreign bodiea?
S A, s. epidermidis, fungi
87
What are the RF for sepsis?
Extremes of hair, underlying condition, immuno suppression, major surgery, prolonged hospital stay, generic susceptability, invaasive procedures, previous antibiotic treatment
88
What are the RF for early mortality with sepsis?
Curb 65, acute failure of 2 or more organ systems, low pH, shock
89
What are the complications of sepsis?
ARDS, AKI, DIC, chronic renal dysfuntion, mesenteric ischaemia, MI, liver failure`
90
What are the signs and symptoms of active pulmonary TB?
Cough, fever, night sweats chills, haemoptysis, fatigue, weight loss, anorexia, chest pain, Abnomal breath sounds, bronchial breath
91
Which group of people may not show trypical signs and symptoms of TB?
Elderly
92
What are the signs and symptoms of TB meningitis?
Persistent headache (2-3 weeks), mental status change, progressive deterioration, low grade or absent fever
93
What are the signs and symptoms of skeletal TB?
Back pain or stiffness, lower extremity paralysis, TB arthritis
94
What are the symptoms genitourinary TB?
Flank pain, dysuria, frequent urination, painful scrotal mass, prostatis, orchitis, epdidymitis, like PID
95
What are the symptoms of GI TB?
Malabsorption, pain, diarrhea, abdo pain like ppeptic ulcers, nonhealing ulcers of mouth and anus
96
How is TB diagnosed?
Mantoux tuberculin skin test, invitro blood test for mycobacterium TB antigens, acid-fast bacilli smear, HIV serology, blood culture, FBC, bedsides, CXR,
97
What are the signs seen due to TB on a CXR?
Cavity formation, non calcified round infiltrates, calcified nodules
98
What des primary TB look like on a CXR?
Pneumonia like
99
What does reactivation TB look like on a CXR
Previous pulmonary lesions
100
What does healed and latent TB look like on a CXR
Dense pulmonary nodules, , smaller nodues in upper lobes
101
What does TB with HIV look like on a CXR?
Frequently atypical lesions
| Normal CXR
102
What does miliary TB look like on a CXR??
Numerous small, nodular lesions
| Like mill seeds
103
What does pleural TB look like on a CXR?
Empyema, pleural effusion
104
How are patients with TB managed?
Isolation, high infection, 4 drug regimens, sensitivity of TB must be checked
105
What is infective endocarditis?
Infectionof endocardial or endothelial surface of the heart by any microorganism
106
What happens if infective endocarditis isn't treated?
DEATH
107
What are the intracardiac effects of infective endocarditis?
Congestive HF, myocardial abscess, severe valvular insuffiency
108
What are the classic signs and symptoms of infective endocarditis?
FEVER, HEART MURMUR, Janeway lesions, oslers nodes, roth spots, petechia, splinter haemorrhage, strope, intracerebral haemorrhage, multiple microabscess in the brain, splenomegaly, stiff neck, delirium, pallor, gallops, pericardial/pleural rub, rales, cardiac arrhythmia,, rales, anorexia, non-specific signs
109
How can infective endocarditis be investigated?
Bedsides, ECG, FBC, echocardiogram, LFT, TFTs, echocardiogram,
110
How is infective endocarditis treated?
antibiotics (IV) 2-6 weeks
Surgery for debridement if valve doesn't work
111
What are the types of infective endocarditis?
Native valve endocarditis, prosthetic valve endocarditis, IV drug abuse endocarditis
112
What is acute of native valve endocarditis?
Normal valves
113
What is acute native valve endocarditis progress?
Aggresive course
114
What does subacute native endocarditis usually effect?
Abnormal valves
115
What usually causes subacute native endocarditis?
Alpha-haemolytic streptococci, enterococci
116
What usually causes prosthetic valve endocarditis?
Coagulase-ve staphylococci, gram-ve bacilli, candida,staph, alpha-haemolytic streptococci and enterococci, staph A
117
Which is the most common place affected by infective endocarditis?
Mitral,
118
What is the pathophysiology of infective endocarditis?
Smooth muscle damage due to turbulent blood flow in the heart body creates platelet plug, Bacteremia, adhesion of organisms, invasion of valvular leaflets
119
How many blood cultures should be taken in a patient with query infective endocarditis?
Max three
120
What are the complications of endocarditis
Congestive HF, emboli, glomerulonephritis, abscess, stroke
121
What is the most common causative agent of infective endocarditis in IVDU?
Staph A
122
What is SIRS?
Systemic inflammatory response syndrome
| Abnormal regulation of cytokines, endotoxins and acid metabolism
123
How are patients with suspected sepsis initially assessed?
ABCDE
History
Examination
124
What are the rf for sepsis?
Extremes of age, impaired immune sustem, given birth, termination, miscarriage in the last 6 weeks
125
How is sepsis recognised early?
NEWS, qSOFA
126
How is sepsis managed?
| Buffaloes buffalo, Y'know?
```
Bloods
Urine output
Fluids,
Antibiotics
Lactate
Oxygen
```
127
What are the complications of septic shocks
ARDS, encephalopathy, AKI, protein from liver
128
What is qSOFA.
```
Quick sepsis related organ failure assessment
3 criteria,
Low Bp
Tachypnoea
Altered mental state (GCS<15)
```
129
What type of virus is Hep a?
Small, unenveloped, symmetrical RNA virus
| Picornovirus
130
How does hep a spread
Faecal oral
131
What prevents the spread of infection of hep a
Hand washing and food and drink hygiene
132
What is the most important determinant of illness severity in hep a?
Age extremes
133
What are the rf for hep a?
Travellers, IVDU, immunocompromised, personal contact, occupation, anal sex with multiple partners, clothing factor disorders receiving factor VIII and IX.
134
What species are reservoirs for hep A
Humans
135
What is the incubation time of hep a?
2-6 weeks
136
Hat does viral replication depend on in hep a?
Uptake of hepatocytes
137
What does the onset of symptoms depend on in hep a?
Viral load
138
What is the life cycle of hep a?
Virus uptake into hepatocytes- virus un coats- host ribosomes bind to RNA- viral genome copied by viral RNa polymerase- assembled viruses shed through biliary tree to faeces
139
What is the most common type of viral hepatitis?
Hep a
140
Where are the high risk areas of hep a?
Indian subcontinent, Far East, central and South America, Middle East, Africa
141
When is hep a most infectious?
12-21 days post infection
142
What can be seee in the prodromal phase of hep a?
Flu like symptoms, anorexia, nausea, joint pain, malaise, fatigue, jaundice diarrhoea
143
What can be seen in hep a in a serious infection? Icteric phase
Dark urine, pale stools, jaundiced Abdo pain, itch, arthralgia, skin rash, tender Hepatomegaly, splenomegaly, lymphadenopathy
144
What are the differentials of hep a?
Other viral hepatitis, acute HIV, drugs, CMV
145
What can be used to investigate hep a?
IgM antibody and igG for hep a, LFTs, Fbc, bilirubin
146
What is the management of hep a?
Supportive, avoid alcohol
147
What are the complications of hep a?
Cholestatic hepatitis, fulminant hep, AKI, guillan barré, relapsing hep a
148
How is hep a prevented?
Vaccine
149
What is the most common cause of hepatitis?
Hep b
150
What is the incubation period of hep b?
40-160 days
151
What is the presentation of hep B?
Anorexia, nausea, ache in RUQ, mild fever, malaise, jaundice, darkening urine and lightening faeces
152
What is the presentation of de compensated liver disease caused by hep b?
Ascites, encephalopathy, GI haemorrhage
153
What is the definition of chronic hep b?
Spectrum of disease characterised by presence of detectable,hep b surface antigen in blood or serum for longer than six months
154
What is the route of transmission if hep b .
Parenteral
Via fluids or blood
Vertically
155
What general investigations should be done on query hep b?
Fbc, lft, bilirubin clotting, lipid profile, ferritin, antibody screen, caeruloplasmin,
156
What are the investigations specific to hep B?
HbsAg, HBeAg, anti-HBe, anti-HBs, anti-HB core.
| Quantitative hep B virus DNA, HBV genotype, HDV serology
157
What is the treatment for chronic hep B?
Peginterferone Alfa-2a, tenor obit disoproxil as second line
158
What type of virus is hep C?
Enveloped RNA virus in flaviviridae familu
159
How does HCV spread?
Blood borne
160
What is the incubation period of HCV?
6-9 weeks
161
What are the rf of Hep C?
IVDU, blood transfusion, pregnancy and breast feeding, sex, needles tick, tattooing, shaving razors
162
What rfs are associated with more rapid disease progress in HCV?
Over forty, alCohol, male, co infection with hep b,, HIV
163
What is the presentation of acute HCV?
Anorexia, weakness, malaise, jaundice, deranged liver enzymes, abdopain,
164
How long does it take post infection for signs of HCV to appear?
6-7 weeks
165
What percentage of patients develop chronic HCV?
75%
166
What investigations can be used for HCV?
Anti-HCV, HCV RNA to confirm ongoing infection, LFTs,baseline us to look for lesions, liver biopsy, HIV testing, non invasive. MErasures to test fibrosis
167
What diseases are associated with HCV?
DM, sjorgen's, cryoglobulinaemia, polyarthritis autoimmune hepatitis, thyroid it's, glomerulonephritis, lichen planus, thrombocytopenia, Hepatocellular carcinoma
168
What is the drug treatment for HCV?
Weekly, sc injections of Peginterferone Alfa-2a and daily oral ribavirin
169
What type of virus is hep D?
Unusual, defective single stranded RNA virus, requires HBV to replicate
170
How does hep D sprad?
Bloodborne
171
What is the main reservoir of HEV?
Pigs
172
How is HEV transmitted?
Faecal oral,contaminated water
173
What is the incubation period of HEV?
2-9 weeks
174
How does HEV create a chronic infection?
It does not
175
How is HEV prevented?
Good hand hygiene, avoid contaminated water
176
what are the viral causes of hepatitis?
HAV, HBV, HCV, HDV, HEV, CMV, EBV, HSv, adenovirus
177
WHat is the acute presentation of viral hepatitis?
Nausea, vomiting, myalgia, fatigue, malaise, RUQ, change in smell or taste, coryza, photophobia, headache, hepatosplenomegaly, lymphadenopathy, diarrhoea, pale stools dark urine, jaundice
178
Which viruses are most likely to form chronic hepatitis infections>
HBV, HCV, HDV
179
What are the non-infectious causes of acute hepatitis?
Drugs, toxins, alcohol
180
What are the non-infectious causes of chronic hepatitis?
Drugs, alcohol, autoimmune hepatitis, haemochromatosis, wilson's disease
181
What is TB?
Chronic granulomatous disease caused by mycobacterium tb, m. bovis and m. africanum
182
How is TB spread?
Inhalation of infected drops
183
What is the pathophysiology of TB?
M. TB is encountered and engulfed by macrophages, carried into to hilar lymph nodes
184
What is miliary TB?
Primary infection is not adequately contained, spreads to blood stream
185
What is secondary TB?
Reactivation of semi-dormant TB
186
What can cause the reactivation of TB?
Malnutrition, AIDs, immunosuppressive therapy
187
Where does reactivation of TB usually occur?
Apex of lungs, can spread locally or to distant sites
188
What are the RF of TB infection?
Homelessness, close contact with a TB patient, ethnic minorities, alcoholics, drug users, HIV patients, immunocompromise, elderly, children
189
What is the definition of an uncomplicated UTI?
UTI in a patient with a normal urinary tract and kidney function
190
What is the definition of an abnormal UTI?
anatomical, functional or pharmacological factors preispose a person to persistent or recurrent infection, or treatment failure
191
What is a Lower UTI?
Cystitis
192
What is an upper UTI?
pyelitis or pyleonephritis
193
What are the common causes of UTIs in normal people?
Ecoli, staph saprophyticus, proteus, enterococci
194
What are the causes of UTIs in patients with underlying pathology, frequent infections or immunocompromise?
Klebsiella, proteus vulgaris, candida, pseudomonas
195
What are the RF for a UTI?
Instrumentation, incomplete emptying, antibiotics, new sex partner, spermicides, diabetes, catheter, anatomical abnormality, institutionalization, immunocompromise, pregnancy genetic
196
What is the presentation of a UTI?
Urinary frequency, painful passing of small amountss of urine, dysuria, foul-smelling, cloudy urine, urgency, incontinence, pyrexia, rigoors, suprapubic or loin pain, nausea anf vomiting, confusion
197
What are the differentials for a UTI?
Urethrl syndrome, atrophic vaginitis, GTIs, enlarged prostate
198
What are the investigations for a UTI?
Dipstick, microscopy, culture, US, PSA if suspspicion of prostate cancer
199
Who should be referred with UTI?
Persistently not responded to treatment, history of renal tract disease or anomaly, haematuria, recurrent infections
200
What is the treatment of an uncomplicated UTI?
Trimethoprim or nitrofurantoino, fluids
201
How long is the treatment for an complicated UTI in women?
3 days
202
How long is the treatment of an uncomplicated UTI in men?
7 days
203
What is the treatment for an uncomplicated pyelonephritis?
Ciprofloxacin for 7-10 days
204
What are the complications of a UTI due to ascending infection?
Pyelonephritis, perinephric ad ubtrarenal abscess, hydronephrosisor pyonephritis, AKI, sepsis, prostatic abscess, prostatitis
205
What are tge complications of an untreated bacteruria in pregnancy?
Pyelonephritis, prem, anaemia
206
How is HIV diagnosed?
anti HIV antibodies in serum
207
How is an acute HIV infection diagnosed?
presence of p24 antigen or HIV RNA by PCR, precedes appearance of IgM and IgA
208
WHat is the combination test for HIV?
Screening of HIV antigen and p24. Takes 4 weeks
209
What are the 5 stages of HIV infection?
Seroconversion illness, asymp infection, persistent genralized lymphadenopathy, symptomatic infection, AIDS
210
When does a seroconversion illness occur?
1-6 weekspost-infection
211
What are the symptoms of an HIV seroconversion illness?
Glandular-fever like, fever, malaise, myalgia, pharyngitis, headaches, diarrhoea, neuralgia, neuropathy lymphadenopathy, maculopapular rash
212
What tests can be done in the seroconversion illness stage of HIV?
p24 and hIV RNA
213
What is the definition of persistet generalised lymphadenopathy?
Nodes >1 cm at two estra inguinal sites persisting for three months or longer, not due to any other causes
214
What investigations should be done for HIV?
detection of HIV antibody, assessment of viral load, FBC, EXR, signs of other infections, screening for STIs, CXR, cervical smear
215
Why should FBC done for HIV?
anaemia, thrombocytopenia, lymphocytopenia, reduced CD4
216
What is the CD4 staging technique for HIV?
CD4 > 500 cells/mm3 (29%)
CD4 200 - 500 cells/mm3 (14-28%)
CD4 < 200 cells/mm3 (14%)
217
What are the aids defining illnesses (10)
Candadiasis, karposi's sarcoma, TB, cervical carcinoma, CMV, encephalopathy, cryptosporidiasis, toxoplasmosis, histoplasmosis, recurrent pneumonia, lymphoma, burkitt's, pneumocystitis jirovecii pneumonia, wasting syndrome
218
How is HIV monitored?
clinical assessment, CD4 monitoring, plasma HIV RNA, clinical benefit from treatment
219
How is HIV managed?
Antiretrovirals, prevention of getting aids defining illness, advice on the spread of infection
220
What is dengue?
Mosquito borne viral haemorrhagic fever transmitted by female aedes mosquitos
221
How is dengue classified?
Non-severe dengue (with or without warning signs), severe dengue
222
What are the warning signs of dengue?
fever, nausea, vomiting, rash, aches, pains, positive tourniquet test, leukopenia, abdopain, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy, liver enlargement, blood in vomit, bleeding gums, restlessness
223
What are the signs of severe dengue?
severe plasma leakage, severe bleeding, organ failure, shock, res. distress,
224
Where is dengue endemic too?
Africa, americas, eastern mediterranean, southest aia, western pacific
225
What are the risk factors for contracting dengue?
High population density urban living, poor public hygiene exposure to mosquito
226
What are the rf for developing severe dengue?
Age (under 15), repeated dengue infections, genetic F viral genotypes, nutritional status
227
What is the incubation period of dengue?
2-7 days
228
What causes haemorrhage in dengue?
severe thrombocytopenia
229
What causes plasma leakage in dengue?
Proliferation of T cells and the production of cytokines
230
What are the signs of capillary leak in dengue?
raised haematocrit, hypoalbuminaemia, pleural effsuions, ascites
231
What are the symptoms of dengue?
Biphasic high fever, severe headache, pain behind the eyes, muscle and joint pain, nausea vomiting, rash, swollen glands
232
What is the tourniquet test for dengue?
Inflating bp cough between systolic and diastolic bp, shows more than 20 petechiae per 2.5 cm2 are seen
233
What are the signs of nonsevere dengue?
machular, blanging rash, tender muscles, +ve tourniquet test
234
What are the signs of non-severe dengue with warning signs?
Haemorrhagi manifestations, purpura, gum bleeding, epistaxis, gi haaemorrhage, menorrhagia, hypotension, narrow pulse ressure, poor cap refill, relative bradycardia, hepatomegaly, lymphadenopathy
235
What are the signs of severe dengue?
Pleural effusion, ascites, pericarditis, periorbital oedema, proteinuria, maculopathy, retinal haemorrhage, hypovolaemic shock, CNS involvement, hepatitis, myocarditis
236
what investigations can be done for dengue?
FBC, clotting, U and Es, bicarbonate, IgM, IgG, PCR techniques, CXR, blood culture, malaria films, LFTs
237
What does a FBC show in dengue?
high PCV, low platelets
238
What does the clotting studies show in dengue?
prolonged APTT and PT
239
What do U and Es and LFTs reveal in dengue?
electrolyte abnormalitis, raised LFTs
240
What is the management of dengue?
fever control with paracetamol, sponging and fans, IV fluid resus, FFp and platelets, monitor CVP, urine output, electrolytes, packed cell volume, platelets, LFTs
241
What is the prognosis of dengue?
Usually a self limiting illness
242
What are the complications of dengue?
Hepatic failure, encephalopathy, myocarditis, disseminted IV coag septicaemia,
243
how is dengue prevented?
Vaccine, removing stagant water sources, pesticides
244
What is typhoid fever caused by?
Gram-ve salmonella enterica typhi from contaminated waters
245
What causes paratyphoid fever?
S. paratyphi A, S. schottmuelleri, S. hirschfeldii
246
What are the RF of typhoid?
reduction in stomach acidity, immunosuppression, other infections, haemoglobinapathies,
247
What is the presentation of typhoid in week 1?
Gradual rise in temp, dry cough, relative bradycardia, malaise, headache, epistaxis, abdo pain, leukopenia, blood cultures,
248
What is the presentation of typhoid in week 2?
toxic appearance with apathy and sustained pyrexia.
High fever around 40°C (104°F), often swinging.
Malaise and weakness.
Relative bradycardia, with dicrotic pulse wave.
Confusional state, which gave typhoid the name of 'nervous fever'.
Rose spots on the lower chest and abdomen - seen in around one third of Caucasian patients; difficult to see in darker skin. Rose spots are caused by bacterial emboli. They are crops of macules 2-4 mm in diameter that blanch on pressure.
Lung base rhonchi.
Abdominal distension with right lower quadrant tenderness and increased borborygmi.
Diarrhoea, typically green, with a characteristic foul smell, often compared to pea soup.
Constipation may also occur.
Hepatosplenomegaly
Elevated liver transaminases.
249
What is the presentation of typhoid in week 3?
considerable weight loss.
Pyrexia persists and a toxic confusional state may occur.
Marked abdominal distension develops and liquid, foul, green-yellow diarrhoea is common.
The patient is weak with a weak pulse and raised respiratory rate.
Crackles may develop over the lung bases.
Death can occur at this stage from overwhelming toxaemia, myocarditis, intestinal haemorrhage, or perforation of the gut, usually at Peyer's patches.
Complications which are most likely to develop at this stage include:
Intestinal haemorrhage due to bleeding from congested Peyer's patches.
Perforation of the distal ileum, frequently fatal. There may be little warning, and peritonitis is a common complication.
Encephalitis.
Neuropsychiatric symptoms: muttering, picking at clothes, confusion.
Metastatic abscesses.
Cholecystitis.
Endocarditis.
Osteitis.
Dehydration is a significant risk.
One third develop a macular truncal rash.
Thrombocytopenia with risk of bleeding.
Eye complications may occur
250
What is the presentation of typhoid in week 4
In the untreated patient the fourth week sees the fever, mental state and abdominal distension slowly improve over a few days, but intestinal complications may still occur. Convalescence is prolonged, and most relapses occur at this stage.
251
What are the symptoms of parathyroid fever?
Vague chills, sweating, headache, weakness, dry cough, anorexia, sore throat, dizziness, and muscle pains are frequently present before the onset of fever.
Rising then persistent fever.
Abdominal pain (in about a third of patients).
Relative bradycardia.
Hepatosplenomegaly.
Rose spots (in about a third of patients).
Constipation (more common than diarrhoea).
Very rarely, neuropsychiatric symptoms
Very rarely, epileptiform seizures
252
What tests can be used to investigate typhoid fever?
Blood cultures, widal's test
253
How is typhoid fever managed?
Rapid diagnosis and institution of appropriate antibiotic treatment.
Adequate nutrition
Supportive
Antipyretic therapy
Hygiene
Regular follow-up and monitoring for complications and clinical relapse (
Antibiotics (see below) -
Steroids
Surgical - if perforation of the bowel occurs it will require closure.
254
What antibiotics can be used for typhoid?
3rd generation of cephalosporin: cefotaxime, ciprofloxacin
255
What are the complications of typhoid?
The two most common complications are haemorrhage (including disseminated intravascular coagulation) and perforation of the bowel. Before antibiotics, perforation had a mortality of around 75%.
Jaundice may be due to hepatitis, cholangitis, cholecystitis, or haemolysis.
Pancreatitis with acute kidney injury and hepatitis with hepatomegaly are rare.
Toxic myocarditis occurs in 1-5% of patients (ECG changes may be present). It is a significant cause of death in endemic areas.
Toxic confusional states and other neurological and psychiatric disturbances have been reported.
256
What is the most frequent organism causing septic arthritis?
Staph A
257
What are the risk factors for septic arthritis?
Increasing age, DM, prior joint damage, joint surgery, prosthetics, skin infection with prosthetics, immunodeficiency
258
WHat is the classic picture of septic arthritis?
Fever, swollen joint, pain on active and passive movement, rigors, bacteremia
259
What are the differentials for septic arthritis?
RA, osteoarthritis, vasculitis, gout, pseudogout, reactive arthritis, lymes
260
What is the causes of septic polyarticular arthritis?
Staph A, Lyme's, gonoccal disease, reactive A
261
What causes infection of sternoclavicular and sacroiliac joints?
Group B strep
262
What type of septic arthritis usually presents with fever, arthralgia, multiple skin lesions, tenosynovitis of hands, knees, wrists, ankles and elbows?
Gonoccal disease
263
What causes Lyme's disease?
Borrelia burgdorferi
264
What can cause viral arthritis?
HIV, rubella, parvovirus, hep C
265
What lab tests investigate septic arthritis?
CRP, FBC, ESR, lactate, synovial fluid exam and culturem blood culture if there is a fever, PCR, test for lymes
266
What imaging should be done for septic arthritis?
X ray
267
What signs would be seen in an x ray with septic arthritis?
fat pad displacement, swelling of capsule and soft tissuesm joint space narrowing
268
How is septic arthritis treated?
Empirically to cover staph A and strep
269
What is the recommended treatment for septic arthritis?
Fluclox for 4-6 weeks
270
How is MRSA septic arthritis treated?
Vancomycin 4-6 weeks
271
How is gonoccocal or gram -ve arthritis treated?
4-6 weeks
272
What are the complications of septic arthritis?
Amputation, arthrodesis, prosthetic surgeerym severe functional deterioration
273
What is Malaria?
Parasitic disease caused by infection of the genus plasmodiu
274
Which species can cause malaria?
Falciparum, vivax, ovale, malaria
275
WHat is the most common cause of malaria in England?
P. Falciparum
276
What is the clinical features of P. falciparum?
Severe disease and malaria related deaths
Incubation of 7-14 days
swinging fever every 48-36 hours)
277
What are the clinical features of P.Vivax?
Causes benign tertian malaria - fever every third day.
Incubation period of 12-17 days.
Relapse due to dormant parasites in the liver.
278
What are the clinical features of P. ovale?
Relapsing course as with P. vivax.
| Incubation period of 15-18 days.
279
What are the RF of severe malaria?
Poor, extremes of age, pregnant, non-immune people
280
What are the RFs of developing malaria?
Travels to area of humidity, temp 20-30, monsoon, ruralareas, accomodation, outside at dusk or dawn, longer trips
281
What are the symptoms of malaria?
```
Fever, often recurring
Chills
Rigors
Headache
Cough
Myalgia
Gastrointestinal upset
```
282
What are the signs of malaria?
```
Fever
Splenomegaly
Hepatomegaly
Jaundice
+/- abdominal tenderness
```
283
What are the signs of severe disease in malaria?
```
Impaired consciousness.
Shortness of breath.
Bleeding.
Fits.
Hypovolaemia.
Hypoglycaemia.
Acute kidney injury.
Nephrotic syndrome.
Acute respiratory distress syndrome (during treatment).
```
284
What are the investigations involved with Malaria?
Thick and thin blood smear
Rapid diagnostic tests, nucleic acid based tests
FBC, G6PD, LFTs
Uand E, ABG, Blood culture, clotting studies, urine and stool culture, CXR, lumbar
285
What would LFTs and U and Es show in Malaria
LFTs - often abnormal.
| U&Es - may show lowered Na+ and increased creatinine.
286
What aould an FBC show in Malaria?
typically reveals thrombocytopenia and anaemia. Leukocytosis is rarely seen but is an indicator of a poor prognosis when present.
287
What is the treatment of non-falciparum malaria?
Chloroquinine
| prevention of relapse: primaquine
288
What is the treatment of uncomplicated falciparum malaria?
Oral quinine sulfate 600 mg/8 hours for 5-7 days plus doxycycline 200 mg daily (or clindamycin 450 mg/8 hours for pregnant women) for seven days.
Atovaquone-proguanil (Malarone®): four standard tablets daily for three days.
Artemether with lumefantrine (Riamet®): if weight >35 kg, four tablets stat and then a further four tablets at 8, 24, 36, 48 and 60 hours.
289
What is the treatment of severe or complicated falciparum malaria?
IV quinine dihydrochloride is the first-line antimalarial drug.
Oral quinine sulfate 600 mg tds
Artesunate regimen
290
What are the complications of malaria?
```
Impaired consciousness or seizures (cerebral malaria).
Renal impairment.
Acidosis.
Hypoglycaemia.
Pulmonary oedema or acute respiratory distress syndrome.
Anaemia.
Splenic rupture.
Disseminated intravascular coagulopathy.
Shock secondary to complicating bacteraemia/sepsis (algid malaria).
Haemoglobinuria ('black water fever').
Multiple organ failure.
Death.
```
291
What are the methods of prevention of Malaria prophylaxis?
Use of effective chemoprophylaxis and insecticide-treated nets (ITNs) prevents about 90% of malaria.[7]Travellers should be encouraged to use a prophylactic regime appropriate to their travel itinerary
Be mosquito smart
292
WHat is meningitis?
Inflammation of the leptomeninges and underlying subarachnoid CSF
293
What are the RF of meningitis?
Spinal procedures, CSF shunts, renal insufficiency, DM, Infective endocarditis, hypoparathyroidism, adrenal insufficiency, thalassameia, crowding, immunosuppression
294
What are the common causes of meningitis in neonates?
Group B strep, L. monocytogenes, E. coli
295
What are the common causes of meningitis in onfants or younger children?
HiB, strep. pneumonia, N. meningitidis
296
What are the causes of meningitis in adults and older children?
Strep pneumoniae, HiB, N. meningitidis, gram -ve bacteria, staph, strop, L. monocytogenes
297
What are the common causes of meningitis in the elderly and immunocompromised>
S. pneumoniae, L. monoctytogenes, TB gram -ve
298
What are the causes of hospital acquired and post traumatic meningitis?
SA, klebsiella pneumoniae, E. coli, pseudomonas aeruginosa
299
What are the causes of aseptic meningitis?
Partly treated bacterial meningitis, viral infection, fungal infection, parasities, mollaret's meningitis, kawaski's
300
What are the viral causes of meningitis?
HIV, HSV, measles, influenza arbovirus, coxsackie, echovirus, mumps, zoster
301
What are the non-infective causes of meningeal irritation?
Malignancy, chemicals, drugs, sarcoidosis, SLE, behcets
302
What is the clinical presentation of meningitis?
Fever, headache, stiff neck, altered mental status, shock,kernig and babinski's sign, photophobia, menigoccal septicaemia - purpuric, non-blanching rash, seizures,
303
What are the differentials of meningitis?
Intracranial abscess, other causes of fevers and rashes, encephalitis, subarach haemorrhage, brain tumours, encephalopathies
304
What investigations should be done for meingitis?
FBC, serum glucose, Lumbar puncture, CRP, blood cutule, ABG, serology of blood, urine and CSF, test for syphilis, cryptococcal antigen, coag screen
305
What is the management of viral meningitis?
Analgesia, antipyretics, nutritional support, hydration
306
What is the manageent of bacterial meningitis?
Benzylpenicillin IM, IV ceftriaxime, fluids, antipyretics, corticosteroids
307
What are the complications of meningitis?
Septic shock, disseminated IV coag, coma, cerebral oedema, raised ICP, seizures CN dysfunction, hydrocephalus, intellectual difficulties, ataxia, blindness
308
What is the prevention of meningitis?
Vaccinations: hib, meningococcus B, C, strep/ pneumoniae
309
What is encephalitis?
Inflammation of brain parenchyma?
310
What are the viral causes of encephalitis?
HSV, CMV, adenovirus, HIV, toxoplasmosis, parvovirus B19, japanese encephalitis, equine encephalitis, arbovirus, polio, influenza, rubella rabies
311
What are the bacterial causes of encephalitis?
TB, mycoplasma, listeria, lymes, cat scratch fever, lepospira. legionella, neurosyphilis
312
What are the fungal causes of encephalitis?
Cryptococcosis, coccidiomyocosis, north american blastoyocosis, candidiasis
313
What are the parasitis causes of encephalitis?
African trypanosomiasis, tocoplasmosis, echinococcus, schistosomiasis
314
What is the presentation of encephalitis?
flu-like illness, headache, rapid development of altered consciousness, confusion, drowsiness, seizures, coma, ICP raised, photophobia, sensory changes, focal neurological signs, cognitive impairment
315
What are the investigations needed for encephalitis?
FBC, blood culture, CRP, CSF LP, CT scan, EEG
316
What is the management of encephalitis?
Urgent hospital admission, IV antibiotics, IV acyclovir,
317
What are the complications of encephalitis?
DIC, inappropriate ADH secretion, cardiac, and resp distress, epilepsy, neuropsychiatric problems,
318
What are warning signs in the presentation of the tropical traveller?
Jaundica, rash, paralysis, difficulty breathing, persistent vomiting, uncontrolled bleeding altered consciousness
319
What conditions should be considered in a tropical traveller presenting with fever?
Malaria, hepatitis, typhoid, cholera, yellow fever, dengue, typhus, rocky mountain fever, rabies, plague, viral haemorrhagic feversbrucellosis, histoplasmosis
320
What conditions should be considered in a tropical traveller presenting with respiratory problems?
TB, influenza, SARS
321
What conditions should be considered in a tropical traveller presenting with lymphadenopathy?
Plague, HIV< rickettsial, brucellosis, leishmaniasis, dengue, lymphogranuloma, lassa fever
322
What conditions should be considered in a tropical traveller presenting with jaundice?
Hepatitis, malaria, brucellosis, typhoid, yellow fever, dengue,
323
What conditions should be considered in a tropical traveller presenting with hepatosplenomegaly?
Malaria hepatitis, typhoid, yellow fever, dengue, leishmaniasis, schistosomiasis, toxoplasmosis
324
What conditions should be considered in a tropical traveller presenting with petechia and bruising?
Viral haemorhagic fever, dengue, yellow fever, meningococcal fever
325
What are the STIs seen in tropical travellers?
HIV, chlamydia, HIV, syphilis,
326
What happens in the infectious stage of typhoid?
Constipation
327
What is the main cause of death due to typhoid?
Intestinal bleeding due to necrosis of intestine
328
What is the incubation period of typhoid?
7-14 days
329
What are the three types of bacteria with notable polysaccharide capsid that forms a noticed pathogenicity?
Hib, strep pneumonia, pseudomonas
330
What does raised neutrophils suggest?
Bacterial infection
331
What does raised lymphocytes suggest?
Viral infection
332
What is osteomyelitis?
Inflammation of bone tissue
333
What is pyogenic osteomyelitis?
Organisms cause pus
334
What are the signs and symptoms of pneumonia?
Breathlessness, productive cough, green sputum, bronchial breathing, crepitations, dullness to percussion, reduced vocal resonance, fever, chills, myalgia
335
What are the common causes of community aquired pneumonia?
Strep pneumonia, HiB, klebsiella, morazella
336
What are the causes of atypical pneumonia?
Chlamydia, legionella, mycoplasma
337
What are the causes of hospital acquired pneumonia?
SA, MRSA
338
WHat investigations should be done for pneumonia?
Obs, ECG, sputum culture, throat swab, FBC, PCT, CRP, ESR, blood culture, Us and Es, LFTs, CXR
339
What are the RF of pneumonia?
COPD, asthma, lung cancer, hospitalization age, immunoompromise, aspiration
340
What is the CURB 65 score?
Measure of mortality fdue to pneumonia. Decision making aid on what antibiotics to use for a patient and whether the patient should be hospitalised
341
What is the criteria for CURB65?
```
one point for
Confusion
Urea>7mmol/l
Resp>30
BP<90/60
Age>=65
```
342
How mmany points need to be scored toon CURB65to nesscisate a hospital admission?
2 or more
343
What are the complications of pneumonia?
Sepsis, lung abscess, death, pulmonary scarring, lobar collapse, pleural effusion
344
What is cholecystitis?
Inflammation/infection of th cystic duct due to gallstones
345
What are the risk factors of cholecystitis?
Fat, forty, fertile, female, fair, sudden weightloss, chron's
346
What are the signs and symptoms of cholecytitis?
RUQ pain, vomiting, fever, local peritonism, GB mass, Murphy's sign
347
What is murphy's sign?
Cessation or holding of breath when two fingers are placed in the RUQ
348
When is Murphy's sign positive?
When the arrest of respiration is NOT seen on the left side
349
What is the management of cholecytitis?
Analgesia, IV antibiotics, cholecystectomy
350
What are the investigations of cholecystitis?
FBC, LFTs, US, hydroxyiminodiacetic acid
351
What can be seen in the LFTs and FBCs in cholecystitis?
Raised WCC, slightlyderanged LFTs
352
What can be seen in an US of cholecystitis
Gallstones, thickened gallbladdrr wall
353
WHat is cholangitis?
Inflammation of the gallbladder
354
Whar is charcot's triad?
RUQ pain, fever, jaundice
355
What does charcot's triad show?
Cholangitis
356
What are the causes of Cholangitis?
Iaschaemia, motility disorders, chemical injury, microorganisms
357
what pathogens can cause cholangitis?
Klebsiella, enterococci, Streptococci, E. coli, Round worm enterobacter
358
Whatis the presentatin of cholangitis?
Fever, RUQ pain, jaundice
| Myalgia, malaise, lethargy, cnonfusion shock
359
What can be used to investigate cholangitis?
OBs, FBC, CRP, blood cultures, LFTs, Us nd Es, ERCP, MRCP,
360
What is the management of cholangitis?
Fluid resus, IV antibiotics,
361
WHat are the complications of cholangitis?
Shock, Acute lung injury, AKI, Confusion, DC hepatic injury, liver abscess, liver failure
362
What is the definition of a UTI?
Presence for a pure growth if more than 10^5 organisms in an MSU, and the patient is symptomatic
363
Who is asymptomatic bacteria is treated in?
Pregnant women
| Urology procedure patients with expected mucosal bleeding
364
What can cause complicated UTIs?
Abnormal anatomy, abnormal renal function immunosuppression. Pregnancy
365
Why is pregnancy a risk factor for a UTI?
Increased levels of progesterone increases reflux
366
What are the rf of UTI?
Female, sex, stones, catheter, DM, decreased bladder emptying, pregnancy, elderly, hospitalization
367
What are the symptoms of cystitis and urethritis?
Dysuria, increased frequency, fevers, haematuria, loin pain lower back ache,
368
What are the symptoms of prostatitis?
Prodromal flu-like symptoms, lower back pain, perineal pain, not many urinary symptoms
369
What is the presentation of pyelonephritis?
Loin to groin pain, rigors, fever, nausea, vomiting, oligouria with AKI
370
What bug does not cause a raised nitrite in a urine dipstick?
Proteus
371
What are the complications of UTI?
Sepsis, renal failure
372
Risk factors for catheter associated UTIs
Frequency of changing catheter, aseptic technique, hygiene, female. Duration, bacteria in drainage bag, DM, older age, poor catheter care
373
What are the common cause of catheter associated UTIs?
E. coli, enterococcus, pseudomonas, candida
374
How is TB spread?
Airborne
375
What causes TB?
mycobacterium TB, mycobacterium bovis, mycobacterium africanum
376
What are the signs and symptoms of TB?
Dramatic weight loss, fever, night sweats, tiredness, fatigue, persistent cough. Coughing up blood
377
What are the investigations if TB?
Sputum fir afbx3
CXR
IGR,
Bronnchial lavage
378
What are TB sputum screened for?
Acid fast bacilli
379
What causes more deaths, meningococcal septicaemia or meningitis?
Meningococcal septicaemia, because it tends to incubate longer
380
Gram +ve diplococci
Strep pneumonia
381
Gram -ve diplococci(bacilli)
Neisseria meningitidis
382
What is the empirical treatment if meningitis/encephalitis
IV cefotaxime 2g qds
| Ceftriaxone 2g bd
383
What can be seen in latent TB in an x ray"
Calcifying lesion on apex of lung
| Primary complex
384
What tests can be used to diagnose latent TB.
Manitou, interferon gold
385
What is the term for raised neutrophils?
Neutrophilia
386
What are the causes of severe raised CRP?
Vasculitis, infection
387
What is the likely causes of peri orbital cellulitis?
GAS, spreads faster
| SA
388
What is the antibiotic of choice for GAS?
Coamox
389
What does a GAS Cause?
Cellulitis
390
Which cause of endocarditis is more likely to cause enterococcus?
Enterococcus
391
What are the side effects of gentamicin
Nephrotoxic, ototoxic
392
Describe janeway lesions
Flat to skin, non tender, red
393
Describe Roth slots
Emboli on the eye
394
Describe Osler nodes,
Tips of fingers and toes, tender, immunological response, raised, white
395
What can cause a rapid drop of polumorphonuclear leucocytes?
Chemo
396
What are the key indicators of rf for neutropenia fever?
Chemo, long lines, steroids, immunosuppressants,
397
What is the most common cause of a line infection?
Coag -ve staphylococcus
398
What are the warning signs for immunocompromise
Recurrent ear infection, pneumonia, sinus, skin. Deep seated infection, poor response to antibiotics, antibiotics with little effect, faltering growth in child
399
Describe C. difficile
Enterotoxin a and b
Faecal oral spread
Forms spores
400
What is the typical clinical manifestation of C. difficile
Green watery diarrhoea, difficulty to control
401
What are the worst complications of C. difficile
Pseudo membranous colitis,
| Toxic mega colon
402
Why does C. difficile cause diarrhoea?
Enterotoxins, physiological response to flush out toxins and pathogen
403
What is the severe clinical manifestation of C. difficile
Abdo pain, cramps, peritonism, toxic patient, high frequency of green smelly watery diarrhoea
404
How is c diff investigated
C diff specific gluteraldehylde de hydrogenated antigen, toxins a and b,
C. Diff culture, PCR
405
What % of bacteria in the gut is anaerobic?
99%
406
What are the stages of dengue?
Febrile
Leaky capillaries
Convalescent
407
What is the presentation of bacterial conjunctivitis?
Purulent, sticky, crusty discharge, conjunctival redness, foreign body sensation, no acuity change, no photophobia
408
What is a red flag for bacterial conjuctivitis
Bilateral conjunctivitis
| N. Gonorrhoea
409
What is the clinical presentation of viral conjunctivitis?
Bilateral watery discharge, redness in one eye followed by the second a few darts later
410
What can cause viral conjunctivitis?
Adenovirus, hsv, vsv, molluscum
411
What is the clinical picture of acanthamoeba?
Pain, redness, blurred vision, photophobia, excess tearing
| Associated with corneal injury
412
What is the clinical presentation if trachoma
Most common cause if preventable blindness
Chlamydia in the eye, conjuctivitis,
Scarring under eyelid
413
What is the clinical picture of ophthalmia neonatrum
Neonatal conjunctivitis, orbital pain, purulent discharged conjunctival hyperaemia
414
What are the stages of dengue?
Febrile
Leaky capillaries
Convalescent
415
What is the presentation of bacterial conjunctivitis?
Purulent, sticky, crusty discharge, conjunctival redness, foreign body sensation, no acuity change, no photophobia
416
What is a red flag for bacterial conjuctivitis
Bilateral conjunctivitis
| N. Gonorrhoea
417
What is the clinical presentation of viral conjunctivitis?
Bilateral watery discharge, redness in one eye followed by the second a few darts later
418
What can cause viral conjunctivitis?
Adenovirus, hsv, vsv, molluscum
419
What is the clinical picture of acanthamoeba?
Pain, redness, blurred vision, photophobia, excess tearing
| Associated with corneal injury
420
What is the clinical presentation if trachoma
Most common cause if preventable blindness
Chlamydia in the eye, conjuctivitis,
Scarring under eyelid
421
What is the clinical picture of ophthalmia neonatrum
Neonatal conjunctivitis, orbital pain, purulent discharged conjunctival hyperaemia
422
What are the stages of dengue?
Febrile
Leaky capillaries
Convalescent
423
What is the presentation of bacterial conjunctivitis?
Purulent, sticky, crusty discharge, conjunctival redness, foreign body sensation, no acuity change, no photophobia
424
What is a red flag for bacterial conjuctivitis
Bilateral conjunctivitis
| N. Gonorrhoea
425
What is the clinical presentation of viral conjunctivitis?
Bilateral watery discharge, redness in one eye followed by the second a few darts later
426
What can cause viral conjunctivitis?
Adenovirus, hsv, vsv, molluscum
427
What is the clinical picture of acanthamoeba?
Pain, redness, blurred vision, photophobia, excess tearing
| Associated with corneal injury
428
What is the clinical presentation if trachoma
Most common cause if preventable blindness
Chlamydia in the eye, conjuctivitis,
Scarring under eyelid
429
What is the clinical picture of ophthalmia neonatrum
Neonatal conjunctivitis, orbital pain, purulent discharged conjunctival hyperaemia
