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Year 4 Overview/Random tests > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

Parameters for SIRS?

A 
Temperature above 38 or below 36.
Pulse above 90 bpm
RR above 20
WCC <4 or >12
Altered mental state
Known/suspected neutropenia
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2
Q

NEWS score of what plus infection = sepsis

A

more than or equal to 5

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3
Q

Standard oral/IV dose of amoxicillin?

A

Oral: 1g TDS
IV: 1g TDS

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4
Q

Standard oral/IV dose of co-trimoxazole?

A

Oral + IV: 960mg BD

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5
Q

Standard oral/IV dose of co-amoxiclav?

A

Oral: 625 mg TDs
IV: 1g TDS

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6
Q

Clarithromycin - interactions/biggest risk?

A

Interactions: statins

Biggest risk: ?prolongs QT

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7
Q

Standard oral/IV dose of clarithromycin?

A

Oral + IV: 500mg BD

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8
Q

Standard oral/IV dose of metronidazole?

A

Oral: 400mg TDS
IV: 500mg TDS

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9
Q

Standard oral/IV dose of flucoxacillin?

A

Oral: 1g QDS
IV: 1-2g QDS

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10
Q

Treatment for meningitis?

A

IV ceftriaxone 2g BD + IV dexamethasone 10mg QDS for four days

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11
Q

Treatment for encephalitis?

A

IV ceftriaxone 2g BD + IV dexamethasone 10mg QDS for four days plus aciclovir (IV 10mg/kg tads)

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12
Q

Treatment for meningitis if over 60 or immunocompromised?

A

IV ceftriaxone 2g BD + IV amoxicillin 2g/4 hours + IV dexamethasone 10mg QDS for four days

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13
Q

Treatment for epiglottitis/supraglottitis?

A

IV ceftriaxone 2g OD

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14
Q

Treatment for CAP 0-2?

A

IV/PO amoxicillin 1g TDS for 5 days

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15
Q

Treatment for CAP 0-2 if penicillin allergic?

A

PO Doxycyline 200mg day one then 100mg OD

or IV clarity if NBM

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16
Q

Treatment for CAP 3-5?

A

IV co-amoxiclav 1.2g TDS _ PO doxycyline 100mg BD for 7 days

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17
Q

Treatment for CAP 3-5 if penicillin allergic?

A

IV levofloxacin 500mg BD for 7 days

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18
Q

IF severe CAP and in HDU/ICU? or if NBM?

A

Swap the doxycycline for IV clarithromycin 500mg BD.

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19
Q

Treatment for severe hospital acquired pneumonia or aspiration pneumonia?

A

IV amoxicillin + metronidazole + gentamicin -> PO co-trimoxazole + met (7 days)

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20
Q

Treatment for severe hospital acquired pneumonia or aspiration pneumonia if penicillin allergic?

A

IV co-trimoxazole and metronidazole +/- gent.

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21
Q

Not severe HAP or aspiration pneumonia?

A

PO amoxicillin and metronidazole (5 days)

If penicillin allergic - swap for co-trimoxazole

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22
Q

Acute COPD exacerbation?

A 
Only if increase in sputum purulence give abx.
Amoxicillin 500mg TDS
or 
Doxycyline 200mg then 100mg OD 
(5 days)
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23
Q

Acute bronchitis?

A

Only real in frail elderly - same as acute COPD

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24
Q

Tx for severe native valve endocarditis (acute)?

A

IV flucloxacillin 2g 6 hourly (4 hourly if >85 kg)

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25
Q

Tx for indolent native valve endocarditis (subacute)?

A

IV amoxicillin 2g 4 hourly _ Gentamicin 1mg/kg BD

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26
Q

Tx for prosthetic valve endocarditis or MRSA?

A

IV vancomycin + PO rifampicin 600mg BD + IV Gentamicin 1mg/kg BD

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27
Q

Tx for non-severe C diff?

A

PO metronidazole 400mg TDS (10 days)

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28
Q

Tx for severe C diff?

A

PO/NG vancomycin 125mg QDS

+/- IV metronidazole (10 days)

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29
Q

Tx for peritonitis/acute biliary tract infection/intra-abdominal infection?

A

IV amox + met + gent

7-10 days

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30
Q

Mild proven spontaneous bacterial peritonitis?

A

PO co-trimoxazole

no symptoms

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31
Q

Severe proven spontaneous bacterial peritonitis?

A

IV piperacillin/tazobactam 4.5gTDS

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32
Q

Tx for uncomplicated female lower UTI?

A

PO nitrofurantoin 500mg QDS OR MR 100mg BD

OR Trimethoprim 200mg BD for three days (3)

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33
Q

Tx for uncatheterised male UTI

A

PO nitrofurantoin 500mg QDS OR MR 100mg BD

OR Trimethoprim 200mg BD for seven days (7)

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34
Q

Tx for complicated UTI/pyelonephritis/urosepsis

A

IV amox + gent (if p allergic - IC co-trimoxazole + gent) with step down as improving. Total: 7 days

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35
Q

Tx for cellulitis?

A

IV/PO flucloxacillin 1g QDS

If p allergic - doxycyline 100mg BD PO

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36
Q

Tx for mild diabetic foot infection?

A

Fluclox 1g QDS or Doxycyline 100mg BD (7 days)

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37
Q

Tx for severe diabetic foot infection?

A

Fluclox 1g QDS + metronidazole 400mg TDS (7 days)

OR replace fluclox with doxyxcyline 100mg BD if PA

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38
Q

Tx for acute septic arthritis or osteomyelitis?

A

Seek ID advice but 2g IV fluclox

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39
Q

Tx for open fracture prophylaxis?

A

IV co-amoxiclav 1.2g TDS
Start within 3 hours for max 72 hours.
If PA - IV co-trimoxazole 960mg BD + metronidazole 500mg TDS

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40
Q

Empirical treatment for unknown source of infection?

A

IV amox + met + gent (add in fluclox/vanc if worried re staph)

If PA - IV vancomycin + met + gent

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41
Q

Which groups of antibiotics act on the bacterial cell wall?

A

Penicillins
Cephalosporins
Glycopeptides

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42
Q

MoA of penicillins?

A

Bactericidal, inhibits cell wall synthesis through: preventing cross linking
of peptidoglycans and autolysins -> which degrade the cell wall.
Excreted via kidneys.
Safe in pregnancy.

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43
Q

MoA of cephalosporins?

A

Bactericidal, inhibits cell wall synthesis through: preventing cross linking
of peptidoglycans and autolysins -> which degrade the cell wall.
Excreted via kidneys.
Safe in pregnancy.

(ceph/cef)

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44
Q

MoA of glycopeptides

A

Bacteriacidal, binds to end of growing pentapeptide chain during peptidoglycan synthesis - preventing cross-linking.
NB - only absorbed via IV

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45
Q

Examples of glycopeptides?

A

Vancomycin, teicoplanin.

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46
Q

Cover from glycopeptides?

A

ONLY gram positive

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47
Q

When is only case of giving oral vancomycin?

A

C diff - acts locally within gut.

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48
Q

Which antibiotics are bacteriostatic/act on protein synthesis?

A

Macrolides (ycins), aminoglycosides (gentamicin) and others - clindamycin, chloramphenicol, tetracylcines

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49
Q

Examples of macrolides?

A

Erythromycin, clarithromycin and azithromycin

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50
Q

How are macrolides excreted? When useful?

A

Liver, biliary tract and into the gut. Lipophilic - good for hiding bacteria within cells.

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51
Q

Which of the antibiotics that inhibit protein synthesis are bactericidal?

A

Gentamicin - aminoglycoside.

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52
Q

What is gentamicin active against?

A

Gram negative aerobics - cloakrooms and pseudomonas aeruginosa

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53
Q

What is clindamycin active against/used for?

A

Active against: True anaerobes and staph/strep

Used for penicillin allergic patients with serious staph/strep infections

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54
Q

Example of tetracyclines?

A

Doxycyline

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55
Q

How are tetracyclines excreted?

A

Liver/biliary system

56
Q

Which antibiotics act on bacterial DNA?

A

Metronidazole
Trimethoprim/sulphamethoxazole
Fluoroquinolones

57
Q

How does metronidazole work? What is it useful for?

A

Causes strand breakage of bacterial DNA

Useful for true anaerobes and protozoal infections

58
Q

How does trimethoprim work?

A

Inhibits bacterial folic acid by enzyme inhibition

Folic acid required for DNA replication

59
Q

What is co-trimoxazole? Why is it useful?

A

Trimethoprim and sulphamethoxazole

Inhibits folic acid synthesis using 2 pathways

60
Q

At what point in pregnancy is trimethoprim safe after?

A

4th month onwards

61
Q

Cover of trimethoprim?

A

Gram negative and positive

62
Q

MoA of fluoroquinolones?

A

Bacteriacidal: interact with topoisomerases (supercoil/uncoil bacterial DNA) which inhibits replication

63
Q

Example of fluoroquinolone and why not used anymore

A

Ciprofloxacin - wide spectrum c diff risk

64
Q

What used to tx pseudomonas (oral route)?

A

Ciprofloxacin

65
Q

What is levofloxacin used of?

A

Severe CAP in penicillin allergic patients

66
Q

Side effects of aminoglycosides?

A

Gentamicin damages kidneys and causes deafness/dizziness

67
Q

Side effects of glycopeptides?

A

Vancomycin - damages kidneys/red man syndrome

68
Q

Side effects of tetracyclines?

A

Teeth/bone staining in children under 12 (permanent)

69
Q

Side effects of quinolones?

A

Weakens tendons - rupture
May damage joints in children
Seizures?

70
Q

True penicillin allergy incidence?

A

<0.05%

71
Q

Rashes to penicillin

A

1-10%

72
Q

Which antibiotics safe in pregnancy?

A

Penicillin/cephalosporins

73
Q

Which antibiotics are to be avoided in the first three months of pregnancy?

A

Trimethoprim

Metronidazole

74
Q

Which antibiotics are not given to pregnant women?

A

Gentamicin
Tetracyclines
Fluoroquinolones

75
Q

Two mechanisms of bacterial resistance?

A

Genetic mutation or
Three ways of DNA coding for resistance transferal from one bacterium to another”
Transformation/conjugation/transduction

76
Q

Transformation?

A

From dead bacteria

77
Q

Conjugation?

A

From plasmid replication

78
Q

Transduction?

A

Bacterial DNA transfer via a virus (phage or bacteriophage)

79
Q

Three common mechanisms of antibiotic resistance?

A

Altered binding site (MRSA)
Antibiotic destruction (beta-lactamases/cephalosporinases - target beta-lactam ring)
Increased efflux

80
Q

Primary care management of suspected meningitis

A

If time permits - IV/IM benxypenicillin 1.2g or 2g cefotaxime

81
Q

Primary care management of conjunctivitis

A

Chloramphenicol

82
Q

Dose for shingles?

A

Oral aciclovir 800mg 5 times daily

83
Q

Primary care management of bacterial source tonsil/pharyngitits?

A
  1. Penicillin V 1g BD 7 days

Doxycycline 200mg, then 100mg OD 7 days

84
Q

Primary care management of sinusitis of >7/10 days?

A
  1. Penicillin V 1g BD 7 days

2. Doxycycline 200mg, then 100mg OD 7 days

85
Q

Primary care management of otitis media with ottorrhoea?

A
  1. Amoxicillin 500mg TDS
  2. Clarithromycin 5000mg BD
    (Both 5 days)
86
Q

Primary care management of otitis external?

A

Acetic acid

87
Q

Primary care management of oral thrush?

A
  1. Miconazole gel QDS (avoid with warfarin)

2. Fluconazole 50mg OD

88
Q

CRB65 criteria?

A

Confusion
Resp rate > 30
BP <90 SBP or <60 DBP
Age over 65

89
Q

Primary care management of CAP?

A

Amoxicillin 1g TDS

Doxycyline 200mg-100mg 5 days

90
Q

Primary care management of severe CAP pre-transfer to hospital?

A

Amoxicillin 1g oral or benzypenicillin 1.2g IV

91
Q

Primary care management of diverticulitis which indicates antibiotics?

A

Metranidazole 400mg TDS + Co-trimoxazole 960mg BD

5 days

92
Q

Primary care management of UTI in catheterised pts?

A
  1. Co-trimoxazole 960mg BD
  2. Co-amoxiclav 625mg TDS
    (7 days)
93
Q

Primary care management of uncomplicated lower female UTI?

A

Nitrofurantoin 50mg QDS or 100mg MRBD
OR
Trimethoprim 200mg BD (3 days)

94
Q

Primary care management of pyelonephritis?

A

Send MSSU
Co-trimoxazole 960mg BD
OR
Co-amoxiclav 625mg TDS

95
Q

Primary care management of uncatheterised male UTI?

A

Send MSSU
Nitrofurantoin MR 100mg BD etc
OR
Trimethoprim 200mg BD (7 days)

96
Q

Primary care management of UTI or bacteriuria in pregnancy?

A

Send MSSU

  1. 1st or 2nd trimester: nitrofurantoin MR 100mg BD 3rd trimester: trimethoprim 200mg BD
  2. Any trimester: cefalexin 500mg TDS
97
Q

Primary care management of prostatitis?

A

Ofloxacin 200mg BD or Ciprofloxacin 500mg BD

98
Q

Primary care management of uncomplicated chlamydia?

A

Azithromycin 1g stat OR doxycyline 100mg BD

99
Q

Primary care management of pelvic inflammatory disease?

A

Metronidazole 400mg BD + ofloxacin 400mg BD (14 days)

100
Q

Primary care management of trichomoniasis/BV?

A

Metronidazole 400mg BD

101
Q

Dose of flucloxacillin for cellulitis?

A

1g QDS (7 days)

102
Q

Alternative to flucloxacillin for cellulitis?

A

100mg BD (7 days)

103
Q

Primary care management of athletes foot?

A

Topical 1% terbinafine OD-BD

104
Q

Primary care management of impetigo - localised/generalised?

A

Topical fusidic acid or:

  1. Flucloxacillin 500mg QDS
  2. Clarithromycin 500mg BD (7 days)
105
Q

Primary care management of bites?

A
  1. Co-amoxiclav 625mg TDS

2. Metronidazole 400mg TDS + Doxycycline 100mg BD (7 days)

106
Q

What kind of pathogen is C difficile?

A

Gram positive
Anaerobic
Forms spores
Motile/abx resistant

107
Q

Where are the spores of C diff found?

A

Soils, fresh and salt water, GI tract of young animals inc humans

108
Q

Which strains of C diff cause disease?

A

Only toxin-producing ones

109
Q

Spectrum of disease with C diff?

A

Asymptomatic carriage
Diarrhoea/simple colitis
Pseudomembraneous colitis
Fulimant colitis

110
Q

What percentage of patients suffer a relapse of symptoms following initial treatment/cure of 1 c diff infection?

A

20%

111
Q

Hypervirulent strain of c diff?

A

027/NAP1/B1

30% relapse rate

112
Q

Risk factors for C diff?

A 
Antimicrobial use 
Increased age
Prolonged hospital stay
Serious underlying diseases
Surgical procedures - esp bowel ops
Immunocompromising conditions
PPI use
113
Q

Additional risk factors?

A
  • Non-surgical gastrointestinal procedures
  • Presence of a naso-gastric tube
  • Stay on intensive care unit
  • Long duration of antibiotic course
  • Receiving multiple antibiotics
  • Specific antibiotics, in particular, clindamycin, cephalosporins and penicillins
114
Q

What groups of patients are we more aware of contracting C diff?

A

Paeds, younger adults and peripartum women

115
Q

What percentage of healthy adults carry C diff?

A

0-4%

116
Q

What percentage of hospital patients may be caring C diff asymptomatically?

A

50%

117
Q

Healthcare associated CDI defined as:

A

Onset of symptoms at least 48 hours after admission or up to 4 weeks post-discharge

118
Q

Community associated CDI defined as:

A

Onset of symptoms within 48 hours of admission or if no previous stay in hospital in past 12 weeks

119
Q

What do C diff spores do in colon to prevent elimination by gut motility?

A

Attach!

Penetration of the mucus by flagellar movement

120
Q

Role of bile and C diff spores?

A

Can germinate in anaerobic conditions

121
Q

Role of immunoglobulins in defence against C diff?

A

IgA - neutralise toxins and ?prevent adhesion

122
Q

Virulence factors for C diff?

A
  • Toxins A and B
  • Attachment /penetration of mucus
    (flagella,
    adhesions,
    capsule and
    extracellular enzyme)
  • Binary toxin CDT
  • Spore production and survival
123
Q

Host defences against C diff?

A
  • Intact normal flora in the colon
  • Gastric acid
  • GI motility
  • Innate immunity: pathogen recognition mechanisms
  • Humoral immunity:
    secretory immunoglobulins and
    systemic immunoglobulins
  • Cellular immunity in gut wall.
124
Q

What forms the pseudomembranes in c diff infection?

A

Fibrin

125
Q

What do toxins A and B do?

A

Kill cells - B is stronger - this leads to damage of GI tract

126
Q

What kind of damage to GI tract in c diff infection?

A

Loss of fluid by leakage through damaged mucosa
Reduced absorption across gut wall
Pseudomembranes
Gut inflam/toxic megacolon/risk of perforation

127
Q

How can C diff be diagnosed?

A

Signs and symptoms and microbio shows no other source
OR
pseudomembraneous colitis during endoscopy/colectomy/post mortem

128
Q

Rough outline of mild CDI?

A

Mild diarrhoea
No systemic symptoms
No raised WCC

129
Q

Rough outline of moderate CDI?

A

Moderate diarrhoea
Raised WCC <15
Some systemic symptoms

130
Q

Severe CDI?

A

As for moderate plus: two or more severity markers e.g. temperature >38.5 °C,
WBC>15 cell/mm3; creatinine > 1.5x baseline

131
Q

Life-threatening CDI?

A

Hypotension
Partial/complete ileus
Toxic megacolon
CT shows severe disease

132
Q

Who should be tested for C diff?

A

All patients over 15 with diarrhoea

133
Q

Gold standard for c diff?

A

toxigenic culture - use antiserum?

CytoToxin Assay for detecting Toxin B

134
Q

When to culture C diff?

A

epidemiological purposes, either during a possible outbreak or if there are apparent changes in virulence or an increase in treatment failures.

Also monitoring antibiotic resistance

135
Q

famous hyper virulent cdi strain?

A

ribotype 027

NB higher toxin levels/resistant to flouroquinolones

136
Q

Other than abx tx - what else for CDI?

A

Avoid opiates/antiperistaltic

Reduce/stop antimicrobials

137
Q

When to operate in severe CDI?

A

Before lactate exceeds 5mmol/l

Year 4 Overview/Random tests (11 decks)

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