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4th Year Finals Revision > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

What 3 symptoms make up the classic triad of meningism?

A

Neck stiffness

Photophobia

Headache

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2
Q

Which layer of the meninges do bacterial infections most commonly affect?

A

Sub-arachnoid layer

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3
Q

What are the main causative pathogens of meningism in neonates?

A

Group B strep

E. coli

Listeria monocytogenes

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4
Q

What are the main causative pathogens of meningism in infants?

A

Neiserria meningitides

Haemophilus influenzae

Strep pneumoniae

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5
Q

What are the main causative pathogens of meningism in children/adolescents?

A

N. meningitides

Strep pneumoniae

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6
Q

What are the main causative pathogens of meningism in adults?

A

Strep pneumoniae

N. meningitides

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7
Q

What are the main causative pathogens of meningism in the elderly?

A

Strep pneumoniae

Listeria monocytogenes

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8
Q

What pathogen, capable of causing meningites, can be transmitted in soft cheeses and should be of particular concern to pregnant women due to possible vertical transmission?

A

Listeria monocytogenes (gram positive facultative anaerobe)

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9
Q

If a patient presented with symptoms of meningism, what would be your main suspected causative pathogen if they…

a) had a fractured cribriform plate?
b) had recently had neurosurgery or head trauma?

A

a) Strep pneumoniae
b) Staph aureus and epidermidis

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10
Q

What is Waterhouse-Friederichsen Syndrome?

What pathogen is it associated with?

A

Form of rapidly escalating fulminant meningococcal disease with accompanying septicaemia, bilateral haemorrhages into the adrenal glands and DIC

Associated with N meningitides

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11
Q

What was previously the most common cause of meningitis in children until the introduction of a vaccine?

What is now the most common cause?

A

Previously Haemophilus influenzae

Now N meningitides

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12
Q

Other than meningism, there are some other clinical signs of meningeal infection.

What are Kernig’s sign and Brudzinki’s sign?

A

Kerning sign - patient resists knee extension when their hip is flexed. May be positive in meningococcal disease

Brudzinki’s sign - flexion of the neck will ellicit flexion of the hip and knee joints

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13
Q

So you’ve got a patient with suspected meningitis - what investigations do you perform?

A

Urgent CT - required to rule out increasing cranial pressure (always indicated prior to LP?)

According to ward notes, LP is the most urgent test to perform but a CT should be performed first if the patient has a reduced GCS

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14
Q

How is community acquired meningitis treated? What additional treatment may be of benefit within the first 12 hours of symptoms?

What would you add if the patient was over 60, or immunocompromised?

A

Treated with IV Ceftriaxone 2g BD

If first 12 hours, add IV dexamethasone 10mg QDS

If the patient is over 60 or IC/IS, add IV amoxicillin 2g every 4 hours

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15
Q

When treating a patient with meningitis, what additional medication would you add if you suspected encephalitis?

A

IV Aciclovir

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16
Q

Are there any contact precautions that should be taken by those close to someone with confirmed meningitis?

A

Yes, treat prophylactically with Ciprofloxacin

17
Q

What would the following LP results suggest as a cause of meningitis?

Clear fluid

Raised cell count

Low/normal glucose

Normal Protein

Normal opening pressure

A

Asceptic/Viral meningitis

18
Q

What type of viruses are commonly associated with asceptic meningitis?

What type of viral meningitis can lead to a more severe infection and potentially encephalitis?

A

Enteroviruses are most commonly associated with viral meningitis

HSV infection is associated with more severe meningitis and subsequent encephalopathy

19
Q

How is asceptic meningitis managed?

A

In many cases the condition is self-limiting and is managed conservatively

If infection is severe, IV Aciclovir may be used

20
Q

What would the following LP results suggest as a cause of meningitis?

Clear CSF

Culture negative

Raised white cells

Low blood glucose

High protein

Elevated opening pressure

Fibrin webs appear if the CSF is left to settle

A

Tuberculosis meningitis

21
Q

What is the diagnosis?

Child presents with rapidly developing signs of severe infection over the course of 24 hours, excessive drooling, difficulty swallowing, voice changes, fever and increased resp rate

What does the presence of stridor indicate?

A

Epiglottitis/Supraglottitis

Presence of stridor indicates upper airway obstruction and is an indication of emergency

22
Q

Historically epiglottitis was most commonly caused by Haemophilus influenzae type B, however since vaccination this has become less common.

What are the most common causes now of epiglottitis?

A

Strep pneumoniae

Strep pyogenes

Staph aureus

23
Q

Other than bacterial infection, what else might cause epiglottitis/supraglottitis?

A

Severe burns/trauma

Excessive use of crack cocaine

Graft vs Host Disease

24
Q

How is epiglottitis medically managed?

A

IV Ceftriaxone, 2g OD

25
Q

When diagnosing community acquired pneumonia, assessing the patient with CURB65 is useful.

What does CURB65 refer to?

A

Confusion (new onset)

Urea (Blood Urea Nitrogen) greater than 7 mmol/l

Respiratory rate of 30 or more

BP less than 90 systolic or 60 diastolic

Age 65 or older

26
Q

What is the most common causative organism of CAP?

A

Strep Pneumoniae

27
Q

What might be the causative pathogens of pneumonia in a patient with IC/IS?

A

H. influenzae

Pneumocystis jirovecii

28
Q

What might be the causative pathogens of pneumonia in neonates?

A

Group B Strep (S. agalacticae)

Listeria monocytogenes

HSV

Adenovirus

Mumps

Enterovirus

Chlamydia trachomatis

29
Q

Give an example of (and an associated condition)…

Group A Strep

Group B Strep

A

Group A Strep - Strep. pyogenes (

30
Q

Suspect CAP? What investigations do you perform?

A

Clinical examination and CURB65

CXR

+/- Sputum examination

31
Q

How is mild/moderate CAP treated (CURB65 score of 0-2)?

A

IV/PO Amoxicillin, 1g TDS for a total of 5 days

If penicillin allergic, give PO Doxycycline on day 1 then 100mg OD or IV Clarithromycin

32
Q

How is severe CAP treated (CURB65 3 or more, or in the ICU/HDU, or if nil by mouth)

A

IV Co-amoxiclav 1.2g TDS

AND

IV Clarithromycin 500mg BD for a total of 7 days

If penicillin-allergic, give IV Levofloxacin 500mg BD monotherapy

Step-down therapy for all patients is PO Doxycycline 100mg BD

33
Q

HAP is, after UTI, the most common nosocomial infection seen and lengthens hospital stay by 1-2 weeks. It can be caused by both bacteria and viruses.

What are the most common causes of both?

A

Bacteria - most commonly caused by gram-negative rods (Pseudomonas aeruginosa), but can also be caused by Staph aureus, H influenzae, Klebsiella and enterobacter

Viral - influenza, RSV and CMV in immunocompromised hosts

34
Q

How is non-severe HAP treated?

A

PO Amoxicillin for total 5 days

If penicillin allergic, PO Doxycycline 100mg BD

35
Q

How is severe HAP treated?

A

IV Amoxicillin AND Gentamicin

If penicillin-allergic, IV Co-trimoxazole and Gentamicin

Step-down to PO Co-trimoxazole

All IV/PO therapy should total 7 days

36
Q

When would you treat an exacerbation of COPD?

What medications are used?

A

If there is purulent discharge, or signs of consolidation/pneumonia on CXR

Treat with Amoxicillin 500mg TDS, or if penicillin-allergic with Doxycycline 200mg on day 1 then 100mg OD for a total of 5 days

37
Q

What is Duke’s criteria used for?

It consists of major and minor criteria - what are the two major criteria?

A

Duke’s criteria is used to assess likelihood of endocarditis

The two major criteria are…

positive blood cultures for infective endocarditis

evidence of endocardial involvement

4th Year Finals Revision (13 decks)

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