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Y4 > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

What is staphylococcus aureus bacteraemia?

A

MRSA or MSSA

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2
Q

You should consider changing a peripheral venous catheter (line) if it has been in situ for over ___ hours?

A

Over 72 hours

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3
Q

When looking at blood culture bottles, the bottom ‘sediment’ should be what colour? Greenish or Orange

A

Greenish

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4
Q

What is important to remember when filling blood culture bottles?

A

Make sure the bottles are kept upright

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5
Q

What should you take first - blood cultures or blood samples?

A

Blood cultures

- taking blood samples first would increase the risk of contamination

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6
Q

Blood cultures should aim to be taken before/after initiation of antibiotic therapy?

A

Before antibiotics are administered

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7
Q

If patient has started antibiotics before blood cultures are taken, when is the best time to take blood cultures?

A

Immediately before the next dose of antibiotics is due

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8
Q

Which class of antibiotics are used to treat atypical pneumonias?

A

Macrolides (clarithromycin, azithromycin, erythromycin)

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9
Q

Bronchiolitis is most commonly due to which virus?

A

RSV

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10
Q

Which investigation is done to look for virus?

A

PCR

  • nasopharyngeal swab
  • throat swab
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11
Q

Blood cultures should ideally be taken at different times. True or false?

A

True

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12
Q

What is the name of the criteria used for endocarditis?

A

Duke criteria

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13
Q

Blood cultures are taken for suspected infective endocarditis but all 3 blood cultures have come back -ve. What is the next investigation?

A

Serology

- for atypical organisms

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14
Q

If there is a clinical suspicion of endocarditis, which imaging investigation should be carried out?

A

Transthoracic echo

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15
Q

Which type of echo should be done initially: transthoracic or trans oesophageal?

A

Trans oesophageal

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16
Q

Patient with red eye, gritty sensation, lots of pus and sticky discharge. Started unilaterally and now spread bilaterally. Vision is unaffected. What is the likely condition?

A

Bacterial conjunctivitis

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17
Q

What is the treatment of bacterial conjunctivitis

A

Self limiting

- chloramphenicol drops make infection clear up faster

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18
Q

Patient with bacterial conjunctivitis but the causative organism is pseudomonas aerginosa. What is the management>

A

Gentamicin

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19
Q

Chronic unilateral follicular conjunctivitis is a buzzword for which type?

A

Chlamydial conjunctivitis

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20
Q

Patient with watery eyes that are pink. There is a red velvety appearance of the conjunctiva. What is the likely diagnosis?

A

Viral conjunctivitis

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21
Q

Patient presents with a painful eye which is red around the limbus. There is reduced vision and a white lump is visible in the cornea. what is the likely diagnosis?

A

Bacterial keratitis

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22
Q

Investigation for bacterial keratitis

A

Corneal scrape

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23
Q

Management of bacterial keratitis

A

Hourly drops of ofloxacin (must be admitted to hospital)

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24
Q

What is a dendritic ulcer associated with (condition)

A

Viral keratitis

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25
Q

Patient presents with painful eye which is red around the limbus and also complains of reduced vision. There is profuse lacrimation. On examination, there is a thin white appearance in the cornea which looks like branches of a tree. what is the most likely diagnosis?

A

Viral keratitis (dendritic ulcer)

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26
Q

Management of dendritic ulcer

A

Antiviral (aciclovir)

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27
Q

Which medication causes a geographical ulcer in a patient with viral keratitis

A

Steroids

- avoid this

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28
Q

Patient presents with an extremely red and painful eye post surgery. What is the likely diagnosis?

A

Endophthalmitis

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29
Q

Main cause of orbital cellulitis in children?

A

Sinusitis

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30
Q

Child with pain and redness around the orbit. Also has a swollen tender eyelid and mucous dripping out of their nose. What is the likely diagnosis and how should it be investigated

A

Diagnosis: orbital cellulitis
Investigation: CT

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31
Q

What is the important investigation to carry out for orbital cellulitis

A

CT scan

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32
Q

Bilateral conjunctivitis in young adults. What should you suspect?

A

Chlamydial conjunctivits

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33
Q

What is the most common causative organism for endophthalmitis?

A

staph epidermidis

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34
Q

investigation for endophthalmitis

A

Aqueous / vitreous for culture

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35
Q

Chloramphenicol is bacteriocidal / bacteriostatic for staph?

A

Bacteriostatic

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36
Q

Chloramphenicol is bacteriocidal / bacteriostatic for strep?

A

Bacteriocidal

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37
Q

Side effect of chloramphenicol

A

Aplastic anaemia

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38
Q

What class of antibiotic is ofloxacin

A

Quinolone

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39
Q

Which specific bacteria does chloramphenicol not treat

A

Pseudomonas aerginosa

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40
Q

Hand foot and mouth disease is caused by which virus?

A

Coxsackie virus

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41
Q

Which patients with sore throats definitely SHOULD NOT receive a throat swab?

A

Patient with stridor

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42
Q

What is the most common cause of a bacterial sore throat

A

Tonsilitis

- group A strep (strep pyogenes)

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43
Q

Strep pyogenes (group A strep)
gram +ve or gram -ve
Cocci or bacilli
haemolysis: complete, partial or none

A

Gram +ve
Cocci
Complete haemolysis

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44
Q

Why should you be careful with carbimazole

A

It can cause neutropenia

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45
Q

Name 3 things which can cause neutropenia

A

Carbimazole
Chemotherapy
HIV with low CD4 count

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46
Q

Infectious mononucleosis (glandular fever) is caused by which virus?

A

EBV

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47
Q

What is the management of infectious mononucleosis?

A

Selt limiting

- steroids if very severe

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48
Q

Investigations for infectious mononucleosis

A

EBV IgM
monospot test
paul bunnell test

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49
Q

CMV and infectious mononucleosis present similarly. What is the difference to differentiate them by investigation

A

In CMV

  • negative monospot test
  • negative paul bunnell test
  • fewer atypical lymphocytes
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50
Q

Name 3 causes of candida in the mouth

A

post antibiotics
immunosuppressed
inhaled steroids

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51
Q

Management of candida

A

Fluconazole

52
Q

You should swab pus in acute ottitis media. True or false?

A

False

- only do this if the eardrum has perforated

53
Q

Management of ottitis media

A

In first 4 days - self limiting
If over 4 days
- first line: amoxicillin
- second line: erythromycin

54
Q

What is usually the causative organism of malignant ottitis?

A

Pseudomonas aerginosa

55
Q

What is malignant ottitis?

A

Extension of otitis externa into the nearby bones (temporal, mastoid) and causes osteomyelitis

56
Q

Name 3 bacterial causes of ottitis externa

A

Staph aureus
Proteus
Pseudomonas aerginosa

57
Q

You should use topical / oral antibiotics for treatment of ottitis media?

A

Topical

58
Q

Persisting sinusitis infection over 10 days. Which antibiotic is used to treat?

A

Phenoxymethylpenicillin

59
Q

Which criteria is used for differentiating viral vs bacterial tonsilitis

A

centor criteria

60
Q

What is the management of bacterial tonsilitis

A

Penicillin

61
Q

Bacterial meningitis - which types of cells will be present

A

Abundant neutrophils

62
Q

Which antibiotic is used in bacterial meningitis

A

2b IV ceftriaxone BD

63
Q

Management of bacterial meningitis

A

IV ceftriaxone 2g IV BD

IV dexamethasone 10mg QDS

64
Q

Patient has bacterial meningitis. They have been started on ceftriaxone at 0800. At 2200 that evening, the doctor goes to prescribe dexamethasone. Is this ok and why>

A

No, if dexamethasone hasnt been started within first 12 hours of antibiotic therapy then don’t include it

65
Q

What is the purpose of using dexamethasone in the treatment of bacterial meningitis?

A

It is used to cover pneumococcal organism.
If the organism comes back and IS pneumococcal, continue dexamethasone for 4 days.
If the organism comes back and is a DIFFERENT ORGANISM, stop dexamethasone

66
Q

Patient with a gradual onset of stupor and confusion. What is the likely diagnosis?

A

encephalitis

67
Q

Management of encephalitis

A

IV aciclovir

68
Q

Meningitis clinical features

A 
Severe Headache 
Neck stiffness
Non blanching rash 
N+V 
Confusion
Drowsy 
Severe muscle pain
69
Q

Age 10-21, what is the most likely organism causing bacterial meningitis?

A

Neiserria meningitides

70
Q

Age over 21, what is the most likely organism causing bacterial meningitis?

A

Strep pneumoniae

then Neiserria meningitides

71
Q

Patient having neurosurgery and gets bacterial meningitis. What is the most likely causative organism?

A

Staph aureus

72
Q

Patient has fractured cribriform ethmoid plate and gets bacterial meningitis. What is the most likely cause?

A

Strep pneumoniae

73
Q

Patient has basilar skull fracture and gets bacterial meningitis. What is the most likely causative organism?

A

Strep pneumoniae

74
Q

Most common causative organism of bacterial meningitis in children under 4 years old?

A

Haemophilus influenzae B

75
Q

antibiotic of choice for treatment of listeria infection?

A

Amoxicillin

or Ampicillin

76
Q

For meningitis, in which patients is penicillin resistant pneumococci a posibility?

A

Travelers

- give them prophylactic IV vancomycin or PO rifampicin

77
Q

Treatment of bacterial meningitis in a patient who is allergic to ceftriaxone?

A

Chloramphenicol

78
Q

Every patient with suspected bacterial meningitis should get a lumbar puncture. true or false?

A

False

- only if clinically feasible

79
Q

Typical CSF findings for bacterial meningitis

  • predominant cells
  • WBC count (high/low)
  • protein (high/low)
  • glucose (high/low)
A

abundant neutrophils
WBC = high
Protein = high
Glucose = low

80
Q

Typical CSF findings for viral meningitis

  • predominant cells
  • protein (high/low)
  • glucose (high/low)
A

lymphocytes
protein = normal, maybe slightly high
glucose = normal

81
Q

Typical CSF findings for TB meningitis

A

lymphocytes
protein = very high
glucose = low

82
Q

Provided the patient’s airway, breathing and circulation are under control, what is the initial management of meningitis in the hospital setting?

A

Blood for blood culture
Initial Tx (ceftriaxone, dexamethasone)
Throat swab

83
Q

Some patients need to undergo CT prior to lumbar puncture. Which patient groups are these?

A 
Immunocompromised patients 
Hx CNS disease
New onset seizure
Papilloedema 
Focal neurological deficit
84
Q

In bacterial meningitis, which should be given first….antibiotics or lumbar puncture?

A

Antibiotics first

- if LP will be performed under 30 mins then can do LP first. otherwise, antibiotics first

85
Q

Management of bacterial meningitis in patients with GCS < 12 or fluctuating consciousness levels

A 
Secure airway
high flow oxygen 
IV 2g ceftriaxone 
IV dexamethasone 10mg 
DO NOT WAIT FOR CT / LP
86
Q

All clinically suspected meningitis cases must be reported to public health. True or false?

A

True

87
Q

Contact prophylaxis regieme for bacterial meningitis

A

PO rifampicin 600mg 12-hourly for 4 doses

88
Q

Pseudomonas aeruginosa is a gram negative bacilli. true or false?

A

True

89
Q

Pseudomonas aeruginosa is a coliform. True or false?

A

False

90
Q

Best antibiotic to treat a pseudomonas aeruginosa infection?

A

Ciprofloxacin

91
Q

Ciprofloxacin is safe / unsafe to use in pregnant woman

A

unsafe

92
Q

Which 2 groups of people should you NOT do urinalysis on

A

Elderly patients

Catheterised patients

93
Q

In urinalysis (dipstick urine), what features point towards a UTI diagnosis

A 
Leukocyte esterase (indicates presence of WBC)
Nitrites (indicates presence of bacteria in urine)
94
Q

Urine microscopy is a common investigation for UTI. True or false?

A

False

- only in selected (urgent) cases

95
Q

Over 10 to the power ?? of organisms/ml urine suggests a probable UTI

A

Over 10 to the power 5 (10^5)

96
Q

For a lower UTI, ideally the antibiotic used should be excreted where ?

A

Excreted in the Urine

97
Q

What is abacterial cystitis

A

Patient has symptoms of Lower UTI

No organisms grown on culture

98
Q

Define asymptomatic bacteruria

A

Over 10^5 organisms/ml urine present

Patient is asymptomatic

99
Q

Antibiotic treatment is required for asymptomatic bacteruria. True or false?

A

False

- not required

100
Q

Which one group of patients requires antibiotic treatment for asymptomatic bacteruria?

A

Pregnant woman

101
Q

Gentamicin is safe / unsafe to use in pregnancy?

A

Unsafe

102
Q

Which UTI antibiotic should be avoided in the first trimester?

A

Trimethoprim

103
Q

Which antibiotic is ONLY for lower UTI and not used to treat upper UTI

A

Nitrofurantoin

104
Q

What is a c.diff infection?

A
  1. Patient receives antibiotics.
  2. This alters normal gut flora
  3. Pts are exposed to c.diff and can become colonised
  4. A - asymptomatic colonisation
  5. B - c. diff multiplies and releases toxins causing c.diff infection
105
Q

Name the 4 C antibiotics

A

Co-amoxiclav
Cephlasporins
Ciprofloxacin
Clindamycin

106
Q

What is the main risk factor for the development of C. diff infection?

A

Previous exposure to antibiotics

107
Q

What is the most common bacterial cause of healthcare associated GI infection in adults?

A

C. diff

108
Q

What is the main symptom of c. diff infection?

A

Diarrhoea

109
Q

When do symptoms of C.diff usually occur?

A

Between day 4 and day 9 of antibiotic treatment

110
Q

How is c.diff spread

A

Faecal-oral route

111
Q

How does c.diff bacteria most commonly get into the environment?

A

Diarrhoea

112
Q

Where should a patient with c. diff infection be treated?

A

Side room

113
Q

How should you perform hand hygeine when faced with c. diff infection?

A

SOAP AND WATER

114
Q

When is a patient considered to be clear of a c diff infection?

A

if patient has been symptom free for over 48 hours

115
Q

A young male patient has a 3 day history of pain and swelling in his left knee. He is a keen footballer and developed his symptoms 3 days following trauma to his knee. His temperature is 38ºC, respiratory rate 16 per minute and pulse 60 per minute. He has a hot, swollen left knee with tenderness along the joint margins and a reduced range of movement. What is the likely diagnosis?

A

Septic arthritis

116
Q

In a young otherwise fit patient with septic arthritis, what is the most common causative organism?

A

Staph aureus

117
Q

A 30 year old immigrant from India with a history of non productive cough, weight loss and night sweats for three weeks. Chest x-ray shows right apical consolidation. What is the likely diagnosis?

A

TB

118
Q

A 30 year old immigrant from India with a history of non productive cough, weight loss and night sweats for three weeks. Chest x-ray shows right apical consolidation. Given the likely diagnosis, what is the most appropriate diagnosis that would help support the diagnosis?

A

Bronchoscopy with lavage

119
Q

A young child is admitted with abdominal pain and bloody diarrhoea for 4 days. Renal function indicates renal failure. What test is most appropriate to diagnose the likely source of infection?

  • stool toxin test
  • stool microscopy
  • stool culture
A

stool culture

120
Q

Patients admitted for elective joint replacements (eg hip, knee) should receive prophylactic antibiotics before the surgery. True or false?

A

True

121
Q

For patients receiving prophylactic antibiotics before joint replacement, how long should the course of antibiotics be

A

No longer than 24 hours

122
Q

Name 3 blood borne viruses

A

HIV
Hep B
Hep C

123
Q

IVDU and phlebotomist gets a needlestick injury. What infection is most likely to be acquired following exposure to this patient?

  • Hep C
  • HIV
A

Hep C

124
Q

Which hepatitis is a common and important cause of liver disease in the UK

A

Hep C

125
Q

What is the treatment for giardia infection

A

Metronidazole 5 days

Y4 (23 decks)

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