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Year 4 Medical specialties > Infectious diseases > Flashcards

Infectious diseases Flashcards

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USMLE® Step 1 flashcards
1
Q

define colonisation

A

presence of a microbe in the human body without an inflammatory response

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2
Q

define infection

A

inflammation due to a microbe

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3
Q

define bacteraemia

A

presence of viable bacteria in the blood

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4
Q

define sepsis

A

life threatening organ dysfunction caused by a dysregulated host response to infection

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5
Q

define septic shock

A

sepsis AND (despite adequate fluid resuscitation + vasopressors) persistent hypotension AND lactate >=2

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6
Q

what is SIRS

A 
NON-specific clinical response including >=2 of the following:
temp >38 <36 
HR >90
RR >20 
WBC >12000
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7
Q

causes of SIRS

A 
infection 
burns 
trauma 
pancreatitis 
and other insults
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8
Q

What is the term for SIRS with a presumed/confirmed infectious process

A

sepsis

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9
Q

list the organ dysfunction that can occur due to sepsis

A 
renal 
CNS 
haematological - DIC 
CVS
hepatic 
respiratory 
metabolic acidosis
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10
Q

what is the qSOFA score

A 
screening for outcome rather than diagnosis 
(see slide)
RR >22
sBP <100 
Altered GCS
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11
Q

NEWS of ?, think sepsis

A

NEWS of >=5 with a known infection, think sepsis

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12
Q

RF for sepsis

A 
age: <1yr or >75yr 
frail people 
recent trauma / invasive procedure 
immunocompromised
- DM, hyposplenism, Coeliac
- steroids, chemo, DMARDs, biologics
Indwelling lines - catheters, cannulas
PWID 
breach in skin integrity - burns, ulcers, wounds,  infections 
pregnancy/puerperium, PPROM
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13
Q

What is the sepsis 6 bundle

A 
Cultures: blood, sputum, urine, stool, wound
Lactate 
Urine output 
Oxygen 
IV fluids 
IV antibiotics 
WITHIN 1 HOUR!!!
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14
Q

principles in fluid resuscitation in sepsis

A

250-500ml 0.9% saline/Hartmanns over 15 min
aim for MAP >65mmHg
aim for 30ml/kg over first 3 hours

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15
Q

if BP is unresponsive after fluid resuscitation, what should you do

A

consider transfer to HDU for vasopressors via CVC e.g. noradrenaline, vasopressin

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16
Q

what is a high lactate a sign of

A

ischaemia and hypoperfusion

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17
Q

minimal target for urine output in sepsis

A

0.5ml/kg/hour

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18
Q

signs of infection in someone with a NEWS >5

A 
new onset confusion 
cough 
UTI - dysuria 
abdo pain 
abnormal bloods
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19
Q

skin colonisers/commensals

A

staphylococcus aureus, epidermidis

corynebacterium - diphtheroids

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20
Q

what are potential contaminants of cultures

A

staph epi

diphtheroids

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21
Q

what is a pathogen

A

any bug that has the potential to cause disease

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22
Q

Gram positive bacteria have a thick/thin peptidoglycan wall

A

thick

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23
Q

Gram negative bacteria have a thick/thin peptidoglycan wall and an additional __ layer

A

thin wall

additional lipopolysaccharide layer

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24
Q

what do the following severity scoring systems assess:
CURB65
Dukes

A

CURB65 - CAP

Dukes - IE

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25
Q

oral cavity colonisers

A

strep viridans group

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26
Q

vagina colonisers

A

enterobactereriaceae
lactobacillus
candida
staph aureus

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27
Q

large bowel colonisers

A

enterobactereriaceae - E.coli, klebsiella, enterobacter, proteus
enterococci - E.faecalis / faecium

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28
Q

what is IVOST

A

IV to oral switch

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29
Q

List B lactam antibiotics

A 
penicillin 
flucloxacillin 
amoxicillin 
co-amoxiclav 
cephalosporins 
pipercillin / tazobactam 
carbepenems
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30
Q

what is the allergy causing part in some antibiotics

A

B lactam ring

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31
Q

Penicillin G is IV/PO?

A

penicillin G = IV = benzylpenicillin

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32
Q

Penicillin V is IV/PO?

A

penicillin V = PO = phenoxymethylpenicillin

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33
Q

which is more effective PO penicillin or amoxicillin

A

PO amoxicillin > penicillin

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34
Q

describe the haemolysis in the following for strep:
alpha
beta
gamma

A

alpha - partial / green tinge
beta - complete / golden
gamma - none

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35
Q

what is the antibiotic of choice for Gm + bacteria

A
  1. amoxicillin

2. vancomycin

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36
Q

what is VRE

A

vancomycin resistant enterococcus

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37
Q

antibiotic of choice for staph. Aureus

A

FLUCLOXACILLIN

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38
Q

antibiotic of choice for MRSA or penicillin allergy

A

vancomycin

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39
Q

RF for C. diff infection

A 
elderly 
4 Cs antibiotics 
PPIs 
prolonged hospital stay 
surgical procedure 
immunocompromised
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40
Q

4 Cs for C.diff

A 
cephalosporins 
ciprofloxacin (and all quinolones)
clindamycin 
co-amoxiclav 
NOT clarithromycin
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41
Q

what is used to assess severity of C.diff infection

A

severity assessment

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42
Q

management of non-severe c.diff infection

A

PO metronidazole

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43
Q

management of severe c.diff infection

A

PO vancomycin +- IV metronidazole

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44
Q

C.diff requires isolation?

A

yes

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45
Q

in a case of intra-abdominal sepsis, which antibiotics cover the following:
enterococci
anaerobes
gram negative coliforms

A

enterococci - amoxicillin
anaerobes - metronidazole
gram negative coliforms - gentamicin

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46
Q

side effects of quinolone antibiotics

A 
tendon rupture 
lower seizure threshold 
c.diff infection 
psychosis 
aortic rupture
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47
Q

the pathogenicity of gram negative bacteria is associated with what

A

LPS layer of the outer membrane

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48
Q

antibiotics that may be active against Gm-

A 
B lactams 
monobactam - aztreonam 
aminoglycosides - gentamicin 
macrolides 
tetracyclines 
chloramphenicol 
co-trimoxazole
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49
Q

aztreonam is only effective against Gm + or -

A

Gm -ves

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50
Q

RF for Gm - infection

A 
HAP vs CAP 
ventilated vs not 
time of year 
immunosuppressed 
chronic lung disease 
travel 
epidemiological exposures
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51
Q

what is HiB

A

gram negative coccobacillus

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52
Q

examples of microbes causing atypical pneumonia and what is the management

A 
legionella 
mycoplasma 
coxiella 
C. psittaci 
macrolides, tetracyclines, quinolones
53
Q

RF for legionella

A 
lukewarm aerosolised water 
smokers 
males 
COPD 
immunocompromised 
malignancy 
DM 
dialysis 
hot tubs
54
Q

test for legionella (serotype 1)

A

urinary antigen

55
Q

antibiotics for legionella

A

levofloxacin

56
Q

what are coliforms

A

Gm - rods

57
Q

which microbes cause Gm - sepsis

A 
E.coli 
Klebsiella 
Pseudomonas 
Enterobacter 
N. meningitides
58
Q

what are ESBLs

A

extended spectrum B lactamases

bacteria that are resistant to B lactam antibiotics i.e. resistant Gm -ves

59
Q

side effects of gentamicin

A

otoxicity

nephrotoxicity

60
Q

max duration of gentamicin therapy

A

72 hours

61
Q

CVS dysfunction in sepsis

A

hypotension due to vasodilatation

distributive shock

62
Q

pulmonary dysfunction in sepsis

A

ARDS

resp failure

63
Q

renal dysfunction in sepsis

A

AKI

64
Q

hepatic dysfunction in sepsis

A

transaminitis due to hypoperfusion

jaundice

65
Q

CNS dysfunction in sepsis

A

delirium / acute confusional state
drowsy
altered GCS

66
Q

what is lactic acidosis

A

diffuse tissue hypoxia and hypoperfusion leads to anaerobic metabolism and therefore lactic acid production –> met acidosis

67
Q

haemtological dysfunction in sepsis

A

DIC = imbalance between clotting and bleeding from endothelial dysfunction
thrombocytopaenia, prolonged PTT/APTT, low fibrinogen, raised d dimers

68
Q

allergy to 1 B lactam = allergy to all?

A

yes

69
Q

examples of quinolones

A

ciprofloxacin
levofloxacin
oflaxacin
moxifloxacin

70
Q

B lactams are bactericidal/bacteriostatic

A

bactericidal

71
Q

side effects of tetracyclines

A

photosensitivity

teeth staining in kids

72
Q

which antibiotic does NOT cover strep pneumoniae

A

ciprofloxacin

73
Q

what does clindamycin cover

A

Gm + and anaerobes

74
Q

what infections can listeria cause

A

meningitis in immunosuppressed

gastroenteritis

75
Q

vancomycin works against Gm -, true or false

A

FALSE

only Gm +

76
Q

which antibiotic should never be prescribed on its own

A

rifampicin

77
Q

side effects of antibiotics in general

A

N+V
diarrhoea
rashes
candida

78
Q

side effects of penicillins

A

hypersensitivity

skin reactions

79
Q

what antibiotics can cause cholestatic jaundice

A

flucloxacillin

co-amoxiclav

80
Q

side effects of macrolides

A

N+V
GI upset
hepatotoxicity
long QT

81
Q

side effects of quinolones

A

long QT
lower seizure threshold
tendonitis and rupture
AAA

82
Q

side effects of aminoglycosides

A

nephrotoxicity

ototoxicity

83
Q

side effect of vancomycin

A

red man syndrome

84
Q

side effects of tetracyclines

A

photosensitivity
hepatotoxicity
teeth staining
dysphagia

85
Q

side effects of nitrofurantoin

A

peripheral neuropathy

pulmonary fibrosis

86
Q

side effects of sulphonamides

A

SJS

haematological

87
Q

side effect of trimethoprim

A

blood dyscrasias

88
Q

side effects of chloramphenicol

A

aplastic anaemia

grey baby syndrome

89
Q

aztreonam does not cause a penicillin associated allergy

A

true

90
Q

how many blood cultures should you take for suspected IE

A

3

91
Q

Criteria for IVOST

A 
HOME 
Haemodynamically stable 
Oral route available 
Markers of inflammation improving 
Exclude deep seated infection
92
Q

what is a SAB

A

Staph Aureus Bacteraemia

93
Q

which antibiotics cover Gm+ bacteria?

A 
Penicillins: flucloxacillin, amoxicillin, co-amoxiclav
Vancomycin 
Cephalosporins 
Rifamipicin 
Fusidic acid 
Co-trimoxazole 
Clindamycin 
Carbepenems
94
Q

which antibiotics cover anaerobic bacteria?

A 
Metronidazole 
Clindamycin 
Vancomycin 
Co-trimoxazole 
Carbepenems
95
Q

which antibiotics cover Gm- bacteria?

A 
Gentamicin 
Co-trimoxazole 
Amoxicillin 
Carbepenems 
Quinolones
96
Q

why is nitrofurantoin never used for pyelonephritis

A

only penetrates the bladder

not effective in the kidneys - poor tissue penetration

97
Q

antibiotics for pyelonephritis

A

amoxicillin and gentamicin

98
Q

how do you make a diagnosis of pneumonia

A

consolidation on a CXR

99
Q

in someone with a UTI/pyelonephritis what else should you ask in the history

A

PV discharge / symptoms

recent STI

100
Q

another differential you should consider in pyelonephritis

A

renal calculi

101
Q

what are possible infectious causes of diffuse generalised abdominal pain in e.g. elderly patients

A

UTI

102
Q

what strain of Staph A can cause multiple boils in the skin

A

PVL producing Staph

103
Q

what toxin does E.coli 0157 release that causes HUS

A

shiga toxin

104
Q

types of infections that PWID are at increased risk of

A 
cellulitis - repetitive breach into the skin 
Infective endocarditis 
phlebitis / DVT 
abscess 
bacteraemia 
pseudoaneurysm from arterial puncture
105
Q

what side of the heart are PWID more likely to get IE

A

right sided because of venous access

but technically can get vegetations at any part

106
Q

what is required to have IE

A

bacteraemia

107
Q

what bug specifically causes IE in prosthetic valves

A

staph epi

108
Q

what is the most common bug cause of IE

A

staph aureus

109
Q

causes of acute IE

A

staph A
strep viridans
MRSA

110
Q

causes of subacute IE

A

enterococci

strep viridans

111
Q

where are you most likely to get MRSA IE

A

repeated hospital admissions

112
Q

what is the logic behind prescribing gentamicin for IE

A

it has a synergistic effect when given with amoxicillin / vancomycin, against strep
normally 7mg/kg but in IE, 1mg/kg

113
Q

differential diagnoses of fevers, weight loss

A 
subacute IE 
TB 
malignancy 
abscess 
osteomyelitis 
deep seated infection
114
Q

investigations for TB swab

A

PCR - faster and more sensitive

acid fast bacilli - needs a large number of bacteria

115
Q

treatment for TB

A 
2 RIPE 4 RI 
rifampicin 
isoniazid 
pyrazinamide 
ethambutol
116
Q

side effect of TB drugs

A

rifampicin - orange urine, hepatitis
isoniazid - peripheral neuropathy, hepatitis, P450 inhibitor
pyrazinamide - gout
ethambutol - loss of colour vision

117
Q

N. meningitides is a commensal of ??

A

the throat in some people

118
Q

causes of meningitis in adults

A 
N. meningitides - younger 
HiB 
strep pneumoniae - older 
(NHS)
enteroviruses  
HSV2
119
Q

which virus commonly causes encephalitis

A

HSV1

120
Q

imaging for encephalitis

A

CT - to rule out mass lesions…

MRI - better to look at brain parenchyma

121
Q

why do you do a CT for some people with meningitis

what are the indications

A

to exclude risk of brain herniation in those with signs to carry out LP safely

  • focal neurology
  • low GCS <12
  • seizures
  • papilloedema
122
Q

ICP will be raised in all causes of neuro infection?

A

true

123
Q

when doing a LP, where will you send the sample?

A

microbiology - gram stain and culture, viral PCR
microscopy - white cells
biochemistry - glucose, protein

124
Q

causes of liver abscesses

A

portal venous system - carrying blood from other areas in the abdomen which may have disease e.g. diverticular abscess, CRC
hepatobiliary - cholecystitis, cholangitis
haematogenous seeding
external - surgery, biopsy

125
Q

in severe C.diff infection, why would you add IV met to PO vanc

A

IV metronidzaole in those with ileus to help vancomycin reach the gut better

126
Q

indications for IVOST

A

exclude deep seated infection
safe oral route available with good choice of antibiotic
resolution of inflammation and improvement seen

127
Q

in those with febrile neutropaenia, what is the most common bug

A

gram negatives e.g. pseudomonas

treat with pip/taz

128
Q

rapid diagnostic test for C.diff

A

stool toxin

Year 4 Medical specialties (3 decks)

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