Infectious Diseases Doc

Question 1

SIRS CRITERIA

Answer 1

2 of:
HR>90 
RR>20
T<36 or >38
WCC < 4000 or >12000

Question 2

qSOFA

Answer 2

RR >22
BP < 100
Altered mental status

Question 3

Bloods to take in suspected sepsis

Answer 3

Cultures plus others as appt. (urine,sputum, ascitic)

Lactate + FBC.U&Es,LFTs,coagulation,CRP

Question 4

Antibiotics which act on the cell wall

Answer 4

Penicillin 
Cephalosporin
Monobactams - Aztreonam
Carbapenams - meronpenam 
Glycopeptides (vancomycin, teicoplanin)

Question 5

Antibiotics which act on protein synthesis:

Answer 5

Macrolides
Aminoglycosides
Tetracyclines
Clindamycin

Question 6

Antibiotics which target DNA synthesis

Answer 6

Metronidazole
Sulphonamides + trimethoprim (co-trimoxazole)
Quinolones

Question 7

Where is penicillin excreted

Answer 7

Renal

Question 8

Class of antibiotic which acts on cell wall but is not a beta-lactam

Answer 8

Glycopeptides

Question 9

Antibiotics which are useless in UTI due to gut excretion

Answer 9

Macrolides

Question 10

Antibiotic with main act against anaerobic bacteria

Answer 10

Metronidazole

Question 11

Antibiotic which can enhance the effect of sulphonylureas

Answer 11

Co-trimoxazole - due to sulphonamide reaction

Question 12

Quinolones - broad spectrum but have mainly gram ____ cover

Answer 12

Negative

Question 13

Antibiotics which react with THEOPHYLLINE

Answer 13

Macrolides and ciprofloxacin -> increased plasma concentration so can cause seizures

Question 14

Malaria presentation:

Answer 14

Flu-like prodrome
Then fever which is paroxysmal
Sweating

O/E = hepatosplenomegaly

Question 15

Typhoid: enteric fever: Causative organism

Answer 15

Salmonella typhi

Question 16

Typhoid presentation

Answer 16

Abdominal pain, diarrhoea after the first week of malaise

The ROSE SPOT rash appears

Question 17

Typhoid investigation and management

Answer 17

Diagnostic investigation is blood culture
Urine and stool cultures may also be helpful
Seek infectious diseases help for treatment/antibiotics

Question 18

Cholera usually seen in

Answer 18

India

Question 19

Cholera investigation

Answer 19

Stool microscopy and culture

Question 20

Drum stick shaped organism on culture

Answer 20

Tetanus

Question 21

Management of tetanus

Answer 21

Tetanus immunoglobulin

Metronidazole and penicillin

Question 22

Tetanus prophylaxis in wound management:

Answer 22

Vaccine (anti-toxin) or tetanus immunoglobulin

Question 23

High risk would - Tetanus treatment if completed all 5 courses

Answer 23

If dose within the last 10 years - no treatment requires regardless of wound severity

Question 24

Patient has had full course of tetanus vaccines with last dose > 10 years ago

Answer 24

Reinforcing dose of vaccine (anti-toxin)

If high risk wound - vaccine and immunoglobulin

Question 25

If tetanus history is incomplete or unknown

Answer 25

Vaccine regardless of wound severity High risk: Dose of vaccine and tetanus immunoglobulin

Question 26

Endocarditis investigation: 1st and 2nd line imaging

Answer 26

BLOOD CULTURES FROM AT LEAST 3 SITES 1st line is trans-thoracic echo 2nd line is transoesophageal echo - done if prosthetic valve, vegetation’s or non-diagnostic images on TTE.

Question 27

Initial blind therapy endocarditis - native valve

Answer 27

Amoxicillin - consider adding low dose gentamicin (AG)

Question 28

Prosthetic valve endocarditis blind therapy:

Answer 28

VGR - vancomycin + rifampicin + low-dose gentamicin

Question 29

Native valve endocarditis prove to be staph

Answer 29

Flucloxacillin

Question 30

Prosthetic valve endocarditis proven to be staph

Answer 30

FRG - flucloxacillin plus gentamicin plus rifampicin

Question 31

Strep viridans endocarditis tx.

Answer 31

Be green Benzylpenicillin plus gentamicin

Question 32

Indications for surgery endocarditis

Answer 32

``` Severe valvular incompetence Aortic abscess Resistant infections Cardiac failure Recurrent emboli after antibiotic therapy ```

Question 33

Which organism is most likely to colonise a prosthetic valve? After which time does it go back to the most common cause? What is the most common cause?

Answer 33

Staph Epidermidis | After 2 months it returns to usual most common organism which is Staph aureus.

Question 34

Strep Bovis endocarditis association

Answer 34

Colorectal cancer

Question 35

Gold standard test for c.difficile

Answer 35

Stool toxin

Question 36

Antibiotic class which causes QT prolongation

Answer 36

Macrolides