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Year 3: Immunity; Infection > Management of Common Infections > Flashcards

Management of Common Infections Flashcards

1
Q
A
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2
Q

How (and why) do you collect urine sample when investigating a UTI? [1]

A

Mid stream (avoid contamination of bacteria around urethra)

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3
Q

Describe how you would step up investigations for following UTIs:

  • Asymptomatic bacterial infection
  • Pyelonephritis
  • Urosepsis
A

Asymptomatic bacterial infection:
- DIpstick
- MSU Culture

Pyelonephritis
- DIpstick
- MSU Culture
- Renal US or renal CT

Urosepsis
- DIpstick
- MSU Culture AND Blood culture
- Renal US or renal CT +/- abdomonal CT

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4
Q

Describe the overall managment plan for following:

  • Asymptomatic bacterial infection
  • Pyelonephritis
  • Urosepsis
A
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5
Q

When would you treat asymptomatic bacteria? [4]

A

Normally - don’t, but do if:
- Immunosuppresed
- Abnormal anatomy
- Children
- Prenant

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6
Q

Which bacteria causing UTIs are strongly associated with renal calculi? [1]

A

Proteus mirabilis
Consider imaging

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7
Q

If you find S. aureus as a cause of UTI - what other pathology would you have a suspicion of? [1]

A

S. aureus isn’t usual uropathogen - have suspicion for endocarditis
- endocarditis -> renal abscess -> urine

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8
Q

What is important to think about nitrofurantoin when treating UTIs? [1]

A
  • Need a eGFR > 60 otherwise won’t get into urine and effect
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9
Q

How long does usually fever last in pyelonephritis? [1]

A

3/4 days

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10
Q

Under what conditions would warrant further investigations w UTI? [5]

A
  • UTI in child
  • UTI in a man
  • Recurrent UTIs
  • Persistent symptoms
  • Urinary catheter
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11
Q

Define:

  • Cellulitis
  • Erysipelas
  • Impetigo
A

Cellulitis:
- Infection of dermis AND subcut tissue
- Typically indistinct edge

Erysipelas:
- Infection of dermins only
- Demarcated edge

Impetigo
- Infection usually of epidermis around mouth

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12
Q

Which organsims most commoly cause impetigo? [2]

A

Staph aureus
Streptococcus pyogenes

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13
Q

What is the usual treatment for skin & soft tissue infections? [1]

A

Flucoxacillin (high activity agaisnt staph aureus / strep pyogenes)

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14
Q

What is key to think about SSTIs? [1]

A

If pain is disproportinate to degree of skin change - if so: necrotising fascitis?

Fascia doesn’t have rich blood supply - so little lymphocytes

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15
Q

What is key to thing about cellulitis infection? [1]

A

Highly unlikely that is bilateral - think of a differential diagnosis

Bilateral cellulitis does not exist

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16
Q

Give three differentials for a hot red leg [3]

A

Cellulitis
DVT
Drug reaction
Gout
Insect bites
Exacerbation of lymphoedema

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17
Q

How do you assess for Mycoplasma pneumonia? [1]

18
Q

Describe how atypical pneumonias present differently to typical resp infections

A
  • Illness often milder
  • WBC often less elevated
  • May be associated with abnormal LFTs & hyponatraemia
  • Extra-pulmonary manifestations more common: at the time of resp. infection - e.g. myalgia; post-pulm. Infection -
    e.g. mycoplasma and ADEM, deafness, skin rashes etc
19
Q

Most atypical pneumonias are more mild - except for which one? [1]

A

Legionella infection

20
Q

What are the general principles for CAP:

  • Low severity [1]
  • Moderate severity [2]
  • High severity [3]
A

Low severity
- single antibiotic

Moderate severity:
- amoxicillin & a macrolide (azithromycin, clarithromycin, and erythromycin)

High severity
- β-lactamase stable β-lactam (e.g. co-amox) & a macrolide

21
Q

A patient presents with CAP - under what conditions would you give pip-taz? [3]

A

If they have pseudomonas infection:
-CF; bronchiectasis

22
Q

A patient comes back from the Gulf with a resp. infection - what should you consider? [1]

23
Q

How do you test for infections for [3]
- Pneumococcal
- Legionella
- Mycoplasma

A

Pneumococcal
- Urinary antigen - if haven’t been able to isolate strep pneumonia from another site

Legionella:
- Urinary antigen

Mycoplasma:
- PCR

24
Q

How do you differentiate between the symptoms of meningitis and encephaltiis?

A

Meningitis
- Symptoms of headache, neck stiffness & photophobia

Encephalitis:
- Symptoms associated with altered cerebral function (e..g Seizures, weakness, behaviour change, drop in GCS etc)

25
What are the implications of dinstinction betwen mengintis vs encephalitis with regards to treatment? [2]
Likely causes e.g. in UK **encephalitis viral** > **bacterial** Treatment e.g. **viral** **meningitis** does **NOT** need treatment, **enceph** **DOES**
26
What are the different ways of classify infective endocarditis? [3]
Native vs. prosthetic valve Indolent vs. acute Culture positive vs. culture negative
27
Under what conditions would you suspect Streptococcus gallolyticus causing infective endocarditis? [1]
Due to **GI malignancy**
28
Under what conditions would you suspect Viridans streptococci causing infective endocarditis? [1]
**Dental disease**
29
Under what clinical picture would you suspect Salmonella typhi infection? [1] What would you use to treat? [2]
Fever; malaise; abdominal pain; diarrhoea; constipation; travel history where there is poor sanitation Treat early because can lead to septiciaemia and death :( With a **cephalosporin** (e.g cefuroxime) or **fluoroquinolone**
30
What are the three most common causes of viral meningitis? [3]
**Enteroviruses** (e.g., coxsackievirus) Herpes simplex virus (**HSV**) Varicella zoster virus (**VZV**)
31
Viral meningitis is generally self-limiting. How do you treat HSV and VZV if needed? [1]
Viral PCR testing can be performed on a CSF sample. **Aciclovir** is used to treat **HSV and VZV.**
32
The causes of bacterial meningitis include: [5]
Neisseria meningitidis Streptococcus pneumoniae (pneumococcus) Haemophilus influenzae Group B streptococcus (GBS) (particularly in neonates as GBS may colonise the vagina) Listeria monocytogenes (particularly in neonates)
33
What does a non-blanching rash indicate with meningitis? [1]
Where there is **meningococcal septicaemia**, children can present with a non-blanching rash. Other causes of bacterial meningitis do not usually cause the non-blanching rash.
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35
Children seen in the primary care setting with suspected meningitis and a non-blanching rash should receive an urgent dose of **[]** (IM or IV) while awaiting transfer to hospital (it should not delay transfer).
Children seen in the primary care setting with suspected meningitis and a non-blanching rash should receive an urgent dose of **benzylpenicillin** (IM or IV) while awaiting transfer to hospital (it should not delay transfer). Where there is a true penicillin allergy, transfer should be the priority rather than other antibiotics.
36
Typical antibiotics are to treat bacterial meningitis include Under 3 months – **[]** plus **[]** ([] is to cover listeria) Above 3 months – **[]** PLUS []
Typical antibiotics are: Under 3 months – **cefotaxime** plus **amoxicillin** (amoxicillin is to cover listeria) Above 3 months – **ceftriaxone** PLUS **Steroids** (e.g., **dexamethasone**) are also used in bacterial meningitis to reduce the frequency and severity of hearing loss and neurological complications.
37
When treating bacterial meningitis - what drug should be given if suspect penicillin-resistant pneumococcal infection? [1]
**Vancomycin** should be added if there is a risk of penicillin-resistant pneumococcal infection (e.g., recent foreign travel or prolonged antibiotic exposure).
38
Significant exposure to meningococcal infection puts contacts at risk. This risk is highest with close prolonged contact within 7 days before the onset of the illness. The risk to contacts decreases 7 days after the diagnosis. Post-exposure prophylaxis is guided by the local health protection team when they are notified of the diagnosis. The usual choice is a single dose of **[]** given as soon as possible after the diagnosis.
Post-exposure prophylaxis is guided by the local health protection team when they are notified of the diagnosis. The usual choice is a single dose of **ciprofloxacin** given as soon as possible after the diagnosis.
39
Describe the Eron classification for the assessment of the severity of cellulitis [4]
The Eron classification assesses the severity of cellulitis: **Class 1** – no systemic toxicity or comorbidity **Class 2** – systemic toxicity or comorbidity **Class 3** – significant systemic toxicity or significant comorbidity **Class 4** – sepsis or life-threatening infection
40
Patients with **cellulitis** who are **penicillin** allergic can be given [3]
Patients with cellulitis who are penicillin allergic can be given **clarithromycin, erythromycin (in pregnancy) or doxycyline**

Year 3: Immunity; Infection (16 decks)

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