MedEd Infection 2

Question 1

Meningitis vs encephalitis

Answer 1

Meningitis - affects old or young people, mainly bacterial

Encephalitis - inflammation of brain itself, mainly viral

Question 2

Causes of meningitis

Answer 2

Streptococcus pneumoniae,
Neisseria meningitidis, Haemophilus influenzae type B
Viral, fungal, parasites, non-infectious

Question 3

Causes of encephalitis

Answer 3

Infectious and non infectious causes

Virus – main cause (herpesvirus)

Question 4

Symptoms - meningitis vs encephalitis

Answer 4

Meningitis - photophobia, neck stiffness, headache, fever

Encephalitis - seizures, change in consciousness, personality changes, cranial nerve palsies, speech problems, motor and sensory deficit

Question 5

How would you investigate for meningitis vs encephalitis

Answer 5

M - LP

E - Blood cultures, MRI, CSF analysis

Question 6

Management of meningitis

Answer 6

Empirical antimicrobial therapy - ceftriaxone and vancomycin

Question 7

Neonatal infection post extended labour

Answer 7

Group B streptococci

Question 8

Late neonatal infection

Answer 8

E-coli

Question 9

Key neonatal infection

Answer 9

Listeria monocytogenes

Question 10

Gram negative diplocci in children and teenagers

Answer 10

Nisseria meningitis

Question 11

Meningitis in unvaccinated children

Answer 11

Haemophilus influenzae

Question 12

Meningitis in adults - gram positive cocci

Answer 12

Strepococcus pneumoniae

Question 13

Meningitis in elderly after drinking unpasteurised milk, cheese, or in alcoholics

Answer 13

Listeria monocytogenes

Question 14

Signs in meningitis

Answer 14

Brudzinki - flexing neck flexes knees
Kernig's - difficulty extending knee
Fever
Tachycardia
Hypotension
Skin rash - meningococcal septicemia 
Altered mental state

Question 15

Invx for meningitis

Answer 15

Two sets of blood cultures
CT to exclude intracranial pressure
Lumbar puncture

Question 16

Non blanching rash or meningococcal septicemia - mx

Answer 16

Admit and give single dose IV benzylpenecillin

Question 17

Bacterial meningitis mx

Answer 17

IV ceftriaxone

+ dexamethasone but AVOID if meningococcal septicemia

Question 18

3 main bacterium in neonates

Answer 18

Group B strep
E coli
Listeria

Question 19

Mx for listeria

Answer 19

Ampicillin

Question 20

Encephalitis mx

Answer 20

IV acyclovir for herpes

Question 21

Neisseria meningitis mx

Answer 21

Rifampicin or ciprofloxacilin

Question 22

Infective endocarditis after abnormal valves e.g. calcification

Answer 22

Streptococcus viridans or Streptococcus bovis

Question 23

Infective endocarditis after prosthetic heart valves / IVDU

Answer 23

Staphylococci - TR

Question 24

Other causes of infective endocarditis

Answer 24

HACEK (Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella), Coxiella burnetii, histoplasma.

Question 25

Key invx for IE

Answer 25

3 blood cultures, 1 hr apart Echo

Question 26

Complications of infective endocarditis

Answer 26

HF Valve incompetence GN - due to emboli

Question 27

Management of infective endocarditis if the pt has prosthetic valves

Answer 27

Prosthetic Valves | Staphylococci = Flucloxacillin/Vancomycin + rifampicin + gentamicin for 4-6 weeks

Question 28

Management of infective endocarditis if the pt has native valves and a staph aureas infection

Answer 28

Flucoxacillin

Question 29

Management of IE if pt has native valves and penicillin sensitive strep viridans infection

Answer 29

Benzylpenecillin and gentamycin

Question 30

If the pt is allergic to penecillin, what do you give?

Answer 30

Vancomycin

Question 31

Viral causes of gastroenteritis

Answer 31

Rotavirus (most common)

Question 32

Bacterial causes of gastroenteritis

Answer 32

``` Campylobacter jejuni E coli Slamonella Vibrio cholerae Listeria Yersinia enterocolitica ```

Question 33

Protazoal causes of gasteroenteritis

Answer 33

Entamoeba histolytica Cryptosporidium parvum Giardia lamblia

Question 34

Causes of dysentry (bloody diarrhoea)

Answer 34

``` CHESS Campylobacter/c diff Haemorrhagic ecoli Entamoeba histolytica Shigella Salmonella ```

Question 35

Diarrhoea after abx use

Answer 35

C diff

Question 36

Diarrhoea 1-6hr after eating

Answer 36

Staph aureas

Question 37

Diarrhoea after eating leafy greens

Answer 37

Ecoli

Question 38

Diarrhoea after reheated rice

Answer 38

Bacillus cereus

Question 39

Diarrhoea after chicken/poultry

Answer 39

Campylobacter

Question 40

Diarrhoea after eggs

Answer 40

Salmonella

Question 41

Diarrhoea that looks like rice water / after poor sanitation

Answer 41

Vibrio cholera

Question 42

Diarrhoea after travelling to tropical places

Answer 42

Entamoeba histolytica

Question 43

Bloody diarrhoea after eating leafy veg

Answer 43

Haemorrhagic e coli - HUS

Question 44

Diarrhoea in gay people

Answer 44

Entamoeba histolytica | Shigella

Question 45

Invx for diarrhoea

Answer 45

Examine mucous membranes for skin turgor and cap refill to check dehydration BP + HR to check for shock Temp Low K+ = severe D and V Stool MC and S

Question 46

Mx of diarrhoea if not in shock

Answer 46

Supportive therapy - fliuds, electrolyte replacement, rehydration etc

Question 47

Mx of diarrhoea if in shock, temp over 39, dehydration, more than 2 weeks or visible blood

Answer 47

Admit and give oral fluids -give IV if vomiting severely | Abx

Question 48

Invx for 'cyclical fevers' and what this means

Answer 48

Giemsa thick and think - malaria Thick - to investigate current parasites Thin - to identify species

Question 49

Mx of chronic Hep B

Answer 49

Tenofovir | or Peginterferon Alpha

Question 50

Mx for hep A and E

Answer 50

Avoid alcohol

Question 51

Most common UTI organism and its gram staining

Answer 51

Ecoli - gram negative bacilli, positive nitrites