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Infection > PUO / Influenza / HAI > Flashcards

PUO / Influenza / HAI Flashcards

1
Q

What is a PUO

A

> 3 febrile episodes

1 week of investigation

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2
Q

What is a fever

A

Elevation of temp above 37

Clinical cut off = 38

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3
Q

What causes a PUO

A 
Infection 
Malignancy
Inflammatory
Drugs
Venous thrombosis 
Neutropenia 
HIV associated
Tropical disease
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4
Q

What infections tend to cause

A

Abscess

TB

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5
Q

What are inflammatory causes of PUO

A

SLE
Vasculitis
IBD

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6
Q

What is a neutropenic fever

A

Undiagnosed fever in patient with low neutrophils <500

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7
Q

What is HIV associated fever caused by

A

Commonly mycobacterium TB / avium

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8
Q

When is tropical disease unlikely

A

If fever <21 days

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9
Q

What tropical diseases cause fever

A

Malaria
Tyhpoid
Dengue

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10
Q

What is important in the Hx of fever

A 
Pattern
Travel
Contact
Food
Sexual 
FH - age on onset
Occupation
PMH / drug / surgery
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11
Q

What do you ask in travel HX

A 
Location 
Risk activities
Purpose of trip
Accommodation
Vaccine
Malaria prophylaxis - always 
Sexual contacts
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12
Q

What investigation should you do for fever

A 
EXAM - REPEAT 
FBC, U+E, LFT, CRP
Blood film
Blood culture 
Urine / stool
Urinanalysis
CXR
USS abdo
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13
Q

When do you do cultures

A

At time of fever

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14
Q

What are further tests that can be done if Dx still unknown

A 
Blood culture / serology for tropical disease
Bone marrow 
ECHO 
Biopsy - if headache 
TB test
BBV
Renal biopsy / USS
Auto Ab 
CT PET
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15
Q

When do you do ECHO

A

New murmur

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16
Q

When do you do bone marrow

A

Malignancy

Leishmaniosis

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17
Q

When do you do renal biopsy

A

Haematuria

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18
Q

How do you treat PUO

A

Steroids if suspect vasculitis
Anti-TB
Steroids / NSAIDs - may respond even if no Dx

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19
Q

When is TB unlikely

A

If no response after 2 weeks of chemo

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20
Q

What is a fabricated fever

A

Fever is real but self induced

Multiple organisms on blood culture

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21
Q

What is a pyrogen

A

Substance which causes fever
Endogenous - cytokine
Exogenous - endotoxin

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22
Q

What do pyrogens do

A 
Act on hypothalamic thermoregulatory centre
Increases set point
Vasoconstriction
Decreased heat loss 
Causes fever
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23
Q

What is a HAI

A

Infection arise >48 hours after admission or discharge

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24
Q

What are common sources of HAI

A 
Catheter
Surgical site
Intubation
Central lines
Break in skin
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25
Q

What does HAI transmit

A 
Direct contact
Respiratory
Faecal - oral
Penetrating injury
Disruption bacteria / host = most common
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26
Q

Microbial RF in hospital

A

Increased resistance

Increased transmission

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27
Q

What are host RF

A 
Devices
Ax
Wounds
Immunosuppression
Age
Overcrowding
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28
Q

What are common HAI

A 
Resp
Blood
GI
SSTI
UTI
29
Q

What does HAI lead too

A 
Increased stay
Death
Cost
Litigation
Loss of public confidence
30
Q

How is surveillance carried out

A

Lab
Ward
National

31
Q

What is an outbreak

A

2+ cases linked in time and space

32
Q

How do you deal with an outbreak

A

Single room isolation
Clinical ara closure
Re-inforce IPC
Staff exclsuion

33
Q

How do you decrease risk

A 
IPC
Risk awareness
Hand hygiene
PPE
Vaccination 
PEP
34
Q

What is influenza

35
Q

What does influenza have

A

H antigen - attachment

N antigen - Virion release

36
Q

What type of influenza cause disease

37
Q

How is influenza spread

A

Airborne - resp droplet

Contact

38
Q

What is the inc

39
Q

What are the symptoms of influenza

A 
Fever 3 days + 2+
Cough
Myalgia
Sore throat
Rhinorhoea / coryzal symptoms 
Headache
Malaise
Increased RR 
Low sats 
N+V+D
NO PNEUMONIA SX
40
Q

When are you non-infectious

A

24 hours after symptoms or when anti-viral completed

41
Q

Who is high risk and what do they get

A 
Chronic disease - renal ,heart, lung, liver - hep B+C, neuro  
DM
Immunosuppression
Asplenia
>65
<6 months
Pregnnant
Obesity BMI >40 
Healthcare

FLU vaccine annually

42
Q

How do you Dx flu

A

PCR nose / throat swab

43
Q

What other investigations can be done

A

Bloods
Blood culture
ABG if low sats

44
Q

What do bloods show

A

Low platelet, WCC

Raised sera protein

45
Q

What should CRP do

A

1/2 when recovering from pneumonia

46
Q

When do you do a CXR

A

If >4 days

47
Q

What are complications

A 
Reyes
Acute bronchitis
Sinusitis
Exacerbation of chronic lung disease 
Otitis media
48
Q

What is Reyes

A 
Rash
Vomiting
Increased LFT
Fatty liver failure 
Encpehalopathy
49
Q

What is another common complication

A

Secondary bacterial pneumonia
S.Aureus = common
H. influenza
S.pneumonia

50
Q

When does it occur

A

4-5 days after

51
Q

What are less common complications

A 
Myocarditis
GBS
Myoglobinuria
Encephaitis
Primary viral pnuemonia
Rapid resp failure
52
Q

When do you give an anti-viral

A 
If within 48 hours 
At high risk 
Complications 
Immuosuppressed
Pregnant
53
Q

What antiviral do you do

A

Oseltamivir (oral) = 1st line

54
Q

SE

A 
N+V+D
Pain
Headache
Hallucination
Renal
55
Q

What are other options

A

Zanamivir (inhaled)

56
Q

CI

A

Bronchospasm

57
Q

What do you give if severe

A

Prophylaxis cipro / co-amoxiclav to prevent pneumonia

58
Q

What other flu

A

Avian flu
H5N1 / H7N9
Infected birds
High mortality

59
Q

What is seasonal flu

A

Every winter

60
Q

What is pandemic flu

A

New virus due to antigenic shift
Sporadic
More serious complications

61
Q

What is the seasonal flu vaccine

A

Inactivated vaccine
Prepare each year
Type A+B
IM

62
Q

What are SE

A

Sore arm
Malaise
Fever

63
Q

Who gets

64
Q

What do children get

A

Live intranasal vaccine

65
Q

When is it CI

A 
Immunocompromised
Current febrile
Current wheeze/ severe asthma
<2 
Egg allergy
Aspirin as risk of Reye's
66
Q

What are SE

A

Blocked nose
Headache
Anorexia

67
Q

What is antigenic drift

A

Small point mutations

Cause epidemics and vaccine mismatch

68
Q

What is antigenic shift

A

Abrupt amor change resulting in H/N combinations

Cause pandemics

Infection (14 decks)

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