Sepsis

Question 1

what is colonisation?

Answer 1

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

Question 2

what is infection?

Answer 2

inflammation due to a microbe

Question 3

what is bacteraemia?

Answer 3

the presence of viable bacteria in the blood

Question 4

what is sepsis?

Answer 4

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

Question 5

what is septic shock>

Answer 5

a subset of sepsis with circulatory and cellular/metabolic dysfunction associated with a higher risk of mortality

Question 6

what clinical features need to be present to diagnose septic shock?

Answer 6

sepsis
persistent hypotension
lactate >2

Question 7

when would the SOFA score be used?

Answer 7

assessing sepsis outcomes in an ICU setting

Question 8

what is the qSOFA used for?

Answer 8

screening for sepsis outcomes in acute settings - gives information about mortality

Question 9

what three things are included in the qSOFA score?

Answer 9

RR >20
systolic BP <100
altered GCS

Question 10

when does sepsis 6 need to be done after sepsis is suspected?

Answer 10

within one hour

Question 11

what fluids can be given in sepsis?

Answer 11

colloids or crystalloids

Question 12

when should vasopressors be given in sepsis?

Answer 12

1-6 hours after onset

Question 13

what vasopressors are suitable for use in sepsis?

Answer 13

norepinephrine
epinephrine
vasopressin

Question 14

what is involved in the sepsis 6 bundle (BUFALO)?

Answer 14

blood cultures 
urine output 
fluid resus 
antibiotics IV 
lactate measurement 
oxygen if needed

Question 15

when should urine output be monitored in sepsis?

Answer 15

hourly

Question 16

how many blood cultures should be taken in suspected sepsis?

Answer 16

one is enough

aim for three within the hour

Question 17

when should blood cultures ideally be taken?

Answer 17

before antibiotics

Question 18

what disease should antibiotics be given for prior to performing blood cultures?

Answer 18

purpura fulminans

Question 19

what needs to be done prior to giving antibiotics if a patient has a large abscess and why?

Answer 19

drainage

abscesses have no blood supply so antibiotics will not penetrate

Question 20

what antibiotics make up the four C’s?

Answer 20

co-amoxiclav
cephalosporins
clindamycin
ciprofloxacin

Question 21

where in the body are gram positives often found?

Answer 21

skin and mucous membranes

Question 22

what colour to gram positives stain and why?

Answer 22

blue/purple

due to thick peptidoglycan wall

Question 23

what colour do gram negative bacteria stain and why?

Answer 23

pink/red

due to thin peptidoglycan wall

Question 24

where are gram negatives often found inn the body?

Answer 24

GI tract

Question 25

where are anaerobes often found in the body?

Answer 25

``` mouth teeth throat sinuses lower bowel ```

Question 26

where are atypical bacterias often found in the body?

Answer 26

chest | GU system

Question 27

what are some general side effects of antibiotics?

Answer 27

N+V diarrhoea rashes candida infection

Question 28

what are some possible side effects of penicillins?

Answer 28

hypersensitivity | skin reactions

Question 29

what is a possible side effect of flucloxacillin and co-amoxiclav?

Answer 29

cholestatic jaundice

Question 30

what are some possible side effects of macrolides?

Answer 30

GI disturbances hepatitis QT prolongation

Question 31

what are some possible side effects of quinolones?

Answer 31

QT interval prolongation convulsions tendonitis

Question 32

what are some possible side effects of aminoglycosides/glycopeptides?

Answer 32

nephrotoxicity | ototoxicity

Question 33

what are some possible side effects of vancomycin when administered too quickly?

Answer 33

red man syndrome

Question 34

what are some possible side effects of tetracyclines?

Answer 34

hepatotoxicity staining of teeth photosensitivity dysphagia

Question 35

what are some possible side effects of nitrofurantoin?

Answer 35

peripheral neuropathy | pulmonary fibrosis

Question 36

what are some possible side effects of chloramphenicol?

Answer 36

aplastic anaemia | grey baby syndrome

Question 37

name some antibiotics that are enzyme inhibitors

Answer 37

``` erythromycin clarithromycin isoniazid metronidazole ciprofloxacin ```

Question 38

name an antibiotic that is an enzyme inducer

Answer 38

rifampacin

Question 39

what can reduce absorption of tetracyclines and quinolones?

Answer 39

antacids | calcium

Question 40

what effect can broad spectrum antibiotics have on oral contraceptives?

Answer 40

can cause failure via entero-hepatic cycling

Question 41

what interaction can occur between broad spectrum antibiotics and warfarin?

Answer 41

increased INR

Question 42

what interaction can occur between metronidazole and alcohol?

Answer 42

makes patient unwell - disulfiram like interaction

Question 43

what interaction can occur between quinolones and steroids?

Answer 43

tendonitis

Question 44

what interaction can occur between quinolones and NSAIDs?

Answer 44

convulsions

Question 45

describe the appearance of coliforms

Answer 45

gram negative rods

Question 46

name some coliforms

Answer 46

e coli klebsiella proteus

Question 47

name some antibiotics that may be active against gram negatives

Answer 47

beta lactams aminoglycosides macrolides tetracyclines

Question 48

describe the appearance of haemophilus influenzae

Answer 48

gram negative coccobacillus

Question 49

describe the oxygen requirements of haemophilus influenzae

Answer 49

usually aerobic can grow as a facultative anaerobe

Question 50

what type of agar does haemophilus influenzae need to grow?

Answer 50

chocolate agar

Question 51

what drugs are active against haemophilus influenzae?

Answer 51

amoxicillin (first line) | doxycycline

Question 52

what time frame should sepsis six be delivered in?

Answer 52

one hour

Question 53

which antibiotic class is broadly used to treat streptococci?

Answer 53

penicillins

Question 54

what is atypical pneumonia?

Answer 54

pneumonia not caused by strep

Question 55

name some examples of causes of atypical pneumonia

Answer 55

mycoplasma pneumoniae coxiella burnetii chlamydophila psittaci legionella

Question 56

what is the main antibiotic used for atypical pneumonia?

Answer 56

doxycycline can also use clarithromycin

Question 57

what type of antibiotic is doxycycline?

Answer 57

tetracycline

Question 58

what type of antibiotic is clarithromycin?

Answer 58

macrolide

Question 59

what antibiotic can be used for severe penicillin allergic atypical pneumonia?

Answer 59

quinolones such as levofloxacin

Question 60

what are some risk factors for legionella?

Answer 60

``` smoking male sex COPD immunosuppression malignancy diabetes dialysis hot tubs ```

Question 61

what is the mechanism of action of legionella infection?

Answer 61

invades and grows in alveolar macrophages as it mistakes them for their natural host

Question 62

what are streptococci?

Answer 62

gram positive cocci that occur in pairs of chains

Question 63

what is the oxygen requirement of streptococci?

Answer 63

facultative anaerobes

Question 64

how are streptococci classified?

Answer 64

action on agar = haemolysis | antigens (Lancefield classification)

Question 65

what is beta haemolysis?

Answer 65

complete haemolysis | presence of a clear zone

Question 66

what is alpha haemolysis?

Answer 66

partial haemolysis agar goes a greenish colour

Question 67

what is gamma haemolysis?

Answer 67

non haemolysis

Question 68

what are the two main types of enterococcus?

Answer 68

``` E faecalis (more common) E Faecium ```

Question 69

what is the antibiotic of choice for enterococcus?

Answer 69

amoxicillin IV

Question 70

what antibiotic is given for enterococcus if penicillin allergic?

Answer 70

IV Vancomycin

Question 71

what is VRE?

Answer 71

vancomycin resistant enterococcus

Question 72

what is the main cause of CAP?

Answer 72

strep pneumoniae