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Yr3 CLASP > Sepsis > Flashcards

Sepsis Flashcards

1
Q

define colonisation

A

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

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2
Q

Define infection

A

inflammation due to a microbe

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3
Q

Define bacteraemia

A

The presence of viable bacteria in the blood

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4
Q

Define sepsis

A

The dysregulated host response to infection

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5
Q

what are the main signs of septic shock

A

Persistent hypotension
Lactate greater than 2mmol/l

(despite adequate volume resuscitation)

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6
Q

Give some differentials of diffuse pain

A 
Aortic aneurysm
Aortic dissection
gastroenteritis
Early appendicitis
Addisonian crisis
Bowel obstruction
DKA
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7
Q

Give some differentials of left upper quadrant abdo pain?

A 
Gastric ulcer
gastritis
herpes zoster
pulmonary embolism
Pancreatitis
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8
Q

Give some differentials of right upper quadrant pain

A 
appendicitis
biliary colic
cholecystitis
herpes zoster
hepatitis
PE
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9
Q

Give some differentials of left lower quadrant pain

A 
diverticulitis (sigmoid)
ectopic pregnancy
endometriosis
ovarian cyst
ovarian torsion
testicular torsion
PID
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10
Q

Give some differentials of right lower quadrant pain

A 
appendicitis
crohn's disease
aortic aneurysm
endometriosis
ectopic pregnancy
testicular/ovarian torsion
meckel's diverticulum 
PID
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11
Q

what tests do you do to diagnose an infection

A

Microbiology - blood, stool, urine, wound/tissue culture, CSF, sputum
Serology
Antigen detection
PCR

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12
Q

What is the sepsis 6

A 
Blood culture
Urine output
Fluid resuscitation 
- also give vasopressors (norepinephrine, vasopressin etc)
Antibiotics IV
Lactate levels
Oxygen
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13
Q

what test do you do to identify whether it is strep or staph

A

Catalase

\+ve = staph
-ve = strep
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14
Q

What test can you do to work out whether is is S.aureus or S. epidermis

A

coagulase

\+ve = S.aureus
-ve = S.epidermis
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15
Q

what are the most common sources of infection in sepsis

A

Respiratory
Abdominal
UTI
Soft tissue, bone, joints

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16
Q

In what 3 ways can you classify a bacteria

A

Shape

  • spirilla
  • Bacilli
  • Cocci

Gram stain

  • Positive = purple
  • negative = pink

Oxygen demand

  • aerobic
  • anaerobic
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17
Q

What is responsible for the gram staining dye remaining purple in positive organisms

A

Thick layer of peptidoglycan which traps the dye

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18
Q

Give some examples of gram positive bacteria

A 
Cocci
(aerobes)
- staphlococcus
- streptococcus
- enterococcus
(anaerobes)
- peptostreptococcus
Rods
(aerobes)
- corynebacterium
- listeria
- lactobacillus
- mycobacterium
- bacillus
(anaerobes)
- clostridium
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19
Q

What type of bacteria are staph and strep classed as and how do you tell them apart?

A

Gram positive

Staph - clusters, wound infections
strep - chains, throat often

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20
Q

Give some examples of gram negative bacteria

A

Cocci
(aerobes)
- Neisseria

Rods
(aerobes)
- pseudomonas
(anaerobes)
- salmonella
- shigella
- Klebsiella
- campylobacter
Spiral
(aerobes)
- leptospira
(anaerobes)
- borrelia
- treponema
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21
Q

what are coliforms

A

E.coli and similar

Gram negative rods

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22
Q

What organism is most associated with UTI

A

E.coli

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23
Q

what organisms are most associated with diarrhoea

A

salmonella
shigella
E.coli

24
Q

What organisms are most associated with lower resp. tract infections

A

klebsiella

enterobacter

25
Q

What kind of antibiotics can be active towards gram negatives

A

Beta lactams - amoxicillin
aminoglycosides - gentamicin
macrolides - erythromycin, clarithromycin
tetracycline - doxycycline

26
Q

what kind of bacteria is H.influenzae

A

gram negative coccobacillus

27
Q

what are some atypical organisms causing of pneumonia and what antibiotic works against them

A

Mycoplasma pneumoniae
coxiella burnetti
Legionella,
chlamydophila psettaci

Doxycycline (main one)
(legionella doesn’t respond great to this)
macrolides

28
Q

Main causes of gram negative sepsis

A

E.coli, klebsiella, enterobacter
Pseudomonas aeruginosa
neisseria gonorrhoea

29
Q

what is the main concern when giving gentamicin

A

nephrotoxicity

30
Q

In streptococcus what can be used to differentiate S. viridans, S.pneumoniae, group A?

A

A - haemolytic - S. viridans, S. pneumoniae

B - haemolytic (green) - group A

31
Q

what is mean inhibitory concentration

A

concentration of the drug required to kill 99.9% of organisms in 18 - 24hrs

32
Q

what class of drugs are penicillin, flucloxacillin, amoxicillin, piperacillin etc in?

A

Beta lactams

33
Q

classification of streptococci on agar?

A 
Beta haemolytic strep
- complete lysis next to growth, clear zone
1. Group A beta - strep. pyogenes
2. Group B beta - strep agalactaiae
Alpha haemolytic strep
- partial haemolysis, greenish colour to blood agar
Gamma haemolytic strep
- non haemolytic
34
Q

Pathology of community acquired pneumonia

A

Organism reaches lungs
Immune activation and infiltration
Fluid and cellular build up in alveoli leads to impaired gas exchange

35
Q

What are the clinical signs of community acquired pneumonia

A 
cough
increased sputum
chest pain
dyspnoea
fever
chest xray with infiltrates
36
Q

what are the most likely organism to cause community acquired pneumonia

A

strep pneumoniae
H. influenzae
Atypicals (legionella, psitacci etc.) and virus
staph aureus

37
Q

what are the investigations for pneumonia

A

sputum culture
viral PCR
Antigen tests
biomarkers

38
Q

what are some clinical signs of TB

A

Haemoptysis
night sweats
weight loss

39
Q

what are some clinical signs of CMV?

A

visual changes
esophagitis
enteritis
encephalitis

40
Q

what are some ways that a pathogen can evade being destroyed by immune responding cells

A

multiple mechanisms
camouflage the surface
Dampen the response

41
Q

what is aspergillus

A

A lung infection caused by aspergillus, which is a type of mould that grows indoors and outdoors

42
Q

what antibiotics target folate synthesis

A

sulfonamides

trimethoprim

43
Q

what kind of antibiotic is gentamicin

A

gram negative

44
Q

Antibiotics can be bactericidal or bacteriostatic, what does this mean?

A

Bactericidal - kill the bacteria directly

Bacteriostatic - supress the growth of bacteria

45
Q

what is bioavailability

A

the proportion of a drug that enters the circulation when introduced to the body (i.e. the amount of the drug that has an active effect

46
Q

A NEWS score of what should make you consider sepsis

A

> 5

47
Q

what happens physilogically in septic shock

A

Capillary leakage
cytokine release
vasodilation

48
Q

risk factors in sepsis

A

very young/very old
immunosuppressed
pregnancy
neonates

49
Q

what is the empirical treatment for sepsis

A

Amoxicillin (vancomycin if penicillin allergic)
Gentamicin
metronizadole

50
Q

what antibiotic would you give if C.diff was found on blood culture

A

Vancomycin

51
Q

what does high lactate levels indicate?

A

Signs of hypoperfusion
(low BP)
>4 = bad, repeat at 4 - 6 hrs

52
Q

what is minimum inhibitory concentration (MIC)?

A

the lowest concentration at which the antibiotic inhibits growth of the organism

53
Q

If a patient is taking antibiotics what is the bacteria that they are at risk from?

A

C. difficile

54
Q

what is flucloxacillin often used for

A

Staphylococcus skin infections

streptococcus skin infections

55
Q

when should you not use urinalysis?

A

in those over 65
those with urinary catheters

will likely show bacteria that is not actually causing an infection

Yr3 CLASP (2 decks)

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