Sepsis Flashcards
What antibiotics do you give to treat a C diff infection?
First line is vancomycin
Patient presents with infectious bloody diarrhoea, what is the most likely cause?
E. coli O157
Need to notify public health immediately, before you even confirm that it is E. coli O157, just as son as you know it’s infectious bloody diarrhoea
Where is listeria monocytogenes typically found?
Meats and cheeses
How is non typhoidal salmonella typically contracted?
Meats or animal contact
How is campylobacter typically contracted?
Meats or animal contact
What is the modified DUKES criteria? And what condition is it for?
For diagnosing infective endocarditis
What is CURB65 used for?
Estimates the mortality of CAP to help determine how to manage treatment including whether inpatient or outpatient treatment is required
What is the CURB 65 criteria?
A 28 year old male presents to A+E with a 1-week history of fever and constipation. He has no past medical history and returned three days ago from a trip to rural India.
On examination, he is hemodynamically stable but febrile, and his pulse is noted to be 35bpm. His abdomen is distended with increased bowel sounds, and there are crops of pigmented macules across his abdomen that blanch on pressure.
Given the likely diagnosis, what is the most accurate diagnostic test?
A 36 year old male presents to A+E with a 24-hour history of abdominal pain and yellowing of his skin and eyes. He is HIV positive and had been started last week on medications for pulmonary TB.
Which antibiotic is most likely to be responsible for his presentation?
-tazocin
-streptomycin
-pyrazinamide
-ethambutol
A 27-year-old man is recovering on the ward following an uncomplicated open reconstruction of the lateral collateral ligament of his left knee. He initially recovers well and is eating and drinking after 24 hours. However, within 36 hours of the procedure, his temperature spikes to 38.6 °C, with a heart rate of 104 bpm and blood pressure of 106/75 mmHg. Cardiovascular and respiratory examinations are unremarkable, but inspection of the surgical site reveals severe swelling and discolouration of the knee, with blisters protruding from the surgical incision. Subcutaneous emphysema can be seen extending distally. He complains of severe pain and weakness in his lower leg that is not adequately controlled with his postoperative analgesia.
Given the likely complication that has occurred, what is the most appropriate management option for this patient at this time?
Antibiotics with surgical debridement- patient has necrotising fasciitis
what organism causes Q fever and what condition is it typically associated with?
Coxiella brunetti
Typically associated with infective endocarditis
what causes rheumatic fever? And how does it usually present?
group A strep not being adequately treated
Patients often present with polyarthritis and mitral valve complications
what type of bacteria is pseudomonas aeruginosa?
gram negative bacilli
A 9-month-old boy presents to the emergency department following development of a rapidly growing rash. Mum reports that he was feverish and irritable yesterday evening, but this morning she found him agitated and crying, with large fluid-filled blisters on his chest, so she immediately brought him to the hospital. He was born at 35+5 weeks by spontaneous vaginal delivery and spent 2 days in the neonatal intensive care unit owing to respiratory distress. He made a good recovery, and has been healthy since, with no concerns over his developmental milestones. He has no other medical conditions, takes no regular medications and has no known drug allergies.
On examination, he is miserable and pyrexial, with a widespread blistering red rash across 90% of the surface of his skin. The oral mucosa is spared. Slight pressure on the skin causes peeling of the superficial epidermis.
What is the most likely diagnosis?
-Steven johnson syndrom
-staphyloccocal scalded skin syndrome
-toxic epidermal necrosis
-strepoccocal toxic shock syndrome
Infants, young children, and adults who are immunocompromised are more likely to get staphylococcal scalded skin syndrome whereas adults are more likely to get TEN
SSSS typically follows recent staph infection whilst TEN typically follows medication use (usually antibiotics or anticonvulsants)
A 92-year-old is in the general medical ward awaiting a package of care for discharge. Unfortunately, she becomes unwell with a productive cough, tachycardia and hypotension. A hospital-acquired pneumonia is suspected, and she is commenced on empirical antibiotics.
A sputum culture shows extended-spectrum beta-lactamase (ESBL) producing Klebsiella pnuemoniae.
Based on this, what is the most appropriate antibiotic?
-metronidazole
-meropenem
-ceftriaxone
-vancomycin
What is the most common bacterial organism implicated in infections affecting the urinary tract?
e coli
what type of bacteria is e coli?
gram negative rod
what antibiotics do you give to treat chlamydia?
doxycycline (azithromycin if penicillin allergic)
A 22 year old man presented to the emergency department of his local hospital complaining of progressively worsening bilateral headache over 2 days. He tells you that he does not normally suffer from headaches and is otherwise fit and well. On examination, he is febrile at 38.4, but there is no associated focal neurological features, neck stiffness or rash, and he denies photophobia.
A CT head is performed which shows some subtle sulcal effacement, and a lumbar puncture is performed. Frankly purulent fluid is exuded with a raised opening pressure, and the sample is sent to the laboratory for further tests.
What is the most likely underlying cause of this patient’s symptoms?
what is the first line antibiotic for group A strep ?
penicillin (erythromycin if penicillin allergic)
A 10 year old child presents to the Emergency Department with a five-day history of joint pain.
On examination, he is alert, orientated and hemodynamically stable. He has a fever of 38 degrees, and painful swelling in his wrist and knee with severe limitation of movement. There is a 30cm area of rough erythematous skin over the patient’s trunk.
Bloods reveal a raised CRP and WCC, normal LFTs and clotting profile. The ECG shows second-degree heart block.
What is the most likely diagnosis?
Acute rheumatic fever
The patient has presented with two major (arthritis and erythema marginatum) and two minor (heart block on ECG and fever) criteria for acute rheumatic fever. Although there has been no mention of a group A strep infection, the combination of these symptoms in a patient between 5-15 years old point strongly towards this diagnosis. Some strep infections may not be noticed by patients (particularly if a mild skin infection), or may not be identified when taking the history from the patient or their parents. This can lead to clinicians overlooking rheumatic fever as a diagnosis
A 51 year old male presents to the clinic with a 3-week history of pain, swelling and discharging pus from his left heel. He suffered a 3 cm-deep penetrating wound to this area a month ago, when he stepped on a large shard of glass. He has no past medical history and has no allergies to medications.
On examination, he is hemodynamically stable, alert and orientated. His left heel has significant soft tissue swelling and the overlying skin is erythematous and hot. There is a sinus tract visible, which is discharging pus.
Investigations are ordered, and a referral is made to the surgeons. What antibiotic regimen is it most appropriate to begin empirically?
how do you treat cellulitis and acute osteomyelitis?
oral flucloxacillin (doxycycline if penicillin allergic) for cellulitis
iv flucloxacillin for osteomyelitis (vancomycin if penicillin allergic)
A 57 year old male has a dry cough. His past medical history includes ischaemic heart disease and a previous renal transplant. On examination, his chest is clear but his saturations drop after walking around the room. He has no medication allergies.
Given the likely diagnosis, what is the most appropriate antibiotic to prescribe?
-Co-trimoxazole
-Co-amoxiclav
-Ciprofloxacin
-Cefuroxime
A 20 year old man presented to the Emergency Department with severe left ear pain, purulent discharge from the left ear and fever. Three days before the ear pain he noticed a maculopapular rash behind his ear which then spread across his whole body.
On examination he appears unwell and flushed. His GCS is 15. He has small areas of grey discolouration in his mouth.
A diagnosis of acute otitis media is made and he is commenced on the appropriate antibiotic ear drops.
Which of the following is the most likely cause of this patient’s acute otitis media?
Measles is an RNA paramyxovirus and is one of the most infectious viruses spread by aerosol transmission. However, it is rarely seen in the developed world due to the immunisation programmes (MMR).
The most common complication of measles is otitis media, whereas the most common cause of death is pneumonia. The rash described in the stem is the ‘classical’ description and the grey discolouration mentioned here are Koplik spots pathognomonic for measles.
what bacteria can you identify through urinary antigen test?
legionella or strep pneumonia e
A 24-year-old sexually active woman presents to the GUM clinic complaining of thin, white, fishy-smelling vaginal discharge.
What is the best investigation to diagnose this patient?
A 27-year-old man has just come back from Bangladesh where he has been working with a charity to help with some recent flooding. He says in the last 24 hours he has been having large amounts of diarrhoea. He describes it as rice water looking and has also been vomiting.
What is the most likely diagnosis?
A 10-month-old girl is brought into the emergency department by her mother, concerned about a cough. Her mother states that her child’s coughing often leads to vomiting, and the child often has a loud inspiratory noise. In addition, there have been several episodes of “breath holding” and then gasping for breath.
Of note is that the child has not received any vaccinations.
What treatment is required?
what bacteria is responsible for causing whooping cough?
Bordetella pertussis
An 18-year-old female presents to Accident and Emergency with a one-day history of severe headache, photophobia and neck pain. She tells you for the last week, she has generally been unwell with a cough and rhinorrhoea. She has recently returned to school following the summer break and reports several students have been unwell with a coryzal illness.
She has no rash present on examination.
She completed her full routine immunisation schedule as a child.
What is the most likely causative agent to be found on lumbar puncture studies?
A 19 year old male attends the Accident and Emergency Department with a one week history of earache, headache and fever. He has no past medical history and is not taking any regular medications. He has not had any vaccinations as a child.
His observations are all stable except a fever at 38.3.
On examination of his face he has pain and swelling over his parotid glands causing difficultly opening his jaw. The remainder of the examination is unremarkable.
What condition does this patient have? Which of the following best describes the mainstay of treatment for the underlying cause of these symptoms?
mumps
supportive treatment
A 35 year old male presents to the GP with a skin rash. He reports it has been present on his skin for over 24 months, but that he has been living on the streets and not sought any medical care. He reports he’s “not really seen a doctor before about anything”.
He has a 20 year pack smoking history, reports previous heroin and crack cocaine use (none in the last six months), and has no drug allergies.
On examination he has widespread umbilicated papular lesions over his face, torso, arms and abdomen. They are associated with a pinkish sheen. They are not painful or itchy.
Which of the following is the most important next investigation?
how do you treat impetigo?
topical hydrogen peroxide 1% cream or fusidic acid 2% cream for 5 days
Given the most likely diagnosis, which treatment option would be the most appropriate to initiate at this stage?
A 2-year-old girl presents to her GP with a 10-day history of a cough, sore throat and mild fever. Her father attributed it initially to her starting at nursery but became concerned when, over the last 2 nights, the cough started to take on a ‘dry, hacking’ quality. He describes that, during the night, she has been coughing continuously for sustained periods, with short interspersed high-pitched gasps for breath. Her past medical history is unremarkable and she takes no regular medications. The GP notes however that she never received her third 6-in-1 booster.
On examination, she appears unhappy, but well with no signs of acute respiratory distress. She experiences several coughing fits during the consultation. Her temperature measures 38.1 °C. Examination reveals a red, sore-looking throat but no sign of exudate or airway obstruction.
What is the most likely causative agent?
Which of the following medications is the most likely cause of his symptoms?
-Levofloxacin
-Rifampicin
-Isoniazid
-Pyrazinamide
-Ethambutol
Pyrazinamide
This is the most likely to cause hepatotoxicity compared to the other anti-TB drugs
A 35-year-old man presents to the Ambulatory Clinic with painless purplish spots on the legs and feet. He has a diagnosis of HIV, but is not compliant with his antiretroviral regime. His most recent CD4 T lymphocyte count is 110 cells/uL (normal >500). Which of the following viruses is responsible for the patient’s lesions?
A 32-year-old man presents to the emergency department with copious watery diarrhoea over the past 36 hours. He returned from visiting relatives in rural India 4 days ago, and has subsequently heard of an outbreak of people presenting with similar symptoms in the village where he was staying. He describes severe abdominal cramping and excessive watery diarrhoea and vomiting. He has tried to drink water, but states he is unable to keep any fluids down. On examination, he appears lethargic, with dry mucosal membranes and turgid skin.
Observations are taken which show:
-HR 104 bpm
-RR 16 breaths per minute
-O2 saturation 98% in air
-BP 102/71 mmHg
-Temperature 38.5 °C
Given the likely diagnosis, what is the most important initial management option?
-Oral doxycycline
-IV cyclizine
-IV paracetamol
-IV Hartmann’s solution
-IV doxycycline
A 12-year-old boy presents with a maculopapular rash with vesicles and crusts which started on his face but have now spread to his chest. He complains of itching and fever. Which of the following is the most likely diagnosis?
A 20 year old male attends the GP with an acutely painful and swollen left knee. He reports he is concerned because earlier this week his left ankle was swollen and before that his right ankle as well as both of his hands. On examination he has a maculopapular rash on his torso.
Which of the following organisms is most likely responsible for this presentation?
A 35 year old woman presents to her GP with blurry vision in her right eye. She describes it as coming on slowly and her vision has got progressively blurrier.
On looking at her medical records she had a widespread maculopapular rash around a year ago that resolved after taking some intramuscular Penicillin.
On examination of the eye, the pupil was constricted, and did not react to light but did react to the accommodation reflex.
What disease is this clinical sign associated with?
Argyll Robertson Pupil- Accomodation Reflex Present (ARP)- Pupillary Reflex Absent (PRA)
Can be present in tertiary syphillis (neurosyphilis)
A 22-year-old male presents with a sore throat and fatigue for the past week. Physical examination is significant for tonsillar enlargement with exudates. Laboratory results show elevated liver enzymes and a positive heterophile antibody test. What is the most likely cause of this patient’s symptoms?
A 68 year old man is admitted to the respiratory ward with pneumonia. He is treated with IV Co-Amoxiclav and improves. However, he then goes on to develop a urinary tract infection which is treated with a different antibiotic. He has a past medical history of COPD and has been hospitalised four times this year with infections.
You have been alerted to the fact that this gentleman has now been having foul smelling watery diarrhoea, although this has not been in a significant amount. He also complains of feeling bloated.
Given the likely diagnosis, what is the most important treatment for this patient?
A continuous ECG is performed, which reveals fluctuating first- and second-degree atrioventricular block.
What is the most likely cause of this patient’s presentation?
A 42-year-old man attends the tuberculosis clinic for follow-up after recently completing a 6-month course of treatment with rifampicin, isoniazid, pyrazinamide and ethambutol. He reports marked improvement in his respiratory symptoms and is clinically cured of tuberculosis, but complains today of bilateral numbness and intermittent paraesthesia in his legs for the last 3 weeks. He reports good compliance to his antibacterial medications. On questioning, he recalls he was initially prescribed a dietary supplement also, but admits he stopped taking this early on in his treatment regimen as he didn’t think it was important.
Given the history, which dietary supplement was most likely prescribed to this patient?
A 23-year-old female student presents to the GP with joint pains. She reports transient but severe pains in different joints, lasting only a day each, over the last week. It started in her left ankle, then moved to her right hip and is now affecting her right knee. She returned from a camping holiday in the United States one month ago. She reports feeling very tired and achy for the last week of her holiday and noticed a red swelling with central clearing on her leg, which cleared after a few weeks. On examination, she looks well, and her vital signs are all within normal limits. There is swelling and warmth around her right knee but her other joints appear normal. There is no rash. The remainder of the examination is unremarkable.
Which of the following is the most appropriate treatment for this presentation?
A 1 month old child is brought to A+E with a 12-hour history of vomiting, crying, not feeding and irritability. He has no medical problems, had a normal delivery at term, and has no known allergies to medications.
On examination, he is listless, pyrexial and cries when his head is moved. The fontanelles are full, and small conjunctival hemorrhages can be seen.
Blood tests, including blood cultures, are sent for analysis. A lumbar puncture is also performed and CSF samples are sent. What is the next most important step in the management of this patient?
A 52-year-old man presents to his GP with 2-day history of fever and a blotchy red rash on the left side of his chest. He reports that this morning he woke up to find that the rash had blistered and crusted over. He describes the rash as band-like and sharply cut-off, with burning pain localised to the area of involvement. He denies any skin changes on the right side of his body. His past medical history is relevant for type 2 diabetes and a kidney transplant 7 years ago, for which he takes metformin and ciclosporin, respectively. He has no drug allergies and takes no medications over the counter.
What is the most appropriate management option?
A 19-year-old man presents to the genitourinary medicine clinic having noticed a perianal lesion 6 days ago. He became concerned when it was still present after a few days and decided to seek medical attention when he noticed a small volume of clear discharge from the lesion. He denies any pain and feels generally well in himself, with no recent illnesses, fevers or weight loss. He is usually fit and healthy, and takes no regular medication. He reports having receptive unprotected anal sex with four casual sexual partners in the last 2 months and has never previously attended a sexual health screening service.
On examination, there is a solitary red, firm perianal ulcer, with a well-defined round margin and an indurated base.
Given the most likely diagnosis, what is the most appropriate management?
A 19 year old male presents with a 1-day history of pain and swelling of his testes. Prior to this, he had experienced five days of flu-like symptoms and fever. He has no past medical history.
On examination, he is systemically well and respiratory and cardiovascular examinations are unremarkable. He is noted to have enlarged, tender parotid glands, and has some mild tenderness in the left hypochondrium.
Given the likely diagnosis, which diagnostic test should be carried out?
A 67 year old female presents to the Emergency Department with a 2 week history of fever, malaise and progressive shortness of breath.
Observations show a temperature of 38.3 degrees Celsius, respiratory rate of 30, oxygen saturations of 89% on room air, heart rate of 75 beats per minute, and blood pressure of 105/70. On examination, there is dullness to percussion and coarse crepitations heard over the left lower lobe. She has a painful purplish discolouration of her fingers and toes, which she says are exacerbated in the cold weather.
Which is the most likely causative organism?
A 70 year old male presents to his GP with a red, hot and painful scrotal swelling that has worsened over the past 2 days. He also reports pain on urination. Examination reveals a red, hot swollen left testicle that is tender on palpation. There is no regional lymphadenopathy.
Which is the most likely cause of his presentation?
A 3-year-old is brought in by his mother to the GP after two days of a fever and sore eyes. The GP looks inside the child’s mouth and notices some white spots on the inside of his cheeks. The child has not been vaccinated .
What is the mode of transmission for this infection?
An 18-month-old boy is brought to his GP by his father. For the last 2 days, he has had a ‘sticky eye’, which first affected the left eye, but has now spread to the right. He has been crying more than usual and has been feeling warm for the last 3 days. Dad reports that he is off his food, but still has wet nappies and is opening his bowels as normal. He was born at term by spontaneous vaginal delivery. There have been no concerns regarding his development so far. His mother and father decided not to vaccinate him as they were concerned about overloading his immune system.
On examination, he is crying and has visible rhinorrhoea. There is bilateral serous discharge in both eyes, with crusting of the eyelids. His tympanic temperature is 39.5 °C. On examination, a reddish blotchy rash with small raised bumps is visible on his chest.
What is the most likely causative organism underlying this child’s presentation?
-mumps
-tb
-coxsackie
-listeria
-cryptococcus
What is the most appropriate investigation to confirm diagnosis?
