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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 a viable bacteria in the blood

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4
Q

define sepsis

A

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

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5
Q

define septic shock

A

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

when the patient has persistent hypotension or lactate >/= 2 after adequate volume resuscitation (30ml/kg and vasopressors)

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6
Q

what are the SIRS criteria

A

temp >38/<36
HR >90
RR> 20
WBC count >12,000 or <400

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7
Q

why dont you use SIRS anymore

A

as too sensitive and not specific

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8
Q

what are the criteria for qSOFA

A

RR>22, sBP <100, altered GCS

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9
Q

when do you have sepsis

A

news score >5 with an infection

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10
Q

when should you get a ST3 to see the patient

A

news score of 7+

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11
Q

list 5 evidences of infection

A

cough, dysuria, abdo pain, abnormal bloods, confusion

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12
Q

why do you get confused in sepsis

A

as brain not well perfused due to hypotension

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13
Q

what is the mortality of septic shock

A

40%

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14
Q

what is sepsis 6

A

take 3

  • blood (and appropriate) cultures
  • lactate
  • measure urine output

give

  • oxygen
  • IV antibiotics
  • IV Fluids
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15
Q

what is high lactate a sign of

A

hypoperfusion

is associated with high mortality

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16
Q

when should lactate measurements be repeated at 4-6 hours

A

if first one is >4

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17
Q

what is urine output a measure of

A

organ perfusion

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18
Q

what should you do if after administering O2 you are worried about sats

A

do ABG- will tell you more about any acidosis

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19
Q

what antibiotics do you give if you cannot localise the source of the infection in sepsis 6

A

amoxicillin
metronidazole
gentamicin

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20
Q

how should you administer fluids in sepsis 6

A

fluid challenge (set volume over set time)- prescribe 250-500 mls over 15 mins (crystalloid 0.9% saline or hartmanns- not dextrose)

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21
Q

what is the aim in giving IV fluids in sepsis 6

A

MAP> 65mmHg

30ml/kg over the 1st three hours

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22
Q

what should you do if there is a lack of response to IV fluids in sepsis

A

early MHDU for CVC +/- vasopressors

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23
Q

how do vasopressors work

A

vasoconstrict to increase BP

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24
Q

why do you get hypotensive in sepsis

A

as vasodilation occurs

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25
Q

what should you do for the septic patient in hours 2-6

A

continue resus- 30ml/kg in first 3 hours
MAP > 65
urine output >0.5 ml/kg/hour
aiming to improve NEWS, haemodynamic stability and a reduction in lactate

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26
Q

what are the signs of a patient going into septic shock

A 
identify deterioration/ lack of improvement
new confusion 
high RR
low BO 
low blood glucose (BM)
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27
Q

what news score warrants 15 min observations

A

7+

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28
Q

when should you use vasopressors

A

in MAP remains <65mmHg via CVC

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29
Q

name a vasopressor

A

Noradrenaline

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30
Q

what should you do if the level of vasopressor in increasing

A

ensure control of the source of infection (abscess, NF)

consider addition of a steroid, refer to ICU

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31
Q

what gram are vibrio (curved rods)

A

gram -ve

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32
Q

what is spirillum

A

rigid spiral bacterium

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33
Q

what is spirochaete

A

flexible spiral bacterium

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34
Q

what is the difference between gram +ve and -ve cell walls

A

gram +ve have a thick peptidoglycan wall (which holds on to the dye why its purple)
gram -ve have thin peptigoglycan and additional outer membrane
composed by phospholipids and lipopolysaccharides

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35
Q

what are obligate aerobes

A

require oxygen to survive

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36
Q

what are obligate anaerobes

A

are killed by oxygen

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37
Q

what are facultative anaerobes

A

they can tolerate oxygen

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38
Q

what strep have alpha haemolysis

A

S. pneumonia and viridans group

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39
Q

how do you differentiate staph aureus

A

is only staph to be coagulase positive

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40
Q

what is virulence

A

the capacity of a microbe to cause damage to the host

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41
Q

what is an opportunistic pathogen

A

an organism that causes infect when opportunity/ change in natural immunity arises

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42
Q

what do gram negative cocci appear in

A

diplococci (in pairs)

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43
Q

what are the normal gut commensals and what type are they

A

gram negative

e. coli (most strains)
klebsiella 
enterobacter 
proteus
clostridium
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44
Q

what are the significant gut pathogens

A

salmonella
shigella
verotoxin producing e coli (e. coli 157)

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45
Q

what is a coliform

A

gram negative large bacilli (inc gut commensals and pathogens):
commensals- e. coli, klebsiella, proteus
pathogens- salmonella, shigella, e. coli 0157

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46
Q

what infections can coliforms cause

A

UTI, peritonitis, biliary tract

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47
Q

what is the 1st line antibiotic against coliforms

A

gentamicin

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48
Q

what is an endotoxin

A

part of cell wall, are released by bacteria die

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49
Q

what is an exotoxin

A

released by living organisms

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50
Q

what releases endotoxins

A

gram negative

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51
Q

what releases exotoxins

A

both gram neg and positive

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52
Q

what strep organisms have gamma haemolysis

A

enterococci

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53
Q

what strep organisms have beta hamolysis

A

strep A and B

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54
Q

name a group A strep

A

strep pyogenes

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55
Q

what are the two types of enterococci

A

eneterococcus faecalis and faecium (both part of normal bowel flora)

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56
Q

what infection do enterococci commonly cause

A

UTI

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57
Q

what is the commonest cause of skin, ST, wound, joint and bone infections

A

S. Aureus

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58
Q

what type of bacteria is clostridium

A

gram +ve anaerobic bacilli

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59
Q

what is pseudomembranous colitis associated with

A

C. diff infection

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60
Q

what are the two types of aerobic gram +ve cocci

A

strep (chains)

staph (clusters)

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61
Q

are strep and staph gram +ve or -ve

A

gram positive (only gram -ve cocci are diplococci (neisseria)

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62
Q

how do you differentiate streptococci

A

haemolysis:
alpha-partial (green)
beta- complete (can see through plate, golden)
gamma- none

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63
Q

what are the alpha haemolytic strep

A

strep pneumoniae and viridans

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64
Q

what does strep viridans cause

A

infective endocarditis (is usually a teeth commensal)

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65
Q

what are the beta haemolytic strep

A

group A strep = strep pyogenes (GAS skin diseases, throat)

Group B strep (neonate meningitis)

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66
Q

what are the gamma haemolytic strep

A

enterococcus (gut commensal, UTI)

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67
Q

how do you classify staphylococcus

A

coagulase +ve (staph aureus- wound, skin, bone, joint) or coagulase -ve staph (inc staph epidermis- skin commensal- IV line infections, prosthetic valve endocarditis)

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68
Q

what most commonly causes prosthetic valve endocarditis

A

staph aureus

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69
Q

how do you classify gram +ve bacilli

A

large and small

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70
Q

what are the small gram +ve bacilli

A

corynebacterium (c. diptheriae (diptheria) and diptheroids (skin commensals))
and
listeria monocytogens (meningitis)

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71
Q

what are the large gram +ve bacilli

A

bacillus sp. (bacillus cereus and bacillus anthracis (anthrax)

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72
Q

what are the types of anaerobic gram +ve bacteria

A

anaerobic streptococci (not staph)

bacilli- clostridium sp. (Cl. tetani (tetanus), Cl. perfringens (gas gangrene), Cl. difficile antibiotic associated (pseudomembranous) colitis

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73
Q

what are the types of gram negative organims

A

strict aerobes (bacilli)
aerobes (cocci and bacilli)
microaerophilic (need extra CO2) (bacilli)
strict anaerobes (cocci and bacilli)

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74
Q

what are the types of strict aerobic gram -ve bacilli

A

legionella

pseudomonas aeruginosa

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75
Q

what are the types of aerobic gram -ve cocci

A

DIPLOCOCCI
neisseria gonorrhoeae
neisseria meningitidis

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76
Q

how do you classify gram -ve aerobic bacilli

A

small and large (coliforms)

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77
Q

what are the small gram -ve bacilli

A 
bordetella pertussis (whooping cough) 
haemophilus influenzae (COPD exacerbation)
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78
Q

what are the large gram -ve bacilli

A 
COLIFORMS
gut commensals:
-escherichia coli (UTI)
-klebsella (UTI, wound)
-proteus (wound)
gut pathogens:
-salmonella 
-shigella 
-E. coli 0157
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79
Q

what are the micro aerobic gram -ve bacterias

A

all bacilli
small curved= camplyobacter
spiral= helicobacter sp

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80
Q

what are rhe gram -ve anaerobes

A

cocci
and
bacilli (bacteroides (gut commensals, wound infection)

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81
Q

what antibiotics target the cell wall

A

pencillins (penicillin, flucloxacillin, amoxicillin, temocillin, co-amoxiclav, piperacillin)
cephalosporins (ceftriaxone)
glycopeptides (vancomycin)

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82
Q

what are the B-lactam antibiotics

A

pencillins: amoxicillin, flucloxacillin, co-amoxiclav
cephalosporins (ceftriaxone)
carbapenems

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83
Q

are penicillins safe in pregnancy

A

yes

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84
Q

what penicillins for gram +ves

A

flucloxacillin

penicillin

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85
Q

what penicillins for gram -ve and +ves

A

amoxicillin
co-amoxiclav
pencillin (only -ve is neisseria)

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86
Q

what pencillin for gram -ves

A

temocillin

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87
Q

what makes up co-amoxiclav

A

amoxacillin and clavulanic acus

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88
Q

what do you use flucloxacillin for

A

s. aureus

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89
Q

what is resistant to flucloxacillin

A

MRSA

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90
Q

what does tenocillin work against

A

coliforms (e. coli, salmonella, enterobacter)

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91
Q

are cephalosporins bacteriocidal or static

A

cidal

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92
Q

are cephalosporins safe in pregnancy

A

yes

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93
Q

what type of antibiotic is vancomycin

A

a glycopeptide

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94
Q

are glycopeptides bacteriocidal or static

A

cidal

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95
Q

what does vancomycin work against

A

gram +ve

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96
Q

what are the protein synthesis antibiotics

A

(usually all bacteriostatic- except aminoglycosides)
aminoglycosides (gentamicin)
tetracyclines (doxycycline)
macrolides (erthromycin, clarithromycin)

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97
Q

what do aminoglycosides work against

A

gram -ve aerobes (coliforms, pseudomonas)

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98
Q

what can aminoglycosides damage

A

kidney and CN VIII

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99
Q

name a tetracycline

A

doxycycline

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100
Q

can you use doxycycline in pregnancy

A

its use is restricted

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101
Q

when are macrolides used

A

commonly in penicillin allergies

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102
Q

what antibiotics work against nucleic acids

A

metronidazole (anaerobes and protozae)
trimethoprine (e. coli UTIs)
fluoroquinolones (gram -ve and +ve)

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103
Q

what does metronidazole work against

A

anaerobes and protozae

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104
Q

what does rifampicin target

A

RNA polymerase

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105
Q

are flouroquinolones bacterio cidal/static

A

cidal

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106
Q

what antibiotics inhibit folic acid synthesis

A

sulphonamides

trimethroprines

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107
Q

what can ciprofloxacin (fluoroquinolone) cause

A

tendonitis

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108
Q

what can you not do when taking metronidazole

A

drink alcohol

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109
Q

what antibiotics should you never combine

A

any bacteriocidals with a bacteriostatic

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110
Q

what are the 4 c antibiotics causing C diff

A

cephalosporins
co-amoxiclav
ciprofloxacin (and all fluroquinolones)
clindamycin

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111
Q

where is candida a commensal

A

skin, GI (mouth, throat) and GU tract (vagina)

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112
Q

can you use antibiotic gel for C diff

A

no need soap and water as spore forming

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113
Q

should the peritoneum and blood be sterile

A

yes

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114
Q

where are corynebacterium commensals

A

skin

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115
Q

what are the commensals of the large bowel

A

enetrobacteriacaea (e. coli, klebsiella, enterbacterer, proteus)
enterococci (e. faecalis and faecium), candida, clostridium

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116
Q

what is the prodrome

A

early signs of illness (subclinical infection) after the incubation period

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117
Q

can aerobic organisms grow without air

A

yes (unless strict anaerobes)

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118
Q

name a strict anaerobe

A

pseudomonas

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119
Q

what turns MacConkey agar pink

A

e. coli and other lactose fermenters

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120
Q

how do you tell if an organisms is intra/extra cellular

A

extracellular will fill dead space between the cells

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121
Q

what antibiotic broadly treats streptococci

A

penicillin

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122
Q

name two spirochete organisms

A

Borrelia burgdorferi (lyme disease), syphilis (Treponema pallidum)

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123
Q

what shape is campylobacter

A

small curved

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124
Q

what shape is helicobacter

A

spiral

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125
Q

in endocarditis how many sets of blood samples should you take in an hour

A

3

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126
Q

what type of bacteria is strep viridans

A

gram -ve cocci, strep, alpha haemolysis

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127
Q

what pathogen in infective endocarditis in IVDU

A

staph aureus/ epi

128
Q

what criteria to assess infective endocarditis

A

DUKEs

129
Q

what are the components of DUKEs criteria

A

major criteria:

  • typical microorganism from 2 blood cultures (viridans, strep bovis, HACEK, staph aureus)
  • +ve echo for IE/ new valvular regurgitation (both evidence of endocardial involvement)

minor criteria:

  • predisposed (heart condition/ IVDU)
  • fever
  • vascular phenomena (emboli, septic pulmonary infarcts), mycotic aneurysm, intracranial haemorrhage, conjunctival haemorrhage, janeway lesions)
  • immunological (glomerulonephritis, olsers nodes, roth spots, RF)
  • microbiological (evidence of infection)
  • echo/culture that doesnt meet major

two major criteria
one major and three minor
five minor

130
Q

what is the criteria for strep pharyngitis

A 
centor and (higher score more likely to be bacterial)
fever PAIN (shows risk of group A strep and need for antibiotic)
131
Q

what are the centor criteria

A 
(shows likely hood of pharygitis being streptococcal)
age (<14/>45) +1
exudate/ swelling on tonsils
cervical lymphadenopathy
fever (>38)
cough absent +1
132
Q

what are the feverPAIN criteria

A 
fever in past 24 hrs 
absence of cough/ coryza
symptoms onset = 3
purulent tonsils 
severe tonsilar inflammation
133
Q

what are the CURB65 criteria

A 
to asses the severity of pneumonia
C= confusion (new onset)
U= urea >7
R= RR >30/mins
B= BP S<90 or D<61
65= age 65 or older 
0-2 mild/mod
3-5 severe
134
Q

what are the typical organisms associated with endocarditis

A

s aureus, enterococcus faecalis, viridans, HACEK (e.g. chlamydia, haemophylis)

135
Q

are babies and the elderly more likely to get hypo or hyper thermic

A

hypo due to hypothalamic insufficiency

136
Q

what pathogens are most likely to cause a gall bladder infection

A

coliforms, enterococci and anaerobes (as all found intrabdominally)

137
Q

what does metronidazole work against

A

anaerobes

138
Q

what does amoxicillin work against

A

gram +ves (enterococci)

139
Q

what pathogen do you expect to be causing a foot ulcer

A

staph aureus

140
Q

what bacteria produce toxins

A

shigella and ecoli 0157

141
Q

what antibiotics for gastroenteritis

A

none

142
Q

what is the prophylaxis for a total hip replacement

A

co-amoxiclav and amoxicillin (if high BMI to increase the dose of amoxicillin)

143
Q

what increases the risk of getting C diff

A

PPIs- reduce stomach acid
steroids + other immunosuppressants
increased age
being an inpatient

144
Q

what can cause bloody diarrhoea

A

e.coli, campylobacter, c. diff

145
Q

what are the complications of an e.coli 0157 that can be precipitated by antibiotics

A

haemolytic-uremic syndrome

146
Q

what are the mechanisms of antibiotic resistance

A

active efflux (pushing it out of cell), target replication, modified drug target, decreased permeability, DRUG INACTIVATING ENZYMES (e.g. beta lactamase)

147
Q

how does the dosage of antibiotic reduce the risk of resistance

A

high dose for short time
low does doesn’t kill- allows resistance
long duration increases risk of resistance

148
Q

should you take samples before/ after giving antibiotics

A

before

149
Q

are oral or IV antibiotics better

A

in general oral better- switch down from IV asap

150
Q

where are anaerobes found and what do they cause

A 
mouth, teeth, throat, sinuses, lower bowel 
cause:
-abscesses
-dental infection 
-peritonitis 
-appendicitis
151
Q

where are atypicals found and what do they cause

A 
chest and GU tract 
cause
-pneumonia
-urethritis 
-pelvic inflammatory disease
152
Q

where are gram -ves found and what do they cause

A

GI tract

  • UTIs
  • peritonitis
  • biliary infection
  • pelvic inflammatory disease
153
Q

where are gram +ves found and what do they cause

A 
skin and mucous membranes
cause:
-pneumonia 
-sinusitis 
-osteomyelitis 
-wound infection 
-line infection
154
Q

what are the general side effects for most antibiotics

A

N&V&D
rashes
candida infections

155
Q

what are the important side effects of penicillin

A

allergies, skin reactions

156
Q

what are the important side effects of flucloxacillin and co-amoxiclav

A

cholestatic jaundice

157
Q

what are the important side effects of macrolides

A

hepatitis, Q-T interval

158
Q

what are the important side effects of quinolones

A

loads inc QT interval, convulsions, tendonitis

159
Q

what are the important side effects of aminoglycosides/ gylcopeptides

A

nephrotoxicity

160
Q

what are the important side effects of vanocmycin

A

red man syndrome (flushing due to histamine)

161
Q

what are the important side effects of tetracyclines (doxycyline)

A

hepatoxicity, stains teeth (why you never give to children), photosensitive, dysphagia

162
Q

when do you use cholarmphenicol

A

in eye drops only

163
Q

what is MRSA sensitive to

A

vancomycin

164
Q

what to treat enterococcus faeclum

A

gent and vancomycin

165
Q

does the ‘garage’ have to be joined to the ‘house’ for a beta lactam allergy to be triggered

A

yes

166
Q

what are the three important enterococci

A

E. faecalis. E. faecium, vancomycin resistant enterococcus

167
Q

what are the most important gram +ve bacilli

A

listeria monocytogenes
coltridia (difficile and perfinigens)
corynebacterium (dipertheroids- not the same as dipetheria)

168
Q

what are the beta lactam drugs

A 
penicillin
flucloxacillin 
amoxicillin 
cephalosporins 
piperacillin/tazobactam 
carbepenems
169
Q

what is the time of beta lactams needed above the MIC of the pathogen

A

need to give beta lactams several times a day as mod of action depends on amount of time spent above the minimum inhibitory concentration

170
Q

name three aminoglycosides

A

gentamicin
amikacin
streptomycin

171
Q

name 3 quinolones

A

levofloxacin

moxifloxacin

172
Q

where is it hardest for antibiotics to get into

A

CNS, eyes, prostate

173
Q

where do biofilms commonly form

A

CF, bronchiectasis, prosthetic material

174
Q

what streptococci catalase +ve/-ve

A

catalase +ve

175
Q

what are facultative anaerobes

A

grow aerobically and anaerobically e.g. streptococci

176
Q

describe group A strep

A

=strep pyogenes
pharyngitis, skin
beta haemolytic

177
Q

describe group B strep

A

= strep agalactaiae

pregnancy and neonatal meningitis

178
Q

what is the new name from strep bovis

A

strep gallollyticus

179
Q

what does streptococcus gallollyticus cause

A

endocarditis

180
Q

what does strep. pneumoniae cause

A

pneumonia, otitis media, meningitis

181
Q

name some of the members of the viridans group

A

e. salivarius, mutans, agalactaiae, anginosus,

182
Q

is there a strep pneumoniae vaccine

A

yes

183
Q

where do enterococci live

A

in the large bowel

184
Q

what diseases do enterococci cause

A

UTI, endocarditis, bacteraemia

185
Q

what antibiotic for enterococci

A

amoxicillin IV
oral or co-trimoxazole step down
vanocmycin used if amoxicillin resistant

186
Q

what is the mean inhibitory concentration

A

concentration of drug required to kill 99.9% of organisms during 18/24 hrs
the conc that allows the tube of well containing the organism to stay clear (by visual examination) after 18 to 24 hrs

187
Q

what antibiotic for staph aureus

A

flucloxacillin IV in sepsis

188
Q

what antibiotic for MRSA

A

vancomycin IV

189
Q

what is pharmacodynamics

A

relationship between infection outcome and drug outcome

190
Q

what is pharmacokinetics

A

is the effect of the body’s processes on the drug

191
Q

when is a drug active

A

when it is unbound

192
Q

what are the C. diff risk factors

A 
antibiotic use
prolonged hospital stay 
PPIs/ H2 antagonists 
age >65y
surgical procedure 
immunosuppressants
193
Q

what are the main symptoms of c. diff

A

constipation with overflow diarrhoea

194
Q

what are the severity markers for C. diff

A

need one or more to be severe:

  • temp >38.5
  • ileus, colonic dilatation >5cm, toxic megacolon and/or pseudomembranous colitis
  • WBC> 15 cells x10(3)L
  • acute rising serum creatinine (>1.5 x baseline)
  • if persisting
195
Q

what is the treatment for non severe C diff

A

oral metronidazole 400mg for 10days
(can give IV if oral nor available)
rehydrate

196
Q

what is the treatment for severe C diff

A

oral vancomycin 125 mg qds for 10 days (NG if oral not available)

197
Q

what is responsible for many of the antigens properties of gram -ves

A

lipopolysaccharide layer

198
Q

what is the treatment for legionella pneumonia

A

co-amoxiclav and levofloxacin

199
Q

what antibiotics are active against gram -ve

A 
beta lactams (and monobactam)
aminoglycosides 
macrolides 
tetracylines 
chloramphenicol
co-trimoxazole
polymixins
200
Q

name an aminoglycoside

A

gentamycin

201
Q

what are the majority of gram -ve bacteria

A

bailli

202
Q

name an enterobacteriacae

A

e. coli

203
Q

how long in hospital before a pneumonia is classed as HAP

A

> 48 hours

204
Q

what type of bacteria is haemophilus influenzae

A

gram -ve coccobacillus

generally aerobic

205
Q

what growth factors does haemophilus influenzae need

A

X factor (hemin), V factor (NAD)

206
Q

what grows in chocolate agar media

A

haemophilus influenzae

207
Q

what antibiotic is active against haemophilus influenza

A

amoxicillin

also doxycycline

208
Q

is there a vaccine against haemophilus influenzae

A

yes

209
Q

where is UK has high levels of resistant gram -ves

A

england

210
Q

what causes atypical pneumonia

A

mycoplasma pneumonia, coxiella burnetii, chlamydophila psittaci, legionella

211
Q

what antibiotics for atypical pneumonia

A

doxycycline
clarithromycin (has more SEs)
quinolones (in penicillin allergic)

212
Q

which aytpical pneumonia has higher mortality than normal bacterial pneumonia

A

legionella

213
Q

what type of bacteria is legionella

A

gram -ve bacilli

214
Q

where is legionella found

A

in lukewarm aerosolised water

215
Q

who is legionella pneumonia more common in

A

smoker, males, COPD, immunosuppressed, malignancy, diabetes, dialysis, hot tubs

216
Q

what is pontiac disease

A

milder form of legionella pneumophila

217
Q

where does legionella grow in body

A

within alveolar macrophages

218
Q

what type of legionella causes the most disease

A

serotype 1

219
Q

how do you diagnose legionella pneumonia

A

urine culture

220
Q

what are the most common causes of gram -ve strep

A

E. coli, klebsiella, pseudomonas, enterobacter (not gram +ve enterococcus), neisseria meningitidis

221
Q

how do you differentiate coliforms

A

biochemical tests

222
Q

what organisms turn macConkey agar pink

A

e coli and other lactose fermenters

223
Q

what is the main cause of gram -ve antibiotic resistance

A

alteration to enzyme (Beta lactamase)

224
Q

what often mediates the spread of beta lactamases

A

plasmid

225
Q

what is the main concern in gentamicin prescribing

A

nephrotoxicity (limit duration (<72 hrs), monitor renal function daily)

226
Q

what do phagocytes act against

A

bacteria and fungi

227
Q

what do T lymphcytes act against

A

viruses, fungi and protozoa

228
Q

what do antibody and B lymphocytes work against

A

bacteria and viruses

229
Q

what do eosinophils work against

A

fungi, protozoa and worms

230
Q

what do mast cells work against

A

worms

231
Q

what does complement work against

A

bacteria

232
Q

what in immunology works against bacteria

A

phagocytes, antibody and B lymphocytes and complement

233
Q

what immunological components work against viruses

A

T lymphocytes and complement

234
Q

what immunological components work against fungi

A

phagocytes, antibody and B lymphocytes, complement

235
Q

what immunological components work against protozoa

A

T lymphocytes, eosinophils

236
Q

what immunological components work against worms

A

eosinophils and mast cells

237
Q

what antimicrobials do keratinocytes secrete

A

defensins

238
Q

what is the secretory immunoglobulin

A

IgA

239
Q

what does incompltete urinary voiding lead to

A

urinary stasis- increased infection risk

240
Q

what are phagocytes

A

neutrophils (blood) and macrophages (tissue)

ingest organisms following opsonisation

241
Q

what can cause phagocyte deficiency

A

haematological malignancy, cytotoxic chemo

242
Q

what causes T lymphocyte deficiency

A

HIV, lymphoma, primary immunodefiency syndromes (SCID)

243
Q

how does HIV affect the immune system

A

infects CD4+ lymphocytes causes progressive decline in numbers

244
Q

what is there high risk of in HIV

A

pneumococcal disease (recurrent pneumonias)

245
Q

what can cause hypospenism

A

splenectomy

sickle cell, cirrhosis, coeliac disease

246
Q

what are you act risk of in hyposplenism

A

infection from encapsulated disease s. pneumoniae, h. influenzae, neisseria meningitidis

247
Q

what signs of infection may be absent in immunocompromised patients

A

fever, inflammatory response (CRP/ neutrophilia)

248
Q

what infections are steroids associated with

A

fungal infections

249
Q

what infections are anti-TNF therapies associated with

A 
mycobacterium tuberculosis
fungal infections (aspergillus)
250
Q

who gets influenza vaccines

A 
pregnant 
chronic heart/lung.kidney/liver disease
immunocompromised
diabetes 
age >65
251
Q

who gets a s. pneumoniae vaccination

A 
chronic heart/lung/kidney/liver disease 
hyposplenism
immunocompromised
diabetes 
age >65
252
Q

who gets h influenzae vaccines

A

all children

253
Q

what pulmonary dysfunction exists in sepsis

A

endothelial injury/ capillary leak
diffuse alveolar oedema (ARDS)
resp failure

254
Q

what renal dysfunction exists in sepsis

A

acute kidney injury (rise in urea/creatinine)

255
Q

what liver dysfunction exists in sepsis

A

shock liver(high ALT/AST)

256
Q

what CNS dysfunction exists in sepsis

A

delirium, confusion due to diffuse central hypoperfusion

may become drowsy/ decreased conscious level

257
Q

what haematological dysfunction exists in sepsis

A

dissesminated coagulation (low Plts, prolonged APTT/PT)

258
Q

do all quinolones cause C diff

A

yes- ciprofloxacin represents all of them in 4 c’s (all end in -acin)

259
Q

are all these statements true? penicillins:

  • inhibit cell wall synthesis
  • are bacterialcidal
  • an allergy to one means an allergy to all
  • all are absorbed orally
A

no some are not absorbed orally

260
Q

what antibiotic causes photosensitivity

A

doxycycline

261
Q

what antibiotic worsens epilecptic control

A

all quinolones ( all end in -acin e.g. levofloxacin)

262
Q

why do you add clarithromycin in pneumonia

A

to cover atypical organisms

263
Q

which antibiotic for strep pneumoniae

A

amoxicillin (doxycycline has some cover but not as good)

264
Q

what has better oral absorption amoxicillin or penicillin

A

amoxicillin

265
Q

what is the resp quinolone

A

levofloxacin

266
Q

does ciprofloxacin cover strep pneumonia

A

no

267
Q

how is aztreonam administered

A

IV

268
Q

when vancomycin is given orally is it absorbed systemically

A

no

269
Q

can c diff be carried asymptomatically

A

yes

270
Q

what is the most common cause for CAP

A

strep pneumoniae

271
Q

is smoking a risk factor for CAP

A

yes

272
Q

why is the first line for UTIs amox and gent

A

as 40% of e. coli is resistant to amoxicillin

273
Q

what are the side effects of quinolones

A

abdo aortic rupture, psychiatric SEs, diffuse tendonitis and tendon rupture, c diff

274
Q

is the oral availability of quinolones the same as IV

A

yes

275
Q

what is clindamycin activa against

A

strep pygoenes, s aureus, anaerobes

doesnt cover gram -ves

276
Q

how is gentamicin adminstered

A

IV for sepsis

can be used as drops

277
Q

is listeria gram -ve or +ve

A

+ve

278
Q

are these gram -ve or pos:

salmonella, campylobacter, shigella

A

gram -ve

gastroenteritis think gram -ve bacilli

279
Q

what antibiotic can give deranged LFTs

A

co-amoxiclav

280
Q

what are the biochem markers in bacterial sepsis

A

raised IL 6, CRP, WBC

lowered platelets

281
Q

what are the defining aids conditions

A

recurrent pneumonia, oropharyngeal candida, salmonella bacteraemia

282
Q

what is extended spectrum beta lactamase (ESBL) klebsiella sensitive and resistant to

A

sensitive: meropenam
resistant: amoxicillin, cephalosporins, aztreonam, piperocillin/tazobactam

283
Q

what antibiotics reacts with a lot of things

A

rifampicin

284
Q

what antibiotic should be avoided in children <12

A

tetracyclines (e.g. doxycycline)

285
Q

what are the main pathogens in celluitis

A

s aureus and s pyogenes

286
Q

does penicillin cover staph aureus

A

no

287
Q

is flucloxacillin sufficient to cover animal bites

A

no

288
Q

what causes walking pneumonia

A

mycoplasma pneumoniae

289
Q

what do you get kplick spots in

A

measels

290
Q

what antibiotic should you never prescribe as a monotherapy

A

rifampicin

291
Q

when should you repeat blood cultures in MSSA bacteraemia

A

2/3 days

292
Q

what are the groups of beta haemolytic strep

A

groups A, C and G

293
Q

what culture should all patients with suspected sepsis get

A

blood

294
Q

why do you only do urine cultures when there is signs of infection

A

as many will have asymptomatic bacteruria

295
Q

can you culture CSF, pleural or ascitic fluid

A

yes

296
Q

what does serolgy measure

A

either the antibody- IgM and/ or IgG (EBV, CMV, syphilis)

or the antigen (hep B- HBsAg)

297
Q

how do antibodies reflect the immune systems memory for a pathogen

A

IgM recent exposure

IgG was exposed at some point

298
Q

what is serology most useful in

A

viruses, spirochaetes (lyme, syphilis), protozoa

299
Q

how does PCR work

A

makes direct copies of DNA

  • Taq polymerase
  • primers
  • repeated cycles of heating and cooling

can be done on bloods (HIV, hep B, hep C, bacterial meningitidis)
or swab/ fluid (viruses- influenza, HSV, VZV, norovirus. bacteria (N.meningitis, S. pneumoniae)

300
Q

what is PCR the main test for

A

virus detection

301
Q

how is PCR used for diagnosis

A

throat swab- viral resp tract infections (influenza, parainfluenza, RSV, coronavirus)
stool sample- norovirus
CSF- HSV, enterovirus, N. meningitidis
sputum- mycobacterium tuberculosis
blood- HIV, hep B, hep C, bacterial meningitidis

302
Q

how is PCR used for monitoring

A

shows how much of organisms is present
HIV- control
Hep b- control
hep C- cure

303
Q

what is maldi-tof

A

type of mass spectometry
identifies organisms
v specific
doesn’t provide sensitivities

304
Q

what is whole genome sequencing used for

A

shows entire DNA of organism
can show antibiotic resistance
used for epidemiology and outbreaks

305
Q

can antibiotics get into pus

A

no- in quinsy or an abcess need ENT person or drainage

306
Q

can other antbiotics cause c diff

A

yes they all can inc the ones that treat it

307
Q

what do you screen any one who has travelled anywhere for

A

gram -ves - do a rectal swab

308
Q

is gentamicin active against anaerobes

A

no only gram -ves

309
Q

is vancomycin active against gram -ves

A

no only gram +ves

310
Q

is aztreonam safe in penicillin allergy

A

yes

311
Q

how long antibiotics for endocarditis

A

6 weeks

312
Q

how long antibiotics for bacteraemia

A

14 days

313
Q

How much 0.9% saline IV should be given initially to patients with sepsis?

A

500mls bolus

314
Q

tx for sepsis caused by a diverticular abscess

A

Amoxicillin,gentamicin and metronidazole (all IV)

step down oral Co-trimoxazole and metronidazole

315
Q

what is the prevalence of type 1 penicillin allergy in the population

A

<0.5 %

316
Q

tx for (ESBL (extended spectrum beta lactamase )producing coliform in blood)

A

Intravenous meropenem

317
Q

what does gentamicin work against

A

gram -ves

CLASP (3 decks)

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