week 2 Flashcards
what are the 3 stages according to the sepsis 3 criteria
simple infection
sepsis
septic shock
what are the criteria for sepsis
lactate >2
new AKI
or one or more of
altered mental state RR≥25 HR≥130 SBP <90 OR 40% below normal Urine output <0.5mls/kg/hr or anuric for 18 hours ashen or mottled skin or purpuric rash cyaniotic skin lips or tongue
what is the criteria for septic shock
persisting hypotension or >2 lactate despite 3L IV fluid
what is sepsis 6
give oxygen give fluids give antibiotics take lactate take cultures record urine/fluid balance
what antibiotic is commonly used prophylactically for chronic chest infection
azithryomycin
what is VBG useful for
lactate
pH
glucose
U&Es
co-amoxiclav can cause jaundice T or F
T
what is creatinine kinase an indicator of
muscle damage
old person with HR of 150 is until proven other wise?
tachy AF
why can BP be low in AF?
heart is pumping fast but inefficiently
how long is an acute wound classed as
<6 weeks
3 stages of wound healing
inflammatory phase
proliferation phase
remodelling/maturation phase
difference between healing by primary secondary and tertiary intention
primary is clean, low infection risk, minimal scar
secondary; slightly bigger scar, takes longer, partial or full thickness
tertiary; high infection risk, left open to heal before attempting to close
criteria for stage 1 AKI
creatinine >50-99% increase within 7 days
or
urine output <0.5ml/kg/hour for more than 6 hours
or creatinine rise >26 micromol within 48 hours
which cell does the HIV infect
CD4
3 routes of transmission for HIV
sexually
blood borne
vertically
how does HIV kill you
infect CD4 cells, destroying them progressively, as CD4 count goes lower, opportunistic infections and other complications arise, eventually leading to death
describe primary HIV infection
most patients go through seroconversion which manifests as flu-like symptoms - fever, malaise, anorexia, myalgia, rash, lymphadenopathy
what are CD4 and viral loads like during seroconversion
VL is high
cd4 drops
what happens after seroconversion
viral load drops
cd4 counts go back up
virus goes into dormant phase
what is the window period for HIV testintg
4-8 weeks
who should you offer HIV screening test
GUM clinic with risk factors
high-risk area GP registrations
diagnosis of HIV/AIDS associated illnesses
how are HIV patients monitored
CD4 and viral counts are checked 6 monthly to assess need for commencement of treatment
risk factors continually assessed
what is AIDS defined as in terms of CD4 count
<200 x 10^6/ml
some side effects of HAART
anaemia
neutropaenia
thrombocytopaenia
4 non-infectious AIDS defining illnessess
kaposis’ sarcoma
lymphoma
progressive multifocal leucoencephalopathy
AIDS dementia
what is the expected order of opportunistic infections as CD4 counts drop
TB
CMV retinitis
PCP
shingles
shingles
TB
PCP
CMV
what is PCP?
pneumocystis jerovecii pneumonia
presents with - sob, tachypnea, dry cough, fever
when should prophylaxis for PCP be given to HIV patients?
CD4 <200 OR hx of PCP infection
what is toxoplasmosis
caused by protozoan toxoplasmosis gondii
infects the brain causing neurological symptoms
symptoms of toxoplasmosis in HIV patients
seizures focal neurological deficits hemiparesis headache confusion
what is PML?
progressive multifocal leucoencephalopathy
progressive demyelination of white matter in brain, leads to progressive neurological and cognitive loss and death
4 types of medicine given in HAART
nucleotide reverse transcriptase inhibitors (NRTI)
Non-NRTI
protease inhibitors
integrase inhibitors
name some classes of antibiotics that target the 30s or 50s RNA subunits
amingoglycosides
macrolides (50s)
tetracyclines
what is co-amoxiclav most given for?
RTIs
what does clavulanic acid do
inhibits beta lactamase
co-amoxiclav is given for MRSA - T or F?
F
what is the 1st line antibiotic for cellulitis
flucloxacillin
flucloxacillin only exists as IV preperation - T or F
F, oral or IV
3rd generation cephalosporins are more potent than 1st generation ones - T or F
F, they have different spectrum of activity
cefutaxime is generation of cephalosporin
3rd gen
what is cef & met commonly given for
intra-abdominal infections
what is cefutaxime commonly given for
bacterial meningitis
what route of administration is meropenem given as
IV
name 1 glycopeptide
vancomycin
what is the target of glycopeptides
cell wall synthesis
why are tetracyclines not given to children and pregnant women
it gets deposited in teeth and bone
give 2 examples of a macrolide
erythromycin azithromycin clarithromycin
in severe pneumonia, co amoxiclav and clarithromycin are given, what does clarithromycin cover?
atypical organisms
ciprofloxacin, moxifloxacin are what class antibiotics?
quinolones
what is ciprofloxacin especially active against?
gram negative intracellular infections
which of these is an aminoglycoside - erythromycin gentamicin doxycyline?
gentamicin
what 2 organs do aminoglycosides damage most?
ototoxicty and nephrotoxicity
what is co-trimoxazole made up of and what is it used for commonly
trimethoprim and sulfamethoxazole, PCP
what can you not take with metronidazole?
alcohol
what kind of organisms does metronidazole work against
anaerobes and protozoans
