CLASP

Question 1

Holiday heart syndrome?

Answer 1

SVT with spontaneous resolution (caused by binge-drinking)

Question 2

Tx methanol poisoning?

Answer 2

Ethanol/dialysis

Question 3

Antabuse?

Answer 3

Inhibits aldehyde dehydrogenase making drinking unpleasant (rehab)

Question 4

Why does heart beat faster when intoxicated?

Answer 4

Alcohol is negative inotrope (faster HR to maintain CO)

Question 5

Veisalgia cephalgia?

Answer 5

Headache :)

Question 6

Septic shock?

Answer 6

Septic shock = sepsis + BOTH of the following:

• Persistent hypotension (requiring vasopressors to maintain MAP greater than 65)
• Lactate greater or equal to 2

Question 7

qSOFA criteria?

Answer 7

RR > 22
aBP <100
altered GCS
* 0 = <1% mortality
* 1 = 2-3%
* >2 = >10%

Question 8

when should you think sepsis?

Answer 8

NEWS score >5 + evidence of infection

Question 9

SEPSIS 6?

Answer 9

BUFALO

• Blood cultures
• Urine output
• Fluids IV - crystalloid, 250-500 mls over 15 mins, aim for 30ml/kg over first 3 hours
• Antibiotics IV
• Lactate - high lactate is sign of hypoperfusion + high mortality if >4
• Oxygen - 94-98%

Question 10

What if no response to fluids?

Answer 10

if no response refer to HDU for CVC and vasopressors (noradrenaline)

Question 11

how to tell if septic patient is deteriorating?

Answer 11

• New confusion
• High RR
• Low BP
• Low BM

Question 12

Gram positive organisms?

Answer 12

Cocci

• staphylococci (aureus + epidermidis)
• streptococci
• enterococci (E. faecalis)

Bacilli

• listeria
• clostridia (c.diff)
• corynebacterium (diptheroids)

Question 13

B lactams? (6)

Answer 13

• penicillin
• flucloxacillin
• amoxicillin
• cephalosporins
• piperacillin/tazobactam
• carbepenems

Question 14

features of streptococci? (2)

Answer 14

• facultative anerobes

* catalase positive

Question 15

Classification of strep via agar?

Answer 15

B haemolytic
Alpha haemolytic - green
Gamma haemolytic

Question 16

Classification of strep via antigens?

Answer 16

Lancefield group

• GAS
• Group B
• Group C

Question 17

Types of streptococci? (5)

Answer 17

• strep pyogenes - GAS (pharyngitis, skin)
• strep agalactaiae - group B (pregnancy and neonates)
• streptococcus pneumoniae
• viridans streptococcal group (own group)
• streptococcus gallollyticus - typical endocarditis pathogen

Question 18

Tx enterococcus faecium?

Answer 18

resistant to penicillin, fluclox, cephalosporin, aminoglycosides

Question 19

gram positive?

gram negative?

Answer 19

\+ = purple
- = pink

Question 20

streptococcus pneumoniae causes? (3)

Answer 20

• otitis
• pneumonia
• meningitis

Question 21

tx streptococcus pneumoniae?

Answer 21

If not penicillin resistant, penicillin

bind to penicillin binding proteins needed to synthesise peptidoglycan

Question 22

E. faecialis found?

Ax?

Answer 22

Gastrointestinal tract

• UTI
• endocarditis
• bacteraemia

Question 23

Tx E. faecalis?

Answer 23

Amoxicillin IV

* step down to oral amox or co-trimoxazole

Question 24

What is used to treat enterococcus (E. faecialis etc) if amoxicillin resistant?

Answer 24

Vancomycin

Question 25

Tx VRE (vancomycin resistant enterococcus)? (4)

Answer 25

* linezolid * daptomycin * tigecycline * quinupristine/dalfopristin

Question 26

what is mean inhibitory concentration (MIC)?

Answer 26

concentration of drug required to kill 99.9% of organisms in first 24 hrs

Question 27

Tx staphylococcus aureus? (2)

Answer 27

Flucloxacillin IV in sepsis | * vancomycin IV in allergy or MRSA

Question 28

Tx coagulae negative staph (i.e. not staph aureus)? | E.g?

Answer 28

many are flucloxacillin resistant * oral doxycycline, cotrimoxazole, clindamycin e.g. staph epidermidis

Question 29

pharmacokinetics? | Pharmacodynamics?

Answer 29

``` pharmacokinetics = how body processes drug Pharmacodynamics = relationship between infection outcome and drug outcome ```

Question 30

gram negative cell envelope?

Answer 30

contains additional outer membrane composed of phospholipids and lipopolysaccharides

Question 31

Pathogenesis of gram-negative bacteria?

Answer 31

stems from lipopolysaccharide (LPS)

Question 32

antibiotics active against gram negatives?

Answer 32

* B-lactams! * aminoglycosides! * macrolides * tetracyclines * chloramphenicol * co-trimoxazole! * polymixins!

Question 33

Haemophillus influenzae? | Growth?

Answer 33

gram-negative coccobacillus | * chocolate agar media

Question 34

Tx haemophillus influenzae?

Answer 34

* Amoxicillin | * Doxycycline

Question 35

Atypical pneumonia?

Answer 35

Not strep pneumonia | * mycoplasma pneumoniae, coxiella burnetti, chlamydophila psittaci, legionella pneumophila

Question 36

Tx for atypical pneumonia? (3)

Answer 36

* doxycycline - not legionella * clarithromycin * quinolones (levofloxacin) - legionella

Question 37

Ax legionella? | Risk factors? (8)

Answer 37

* showers * air conditioning * taps Risk factors * smokers * males * COPD * immunosuppressed * malignancy * diabetes * dialysis * hot tubs

Question 38

pathogenesis legionella?

Answer 38

invades and grows within alveolar macrophages

Question 39

which serogroup of legionella causes most disease?

Answer 39

Serogroup 1

Question 40

Coliforms? | Examples?

Answer 40

gram negative rods | * E.coli and similar organisms e.g. klebsiella, proteus, enterobacter, serratia

Question 41

Agar for coliorms + E.coli?

Answer 41

Macconkey agar = turns pink

Question 42

Extended spectrum B lactamases (ESBLs)?

Answer 42

reistant to penicillins, cephalosporins, and aztreonam

Question 43

Tx ESBLs? (3)

Answer 43

* clavulanate * sulbactam * tazobactam