Micro Flashcards

Question

Amphiteracin

Answer 1

Active against fungi and yeast Large Vd No reliance on renal clearance Toxicity - nephrotoxic, hypokalaemia, fever Ags chills, RTA, hypochromic normocytic anaemia

Answer 2

Antifungals Fluconazole, Voriconazole Prevent synthesis of ergosterol Early generations are only active against candida albicans and, most non albicans and are resistant

Answer 3

``` Candida albicans Other candida resistant Active against cryptococcus No activity against aspergillus Penetrates into CSF Small Vd Relies on renal clearance, readily cleared by dialysis Toxicity - LFTS, alopecia, drug interactions (inhibits CYP 450) ``` Prophylaxis - use does not reduce mortality IV surgical pts May reduce mortality if given in septic shock

Answer 4

Covers all candida, cryptococcus, aspergillus Highly protein bound Vd massive Not renally cleared, not dialysable Inhibits CYP 450 Toxicity - long Qt, hallucinations, psychosis, drug interaction

Answer 5

Anti fungal eg caspofungin Inhibit cell wall synthesis by blocking synthesis of glycine 1,3 beta glucose synthase Very active against candida, useless for cryptococcus, not very helpful for aspergillus Highly protein bound But dependent on renal excretion, not dialysable Minimal toxicity

Answer 6

``` Thrombocytopaenia Anaemia Neuropathy Lactic acidosis Serotonin syndrome ``` All due to mitochondrial toxin activity

Answer 7

Renal or liver dysfunction Thrombocytopaenia Anaemia

Answer 8

N&V, | Teratogenic

Answer 9

``` Minor- RR >30 PF <250 confusion raised urea low WCC low plat low temp low BP ``` Major - - invasive ventilation - need for vasopressors

Answer 10

``` aspergillus Q fever TB nocardia leptospirosis melioidosis ```

Answer 11

``` long admission renal impariment enteral tube feeding proximity to VRE patients elderly long term IV access inter hospital transfer low staff:patient ratio haematological malignancy multiple courses of Abx ```

Answer 12

``` Abx exposure - cipro ,clinda, beta lactams, cephalo immunosuppresant drugs, cytotoxic drugs age >65 PPI renal impairment long admission ```

Answer 13

linezolid teicoplanin (if Van B) daptomycin tigecycline

Answer 14

systemic infection - determined by site of infection | transfer of resistance to staph aureus

Answer 15

Easy Has good predictive validity (AUROC 0.81) BUT - - validated retrospectively - "new onset" vs old changes?? - not proven to be valid in a range of clinical settings

Answer 16

``` Repeated abdominal surgeries Exposure to broad-spectrum antibiotics Exposure to fluconazole Diabetes CVC insertion TPN use Malignancy Renal failure ```

Answer 17

``` Candida endopthalimitis/retinitis Candia endocarditis Hepatosplenic abscesses Pulmonary cavitating lesions CNS involvement (meningitis or abscesses) Candida arthritis ```

Answer 18

Thick (parasite load) and thin (parasite species) blood smears Rapid diagnostic tests utilising malarial antigens (dependents on specific test)

Answer 19

``` Cinchona alkaloids (quinine and quinidine) Artemisinin derivatives (artesunate, artemether). ``` Also - tetracyclines (eg doxycycline), napthoquinones (eg. atovaquone) and lincosamides (eg. clindamycin).

Answer 20

Cerebral Involvement with or without convulsions Respiratory Failure - acute respiratory distress syndrome (ARDS) Circulatory collapse ``` GI - • Renal failure, hemoglobinuria ("black water fever") • Hepatic failure • Splenic Rupture - hepatosplenomegaly ``` Haematological • Disseminated intravascular coagulation • Severe anemia secondary to Haemaolysis • Thrombocytopenia ``` Metabolic • Hypoglycemia • Severe Acidosis • Hyponatraemia -high fever and rhabdo due to rigors ```

Answer 21

Investigate the validity of the reported colonisation rate Investigate the demographics of the colonised patients Investigate the origin of the patients (which ward are they coming from?) Revisit the current infection control policy: is it time to rewrite it? Get expert opinions from infectious diseases and infection control specialists Form a multidisciplinary review panel (ICU specilists, ID physicians, NUMS and RNs) Review the current literature on infection control Rewrite infection control policy Educate the staff regarding the new policy Implement rigorous standards regarding hand washing and bed space cleaning Monitor the effects of the implemented policies

Answer 22

DIC from any cause Sepsis due to the following organisms: - S.pneumoniae - but mainly in asplenic patients for some reason - S.aureus - H.influenzae - N.meningitides Endocarditis of any bacterial aetiology MAHA (microangiopathic haemolytic anaemia) TTP (thrombotic thrombocytopenic purpura) Varicella infection Rickettsial infection Plasmodium falciparum malaria Vasopressor excess Warfarin-induced skin necrosis Congenital Protein C anticoagulant pathway defect Post-infectious purpura fulminans (due to autoimmune destruction of proteins C or S)

Answer 23

Critical illness in general seems to be a risk factor. Risk factors for reactivation: - Trauma - Burns - Severe critical illness (high APACHE score, over 27) - Blood transfusion - Mechanical ventilation - Severe sepsis - Prolonged ICU stay - Pregnancy

Answer 24

Positive CMV antibodies (IgM) - sensitive for recent or acute infection Qualitative PCR - very sensitive for the presence of CMV, but they do not distingusih between active and latent infection. Quantitative PCR - ideal test, as it provides a quantitative assessment of viral load, and allows the monitoring of therapy.

Answer 25

``` Colitis Hepatitis Encephalitis Guillain-Barre syndrome Pneumonitis (rare) Pericarditis and myocarditis Uveitis and retinitis ```

Answer 26

Chronic allograft nephropathy (renal transplant) Hepatic artery thrombosis (liver transplant) Accelerated Hep C recurrence (liver transplant) Bronchiolitis obliterans (lung transplant) New onset NIDDM Post-transplant lymphoproliferative disease

Answer 27

Ganciclovir - initially valganciclovir - when infection under control Resistant strains - foscarnet and cidofovir

Answer 28

May be present in breast milk, saliva, feces, and urine. Not readily spread by casual contact. Requires prolonged or intimate exposure. Once infected, it is carried for life. Reactivation occurs when T-cell immunity is impaired. In organ transplant recipients, the transplanted organ is often the reservoir.

Answer 29

the affected cells are two to four times the size of unaffected cells. These cells typically have large "owl's eye" inclusions

Answer 30

Tigecycline Linezolid (particularly for MRSA pneumonia, where vancomycin penetrates poorly) Quinupristin/dalfopristin Daptomycin Fosfomycin (usually to enhance the effects of other drugs) Rifampicin/fusidic acid (particularly for deep bone and joint infections) Telavancin, dalbavancin and oritavancin Ceftobiprole and ceftaroline Iclaprim Trimethoprim/sulfamethoxazole Moxifloxacin

Answer 31

Vascular - Cerebral infarction/hemorrhage - Myocardial infarction - Ischemic bowel - Subarachnoid hemorrhage - Fat emboli - Deep venous thrombosis/PE - Phlebitis/thrombophlebitis Neoplastic - Lymphoma-associated fever - Renal cell carcinoma - Tumour lysis syndrome Drug-induced - Alcohol/drug withdrawal - Drug fever Idiopathic inflammatory - Postoperative fever (48 h postoperative) - Acalculous cholecystitis - Pancreatitis - Aspiration pneumonitis - ARDS - Gout/pseudogout - IV contrast reaction - GI bleed Autoimmune - Posttransfusion fever - Transplant rejection - Vasculitis - Haemolytic anaemia Traumatic/environmental - Haematoma degradation - Decubitus ulcers - Heat stroke Endocrine - Adrenal insufficiency - Thyrotoxicosis - Thyroiditis (Hashimoto) - Ovulation/pregnancy

Answer 32

``` CRP Procalcitonin LPS-binding protein sTREM-1 Presepsin (sCD14-st) HMGB-1 ```

Answer 33

Nitric oxide synthase induction by cytokines and endotoxin Direct vascular smooth muscle response to acidosis and hypoxia Inflammatory mediators produced by activated leucocytes Vasodilatory mediators (eg. histamine bradykinin and serotonin) produced by leukocytes and platelets Relative vasopressin deficiency Relative adrenal insufficiency, resulting in peripheral catecholamine insensitivity Acidosis, resulting in peripheral catecholamine insensitivity

Answer 34

CMV - valganciclovir Aspergillus - voriconizole or amphoteracin Pneumocystis - bactrim Nocardia - suphonamides

Answer 35

``` Immunocompromised Pregnancy Chronic lung disease Adults (greater risk compared to children) Smoking Number of spots - over 100 ```

Answer 36

cerebritis cerebral venous sinus thrombus increased intracranial pressure abscess

Answer 37

sickle cell disease alcoholic liver disease coeliac disease

Answer 38

``` Extreme of age <2 or >65 Chronic lung disease Asplenia both functional and anatomic Immunosuppression Transplant patients CSF leaks Cochlear implants ```

Answer 39

``` Trauma with massive transfusion Any recent surgery Burns Sepsis TPN Prolonged fasting Critical illness in general ```

Answer 40

``` Thickened gall bladder wall (over 3.5-4mm) Pericholecystic fluid Intramural gas Echogenic or hyperdense bile sludge Sloughed mucosa Gall bladder distension ```

Answer 41

``` E.coli Klebsiella Proteus Enterococcus Bacteroides ```

Answer 42

vancomycin, gentamicin and rifampicin

Answer 43

High fever (> 38.9°) Hypotension and shock Rash consistent with diffuse macular erythroderma Desquamation, particularly of the palms and soles There are also non-diagnostic associated features: Rapid onset: ~ 2 days Staphylococcus may grow in the blood (but blood cultures otherwise negative) Multisystem organ involvement

Answer 44

Some staphylococci produce a characteristic protein (the Toxic Shock Syndrome Toxin, or TSST-1, 2 and 3). TSST activates T-cells directly, acting as a "superantigen" -> Massive inflammatory cytokine release Endothelial dysfunction and vasodilatory shock ensues, which is out of proportion to the severity of the initiating infection.

Answer 45

``` Being female Use of tampons Mastitis Sinusitis Osteomyelitis Burns Compromised immune system (eg. HIV) ```

Answer 46

``` Clindamycin as an adjunct (prevents the synthesis of TSST) Intravenous immunoglobulin (to bind circulating TSST) ```

Answer 47

``` Herpes Simplex PCR Mycobacterium Tuberculosis PCR Mycobacterial Stain and Cultures India Ink Stain, Cryptococcal Ag Fungal cultures Bacterial PCR ```

Answer 48

Intelligence use of CVCs (i.e. does the patient even need one?) Subclavian lines. Minimum number of lumens. Use of dedicated lumens for lipid infusions. Immunosuppressed patients or those with burns should have antibiotic-coated lines. For insertion, use aseptic technique and maximal barrier precautions. 0.5% chlorhexidine in 70% alcohol is the preferred cleaning agent. Handle ends of administration sets with gauze soaked in chlorhexidine). Review the line daily. Remove the line as soon as possible. Change lines early - ideally, every 7 days. Sterile, transparent semipermeable dressings Change dressings regularly (every 7 days for standard dressings)

Answer 49

``` Strongyloides stercoralis Staphylococcus aureus Clostridium perfringens Yersinia CMV Entamoeba Listeria ``` All the enterohaemorrhagic diarrhoea organisms: - Salmonella - Shigella - Campylobacter - E.coli

Answer 50

beta lactam and macolide (eg azithromycin 500mgod) Continue for 7-10 days NB - mild/mod infection; ceph and azithro, 5 days

Answer 51

Pneumonia: VAP or HAP Central line associated bacteraemia UTI due to indwelling catheters Sinusitis due to nasogastric tubes Acalculous cholecystitis due to parenteral nutrition Pressure area infections Meningitis or ventriculitis due to EVD infection C.difficile infections due to broad-spectrum antibiotic use Surgical site infections

Answer 52

endogenous catecholamine release and used of adrenaline Circulatory faliure due to hypoxia and hypotension Cytopathic hypoxia - widespread microvascular shunting and mitochondrial failure inhibition of pyruvate dehydrogenase by endotoxin Coexistent liver disease

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