Infection & Inflammation

Front 1

3 common bacteria causing gastroenteritis

Back 1

Champylobacter
Salmonella
E.coli 0157

Front 2

S&Ss of food poisoning/ gastroenteritis

Back 2

D&V
abdo pain
malaise
?fever- salmonella, e.coli
?blood

Front 3

commonest bacterial cause of food poisoning/ gastroenteritis ?
- source
- incubation
- S&Ss

Back 3

CHAMPYLOBACTER- raw milk, poultry
LONG incubation 2-5days

BLOODy, abdo pain, fever

Front 4

how champylobacter prevented/ treated

Back 4

food hygiene
NO Rx- oral fluids

at risk Rx: ciproflaxacin/ erythromycin

Front 5

salmonella:
- source
- incubation
- S&Ss
- type of bacterial infection

Back 5

meat, eggs, poultry
MED incubation- 1-2d

D&V, abdo pain, fever, SEPTICAEMIA

TOXIN-producing

Front 6

treatment of salmonella infection

Back 6

NO Rx
at risk: ciprofloxacin

Front 7

how is salmonella serogrouped
why

Back 7

- antigens on flagella& body
- identify source, identify outbreaks

Front 8

E.coli:
- source
- incubation
- S&Ss
- mechanism of infection

Back 8

PERSON-person spread from ANIMAL contact, food (beef, raw milk) or water bourne
- 1-3d LONG incubation
- BLOOD d,
- VTEC toxin producing

Front 9

which bacteria can cause outbreaks and which are toxin producing:
- champylobacter, salmonella, E.coli

Back 9

salmonella and E.coli - OUTBREAKS & toxin-producing

E.coli= VTEC

Front 10

what's the commonest cause of acute renal failure in children

Back 10

E.coli 0157 complicated by haemolytic ureamic syndrome (HUS)

Front 11

dangerous complication of E.coli 0157 infection?
- Ix's to Dx

Back 11

HUS;
- thrombocytopaenia ↓plt - blood film fragmented RBCs
- ↓Hb
- ARF: ↑creatinine & ↑urea, haematuria, proteinuria
- neurological involvement

Front 12

abx for e.coli 0157 may precipitate HUS, how do you treat HUS

Back 12

seek expert advice
treat hypovolaemia &HTN
DIALYSIS

Front 13

bacteria incubation;
- SHORT
- MED
- LONG

Back 13

SHORT- staph aureus, bacillus cereus

MED- Salmonella, Cl.perfringens

LONG- Champylobacter, E.coli

Front 14

q's to ask in clinical dx of gastroenteritis/ food poisoning

Back 14

Hx: travel, contact, food, animals, camping
anyone else?
TIME- incubation
DIARRHOEA: blood, severity
PMH: risk comorbidities

Front 15

what bacterial cause of gastroenteritis do you have to notify HPY about

Back 15

suspicion of HUS

Front 16

Dx of causative org

Back 16

STOOL culture (48h)

Front 17

management of pt's with D&V suspected gastroenteritis/ food poisoning

Back 17

oral rehydration
supportive
AVOID antimotiligy agents
IMMUNOCOMPROMISED- abx's, e.g. ciprofloxacin
isolation

Front 18

what's amoebic dysentery by definition (1 important symptom)

Back 18

BLOODy diarrhoea

Front 19

what causes pseudomembranous colitis

how is dx confirmed

Back 19

overgrowth of Cl.difficile following Rx with braod-spec abx's

STOOL culture

Front 20

common pathogen causing food poisoning 1-2hrs after indigestion.
abdo cramps, vomiting, watery diarrhoea.
gram +ve aerobic bacilli.
Pathogenicity due to enterotoxin, usually self-limiting.

Back 20

Bacillus cereus

Front 21

what pathogen is cause of diarrhoea due to broad spec abx's.
enterotoxin A&B = pseudomembranous colitis.
high mortality in elderly.

Rx?

Back 21

Cl. diff

oral metranidazole/ vancomycin

Front 22

what are coliforms:
- loc
- gram stain
- aerobes or anaerobes
- e.g

Back 22

LARGE AEROBIC BACILLI
GUT commensals
E.coli, Klebsiella, proteus

Front 23

what are strict/ obligate aerobes
- eg
- gram stain

Back 23

REQURIE O2 for growth
gram +ve
- bacilli: legionella, pseudomonas aeruginosa (exac bronchectasis)

Front 24

what are strict/ obligate anaerobes
- e.g's
- gram stain

Back 24

WILL NOT grow in presence of O2
-Gram +ve: bacteroides bacilli

Front 25

normal mouth flora

Back 25

Gram +ve aerobic:
- streptococci: strep viridans
- staphylococci

Gram -ve aerobes:
- neisseria

Candida

Front 26

flora of stomach / duodenum (low pH) & bile ducts

Back 26

usually sterile
stomach/ duod.- (some Candida & Staphylocicci)

Front 27

normal flora of jej & ileum (small bowel)

Back 27

Gram -ve:
- aerobes: coliforms (pic)
- anaerobes

Front 28

normal flora of colon

Back 28

Gram -ve:
- aerobes (coliforms)
- anaerobes

Gram +ve:
- aerobes: (streptococci) ENTEROCOCCUS FAECALIS (pic)

Front 29

micro-organisms that leak/ perforate into peritoneal cavity can cause abscesses (pus cells + orgs).
- why can small but not large abscesses be treated with abx's?
- how are large abscesses treated

Back 29

large abscess will have NO BLOOD SUPPLY so abx's won't peneetrate it.
- need incision & drainage

Front 30

which empirical abx therapy for COLIFORM infection (gram -ve large baccili = e.coli & klebsiella)

Back 30

gram -ve aerobes
GENTAMICIN
(>50% are amox-resistant)

Front 31

which empirical abx therapy for ANAEROBE infection (bacteroides -ve and cl.diff +ve)

Back 31

(generally gram +ve bacilli eg Cl.diff)
metranidazole

Front 32

which empirical abx therapy for ENTEROCCOCAL (& staphylococcal) infection

Back 32

aerobic gram +ve streptococci
AMOXICILLIN
(think gram +ve = amoX...X looks like +)

Front 33

what 3 empirical abx's given for INTRA-ABDOMINAL sepsis
- what do each cover

Back 33

GENT..............................aerobes (coliforms)
METRANIDAZOLE......anaerobes
AMOX............................enterococcus sp. (in colon) & staphyloccus

Front 34

whch prophylactic abx's for GI/HEPATO-BILIARY surgery

Back 34

GENT......aerobic coliforms
MET........anaerobes (small bowel- colon)

(not amox which covers enterococcus in colon alone & staphylococcus)

Front 35

what abx if penicillin allergy / MRSA (amox)

Back 35

vancomycin

Front 36

S&Ss of intra-abdominal sepsis

Back 36

temp >38, chills/rigors
↑WCC/ CRP
↑HR, ↓BP
↑RR
N&V
malaise/ anorexia
constipation/ diarrhoea
PERITONITIS (still, no BS, board-like)
pain, tenderness, guarding

Front 37

what classifies SEVERE sepsis

Back 37

1+ acute organ dysfunction:
renal
resp
hepatic
clotting
CNS
metabolic acidosis (↓HCO3-)
↓BP (↓CVS)- refractory to IV fluids

Front 38

Dx by Ix of intra-abdominal infection

Back 38

WCC, CRP, plt, clotting, LACTATE, U/O

micro (cultures): blood, stool, urine, wound, TISSUE

microscopy: stool, urine, CSF, sputum

serology (atypicals/ Ab's)
antigen detection- PCR

Front 39

management of intra-abdominal sepsis:
- empirical abx's
- supportive

Back 39

ABX's: gent (aerobes), metra (anaerobes), amox (enterococcus & staphylococcus)

SUPP.: O2, IV fluids, anaelgesia, VTE prophylaxis (clotting), control electrolytes
- ?transfusion
- ?surgery

Front 40

S&Ss HUS

Back 40

initial follow on from E.coli 0157: diarrhoea BLOODY, vomiting, severe abdo pain, fever

HUS:abdo P, F
low U/O, renal failure, neurological involvement
- low BP, tachycardic, fever
- high urea & WCC, low plt, Hb, abnormal clotting!

Front 41

2 viruses causing diarrhoea

Back 41

ROTAvirus (front pic) & NOROvirus (pic)

Front 42

which viral cause of diarrhoea is common in kids <3
how spread
time of year
infectious dose

Back 42

ROTAvirus: person-person, winter
LOW infectious dose

Front 43

which virus likely cause:
<3yrs
winter
Vomiting first --> watery D & fever (no blood)
post-infecitous malabsorption

Back 43

ROTAvirus

Front 44

which virus:
- winter
- faecal-oral/ air droplet/ direct spread
- low-infectious dose
- asymp shedding
- outbreaks

Back 44

NOROvirus

Front 45

avg time inc for norovirus (short/med/long)

Back 45

SHORT

Front 46

symptoms of norovirus

Back 46

PROFUSE vomiting
SYSTEMIC
SHORT incubation
OUTBREAKS

Front 47

Ix for viral diarrhoea

Back 47

PCR on STOOL

Front 48

complication of Cl.diff infection (gram +ve anaerobe)

Back 48

pseudomembranous colitis

Front 49

treatment for 1st episode of UNcomplicated Cl.diff infection (gram -ve anaerobe)

Back 49

ORAL metrinidazole

stop all other abx's
review PPIs
no anti-motility agents

Front 50

treatment for cl.diff if:
- poor response to SEVERE disease >1 severity marker

Back 50

get help!

oral VANCOMYCIN

Front 51

what's different about hand hygiene for control of Cl.diff and viral diarrhoea

Back 51

HANDWASHING (no gels!)

Front 52

4 core clinical problems in gastroenteritis

Back 52

fever
abdo pain
blood PR
diarrhoea

Front 53

most common cause of bloody diarrhoea

Back 53

champylobacter

Front 54

what bacteria causes typhoid-fever
what is it

Back 54

ENTERIC FEVER: samlonella typhi / paratyphi
SYSTEMIC infection
fever, malaise, DIFFUSE abdo pain, constipation, deleriumm, haeorrhage, perforation

Front 55

what infection gives profuse watery 'RICE-like' diarrhoea

Back 55

CHOLERA

Front 56

presentation S&Ss TYPHOID (enteric fever)
- Ix's

Back 56

malaise, high Fever, bradycardia, cough, CONSTIPATION (D after 1st wk)

BLOOD cultures
stool & urine

Front 57

treatment for typhoid (enteric fever)

Back 57

FLUIDS & nutrition

CIPROFLOXACIN
(if resistant = chloramphenicol, ceftriaxone, azithromicin)

VACCINE (incomplete protection)

Front 58

what's dysentery

Back 58

intestinal infection = Pain , fever
severe diarrhoea, blood & mucus

Front 59

infection with c.diff, what do you suspect if:
- high WCC & creatinine
colonic dilatation on AXR

Back 59

TOXIC MEGACOLON

Front 60

which empirical treatment for...
3+ unformed stool per day & 1+:
abdo pain, N&V, fever, blood in stool, tenesmus

Back 60

ciprofloxacin

Front 61

likely cause of diarrhoea after long stay in hospital on abxs
S&Ss

Back 61

Cl.diff;
- blood D
- P

(complication: toxicmegacolon & pseudomembranous colitis)

Front 62

3 causes of travellers-related diarrhoea

Back 62

amoebiasis
Giardiasis
cryptosporidium

Front 63

cryptosporidium
amoebiasis
giardiasis

commonly cause what

Back 63

traveller's diarrhoea

Front 64

treat travellers diarrhoea

Back 64

self-limiting
LFUIDS
single dose CIPROFLOXACIN
short-term anti-diarrhoeals

Front 65

AMOEBIASIS is a PROTAZOAL infection:
- transmission
- symp
- Dx/ test & results
- Rx

Back 65

faecal-oral, poor sanitation
acute BLOODY D
HOT stool --> ova & cysts
METRANIDAZOLE

Front 66

what infection is HOT stool sampled for ova and cysts

Back 66

amoebiasis (protazoal infection)
giardiasis

Front 67

GIARDIASIS (protazoal infection);
- transmission
- loc of GI tract it affects
- S&Ss

Back 67

contaminated WASTE
SMALL bowel
malabsorption, wt loss, fatty stool, bloating, flatulance, abdo discomfort, EXPLOSIVE diarrhoea

Front 68

dx by Ix for giardiasis

Back 68

stool for ova & cysts
(duodenal aspirate)

Front 69

treatment for protazoal infection with amoebiasis or giardiasis

Back 69

METRANIDAOLE

Front 70

treatment for cryptosporidium (1 of 3 important causes of traveller's diarrhoea)

Back 70

SUPPORTIVE
anti-microbials ineffective

Front 71

pathogens that can cause outbreaks of diarrhoea (5)

Back 71

E.coli 0157
Norovirus
cholera
Cl. diff
Salmonella

Front 72

geography of TYPHOID (enteric fever)
S&Ss

Back 72

india, SE asia
- HIGH fever, malaise, low HR, headache, constipation (>1wk diarrhoea), dry cough

Front 73

in a traveller, what presents with: RUQ pain, HIGH SWINGING fever & sweats, jaundice.

what Ix's would you do to confirm this?

Back 73

AMOEBIC LIVER ABSCESS
LFTs
Inflam markers :WCC, CRP
serology
stool (often -ve)
USS/ CXR/ CT

Front 74

what immune cell is raised in response to helminth (protazoal) infections

Back 74

eosinophilia

Front 75

3 types of parasites (helminth infections)

Back 75

nematodes (roundworms)
tematodes (flukes)
cestodes (tapeworms)