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Year 3 > ICP > Flashcards

ICP Flashcards

1
Q

What type of antibiotics work on the cell wall?

Any examples?

A 
Penicillins - pen V, amoxicillin, flucloxacillin
Cephalosporins - ceftriaxone, cefuroxime
Carbapenems - meropenem, ertapenem
Aztreonam (a monobactam)
Glycopeptides - vancomycin, teicoplanin
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2
Q

Give examples of 1st, 2nd and 3rd generation cephalosporins

A

1st generation - cephalexin
2nd generation - cefuroxime
3rd generation - ceftriaxone, cefotaxime

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3
Q

Give examples of antibiotics that work on protein synthesis

A

Aminoglycosides - gentamicin, streptomycin

Macrolides - erythromycin, clarithromycin

Clindamycin (a lyncosamide)

Tetracyclines - doxycycline
Chloramphenicol

Fusidic acid

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4
Q

Antibiotics working on DNA

A

Fluroquinolones - ciprofloxacin

Metronidazole

Nitrofurantoin

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5
Q

Antibiotics working on RNA

A

Rifampicin

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6
Q

Antibiotics working on folate

A

Trimethoprim

Sulphonamides - sulfamethoxazole

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7
Q

Possible adverse events with antibiotics

A
  • Allergy
  • Side effects of antibiotics
  • Interaction with medications
  • Effect on normal flora - leading to diarrhoea, candidiasis (oral/vaginal), resistance
  • Venflon / central line infection
  • Increased antibiotic resistance
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8
Q

Which drug classes are beta lactams

A

Penicillins
Cephalosporins
Carbapenems
Monobactams (Aztreonam)

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9
Q

Give some examples of mechanisms of antibiotic resistance

A 
Enzymatic inactivation - penicillinase e.g. MRSA
Altered target site
Decreased permeability
Efflux pumps
Utilising alternative metabolic pathway
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10
Q

What is the CURB-65 score for pneumonia?

A 
Confusion - AMT <=8
Urea - >7mmol/L
Respiratory rate - >=30/min
Blood pressure - SBP <90, DBP <60
65 - or older age
1 point for each
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11
Q

Treatment for MRSA

A 
Vancomycin
Clindamycin
--
Teicoplanin
Linezolid
Daptomycin
Gentamicin
Rifampicin/Fusidic acid (not alone)
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12
Q

Treatment for C. difficile

A

Metronidazole PO/IV

Vancomycin PO

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13
Q

Which antibiotics should not be used in any trimester of pregnancy?

A

Tetracyclines - can cause discolouration of the developing teeth

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14
Q

Which trimester should trimethoprim be avoided in?

A

First trimester - as it is an anti-folate

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15
Q

Which trimester should nitrofurantoin be avoided in?

A

3rd trimester

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16
Q

Structure + function of antibodies

A

IgM - pentamer, first antibody produced but it is short acting
IgG - monomer, crosses placenta, involved in long-term immunity
IgA - dimer, secreted into mucous, saliva, tears, colostrum (breast milk)
IgE - monomer, involved in allergy and antiparasitic
IgD - monomer, not much known about function

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17
Q

Why might eczema improve during pregnancy?

A

Immune system is dampened down during pregnancy

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18
Q

What types of bacteria are asplenic patients at risk of?

A

Encapsulated bacteria

  • Neisseria meningidis
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • E coli (some strains)
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19
Q

Risks of vaccinations?

A

Injection site pain and inflammation
Bleeding (can’t take aspirin before vaccination)
Fever
Flu-like symptoms

Major - anaphylaxis and guillian-barré syndrome

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20
Q

Contraindications for vaccination

A 
Previous problems with vaccination
Allergy
Egg allergy
Pregnancy - no live vaccinations allowed
Immunocompromised - no live vaccinations
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21
Q

Which vaccinations are live?

A 
Live flu vaccine
Rotavirus
Shingles
BCG
Oral typhoid
Varicella
Yellow fever
MMR
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22
Q

Examples of quinolones

A

Ciprofloxacin

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23
Q

Contents of septrin?

A

Septrin is co-trimoxazole

  • Sulfamethoxazole
  • Trimethoprim
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24
Q

Side effects of gentamicin?

A

Ototoxic, nephrotoxic

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25
Q

UTI in pregnancy?

A

Cephalosporins e.g. cefalexin 1st line

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26
Q

Risk factors for pneumonia?

A
  • Lung damage e.g. bronchiectasis
  • Alcoholism
  • Diabetes - klebsiella risk
  • Smoking
  • Travel
  • ITU / VAP
  • Occupational e.g. brucellosis in abertoirs
  • COPD - haemophilus/moraxella
  • Immunosuppresion
  • Nursing home
  • Age >65 or <5
  • Air conditioning - Legionella
  • Recent viral illness
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27
Q

Pneumonia organism more common in diabetics / alcohol dependent

A

Klebsiella

28
Q

Most common organisms of pneumonia

A

S. pneumoniae - causes classic whiting out of lobe on CXR

H. influenzae
Klebsiella pneumoniae

29
Q

Most common cause of pneumonia in COPD

A

Haemophilus influenzae

30
Q

Treatment for pseudomonas pneumonia

A

Ciprofloxacin

31
Q

Causes of atypical pneumonia

A

Mycoplasma pneumoniae
Legionella pneumophilia
Coxiella burnetii
Chlamydia pneumoniae (RF birds)

32
Q

Viral causes of pneumonia

A

Influenzae
RSV
Adenovirus

33
Q

Pathophysiology of aspiration pneumonia

A

Acid from stomach entering lungs causing a pneumonitis

34
Q

Protozoal causes of pneumonia

A

Pneumocystis jirovecii

Toxoplasmosis

35
Q

Classic feature of pneumocystis jirovecii pneumonia?

A

Put sats probe on, ask patient to walk and sats will rapidly drop

36
Q

DECAF score

A 
Dyspnoea - MRCD 1-4=0, 5a=1, 5b=2
Eosinophils <0.05 = 1
Consolidation = 1
Acidosis pH <7.3 = 1
Fibrillation (AF) =1
37
Q

Antibiotic therapy for pneumonia with CURB score <=2 or CRB <=1

A

Amoxicillin
or
clarithromycin

38
Q

Antibiotic therapy for pneumonia with CURB score >=3 or CRB >=2

A

Under 65:
Coamoxiclav IV plus clarithromycin

Over 65:
Piperacillin-tazobactam IV + clarithromycin PO

39
Q

Why must a CXR be done 6 weeks post-pneumonia?

A
  • Ensures clearance

Rules out other cause of shadowing e.g. malignancy

40
Q

Complications of pneumonia

A

Parapneumonic effusion
EMpyema
Abscess

41
Q

Appearance of neisseria gonorrhoea on microscopy?

A

Gram negative intracellular diplococci

42
Q

Where to swab to test for gonorrhoea and chlamydia in men and women?

A

Women - vulvovaginal swab best

Men - first pass urine better

43
Q

Treatment of gonorrhoea

A

Ceftriaxone IM once
or
Ciprofloxacin 500mg PO

44
Q

Complications of gonorrhoea

A
  • PID
  • Infertility
  • Neonatal conjunctivitis (ophthalmia neonatorum)
  • Epididymo-orchitis
  • Disseminated gonoccocal infection - rash like meningococcal septicaemia
45
Q

Treatment for chlamydia

A

Doxycycline 100mg BD 1 week

or
Azithromycin for 2 days

46
Q

Types of HSV sti

A

Type 1 - stomatitis

Type 2 - genitals

47
Q

How to diagnose HSV ulcers?

A

Clinical diagnosis

48
Q

Treatment for HSV STI infection

A

Aciclovir if diagnosed within 5 days, otherwise supportive

49
Q

Stages of syphilis

A

Primary - up to 90 days, get chancre formation (painless ulcer)

Secondary - 4-10 weeks after chancre, get maculopapular rash on palms and soles, condylomata lata (raised plaques), fever headache myalgia

Tertiary - neurosyphilis. Argyll Robertson pupil - pupil constricted, not reactive to light but accomodates
Tabes dorsalis - infection of dorsal column so loss of proprioception

50
Q

What is an argyll-roberton pupil

A

Complication of tertiary syphilis

Pupil constricted, not reacting to light but still accommodates

51
Q

Treatment of syphilis

A

Benzylpenicilin injectio
or
doxycycline 100mgBD duration dep on stage

52
Q

How long is syphilis infectious for?

A

It is infectious for up to 2yrs, usually until after the secondary phase

53
Q

Treatment for genital warts

A
  • Do nothing
  • Immune modulation - imiquimod
  • Cryotherapy
54
Q

Characteristics of molloscum contagiosum

A

Round
Same colour as skin
Nodular
No inflammatory changes to skin

55
Q

Causative agent of molloscum contagiousm

A

Molloscipoxvirus

56
Q

Treatment for scabies

A

Permethrin 5% cream

57
Q

Pathophysiology of bacterial vaginosis

A

Loss of usual lactobacilli, leading to proliferation of gram negative anaerobes e.g. garnerella vaginalis

58
Q

Symptoms of bacterial vaginosis

A

Malodorous, grey/white discharge

59
Q

Treatment for bacterial vaginosis

A

Metronidazole

60
Q

Candidiasis clinical features

A

Itchy, dry, smelly discharge, white

61
Q

Risk factors for candidiasis

A

Pregnancy
Anaemia
Diabetes
Recent antibiotics

62
Q

Treatment for candidiasis

A

Fluconazole

63
Q

Management of recurrent candidiasis

A

Investigate for immunosuppresion / underlying factors e.g. diabetes
Genital hygiene advice
Confirm diagnosis with swabs and find out type of candida

64
Q

Trichomoniasis clinical features

A

Yellow, frothy, smelly discharge

Asymptomatic in men

65
Q

Treatment for trichomoniasis

A

Metronidazole

Year 3 (7 decks)

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