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ICS Flashcards

1
Q

what is the most common cause of bacterial pneumonia?

A

strep pneumoniae

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2
Q

which antibiotics inhibit cell wall synthesis?

A

Benzylpenicillin, Cefotaxime, Teicoplanin, Vancomycin

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3
Q

which heart valve is most commonly affected in infective endocarditis?

A

tricuspid

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4
Q

state 4 symptoms of severe infective gastroenteritis

A

bloody diarrhoea, fever, headache, reduced skin turgor

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5
Q

state some complications of C. difficile infection

A

ascending cholangitis, diverticulitis, ischaemic colitis, peptic ulcer

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6
Q

list the gram positive cocci

A
  • staphylococci
  • streptococci (including enterococci)
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7
Q

list the gram negative diplococci

A
  • Neisseria meningitidis
  • Neisseria gonorrhoeae
  • also Moraxella catarrhalis
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8
Q

list the gram positive bacilli

A

mneumonic: ABCD L
- Actinomyces
- Bacillus anthracis (anthrax)
- Clostridium
- Diphtheria: Corynebacterium diphtheriae
- Listeria monocytogenes

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9
Q

list some common gram negative bacilli

A
  • Escherichia coli
  • Haemophilus influenzae
  • Pseudomonas aeruginosa
  • Salmonella sp.
  • Shigella sp.
  • Campylobacter jejuni
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10
Q

why is phenoxybenzamine prescribed to prepare for phaeochromocytoma surgery?

A
  • during removal of the tumour it is possible for a large amount of catecholamine release to occur - causing refractory hypertension.
  • therefore, pre-blocking the a-receptors with phenoxybenzamine you prevent this
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11
Q

what medication is used to treat heroin addiction?

A

methadone

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12
Q

what is co-amoxiclav a mix of?

A

amoxicillin and clavulanic acid

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13
Q

what food decreases warfarin’s effect and how?

A

spinach
- warfarin is a vit K antagonist
- vit K is required for the synthesis of clotting factors 2,7,9,10 - antagonism decreases production of these
- blood becomes thinner and increases INR
- spinach is high in vit K so may decrease effect of warfarin

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14
Q

what is the mechanism of action for penicillin antibiotics?

A

inhibits bacterial wall synthesis

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15
Q

define pharmacodynamics

A

action of drug on body

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16
Q

define pharmacokinetics

A

action of body on drug

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17
Q

what makes mycoplasma resistant to β-lactam antibiotics?

A

they lack a cell wall

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18
Q

What is the mechanism of dobutamine?

A

B1-agonist

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19
Q

what is the basic mechanism of furosemide?

A

Na+/K+/2Cl- inhibitor

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20
Q

which leukocyte in peripheral blood can become pulmonary macrophages in chronic irritation?

A

monocytes

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21
Q

Which investigations is used to confirm a nickel allergy?

A

patch test

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22
Q

which antibody is the initial response to a hep B infection?

A

IgM

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23
Q

Antibody transfer from a mother to infant during breastfeeding is most likely an example of which type of immunity?

A

naturally acquired; passive

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24
Q

What is secreted by virally infected cells as part of a signalling mechanism, and what is its action?

A

interferon-a - they bind target innate cells such as macrophages and NK cells and induce an antiviral state

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25
Q

Which cell in the normal lymph node is a specialised, highly efficient antigen-presenting cell (APC) found mostly in areas of T-cell concentration?

A

dendritic cell

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26
Q

What investigations will be most useful in estimating risk of developing an opportunistic infection in HIV?

A

CD4 count

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27
Q

What is the most common causative organism of traveller’s diarrhoea?

A

E.Coli

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28
Q

Which pathogen is most commonly isolated in cases of chronic diarrhoea associated with HIV?

A

campylobacter

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29
Q

what are toll-like receptors?

A

a type of intracellular pattern recognition receptor that proteins recognise and then bind to PAMPs

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30
Q

what are pathogen associated molecular patterns (PAMPs)?

A

an immune cell that recognises some general molecular features common to many types of pathogen

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31
Q

what is TLR1 associated in detecting?

A

malaria

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32
Q

what is TLR2 associated with detecting?

A

lipoteichoic acid on gram positive bacteria

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33
Q

what is TLR4 associated with detecting?

A

Lipopolysaccharide on the surface of gram negative bacteria

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34
Q

what is TLR5 associated with detecting?

A

flagellin

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35
Q

Which diuretic increases sodium and water excretion by competitively binding to aldosterone receptors in the distal tubules of the kidney?

A

spironolactone

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36
Q

What is the mechanism of action of alendronic acid (bisphosphonate)?

A

Inhibits osteoclastic activity to decrease bone resorption, which reduces bone turnover and improves bone mass

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37
Q

What is the mechanism of action of rivaroxaban (anticoag. medication used in patients with a.fib to reduce risk of stroke)?

A

Directly inhibits activated clotting factor X to prevent conversion of prothrombin to thrombin

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38
Q

name 4 drugs that inhibit the action of COX enzymes and therefore inhibit formation of prostanoids and prostaglandins?

A

aspirin, celecoxib (NSAID), paracetamol, ibuprofen

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39
Q

name 2 side effects of diclofenac (NSAID)?

A

heartburn, abdo pain

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40
Q

name 1 side effect of codeine

A

constipation

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41
Q

how does bendroflumethiazide work?

A

inhibits sodium reabsorption at the DCT by blocking the Na+/Cl- symporter

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42
Q

name one medication contraindicated in parkinson’s disease and explain why

A

metoclopramide - D2 receptor antagonist that crosses the BBB and can cause extra-pyramidal side effects and parkinsonism

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43
Q

The culture showed gram positive cocci, found in clusters. A coagulase test was positive. Name the organism

A

staphylococcus aureus

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44
Q

what does staphylococcus look like on blood cultures / microscopy?

A

gram positive cocci found in clusters. coagulase positive

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45
Q

what substance gives green / yellow colonies in beta haemolysis?

A

biliverdin

46
Q

What causes a positive coagulase test?

A

Organisms that produce an enzyme that converts soluble fibrinogen to insoluble fibrin

47
Q

What colour do gram positive organisms stain and why?

A
  • Purple
  • they have a thick layer of peptidoglycan in their cell walls which retains the crystal violet
48
Q

What organism does the optochin test identify?

A

streptococcus pneumoniae

49
Q

What is the antibiotic used for treatment of streptococcal pneumonia?

A

flucloxacillin

50
Q

gram positive, catalase negative microorganism family?

A

streptococcus

51
Q

what does beta haemolysis look like?

A

clear/colourless zone around colonies

52
Q

What is the recommended treatment for a confirmed group A streptococci infection?

A
  • IV benzylpenicillin
  • IV clindamycin
  • Urgent surgical exploration with extensive debridement
  • amputation
53
Q

What do gram-positive bacteria secrete which causes pathogenicity?

A

exotoxin

54
Q

Give 3 differences between the structure of the cell envelope of gram- positive and gram-negative bacteria.

A
  • Gram positive have single cytoplasmic membrane
  • Gram positive have large layer of peptidoglycan
  • Gram positive do not have endotoxin/LPS
55
Q

What is the name for a malignant tumour of smooth muscle?

A

leiomyosarcoma

56
Q

what is the name for a malignant striated muscle neoplasm

A

rhabdomyosarcoma

57
Q

what is the definition of a granuloma?

A

an aggregate of epithelioid histiocytes

58
Q

name 4 constituents of an atherosclerotic plaque

A

connective tissue, foam cells, lymphocytes, smooth muscle cells

59
Q

typical history of legionella pneumophila?

A

productive cough, rusty coloured sputum, achy joints, headaches, recent travel (spain!!), crackles in right lung base

60
Q

immediate treatment for suspected septic meningitis?

A

IM benzylpenicillin

61
Q

describe strep pyogenes

A

beta-haemolytic gram-positive streptococcus with Lancefield grouping A

62
Q

first line treatment for UTI?

A
  • usually nitrofurantoin
  • if non-pregnant or male, trimethoprim pay be used if low risk of resistance
63
Q

classical triad of encephalitis?

A
  • fever, altered mental state, headache
  • can present with flu like symptoms and be a DD for meningitis
64
Q

what nutrient agar is used to grow mycobacterium tuberculosis?

A

Lowenstein-Jensen

65
Q

describe pseudomonas

A

non-lactose fermenting aerobic bacilli with positive oxidase test

66
Q

what is the most common cause of infective endocarditis in adults with poor dental hygeine? describe it

A

strep. viridans - optochin resistant alpha-haemolytic strep

67
Q

Which test is used to distinguish between staphylococcus and streptococcus?

A

catalase

68
Q

which organisms does the 1,3 beta D-glucan assay detect?

A
  • aspergillus fumigatus
  • candida albicans
  • pneumocystis jirovecii
69
Q

which cell wall feature enables a causative pathogen to resist phagocytic killing?

A

mycolic acid

70
Q

what is the mechanism of action for flucloxacillin?

A

disrupts peptidoglycan

71
Q

what is a papilloma?

A

benign tumour of non-glandular, non-secretory epithelium

72
Q

what is the ligand for TLR-4?

A

lipopolysaccharide, part of the bacterial cell wall

73
Q

what is an adenoma

A

benign tumour of glandular or secretory epithelium

74
Q

what is a carcinoma?

A

malignant tumour of non-glandular, non-secretory epithelium

75
Q

what is a sarcoma?

A

malignant tumour of connective tissue

76
Q

which structure in the bacterial cell do macrolide antibiotics (e.g rifampicin) interfere with to exert their bactericidal effect?

A

ribosome (50s subunit)

77
Q

what is margination?

A

slowing of blood velocity to allow neutrophils to line up along endothelium

78
Q

what is adhesion?

A

“sticking” of neutrophils to endothelium via adhesion molecules

79
Q

what is emigration?

A

Neutrophils move through the walls of small blood vessels

80
Q

what is diapedesis?

A

Where red cells passively escape the circulation due to hydrostatic pressure

81
Q

what is chemotaxis?

A

Where neutrophils follow a concentration gradient of certain compounds

82
Q

what is MHC-1?

A
  • an antigen found on all nucleated cells in the body
  • function: display peptide fragments of proteins from within the cell to cytotoxic T cells to allow response to be triggered
83
Q

describe mycobacteria

A

slow growing, predominantly immobile, rod shaped, intracellular, gram positive

84
Q

what is the most common organism to cause menigitis?

A

strep pneumoniae - gram neg

85
Q

when is a LP contraindicated in meningitis?

A

if septicaemia is suspected e.g. rash

86
Q

what is a dormant malaria spore called?

A

hypnozoites

87
Q

Describe the lifecycle of a malarial plasmodium within the human body, naming each stage of plasmodium development

A
  • sporozoites in mosquito saliva enters blood
  • matures into a hypnozoite in liver and released into blood as schizont
  • then explodes releasing merezoites which enter RBCs and become trophozoites
  • eventually they become gametocyes which are taken up by mosquito
88
Q

what is the gold standard test for malaria?

A

microscopy of thick and thin blood smears stained with Giemsa stain

89
Q

what is the treatment for a non-falciparum malaria infection?

A

chloroquine

90
Q

what is the treatment for a falciparum malaria infection?

A

oral quinine sulfate

91
Q

complications of untreated malaria?

A

seizures, impaired consiousness, renal impairment, anaemia, hypoglycaemia

92
Q

name 2 genes of the HIV genome and their function

A
  • Nef - increases infectivity
  • Eny - encodes the envelope proteins
93
Q

give 2 example of an opportunistic infection that can result from HIV infection

A
  • cytomegalovirus
  • pneumocystis jiroveci
94
Q

What cells do HIV antigens bind to and enter?

A

CD4+ T-lymphocyte

95
Q

Part of the HIV replication process involves the reverse transcriptase enzyme. Give an example of a drug that can inhibit the reverse transcriptase enzyme

A

zidovudine - nucleoside reverse transcriptase inhibitor

96
Q

what is the treatment for syphilis?

A

first line: benzathine penicillin, second line/contraindicated: azithromycin

97
Q

what is the mechanism of action of adrenaline?

A

agonist of beta adrenergic receptors

98
Q

what is the general antibiotics for UTIs?

A

trimethoprim or nitrofurantoin

99
Q

what are DMARDs and give an example

A
  • methotrexate
  • Disease Modifying Anti-Rheumatic Drugs
  • inhibition of pyramidine synthesis
100
Q

what hypersensitivity is Coeliac disease?

A

type 4

101
Q

first line treatment for tonsilitis?

A

Phenoxymethylpenicillin QDS 10 days - only given if severe or persistent

102
Q

Which bacterial structure do glycopeptide antibiotics target?

A

cell wall

103
Q

what does rifampicin target?

A

RNA polymerase

104
Q

what does ethambutol cause?

A

optic neuritis

105
Q

which diuretic can cause hyperkalaemia

A

spironolactone

106
Q

mechanism of action of b-lactam antibiotics?

A

inhibit transpeptidation reactions needed to cross-link peptidoglycans in the cell wall

107
Q

what is the difference between active and latent TB?

A
  • active -> containment of the disease by the immune system is inadequate so the disease shows symptoms and can be spread
  • latent -> infection without disease due to persistence immune system containment
108
Q

define systemic sclerosis

A

A multi-system autoimmune disease in which fibrous tissue accumulates in multiple organs

109
Q

give 4 signs/symptoms of scleroderma

A
  • Calcium deposits,
  • Raynaud’s phenomenon,
  • oesophageal dysfunction,
  • pulmonary hypertension, severe hypertension,
  • renal crisis (due to hypertension),
  • pulmonary fibrosis,
  • skin ulcers
110
Q

describe the pathophysiology of scleroderma

A
  • an abnormal response to an unidentified trigger.
  • This results in the production of cytokines
  • These cytokines stimulation of collagen deposition by fibroblasts.

past questions (11 decks)

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