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1
Q

What is the most common organism causing community-acquired pneumonia (CAP)?

A

Streptococcus pneumoniae (Pneumococcus)

This organism is primarily responsible for CAP cases.

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2
Q

Name three atypical organisms that cause community-acquired pneumonia.

A
  • Chlamydia pneumoniae
  • Mycoplasma pneumoniae
  • Legionella

Atypical organisms account for nearly a quarter of CAP cases.

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3
Q

Which organism is more common in young adults and those with structural lung disease or after invasive ventilation?

A

Staphylococcus aureus

This organism is associated with CAP in specific populations.

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4
Q

What is the role of Pseudomonas aeruginosa in community-acquired pneumonia?

A

It is an unusual pathogen typically found in hospital settings and in patients with structural lung disease or immunosuppression

Pseudomonas aeruginosa is not a common cause of CAP in the general population.

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5
Q

Which organism is more common in alcoholics?

A

Klebsiella pneumoniae

This organism is associated with pneumonia in individuals with alcohol dependence.

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6
Q

What are the common symptoms of community-acquired pneumonia?

A
  • Productive cough
  • Fever
  • Dyspnoea (not always present)
  • Pleuritic chest pain

Pleuritic chest pain occurs with pleural involvement.

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7
Q

What examination findings suggest pneumonia?

A
  • Fever
  • Tachycardia
  • Tachypnoea
  • Hypotension
  • Desaturation
  • Chest signs (crackles, bronchial breath sounds, vocal resonance)

These signs are indicative of pneumonia severity.

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8
Q

What does a chest X-ray show in cases of pneumonia?

A

Consolidation, defined as a lung opacity with air bronchograms

A cavitating lesion may suggest Staphylococcal or Tuberculous infection.

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9
Q

What scoring system is validated for 30-day mortality rates in CAP?

A

CURB 65

This scoring system helps guide inpatient or outpatient treatment.

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10
Q

Fill in the blank: The CURB 65 scoring system includes age > _____ years.

A

65

Other criteria include urea elevation, respiratory rate >30/min, and blood pressure <90/60mmHg.

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11
Q

What is the first-line treatment for mild community-acquired pneumonia?

A

Oral amoxycillin

If atypical organisms are suspected, a macrolide may be added.

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12
Q

What is the recommended treatment for severe community-acquired pneumonia?

A

Intravenous antibiotics for prolonged periods and close observation

Ceftriaxone and intravenous macrolides like Azithromycin are commonly used.

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13
Q

What are common complications of pneumonia?

A
  • Resistant organism infection
  • Tuberculous, fungal, or viral infection
  • Hypoxic respiratory failure
  • Septic shock
  • Parapneumonic pleural effusion
  • Empyema

Each of these complications may require specific management.

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14
Q

What is the prognosis for community-acquired pneumonia?

A

Most patients make a full recovery (80-96%)

Elderly and immunosuppressed individuals have a higher risk of mortality.

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15
Q

Which vaccinations are available for pneumonia prevention?

A
  • Pneumococcus
  • Haemophilus influenzae

These vaccines are recommended for at-risk groups.

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16
Q

What is the most common pathogen responsible for urinary tract infections (UTIs)?

A

E. coli (80%)

Other pathogens include Klebsiella, Pseudomonas, Enterobacter, and Enterococcus.

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17
Q

What increases the risk of urinary tract infection in females?

A

Shorter urethra and sexual intercourse

Use of spermicide also increases the risk.

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18
Q

What is asymptomatic bacteriuria?

A

Positive urinary cultures without symptoms

These cases typically do not require treatment.

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19
Q

What are common symptoms of lower urinary tract symptoms (LUTS)?

A
  • Dysuria
  • Frequency
  • Urgency
  • Incontinence
  • Retention

Haematuria is uncommon, and flank pain indicates progression to pyelonephritis.

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20
Q

What is the first-line treatment for acute cystitis?

A

Oral antibiotic therapy

Trimethoprim or Penicillin are commonly used depending on local sensitivity patterns.

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21
Q

What is the management for pyelonephritis?

A

Intravenous antibiotic therapy

Gram-negative coverage is often provided by Ceftriaxone or Penicillin plus Gentamicin.

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22
Q

What is the primary cause of skin infections related to hair follicles?

A

Staphylococcus aureus

Tinea can also be a less common cause.

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23
Q

What is impetigo and its common causative organism?

A

Clusters of scabby, dark erythematous lesions caused by Staphylococcus aureus

Streptococcus pyogenes is the second most common cause.

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24
Q

What is the typical clinical feature of erysipelas?

A

Acute rash of the upper dermis/epidermis that is bright red, warm, and painful

It often presents on the face.

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25
What is the most common bacterial pathogen in cellulitis?
Streptococcus pyogenes ## Footnote Staphylococcus aureus is a close second.
26
What is the common cause of bacterial meningitis in adults?
Streptococcus pneumoniae and Neisseria meningitidis ## Footnote Children are more predisposed to Haemophilus influenzae.
27
What are the classic symptoms of meningitis?
* Fever * Headache * Nuchal rigidity * Photophobia * Skin rash ## Footnote Meningococcal rash is pathognomic.
28
What is the role of lumbar puncture in meningitis?
To obtain cerebrospinal fluid for analysis ## Footnote This is often performed after a CT scan to exclude intracranial hypertension.
29
What is Kernig's sign?
Passive flexion of hip and knee when supine, results in neck pain when extending the knee.
30
What is Brudzinski's sign?
Flexion of the neck results in involuntary flexion of the hip and knee.
31
What is required for diagnosing meningitis?
Lumbar puncture is required, often performed following CT to exclude intracranial hypertension.
32
What should not delay management in suspected meningitis?
Investigations should not delay management.
33
What is the preferred antibiotic therapy for bacterial meningitis?
Ceftriaxone is preferred for coverage of Pneumococcus, Meningococcus, and Haemophilus.
34
What additional antibiotic is required for Listeria coverage?
Addition of Penicillin is required for neonates or adults over 50 years of age.
35
When should Vancomycin be considered in meningitis treatment?
For people with neurosurgical intervention or known/regional rates of streptococcal resistance to cephalosporins.
36
What is the role of adjuvant Dexamethasone in meningitis treatment?
To dampen meningeal inflammation and possibly increase blood-brain barrier permeability.
37
Is there evidence for the benefit of Dexamethasone in pneumococcus versus meningococcus?
There appears to be benefit in pneumococcus but not in meningococcus.
38
What is the most common type of meningitis?
Viral meningitis is more common than bacterial infection.
39
What are common organisms causing viral meningitis?
* Adenovirus * Enterovirus * Herpes simplex (may cause encephalitis) * Varicella zoster (carries a worse prognosis) * HIV (possible)
40
How is viral meningitis diagnosed?
Lumbar puncture results define the process; PCR assays are available for common viral organisms.
41
What is the preferred treatment for viral meningitis?
Treatment with aciclovir is preferred due to CNS penetration.
42
Who is at particular risk for fungal meningitis?
Profoundly immunosuppressed individuals, particularly those with HIV and low CD4 counts.
43
What organisms are associated with fungal meningitis?
* Cryptococcus neoformans * Histoplasma * Candida
44
What tests are available for cryptococcus in fungal meningitis?
India Ink stains and PCR on CSF samples.
45
What is the preferred treatment for cryptococcal meningitis?
Intravenous amphotericin B and fluocytosine.
46
What is the most common cause of encephalitis?
Viral infection, with Herpes simplex virus being the most likely culprit.
47
What are alternative pathogens for encephalitis?
* Measles * Mumps * HIV * Japanese encephalitis
48
What are common clinical features of encephalitis?
Confusional state, fever, rigors, flu-like symptoms, focal neurological findings, and seizures.
49
What imaging study is indicated in encephalitis?
Neuroimaging is indicated.
50
What does MRI reveal in cases of HSV encephalitis?
Classical temporal lobe hyperintensity.
51
What does a lumbar puncture in encephalitis help identify?
The causative organism.
52
What does an electroencephalogram often show in encephalitis?
Generalized slow-wave predominance.
53
What is the treatment for HSV encephalitis?
Aciclovir.
54
What is the most common sexually transmitted infection worldwide?
Chlamydia.
55
What is the causative organism of Chlamydia?
Chlamydia trachomatis, a Gram-negative bacterium.
56
What are common routes of transmission for Chlamydia?
* Sexual intercourse (vaginal, anal, oral) * Vertical transmission
57
What are common symptoms of Chlamydia in women?
Vaginal discharge and dyspareunia.
58
What are common symptoms of Chlamydia in men?
Penile discharge and testicular pain.
59
What complications can arise from Chlamydia?
* Pelvic inflammatory disease * Ectopic pregnancy * Fitz-Hugh-Curtis syndrome * Conjunctival transmission can lead to blindness * Reactive arthritis
60
What is the recommended screening for Chlamydia?
All people who have undertaken unprotected sexual intercourse.
61
What testing method is widely used to diagnose Chlamydia?
Nucleic acid amplification testing (NAAT).
62
What is the recommended treatment for uncomplicated Chlamydia?
Azithromycin, 1g oral.
63
What should be done for contact tracing in Chlamydia cases?
Essential to inform and test sexual partners.
64
What is the causative organism of Gonorrhea?
Neisseria gonorrhoeae, a Gram-negative diplococcus.
65
What are common symptoms of Gonorrhea in both sexes?
* Urethral or vaginal discharge * Dysuria * Ano-rectal symptoms * Conjunctivitis and pharyngitis
66
What are complications of Gonorrhea in females?
* Pelvic inflammatory disease * Vaginal bleeding * Dyspareunia
67
What is the classical triad of disseminated gonococcal infection?
* Tenosynovitis * Dermatitis * Polyarthritis
68
What is the treatment for uncomplicated Gonorrhea?
Ceftriaxone 500mg intramuscular.
69
What organism causes Chancroid?
Haemophilus ducreyi, a Gram-negative bacterium.
70
What are the presentations of Chancroid?
Deep, painful genital ulcers with ragged edges.
71
What is the recommended management for uncomplicated Chancroid?
Azithromycin or Ceftriaxone.
72
What is Lymphogranuloma Venereum caused by?
Chlamydia trachomatis, serovars L1-3.
73
What is the common presentation of Lymphogranuloma Venereum?
A single small ulcer on the penis or vulva and anus.
74
What is the treatment for uncomplicated Lymphogranuloma Venereum?
Doxycycline 100mg bd for 3 weeks.
75
What is the causative organism of Syphilis?
Treponema pallidum, a Gram-negative bacterium.
76
What is a characteristic lesion of primary syphilis?
Chancre - painless, firm, non-itchy ulcer.
77
What occurs during secondary syphilis?
Constitutional symptoms, widespread erythematous rash, and lymphadenopathy.
78
What can occur in tertiary syphilis?
* Gummatous syphilis * Neurosyphilis * Cardiovascular syphilis
79
What are the congenital defects associated with congenital syphilis?
* Facial abnormalities * Neurosyphilis * Hepatosplenomegaly * Disseminated rash
80
What is the screening recommendation for syphilis?
Recommended in all people who have undertaken unprotected sexual intercourse.
81
What is the treatment for primary, secondary, and latent syphilis?
Benzathine penicillin, 1.8g intramuscular.
82
What is Bacterial Vaginosis (BV)?
A polymicrobial infection involving anaerobes, resulting in increased vaginal pH.
83
What are common symptoms of Bacterial Vaginosis?
Creamy vaginal discharge or a 'fishy' malodour.
84
What are complications associated with Bacterial Vaginosis?
* Pregnancy complications (premature labor, spontaneous abortion) * Increased risk of other STIs
85
What are Amsel's Criteria for diagnosing Bacterial Vaginosis?
* Creamy vaginal discharge * Raised vaginal pH * Malodour * Clue cells on gram stain
86
What is the effective treatment for Bacterial Vaginosis?
Metronidazole.
87
What is the peak incidence period for Influenza?
During winter periods in both hemispheres.
88
What type of virus is Influenza?
RNA virus of the orthomyxovirus family.
89
What is the most virulent type of Influenza virus?
Influenza A.
90
What role does Haemagglutinin play in Influenza?
Mediates binding of the virus.
91
What is the general trend of influenza incidences across continents?
Incidences are generally higher in colder climates ## Footnote Influenza affects all continents.
92
What are the average annual rates of infection for influenza?
Approximately 5 million infections, causing almost a quarter of a million deaths.
93
What type of virus is influenza classified as?
RNA virus of the orthomyxovirus family.
94
What are the three major genotypes of influenza?
A, B, and C.
95
What is the common cause of pandemics among influenza viruses?
Influenza A.
96
Who are the natural hosts for Influenza A?
Birds.
97
What is the function of haemagglutinin in influenza viruses?
Mediates binding of the virus to target cells.
98
What role does neuraminidase play in influenza viruses?
Promotes new viruses leaving the infected cells.
99
What are the two key glycoproteins on the influenza capsule surface?
* Haemagglutinin (H) * Neuraminidase (N)
100
What results from antigenic shift in influenza viruses?
Combination of two virus subtypes to form a new virus.
101
What is antigenic drift?
Sporadic mutations leading to annual epidemics.
102
How do local epidemics turn into global pandemics in influenza?
When antigenic shift and drift produce hypervirulent viruses without previous host immunity.
103
What are the three main modes of influenza transmission?
* Aerosolized particles * Droplet inhalation * Direct contact
104
What is the recommended prevention method for influenza transmission?
Isolation of infected people.
105
What is the efficacy of influenza vaccines?
60% effective, but efficacy varies depending on antigenic drift and shift variations.
106
Who should receive the influenza vaccine?
* Elderly * Comorbid illnesses * Immunocompromised * Chronic respiratory conditions * Health care workers
107
What is the primary treatment for Influenza A?
Neuraminidase Inhibitors (e.g., Oseltamivir).
108
What is the effect of neuraminidase inhibitors on influenza symptoms?
Decreases duration of symptoms by approximately 20 hours.
109
What is a common complication of herpes simplex virus (HSV) infection?
Temporal lobe encephalitis.
110
What are the two major types of herpes simplex virus?
* HSV-1 (oral) * HSV-2 (genital)
111
What is the method of transmission for herpes simplex virus?
Direct contact with active lesions or fluid containing viral particles.
112
What type of testing is used for diagnosing HSV?
PCR testing.
113
What is the first-line antiviral treatment for herpes simplex?
Acyclovir.
114
What is the primary disease caused by Varicella Zoster Virus (VZV)?
Chickenpox.
115
What happens to VZV after the initial infection?
It remains dormant in nerve cells of the dorsal root ganglia.
116
What is the most common complication of shingles?
Postherpetic neuralgia.
117
What is the recommended treatment for chickenpox?
Supportive therapy and analgesia.
118
What is the most common cause of CMV infection?
Asymptomatic or subacute viral-type infection.
119
What is the primary diagnostic method for CMV?
PCR testing.
120
What treatment is effective against CMV?
Intravenous Ganciclovir.
121
What is the primary disease caused by the measles virus?
Measles.
122
What are the common symptoms of measles?
* Cough * Coryza * Conjunctivitis * High fever * Maculopapular rash
123
What is the most effective prevention method for measles?
Vaccination (MMR).
124
What type of virus is rabies?
Lyssavirus.
125
What is the primary mode of transmission for rabies?
Bite from an infected animal.
126
What is the classical symptom of rabies?
Hydrophobia.
127
What is the recommended post-exposure treatment for rabies?
* Rabies immunoglobulin * Rabies vaccination
128
What is the primary vector for Ebola virus?
Fruit bats.
129
What are the initial symptoms of Ebola virus infection?
* Fever * Headache * Myalgia
130
What is a major cause of death in Ebola virus infections?
Hemorrhage and hypovolemia.
131
What type of virus is cytomegalovirus (CMV)?
Double stranded DNA virus.
132
What is a common complication of CMV in immunocompromised individuals?
CMV retinitis.
133
What is the key symptom of rubella infection?
Eruptive exanthum rash.
134
What is the risk associated with congenital rubella syndrome?
Sensorineural deafness, ophthalmic abnormalities, congenital heart disease.
135
What type of assays are now available to detect viral RNA?
PCR assays ## Footnote PCR stands for Polymerase Chain Reaction, a technique used to amplify and detect specific RNA sequences.
136
When is IgkI serology typically positive?
After days to weeks ## Footnote IgkI serology is a test used to detect specific antibodies in the blood.
137
What type of treatment is required for Ebola Virus infection?
Supportive treatment ## Footnote There is no direct cure for Ebola Virus.
138
What is the mortality rate among people infected with Ebola?
46% ## Footnote Mortality rates can vary based on the level of medical support available.
139
What can mortality rates reach in developing countries during Ebola epidemics?
Up to 100% ## Footnote Mortality rates reflect the intensity of medical support in regions affected by epidemics.
140
What is recommended for survivors of Ebola regarding sexual intercourse and breastfeeding?
Avoid for 12 months ## Footnote This recommendation helps prevent potential transmission of the virus.
141
What is the reported effectiveness of the Ebola vaccine formulated in recent years?
70% effective ## Footnote Vaccination is a key strategy in controlling outbreaks.
142
What are the prevention strategies during Ebola epidemics?
Isolation, careful blood handling, correct disposal of bodies ## Footnote These strategies aim to prevent virus spread.
143
What is Parvovirus B19 primarily known for?
Common childhood infection ## Footnote It is associated with a distinctive rash known as Fifth disease.
144
How is Parvovirus B19 transmitted?
Via respiratory droplets ## Footnote This mode of transmission is common for many viral infections.
145
What is the incubation period for Parvovirus B19?
4-40 days ## Footnote This variability can affect the timing of symptom onset.
146
What characteristic rash does Parvovirus B19 cause in children?
Slapped cheek syndrome ## Footnote The rash is a hallmark of Fifth disease caused by this virus.
147
What serious condition can result from bone marrow infection due to Parvovirus B19?
Aplastic anemia ## Footnote Aplastic anemia is a life-threatening condition where the body stops producing enough blood cells.
148
What is the management approach for infections caused by Parvovirus B19?
Supportive treatment only ## Footnote There is no vaccine available for Parvovirus B19.
149
What is Aspergillus?
A genus of moulds ## Footnote Some species of Aspergillus are pathogenic in humans.
150
Which species of Aspergillus are most commonly associated with human infections?
A. fumigatus, A. niger, A. flavus ## Footnote These species can cause various diseases, particularly in immunocompromised individuals.
151
What are Aspergillomas?
Clumps of mould ## Footnote These typically form in the lungs or nasal sinuses, especially in patients with lung diseases.
152
What is the typical first-line therapy for Acute Invasive Aspergillosis?
Voriconazole ## Footnote This medication is effective against infections caused by Aspergillus species.
153
What is Allergic Bronchopulmonary Aspergillosis (ABPA)?
An allergic reaction to Aspergillus moulds ## Footnote This condition is often seen in people with asthma or cystic fibrosis.
154
What imaging findings are typically associated with ABPA?
Upper lobe bronchiectasis, tree-in-bud patterns ## Footnote These findings help in diagnosing ABPA.
155
What is Pneumocystis jiroveci (PJP)?
A cause of opportunistic respiratory infections ## Footnote It is particularly relevant in immunocompromised individuals, especially those with HIV/AIDS.
156
What are common symptoms of Pneumocystis pneumonia?
Dyspnoea, non-productive cough, constitutional symptoms ## Footnote These symptoms may be accompanied by difficulty in expectorating sputum.
157
What is the first-line treatment for Pneumocystis pneumonia?
Bactrim (trimethoprim/sulfamethoxazole) ## Footnote This antibiotic is effective for both treatment and prophylaxis.
158
What is the significance of Cryptococcus neoformans?
It causes fungal infections, especially in immunocompromised individuals ## Footnote Most infections occur through inhalation from the environment.
159
What are the common presentations of cryptococcal meningitis?
Fever, headache, confusion, neck stiffness, photophobia ## Footnote These symptoms are classical for meningitis caused by Cryptococcus.
160
What is the treatment for severe cryptococcal disease?
Intravenous amphotericin B plus fluocytosine ## Footnote This regimen is typically used for severe cases of cryptococcosis.
161
What is the common cause of oral candidiasis?
Overgrowth of Candida due to antibiotic therapy ## Footnote Antibiotics can disrupt normal flora, leading to candidiasis.
162
What is the recommended treatment for esophageal candidiasis?
Oral fluconazole therapy ## Footnote This is necessary for immunosuppressed patients with esophageal candidiasis.
163
What is systemic candidiasis?
A rare condition with haematogenous spread of Candida ## Footnote It is commonly seen in patients with profound immunosuppression.
164
What is Histoplasma capsulatum?
A dimorphic fungus that causes histoplasmosis ## Footnote It exists as a mould in the environment and as a yeast at body temperature.
165
What is the first-line treatment for pulmonary histoplasmosis in immunocompromised patients?
Intravenous amphotericin B followed by oral itraconazole ## Footnote This regimen is effective for managing severe infections.
166
What is coccidioidomycosis?
A fungal infection that can cause severe pulmonary disease ## Footnote It may also lead to systemic complications.
167
What is the treatment for mucormycosis?
Amphotericin B and possible surgical debridement ## Footnote Mucormycosis is particularly challenging to treat.
168
What is the main use of amphotericin B?
To treat serious fungal infections ## Footnote It is available in both deoxycholate and liposomal formulations.
169
What is cholera?
An acute gastrointestinal infection caused by vibrio cholera ## Footnote Transmission is via infected water or food.
170
What is the primary mode of transmission for cholera?
Infected water or food.
171
How many cases of cholera occur annually in the developing world?
Approximately 4 million cases.
172
What is the mortality rate associated with cholera?
Over 100,000 deaths per annum.
173
What are the symptoms of cholera?
Acute, severe, watery diarrhoea.
174
What is the incubation period for cholera?
Less than one day following ingestion.
175
What is the key mechanism of cholera toxin?
Binds to epithelial surface receptors, increasing cAMP and causing chloride efflux.
176
What is the primary management strategy for cholera?
Supportive care through oral or intravenous rehydration.
177
True or False: Antibiotic therapy is beneficial in treating cholera.
False.
178
What strain of E. coli is most well documented for causing severe diarrhoea?
Enterotoxigenic Escherichia Coli (ETEC) 0157:H7.
179
What is the most common cause of traveler's diarrhoea worldwide?
E. coli.
180
What severe condition can occur as a complication of E. coli infection?
Haemolytic uraemic syndrome.
181
How is typhoid fever transmitted?
Faecal-oral route or by infected water sources.
182
What are the symptoms of typhoid fever?
Fever, abdominal pain, and a 'rose-coloured spot' rash.
183
What is the common treatment for typhoid fever?
Intensive supportive care and fluoroquinolone antibiotics.
184
What causes Lyme disease?
Infection by Borrelia spirochete bacteria.
185
What is the characteristic rash associated with Lyme disease?
A classical 'bull's-eye' rash.
186
What is the first-line treatment for Lyme disease?
Doxycycline.
187
What is leptospirosis caused by?
Infection with leptospira spirochete bacteria.
188
How is leptospirosis transmitted?
Via animal urine, typically rats.
189
What are the initial symptoms of leptospirosis?
Fever, headache, and myalgia.
190
What is the treatment for leptospirosis?
Penicillin and doxycycline.
191
What is Chagas Disease caused by?
Infection from the triatomine (kissing) bug.
192
What severe complications can arise from Chagas Disease?
Dilated cardiomyopathy, megacolon, and neurocognitive impairment.
193
What is the main vector for African Sleeping Sickness?
The Tsetse fly.
194
What are the initial symptoms of African Sleeping Sickness?
Fatigue, fever, headache, and myalgia.
195
What is the treatment for African Sleeping Sickness?
Pentamidine and nitazoxanide.
196
What is schistosomiasis caused by?
Infection by parasitic flatworms.
197
What are common symptoms of schistosomiasis?
Entry blisters, chronic granulomatous reactions, and potential liver involvement.
198
What is the treatment of choice for schistosomiasis?
Praziquantel.
199
What is leishmaniasis caused by?
Infection by Leishmania parasites.
200
What are the forms of leishmaniasis?
* Cutaneous * Mucosal * Visceral (kala-azar)
201
What is the treatment for leishmaniasis?
Amphotericin and paromomycin.
202
What causes cysticercosis?
Intestinal infection caused by tapeworms of Taenia species.
203
What is neurocysticercosis?
Severe disease caused by deposition of larvae in the brain.
204
What is the treatment for cysticercosis?
Praziquantel.
205
What is hydatid disease caused by?
Echinococcosis, a parasitic disease caused by tapeworms.
206
What is the primary treatment for hydatid disease?
Combination of surgical resection and albendazole therapy.
207
What is the common name for filariasis?
Elephantiasis.
208
How is filariasis transmitted?
By mosquitoes.
209
What is the treatment for filariasis?
Albendazole plus ivermectin.
210
What is amoebiasis caused by?
Entamoeba histolytica.
211
What is the primary mode of transmission for amoebiasis?
Faecal-oral route.
212
What is the treatment for amoebiasis?
Nitroimidazole or paromomycin.
213
What virus causes hepatitis A?
Picornavirus.
214
How is hepatitis A transmitted?
By faecal-oral route.
215
What is the incubation period for hepatitis A?
10-40 days.
216
True or False: Hepatitis A is self-limiting.
True.
217
What is the recommended prevention for hepatitis A?
Vaccination.
218
What virus causes hepatitis B?
Hepadnavirus.
219
What is the most common mode of transmission for hepatitis B?
Vertical transmission.
220
What serological marker indicates acute hepatitis B infection?
HBsAg.
221
What is the first-line treatment for chronic hepatitis B?
Tenofavir or Entecavir.
222
What are the indications for treatment of Hepatitis B in HBeAg positive patients?
DNA > 20,000, plus ALT 2x ULN or fibrosis on biopsy
223
What are the indications for treatment of Hepatitis B in HBeAg negative patients?
DNA > 20,000, plus ALT 2x ULN or fibrosis on biopsy
224
What is the indication for treatment of compensated cirrhosis in Hepatitis B?
DNA > 2,000 or ALT 2x ULN
225
What is the first line treatment for Hepatitis B?
Tenofovir or Entecavir
226
What type of drug is Tenofovir?
Nucleotide analogue of reverse transcriptase
227
When is Tenofovir indicated?
In Lamivudine resistance and HIV co-infection
228
What are the side effects of Tenofovir?
Renal tubular acidosis and osteoporosis
229
What type of drug is Entecavir?
Guanosine analogue inhibitor of transcriptase enzyme
230
What are the resistance rates for Entecavir?
Very low resistance rates
231
What is Lamivudine used for?
To treat mutant virus or following failed interferon therapy
232
What are the side effects of Interferon-alpha?
Flu-like illness, thyroid dysfunction, myelosuppression, and depression
233
What is the goal of treatment for Hepatitis B?
Sustained virological response (SVR) with no detectable circulating DNA
234
What is the relapse rate after treatment cessation for Hepatitis B?
High relapse rates
235
Who should be screened for Hepatitis B before using immunosuppressants?
Individuals with HBcAB positive, HBsAg positive, or DNA positive
236
What is the recommended prophylactic treatment for Hepatitis B?
Lamivudine monotherapy, unless known prior resistance
237
In pregnancy, which drug is used for Hepatitis B treatment?
Tenofovir in the third trimester
238
What is the screening method for hepatocellular carcinoma in patients with cirrhosis?
6-monthly liver ultrasound and serum AFP levels
239
What is the vaccination indication for Hepatitis B?
All newborn babies, health care practitioners, high-risk sexual contacts, IV drug users, prisoners, patients requiring haemodialysis, patients requiring blood transfusions, and prior to travel to endemic countries
240
What indicates a positive immune response after Hepatitis B vaccination?
Anti-HBsAg titre > 10 IU/ml
241
What is the prevalence of Hepatitis C worldwide?
Approximately 2%
242
What is the primary mode of transmission for Hepatitis C?
Blood-borne and sexual inoculation
243
What is the common screening test for Hepatitis C?
ELISA for anti-HCV IgM
244
What is the typical response of infected individuals to Hepatitis C?
Generally asymptomatic
245
What are Direct Acting Antivirals (DAAs)?
Revolutionary treatments for Hepatitis C management
246
What is the aim of treatment for Hepatitis C?
To achieve sustained virological response (SVR)
247
What are the typical treatment durations for Hepatitis C?
12 weeks without cirrhosis, 24 weeks with cirrhosis
248
What are examples of Direct Acting Antivirals?
* Sofosbuvir * Dasabuvir * Daclatasvir * Ledipasvir
249
What is Hepatitis D?
Single stranded RNA Deltavirus that only occurs in patients co-infected with Hepatitis B
250
What is the transmission method for Hepatitis E?
Faecal-oral route
251
What is the usual management for Hepatitis E?
Supportive care
252
What is the main characteristic of Hepatitis viruses?
They can be RNA or DNA viruses
253
What is the primary vector for malaria?
Female Anopheles mosquitos
254
What is the incubation period for malaria?
Typically 5-25 days
255
What is the primary treatment for severe malaria caused by P. falciparum?
Intravenous therapy with artesunate or artemether
256
What are the common symptoms of malaria?
Fever, headache, arthralgia, cyclical fever
257
What are the genetic mutations that provide natural resistance to malaria?
* Thalassaemia * Sickle cell disease * Glucose-6-phosphate dehydrogenase deficiency
258
What is the primary management strategy for malaria prevention?
Vector control
259
What are the common antimalarial therapies for P. falciparum?
Artemisinin-based regimes
260
What is the role of the World Health Organisation in malaria management?
Screening, endemic management, and resistance tracking
261
What is the causative agent of severe malaria?
P. falciparum ## Footnote Severe malaria can lead to cerebral malaria and has high mortality rates.
262
What is the mortality rate associated with severe malaria?
Exceeds 25% ## Footnote This statistic highlights the seriousness of untreated severe malaria.
263
What is the primary treatment for severe malaria?
Intravenous therapy, often including artesunate and artemether ## Footnote Supportive measures in intensive care may also be necessary.
264
What is the most common mosquito-borne viral infection worldwide?
Dengue Fever ## Footnote Malaria is caused by a parasite, whereas dengue is a viral infection.
265
Where do the bulk of dengue cases occur?
Southeast Asia ## Footnote Other regions include India, Central/South America, and Sub-Saharan Africa.
266
What is the typical mortality rate for dengue in developed countries?
<1% ## Footnote This rate can be significantly higher in developing countries.
267
What type of virus causes dengue fever?
RNA flavivirus ## Footnote It is related to viruses such as Japanese encephalitis and West Nile.
268
How many major serotypes of dengue virus exist?
Three (DENV1-3) ## Footnote Infection with a different serotype can lead to more severe disease.
269
What is the incubation period for dengue fever?
4-14 days ## Footnote This period varies among individuals.
270
What are the classical symptoms of mild dengue infection?
Fever and retro-orbital headache ## Footnote Other symptoms may include rash and myalgia.
271
What severe condition can arise from dengue infection?
Dengue shock syndrome ## Footnote This condition involves hypotension and increased vascular permeability.
272
What laboratory findings are indicative of dengue infection?
*Thrombocytopenia* *Metabolic acidosis* *Hepatitis (ALT elevation)* ## Footnote Additional findings may include hypoalbuminaemia in severe cases.
273
What is the main approach to managing dengue fever?
Supportive care ## Footnote There are no specific antiviral treatments for dengue.
274
Which mosquito is the primary vector for dengue transmission?
Aedes aegypti ## Footnote These mosquitos typically bite during the morning and dusk.
275
What is a key preventive measure against dengue?
Controlling Aedes aegypti breeding grounds ## Footnote This includes covering water sources and using insecticides.
276
What is the classical treatment regimen for active tuberculosis?
RIPE: Rifampicin, Isoniazid, Pyrazinamide, Ethambutol ## Footnote This combination is crucial for effective tuberculosis management.
277
What is the most common cause of tuberculosis?
Mycobacterium tuberculosis ## Footnote This bacterium is an aerobic, non-flagellated bacillus.
278
What are the risk factors for tuberculosis infection?
*Immunosuppression* *Malnutrition* *Chronic lung disease* *Medical comorbidities* ## Footnote These factors significantly increase the risk of TB infection.
279
What are the symptoms of active tuberculosis?
*Cough* *Sputum production* *Haemoptysis* *Weight loss* *Fatigue* *Night sweats* ## Footnote These symptoms may vary in severity.
280
What is the Mantoux Tuberculin Skin Test (TST)?
A test where purified Mycobacterium tuberculosis proteins are injected intradermally ## Footnote Results are read after 48-72 hours to assess TB exposure.
281
What does a positive Interferon Gamma Release Assay (IGRA) indicate?
Active or latent tuberculosis infection ## Footnote Results are not influenced by prior BCG vaccination.
282
What is the typical treatment duration for latent tuberculosis?
6-9 months of isoniazid therapy ## Footnote This treatment helps prevent the progression to active TB.
283
What are common adverse effects of rifampicin?
*Hepatitis* *Gastrointestinal disturbances* *Red-orange discolouration of bodily fluids* ## Footnote These side effects warrant monitoring during treatment.
284
What is the risk of hepatitis associated with rifampicin?
Lower than rifampicin ## Footnote Hepatitis risk varies with different drugs
285
What are common adverse effects of pyrazinamide?
* Hepatotoxicity (dose dependent) * Gastrointestinal disturbances - nausea, diarrhoea * Arthralgia ## Footnote Pyrazinamide creates an acidic environment in tuberculous granulomas and inhibits metabolism
286
What adverse effects are associated with ethambutol?
* Optic neuritis * Peripheral vision defects with central scotoma * Colour blindness * Peripheral neuropathy * Arthralgia ## Footnote Ethambutol disrupts the formation of cell wall in mycobacteria
287
What is the role of pyridoxine (Vitamin B6) in tuberculosis treatment?
To reduce the risk of peripheral neuropathy with isoniazid therapy ## Footnote Isoniazid can cause peripheral neuropathy
288
What is the typical regimen for treating tuberculosis?
All RIPE for 2 months and RI alone for a further 4 months ## Footnote Longer treatment is necessary for large cavities, long periods until smear negative, and disseminated disease
289
How does drug resistance affect tuberculosis treatment?
It alters treatment and requires substitution of drugs ## Footnote This is a specialist area; injectable therapies like aminoglycosides (Amikacin) may be required
290
What are alternative oral therapies for drug resistant TB?
* Fluoroquinolones (e.g., moxifloxacin) ## Footnote Some cases of XDR-TB have no curative treatment options
291
What pathogens are included in the Mycobacterium Avium Complex?
* M. intracellulare * M. avium * M. chimaera ## Footnote These are non-tuberculous mycobacteria (NTM) that cause chronic respiratory infections
292
In which populations is Mycobacterium Avium Complex more commonly seen?
* People with structural lung disease (e.g., severe emphysema) * Immunocompromised individuals (e.g., HIV with CD4 counts <50) ## Footnote These factors increase susceptibility to chronic respiratory infections
293
How is Mycobacterium Avium Complex diagnosed?
By culture ## Footnote Diagnosis involves isolating the organism from clinical samples
294
What is the management regimen for Mycobacterium Avium Complex?
* Macrolide (clarithromycin or azithromycin) * Rifampicin * Ethambutol ## Footnote Treatment regimens often last in excess of 12 months
295
What is a common organism causing chronic lung infections similar to Mycobacterium Avium Complex?
Mycobacterium abscessus ## Footnote It can also cause skin infections in rare cases
296
What is a challenge in treating Mycobacterium abscessus?
Increased rates of drug (macrolide) resistance ## Footnote This makes treatment more difficult
297
What causes leprosy?
M. leprae ## Footnote It is a slowly dividing organism with an incubation period of years
298
How is leprosy transmitted?
Via aerosolized droplets ## Footnote This facilitates the spread of the disease among individuals
299
What areas of the body does leprosy affect?
* Skin * Peripheral nervous system * Mucosal sites ## Footnote Chronic granulomas form, leading to fibrosis and disfigurement
300
What is the treatment for leprosy?
* Rifampicin * Dapsone * Other agents ## Footnote Multidrug therapy is needed for effective treatment
301
What is the highest rate of HIV prevalence in the world?
Africa, particularly Sub-Saharan regions ## Footnote Approximately 28 million affected in Africa.
302
How many new cases of HIV are reported annually in Australia?
Approximately 1,500 new cases per year ## Footnote Overall, there are about 35,000 people living with HIV in Australia.
303
What demographic has the highest HIV rates in Australia?
Men who have sex with men (MSM) ## Footnote 80-90% of new cases.
304
What type of virus is HIV?
Retrovirus of the lentiviridae family ## Footnote HIV is a single-stranded RNA virus.
305
What are the key surface proteins of HIV?
gp-120, Vpr, Nef, p7 ## Footnote Protease is also a key protein.
306
What is the most dominant subtype of HIV in Western countries?
Subtype B ## Footnote Subtype C is the most common in Asia and Sub-Saharan Africa.
307
What is the primary method of HIV transmission to the host?
Via blood ## Footnote Requires binding to CD4 receptor and CCR5 co-receptor.
308
What is the incubation period prior to seroconversion for HIV?
2-4 weeks ## Footnote Early infection may present with flu-like symptoms.
309
What is the aim of antiviral therapy in HIV management?
To maintain an undetectable viral load and normal CD4 count ## Footnote Antiviral therapy is complex and continually changing.
310
What significant results were found in the START Study regarding HIV treatment?
60% reduction in risk of AIDS and opportunistic infections ## Footnote Also shows overall mortality benefit.
311
What is Immune Reconstitution Inflammatory Syndrome (IRIS)?
An overwhelming inflammatory response following immune system reconstitution ## Footnote Has a very high mortality rate.
312
What are the classes of antiviral drugs effective against HIV?
Entry Inhibitors, Reverse Transcriptase Inhibitors, Integrase Inhibitors, Protease Inhibitors ## Footnote Includes both nucleoside and non-nucleoside reverse transcriptase inhibitors.
313
What is the most common cause of treatment failure in HIV?
Poor adherence to medication ## Footnote Resistance can develop if therapy is not followed properly.
314
What is the risk of HIV acquisition from receptive anal intercourse?
Highest risk among sexual exposures ## Footnote Other exposures have significantly lower risks.
315
What should be included in the diagnosis of HIV?
Pre-and post-test counselling, Rapid Antibody Test, Fourth generation ELISA, Western Blot, p24 antigen testing ## Footnote Testing is important for accurate diagnosis.
316
What are the common adverse drug reactions associated with Tenofovir?
Renal issues, osteoporosis ## Footnote Can also lead to proteinuria and decreased GFR.
317
What is the risk of HIV transmission during childbirth?
Highest risk at delivery ## Footnote Undetectable viral load reduces transmission risk significantly.
318
What is Pre-Exposure Prophylaxis (PrEP)?
A preventive treatment for high-risk groups ## Footnote Trials are ongoing in Australia for its effectiveness.
319
What is the key characteristic of Toxoplasmosis in immunocompromised individuals?
Causes encephalitis and can lead to confusion, seizures, and coma ## Footnote Diagnosed through T1 ring-enhancing lesions on MRI.
320
What is the role of the HLA-B57 assay in HIV treatment?
To exclude Abacavir hypersensitivity ## Footnote Important before starting treatment with Abacavir.
321
What is the significance of viral load monitoring in HIV management?
To assess treatment efficacy and adherence ## Footnote Increases or decreases can indicate treatment failure or success.
322
What is the risk of HIV acquisition from a needle stick injury with a known HIV+ source?
0.3% risk
323
What factors reduce the risk of HIV transmission?
Viral load suppression and PEP not generally recommended
324
In Australia, how is the risk of HIV transmission from an unknown source characterized?
Very low due to low prevalence of HIV
325
What is the most common initial complaint in patients with Infective Endocarditis?
Fever (90%+ of cases)
326
What are common systemic symptoms of Infective Endocarditis?
* Chills * Rigors * Weight loss
327
What percentage of patients with Infective Endocarditis present with embolic phenomena at diagnosis?
Approximately 25%
328
What types of emboli can occur in Infective Endocarditis?
* Brain emboli * Renal emboli * Pulmonary emboli * Splenic emboli
329
Which patients are at particularly high risk of Infective Endocarditis?
Patients using intravenous drugs (IVDU)
330
What type of valve lesions are IVDU patients at risk for?
Right sided valve lesions, specifically tricuspid valve vegetations
331
What organisms are commonly associated with Infective Endocarditis in IVDU patients?
Skin organisms like Staphylococcus aureus (including MRSA)
332
What pre-existing cardiac conditions require peri-operative antibiotic prophylaxis?
* Prosthetic valve replacement * Congenital cyanotic heart disease * Previous episodes of infective endocarditis
333
Which dental procedures increase the risk of Infective Endocarditis?
Procedures with manipulation of the gingiva
334
Which antibiotic is recommended for prophylaxis in patients with penicillin hypersensitivity?
Clindamycin IV/Oral, 600mg once only, 60 minutes prior to procedure
335
What are the Modified Duke Criteria used for?
To determine the likelihood of Infective Endocarditis
336
What constitutes 'Definite Infective Endocarditis' according to the Modified Duke Criteria?
Two positive blood cultures and other specific criteria
337
What are common organisms identified in Infective Endocarditis?
* Staphylococcus aureus * Enterococcus * Streptococci (viridans, gallolyticus, bovis)
338
What is the general duration of antibiotic treatment for Infective Endocarditis?
Typically 6 weeks or longer
339
What is the main mechanism of action of beta-lactam antibiotics?
Inhibiting protein synthesis by targeting peptidoglycan in bacterial cell walls
340
What are common adverse effects associated with beta-lactam antibiotics?
* Non-allergic rash * Hepatotoxicity * Interstitial nephritis
341
What is the risk of cross-reactivity for people with hypersensitivity to beta-lactam antibiotics?
10% risk of cross-reactivity to cephalosporins for those with penicillin anaphylaxis
342
What is the first antibiotic developed by Alexander Fleming?
Penicillin
343
What are the three most widely used carbapenems?
* Meropenem * Imipenem * Ertapenem
344
What is the primary use of Vancomycin?
Effective only against gram-positive bacteria
345
What is the indication for surgical intervention in Infective Endocarditis?
* Acute heart failure * Persistent infection despite adequate antibiotics * Extension of infection into perivalvular tissue
346
What is the prognosis for patients with Infective Endocarditis associated with fungal organisms?
Worse prognosis than most bacterial pathogens
347
What is the significance of 'Culture Negative' Infective Endocarditis?
Atypical pathogens should be considered; pathogen identification may require serological testing
348
Fill in the blank: The presence of circulating fungal filaments adds to the _______ prognosis in Infective Endocarditis.
worsened
349
True or False: Empirical antibiotic therapy for Infective Endocarditis should be initiated immediately at presentation.
True
350
What type of bonds does vancomycin form with D-ala-D-ala regions of peptidoglycans?
Hydrogen bonds ## Footnote This prevents cross-linking of the peptidoglycans that normally form the backbone of the cell wall.
351
Is vancomycin effective against MRSA?
Yes ## Footnote It is effective against MSSA but not as potent as other anti-staphylococcal antibiotics.
352
What is the primary use of oral vancomycin?
Treatment of persistent clostridium difficile infection ## Footnote It is virtually 100% excreted and not absorbed.
353
What are the common adverse effects of vancomycin?
* Nephrotoxicity * Ototoxicity * Red Man Syndrome ## Footnote Nephrotoxicity occurs less frequently with new formulations but is still a concern.
354
What does Red Man Syndrome result from?
Localized infusion reaction ## Footnote It causes thrombophlebitis and is characterized by an erythematous rash.
355
What types of bacteria are resistant to vancomycin?
* Vancomycin resistant enterococcus (VRE) * Vancomycin intermediate staphylococcus aureus (VISA) * Vancomycin resistant staphylococcus aureus (VRSA) ## Footnote Resistance is due to the absence of cell wall and D-ala-D-ala targets in Gram-negative bacteria.
356
What is teicoplanin's mechanism of action?
Similar to vancomycin ## Footnote It is highly effective against gram-positive organisms.
357
What are the adverse effects of teicoplanin?
* Nephrotoxicity * Ototoxicity * Red Man Syndrome * Hepatitis * Bone marrow suppression/cytopenias ## Footnote These effects are similar to those of vancomycin.
358
What is the mechanism of action of aminoglycosides?
Inhibition of protein synthesis by binding to 30S ribosomes ## Footnote This leads to abnormal protein production and decreased overall protein synthesis in bacterial cells.
359
What is the main use of gentamicin?
Treatment of urinary tract, intra-abdominal, and severe respiratory tract infections ## Footnote It is potent against gram-negative aerobic bacteria.
360
What are the adverse effects of gentamicin?
* Nephrotoxicity * Ototoxicity * Vestibular toxicity ## Footnote Irreversible sensorineural hearing loss can also occur.
361
What are the primary uses of tetracyclines?
* Acne * Zoonotic infections (Q fever, rickettsia, leptospirosis) ## Footnote Their effectiveness against gram-negative bacteria has decreased due to antibiotic resistance.
362
What is doxycycline particularly effective against?
* Acne * Zoonotic infections * Malaria prevention ## Footnote It is also used for community-acquired pneumonia treatment.
363
What is the primary mechanism of action for macrolides?
Inhibition of protein synthesis by blocking 50S ribosomal subunits ## Footnote They are effective against atypical pneumonia organisms.
364
What are the adverse effects of macrolides?
* Prolonged QT interval * Drug interactions via CYP4503A4 inhibition ## Footnote Erythromycin is particularly noted for this interaction.
365
What are the primary uses of rifamycins?
* Tuberculosis treatment * Non-tuberculous mycobacterial infections ## Footnote Resistance can be tested via genetic testing of cultured organisms.
366
What is the primary adverse effect of fluoroquinolones?
* Tendinitis ## Footnote This can lead to tendon rupture, particularly of the Achilles tendon.
367
What is the mechanism of action of nitroimidazoles?
Metabolized to active metabolites within anaerobic bacteria ## Footnote This disrupts DNA and prevents translation and transcription.
368
What are the adverse effects of nitrofurans?
* Pulmonary toxicity * Hepatotoxicity * Peripheral neuropathy ## Footnote Intravascular hemolysis can occur in the presence of G6PD deficiency.
369
What are the three fundamental mechanisms of antimicrobial resistance?
* Alteration of antimicrobial protein targets * Changes to intracellular drug concentrations * Enzymatic degradation of antimicrobial drugs ## Footnote These mechanisms contribute to the effectiveness of resistance strategies in bacteria.
370
What are the two major methods by which bacteria reduce intracellular drug concentrations?
1. Stop the antibiotic from getting in 2. Actively pump the antibiotic out ## Footnote These mechanisms contribute to antibiotic resistance.
371
Which type of organisms commonly depend on porin channels to gain entry to the bacterial cell?
Gram-negative organisms ## Footnote Porin channels are essential for the uptake of certain antibiotics.
372
What happens to surface porins in gram-negative bacteria under stress?
The number of surface porins can be reduced ## Footnote This reduction can lead to decreased antibiotic susceptibility.
373
What antibiotics are commonly affected by the active pumping mechanism of drug resistance?
Tetracyclines and fluoroquinolones ## Footnote This mechanism allows bacteria to expel antibiotics before they can exert their effects.
374
What is the process that renders beta-lactam antibiotics inactive?
Hydrolysis of the beta-lactam ring ## Footnote This is performed by beta-lactamase enzymes.
375
What type of resistance involves genes that protect bacteria from antimicrobial activity without acquisition from other bacteria?
Intrinsic Resistance ## Footnote This resistance is naturally present in certain bacterial species.
376
What gene do some gram-negative Enterobacteriaceae possess that produces a beta-lactamase protein?
ampC gene ## Footnote This gene is induced in the presence of beta-lactam antibiotics.
377
What are the three mechanisms of horizontal gene transfer that lead to acquired resistance?
1. Conjugation 2. Transduction 3. Transformation ## Footnote These mechanisms allow bacteria to gain new resistance traits.
378
Which antibiotic is the most potent against MSSA (Methicillin-Sensitive Staphylococcus Aureus)?
Flucloxacillin ## Footnote MSSA shows wide sensitivity to various antibiotics, including beta-lactams.
379
What does MRSA stand for?
Methicillin-Resistant Staphylococcus Aureus ## Footnote MRSA is associated with resistance to beta-lactams due to specific genetic mechanisms.
380
What gene is responsible for producing PBP2a in MRSA?
mecA gene ## Footnote PBP2a has a low affinity for beta-lactams, contributing to resistance.
381
What is the major mechanism of resistance for Vancomycin-Resistant Staphylococcus Aureus (VRSA)?
Mutation of genes encoding for D-ala-D-aIa to D-ala-D-lac ## Footnote This mutation decreases vancomycin binding and activity.
382
What does VISA stand for?
Vancomycin-Intermediate Staphylococcus Aureus ## Footnote VISA is characterized by an increased minimum inhibitory concentration for vancomycin.
383
What is the primary target for vancomycin on the bacterial cell wall?
D-ala-D-aIa residues ## Footnote Mutations in these residues lead to resistance.
384
What is the enzyme responsible for hydrolyzing carbapenems in some gram-negative bacteria?
NDM-1 (New Delhi Metallo-beta-lactamase-1) ## Footnote This enzyme contributes to the emergence of carbapenem-resistant Enterobacteriaceae (CRE).
385
What are the two clinically relevant species of Enterococcus?
1. Enterococcus faecalis 2. Enterococcus faecium ## Footnote These species are significant in clinical settings and can exhibit resistance to various antibiotics.
386
What are the three major forms of Vancomycin Resistant Enterococci (VRE)?
1. VanA 2. VanB 3. VanC ## Footnote Each form exhibits different resistance patterns to vancomycin and teicoplanin.
387
What is the first-line treatment for infections caused by organisms with Extended Spectrum Beta-Lactamases (ESBL)?
Carbapenems ## Footnote Carbapenems remain effective against ESBL-producing organisms.
388
What does the acronym ESCAPPM represent?
Enterobacter spp, Serratia spp, Citrobacter freundii, Acinetobacter spp, Proteus vulgaris, Providencia spp, Morganella morganii ## Footnote These organisms exhibit intrinsic resistance to beta-lactams.
389
What are effective infection control methods to prevent the spread of resistant organisms in hospitals?
1. Isolation 2. Barrier techniques (gown, gloves) 3. Hand hygiene ## Footnote These methods help reduce transmission of resistant bacteria.
390
What is an indication for eradication therapy of MRSA carriage?
Recurrent skin boils due to community-associated MRSA infection with PVL-positive strains ## Footnote Nasal mupirocin creams can be used to eradicate nasal carriage in such cases.

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