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FRACP > ID > Flashcards

ID Flashcards

1
Q

What are the two possibilities seen if a gram positive organism is looked at down the microscope
How are gram positive cocci further defined? How do they look under a microscope?

A

Bacilli
Cocci

Catalase test- staph- positive- clusters
Strep- negative- chains

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2
Q

What are 2 gram positive bacilli and how are they defined

A

Anaerobic- clostridium

Aerobic- listeria

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3
Q

What are the 2 ways strep are classified

A

Haemolysis- alpha is total, beta is partial and gamma is none

Lancfield- a,b,d and e

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4
Q

What is an example of
Group A strep
Group B strep
Group E&F strep

Partial haemolysis
Total haemolysis
No haemolysis

A

Pyogenes
Agalactiae
Viridans and pneumonia

Groups E and F
Groups A and B
Enterococcus

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5
Q

What is the most severe form of malaria

What are the most common other 2 forms called? What makes them be able to be latent?

A

Falciparum

Vivax and ovale- hypnosis tests unhook

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6
Q

What does chickungunya cause

A

Febrile convulsions

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6
Q

What causes Chagas’ disease

What does it cause

A

Trypansoma Cruzi

Myocarditis

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8
Q

What is seen on uss with Zika virus other than anencephaly

A

Subcortical calcifications

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9
Q

How does malaria normally present?

What indicates severe disease?

A

Fever, haemolytic anaemia, myalgia and malaise

Drowsiness headache and vomiting

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10
Q

Malaria- what is the difference between thick and thin films?

A

Thick films- counts how many rbc infected

Thin- what species is involved

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11
Q

How is malaria treated?
What is normal prophylaxis?
Why does prophylaxis differ in east Africa? What is used instead?

A

Chloroquine or artemisinin based therapies
Mefloquinine
Likely chloroquine resistance therefore give malarone

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12
Q

What causes typhoid
What protects against it?
What are two characteristic features?

A

Salmonella enteritica
CF
Salmon pink rash and diarrhoea

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13
Q

What type of virus causes dengue?
How does it present
How does haemorrhagic fever present?

A

Flavivirus
Biphasic breakback fever with rash and oedema of extremities
Shock with bleeding bruising and petechiae

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14
Q

What is the most likely bug to cause septic arthritis or osteomyelitis?
What is more likely in toddlers
Which bug is more likely in sickle cell
Where is the most common site

A

Staph aureus
Kingella
Salmonella
Lower limbs

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15
Q

Osteomyelitis

What might you see on X-ray

A

Fat pads, lytic lesions periosteal elevation

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16
Q

Osteomyelitis- length of treatment
Septic arthritis-“
Discitis-“

A

OM- 3-4
SA- 2-3
6 weeks

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17
Q

TB

What are the three phases and what will be seen in each

A

1) exposure- no symptoms and signs, all tests negative
2) primary infection- no symptoms and signs but chest X-ray may have Hohn focus or be normal and TST positive
3) disease- symptoms signs abnormal chest X-ray and tst positive

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18
Q

TB
What are the features in cxr
How does it differ from adults

A

Bilateral hilar lymphadenopathy
Atelectasis
Consolidation

Any lobe is involved
No calcification

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19
Q

What is miliary TB

What other infection might make it more common?

A

Disseminated disease involving multi organs. Lymphohaematogenous spread
HIV/AIDS

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20
Q

What is measured in the mantoux test?
How long after exposure does it become positive
What might give a false negative

A

Area of induration
3w to 3 months
Incorrect admin, reading it wrong, having a bcg previously, doing it too early

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21
Q

What are two benefits of quantiferon gold to TST?

A

Only need one visit

Won’t pick up vaccinated people

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22
Q

Mantoux test size, when is it positive
>5mm
>10mm
>15mm

A

Very high risk exposure or cxr changes
Young or other chronic disease, likely living in a high risk area
No other risk factors

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23
Q

TB
WHO recommended treatment
Recommendations for all exposed kids

A

6 months RI with PE in the first 2 months

3 months treatment then test. If negative give BCG. If positive complete course

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24
Q

Rifampicin
Side effects
What medications does it effect? How? Why?

A

Orange secretions
Hepatitis especially with isoniazid
P450 induced so reduces OCP

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25
Q

Isoniazid
Side effects
What might help?

A

Hepatitis
Peripheral neuropathy

Vitamin b6- pyrodoxine

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26
Q

Pyrazinamide

Side effects

A

GI upset

Hepatitis

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27
Q

Ethambutol
Side effects
Will they resolve when the meds are stopped?

A

Neuritis and colour vision reduction

Yes!

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28
Q

Can you give BCG to HIV positive individuals?

A

No!

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29
Q

CMV
what is the risk to baby if it is mums first infection
What stage of pregnancy is it worst to contract it?
What are the features
What is seen in ultrasound

A

50%
Worst in the first half of preg.
IUGR, blueberry muffin rash, chorioretinitis , SN hearing loss
Periventricular calcification

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30
Q

Zika
What type of virus is it
How does it present
What is different on head ultrasound

A

Flavivirus
Microcephalic, contractures, hypotonia and irritable
Subcritical calcification

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31
Q

Congenital syphillis
What is it associated with
How does it present in the newborn
If it is missed how might it present

A

Lacking antenatal care
Sniffles, peeling skin, pseudopariesis, jaundice and hepatosplenomegaly
Abnormal teeth and facial deformities. Blindness

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32
Q

Toxoplasmosis
When is it most likely to affect the baby?
How does it present?

A

3rd trimester

Asymptomatic or prolonged jaundice then blindness seizures and developmental delay

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33
Q

What is the most common cause of eosinophilic meningitis?
What is usually ingested?
What will you see on LP?
How is it managed?

A

Angiostrongylus
Snails
High opening pressure, high cell count, eosinophils >10%
Analgesia, therapeutic taps and steroids

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34
Q

What is the most common helminithic infection in humans

A

Ascariasis=roundworms

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35
Q

What is the other name for a pinworm infection
How do they present
How are they found

A

Enterobius vermicularis
Itchy bums
Cellotape test

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36
Q

Which helminithic infectionis seen in travellers

What rash do they commonly get?

A

Hookworm-ancylostoma

Itchy rash in the soles of the feet that moves around

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37
Q

Which helminithic infection is involved in sheep stations

A

Echinococcous

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38
Q

Viruses
How do dna and rna viruses differ in how they replicate
What enzyme do retroviruses use to replicate

A

DNA- use the cells nucleus

RNA- replicate within the cytoplasm

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39
Q

Herpes

Where to the 2 main types cause lesions

A

1- mouth

2-genitals

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40
Q

Where does the herpes virus lie dormant

What infection indicates reactivation

A

Sensory ganglion neurons

Cold sores

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41
Q

What are 3 skin manifestations of herpes?

A

Herpetic whitlow
Eczema herpeticum
Erythema multiforme

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42
Q

How does intrauterine herpes present

A

Microcephalic, vesicles and chorioretinitis

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43
Q

What does HHV 6 cause

How does it present?

A

Rosella
High fever
Blanching rash

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44
Q

What does HHV 8 cause?

A

Kaposis sarcoma

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45
Q

Varicella
What does primary infection cause
What is most likely to cause a secondary bacterial infection
What does involvement of the tip of the nose suggest

A

Chicken pox
Strep pyogenes
Hutchinsons sign- corneal involvement

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46
Q

Varicella-
Where is encephalitis likely to involve
What is the more likely CNS manifestation of varicella

A

Temporal lobes

Cerebellar ataxia

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47
Q

How does congenital varicella present

A

IUGR
Scarring
Limb shortening
Chorioretinitis

48
Q

What percentage of people seroconvert to the varicella vaccine

A

97%

49
Q

Poliovirus
What is the most common clinical manifestation?
What else can it cause

A 
Slapped cheek (fifth disease)
Acute aplastic crises
50
Q

Adenoviruses

How do they most likely present

A

Resp infections

51
Q

Enteroviruses
What family of viruses are they
What is the most likely presentation

A

RNA viruses

Non specific viral illnesses

52
Q

Enteroviruses
What causes hand foot and mouth most commonly? What might give cns disease
What causes herpangina

A

Coxsackie A. Enterovirus 71

Coxsackie A

53
Q

Enteroviruses
Give 4 CNS manifestations
What 3 types of enteroviruses might cause them

A

Polio, flaccid paralysis, aseptic meningitis, encephalitis

Polio, echo, coxsackie B

54
Q

What type of enterovirus causes myocarditis

Who is most likely to get it?

A

Coxsackie B

Young adolescent males

55
Q

CMV
What family of viruses does it belong to?
What four things is it the commonest cause of

A

Herpes

CP, SN hearing loss, Low IQ and congenital infections

56
Q

CMV
How do the majority of primary infections present?
How else might they present?
If you are immunocompromised how might you present?
How might it affect transplants

A

Asymptomatic
Mono like but no sore throat
Unwell with fevers and joint pains. Pneumonitis and GI disease
Causes rejection.

57
Q

CMV
How do perinatal and congenital infections differ?
What is seen on head uss

A

Perinatal- majority are still asymptomatic
Congenital- iugr, chorioretinitis, late onset hearing loss, jaundice and seizures
Periventricular calcification

58
Q

How do CMV and HIV link?

A

CMV increases rate of HIV progression

More likely to get retinitis and cns side effects

59
Q

Congenital CMV

Is there firm evidence for treatment? What might be used

A

No!

Ganciclovir

60
Q

EBV
What type of virus is it?
What can reactivate it?
What malignancies is it associated with?

A

DNA virus
Immunosuppression
Burkitts, Hodgkin lymphoma, NP carcinoma and gastric carcinoma

61
Q

Infectious mono
How does it present
What signs might there be?
What can give a diffuse maculopapular rash

A

Fever sore throat and lethargy
Palatal petechiae, lymphadenopathy and hepatosplenomegaly
Amoxicillin

62
Q

EBV

Give 4 complications of acute infection

A

Splenic rupture
Airway obstruction
Myocarditis
GBS

63
Q

EBV

What things can have a severe disseminated reaction?

A

CVID/AT/CH/WA
X linked lymphoproliferative syndrome
HIV

64
Q

EBV

What is seen on blood film

A

Atypical mononuclear cells

65
Q

EBV

What antibodies are positive in acute and chronic infection

A

VCAs early

EBNAs later

66
Q

HIV
What type of cells does it infect
What enzyme is important

A

CD4 cells

Reverse transcriptase

67
Q

HIV
How might an acute infection present
What might be seen on bloods to show progress of hiv
What is most predictive of rate of progress
What is most predictive of complication risks

A

Lymphadenopathy, flu like illness
T cell depletion, increasing viral load
Viral load
CD 4 counts

68
Q

What level of T cells causes AIDS
What are examples of aids defining illnesses (6)
What sign in children is unique to HIV

A 
<200 
Kaposis sarcoma 
PCP pneumonia
Chronic oesophageal candidiasis 
Lymphocytic interstitial pneumonia 
CMV pneumonitis or retinitis 
Mycobacterium avium 
HIV encephalopathy

Chronic or recurrent parotitis

69
Q

Why is combination treatment used in AIDS

What is the aim

A

To prevent resistance

To reduce and slow progression of disease

70
Q

HIV
what 3 drug classes are most commonly used? Give examples
What other 2 drug classes might be used

A

Nucleoside reverse transcriptase inhibitors- lamudivine, zidovudine
Protease inhibitor nelfinar

Non nucleoside RTIs
Fusion inhibitors

71
Q

What 2 large groups of conditions does a group A strep cause
What are the common complications
How are they treated
Are they resistant?

A

Pharyngitis and skin infections
HUS, rheumatic fever, PANDAS, reactive arthritis
Penicillin
Usually never!

72
Q

What causes group A strep to turn into scarlet fever

How does scarlet fever present

A

Production of strep pyogenes erythrogenic exotoxin

Sore throat then strawberry tongue and sandpaper rash

73
Q

Group B strep
What is it called
What is the most likely cause of infection?
What are the 2 different presentations and how do they present
How is it treated
How long is treatment- bacteraemia? Meningitis?

A

Agalactiae
Maternal colonisation
Early onset sepsis- very sick like RDS. Can be still born
Late sepsis- up to 3 months. Occult bacteraemia or meningitis
High dose amoxicillin or penicillin.
Bacteraemia-10 d Meningitis-14 d

74
Q

Strep pneumoniae
How does it link to influenza
How is it treated
What does an intermediate mic to penicillin suggest? What is given instead?

A

Causes secondary bacterial pneumonias
Penicillin
Possible cephalosporin resistance- vanc instead

75
Q

Listeria
In older children what might infection suggest
How does late and early disease differ
What is it resistant to

A 
T cell issues 
Late- more likely meningitis 
Early- vague with maculopapular rash. Might have had a sick fluey mum
Prem babies with MEC stained liquor 
Cephalosporins
76
Q

Coagulase negative staph
Give 2 examples
What do they cause
Are they sensitive to penicillins?

A

Staph epidermidis and staph saphrophyticus
Line infections!
No!

77
Q

Staph Aureus
Give two ways it can become a MRSA
How does it cause diseases like toxic shock syndromes

A

Altered penicillin binding proteins
Beta lactamase
Production of exotoxins

78
Q

What antibiotic is pseudomonas intrinsically resistant to?

What colour of pus does it cause

A

Cefuroxime

Blue/green

79
Q

What type of diarrhoea is seen in cryptosporidium

A

Secretory

80
Q

What is seen on microscopy with giardia?

A

Multi flagellated organism

81
Q

What is klebsiella an example of?

What is it therefore resistant to?

A

ESBL

Resistant to carbapenems

82
Q

What is an example of a VRE

A

E faecum

83
Q

What mnemonic helps remember resistant organisms

A 
E-enterococcus (VRE)
S-staph aureus (MRSA)
K- klebsiella (ESBL) 
A- acinetobacter
P-pseudomonas 
E- enterobacter
84
Q

What might help differentiate strep from staph toxic shock?

A

Septicaemia

85
Q

Measles
How well does it seroconvert after a vaccine? After 2?
Does infection provide life long immunity?
If you are exposed and your immunity is ok how should you be treated
If you’re exposed and you’re immunodeficient how should you be treated?

A

95% 99%
Yes
Give vaccine within 72 hrs
Give IVIG within 1 week

86
Q

What is the most common cause of bacterial tracheitis

A

Staph aureus

87
Q

Which antibacterial agents disrupt cell membrane function

A

Anti fungals

88
Q

Which 3 groups of antibiotics inhibit cell wall synthesis
How do they do this
What 3 days can resistance occur- give examples of bugs
Are they bacteriostatic or bacteriocidal?

A

Penicillins, cephalosporins and carbapenems
Insert a beta lactam ring into the cell membrane
Staph aureus- makes a beta lactamase
MRSA and pneumococcus- alter penicillin binding proteins
Pseudomonas- reduces cell wall permeability
Bacteriocidal

89
Q

Which 2 antibiotics inhibit folate synthesis

What is a way to remember this

A

Co trimoxazole
Trimethoprim

Both used for UTIs- think pregnancy and folate!

90
Q

Which antibiotic inhibits DNA gyrase

A

Ciprofloxacin (quinolones)

91
Q

How does vancomycin work
What pharmacokinetic parameters are most important
What part of the dosing is most important

A

Acts directly on the cell wall
AUC/MIC
Peak concentration

92
Q

Beta lactatams
Which pharmacokinetic parameter is most important
What about the dosing therefore is most important

A

Time above MIC

Dosing interval

93
Q

Give 2 examples of antibiotics that act on the 30s subunit

A

Gentamicin

Doxycycline

94
Q

Give 3 examples of antibiotics that act on the 50s subunit

A

Macrolides
Clindamycin
Chloramphenicol

95
Q

What pharmacokinetic parameter is most important in amino glycosides
What therefore in dosing is most important

A

Cmax/MIC

Peak concentration

96
Q

What pharmacokinetic profile suggests resistance

A

MBC >4x MIC

97
Q 
Cephalosporins 
Give examples of the 5 generations 
What do generation 1-3 treat well
What is good about generation 3
What dose generation 4 treat 
What does generation 5 treat
A 
1- cephalexin 
2- cefuroxime 
3- cefotaxime and cefreiaxone 
4- cefepime 
5- ceftaroline

1-3 improving gram negative cover, gradually lose gram positive
3- blood brain barrier cover
4- pseudomonas
5- MRSA

98
Q

What do cephalosporins not cover?

A

Listeria
Atypical (mycoplasma and chlamydia)
MRSA (unless 5th gen)
Enterococcus

99
Q

What organisms rarely can be resistant to carbapenems

What antibiotics have to be used instead

A

Klebsiella and E. coli (new deli metallo beta lactams)

Coloistin or fosfamycin

100
Q

What does vancymicin cover well

A

Gram positives and MRSA

101
Q

If vanc does not work well for MRSA what is another good option

A

Linezolid

102
Q

What do aminoglycosides cover well?

What is an example of a bug it won’t cover well

A

Gram negatives

Enterococcus

103
Q

What do macrolides cover well- give 2 examples

A

Atypical

Mycoplasma and gonorrhoea

104
Q

Why are macrolides useful in CF

A

Modulate airway inflammation

105
Q

How effective is the pertussis vaccine if three doses are given

A

95%

106
Q

Can pertussis cause retinal haemorrhages?

A

No!! (New evidence)

107
Q

Pneumococcus
What type of organism is it
To use penicillin what is needed. If not what is used to treat

A

Encapsulated

High MIC needed- <0.6. Otherwise 3rd gen cephalosporins

108
Q

How are staph further characterised?

A

Coagulase- positive- epi negative- aureus

109
Q

What are enterococcus
How are they normally treated. What are they normally resistant to?
How is e cloacae treated
How is VRE treated? Is it bacteriocidal or bacteriostatic? What will this not be useful for?
HOW IS CPE treated

A 
Strep with no haemolysis 
Amoxicillin 
Cephalosporins 
Meropenem 
Linezolid. Cloacae 
Tigecycline
110
Q

How long before and after the rash are the following infectious?
Measles
Chicken pox

A

Measles- 3D before 5-6 after

Chicken pox- 24-48 hrs before, 3-7days after

111
Q

What is aspergillosis usually resistant to?
What is It therefore treated with
What are most species of candida sensitive to

A

Fluconazole
Voriconazole
Amphotericin B

112
Q

What are three vaccines that can’t be frozen

A

Hep A and B
DTAp
Tetanus

113
Q

How does rubella normally present
When is it infectious
What can happen especially in girls
What is it otherwise known as

A

Painful lymphadenopathy with rash
5 days before and after rash
Arthritis
3 day measles

114
Q 
What are 2 examples of an inactivated vaccine 
Attenuated 
Toxoid
Subunit 
Conjugate
A 
Influenza and polio
MMR and TB
Diphtheria and tetanus 
HPV and hep B
Hib
115
Q

What can adenovirus cause

A

Haemorrhaging cystitis

FRACP (23 decks)

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