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FRACP NOSH 2020 > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

How does addition of beta-lactamase inhibitor broaden spectrum of amoxycillin?

A

Adds MSSA, gram neg and anaerobic cover

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2
Q

What is the main addition bacterial cover achieved by Tazocin rather than Augmentin?

A

Pseudomonas

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3
Q

What is the mechanism of resistance in ESBL?

A

Plasmid-mediated resistance - acquired, mediated by DNA molecule within a cell which is separate to chromosomes

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4
Q

What is the benefit in coverage of ceftazidime over ceftriaxone?

A

Pseudomonal cover

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5
Q

What are the main differences between meropenem and ertapenem? (2)

A

Ertapenem once daily dosing

Ertapenem does not cover pseudomonas

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6
Q

What bacteria is teicoplanin used to treat?

A

Van B VRE

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7
Q

What site of the body does daptomycin NOT work in?

Why?

A

Lung

Inhibited by lung surfactant

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8
Q

What does daptomycin cover?

A

Gram positives, including VRE

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9
Q

2 major site effects of linezolid?

A

Peripheral neuropathy

Marrow suppression

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10
Q

What does aztreonam cover?

A

Gram negatives, pseudomonas

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11
Q

What is the mechanism of resistance in ESCAPPMs?

A

Chrosomally-mediated through AmpC

Gram negatives with inducible cephalosporinase

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12
Q

Why can tigecycline not be used in bacteraemia?

A

Large volume of distribution, so does not reach high enough concentrations in blood

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13
Q

Why is rifampicin used in othopaedic infections?

A

It is active against biofilm

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14
Q

Which is preferable in penicillins -

  1. Higher dose less frequent
  2. Lower dose more frequent
A
  1. Lower dose more frequently -> to optimise time above MIC
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15
Q

What is main consideration in dosing of aminoglycosides?

A

Area under curve -> higher dose less frequent (i.e. maximal concentration)

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16
Q

What is the reason for giving antibiotics as prolonged infusions in difficult to treat infections?

A

To optimise time above MIC

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17
Q

What is first line treatment for invasive aspergillosis?

A

Voriconazole

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18
Q

1st line for candidaemia?

A

Echinocandins

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19
Q

1st line for cryptococcal meningitis?

A

Ambisome (liposomal amphotericin)

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20
Q

Which strain of malaria is most benign usually?

A

P. malariae

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21
Q

Which strains of malaria can cause late relapses?

Why?

A

P. ovale, P. vivax

Form hypnozoites in the liver

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22
Q

What is the most common pathogen found in Traveller’s diarrhoea?

A

Enterotoxigenic E.Coli

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23
Q

What is the preferred treatment for candida krusei?

A

Amphotericin B

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24
Q

Which anti-TB drug has the highest rate of mono-drug resistance?

A

Isoniazid

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25
Q

What condition is strep bovis endocarditis closely associated with?

A

Bowel malignancy

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26
Q

What is the most likely organism for native valve endocarditis in IVDU?

A

Staph aureus

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27
Q

What is the commonest specific diagnosis made in febrile returned travellers?

A

Malaria

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28
Q

Why does amoxycillin not work to treat Klebsiella?

A

All Klebsiella are intrinsicially resistant due to narrow spectrum beta lactamase in genome

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29
Q

What is the class of antibiotics usually used to treat ESBL infections?

A

Carbapenems

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30
Q

What is the broad empiric management of suspected CRE infection?

A

Meropenem via extended infusion PLUS amikacin or colistin

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31
Q

How do penicillin abx work?

A

Bind with penicillin-binding proteins on cell wall to inhibit cell wall synthesis

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32
Q

Which cephalosporins have pseudomonal cover? (2)

A

Cefepime

Ceftazadime

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33
Q

Which beta lactam does NOT have strep cover?

A

Aztreonam (only gram neg cover)

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34
Q

How does metronidazole work?

A

Captures electrons, which creates free radicals and destabilises bacterial DNA

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35
Q

Which antibiotic can cause metallic taste?

A

Metronidazole

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36
Q

Name 4 Abx with equal PO / IV bioavailability

A

Quinolones
Metronidazole
Bactrim
Doxycyline

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37
Q

Which VRE active antibiotic has equivalent PO = IV bioavailability ?

A

Linezolid

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38
Q

What is the mechanism for VRE resistance?

A

Peptidoglycan residue D-ala-D-ala changing to D-lac, so reducing affinity of binding to vancomycin

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39
Q

What does daptomycin cover?

A

VRE

MRSA

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40
Q

What are 2 unique adverse effects of daptomycin?

A

Rhabdomyolysis

Eosinophilic pneumonia

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41
Q

Which two classes of ABx cause ototoxocity with prolonged dose?

A

Aminoglycosides

Macrolides

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42
Q

Which antibiotics inhibit bacterial DNA gyrase?

A

Fluoroquinolones

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43
Q

Which abx causes achilles tendinopathy?

A

Fluoroquinolones

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44
Q

What is the only oral anti-pseudomonal agent?

A

Ciprofloxacin

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45
Q

What is the 1st line bx for Nocardia?

A

Bactrim

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46
Q

What does mutation in the rpoB gene in bacteria cause?

A

Rifampicin resistance

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47
Q

What does erm gene mutation in bacteria cause?

A

Macrolide resistance

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48
Q

What are ESBLs generally resistant to?

A

Penicillins and up to third generation cephalosporins, aztreonam

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49
Q

What does AmpC gene in bacteria confer resistance to?

A 
Penicillins
Cephalosporins (except cefepime)
50
Q

What is the empiric abx management of traveller’s diarrhoea?

A

Azithromycin

51
Q

What is treatment for suspected giardia?

A

Tinidazole

52
Q

What is the main differential for febrile returned traveller when presenting <2 weeks post return?

A

Dengue fever

53
Q

When does the critical phase of dengue occur?

A

After fever subsides

54
Q

What test for dengue is most helpful to diagnose in acute phase?

55
Q

What condition in febrile returned travellers is associated with relative bradycardia?

56
Q

What is 1st line treatment for severe typhoid?

A

Ceftriaxone

57
Q

What is the 1st line treatment for severe falciparum malaria?

A

IV artesunate

58
Q

What treatment is added to ACT for P.vivax / P.ovale strains?

Why?

What must be checked prior?

A

Primaquine

Required to eliminate dormant liver parasites, for relapse prevention

G6PD deficiency must be excluded

59
Q

What is the standard treatment for uncomplicated malaria?

A

Artemether + lumefantrine

60
Q

What are 4 criteria which define severe dengue?

A

Plasma leakage resulting in shock
Accumulation of serosal fluid sufficient to cause respiratory distress
Severe bleeding
Severe organ impairment

61
Q

What is the key lab feature which indicates impending critical dengue infection?

A

Increasing haematocrit level alongside rapid decrease in platelet count

62
Q

What are the three Cs of measles presentation?

A

Cough, coryza, and conjunctivitis

63
Q

What is the most common cause of traveller’s diarrhoea persisting beyond 2 weeks?

64
Q

What is the classic lab finding in strongoloides?

A

Eosinophilia

65
Q

Homozygotes for what genetic mutation are essentially resistant to HIV?

A

CCR5 D32 homozygotes

66
Q

Commonest cause of death in HIV positive people?

A

CV disease

67
Q

When should ART be started in someone who is found to be HIV positive?

A

As soon as possible after diagnosis, in EVERYONE

Opportunistic infections can delay this, due to risk of IRIS

68
Q

Which classes of ART should be involved at time of therapy initiation?

A

Integrase inhibitors +
Nucleotide/side reverse transcriptase inhibitors

Usually INSTI + 2 NRTIS

69
Q

What is the role of cobicistat in ART?

A

Pharmaco-enhancer, by inhibiting CYP450 3a enzyme. Increases effective dose of certain ART

70
Q

Which ART has risk of hypersensitivity in those with HLA -B5701?

A

Abacavir (NRTI)

71
Q

Which drug should be involved in treatment if concomitant HBV?

72
Q

What defines virological failure in ART?

A

HIV RNA >200 copies after 24 weeks on treatment

73
Q

What are 2 main toxicities associated with Tenofovir?

A

Renal -> Fanconi’s, decline in eGFR

Bone -> osteoporosis

74
Q

Other than hypersensitivity, what is the other major side effect of Abacavir?

A

CV risk -> elevated AMI risk

75
Q

Which class of ART cause increased CV risk and increase lipids?

A

Protease inhibitors

76
Q

What is the risk of dolutegravir in pregnancy?

A

Increased risk of neural tube defects

77
Q

What, aside from cobicistat, is often used as a drug booster / pharmaco-enhancer?

A

Ritonavir - protease inhibitor which potently inhibits CYP3A4

78
Q

What type of sexual exposure with a known HIV positive person would NOT warrant post-exposure prophylaxis, even with unknown viral load?

A

Oral intercourse

79
Q

What distinguishes hospital-acquired MRSA from nmMRSA?

A

Most nmMRSA strains are susceptible to non-beta lactam abx, like Bactrim, Clindamycin, macrolides

80
Q

What is the significance of Panton-Valentine leukocidin cytotoxin in nmMRSA?

A

Confers enhanced virulence

81
Q

At what MIC is VISA defined?
What change is seen within the bacterial cell?

What is the preferred treatment?

A

4-8 microg / ml
Thickened cell wall

Linezolid

82
Q

What are the preferred Abx options for VRE Rx? (3)

A

Linezolid
Daptomycin
Tigecycline
(teicoplanin is not very effective)

83
Q

What is the change in the vancomycin binding site which confers vanc resistance?

A

D-ala-D-ala to D-ala-D-lac

84
Q

What is the main toxicity to be aware of with combination therapy with Vancomycin + Tazocin?

A

Renal toxicity

85
Q

What is the biggest risk factor for TB reactivation?

A

HIV infection

86
Q

Most common AEs from Rifampicin?

A

Drug interactions (potent CYP inducer)
Hepatitis
Thrombocytopaenia

87
Q

Most common AEs from Isoniazid?

A

hepatitis, rash, neuropathy (give pyridoxine to minimise risk)

88
Q

Pyrazinamide AEs?

A

Hepatitis (most likely culprit for deranged LFTs)
skin
gout

89
Q

Ethambutol AEs?

A

Optic neuropathy

90
Q

Which major TB drugs need to be dose-adjusted in renal impairment?

A

Pyrazinamide + ethambutol

91
Q

What defines MDR in TB?

A

Resistance to rifampicin AND isoniazid

92
Q

What defines XDR in TB?

A

Resistance to rifampicin AND isoniazid, plus quinolones and injectables

93
Q

Which parasitic illness is associated with bladder carcinoma?

A

Schistosomiasis

94
Q

What is the way to differentiate between Nocardia and Actinomyces in the lab?

A

Nocardia retains its stain on modified acid-fast stain

95
Q

What are the 4 key types of clostridium bacteria?

A

Perfringens
DIfficile
Tetani
Botulinum

96
Q

What type of paralysis does tetanus cause, vs botulism?

A

Tetanus -> spastic paralysis

Botulism -> flaccid paralysis

97
Q

What is the difference in appearance on culture between staph and strep / enterococcus?

A

Staph is in clusters

Strep and enterococcus are in chains

98
Q

What are some key coagulase-negative staph? (3)

What is their clinical significance?

A

Staph epidermidis
Staph saprophyticus (UTI)
Staph lugdenensis

Part of normal skin flora, can be commonly found as contaminants in BCs. Can cause clinically significant infection with IE, sepsis.
People at particular risk -> prosthetic devices, immunocompromise

99
Q

Which coagulase negative staph has a tendency to behave with as much virulence as staph aureus?

A

Staphylococcus lugdunensis

100
Q

What is Group A strep also known as?

What kind of infections can it cause?

A

Strep pyogenes

Throat, soft tissue
Can lead to immunological sequelae e.g. rheumatic fever, GN

101
Q

What is group B strep also known as?

What is its clinical significance?

A

Strep agalactiae

Colonises the human genital and gastrointestinal tracts and the upper respiratory tract in young infants. Thus can cause serious infections in neonates, pregnant women

102
Q

What are two classic presentations of rickettsial infections?

A

Spotty rash plus fever

Eschar at bite site

103
Q

Name three important spirochetes

A

Syphilis

Leptospirosis

Borrelia (Lyme disease)

104
Q

What is the mechanism of penicillin resistance when it occurs in Strep pneumoniae?

A

Altered PBPs

105
Q

What is the usual mechanism of resistance in metallo-beta-lactamases e.g. New Delhi M?

A

Plasmid mediated

106
Q

What bugs is colistin used against?

A

Resistant gram negatives

NO gram positive activity

107
Q

Which strain of flu is Tamiflu more effective against?

A

Influenzae A

108
Q

Name indications for surgery in IE? (5)

A
  • Heart failure
  • Paravalvular extension
  • Persistent bacteraemia >10 days despite appropriate Abx
  • Resistant organisms (pseudomonas etc)
  • Recurrent embolic events despite Abx
109
Q

Which virus causes Kaposi’s sarcoma?

A

Human herpes virus 8 (HHV-8)

110
Q

What bacteria causes the Plague?

A

Yersinia Pestis

111
Q

How is the common cold spread (mode of transmission)?

A

Droplet spread

112
Q

What is the mode of transmission of TB?

A

Airborne spread

113
Q

What is the phenomenon responsible for influenzae pandemics?

A

Antigenic shift

114
Q

Which is the organism involved in meningitis, in which it has been shown that steroid treatment has mortality benefit?

A

Pneumococcus

115
Q

Which antibiotic is added in Toxic Shock Syndrome for its supposed anti-toxin effect?

A

Clindamycin

116
Q

What is the key factor in determining risk of an occupational HBV exposure leading to infection?

A

Source HBeAg positivity

117
Q

What are the recommendations for PEP following occupational HIV exposure?

A

2 drugs if source undetectable or very low risk exposure

3 drugs if source detectable / higher risk exposure

118
Q

What is the gene which confers colistin resistance?

119
Q

What is the first line therapy for candida auris?

A

Echinocandins

120
Q

What infection is a major cause of portal HTN and pulmonary HTN worldwide?

A

Schistosomiasis

121
Q

What is 1st line treatment for strongyloides?

A

Ivermectin

122
Q

MRSA mechanism of resistance?

A

MEC-A gene - alters PBP so that it is resistant

FRACP NOSH 2020 (18 decks)

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