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good paeds > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Virus causing myocarditis most commonly

A

Coxsackie B (HFM - coxsackie A16 and enterovirus 71 - meningitis)

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2
Q

Ganiciclovir s/e

A

BM suppression

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3
Q

Treatment hep c

A

Can give birth naturally (5%)

Interferon and ribavirin

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4
Q

BF contraindicated in..

A

HIV

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5
Q

Most common LRTI in HIV

A

Lymphoid interstitial pneumonitis

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6
Q

Measles infectious period

A

5 days either side of rash (morbiliform)

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7
Q

Rubella worse in T1 causes

A

IUgR, SNHL, brain, heart, cataract, LFT

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8
Q

Congenital varicella

A

Limb defects, pox lesions (risk only 2%)

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9
Q

Mother at risk varicella to neonate when?

A

5 days before and 2 after

Complications include Ramsay hunt

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10
Q

H pylori related to which ca

A

Gastric lymphoma MALT

Gram negative curved

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11
Q

Neisseria meningitidis gram stain

A

Gram negative diplococcus

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12
Q

Antibiotic if strep pneumoniae high grade resistance or meningitis

A

Vancomycin

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13
Q

Sickle cell with salmonella get..

A

Osteomyelitis (5% bacteraemia)

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14
Q

Brain abscess higher risk

A

CHD

Treat with met and cef

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15
Q

Gonorrhoea conjunctivitis

A

Day 2-3 thick risk corneal ulcer and visual loss

Tx with ceftriaxone

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16
Q

LP not contraindicated in

A

Mild drowsiness or bulging fontanelle

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17
Q

School exclusion pertussis

A

Until 5 days after Tx started

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18
Q

Aminoglycosides mechanism of action

A

Bind to 30s ribosome, inhibit protein synthesis

Effect due to peak level and some post antibiotic effect

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19
Q

Penicillins and most other abx effectiveness related to

A

Time above MIC

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20
Q

Strep pneumoniae resistance from

A

Altered PBP - insert neucleotides to cause decreased affinity

(Same as MrSA)

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21
Q

HiB resistance from

A

Production of beta lactamase

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22
Q

Pseudomonas resistance from

A 
DNA gyrase mutation
Efflux pump (Pumping antibiotics out of cytoplasm) and decreased permeability
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23
Q

ESBL resistance from

A

Modifying structure of beta lactamase

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24
Q

TB under 5 if exposed

A

Treat all with isoniazid

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25
Q

Pseudomonas treatment

A

Ceftaz

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26
Q

Beta lactams MIC

A

Time above MIC (dose interval with no post abx effect)

Macrolides, carbapenem and glycopeptides also

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27
Q

Aminoglycosides Killing mechanism

A

Concentration dependent AUC/MIC
Post abx effect
(Also fluroquinolones)

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28
Q

Cell wall abx

A 
Penicillin
Cephalosporins 
Meropenem
Aztreonam
Vanc 
Teicoplanin
Bacitracin
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29
Q

Quinolone mechanism of action, resistance and example of an antibiotic

A

DNA gyrase
Resistance from DNA gyrase mutation

Fluroquinolone

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30
Q

RNA polymerase affected therefore no mRNA synthesis abx mechanism?

A

Rifampicin (never use alone)

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31
Q

Folic acid metabolism abx mechanism

A

Cotrimoxazole (Trimethoprim sulfonamides)

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32
Q

Chloramphenicol mechanism of action

A

Transacetylase and protein synthesis 50S

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33
Q

Ribosome protein synthesis abx mechanism of action 50S and 30S

A

30S
SAT
Spectinomycin Aminoglycosides tetracycline

50S
MOCKA
Macrolides 
Oxazolidinones
Chloramphenicol / Clindamycin
Kerolides
Azithromycin
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34
Q

Gram negatives intrinsic resistance to

A

Vancomycin we not effective cell wall properties

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35
Q

Pseudomonas intrinsic resistance to..

A

Cefotaxime low affinity for PBP and low permeability

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36
Q

Enterococci intrinsic abx resistance to..

A

Cefalosporins low affinity for enterococcus PBP

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37
Q

E. coli resistance to beta lactams

A

B lactamase

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38
Q

MRSA resistance due to

A

Altered receptor binding PBP (transpeptidases) I.e. Altered binding site
Resistance to all penicillin and cephalosporins
Tx: erythromycin, clinda, doxy (stains teeth), cotrimox
Gentamicin
Vancomycin (bacterical against most except enterococci)

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39
Q

MIC => 2 is?

A

Resistant in meningitis

1 is cutoff in non-meningitis

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40
Q

Pneumococcal resistance to abx mechanism

A

Decreased affinity of penicillin binding proteins

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41
Q

Carbapenems can treat ESBL?

A

Yes it is the drug of choice

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42
Q

How does tamiflu work

A

Competitive inhibitor neuraminidase (prevents release of new virus from cells)

(Also site of action for amantidine and ramantidine)

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43
Q

Current flu strains

A

H1N1
H3N2
Flu B

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44
Q

HHV8 is responsible for..

A

Karposis sarcoma

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45
Q

Inv candidiasis Tx or high risk

A

Amphotericin B (covers most sp)

(Fluconazole for Candida albicans not invasive)

Candida kruse and glabrata use caspofungin due to resistance

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46
Q

Toxoplasmosis mother treated with

A

Spiromycin

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47
Q

Linezolid

A

Oxazolidinones
Good abx if can’t have vancomycin
SE reversible optic neuritis and irreversible peripheral neuropathy

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48
Q

No herd immunity with what

A

Tetanus toxin

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49
Q

Effectiveness of varicella vac

A

> 95% preventing serious disease

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50
Q

Vaccinate ? Weeks per transplant

A

4 (2w-3m)

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51
Q

Vertical transmission rates HIV

A

15-50%

Prevented by IV zidovudine and LSCS with no BF and infant chemoprophylaxsis (risk reduced to 1%)

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52
Q

TB treatment

A

Pulmonary 6m
2m isoniazid and rifampicin and pyrazinamide (RIP)

Meningitis and disseminated
Other 12m as above but also ethionamide (RIPE)
(Prothionamide)

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53
Q

Hansen disease (leprosy)

A

Salmon coloured fine scale rash central clearing

Ulnar nerve dysfunction

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54
Q

50-60% of what will have meningococcal

A

Alternative haemolytic complement test

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55
Q

Swimmers ear treatment

A

Swimmers ear treatment Clioquinol + flumethasone (Locorten Vioform) 2 to 3 drops 2 times daily
or
Dexamethasone + framycetin + gramicidin (Sofradex) 2 to 3 drops, 3 to 4 times daily.

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56
Q

Cat scratch disease main organism

A

Bartonella henselae gram negative rod

Antibiotics not usually used

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57
Q

alopecia, scale, and adenopathy is diagnostic of this condition…

Treatment?

A

Kerion

Treat with terbinafine

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58
Q

Gardasil against which HPV strains and how does vaccine work

A

contain HPV virus like particles (VLPs), composed of L1
protein (component of outer layer of virus) aggregated into
clumps to mimic outer structure of HPV virion

16, 18, 6, 11

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59
Q

CMV disease > 1 month think

A

HIV

Ganciclovir

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60
Q

Side effects of antiretrovirals

A

GI, hepatitis, skin (SJS), lipid, lipodystrophy

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61
Q

IE causative organisms

A

Strep and SA
Enterococcus
HACEK are gram negative coccobacilli (Haemophilus
aphrophilus,Actinobacillus
actinomycetemcomitans,
Cardiobacterium hominis,
Eikenella corrodens,
Kingella kingae)

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62
Q

Invasive candida Tx

A

Caspofungin (doesn’t penetrate csf or urine)

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63
Q

How to differentiate toxo, CMV and rubella

A

Rubella no microcephalic and no intracranial calcium
Toxo no cardiac and 85% appear normal at birth
CMV no bones, no cardiac and NO CATARACTS

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64
Q

Treating maternal toxo

A
  • Spiramycin 3g/day
  • Aim is to reduce transmission to fetus
    • rationale: lag time between maternal and fetal infection
    • continue throughout pregnancy
    • does not cross the placenta so does not treat fetus
    • Pyrimethamine 25mg/day (potentially teratogenic – after 18 weeks
    gestation) plus Sulphadiazine 4g/day
    • Added if amnio PCR positive / fetal infection confirmed
    • Supplement with folinic acid (leucovorin) – protects marrow
    • monitor FBC weekl
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65
Q

Brain eating amoeba

A

Naegleria infection

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66
Q

Facial nerve palsy can indicate

A

Lyme disease

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67
Q

Necrotic palate in immunosuppressed can indicate

A

Fungal

68
Q

Non healing wound with pathergy (worsens with debridement)

A

Pyoderma gangrenosum

IBD (DDx other autoimmune, infective, cancer, dermatitis artefacta)

69
Q

Who gets abx prophylaxis with pertussis child

A

All adults and children home and daycare

70
Q

Which malaria more severe

A

P.falciparum most resistant to chloroquine

71
Q

Biliary sludge from what antibiotic

A

Ceftriaxone

72
Q

Efficacy varicella vac after one dose

A

94%

2 doses is 98-99% and prevents outbreaks

73
Q

Invasive aspergillosis Tx

A

Voriconazole

74
Q

Toxoid vaccine

A

Diphtheria

75
Q

Recombinant vaccine (take gene and use it to make protein of interest) examples (2)

A

Hep B and HPV

76
Q

Can live vaccine be given to pregnant woman

A

No

77
Q

Egg allergy and vaccines

A

Influenza given in hospital and MMR can be given

78
Q

Wait time for live vaccine and immunoglobulin or blood product

A

At least 3 weeks before (at same time of over 4 we is apart) and up to 11 month deferral (NOT including rotavirus)

11m treated Kawasaki and ITP
8m Immunoglobulin def treatment 
7m plasma or platelet product
6m whole blood
5m packed RBC
79
Q

Mother HBeAg positive risk neonate

A

70-90%

80
Q

Current influenza vaccine strains

A

Two influenza A strains (H1N1 and H3N2) and one prevailing B strain

81
Q

Meningococcal outbreak

A 
Large group or non preg woman on OCP = cipro
Normally rifampicin (CI in pregnancy so given ceftriaxone)
82
Q

If rotavirus vaccine vomited what to do

A

DO NOT give it again

83
Q

Hydatid disease Tx

A

Albenazole

84
Q

If newborn colonised GbS what percent unwell with it

A

1-2%

85
Q

B.burgdorferi in joint indicates

A

Lyme disease

86
Q

Two or more episodes of meningococcal must test

A

CH50 (for complement problem)

[AH50 tests alternate pathway]

87
Q

If mother and baby treated HIV risk to baby is..

A

10%

88
Q

Custard cream mayo can all be infected with what organism giving you gastro

A

S.A

89
Q

CT chest showing crescent sign and halo sign is likely?

Treatment?

A

Aspergillosis
Vorconizole
(Can us ampB or as presumptive Tx)

90
Q

ENDOtoxin which bacteria

A

On outside of gram negative such as n.meningitidis, E. coli in HUS

91
Q

Strep uses ENDOtoxin or EXOtoxin?

A

EXOtoxin

92
Q

Membranous conjunctivitis typical for what infection

A

Diphtheria

93
Q

Invasive aspergillosis Tx

A

Vorconizole

94
Q

Efficacy pertussis vaccine

A

84% efficacy after 3 doses.

95
Q

Groups meningococcal that cause disease

A

A, B, C, W-135 and Y (generally B predominant)

96
Q

Three diseases high risk for yersinia and treatment invasive disease

A

Because pathogenic strains need iron, patients with iron overload
(haemachromatosis, thalassemia, sickle cell) are at high risk.

Treatment: supportive, cotrimoxazole in systemic disease. Resistance to penicillins and
cephalosporins due to beta lactamase production.

97
Q

How does quantiferon work

A

Quantiferon: detect IFNϒ generation by the patient’s T cell’s in response
to specific M.tuberculosis antigens.

98
Q

Syphillis tx

A

Penicillin

99
Q

HHV 6/7 and 8 cause

A

Roseola

Kaposi sarcoma

100
Q

Infection causing SJS

A

Mycoplasma

101
Q

High resistance > 50% of h.pylori to what abx

A

Metronidazole

102
Q

Mother with varicella when highest risk to baby

A

2% 13-20w (0.4% 1st trimester)

103
Q

Two other glycopeptide antibiotics like vancomycin

A

Bleomycin and teicoplanin

104
Q

Acquired epilepsy from what organism

A

neurocysticercosis

Treat with praziquantel

105
Q

Hydatid disease commonly affects

A

Liver
Then lungs
Only 1% brain in mca territory

106
Q

Schistosomiasis treatment

A

Praziquantal 3 dose regieme

107
Q

Dengue fever type of virus

A

Flavivirus

108
Q

Work that can obstruct

A

Ascaris/roundworm

109
Q

SSSS histology different to TEN

A

Granular layer split

110
Q

Linezolid treats and side effects

A

OxaZolidinone
Acts on protein synthesis
MRSA VRSA VRE
Gram positive bacteria even MrSA (like vancomycin) but can’t treat pseudomonas (gram negative rod)
SE myelosuppresion peripheral neuropathy abnormal LFTs

111
Q

Treatment for malaria?

A

Artemether-lumefantrine (primaquine for liver only and chloroquine if uncomplicated malaria)

112
Q

Enterococcus faecalis Tx

A

Ampicillin

113
Q

Obligate intracellular (2)

A

stay inside (cells) when it’s Really Cold =Rickettsia, Clamydia. can’t make own ATP

114
Q

Earliest marker hep b infection

A

Earliest marker Acute HBV infection is characterized by the presence of HBsAg

115
Q

Strongyloides stercoralis is a human pathogenic parasitic roundworm causing the disease strongyloidiasis treatment?

A

Its common name is threadworm treat with ivermectin

116
Q

Aminoglycosides killing dependent on?

Quinolones killing ?

A

C max/Mic

Auc/mic

117
Q

Examples of 4th and 5th generation cephalosporins

A

4th gen cefepime, cefpirome

5th gen ceftaroline, ceftobripole

118
Q

aztreonam

only active against?

A

GNB

119
Q

ESBL treatment

A

Esbl treatment arbapenems drug of choice +/‐ aminoglycosides or quinolones

120
Q

Classification of antifungal agents
• Polyenes –
•Azoles –
• Echinocandins‐

A

All impact cell membrane/wall
• POlyenes – POke holes in cell membranes
• AzOLes – interfere with cell membrane
function by inhibiting sterOL synthesis (interfere)
• EchINocandins‐ INhibit cell wall synthesis

121
Q

H.pylori increased resistance to what antibiotic especially

A

Metronidazole
Clarithromycin

Use bismuth quadruple therapy if resistance high

122
Q

Antibiotic against VRSA MRSA and VRE and action

A

Linezolid
Streptogramins (not effective on E faecalis) both act on protein synthesis by binding to 50S ribosomal unit

Daptomycin (lipopeptide abx acts on cell membrane - not L sided endocarditis or pneumonia)

123
Q

Example of a licosamide antibiotic

A

Clindomycin (binds to 50S ribosomal unit)

124
Q

Macrolides and ketolide telothromycin mechanism of action

A

Bind to 50s ribosomal unit to inhibit protein synthesis

125
Q

Palivizumab cochrane study showed

A

In high risk popn can reduce hospitalisation

Monoclonal antibody produced by recombinant DNA technology for immunoprophylaxsis against RSV

126
Q

Zika mosquito called

A

Aedes aegypti

127
Q

Wound through tennis shoe infection

A

Pseudomonas

128
Q

Rubella like measles but..

A

No Coryza, prominent LN behind ear, arthritis

129
Q

ESBL serious treatment

A

Meropenem IV

130
Q

Ebola virus

A

Filoviridae family

131
Q

Gram negative diplococci in neutrophil seen on 2 day old with conjunctivitis
What is the organism likely to be?
Risk corneal damage

A

Gonorrhoea

Chlamydia can cause haemorrhagic conjunctivitis

132
Q

What is Fitz-high-Curtis syndrome?

A

Adhesionsee from PID between diaphragm and liver

133
Q

Chlamydia diagnostic test

A

PCR

134
Q

Flagellated protozoan on vaginal swab?

A

Trichomonas

135
Q

Latest STI dx using NAAT as no cell wall and linked to preterm delivery?
Treatment?

A

Mycoplasma genitalium

Azithromycin (if resistance use moxifloxacin)

136
Q

DNA disruption mechanism of antibiotic? Two examples

A

Metronidazole and nitrofurantoin

137
Q

Azithromycin, quinolone and vancomycin killing mechanism

A

24h AUC (concentration and time)/MIC

138
Q

What bug has no cell wall

A

Mycobacterium

139
Q

Example of anaerobic gram negative rod

A

Bacteroides

140
Q

Listeria gram stain result

A

Gram positive rod

141
Q

Pure UTI antibiotics

A

Gentamicin and amoxicillin

142
Q

Enterococcus intrinsically resistant to? So treat with

A

Flucloxicillin, cephalosporins, cotrimoxazole resistant
Sensitive to amoxicillin (or Vanc or linezolid)

Other examples of bugs like this don’t respond to flucloxicillin but like amoxicillin are LACE (listeria, actinomyces, clostridium but not c.diff, enterococcus)

143
Q

Strep pneumonia resistant in meningitis use?

A

Ceftriaxone but if high resistance need vancomycin

If just pneumonia continue penicillin

144
Q

Osteomyelitis six organisms and most common

A 
Staph aureus most common
Strep
hiB
Salmonella
Group B strep in neonate
Kingella (needs cefazolin)
145
Q

Bones need what other vitamin (other than D)

A

Vitamin k dependent osteocalcin and other proteins

146
Q

Mechanism of penicillin resistance to pneumococcal infection?

A

Decreased affinity of penicillin binding proteins

147
Q

MRSA mechanism of resistance

A

Altered PBP (MecA encoding PBP2a)

148
Q

Most common cause brain abscess (organism)

A

Strep

149
Q

Abx for and not for pseudomonas

A

Clindamycin doesn’t work and neither does 1-3rd Gen cephalosporins
Cefepime and ceftazidime do work

150
Q

What bug intrinsic resistance to nitrofurantoin

A

Proteus

151
Q

What bug intrinsic resistance to aminoglycosides

A

Salmonella

152
Q

What drugs treat with carbapenem? (5)

A

“Friends enter PMS”

Freundii
Enterobacter/ESBL
Proteus
Morg
Serratia
153
Q

Drugs used to treat brain abscess

A

Metronidazole and cefotaxime

154
Q

Carbapenamase treatment

A

Colistin (fosfomycin)

155
Q

Abx prophylaxis for base of skull fracture?

A

No

156
Q

Aspiration pneumonia and dental infection Tx

A

Penicillin (all bugs from mouth sensitive)

157
Q

Water diarrhoea after seafood could be from

A

Vibrio

Supportive management

158
Q

Cause of death measles

A

Pneumonia

159
Q

Baby with hydrocephalus and intracranial diffuse calcification and small, HSM, blueberry muffin rash, eyes affected
Diagnosis and treatment

A

Toxoplasmosis

Pyrimethamine, sulfadiamine and lencovorin

160
Q

Newborn with haemolytic anaemia, snuffles, periostitis and palm and sole lesions hutchinstons peg teeth and mulberry molars from?

A

Syphillus

Trponma pallidum

161
Q

Newborn with heart disease especially PDA and chorioretinistis and IUGR cause

A

Rubella

162
Q

Very unwell neonate with petechiae, HSM and calcified MRI around ventricles

A

CMV

163
Q

Pseudomonas treatment

A 
Cipro
Ceftazadime 
Gent 
Tobramycin
Pip/taz 
Mero and imipenem
164
Q

TNF gamma has response against

A

Viruses

165
Q

From Iran non healing sores plaquelike ukcerated on neck and splenomegaly in some
Causes

A

Leishmaniasis

166
Q

Four causes of macular stars

A

Toxo
Syphillis
Lyme
Cat scratch

good paeds (19 decks)

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