Infectious Disease Flashcards
1
Q
Virus causing myocarditis most commonly
A
Coxsackie B (HFM - coxsackie A16 and enterovirus 71 - meningitis)
2
Q
Ganiciclovir s/e
A
BM suppression
3
Q
Treatment hep c
A
Can give birth naturally (5%)
Interferon and ribavirin
4
Q
BF contraindicated in..
A
HIV
5
Q
Most common LRTI in HIV
A
Lymphoid interstitial pneumonitis
6
Q
Measles infectious period
A
5 days either side of rash (morbiliform)
7
Q
Rubella worse in T1 causes
A
IUgR, SNHL, brain, heart, cataract, LFT
8
Q
Congenital varicella
A
Limb defects, pox lesions (risk only 2%)
9
Q
Mother at risk varicella to neonate when?
A
5 days before and 2 after
Complications include Ramsay hunt
10
Q
H pylori related to which ca
A
Gastric lymphoma MALT
Gram negative curved
11
Q
Neisseria meningitidis gram stain
A
Gram negative diplococcus
12
Q
Antibiotic if strep pneumoniae high grade resistance or meningitis
A
Vancomycin
13
Q
Sickle cell with salmonella get..
A
Osteomyelitis (5% bacteraemia)
14
Q
Brain abscess higher risk
A
CHD
Treat with met and cef
15
Q
Gonorrhoea conjunctivitis
A
Day 2-3 thick risk corneal ulcer and visual loss
Tx with ceftriaxone
16
Q
LP not contraindicated in
A
Mild drowsiness or bulging fontanelle
17
Q
School exclusion pertussis
A
Until 5 days after Tx started
18
Q
Aminoglycosides mechanism of action
A
Bind to 30s ribosome, inhibit protein synthesis
Effect due to peak level and some post antibiotic effect
19
Q
Penicillins and most other abx effectiveness related to
A
Time above MIC
20
Q
Strep pneumoniae resistance from
A
Altered PBP - insert neucleotides to cause decreased affinity
(Same as MrSA)
21
Q
HiB resistance from
A
Production of beta lactamase
22
Q
Pseudomonas resistance from
A
DNA gyrase mutation Efflux pump (Pumping antibiotics out of cytoplasm) and decreased permeability
23
Q
ESBL resistance from
A
Modifying structure of beta lactamase
24
Q
TB under 5 if exposed
A
Treat all with isoniazid
25
Pseudomonas treatment
Ceftaz
26
Beta lactams MIC
Time above MIC (dose interval with no post abx effect)
Macrolides, carbapenem and glycopeptides also
27
Aminoglycosides Killing mechanism
Concentration dependent AUC/MIC
Post abx effect
(Also fluroquinolones)
28
Cell wall abx
```
Penicillin
Cephalosporins
Meropenem
Aztreonam
Vanc
Teicoplanin
Bacitracin
```
29
Quinolone mechanism of action, resistance and example of an antibiotic
DNA gyrase
Resistance from DNA gyrase mutation
Fluroquinolone
30
RNA polymerase affected therefore no mRNA synthesis abx mechanism?
Rifampicin (never use alone)
31
Folic acid metabolism abx mechanism
Cotrimoxazole (Trimethoprim sulfonamides)
32
Chloramphenicol mechanism of action
Transacetylase and protein synthesis 50S
33
Ribosome protein synthesis abx mechanism of action 50S and 30S
30S
SAT
Spectinomycin Aminoglycosides tetracycline
```
50S
MOCKA
Macrolides
Oxazolidinones
Chloramphenicol / Clindamycin
Kerolides
Azithromycin
```
34
Gram negatives intrinsic resistance to
Vancomycin we not effective cell wall properties
35
Pseudomonas intrinsic resistance to..
Cefotaxime low affinity for PBP and low permeability
36
Enterococci intrinsic abx resistance to..
Cefalosporins low affinity for enterococcus PBP
37
E. coli resistance to beta lactams
B lactamase
38
MRSA resistance due to
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)
39
MIC => 2 is?
Resistant in meningitis
| 1 is cutoff in non-meningitis
40
Pneumococcal resistance to abx mechanism
Decreased affinity of penicillin binding proteins
41
Carbapenems can treat ESBL?
Yes it is the drug of choice
42
How does tamiflu work
Competitive inhibitor neuraminidase (prevents release of new virus from cells)
(Also site of action for amantidine and ramantidine)
43
Current flu strains
H1N1
H3N2
Flu B
44
HHV8 is responsible for..
Karposis sarcoma
45
Inv candidiasis Tx or high risk
Amphotericin B (covers most sp)
(Fluconazole for Candida albicans not invasive)
Candida kruse and glabrata use caspofungin due to resistance
46
Toxoplasmosis mother treated with
Spiromycin
47
Linezolid
Oxazolidinones
Good abx if can't have vancomycin
SE reversible optic neuritis and irreversible peripheral neuropathy
48
No herd immunity with what
Tetanus toxin
49
Effectiveness of varicella vac
>95% preventing serious disease
50
Vaccinate ? Weeks per transplant
4 (2w-3m)
51
Vertical transmission rates HIV
15-50%
Prevented by IV zidovudine and LSCS with no BF and infant chemoprophylaxsis (risk reduced to 1%)
52
TB treatment
Pulmonary 6m
2m isoniazid and rifampicin and pyrazinamide (RIP)
Meningitis and disseminated
Other 12m as above but also ethionamide (RIPE)
(Prothionamide)
53
Hansen disease (leprosy)
Salmon coloured fine scale rash central clearing
| Ulnar nerve dysfunction
54
50-60% of what will have meningococcal
Alternative haemolytic complement test
55
Swimmers ear treatment
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.
56
Cat scratch disease main organism
Bartonella henselae gram negative rod
| Antibiotics not usually used
57
alopecia, scale, and adenopathy is diagnostic of this condition...
Treatment?
Kerion
| Treat with terbinafine
58
Gardasil against which HPV strains and how does vaccine work
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
59
CMV disease > 1 month think
HIV
| Ganciclovir
60
Side effects of antiretrovirals
GI, hepatitis, skin (SJS), lipid, lipodystrophy
61
IE causative organisms
Strep and SA
Enterococcus
HACEK are gram negative coccobacilli (Haemophilus
aphrophilus,Actinobacillus
actinomycetemcomitans,
Cardiobacterium hominis,
Eikenella corrodens,
Kingella kingae)
62
Invasive candida Tx
Caspofungin (doesn't penetrate csf or urine)
63
How to differentiate toxo, CMV and rubella
Rubella no microcephalic and no intracranial calcium
Toxo no cardiac and 85% appear normal at birth
CMV no bones, no cardiac and NO CATARACTS
64
Treating maternal toxo
* 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
65
Brain eating amoeba
Naegleria infection
66
Facial nerve palsy can indicate
Lyme disease
67
Necrotic palate in immunosuppressed can indicate
Fungal
68
Non healing wound with pathergy (worsens with debridement)
Pyoderma gangrenosum
| IBD (DDx other autoimmune, infective, cancer, dermatitis artefacta)
69
Who gets abx prophylaxis with pertussis child
All adults and children home and daycare
70
Which malaria more severe
P.falciparum most resistant to chloroquine
71
Biliary sludge from what antibiotic
Ceftriaxone
72
Efficacy varicella vac after one dose
94%
| 2 doses is 98-99% and prevents outbreaks
73
Invasive aspergillosis Tx
Voriconazole
74
Toxoid vaccine
Diphtheria
75
Recombinant vaccine (take gene and use it to make protein of interest) examples (2)
Hep B and HPV
76
Can live vaccine be given to pregnant woman
No
77
Egg allergy and vaccines
Influenza given in hospital and MMR can be given
78
Wait time for live vaccine and immunoglobulin or blood product
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
Mother HBeAg positive risk neonate
70-90%
80
Current influenza vaccine strains
Two influenza A strains (H1N1 and H3N2) and one prevailing B strain
81
Meningococcal outbreak
```
Large group or non preg woman on OCP = cipro
Normally rifampicin (CI in pregnancy so given ceftriaxone)
```
82
If rotavirus vaccine vomited what to do
DO NOT give it again
83
Hydatid disease Tx
Albenazole
84
If newborn colonised GbS what percent unwell with it
1-2%
85
B.burgdorferi in joint indicates
Lyme disease
86
Two or more episodes of meningococcal must test
CH50 (for complement problem)
[AH50 tests alternate pathway]
87
If mother and baby treated HIV risk to baby is..
10%
88
Custard cream mayo can all be infected with what organism giving you gastro
S.A
89
CT chest showing crescent sign and halo sign is likely?
| Treatment?
Aspergillosis
Vorconizole
(Can us ampB or as presumptive Tx)
90
ENDOtoxin which bacteria
On outside of gram negative such as n.meningitidis, E. coli in HUS
91
Strep uses ENDOtoxin or EXOtoxin?
EXOtoxin
92
Membranous conjunctivitis typical for what infection
Diphtheria
93
Invasive aspergillosis Tx
Vorconizole
94
Efficacy pertussis vaccine
84% efficacy after 3 doses.
95
Groups meningococcal that cause disease
A, B, C, W-135 and Y (generally B predominant)
96
Three diseases high risk for yersinia and treatment invasive disease
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
How does quantiferon work
Quantiferon: detect IFNϒ generation by the patient’s T cell’s in response
to specific M.tuberculosis antigens.
98
Syphillis tx
Penicillin
99
HHV 6/7 and 8 cause
Roseola
| Kaposi sarcoma
100
Infection causing SJS
Mycoplasma
101
High resistance > 50% of h.pylori to what abx
Metronidazole
102
Mother with varicella when highest risk to baby
2% 13-20w (0.4% 1st trimester)
103
Two other glycopeptide antibiotics like vancomycin
Bleomycin and teicoplanin
104
Acquired epilepsy from what organism
neurocysticercosis
| Treat with praziquantel
105
Hydatid disease commonly affects
Liver
Then lungs
Only 1% brain in mca territory
106
Schistosomiasis treatment
Praziquantal 3 dose regieme
107
Dengue fever type of virus
Flavivirus
108
Work that can obstruct
Ascaris/roundworm
109
SSSS histology different to TEN
Granular layer split
110
Linezolid treats and side effects
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
Treatment for malaria?
Artemether-lumefantrine (primaquine for liver only and chloroquine if uncomplicated malaria)
112
Enterococcus faecalis Tx
Ampicillin
113
Obligate intracellular (2)
stay inside (cells) when it's Really Cold =Rickettsia, Clamydia. can't make own ATP
114
Earliest marker hep b infection
Earliest marker Acute HBV infection is characterized by the presence of HBsAg
115
Strongyloides stercoralis is a human pathogenic parasitic roundworm causing the disease strongyloidiasis treatment?
Its common name is threadworm treat with ivermectin
116
Aminoglycosides killing dependent on?
| Quinolones killing ?
C max/Mic
| Auc/mic
117
Examples of 4th and 5th generation cephalosporins
4th gen cefepime, cefpirome
| 5th gen ceftaroline, ceftobripole
118
aztreonam
| only active against?
GNB
119
ESBL treatment
Esbl treatment arbapenems drug of choice +/‐ aminoglycosides or quinolones
120
Classification of antifungal agents
• Polyenes –
•Azoles –
• Echinocandins‐
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
H.pylori increased resistance to what antibiotic especially
Metronidazole
Clarithromycin
Use bismuth quadruple therapy if resistance high
122
Antibiotic against VRSA MRSA and VRE and action
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
Example of a licosamide antibiotic
Clindomycin (binds to 50S ribosomal unit)
124
Macrolides and ketolide telothromycin mechanism of action
Bind to 50s ribosomal unit to inhibit protein synthesis
125
Palivizumab cochrane study showed
In high risk popn can reduce hospitalisation
| Monoclonal antibody produced by recombinant DNA technology for immunoprophylaxsis against RSV
126
Zika mosquito called
Aedes aegypti
127
Wound through tennis shoe infection
Pseudomonas
128
Rubella like measles but..
No Coryza, prominent LN behind ear, arthritis
129
ESBL serious treatment
Meropenem IV
130
Ebola virus
Filoviridae family
131
Gram negative diplococci in neutrophil seen on 2 day old with conjunctivitis
What is the organism likely to be?
Risk corneal damage
Gonorrhoea
| Chlamydia can cause haemorrhagic conjunctivitis
132
What is Fitz-high-Curtis syndrome?
Adhesionsee from PID between diaphragm and liver
133
Chlamydia diagnostic test
PCR
134
Flagellated protozoan on vaginal swab?
Trichomonas
135
Latest STI dx using NAAT as no cell wall and linked to preterm delivery?
Treatment?
Mycoplasma genitalium
| Azithromycin (if resistance use moxifloxacin)
136
DNA disruption mechanism of antibiotic? Two examples
Metronidazole and nitrofurantoin
137
Azithromycin, quinolone and vancomycin killing mechanism
24h AUC (concentration and time)/MIC
138
What bug has no cell wall
Mycobacterium
139
Example of anaerobic gram negative rod
Bacteroides
140
Listeria gram stain result
Gram positive rod
141
Pure UTI antibiotics
Gentamicin and amoxicillin
142
Enterococcus intrinsically resistant to? So treat with
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
Strep pneumonia resistant in meningitis use?
Ceftriaxone but if high resistance need vancomycin
If just pneumonia continue penicillin
144
Osteomyelitis six organisms and most common
```
Staph aureus most common
Strep
hiB
Salmonella
Group B strep in neonate
Kingella (needs cefazolin)
```
145
Bones need what other vitamin (other than D)
Vitamin k dependent osteocalcin and other proteins
146
Mechanism of penicillin resistance to pneumococcal infection?
Decreased affinity of penicillin binding proteins
147
MRSA mechanism of resistance
Altered PBP (MecA encoding PBP2a)
148
Most common cause brain abscess (organism)
Strep
149
Abx for and not for pseudomonas
Clindamycin doesn't work and neither does 1-3rd Gen cephalosporins
Cefepime and ceftazidime do work
150
What bug intrinsic resistance to nitrofurantoin
Proteus
151
What bug intrinsic resistance to aminoglycosides
Salmonella
152
What drugs treat with carbapenem? (5)
"Friends enter PMS"
```
Freundii
Enterobacter/ESBL
Proteus
Morg
Serratia
```
153
Drugs used to treat brain abscess
Metronidazole and cefotaxime
154
Carbapenamase treatment
Colistin (fosfomycin)
155
Abx prophylaxis for base of skull fracture?
No
156
Aspiration pneumonia and dental infection Tx
Penicillin (all bugs from mouth sensitive)
157
Water diarrhoea after seafood could be from
Vibrio
| Supportive management
158
Cause of death measles
Pneumonia
159
Baby with hydrocephalus and intracranial diffuse calcification and small, HSM, blueberry muffin rash, eyes affected
Diagnosis and treatment
Toxoplasmosis
| Pyrimethamine, sulfadiamine and lencovorin
160
Newborn with haemolytic anaemia, snuffles, periostitis and palm and sole lesions hutchinstons peg teeth and mulberry molars from?
Syphillus
| Trponma pallidum
161
Newborn with heart disease especially PDA and chorioretinistis and IUGR cause
Rubella
162
Very unwell neonate with petechiae, HSM and calcified MRI around ventricles
CMV
163
Pseudomonas treatment
```
Cipro
Ceftazadime
Gent
Tobramycin
Pip/taz
Mero and imipenem
```
164
TNF gamma has response against
Viruses
165
From Iran non healing sores plaquelike ukcerated on neck and splenomegaly in some
Causes
Leishmaniasis
166
Four causes of macular stars
Toxo
Syphillis
Lyme
Cat scratch
