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BPT exams > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

Aedes aegyptes is the mosquito that transmits _____

A

Zika and Dengue

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2
Q

Anopheles mosquitos transmit _______

A

Malaria - Falciparum

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3
Q

Tsetse flies transmits _______
Sandflies transmit _________

Ixodes ticks transmit ________

A

Tsetse flies transmits trypanosomiasis.

Sandflies transmit leishmaniasis.

Ixodes ticks transmit Lyme disease.

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4
Q

Toxoplasmosis crosses the placenta ______ weeks after maternal infection

A

4-8 weeks

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5
Q

If mother get Toxoplasmosis during the pregnancy what do you treat her with?

And if amniotic fluid is positive?

A

Spiramycin

Pyrimethamine plus Sulphadiazine (supplement with folonic acid)

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6
Q

What are the most common clinical findings in a newborn with congenital Toxoplasmosis?

A

85% of congenitally infected infants appear normal at birth
85% of these will suffer one or more episodes opf chorioretinitis if left untreated
Hearing loss in 10-30%
Developmental delay in 20-75%

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7
Q

How long and what do you treat a newborn with confirmed diagnosis of congenital toxoplasmosis?

A

Pyrimethamine + Sulfadiazine + Folonic acid

Treat until 12 months of age (immune competent)

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8
Q

Are the risks of meningitis higher in EOS or LOS?

A

LOS

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9
Q

Perinatal syphillis can present in various ways - list atleast 5/7 of common signs seen?

A
  • Osteochondritis/periostitis
  • Snuffles, haemorrhagic rhinitis
  • Skin changes: bullous lesions, palms/soles involved
  • Unexplained enlarged placenta
  • Nephrotic syndrome (rare, usually at 2-3 months of age)
  • Hepatosplenomegaly +/- splenomegaly jaundice
  • Non immune hydrops fetalis
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10
Q

Darkfield microscopy for spirochetes is seen in ______

A

Syphillis

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11
Q

If a mother is HBsAg positive and maternal HBeAg is positive - the rate of transmission:

  • with treatment?
  • without treatment?
A
  • With treatment - 7-28%

- Without treatment 90%

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12
Q

RIsk of congenital rubella infection:

<8 weeks: XX
8-12 weeks: XX
12-20 weeks: XX
>20 weeks: XX

A

<8 weeks: 100%
8-12 weeks: 50%
12-20 weeks: 20%
>20 weeks: <1 %

Vaccine related birth defects in 1% if vaccine given first 4 weeks of pregnancy

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13
Q

Congenital XX syndrome:

SNHL (58%) + Eyes (cataracts, retinopathy, micropthalmia 43%), Cardiac (PDA, PS stenosis) + neurodevelopmental disability

A

Congenital rubella syndrome!

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14
Q

What time period of neonatal exposure to maternal varicella warrants treatment with ZIG?

A

If mother develops Varicella 7 days before delivery or 7 days after delivery

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15
Q

When is varicella normally infectious?

A

Varicella (chickenpox) is infectious from 48 hours before rash until crusting of all lesions has occurred (usually 5 days after rash starts).

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16
Q

Multiple plasmodium in an RBC is indicative of _______

A

Falciparum

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17
Q

Strep on agar plate with green haemolysis seen?

A

Alpha haemolytic

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18
Q

Three viruses with high R0 value?

A

Measles, pertussis, polio

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19
Q

What meningococcal vaccines are available?

A

Meningicoccal C conjugate
Meningicoccal conjugate vaccine - ACWY

(Above funded in australia)

Meningicoccal B vaccine
- there is a new 4C meningicoccal B vaccine

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20
Q

Which meningicoccal strain is on the rise?

A

W

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21
Q

Which vaccinations should be given in pregnancy?

A

Influenzae and pertussis

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22
Q

When during the pregnancy is the immunisation recommended?

A

Funded from 13 weeks gestation (recommended in second trimester)

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23
Q

HBIG can be administered upto ____ days after delivery

A

7 days

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24
Q

Check the Hep b status of babies with infected mothers at ___ months

A

at 9 mo

Check HbsAg and HBsAb

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25
Q

Vaccination prior to immunosuppression?

A
  • complete all age appropriate vaccinations according to schedule
  • Live viral vaccines are recommended prior to planned immunosuppression - if time permits
  • Immunosuppression should not be delayed
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26
Q

If a patient is on high dose Azathioprine (>3mg/kg), 6-MP (>1.5mg/kg) or Methotrexate (>0.4mg/kg) how long do you delayed the administration of live vaccines?

A

Delay for 3 months after discontinuation

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27
Q

How long do you delay live vaccines after Leflunomide, teriflunomide?

A

6 months after discontinuation

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28
Q

How long after IVIG do you delay live vaccines?

A

?10 months

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29
Q

How long do you delay vaccines if a patient is on Sirolimus?

A

6 months

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30
Q

How much do you delaye vaccines for most biologics?

A

12 months

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31
Q

AUC/MIC is important in prescription of which anitbiotics

A

Vancomycin, azithromycin, fluoroquinolone, aminoglycosides

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32
Q

CMax/MIC is imporrtant in prescription of which antibiotics?

A

Aminoglycosides and fluoroquinolones

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33
Q

Vancomycin has no effect on ______-

A

Gram negatives

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34
Q

P. Aerigunosa is intrinsically resistant to ______

A

Cefotaxime (and other first and second Gen Cephs)

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35
Q

Enterococci have intrinsic resistant to ______

A

Cephalosporins

E. Faecalis - need to use Pen or Amox; or vanc

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36
Q

How does Clavulonic acid work?

A

Inhibits beta lactamase

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37
Q

Cephalosporins are resistant to ________ produced by Staph Aureus

A

Penicillinase (beta-lactamase)

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38
Q

Ceftriaxone, Cefotaxime and Ceftazidime are ______ generation cephalosporin

Cefepime is a _____ generation cephalosporin

A

3rd generation

4th Generation

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39
Q

Which cephalosporins will have some pseudomonas cover?

A

Ceftaroline and Cefepime

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40
Q

How do beta lactams work?

A

PBP (penicillin binding protein) normally connect and help form the bacterial cell wall - Beta lactams help bind onto PBP’s

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41
Q

What are the narrowest penicillin?

A

Pen V and Pen G

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42
Q

What bacteria are 1st generation cephalosporin effective against?

A

Stretococci
Staphylococci

Proteus
Escheria Coli
Klebsiella

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43
Q

Which Cephalosporin can treat Pseudomonas?

A

Ceftazidime

44
Q

Which Cephalosporin can cross BBB?

A

Cefepime (4th) and Ceftazidime/Cefotaxime/Ceftriaxone (3rd gen)

45
Q

How do Tetracyclines work?

A

Inhibit bacterial ribosomes and prevent protein synthesis

Bind to 30S subunit of ribosomes

46
Q

What are side effects of Tetracycline?

A

Phototoxicity
Tinnitus
Accumulate in teeth and ones - permanent teeth discoloration

Not Doxy!

47
Q

How do carbapenem work?

A

They bind to PBP’s and are resistant to beta lactamases

Cover Gram +ve, Gram -ve, Anaerobic species

48
Q

How does Vancomycin work?

A

Latch onto the tetrapeptide chain (do not actually bind to the PBP)

49
Q

How is Vancomycin resistance to Staph developing?

A

The Staph bug, puts a D-Lactate on tetra-peptides

50
Q

What antibiotic is effective against ESBL?

A

Carbapenems

51
Q

Which antibiotic lowers seizure threshold?

A

Carbapenem (Imipenem)

52
Q

How is pneumococcal resistance to penicillin developing?

A

Changes in PBP which leads to decrease affinity of penicillin

53
Q

Ciprofloxacin is a good or bad agent for Staph?

A

Bad!

54
Q

Prolonged high dose of Fluxcloxicillin can have adverse event including….

A

Bone marrow suppression (neutropenia)

55
Q

How does MRSA get it’s resistance?

A

Alteration to PBP site which prevents it binding to all penicillins and Cephalosporins (except Ceftaroline)

56
Q

What is Ecthyma gangrenosum associated with?

A

Pseudomonas septicaemic - appears as skin lesions

57
Q

How do you treat Strenotrophomonas maltophilia?

A

Co-Trimoxazole

58
Q

Galactomannan antigen can be done on bronchial wash do diagnose….

A

Aspergillosis

59
Q

First line agent for Aspergillus?

A

Voriconazole

2nd line - Caspofungin

(resistant to Fluconazole)

60
Q

How do Polyenes work? (Amphotericin/Nyastatin)

A

Make holes in cells

61
Q

How do the -Azoles work? (Antifungal)

A

Interfere with cell membrane synthesis (Ergosterol)

62
Q

How does Echinocandins work? (Caspofungin/micafungin)

A

Inhibit cell wall synthesis by targetting Beta 1,3 D glucan synthesis

63
Q

1st line empiric antifungal?

A

Amphotericin

64
Q

Does Caspofungin penentrate urine/CSF?

A

NO

65
Q

Side effects of Co-trimoxazole?

A

Neutropenia

66
Q

HHV 5 is ….

A

CMV

67
Q

What are the effects of CMV in a immunocompromised person?

A

Pancytopenia, colitis, pneumonitis, retinitis, encephalitis, myocarditis

68
Q

First line for CMV treatment in HSCT?

A

Gancyclovir (IV)

69
Q

How can you treat RSV in an immunocompromised patient?

A

Ribavirin

70
Q

How do you treat Adenovirus in immunocompromised?

A

Cidofovir

71
Q

Before commencing TNF alpha antibody?

A

It puts you at risk of TB - thus important to do IGRA and CXR

72
Q

If starting Eculizumab (anti-terminal complement 5) what should you vaccinate for?

A

Meningicoccal vaccination (add oral amoxicillin for two weeks if urgent)

73
Q

The predominant organisms isolated from anaerobic empyemas are Fusobacterium nucleatum, Prevotella sp, Peptostreptococcus, bacteroides fragillis

  • what might be a good antibitoics to treat?
A

Clindamycin

74
Q

What is the MIC cut off for Penicillin and Cef in bacterial meningitis?

A

Penicillin MIC <0.125

Cef MIC <1

75
Q

How do you treat Malaria?

A

IV Artesunate and fluid boluses ARE NOT recommended

76
Q

What are the two malaria types that can lay dormant in the liver before becoming active?

A

Plasmodium Vivax and Ovale

77
Q

Erythrocytes lacking Duffy blood group antigen are relatively resistant to _______, and erythrocytes containing hemoglobin F (fetal hemoglobin) and ovalocytes are resistant to ________

A

Erythrocytes lacking Duffy blood group antigen are relatively resistant to P. vivax, and erythrocytes containing hemoglobin F (fetal hemoglobin) and ovalocytes are resistant to P. falciparum

78
Q

While the rupture of schizonts that occurs every 48 hr with ______ and ______and every 72 hr with ________ can result in a classic pattern of fevers every other day or every 3rd day (as it is related to when the bug breaks out of the erythrocyte

A

While the rupture of schizonts that occurs every 48 hr with P. vivax and P. ovale and every 72 hr with P. malariae can result in a classic pattern of fevers every other day (P. vivax and P. ovale) or every 3rd day (P. malariae)

79
Q

Most severe form of malaria is ______

A

Falciparum - shorter incubation and higher parasite load

80
Q

Childhood herpes zoster has several recognised risk factors, which include the following:

A
  • Acute lymphocytic leukaemia and other malignancies
  • Immunocompromised state as a result of treatments or human immunodeficiency virus (HIV)
  • In utero varicella exposure
  • Primary VZV infection that occurred in the first year of life
  • Antitumor necrosis factor-alpha agents (may pose an increased risk)
81
Q

Parovirus B19 causes….

A

Slapped cheek - erythema infectiosum

82
Q

How do you treat Kingella?

A

Cefazolin

83
Q

If an infant receives the MMR vaccine early (6-11mo) - what should be the further follow up/vaccine schedule?

A

Infants who receive a dose of MMR vaccine at 6 through 11 months of age should receive
two additional doses, separated by at least 28 days, beginning at age 12 to 15 months.

84
Q

Properidin deficiency is associated with ______

A

N. meningitidis meningitis

85
Q

What are the four minor manifestations in Rheumatic fever?

A

The four minor manifestations are:
1. Arthralgia
2. Fever
3. Elevated acute phase reactants (erythrocyte sedimentation rate [ESR], C-reactive
protein [CRP])
4. Prolonged PR interval on electrocardiogram

86
Q

What are the five major manifestations of Rheumatic fever?

A
  1. Carditis and valvulitis (e.g., pancarditis) that is clinical or subclinical – 50 to 70
    percent
  2. Arthritis (usually migratory polyarthritis predominantly involving the large joints) –
    35 to 66 percent
  3. Central nervous system involvement (e.g., Sydenham chorea) – 10 to 30 percent
  4. Subcutaneous nodules – 0 to 10 percent
  5. Erythema marginatum
87
Q

What are the four minor manifestations in Rheumatic fever?

A

The four minor manifestations are:
1. Arthralgia
2. Fever
3. Elevated acute phase reactants (erythrocyte sedimentation rate [ESR], C-reactive
protein [CRP])
4. Prolonged PR interval on electrocardiogram

88
Q

What are the five major manifestations of Rheumatic fever?

A
  1. Carditis and valvulitis (e.g., pancarditis) that is clinical or subclinical – 50 to 70
    percent
  2. Arthritis (usually migratory polyarthritis predominantly involving the large joints) –
    35 to 66 percent
  3. Central nervous system involvement (e.g., Sydenham chorea) – 10 to 30 percent
  4. Subcutaneous nodules – 0 to 10 percent
  5. Erythema marginatum
89
Q

Urease-producing bacteria (mnemonic PUNCH):

A 
Proteus, Klebsiella - predispose to struvite stone production (UTI)
Ureaplasma urealyticum
Nocardia
Cryptococcus
Helicobacter pylori
90
Q

What is the triad seen in infant botulism?

A

1) Acute onset of a symmetric flaccid descending paralysis with clear sensorium
2) No fever
3) No paresthesias

91
Q

How do you diagnose infant botulism?

A

Presence of botulinum toxin in serum

C. botulinum toxin or organisms in wound material, enema fluid, or feces

92
Q

How do you treat infant botulism?

A

Human botulism immune globulin, given intravenously

93
Q

When is measles most infectious?

A

3 days before rash to 6 days after rash onset

94
Q

3 week, non-bloody diarrhea post bali

A

Giardia (chronic, non-bloody diarrhea)

95
Q

Patient should be tested for latent TB before commencing which immunosupressant?

A

TNF-alpha inhibitor

96
Q

What is the primary site of action of clindamycin?

A

50S ribosomal RNA

97
Q

What is the gram stain appearance of Listeria monocytogenes?

A

Gram positive rod

98
Q

Why is enterobacter cloacae resistant to cephalosporins?

A

Upregulation of chromosomal beta-lactamase

99
Q

Precautions for chickenpox?

A

Airborne

100
Q

Hypotension, interstitial pneumonitis, aseptic meningitis and associated hepatosplenomegaly with jaundice

A

Leptospirosis

101
Q

By which mechanism do super antigens work?

A

T cell stimulation?

102
Q

Vancomycin is similar to which antibiotic?

A

Teicoplanin

103
Q

What sort of bug is Kingella?

And what should you treat with?

A

Gram-negative facultative anaerobic β-hemolytic coccobacilli

Often Kingella is more indolent

Treat with - Cefazolin, ceftriaxone

104
Q

Is MRSA sensitive to Bactrim?

A

Yes

105
Q

What antibiotics would you use for GAS toxic shock?

A

Penicillin + Clindamycin!

BPT exams (24 decks)

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