infectious diseases Flashcards
1
Q
feature gram positive bacteria
A
thick peptidoglycan cell wall
2
Q
bacilli
A
rod
3
Q
cocci
A
circular
4
Q
gram positive cocci
A
staph
strep
enterococcus
5
Q
gram positive rod
A
corneybacteria
mycobacteria
listeria
bacillus
nocardia
6
Q
common gram negative bacteri
A
n.meningitidis
n.gonorrhoea
h.influenzae
e.coli
klebsiella
pseudomonas aeruginosa
moraxella cattarhali
7
Q
gram positive anaerobes
A
clostridium
lactobacillus
actinonyces
propionibacterium
8
Q
features atypical bacteria
A
cant be gram stained
often cause atypical pnuemonia
9
Q
what is MRSA
A
staph aureus resistant to beta lactams
10
Q
mx MRSA
A
doxycycline, clindamycin, vancomcin, teicoplanin, linezolid
11
Q
e.g. extended spectrum beta lactamase bacterua
A
e.coli
klebsiella
12
Q
mx extended spectrum beta lactamase bacterua
A
carbapanems (meropenem, imipenem)
13
Q
abx that inhibit cell wall synthesis with a beta lactam ring
A
penicllin
carbapenems
cephalopsporins
14
Q
abx that inhibit cell wall synthesis without a beta lactam ring
A
vancomycin
teicoplanin
15
Q
abx that inhibit folic acid metabolism
A
sulfamethoxazole: blocks DHFA to THFA
trimethoprim: blocks THFA ro folic acid
16
Q
mechanisms action abx
A
inhibit cell wall synthesis
inhibit folic acid metabolism
inhibit nucleic acid synthesis
inhibit protein synthesis
17
Q
how does metronidazole work
A
inhibits nucleic acid synthesis in anaerobes
18
Q
abx that inhibit protein synthesis by targeting ribosome
A
macrolides
clindamycin
tetracyclines
gent
chloramphenicol
19
Q
penicillins
A
pen v
amoxicillin
fluclox
benpen
coamox
tazocin
20
Q
what does pen v work against
A
beta haemolytic strep, strep pneumoniae, anaerobes
21
Q
what does amoxicillin work against
A
beta haemolytioc strep
strep pnuemonia
enterococcus
anaerobes
22
Q
what does fluclox work against
A
staph aureus
beta haem strep
anaerobes
23
Q
what does benpen work against
A
beta haem strep
strep pnuemonia
enterococcus
n.meningitidis
24
Q
what does co amox work against
A
staph aureus
beta haemolytic strep
strep pneumonia
enterococus
h.influenzae
e.coli
anaerobes
25
what does tazocin work against
staph aureus
beta haem strep
strep pneumonia
enterococcus
h.influenzae
e.coli
pseudomonas aueruginosa
moraxella catarrhalis
anaerobes
26
e.g. cephalosporin
ceftriaxone
27
what does ceftriaxone work against
staph aureus
beta haemolytic strep
strep pneumoniae
n.meningitidis
h.influenzae
e.coli
moraxella catarrhalis
28
e.g. carbapenems
meropenem
29
what does meropenem work against
staph aureus
beta haem strep
stre pnuemonae
enterococcus
n.meningitidis
h.influenzae
e.coli
ESBL
pseudomonas aeruginosa
moraxella catarrhalis
anaerobes
30
what does trimethoprim work against
e.coli
31
e.g. macrolides
erythromicin
clarithromycin
azithromycin
32
what does macrolides work against
staph aureus,
beta haem strep
strep pneumonia
atypicals
33
e.g. lincosamides
lindamycin
34
what does lindamycin work against
staph aureus
beta haem strep
strep pneumoniae
anaerobes
35
what does gentamicin work against
staph aureus
MRSA
e.coli
pseudomonas aeruginosa
moraxella catarrhalis
36
e.g. aminoglycoside
gentamicin
37
e.g. quinolones
ciprofloxacin
levofloxacin
38
what does ciprofoxacin work against
staph aureus
n.meningitidis
h.influenzae
pseudomonas aeruginosa
moraxella catarrhalis
atypicals
39
what does levofloxacin work against
staph aureus
n.meningitidis
h.influenzae
pseudomonas aeruginosa
moraxella catarrhalis
atypicals
strep pneumonia
40
e.g. glycopeptides
vanomycin
teicoplanin
41
what does vancomycin and teicoplanin work against
staph aureus
MRSA
beta haem strep
strep pnuemonia
enterococus
42
what does metronidazole work against
anaerobes
43
give e.g. tetracyclines
doxycycline
44
what does doxycycline work against
staph aureus
MRSA
strep pneumoniae
h.influenzae
moraxella catarrhalis
anaerobes
atypicals
45
what is sepsis
immune response to pathogens->cytokines->immune activation ->vasodilation
more permeable=oedema
activation coag syte ->thrombocytopenia and haemorrhage ->DIC
increased lactate due to anaerobic resp
46
features septic shock
BP<90
lactate >4
47
mx septic shock
fluids
inotropes (noradrenaline)
48
what is severe sepsis
organ dysfunction e.g. hypoxia, oliguria, AKI, thrombocytopaenia, coag, low BP high lactate
49
presentation sepsis
increased RR
confused
infection source
AF
temp
reduced urine output
mottled skin
50
mx sepsis
within 1 hr: blood lactate, blood cultures, urine output + oxygen, broad sepctrum abx, iV fluid
51
neutropenic sepsis
sepsis and neutrophils <1
52
when to suspect neutropenic sepsis
temp>38
53
mx neutropenic sepssi
abx e.g. tazocin
54
meds causing neutropenia
chemo
clozapine
hydroxychloroquine
methotrexatee
quinines
sulfasalazine
carbimazole
infliximab
rituximab
55
lowe UTI sx
dysuria
suprapubic pain
frequency
urgency
incontinence
confusion
56
sx pyelonephritis
fever
loin/back pain
N+V
redued appetite
haematuria
renal angle tenderness
57
ix UTI
dipstick: nitrities=bacteria, leukocytes=infection/inflammation
MSU culture
58
causes UTI
e.coli
klebsiella pneumoniae
enterococcus
59
mx simple UTI
trimethoprim or nitrofurantoin
F=3d, F abnormal anatomy=5-10d, M or catheter=7d
60
mx UTI in pregnancy
7d nitrofurantoin (not in 3rd T) or cefalexin
61
mx pyelonephritis
7-10d cefalexin, co-amox, trimethoprim, ciprofloxacin
62
features cellulitis
warm
erythema
oedematous
bullaie
63
causes cellulitis
staph aureus
group A strep (pyogenes)
group C strep (dysgalactiae)
MRSA
64
features staph aureus cellulitis
gold crust
65
class cellulitis
1=no systemic activity
2=systemic toxicity or comborbidity
3= significant systemic toxicity or comborbidity
4=sepsis
66
mx cellulitis
admit for IV if class 3/4
abx: fluclox. 2nd line=clarithromycin or co-amox
67
cause tonsilliti
viral
group A strep (pyogenes)
68
centor criteria
bacterial tonsiliits:
fever>/= 38
tonsillar exudate
no cough
lymphadenopathy
69
mx tonsilitis
centor score >/= 3 = 10d penicillin V
70
features otitis media
bulging red tympanic membrane
71
cause otitis media
viral
strep pyogenes
strep pneuminoae
72
mx otitis media
3-7d without abx or amoxicillin
2nd line: clarithromycin, co-amox
73
mx sinusitis
none
after 10d: 2w steroid nasal spray
if likely bacteria then penicillin V or clarithromycin
74
commob causes intra abdo infecion
anaerobes: bacteroids, Clostridium
e.coli
klebsiella
enteroccocus
strep
75
mx intra abdo infection
abx
oral if mild +/- stat gentamicin
co-amox or amox + gent + metronidazole or ciprofloxacin +metronidazole
76
mx spontaneous bacterial peritonitis
piperacillin + tazobactam
levofloxacin + metronidazole
77
septic arthritis sx
often knee
hot
red
reduced ROM
fever
sepsis
78
cause septic arthritis
staph aureus
neisseria gonorrhoea
79
mx septic arthritis
aspiraye and culture/gram staine
abx: IV fluclox and rifampicin for 3-6w
80
what s influenza
RNA virus
81
types influenza
A, B and x
A and B most common
82
ix influenza
nasal/throat swab
83
mx influenza
none
if high risk: oral oseltamivir or inhaled zanamivir within 48h
84
common viral causes gastroenteritis
rotavirus
norovirus
adenovirus
85
features e.coli gastroenteritis
faeces, salads, water
e.coli157: shiga toxin->bloody diarrhoea and vom
86
features salmonella gastroenteritis
raw eggs and poultry
sx start 12h-3d after: water diarrhoea
87
features campylobacter jejuni gastroenteritis
travellers: poultry, water, milk
after 2-5d: bloody diarrhoea, vom
give azithromycin
88
features shigella gastroenteritis
faeces
bloody diarrhoea after 1-2d
89
features bacillus cerus gastroenteritis
rice
vom after 5h, watery diarrhoea after 8h, resolves after 24h
90
features yersina enterocolitica gastroenteritis
pork
after 4-7d: watery/bloody diarrhoea. lymphadenopathy
often children
can last 3w
adults=mesenteric lymphadenitis
91
features staph aureus toxin gastroenteritis
eggs, dairy, meat
D+V within hours, resolves 1d
92
features giardiasos
parasite
faeco-oral
chronic diarrhoea
give metronidazole
93
mx gastroenteritis
culture stool
rehydration
avoid work for 48h after sx resolve
94
complications gastroenteritis
lactose intolerance
IBS
reactive arthritis
GBS
95
what is TB
acid fast bacili
96
stain for acid fast bacili
zeihl nellson
goes red
97
where can TB spread
extra-pulmonary: lymph nodes (cold abscess)
pleura
CNS
GI
GU
bones
98
miliary TB
disseminated and severe
99
presentation TB
lethargy
fever/night sweat
decreased wt
cough +/- haemoptysis
lymohadenipathy
erythema nodosum
100
ix TB
mantoux test
interferon gamma release assay
CXR
cultures and NAAT - sputum, blood, lymoh node
101
mantoux test
result >5mm = TB vaccination, latent or active TB
102
interferon gamma release assay TB
confirms latent
103
CXR findings TB
primary: patchy consolidation, pleural effusion, hilar lymohadenopathy
secondary: patchy or nodular consolidation with cavitation
miliary=millet seeds
104
mx latent TB
isoniazid or rifampicin for 3m or isoniazid 6m
105
mx active TB
rifampicin and isoniazid 6m
pyrazinamide and ethambutol 3m
106
SE rifampicin
red urine and reduced effect other drugs
107
SE isoniazid
peripheral neuropathy
need pyridoxine (vit B6) alongside
108
SE pyrazinamide
increased uric acid
109
SE ethambutol
colour blind
reduced visual acuity
110
TB vaccination
BCG vaccine for those at risk
111
what is HIV
RNA retrovirus
types 1 and 2
destroys CD4 TH cells
112
HIV progression
flu like illness
asx
immunocompromised and AIDs
113
AIDS defining illnesses
kaposis sarcoma
pneumocystis
jirovecci
pneumonia
CMV
candidiasis
lymphomas
TB
114
testing for HIV
Ab
PCR p24 Ag
PCR HIV RNA
115
monitoring HIV
CD4 count <200=AIDS
viral load
116
mx HIV
ART e.g. HAART=protease inhibitor, integrase inhibitor, nucleoside reverse transcriptase inhibitor, non-nucleosude reverse transcriptase inhibitor, transcriptase inhibitor, entry inhibitor
prophylactic co-trimoxazole for PCP
monitor: CVD, cervical smears,
vaccines (no live): flue, pneumococcal, hep A+B, tetanus, diphtheria, polio
117
HIV post exposure prophylaxis
start within 72h for 3w
truvada + raltegravir
HIV test after 3m
118
malaria cause
plasmodia (protozoan parasites)
spread through bite of female anopheles mosquito
119
types plasmodium in malaria
plasmodium falciparum = most sev
plasmodium vivax
plasmodium ovale
plasmodium malariae
120
life cycle malaria
infected blood sucked up by anopehles ->reproduces in mosquito producing sporozites ->bites new person ->sporozites to persons liver
then either lay dormant (in P.vivax and P.ovale) or mature into merozoites->enter RBC->rupture_>haemolytic anaemia
121
sx malariea
incubation 1-4w
fever
rigot
malaise
myalgia
headache
vom
pallor due to anaemia
hepatospenlomegaly
jaundice
122
ix malaria
blood film on 3 consecutive days
123
mx malaria
uncomplicated: oral riamet/malarone/quinine sulphate/doxycycline
complicated=IV artesunate, quinine dihydrochloride
124
malaria prophylaxis
spray (DEET)
nets
malarone: progvanil, atovoquone
mefloquine
doxycycline
125
falciparum complications
cerebral malaria
seizure
LOC
AKI
pulmonary oedema
DIC
haemolytic anaemia
multiorgan failure
126
fever and been to nigeria
malaria
typhoid
dengue fever
127
fever and been to india
typhoid fever
dengue fever
chikungunya
128
fever and been to brazil
dengue fever
chinungunya
scrub typhus
129
swimming in lakes i africa
schistosomiasis
130
where is typhoid fever common
south asia (india, pakistan bangladesh)
southern and eastern africa
131
e.g. viral haemorrhagic fever
lassa
ebola
marburg
132
which abx to avoid in EBV and why
amoxicillin and ampicillin - cause widespread rash
133
what to avoid after EBV infection and why
contact sports for 4 w - complication EBV is splenomegaly which can rupture and haemorrhage
134
Mild pneumonia and mx
Curb 0/1
Amoxicillin PO
135
Sev pneumonia and mx
Curb 3-5
IV co amox + PO clarithromycin
136
Definition HAP
Been in hospital over 48h
Or been admitted in past 30d
137
First line ix IE
3 sets blood cultures at 30 mins apart with at least 10ml blood (high vol) before abx)
138
Cause IE IVDU
Staph aureus
139
Cause IE hx prostatitis
Enterococcus faecalis
140
Cause IE immunocompromised
Candida
141
Cause IE prosthetic valve (early)
Staph epidermidis
142
Cause IE poor oral dentition
Strep mutans
143
Mx suspected meningitis while waiting LP
Assume bacterial unless confused
Ceftriaxone and dexamethasone
Add amoxicillin IV if over 60y to cover listeria
144
?Meningitis and normal CSF
IT IS NOT MENINGITIS
stop any abx if started
145
Abx if UTI/pyelonephritis and unwell
Iv co amox
If old = IV Piperacillin and tazobactam
146
Why is nitrofurantoin not good for pyelonephritis
Is concentrated in the urine
147
how does rifampicin effect contraception
reduced effectiveness COCP
148
what needs prescribing with isoniazid
pyridoxine (vit b6) to reduce peripheral neuropathy
149
which TBV tx can cause uric acid stones
pyrazinamide - increaes uric acid causing kidney stones and gout
150
how to test for legionnaires disease
urine antigen testing
151
mx legionnaiers pnuemoniae
clarithromycin
152
how can legionnaires pneumoniae present
SIADH
hyponatraemia
