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FRACP Shuyu > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

Most common cause of bacterial cellulitis

A

Group A/C/G strep

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2
Q

Cause of nec fas

A

Group A strep, toxin mediated Clostridium perfringens Polymicrobial - e.g. fourniers gangrene

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3
Q

Role of clindamycin in necrotising fasciitis

A

stop protein synthesis and toxin production

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4
Q

Cellulitis infection associated with cat bites

A

Pasteurella multocida - resistant to fluclox and cephazol; sensitive to amoxil and 3rd generation ceflosplorins. Need plastics involvement due to deep wound

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5
Q

Cellulitis associated with fish/shellfish exposure

A

erysipelothrix - associated with endocarditis

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6
Q

Clinical distinguishing feature of erysipelas

A

Sharp border

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7
Q

incubation period for falciparum malaria

A

7-10 days (but can have delayed presentation; especially if there’s been prophylaxis)

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8
Q

Immunochromographic test

A

Paired with a thick and thin for detection of malaria antigen (best for falciparum)

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9
Q

Dengue incubation period

A

maximum 2 weeks

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10
Q

What test do you do in conjunction with TB PCR in diagnosis

A

genexpert testing for rifampicin resistance - rifampicin resistance would suggest multi-drug resistance TB

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11
Q

What diagnostic investigation for pleural TB

A

pleural biopsy

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12
Q

Strongylodiasis infection - how to acquire

A

Usually from walking barefoot in tropical regions

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13
Q

What happens to eosinophils in bacterial infections

A

Hypooesinophilia due to TH1 activation

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14
Q

What is streptococcus milleri associated with

A

Abscess formation

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15
Q

Treatment for giardia

A

Tinidazole (then metronidazole)

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16
Q

What kind of bacterial is salmonella typhi

A

gram negative bacillus

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17
Q

What is the rash pattern in measles and 5 ‘c’s

A

starts at neck and ears and spreads down the trunk cough coryzal koplik conjunctivitis crappy

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18
Q

NS1 antigen

A

part of the dengue virus

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19
Q

Dengue shock syndrome - suggestive feature on FBE

A

rise in haematocrit due to leaking capillaries

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20
Q

Most common cause of liver abscess in SE Asia

A

Klebsiella pneumoniae (hypervirulence strain in asia)

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21
Q

Melioidosis

A

Burkholderia pseudomallei (Northen Australia)

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22
Q

What do you need to do before giving tafenoquine

A

G6PD testing (for Malaria prophylaxis)

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23
Q

How does beta lactamases cause resistance and what organisms are they most commonly found

A

Enzymatic degradation Gram -ve> gram +ve

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24
Q

“non multi” MRSA vs “multi” MRSA

A

non multi is generally community acquired still sensitive to clindamycin, bactrim this is due to resistance genes being co-transmitted (e.g. through plasmids)

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25
Q

What gram negative rod has an intrinsic narrow spectrum beta-lactamases

A

Klebsiella (but wildtype should be susceptible to augmentin, ceftriaxone etc)

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26
Q

What gram negatives have chromosomal mediated (sometimes expressed) beta lactamases

A

ESCAPPM E: Enterobacter spp. S: Serratia spp. C: Citrobacter freundii. H: Hafnia spp. Cannot use 2rd gen cephalosporin for >48hr. The beta lactamase is inducible. The enzyme is called AmpC

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27
Q

What gram negatives have an intrinsic resistance to carbapenems

A

Stenotrophomonas But not very pathogenic

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28
Q

what is a common mutation for quinolone resistance?

A

fluoroquinolone gyrA mutation

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29
Q

Long term bug lines

A

gram positive, sticky gram negatives (pseudomonas), candida

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30
Q

Where does tigecycline distribute to

A

It is poorly protein bound so serum levels are low but can distribute well into tissues. Not good for bacteraemia.

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31
Q

What empirical therapy should be used in suspected CPE

A

Meropenem 2g TDS PLUS aminoglycoside (amikacin) OR colistin PLUS fosfomycin IV or tigecycline

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32
Q

What class of drug is colistin

A

polymixin

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33
Q

What bug implicated in severe mucositis

A

VRE/enterococcus

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34
Q

What enterococcus species is more likely to be resistant

A

Entercoccus faecium The other common enterococcus is faecalis

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35
Q

Linezolid side effects

A

myelosuppression peripheral neuropathy optic issues

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36
Q

Should beta lactams have peak concentrations or more time above MIC?

A

More time above MIC. Aim for >50% (but more is better). Beta lactams do better w more frequent dosing

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37
Q

Micro associated w ethmoid surgery

A

Pneumococcal

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38
Q

What antibotics can cause prolonged INR

A

erythromycin

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39
Q

What does bactrim do to the kidneys

A

inhibits tubular secretion of potassium and creatinine

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40
Q

What kind of HIV drug is ritonavir

A

Booster drug (often used w/ protease inhibitors)

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41
Q

What does ritonavir do to methadone

A

Decrease plasma methadone concentration

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42
Q

What is panton-valentine Leucocidin toxin most associated with

A

pyogenic skin infections community acquired MRSA

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43
Q

group D strep (strep gallolyticus/bovis) - what malignancy is it associated with

A

colon cancer

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44
Q

most common organism associated with IVDU IE

A

staph aureus

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45
Q

what heart disease does streptococcus pyogenes

A

rheumatic heart disease - M protein

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46
Q

What are HACEK organisms susceptible to

A

ceftriaxone

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47
Q

When is the best time to take blood cultures

A

before the febrile episode

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48
Q

What is the most common valvular lesion predisposing to infective endocarditis

A

mitral valve prolapse (but mitral stenosis in places w rheumatic fever)

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49
Q

what kind of valves should get antibiotic prophylaxis for dental procedures

A

prosthetic valves

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50
Q

what is the main risk factor for C. Diff infection

A

advancing age

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51
Q

c. diff binary toxin

A

very virulent c. diff toxin more likely to cause toxic megacolon

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52
Q

what causes a pandemic flu in influenzae A

A

Antigenic shift in H and N proteins of influenzae A

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53
Q

what is a neuraminidase

A

osteltamivir

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54
Q

wht is the greatest risk factor for severe respiratory disease asosicated with the 2009 H1N1 swine flu

A

BMI >35 second biggest is pregnancy

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55
Q

what haematological condition is mycoplasma pneumonia associated with

A

cold agglutinin haemolysis

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56
Q

what is the most treatment option most likely to improve chronic fatigue

A

material explaining chronic fatigue supervised graded exercise program is next

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57
Q

prevention of rheumatic fever recurrence in young patients with rheumatic heart disease

A

secondary prophylaxis with benzathine penicillin G 3 weekly

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58
Q

the most common cause of viral meningitis

A

enterovirus

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59
Q

what is the most common cause of recurrent meningitis

A

HSV2

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60
Q

the most common cause of viral meningitis

A

enterovirus

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61
Q

what is the most common cause of recurrent meningitis

A

HSV2

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62
Q

What opportunistic infections are likely to occur in a HIV patient with CD4 200-500

A

Herpes zoster, pneumococcal pneumonia, oral candidiasis, tuberculosis

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63
Q

What and when should primary prophylaxis be initiated in HIV

A

CD4 <200 PJP and CNS toxoplasmosis - cotrimoxazole

CD4 <50 MAC - azithromycin

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64
Q

When to start ART in the symptomatic HIV patient or CD4 <200 (OI, TB)

A
  1. Investigate and commence treatment for OI
  2. Commence ART 2-4 weeks later (or earlier)
  3. TB and CD4 >50 - do not start ART until 4-8 weeks of TB treatment
  4. TB and CD <50 - initiate ART at 2-4 weeks
  5. If cryptococcal meningitis or other neurological OP - unclear evidence
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65
Q

Steps in HIV viral life cycle

A
66
Q

Adverse effects of tenofovir

A

Renal fx; Osteopenia

67
Q

MOA of tenofovir

A

nucleotide analogue

68
Q

what is the renal function cut off in tenofovir

A

CrCl <30 mL/min

69
Q

What HIV medications are used as boosters?

A

Ritonavir (PI) and colbistat (CYP3A4 inhibitor)

70
Q

What HIV ARTs cause dyslipidaemia?

A

Protease inhibitors

Atazanavir (ATZ)

Darunavir (DRV)

Lopinavir/ritonavir (LPV/rtv)

71
Q

Recommended initial regimens for most people with HIV (2)

A

BIC/TAF/FTC - two NRTIs and an INSTI (Bictegravir, tenofivir, Emtricitabine)

DTG/ABC/3TC (if HLA-B*5701 negative) - abacavir (ABC)/lamivudine (3TC)/dolutegravir

72
Q

What HIV mediations are metabolised by CYP4503A4

A

Protease inhibitors (inhibits P450 3A4) and NNRTI (induces CYP P4504A4)

73
Q

What is virologic failure in HIV?

A

Inability to maintain suppression of viral replication (to an HIV RNA level <200 copies/mL)

74
Q

When should testing for drug resistane be done in HIV patients

A

All at baseline and for all pregnant women

At virologic failure

75
Q

what HIV ARTs leads to lipoatrophy

A

stavudine or zidovudine (Old NRTIs)

76
Q

what HIV ARTs cause visceral fat accumulation and buffalo hump ?

A

Protease inhibitor use

77
Q

PBS listed PrEP

A

Tenofovir + emtricitabine (TDF + FTC)

78
Q

What respiratory OI is a HIV patient at risk of if CD4 <50

A

MAC, CMV pneumonitis (and all the other stuff at higher CD4 counts)

79
Q

Typical PJP CXR findings

A

diffuse bilateral, symmetrical interstitial infiltrates

CT - diffuse groundglass changes

80
Q

Cryptococcis treatment

A

liposomal amphotericin B 3 mg/kg IV daily + flucytosine 25 mg/kg QID (flucytosine rarely tolerated, levels must be monitored) – 2-3 weeks

Need repeat LP to check clearance

81
Q

What is the most common cause of death in AIDS patients worldwide

A

TB

82
Q

Treatment of disseminated MAC

A

Clarithromycin + ethambutol

83
Q

CMV in HIV most common clinical manifestation of CMV end organ disease

A

retinitis

84
Q

Kaposi sarcoma viral aetiology

A

HHV 8

85
Q

Which HIV strain is more predominent

A

HIV 1 by far

86
Q

Differences between HIV 1 and 2

  1. Distribution
  2. Viral load
  3. CD4+ counts in undetectable viral load
  4. Coreceptor use
  5. Ineffective HRT
A
87
Q

What is the MOA of maraviroc?

A

inhibits CCR5 binding (entry)

88
Q

What is the MOA of enfuviritide

A

HIV drug - inhibits fusion of the HIV onto the host cell

89
Q

MOA of abacavir

A

NRTI

90
Q

MOA of lamivudine

A

NRTI

91
Q

MOA of emtricitabine

A

NRTI

92
Q

MOA of zidovudine

A

NRTI

93
Q

MOA of raltegravir

A

Integrase inhibitor

94
Q

MOA dolutegravir

A

InSTIs

95
Q

HIV entry co-receptors

A

CCR5 co-receptor; CXCR4 co-receptor]

CCR5 is present on many types of cells

96
Q

What is immune activation associated with in HIV

A

Increased mortality and morbidity

Increased atherosclerosis

Poor CD4 recovery

97
Q

What mutation is assocaited with HIV protection

A

Delta32 mutation in CCR5

98
Q

What is control of MTB dependent on?

A

T-cell immunity, IFNgamma, TNFalpha

99
Q

What is the second most common manifestation of active TB?

A

Tuberculosis lymphadenitiis

100
Q

Treatment of TB meningitis

A

isoniazid (H), rifampicin (R), pyrazinamide (Z) + moxifloxacin

101
Q

Standard course therapy for TB

A

RIPE for 2 months

RI for 4 months

102
Q

What component of the RIPE therapy is best at killing rapidly multiplying bacteria

A

isoniazid

103
Q

What TB medication is most likely to cause hepatitis

A

pyrazinamide

104
Q

what TB drug is most likely to cause neuropathy

A

isoniazid

105
Q

What TB drug is associated with optic neuropathy?

A

Ethambutol

106
Q

Management of TB therapy induced hepatitis

A

If 2-5x normal, asymptomatic, monitor closely

If >5x normal, or >3x and symptoms, cease

107
Q

What is the most common non-drug resistance in TB?

A

Isonaizid

108
Q

rifampicin and CYP3A4

A

induces CYP3A4

109
Q

What is contraindicated with rifamycin?

A

tenofivir alafenamide (tenofivir disproxil fumarate ok)

bictegraivir

elvitegravir

protease inhibitors are contraindicated with rifampicin but can be taken with a dose reduced rifabutin

110
Q

What is the MOA of echinocandins and what are examples of them

A

Cell wall beta (1, 3) - glucan synthesis inhibitors

e.g. Caspofungin, anidulafungin, micafungin

111
Q

What is the MOA of triazoles? (and examples)

A

endoplasmic reticulum ergosterol biosynthesis inhibitors:

  • Inhibits C-14alpha demethylase required for ergosterol synthesis
    e. g. fluconazole, itraconazole, voriconazole, posaconazole, ravuconazole
112
Q

What is the MOA of amphotericine

A

plasmalemma ergosterol plasma membrane integrity

113
Q

pharmacokinetics of conventional amphotericin B

A

Unknown - not affected by the hepatic or renal system and haemodialysis does not alter blood concentrations

BUT can cause nephrotoxocity

114
Q

What is the clinical use of conventional amphotericin B

A

Not widely available in Australia:

  • Selected cases of invasive candidiasis
  • Cryptococcal meningitis (now L-AMB is first line)
  • Empiric therapy in selected cases

Pros: broad spectrum of activity and resistance is slow to develop

Cons: drug toxicities limit efficacy/response

115
Q

What is the general preferred polyene (antifungal)

A

Liposomal amphotericin B (compared with conventional amphotericin B):

  • Less nephrotoxic
  • Less infusion related side effects
  • Similar efficacy
116
Q

What is the indication for inhaled amphotericin B?

A
  1. Prophylaxis in lung transplant patients
  2. Occasionally in the haematology population if oral antifungals are contra-indicated and cannot have IV ampotericin B
117
Q

Which anti-fungal has increased affinity for aspergillus?

A

Voriconazole - because it has the addition of a methyl group to propyl backbond of fluconazole and the substitution of a triazole moiety with a fluoropyrimidine group.

This results in an increased afinity for the 14-alpha-sterol demethylase enzyme in Aspergillus

118
Q

Voriconazole toxicities

A

Elevation of LFTs

Photosensitive rash

Transient dose related visual disturbance in 8-10%

119
Q

1st line therapy for definite or probably invasive aspergillosis

A

1st line - Voriconazole IV

2nd line - LAB

120
Q

Initial therapy for candidaemia

  1. Candida albicans
  2. Other candida species
  3. Critically ill candidaemia
A
  1. fluconazole
  2. anidulafungin
  3. anidulafungin
121
Q

subacute endocarditis most common organisms

A

viridans streptococci (17% of all IE)

Enterococcus faecalis (11 of all IE)

122
Q

IVDU with pneumonia differential

A

infective endocarditis

(75% of R) IE have pneumonia/infective pulmnonary emboli)

123
Q

what is a key cause of culture negative infective endocarditis and what is the next investigation to do?

A

Q fever - serology

others: bartonella, tropheryma whipplei, psittacosis, brucellosis

124
Q

Viridans strep subacute endocarditis treatment

A

2 weeks IV penicillin + 2 weeks IV gentamicin or 4 weeks IV penicillin

Use vanc if MIC >2mg/L

125
Q

Treatment of enterococcal infective endocarditis

A

4-6 weeks of IV penicillin or amoxil/amp + gent

126
Q

Treatment of staph IE

A

MSSA: 4-6 weeks of IV fluclox/1st gen cephalosporin

MRSA: Vanc 4-6 weeks

127
Q

Uncomplicated tricuspid valve endocarditis treatment

A

2 weeks IV fluclox + gent

4 weeks if complicated (e.g. lung lesions, prosthesis, L side involvement)

128
Q

Treatment of culture negative endocarditis

A

ceftriaxone 3-4 weeks + gentamicin 2 weeks

129
Q

Indications for surgery in infective endocarditis

A
  1. Heart failure
  2. Paravalvular exdension
  3. Uncontrolled infection/difficult organism (persistent bacteraenia >10 days despite appropriate antibiotics; fungal/brucella/pseudomonas)
  4. Recurrent embolic events despite appropriate antibiotics
130
Q

Mean time to PJP after transplant

A

~20 weeks

131
Q

Incubation period typhoid fever

A

up to 21 days

132
Q

First line uncomplicated malasia

A

artemether-lumefantrine (po)

send line atovaquone-proguanil

133
Q

adverse effects of artesunate

A

cerebellar ataxia, abdo pain/diarrhoea, increased ALT, delayed haemolysis

134
Q

SE quinine

A

hypoglycaemia, hearing loss, increased QT, diarrhoea

135
Q

Severe malaria treatment

A

IV artesunate

136
Q

mutation assocaited with artesunate resistance

A

single point mutation in propellar region of P falciparum kelch protein on chromosome 13

137
Q

Treatment for travellers’ diarrhoea

A

mild diarrhoea - symptom management alone

blood, mucus, unwell, profuse diarrhoea then use antibiotics:

  • azithromycin 1g stat or 500mg daily for 2 days
  • Cipro 500mg bd for 2 days
138
Q

Treatment of giardia lamblia

A

tinidazole 2g orally stat

139
Q

zika and timing of conception/pregnancy

A

3 months for men, 8 weeks for women

140
Q

what fetal deformity does zika cause and which trimester is associated with the highest risk?

A

microcephaly, trimester 1

141
Q

4 criteria for dengue haemorrhagic fever

A

fever/recent history of acute fever

haemorrhagic anifestations

low platelet count <100

objective evidence of leaky capillaries

142
Q

What classes of drug inhibit the 30S ribosomal sub-unit?

A

aminoglycosides and tetracyclines

143
Q

What is the mechanism of resistance for MSSA

A

alteration to the penicillin binding site

144
Q

second gen cephalosporins examples and coverage

A

cefoxitin, cefotetan, cefuroxime

gram +ve, enterbacter, klebsiella, H. influenzae

145
Q

what aminoglycoside is the worst for hearing?

A

amikacin

146
Q

what antibiotic causes orange-pink discolouration of the urine?

A

rifamycins

147
Q

what antibiotic can cause irreversibe aplastic anaemia with toxicity

A

chloramphenicol

148
Q

MOA of linezolid

A

23S ribosomal RNA of the 50S subunit of the bacterial ribosome and prevents the formation of a functional 70S initiation complex which is an essential component of the bacterial translation process

149
Q

MOA daptomycin

A

binds to bacterial membranes and causes a rapid depolarisation of membrane potential in both growing and stationary phase cells. This loss of membrane potential causes inhibition of protein, DNA and RNA synthesis. This results in bacterial cell death with negligible cell lysis

150
Q

what are enterococci intrinsicly resistant to?

A

cephalosplorins

151
Q

what’s the difference in cover for meropenem vs ertapenem

A

ertapenem has no pseudomonal cover

152
Q

how are beta lactams excreted

A

renally excreted (except ceftriaxone)

153
Q

what kind of VRE can teicoplanin treat

A

van B

154
Q

what site of infection should daptomycin not be used?

A

lung - due to surfactant

155
Q

linezolid SE

A

marrow suppression

peripheral neuropathy

dose and duration dependent - so try to keep duration <2 weeks and monitor for SE

156
Q

clinda spectrum of activity

A

gram positives and anaerobes

157
Q

difference in spectrum of activity between ciprofloxacin and moxifloxacin

A

cipro has pseudomonas

moxi has strep and anaerobes

158
Q

what broad spectrum antibiotic has poor protein carriage and what are the clinical indications

A

tigecyclines - not good for bacteraemias

159
Q

what gram positive directed antibiotic is effective at managing biofilms and what are the clinical indications

A

rifampicin - good for prosthetic joints

160
Q
A

FRACP Shuyu (65 decks)

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