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Finals > Infectious diseases and micro > Flashcards

Infectious diseases and micro Flashcards

1
Q

Bacterial causes of pneumonia

A
  • Strep pneumonia
  • H. influenza
  • Staph aureus

Atypicals:

  • Legionella (stagnant warm water)
  • Mycoplasma pneumoniae
  • Chlamydia pneumonia
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2
Q

fungal causes of penumpnia

A
  • histoplasmosis
  • cryptococcus
  • pneumocystis jiroveci (pneumocystis pneumnoia)
  • aspergillosis
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3
Q

viral causes of pneumonia

A
  • influenza
  • SARS
  • RSV
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4
Q

signs of pneumonia O/E

A
  • dull percussion
  • increased tactile vocal fremitus
  • bronchial breath sounds
  • late inspiratory crackles
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5
Q

what is the CURB65

A

pneumonia mortality risk

  • Confusion (abbreviated mental test <=8 or new
  • Urea >7mmol/L
  • Raised RR >=30
  • BP <90 S or <60 D
  • Age >=65

1 point- OP tx
2 points- IP tx or OP with close f/u
>3 points- IP tx with ITU admission

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6
Q

ix pneumonia

A 
- CRP
!!!!- procalcitonin
- sputum culture/lavage
- bloods culture
- CXR- veil like opacity, +-lobar
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7
Q

Tx peumonia

A

CAP

  • low severity- PO amoxicillin, doxy, clarithro, erythro
  • severe- PO or IV- coamox with clarithro if atypical or PO erythro

HAP

  • coamox PO or doxy, cefalexin
  • severe- IV Taz
  • add vanc/teic/linezolid if ?MRSA
  • pain meds
  • CPAP
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8
Q

what organism causes epiglottitis

A
  • Haemophilus influenza B
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9
Q

tx epiglottitis

A
  • keep child calm, do not lie them down
  • intubate under GA, THEN take bloods, cultures
  • rigid laryngoscopy
  • IV cefotaxime, chloramphenicol if allergy hx
  • rifampicin to household
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10
Q

what organism tends to cause respiratory infections in CF patients

A
  • peusdomonas aeruginosa (adults)
  • S aureus (most common in children)
  • HiB
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11
Q

what organisms most commonly cause flu

A
  • influenza A, B, C
  • A and B= seasonal flu
  • A- pandemics
  • C- mild illness, no vaccine
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12
Q

drug tx flu

A

antiviral eg oseltamivir PO or canamivir inhaled if any of the following apply:

  • -> national surveillance indicated flu is circulating
  • -> person is in ‘at risk’ group
  • -> person can start tx within 48hours of sx onset (off-label use outside of this duration, use clinical judgement)
  • -> person is not in at risk group but felt they may develop complications
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13
Q

what is considered an ‘at risk’ group of flu

A
  • splenic dysfunction
  • sickle cell
  • coeliac
  • chronic resp disease
  • chronic heart, liver or kidney disease
  • neuro disease
  • diabetes
  • immunosupression (HIV, CT)
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14
Q

advice to give someone with flu

A
  • oral fluids
  • paracetemol, NSAID
  • bed rest
  • fever, GI sx should start to resolve within 1w
  • fatigue, cough may last longer (2w)
  • safety net for hospital- confusion, no urine, persistent D+V, SOB, pleuritic chest pain, cough up blood
  • arrange f/u if no improvement in 1w
  • lower threshold for admission/visit to hosp if child/baby
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15
Q

causes of UTI/pyelonephritis

A 
- E.coli (most)
!!!- staph saprophyticus (young women)
- proteus
- Kelbsiella
- enterococcus faecalis
!!- yeast
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16
Q

what organisms cause UTI with catheter

A
  • E.coli
  • candida
  • pseudomonas
  • enterococcus
  • staph aureus
  • coag -ve staph (S.epidermis, S capitis, S.haemolyticus
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17
Q

causes of UTIs in children

A
  • E.coli
  • proteus (more common in boys)
  • pseudomonas (indicates structural abnormality
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18
Q

abx to tx UTIs

A
  • non pregnant women, men, children
    1. nitrofurantoin, trimethoprim
    2. amox, or if a man, consider prostatis/pyelonephritis if no improvement witin 48hours of 1st line
  • pregnant women
    1. nitro
    2. amox, cefalexin
  • asx- amox, cefalexin, nitro
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19
Q

tx recurrent UTIs

A

one dose after trigger/post coital, or once nightly

  1. nitro, or trimeth
  2. amox or cefalexin
    - review every 6months
    - suggest vaginal oestrogen in post meno women
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20
Q

tx UTIs with catheter

A

nitro/trimeth
if with upper UTI- cefalexin
IV- ceftriaxone, amikacin

Pregnant
1- cefalexin
IV cefuroxime

Children
1. cefalexin
IV- ceftriaxone, amikacin

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21
Q

tx pyelonephritis

A

Adults and children:
PO- cefalexin
IV- amikacin, ceftriaxone

pregnant-
cefalexine PO,
IV cefuroxime

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22
Q

sx acute prostatitis

A
  • UTI- LUTS
  • weak stream
  • acute retention
  • lower back pain
  • perineal, penile or rectal pain
  • pain on ejaculation
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23
Q

sx chronic prostatitis

A
  • complication of acute
  • at least 3m of urogenital pain
  • with LUTS
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24
Q

ix ?prostatitis

A
  • MSU (shows UTI)
  • blood cultutres, FBC
  • abdo examination- distended bladder, costovertebral angle tenderness
  • DRE- GENTLY– do not massage or collect secretions for culture as you risk causing sepsis. Will feel warm, large and boggy
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25
Q

management of prostatits

A

ABX

  • PO cipro, levofloxacin
  • IV amikacin, ceftriaxone

PAIN
- paracetemol +- low ose weak opioid, NSAID

ADVICE

  • fluids
  • usual course= several weeks
  • safety net- worsening sx, sx dont improve within 48hour of starting abx, very feverish, confusion

ADMIT

  • admit if severe, sepsis/retention/abscess sx, no improvement within 48hours of abx
  • urgent referral if immunocomprimised, pre-existing urological conditions eg BPH, indwelling catheter, STI is identified

F/U

  • arrange f/u in 48hours to check on progress, review abx with culture results
  • reveiw abx after 14d- to continue?
  • refer to r/o structural abnormalities of the UT
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26
Q

management of sepsis

A

BUFALO 6

Inform seniors/get help

  • ask someone to catheterise
  • O2
  • IV access- chultures, X match, clotting, FBC, UE, LFT, VBG
  • fluids- 500ml bolus NaCl 0.9%
  • IV abx
  • UO- make sure it’s completed
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27
Q

abx used in sepsis

A

depends to local protocols, but generally:

ADULTS
Community acquired:
- Tazocin (allergy-cefuroxime)
- add vanc or teic or 2-linezolid if ?MRSA
- anaerobic- add metro to broad spec cephalo eg cefuroxime
- if resisatnt- meropenem

CHILDREN( 1m-18yrs)- 
comm acquired
- aminoglycoside (gent, amikacin, streptomycin) plus amox/ampicillin 
- or 
 cefotaxime/ceftriaxone alone

ALL PEEPS:
Hospital acquired
- IV taz or meropenem
- add vanc or teic or 2. linezolid if ?MRSA- anaerobic- add metro to broad spec cephalo eg cefuroxime

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28
Q

tx sepsis ?related to vasc catheter

A

vanc or teic

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29
Q

tx meningococcal sepsis

A
  • benzylpen or cefotaxime for 7d
  • chloramphenicol in pen allergy

Meningitis:
3m-50years
- cefotaxime or chloramphenicol or ceftriaxone 2-4g IV
- note- dont give ceftriaxone in <3m as may lead to hyperbilirubinaemia and risks Kernicterus
- add amox IV if >50y/<3m to cover for listeria
- dexamethasone
- IV aciclovir if ?viral

Contacts:
- ciprofloxacin, (rifampicin or ceftriaxone)

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30
Q

what counts as low urine output

A

1ml/kg/hour is normal
<0.5ml/kg/hour is low

anuria is <100mls in 24hours

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31
Q

Management of pt with low UO

A

A-E

  • high flow O2
  • bloods- FBC, UE, clotting, gas
  • BP
  • fluid challende- 250-500ml boluses
  • aim for S >100mmHg
  • anuric- consider obstruction (post-renal)– check catheter, bladder washout using 50mls normal saline
  • check drug chart- no renal damaging drugs (ACEI, NSAIDs, abx)
  • AKI–> furosemide
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32
Q

definition and sx of AKI

A
  • oliguria <0.5mls/kg/hour for >6 hours or anuria
  • rise in Cr >26micromol/L in 48hours/50% rise in 7 days
  • JVP raised
  • chest auscultation- basal crackles
  • ankle oedema
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33
Q

what organism causes meningococcal sepsis, histological appearance

A
  • Neisseria meningitidis
  • gram negative (pink)
  • diplocccus
  • intracellular
  • coffee bean shaped
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34
Q

histological appearance of strep pneumonia

A
  • lancet shaped
  • (diplo)cocci
  • gram positive (purple)
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35
Q

histological appearance of E.coli

A
  • rod shaped/bacilli
  • anaerobe
  • gram negative (pink)
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36
Q

what is trichomonas vaginalis

A
  • spread through sexual contact
  • protozoan , single cells
  • flagella
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37
Q

sx trichomonas vaginalis

A
  • 50% no sx
  • frothy, yellow/green discharge
  • fishy odour
  • itching
  • dysuria
  • dyspareunia
  • balanitis
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38
Q

signs trichomonas vaginalis

A
  • strawberry cervic (colpitis macularis

- vaginal Ph raised (>4.5)

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39
Q

ix ?trich

A
  • F- charcoal swab with microscopy (posterior fornix or self taken)
  • M- urethral swab or first catch urine
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40
Q

tx trich

A
  • GUM referral

- metronidazole

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41
Q

what is a tapeworm, where is it caught from

A
  • cestoda class worm
  • long worm
  • raw/undercooked meat, contaminated water
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42
Q

life cycle of a tape worm

A
  • eggs passed in faces from host
  • ingested by intermediate host
  • hatch
  • larvae enter tissues of internmediate host
  • encyst
  • cysts ingested by human host
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43
Q

sx tapeworm

A
  • mostly no sx
  • passage of worm (proglottids)
    !!!!- itching
  • vague GI sx- abdo pain, cramps, D+N, wt loss, malaise
    !!!!!- worm absorbs lots of B12- pernicious anaemia (paraesthesia, balance, confusion
  • hydatid cyst- liver, lungs
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44
Q

sx hydatid cyst in liver

A
  • epigastric pain
  • dyspepsia
  • obstructive jaundice, pruritis (obstructs bile duct)
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45
Q

tx tapeworm

A
  • praziquantel
  • niclosamide
  • neuro sx- albendazole
  • cyst aspiration
  • surgery
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46
Q

what is pinworm

A
  • small slender worms with pointed tail
  • reside in caecum, appendix, ascending colon
  • enterobius vermicularia
  • primarily paediatric
  • transmitted via contact- bedblothes, bedding, towels, toilets, doorknobs, sex
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47
Q

sx pinworm

A
  • asx
  • intense itching, prickling pain in anal area/vaginal
  • worse at night
  • abdo discomfort, loss of appetite rarely
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48
Q

ix pinworm

A
  • glass slide microscopy by dabbing stretched anal folds with cellophane tape in the early morning :)
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49
Q

tx pinworm

A
  • mebendazole, albendazole- 2 doses 2w apart
  • tx household and class at same time
  • wash sheets, clothing
  • strict handwashing and cleaning after appt
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50
Q

what is schistosomiasis (bilharzia)

A
  • parasitic worm

- contact with fresh water and snails–> transmission

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51
Q

sx schistosomiasis

A

Acute:

  • maculopapular lesions
  • itchy
  • diarrhoea, cough
  • abdo pain
  • malaise, arthralgia

Chronic:

  • bowel wall egg deposition- blood diarrhoea, cramping, perf, appednicitis
  • portal tracts- splenomegaly, ascites
  • UT- haematuria, dysuria, sq cell carcinoma
  • CNS sx
  • postcoital bleeding, ulceration, irreg menstruation
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52
Q

ix ?schistosomiasis

A
  • microscopic examination for ova in stool/urine samples

- antiodies/antigens in blood or urine

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53
Q

tx schistosomiasis

A
  • corticosteroids

- praziquantel

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54
Q

what is legionnaries disease

A

severe form of penumonia caused by legionella pneumophila

  • found in warm stagnant water and fresh water
  • cannot spread person to person
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55
Q

sx legionnaires disease

A

cough is dry
pneumonia sx plus systemic infective sx:

headaches, muscle pain, chills
fever
fatigue
cough, dyspnoea, chest pain 
N+V, diarrhoea
chest pain
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56
Q

tx legionnaries disease

A
  • notifiable disease
  • fluroquinolones- levofloxacine, cipro
  • macrolides- azithromycin, clarithro, erythro
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57
Q

microscopic appearance of legionela

A

gram negative (pink)
rod/bacillus
aerobic
non spore forming

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58
Q

what causes mumps

A
  • paramyxovirus

- RNA virus of the rubulavirus family

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59
Q

complications of mumps

A
  • **- pancreatitis (abdo pain)
  • orchitis and redcued fertility
  • meningitis, encephalitis
  • **- sensorineural hearing loss
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60
Q

ix for ?mumps

A
  • PCR testing of saliva swab

- blood/saliva antibody testing

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61
Q

transmission of mumps

A
  • droplets of saliva

- kissing, sneezing, coughing

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62
Q

what causes pertussis

A

ie whopping cough

- bordetella pertussis- gram negative

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63
Q

ix for pertussis

A
  • nasopharyngeal or nasal swab —> PCR or bacterial culture

- if cough present >2w- antipertussis toxin immunoglobulin G (oral fluid or blood)

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64
Q

management of pertussis

A
  • notify UKHSA
  • supportive
  • avoid contact with vulnerable people
  • macrolides– azithromycin, ertyrho, clarithro
  • co-trimoxazole
  • should resolve within 2m
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65
Q

what causes yellow fever

A
  • virus in genus flavivirus
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66
Q

locations where yellow fever is high

A

South america, sub-saharan africa

  • nigeria
  • brazil
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67
Q

vector of yellow fever

A

mosquito

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68
Q

sx yellow fever

A
  • fevere, photophobia, headaches

Acute phase
- vomiting, fever
!!!- headache, rigors, myalgia
- anorexia

toxic phase- occurs in next few days in 15% or people, half of whom die from shock
- fever
!!!- jaundice
- haemorrhage (mouth, eyes, stomach)
!!!- DIC
!!!- renal function deterioration (prerenal or gomerulonephritis and intersitial nephritis)–> oedema
- hypothermia

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69
Q

what is haemolytic uraemic syndrome

A
  • due to E.coli shiga toxins, also produced by shigella
  • antimotility meds eg loperamide during infection of these pathogens increases the risk
  • thrombosis within small BVs
  • platelets consumption
  • thrombotic microangiopathy
  • high bleed risk
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70
Q

sx HUS

A
  • haemolytic anaemia
  • thrombocytopania
  • AKI

AKI

  • reduced UO
  • haematuria, dark brown
  • lethargy, confusion
  • vomiting
  • oedema
  • HTN

THROMBO

  • bloody diarrhoea
  • abdo pain
  • bruising
  • fever, rigors, headache
  • note: jaundice is rare
  • often children <5yo
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71
Q

ix ?HUS

A
  • FBC, clotting, LFTs, UE
  • peripheral blood smear show signs of RBC injury/haemolysis- schistocytes, RBC fragments
  • stool culture- shiga toxin
  • urinalysis
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72
Q

tx of HUS

A
  • supportive
  • dialysis
  • anti HTN
  • fluid balance
  • blood
  • renal transplant
  • avoid abx, antimotility agents, NSAIDs
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73
Q

name some aminoglycosides

A

gentamicin

streptomycin

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74
Q

name some cephalosporins

A

‘cef-‘

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75
Q

name some penicillins

A

‘-cillin’

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76
Q

name some tetracyclines

A

-cycline

tetracycline
doxycycline

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77
Q

name come (fluoro)quinolones

A

-floxacin

ciprofloxacin
levofloxacin
ofloxacin

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78
Q

name some macrolides

A
  • mycin

erythromycin
clarithromycin
azithro

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79
Q

name some sulphonamides

A

sulfalazine
sulphmethoxazole
sulfadiazine

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80
Q

names some glycopeptides

A

vancomycin

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81
Q

what is augmentin

A

co-amoxicillin

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82
Q

what are some important things to consider when px aminoglycosides

A

gent, streptomycin
!!!!- must be taken IV
!!!!!- usage should not exceed 7 days where possible
- nephrotoxic
- weight dosed and monitored using normogram

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83
Q

SE of aminoglycosides

A
  • ototoxicity
  • aphonia
  • GI upset
  • nephrotoxicity
  • skin reactions
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84
Q

what are some things to consider when using carbapenems

A

eg meropenem

  • beta lactam ring in structure- be careful in those with penicillin allergy
  • imipenem is broken down by enzyme in the kidney, so is given with cilastatin (enzyme inhibitor), to block this renal metab
  • v broad spec- often used in sepsis and severe/resistant infections
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85
Q

SE carbapenems

A
  • GI
  • *- skin reactions
  • *- seizure inducing (rare)
  • pancytopenia
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86
Q

things to consider when givign cephalosporins

A
  • do NOT give in pen allergic patients
  • **- accumulate in renal impairment as are excrete renally
  • may cause c.diff
  • ***- may cause false positives on coombs test
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87
Q

things to consider when giving glycopeptides

A
  • used in MRSA clearance
  • vanc should not be given PO as will not be absorbed (give IV)
  • vanc needs plasma conc monitoring
  • dont infuse too quickly
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88
Q

glycopeptide SEs

A
  • otoxicity
  • nephrotoxicity
  • skin reactions
  • red man syndrome if given too quickly
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89
Q

things to consider when giving macrolides

A
  • similar spectrum to penicillins- good alterative in pen allergic pts
  • erythro safest in pregnancy
  • clarithro+statin interaction
  • clarithro- increase digoxin tox risk
  • dose adjust in renal impairment
90
Q

SE of macrolides

A
  • QT prolongation
  • **- worsening of MG
  • GI
  • **- hearing impairment
  • skin reactions
91
Q

things to consider when giving penicillins

A
  • some may be inactivated by beta-lactamases (fluclox isnt)
  • allergy
  • co-amox is amox with clavulanic acid which is a lactamse inhibitor
92
Q

SE penicillines

A
  • hypersensitivity
  • GI
  • abx- related colitis
  • ## amoxicillin- skin reaction in EBV (and CMV, CLL)
93
Q

SE and CI or fluoroquinolones

A 
Cipro, levo
- GI
- skin
!!!!- seizures
- tendon damage/rupture! increased risk if also on steroids
!!!- heart valve regurg
!!!- photosensitivity
- QT prolongation

CI

  • QT prolongation
  • tendon disease hx with quinolones
  • epilepsy/seizure disorders
  • reduced dose in renal impairment
94
Q

things to consider when givign tetracyclines

A
  • NOT in pregnancy

- broad spec

95
Q

SE tetracyclines

A
  • worsen SLE
  • worsen MG
  • GI
  • skin reactions
  • photosensitivity
96
Q

causes of neutropenic sepsis

A

Gut microorgs:

  • e/coli
  • klebsiella
  • pseudomonas
97
Q

pts t risk of neutropenic sepsis

A

5-10d post chemo
can occur months afterwards
immunosup therapy

98
Q

tx neutropenic sepsis

A
  • 1st- IV tazocin (+gent)
  • 2- ceftazidime
  • 3- meropenem
  • paracetemol
  • fluids
99
Q

tx skin infections

A

mild- fluclox (clarithro/doxy/erythro if allergic)

mod/severe

  • fluclox +- gent +- metronidazole IV
  • pen allergy- co-trimoxazole +- gent +- metronidazole IV
  • if pseudomonas- IV tazocin + cipro
  • if MRSA- add vanc/teic or 2. linezolid IV
100
Q

tx impetigo

A

Localised non bullous, well:
1- hydrogen peroxide 1% cream
2- TOP fusidic acid

Widespread non bullous/bullous/unwell
1- PO fluclox (pen allergy- clarithro/erythro)

101
Q

tx cellulitis/erysipelas

A

PO/IV

  • fluclox
  • allergy- clarithro/erythro/doxy

near eyes/nose- PO/IV

  • co-amox
  • allergy- clarithro + metronidazole

severe- PO/IV

  • co-amox
  • Add IV vanc if ?MRSA
102
Q

tx secondary infeciton of eczema

A
  • TOP fusidic acid

- PO fluclox (clarithro/erythro)

103
Q

tx of osteomyelitis/septic arthritis

A
  • fluclox, (+-fusidic acid/rifampicin for oesteomyelitis)
  • clindamycin (+- as above)
  • MRSA- + vanc/teic
  • septic arthritis– flucloxacillin, clindamycin if allergic.. if ?gonococcal/gram -ve– cefotaxime/ceftriaxone
104
Q

tx eye infections (and micro cause)

A
  • often causesd by staph aureus, strep pneumonia, h influenzae
    1. chloramphenicol

trachoma- azithromycin PO

105
Q

micro cause of otitis externa

A

staph aureus

P.aeruginosa

106
Q

structure and stain of s aureus

A

gram positive (purple)
cocci
spherical

107
Q

tx otitis externa

A
  • fluclox
  • clarithro/azithro/erythro if allergic/preg
  • if pseudomonas- cipro or aminoglycoside (eg gent)
108
Q

micro causes of otitis media

A

H influenzae, strep pneumonia, strep pyogenes

can be viral (RSV, rhinovirus, adeno, influenzae, parainfl.)

109
Q

tx otitis media

A
  1. amoxicillin (clarithro/erythro)

2. co-amox– worsening sx despite 2-3d of 1st line

110
Q

tx sinusitis

A
  1. phenoxymethylpenicilline
  2. co-amox

severe/hgih risk
1. co-amox

pen allergy- doxy, clarithro, erythro

111
Q

sore throat/tonsillitis tx

A

Fever PAIN score
strep
- penicillin V (phenoxymethylpen)
- clarithro/erythro if pen allergy

112
Q

tx exacerbation of COPD

A
  1. amox/clarithro/doxy PO
  2. try other of 1st line didnt try, after 2-3 no improvement

severe- IV amox, co-amox, clarithro, co-trimoxazole, taz

113
Q

tx bronchiectasis

A

PO amox, clarithro, doxy

severe- IV coamox, Taz, Levofloxacin

similar to acute COPD exac

114
Q

drugs that cause c.diff

A
  • clindamycin
  • cephalosporins
  • quinolones (eg cipro)
  • wide spectrum abx eg tazocin
  • PPIs!
115
Q

structure and histo appearance of c.diff

A
  • gram positive
  • anaerobic
  • rod/bacillus
  • spore forming (resistant to cleaning)
116
Q

complications of c.diff infection

A
  • pseudomembranous colitis
  • toxic megacolon (avoid anti-diarrhoeals)
  • perf
  • sepsis
117
Q

ix c.diff

A

stool sample:

  • exotoxins- A and B
  • glutamate dehygrogenase
118
Q

tx c.diff

A

1st episode- PO vanc, then fidamoxicin

  • other episode within 12w- PO fidamoxicin
  • Other episode after 12w- PO either vanc of fidamoxicin
  • severe- PO vanc with IV metronidazole
119
Q

tx H.pylori

A

PO 1st line- 7 days

  • PPI+amox+ clarithro/metronidazole
  • pen allergy- PPI + clarithro + metronidazole

PO 2nd line- 7 days (if ongoing after 1st line)

  • PPI + amox + metronidazole/clarithro (whichever not used 1st line)
  • pen allergy- PPI + metronidazole + levofloxacin

can also try levofloxacin or tetracycline

120
Q

tx mild acute diverticulitis

A
  • co-amox PO

pen allergy-** trimethoprim + metro

121
Q

tx severe/complicated diverticulitis

A
  • coamox IV OR cefuroxime + metro

- pen allergy- cipro + metro

122
Q

tx peritonitis

A
  • cephalosporin + metro
  • gent+ metro or + clinda
  • taz

assoc with peritoneal dialysis- vanc/teic + ceftazidime added to dialysis fluid

123
Q

tx bacterial vaginosis

A

PO metronidazole 7 days

topical metro/clinda 7 days

124
Q

tx chlamydia

A

azithro 1g one dose/doxy BD 7 days

erythro 14d

125
Q

tx gonorrhoea

A
  • IM ceftriaxone
  • cipro if sensitive
  • IM gent + PO azithro
126
Q

tx PID

A

14 doxy + metro, + stat IM ceftriaxone

127
Q

tx syphilis

A
  • benzathine benzylpenicillin
  • pen allergy- doxy/erythro
  • asx contacts- doxy
128
Q

histological appearance of chlamydia

A

chlamydia trachomatis (and chlamydia pneumoniae

  • gram negative
  • aerobic
  • intracellular
  • coccoid or rod-shaped
129
Q

histological appearance of gonorrhoea

A
  • Neisseria gonorrhoeae
  • gram negative
  • coffee bean shaped
  • intracellular
  • diplococcus
130
Q

histological appearance of syphillis and stains used

A

Teponema pallidum

(blood test, exudate swab from sore)
- spirochete- spiral shaped
- gram negative
- worm like
Staining:
- Giemsa staining
- Silver impregnation stain
- Ryu's stain
131
Q

microorganism cause of spontaneous bact peritonitis

A

gram negative bacilli

  • E.coli- most common
  • Klebsiella- second most common

Gram positive cocci

  • strep spp
  • enterococcus
  • staphs pp
132
Q

stages of HIV

A

seroconversion/primary/acute

  • up to 6 w post infection
  • flu like
  • most infectious

asx

  • can last several years
  • virus is active, damagng immune system, replicating

Sx

  • secondary infections, cancers
  • wt loss
  • night sweats
  • lympadenopathy
  • diarrhoea
  • fatigue, malaise
  • dry mouth, thrush, gingivitis, ulcer,s herpes, canker

Later stage

  • AIDS
  • penumonia- TB, PCP
  • Kaposi’s- cancer of lymph and blood vessels
  • invasive cervical cancer
  • non-hogkins
133
Q

pathophysio of HIV

A

human immunodeficiency virus

  • member of lentivirus (retrovirus)
  • attacks CD4 lymphocytes (t helpers)
  • transmitted via blood, semen, vaginal fluid, anal mucus, breast milk
134
Q

what is AIDs

A

CD4 count <200

AIDs defining illnesses

135
Q

ix ?HIV

A
  • CD4 count
  • 3rd gen antibody test- blood, oral fluid, urine, only after seroconversion stage (3m post exposure)
  • 4th gen combined antigen/antibody test- reliable from 1m post exposure
136
Q

management of HIV

A
  • condom use
  • PrEP- pre-exposure prophylaxis-antiretrovirals- emtricitabine with tenofovir disoproxil
  • Post-exposure prophylaxis after sexual exposure (PEPSE)- 24hours after exposure, MUSt be withinin 72hours, 28d course, emtricitabine with tenofovir disoproxil + raltegravir
  • Highly active antiretrovial therapy (HAART)- stops replication and reduces viral levels- eg nucleoside reverse transcriptase inhibis, non-nucleoside reverse transcriptase inhibis, protease inhibis, integrase strand transfer inhibis
137
Q

micro causes of infective endocarditis

A

most commonly gram positive cocci bacteria

  • staph aureus
  • viridans strep
  • enterococci

Rarely

  • e/coli or pseudomonas aeruginosa
  • candida, aspergillus
138
Q

red flag sx for infective endocarditis

A
  • new murmur in feverish pt
  • splinter haemorrhages
  • Osler’s (red, tender nodules on digits)
  • Janeway- macular red non tender lesions on palms/sole
  • **- Roth spots on fundoscopy
139
Q

what criteria is used for infective endocarditis, what is in it

A

Duke’s
2 majors/1major + 3 minors/5 minors

major

  • 2x blood cultures- viridans strep, strep bovis, staph aureus, enterococci
  • echo

minor

  • **- predisposing factor- heart cond, IVDU
  • **- fever
  • vasc phenomenon- janeway, embolism
  • immune phenomena- roth, oslers, glomerulonephritis
  • 1x blood culture/atypical organism
140
Q

tx endocarditis

A
  • 6w- abx depending on cause
  • prosthetic valve– empiric- vanc, gent, (meropenem)
  • streptococcus- penicillin/ceftriaxone
  • native- (ampicillin+gent +fluclox or) vanc plus gent

surgery to remove vegetation/replace valves/remove emboli elsewhere
drainage of cavities
pacemaker insertion
stroke rehab

141
Q

micro cause of rheumatic fever

A
  • group a haemolytic strep (strep pyogenes)
142
Q

strep pyogenes histo appearance

A
  • gram positive purple
  • cocci (round, chains)
  • group b haemolytic
  • group A lancefield
143
Q

sx rheumatic fever

A
  • fever
  • carditis (endo, peri, myo)- tachycarida, murmur, pericardial rub, cardiomegaly, chest pain
  • **- arthritis- fleeting, migratory, large joints
  • ***- erythema marginatum (red, raised edge rash with clear centre), usually over joints and spine
  • chorea
144
Q

ix rheumatic fever

A
  • ESR/CRP
  • blood cultures
  • throat swabs
  • antigen test and titres
  • pr prolongation
145
Q

diagnostic criteria for rheumatic fever

A

Jones
strep infection plus 2 major criteria/ 1 major 2 minor:

  • major- carditis, arthritis, ***nodules/erythema, chorea
  • minor- **fever, rasied CRP/ESR, prolonged PR interval
146
Q

management rheumatic fever

A
  • bed rest until CRP normal
  • benxylpen or phenoxymethylpenicillin
  • corticosteroids
  • analgesia
  • immobilisation of joints if severe
  • diuretics/ACEI if in HF
  • daily PO penicillin for at least 5 years or up to 21yo to prevent recurrence and chronic rheumatic heart disease
147
Q

what causes malaria

A

parasitic protazoa

  • plasmodium falciparum
  • plasmodium vivax
  • plasmodium ovale
  • plasmodium ***malariae
  • plasmodium knowlesi
148
Q

tx malaria

A

Falciparum

  • artesunate
  • quinine
  • ****artemisinin combination therapy/artemether + lumefantrine/ atovaquone-proguanil
  • quinine + doxy

non - falciparum

  • chloroquine
  • primaquine- prevents relapses, check for G6PD deficiency
149
Q

prevention of malaria

A

when travelling to Africa, Asia, the Indian subcontinent, South America and some areas in the Far and Middle East. (The risk is particularly high in sub-Saharan Africa.)

  • proguanil and atovaquone (malarone)
  • mefloquine
  • doxy
150
Q

name some obligate intracellular bacteria

A
  • rickettsia- cause typhus, rockly mountain/brazilian/Mediterranean spotted fever
  • chlamydia
  • coxiella
  • have to be cultured in cells/cant be cultured- have to do PCR
151
Q

list gram positive bacteria (purple/blue)

A
  • Staphlococcus (cocci,/round, clusters)
  • streptococcus (cocci, chains)
  • enterococcus
  • corynebacteria
  • clostridia eg tetanus
152
Q

what does coagulase positive and negative mean

A

Way of classifying staphlococcus:

coag positive- Staph aureus

coag negative- other staph eg staph epidermis, staph saprophyticus

153
Q

how are streptococci classified

A

haemolytic type (culture on red blood cell plate)

Lancefield typing- carbohydrate cell surface antigen grouping

154
Q

list gram negative bacteria (pink)

A

Gammaproteobacteria

  • Enterobacteria (coliforms)
  • Vibrio
  • Pseudomonas
  • haemophilus
  • legionella

Betaproteobacteroa

  • boredetella
  • Neisseria

Epsilonproteobacteria

  • campylobacter
  • H.pylori

Chlamydia
Spirochetes

155
Q

name some enterobacteria

A
  • Eschericha coli
  • shigella
  • salmonella
  • proteus mirabilis
  • klebsiella
  • yersinia
156
Q

structure of enterobacteria

A
  • gram neg
  • rods/bacillus
  • covered in peritichous flagella (motile)
  • anaerobic
157
Q

structure of campylobacter

A
  • srpial rods
  • flagella
  • gram neg
158
Q

structure of H/pylori

A
  • require CO2 (microaerophilic)
  • spiral shaped
  • tuft of polar flagella
159
Q

what is diptheria caused by

A
  • corynebacterium diptheriae (gram positive, polymorphic)

- diptheria toxin- causes pharyngitis and pseudomembran ein the throat (white)

160
Q

sx diptheria

A
  • sore throat, dysphagia
  • pseudomembrane, can block airway and produce barking like cough
  • lymphadenopathy
  • may involve eyes, skins, genitals
161
Q

tx diptheria

A
  • vaccine in childhood
  • diptheria antitoxin
  • metronidazole/erythro/benzylpen
162
Q

cause of rabies

A
  • lyssavirus
  • bite wound of animals usually in SE asia
  • causes brain inflam
163
Q

sx rabies

A
  • hypersal
  • fever
  • furious sx- anxiet, confusion, agression, ecxitement, halluc, hyper, violent, hydrophobia
  • paralytic sx- weakness, loss of sensation, paralysis
164
Q

ix rabies

A
  • fluorescent antibody test
  • serology screen for other encephalitis causes
  • CT head
165
Q

tx rabies

A
  • vaccine
  • wash wound under runnign water for 15min
  • iodine
  • IVIG immediately
166
Q

tetanus cause

A

clostridium tetani wound infection

  • soil dwelling
  • gram negative rod
  • releases toxins causing muscle spasms
167
Q

sx tetanus

A
  • lockjaw/trismus
  • spasms progress **down the body
  • can break bones
  • fever, sweating, headache, dysphagia
  • HTN, tahcycardia
168
Q

ix tetanus

A
  • clinical

- spatula test- attempt illicit gag reflex pt will bite down involuntarily

169
Q

management tetanus

A

If pt has had full course of vaccine (5 doses) within that last <10 years
- no vaccine or tetanus Ig needed, regardless of wound severity

Pt has had full course >10yrs ago

  • tetanus prone wound- reinforcing vaccine dose
  • high risk wound- vaccine plus Ig

vaccination hx is incomplete/unknown-

  • **- vaccine dose in clean wounds
  • vaccine dose and Ig in tetanus prone and high risk

tetanus prone=

  • injury in contaminated environment (eg gardening)
  • wound containing foreign body
  • compound #
  • systemic sepsis
  • animal bites/scratches

high risk=any of the above plus:

  • soil, manure
  • devitalised tissue
  • any requirement of surgical intervention delayed >6hrs
  • muscle relaxants
  • mechanical vent if required
170
Q

cause of cholera

A

vibrio cholerae- gram negative, anaerobic
cholera toxin
spread thought contaminated water and food

171
Q

sx cholera

A

profuse watery diarrhoea- ‘rice water’- grey/brown
vomiting, abdo pain
muscle cramps

172
Q

management of cholera

A 
oral rehydration therapy/IV fluids
PO vaccination (6m protection)
doxy if severe
173
Q

causes of food poisoning

A
  • campylobacter jejuni- most common (raw or undercooked poultry or something that touched it.)- dysentery
  • E.coli- (meat, milk) may cause dysentery
  • salmonella (meat, eggs )- dysentery
  • *- norovirus (Care home!)
  • bacilius cereus- rice, meat
  • *- clostridium botulinum- fish, meat
  • Listeria- pate, cheese
  • Shigella- eggs, salads
  • *- S aureus- dairy, meat
  • yersinia- milk, poultry
174
Q

histo appearance of campylobacter jejuni

A
  • gram negative
  • spiral shaped/curved/rod
  • vibrio
175
Q

what causes bloody diarrhoea

A
  • campylobacter- meat (raw/undercooked)
  • ***- shigella
  • salmonella- animal products
  • some strains of e.coli- water, food, hand to mouth
  • **- HUS
  • ***- C-diff- abx/person to person

**- amoebiasis- tropical location

  • intussusception
  • infant- NEC
  • mesenteric ischaemia/colitis
  • **- IBD flare
  • diverticulitis
  • cancer
176
Q

what organism causes scarlet fever

A

strep pyogens (group A streptococcus, b haemolytic )

177
Q

sx scarlet fever

A
  • flu like sx
  • rash- small raised red bumps, rough
  • starts centrally and then spreads to peripheries
  • strawberry tongue- red, swollen, bumps, white coating
178
Q

ix scarlet fever

A
  • cinical
  • throat/tongue swabs
  • bloods- antistreptolysin
179
Q

management of scarlet fever

A
  • phenoxymethylpen/amox/ azithro/erythro
  • antipyretics
  • analgesia
  • fluids
  • notify
180
Q

sx streptococcal toxic sock syndrome

A

strep pyogens/group A strep
- more severe that staph aureus toxic shock

  • diffuse erythroderma
  • desquamation (palms, soles)
  • fever
  • hypotension, shock
  • organ failure (D+V, myalgia, AKI, hepatitis, thrombocytopenia, confusion)
181
Q

tx of strep toxic shock syndrome

A
  • aggressive fluid management
  • ventilate
  • renal replacement therapy
  • inotropes
  • cephalosporins, penicillins, vancomycin
  • clinda or gent
  • IVIG
182
Q

Causes of meningitis (bacterial) accoridng to age

A

0 - 3 months

  • Group B Streptococcus- agalactiae (most common cause in neonates)
  • E. coli
  • Listeria monocytogenes

3 months - 6 years

  • Neisseria meningitidis
  • Streptococcus pneumoniae
  • Haemophilus influenzae

6 years - 60 years

  • Neisseria meningitidis
  • Streptococcus pneumoniae

> 60 years

  • Streptococcus pneumoniae
  • Neisseria meningitidis
  • Listeria monocytogenes

Immunosuppressed
- Listeria monocytogenes
(- fungal- cryptococcus , Histoplasma, candida)

183
Q

who should be screened for MRSA

A
  • all pts havig elective surgery

- from 2011 all emergency admissions (still the case?)

184
Q

tx of MRSA if identified as carrier

A
  • mupirocin paraffin TDA 5 days in nose
  • chlorhexidine gluconate skin, OD 5 days
  • vanc, teic, 2.- linezolid
185
Q

infection (lung) in 4w post transplant pt- likely organism

186
Q

Bilateral conjunctivitis, bilateral calf pains and high fevers in a sewage worker suggests..?

A 
LEPTOspirosis:
- flu-like illness
- pulmonary haemorrhage
- conjuncitvitis, subconjunctival haemorrhage
organ injury:
- hepatitis, jaundice
- AKI
  • transmission- broken skin with urine of infected rodents— farmers’ / sewage workers
187
Q

sx of enteric fever

A
  • abdo pain
  • fever
  • rose spot macular rash
188
Q

abx for human/animal bites

189
Q

sx giardiasis

A
  • watery diarrhoea
  • systemicaly well- apyrexial, SNT
  • may feel bloated/flatulence
  • induces/precipitates lactose intolerance! may be lasting after infeciton has cleared
  • malabsorption- steatorrhoea
190
Q

transmission of giardiasis

A
  • swimming/drinking river from river/lake
  • travel
  • MSM
191
Q

ix giardiasis

A
  • stool microscopy
  • stool antigen
  • PCR assays
192
Q

tx giardiasis

A

metronidazole

193
Q

sx pneumocystitis jiroveci

A
  • immunosupressed
  • SOB, esp on exertion
  • lethargy
  • recurrent chest infections/HIV positive– immunosupressed
  • no/dry cough
  • fever
194
Q

signs of peumocystitis jiroveci

A

DESATS ON EXERTION!!!

  • clear chest on ausc
  • normal CXR, may show BL intersitisal pulm infiltrates
195
Q

tx penumocystitis jiroveci

A

co-trimoxazole

IV pentamidine if severe
steorids if hypoxic

196
Q

live attenuated vaccines

A 
BCG
MMR
yellow fever
shingles, chickenpox
***rotavirus
oral polio
***oral typhoid
oral diptheria
197
Q

sx and signs of hep A

A
  • flu like
  • RUQ pain- tender hepatomegaly
  • Jaundice-dark urine, clay coloured stools
  • joint pain

cholestatic LFTs- raised bili, ALT/AST, normal or raised ALP

198
Q

transmission of hep A

A

faecal-oral, often in institutions

199
Q

tx of letospirosis

A

high dose benzylpenicillin/doxy

200
Q

what two abx have a dilsulfiram like reaction to alcohol

A

metronidazole

cefoperazone (a cephalosporin)

201
Q

what organism presents with fever an drash, and in pts with haematologucal conditions, may cause pancytopnia ?

A

Parvovirus B19

202
Q

sx amoebiasis

A

travel related infection
bloody diarrhoea
profuse

203
Q

sx shigella

A

bloody diarrhoea

204
Q

what is Chagas’ disease

A

ie American trypanosomiasis/sleeping sickness

  • parasite- Trypanosoma cruzi
  • transmitted via kissing bug
  • muscles changes
  • asymptomatic in most
  • erythematous nodule at site of infectin
  • periorbital oedema
    complications:
  • myocarditis–> dilated cardiomyopathy, arrhythmias
  • GI- megaoesophagus, megacolone- dysphagia and consti
205
Q

management of Chagas’ disease

A
  • Azole or nitroderivatives (nifurtimox)
206
Q

sx of AFRICAN trypanosomiasis/sleeoing sickness

A

parasite- Trypanosoma bruce, transmitted via fly
sx
- chancre- painless SC nodule at site of infection
- fever (intermittent)
- cervical lymph nodes
- CNS - headaches, mood , meningoencephalitis

207
Q

tx of African trypanosomiasis

A
  • IV pentamidine, suramin

- IV melarsoprol if CNS

208
Q

what drug tx should all people with CD4 <200 receive

A

high active anti-retroviral therapy ( eg nucleoside/tide reverse transcriptase inhibis, non-nucleosie reverse transcriptase inhibis, protease inhibis, integrase strand transfer inhibis)
and PO co-trimoxazole

209
Q

what is AIDS CD4 count

A

<200/mm3 CD4 count

210
Q

differentiation of possible causes of food poisoning

A

S. aureus

  • market stool
  • 1-6hours incubation–very short compared to others
  • severe vomiting

Camylobacter

  • most common
  • flu like illness
  • often bloody

Salmonella

  • cramps, diarrhoea
  • animal products
  • bloody

Bacillus cereus

  • watery
  • N+V
  • cooked foods left uncovered- rice, meats

E.coli

  • traveller’s
  • watery, bloody

Clostridium perfringens

  • intense abdo cramps
  • non bloody diarrhoea

Clostirdium botulism

  • weakness, double vision, diffucly speaking, swallowing, death
  • processed foods

Giardia

  • prolonged non bloody diarrhoea
  • incubation of >7 days
  • lactose intol
  • travel
211
Q

infective causes of diarrhoea

A

non inflammatory (watery)

  • rotovirus
  • norovirus
  • CMV
  • adeno
  • Ecoli
  • staph aureus
  • Bacillis cereus
  • cholera- rice water/grey-brown
  • giradia
  • cryptospoidium parvum

Inflammatory (dysentry)

  • salmonella
  • Shigella
  • Campylobacter
  • E.coli
  • C.diff
  • yerinia
  • Entamoeba-Amoebic
212
Q

tx typhoid fever

A
  • cipro
  • Supportive therapy: hydration, nutrition, antipyretics etc.
  • May need surgery for bowel perforation
  • Hygiene and hand washing
213
Q

typhoid fever transmission and cause

A
  • contaminated water, faeco-oral

Salmonella typhi

214
Q

sx of typhoid fever

A
  • weakness, fatigue
  • stomahc pain, diarrhoea, consti, perf
  • headache, cough
  • loss of appetite
215
Q

diagnosis of tyhpid fever

A

stool sample for culture

DNA blood test

216
Q

test for mumps

A

PCR of oropharyngeal swab

igM Ab in serum

217
Q

decolonisation tx for MRSA

A

Nasal mupirocin and chlorhexidine wash

218
Q

What are infections classically caused by coagulase -ve staphylococci?

A

hospital lines

prostheses

219
Q

tx meningitis

A

IM benzylpenicillin in community pending hospital transfer if there is a non-blanching rash.

  • 2g of IV ceftriaxone twice daily (twice the standard dose to ensure CNS penetration)
  • cefotaxime and amox if <3m as risk of hyperbili with ceftriaxone in neonates!!
  • addition of IV amoxicillin in young/old patients to better cover listeria
  • IV aciclovir if viral encephalitis is suspected.
  • penicillin allergic - chloramphenicol
  • contacts- cipro (or rifampicin)
220
Q

most common viral causes of meningitis

A

Enteroviruses such as:
echoviruses
coxsackie A and B
poliovirus

221
Q

most common viral cause of encephalitis

222
Q

tests for TB

A

CXR
Sputum- MC&S
- microscopy staining with Ziehl Neelsen or auamine
- culture on Lawenstein Jensen media

Interferon Gamma release assays- not affected by BCG, but cannot tell between acitve/latent TB
PCR for rapid results

Mantoux- tuberculin skin test for screening of contacts

Finals (15 decks)

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