Infective

Question 1

Which of bacterial, viral and TB/ fungal meningitis causes: Appearance: Clear, turbid, fibrin web Protein: >1, <1, 0.1-0.5 Glucose: normal, <2.2, 1.6-2.5 Pressure: >30, normal

Answer 1

Bacterial: turbid, >1, <2.2 glucose, pressure >30 viral: clear, <1 protein, glucose normal, pressure normal TB: fibrin web, 1.6-2.5 glucose, protein 0.1-0.5

Question 2

Most common cause of bacterial meningitis.

Answer 2

Strep pneumo. Haemophilus influenzae B also a cause.

Question 3

Patient with sepsis and rash and neuro Sx shows a gram - diplococcus. What do they have

Answer 3

Meningococcal meningitis caused by neisseria meningitidis.

Classically presents with sepsis and purpuric rash

Question 4

Age at risk of meningococcal meningitis

Answer 4

1st decade of life (under 5), then 11-19, then >65

Question 5

Most common causative agents of viral meningitis. And prognosis

Answer 5

Human enteroviruses (coxsackie B and echovirus). Usually self limiting, although complications may arise in very young and very old.

Question 6

Most common pathogen in immunocompromised patient with meningitis.

Answer 6

Cryptococcus neoformans. (A fungal organism)

Question 7

Treatment of tuberculosis

Answer 7

Isoniazid + rifampicin + pyrazinamide + ethambutol

Question 8

Staphylococcus & Streptococcus claddification

Answer 8

Gram + cocci.

Staph form into grape like clusters

Strep form in chains/ pairs

Question 9

Clostridium classification

Answer 9

Gram positive bacilli (rod), forming spores

Question 10

Name one gram - cocci

Answer 10

Neisseria

Question 11

Name 2 gram negative bacilli anaerobic

Answer 11

enterobacteriacae (straight)

Vibrionioaceae (curved)

Question 12

Pseudomonas classification

Answer 12

gram - aerobic bacilli

Question 13

Bacteria showing acid fast stain

Answer 13

mycobacteria

Question 14

Poorly staining bacteria

Answer 14

Mycoplasma

Question 15

Chlamydia view on microscopy

Answer 15

Intracellular bacteria so you won’t see on staining

Question 16

Ghonorrhoea is a…

Answer 16

Gram - diplococci (2 cocci together)

Question 17

examples of

diplococci

streptococci

staphylococci

Answer 17

Diplococci - in pairs (neisseria gonnorhoea/ meningitidis gram - and strep pneumo gram +)

Streptococci - in chains. (Streptoccoccus pyogenes gram +)

Staphylococci - in clusters (staph aureus gram +)

Question 18

Explain role of tat, rev, fiv, nef, vpu proteins in HIV

Answer 18

tat (viral transcription activator),

Rev (unspliced RNA nuclear export),

Vif (counteracts restriction factors APOBEC3f/G/H which protect us from viral activity),

nef (downregulates CD4 and MHC molecules, counteracts SERINC3/5)

vpu degrades CD4, counteracts tetherin

Question 19

Action of tetherin, APODEC3

Answer 19

Tetherin inhibits release of viruses from cell suface (counteracted by vpu)

APODEC3 inhibits RT and disrupts DNA handling (inhibited by vif)

Question 20

Major target tissue in acute HIV-1 infection

Answer 20

CD4 T cells in gut-associated lymphoid tissue through the CCR4 receptors.

Question 21

HIV investigation

Answer 21

Serum ELISA looking for anti-p24 (only present once patient has seroconverted approx 3 month later). To confirm diagnosis, essential to perform a RT-PCR to detect HIV genomic RNA in the blood (can detect before seroconversion). CD4 cell count (below 500 abnormal, below 200 AIDS).

Question 22

AIDS defining illnesses and causative organisms

Answer 22

Kaposi’s sarcoma (Herpes virus 8), PCP (pneumocystis carinii), toxoplasmosis (toxoplasma gondii), reactivation of herpes simplex virus 1/2, cytomegalovirus-induced retinitis, tuberculosis )mycobacterium tuberculosis)

Question 23

Causes of disseminated intravascular coagulation

Answer 23

major trauma, spesis, malignancies, vascular disroders, severe toxic and immunological reactions and obstetric disorders.

Main treatment is solve underlying disorder and give fresh frozen plasma (platelets and coagulation factors).

Question 24

Cause of shingles and complication.

Answer 24

Reactivation of varicella zoster which sits in the sensory ganglion of specific nerve roots. Aka herpes zoster.

Post-herpetic neuralgia complication.

Question 25

Main associations with EBV infection

Answer 25

Hogking’s lymphoma, burkitt’s lymphoma, nasopharyngeal carcinoma, HIV-associated CNS lymphomas, leukoplakia.

Question 26

Management of UTI

Answer 26

Trimethoprim or nitrofurantoin for 3 days female or 7 days males.

Question 27

treatment for meningococcal (nessieria meningitidis) meningitis

Answer 27

benzylpenicillin IM in primary care, IV ceftriaxone in hospital. Chloramphenicol if allergic.

Question 28

Cause of meningitis that can be vaccinated against

Answer 28

H influenza -

Question 29

Maculopapular rash, cough, coryza, conjunctivitis, pathognomonic enanthem (lesions in buccal mucosa)

Answer 29

Measles