MedEd Micro 1 Flashcards
1
Q
50M 6/12 Hx of weight loss and haemoptysis. Gold standard test for Dx?
A
sputum culture
2
Q
why give b6 in TB Tx?
A
protect against side effects of isoniazid
3
Q
stages of TB infection
A
primary - mycobacterium tuberculosis initial infection, often in childhood. no Sx
latent - suppressed, hanging around in foci, no Sx
post primary / secondary - reactivation of latent, often due to immunosuppression. Sx!!
4
Q
causes of reactivation of TB
A
HIV infection
started on monoclonal ABs / immunosuppression
illness
5
Q
3 stages of TB on a CXR
A
ball of macrophages = ghon foci
+ lympahdenopathy = ghon complex
+ calcification = ranki complex
6
Q
PC of active TB (4)
A
weight loss / fever / night sweats / loss of appetite / fatigue
pulmonary - haemoptysis
lymphadenopathy
erythema nodosum
7
Q
less common PC of active TB
A
miliary TB
meningeal TB
Pott’s disease
GUM TB
serosal / GI / adrenal / cutaneous
8
Q
what is miliary TB
A
TB lesion erodes into BV and spreads all over body
9
Q
how does meningeal TB present, in whom & what complication
A
subacute meningitic sx
HIV pts
++++ morbidity
10
Q
what is pott’s disease and how does it present
A
TB in vertebrae
back pain / compression fracture / focal neurology
11
Q
incidental result of GUM TB and why
A
sterile pyuria !! UTI Sx with nothing grown on MCS (bcos they don’t look for TB)
12
Q
how does miliary TB look on CXR
A
lots of little white dots all over CXR (also all over rest of body but not as easy to see)
13
Q
name pathognomonic cutaenous presentation of TB
A
lupus vulgaris
14
Q
gold standard Ix for active TB with medium used
A
sputum culture, on Lowenstein-Jensen media
** buzzword **
15
Q
what Ix is done for active TB in practice
A
sputum smear and Ziehl Neelson stain for acid fast bacilli
** buzzword **
16
Q
why isnt sputum culture done for TB Dx in practice
A
takes too long to culture TB
17
Q
another stain for acid fast bacilli
A
auramine rhodamine stain
(stains red / yellow)
** buzzword **
18
Q
how is latent TB diagnosed
A
mantoux test
interferon gamma release assay (ellaspot)
19
Q
difference between mantoux test and IFGRA for TB
A
mantoux - tests positive if you’ve had BCG vaccine OR you have latent TB, cheap
IFGRA - only positive if you have latent TB, expensive
20
Q
5 drugs for TB Tx
A
RIPE
rifampicin
isoniazid + pyridoxine
pyrazinamide
ethambutol
21
Q
duration of Tx for TB
A
all 4 RIPE drugs for 2 months,
then just 2 for 4 months (rifampicin and isoniazid)
22
Q
what is pyridoxine and why is it given with RIPE
A
vitamin b6
isoniazid causes peripheral neuropathy due to depletion of b6
23
Q
drugs used for drug resistant TB
A
aminoglycosides
fluroquinolones
new drugs
specifics - streptomycin / amicacin
24
Q
Mx of latent TB
A
just rifampicin and isoniazid (less intensive regime)
25
2nd most common mycobacterium
leprosy (mycobacterium leprae / lepromatosis)
26
PC of mycobacterium leprae / lepromatosis
(2 Sx, buzzword finding, Hx finding)
skin changes - hypo/hyperpigmented lesions
peripheral nerve disease
*thickening of nerves ** buzzword
+ travel Hx / exposure
27
name other mycobacterium
mycobacterium leprae / lepromatosis
MAC - mycobacterium avium complex
mycobacterium marinum
mycobacterium ulcerans
28
who gets MAC
preexisting lung disease / HIV
29
PC of MAC
same as pulmonary TB
slow PC,
FLAWS / cough
30
PC buzzwords for mycobacterium marinum
"fish tank granuloma"
exposure to swimming pools / fish tanks
skin disease
31
what does mycobacterium ulcerans cause
buruli ulcer
32
PC of buruli ulcer
been in the tropics
painless, destructive ulcer
33
23F 2/52 dry cough, fever, myalgia.
O/E rash, jaundice
CXR bilateral consolidation
Organism?
mycoplasma pneumonie
34
what does LRTI encompass
bronchitis
pneumonia
abscess
empyema
35
describe bronchitis - who gets it / Mx and why / CXR
smokers / kids
don't tend to get that unwell, so don't usually treat unless supportive
CXR no changes
36
describe pneumonia - progression / CXR
look sick
treat with ABx
CXR shows consolidation
37
what is an abscess
puss filled cavitating lesion within lung parenchyma
38
2 key PC of abscess
FLAWS - esp swinging fevers !
Hx pneumonia - esp pneumonia not responding to ABx = abscess
39
MX of abscess
drainage
ABx alone not enough
40
what is an empyema
infection within an existing space in lung (ie the pleura)
41
3 classifications of pneumonia with definitions
CAPs - develop in community
HAPs - develop >48hrs after hospital admission
VAPs - develop in patients on ventilators
42
CXR of bronchitis
nothing
thickening of central bronchi
43
CXR of abscess
well circumscribed lesion with patchy airspaces within (cavity with fluid in)
44
what does CXR of empyema look similar to
pleural effusion - loss of costophrenic angle with meniscus
45
why are typicals / atypicals called that
typicals all present the same in classic pneumonia fashion
atypicals present weirdly
--> nothing to do with how common they are !!
46
describe typical pneumonia PC
systemically unwell
productive cough, fever, etc
lobar consolidation on CXR
47
what Mx do typical pneumonias respond to
penecillins
48
how do atypical pneumonias present
flu like prodrome
dry cough rather than productive
extra pulmonary manifestations
49
how does the Mx of atypicals differ from typical pneumonia
atypicals respond to macrolides, not penecillins like typicals
50
3 buzzwords for strep pneumoniae (Sx, unique Ix, path)
rusty coloured sputum
gram positive diploccoci
positive urine antigen test
51
buzzwords for h.influenzae (path, at risk)
COPD
gram neg coccobacillus
52
buzzwords for moraxella catarrhalis (path, at risk)
smokers
gram negative coccus
53
most common pneumonia bug
strep pneumoniae
54
3 buzzwords for staph aureus pneumonia (RFs, CXR lesion, path)
post-influenza pneumonia
cavitating lesions - cavity
gram positive cocci (grape like bunch)
55
4 buzzwords for klebsiella pneumoniae (RFs, CXR lesion, Sx, path)
alcoholics !! / post aspiration eg stroke
haemoptysis
cavitating lesions
gram negative rods
56
who gets chlamydia pneumoniae and how sick are they
asthmatics
not very sick
(less important)
57
3 buzzwords for legionella pneumophilia (RFs, Sx, Ix)
air conditioning - plumbers / travellers
very unwell - hepatitis, low Na, lymphopaenia
+ urine antigen test
58
pt has positive urine antigen test with pneumonia. what bugs?
strep pneumonia
legionella
59
3 buzzwords for mycoplasma pneumoniae (RFs, 2 buzzword signs)
young people in close proximity - halls etc
cold AIHA !! (jaundiced)
erythema multiforme !! (target lesions)
60
2 buzzwords for chlamydia psittaci (RFs, complication)
own exotic birds !!
culture negative endocarditis
61
2 buzzwords for coxiella burnetti (RFs, complication)
farm animals !!
culture negative endocarditis
62
what LRTIs can HIV+ patients get
PCP
TB
cryptococcus neoformans
nocardia
63
how does PCP classically present
dry cough
** desaturation on exertion >10%** buzzword
64
LRTIs in splenectomy pts
encapsulated organisms
- haemophilus
- strep
65
LRTIs in CF
pseudomonas aeruginosa
burkolderia cepacia
66
why is burkholderia cepacia important to know about in CF kids
contraindication to lung transplant
67
what LRTI bugs are people taking monoclonal ABs at risk of
TB reactivation
68
what LRTI bug do people with neutropaenia / asthma get
aspergillus
69
CXR of PCP
relatively normal
bat wing shadowing around the hilar
70
CT of PCP
honeycombing - big open spaces
ground glass shadowing
71
CURB 65 criteria
confusion - AMTS <9
urea >7
RR >30
BP <90/60
65 or older
72
What does a CURB 65 score of 0-1/2/3-5 mean
curb65 0-1 = treat at home, PO amoxicillin
curb65 2 = admit, co-amoxicillin and clarithromycin
curb65 3-5 = admit, co-amoxicillin and clarithromycin, consider ICU
73
standard tx of CAP
amoxicillin / co-amoxicillin / clarithromycin
- some combo of this
74
Tx of HAP
(1st / severe)
LOCAL TRUST GUIDELINES
usually 1st = ciprofloxacin and vancomycin
severe = piperacillin / tazobactam and vancomycin
75
what are you covering for in HAP
MRSA
pseudomonas
76
go to ABx for pseudomonas
piperacillin and tazobactam (tazocin)
77
go to ABx for MRSA
vancomycin
78
ABx for aspiration pneumonia
usually aspiration is a pneumonitis not pneumonia (ie chemical acid damage to lung, not infection) so not usually needed
79
go to ABx for anaerobic cover
metronidazole
clindamycin
80
indications for starting ABx for anaerobic cover
MUST be an indication not just if they've aspirated
- culture
- empyema / abscess
81
3 classifications of infective endocarditis
subacute
acute
prosthetic
82
PC of subacute endocarditis
indolent presentation
fever of unknown origin
FLAWS
new regurgitant heart murmur
splinter haemorrhages / janeway lesions
septic emboli - brain / spleen / kidney
immune phenomena - roth spots / osler nodes / glomerulonephritis
*****BUZZWORDS*****
83
PC of acute endocarditis
rapid onset
VERY septic / unwell
84
who gets prosthetic endocarditis and when
valve replacement pts (1-2 months post op)
85
location of IE usually
most ppl - left side as higher pressure
IVDU - tricuspid / right sides
86
osler nodes vs janeway lesions
oslernodes = painful
janeway lesions = painless
87
where do roth spots occur
retina
88
common organisms causing IE
strep viridans
staph aureus
89
most common organism in UK vs world causing IE
UK = staph aureus
world = strep viridans
90
organism causing IE within 2 months of valve replacement
staph epidermidis
91
organism causing IE in colon tumours
strep bovis
92
organisms causing culture negative IE
HACEK organisms
93
organism causing IE in bird keeper
chlamydia psittaci
94
organism causing IE in farmer
coxiella burnetti
95
organism causing IE in someone who's had unpasteurised dairy
brucella spp.
96
what criteria is used to diagnose IE
Dukes
97
major criteria for Dukes IE
blood cultures positive for IE - 2+ culture of a bug associated with IE
evidence of endocardial involvement - scan showing vegetations
98
minor criteria for Dukes IE
predisposing factor - IVDU / heart condition
fever >38
vascular phenomena - emboli / infarcts / ICH / janeway lesions
immunological phenomena - osler nodes / roth spots / RF+ / GN
microbiological evidence - culture that doesn't meet major criteria
99
how is IE diagnosed with Dukes
definite = 2 major OR 1 major + 3 minor OR all 5 minor
possible = 1 major + 1 minor OR 3 minor
100
Tx of IE
long course of ABx
- empirical / broad unless known organisms
- includes gentamicin
+/- surgery if indicated
101
indications for surgery in IE
continuing to worsen on ABx
acute heart failure
aortic root abscess
prosthetic valve
102
how is IE abscess development picked up on ECG
prolonged PR
103
what is non infective endocarditis
endocardial vegatations without infection
104
2 causes of non infective endocarditis
mucin producing adenocarcinomas - pancreatic especially
SLE / ALPS - Libman Sacks endocarditis
105
3 groups of presentations of GI infections
secretory - normal Sx
inflammatory - bloody diarrhoea
systemic sx
106
what Tx is not really used in GI infections and why
ABx - usually not bacterial, but protazoa
NB - exception is c.diff / very high risk and unwell
107
if an ABx is indicated in GI infection, which one is usually given
ciprafloxacin
108
organisms causing a secretory diarrhoea
bacillus cereus
staph aureus
e.coli
cholera
109
buzzword for bacillus cereus GI infection
reheated rice
110
buzzword for staph aureus GI infection
BBQs !!
short incubation - damage due to preformed toxins
111
buzzword for e.coli GI infection
traveller's diarrhoea
NB - usually none bloody, only 1 specific type is bloody
112
2 buzzwords for vibrio cholera GI infection (sx and path)
ricewater stool
comma shaped bacteria
113
causes of blood diarrhoea
CHESS
campylobacter jejuni
haemorrhagic e coli
entamoeba histolytica
salmonella enterides
shigella spp
AND yersinia enterocolitica !!
114
buzzword for salmonella enterides
poultry / eggs
115
does salmonella typhi cause bloody diarrhoea
NO - causes typhoid which is constipation
116
how does yersinia present
bloody or non bloody diarrhoea
terminal ileitis / adenitis --> similar to appendicitis
117
protazoal GI infections
entamoeba histolytica
giardia lamblia
cryptosporidium / micosporidium spp
118
PC of entamoeba histolytica
bloody diarrhoea / chronic diarrhoea
liver abscess
119
histology of entamoeba histolytica
flask shaped ulcer
anchovy paste in abscess
**buzzwords**
120
tx of entamoeba histolytica
metronidazole
121
PC of giardia lamblia
chronic diarrhoea
malabsorption
- like coealic !
122
histology of giardia lamblia
pear shaped trophozoites
**buzzword**
123
tx of giardia lamblia
metronidazole
124
buzzword / who gets cryptosporidium or microsporidium diarrhoea
HIV+ patients
125
who gets c.diff diarrhoea
post ABx
126
which ABx cause c.diff diarrhoea
cephalosporins, clindamycin, ciprofloxacin
127
Ix for c.diff
stool c.difficile toxin
visualise pseudomembrane - looks like wet cornflakes
128
Tx of c.diff
- 1st infection
- 1st recurrence
- further recurrence
- fulminant infection
1st = oral vancomycin
recurr = oral fidaxomicin
mutliple recurr = faecal microbiota transplant
fulminant = oral vancomycin + IV metronidazole +/- surgery
(Meeran says 1st line is metronidazole tho)
129
27F with dysuria, smelly urine.
Urine dip shows leucocytes but no nitrites.
why?
UTI causes by staph aureus
130
what is a complicated UTI
UT abnormality
pregnant
immunocompromised
instrumentation
131
what is lower UTI vs pyelonephritis vs pyonephrosis
lower UTI / cystitis = only affects bladder
pyelonephritis = infection to kidneys
pyelonephrosis = pyelonephritis + obstruction
132
Mx of pyelonephritis vs pyonephrosis
nephrosis needs a surgical intervention to drain fluid / fix blockage
133
Ix UTI
urine dip
MC&S
renal tract imagine - USS or CT
134
what do nitrites signify on urine dip
coliform UTI - whether an enzyme is present
--> e.coli mainly makes the enzyme, so nitrites indicate e.coli UTI
135
diagnostic value for any UTI on MC&S
>10^4 colony forming units/ml of any organism
136
diagnostic value for e.coli / staph saprophyticus UTI on MC&S
>10^3 colony forming units/ml
137
MC&S features that show contaminated sample
epithelial / squamous cells
staph aurues (doesn't cause UTI, on skin)
mixed growth
138
who are the only group in whom you'd treat asymptomatic UTI
pregnant women
139
most common cause of UTI
e.coli
140
most common cause of UTI in young women
staph saprophyticus
141
2 organisms in UTI that would indicate renal tract abnormalities
proteus mirabilis
klebsiella
142
buzzword for proteus mirabilis
struvite stones ** key
alkaline urine
143
what organism causes sterile pyruia
TB ** key
STIs - chlamydia
144
Tx of lower UTI
nitrofurantoin
trimethoprim
cephalexin
145
Tx course of lower UTI in complicated / uncomplicated
uncomplicated = 3d
complicated in male = 7d
146
when can you not give trimpethoprim / nitrofurantoin
can't give trimethoprim in 1st trimester
can't give nitrofurantoin in 3rd trimester
147
drug interaction of trimethoprim
methotrexate (folate antagonist)
148
Tx for pyelonephritis
admit pt
IV co-amoxiclav + gentamicin
149
organisms that cause surgical site infections, from most to least common
staph aureus
e.coli
strep spp.
pseudomonas
**EMQ Q
150
organisms that cause osteomyelitis or septic arthritis from most to least common
staph aureus
strep spp.
e.coli
** EMQ Q
151
organism that causes osteomyelitis or septic arthritis in sickle cell disease
salmonella
152
organisms that cause prosthetic joint infection from most to least common
staph epidermidis
staph aureus
strep spp.
e.coli
** EMQ Q
153
when is staph epidermidis the most common organism to cause prosthetic joint infection
ONLY IN FIRST 2 MONTHS POST OP
- after that, its staph aureus --> strep --> e.coli
154
34M 2/7 fever and menigism.
LP - clear, lymphocytosis, high protein / glucose
Dx?
viral meningitis
155
sites of CNS infection
meningitis - bacterial / viral / fungal
encephalitis - usually viral
brain abscess - infective collection in parenchyma
156
what can cause meningism that isn't meningitis
SAH
157
causes of bacterial meningitis in neonates
GBS
listeria monocytogenes
e.coli
158
causes of bacterial meningitis in adults
neisseria meningitides
strep pneumoniae
159
causes of bacterial meningitis in elderly
GBS
listeria monocytogenes
adult ones too
160
causes of bacterial meningitis in immunocompromised ppl
TB
161
viral causes of mengitis
enteroviruses
HSV2
HIV seroconversion can present with meningitis
162
fungal causes of menigitis in HIV / immunocompetent
cryptococcus neoformans in HIV
cryptococcus gattii in immunocompetent
163
why can LP in raised ICP be a problem
raised ICP due to SOL --> worried about coning
164
indications for CT before LP
(rule out SOL)
focal neurology
seizures
reduced GCS
papilloedema
165
when should LP be done ideally
before ABx but don't hold ABx off for this
166
buzzword for cryptococcus stain in LP
india ink stain
167
Ix in CSF analysis for ?meningitis
biochemical analysis
gram stain for bacteria
PCR viruses
Ziehl Neelson stain for TB
india ink stain for cryptococcus
168
CSF in viral meningitis
- colour
- WCC
- predominant WC
- protein
- glucose (CSF:blood)
- opening CSF pressure
clear
slightly high
lymphocytes
normal / slightly high
normal
normal / slightly high
169
CSF in bacterial meningitis
- colour
- WCC
- predominant WC
- protein
- glucose (CSF:blood)
- opening CSF pressure
cloudy / turbid
very high
neutrophils
very high
low
high
170
CSF in fungal meningitis
- colour
- WCC
- predominant WC
- protein
- glucose (CSF:blood)
- opening CSF pressure
fibrin web
normal / slightly high
lymphocytes
normal / slightly high
normal / slightly low
high / very high
171
CSF in TB meningitis
- colour
- WCC
- predominant WC
- protein
- glucose (CSF:blood)
- opening CSF pressure
cloudy and viscous
slightly high
lymphocytes
very high
very low
high
172
Tx of meningitis in GP
IM benzylpenecillin
999
173
Tx of meningitis in hospital
empirical IV ceftriaxone / cefotaxime
+ ampicillin if <3 months / >55y/o
174
2 other medications that can be added to meningitis ABx and why
dexamethasone if strep / h.influenzae
aciclovir if encephalitis can't be excluded
175
most common HHV cause of encephalitis
HSV1
176
who gets arbovirus encephalitis
travellers - no 1 cause worldwide
177
unvaccinated. measles as a child, now 10 years later has encephalitis. Dx?
(** measles = buzzword)
SSPE
subacute sclerosing panencephalitis
178
HIV + on monoclonal treatment, now has encephalitis. cause?
JC virus
** buzzword with HIV
179
what syndrome does JC virus cause
PML - progressive multifocal leucoencephalopathy
**buzzword with HIV
180
Tx of encephalitis
empirically treat with aciclovir
181
Ix for encephalitis
MRI
LP / CSF PCR
182
what kind of growth pattern is seen in brain abscess
mixed growth !! strep / staph + anaerobes
183
pt with HIV and brain abscess. Dx?
toxoplasmosis
** buzzword with HIV
184
Ix and result of brain abscess
MRI > CT
ring enhancing lesion
185
Mx of brain abscess
ABx - wide spectrum and anaerobic cover
surgical drainage
+/- steroids +/- anti seizures
186
23M Hx of STIs. PC fevers, pustular rash, red swollen knee and wrist. Organism?
neisseria gonorrhoea
187
most common STI
chlamydia
188
5 different PCs of chlamydia
often asymptomatic
STI Sx - pain passing urine, discharge change, PID
reactive arthritis
serovars L1-3 --> lymphogranuloma venereum
opthalmia neonatorum, 1-2wks of life
189
PC of lymphogranuloma venereum
proctitis
obviously, painful inguinal lymph nodes
190
who gets lymphogranuloma venereum
MSM
191
what is opthalmia neonatorum
neonatal conjunctivitis
192
ix of chalmydia
NAAT
NOT culture
193
tx of chlamydia
doxycycline >azithromycin
194
reactive arthritis features of chlamydia
keratoderma blenorrhagica (brown rash)
balanitis
195
4 different PCs of gonorrhoea
asymptomatic
STI Sx --> PID
disseminated gonococcal infection
opthalmia neonatorum
196
PC of disseminated gonoccoal infection
fever
migratory arthritis - painful knee --> wrist
pustular rash
tendonitis
197
how does opthalmia neonatorum differ in chlamydia and gonorrhoea
chlamydia = after first 1-2 weeks of life
gonorrhoea = after first few days of life
198
Ix of gonorrhoea
gold standard = culture
usually diagnosed with NAAT
199
Tx of gonorrhoea
IM ceftriaxone
200
cause of syphilis
treponema pallidum
201
stages of syphilis with Sx & buzzword for each
primary = *painless chancre* (ulcer)
secondary = unwell, *condyloma lata*, lymphadenopathy, maculopapular rash
latent = nothing
tertiary = *gummatous disease*, aortitis, neurosyphilis, tabes dorsalis
202
what are conyloma lata
greyish, painless, wart like lesions in genitals or mouth
** buzzword for secondary syphillis
203
what is gummatois disease
erosion through cartilage in mouth
204
classic buzzword sign of neurosyphilis
argyll robertson pupils
(accomodation but not constriction)
205
what is tabes dorsalis
degeneration of spinal cord
206
Tx of syphillis
IM benzylpenecillin
207
what reaction can occur upon Tx of syphillis and why
Jarish - Herxheimer reaction **buzzword
- killing of bacteria releases toxins that make pt feverish / unwell for a few days
208
where does the rash of secondary syphillus affect
palms and soles of feet
209
testing in primary syphillis
darkfield microscopy of chancre sample (** buzzword) and look under microscope
if not possible:
- non treponemal - VDRL, RPR
- treponemal - TPHA, TP-EIA
210
cons of non treponemal tests for primary syphillis
not specific for syphilis, can react to like HIV etc
211
cons on treponemal tests for syphilis
stay positive even after primary syphillis treated - can cause confusion in latent
212
how is adequate treatment of syphillis confirmed
4x reduction in non treponemal titre
213
organism causing chancroid
haemophilus ducreyi
214
buzzword for chancroid
painful ulcers
lymphadenopathy
tropical regions
215
organism causing donovanosis / granuloma inguinale
klebsiella granulomatis
216
buzzwords for donovanosis
painless beefy red ulcers
tropical regions
donovan bodies on histology
217
buzzwords for TV
yellow-green discharge
strawberry cervix
218
cause of genital warts
HPV
219
PC of HSV
painful ulcers with NO lymph nodes
