Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Year 5 Pathology > Micro > Flashcards

Micro Flashcards

1
Q

Main pathogens that cause SSIs

A

Surgical site infections:
Staphlococcus aureus (MSSA and MRSA)
Escherichia coli
Pseudomonas aeruginosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pathology and types of SSIs

A

Wound contamination

  • superficial incisional (skin and subcut. tissue)
  • deep incisional (fascial and muscle)
  • organ/space infection (any part of anatomy other than incision)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Mx of SSIs

A

Ix
- clinical + wound swabs

Tx
- abx; flucloxacillin for Staph

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Main pathogens that cause septic arthritis

A

Staphylococcus aureus

Streptococci
- pyogenes, pneumonia, agalactiae

Gram-negative
- Escherichia coli

Bacterial proliferation occurs in synovial fluid -> inflammatory response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Mx of septic arthritis

A

Ix

  • joint aspirate, MC&S
  • synovial count >50,000 WBC/ml
  • blood culture

Tx

  • IV abx
  • drain joint
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Risk factors for septic arthritis

A 
Rheumatoid arthritis
Osteoarthritis
Joint prosthesis
IVDU
Diabetes, CKD, CLD
Immunosuppression
Trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Main pathogen that causes osteomyelitis

A

Staphylococcus aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Mx of osteomyelitis

A

Ix

  • MRI (90% sensitive)
  • blood cultures
  • bone biopsy for culture/histology

Tx

  • IV abx, at least 6 weeks
  • 2nd line; debridement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What results in osteomyelitis?

A

Acute haematogenous spread of bacteria or exogenous spread (implantation during surgery)

Mainly localises into lumbar spine, can also localise in cervical spine causing back pain, fever, and neurological impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Main pathogen that causes prosthetic joint infection

A

Coagulase-negative staphylococci
Staphylococcus aureus
Escherichia coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Mx of prosthetic joint infection

A

Ix

  • XR/CT/MRI shows ‘loosening’
  • joint aspirate; CAUTION can cause infection if not already

Tx

  • IV abx
  • remove prosthesis and revise replacement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How may chronic osteomyelitis present?

A

Pain
Brodie’s abscess (within long bones)
Sinus tract of recurring infection in soft tissue over bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which abx drug class inhibit cell wall synthesis?

A

Beta-lactams

  • penicillins
  • cephalosporins (1-3 gens)
  • carbapenems

Glycopeptides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which abx drug class inhibit protein synthesis?

A

Aminoglycosides
Macrolides
Chloramphenicol
Oxazolidinones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which abx drug class inhibits DNA synthesis?

A

Fluoroquinolones

Nitroimidazoles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which abx drug class produces cell membrane toxins?

A

Polymyxin

Cyclic lipopetide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which abx drug class inhibits RNA synthesis?

A

Rifamycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which abx drug class inhibits folate metabolism?

A

Sulfonamides

Diaminopyrimidines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which abx are indicated for MRSA?

A

Glycopeptides

  • vancomycin
  • teicoplanin

Oxazolidinones
- linezolid

Cyclic lipopeptide
- daptomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which abx are indicated against gram positive bacteria?

A

Beta-lactams
- amoxicillin

Macrolides
- erythromycin (penicillin allergy)

Oxazolidinones
- linezolid

Cyclic lipopeptide
- daptomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which abx are indicated against gram negative bacteria?

A

3rd gen cephalosporin
- ceftriaxone

Carbapenems
- meropenem

Aminoglycosides (for sepsis)
- gentamicin

Fluoroquinolones
- ciprofloxacin

Polymyxin
- colistin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which abx are indicated for the following conditions:

a) C. diff
b) Chlamydia
c) Atypical pneumonia
d) Bacterial conjunctivitis
e) Anaerobes/protozoa
f) PCP
g) UTI

A

a) Glycopeptides; vancomycin, teicoplanin
b) Tetracycline; doxycycline
c) Macrolide; erythromycin
d) Chloramphenicol eye drops
e) Nitroimidazoles; metronidazole
f) Sulfonamide; sulphamethoxazole
g) Diaminopyrimidine; trimethoprim

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which abx are indicated for VRE?

A

Vancomycin resistant enterococci

Oxazolidinones
- linezolid

Cyclic lipopeptide
- daptomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Name broad spectrum abx

A

Co-amoxiclav (amox + clavulanic acid)

Tazocin (piperacillin + tazobactam)

Ciprofloxacin

Meropenem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Name narrow spectrum abx

A

Flucloxacillin
Metronidazole
Gentamicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Name the four mechanisms of abx resistance, including an example for each

A
  1. Bypasses abx-sensitive step in pathway, i.e. MRSA
  2. Enzyme-mediated drug inactivation, i.e. beta-lactams
  3. Impairment of accumulation of drug, i.e. tetracycline resistance
  4. Modification of drug’s target in microbe, i.e. quinolone resistance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Which abx is likely prescribed for a skin infection?

A

Flucloxacillin (unless allergic) against Staph. aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Which abx is likely prescribed for pharyngitis?

A

Benzylpenicillin against beta-haemolytic strep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which abx is likely prescribed for community-acquired pneumonia?

A

Amoxicillin if mild

co-amox + clarithromycin if severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Which abx is likely prescribed for hospital-acquired pneumonia?

A

Co-amox + gent/tazocin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Which abx is likely prescribed for bacterial meningitis?

A

Ceftriazone against meningococcus/streptococcus

Amox if listeria suspected (baby/old)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Which abx is likely prescribed for a UTI?

A

Community

  • Trimethoprim
  • Nitrofurantoin

Nosocomial

  • Co-amox
  • Cephalexin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Which abx is likely prescribed for sepsis?

A

Severe
- tazocin/cetriazone
+ metronidazole
+/- gentamicin

Neutropenic
- tazocin
+ gentamicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Which abx is likely prescribed for colitis?

A

Metronidazole against C. diff

Vancomycin 2nd line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Presentation of TB

A

Fever, night swears, wt loss, malaise
Cough, haemoptysis
More likely in immunosuppressed pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Ix for TB

A

CXR - upper lobe cavitation
Sputum samples x3 - microscopy, bronchoalveolar lavage
Tuberculin skin tests (Mantoux/Heaf) - show exposure
IGRA (Elispot/Quantiferon) - show exposure NOT BCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the gold-standard ix for TB?

A

Ziehl-Neelson stain for culture on Lowenstein-Jensen medium for 6 weeks -> acid fast bacilli seen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How may TB present in pts with immunosuppresion?

A

Subacute meningitis
- headache, personality change, meningism, confusion, LP diagnosis

Spinal (Pott’s disease)
- back pain, discitis, vertebral destruction, iliopsoas abscess

Miliary TB
- disseminated haematogenous spread

Pericarditis, peritonitis, renal, testicular, liver TB the list goes on…

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

TB risk factors

A 
Travel (South Asian/Eastern Europe) 
Recent migration
HIV+ 
Homeless
IVDU
Close contacts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

1st line TB tx

A

Rifampicin (6 months)
Isoniazid (6 months)
Pyrazinamide (2 months)
Ethambutol (2 months)

  • take three/four for 2 months
  • continue R and I for further 4 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

2nd line TB tx

A

Injectables (amikacin, kanamycin)
Quinolones
Linezolid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

TB prophylaxis tx

A

Isoniazid monotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What type of vaccine is BCG?

A

Bacille-Calmette-Guerin

  • attenuated strain of M. bocis
  • contraindicated in immunosuppression (live vaccine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Side effects of TB tx

A 
Rifampicin = orange secretions, CYP450 inducer, raised transaminases
Isoniazid = peripheral neuropathy, hepatotoxicity
Pyrazinamide = hepatotoxic
Ethambutol = optic neuritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Name four mycobacterial diseases

A

Leprosy (M. Leprae)
- skin pigmentation, nerve thickening, disability

Mycobacterium Avium-Intracellulare complex
- immunocompromised pts, disseminated infection

Mycobacterium Marinarum (fish tank granuloma)
- aquarium owners, papules/plaques
Mycobacterium ulcerans (Buruli ulcer)
- tropics/Australia, painless nodules progress to ulcers, scarring and contractures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Risk factors for reactivation of TB

A

Immunosuppression
Chronic alcohol excess
Malnutrition
Ageing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What classic lesions are seen in pulmonary TB?

A

Caseating granulomata found in lung parenchyma and mediastinal lymph nodes

Commonly in upper lobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What does the tuberculin skin test do?

A

Mantoux test

  • looks for previous exposure thus looks for latent TB
  • delayed-type hypersensitivity reaction
  • cross-reacts with BCG so can confuse interpretation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What do IGRAs do?

A

Interferon gamma release assays

  • detection of antigen specific IFN gamma production to measure how many activated T cells against specific TB antigens
  • no cross-reaction with BCG
  • does NOT distinguish between latent and active TB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Risk factors for infective endocarditis

A 
Long-term lines (i.e. ITU) 
IVDU
Poor dentition/dental abscess
Prosthetic valve
Rheumatic heart disease
Immunosuppression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Which pathogens are seen in acute infective endocarditis?

A

Acute -> high-virulence bacteria:

  1. Strep pyogenes (Group A Strep)
  2. Staph aureus (most common in IVDU)
  3. Coagulase-negative staphylococci (most common in prosthetic valve)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Which pathogens are seen in subacute infective endocarditis?

A

Subacute -> low-virulence bacteria:

  1. Staph epidermidis
  2. Strep viridans
  3. HACEK (uncommon and don’t grow on culture so consider if culture -ve)
    - Haemophilus, Acinetobacter, Cardiobacterium, Eikinella, Kingella
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

How can infective endocarditis be classified?

A 
Acute = fulminant illness, pt very unwell
Subacute = over weeks/months, pt less unwell, more signs O/E
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How can infective endocarditis be diagnosed?

A

Duke’s Criteria:
You need 2 major OR 1 major + 3 minor OR 5 minor criteria

Major

  • +ve blood culture growing typical organisms (>2x cultures >12hrs apart)
  • new regurgitant murmur or evidence of vegetation on ECHO

Minor

  • Risk factor
  • Fever > 38oC
  • Embolic phenomena
  • Immune phenomena
  • +ve blood culture not meeting major criteria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What embolic phenomena may you see in infective endocarditis?

A 
Janeway lesions
Splinter haemorrhages
Splenomegaly
Septic abscesses in lungs/brains/spleen/kidney
Microemboli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What immune phenomena may you see in infective endocarditis?

A

Roth spots
Osler’s nodes
Haematuria due to glomerulonephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Signs and sx of infective endocarditis

A

Fever
Anorexia, wt loss, malaise, fatigue, night sweats, SOB
New heart murmur, changes day to day, often regurgitant
Subacute will see embolic and immune phenomena

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Which valves are involved in infective endocarditits?

A

Usually involves mitral and aortic valves

R sided (tricuspid) is most common in IVDU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Tx for infective endocarditis

A

IV abx for ~6 weeks (local guidelines)

  • Acute = flucloxacillin
  • Subacute = benzylpenicillin + gentamycin
  • Prosthetic valve = vancomycin + gentamycin + rifampicin

Surgical debridement sometimes considered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How can UTIs be classified?

A

Uncomplicated vs complicated
- complicated = abnormal structure, men, catheters, pregnancy

Lower vs upper/pyelonephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Common pathogens causing UTIs

A

E. coli (can adhere to fimbriae)
Staph saphrophyticus (young women)
Proteus, Klebsiella (abnormal urinary tracts)
S aureus (haematogenous spread)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Presentation of UTI

A

Frequency, dysuria, abdo pain

  • elderly = non-specific, delirium falls
  • pyelonephritis = systemically unwell, fever + rigors, loin pain
  • urosepsis = sepsis due to UTI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Ix of UTI

A

Clinical dx if typical sx
Urine dip = +ve nitrites (specific) & leukocytes (non-specific)
Urine MCS = culture of >10^4 units/ml is diagnostic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Rx of UTI

A

Check local guidelines

  • lower UTI = nitrofurantoin, trimethoprim, cephalexin PO, 3d if uncomplicated, 7d if complicated/male
  • pyelonephritis = admit, IV co-amox + gent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What UTI would be -ve nitrite and +ve leucocyte on dipstick?

A

Non-coliform bacterium

*nitrites produced by E. coli, suggestive of coliforms present in urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Causes of sterile pyuria

A 
Prior tx with abx 
Calculi
Catheterisation 
Bladder neoplasm 
TB 
STI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Why can fungal infections be difficult to diagnose?

A

Slow growing

Can be masked by bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Yeast vs Mould

A

Yeasts
- single celled, reproduce by budding

Mould
- multicellular hyphae, grow by branching and extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What are fungi?

A

Eukaryotic organisms with chitinous cell walls and ergosterol plasma membranes

They take the form of yeasts or moulds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Which fungal infections are diagnosed by Wood’s Lamp examination?

A

Superficial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

How are deep seated fungal infections diagnosed?

A

Clinical details
Lab results
Imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Who is at risk of fatal fungal infections?

A

Immunocompromised, i.e. malignancy, HIV, burns patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Name two yeast fungal infections

A

Candida

Cryptococcus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Name two mould fungal infections

A

Dermatophytes

Aspergillus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Tx of candida

A

Fluconazole for C. albicans

Amphotericin-B for invasive disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Aspergillus presentation

A

Pneumonia (especially in immunocompromised)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Tx of aspergillus

A

Voriconazole/intraconazole

+ ambisome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Cryptococcus presentation

A

Meningitis with insidious onset in HIV

Associated with birds, particularly pigeons ew

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Tx of cryptococcus

A

3/52 amphotericin B

+/- flucytosine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What might India Ink staining of CSF show?

A

Cryptococcus fungal infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What is PCP?

A

Pneumocystic jirovecii

  • pneumonia
  • cough, SOB, desaturates when walking
  • associated with immunodeficiency, immunosuppressive drugs, severe protein malnutrition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What is the name for the following dermatophyte fungal infections affecting the following parts of the body?

a) Foot
b) Scalp
c) Groin
d) Abdomen

A

a) Tinea pedis
b) Tinea capitis
c) Tinea cruris
d) Tinea corporis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Which dermatophytes cause the following fungal infections?

a) Tinea pedis
b) Tinea capitis
c) Tinea cruris
d) Pityriasis versicolor

A

a) Trichophyton rubrum
b) Trichophyton rubrum, Tonsurans
c) Trichophyton rubrum, E. floccosum
d) Malassezia globosa/furfur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What do dermatophytes invade?

A

Dead keratin of skin, hair and nails

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Name the antifungal drug classes available

A 
Polyene
Azole
Terbinafine
Flucytosine (pyrimidine analogue)
Echinocandin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Which antifungals act against the cell membrane?

A

Polyene (integrity)
Azole (synthesis)
Terbinafine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Which antifungals act against DNA synthesis?

A

Flucytosine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Which antifungals act against the cell wall?

A

Echinocandin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Which antifungals are indicated for yeasts?

A

Polyene
Azole
Echinocandin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Which antifungals are indicated for moulds?

A

Terbinafine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

When is amphotericin B used?

A

Cryptococcal meningitis

Invasive fungal infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Presentation of STIs in men

A 
Asx 
Urethral discharge
Dysuria
Scrotal pain/swelling
Rash/sores
Systemic sx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Presentation of STIs in women

A 
Asx 
Vaginal discharge (+/- urethral, rectal)
Ulceration painful/painless
Itching/soreness 'lumps/growths'
Abnormal bleeding (IMB, PCB)
Abdo pain 
Dyspareunia 
Dysuria 
Systemic sx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Which STIs cause abnormal discharge?

A 
Gonorrhoea
Chlamydia 
Trichomonas
Candida
Bacterial Vaginosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Which STIs cause ulceration?

A 
Syphilis - painful 
HSV - painless
LGV
Chancroid
Donovanosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Which STIs cause rashes and lumps/growths?

A

Genital warts (HPV)
Molluscum contagiosum
Scabies
Pubic lice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Diagnosis and tx of gonorrhoea

A

Urethral (95% sensitive)/ rectal (20% sensitive) smear

Ceftriaxone IM - 250mg single dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Complication of gonorrhoea during pregnancy

A

During vaginal delivery, baby develops opthalmia neonatorum (neonatal conjunctivitis) if left untreated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What may you see in complicated infections of gonorrhoea?

A

Men
- prostatitis

Women

  • PID (salpingitis)
  • ascending infection

Pts with complement deficiencies
- disseminated infection: sepsis, rash, arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What would you see in an uncomplicated infection of gonorrhoea in a man?

A

Gonococcal urethritis
- mucoid/mucopurulent discharge

Post-gonococcal urethritis

  • occurs after
  • requires extra tetracycline to treat

Rectal proctitis
- seen in MSM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What would you see in an uncomplicated infection of gonorrhoea in a woman?

A

Mucopurulent cervicitis

  • erythema and oedema
  • urethra (vaginal leakage)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Obligate intracellular gram -ve diplococcus taken on urethral swab of man with mucopurulent discharge

Which pathogen is this?

A

Neisseria gonorrhoeae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Obligate intracellular gram -ve pathogen that cannot be cultured on agar found on genital swabs

Which pathogen is this?

A

Chlamydia trachomatis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

How is chlamydia classified?

A

Serovars A, B, C: trachoma (infection of eyes causing blindness)

Serovars D-K: genital chlamydia, opthalamia neonatorum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Diagnosis and tx of chlamydia

A

NAAT from genital swabs

Azithromycin 1g stat
OR
Doxycycline 100mg BD for 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Complications of chlamydia

A

PID: tubal factor infertility, ectopic pregnancy, chronic pelvic pain
Epididymitis
Reactive arthritis
Adult conjunctivitis, ophthalmia neonatorum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Which STI is commonly asx?

A

Chlamydia trachomatis

  • 50% men
  • 80% women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What is LGV?

A

Lympho-granuloma venereum

  • lymphatic infection with chlamydia trachomatis
  • endemic in developing world and MSM in developed world
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

1st stage sx of LGV

A 
3-12 days 
Painless genital ulcer 
Proctitis
Balanitis
Cervicitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

2nd stage sx of LGV

A

2wks-6months
Painful inguinal buboes
Fever
Malaise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Late stage sx of LGV

A

Inguinal lymphadenopathy
Genital elephantiasis
Genital and perianal ulcers/abscesses
Frozen pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Diagnosis and tx of LGV

A

NAAT, genotypic identification of L1/2/3 serovar

Doxycycline 100mg BD for 3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Haemophilus ducreyi, chocolate agar on culture

What is this and main sx of pt?

A

Chancroid (gram -ve coccobacillus)

Multiple painful ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Large beefy red ulces and donovon bodies on Giemsa stain

What is this and its tx?

A

Donovanosis = granuloma inguinale (Klebsiella granulomatis, gram _ve bacillus)

Azithromycin

115
Q

Name enteric pathogens that can cause STIs via the oro-anal route

A

Shigella
Salmonella
Giardia (protozoan)
Strongyloides

116
Q

What causes trichomoniasis?

A

Flagellated protozoan - T. vaginalis

117
Q

Sx of trichomoniasis

A

Men: usually asx, urethritis

Women: discharge, strawberry cervix

118
Q

Diagnosis and tx of trichomoniasis

A

Wet prep microscopy (flagellated organisms seen), PCR

Metronidazole

119
Q

What causes bacterial vaginosis?

A

Abnormal vaginal flora results in polymicrobial environment, reducing lactobacilli present

NOT transmitted, associated with sex and hygiene practices (soaps)

120
Q

Diagnosis and tx of BV

A

Microscopy of gram stain, raised pH, whiff test, clue cells

Lifestyle (no soaps, only water washing)
Metronidazole PO/topical

121
Q

Diagnosis and tx of candidiasis

A

Clinical - thick white discharge, itching, redness

Associated with immunodeficiency, hygiene practices

PO/topical antifungals

  • clotrimazole
  • fluconazole
122
Q

Name viral STIs

A

Hepatitis - HAV, HBV, HCV
Herpes
HIV

123
Q

Which pathogen causes genital warts?

A

dsDNA Human Papillomavirus

  • HPV 6, 11
  • NOT associated with cervical dysplasia
124
Q

Diagnosis and tx of genital warts

A

Clinical - papular, planar, pedunculated, carpet, keratinised, pigmented lesions

Home tx
- podophyllotoxin solution/cream (NOT for pregnant women)

Clinic tx

  • cryotherapy
  • imiquimod
125
Q

Which pathogen causes syphilis?

A

Treponema pallidum

126
Q

Describe treponema pallidum

A

Obligate gram -ve spirochaete

127
Q

Primary syphilis

A

Macule -> papule -> painless solitary genital ulcer

Appears 1-12 weeks after transmission

Can persist 4-6 weeks (chancre)

Regional adenopathy

128
Q

Secondary syphilis

A

Systemic bacteraemia 1-6 months after infection

Rash on palsm and soles

Condyloma acuminate (genital warts_

Mucosal lesions, uveitis

Neurological involvement

129
Q

Tertiary syphilis

A

2-30 years later, 3 syndromes:

  1. Gummatous
    - skin/bone/mucosa granulomas
    - spirochaetes scanty
  2. Cardiovascular
    - aortic root dilatation/aortitis
    - spirochaetes +++, inflammation +++
  3. Neurosyphilis
    - dementia, tabes dorsalis, Argyll-Robertson pupil
    - spirochaetes in CSF
130
Q

Diagnosis of syphilis

A

Treponemes seen in primary lesions by dark-ground microscopy

Antibody tests

  1. Non-treponemal = VDLR slide test, non-specific, useful in primary syphilis
  2. Treponemal = detects Abs against specific antigens, EIA/FTA/TPHA, remains +ve for years after tx
131
Q

Tx of syphilis

A

Single dose IM benzathine penicillin

  • doxycycline if allergic
  • monitor RPR for x4-fold reduction
132
Q

Side effect of syphilis tx

A

Jarisch-Herxheimer reaction

  • flu-like sx, exacerbation of syphilitic sx
  • develops within hours of taking abx
  • clears within 24hrs
133
Q

Causes of immunocompromise

A

Transplant
AIDS
Iatrogenic: chemotherapy/biologics
Rare genetic causes

134
Q

Which viruses cause more severe disease in the immunocompromised?

A

Herpesviridae
- CMV, EBV, HSV, HHV8, VZV

Polyomaviridae
- JC virus, BK virus

Respiratory
- influenza A & B, parainfluenza 1-6, RSV, adenovarius, MERS cornavirus

135
Q

Which fungi cause more severe disease in the immunocompromised?

A 
Candida
Cryptococci
Aspergillu
Dermatophytes
Mucormycosi
136
Q

Which organism can cause all of the following syndromes?

Catheter associated BSI
Urinary catheter associated UTI
Surgical site infection

137
Q

Which organism can cause all of the following syndromes?

Antibiotic associated diarrhoea

A

C. difficile

138
Q

Which organism can cause all of the following syndromes?

Urinary catheter associated UTI
Ventilator associated pneumonia

139
Q

Which organism can cause all of the following syndromes?

Catheter associated BSI
Surgical site infection

140
Q

Which organisms can cause all of the following syndromes?

Catheter associated BSI
Urinary catheter associated UTI
Surgical site infection
Ventilator associated pneumonia

A

Gram negatives

141
Q

Which organisms can cause all of the following syndromes?

Catheter associated BSI
Urinary catheter associated UTI

A

Yeasts/candida

142
Q

Most common syndromes of HAI

A

Hospital-acquired pneumonia

Surgical site infections

Urinary tract infections

143
Q

Predisposing factors for C. diff

A

Existing gut flora disturbed by abx, particularly by 3 Cs:

  • clindamycin
  • cephalosporins
  • ciprofloxacin
144
Q

When is clindamycin typically used?

A

Given to pts with penicillin allergy when they have cellulitis

145
Q

Why does C. diff result in diarrhoea?

A

Toxins produced after spore ingestion

Leads to pseudomembranous colitis

146
Q

Rx for C. diff

A

Oral metronidazole

147
Q

What are the three fibrous membranes that protect the CNS?

A

Pia mater
Arachnoid mater
Dura mater

148
Q

20yo woman presents with headache and neck stiffness

Gram +ve diplococci

Blood agar show alpha haemolysis

Dx?

A

Streptococcus pneumoniea meningitis

  • gram+ve alpha-haemolytic diplococcus
149
Q

18 yo man presents with headache and neck stiffness

CSF shows loads of neutrophils

Gram -ve diplococci with no haemolysis

Dx?

A

Meningococcus

- Neisseria meningitidis

150
Q

65 yo woman presents with headache and neck stiffness

Gram +ve rods

Dx?

A

Listeria monocytogenes

151
Q

45 yo presents with chronic headache and neck stiffness

Ziehl-Neelsen stain is red and blue

Dx?

A

TB meningitis

152
Q

Bacterial causes of meningitis

A

Neisseria meningitidis (gram -ve)

Streptococcus pneumoniea (gram +ve)

Haemophilus influenzae

Group B strep (elderly/neonates/immunocompromised)

Listeria monocytogenes (elderly/neonates/immunocompromised)

E. coli (neonates)

153
Q

Viral causes of meningitis

A

Enterovirus (coxsackie, echovirus)

Mumps

HSV2

154
Q

Fungal cause of meningitis

A

Cryptococcus neoformans (chronic)

155
Q

Meningitis that presents with headaches for months

A

TB

Cryptococcus

156
Q

Encephalitis summary

A

Inflammation of brain parenchyma

Sx: confusion, fluctuating consciousness

Commonly viral (HSV1)

Rx: IV acyclovir

157
Q

Brain abscess summary

A

Localised collection of infection

Sx: SOL, swinging fever

Commonly due to local extension (otitis media) or haematogenous spread (endocarditis)

158
Q

Organisms that cause bacteraemia

A

MRSA
Coag -ve staph
E. coli

159
Q

Risk factors for bacterial meningitis

A

Overcrowding
Very young/very old

N. meningitidis:

  • complement deficiency
  • hyposplenism
  • hypogammaglobulinaemia

S. pneumoniea:

  • complement deficiency
  • hyposplenism
  • immunosuppressed (alcoholic)
  • infection (pneumonia)
  • entry #
  • previous head trauma w/ CSF leak
160
Q

Rx for bacterial meningitis

A

Resuscitate!

IV ceftriaxone and corticosteroids

Cover Listeria with ampicillin

161
Q

Appearance: turbid
Glucose: low
White cells: high
Cell type: polymorphs

Dx?

A

Bacterial meningitis

162
Q

Appearance: clear
Glucose: normal
White cells: high
Cell type: mononuclear

Dx?

A

Viral meningitis

163
Q

Appearance: turbid
Glucose: normal
White cells: high
Cell type: polymorphs

Dx?

A

Partially treated bacterial meningitis

164
Q

Appearance: clear/turbid
Glucose: low
White cells: high
Cell type: mononuclear, protein present

Dx?

A

TB meningitis

165
Q

Describe viruses from the family Orthomyxoviridae

A

Enveloped virus
Wild-type virion, filamentous morphology
Negative sense segmented RNA genome (8 segments)

166
Q

Which 3 antigenically different flus affect humans and during which period of the year?

A 
Influenza A (H1) = peaks beginning January
Influenza A (H1N1) = peaks end December
Influenza B = peaks March
167
Q

Define antigenic drift

A

Accumulation of point mutations changing the nature of the antigen over time (drift)

168
Q

Define antigenic shift

A

Recombination of genomic segments during assembly and egress of two co-infecting flu strains

Leads to rapid potentially whole antigenic change for a viral strain (shift)

169
Q

Antivirals for influenza

A

Amantadine (Influenza A)

Neuraminidase inhibitors

  • oseltamivir (tamiflu)
  • zanamivir (relenza)
  • sialic acid
170
Q

Neuraminidase (sialidase) activity in viral RNA segments action

A

Cleaves sialic acid residues, allowing exit of virions from host cells, disrupting mucin barrier

171
Q

TORCH infections

A 
Toxoplasmosis 
Other (HIV, Hep B, syphilis) 
Rubella
CMV
HSV
172
Q

Presentation of congenital infection

A 
Thrombocytopenia 
Other (eyes/ears - cataracts, chorioretinitis)
Rash
Cerebral abnormality, i.e. microcephaly
Hepatosplenomegaly
173
Q

Early onset vs late onset neonatal sepsis defintion

A

Early onset = < 48 hours after birth

Late onset = > 48 hours after birth

174
Q

Early onset neonatal sepsis causative agents

A

Group B streptococci
E. coli
Listeria

175
Q

Late onset neonatal sepsis causative agents

A

Coagulase -ve staph + GBS
E. coli
Listeria

176
Q

Abx tx in early onset neonatal sepsis

A

BenPen + gentamicin

Amox/ampicillin if Listeria

177
Q

Abx tx in late onset neonatal sepsis

A

1st line = benzylpenicillin + gentamicin
2nd line = tazoxin + vancomycin
Community = amox + cefotaxime (BenPen given in GP)

178
Q

Ddx in fever in a returning traveller

A 
Malaria
Typhoid 
Dengue
Viral haemorrhagic fever
Bacterial diarrhoea (E. coli, cholera)
179
Q

Typhoid pathogens

A

Salmonella typhi and paratyphi

180
Q

Anaerobic gram -ve bacilli in pt returning from India with fever

A

Salmonella typhi

- causes enteric fever

181
Q

Fever, constipation, rose spots in pt returning from India

What rx needed?

A

Typhoid!

IV ceftriaxone then PO azithromycin

182
Q

Dengue pathogen

A

Flavivirus spread by Ades mosquito

183
Q

Pt comes back from Thailand with fever, myalgia, and rash

Top ddx?

A

Dengue

- consider dengue haemorrhagic fever/dengue shock syndrome if re-infected

184
Q

Malaria pathogen

A

Plasmodium spp. (protozoal infection) spread by female Anopheles mosquito

185
Q

Features of severe falciparum malaria

A 
Impaired consciousness/seziures
Renal impairment
Acidosis
Hypoglycaemia
Anaemia
Spontaneous bleeding/DIC
Shock
Haemoglobinuria (without G6PDD)
186
Q

Non-falciparum malaria species

A

Plasmodium

  • vivax
  • ovale
  • malariae
  • knowlesi

Less severe, Schuffners dots on blood film

187
Q

Tx of falciparum malaria

A

Mild
- artemesin combination therapy (Riamet - aremether + lumefantrine)

Severe
- IV artesunate (1st line - quinolone if 1st line not available)

188
Q

Tx of non-falciparum malaria

A

Chloroquine then primaquine

189
Q

Postive ix for falciparum malaria

A

THREE Thick and thin blood films

  • thick = identify malaria
  • thin = identify species

Field’s or Giemsa stain

190
Q

Which pathogens should you consider in the UK from the following types of animals?

a) Farm/wild
b) Companion

A

a) Campylobacter, Salmonella

b) Bartonella, Toxoplasmosis, Ringworm, Psittacosis

191
Q

Which pathogens should you consider in tropical areas/outside the UK from the following types of animals?

a) Farm/wild
b) Companion

A

a) Brucella, Coxiella, Rabies, VHF

b) Rabies, Tick-borne diseases, Spirillum minus

192
Q

Farmer comes in with fever worse in the evenings, arthritis, and hepatosplenomegaly

Cultures show gram -ve aerobic bacilli

What is ddx?

A

Brucellosis

  • contaminated milk/dairy products
  • direct contact w cows, goats, sheep, pigs
193
Q

Farmer comes in with fever worse in the evenings, arthritis, and hepatosplenomegaly

Cultures show gram -ve aerobic bacilli

What is tx?

A

Brucellosis

- 4-6 weeks doxycycline + streptomycin

194
Q

Negri bodies on serology in pt presenting with fever, sore throat, and headache

Diagnosis?

A

Rabies
- eosinophilic, sharply outlined, pathognomonic inclusion bodies found in the cytoplasm of certain nerve cells containing the virus of rabies, especially in pyramidal cells within Ammon’s horn of the hippocampus

195
Q

Plague pathogen

A

Yersinia pestis

  • gram-ve lactose fermenter
  • still in American National Parks, i.e. Yosemite
196
Q

Pt presents with high fever, red conjunctiva, and jaundice

They recently went on holiday and swam in a still body of water in an area full of stray dogs and a rat problem

Most likely pathogen?

A

Leptospirosis interrogans

  • gram -ve
  • obligate, aerobic, motile spirochaetes
197
Q

Compare cutaeneous and pulmonary presentations of anthrax

A

Cutaneous
- painless round black lesions + rim of oedema

Pulmonary
- massive lymphadenopathy + mediastinal haemorrhage

198
Q

Lyme disease pathogen

A

Borrelia burgdoferi (spirochaete)

  • Arthropod-borne
  • Ixodes = tick
199
Q

Pt presents with expanding ring of redness on their leg after a hike in Richmond Park, and flu-like sx

Which tx do they need?

A

Lyme disease
- erythema chronicum migrans (bullseye rash)

Doxycycline 2-3 weeks (also amox, cephalosporins)
- CNS issues, IV cef 2-4 weeks

200
Q

Vet presents with a dry cough, high fever, aching muscles

No rashes on O/E and does not respond to initial abx tx for CAP

Potential pathogen and next abx px?

A

Q fever
- Coxiella burnetii

Doxycycline

201
Q

Rat Bite fever pathogens

A

Streptobacillus moniliformis (USA)

Spirillum minus (Asia/Africa)

*from rat bites, contact with infected urine or droppings

202
Q

Which protozoa pathogen cause the following types of Leishmania?

a) Cutaneous
b) Diffuse cutaneous
c) Muco-cutaneous
d) Visceral

A

a) L. major, L tropica
b) “ “
c) L. braziliensis
d) L. donovani, L. infantum, L. chagasi in S. America

203
Q

CAP organisms

A 
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus
Klebsiella pneumoniae
204
Q

Main causes of cavitation on CXR

A

Staphylococcus aureus
Klebsiella pneumoniae
TB

205
Q

Atypical pneumonia causes

A 
Legionella pneumophilia 
Mycoplasma pneumoniae 
Chlamydia pneumoniae 
Chlamydia psittaci 
Coxiella burnetii
206
Q

Which pneumonia has extra-pulmonary features? Include what they are

A

Atypical pneumonia

  • hepatitis
  • hyponatraemia
207
Q

Cough, fever, rusty-coloured sputum

Micro: +ve diplococci

A

Streptococcus pneumoniae

208
Q

Cough, fever, smoker with COPD background

Micro: -ve cocco-bacilli

A

Haemophilus influenzae

209
Q

Cough, fever, smoker

Micro: -ve cocci

A

Moraxella catarrhalis

210
Q

Post-influenza cough, fever

Micro: +ve cocci “grape-bunch clusters”

A

Staphylococcus aureus

211
Q

Cough, fever, haemoptysis, alcoholic

Micro: -ve rod, enterobacter

A

Klebsiella pneumoniae

212
Q

Travel, air conditioning, water towers pneumonia pathogen

A

Legionella pneumophilia

213
Q

Uni students, dry cough, arthralgia with autoimmune haemolytic anaemia and erythema multiforme pneumonia pathogen

A

Mycoplasma pneumoniae

214
Q

Pathogens seen in HIV pts

A

Pneumocystis jiroveci
TB
Cryptococcus neogormans

215
Q

Pathogens seen in splenectomy pts

A

Encapsulated organisms

  • Haemophilus influenzae
  • Streptococcus pneumoniae
  • Neisseria meningitis
216
Q

Pathogens seen in CF pts

A

Pseudomonas aeruginosa

Burkholderia cepacia

217
Q

Pathogens seen in neutropenia pts

A

Aspergillus

218
Q

Tx of mild pneumonia

A

CURB 0-1
= Amoxicillin PO 5d
= 2nd line/pen allergy: macrolide PO 5d
= outpatient

219
Q

Tx of moderate pneumonia

A

CURB 2
= Amoxicillin PO 5-7d + clarithromycin PO 5-7d
= consider admission

220
Q

Tx of severe pneumonia

A

CURB 3-5
= Co-amoxiclav IV 7d + clarithromycin IV 7d
= Admit +/- consider ITU

221
Q

CURB 65 scoring

A

1 point for:

  • Confusion
  • Urea
  • RR > 30
  • BP < 90/60
  • > /= 65
222
Q

Tx of HAP

A

Depends on trust guidelines, generally:

1st line
- ciprofloxacin + vancomycin

Severe
- tazocin + vancomycin

Aspiration
- tazocin + metronidazole

223
Q

What do raised marker 14-3-3 protein S100 represent?

A

Rapid neurodegeneration

224
Q

Where is the prion protein gene?

A

Chr 20, predominately expressed in CNS

225
Q

CJD tx

A

Symptomatic

  • clonazepam for myoclonus
  • valproate, levetiracetam, piracetam

Delaying prion ‘conversion’
- quinacrine, pentosan, tetracycline

226
Q

Genetic mutations seen in CJD

A

Codon 129 polymorphism

Specific PRNP mutations

227
Q

Rapid, progressive dementia with myoclonus, cortical blindness, akinetic mutsim and lower motor neuron signs

What is this condition and its typical onset and prognosis?

A

Sporadic CJD (80% cases)

Mean onset 45-75 yrs and mean survival time within 6/12 of sx starting

228
Q

Anxiety, paranoia, hallucinations followed by development of peripheral sensory sx, ataxia, and myoclonus

What is this condition and its typical onset and prognosis?

A

Acquired variant CJD

Younger age of onset, typically < 30 yrs

Later sx: choreo, ataxia, dementia (not great)

229
Q

Presents with progressive ataxia after a surgery that leads onto dementia and myoclonus later on

What is this condition and its aetiology?

A

Acquired iatrogenic CJD

Inoculation with human prions

  • from surgery
  • from transfusions
230
Q

Progressive cerebellar syndrome with dementia sx at end stage of disease

What is this condition and its prognosis?

A

Acquired kuru CJD
- result of exposure to human prions via cannibalism following 45 yr incubation

Death within 2 years

231
Q

Dysarthria starts around 30 years old and progresses to cerebellar ataxia ending ini dementia

What is this condition and how is it passed on?

A

Gerstmann-Straussler-Scheinker syndrome (inherited prion disease)
- familail CJD, GSS, FFI, atypical dementia

Autosomal dominant

20-60 yr onset, mean survival = 5 yrs

232
Q

Insomnia and paranoia progresses to hallucinations and weight loss. Pt is then mute and dies after 6 months of sx onset

What is this condition and how is it passed on?

A

Fatal Familial Insomnia (inherited prion disease)
- PRNP mutations

Autosomal dominant

Death 1-18/12 after sx onset

233
Q

Secretory diarrhoea clinical syndrome

A

Toxin production => Cl- secreted into lumen => loss of water and electrolytes => D&V

Watery diarrhoea, no fever

234
Q

Inflammatory diarrhoea clinical syndrome

A

Inflammation and bacteraemia

Bloody diarrhoea (dysentry) and fever

235
Q

Enteric fever clinical syndrome

A

Unwell with fever, fewer GI symptoms

236
Q

Student eats canned packed beans and later has D&V followed by descending paralysis

Which organism is this?

A

Clostridium botulinum

- antitoxin is tx

237
Q

Reheated meat consumed and 8 hours later patient has watery diarrhoea and cramps lasting for an entire day but presents to A&E due to blackening of right leg and extreme pain

Which organism is this?

A

Clostridium perfringens

- gas gangrene!! emergency!!

238
Q

Which abx cause pseudomembranous colitis?

A

Cephalosporins
Ciprofloxacin
Clindamycin
Co-amoxiclav

239
Q

C diff tx

A

1st: metronidazole
2nd: vancomycin

240
Q

Sudden D&V, no blood in stool and instead very watery. Patient noted to have had chinese takeout last night.

Which organism is this?

A

Bacillus cereus

  • self-limiting
  • reheated rice, short incubation round 4 hours
241
Q

Prominent vomiting and watery diarrhoea. Stool cultures show gram +ve clusters of cocci

Which organism is this?

A

Staph aureus

242
Q

What do the following types of E. coli syndromes cause?

a) ETEC
b) EIEC
c) EHEC
d) HUS
e) EPEC

A

a) toxigenic - traveller’s diarrhoea
b) invasive dysentery
c) haemorrhagic
d) anaemia, thrombocytopenia, renal failure (0157:H7 toxin)
e) infantile diarrhoea (Paeds)

243
Q

Fever, constipation and rose spots noted. What is organism and tx?

A

Salmonella typhi/paratyphi

IV ceftriaxone then PO azithromycin

244
Q

Uncooked meat and eggs eaten at BBQ, leading to non-bloody diarrhoea

Which organism is this?

A

Salmonella enteritides

245
Q

What does shigella affect?

A

Distal ileum and colon

  • > mucosal inflammation
  • > fever, pain
  • > bloody diarrhoea
246
Q

Rice water stool, what is the shape of the organism?

A

Vibrio cholera

- comma shaped bacteria

247
Q

Organism common in Japan that can cause D&V after consumption of raw seafood

A

Vibrio parahaemolyticus

248
Q

Organism that causes cellulitis in shellfish handlers

A

Vibrio vulnificus

249
Q

Chicken at BBQ eaten then patient felt a bit unwell, eventually followed by abdo cramps and bloody diarrhoea

Which organism is this?

A

Campylobacter jejuni

- lasts around 10 days

250
Q

Complications of campylobacter infection

A

GBS

Reactive arthritis

251
Q

Campylobacter tx

A

Erythromycin or cipro if in first 5 days

252
Q

Elderly man on long-term steroids eats unpasteurised dairy and presents with nasty D&V

Which organism is this?

A

Listeria monocytogenes

- severe infection in immunocompromised, pregnant, neonates

253
Q

Listeria tx

A

Ampicillin

254
Q

Patient presents with dysentery, flatulence, and tenesmus

Flask-shaped ulcer on histology of colon

Which organism is this?

A

Entamoeba histolytica

- more common in MSM

255
Q

Patient presents with foul-smelling non-bloody diarrhoea. Recent history of hiking for the past week

Pear-shaped trophozoite on histology

Which organism is this?

A

Giardia lamblia

- affect travellers, hikers, residential homes, psych inpatients, MSM

256
Q

Entamoeba histolytica tx

A

Metronidazole

257
Q

Giardia tx

A

Metronidazole

258
Q

Severe diarrhoea in immunocompromised caused by a protozoa

A

Cryptosporidium parvum

- tx: paromomycin

259
Q

What viruses cause D&V?

A 
Norovirus
- adults
Adenovirus
- < 2 years old
Rotavirus
- < 6 years old

*all cause secretory diarrhoea

260
Q

HSV tx

A

1st line: Acyclovir
2nd line: Valaciclovir

PO first, IV severe

261
Q

VZV tx

A

Acyclovir 800mg PO TDS 7/7 or
Valaciclovir 1g TDS
or
VZIG post-exposure for immunocompromised/pregnant women

262
Q

VZV congenital infection

A

Eyes: chorioretinitis, cataracts
Neurological: microcephaly, cortical atrophy
MSK/skin: limb hypoplasia, cutaneous scarring

263
Q

VZV neonate infection

A

Purpura fulminans
Visceral infection
Pneumonitis

264
Q

Shingles tx

A 
Aciclovir 800mg PO x5 daily
Famciclovir 250mg PO TDS 
Valaciclovir 1g PO TDS 
Topical eye drops 
PEP 7-9/7 for immunocompromised
265
Q

CMV congenital infection

A 
Ears: sensorineural deafness
Eyes: chorioretinitis
Heart: myocarditis
Neurology: microcephaly, encephalitis
Lung: pneumonitis
Liver: hepatitis, jaundice, hepatosplenomegaly
266
Q

CMV tx

A

1st line
= ganciclovir IV
= valganciclovir PO

2nd line
= foscarnet IV (nephrotoxic)

3rd line
= cidofovir IV

IVIg if pneumonitis present

267
Q

Which abx should you avoid in EBV infection?

A

Penicillin

= provoke widespread maculopapular rash known as infectious mononucleosis exanthema

268
Q

Which virus causes Kaposi’s sarcoma?

269
Q

Name two polyomaviridae viruses

A

JC virus
BK virus

Occurs in immunocompromised patients!

270
Q

JC virus features and tx

A

Progressive multifocal leukoencephalopathy
Rapidly demyelinating disease with neurological deficits

Tx: Anti-retrovirals

271
Q

BK virus features and tx

A

BK haemorrhagic cystitis
BK nephropathy

Tx: Cidofovir

272
Q

Influenza tx

A

Oseltamivir (tamiflu)

273
Q

Adenovirus tx if multiorgan involvement

A

Cidofovir, IVIG

274
Q

Hep B drug tx

A
  1. Interferon alpha
  2. Lamivudine
  3. Entecavir
  4. Telbivudine
  5. Tenofovir

2-5 = nucleoside analogues

275
Q

Hep C drug tx

A

Initially interferon therapy (Peg INF-alpha 2b/2a)

Then direct acting antivirals:
1. NS3/4 protease inhibitors (-previrs; block translation)

  1. NS5A inihbitors (-asvirs; block release)
  2. Direct polymerase inhibitors (-buvirs; block replication)
276
Q

Hep D drug tx

A

Peginterferon-alpha

277
Q

Congenital rubella syndrome

A

Ears: sensorineural deafness
Eyes: cataracts, glaucoma, retinopathy, microphthalmia
Heart: PDA, VSD
Neurology: microcephaly, psychomotor retardation
Pancreas: insulin dependent DM (late)

278
Q

Parovirus B19 congenital infection

A

Foetal anaemia
Cardiac failure
Hydrops foetalis

279
Q

What does morbillivirus cause?

280
Q

Congenital zika infection

A 
Severe microcephaly & skull deformity 
Decreased brain tissue, subcortical calcification
Retinopathy, deafness
Talipes, contractures
Hypertonia
281
Q
  1. Anti-HAV IgM
  2. Anti-HAV IgG

What would you expect to see for Hep A in the following?

a) acute infection
b) previous infection
c) vaccinated

A
  1. Anti-HAV IgM
  2. Anti-HAV IgG

a) 1. + 2. -
b) 1. - 2. +
c) 1. - 2. +

282
Q
  1. Anti-HEV IgM
  2. Anti-HEV IgG

What would you expect to see for Hep E in the following?

a) acute infection
b) previous infection
c) vaccinated

A
  1. Anti-HAV IgM
  2. Anti-HAV IgG

a) 1. + 2. -
b) 1. - 2. +
c) Not yet widely available, tricked u bb

283
Q
  1. Anti-HCV IgG
  2. HCV RNA

What would you expect to see for Hep C in the following?

a) acute infection
b) previous infection
c) chronic infection

A
  1. Anti-HCV IgG*
  2. HCV RNA

a) 1. - 2. +
b) 1. + 2. -
c) 1. + 2. +
* note: utility still widely contested, not commonly used

284
Q
  1. HBsAg
  2. Anti-HBc (core antigen)
  3. IgM anti-HBc
  4. Anti-HBs (surface antigen)

What would you expect to see for Hep B in the following?

a) acute infection
b) chronic infection
c) previous infection
d) vaccinated

A
  1. HBsAg
  2. Anti-HBc
  3. IgM anti-HBc
  4. Anti-HBs

a) 1. + 2. + 3. - 4. -
b) 1. + 2. + 3. + 4. -
c) 1. + 2. - 3. - 4. -
d) 1. - 2. - 3. + 4. +

Year 5 Pathology (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions