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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

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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)
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3
Q

Mx of SSIs

A

Ix
- clinical + wound swabs

Tx
- abx; flucloxacillin for Staph

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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

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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
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6
Q

Risk factors for septic arthritis

A 
Rheumatoid arthritis
Osteoarthritis
Joint prosthesis
IVDU
Diabetes, CKD, CLD
Immunosuppression
Trauma
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7
Q

Main pathogen that causes osteomyelitis

A

Staphylococcus aureus

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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
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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

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10
Q

Main pathogen that causes prosthetic joint infection

A

Coagulase-negative staphylococci
Staphylococcus aureus
Escherichia coli

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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
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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

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13
Q

Which abx drug class inhibit cell wall synthesis?

A

Beta-lactams

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

Glycopeptides

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14
Q

Which abx drug class inhibit protein synthesis?

A

Aminoglycosides
Macrolides
Chloramphenicol
Oxazolidinones

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15
Q

Which abx drug class inhibits DNA synthesis?

A

Fluoroquinolones

Nitroimidazoles

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16
Q

Which abx drug class produces cell membrane toxins?

A

Polymyxin

Cyclic lipopetide

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17
Q

Which abx drug class inhibits RNA synthesis?

A

Rifamycin

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18
Q

Which abx drug class inhibits folate metabolism?

A

Sulfonamides

Diaminopyrimidines

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19
Q

Which abx are indicated for MRSA?

A

Glycopeptides

  • vancomycin
  • teicoplanin

Oxazolidinones
- linezolid

Cyclic lipopeptide
- daptomycin

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20
Q

Which abx are indicated against gram positive bacteria?

A

Beta-lactams
- amoxicillin

Macrolides
- erythromycin (penicillin allergy)

Oxazolidinones
- linezolid

Cyclic lipopeptide
- daptomycin

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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

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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

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23
Q

Which abx are indicated for VRE?

A

Vancomycin resistant enterococci

Oxazolidinones
- linezolid

Cyclic lipopeptide
- daptomycin

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24
Q

Name broad spectrum abx

A

Co-amoxiclav (amox + clavulanic acid)

Tazocin (piperacillin + tazobactam)

Ciprofloxacin

Meropenem

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25
Q

Name narrow spectrum abx

A

Flucloxacillin
Metronidazole
Gentamicin

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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
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27
Q

Which abx is likely prescribed for a skin infection?

A

Flucloxacillin (unless allergic) against Staph. aureus

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28
Q

Which abx is likely prescribed for pharyngitis?

A

Benzylpenicillin against beta-haemolytic strep

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29
Q

Which abx is likely prescribed for community-acquired pneumonia?

A

Amoxicillin if mild

co-amox + clarithromycin if severe

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30
Q

Which abx is likely prescribed for hospital-acquired pneumonia?

A

Co-amox + gent/tazocin

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31
Q

Which abx is likely prescribed for bacterial meningitis?

A

Ceftriazone against meningococcus/streptococcus

Amox if listeria suspected (baby/old)

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32
Q

Which abx is likely prescribed for a UTI?

A

Community

  • Trimethoprim
  • Nitrofurantoin

Nosocomial

  • Co-amox
  • Cephalexin
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33
Q

Which abx is likely prescribed for sepsis?

A

Severe
- tazocin/cetriazone
+ metronidazole
+/- gentamicin

Neutropenic
- tazocin
+ gentamicin

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34
Q

Which abx is likely prescribed for colitis?

A

Metronidazole against C. diff

Vancomycin 2nd line

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35
Q

Presentation of TB

A

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

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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

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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

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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…

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39
Q

TB risk factors

A 
Travel (South Asian/Eastern Europe) 
Recent migration
HIV+ 
Homeless
IVDU
Close contacts
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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
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41
Q

2nd line TB tx

A

Injectables (amikacin, kanamycin)
Quinolones
Linezolid

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42
Q

TB prophylaxis tx

A

Isoniazid monotherapy

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43
Q

What type of vaccine is BCG?

A

Bacille-Calmette-Guerin

  • attenuated strain of M. bocis
  • contraindicated in immunosuppression (live vaccine)
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44
Q

Side effects of TB tx

A 
Rifampicin = orange secretions, CYP450 inducer, raised transaminases
Isoniazid = peripheral neuropathy, hepatotoxicity
Pyrazinamide = hepatotoxic
Ethambutol = optic neuritis
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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
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46
Q

Risk factors for reactivation of TB

A

Immunosuppression
Chronic alcohol excess
Malnutrition
Ageing

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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

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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
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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
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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
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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)
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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
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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
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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
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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
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56
Q

What immune phenomena may you see in infective endocarditis?

A

Roth spots
Osler’s nodes
Haematuria due to glomerulonephritis

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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

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58
Q

Which valves are involved in infective endocarditits?

A

Usually involves mitral and aortic valves

R sided (tricuspid) is most common in IVDU

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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

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60
Q

How can UTIs be classified?

A

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

Lower vs upper/pyelonephritis

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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)

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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
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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

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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
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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

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66
Q

Causes of sterile pyuria

A 
Prior tx with abx 
Calculi
Catheterisation 
Bladder neoplasm 
TB 
STI
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67
Q

Why can fungal infections be difficult to diagnose?

A

Slow growing

Can be masked by bacteria

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68
Q

Yeast vs Mould

A

Yeasts
- single celled, reproduce by budding

Mould
- multicellular hyphae, grow by branching and extension

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69
Q

What are fungi?

A

Eukaryotic organisms with chitinous cell walls and ergosterol plasma membranes

They take the form of yeasts or moulds

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70
Q

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

A

Superficial

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71
Q

How are deep seated fungal infections diagnosed?

A

Clinical details
Lab results
Imaging

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72
Q

Who is at risk of fatal fungal infections?

A

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

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73
Q

Name two yeast fungal infections

A

Candida

Cryptococcus

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74
Q

Name two mould fungal infections

A

Dermatophytes

Aspergillus

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75
Q

Tx of candida

A

Fluconazole for C. albicans

Amphotericin-B for invasive disease

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76
Q

Aspergillus presentation

A

Pneumonia (especially in immunocompromised)

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77
Q

Tx of aspergillus

A

Voriconazole/intraconazole

+ ambisome

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78
Q

Cryptococcus presentation

A

Meningitis with insidious onset in HIV

Associated with birds, particularly pigeons ew

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79
Q

Tx of cryptococcus

A

3/52 amphotericin B

+/- flucytosine

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80
Q

What might India Ink staining of CSF show?

A

Cryptococcus fungal infection

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81
Q

What is PCP?

A

Pneumocystic jirovecii

  • pneumonia
  • cough, SOB, desaturates when walking
  • associated with immunodeficiency, immunosuppressive drugs, severe protein malnutrition
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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

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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

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84
Q

What do dermatophytes invade?

A

Dead keratin of skin, hair and nails

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85
Q

Name the antifungal drug classes available

A 
Polyene
Azole
Terbinafine
Flucytosine (pyrimidine analogue)
Echinocandin
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86
Q

Which antifungals act against the cell membrane?

A

Polyene (integrity)
Azole (synthesis)
Terbinafine

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87
Q

Which antifungals act against DNA synthesis?

A

Flucytosine

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88
Q

Which antifungals act against the cell wall?

A

Echinocandin

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89
Q

Which antifungals are indicated for yeasts?

A

Polyene
Azole
Echinocandin

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90
Q

Which antifungals are indicated for moulds?

A

Terbinafine

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91
Q

When is amphotericin B used?

A

Cryptococcal meningitis

Invasive fungal infection

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92
Q

Presentation of STIs in men

A 
Asx 
Urethral discharge
Dysuria
Scrotal pain/swelling
Rash/sores
Systemic sx
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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
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94
Q

Which STIs cause abnormal discharge?

A 
Gonorrhoea
Chlamydia 
Trichomonas
Candida
Bacterial Vaginosis
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95
Q

Which STIs cause ulceration?

A 
Syphilis - painful 
HSV - painless
LGV
Chancroid
Donovanosis
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96
Q

Which STIs cause rashes and lumps/growths?

A

Genital warts (HPV)
Molluscum contagiosum
Scabies
Pubic lice

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97
Q

Diagnosis and tx of gonorrhoea

A

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

Ceftriaxone IM - 250mg single dose

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98
Q

Complication of gonorrhoea during pregnancy

A

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

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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

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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

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101
Q

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

A

Mucopurulent cervicitis

  • erythema and oedema
  • urethra (vaginal leakage)
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102
Q

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

Which pathogen is this?

A

Neisseria gonorrhoeae

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103
Q

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

Which pathogen is this?

A

Chlamydia trachomatis

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104
Q

How is chlamydia classified?

A

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

Serovars D-K: genital chlamydia, opthalamia neonatorum

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105
Q

Diagnosis and tx of chlamydia

A

NAAT from genital swabs

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

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106
Q

Complications of chlamydia

A

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

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107
Q

Which STI is commonly asx?

A

Chlamydia trachomatis

  • 50% men
  • 80% women
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108
Q

What is LGV?

A

Lympho-granuloma venereum

  • lymphatic infection with chlamydia trachomatis
  • endemic in developing world and MSM in developed world
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109
Q

1st stage sx of LGV

A 
3-12 days 
Painless genital ulcer 
Proctitis
Balanitis
Cervicitis
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110
Q

2nd stage sx of LGV

A

2wks-6months
Painful inguinal buboes
Fever
Malaise

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111
Q

Late stage sx of LGV

A

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

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112
Q

Diagnosis and tx of LGV

A

NAAT, genotypic identification of L1/2/3 serovar

Doxycycline 100mg BD for 3 weeks

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113
Q

Haemophilus ducreyi, chocolate agar on culture

What is this and main sx of pt?

A

Chancroid (gram -ve coccobacillus)

Multiple painful ulcers

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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

A

MRSA

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

A

E. coli

139
Q

Which organism can cause all of the following syndromes?

Catheter associated BSI
Surgical site infection

A

MSSA

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?

A

HHV8

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?

A

Measles!!

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)

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