Micro Flashcards
HIV positive pt with dry cough and sob. Gomori’s methanamine silver stain shows flying saucer shaped cysts on microscopy. CXR shows diffuse bilateral pulmonary infiltrates
Pneumocystis jirovecii
Rusty coloured sputum with lobar consolidation on CXR
Streptococcus pneumoniae
Streptococcus pneumoniae under microscope
Gram positive diplococcus
Pneumonia post flu infection, cavitation on CXR
Staphylococcus Aureus
Staphylcoccus aureus under miscroscope
Gram positive coccus in grape shaped clusters
Smoker with history of COPD has pneumonia
Moraxella catarrhalis, haemophilus influenzae
Moraxella catarrhalis under microscope
Gram negative diplococcus
Haemophilus influenzae under microscope
Gram genative bacilli
Elderly alcoholic pt presents with pneumonia, haemoptysis
Klebsiella pneumoniae
Klebsiella pneumoniae under microscope
Gram negative rod
Pt with headache, myalgia, hyponatraemia, deranged LFTs, hypophosphataemia. Just spent a week in a hotel.
Legionella Pneumophila (atypical penumonia)
Legionella pneumophila under microscope
Gram negative rod
University student with flu like symptoms, erythema multiforme. Cold-agluttinin positive.
Mycoplasma pneumoniae (atypical pneumonia)
Mycoplasma pneumoniae under microscope
Obligate intracellular
Patient with exotic parrot, pneumonia, splenomegaly
Chlamydia psittaci (atypical pneumonia)
Chlamydia psittaci under microscope
Intracellular
Pt w/ fever, haemoptysis, weight loss, night sweats. CXR shows bihilar lymphadenopathy, upper lobe cavitation. Ziehl-Neelson stain reveals acid fast bacilli. Cultured on Lowenstein-Jensen medium over 6 weeks.
Mycobacterium tuberculosis
TB treatment
6 months Rifampicin
6 months Isoniazid
2 months Pyrazinamide
2 months Ethambutol
Man has watery diarrhoea, abdo cramps, headache and fever after eating unpasteurised dairy.
Listeria monocytogenes
Listeria monocytogenes under microscope
gram positive rod
Man comes back from India with bloody diarrhoea and renal failure
escherichia coli
escherichia coli under microscope
gram negative rod
Rice water diarrhoea without inflammatory cells, after eating shellfish
Vibrio cholerae
Vibrio cholerae under microscope
comma shaped
Homosexual man/ traveller with non-bloody steatorrhoea. Cysts seen in stool under microscopy
Giardia lamblia
Giardia lamblia under microscope
pear-shaped trophozite
Slow onset fever, myalgia, constipation, splenomegaly, rose spots on trunk.
salmonella typhi
salmonella typhi under microscope
gram negative rod
typhoid treatment
IV ceftriaxone, the PO azithromycin
pt eats chicken at bbq, has bloody, foul smelling diarrhoea. poor chap goes on to develop GBS
campylobacter jejuni
vomiting 4 hours after eating rehated rice
bacillus cereus
24 hrs of watery diarrhoea after eating reheated meat. gas gangrene if extremely unlucky
staphylcoccus aureus
outbreak of bloody diarrhoea amongst MSM
Shigella
non-bloody diarrhoea after eating chicken sashimi
salmonella enterides
dysentry, chornic weight loss and liver abcess. Flask shaped ulcer
entamoeba histolytica
chronic fever, headache and confusion. CSF is colourless, with raised protein, raised lymphocytes and low glucose.
TB meningitis
man who volunteers at a zoo has fever, headache, malaise and photphobia. CSF shows raised white cells, microscopic agglutination test positive
leptospira interrogans
20 y/o w/ photophobia, neck stiffness, headache, fever.
Neisseria meningitidis (only one with rash))
Streptococcus pneumoniae
neisseria meningitidis under microscope
gram negative dipplococcus
HIV patient with meningism. CSF examination with india ink staining shows yeast cells with surrounding halo
cyrptococcus neoformans
recurrent meningitis, CSF is clear with raised white cells and normal glucose
Herpes simplex virus 2
other forms of viral meningitis - enterovirus, mumps
hiker develops flu like symptoms, then late neuro signs, and bullseye rash (erythema chronicum migrans)
borrelia burgdorferi
woman bitten by bat has hypersalivation, hydrophobia. Negri bodies on histopathology
Rabies
chlamydia trachomatis management
doxycycline 100mg BD 7d
or
azithromycin 1g stat
widespread rash with lymphadenopathy. pt had a painless genital ulcer that appeared 1 month after unprotected sex with stranger, but resolved a few weeks later without treatment
treponema pallidum (syphilis)
syphilis treatment
IM benzathine penicillin stat
gonorrhoea management
ceftriaxone 250mg IM stat
painful genital ulcer with unilateral swollen inguinal nodes
haemophilus ducreyi
fishy vaginal discharge, clue cells on microscopy
bacterial vaginosis
donovan bodies on giemsa stain
klebsiella granulomatis
Abx for skin infections with s. aureus
flucloxacillin
Abx for pharyngitis
benzylpenicillin
Abx for mild community acquired pneumonia
amoxicillin
Abx for severe community acquired pneumonia
co-amoxiclav
Abx for atypical community acquired pneumonia
clarithromycin
Abx for hospital acquired pneumonia
co-amoxiclav + gentamycin/ tazocin
Abx for bacterial meningitis
ceftriaxone + amoxicllin if young/ old (listeria)
Abx for UTI
trimethoprim/ nitrofurantoin/ cephalexin/ co-amoxiclav
Abx for C. diff
metronidazole
vancomycin
Amoxicillin uses
mild CAP
UTI
listeria meningitis
endocarditis prophylaxis
protection vs s. pneumoniae in asplenic pts
Flucloxacillin uses
s. aureus
cellulitis, folliculitis, mastitis
osteomyelitis
septic arthritis
endocarditis
Vancomycin uses
MRSA
c. diff
cefotaxime uses
pyelonephritis
sepsis secondary to HAP
soft tissue infections
doxycycline
COPD exacerbations
STIs
Acne
meropenem
broad spectrum for v sick pts
beta-lactamase resistant
what does HHV8 cause
kaposi sarcoma
hep b serology in vaccinated individual
HBsAg NEGATIVE
Anti-HBc NEGATIVE
HBsAb POSITIVE
hep b serology in acute infection
HBsAg POSITIVE
Anti-HBc IgM POSITIVE
HBsAb NEGATIVE
hep b serology resolved infection
HBsAg NEGATIVE
Anti-HBc IgG POSITIVE
HBsAb POSITIVE
hep b serology chronic infection
HBsAg POSITIVE
Anti-HBc IgG POSITIVE
HBsAb NEGATIVE
hep b treatment
interferon alpha w/ nrti (zidovudine, lamivudine)
80%+ acute, rest chronic
hep c treatment
pegylated IFN-alpha
60-80% chronic
fungus that causes hypopigmentation in dark skinned people, hyperpigmentation in light skinned people. microscopy with KOH stain shows a speghetti with meatballs appearance
pityriasis vesicolor
IVDU patient with fever, new mumur, roth spots, osler’s nodes, janeway lesions
infective endocarditis
infective enodcarditis management
IV Abx 6 wks
Infective endocarditis organisms
acute - strep pyogenes, staph aureus (IVDU), CoNS (prosthetic valves)
aubacute - staph epidermidis, strep viridans
aflatoxin is a risk factor for
hepatocellular carcinoma
HIV positive man with sob, cough. CXR shows sphericla opacity (aspergilloma)
aspergillus flavus
rose gardner develops nodular lesions that are initially painless, that become ulcerated
sporothrix schenckii
man who frequents the woods develops a warty lesion resembling a cauliflower
phialphora verrucosa
child develops scaly red lesions on head with loss of hair, expanding ring on scalp
tinea capitis
raised red rings affecting trunk, arms and legs
tinea corporis
man has fever, myalgia, arthralgia, tiredness and depression after eating unpasteruized cheese and spending some time at a cow petting zoo
brucellosis
man develops fever, dry cough and plueral effusion after spending some time clearing up faeces on a livestock farm
Q fever (coxiella burnetti)
woman develops nodules on elbows, knees and feet after being bitten by a fish
mycobacterium marinium
culture medium for TB
lowenstein-jensen medium (grows as brown, coffee coloured, breadcumb-like colonies)
stain for mycobacterium leprae (leprosy)
fite stain
positive mantoux test means…
someone has been exposed to TB
what diameter is considered a positive mantoux
5mm or more if HIV +
10mm or more if high risk
15mm or more in anyone
optochin resistant alpha haemolytic strep
strep viridans
optochin sensitive alpha haemolytic strep
strep pneumoniae
acute endocarditis most common causative organism
staph aureus
common in IV drug users
subacute endocarditis most common causative organism
strep viridans
subacute endocarditis presentation
insidious onset of fevers, night sweats, weight loss, potentially stroke/ pe
foscarnet use
CMV (inhibits viral DNA polymerase)
most common UTI cause
e coli
gram negative, lactose fermenting, rod implicated in UTIs in immunocompromised
enterobacter
patients immunocompromised or with indwelling catheter are at increased risk of UTI from this organism
klebsiella
second most common UTI cause in young, sexually active women
staph saphrophyticus
flagellated protozoan (pear shaped) parasite causing weight loss, flatulence, chronic diarrhoea and bloating
giardia lamblia
giardasis treatment
metronidazole
undulating fevers, arthralgia, myalgia, weight loss, fatigue, lymphadenopathy, sacroilitis, depression following contact with livestock
brucellosis
brucellosis management
doxycycline or gentamicin for 6 weeks
character of erythema chronicum migrans
begins as red macule/ papule
approx 1 week later - expands to target appearance with central fading
most common cause of septic arthritis in young, sexually active adults
neisseria gonorrhoea
most common cause of septic arthritis in older adults
staphylococcus aureus
gram negative septic arthritis management
IV cefotaxime for 4-6 weeks
staphylococcal septic arthritis management
IV flucloxacillin for 4-6 weeks
HBcAb IgM POSITIVE
HBcAb IgG POSITIVE
HBsAg POSITIVE
anti-HBs NEGATIVE
HBeAg POSITIVE
anti-HBe NEGATIVE
acute hep b infection
HBcAb IgM NEGATIVE
HBcAb IgG POSITIVE
HBsAg POSITIVE
anti-HBs NEGATIVE
HBeAg POSITIVE/ NEGATIVE
anti-HBe POSITIVE/ NEGATIVE
Chronic Hep B infection
HBcAb IgM NEGATIVE
HBcAb IgG POSITIVE
HBsAg NEGATIVE
anti-HBs POSITIVE
HBeAg NEGATIVE
anti-HBe POSITIVE/ NEGATIVE
cleared hep b
HBcAb IgM NEGATIVE
HBcAb IgG NEGATIVE
HBsAg NEGATIVE
anti-HBs POSITIVE
HBeAg NEGATIVE
anti-HBe NEGATIVE
vaccinated
c diff treatment
10-14 days oral metronidazole
second line = 10-14 days oral vancomycin
sudden decline in cognitive function, combined with myoclonic jerks, normal CT + dementia screen
consider sporadic creutzfeldt-jakob disease
CJD diagnostic test
EEG
why lumbar puncture in CJD
look for 14-3-3 protein
turbid CSF with raised neutrophils, raised protein, low glucose
bacterial meningitis
clear/ slightly turbid CSF, slightly raised protein, raised lymphocytes, normal glucose
viral meningitis
clear/ slightly turbid CSF, v high protein, raised lymphocytes, reduced glucose
TB meningitis
patient with chronic liver disease –> pyrexia, abdo tenderness, tachycardia, ascites, nausea
spontaneous bacterial peritonitis
spontaneous bacterial peritonitis organisms
e coli
gram-positive cocci
enterococci
spontaneous bacterial peritonitis management
cefotaxime
ethambutol worrying side effect
ocular toxicity
isoniazid side effect
peripheral neuropathy
falciparum malaria management
ADMIT
if uncomplicated –> oral quinine + doxycycline 5-7 days
if severe –> IV quinine, IV artesunate if v severe
first line abx for treatment of bacterial sore throat
phenoxymethylpenicillin
which herpes virus in encephalitis
HSV 1
athlete’s foot antifungal
clotrimazole
athlete’s foot organism
trichophyton rubrum
first line abx for treatment of bacterial sore throat (penicillin allergy)
clarithromycin
dengue vector
female aedes mosquito
tapeworms treatment for adults
praziquantel
blood test prior to starting systemic anti-fungals
LFTs
pregnancy UTI abx
nitrofurantoin
schistosomiasis is associated with which cancer
bladder
what does maternal parvovirus increase the risk of
hydrops fetalis
q fever organism
coxiella burnetii
abx for copd infective exacerbation
amoxicillin
abx for acute otitis media
amoxicillin