Micro Flashcards
Returned from holiday with fever, headache and confused
Legionella
Hypernatraemic, diarrhoea, abdo pain, just stayed in hotel
Legionella
with Hepatitis
Legionella Ix and Mx
Urine or serum Ag detection
Macrolides e.g. azithromycin
50yo, LLL pneumonia, haemoptysis, cavitation, gram -ve coccobacilli
H. influenzae
Associated with smoking/COPD
Which respiratory infection is more common in
- Diabetics
- Post influenza
- S. aureus
2. S. aureus
Silver stain, boat shaped organism, eosinophils in alveoli, dry cough
Pneumocystis jirovecii pneumonia
Man goes to wedding in devon, comes back with pneumonia and confusion. What’s the organism?
Legionella (hyponatraemia –> confusion)
Transplant patient develops pneumonia, halo sign on Xray/CT
Aspergillosis
Complement deficiency, septicaemia, rash and arthritis after unprotected sex
Disseminated gonorrheoa
Wet slide microscopy
Trichomonas Vaginalis
Gram +ve coccus, Coag neg
S. epidermis
S. aureus is coag positive
Gram neg rod
Lactose fermenting
Name 2
E coli
Klebsiella
UTI ass with renal calculus
Proteus
Excess ammonia –> what type of renal stones?
Phosphate stones
Rotavirus vs norovirus
- Age group
- Length of presentation
- Classical symptoms
Rota:
- young children or old adults
- lasts for 1 week
- D&V and dehydration
Noro:
- Adults and children
- Similar presentation but for 2-3 days
Diarrhoea after BBQ
- Potential organisms
- Ix
- Salmonella/shigella
2. Stool culture
MSM is abroad hiking, severe flatulence, foul smelling stool, steatorrhoea, cysts, pear shaped trophozoite
Giardia
Do stool microscopy and immunoassay to diagnose
Post surgery boil on legs, not responding to fluclox etc. What pathogen & treatment?
MRSA –> vancomycin/teicoplanin
MSSA with penicillin allergy
Macrolide e.g. erythromycin OR 3rd gen cephalosporin (but DO NOT use a ceph during acute penicillin reaction i.e. rash still present)
Psuedomonas Abx
Tazocin
Good for pseudomonas bad for anaerobes
Ciprofloxacin
Macrolide antibiotic for atypical pneumonias
Azithromycin
Jaundice, seizures, intracranial calcification in neonate, what antenatal infection?
Toxoplasmosis
STI can cross placenta 3rd trimester
Syphilis
If mother is highly infectious it requires rapid vaccination and immunoglobulins at birth
Hep B
Haemorrhagic cystitis in kids
Adenovirus
PTLD virus
EBV
PML virus
JC virus
Molluscum contagiosum virus
Pox virus
Patient has a skin infection and his son also has a sore throat
Strep pyogenes
Child has red oedematous rash on face then nasal bridge then spread
Erysipelas (?) - strep pyogenes
Painless ulcer on finger after trip to Afghanistan
- Condition
- Bugs
- Vector
- Cutaneous Leishmania
- L.major, L.tropica
- Sandfly
Diarrhoea, sweating, tenesmus, RUQ abscess, flask shaped ulcer on microscopy
Entamoeba Histolytica
Comma shaped, oxidase positive, bloody smelly diarrhoea
Campylobacter
Abdo pain, fever, no diarrhoea, constipation, rose spots, gram negative
Salmonella
Sandflies
Leishmaniasis
Fever, headache, shakes, confusion, just been to Tanzania
Malaria (falciparum)
Treponome specific Ab test (type of microscopy)
Dark-field / dark-ground
Antiviral for severe RS bronchiolitis
Ribavirin
Rsv, Ribavirin
Flu antiviral
Oseltamavir
Can enterovirus cause damage antenatally?
Yes - associated with intrauterine foetal death
Vector for Trypsanoma Brucei Rhodensiense
Tsetse fly
Causes African Trypsanomiasis
Man eats chicken and gets foul smelling bloody diarrhoea with abdo cramps
Campylobacter jejuni
Most common UTI organism in pregnant women
E coli
Urease-producing organism ass. with renal stones
Proteus
proteuS Stones
Catheter associated UTIs
S. epidermis
26 year old cuts leg shaving, 2 days later she presents with a well demarcated area of induration and erythema surrounding the wound - organism?
S. aureus
34 year old farmer/gardener cuts his leg whilst working, 3 days later presents to A&E with grossly oedematous leg that is discoloured with multiple necrotic bullae - organism?
Clostridium perfringens
6 year old girl presents with a well demarcated erythematous rash of her face in the nasolabial distribution - organism?
Strep pyogenes –> Erisypelas
Cysts on microscopy (lung infection)
PCP
Legionella diagnostic test
Urine Antigen Test
Listeria microscopy
V/L shaped, tumbling motility
Bloody travellers diarrhoea, anaemia and low platelets
HUS
Which GI infections have superantigens?
S. aureus
B. cereus
C. diff
C. perfringens
CSF: high protein, normal glucose, lymphocytes
Viral meningitis e.g. HSV
CSF: high protein, low glucose, lymphocytes
TB
CSF: high protein, low glucose, neutrophils
Bacterial
Chancroid
Haemophilus ducreyi (on choc agar) Painful ulcer, unilateral LNpathy
Mild CAP treatmetn
Amoxicillin
Severe CAP treatmetn
Co-amoxiclav and clarithromycin
Staph aureus resistant to ß-lactamase & treatment
MRSA (Methicillin-resistant Staph aureus)
Vancomycin/Teicoplanin
adynophagia meaning
painful swallowing
EBV on blood film and special test
Atypical lymphocytes
Positive monospot test
Oseltamavir target
NA on influenza
Hep B treatment
IFNa
Acyclovir (MoA and use)
Guanosine
HSV, VZV, EBV
Light and dark spots on body
Spag with meatballs on microscopy
Pitoriasis versicolour
Zoonoses from animals and dairy
Brucellosis
Ticks and macpap rash
Rickettsia
Rocky Mt Spotted fever
Rickettsia
Negribodies
Rabies
Lowen Jensen Culture
TB –> Brown granular
Pneumonia in alcoholics (+ list two more features)
Klebsiella pneumponiae
Cavitation + haemoptysis (red currant jelly haemoptysis)
GI infection which attaches to bowel but does not invade –> malnutrition, bloating, weight loss
Giardia lambia
Crusty ulcer and LNpathy after walking on the beach
Leishmania (cutaneous)
Leishmania major/tropica
Sandflies are vector
Kala azar
Visceral leishmania (fever and splenomegaly)
Presentation like cutaneous leishmania but with mouth ulcers too (later)
- Name
- Pathogen
Muco-cutaneous Leishmania
L. braziliensis
Leishmanias are what type of organism
Protozoa
Visceral Leishmania pathogens
donovania, chagasi and infantum
Septic arthritis pathogen
Gon > chlam
sCJD vs vCJD
Sporadic Creutzfeldt–Jakob disease
- 14-3-3 in CSF
- Neuro mainly
Variant Creutzfeldt–Jakob disease
- tonsillar biopsy
- psych before neuro
HBeAg
High Infectivity
HBsAg
acute or chronic
Anti-HBc (HBcAb) IgM
Acutely infected
HBcAb IgG
What if HBsAg also +ve?
Previous infection, now immune
HBsAg +ve: Chronic infection
HBsAb (anti-HBs)
Recovered from natural infection
If all others negative = vaccinated
Vancomycin side effect
Red man syndrome (and only has gram +ve cover and MRSA)
Consider when treating C diff
C. diff protocol
Metronidazole 10-14 days (two trials before moving onto vancomycin 10-14d)
P. falciparum on blood film
Maurer’s cleft (membrane-limited vacuoles or sack-like structures in the cytosol of the erythrocyte)
Treatment for listeria meningitis
Amoxicillin + gentamycin
Ampicillin + gentamycin
Meningitis • Escherichia coli • HSV • Listeria monocytogenes • Neisseria meningitidis • Streptococcus pneumoniae
A. A girl has been noted by her parents to be acting strange lately. A Lumbar puncture is performed and the CSF shows high lymphocytes and a raised protein, but normal glucose, what organism is the cause?
B. An 18 year old student is found to have Gram negative diplococcus causing meningitis
C. A man is found to have a Gram positive diplococcus causing meningitis
D. Gram negative rod causing sepsis in a neonate
E. Gram positive rod causing meningitis in a 72 year-old
A. HSV B. Neisseria meningitidis C. Streptococcus pneumoniae D. Escherichia coli E. Listeria monocytogenes
HIV RNA forms HIV, via which error prone enzyme?
a. RNA polymerase
b. DNA polymerase
c. RNA transcriptase
d. Reverse transcriptase
d. Reverse transcriptase
Which vector transmits Trypanosoma brucei rhodesiense?
a. Anopheles mosquitoes
b. Sandfly
c. Tsetse Fly
d. Aedes
c. Tsetse Fly
a. Anopheles mosquitoes – Causes Malaria. Females carry the disease.
b. Sandfly – Causes Leishmaniasis (also known as Kala Azar)
d. Aedes – Causes Aedes aegypti (Yellow Fever)(Pyramids are in Egypt and pyramids are yellow)
What does the number of True positives divided by the total number who have the disease describe?
a. Positive predictive value
b. Negative predictive value
c. Sensitivity
d. Specificity
e. Z score
c. Sensitivity
Which of these does not lead to/cause Chronic Hepatitis?
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
e. Hepatitis E
a. Hepatitis A
- Which of these can cause peri/neonatal illness without causing damage to the foetus if the mother is infected antenatal?
a. Cytomegalovirus (CMV)
b. Herpes Simplex Virus (HSV)
c. Enterovirus
d. Varicella Zoster Virus (VZV)
e. Rubella
c. Enterovirus
- Which of these is the most likely causative organism of a hospital acquired pneumonia?
a. Haemophilus influenza
b. Steptococcus pneumonia
c. Staphylococcus aureus
d. Microplasma meunomia
e. Pseudomonas aregenosa
f. Aspergillus
c. Staphylococcus aureus (Commonly MRSA)
Steptococcus pneumonia - Most common community acquired pneumonia
Which/What is the most common cause of jaundice/fever in a returning traveller with a fever?
a. Malaria
b. Hepatitis
c. HIV seroconversion
d. Typhoid
e. Dengue
a. Malaria
Name an infectious gram +ve and -ve microorganism which is a common cause of meningitis in 3 months or older?
\+ve = Streptococcus pneumoniae -ve = Neisseria Meningitis
What drug is used to treat severe falciparum malaria?
Artesunate (and you only use quinine to treat severe malaria infections if artesunate isn’t available)
What zoonotic disease does the Ixodes Tick cause?
Lyme disease
Antivirals treatment • Aciclovir • Ganciclovir • Oseltamivir • Ribavirin
- CMV retinitis
- HSV meningitis
- VZV
- Child with RSV
- Asthmatic with flu
- Ganciclovir
- Aciclovir
- Aciclovir
- Ribavirin
- Oseltamivir
Cat scratch disease full name (genus and species) of bacteria
Bartonella henselae
Stain used for acid-fast bacilli
Ziehl-Neelsen stain (Mycobacterium tuberculosis)
Name 1 of 3 characteristics of influenza A that could cause a pandemic
- Novel antigenicity
- Efficient replication in human airway
- Efficiency viral transmission between people
Alcoholic man is on ceftriaxone for meningitis, what organism is he at risk of which this does not cover for?
Listeria monocytogenes
What virus increases risk of nasopharyngeal cancer?
EBV
What additional virus apart from HIV and HBV are screened for in platelet donations to pregnant women?
Cytomegalovirus
Has contact with someone with TB, what is the risk of getting active TB?
10%
A 20 y/o woman presents w 2 days of dysuria, increased urinary frequency, and suprapubic pain. Rank the organisms by likelihood of being causative:
a. Proteus mirabilis
b. Acinetobacter baumanii
c. Candida albicans
d. Escherichia coli
e. Staphylococcus saprophyticus
d. Escherichia coli
e. Staphylococcus saprophyticus
c. Candida albicans
a. Proteus mirabilis
b. Acinetobacter baumanii
A neonate develops meningitis at 36 hours old. Rank the organisms by likelihood of being causative:
a. Escherichia coli
b. Group B Strep
c. Cryptococcus neoformans
d. Pseudomonas aeruginosa
e. Listeria monocytogenes
b. Group B Strep
a. Escherichia coli
e. Listeria monocytogenes
c. Cryptococcus neoformans
d. Pseudomonas aeruginosa
Most common cause of constrictive pericarditis in developing world?
Tuberculosis
Which organism causes pneumonia with ‘red currant jelly sputum’ in alcoholics and diabetics?
Klebsiella pneumoniae
What is the most common cause of myocarditis?
Viral infection
What is the most common cause of portal vein thrombosis?
Cirrhosis
What is the most common primary breast cancer?
Invasive ductal carcinoma
Which underlying pathology is commonly associated with nephrotic syndrome in adults?
Membranous glomerulonephritis or Focal segmental glomerulosclerosis
What is the most common primary tumour of the heart?
Myxoma
Raised anti-mitochondrial antibodies is associated with which liver disease?
Primary biliary cirrhosis
What is the equivalent of a dysgerminoma in a testis?
Seminoma
Intestinal metaplasia in Barrett’s oesophagus is most commonly due to the presence of which cell?
Simple columnar epithelial cells
What type of emphysema is associated with smoking and chronic bronchitis?
Centrilobular
Which vascular tumour is associated with HHV8?
Kaposi’s sarcoma
Which virus causes encephalitis that particularly affects the temporal lobes?
Herpes Simplex virus
29 y/o man returns from charity work in Yemen with profuse watery diarrhoea that “looks like water after you cook rice in it”. What is the causative organism?
Vibrio cholerae
43 y/o receiving chemotherapy for leukaemia has ongoing fever and raised inflammatory markers after broad spectrum antibiotic therapy with Meropenem and Amikacin. CT chest shows nodules with surrounding hypoattenuation (halo signs). What is the most likely causative organism?
Aspergillus fumigatus
18 y/o man with 1 day history of headache, neck stiffness, and photophobia, but no confusion or other signs of encephalitis. HSV1 detected in CSF PCR. What antiviral treatment would you recommend?
Aciclovir
A 4 y/o presents to A&E with bloody diarrhoea and haemolytic-uraemic syndrome after visiting a petting farm. What is the likely causative organism?
Escherichia coli (specifically the 0157:H7 serotype)
What property of the MMR vaccine makes it unsuitable for pregnant women?
It is a live vaccine
42 y/o man returns from India with high fever and abdo pain but no diarrhoea. Blood cultures grow Gram negative bacilli and Malaria rapid test is negative. What is the most appropriate initial antibiotic therapy?
Ceftriaxone
Which virus can cause hydrops fetalis if it infects a pregnant woman in the first 20 weeks?
Parvovirus B19
Which Herpes virus causes post-transplant lymphoproliferative disorder?
Epstein-Barr virus (HHV4)
27 y/o poorly controlled HIV patient presents with meningism (headache, stiff neck, photophobia) and CSF has yeasts in it. What is the likely causative organism?
Cryptococcus neoformans
37 y/o woman with hot swollen, painful left knee has Gram positive cocci in clusters on joint aspirate. NKDA and MRSA screen is negative: which narrow spectrum antibiotic is most appropriate here?
Flucloxacillin
73 y/o woman with headache, confusion, photophobia, and fever. Gram positive rods are found in her CSF, what is the likely causative organism?
Listeria monocytogenes
This vaccine-preventable disease presents with headache, fever, and parotid swelling. Can cause epididymo-orchitis in adults and sometimes even meningitis. What is the causative organism?
Mumps orthorubulavirus
Name an antibiotic class with concentration-dependent killing and prolonged persistent effects where the goal is to maximise the concentration above the Minimum Inhibitory Concentration (Peak>MIC)
Aminoglycosides
Fluoroquinolones
Ketolides
78 y/o woman has loose green mucoid stool after a week of I.V. Ceftriaxone. What is the causative organism?
Clostridium difficile
64 y/o man with poorly controlled T2DM develops periorbital oedema, headache, sinus pain, purulent nasal discharge, and orbital cellulitis. The symptoms started yesterday and he is taken to theatre as an emergency. What anti-fungal should be started immediately?
Amphotericin B
Which virus is associated with nasopharyngeal carcinoma?
a. Epstein-Barr virus
b. Hepatitis B virus
c. Hepatitis C virus
d. HHV8
e. HPV16
a. Epstein-Barr virus
What is the most common type of skin cancer?
a. Basal cell carcinoma
b. Keratoacanthoma
c. Melanoma
d. Metastatic cancer
e. Squamous cell carcinoma
a. Basal cell carcinoma
What is the inheritance pattern of hereditary haemochromatosis?
a. Autosomal dominant
b. Autosomal recessive
c. Polygenic
d. X-linked dominant
e. X-linked recessive
b. Autosomal recessive
An extradural/ epidural haemorrhage is caused by damage to which blood vessel?
a. Berry aneurysm
b. Bridging veins
c. Internal carotid
d. Middle cerebral artery
e. Middle meningeal artery
e. Middle meningeal artery
Which type of necrosis is associated with a myocardial infarction?
a. Abscess formation
b. Caseous necrosis
c. Coagulative necrosis
d. Fat necrosis
e. Liquefactive necrosis
c. Coagulative necrosis
What is the most common glial cell of the CNS?
a. Astrocytes
b. Endothelial cells
c. Ependymal cells
d. Microglia
e. Oligodendrocytes
a. Astrocytes
What is the most common cause of pancreatitis in adults? (not specified whether acute or chronic)
a. Alcohol
b. Autoimmune
c. Cystic fibrosis
d. Drugs
e. Gallstones
e. Gallstones (acute)
a. Alcohol (chronic)
What is the most common cause of mitral valve stenosis?
a. Congenital
b. Infective endocarditis
c. Pulmonary hypertension
d. Rheumatic heart disease
e. Systemic lupus
d. Rheumatic heart disease
What is the most common type of ovarian tumour?
a. Brenner tumour
b. Mucinous cystadenocarcinoma
c. Mucinous cystadenoma
d. Serous cystadenoma
e. Serous mucinous cystadenocarcinoma
d. Serous cystadenoma
What is the mechanism behind pulmonary oedema due to liver disease?
a. Decreased osmotic pressure
b. Direct injury to the alveolar wall
c. Increased hydrostatic pressure
d. Indirect injury to the alveolar wall
e. Lymphatic obstruction
a. Decreased osmotic pressure
Which of the following occurs near the surface of the brain and is frequently asymptomatic?
a. Glioblastoma multiforme
b. Haemangioma
c. Meningioma
d. Oligodendroglioma
e. Schwannoma
c. Meningioma
What is the most common cause of acute respiratory distress syndrome?
a. Aspiration
b. Drug reaction
c. Pancreatitis
d. Sepsis
e. Trauma
d. Sepsis
Which valve is classically involved in infectious endocarditis in I.V. drug users?
a. Aortic
b. Mitral
c. Prosthetic
d. Pulmonary
e. Tricuspid
e. Tricuspid
Which of the following is a characteristic of hypercalcaemia?
a. Diarrhoea
b. Easy bruising
c. Hypotension
d. Polyuria and polydipsia
e. Tetany
d. Polyuria and polydipsia
25 y/o man brought to A&E with abdominal pain followed by collapse. His blood pressure shows he is in shock and his blood gas results are: Na+ 120 (low) K+ 6.2 (high) HCO3 10.1 (low) Urea 9.4 (high) Creatinine 146 (high) Glucose 2.5 (low) pH 7.2 (low) pCO2 3.0 (low) What is the most likely cause of the abnormal potassium? a. Renal loss of sodium b. Vomiting c. Renal failure d. Perforated appendix e. Dehydration
a. Renal loss of sodium
Which of the following tests is useful in diagnosing invasive Candida albicans infection?
a. Beta-D-Glucan
b. Galactomannan
c. RPR
d. TPPA
e. Widal test
a. Beta-D-Glucan
A 22 y/o man is a close household contact of someone diagnosed with TB. What is his lifetime risk of developing the disease?
a. 0.1%
b. 1%
c. 10%
d. 50%
e. 90%
c. 10%
Which of the following is the most appropriate antibiotic for Legionella pnemophilia pneumonia?
a. Amoxicillin
b. Azithromycin
c. Ceftriaxone
d. Co-trimoxazole
e. Meropenem
b. Azithromycin
Which virus is associated with severe hepatic disease and potentially death if it infects a pregnant patient?
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
e. Hepatitis E
e. Hepatitis E
What is the most common form of prion disease?
a. Fatal familial insomnia
b. Iatrogenic Creutzfeldt-Jakob disease
c. Kuru
d. Sporadic Creutzfeldt-Jakob disease
e. Variant Creutzfeldt-Jakob disease
d. Sporadic Creutzfeldt-Jakob disease
Streptobacillus moniliformis causes which infection?
a. Bacillary angiomatosis
b. Lyme disease
c. Q fever
d. Rat bite fever
e. Syphilis
d. Rat bite fever
A 45 y/o woman with malaria has a GCS of 11, temp 39.1, HR 108, BP 90/60. Her parasitaemia is 10%, what is the most appropriate anti-malarial therapy?
a. Intravenous Artesunate
b. Intravenous Quinine
c. Oral artemether and proguanil
d. Oral atorvaquone and proguanil
e. Oral mefloquine
a. Intravenous Artesunate
Which of the following drugs is used to treat Hepatitis B?
a. Aciclovir
b. Oseltamivir
c. Ribavirin
d. Tenofovir
e. Zanamivir
d. Tenofovir
Infants under 1 year of age shouldn’t be fed honey because of the risk of infection with which organism?
a. Campylobacter jejuni
b. Clostridium botulinum
c. Escherichia coli 0157
d. Salmonella typhi
e. Vibrio cholerae
b. Clostridium botulinum
Pneumonia • Aspergillus fumigatus • Klebsiella pneumoniae • Legionella pneumophilia • Pneumocystis jirovecii • Streptococcus pneumoniae
A. HIV patient who desaturates on exercise
B. Girl receiving chemotherapy for leukaemia with ‘Halo’ sign on CXR
C. Lower lobe pneumonia in a 22 year-old who is coughing up rusty coloured sputum
D. Upper lobe cavitation on CXR in an alcoholic
E. Smoker back from holiday in Spain, also hyponatraemic and confused
A. Pneumocystis jirovecii B. Aspergillus fumigatus C. Streptococcus pneumoniae D. Klebsiella pneumoniae E. Legionella pneumophilia
Fungi • Coccioides • Cryptococcus neoformans • Malassezia furfur • Rhizopus species • Trichophytum rubrum
A. HIV patient with CD4+ count of 150 with meningitis
B. Water polo player with itchy scaly rash on lateral toe which then moved along lateral side of foot
C. Pityriasis versicolor
D. Lady came back from visiting her sister in Arizona with systemic symptoms, fever etc.
E. Man in his 60s with poorly controlled diabetes presents with rapidly progressing periorbital swelling, sinus pain and confusion
A. Cryptococcus neoformans B. Trichophytum rubrum C. Malassezia furfur D. Coccioides E. Rhizopus species
Traveller's infections • Entamoeba histolytica • Leishmaniasis • Malaria • Salmonella typhi • Treponema pallidum
A. A soldier returning from Afghanistan has a small ulcer on right ring finger that won’t heal and keeps getting bigger
B. Snail trail oral ulcer in a homosexual man
C. A South American man presents to a doctor in the UK with fever and bloody diarrhoea, and investigations detect a cyst in the right lobe of the liver
D. A Nigerian man presenting with fever and chills, has just returned from Nigeria, did not take prophylaxis, and was bitten a lot
E. A woman returning from travel in Asia presents with abdo pain, headache, and constipation. A Gram- rod is later cultured from her blood
A. Leishmaniasis B. Treponema pallidum C. Entamoeba histolytica D. Malaria E. Salmonella typhi
Maternal viral infections • CMV • HSV • Parvovirus • Rubella • Varicella-Zoster
A. Virus that may cause Hydrops fetalis if caught in first 20wks of pregnancy
B. Immunoglobulin may be given to the mother if she is exposed to this virus in pregnancy to prevent infection
C. Virus that require C-section if mother has an outbreak at 34wks or later due to risk of transmission vaginally
D. Virus that can cause baby to have cataracts, sensorineural deafness, hepatomegaly and thrombocytopenia
E. Virus which if transmitted to baby: they can initially be symptomless but then come down with long term sequelae
A. Parvovirus B. Varicella-Zoster C. HSV D. Rubella E. CMV
GI infections • Bacillus cereus • Campylobacter jejuni • Clostridium difficile • Entero-toxigenic Escherichia coli • Norovirus
A. The most common cause of traveller’s diarrhoea
B. A man develops foul-smelling diarrhoea and cramping pain 5 days after eating chicken at a barbeque
C. A woman develops vomiting a few hours after eating a Chinese meal with lots of rice
D. Women has had some surgery which required antibiotics, and now has profuse watery diarrhoea
E. A ward sister gets diarrhoea, and patients on the ward have been ill recently with similar symptoms
A. Entero-toxigenic Escherichia coli B. Campylobacter jejuni C. Bacillus cereus D. Clostridium difficile E. Norovirus
Antibiotics • Amoxicillin • Benzylpenicillin • Flucloxacillin • Trimethoprim • Vancomycin
A. Included in meningitis treatment to cover Listeria monocytogenes
B. Antibiotic for Group A Strep pharyngitis
C. Young women with cystitis and fully sensitive E-Coli
D. Which antibiotic would you use for cellulitis with MRSA
E. Which antibiotic would you use to treat someone who has cellulitis with a Methicillin SENSITIVE strain of Staphylococcus aureus
A. Amoxicillin B. Benzylpenicillin C. Trimethoprim D. Vancomycin E. Flucloxacillin
Antibiotics • Amoxicillin • Ceftazidime • Ciprofloxacin • Clarithromycin • Vancomycin
A. Beta lactam with anti-pseudomonal activity
B. Broad spec, no pseudomonal activity usually given with a beta lactamase inhibitor
C. A glycopeptide used to treat MRSA
D. A DNA synthesis inhibitor used to treat Pseudomonal infections but poor against anaerobes
E. Abx of the Macrolide/lincosamide/streptogrammin group used to treat some atypical pneumonias
A. Ceftazidime B. Amoxicillin C. Vancomycin D. Ciprofloxacin E. Clarithromycin
STIs • Chlamydia trachomatis • HPV • Neisseria gonorrhoea • Treponema pallidum • Trichomonas vaginalis
A. Painless indurated ulcer, grown on dark brown medium, spiral shaped organism found
B. Teenager with genital warts
C. Lady with discharge, no other symptoms, and causative infection found on wet slide microscopy
D. Lady with PID and positive urinary NAAT test
E. Man with discharge - Gram negative diplococci found
A. Treponema pallidum B. HPV C. Trichomonas vaginalis D. Chlamydia trachomatis E. Neisseria gonorrhoea
Misc. infections • Group B Streptococcus • Staphylococcus aureus • Staphylococcus saprophyticus • Streptococcus pneumoniae
A. Woman with UTI - culture grows Gram positive cocci in clusters
B. 49 Year old with no medical problems has septic arthritis
C. 19 year old rugby player with boils, members of his team have similar boils, as do members of his family
D. Neonate has meningitis, Gram positive organism in chains
E. 50 year old male smoker has meningitis with Gram positive diplococci
A. Staphylococcus saprophyticus B. Staphylococcus aureus C. Staphylococcus aureus D. Group B Streptococcus E. Streptococcus pneumoniae
Vaccine-preventable diseases • Diphtheria • Measles • Mumps • Polio • Tetanus
A. Virus that resides in pharynx and GIT - 1:100 encephalitis, 1:1000 destruction of motor neurons
B. Develops a grey film over the back of the throat
C. Causes lumps on parotid and neck
D. Maculopapular rash moves from face that can cause encephalitis and pneumonitis
E. Lockjaw
A. Polio B. Diphtheria C. Mumps D. Measles E. Tetanus
Receptor/cytokine mutation that could be protective in HIV?
CCR5/Mip-1a/b
What is the definition of herd immunity threshold?
The proportion of immune healthy people needed within a population to stop a pathogen’s spread: 1- (1/R0)%
Returning traveller with fever and constipation (salmonella typhi) - what abx do you give if she hasn’t been started on them already?
Ceftriaxone
Septic arthritis in a 56yo man - likely organism?
Staphylococcus aureus
What does it mean if urine MC&S sample has epithelial cells and mixed bacterial growth?
It is a poor sample and has not properly been taken mid-stream
What is the most common cause of traveller’s diarrhoea?
Enterotoxigenic Escherichia coli
Which bacterial species causes scarlet fever?
Streptococcus pyogenes
What is the most common cause of viral meningitis?
Non-polio enteroviruses (Echoviruses & Coxsackie viruses)
What is the most likely cause of early-onset sepsis in a neonate?
Group B Streptococcus
HIV +ve patient with v low CD4 + purple lesions seen on trunk. What virus causes this cancer?
HHV8
What is the treatment for MRSA?
Vancomycin
What does John Cunningham (JC) virus cause?
Progressive multifocal leukoencophalopathy
Diffuse white plaques that can be easily brushed away are seen on an OGD, what is the diagnosis?
Oesophageal candidiasis
Painless penile ulcer which healed in few weeks, followed by fine snail track oral ulcer - organism?
Treponema pallidum
What is the treatment for pseudomembranous colitis?
Metronidazole or Vancomycin depending on severity (if in doubt say Vancomycin)
Via which route does Hep A spread?
Faeco-oral
Which would be the most useful test in confirming acute EBV infection 2 weeks after possible exposure in an immunocompetent patient?
IgM
Name a complication of infection of a pregnant woman with Parvovirus B19
Hydrops foetalis
How do you initially treat Malaria falciparum; 38.9 fever, hypotension, 4% parasitaemia?
I.V. Artesunate or I.V. Quinine if Artesunate not available
Young gentleman brough to A&E by friends due to confusion. CSF is clear, raised lymphocytes, high protein, normal glucose. Causative organism?
HSV
Neonate (2 day old) has meningitis and blood cultures isolate gram negative rods, what is the organism?
Escherichia coli
Gram +ve cocci UTI in a young woman?
Staphylococcus saprophyticus
Which vaccine-preventable organism causes cough, lymph node enlargement and has a potential to occlude the airway?
Corynebacterium diphtheriae
What cell type is raised in the blood in schistosomiasis?
Eosinophils
Boy visits grandparents in Wiltshire, comes back with 5 days of diarrhoea, no vomiting, and unexplained bruises all over body, which organism has most likely triggered this?
Escherichia coli 0157:H7
Natural antibodies against what can confer protective immunity against HIV? A. HIV – GAG B. HIV – gp120 C. CXCR4 D. Protease E. Reverse transcriptase
B. HIV – gp120
Which of the following is the most common cause of cellulitis? A. S. epidermidis B. S. saprophyticus C. S. pyogenes D. S. agalactiae E. E. coli
C. S. pyogenes
A Girl develops a throat infection. She is given amoxicillin, and a rash develops. It is later found out that she has infectious mononucleosis, and her symptoms persist. What is the most likely cause of the rash? A. Drug reaction B. Penicillin allergy C. Mastocytosis D. Erythema nodosum E. Pyoderma gangrenosum
A. Drug reaction
A 69 year old man presents with a red, hot swollen knee. He has type 2 diabetes mellitus and osteoarthritis but it is a native joint. In this case of septic arthritis, rank the causative organisms below in order of likelihood, with (1) being the most likely and (5) being the least likely. A. Staphylococcus epidermidis B. Staphylococcus aureus C. Brucella melitensis D. Escherichia coli E. Streptococcus pyogenes
B. Staphylococcus aureus E. Streptococcus pyogenes D. Escherichia coli A. Staphylococcus epidermidis C. Brucella melitensis
A 23 year old man presents with cellulitis having cut himself while skateboarding. A wound swab has grown Streptococcus pyogenes (Group A Streptococcus). List the following antimicrobials which can beused for treatment in order of spectrum of activity with being the narrowest spectrum and 5 being the broadest spectrum agent. Ceftriaxone Meropenem Piperacillin/tazobactam Benzylpenicillin Amoxicillin
Benzylpenicillin Ceftriaxone Amoxicillin Piperacillin/tazobactam Meropenem
