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Path - Things to Go Over > Micro > Flashcards

Micro Flashcards

1
Q

A 46-year-old man with poor adherence to his HIV medication presents to his GP with neck stiffness, fever and photophobia. The GP arranges for an ambulance.

In the emergency department, an LP is performed.

India ink staining of CSF shows the following:

The report reads: “CSF sample positive for yeast cells with a gelatinous capsule. Positive halo sign.”

What is the causative organism?

A

Cryptococcus neoformans

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2
Q

Way to remember Kernig and Brudzinski sign

A
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3
Q

A 26 year old IV drug user is diagnosed with infective endocarditis. He described a short history, with symptoms appearing over a period of three weeks, culminating in admission to the hyperacute stroke unit following a stroke.

A transthoracic echocardiogram reveals a vegetation on the tricuspid valve.

What organism is most likely responsible?

A

Staphylococcus Aureus.
It is the most commonly implicated organism in IVDU associated infective endocarditis.

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4
Q

What growth medium is used to differentiate Streptoccoci in the laboratory setting?

A

Blood agar

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5
Q

What is the first line antibiotic for the treatment of a bacterial sore throat in a patient with no known allergies?

A

Phenoxymethylpenicillin

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6
Q

What is the treatment for human tapeworms in adults?

A

Praziquantel

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7
Q

A fine art student travels to New York, where he eats scrambled eggs.

12 hours later, he becomes unwell with profuse diarrhoea. There is no blood. He has diffuse abdominal pain with pain that comes and goes in waves.

What organism is likely responsible for his symptoms?

A

Salmonella enterica

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8
Q

What is the primary infective lesion produced by Mycobacterium tuberculosis called in the lungs?

A

Ghons Focus

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9
Q

Which malarial species presents with a 72 hour fever pattern?

A

Plasmodium malariae

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10
Q

What is the host protein required for entry of SARS-CoV-2 into human cells?

A

Angiotensin Converting Enzyme 2

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11
Q

A patient is suspected to have a community acquired pneumonia. Their CURB 65 is 0.

If indicated, what is the first line antibiotic for the treatment of this patient?

A

Amoxicillin, still treat if CURB is 0

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12
Q

What is the first line topical antibiotic treatment of limited impetigo?

A

Fusidic acid

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13
Q

What test is typically used to detect the presence of SARS-CoV-2 on a nasopharyngeal swab?

A

Polymerase Chain Reaction

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14
Q

A 39 year old alcoholic is admitted to the respiratory ward due to a chest infection.

There are crepitations in the left mid zone and this is associated with consolidation on X ray.

Past medical history is unremarkable.

Sputum culture showed Gram Negative Rods in clusters.

What organism is responsible for his chest infection?

A

Klebsiella pneumoniae

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15
Q

A 55 year old gentleman is referred to gastroenterology by his GP.

He has persistent dysphagia and weight loss. He has no other past medical history.

At endoscopy a diagnosis of oesophageal candidiasis is made.

What is the next most appropriate investigation?

A

HIV test

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16
Q

A 20 year old is seen by his GP 5 months after returning from his gap year in India.

He has been given several courses of antibiotics and steroids for a single, non healing ulcer approximately 2-3cm in diameter on his left ankle.

On examination, there is a 2-3cm painless, volcano-like lesion on his shin with raised indurated borders.

Blood tests including a full blood count are essentially unremarkable.

What is the likely diagnosis?

A

Cutaneous Leishmaniasis

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17
Q

What is the vesctor of leishmaniasis? Were does it multiply?

A

sandflies

Leishmania parasites multiply inside macrophages in the human body.

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18
Q

Treatment of leishmaniasis

A

amphoterecin B

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19
Q

What is black fever?

A

Type of leishmaniasis - visceral

Signs and symptoms include (massive) splenomegaly, hepatomegaly. Otherwise, symptoms are nonspecific and include fever, weight loss, lethargy and anaemia. Rarely, hyperpigmentation of skin may occur - leading to the name “black fever”.

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20
Q

Diagnosis of leishmaniasis

A

It is diagnosed with microscopy of splenic or bone marrow aspirate.

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21
Q

What antibiotic should be prescribed for a penicillin allergic, clinically stable patient with cellulitis?

A

Clarithromycin

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22
Q

What viral enzyme is inhibited by oseltamivir?

A

Neuraminidase

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23
Q

Indications for aciclovir

A

the classical, common antiviral used for DNA viruses such as Herpes Simplex (cold sores/ STIs) and Varicella Zoster (chickenpox/shingles).

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24
Q

Indications for ganciclovir/vanciclovir

A

covers HSV/VZV but also CMV (retinitis/pneumonitis/mucositis) and HHV-6 (immunosuppressed patients)

25
Q

Indications for cidofovir

A

covers HSV/VZV/CMV/HHV-6/BK Virus and Adenovirus

26
Q

What antiviral drug is used in Hep B?

A

Tenofovir

NOTE: Ribavarin is used in Hep C and E

27
Q

What antivirals are used for SARS-COR2?

A

Nirmatrelvir/ritonavir

28
Q

What antiviral do you use in the treatment of flu? MOA?

A

Oseltamivir. Neuraminidase inhibitor.

29
Q

Aspergillus

A

Methenamine Silver Stain

30
Q

Stain for cryptococcus

A

India Ink

31
Q

Stain for pneumocystitis

A

methanamine silver stain or periodic acid schiff stain

32
Q

Stain for candida

A

Periodic Acid-Schiff or methenamine silver stain

33
Q

Stain for aspergillus

A

Methenamine Silver Stain or PAS stain

34
Q

Antigen test for cryptococcus

A

Glucuronoxylomannan (GXM)

35
Q

Antigen test for aspergillus

A

Galactomannan

36
Q

Antigen test for candida/PCP/asperg

A

Beta-D-Glucan

37
Q

How to differentiate between candida and aspergillus on antigenic test?

A

Both test positive for Beta-D-Glucan, only aspergillus tests positive for galactomannan

38
Q

In immunocompetent patients, what is the typical presentation of listeriosis?

A

Gastroenteritis

39
Q

What antimicrobial is first line for severe, widespread fungal nail infection in a an elderly patient with no known allergies?

Recent bloods including FBC, U&Es, LFTs and TFTs were all normal.

A

Terbinafine

40
Q

What is the gold standard diagnostic test for Leishmaniasis?

A

Splenic aspirate

41
Q

What is the scientific name of the beef tapeworm?

A

Taenia saginata

42
Q

A 50 year old woman is seen by her GP with 3 days of mild headache, sneezing and coughing. She also has a sore throat. She takes ramipril for hypertension but has no other past medical history.

On examination her chest is clear, there is no cervical lymphadenopathy and no visible exudate on the tonsils.

What is the likely responsible organism?

A

Rhinovirus

43
Q

A 18 year old man reports significant discolouring of one of his great toenails with associated onycholysis of that nail. There is a small amount of nail pitting visible also. No other nails are affected.

You decide to send the sample for culture but wish for a quicker result in the meantime.

What test would be appropriate to order to determine if treatment is needed?

A

Potassium Hydroxide, the gold standard for fungal infection is culture but this takes ages

44
Q

A 20 year old white man presents to their GP having noticed the development of a rash on his back over the last few months. He reports no symptoms from it.

On examination, there are scaly areas of hypopigmentation across the back. There is no evidence of erythema or excoriation.

Under Wood’s Lamp, the patch fluoresces a very faint orange colour.

What is the likely diagnosis?

A

Pityriasis versicolor

45
Q

A 60 year old farmer presents to the emergency department feeling unwell with what he thinks is the flu. He said there was a sudden onset 4 days ago of chills, severe muscle aches and abdominal pain.

Today he is visibly jaundiced and is complaining of muscle pains. He says that he has a headache behind his eyes. He is mildly photophobic. There is a subconjunctival haemorrhage in the right eye.

You take a full history and find he has long standing arthritis of his knees but no other medical history of note. He has a fever of 38.5C and an ECG is normal. His observations are otherwise within normal limits.

A

Leptospirosis

symptoms of flu-like illness with jaundice, muscle pains, headache, and subconjunctival hemorrhage, and has abnormal U&Es. These are all consistent with the diagnosis of leptospirosis, which is a bacterial infection commonly seen in farmers and can cause liver and kidney damage.

46
Q

How to differentiate between leptospirosis and Q fever?

A

Q fever typically presents with respiratory symptoms first (being an inhalational bacteria) rather than other symptoms.

47
Q

Give an example of a beta haemolytic Streptoccoccus

A

Streptococcus agalactiae

48
Q

What antiviral drug is typically given prophylactically to patients undergoing allogenic stem cell transplantation to protect against CMV infection?

A

Gancyclovir

49
Q

During infection with Plasmodium falciparum, typically how long does it take for the patient’s temperature to peak, nadir, then return to the peak again?

A

48 hours

50
Q

Which malaria presents with tertian fevers (every two days)?

A

P. falciparum, P. vivax and P. ovale

51
Q

Which malaria presents with quartian fevers (every three days)?

A

P. malariae.

52
Q

What is the first line antibiotic for the treatment of sinusitis in a systemically well patient with no known allergies, assuming there has been no improvement of symptoms for at least 10 days?

A

Phenoxymethylpenicillin

53
Q

Prior to starting terbinafine, a systemic antifungal, what blood test should be ordered?

A

LFTs

54
Q

Severe malaria in adults may be defined as parasitaemia of more than what % of RBCs?

A

10

55
Q

What is the recommended duration of antibiotic therapy for a hospital acquired pneumonia?

A

5 days

56
Q

A 74 year old gentleman is admitted to the surgical ward following a right hemicolectomy. His surgery was 4 days ago and he is now moving onto a soft diet after a brief period of ileus.

He begins to feel unwell, becomes pyrexial, hypotensive and clinical examination reveals coarse crepitations in the left mid zone of the lung. He is noted to have a reduced urine output at less than 0.5ml/kg/hour.

A chest x ray shows the presence of consolidation in the left mid zone.

Until now, the patient has remained on intravenous co-amoxiclav.

What is an appropriate empirical antibiotic switch for this gentleman?

A

Piperacillin-Tazobactam

57
Q

Medications that cause C. Difficile

A

Antibiotics (Cs - co-amoxiclav [+], clindamycin[+++], ciprofloxacin [++], cephalosporins [+])
Proton Pump Inhibitors (omeprazole, lansoprazole) [+++]
H2 receptor antagonists (Ranitidine [+])

58
Q

What protein is most commonly implicated in the human forms of Creutzfeldt–Jakob disease?

A

Major Prion Protein

59
Q

What is the most common genetic polymorphism implicated in the development of variant Creutzfeldt–Jakob disease?

A

Codon 129 polymorphism

Path - Things to Go Over (6 decks)

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