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Sophia's Path > Micro > Flashcards

Micro Flashcards

1
Q

Adult onset Still’s disease and MAS

A

Very high ferritin

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2
Q

EBV Serology

A

PCR is pointless in healthy person

Viral Capsid Antigen (VCA) - with symptoms
EP Nucleic Antibody (EBNA) - later

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3
Q

Bartonella

A

Cat scratch illness, regional adenopathy, sometimes PUO

Sometimes HSM and haem abnormalities.

Diagnosis by serology

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4
Q

Brucella

A

Must have exposure (farm animal contact or unpasteurised milk)

LFTs rise. Diagnosis by serology.

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5
Q

PET CT

A

All activated leukocytes demonstrate increased FDG uptake

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6
Q

IGRA

A

Test for latent TB

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7
Q

TTE (transthoracic echocardiogram)

A

Useful in IE

5-10% have negative BCs because of abx or Fastidious organisms (HACEK) or Aspergillus, Bartonella, Brucella, Coxiella, Rickettsia, Mycobacteria, Nocardia, Chlamydia

(IV drug user may take abx themselves and not tell you – linezolid)

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8
Q

HACEK

A

Haemophilus, Aggregatibacter
Cardiovacterium
Eikenelia
Kingella

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9
Q

Dukes Criteria

A

2 major or 1 major + 3 minor criteria

Major
Persistent bacteraemia (>2 BC pos)
Echocardiogram: vegetation
Positive serology for Bartonella, Coxiella or Brucella

Minor
Predisposition (murmur, IVDU)
Inflammatory markers (fever , CRP high)
Immune complexes: splinters, RBCs in urine
Embolic phenomena: Janeway lesions, CVA
Atypical echo
1 positive BC
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10
Q

Giant Cell arteritis

A 
>50y
Jaw claudication 
Headache
ESR >45
High risk of sight impairment / stroke
Temporal biopsy gold standard
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11
Q

Adult onset Stills disease

A

Salmon pink rash (macular papular)

Very high ferritin

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12
Q

Which of the following malignancies is least likely to be associated with fevers

Lymphoma
Renal cell carcinoma
Leukaemia
Hepatocellular carcinoma
Adenocarcinoma of the lung
A

Adenocarcinoma of the lung

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13
Q

African tick bite fever

A

Ricketssia

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14
Q

Lyme disease, ticks

A

Borrelia

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15
Q

Cyclist, Richmond, insect bite

A 
Borrelia
Lyme disease (tick bites)
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16
Q

safari, TseTse fly, Winterbottom’s sign

A

Trypanosoma brucei

- sleeping sickness

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17
Q

Goat, Unpasteurized milk, back pain + discitis

A

Brucellosis

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18
Q

Comma, oxidase +ve, bloody foul diarrhoea, a/w Guillain-Barre, Reiters

A

Campylobacter

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19
Q

Slow onset fever, constipation, bradycarida, splenomegaly, rose spots

A

Salmonella typhi or paratyphi

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20
Q

Non-bloody diarrhoea, poultry/eggs/meat

A

Salmonella enteritedes

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21
Q

Bartonella henselae – cat scratch disease

A

Macule at site of innoculation
Becomes pustular
Regional adenopathy
Progress to systemic symptoms in 14%

Mx: erythromycin, doxycycline

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22
Q

Bartonella henselae – bacillary angiomatosis

A

Occurs in immunocompromised - HIV
Skin papules
Disseminated multi-organ and vasculature involvement

Mx: Erythromycin, Doxycycline PLUS rifampicin

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23
Q

Cats/ undercooked meat, obligate intracellular parasite

A

Toxoplasmosis (T. gondii)

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24
Q

toxoplasmosis features

A 
Fever
Adenopathy
Still-birth
Progressive visual, hearing, motor, & cognitive issues
Seizures (immunocompromised)
Neuropathies (immunocompromised)
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25
Q

toxoplasmosis management

A

Spiramycin

Pyrimethamine plus sulfadiazine – don’t give to pregnant woman – treatment for immunosupressed head toxo

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26
Q

anti-O-polysaccharide Ab, normal WCC

A

Brucellosis

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27
Q

Brucellosis treatment

A

Doxycycline PLUS

Gentamicin OR Rifampicin

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28
Q

Back pain, undulant fever (peaks in evening), focal abscess (psoas)

A

Brucellosis

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29
Q

Rhabdo virus, warm blooded animals, Negri bodies, fatal encephalitis

A

Rabies

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30
Q

Fever, polyarthralgia, maculopapular rash becomes purpuric, may progress to endocarditis, transmitted by rats

A

Rat bite fever
Spirillosis or streptobacillosis
mx: penicillin

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31
Q

Natural reservoir of influenza A viruses

A

Ducks

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32
Q

Influenza virus infection causes respiratory disease because

A

influenza virus requires activation by host cell proteases that are only expressed in the respiratory tract

Haemagglutinin must be cleaved in two in order for fusion event (release genome) to take place
Requires human airway tryptase

Some avian viruses have mutations which allow them to be cleaved in any part of the body = very pathogenic

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33
Q

Binds sialic acis on host cell allowing entry of virus

A

Haemagluttinin

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34
Q

Cleaves sialic acid residues, exposes host cell receptors, disrupts mucin barrier

A

Neuroaminidase

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35
Q

Gene in all human influenza viruses

A

PB2 627K

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36
Q

Avian virus gene

A

PB2 627E

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37
Q

Human H5N1 and H7N9 (avian flu) infections associated with severe disease gene mutation

A

PB2 E627K mutation - allows avian virus to infect humans

Lysine residue in a PB2 gene = hallmark

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38
Q

Features of HA and NA that affect influenza transmission

A

Receptor binding - HA adapted to binding

Virion stability - HA adapted to fusion at lower pH (mucus is acidic)

NA stalk length

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39
Q

Swine flu

A

pH1N1

similar to H1N1 in 1920 - people alive at this time were relatively protected

40
Q

severe outcomes from pH1N1

A

High dose, route of exposure
Mutant virus (D225G mutation)
Bacterial superinfection
Co morbidity: Asthma, pregnancy, obesity, diabetes
Genetic predisposition: IFITM3 mutation; ethnic bias

41
Q

IFITM3

A

Gene normally protective against viral infection
Loss = increase susceptibility
Higher prevalence in China and Japan

42
Q

Antiviral for flu - Targets M2 ion channel

A

Amantadine – old fashioned drug

Single amino acid mutation in M2 (S31N) renders virus resistant

Does not work against influenza B or pH1N1 or seasonal H3N2

43
Q

Antiviral for flu - Neuraminidase inhibitors

A

Tamiflu (oseltamivir) oral – largely available in UK
Relenza (zanamivir) inhaled or iv formulation
Peramivir iv

44
Q

Antiviral for flu - Polymerase inhibitors

A

Favipiravir (licensed in Japan excluding pregnant women - teratogenic)
Baloxavir (licensed in Japan)
Currently license in Japan (particularly in pandemic)

45
Q

Seasonal Influenza vaccine

A

A purified fraction containing HA and NA of an inactivated virus
Given to at risk groups
Short term strain specific immunity

46
Q

Seasonal Influenza vaccine - children

A

Live attenuated vaccine, also tri or quadrivalent
Cold adapted virus limited to URT (sprayed up nose)
Broader immunity including cellular response

47
Q

Malaria - P. Falciparum

A

Length of rhythm - 48h (tertian)

Blood film = young trophozites (rings), crescent-shaped gametocytes

48
Q

Malaria - P. Vivax

A

Length of rhythm - 48h
Chronic liver stage (hypnozites)
Blood film = Schuffners dots, >20 merozites/ schizont

49
Q

Malaria - P. Ovale

A

Length of rhythm - 48h
Chronic liver stage (hypnozites)
Blood film = Schuffners dots

50
Q

Malaria - P. Malariae

A

Length of rhythm - 72h (quartan)
Benign
Similar morphology to P. Knowlesi

51
Q

Malaria - P. Knowlesi

A

Behaves like falciparum
Increasing incidence in SE Asia
1-2 cases/year UK

52
Q

Malaria treatment - non-falciparum

A

Chloroquine (3d)
Primaquine (14 days) - for liver stage
Complications - rare (splenic rupture = fatal)

53
Q

Malaria treatment - falciparum

A

Mild: oral
First line = Malarone (Atovoquone/ Proguanil)

Severe (>2% parasitaemia)
IV Artesunate

54
Q

Dengue Fever

A

Vector - Aedes mosquito
Flavivirus
Short incubation, urban disease
Usually mild/ self limiting - fever, rash, arthralgia
Already infected with different serotype = increased risk of dengue haemorrhagic fever and shock (bleeding, complications)
Tx - supportive, no specific antiviral tx

55
Q

Typhoid

A

Salmonella Typhi or Paratyphi

56
Q

Typhoid Clinical features

A 
Insidious onset (incubation 7-18d)
High, prolonged fever
Headache
Rose spots (minority)
Constipation
Complications - GI bleeding, perforation, encephalopathy
57
Q

Typhoid Tx

A 
Empiric ceftriaxone (2g IV OD)
Azithromycin (500mg BD 7days)
58
Q

Mononucleosis

A 
EBV, CMV
Tonsillar enlargement with exudates
atypical lymphocytosis
monospot
IgM + EBV/CMV
59
Q

Ricketssial Disease

A

obligate intracellular bacteria
fever, headache, myalgia +/- eschar
vectors - ticks/ lice/ mites
tx - doxyxycline

60
Q

Entameoba Histolytica

A 
MSM
food, water, soil
motile trophozite in stool - 4 nuclei
flask-shaped ulcer
dysentery, wind, tenesmus
wt loss RUQ pain (liver anscess)
tx: metronidazole
61
Q

Giardia lamblia

A

travellers/hikers/MSM/mental hospitals
pear shaped trophozite in stool - 2 nuclei
malabsorption - foul-smelling non-bloody diarrhoea
ELISA string test
tx: metronidazole

62
Q

Cryptosporidium parvum

A 
jejunum
severe diarrhoea
immunocompromised
oocytes in stool
tx: paromomycin
63
Q

Kinyoun acid fast stain

A

tests for oocytes in stool in Cryptosporidium parvum

64
Q

Katayama fever

A

acute schistosomiasis

eosinophilia a/w invasive helminth

65
Q

Cholera toxin mechanism (secretory diarrhoea)

A

cAMP opens Cl- channel on enterocytes

Efflux Cl to lumen; loss of H20 and electrolytes

66
Q

Superantigens mechanism (diarrhoea)

A

Directly bind T cell receptors and MHC molecules
Outside peptide binding site
» massive cytokine production (CD4+)
Systemic toxicity and suppression of adaptive immune response

67
Q

S. Aureus food poisoning

A 
Shed via skin into food
Virulence factor - Protein A
Catalase, coagulase +ve, clusters
Beta haemolytic
Vomiting, watery diarrhoea, non-bloody diarrhoea
Tx: self limiting
68
Q

Bacillius cereus

A 
reheated rice - spores
superantigen
short incubation period - 4hrs
watery non bloody diarrhoea 
Tx: self limiting
69
Q

Clostridia Botulinum

A

Canned food - honey in children, beans in students
Blocks Ach release - descending paralysis (botulinism)
Tx: antitoxin

70
Q

Clostridia Perfringens (food poisoning)

A

reheated food/ meat
enterotoxin/ super antigen acts on small bowel
incubation 8-16h
watery diarrhoea, cramps, little vomiting (lasts 24h)
prolonged - gas gangrene - gut necrosis?

71
Q

Clostridia Difficile

A

anaerobe
abx related colitis (cephalosporins/ fluorquinolones)
pseudomembrnaous colitis
Tx: metronidazole (stop causative abx)

72
Q

Listeria monocytogenes

A 
febrile gastroenteritis
Beta haemolyitc
Aesculin positive with tumbling motility
refrigerated food/ unpasteurised dairy/ veg
perinatal infection, immunocompromised
Tx: ampicillin
73
Q

ETEC

A

toxigenic

travellers diarrhoea

74
Q

EIEC

A

invasive dysentary

75
Q

EHEC

A

haemorrhagic
O157:H7 shiga-like verocytotoxin causes HUS
petting zoo - very unwell (ICU)

76
Q

EPEC

A

infantile diarrhoea (P for paeds)

77
Q

Shigella

A

distal ileum and colon
Inflammation, fever pain, bloody diarrhoea
Shiga enterotoxin

78
Q

Yersinia enterocolitis

A

Mesenteric adenitis w necrotising granulomas
A/w reactive arthritis and erythema nodosum
Food contaminated w domestic animal excreta

79
Q

Virbriosis Cholera

A

rice water stool
cAMP binds Cl channels - increas Cl in lumen (loos H20/ electrolytes)
massive diarrhoea without inflammation
supportive tx

80
Q

Vibriosis Parahaemolyticus

A 
Ingestion of raw undercooked seafood (Japan)
3/7 diarrhoea
self limiting
salty agar
tx: doxycycline
81
Q

Vibriosis vulnificus

A

cellulitis in shellfish handlers
tx: doxycycline
HIV - fatal septicaemia w D+V

82
Q

Campylobacter jejuni

A 
curved/comma/ S shaped
unpasteurised milk, food eg poultry
bloody foul smelling diarrhoea
prodrome: headache fever, cramps
oxidase +ve, motile, sensitive to nalidixic acid

A/w Guillain-Barre, reactive arthritis (Reiter’s)

83
Q

Listeria

A

watery diarrhoea, little vomiting
perinatal infection, immunocompromised
febrile gastroeneteritis (outbreaks)
unpasteurised dairy, refrigerated food, vegetables

84
Q

Norovirus

A

adult outbreaks

vomiting

85
Q

Rotavirus

A

dsRNA “wheel like”
<6yrs
secretory, diarrhoea no inflammation
watery diarrhoea by stimulation of eneteric nervous system
exposure to natural infection twice = life long immunity

86
Q

Adenovirus

A

types 40, 41

cause non bloody diarrhoea in <2yrs

87
Q

Sporadic CJD

A

80%
Somatic PRNP mutation or spontaneous conversion
Rapid progressive dementia (myocoluns, cortical blindness, LMN signs)
45-75y
Survival - 6m

88
Q

Sporadic CJD Investigations

A

EEG - periodic triphasic changes
MRI - Highlighting basal ganglia (may be normal)
14-3-3 protein +ve
129 codon MM (most)
Post mortem - spongiform vacuolation, PrP amyloid plaques

89
Q

Variant CJD

A

Acquired - exposure to Bovine Spongiform Encephalitis
Anxiety/paranoia/hallucinations + neuro symptoms
later - chorea, ataxia, dementia
30yrs
Survival - 14m

90
Q

Variant CJD Investigations

A

EEG - non specific slow waves
MRI - posterior thalamus (pulvinar sign)
129 codon MM (all)
Post mortem - PrPsc 4t detectable in CNS, florid plaques

91
Q

Iatrogenic CJD

A

Inoculation - surgery
Progressive ataxia
Later - dementia and myoclonus
Progression - depends on route of inoculation (CNS - fastest)

92
Q

Kuru CJD

A

Acquired CJD
Cannibalism
Progressive cerebellar syndrome
Death within 2y

93
Q

Gerstmann Straussler-Scheinker Syndrome

A 
Inherited CJD
Autosomal dominant
20-60y
Survival - 5y
Dysarthia - progresses to cerebellar ataxia (+ dementia)
94
Q

Fatal Familial Insomnia

A 
Inherited CJD
Inherited CJD
Autosomal dominant
Insomnia + paranoia - hallucinations + wt loss
Mute
Survival 1-18m
95
Q

Inherited CJD investigations

A

MRI - high signal in basal ganglia

129 codon homozygosity - earlier onset

Sophia's Path (8 decks)

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