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MicroB by Clinical Scenarios Flashcards

1
Q

Top 3 most common causes of UTI in males

A
  1. Escherichia Coli
  2. Proteus
  3. Klebsiella
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2
Q

Top 2 most common causes of UTI in females

A
  1. Escherichia Coli
  2. Staphylococcus Saprophyticus
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3
Q

Other (less common but) possible causes of UTI

A

Enterococci, Enterobacter, P. aeruginosa

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4
Q

Lower tract UTI symptoms include:

A

Frequency, urgency, small volumes, dysuria (painful urination), lower abdominal pain

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5
Q

Upper tract UTI symptoms include:

A

Pyelonephritis with flank pain, rigors, high fever, sepsis

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6
Q

UTIs are commonly found in:

A

Older women and (older) men with enlarged prostate
Patients with impaired urine flow
Sexually active women
Babies with congenital abnormalities of urinary tract
Pregnant women (due to anatomy)

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7
Q

Why might dipstick/culture be problematic for diagnosis of females’ UTI?

A

Urine is often contaminated with vulval flora

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8
Q

Why are UTIs more commonly found in females?

A

They have a shorter urethra

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9
Q

Treatment for E. Coli caused UTI

A

Co-amoxiclav, Cotrimoxazole, Ciprofloxacin, Cephalexin, Vancomycin (for Methicillin-resistant S. saprophyticus)

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10
Q

Complications that could follow E. Coli caused UTI?

A

Diarrhoeal disease

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11
Q

Complications that could follow Klebsiella caused UTI?

A

Friedlander’s pneumonia (chronic destruction and multiple abscess formation in lungs) / Nosocomial infections / Bacteraemic infections

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12
Q

Complications that could follow Enterococci caused UTI?

A

Endocarditis and bacteraemia nosocomial infection

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13
Q

Majority of wound infections are caused by ___ and ___

A

Staphylococcus Aureus (Open wound)
Streptococcus pyogenes (No obvious wound) -> Check toe webs

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14
Q

Treatment for MRSA caused wound infections?

A
  1. Wound debridement/incision and drainage
  2. Cloxacillin
    3.Erythromycin -> For penicillin allergic patients
  3. Vancomycin -> For MRSA
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15
Q

Complications of S. aureus wound infections?

A
  1. Toxic shock syndrome toxin-1
  2. Endocarditis (acute)
  3. Osteomyelitis
  4. Pneumonia
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16
Q

Complications of Strep. pyogenes wound infections?

A
  1. Scarlet fever (Exotoxins A and C)
  2. Acute Rheumatic Fever (ARF) (JONES criteria) -> Rheumatic Heart Disease
  3. Acute glomerulonephritis -> Acute renal failure
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17
Q

Skin and soft tissue infections associated with water can be caused by:

A

(Apart from most common Staph aureus and Strep pyogenes)
1. Pseudomonas aeruginosa (PAE)
2. Vibrio vulnificus
3. Aeromonas

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18
Q

Complications of Vibrio vulnificus?

A

Oedema, erythema and life-threatening necrosis

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19
Q

Complications for Aeromonas?

A

Septicaemia

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20
Q

Treatment for Strep pyogenes?

A

Benzylpenicillin (IV)

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21
Q

Treat Vibrios vulnificus with?

A

Ceftazidime

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22
Q

Necrotising fasciitis can be caused by?

A

Staphylococcus Aureus, Streptococcus pyogenes, Vibrio vulnificus, Aeromonas (with water exposure)

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23
Q

Investigations for necrotising fasciitis:
Check for myelitis and presence of gas and fluid with ___ (Better than ___)

A

MRI, CT

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24
Q

Gas gangrene with environmental interaction is caused by?

A

Clostridium perfringens

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25
Treatment for Clostridium perfringens?
Debridement (VITAL) + Benzylpenicillin + Clindamycin (to inhibit toxin production)
26
Complications of Clostridium perfringens?
Skin discoloration with fluid-filled blebs. May be accompanied with smelly discharge. Systemically unwell -> Unconsciousness
27
Organism that causes SSTIs after animal bite is ___. Could lead to ___ and requires checking of vaccination.
Pasteurella, Rabies
28
Organism that causes SSTIs in a farm animal worker with a black lesion is _____. Presents as _____. Treated with _____ and may progress to _____.
Bacillus anthracis, anthrax -> eschar surrounded by ring of vesicles and oedema, ciprofloxacin, septicaemia and death
29
SSTIs caused by Candida (yeast) is treated with?
Amphotericin B + Caspofungin + Ketoconazole
30
Most common cause and bacterial cause of acute pharyngitis is
Commonest cause: Viruses Bacterial cause: Streptococcal pyogenes
31
Causes of acute otitis media / sinusitis? Treatment?
1. Viruses 2. Streptococcus pyogenes 3. Haemophilus influenzae 4. Moraxella catarrhalis Treatment: Coamoxiclav or vancomycin (if Strep pneumoniae is penicillin-resistant)
32
Complications of Strep. Pneumoniae?
Pneumonia and meningitis, pneumococcal endocarditis
33
Complications of Moraxella catarrhalis?
Chest infections (especially immunocompromised)
34
Causes of malignant otitis externa?
Pseudomonas aeruginosa
35
Treat of P. aeruginosa caused otitis externa?
Pip-tazo and amikacin
36
Acute epiglottitis is caused by
1. Haemophilus influenzae 2. Streptococcal pneumoniae
37
Treatment for acute epiglottitis?
1. Alert anaesthetist (for intubation due to airway obstruction) 2. IV Ceftriaxone
38
Walking pneumonia is caused by
1. Streptococcal pneumoniae 2. Mycoplasma pneumoniae
39
Mycoplasma pneumoniae is resistant to all ___ because ___
Beta lactams, Mycoplasma do not have cell walls (cannot be stained with Gram stain)
40
Complications of Mycoplasma pneumoniae?
Stevens-Johnson syndrome (Together with joint pains, encephalitis, haemolytic anaemia, myocarditis)
41
Causes of community acquired pneumonia?
1. Streptococcal pneumoniae 2. Influenza virus 3. Mycoplasma pneumoniae
42
Causes of community acquired pneumonia with travel history?
1. Streptococcal pneumoniae 2. Influenza virus 3. Legionella
43
Treatment for mycoplasma pneumoniae?
*NO CELL WALL INHIBITORS as Mycoplasma does not have a cell wall Amoxicillin + Benzylpenicillin Cannot prescribe macrolide alone as it is bacteriostatic
44
Causes of acute severe community acquired pneumoniae in Asia with Diabetes Mellitus?
1. Streptococcal pneumoniae 2. Influenza virus 3. Klebsiella pneumoniae 4. Burkholderia pseudomallei (Has special association with DM)
45
Hospital acquired infection in pneumonia in ICU?
1. Staphylococcus aureus 2. Klebsiella pneumoniae 3. Pseudomonas aeruginosa 4. Acinetobacter baumannii 5. Legionella 6. Mycobacterium TB
46
Causes of cough, fever and weight loss over weeks to months?
1. Burkholderia pseudomallei 2. Mycobacterium TB
47
Common typical causes of community acquired pneumonia? Treatment?
Strep pneumoniae, Haemophilus Influenzae, Moraxella catarrhalis Treated with penicillin / augmentin
48
Common atypical causes of community acquired pneumonia? Treatment?
Mycoplasma tuberculosis, Chlamydia pneumoniae, Legionella Treated with tetracycline and macrolide erythromycin or azithromycin for Legionella)
49
Causes of hospital acquired pneumonia and respective treatment?
Pseudomonas -> Piptazo Gram negatives -> Gentamicin (aminoglycoside) MRSA -> Vancomycin and tetracycline
50
Causes of conjunctivitis? (No trauma/contact lens)
1. Adenovirus -> Follicular conjunctivitis and keratoconjunctivitis 2. Strep. pneumoniae 3. Haemophilus Influenzae
51
Complications of Adenovirus?
- Pharyngoconjunctival fever - Pneumonia, pharyngitis (UTI), chronic tonsilitis - Haemorrhagic cystitis (bladder inflammation with blood in urine) - Enteritis (inflammation of lymph nodes)
52
Treatment for Conjunctivitis caused by Adenovirus?
Fluoroquinolone
53
Dendritic ulcer is caused by
Herpes Simplex (HSV1)
54
Local zoster is caused by
Varicella-Zoster Virus
55
Complications of Varicella/Zoster?
Varicella: Skin superinfections, aseptic meningitis, pneumonia, arthritis, haemorrhagic condition Zoster: Encephalomyelitis, post-herpetic neuralgic, disseminated zoster
56
Causes of eye infections in soft contact lens user is likely to be caused by
Pseudomonas aeruginosa NOT treated with conjunctivitis drugs
57
Complications of P. aeruginosa caused eye infections?
Pseudomonas keratitis (Small corneal ulcer -> Rapidly penetrate -> Perforate cornea -> Blindness)
58
Cause of eye infection after swimming with contact lenses? How does it present itself?
Acanthamoeba Presents with ocular pain and corneal lesions (Differential diagnosis: Herpes simplex)
59
Red eye with trauma is caused by
1. Pseudomonas Aeruginosa 2. Bacillus Cereus 3. Fungi -> Aspergillus, Candida (keratomycosis)
60
Red eye after outdoor sports is caused by
Microsporidia
61
Opthalmia neonatorum found in neonates in days 1-3 is caused by ___ and treated with ___
Neisseria gonorrhoeae, ceftriaxone
62
Eye infections found in neonates from days 3-10 is caused by ___ and treated with ___. Complications include ___.
Chlamydia trachomatis, erythromycin, pneumonitis
63
Trachoma is caused by ___ and can be treated with ___. Complications include ___.
Chlamydia trachomatis, azithromycin, pannus formation, chronic inflammation and scarring of eyelids leading to blindness
64
Eye infections that are uncommon in Singapore 1. Ocular larva migrans caused by _____ 2. Cornea opacity caused by _____ 3. Irritated, swollen, painful eye caused by _____ 4. Choroiditis retinitis caused by _____
1. Toxocariasis 2. Onchocerca volvulus 3. Loa loa 4. Toxoplasmosis
65
Vomiting in an adult is likely to be caused by ___ from ___. Diarrhoea is described to be ___ and resistant to ___.
Norovirus, injested contaminated seafood. Watery, chlorination/drying
66
Diarrhoea in children is often caused by ___ and can be prevented by ___ including ___ & ___. Can be avoided by ___.
Rotavirus Rotarix, Rotateq Not drinking bottled milk
67
Acute diarrhoea in travellers is caused by ___. Treatment is ___.
1. E. Coli (EPEC, ETEC) -> Ciprofloxacin 2. Entamoeba histolytica -> Metronidazole 3. Cryptosporidium -> Self-limiting, no treatment needed
68
Cause of bloody diarrhoea with Haemolytic Uraemic Syndrome is caused by ___ with antigen ___.
Enterohaemorrhagic E. Coli Antigen O157
69
Acute to chronic diarrhoea with bloating and foul stools is caused by ___. Treated with ___.
Giardia, metronidazole
70
Acute diarrhoea with fever and blood is caused by _____. Could lead to ___ and ___.
Campylobacter Severe haemorrhage, Guillain Barre Syndrome (reactive arthritis)
71
Campylobacter has an incubation period of 1-7 days where it presents as a flu-like illness with abdominal pain and diarrhoea. It is sometimes misdiagnosed as?
Appendicitis
72
Cause of meningitis in immunocompromised (AIDS/organ transplant) with gradual onset? Treated with?
Cryptococcus neoformans Amphotericin B
73
Patient presents with headache for 5 days, high protein, low glucose and WBC in 100s (high). What is patient likely to have?
Mycobacterium Tuberculosis
74
Travel associated diarrhoea is likely to be ___ which presents as ___ with ___. It is typically caused by antigen ___.
Vibrio cholerae, rice water stools, fishy odour, O1
75
How is outbreak/travel associated diarrhoea treated? (Vibrio cholerae)
Azithromycin or doxycycline + Rehydration
76
What causes shellfish associated diarrhoea and vomiting?
Vibrio parahaemolyticus
77
What is likely to cause antibiotic associated diarrhoea? How is it treated?
CDAD (Clostridium difficile associated diarrhoea) Treatment: Oral vancomycin / metronidazole
78
What causes food associated diarrhoea and vomiting? What are the accompanying treatment methods?
1. Staphylococcus aureus 2. Salmonella (poultry/eggs) -> Ciprofloxacin or ceftriaxone 3. Campylobacter -> Erythromycin or ciprofloxacin 4. Bacillus cereus (fried rice) -> Ciprofloxacin or azithromycin
79
Blisters on genitals is likely to be caused by ___. (Assume no ulceration)
Herpes Simplex Virus 2
80
Blisters on genitals with ulceration is caused by
1. HSV2 2. Treponema pallidum (primary syphilis) 3. Haemophilus ducreyi
81
Complications of syphilis?
1. Meningovascular syphilis -> Stroke 2. General paresis -> Dementia 3. Tabes dorsalis -> Demyelination of spinal cord, proprioception lost and ataxic gait 4. Gummatous syphilis -> Necrotic granulomatous lesions 5. Cardiovascular syphilis -> Aortic aneurysm
82
Dysuria is caused by
1. Chlamydia trachomatis 2. Mycoplasma
83
How is Chlamydia and N. gonorrhoea tested for?
Morning urine PCR
84
Purulent urethral discharge is caused by ___
Neisseria gonorrhoea
85
N. gonorrhoea is resistant to ___ and ___ and can be treated with ___ and ___.
Resistant to penicillin and ciprofloxacin Treated with ceftriaxone and azithromycin
86
Chlamydia trachomatis can be treated with
Oral doxycyline and azithromycin
87
Pruritus and cheesy vaginal discharge is caused by
Candida albicans yeast
88
Malodourus (foul-smelling) vaginal discharge is caused by
Bacterial vaginosis
89
Candida can be treated with
Clotrimazole and Amphotericin B
90
Grain stain for bacterial vaginosis will show
Clue cells (Epithelial cells covered with small adherent bacteria)
91
Treatment for bacterial vaginosis
Oral metronidazole
92
Copious, foamy, purulent, frothy, yellow-greenish vaginal discharge is caused by ___ and can be treated with ___.
Trichomonas vaginalis, metronidazole (ping-pong infection)
93
Condylomata acuminate (genital warts) is caused by
Human Papillomavirus (HPV)
94
Scaly rash on skin, palms and soles is caused by ___. Occurs only in ___ and is transmitted through ___. It ___ be cultured and ___ must be used for visualisation.
Treponema pallidum Men, sex Cannot, Dark Ground illumination
95
Small papule that grows in discrete waxy, smooth, dome-shaped, pearly nodules with semi-sold caseous material is caused by
Molluscum contagiosum virus
96
Where are the papule lesions found in Molluscum contagiosum?
Trunk Children: Proximal extremities Adults: Pubic areas and thighs
97
Molluscum contagiosum virus is a ___ infection and has ___.
Self-limiting, NO lifelong immunity
98
Investigation method for Trichomonas vaginalis?
Wet mount microscopy
99
Treatment for primary syphilis?
IM benzylpenicillin

Microbiology (9 decks)

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