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Year 5 😊✌🏼 > Microbio > Flashcards

Microbio Flashcards

1
Q

Why is Vit B6 given with TB treatment?

A

to protect against the SE of isoniazid

(to prevent peripheral neuropathy SE, isoniazid (promotes pyridoxine excretion)

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2
Q

Phases of TB infeection

A

Primary infection - initial infection, often in childhood, often asymptomatic
latent infection - suppressed, hangs around in foci
post-primary: reactivation of latent, often immunoupresseion - can disseminate

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3
Q

What is a ghon focus?

A

a granuloma typically located in the middle/lower lung lobes.(latent TB)

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4
Q

What is a ghon complex?

A

ghon focus with lymphadenopathy (latent TB)

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5
Q

ranky complex

A

ghon complex that became calcified (latent TB)

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6
Q

Presentation types of TB

A
  • constitutional sx (FLAWS)
  • pulmonary TB
  • TB lymphadenitis

military TB
Meningeal TB (presents as subacute meningitis)
Pott’s disease (TB of the spine)
genitourinary TB
serosa, GI, adrenal, cutaneous etc.

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7
Q

What is miliary TB?

A

pulmonary TB erodes into a blood vessle and disseminates across body

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8
Q

Meningeal TB

A

subacute presentation
add

often seen in HIV patients

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9
Q

Skin disease in TB

A

lupus vulgaris (pathognemonic)

erythema nodosum (common)

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10
Q

IX for TB

A

active
- sputum culture - gold standard (in Lowenstein Jensen media)
- sputum smear and Ziehl-Neelson stain for AFB (quicker, in reality used more often to make a dx. other stain is rhodamine auramine stain)

latent
- Mantoux test (will come back +ve if had BCG)
- IGRA ( can be used if previously vaccinated, only +ve in TB not BCG, more expensive)

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11
Q

Rhodamine vs rhodamine auramine stain

A

rhodamine - copper -> wilsons

RA - TB

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12
Q

Mx of TB

A

RIPE

R - rifampicin
I - isoniazid (+pyridoxine)
P - Pyrazinamide
E - Ethambutol

4 for 2m (RIPE) and continue 2 for 4m (RI)

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13
Q

Latent TB Mx

A

2 drugs (R+I) for 3 months

OR

1 drug (I) for 6 months

(double check)

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14
Q

Mx of DR TB

A

RIPE +

xxxx
fluoroquiolones?

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15
Q

name some mycobacterial diseases

A

Tuberculosis
Leprocy (skin changes and peripheral nerve disease)
MAC (mycobacterium avian complex, looks like pulm TB in pts with RF e.g. HIV, CF, bronchiectasis)
Swimming pool granuloma (superficial ulcers, exposed to fishtanks, aquarium)
Buruli ulcer (pt in tropics with slowly progressive, painless , ulcer)

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16
Q

Presentation of leprosy

A

hypo/hyperpigemnted nerve patches
peripheral nerve palsies
thickening of nerves

amyloidosis
median nerve palsies

150 cases annually - worldwide/USA?

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17
Q

Typical vs atypical pneumonia

A

typical presents with classic signs and symptoms of pneumonia and classic CXR changes

atypical pneumonia: no/atypical signs and symptoms, not in-keeping with CXR, don’t respond to penicillin abx because no cel wall

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18
Q

What abx do typical and atypical pneumonias generally respond well to?

A

typical - penicillins

atypical - macrolides

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19
Q

Strep pneumoniae pneumonia features

A

most common

rusty coloured sputum
gram +ve diplococcus
positive urine antigen test

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20
Q

H influenzae pneumonia

A

common in pts with COPD
gram -ve coccobacillus

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21
Q

Moraxella catarrhalis pneumonia

A

seen in smokers
gram -ve coccus

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22
Q

Buzzwords for Staphylococcus aureus pneumonia

A

post-influenza (2w bad influenza, better for 2d, then bad again)
cavitatiing lesions
gram positive cocci in grape like bunches

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23
Q

Klebsiella pneumonia buzzwords

A

alcoholics and aspiration
haemoptysis and cavitating lesion
alcoholics and post stroke (aspiration)

one more

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24
Q

chlamydia pneumoniae pneumonia

A

atypical pneumonia
3-4 w incubation

Chlamydia IgG and IgM serology
NAAT with sputum or nasopharyngeal swab.

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25
Q

Legionella pneumonia buzzwords

A

exposed to air conditioning, plumbers, travellers

vey unwell

hepatitis, hyponatraemia, lymphopaemia,

urine antigen test +ve

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26
Q

What pneumonia if urine antigen test is +ve

A

strep pneumoniae

or

legionella

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27
Q

Mycoplasma pneumoniae infection buzzwords

A

cold AIHA
erythema multiforme - can progress to SJS

young people in close proximity e.g. halls

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28
Q

psitacci

A
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29
Q

coxiella brunetti

A

gram -ve
zoonotic infection (cattle, goats, sheep)
Q-fever

add information from slides

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30
Q

LRTIs in HIV immunocompromised

A

PCP
TB
Cryptococcus neoformans
Nocardia

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31
Q

How does PCP present?

A

dry cough
desaturation on exertion

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32
Q

What organisms are encapsulated?

A

SHiNS/NHS

neisseria
haemophilus
strep

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33
Q

Reheated rice diarrhoea - which pathogen?

A

bacillus cereus

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34
Q

Staph aureus buzzwords (GI infection)

A

recent hx of bbq, short incubation because it is due to toxins, not bacteria dividing

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35
Q

traveller diarrhoea - organism

A

E coli

usually non-haemorrhagic unless EHEC

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36
Q

rice water stool - pathogen?

A

cholera

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37
Q

Which pathogens cause dysentery?

A

CHESS

campylobacter
hemorrhagic e coli
entamoeba histolytica
salmonella enterirides
shigella spp

Yersinia enterolitica (often causes terminal ileitis and adenitism can reseblne appendicitis, can be bloody or non blody

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38
Q

How can you classify GI infections?

A

secretory

inflammatory (cause dysentery)

systemic symptoms

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39
Q

Yersinia - what kind of pathogen is it? How and where can you get it? Sx? Dx via? Mx?

A

Yersinia pestis (‘‘plague’’)

gram-ve lactose fermenter

reserviour in rats, transmitted by fleas

still seen in some American national parks e.g. Yosemite

Sx
- bubonic plague: flea bites human -> swollen LN (bubo) - dry gangrene
- pneimonic plague: usually seen during epidemics, person-person spread

dx via PCR

Mx: streptomycin, doxycycline, gentamicin, chloramphenicol (in meningitis)

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40
Q

Entamoeba histolyitca

A

presents with dysebtertm chronic

t

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41
Q

Protozoal GI infections - examples

A

Entamoeba histolytica

Giardia lamblia

Cryptosporidium/

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42
Q

Giardia

A
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43
Q

Cryptosporidium

A
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44
Q

C diff diarrhoea buzzwords

A
  • hx of abx
  • hospital inpatient admission
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45
Q

Which abx are associated with c diff?

A

cephalosporins

clindamycin
ciprofloxacin

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46
Q

How do you diagnose c diff?

A

stool c diff toxin
visualise pseudomembrane

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47
Q

How do you manage c diff?

A

1st infection: oral vancomycin
1st recurrence (within 12 w of last episode) fidaxomicin

further recurrence - consider faecal microbiota transplant
fulminant infection - oral vancomycin + IV metronidazole

48
Q

Pseudomembranous colitis

A

c difficile GI infection

49
Q

1st line management of C diff

A

oral vancomycin

50
Q

Pyelonephrosis

A

pyelonephritis with obstruction - insert nephrostomy tubes

51
Q

What makes a UTI complicated?

A

abnormal UT
pregnancy
imunocompromised
instrumentalisation

52
Q

types of UTIs

A

cystitis
pyelonephritis
pyelonephrosis

53
Q

When are nitrites +ve on urine dip

A

in coliform UTIs (i.e. E coli)

they have an enzyme that reduces nitrates to nitrites

54
Q

Urine MCS for UTI dx

A

> 10^4 colony-forming units/ml is diagnostic
10^3 colony forming units/ml E coli or staph saprophyticus

55
Q

What makes a urine sample

A

mixed growth
squamous cells

if not UTI sx

56
Q

Struvite stones - what organism?

A

proteus mirabilis (because it makes the urine alkaline and makes it easier for these stones to form)

57
Q
A

klebsiella

58
Q

Which organisms causing UTI indicated renal tract abnormalities?

A

proteus
klebsiella

59
Q

Abx for UTI

A

lower UTI: nitrofurantoin, trimethoprim, cephalexin

uncomplicated - 3d
complicated or male - 7d

60
Q

UTI in pregnancy - when not to use certain abx.

A

nitrofurantoin - not in 3rd TM because it causes haemolytic jaundice in the baby

trimethoprim - don’t use in 1st TM because it is a folate infection

61
Q

What drug do you have to look out for when giving trimethoprim

A

methotrexate

62
Q

Mx of pyelonephrits

A

IV co-amox + gent

63
Q

asymptomatic UTI mx

A

do not treat unless they are pregnant

64
Q

What is meningism?

A

stiff neck
photophobia
headache
+ve ??? sign

65
Q

What causes meningism but is not meningitis?

A

subarachnoid haemorrhage

66
Q

Difference between meningitis and encephalitis in presentation?

A

altered mental state in encephalitis

67
Q

Types of CNS infection

A

meningitis
encephalitis
brain infection

68
Q

Bacterial causes of meningitis in neontaes

A

GBS
listeria monocytogenes
E coli

69
Q

Bacterial causes of meningitis in adults

A

neisseria meningitis
strep pneumoniae

70
Q

Bacterial causes of meningitis in elderly

A

GBS
listeria monocytogenes and as adults

71
Q

Bacterial causes of meningitis in immunocompromised

A

TB

72
Q

Viral causes of CNS infections

A

Enteroviruses

HSV 2 - meningitis
HSV 1 - encephalisits
HIV seroconversions

73
Q

Fungal CNS infections

A
74
Q

Diagnosing meningitis

A

history and LP

75
Q

Why do we worry about and LP in raised ICP

A

Coning

we worry if they have raised ICP due to a SOL, then you cone.

76
Q

signs to not do LP (in rase

A

seizures
reduced GCS
focal neurology
papilloedema

77
Q

Ix for CSF analysis in ?CNS infection

A
78
Q

MX of meningitis in the hospital

A

empiric treatment (IV ceftraizone/cefotaxime (+ampicillin if baby/elderly)

steroids (dex) are controversial - yes according to guidelines (just before the 1st dose, if strep or H flu then continue for 5/7 otherwise stop)

give aciclovir if cannot rule out encephalitis

79
Q

Mx of meningitis in community

A

IM benpen and call ambulance

80
Q

Mx of TB meningitis

A
81
Q

Commonest causes of encephalitis in the UK

A

HSV1

82
Q

unvaccinated, measles as a child now encephalitis - diagnosis

A

SSPE

subacute sclerosing pan encephalitis

83
Q

HIV pt or just started monoclonal treatment now has encephalitis - dx?

A

PML caused by JC virus (progressivve …

84
Q

Management of encephalitis

A

empirically treat with aciclovir (MRI and CSF PCR to help identify organisms)

85
Q

What organisms cause brain abscesses

A

mainly mixed growth -> broad spectrum and anaerobic coverage

HIV - Toxoplasmosis

86
Q

Mx of brain abscess

A

abx (wide spectrum + anaerobe coverage)

surgical drainage

steroids to reduce swelling and Kepra to prevent seizures

87
Q

What is the commonest STI?

A

chlamydia trachomatis

88
Q

What is the commonest STI?

A

chlamydia trachomatis

89
Q

How can chlamydia STI present?

A
  • STI sx e.g. dysuria
  • reactive arthritis
  • serovars L1-3 _> lymphogranuloma venereum (proctatis followed by very swollen groin lymphobuboles)
  • ophthalmia neonatorum, 1-2 w after birth

can often be asymptomatic

90
Q

can you culture chalmydia?

A

no

91
Q

What STI causes reactive arthritis?

A

chlamydia

92
Q

How does gonorrhoea present?

A

typical sti sx progressing to PID
migratory arthritis
disseminated gonococcal infection
painful tendnds

ophthalmia neonatirm - first few days after birth

93
Q

How can you differentiate if neonatal conjunctivitis in gonorrhoea or chlamydia?

A

gonorrhoea - first few days

chlamydia - 1-2 w post birth

94
Q

Mx of gonorrhoea

A

IM cef

95
Q

gold standard in dx gonorrhoea

A

?culture

96
Q

Syphylis stages

A

1) painless chancre

2) unwell, condylomata lata (genitals or oral), lymphadenopathy, maculopapular rash

3) tertiary gummatous disease, aortitis, neurosyphilis, tabes dorsalis

97
Q

What pathogen causes syphilis?

A

treponema pallidum

98
Q

How do we manage syphylis?

A

IM benpen

99
Q

How do we manage neurosyphilis?

A
100
Q

Jarish Herxheimer reaction

A

when you treat syphilis they are more unwell for the first 1-2 days, can give paracetamol and maybe steroids if necessary

101
Q

How do we test for primary syphlis?

A

darkfield microscopy of chancre sample looking for ??

or serology:

non-treponemal tests: VDRL, RPR tests (non specific)
treponema tests - TPHA, TP-EIA (stays positive in treated)

102
Q
A

4x reduction in titre in non terponemal titre suggests resopsen to treatment

103
Q

Chancroid - dx

A

haempphilus ducreyi

painful ulcers,
lypmhadenopathy

patients often from tropical regions

104
Q

What is the commonest pathogen causing pneumonia

A

streptococcus pneumoniae

105
Q

In someone who has had the BCG vaccine, how can you test for latent TB?

A

IGRA

-> only positive in infection, however, more expensive than Mantoux test.

Mantoux test is positive for both BCG and infection

106
Q

Culture medium for TB and duration of culture

A

Lowenstein-Jensen Medium for 6 weeks -> acid fast bacilli seen

107
Q

What does IGRA stand for?

A

interferon gamma release assay

108
Q

Reservoirs for mycobacterium leprae

A

humans
9 banded armadillos (in the USA)

109
Q

What pathogen is likely to cause pneumonia in patients with COPD?

A

H influenzae

110
Q

What pathogen is likely to cause pneumonia in smokers?

A

Moraxella catarrhalis
Haemophilus influenzae

111
Q

What pathogen is associated with pneumonia in alcoholics?

A

Klebsiella pneumoniae

112
Q

What organism causes post-influenza bacterial pneumonia?

A

Staphylococcus aureus

113
Q

Name pathogens that cause typical pneumonia

A

Strep pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus
Klebsiella pneumoniae

114
Q

Name pathogens that cause atypical pneumonia

A

Legionella pneumophilia (zircon, travel, water, hepatitis, low Na)
Mycoplasma pneumoniae (uni student, AIHA, erythema multiforme)
Chlamydia psitacci (associated with birds)
Chlamydia pneumoniae

115
Q

Name pathogens that cause atypical pneumonia

A

Legionella pneumophilia (zircon, travel, water, hepatitis, low Na)
Mycoplasma pneumoniae (uni student, AIHA, erythema multiforme0
Chlamydia psitacci (associated with birds)
Chlamydia pneumoniae

116
Q

What pneumonia pathogen is associated with erythema multiforme?

A

mycoplasma pneumoniae

Year 5 😊✌🏼 (53 decks)

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