Microbiology Flashcards
1
Q
What happens following TB exposure?
A
Either infection or not
If infected then primary TB with symptoms or latent TB (gohn focus)
Then latent TH can be reactivated with symptoms or not reactivated
2
Q
Classic signs of TB
A
Fever, night sweats, weight loss, upper lobe cavitation, haemoptysis, caseating granuloma
3
Q
Types of TB seen in the body
A
Subacute meningitis - headaches etc, can have confusion, diagnose LP
Spinal (Potts disease) - back pain, discitis, vertebral destruction, iliopsoas abscess
Miliary TB - disseminated causing pericarditis, renal issues, liver, testicular, lymphadenitis
4
Q
Gold standard for TB, and results
A
Ziehl-Neelson stain on Lowenstein Jensen medium for 6 weeks
Acid fast bacilli seen
5
Q
Other TB investigations
A
Sputum samples x3
Tuberculin skin test - detects active, latent or BCG
IGRA - only active or latent
6
Q
Treatment for TB and how long are they given for
A
RIPE - rifampicin, isoniazid, pyrazinamide, ethambutol
All for 2 months then R&I for 4 more
7
Q
Side effects of TB treatment
A
R - orange secretions
I - peripheral neuropathy
P - hepatotoxic
E - optic neuritis
Orange people have oranges
8
Q
Second line TB treatment
A
Injectables, quinolones, linezolid
9
Q
TB prophylaxis
A
Isoniazid
10
Q
What does the BCG vaccine contain
A
Attenuated M.Bovis
Contraindicated in immunosuppression
11
Q
Mycobacterium Leprae
A
Causes leprosy, skin pigmentation, nodules, nerve thickening and disability
12
Q
CURB -65
A
13
Q
Treatment according to CURB scores
A
14
Q
Atypical vs typical pneumonia
A
Typical=classic signs and symptoms , classic X-ray changes (i.e.
consolidation), respond to penicillin Abx
Atypical=no/atypical signs and symptoms, not keeping with X-ray, don’t respond to penicillin Abx (because no cell wall). May have extra-pulmonary
features, e.g. hepatitis, hyponatraemia
15
Q
What is HAP? Common causative agents
A
After 48 hours of hospital admission
E.coli, Klebseilla, Staph, Pseudomomas, Haemophilus
16
Q
Typical pneumonia causes
A
Strep p Haemophilus I Moraxella catarrhalis Staph a Klebseilla
17
Q
Key features of strep pneumonia
Microscopic feature
A
Most common
Rusty coloured sputum, lobar
+ve diplococci
18
Q
What is Haemophilus pneumonia associated with?
Microscopic feature
A
Associated with smoking, COPD
-ve cocco bacilli
19
Q
What is Moraxella pneumonia associated with?
Microscopic feature
A
Smoking
-ve cocci
20
Q
Key features of staph pneumonia
Microscopic feature
A
Associated with recent viral infection
Cavitation of CXR
+ve cocci, bunch brunch cluster
21
Q
Key feature of klebseilla pneumonia
Microscopic feature
A
Alcoholics, elderly, haemoptysis
-ve rod
22
Q
Causes of atypical pneumonia
A
Legionella pneumophilia
Mcyoplasma pneumoniae
Chlamydia pneumomiae
Chylamydia psittaci
23
Q
Key points about legionalla pneumophilia
A
Travel, air conditioning, water towers, hepatitis, hyponatraemia
24
Q
Key points about mycoplasma pneumoniae
A
Uni students Boarding schools Dry cough Arthralygia Cold agglutinin test/AIHA Erythema multiforme
25
Where does Chlamydia psittaci come from?
Birds
26
What are some infections you can get in AIDS?
```
TB
CMV, EBV, HSV, JCV
PCP (pneumocystis pneumonia), Candida
Cryptococcus neoformans
Toxoplasma
Salmonella septicaemia
Cryptosporidium
```
27
What does a splenectomy put pts at risk of?
Encapsulated bacteria
| E.g. H influenzae, S.pneumomiae, N.meningitidis
28
Key infections in CF
Pseudomonas aeruginosa
| Burkholderia cepacia
29
What does neutropenia put pts at risk of?
Aspergillus
30
Treatment for HAP?
ciprofloxacin and vancomycin (tazocin and vancomycin if severe)
31
What is infective endocarditis?
Infection of innermost layer, mainly valves, vegetation off valves that fly around body forming emboli
32
Which valves are involved mainly in infective endocarditis and which side is associated with IVDU?
Mitral and aortic
Right sided
33
Risk factors for IE
Long term lines, IVDU, poor dentition, prosthetic valve, rheumatic heart disease, immunosuppression
34
Acute causes of IE
Strep pyogenes (GAS), staph aureus (IVDU), CoNS (prosthetic)
35
Causes of subacute IE (low virulence)
HACEK - Haemophilus, acinetobacter, cardiobacterium, eikinella, kingella
Strep viridans
Staph epidermidis
36
Signs of IE
Fever, anorexia, malaise, fatigue, night sweats, SOB, new mumur, janeway lesions, splinter haemorrhages, splenomegaly, Osler nodes, haematuria, septic abscesses, microemboli
37
Investigations for IE
Blood cultures at 3 sites, echo
38
Dukes criteria - major and minor
Major -
- Positive blood cultures growing typical organisms (12 hours apart >2)
- New regurgitant murmur/vegetation on echo
Minor -
- Risk factors
- >38
- Emboli phenomena (janeway lesions, splinter haemorrhage, splenomegaly, abscess)
- Immune phenomena (Roth spots(in eyes), oslers nodes, haematuria)
- Positive culture not meeting major
2 major, OR 1 major + 3 minor, OR 5 minor criteria
39
Treatment for IE
IV Abx
Start as soon as culture taken
Acute - flucloxacillin
Subacute - benzlypenicillin + gentamycin
Prosthetic valve - vancomycin+ gentamicin+ rifampicin
40
Three forms of GI infections , examples and symptoms of each
Secretory diarrhoea - toxins, chloride ions, water and electrolyte loss, watery, no fever (CHOLERA)
Inflammatory diarrhoea - inflammation and bacteraemia, fever, bloody (SHIGELLA, CAMPYLOBACTER, NON TYPHOIDAL SALMONELLA)
Enteric- fever, unwell, fewer GI symptoms ( TYPHOIDAL SALMONELLA, YERSINIA, BRUCELLA)
Enteric fever aka typhoid fever is caused by salmonella
41
Gives some GI viruses
Norovirus, rotavirus (<6yo), adenovirus (< 2 yo), hep A, enterovirus
42
Give examples of GI organisms
C.diff (after 3C - ciprofloxacin, clindomycin, cephalosporins)
Vibrio cholera (rice water stool, shellfish)
S.Aureus (vomiting and watery)
Clostridium perfringens (after reheated meat, 24hrs lasting, gas gangrene)
Clostridium botulism - canned foods and honey causing paralysis
Bacillus cereus (Chinese takeout - reheated rice)
E. coli - travellers diarrhoea, some types cause bloody diarrhoea
Shigella - inflammatory, bloody
Campylobacter jejuni- poultry, bloody foul smelling, GBS and reactive arthritis associated
Salmonella enteritides - poultry and eggs
43
Typhoid - causes and symptoms
Salmonella typhi and paratyphi
Transmitted by food and water
Symptoms:
- Constipation (not diarrhoea!)
- Fever, headache, myalgia
- Rose spots on trunk
- Relative bradycardia
- Hepatosplenomegaly
44
Typhoid treatment
IV ceftriaxone then PO azithromycin
45
Dengue - causes and symptoms
Flavivirus - dengue virus
Symptoms:
•Fever, myalgia, rash (50%)
•Mild and self-limiting
46
What happens if reinfected with different sero type of dengue?
* Dengue haemorrhagic fever / Dengue shock syndrome
* Rare in travellers
* Supportive management
47
Cause of malaria and symptoms
Plasmodium spp.
Life cycle: mosquitoes and humans (RBCs and liver)
Symptoms:
- Tertian fever (48hrly)
- Hepatosplenomegaly
- Anaemia
48
Symptoms of severe falciparum malaria
49
What is zoonoses?
Infections which are transmitted naturally between vertebrate animals and humans
50
Give examples of zoonoses
Rabies (rhabdovirus) - hypersalivation, hydrophobia, negri bodies, encephalitis
Lyme disease (borellia burgoferi) - walking, camping, deer ticks, flue like, later neuro signs, bulls eye rash
Leptospirosis - swimming, dog/cat urine, conjuctival haemorrhage, jaundice, spiking fever
Q Fever (coxiella burnetti from sheep/cattle) - atypical pneumonia symptoms
51
Management for non falciparum malaria
Chloroquine then primaquine
52
Management for falciparum malaria
Mild: artemesin combination therapy (Riamet – artemether + lumefantrine)
Severe: IV artesunate
53
Distinguish between falciparum and non-falciparum
Thick and thin blood films
| Thick demonstrates malaria; thin demonstrates species
54
Leishmania
Cutaneous
Diffuse cutaneous
Muco-cutaneous
Visceral - young malnourished child, abdo discomfort, distension, anorexia, weight loss
55
Organisms causing UTIs
E.coli
Staph saprophyticus - young females
S.aureus
Abnormal tracts - proteus, Klebseilla
56
Symptoms of pyelonephritis
systemically unwell, fever + rigors, loin pain
57
Treatment for UTIs
Lower: nitrofurantoin / trimethoprim / cephalexin / amoxicillin
•3d if uncomplicated; 7d if complicated
Upper: admit, IV co-amox + gent
58
How much upgrowth is needed in urine MC&S to diagnose UTI?
Culture of >10^4 colony forming units / ml is diagnostic (10^3 for E.
coli / S. saprophyticus)
59
Organisms causing infection in surgical sites
S. Aureus - flucoxacillin
E. Coli
Strep
Pseudomonas
60
Cause of osteomyelitis, symptoms, investigations m management
S. Aureus
Pain, swelling, febrile
MRI, culture, bone biopsy
IV Abx, debridement
61
Septic arthritis causes, signs, management, investigations
S. Aureus, Strep, E. Coli
Red, hot, swollen, febrile
Joint aspirate MCS, blood culture
I’ve Abx, drain
62
Prosthetic joint infection causes, symptoms, investigations, management
CoNS, S. Aureus, E.coli
Red, hot, swollen, joint failure
X-RAY/MRI, joint aspirate
IV Abx, remove prosthetic
63
C. Diff - transmission, causes, management
Transmission: Spore ingestion.
3Cs: clindamycin, cephalosporins,
ciprofloxacin
Toxin -> Pseudomembranous colitis.
Vancomycin.
64
MRSA
coag –ve staph
65
Symptoms of brain abscess
Swinging fever
Extension causing otitis media, endocarditis
66
Treatment of encephalitis and common causes
HSV1
| IV acyclovir
67
Most common causes of bacterial meningitis
N. Meningitidis, Strep Pneumoniae, Group B Strep, Listeria, E.coli
68
Common causes of viral meningitis
Enterovirus (coxsackie, echovirus), mumps, HSV2
Viral presents the same as bacterial (but often less severe)
69
Common causes of fungal meningitis
Cryptococcusneoformans
70
Common causes of chronic/subacute meningitis
presents with headaches for months
| caused by TB or cryptococcus
71
Risk factors for N.Meningitidis and Strep
N.meningitidis: complement deficiency, hyposplenism, hypogammaglobulinaemia
S.pneumoniae: Complement deficiency, hyposplenism, immunosuppressed, infection, previous head trauma
72
Treatment for meningitis
ceftriaxone and corticosteroids
| Listeria cover with ampicillin
73
CSF analysis for meningitis
74
Symptoms of STDs in men and women
Men - urethral discharge, dysuria, scotsil pain or swelling, rash, sores, systemic symptoms
Women- discharge, ulceration, itchy, abdo pain, dysuria, dyspareunia, abnormal bleeding, systemic symptoms
75
Which STDs cause ulceration?
Syphilis, HSV
76
Which STDs cause rashes/lumps/growths?
HPV, scabies, molluscum contagiosum
77
Gonorrhoea - treatment and symptoms
Gram -ve diplococcus
Can transfer to neonate and cause conjunctivitis, can be disseminated and cause sepsis, rash and arthritis
Diagnosed with swabs and producing a culture
IM ceftriaxone
78
Chlyamydia treatment and diagnosis
Genital swabs / urine sample
NAAT (nucleic acid amplification tests)
Azithromycin, or Doxycycline
79
Is chlamydia gram negative or positive
Negative
80
Syphilis stages
Primary - macule to papule (painless genital ulcer)
Secondary - systemic bacteraemia after 1-6 m of infections, rash on palms/soles/back/trunk/limbs, mucosal lesions, uveitis, CNS involved
Tertiary - 20-30years, can have neurospyphilis, gummatous, cardiovascular syphilis
Latent
81
Gummatous, cardiovascular and neurosyphilis symptoms
Gummatous – skin / bone / mucosa granulomas Spirochaetes scanty
Cardiovascular – mimics any cardiac disease, especially causes aortic root dilatation /
aortitis. +++ spirochaetes, +++ inflammation
Neurosyphilis – dementia, tabes dorsalis, Argyll-Robertson pupil. Spirochaetes in CSF
82
Diagnosis of syphilis
- Dark-ground microscopy from primary lesions -> visualise Treponemes
- Antibody tests (treponemal or non)
Non-Treponemal tests:
•Detect antibodies against non-specific antigens
•False positives are common (need to confirm with treponemal test)
•Titre falls in response to treatment
Treponemal tests:
•Detect antibodies against specific antigens from T. pallidum
•Remains positive for years (even after treatment)
83
Treatment for syphilis
Single dose IM benzylpenicillin
84
Trichomoniasis
Strawberry cervix, wet prep microscopy, metronidazole
85
Management for candidiasis
Treatment: PO / topical antifungals, e.g. clotrimazole or fluconazole
86
Molluscum contagiosum
Pox virus
* Small papules with central punctum
* Children: hands and faces, spread by skin-to-skin contact.
* Adults: genital lesions, spread via sexual contact.
* Widespread lesions in immunosuppressed / HIV
* Usually no treatment necessary; cryotherapy if persistent / extensive
87
A urine MC&S shows a mixed growth of Staph and Strep organisms, with squamous epithelium. What is the most likely explanation?
Contaminants
88
Gram negative cocci
Neiserria
89
Gram positive bacilli
MACDONALD
```
Mycobacterium
Actinomycetes
Clostridium
Diphtheria corneyebacterium
O
Nocardia
Anthracis bacillus
Listeria
Diptheroids
```
90
Gram positive cocci
Streptococcus - diplococci/chains
Enterococcus
Staphylococcus - grape like clusters, coagulate positive is aureus
91
Gram negative coccobacilli
Can’t Polar Bears Hop
Chlamydia
Pseudomonas
Bordatella
Haemophilus
92
Gram negative bacilli
Enterobacterias
Salmonella, shigella, yersinia, e.coli, Klebseilla
93
Gram negative sphirocytes
Leptospira
Borrelia
Treponema pallidum (syphilis)
94
Four mechanisms of antibiotic resistance
BEAT
Bypass antibiotic sensitive pathway (MRSA)
Enzyme mediates drug inactivation (beta lactamases)
Impairment of accumulation of drug ( tetracycline resistance)
Modification of drugs target (quinolone resistance)
95
Give examples of broad spectrum and narrow spectrum ABx
Broad spectrum: Co-amoxiclav (amoxicillin + clavulanic acid), tazocin (piperacillin + tazobactam), ciprofloxacin, meropenem
Narrow spectrum: flucloxacillin, metronidazole, gentamicin
96
Antibiotic for S.aureus
Flucloxacillin
97
Antibiotic for CAP
Amoxicillin
Severe then co-amoxiclav and clarithryomycin
98
Antibiotic for HAP
Co-amox + gent or tazocin
99
Antibiotic for c.diff
Vancomycin
100
ABx for UTI
Trimethoprim/nitrofurantoin
101
Viruses causing disease in immunocompromised
Herpesviridae: CMV, EBV, HSV, HHV8, VZV
- Polyomaviridae: JC virus + BK virus
- Respiratory viruses: Influenza A and B, Parainfluenza 1, 2, 3 and 4, Respiratory
Syncytial Virus (RSV), Adenovirus, MERS coronavirus.
102
What are some DNA and RNA virus examples?
DNA- herpes,VSV,HSV,EBV,HPV
RNA - (negative sense) measles, mumps, flu, RSV
(Positive sense) polio, hep A, hep c, rubella, dengue, coronavirus
Reversivirus- HIV, Hep B
Negative sense have RNA which must become mRNA in the host (with viruses own polymerase) whilst positive sense already has mRNA
103
How does a virus enter a cell and replicate?
Entry-> uncoating -> immune evasion and DNA synthesis, protein synthesis -> assembly of virus and release -> transmissions
104
What is antigenic shift and antigenic drift?
Shift - when different strains infect at the same time, during virus assembly recombination of the two can occur with different genomic segments leading to a rapid and large shift can even change organisms it can infect
Drift - point mutations which change the virus over time
105
Why can some viruses evade host immune response?
They take the membrane from the host cell so there are some self antigens present which provide evasion ability
106
What is the normal WCC range?
4.5-11
107
What does a respiratory PCT panel include?
RSV A+B
Parainfluenza
Influenza
Human metapneumovirus (most have had this already)
108
What are some of the key parts of the influenza virus?
Nuclear export protein
Ion channel
RNA/DNA segment
Haemogluttinin - binds to sialic acid receptors on the host cell to allow entry
Neuroaminidase - it cleaves sialic acid residues allowing the virus to leave the cell
these are used when naming viruses
109
Bird flu
Human to human transmission of bird flu (H5N1) difficult as virus does not replicate very well at cold temperatures of upper airways (32OC).
Better in deeper lung tissue (still not ideal – 41.5OC) and from here it is difficult to escape.
110
What are some antivirals for the flu?
Amantadine - experimental and targets the m2 ion channel
Neuroaminidase inhibitors - oseltamivir (tamiflu), zanamavir (relenza)
111
How does influenza enter the cell?
Binds and fuses ->endocytosis -> early endosome -> late endosome -> nuclear fusion
112
Influenza vaccine
Custom made every year depending on the dominant strain the previous year or in Australia
113
What is a marker of bacterial infection over viral?
Pro calcitonin
114
SARS - COVID
Positive sense RNA with spike glycoprotein
Causes multi system disease attacking lung, kidneys, CNS, GI
Prothrombotic infection
Mainly supportive treatment
Sotrovimab - Ab
115
HCMV
In immunocompromised (major issue for transplant patients):
1. Encephalitis
2. Retinitis
3. Pneumonitis
4. Colitis
5. Marrow suppression
```
Congenital infection:
1. Ears: sensorineural deafness
2. Eyes: chorioretinitis
3. Heart: myocarditis
4. Neurology: microcephaly, encephalitis
5. Lung: pneumonitis
• Liver: hepatitis, jaundice, hepatosplenomegaly
```
116
EBV - glandular fever symptoms and diagnosis
Glandular fever triad-
Fever, pharyngitis, lymphadenopathy and maculopapular rash
Blood film, monospot agglutination, EBV antibodies Nb: Paul-Bunnell test
Burkitts lymphoma
117
HHV8
Kapoks sarcoma herpes virus
HIV
118
JC virus
Causes progressive multi focal leucoencephalopathy in HIV patients
119
Hep A
Faeco- oral transmission, 2-6 w incubation, months to recover, self limiting
120
Hep C
Body fluids mainly blood
Acute and chronic disease
Can cause cirrhosis and increase risk of HCC
Mainly in IVDU
It mutates a lot so usually infected with many strains at once so if you clear one another becomes dominant hence chronic
Antiviral is available but most successful with type 2/3
121
Hep B
Big virus with lots of DNA/RNA so can make lots of complex machinery to be latent and does this by inserting self into the host DNA
Most people clear it
Bodily fluids transmission
Acute and chronic disease
```
In immunocompromised (especially B-cell depleting therapies i.e. rituximab):
Risk of reactivation
```
122
Hepatitis D
Always coinfection with HBV
| Transmission: Sexual, parental, perinatal (only possible in combination with HBV)
123
Hepatitis E
Acute hepatitis – India
Faeco-oral transmission
Rare complications: CNS disease – Bell’s palsy, Guillain Barre, other neuropathy;
124
When is IgM made and when is IgG made?
IgM is accuse and IgG is chronic
125
Rubella congenital syndrome
1. Ears: sensorineural deafness
2. Eyes: Cataracts, glaucoma, retinopathy, microphthalmia
3. Heart: PDA, VSD
4. Neurology: microcepahly, psychomotor retardation
5. Pancreas: insulin dependent DM (late)
126
Symptoms of rubella
a. Maculopapular rash
b. Lymphadenopathy
c. Fever
d. Lesions on soft palate (Forchheimer sign)
127
Human parvovirus
Slapped cheek (fifth disease)
a. Erythema infectiosum
b. Transient aplastic crisis
c. Arthralgia
d. Fever and malaise
2. Viral myocarditis
Congenital infection:
1. Foetal anaemia -> cardiac failure -> hydrops foetalis
128
Hepatitis B serology
During infection - surface and envelope antigen is exposed
With replication etc, the core antigen is exposed
Anti-HbS made when leaving the cell and you are immune to it
Anti HbC is made if you are exposed and then immune to it but won’t be present if u had just a vaccine
In chronic infection no anti HbS as you aren’t immune yet
129
Complication of glandular fever
EBV can cause EBV hepatitis
130
When is ALP and ALT raised?
ALP - gallbladder, cholestasis
| ALT - hepatocellular injury
131
Hep B vaccine
Synthetic HbsAg
132
Serology in hepatitis
133
What are the types of vaccines?
Live - attenuated, related
Dead - inactivated, subunit, RNA
Passive - antibodies
134
What type of vaccine is HPV?
Dead
135
What type of vaccine is MMR?
Live
136
What type of vaccine is varicella zoster?
Live hence can get chicken pox
137
What type of vaccine is polio?
Live (Sabin)
| Dead (Salk)
138
What are some CNS AIDS diseases?
PML
CNS lymphoma
Cerebral toxoplasmosis
Neurocystorcosis
139
What are some AIDS lung infections?
Aspergillus fumigatus - Ball of fungus
Mucosa - like necrotising fungus
140
Fungi in AIDS patients
Candida albicans
| Cryptococcus neoformans
141
Air bronchogram
Normally can’t see but when there is consolidation around it you can see
142
What is pneumocystitis pneumonia?
Seen in immunocompromised such as HIV patients
Most people have had it but in immunocompromised it’s bad
143
What is Cryptococcus associated with?
Bird and pigeons
144
Tinea
Ringworm, athletes foot
145
Pityriasis
Sebhorric dermatitis, depigmentation in those with darker skin
146
Treatment for Candida and Aspergillus
Candida is fluconazole
Voriconazole for Aspergillus
147
How can Cryptococcus present in HIV patients?
Presents as meningitis with insidious onset in HIV
148
What can antifungals target?
Cell membrane integrity, cell membrane synthesis, DNA synthesis, cell membrane, cell wall
149
What do Azoles do?
Give examples
Ergosterol synthesis in cell wall
Clotrimazole
Fluconazole
Voriconazole
150
What do polyenes do
| Give examples
Cell membrane integrity
Amphotericin B used for invasive fungal infections and Cryptococcal meningitis
151
What does Caspofungin do?
Beta 1,3 glucagon synthesis affected
| Is an echinocandin
152
HIV treatment types
Egra - integrate inhibitor e.g. raltegravir
Pine - transciptase inhibitor e.g zidovudine
Maraviroc - CCR5 stops viral entry
Protease inhibitor- saquinavir
153
HAART regimen drug types
Nucleoside reverse transcriptase inhibitors (NRTI); zidovudine
Non-nucleoside reverse transcriptase inhibitors (NNRTI): afavirenz
Protease inhibitors; ritonavir
Entry inhibitor: enfurvitide
154
How does HIV enter cells?
Bind by gp120/gp41 to cd4 on white cells and fuses -> reverse transcriptase in cytoplasm -> when binds to nuclear pore already has mRNA -> integration
HIV has pairs of genomes to make it less error prone
155
What is prion disease?
Rare transmissable spongiform encephalopathies in humans and animals resulting in rapid neuro-degeneration and death in months.
Currently untreatable. If suspected be very careful handling lab samples!
156
Types of CJD
Sporadic
Variant
Iatrogenic
Inherited prion disease
157
Sporadic CJD
Rapid, progressive dementia with myoclonus, cortical blindness, akinetic mutism and lower motor neuron signs Mean onset is 45-75yrs and mean survival time = within 6/12 of symptoms starting
158
Iatrogenic CJD
Progressive ataxia initially. Dementia and myoclonus later stages. Speed of progression depends on route of inoculation (CNS inoculation fastest)
159
Variant CJD
Exposure to bovine spongiform encephalopathy
Younger age of onset – typically 30yrs. Mean survival 14/12. Psychiatric symptoms to start (anxiety, paranoia, hallucinations) followed by the neuro symptoms
160
Inherited prion disease
Fatal familial insomnia is an example it’s autosomal dominant
161
Neurocysticercossis treatment
Steroids
Anticonvulsant
Anti parasitic
Surgery
162
Protozoa vs helminths
Protozoa - 1 cell, e.g. toxoplasma gondii, plasmodia, leishmania, trypanosma bruceii (sleeping sickness)
Helminth - worms e.g, ascaris, schistosoma, necatar americanus
163
Toxoplasma
Definitive host is one in which sexual reproduction occurs
Disease of immunocompromised and pregnancy
Cats litter and mainly affects muscle by causing cysts and affecting function
164
What are hookworms?
They bite the wall of the intestine and drink the blood- necator americanus and ancylostoma duoedenale
Can cause anaemia esp in developing world
165
How do some helminths move from the skin to the gut?
Burrow and travel to lungs via lymphatics, cough then swallow into the gut
166
Schistosoma Mansoni
Swimming in infected water
| From freshwater snail, burrows through skin
167
If you suspect tonsillitis, which antibiotic shouldn’t you prescribe and why?
Amoxicillin. If the infection is glandular fever, then the amoxicillin can cause a widespread skin reaction
168
Commonest causes of CAP
Streptococcus, Haemophilus, Moraxella, Staphylococcus, Klebseilla
169
MRSA
Catheters, surgical sites, catheter associated UTI
170
E.coli
Catheter associated UTI, ventilator associated pneumonia
171
Most common HAI
Pneumonia
172
Pneumonia in immunocompromised
PCP, TB, Aspergillus
173
Morbillivirus
Measles
a. Fever, malaise
b. Cough, coryzal symptoms, conjunctivitis
c. Koplik’s spots (buccal mucosa)
d. Maculopapular rash
Congenital infection:
1. No foetal abnormalities
2. Foetal loss, preterm delivery
174
UTI in kids
Culture >105cfu/ml. Microscopy: pyuria (pus cells)
175
Brucellosis
Brucellosis – Gram-ve bacilli
• Transmission: contaminated food (untreated milk / dairy products), direct animal contact (cows, goats, sheep, pigs)
• Presentation: undulant fever (peaks in evening), myalgia, arthritis, spinal tenderness, hepatosplenomegaly, epididymo-orchitis
• Ix: Serology - anti-O-polysaccharide antibody
176
Plague
Plague – Yersinia pestis, gram-ve lactose fermenter
• Transmission: reservoir in rats, transmitted by flea
• Presentation:
o Bubonic plague–flea bites human, Swollen nodes, dry gangrene
o Pneumonic-plague– epidemics ,person-person spread
177
Anthrax
Anthrax - Bacillus anthracis
• Cutaneous: Painless round black lesions + rim of oedema
• Pulmonary: Massive lymphadenopathy + mediastinal haemorrhage
178
Meningitis causes in kids
<3 m - GBS, E.coli, Listeria
3m - 6 years - N.Meningitides, S. Pneumomiae, H. Influenzae
>6yo - N.Meningitides, S. Pneumomiae
179
What does terbinafine do?
Cell membrane
180
Flucystosine
DNA synthesis
181
Caspofungin
Echinocandin
| Affects beta 1,3 glucagon synthesis
