Microbiology Flashcards
Significance of HIV viral load <50 copies
??
Suprapubic pain and leucocytosis
UTI (q says PID, prob wrong)
Patient pregnant in 2nd trimester.
Lower abdo pain, offensive PV discharge, 2 days later presents with still birth.
What is the causative organism?
Chlamydia (check answer?)
Rate of transmission of hepatitis in HBsAg positive mother
70-90% without intervention
(CDC online)
A woman in 2nd trimester goes into premature labour- chorioamnionitis, what is the most likely organism
Streptococcus
GBS
Hepatitis serology - what is the patient’s infection status?
HBsAg
anti-HBc
anti-HBs
IgM anti-HBc
HBsAg: currently infective
anti-HBc ‘caught it’
anti-HBs: immune ‘s for shield’ (infection/vaccination)
IgM anti-HBc: recent/current infection
After disinfection, which organism survives?
My guess/google - Spores
Treatment of chlamydia
Azithromycin stat (safe in pregnancy)
Doxycyline 7/7
What antibiotic can be used to treat UTI in 1st/2nd trimester, but is not safe in 3rd trimester
Nitrofurantoin
In a HIV +ve woman in Labour, at what viral load will you allow vaginal delivery?
VL <50 copies/ml
HIV Ag/Abx ratio =1.5
1 confirmatiry test = negative
2 cimfirmatiry test specimen not adequate
A patient in her first trimester of pregnancy found to have HIV Ab weakly positive, the first confirmative was negative while the second was inconclusive. Your next step would be:
Refer her to GUM clinic for further testing
Pregnant lady with fever, loin pain, tenderness, GUE +++ pus cell. How do you manage?
Admit for intravenous fluid and iv cephalosporin
Management of a severe caesarian section wound infection
Admit and cover with IV antibiotics
A wound infection caused by this microorganism shows sulfur granules under microscopy
Actinomycosis israelii
What is the antibiotic treatment for MRSA?
Vancomycin
Varicella Zoster Ig interpretation:
IgG positive
IgM negative
Previously infected, now immune
Pregnant 24 wks with vulval soreness
+ve candida
+ve B streptococci
(give fluconazole)
vs
Don’t give anything - will get abx at time of delivery (this one chosen in recall paper)
I think give clotrimazole pessary but not listed
A pregnant woman plans to go to Middle East. What vaccination can’t be given to her?
BCG
Live attenuated
The thick white vaginal discharge
Candida?
What is the most common microorganism that causes UTI in a patient with a catheter
Pseudomonas
Treatment in acutely unwell patient with vaginal discharge and MRSA+ culture
IV vancomycin
Hpv 16 and 18 responsible for ___ % of infections
70%
(google - not confident)
Streptococci may cause
toxic shock syndrome
Which of the following antibiotics can be given orally
A)- tetracycline
B)- chloramphenicol
C)-streptomycin
D)-Gentamycin
A)- tetracycline
B)- chloramphenicol
What is the highest risk time for vertical HIV transmission?
During Labour and delivery
What organism has four flagella
Trichomonas has several flagella
Drug of choice for treatment of severe malaria in pregnancy
Artesunate
Which test is most sensitive in detecting pelvic inflammatory disease (PID)
Nucleic acid amplification test
Patient 2/52 post-op develops red swelling/itching/warmness around abdominal hysterectomy surgical wound scar. Abx treatment?
co-amoxiclav
(?)
Under what circumstances is GBS treated during the pregnancy (and before labour)
UTI with bacteria on MSU
What GBS risk factors lead to antibiotic treatment?
6
(3 about ROM and 3 others)
GBS in previous pregnancy
GBS dx in this pregnancy (incidental)
Intrapartum temp >38 degrees
Term PROM >18h
P-PROM with known GBS
?P-PROM now in labour (<37/40)
PROM = pre-labour rupture of membranes
P-PROM = preterm pre-labour rupture of membranes
Pregnant 16 weeks, Rubella IgM: +ve and IgG: -ve. Next step?
Give vaccine after delivery
(an acute infection)
Varicella infection IgM positive.
Acute infection
VDRL+ & TPPA -
False +ive
TPPA stays positive for life
What is the function of a PCR?
Make multiple copies of a segment of DNA
What is the most common type of nosocomial infection in hospitals?
UTI
(catheter associated)
Which single organism is the most common cause of sepsis in pregnancy?
Group A Streptococcus
aka
Streptococcus pyogenes
No 1 cause is ‘polymycrobial’
A 16-year-old has recently become sexually active. She complains of intensely irritating greenish frothy vaginal discharge. The organism is seen under microscope with peri nuclear halo. What is the most likely causative organism?
Trichomonas vaginalis
Chest x ray findings of a tuberculosis patient showing T.B granuloma at the apex of the lung. Which of the following cells is responsible for caseous (? granulomatous) necrosis?
macrophages
A pregnant woman presents at booking. No UTI sx. Urine analysis shows : wbc 10×10, 6 and E. coli growth. Sensitive to trimethoprim, nitrofurantoin, cephalexin and resistant to ampicillin. Treatment?
Nitrofurantoin 7/7
Which group of viruses cause 1Tmolluscum contagiosum?
Pox virus
Which is the commonest commensal organism that form common flora in vagina?
Doderlin lactobacilli
Which antibiotic is effective against staphylococcus exotoxin?
Clindamycin
Which congenital infections is most characteristically associated with fetal hydrops?
Parvovirus B19
Which bacteria produces an exotoxin causing ‘toxic shock syndrome’ associated with tampon usage?
Streptococcus pyogenes (Group A)
OR
Staphylococcus aureus
Fever, abdo pain, cervical motion tenderness. Gram negative intracellular diplococci. Organism?
Neisseria gonorrhoeae
A 33-year-old woman with an intrauterine contraceptive device develops symptoms of acute salpingitis. On laparoscopy, sulfur granules appear at the fimbria of the tubes. Organism?
Actinomyces species
Woman with white vaginal discharge. She is 7 weeks pregnant. Chlamydia swab is positive. Treatment?
Azithromycin OR Erythromycin
(Bashh guideline)
A patient presents with condyloma lata. At what stage of syphilis does this feature occur?
secondary syphilis
What STD is caused by Haemophilus ducreyi?
Chancroid
The vaccine for measles, mumps and rubella (MMR) is best characterized as
live (attenuated)
Hep B serology interpretation
HBsAg; POSITIVE
Anti-HBc; POSITIVE
Anti-HBcIgM; NEGATIVE
HBeAg; NEGATIVE
Anti-HBe; POSITIVE
HBV DNA; 203 iu/ml
Chronic infection
Pearly-white, non-tender dome-shaped ulcers around 3 mm in diameter
molluscum contagiosum
Which of the following human papilloma virus (HPV) subtypes cause genital warts?
6 & 11
Lancefield grouping of streptococci is based on the presence of___
Carbohydrate antigen on the cell wall
Two days after undergoing total abdominal hysterectomy and bilateral salpingo- oophorectomy a 60-year-old woman develops high temperature and confusion. On examination; She has a temperature of 38.2°C, a respiratory rate of 28/min, a pulse of 103 beats/min, a blood pressure of 130/80 and a urine output of 10 ml/hr after catheterization. Diagnosis?
Severe sepsis
UTI at 37/40, previously had cefuroxime. Growing E coli
Co-amoxiclav; sensitive Nitrofurantoin; sensitive Trimethoprim; sensitive
Gentamicin; sensitive
Cefuroxime; resistant
Which abx?
Trimethoprim
(No nitrofurantoin in 3rd trimester)
What antibiotic used during pregnancy causes grey discolouration of teeth in the foetus
Tetracycline / doxycyline
Without treatment, asymptomatic bacteriuria at 32 weeks gestation increases risk of what complication?
Preterm labour
What percent of untreated individuals move on to the third stage of syphilis?
35%
A 34 yr old woman has just returned to the UK following missionary work in the northern part of South America. She is delighted to be pregnant and presents for booking at 12 wks of gestation. After counseling she agrees to have routine blood investigations including screening for syphilis. The results are returned as following:
Venereal Disease Research Lab. (VDRL) test: reactive
Traponema Pallidum particle agglutination (TP-PA): non reactive
Fluorescent Traponemal Ab absorption (FTA-Abs) : non reactive
Likely biological false positive
23-year-old woman presents with fishy foul smelling vaginal odour. ‘Clue cells’ are found in the smear. What is the most likely causative organism?
Gardenerella vaginalis
Which type of vaccine is contraindicated during pregnancy? Give 3 examples
Live attenuated
MMR
Polio
BCG
A 64-year-old woman undergoes a total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometrial carcinoma. This procedure will be placed in which of the following wound classifications?
clean/contaminated
What is the most appropriate treatment for pelvic inflammatory disease (PID)?
Ceftriaxone 1g IM stat +
Doxycycline 100mg (14/7) +
Metronidazole 400 mg (14/7)
The bacteria Neisseria gonorrhoeae can be described as what?
Gram-negative AEROBIC cocci
Which fungi is most commonly found in catheter-related infection?
Candida
VZV IgG : Negative
VZV IgM: Negative
What is the most likely diagnosis?
Non-immunity to chicken pox
A 26y/o at 25/40 presents with a vesicular rash on her back and abdomen. Her GP confirms the diagnosis of chickenpox. What is the most appropriate action?
Oral acyclovir
Has chickenpox with rash for <24h and >20/40 = give oral acyclovir
Has chickenpox exposure and IgG negative (not immune) = give VZIG
A 30-year-old woman underwent lower segment caesarean section. Two weeks into the postpartum period, she has experienced nausea and vomiting for three days. On examination, she has a temperature of 390C, a respiratory rate of 30/min, and a blood pressure of 90/50 mmHg. The patient has warm peripheries with normal capillary refill time. What is the most likely diagnosis?
Septic shock
A 19-year-old married female complains of vaginal discharge, odor, and itching. Speculum examination reveals a homogeneous grey discharge, vulvar and vaginal erythema, and a “strawberry” cervix. The most likely causative organism is
Trichomonas
Is there routine antenatal screening for GBS?
No routine antenatal screening for GBS
Note will be treated if other RF
The most common in uetro infection causing fetal anemia in the UK is
Parvovirus B19
A 15-year-old girl attends the genitourinary medicine clinic complaining of frothy yellow vaginal discharge. She is sexually active with her 17-year-old boyfriend and uses the oral contraceptive pill. Speculum examination reveals haemorrhages on her cervix. A urine pregnancy test is negative. Considering the most likely diagnosis, what is the most appropriate first line antibiotic?
Metronidazole
Which HPV subtypes are high-risk for the development of cervical intraepithelial neoplasia?
16 & 18
25-year-old woman patient presents with number of small genital blisters. A swab results reveals a diagnosis of genital herpes. Which of the following is the best drug to be used to treat this patient?
Topical acyclovir
(oral acyclovir not an option)
Surgical wound infection after caesarean section. Culture: (MRSA). Treatment?
Clindamycin and vancomycin
What type of vaccine is the influenza vaccine
Organism subunit vaccine
Which of the following organisms Colonize copper IUD?
Actinomyces
Bacterial vaginosis is diagnosed with depletion in numbers of which
organism?
Lactobacillus
20/40 woman with h/o recent travel to India, presents with fever, chills. Blood test falciparum Vivax +VE. Best treatment?
Chloroquine
??falciparum AND vivax
Regarding Genital herpes infection , what is the best management?
Acyclovir
14/40 exposed to chicken pox.
Can’t recall whether had as child
IgG negative
IgM negative
Interpretation?
Not immune to chicken pox
What is Varicella Zoster’s infectivity period?
2 days before rash until crusts appear
A 55 year old presents to clinic due to vulval itch and discolouration. examination reveals pale white discoloured areas to the vulva.
A biopsy shows epidermal atrophy with subepidermal hyalinization and deeper inflammatory infiltrate.
Lichen sclerosus
11/40 with UTI. Treatment?
Nitrofurantoin
The HPV vaccine is what type of vaccine?
Recombinant / subunit vaccine
28/40. Diarrhoea and flu like symptoms. A blood culture: listeria. Treatment?
Amoxicillin
Indian origin, lives in London. History Of Low Grade Fever Weight Loss and Cough 5/12 .She is pregnant. CXR image
TB
Less common HPV types high risk for cervical ca.
33
31, 35
Classic HPV high risk cervical ca types
16
18
HIV positive patient came with ruptured membranes 38 weeks. Already on HAART. Viral copies 1450. Recommended MOD and any other treatment?
Cat 3 Caesarean section with IV zidovudine
A woman was injured while walking in the garden barefoot. After that she developed cellulitis. What’s the possible cause?
Staph aureus
VIN3 is caused by which organism
HPV 16
What type of virus is Zika virus?
ss/ds etc
Ss RNA
Patient presented with heavy vaginal discharge but no itching, PH 6. What is the cause?
Bacterial vaginosis
Most common protozoan causing zoonotic infection (cerebral calcification, retinitis)
Toxoplasma
Congenital conjunctivitis organism. Purulent discharge 36 hours after birth
Chlamydia trachomatis
18 y/o non penetrative intercourse, + painful ulcers in the vagina
Behchets disease
What type of virus is Herpes simplex?
ds/ss etc
Ds DNA
Tetanus vaccine type
Toxoid
USS anomaly, baby with microcephaly, most common infection?
CMV
(vs toxoplasmosis)
When does the influenza vaccine become effective after the dose is given
?2 weeks
Stable relationship with IUD for 11 years, has PID, most likely organism
?Actinomyces
Early onset neonatal infection - most common organism
Streptococcus agalactia
(aka GBS)
Patient with RIF pain and tenderness, has history of chlamydial infection that was treated, ultrasound reports a tubular echogenic mass superior to rt ovary, both ovaries look normal.
Mucinous appendix
(mucocele)
80 y/o came in for pessary change then with profuse vaginal discharge. Culture result moderate beta hemolytic streptococcus with coliform and anaerobic bacteria. Treatment?
Metronidazole + Clindamycin PO 7/7
23-year-old woman presents with fishy foul smelling vaginal odour. ‘Clue cells’ are found in the smear. What type of cells are ‘clue cells’?
Epithelial cells
Trichomonas Vaginalis is what kind of pathogen
Flagellated protozoan
Parvo + in first trimester. What is the risk of miscarriage
10%
Test of cure for chlamydia in how many days?
21 days?
GBS treatment for women who are penicillin allergic?
Vancomycin (confirmed answer)
Abnormal LFTs,
HbsAg -ve, HbeAg -ve, HbeAb +ve, HbsAb 3miu/hr
HbcAb +ve
Chronic infection, low infectivity
6 hours post laparoscopic tubal ligation, patient c/o pain abdomen. Not relieved by analgesia. On examination a tender cystic mass felt under umbilicus with oozing pus from one of the port sites.
Hb 11, WBC 17
VS
Post lap ligarion as daycare surgery pt was admitted for pain management. Given morphine. After 6 hrs pt cmpls of pain.
A cystic swelling present upto umbilicus. Tender with oozing from port sites….
Port site infection
vs
Urinary retention??
Transmission of chlamydia to baby
During labour and delivery, when passing through birth canal
Treatment for gonorrhoea in pregnant patient (X OR Y?)
IM Ceftriaxone
OR
Azithromycin (Bash)
Mother has flu sx and myalgia
Foetus has hepatosplenomegaly
CMV
Malaria Prophylaxis
Proguanil (malarone) - any time
Mefloquine -Trimester 2 and 3
What colour does pseudomonas go on MacConkey agar?
Yellow (no reaction)
MacConkey - lactose fermenters pink
MacConkey - non fermenters stay yellow
What is Lancefield grouping?
Categorisation of G+ cocci
Streptococcae
On basis of the antigens found on the cell wall
What is Lancefield grouping?
Categorisation of G+ cocci
Streptococcae
On basis of the antigens found on the cell wall
What is a key element of both NAAT and PCR tests?
Taq polymerase
What % of foetuses infected with CMV will be symptomatic at birth
20%
Define exotoxin
Toxin secreted out (exo) of G+ and G- cells
Endotoxin is part of membrane of G- cells
What type of vaccine is influenza vaccine
Inactive
When should ART be commenced in new HIV dx
First trimester if VL >100,000 or CD4 <200
Then all on ART by 24/40
What is the virus type of Ebola virus?
DNA/RNA etc
SS RNA
single stranded RNA
Treatment of GBS in labour
Benzylpenicillin STAT and then 4 hourly
What kind of vaccine is the MMR / Rubella
Live attenuated
Most common cause of malaria
P Falciparum
What shape are mycoplasma genitalium under the microscope?
flask shaped
What type of lancefield is group A strep
beta haemolytic
What family of viruses does varicella zoster belong to?
Herpes virus
What arrangement is HSV1
ds/ss/dna/rna
Double stranded DNA
