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Year 5 MEDICINE Pathology > Microbiology > Flashcards

Microbiology Flashcards

1
Q

Meningitis

A

Acute - key = Neisseria meningitidis, Strep pneumonia Hemophilia influenzae. Others - listeria, group B strep, ecoli

chronic - CT here will show changes (thickening of dura)

aseptic - enterovirus - cocksackie group B, echovirus

Mortality - 10%
Morbidity - 5, deafness most common

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2
Q

Encephalitis

A

Rabies virus, arbovirus eg West Nile
Amoeba - Naegleria fowleri
Bacteria - listeria
Trypansoma species
Prions
Toxoplasmosis

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3
Q

Brain abscess

A

Otitis media, mastoiditis etc
Staph etc

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4
Q

Spinal

A

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5
Q

CSF studies, how to Interpret results

A

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6
Q

Listeria meningitis management?

A

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7
Q

Viral hepatitis A B C D E

A

Jaundice dark urine , pale stools, pruritus

Check what antibodies/ surface markers mean

HbsAg = surface antigen most important. Positive means current infection
HbcIgM = recent infection
AntiHbc = exposure to HbV, could be past or present
AntiHbs = surface antibody = immunity due to vaccination or cleared infection

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8
Q

Which immunoglobulin class shows recent infection?

A

IgM

IgG = past/ chronic

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9
Q

Insert table interpreting hep B findings

A

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10
Q

Hep B medications

A

Nucleoside/tide analogues
Entecavir, tenofovir

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11
Q

If treatment history is unknown , what assay will help establish previous patients HBV status

A

HBV DNA viral load

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12
Q

Why are genotypes 1 and 2 of hep B important?

A

30% mortality in pregnant women

Chronic infection of hep e only happens in immunocompromised

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13
Q

Hep D requires infection with hep what to enter?

A

Hep B

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14
Q

Diagnosing pyrexia of unknown origin (PUO)]

History taking?




examination





investigation

A

definition = Fever >38.3 lasting for at least 3 weeks

1. B symptoms, localising symptoms
2. Medications - doses and initiation date
3. Contact history, pets/animal exposures
4. injecting drug use, sexual history
5. foreign travel


physical including fundoscopy (e.g roth spot endocarditis), look at spine

PET scan, Echo, brucella serology e.g patient from lebanon, HIV test for all patients, must test malaria if travel in last 2 days

if BP is 75/50 -> start Antibiotics immediately!!!!, this is sepsis and not PUO.

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15
Q

Infective causes of PUO

A

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16
Q

Inflammatory causes of PUO

A

SLE
rheumatoid arthritis
sjogrens syndromes
vasculitis syndromes

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17
Q

Malignant causes of PUO

A

lymphoma - especially non-hodgkins
leukaemia
renal cell carcinoma

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18
Q

Miscellaneous causes of PUO

A

endocrine - thyroiditis, addisons disease

TFTs screening

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19
Q

4 urgent causes of PUO

A

1. infective endocarditis
2. disseminated TB
3. central nervous system TB
4. Giant cell/ temporal arteritis

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20
Q

specific zoonoses

A

- farm/wild animals - UK or tropical
- companion animals - UK or tropical

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21
Q

managing patients with zoonoses

A

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22
Q

classic zoonoses

A

- campylobacter - chicken - diarrhoea - stool pcr for diagnosis - self resolving

- salmonella - chicken

- bartonella henslae - cats- bacilliary angiomatosis if immunosuppressed

- cats - toxoplasmosis

- brucellosis - unpasteurised milk from cattle/goat - fever, back pain, night sweats/weight loss - can present like TB. psoas abscess. psoas pus culture important


- coxiella burnetii - goat and sheep feces/milk, is aerosolised. learn presentation

- rabies - dogs, bats, cats

- rat bite fever -athralgia, fever

- hantavirus - rodents/rates - pulmonary-renal syndrome

- viral hemorrhagic fever - ebola, marburg, lassa, CCHF

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23
Q

opportunistic viral infections

A

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24
Q

51 year old with recent HSCT is unwell with ALT=800, what is the important test to do?

A

serology tests e.g EBV, hepB are not useful in immunosuppressed.

HEV PCR is useful

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25
Q

which type of immunosuppression carries the greatest relative risk of developing a viral infection?

A

allogenic stem cell transplant

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26
Q

EBV

A

in tansplant patients, you worry about lymphoma (post-transplant lymphoproliferative disease)

Rituximab treatment

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27
Q

CMV

A

HIV/AIDS
- retinitis
- polyradiculopathy
- pneumonitis
- GI tract
inclusion bodies seen

Ganciclovir

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28
Q

JC virus

A

polyomavirus
progressive multifocal leukoencephalopathy - personality change, motor deficit, cognitive dysfunction

- demyleination of white matter -> MRI

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29
Q

BK virus

A

polyomavirus
cystits post SCT
Nephropathy post renal transplant

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30
Q

Hepatitis B

A

tenofovir

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31
Q

Herpes simples 1,2

A

immunoglobulins given to bone marrow transplant patients

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32
Q

varicella zoster

A

chicken pox -purpura fulminans, hepatitis, encephalitis, pneumonitis

shingles - reactivation

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33
Q

SOT vs HSCT
CMV

A

SOT CMV concern = positive donor and negative recipient. give prophylaxis ganciclovir (can cause bone marrow suppression)

HSCT CMV concern = positive recipient and negative donor

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34
Q

Influenza A and B treatment in immunosuppresed

A

oseltamivir

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35
Q

the natural reservoir of influenza A virus is?

A

Ducks

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36
Q

influenza

A

hemaglutinn
neuraminidase

PB2E627K virus

antigenic shift - alone is not sufficient to cause a pandemic. you need antigenic shift + hemaglutinn adaptation (to allow transmission)

influenza entry to human is also pH dependent

influenza drugs are used separately and not together - neuraminidase inhibitors

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37
Q

The influenza vaccine given to those at greater risk of complications from flu in the UK is

A

inactivated virus


the live attenuated is given instead to children, not adults

*children are the key flu spreaders


hemaglutinnin has been the molecule used for vaccines

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38
Q

most likely origin of SARS COV2?

A

bats

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39
Q

Treatment for Covid

A

dexamethasone
monoclonal antibodies - Sotrovimab, remdesivir etcmRNA vaccines encoding stabilized spike - omicron variant less well controlled by this

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40
Q

antibiotics that inhibit cell wall syntheisis

A

beta lactam antibiotics eg penicillins, cephalosporins, carbapenems(carbapenems stable to ESBL enymes) - ineffective against bacteria that lack peptidoglycan cell walls eg mycoplasma, chlamydia. only kill bacteria actively dividing - may be ineffective against abscess, biofilm

glycopeptides - vancomycin, teicoplanin - used for MRSA infections

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41
Q

antibiotics that inhibit protein synthesis

A

Aminoglycosides (e.g. gentamicin, amikacin,tobramycin)

Tetracyclines

Macrolides (e.g. erythromycin) / Lincosamides (clindamycin) / Streptogramins (Synercid) – The MSL group

Chloramphenicol

Oxazolidinones (e.g. Linezolid)

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42
Q

finish antimicrobials notes

A

-------

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43
Q

bacteria that cause TB

A

m tuberculosis
m bovis
m africanum
m microti
m caneti

(m avium complex does not cause TB)
not all AFB is TB!

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44
Q

what percentage of world population has latent TB?

post latent infection, what is lifetime risk for active TB?

A

1/4 to 1/3

10%

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45
Q

HSV in pregnancy and neonates

A

neonates - SEM -> SEM + CNS -> disseminated

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46
Q

Maternal varicella and congenital VZV

A

treat maternal infection with oral acyclovir

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47
Q

entervoviruses in pregnancy and neonates


most commonly cocksackie

A

rash, hand foot and mouth disease, encephalitis, myocarditis

neonates are at higher risk of myocarditis, encephalitis, meningitis

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48
Q

Rubella in pregnancy, congenital, neonates

A

rash that spreads from head down to trunk

congenital rubella:
cataracts, hearing loss, hepatospleenomegaly

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49
Q

Measles in pregnancy

A

conjuctivitis, rash from head to trunk, koplik spots
SSPE risk in neonates

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50
Q

Parvovirus B19

A

slapped cheek, polyarthropathy, aplastic crisis

fetal hydrops

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51
Q

CMV

A

maculopapular rash, infectious mono

congenital - microcephaly, retinitis, IUGR,

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52
Q

zika virus

A

send a serum and save and alert obstetric team if 4 week pregnant with recent travel to antigua and worried about zika if NO symptoms. -> if symptoms do serum and urine sample

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53
Q

Hep B, HIV in pregnancy

A

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54
Q

pregnant woman presents with a rash, what do you do?

A

gestation
date of onset, clinical features
past history of infection/antibody testing
past immunisation testing

tests:
antibody
blood samples
pcr

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55
Q

HIV in children

describe certain presentations



how to prevent

A

molluscum contagiosum
tb of spine
rashes

HIV encephalopathy - basal ganglia calcification, cortex atrophy

CMV - retinitis - blindness
First born twin is more at risk than second twin -> sits in birth canal and dilates it

16% excess risk of HIV with breastfeeding in Nairobi study - balance against increased rissk from formula feeding only in certain places in world

triple therapy for pregnant women, infant should get prophylaxis for 6 weeks, uninfected infants should be exclusively BF for 6 months

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56
Q

what is prion disease?

what gene is prion protein found on? what polymophism predisposes to disease?

presentation?

A

an infectious protein

chromosme 20 - condon 129 MM polymorphism predisposes to disease (3 polymoprhisms MM, MV, VV)

Rapid neurodegeneration (cjd maximum survival 6 months), spongiform enceophalopathies

paresethesia
unseteadiness
jerky tremor

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57
Q

state the different types of prion disease

A

1. Sporadic - CJD - 80%
2. Acquired <5%
- Kuru - papua new guinea, cannibalisms. ataxia & myocolonus. dementia late or absent
- Variant CJD - mad cow disease
- Iatrogenic CJD - GH, blood, surgery
3. Genetic 15%
- PRNP mutations eg Gerstmann-Straussler-Sheinker Syndrome, Familial fatal insomnia

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58
Q

what is the most common form of prion disease?

symptoms?

median survival and mean age of onset

cause?

diagnosis?

neuropathology?

A

Sporadic CJD

rapid dementia with:
- myoclonus!!
- cortical blindness - problem with occipital cortex, optic nerve normal
- akinetic mutism
- LMN signs

<6 months, 65 years

cause is unclear - may be environmental exposure, PRNP mutation etc


EEG:
periodic triphasic complexes - non specific, not always present

MRI:
- increased signal in basal ganglia, cortex

CSF:
- elevated markers of rapid neurodegeneration; 14-3-3 protein, S100

neurogenetics to rule out mutation

tonsillar biopsy NOT useful - only useful in variant CJD


spongiform vacuolation, Prp amyloid plaques



- Alzheimers
- vascular dementia
- CNS neoplasm
- Cerebral vasculitis
- Paraneoplastic syndrome

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59
Q

Variant CJD

symptoms?

median survival and mean age of onset

cause?

diagnosis?

neuropathology?

A

psychiatric onset:
- dysphoria, anxiety, paranoia, hallucinations

then neurological:
- peripheral abnormal sensations
-ataxia
- myoclonus
- dementia

14 months, 26 years median onset

linked to mad cow disease, few cases linked to blood transfusion

MRI:
- positive pulvinar sign = high signal in posterior thalamus/putamen

EEG:
- non specifc slow waves

CSF markers not raised

Neurogenetics:
- almost everyone is MM at codon 129

Tonsil biopsy = 100% sensitive and specific

florid plaques in brain

60
Q

Iatrogenic CJD causes?

symptoms?

A

1. human cadaveric growth hormone
2. corneal transplants
3. neurosurgical procedures
4. blood and blood products transfusions

progressive ataxia initially
dementia and myoclonus later stages
speed of progression depends on route of inocculation

61
Q

Genetic prion disease

questions to ask?

symptoms

diagnosis

A

GSS, FFI, CJD

FH is important:
- dementia, MS, ataxia, psychiatric

GSS:
- slow progressive ataxia and dementia
- survival 2-10 years

FFI:
- untreatable insomnia, ataxia, dysautonmia (BP surges)

neurogenetics

62
Q

CJD treatment?

A

1. myoclonus = clonazepam


research into antiprion antibodies, depleting prion protein

63
Q

secretory diarrhea presentation?

organisms?

A

- no or low fever
- no wbc in stool

- cholera, ETEC, EPEC, EHEC, EAggEC

64
Q

inflammatory diarrhea presentation?

organisms?

A

- fever
- wbc in stool - neutrophils

- campylobacter, shigella, non typhoidal salmonella, EIEC

65
Q

Enteric fever diarrhea presentation?
organisms?

A

- fever
- wbc in stool - mononuclear cells

- typhoidal salmonella, enteropathogenic yersinia, brucella

66
Q

s. aureus food poisoning

A

prominent vomiting and watery non-bloody diarrhea
self limiting
skin cells shedding into food

67
Q

b cereus food poisoning

A

gram positive-rod spores
reheating rice
water non blooding diarrhea
can cause bacteremia

68
Q

clostridium botulinum/ botulism

cause?
symptoms
treatment

A

canned or vaccumed packed foods/honey

blockage of ACh receptors -> paralysis

antitoxin

69
Q

clostridium perfringens food poisoning

A

reheated food -> meat
superantigen
watery diarhea, cramps, vomiting

anaerobic infection!!!

70
Q

c difficile

A

diarrhea
hospitalisation and antibiotics = risk

anaerobic infection!!!

71
Q

listeria monocytogenes

symptoms?

sources?

treatment?

A

febrile gastroenteritis

b hemolytic bacteria with tumbling motility

unpasteurised dairy, refrigerated food

ampicillin

72
Q

ecoli diarrhea


source

A

etec = travellers

EHEC = hemorrhagic

food/water contaminated with faeces

73
Q

salmonella enteritidis presentation?

A

non bloody diarrhea, self limiting
poultry, eggs, meat

bacteremia and fever infrequent

74
Q

salmonella typhi presentation?

A

typhoid fever

bacteremia

slow onset FEVER and CONSTIPATION
spleenomgaly, rose spots

anemia, leucopenia

positive blood cultures
ceftriaxone treatment

75
Q

Shigella presentation?

A

dysentery

avoid antibiotics

76
Q

vibrio cholera presentation and treatment


vibrio parahemolytics cause and treament

vibrio vulnificus presentation?

A

rice water stool
treat loss, electolyte and fluid replacement

raw or undercooked seafood, self limiting

cellulitis in shellfish handlers, risk of septicemia

77
Q

campylobacter source?
presentations?

A

poultry, meat, unpasteurised milk

diarrhea -> GBS syndrome

78
Q

Yersinia enterocolitica presentation?

A

enterocolitis, mesenteric adenitis
food contaminated with waste from domestic animals

79
Q

abdominal symptoms +/- diarrhea -> always think could this be mycobacterium eg TB

A

80
Q

entamoeba presentation?

A

dysentery, tenesmus, flatulence, liver abscess

metronidazole + paramomycin for luminal disease

81
Q

Giardia presentation?

A

2 nuclei and flagella

malabsorption of protein and flat

stool microscopy - ova cysts and parasites

metronidazole

82
Q

cryptospordium parvum

A

severe diarrhoea in immunocompromised
oocytes in stool
no treatment

83
Q

Viruses that cause diarrhea?

A

norovirus - CAN CAUSE OUTBREAKS!! - big concern
rotavirus - Exposure can cause immunity
adenovirus

(polio, enteroviruses, hep A )

84
Q

all forms of gasteroenteritis are notifiable

A

85
Q

congenital toxoplamosis presentation

A

classic triad:
1. intracranial calcifications
2. hydrocephalus
3. chorioretinitis

+/- blueberry muffin rash

60% asymtomatic at birth but can develop -> deafness, low iq, microcephaly

*contrast to CMV which causes hearing loss and chorioretinitis but PERIVENTRICULAR calcifications and no hydrocephalus

86
Q

congenital rubella presentation

A

Eyes: cataracts!!!; microphthalmia; glaucoma; retinopathy

Ears: deafness

Heart : PDA!!!; ASD/VSD ("Ruby red heart")

+/- blueberry muffin rash

87
Q

name common organisms that cause neonatal infection

A

1. group b strep - meningitis, bacteremia, joint infection
2. E coli - bacteremia, meningitis, UTI
3. listeria monocytogenes

88
Q

maternal sepsis risk factors

A

PROM/prem. Labour
Fever
Foetal distress
Meconium staining
Previous history

89
Q

neonatal sepsis rfs

A

Birth asphyxia
Resp. distress
Low BP
Acidosis
Hypoglycaemia
Neutropenia
Rash
Hepatosplenomegaly
Jaundice

90
Q

neonatal sepsis investigations?

A

Full blood count
C-reactive protein (CRP)
Blood culture
Deep ear swab
Lumbar puncture (CSF)
Surface swabs
Chest X-ray (full body)

91
Q

neonatal sepsis treatment

A

Ventilation
Circulation
Nutrition
Antibiotics: e.g. benzylpenicillin & gentamicin

92
Q

what is late onset sepsis?
features?


investigations?


treatment

A

after 48 -72 hours
Bradycardia
Apnoea
Poor feeding/bilious aspirates/ abdominal distension
Irritability
Convulsions
Jaundice
Respiratory distress
Increased CRP; sudden changes in WCC/platelets
Focal inflammation – e.g. Umbilicus; drip sites etc.


FBC
CRP
Blood culture(s)
Urine
ET secretions if ventilated
Swabs from any infected sites

1st line: cefotaxime & vancomycin
2nd line: meropenem

93
Q

Learn CSF to diagnose type of meningitis - viral fungal bacterial

A

94
Q

list the organisms that cause meningitis in children by age group

A

<3/12: N. meningitidis; S. pneumoniae; (H. influenzae (Hib) if unvaccinated); GBS; E. coli; Listeria sp.

3/12 - 5 years:N. meningitidis; S. pneumoniae; (Hib if unvaccinated)

>6 years: N. meningitidis; S. pneumoniae

95
Q

common causes of respiratory infections in children

A

1. s pneumonia = most important bacterial cause
2. mycoplasma = >4 years old, treat with macrolide. cold aggluttinins (IgM Antibodies). neurological signs in 1% eg encephalitis
3. also consider whooping cough, tb

96
Q

causes of UTI in children

managment?

A

E. coli = MOST COMMON
Other coliforms e.g. Proteus species, Klebsiella Enterococcus sp.
Coagulase negative Staphylococcus
Staph saprophyticus

treatment
renal tract imaging
antibiotics as prophylaxis
recurrent may be sign of immunodeficiency either congenital or acquired - HIV, SCID

97
Q

Risk factors for fungal disease?


diagnostic tests?

3 targets of antifungals and types of drugs for each?

A

1. immunocompromised
2. inhaled steroids
3. malignancy, burns, complicated post ops, long lines -> invasive candida
4. diabetes -> mucormycosis
5. moisture, gentetics, CMI -> dermatophytes

MC&S, Bx- Histology, serology, PCR, imaging

cell membrane - polyene (eg ambisome, amphoceritin B ), Azoles
DNA/RNA synthesis - pyrimidine analogues (flucytosine)
cell wall - echinocandins

98
Q

what are yeasts? give examples

A

single cell fungi, reproduce by budding
1. candida
2. cryptococcus
3. Histoplasma - dimorphic

99
Q

what are moulds? give examples

A

multicellular hyphae fungi. grow by branching and extension

1. dermatophytes
2. aspergillus
3. agents of mucormycoses

100
Q

what is the most common cause of fungal infections in humans?

what infections does it cause? treatments for each?

A

candida


1. oral thrush = topical nystatin
2. candida oesophagitis = oral fluconazole
3. vulvovaginitis = topical clotrimazole or oral fluconazole
4. cutaneous -> localised or generalised = topical clotrimazole
5. invasive candida infections

101
Q

list types of invasive candida infections

A

candidemia
cns
endocarditis
bone and joint
urinary tract eg vulvovaginitis
intraabdominal

102
Q

which animal is cryptococcus associated with?

rfs?

presentation?

diagnosis?

management

A

pigeons

immunodeficiency


c gatti -> meningitis in immunocopetent, space occupying lesions in brain and lung (sob, cough)

imaging eg brain
india ink staining of CSF
serum/CSF Ag

amphotericin b and flucytosin
then consolidation and maintenance with fluconazole

103
Q

Aspergillosis

diagnosis?
management?

A

- can colonize preformed cavities and debilitated tissues eg tb cavity

imaging, sputum
looking for antibodies = precipitins
OR serology for galactomannan (polysaccharide)

voriconazole
ambisome

104
Q

why might antifungals targeting cell wall not work in PCP?

pcp symptoms

A

it lacks ergosterol in cell wall

pneumnia -> fever cough sob

105
Q

name some dermatophytes

A

tinea corporis
tinea cruris
tinea pedis
tinea capitis

pityriasis versicolor -> Malassezia furfur

106
Q

amphotericin B key side effect?

A

nephrotoxicity

107
Q

azoles key side effect?

A

abnormal LFTs

108
Q

polyenes key side effect?

A

nephrotoxicity

109
Q

pyrimidine analogues key side effect?

A

blood disorders

110
Q

what is the most likely organism causing intracranial abscesses?

A

MRSA

111
Q

Diagnosis of septic arthritis requirement?

A

> 50,000 White cells on synovial fluid analysis
negative culture does not exclude

112
Q

most likely organism causing a prosthetic joint infection?

A

coagulase negative staphylococcus

113
Q

adult onset stills disease

A

114
Q

most common cause of lobar pneumonia?

A

strep penumoniae

115
Q

CRB-65 score

A

116
Q

50 year old man
LLL pneumonia
Hemoptysis
cavitation of CXR
patient not particularly unwell

what organism would you suspect?

A

Hemophilus influenzae

- gram negative coccobacillus

117
Q

coxiella burnetti pneumonia typically caused by contact with?

A

domestic/farm animals

118
Q

74 year old woman, penumonia, on antibiotics but not getting better. most likely diagnosis?

A

empyema

119
Q

64 year old treated for lymph node TB
increasing SOB and cough
ground glass diffuse shadowing on CXR
Most likely organism?

A

pneumocysitis jirovecii

120
Q

22 year old man. chemo for leukemia
prolonged neutropenia
ongoing fevers and raised inflammatory markers
what is the likely organism?

A

aspergillus fumigatus (patient immunosuppressed)

121
Q

which antibiotics inhibit cell wall synthesis? give examples from each class

A

B-lactams = Penicillins, cephalosPorins, carbaPenems (carbapenems stable to ESBLs)
Glycopeptides = vancomycin and Teicoplanin

122
Q

B lactams mechanism of action?
what are they inefective against?

A

inactivate transpeptidases/penicillin binding proteins which are involved in cell wall synthesis

only effective against rapidly dividing bacteria

ineffective for organisms without peptidoglycan cell wall - mycoplasma, chlamydia

123
Q

function of clavulanic acid and tazobactam?

A

B-lactamase inhibitors. protect penicillins from enzymatic breakdown

124
Q

name examples of cephalosporins from each generation. how do they change with generation

A

1st generation = cephalexin
2nd generation = cefuroxime
3rd = cefotaxime, ceftriaxone, ceftazidime

as generation increases, more gram negative cover and less gram positive

125
Q

What bacteria are glycopeptides active against?
mechanism of glycopeptides action

A

gram+ve only - too large to penetrate gram negative cell walls

binds to peptide chain -> prevents formation of glycosidic bonds and peptide cross linkes

126
Q

name antibiotic classes that inhibit protein synthesis
state their mechanisms of action.

A

aminoglycosides - gentamicin, amikacin, tobramycin - bind to 30s ribosomal subunit, prevent elongation of polypeptide chain

tetracylines - bind 30s subunit and prevent trna binding to ribosomal site. active against intracellular pathogens eg chlamydia, rickettsia, mycoplasma. may cause light-sensitive rash

macrolides(bind 50s subunit, interfere with translocation, stimulate dissociation of trna), lincosamides eg clindamycin, streptogramins eg synercid ( the MSL group)

Chloramphenicol - binds peptidyl transferase of 50s subunit. rarely used due to risk of aplastic anaemia and grey baby syndrome

Oxazolidinones eg linezolid - highly active against gram positives mostly, including MRSA and VRE. optic neuritis and thrombocytopenia risk!

127
Q

name an antibiotic class that is ototoxic

A

aminoglycoside

128
Q

name antibiotic clases that inhibit DNA synthesis

A

Quinolones - ciprofloxacin, levofloxacin, movifloxacin. act on DNA Gyrase

nitroimidazoles - metronidazole, tinidazole - active against anaerobes and protozoa

129
Q

what antibiotic class inhits RNA synthesis?

A

Rifamycins - rifamipicin (inhibits dna dependent rna polymerase), rifabutin

130
Q

State 2 cell membrane toxins used

A

Daptomycins - complex gram +ve eg MRSA

Colistin - gram -ves

131
Q

state 2 antibiotics that inhibit folate synthesis

A

sulfonamides
diaminopyrimidines eg trimethoprim

132
Q

describe mechanisms of resistance to antibiotics

A

1. modification/ inactivation of antibiotic = penicillin resistance, ESBL ecoli resistance to ceftriaxone
2. modification/replacement of target - MRSA Have a MecA gene making them resistant to flucloxacillin!! -> new PBPs with low affinity for B-lactams, strep pneumonia acquires multiple mutations in PBPs genes. fluclox was developed to not be broken down by beta lactamases
3.reduce antibiotic accumulation
- impared uptake
- increased efflux
4. bypass antibiotic sensitive step - eg in trimethprim and sulfonamides

133
Q

avibactam mechanism of action?

A

inhibits ox-48 and most kpc enzymes

134
Q

meropenem verobactam mechanism?

A

inhibit kpc enzymes

135
Q

cefiderecol mechanism of action?

A

enters through ion channels

136
Q

make notes for antimicrobial 2 lecture

A

137
Q

Covid 19 treatment

A

Kaletra = lopinavir + ritonavir
hydroxychloroquine
Remdesivir
dexamethasone

138
Q

host proteins in influenza infection

A

butrophilin a3 = inhibits influenza polymerase

ANP32 = host proteins - copted by influenza virus

139
Q

Oral thrush treatment?

A

Topical nystatin

140
Q

Oseophagitis treatment?

A

Oral fluconazole

141
Q

Which organism is cryptococcus associated with ?

A

Pigeons ! = infects lungs and can disseminate into blood
C gattii = particular strain that can cause meningitis in immunocompetent patients

142
Q

PCP cxr findings?

A

Diffuse ground glass changes

Microscopy
Pcr
Beta d glucan

Co trimoxazole to treat

143
Q

Tinea cruris affects where?

A

Groin

144
Q

Most common side effects with
1. Azoles
2. Polyenes
3. Echinocandins
4. Pyrimidine analogues

Learn what each antifungal targets!

A

Azoles = abnormal lfts
Polyenes = nephrotoxicity
Echinocandins = relatively safe
Pyrimidine analogues = blood disorders

145
Q

fever in a returning traveller
dengue - transmitted by aedes mosquito
typhoid
malaria

A

Year 5 MEDICINE Pathology (11 decks)

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