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BM4 Part 1 > Microbiology > Flashcards

Microbiology Flashcards

1
Q

What is the mechanisms of action of beta-lactams?

A

Inhibition of cell wall synthesis by binding to Pencilling Binding Proteins.

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2
Q

What is the mechanism of action of fluoroquinolones?

A

Blocking DNA synthesis through inhibiting DNA Gyrase and Topoisomerase Type II.

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3
Q

What is the mechanism of action of polymyxins?

A

Disruption of the cell membrane.

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4
Q

What is the mechanism of action of glycopeptides?

A

Inhibition of cell wall synthesis by blocking peptidoglycan synthesis.

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5
Q

What is the mechanism of action of macrolides?

A

50S ribosomal subunit inhibition, blocking protein synthesis.

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6
Q

What is the mechanism of action of lincosamides?

A

50S ribosomal subunit inhibition, blocking protein synthesis.

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7
Q

What is the mechanism of action of oxalidinones?

A

50S ribosomal subunit inhibition, blocking protein synthesis.

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8
Q

What is the mechanism of action of chloramphenicol?

A

50S ribosomal subunit inhibition, blocking protein synthesis.

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9
Q

What are the subclasses of beta-lactams?

A

Penicillins, cephalosporins (1-5 generations), carbapenems and monobactams.
Also get beta-lactamase inhibitors (e.g. clavulanic acid, sulbactam and tazobactam).

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10
Q

What is the mechanism of action of streptogramins?

A

50S ribosomal subunit inhibition, blocking protein synthesis.

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11
Q

What is the mechanism of action of tetracyclines?

A

30S ribosomal subunit inhibition, blocking protein synthesis.

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12
Q

What is the mechanism of action of aminoglycosides?

A

30S ribosomal subunit inhibition, blocking protein synthesis. Binding is irreversible so drugs are bactericidal.

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13
Q

What is the mechanism of action of rifamycins?

A

Inhibit RNA synthesis by inhibiting bacterial RNA polymerase.

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14
Q

Which antibiotic classes are bacteriostatic?

A

Chloramphenicol, oxazolidinones, sulphonamides, tetracyclines and macrolides.

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15
Q

What is the mechanism of action of sulphonamides?

A

Blocking the synthesis of folic acid through inhibiting duhydropteroate synthase (DHPS).

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16
Q

What is the mechanism of action of trimethoprim?

A

Blocking the synthesis of folic acid through inhibiting dihydrofolate reductase.

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17
Q

Why are trimethoprim and sulfamethoxazole used together?

A

They act synergistically to block the bacterial folate metabolism.

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18
Q

What is the mechanism of action of nitroimidazoles?

A

Disruption of DNA and inhibition of protein synthesis of the cell wall.

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19
Q

How are nitroimidazoles named?

A

-nidazole (suffix)

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20
Q

How are quinolones named?

A

-floxacin (suffix)

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21
Q

How are rifamycins named?

A

Rifa- (prefix)

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22
Q

How are lincosamides named?

A

Lin- (prefix or near the start)

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23
Q

Name the main macrolides.

A

Clarithromycin, azithromycin and erythromycin.

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24
Q

Name the main glycopeptides.

A

Vancomycin and teicoplanin.

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25
Q

What are the main 1st generation cephalosporins?

A

Cefazolin, cefalexin, cefradine and cefadroxil.

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26
Q

What is important about ceftriaxone?

A

It can penetrate the blood-brain barrier and so can be used against bacteria within the CSF (e.g. meningitis).

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27
Q

What are the main 3rd generation cephalosporins?

A

Ceftriaxone, cefotaxime, ceftazidime and cefixime.

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28
Q

What are 4th generation cephalosporins most often used for?

A

Broad spectrum antibiotics, typically used in sepsis and serious infection.

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29
Q

What is important about cefepime?

A

It can penetrate the blood-brain barrier and has coverage for Pseudomonas.

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30
Q

What are the main 5th generation cephalosporins?

A

Ceftaroline and ceftobiprole.

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31
Q

What are the main 2nd generation cephalosporins?

A

Cefoxitin, cefaclor and cefuroxime.

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32
Q

Penicillinase is mainly produced by which bacteria?

A

Gram positive (e.g. Staphylococcus spp.).

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33
Q

How can pencillinase activity be inhibited?

A

Use of pencillanase inhibitor such as clavulanic acid.
Use of pencillase resistant beta lactams (e.g. flucloxacillin which sterically inhibits activity).

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34
Q

What are the cautions of penicillins?

A

Renal impairment due to kidney excretion.
Resistance.
Hypersensitivity.

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35
Q

What are the indications of penicillin hypersensitivity?

A

Fever, rash, urticaria, angioedema, nephritis, lymphadenopathy, arthralgias, anaphylaxis.

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36
Q

What antibiotics can be used in a patient with a penicillin allergy?

A

Non-beta lactams can be used safely.
Other beta-lactams should be avoided or used with extreme caution.

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37
Q

What are 1st and 2nd generation cephalosporins mainly used for?

A

UTIs, respiratory tract infections, otitis media, skin and soft-tissue infections.
Cefaclor good activity against H. influenzae.

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38
Q

What are ESBLs?

A

Extended Spectrum Beta Lactamases.
Present in some E. coli and Klebsiella, usually associated with UTIs.

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39
Q

Which beta-lactams can be used against ESBLs?

A

Later generation cephalosporins and carbapenems.

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40
Q

What is given with impenem and why?

A

Cilastatin to inhibit renal metabolism of impenem.

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41
Q

What are CREs?

A

Carbapenem Resistant Enterobacteriaceae.

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42
Q

What are glycopeptides used for?

A

Serious Gram positive infections.

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43
Q

Penicillin coverage

A

Gram positive (mainly strep) and lack effectiveness against Gram negative.

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44
Q

Which penicillin has better coverage against Gram negative?

A

Amoxicillin has some activity.

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45
Q

What is flucloxacillin effective against?

A

Staph and Strep

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46
Q

Coverage of cephalosporins

A

No activity against anaerobic but otherwise broad spectrum.

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47
Q

What is a main risk of cephalosporins other than hypersensitivity?

A

Risk of C. diff overgrowth.

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48
Q

Carbapenem coverage

A

Broad spectrum including Gram negative, Gram positive and anaerobic.

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49
Q

What is important about piperacillin?

A

It has coverage against Pseudomonas.

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50
Q

What bacteria is meropenem most effective against?

A

E. coli, P. aeruginosea and S. aureus (not MRSA).

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51
Q

What bacteria is vancomycin not bactericidal against?

A

Streptococci

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52
Q

What is the route of administration of vancomycin?

A

IV as it is not absorbed in the gut.

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53
Q

What are the risks of vancomycin?

A

Narrow therapeutic window (ototoxicity), red man syndrome.
Many bacteria not resistant, so avoid overuse.

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54
Q

Tetracycline coverage

A

Broad spectrum Gram negative and positive.

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55
Q

Cautions of tetracyclines

A

Yellowing of teeth, so not given <12 years.
Wide spread resistance so use is limited (e.g. large percentage of Strep resistances).
Hepatotoxicity so cannot be given in pregnancy.

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56
Q

Coverage of aminoglycosides

A

Most effective against Gram negative, limited activity against Gram positive and anaerobes.

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57
Q

What are glycopeptides mainly used for?

A

Usually reserved for serious Gram positive infections.

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58
Q

What are the first line uses for tetracyclines?

A

Anthrax, Chlamydia, Lyme disease, Brucellosis and Q fever.

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59
Q

What are the first line uses of aminoglycosides?

A

Gram negative septicaemia, MRSA, endocarditis.

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60
Q

Risks of aminoglycosides

A

Ototoxicity and nephrotoxicity.

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61
Q

Macrolide coverage

A

Gram positive and atypical but limited Gram negative (azithromycin has better activity against Gram negative, particularly H. influenzae).

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62
Q

What are the first line uses of macrolides?

A

Legionnaire’s, Chlamydia, Syphillis, Respiratory infection, Campylobacter enteritis, H. pylori eradication, skin infections.

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63
Q

Quinolones coverage

A

Effective against Gram negative and atypicals (including Pseudomonas), limited against Gram positive.

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64
Q

What are the first line uses of fluoroquinolones?

A

UTIs, pyelonephritis, bacillary dysentery, severe gastroenteritis and pseudomonas.

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65
Q

What is trimethoprim alone used for?

A

UTIs, acne, prostatitis and shigellosis.

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66
Q

What are the first line uses of co-trimoxazole?

A

Toxoplasmosis, PCP pneumonia, nocardiosis, UTIs, RTIs.

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67
Q

What are the two families of anti-fungals?

A

Azoles and polyenes

68
Q

What is the main azole?

A

Fluconazole

69
Q

What is the mechanism of action of fluconazole?

A

Inhibition of cell wall synthesis, growth and cell adhesion.

70
Q

What is an alternative to fluconazole in Aspergillus infection?

A

Posaconazole

71
Q

What is the mechanism of action of polyenes?

A

Inhibition of cell membrane function.

72
Q

What are two examples of polyenes?

A

Nystatin (topical candida) and amphotericin (IV for systemic fungal infections)

73
Q

What is the mechanism of action of aciclovir?

A

Inhibits viral DNA polymerase

74
Q

What are two viruses aciclovir might be used against?

A

HSV and VZV

75
Q

What is the mechanism of action of oseltamivir (tamiflu)?

A

Inhibition of neuraminidase

76
Q

Coverage of metronidazole

A

Anaerobic bacteria and protozoa

77
Q

Side effects of sulphonamides

A

Hepatitis, hypersensitivity, bone marrow depression, renal failure.

78
Q

Side effects of co-trimoxazole

A

Diarrhoea, electrolyte imbalance, fungal overgrowth, headache, nausea, skin reactions.
Rare Stevens-Johnson syndrome (bone marrow suppression)

79
Q

Side effects of fluoroquinolones

A

GI disorders, rashes, arthropathy (young), headaches, dizziness, convulsions, tendon damage.

80
Q

What other drugs need to be considered with fluoroquinolones?

A

Theophylline and warfarin.
P450 inhibition.

81
Q

What other drugs need to be considered with fluoroquinolones?

A

Ethanol, warfarin and statins (metabolism)

82
Q

Side effects of tetracyclines

A

GI irritation, erythema and photosensitisation.

83
Q

What are the first line uses of chloramphenicol?

A

Conjunctivitis (eye drops), meningitis, H. influenzae.

84
Q

Risks of chloramphenicol

A

Very toxic - severe bone marrow suppression, effects on newborn (grey baby syndrome), hypersensitivity and GI disturbance. Reserved for serious infections.

85
Q

Side effects of macrolides

A

GI disturbances, jaundice, allergies, opportunistic infections.

86
Q

What other drugs need to be considered for macrolides?

A

All other drugs as it inhibits P450.

87
Q

What antibiotics are highly associated with C. diff?

A

Co-amoxiclav
Clindamycin
Cephalosporins (3rd + 4th)
Ciprofloxacin and other quinolones

88
Q

What are the main causative agents of bacterial meningitis?

A

Streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenzae
Streptococcus agalactiae
Listeria monocytogenes

89
Q

What are the main causative agents of bacterial otitis media?

A

Streptococcus pneumoniae

90
Q

What are the main causative agents of bacterial CAP?

A

Streptococcus pneumoniae
Haemophilus influenzae
Staphylococcus aureus

91
Q

What are the main causative agents of bacterial atypical pneumonia?

A

Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella pneumophila

92
Q

What are the main causative agents of bacterial skin infections?

A

Staphylococcus aureus
Streptococcus pyogenes
Pseudomonas aeruginosa

93
Q

What are the main causative agents of bacterial eye infections?

A

Staphylococcus aureus
Neisseria gonorrhoeae
Chlamydia trachomatis

94
Q

What are the main causative agents of bacterial sinusitis?

A

Streptococcus pneumoniae
Haemophilus influenzae

95
Q

What are the main causative agents of bacterial URTI?

A

Streptococcus pyogenes
Haemophilus influenzae

96
Q

What are the main causative agents of bacterial gastritis?

A

Helicobacter pylori

97
Q

What are the main causative agents of bacterial food poisoning?

A

Campylobacter jejuni
Salmonella
Shigella
Clostridium
Staphylococcus aureus
E. coli

98
Q

What are the main causative agents of bacterial UTI?

A

E. coli
Enterobacteriaceae
Staphylococcus saprophyticus
Pseudomonas aeruginosa

99
Q

What are the main causative agents of bacterial STIs?

A

Chlamydia trachomatis
Neisseria gonorrhoeae
Treponema pallidum
Ureaplasma urealyticum
Haemophilus ducreyi

100
Q

What is a pathogen?

A

Organism that causes or is capable of causing disease

101
Q

What is a commensal?

A

Organism which colonises the host, but causes no disease in normal circumstances

102
Q

What is an opportunistic pathogen?

A

Microbe that only causes disease if host defenses are compromised

103
Q

What is virulence/pathogenicity?

A

The degree to which a given organism is pathogenic (disease-causing)

104
Q

What is asymptomatic carriage?

A

When a pathogen is carried harmlessly at a tissue site where it causes no disease

105
Q

What are the possible routes of transmission of infectious disease?

A

Contact
Airborne
Faecal-oral
Sexually
Blood borne
Vector-borne

106
Q

What is the main constituent of the bacterial cell wall?

A

Peptidoglycan

107
Q

What makes up lipopolysaccharides?

A

Lipid A
O antigen
Terminal sugars

108
Q

Which bacteria can produce endotoxins?

A

Gram negative - component of the outer membrane (e.g. LPS)

109
Q

What are exotoxins?

A

Secreted proteins of Gram positive and negative bacteria

110
Q

What are the three modes of gene transfer in bacteria?

A

Transformation (plasmid)
Transduction (phage)
Conjugation (sex pilus)

111
Q

Which bacteria are obligate intracellular?

A

Rickettsia (rickettsii, prowazekii, conorii etc.)
Chlamydia (trachomatis, psittaci, pneumoniae)
Coxiella - burnetii

112
Q

Which bacteria have no cell wall?

A

Mollicutes:
Mycoplasma pneumoniae, Mycoplasma hominis, Ureaplasma urealyticum

113
Q

Which bacteria grow as filaments?

A

Actinomyces
Nocardia
Streptomyces

114
Q

Which bacteria grow as spirochaetes?

A

Leptospira
Treponema (T. pallidum)
Borrelia

115
Q

Are the spirochaetes Gram positive or negative?

A

Gram negative - though all stain weakly

116
Q

Anaerobic, Gram negative cocci?

A

Veillonella

117
Q

Aerobic, Gram negative diplococci?

A

Neisseria (N. meningitidis, N. gonorrhoeae)

118
Q

Anaerobic, Gram positive cocci?

A

Peptostreptococcus

119
Q

Aerobic, Gram positive cocci?

A

Streptococcus
Staphylococcus

120
Q

Beta Haemolytic

A

pyogenes
agalactiae

121
Q

Alpha Haemolytic

A

pneumonia
oralis
milleri
sanguis

122
Q

Gamma haemolytic

A

bovis
Enterococcus (E. faecium, E. faecalis)

123
Q

Aerobic, Gram positive cocci, Catalase positive?

A

Staphylococcus

124
Q

Aerobic, Gram positive cocci, Catalase negative?

A

Streptococcus

125
Q

How can you distinguish S. pneumoniae from viridans?

A

S. pneumoniae is sensitive to optochin

126
Q

Group A Streptococcus?

A

S. pyogenes

127
Q

Group B Streptococcus?

A

S. agalactiae

128
Q

Group D Streptococcus?

A

Enterococcus

129
Q

Group C Streptococcus?

A

S. dysgalactiae

130
Q

Aerobic, Gram positive cocci, Catalase positive, Coagulase positive?

A

S. aureus

131
Q

Aerobic, Gram positive cocci, Catalase positive, Coagulase negative?

A

S. saprophyticus
S. epidermidis

132
Q

Acid-fast bacilli (ZN positive)?

A

Mycobacteria: tuberculosis, leprae, avium-intracellulare, ulcerans, kansasii

133
Q

Anaerobic, Gram positive bacillus?

A

Clostridium (perfringens, tetani, botulinum, difficile)
Proprionibacterium (acnes)

134
Q

Aerobic, Gram positive bacillus?

A

Corynebacterium (diphtheriae)
Listeria (monocytogenes)
Bacillus (anthracis, cereus)
Erysipelothrix (rhusiopathiae)

135
Q

What genera make up the coliforms?

A

Klebsiella
Escherichia
Enterobacter
Citrobacter

136
Q

What defines a coliform?

A

Facultatively anerobic, Gram-negative, non-spore-forming rods that produce beta-galactosidase (ferment lactose).

137
Q

What are enterobacteriacae?

A

A large family of Gram negative bacilli that ferment glucose to lactic acid.
All coliforms are enterobacteriaceae.

138
Q

Name the main genera of enterobacteriacae.

A

Citrobacter
Enterobacter
Escherichia
Klebsiella
Raoultella
Salmonella
Shigella
Serratia
Yersinia

139
Q

Anaerobic, Gram negative bacillus?

A

Bacteroides (B. fragilis)

140
Q

What are the components of the mycobacterium cell wall?

A

Mycolic acids and arabinogalactan
Peptidoglycan layer internal to this
Lipoarabinomannan

141
Q

Syncytium or Syncytia

A

A multinucleated cell resulting from multiple cell fusions of uninuclear cells

142
Q

Which viruses are associated with syncytia formations?

A

Herpesviruses

143
Q

Which virus has a ssDNA genome?

A

Parvovirus

144
Q

What are examples of DNA viruses?

A

Hepatitis B
Herpesviruses
Papvaviruses
Parvoviruses (ssDNA)
Poxviruses

145
Q

Herpesviruses

A

HHV-1 (HSV-1)
HHV-2 (HSV-2)
HHV-3 (VZV)
HHV-4 (EBV)
HHV-5 (CMV)
HHV-6 (Roseolovirus)
HHV-7 (Roseolovirus)
HHV-8 (Kaposi sarcoma)

146
Q

What are examples of dsRNA viruses?

A

Reovirus
Rotavirus

147
Q

What are examples of ssRNA viruses?

A

Astrovirus
Coronavirus
Coxsackie A and B
Dengue fever
Hepatitis A, C, D and E
HIV
HTLV1
Influenza A, B and C
Measles
Mumps
Parainfluenza virus
Polio
Rabies
RSV
Rhinovirus
Rubella
Yellow fever

148
Q

What are examples of live-attenuated vaccines?

A

BCG
Influenza (intranasal)
MMR
Rotavirus
Typhoid
VZV
Yellow fever

149
Q

What are examples of inactivated vaccines?

A

Hepatitis A
Influenza (IM)
Polio
Japanese encephalitis
Rabies

150
Q

What are examples of recombinant vaccines?

A

Hepatitis B
HPV
Meningitis B

151
Q

What are examples of toxoid vaccines?

A

Diphtheria
Tetanus
Pertussis

152
Q

What are examples of conjugate vaccines?

A

HiB (Haemophilus influenzae type B)
Meningitis C
Meningitis ACWY
Childhood pneumococcal

153
Q

What are recombinant vaccines?

A

Vaccines produced by recombinant cells containing DNA, which produce target antigens without pathogenicity

154
Q

What are examples of toxoid vaccines?

A

Inactivated toxins

155
Q

What are examples of conjugate vaccines?

A

Polysaccharide with attached inactivated diphtheria/tetanus toxins.
Stimulates an immune response with subsequent immunogenicity to the polysaccharide.

156
Q

Which live vaccines can be used in HIV if CD4+ count > 200?

A

MMR
VZV
Yellow fever

157
Q

Which live vaccines are contraindicated in HIV, regardless of CD4+ count?

A

BCG
Intranasal influenza
Typhoid

158
Q

Post-streptococcal complications

A

Result of antigenic cross-reactivity to streptococcal M protein which resembles proteins present in the bodies connective tissue
Occurs ~2 weeks post strep infection

159
Q

What are the most common causative agents of neonatal bacterial meningitis?

A

Group B Streptococcus (S. agalactiae)
E. coli
S. pneumoniae
Listeria monocytogenes

160
Q

What are the most common causative agents of bacterial meningitis in children and young people?

A

Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae type B (HiB)

161
Q

Buy AT 30, Cells at 50

A

30S:
Aminoglycosides
Tetracyclines
50S:
Chloramphenicol
Erythromycin (macrolides)
cLindamycin
Linezolid (oxazoladinones)
Streptogramins

162
Q

Hen Peck

A

1st Gen cephalosporins:
Proteus, E. Coli, Klebsiella

2nd Gen:
H. influenzae, Enterobacter aerogenes, Neisseria.

163
Q

Cephalosporin Naming

A

1 - FA/PHA
2 - ….
3 - ONE/TEN/IME
4 - PI
5 - ROL

164
Q

What WBC is typically raised in TB infection?

A

Macrophages

165
Q

What cells make up a TB granuloma?

A

Lymphocytes
Macrophages
Pathogen
Dendritic cells

166
Q

What are the typical presenting features of pulmonary TB?

A

Cough
Fever
Night sweats
Fatigue
Weight loss
Haemoptysis/hoarseness (late disease)

167
Q

What is the recommended treatment for TB?

A

Intensive phase (e.g. isoniazid, rifampicin, pyrazinamide, ethanbutol)
Continuation phase - Isoniazid + Rifampicin (18 weeks)

BM4 Part 1 (11 decks)

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