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Path (Owen) > Microbiology > Flashcards

Microbiology Flashcards

1
Q

What type of organism is neisseria gonorrhoea

A

Intracellular gram neg diplococcus

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2
Q

Treatment of gonorrhoea

A

IM Ceftriaxone single dose 1g

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3
Q

Name of chlamydia bacteria

A

Chlamydia trachomatis

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4
Q

What bacteria is chlamydia trachomatis

A

Obligate intracellular gram-ve that can not be cultured on agar

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5
Q

Typical presentation of chlamydia

A

Asymptomatic especially in women (80%)
Men get dysuria and discharge
Women get vaginal discharge and bleeding

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6
Q

How are chlamydia infections classified

A

By serovars
A-K

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7
Q

Division of chlamydia serovars and where they affect

A

A-C- trachoma
D-K- genital chlamydia

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8
Q

What is trachoma

A

The keratoconjunctivitis cause by chlamydia trachomatis- most common infective cause of blindness worldwide

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9
Q

What happens in trachoma

A

Keratoconjunctivits and then can get downward curling of eyelashes into the eye

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10
Q

Treatment for chlamydia

A

Doxycycline
2nd line azithromycin

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11
Q

What is lymphogranular venereum

A

Infection of the lymphatics by chlamydia trochomatis L1-3

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12
Q

Which people does LGV occur in

A

Typically those in endemic regions by more recently MSM

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13
Q

Complications of chlamydia PID

A

Tubal factor infertility
Ectopic pregnancy
Chronic pelvic pain

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14
Q

Disease course of LGV

A

Primary stage (3-12 days)- painless ulcers, proctitis, balanitis and cervicitis
Secondary stage (2wks-6mths)- painful inguinal buboes, fever, malaise
Late LGV- inguinal lymphadenopathy, genital elephantiasis. frozen pelvis, perianal ulcers

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15
Q

Diagnosis of LGV

A

NAAT to detect L1-3

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16
Q

What bacteria causes syphillis

A

Treponema pallidum- obligate gram negative spirochaete

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17
Q

What are the stages of syphillis infection

A

Primary
Secondary
Latent
Tertiary

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18
Q

Primary syphillis

A

Painless solitary genital ulcer that developed from a macule -> papule
Regional adenopathy

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19
Q

How long after transmission do you get ulcer in syphillis

A

1-12 weeks

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20
Q

What is a chancre

A

Ulcer seen in primary syphillis

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21
Q

Secondary syphillis

A

Disseminated syphilis
Get systemic bacteraemia after syphilis reaches the lymphatics
Fever, malaise, lymphadenopathy
Maculopapular rash on trunk -> limbs -> soles and palms
Genital warts (condyloma acuminate)

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22
Q

How do condyloma acuminate appear

A

Smooth white and painless

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23
Q

What happens in latent syphillis

A

Asymptomatic but still a serological infection

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24
Q

3 types of tertiary syphillis

A

Gummatous- skin/bone/mucosa granulomas (gumma = granuloma) BARELY ANY SPIROCHAETES here
Cardiovascular- aortic dilation and aortitis
Neurosyphilis- tabes dorsalis, argyll-robertson pupil, dementia/any focal neurology

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25
Q

What is tabes dorsalis

A

Degenerative disease of the dorsal column and dorsal root of the spinal cord as a result of syphilis caused by infection with Treponema pallidum pallidum

Get loss of proprioception and vibration

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26
Q

What is argylles robertson pupil

A

Lose light reflex but not the accommodation reflex

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27
Q

What is investigation for neurosyphilis

A

CSF spirochaetes

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28
Q

How is syphilis diagnosed

A

Spirochaetes seen in primary lesions using dark microscopy
Confirmed using serology
Non-treponemal
- Rapid Plasma Reagin (RPR)
- Venereal disease research laboratory test (VDRL)
- anti-cardiolipin
BUT CAN GET FALSE POSITIVE SO NEED TO CONFIRM WITH….
Treponemal
- T pallidum haemoaglutinin test

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29
Q

Which tests can be used to monitor syphilis treatment

A

Non-treponemal tests. RPR in particular
Ideally will see a 4 fold decrease

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30
Q

Treatment for syphilis
- if penicillin allergic

A

Single dose IM benzathine penicllin
Doxycycline if allergic

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31
Q

What is common reaction to syphilis treatment

A

Jarisch herxheimer reaction
Get flu like reaction which will clear in 24 hrs

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32
Q

What is congenital syphilis

A

Where baby gets syphilis infection from birth or pregnancy
Presents with symptoms over first couple of years
- rash
- fever
- neurosyphilis
- pneumonitis

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33
Q

What is chancroid caused by

A

Haemophilus ducreyi- gram neg coccobacilis

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34
Q

Symptoms of chancroid

A

Mutliple painful ulcers
Inguinal lymphadenopathy

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35
Q

How is chancroid diagnosed

A

THINK: CHANCROID ON CHOCOLATE

Culture on chocolate agar, PCR

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36
Q

What causes donovanosis

A

Klebsiella granulomatis- gram negative bacillus
Typically seen in African, Indian, aborigenese populations

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37
Q

What are beefy red ulcers seen in

A

Donovanosis

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38
Q

How is donovanosis diagnosed

A

THINK: DONOVANOSIS –> DONOVAN BODIES

Giemsa stain of biopsy
See Donovan bodies

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39
Q

Treatment for donovanosis

A

Azithromycin

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40
Q

What causes trichomoniasis

A

Flagellated protozoa- trichomoniasis vaginalis

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41
Q

Problem with trichomoniasis

A

Increased risk of HIV infection

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42
Q

How is bacterial vaginsosi diagnosed

A

Amsel criteria- must have at least 3/4
- white discharge
- pH above 4.5
- clue cells on microscopy
- positive whiff test

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43
Q

What are clue cells

A

Vaginal epithelial cells with bacterial rods on the cell membrane

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44
Q

What is the whiff test

A

Done in bafcterial vaginosis
Add potassium hydroxide to discharge- if positive will get fishy odour

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45
Q

What happens if get molloscum contagiosum if immunosuppressed

A

Widespread lesions

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46
Q

What are condylomata acuminate

A

Genital warts
Seen in secondary syphilis
HPV 6 or 11

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47
Q

How are viral warts diagnosed

A

Clinical diagnosis

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48
Q

How are viral warts treated

A

Hyperkeratotic- cryotherapy
Soft non-hyperkeratotic- podophyllotoxin

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49
Q

Who is podophyllotoxin contraindicated in

A

Pregnant women

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50
Q

CXR of HIV child with diffuse changes but is well

A

Lymphoid interstitial pneumonitis

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51
Q

What proportion of children will get HIV from untreated mothers

A

1/3

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52
Q

How can HIV be transmitted vertically

A

Breastfeeding
In utero
Intra partum

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53
Q

What is main predictor of vertical transmission of HIV

A

Viral load after primary infection settles

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54
Q

What is miliary TB

A

Disseminated haematogenous spread of TB

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55
Q

Initial investigations for TB

A

CXR- see upper lobe cavitation
3 sputum samples- if cant get sputum do BAL
Do NAAT to look for resistance

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56
Q

What is gold standard for TB

A

Culture myobcaterium for 6 weeks on lowenstein jensen medium then do ziehl neelson stain

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57
Q

What type of bacteria are mycobacteria

A

ROd shaped gram positive non motile

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58
Q

What is treatment for TB

A

RIPE for 2 months
Rifampicin and isoniazad for 2 more months

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59
Q

When do you treat TB for longer

A

Subacute meningitis
Potts disease

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60
Q

What is prophylaxis for TB

A

Isoniazid monotherapy

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61
Q

Side effects of each TB medication

A

Rifampicin-orange secretions
Isoniazad- peripheral neuropathy
Pyrazinamide- hepatoxic, gout
Ethambutol- optic neuritis

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62
Q

Second line for TB

A

Amikacin
Kanamycin
Quinoloines

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63
Q

What is hansens disease

A

Leprosy

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64
Q

What is the organism which causes leprosy

A

Mycobacterium leprae

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65
Q

Presentation of leprosy

A

Skin depigmentation
Nodules
Trophic ulcers
Nerve thickness- causes sensory and motor defects

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66
Q

What are lower resp tract infections

A

Broad term for lung infection- includes pneumonia, bronchitis, empyema, abscess
Tend to not have CXR changes

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67
Q

What is bronchitis versus pneumonia

A

Bronchitis- nflammation of medium sized airways- mainly in smokers
Pneumonia is infection of lung alveoli

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68
Q

Most common cause of HAP

A

Pseudomonas aeruginosa

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69
Q

What causes rusty coloured sputum CAP

A

S pneuominae

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70
Q

What type of organism is s pneumoniae

A

+ve diplococci

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71
Q

What type of organism is h influenzae

A

-ve cocco-bacilli

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72
Q

What bacteria causes grape bunch clusters

A

Staph aureus

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73
Q

What CAP seen in alcoholics

A

Klebsiella pneumonia
Often see haemoptysis

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74
Q

What type of organism is klebsiella

A

-ve rod

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75
Q

What organism associated with cavity in CAP

A

S aureus

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76
Q

What precedes staph aureus CAP

A

influenza infection

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77
Q

What is treatment for atypical pneumonias

A

Clarithomycin

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78
Q

Which pneumonia causes hepatitis and hyponatraemia

A

Legionella pneumophilia

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79
Q

Presentation of mycoplasma pneumoniae

A

Dry cough
Arthralgia
Erythema multiforme

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80
Q

Which pneumonia is associated with uni students/ boarding schools

A

Mycoplasma pneumoniae

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81
Q

Tests for mycoplasma

A

Cold agglutin test

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82
Q

What pneumonia is associated with birds

A

Chlamydia psitticae

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83
Q

Pneumonia in patient who just had bone marrow transplant

A

CMV

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84
Q

What pneumonia in patients who have neutropenia

A

Aspergillus

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85
Q

Which type of bacteria are splenectomy patinets at risk for pneumonia

A

Encapsulated bacteria
- H.influenzae
- S.pneumoniae
- N.meniningitidis

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86
Q

What bacteria are worried about in cystic fibrosis

A

Pseudomonas aeruginosa
Burkholderia cepacia

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87
Q

Investigations for pneumonia

A

CXR
Sputum MC&S- consider BAL if non-productive
Work out CURB-65

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88
Q

Investiations if atypical pneumonia

A

Legionella urine antigen
Serum antibody tests

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89
Q

Crtieria for CURB-65

A

Confusion
Urea- >7
RR- >30
BP- <90/60
65- aged older than 65

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90
Q

Treatment for CURB 65 0-1

A

Oral amoxicillin 5 days
Allergic to penicillin- clarithomycin

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91
Q

Treatment for CURB65 2

A

Oral amoxicillin and oral clarithomycin
Consider admission

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92
Q

Treatment for CURB65 3-5

A

IV co-amoxiclav
IV clarithomycin
Admission

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93
Q

1st line for HAP

A

Ciprofloxacin and vancomycin

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94
Q

2nd line for HAP

A

Tazocin and vancomycin

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95
Q

Aspiration pneumonia treatment

A

Tazocin and metronidazole

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96
Q

What are some causes of HAP

A

Pseudomonas
Haemophilus
S aureus
Klebsiella

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97
Q

Best treatment if confirmed pseudomonas

A

Tazocin and gentamicin

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98
Q

What organism is common causative agent in young females UTI- not most common though

A

Staphylococcus saphrophyticus

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99
Q

Which antibiotics inhibtis cell wall synthesis

A

Beta lactams
Glycopeptides

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100
Q

What are the beta lactams

A

Penicillin
Cephalosporin
Carbapenems

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101
Q

How do beta lactams work

A

Inactivate the enzymes involved in cell wall synthesis (transpeptidases)
Only work when bacteria dividing
Bactericidal

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102
Q

Why dont beta lactams work against mycoplasma and chlamydia

A

Lack peptidoglycan cell wall

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103
Q

Why dont beta lactams work on abscesses

A

Bacteria arent dividing
Also not divinding in biofilms

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104
Q

How can s aureus defend against penicillin

A

Produce beta lactamases

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105
Q

Coverage of each methicillin antibiotics

A

Penicillin- gram positive, streptococci, clostridia
Amoxicillin- quite a broad spectrum- covers more gram negatives
Flucloxacillin- produced to replace penicillin. More stable to beta lactamse

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106
Q

How does clavlulanic acid and tazobactam work

A

Beta lactamase inhibitor- given with penicillins

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107
Q

What is tazocin

A

Combination of piperacillin and tazobactam

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108
Q

What is different between different gen cephalosporins

A

Increasing generations increases cover against gram negative and pseudomonas
All are stable to beta lactamase

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109
Q

What are extended spectrum beta lactamases

A

Enzymes which can act agaisnts cephalosporins
Increasingly common in E coli and klebsiella

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110
Q

Advantage of carbapenems

A

Stable to extended spectrum beta lactams (ESBL) enzymes

Can be used against E.coli and Klebsiella

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111
Q

What is used by bacteria against carbapenems

A

Carbapenemase produced

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112
Q

Key features of beta lactams

A

Non toxic
Renally excreted
Short half life
Dont cross BBB- but can if meninges inflammed

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113
Q

What are glycoppetides active against

A

Gram positive- c diff, MRSA, strep, myco
Cant do gram neg as too large to pass through cell wall

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114
Q

Disadvantage of vancomycin

A

Nephrotoxic
Must monitor

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115
Q

MOA of glycopeptide

A

Inhibit transpeptidase AND transglycoside enzymes in cell wall cross links. Similar to BLs but also inhibit transglycoside enzyme.

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116
Q

Abx which inhibit protein synthesis

A

THINK: TAMCO

Tetracyclines
Aminoglycoside
Macrolides
Chloramphenicol
Oxazolidinines

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117
Q

Problems of aminoglycoside

A

Nephrotoxic and ototoxic

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118
Q

Indication of aminoglycosides

A

Gram negative

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119
Q

Indication of tetracycline

A

Intracellular pathogens- chlamydia and mycoplasma

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120
Q

Who cant you give tetracyclines to

A

Children
Pregnant women

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121
Q

Indication of macrolides

A

Gram+ in penicillin allergy
Atypical penumonia
Campylobacter

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122
Q

Indication of chloramphenicol

A

Eye drops- bacterial conjunctivitis

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123
Q

INdications of oxalizininoes

A

Gram+ve
MRSA

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124
Q

Which Abx inhibit DNA synthesis

A

Fluoroquinolones
Nitroimidazole

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125
Q

Fluroquinolones indications (ciprofloxacin)

A

Gram negative

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126
Q

Indications of nitroimidazole

A

Anaerobes and protozoa

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127
Q

Which antibiotic is nitrofurantoin similar to

A

Metronidazole

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128
Q

MOA of rifamycins

A

THINK: R and R, Rifamycin inhibits RNA synthesis

Inhibit RNA synthesis

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129
Q

Indications for rifamycins

A

Mycoplasma
Chlamydia
TB

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130
Q

Which antibiotics target cell membrane through toxins

A

Polymyxin
Cyclic lipopeptide

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131
Q

Example of polymyxin

A

Colistin- gram negative

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132
Q

Example of cyclic lipopeptide

A

daptomycin- gram +ve, MRSA, vancomycin resistant enterococcus

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133
Q

Which antibiotics inhibit folate metabolism

A

Sulfonamides
Diaminopyrimidines

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134
Q

What is indication of sulphonamides

A

PCP
Combine sulphamethoxazole and trimethopin

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135
Q

Mechanisms of resitance

A

Bypass antibiotic sensitive step
Enzyme mediated drug inactivation
Impair accumulation of the drug
Modify the target of the drugs
BEAT

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136
Q

Give an example of bacteria inactivating the antibiotic

A

Beta lactamases

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137
Q

Give an example of alered target

A

MRSA
Encodes gene (mecA) which produces a novel penicillin binding protein which cant bind to the antibiotic

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138
Q

How is strep penumoniae resistant

A

Stepwise mutations in PBP- if low resistance increase the dose
Is an issue in meningitis as not many beta lactams can cross the BBB

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139
Q

Mechanism of macrolide resistance

A

Altered target by methylating ribosome- reduces the bindnig
Encoded by erythromycin ribosome methylation gnes

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140
Q

Most common reaction to antimicrobial agents

A

GI upset

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141
Q

Factors which affect prescribing abx for a patient

A

CHAOS
Host characteristics
Antimicrobial susceptibilities
Organism itself
Site of infection

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142
Q

What is MIC

A

Minimum amount of antibiotic needed to stop growth in a bacteria in vitro

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143
Q

When must specimens for cultures be taken

A

Before start Abx

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144
Q

First investigation done on culture

A

Gram stain

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145
Q

Other than gram stain what tests will be done on bacteria in microbiology

A

Immunofluorescence
PCR

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146
Q

When do you do gram stain

A

CSF
Joint aspirate
Pus

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147
Q

How long is N meningitidis treated for

A

10 days

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148
Q

How long is Acute osteomyelitis treated for

A

6 weeks

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149
Q

How long is Infective endocarditis treated for

A

6 weeks

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150
Q

If patient hasnt responded in 48 hours to abx what could be cause

A

Actually have infection
Catheter
Infective endocardiitis

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151
Q

Most narrow spectrum for e coli

A

Amoxicillin

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152
Q

What is an opportunistic infection

A

Organism which does not normally cause disease or where symptomology becomes worsened based off the patients immune system
Can be endogenous- reactivated
Exogenous

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153
Q

What causes oral thrush and CMV retinitis

A

HIV

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154
Q

Sources of infection in SAT

A

Virus from graft
Viral reactivation in host
Infection from social contact

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155
Q

Order of greatest relative risk of opportunistic viral infection

A

Steroids
Cytotoxic chemo
Monoclonal AB therapy
Solid organ transplant
HIV
Allogenic stem cell transplant

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156
Q

What does JC virus cause

A

Progressive multifocal leukoencephalopathy

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157
Q

What does Progressive Multifocal Leukoencaphalopathy (PML) cause

A

Get demyelination of white matter leading to personality changes, cognitive dysfunction and focal neurology

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158
Q

What causees haemorrhagic UTI post stem cell transplant

A

BK virus

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159
Q

Prophylaxis for monkeypox

A

Small pox vaccine

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160
Q

Treatment for monkey pox

A

Analgesia
Tecovirimat if very severe

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161
Q

Where is natural resevoir for influenza A

A

Ducks- any water bird

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162
Q

What are 2 types of influenza

A

A and B

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163
Q

What are 2 spike proteins in influenza

A

Haemaglutinin
Neuraminidase

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164
Q

Risks of aminoglycosides

A

Ototoxic
Nephrotoxic

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165
Q

Side effect of tetracyclines

A

Light-sensitive rash

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166
Q

Why dont use chloramphenicol in neonates

A

Risk of aplastic anaemia
Get grey baby syndrome in neonates as cant metabolise the drug

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167
Q

Risks of oxazolidinones

A

Thrombocytopenia
Optic neuritis

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168
Q

MOA of fluoroquinolones

A

Binds to alpha subunit of DNA gyrase
Bactericidial

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169
Q

MOA of nitroimidazoles

A

Rapidly bactericidal

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170
Q

MOA of rifampicin

A

DNA dependant RNA polymerase is target
Bactericidal

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171
Q

Why is rifampicin so susceptible to resistance

A

Get rapid resistance as chromosomal mutations lead altered target in the beta subunit of RNA polymerase

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172
Q

When is only time give rifampicin alone

A

Prophylaxis in meningococcal infection

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173
Q

Which bacteria use beta lactamases as their major mechanism of resistance to Beta lactams

A

Staph aureus
Gram negative bacili- E coli and pseudomonas
NOT MRSA and streptococci

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174
Q

How is MRSA resitant to beta lactams

A

Encodes gene (mecA) which produces a novel penicillin binding protein which cant bind to the antibiotic

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175
Q

How are e.coli and klebsiella becoming resistant to Cef

A

ESBL

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176
Q

What is bacteriuria

A

Presence of bacteriuria
Not necessarily pathogenic as common in elderly in particular
Get commensal bacteria in urethra

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177
Q

What is a complicated UTI

A

This occurs in people with structurally abnormal urinary tracts- catheters, calculi
Normally occurs in men and patients with catheters

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178
Q

Most common infective organism in UTI

A

E.coli but this is done by a select group of serovars

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179
Q

Organism if getting recurrent UTIs

A

Pseudomonas

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180
Q

Which bacteria is associated in presence of renal stones

A

Proteus mirabilis

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181
Q

Antibacterial host defence in Urinary tract

A

Urine- pH, organic acids, osmolality
Urine flow
Musoca has cytokines

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182
Q

What increases risk of UTI structurally

A

Literally anything which interferes with urine flow or abnormalities
Neurogenic dysfunction too

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183
Q

What increases risk of UTI in children

A

Vesicoureteral reflux

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184
Q

What is common cause of abscesses in kidney

A

If haematogenous then staph aureus- IE
Rarely see gram negative bacilli abscesses from haematogenous route- typically ascending

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185
Q

How treat abscess in kidney caused by s aureus

A

IV flucloxacillin

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186
Q

How does UTI present in elderly patients

A

Tend to be non-specific
Abdo pain
Change in mental status

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187
Q

Which patients dont you do urine dip in

A

Those over 65 as often have bacteria in tract anyway

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188
Q

When is only time treat asymptomatic bacteriuria

A

Pregnancy

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189
Q

What does mixed growth suggest on urinary MCS report

A

Poorly taken sample
Only reports it 1 orgnaism predominate

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190
Q

What are squamous cells indicative of on urine dip

A

Contamination

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191
Q

What can sterile pyuria suggest

A

Prior treatment with abx
Calculi
TB
Bladder neoplasm
STI

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192
Q

Which is main risk factor for candida UTI

A

Catheter

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193
Q

Treatment for catheter UTI

A

Can give stat aminoglycoside and then remove it

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194
Q

Complications of pyelonephritis

A

Abscess
Chronic
Septic shock
Acute papillary necrosis

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195
Q

UTI guidelines for women under 65 for investigations

A

Once ruled out pyelo and other vaginal/sexual health causes of symptoms
Does have
- dysuria
- new nocturia
- cloudy urine
If has 2 or more do urine culture
If has 1 do urine dipstick

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196
Q

Urine dip guidelines for women under 65 urine dip

A

If nitrite positive or leukocyte and RBC positive UTI likely- send for culture and give consider abx or back
If neg nitrite and pos leukocyte UTI equally likely as other diagnoses- send for culture and give consider abx or back
If all neg isnt UTI

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197
Q

What should be interpreted as positive UTI on urine culture

A

Culture of over 10^4/5 colony forming units unless E.coli or staphylococcus saprophyticus where 10^3 colony forming units
10^5 colony forming units mixed growth with 1 orgnaism predominating
ALWAYS IN CONJUNCTION WITH SYMPTOMS

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198
Q

Treatment for pyelonephritis

A

IV co-amoxiclav and gentamicin

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199
Q

Treatment for uncomplicated female UTI

A

Cephalexin PO 3 days or nitro oral 7 days

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200
Q

Treatment for uti if female or breastfeeding

A

1st line cefalexin oral 7 days
2nd line co-amoxiclav
If allergic consult micro

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201
Q

Treatment for UTI if male

A

Cephalexin for 7 days
If suspect prostatis ciprofloxacin 14 days

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202
Q

Treatment for UTI chronic prostatitis

A

Oral cipro for 4-6 weeks

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203
Q

Treatment for urosepsis

A

Aminoglycoside

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204
Q

Treatment for catheter associated UTI

A

Give macrolide before removal

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205
Q

What tests cant you use in an immunocompromised patient

A

Serology

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206
Q

What is done if immunosuppressed patient becomes unwell

A

Screening based on syndromes
- csf
- resp
- gut biopsy
- blood

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207
Q

How does HSV present in immunocompromised

A

Mouth ulcers
Oesophagitis
Pneumonitis
Hepatitis
DOES NOT INCREASE RISK OF ENCEPHALITIS

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208
Q

Where does herpes lie latent

A

Sensory neurones

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209
Q

How can varicella present in immunocompromised

A

Pneumonitis
Encephalitis
Hepatitis
Progressive outer retinal necrosis- PORN
Acute retinal necrosis

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210
Q

How can varicella present in immunocompromised in neo-nates

A

Purpura fulminans

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211
Q

How can zoster present in immunocompromised

A

Shingles that is multidermatomal

212
Q

How is varicella treated in immunocompromised

A

IV aiclovir until no new lesions, PO until all crusted

213
Q

How is zoster treated in immunocompromised if disseminated

A

IV aciclovir and analgesia

214
Q

What is post transplant lymphoproliferative disease

A

When immunosuppressed B-cells containing latent EBV get polyclonally activated

215
Q

When does post transplant lymphoproliferative disease occur

A

Solid organ transplant
Allogenic haematopoietic stem cell transplant

216
Q

How is post transplant lymphoproliferative disease confirmed

A

Lymph node biopsy
Suspicion when see rising EBV and CT scan

217
Q

What are issues of EBV in immunosuppressed

A

Onchogenesis
B-cell lymphoma
Post transplant lymphoproliferative disease

218
Q

Management of EBV when immunosuppressed

A

Rituximab
Reduce immunosuppression

219
Q

What is diagnosis of african kids with big jaws

A

Burkitts lymphoma

220
Q

Where does CMV lay dormant

A

In dendritic cells so in transplants, some are transplanted

221
Q

Which patients is CMV a problem in

A

SOT
HIV with CD4 under 50

222
Q

How do cells with CMV appear

A

Owls eye inclusions

223
Q

How does CMV present

A

Encephalitis
Polyradiculopathy
Retinitis
Pneumonitis
Colitis

224
Q

Treatment for CMV

A

1st line-Ganiciclovir IV or valganciclovir PO
2nd line- Foscarnet
3rd line- Cidofovir

225
Q

What is difference in challenges between CMV in SOT vs HSCT

A

SOT- problem is if donor is positive as immunosuppressed patient now has disease
HSCT- problem is if recipient is positive as new immune system naive to it

226
Q

How is CMV infection prevented post transplant in HSCT vs SOT

A

HSCT- CMV viral load measured twice weekly for 100 days
SOT- Valganciclovir for 100 days

227
Q

What is problem of ganiciclovir

A

Suppresses the BM

228
Q

What is problem of cidofovir and foscarnet

A

Nephrotoxic

229
Q

How is progressive multifocal leukoencephalopthy diagnosed and treated

A

MRI and CSF PCR
Cidofovir

230
Q

Which immunocompromised patients specificay is JC virus seen in

A

Mycophenolate
MS patients on Natalizumab

231
Q

Where does the BK virus reside

A

Kidney

232
Q

How does BK virus present in renal transplant patients versus in BMT

A

Renal transplant- BK nephropathy
BMT- haemorrhagic cystitis

233
Q

Treatment for BK virus

A

Cidofovir- nephrotoxic so also reduce immunosuppression

234
Q

What can happen to Hep B in immunocompromised

A

Carriers will have flare up
Those who have had infection will reactivate

235
Q

How to prevent Hep B

A

Lamivudine
Tenofovir and entecavir

236
Q

How can monkeypox present

A

Atypical rash
Fever
Myalgia
Pain
Lesions on penis and anus

237
Q

Complications of monkeypox

A

Rectal perforation
Penile oedema

238
Q

Treatment for monkeypox

A

Analgesia and supportive
If severe tecovirimat

239
Q

Define PUO

A

Depends on the category but all with fever over 38.3
Classic- over 3 weeks and at least 3 days of hospital evaluation
Nosocomial- admitted over 24 hours ago with no fever, evaluated for 3 days
Immune deficient- neut count under 500 and eval for over 3 days
HIV- confirmed case, lasted over 4 weeks as outpatinet, 3 days outpatient

240
Q

What are 4 types of PUO

A

Classic
Nosocomial
Immune deficient (neutropenic)
HIV-associated

241
Q

When does IgG begin to rise

A

After 2 weeks

242
Q

PUO from lebanon

A

Brucella

243
Q

What is unique for adult onset stills

A

Very high ferritin from macrophage activation

244
Q

PUO malignancy

A

NHL
Leukaemia
RCC
HCC

245
Q

What to do if patinet with PUO and recent travel history

A

Refer to RIPL
Rare and imported pathogen lab

246
Q

How are zoonoses classified

A

Companion versus wild
Tropical versus UK

247
Q

Resevoir for salmonella

A

Poultry
Reptiles/amphibians

248
Q

How is salmonella transmitted

A

Contaminated food
Poor hand hygiene

249
Q

3 types of shigella

A

Shigella sonii- watery diarrhoea
Shigella flexioni- bloody diarrhoea fever aswell with antibiotic resistance
Shigella dysenterii-

250
Q

Presentation of cat scratch disease

A

Macule at site of innoculation which can become pustular
Local adenopathy
Systemic symptoms

251
Q

Investigations of bartonella henselae

A

Serology
Do histopathology with bacillary angiomatosis

252
Q

Resevoir for toxoplasmosis

A

Cats
Sheep

253
Q

Resevoir for brucellosis

A

Cattle
Goats

254
Q

Transmission of brucellosis

A

Unpasteurised milk
Undercooked milk
Mucosal splash
Aerosolisation

255
Q

Presentation of brucella

A

Fever which peaks in evening- normally just this
Back pain
Orchitis
Focal abscesses

256
Q

Management of brucellosis

A

Doxycycline plus streptomycin

257
Q

What causes Q fever

A

Coxiella burnetii

258
Q

Resevoir for coxiella

A

Goats
Sheep
Cattle

259
Q

Transmission of Q fever

A

Aerosolisation of secretions/waste of farm animals

260
Q

Resevoir of rabies

A

Dogs
Bats

261
Q

Cause of rabies

A

Lyssa virus

262
Q

Presentation of VHF

A

Flu like illness with fever
Bleeding

263
Q

Management of VHF

A

Supportive

264
Q

Investigations for VHF

A

PCR
Serology

265
Q

Infection with renal pulmonary syndrome

A

Hanta virus

266
Q

How is herpes diagnosed

A

Lesion swab for PCR

267
Q

What causes foetal herpes infection

A

Ascending infection in premature rupture of membrane

268
Q

What are 3 types of gential herpes infection

A

Primary infection- 1st episode of genital HSV
Non-primary infection- 1st episode of genital HSV but antibodies to HSV1
Recurrent- infection but with antibodies to HSV (can be symptomatic or asymptomatic)

269
Q

What is main problem of HSV in pregnancy

A

Main problem is primary infection in final trimester
- greatest risk of transmission so if active HSV in last 6 weeks fo C-section

270
Q

Complications of HSV infection in utero-infection

A

Miscarriage
Congenital abnormalities- ventriculomegaly, CNS abnormalities
Preterm
IUGR

271
Q

How does neonatal HSV eye disease present

A

Excessive eye watering and conjunctival erythema
Can get periorbital vesicles

272
Q

Complications of maternal varicella

A

Varicella pneumonia
Encephalitis

273
Q

What do if maternal CMV suspected in pregnancy

A

Check serology then refer to fetal medicine for USS
Urine and saliva CMV PCR within 21 days of birth

274
Q

How will CMV infection present in pregnancy

A

Maculopapular rash
Mononucleosis presentation

275
Q

What type of virus is rubella

A

Togavirus- positive sense ssRNA

276
Q

Rubella presentation in pregnancy

A

Prodrome pre rash
Macular rash which is mildly pruritic
Starts on face spreads to trunk and limbs rapidly

277
Q

Examination finding of rubella infection

A

Tender
Post auricular/cervical/suboccipital
Forchmeicher spots on palate (these are red

278
Q

Rubella infection in pregnancy implications

A

Early infection within 10 weeks- abortion and fetal defects common
Later from 13 weeks associated with hearing defects and retinopathy

279
Q

Infacny presentation of congenital rubella syndrome

A

PDA
VSD
Microcephaly
Puroura
Hepatosplenomegaly

280
Q

Later presentations of congenital rubella syndrome

A

Intellectual disability
Hearing loss
Cataracts and retinopathy
DM very late

281
Q

Difference in rash in measles and rubella

A

Rubella- very fast progression from face to trunks
Measles- starts at hairline/ear then spreads cephalocaudally

282
Q

Presentation of measles

A

Prodrome for a few days
Conjunctivitis
Koplik spots
Rash

283
Q

What is name of measles virus

A

Morbillivirus

284
Q

Complications of meales

A

Pneumona
Secondary bacterial infection
Otitis media
Encephalitis

285
Q

Measles complications in pregnancy

A

Typically no abnormalities
Can lead to fetal loss and preterm delivery
Can get subacute sclerosing panencephalitis 7-10 years after infection

286
Q

Presentation of parvovirus 19 infection in pregnancy

A

Slapped cheek and rash
Polyarthropathy
Fever and malaise

287
Q

Difference in complications of parvovirus B19 across pregnancy

A

Before 20 weeks- hydrops fetalis, foetal anaemia and HF
After 20 weeks- no documented risk

288
Q

Management of parvovirus B19 infection during infection

A

Refer to fetal medicine for monitoring with possibility of intrauterine transfusion

289
Q

How can enteroviruses present

A

Hand foot and mouth
Encephalitis
Myocarditis

290
Q

Which enterovirus presents with most severe outcomes in newborns and what can cause

A

Cocksackie
- fulminant hepatitis
- encephalitis
- bleeding

291
Q

What type of virus is zika

A

Enveloped falvivirus positive sense ssRNA

292
Q

How can zika virus present in newborn

A

Severe microcephaly and craniofacial disproportion
Deafness and retinopathy
Talipes
Hypertonia

293
Q

Zika virus advice

A

If pregnant avoid the areas where prevalent
Only get tested if symptomatic or abnormalities identified on antenatal USS

294
Q

Causes of surgical site infections

A

If abdo- likely to get gram neg like Ecoli
If joint likely to be staph aureus
Pseudomonas another common cause

295
Q

How are surgical site infetions diagnosed

A

Colony of over 10^5 microorganisms

296
Q

What are 3 levels of SSI

A

Superficial incisionial- skin and subcut
Deep incisional- affects muscle and fascial
Organ/space infection- any part of anatomy other than incision

297
Q

Risk factors for surgical site infection

A

Obesity
DM
Old age
RA

298
Q

What are the factors involved with preventing SSI

A

Hair removal
Showering
Reduced number of people in the room
Positive air ventialtion
Aseptic surgical technique

299
Q

What is significant risk factor for septic arthritis

A

Rheumatoid arthritis

300
Q

Rfs for septic arthritis

A

Any arthritis
Joint prosthesis
IV drug use
DM
Renal diseases
Any trauma

301
Q

What are some techniques for pathogenesis in joints for bacteria

A

S aureus has a receptor for fibronectin
Kingella kingae adheres to synovium with pili

302
Q

What is associated with fulminant septic arthritis

A

Strains producing rhe PVL (panton valentine leucocidin) cytotoxin

303
Q

Organisms which cause septic arthritis

A

Staph aureus most common
Streptococci pneumonia
Strep pyogenes
Ecol
H influenza
Neisseria gonorrhoea
Rare- TB, brucella, lyme

304
Q

What diagnoses septic arthritis

A

Synovial count over 50,000 WBC cells/mm3
Negative culture does not exclude however

305
Q

Management of septic arthritis

A

Culture then give abx- iv ceph or fluclox
Synovial fluid aspiration for MCS
Arthroscopic washout may be needed

306
Q

Best imaging for septic arthritis

A

MRI
Use US for guided aspiration

307
Q

What are causes for vertebral osteomyelitis

A

Acute haematogenous
Disc surgery
CNS spread

308
Q

Most common cause of vertebral osteomyelitis

A

S aureus
Strep
Gonorroea
Most commonly lumbar

309
Q

Most sensitive imaging for vertebral osteomyelitis

A

MRI

310
Q

When get osteomyelitis what causes can cause granuloma

A

TB
Brucella

311
Q

What are brodies abscesses

A

When get chronic osteomyelitis of pyogenic source in cancellous (metaphyseal) bone
Normaly in children at proximal or distal tibia

312
Q

Management of osteomyelitis

A

Culture
IV abx
MRI
Bone biopsy for culture and histology

313
Q

How can chronic osteomyelitis be treated surgically

A

Masquelet technique
1. Removal of foreign bodies; filling the defect with antibiotic 2. loaded cement spacer and external fixation
In 6-8 weeks , remove the cement spacer, and fill the defect with autologous bone graft

314
Q

Causes of prosthetic implant infection most likely cause

A

Coagulase negative staphylococci (epidermis)

315
Q

How can prosthetic implant infection be managed

A

2 ways
- on histopathology infection defined as over 5 neutrophils per high power field
- intraoperative micro sampling taken from at least 5 sites and if 3 specimens yield infection of same source then indicative of infection

316
Q

Desaturation after walking around a room

A

PJP

317
Q

How is h influenzae becoming resistant to typical abx

A

Production of beta lactamase

318
Q

Difference in susceptibility of amoxicillin and fluclox to beta lactamase

A

Fluclox very stable however amox very susceptible

319
Q

Give an example of each gen cephalosporin

A

1st gen- cephalexin
2nd gen- cefuroxime
3rd gen- ceftriax, cefotaxime

320
Q

How is adult onset stills disease diagnosed

A

At least 5 criteria with 2 or more major

Major
- temp over 39 for 1 week
- leukocytes over 10,000
- typical rash
- arthralgia over 2 weeks

Minor
- sore throat
- lymphadenopathy
- splenomegaly/hepatomegaly
- faulty LFTs
- negative ANA or RF

DONT NEED TO KNOW EXACTLY JUST BE AWARE

321
Q

Investigation and mangement of salmonella

A

Investigation- stool culture
Management- ciprofloxacin and azithromycin

322
Q

What diseases does bartonella henselae cause

A

Cat scratch disease
Bacillary angiomatous in immunocompromised

323
Q

How does bacillary angiomatosis present

A

Cat bite
Skin papules around area
Disseminated multiorgan and vascular involvement

324
Q

Management of cat scratch disease versus bacillary angiomatosis

A

Both need erythomycin and doxycyline
Add rifampicin if bacillary angiomatosis

325
Q

Presentation of toxoplasmosis

A

Fever
Adenopathy
In adult flu like

326
Q

Managment of toxoplasmosis

A

Spiramycin
Pyrimethamine

327
Q

Presentation of q-fever

A

Fever
Atypical pneumonia
Can cause- pneumonia, endocarditis, epatitis, focal abscesses

328
Q

Management of q fever

A

Doxycycline

329
Q

Presentation of rabies

A

Seizures
Excessive salivation
Agitation
Confused
Headache

330
Q

Investigation and management of rabies

A

Serology
Brain biopsy
Management- IG, vaccine

331
Q

When bitten by rats what are often the resposible organisms

A

Streptobacillus moniliforms
Spirillum minus

332
Q

Presentation of rat bite fever

A

Fever
Polyarthralgia
Maculopapular rash developing to purpuric rash

333
Q

Investigation rat bite fever

A

Joint fluid MCS

334
Q

Management of rat bite fever

A

Penicillins

335
Q

Which mycobacterium cause TB

A

M. tuberculosis- not just!

336
Q

How does mycobacterium avium present

A

Disseminated disease resembling TB in immunocompromised

337
Q

What given if isoniazid resistant TB

A

Levofloxacin

338
Q

What type of virus is influenza

A

Negative sense segmented genome (8 segments)

339
Q

Difference between antigenic drift and shift

A

Drift- accumulation of point mutations from error prone RNA polymerase which changes antigenicity
Shift- recombinatino of genomic material from 2 co-infecting strains leads to completely novel strain

340
Q

What are 2 main phenotypes of influenza virus and their role

A

Haemagglutin- binds to sialic acid receptor allowing entry of virion
Neuraminidase- cleaves sialic acid on exitting from cell which disreupts mucin barrier

341
Q

What are the antivirals available for influenza and what are their target

A

Oseltamivir- neuraminidase inhibitor
Zanamivir- neuraminidase inhibitor
Amantadine- M2 protein inhibitor

342
Q

Treatment of influenza

A

Oseltamivir- neuraminidase inhibitor

343
Q

What is used in treatment of influenza if underlying lung disease or immunosuppressed

A

Zanamivir

344
Q

What sort of vaccine is given to under 18s for influenza

A

Live attenuated

345
Q

What sort of vaccine is given to those at risk of influenza virus

A

Inactivated subunit rich in haemagglutin

346
Q

What type of virus is coronavirus

A

Single stranded positive sense RNA virus

347
Q

What does SARS COV 2 bind to

A

ACE2

348
Q

Treatment for COVID19

A

Dexamethasone
Remdesivir

349
Q

How are viruses screened for/ monitored in an immunosuppressed patient undergoing a treatment

A

Viruses are screened for beforehand with serology
Then after become immunosuppressed we monitor using PCR as serology doesnt work as well in these patients

350
Q

What is difference in immunosuppression between solid organ transplant and HSCT

A

SAT- induction immunosuppression and then maintenance
HSCT- undergo conditioning regime beforehand with total body irradiation or cyclophsophamide to eradicate immune system. Then have ongoing to prevent graft versus host disease

351
Q

How is HSV treated in immunocompromised

A

Aciclovir
NOTE IS INCREASED RESISTANCE IN THESE PATIENTS

352
Q

What is the MOA of aciclovir, ganiciclovir and valganiciclovir

A

Competitive guanosine analogue which inactivates DNA polymerase (nucleoside analogue)

353
Q

MOA of cidofovir

A

Cytidine analogue terminator

354
Q

MOA of foscarnet

A

Non-competitive inhibitor of viral DNA polymerase

355
Q

What is ramsay hunt syndrome and what causes it

A

Varicella
Facial nerve palsy with vesicles in the ear

356
Q

How is ramsay hunt treated in immunocompromised

A

Aciclovir and steroids

357
Q

When on rituxumab or other B cell therapies which infection are particularly worried about reactivating

A

Hep B

358
Q

Problem of Hep A if immunosuppressed and how manage

A

More severe infection
Vaccinate

359
Q

Problem of Hep C if immunosuppressed and how manage

A

Increased fibrosis
Traet with NS3/4 protease inhibitors- telapravir

360
Q

Problem of Hep E if immunosuppressed and how manage

A

Chronic infection
Reduce immunosuppression

361
Q

How is Hep B treated

A

Interferon alpha
Lamivudine
Entecavir and tenofovir

362
Q

MOA of lamivudine

A

Nucleoside analogue

363
Q

MOA of tenofovir

A

Nucleotide analogue

364
Q

How is Hep C treated

A

Peg inteferon alpha
Telaprevir
Ledipasvir

365
Q

MOA of telaprevir

A

NS3/4 protease inhibitor

366
Q

MOA of ledipasvir

A

NS5A inhibitor which blocks release

367
Q

How does monkeypox present

A

Atypical rash on genitals and perianal area
Systemic effects

368
Q

What is pathophysiology of prion disease

A

Prion proteins normally found in the brain however can undergo transformation to beta pleated sheet insoluble version where all normal prion proteins are triggered to undergo the conversion

369
Q

What is the most common prion disease

A

Sporadic creutzfield jacob- also has the most rapid deterioratino

370
Q

What is classficaion of prion diseases

A

Sporadic- CJD

Acquired- variant CJD, Kuru, iatrogenic from surgical tools or transplants

Genetic conditions

371
Q

Presenation of sporadic CJD

A

Older person
Rapid dementia
Myoclonus
Cortical blindness (problem is in brain)
Aphasia
LMN weakness

372
Q

Investigations for sporadic CJD

A

EEG- periodic triphasic complexes
MRI- basal ganglia and cortical increased signal
CSF- 14-3-3 protein, S100
DIAGNOSIS CONFIRMED ON BRAIN BIOPSY

373
Q

What are the CSF markers of sporadic CJD

A

14-3-3 protein
S100

374
Q

Brain biopsy of sporadic CJD

A

Spongiform vacuolation
PrP amyloid plaques

375
Q

Presentation of variant CJD

A

Younger person
Initial psych presentation of hallucinations, depression and paranoia
Then get dementia, myoclonus and sensory abnormalities

376
Q

Investigations for variant CJD

A

MRI- pulvinar sign
Tonsillar biopsy
Neurogenetics- all MM variant of PrP

377
Q

What is pulvinar sign on MRI seen in

A

Variant CJD

378
Q

What are the familial prion diseases

A

Fatal familial insomnia
Gerstmann-straussler strackman

All will present with family history of someone dying of MS, dementia etc

379
Q

What causes kuru disease

A

Cannibalistic feasts leading to cerebellar symptoms and dementia

380
Q

What prion disease are florid plaques seen in

A

Variant CJD

381
Q

What prion disease are florid plaques seen in

A

Variant CJD

382
Q

How is prion diseases treated

A

Treat myoclonus- clonazepam
Delay conversino to PrPsc- Quinacrine

383
Q

What genetic polymorphism is associated with prion diseases

A

Codon 129- MM

384
Q

Presentation of HSV in neonates

A

Most cases- skin, eye mouth disease
Chance of progression to CNS involvement with lethargy, seizure and poor feeding
Can also get disseminated disease with multorgan failure sepsis

385
Q

What subunits do antibiotics affecting protein synthesis bind to

A

30s
- aminoglycoside
- tetracycline

23s
- oxazolidinones

50s
- chloramphenicol
- macrolides
ALL BACTERIOSTATIC EXCEPT FOR AMINOGLYCOSIDE WHICH BACTERIACIDAL

386
Q

To what antibiotic is the method of resistance bypassing antibiotic sensitive step

A

MRSA
Also encodes MECA for altered target

387
Q

To what antibiotic is the method of resistance preventing accumulation of drug

A

Tetracycline

388
Q

Examples of live vaccines

A

MMR
Yellow fever
BCG
Under 18s flu

389
Q

Example of inactivated vaccines

A

Influenza
Cholera
Polio
Hep A
Pertussis

390
Q

Examples of toxoid vaccines

A

Tetanus
Diphteria

391
Q

Examples of subunit vaccines

A

Hep B
HPV

392
Q

Example of conjugate vaccine

A

HIB
Meningococcus
Pneumococcus

393
Q

Example of heterotypic vaccine

A

BCG

394
Q

Examples of viral vectored vaccines

A

Ebola
AZ COVID vaccine

395
Q

Examples of nucleic acid vaccines

A

Pfizer and moderna COVID vaccines

396
Q

What happens in viral vectored vaccines

A

Incorporate genetic material into DNA of virus that does not cause harm in humans

397
Q

What is risk of using chimp adenovirus

A

Vaccine induced thrombocytopenia and thrombosis
Capillary leak syndrome
Seen in AZ covid vaccine

398
Q

Risk of pfizer covid vaccine

A

Myocarditis

399
Q

Ways to get CNS infection

A

Haematogenous spread
Direct implantation- instruments
Local extension- cribriform plate abnormality
PNS into CNS- rabies

400
Q

Pathogenesis of neuro damage meningitis

A

Bacterial toxicity
Excessive inflam response
Hypoperfusion or seizures from systemic hypoperfusion

401
Q

Most common n.meningitidis form

A

B

402
Q

Meningococcal septicaemia problems

A

Capillary leak- hypovolaemia
Coagulopathy

403
Q

Causes of chronic meningitis

A

TB
Crytococcus
Spirochetes

404
Q

Complications of TB meningitis

A

Granulomas
Abscesses
Cerebritis

405
Q

Aseptic causes of meningitis

A

Enteroviruses
HSV

406
Q

Encephalitis causes in UK

A

HSV
Enteroviruses
More recently flaviviridae- western nile virus

407
Q

Bacterial cause of encephalitis

A

Listeria

408
Q

Amoebic causes of encephalitis

A

Naegleria fowleri which inhabits warm water in the UK

409
Q

Parasitic causes of encephalitis

A

Toxoplasma gondii

410
Q

Spinal abscess causes

A

Iatrogenic
Haematogenous spread- IVDU in particular

411
Q

Best imaging for brain infections

A

MRI

412
Q

What do HHV6 and HHV7 cause

A

Exanthema subitum

413
Q

What activates aciclovir

A

Viral thymidine kinase

414
Q

2nd line for HSV and VZV

A

Foscarnet
Cidofovir

415
Q

Prophylaxis for CMV before tansplants

A

Solid organ transplant- valganciclovir
BMT- letermovir

416
Q

How is zanamavir given

A

Inhaled if uncomplicated
IV if serious

417
Q

Treatment for severe RSV

A

Ribavirin
IVIG

418
Q

How is RSV prevented

A

Palivisumab

419
Q

When treat monkeypox with tecovirimat

A

Over 100 lesions
Near eyes
Sepsis

420
Q

How is BK haemorrhagic cystitis treated

A

Cidofovir

421
Q

Where does adenovirus affect

A

GI
Conjunctiva
Resp infection

422
Q

Treatment for severe adenovirus

A

Cidofovir

423
Q

What is test for hep A

A

Anti-HAV IgM

424
Q

How long do you need to be HBsAg +ve for to be classed as chronic hep B

A

Over 6 months

425
Q

What does positive HBeAg suggest

A

Active virus replication

426
Q

MOA of entacavir

A

Nucleoside analogue

427
Q

Test for acute Hep E

A

Immunocompetent- HEV IgM and IgG
Immunosuppressed- HEV PCR

428
Q

What are the 3 types of helminths

A

Cestodes
Trematodes
Nematodes

429
Q

Examples of nematodes

A

Ascarid
Strongyloide

430
Q

Examples of trematodes

A

Schistomiasis

431
Q

Definitive host of tapeworm

A

Human

432
Q

What is cystericosis

A

Parasitic infection of brain tissue with larvae containing taenia solium

433
Q

Management of tape worms and hydatid

A

Praziquantel

434
Q

What is host of hydatid

A

Dog

435
Q

Proper name for tape worm and hydatid

A

Tapeworm- taenia solium
Hydatid- echinoccus

436
Q

Treatment of schistomiasis

A

Praziquentel

437
Q

Host for schistomiasis

A

Human veins

438
Q

What is the most common malaria

A

Plasmodium falciparum

439
Q

How are malarias classfied

A

Plasmodium falciparum versus non falciparum

440
Q

What is most common non-falciparum malaria

A

Plasmodium vivax

441
Q

What classifies severe malaira

A

Parasitaemia over 2%

442
Q

What is investigation for malaria

A

Thick and thin blood smear x3

443
Q

Difference between thich and thin blood films

A

Thick- screen parasiets
Thin- identify species and quanitfy parasitaemia

444
Q

Management of falciparum malaria

A

Mild- riamet
Severe- IV artesunate

445
Q

Management of non-flaciparum malaria

A

Chloroquine

446
Q

Prsentation of dengue fever

A

Fever
Rash- sunburn
Arthralgia
Myalgia
Coming back from urban areas in south east asia

447
Q

Problem of dengue fever

A

If reinfected with different serotype then get haemorrhagic fever
- bleeding from gums
- haematemesis
- GI bleeding

448
Q

What transmits dengue

A

Aedes mosquito

449
Q

What type of bacteria is typhoid

A

Gram negative flagellated rods

450
Q

What causes enteric fever

A

Typhoid

451
Q

Most common cause of adult onset epilepsy worldwide

A

Cystericosis

452
Q

Congenital toxoplasmosis presentation

A

Majority asymptomatic but then go on to develop low IQ, deafness and microcephaly
If symptomatic
- choroidretinitis
- microcephaly
- intracranial calcifications
- hepatosplenomegaly

453
Q

What is classed as neonatal infection and what predisposes infants

A

Onset in first 4-6 weeks of life
Risks
- immune system not mature
- prematurity as IgG not passed over, exposure to organisms in hospital

454
Q

What type of bacteria are GBS

A

Gram positive coccus
Catalase negative

455
Q

Late onset sepsis causes

A

Coagulase nagative staphylococcus
S.aureus
Enterococcus
Klebsiella
Pseudomonas

456
Q

What is invasive pneumoccal disease

A

Where get strep pneumoniae cultured in blood or in normally sterile area
Problem is that pneumococcal vaccine does not cover all of the strains

457
Q

Which age group of children does mycoplasma pneumoniae tend to affect

A

3-4 year olds
Get epidemics

458
Q

Complications of mycoplasma infection

A

Haemolysis (IgM to I antigen on erythrocyte in 60% of patients)
Enchephalitis
Cardiac
Joint problems
Otitis media

459
Q

What consider in children when resp infections fail to respond to abx

A

Bordatella pertussis
TB

460
Q

What are fungi

A

Eukaryotic organisms
- Chitinous cell wall
- Ergosterol membrane

461
Q

Difference between yeast and moulds

A

Yeasts- single celled which reproduce by budding
Moulds- multicellular hyphae which grow by branching and extension

462
Q

Examples of yeast

A

Candida
Cryptococcus

463
Q

Examples of moulds

A

Dermatophytes
Aspergillus
Murcomycoses

464
Q

Most common cause of fungal infection in humans

A

Candida

465
Q

Candida presentations

A

Oral thrush
Oesophagitis
Vulvovagintis

466
Q

Treatment for different candida infections

A

Oral thrush- topical nystatin
Vulvovaginitis- topical clotrimazole or oral fluconazole
Localised cutaneous- topical clotrimazole
Oesophagitis- oral fluconazole

467
Q

How does candida appear compared to gram positive cocci on gram stain

A

Larger and more ovoid

468
Q

Rfx for candidaemia

A

Burns
Malignancy
Long lines

469
Q

Management of candidaemia

A

Beta-D-glucan
Echo to rule out endocarditis
Fundoscopy
Echinocandin

470
Q

Where can invasive candida occur and what are the rfx for them

A

CNS- dissemination, trauma
Endocarditis- abnormal/prosthetic valves, long lines, IVDU
UTI= catheters
Bone and joint- dissemination, trauma
Intra-abdominal- peritoneal dialysis, perforation

471
Q

Which cryptococcus affects immunocompetent patients

A

Cryptococcus gatti (serotypes B&C)

472
Q

Which animal does cryptococcus associate with

A

Pidgeon

473
Q

Management of cryptococcus

A

Amphotericin B and flucytosine

474
Q

Management of mild pulmonary cryptococcus disease

A

Fluconazole

475
Q

What measure serologically in candida

A

Beta-d glucan

476
Q

What measure in aspergillus serologically

A

Galactomannan
Aspergillus antibodies

477
Q

Management of aspergillus

A

Voriconazole

478
Q

Management of PJP

A

Co-trimoxazole

479
Q

Why do antifungals not work on PJP

A

Lacks ergosterol in cell membrane

480
Q

What is elevated in PJP serologically

A

Beta-d glucan

481
Q

What are mucormycoses

A

Rhizopus species

482
Q

Management of mucormycosis

A

Amphotericin B

483
Q

Cellulitis of orbit with black discharge from palate and nose
Proptosis and opthalmoplegia

A

Mucormycosis

484
Q

Organism for tinea pedis and cruris

A

Tricophyton rubrum

485
Q

Organism for tinea capitis

A

Tricophton rubrum or tonsurans

486
Q

Cause of onchomycosis

A

Tricophyton unguium

487
Q

What causes piyriasis versicolor

A

Malassezia furfur

488
Q

What are dermatophytes

A

Fungi which invade dead keratin of skin, hair and nails

489
Q

What are the 3 targets of antifungals

A

DNA synthesis
Cell wall
Cell membrane

490
Q

Which antifungals target the cell membrane

A

Polyene
- amphotericin and nystatin
Azole

491
Q

How do azoles work

A

Inhibit lanosterol 14 alpha demethylase which converts lanosterol to ergosterol

492
Q

How do polyenes (amphotericin B work)

A

Binds sterols in fungal cell membrane which causes electrolye leak

493
Q

Main side effect of antifungals which target cell membrane

A

Nephrotoxic

494
Q

Which antifungals target the cell wall

A

Echinocandins

495
Q

How do echinocandins work

A

Inhibit beta d glucan

496
Q

Management of non-albicans candida

A

Echinocandins

497
Q

Which antifungals inhibit DNA synthesis

A

Pyrimidine analogues- flucytosine

498
Q

How does flucocytisine work

A

Affects DNA synthesis

499
Q

Which viruses belong to herpesviridae family

A

VZV
CMV
HSV
HHV6
HHV8
EBV

500
Q

What is virology of herspesviridae viruses

A

Enveloped dsDNA

501
Q

What are the polyomaviridae

A

BK
JC

502
Q

What is virology of polyomaviridae

A

Unenveloped dsDNA
Adenovirus is too as why all treated with cidofovir

503
Q

What are the flaviviruses

A

Hep C
Dengue

504
Q

Coagulase negative versus positive staph

A

Staph aureus- positive
Staph epidermis- negative

505
Q

Virology of Hep A and E

A

Unenveloped positive sense ssRNA genome

506
Q

Virology of Hep B

A

Enveloped DNA with RNA hybrid

507
Q

Virology of Hep C

A

Enveloped positive ssRNA

508
Q

Management of Hep D

A

Peginterferon alpha

509
Q

What are the treatment options for Hep C and how remember names

A

previr- NS3/4 protease inhibitors
asvir- NS5A protease inhibitor
uvir- direct polymerase inhibitor

510
Q

How is leptospirioris transmitted

A

Swimming in contaminated waters
Rats urine

511
Q

How does bacillus anthrax present

A

Cutaneous- Painless black round lesions
Pulmonary- Mediastinal haemorrhage

512
Q

Which countries is leishmaniasis endemic to

A

India
South America
East africa

513
Q

What spreads the protozoa leishmaniasis

A

Sandflies

514
Q

Where does leishmaniasis divide

A

Macrophages

515
Q

How does cutaneous leishmaniasis present

A

Open sore that takes a year to recover and scars

516
Q

How does muco-cutaneous leishmaniasis present

A

Oral and skin ulcers

517
Q

How does visceral leishmaniasis present

A

Hepatosplenomegaly
BM failure- anaemia, infections
Hyperpigmentation

518
Q

What use to diagnose superficial versus deep fungal infections

A

Superfical - woods lamp
Deep- serological

519
Q

MOA of ritonavir

A

Protease inhibitor

520
Q

Name for brucella organism

A

Brucella melitensis

521
Q

What type of organism is brucella

A

Small gram negative cocco-bacilli

522
Q

What medium is used for brucella melitensis

A

Castenadas

523
Q

Management of leishmaniasis

A

Amphotericin B

524
Q

Which bacteria commonly causes infantile diarrhoea

A

Enteropathogenic e coli

525
Q

What are the paramyxoviruses

A

RSV
Mumps
Measles
Parainfluenza

Path (Owen) (8 decks)

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