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Arjun's Copy- Owen's Path > Microbiology > Flashcards

Microbiology Flashcards

1
Q

What type of organism is neisseria gonorrhoea

A

Intracellular gram neg diplococcus

both chlamydia and gonorrhoea are intracellular- but chlamydia can’t be cultured- hence do NAAT for both!

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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

L1,2,3 are cause of LGV

(A-see (C) is trachoma)
(D-K affects your DicK)

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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

single, indurated, painless ulcer = chancre

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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 lata)

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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

ARP = near-light dissociation
syphillis has predisposition to aorta

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25
Q

What is tabes dorsales

A

Degeneration of the posterior spinal chord
Get loss of proprioception and vibration

get ataxic gait as lack of proprioception

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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
- RPR
- 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

as treponemal tests +ve for whole life! even when cleared e.g. EIA

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30
Q

Treatment for syphilis
- if penicillin allergic

A

Single dose IM benzathine penicllin (aka penicillin G)
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

as bacterial cells all die simultaneously so release of toxins

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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

ducreyi aka ‘do cry’ hence painful

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35
Q

How is chancroid diagnosed

A

Culture on chocolate agar, PCR

chancroid and chocolate agar (ch and ch)

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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 (aka granuloma inguinale)

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38
Q

How is donovanosis diagnosed

A

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

watch microscope vid- https://en.wikipedia.org/wiki/Trichomonas_vaginalis

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41
Q

Problem with trichomoniasis

A

Increased risk of HIV infection

The damage caused by T. vaginalis to the vaginal epithelium increases a woman’s susceptibility to an 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

AMSEl criteria
Adherent bacteria (clue cells: vaginal epithelial cells that have bacteria adherent to surface) + Milky discharge + Stench (strong amine odour) on KOH whiff testing + Elevated pH (4.5+)

need>= 3/4 for Dx of BV

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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
NOT Seen in secondary syphilis - condyloma lata
HPV 6 or 11 (low risk strains)

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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

toxic to embryos

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50
Q

CXR of HIV child with diffuse changes but is well

A

Lyphoid interstitial pneumonitis

Lymphocytic interstitial pneumonia (LIP) is a syndrome secondary to autoimmune and other lymphoproliferative disorders. Symptoms include fever, cough, and shortness of breath. Lymphocytic interstitial pneumonia applies to disorders associated with both monoclonal or polyclonal gammopathy.
Possible causes of lymphocytic interstitial pneumonia include the Epstein–Barr virus, auto-immune, and HIV.

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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 (hence CI in this country, in LEDC countries more promoted as lack of other nutrition)
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 Ix 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

‘myco’ as look like fungus/produce fungus like film
many but not all are intracellular

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58
Q

What is treatment for TB

A

RIPE for 2 months
Rifampicin and isoniazad for 2 more months

4 for 2 and 2 for 4

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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

for latent TB think it’s just R and I

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61
Q

Side effects of each TB medication

A

Rifampicin-orange secretions
Isoniazad- peripheral neuropathy (hence pyridoxine (B6) needed)
Pyrazinamide- hepatoxic, gout
Ethambutol- optic neuritis

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62
Q

Second line for TB

A

Amikacin
Kanamycin
Quinoloines

RIPE Apples (amikacin)

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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 (tested with monofilament) and motor defects

derformities 2ndary to no sensation

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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

HAP has AP ie PA (pseudomonas aeruginosa) in the name

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69
Q

What causes rusty coloured sputum CAP

A

S pneuominae

The sputum produced by those with S. pneumoniae is described as “blood-tinged” or “rust-colored,” however, the sputum produced by those infected by Klebsiella pneumoniae is described as “currant jelly.” The reason for this is that K. pneumoniae results in significant inflammation and necrosis of the surrounding tissue.

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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

‘influenzae’ so -ve as name like a virus, cocco bacilli as name is like a virus so not 1 or the other. Haemophilus influenzae received its name because it was first isolated from the lungs of individuals who died during an epidemic of influenza virus infection in 1890.

chocolate agar

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72
Q

What bacteria causes grape bunch clusters

A

Staph aureus

Staphylococcus aureus, from the Latin aurum for gold (as eg gold crust of impetigo?), and Staphylococcus albus (now called epidermidis), from the Latin albus for white

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73
Q

What CAP seen in alcoholics

A

Klebsiella pneumonia
Often see haemoptysis

as huge inflammation with klebsiella

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74
Q

What type of organism is klebsiella

A

-ve rod, enterobacteriaceae

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75
Q

What organism associated with cavity in CAP

A

S aureus

also klebsiella and TB

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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

atypicals don’t have cell walls so penicillins don’t work

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78
Q

Which pneumonia causes hepatitis and hyponatraemia

A

Legionella pneumophilia

high LFTs and low Na+ (hypoNa+ presents as confusion)

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79
Q

Presentation of mycoplasma pneumoniae

A

Dry cough
Arthralgia
Erythema multiforme

cold agglutinin also

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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

CMV can cause multi-organ disease after SCT including pneumonia, hepatitis, gastroenteritis, retinitis, and encephalitis.

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84
Q

What pneumonia in patients who have neutropenia

A

Aspergillus (fumigatus)

Aspergillus was first catalogued in 1729 by the Italian priest and biologist Pier Antonio Micheli. Viewing the fungi under a microscope, Micheli was reminded of the shape of an aspergillum (holy water sprinkler)

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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

NHS

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86
Q

What bacteria are worried about in cystic fibrosis

A

Pseudomonas aeruginosa
Burkholderia cepacia (absolute CI to lung Tx)

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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 (other urine AG is strep p)
Serum antibody tests (mycoplasma)

atypical as virus like presentation + harder to culture

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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

0u1patients

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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

ITU 3 letters so 3+ CURB

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93
Q

1st line for HAP

A

Ciprofloxacin and vancomycin

vanc for MRSA? cipro (fluoroquinolone) for pseudomonas?

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94
Q

2nd line for HAP

A

Tazocin and vancomycin

MRSA and pseudomonas?

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95
Q

Aspiration pneumonia treatment

A

Tazocin and metronidazole

got 2 problems - anaerobic gut bact (+ some gram +ve) and pneumonitis

Bacteria involved in aspiration pneumonia may be either aerobic or anaerobic.[12] Common aerobic bacteria involved include:

Streptococcus pneumoniae[13]
Staphylococcus aureus[13]
Haemophilus influenzae[13]
Pseudomonas aeruginosa[13]
Klebsiella: often seen in aspiration lobar pneumonia in alcoholics
Anaerobic bacteria also play a key role in the pathogenesis of aspiration pneumonia.[14] They make up the majority of normal oral flora

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96
Q

What are some causes of HAP

A

Pseudomonas
Haemophilus
S aureus
Klebsiella

Mnemonic – All Hospital Pneumonias Kill (Aureus, haemoph, pseudomonas, klebs)

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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

i think about 20% of 20 y/os with UTI (women)

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99
Q

Which antibiotics inhibtis cell wall synthesis

A

Beta lactams
Glycopeptides

hence gram -ves with thin cell wall (but outer membrane)- b lactams and glycopeptides not effective against them

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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 (remember eagle effect!)
Bactericidal

inhibit PBPs so no cross linking of PG cell wall

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102
Q

Why dont beta lactams work against mycoplasma and chlamydia

A

Lack peptidoglycan cell wall

as gram -ve

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103
Q

Why dont beta lactams work on abscesses

A

Bacteria arent dividing
Also not divinding in biofilms

eagle effect

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104
Q

How can s aureus defend against penicillin

A

Produce beta lactamases

ESBLs

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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 ESBL enzymes

very powerful drugs so use with caution- as best defence (can’t afford resistance to develop)

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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 (hence why can be used in meningitis)

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113
Q

What are glycoppetides active against

A

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

MRSA resistant to methicillin hence penicillins

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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

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116
Q

Abx which inhibit protein synthesis

A

Tetracyclines
Aminoglycoside
Macrolides
Chloramphenicol
Oxazolidinines

TAMCO

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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

amiNoglycosides ans gram Neg

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119
Q

Indication of tetracycline

A

Intracellular pathogens- chlamydia and mycoplasma

e.g. doxy for chlamydia infection

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120
Q

Who cant you give tetracyclines to

A

Children
Pregnant women

in kids- associated with impaired bone growth and permanent discoloration of teeth and enamel hypoplasia

can give >12s

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121
Q

Indication of macrolides

A

Gram+ in penicillin allergy
Atypical penumonia
Campylobacter

gram +ves obvs as if pen allergic, and used alongisde beta lactams for atypical pnuemonias

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122
Q

Indication of chloramphenicol

A

Eye drops- bacterial conjunctivitis

rememebr grey baby syndrome- CI in kids

Each ribosome is composed of small (30S) and large (50S) components, called subunits, which are bound to each other:

(30S) has mainly a decoding function and is also bound to the mRNA
(50S) has mainly a catalytic function and is also bound to the aminoacylated tRNAs.

chloramphenicol inhibits the 50S ribosomal subunit, preventing peptide bond formation.[40] Chloramphenicol directly interferes with substrate binding in the ribosome, as compared to macrolides, which sterically block the progression of the growing peptide

complete side note- tetracyclines irreversibly stain teeth if given to children

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123
Q

INdications of oxalizininoes

A

Gram+ve
MRSA and VRE

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124
Q

Which Abx inhibit DNA synthesis

A

Fluoroquinolones
Nitroimidazole

quinolones and gyrase
nitro as DNA contains nitrogenous AAs - metronidazole (key for anaerobes! and protozoan)

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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

think e coli (nitro in UTI)- e coli is facultative anaerobe (ie anaerobic but if O2 available releases ATP via aerboic resp)
nitrofuran and nitroimidazole

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128
Q

MOA of rifamycins

A

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

Polymyxins are antibiotics. Polymyxins B and E (also known as colistin) are used in the treatment of Gram-negative bacterial infections. They work mostly by breaking up the bacterial cell membrane.
bind to LPS- Lipopolysaccharides (LPS) are important outer membrane components of gram-negative bacteria.

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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 (sulfamethoxazole)
Diaminopyrimidines (trimethoprim?)

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134
Q

What is indication of sulphonamides

A

PCP
Combine sulphamethoxazole and trimethopin

pcp = co-trimoxazole

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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
carbapenemases

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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

50s ribosomes as macro
aminoglycosides are 30s

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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

minimum inhibitory concentration

remember type 1,2,3 (type 1 = amniglycosides, 2= beta lactams, 3= macrolides)

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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

Gram staining differentiates bacteria by the chemical and physical properties of their cell walls. Gram-positive cells have a thick layer of peptidoglycan in the cell wall that retains the primary stain, crystal violet. Gram-negative cells have a thinner peptidoglycan layer that allows the crystal violet to wash out on addition of ethanol. They are stained pink or red by the counterstain,[3] commonly safranin or fuchsine. Lugol’s iodine solution is always added after addition of crystal violet to strengthen the bonds of the stain with the cell membrane.

Gram staining is almost always the first step in the identification of a bacterial group.

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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

can be hard to cross BBB

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148
Q

How long is Acute osteomyelitis treated for

A

6 weeks

hard to target bone

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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

abscess?

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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

ie indicates aids

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154
Q

Sources of infection in SCT?

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 (depends on specifics)
Solid organ transplant (as ongoing immunosupp)
HIV (as untreated- no T cells)
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 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 (haemorrhagic cystitis) post stem cell transplant

A

BK virus
v rare complication
The BK virus rarely causes disease but is typically associated with patients who have had a kidney transplant; many people who are infected with this virus are asymptomatic

The BK virus, also known as Human polyomavirus 1, is a member of the polyomavirus family. Past infection with the BK virus is widespread,[1] but significant consequences of infection are uncommon, with the exception of the immunocompromised and the immunosuppressed. BK virus is an abbreviation of the name of the first patient

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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 (as viral infection)
Tecovirimat if very severe

Tecovirimat SIGA is a medicine to treat smallpox, monkeypox and cowpox, three infections caused by viruses belonging to the same family (orthopoxviruses). It is also used to treat complications that can happen following vaccination against smallpox.

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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

as blocks DNA synthesis
for anaerobes! i.e. metro for gut bact
also used for protozoa

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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

they are gram -ve cocci - cefalexin has some gram -ve cover? ESBL by def = resistant to cephalosporins

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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

As false +ves (non pathological bacteriuria common)

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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

ciprofloxacin?

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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

Dorsal root ganglia (eg HSV-1 commonly trigeminal ganglion, HSV-2 sacral ganglia)

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209
Q

How can varicella present in immunocompromised

A

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

Multidermatomal shingles is herpes zoster not varicella!

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210
Q

How can varicella present in immunocompromised in neo-nates

A

Purpura fulminans

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

i.e. body is immunosupressed (in either HSCT or SOT) so EBV can drive B cell proliferation!

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

EBV has preference for B cells!

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

just hoe ebv has a preference for B cells, CMV has a preference for dendritic cells

221
Q

Which patients is CMV a problem in

A

SCT
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

remember as bK K for 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

CHIN

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 sonnei- watery diarrhoea
Shigella flexneri- bloody diarrhoea fever aswell with antibiotic resistance
Shigella dysenteriae-

acc sonnei, flexneri, dysenteriae + 4th type (boydii)

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

direct contact/milk

254
Q

Transmission of brucellosis

A

Unpasteurised milk
Undercooked meat
Mucosal splash
Aerosolisation

255
Q

Presentation of brucella

A

Fever which peaks in evening (undulating fever)- normally just this
Back pain
Orchitis
Focal abscesses (granulomatous hepatitis)

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

mouse reservoir

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 (HSV-2) 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

as state of immunocompromise
dont forget FVS

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
Forchheimer 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
Purpura
Hepatosplenomegaly

congenital deafness, congenital cataracts, learning disability, CHD (PDA, pulmonary stenosis)

rememebr I love (heart) ruby earrings

280
Q

Later presentations of congenital rubella syndrome

A

Intellectual disability
Hearing loss
Cataracts and retinopathy
DM very late

i heart ruby earrings

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

ie makes you morbid

284
Q

Complications of meales

A

Pneumona
Secondary bacterial infection
Otitis media (the most common complication)
Encephalitis (SSPE)

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

or PE

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 (against gram -ves) and azithromycin

salmonella is gram -ve rod (as enterobacteriaciae)

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

acc. Rx is pyrimethamine + sulfadiazine, in pregnat give spiramycin to stop foetal infection

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

both causes of rat bite fever

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

LAIV- 2-17 y/os

345
Q

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

A

Inactivated subunit rich in haemagglutin

e.g. elderly, asthmatics?

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 (i.e. high dose to stop acute rejection) and then maintenance

HSCT- undergo conditioning regime beforehand with total body irradiation or cyclophsophamide to eradicate immune system (making space for SCs and less rejection). Then have ongoing to prevent graft versus host disease

key in SOT main principle is to stop rejection
in HSCT - stop GvHD and allow acceptance

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

remember vaccine only for hep A and B

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 reverse transcriptase inhibitor (HIV) + nucleoside analogue (HBV)

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 (form alpha helices) insoluble version where all normal prion proteins are triggered to undergo the conversion

chromosome 20 PRPN gene

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

How is prion diseases treated

A

Treat myoclonus- clonazepam
Delay conversino to PrPsc- Quinacrine

382
Q

What genetic polymorphism is associated with prion diseases

A

Codon 129- MM

383
Q

Presentation of HSV in neonates

A

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

rememebr SEM, DIS and CNS disease

384
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

TAMCO

385
Q

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

A

MRSA
Also encodes MECA for altered target

also e.g. trimethoprim resistnce

386
Q

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

A

Tetracycline

efflux pumps

387
Q

Examples of live vaccines

A

MMR
Yellow fever
BCG
Under 18s flu

388
Q

Example of inactivated vaccines

A

Influenza
Cholera
Polio
Hep A
Pertussis

always ripp for the killed

389
Q

Examples of toxoid vaccines

A

Tetanus
Diphteria

390
Q

Examples of subunit vaccines

A

Hep B
HPV

391
Q

Example of conjugate vaccine

A

HIB
Meningococcus
Pneumococcus

392
Q

Example of heterotypic vaccine

A

BCG?

a vaccine e.g. used on humans but of another animal
e.g. BCG uses mycobacterium bovis

393
Q

Examples of viral vectored vaccines

A

Ebola
AZ COVID vaccine

394
Q

Examples of nucleic acid vaccines

A

Pfizer and moderna COVID vaccines

395
Q

What happens in viral vectored vaccines

A

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

396
Q

What is risk of using chimp adenovirus

A

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

397
Q

Risk of pfizer covid vaccine

A

Myocarditis

398
Q

Ways to get CNS infection

A

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

399
Q

Pathogenesis of neuro damage meningitis

A

Bacterial toxicity
Excessive inflam response
Hypoperfusion or seizures from systemic hypoperfusion

400
Q

Most common n.meningitidis form

A

B

401
Q

Meningococcal septicaemia problems

A

Capillary leak- hypovolaemia
Coagulopathy

402
Q

Causes of chronic meningitis

A

TB
Crytococcus
Spirochetes

403
Q

Complications of TB meningitis

A

Granulomas
Abscesses
Cerebritis

404
Q

Aseptic causes of meningitis

A

Enteroviruses
HSV

405
Q

Encephalitis causes in UK

A

HSV
Enteroviruses
More recently flaviviridae- western nile virus

406
Q

Bacterial cause of encephalitis

A

Listeria

407
Q

Amoebic causes of encephalitis

A

Naegleria fowleri which inhabits warm water in the UK

408
Q

Parasitic causes of encephalitis

A

Toxoplasma gondii

409
Q

Spinal abscess causes

A

Iatrogenic
Haematogenous spread- IVDU in particular

410
Q

Best imaging for brain infections

A

MRI

411
Q

What do HHV6 and HHV7 cause

A

Exanthema subitum

412
Q

What activates aciclovir

A

Viral thymidine kinase

413
Q

2nd line for HSV and VZV

A

Foscarnet
Cidofovir

414
Q

Prophylaxis for CMV before tansplants

A

Solid organ transplant- valganciclovir
BMT- letermovir

415
Q

How is zanamavir given

A

Inhaled if uncomplicated
IV if serious

416
Q

Treatment for severe RSV

A

Ribavirin
IVIG

417
Q

How is RSV prevented

A

Palivisumab

418
Q

When treat monkeypox with tecovirimat

A

Over 100 lesions
Near eyes
Sepsis

419
Q

How is BK haemorrhagic cystitis treated

A

Cidofovir

420
Q

Where does adenovirus affect

A

GI
Conjunctiva
Resp infection

421
Q

Treatment for severe adenovirus

A

Cidofovir

422
Q

What is test for hep A

A

Anti-HAV IgM

423
Q

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

A

Over 6 months

424
Q

What does positive HBeAg suggest

A

Active virus replication

425
Q

MOA of entacavir

A

Nucleoside analogue

426
Q

Test for acute Hep E

A

Immunocompetent- HEV IgM and IgG
Immunosuppressed- HEV PCR

427
Q

What are the 3 types of helminths

A

Cestodes
Trematodes
Nematodes

428
Q

Examples of nematodes

A

Ascarid
Strongyloide

429
Q

Examples of trematodes

A

Schistomiasis

430
Q

Definitive host of tapeworm

A

Human

431
Q

What is cystericosis

A

Parasitic infection of brain tissue with larvae containing taenia solium

432
Q

Management of tape worms and hydatid

A

Praziquantel

albendazole? as well

433
Q

What is host of hydatid

A

Dog

434
Q

Proper name for tape worm and hydatid

A

Tapeworm- taenia solium
Hydatid- echinoccus

435
Q

Treatment of schistomiasis

A

Praziquentel

436
Q

Host for schistomiasis

A

Human veins

437
Q

What is the most common malaria

A

Plasmodium falciparum

438
Q

How are malarias classfied

A

Plasmodium falciparum versus non falciparum

439
Q

What is most common non-falciparum malaria

A

Plasmodium vivax

440
Q

What classifies severe malaira

A

Parasitaemia over 2%

441
Q

What is investigation for malaria

A

Thick and thin blood smear x3

442
Q

Difference between thich and thin blood films

A

Thick- screen parasiets
Thin- identify species and quanitfy parasitaemia

443
Q

Management of falciparum malaria

A

Mild- riamet
Severe- IV artesunate

444
Q

Management of non-flaciparum malaria

A

Chloroquine

445
Q

Prsentation of dengue fever

A

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

breakbone fever
saddle back fever
retro-orbital headache

446
Q

Problem of dengue fever

A

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

447
Q

What transmits dengue

A

Aedes mosquito

448
Q

What type of bacteria is typhoid

A

Gram negative flagellated rods

449
Q

What causes enteric fever

A

Typhoid

450
Q

Most common cause of adult onset epilepsy worldwide

A

Cystericosis

451
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

452
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

453
Q

What type of bacteria are GBS

A

Gram positive coccus
Catalase negative

454
Q

Late onset sepsis causes

A

Coagulase nagative staphylococcus
S.aureus
Enterococcus
Klebsiella
Pseudomonas

455
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

456
Q

Which age group of children does mycoplasma pneumoniae tend to affect

A

3-4 year olds
Get epidemics

457
Q

Complications of mycoplasma infection

A

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

458
Q

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

A

Bordatella pertussis
TB

459
Q

What are fungi

A

Eukaryotic organisms
- Chitinous cell wall
- Ergosterol membrane

460
Q

Difference between yeast and moulds

A

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

461
Q

Examples of yeast

A

Candida
Cryptococcus

462
Q

Examples of moulds

A

Dermatophytes
Aspergillus
Murcomycoses

463
Q

Most common cause of fungal infection in humans

A

Candida

464
Q

Candida presentations

A

Oral thrush
Oesophagitis
Vulvovagintis

465
Q

Treatment for different candida infections

A

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

466
Q

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

A

Larger and more ovoid

467
Q

Rfx for candidaemia

A

Burns
Malignancy
Long lines

468
Q

Management of candidaemia

A

Beta-D-glucan
Echo to rule out endocarditis
Fundoscopy
Echinocandin (caspofungin, anadulafungin)

469
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

470
Q

Which cryptococcus affects immunocompetent patients

A

Cryptococcus gatti (serotypes B&C)

471
Q

Which animal does cryptococcus associate with

A

Pidgeon

472
Q

Management of cryptococcus

A

Amphotericin B and flucytosine

473
Q

Management of mild pulmonary cryptococcus disease

A

Fluconazole

474
Q

What measure serologically in candida

A

Beta-d glucan

475
Q

What measure in aspergillus serologically

A

Galactomannan
Aspergillus antibodies

476
Q

Management of aspergillus

A

Voriconazole

477
Q

Management of PJP

A

Co-trimoxazole

478
Q

Why do antifungals not work on PJP

A

Lacks ergosterol in cell membrane

479
Q

What is elevated in PJP serologically

A

Beta-d glucan

480
Q

What are mucormycoses

A

Rhizopus species

481
Q

Management of mucormycosis

A

Amphotericin B

482
Q

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

A

Mucormycosis

483
Q

Organism for tinea pedis and cruris

A

Tricophyton rubrum

484
Q

Organism for tinea capitis

A

Tricophton rubrum or tonsurans

485
Q

Cause of onchomycosis

A

Tricophyton unguium

486
Q

What causes piyriasis versicolor

A

Malassezia furfur

487
Q

What are dermatophytes

A

Fungi which invade dead keratin of skin, hair and nails

488
Q

What are the 3 targets of antifungals

A

DNA synthesis
Cell wall
Cell membrane

489
Q

Which antifungals target the cell membrane

A

Polyene
- amphotericin and nystatin
Azole

490
Q

How do azoles work

A

Inhibit lanosterol 14 alpha demethylase which converts lanosterol to ergosterol

491
Q

How do polyenes (amphotericin B work)

A

Binds sterols in fungal cell membrane which causes electrolye leak

492
Q

Main side effect of antifungals which target cell membrane

A

Nephrotoxic

493
Q

Which antifungals target the cell wall

A

Echinocandins

494
Q

How do echinocandins work

A

Inhibit beta d glucan

495
Q

Management of non-albicans candida

A

Echinocandins

496
Q

Which antifungals inhibit DNA synthesis

A

Pyrimidine analogues- flucytosine

497
Q

How does flucocytisine work

A

Affects DNA synthesis

498
Q

Which viruses belong to herpesviridae family

A

VZV
CMV
HSV
HHV6
HHV8
EBV

499
Q

What is virology of herspesviridae viruses

A

Enveloped dsDNA

500
Q

What are the polyomaviridae

A

BK
JC

501
Q

What is virology of polyomaviridae

A

Unenveloped dsDNA
Adenovirus is too as why all treated with cidofovir

502
Q

What are the flaviviruses

A

Hep C
Dengue

503
Q

Coagulase negative versus positive staph

A

Staph aureus- positive
Staph epidermis- negative

504
Q

Virology of Hep A and E

A

Unenveloped positive sense ssRNA genome

505
Q

Virology of Hep B

A

Enveloped DNA with RNA hybrid

506
Q

Virology of Hep C

A

Enveloped positive ssRNA

flavivirus

507
Q

Management of Hep D

A

Peginterferon alpha

508
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

509
Q

How is leptospirioris transmitted

A

Swimming in contaminated waters
Rats urine

510
Q

How does bacillus anthrax present

A

Cutaneous- Painless black round lesions
Pulmonary- Mediastinal haemorrhage

511
Q

Which countries is leishmaniasis endemic to

A

India
South America
East africa

512
Q

What spreads the protozoa leishmaniasis

A

Sandflies

513
Q

Where does leishmaniasis divide

A

Macrophages

514
Q

How does cutaneous leishmaniasis present

A

Open sore that takes a year to recover and scars

515
Q

How does muco-cutaneous leishmaniasis present

A

Oral and skin ulcers

516
Q

How does visceral leishmaniasis present

A

Hepatosplenomegaly
BM failure- anaemia, infections
Hyperpigmentation

517
Q

What use to diagnose superficial versus deep fungal infections

A

Superfical - woods lamp
Deep- serological

518
Q

MOA of ritonavir

A

Protease inhibitor

519
Q

Name for brucella organism

A

Brucella melitensis

520
Q

What type of organism is brucella

A

Small gram negative cocco-bacilli

521
Q

What medium is used for brucella melitensis

A

Castenadas

522
Q

Management of leishmaniasis

A

Amphotericin B

523
Q

Which bacteria commonly causes infantile diarrhoea

A

Enteropathogenic e coli

524
Q

What are the paramyxoviruses

A

RSV
Mumps
Measles
Parainfluenza

Arjun's Copy- Owen's Path (8 decks)

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