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..Pathology- Imperial College London MBBS > Microbiology > Flashcards

Microbiology Flashcards

1
Q

Name 3 examples of an URTI?

A

pharyngitis, sinusitis, and tonsillitis.

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2
Q

Which pulmonary structure is affected in pneumonia?

A

lung alveoli

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3
Q

Which scoring criteria is used to risk stratify pneumonia?

A

CURB-65

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4
Q

Examples of LRTI (5)

A
  1. Pneumonia
  2. Bronchitis
  3. Empyema
  4. Abscess
  5. Bronchiectasis
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5
Q

Which is the most common cause of CAP?

A

Streptococcus pneumoniae

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6
Q

Which gram positive ‘grape-like clusters” bacteria is a common cause of CAP?

A

o Staphylococcus aureus

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7
Q

List the common causative organisms for CAP (5)?

A

o Streptococcus pneumoniae (most common) – Gram-positive cocci, chains.
o Haemophilus influenzae
o Moraxella catarrhalis (Gram-negative cocci)
o Staphylococcus aureus (Gram +ve grape-like clusters)
o Klebsiella pneumoniae

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8
Q

Which is the number one most common causative organism for HAP?

A

o Enterobacteriaceae (most common) – E. coli and Klebsiella – 31%

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9
Q

Name the 2 most common Enterobacteriaceae?

A

E coli
Klebsiella

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10
Q

Name the common causative organisms of HAP?

A

o Enterobacteriaceae (most common) – E. coli and Klebsiella – 31%
o S. aureus – 19%
o Pseudomonas spp – 17%
o Acinetobacter baumanii – 4%
o Haemophilus – 5%
o Fungi (Candida spp) – 7%

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11
Q

Which are the most common organisms for pneumonia in neonates (0-1 month)?

A

E. coli
Group B streptococcus
Listeria monocytogenes

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12
Q

Which pathogen is the K1 antigen associated with?

A

E coli

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13
Q

Which organism is associated with the following description?

‘Beta-haemolysis on agar, Lancefield Group B, catalase-negative”

A

Group B streptococcus
Strep Agalactiae

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14
Q

Sputum colour for Streptococcus pneumoniae

A

Rusty coloured

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15
Q

Type of pneumonia associated with Streptococcus pneumoniae

A

Lobar

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16
Q

Microscopy findings for Streptococcus pneumoniae

A

+ve diplococci
Optochin sensitive, Alpha haemolysis on agar
* Draughtsmen colonies
* Urinary antigen positive.

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17
Q

Draughtsmen colonies are associated with which pathogen in pneumonia?

A

Streptococcus pneumoniae

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18
Q

Which pathogen is the most common cause of bronchpneumonia?

A

Haemophilus influenzae

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19
Q

Glossy colonies are associated with which organism in pnuemonia?

A

Haemophilus influenzae

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20
Q

Which type of bacteria is Moraxella catarrhalis?

A

Gram-negative diplococci

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21
Q

+ve cocci “grape-bunch clusters”
Pneumonia?

A

Staphylococcus aureus

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22
Q

Which organism is associated with a post-influenza pneumonia?

A

Staphylococcus aureus

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23
Q

Which pneumonia is associated with alcoholics?

A

Klebsiella pneumoniae

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24
Q

Define typical pneumonia?

A

Typical – Classic signs and symptoms, classic CXR changes (Consolidation) and penicillin-responsive.

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25
Q

Define atypical pneumonia?

A
  • Atypical: No/atypical signs and symptoms, not in keeping with CXR and does not respond to penicillin antibiotics (absent cell wall).
  • Exhibit extra-pulmonary features e.g., hepatitis, hyponatraemia, arthralgia – managed with macrolides.
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26
Q

Which class of antibiotics are used to manage atypical pneumonia?

A

Macrolides

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27
Q

Name 4 common atypical pneumonia organisms?

A
  • Legionella
  • Mycoplasma pneumoniae
  • Coxiella Burnetti (Q fever) from exposure to farm animals.
  • Chlamydia Psitacci from exposure to birds
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28
Q

Which pneumonia type is associated with desaturation upon walking around the room?

A

Pneumocystis Jirovecci (PCP)

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29
Q

Which CXR appearance is associated with Pneumocystis Jirovecci (PCP)?

A

Bat’s wing appearance on CXR
(Ground-glass shadowing)

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30
Q

What is the management of Pneumocystis Jirovecci (PCP)?

A

Co-trimoxazole

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31
Q

What is the presentation associated with Pneumocystis Jirovecci (PCP)?

A

Presentation:
* Dry cough
* Weight loss, malaise
* dyspnoea
- Desaturation upon exertion

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32
Q

Which stain is associated with Pneumocystis Jirovecci (PCP)?

A

Silver stain

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33
Q

Which type of organisms are more prone to infection following a splenectomy?

A

encapsulated organisms including Influenzas and S. pneumoniae.

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34
Q

Which organisms are associated with cystic fibrosis patients?

A

Pseudomonas aeruginosa (worse prognosis) – ceftazidine.

  • Burkholderia cepacia.
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35
Q

Halo sign on CT is associated with what respiratory tract infection.

A

Aspergillus Fumigatus

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36
Q

What is the management for Invasive aspergillosis?

A

Amphotericin B

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37
Q

What is the diagnostic test for Legionella pneumophilia ?

A

Urinary antigen testing

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38
Q

What electrolyte abnormality is associated with Legionella pneumophilia ?

A

Hyponatraemia

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39
Q

What culture is used for Legionella pneumophilia ?

A

Charcoal Yeast

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40
Q

Which rash is associated with Mycoplasma pneumoniae ?

A

Erythema multiforme

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41
Q

Which ABx is used to manage Mycoplasma pneumoniae ?

A

Tetracycline or macrolide

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42
Q

Which investigation is used to diagnose Mycoplasma pneumoniae ?

A

cold agglutinin test

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43
Q

Which atypical pneumonia is associated with birds?

A

Chlamydia psittaci

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44
Q

What are the parameters of the CURB-65 score?

A

CURB-65 Score:
* Confusion
* Urea >7 mmol/L
* RR >30 breaths per minute
* BP <90 systolic or <60 diastolic
* Age 65+

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45
Q

Urea range for CURB-65?

A

> 7 mmol/L

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46
Q

RR range for CURB-65?

A

> 30 breaths per minute

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47
Q

BP (systolic and diastolic ranges) for CURB-65?

A

BP <90 systolic or <60 diastolic

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48
Q

CURB-65 cut off for admission

A

2

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49
Q

Management for CURB-65 score of 0-1?

A

Outpatient Abx
Amoxicillin PO 5 days

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50
Q

Management for CURB-65 score of 2? (which 2 ABx)

A

Amoxicillin PO + Clarithromycin PO

Note: Consider admission

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51
Q

Which ABx are prescribed for CURB-65 score of 3-5?

A

Co-amoxiclav IV + Clarithromycin IV

Admission and consider ITU

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52
Q

What is the first line ABx treatment for HAP?

A

Ciprofloxacin + vancomycin

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53
Q

What ABx are indicated for the management of aspiration pneumonia?

A

Tazocin + metronidazole

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54
Q

Classic presentation of empyema?

A

Spiking fevers despite ABx management (Due to wall encapsulation and inactivation of ABx due to acidotic pus).

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55
Q

What are the CHESS organisms?

A

Campylobacter jejuni, Enterohaemorrhagic E. coli, Entamoeba, non-typhoidal salmonella, shigella.

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56
Q

Which proteins are associated with clostridium botulinium?

A

SNARE proteins

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57
Q

What do SNARE proteins do in Botulinum?

A

Prevent ACh release

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58
Q

What is the characteristic presentation of C. Botulinum?

A

Descending paralysis

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59
Q

Which type of clostridium is associated with gas-gangrene?

A

Perfringens

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60
Q

Which 3 ABx are associated with precipitating C. difficile?

A

Cephalosporins, Ciprofloxacin (fluoroquinolones), Clindamycin

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61
Q

Which type of colitis is associated with C Difficile?

A

Pseudomembranous colitis

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62
Q

Which IL is released in response to staph aureus enterotoxins?

A

IL-1/2

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63
Q

Traveller’s diarrhoea affects which part of the GI tract?

A

Jejunum and Ileum

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64
Q

Which pathogen is associated with EHEC?

A

0157:H7 STEC

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65
Q

Which toxin is produced by O157:H7 E coli?

A

Shiga-like toxin

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66
Q

What are the manifestations associated with EHEC?

A

Microangiopathic anaemia
Thrombocytopenia
Acute renal failure
HUS
Dysentery

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67
Q

Which type of E.coli is associated with paedaitrics?

A

EPEC - Infantile (Paeds)

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68
Q

Rose spots are associated with what type of bacteria?

A

Salmonella Typhi (+paratyphi)

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69
Q

What is the clinical presentation of Salmonella Typhi?

A

Enteric fever: constipation, fever, rose spots, splenomegaly.

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70
Q

Where does Salmonella Typhi replicate?

A

Peyer’s Patches

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71
Q

What is the management for C. Botulinum?

A

Antitoxin

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72
Q

Which is the first line ABx for c. difficle?

A

vancomycin

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73
Q

Which ABx is prescribed for the management of Salmonella Typhi?

A

IV ceftriaxone then PO azithromycin

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74
Q

What are the three types of Shigella?

A

Flexneri (MSM)
Sonnei
Dysenteriae

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75
Q

Rice water stools are associated with what type of diarrhoea?

A

Vibrio Cholera

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76
Q

Which enterotoxins are associated with Vibrio Cholera?

A

Enterotoxin A and B

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77
Q

Which type of diarrhoea is associated with Shigella?

A

Bloody

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78
Q

Which type of diarrhoea is associated with Campylobacter Jejuni?

A

Bloody

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79
Q

What associated conditions are associated with Campylobacter Jejuni?

A

GBS
Reactive arthritis

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80
Q

Which ABX is prescribed for Campylobacter Jejuni?

A

Erythromycin or cipro for the first 5 days.

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81
Q

What are the common sources of Listeria Monocytogenes ?

A

Refrigerated food, unpasteurised dairy (monocyto-cheese!) – cold enhancement.

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82
Q

What is the common source for Yersinia Entero-colitica?

A

Undercooked pork

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83
Q

What are the symptoms of Yersinia Entero-colitica?

A

Fever, abdominal pain, diarrhoea (terminal ileitis)

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84
Q

What are the complications associated with Yersinia Entero-colitica?

A

Erythema nodosum and reactive arthritis

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85
Q

Flask-shaped ulcers on histology is associated with what protozoan infection?

A

Entamoeba Histolytica

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86
Q

On histology, what is the characteristic finding associated with Entamoeba Histolytica infection?

A

Flash-shaped ulcers

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87
Q

How many trophozoite nuclei is associated with Entamoeba Histolytica?

A

4

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88
Q

What is the presentation of Entamoeba Histolytica?

A

Dysentery
Flatulens
Tenesmus

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89
Q

Which ABx is indicated for the management of Entamoeba Histolytica?

A

Metronidazole

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90
Q

What is the hepatic complication associated with Entamoeba Histolytica?

A

Liver abscess

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91
Q

Pear-shaped trophozoites are associated with what protozoan infection?

A

Giardia Lamblia

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92
Q

Giardia Lamblia is associated with what characteristic finding ?

A

Pear-shaped trophozoites with 2 nuclei

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93
Q

What is the ABx of choice for Giardia Lamblia?

A

Metronidazole

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94
Q

What is the presentation of Giardia Lamblia?

A

Causes malabsorption of fat - foul-smelling non-bloody diarrhoea

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95
Q

Which stain is used to detect Cryptosporidium Parvum?

A

Kinyoun Acid Fast stain

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96
Q

What is present in the stool for a Cryptosporidium Parvum infection?

A

Oocytes

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97
Q

Which ABx of choice is used to manage Cryptosporidium Parvum?

A

Paromycin

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98
Q

Name 3 causes of viral diarrhoea?

A

Norovirus
Adenovirus
Rotavirus

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99
Q

What are the causes of complicated UTI?

A
  • Complicated – Functionally/structurally abnormal tract, men, catheters, pregnant.
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100
Q

UTI of the bladder is termed what?

A

Cystitis

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101
Q

Why are women predisposed to developing UTIs?

A

Shorter urethra

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102
Q

Which is the most common causative organism for UTIs?

A

E coli

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103
Q

Which is the second most common cause of UTI?

A

Klebisella

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104
Q

Name a nitrite negative staphylococcus that is a a common cause of UTI in young women?

A

Staphylococcus saprophyticus

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105
Q

Which bacteria is urease-positive and is associated with struvite stones?

A

Proteus

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106
Q

What type of renal stones are produced as a result of urease activity?

A

Struvite stones

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107
Q

Which causative organisms is implicated in indwelling catheter-associated UTI?

A

Candida

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108
Q

Which 4 factors promote a UTI?

A
  • pH< 5
  • High urea levels
  • Hyperosmolality
  • Urinary proteins – Tamm–Horsfall glycoproteins, nitrites, and urea
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109
Q

Presentation of UTI?

A
  • Dysuria
  • Frequency
  • Hesitancy, urgency
  • Suprapubic pain or discomfort
  • Bladder spasms
  • Haematuria
  • Foul-smelling cloudy urine
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110
Q

What are the features of a UTI in older/frail patients?

A

Mental status changes – unexplained lethargy, disorganised speech or altered perception, delirium + falls.

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111
Q

Features of UTI in <2 years old?

A

Fever, vomiting, not eating.

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112
Q

Features of Pyelonephritis

A

Systemically unwell, fever, rigours + loin pain

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113
Q

What 2 positive findings on a urine dipstick is consistent with a diagnosis of uti?

A

Nitrite
Leukocyte

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114
Q

Which urinanalysis parameter is specific for UTI?

A

Nitrites

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115
Q

What urine MC&S culture finding is diagnostic of UTI?

A

> 104 colony forming units

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116
Q

What are the ABx of choice for a lower UTI?

A

nitrofurantoin / trimethoprim / cephalexin

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117
Q

What is the Mx for · Pyelonephritis?

A

Admit, IV co-amox + gent

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118
Q

Which organisms are associated with SSIs?

A

S. aureus (MRSA + MSSA), E. coli, Pseudomonas

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119
Q

Clue cells are associated with which STI?

A

Bacterial vaginosis

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120
Q

Chancre is associated with which STI?

A

Syphillis

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121
Q

Gumma is associated with what?

A

Tertiary Syphillis (ulcerative deep subcutaneous nodule)

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122
Q

What is the pathogenic sign associated with TV?

A

Strawberry cervix

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123
Q

Klebsiella granulomatis is associated with what?

A

Donovan bodies

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124
Q

What type of bacteria of gonorrhoea?

A

Obligate intracellular gram-negative diplococcus

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125
Q

Which protein facilitates adhesion of gonococci to epithelial cells?

A

CR3

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126
Q

What are the uncomplicated manifestations of gonorrhoea in men?

A

Gonococcal urethritis

Post-gonococcal urethritis

Rectal proctitis - mainly in MSM

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127
Q

What is the uncomplicated manifestation of Gonococcal disease in women?

A

Mucopurulent cervicitis

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128
Q

What are the complicated manifestations of Gonococcal disease in men?

A

Epididymytiis
Prostatitis

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129
Q

What is the complicated manifestation of Gonococcal disease in women?

A

Pelvic inflammatory disease

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130
Q

What is Ophthalmia neonatorum?

A

Ophthalmia neonatorum (neonatal conjunctivitis) develops if left untreated when transmission to the child in the birth canal.

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131
Q

What is the complication of disseminated gonococcal infection?

A

Septic arthritis
Endocarditis
Sepsis

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132
Q

How is gonococcal disease confirmed?

A

1st line -Smears for NAAT

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133
Q

Which 1st ABx is indicated for the management of gonococcal disease?

A

Ciprofloxacin 500 mg oral – single dose (STAT)

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134
Q

If antimicrobial susceptibility is not known, what is the ABx of choice for gonococcal diseases?

A

Ceftriaxone 1 g IM

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135
Q

When should a test of cure be arranged for gonococcal disease following ABx management?

A

7 days

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136
Q

What type of pathogen is Chlamydia trachomatis ?

A

Obligate intracellular gram-negative pathogen

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137
Q

What is ascending chlamydia?

A

Pelvic inflammatory disease.

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138
Q

Which chlamydia serovars result in trachoma?

A

Serovars A-C

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139
Q

What are the clinical features of trachoma?

A

rachoma is a serious ocular illness that is endemic in Africa and Asia – Characterised by chronic conjunctivitis and can cause blindness.

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140
Q

What are the consequences of chlamydia serovars D-K?

A

Genital chlamydia, ophthalmalgia neonatorum

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141
Q

Lymphogranuloma venereum is caused by which pathogen?

A

Chlamydia trachomatis

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142
Q

Which chlamydia serovars are associated with Lymphogranuloma venereum ?

A

L1-L3

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143
Q

What is the first line of investigation for chlamydia?

A

Vulvovaginal/endocervical/Genital swab

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144
Q

Which cell type is observed on direct microscopy for chlamydia?

A

Neutrophils

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145
Q

What is the first line drug for the management of Chlamydia (dose and duration)?

A

Doxycycline 100 mg BD for 7 days

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146
Q

Which drug is indicated for the management of chlamydia for pregnancy and breastfeeding women (dose included)

A

Azithromycin 1 g single dose

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147
Q

What are the complications associated with Chlamydia infection?

A
  • Pelvic inflammatory disease – leading to tubal factor infertility, ectopic pregnancy, and chronic pelvic pain.
  • Epididymitis
  • Reiter’s syndrome
  • Adult conjunctivitis, ophthalmalgia neonatorum.
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148
Q

LGV is caused by which organism?

A

Chlamydia Trachomatis

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149
Q

What is the characteristic primary stage for Lympho-Granuloma Venereum ?

A

Painless genital ulcers or papules

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150
Q

What is the second stage of Lympho-Granuloma Venereum ?

A

Unilateral or bilateral tender inguinal/femoral lymphadenopathy (buboes) (2 weeks to 6 weeks).
- Lymphoproliferative reaction – binding occurs via heparin sulphate receptors.
- Anorectal Syndrome: Proctitis, proctocolitis-like symptoms – pain during urination, rectal bleeding, pain during passing stools, abdominal pain, anal pain, tenesmus.
- Rare complications: Hepatitis, Meningocepahlitis, pneumonitis.

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151
Q

What are the clinical manifestations of LGV?

A

Necrosis and rupture of the lymph nodes.
- Anogenital fibrosis and strictures.
- Anal fistulae – rectal symptoms (pain, tenesmus, bleeding).
- Genital elephantiasis.

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152
Q

Genital elephantiasis is associated with what STI?

A

Lympho-Granuloma Venereum

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153
Q

What is the management for LGV?

A

Doxycycline 100 mg BD for 21 days.

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154
Q

What is the causative organism for syphillis?

A

Treponema pallidum

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155
Q

What is the causative organism of Chandcroid?

A

Haemophilus ducreyi

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156
Q

Haemophilus ducreyi causes which disease?

A

Chancroid

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157
Q

Which STI is characterised by a ‘school of fish’ or ‘Railroad track’ apperance?

A

Chancroid

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158
Q

What is the clinical presentation of Chandcroid?

A

Painful ulcers (multiple)

erythematous papules at the site of inoculation

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159
Q

What type of agar is implicated for the diagnosis of chancroid?

A

Chocolate agar culture

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160
Q

Which ABx is used for the maangement of chancroid?

A

Azithromycin STAT dose 1 gm.

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161
Q

Which bacteria is implicated in pathogenesis of Dnovanosis/Granuloma inguinale?

A

Klebsiella granulomatis

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162
Q

On a Giemsa-stained smear which histological feature is characteristic of Donovanosis/Granuloma Inguinale?

A

Donovan bodies

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163
Q

What is the classic appearance of the painless papule or subcutaneous nodule in Donovanosis/Granuloma Inguinale?

A

Beefy red appearance

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164
Q

What are Donovan bodies are associated with Donovanosis?

A

Large mononuclear (pund) cells - gram-negative intracytoplasmic cysts

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165
Q

What is the management for Donovanosis?

A

Azithromycin 1 g followed by 500 mg daily

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166
Q

What causes Brucellosis?

A

Brucella species (Mediterranean fever)

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167
Q

How is brucellosis transmitted?

A

Unpasteurised milk, and dairy products, undercooked meat, skin penetration of those in contact with livestock (Animal to human transmission e.g., sheep, pigs, cattle and dogs).

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168
Q

How is Brucella transported throughout he body?

A

Brucella organisms are phagocytosed by circulating macrophages and PMNs – transported into the lymphatic system and replicated locally.

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169
Q

Spinal tenderness and cyclical fever following the consumption of unpastuerised milk is associated with which disease?

A

Brucellosis

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170
Q

What is the presentation of Brucellosis?

A

Presentation:
* Headache
* Cyclical fever (peaks in the evening)
* Migratory arthralgia
* Myalgia
* Asthenia
* Anorexia, fatigue, malaise, weakness
* Spinal tenderness – sacroiliitis, spondylodiscitis
* Septic arthritis
* Miscarriage
* Epidiymo-orchitis

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171
Q

FBC findings of Brucellosis

A

Neutropenia + Anaemia

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172
Q

What serologic testing is used for Brucellosis?

A

Standard agglutination testing, ELISA, and Rose Bengal testing.

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173
Q

What medium is used to grow Brucellosis?

A

Castaneda medium.

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174
Q

On radiography, what characteristic sign is observed in Brucellosis associated lumbar vertbrae?

A

Pedro pons signs

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175
Q

Which antibody is associated with brucellosis?

A
  • Anti-O polysaccharide antibody
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176
Q

What ABx is indicated for the management of Brucellosis?

A

Doxycycline + streptomycin/rifampin/gentamicin for 4-6 weeks.

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177
Q

What are the complications associated with Brucellosis?

A

Endocarditis, meningoencephalitis, osteomyelitis.

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178
Q

How is Rabies transmitted?

A

Transmission – Through saliva via a bite by an infected mammal (e.g., bats, dogs).

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179
Q

What is the first stage of Rabies?

A

First few days – tingling sensation at the bite site.

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180
Q

What is stage 2 of rabies?

A

Stage 2:
Non-specific viral prodrome (flu-like illness): Fever, malaise, headache, sore throat – progress to anxiety, agitation, and frank delirium.

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181
Q

What is stage 3 of rabies?

A
  • Encephalitic form (85%): Hydrophobia or aerophobia – spasms develop as a result of stimuli; autonomic dysfunction, increased deep tendon reflexes, nuchal rigidity and positive Babinski sign.
  • Progresses to hyperactivity stage.
  • Paralytic form (less common) – Weakness, altered mentation, ongoing fevers, and bladder dysfunction.
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182
Q

What is stage 4 of Rabies?

A

Stage 4:
Coma stage (within 10 days of stage 3) – hydrophobia, prolonged apnoea periods and flaccid paralysis.
* Cardiopulmonary failure.

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183
Q

What is the first line investigation for suspected Rabies?

A

IgM antibodies

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184
Q

On autopsy what characteristic feature is seen in patients with Rabies?

A

Negri bodies

(dense, ovoid, intracytoplasmic inclusions – observed within neurones of the CNS).

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185
Q

What post-exposure prophylaxis is available for Rabies?

A

Rabies IgG post-exposure (before symptoms) + full rabies vaccination course.

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186
Q

What is the causative organism of the plague?

A

Yersinia pestis

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187
Q

What is the primary vector for the plague?

A

Rattus rattus, and rattus novegicus

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188
Q

Which is the efficient vector for the plgue?

A

Xenopsylla cheopis

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189
Q

What are the two types of plague?

A

Bubonic

Pneumonic

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190
Q

What is the first line ABx for the plague?

A

Aminoglycosides

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191
Q

Which ABx is prescribed for plague meningitis?

A

Chloramphenicol

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192
Q

What type of bacteria causes leptospirosis?

A

Gram-negative spirochete bacterium Leptospira

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193
Q

How is leptospirosis transmitted?

A

Transmitted through exposure to the urine of infected animals (e.g., cattle, pigs, and horses).

contaminated soil and water – organism shed in the infected animal’s urine; swimming.

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194
Q

What is the Anicteris syndrome of Leptospirosis?

A

Anicteric syndrome – Self-limiting and non-specific flu-like illness – headache, cough, non-pruritic rash, fever, rigours, myalgia, anorexia, and diarrhoea

  • Aseptic meningitis (immune stage, recurrence).
  • Associated with uveitis.
  • Conjunctival hyperaemia (Conjunctival erythema without purulent discharge).
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195
Q

Which zoonotic infection is associated with conjunctival hyperaemia and aseptic meningitis?

A

Leptospirosis

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196
Q

What causes Weils disease?

A

Leptospira

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197
Q

What zoonotic infection is characterised by the following presentation (hint: Rat urine)?

  • Severe infection – fever, renal failure, jaundice (scleral icterus, and conjugated hyperbilirubinemia), haemorrhage, and respiratory distress’?
A

Weils disease

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198
Q

What is the Ix of choice for leptospirosis?

A
  • Positive PCR of blood or urine
  • Nuclei acid detection
  • Positive serologic testing
  • IgM and IgG antibodies against Leptospira organisms.
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199
Q

What antibiotic therapy is indicated for leptospirosis?

A

Amoxicillin, doxycycline, ampicillin or erythromycin.

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200
Q

What is the complication associated with leptospirosis during pregnancy?

A

Can cross the placenta  Miscarriage in the first two trimesters (<24 weeks) or stillbirth/IUD.

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201
Q

What is the causative organism implicated in Anthrax?

A

gram-positive spore-forming rod (Bacillus anthracis);

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202
Q

How is Anthrax transmitted?

A

Under-cooked meat contaminated with spores - exposure to livestock

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203
Q

What are the three types of anthrax?

A

Inhalation

GI

Cutaneous

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204
Q

What dermatological presentation is characterised by Anthrax?

A

Non painful eschar

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205
Q

A non-painful Eschar is associated with which zoonotic infection?

A

Anthrax

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206
Q

What CXR findings are found on imaging for Anthrax?

A

Widened mediastinum, and hilar adenopathy

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207
Q

What is the ABx of choice for anthrax?

A
  • Doxycycline or ciprofloxacin
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208
Q

What is the causative organism for Lyme disease?

A

Borrelia burgdorferi

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209
Q

What type of bacteria is Borrelia burgdorferi?

A

Spirochete

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210
Q

How is Lyme disease transmitted?

A

By tick-bite of the Ixodes genus

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211
Q

What is the first presenting sign of Lyme disease?

A

Erythema migrans rash - appears as a targetoid appearance

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212
Q

What are the neurological manifestations of Lyme disease?

A

Facial nerve palsy

Lymphocytic meningitis

Radiculopathy

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213
Q

What are the cardiovascular manifestations of Lyme disease?

A

Myopericarditis + heart block

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214
Q

What is the appearance of the rash in stage 1 of Lyme disese?

A

Bullseye rash

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215
Q

What is stage 2 of Lyme disease?

A

Stage 2 (3-12 weeks): General malaise, fever, neurological features (dizziness, headache), muscle pain and cardiac symptoms (chest pain, palpitations, and dyspnoea).
- Cranial neuropathy – diplopia, eye pain.
- Arthritis
- Bell Palsy (5%)

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216
Q

FACE pneumonic for Lyme disease presentation

A

FACE: facial nerve palsy, arthritis, carditis, erythema migrans.

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217
Q

What is the diagnostic investigation for confirming Lyme Disease?

A

Serum antibodies for B burgdorferi

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218
Q

What is the antibiotic of choice regarding the management of lyme disease?

A

Doxycycline for 10 days

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219
Q

What additional investigation is implicated to monitor complications of Lyme Disease?

A

ECG for heart block

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220
Q

What causes Q fever?

A

Coxiella Burnetti

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221
Q

How is Coxiella Burnetti transmitted (vectors)?

A

Cattle/sheep

222
Q

What is the fatal presentation of Q fever?

A
  • Fatal interstitial pneumonia – dry cough, fever, no rash
  • Myopericarditis.
223
Q

What are the chronic presenting features of Q fever?

A
  • Q fever fatigue syndrome
  • Bone marrow necrosis
  • Vascular prosthesis infection
224
Q

ABx for Q fever?

A
  • Doxycycline 100 mg BD for 14 days.
225
Q

How is Leischmania transmitted?

A

Protozoan disease transmitted by infected sandflies

226
Q

What is the commonest subtype for Leishmania?

A

Cutaneous disease

227
Q

What is the presentation of cutaneous Leishmania?

A
  • Asymptomatic papules, multiple papules, or nodules at the site of inoculation – enlarge and transform into well-circumscribed ulcers with a raised violaceous border.
  • Heal within 2-5 years with a secondary depressed depigmented scar (‘poor healing ulcer’ + past travel).
228
Q

Which type of Leishmania is characterised by non-ulcerative painless nodules?

A

Diffuse cutaneous

229
Q

Which type of Leishmania is ulcerative?

A

Mucosal disease

230
Q

What type of Leishmania is characterised by splenomegaly, fever and pancytopenia?

A

Visceral Disease (Kala-Azar)

231
Q

What are the strains of Leishmania that cause Kala-Azar?

A

L. donovani, L. infantum, and L. chagasi.

232
Q

What type of disease arises due to Leishmania Donovani ?

A

Disfiguring Dermal disease - invasion of the reticuloendothelial system

233
Q

What is the gold-standard investigation for Leishmania?

A

Giemsa-stained samples from biopsies or impression smears + splenic aspirate.

234
Q

What drug is first line for Leishmania?

A

Amphotericin B.

235
Q

How is Trypanosoma transmitted (vector)?

A

Tsetse fly

236
Q

What is the cause of Trypanosoma?

A

Flagellate, unicellular protozoan.

237
Q

Sleeping sickness is also known as what?

A

Trypanosoma

238
Q

What is the presentation of Trypanosoma ?

A

Presentation:
* Fever
* Sleep disturbance.
* Headaches
* Irritability
* Extreme fatigue
* Swollen lymph nodes

239
Q

Trypanosoma cruzi causes what disease?

A

Chagas disease

240
Q

What is the management for Trypanosoma ?

A

Pentamidine

241
Q

What is the cause of Cat Scratch Disease?

A

Bartonella Hensalae

242
Q

What is the appearance of Bartonella Hensalae ?

A

Curved, gram-negative rod

243
Q

How is Bartonella Hensalae transmitted?

A

Scratches, bites, licks of open wounds, fleas (typically by cats).

244
Q

What is the presentation of Bartonella Hensalae (Cat Scratch Disease) in immunocompetent individuals?

A
  • Macule at the site of inoculation  Pustular
  • Regional adenopathy
  • Systemic symptoms: Fever, night sweats, weight loss.

Similar to TB

245
Q

What is the presentation of Cat Scratch Disease in Immunocompromised patients?

A

Bacillary Angiomatosis

246
Q

What is the presentation of Bacillary Angiomatosis ?

A
  • Skin papules
  • Disseminated multi-organ and vasculature involvement.
  • Leads to the bursting of blood vessels in various organs and tissues.
247
Q

What is the management of Bacillary Angiomatosis ?

A

Erythromycin, doxycycline – add rifampicin

248
Q

What is the cause of Rat Bite Fever?

A

Streptobacillus moniliformis or Spirillum minus.

249
Q

What is the presentation of rat bite fever?

A

Presentation (comes on 2-10 days after bite):
* 1st: Fevers, polyarthralgia, maculopapular  purpuric rash
* 2nd: Endocarditis (Looks like septic arthritis).

250
Q

What drug is used to manage rat bite fever?

A

Penicillin

251
Q

What are the three types of Helminths?

A

Nematodes (round worms)

Cestodes (Tapeworks)

Trematodes (Flukes)

252
Q

Hookworms are what type of Helminth?

A

Nematodes

253
Q

Name three types of nematodes:

A
  • Hookworms
  • Ascarids
  • Strongyloides
254
Q

Name 2 types of cestodes (tapeworms)

A

Hydatid

Pork/beef/fish tapeworm

255
Q

Schistosomiasis is what type of Helminths?

A

Trematodes (flukes)

256
Q

What tapeworm is associated with pigs?

A

Taenia solium

257
Q

Taenia solium tapeworm is associated with what complication?

A

neurocysticercosis (brain cysts) – most common cause of adult-onset epilepsy

258
Q

Tapeworm species for cows?

A

Taenia saginata

259
Q

Which drug is used to treat tapeworm?

A

Praziquantel

260
Q

What type of Helminth causes autoinfection?

A

Strongyloides

261
Q

Which larvae are formed from pinworms in Strongyloides ?

A

rhabditiform larvae

262
Q

rhabditiform larvae form which auto infection larvae?

A

Filariform larvae

263
Q

What is the main symptom associated with Strongyloides ?

A

Malabsorption

264
Q

What is the management for Strongyloides ?

A

Ivermectin

265
Q

Asacaris is associated with what two stages?

A
  1. Respiratory stage – eggs ingested, larvae hatch in the GI tract, are absorbed and then migrate to the lungs to grow.
  2. Gastrointestinal stage – Larvae are coughed up and re-swallowed to the gastrointestinal tract to mature.
266
Q

What is the gastrointestinal stage of Ascaris lumbricoides?

A

Larvae are coughed up and re-swallowed to the gastrointestinal tract to mature

267
Q

What is the definitive host for Hydatid cysts?

A

Dogs

268
Q

What is the main complication associated with Hydatid cysts?

A

Mass effect or cyst rupture

269
Q

What is the management for a hydatid cyst?

A

require surgery, long-term albendazole, praziquantel.

270
Q

How is Schistosomiasis transmitted?

A

Cercariae invade human skin when in contact with contaminated water

271
Q

Where do Schistosomiasis adult worms migrate?

A

To the mesenteric venules or the venous plexus in the bladder

272
Q

What are the complications of Schistosomiasis ?

A

Damage is caused by the laying of eggs - migration of eggs through the bladder or bowel causes damage and increases the risk of squamous cell carcinoma of the bladder

273
Q

What hepatic complication is associated with Schistosomiasis ?

A
  • Retrograde passage of eggs into the liver causes cirrhosis (synthetic function is preserved)
274
Q

How is Schistosomiasis diagnosed?

A

Microscopy – Urine: S. haematobium; Stool – S mansoni, S japonicum.

275
Q

What is filarisis?

A

A nematode infection spread by blackflies and mosquitoes - adult worms release larvae taken up by a vector

276
Q

What is the main clinical presentation of Filariasis caused by adult worms?

A

lymphatic filariasis (scrotal swelling, elephantiasis)

277
Q

What is the main complication caused by microfilariae?

A

onchocerciasis (depigmentation, river blindness)

278
Q

On ultrasound what is the diagnostic feature associated with Filariasis?

A

Dance sign - loa loa migration

279
Q

What is the commonest yeast?

A

Candida

280
Q

What are the two classifications of fungal infections?

A

Yeast versus mould

281
Q

What is the cause of tinea?

A
  • Dermatophyte e.g., trichophyton rubrum
282
Q

What is Tinea corporis?

A

Ringworm

283
Q

What is the complication of Tinea pedis?

A

Athlete’s foot

284
Q

How is onychomycosis managed?

A

Terbinafine and nail lacquers

285
Q

Which organism is responsible for Pityriasis ?

A

Malassezia globosa/furfur

286
Q

What is the diagnostic investigation for candida?

A

Periodic-acid Schiff stain

287
Q

On microscopy what is the characteristic feature associated with Candida?

A

Pseudohyphae (germ tube)

288
Q

What is the management for C. albicans?

A

Fluconazole

289
Q

What is the management for invasive candida disease?

A

amphotericin-B

290
Q

What are the risk factors for candidiasis?

A
  • Very low birth weight infants
  • Immunocompromised patients
  • Patients on ITU with lines
  • Invasive candidiasis common in patients receiving TPN.
291
Q

What are the systemic disease complications associated with candida?

A
  • Eyes – Candida endophthalmitis.
  • Chronic oral candidiasis - Angular cheilitis.
  • Spleen and liver
  • Generalised candidiasis – cutaneous – intertrigo.
  • Invasion - Upper GI perforation - Leakage of candida into the mediastinum = me
292
Q

What agar plate is used to grow candidiasis?

A

Sabouraud agar

293
Q

What serology marker is specific for candidiasis?

A

Beta-D glucan

294
Q

What is the management for candidial infections?

A

1st line: Antifungals (>2 weeks antifungals from 1st -ve blood samples).

  • Echinocandin (do not penetrate the CNS, use Ambisome instead)

-Fluconazole

295
Q

Aspergillus fungal balls can colonise the cavity secondary to which infection?

A

TB

296
Q

What is the microscopy stain for aspergillus?

A

Methenamine silver

297
Q

Which antigen is specific for aspergillus?

A

Galactomannan

298
Q

Which agar is used to grow Aspergillus?

A

Czapek dox agar.

299
Q

What is the first-line antifungal agent of choice for Aspergillus infefctions?

A

Voriconazole (>6 weeks treatment)
1st line: Ambisome/Amphotericin B.

300
Q

Which fungal infection has a predilection to the CNS?

A

Cryptococcus neoformans

301
Q

How is Cryptococcus neoformans transmitted?

A

Bird droppings and decaying wood

302
Q

What stain is used for Cryptococcus neoformans?

A

Indian Ink staining (halo)

303
Q

What sign is sign in Indian Ink staining for cryptococcus neoformans?

A

Halo sign

304
Q

What are the complications of Cryptococcal Neoformans?

A

Cryptococcal meningitis
Can cause hydrocephalus - repeat LP

305
Q

Which test is used to as confirm the definitive diagnosis of Cryptococcal Neoformans?

A

Cryptococcal antigen in CSF/serum

306
Q

CD4 count to predispose Cryptococcal Neoformans

A

CD4 <200

307
Q

Which drug is indicated for the management for Cryptococcal Neoformans?

A

flucytosine

308
Q

What is the cause of Mucormycosis?

A

Rhizopus

309
Q

What are the features of Mucormycosis?

A
  • Features: Swelling, black lesions, ulcers, see in diabetes (poorly controlled diabetics)
  • Retro-orbital extension  proptosis, chemosis, ophthalmoplegias and blindness.
310
Q

What is the management for Mucormycosis?

A

Surgical emergency - resection of necrotic tissue

High-dose amphotericin B

311
Q

What is the diagnostic test for tinea or tricophyton?

A
  • Nail/skin sample – Potassium hydroxide KOH
312
Q

Which antigen is associated with candida infections?

A

Beta-d-glucan

313
Q

Which antigen is associated with aspergillus?

A

Galactomannan

314
Q

Which antigen is associated with cryptococcus?

A

Glucuronoxylomannan

315
Q

Which enzyme is inhibited by azoles?

A

Lanosterol 14-a demethylase

316
Q

What class of drug is amphotericin B and nystatin?

A

Polyene

317
Q

Mechanism of action for polyenes?

A

Binds to ergosterol - creates transmembrane channels

318
Q

Which antifungal inhibits DNA synthesis?

A

Flucytosine

319
Q

Which enzyme is inhibited by flucytosine?

A

thymidylate synthetase

320
Q

Which organism is implicated in tyhphoid?

A

Salmonella typhi and parathyphi

321
Q

How is typhoid transmitted?
HINT - 4F’s

A

Flies
Fingers
Fomites
Faeces

322
Q

What is the incubation period for typhoid?

A

1-2 weeks

323
Q

Which toxin determines virulence in thyphoid?

A

Vi antigen (Polysaccharide capsule), O antigen, and flagellar H antigen

324
Q

Where do the bacteria in typhoid proliferate in the gut?

A

Peyer’s patches (causes intestinal necrosis)

325
Q

What are the 5’s regarding the clinical presentation of Typhoid fever?

A

Rose spots

Hepatosplenomegaly

Solid stools

sphygomothermic dissociation

326
Q

What is Faget’s sign in Typhoid disease?

A

Low heart rate and fever - sphygothermic dissociation

327
Q

What is the clinical presentation of typhoid?

A

5S’s: Rose spots, hepatosplenomegaly, solid stools, sphygomothermic dissociation (low HR + fever aka Faget’s sign).
* Arthralgia
* Nausea, and vomiting initially  Diffuse abdominal pain, bloating, anorexia and diarrhoea  severe.
* Enterocolitis
* Constipation
* Dry cough – due to pneumonia
* Bowel perforation as a complication

328
Q

What is the complication associated with Typhoid?

A

Bowel perforation

329
Q

What is the pattern of fever in typhoid?

A

Step-ladder pattern

330
Q

What dermatological manifestation is associated with typhoid?

A

Rose spots

331
Q

What two antibiotics are implicated in the management of typhoid?

A

IV ceftriaxone

followed by PO azithromycin

332
Q

What is the prophylaxis for typhoid?

A

Vaccine against S typhi

333
Q

How is Dengue transmitted?

A

Females Aedes mosquito

334
Q

Rose spots are associated with which enteric fever?

A

Typhoid

335
Q

‘Breakbone’ fever is associated with which tropical disease?

A

Dengue

336
Q

What is dandy fever?

A

A seven day fever associated with dennue

337
Q

Which virus causes dengue?

A

Flavivirus

338
Q

How many serotypes are associated with Dengue?

A

4 (DENV1-4)

339
Q

Dengue infects which cell type?

A

Dermal macrophages and dendritic cells

340
Q

What is the first phase of dengue?

A

Febrile phase

341
Q

What are the characteristic features associated with the febrile phase of dengue?

A
  • Sudden-high grade fever
  • Facial flushing, skin erythema (sunburn rash)
  • Myalgia, arthralgia, retro-orbital headache, sore throat, conjunctival injection
342
Q

A sunburn rash is associated with which type of tropical disease?

A

Dengue

343
Q

What is the critical phase of Dengue?

A

Increased capillary permeability + defervescence (fever drops)

Leukopenia

Thrombocytopenia

Complications - shock and organ dysfunction

344
Q

What is the major complication associated with Dengue?

A

Dengue Haemorrhagic Fever/Shock Syndrome

345
Q

What is the management of Dengue?

A

Self-limiting

346
Q

How is malaria transmitted (vector name)?

A

Female anopheles mosquito

347
Q

What are the 5 types of malaria?

A

P vivax

P. Ovale

P. malariae

P. Falciparum

P knowlesi

348
Q

How is Malaria classified by species?

A

Falciparum versus non-falciparum

349
Q

Which is the most severe type of malaria?

A

P Falciparum (most common)

350
Q

Which type of fever is associated with ovale, vivax and Knowlesi?

A

Tertian fever - every 48 hours

351
Q

Which feature on blood film is seen on non-falciparum malaria?

A
  • Schuffner’s dots on blood film.
352
Q

What is the management of non-falciparum malaria?

A

Chloroquine then primaquine (to kill hypnozoites asleep in liver).

353
Q

What type of fever is associated with falciparum malaria?

A

Tertian fever - every 48 hours

354
Q

Which is the investigation of choice for diagnosing falciparum malaria?

A

Thick and thin giemsa blood smears

355
Q

Thick smears detect what?

A

Malaria

356
Q

Thin smears detect what in malaria diagnosis?

A

Species and quantifies parastiaemia

357
Q

What is detected on Giemsa staining on thick and thin smears?

A

Maurer’s cleft on film

358
Q

What is the threshold for severe parasitaemia for child malaria?

A

> 2%

359
Q

What is the threshold for severe parasitaemia in adults?

A

> 10%

360
Q

Name 2 malaria antigen detection tests

A
  • Paracheck-PF (Detects plasmodium HRP-II)
  • OptiMAL-IT (Detects parasite LDH).
361
Q

What is the drug of choice for mild malaria?

A

Artemesin-combination therapy (Riamet – Artemether + lumefantrine).

362
Q

What is the drug of choice for severe malaria?

A

IV Artesunate

363
Q

What are the side effects associated with quinine?

A

Cinchorism (tinnitus, dizziness, N&V), arrhythmias, hyperinsulinemia (causes hypoglycaemia)

364
Q

What is the drug of choice for malaria in children?

A

oral malarone, QDS 3 days.

365
Q

What are the features of severe falciparum malaria?

A
  • Impaired consciousness or seizures
  • Renal impairment
  • Acidosis (pH<7.3)
  • Hypoglycaemia (<2.2 mmol/L)
  • Pulmonary oedema or ARDS.
  • Anaemia (Hb <8g/dL)
  • Spontaneous bleeding/DIC
  • Shock (BP <90/60 mmHg)
  • Haemoglobinuria (Without G6PDD)
  • Other indications for IV therapy - >2% parasitaemia OR schizonts.
366
Q

The hypnozoite stage is associated with which type of malaria?

A

Vivax

367
Q

What term denotes an infected hepatocyte?

A

Schizont

368
Q

What is the virology of SARS-COV2?

A

Enveloped single-stranded positive sense virus

369
Q

Which viral protein binds to ACE2 to the pulmonary cell surface (SARS-COV2)?

A

Spike protein

370
Q

The SARS-COV2 spike protein binds to what pulmonary cell surface marker?

A

angiotensin-converting enzyme 2

371
Q

Which cytokines are released in a cytokine storm in response to SARS-CoV2?

A

il-1, il-6, TNF-alpha

372
Q

What pulmonary complication is associated with Covid?

A

ARDS

373
Q

Which corticosteroid is first line to treating SARS-COV2?

A

Dexamethasone

374
Q

Which 2 antivirals are indicated in the management of SARS-COV2?

A
  • Remdesivir /Molnupiravir– Nucleoside analogue that inhibits the action of RNA polymerase.
  • Paxlovid – Targets protease
375
Q

What is the molecular target of Paxlovid?

A

Protease

376
Q

Which 2 monoclonal antibodies are implicated in the management for SARS-COV2?

A
  • Sotrovimab
  • Tocilizumab
377
Q

What is the target of Tocilizumab ?

A

IL-6 receptor

378
Q

Sotrovimab - target?

A

Binds to the spike protein of SARS-COV2

379
Q

What is the natural reservoir for influenza A?

A

Ducks

380
Q

What are the two types of influenza?

A

A and B

381
Q

How does influenza bind to the cell membrane?

A

haemagglutinin to bind to sialic acid

382
Q

What term describes an accumulation of point mutations resulting in antigen change?

A

Antigenic drift

383
Q

What term describes a recombination of genomic segments of two co-infecting flu strains?

A

Antigenic shift

384
Q

What is the target of amantadine?

A

Targets the M2 ion channel for influenza A

385
Q

What class of drug is baloxavir (target)?

A

Polymerase inhibitors

386
Q

Tamiflu inhibits which enzyme?

A

Neuraminidase

387
Q

Name 2 neuraminidase inhibitors?

A
  • Oral oseltamivir (Tamiflu)
  • Inhaled Zanamivir (Relenza – used in patients with underlying respiratory disease).
388
Q

Which beta-lactam antibiotic is indicated for the management for skin infections?

A

Flucloxacillin

389
Q

Name a broad-spectrum penicillin?

A

Amoxicllin

390
Q

Which beta-lactam is indicated for the management of ESBL?

A

Carbapenems (e.g.., meropenem)

391
Q

Which glycopeptide antibiotics are indicated for gram-positive coverage in MRSA or C diff infections?

A

Vancomycin
Teicoplanin

392
Q

What class of antibiotic is vancomycin?

A

Glycopeptide

393
Q

What is the molecular target for tetracycline?

A

30S Ribosomal subunit

394
Q

Gentamicin, amikacin are what class of drug?

A

Aminoglycoside

395
Q

Aminoglycosides target which part of the cell?

A

30s ribosomal subunit

396
Q

Name 3 macrolide antibiotics

A

Erythromycin, clarithromycin, azithromycin

397
Q

What are the adverse effects associated with aminoglycosides?

A

Ototoxic + nephrotoxic

398
Q

Which class of antibiotic is indicated for penicillin allergy?

A

Macrolides

399
Q

Which class of antibiotic is indicated from for gram-positive atypical pneumonia?

A

Macrolides

400
Q

Molecular target for macrolides?

A

50s ribosomal sub-unit

401
Q

Molecular target for chloramphenicol?

A

50s ribosomal sub-unit

402
Q

What ABx is indicated for the management for bacterial conjunctiivits?

A

chloramphenicol

403
Q

What are the adverse effects associated with chloramphenicol?

A

Aplastic anaemia/grey baby risk

404
Q

What is the molecular target of oxazolidinones?

A

23s component of 50s ribosomal subunit

405
Q

What class of drug is linezolid?

A

Oxazolidinones

406
Q

What class of drug is ciprofloxacin?

A

Fluoroquinolones

407
Q

What is the target of Fluoroquinolones?

A

DNA gyrase

408
Q

Name an anti-protozoal and anaerobic antibiotic?

A

Metronidazole

409
Q

Which drug inhibits RNA synthesis and indicated in the management of mycobacteria e.g., TB?

A

Rifamycin

410
Q

Adverse effects associated with Rifamycin?

A

Orange secretions

411
Q

What is the drug target of colistin?

A

Polymyxin

412
Q

What adverse effect is associated with polymyxin?

A

Nephrotoxic

413
Q

Daptomycin is what class of drug?

A

Cyclic lipopeptide

414
Q

What class of drug is trimethoprim?

A

Diaminopyrimidines

415
Q

What drug is recommended for vancomycin-resistant enterococcus?

A

Daptomycin

416
Q

What are the narrow spectrum antibiotics?

A

Flucloxacillin, metronidazole, gentamicin.

417
Q

What kind of antibiotic is Flucloxacillin?

A

Narrow-spectrum

418
Q

Name 5 anti-pseudomonal drugs?

A

Tazocin, ceftazidime, ciprofloxacin, meropenem, gentamicin.

419
Q

What is the common mechanism implicated in trimethoprim resistance?

A

Bypass antibiotic-sensitive step in pathway

420
Q

Example of enzyme-mediated drug inactivation for AMR?

A

beta-lactamases

421
Q

Common mechanism for tetracycline resistance?

A

Impairment of accumulation of the drug

422
Q

What is the common skin organism?

A

S. aureus

423
Q

What is the common organism implicated in pharyngitis?

A

β-haemolytic Streptococcus

424
Q

Which antibiotic is indicated for the management of β-haemolytic Streptococcus?

A

Phenoxymethylpenicillin

425
Q

Which antibiotic is indicated for mild CAP?

A

Amoxicilin

426
Q

Which antibiotic is indicated for the management of severe CAP?

A

Co-amoxiclav + clarithromycin

427
Q

Which antibiotic combination is indicated for HAP?

A

Co-amox + gent or tazocin

428
Q

Which antibiotic is indicated for bacterial meningits?

A

Ceftriaxone
(+ amox if RFs for listeria – young/old)

429
Q

Antibiotic regiment for community UTI?

A

Trimethoprim / nitrofurantoin

430
Q

Antibiotic regiment for nosocomial UTI?

A

Co-amoxiclav or cephalexin

431
Q

Which broad-spectrum ABx are recommended fro severe sepsis?

A

Broad-spectrum antibiotics e.g., Tazocin / ceftriaxone, metronidazole ± Gent

432
Q

Which ABx are indicated for the management of neutropenic sepsis?

A

Tazocin or gentamicin

433
Q

Which antibiotic is indicated for the mdianagement of colitis and clostriidum difficile?

A

Oral vancomycin

434
Q

Prion disease is characterised by which particles?

A

Protein-containing particles

435
Q

Prion disease is associated with which chromsome?

A

Chromosome 20

436
Q

Abnormal folding of prion protein in prion disease results in the formation of what?

A

Beta-sheet configuration

437
Q

Which codon is implicated in prion disease?

A

Codon 129

438
Q

What is the management for symptomatic prion disease?

A

Clonazepam for myoclonus (or valproate/levetiracetam).

439
Q

Which drugs delay prion conversion?

A

Quinarine, pentosan, tetraycline.

440
Q

Which EEG changes are observed in sporadic CJD?

A

Triphasis changes

441
Q

What are the post-mortem findings associated with sporadic CJD?

A
  1. Spongiform vacuolation
  2. PrP amyloid plaques
442
Q

What MRI finding is observed in variant CJD?

A

Posterior thalamus highlighted on MRI-T2 (pulvinar sign)

443
Q

Pulvinar sign is seen in which type of CJD?

A

Variant CJD

444
Q

Florid post-mortem plaques is seen in which type of CJD?

A

Variant CJD

445
Q

Which type of CJD is most common?

A

Sporadic

446
Q

What is the mean onset of sporadic CJD?

A

45-75years

447
Q

When does death arise in sporadic CJD?

A

Death within 6/12 of symptoms beginning

448
Q

What are the symptoms associated with sporadic CJD?

A

Rapid, progressive dementia with myoclonus, cortical blindness, akinetic mutism and lower motor neuron signs

449
Q

Which type of CJD is associated with bovine spongiform enecephalopathy?

A

Variant CJD

450
Q

Which type of CJD is associated with psychiatric symptoms as the initial presentation including anxiety, paranoia, and hallucinations?

A

Variant CJD

451
Q

Which type of CJD is associated with cannibalism?

A

Kuru

452
Q

Which type of CJD is associated with Dysarthria progressing to cerebellar ataxia?

A

Inherited

453
Q

What is the viral serology of acute Hep-A infection?

A

Anti-HAV IgM

454
Q

Which viral serology is observed in acute infection of HepB?

A

HBsAg +
Anti-HBc +
IgM anti-HBc +

455
Q

HBsAg +
Anti-HBc +
IgM anti-HBc +

HepB status?

A

Acute infection

456
Q

HBsAg +
Anti-HBc +

HepB Status?

A

Chronic infection

457
Q

Anti-HBc +
Anti-HBs +

HepB Status?

A

Previous infection

458
Q

Which two antibodies are implicated in previous infection of HepB?

A

Anti-HBc

Anti-HBs

459
Q

Which antibody is implicated in previous vaccination against HepB?

A

Anti-HBs

460
Q

Which two serology viral-specific parameters are associated with HepB?

A

Surface (HBsAG)
Core

461
Q

Which is the gold-standard HepB viral protein indicative of chronic infection?

A

Serum HBsAg

462
Q

Viral hepB vaccine is associated w what marker?

A

Anti-HBs

463
Q

Which type of HSV is associated with cold sores?

A

HSV-1

464
Q

Which type of HSV is associated with genital ulceration?

A

HSV-2

465
Q

Which anti-viral is used for the treatment of HSV?

A

Aciclovir OR Valaciclovir

466
Q

What is the diagnostic test for HSV?

A

swab from lesion for HSV PCR

467
Q

Which virus is implicated in the chickenpox?

A

Varicella-Zoster virus

468
Q

What are the complications associated with Varicella zoster?

A

· scarring
1. pneumonitis
2. Ramsay Hunt syndrome – facial palsy + vesicles in ear
3. Encephalitis
4. Post-herpetic neuralgia

469
Q

What are the three neonatal clinical features for chickenpox?

A

· Purpura fulminans
· Visceral infection
· Pneumonitis

470
Q

What is the management for adult chickenpox at risk of complications?

A

Aciclovir or Valaciclovir

471
Q

What is the management for neonatal chickenpox?

A

Aciclovir or Valaciclovir

472
Q

What is the post-exposure prophylaxis for chickenpox?

A

VZIG

473
Q

What is the first-line antiviral for CMV?

A

Ganciclovir (IV)/valganciclovir

474
Q

What is the immunocompromised features of CMV?

A
  1. Encephalitis
  2. Retinitis
  3. Pneumonitis
  4. Colitis
  5. Marrow suppression
475
Q

What is the post-transplant test for CMV infection?

A

Nucleic acid testing from blood sample

476
Q

What is the causative organisms for Glandular fever?

A

Epstein-Barr virus

477
Q

What is the triad of features associated with glandular fever?

A

· Triad of fever, pharyngitis, posterior cervical lymphadenopathy

478
Q

What does EBV predispose to?

A

Burkitt lymphoma

479
Q

Which post-transplant disease is associated with EBV infection?

A

Post-transplant lymphoproliferative disease

480
Q

Which monoclonal antibody is prescribed in post-transplant immunocompromised individuals?

A

Rituximab

481
Q

Rituximab targets which CD marker?

A

CD20

482
Q

What is the diagnostic investigation for glandular fever?

A

Monospot for heterophile antibodies

483
Q

What is the cause of roseola infantum?

A

HHV-6

484
Q

What is the most common cause of febrile convulsions?

A

HHV-6

485
Q

What is the cause of Karposi’s sarcoma?

A

HHV-8

486
Q

HHV-8 can cause what three features in immunocompromised patients?

A
  1. Kaposi’s sarcoma (Pathognomonic for HIV)
  2. Primary effusion lymphoma (associated with EBV coinfection)
  3. Castleman’s disease (non-cancerous growth in the LNs).
487
Q

What is the causative virus implicated in Castleman’s disease?

A

Human herpesvirus 8

488
Q

JC virus can cause what complication in immunocompromised patients?

A

Progressive multifocal leukoencephalopathy

489
Q

What is the causative virus for Progressive multifocal leukoencephalopathy?

A

JC virus

490
Q

What causes BK haemorrhagic cystitis in bone marrow transplant?

A

BK virus

491
Q

What complication of BK virus is associated following bone marrow transplant?

A

haemorrhagic cystitis

492
Q

What is the management of haemorrhagic cystitis ?

A

Cidofovir

493
Q

What is the common viral cause of encephalitis in immunocompromised children?

A

Adenovirus

494
Q

Which antiviral agent is used in the management of adenovirus?

A

Cidofovir

495
Q

How is HepC transmitted?

A

blood product spread- transfusions, sharing needles

496
Q

Which hepatitis strain causes cirrhosis and hepatocellular carcinoma?

A

HepC

497
Q

Which Hep virus co-infects with Hep B?

A

Hep D

498
Q

What is the management of HepD virus?

A

Peginterferon-⍺

499
Q

Which Hep strain is associated with severe disease in pregnancy?

A

HepE

500
Q

Which drug is used to treat HepE virus?

A

Ribavirin

501
Q

Which lesions present on the soft palate are seen in Rubella Virus?

A

Forchheimer sign

502
Q

Which congenital cardiac complication is associated with Rubella?

A

Patent ductus arteriosus

503
Q

Which virus causes hydrops foetalis?

A

Parvovirus b19

504
Q

Cause of fifth disease?

A

Parvovirus b19

505
Q

Which Buccal mucosa spots are seen in Measels?

A

· Koplik’s spots

506
Q

What are the three complications associated with Mumps virus?

A

· Epididymo-orchitis (can lead to infertility)
· Pancreatitis
· Meningitis

507
Q

What virus is responsible for Molluscum contagiousum?

A

Poxvirus

508
Q

A flesh-coloured papule with a central umbilication is characteristic of what?

A

Molluscum contagiosum

509
Q

What is the first line medication for the management for molluscum contagiosum?

A

Imiquimod 5% cream, podophyllotoxin

510
Q

Which HPV strains are associated with anogenital warts?

A

6 and 11

511
Q

What is the primary syphillis?

A

Chancre - primary painless solitary genital ulcer appearing 1-12 weeks following transmission

512
Q

Which type of bacteria is responsible for syphillis?

A

Gram-negative spirochete

trepenoma pallidum

513
Q

What is secondary syphyllis?

A

Systemic bacteraemia symptoms e.g., maculopapular rash, condylomata lata, lymphadenatophy

514
Q

What is Tabes dorsalis?

A

A progressive degenerative disease of the dorsal column

515
Q

What pupil is associated with syphilis?

A

Argyll-Robertson Pupil

516
Q

What microscopy is used for syphillis?

A

Darkfield microscop y and serology

517
Q

What non-treponemal test is used to diagnose acute syphilis?

A

Rapid plasmin reagin (RPR)

Venereal disease research laboratory

518
Q

What treponemal test is used to diagnose syphillis and remain positive for years?

A

Enzyme immunoassay - T-pallidum haemoggluatination

519
Q

What is the first-line management for syphilis?

A

IM benzathine penicillin

520
Q

What reaction occurs within 24 hours of antibiotic for syphillis?

A

Jerish-Hersxheimer

521
Q

What are the causative organism for chancroid?

A

Haemophilus Ducreyi

522
Q

What is the gram-stain pattern is seen in chancroid?

A

Railroad track appearance

523
Q

Which STI is associated with painful ulcers?

A

Chancroid

524
Q

Negri bodies are associated with what?

A

Rabies

525
Q

Which prion disease is associated with cannabiliism?

A

Kuru

526
Q

Variant CJD is associated with what?

A

Bovine spongiform encephalopathy

527
Q

What is catalase status for streptoccous?

A

Catalase negative

528
Q

What type of streptoccous is pyogenes?

A

Beta-haemolytic group A

529
Q

What type of streptoccous is associated with Agalactiae?

A

Beta-haemolytic Group B

530
Q

Name two types of alpha-haemolytic streptoccous?

A

Viridans

Pneumoninae

531
Q

Most common cause of meningitis in neonates?

A

Group B streptococcus

Gram-negative rods e.g., E.coli, and listeria monocytogenes

532
Q

Most common cause of meningitis in infants (>3 months <3 years)?

A

Streptococcus pneumoniae, N meningitis, S. agalactiae

533
Q

Most common cause of meningitis in age >10 and <19

A

N meningitis, streptococcus pneumoniae

534
Q

Most common viral cause of meningitis?

A

Coxsackie, echovirus
Mumps e..g, HSV-2

535
Q

What are the most common fungal cause of meningitis?

A

Cryptocococcus neoformans

536
Q

What is the managemnt for cyrptococcus neoformans?

A

Flucytosine

537
Q

What is the first line management for severe meningitis?

A

IV ceftriaxone and corticosteroids (do not prescribe corticosteroids if meningococcal septicaemia)

538
Q

What additional antibiotic is added to ceftriaxone for bacterial meningitis in the eldelry?

A

Amoxicillin

539
Q

What is the most common cause of encephalitis?

A

HSV-2

540
Q

What is the first line drug to manage encephalitis?

A

IV acyclovir

541
Q

What is the first line antiviral for CMV infections?

A

Ganiciclovir

542
Q

What heart defect is associated with rubella?

A

Patent ductus arteriosus

543
Q

Hydrocephalus, cerebral calcifications, and chorioretinitis is associated with which neonatal infection?

A

Toxoplasmosis

544
Q

What is the most common form of neonatal herpes simplex?

A

SEM

545
Q

What is the management for positive Rubella infection <18 weeks?

A

Termination of pregnancy

546
Q

What drug is given to the mother for PCR positive toxoplasmosis?

A

Spiramycin

547
Q

Hutchinson’s teeth is seen in what?

A

Neonatal herpes

548
Q

What are the adverse fetal complications associated with Zika firus?

A

Club foot,
IUGR
Ventricular calcifications

549
Q

Which type of CJD can be diagnosed by a tonsillar biopsy?

A

Variant

550
Q

Which type of prion disease is associated with bovine spongiform encephalopathy?

A

vCJD

551
Q

For complicated UTI, what is the duration of ABx?

A

7 days

552
Q

What are the three types of diarrhoea?

A

Secretory - toxin production - Cl- secretion into the lumen

Inflammatory

Enteric fever

..Pathology- Imperial College London MBBS (5 decks)

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