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ACS > Microbiology > Flashcards

Microbiology Flashcards

1
Q

Pro karyote

A

70s
no nucleus
plasmid chormosome
no organelles

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2
Q

Eukaryote

A

80s
nucleus
organelles and cytoskeleton

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3
Q

size order of microbes

A 
virus
bacteria
fungi
protozoa
helminths
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4
Q

gram positive

A

thick peptidoglycan retains the stain

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5
Q

gram staining

A 
fixation
crystal violet
iodine treatment
decolonisation- acetone
counterstain
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6
Q

catalase

A

+=staph
-=strep

enzyme decomposes hydrogen peroxide into water and oxygen

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7
Q

coagulase

A

+=staph aureaus (MRSA and MSSA)

-= CoNS (epidermis and saphrophyticus)

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8
Q

different strep

A

alpha- partial clearing, green
beta- complete clearing
gamma- non haemolytic

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9
Q

optochin

A

susceptible- strep pneumonia

resistant- viridans strep (oral)

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10
Q

viridans strep

A

mitis
oralis
salivarius
mutans

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11
Q

lactose fermentor

A

pH agar change

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12
Q

beta lactams examples

A 
penicillin
cephalosporin
carapenams
monobactams
beta=lactamase inhibitors
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13
Q

beta lactams all contain…

A

common ring
binds to dalamine on bacteria
inhibits cell wall synthesis

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14
Q

penicillins

A

natural V or G
penicillinase resistant fluclox
broad spectrum
b/lactam+blactamase inhibitor= coamoxiclav

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15
Q

cephalosporins

A

1st gen: +cocci and -UTI ORAL

2nd: +cocci and -UTI ORAL +CAP/COPD IV
3rd: -rods
4th: pseudomonas and some +cocci

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16
Q

clavam

A

clavulanic acid

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17
Q

cephalosporins types

A

1st cefalexin

  1. cefuroxime
  2. cefotaxime and ceftriaxone (T’s)
  3. cefepime (strange name)
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18
Q

mono bactam

A

aztreonam

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19
Q

penicillin ADME

A

IV/oral
1-2hours
body water
urinary excretion

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20
Q

side effects of penicillins

A 
allergy
c.diff
liver
platelet
cns
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21
Q

Pen V

A

beta strep
pneumococci
meningococci
gonococci

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22
Q

fluclox

A

s. aureus

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23
Q

co-amoxiclav

A 
otitis media
COPD
CAP
UTI
skin and soft tissue
gonococcus
salmonella
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24
Q

tazobactam+piperacillin=tazocin

A

hospital IV therapy

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25
Q

carbapenem

A

meropenem
IM only
2/3 line
works like other beta lactams

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26
Q

cephalosporins dont’ work for

A 
MRSA
enterococci
listeria
legionella
c.diff
camplylobacter
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27
Q

hospital acquired sepsis unknown site

A

ceftazidime +2nd agent

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28
Q

CAP you give

A

ceftriaxone

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29
Q

intra abdominal infection you give

A

metronidazole

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30
Q

pseudomonas you give

A

ceftazidime

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31
Q

fluoroquinolones

A

ciprofloxacin

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32
Q

use fluoroquinolones for

A

gram -ves

lower urinary tract

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33
Q

fluroquinolones

A

inhibit gyrase

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34
Q

fluroquinolones ADME

A

PO/IV

metabolism and renal clearance

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35
Q

SE of fluroquinolones

A

rashes/photosensitivity
tendenitis and rupture
c.diff
QTC PROLONGATION with moxi- suddent death and hepatotoxicity

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36
Q

ciprofloxacin good for

A

gram -ves

atypical chest pathogens

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37
Q

moxifloxacin good for

A

like cipro but also staph and strep

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38
Q

aminoglycasides

A

gent

inhibit protein making at ribosome

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39
Q

aminoglycasides ADME

A

IV/IM
concentrates in kidneys and ears (toxic)
renal excretion

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40
Q

use aminoglycasides for..

A

gram -ves
e coli
pseudomonas

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41
Q

always use gent…

A

with something!

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42
Q

SE of aminoglycasides

A

kidney, ear toxicity
kidney reversible.
required therapeutic monitoring and dose adjustment.

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43
Q

glycopeptides

A

IV only
cell wall
vancomycin

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44
Q

glycopeptides for…

A

MRSA
gram +ves nearly all!
no action against negs

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45
Q

glycopeptides ADME

A

IV
renal excretion
nephro/oto toxicity

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46
Q

side effects of glycopeptides

A

red man syndrome

thrombocytopaenia with teicoplanin

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47
Q

oral vancomycin for

A

c.diff

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48
Q

macrolides examples

A

erythromycin, clarithrymycin

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49
Q

macrolides

A

IV/PO
lower respiratory tract
good for penicillin allergic
inhibits protein at ribosome

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50
Q

macrolides ADME

A

renal and biliary excretion

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51
Q

macrolides SE

A

nausea, GI upset.

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52
Q

macrolides good for….

A

gram +ves (staph, strep)
legionella
mycoplasma, clamydia
only neg good for it campylobacter

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53
Q

tetracyclines

A

minocycline, doxycyline

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54
Q

tetracyclines good for

A

acne

oral against MRSA

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55
Q

tetracyclines ADME

A

inhibits ribosome
resistance quite common

NOT for kids- binds to calcium, funny teeth.

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56
Q

metronidazole

A

anaerobes
resistance rare
disrupts DNA

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57
Q

side effects of metronidazole

A

disulphiram like reaction with alcohol

peripheral neuropathy with long term use.

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58
Q

trimeth works by

A

inhibiting folate synthesis

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59
Q

linezolid

A

PO/IV

gram +ves including MRSA

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60
Q

side effects of linezolid

A

thrombocytopenia (FBC EVERY WEEK)

neuropathy

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61
Q

when do we use linezolid?

A

second ling against serious gram +ve infection

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62
Q

daptomycin

A

IV only

good for MRSA

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63
Q

side effects of daptomycin

A

muscle toxicity

not suitable for lung infections.

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64
Q

HSV drugs

A

aciclovir, valaciclovir, famiclovir

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65
Q

CMV drugs

A

ganciclovir

foscarnet

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66
Q

Hep B drugs

A

lamivudine, adefovir

interferon and peg.

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67
Q

Hep C drugs

A

ribavirin

interferon

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68
Q

Influenza A drug

A 
Amantadine
rimantidine
non-nucleosides
block function of matrix protein
hardly ever used because of parkinsonianism
post exposure NOT treatment
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69
Q

Infuenza drugs

A

Zamanavir

Oseltamirvir

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70
Q

Broad spectrum antivirals

A

ribavirin- anti RNA

cidofovir- anti DNA

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71
Q

nucleosides

A

mimic ACTG but need to be phosphorylated

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72
Q

aciclovir

A

guanosine
inhibits viral DNA polymerase
needs phosphate from viral thymidine kinase
incorporated into viral DNA

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73
Q

how to give aciclovir

A

5x a day! for a week
need to start within 72 h
IV is much better! 8 hourly.
topical sucks.

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74
Q

aciclovir and renal failure

A

dose reductino

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75
Q

valaciclovir

A

prodrug for aciclovir
take 3x a day
good for immunocompromised
when aciclovir causes GI problems..

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76
Q

famiciclovir

A

prodrug
take it just once!
Old people with zoster

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77
Q

ganciclovir

A 
PO/IV
nucleoside
inhibits polymerase
needs viral kinase
becomes resistant after 3 months
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78
Q

ganciclovir side effects

A

induces neutropaenia

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79
Q

Foscarnet

A

IV only
doesn’t need phosphorylation
if resistant to ganciclovir

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80
Q

foscarnet side effects

A

renal toxicity.

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81
Q

NRTI (nucleoside)

A

Zidovudine

require host cell phosphate
resistance after 2-5 years

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82
Q

pNRTI (nucleotide)

A

Tenofovir

already phosphated
chain terminator

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83
Q

NNRTI (non-nucleoside)

A

Nevirapine

blocks reverse transcriptase
resistance after 3 years
ALWAYS WITH NRTI/pNRTI

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84
Q

PI

A

nelfinavir

makes HIV immature
very, very potent but high resistance
metabolised by p450

(use with ritonavir to inhibit P450)
ALWAYS WITH NRTI/pNRTI

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85
Q

FI

A

T20

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86
Q

start HAART when

A

uner 350/ml of blood

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87
Q

HAART treatment failure

A

not VL<400

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88
Q

viral rebound

A

more than one drug changed at a time

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89
Q

side effects of NRTIs

A

anaemia
neutropenia
lactic acidosis

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90
Q

triple therapy

A

zidovudine, lamivudine, nelfinavir

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91
Q

side effects of NNRTIs

A

rash, fever, myalgia, hepatitis, diarrhoe

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92
Q

side effects of PIs

A

GI.

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93
Q

good types of hep C (genotype

A

2/3

treat for 24 weeks

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94
Q

bad types of hep C

A

1/4/5

treat for 48 weeks

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95
Q

Interferon alpha side effects

A

lethargy
insomnia
diarrhoea
depression

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96
Q

no interferon for

A

heart and liver disease
renal filaure
epilepsy
pregnant

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97
Q

pegylated IFalpha for

A

HCV 1

normal for others

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98
Q

meningococcus live in

A

the nose

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99
Q

h.influenza lives in

A

the nose

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100
Q

strep pneumonia lives in

A

the nose

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101
Q

moraxella catarrhalis lives in

A

the nose

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102
Q

cefotaxime

A

third gen ceph
gram -ves! neisseria, hinfluenza
SOME +ves

IV 8 hourly
good CSF penetrance

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103
Q

amoxicillin

A 
broad
gram -ve and +ve
resistance frequent
can be oral
can be with betalactamase inhibitor (Co-amoxiclav)
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104
Q

penicillin sensitivity

A

pneumococcus- almost always
menigococcus- usually
H.influenza b- nearly never
m catarrhalis- frequently not

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105
Q

how many amoxicillin in one day?

A

8

bananas

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106
Q

how many penV in a day?

A

6

petrol

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107
Q

2 methods of spread of bone infection

A 
deep penetration (adults)
haematogenous (children- have capillaries that cross joint)
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108
Q

3 types of osteomyelitis

A

haematogenous- bacteraemia
contiguous- trauma or surgery, external fixation etc.
diabetic- reduced blood flow, skin changes, reduced immunity

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109
Q

osteomyelitis and antibiotics

A

don’t start antibiotics until samples taken…

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110
Q

most common cause of osteomyelitis

A

s.aureus
collagen binding adhesin (cartilage)
fibronectin binding adhesins (foreign)

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111
Q

septic arthritis

A

usually hip or knee

usually just one

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112
Q

how does septic arthritis happen

A

membrane very vascualr
local cellular response
releases proteolytic enxymes and bacterial toxins
destroys cartilate
joint effusin
decreased blood supply (becomes so swollen it cuts it off)

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113
Q

most common cause of septic arthritis

A

s.aureus or strep

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114
Q

septic arthritis in under 3?

A

h. influenzae

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115
Q

gram negative septic arthritis?

A

IVDU pseudomonas

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116
Q

reactive arthritis is NOT

A

an infection

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117
Q

reactive arthritis may occur (EXAM)

A

after infectious diarrhoea
Chlamydia
Gonorrhoea
Hep B

NO BACTERIA TO CULTURE

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118
Q

prosthetic joint infection

A 
within 3 months (early) or else late
direct inoculation- skin type flora
usually haematogenous if late
biofilm
multiple organisms not uncommon

COAGULASE NEGATIVE STAPH

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119
Q

biofilm

A

glood on a bone under a duvet
glycocalx
because not dividing- antibiotics won’t work.

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120
Q

tests for prosthetic joint infection

A

histology more important than culture.

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121
Q

treatment for prosthetic joint infection

A

surgical drainage +6 weeks Abx

replacement (1 stage or 2 stage) 2 stage better

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122
Q

Abx for bone infection

A

2-3 weeks septic arthritis
4 weeks kids
6-8 weeks adult osteomyelitis.

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3
4
5
Perfectly
123
Q

ultra clean ventilation

A

air changed 30 times an hour

fine filter to catch viruses

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124
Q

mycosis

A

infection caused by fungi

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125
Q

mycotoxicosis

A

condition resulting from ingestion of fungus

126
Q

fungi are..

A

eukaryotes

127
Q

yeast

A

single oval cell

128
Q

moulds

A

tubes (hyphae) and multicelled structures

129
Q

superficial funcal infections

A

dermatophytes
candidosis
pityrisasis versicolor

130
Q

Anthropophilic

A

man

131
Q

zoophilic

A

animals

132
Q

geophilic

A

soil

133
Q

rubra

A

athletes foot

134
Q

microsporum

A

hair and skin

135
Q

epidermophyton

A

skin and nails

136
Q

candidiasis

A

cutaneous
nail
mucosal
chronic mucocutaneous (usually immunosuppressed)

subcutaneous infection- spread through lymphatic system.

137
Q

opportunistic deep funal infections

A

usually environmental organisms
inhaled
life threatening disseminating infection

138
Q

4 opportunistic deep fungal infections

A

mucoromycosis
cryptococcosis (neoformans)
candidosis
aspergillosis

139
Q

mucoromycosis

A

grow in 3 weeks
spreads so fast you have to ACT
man without a face

140
Q

saksenaea vasiformis

A

burns, deep cuts, wounds

141
Q

cryptococcosis

A

usually meningitis
AIDS patients
most common fungal meningitis

142
Q

invasive candidosis

A

oesophagus
endocarditis
disseminated
osteomyelitis

143
Q

aspergillosis

A

soil, plants, air, dust, food
waxy spores

onychomycosis
cutaneous
otitis externa
keratitis
aspergilloma in lungs
invasive- brain
144
Q

diagnosing fungal infections

A

direct microscopy
culture and immunofluorescence
serology

145
Q

antifungals

A 
echinocandins -fungin
polyenes- amphoterecin B and nystatin
Azoles
Allylamine- Terbinafine
flucytosine- fluoropyrimidine
146
Q

scalp and nail fungal infections need…

A

oral therapy

147
Q

sporotrichosis

A 
rose thorns
spores
nodules
ulcers
along lymphatic channel
148
Q

cryptococcus treatment

A

ampho B and flucytosine

149
Q

aspergillosis treament

A

voriconazole

150
Q

zygomyocosis

A

mucor
rhizo

rhinocerebral and cutaneous in wounds.
uncontrolled diabetes or neutropenia

151
Q

most common bacterial gi bug

A

campylobacter or salmonella

152
Q

bacillus cereus

A

rice

153
Q

gastro viruses

A

rota

calici, adeno, astro etc…

154
Q

gastro parasites

A

giardia
cryptosporidium
entamoeba

155
Q

natural defences against gi bugs

A 
gastric acid- breaks down coating
bile salt- disrupts cell wall
normal flora- competition
mucosa- immunity and IgA
motility- clear it out!
156
Q

adult gut hands…..ml a day

A

6500

157
Q

fluid in stool per day

A

250ml

158
Q

ORS

A

coupled transport of sodium and glucose into enterocytes to water follows.

159
Q

3 types of enteric infection

A
  1. non-inflammatory: watery
  2. inflammatory
  3. penetrating
160
Q

non-inflammatory infection gi

A

clostridium, b. cereus, s aureus, crypto, rota, noro, ETEC, EPEC

161
Q

inflammatory gi infection

A

dysentery, shigella, c. diff, VTEC, entamoeba

162
Q

penetrating infection

A

typhi, yersinia

163
Q

investigating gi infection

A

stool
blood culture
microscopy for ova, cysts
specific typing

164
Q

ETEC

A

eneterotoxigenic- cholera like, hypersecretion

commonest bacteria diarrhoea in children in africa
uncommon england

165
Q

VTEC

A

verotoxigenic- kills cells, causes HUS

0157 normal cow flora

166
Q

EIEC

A

Enteroinvasive

167
Q

EPEC

A

Enteropathogenic

168
Q

haemorrhagic colitis

A

0157
diarrhoea–> bloodly abdo pain
low fever

169
Q

HUS

A

high urea, creatining, haemolytic anaemia, thrombocytopenia
fitting
need dialysis

170
Q

0157

A

doesn’t fermet SORBITOL

171
Q

E COLI treatment

A

ciprofloxacin

not for HUS.

172
Q

salmonella

A 
1-3 days
poulty
dairy products
summer
gut epithelium
watery diarrhoea
173
Q

complications of salmonella

A

can lead to colitis
bacteraemia (bones, joints)
reactive arthritis

174
Q

salmonella treatment

A

cipro

175
Q

commonest cause of shigellosis

A

s.sonnei

invade gut, destroy submucosa
infect cells
spread cell to cell
shiga toxin produced

176
Q

commonest cause of food poisoning

A

campylobacter

birds

177
Q

campylobacter

A

24h prodrome
watery diarrhoea
can be bloody
systemic rare

GUILLAIN BARRE SYNDROME

178
Q

gull wing morphology

A

campylobacter

179
Q

c diff

A

c diff toxin testing
stop or change antibiotics
fluids
treat with metronidazole or vanc

180
Q

viral GI tests

A

stool microscopy
stool immunoassay (rota)
stool PCR

181
Q

rotavirus

A 
dsRNA
no envelope
group A is human one
abrupt D and V (more diarrhoea)
mild fever
recover in 2 days
182
Q

calici viruses

A

noro and sapo

183
Q

norovirus

A

10-50 hours
explosive diarrhoea
lasts 1-2 days

184
Q

enteric adenovirus

A

hot places
watery
10 days incub

185
Q

Hep A-

A 
pico virus
no envelope
10-50 days incub
10 days prodrome
icteric phase- yellow, fever, ill (pale stool, dark urine)
convalescense
186
Q

Hep A may progress to

A

fulminant hep
cholestasis
relapsing hepatitis

187
Q

Hep A diagnosis and treatment

A

serology IgM
no treatment
notifiable disease
NHIG post exposure

give to IVDUs

188
Q

Hep E

A 
water
refugee camps
virus in stool during illness
undercooked pork, shellfish
old bloke
bad if preggers
no chronic progression in immunocompetent
40 days inc
189
Q

diagnose hep E

A

exposure IgG/IgM
no treatment
no prophylaxis

190
Q

hep b

A

acute, resolved infection OR chronic infection

sex, mum, IVDU
Hepadna virus
DNA
60-90 days
in children- fine
in adults- disease!
191
Q

treatment for hep B

A

antivirals not usually given
check liver function
transplant if need be

192
Q

chronic hep B

A

more than 6 months

193
Q

treat hep B

A

1st line: tenofovir or pegylated IFN.

lamivudine

194
Q

hep D

A

IVDU
sexual contact
fairly uncommon
friends with B.

prevent: pre or post exposure to HBV

195
Q

Hep C

A 
IVDUs
cirrhosis and hepatocellular carcinoma
liver transplant! 
flavivirus
hepacivirus
usually become chronic
usually don't notice the acute
196
Q

managment of hep C

A 
high dose inteferon
otherwise supportive
NOTIFIABLE
immunise against hep A and B
RIBAVIRIN
sustained virological response
197
Q

single cell parasites

A 
protozoa (malaria, giardia)
sporozoa- intracellular
flagellates
amoeba- blobs
cilliates- beating cilia.
198
Q

multicellular parasites

A

metazoa (helminths)

199
Q

ectoparasites

A

lice!

200
Q

Malaria 4 types

A

falciparum- KILLER (most common)
vivax- can take up to a year!
ovale
malariae

201
Q

malaria

A

7-30 days

202
Q

hypnozoites

A

reactivated years later

203
Q

symptoms of malaria

A 
Flu
respiratory- cough, pulmonary oedema
Gi- nausea, vomiting
CNS- headache, coma
Shock, acidosis, renal impairment, DIC, hypoglycaemia, speen rupture.
204
Q

malaria tests

A 
malaria film
malaria antigen test
FBC (reduced platelets)
clotting
U+E
culture
serology
pH
205
Q

viral haemorrhagic fever

A

Lassa
Marburg
Ebola

206
Q

malaria treatment

A

antimalarials (quinine, doxy, fansida, prima)
supportive therapy
consider exchange transfusion

207
Q

leishmaniasis

A

sandflies
diagnose- biopsy
treat- antimonials, pentamidine, amphotercin

208
Q

trypanosomiasis

A

sleeping sickness
tsetse fly
CHAGAS

209
Q

CHAGAS

A

big oesophagus
big colon
big heart

210
Q

helminths

A

eat it
inocculated by it
bit by it (and burrows)

211
Q

schistosomiasis

A

swimmer’s itch- trematode

haematobium
mansonii
japonicum

OVA IN URINE, STOOL OR BIOPSY.

212
Q

soil transmitted helminths

A

ascaris lumbricoides
strongyloides
hook work
cutaneous larva migrans

213
Q

hyatid disease

A

ecchinococcus

214
Q

filariasis

A

arthropod borne helminth

215
Q

acute bronchitis

A

influenza
RSV
rhino

216
Q

anthonisen criteria

A

COPD
if 2/3 give antibiotics

SOB
sputum volume
sputum purulence

217
Q

treatment for COPD

A

amoxicillin

218
Q

CAP

A

<48h
s.pneumoniae
narrow spectrum

219
Q

HAP

A

multi-resistant flora

broad spectrum

220
Q

aspiration causes… of CAP

A

10%

usually posterior upper right lobe.

221
Q

CURB 65

A 
Confusion
Urea >7
RR >30
BP 3: SEVERE- admit
2: non-severe, consider
1: non-severe, home
222
Q

sputum only good for

A

legionella

TB

223
Q

typical pneumonia

A

strep. pneumonia
lobar
amoxicillin sensitive
can use macrolides too

224
Q

atypical pneumonia

A 
multilobar
mycoplasma
chlamydia
coxiella
legionella
need a macrolide
225
Q

HiB vaccine ineffective against

A

non-capsular strains

226
Q

Hinfluenza needs

A

haem (X) and V to grow

sensitive to amoxicillin, cefuroxime, co-amoxiclav.

227
Q

mycoplasma resistant to beta lactams

A

because of no wall.

need to use macrolides, tetracyclines and quinolones.

228
Q

Legionella

A

survive and multiply in macrophages.
pontiac fever
severe pneumonia+organ damage=legionnaires disease)

macrolides, quinolones

229
Q

coxiella

A

Q fever
airborne, milk, faeces, animal urine.
SEROLOGY
chronic disease and endocarditis

treat with tetracycliens.

230
Q

CAP increasing treatment

A

amoxicillin oral
amox+erythro oral
ampicillin+erythro IV

231
Q

HAP treatment

A

co-amoxiclav/cefuroxime

but if recent drugs then third gen cephalosporin

232
Q

PJP

A 
Ch4<200
co-trimoxazole
pneumocystis
diagnose on induced sputum or lavage.
cannot be cultured.
233
Q

parapneumonic effusion

A

reactive, pH>7.2

234
Q

empyema

A

infected, pH<7.2 DRAIN

235
Q

haematogenous abscess usually due to

A

s.aureus

236
Q

rare lung abscesses

A

klebsiella
pseudomonas
fungi.

237
Q

mycobacterium

A

acid and alcohol fast.

air droplets.

238
Q

MTB complex

A

tuberculosis
bovis
leprae

239
Q

1 Tb to make infection

A

10 infected by 1

20 hours to replicate on a plate.

240
Q

tuberculin skin test (HEAF) (Mantoux)

A

cross reactivity of PPD with BCG.

<5mm- good response

a person who has been exposed to the bacteria is expected to mount an immune response in the skin containing the bacterial proteins.

241
Q

ELISPOT

A

detects IFN-gamma
each spot is a footprint of reaction to an antigen
VERY sensitive
rapid

242
Q

MDR TB

A

resistant to at least 2 main first line TB drugs

243
Q

XDR-TB

A

three or more of the 6 second line drugs.

244
Q

MOTT

A

mycobacterium other than TBx

245
Q

TB cavity contains 10^7 to 10^9 bacilli

A

spontaneous MDR is 1 in 10^14

246
Q

infective endocarditis

A

bacterial or fungal infection of a heart valve

or area of endocardium.

247
Q

mortality with IE

A

20%

248
Q

rheumatic fever used to be prime risk factor

A

but now rare

s.aureus and strep responsible for >80% now

249
Q

4 categories of IE

A

native valve infective
prostetic valve infective
IVDU associated
nosocomial

250
Q

Native valve IE

A 
congenital heart disease
rheumatic heart disease
mitral valve prolapse
degenerative valve lesions
STREP VIRIDANS
251
Q

Prosthetic valve IE

A

early or late

CoNS

252
Q

IVDU IE

A 
30 years
Males
right side more common
usually tricuspid valve
STAPH AUREUS
253
Q

nosocomial IE

A

usually underlying cardiac disease
IV lines, surgery
right sided.

254
Q

pathogenesis of IE

A 
heart defect
pressure gradient across valve
fibrin-platelet deposition
colonized
further depostion of thrombus
vegetation
255
Q

HACEK

A 
haemophilis aphrophilus
actinobacillus
cardiobacterium
Eikenella
Kingella
256
Q

culture negative causes of IE

A

Q fever
Chlamydia
Brucella

257
Q

strep and staph with IE

A

strep>staph

258
Q

symptoms of IE

A

malaise, pyrexia, murmur, Osler node, Janeway lesion, splinter haemorrhages
Roth spots
Splenomegaly
Cerebral emboli

259
Q

Definitive infective endocarditis

A
  1. positive blood culture (2 sites)- persistently positive.
  2. evidence of endocardial involvement (vegetation, abscess, regurg etc).
minor:
Fever
Immunological phenomena
microbiological evidence (but not enough for major)
Echo- consistnet
underlying heart condition
vascular phenomena
260
Q

IE bloods

A

normal anaemia, raised WCC, raised CRP, raised ESR

261
Q

complications of IE

A 
cardiac failure
embolisation
acute renal failure
mycotic aneurysms
death
262
Q

in most cases of IE….

A

4 weeks of therapy required (parenteral)

263
Q

neutropenic sepsis

A

<0.5 x 10^9 AND
temperature
or other signs

264
Q

85% of infections are due to

A

endogenous flora

265
Q

door to needle

A

1 hour

fever in neutropenia

266
Q

which drug for suspected sepsis?!

A

anti-pseudomonal taz or meropenem or ceftazidime

start empiric therapy then consider need to broader OR add gent at 2-3 days

267
Q

ciprofloxacin for duration of neutropenia

A

–

268
Q

protective isolation

A

HEPA

269
Q

meningitis in HIV

A

cryptococcus neoformans

270
Q

primary prophylaxis in HIV

A

give Abx when CD4<200

271
Q

protein deficiency and hypo/asplenism

A

cause b cell loss

272
Q

Erysipelas

A

Group A strep

273
Q

Erysipeloid

A

Erysipelothrix

274
Q

Erythrasma

A

Corynebacterium

275
Q

Cellulitis

A

Strep usually.

276
Q

scarlet fever

A

group A strep

desquamation 2-5 days later

277
Q

Scalded skin

A

group A strep

278
Q

Toxic shock syndrom

A

group A strep

279
Q

necrotising fasciitis types

A

1=poly (pre existing conditions)

2=group A strep (IVDU)

280
Q

clostridial cellulitis

A

gas gangrene

281
Q

regiment for necrotising fasciitis

A

meropenem + vanc

imepenem + vanc

282
Q

gas gangrene

A

usually the result of trauma
clostridia spores on wound
can happen after bowel surgery
gas bubble under diaphragm

283
Q

gas gangrene treamtent

A

benpen + gent +metronidazole!
surgery vital!

only 2 hyperbaric chambers in england (not used

284
Q

sepsis

A

evidence of infection and evidence of systemic response

285
Q

severe sepsis

A

infection + SIRS= sepsis

286
Q

septic shock

A

sepsis + hypoperfusion/organ dysfunction/hypotension

287
Q

SIRS

A

temp above 38 below 36
hr below 90
RR >20
WCC >12 or <4

systemic inflammatory response syndrome

288
Q

septic shock

A

severe sepsis refractory to fluid

289
Q

cell pathogen interaction

A

classical pathway or
MB lectin pathway and
complement pathway

290
Q

pro inflammatory cytokines

A

TNFalpha
IL1
IL6

291
Q

complement cascade

A

recruitment of inflammatory cells
lysis of pathogen
opsonisation of pathogen

292
Q

Platelet activation factor

A

causes inccreased platelet aggregation
TNF causes increased permeability
No causes loss of contractility of vascular smooth muscle

293
Q

TNFalpha and IL1 activate the

A

coagulation cascade

294
Q

heart in sepsis

A

initial bounding pulse

then cold, clammy, poor pulse

295
Q

NO on the tissues

A

causes damage

toxins release by pathogens also damage the tissue.

296
Q

early sepsis

A

respiratory alkalosis
oliguria

consider vasopressor agents

297
Q

late sepsis

A

increase lactate!
metabolic acidosis
decreased capillary refill

consider inotropic agents.

298
Q

SOFA

A

score for organ failure.

sequential organ failure assessment

299
Q

HIV envelope

A

GP 120 and 41
specific binding to CD4 cells
coreceptors on host cells are required for viral entry.

300
Q

types of virus

A

lymphotrophic and macrophage trophic

(lymphotrophic predominant later in course of infection

301
Q

innate immunity

A

no memory

302
Q

adaptive immunity

A

specific and memory

303
Q

b cells

A

from bone marrow
respons to antigen
need T cell help

304
Q

T cell

A

thymus
recognizes antigents
CD4- helper (type 2 MHC)
CD8- killer (type 1 MHC)

305
Q

big 5 foodborne illnesses

A 
salmonella
campylobacter
e.coli
listeria
clostridium
306
Q

mandatory surveillance

A

MRSA
c.diff
e.coli
surgical site infections

307
Q

contact tracing for

A

Meningococcal
H. influenza
TB
Strep A

308
Q

conjugation vaccine

A

attachment of a carrier protein to a polysaccharide antigen

309
Q

PCV

A

children under 2

13 types

310
Q

PPV

A

over 65

23 types

ACS (4 decks)

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