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Respiratory > Microbiology > Flashcards

Microbiology Flashcards

1
Q

what is the clinical presentation of influenza?

A 
fever: high, abrupt onset
malaise
myalgia
headache
cough (initially dry, painless- becomes productive and painful)
prostration (extreme physical weakness)
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2
Q

what are the 2 important types of classical flu?

A

influenza A

influenza B

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3
Q

what is haemophilus influenzae?

A

a Gram-negative, aerobic, small bacilli

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4
Q

how is influenza transmitted?

A

droplets or direct contact with infected respiratroy secretions

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5
Q

what are the 5 major complications of influenza?

A
  1. primary influenza pneumonia
  2. secondary bacterial pneumonia
  3. bronchitis
  4. otitis media
  5. pregnancy complications
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6
Q

what is otitis media?

A

infection of the middle ear

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7
Q

what type of complications can occur if patient gets influenza during pregenancy?

A

perinatal mortality
prematurity
smaller neonatal size lower birth weigh

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8
Q

what is the treatment of flu?

A

bed rest
fluids
paracetamol

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9
Q

when should antivirals be given in the treatment of flu?

A

only when patient iss at risk of complications

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10
Q

what is an antigenic drift?

A

minor mutations in the antibody binding sites

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11
Q

what is an antigenic shift?

A

process by which 2 or more different strains of virus combine to form a new subtype having a mixture of the surface antigens

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12
Q

what types of influenzae can go through antigenic drift?

A

influenza A

influenza B

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13
Q

what types of influenzae can go through antienic shift?

A

influenza A only

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14
Q

what type of mutations to the influenzae virus cause epidemics?

A

antigenic drifts

influeza A or B

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15
Q

what type of mutations to the influenzae virus cause pandemics?

A

antigenis shift
segmented genome
animal reservoi/mixing vessel
(influenza A only)

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16
Q

what is the name of the H1N1 sub type of influenzae A?

A

swine flu

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17
Q

what is the best way for direct detection of the influenza virus?

A

PCR using nasopharyngeal/throat swabs or other respiratory samples

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18
Q

what is an indirect way to detect the influenza virus?

A

antibody detection

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19
Q

what 2 types of vaccines used for the prevention of flu?

A

killed vaccine

live attenuated vaccine

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20
Q

who is the killed influenza vaccine given to?

A

adult patients at risks of complications
health care workers
children 6 months - 2 years at risk of complications
(annually)

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21
Q

who is the live attenuated vaccine given to?

A

offered to
all children 2-5
all primary school children
(because live attenuated vaccine more effective in children 2-17 than killed vaccine)

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22
Q

how is the live attenuated vaccine given?

A

intra-nasally

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23
Q

what bacteria are known as ‘atypical pneumonia’?

A

mycoplasma pneumoniae
coxiella burnetti
chlamydophila psittaci/pneumoniae

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24
Q

what antibiotics do atypical pneumonia respond to?

A

tetracycline and macrolides

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25
Q

what are the 2 main ways to get lab confirmation ofmycoplasma, coxiella and chlamydophila?

A 
serology
virus detection (PCR on resp swabs/secretions)
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26
Q

what 2 disesaes does Coxiella burnetii cause?

A

pneumonia

pyrexia of unknown origin (Q fever)

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27
Q

Coxiella burnetii is a zoonotic bacteria, what does this mean?

A

an animal infection orginally

sheep and goats

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28
Q

what is a major complication of Coxiella burnetii?

A

culture negative endocarditis

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29
Q

Chlamydophila psittaci is a zoonotic bacteria, what animal is it caught from?

A

pet birds

parrots, budgies, cockatiels

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30
Q

what does Chlamydophila psittaci cause?

A

Psittacosis

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31
Q

what does psittacosis usually present as?

A

pneumonia

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32
Q

how does bronchiolitis usually present?

A 
1st/2nd year of life
fever
coryza
cough wheeze
severe:
(grunting
decreased PaO2
intercostal/sternal indrawing)
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33
Q

what are the 2 major severe cimplications of bronchiolitis?

A

respiratroy failure

cardiac failure

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34
Q

what are >90% of bronchiolitis cases caused by?

A

respiratroy syncytial virus

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35
Q

how is RSV confirmed?

A

PCR on throat/pernasal swab

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36
Q

what is the treatment for RSV?

A

supportive therapy

37
Q

what is the one treatment for RSV which was made but was shown not to reduce mortality and so is not widely used?

A 
monoclonal antibody
(passive immunisation)
38
Q

what is the second most common cause for bronchiolitis?

A

metapneumovirus

39
Q

how is metapneumovirus confirmed?

A

PCR on throat/nasopharyngeal swab

40
Q

what is chlamydia trachomatis?

A

an STI which can cause infantile pneumonia

41
Q

how is chlamydia trachomatis diagnosed?

A

PCR on urine of mother or pernasal/throat swabs of child

42
Q

how is chlamydophila pneumoniae spread?

A

person to person

43
Q

what does chlamydophila pneumoniae cause?

A

mild respiratory infection

44
Q

what are 4 important infections of the trachea and bronchi?

A

acute epiglottitis
acute exacerbations of COPD
cystic fibrosis
pertussis (whooping cough)

45
Q

what causes acute epiglottitis in children aged 2-7 years old?

A

haemophilus influenzae

46
Q

why can’t you do a normal mouth inspection if you suspect epiglottitis?

A

because if you push the tongue down the epiglottis will move to the top to cover the airways. if the epiglottis is inflamed it might stick to the top and not come down causing respiratory obstruction

47
Q

what is a test that identifies H. influenzae?

A

‘X and V’ test

H. influenzae needs both factors X and V to grow

48
Q

where is the habitat of Haemophilus influenzae as part of the normal flora?

A

upper respiratory tract

49
Q

why do you culture Haemophilus influenzae on chocolate agar instead of blood agar?

A

chocolate agar makes nutrients more readily accessible

50
Q

what is the treatment for acute epiglottitis?

A

ITU and ceftriaxone (a 3rd generation cephlasporin)

51
Q

why is acute epiglottits relatively rare now?

A

most children get a HIB vaccination

52
Q

what are the clinical signs of an infective exacerbation of COPD?

A

sputum gets worse and changes from clear to green (purulent)

53
Q

what are the 3 most common bacterial organisms associated with an acute exacerbation of COPD?

A

haemophilus influenzae
streptococcus pneumoniae
moraxella catarrhalis
(all present in normal upper respiratory tract flora, but in COPD colonise lower airways- pathological)

54
Q

when do you give antibioitcs for an acute exacerbation of COPD?

A

if sputum is purulent
or signs of consolidation on CXR
or signs of pneumonia

55
Q

what is the 1st line treatment of an infective exacerbation of COPD?

A

amoxicillin 500mg

3x per day (5 days)

56
Q

what is the 2nd line treatment of an infective exacerbation of COPD?

A 
doxycycline 200mg (day 1)
100mg (day 2-5)
57
Q

what is Cystic Fibrosis?

A

an inherited defect which leads to abnormally viscid mucus which blocks tubular structures in many different organs including lungs)

58
Q

in young CF patients what is the most likely bacteria to be causing infection?

A

staph aureus

haemophilus influenzae

59
Q

in older CF patients, what are the extermely resistant organisms that can cause infection?

A

pseudomonas aeruginosa

burkholderia cepacia

60
Q

what oral antibiotic covers pseudomonas aeruginosa?

A

ciprofloxacin

61
Q

what IV antibiotics cover pseudomonas aeruginosa?

A

gentamycin

tayzocin

62
Q

what is the organism that causes whooping cough?

A

bordetella pertussis

63
Q

how would you describe the timing of coughing in whooping cugh?

A

paroxysmal coughing

repeated violent exhalations with sever inspiratory whoop

64
Q

what treatment do you use for borderella pertussis? (whooping cough)

A

erythromycin

65
Q

what is the clinical features of a patient with CAP?

A

cough
sputum production
dyspnoea
fever

66
Q

what is the most common cause of CAP?

A

Strep pneumoniae

67
Q

What are the main causes of CAP?

A

strep pneumonia
atypicals/viruses
staph aureus
haemophilus influenzae

68
Q

when does staph aureus usually cause CAP?

A

as a secondary bacterial pneumonia after the flu

69
Q

describe Strep pneumoniae?

A

gram positive cocci in pairs/short chains, alpha haemolytic

70
Q

why are atypicals not sensitive to penicillins?

A

because they have a strange cell wall (penicillin usually inhibits cell wall)

71
Q

if the pnemonia is mild what is the likely causative organism?

A

strep pneumoniae

72
Q

if the CAP is mild (CURB65 0 or 1) what is the treatment? (if oral route available)

A

amoxicillin 1g TDS PO (5 days)

penicillin allergic:
doxycycline 200mg PO (day 1), 100mg (day 2-5)

73
Q

if the CAP is mild (CURB65 0 or 1) what is the treatment? (oral route unavailable)

A

amoxicillin 1g TDS IV (5 days)

penicillin allergic:
clarithromycin 500mg BD IV (5 days)

74
Q

if the CAP is moderate (CURB65 2) what is the treatment?

A

amoxicillin 1g TDS IV/oral (5 days)

penicillin allergic:
doxycycline 200mg PO (day 1), 100mg PO (day2-4)

if penicillin allergic and IV required:
clarithromycin 500mg BD IV (5 days)

75
Q

if the CAP is severe (CURB65 3+) what is the treatment?

A 
Co-amoxiclav 1.2g TDS IV (7 days)
PLUS
clarithromycin 500mg BD IV (7 days)
or
doxycycline 100mg BD PO (7 days)

if penicillin allergic:
Levofloxacin 500mg BD IV (7 days, monotherapy)

76
Q

what are 5 predisposing factors to hospital acquired pneumonia?

A 
intubation
ICU
antibiotics
surgery
immunsuppression
77
Q

what are the clinical features of legionella pneumophila?

A

flu-like illness which may progress to severe pneumonia
mental confusion
acute renal failure
GI symptoms

78
Q

what is legionella pneumophila associated with?

A

travel

water

79
Q

how do you diagnose legionella?

A

legionella urinary antigen
serology
PCR test on sputum

80
Q

what is the tereatment for legionella?

A

erythromycin/clarithromycin
fluroroquinolones eg levofloxacin
(legionella is a atypical so penicillin cant be used)

81
Q

what type of pneumonia do patients with AIDS get?

A

pneumocystis jiroveci

PCP

82
Q

how do you diagnose pneumocystis jiroveci?

A 
bronchioalvelar lavage (BAL)
induced sputum
direct immunofluorescence (antigen detection)
83
Q

what is the treatment for pneumocystis jiroveci?

A

co-trimoxazole

84
Q

how long does it take for mycobacterium tuberculosis to be grown on culture?

A

up to 3 months

85
Q

how do you test for mycobacteria?

A

positive test to acid and alcohol fast bacili

TB PCR

86
Q

what is the con about acid and alcohol dast bacili testing?

A

doesnt give an indication of species or antibiotic sensitivity

87
Q

what is good about PCR for TB?

A

provides information on species and sensitivity

88
Q

what are the pros and cons about culturing TB?

A

provides best information on antibiotic sensitivity

but very slow

89
Q

when taking a sputum culture why do you want as little saliva as possible?

A

saliva will have normal flora, you want to isolate causal pathogen as much as possible

Respiratory (10 decks)

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