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Microbiology Flashcards

1
Q

What is post-primary tuberculosis?

A

aka secondary TB.

Due to reactivation of latent M. tuberculosis or reinfection with M. tuberculosis.

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2
Q

What part of the lungs does post-primary TB usually affect?

A

Lung apices

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3
Q

What is the classic lesion in post-primary TB?

A

caseating granuloma.

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4
Q

by what processes does the lesion in post-primary TB heal?

A

fibrosis and calcification

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5
Q

What is a Ghon focus?

A

Primary lesion, usually subpleural, caused by M. tuberculosis.

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6
Q

Granulomatous conditions have a certain type of large cell usually found in them, what is that cell?

A

Langhans Giant Cells

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7
Q

What is the first-line treatment in tuberculosis and for how long?

A

RIPE

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

1st two: 6 months. 2nd two: only first 2 months.

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8
Q

Side effects of Rifampicin?

A

orange secretions

hepatotoxicity

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9
Q

Side effects of Isoniazid? what can you give to combat one of the side effects?

A

peripheral neuropathy - give B6/pyridoxine

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10
Q

Lowenstein-Jensen medium is a growth medium commonly used to grow what?

A

M tuberculosis.

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11
Q

Ziehl-Neelsen staining is used to detect what specific type of microorganisms?

A

Acid-Fast bacteria

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12
Q

A positive Ziehl-Neelsen stain will appear what colour?

A

Red stain = acid-fast bacteria

Blue stain = non-acid fast

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13
Q

What are the components of the CURB-65 score?

A 
Confusion of new onset
blood Urea nitrogen greater than 7mmol/l
Respiratory rate greater than 30
Blood pressure lower than 90mmHg systolic or 60mmHg diastolic
65 years or older.
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14
Q

The CURB-65 score is used for what?

A

predicting mortality in community acquired pneumonia

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15
Q

Rusty-coloured suputum is associated with what infection?

A

Streptococcus Pneumonia

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16
Q

What microscopic appearance does Streptococcus Pneumonia have?

A

diplococci

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17
Q

What microscopic appearance does klebsiella pneumonia have?

A

rod

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18
Q

What microscopic appearance does staphylococcus have?

A

cocci, grape-bunch clusters

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19
Q

What microscopic appearance does mycobacterium cararrhalis have?

A

coccus

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20
Q

What microscopic shape does Haemophilus influenza have?

A

cocco-bacilli

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21
Q

Cold agglutinin test can be used in detecting what bacterial infection?

A

Mycoplasma pneumonia

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22
Q

What antibiotics would you prescribe for a mild-moderate Community Acquired Pneumonia with classical bacteria and for how long?

A

Amoxillin or a Macrolide (5-7 days)

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23
Q

What antibiotics would you prescribe for moderate-severe community acquired pneumonia with classical bacteria and for how long?

A

Clarithromycin + Co-amoxiclav/Cefuroxime (2-3 weeks)

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24
Q

What antibiotic would you use for atypical community acquired pneumonia?

A

Macrolide/tetracycline

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25
Q

What is 1st line antibiotic treatment for hospital acquired pneumonia?

A

Ciprofloxacin +/- Vancomycin

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26
Q

Genital ulcers in herpes can be painful or painless?

A

Painful

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27
Q

Genital ulcers in syphilis can be painful or painless?

A

Painless

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28
Q

What type of bacteria is Neisseria gonorrhoeae?

A

Gram negative diplococcus

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29
Q

Opthalmia neonatorum is caused by what organism(s)?

A

Neiserria gonorrhoeae or Chlamydia trachomatis

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30
Q

Who does opthalmia neonatorum affect and what symptoms does it produce?

A

It affects newborns

neonatal conjunctivitis: pain/tenderness of eyeball; conjuctival discharge; swollen eyelids.

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31
Q

What can people with complement deficiencies get with gonococcal infections?

A

Disseminated gonococcal infections –> septicaemia, rash and/or arthritis.

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32
Q

What does NICE recommend to prescribe for uncomplicated anogenital gonorrhoea?

A

Ceftriaxone 500mg IM as a single dose, plus azithromycin 1g orally.

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33
Q

Cephalosporins are bactericidal or bacteriostatic?

A

Bactericidal

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34
Q

Cephalosporins belong to what class of antibiotics?

A

B-lactams

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35
Q

What are the B-lactams’ mode of action?

A

Bacteriocidal.

B-lactams irreversibly bind to penicillin-binding proteins which prevents final crosslinking of peptidoglycan layers in cell wall synthesis.

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36
Q

What gram type is Chlamydia trachomatis?

A

Gram-negative

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37
Q

What colour are gram positive bacteria upon staining?

A

Purple (P for positive/purple)

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38
Q

What colour are gram negative bacteria upon staining?

A

Red/pink

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39
Q

What are the different biovars of chlamydia trachomatis and what conditions do each cause?

A

Biovar = a strain within a species

Serovars A, B, C: Trachoma = infection of the eyes –> blindness

Serovars D-K: CUPPP (neonatal Conjuctivitis, Urethritis, ectopic Pregnancy, Pelvic inflammatory disease, neonatal Pneumonia)

Serovars L1-3: Lymphogranuloma venereum

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40
Q

What is NICE first-line treatment for Chlamydia?

A

Azithromycin 1g single dose OR doxycycline 100mg BD for 7 days.

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41
Q

What is NICE treatment for Chlamydia infection in pregnant/breastfeeding women?

A

Azithromycin 1g single dose OR
Amoxicillin 500mg TDS for 7 days OR
Erythromycin 500mg QDS for 7 days

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42
Q

What organism is lymphogranuloma venereum caused by?

A

Chlamydia trachomatis

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43
Q

What site-specific signs/symptoms can lymphogranuloma venereum present with?

A

External sex organs: abscesses in the groin (around draining lymph nodes)

Rectal: Proctocolitis

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44
Q

The primary stage of lymphogranuloma venereum occurs how long after infection?

A

3-12 days after infection

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45
Q

The secondary stage of lymphogranuloma venereum occurs how long after infection?

A

10-30 days later or even up to six months after infection.

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46
Q

What sign/symptom do people get in primary lymphogranuloma venereum?

A

Painless genital ulcer.

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47
Q

What signs/symptoms can people get in secondary lymphogranuloma venereum?

A

unilateral painful buboes (enlarged lymph nodes)

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48
Q

What is first-line treatment for lymphogranuloma venereum? An alternative?

A

Doxycycline 100mg BD for 21 days

alternative: Erythromycin QDS for 21 days.

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49
Q

What organism causes syphilis?

A

Treponema pallidum

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50
Q

Treponema pallidum is what gram-type?

A

negative

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51
Q

What blood tests can we use to diagnose syphilis?

A

Non-treponemal tests: Venereal Disease Research Laboratory (VDRL) and Rapid Plasma Reagin

Treponemal tests:
Treponemal pallidum particle agglutination (TPHA) or Fluorescent Treponemal Antibody Absorption (FTA-Abs)

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52
Q

What signs may a person have with primary syphilis?

A

Macule –> papule –> ulcer/erosion.

1-12 weeks following transmission.

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53
Q

What is a chancre?

A

Painless solitary ulceration associated with treponema pallidum infection. Appear approximately 3 weeks after infection.

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54
Q

Condylomata lata are associated with what organism?

A

Treponema pallidum

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55
Q

What skin symptoms can secondary syphilis present with?

A

Symmetrical, reddish, non-itchy maculopapular/pustular rash on the trunk, palms and/or soles.

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56
Q

What non-specific symptoms can syphilis present with?

A

Fever
Sore throat
Weight loss
Headache

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57
Q

How long after initial infection does tertiary syphilis present?

A

YEARS, like 3-40 years later.

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58
Q

What three different forms of tertiary syphilis are there?

A

Gummatous syphilis
late neurosyphilis
cardiovascular syphilis

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59
Q

What form in gummatous syphilis and where?

A

Gummas - soft, tumour-like balls of inflammation.

Can affect skin, bone, liver but can occur anywhere.

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60
Q

What are Argyll Robertson pupils and what are they a sign of?

A

Small pupils that constrict to near objects (accomodate) but do not constrict in response to bright light.

Sign of neurosyphilis, diabetic neuropathy.

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61
Q

What is General Paresis?

A

neuropsychiatric disorder caused by chronic meningoencephalitisi leading to cerebral atrophy in neurosyphilis.

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62
Q

What is Tabes Dorsalis?

A

Demyelination of the dorsal columns in the spinal cord

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63
Q

What are late symptoms of neurosyphilis?

A

General paresis, Tabes Dorsalis, Menigovascular syphilis

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64
Q

What is first-line treatment for syphilis?

A

Benzathine benzylpenicillin

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65
Q

The Jarisch-Heimer reaction is classically caused by what?

A

Antibiotic treatment of syphilis.

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66
Q

How soon does a Jarisch-Heimer reaction occur and what are the signs/symptoms?

A

Hours after administration of antibiotics.

Fever, chills, rigor, hypotension, tachycardia, myalgia, flushing - it mimics septicaemia basically!

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67
Q

What organism causes chancroid? and what gram-type is it?

A

Haemophilus ducreyi: gram-negative.

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68
Q

What is a chancroid?

A

Painful ulcer, can be found around inguinal lymph nodes

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69
Q

What organism causes Granulom inguinale and what Gram-type is it?

A

aka Donovanosis

Klebsiella granulomatis: gram-negative.

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70
Q

What do we do to diagnose granuloma inguinale?

A

Giemsa stain

Look for Donovan bodies in tissue biopsy

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71
Q

What organism causes trichomoniasis?

A

Trichmonas vaginalis

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72
Q

What can you prescribe in trichomoniasis?

A

Metronidazole

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73
Q

What organism causes molluscum contagiosum?

A

DNA poxvirus, aka molluscum contagiosum virus.

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74
Q

Which organism can cause genital warts?

A

Human Papillomavirus 6 or 11.

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75
Q

Which HPV types are associated with cervical/anal/penile cancers?

A

16 and 18

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76
Q

What is Tinea?

A

Common fungal infection of the skin, e.g. Athelete’s foot.

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77
Q

What are the signs/symptoms in Tinea versicolor?

A

Fine-scaling of the skin

Hypopigmentation eruption on trunk/proximal extremities.

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78
Q

Polyenes antimycotics work by what action?

A

Bind to ergosterol in fungal cell membrane, reduce integrity and can cause K/Na loss.

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79
Q

Azole antimycotics work by what action?

A

Inhibit lanosterol–>ergosterol conversion in cell membrane thereby inhibiting cell growth.

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80
Q

How do echinocandins work?

A

Inhibit glucan synthesis in cell walls

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81
Q

Herpes Simplex Virus is ssDNA or dsDNA?

A

dsDNA

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82
Q

Which organism causes Mollaret’s Meningitis?

A

HSV

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83
Q

What is Mollaret’s meningitis?

A

benign recurrent aseptic meningitis >4 weeks

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84
Q

Signs/symptoms of Mollaret’s meningitis?

A 
Meningism (Neck stiffness, photophobia, irritation)
CSF pleocytosis (increased cell count) with large endothelial cells.

Symptom-free periods of weeks/months inbetween bouts.

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85
Q

Primary infection in the ocular region with HSV can manifest in what condition, the symptoms/signs of which are?

A

Herpetic keratitis

Blepharoconjuctivitis (swelling of lids and conjuctiva)
Lid vesicles

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86
Q

Define a dendritic ulcer?

A

A linear branching corneal ulcer.

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87
Q

What symptoms might a person with a dendritic ulcer complain of?

A

Sensation of foreign-body
Redness
Light sensitivity
Blurred vision

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88
Q

In what condition do dendritic ulcers usually appear?

A

Herpetic Keratitis

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89
Q

Disciform keratitis usually manifests itself how?

A

Disc shaped area of corneal oedema

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90
Q

Disciform keratitis is caused by what organism?

A

HSV

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91
Q

In which trimester of pregnancy is the foetus at greatest risk when the mother has a primary HSV infection?

A

3rd trimester

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92
Q

Which HSV is the usual suspect in viral encephalitis?

A

HSV-1

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93
Q

What are some symptoms of herpesviral encephalitis?

A

CCC

Confusion
Changes in personality
Consciousness reduced

as well as …
N+V, fever, focal neurology

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94
Q

What one test would you like to perform to confirm a diagnosis of herpesviral encephalitis? What are you looking for?

A

Lumbar puncture and analyse CSF.

Look for:
Lymphocytic pleiocytosis
Presence of virus - PCR

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95
Q

How would you treat somebody you suspect of herpesviral encephalitis?

A

IV acyclovir ASAP!

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96
Q

What are the signs/symptoms of herpes gladiatorum?

A

Scrum pox (painful blisters around the neck, face, chest, stomach, legs; inguinal lymphadenopathy)

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97
Q

Tzanck cells can be found in what infections?

A

‘Her Very Heavy Pearly Case’

Herpes Simplex
Varicella + Herpes Zoster
Pemphigus vulgaris
Cytomegalovirus

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98
Q

If indicated, what would you prescribe for chickenpox?

A

Aciclovir

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99
Q

Shingles is caused by what infection?

A

Herpes Zoster

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100
Q

What is the presentation of congenital cytomegalovirus infection?

A

Generalised: IUGR; Microcephaly; Chorioetinitis; Thrombocytopenia; Hepatosplenomegally; Impaired IQ.

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101
Q

What diseases are immunocompromised patients at risk of when exposed to CMV infection?

A

CHERP

CMV Colitis
CMV Hepatitis
CMV Esophagitis
CMV Retinitis
CMV Pneumonitis
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102
Q

What would you prescribe to an immunocompromised patient with CMV infection?

A

Ganciclovir

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103
Q

What infection causes roseola infantum?

A

HSV 6 and HSV 7 aka Roseola Virus

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104
Q

Who is most likely to develop roseola?

A

Children under 2 years old

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105
Q

What is a typical presentation in a patient with Roseola?

A

A few days of fever, subsides and then a red rash appears spreading to legs/neck.

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106
Q

What might you prescribe to a patient with Roseola?

A

Ganciclovir, foscarnet or cidofovir

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107
Q

What is the characteristic presentation of infectious mononucleosis?

A

Triad of:
Fever
Sore throat
Lymphadenopathy

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108
Q

What type of rash can a person develop in infectious mononucleosis?

A

Maculopapular rash

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109
Q

A positive monospot test indicates what?

A

Epstein-Barr Virus infection

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110
Q

The monospot test responds to the presence of what specifically?

A

antibodies produced in response to EBV

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111
Q

Which infection is associated with Kaposi’s sarcoma?

A

HHV-8

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112
Q

What does PUO stand for?

A

Pyrexia of Unknown Origin

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113
Q

What is the classical definition of PUO?

A

> 38.8C fever
Persisting >3 weeks
Despite >1 week of intensive investigations

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114
Q

What conditions are classed as ‘classical PUO’

A

5 categories:

1) Infections
2) Neoplasms
3) Connective Tissue Diseases
4) Miscellaneous (e.g. alcoholic hepatitis, granulomatous conditions)
5) Undiagnosed

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115
Q

How can you define nosocomial PUO?

A

Pyrexia that develops in patients that have been in hospital >24 hours

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116
Q

Causes of nosocomial PUOs?

A

Think of a patient lying on a bed post-surgery:

Surgery
Immobilisation
IV lines
Urinary catheters 
Drugs
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117
Q

How can you define neutropaenic PUO?

A

Pyrexia with neutropaenia (

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118
Q

Causes of a neutropaenic PUO?

A

Chemotherapy

Haematological malignancies

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119
Q

What are the different classes of PUO?

A

1) Classical
2) Nosocomial
3) Neutropaenic
4) HIV-associated

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120
Q

Which organism causes Typhoid? What gram-type is it?

A

Salmonella typhi

Gram negative

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121
Q

What is Faget sign?

A

Fever paired with bradycardia

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122
Q

What skin changes can be seen in Typhoid?

A

Rose spots (red macules 2-4mm )

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123
Q

What are the symptoms of untreated Typhoid?

A

Fever, abdominal pain, headache, epistaxis, exhaustion.

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124
Q

What test do you want to perform to confirm your diagnosis of Typhoid?

A

Blood or stool cultures

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125
Q

What is first-line treatment of Typhoid?

A

IV fluids

Fluoroquinolones, e.g. ciprofloxacin.

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126
Q

Which species cause malaria?

A 
P. Falciparum
P. Vivax
P. Ovale
P. Malariae
P. Knowlesi
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127
Q

On a blood film you see:

Young trophozoites alonside crescent-shaped gametocytes.

What is the cause?

A

P. Falciparum

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128
Q

A patient with P. Falciparum would show what on a blood film?

A

Young trophozoites (rings). Crescent-shaped gametocytes.

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129
Q

How can you treat P. Falciparum?

A

One option is using ‘Artemisinin based combination therapies’ aka ACTs.

Another option is Quinine plus tetracycline/doxycycline/clindamycin for 7 days.

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130
Q

You see a blood film report: ‘Schuffner’s dots’ are present. What could have caused this?

A

P. Vivax or P. Ovale.

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131
Q

In malarial investigations, what can we use a thick film for?

A

Detect the presence of parasites

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132
Q

In malarial investigations, what can we use a thin film for?

A

Distinguishing malarial species

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133
Q

What are the classic triad of symptoms in botulism?

A

1) bulbar palsy (CN IX, X, XI, XII) and descending paralysis
2) lack of fever
3) clear sense and mental status

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134
Q

Classical sources of botulinum toxin?

A 
Honey (children)
Canned food
Open wound
Inhalation (lab workers)
Inappropriate injection
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135
Q

What gram-type is Clostridium Botulinum?

A

Gram Positive

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136
Q

Sources of C. Perfringens?

A

Reheated/poorly heated meats
Decaying vegetation
Faeces
Marine sediment

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137
Q

Effects of C. Perfringens infection?

A

Food poisoning - third most common cause of food poisoning in the UK.

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138
Q

Signs/symptoms of C. dificile?

A 
>3 watery stools in 24 hour period
Recent Abx exposure
Abdominal pain
Fever
Foul odour stool
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139
Q

Sources of Bacillus cereus?

A

Poorly refrigerated cooked rice, milk or infant formula.

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140
Q

What is the route of transmission for E. coli?

A

faeco-oral route

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141
Q

Which enterotoxins does ETEC produce?

A

LT and ST enterotoxins

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142
Q

What are the effects of ST enterotoxin produced by ETEC?

A

stimulates cGMP accumulation in target cells

leads to fluid/electrolyte moving into intestinal lumen

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143
Q

What gram-type is E. Coli?

A

Negative

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144
Q

What gram-type is Salmonella?

A

Negative

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145
Q

What gram-type is Shigella?

A

Negative

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146
Q

Through what route does Shigella invade the host?

A

Through M cells within the small intestine

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147
Q

Common symptoms of Shigella infection?

A 
Diarrhoea
Nausea
Vomiting 
Fever
Stomach cramps
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148
Q

What gram-type is Yersinia enterocolitica?

A

Negative

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149
Q

What is the usual source of Yersinia enterocolitica?

A

Poorly cooked pork

Contaminated water, meat, milk

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150
Q

Symptoms of Yersinia enterocolitica?

A

Diarrhoea
Fever
Mimics shigella infection/appendicitis
Later, lymphadenopathy

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151
Q

What conditions is Yersinia enterocolitica associated with?

A

Reactive arthritis

Erythema nodosum

152
Q

What is a common source of Vibrio parahaemolyticus?

A

raw, undercooked seafood

153
Q

Vibrio parahaemolyticus is what gram-type?

154
Q

What are three types of Vibrio vulnificus infections?

A

Acute gastroenteritis - consuming raw, undercooked seafood

Necrotising skin wounds - contamination from contaminated waters

Septicaemia

155
Q

Sources of campylobacter jejuni?

A

Poultry

Unpasteurised milk

156
Q

What gram-type is Campylobacter jejuni?

157
Q

Is Campylobacter jejuni aerobic or anaerobic?

A

Microaerophilic

158
Q

What would you prescribe for Campylobacter jejuni infection?

A

Erythromycin or Ciprofloxacin

159
Q

What gram-type is Listeria monocytogenes?

160
Q

Signs and symptoms of a Listeria monocytogenes infection?

A

Diarrhoea
Fever
Muscle aches

161
Q

What is the treatment of choice for Listeria infection?

A

Ampicillin

162
Q

What type of organism is Entamoeba Histolytica?

163
Q

What is the active form of Entamoeba Histolytica and where can it be found?

A

Trophozoite

Within host or fresh faeces

164
Q

How is entamoeba histolytica transmitted and in what form is it found?

A

Consumption of contaminated food/drink

Exists as a cyst outside of the human body

165
Q

A pathology report comes back describing ‘flask-shaped ulcers’ on bowel histology. What’s the cause?

A

Entamoeba Histolytica

166
Q

What is the characteristic lesion caused by Entamoeba Histolytica?

A

Flask-shaped ulcer

167
Q

What is tenesmus?

A

A recurrent inclination to evacuate the bowels.

168
Q

What could you prescribe for somebody with entamoeba histolytica intestinal infection?

A

Metronidazole and paromomycin

169
Q

What type of organism is Giardia lamblia?

170
Q

In the faeces of an unwell patient you find a cyst with 4 nuceli and a retracted cytoplasm. What could be causing this?

A

Giardia lamblia

171
Q

Signs and symptoms of Giardiasis?

A

Loose/watery stools
Diarrhoea
Bloating
Sulphurous burping

172
Q

What test would you like to perform to confirm your diagnosis of Giardia lamblia infection?

173
Q

What type of organism is Cryptosporidium Parvum?

174
Q

If you wanted to prescribe something for Giardia lamblia infection, what would you prescribe?

A

Metronidazole

175
Q

What would you like to prescribe for somebody with a Cryptosporidium parvum infection?

A

Paromomycin

176
Q

Which antibiotics can predispose to C. difficile infection?

A

The Three Cs

Clindamycin
Cephalosporins
Ciprofloxacin

177
Q

Pseudomembranous colitis is associated with which condition?

A

C. difficile

178
Q

What is a prion?

A

An infectious agent composed entirely of protein

179
Q

What do prions cause?

A

Transmissable spongiform encephalopathies

180
Q

What agent causes CJD?

181
Q

CSF contains 14-3-3 protein. What is the diagnosis?

182
Q

You suspect CJD in a patient and collect a sample of CSF. What are you looking for?

A

14-3-3 protein.

183
Q

What are the signs/symptoms of CJD?

A 
Rapid dementia 
Memory loss
Personality changes
Hallucinations
Myoclonus
Ataxia 
Seizures
184
Q

What type of organism is Brucella?

A

Gram-negative bacteria

185
Q

What is the source of transmission of Brucella?

A 
Contaminated food (untreated milk/dairy) 
Laboratory acquired
186
Q

What is the classical triad of symptoms in Brucella infection?

A

1) Undulant fever (peaks in evening, better by morning)
2) Sweating (smells like wet hay)
3) Migratory myalgia/arthritis

187
Q

When investigating Brucella, what agglutination titre would you consider significant in non-endemic areas?

188
Q

When investigating Brucella, what agglutination titre would you consider significant in endemic areas?

189
Q

Which antibody are you looking for when investigating Brucella?

A

Anti-O antibody

190
Q

What treatment options are there for Brucella?

A

Tetracyclines

Doxycycline with Streptomycin

Doxycycline with Rifampicin

191
Q

What type of organism is Rabies?

A

Rhabdovirus

192
Q

You see Negri Bodies. What condition is it? Where are these bodies found?

A

Rabies.

Found in CNS.

193
Q

Signs/symptoms of Rabies?

A

Prodrome of fever, headache, sore throat.

Leads to …

Partial paralysis, anxiety, insomnia, agitation, paranoia, hallucinations, hydrophobia.

194
Q

What to give to treat Rabies?

A

Human Rabies immunoglobulin

195
Q

Which organism causes Plague?

A

Yersinia pestis

196
Q

What type of organism is Yersinia pestis?

A

Gram negative anaerobe

197
Q

How is the bubonic plague spread?

A

flea bites

198
Q

What type of organisms are Leptospira?

A

Gram negative spirochaetes

199
Q

How is Leptosira transmitted?

A

Urine of infected animals, e.g. dog/rat

200
Q

What are the signs/symptoms of Leptospirosis?

A

First phase: Fever; Chills; Headache; Myalgia; Red eyes.

Second Phase: Meningitis

201
Q

treatment for leptospirosis?

A

Amoxicillin, ampicillin or doxycycline

202
Q

Which organism causes Anthrax?

A

Bacillus anthracis

203
Q

What would you prescribe for Anthrax?

A

Fluoroquinolones e.g. ciprofloxacin

Doxycycline

204
Q

What is the cutaneous form of Anthrax otherwise known as?

A

Hide Porter’s Disease

205
Q

Hide Porter’s Disease is caused by what organism?

A

Bacillus anthracis

206
Q

What are the skin manifestations of Anthrax?

A

painless round black lesions and rings of oedema

207
Q

What type of organism is Borrelia burgdoferi?

A

Diderm (not gram positive/negative) spirochaete

208
Q

Bullseye rash is classically associated with which condition?

A

Lyme disease

209
Q

Lyme disease can manifest itself on the skin in what way?

A

Bullseye rash aka Erythema Migrans

Borrelial lymphocytoma - purplish lump

210
Q

What are the early phase signs/symptoms of Lyme disease?

A 
Malaise
Lymphadenopathy
Hepatitis
Carditis
Arthritis
211
Q

What are the late phase signs/symptoms of Lyme disease?

A

Arthritis, focal neurology, neuropsychiatric disturbance, ACA (acrodermatitis chronic atrophicans) = a skin condition, reddish blue in colour on back of hands/feet in elderley.

212
Q

What is your first choice of treatment in Lyme disease?

A

Doxycycline

or amoxicillin

213
Q

Which organism causes Q fever?

A

Coxiella burnetii

214
Q

What gram-type is coxiella burnetii?

A

Gram-negative

215
Q

What are the signs/symptoms of Q fever?

A

Abrupt onset of flu-like symptoms

fever
malaise
headache

50% of people have no symptoms

216
Q

What would you prescribe for Q fever?

A

Doxycycline

Tetracycline

217
Q

What type of organism is Leishmania?

A

Trypanosomes, a type of protozoa

218
Q

Which Leishmanias can cause cutaneous leishmaniasis?

A

L. major

L. tropica

219
Q

Which leishmanias can cause muco-cutaneous leishmanias?

A

L. braziliensis

220
Q

Which leishmanias can cause visceral leishmaniasis?

A

L donovani

221
Q

How is cutaneous lesihmaniasis transmitted?

A

Bite of the sandfly

222
Q

What are the signs/symptoms of cutaneous leishmaniasis?

A

Skin ulcer at site of bite - heals after a year, leaves a depigmented scar.

223
Q

What Past medical history would get you thinking about Infective Endocarditis?

A 
Right Heart failure
Congenital heart disease
Cardiac surgery
Valve Replacements
Long term lines
Bacteraemias
IVDU Hx
224
Q

Signs/Symptoms of Infective Endocarditis?

A

FROM JANE

Fever
Roth Spots
Osler nodes
Murmur

Janeway lesions
Anaemia
Nail haemorrhage (splinter haemorrhage)
Emboli

225
Q

What is the Dukes Criteria?

A

BE FEVEER

Major:
Blood culture positive >2 times
Endocardial involvement seen e.g. echo (e.g. vegetations, abscess, valve loose)

Minor:
Fever
Echo findings not meeting a major criteria
Vascular (e.g. major arterial emboli, stroke, PE)
Evidence that of blood culture that does not meet Major
Risk factors - like heart surgery, IVDU, etc.

226
Q

What are the three common culprits of infective endocarditis?

A

Staphylococcus aureus
Streptococci of the Viridans group
Coagulase negative staphylococci

227
Q

What is the HACEK group?

A

Gram-negative group of bacteria responsible for uncommon causes of infective endocarditis

Haemophilus parainfluenzae
Aggregatibacter/Actinobacillus
Cardiobacterium hominis
Eikenella corrodens
Kinglla kingae
228
Q

Infective endocarditis causative agent is Staphylococcus Aureus, it is most likely resistant to penicillin. What will you give instead?

A

Vancomycin

229
Q

Are influenza viruses RNA or DNA viruses?

230
Q

What family of viruses do the influenza viruses belong to?

A

Orthomyxoviridae

231
Q

What do the ‘H’ and ‘N’ refer to in influenza classifications, e.g. H1N1 or H1N2?

A 
H= haemagglutinin
N= neuraminidase

Refers to the H or N antigens they express.

232
Q

What population is the main reservoir for Influenza A?

A

Wild aquatic birds, e.g. ducks

233
Q

What is the other name for neuraminidases?

A

Sialidases

234
Q

What is the function of neuraminidases?

A

Cleaves sialic acid residues to expose receptors on host cells and disrupts the mucin barrier.

235
Q

What is the function of influenza haemagglutinin?

A

1) Recognise vertebrate cells through sialic acid binding

2) Facilitate viral genome entry by fusing endosomal membrane with viral membrane

236
Q

What is antigenic drift?

A

Variations arising in viruses due to natural mutations in the genes coding for antigens, e.g. haemagglutinin and neuraminidase.

237
Q

In which strains of influenza does antigenic drift occur?

A

A, B and C

238
Q

What is antigenic shift?

A

When two or more viruses combine to form a new strain of virus with a mixture of antigens.

239
Q

In which strains of influenza does antigenic shift occur?

A

Influenza A

because A infects more than just humans

240
Q

Name the classes of antivirals and give a couple of examples for each

A

Neuraminidase inhibitors, e.g. oseltamivir (Tamiflu) and Zanamivir (Relenza)
M2 protein inhibitors, e.g. Amantadine and Rimantadine.

241
Q

What is the mechanism of action of Aciclovir?

A

Aciclovir –> Aciclovir Monophosphate (converted by viral thymidine kinase)

Aciclovir monophosphate –> Aciclovir triphosphate (converted by host cells)

A-Tri-P inhibits and inactivates HSV-specific DNA polymerases

242
Q

Which conditions is Aciclovir used for?

A

Herpes simplex infection
Chickenpox
Shingles

243
Q

Ganciclovir is used in treating what?

A

cytomegalovirus infections

244
Q

What conditions can CMV cause?

A

RCHEP

Retinitis
Colitis
Hepatitis
Encephalitis
Pneumonitis
245
Q

What are the three medications used to treat CMV infections?

A

Ganciclovir
Foscarnet
Cidofovir

246
Q

What is the major side effect of Foscarnet and Cidofovir?

A

Nephrotoxicity

Maintain adequate hydration

247
Q

What are three medications we can use to treat herpes simplex virus?

A

Act Very Fast!

Aciclovir
Valaciclovir
Famciclovir

248
Q

Ground glass hepatocytes are associated with what condition?

A

Chronic Hepatitis B infection

not acute Hep B!

249
Q

What is the decision to treat Hepatitis B infection based upon?

A

1) raised Serum HBV DNA levels (the viral load)
2) raised Serum aminotransferase levels
3) liver biopsy histological stage and grade

250
Q

What are the medical treatment options in Hep B infection?

A

Viral polymerase inhibitors
Reverse transcriptase inhibitors
Interferons

251
Q

Give examples of Reverse transcriptase inhibitors used in HBV infections.

252
Q

Give examples of Viral polymerase inhibitors used in HBV infections.

A

Entecavir (no resistance)
Lamivudine
Telbivudine

253
Q

Give examples of interferons used in HBV infections.

A

Pegylated Interferon alpha 2a (Pegasys)

254
Q

Which genotypes of Hepatitis C respond best to treatment? and genotypes that respond less well?

A

Best responders: Genotypes 2 and 3

Less well: Genotypes 1, 4, 5 and 6

255
Q

Name the 3 steps of the PCR procedure.

A

Denaturation at 94-96C
Annealing at 68C
Elongation at 72C

256
Q

Cause of Kaposi’s sarcoma?

A

Human Herpes Virus (HHV) 8

257
Q

Flucloxacillin is broad or narrow spectrum?

258
Q

Usual suspect organisms in septic arthritis?

A

Staphylococcus aureus

Streptococci

259
Q

Signs/symptoms of septic arthritis?

A

Febrile
Red hot swollen joint
Patient unwilling to move joint

260
Q

How would you go about confirming a diagnosis of septic arthritis?

A

Arthrocentesis: WCC>50,000 cells/mm3
Raised ESR+CRP
Imaging demonstrating effusion

261
Q

How to treat septic arthritis?

A

IV antibiotics
Analgesia
Joint aspiration

262
Q

What is a Brodie abscess?

A

A subacute osteomyelitis which may persist for years before becoming frank osteomyelitis.

263
Q

How can we classify osteomyelitis?

A

Suppurative: Acute vs Chronic

Non-suppurative: Diffuse/Focal sclerosing

264
Q

Name a likely causative agent in osteomyelitis?

A

Staphylococcus Aureus

265
Q

What would you like to perform to confirm your diagnosis of Osteomyelitis?

A

MRI

Bone biopsy for culture/histology

266
Q

Treatment for Osteomyelitis?

A

Antibiotics (type depends on causative organism) for weeks/months.
Debridement in severe cases.

267
Q

What is Osteomyelitis?

A

Infection and inflammation of the bone marrow or bone.

268
Q

Common causative agents of UTIs?

A

E. Coli
Staphylococcus saprophyticus
Klebsiella

269
Q

Signs/symptoms of UTIs?

A

Frequency
Dysuria
Abdominal pain

270
Q

Investigations for UTI?

A

Urine dipstick - nitrites, leukocytes

MC&S

271
Q

What are you going to prescribe for an uncomplicated UTI?

A

Trimethoprim or nitrofurantoin

272
Q

What are the glycopeptide antibiotics mechanism of action?

A

Bind to amino acids in cell wall and prevent further synthesis.

273
Q

For what gram type bacteria do we give Beta-lactams?

A

Gram positive

Gram negative: 3rd generation cephalosporins

274
Q

What is the indication for glycopeptide antibiotics?

A

MRSA

C Diff

275
Q

What is the indication for aminoglycoside antibiotics?

A

Gram negative sepsis

276
Q

What is the basic mechanism of action of tetracycline antibiotics?

A

Protein synthesis inhibitors

277
Q

What is the indication for tetracycline antibiotics?

A

ARC UTIs

Acne
Rosacea
Chlamydia

UTIs

278
Q

What is the basic mechanism of macrolides?

A

Protein synthesis inhibitors

279
Q

What is the indication for macrolide antibiotics?

A

Gram positive (Strep pneumoniae)
Alternative to Penicillin
Some gram negative (bordetella, haemophilus)

280
Q

What class of antibiotic is gentamicin?

A

Aminoglycoside

281
Q

What class of antibiotic is Erythromycin?

282
Q

What class of antibiotic is Doxycycline?

A

Tetracycline

283
Q

What type of antibiotic is Benzylpenicillin?

A

Beta-lactam - penicillin

284
Q

What type of antibiotic is ceftriaxone?

A

Beta-lactam - cephalosporin

285
Q

What type of antibiotic is meropenem?

A

Beta-lactam - carbapenem

286
Q

What type of antibiotic is Vancomycin?

A

Glycopeptide

287
Q

What type of antibiotic is Teicoplanin?

A

Glycopeptide

288
Q

What is chloramphenicol’s basic mechanism of action?

A

protein synthesis inhibitor

289
Q

What are Oxazolidinone antibiotics basic mechanism of action?

A

Protein synthesis inhibitors

290
Q

What type of antibiotic is Linezolid?

A

Oxazolidinone

291
Q

What is the basic mechanism of action of fluoroquinolones?

A

Inhibit DNA synthesis

Gram negative = DNA gyrase
Gram positive = topoisomerase IV

292
Q

What class of antibiotic is Ciprofloxacin?

A

Fluoroquinolone

293
Q

What is the basic mechanism of action of Nitroimidazoles?

A

Inhibit DNA synthesis

294
Q

What class of antibiotic is Metronidazole?

A

Nitroimidazole

295
Q

What are the indications for a nitroimidazole?

A

Anaerobic bacteria and parasitic infections

296
Q

What is the basic mechanism of Rifamycins?

A

Inhibit RNA synthesis

297
Q

What type of antibiotic is Rifampicin?

298
Q

What are the indications for Rifamycins?

A

Mycobacteria

e.g. TB, leprosy, mycobacterium avium complex (MAC)

299
Q

What is the basic mechanism of Polymyxin antibiotics?

A

Cell membrane toxin

300
Q

What type of antibiotic is Colistin?

301
Q

What are the indications for Polymyxins?

A

Gram-negative bacteria (because of the LPS which polymyxins can bind to)

Last resort if there are multi-drug resistant pathogens.

302
Q

What type of antibiotic is daptomycin?

A

Lipopeptide antibiotic

303
Q

How does daptomycin work?

A

Cell membrane toxin - causes leak of ions –> depolarisation –> cell death.

304
Q

What are the indications of daptomycin?

A

Skin infections with Gram positive bacteria
Staph aureus bacteraemia/endocarditis
NOT pneumonia as can bind surfactant.

305
Q

What is the basic mechanism of action of sulfonamides?

A

Inhibition of folate metabolism

306
Q

What class of antibiotic is sulphamethoxazole?

A

Sulfonamide

307
Q

What is in tri-moxazole?

A

Sulphamethoxazole and trimethoprim

308
Q

What is the basic mechanism of action of trimethoprim?

A

Inhibition of folate metabolism

309
Q

Indications for trimethoprim?

310
Q

Give examples of antibiotic classes that inhibit cell wall synthesis.

A

Beta-lactams

Glycopeptides

311
Q

Give examples of antibiotic classes that inhibit protein synthesis.

A

MATChO

Macrolides
Aminoglycosides
Tetracyclines
Chloramphenicol
Oxazolidinones
312
Q

Give examples of antibiotic classes that inhibit DNA synthesis.

A

Fluoroquinolones

Nitroimidazoles

313
Q

Give examples of antibiotic classes that inhibit RNA synthesis

314
Q

Give examples of antibiotic classes that are cell membrane toxins.

A

Polymyxin

Lipopeptides

315
Q

Give examples of antibiotic classes that inhibit folate metabolism.

A

Sulfonamides

Diaminopyrimidines

316
Q

Give examples of Broad spectrum antibiotics.

A

Co-amoxiclav
Tazocin
Ciprofloxacin
Meropenem

317
Q

Give examples of Narrow spectrum antibiotics.

A

Flucloxacillin
Metronidazole
Gentamicin

318
Q

What are the four mechanisms of antibiotic resistance?

A

BEAT drug action

Bypass antibiotic-sensitive step in pathway, e.g. MRSA
Enzyme-mediated drug inactivation, e.g. B-lactamases
Accumulation of the drug is impaired, e.g. tetracycline resistance
Target in microbe is modified, e.g. Quinolone resistance.

319
Q

What are you likely to prescribe for a community-acquired UTI?

A

Trimethoprim

320
Q

What are you likely to prescribe for a nosocomial acquired UTI?

A

Augmentin or cephalexin

321
Q

What are you likely to prescribe for a Community-acquired pneumonia that is mild?

A

Amoxicillin

322
Q

What are you likely to prescribe for a Community-acquired pneumonia that is severe?

A

Cefuroxime + clairthromycin

323
Q

What are you likely to prescribe for a hospital-acquired pneumonia?

A

Cefuroxime

324
Q

What are you likely to prescribe for a bacterial meningitis?

A

Ceftriaxone

325
Q

What are the TORCH infections?

A 
Toxoplasmosis
Other (VZV, HIV, HBV)
Rubella
CMV
HSV
326
Q

How are the TORCH infections acquired?

A

Transmitted from mother to the fetus/baby

327
Q

An aseptic meningitis is usually caused by what organism?

328
Q

What are the most common causative organisms of meningitis in adults?

A

Neisseria meningitidis

Streptococcus pneumoniae

329
Q

What are the most common causative organisms of meningitis in neonates?

A

Group B Streptococci
Listeria monocytogenes
E. Coli

330
Q

What are some causes of viral meningitis?

A

Enteroviruses

Herpes simplex virus 2

331
Q

What is the most common fungal cause of meningitis?

A

Cryptococcus neoformans

332
Q

What is the normal range of CSF WCC?

A

0-5 x10^6/l

333
Q

What is the normal range of CSF protein?

A

0.2-0.4g/l

334
Q

What is the normal range of CSF glucose?

A

around 2-4mmol/l or >50-60%

335
Q

CSF: low glucose, high WCC with polymorphs. What are you thinking?

A

Bacterial infection

336
Q

What might you see in CSF analysis with a bacterial infection?

A

Low glucose
High WCC
Polymorphs

337
Q

CSF: normal glucose; WCC is high with polymorphs. What are you thinking?

A

Partially treated bacterial infection

338
Q

What might you see in CSF analysis with a partially treated bacterial infection?

A

Normal glucose
High WCC
Polymorphs

339
Q

CSF: Glucose normal; WCC high with mononuclear cells. What are you thinking?

A

Viral meningitis/encephalitis.

340
Q

What might you see in CSF analysis with viral meningitis/encephalitis?

A

Normal glucose
High WCC
Mononuclear cells

341
Q

CSF: High protein; High WCC; Mononuclear cells. What are you thinking?

A

Mycobacterium TB or cryptococcus.

342
Q

What might you see in CSF analysis with Mycobacterium TB or cryptococcus?

A

High protein
High WCC
Mononuclear cells

343
Q

What type of virus (RNA, ssDNA, dsDNA) is Hepatitis A?

344
Q

What type of virus (RNA, ssDNA, dsDNA) is Hepatitis B?

345
Q

What type of virus (RNA, ssDNA, dsDNA) is Hepatitis C?

346
Q

How is hepatitis A transmitted?

A

Faecal-oral

347
Q

How is hepatitis B transmitted?

A

Sexually
Vertically
Blood products

348
Q

How is hepatitis C transmitted?

A

Blood products

needles

349
Q

What can we look for when diagnosing hepatitis A virus?

A

Anti-Hep A Virus IgM

350
Q

What do we look for when diagnosing hepatitis B virus?

A

HBsAg (Hep B surface antigen)

351
Q

How is parvovirus B19 transmitted?

A

Respiratory droplets

Bloodborne

352
Q

What are the signs/symptoms of Parvovirus B19?

A

Fever
Malaise
Erythema infectiosum ‘slapped cheek’

353
Q

What is a potntial complication of parvovirus B19 in those with sickle cell?

A

Transient aplastic crisis

354
Q

What is a typical incubation period for parvovirus B19?

A

6-14 days.

355
Q

Rubella is a RNA, dsDNA, ssDNA virus?

356
Q

How is rubella transmitted?

A

Respiratory

357
Q

Signs/symptoms of rubella?

A

low grade fever
rash starting on face, spread to trunk/arms
cervical lymphadenopathy

358
Q

What is the risk of rubella infection during early pregnancy?

359
Q

Signs/symptoms of congenital rubella syndrome?

A

‘Rubber Ducky I’m Blue’

Rubber=Rubella
Ducky = Ductus Arteriosus, Pulmonary artery stenosis
I’m = Eyes (cataracts, glaucoma, retinopathy)
Blue= Blueberry muffin rash (extramedullary haematoposis causing a rash)

Hearing defects
Mental retardation
Splenomegaly

360
Q

What does influenza infection during pregnancy increase the risk of?

A 
Stillbirth (~5x)
Preterm delivery (~3x)
361
Q

Wgat type of vaccine should you not give during pregnancy?

A

Live attenuated vaccines

362
Q

What gram type and shape is Staphylococcus?

A

Positive

Cocci

363
Q

What gram type and shape is Streptococcus?

A

Positive

Cocci

364
Q

What gram type and shape is Enterococcus?

A

Positive

Diplococci + chains

365
Q

What gram type and shape is Actinomyces?

A

Positive

Rods

366
Q

What gram type and shape is Bacillus?

A

Positive

Rods

367
Q

What gram type and shape is Clostridium?

A

Positive

Rods

368
Q

What gram type and shape is Diphtheria?

A

Positive

Rods

369
Q

What gram type and shape is Listeria?

A

Positive

Rods

370
Q

What gram type and shape is Neisseria?

A

Negative

Cocci

371
Q

What gram type and shape is Moraxella?

A

Negative

Cocci

372
Q

What gram type and shape is Enterobacteriaceae?

A

Negative

Rods

373
Q

What gram type and shape is Bordetella?

A

Negative

Coccobacilli

374
Q

What gram type and shape is Pseudomonas?

A

Negative

Coccobacilli

375
Q

What gram type and shape is Chlamydia?

A

Negative

Coccobacilli

376
Q

What gram type and shape is Treponema?

A

Negative

Spirochaetes

377
Q

What gram type and shape is Leptospirosis?

A

Negative

Spirochaetes

Pathology (5 decks)

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