Microbiology

Question 1

“Normal” vaginal flora (4)

Answer 1

Lactobacillus
+/- strep viridans
+/- group B strep
+/- candida

Question 2

Diagnostic features of bacterial vaginosis (3)

Answer 2

Thin, fishy-smelling vaginal discharge
Raised vaginal pH
Clue cells (epithelial cells covered with bacilli)

Question 3

What is Hay-Ison scoring?

Answer 3

Estimate of the proportions of clue cells to epithelial and lactobacilli

Question 4

Cause of acute bacterial prostatitis (2)

Answer 4

Complication of UTI (E.coli usually)

STI in patients younger than 35

Question 5

Difference in cell wall between Gram negative and Gram positive cells

Answer 5

Gram positive cells retain the purple dye because they have more peptidoglycan

Question 6

Empirical treatment of

a) chlamydia
b) gononorrhoea

Answer 6

a) azithromycin 1g stat

b) azithromycin 1g stat + ceftriazome IM

Question 7

Samples for diagnosis of chlamydia and gonorrhoea (4)

Answer 7

Male- first-pass urine
Female- Vulvo-vaginal swab
Rectal swabs
Throat swabs

Question 8

Testing for syphilis (2)

Answer 8

PCR swab of lesions

Serology for specific and non-specific antibodies

Question 9

Non-specific test that can be used for monitoring response to syphilis therapy

Answer 9

VDRL

Question 10

Screening test for syphilis in Tayside

Answer 10

Combined IgM and IgG ELISA on clotted blood sample

Question 11

Cause of genital warts

Answer 11

HPV, mainly serotypes 6 and 11

Question 12

Treatment of pubic lice

Answer 12

Malathion lotion

Question 13

Manifestations of chlamydyial transmission to neonate (2)

Answer 13

Conjunctivitis

Pneumonia

Question 14

Microsocopic appearance of gonorrheoa

Answer 14

Gram negative diplococci

Question 15

Signs of secondary syphilis (4)

Answer 15

Skin rashes (particularly palms + soles)
Mucous membrane lesions
Generalized lymphadenopathy
Condylomata lata

Question 16

Pseudomonas sp. are…

Answer 16

strict aerobes

Question 17

Clostridium sp. are…

Answer 17

strict anaerobes

Question 18

Normal flora of the bowel

Answer 18

Small gut- small numbers of coliforms and anaerobes

Colon- large numbers of coliforms, anaerobes and enterococcus faecalis

Question 19

Antibiotic treatment of intra-abdominal sepsis (and the targets of the drugs)

Answer 19

Gentamicin (coliforms)
Metronidazole (anaerobes)
Enterococcus (amoxicillin)

Question 20

Potential causes of peritonitis (4)

Answer 20

Perforated:
tumour
appendix
diverticulum
duodenal ulcer

Question 21

Why do large abscesses need drainage?

Answer 21

Because they lack blood supply, therefore antibiotics can’t penetrate

Question 22

What is sepsis?

Answer 22

The systemic inflammatory response to infection; SIRS with a presumed or confirmed infectious process

Question 23

What is SIRS? (5)

Answer 23

Non-specific clinical response including 2 or more of:
temperature greater than 38/less than 36
Heart rate greater than 90bpm
RR greater than 20/min
WBC more than 12K/mm3, less than 4K/mm3 or more than 10% immature neutrophils

Question 24

What is severe sepsis?

Answer 24

Sepsis with signs of at least one acute organ dysfunction due to hypoperfusion

Question 25

Sepsis 6 bundle (6)

Answer 25

``` 100% oxygen (unless COPD) IV Fluid bolus Blood cultures (+ other sites if clinically indicated) IV antibiotics Lactate + bloods Monitor urine output ```

Question 26

Acute CNS infections (2)

Answer 26

Encephalitis | Meningitis (viral and bacterial)

Question 27

Common causes of viral encephalitis (2)

Answer 27

Herpes simplex | Varicella zoster

Question 28

Treatment of viral encephalitis

Answer 28

High dose aciclovir

Question 29

Causes of bacterial meningitis (4)

Answer 29

Neisseria meningitides Strep pneumonia Haemophilus influenzae Listeria

Question 30

Agents of bacterial meningitis in immunocompromised patients

Answer 30

Conventional agents e.g. pneumococcal, meningococcal Listeria Tuberculosis

Question 31

Agent of meningitis in AIDS patients

Answer 31

Cryptococcus neoformans

Question 32

Commonest cause of meningitis in children under age of 4

Answer 32

Haemophilus influenzae B

Question 33

Management of listeria meningitis

Answer 33

Amoxicillin

Question 34

Management of tuberculous meningitis (2)

Answer 34

Isoniazid + rifampicin

Question 35

Major clinical signs of bacterial meningitis (3)

Answer 35

``` Fever Headache Stiff neck Mental state change (95% have 2/4) ```

Question 36

Microbiological samples in meningitis (4)

Answer 36

Blood culturres Throat swab Blood EDTA for PCR CSF

Question 37

Pre-hospital antibiotics for meningitis

Answer 37

Benzylpenicillin 1.2mg

Question 38

Hospital antibiotic management of meningitis

Answer 38

Ceftriaxome IV 2g bd | + amoxicillin if older than 55

Question 39

Role of steroids in management of meningitis

Answer 39

Give with first dose of antibiotics; reduces mortality esp. in pneumococcal

Question 40

How long can gentamicin be given for?

Answer 40

Three days (three doses)

Question 41

Why is coliform growth in a blood culture bottle always significant?

Answer 41

Coliforms are very rarely a contaminant

Question 42

Abstinent period following chlamydia treatment

Answer 42

At least a week until treatment is completed

Question 43

Aztreonam is...

Answer 43

Narrow-spectrum antibiotic against coliforms, similar to gentamicin but less nephrotoxic

Question 44

When should leg ulcers be treated?

Answer 44

Evidence of infection (i.e. red, hot, swollen, skin, pus)

Question 45

For GI and GU infections which antibiotic should be stepped down to following IV therapy?

Answer 45

Co-trimoxazole

Question 46

Which antibiotic should not be used for complicated UTI?

Answer 46

Nitrofurantoin

Question 47

Risk of ciprofloxacin

Answer 47

C. diff

Question 48

Alternative to penicillin for pre-hospital antibiotics

Answer 48

Chloramphenicol