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Transition block > Microbiology > Flashcards

Microbiology Flashcards

1
Q

What are coliforms?

A

E.coli and similar organisms that inhabit the large bowel such as Klebsiella sp., Proteus sp., Enterobacter sp., Serratia sp. etc.

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2
Q

In what type of environment (aerobic, anaerobic, etc) does Pseudomonas sp. survive?

A

It is strictly aerobic

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3
Q

What does the normal mouth flora include?

A

Strep. viridans, Neisseria sp., anaerobes
Candida
Staphylococci

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4
Q

What is the normal flora of the stomach and duodenum?

A

It is usually sterile

A few candida sp. and staphylococci may survive

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5
Q

What is the normal flora of the jejunum?

A

Small numbers of coliforms and anaerobes

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6
Q

Describe the normal colon flora?

A

Large numbers of coliforms
Anaerobes
Enterococcus faecalis

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7
Q

Describe the normal flora of the bile ducts

A

Normally sterile

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8
Q

How are abdominal abscesses managed?

A

Small abscesses can be treated with antibiotics

Large collections need incision and drainage

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9
Q

What antibiotic is used to treat coliforms?

A

Gentamicin

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10
Q

What antibiotic is used to treat anaerobes?

A

Metronidazole

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11
Q

What antibiotic is used to treat enterococcus sp.?

A

Amoxicillin

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12
Q

What antibiotics are used to treat intra-abdominal sepsis?

A

AMet-a-Gent
Amoxicillin
Metronidazole
Gentamicin

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13
Q

What antibiotics are used for prophylaxis against intraabdominal sepsis (GI/hepatobiliary surgery)?

A

Metronidazole

Gentamicin

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14
Q

What aspects of the immune system are defective in neonates?

A

T lymphocytes

Natural killer cells

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15
Q

Which aspects of the immune system are defective in the elderly?

A

Complement
Macrophages
NK cells

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16
Q

What aspects of the immune system are defective in alcohols?

A

Cytokines

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17
Q

What pathogens does the complement target?

A

Bacteria

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18
Q

What pathogens does phagocytes target?

A

Bacteria

Fungi

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19
Q

What pathogens do T lymphocytes target?

A

Viruses
Fungi
Protozoa

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20
Q

What pathogens do B lymphocytes and antibodies target?

A

Viruses

Bacteria

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21
Q

What pathogens do eosinophils target?

A

Worms
Protozoa
Fungi

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22
Q

What pathogens do mast cells target?

A

Worms

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23
Q

What are the SIRS criteria?

A

A non-specific clinical response involving at least two of:

  • Temperature >38 or 90 beats/min
  • Respiratory rate >20/min
  • White blood cell count >12,000/mm3 or 10% immature neutrophils
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24
Q

Apart from infection, what else can cause SIRS?

A

Trauma
Burns
Pancreatitis

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25
Q

What is sepsis?

A

SIRS with a presumed or confirmed infective process.

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26
Q

What is the definition of severe sepsis?

A 
Sepsis with signs of at least one acute organ dysfunction:
Renal
Respiratory
Hepatic
Haematological (e.g. DIC)
CNS
Unexplained metabolic acidosis
Cardiovascular (hypotension)
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27
Q

What is the definition of septic shock?

A

Severe sepsis with hypotension refractory to adequate volume resuscitation.

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28
Q

What are the main causes of community acquired bacteraemia?

A

E.coli (urine/abdomen)
S.pneumoniae (respiratory)
S.aureus (usually MSSA - skin)

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29
Q

What are the main causes of hospital acquried bacteraemia?

A 
E.coli (catheter related or abdomen)
S.aureus (usually MRSA - line or wound)
Enterococci (urine, wound, line)
Klebsiella (urine, wound)
Pseudomonas spp.
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30
Q

Which drug is associated with concerns over nephrotoxicity, and must have its levels checked?

A

Gentamicin

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31
Q

What is the sepsis 6 bundle?

A

Give high flow oxygen
-Target sats 94-98 unless COPD (88-92) or severe sepsis
Start IV fluid resuscitation
-500mls saline STAT
Take blood cultures
- and other cultures e.g. urine, wound swabs
Give IV antibiotics
- In severe sepsis, mortality increase by 7.6% for each hour delay in giving antibiotics
Measure lactate and FBC
- Higher lactate may require higher level of care
Monitor accurate hourly urine output
-

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32
Q

Describe the normal vagina flora

A 
Lactobacillus spp. predominate (produce lactic acid +/- hydrogen peroxide which suppresses growth of other bacteria)
Other organisms which may be present:
- strep viridans
- Group B beta-haemolytic strep
- candida spp. (small numbers)
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33
Q

What are the three non-sexually transmitted genital tract infections?

A

Candida infection
Bacterial vaginosis
Prostatitis

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34
Q

What proportion of females are colonised with small numbers of candida in their vagina and have no symptoms?

A

30%

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35
Q

List predisposing factors for development of candida infection

A

Recent antibiotic therapy
High oestrogen levels (pregnancy, certain types of contraceptives)
Poorly controlled diabetes
Immunocompromised patients

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36
Q

How is vaginal thrush diagnosed?

A 
Clinical diagnosis (intensely itchy with white vaginal discharge)
Can do high vaginal swab for culture - the majority of cases are candida albicans.
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37
Q

How is vaginal thrush treated?

A 
Topical Clotrimazole (pessary or cream)
Oral fluconazole
38
Q

What is the appearance of candida balanitis?

A

Spotty

39
Q

What microorgansims are involved in bacterial vaginosis?

A

Gardnerella vaginalis
Mobiluncus sp.
others, including anaerobes

40
Q

What are the symptoms of bacterial vaginosis?

A

Thin, watery, fishy smelling discharge

41
Q

How is bacterial vaginosis diagnosed?

A

Clinical diagnosis
Raised vaginal pH (pH >4.5)
Lab testing: high vaginal swab - examined for presence of CLUE cells

42
Q

How is bacterial vaginosis treated?

A

Oral metronidazole

43
Q

How is prostatitis classified?

A

Acute bacterial prostatitis
Chronic bacterial prostatitis
Chronic prostatitis/chronic pelvic pain syndrome

44
Q

How does acute prostatitis present?

A

Symptoms ofUTI

May have lower abdo pain, back, perineal, penile pain and tender prostate on examination

45
Q

What are the causative organisms of acute bacterial prostatitis?

A

Same as UTI (E.coli and other coliforms, enterococcus sp.)

Check for STI (chlamydia, gonorrhoea) in men

46
Q

How is acute prostatitis diagnosed?

A

Clinical signs + MSSU for C&S

+/- first pass urine for chlamydia/gonorrhoea tests

47
Q

What is the treatment for acute prosatitis?

A

Ciprofloxacin for 28 days
altered depending on culture result
Trimethoprim for 28 days if high C diff risk

48
Q

What are the bacterial STIs?

A

Chlamydia trachomatis
Neisseria gonorrhoea
Treponema pallidum (syphilis)

49
Q

What are the viral STIs?

A

HPV
Herpes simplex
Hepatitis and HIV

50
Q

What are the parasitic STIs?

A

Trichomonas vaginalis
Pthirus pubis (pubic lice)
Scabies

51
Q

What is the commonest bacterial STI in the UK?

A

Chlamydia

52
Q

What areas does chlamydia infect?

A

urethra, rectum, throat, eyes, endocervix

53
Q

Describe chlamydia trachomatis

A

An obligate intracellular bacteria with a biphasic life cycle
Does not reproduce outside a host cell
Does not stain with gram stain (no peptidoglycan in the cell wall)

54
Q

What are the serological groups of chlamydia trachomatis and what infections do they cause?

A

Serovars A-C: trachoma (eye infection) - not an STI
Serovars D-K: Genital infection
Serovars L1-L3: Lymphogranuloma venerum

55
Q

What is the treatment for uncomplicated chlamydia?

A

Azithromycin (1g oral dose stat) and doxycycline 100mg BD x 1 week

56
Q

What areas does gonorrhoea infect?

A

Urethra, rectum, throat, eyes and endocervix

57
Q

Describe neisseria gonorrhoea

A

Gram negative diplococcus
looks like 2 kidney beans facing each other
easily phagocytosed by polymorphs so often appear intracellularly on gram film
Does not survive well outside the body

58
Q

How are chlamydia and gonorrhoea diagnosed?

A

Combined nucleic acid amplication tests (NAATs) or PCR - tests for both organisms in one test
Male patients: first pass urine sample
female patients: HVS or VVS or endocervical swab (if patient having speculum examination)
Rectal and throat swabs
Eye swabs (babies and adults)
Other tests for gonorrhoea:
microscopy of urethral/endocervical swabs - done in SRH clinic. 90+% specificity in males, less in females.
Culture on selective agar plates:
- done on endocervical, rectal and throat swabs but not high vaginal swabs (only done in SRH clinic)

59
Q

What are the advantages of PCR/NAATs over culture?

A

Much less invasive specimens required
Much more sensitive than culture
Will be positive even if organisms died in transit
Test takes hours, not days

60
Q

What are the disadvantages of PCR/NAATs?

A

Cannot test antibiotic sensitivities

Will detect dead organisms, so have to wait 5 weeks to do test of cure.

61
Q

What is the treatment for gonorrhoea?

A

IM ceftriaxone plus oral azithromycin

62
Q

What organism causes syphilis?

A

Treponema pallidum

63
Q

How is syphilis diagnosed?

A

Dark ground microscopy of exudate from primary/secondary lesions to look for spirochaeates can be done (not done in Tayside).
Swab of primary or secondary lesions sent for PCR
Serology - tests for specific antibodies (confirms diagnosis, not representative of disease activity) and for non-specific antibodies (monitor disease activity and response to treatment).

64
Q

What are the non-specific serological tests for syphilis?

A

VDRL

RPR

65
Q

What are the specific serological tests for syphilis?

A

TPPA (T. pallidum particle agglutination assay)
TPHA (T. haemagglutination assay)
IgG and IgM ELISA - used as screening for syphilis

66
Q

How is syphilis treated?

A

Injectable long-acting penicillin

67
Q

What HPV types cause genital warts most commonly?

A

6 and 11

68
Q

What HPV types are associated with an increased risk of cervical cancer?

A

16 and 18

69
Q

How are genital warts treated?

A

cryotherapy

podophyllin toxin cream/lotion

70
Q

Does HSV 1 and 2 contain RNA or DNA?

A

Double stranded DNA

71
Q

How is HSV diagnosed?

A

Blister deroofed, swabbed and swab sent for PCR

72
Q

How is genital herpes treated?

A

Aciclovir may be helpful if taken early enough

Pain relief

73
Q

What is trichomonas vaginalis?

A

A single celled protozoal parasite transmitted by sexual contact

74
Q

What are the symptoms of trichomonas vaginalis?

A

Vaginal discharge and irritation in females and urethritis in males

75
Q

How is trichomonas vaginalis diagnosed?

A

High vaginal swab for microscopy

76
Q

How is trichomonas vaginalis treated?

A

Oral metronidazole

77
Q

How is pubic lice treated?

A

Malathion lotion

78
Q

What percentage of women with chlamydia develop PID?

A

9%

79
Q

What are the symptoms of chlamydia in females?

A

PCB/IMB
Lower abdominal pain
Dyspareunia
Muculopurulent cervicitis

80
Q

What are the symptoms of chlamydia in males?

A

Urethral discharge
Dysuria
Urethritis
Epididymo-orchitis

81
Q

How long after exposure do you test for chlamydia?

A

14 days

82
Q

What is the incubation period of urethral infection of men with gonorrhoea

A

2-5 days

83
Q

What are the symptoms of gonorrhoea?

A

Males: may be asymptomatic, urethral discharge >80%, dysuria
Pharyngeal/rectal infections mostly asymptomatic
Females: 50% asymptomatic, increased/altered vaginal discharge, dysuria, pelvic pain

84
Q

What is second line treatment for gonorrhoea?

A

Cefixime 400mg oral (only if IM injection contraindicated or refused by patient)

85
Q

How is syphilis transmitted?

A

Sexual contact
Transplacental/during birth
Blood transfusions
Non-sexual contact - healthcare workers

86
Q

What are the stages of acquired syphilis?

A 
Early infectious:
Primary
Secondary
Early latent
Late non-infectious:
Late latent
Tertiary
87
Q

What is the incubation period of syphilis?

A

9-90 days (mean 21 days)

88
Q

What is the lesion known as in primary syphilis?

A

Chancre
Appear at site of innoculation
Painless

89
Q

What other signs (apart from a chancre) may be present in primary syphilis?

A

non-tender local lymphadenopathy

90
Q

What is the incubation period of secondary syphilis?

A

6 weeks to 6 months

91
Q

What are the features of secondary syphilis?

A

Skin (macular, follicular or pustular rash on palms and soles)
Lesions of mucous membranes

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