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Microbiology Flashcards

1
Q

Gram positive bacteria have a ? proteoglycan cell wall and stain ? with Gram stain

A

thick proteoglycan cell wall

purple

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2
Q

Gram negative bacteria have a ? proteoglycan cell wall and stain ? with Gram stain

A

thin proteoglycan cell wall

pink

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3
Q

Classification of antimicrobial agents? (6)

A
  1. inhibit cell wall synthesis
  2. inhibit protein synthesis
  3. inhibit DNA synthesis
  4. inhibit RNA synthesis
  5. cell membrane toxin
  6. inhibit folate metabolism
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4
Q

Types of antimicrobials that inhibit cell wall synthesis? (2)

A
  1. B lactams

2. Gycopeptides

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5
Q

How do B lactams work?

A
  • inhibit the enzymes responsible for building the proteoglycan cell wall of the bacteria i.e. penicillin binding protein
  • bacteriocidal - prevents peptide cross linking thus daughter cells are weaker and lyse when they divide
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6
Q

Which bacteria are B lactam effective against?

Which bacteria are B lactam ineffective against?

A

a) gram +, gram -, enterococci

b) mycoplasma, chlamydia

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7
Q

Resistance against B lactams?

A

production of B lactamase

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8
Q

Penicillin

  • which organisms?
  • resistance?
A

Gram +

Broken down by B lactamase produced by Staph aureus

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9
Q

Amoxicillin

  • broad or narrow?
  • which organisms?
  • resistance?
A

Broad spectrum Penicillin
Gram + Gram - Enterococci
Broken down by B lactamase produced by Staph aureus

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10
Q

Flucloxacillin

  • broad or narrow?
  • which organisms?
  • resistance?
A
  • narrow spectrum penicillin
  • Gram +
  • stable to B lactamase produced by Staph aureus
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11
Q

Piperacillin

  • which organisms?
  • resistance?
  • example with Tazobactam?
A

Gram + Gram - Pseudomonas
Broken down by B lactamase produced by Staph aureus
Tazocin

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12
Q

What are Clavulanic Acid and Tazobactam?

A

B-lactamase inhibitors
Protect penicillins from B lactamase produced by Staph aureus
Allows broader spectrum

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13
Q

Examples of B lactams? (3)

A
  1. Penicillins
  2. Cephalosporins
  3. Carbepenems
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14
Q

Cephalexin

- type of B lactam

A

First generation cephalosporin

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15
Q

Cefuroxime

  • type of B lactam
  • resistance
A

Second generation cephalosporin

Stable to many B lacatamases produced by Gram -

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16
Q

Ceftriaxone

  • type of B lactam
  • broad or narrow?
  • which organisms?
  • association
  • # 1 use
A 
Third generation cephalosporin 
Broad
Gram + Staph & Strep 
C difficile 
Meningitis first line
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17
Q

Cephtazidime

  • type of B lactam
  • which organisms?
A

Third generation cephalosporin

Pseudomonas

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18
Q

Extended Spectrum B Lactamases?

A

Organisms producing these are resistant to ALL cephalosporins

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19
Q

Carbepenems

  • resistance
  • broad or narrow?
  • examples (3)
A 
Resistant to Extended Spectrum B Lactamases 
Broad spectrum 
1. Meropenem 
2. Imipenem 
3. Ertapenem
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20
Q

Key features of B Lactams (5)

A
  1. Non-toxic
  2. Renally excreted (low dose is renal impairment)
  3. Short half life (multiple daily doses)
  4. Do NOT cross BBB
  5. Cross-allergenic (if allergic to Penicillin 10% cross reactivity with Cephallosporins and Carbepenems)
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21
Q

Glycopeptides

  • how do they work?
  • which organism
  • side effect
A

Inhibit cell wall synthesis
Gram - only
Nephrotoxic therefore drug level must be monitored

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22
Q

Vancomycin

  • Class of Abx?
  • use?
A

Glycopeptide

C difficile

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23
Q

Aminoglycosides

  • mode of action?
  • binding site
  • toxicity? (2)
  • which organism?
A
  • inhibit protein synthesis
  • 30s ribosomal subunit
    1. ototoxic
    2. nephrotoxic
    Gram -ve
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24
Q

Gentamycin

  • Class of abx?
  • organisms?
  • use
A

Aminoglycoside
Gram - especially Pseudomonas
Gram - sepsis

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25
Q

Tetracylines

  • mode of action?
  • binding site
  • contraindications (2)
  • which organisms? (3)
  • association
A
  • inhibit protein synthesis
  • 30s ribosomal subunit
    1. children
    2. pregnant women
  1. chlamydia
  2. rickettsiae
  3. mycoplasma
  • light-sensitive rash
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26
Q

Doxycyline

  • class of Abx?
  • organisms?
A
  • Tetracycline

- intracellular chlamydia

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27
Q

Macrolide

  • mode of action?
  • binding site
  • which organisms?
  • indication
A

inhibit protein synthesis
50s subunit of ribosome
Gram + (Staph, Strep)
Pen allergic

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28
Q

Erythromycin

  • class of Abx?
  • organisms? (2)
A

Macrolide

  1. Staph
  2. Strep
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29
Q

Chloramphenicol

  • mode of action?
  • binding site?
  • broad or narrow?
  • associations (2)
  • uses (2)
  • avoid
A
  • inhibit protein synthesis
  • peptidyl transferase of 50s ribosomal subunit
  • very broad
  1. aplastic anemia
  2. grey baby syndrome
  3. bacterial conjunctivitis
  4. Genuine Pen allergy - meningitis
  • systemic use due to risk of aplastic anaemia
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30
Q

Oxazolidinones

  • mode of action?
  • binding site
  • which organisms?
  • indication
  • example
  • association
A
  • inhibit protein synthesis
  • 23s of 50s ribosomal subunit
  • Gram +
  • MRSE VRE
  • Linezolid
  • thrombocytopenia after prolonged use
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31
Q

Quinolones

  • mode of action
  • binding site
  • which organisms?
  • broad or narrow?
  • indications (3)
  • examples (3)
A
  • inhibit DNA synthesis
  • a-subunit of DNA gyrase
  • Gram -ve
  • broad
    1. UTI
    2. Pneumonia
    3. atypical pneumonia
  1. Ciprofloxacin
  2. Levofloxacin
  3. Moxifloxacin
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32
Q

Nitroimidazoles

  • mode of action
  • broad or narrow?
  • which organisms? (2)
  • examples (2)
  • indication
  • related
A
  • inhibit DNA synthesis
  • narrow
    1. anaerobic
    2. protozoa
  1. Metronidazole
  2. Tinidazole

Giardia

Nitrofuratoin - UTI

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33
Q

Rifamycins

  • mode of action
  • binding site
  • which organisms?
  • indication
  • examples (2)
A
  • inhibit protein synthesis
  • RNA polymerase
  • mycobacteria
  • TB
    1. Rifampicin
    2. Rifabutin
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34
Q

Rifampacin

  • class of Abx
  • use
  • drug interactions (2)
  • monitoring required
  • side effects
  • resistance
A
  • Rifamycin
  • TB
    1. OCP
    2. Warfarin
  • LFTs
  • orange bodily secretions
  • rapid resistance whereby chromosomal mutation changes B-subunit so that Rifampacin can’t bind to RNA polymerase
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35
Q

Daptomycin

  • mode of action
  • organisms
  • indications (2)
A
  • cell membrane toxin
  • Gram +ve
    1. MRSA
    2. VRE
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36
Q

Colistin

  • mode of action
  • organisms
  • indications
  • administered by
  • toxicity
A
  • cell membrane toxin
  • Gram -ve
  • multi-drug resistant organisms
  • IV only
  • nephrotoxic
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37
Q

Sulfonamides

  • mode of action
  • indication
  • used in conjunction with
  • toxicity
  • example
A
  • inhibit folate metabolism
  • PCP
  • Trimethroprim
  • teratogenic
  • Sulphamethoxazole
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38
Q

Diaminopyrimidines

  • mode of action
  • indication
  • toxicity
  • example
A
  • inhibit folate metabolism
  • community acquire UTI
  • teratogenic
  • Trimethroprim
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39
Q

Mechanisms of Abx resistance? (4)

A

BEAT

  1. Bypass Abx sensitive step
  2. Enzyme-mediated drug inactivtion e.g. B-lactamase
  3. Accumulation inhibition
    a) impaired uptake
    b) increased efflux
  4. Target altered in microbe
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40
Q

Major mechanism of resistance to B Lactams?

- example organisms (2)

A

Enzyme-mediated inactivation

  1. Staph aureus
  2. Gram -ve bacilli
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41
Q

Mechanism of resistance in MRSA?

A

Methicillin-Resistant Staph Aureus

Altered target, PBPs now have a low affinity for B Lactams

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42
Q

Mechanism of resisatnce of Strep pneumonniae?

A

Altered target, lowered affinity for B lactams

Can be overcome by increasing dose

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43
Q

Common organisms with Extended Spectrum B Lactamases? (2)

A
  1. E coli

2. Klebsiella

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44
Q

Which ABX?

Staph aureus

A

Flucloxacilin (unless allergy)

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45
Q

Which ABX?

Strep throat

A

Benzylpenicillin

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46
Q

Which ABX?

CAP (mild)

A

Amoxicillin

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47
Q

Which ABX?

CAP (severe)

A

Cefuroxime + Clarithromycin

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48
Q

Which ABX?

HAP

A

Cefuroxime

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49
Q 
Which ABX?
Bacterial meningitis (Meningococcus/Strep)
A

Ceftriaxione

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50
Q 
Which ABX?
Bacterial meningitis (Listeria)
A

Amoxicillin + Ceftriaxone

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51
Q

Which ABX?

UTI (community)

A

Trimethroprim

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52
Q

Which ABX?

UTI (hospital)

A

Augmentin or Cephalexin

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53
Q

Which ABX?

Sepsis (severe)

A

Cefuroxime
Metronidazole
Gent

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54
Q

Which ABX?

Neutropenic sepsis

A

Tazocin + Gentamycin

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55
Q

Which ABX?

Collitis (C diff)

A

Metronidazole

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56
Q

Natural reservoir of Influenza A (H1)

A

ducks

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57
Q

Natural reservoir of Influenza A (H1N1)

A

pigs

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58
Q

Who receives trivalent flu vaccine?

- type of vaccine?

A

At risk populations (health workers)
Inactivated
purified HA + NA rich

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59
Q

Who receives quadrivalent flu vaccine?

- type of vaccine?

A

Children
Live attenuated vaccine
HA rich

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60
Q

Why does influenza cause a respiratory illness? (4)

A
  1. sialic acid is only expressed
  2. virus enters through the mouth
  3. virus is activated by proteases expressed in the mouth
  4. can only fuse with mucus secreting cells
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61
Q

Where in the lungs can influenza virus survive?

A

LRTI not URTI as does not replicate well at low temperatures

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62
Q

Surface glycoproteins of influenza virus (2)

  • cause of seasonal variation?
A
  1. NA neuraminidase activity
    - cleaves sialic acid to allow virus to exit host cell
  2. HA haemogglutinin activity
    - binds to sialic acid receptors allowing virus to attach to host cell and causes membrane fusion
  • RNA segments of the virus are prone to mutation hence variation in influenza virus to produced new strains
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63
Q

Antigenic Drift

A

mutation in HA/NA to give new strains of the virus therefore vaccine must be updated annually

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64
Q

Antigenic Shift

  • which strain?
  • how?
A

complete change of HA/NA

  • only happens with Influenza A
  • trading of RNA segments between human and animal strains
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65
Q

Protease that activates influenza virus?

A

clara tryptase

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66
Q

Severe outcomes of the flu? (4)

A
  1. secondary bacterial pneumonia
  2. mutant virus
  3. co-morbidity
  4. cytokine storm (H5N1)
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67
Q

Antivirals for flu? (3)

A
  1. Amantadine
  2. Tamiflu
  3. Oseltamivir
  4. Zanamivir
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68
Q

Mechanism of Amantadine/Rimantidine?

- which strain?

A

M2 ion channel inihibitor

Influenza A

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69
Q

Mechanism of Oseltamivir/Zanamivir?

  • which one is oral?
  • which one is inhaled powder/IV?
  • which strain?
  • who is treated?
A 
Neuraminidase inhibitors 
Oseltamivir - oral 
Zanamivir - IV/inhaled powder
Influenza A & B
High risk groups 
Aged ≥ 65 years
Immunosuppressed
Chronic respiratory disease
Chronic heart disease
Chronic liver disease
Chronic neurological disease
Diabetes mellitus
Pregnant women
Morbid obesity (BMI ≥ 40)
Children
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70
Q

MIC

A

Minimum Inhibitory Concentration

How much abx is required to inhibit growth of organism in a test tube

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71
Q

Bacteriuria

A

presence of bacteria in urine

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72
Q

Cystitis

A

inflammation of the bladder, normally caused by infection

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73
Q

Uncomplicated UTI

A

Presence of UTI in functionally/structurally normal urinary system

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74
Q

Complicated UTI

A

Presence of UTI in functionally/structurally abnormal tract

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75
Q

Why does obstruction increase likelihood of UTI?

A

inhibits flow of urine, stasis of urine, increased chance of infection

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76
Q

Causes of obstruction within urinary tract

a) Extrarenal (5)
b) Intrarenal (6)

A

Extrarenal

  1. Valves
  2. Stenosis
  3. Bands
  4. Calculi
  5. Ureteral compression e.g. BPH

Intrarenal

  1. nephorcalcinosis
  2. uric acid nepropathy
  3. analgesic nephropathy
  4. PKD
  5. hypokalaemic nephropathy
  6. intrarenal lesions of sickle cell trait/disease
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77
Q

Neurogenic causes of urinary obstruction? (4)

A
  1. poliomyelitis
  2. tabes dorsalis (syphilis)
  3. diabetic nephropathy
  4. spinal cord injuries
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78
Q

Most common bacteria causing UTI?

A

E coli

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79
Q

Other bugs causing UTI? (5)

A
  1. Proteus fimbriae
  2. Klebsiella
  3. Staph epidermis
  4. Staph saprophyticus
  5. Enterococcus faecalis
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80
Q

Routes of infection of UTI (2)

A
  1. contamination from rectum

2. haematogenous route

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81
Q

Symptom of UTI (6)

A
  1. frequency
  2. dysuria
  3. abdo pain
  4. flank pain
  5. fever
  6. vomiting
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82
Q

Investigation of UTI (4)

A
  1. urine dipstick ( nitrites, leukocytes)
  2. MSU MC+S
  3. Bloods - FBC, U+Es, CRP
  4. Renal USS
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83
Q

Which of the following cell types on microscopy suggests a poorly taken sample.

  1. White blood cells
  2. Squamous epithelial cells
  3. Red blood cells
A

Squamous epithelial cells

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84
Q

Treatment for uncomplicated lower urinary tract infection in women?

A

Trimethroprim 3/7

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85
Q

Treatment of UTI in women with previous history of UTIs or men?

A

Nitrofuratoin 7/7

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86
Q

Treatment of pyelonephritis?

A

Co-amoxiclav + Gentamycin

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87
Q

Pathogenesis of CNS infection (4)

A
  1. haematogenous spread
  2. direct infection
  3. PNS to CNS
  4. local extension
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88
Q

Common organisms causing bacterial meningitis (2)

A
  1. N.meningitidis (Gram -ve)

2. Step pneumoniae (Gram +ve)

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89
Q

Common organisms causing bacterial meningitis in neonates? (3)

A
  1. Group B Strep
  2. Listeria
  3. E coli
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90
Q

Common organisms causing bacterial meningitis in elderly? (3)

A
  1. Group B Strep
  2. Listeria
  3. TB
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91
Q

Symptoms of bacterial meningitis? (8)

A
  1. headache
  2. neck stiffness
  3. fever
  4. focal neurology
  5. rash
  6. photophobia
  7. irritability
  8. vomiting
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92
Q

Common organisms causing viral meningitis? (3)

A
  1. Coxsackie
  2. Mumps
  3. HSV 2
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93
Q

Organism causing fungal meningitis?

A

Cryptococcus neoformans

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94
Q

Meningococcal septicaemia

  • percentage
  • clinical spectrum (4)
A
  • 40%
    1. capillary leak - hypoalbuminaemia
    2. coagulopathy
    3. metabolic derangement
    4. myocardial failure
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95
Q

Likely organisms causing chronic meningitis? (2)

A
  1. TB

2. Cryptococcus

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96
Q

Encephalitis

- transmission

A

inflammation of brain parenchyma

person to person or through vectors e.g. ticks

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97
Q

leading cause of encephalitis internationally?

A

Western Nile Virus

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98
Q

Treatent of meningoencephalitis?

A

Ceftriaxone + Acyclovir

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99
Q

Normal CSF Levels in adult
WCC
Protein
Glucose

A

0 - 5

  1. 15 - 0.4
  2. 2 - 3.3
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100
Q

CSF levels in bacterial meningitis?
WCC
Glucose

A

HIGH with polymorphs

LOW

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101
Q

CSF levels in viral meningitis?
WCC
Glucose

A

HIGH with mononuclear cells

Normal

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102
Q

CSF levels in TB/cryptococcus meningitis?
WCC
Protein

A

HIGH with mononuclear cells

HIGH

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103
Q

Pathophysiology of cerebral abscess? (5)

A
  1. otitis media
  2. mastoiditis
  3. paranasal sinuses
  4. endocarditis
  5. haematogenously
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104
Q

Pathophysiology of spinal infection (3)

A
  1. open spinal trauma
  2. infection in adjacent structures
  3. haematologenously
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105
Q

Risk factors for spinal infection (7)

A
  1. age
  2. IVDU
  3. DM
  4. transplantation
  5. long-term steroids
  6. malignancy
  7. malnutrition
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106
Q

Hepatitis A

  • type of virus
  • immunoglobulin associated with acute infection
  • immunoglobulin associated with previous vaccination
  • diagnosis
  • transmission
  • incubation
  • symptoms (7)
  • EMQ (3)
A 
RNA virus 
IgM
IgG
Anti-HAV IgM
fecal-oral 
2-6 weeks
  1. fatigue
  2. low grade fever
  3. diarrhoea
  4. nausea
  5. pruritis
  6. jaundice
  7. arthralgia
  8. undercooked fish
  9. South East Asia
  10. Mardi Gras
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107
Q

Hepatitis B

  • type of virus
  • transmission (3)
  • acute/chronic
  • incubation
  • lab findings
A

dsDNA virus

  1. sexual
  2. vertical
  3. blood products

Acute 6/12

2 - 6 months

increased AST, increased ALT due to liver inflammation

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108
Q 
Hepatitis B - diagnosis 
HBsAg
HBeAg
HBcAb IgM
HBcAb IgG
HBsAb
A 
HBsAg - active infection marker 
HBeAg - high level of viral replication 
HBcAb IgM - recent infection
HBcAb IgG - exposure to HBV/chronic infection 
HBsAb - immunity HBV vaccination
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109
Q

Complications of HBV (3)

A
  1. Fibrosis
  2. Cirrhosis
  3. HCC
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110
Q

Treatment of HBV (3)

A
  1. IFN alpha - can clear virus
  2. Lamivudine - can suppress viral replication
  3. Tenofovir - can suppress viral replication
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111
Q

Hepatitis C

  • type of virus
  • transmission
  • acute/chronic
  • incubation
  • lab findings
A 
RNA virus 
blood products 
80% progress to chronic 
2 weeks - 6 months
ALT - responds to viral load
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112
Q

Hepatitis C diagnosis
Anti - HCV
HCV RNA
Anti-HCV Ab

A

Anti - HCV - active infection
HCV RNA - acute HCV
Anti-HCV Ab - chronic HCV

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113
Q

Treatment of HCV (2)

A
  1. Peg IFN - allows less drug to be given and is better tollerated, sustained response
  2. Ribavirin
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114
Q

Complications of Hep C (2)

A
  1. Cirrhosis

2. HCC

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115
Q

Hepatitis D

- type of virus

A

ONLY if you already have HBV

RNA virus

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116
Q

Hepatitis E

  • type of virus
  • transmission
  • incubation
  • poor prognosis
A

RNA virus
faecal-oral
3-8weeks
pregnancy

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117
Q

Which organisms cause bloody diarrhoea? (5)

A

SECSY

  1. Salmonella
  2. E coli
  3. Campylobacter
  4. Shigella
  5. Yersinia enterocolitis
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118
Q

Two viruses commonly causing GI infection in children?

A
  1. Rotavirus

2. Adenovirus

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119
Q

4 lab findings for Staph aureus

A
  1. Catalase +
  2. Coagulase +
  3. Gram +
  4. yellow colonies of blood agar, B haemolytic
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120
Q

Pathophysiology of Staph aureus as GI infection?

  • incubation
  • duration
  • transmission
  • treatment
  • aerobic/anaerobic?
A
  • produces enterotoxin
  • release IL-1 IL-2
  • prominent vomiting & watery non-bloody diarrhoea

2-7days

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121
Q

B.cereus

  • association
  • pathophysiology (3)
  • aerobic/anaerobic?
A 
REHEATED RICE
2 spore toxins 
1) heat stable - emetic causing 
2) heat labile - diarrhoeal causing 
sudden vomiting + non-bloody diarrhoea

aerobic

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122
Q

Clostridium botulinum

  • associations (2)
  • pathophysiology (3)
  • symptoms
  • aerobic/anaerobic?
A

vaccum-packed/canned foods

1) honey - children
2) beans - students

  • ingestion of preformed toxin
  • blocks Ach release from peripheral nerves
  • paralysis

descending paralysis

anaerobic

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123
Q

Clostridium perfringens

  • association
  • pathophysiology (2)
  • incubation
  • symptoms (2)
  • aerobic/anaerobic?
A
  • reheated meats
    1. enterotoxin binds to TCR & MHC
  • massive cytokine release causing systemic toxicity
  • 8-16hrs
    1. watery diarrhoea
    2. cramps
    anaerobic
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124
Q

Clostridium difficile

  • who
  • why?
  • pathology
  • treatment
  • aerobic/non-aerobic?
A
  • hospitalised patients
  • Abx therapy cephalosporins/fluorquinolones
  • pseuomembranous colitis
  • Stop Abx
    Metronidazole/Vancomycin
  • anaerobic
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125
Q

Listeria monocytogenes

  • susceptible cohorts? (2)
  • type of bacteria (2)
  • maternal concerns (3)
  • source of foods (3)
  • symptoms (5)
  • treatment
A
  1. immunocompramised
  2. pregnant women

B haemolytic , tumbling mobility

  1. miscarriage
  2. stillborn
  3. mental retardation of fetus
  4. unpasteurised dairy products
  5. pre-packaged meals
  6. cured meats
  7. watery diarrhoea
  8. cramps
  9. fever
  10. headache
  11. vomiting

Ampicillin

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126
Q

Types of E.coli? (4)

A

ETEC
EIEC
EHEC
EPEC

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127
Q

ETEC E.coli

  • what
  • who
  • 2 toxins
  • source
A
  • Toxigenic
  • travellers diarrhoea
    1. heat labile - stimulates adenyl cyclase & cAMP
    2. heat stable - stimulates guanylate cyclase
    food/water contaminated with human faeces
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128
Q

EIEC

  • what
  • source
A
  • Invasive dysentery

- food/water contaminated with human faeces

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129
Q

EHEC

  • what
  • source
  • cause
  • result
A
  • Haemorrhagic
  • food/water contaminated with human faeces
  • verotoxin
  • HUS
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130
Q

EPEC

  • what
  • source
  • who
  • complication
A
  • Pathogenic
  • food/water contaminated with human faeces
  • infantile diarrhoea
  • HUS
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131
Q

Typhoid/Enteric Fever

  • causative agent
  • multiplies where?
  • symptoms (2)
  • signs (5)
  • treatment
A
  • salmonella typhi + paratyphi
  • Peyers patches
    1. slow onset fever
    2. constipation
  1. bradycardia
  2. splenomegaly
  3. rose spots
  4. anaemia
  5. leukopenia
  • Ceftriaxone
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132
Q

Salmonella enteritides

  • association (3)
  • symptoms
  • treatment
A
  1. poultry
  2. eggs
  3. meat

bloody diarrhoea

self-limiting/ceftriaxone

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133
Q

Dystenery

  • causative agent
  • enterotoxin
  • symptoms (3)
A 
Shigella dysenteriae 
Shiga enterotoxin 
Invades mucosal cells of distal ileum and colon causing inflammtion 
1. fever
2. pain 
3. bloody diarrhoea
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134
Q

Vibriosis cholera

  • source
  • symptoms
  • pathophysiology
  • organism appearance
A

water contaminated with human faeces - SHELLFISH
rice water diarrhoea
cholera toxin causes cAMP to open Cl channels -> massive loss of electrolytes
comma shaped

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135
Q

Campylobacter jejuni

  • sources (3)
  • organism appearance
  • duration
  • symptoms (4)
  • complications (3)
  • treatment
A

food/water contaminated with animal faeces

  1. poultry
  2. meat
  3. unpasteurised milk

can be up to 20days

  1. fever
  2. headache
  3. severe abdo cramps
  4. foul-smelling bloody diarrhoea
  5. Reactive arthritis
  6. Reiter’s syndrome
  7. Guillan Barre syndrome
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136
Q

What is Reiter’s syndrome? (3)

A
  1. arthritis
  2. uvetitis
  3. conjunctivitis
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137
Q

Yersinia

  • preference
  • source
  • associations (3)
A
  • 4*C cold enrichment
  • food contaminated with domestic animals faeces
    1. arthritis
    2. necrotising granulomas
    3. erythema nodosum
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138
Q

Diarrhoea causing protozoa (3)

A
  1. Entamoeba histolytica
  2. Giardia lamblia
  3. Crystosporidium parvum
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139
Q

Entomoeba histolytica

  • EMQ hint
  • histology
  • symptoms (6)
  • treatment
A 
men who have sex with men 
flask-shaped ulcer in colon
1. diarrhoea
2. flatulence 
3. dysentery 
4. tenesmus
5. weight loss
6. RUQ pain due to liver abscesses
- Metronidazole
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140
Q

Giardia lamblia

  • EMQ hints (4)
  • histology
  • source
  • symptoms (4)
  • test
  • treatment
A
  1. travellers
  2. hikers
  3. MSM
  4. mental hospitals

faecally contaminated water containing cysts

  1. flatulence
  2. foul-smelling non-bloody diarrhoea
  3. cramps
  4. malabsorption of protein & fat

ELISA string test

Metronidazole

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141
Q

Cryptosporidium parvum

  • who
  • where
  • test
A
  • immunocompramised
  • jejenum
  • Kinyoun acid fast stain
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142
Q 
Secretory Diarrhoea (2)
- cause
A
  1. no fever
  2. no WCC in stool sample
  • enterotoxin causes massive cytokine production & supression of adaptive immune response
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143
Q

Inflammatory diarrhoea (2)

A
  1. fever

2. WCC in stool sample - neutrophils

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144
Q

Enteric fever (2)

A
  1. fever

2. WCC in stool sample - mononuclear cells

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145
Q

Viruses causing diarrhoea (5)

A
  1. norovirus
  2. enteroviruses
  3. rotavirus
  4. adenovirus
  5. poliovirus
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146
Q

Rotavirus

  • who
  • type of virus
  • symptoms
A
  • children
  • ds-DNA
  • secretory diarrhoea, massive cytokine production
  • low grade fever
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147
Q

Adenovirus

  • who
  • symptoms
  • which strains cause bloody diarrhoea?
A
  • children
  • bloody diarrhoea
  • 40 and 41
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148
Q

Norovirus

  • who
  • immunity
  • outbreaks
  • predominant symptom
A
  • adults
  • no lifelong immunity
  • high infectivity, high resilience
  • vomiting ++
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149
Q

Notifiable diarrhoea causing diseases (5)

A
  1. Campylobacter
  2. Clostridium difficile
  3. Listeria
  4. Virbrio cholera
  5. Yersinia
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150
Q

Passive immunity

A

Transfer of immune effectors i.e. immunoglobulins e.g. HBIG, VZIG

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151
Q

Types of vaccine (5)

A
  1. Immunoglobulin
  2. Anti-toxins
  3. Inactivated
  4. Subunit
  5. Live attenuated
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152
Q

Examples of live attenuated vaccines (6)

  • contraindicated
  • advantage
A
  1. MMR
  2. Rotavirus
  3. Yellow fever
  4. VZV
  5. BCG
  6. Polio
  • in pregnancy/immunosuppressed
  • act most like the real infection therefore give long-lasting immunity
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153
Q

Examples of inactivated vaccines (3)

A
  1. Rabies
  2. Hep A
  3. HiB
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154
Q

Examples of subunit vaccines (2)

A
  1. Influenza

2. Typhoid

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155
Q

Examples of antitoxin (2)

A
  1. Botulinum antitoxin

2. Diptheria antitoxin

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156
Q

When to give VZIG?

A

used in susceptible pregnant women neonates or immunosuppressed patients exposed to chickenpox

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157
Q

When to give HBIG?

A

Prevention of HBV infection. Used in conjunction with vaccination

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158
Q

When to give NHIG?

A

prevention of HAV, rubella and polio infection (limited efficacy)

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159
Q

Patients with HIV should NOT receive which virus vaccine?

a. Bacillus Calmette–Guérin (BCG)
b. Measles, mumps, rubella (MMR)
c. Hepatitis B vaccine
d. Inactivated poliovirus vaccine
e. Yellow fever vaccine

A

e. Yellow Fever

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160
Q

Whooping cough is caused by which species of bacteria?

a. Bordatella pertussis
b. Streptococcus pneumoniae
c. Corynebacterium diphtheriae
d. Corynebacterium ulcerans
e. Haemophilus influenzae

A

a. Bordatella pertussis

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161
Q

Congenital rubella syndrome (CRS)

  • worst time
  • manifestations (4)
A

first trimester

  1. cardiac
  2. auditory
  3. opthalmic
  4. neurological
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162
Q

Purified polysaccharide pneumococcal vaccine activates B cells to produce which sort of immunoglobulin (Ig)?

a. IgG
b. IgA
c. IgM
d. IgE
e. IgD

A

c. IgM

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163
Q

Mycobacterium tuberculosis

- description of bacteria (5)

A
  1. slow growing
  2. Gram + rods
  3. non-motile
  4. waxy cell wall with long-chain fatty acids
  5. acid alcohol fast
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164
Q

2 acid fast stains

A
  1. Ziehl-Neeson

2. Auramine

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165
Q

What colour does AFB stain with ziehl-neeson?

A

Red

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166
Q

Non-tuberculous myocobacteria

a) slow-growing (3)
b) fast-growing (3)

  • source
  • transmission
  • association
  • treatment
A
  1. M.avium
  2. M.marinum
  3. M.ulcerans
  4. M.fortuitum
  5. M.abscessus
  6. M.chelonae
  • water & soil
  • no person to person
  • immunosuprression
  • little response to anti-TB
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167
Q

M.avium

  • children
  • immunossuppressed
  • underlying resp disease
A

children - pharyngitis & cervical adenitis
immunossupressed - disseminated infection
underlying bronchiectasis etc - pulmonary resembles TB

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168
Q

M.marinum

  • who
  • what
A
  • swimming pool/aquarium owners

- single or clusters of papules/plaques over fingers/hands/elbows

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169
Q

M.Ulcerans

  • who
  • transmission
  • what
A
  • Australia
  • insects
  • starts as painless nodules and develops into chronic, progressive ulcer
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170
Q

Fast-growing non-tuberculous mycobacterium

  • what
  • where
A
  • skin and soft tissue infections

- hospital-setting e.g. catheters

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171
Q

Leprosy “Hansen’s Disease”

  • causative organisms (2)
  • incubation
  • transmission
  • symptoms
    a) skin (5)
    b) nerves (2)
    c) eyes (2)
    d) bones (2)
  • treatment (3)
  • types (2)
A
  1. M.leprae
  2. M.lepromatosis

2-10 years
nasal secretions

a) depigmentation, macules, plaques, nodules, trophic ulcers
b) thickened nerves, sensory neuropathy
c) keratitis, iridocyclitis
d) periositis, aseptic necrosis

Rifampicin, Dapsone, Clofazimine

  1. Paucibacillary/Tuberculoid 5 lesions
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172
Q

Most common opportunistic infection in HIV?

A

TB

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173
Q

Risk factors associated with TB incidence? (6)

A
  1. migrants
  2. IVDU
  3. HIV+
  4. homelessness
  5. prison
  6. close contacts
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174
Q

Which strain does BCG vaccinate against?
Efficacy?
At risk populations who receive BCG? (2)
Contraindicated?

A

M.bovis
80%
1. babies born in high areas of prevalence
2. unvaccinated new immigrants from high prevalence countries

HIV patients

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175
Q

TB Disease process (2)

A
  1. Primary TB
    - infection during childhood/elderly/HIV
    - asymptomatic
    - granuloma present
  2. Post-primary
    - > 5 years after primary infection
    - re-activation/re-infection
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176
Q

Risk factors for reactivation of TB? (4)

A
  1. immunosuppression
  2. chronic alcohol excess
  3. malnutrition
  4. ageing
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177
Q

Characteristic feature of TB granuloma?

A

Langhan’s giant cells

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178
Q

Progressive primary TB? (2)

A
  1. LN ulcerates into bronchus causing pneumonia

2. cavity formation causes bronchiectasis, consolidation & collapse

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179
Q

Miliary TB? (2)

A
  1. progressive disease

2. haematological spread

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180
Q

Pulmonary TB Presentation (6)

A
  1. cough
  2. haemoptysis
  3. weight loss
  4. fever
  5. night sweats
  6. malaise
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181
Q

Pulmonary TB signs (3)

A
  1. Upper lobe consolidation
  2. caseating granuloma
  3. mediastinal lymph nodes
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182
Q

Extrapulmonary TB

  • percentage
  • signs & symptoms (8)
A

20%

  1. lymphadentitis (cervical) “scrofula”
  2. abscesses
  3. pericarditis
  4. perotinitis
  5. ileitis
  6. skin involvement
  7. renal disease
  8. genitourinary involvement
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183
Q

Spinal TB

  • percentage
  • presentation (4)
  • complications (2)
  • treatment
A

4%

  1. weight loss
  2. fever
  3. sweats
  4. back pain
  5. vertebral collapse
  6. ileopsoas abscess

12 months anti-TB

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184
Q

TB Meningitis

  • percentage
  • presentation (8)
  • investigation (2)
  • treatment
A

2%

  1. headache
  2. weight loss
  3. malaise
  4. fevers
  5. sweats
  6. neck stiffness
  7. personality changes
  8. focal neurology
  9. LP - lymphocytic
  10. CT - tuberculomata
  • 12 months anti-TB + steroids
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185
Q

Investigations in suspected TB

a. imaging (2)
b. cultures (3)
c. sputum stains (2)
d. histological features (4)
e. skin tests (2)
f. other (2)

A

a. CT, CXR
b. sputum, bronchoalveolar lavage (BAL), urine (EMU)
c. ziehl neeson, auramine
d. gram + rods, acid fast, aerobic, intracellular
e. heaf test, mantoux
f. PCR assay, IFNgamma assay

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186
Q

First line treatment of TB

- dosing

A 
RIPE
Rifampycin 
Isoniazid
Pyrazinamide
Ethambutol

all 4 for 2/12
Rifampycin & Isoniazid for 4/12

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187
Q

Side effects of Rifampycin (2)

A

orange secretions

hepatotoxicity

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188
Q

Side effects of Isoniazid (2)

A

peripheral neuropathy

hepatotoxicity

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189
Q

Side effects of Pyrazinamide (2)

A

hyperuricaemia

hepatotoxicity

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190
Q

Side effects of Ethambutol (2)

A

optic neuritits

visual disturbances

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191
Q

Treatment schedule for TB Meningitis

A

all 4 for 2/12

Rifampycin & Isoniazid for 8-10/12

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192
Q

Treatment for latent TB

A

6/12 Isoniazid

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193
Q

Second line treatment for TB? (6)

A
  1. injectables (Capreomycin, Kanamycin, Amikacin)
  2. Quinolones (Moxifloxacin)
  3. Linelozid
  4. PAS
  5. Cycloserine
  6. Clofazamine
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194
Q

Difficulties in viral selective toxicity? (2)

A
  1. viruses are obligate intracellular parasites

2. viruses use hosts enzymes for replication

195
Q

How viruses are detected by the immune system? (2)

A
  1. Pattern-recognition receptors (PRRs) recognise virus

2. PRRs triggers innate immune response -> release of IFNs and restriction factors

196
Q

Types of anti-viral therapy (3)

A
  1. Selective toxicity
  2. Immunomodulation
  3. Direct-acting antivirals
197
Q

Which ONE of the following statements about antiviral therapy is correct?

a. Directly-acting antiviral drugs are the only effective treatments
b. Supportive treatment is of no benefit
c. Immunomodulation (e.g. interferon treatment) is effective against a single family of viruses
d. Reduction of immune suppression may enhance viral clearance
e. Selective toxicity cannot be achieved as viruses replicate inside host cells

A

d. Reduction of immune suppression may enhance viral clearance

198
Q

Which strains of Herpes Simplex Virus are responsible for genital warts?

A

HSV-2 (80%)

199
Q

What strain of HSV is responsible for cold sores (herpes lapialis)?

200
Q

Herpes Simplex Encephalitis

- signs and symptoms

A
  • no seasonal occurance, sporadic
  • Fits, fevers, Funny behaviour
  • Meninginism - headache, photophobia, neck stiffness, fever
201
Q

VZV

  • presentation in children
  • presentation in adults
  • seasonal occurrence
  • infectivity
  • complications (2)
A
  • generalised vesicular rash over trunk, face and arms
  • lesions of different stages papules/ulcers/blisters
  • dermatomal distribution not crossing midline
  • lesions are of similar stage

Spring/summer

1-2days before rash onset until all lesions have crusted over

  1. pneumonitis
  2. disseminated infection
202
Q

Treatment of HSV/VZV (3)

- mode of action

A

“Act Very Fast”
Acyclovir
Valaciclovir
Famiclovir

  • target viral-encoded enzymes; thymidine kinase and DNA polymerase
203
Q

Always treat VZV/HSV if… (4)

A
  1. pregnant
  2. immunocompramised
  3. adults with pneumonitis
  4. eye involvement
204
Q

Treatment of orogenital HSV

a) single episode
b) normal
c) immunocompramised

A

Single episode - supportive

ACV 500mg x5 daily 5/7
vACV 500mg BD 5/7

Double dose in immunocompramised

205
Q

Treatment of VZV

a) normal
b) immunocompramised

A

ACV 800mg x5 daily 5/7
vACV 1G tds 5/7

Immunocompramised
IV ACV 10mg/kg 8hrly 5-7/7

206
Q

Treatment of HSV encephalitis

A

IV ACV 10mg/kg 8hrly 14-21/7

207
Q

The following statements are about treatment of herpesvirus infections. Choose the best answer.

a. Oral ganciclovir is recommended to treat recurrent herpes genitalis
b. Valaciclovir is recommended to treat HSV encephalitis
c. IV aciclovir is recommended to treat uncomplicated chickenpox
d. Valaciclovir is an oral pro-drug of aciclovir
e. Famciclovir is an oral pro-drug of aciclovir

A

d. Valaciclovir is an oral pro-drug of aciclovir

208
Q

Concerning the mode of action of aciclovir (ACV), which ONE of the following statements is correct?

a. ACV directly inhibits viral thymidine kinase
b. ACV is triphosphorylated by host cell kinase
c. ACV directly inhibits viral DNA polymerase
d. ACV is triphosphorylated by viral thymidine kinase
e. ACV is monophosphorylated by viral thymidine kinase

A

e. ACV is monophosphorylated by viral thymidine kinase

209
Q

A 42-year-old lady is admitted with a 2 day history of fever and confusion and presents with new onset seizures. What antiviral medication should she receive as soon as possible? Choose the best answer.

a. Oral aciclovir
b. IV foscarnet
c. Oral valaciclovir
d. IV ganciclovir
e. IV aciclovir

A

e. IV aciclovir

210
Q

CMV

  • what? (5) PERCH
  • where does it remain latent?
  • histology
  • common age groups affected (2)
  • common association
A 
PERCH 
Pneumonitis
Encephalitis 
Retinitis
Colitis 
Hepatitis

monocytic cells, can reactivate in immunosupression

Owls eye inclusions or nuclei of infected cells

  1. children 1-4 yrs
  2. > 65 yrs

CMV infection after solid organ transplant or BMT

211
Q

EBV

  • transmission
  • age group commonly affected
  • causes
  • signs (2)
  • association
A
  • salivary
  • early teens
  • Glandular fever
    1. exudative pharyngitis
    2. atypical lymphocytosis
  • Burkitts lymphoma in immunosuppressed
212
Q

Treatment of CMV (3)

A
  1. Ganciclovir
  2. Cidoflovir
  3. Foscarnet
213
Q

Mode of action of Ganciclovir

A

monophosphorylated by viral protein kinase, nucleoside analogue

214
Q

Mode of action of Cidoflovir

A

di/triphosphorylated by cellular enzymes, nucleoside analogue

215
Q

Mode of action of Foscarnet

- use

A
  • inhibits nucleic acid synthesis without requiring activation
  • Prophylaxis post-organ transplant
216
Q

Universal prophylaxis for all post-transplant patients?

A

Ganciclovir

217
Q

Side effect associated with Ganciclovir?

A

bone marrow supression

218
Q

The following statements concern the antiviral treatment of cytomegalovirus (CMV) infection. Choose the best answer.

a. No treatment is required for uncomplicated infection
b. IV ganciclovir should always be given
c. IV aciclovir is effective
d. Oral valganciclovir OD should be used initially
e. IV foscarnet is highly myelosuppresive

A

a. No treatment is required for uncomplicated infection

219
Q

Which of the following statements concerning the antiviral treatment of cytomegalovirus (CMV) infection is NOT correct?

a. IV ganciclovir is effective
b. Oral foscarnet is effective
c. IV cidofovir is effective
d. Maintenance therapy with oral valganciclovir can be used
e. Ganciclovir can cause neutropenia

A

b. Oral foscarnet is effective

220
Q

When to treat CMV? (4)

A
  1. Congenital
  2. immunocompramised
  3. pregnancy
  4. HIV
221
Q

What organism causes sixth disease in children?

  • presentation (3)
  • complication
A 
HHV-6
1. high fever +/- convulsions
2. coryzal symptoms
3. sudden rash "exanthum subitum"
PINK / RED, MACULAR, CAN BE RAISED PATCHES, NON-ITCHY
- HHV-6 encephalitis
222
Q

Exanthum subitum is associated with what disease?

A

Sixth Disease

223
Q

Which organism is associated with Karposi’s sarcoma?

224
Q

Presentation of Karposi’s Sarcoma?

A

multiple raised red/violet macules

225
Q

Types of Karposi’s Sarcoma, who & prognosis (4)

A
  1. Classical - middle aged men - indolent
  2. Endemic - Africa - aggressive
  3. Iatrogenic - immune suppression - atypical location
  4. HIV - widespread - aggressive
226
Q

Treatment of HHV - 8

A
  1. Ganciclovir
  2. Foscarnet
  3. Cidofovir
227
Q

Pathogenesis of drug resistance to Acyclovir?
Which organism?
Second-line?

A
  1. Thymidine kinase mutation
  2. DNA polymerase mutation

HSV

Foscarnet
Cidofovir

228
Q

Pathogenesis of drug resistance to Genciclovir?
Which organism?
Second-line?

A
  1. Protein kinase mutation
  2. DNA polymerase mutation

CMV

Foscarnet
Cidofovir

229
Q

The following statements concern resistance to antiviral drugs. Choose the best answer.

a. Resistance of HSV to aciclovir is common
b. Genotypic resistance testing is routinely used to detect resistance of CMV to ganciclovir
c. Aciclovir resistance in HSV is most commonly mediated by mutations in the viral thymidine kinase
d. Aciclovir resistance in HSV is most commonly mediated by mutations in the viral DNA polymerase
e. Aciclovir-resistant HSV may be treated with ganciclovir

A

c. Aciclovir resistance in HSV is most commonly mediated by mutations in the viral thymidine kinase

230
Q

Which ONE of the following statements concerning the treatment of influenza is NOT correct?

a. Oseltamivir is effective for influenza B
b. Oral zanamivir is effective
c. Antiviral treatment can be given before the diagnosis is confirmed
d. Amantadine is NOT effective for influenza A
e. Supportive treatment is indicated for uncomplicated influenza

A

b. Oral zanamivir is effective

231
Q

The following statements concern the antiviral drugs oseltamivir and zanamivir. Choose the best answer.

a. Oseltamivir directly inhibits the influenza neuraminidase
b. Zanamivir blocks binding of viral haemagglutinin to host cell sialic acid
c. Oseltamivir inhibits influenza virus uncoating
d. Zanamivir is usually given intravenously
e. Zanamivir is usually given by nebuliser

A

a. Oseltamivir directly inhibits the influenza neuraminidase

232
Q

A 82-year-old lady is in A&E on Christmas Eve with a 4 day history of fever, cough, myalgia and breathlessness. Her respiratory rate is 50 / min and her SaO2 is 88% when breathing air. In addition to empirical antibiotic therapy, what other drug(s) might be indicated right now? Choose the best answer.

a. Oral amantadine
b. Oral oseltamivir
c. Zanamivir dry powder inhaler
d. IV ribavirin
e. Oral ibuprofen

A

b. Oral oseltamivir

233
Q

Commonest virus causing bronchiolitis?

234
Q

Which ONE of the following statements regarding RSV bronchiolitis is correct?

a. Palivizumab is effective for treatment
b. Oral ribavirin is effective for treatment
c. Oseltamivir is effective for treatment
d. Supportive treatment is of no benefit
e. Palivizumab may be effective for prevention

A

e. Palivizumab may be effective for prevention

235
Q

Side effects of Foacarnet and Cidofovir?

A

nephrotoxic

236
Q

Treatment basis for HBV? (3)

A
  1. Serum HBC DNA levels > 2000IU/ml
  2. Serum aminotransferase levels > upper limit
  3. Liver biopsy - grade/stag e- active necroinflammation or fibrosis
237
Q

Complications of uncontrolled HBV? (2)

A
  1. cirrhosis

2. HCC

238
Q

First-line HBV treatment (3)

A
  1. Entecavir
  2. PegIFN alpha 2a
  3. Tenofovir
239
Q

Mode of action Entecavir

A

nucleoside analogue, inhibits viral polymerase

240
Q

Mode of action Tenofovir

A

inhibits reverse transcriptase

241
Q

Combination treatment of HCV? (3)

A
  1. PegIFN alpha 2a
  2. PegIFN alpha 2b
  3. Ribavirin
242
Q

What is included in Antenatal Booking appt (12/40) Serological Screening? (5)

A
  1. HIV
  2. HBV
  3. Syphilis
  4. Rubella
    +/- toxoplasmosis and VZV
243
Q

Most concerning time for Rubella infection during pregnancy?

244
Q 
Classical triad of Congenital Rubella Syndrome (CRS)? 
Additional features (4)
A
  1. Sensorineural deafness
  2. Eye defects - cataracts, congenital glaucoma, pigmentary retinopathy
  3. congenital heart defects - PA stenosis, PDA
  4. purpura
  5. splenomeglay
  6. microencephaly
  7. mental retardation
245
Q

Clinical presentation of rubella? (4)

Investigations (2)

A
  1. fever
  2. rash
  3. occipital lymadenopathy
  4. myalgia
  5. serology - seroconversion to rubella IgG
  6. PCR from throat swab or blood culture
246
Q

Which ONE of the following is NOT part of routine antenatal serological screening:

a. HIV
b. Syphilis
c. Hepatitis B
d. Rubella IgG
e. Measles IgG

A

e. Measles IgG

247
Q

Which ONE of the following is NOT a typical finding in congenital rubella syndrome:

a. Congenital heart disease
b. Cataracts
c. Retinopathy
d. Limb deformity
e. Sensorineural deafness

A

d. Limb deformity

248
Q

Complications of CMV infection during pregnancy to the unborn baby? (2)

  • suspicious features of USS? (6)
  • virus detection?
  • congenital infection?
A
  1. developmental delay
  2. congenital abnormalities
  3. growth restriction
  4. hepatosplenomegaly
  5. ventriculomegaly
  6. cardiac defects
  7. microcephaly
  8. cerebral calcification

Virus detection: saliva, urine, blood, amniotic fluid

Congenital infection: urine or saliva for PCR in 1st 21 days of life

249
Q

HSV routes of infection during pregnancy (3)

A
  1. direct contact during vaginal birth
  2. ascending infection PROM
  3. orolabial transmission - kissing baby
250
Q

High risk time of acquisiation of HSV?

A

3rd trimester

251
Q

The following statements concern cytomegalovirus (CMV) infection in pregnancy. Choose the best answer.

a. Antenatal ganciclovir is recommended for prevention of congenital CMV
b. Diagnosis of congenital CMV in the neonate can be confirmed by PCR of a urine specimen taken in the 1st 21 days of life
c. Congenital CMV infection is usually produces symptoms in the neonate from birth
d. Congenital CMV infection is a rare infectious cause of developmental delay
e. CMV infection in pregnant women is usually symptomatic

A

b. Diagnosis of congenital CMV in the neonate can be confirmed by PCR of a urine specimen taken in the 1st 21 days of life

252
Q

The following statements concern genital herpes (HSV) in pregnancy. Choose the best answer.

a. Delivery by Caesarean section is recommended for a woman with primary HSV who is 35 weeks pregnant
b. Delivery by Caesarean section is recommended for a woman with a history of recurrent genital herpes with genital ulcers present during labour
c. The risk of neonatal HSV in an infant born to a mother with untreated recurrent genital HSV is high
d. Oral valaciclovir is recommended as prophylaxis against recurrent genital HSV in pregnancy
e. Neonatal herpes is nearly always caused by HSV-2

A

a. Delivery by Caesarean section is recommended for a woman with primary HSV who is 35 weeks pregnant

253
Q

Management of primary HSV infection during pregnancy? (4)

A
  1. lesion swab PCR
  2. Offer acyclovir treatment and prophylaxis until delivery
  3. Recommend C-section if presenting within 6/7 of delivery or active lesion during labour
  4. Swabs from neonate & neonatal IV acyclovir empirically until ruled out infection
254
Q

Time of increased maternal morbidity due to VZV in pregnancy?

A

2nd and 3rd trimester

255
Q

Features of Congential Varicella Syndrome (3)

- gestation CVS occurs?

A
  1. limb hypoplasia
  2. microencelphaly
  3. scarring
256
Q

Risk to fetus during 7days before and 7 days after birth with VZV?

A

Neonatal Varicella

severe disseminated infection

257
Q

Management of pregnant woman exposed to VZV with no previous infection?

A

VZIG up to 10/7 after contact

258
Q

What is the causative organism in Fifth’s Disease?

A

Parvovirus B19

259
Q

Presentation of Fifth’s Disease? (4)

A

“Slapped Cheek Disease”

  1. fever
  2. rash - erythema infectiosum
  3. arthropathy
  4. aplastic anaemia
260
Q

Gestation most at risk to Parvovirus B19?
Effects on fetus? (3)
Treatment?

A

1-20/40

  1. fetal death
  2. fetal anaemia
  3. hydrops fetalis

intrauterine transfusion

261
Q

Which ONE of the following patients is at greatest risk of infection with varicella-zoster virus (VZV)?

a. A healthy term infant born to a mother who develops shingles the day after delivery
b. A pregnant woman born in the UK exposed to her own child who has confirmed chickenpox
c. An 18 month old child with no previous history of chickenpox whose mother has developed shingles affecting her face
d. A pregnant woman who recalls having chickenpox as a child who works in a nursery and has been exposed to multiple children with probable chickenpox
e. A pregnant woman who says she has never had chickenpox whose long-term partner has developed cold sores

A

a. A healthy term infant born to a mother who develops shingles the day after delivery

262
Q

Which ONE of the following patients does NOT need to receive varicella immunoglobulin (VZIG)?

a. A confirmed VZV-susceptible pregnant woman whose own child developed a widespread vesicular rash 3 days ago
b. An infant born to a mother who herself develops chickenpox 4 days after delivery
c. A pregnant woman with an unknown history of chickenpox whose partner developed shingles affecting the face 10 days ago
d. An infant born at 30 weeks gestation to a mother with confirmed VZV-IgG in the serum, who is on the neonatal unit where a member of staff looking after the infant has developed chickenpox
e. A pregnant woman with an unknown history of chickenpox who has heard from a colleague that someone at her workplace had shingles last week

A

e. A pregnant woman with an unknown history of chickenpox who has heard from a colleague that someone at her workplace had shingles last week

263
Q

The following statements concern parvovirus B19 (B19V) infection. Choose the best answer.

a. Reinfection with B19V does not occur
b. Asymptomatic B19V infection in the 1st 20 weeks of pregnancy poses minimal risk to the fetus
c. There is no intervention to reduce harm to the fetus from maternal B19V infection
d. Maternal B19V infection may result in fetal anaemia
e. B19V-IgM is a reliable indicator of primary B19V infection

A

d. Maternal B19V infection may result in fetal anaemia

264
Q

Increased risk of vertical transmission of HBV (2)

Not a risk factor

A
  1. Maternal viral load
  2. HBeAg positivity
  • breastfeeding, mode of delivery
265
Q

HBsAg positive mother, how to manage baby after birth?

A

Accelerated HBV vaccine, 1st dose within 12 hours of delivery

266
Q

HBeAg positive mother, how to manage baby after birth? (2)

A
  1. Accelerated HBV vaccine, 1st dose within 12 hours of delivery
  2. HBIG at birth
267
Q

HBV viral load > 10*6 copies, how to manage baby after birth? (3)

A
  1. Accelerated HBV vaccine, 1st dose within 12 hours of delivery
  2. HBIG at birth
  3. Antenatal antiviral therapy 6-8weeks before birth to reduce viral load
268
Q

Maternal influenza infection, risks to fetus? (2)

A
  1. stillbirth

2. preterm delivery

269
Q

A pregnant woman is found to have hepatitis B surface antigen (HBsAg) detected in her booking serum. What should be the plan for treatment? Choose the best answer.

a. The woman should receive hepatitis B immunoglobulin
b. The infant should receive hepatitis B immunoglobulin at birth
c. The infant should receive hepatitis B vaccine at birth
d. The infant should receive lamivudine at birth
e. The woman should receive tenofovir therapy from 34 weeks gestation

A

c. The infant should receive hepatitis B vaccine at birth

270
Q

A woman who is 34 weeks pregnant presents to A&E during the winter with a 2 day history of fever, myalgia, tachypnoea and cough. The following statements concern her management. Choose the best answer.

a. A viral throat swab should be taken and she should receive paracetamol
b. A viral throat swab should be taken and she should receive oseltamivir
c. She should be offered the current seasonal influenza vaccine
d. She should be reassured that there is no risk to her baby
e. A viral throat swab should be taken and arrangements made to call her with the result the following day

A

b. A viral throat swab should be taken and she should receive oseltamivir

271
Q

Risk of measles to unborn fetus? (3)

A
  1. miscarriage
  2. preterm delivery
  3. increased maternal morbidity
272
Q

Congenital infections transmissable from mother?
Presentation of fetus

TORCH

A 
T - Toxoplasmosis
Other - Parvovirus B19, Syphilis, VZV, HBV, HIV
R - Rubella
C - CMV
H - HSV

T - Thrombocytopenia
Other - ears, eyes
R - Rash 
C - Cerebral abnormalities
H - Hepatosplenomegaly
273
Q

Common causative organisms of surgical site infection? (3)

A
  1. Staph aureus
  2. E.coli
  3. Pseudomonas aeruginosa
274
Q

Risk factors for surgical site infection? (8)

A
  1. age >75yrs
  2. underlying illness
  3. obesity
  4. smoking
  5. DM
  6. steroid use
  7. radiotherapy
  8. RA - stop DMARDs 7-8weeks before surgery
275
Q

Preventative measures to reduce risk of SSI pre-operatively? (4)

A
  1. showering with soap
  2. hair removal with electrical clippers, and only if necessary
  3. nasal decontamination of S.aureus
  4. Abx prophylaxis
276
Q

Preventative measures to reduce risks of SSI intra-operatively? (3)

A
  1. Cleaning skin with chlorhexidine
  2. Normothermia
  3. Oxygenation
277
Q

Pathogenesis of Septic Arthritis? (5)

A
  1. organism adheres to synovial fluid
  2. organism multiplies in synovial fluid
  3. triggers host inflammatoy response
  4. host produces fibronectin to which the organisms stick
  5. proteases and cytokines can causes cartilage destruction and bone loss
  6. increased intra-articular pressure can hamper blood flow and can cause bone ischaemia and necrosis
278
Q

Most common causative organism in septic arthritis?

A

Staph aureus (46%) - has receptors to fibronectin

279
Q

Clinical features of septic arthritis? (4)

A

1-2 week history of

  1. red
  2. hot
  3. swollen joint
  4. febrile
280
Q

Investigations in septic arthritis? (4)

A
  1. Blood culture prior to Abx
  2. joint aspirate for MC+S
  3. CRP/ESR
  4. Imaging - effusion
281
Q

Treatment of septic arthritis? (2)

- if MRSA?

A
  1. Drainage
  2. Abx 6weeks Flucloxacillin/Cephalosporin

Abx Vancomycin

282
Q

Osteomyelitis

  • route of infection (2)
  • presentation (3)
  • investigations (3)
A

local or haematogenous spread

  1. fever
  2. pain
  3. swelling
  4. blood culture
  5. MRI
  6. CT with biopsy
283
Q

Associated with chronic osteomyelitis?

- management

A

Brodie’s abscess

Radical debridement, remove sequestra, remove infected tissue & bone

284
Q

Prosthetic Joint Infection

  • route of infection? (2)
  • presentation (4)
  • investigations (3)
  • management
A

local or systemic bacteraemia (UTI)

  1. pain
  2. pt complains that “joint was never right”
  3. early failure of joint
  4. sinus tract
  5. imaging - loosening
  6. inflammatory markers
  7. joint aspiration

Replace joint using abx impregnated cement

285
Q

Common sites of hospital acquired infections (3)

A
  1. GI
  2. UTI
  3. SSI
286
Q

Common causative organisms of hospital-acquired UTI? (4)

  • risk factors
  • resistance
A

Gram neg

  1. E.Coli
  2. Klebsiella
  3. Pseudomonas
  4. Proteus
    - in-swelling catheter
    - extended spectrum beta-lactamases
287
Q

Common Abx associated with C.diff infection? (3)

A

3 C’s
Clindamycin
Cephalosporins
Ciprofloxacin

288
Q 
Predisposing factor to C.diff diarrhoea?
Transmission of C.diff...
Treatment 
a) moderate
b) severe
A

Existing gut flora distrubed by use of broad spectrum Abx

C diff is a spore forming anaerobe, spores are very transmissible, contaminate environment and persist for long periods

STOP Abx

a) Metronidazole 10-14/7
b) Vancomycin 10-14/7

289
Q

Risk associated with C.diff?

A

pseudomembranous colitis due to toxins produced by c.diff

290
Q

Route of infection of MRSA

A

skin-breach e.g. invasive procedure, skin disease, skin lesions

291
Q

Steps of PCR (4)

Use of PCR

A
  1. DNA is denatured
  2. Primer is annealed to DNA
  3. DNA is exponentially multiplied by DNA polymerase starting chain elongation
  4. New strand and template are separated by melting

DNA of unknown virus can be probed and amplified to detect virus

292
Q

What is latent infection?

A

When the host has lifelong infection of a virus, but during the latent period only a small subset of viral genes are expressed

293
Q

Viruses that causes a latent infection in the host? (5)

A
  1. HSV
  2. VZV
  3. CMV
  4. EBV
    5 HHV
294
Q

HSV and VZV site of latency?

A

sensory nerve ganglia

295
Q

EBC and CMV site of latency?

A

leucocytes

296
Q

Complications of HSV in immunocompramised? (2)

A
  1. cutaneous dissemination

2. visceral involvement e.g. hepatitis, oesaphagitis

297
Q

Complications of VZV in immunocompramised? (2)

A
  1. hepatitis

2. pneumonitis

298
Q

Complication associated with CMV infection in HIV+ pt?

A

CMV retinitis

299
Q

Complication associated with CMV infection in HSCT pt?

A

CMV pneumonitis

300
Q

Complication associated with EBV infection in HIV+ pt? (2)

A
  1. Oral hairy leukoplakia

2. Lymphomas

301
Q

Complication associated with EBV infection in post-transplant pt?

Management (2)

A

Post-transplant lymphoproliferative disease (PTLD)
- control of proliferation in latently infected B cells is lost

  1. Reduce immunosuppression
  2. Rituximab
302
Q

Complication associated with Paediatric post-BMT?

Presentation (6)

A

Disseminated Adenovirus infection

  1. Fever
  2. Bone marrow suppression
  3. Haemorrhagic crisis
  4. Necrotising pneumonitis
  5. Hepatitis
  6. Colitis
303
Q

Which one of the following statements is not true?
A.CMV pneumonitis has a poor prognosis
B. CMV infection can cause bone marrow suppression
C. Aciclovir is the treatment of choice of CMV infection
D. CMV can be transmitted from the graft
E. CMV is a herpes virus that establishes latency in B lymphocytes

A

C. Aciclovir is the treatment of choice of CMV infection

It’s Ganciclovir

304
Q

An HIV infected patient presents with skin lesions resembling Kaposi Sarcoma, what is the causative virus?

305
Q 
A patient who received a stem cell transplant 2 weeks ago presents with mouth ulcers. Which of the following viral PCRs would you request on the mouth swab?
A. Enterovirus PCR
B. Adenovirus PCR
C. HSV PCR
D. HHV6 PCR
E. HHV8 PCR
A

A. Enterovirus PCR

C. HSV PCR

306
Q

What virus causes progressive multifocal leukoencephalopathy?

307
Q 
Which of the following viruses are associated with lymphoma? 
A. CMV
B.  Adenovirus	
C. HHV8
D. JC
E. EBV
A

C. HHV8

E. EBV

308
Q

Complications of measles in immunocompramised patient? (2)

A

Fatal

  1. encephalitis
  2. giant cell pneumonia
309
Q

Please examine the following hepatitis B serology results, which profile is consistent with past hepatitis B infection?
A. HBV sag (+), HBV core ab (+), HBV sab (-)
B. HBV sag (-), HBV core ab (-), HBV sab>100mIU/ml
C. HBV sag (-), HBV core ab (-), HBV sab (-)
D. HBV sag (-), HBV core ab (+), HBV sab of 15mIU/ml

A

D. HBV sag (-), HBV core ab (+), HBV sab of 15mIU/ml

310
Q 
A patient who received a stem cell transplant recently has a transaminitis. What investigations would you request on blood?
A. EBV serology
B. Hepatitis B surface antigen
C. Hepatitis C PCR
D. Hepatitis E PCR
E. CMV serology
A

B. Hepatitis B surface antigen
C. Hepatitis C PCR
D. Hepatitis E PCR

311
Q

Toxoplasmosis association

A

Cats faeces

312
Q

Common causative organisms in early onset sepsis (3)

A
  1. GBS
  2. E.Coli
  3. Listeria
313
Q

Maternal risk factors for early onset sepsis? (5)

A
  1. PROM
  2. Fetal distress
  3. Mec
  4. Fever
  5. Previous hx
314
Q

Fetal risk factors for early onset sepsis? (8)

A
  1. birth asphyxia
  2. acidosis
  3. resp distress
  4. low BP
  5. hypoglycaemia
  6. neutropenia
  7. jaundice
  8. hepatosplenomegaly
  9. rash
315
Q

Investigations in early onset sepsis? (7)

A 
FBC
Throat Swab
Deep ear swab 
Surface swabs 
CSF
CRP
CXR
316
Q

Management of early onset sepsis? (4)

A
  1. ABC approach
  2. Ventillation
  3. Nutrition
  4. Abx BenPen + Gentamycin

Amoxicillin/Ampicillin if Listeria

317
Q

Causative organism in late (>48hrs) onset sepsis? (4)

A
  1. Staphylococcal
  2. GBS
  3. E.Coli
  4. Listeria
318
Q

Presentation in late onset sepsis (9)

A 
Bradycardia
Apnoea
Poor Feeding 
Abdo distension 
Irritability
Convulsions
Jaundice 
Resp distress
HIGH CRP
319
Q

Investigations in late onset sepsis? (6)

A 
FBC
CRP
Cultures
Swabs from any infected areas
ET secretions if ventilated 
Urine
320
Q

Management in late sespis

a) hospital
b) community

A

a) Fluclocacillin + Gentamycin

b) Amoxicillin + Cefotaxime

321
Q

Pyrexia of Unknown Origin definition

A

Fever higher than 38.3º C on several occasions, persisting without diagnosis for at least 3 weeks in spite of at least 1 weeks investigation in hospital

322
Q

Commonest cause of fever in returning traveller?

323
Q

Causes of fever in the returning traveller? (10)

A 
Malria
Dengue
Typhoid
Rickettsia
Bacterial diarrhoea
UTI
Pneumonia
HIV seroconversion 
Brucella 
Viral haemorrhagic fevers
324
Q

What is Rickettsia?

Where is it common?

A 
"Spotted Fever"
Gram -ve bacteria
Zoonose
Rocky Mountains USA
India
325
Q

Organism associated with unpasteurised milk?

326
Q

What is Sixth Disease?

  • causative organism
  • presentation
  • site of latency
A

“Roseola Virus”
HHV-6
fever, 3/7, transient rash “exanthum subitum
lymphocytes

327
Q

Infectious Mononucelosis

  • what is it?
  • causative organism
  • triad
  • investigations
A 
Glandular fever
EBV
1. fever
2. pharyngitis
3. lymphadenopathy 
Paul Bunnel Test 
Monospot Agglutination
328
Q

Types of PUO (4)

A

Classical PUO
Health-care associated PUO
Neutropenic PUO
HIV-associated PUO

329
Q

Differentials in classical PUO? (7)

Definition

A

> 3/7 in hospital with investigations or > 3 OP visits with ambulatory investigation

  1. infection
  2. malignancy incl myeloma
  3. CTDs
  4. Abscesses
  5. IE
  6. TB
  7. Complicated UTIs
330
Q

Differentials in Healthcare associated PUO? (6)

A
  1. SSI
  2. Drugs
  3. Medical devices - catheters, IV line bacteraemia
  4. LRTI
  5. C.diff colitis
  6. Immobilisation - bed sores
331
Q

Differentials in Neutropenic PUO? (6)

A
  1. Chemotherapy
  2. Haematologiucal malignancies
  3. Fungal
  4. Bacterial
  5. Mycobacteria
  6. GVHD
332
Q

Differentials in HIV associated PUO? (9)

A
  1. Seroconversion
  2. TB
  3. Karposi’s Sarcoma
  4. Bacterial
  5. PCP
  6. CMV
  7. Cryptococcus
  8. Toxoplasmosis
  9. Lymphoma
333
Q

Clinical features of Typhoid/Enteric Fever? (7)

A
  1. fever
  2. headache
  3. abdo pain
  4. diarrhoea/constipation
  5. rose spots
  6. bradycardia
  7. hepatosplenomegaly
334
Q

Causative bacteria in eneteric fever?

Transmission?

A

Salmonella typhi/paratyphi

Food and water

335
Q

Rose spots are associated with?…

A

Enteric Fever

336
Q

Eosinophilia in the returning traveller?

337
Q

What is malaria spread by?

A

Female Anopheles mosquito

338
Q

Types of malaria? (4)

A

Plasmodium falciparum
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae

339
Q

Most severe malarial species?

A

P.falciparum

340
Q

Investigations for suspected malaria (3)

A 
Thick and thin blood film 
FBC - raised WCC
- low platelets 
- anaemia
LFTs - deranged
341
Q

Benign malarial species?

A

P.malariae

342
Q

Symptoms of malaria?
Common (7)
Uncommon (4)

A 
Common 
flu-like symptoms
fever
rigors
myalgia 
N&V
headache
back pain 
Uncommon 
diarrhoea
Abdo cramps 
Cough 
Dark urine
343
Q

Blood film findings in P.falciparum? (2)

A 
young trophozoites (rings)
Crescent-shaped gametocytes
344
Q

Blood film findings in P.vivax (2)

A

Schuffner’s dots

Merozites/Schizont

345
Q

Blood film findings in P.ovale?

A

Schuffner’s dots

346
Q

Treatment of mild P.falciparum? (3 options)

A
  1. Quinine + Doxycycline/Clindamycin
  2. Malarone
  3. Riamet
347
Q

Treatment of severe P.falciparum? (2 options)

A
  1. Quinine + Doxycycline/Clindamycin

2. Artemisin Combination therapy

348
Q

Treatment of P.vivax/P.ovale?

A

Chloroquine then Primaquine

349
Q

Complications in Falciparum Malaria? (9)

A 
Impaired conciousness
Renal impairment
Acidosis
Hypooglycaemia
Pulmonary oedema 
Spontaneous bleeding/DIC
Anaemia 
Shock 
Haemoglobinuria
350
Q

Infective Endocarditis

A

infection of the innermost layer of the heart, usually the valves

351
Q

Most common areas for vegetations in IE?

A

Mitral valve

Aortic Valve

352
Q

Risk factors associated with IE? (7)

A
  1. IVDU
  2. Poor dentition
  3. Rheumatic Fever
  4. congenital heart disease
  5. Valve replacement
  6. Long term lines
  7. GI issues
353
Q

Acute symptoms in IE? (9)

A 
fever
malaise 
anorexia
weight loss
rigors
night sweats
chest pain 
SOB
weakness
354
Q

Dukes Criteria for IE Diagnosis

A
  1. 2 major criteria
  2. 1 major + 3 minor criteria
  3. 5 minor criteria
355
Q

Major Criteria for IE (3)

A
  1. persistant bacteraemia > 2 positive blood cultures
  2. ECHO - vegetation seen
  3. Serology - postivive for Bartonella/Coxiella/Brucella
356
Q

Minor Criteria (7)

A
  1. predisposing risk factor
  2. fever >38*C
  3. high CRP
  4. evidence of immune complex formation (Janeway lesions, splinter haemorrhages)
  5. vascular phenomena (stroke, PE)
  6. positive ECHO that doesn’t meet major criteria
  7. positive serology that doesn’t meet major criteria
357
Q

Signs of subacute IE? (7)

A 
clubbing
splinter haemorrhages
Osler's nodes
Janeway lesions 
Roth spots
Splenomegaly 
Haematuria
358
Q

Investigations in IE? (9)

A 
FBC - aneamia
U+Es
CRP - high
ESR - high 
x3 blood cultures BEFORE Abx
ECHO
CXR
Serology
Urine analysis
359
Q

Common causative agent in subacute endocarditis?

Onset

A

Strep viridans

mild - moderate illness

360
Q

Common causative agent in acute endocarditis?

Onset

A

Staph aureus

days - weeks

361
Q

Unusual causes of IE? HACEK

A 
H - haemophilus parainfluenzae
A - aggregatibacter/actinobacillus
C - caridobacterium hominis
E - eikenella corrodens 
K - kingella kingae
362
Q

Right sided IE is common in who? Why?

A

IVDU, inject into venous system, bacteria goes into SVC into R side of the heart

363
Q

Treatment of IE in prosthetic valve?

A

Vancomycin + Gentamycin + Rifampicin

364
Q

Treatment of acute IE in native valve?

A

FLucloxacillin

365
Q

Treatment of subacute IE?

A

Benzylpenicillin + Gentamycin

366
Q

What is a zoonose?

A

pathogenic diseases and infections that are transmitted naturally between vertebrate animals and humans

367
Q

Brucellosis

  • carriers (4)
  • incubation
  • transmission (2)
  • who is at risk? (2)
  • symptoms (5)
  • complications (2)
  • treatment
A 
dogs, goats/sheep, cattle pigs 
3-4 days
direct contact or contaminated food e.g. unpasteurised dairy 
vets, farm workers
1. undulant fever
2. malaise 
3. sweats
4. rigors
5. myalgia
  1. carditis
  2. osteomyelitis

Tetracycline/Doxycycline with Streptomycin

368
Q

Rabies

  • carriers (2)
  • transmission
  • pathognomonic histology
  • prodrome (3)
  • acute symptoms (2)
  • management
A
  • dogs, bats
  • bite
  • Negri bodies
  • headache, fever, sore throat
  • acute encephalitits, hyperactive state, fear of water
  • rabies IgG post-exposure
369
Q

Plague

  • causative organism
  • carriers
  • transmission
  • types (2)
  • treatment
A 
Yersinia pestis
fleas on rats 
flea bites human 
1. Bubonic - flea bites human 
2. Pulmonary - human to human spread during epidemic 
Streptomycin/Doxy/Gent/Chloramphenicol
370
Q

Leptospirosis

  • causative organism
  • transmission
  • who is at risk?
  • symptoms (6)
  • complications (3)
  • treatment
A 
L.interrogans
spirochaetes excreted in dog/rat urine, penetrates broken skin in contaminated water 
swimmers 
1. headache
2. spiking temp 
3. conjunctival haemorrhages 
4. jaundice
5. malaise
6. myalgia
  1. carditis
  2. renal failure
  3. haemolytic anaemia

Amoxicillin

371
Q

Cutaneous anthrax presentation

A

painless round black lesions with rim of oedema

372
Q

Pulmonary Antrax presentation (4)

A
  1. lymphadenopthy
  2. mediastinal haemorrhage
  3. pleural effusion
  4. resp failure
373
Q

Lyme Disease

  • transmission
  • where
  • causative agent
  • three stages
  • diagnosis
  • treatment
A 
tick bite
woodland/gardens/parks
Borrelia burgdo
1. Early localised
2. Early disseminated
3. Late persistant 
biopsy + ELISA for Lyme Abs
Doxycycline
374
Q

Symptoms of early localised Lyme Disease? (3)

A
  1. Erythema Chronicum Migrans (ECM) “Bullseye Rash”
  2. non-specific flu-like symptoms
  3. cyclical fevers
375
Q

What is erythema chronicum migrans associated with?

A

Lyme Disease

376
Q

Symptoms of early disseminated Lyme Disease (6)

A
  1. malaise
  2. lymphadenopathy
  3. hepatitis
  4. carditis
  5. arthritis
  6. palsies
377
Q

Symptoms of late persistent Lyme Disease? (4)

A
  1. Arthritis
  2. focal neurology
  3. neuropsychiatric distrubance
  4. acrodermatitis chronic atrophicans
378
Q

What is acrodermatitis chronic atrophicans?

A

widespread atrophy of the skin most evident peripherally at first

379
Q

Q fever

  • causative organism
  • vectors (2)
  • presentation (5)
  • treatment
A 
Coxiella burnetti 
cattle/sheep 
1. fever
2. dry cough 
3. fatigue
4. pleural effusions
5. diarrhoea 
Doxycycline
380
Q 
Leishmania
- vector 
- transmission 
- where?
types of infection (4)
A
  • sandfly
  • bite from sand fly
  • South & Central America, Middle East
    1. Cutaneous
    2. Diffuse Cutaneous
    3. Muco-cutaneous
    4. Visceral
381
Q

Presentation of cutaneous Leischmania?

Type of hypersensitivity reaction?

A

skin ulcer at site of sandfly bite, heals after a year leaving a deep depigmented scar
Type IV

382
Q

Who gets diffuse cutaneous Leischmania?

A

immunocompramised

Lots of nodules

383
Q

What are prion diseases?

A

rare, transmission encephalopathies in humans and adults, caused by protein-only infectious agents
cause rapid neuro-degeneration in animals and humans

384
Q

How does the prion embed in the brain? (3)

A

Prion protein gene is expressed on chromosome 20, predominantly expressed in the brain
Normal PRP structure is alpha-helical, but the infected PRP abnormally fold into beta-sheet configuration and becomes insoluble

385
Q

What is the commonest form of prion disease?

a. Kuru
b. Iatrogenic CJD
c. Gerstmann-Straussler-Sheinker syndrome
d. Variant CJD
e. Sporadic CJD

A

e. Sporadic CJD

386
Q

Features found of post-mortem in Sporadic CJD? (2)

A
  1. spongiform vaculation

2. PrP amyloid plaques

387
Q

Sporadic CJD

  • onset
  • presentation (5)
  • prognosis
A

45-75 years

  1. rapid, progressive dementia
  2. myoclonus
  3. cortical blindness
  4. akinetic mutism - inability to move or speak
  5. LMN signs
388
Q

18 yr old woman
LLL pneumonia
Unwell
Raised WCC + CRP

What is the likely organism?

a. Pseudomonas aeruginosa
b. Mycobacterium tuberculosis
c. Legionella pneumophilia
d. Streptococcus pneumoniae
e. Staphylococcus aureus

A

d. Streptococcus pneumoniae

389
Q

56 yr old man
LLL pneumonia
Haemoptysis
Cavitiation on CXR

What is the likely organism?
A) Streptococcus pneumoniae
B) Haemophilus influenzae
C) Staphylococcus aureus
D) Klebsiella pneumoniae
E) Any of the above
A

B) Haemophilus influenzae

390
Q

62 yr old smoker
Confused
Bilateral interstitial change
Hyponatraemic

what is the likely organism?

a. Moraxella catarrhalis
b. Mycobacterium tuberculosis
c. Legionella pneumophilia
d. Cytomegalovirus (CMV)
e. Staphylococcus aureus

A

c. Legionella pneumophilia

391
Q 
What is the probable diagnosis?
74 year old woman
RLL pneumonia
On standard Abx
Not getting better

a. Tuberculosis
b. Empyema
c. Mesothelioma
d. MRSA pneumonia
e. Aspiration pneumonia

A

b. Empyema

392
Q

21 yr old from Ecuador
Cough and weight loss
RUZ shadowing on CXR
What is the likely organism?

a. Staphylococcus aureus
b. Aspergillus fumigatus
c. Mycobacterium tuberculosis
d. Haemophilus influenzae
e. Pneumocystis jiroveci

A

c. Mycobacterium tuberculosis

393
Q

64 yr old man
Treated for TB
CXR shows bilateral ground-glass shadowing
What is the likely organism?

A)	Aspergillus fumigatus
B)	H1N1 Swine flu 
C)	Mycoplasma pneumoniae
D)	Cytomegalovirus (CMV)
E)	Pneumocystis jiroveci
A

E) Pneumocystis jiroveci

394
Q

22 year old man
Chemotherapy for leukaemia
Prolonged neutropenia (

A

b. Aspergillus

395
Q

Pneumonia

  • what
  • presentation (7)
  • assessment of severity
A

inflammation of lung alveoli

  1. fever
  2. cough
  3. sputum
  4. SOB
  5. pleuritic chest pain
  6. fever
  7. malaise
  8. N&V

CURB65

396
Q

What is the CURB65 score?

A

Confusion
Urea >7nmol
RR >30
BP 65yrs

397
Q

Most common organisms causing CAP?

A
  1. Step pneumoniae

2. H.influenzae

398
Q

Strep pneumoniae pneumonia

  • where in the lungs?
  • microscopy
  • sputum colour?
A

lobar
gram+ve diplococci
rust-coloured sputum

399
Q

H.influenzae pneumonia

  • associated with who? (3)
  • common sign
  • microscopy (2)
A
  1. smokers
    2, pre-existing lung conditionse.g. COPD
  2. kids aged
400
Q

M.catarrhalis pneumonia is associated with who?

401
Q

Common cause of HAP?

A

Staph aureus

402
Q

Staph. aureus pneumonia

  • association
  • EMQ
  • sign on CXR?
  • microscopy
A
  • previous viral infection
  • post-influenza
  • cavitation on CXR
  • Gram +ve cocci “bunch of grape” clusters
403
Q

Klebsiella pneumoniae

  • association (2)
  • common sign
  • sign on CXR
  • microscopy
A
  1. alcoholics
  2. elderly

haemoptysis
cavitation on CXR
Gram -ve rod

404
Q

First line treatment of moderate CAP?

A

Amoxicillin or Erythromycin/Clarithromycin if Pen allergic

405
Q

Treatment of sever CAP?

A

Augmentin + Erythromycin/Clarithromycin

406
Q

Common cause of atypical pneumonia in paediatrics?

A

Mycoplasma pneumoniae

407
Q

Legionella pneumonia

  • who in EMQ
  • association (3)
  • presentation (4)
  • clinical features (3)
  • culture requires?
A
  • travelling business men
    1. travel
    2. air conditioning
    3. water towers
  1. SOB
  2. Confusion
  3. Abdo pain
  4. diarrhoea
  5. hepatitis
  6. HYPOnatremia
  7. lymphocytopenia

buffered charcoal yeast extract

408
Q

Mycoplasma pneumonia

  • who
  • where
  • presentation (2)
  • specific test
  • complications (2)
A
  • children 6months - 5 years
  • Mexico
    1. erythema multiforme
    2. joint pain
  • cold agglutinin test
  1. SJS
  2. AIHA
409
Q

Signs associated with chlamydia pneumoniae?

A

ENT involvement

410
Q

Chlamydia psittaci
- who?
clinical symptoms (3)

A

BIRD FANCIERS

  1. hepatosplenomegaly
  2. rash
  3. haamolytic anaemia
411
Q

Causative agent of whooping cough?

Who is at risk?

A

Bordatella pertussis

Unvaccinated e.g. travelling community

412
Q

Treatment of atypical pneumonias? (2)

why?

A

Macrolides and Tetracyclines that work on protein synthesis because atypical organisms do not have a cell wall

413
Q

Pneumonias that HIV-patients are susceptible to? (3)

A
  1. P.jiroveci/Pneumocystis carinii pneumonia
  2. TB
  3. Crytococcus neoformans
414
Q

P.jiroveni/PCP

  • sign on CXR?
  • onset
  • diagnosis (2)
  • microscopy
A
  • ground-glass shadowing
  • insiduous
    1. Silver stain
    2. immunofluorescence
  • boat-shaped organisms
415
Q

Common cause of pneumonia in chemotherapy patients with neutropenia?

  • presentation (2)
  • clinical feature
A

Fungus - Aspergillus

  1. bronchiectasis
  2. chronic wheeze
    - eosinophilia
416
Q

Common cause of pneumonia in BMT patients? (2)

A
  1. Aspergillus

2. CMV

417
Q

Caustaive organisms of pneumonia in splenoectomy patients? (3)

A
  1. H.influenzae
  2. S.pneumoniae
  3. Neisseria meningitidis

ENCAPSULATED BACTERIA

418
Q

Common cuase of pneumonia in CF patients? (2)

A
  1. Pseudomonas aeruginosa

2. Burkholderia cepacia

419
Q

What is bronchitis?
- presentation (4)
- association
treatment (3)

A
  1. SOB
  2. increased sputum production
  3. cough
  4. fever

smokers

  1. Physiotherapy
  2. broncodilation
  3. Abx
420
Q

Diagnostic test used in severe CAP?

A

Urine antigen tests to look for
S.pneumoniae
Legionella

421
Q

Causative organism in cat scratch disease?

A

Bartonella henselae

422
Q

A man was bitten by a rat in Asia. Ten days later he complains of fever, malaise, headache and myalgia

A

Haverhill Fever

caused by Spririllum minus

423
Q

A zoonosis associated with hepatitis, jaundice, conjunctival injection and renal impairment. Transmission normally occurs by direct contact with either the urine or tissues of an infected animal.

A

Leptospirosis

424
Q

A 45 year old male farmer presents with a raised, erythematous rash, with clearing in the centre. He also complains of headache, fever, athralgia and malaise

A

Borrelia burgdoferi

Lyme disease

425
Q

A 22 year old student presented to her GP upon return from a biology field trip, with a lesion on her leg which was 3” in diameter and flat, with a red edge and dim centre. She also mentioned feeling tired and suffering from headaches. On examination, the GP noted a fever of 38.0°C and an irregular heartbeat.

A

Borrelia burgdoferi

Lyme Disease

426
Q

A tanner on holiday from India presented to hospital with an ulcerating papule on his hand. On inspection of the ulcer, the centre was black and necrotic. Gram-positive rods grew on blood agar culture and responded to treatment with large doses of penicillin.

A

Bacillus anthracis

427
Q

A 21 year old man presents at his GP complaining of an itchy, scaly rash on the soles of his feet. Skin scrapings are taken and sent away for microscopic examination. Which fungi might be identified?

A

Tricophyton rubrum -> tinea pedis

428
Q

A 17 year old Nigerian girl presents at her GP with patches of hypopigmentation on her trunk. After an initial trial of steroid cream, the girl returns complaining that the rash is spreading. Woods lamp examination of the rash produces a yellow fluorescence. What is the causative fungus?

A

Pityriasis orbiculare

429
Q

A 45 year old female whose main hobby was pigeon racing was noted by her GP to an enlarged lymph node in her neck. What is the most likely diagnosis?

A

Cryptococcus neoformans, is a pathogenic fungus commonly found in pigeon droppings and pigeon nests (and also soil). The predominant clinical process usually in immunocompromised pts, is a variably subacute meningitis with occasional patients showing features of brain abscess or inflammatory cerebral vasculitis, so the clinical feats are usually - headache, fever, nausea, neck stiffness, feats of raised ICP. Histoplasmosis, is also spread from bird droppings -but apparently not so specific to pigeons. Disseminated histoplasmosis, as you correctly state can cause lymphadenopathy (resembles disseminated TB - fever, weight loss, lymph nodes). PS. Remember India Ink staining for cryptococcus, which is often a clue in questions.

430
Q 
Superficial fungae (2)
- diagnosis
A
  1. Tinea
  2. Pityriasis
    - Wood Lamp
431
Q

Causative organism in Athlete’s foot?

- yeats or mould?

A

Tricophyton rubrum

mould

432
Q

Causative organism in seborrhoeic dermatitis?

yeats or mould?

A

Malessezia furfur

mould

433
Q

Causative organism in Tinea versicolor?

  • presentation
  • yeast or mould
A

Malessezia globosa
depigmented lesiosn in darker skin
mould

434
Q

Deep-seated fungae (3)

A
  1. Candida
  2. Aspergillus
  3. Crytococcus
435
Q

How to diagnose Candida infection? (2)

- yeast or mould?

A
  1. Culture
  2. Mannan Antibodies

yeast

436
Q

Aspergillus

  • yeats or mould?
  • who
  • associated
  • diagnosis (3)
A 
yeast 
immunocompramised patients
HCC
1. ELISA
2. PCR
3. beta-Glucan test
437
Q

Crytococcus

  • yeast or mould?
  • who?
  • type of infection
  • where
  • diagnosis (2)
A
  • yeast
  • immunocompramised
  • meningitis with insidious onset in HIV patients
  • pigeon poo
    1. Cryptococcal antigen in serum
    2. CSF
438
Q

Mode of action of Amphotericin?

  • type of fungus
  • use
A

interupts cella membrane integrity
Yeast
Crytptococcus meningitis

439
Q

Mode of action of Azoles?

  • type of fungus
  • use
  • e.g.
A

interupy cell membrane synthesis
yeast
candida
fluconazole

440
Q

Mode of action of Terbinafine?

  • type of fungus
  • use
A

targets cell membrane
mould
Tinea

441
Q

Mode of action of Echinpcandin?

  • type of fungus
  • example
A

targets cell wall
yeast
Caspofungin

442
Q

STIs causing discharge (5)

A
  1. Gonorrhea
  2. Chlamydia
  3. Trichomonas
  4. Candida
  5. BV
443
Q

STIs causing ulceration (5)

A
  1. Syphilis
  2. HSV
  3. LGV
  4. Chancroid
  5. Donovanosis
444
Q

STIs causing rashes/lumps/growths (4)

A
  1. HPV
  2. Molluscum contagiosum
  3. Scabies
  4. Pubic lice
445
Q

Painful ulcers…

A

Herpes > Chancroid

446
Q

Painless ulcers…

A

Syphilis > LGV + granuloma inguinale

447
Q

Causative organism in opthalmia neonatorum (neonatal conjunctivitis) & microscopy (2)

A
  1. Neisseria gonorrhoeae
    Gram negative diplococcus
  2. Chlamydia trachomatis
    Gram negative
448
Q

Gonorrhoea

  • presentation in men (3)
  • presentation in women (6)
A 
Men 
- urethral discharge
- dysuria
- scrotal pain/swelling
Women 
- vaginal discharge 
- itching/soreness
- erythema/oedema 
- abdo pain 
- dyspareunia
449
Q

Gonorrhoea

  • transmission
  • who is at risk? symptoms (3)
  • diagnosis
  • treatment
A
  • sexual
  • during vaginal delivery through birth canal

complement deficiencies - disseminated gonococcal infection

  • septicaemia
  • rash
  • arthritis

Urethral/rectal smears

Ceftriaxone IM/ Cefixime PO

450
Q

Complications of Gonorrhoea

a) Men
b) Women

A

a) prostatitis

b) PID -> infertility

451
Q

Which chlamydia serovars cause trachoma?

A

Serovars A, B, C

infection of the eyes which can lead to blindness

452
Q

Which chlamydia serovars cause genital chlamydia infection and opthalmia neonatorum?

A

Serovars D - K

453
Q

Chlamydia

  • who
  • causative organism
  • presentation
  • complications in women (7)
  • complication in men (3)
  • diagnosis
  • treatment
A

younger population, in the UK 10%

454
Q

Side effects of azithromycin (2)

Contraindicated & why? (2)

A
  1. N&V
  2. photosensitivity

Pregnancy
bone growth disturbance & tooth discolouration in babies

455
Q

What is Reiters Syndrome?

  • triad
  • who gets it?
A
  1. conjunctivitis
  2. urethritis
  3. arthritis

young men with chlamydia trachomitis infection

456
Q

What is LGV?

A

Lympho-granuloma venereum

Lymphatic infection with chlamydia trachomatis

457
Q

Which chlamydia serovars cause LGV?

A

L1, L2, L3

458
Q

EMQ land who commonly gets LGV?

A
  • developing world

- MSM

459
Q

Presenting features of LGV?

a) early day 3-12 primary stage
b) late week 2-25 secondary stage
c) late
d) current outbreak

A

a) PAINLESS genital ulcer
b) PAINFUL buboes (inguinal abscesses)
c) inguinal lymphadenopathy, rectal strictures/fistulas
d) rectal symptoms - pain, tenesmus, bleeding, discharge

460
Q

Treatment of LGV?

A

Doxycycline BD 3 weeks

461
Q

Causative organism in Syphilis?

A

Treponema pallidum

Gram negative spirochaete

462
Q

Common co-infection with syphilis?

463
Q 
The course of syphilis?
Primary
Secondary
Latent
Tertiary
A

Primary - indurated painless ulcer appears 1-12 weeks following transmission
Secondary - systemic bacteraemia within 6 months following transmission
Latent - no signs but serological infection
Tertiary - years after transmission

464
Q

Primary syphilis features

A

PAINLESS indurated genital ulcer
often solitary
can persist for 4-6weeks -> chancre
regional lymphadenopathy

465
Q

Secondary syphilis features (9)

A
  1. low grade fever
  2. malaise
  3. symmetrical, non-pruritic, widespread maculo-papular rash
  4. mucosal “snail track” mucosal lesions
  5. uveitis
  6. choroidoretinitis
  7. alopecia
  8. genital warts “condyloma acuminate”
  9. neurological involvement
466
Q

Latent syphilis

A

no obvious signs, but serological infection

467
Q 
Tertiary syphilis
3 types (3)
A
  1. Granuloma/Gumma
  2. Cardiovascular
  3. Neurosyphilis
468
Q

Features of Gumma Syphilis (3)

  • onset
  • type of reaction
A
  1. skin
  2. bone
  3. mucosa

2-40 years later
delayed hypersensitivity reaction

469
Q

Features of cardiovascular syphilis

- onset

A

aortitis
+++ inflammation
10-30 years later

470
Q

Features of neurosyphilis (4)

  • onset
  • who is most at risk?
  • CSF findings
  • type of reaction
  • pathgnomonic
A
  1. meningovascular
  2. general paresis of the insane
  3. tabes dorsalis
  4. gumma
    - 2-30 years later
    - HIV +ve
    - spirochaetes
    - small vessel vasculitis
    - Argyll-Robertson pupil
471
Q

What is tabes dorsalis?

A

Slow degeneration of the nerves of the dorsal column leading to loss of proprioception/fine touch/vibration

472
Q

What is an Argyll-Robertson pupil?

What is it pathgnomonic of?

A

pupil can accommodate to near objects but does not constrict in bright light
Neurosyphilis

473
Q

Treatment of Syphilis?

- side effects

A

IM Benzathine Penicillin
Doxycyline is Pen allergic

Jarisch-Heimer reaction - fever, headache, myalgia, exaccerbation of syphilic features

474
Q

Congenital syphilis

  • transmission
  • features (5)
A

during pregnancy or birth

  1. fever
  2. rash
  3. hepatosplenomegaly
  4. neurosyphilis
  5. pneumonitis
475
Q

Chancroid

  • what
  • presentation (2)
  • causative organism
  • diagnosis
  • treatment
A 
bacterial tropical ulcer disease
multiple painful genital ulcers , painful lymphadenopathy
Haemophilus ducreyi
chocolate agar plate 
Azithromycin
476
Q

Donovanosis

  • causative organism
  • where in the world (3)
  • presentation (3)
  • diagnosis
  • treatment
A

Klebsiella granulomatis

  1. India
  2. Africa
  3. Australia aborigines
  4. expanding ulcers
  5. start as papule/nodule then break down
  6. beefy red appearance
  • Giemsa stain showing Donovan bodies
  • Azithromycin
477
Q

Tichomoniasis

  • causative organism
  • presentation in men
  • presentation in women
  • associated risk
  • treatment
A 
trichomoniasis vaginalis
asymptomatic or urethritis
green malodorous discharge
increased risk of HIV
Metranidazole
478
Q

Bacterial vaginosis

  • what
  • presentation
  • diagnosis (3)
  • complications (2)
A 
change in vaginal flora, polymicrobial
odour, discharge
- MC + S
- raised pH
- clue cells
  • preterm delivery
  • often recurrent
479
Q

Candidiasis

  • causative organsim
  • presentation in women (5)
  • presentation in men
  • treatment (2)
  • association
A

candida albicans

  1. vulvovaginitis
  2. thick white discharge
  3. itchiness
  4. redness
  5. soreness
  6. Clotrimazole
  7. Fluconazole

immunosuppressed

480
Q

Molluscum contagiosum

  • causative agent
  • who? (2)
  • where? (2)
  • transmission
  • treatment
A 
Pox virus
a) children - hands and face
b) adults - genital lesions
skin to skin contact 
cryotherapy
481
Q

Genital warts

  • causative agent
  • which strains?
  • presentation (6)
  • incubation
  • treatment
  • contraindication
A

HPV
6 and 11

Warts

  1. papular
  2. planar
  3. pedunculated
  4. carpet
  5. keratinised
  6. pigmented

3 weeks -> 8 months

Podophyllotoxin
pregnant women

482
Q

The antiviral which is given to untreated pregnant women with HIV to prevent vertical transmission of the virus during childbirth.

A

Nevirapine

483
Q

A drug that is effective against influenza A but not influenza B

A

Amantidine

Pathology (7 decks)

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