Microbiology Flashcards
1
Q
anti-retroviral given to UNTREATED pregnant woman presenting late in order to prevent HIV vertical transmission
A
nevirapine
2
Q
what immunomodulation therapy is used in hepatitis B?
what are 2 antivirals used along side this?
A
PEGylated-interferon alpha 2A or 2B
tenofovir & entecavir
3
Q
the final metabolite of the antiviral used to treat herpes simplex
A
aciclovir triphosphate
4
Q
aerosolised antiviral to prevent RSV in children with heart and lung disease
A
ribavirin - nucleoside analog. similar in structure to GUANOSINE
5
Q
if aciclovir doesn’t work on HSV, what is the next antiviral?
A
foscarnet
6
Q
what antiviral has action against influenza A but not influenza B?
A
amantadine - blocks a channel on virion that is required for the onset of viral replicaiton. influenza B has a structurally distinct channel that does not become blocked by amantadine
7
Q
thymidine kinase is a specific requirement for the action of which antiviral?
A
aciclovir
8
Q
an antiviral similar to oseltamavir that can be given inhaled. what is the benefit?
A
zanamivir - inhaled drug has lower systemic levels meaning it is safer in pregnancy
9
Q
atypical pneumonia - Dry cough, new infiltrates on CXR, dyspnoea and target shaped lesions on the palms. No recent history of herpes. What is the causative organism?
A
mycoplasma pneumoniae
10
Q
besides p. aerugenosa, name another bug that causes persistent pneumoniae in cystic fibrosis
A
burkholderia cepacia
11
Q
A 35 year old clown who is a specialist in bird/clown comedy is found to have an atypical pneumonia which is treated with Augmentin and Clarythromicin. What is the causative organism?
A
chlamidophilia psittici
12
Q
what is the treatment for standard HCV?
A
INF-alpha 2B, ribavirin
changes depending on the genotype of HCV under specialist guidance
13
Q
which are the live attenuated vaccines?
A
MMR
yellow fever
Rotavirus
BCG
14
Q
which are the inactivated/subunit vaccines?
A
HAV
HBV
pneumovax (PPV-23) (polysaccheride)
HPV
15
Q
which are the conjugate vaccines? (5)
A
diptheria, tetanus, pertussis
HiB
5 in 1 (DTaP/IPV/Hib)
pneumococcal conjugate vaccine
meningococcal
16
Q
which are the inactivated toxin vaccines?
A
tetanus
diptheria
17
Q
the contraindication valid for all vaccines?
A
confirmed anaphylactic reaction to a previous dose of the vaccine or component of the vaccine
18
Q
a precaution for consideration for DTaP vaccine
A
evidence of evolving neurological condition (e.g. epilepsy)
postpone until condition under control
19
Q
a contraindication only for influenza vaccine
A
confirmed allergy/hypersensitivity to egg
20
Q
what are the added contraindications to live vaccines?
(on top of previous anaphylaxis and egg allergy)
A
immunocompromising treatment or condition
pregnancy
21
Q
which vaccines should and should not be given in HIV?
A
SHOULD give - MMR, 5 in 1
SHOULD NOT give - yellow fever, BCG
22
Q
what vaccinations are given at 8 weeks?
A
5 in 1
PCV
Men B
Rotavirus
23
Q
what vaccinations are given at 12 weeks?
A
5 in 1
Rotavirus
24
Q
what vaccines are given at 16 weeks?
A
5 in 1
PCV
MenB
25
what vaccines are given at 1 year?
MMR
Hib booster
PCV booster
MenB/C
26
what vaccines are given at 3 years 4 months?
MMR
DTaP/IPV
27
what vaccines are given at 12-13 years old?
HPV quadravalent
repeated 6-24 months apart
28
what vaccines are given at 14 years?
tetanus, diptheria and polio (Td/IPV)
MenAWCY
29
at what ages are the influenza vaccine given?
2-7
\>65
30
what is a naturally occuring cytokine that inhibits HIV fusion to CD4+ cells?
MIP-1alpha
31
antibiotic for MRSA
vancomyin or ticoplanin
32
treatment for hairy leukoplakia?
aciclovir, EBV is implicated organism
33
treatment for VRE?
amoxillin (if susceptable), gentamicin, linezolid
doxycyclin
34
which of RIPE is given as TB prophylaxis?
isoniazid
35
This microbes affects mainly the distal colon, producing acute mucosal inflammation and erosion. It is spread by person-to-person contact, and its clinical features include fever, pain, diarrhoea and dysentery.
Shigella
36
This microbe affects the ileum, appendix and colon. Its peyer patch invasion leads to mesenteric lymph node enlargement with necrotising granulomas. Complication can include peritonitis, pharyngitis and pericarditis.
Yersinia enterocolitica
37
how do you contract brucellosis?
ingestion of unparteurised milk or undercooked meat
38
cyclical fever, arthralgia, sacoiliac pain, anorexia, weakness and malaise
should make you think of what infection?
brucellosis
39
Q fever is caused by which bug?
coxiella burnetii
40
fever, dry cough, headache, animal exposure in southern france or spain
Q fever - coxiella burnetii
41
typhus is caused by ...
typhoid is caused by...
typhus = *rickettsia spp.*
typhoid = *salmonella typhi/paratyphi*
42
what bug causes psittacosis?
*Chalmidophila psittaci*
43
An ornithologist presents to his GP with fever, arthalgia and cough and dyspnoea
diagnosis?
psittacosis
44
what is the animal vector for leptospirosis?
rodents
45
a flu-like illness followed by diarrhoea and jaundice
zoonosis
what bug?
leptospira
46
flu-like illness, jaundice, haemorrhage, red eyes...
leptospirosis
47
how do you make the diagnosis of leptospirosis?
microscopic agglutination test
48
what is the other cancer caused by HHV8 in HIV+ patients?
primary effusion lymphoma
49
what is the bug in rat-bite fever? Commonly in Asia
*spirillium minor*
50
A student who presented with two day history of bloody diarrhoea, vomiting, fever, headache and myalgia. He has just returned from camping in the country side near a farm where he had fresh cow’s milk for breakfast everyday.
What bug?
*Campylobacter jejuni*
51
A 2 year old boy living in the slums who has a one day history of profuse watery diarrhoea, fever and abdominal cramps. His family’s main source of water is the river near their squatters.
What bug?
*cryptosporidium parvum*
52
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.
disease/bug?
leptospirosis
## Footnote
*leptospira interrogans*
53
A 22 year old student, who returned from a holiday in the **Mediterranean** 3 weeks ago, presents with an **undulant fever**, malaise, weakness and generalized bone pain. Upon examination lymphadenopathy and hepatosplenomegaly are also noted.
disease?
Brucellosis
54
*Brucella* is a ..
small, gram -ve facultative intracellular bacteria
55
how do you get brucellosis?
from ingestion or contact with contaminated food (usually milk and dairy products)
also from animal/environmental contact
56
classically a fever that undulates
peaks in the evening and normal by morning
brucellosis
57
what is the incubation period of brucellosis?
3-4/52
58
anti-O-polysaccheride antibody is the serological test for what disease?
what would you find on FBC?
brucellosis
WCC normal/neutropaenic
59
what is the treatment of brucellosis?
duration of treatment
Tetracycline/doxycycline + streptomycin
duration: 4-6/52
60
fatel encephalitis with Negri bodies suggests...
rabies
61
*leptospira* is a..
how do you classically get this bug?
spirochete
swimming in contaminated water
62
conjunctival haemorrhage with jaundice suggests...
leptospirosis
63
lyme disease
how can you confirm the diagnosis?
1. skin biopsy at edge of ECM
2. ELISA for anti-Lyme antibodies
64
first line treatment for lyme?
with CNS involvement?
doxycycline 2-3/52
CNS = IV ceftriaxone 2-4/52
65
Skin ulcer at site of bite
multiply in dermal macrophages
Heals after 1yr leaving depigmented scar
May be single or multiple painless nodules which grow + ulcerate
cutaneous leishmaniasis
66
what is the difference between cutaneous and diffuse cutaneous leishmaniasis?
C = single nodule that ulcerates and heals over
DC = diffuse nodular skin lesions that do not ulcerate or heal and spread over the body in immunocompromised patients
67
what bug is likely to cause prostatic valve endocarditis?
CoNS
68
what are the major Dukes Criteria? (3)
* persistent bacteraemia (\>2 cultures +ve)
* echo findings suggestive of IE
* +ve serology for bartonella, coxiella or brucella
69
what are the minor Dukes criteria? (6)
1. predisposing RF - new murmur, IVDU
2. fever \>38 degC or elevated CRP
3. evidence of immune complex deposition
4. vascular phenomena
5. Positive echo that doesn't meet major criteria
6. Positive blood culture that doesn't meet major criteria
70
what is the empirical antibiotic treatment for IE with native or prosthetic valve?
native - fluclox
prosthetic - vanc, gent and rif
71
what animal has *brucella abortis*? and what animal has *brucella melitensis*?
* b. abortis* - cattle
* b. melitensis* - goat (people from med/europe)
72
A 55 year old farmer is seen in the Oncology clinic with a diagnosis of hepatocellular carcinoma. He is a lifelong teetotal and his virology has all been negative. Which fungus may have indirectly been a cause of his cancer?
*aspergillus falvus*
73
which inhaled pathogenic fungus is associated especially with pigeon?
*cryptococcus neoformans*
74
what are the pnaeumoina bugs that CF patientes get?
* pseudomonas aeruginosa*
* burkholderia cepacia*
75
Can be used as monotherapy for acute pyelonephritis and should always be prescribed orally because its bioavailability is near 100% and iv dosing is 30 times more expensive
ciprofloxacin
76
bug that causes haemorrhagic cystitis in children
adenovirus
77
In combination with iv ampicillin, this drug is used iv for very sick patients with obstructed infected upper UTIs and gram negative septicaemia
gentamicin
78
why do you avoid nitrofurantoin at term in pregnancy?
haemolysis in the foetus/newborn
79
a sterile pyuria suggests what organism?
tuberculosis
80
A 35 year old woman receiving chemotherapy for high grade lymphoma develps SOB and dry cough. CXR shows bilateral reticulonodular shadowing. A transbronchial biopsy shows alveoli filled with foamy eosinophilic material and numerous boat-shaped organisms staining positively with silver stain. Sputum culture is negative.
what bug?
PCP
don't forget that all immunocompromised patients are at risk, not just AIDS
81
what is the timing for antibiotic prophylaxis for colorectal surgery?
cef & met 2 hours before and for 24 hours after surgery
82
gram positive cocci in chains, which is aesculin-positive and resistant to the conventional anti-streptococcal antibiotics
VRE
83
what is the treatment for EBSL?
carbapenems
84
what is the treatment for MRSA?
vancomycin
85
microfilariae and eosinophilia suggests...
*wuchereria bancrofti*
86
how do you treat entamoeba?
metronidazole
if luminal disease, add paromomycin
87
bloody diarrhoea, weight loss, tenesmus and RUQ pain
entamoeba histolytica
88
Slow onset fever + constipation, relative bradycardia
Splenomegaly and rose spots, anaemia and leukopaenia
typhoid fever (salmonella typhi and paratyphi)
89
you should give antibiotics to shigella or salmonella?
which one?
salmonella - ceftriaxone/ciprofloxacin
90
who gets vibrio parahaemolyticus?
people eating raw/undercooked seafood
common in Japan
91
which bug is associated with muco-cutaneous leishmeniasis?
*L. braziliensis*
92
An acutely unwell 42 yr old male presents to A&E with high fever accompanied by chills, sweats and vomiting with a 24 hour history. O/E he is clinically jaundiced with cool clammy skin. He is tachypnoeic and tachycardic. You note hepatosplenomegaly and that he is producing small amounts of dark brown urine in his catheter bag. His wife tells you that they recently returned from safari in Tanzania 10 days ago
plasmodium falciparum
93
A French mother brings her 2 month old daughter with fever to hospital. The infant is shown to have elevated hepatic enzymes and is treated with pyrimethamine, sulphadiazine and folic acid for a year after appropriate investigations are performed
congenital toxoplasmosis
94
A neonate is referred and presents with skin lesions, lymphadenopathy and failure to thrive. The mother had an infection
syphilis
95
how do you diagnose PCP?
sputum/BAL --\> Gomori's stain looking for flying saucer shaped cysts
96
A 34-year-old HIV-positive woman is seen in the GP clinic due to 3 days of **diarrhoea**, headaches and fever. History reveals the patient had recently drunk **unpasteurized milk**. The causative organism is found to be beta haemolytic with **tumbling motility**.
*listeria monocytogenes*
97
miscroscopic agglutination test ...
leptospirosis
98
what is Mollaret's meningitis?
what are the findings on CSF?
recurrent, aseptic meningitis caused by HSV-1/-2
clear CSF, high lymphocytes, high protein, normal glucose
99
blood culture on Castaneda medium means what?
*Brucella spp.*
100
what is the diagnostic test for CJD?
how do you proceed from there?
EEG - abnormal in 2/3 patients..
Then LP looking for 14-3-3 protein
if negative, can continue to tonsilar biopsy if you suspect vCJD (100% sensitivity and specificity)
101
what are the symptoms of CJD?
'demented **LAMB**'
Lower motor neuron signs, Akinetic mutism, Myoclonus, cortical Blindness
102
on CSF analysis, what is the differentiating factor between viral and TB meningitis?
TB = VERY high protein
viral = very high lymphocytes, all else quite normal
103
what is the diagnostic criteria for SBP on ascitic tap?
1. WCC \>500 cells/mm^3
2. neuts \>250 cells/mm^3
104
what is the treatment for hepatitis C?
what does this depend on?
interferon and ribavirin
genotype 1, 4, 5, 6 = 48 weeks
genotype 2, 3 = 24 weeks
105
what is the difference between *trypanosoma brucei* subspecies?
what is the bug that bites to give this infection?
* gambiense* = gradual (95% of cases)
* rhodesiense* = gradual (5% of cases)
Tse-tse fly
106
what disease is transmitted by sandfly?
leishmaniasis in afria, america and middle east
107
which TB drug needs monitoring in a certain patient setting? which patients? what is the potential consequence?
**ethambutol** in **renal failure**
renally excreted so will increase chances of **optic neuritis**
108
what must not be missed when starting anti-malarials?
G6PD deficiency
109
Maurer's clefts on thin blood film...
*falciparum*
110
Schuffer's dots on thin blood film...
*vivax* and *ovale*
111
what is amantadine?
anti-influenza A
targets M2 ion channel, resistance easily aquired
112
what is the main use of cidofovir?
CMV retinitis
113
what must be given with foscarnet and cidofovir?
both nephrotoxic so maintain positive fluid balance
add **probenecid**
114
what gives hydrops fetalis? what gestation is foetus at risk?
parvovirus B19
first 20 weeks
115
a gram +ve rod that give meningitis...
*listeria monocytogenes*
116
how do you treat cephalosporin resistant N gonorrhoaea?
spectinomycin
117
how is the treatment different for LGV versus chlamydia?
needs doxy
118
silver stain, boat shaped cells...
PCP pneumonia
119
gram negative coccus pneumonia associated with smoking
*M catarrhalis*
120
what is the treatment for CAP? Mild/moderate+/atypical
mild - amoxicillin or macrolide (at home)
moderate/severe - coamox/cefuroxime or clarithromycin (hospital)
atypical - macrolide or tetracycline (hospital)
121
*campylobacter* treatment
erythromycin
122
what medication do you give to CF patients for anti-pseudomonas lung cover?
nebs ceftazidime
123
fish tank granuloma - slinge or clusters of papules/plaques
seen in swimming pool/aquarium workers
mycobacterium marinarum
124
returning from tropics/australia
painless nodule, progresses to ulceration, grossly disfiguring scarring and contracture
mycobacterium ulcerans
125
what disease do you get with infection from microsporum canis?
tinea capitis and corporis
126
what is the treatment for JC virus PML?
dexamethasone and HAART
127
which UTI is associated with renal calculus?
proteus
