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flashcards of path guide 2018 > Microbiology > Flashcards

Microbiology Flashcards

1
Q

Presentation of TB

A

weight loss
cough
haemoptysis
fever with night sweats

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2
Q

where is post primary TB found

A

in the upper lobes

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3
Q

who is affected by post primary TB

A

young adults

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4
Q

how does post primary TB heal

A

fibrosis and calcifications

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5
Q

what is the classic lesion in post primary TB

A

caseating granuloma

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6
Q

What is the Ghon focus?

A

multiplication of TB at pleural surface

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7
Q

what sort of cells are in a TB granuloma

A

Langhan’s giant cells

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8
Q

buzzword for miliary TB

A

rich foci

haemotological spread

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9
Q

First line treatment for TB

A

Rifampicin
Isoniazid
Pyrazinumide
Ethambutol

Give all for 2 months then R and I for another 4 months

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10
Q

Rifampicin side effects

A

orange secretions
CYP450 induction
hepatotoxic
raised transaminases

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11
Q

second line treatments for TB

A 
Injectables- capreomycin, anamycin and kanamycin
quinolones- moxifloxacin
ethionamide/ protionamide
Linelozid
PAS
chlofazamine
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12
Q

treatment of TB meningitis

A

RIPE for 4 months then R and I for 8-10 months

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13
Q

Treatment of post primary TB

A

RIPE for 2 months then R &I for 4 months

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14
Q

treatment of latent TB

A

8 months of isoniazid

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15
Q

what is mono drug resistent TB resistant to

A

one drug (duh)

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16
Q

what is MDR TB resistant to

A

Rifampicin and isoniazid

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17
Q

what is XDR TB resistent to

A

rifampicin
isoniazid
injectables (kanamycin and amakacin)
quinolones

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18
Q

imaging for TB

A

CXR

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19
Q

cultures for TB

A

3x cultures
broncho-alveolar lavage
EMU
lowenstein-jensen sputum sample

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20
Q

gold standard for TB diagnosis

A

pus in lowenstein jensen medium

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21
Q

what do you see on microscopy of TB

A

acid fast aerobic bacilli

waxy cell wall

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22
Q

investigations in TB

A

mantoux/ heaf test
interferon gamma assays e.g. ellispot
NAAT- PCR probes
liquid culture mediums

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23
Q

TB meningitis symptoms

A

personality change, focal neurological deficit and declining GCS

neck stiffness, headache

weight loss, malaise, fever night sweats

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24
Q

diagnosis of TB meningitis

A

tuburculotoma on head CT

lymphocytes in lumbar puncture

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25
Q

treatment of TB meningitis

A

12 months of RIPE plus steroids

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26
Q

extra pulmonary TB symptoms

A 
lymphadenitis
CVS: pericarditis
GIT: ileitis, peritonitis
GUM: renal, testes
skin and liver also can be affected
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27
Q

risk factors for reactivating latent TB

A

immunosupression
aging
chronic alcohol intake
malnutrition

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28
Q

pathology of spinal TB

A

haematogenous spread of TB leading to discitis
this then leads to vertebral destruction and collapse
this can then lead to anterior extention and ileo-psoas abscess

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29
Q

BCG efficacy

A

0-80%

bad for pulmonary TB but good against leprosy, TB meningitis and disseminated TB

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30
Q

why is the BCG contraindicated inPLWH

A

-HIV –ve latent TB –> active TB 5-10% lifetime risk
-HIV +ve latent TB –> active TB 5-10% yearly risk
-

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31
Q

mycobacteria in leprosy

A

M leprae and M lepromatosis

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32
Q

treatment for leprosy

A

rifampicin
dapsone
clofazimine if multibacteria

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33
Q

leprosy symptoms

A

skin: depigmentation, plaques, macules, nodules
nerves: sensory neuropathy, thickened nerves
eyes: iridocyclitis, keratitis
bones: periositis, aseptic necrosis

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34
Q

tuberculoid leprosy is mediated by

A

Th1

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35
Q

lepromatous leprosy is mediated by

A

Th2

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36
Q

M Avium symptoms

A

in children: pharyngitis, cervical lympth adenitis
lung sx if underlying pulmonary disease
if cytoxic/ lymphoma disease then disseminated
If AIDS then disseminated multibacilliary infection with bacteraemia

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37
Q

M marinarum

A

swimming pool/ aquarium owner getsa single/ cluster of papules

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38
Q

Baruli ulcer (m bulurans)

A

a painless ulcer which progresses to a huge deformity with scarring, ulceration and contractures

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39
Q

how to decude if IV or oral treatment for pneumonia

A

CURB65 score

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40
Q

pathology of pneumonia

A

inflammation of alveoli

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41
Q

pathology in bronchitis

A

cough for most days of three months with phlegm for 2 or more consecutive years

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42
Q

strep pneumoniae pneumonia
sx
microscopy

A

gram positive diplococci

rusty brown sputum

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43
Q

haemophilis influenzae

microscopy and vulnerable group

A

associated with smoking/ COPD

gram negative coccobacillae

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44
Q

M catarrharis

microscopy and vulnerable group

A

associated with smoking

gram negative coccus

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45
Q

staph aureus as a cause of pneumonia

what is it associated with and what is seen on microscopy

A

associated with a recurrent viral infection (post flu in emq land)
gram +ve cocci (grape bunch clusters)

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46
Q

klebsiella pneumona
susceptible person
sx
micro

A

alcoholic/ elderley pt

sx: haemotysis
micro: gram negative rod, enterobacter

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47
Q

Atypical pneumonia microbes

A 
legionella pneumophilia
bordatella pertuccusis
chlamydia psittici
chlamydia pneumonia
mycoplasma pneumonia
TB
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48
Q

legionella pneumophilia

risk factors and findings

A

low sodium
hepatitis

risk in water towers/ air con

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49
Q

mycoplasma pneumonia
symptoms
test

A

systemic symptoms erythema multiforme, joint pain
cold agglutinin test
risk of SJS

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50
Q

bordella pertussis

A

often travelling community in EMQ

whooping cough in unvaccinated people

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51
Q

pathogen causing RTI in cystic fibrosis

A

psuedomonas aeringosa

burkholderia cepacia

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52
Q

pathogen causing RTI in BMT

A

aspergillus

CMV

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53
Q

pathogen causing RTI in neutropaenic patients

A

aspergillus spp

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54
Q

pathogen causing RTI in HIV patients

A

pneumocystitis jirovii
TB
cryptococcus neoformans

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55
Q

pathogen causing RTI in splenectomy patient

A

haemophilus influenzae
strep pneumoniae
neisseria meningitidis

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56
Q

which organisms do you identify with paired serum tests for pneumonia

A

legionella
chlamydia
if at 10 weeks

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57
Q

how to identify PCP on lab testing

A

silver staining in the cytology lab- boat shaped organisms

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58
Q

which pneumonias can you identify by urine antigen

A

legionella

strep pneumoniae

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59
Q

define hospital acquired pneumonia

A

pneumonia after >48 hours into hospital stay with no previous infection

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60
Q

treatment of classical community acquired pneumonia

A

if mild a macrolide/ amoxicillin for 5-7 days

if moderate to severe then use clarithromycin +coamxiclav/ cefuroxamine for 2-3 weeks

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61
Q

how to treat atypical community acquired pneumonia

A

use a macrolide/ tetracycline

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62
Q

what does clarithromycin interact with

A

WARFARIN

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63
Q

treatment of hospital acquired pneumonia

A

1st line: ciprofloxacin +/- vancomycin

2. piptazobactam + vancomycin

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64
Q

treatment of aspiraton pneumonia

A

metronidazole + cefuxamine

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65
Q

treatment of legionella pneumonia

A

rifampicin + macrolide

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66
Q

treatment of staph aureus pneumonia

A

flucloxacillin

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67
Q

treatment of pseudomonas HAP

A

ciprofloxacin plus gentamycin

ortazocin + piperacillin

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68
Q

treatment of MRSA HAP

A

vancomycin

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69
Q

Isoniazid side effects

A

hepatotoxicity
peripheral neuropathy
(give pyroxidine or B6)

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70
Q

Pyrazinamide

A

hyperuricaemia

hepatotoxicity

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71
Q

Ethambutol

A 
visual disturbances (red-green colour blindness)
optic neuritic
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72
Q

second line treatment of TB

A

1) injectables (amakacin, capreomycin, kanamycin)

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73
Q

Painful genital ulcers are most likely to be

A

Herpes

Chancroid (less likely)

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74
Q

Painless genital ulcers could be

A

Syphilis
Lymphogranuloma venereum
granuloma inguinale

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75
Q

What is seen on microscopy of gonorrhea

A

Gram negative diplococcus

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76
Q

What complication occurs when a baby contracts gonorrhea from mums birth canal

A

Ophthalmia neonatorum

The baby develops a conjunctivitis is left untreated

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77
Q

What happens to a patient with a complement deficiency if they contract gonorrhea

A

They get disseminated gonorrhea, septicaemia, arthritis and/ or rash

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78
Q

Gold standard diagnosis of gonorrhea

A

Culture from urethral swab (95% sensitive) rectal swab is 20% sensitive

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79
Q

Treatment of gonorrhea

A

200mcg of cefrtriaxone IM

or 400 mcg of oral ceftriaxone

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80
Q

What antibiotic is used if gonorrhea is resistant to ceftriaxone

A

Spectinomycin 2g im

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81
Q

Consequences of gonorrhea

A

Prostatitis or salpingitis

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82
Q

What is seen on microscopy of chlamydia

A

Intracellulaire pathogen

Ovoid and gram negative ( non spore forming)

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83
Q

What are the two stages of chlamydia’s life cycle

A

Intracellular reticular bodies that are metabolically active

Extracellular stable elementary bodies

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84
Q

Complications of chlamydia

A

PIX, ectopic risk, endometriosis

Reiters syndrome

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85
Q

Gold standard for chlamydia diagnosis

A

NAAT

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86
Q

Treatment of chlamydia

A

1g azithromycin P.O.

Alternatively 7 days100mcg BD doxycycline P.O.

Contraindicated in pregnancy ( give erythromycin 7/7 500mcg QDS )

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87
Q

What is lymphogranuloma venereum

A

Lymphatic infection with chlamydia trachomatis Serovars L1-3

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88
Q

syphilis on microscopy
what shape
gram positive or negative

A

obligate gram negative sphirochaete (helically coiled- squiggly)
use dark ground microscopy

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89
Q

how do you detect treponemes

A

PCR is gold standard

dark ground microscopy

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90
Q

what reagents cause a false positive on syphilis testing

A

cariolipin
lecathin
cholesterol

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91
Q

non treponomal tests for syphilis

A

useful in primary infection and to check the treatment response
detect non-specific antigens
VDRL slide test

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92
Q

treponomal tests for syphilis

A

these test specific antigens for t. pallidum
Enzyme immuno-assay (EIA)
flourescant treponemal antibody (FTA)
T. pallidum haemagglutinin test (TPHT)

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93
Q

pros and cons of treponemal tests for syphilis

A

it is more sensitive than non-treponemal tests

the results stay positive for years despite effective treatment

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94
Q

appearance of primary syphilis infection

A

macule –> papule

–>painless lump that appears 1-12 weeks after infection and persists for 4-6 weeks.
Serous exudate with clean base
regional adenopathy

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95
Q

symptoms of secondary syphilis

A

general: malaise, low grade fever
derm: symmetrical non-pruritic maculopapular rash on back, trunk, palms, soles, trunk, face, arms, legs
genital: genital ulcers
mouth: snail track ulcers, mucosal lesions
eyes: uveitis, choroidoretinitis
alopecia
neuro: aseptic meningitis, cranial nerve palsies, acute nerve deafness, optic neuritis

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96
Q

when do symptoms of secondary syphilis occur

A

1-6 months after infection

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97
Q

tertiary syphilis

A

cardio: aortitis
granuloma
meningitis: “pariesis of the insane”,
tabes dorsalis: degeneration of the dorsal columns resulting in hyporeflexia, loss of proprioception and sensation and therefore causes ataxia

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98
Q

treatment of syphilis

A

single dose IM penecillin (doxycyclin if allergic)

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99
Q

what is the jarisch-heimer reaction

A

(fever, headache, myalgia, sometimes exacerbation of

syphilitic symptoms) – common, develops within hours of syphilis abx administration and clears within 24hrs.

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100
Q

congenital syphilis

A 
occurs during birth/ pregnancy
hepatosplenomegaly
rash
neurosyphilis
fever
pneumonitis
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101
Q

what pathogen causes chancroid

A

haemophilus ducreyi

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102
Q

what are the symptoms of chancroid

A

multiple painful ulcers

often in african tropical countries

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103
Q

what will be seen on microscopy of chancroid

A

gram negative cocco-bacillus

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104
Q

how do you diagnose chancroid

A

PCR

culture on chocolate agar

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105
Q

what pathogens are contracted from oral-anal contact

A

shigella, salmonella, giardia

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106
Q

trichomonias infection symptoms

A

urethritis in men
discharge in women
strawberry cervix

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107
Q

what pathogen causes trichomoniasis

A

T. vaginalis

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108
Q

how is trichomoniasis diagnosed

A

wet prep microscopy

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109
Q

how is trichomoniasis treated

A

metronidazole

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110
Q

what is the abnormality in bacterial vaginosis

A

reduced lactobacilli
polymicrobial
abnormal vaginal flora

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111
Q

how to diagnose BV

A

gram stain the discharge

positive whiff test

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112
Q

candidiasis symptoms

A

cottage cheese discharge: thick white discharge with itching, soreness and skin breaking
balanitis in men
vulvo-vaginitis in women

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113
Q

mollascum contagiosum

A

spread by touch/ sexual contact
dsDNA pox virus
huge lesions if immunocompromised, assume HIV until proved otherwise

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114
Q

genital warts pathogen

A

HPV virus usually strains 6 and 11 which ARE NOT associated with cervical cancer
dsDNA

(16, 18 is increased risk of cervical dysplasia, though the quad vaccine does protect against all 4 strains)

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115
Q

incubation time and appearance of genital warts

A

3 weeks to 8 months

can be keratinised, pedunculated, planar, carpeted, pigmented or papular

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116
Q

viral STIs

A

HAV, HBV,HCV (usually HIV+ MSM)
HIV
HSV

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117
Q

Examples of disease from tinea infection

A

ringworm

athletes foot

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118
Q

diseases from pyteriasis

A

t versicolour

sebhorreic dermatitis

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119
Q

how to test for candida

A

culture: mannan

antibodies

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120
Q

how to test for aspergillus

A

PCR
ELISA
beta glucan test
grows on czapek dox agar

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121
Q

how to test for cryptococcus

A

cryptococcal antibodies in serum/ CSF

india ink staining

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122
Q

example of a polyene
what do they target
give e.g. of organism affected

A

amphotericin
cell wall integrity
yeast

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123
Q

example of an azole
what do they target
give e.g. of organism affected

A

fluconazole
cell membrane synthesis
yeast

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124
Q

Terbinafine
what do they target
give e.g. of organism affected

A

targets cell membrane

against dermaphytes/ mould

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125
Q

what does flucytosine do

A

targets DNA synthesis in fungal infection

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126
Q

echinocandin

A

against yeast
targets cell membrane
e.g. capsofungin

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127
Q

what is used to treat cryptococcal meningitis/ invasive fungal disease

A

amphotericin B

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128
Q

what are the types of PUO

A

classical
healthcare associated
neutropenic
HIV assocaited

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129
Q

causes of classical PUO

A 
infection
returning traveller
neoplasm
malignancy
genetic
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130
Q

causes of healthcare acquired PUO

A

c diff
immobilisation
surgical lines
drugs: vancomycin, penecillin, serotonergics

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131
Q

causes of neutropaenic PUO

A 
GVHD
chemo
haematological malignancy
mycobacteria
drug fever
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132
Q

causes of HIV associated PUO

A 
seroconversion
TB
kaposis sarcoma
PCP
cryptococcus
lymphoma histoplasmosis
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133
Q

what to screen for in PUO

A

vasculitis: cANCA, pCANCA
genetics: fabry’s, FMF, cyclic neutropenia
Bence jone proteins
casts i nurine

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134
Q

differentials for fever in a returning traveller

A 
malaria
dengue
typhoid
rickettsia
brucella 
viral haemmorhagic fever e.g. lassa/ ebola
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135
Q

typhoid bacteria type

A

gram negative bacillus

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136
Q

typhoid pathogen

A

salmonella typhi

salmonella paratyphi

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137
Q

what is the infection in typhid

A

enteric fever infecting peyers patches

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138
Q

how is typhoid fever transmitted

A

water and food

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139
Q

symptom of typhoid

A 
ROSE SPOTS
RELATIVE BRADYCARDIA
hepatosplenomegaly
abdo pain and diarrhoea/ constipation
fever
headache
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140
Q

consequences of chronically carrying typhoid

A

gallstones

immunospression

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141
Q

diagnosis of typhoid

A

stool culture

blood test

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142
Q

is typhoid a notifiable disease

A

yes

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143
Q

what the the subtypes of malaria

A

p falciparum
p vivax
p ovale
p malariae

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144
Q

which is the severe type of malaria

A

p falciparum

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145
Q

what is the common type of malaria

A

p vivax

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146
Q

what is the benign type of malaria

A

p malariae

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147
Q

what is seen on blood film of p falciparum

A

immature ring trophozoites/ mature trophozoites and schizont
crescent shaped gametocytes

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148
Q

how is p falciparum treated

A

quinine + doxycyclin/ clindamycin/
riamet (artemether/ lumefantrine)/
malarone

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149
Q

what is seen on blood film of p vivax

A

schuffner dots

>20 merozoites. schizont

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150
Q

what is seen on blood film of p ovale

A

schuffner dots

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151
Q

how is p ovale treated

A

chloroqiune then primaquine

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152
Q

how is p vivax treated

A

chloroquine then primaquine

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153
Q

what is a thick film used for in malaria

A

to discover parasitaemia

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154
Q

what is the thin film used for in malaria

A

to determine species

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155
Q

blood findings in p falciparum malaria

A

wcc normal
reduced platelets
deranged LFTs
anaemia

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156
Q

symptoms of malaria

A

fever/ rigors
flu like disease- myalgia, headache
N&V
splenomegaly
may have focal neurology- reduced gcs or shock
rarely dark urine- diarrhoea, abdo cramps

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157
Q

when is parenteral therapy indicated i p falciparum

A

parasitaemia>2%, pregnancy, comiting

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158
Q

what GI infections are caused by anaerobes

A

clostridium (difficicle, perfringens and botulinium)

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159
Q

what are the symptoms of c. botulinum

A

descending paralysis

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160
Q

pathology of c bolutlinum

A

preformed toxin blocks ach release from peripheral nerves

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161
Q

treatment of c botulinum

A

antitoxin

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162
Q

clostriium perfringens pathology

A

superantigen enterotoxin binds to MHC/ TCR

massive cytokine production and supression of immune response

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163
Q

where does clostridium perfringens act

A

small bowel

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164
Q

incubation period of clostridium perfringens

A

8-16 hours

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165
Q

symptoms of clostridium perfringens

A

watery diarrhoea and cramps

risk of gas gangrene

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166
Q

symptoms of c difficile infection

A

pseudomembranous colitis

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167
Q

what abx cause c diff infection

A

flouroquinolones or cephalosorins

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168
Q

treatment of c diff

A

metronidazole

PO vancomycin

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169
Q

gram negative lactose fermenting gi infection

A

e coli

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170
Q

subtypes of e coli

A

ETC
EIEC
HIS
EPEC

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171
Q

ETEC

A

travellors diarrhoea

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172
Q

EIEC

A

invasive dysentary

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173
Q

EPEC

A

infantile diarrhoea

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174
Q

treatment of ecoli

A

ciprofloxacin

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175
Q

no lactose fermenting git infections

A

salmonella
shigella
yersina enterocoli
enteritides

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176
Q

enteritides symptoms

A

self limited non blood diarrhoea

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177
Q

treatment of enteritides

A

ceftriaxone or ciprofloxacin

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178
Q

shigella symptoms

A

fever
pain
bloody diarhorrea

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179
Q

pathology of shigella

A

affects distal ileum and colon

shiga enterotoxin

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180
Q

yersinia enterocolitis pathology

A

mesenteric adenitis with necrotising granulomas

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181
Q

association sof yersinia

A

erythema nodosum

reactive arthritis

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182
Q

what are the characteristics of vibriosis

A

late lactose femeneters
oxidase positive
gram negative

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183
Q

campylobacter jejuni microscopy

A

gram negative
s shaped
oxidase positive

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184
Q

campylobacter symptoms

A

prodrome of headache and fever
abdo cramps
foul smelling diarrhoea

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185
Q

treatment of campylobacter

A

erythromycin

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186
Q

causes of campylobacter

A

drinking unpasturised milk

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187
Q

listeria monocytogenes

A

V/L shaped
tumbling motility
beta haemolytic
aesulin positive

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188
Q

symptoms of listeria

A 
watery diarrhoea
cramps
headache
fever
little vomiting
febrile gastroenteritis
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189
Q

entamoeboeba histolytica

A

MSM
non motile cyst in diarrhoeal illness
flask shaped ulcer on histology

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190
Q

symptoms of entamoeba histolytica

A

dysentery, wind, tenesmus, wt loss

RUQ pain and liver abscess

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191
Q

giardia lamblia buzzwords

A

hikers/ trvellers/ MSM/ mental hospitals

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192
Q

pathology of giardia lamblia

A

pear shaped trophozoites- 2 nuclei

trophozoites in stool

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193
Q

symptoms of giardia lamblia

A

malabsorptio nof protein and far- foul smelling non bloody diarrhoea

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194
Q

treatment of giardia lamblia

A

metronidazole

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195
Q

cyptosporidium parvum

A

severe diarrhoea in immunocompromised

oocytes in stool

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196
Q

treatment of cryptosporidium parvum

A

paromycin

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197
Q

viruses causing secretory diarrhoea

A 
rotavirus
adenovirus
norovirus
poliovirus
enterovirus
hep A
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198
Q

Examples of HAI

A

C diff
E. coli (UTI)
MRSA causing bacteraemia

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199
Q

Predisposing factors to C diff infection

A

The three c’s

Cephalosporins, clindomycin and ciprofloxacin

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200
Q

How is Ecoli resistant in HAI

A

Extended spectrum beta lactamases

201
Q

What organisms other than ecoli can be responsible for HAI UTI

A

Klebsiella
Proteus
Pseudomonas

202
Q

Which chromosome is the prion gene on

A

Chr 20

203
Q

What pathogens could cause a surgical site infection

A

Coagulase negative staph

MRSA

204
Q

What pathogens could be responsible for hospital acquired infection resulting in bacteraemia

A

MRSA
Coagulase negative staph
E. coli

205
Q

Differentials in a prion disease patient

A

Huntington’s

Spinocerebellar ataxia

206
Q

What is the difference between PrP and PrPsc (prion structure)

A

Alpha helix to beta plateau sheet

No longer broken down by protease or radiation

207
Q

What genetic polymorphism is associated with prion disease

A

Codon 129 MM/ MV/VV

208
Q

Treatment of CJD symptoms

A

Clonazapam for myoclonus

Quinacrine, pentosan and tetracycline to delay prion conversion

209
Q

EEG findings in CJD

A

Triphasic spikes

210
Q

CSF analysisin sporadic CJD

A

14-3-3 protein positive

211
Q

What is seen in post mortem of sporadic CJD patients

A

Spongiform vaccuolation

PrP amyloid plaques

212
Q

Where in the brain does sporadic CJDaffect

A

Most areas normal except basal ganglia

213
Q

What are the EEG changes in variant CJD

A

Non specific slow waves

214
Q

Where does variant CJD affect the brain

A

Thalamus

215
Q

Is 14-3-3 protein normal in variant CJD

A

Sometimes

216
Q

What genetics are common in variant CJD

A

All sufferers are 129MM homozygotes

217
Q

What is seen on western blot in variant CJD

A

Tonsillitis biopsy shows type 4t PrPsc

218
Q

What is seen on post mortem of variant CJD

A

PrPsc 4t in CNS and lymphoreticular tissue

Florid plaques

219
Q

Sporadic CJD causes

A

PRNP mutation or spontaneous conversion of PrP to PRPsc

220
Q

Symptoms of sporadic CJD

A

Rapid progressive dementia
Cortical blindness
Akinetic mutism
Lower motor neurone signs

221
Q

Survival time for sporadic CJD

A

6 months

222
Q

Causes of acquired CJD

A

BSE- vCJD
Iatrogenic
Kuru

223
Q

vCJD age of onset

A

30s so younger than sCJD

224
Q

VCJD symptoms

A

Psychiatric symptoms e.g. paranoia followed by neuro signs e.g. peripheral sensory loss, ataxia and myoclonus then finally chorea and dementia

225
Q

Causes of vCJD

A

Bovine spongiform encephalopathy

226
Q

Symptoms of iatrogenic CJD

A

Ataxia

Eventually dementia and myoclonus

227
Q

Kuru symptoms

A

Progressive cerebellar syndrome

45 year incubation period then 2 years of disease then death

228
Q

Causes of kuru

A

Cannibalism

229
Q

Inheritance of GSS

A

Autosomal dominant

230
Q

Symptoms of GSS

A

Dysarthria then cerebellar ataxia then dementia

231
Q

FFI symptoms

A

insomnia and paranoia then weight loss then mutism

232
Q

How is FFI inherited

A

Autosomal dominant

233
Q

Zoonoses: mice

A 
Hantan virus
Lyme borreliosis
Ehrlichia
Bartonella
Lymphatic choriomeningitis
234
Q

Rat zoonoses

A 
Rabies
Leptospirosis
Lassa fever
Hantan virus
Plague 
Haverhill (rat bite ) fever
Pasteruellosis
235
Q

Cat zoonoses

A 
Bartonellosis (cat scratch)
Leptospirosis 
Q fever 
Toxoplasmosis 
Rabies
Ringworm
Toro arias is
236
Q

Small ruminants

A 
Anthrax
Toxoplasmosis
Brucellosis 
Q fever
Cryptosporidium
237
Q

Dog zoonoses

A 
Hydatid disease
Leptospirosis 
Brucellosis 
rabies
MRSA
Ring worm
Toxocariasis
238
Q

Zoonoses cattle

A 
Anthrax
Leptospirosis 
Brucellosis
Bovine TB
Toxoplasmosis 
Ring worm
E. coli
239
Q

Swine zoonoses

A 
Influenza A
Cystericercosis 
Brucellosis
Leptospirosis 
Erysipeloid
240
Q

Bird zoonoses

A 
Psittacosis 
Influenza
Cryptococcus 
Influenza A
Salmonella from poultry 
west Nile fever
241
Q

Water sports associated zoonoses

A 
Leptospirosis 
HAV
Giardia
Toxoplasmosis 
Mycobacterium marinos/ ulcerans
Burkholderia pseudomallei
E. coli
242
Q

Water bornezoonoses

A

Campylobacter
Salmonella
VTEC
Cryptosporidium

243
Q

Food associated zoonoses

A 
Listeria
Tania
Cysticercosis
Toxoplasmosis 
Trichonellosis
Yersiniosis
Giardia
244
Q

Definition of zoonoses

A

Disease and infection which are transmitted naturally between humans and other vertebrates

245
Q

Brucellosis pathogen

A

Gram negative aerobic bacillia

246
Q

How is brucellosis transmitted

A

Inhalation or skin/ membrane contact

Eating contaminated food (untreated dairy)

247
Q

Symptoms of brucellosis

A 
Incubation period of 3 weeks 
Then undulant fever that is bad at night but normal by morning
Malaise
Rigours
Fatigue 
Myalgia
248
Q

Signs of brucellosis

A 
Arthritis 
Spinal tenderness
Lymphadenopathy 
Splenomegaly 
Hepatomegaly 
Epidemiologists-orchid is
249
Q

Investigations in brucellosis

A

WCC normal
Anti O polysaccharide antibody >1/160
May be neutropaenic

250
Q

Treatment of brucellosis

A

Streptomycin with either tetracycline or doxycycline for 4-6 weeks
Otherwise oral doxy and rifampicin for 8 weeks

251
Q

Which virus causes rabies

A

Rhabdovirus

252
Q

What is pathognomic of rabies

A

Negri bodies

253
Q

Severe complication of rabies

A

Encephalitis

254
Q

Symptoms of rabies

A

Fever
Headache
Sore throat

Acute encephalitis

255
Q

How to diagnose rabies

A

ELISA test for IgM

IFA for rabies antigen in brain tissue

256
Q

Treatment of rabies

A

IgG

257
Q

What pathogen causes the plague

A

Yersinia pestis

258
Q

What type of pathogen is yersinia pestis

A

Gram negative lactose fermenter

259
Q

How to diagnose plague

A

PCR

260
Q

What are the subtypes of yersinia pestis plague

A

Bubonic

Pneumonic

261
Q

Symptoms of bubonic plague

A

Dry gangrene

Swollen lymph nodes

262
Q

How are the different plagues spread

A

Bubonic- flea bite

Pneumonic- person to person contact

263
Q

Plague treatments

A

Streptomycin
Doxycycline
Gentamicin
Chloramphicol

264
Q

Leptospirosis pathogen

A

L interrogans
Obligate
Gram negative
Aerobic motile spirochaetes

265
Q

How is leptospirosis transmitted

A

Dog/ cat urine and when swimming in infected water it penetrates broken skin

266
Q

Symptoms of leptospirosis

A 
High spiking temp 
Headache
Conjunctival haemorrhages
Jaundice
Malaise
haemolytic anaemia, renal failure,c arditis, meningism
267
Q

Incubation of leptospirosis

A

10-14 days

268
Q

Treatment of leptospirosis

A

Amoxicillin
Erythromycin
Doxycycline
Ampicillin

269
Q

Anthrax pathogen

A

Bacillus anthracite

270
Q

What are the subtypes of anthrax

A

Cutaneous and pulmonary

271
Q

What is cutaneous anthrax

A

Painless round black lesions with a ring of oedema

272
Q

What is pulmonary anthrax

A 
Woolsorters disease
Massive lymphadenopathy
Mediastinal haemorrhage
Pleural effusion 
Resp failure
273
Q

What pathogen causes Lyme disease

A

Bordelaise burdoferi

274
Q

What are the stages of Lyme disease and what happens in each one

A

Early localised: bullseye rash, cyclical fever, flu like sx
Early disseminated: malaise, lymphadenopathy, hepatitis, carditis, arthritis
Late persistent: arthritis, focal neurology, neuropsych disturbance, acrodermitis chronic atrophicans

275
Q

How to diagnose Lyme disease

A

Biopsy edge of erythema chronicum migrans (bulls eye rash)

ELISA for lyme antibodies

276
Q

Treatment o Lyme disease

A

Doxycycline for 2-3 weeks

If CNS problems also IV ceftriaxone for 2-4 weeks

277
Q

Complication associated with Lyme disease

A

ME

278
Q

Q fever pathogen

A

Coxiella burnetii

279
Q

Presentation of Q fever

A

Atypical pneumonia

DRY Cough, fatigue, pleural effusion and diarrhoea

280
Q

Treatment of Q fever

A

Doxycycline

281
Q

Types of leishmaniasis

A

Cutaneous-L major, L tropica
Diffuse cutaneous:
Mucocutaneous: L Brazilians is
Visceral (kala afar): L infantum, L Donovani, L chagasi in south america

282
Q

Cutaneous leishmania

A

L major and L tropica

Transmitted by sandfly bite

283
Q

Pathogenesis of cutaneous leishmania

A

Bit ulcerated as dermal macrophages multiply
After one yearheals and leaves a depigmented scar
Single or multiple painless nodules

Type IV reaction

284
Q

Diffuse cutaneous leishmania

A

Modular non ulcerting lesions on nose

285
Q

Who gets diffuse cutaneous leishmania

A

Immunocompromised patients

Therefore the skin test is negative

286
Q

Mucocutaneous lieshamania

A

L Braziliensis

Dermal ulcer like cutaneous leishmaniasis and years later ulcers in nasal mucosa

287
Q

Visceral leishmania

A

L donovani, L infantum, L chagasi

Abdo discomfort, weight loss and distension in malnourished child

288
Q

Complication of visceral leishmania caused by L donovani

A

PKDL
The reticulo-endothelial system is invaded causes hepatosplenomegaly
BM invasion

289
Q

3 antigenic variants of flu in human

A 
Influenza A (H1)- January 
Influenza A (H1N1)=December
Influenza B

Flu vaccine is fractioinsof HA and NA to combat

290
Q

What sort of vaccine is flu vaccine

A

Inactivated

291
Q

Bird flu- natural reservoir and serotonin

A

Ducks

H5N1

292
Q

How does neuramidase increase flu infection

A

Cleaves sialic acid residues exposing receptors on host cell
Disrupts mucin barrier

293
Q

How does haemagglutinin increase flu transmission

A

Binds sialicacid receptors and enables virus entry

Endosomal-viral envelope fusion and release

294
Q

What is antigenic drift re: flu

A

New strains of virus because of HA/ NA mutations

295
Q

What is antigenic shift

A

Complete change of HA/ NA and trading of RNA segments between human and virus
Only in influenza A

296
Q

What causes the huge tropism for influenza A

A

Cleavage by Clara tryptase inthe lung

297
Q

What is an antiviral for influenza A

A

Amantadine

Targets M2 ion channel

298
Q

Is amandine effective against influenza A

A

No AA mutation in M2 means many flu is resistant

299
Q

What are the neuramidase inhibitors for influenza

A

Tamiflu
Relenza
Sialic acid

Need to be given in 48 hours of infection

300
Q

What does acyclovir do

A

Treatment for herpes

Prevents HSV thymidine kinase from being activated and so prevents viral DNA extension

301
Q

What are symptoms CMV infection

A 
RCHEP
Retinitis
Colitis
Hepatitis
Encephalitis 
Pneumonitis

Owls eye inclusions in CMV cells

302
Q

How is CMV treated

A

Gangyclovir - risk of marrow toxicity
Foscarnet is second line - nephrotoxic
Cidofivir is third line- nephrotoxic

303
Q

How does gangcycloivr work

A

Nucleoside analogue

304
Q

How does foscarnet work

A

Pyrophosphate analgue

Inhibits nuclei acid synthesis and doesn’t need activation

305
Q

How does cidofivir work

A

Nucleoside phophonate

Used for CMV retinitis

306
Q

What needs to be given alongside foscarnet or cidofivir

A

Probenecid because they are nephrotoxic

307
Q

When do you treat VZV

A

If immunosuppressive, pregnant or have pneumonitis as an adult

308
Q

Act Very Fast with herpes- what are these meds

A

Acyclovir
Valaciclovir
Famciclovir

309
Q

When do you treat HBV

A

If HBV DNA levels are greater than 2000
When serum ALT rises
When liver biopsy shows moderate active disease

310
Q

How do you treat HBV

A

Peginterferon 2alpha (sc)
Tenofovir
Entecavir

311
Q

What is the aim. Of HBV treatment

A

Prevent conversion to HCC or cirrhosis
Normalise ALT
Maintain serum HBV DNA

312
Q

Treatment options for HBV

A

Peginterferon
Nucleoside analogues
Nucleotide analogues

313
Q

HCV treatment goal

A

Persistent absence of HCV 6 months after treatment

Prevent progression to cirrhosis

314
Q

Treatment of HCV

A

Peginterferon alpha 2b/2c

Nucleoside analogues e.g. ribivarin

315
Q

Side effects of ribivrin (nucleoside inhibitor for HCV)

A

Haemolytic anaemia

316
Q

What genotypes are more likely to benefit for HCV treatment

A

Genotypes 2 and 3

Genotypes 1,4,5,6 tend to have less successful treatment

317
Q

Influenza treatments: NA inhibitors

A

Oseltamavir
Zanamivir
Amantadine

318
Q

RSV/ parainfluenza treatment

A

Ribivarin— guanasine alalogue

319
Q

Stages of PCR

A

1) denature
2) primer annealing
3) chain elongation with Taq polymerase

320
Q

Three cause of post transplant viral infection and examples

A
  1. Reactivation of latent infection e.g. herpes
  2. Graft brought infection with it e.g. Hep B
  3. Exogenous opportunistic infection post transplant e.g. measles
321
Q

Where do herpes and VZV stay latent

A

Neurones

322
Q

Where do EBV and CMV stay latent

A

Leukocytes

323
Q

What are complications of VZV in the immunocompromised

A

Pneumonitis

Hepatitis

324
Q

How to prevent varicella infection

A

Varicella zoster Ig

325
Q

Treatment of VZV

A

Acyclovir

326
Q

How to treat EBV after BMT

A

Rituximab and reduce immunosuppressive

327
Q

What does HHV 8 causes

A

Castleman’s disease

Kaposi’s sarcoma

328
Q

How is kaposi’s sarcoma diagnosed

A

Spindle cells

KSHV proteins on biopsy

329
Q

What does HHV6 do

A

Causes graft rejection

Symptoms similar to CMV

330
Q

How is HHV6 treated

A

Gangcyclovir
Foscarnet
Cidofovir

331
Q

Who gets adenovirus

A

Paediatric outpatients after BMT

332
Q

How is adenovirus treated i n paediatric patients after BMT

A

Ribivarin

Reduce immunosupression

333
Q

Complications of measles

A

Giant cell pneumonia

Encephalitis

334
Q

How to treat measles

A

Supportive

Normal human Ig

335
Q

What pathogens colonise the surgical site and cause infection

A

Staph aureus, pseudomonas, E. coli and haemolytic strep

336
Q

How is surgical site infection treated

A

Flucloxacillin

337
Q

RF of septic arthritis

A

Immunosupression
Abnormal joint
Bacteraemia

338
Q

Bugs causing septic arthritis

A

Staph aureus,
Strep
Gram negatives e.g. E. coli rarely

339
Q

What’s the underlying pathology in septic arthritis

A

Bug adheres to synovial membranes and proliferates in fluid

340
Q

Symptoms of septic arthritis

A

Unwell febrile patient with a hot swollen joint

341
Q

How to diagnose septic arthritis

A

Blood culture before ABX
Joint aspirate (>50 000 cells/ mm3)
Imaging shows effusion
inflammatory markers

342
Q

Treatment of septic arthritis

A

IV cephalosporin or flucloxacillin

If MRSA vancomycin

Drain joint

343
Q

What is the pathogenesis of osteomyelitis

A

Subacute (Brodie) abscess to frank osteomyelitis

Local or haematological spread

344
Q

Bugs causing osteomyelitis

A

Staph aureus

345
Q

How to diagnose osteomyelitis

A

MRI

Biopsy bone

346
Q

Symptoms of osteomyelitis

A

Pain
Fever
Local swelling

347
Q

How to treat osteomyelitis

A

Abx

Second line: debridment

348
Q

Pathogens causing prosthetic joint infection

A

Staph aureus

Enterobacteriae

349
Q

Symptoms of prosthetic joint infection

A

Failure of joint
Pain
Loosening on radiology

350
Q

Diagnosis of prosthetic joint infection

A

Joint aspiration

Loosening on radiology

351
Q

Treatment of prosthetic joint infection

A

Remove metalwork- revise joint

Abximpregnated cement

352
Q

Treatment of pyelonephritis

A

Coamoxiclav+ gentamicin

Cefuroxime + gentamicin

353
Q

Antimicrobials that inhibit cell wall synthesis

A

Beta lactams

Glycopeptides

354
Q

Examples of beta lactams

A

Cephalosporins
Carbapenems
Penecillins

355
Q

Example of a cephalosporins

A

Ceftriaxone

356
Q

Example of a carbapenem

A

Meropenem

357
Q

Example of glycopeptide

A

Vancomycin

358
Q

Abx that inhibit protein synthesis

A 
Aminoglycosides
Tetracyclines
Macro lines
Chloramphenicol
Oxazolidinones
359
Q

When are aminoglycosides used and give an e.g

A

Gram negative sepsis

Gentamicin

360
Q

When are tetracyclines used and give an e.g.

A

Intracellular chlamydia

Doxycycline

361
Q

When are macrolides used and give an example

A

Gram positive organisms if there is a penicillin allergy

362
Q

Eg of macrolide

A

Erythromycin

363
Q

When is chloramphicil used

A

Bacterial conjunctivitis

364
Q

When are oxazolidonones used andgive e.g.

A

Gram positive, MRSA positive VRE

Linezolid

365
Q

Antibiotics that inhibit DNA synthesis

A

Flouroquinolones

Nitroimidazoles

366
Q

When are flouroquinolones used

A

Gram negative

Ciprofloxacin

367
Q

When are nitroimadazoles used and give e.g.

A

Anaerobes and Protozoa

Metronidazole

368
Q

Abx that inhibit RNA synthesis

A

Rifamycin

369
Q

When are rifamycins used and giv e e.g.

A

TB

Rifampicin

370
Q

What abx target cell membrane toxins

A

Polymyxin

Cyclic lipopeptide

371
Q

When are polymyxins used and what do they target

A

Gram negatives

Colistin

372
Q

What do cyclic lipopeptides target and give e.g.

A

gram positive MRSA positive VRE

Daptomycin

373
Q

What abx inhibit phosphate metabolism

A

Sulphonamides

Diaminopyramidines

374
Q

When are sulphonamides used and give e.g.

A

PCP with trimethoprim

Sulphamethoxazole

375
Q

When are diaminopyramidines used and give .e.g

A

UTI

Trimethoprim

376
Q

Which abx are broad spectrum

A

Co-amoxiclav
Tazocin
Ciprofloxacin
Meropenem

377
Q

Narrow spectrum abx

A

Gentamicin
Flucloxacillin
Metronidazole

378
Q

4 mechanisms of antibiotic resistance

A

Bypass abx sensitive step (MRSA)
Enzyme mediated drug inactivation (beta lamases)
Impairment of accumulation of drug (tetracycline resistance)
Modification of drug target in microbe (quinolone resistance)

379
Q

Acronym for abx resistance

A

BEAT

380
Q

Pathogen and abx inskin infection

A

Staph aureus

Flucloxacillin

381
Q

Pathogen and abx in pharyngitis

A

Beta haemolytic streptococcus

Benzylpenecillin

382
Q

Community acquired pneumonia abx if mild

A

Amoxicillin

383
Q

Sever community acquired pneumonia abx

A

Co-amoxiclav + clarithromycin

384
Q

Hospital acquired pneumonia abx

A

Amoxicillin + gentamicin

/ tazocin

385
Q

Abx and pathogen for bacterial meningitis

A

Meningococcus/ streptococcus

Ceftriaxone unlessits likely to be listeria induced in which case amox

386
Q

Abx for UTI

A

Trimethoprim/ nitrofurantoin

387
Q

Abx for nosocomial UTI

A

Co-amoxiclav/ cephalexin

388
Q

Abx for severe sepsis

A

Tazocin/ ceftriaxone

Metronidazole+ gentamicin

389
Q

Abx for neutropaenic sepsis

A

Tazocin + gentamicin

390
Q

Pathogen and abx for colitis

A

C. difficile

Stop ceph and start PO metronidazole

391
Q

Congenital infections (TORCH)

A 
Toxoplasmosis
Other (HIV/ HBV)
Rubella
CMV
HSV
392
Q

Sx of congenital infection (TORCH)

A 
Thrombocytopenia 
Other- ears/ eyes e.g. cataracts, choroidoretinitis 
Rash
Cerebral anomaly e.g microcephaly
Hepatosplenomegaly
393
Q

When do neonatal infections present

A

<6 weeks

394
Q

What causes neonatal infection

A

Group B strep
E. coli
Listeria

395
Q

How to prevent congenital infections

A

TORCH screen

396
Q

Symptoms of neonatal infection

A

Fever

Meningitis

397
Q

Diagnosis of neonatal infection

A 
Septic screen
FBC
CRP
Blood culture
Deep ear swab 
CSF
Surface swab
CXR
398
Q

Treatmetn of early onset sepsis in the neonate

A

Supportive

Benpen + gentamicin (unless listeria in which case use amox/ ampicillin)

399
Q

Diagnosis of late onset neonatal sepsis

A

Septic screen plus urine

400
Q

Causesof late onset sepsis in the neonate

A

Coagulase negative staph
GBS
Ecoli
Listeria

401
Q

Sx of late onset neonatal sepsis

A 
Bradycardia
Apnoea
Poor feeding
Irritability
Convulsions
Jaundice
Resp distress 
Focal inflammation e.g.umbilicus
402
Q

Abx in late onset neonatal sepsis

A
  1. benzylpenecillin plus gentamicin
  2. Tazocin + vancomycin if v ill

If community amox plus cefotaxime

403
Q

Common causes of childhood infections

A

VZV
HSV
Bacterial infection

404
Q

Causes of paeds bacterial meningitis by age

A

1-3 months GBS, E. coli, listeria
<3months haemophilia influenza’s
>3 months- neisseria meningitidus
<2 years strep pneumoniae

405
Q

Paeds causes of RTIs

A

Virus
S pneumoniae
Mycoplasma

406
Q

Causes of UTI in paeds and sx

A

E. coli, proteus, klebsiella, enterococcus

Pyuria and clinical sx
>10^5 Cafu/ ml

407
Q

Fungal cause of meningitis

A

Cryptococcus

408
Q

Viral causes of meningitis

A

Coxackie
HSV2
Echovirus
Mumps

409
Q

How does bacterial meningitis spread

A

Systemic from mucosa or local from skull fracture

410
Q

Risk factors for bacterial meningitis

A

Complement deficiency
Hyposplenism
Immune defect

411
Q

RF for strep pneumoniae meningitis

A

Fractured skull - esp if CSF leak

412
Q

How to diagnose meningitis

A

Blood cultures
Serum AG
EDTA-PCR
Throat swab

Clinical suspicion

413
Q

Management of bacterial meningitis

A

Resuscitate- ceftriaxone and corticosteroids

Cover listeria with ampicillin and encephalitis with IV acyclovir

414
Q

Hepatitis A Ig

A

IgG if vaccinated/ prev infecction

acutely IgM

415
Q

How long do anti hep A IgM antibodies persist for

A

14 weeks

416
Q

What type of virus is hep A

A

RNA

417
Q

What type of virus is hep B

A

DsDNA

418
Q

Method of hep Btransmission

A

Sexual, vertical, horizontal

419
Q

Signs for diagnosing hep B infection

A

Very high ALT and high AST
HBsAg for infection/ vaccine
HBeAg for infectivity
HBcAb for exposure

420
Q

Treatment of hep B

A

Lamivudine
Tenofivir
Peginterferon alpha 2a

421
Q

Consequences of hep b infection

A

HCC
Cirrhosis
Fibrosis
Polyarteritis nodosa

422
Q

What type of virus is hep C

A

RNA

423
Q

How is hep C transmitted

A

Blood products

424
Q

How to diagnose HCV infection

A

ALT

Anti HCV

425
Q

Treatment of HCV infection

A

Peginterferon alpha 2b

Ribivarin

426
Q

Consequences of HCV infection

A

Cirrhosis

Cyroglobin antibodies- glomerulonephritis

427
Q

Hepatitis D

A

Only infects those with hep b

428
Q

Hep E

A

Faecooral route in India

429
Q

Common viral infections in pregnancy

A

Rubella
Influenza
Measles
Parvovirus B19

430
Q

Parvovirus B19 in pregnancy risks

A

3% risk of hydrous fatalis

IF >20 weeeks no risk

431
Q

Parvovirus B19 symptoms

A

Fever
Malaise
Slapped cheek- erythema infectious
Transient aplastic crisis

432
Q

Transmission of parvovirus B19

A

Resp/ blood borne

6-8 days incubation

433
Q

Symptoms of rubella in mum

A

Flu like symptoms
Pinpoint maculopapular rash
Lymphadenopathy

434
Q

How to diagnose maternal rubella

A

Serology of saliva swabs

435
Q

Implications of rubella on foetus

A

Congenital rubella syndrome

436
Q

What is congenital rubella syndrome

A

If infected before 8 weeks- risk of spontaneous abortion (20 %)

Cataracts
Glaucoma
Retinopathy
Deafnesss
Mental retardation
Heart disease 
Splenomegaly
Meningoencephalitis
437
Q

Risks of influenza in pregnancy

A

5x still birth

3x preterm delivery

438
Q

Implication of measles while pregnant

A

IUD/ miscarriage
Pre term delivery
Increased maternal morbidity

439
Q

Types of vaccination

A 
Live attenuated
Inactivated
Recombinant proteins
Conjugated 
Subunit
440
Q

E.g. of live attenuated vaccine

A

MMR
VZV
Yellow fever

441
Q

E.g. of inactivated vaccine

A

HAV

Rabies

442
Q

E.g. of recombinant protein vaccine

A

HBV

443
Q

E.g. of subunit vaccines

A

Influenza

Typhoid

444
Q

E.g. of conjugate vaccine

A

Meningitis c

445
Q

Clinical spectrum of leprosy

A 
TT
BT
BB
BL
LL
446
Q

What is TT leprosy

A

Tuberculoid

Th1 mediated

Depigmented lesions

447
Q

What is B.B. leprosy

A

Borderline

Multiple plaques

448
Q

What is LL leprosy

A

Lepromatous

Th2 mediated, multibacilliary

Neuropathic ulcers

449
Q

What does BT leprosy cause

A

Nerve damage

450
Q

granuloma inguinale another name

A

donovanosis

451
Q

symptoms of donovanosis

A

papule or nodule that breaks down into large expanding ulcers

452
Q

appearance of donovanosis ulcers

A

beefy red appearance

453
Q

how to diagnose donovanosis

A

giemsa stain of biopsy/ tissue crush

donovan bodies seen

454
Q

treatment of donovanosis

A

azithromycin

455
Q

LGV first stage

A

painless ulcer that develops 2-12 days after exposure

also balanitis, proctitis, cervicitis

456
Q

second stage of LGV

A

iunilateral painful inguinal buboes, fever , malaise and rarely meningoencephalitis
proctocolitis and hyperplasia of lymphoid tissue

457
Q

late LGV sx

A

strictures, lymphadenopathy, abscess, frozen pelvis, genital elephantiasis

458
Q

LGV treatment

A

21/7 doxycycline BD

or erythromycin 21/7 QDS 500mg/ azithromycin 1g once weekly for 3 weeks

459
Q

STI:: oral anal pathogens

A

shigella
salmonella
giardia

460
Q

treatment of genital warts

A
  1. podophyllotoxin home treatment (CI in pregnancy)

2. cryotherapy/ imiquimod

461
Q

symptoms of T versicolour

A

depigmentation in those with darker skin

ptyriasis: malassezia globosur/ furfur

462
Q

ptyriasis fungus

A

malassazia globosa/ furfur

463
Q

candidaalbicans treatment

A

fluconazole

464
Q

treatment of invasive fungal disease from candida

A

amphotericin-B

465
Q

treatment of aspergillus

A

voriconazole

466
Q

what vector is cryptococcus associated with

A

birds (pigeons)

HIV

467
Q

treatment of cryptococcus

A

2/52 amphotericin B +/- flucytocine

468
Q

congenital CMV symptoms

A 
IUGR
jaundice
hepatosplenomegaly
thrombocytopenia
impaired IQ
sensorineural deafness
microcephaly
cytomegalic inclusion disease
469
Q

how to diagnose CMV

A

paul bunnel test
serology: IgG and IgM
cell culture in human fibroblasts- owls eye inclusions

470
Q

roseola virus

A 
roseola infantatum (exanthum subitum, sixth disease)
3/7 fever then transient rash
471
Q

where is roseola virus latent

A

lymphocytes

472
Q

treatment of roseola virus reactivation after BMT immunospression

A

gangcyclovir
foscarnet
cidofivir

473
Q

gential herpes symptoms

A 
fever
dysuria
malaise
painful vesicular rash
sacral radiculomyeltis (self limiting urinary retention)
474
Q

oral herpes symptoms

A

painful rash with erythematous base- coalesce
submandicular lymphadenopathy
fever

475
Q

differential for oral herpes

A

herpangina (coxackie A)

476
Q

symptoms of herpes encephalitis if HSV 1

A

2 week flu like prodrome
focal neurology and personality change
seizures
coma/ death

477
Q

symptoms of herpes encephalitis if HSV 2

A

mollarets meningitis

recurrent aswptic meningitis

478
Q

CSF findings in herpes encephalitis

A

lymphocytic pleiocytosis
normal glucose
raised protein

479
Q

MRI/ CT findings in herpes encephalitis

A

front- temporal or parietal lobe lesions

480
Q

tx of herpes encephalitis

A

dont wait for test results

10mg/kg IV acyclovir STAT TDS then switch to three weeks of oral acyclovir

481
Q

herpes skin manifestations

A 
scrum pox- herpes gladiatorum (painful blister and inguinal LN)
herpetic whitlow- painful red finger
erythema multiforme
eczema herpeticum
zosteriform HS
HS dermitits
482
Q

neonatal herpes

A

foetal loss
skine/ eye/ mouth lesions with LT sequelae
diseeminated disease and bvesicles 10 days post partum - multi organ failure/ fulminant hepatitis
neuroloigcal consequences

483
Q

treatment of neonatal herpes

A

oral/ IV acyclovir 6 weeks before EDD

484
Q

VZV cytology findings

A

tzanck cells (multinucleated giant cells)

485
Q

symptoms of VZV

A

vesicular rash- dew on a rose petal
fever malaise headache
rash scabs after a week

486
Q

complications of VZV

A 
ramsey hunt syndrome
pneumonitis/ scarring/ reyes syndrome
guillian barre
geniculate ganglion of CN VII- hearing loss and vertigo
post herpetic neuralgia
487
Q

VZV in pregnancy causes

A

congenital varicella syndrome

488
Q

implicationso fcongenital varicellar syndrome

A 
scarring
hypoplastic limbs
cortical atrophy
psychomotor retardation
chorioretinitis
cataracts
disseminated disease 7 days after delivery
489
Q

treatment of VZV in pregnancy

A

VZIG

490
Q

VZV in adulthood treatment

A

anyone at risk 800mg acyclovir

PO TDS 7/7

491
Q

shingles

A

dermotomal painful rash

492
Q

treatment of shingles

A

800mg acyclovir PO 5 times daily
topical eye drops
only if <24 hours of rash

493
Q

glandular fever sx

A

triad of fever, pharyngitis, lymphadenopathy and a maculopapular rash

494
Q

how to diagnose glandular fever

A

blood film
monospot agglutination
EBV antibodies
Paul bunnell test

495
Q

ocular herpes

A

PORN
acute retinal necrosis if immuncompromised

herpetic keratitis- uni/bi lateral conjunctivits and pre auricular LN involvment

496
Q

how is neonatal herpes transmitted

A

during delivery

497
Q

what colour is a gram positive bacteria stained

A

purple

498
Q

what colour is a gram negative bacteria stained

A

red

flashcards of path guide 2018 (15 decks)

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