Microbiology Flashcards
1
Q
Presentation of TB
A
weight loss
cough
haemoptysis
fever with night sweats
2
Q
where is post primary TB found
A
in the upper lobes
3
Q
who is affected by post primary TB
A
young adults
4
Q
how does post primary TB heal
A
fibrosis and calcifications
5
Q
what is the classic lesion in post primary TB
A
caseating granuloma
6
Q
What is the Ghon focus?
A
multiplication of TB at pleural surface
7
Q
what sort of cells are in a TB granuloma
A
Langhan’s giant cells
8
Q
buzzword for miliary TB
A
rich foci
haemotological spread
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
10
Q
Rifampicin side effects
A
orange secretions
CYP450 induction
hepatotoxic
raised transaminases
11
Q
second line treatments for TB
A
Injectables- capreomycin, anamycin and kanamycin quinolones- moxifloxacin ethionamide/ protionamide Linelozid PAS chlofazamine
12
Q
treatment of TB meningitis
A
RIPE for 4 months then R and I for 8-10 months
13
Q
Treatment of post primary TB
A
RIPE for 2 months then R &I for 4 months
14
Q
treatment of latent TB
A
8 months of isoniazid
15
Q
what is mono drug resistent TB resistant to
A
one drug (duh)
16
Q
what is MDR TB resistant to
A
Rifampicin and isoniazid
17
Q
what is XDR TB resistent to
A
rifampicin
isoniazid
injectables (kanamycin and amakacin)
quinolones
18
Q
imaging for TB
A
CXR
19
Q
cultures for TB
A
3x cultures
broncho-alveolar lavage
EMU
lowenstein-jensen sputum sample
20
Q
gold standard for TB diagnosis
A
pus in lowenstein jensen medium
21
Q
what do you see on microscopy of TB
A
acid fast aerobic bacilli
waxy cell wall
22
Q
investigations in TB
A
mantoux/ heaf test
interferon gamma assays e.g. ellispot
NAAT- PCR probes
liquid culture mediums
23
Q
TB meningitis symptoms
A
personality change, focal neurological deficit and declining GCS
neck stiffness, headache
weight loss, malaise, fever night sweats
24
Q
diagnosis of TB meningitis
A
tuburculotoma on head CT
lymphocytes in lumbar puncture
25
treatment of TB meningitis
12 months of RIPE plus steroids
26
extra pulmonary TB symptoms
```
lymphadenitis
CVS: pericarditis
GIT: ileitis, peritonitis
GUM: renal, testes
skin and liver also can be affected
```
27
risk factors for reactivating latent TB
immunosupression
aging
chronic alcohol intake
malnutrition
28
pathology of spinal TB
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
29
BCG efficacy
0-80%
| bad for pulmonary TB but good against leprosy, TB meningitis and disseminated TB
30
why is the BCG contraindicated inPLWH
-HIV –ve latent TB --> active TB 5-10% lifetime risk
-HIV +ve latent TB --> active TB 5-10% yearly risk
-
31
mycobacteria in leprosy
M leprae and M lepromatosis
32
treatment for leprosy
rifampicin
dapsone
clofazimine if multibacteria
33
leprosy symptoms
skin: depigmentation, plaques, macules, nodules
nerves: sensory neuropathy, thickened nerves
eyes: iridocyclitis, keratitis
bones: periositis, aseptic necrosis
34
tuberculoid leprosy is mediated by
Th1
35
lepromatous leprosy is mediated by
Th2
36
M Avium symptoms
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
37
M marinarum
swimming pool/ aquarium owner getsa single/ cluster of papules
38
Baruli ulcer (m bulurans)
a painless ulcer which progresses to a huge deformity with scarring, ulceration and contractures
39
how to decude if IV or oral treatment for pneumonia
CURB65 score
40
pathology of pneumonia
inflammation of alveoli
41
pathology in bronchitis
cough for most days of three months with phlegm for 2 or more consecutive years
42
strep pneumoniae pneumonia
sx
microscopy
gram positive diplococci
| rusty brown sputum
43
haemophilis influenzae
| microscopy and vulnerable group
associated with smoking/ COPD
| gram negative coccobacillae
44
M catarrharis
| microscopy and vulnerable group
associated with smoking
| gram negative coccus
45
staph aureus as a cause of pneumonia
| what is it associated with and what is seen on microscopy
associated with a recurrent viral infection (post flu in emq land)
gram +ve cocci (grape bunch clusters)
46
klebsiella pneumona
susceptible person
sx
micro
alcoholic/ elderley pt
sx: haemotysis
micro: gram negative rod, enterobacter
47
Atypical pneumonia microbes
```
legionella pneumophilia
bordatella pertuccusis
chlamydia psittici
chlamydia pneumonia
mycoplasma pneumonia
TB
```
48
legionella pneumophilia
| risk factors and findings
low sodium
hepatitis
risk in water towers/ air con
49
mycoplasma pneumonia
symptoms
test
systemic symptoms erythema multiforme, joint pain
cold agglutinin test
risk of SJS
50
bordella pertussis
often travelling community in EMQ
| whooping cough in unvaccinated people
51
pathogen causing RTI in cystic fibrosis
psuedomonas aeringosa
| burkholderia cepacia
52
pathogen causing RTI in BMT
aspergillus
| CMV
53
pathogen causing RTI in neutropaenic patients
aspergillus spp
54
pathogen causing RTI in HIV patients
pneumocystitis jirovii
TB
cryptococcus neoformans
55
pathogen causing RTI in splenectomy patient
haemophilus influenzae
strep pneumoniae
neisseria meningitidis
56
which organisms do you identify with paired serum tests for pneumonia
legionella
chlamydia
if at 10 weeks
57
how to identify PCP on lab testing
silver staining in the cytology lab- boat shaped organisms
58
which pneumonias can you identify by urine antigen
legionella
| strep pneumoniae
59
define hospital acquired pneumonia
pneumonia after >48 hours into hospital stay with no previous infection
60
treatment of classical community acquired pneumonia
if mild a macrolide/ amoxicillin for 5-7 days
| if moderate to severe then use clarithromycin +coamxiclav/ cefuroxamine for 2-3 weeks
61
how to treat atypical community acquired pneumonia
use a macrolide/ tetracycline
62
what does clarithromycin interact with
WARFARIN
63
treatment of hospital acquired pneumonia
1st line: ciprofloxacin +/- vancomycin
| 2. piptazobactam + vancomycin
64
treatment of aspiraton pneumonia
metronidazole + cefuxamine
65
treatment of legionella pneumonia
rifampicin + macrolide
66
treatment of staph aureus pneumonia
flucloxacillin
67
treatment of pseudomonas HAP
ciprofloxacin plus gentamycin
ortazocin + piperacillin
68
treatment of MRSA HAP
vancomycin
69
Isoniazid side effects
hepatotoxicity
peripheral neuropathy
(give pyroxidine or B6)
70
Pyrazinamide
hyperuricaemia
| hepatotoxicity
71
Ethambutol
```
visual disturbances (red-green colour blindness)
optic neuritic
```
72
second line treatment of TB
1) injectables (amakacin, capreomycin, kanamycin)
73
Painful genital ulcers are most likely to be
Herpes
Chancroid (less likely)
74
Painless genital ulcers could be
Syphilis
Lymphogranuloma venereum
granuloma inguinale
75
What is seen on microscopy of gonorrhea
Gram negative diplococcus
76
What complication occurs when a baby contracts gonorrhea from mums birth canal
Ophthalmia neonatorum
The baby develops a conjunctivitis is left untreated
77
What happens to a patient with a complement deficiency if they contract gonorrhea
They get disseminated gonorrhea, septicaemia, arthritis and/ or rash
78
Gold standard diagnosis of gonorrhea
Culture from urethral swab (95% sensitive) rectal swab is 20% sensitive
79
Treatment of gonorrhea
200mcg of cefrtriaxone IM
| or 400 mcg of oral ceftriaxone
80
What antibiotic is used if gonorrhea is resistant to ceftriaxone
Spectinomycin 2g im
81
Consequences of gonorrhea
Prostatitis or salpingitis
82
What is seen on microscopy of chlamydia
Intracellulaire pathogen
| Ovoid and gram negative ( non spore forming)
83
What are the two stages of chlamydia’s life cycle
Intracellular reticular bodies that are metabolically active
Extracellular stable elementary bodies
84
Complications of chlamydia
PIX, ectopic risk, endometriosis
Reiters syndrome
85
Gold standard for chlamydia diagnosis
NAAT
86
Treatment of chlamydia
1g azithromycin P.O.
Alternatively 7 days100mcg BD doxycycline P.O.
Contraindicated in pregnancy ( give erythromycin 7/7 500mcg QDS )
87
What is lymphogranuloma venereum
Lymphatic infection with chlamydia trachomatis Serovars L1-3
88
syphilis on microscopy
what shape
gram positive or negative
obligate gram negative sphirochaete (helically coiled- squiggly)
use dark ground microscopy
89
how do you detect treponemes
PCR is gold standard
| dark ground microscopy
90
what reagents cause a false positive on syphilis testing
cariolipin
lecathin
cholesterol
91
non treponomal tests for syphilis
useful in primary infection and to check the treatment response
detect non-specific antigens
VDRL slide test
92
treponomal tests for syphilis
these test specific antigens for t. pallidum
Enzyme immuno-assay (EIA)
flourescant treponemal antibody (FTA)
T. pallidum haemagglutinin test (TPHT)
93
pros and cons of treponemal tests for syphilis
it is more sensitive than non-treponemal tests
| the results stay positive for years despite effective treatment
94
appearance of primary syphilis infection
macule --> papule
-->painless lump that appears 1-12 weeks after infection and persists for 4-6 weeks.
Serous exudate with clean base
regional adenopathy
95
symptoms of secondary syphilis
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
96
when do symptoms of secondary syphilis occur
1-6 months after infection
97
tertiary syphilis
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
98
treatment of syphilis
single dose IM penecillin (doxycyclin if allergic)
99
what is the jarisch-heimer reaction
(fever, headache, myalgia, sometimes exacerbation of
| syphilitic symptoms) – common, develops within hours of syphilis abx administration and clears within 24hrs.
100
congenital syphilis
```
occurs during birth/ pregnancy
hepatosplenomegaly
rash
neurosyphilis
fever
pneumonitis
```
101
what pathogen causes chancroid
haemophilus ducreyi
102
what are the symptoms of chancroid
multiple painful ulcers
| often in african tropical countries
103
what will be seen on microscopy of chancroid
gram negative cocco-bacillus
104
how do you diagnose chancroid
PCR
| culture on chocolate agar
105
what pathogens are contracted from oral-anal contact
shigella, salmonella, giardia
106
trichomonias infection symptoms
urethritis in men
discharge in women
strawberry cervix
107
what pathogen causes trichomoniasis
T. vaginalis
108
how is trichomoniasis diagnosed
wet prep microscopy
109
how is trichomoniasis treated
metronidazole
110
what is the abnormality in bacterial vaginosis
reduced lactobacilli
polymicrobial
abnormal vaginal flora
111
how to diagnose BV
gram stain the discharge
| positive whiff test
112
candidiasis symptoms
cottage cheese discharge: thick white discharge with itching, soreness and skin breaking
balanitis in men
vulvo-vaginitis in women
113
mollascum contagiosum
spread by touch/ sexual contact
dsDNA pox virus
huge lesions if immunocompromised, assume HIV until proved otherwise
114
genital warts pathogen
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)
115
incubation time and appearance of genital warts
3 weeks to 8 months
| can be keratinised, pedunculated, planar, carpeted, pigmented or papular
116
viral STIs
HAV, HBV,HCV (usually HIV+ MSM)
HIV
HSV
117
Examples of disease from tinea infection
ringworm
| athletes foot
118
diseases from pyteriasis
t versicolour
| sebhorreic dermatitis
119
how to test for candida
culture: mannan
| antibodies
120
how to test for aspergillus
PCR
ELISA
beta glucan test
grows on czapek dox agar
121
how to test for cryptococcus
cryptococcal antibodies in serum/ CSF
| india ink staining
122
example of a polyene
what do they target
give e.g. of organism affected
amphotericin
cell wall integrity
yeast
123
example of an azole
what do they target
give e.g. of organism affected
fluconazole
cell membrane synthesis
yeast
124
Terbinafine
what do they target
give e.g. of organism affected
targets cell membrane
| against dermaphytes/ mould
125
what does flucytosine do
targets DNA synthesis in fungal infection
126
echinocandin
against yeast
targets cell membrane
e.g. capsofungin
127
what is used to treat cryptococcal meningitis/ invasive fungal disease
amphotericin B
128
what are the types of PUO
classical
healthcare associated
neutropenic
HIV assocaited
129
causes of classical PUO
```
infection
returning traveller
neoplasm
malignancy
genetic
```
130
causes of healthcare acquired PUO
c diff
immobilisation
surgical lines
drugs: vancomycin, penecillin, serotonergics
131
causes of neutropaenic PUO
```
GVHD
chemo
haematological malignancy
mycobacteria
drug fever
```
132
causes of HIV associated PUO
```
seroconversion
TB
kaposis sarcoma
PCP
cryptococcus
lymphoma histoplasmosis
```
133
what to screen for in PUO
vasculitis: cANCA, pCANCA
genetics: fabry's, FMF, cyclic neutropenia
Bence jone proteins
casts i nurine
134
differentials for fever in a returning traveller
```
malaria
dengue
typhoid
rickettsia
brucella
viral haemmorhagic fever e.g. lassa/ ebola
```
135
typhoid bacteria type
gram negative bacillus
136
typhoid pathogen
salmonella typhi
| salmonella paratyphi
137
what is the infection in typhid
enteric fever infecting peyers patches
138
how is typhoid fever transmitted
water and food
139
symptom of typhoid
```
ROSE SPOTS
RELATIVE BRADYCARDIA
hepatosplenomegaly
abdo pain and diarrhoea/ constipation
fever
headache
```
140
consequences of chronically carrying typhoid
gallstones
| immunospression
141
diagnosis of typhoid
stool culture
| blood test
142
is typhoid a notifiable disease
yes
143
what the the subtypes of malaria
p falciparum
p vivax
p ovale
p malariae
144
which is the severe type of malaria
p falciparum
145
what is the common type of malaria
p vivax
146
what is the benign type of malaria
p malariae
147
what is seen on blood film of p falciparum
immature ring trophozoites/ mature trophozoites and schizont
crescent shaped gametocytes
148
how is p falciparum treated
quinine + doxycyclin/ clindamycin/
riamet (artemether/ lumefantrine)/
malarone
149
what is seen on blood film of p vivax
schuffner dots
| >20 merozoites. schizont
150
what is seen on blood film of p ovale
schuffner dots
151
how is p ovale treated
chloroqiune then primaquine
152
how is p vivax treated
chloroquine then primaquine
153
what is a thick film used for in malaria
to discover parasitaemia
154
what is the thin film used for in malaria
to determine species
155
blood findings in p falciparum malaria
wcc normal
reduced platelets
deranged LFTs
anaemia
156
symptoms of malaria
fever/ rigors
flu like disease- myalgia, headache
N&V
splenomegaly
may have focal neurology- reduced gcs or shock
rarely dark urine- diarrhoea, abdo cramps
157
when is parenteral therapy indicated i p falciparum
parasitaemia>2%, pregnancy, comiting
158
what GI infections are caused by anaerobes
clostridium (difficicle, perfringens and botulinium)
159
what are the symptoms of c. botulinum
descending paralysis
160
pathology of c bolutlinum
preformed toxin blocks ach release from peripheral nerves
161
treatment of c botulinum
antitoxin
162
clostriium perfringens pathology
superantigen enterotoxin binds to MHC/ TCR
| massive cytokine production and supression of immune response
163
where does clostridium perfringens act
small bowel
164
incubation period of clostridium perfringens
8-16 hours
165
symptoms of clostridium perfringens
watery diarrhoea and cramps
| risk of gas gangrene
166
symptoms of c difficile infection
pseudomembranous colitis
167
what abx cause c diff infection
flouroquinolones or cephalosorins
168
treatment of c diff
metronidazole
| PO vancomycin
169
gram negative lactose fermenting gi infection
e coli
170
subtypes of e coli
ETC
EIEC
HIS
EPEC
171
ETEC
travellors diarrhoea
172
EIEC
invasive dysentary
173
EPEC
infantile diarrhoea
174
treatment of ecoli
ciprofloxacin
175
no lactose fermenting git infections
salmonella
shigella
yersina enterocoli
enteritides
176
enteritides symptoms
self limited non blood diarrhoea
177
treatment of enteritides
ceftriaxone or ciprofloxacin
178
shigella symptoms
fever
pain
bloody diarhorrea
179
pathology of shigella
affects distal ileum and colon
| shiga enterotoxin
180
yersinia enterocolitis pathology
mesenteric adenitis with necrotising granulomas
181
association sof yersinia
erythema nodosum
| reactive arthritis
182
what are the characteristics of vibriosis
late lactose femeneters
oxidase positive
gram negative
183
campylobacter jejuni microscopy
gram negative
s shaped
oxidase positive
184
campylobacter symptoms
prodrome of headache and fever
abdo cramps
foul smelling diarrhoea
185
treatment of campylobacter
erythromycin
186
causes of campylobacter
drinking unpasturised milk
187
listeria monocytogenes
V/L shaped
tumbling motility
beta haemolytic
aesulin positive
188
symptoms of listeria
```
watery diarrhoea
cramps
headache
fever
little vomiting
febrile gastroenteritis
```
189
entamoeboeba histolytica
MSM
non motile cyst in diarrhoeal illness
flask shaped ulcer on histology
190
symptoms of entamoeba histolytica
dysentery, wind, tenesmus, wt loss
| RUQ pain and liver abscess
191
giardia lamblia buzzwords
hikers/ trvellers/ MSM/ mental hospitals
192
pathology of giardia lamblia
pear shaped trophozoites- 2 nuclei
| trophozoites in stool
193
symptoms of giardia lamblia
malabsorptio nof protein and far- foul smelling non bloody diarrhoea
194
treatment of giardia lamblia
metronidazole
195
cyptosporidium parvum
severe diarrhoea in immunocompromised
| oocytes in stool
196
treatment of cryptosporidium parvum
paromycin
197
viruses causing secretory diarrhoea
```
rotavirus
adenovirus
norovirus
poliovirus
enterovirus
hep A
```
198
Examples of HAI
C diff
E. coli (UTI)
MRSA causing bacteraemia
199
Predisposing factors to C diff infection
The three c’s
| Cephalosporins, clindomycin and ciprofloxacin
200
How is Ecoli resistant in HAI
Extended spectrum beta lactamases
201
What organisms other than ecoli can be responsible for HAI UTI
Klebsiella
Proteus
Pseudomonas
202
Which chromosome is the prion gene on
Chr 20
203
What pathogens could cause a surgical site infection
Coagulase negative staph
| MRSA
204
What pathogens could be responsible for hospital acquired infection resulting in bacteraemia
MRSA
Coagulase negative staph
E. coli
205
Differentials in a prion disease patient
Huntington’s
| Spinocerebellar ataxia
206
What is the difference between PrP and PrPsc (prion structure)
Alpha helix to beta plateau sheet
| No longer broken down by protease or radiation
207
What genetic polymorphism is associated with prion disease
Codon 129 MM/ MV/VV
208
Treatment of CJD symptoms
Clonazapam for myoclonus
| Quinacrine, pentosan and tetracycline to delay prion conversion
209
EEG findings in CJD
Triphasic spikes
210
CSF analysisin sporadic CJD
14-3-3 protein positive
211
What is seen in post mortem of sporadic CJD patients
Spongiform vaccuolation
| PrP amyloid plaques
212
Where in the brain does sporadic CJDaffect
Most areas normal except basal ganglia
213
What are the EEG changes in variant CJD
Non specific slow waves
214
Where does variant CJD affect the brain
Thalamus
215
Is 14-3-3 protein normal in variant CJD
Sometimes
216
What genetics are common in variant CJD
All sufferers are 129MM homozygotes
217
What is seen on western blot in variant CJD
Tonsillitis biopsy shows type 4t PrPsc
218
What is seen on post mortem of variant CJD
PrPsc 4t in CNS and lymphoreticular tissue
| Florid plaques
219
Sporadic CJD causes
PRNP mutation or spontaneous conversion of PrP to PRPsc
220
Symptoms of sporadic CJD
Rapid progressive dementia
Cortical blindness
Akinetic mutism
Lower motor neurone signs
221
Survival time for sporadic CJD
6 months
222
Causes of acquired CJD
BSE- vCJD
Iatrogenic
Kuru
223
vCJD age of onset
30s so younger than sCJD
224
VCJD symptoms
Psychiatric symptoms e.g. paranoia followed by neuro signs e.g. peripheral sensory loss, ataxia and myoclonus then finally chorea and dementia
225
Causes of vCJD
Bovine spongiform encephalopathy
226
Symptoms of iatrogenic CJD
Ataxia
| Eventually dementia and myoclonus
227
Kuru symptoms
Progressive cerebellar syndrome
| 45 year incubation period then 2 years of disease then death
228
Causes of kuru
Cannibalism
229
Inheritance of GSS
Autosomal dominant
230
Symptoms of GSS
Dysarthria then cerebellar ataxia then dementia
231
FFI symptoms
insomnia and paranoia then weight loss then mutism
232
How is FFI inherited
Autosomal dominant
233
Zoonoses: mice
```
Hantan virus
Lyme borreliosis
Ehrlichia
Bartonella
Lymphatic choriomeningitis
```
234
Rat zoonoses
```
Rabies
Leptospirosis
Lassa fever
Hantan virus
Plague
Haverhill (rat bite ) fever
Pasteruellosis
```
235
Cat zoonoses
```
Bartonellosis (cat scratch)
Leptospirosis
Q fever
Toxoplasmosis
Rabies
Ringworm
Toro arias is
```
236
Small ruminants
```
Anthrax
Toxoplasmosis
Brucellosis
Q fever
Cryptosporidium
```
237
Dog zoonoses
```
Hydatid disease
Leptospirosis
Brucellosis
rabies
MRSA
Ring worm
Toxocariasis
```
238
Zoonoses cattle
```
Anthrax
Leptospirosis
Brucellosis
Bovine TB
Toxoplasmosis
Ring worm
E. coli
```
239
Swine zoonoses
```
Influenza A
Cystericercosis
Brucellosis
Leptospirosis
Erysipeloid
```
240
Bird zoonoses
```
Psittacosis
Influenza
Cryptococcus
Influenza A
Salmonella from poultry
west Nile fever
```
241
Water sports associated zoonoses
```
Leptospirosis
HAV
Giardia
Toxoplasmosis
Mycobacterium marinos/ ulcerans
Burkholderia pseudomallei
E. coli
```
242
Water bornezoonoses
Campylobacter
Salmonella
VTEC
Cryptosporidium
243
Food associated zoonoses
```
Listeria
Tania
Cysticercosis
Toxoplasmosis
Trichonellosis
Yersiniosis
Giardia
```
244
Definition of zoonoses
Disease and infection which are transmitted naturally between humans and other vertebrates
245
Brucellosis pathogen
Gram negative aerobic bacillia
246
How is brucellosis transmitted
Inhalation or skin/ membrane contact
| Eating contaminated food (untreated dairy)
247
Symptoms of brucellosis
```
Incubation period of 3 weeks
Then undulant fever that is bad at night but normal by morning
Malaise
Rigours
Fatigue
Myalgia
```
248
Signs of brucellosis
```
Arthritis
Spinal tenderness
Lymphadenopathy
Splenomegaly
Hepatomegaly
Epidemiologists-orchid is
```
249
Investigations in brucellosis
WCC normal
Anti O polysaccharide antibody >1/160
May be neutropaenic
250
Treatment of brucellosis
Streptomycin with either tetracycline or doxycycline for 4-6 weeks
Otherwise oral doxy and rifampicin for 8 weeks
251
Which virus causes rabies
Rhabdovirus
252
What is pathognomic of rabies
Negri bodies
253
Severe complication of rabies
Encephalitis
254
Symptoms of rabies
Fever
Headache
Sore throat
Acute encephalitis
255
How to diagnose rabies
ELISA test for IgM
| IFA for rabies antigen in brain tissue
256
Treatment of rabies
IgG
257
What pathogen causes the plague
Yersinia pestis
258
What type of pathogen is yersinia pestis
Gram negative lactose fermenter
259
How to diagnose plague
PCR
260
What are the subtypes of yersinia pestis plague
Bubonic
| Pneumonic
261
Symptoms of bubonic plague
Dry gangrene
| Swollen lymph nodes
262
How are the different plagues spread
Bubonic- flea bite
| Pneumonic- person to person contact
263
Plague treatments
Streptomycin
Doxycycline
Gentamicin
Chloramphicol
264
Leptospirosis pathogen
L interrogans
Obligate
Gram negative
Aerobic motile spirochaetes
265
How is leptospirosis transmitted
Dog/ cat urine and when swimming in infected water it penetrates broken skin
266
Symptoms of leptospirosis
```
High spiking temp
Headache
Conjunctival haemorrhages
Jaundice
Malaise
haemolytic anaemia, renal failure,c arditis, meningism
```
267
Incubation of leptospirosis
10-14 days
268
Treatment of leptospirosis
Amoxicillin
Erythromycin
Doxycycline
Ampicillin
269
Anthrax pathogen
Bacillus anthracite
270
What are the subtypes of anthrax
Cutaneous and pulmonary
271
What is cutaneous anthrax
Painless round black lesions with a ring of oedema
272
What is pulmonary anthrax
```
Woolsorters disease
Massive lymphadenopathy
Mediastinal haemorrhage
Pleural effusion
Resp failure
```
273
What pathogen causes Lyme disease
Bordelaise burdoferi
274
What are the stages of Lyme disease and what happens in each one
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
How to diagnose Lyme disease
Biopsy edge of erythema chronicum migrans (bulls eye rash)
| ELISA for lyme antibodies
276
Treatment o Lyme disease
Doxycycline for 2-3 weeks
| If CNS problems also IV ceftriaxone for 2-4 weeks
277
Complication associated with Lyme disease
ME
278
Q fever pathogen
Coxiella burnetii
279
Presentation of Q fever
Atypical pneumonia
DRY Cough, fatigue, pleural effusion and diarrhoea
280
Treatment of Q fever
Doxycycline
281
Types of leishmaniasis
Cutaneous-L major, L tropica
Diffuse cutaneous:
Mucocutaneous: L Brazilians is
Visceral (kala afar): L infantum, L Donovani, L chagasi in south america
282
Cutaneous leishmania
L major and L tropica
| Transmitted by sandfly bite
283
Pathogenesis of cutaneous leishmania
Bit ulcerated as dermal macrophages multiply
After one yearheals and leaves a depigmented scar
Single or multiple painless nodules
Type IV reaction
284
Diffuse cutaneous leishmania
Modular non ulcerting lesions on nose
285
Who gets diffuse cutaneous leishmania
Immunocompromised patients
| Therefore the skin test is negative
286
Mucocutaneous lieshamania
L Braziliensis
| Dermal ulcer like cutaneous leishmaniasis and years later ulcers in nasal mucosa
287
Visceral leishmania
L donovani, L infantum, L chagasi
| Abdo discomfort, weight loss and distension in malnourished child
288
Complication of visceral leishmania caused by L donovani
PKDL
The reticulo-endothelial system is invaded causes hepatosplenomegaly
BM invasion
289
3 antigenic variants of flu in human
```
Influenza A (H1)- January
Influenza A (H1N1)=December
Influenza B
```
Flu vaccine is fractioinsof HA and NA to combat
290
What sort of vaccine is flu vaccine
Inactivated
291
Bird flu- natural reservoir and serotonin
Ducks
| H5N1
292
How does neuramidase increase flu infection
Cleaves sialic acid residues exposing receptors on host cell
Disrupts mucin barrier
293
How does haemagglutinin increase flu transmission
Binds sialicacid receptors and enables virus entry
| Endosomal-viral envelope fusion and release
294
What is antigenic drift re: flu
New strains of virus because of HA/ NA mutations
295
What is antigenic shift
Complete change of HA/ NA and trading of RNA segments between human and virus
Only in influenza A
296
What causes the huge tropism for influenza A
Cleavage by Clara tryptase inthe lung
297
What is an antiviral for influenza A
Amantadine
Targets M2 ion channel
298
Is amandine effective against influenza A
No AA mutation in M2 means many flu is resistant
299
What are the neuramidase inhibitors for influenza
Tamiflu
Relenza
Sialic acid
Need to be given in 48 hours of infection
300
What does acyclovir do
Treatment for herpes
| Prevents HSV thymidine kinase from being activated and so prevents viral DNA extension
301
What are symptoms CMV infection
```
RCHEP
Retinitis
Colitis
Hepatitis
Encephalitis
Pneumonitis
```
Owls eye inclusions in CMV cells
302
How is CMV treated
Gangyclovir - risk of marrow toxicity
Foscarnet is second line - nephrotoxic
Cidofivir is third line- nephrotoxic
303
How does gangcycloivr work
Nucleoside analogue
304
How does foscarnet work
Pyrophosphate analgue
| Inhibits nuclei acid synthesis and doesn’t need activation
305
How does cidofivir work
Nucleoside phophonate
Used for CMV retinitis
306
What needs to be given alongside foscarnet or cidofivir
Probenecid because they are nephrotoxic
307
When do you treat VZV
If immunosuppressive, pregnant or have pneumonitis as an adult
308
Act Very Fast with herpes- what are these meds
Acyclovir
Valaciclovir
Famciclovir
309
When do you treat HBV
If HBV DNA levels are greater than 2000
When serum ALT rises
When liver biopsy shows moderate active disease
310
How do you treat HBV
Peginterferon 2alpha (sc)
Tenofovir
Entecavir
311
What is the aim. Of HBV treatment
Prevent conversion to HCC or cirrhosis
Normalise ALT
Maintain serum HBV DNA
312
Treatment options for HBV
Peginterferon
Nucleoside analogues
Nucleotide analogues
313
HCV treatment goal
Persistent absence of HCV 6 months after treatment
| Prevent progression to cirrhosis
314
Treatment of HCV
Peginterferon alpha 2b/2c
| Nucleoside analogues e.g. ribivarin
315
Side effects of ribivrin (nucleoside inhibitor for HCV)
Haemolytic anaemia
316
What genotypes are more likely to benefit for HCV treatment
Genotypes 2 and 3
| Genotypes 1,4,5,6 tend to have less successful treatment
317
Influenza treatments: NA inhibitors
Oseltamavir
Zanamivir
Amantadine
318
RSV/ parainfluenza treatment
Ribivarin— guanasine alalogue
319
Stages of PCR
1) denature
2) primer annealing
3) chain elongation with Taq polymerase
320
Three cause of post transplant viral infection and examples
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
Where do herpes and VZV stay latent
Neurones
322
Where do EBV and CMV stay latent
Leukocytes
323
What are complications of VZV in the immunocompromised
Pneumonitis
| Hepatitis
324
How to prevent varicella infection
Varicella zoster Ig
325
Treatment of VZV
Acyclovir
326
How to treat EBV after BMT
Rituximab and reduce immunosuppressive
327
What does HHV 8 causes
Castleman’s disease
| Kaposi’s sarcoma
328
How is kaposi’s sarcoma diagnosed
Spindle cells
| KSHV proteins on biopsy
329
What does HHV6 do
Causes graft rejection
| Symptoms similar to CMV
330
How is HHV6 treated
Gangcyclovir
Foscarnet
Cidofovir
331
Who gets adenovirus
Paediatric outpatients after BMT
332
How is adenovirus treated i n paediatric patients after BMT
Ribivarin
| Reduce immunosupression
333
Complications of measles
Giant cell pneumonia
| Encephalitis
334
How to treat measles
Supportive
| Normal human Ig
335
What pathogens colonise the surgical site and cause infection
Staph aureus, pseudomonas, E. coli and haemolytic strep
336
How is surgical site infection treated
Flucloxacillin
337
RF of septic arthritis
Immunosupression
Abnormal joint
Bacteraemia
338
Bugs causing septic arthritis
Staph aureus,
Strep
Gram negatives e.g. E. coli rarely
339
What’s the underlying pathology in septic arthritis
Bug adheres to synovial membranes and proliferates in fluid
340
Symptoms of septic arthritis
Unwell febrile patient with a hot swollen joint
341
How to diagnose septic arthritis
Blood culture before ABX
Joint aspirate (>50 000 cells/ mm3)
Imaging shows effusion
inflammatory markers
342
Treatment of septic arthritis
IV cephalosporin or flucloxacillin
If MRSA vancomycin
Drain joint
343
What is the pathogenesis of osteomyelitis
Subacute (Brodie) abscess to frank osteomyelitis
| Local or haematological spread
344
Bugs causing osteomyelitis
Staph aureus
345
How to diagnose osteomyelitis
MRI
| Biopsy bone
346
Symptoms of osteomyelitis
Pain
Fever
Local swelling
347
How to treat osteomyelitis
Abx
| Second line: debridment
348
Pathogens causing prosthetic joint infection
Staph aureus
| Enterobacteriae
349
Symptoms of prosthetic joint infection
Failure of joint
Pain
Loosening on radiology
350
Diagnosis of prosthetic joint infection
Joint aspiration
| Loosening on radiology
351
Treatment of prosthetic joint infection
Remove metalwork- revise joint
| Abximpregnated cement
352
Treatment of pyelonephritis
Coamoxiclav+ gentamicin
| Cefuroxime + gentamicin
353
Antimicrobials that inhibit cell wall synthesis
Beta lactams
| Glycopeptides
354
Examples of beta lactams
Cephalosporins
Carbapenems
Penecillins
355
Example of a cephalosporins
Ceftriaxone
356
Example of a carbapenem
Meropenem
357
Example of glycopeptide
Vancomycin
358
Abx that inhibit protein synthesis
```
Aminoglycosides
Tetracyclines
Macro lines
Chloramphenicol
Oxazolidinones
```
359
When are aminoglycosides used and give an e.g
Gram negative sepsis
Gentamicin
360
When are tetracyclines used and give an e.g.
Intracellular chlamydia
Doxycycline
361
When are macrolides used and give an example
Gram positive organisms if there is a penicillin allergy
362
Eg of macrolide
Erythromycin
363
When is chloramphicil used
Bacterial conjunctivitis
364
When are oxazolidonones used andgive e.g.
Gram positive, MRSA positive VRE
Linezolid
365
Antibiotics that inhibit DNA synthesis
Flouroquinolones
| Nitroimidazoles
366
When are flouroquinolones used
Gram negative
Ciprofloxacin
367
When are nitroimadazoles used and give e.g.
Anaerobes and Protozoa
Metronidazole
368
Abx that inhibit RNA synthesis
Rifamycin
369
When are rifamycins used and giv e e.g.
TB
| Rifampicin
370
What abx target cell membrane toxins
Polymyxin
| Cyclic lipopeptide
371
When are polymyxins used and what do they target
Gram negatives
Colistin
372
What do cyclic lipopeptides target and give e.g.
gram positive MRSA positive VRE
Daptomycin
373
What abx inhibit phosphate metabolism
Sulphonamides
| Diaminopyramidines
374
When are sulphonamides used and give e.g.
PCP with trimethoprim
| Sulphamethoxazole
375
When are diaminopyramidines used and give .e.g
UTI
| Trimethoprim
376
Which abx are broad spectrum
Co-amoxiclav
Tazocin
Ciprofloxacin
Meropenem
377
Narrow spectrum abx
Gentamicin
Flucloxacillin
Metronidazole
378
4 mechanisms of antibiotic resistance
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
Acronym for abx resistance
BEAT
380
Pathogen and abx inskin infection
Staph aureus
Flucloxacillin
381
Pathogen and abx in pharyngitis
Beta haemolytic streptococcus
Benzylpenecillin
382
Community acquired pneumonia abx if mild
Amoxicillin
383
Sever community acquired pneumonia abx
Co-amoxiclav + clarithromycin
384
Hospital acquired pneumonia abx
Amoxicillin + gentamicin
/ tazocin
385
Abx and pathogen for bacterial meningitis
Meningococcus/ streptococcus
Ceftriaxone unlessits likely to be listeria induced in which case amox
386
Abx for UTI
Trimethoprim/ nitrofurantoin
387
Abx for nosocomial UTI
Co-amoxiclav/ cephalexin
388
Abx for severe sepsis
Tazocin/ ceftriaxone
Metronidazole+ gentamicin
389
Abx for neutropaenic sepsis
Tazocin + gentamicin
390
Pathogen and abx for colitis
C. difficile
Stop ceph and start PO metronidazole
391
Congenital infections (TORCH)
```
Toxoplasmosis
Other (HIV/ HBV)
Rubella
CMV
HSV
```
392
Sx of congenital infection (TORCH)
```
Thrombocytopenia
Other- ears/ eyes e.g. cataracts, choroidoretinitis
Rash
Cerebral anomaly e.g microcephaly
Hepatosplenomegaly
```
393
When do neonatal infections present
<6 weeks
394
What causes neonatal infection
Group B strep
E. coli
Listeria
395
How to prevent congenital infections
TORCH screen
396
Symptoms of neonatal infection
Fever
| Meningitis
397
Diagnosis of neonatal infection
```
Septic screen
FBC
CRP
Blood culture
Deep ear swab
CSF
Surface swab
CXR
```
398
Treatmetn of early onset sepsis in the neonate
Supportive
| Benpen + gentamicin (unless listeria in which case use amox/ ampicillin)
399
Diagnosis of late onset neonatal sepsis
Septic screen plus urine
400
Causesof late onset sepsis in the neonate
Coagulase negative staph
GBS
Ecoli
Listeria
401
Sx of late onset neonatal sepsis
```
Bradycardia
Apnoea
Poor feeding
Irritability
Convulsions
Jaundice
Resp distress
Focal inflammation e.g.umbilicus
```
402
Abx in late onset neonatal sepsis
1. benzylpenecillin plus gentamicin
2. Tazocin + vancomycin if v ill
If community amox plus cefotaxime
403
Common causes of childhood infections
VZV
HSV
Bacterial infection
404
Causes of paeds bacterial meningitis by age
1-3 months GBS, E. coli, listeria
<3months haemophilia influenza’s
>3 months- neisseria meningitidus
<2 years strep pneumoniae
405
Paeds causes of RTIs
Virus
S pneumoniae
Mycoplasma
406
Causes of UTI in paeds and sx
E. coli, proteus, klebsiella, enterococcus
Pyuria and clinical sx
>10^5 Cafu/ ml
407
Fungal cause of meningitis
Cryptococcus
408
Viral causes of meningitis
Coxackie
HSV2
Echovirus
Mumps
409
How does bacterial meningitis spread
Systemic from mucosa or local from skull fracture
410
Risk factors for bacterial meningitis
Complement deficiency
Hyposplenism
Immune defect
411
RF for strep pneumoniae meningitis
Fractured skull - esp if CSF leak
412
How to diagnose meningitis
Blood cultures
Serum AG
EDTA-PCR
Throat swab
Clinical suspicion
413
Management of bacterial meningitis
Resuscitate- ceftriaxone and corticosteroids
| Cover listeria with ampicillin and encephalitis with IV acyclovir
414
Hepatitis A Ig
IgG if vaccinated/ prev infecction
| acutely IgM
415
How long do anti hep A IgM antibodies persist for
14 weeks
416
What type of virus is hep A
RNA
417
What type of virus is hep B
DsDNA
418
Method of hep Btransmission
Sexual, vertical, horizontal
419
Signs for diagnosing hep B infection
Very high ALT and high AST
HBsAg for infection/ vaccine
HBeAg for infectivity
HBcAb for exposure
420
Treatment of hep B
Lamivudine
Tenofivir
Peginterferon alpha 2a
421
Consequences of hep b infection
HCC
Cirrhosis
Fibrosis
Polyarteritis nodosa
422
What type of virus is hep C
RNA
423
How is hep C transmitted
Blood products
424
How to diagnose HCV infection
ALT
| Anti HCV
425
Treatment of HCV infection
Peginterferon alpha 2b
| Ribivarin
426
Consequences of HCV infection
Cirrhosis
| Cyroglobin antibodies- glomerulonephritis
427
Hepatitis D
Only infects those with hep b
428
Hep E
Faecooral route in India
429
Common viral infections in pregnancy
Rubella
Influenza
Measles
Parvovirus B19
430
Parvovirus B19 in pregnancy risks
3% risk of hydrous fatalis
| IF >20 weeeks no risk
431
Parvovirus B19 symptoms
Fever
Malaise
Slapped cheek- erythema infectious
Transient aplastic crisis
432
Transmission of parvovirus B19
Resp/ blood borne
6-8 days incubation
433
Symptoms of rubella in mum
Flu like symptoms
Pinpoint maculopapular rash
Lymphadenopathy
434
How to diagnose maternal rubella
Serology of saliva swabs
435
Implications of rubella on foetus
Congenital rubella syndrome
436
What is congenital rubella syndrome
If infected before 8 weeks- risk of spontaneous abortion (20 %)
```
Cataracts
Glaucoma
Retinopathy
Deafnesss
Mental retardation
Heart disease
Splenomegaly
Meningoencephalitis
```
437
Risks of influenza in pregnancy
5x still birth
| 3x preterm delivery
438
Implication of measles while pregnant
IUD/ miscarriage
Pre term delivery
Increased maternal morbidity
439
Types of vaccination
```
Live attenuated
Inactivated
Recombinant proteins
Conjugated
Subunit
```
440
E.g. of live attenuated vaccine
MMR
VZV
Yellow fever
441
E.g. of inactivated vaccine
HAV
| Rabies
442
E.g. of recombinant protein vaccine
HBV
443
E.g. of subunit vaccines
Influenza
| Typhoid
444
E.g. of conjugate vaccine
Meningitis c
445
Clinical spectrum of leprosy
```
TT
BT
BB
BL
LL
```
446
What is TT leprosy
Tuberculoid
Th1 mediated
Depigmented lesions
447
What is B.B. leprosy
Borderline
Multiple plaques
448
What is LL leprosy
Lepromatous
Th2 mediated, multibacilliary
Neuropathic ulcers
449
What does BT leprosy cause
Nerve damage
450
granuloma inguinale another name
donovanosis
451
symptoms of donovanosis
papule or nodule that breaks down into large expanding ulcers
452
appearance of donovanosis ulcers
beefy red appearance
453
how to diagnose donovanosis
giemsa stain of biopsy/ tissue crush
| donovan bodies seen
454
treatment of donovanosis
azithromycin
455
LGV first stage
painless ulcer that develops 2-12 days after exposure
| also balanitis, proctitis, cervicitis
456
second stage of LGV
iunilateral painful inguinal buboes, fever , malaise and rarely meningoencephalitis
proctocolitis and hyperplasia of lymphoid tissue
457
late LGV sx
strictures, lymphadenopathy, abscess, frozen pelvis, genital elephantiasis
458
LGV treatment
21/7 doxycycline BD
| or erythromycin 21/7 QDS 500mg/ azithromycin 1g once weekly for 3 weeks
459
STI:: oral anal pathogens
shigella
salmonella
giardia
460
treatment of genital warts
1. podophyllotoxin home treatment (CI in pregnancy)
| 2. cryotherapy/ imiquimod
461
symptoms of T versicolour
depigmentation in those with darker skin
| ptyriasis: malassezia globosur/ furfur
462
ptyriasis fungus
malassazia globosa/ furfur
463
candidaalbicans treatment
fluconazole
464
treatment of invasive fungal disease from candida
amphotericin-B
465
treatment of aspergillus
voriconazole
466
what vector is cryptococcus associated with
birds (pigeons)
| HIV
467
treatment of cryptococcus
2/52 amphotericin B +/- flucytocine
468
congenital CMV symptoms
```
IUGR
jaundice
hepatosplenomegaly
thrombocytopenia
impaired IQ
sensorineural deafness
microcephaly
cytomegalic inclusion disease
```
469
how to diagnose CMV
paul bunnel test
serology: IgG and IgM
cell culture in human fibroblasts- owls eye inclusions
470
roseola virus
```
roseola infantatum (exanthum subitum, sixth disease)
3/7 fever then transient rash
```
471
where is roseola virus latent
lymphocytes
472
treatment of roseola virus reactivation after BMT immunospression
gangcyclovir
foscarnet
cidofivir
473
gential herpes symptoms
```
fever
dysuria
malaise
painful vesicular rash
sacral radiculomyeltis (self limiting urinary retention)
```
474
oral herpes symptoms
painful rash with erythematous base- coalesce
submandicular lymphadenopathy
fever
475
differential for oral herpes
herpangina (coxackie A)
476
symptoms of herpes encephalitis if HSV 1
2 week flu like prodrome
focal neurology and personality change
seizures
coma/ death
477
symptoms of herpes encephalitis if HSV 2
mollarets meningitis
| recurrent aswptic meningitis
478
CSF findings in herpes encephalitis
lymphocytic pleiocytosis
normal glucose
raised protein
479
MRI/ CT findings in herpes encephalitis
front- temporal or parietal lobe lesions
480
tx of herpes encephalitis
dont wait for test results
| 10mg/kg IV acyclovir STAT TDS then switch to three weeks of oral acyclovir
481
herpes skin manifestations
```
scrum pox- herpes gladiatorum (painful blister and inguinal LN)
herpetic whitlow- painful red finger
erythema multiforme
eczema herpeticum
zosteriform HS
HS dermitits
```
482
neonatal herpes
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
treatment of neonatal herpes
oral/ IV acyclovir 6 weeks before EDD
484
VZV cytology findings
tzanck cells (multinucleated giant cells)
485
symptoms of VZV
vesicular rash- dew on a rose petal
fever malaise headache
rash scabs after a week
486
complications of VZV
```
ramsey hunt syndrome
pneumonitis/ scarring/ reyes syndrome
guillian barre
geniculate ganglion of CN VII- hearing loss and vertigo
post herpetic neuralgia
```
487
VZV in pregnancy causes
congenital varicella syndrome
488
implicationso fcongenital varicellar syndrome
```
scarring
hypoplastic limbs
cortical atrophy
psychomotor retardation
chorioretinitis
cataracts
disseminated disease 7 days after delivery
```
489
treatment of VZV in pregnancy
VZIG
490
VZV in adulthood treatment
anyone at risk 800mg acyclovir
| PO TDS 7/7
491
shingles
dermotomal painful rash
492
treatment of shingles
800mg acyclovir PO 5 times daily
topical eye drops
only if <24 hours of rash
493
glandular fever sx
triad of fever, pharyngitis, lymphadenopathy and a maculopapular rash
494
how to diagnose glandular fever
blood film
monospot agglutination
EBV antibodies
Paul bunnell test
495
ocular herpes
PORN
acute retinal necrosis if immuncompromised
herpetic keratitis- uni/bi lateral conjunctivits and pre auricular LN involvment
496
how is neonatal herpes transmitted
during delivery
497
what colour is a gram positive bacteria stained
purple
498
what colour is a gram negative bacteria stained
red
