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Phase 2 > MICROBIOLOGY > Flashcards

MICROBIOLOGY Flashcards

1
Q

Doxycycline mechanism and is used for..

A

Inhibits bacterial protein synthesis…. Broad gram +ve’s. Chest infections

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2
Q

Cephalosporins.. mechanism, used for, examples

A

Beta lactam - has best resistance to beta lactamases. Good bactericide. Used when want to kill bacteria quickly. Endocarditis, meningitis.
Cefotaxime

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3
Q

Macrolide.. mechanism, used for, examples..

A

Inhibits protein synthesis, used for gram positives and atypical pneumonia pathogens, clarithromycin and erythromycin

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4
Q

Metranidazole… mechanism, used for…

A

Inhibits nucelic acid synthesis, can only do this in anaerobic bacteria, eg bacteroides, C Diff (although may need something like Vancomycin for C Diff instead)

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5
Q

What antibiotic combination would you give for a pt with suspected aerobic (eg E coli) and anaerobic (eg Bacteroides) infection of peritoneum (eg from appendix rupture)

A

Beta lactam to cover aerobe - eg. penicillin (if not allergic), co-amoxiclav, cephalosporin (if concerned about resistance) + metronidazole to cover anaerobes

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6
Q

Is E coli aerobic or anerobic

A

Aerobic - t/f do not treat with metronidazole

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7
Q

Is C Diff aerobic or anerobic - how would this guide antibiotics?

A

Its anerobic so could you metronidazole. But something like IV vancomyosin could also be used.

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8
Q

Empirical antibiotics for suspected bacterial meningitis

A

Cephalosporin - cefotaxime

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9
Q

Empirical antibiotics for strep pnemoniae

A

Amoxicillin (beta lactam - gram +ve)

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10
Q

Empirical antibiotics for staph aureus (no resistant) and resistant; penicillin allergy

A

Not resistant - flucloxicillin
?Resistance - co-amoxiclav, cephalosporin
Penicillin allergy - vancomysin

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11
Q

Empirical antibiotics for cellulitis and why

A

Probably gram positive stap or strep.

  1. If no penicillin allergy - start on beta lactam. Use something that covers resistance until you know more - eg co-amoxiclav (if it is sensitive to just penicillin, can use this later). Bactericide - will kill bacteria.
    • clindomyacin (protein synthesis inhibitor) - bacteriostatic - stops bacteria from making endotoxins - so will neutralise endotoxin release from active bacteria
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12
Q

Empirical antibiotics from UTI and why

A

Gram -ve = trimethoprim, nitrofuratoin

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13
Q

Snail worm infection is called…

A

Schistosomiasis

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14
Q

Define protozoa

A

Single cell eukaryotic organism.

Have parasitic and symbiotic relationships

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15
Q

List 5 important infectious protozoa

A

Giardia - treat w/ metronidazole. No blood. Flatulence & cramping.

Cryptosporidium (water) - No blood. D&V. No cramping. fluids & antiemetic

Amoeba - amoebic dysentery (blood) and liver abscess - metronidozole.

Toxoplasmosis - would see this is immunocomp - HIV

Malaria - treat depending on resistence, quiniolones

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16
Q

What antibiotics are commonly used for parasitic infections

A

Metronidazole

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17
Q

Treatment of cryptosporidium infection

A

IV fluids & anti-emetics

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18
Q

What is the most common tropical disease in UK

What are the symptoms & signs, how would you check for it

A

Malaria
Fever, sweats, chills, diarrhoea, nausea, vomitting, headache, myaglia, fatigue
Signs: jaundice, anaemia, hepatosplenomegaly, black water fever - dark urine

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19
Q

What antibiotics cause C Diff

A 
Antibiotics “rule of C’s”
Clindamycin
Ciprofloxacin (Quinolones)
Co-amoxiclav (Penicillins)
Cephalosporins (especially 2nd and 3rd generation)
20
Q

List some risk factors for developing C diff

A 
Age
If patient is on PPI (can increase risk)
Long hospital stay
Immunocompromised
Nasal tube, GI surgery
21
Q

What is the treatment for C Diff

A

Metrondazole
ORAL Vancomycin
Rifampicin/rifaximin
Stool transplant

22
Q

What is the commonest site of infection

A

Respiratory tract

23
Q

What is the characteristic presentation of chickenpox rash

A

Central distribution - likes warm places, so usually torso under skin, not peripheral where it is cooler
Starts as macule (not raised - could be anything at this stage) - then papule (raised) - vesicle (fluid)- pustule (pus) - enlarges - crusts over and heals

macule - papule - vesicle - pustule

24
Q

What is the infectious period of chickenpox

A

Infectious from 2 days before rash presents till all pustules have crusted over

25
Q

What is the most important complication of primary varicella virus (chickenpox) infection and which patient groups should you be worried about with this complication

A

Pneumonia
Pregnant women
Compromised
*NB this is only a complication for those who have never been exposed as it is to do with the virus being in the respiratory tract

26
Q

Systemic symptoms of respiratory infection are most commonly associated with which conditions

A

Pneumonia and Influenza A

Examples: myalgia (muscle aches), arthralgia (joint aches)

27
Q

Sore throat and headache is associated with which respiratory pathogen

A

Mycoplasma pneumonia - really bad cold with sore throat, headache/ congestion - occurs in epidemics

28
Q

If you have a patient with presentation of bacterial pharyngitis, what pathogens do you need to consider and rule out

A

Strep pyogenes - scarlet -> rheumatic fever
Mycoplasma pneumoniae - headache/ congestion
Neisseria gonorrhoea
Corynebacteria Diptheria
Lemierres disease - IJV

29
Q

What are the complications of bacterial sinusitis

A

Brain abscess, Sinus vein thrombosis, ortibal cellulitis

30
Q

How can you tell if sinusitis is viral or bacterial

A

Bacterial signs:
Unilateral facial pain
Pus discharge from nose (purulent discharge)
>10 days of fever
acute onset with complications - eg swelling and signs on vein thombosis

31
Q

What are the phases of whooping cough - what is the pathogen

A

Incubation 7-10 (5-21d)
Catarrhal phase 1-2 weeks; rhinorrhoea, conjunctivitis, low-grade fever and at end of phase lymphocytosis
Paroxysmal phase 1-6 weeks coughing spasms ,inspiratory ‘whoop’ post-ptussive vomitting, cough>14d
Convalescent phase

32
Q

List some paraneoplastic signs on lung cancer

A 
Finger clubbing
Hypertrophic pulmonary osteoarthropathy 
Hypercalcaemia
Weight loss
Anorexia
Peripheral neuropathy (muscle weakness of the limbs)
33
Q

Describe the causes and pathology of lung cancer

A 
Causes:
Smoking
Asbestos
Radon
Chromium
Coal products

Pathology:
Small cell lung cancer - neuroendocrine cells (15%)
Non-small cell lung cancer (80%)
-squamous cell carcinoma (squamous hyperplasia of columnar cells) (20%)
-adenocarcinoma (columnar cells) (40%)
-large cell - poorly differentiated
-NOS - not any of the above. - cant be identified

34
Q

Describe how lung cancer presents

A 
Often asymptomatic until stage 3 or 4 - when it has metastasised 
Symptoms can be local:
Cough
Chest pain
Haemoptysis 
Hoarse voice 
Symptoms can be from metastises:
Bone pain
Brain - seizures, neurological deficit 
Lymph - adenopathy, swelling
Adrenal
Liver - hepatic pain; abnominal pain
35
Q

Which stages of lung cancer are resectable

A

Stages 1 and 2
Before it metastises
Outcomes declines the more tumours and nodes there are involved, even if still only local invasion

36
Q

Outline the survival rates (roughly) for the different stages of lung cancer

A 
Survival at 5 years
Stage 1: T1 - 60%; T2 - 40%
Stage 2: T1, N1 - 30%; T3 - 20%
Stage 3: 5-10%
Stage 4: 1%
37
Q

What stage does NSCLC most often present at

A

70% of presentations are stage 3 or 4

38
Q

What affects chemotherapy outcomes in NSCLC

A

Performance status - there is approximately a 20-30% benefit in survival at one year in those with performance status 0-1 vs 3. 0-1 with chemo = 35% survival at 1 year. 3 with chemo = <5% survival.
Performance status 4 + chemo = 0% survival at 1 year

39
Q

Outline the treatment options for the different stages of NSCLC

A

Stages 1 & 2 = surgery & RTX. +/- chemo.

Stages 3 & 4 = palliative chemo, palliative care, chemo + RTX (palliative?)

40
Q

What is the main difference in management / treatment options between NSCLC and SCLC

A

Some NSCLC will be eligible for surgery
SCLC - surgery is not an option.
Both have bad outcomes, but a low stage NSCLC probably has the best outcomes out of them all.

41
Q

What investigations are required for a patient who you suspect might have lung cancer

A

Imaging:
CXR
CT
PET - be aware of false positive (infection etc) and negatives - some tumours don;t show up

Biopsy:
Bronchoscopy 
Bronchoscopy +/- US guided biopsy
percutaneous (CT guided) needle biopsy
US guided aspirate or biopsy
Surgical biopsy

Bloods: to look for signs of metastatic spread and damage being done to any organs, or to rule out other causes - infection etc
CT thorax/abdo, PET scan,
CT head, medistinoscopy, pleural aspiration,

42
Q

What should be the focus of a history for a patient that you suspect may have lung cancer

A

1.Social & occupational history
-Do they smoke?
-Where do they live - Radon exposure?
-What is or was their job - asbestos, chromium exposure? Try to identify any risk factors of lung cancer.
2.Past medical history
-Have they previously had cancer?
-Think about breast, prostate, colorectal cancers that can metastasise to lung
3.Symptoms of metastatic spread
-any recent onset bone, joint pain?
-any weakness in muscles? - peripheral neuropathy?
-any swelling anywhere - lymph adenopathy?
-think about brain, bone, lymph, adrenal glands etc
4.Any paraneoplastic symptoms
Finger clubbing
Peripheral neuropathy etc
5.Performance status
-Ask the patient about their daily living - what are they able to manage?

43
Q

What would you include in a differential for lung cancer

A

Pneumonia
Pulmonary embolism
Any other lung disease that can cause a cough or chest pain
GORD

44
Q

What lung cancer has the best outcomes

A

Stage 1: T1 N0 M0 - 60-80% survival at 5 years

45
Q

What serology profile would indicate that a patient does not have chronic hepatitis after an acute infection

A

Presence of Antibodies against Hep B surface antigen

+ No detectable levels of HepB surface antigen or cor antigen

46
Q

What serology profile would indicate that a pt who has previously had an acute hep B infection has progressed to chronic

A

Detectable levels of Hep B surface antigen in bloods >6 months after acute infection
No antibodies against HepB surface antigen

Phase 2 (12 decks)

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