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Paddy Phase 2 Qs > Microbiology > Flashcards

Microbiology Flashcards

1
Q

How do you treat an infective endocarditis?

A

If Strep IV Benzylpenicillin and Gentamycin
If Staph IV Flycloxacillin and gentamicin

For both supportive care and consider surgery such as valve replacement

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2
Q

Which organism is the commonest cause of Community Aquired Pneumonia?

A

S. Pneumoniae

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3
Q

What are the symptoms of Pneumonia?

A 
Fever
Productive Cough
Pleuritic Chest Pain
SOB
Systemic Features such as hypotension
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4
Q

What are the clinical signs of pneumonia?

A

Abnormal Vital Signs - increased respiratory rate

Unilateral signs of consolidation (dull percussion, reduced air entry on auscultation, crackles, wheeze)

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5
Q

Which investigations should be performed when pneumonia is suspected?

A

Bloods - CRP, ABG to check for respiratory failure)
Chest Z Ray - Opacity/Consolidation of Affected Lobe
Sputum Sample and blood cultures

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6
Q

How do you assess severity of CAP? Why are they important?

A

CURB 65: Confusion, urea (>7mmol/L), RR (>30/min), BP (<90mmHg), ≧ Age 65
Mild: 0-1 (outpatient)
Moderate: 2 (hospital admission)
Severe: 3+ (hospital admission + ?ICU)

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7
Q

How is Community Acquired Pneumonia treated?

A

O2, analgesia (pleuritic pain), IV fluids

Mild: PO amoxicillin
Moderate: PO amoxicillin + clarithromycin
Severe: IV co-amoxiclav + clarithromycin

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8
Q

Give two complications of pneumonia.

A

Empyema

Lung Abscess

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9
Q

What is empyema?

A

Pleural empyema is a collection of pus in the pleural cavity caused by microorganisms, usually bacteria. Often it happens in the context of a pneumonia, injury, or chest surgery. It is one of various kinds of pleural effusion.

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10
Q

How is hospital acquired pneumonia defined?

A

Defined as new onset cough w/ purelent sputum,
acquired 2 days or more after admission,
CXR showing consolidation

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11
Q

What are the common causes of Hospital Acquired Pneumonia?

A

Same organisms as CAP (S. Pneumonia)

But also Staph Aureus (+ MRSA), Klebsiella Pneumoniae, Pseudomonas Aeruginosa

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12
Q

Which antibiotic might you use if someone has a pneumonia caused by MRSA? Why?

A

Vancomycin - It is Broad Spectrum

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13
Q

What is the diagnostic criteria for Infective Endocarditis? What is required for diagnosis?

A

Duke’s Criteria
Definite Infective Endocarditis: either 2 major and 1 minor criteria / 1 major and 3 minors / 5 minors
Possible IE: 1 major and 1 minor or 3 minors

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14
Q

What are the Dukes Criteria?

A

BE FEVEER
Major:
Blood Cultures Positive more than 12 hours apart
Evidence of Endocardial Involvement (ECHO)

Minor:
Fever
Echo
Evidence from Microbiology (positive blood cultures not meeting major criteria)
Evidence from immunology (Roths Spots, Oslers Nodes, Glomerulonephritis)
Risk Groups (prosthetic valve, IVDU, Valvular Disease)

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15
Q

How is a gram stain performed?

A 
Fixation
Crystal Violet
Iodine Treatment
Discolourisation
Counter Stain with Safranin
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16
Q

How are staphylococcus and streptococcus differentiated?

A

Staph - Clusters
Strep - Chains

Test to differentiate - Catalase Positive Staph, Catalase Neg Strep

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17
Q

How are the different streptococci differentiated?

A 
Haemolysis on Blood Agar:
Alpha Haemolytic (Greening around colonies)
Beta Haemolytic (Clearing around colonies)
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18
Q

What can be done after haemolysis to further differentiate streptococci?

A

If alpha - Optochin test - if sensitive S. Pneumoniae, if resistant S. Viridans

If Beta - Lancefield groups - for example A = S. Pyogenes

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19
Q

How are the different Staphylococci differentiated?

A

Coagulase Test - if positive S. Aureus, if negative commonly s. epidermidis

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20
Q

What are the two main groups of gram positive bacilli?

A

Aerobic (e.g. listeria monocytogenes) and Anaerobic (e.g. clostridium difficile)

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21
Q

Are Staphylococcus and Streptococcus gram positive or gram negative?

A

Gram Positive

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22
Q

What are examples of Gram Negative cocci?

A

Neisseria (N. Gonorrhoea, N. Miningitidis)

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23
Q

How do you differentiate between Gram Negative Bacilli?

A

MacConkey Plate
Lactose Fermenters (Pink): E. coli, Klebsiella Pneumoniae
Non Lactose Fermenters (Pale): Oxidase Test (If negative salmonella and shigella which are differentiated by XLD)

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24
Q

Which antibiotics are Beta lactams? What does this mean?

A

Beta Lactams inhibit cell wall synthesis:
Penicillins such as benzylpenicillin, flucloxacillin, amoxicillin
Cephalosporins such as cqphalexin, cefuroxime, ceftazimide
Carbapenems such as imipenem, ertapenem

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25
Q

Which antibiotic inhibits folate synthesis and therefore nucleic acid synthesis?

A

Trimethoprim

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26
Q

Which antibiotic inhibits DNA gyrase and therefore nucleic acid synthesis?

A

Fluroquinolones

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27
Q

Which antibiotic binds to RNA polymerase and is used to treat TB?

A

Rifampicin

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28
Q

Which antibiotic breaks the DNA strand?

A

Metronidazole

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29
Q

Which antibiotics inhibit protein synthesis?

A

Macrolides such as clarithromycin and erythromycin

Aminoglycosides such as gentamycin

30
Q

A patients sputum sample reveals a gram positive alpha haemolytic cocci, which is sensitive to optochin. What is the likely bacteria? Name a suitable antibiotic.

A

S. Pneumoniae

Amoxicillin

31
Q

When would a staphylococcus aureus be suspected instead of streptococcus pneumoniae in a patient with pneumonia?

A

If the patient has had an influenza viral infection

32
Q

How would you treat an E. coli or Klebsiella infection for Urinary Tract Infections?

A

Trimethoprim or Nitrofurantoin

33
Q

If a UTI spread upwards and a patient complained of a loin to groin pain, what pathology would you be most worried about?

A

Pyelonephritis

34
Q

Which antibiotic would you use to treat most cellulitis caused by s. progenies or s. aureus?

A

Flucloxacillin

35
Q

How would you treat suspected sepsis?

A

15L Oxygen
fluids
Broad Spectrum Antibiotics

36
Q

What are the symptoms of Sepsis?

A 
SEPSIS Pneumonic
Shivering, Fever or Very Cold
Extreme Pain or General Discomfort ("Worst ever")
Pale or Discoloured Skin
Sleepy, Difficult to Wake Up, Confused
"I Feel Like I Might Die"
Short of Breat
37
Q

A Patient presented with food poisoning and a stool sample shows a gram negative bacilli, which is non-lactose fermenting and negative to oxidase test. What is the causative organism? How is it treated?

A

Salmonella spp.

Supportive treatment
Encourage fluid oral intake
Anti-emetic (prochlorperazine)
Anti-diarrhoeals (loperamide)

38
Q

What is the incubation period for Salmonella spp. ? Main causes?

A

12-48 hours

Poultry and Eggs

39
Q

What is the incubation period for Campylobacter spp. ? Main causes?

A

24-72 hours

Meat Products

40
Q

What is the incubation period or Bacillus Cereus? Main cause?

A

1 - 6 Hours

Rice

41
Q

A patient is suspected to have infective endocarditis. Name some other findings on examination that would support this diagnosis.

A

Roth Spots
Splinter Haemorrhages
Osler’s Nodes
Janeways Lesions

42
Q

Which heart valve is most commonly affected in Intra-venous drug users with Infective Endocarditis?

A

Tricuspid Valve

43
Q

What are the predisposing factors to infective endocarditis?

A

Prosthetic Heart Valve
Recent Dental Work
IVDEU

44
Q

How is S. Viridans treated?

A

Amoxicillin and Gentamicin

45
Q

What antibiotics would you give somebody with suspected C. difficile?

A

Oral Vancomycin or Metronidazole

46
Q

What is the treatment for Tuberculosis? Name a side-effect for each drug.

A

Rifampicin - Stains urine pink/orange
Isoniazid - polyneuropathy
Pyrazinamide - arthralgia/gout
Ethambutol - optic neuritis

47
Q

Which stain would you use to determine the causative organism obtained from a sputum sample when diagnosing TB?

A

Ziehl-Neelson stain

48
Q

What is the causative organism of TB?

A

Mycobacterium Tuberculosis

49
Q

How would you treat Necrotising Fasciitis?

A

Surgical Debridement

Empirical Antibiotics: IV Benzylpenicillin and Clindamycin

50
Q

What are the common causes of Meningitis?

A

Neisseria Meningitides
Strep Pneumoniae
Group B Streptococcus

51
Q

How does meningitis present clinically?

A

Classic Triad
Headache
Stiff Neck and Photophobia
Fever

52
Q

How is Meningitis treated?

A

Start antibiotics immediately when suspected
Cefotaxime IV
If in community - IV Benzylpenicillin

53
Q

How does encephalitis present clinically?

A 
Confusion
Decreased Consciousness
Fever
Headache
Seizures
54
Q

What are the common causes of encephalitis?

A

Mostly viral - Herpes Simplex, Enteroviruses

55
Q

How is encephalitis treated?

A

IV Acyclovir

56
Q

How would you treat an upper urinary tract infection (loin to groin pain)?

A

Gentamicin and Cefuroxime, Co-amoxyclav

57
Q

Name some of the high risk groups for Tuberculosis.

A 
Immunocompromised
IVDU
Homeless
Alcoholics
Foreign Born and those with parents from High Risk Countries
Viral Hepatitis B/C
58
Q

What are the two types of TB (in terms of presentation) how are they treated differently?

A

Pulmonary and Extra-Pulmonary - Extra Pulmonary has to be treated for 12 months rather than 6

59
Q

What are the clinical features of Tuberculosis?

A

Weight Loss, Night Sweats, Malaise, Anorexia, Fever
Pulmonary TB: productive cough + haemoptysis
Lymph node TB: lymphadenopathy (non-tender)
CNS TB: symptoms of meningism, raised ICP (headache, vomiting, altered behaviour, altered consciousness)
Bone TB: osteomyelitis
Abdominal TB: ascites…
Miliary TB: due to spread of bacilli to multiple sites
Other extra-pulmonary forms of TB: pleural, skin, pericardial, GU…

60
Q

Which investigations should be performed when suspecting TB?

A

Chest X Ray

Microbiological Samples - sputum samples and biopsy - Ziehl Neelson staining

61
Q

What are the risk factors for septic arthritis?

A 
Prosthetic Joint (Rare in Native Joints()
Diabetes Mellitus
Immunosuppression
Elderly
Damaged Joints
62
Q

What are the causes of septic arthritis?

A

In Prosthetic Joints usually Gram positive Staphylococcus
In young and sexually active usually gonococcal
In children Staph Aureus

63
Q

Which investigations would you perform when you suspect septic arthritis?

A

Joint Aspirate and Culture

64
Q

How do you treat septic arthritis?

A

Aspirate for pain
IV Antibiotics guided by culture - long course
Surgical Joint Wahsout
Reduce Inflammation
Physiotherapy
Temporarily stop immunosuppressive drugs but double prednisolone to prevent adrenal crisis

65
Q

What must cellulitis be differentiated from before treatment?

A

Deep Vein Thrombosis

66
Q

How is cellulitis treated?

A

Penicillin V and Flucloxacillin

67
Q

Which conditions will see an increase in neutrophils? (6)

A

Bacterial Infections
Inflammation (eg MI, Polyarteritis nodosa)
Myeloproliferative Disorders
Drugs (Steroids)
Disseminated Malignancy
Stress (Surgery, trauma, burns, haemorrhage, seizure)

68
Q

Which conditions will see a decrease in neutrophils? (6)

A 
Viral Infections
Drugs: Post-chemotherapy, cytotoxic agents, carbimazole, sulfonamides
Severe Sepsis
Neutrophil Antibodies - SLE for example
Hyperslpenism
Bone Marrow Failure
69
Q

Which conditions will see an increase in lymphocytes? (3)

A

Acute Viral Infections
Chronic Infections (TB, Hepatitis, Syphilis)
Leukaemias and Lymphomas

70
Q

Which conditions will see an increase in eosinophils? (4)

A

Drug Reactions (eg with erythema multiforme)
Allergies: asthma, atopy
Parasitic Infections
Skin Disease

71
Q

When will you see an increase in monocytes? (4)

A

In the aftermath of chemo or radiotherapy
Chronic Infections (eg malaria, TB)
Malignant Disease
Myelodysplasia

72
Q

When will you see an increase in basophils?

A

IgE mediated hypersensitvity (Type 1)
Myeloproliferative disease
Viral Infections

Paddy Phase 2 Qs (15 decks)

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