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Microbiology Flashcards

1
Q

What lesion do you see in TB?

A

Caseating granuloma

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2
Q

When TB multiples at pleural surface and involves lymph nodes

A

Ghon focus

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3
Q

When TB goes systematic?

A

Miliary TB - haematogenous spread

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4
Q

Ix for TB

A 
CXR - upper lobe cavitation
Sputum culture - bronchoaveolar lavage if needed 
PCR/NAAT on sputum culture 
Mantoux test 
Acid fast bacilli with Ziehl-Neelsen
IGRA
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5
Q

What are the features of TB meningitis?

A 
Weight loss
Fever 
Night sweats 
Headache 
Stiff neck 
Photophobia 
Low GCS 
Focal neurological deficit
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6
Q

How to diagnose TB meningitis?

A

CT

LP

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7
Q

Tx of TB meningitis

A

12 months anti-TB medication and steriods

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8
Q

Manifestation of spinal TB

A

All the TB symptoms and back pain
Discitis leads to vertebral destruction + collapse
Iliopsoas abscess

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9
Q

Ix of spinal TB + Tx

A

MRI/CT + biopsy/aspirate + one year anti-TB tx

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10
Q

What kind of vaccine is the BCG?

A

Attenuated

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11
Q

What kind of strain does the BCG use?

A

M.bovis

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12
Q

Who cant have the BCG vaccine?

A

HIV patients

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13
Q

What causes leprosy?

A

M.leprae + M.lepromatosis

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14
Q

Manifestations of leprosy?

A

Skin : depigmentation that lacks sensation, macules, nodules, ulcers
Neuro: thickened nerves causing neuropathy
Eyes: iridocyclitis, keratitis
Bone: periositis aseptic necrosis

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15
Q

Types of leprosy

A

Paucibacillary –> Multibacillary

TT - tuberculoid
BT - borderline tuberculoid
BB - borderline 
BT - borderline lepromatous 
Lepromatous BT
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16
Q

Tx of leprosy

A

Rifampicin, dapsone, clofazimine

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17
Q

Tx of TB

A

Initiation phase: 8 weeks

  • Rifampicin - hepatoxiticy and drug interactions
  • Isoniazid - hepatoxicity + peripheral neuropathy
  • Ethambutol - optic neuritis and visual disturbances
  • Pyrazinamide - dont give to gout patients. hepatoxicity
  • Pyrodixone (B6) - give to pregnant, alcoholics, HIV+, neuropathy patients

Continuation phase: 16 weeks

  • Rifampicin
  • Isoniazid
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18
Q

Tx of latent TB

A

6 months of isoniazid

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19
Q

Tx of resistant TB

A

mono - one drug only
MDRTB - RIF + INA
XDRTB - RIF + INA + injectables (amikacine) + quinolones

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20
Q

CURB65

A 
Confusion 
Urea > 7 
Resp rate >30 
BP <90
65 - age +

Score more than 2+ = hospitalisation, more than 3+ = severe pneumonia

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21
Q

Types of pneumonia

A

CAP + HAP
Bronchopneumoniae
Lobar
Atypical - usually in the interstium so outside the alveoli

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22
Q

Red hepatisation

A

Liver-like appearance of the lung tissue due to exudate filling the air spaces. Day 3-5

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23
Q

Gray hepatisation

A

Happens after red hepatisation when the RBC in the exudate start to break down. Day 5-7

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24
Q

Reticular CXR ?

A

Atypical pneumonia

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25
Organisms associated with pneumoniae
Typical: ``` Strep pneumoniae + Staph aureus + H. influenzae - K. pneumonia - M. catarrhalis - ``` Atypical: look for extrapulmonary features and weird CXR or no signs ``` Klebsiella Mycoplasma pneumonia Legionella pneumophilia Chlamydia pneumonia Chlamydia psittaci Bordatella pertussis TB ```
26
Legionella pneumophilia
Airconditioning, water towers, hepatitis, hyponatremia
27
Mycoplasma pneumonia
``` THINK COLD AGGLUTININ TEST JOINT PAIN SJS Erythema multiforme Systemic symptoms ```
28
Chlamydia psittaci
Birds
29
Strep pneumonia
Lobar pneumoniae | Rusty-coloured sputum
30
H.Influenzae
COPD and smokers
31
M.Catarrhalis
Smokers
32
S.Aureus
Think recent viral infection
33
K.pneumonia
Alcoholics Old people Haemoptysis
34
ok bmt, what is the treatment for CAP? (mild)
outpatient amoxicillin | If allergic/2nd line - erythomycin (macrolide)
35
Supportive care for pneumonia
O2 therapy (careful COPD patients - aim for 92%) IV fluids OBs
36
Tx for CAP (moderate)
Amoxicillin + Erthyromycin/clarithyromycin
37
Tx for atypical pneumonia
Macrolide/Tetracyline AKA - clarithomycin + doxycycline (?)
38
Tx for HAP ?
Cipro + vancomycin
39
Tx for aspiration pneumonia
Cefuroxime + metro
40
Tx for s.aureus
Flucloxacillin
41
Tx for legionella pneumonia
Macrolide + rifampicin
42
Tx for MRSA pneumonia
Vancomycin
43
Tx for pseudomonas spp
Cipro + gentamicin
44
Reid index in chronic bronchitis
>40%
45
Blue bloaters
Chronic bronchitis
46
What infections are patients with chronic bronchitis at risk of?
Chest: - Viral - Strep pneumonia - M. Cattahalis - H. influenzae
47
What kind of pneumonia would HIV patients get?
P. Jiroveci TB Cryptococcus neoformans
48
What kind of risk do patients with splenectomy
Encapsulated organisms: - H.influenzae - N.meningitiditis - S.pneumonia
49
Which organism do cystic fibrosis patients get?
Pseudomonas aeruginosa
50
Which organism can cause bone marrow suppression?
Aspergillus + CMV
51
Tx of bronchitis
Bronchodilators Physiotherapy Antibiotics if secondary infection as well
52
Types of fungal infections
Superficial vs deep | Yeast vs mould
53
How to diagnose superficial fungal infection
wood's lamp
54
Types of superficial fungal infection
Tinea - athletes foot, ringworm | Pityriasis - seborrhoeic dermatitis, t.vesicolour (weird depigmentation)
55
Types of deep fungal infections
Candida - esp immunocompromised Aspergillus - allergy, pneumonia in immunocompromised Cryptococcus - immunocompromised (meningitis)
56
How to diagnose deep candida infection?
Culture, antibodies, mannan
57
How to diagnose deep aspergillus infection ?
ELISA, PCR, beta-glucan test
58
How to diagnose deep crytococcus infection?
Crytococcal antigen in serum/CSF
59
How do you treat cryptococcus meningitis?
Amphotericin B
60
Which antifungal target cell membrane synthesis
Fluconazole
61
Which antifungal targets cell membrane integrity
Amphotericin
62
Which antifungal targets DNA synthesis
Flucytosine
63
Which antifungal targets cell wall
Caspofungin
64
What causes clostridium botulinum?
Canned/vacuum packed food esp honey and beans
65
How does clostridium botulinum affect the body? (Anaeorbic)
Blocks Ach release from peripheral nerves | Leads to descending paralysis (opposite of GBS)
66
What causes clostridium perfringens? (Anaerobic)
Reheated meat, super antigen enterotoxin Leads to massive cytokine production by CD4 Acts on small bowel - think watery diarrhoea + cramps. Lasts 24 hours
67
What causes clostridium difficile? (Anaerobic)
``` 2 exotoxins (A,B) Results in pseudomembranous colitis CAUSED BY ABX - meeeeeee ciproooo ```
68
Virulence factors in s.aureus
Protein A Catalase Coagulase +ve
69
Symptoms of s.aureus (aerobic) GI infection?
Persistent vomting and diarrohea. No blood
70
What would you see on the blood agar - s.aureus?
Beta haemolytic
71
Different types of E.Coli infections?
EPEC - infantile diarrhoea (Paeds) EHEC - haemorrhagic ETEC - Toxigenic, Traveller's diarrhoea. Acts on jejeunum, heat labile LT, ST? EIEC - Invasive dystentry HUS - anaemia, thrombocytopenia and renal failure (0157:H7 toxin)
72
How to treat e.coli GI infections?
Self-limiting or use ciproflaxcilin
73
How to treat Clostridia (perfrigens, difficile, botulinum)
Antitoxin. Metro/vanc for difficile - PO
74
How to treat s.aureus GI infections?
Self-limiting
75
Different types of salmonella?
Typhi Paratyphi - Multiples in the peyers patches - Slow onset fever + constipation with bradycardia - Splenomegaly - Rose spots - Anaemia - Leukopenia
76
Tx of salmonella
Cipro or Ceftriaxone
77
Where does shigella attack?
Distal ileum and colon causing mucousal inflammation
78
Symptoms of shigella?
Bloody diarrhoea Fever Pain Caused by the shigella enterotoxin
79
da fuck is Yersinia entercolitis
Animals shitting in food or something So bad - you get reactive arthritis, erythema nodosum, mesentric adenitis, enterocolitis, necrotising granulomas. Likes a cold environment 4 degrees
80
How do you tx shigella?
Avoid antibiotics. Use cipro if you have to
81
What is the mechanism in cholera?
increased cAMP opens Cl- channel at apical membrane of enterocytes --> efflux of Cl- to lumen. Lose a lot of water and electrolytes
82
Why would me and yaz have 3 day hx of diarrhoea in japan?
parahaemolyticus and you get it from undercooked seafood
83
Tx of vibrio 1parahaemolyticus
Doxycycline
84
Tx of vibrio cholera
supportive
85
What is vibrio vulnificus?
cellulitis in peeps that handle shellfish handlers | Fatal septiciaemia with D+V in HIV patients
86
What causes campylobacter jejuni?
drinking unpastuerised milk, food | First you get headache, fever and the you get the tummy pain and foul, bloody diarrhoea
87
How do you treat campylobacter jejuni?
Erythomycin
88
Symptoms of listeria
Watery diarrhoea, fever but little vomiting | Neonates and immunocompromised at risk
89
Tx of listeria
Ceftriaxone
90
Who gets Entamoeba histolytica
gay dudes Its a motile trophozoite in diarrhoea
91
Symptoms of entamoeba histolytica
Tenesmus, wind, dysentery, weight loss, RUQ due to liver abscess
92
Dx of entamoeba histolytica
Stool microscopy and histology shows flask shaped ulcer on histology
93
Who gets Giardia lamblia
Mental hospital patients, MSM, travellers
94
Symptoms of Giardia lamblia
you get malabsorption of proteins + fats so you get foul smelling non-bloody diarrhoea
95
Dx of Giardia lamblia
ELISA string test
96
Tx of both Giardia lamblia and entamoeba histolytica
Metro
97
What are the viral causes of secretory diarhorrea
``` Rotavirus - kids under 6 years Adenovirus - non bloody diarrhoea. Think kids under 2 years Norovirus Enterovirus Poliovirus ```
98
Good way to remember what triggers clostridium difficile diarrhoea
3Cs : cipro, clindamycin, cephalosporins
99
when can we say someone has pyrexia of unknown origin?
More than 3 weeks and over 38.3 degrees without a diagnosis despite intensive investigations
100
Classic PUO - what causes it
Mneumonic : Infections can make undergraduates die ``` Infection - TB, EBV, abscess Connective tissue disorder - SLE, RA Malignancy Undiagnosed - Drugs - phenytoin (rare) ```
101
Nosocomial PUO
Happens in patients after 24 hours in hospital ``` Surgery Drugs - vanc, serotonergics Medical devices - lV line, catheter C.diff Immobilisation LRTI - esp ventilator-associated in ITU ```
102
Neutropenic PUO (less than 500)
MEDICAL EMERGENCY Look for: - Chemotherapy - Haematological malignancies - GVHD - Fungal and bacterial sepsis - Mycobacteria
103
HIV associated PUO
``` Seroconversion TB Kaposi sarcoma CMV PCP Lymphoma Drug fever Cryptococcus ```
104
Ix PUO
Rule out foreign travel Vasculitis screen : pANCA, cANCA, Rho, La Urine dip Bence-jones proteins/protein electrophoresis Familial diseases: cyclic neutropenia, fabry's disease
105
What causes fever in a returning traveller?
``` Dengue Typhoid Malaria HIV seroconversion Viral haemorrhagic fever (ebola) Brucella ```
106
Different types of malaria species
P. Falciparum - most common and most severe P. Vivax P. Ovale P. Malariae
107
Duffy antigen
P. Vivax. Reason for SCD immunity cos they lack this receptor
108
Which malaria species goes dormant? (hypnozites)
P.Ovale + P.Vivax
109
What do you see under the microscope in early P.Falciparum erythocytic phase?
Young trophozites (ring form)
110
Schizonts
P.Falciparum (seen in the later stage) - brown smudge
111
Quartan fevers (every 72 hours)
P.Malariae
112
Tertain fevers (every 48 hours)
P.falciparum, p.ovale, p.vivax
113
Ischaemic damage in malaria
P.falciparum (organ failure - sticky so adheres and blocks vessels 'knobs')
114
Complications of malaria
``` Cerebral malaria - seizures, coma etc Bilous malaria - involving the liver causing jaundice Spleen infarction Anaemia Shock Pulmonary oedema Acidosis Renal impairment Hypoglycaemia ```
115
Ix of malaria
``` Thick blood film - to find parasites Thin blood film - to identify the species LFTs Plt count - low Normocytic normochromic anaemia - low Hb ```
116
Tx of malaria
P. falciparum - quinine (mild) for 7 days then doxycycline P. Vivax and P.ovale - chloroquine and then primaquine
117
Symptoms of malaria
``` Fever Splenomegaly Anaemia Vomiting Rigors Myalgia Jaundice ```
118
Prion protein gene - which chromosome?
Chr20
119
Pathology of prion disease
PrP --> PrP^sc | Accumulation of misfolded proteins
120
Delaying prion disease
Tetracycline Pentosan Quinacrine
121
symptomatic relief of prion disease
clonazepan for myoclonus
122
Different types of CJD
Sporadic Variant Iatrogenic Inherited prion disease
123
Sporadic CJD
``` PRNP mutation (129 codon) EEG - periodic triphasic changes Raised CSF 14-3- protein +ve ```
124
14-3-3 protein
Helps with apoptosis of neurones esp in prion disease
125
Variant CJD
From eating infected cows | Diagnosed from tonsillar biopsy
126
Pulvinar sign
Posterior thalamus highlighted on MRI-T2
127
Symptoms of sporadic CJD
Rapid, progressive dementia with myoclonus, lower motor neuron signs, akinetic mutism
128
Symptoms of variant CJD
Pyschiatric symptoms and then neuro symptoms then dementia
129
Gerstmann-Straussler-Scheinker syndrome
Autosomal dominant | Dysarthia progressing to cerebellar ataxia ending in dementia
130
Fatal familial insomnia
Autosomal dominant Insomnia, paranoia progressing to hallucinations and weight loss Mute period Death 8 weeks post symptoms
131
Brucellosis - gram stain and how do you get it
Gram -ve | From eating/drinking untreated dairy products
132
Symptoms of Brucellosis
``` Undulant fever malaise rigors sweating myaliga fatigue ```
133
Ix of brucellosis
High Anti-O-polysaccharide antibody WCC normal Neutropenia
134
Tx of brucellosis
4-6 wks of tetracycle + streptomycin
135
Negri bodies
Pathognomonic for Rabies
136
What cauases plague?
Yersinia pestis | Gram -ve
137
Tx of plague
Streptomycin Doxycycline Gentamicin Chloramphenicol (meningitis)
138
Leptospirosis- how do you get it?
Swimming in water with dog/rat piss | Gram -ve, L.interrogans
139
Anthrax- how do you get it?
Farm animals | Gram -ve Bacillus anthracis
140
What does Anthrax look like?
Painless round black lesion + rim of oedema
141
Lyme disease? - causes
Borrelia Burgdoferi via ticks
142
Lyme disease - dx
Biopsy edge of ECM + ELISA for lyme abs
143
Tx of lyme disease
Doxy 2 wks
144
What does Q fever look like?
Atypical pneumonia
145
What organism causes Q fever?
Coxiella burnetii
146
What animal causes Q fever
Cattle
147
What do you give in Influenza A?
Amantadine (targets M2 ion channel)
148
Up to when can you give antivirals for influenza?
48 hours Oseltamivir Zanamivir
149
Antigenic drift
mutuations occur to NA/HA to give new strains of influenza virus
150
Antigenic shift
Complete change of HA/NA so that strains can infect humans or animals when it couldnt before
151
How does acyclovir (guanosine analogue) work
Blocks viral DNA replication via activation by viral thymidine kinase
152
Why doesnt acyclovir work in CMV?
CMV doesnt have thymidine kinase so acyclovir wont work
153
What do you give in CMV?
Ganciclovir
154
Side effects of Ganciclovir?
Bone marrow suppression
155
What does CMV infection do?
``` Retinitis Colitis Hepatitis Encephalitis Pneumonitis ```
156
Owl eye inclusions
CMV cells
157
Used in prophylaxis post organ transplant and resistant CMV
Foscarnet (nephrotoxic)
158
Used in CMV retinitis
Cidofovir (nephrotoxic)
159
when do you treat varicella zoser virus?
Pregnant women Immunocompromised Adults with pneumonitis
160
Tx of Hep B
Interferon alpha 2a - upregulates MHC expression and direct antiviral effect Lamivudine and entecavir - inhibits viral polymerase Tenefovir - inhibits reverse transcriptase
161
Tx of Hep C
Interferon alpha 2a/2b + Ribavirin
162
SE of ribavirin
Haemolytic anaemia
163
Treatment is more successful in which HCV genotype?
2 + 3
164
What else can you use ribavirin for apart from HCV?
RSV and parainfluenza infection
165
3 origiins of opportunisitic viral infections post transplant?
Reactivation of latent infection : herpes Graft brought infection with it: Hep B Post transplant oppurtunistic infection: measles etc
166
Where do EBV and CMV remain dormant?
Leucocytes
167
What is post-transplant lymphoproliferative disease?
EBV infection causes loss of control over latently infected b-cells
168
How do you treat post-transplant lymphoproliferative disease
Reduce immune suppression + rituximab (anti-CD20)
169
What virus causes kaposi sarcoma?
HHV 8
170
What does a biopsy of kaposi sarcoma show?
Spindle cells and KSHV proteins
171
Complications of measles
Giant cell pneumonia and encephalitis
172
Ix of septic arthritis
Blood cultures before Abx Joint aspiration Inflammatory markers
173
Abx for septic arthritis
Flucloxacillin - s.aureus IV Can also be caused by strep. pneumoniae
174
Tx of pyelonephritis
IV co-amoxiclav
175
Inhibits cell wall synthesis
B-lactams - pencillin, ceph | Glycopeptides - vancomycin
176
inhibits protein synthesis abx
``` Macrolides - erythromycin (gram +ve) Aminoglycoside - gentamicin (gram -ve) Tetracyclines - doxy (dont give to pregger or kids) Chloramphenicol Oxazolidinones - linezoid (gram +ve) ```
177
Inhibits DNA synthesis
Fluoroquinolones - cipro (gram -ve) | Nitroimidazoles - metro (anaerobes)
178
Inhibit RNA synthesis
Rifampicin
179
Inhibit folate metabolism
Trimethoprim | Sulphamethoxazole (PCP)
180
Broad spectrum Abx
Cipro, co-amoxiclav, tazocin and meropenem
181
Narrow spectrum
Metro, Gent, fluclox.
182
Septic screen in neonatal sepsis
FBC, CRP, CSF, swabs, blood culture, CXR
183
When is early onset neonatal sepsis?
Before 48 hours after birth
184
Symptoms of late onset sepsis
poor feeding, irritability, resp distress, acidosis, bradycardia, jaundice, focal inflammation (umbilicus), convulsions,
185
Causes of late onset sepsis
Coagulase negative staph, listeria, GBS and ecoli
186
Dx of late onset sepsis
Septic screen: FBC, CRP, Swabs, CXR, CSF, blood culture | Urine dip
187
Abx for late onset sepsis
BenPen + Gent - 1ST LINE | Tazocin + vanco - 2nd line
188
Causes of meningitis - kids
Less than 3 months: GBS, ecoli, listeria, h.influenzae More than 3 months: neisseria menigitidis Less than 2 years : strep pneumonia
189
What would you see in CSF of someone with bacterial meningitis?
High protein, high WCC and low glucose
190
Tx of bacterial meningitis
Ceft and steriods | + Amoxicilin for listeria cover
191
When is CSF normal?
Viral encephaltitis - herpes | Cerebral abscess
192
How do you treat meningoencephalitis
Acyclovir and ceft.
193
Painful ulcers
Herpes > chancroid
194
Painless ulcers
Syphilis> LGV
195
Tx of gonorrhoea (SINGLE DOSE)
Ceft 250mg IM | Cefixime 400mg PO
196
Tx of chlamydia
Doxycycline - 100mg BD 7/7 | or azithromycin 1g single dose
197
Rectal symptoms
Think LGV - chlamydia trachomatis, serovars L1,2,3
198
Tx of LGV
Same as chlamydia | Doxy 1 wk 100mg BD
199
Dx of syphilis
Non-treponemal tests: VDRL and RPR | Treponemal tests: Enzymes immunoassay
200
Argyll-Roberston pupil
Syphillis | Prostititue pupil - accomodates but doesnt react
201
Tx of syphillis
single dose Benzathine Pencillin
202
Jarisch-Heimer reaction
Seen 4 hours post abx administration with fever, headache, myalgia and sometimes worsening of the syphillis symptoms
203
Chancroid organism?
``` Haemophilus ducreyi (-) Painful ```
204
Donovanosis
Klebsiella granulomatis
205
Dx of donovanosis
Giemsa stain of biopsy - donovan bodies
206
Organism - molluscum contagiosum?
Pox virus
207
Which HPV causes genital warts?
HPV 6 + 11 - podophyllotoxin cream (not suitable for pregnant women)
208
Neonatal Herpes
Risk more at 3rd trimester and during delivery
209
Tzanck cells
VZV cytology
210
Paul bunnel/monospot - heterophil Abs
CMV
211
Rose spots
Typhoid
212
Tx of typhoid fever
Cipro
213
Live vaccine
MMR VZV Yellow fever
214
Inactivated vaccine
Rabies | Hep A
215
Recombinant proteins vaccine
HBV
216
Subunit vaccine
Influenza | Typhoid
217
Conjugate vaccine
Meningitis C

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