Microbiology

Question 1

Which is the best specimen to send
to the Microbiology Lab to screen for sexually transmitted infections in a 20 year old asymptomatic female who attends her GP Practice?

Answer 1

A vulvovaginal swab for chlamydia/gonococcal PCR

Endocervical swabs are done during a pelvic exam and not really done otherwise

Question 2

Metronidazole is the treatment of choice for which of infections?`

Answer 2

Bacterial vaginosis

Trichomons vaginalis

Question 3

What are the L1-L3 serotypes associated with in chlamydia infection?

Answer 3

Lymphogranuloma Venereum infection in MSM

Question 4

Which genital infection is indicated by the presence of “Clue cells” on microscopy?

Answer 4

Bacterial vaginosis

Question 5

The increase in antimicrobial resistance for patients with gonorrhoea has resulted in what change of management?

Answer 5

Test of cure for all patients at 2 weeks

Question 6

What is the current recommended treatment for Neisseria gonorrhoeae infection?

Answer 6

IM ceftriaxone

Question 7

Most coliforms are sensitive to which antibiotic?

Answer 7

Gentamicin

Question 8

What type of organism is a coliform?

Answer 8

Gram negative bacilli

Question 9

Enteroccoci are sensitive to which antibiotic?

Answer 9

Amoxicillin

Question 10

Gram negative anaerobes are sensitive to which antibiotic?

Answer 10

Metronidazole

Question 11

What is the recommended empirical antibiotic treatment for a patient with suspected intra-abdominal sepsis who has normal renal function and is NOT hypersensitive to penicillin?

Answer 11

Amoxicillin
Metronidazole
Gentamicin

Question 12

What is the recommended empirical antibiotic treatment for a patient with suspected intra-abdominal sepsis who has normal renal function and IS hypersensitive to penicillin?

Answer 12

Co-trimoxazole
Metronidazole
Gentamicin

Question 13

Define what is meant by septic shock

Answer 13

Low blood pressure that does not come back up when IV fluids are given

Question 14

What is a well recognised side effect of gentamicin?

Answer 14

Dizziness

Question 15

Which is the MOST likely cause of bacterial meningitis in a previously healthy young adult in the UK?

Answer 15

Neisseria meningitidis

Healthy young person just gone into halls as a fresher with non-blanching maculopapular rash

Question 16

What should be given with or just before the first dose of antibiotics if they are indicated in a patient with bacterial meningitis? Why?

Answer 16

Steroids (dexamethasone)

help reduce the morbidity associated with inflammation.

Question 17

Listeria is associated with the consumption of which foodstuff?

Answer 17

Soft cheese

Question 18

Why is ceftriaxone chosen for empirical treatment for suspected bacterial meningitis instead of penicillin?

Answer 18

Ceftriaxone has a longer half-life than penicillin

The longer half-life means patients can be treated with twice daily dosing

Question 19

What should be done if a patient does not want to tell their partner they have been infected?

Answer 19

Advise to tell him to get treated on the first instance

Next step would be referral to sexual services

Question 20

How long should you advise someone with an STI to abstain from sex?

Answer 20

Abstain for one week after both have been treated

Question 21

Chlamydia can remain in the system indefinitely in an asymptomatic state. True/False?

Answer 21

True

This can be the reason why a person with a long term partner can test positively for infection

Question 22

A test of cure is required for patients after treatment of chlamydia. True/ False?

Answer 22

False

Question 23

What type of urine sample is used to test for STI’s in men?

Answer 23

First pass urine for GC/CT PCR

Question 24

What type of urine sample is used to test for a UTI?

Answer 24

Mid-stream urine sample

Question 25

HSV should be tested for in a routine STI screen in a patient who is asymptomatic for this virus. True/False?

Answer 25

False HSV should only be tested for in a symptomatic patient with active infection. Leaflets should be given advising the patient of symptoms.

Question 26

What is the SIRS criteria for sepsis?

Answer 26

Temp <36 or >38 Respiratory rate >20 Pulse >90bpm WCC >12,000 or <4,000

Question 27

What is classed as severe sepsis?

Answer 27

Sepsis + organ dysfunction

Question 28

How is septic shock differentiated from sepsis?

Answer 28

Septic shock is sepsis + hypotension

Question 29

List the parts of the Sepsis 6 bundle?

Answer 29

``` Administer oxygen Take blood cultures Give IV antibiotics Give IV fluids Check serum lactate Measure urine output ```

Question 30

List antibiotics that are at risk causing a C. difficile infection

Answer 30

Co-amoxiclav Cephalosporins Clindomycin Ciprofloxacin

Question 31

List advice to give to a patient with recurrent UTI

Answer 31

Encourage better hydration (1.6l/day) Encourage post-coital urination Advise trying cranberry juice or supplements

Question 32

What is the first line treatment for bacterial meningitis?

Answer 32

Ceftriaxone IV Dexamethasone IV Amoxicillin IV for listeria cover

Question 33

What is the first line treatment for encephalitis?

Answer 33

Aciclovir IV

Question 34

What is characteristic of partially treated bacterial meningitis?

Answer 34

High lymphocytes