Microbiology

Question 1

What is the best sample and test type for an asymptomatic female presenting for an STI screen?

Answer 1

Vulvovaginal swab for chlamydia/ gonococcal PCR

Bloods for HIV and syphilis

(PCR rather than culture as you can’t culture chlamydia and vulvovaginal over endocervical swab as it is less invasive and can be self taken)

Question 2

When would you do an endocervical swab over a vulvovaginal swab for STI testing?

Answer 2

If a smear was being done anyway

Question 3

Oral metronidazole is the treatment for which repro conditions?

Answer 3

Bacterial vaginosis

Trichomonas vaginalis

Question 4

Serotypes L1,2,3 of chlamydia trachomatis are associated with which condition?

Answer 4

Lymphogranuloma venereum infection in MSM

Question 5

Which repro condition is associated with clue cells on microscopy?

Answer 5

Bacterial vaginosis

Question 6

A test of cure is advised for all patients with which STI?

Answer 6

Neisseria gonorrhoea

This is because of the increase in antimicrobial resistance

Question 7

What is the first line treatment for neisseria gonorrhoea?

Answer 7

IM ceftriaxone

oral azithromycin was previously also used but has been removed because of issues of resistance

Question 8

What the heck are coliforms?

Most coliforms are sensitive to which antibiotic?

Answer 8

Coliforms are gram negative bacteria

Gentamicin is active against most gram negatives (coliforms)

Question 9

Amoxicillin, gentamicin and metronidazole are used for intra-abdominal sepsis.

Which antibiotics acts against which bacterias?

Answer 9

Amoxicillin acts against enterococci

Gentamicin acts against gram negatives (coliforms)

Metronidazole acts against anaerobes

Question 10

What is septic shock?

Answer 10

Sepsis which doesn’t respond to resuscitation

E.g BP which doesn’t come back up after IV fluids are given

Question 11

What side effect is gentamicin associated with?

Answer 11

Dizziness

Gentamicin causes ototoxicity

Question 12

Which type of meningitis should you be particularly aware of in healthy young people that present with bacterial meningitis?

Answer 12

Neisseria meningitides

Question 13

Steroids are given with or just before the first dose of antibiotics if they are indicated in a patient with bacterial meningitis. Why is this?

Answer 13

Steroids help to reduce the inflammation that is associated with the infection

Question 14

Listeria infection is associated with the consumption of which food types?

Answer 14

Dairy foods

Question 15

Why is ceftriaxone used as empirical treatment for suspected bacterial meningitis rather than penicillin?

Answer 15

Ceftriaxone has a longer half-life than penicillin

Question 16

What is ceftriaxone (BAD THING)

Answer 16

IT’S A 4C

WHY HAVEN’T YOU MEMORISED THESE YET

Question 17

When should a test of cure be done for chlamydia?

Answer 17

It’s not routine but should be done in pregnancy

Question 18

For which tests should a male patient give a first pass Vs a mid stream urine sample?

Answer 18

First pass urine sample for gonococcal/ chlamydia PCR

Mid stream sample for UTI testing

Question 19

When should a patient be tested for herpes? How is this done?

Answer 19

The patient can only be tested when symptoms appear (give them a leaflet about the symptoms in the meantime)

Tested by taking swabs of the de-roofed blisters for PCR

Taking bloods for antibodies can be done to identify if the patient has ever been infected in the past

Question 20

A NEWS score of what indicates sepsis in a patient with an infection?

Answer 20

5+

Question 21

Coliforms are not generally contaminants, so if they are found in blood it is a sign of infection and they should be treated before waiting for the test results…

Answer 21

True

Question 22

Gentamicin should only be given for 3 days, after this it should be substituted for which drug?

Answer 22

Aztreonam

Question 23

What is the step-down option for patients being treated for intra-abdominal sepsis with metronidazole, gentamicin and amoxicillin?

Answer 23

Co-trimoxazole

Question 24

What is the advice for female patients who have had 3+ UTIs in 12 months?

Answer 24

Keep hydrated

Consume cranberry products

Postcoital voiding (pee after sex)

May need antibiotics (e.g trimethoprim taken within 2 hours of intercourse)

Question 25

If a patient presents with a history which is suggestive of bacterial meningitis but the results look clear/ viral, what should you be thinking?

Answer 25

Consider partially treated bacterial meningitis if they have already been given antibiotics

Usually neutrophils are high in bacterial meningitis and lymphocytes in viral, bit high lymphocytes are also classic of partially treated bacterial meningitis

Question 26

When should the healthcare protection team be notified in cases of suspected meningitis?

Answer 26

Need to inform them within 24 hours of patient admission

Don’t need to wait for test confirmations