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MRCOG - Part 1 > Microbiology > Flashcards

Microbiology Flashcards

1
Q

What are the consequences of toxoplasmosis in pregnancy?

A

1) Microcephaly
2) Hydrocephalus
3) Cerebral calcifications
4) Cerebral palsy
5) Epilepsy
6) Choroidoretinitis
7) Thrombocytopenia.

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2
Q

When are fetal consequences most severe in toxoplasmosis?

A

If transmission occurs in first 10 weeks

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3
Q

When is there the greatest risk of transmission?

A

Further into the pregnancy, however although the transmission rate increases, the severity decreases with greater gestation

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4
Q

What does HBsAG show?

A

Acute infection

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5
Q

What does HBeAG show?

A

Viral replication, and therefore high infectivity

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6
Q

Anti-HBc shows what?

A

Previous or ongoing infection

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7
Q

Anti-HbsAb shows what?

A

Either vaccination or immunity following previous infection

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8
Q

What is the most common congenital infection?

A

CMV

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9
Q

What proportion of children with congenital CMV infection are a) symptomatic at birth? b) symptomatic in later life?

A

a) 10-15%

b) 10-15%

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10
Q

What infection causes strawberry cervix?

A

TV

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11
Q

What is the drug combination used in TB?

A

Rifampicin + Isoniazid + Pyrazinamide + Ethambutol

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12
Q

What are the S/Es of rifampicin?

A

Orange urine and tears

Hepatotoxicity

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13
Q

What are the S/Es of isoniazid?

A

Hepatotoxicity

Peripheral neuropathy

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14
Q

What are the S/Es of pyrazinamide?

A

Hepatotoxicity

Gout

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15
Q

What are the S/Es of ethambutol?

A

Optic neuritis

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16
Q

What are the polymicrobial causes of endometritis?

A

Ureaplasma
Gardnerella
Group B Strep

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17
Q

What are the alpha haemolytic streps?

A

Strep pneumonia

Strep viridans

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18
Q

Which type of bacteria produce endotoxins?

A

Gram -ve ONLY. Only gram -ve can produce endotoxins, whilst both gram +ve and gram -ve bacteria can produce exotoxins

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19
Q

What is CMV caused by?

A

Human herpes virus 5

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20
Q

What are the gram +ve bacilli?

A

Listerias
Clostridiums
Actinomyces’
Mycobacteriums

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21
Q

What are the gram +ve cocci?

A

Staphylococcus’
Streptococcus’
Enterococcus’

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22
Q

What are the gram -ve bacilli?

A 
Escherichias
Enterobacters
Klebsiellas
Salmonellas
Shigellas
Campylobacters
Legionellas
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23
Q

What are the gram -ve cocci?

A

Neisserias

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24
Q

Which bacteria is associated with sulphur granules on coils?

A

Actinomyces israelis

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25
Q

What does the gardasil vaccine consist of?

A

HPV 6/11/16/18

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26
Q

What proportion of HPV-related cancer is caused by 16 and 18?

A

70%

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27
Q

What type of vaccine is gardasil?

A

Vaccine of virus-like particles (VLPs)

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28
Q

What oncoproteins are associated with HPV?

A

E6 and E7

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29
Q

What tumour suppressor protein is inactivated by E6?

A

p53

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30
Q

What tumour suppressor protein is inactivated by E7?

A

pRB

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31
Q

What are the ssRNA viruses?

A

Hep A/C/D/E
Rubella
HIV

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32
Q

What are the dsRNA viruses?

A

Rotavirus

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33
Q

What are the ssDNA viruses?

A

Parvovirus B19

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34
Q

What are the dsDNA viruses?

A 
Hep B
CMV
HSV
HPV
EBV
VZV
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35
Q

What is group A beta haemolytic bacteria?

A

Streptococcus pyogenes

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36
Q

What is a group B beta haemolytic bacteria?

A

Streptococcus agalactia

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37
Q

What is a group C beta haemolytic bacteria?

A

Streptococcis dysgalactiae

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38
Q

What is a group D beta haemolytic bacteria?

A

Re-classified as enterococcus

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39
Q

What is a group F beta haemolytic bacteria?

A

Streptococcus anginosus

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40
Q

What is a group G beta haemolytic bacteria?

A

No specific name - just group G streptococcus

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41
Q

What does group G streptococcus cause?

A

Toxic shock
Necrotising fasciitis
Vaginitis

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42
Q

What does Streptococcus anginosus cause?

A

Liver abscess

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43
Q

What does enterococcus cause?

A

Colitis

Endocarditis

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44
Q

What does Streptococcis dysgalactiae cause?

A

Pharyngitis
Endocarditis
Toxic shock
Necrotising fasciitis

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45
Q

What does Streptococcus agalactia cause?

A

GBS disease of the newborn
Chorioamnioitis
Endometritis

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46
Q

What does Streptococcus pyogenes?

A 
Scarlet fever
Rheumatic fever
Tonsilitis/pharyngitis
Toxic shock
Necrotising fasciitis
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47
Q

What is the most common causative organism of cellulitis?

A

Streptococcus pyogenes

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48
Q

What is the most common causative organism of skin/superficial wound/SSI?

A

Staphylococcus aureus

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49
Q

What are the treatments for anogenital warts?

A

1) Podophylline paint
2) 5-FU
3) Trichloracetic acid
4) Liquid nitrogen cryotherapy
5) Imiquimod 5% cream
6) LASER

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50
Q

What are the treatments for anogenital warts not suitable in pregnancy?

A

Podophylline paint and 5-FU

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51
Q

What is the cause of gas gangrene?

A

Clostridia perfringens

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52
Q

How is toxoplasmosis treated?

A

Spiromycin

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53
Q

How is toxoplasmosis diagnosed?

A

PCR/immunoglobulins, or ring-enhancing lesions on MRI/CT

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54
Q

When are Abx not needed in a GBS +ve pregnancy?

A

In a planned elective section, in the absence of labour where the membranes are intact

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55
Q

What is the FVS risk in the first 12 weeks of gestation?

A

0.4%

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56
Q

What is the FVS risk in weeks 13-20/40?

A

2%

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57
Q

What are the consequences of FVS?

A

1) hypoplasia of 1 limb
2) CNS abnormalities
2) Eye abnormalities

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58
Q

What is the incidence of listeriosis in pregnancy?

A

12/100,00. It is 20x more likely in pregnancy

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59
Q

How is listeria treated?

A

2-3/52 amoxicillin

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60
Q

What does listeriosis in pregnancy cause?

A

1) Chorioamnionitis
2) Placental necrosis
3) Granuloma formation

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61
Q

What is the fetal mortality of listeria?

A

20-30%

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62
Q

What infection is blueberry muffin rash associated with?

A

Congenital rubella syndrome

63
Q

What is the HIV testing regime of formula fed infants?

A

During hospital admission
2 weeks post cessation of prophylaxis (age 6 weeks)
2 months post cessation (age 12 weeks)
HIV Ab testing for seroreversion at 18 months

64
Q

When should children breast-fed by HIV mothers be tested?

A

As above, but tests additionally every month.

65
Q

What is the incubation of chickenpox?

A

14 (10-21)

66
Q

What is the incubation of rubella?

A

14 (12-23)

67
Q

What is the incubation of influenza?

A

1-3

68
Q

What is the incubation of parvovirus (fifth disease)?

A

4-20

69
Q

What is the incubation of CMV?

A

3-12/52

70
Q

What is the risk of congenital CMV with primary infection in pregnancy?

A

30-40%

71
Q

What is the risk of congenital CMV with recurrent infection in pregnancy?

A

1-2%

72
Q

Which organism causes lymphogranuloma venereum?

A

Chlamydia trachomatis L1–L3

73
Q

Which organism causes ocular trachoma?

A

Chlamydia trachomatis A–C

74
Q

What type of fungus is Candida albicans?

A

Yeast-like fungus

75
Q

How does listeria monocytogenes circumvent the immune system?

A

It is an intracellular pathogen and ‘hides’ within phagocytic cells

76
Q

What is the route through which CMV is most commonly transmitted?

A

Breastfeeding

77
Q

What proportion of people whom are admitted to hospital develop and hospital-acquired infection?

A

10%

78
Q

What pressure do theatre air systems generate and why?

A

Generates positive air pressure in order to draw air away from the patient so that it may be filtered for airborne infections

79
Q

How are gram -ve organisms usually spread?

A

Aerosol route

80
Q

What may cause sudden deterioration in a Hep B infection?

A

Delta-virus super-infection, esp. in IVDU’s

81
Q

Which microorganism most commonly causes catheter-associated UTIs?

A

Pseudomonas

82
Q

What is leptospirosis also called?

A

Well’s disease. It is caused by leptospira which is a spirochaete

83
Q

What are the zoonoses?

A 
Anthrax (cattle, goats)
Listeriosis (pets)
Leptospirosis (rats)
Toxocara (cats)
Toxoplasmosis (dogs)
Tapeworms (dogs)
Brucella (sheep)
TB (cattle)
84
Q

What type of organism is actinomyces israelii?

A

Gram positive, cast-forming, non-acid-fast, non-spore-forming anaerobic bacillus

85
Q

How is actinomyces israelii treated?

A

Penicillins/cephalosporins. In those that are penicillin allergic, tetracyclines may be used

86
Q

What are the notifiable diseases?

A 
Food poisoning
Haemolytic uraemic syndrome
Meningitis
Meningococcal septicaemia
Rubella
Malaria
Mumps
Measles
TB
87
Q

What bacteria can cause osteomyelitis?

A

Staphylococcus
Haemophilus influenzae
Salmonella
P. aeruginosa

88
Q

What happens when blood agar exposed to staph aureus?

A

Haemolysis

89
Q

What is the mechanism of action of ciprofloxacin?

A

Interferes with DNA synthesis by disrupting the function of DNA gyrase

90
Q

With what stain is toxoplasmosis identified?

A

Giemsa stain

91
Q

What is the mechanism of action of glycopeptides (for example, vancomycin)?

A

Inhibit cell wall synthesis through steric hindrance of peptidoglycans

92
Q

Which organism causes lymphogranuloma venereum?

A

Chlamydia

93
Q

What family of viruses does EBV belong to?

A

Herpes virus

94
Q

What are the predominant organisms of the vagina?

A

Lactobacilli

95
Q

What is the pH of the vagina during a woman reproductive life?

A

3.5-4.5

96
Q

What is the pH of the vagina after menopause?

A

7 (the bacterial flora become more like the skin again)

97
Q

What causes the cuboidal epithelium lining the vagina of a child to turn into the stratified squamous epithelium found in the vagina of a woman of reproductive years?

A

Puberty and the influence of oestrogen

98
Q

What are the constituents of physiological discharge?

A
  1. Desquamated epithelial cells
  2. Mucus from the cervical glands
  3. Bacteria - mainly lactobacilli
  4. Transudate from through the vaginal wall (major constituent)
99
Q

What are the types of vaginal candidia?

A

C. albicans - 80% of affected women

C glabrata, C krusei, C tropicalis - remaining 20% of affected women

100
Q

What factors predispose to vaginal candidiasis?

A
  1. Immunosuppression
  2. DM
  3. Vaginal douching
  4. Increased oestrogen levels - e.g. pregnancy
  5. Broad spec Abx therapy
  6. Skin conditions
101
Q

What treatment should be given fro candidiasis in pregnancy?

A

Clotrimazole 100mg/day pessaries for 7/7. Oral therapies NOT recommended

102
Q

What is the pH of the vagina in BV?

A

4.5-7.0 due to the loss of lactobacilli

103
Q

What are the Amsel criteria for diagnosis of BV?

A

1) Fishy smell
2) pH>4.5
3) Clue cells
4) Characteristic discharge O/E

104
Q

What are the complications of BV?

A

1) Increased risk of second-trimester miscarriage

2) Increased risk of preterm delivery

105
Q

What medium should be used for culture of TV?

A

Feinberg-Whittington medium

106
Q

Which serovars of chlamydia cause LGV?

A

L1-L3

107
Q

What is the ‘gold standard’ method of diagnosis of PID?

A

Laparoscopy

108
Q

What is Reiter syndrome?

A

Disseminated infection with chlamydia trachomatis resulting in asymmetrical oligoarthritis of the large joints of the lower limbs, uveitis and a rash

109
Q

Which is HLA is associated with Reiter syndrome?

A

HLA B27

110
Q

What can chlamydia and/or gonorrhoea cause in newborns?

A

Opthalmia neonatorum - causes keratoconjunctivitis, corneal scarring and blindness. They may also cause pneumonitis in the first few months of life and so newborns with opthalmia neonatorum should recieve systemic therapy with erythromycin

111
Q

What causes yaws?

A

Treponema pallidum pertenue

112
Q

What causes pinta?

A

Treponema pallidum carateum

113
Q

What causes bejel (endemic syphillis)?

A

Treponema pallidum endemicum

114
Q

Over what period does a chancre appear in syphillis?

A

3-6/52

115
Q

What are the conseqences of syphillis for a neonate?

A

Fetal death
Eight-nerve deafness
Interstitial keratitis
Mulberry teeth

116
Q

What may be seen on dark-field microscopy in syphillis?

A

Spirochaetes

117
Q

What is the Jarisch-Herxheimer reaction?

A

An exacerbation in symptoms +/- fever that may occur 24 hours after the start of treatment of syphillis. It is due to the release of proinflammatory cytokines following death of organisms.
This reaction may induce preterm labour in a woman with a high organism load when treated in pregnancy.

118
Q

What disease is ‘groove sign’ associated with?

A

Lymphogranuloma venereum (LGV) - occurs when the enlargement of LNs in the groin region form buboes which are then compressed by the inguinal ligament

119
Q

What infection causes chancroid?

A

Haemophilus ducreyi

120
Q

What is more common - HIV1 or HIV2?

A

HIV1

121
Q

How does HIV gain access to a cell?

A

The viral outer membrane protein gp120 binds to the CD4 receptors present on T lymphocytes, macrophages etc.

122
Q

What is the proportion of vertical transmission of HIV if no intervention is made?

A

25-40% - mainly through transmission from breastfeeding

123
Q

What should happen if varicella develops at the end of pregnancy?

A

It may be that the fetus is exposed to infection without the benefit of passive maternal antibodies. Therefore, if maternal infection occurs 7 days before or after pregnancy VZIG should be given to prevent severe infection

124
Q

What proportion of pregnancies does CMV affect?

A

0.5%

125
Q

How is transmission rate and severity related in CMV?

A

Transmission rate increases the further along the pregnancy, but severity decreases the further along the infection is acquired

126
Q

What are the possible USS features of CMV?

A

1) Ventriculomegaly
2) Pseudocysts
3) Microcephaly
4) Intra-cranial calcification
5) Abnormalities of cerebellum
6) Echogenic bowel
7) IUGR
8) Splenomegaly
9) Cardiomegaly/pericardial effusion
10) Hydrops

127
Q

What are the only infections to be routinely screened for at booking?

A

HIV
Hep B
Rubella
Syphillis

128
Q

How do you tell the difference between gram +ve and gram -ve bacteria?

A

Gram +ve bacteria retain the colour violet dye

Gram -ve bacteria do not retain the violet dye’s colour and instead turn pink with the addition of a counter stain

129
Q

What are obligate aerobes?

A

Require the presence of O2 to grow

130
Q

What are facultative anaerobes?

A

Can tolerate aerobic and anaerobic conditions

131
Q

What are obligate anaerobes?

A

Require the exclusion of O2 to grow

132
Q

What type of bacteria is listeria?

A

Gram +ve, rods, facultative anaerobes

133
Q

What are the 2 types of listeriosis?

A

Early - occurs within 2 days postpartum, they usually present septic with disseminated organ involvement. mortality is 60%
Late - occurs more than 5 days postpartum, usually as meningitis

134
Q

What are enterobacteriaceae?

A

Gram -ve rods that ferment glucose - 2 types, gut commensals and overt bacteria

135
Q

What are the enterobacteriaceae gut commensals?

A 
E.coli
Klebsiellas
Proteus
Enterobacter
Citrobacter
136
Q

What are the enterobacteriaceae overt bacteria?

A

Salmonellas
Shigella
Campylobacter

137
Q

What are the complications of severe malaria?

A
  1. Severe anaemia
  2. Acute pulmonary oedema
  3. Hypoglycaemia
  4. Cerebral malaria - reduced GCS and seizures
  5. DIC
  6. Acute renal failure - blackwater fever due to intravascular haemolysis
138
Q

What haematological characteristic is associated with increased incidence of malaria?

A

Duffy antigen

139
Q

Are bacteria visible using light microscopy?

A

Yes

140
Q

What are the mechanisms of bacterial antimicrobial resistance?

A
  1. Drug inactivation
  2. Alteration of drug target site
  3. Alternation in the bacteria’s metabolic pathway
  4. Fibronectin coast
  5. IgA cleaving protease
141
Q

How many of the Amsel criteria are required for diagnosis of BV?

A

3/4

142
Q

What are Argyll Robertson pupils?

A

Small, irregularly shaped, difficult to dilate pupils, that may occur as a result of neurosyphillis

143
Q

What is mycoplasma hominis?

A

May be a primary or co-pathogen in PID, or a co-pathogen in chorioamnionitis

144
Q

Which types of chlamydia causes genital chlamydia?

A

D-K

145
Q

What is the serology process for diagnosing syphillis?

A

IgM/FTA-ABS –> IgG –> TPPA –> VDRL

146
Q

How many organism are required to develop a wound infection?

A

10 to power 5 (usually), 10 to power 3 in the presence of a foreign body

147
Q

What is the difference between type 1 and type 2 necrotising fascitis?

A

Type 1 = associated with surgery/diabetes. Polymicrobial

Type 2 = due to group A streptococcus

148
Q

What culture does chlamydia grow on?

A

McCoy’s culture

149
Q

What are the different types of, and examples of, fungal groups?

A
  1. Mould - e.g. aspergillus
  2. True yeast - e.g cryptococcus
  3. Yeast-like - e.g. candida
  4. Dimorphic - e.g. histoplasma
150
Q

What are the 2 types of protozoa?

A
  1. Protozoa

2. Helminths

151
Q

What are the 3 groups of helminths?

A
  1. Fluke
  2. Tape
  3. Worm
152
Q

At what CD4 count foes AIDS occur?

A

<200

153
Q

What proportion of Hep B feto-maternal transmissions occur in the 3rd trimester?

A

90%

154
Q

What is the Hep B feto-maternal transmission rate when mother is HBeAg positive?

A

90%

MRCOG - Part 1 (13 decks)

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