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USMLE > Microbiology - general and antibiotics > Flashcards

Microbiology - general and antibiotics Flashcards

1
Q

Gram + cell membrane component

A

Lipoteichoic acid

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2
Q

2 unique features of Gram - bac cell wall

A
  1. Periplasm

2. Outer membrane

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3
Q

3 components of outer cell membrane of Gram - bacteria

A

Polysaccharide
Lipid A
O antigen

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4
Q

2 components of peptidoglycan sheets of bacterial cell wall

Which one connects peptides?

A

NAG

NAM (connects peptides)

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5
Q

Make up of capsule

Which bacteria is the exception?

A

Polysaccharide

Exception - Bacillus anthracis - poly D glutamate peptide capsule (major virulence factor)

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6
Q

3 conjugated vaccines with capsule polysaccharide

A

Strep pneumonia
H influenzae b
N meningitidis

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7
Q

Bacteria using glycocalyx

A

Staph epidermidis - forms biofilm

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8
Q

2 key bacteria using pili/fimbria

A 
E. Coil
Neisseria gonorrhoea (antigenic variation —> risk subsequent infection
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9
Q

3 components of bacteria spores

A

Keratin-like outer coating
Dipicolinic acid
Peptidoglycan cortex/core wall

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10
Q

2 main spore-forming groups of bacteria

A

Bacillus

Clostridium

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11
Q

Name the microbes that poorly Gram stain.

A 
‘These Little Microbes May Unfortunately Lack Real Colour But Are Everywhere’
Treponema (too thin to visualise)
Leptospirosis (too thin to visualise)
Mycobacterium (high lipid content)
Mycoplasma (lack cell wall)
Ureaplasma (lack cell wall)
Legionella (primarily intracellular)
Rickettsia (primarily intracellular)
Chlamydia (primarily intracellular; lacks muramic acid)
Bartonella (primarily intracellular)
Anaplasma (primarily intracellular)
Ehrlichia (primarily intracellular)
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12
Q

Giemsa staining microbes (4)

A 
‘Ricky got Chlamydia as he tried to Please the Bored Geisha’
Rickettsia
Chlamydia
Plasmodium
Borrelia
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13
Q

Staining for Cryptococcus (2)

A

India ink

Mucicarmine (stains capsule red)

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14
Q

Chocolate agar

A

H influenzae

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15
Q

Thayer Martin agar

A

Neisseria gonorrhoea

Neisseria meningitidis

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16
Q

Bordet Gengou agar

A

Bordatella pertussis

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17
Q

Tellurite agar

A

C diphtheria

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18
Q

Loffler medium

A

C diphtheria

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19
Q

Lowenstein Jensen agar

A

M TB

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20
Q

Eaton agar

A

Mycoplasma

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21
Q

MacConkey agar

A

Lactose-fermenting enteric

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22
Q

Eosin-methylene blue (EMB) agar

A

E. Coil

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23
Q

Charcoal yeast extract agar buffered with cysteine and iron

A

Legionella

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24
Q

Sabouraud agar

A

Fungi

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25
Silver stain (3)
PCP (fungi) Legionella H pylori
26
Most cocci are Gram + | Name 2 cocci that are Gram -
Neisseria meningitidis/gonorrhoea | Moraxella
27
Most rods are Gram -ve | Name the G+ rods (4)
Corynebacterium Clostridium Listeria Bacillus
28
Branching/filamentous
Nocardia | Actinomyces
29
Sorbitol culture
Used to detect E.coli 0157 (colourless colonies instead of pink)
30
Facultative aerobes (3)
Staph Strep Enteric gram -
31
Obligate aerobes (3)
Pseudomonas M TB Nocardia
32
Key obligate intracellular organisms (2)
Rickettsia | Chlamydia
33
Facultative intracellular (8)
``` ‘Some Nasty Bugs May Live FacultativeLY’ Salmonella Neisseria Brucella Mycobacterium Listeria Francisella Legionella Yersinia ```
34
Urease +ve organisms
``` ‘Pee CHUNKSS’ Proteus Cryptococcus H pylori Ureaplasma Nocardia Klebsiella S epidermidis S saprophyticus ``` Predisposes to struvite stones
35
Catalase +ve organisms
‘Cats Need PLACESS to Belch their Hairballs’ ``` E.g.s Nocardia Pseudomonas Listeria Aspergillus Candida E. coli Staph Serratia B cepacia H pylori ```
36
Name 3 key virulence factors.
Protein A IgA protease M protein
37
MOA protein A virulence factor. | Which bacteria?
Binds FC portion of IgG —> prevents opsonisation and phagocytosis Staph aureus
38
MOA IgA protease. | Which bacteria?
Cleaves IgA —> adhere and colonise mucous membranes SHiN bacteria - S pneumonia - H influenzae type b - Neisseria
39
MOA M protein virulence factor | Expressed by which bacteria?
Helps prevent phagocytosis (binds factor H, break down of C3 convertase) Gp A Strep
40
MOA diphtheria toxin
ADP ribosylation of EF-2 —> prevents protein synthesis
41
MOA exotoxin A of Pseudomonas
ADP ribosylation of EF-2 —> prevents protein synthesis
42
MOA Shiga toxin
Inactivated 60S ribosome by removing adenine residue from rRNA
43
MOA EHEC toxin
Inactivated 60S ribosome by removing adenine residue from rRNA
44
What causes the HUS with enterohaemorrhagic E. coli?
Shiga-like toxin enhances cytokines release.
45
MOA ETEC heat labile toxin
Overactivation adenyulate cyclise —> increases cAMP —> increased chloride secretion into gut
46
MOA EHEC heat stable toxin
Overactivates cGMP —> increased cGMP —> reduced resorption of NaCl and water in gut
47
MOA oedema toxin of Bacillus anthracis
Mimics adenylate cyclase —> increased cAMP
48
MOA Vibrio cholera’s toxin
Activates Gs —> increased cAMP —> increased chloride secretion into gut Voluminous ‘rice water’ diarrhoea
49
MOA Pertussis toxin
Disables Gi —> increased cAMP —> impaired phagocytosis
50
MOA tetanospasmin
Cleaves SNARE (soluble NSF attachment protein receptor; required for neurotransmitter release via vesicular fusion) —> prevent release of inhibitory GABA and glycine from Renshaw cells —> spastic paralysis
51
MOA Boutlinum toxin
Cleaves SNARE (soluble NSF attachment protein receptor; required for neurotransmitter release via vesicular fusion) —> prevents release stimulators (ACh) signals at NMJ —> flaccid paralysis
52
MOA of alpha toxin (Clostridium perfringens)
Phospholipase (lecithinase) —> degrades tissue and cell membranes Myonecrosis and double zone haemolysis on blood agar
53
MOA Strep pyogenes Streptolysin O
Degradation cell membrane RBC lysis, contribute to beta haemolysis
54
MOA TSST-1 of Staph aureus and erythrogenic exotoxin A of Strep pyogenes
Cross-links beta region TCR to MHCII outside of antigen binding site —> overwhelming release IL-1, IL-2, IFN-gamma, TNF-alpha
55
3 main effects LPS of outer membrane of Gram -
1. Macrophage activation (TLR4/CD14) 2. Complement activation 3. Tissue factor activation
56
Bacterial transformation
Uptake of DNA from surrounding environment
57
What prevents bacterial transformation?
Add deoxyribonuclease (degrades naked DNA)
58
Bacteria using bacterial transformation (3)
‘SHiN’ S pneumonia H influenza type b Neisseria
59
Bacterial conjugation
DNA t/f of plasmids via sex pili
60
High frequency strains in bacterial conjugation
Allow gene mapping
61
Bacterial transduction
Transfer of DNA via bacteriophage
62
What are the two types of bacterial transduction?
1. Generalised (lytic phage) - virus infects bacteria and multiplies randomly picking up host DNA —> transfer to another bacteria 2. Specialised (lysogenic phage) - virus DNA inserts into host DNA, some host DNA then excised with phage DNA
63
Name the bacteria whose toxins are formed from lysogenic phages.
‘ABCDS’ ``` Group A erythrogenic toxin Botulinum toxin Cholera toxin Diphtheria toxin Shiga toxin ```
64
What is the term given to phages only replicating in the lytic cycle?
Virulent
65
What is the term given to phages replicating in both the lytic and lysogenic forms?
Temperate
66
Bacterial transposition | Give an example.
Transposons excised and re-integrated in new locations Mechanism of abx resistance E.g. Tal456 with vanA gene from VRE —> Staph aureus
67
What do penicillin binding proteins do?
Cross link alanine residues in bacterial cell wall
68
MOA penicillins
Mimic alanine residues (D-ala-D-ala) —> breakdown >creation of cell wall —> autolysis —> cell death Therefore bacteriocidal
69
Name 2 natural penicillins
Penicillin G | Penicillin VK
70
Which drug increases the concentration of pen G/VK when co-administered?
Probenecid (usually used in gout)
71
Name 3 mechanisms by which bacteria develop resistance to penicillins.
1. Modify PBPs e.g. Strep pneumonia 2. Reduced bacterial cell penetration (G- outer cell membrane has poor penetration; reduced porins) 3. Beta lactamase enzymes
72
Which bacteria produce beta-lactamase enzymes? (2)
1. Gram negative (present in periplasm) | 2. Staph aureus (no periplasm therefore secretes)
73
Name 3 inhibitors of beta lactamase.
1. Clavaulanic acid 2. Sulbactam 3. Tazobactam
74
How many hours after administration of penicillin does the Jarisch-Herxheimer reaction occur?
2 hours
75
Name examples for each hypersensitivity reaction in penicillin. (Similar for cephalosporins)
Type 1 - acute (IgE) anaphylaxis Type 2 - haemolysis (IgG) Type 3 - serum sickness (IgG) Type 4 - skin reaction, interstitial nephritis
76
What type of T cell mediates the SJS and TEN reactions that you see with penicillin use?
CD8
77
With which abx can you see SJS/TEN?
Aminopenicillins TMP-SMX Cephalosporins
78
Name 3 anti-staph penicillins. Why are they anti-staph?
Oxacillin Naficillin Dicloxacillin Side chain protects from Staph penicillinase.
79
Name 3 uses of anti-staph penicillins.
Community-acquired cellulitis Impetigo Staph endocarditis (once sensitivities confirmed)
80
Name 2 aminopenicillins
Amoxicillin (po) | Ampicillin (iv - poor bioavailability)
81
MOA resistance to penicillin G & V
Beta lactamase cleaves beta lactam ring
82
Name the 8 bacteria where aminopenicillins are used.
‘HHELPSS kill Enterococci’ ``` H influenzae (G-) H pylori (G-) E coli (G-) Listeria monocytogenes (G+) Proteus mirabilis (G-) Salmonella (G-) Shigella (G-) Enterococci (G+) ```
83
Mechanism of resistance to aminopenicillins.
Penicillinase (type of beta lactamase) - cleaves beta lactam ring
84
Why is MRSA resistant to penicillinase-resistant penicillins (anti-staph penicillins)?
Altered PBP target site
85
Name 2 antipseudomonal penicillins.
Piperacillin | Ticarcillin
86
MOA of antipseudomonal penicillins (ticarcillin, pipercillin).
Increase porin channel penetration
87
Which 3 abx groups are ESBL resistant to?
Penicillins Cephalosporins Aztreonam
88
In which type of bacteria do you find ESBL?
Gram -
89
MOA of cephalosporins
Beta lactam drugs that inhibit cell wall synthesis (less susceptible to penicillinases)
90
Cephalosporins - bacteriostatic or bactericidal?
Bactericidal
91
Which organisms are not covered by 1-4th generation cephalosporins?
‘LAME’ Listeria Atypicals (Chlamydia, Mycoplasma) MRSA Enterococci
92
Name the 2 1st generation cephalosporins
Cefazolin | Cephalexin
93
Name the 4 2nd generation cephalosporins
Cefaclor Cefoxitin Cefuroxime Cefotetan
94
Name the 8 bacteria in which 2nd generation cephalosporins are effective
‘HENS PEcK’ ``` Gram + cocci H influenzae Enterobacter aerogenes Neisseria spp. Serratia marcesens Proteus mirabilis E coli Klebsiella ```
95
Name the 4 organisms which can be treated with 1st generation cephalosporins
‘PEcK’ Gram + Proteus mirabilis E coli Klebsiella
96
Which cephalosporin might you use prophylactically prior to surgery to prevent S aureus wound infections?
Cefazolin (1st generation)
97
Name 4 3rd generation cephalosporins
Ceftriaxone Cefotaxime Cefpodoxime Ceftazidime
98
Name 3 conditions in which you would use ceftriaxone
Meningitis Gonorrhoea Disseminated Lyme disease
99
When might you use ceftazidime
Pseudomonas
100
Name a 4th generation cephalosporin
Cefepime
101
Coverage of cefepime
Gram - with increased activity against Pseudomonas and G+
102
List the following according to beta lactamase sensitivity from most sensitive to most resistant 1-4th generation cephalosporins Carbapenems Aztreonam Penicillins
1. Penicillins (anti-staph penicillins resistant to staph penicillinases) 2. 1st gen ceph 3. 2nd gen ceph 4. 3rd gen ceph 5. 4th gen ceph 6. Aztreonam 7. Carbapenems
103
Name a 5th generation cephalosporin
Ceftaroline
104
Which two microbes is ceftaroline (5th gen cephalosporin) particularly effective against?
MRSA | VRSA
105
Name 5 adverse reactions seen with cephalosporins and their mechanisms
HS reactions Vitamin K deficiency - reduced K2 (reduced GI bacteria) Hypoprothrombinaemia - NMTT side chains inhibit epoxide reductase; mainly seen in malnourished patients Nephrotoxicity with aminoglycosides Disulfiram reaction - inhibits acetaldehyde dehydrogenase
106
What are the 3 mechanisms of resistance to cephalosporins?
1. Modified PBPs 2. Altered cell permeability 3. Inactivation by cephalosporinases (type of beta lactamase)
107
What is the name of the drug co-administered with impenem and what is its purpose?
Cilastatin - reduce inactivation of drug in renal tubules
108
What is the MOA of cilastatin?
Inhibits dehydropeptidase I
109
Where do carbapenems act?
Bacterial cell wall - affect peptidoglycan cross-linking
110
Name a monobactam and state its MOA
Aztreonam - affects peptidoglycan cross-linking
111
Name the 3 main SEs of carbapenems
Rash GI distress Neurotoxicity (seizures)
112
What is the mechanism of neurotoxicity of carbapenems?
Inhibit GABA
113
When are you more likely to get the neurotoxicity effects of carbapenems? (2)
High doses | Renal failure
114
What is the MOA of aztreonam?
Binds PBP 3 (found in G-)
115
Is there any cross reactivity of aztreonam with penicillin allergies?
No
116
Which type of bacteria is aztreonam effective against?
G-
117
What is the MOA of sulphonamides?
Inhibit dihydropterate synthase
118
3 mechanisms of resistance to sulphonamides
Increased PABA synthesis Reduced uptake Altered dihydropterate synthase
119
What is the MOA of trimethoprim and pyrimethamine?
Inhibition of DHF reductase
120
What is the main toxic effect of TMP/pyrimethamine and how can this be prevented?
BM suppression; leucovorin (avoids need of DHF reductase to convert to THF)
121
Name the main SEs of sulphonamides and their mechanisms where applicable. (6)
Hypersensitivity - due to NH2 group at N4 and N ring at N1 SJS/TEN Photosensitivity - drug interaction with UV light Haemolysis in G6PD deficiency Kernicterus - displaces other albumin bound substances; increased unconjugated bilirubin Raised INR if taking warfarin - displaces other albumin bound substances
122
What is the MOA of dapsone?
Inhibition of DHF reductase
123
Is dapsone bactericidal or bacteriostatic?
Bacteriostatic
124
Name 2 uses of dapsone
1. Leprosy | 2. PCP prophylaxis
125
Name 2 adverse effects of dapsone
Haemolysis if G6PD deficient | Methaemoglobinaemia
126
MOA of sulfonamide abx
Mimic PABA —> competitive inhibition of dihydropterate synthase (PABA —> dihydropteric acid)
127
Mechanisms of resistance to sulfonamides (3)
1. Increased PABA production 2. Altered dihydropterate synthase 3. Reduced uptake
128
Which microbes does TMP-SMX not cover?
PsA B fragilis Most anaerobes
129
What are the main problems with the use of TMP-SMX in pregnancy? (2)
Sulfonamides —> kernicterus | TMP —> NTDs
130
Name the 3 stages of protein synthesis that protein inhibitors affect and name the abx acting in each one.
1. Initiation - aminoglycosides, linezolid 2. Add tRNA - tetracyclines 3. Add peptides - chloramphenicol, macro lives, clindamycin
131
MOA of aminoglycosides
Block initiation by binding 30S subunit of ribosomes
132
Are aminoglycosides effective against anaerobes?
No - require transport into cells
133
Are aminoglycosides effective against intracellular bacteria?
No
134
Mechanisms of resistance to aminoglycosides (2)
Phosphorylation aminoglycoside kinases | Adenylation/acetylation of transferases
135
Main SEs with aminoglycosides (3)
Ototoxicity Nephrotoxicity Neuromuscular blockade (blocks ACh release at NMJ) - mainly occurs with pre-existing neuromuscular disease/high levels
136
MOA macrolides
Blocks tRNA translocation (from A site, where peptide bond catalysed to P site) by binding to P site of 50S subunit
137
Cover of macrolides
G+ cocci Some G- Intracellular pathogens - Chlamydia (obligate), Legionella (facultative)
138
Why is erythromycin used in gastroparesis?
Binds to motilin rec in GIT —> smooth muscle contraction
139
Mechanism of resistance of macrolides
Alter 23S rRNA (component of 50S) by methylation
140
3 main SEs of macrolides
``` Increased motility Increased QT (blocks K+, especially erythromycin) Cholestatic hepatitis ```
141
Why do macrolides —> raised theophylline/warfarin levels?
P450 inhibitor
142
MOA tetracyclines
Binds 30S ribosome —> prevent attachment tRNA
143
Are tetracyclines transported into the cell?
Yes
144
What type of drugs impair the absorption of tetracyclines?
Minerals and antacids (Ca, Mg, Fe, dairy) - chelate drug
145
Mechanisms of developing resistance to tetracyclines (1)
Reduced influx/increased efflux from cells via plasmid-encoded transport pumps
146
Main SEs tetracyclines (4)
GI Photosensitivity Teeth discolouration (in under 8 year olds) Inhibit bone growth in children Chelates calcium
147
MOA chloramphenicol
Inhibition peptidyl transferase
148
Main SEs of chloramphenicol (3)
Anaemia (BM suppression) Aplastic anaemia (irreversible and often fatal) Grey baby syndrome (babies lack UDP glucoryltransferase that is required for excretion) - grey skin, hypotension, fatal
149
MOA clindamycin
Similar MOA to macrolides - bind to 23S rRNA of 50S ribosomes —> prevent translocation
150
Mechanism resistance to macrolides
Methylation of 23S rRNA binding site
151
Why use metronidazole over clindamycin for ‘below the diaphragm’?
B fragilis - high resistance
152
Main SE of clindamycin
Diarrhoea (C. Difficile, abx-associated)
153
MOA linezolid
Binds to 50S ribosome, blocking initiation
154
Main use of linezolid
VRE
155
MOA streptogramins
Act at 50S ribosome
156
Uses of streptogramins (quinipristin, dalfopristin)
VRE | VRSA
157
Aminoglycosides - bactericidal/bacteriostatic?
Bacteriocidal
158
Macrolides - bactericidal/bacteriostatic?
Bacteriostatic
159
Tetracyclines - bactericidal/bacteriostatic?
Bacteriostatic
160
Chloramphenicol - bactericidal/bacteriostatic?
Bacteriostatic
161
Clindamycin - bactericidal/bacteriostatic?
Bacteriostatic
162
Linezolid - bactericidal/bacteriostatic?
Bacteriostatic (mostly)
163
MOA quinolones
Inhibit DNA synthesis - DNA grasses, topoisomerase IV
164
Quinolones - bactericidal/bacteriostatic?
Bactericidal
165
Mechanism of resistance to quinolones (3)
Altered DNA gyrase and topoisomerase IV Altered cell permeability Efflux of drug
166
3 main uses of quinolones (3)
UTI Pneumonia Abdo infection (enteric G-)
167
Order of PsA cover for cipro, levo and moxi
Cipro>levo>moxi
168
Levofloxacin use
Strep pneumonia MSSA Therefore use in pneumonia
169
MOA vancomycin
Inhibits peptidoglycan (cell wall) formation by binding D-ala-D-ala peptides and preventing cross-linking (vs beta lactams, which inhibit transpeptidases)
170
Mechanism of resistance to vanc
Terminal acid change | E.g. D-ala-D-ala —> D-ala-D-lactate in VRSA
171
Cover of vancomycin
G+ (too large to enter cell)
172
2 main uses of vanc
MRSA | C diff
173
3 main SEs of vanc
Nephrotoxicity Ototoxicity Red man syndrome
174
What is red man syndrome?
Seen with vanc infusion (if given too fast) Histamine release from mast cells Prevent with slow infusion NOT a hypersensitivity reaction
175
MOA metronidazole
Reduced form = activated —> free radicals —> interact with DNA —> DNA breakage/destabilisation —> cell death
176
Main SEs metronidazole (3)
Metallic taste Non-specific GI/neuro (e.g. neuropathy) Disulfiram-like reaction ?MOA
177
Nitrofurantoin - bactericidal/bacteriostatic?
Bactericidal
178
In which condition might nitrofurantoin cause haemolysis?
G6PD deficiency
179
4 bacteria resistant to cephalosporins and reason for resistance
Resistant PBP - Listeria - MRSA - Enterococci No cell wall - atypicals e.g. Mycoplasma, Chlamydia
180
Name 10 granulomatous infections.
Mycobacterium - TB and leprosy Fungal pneumonias - Histo, Blasto, Coccidio Zoonotic - Bartonella, Brucella Listeria in infants (granulomatosis infantiseptica) Shistosomiasis Syphilis
181
3 infections causing a rash involving palms and soles
1. Secondary syphilis 2. Rocky Mountain Spotted Fever (Rickettsia) 3. Coxsackie
182
All DNA viral genomes are double-stranded except for?
Parvovirus
183
All DNA viral genomes are linear except for? (3)
‘PPH’ Papilloma Polyoma Hepadnavirus
184
Name the 4 groups of naked DNA viruses.
Parvo Adeno Papilloma Polyoma
185
Name the 3 groups of enveloped DNA viruses.
Hepadna Herpes Pox
186
DNA viruses - icosahedral or helical? Which virus is the exception?
Icosahedral | Pox virus does not have icosahedral capsid
187
Where do DNA viruses replicate? Which virus is the exception?
Nucleus | Pox virus - replicates in cytoplasm
188
All RNA viruses are single stranded except for _____?
Reovirus (dsRNA)
189
All RNA viruses are linear except for? (3)
‘BAD’ Bunyavirus Arenavirus Delta virus
190
All RNA viruses replicate in the cytoplasm except for? (2)
Influenza | Reovirus
191
Name the 4 viruses that have segmented genomes.
``` ‘BOAR’ Bunyavirus Orthomyxovirus Arenavirus Reovirus ```
192
Name the 4 + sense naked viruses.
``` CHRP Calci Hepe Reo Picorna ```
193
Name the 4 +ve sense enveloped viruses.
``` CFTR Corona Flavi Retro Toga ```
194
Name the 5 -ve sense enveloped virus families.
``` BROAD FP Bunya Rhabdo Orthomyxo Arena Delta Filo Paramyxo ```

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