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Pathology > Microbiology- (p35-44- TB, RTIs + STIs) > Flashcards

Microbiology- (p35-44- TB, RTIs + STIs) Flashcards

1
Q

What is the presentation of TB?

A 
Cough +/- haemoptysis
Fever (night sweats)
Weight loss
Malaise
Ethnicity
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2
Q

How does post-primary TB present and in who?

A 
In young adults
?Reactivation/re-infection
Upper lobes affected
May progress to cavitation
Classic lesion- caseating granuloma
Healing by fibrosis and calcification
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3
Q

How does primary TB present and in who?

A

Children, elderly, HIV
Multiplies at pleural surface
LN involvement
Classic lesion- granuloma (Langhan’s giant cells)
Can be asymptomatic
Can be miliary- progressive, disseminated haematogenous spread

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4
Q

Treatment for TB (First line and second line)?

A 
1st Line: RIPE
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
RI for 4 months
PE for 2 months

2nd line:
Injectables (capreomycin, kanamycin, amikacin), quinolones, cycloserine, ethionamide, PAS etc

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5
Q

Investigations for TB?

A

Imaging- CXR (upper lobe cavitation in post-primary), CT

Culture- Sputum (x3), bronchoalveolar lavage, urine, pus etc in Lowenstein Jensen medium (Gold standard)
Sputum microscopy- ZN/auramine stain- Gram +ve rods, acid fast, aerobic, intracellular

Tuberculin skin tests- Mantoux/Heaf
Interferon gamma release assays
NAAT

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6
Q

How does TB meningitis present and how is it diagnosed?

A 
Subacute
Weight loss, fever, night sweats
Headache, neck stiffness
Personality change, decreased GCS
Focal neurological deficit
Diagnosis- CT or LP (lymphocytic)
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7
Q

Treatment for TB meningitis?

A

> 12 months of TB treatment and steroids

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8
Q

Types of extrapulmonary TB and who is at risk?

A 
Lymphadenitis
Pericarditis
Abdominal 
Genito-urinary, renal, testicular
Skin, liver etc

People at risk with HIV coinfection

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9
Q

Risk factors for TB and reactivation of latent TB?

A

Recent migration, HIV, homeless, drug users, prison, close contacts

Reactivation of latent:
Immunosuppression, malnutrition, ageing, chronic alcohol excess

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10
Q

Vaccination for TB?

A

BCG- attenuated strain of m. bovis

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11
Q

Manifestations of leprosy?

A

Skin- depigmentation, macules, plaques, nodules, trophic ulcers
Nerves- thickened nerves, sensory neuropathy
Eyes- Keratitis, iridocyclitis
Bone- periostitis, aseptic necrosis

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12
Q

Treatment for leprosy?

A

Rifampicin, dapsone, clofazimine

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13
Q

Other mycobacteria?

A

M. Avium
M. marinarum (fish tank granuloma)
M. ulcerans (insects- tropics/Aus)

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14
Q

Definition of pneumonia?

A

Inflammation of lung alveoli

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15
Q

Definition of bronchitis?

A

Inflammation of medium sized airways

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16
Q

Presentation of pneumonia

A

Fever, cough, pleuritic chest pain, SOB

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17
Q

Presentation of bronchitis?

A

Cough, fever, increased sputum production, increased SOB

Commonly smokers

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18
Q

What would the bronchitis CXR show?

A

Normal

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19
Q

How do you assess pneumonia severity?

A

CURB 65

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20
Q

Treatment of pneumonia?

A

Supportive (O2, fluids etc) and Abx

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21
Q

Treatment of bronchitis?

A

Bronchodilation, physiotherapy +/- Abx

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22
Q

What pathogen is associated with rusty coloured sputum and is normally lobar on CXR?

A

S. pneumonia

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23
Q

What would you see down the microscope for S. pneumonia?

A

+ve diplococci

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24
Q

What would you see down the microscope for H. influenza?

A

-ve cocco-bacilli

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25
Q

What would you see down the microscope for S. aureus?

A

+ve cocci grape bunch clusters

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26
Q

Which organism is associated with recent viral infection (e.g. influenza) +/- cavitation on CXR?

A

S. aureus

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27
Q

What would you see in the microscope for K. pneumonia?

A

-ve rod, enterobacter

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28
Q

Name 3 atypical pneumonias

A

Legionella pneumophilia
Mycoplasma pneumonia
Chlamydia pneumonia

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29
Q

Which organism is associated with travel, air conditioning, water towers, hepatitis and low Na?

A

Legionella pneumophilia

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30
Q

What symptoms do you see in mycoplasma pneumonia?

A

Systemic, joint pain, erythema multiforme

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31
Q

What would you associate with chalmydia psittaci?

A

Birds

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32
Q

Which pathogen causes whooping cough in unvaccinated (e.g. travelling community in EMQs)?

A

Bordatella pertussis

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33
Q

What pathogens cause respiratory tract infections in HIV?

A

P. jiroveci, TB, cryptococcus neoformans

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34
Q

What pathogens cause respiratory tract infections after bone marrow Tx?

A

Aspergillus + CMV

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35
Q

What pathogens cause respiratory tract infections post-splenectomy?

A

Encapsulated organisms- H. influenza, S. pneumonia + N. menigitidis

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36
Q

What pathogens cause respiratory tract infections in cystic fibrosis?

A

Pseudomonas aeruginosa, burkholderia cepacia (v high mortality)

37
Q

How do you diagnose respiratory tract infections?

A

Urine antigen tests in severe CAP for s. pneumonia and legionella

Antibody tests- paired serum samples, most useful for those difficult to culture e.g. chlamydia, legionella)

Immunofluorescence- Antibody labelled with fluorescent dye- used in virology

38
Q

What is the definition of hospital acquired pneumonia?

A

> 48h into hospital stay without previous infection

39
Q

What abx do you use to treat a mild-moderate CAP?

A

Penicillin 1st line (amoxicillin) or macrolide if penicillin allergy for 5-7d

40
Q

What abx do you use to treat a moderate-severe CAP?

A

Penicillin + macrolide (co-amoxiclav + clarithromycin) 2-3w

41
Q

What abx do you use to treat atypical CAPs?

A

Use protein synth. Abx- Macrolide/tetracycline

42
Q

What commonly used drug does clarithromycin interact with?

A

Warfarin

43
Q

What is the first line treatment for HAP?

A

Ciprofloxacin +/- vancomycin

If no joy, bring in the piptazobactam

44
Q

Special tx for legionella?

A

Macrolide + Rifampicin

45
Q

Special tx for s. aureus?

A

Flucloxacillin

46
Q

Special tx for pseudomonas spp.?

A

Piperacillin + tazobactam
or
Ciprofloxacin +/- gentamicin

47
Q

Special tx for MRSA?

A

Vancomycin

48
Q

Which STIs cause discharge?

A 
Gonorrhoea
Chlamydia
Trichomonas
Candida
BV
49
Q

What STIs cause ulceration?

A 
Syphilis
HSV
LGV
Chancroid
Donovanosis
50
Q

What STIs cause rashes and lumps

A

Genital warts- HPV
Molluscum contagiosum
Scabies
Pubic lice

51
Q

What is most likely diagnosis if painful genital ulcers?

A

Herpes

52
Q

What is most likely diagnosis if painless genital ulcers?

A

Syphillis

53
Q

What would you see down the microscope in N. gonorrhoeae??

A

Intracellular gram -ve diplococci

54
Q

What condition can gonorrhoea lead to in neonates?

A

Opthalmia neonatorum (neonatal conjuctivitis) if left untreated when transferred to child from birth canal

55
Q

How is gonorrhoea diagnosed?

A

Urethral (95% sensitivity) or rectal (20% sensitivity) smears- culture from these is gold standard

56
Q

Tx of gonorrhoea?

A

Ceftriaxione IM- 250mg single dose or cefixime PO- 400mg single dose

57
Q

What can gonorrhoea and chlamydia lead to in women?

A

PID- most common cause of female infertility in europe

58
Q

How is chlamydia diagnosed?

A

Nucleic acid amplication tests (NAATs) - gold standard

59
Q

Tx of uncomplicated chlamydia?

A

Azythromycin- 1g stat Doxycycline- 100mg BD 7/7

60
Q

What is lympho-granuloma venereum?

A

Lymphatic infection with chlamydia trachomatis

61
Q

How is lympho-granuloma venereum treated?

A

Doxycycline for 21/7 100mg BD

62
Q

What pathogen is responsible for syphillis and what would you see on microscopy?

A

Treponema pallidum- gram negative spirochaete

63
Q

How is syphilis diagnosed?

A

Detection of antibody (RPR), real time PCR and microscopy

64
Q

How does primary syphilis present?

A

Macule -> papule -> indurated painless genital ulcer appearing 1-12w following transmission
May persist 4-6wks. Regional adenopathy.

65
Q

How does secondary syphilis present?

A

Systemic bacteraemia. Low grade fever, malaise, symmetrical, non-pruritic, maculo-papular rash on back, trunk, arms, legs, palms, soles, face

66
Q

How does tertiary syphilis present?

A

Gumma (granuloma- 2-40y later
Cardiovascular- 10-30y later
Neurosyphilis (most common in HIV +ve)- 2-30y later

67
Q

Treatment of syphilis?

A

Single dose IM benzathine penicillin

68
Q

What pathogen causes chancroid?

A

Haemophillus ducreyi

69
Q

How and where does chancroid usually present?

A

Tropical ulcer disease mainly in Africa + rare in UK

Multiple painful ulcers

70
Q

How is chancroid diagnosed?

A

Culture (chocolate agar) + PCR

71
Q

Where is donovanosis common?

A

Africa, India, Australian aboriginal communities

72
Q

How does donovanosis present?

A

Large expanding ulcers starting as papule or nodule that breaks down
Beefy red appearance.

73
Q

How is donovanosis diagnosed?

A

Giemsa stain of biopsy or tissue crush. Donovan bodies.

74
Q

How is donovanosis treated?

A

Azithromycin

75
Q

What enteric pathogens are spread through oro-anal contact?

A

Shigella, salmonella, giardia (protozoan), occasionally others (strongyloides)

76
Q

What do you see down the microscope in trichomoniasis vaginalis?

A

Flagellated protozoan

77
Q

How is trichomoniasis diagnosed?

A

Wet prep microscopy, PCR

78
Q

How is trichomoniasis treated?

A

Metronidazole

79
Q

What happens in bacterial vaginosis?

A

Abnormal vaginal flora, polymicrobial, decreased lactobacilli
Smelly discharge

80
Q

How is BV diagnosed?

A

Microscopy of gram stain, raised pH, whiff test and clue cells

81
Q

Symptoms of candidiasis?

A

White thick discharge, itching, soreness, redness, vulvovaginitis in women and balantis in men

82
Q

How is candidiasis treated?

A

Topical or oral antifungals- e.g. clotrimazole or fluconazole

83
Q

What causes molluscum contagiousum?

A

Pox virus

84
Q

How does molluscum contagiosum present and spread in children vs adults?

A

Children- hands and faces, skin to skin contact

Adults- genital lesions, sexual contact

85
Q

Treatment of molluscum contagiosum?

A

Cryotherapy- destructive

86
Q

Cause of genital warts?

A

dsDNA HPV

87
Q

How are genital warts diagnosed?

A

Examination- papular, planar, pedunculated, carpet, keratinised, pigmented

88
Q

How are genital warts treated?

A

Podophyllotoxin solution or cream

Cryotherapy

Pathology (13 decks)

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