Questions From Drive. Codename:PAIN Flashcards
Mention some capsulated bacteria like Strep.pneumonia
Capsule is made by polysaccharides to evade host’s immune system.
Haemophilus influenzae: hib types. Pneumonia and meningitis.
Neisseria meningitidis: several serogroups. Meningitis and septicemia.
Some strains of Escheria coli
Typhoidal Salmonella.
Patient with dysentery after a trip to Kenya?
Vibrio cholera.
Give 3 examples about antifungal drugs?
Azoles: Flucanazole and micanazole.(inhibit ergosterol synthesis)
Polyenes: Amphotercin B and nystatin.(Bind to ergosterol to disrupt cell membrane)
Other: Flucytosine(inhibit nucleic acid synthesis, used in systemic infection.)
Echinocandis: inhibit glucan synthesis. Used in systemic fungal infections. Like caspofungin and macofungin.
CS1: Lung auscultation shows infection in the lower lobes of the lungs?
Legionnaire’s disease because pneumonia generally affecting upper lobes where the O2 concentration is higher. Legionella pneumophila affects lower lobes and it can be transmitted.
Child with unilateral lymphadenopathy. What could it be?
Ask about if there is a cat at home. Cat scratch disease.
Bartonella henselae (BH)
Antibiotics targeting nucleic acid synthesis?
RNA: rifamycin group: rifampin.
DNA: Fluoroquinolones acting on topoisomerase. Crucial enzymes on DNA replication and repair. Levofloxacin, ciprofloxacin and moxifloxacin.
Sulfonamides: inhibit folic acid synthesis which is a precursor of nucleic acids. Sulfamethoxazole.
What is the toxicity of the Fluoroquinolones?
Stick to the cartilage and degrade it. Tendon rupture. Prolonged QT waves in ECG.
Baby with strawberry like tongue and Scarlet fever, which bacteria is the cause of it ? Is Scarlet fever common in Adults?
Streptococcus pyogenes. (GAS)
No it can be seen in pediatrics.
Treat with penicillin
If not responding macrolides such as azithromycin.
What are the skin infections of streptococcus? Treatment?
Stretococcus pyogenes can cause
Impetigo: topical mupirocin and oral penicillin
Erysipelas, oral or IV penicillin or cephalosporins.
Cellulitis penicillin or cephalosporins. Oral or IV
Scarlett fever penicillin or azithromycin if necessary.
Necrotizing fasciitis(NF): no treatment, death.
What is Active TB’s treatment?
INF: Isoniazid
IRF: Rifampin
EMB:Ethambutol
PZA: pyrazinamide
Used for 2 months then for 6 months INH and RIF.
You have the rash in the palm and all over the body, what is the disease and its stage?
Secondary syphilis. Life expectancy is low. Treponema pallidum attacking to the liver, spleen, heart and lungs.
IV cephalosporins.
High killing of the bacteria causing inflammation called Jarisch-Herxheimer Reaction. High fever, chills, hypotension, headache, tachycardia and hyperventilation can be seen.
What is the mechanism of the Fluoroquinolone?
Topoisomerase block which helps unwinding of DNA before replication.
To where does Rifampicin’s toxicity apply?
Hepatotoxicity (ChatGPT)
How do you diagnose duodenal and gastric ulceration
Blood, stool or breath(urease) test.
Endoscopy
Ask: vomiting if yes gastric
Immediate pain after a meal gastric ulcers
Also if eating alleviate the pain it is duodenal.
Why Melena occurs?
Because of bleeding in the upper GI tract for example nose.
Blood get digested and bilirubin causing black color of the feces.
How do you treat Meningitis? And How do you diagnose?
Symptoms of meningitis: photophobia, phonophobia, sepsis symptoms, neck stiffness, alteration of mental status, headache. A distinct type of rash in case of neisseria meningitis. Brudzinski’s neck sign in children. We need to the lumbar puncture and collect CSF then we can deduce if it is bacterial,viral or fungal.
For the treatment we use cephalosporins(ceftriaxone) which are the atomic bombs and cause inflammation in the body thus we can inject steroids.
In case of listeria monocytogenes use ampicillin penicillin.
If fungal like crytococcus Neoformans which is quite rare use Amphotercin B and flucanazole.
Can we also use rifampin for the meningitis?
Yes it is acting on BBB but for the prophylactic measures.
What is mononucleosis, symptoms and treatment?
Kissing disease.
Caused by Epstein-Barr virus or in rare cases CMV.
Causing lymphoadenopathy specifically in the neck and armpits and also tonsils are swollen, white patches might be present. Symptoms like fever, headache, fatigue and sore throat.
Most importantly swollen spleen and liver.
For therapy painkillers and resting important.
What is Gonococcal arthritis?
More commonly affecting women.
Neisseria gonorrhea which also cause PID in women cause arthritis which is the inflammation of the joints especially wrist, finger, toes and ankles.
Pain in the joints and rash.
Treated with ceftriaxone and azithromycin.
Pregnant woman with cystitis.
Cystitis is the inflammation of the bladder generally caused by E.coli. Can be treated with nitrofurantoin or some special cephalosporins.
Endocarditis patient in the emergency room.
Symptoms: Fever, heart murmur, fatigue, shortness of breath, joint and muscle pain.
Echocardiogram and electrocardiogram(ECG) is very important to asses info about condition.
Collect hemoculture.
It can be caused by Streptococcus(viridans) or Staphyloccocus.
IV penicillin or cephalosporins + gentamicin (for strep infections)
Vancomycin especially for MRSA.
High mortality rate
Bacteria gain entry through dental procedures, surgical interventions or trauma.
Why do we need vaginal swab test in case of pregnancy?
To get information about genital and rectal area. Some problematic species as follows:
Group B streptococcus(GBS)
Bacterial Vaginosis (BV)
Vaginal yeast infections candida
Chlamydia and gonorrhea
Even Lyme and listerosis.
Cat scratch disease what is the agent and treatment?
Bartonella henselae
Resolves on its own without ABs generally but in some cases azithromycin.
Conditions causing swollen lymph nodes?
Infections such as strep throat, mono, diphtheria, TB, cold,flu.
AIDS, cancer, allergies or insect bites such as ticks.
Brucellosis?
Malta fever.
Brucella melitensis can be seen in farmers. Unpasteurized milk, cheese or undercooked meat.
Causing lymphadenopathy, and night sweats and most importantly undulant fever.
Symptoms of GI tract infections in general?
Diarrhea
Abdominal pain and cramps
Nausea and vomiting
Fever
Dehydration and loss of appetite
Fatigue.
Clostridium difficile?
Affecting colon and making pseudomembranous colitis (white patches all around the colon)
Symptoms: diarrhea or dysentery, abdominal pain,fever ,loss of appetite and nausea.
Stool test(presence of C.difficile toxins) or colonoscopy
Caused by prolonged usage of ABs.
Generally treated with fecal transplantation.
Vaccine types
Inactivated or killed vaccines: Microbe is killed or inactivated cannot cause the disease.
Live attenuated vaccines: weakened forms of microbes.
Protein vaccines: use sugars or proteins to stimulate immune response.
mRNA vaccines: instruct cells in the body to produce a protein similar to the viral protein to trigger immune response. Like Pfizer covid-19 vaccine.
SSSS?
Methicillin
Staphylococcus caused Scalded Skin Syndrome. A condition common in children <6yo. Babies are more susceptible because they produce IgG not IgA. S.aureus produce exfoliative toxin which accumulates in the skin.
Therapy IV augmentin or B-lactams, painkillers, creams for the raw exposed skin and hydration.
Skin infections?
Skin infections can be caused by bacteria, virus, fungal or parasites.
Bacterial Strep.pyogenes can cause erysipelas, cellulitis and abscess.
S.aureus is another usual suspect. It infects hypodermic tissue which is rich in fat and cause abscess.
For the therapy we use starvation therapy which is the removal of excess fat from the skin by soaps containing sulfurs or azoles(antifungal) they intervene the androgen production.
Infections causing death in newborns?
Sepsis: GBS, E.coli, S.aureus
Meningitis: Strep.agalactiae (GBS), E.coli and Listeria monocytogenes.
Pneumonia: Respiratory syncytial virus(RSV), strep.pneumoniae, Haemophilus influenzae.
Herpes simple virus HSV
Congenital: CMV, Toxoplasma gondi.
Streptococcus pyogenes.
clinical scenario: description of a patient under sepsis/septic shock → what do we
do? (all steps from diagnosis to treatment)
1-Track vital signs. Temperature, heart rate, respiratory rate, blood pressure and oxygen levels.
2-obtain hemoculture send it to the laboratory
3-Administer crystalloids to restore blood volume and improve perfusion. For kidney and brain. Use adrenaline shots to restore 65mmHg BP at least.
4-Empirical AB treatment: Use ABs in combination, for broad spectrum. Quinolones for DNA, azithromycin for ribosome, rifampin for RNA, Streptomycin for cell membrane.
We can also use Ceftriaxone or Vancomycin(MRSA)
My question: Why sepsis causing low BP?
Because of the cytokines released in case of inflammation, cause vasodilation, fever and increased permeability in the vessels. Vessels are enlarged, fluid in the blood pass to the tissues. So the volume of blood reduced and vessels are enlarged in the end hypotension. That is why we need to inject fluids and epinephrine.
Toxic antibiotics
1-Tetracyclines: stain teeth and bones. Doxycycline, tetracycline.
2-Fluoroquinolones: Tendon rupture, cartilage damage. Levofloxacin, Moxifloxacin and Ciprofloxacin
3-Chloramphenicol cause grey baby syndrome. Hepatotoxic.
4-Aminoglycosides: Gentamicin ototoxic. Can cross the placenta and cause damage in the fetal ears and kidneys.
5-Sulfonamides: block folic acid synthesis which is crucial for the baby. Sulfomethoxazole. Brain damage.
Meningitis caused by Crytococcus neoformans?
Fungal can be transmitted by pigeons. Use Amphotercin B and Flucanazole.
Clear CSF in case of which bacterial infections?
Listeria monocytogenes
Treponema pallidum(syphilis)
Mycobacterium tuberculosis.
Lymphogranuloma venerum caused by what?
Chlamydia trachomatis. Is a STD.
In the primary stage; painless genital ulcers
Secondary; swelling of lymph nodes in the pubic area.
Tertiary stage; fistulas and elephantiasis.
Mycobacterium -> everything theoretical (bacterial characteristics, pathogenesis, diagnostics, pathogenic forms)
Neither gram +/-
Special(waxy) cell wall: mycolic acid and arabinogalactan which contribute to the resistance against antibiotics. They are growing slowly in culture.
Pathogenesis: Primarily affecting lungs through inhalation of air droplets containing bacteria. Granuloma formation meaning phagocytes eat them up but cannot kill the bacteria because they need CD4 T cells. This vicious cycle causing caseous lesions in the upper lobes of the lung and causing necrosis of the lung tissue. Accumulation of dead monocytes make pus-like formations in the lungs. First sign is the pulmonary cavitation in the X-rays. Bacteria can stay dormant within the granuloma(çember) for years. After people get aids or because of aging it become active TB. So yes TB can get activated by time.
Diagnostics: Tuberculin skin test is injecting a purified protein derivative into skin and measuring the hypersensivity of the response or interferon gamma test which is a blood test basically.
Mycobacterium tuberculosis, bovis and leprae is pathogenic.
