Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ID > Revision gems > Flashcards

Revision gems Flashcards

1
Q

What is the cause of the hypervirulent C difficile strain?

ribotype 027

A

Mutation in tcdc gene–> binary toxin that usually downregulates other toxins is mutated–>increased production of toxins A and B

Diagnosed through standard tests.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hypervirulent c diff has what clinical implications?

A

increased complications, mortality, and relapse

associated with fluroquinolone resistance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does severe C diff look like?

A

No diarrhoea, shocked, high WCC, ileus, low albumin
Megacolon and perforation at end stage
May have paucity of signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

C diff outbreak control- what works?

A

Infection control does not work
Antibiotic control does work- restrick FQ, cephalosporins
early and rapid diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

C diff looks like what type of bug…

A

gram positive spore forming rod

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

C diff treatment?

A

Stop inciting abx if possible/lower spectrum abx
metronidazole orally
vanc orally
In relapsed cases, use the drug you have just failed with!!!
Second relapse, tapering and pulsed oral vanc
Third relapse: vanc and rifamixin
If so sick can’t have PO- can give IV due to biliary excretion, NGT if surgeons allow, or retention enema
IVIG has been used
Surgery if near perforation
probiotics for treatment not that effective but some people use as an adjunct to therapy
NOTE THE TOXIN CAN BE DETECTED FOR WEEKS DESPITE SUCCESSFUL TREATMENT
Faecal microbiota therapy- deliver via NGT or colonoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

2/3 deaths in late HAART era are from…

A

non AIDS related illnesses
cancer
HCV
CV disease- theory of immune activation secondary to first few weeks of gut peyers patches breakdown after infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which HIV drugs can get into the CNS?

A

Abacavir (NRTI)
Nevirapine, delaviridine (NNRTI)
Kaletra, indinavir-rit, fosamprenavir-rit (PI)
(But no study currently re:prevention of neurocognitive impairment if commence therapy early- observational data only)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Where does HIV rank as an independent risk factor?

A

Not as high as smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which HAART is the worst for cardiovascular risk?

A

Abacavir and the protease inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When do you start HAART?

A

Any CD4 count.
Other concept is community viral load and reduction of transmission ?ongoing high risk behaviour ?couple not seromatched
Though evidence less strong (3B) for CD4 count over 500

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the implications of a lower CD4 count when starting HART

A

Marked benefit if start over 350- mortality implications, will not make it up to a higher CD4 count
SMART study is a prospective study enrolling those over 500
Especially important if pregnant, HBV, HCV, nephropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pneumonia in an alcoholic… think?

A

Klebsiella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Lymphogranuloma venerum is secondary to what?

A

Chlamydia trachomatis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Stages of lymphogranuloma venerum ?
(3)

And how do you treat?

A
  1. small PAINLESS pustule which later forms an ulcer
  2. Painful bilateral inguinal lymphadenopathy
  3. Proctocolitis

Tx is doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Causes of a painful genital ulcer?

A

Becet’s
Herpes
Chancroid (unilateral painful inguinal LN, sharply defined and ragged edges, tropical disease caused by haemophilus ducreyi)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Causes of a painless genital ulcer?

A

Syphilis
Lymphogranuloma venerum
Carcinoma
Granuloma inguinale (secondary to klebsiella granulomatis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the alpha haemolytic streps?

A

alpha = PARTIAL haemolysis
Looks green on the plate

S viridans
S pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the beta haemolytic streps?

A

complete haemolysis meaning looks clear on plate

Groups A-H but ABD are the only ones clinically relevant

A= S pyogenes (erythrogenic, toxins cause scarlett fever. Impetigo, erysepilas, cellulitis, phar, tonsilitis, post S GN, rheumatic fever) 
B= S agalactiae 
D= enterococcus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What things do you do to prevent CVC infection?

A 
Educate and trainig staff
Sterile insertion
Chlorhex skin prep
Daily review if needed
antibiotic impregnated catheters if still high rates (not part of the "bundle" they talk about from NEJM)
NOT antibiotic "locks"
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What do the toxins A and B from C diff actually do?

A

Toxin A is an enterotoxin specific for CHO intestinal receptors

Toxin B is an cytotoxin that disrupts cellular tight junctions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What would be your treatment for carbapenem resistant enterobacteriacae?

A

eg E coli, Klebsiella, Salmonella, Shigella, Enterobacter

Infection prevention precautions

Treatment:

  • combination regimens
  • colistin
  • Infusion carbapenem if low MIC (4-8_
  • Tigecycline
  • Fosfomycin (oral agent if need outpatient care)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Who gets PEP for varicella?

A

Immunocompromised - VZIG if less than 96 hours, also give aciclovir but limited evidence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Legionella is found in what sources?

A

L longbechiae- potting mix

L pneumophilia- humidifiers, cooling towers

25
Q

Legionella clinical picture

A 
Fever called "pontiac fever" - flu like
pneumonia
Renal impairment
Abnormal LFTs
Hyponatraemia
Raised CK
26
Q

Legionella treatment

A

Macrolide

Cipro

27
Q

leptospirosis happens in what group of people? (It is a spirochette!)

A

Farmers, abbotoir workers
Get it from cattle, pigs, rodents especially after rain via skin cuts or abrasions
Also participation in recreational water sports

28
Q

What does leptospirosis look like clinically?

A

Mild self limiting usually
Sometimes hyperbilirubinaemia/jaundice , AKI, pulm haemorrhage, conjunctival haemorrhages

Bipahsic illness- early then late an immune mediated illness

Treat with penicillin and doxy- improve symptoms and complications but not mortality.

29
Q

Melioidosis is caused by what?

A

Burkholderia pseudomallei

Gram negative rod, soil saprophyte

30
Q

Clinically what does melioid look like?

A

Pneumonia, abscesses of SPLEEN and PROSTATE
Osteomyelitis, septic arthritis
Skin and soft tissue infection

HIGH MORTALITY WITH SEPSIS
Relapses common so long term eradication therapy needed

31
Q

How do you manage melioid?

A

Ceftazidime, carbapenem

GCSF in septicaemia

32
Q

EBV is associated with what cancers?

A

Burkitt’s lymphoma (Chromosome 8 translocation and deregulation of c-MYC oncogene)
Nasopharyngeal carcinoma
HL
NHL ONLY IN IMMUNOCOMPROMISED

33
Q

HHV8 is associated with what cancers?

A

Kaposi’s sarcoma
Primary effusion lymphoma
Multicentric castlemans disease

34
Q

HTLV-1 is associated with which pneumonia?

A

Adult T cell leukaemia

35
Q

Opisthochis viverrini and Chonorchis sinensis are associated with what cancer?

A

CholangioCa

36
Q

What is the clinical picture in Whipples disease?

A

Migratory large joint arthralgias
Weight loss and diarrhoea, abdo pain
Dementia, eye signs
Culture negative endocarditis, pleural effusion

Dx via small bowel biopsy or PCR

Tx is ceftriaxone then long term bactrim

37
Q

What does HHV-6 do in immunosupression and how is it transmitted?

A

Transmitted in saliva
In transplant causes pneumonitis, hepatitis, encephalitis, bone marrow suppression or graft rejection, fever (reactivation around day 17)

38
Q

How does botulism work?

A

Toxins A B E bind to pre-synaptic nerves and prevent release of ACh

Cranial nerves then symmetrical descent

Check food, EMG

Treat supportive + antitoxin and penicillin

39
Q

Overwhelming post splenectomy infection- what is the empirical treatment?

A

Ceftriaxone and vancomycin

40
Q

Empirical treatment for suspected IE?

A

Gent
Benpen
Fluclox

41
Q

Does entamoeba cause eosinophilia?

A

No

42
Q

H1N1 list of factors in order risk of hospitalisation, and risk of death.

A

Hospitalisation: Immunocompromise, obesity, pregnancy
Death: Obesity, Immunocompromise, renal failure, death

43
Q

Gram stain CSF:

Gram positive cocci

A 
S pneumoniae-->vanc and ceftriaxone
S aureus (if neurosurg or head trauma within one month)-->vanc
44
Q

Gram stain CSF:

Gram neg cocci

A

N meningitidis

Ceftriaxone

45
Q

Gram stain CSF:

Gram positive bacilli

A

Listeria

Penicillin G or ampicillin

46
Q

Gram stain CSF:

Gram neg bacilli

A

Klebsiella or E coli–>ceftriaxone

Pseudomonas or acinetobacter if neurosurg last month or a neurosurgical device: ceftazidime, cefepime or meropenem

47
Q

What medications can cause a drug related fever?

A 
Carbamazepine
Phenytoin
Antimicrobials
Allopurinol
Heparin

Look for relative BRADYCARDIA- only seen in 10% but can be a clue to drug fever

48
Q

What defines MRSA?

A

Presence of the mec gene.

MecA encodes for PBP2A- PBP no longer binds the oxacillin

49
Q

MRSA - what are your options? (4)

A

Vancomycin
Linezolid
Daptomycin
Ceftaroline (only if MIC low)

50
Q

VISA- what are your options?

A

Linezolid
Daptomycin
Ceftaroline

51
Q

VRE- what are your options?

A 
Linezolid
Daptomycin
Tigecycline
If UTI- nitrofurantoin
If penicillin susceptible- penicillin G
52
Q

Pseudomonas- what are your options?

A 
Tazocin
Gent/Tobra
Cefepime, Ceftazidime
Aztreonam
Ciprofloxacin
Meropenem NOT ertapenem
Colistin
53
Q

Most common cause of PCR proven viral myocarditis?

A

Adenovirus!

54
Q

Clinically, difference between meningitis and encephalitis?

A

In encephalitis there is clouded sensorium

In meningitis, they feel unwell but usually cognition is unchanged, unless they are postictal

55
Q

When do the new guidelines say IE is indicated? (4)

A
  1. PMH IE
  2. Prosthetic heart valve
  3. Heart Tx with an abnormally functioning valve
  4. Unrepaired cyanotic CHD, Repaired in last 6 months, or persistent leak adjacent to synthetic material used for repair.

Additionally, taking antibiotics just to prevent endocarditis is not recommended for patients who have procedures involving the reproductive, urinary or gastrointestinal tracts.

56
Q

Most common cause of OM?

A

S aureus

If sickle cell- salmonella

57
Q

Tetanus caused by what bug and what is the treatment?

A

Clostridium tetani
Spores prevent GABA release

Treatment is IV metronidazole (better than penicillin)
IM human tetanus immunoglobulin for high risk wounds.

58
Q

All the gram positive bacilli there are 5…?

ABCDL

A 
Actinomyces
Bacillus anthracis (anthrax)
Clostridium
Diphtheria: Corynebacterium diphtheriae
Listeria monocytogenes
59
Q

Penicillin allergy in cellulitis?

A

Clindamycin or clarithromycin

ID (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions