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Infectious Disease > Study Group > Flashcards

Study Group Flashcards

1
Q

What is the half-life of antibodies?

A

3 weeks

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2
Q

What are examples of antibodies?

A

anti-toxins, humanised monoclonal antibodies, maternal immunoglobulins, IVIG

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3
Q

What are the indications for antibodies?

A

acute infection, post-exposure elimination of a pathogen, rhesus incompatibility prevention

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4
Q

What are examples of live attenuated vaccines?

A

MMR, varicella, zoster, yellow fever, rotavirus, adenovirus, BCG, typhoid

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5
Q

At what CD4 cell count can you vaccinate HIV positive patients?

A

> 200 cells/mm3

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6
Q

How long do you have to wait to give live vaccines to HSCT patients?

A

24 months

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7
Q

What is the pneumococcal vaccine schedule for indigenous people?

A

1) a dose of pneumococcal conjugate vaccine (13vPCV, 15vPCV or 20vPCV) at age >50 years

2) a dose of polysaccharide 23vPPV 12 months

3) a 2nd dose of 23vPPV at least 5 years after the 1st dose of 23vPPV

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8
Q

Which vaccine is contraindicated if you have anaphylaxis to egg product?

A

yellow fever

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9
Q

Which vaccines do you give patients with COPD?

A

influenza, pneumococcal

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10
Q

When do you give a tetanus vaccine?

A

-Adolescents and adults with a tetanus-prone wounds if their last dose was more than 5 years ago.

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11
Q

List antibiotics that inhibit cell wall synthesis

A

vancomycin, penicillins, cephalosporins, monobactams, carbapenems

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12
Q

What class is vancomycin?

A

Glycopeptide antibiotics, inhibit cell wall synthesis

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13
Q

What is the MOA of beta lactams?

A

Beta lactams prevent the cross-linking peptides from binding to the tetrapeptide side-chains.

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14
Q

What are examples of 50s inhibitors?

A

erythromycin (macrolides), chloramphenicol, clindamycin, lincomycin

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15
Q

What are examples of 30s inhibitors?

A

tetracyclines, streptomycin, aminoglycosides

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16
Q

What antibiotics attack folic acid metabolism?

A

trimethoprim, sulfonamides

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17
Q

Which antibiotics are inhibitors of bacterial nucleic acid function/synthesis?

A

quinolones

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18
Q

What is the most common cause of traveller diarrhoea?

A

enterotoxigenic E.Coli (ETEC)

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19
Q

Which organisms cause blood diarrhoea?

A

Campylobacter jejuni and shigella

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20
Q

Which organisms cause watery diarrhoea?

A

Cholera and cryptosporidiosis

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21
Q

Which organisms cause diarrhoea + UGI symptoms (bloating, gas, nausea)?

A

Giardia

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22
Q

What are the symptoms of dengue fever?

A

eye pain, bone pain, myalgias, hemorrhagic

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23
Q

How do you diagnose dengue fever?

A

serology- DNA (first week), IgM/G

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24
Q

What are the types of plasmodium?

A

Falciparum, vivid, ovale, malarias knoweski

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25
Q

How do you diagnose malaria?

A

Thick film for screening, thin film for speciation

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26
Q

What are the symptoms of leptospirosis?

A

Fever with jaundice

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27
Q

What are risk factors for leptospirosis?

A

rainfall, flooding, animal urine, contaminated water or soil

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28
Q

What organism causes leptospirosis?

A

spiral shaped bacteria

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29
Q

How do you diagnose leptospirosis?

A

Dark field microscopy, silver stain, fluorescent microscopy

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30
Q

What are the symptoms of typhoid?

A

fever, “rose spots”- faint salmon-coloured macules on the trunk and abdomen

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31
Q

How is typhoid transmitted?

A

direct contact, contaminated food/water

32
Q

Which organism causes typhoid?

A

Gram negative rod
salmonella enterica (typhi, paratyphy A, B, C)

33
Q

How do you diagnose typhoid?

A

stool culture, bone marrow culture is most sensitive, widal test (may be positive with past exposure)

34
Q

When do you urgently treat malaria?

A
  • any degree of altered consciousness, jaundice, oliguria, respiratory distress, severe anaemia, or hypoglycaemia.
  • A parasite count more than 2% of RBCs), vomiting, clinical acidosis or metabolic acidosis on blood biochemistry, AKI
35
Q

How do you urgently treat malaria?

A

Treatment is with: IV artesunate or IV quinine. +/- ceftriaxone due to high rates of concomitant bacteraemia and paracetamol to protect for haemolytic acute kidney injury.

36
Q

Which plasmodium can be dormant?

A

P.Vivax and P.ovale

37
Q

When do gametocytes in malaria peak?

A

Gametocytes may peak and persist for 1 week after treatment of malaria

38
Q

Describe the xanthem of measles

A

erythematous, maculopapular blanching rash, often begins in the face and upper trunk, then spreads to the extremities. Can also present in the oral mucosa.

39
Q

Describe the critical phase of dengue fever.

A

often get thrombocytopenia, with fluid overload, ascites, pleural effusions, persistent vomiting, confusion, mucosal bleeding, and abdominal pain

40
Q

Listeria is intrinsically resistant to?

A

cephalosporins

41
Q

What are the ESCAPPM organisms?

A

inducible beta lactamase production

ESCAPPM: Enterobacter, serratia species, Citrobacter species, Acinetobacter, pseudomonas aeruginosa, proteus vulgaris, morganella morganii

42
Q

Enterococci are all resistant to?

A

low concentrations of penicillin, aminoglycosides at concentrations achieved with standard dosing

43
Q

What is the mechanism of action of VRE?

A

D-ala-D-ala-lac mutation

44
Q

For Penicillin non-susceptible S pneumonia, what are the MIC cut-offs for ceftriaxone?

A

<0.5mg/L is generally considered susceptible, 1-2mg/L indicates intermediate susceptibility, and >4mg/L is resistant

45
Q

How do you treat hospital acquired MRSA?

A

fusidic acid + rifampicin, linezolid

46
Q

How do you treat community acquired MRSA?

A

Bactrim, clindamycin, ciprofloxacin

47
Q

How do you treat MRSA if the patient is sick?

A

Vancomycin

48
Q

How do you treat vancomycin resistant staph aureus?

A
  • IV teicoplanin and linezolid, daptomycin, quinupristin, dalfapristin, tigecycline
  • Oral: Rifampicin + fusidic acid, cotrimoxazole, pristinamycin
49
Q

How do you treat VRE?

A

linezolid, tigecycline, daptomycin

50
Q

What are examples of ESBL?

A

Klebsiella, e-coli

51
Q

How do you treat ESBL?

A

Nitrofurantoin, carbapenems eg meropenem, colistin, tigeycyline

52
Q

How to treat CRE (cabapenem resistant enterobacter)?

A

Meropenem

53
Q

What is the most consistently observed risk factor for hospital acquired VRE?

A

previous antimicrobial therapy

54
Q

What is the management of enterococcal IE?

A
  • Cef + amp for 6 weeks
  • Amp or penicillin + gent for 4-6 weeks (then can reduce gent dose)
  • If penicillin allergy – vanc + gent 6 weeks or sensitisation to penicillin
55
Q

What is the most common microorganism causing UTI?

A

E.coli
other pathogens include: enterobacteriacae, streptococci, enterococci, staph saprophyticis

56
Q

What is the definition of asymptomatic bacteriuria?

A

The presence of at least 10^5 CFU/mL of a uropathogen from two consecutive voided urine specimens in women or one specimen in men, or more than 10^2 CFU/mL of one pathogen from a catheterized urine specimen in women or men

57
Q

What is the empirical therapy for cystitis?

A

Empirical therapy (for men all therapies 7 days)
- Trimethoprim 300mg PO daily for 3 days
- Nitrofurantoin 100mg PO Q6hrly for 5 days (P – not 1st trimester or near term)
- Cefalexin 500mg PO BD for 5 days (if above can’t be used) (P)

Second line empirical
- Amoxicillin 500mg TDS for 5 days
- Trimethoprim-sulfamethoxazole 160+800mg BD for 3 days (P – only 2nd trimester)
- Augmentin duo 500-125mg BD for 5 days (P)

Third line (if resistant to all of above)
- Norfloxacin 400mg BD for 3 days
- Ciprofloxacin 250mg BD for 3 days

58
Q

For a UTI, which abx are safe in pregnancy?

A

During pregnancy, the safest antibiotics are amoxicillin-clavulanate, cephalosporins, and nitrofurantoin (avoid in first trimester and near term);

fluoroquinolones are contraindicated

trimethoprim-sulfamethoxazole can only be used safely during the second trimester.

59
Q

What is the empirical therapy for acute pyelonephritis?

A

Empirical therapy
- Augmentin duo forte BD for 14 days
- Ciprofloxacin 500mg BD for 7 days (if penicillin hypersensitivities)

If susceptible to narrower-spectrum, switch to the following
- Amoxicillin 500mg TDS for 14 days
- Trimethoprim 300mg daily for 14 days
- Cefalexin 500mg Q6hrly for 14 days
-Trimethoprim+sulfamethoxazole 160-800mg BD for 14 days

If resistance to all of above or Pseudomonas aeruginosa isolated
Ciprofloxacin 500mg BD for 7 days

60
Q

What is the empirical therapy for severe pyelonephritis?

A

Empirical therapy

Gentamicin 7mg/kg for first dose (4-5mg/kg if pre-existing kidney impairment)
+ amoxicillin 2g IV 6hrly or ampicillin 2g IV 6hrly

If gentamicin contraindicated
Ceftriaxone 1g IV daily (or BD if ICU)
Cefotaxime 1g IV Q8hrly (or 2g if ICU)

If suspected multidrug-resistant gram-negative bacteria e.g. ESBL
Meropenem 1g IV Q8hrly

61
Q

Which of the following type of renal calculus is most commonly associated with Proteus urinary tract infection?

A

Urea-splitting bacteria, including Proteus, Klebsiella, Pseudomonas, and coagulase-negative Staphylococcus, alkalinize the urine and may be associated with struvite stones

62
Q

What are symptoms of vancomycin infusion reaction/red man syndrome?

A

flushing, erythema, and pruritus, usually of the upper body

63
Q

What causes red man syndrome?

A

It is a rate-related infusion reaction caused by direct activation of mast cells by the drug.

64
Q

What is the management of red man syndrome?

A

Mild reactions - nothing, resort the infusion a 1.5 of the previous rate

moderate reactions- antihistamine

severe reaction (muscle spasms, chest pain or hypotension)- antihistamines, IVF, infuse further vans doses over 4 hours

64
Q

In addition to chorioretinitis, which ocular manifestation is associated with candidaemia

A

Endophthalmitis

65
Q

What is the abx regimen for necrotising fasciitis?

A

Abx regimen
Meropenam 1g q8hrly or Tazocin 4.5g q6hrly AND
Vancomycin 30mg/kg AND
Clindamycin 600mg q8hrly or Lincomycin 600mg q8hrly

If wound immersed in water also add ciprofloxacin 400mg q8hrly

66
Q

What are examples of echinocandin?

A

Andulafungin
Caspofungin

66
Q

What is the abx therapy for preseptal cellulitis?

A

Vancomycin PLUS Ceftriaxone/ Cefotaxime
Add metronidazole if need to cover anaerobes

67
Q

What medication do we use for CMV prophylaxis?

A

Valganciclovir

68
Q

What type of organism is bartonella?

A

gram negative rod- cause of cat scratch disease

68
Q

What type of organism is pasteurella multocida?

A

gram-negative, bipolar staining coccobacillus

found on cats and dogs

69
Q

What classes of antifungals disrupt the fungal cell wall/membrane?

A

echinocandins
azoles
polyenes

70
Q

Which classes of antifungals inhibit DNA and RNA synthesis?

A

5-Flucytosine – for cryptococcal meningitis

71
Q
A
72
Q

What is the management of candidaemia?

A

Critically ill: Echinocandin (Anidulafungin, caspofungin, micafungin)

Non-critically ill
Fluconazole (c. albicans, not previously exposed to azole antifungals)
Echinocandin

72
Q

What is the treatment of PJP?

A

Bactrim + steroids for HIV patients or severe PJP pneumonia

Infectious Disease (1 decks)

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