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Third year > Week 6&7 - Clinical microbiology/Infection > Flashcards

Week 6&7 - Clinical microbiology/Infection Flashcards

1
Q

What is a bacterostatic antibiotic?

A

Suppresses growth, doesn’t produce sterilisation of infected site. requires additional factors. Immune mediated killing

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2
Q

What is antibiotic spectrum?

A

The range of bacterial species effectively treated by an antibiotic

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3
Q

What are Beta-lactamases?

A

Enzymes that lyse and inactivate beta-lactam drugs. secreted by gram - ve or S.aureus

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4
Q

How do beta-lactamase inhibitors work?

A

They have weak antibacterial activity, but they bind beta-lactamase allowing beta-lactam to work

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5
Q

What are some mechanisms of horizontal gene transfer/Extrinsic mechanisms of resistance?

A

Conjugation (pilus)
Tranformation (short, fragmented, naked DNA)
Tranduction (bacteriophage)

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6
Q

What are some non-genetic mechanisms of resistance?

A

Change cell wall permeability
Produce active enzymes to destroy drug
Infect sites where antibiotics cant act
Alter structural target

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7
Q

What might cause Red man syndrome?

A

Injecting Vancomycin too quickly

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8
Q

What are the antibiotics C.diff is resistant to?

A 
4 C's
Clindamycin
Cephalosporins
Ciprofloxacin
Co-amoxiclav
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9
Q

Define Sepsis.

A

Life threatening organ dysfunction due to a dysregulated host response to infection

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10
Q

What does Clindamycin do?

A

Protein synthesis inhibitor. 50s ribosome

Effective at stopping exotoxin production. Given in addition in gram +ve toxic mediated infections

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11
Q

What is antimicrobial resistance?

A

Occurs when microorganisms such as bacteria, viruses, fungi or parasites change in such a way that renders the medication used to clear the infection the microbe causes, ineffective

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12
Q

What is intrinsic resistance?

A

Innate ability of the bacteria to resist the activity of a antimicrobial agent, through inherent structural or functional characteristics allowing tolerance.

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13
Q

What is antibiotic stewardship?

A

Systemic approach to safe and effective use of antibiotic. to optimise outcome and minimise harm

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14
Q

What may tetracycline cause if used in pregnancy?

A

Bone and teeth abnormalities

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15
Q

What may Trimethoprim cause if used in pregnancy?

A

Neural tube defect

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16
Q

What may nitrofurantoin cause if used in pregnancy?

A

Haemolytic anaemia

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17
Q

What may aminoglycosides cause if used in pregnancy?

A

Otoxicity

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18
Q

What Signs might make you think its an infection?

A

Shiver, sweats, fever

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19
Q

How would you tell if the pharyngitis is bacterial or viral?

A

Viral has nasal symtoms bacterial doesn’t.

Bacteria has a swollen uvula, white spots on tonsils and a grey furry tongue

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20
Q

How is Norovirus most commonly spread?

A

Contaminated hands

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21
Q

Why can’s viruses like norovirus be cultured?

A

Immunity from them only lasts 6-14 weeks

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22
Q

What virus commonly causes outbreaks in paediatric hospital ward?

A

Rotavirus (incubation 1-3days)

Via respiratory droplets

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23
Q

What type of vaccine is the rotavirus vaccine?

A

Live attenuated vaccine

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24
Q

What is Community acquired pneumonia?

A

A result of lung infection by microorganisms and the immune system’s response to the infection
Strep. pneumonia, haemphilus influenza
Mycoplasma pneumonia, legoniella pneumonia

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25
Q

What clinical assessment is used in pneumonia?

A

CURB65
Confusion, urea >7, resp >30, BP d<60, s<90, age > 65
To determine if septic - SIRS and qSOFA

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26
Q

What is the clinical triad in Meningitis?

A

Fever
Nuchal rigidity
Altered mental status

Photophobia, headache, purpuric rash (non-blanching)

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27
Q

What prophylaxis is used in meningitis?

A

Ciprofloxacin or Rifampicin

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28
Q

What treatment would you use for mycobacterium tuberculosis infection?

A

Rifampicin (6 months) - orange- red urine
Isoniazid (6 months). - Neuropathy
Ethambutol (2 months) - optic neuritis
Pyrazinamide (2months) - gout

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29
Q

How would you treat Syphilis?

A

Benzathine penicillin

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30
Q

What is the criteria for SIRS? (2 or more)

A

Temp >38 or <36
WCC >12 or <4 x10^9/L
Tachycardia >90
Tachyopnoea >20

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31
Q

Give examples of alpha-haemolytic strep.

A

Strep pneumonia, strep viridans

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32
Q

Give examples of Beta haemolytic strep

A

Group A strep (strep pyogens)
Group B strep (strep agalactiae)
Group D strep (enterococcus)

33
Q

What does breakpoint mean?

A

Concentration of antibiotic which defines a species as sensitive or resistant

34
Q

What is the clinical definition of resistance?

A

When infection is highly unlikely to respond, even to the maximum dose of antibiotics

35
Q

Give an example of a Extended spectrum beta lactamase.

A

Cefotaximase

36
Q

How would you treat extended spectrum beta lactamase?

A

Carbapenems

37
Q

What types of infection does Carbapenemase resistant enterobactericeae cause?

A

(CRE is gram -ve)

Pneumonia, UTI, bacteaemia, wound infection

38
Q

What is the key difference between clindamycin and Macrolides.

A

Clindamycin has no action agains aerobic gram -ve or atypical. It has excellent activity against anaerobes

39
Q

What are the toxic effects of Chloramphenicol?

A

Bone marrow suppression, aplastic anaemia, optic neuritis

40
Q

What is the first choice of antibiotic used in streptococcus infection?

A

Benzylpenicllin

41
Q

What is pneomocystitis Jiroveci pneumonia?

A

Opportunistic infection, caused by a fungal infection in immunocompromised individuals.
An EC pathogen causing interstitial plasma cell pneumonia with foamy exudate in alveoli.
SoB, fever, dry cough, failure to respond to antibiotics
Co-trimoxazole and steroid therapy

42
Q

What is HIV viral load?

A

Measure of HIV RNA In the plasma.

Can use it to monitor response to antiretrovirals

43
Q

What treatment is available for influenza?

A

Neuraminidase inhibitors - Oseltamivir (PO) or Zanamivir (INH) 2X daily for 5 days
M2 inhibitors - amantadine, Rimantadine

44
Q

What bacteria causes Syphilis?

A 
Treponema pallidum (gram -ve spirochete)
Tx - Benzathine penicillin
45
Q

What is HIV brain disease?

A

Consequence of unrecognised, untreated infection and marked immunodeficiency

46
Q

What is Neutropenic fever?

A

Single oral temp of 38.3 or a temp of >38, sustained for more than 1 hour in a neutropenic patient

47
Q

What infections might occur after a solid organ transplant?

A

Community acquired pathogen - Penumococcus, salmonella, influenza, RSV
Opportunistic - aspergillus, pneumocystis
Donor derived- salmonella, HIV, TB, E.coli, syphilis
Nosocomical infection - CDAD
Reactivaton of infections - HSV, CMV, M.TB

48
Q

What are the different populations of cells in TB?

A

Actively growing - Isoniazid
Semi-dormant killed by acid environment - Pyrazinamide
Semi-dormant with spurts of active metabolism - Rifampicin
Completely dormant

49
Q

What are some clinical complications of infection with the gram -ve bacilli, vibrio cholera?

A

Profound fluid loss and dehydration:

Hypokalaemia, metabolic acidosis. hypovolaemic shock, cardiac failure

50
Q

What type of anaerobic, spore forming gram positive bacilli produces a heat labile protein neurotoxin?

A

Clostridium botulinum
Foodborne botulism: pre-formed toxin in food.
absorbed toxins spread via blood stream and enter peripheral nerves

51
Q

What gram positive coccobacilli might affect pregnant women?

A

Listeria monocytogenes

Present with severe infection - meningitis or septicaemia

52
Q

What are complications of the common cold?

A

(Viral infection of the upper respiratory tract- Rhinovirus or coronavirus)
Otitis media or sinusitis

53
Q

What antibiotic is used in treating Gonorrhoea (Nesseria gonorrhoea)

A

Ceftriaxone IM

54
Q

What antibiotic would you use after a positive NAAT test for Chlamydia trachomatis?

A

Doxycycline

55
Q

What treatment would you start if someone had multi-drug resistant TB?

A 
Pyrazinamide + 4 2nd line 
Fluoroquinolone
Injectable - Amikacin or kanamycin
Ethionamide 
Cycloserine
56
Q

Define septic arthritis

A

Inflammation of the synovial membrane of the joint, with effusion into the joint capsule due to infection.

57
Q

What are the 4 causes of malaria?

A

Plasmodium falciparum (severe malaria)
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae

58
Q

List some AIDS defining Illnesses

A

Penumocystic jiriveci pneumonia, invasive cervical cancer, CMV, PML caused by JC virus, lymphoma, PCP, TB

59
Q

What would you use first line to treat MRSA?

A

IV vancomycin

If cant try Teicoplanin

60
Q

What are some adverse effects of beta lactamases?

A

Hypersensitivity, haemolysis, seizures, infection

61
Q

What are some SE of trimethoprim?

A

Hyperkalaemia, raised serum creatinine, rash

62
Q

What antibiotic might you give if you have a gram positive toxin mediated disease like NF or Toxic shock syndrome?

A

Clindamycin

63
Q

What antibiotic could you use for multidrug resistant bacteria?

A

Carbapenem

64
Q

If SIRS is confirmed, what test could you perform to confirm sepsis?

A

qSOFA - quick sequential organ failure assessment

Confusion, hypotension, tachypnoea

65
Q

What might long term use to Metronidazole cause?

A

Peripheral neuropathy

66
Q

What are some causes of pneumonia?

A

Typical - strep pneumonia. Haemophilus influenza, moraxella catarrhalis
Atypical (malaise, myalgia, headache) - Legionella pneumonia (neurological Sx, urinary antigen test), mycoplasma pneumonia, chlamydophila pneumonia

67
Q

What test can you perform to examine for nuchal rigidity?

A

Brudzinski sign - spontaneous flexion of the hips when the neck is flexed passively

Also Kernig sign which is reluctance to allow full extension of the knee when hip flexed at 90

68
Q

List some risk factors for Strep pneumonia Bacterial meningitis?

A

head injury, middle ear disease, 70% have an underlying disorder, neurosurgery, alcohol, immunosuppression

69
Q

Give some contra-indications for a lumbar puncture

A 
Infection at the LP site
Reduced GCS
Coagulopathy 
Seizures, sepsis 
Papilloedema
70
Q

What might the JC virus cause?

A

Progressive multifocal leukencaphalopathy

- progressive motor dysfunction

71
Q

What might toxoplasma gondii cause?

A

intra-cerebral toxoplasmosis

headache, seizures, focal CNS signs

72
Q

What are some triggers for meningitis?

A

Infection - HSV, N. meningitis
AI disease e.g. lupus
Adverse drug reactions

73
Q

What may be present on a TB histology?

A

Ceaseating granuloma

74
Q

Constitutional Sx are really important in the presentation of TB, list some.

A

Night sweats, fever and chills, fatigue, lymphadenopathy, loss of appetite, weight loss

75
Q

What tests might you perform to test for TB?

m.tb - mycolic acids, mannose-capped LAM is a major immune stimulator during infection

A

Mantoux- tuberculin skin test
Interfernon gamma release assay

sputum >/= 3 with one early morning sample
Acid fast bacilli on Ziehl-Neelsen stain

76
Q

What clinical signs may indicate malaria?

A

Jaundice, anaemia, renal impairment, hepatosplenomagely

Severe malaria - shock, acidosis, pulmonary oedema, seizures

77
Q

How would you treat Enteric fever?

A

Quinolones, cephalosporins, azithromycin

78
Q

Campylobacter can cause inflammation, ulceration and bleeding of the small and large bowel due to bacteria invasion. how would you treat?

A
  1. Fluid replacement
  2. Macrolides - severe and persistent
  3. Ciprofloxacin or gentamicin for invasive
79
Q

Where does shigella act?
S. sonnei, S. boydii, S. flexneri, S. dysenteriae
initially watery diarrhoea - bloody

A

Attaches to and colonises the mucosal epithelium of the terminal ileum and colon. Produces a protein exotoxin (shiva toxin) damaging intestinal ep and glomerular endothelium - renal failure - HUS

Third year (15 decks)

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