1
Q
Antibiotics used for multi-drug resistant TB
A
Bedaquiline, pretomanid, and linezolid
Bedaquiline - diarylquinolines (inhibits ATP synthase enzyme)
Pretomanid - inhibits the biosynthesis of mycolic acids, a crucial component of the mycobacterial cell wall
Linezolid - inhibiting bacterial protein synthesis, specifically by binding to a unique site on the bacterial 23S ribosomal RNA of the 50S subunit
2
Q
Which carbapenem has no activity against pseudomonas
A
Ertapenem
3
Q
Linezolid mechanism of resistance
A
Efflux pump
4
Q
Strep pneumoniae, MRSA, Coag negative staph - mechanism of resistance
A
Alteration of target - penicillin binding protein (which crosslinks peptidoglycan cell wall), less affinity.
5
Q
Daptomycin and pulmonary surfactant
A
Daptomycin is not useful in pneumonia - inactivated by pulmonary surfactant
6
Q
Meningitis Anti-Microbial Therapy
Strep pneumoniae:
A
Use benzylpenicillin for susceptible strains with MIC
Use ceftriaxone or cefotaxime for susceptible strains with MIC <1.0mg/L.
For strains of penicillin MIC 0.125mg/L or greater and ceftriaxone or cefotaxime MIC 1.0 to 2.0 mg/L, use either ceftriaxone or cefotaxime PLUS vancomycin.
7
Q
Meningitis Anti-Microbial Therapy
Neisseria Menigitis
In penicillin allergy
A
Neisseria meningitidis: Use benzylpenicillin. For patient who is hypersensitive to penicillin, use IV ceftriaxone or IV cefotaxime. For patients with immediate penicillin or cephalosporin hypersensitivity, use IV ciprofloxacin OR IV chloramphenicol.
8
Q
Meningitis Anti-Microbial Therapy
Listeria monocytogenes:- in penicillin resistance
A
Use benzylpenicillin In patients hypersensitive to penicillin, use trimethoprim + sulfamethoxazole.
9
Q
Haemophilus Influenzae Mechanism of Resistance
A
Beta lactamase production
10
Q
Treatment of Giardia
A
Tinidazole
11
Q
Candida treatment if not Albicans
A
Echinocandins (capsofungin) or amphotericin B
12
Q
CCR5 Delta 32 allele
A
associated with slower disease progression to AIDS in HIV-infected individuals.
homozygous state (having two copies of the mutated gene) that is associated with a high level of protection against HIV infection
13
Q
Which bacteria is strongly linked with IE
A
Strep gallolyticus
14
Q
Most common cause of cellulitis
A
Group A Strep
15
Q
Toll Like receptors
Peptidoglycan
LPS
Flagellin
A
Peptidoglycan - TLR2
LPS - TLR4
Flagellin - TLR 5
16
Q
Causes of hepatic abscess
A
Pyogenic liver abscess
Hydatid disease (daughter lesions)
Entamoeba
17
Q
Most sensitive way to test for typhoid
A
Bone marrow culture
18
Q
What infective condition does this?
Aseptic meningitis
Kidney failure
Hepatic failure
Pulmonary haemorrhage
A
Leptospirosis
19
Q
Severe malaria definition
A
Blood parasite >2%
AKI metabolic acidosis, oliguria, jaundice
20
Q
What to check before giving primaquine
A
G6PD deficiency
21
Q
Which mosquito carries
- malaria
- Zika
- dengue
A
- malaria: Anopheles
- Zika and dengue: Aedes
22
Q
Differentiating between Zika and Chikungunya
A
Chikungunya has joint symptoms - arthralgia
23
Q
Definitions:
Multidrug resistant TB
Extensively drug resistant TB
A
24
Q
IGRA vs TST
A
IGRA doesn’t cross react with past BCG vaccination
TST can cross react with previous exposure to NTM and BCG
25
%life time risk of reactivation of latent TB
5-15%
26
Van A vs Van B VRE
Van A is resistant to Teicoplanin
27
Caving - which infectious condition can you get
Histoplasmosis
28
Bats transmit which disease
Lyssa virus
29
Wading in a rice paddy - which infectious condition
Leptospirosis
30
Living near pigs
Japanese encephalitis
31
Archaeological dig
Coccidioides
32
R0
Average number of people that a single infected person can be expected to transmit the disease to
33
Disseminated cysticerocosis
34
What malaria persists in the liver
P vivax and p ovale
35
Malaria ICT is validatated in:
Disadvantage:
P vivax and falciparum
Disadvantage:
False positive with rheumatoid factor
Persistent antigenaemia after eradication of blood stage parasites
36
Malaria LAMP PCR disadvantage
Can’t distinguish between species
37
Severe malaria treatment from Greater Mekong Subregion (basically SEA)
combination IV artesunate + IV Quinine
38
Uncomplicated falciparum malaria management
39
Vivax and ovale - second stage antibiotic
Primaquine (test G6PD first)
40
Vivax and ovale - second stage antibiotic
Primaquine (test G6PD first)
41
What type of virus is dengue
Flavivirus
42
Which type of Hepatitis Virus is Hep B
DNA virus
43
What type of virus is COVID
rna
44
Critical period for dengue
D3-D6
45
Treatment of Entamoeba
Metronidazole
With luminal agent to clear bowel parasites paramyomycin
46
47
Gram positive
48
Gram positive bacteria
49
Gram negative bacteria
50
Gram negative bacteria
51
Necrotising fasciitis types
52
Treatment of toxic shock syndrome
Remove source
IV benpen (directed)
IV clindamycin (anti toxin)
Toxin binding (IVIG)
53
Antibiotics in E Coli O157
Avoid antibiotics and antimotility agents
( increases shiga toxin release )
54
Botulism treatment
Botulism anti toxin (doesn’t reverse current symptoms)
55
C Diff monoclonal antibody
Bezlotoxumab
56
tetanus treatments (clostrifium tetani)
Tetanus antitoxin
57
Mechanism of botulism
Inhibits pre synaptic neurotransmitter release
58
Opsithorchis viverinni is linked to which cancer
Cholangiocarcinoma
59
Opsithorchis viverinni is linked to which cancer
Cholangiocarcinoma
60
MRSA mechanism of resistance
Penicillin binding protein changes
61
Enterococcus faecium resistance
Change in peptidoglycan component D-ala-D-lac
62
van A vs Van B
Van A - teicoplanin resistant
Van B - teicoplanin sensitive
(A/B Plasmid transfer , Van C is chromosomal)
63
ESBL, AmpC, carbapenemase mechanism of resistance
Beta lactamase production
64
POEM trial for infective endocarditis
Step down to oral after 10 days of IV
65
IE Prophylaxis
66
A
67
Meningitis treatment
IV ceftriaxone + IV Benpen + IV dex
68
Evidence for dexamethasone in meningitis - which organism
Step pneumoniae
69
How do you get Neurocystercercosis (Taenia solium)
Eating eggs of pork tape worm
70
Cellulitis organisms
1) salt water
2) fresh water
3) animal bites
1) Vibrio spp
2) Aeromonas spp
3) pasturella multocida, Capnocytophaga spp
71
Which antibiotic can cause lactic acidosis and serotonin syndrome
Linezolid
72
73
Which antibiotic can causes SJS TENS
Bactrim
74
Carbapenem and sodium valproate interaction
Contraindicated as reduction of valproate levels
75
Which antimicrobials affect CYP3A4
Rifampicin
Azoles
76
Which antibiotic can you not take with mg and calcium
Tetracyclines
Quinolones
77
What precautions for measles and chicken pox
Airborne
78
Mollarets meningitis
Recurrent benign lymphocytic meningitis caused by HSV2
79
EBNA (EBV nuclear antigen) in EBV infection
Positive from week 5 of infection
Think old infection (positive for 7 months)
80
New treatments for CMV
Prophylaxis - Letermovir
Salvage - Maribavir
81
CMV in pregnancy
- screening
- transmission risk
1st trimester routine screening not recommended
30% transmission in primary CMV, of these 10-15% will develop symptomatic congenital CMV
82
Antigenic drift vs shift
83
Measles viral structure
Single stranded RNA virus
Mobili virus of the paramyxoviridae family
84
Timing of vaccinations for elective and emergency splenectomy
7-14 days prior, and at least 7 days after
85
Pregnancy vaccines
Pertussis
influenza
RSV
86
Shingles Shingrix vaccine
Type of vaccine
Recombinant subunit (not live attenuated) - but does not protect against chicken pox
Zostavax - older one is live attenuated
87
What should you do if you give live attenuated VZV vaccine to immunocompromised patient
Pre emptive anti viral therapy or VZV IGS
88
Who gets RSV Vaccine
89
Voriconazole side effect
Visual hallucinations
LFT
QTc
Enzyme induction
90
Which anti fungal for systemic Candida infections
Echninocandins
Eg Anidulafungin
91
Amphotericin B side effect
Nephrotoxicity
92
Cryptococcus gatii
Tropical eucalyptus trees
93
Aspergillosis
- prophylaxis
- treatment
Prophylaxis: Posoconazole
Treatment: Voriconazole
94
Syphyllis tests
95
Most common form of disseminated gonorrhoeal infection
Gonococcal arthritis
96
Treatment of gonorrhoeal now
IV ceftriaxone and azithromycin (dual therapy now)
97
Chlamydia treatment
Doxycycline 100 mg BD for 7 days or azithromycin 1g stat
98
PID treatment
Empirical
iv ceftriaxone + doxycycline (azithromycin if severe) + metronidazole
99
DoxyPREP
200 mg of doxycycline within 72 hours of condomless sex
100
TORCH infection - what does it stand for
101
Latent TB management in those undergoing TNFi
Rifampicin and isoniazid equally effective Start TNFi after one month of treatment
102
Cryptosporidium usual treatment
Just observe
If needing to treat, Nitazoxanide
103
TB usual regimen
2 months RIPE, followed by
4 months RI (6 total)
104
Type of Brucella in Australia
Brucella suis from pigs - high risk of infection among feral pig hunters
105
Who is eligible for RSV vaccine
Over 60 and pregnant women between 24-36 weeks and
106
Syphilis screening in pregnancy
Routine booming and at 26-28 weeks, repeat testing in high risk individuals
107
MPOX vaccine use
Can be both primary and PEV
108
Severe MPOX treatment
Tecovirimat can be used for severe cases
109
How is measles diagnosed
Measles PCR On NP or throat swab
Serology limited utilisation in immunised hosts
110
cabotegravir and rilpivirine (CAB + RPV) - what is it used for?
Long acting HIV treatment
111
Diarrhoea illnesses which can cause sepsis and skin disease
Vibrio vulnificus and clostridium perfringens
112
Mechanism of Ceftriaxone resistance in Enterobacter Clocae
AmpC
113
Mechanism of E Coli resistant to Ceftriaxone
ESBL
114
Mechanism of resistance MRSA
Penicillin binding protein changes
115
Campylobacter Jejuni gram stain
Gram negative curved rod
116
Grocott gomori stain
Used for fungus - candida
117
Immunocompetent exposure for measles
Vaccination within 72 hours
IVIG if immunocompromised as no specific Ig exists
118
Cyst with dot sign in Neurocysticercosis
119
Pfizer vaccine contraindicated in which allergy
PEG allergy
120
25-year-old male is diagnosed with MSSA native valve endocarditis with a perivalvular abscess. He is commenced on IV flucloxacillin. What is the optimal duration of treatment?
6 weeks for complicated infection
4 weeks for uncomplicated infection
121
What is the most likely long-term consequence of steroid therapy?
VZV
122
Splenectomy vaccination schedule
123
Polysaccharide vs conjugate vaccine
124
Rifampicin mutation conferring resistance
RpoB
125
Isoniazid mutation conferring resistance
KATG
126
HIV 1 vs 2 in terms of treatment
HIV 2 is resistant to NNRTIs
127
Components of new HIV injectable drugs
Cabotegravir + Rilpivirine
128
129
Antibiotic for amoebiasis
1)Initial therapy
2)luminal cysts
1) metronidazole /tindazole (2nd line chloroquine)
2) Paramomycin
130
Disseminated candidasis
IV amphotericin
131
Treatment of cryptococcal meningitis
Amphotericin + flucytosine (improves CNS penetration)
132
HLA B5701 and HIV meds
Don’t give Abacavir
133
Which medication to give with protease inhibitor
Ritonavir - potent inhibitor which will increase protease inhibitor levels
134
New injectable HIV drug cabitegovir + rilpivirine
Who is not a candidate
Can’t use as initiation drug
Pregnancy
NNRTI resistance
135
Breastfeeding and HIV
Not recommended
136
How many hours does Norovirus infection require isolation
48 hours
137
Which tenofovir is bad in terms of renal toxicity and bone density loss
TDF
(TAF a for alternative had minimal effect on renal function and bone density)
138
Which tenofovir is bad in terms of renal toxicity and bone density loss
TDF
(TAF a for alternative had minimal effect on renal function and bone density)
139
How does post exposure prophylaxis work?
72 hours after exposure, for 28 days
140
HIV testing
Which tests for screening and which one for confirmatory
141
Gene mutations
MecA
CTX-M
Van A
gyrA
MecA = MRSA
CTX = ESBL
Van A = vancomycin resistance
GyrA= quinolone resistance
142
Treatment of invasive fungal sinusitis
Amphotericin B
143
Liposomal amphotericin B advantage over standard
Less nephrotoxicity, fewer reactions ( targeted delivery liposomes)
Favoured if higher dose needed / renal impairment
144
Common but not AIDS defining illness
VZV
Oral candida (without oesphageal)
CAP <2/year
HSV <1 month
145
Buy AT 30 Cell at 50 (mnemonic)
Aminglycoside - bacteriocidal irreversible 30S binding
Tetracycline (doxy minocycline etc) - 30S inhibition
50S
Chloampehnicol
Erythromycin
Lincosamides
Linezolid
146
Artemether resistance gene
Kelch13
Particularly Mekong
Slower clearance + longer duration treatment
147
Enteric fever with travel to Pakistan - what treatment?
Meropenem ( otherwise ceftriaxone 2g daily)
148
Vaccinations for splenectomy
149
Which vaccines contain egg
Influenza
MMR
yellow fever
Qfever
Rabies
150
What anti fungal to use for invasive pulmonary aspergillosis
Voriconazole preferred
151
MRSA mechanism of action
Penicillin binding proteins (required for cell wall synthesis) are inactivated by beta lactams
MecA Gene encodes PBP2a which has lower affinity to beta lactams
152
Enteric fever - what to give if patient travelled to Pakistan
Meropenem 1g IV 8 hourly
153
Malaria chemoprophylaxis options
154
Lifecycle of Malaria
155
What pneumonia can you get from soil and compost
Legionella longbeachae
156
Treatment of Primary, Secondary (early and late), tertiary syphilis
Primary, Secondary, and Early Latent Syphilis (<12 months)
First-line therapy
- Benzathine penicillin G 2.4 million units IM × 1 dose
Late Latent Syphilis (>12 months)
- Benzathine penicillin G 2.4 million units IM weekly × 3 doses
(total of 7.2 million units)
Tertiary Syphilis (Gummatous or Cardiovascular)
- Benzathine penicillin G 2.4 million units IM weekly × 3 doses
Neurosyphilis, Ocular, or Otic Syphilis (for completeness)
Aqueous crystalline penicillin G 18–24 million units/day IV, given as, 10-14 days
157
Dengue shock
Binding of antibodies but non neutralising
Tnf-alpha
Drives permeability
Endothelial leak
158
Types of Nec Fasciitis
1) Polymicrobial
2) GAS
3) vibrio gram negative
4) fungal
159
Tetanus guidelines
If immunodeficiency or unclear vaccine = Ig + Vaccine
If >5 years and <10 years clean = no vaccine
If not clean or >10 years = vaccine
160
Amantadine MOA
Inhibits viral M2 protein
Prevents viral uncoating and releasing genetic material into host cell
161
Oseltamivir
Neuraminidase inhibitor
Prevents new visions exiting the host cell
162
Empirical therapy for neutropenic fever
Piptaz
If septic = add gentamicin
If MRSA = add vancomycin
163
Aminoglycoside toxicity - amikacin vs gentamicin
Gentamicin = more vestibular
Amikacin = more cochlear (high frequency hearing loss)
164
Who would be a candidate for MSSA decolonization, and when would you do this?
Recurrent MSSA soft tissue and skin infection
Ideally do mupirocin 2% decolonization after boils have resolved
165
Salmonella Typhi recent travel to Pakistan
XDR salmonella
Avoid ceftriaxone
Meropenem Or Azithromycin
166
Which ART drug leads to rise in Cr?
Dolutegravir inhibits Cr secretion
167
Negative pressure isolation
Measles
TB
Disseminated VZV
168
Most common parasitic cause of eosinophilic meningitis
Angiostrongylus cantonensis
169
Orbital cellulitis treatment
IC ceftriaxone and IV fluclox
170
Gram positive beaded branching bacilli
Nocardia
Elly FRACP
flashcards
Decks in class (17)
# Cards
-
ECG13
-
Echo4
-
Cardiology Questions149
-
Endocrine Questions152
-
Gastro Questions125
-
Geriatric Questions23
-
Haematology Questions85
-
ID Questions170
-
Neurology Questions150
-
Oncology113
-
Renal Questions132
-
Respiratory Questions108
-
Rheum Questions84
-
Genetics28
-
Statistics21
-
Immunology Questions42
-
Pharmacokinetics29
