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Microbiology Flashcards

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1
Q

Gram positive bacteria have a ? proteoglycan cell wall and stain ? with Gram stain

A

thick proteoglycan cell wall

purple

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2
Q

Gram negative bacteria have a ? proteoglycan cell wall and stain ? with Gram stain

A

thin proteoglycan cell wall

pink

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3
Q

Classification of antimicrobial agents? (6)

A
  1. inhibit cell wall synthesis
  2. inhibit protein synthesis
  3. inhibit DNA synthesis
  4. inhibit RNA synthesis
  5. cell membrane toxin
  6. inhibit folate metabolism
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4
Q

Types of antimicrobials that inhibit cell wall synthesis? (2)

A
  1. B lactams

2. Gycopeptides

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5
Q

How do B lactams work?

A
  • inhibit the enzymes responsible for building the proteoglycan cell wall of the bacteria i.e. penicillin binding protein
  • bacteriocidal - prevents peptide cross linking thus daughter cells are weaker and lyse when they divide
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6
Q

Which bacteria are B lactam effective against?

Which bacteria are B lactam ineffective against?

A

a) gram +, gram -, enterococci

b) mycoplasma, chlamydia

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7
Q

Resistance against B lactams?

A

production of B lactamase

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8
Q

Penicillin

  • which organisms?
  • resistance?
A

Gram +

Broken down by B lactamase produced by Staph aureus

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9
Q

Amoxicillin

  • broad or narrow?
  • which organisms?
  • resistance?
A

Broad spectrum Penicillin
Gram + Gram - Enterococci
Broken down by B lactamase produced by Staph aureus

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10
Q

Flucloxacillin

  • broad or narrow?
  • which organisms?
  • resistance?
A
  • narrow spectrum penicillin
  • Gram +
  • stable to B lactamase produced by Staph aureus
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11
Q

Piperacillin

  • which organisms?
  • resistance?
  • example with Tazobactam?
A

Gram + Gram - Pseudomonas
Broken down by B lactamase produced by Staph aureus
Tazocin

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12
Q

What are Clavulanic Acid and Tazobactam?

A

B-lactamase inhibitors
Protect penicillins from B lactamase produced by Staph aureus
Allows broader spectrum

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13
Q

Examples of B lactams? (3)

A
  1. Penicillins
  2. Cephalosporins
  3. Carbepenems
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14
Q

Cephalexin

- type of B lactam

A

First generation cephalosporin

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15
Q

Cefuroxime

  • type of B lactam
  • resistance
A

Second generation cephalosporin

Stable to many B lacatamases produced by Gram -

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16
Q

Ceftriaxone

  • type of B lactam
  • broad or narrow?
  • which organisms?
  • association
  • # 1 use
A 
Third generation cephalosporin 
Broad
Gram + Staph & Strep 
C difficile 
Meningitis first line
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17
Q

Cephtazidime

  • type of B lactam
  • which organisms?
A

Third generation cephalosporin

Pseudomonas

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18
Q

Extended Spectrum B Lactamases?

A

Organisms producing these are resistant to ALL cephalosporins

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19
Q

Carbepenems

  • resistance
  • broad or narrow?
  • examples (3)
A 
Resistant to Extended Spectrum B Lactamases 
Broad spectrum 
1. Meropenem 
2. Imipenem 
3. Ertapenem
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20
Q

Key features of B Lactams (5)

A
  1. Non-toxic
  2. Renally excreted (low dose is renal impairment)
  3. Short half life (multiple daily doses)
  4. Do NOT cross BBB
  5. Cross-allergenic (if allergic to Penicillin 10% cross reactivity with Cephallosporins and Carbepenems)
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21
Q

Glycopeptides

  • how do they work?
  • which organism
  • side effect
A

Inhibit cell wall synthesis
Gram - only
Nephrotoxic therefore drug level must be monitored

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22
Q

Vancomycin

  • Class of Abx?
  • use?
A

Glycopeptide

C difficile

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23
Q

Aminoglycosides

  • mode of action?
  • binding site
  • toxicity? (2)
  • which organism?
A
  • inhibit protein synthesis
  • 30s ribosomal subunit
    1. ototoxic
    2. nephrotoxic
    Gram -ve
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24
Q

Gentamycin

  • Class of abx?
  • organisms?
  • use
A

Aminoglycoside
Gram - especially Pseudomonas
Gram - sepsis

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25
Tetracylines - mode of action? - binding site - contraindications (2) - which organisms? (3) - association
- inhibit protein synthesis - 30s ribosomal subunit 1. children 2. pregnant women 1. chlamydia 2. rickettsiae 3. mycoplasma - light-sensitive rash
26
Doxycyline - class of Abx? - organisms?
- Tetracycline | - intracellular chlamydia
27
Macrolide - mode of action? - binding site - which organisms? - indication
inhibit protein synthesis 50s subunit of ribosome Gram + (Staph, Strep) Pen allergic
28
Erythromycin - class of Abx? - organisms? (2)
Macrolide 1. Staph 2. Strep
29
Chloramphenicol - mode of action? - binding site? - broad or narrow? - associations (2) - uses (2) - avoid
- inhibit protein synthesis - peptidyl transferase of 50s ribosomal subunit - very broad 1. aplastic anemia 2. grey baby syndrome 1. bacterial conjunctivitis 2. Genuine Pen allergy - meningitis - systemic use due to risk of aplastic anaemia
30
Oxazolidinones - mode of action? - binding site - which organisms? - indication - example - association
- inhibit protein synthesis - 23s of 50s ribosomal subunit - Gram + - MRSE VRE - Linezolid - thrombocytopenia after prolonged use
31
Quinolones - mode of action - binding site - which organisms? - broad or narrow? - indications (3) - examples (3)
- inhibit DNA synthesis - a-subunit of DNA gyrase - Gram -ve - broad 1. UTI 2. Pneumonia 3. atypical pneumonia 1. Ciprofloxacin 2. Levofloxacin 3. Moxifloxacin
32
Nitroimidazoles - mode of action - broad or narrow? - which organisms? (2) - examples (2) - indication - related
- inhibit DNA synthesis - narrow 1. anaerobic 2. protozoa 1. Metronidazole 2. Tinidazole Giardia Nitrofuratoin - UTI
33
Rifamycins - mode of action - binding site - which organisms? - indication - examples (2)
- inhibit protein synthesis - RNA polymerase - mycobacteria - TB 1. Rifampicin 2. Rifabutin
34
Rifampacin - class of Abx - use - drug interactions (2) - monitoring required - side effects - resistance
- Rifamycin - TB 1. OCP 2. Warfarin - LFTs - orange bodily secretions - rapid resistance whereby chromosomal mutation changes B-subunit so that Rifampacin can't bind to RNA polymerase
35
Daptomycin - mode of action - organisms - indications (2)
- cell membrane toxin - Gram +ve 1. MRSA 2. VRE
36
Colistin - mode of action - organisms - indications - administered by - toxicity
- cell membrane toxin - Gram -ve - multi-drug resistant organisms - IV only - nephrotoxic
37
Sulfonamides - mode of action - indication - used in conjunction with - toxicity - example
- inhibit folate metabolism - PCP - Trimethroprim - teratogenic - Sulphamethoxazole
38
Diaminopyrimidines - mode of action - indication - toxicity - example
- inhibit folate metabolism - community acquire UTI - teratogenic - Trimethroprim
39
Mechanisms of Abx resistance? (4)
BEAT 1. Bypass Abx sensitive step 2. Enzyme-mediated drug inactivtion e.g. B-lactamase 3. Accumulation inhibition a) impaired uptake b) increased efflux 4. Target altered in microbe
40
Major mechanism of resistance to B Lactams? | - example organisms (2)
Enzyme-mediated inactivation 1. Staph aureus 2. Gram -ve bacilli
41
Mechanism of resistance in MRSA?
Methicillin-Resistant Staph Aureus | Altered target, PBPs now have a low affinity for B Lactams
42
Mechanism of resisatnce of Strep pneumonniae?
Altered target, lowered affinity for B lactams | Can be overcome by increasing dose
43
Common organisms with Extended Spectrum B Lactamases? (2)
1. E coli | 2. Klebsiella
44
Which ABX? | Staph aureus
Flucloxacilin (unless allergy)
45
Which ABX? | Strep throat
Benzylpenicillin
46
Which ABX? | CAP (mild)
Amoxicillin
47
Which ABX? | CAP (severe)
Cefuroxime + Clarithromycin
48
Which ABX? | HAP
Cefuroxime
49
``` Which ABX? Bacterial meningitis (Meningococcus/Strep) ```
Ceftriaxione
50
``` Which ABX? Bacterial meningitis (Listeria) ```
Amoxicillin + Ceftriaxone
51
Which ABX? | UTI (community)
Trimethroprim
52
Which ABX? | UTI (hospital)
Augmentin or Cephalexin
53
Which ABX? | Sepsis (severe)
Cefuroxime Metronidazole Gent
54
Which ABX? | Neutropenic sepsis
Tazocin + Gentamycin
55
Which ABX? | Collitis (C diff)
Metronidazole
56
Natural reservoir of Influenza A (H1)
ducks
57
Natural reservoir of Influenza A (H1N1)
pigs
58
Who receives trivalent flu vaccine? | - type of vaccine?
At risk populations (health workers) Inactivated purified HA + NA rich
59
Who receives quadrivalent flu vaccine? | - type of vaccine?
Children Live attenuated vaccine HA rich
60
Why does influenza cause a respiratory illness? (4)
1. sialic acid is only expressed 2. virus enters through the mouth 3. virus is activated by proteases expressed in the mouth 4. can only fuse with mucus secreting cells
61
Where in the lungs can influenza virus survive?
LRTI not URTI as does not replicate well at low temperatures
62
Surface glycoproteins of influenza virus (2) - cause of seasonal variation?
1. NA neuraminidase activity - cleaves sialic acid to allow virus to exit host cell 2. HA haemogglutinin activity - binds to sialic acid receptors allowing virus to attach to host cell and causes membrane fusion - RNA segments of the virus are prone to mutation hence variation in influenza virus to produced new strains
63
Antigenic Drift
mutation in HA/NA to give new strains of the virus therefore vaccine must be updated annually
64
Antigenic Shift - which strain? - how?
complete change of HA/NA - only happens with Influenza A - trading of RNA segments between human and animal strains
65
Protease that activates influenza virus?
clara tryptase
66
Severe outcomes of the flu? (4)
1. secondary bacterial pneumonia 2. mutant virus 3. co-morbidity 4. cytokine storm (H5N1)
67
Antivirals for flu? (3)
1. Amantadine 2. Tamiflu 3. Oseltamivir 4. Zanamivir
68
Mechanism of Amantadine/Rimantidine? | - which strain?
M2 ion channel inihibitor | Influenza A
69
Mechanism of Oseltamivir/Zanamivir? - which one is oral? - which one is inhaled powder/IV? - which strain? - who is treated?
``` Neuraminidase inhibitors Oseltamivir - oral Zanamivir - IV/inhaled powder Influenza A & B High risk groups ``` ``` Aged ≥ 65 years Immunosuppressed Chronic respiratory disease Chronic heart disease Chronic liver disease Chronic neurological disease Diabetes mellitus Pregnant women Morbid obesity (BMI ≥ 40) Children ```
70
MIC
Minimum Inhibitory Concentration | How much abx is required to inhibit growth of organism in a test tube
71
Bacteriuria
presence of bacteria in urine
72
Cystitis
inflammation of the bladder, normally caused by infection
73
Uncomplicated UTI
Presence of UTI in functionally/structurally normal urinary system
74
Complicated UTI
Presence of UTI in functionally/structurally abnormal tract
75
Why does obstruction increase likelihood of UTI?
inhibits flow of urine, stasis of urine, increased chance of infection
76
Causes of obstruction within urinary tract a) Extrarenal (5) b) Intrarenal (6)
Extrarenal 1. Valves 2. Stenosis 3. Bands 4. Calculi 5. Ureteral compression e.g. BPH Intrarenal 1. nephorcalcinosis 2. uric acid nepropathy 3. analgesic nephropathy 4. PKD 5. hypokalaemic nephropathy 6. intrarenal lesions of sickle cell trait/disease
77
Neurogenic causes of urinary obstruction? (4)
1. poliomyelitis 2. tabes dorsalis (syphilis) 3. diabetic nephropathy 4. spinal cord injuries
78
Most common bacteria causing UTI?
E coli
79
Other bugs causing UTI? (5)
1. Proteus fimbriae 2. Klebsiella 3. Staph epidermis 4. Staph saprophyticus 5. Enterococcus faecalis
80
Routes of infection of UTI (2)
1. contamination from rectum | 2. haematogenous route
81
Symptom of UTI (6)
1. frequency 2. dysuria 3. abdo pain 4. flank pain 5. fever 6. vomiting
82
Investigation of UTI (4)
1. urine dipstick ( nitrites, leukocytes) 2. MSU MC+S 3. Bloods - FBC, U+Es, CRP 4. Renal USS
83
Which of the following cell types on microscopy suggests a poorly taken sample. 1. White blood cells 2. Squamous epithelial cells 3. Red blood cells
Squamous epithelial cells
84
Treatment for uncomplicated lower urinary tract infection in women?
Trimethroprim 3/7
85
Treatment of UTI in women with previous history of UTIs or men?
Nitrofuratoin 7/7
86
Treatment of pyelonephritis?
Co-amoxiclav + Gentamycin
87
Pathogenesis of CNS infection (4)
1. haematogenous spread 2. direct infection 3. PNS to CNS 4. local extension
88
Common organisms causing bacterial meningitis (2)
1. N.meningitidis (Gram -ve) | 2. Step pneumoniae (Gram +ve)
89
Common organisms causing bacterial meningitis in neonates? (3)
1. Group B Strep 2. Listeria 3. E coli
90
Common organisms causing bacterial meningitis in elderly? (3)
1. Group B Strep 2. Listeria 3. TB
91
Symptoms of bacterial meningitis? (8)
1. headache 2. neck stiffness 3. fever 4. focal neurology 5. rash 6. photophobia 7. irritability 8. vomiting
92
Common organisms causing viral meningitis? (3)
1. Coxsackie 2. Mumps 3. HSV 2
93
Organism causing fungal meningitis?
Cryptococcus neoformans
94
Meningococcal septicaemia - percentage - clinical spectrum (4)
- 40% 1. capillary leak - hypoalbuminaemia 2. coagulopathy 3. metabolic derangement 4. myocardial failure
95
Likely organisms causing chronic meningitis? (2)
1. TB | 2. Cryptococcus
96
Encephalitis | - transmission
inflammation of brain parenchyma | person to person or through vectors e.g. ticks
97
leading cause of encephalitis internationally?
Western Nile Virus
98
Treatent of meningoencephalitis?
Ceftriaxone + Acyclovir
99
Normal CSF Levels in adult WCC Protein Glucose
0 - 5 0. 15 - 0.4 2. 2 - 3.3
100
CSF levels in bacterial meningitis? WCC Glucose
HIGH with polymorphs | LOW
101
CSF levels in viral meningitis? WCC Glucose
HIGH with mononuclear cells | Normal
102
CSF levels in TB/cryptococcus meningitis? WCC Protein
HIGH with mononuclear cells | HIGH
103
Pathophysiology of cerebral abscess? (5)
1. otitis media 2. mastoiditis 3. paranasal sinuses 4. endocarditis 5. haematogenously
104
Pathophysiology of spinal infection (3)
1. open spinal trauma 2. infection in adjacent structures 3. haematologenously
105
Risk factors for spinal infection (7)
1. age 2. IVDU 3. DM 4. transplantation 5. long-term steroids 6. malignancy 7. malnutrition
106
Hepatitis A - type of virus - immunoglobulin associated with acute infection - immunoglobulin associated with previous vaccination - diagnosis - transmission - incubation - symptoms (7) - EMQ (3)
``` RNA virus IgM IgG Anti-HAV IgM fecal-oral 2-6 weeks ``` 1. fatigue 2. low grade fever 3. diarrhoea 4. nausea 5. pruritis 6. jaundice 7. arthralgia 1. undercooked fish 2. South East Asia 3. Mardi Gras
107
Hepatitis B - type of virus - transmission (3) - acute/chronic - incubation - lab findings
dsDNA virus 1. sexual 2. vertical 3. blood products Acute 6/12 2 - 6 months increased AST, increased ALT due to liver inflammation
108
``` Hepatitis B - diagnosis HBsAg HBeAg HBcAb IgM HBcAb IgG HBsAb ```
``` HBsAg - active infection marker HBeAg - high level of viral replication HBcAb IgM - recent infection HBcAb IgG - exposure to HBV/chronic infection HBsAb - immunity HBV vaccination ```
109
Complications of HBV (3)
1. Fibrosis 2. Cirrhosis 3. HCC
110
Treatment of HBV (3)
1. IFN alpha - can clear virus 2. Lamivudine - can suppress viral replication 3. Tenofovir - can suppress viral replication
111
Hepatitis C - type of virus - transmission - acute/chronic - incubation - lab findings
``` RNA virus blood products 80% progress to chronic 2 weeks - 6 months ALT - responds to viral load ```
112
Hepatitis C diagnosis Anti - HCV HCV RNA Anti-HCV Ab
Anti - HCV - active infection HCV RNA - acute HCV Anti-HCV Ab - chronic HCV
113
Treatment of HCV (2)
1. Peg IFN - allows less drug to be given and is better tollerated, sustained response 2. Ribavirin
114
Complications of Hep C (2)
1. Cirrhosis | 2. HCC
115
Hepatitis D | - type of virus
ONLY if you already have HBV | RNA virus
116
Hepatitis E - type of virus - transmission - incubation - poor prognosis
RNA virus faecal-oral 3-8weeks pregnancy
117
Which organisms cause bloody diarrhoea? (5)
SECSY 1. Salmonella 2. E coli 3. Campylobacter 4. Shigella 5. Yersinia enterocolitis
118
Two viruses commonly causing GI infection in children?
1. Rotavirus | 2. Adenovirus
119
4 lab findings for Staph aureus
1. Catalase + 2. Coagulase + 3. Gram + 4. yellow colonies of blood agar, B haemolytic
120
Pathophysiology of Staph aureus as GI infection? - incubation - duration - transmission - treatment - aerobic/anaerobic?
- produces enterotoxin - release IL-1 IL-2 - prominent vomiting & watery non-bloody diarrhoea 2-7days
121
B.cereus - association - pathophysiology (3) - aerobic/anaerobic?
``` REHEATED RICE 2 spore toxins 1) heat stable - emetic causing 2) heat labile - diarrhoeal causing sudden vomiting + non-bloody diarrhoea ``` aerobic
122
Clostridium botulinum - associations (2) - pathophysiology (3) - symptoms - aerobic/anaerobic?
vaccum-packed/canned foods 1) honey - children 2) beans - students - ingestion of preformed toxin - blocks Ach release from peripheral nerves - paralysis descending paralysis anaerobic
123
Clostridium perfringens - association - pathophysiology (2) - incubation - symptoms (2) - aerobic/anaerobic?
- reheated meats 1. enterotoxin binds to TCR & MHC - massive cytokine release causing systemic toxicity - 8-16hrs 1. watery diarrhoea 2. cramps anaerobic
124
Clostridium difficile - who - why? - pathology - treatment - aerobic/non-aerobic?
- hospitalised patients - Abx therapy cephalosporins/fluorquinolones - pseuomembranous colitis - Stop Abx Metronidazole/Vancomycin - anaerobic
125
Listeria monocytogenes - susceptible cohorts? (2) - type of bacteria (2) - maternal concerns (3) - source of foods (3) - symptoms (5) - treatment
1. immunocompramised 2. pregnant women B haemolytic , tumbling mobility 1. miscarriage 2. stillborn 3. mental retardation of fetus 1. unpasteurised dairy products 2. pre-packaged meals 3. cured meats 1. watery diarrhoea 2. cramps 3. fever 4. headache 5. vomiting Ampicillin
126
Types of E.coli? (4)
ETEC EIEC EHEC EPEC
127
ETEC E.coli - what - who - 2 toxins - source
- Toxigenic - travellers diarrhoea 1. heat labile - stimulates adenyl cyclase & cAMP 2. heat stable - stimulates guanylate cyclase food/water contaminated with human faeces
128
EIEC - what - source
- Invasive dysentery | - food/water contaminated with human faeces
129
EHEC - what - source - cause - result
- Haemorrhagic - food/water contaminated with human faeces - verotoxin - HUS
130
EPEC - what - source - who - complication
- Pathogenic - food/water contaminated with human faeces - infantile diarrhoea - HUS
131
Typhoid/Enteric Fever - causative agent - multiplies where? - symptoms (2) - signs (5) - treatment
- salmonella typhi + paratyphi - Peyers patches 1. slow onset fever 2. constipation 1. bradycardia 2. splenomegaly 3. rose spots 4. anaemia 5. leukopenia - Ceftriaxone
132
Salmonella enteritides - association (3) - symptoms - treatment
1. poultry 2. eggs 3. meat bloody diarrhoea self-limiting/ceftriaxone
133
Dystenery - causative agent - enterotoxin - symptoms (3)
``` Shigella dysenteriae Shiga enterotoxin Invades mucosal cells of distal ileum and colon causing inflammtion 1. fever 2. pain 3. bloody diarrhoea ```
134
Vibriosis cholera - source - symptoms - pathophysiology - organism appearance
water contaminated with human faeces - SHELLFISH rice water diarrhoea cholera toxin causes cAMP to open Cl channels -> massive loss of electrolytes comma shaped
135
Campylobacter jejuni - sources (3) - organism appearance - duration - symptoms (4) - complications (3) - treatment
food/water contaminated with animal faeces 1. poultry 2. meat 3. unpasteurised milk can be up to 20days 1. fever 2. headache 3. severe abdo cramps 4. foul-smelling bloody diarrhoea 1. Reactive arthritis 2. Reiter's syndrome 3. Guillan Barre syndrome
136
What is Reiter's syndrome? (3)
1. arthritis 2. uvetitis 3. conjunctivitis
137
Yersinia - preference - source - associations (3)
- 4*C cold enrichment - food contaminated with domestic animals faeces 1. arthritis 2. necrotising granulomas 3. erythema nodosum
138
Diarrhoea causing protozoa (3)
1. Entamoeba histolytica 2. Giardia lamblia 3. Crystosporidium parvum
139
Entomoeba histolytica - EMQ hint - histology - symptoms (6) - treatment
``` men who have sex with men flask-shaped ulcer in colon 1. diarrhoea 2. flatulence 3. dysentery 4. tenesmus 5. weight loss 6. RUQ pain due to liver abscesses - Metronidazole ```
140
Giardia lamblia - EMQ hints (4) - histology - source - symptoms (4) - test - treatment
1. travellers 2. hikers 3. MSM 4. mental hospitals faecally contaminated water containing cysts 1. flatulence 2. foul-smelling non-bloody diarrhoea 3. cramps 4. malabsorption of protein & fat ELISA string test Metronidazole
141
Cryptosporidium parvum - who - where - test
- immunocompramised - jejenum - Kinyoun acid fast stain
142
``` Secretory Diarrhoea (2) - cause ```
1. no fever 2. no WCC in stool sample - enterotoxin causes massive cytokine production & supression of adaptive immune response
143
Inflammatory diarrhoea (2)
1. fever | 2. WCC in stool sample - neutrophils
144
Enteric fever (2)
1. fever | 2. WCC in stool sample - mononuclear cells
145
Viruses causing diarrhoea (5)
1. norovirus 2. enteroviruses 3. rotavirus 4. adenovirus 5. poliovirus
146
Rotavirus - who - type of virus - symptoms
- children - ds-DNA - secretory diarrhoea, massive cytokine production - low grade fever
147
Adenovirus - who - symptoms - which strains cause bloody diarrhoea?
- children - bloody diarrhoea - 40 and 41
148
Norovirus - who - immunity - outbreaks - predominant symptom
- adults - no lifelong immunity - high infectivity, high resilience - vomiting ++
149
Notifiable diarrhoea causing diseases (5)
1. Campylobacter 2. Clostridium difficile 3. Listeria 4. Virbrio cholera 5. Yersinia
150
Passive immunity
Transfer of immune effectors i.e. immunoglobulins e.g. HBIG, VZIG
151
Types of vaccine (5)
1. Immunoglobulin 2. Anti-toxins 3. Inactivated 4. Subunit 5. Live attenuated
152
Examples of live attenuated vaccines (6) - contraindicated - advantage
1. MMR 2. Rotavirus 3. Yellow fever 4. VZV 5. BCG 6. Polio - in pregnancy/immunosuppressed - act most like the real infection therefore give long-lasting immunity
153
Examples of inactivated vaccines (3)
1. Rabies 2. Hep A 3. HiB
154
Examples of subunit vaccines (2)
1. Influenza | 2. Typhoid
155
Examples of antitoxin (2)
1. Botulinum antitoxin | 2. Diptheria antitoxin
156
When to give VZIG?
used in susceptible pregnant women neonates or immunosuppressed patients exposed to chickenpox
157
When to give HBIG?
Prevention of HBV infection. Used in conjunction with vaccination
158
When to give NHIG?
prevention of HAV, rubella and polio infection (limited efficacy)
159
Patients with HIV should NOT receive which virus vaccine? a. Bacillus Calmette–Guérin (BCG) b. Measles, mumps, rubella (MMR) c. Hepatitis B vaccine d. Inactivated poliovirus vaccine e. Yellow fever vaccine
e. Yellow Fever
160
Whooping cough is caused by which species of bacteria? a. Bordatella pertussis b. Streptococcus pneumoniae c. Corynebacterium diphtheriae d. Corynebacterium ulcerans e. Haemophilus influenzae
a. Bordatella pertussis
161
Congenital rubella syndrome (CRS) - worst time - manifestations (4)
first trimester 1. cardiac 2. auditory 3. opthalmic 4. neurological
162
Purified polysaccharide pneumococcal vaccine activates B cells to produce which sort of immunoglobulin (Ig)? a. IgG b. IgA c. IgM d. IgE e. IgD
c. IgM
163
Mycobacterium tuberculosis | - description of bacteria (5)
1. slow growing 2. Gram + rods 3. non-motile 4. waxy cell wall with long-chain fatty acids 5. acid alcohol fast
164
2 acid fast stains
1. Ziehl-Neeson | 2. Auramine
165
What colour does AFB stain with ziehl-neeson?
Red
166
Non-tuberculous myocobacteria a) slow-growing (3) b) fast-growing (3) - source - transmission - association - treatment
1. M.avium 2. M.marinum 3. M.ulcerans 1. M.fortuitum 2. M.abscessus 3. M.chelonae - water & soil - no person to person - immunosuprression - little response to anti-TB
167
M.avium - children - immunossuppressed - underlying resp disease
children - pharyngitis & cervical adenitis immunossupressed - disseminated infection underlying bronchiectasis etc - pulmonary resembles TB
168
M.marinum - who - what
- swimming pool/aquarium owners | - single or clusters of papules/plaques over fingers/hands/elbows
169
M.Ulcerans - who - transmission - what
- Australia - insects - starts as painless nodules and develops into chronic, progressive ulcer
170
Fast-growing non-tuberculous mycobacterium - what - where
- skin and soft tissue infections | - hospital-setting e.g. catheters
171
Leprosy "Hansen's Disease" - causative organisms (2) - incubation - transmission - symptoms a) skin (5) b) nerves (2) c) eyes (2) d) bones (2) - treatment (3) - types (2)
1. M.leprae 2. M.lepromatosis 2-10 years nasal secretions a) depigmentation, macules, plaques, nodules, trophic ulcers b) thickened nerves, sensory neuropathy c) keratitis, iridocyclitis d) periositis, aseptic necrosis Rifampicin, Dapsone, Clofazimine 1. Paucibacillary/Tuberculoid 5 lesions
172
Most common opportunistic infection in HIV?
TB
173
Risk factors associated with TB incidence? (6)
1. migrants 2. IVDU 3. HIV+ 4. homelessness 5. prison 6. close contacts
174
Which strain does BCG vaccinate against? Efficacy? At risk populations who receive BCG? (2) Contraindicated?
M.bovis 80% 1. babies born in high areas of prevalence 2. unvaccinated new immigrants from high prevalence countries HIV patients
175
TB Disease process (2)
1. Primary TB - infection during childhood/elderly/HIV - asymptomatic - granuloma present 2. Post-primary - > 5 years after primary infection - re-activation/re-infection
176
Risk factors for reactivation of TB? (4)
1. immunosuppression 2. chronic alcohol excess 3. malnutrition 4. ageing
177
Characteristic feature of TB granuloma?
Langhan's giant cells
178
Progressive primary TB? (2)
1. LN ulcerates into bronchus causing pneumonia | 2. cavity formation causes bronchiectasis, consolidation & collapse
179
Miliary TB? (2)
1. progressive disease | 2. haematological spread
180
Pulmonary TB Presentation (6)
1. cough 2. haemoptysis 3. weight loss 4. fever 5. night sweats 6. malaise
181
Pulmonary TB signs (3)
1. Upper lobe consolidation 2. caseating granuloma 3. mediastinal lymph nodes
182
Extrapulmonary TB - percentage - signs & symptoms (8)
20% 1. lymphadentitis (cervical) "scrofula" 2. abscesses 3. pericarditis 4. perotinitis 5. ileitis 6. skin involvement 7. renal disease 8. genitourinary involvement
183
Spinal TB - percentage - presentation (4) - complications (2) - treatment
4% 1. weight loss 2. fever 3. sweats 4. back pain 1. vertebral collapse 2. ileopsoas abscess 12 months anti-TB
184
TB Meningitis - percentage - presentation (8) - investigation (2) - treatment
2% 1. headache 2. weight loss 3. malaise 4. fevers 5. sweats 6. neck stiffness 7. personality changes 8. focal neurology 1. LP - lymphocytic 2. CT - tuberculomata - 12 months anti-TB + steroids
185
Investigations in suspected TB a. imaging (2) b. cultures (3) c. sputum stains (2) d. histological features (4) e. skin tests (2) f. other (2)
a. CT, CXR b. sputum, bronchoalveolar lavage (BAL), urine (EMU) c. ziehl neeson, auramine d. gram + rods, acid fast, aerobic, intracellular e. heaf test, mantoux f. PCR assay, IFNgamma assay
186
First line treatment of TB | - dosing
``` RIPE Rifampycin Isoniazid Pyrazinamide Ethambutol ``` all 4 for 2/12 Rifampycin & Isoniazid for 4/12
187
Side effects of Rifampycin (2)
orange secretions | hepatotoxicity
188
Side effects of Isoniazid (2)
peripheral neuropathy | hepatotoxicity
189
Side effects of Pyrazinamide (2)
hyperuricaemia | hepatotoxicity
190
Side effects of Ethambutol (2)
optic neuritits | visual disturbances
191
Treatment schedule for TB Meningitis
all 4 for 2/12 | Rifampycin & Isoniazid for 8-10/12
192
Treatment for latent TB
6/12 Isoniazid
193
Second line treatment for TB? (6)
1. injectables (Capreomycin, Kanamycin, Amikacin) 2. Quinolones (Moxifloxacin) 3. Linelozid 4. PAS 5. Cycloserine 6. Clofazamine
194
Difficulties in viral selective toxicity? (2)
1. viruses are obligate intracellular parasites | 2. viruses use hosts enzymes for replication
195
How viruses are detected by the immune system? (2)
1. Pattern-recognition receptors (PRRs) recognise virus | 2. PRRs triggers innate immune response -> release of IFNs and restriction factors
196
Types of anti-viral therapy (3)
1. Selective toxicity 2. Immunomodulation 3. Direct-acting antivirals
197
Which ONE of the following statements about antiviral therapy is correct? a. Directly-acting antiviral drugs are the only effective treatments b. Supportive treatment is of no benefit c. Immunomodulation (e.g. interferon treatment) is effective against a single family of viruses d. Reduction of immune suppression may enhance viral clearance e. Selective toxicity cannot be achieved as viruses replicate inside host cells
d. Reduction of immune suppression may enhance viral clearance
198
Which strains of Herpes Simplex Virus are responsible for genital warts?
HSV-2 (80%)
199
What strain of HSV is responsible for cold sores (herpes lapialis)?
HSV-1
200
Herpes Simplex Encephalitis | - signs and symptoms
- no seasonal occurance, sporadic - Fits, fevers, Funny behaviour - Meninginism - headache, photophobia, neck stiffness, fever
201
VZV - presentation in children - presentation in adults - seasonal occurrence - infectivity - complications (2)
- generalised vesicular rash over trunk, face and arms - lesions of different stages papules/ulcers/blisters - dermatomal distribution not crossing midline - lesions are of similar stage Spring/summer 1-2days before rash onset until all lesions have crusted over 1. pneumonitis 2. disseminated infection
202
Treatment of HSV/VZV (3) | - mode of action
"Act Very Fast" Acyclovir Valaciclovir Famiclovir - target viral-encoded enzymes; thymidine kinase and DNA polymerase
203
Always treat VZV/HSV if... (4)
1. pregnant 2. immunocompramised 3. adults with pneumonitis 4. eye involvement
204
Treatment of orogenital HSV a) single episode b) normal c) immunocompramised
Single episode - supportive ACV 500mg x5 daily 5/7 vACV 500mg BD 5/7 Double dose in immunocompramised
205
Treatment of VZV a) normal b) immunocompramised
ACV 800mg x5 daily 5/7 vACV 1G tds 5/7 Immunocompramised IV ACV 10mg/kg 8hrly 5-7/7
206
Treatment of HSV encephalitis
IV ACV 10mg/kg 8hrly 14-21/7
207
The following statements are about treatment of herpesvirus infections. Choose the best answer. a. Oral ganciclovir is recommended to treat recurrent herpes genitalis b. Valaciclovir is recommended to treat HSV encephalitis c. IV aciclovir is recommended to treat uncomplicated chickenpox d. Valaciclovir is an oral pro-drug of aciclovir e. Famciclovir is an oral pro-drug of aciclovir
d. Valaciclovir is an oral pro-drug of aciclovir
208
Concerning the mode of action of aciclovir (ACV), which ONE of the following statements is correct? a. ACV directly inhibits viral thymidine kinase b. ACV is triphosphorylated by host cell kinase c. ACV directly inhibits viral DNA polymerase d. ACV is triphosphorylated by viral thymidine kinase e. ACV is monophosphorylated by viral thymidine kinase
e. ACV is monophosphorylated by viral thymidine kinase
209
A 42-year-old lady is admitted with a 2 day history of fever and confusion and presents with new onset seizures. What antiviral medication should she receive as soon as possible? Choose the best answer. a. Oral aciclovir b. IV foscarnet c. Oral valaciclovir d. IV ganciclovir e. IV aciclovir
e. IV aciclovir
210
CMV - what? (5) PERCH - where does it remain latent? - histology - common age groups affected (2) - common association
``` PERCH Pneumonitis Encephalitis Retinitis Colitis Hepatitis ``` monocytic cells, can reactivate in immunosupression Owls eye inclusions or nuclei of infected cells 1. children 1-4 yrs 2. > 65 yrs CMV infection after solid organ transplant or BMT
211
EBV - transmission - age group commonly affected - causes - signs (2) - association
- salivary - early teens - Glandular fever 1. exudative pharyngitis 2. atypical lymphocytosis - Burkitts lymphoma in immunosuppressed
212
Treatment of CMV (3)
1. Ganciclovir 2. Cidoflovir 3. Foscarnet
213
Mode of action of Ganciclovir
monophosphorylated by viral protein kinase, nucleoside analogue
214
Mode of action of Cidoflovir
di/triphosphorylated by cellular enzymes, nucleoside analogue
215
Mode of action of Foscarnet | - use
- inhibits nucleic acid synthesis without requiring activation - Prophylaxis post-organ transplant
216
Universal prophylaxis for all post-transplant patients?
Ganciclovir
217
Side effect associated with Ganciclovir?
bone marrow supression
218
The following statements concern the antiviral treatment of cytomegalovirus (CMV) infection. Choose the best answer. a. No treatment is required for uncomplicated infection b. IV ganciclovir should always be given c. IV aciclovir is effective d. Oral valganciclovir OD should be used initially e. IV foscarnet is highly myelosuppresive
a. No treatment is required for uncomplicated infection
219
Which of the following statements concerning the antiviral treatment of cytomegalovirus (CMV) infection is NOT correct? a. IV ganciclovir is effective b. Oral foscarnet is effective c. IV cidofovir is effective d. Maintenance therapy with oral valganciclovir can be used e. Ganciclovir can cause neutropenia
b. Oral foscarnet is effective
220
When to treat CMV? (4)
1. Congenital 2. immunocompramised 3. pregnancy 4. HIV
221
What organism causes sixth disease in children? - presentation (3) - complication
``` HHV-6 1. high fever +/- convulsions 2. coryzal symptoms 3. sudden rash "exanthum subitum" PINK / RED, MACULAR, CAN BE RAISED PATCHES, NON-ITCHY - HHV-6 encephalitis ```
222
Exanthum subitum is associated with what disease?
Sixth Disease
223
Which organism is associated with Karposi's sarcoma?
HHV-8
224
Presentation of Karposi's Sarcoma?
multiple raised red/violet macules
225
Types of Karposi's Sarcoma, who & prognosis (4)
1. Classical - middle aged men - indolent 2. Endemic - Africa - aggressive 3. Iatrogenic - immune suppression - atypical location 4. HIV - widespread - aggressive
226
Treatment of HHV - 8
1. Ganciclovir 2. Foscarnet 3. Cidofovir
227
Pathogenesis of drug resistance to Acyclovir? Which organism? Second-line?
1. Thymidine kinase mutation 2. DNA polymerase mutation HSV Foscarnet Cidofovir
228
Pathogenesis of drug resistance to Genciclovir? Which organism? Second-line?
1. Protein kinase mutation 2. DNA polymerase mutation CMV Foscarnet Cidofovir
229
The following statements concern resistance to antiviral drugs. Choose the best answer. a. Resistance of HSV to aciclovir is common b. Genotypic resistance testing is routinely used to detect resistance of CMV to ganciclovir c. Aciclovir resistance in HSV is most commonly mediated by mutations in the viral thymidine kinase d. Aciclovir resistance in HSV is most commonly mediated by mutations in the viral DNA polymerase e. Aciclovir-resistant HSV may be treated with ganciclovir
c. Aciclovir resistance in HSV is most commonly mediated by mutations in the viral thymidine kinase
230
Which ONE of the following statements concerning the treatment of influenza is NOT correct? a. Oseltamivir is effective for influenza B b. Oral zanamivir is effective c. Antiviral treatment can be given before the diagnosis is confirmed d. Amantadine is NOT effective for influenza A e. Supportive treatment is indicated for uncomplicated influenza
b. Oral zanamivir is effective
231
The following statements concern the antiviral drugs oseltamivir and zanamivir. Choose the best answer. a. Oseltamivir directly inhibits the influenza neuraminidase b. Zanamivir blocks binding of viral haemagglutinin to host cell sialic acid c. Oseltamivir inhibits influenza virus uncoating d. Zanamivir is usually given intravenously e. Zanamivir is usually given by nebuliser
a. Oseltamivir directly inhibits the influenza neuraminidase
232
A 82-year-old lady is in A&E on Christmas Eve with a 4 day history of fever, cough, myalgia and breathlessness. Her respiratory rate is 50 / min and her SaO2 is 88% when breathing air. In addition to empirical antibiotic therapy, what other drug(s) might be indicated right now? Choose the best answer. a. Oral amantadine b. Oral oseltamivir c. Zanamivir dry powder inhaler d. IV ribavirin e. Oral ibuprofen
b. Oral oseltamivir
233
Commonest virus causing bronchiolitis?
RSV
234
Which ONE of the following statements regarding RSV bronchiolitis is correct? a. Palivizumab is effective for treatment b. Oral ribavirin is effective for treatment c. Oseltamivir is effective for treatment d. Supportive treatment is of no benefit e. Palivizumab may be effective for prevention
e. Palivizumab may be effective for prevention
235
Side effects of Foacarnet and Cidofovir?
nephrotoxic
236
Treatment basis for HBV? (3)
1. Serum HBC DNA levels > 2000IU/ml 2. Serum aminotransferase levels > upper limit 3. Liver biopsy - grade/stag e- active necroinflammation or fibrosis
237
Complications of uncontrolled HBV? (2)
1. cirrhosis | 2. HCC
238
First-line HBV treatment (3)
1. Entecavir 2. PegIFN alpha 2a 3. Tenofovir
239
Mode of action Entecavir
nucleoside analogue, inhibits viral polymerase
240
Mode of action Tenofovir
inhibits reverse transcriptase
241
Combination treatment of HCV? (3)
1. PegIFN alpha 2a 2. PegIFN alpha 2b 3. Ribavirin
242
What is included in Antenatal Booking appt (12/40) Serological Screening? (5)
1. HIV 2. HBV 3. Syphilis 4. Rubella +/- toxoplasmosis and VZV
243
Most concerning time for Rubella infection during pregnancy?
244
``` Classical triad of Congenital Rubella Syndrome (CRS)? Additional features (4) ```
1. Sensorineural deafness 2. Eye defects - cataracts, congenital glaucoma, pigmentary retinopathy 3. congenital heart defects - PA stenosis, PDA 1. purpura 2. splenomeglay 3. microencephaly 4. mental retardation
245
Clinical presentation of rubella? (4) | Investigations (2)
1. fever 2. rash 3. occipital lymadenopathy 4. myalgia 1. serology - seroconversion to rubella IgG 2. PCR from throat swab or blood culture
246
Which ONE of the following is NOT part of routine antenatal serological screening: a. HIV b. Syphilis c. Hepatitis B d. Rubella IgG e. Measles IgG
e. Measles IgG
247
Which ONE of the following is NOT a typical finding in congenital rubella syndrome: a. Congenital heart disease b. Cataracts c. Retinopathy d. Limb deformity e. Sensorineural deafness
d. Limb deformity
248
Complications of CMV infection during pregnancy to the unborn baby? (2) - suspicious features of USS? (6) - virus detection? - congenital infection?
1. developmental delay 2. congenital abnormalities 1. growth restriction 2. hepatosplenomegaly 3. ventriculomegaly 4. cardiac defects 5. microcephaly 6. cerebral calcification Virus detection: saliva, urine, blood, amniotic fluid Congenital infection: urine or saliva for PCR in 1st 21 days of life
249
HSV routes of infection during pregnancy (3)
1. direct contact during vaginal birth 2. ascending infection PROM 3. orolabial transmission - kissing baby
250
High risk time of acquisiation of HSV?
3rd trimester
251
The following statements concern cytomegalovirus (CMV) infection in pregnancy. Choose the best answer. a. Antenatal ganciclovir is recommended for prevention of congenital CMV b. Diagnosis of congenital CMV in the neonate can be confirmed by PCR of a urine specimen taken in the 1st 21 days of life c. Congenital CMV infection is usually produces symptoms in the neonate from birth d. Congenital CMV infection is a rare infectious cause of developmental delay e. CMV infection in pregnant women is usually symptomatic
b. Diagnosis of congenital CMV in the neonate can be confirmed by PCR of a urine specimen taken in the 1st 21 days of life
252
The following statements concern genital herpes (HSV) in pregnancy. Choose the best answer. a. Delivery by Caesarean section is recommended for a woman with primary HSV who is 35 weeks pregnant b. Delivery by Caesarean section is recommended for a woman with a history of recurrent genital herpes with genital ulcers present during labour c. The risk of neonatal HSV in an infant born to a mother with untreated recurrent genital HSV is high d. Oral valaciclovir is recommended as prophylaxis against recurrent genital HSV in pregnancy e. Neonatal herpes is nearly always caused by HSV-2
a. Delivery by Caesarean section is recommended for a woman with primary HSV who is 35 weeks pregnant
253
Management of primary HSV infection during pregnancy? (4)
1. lesion swab PCR 2. Offer acyclovir treatment and prophylaxis until delivery 3. Recommend C-section if presenting within 6/7 of delivery or active lesion during labour 4. Swabs from neonate & neonatal IV acyclovir empirically until ruled out infection
254
Time of increased maternal morbidity due to VZV in pregnancy?
2nd and 3rd trimester
255
Features of Congential Varicella Syndrome (3) | - gestation CVS occurs?
1. limb hypoplasia 2. microencelphaly 3. scarring
256
Risk to fetus during 7days before and 7 days after birth with VZV?
Neonatal Varicella | severe disseminated infection
257
Management of pregnant woman exposed to VZV with no previous infection?
VZIG up to 10/7 after contact
258
What is the causative organism in Fifth's Disease?
Parvovirus B19
259
Presentation of Fifth's Disease? (4)
"Slapped Cheek Disease" 1. fever 2. rash - erythema infectiosum 3. arthropathy 4. aplastic anaemia
260
Gestation most at risk to Parvovirus B19? Effects on fetus? (3) Treatment?
1-20/40 1. fetal death 2. fetal anaemia 3. hydrops fetalis intrauterine transfusion
261
Which ONE of the following patients is at greatest risk of infection with varicella-zoster virus (VZV)? a. A healthy term infant born to a mother who develops shingles the day after delivery b. A pregnant woman born in the UK exposed to her own child who has confirmed chickenpox c. An 18 month old child with no previous history of chickenpox whose mother has developed shingles affecting her face d. A pregnant woman who recalls having chickenpox as a child who works in a nursery and has been exposed to multiple children with probable chickenpox e. A pregnant woman who says she has never had chickenpox whose long-term partner has developed cold sores
a. A healthy term infant born to a mother who develops shingles the day after delivery
262
Which ONE of the following patients does NOT need to receive varicella immunoglobulin (VZIG)? a. A confirmed VZV-susceptible pregnant woman whose own child developed a widespread vesicular rash 3 days ago b. An infant born to a mother who herself develops chickenpox 4 days after delivery c. A pregnant woman with an unknown history of chickenpox whose partner developed shingles affecting the face 10 days ago d. An infant born at 30 weeks gestation to a mother with confirmed VZV-IgG in the serum, who is on the neonatal unit where a member of staff looking after the infant has developed chickenpox e. A pregnant woman with an unknown history of chickenpox who has heard from a colleague that someone at her workplace had shingles last week
e. A pregnant woman with an unknown history of chickenpox who has heard from a colleague that someone at her workplace had shingles last week
263
The following statements concern parvovirus B19 (B19V) infection. Choose the best answer. a. Reinfection with B19V does not occur b. Asymptomatic B19V infection in the 1st 20 weeks of pregnancy poses minimal risk to the fetus c. There is no intervention to reduce harm to the fetus from maternal B19V infection d. Maternal B19V infection may result in fetal anaemia e. B19V-IgM is a reliable indicator of primary B19V infection
d. Maternal B19V infection may result in fetal anaemia
264
Increased risk of vertical transmission of HBV (2) | Not a risk factor
1. Maternal viral load 2. HBeAg positivity - breastfeeding, mode of delivery
265
HBsAg positive mother, how to manage baby after birth?
Accelerated HBV vaccine, 1st dose within 12 hours of delivery
266
HBeAg positive mother, how to manage baby after birth? (2)
1. Accelerated HBV vaccine, 1st dose within 12 hours of delivery 2. HBIG at birth
267
HBV viral load > 10*6 copies, how to manage baby after birth? (3)
1. Accelerated HBV vaccine, 1st dose within 12 hours of delivery 2. HBIG at birth 3. Antenatal antiviral therapy 6-8weeks before birth to reduce viral load
268
Maternal influenza infection, risks to fetus? (2)
1. stillbirth | 2. preterm delivery
269
A pregnant woman is found to have hepatitis B surface antigen (HBsAg) detected in her booking serum. What should be the plan for treatment? Choose the best answer. a. The woman should receive hepatitis B immunoglobulin b. The infant should receive hepatitis B immunoglobulin at birth c. The infant should receive hepatitis B vaccine at birth d. The infant should receive lamivudine at birth e. The woman should receive tenofovir therapy from 34 weeks gestation
c. The infant should receive hepatitis B vaccine at birth
270
A woman who is 34 weeks pregnant presents to A&E during the winter with a 2 day history of fever, myalgia, tachypnoea and cough. The following statements concern her management. Choose the best answer. a. A viral throat swab should be taken and she should receive paracetamol b. A viral throat swab should be taken and she should receive oseltamivir c. She should be offered the current seasonal influenza vaccine d. She should be reassured that there is no risk to her baby e. A viral throat swab should be taken and arrangements made to call her with the result the following day
b. A viral throat swab should be taken and she should receive oseltamivir
271
Risk of measles to unborn fetus? (3)
1. miscarriage 2. preterm delivery 3. increased maternal morbidity
272
Congenital infections transmissable from mother? Presentation of fetus TORCH
``` T - Toxoplasmosis Other - Parvovirus B19, Syphilis, VZV, HBV, HIV R - Rubella C - CMV H - HSV ``` ``` T - Thrombocytopenia Other - ears, eyes R - Rash C - Cerebral abnormalities H - Hepatosplenomegaly ```
273
Common causative organisms of surgical site infection? (3)
1. Staph aureus 2. E.coli 3. Pseudomonas aeruginosa
274
Risk factors for surgical site infection? (8)
1. age >75yrs 2. underlying illness 3. obesity 4. smoking 5. DM 6. steroid use 7. radiotherapy 8. RA - stop DMARDs 7-8weeks before surgery
275
Preventative measures to reduce risk of SSI pre-operatively? (4)
1. showering with soap 2. hair removal with electrical clippers, and only if necessary 3. nasal decontamination of S.aureus 4. Abx prophylaxis
276
Preventative measures to reduce risks of SSI intra-operatively? (3)
1. Cleaning skin with chlorhexidine 2. Normothermia 3. Oxygenation
277
Pathogenesis of Septic Arthritis? (5)
1. organism adheres to synovial fluid 2. organism multiplies in synovial fluid 3. triggers host inflammatoy response 4. host produces fibronectin to which the organisms stick 5. proteases and cytokines can causes cartilage destruction and bone loss 6. increased intra-articular pressure can hamper blood flow and can cause bone ischaemia and necrosis
278
Most common causative organism in septic arthritis?
Staph aureus (46%) - has receptors to fibronectin
279
Clinical features of septic arthritis? (4)
1-2 week history of 1. red 2. hot 3. swollen joint 4. febrile
280
Investigations in septic arthritis? (4)
1. Blood culture prior to Abx 2. joint aspirate for MC+S 3. CRP/ESR 4. Imaging - effusion
281
Treatment of septic arthritis? (2) | - if MRSA?
1. Drainage 2. Abx 6weeks Flucloxacillin/Cephalosporin Abx Vancomycin
282
Osteomyelitis - route of infection (2) - presentation (3) - investigations (3)
local or haematogenous spread 1. fever 2. pain 3. swelling 1. blood culture 2. MRI 3. CT with biopsy
283
Associated with chronic osteomyelitis? | - management
Brodie's abscess | Radical debridement, remove sequestra, remove infected tissue & bone
284
Prosthetic Joint Infection - route of infection? (2) - presentation (4) - investigations (3) - management
local or systemic bacteraemia (UTI) 1. pain 2. pt complains that "joint was never right" 3. early failure of joint 4. sinus tract 1. imaging - loosening 2. inflammatory markers 3. joint aspiration Replace joint using abx impregnated cement
285
Common sites of hospital acquired infections (3)
1. GI 2. UTI 3. SSI
286
Common causative organisms of hospital-acquired UTI? (4) - risk factors - resistance
Gram neg 1. E.Coli 2. Klebsiella 3. Pseudomonas 4. Proteus - in-swelling catheter - extended spectrum beta-lactamases
287
Common Abx associated with C.diff infection? (3)
3 C's Clindamycin Cephalosporins Ciprofloxacin
288
``` Predisposing factor to C.diff diarrhoea? Transmission of C.diff... Treatment a) moderate b) severe ```
Existing gut flora distrubed by use of broad spectrum Abx C diff is a spore forming anaerobe, spores are very transmissible, contaminate environment and persist for long periods STOP Abx a) Metronidazole 10-14/7 b) Vancomycin 10-14/7
289
Risk associated with C.diff?
pseudomembranous colitis due to toxins produced by c.diff
290
Route of infection of MRSA
skin-breach e.g. invasive procedure, skin disease, skin lesions
291
Steps of PCR (4) | Use of PCR
1. DNA is denatured 2. Primer is annealed to DNA 3. DNA is exponentially multiplied by DNA polymerase starting chain elongation 4. New strand and template are separated by melting DNA of unknown virus can be probed and amplified to detect virus
292
What is latent infection?
When the host has lifelong infection of a virus, but during the latent period only a small subset of viral genes are expressed
293
Viruses that causes a latent infection in the host? (5)
1. HSV 2. VZV 3. CMV 4. EBV 5 HHV
294
HSV and VZV site of latency?
sensory nerve ganglia
295
EBC and CMV site of latency?
leucocytes
296
Complications of HSV in immunocompramised? (2)
1. cutaneous dissemination | 2. visceral involvement e.g. hepatitis, oesaphagitis
297
Complications of VZV in immunocompramised? (2)
1. hepatitis | 2. pneumonitis
298
Complication associated with CMV infection in HIV+ pt?
CMV retinitis
299
Complication associated with CMV infection in HSCT pt?
CMV pneumonitis
300
Complication associated with EBV infection in HIV+ pt? (2)
1. Oral hairy leukoplakia | 2. Lymphomas
301
Complication associated with EBV infection in post-transplant pt? Management (2)
Post-transplant lymphoproliferative disease (PTLD) - control of proliferation in latently infected B cells is lost 1. Reduce immunosuppression 2. Rituximab
302
Complication associated with Paediatric post-BMT? | Presentation (6)
Disseminated Adenovirus infection 1. Fever 2. Bone marrow suppression 3. Haemorrhagic crisis 4. Necrotising pneumonitis 5. Hepatitis 6. Colitis
303
Which one of the following statements is not true? A.CMV pneumonitis has a poor prognosis B. CMV infection can cause bone marrow suppression C. Aciclovir is the treatment of choice of CMV infection D. CMV can be transmitted from the graft E. CMV is a herpes virus that establishes latency in B lymphocytes
C. Aciclovir is the treatment of choice of CMV infection It's Ganciclovir
304
An HIV infected patient presents with skin lesions resembling Kaposi Sarcoma, what is the causative virus?
HHV-8
305
``` A patient who received a stem cell transplant 2 weeks ago presents with mouth ulcers. Which of the following viral PCRs would you request on the mouth swab? A. Enterovirus PCR B. Adenovirus PCR C. HSV PCR D. HHV6 PCR E. HHV8 PCR ```
A. Enterovirus PCR | C. HSV PCR
306
What virus causes progressive multifocal leukoencephalopathy?
JC virus
307
``` Which of the following viruses are associated with lymphoma? A. CMV B. Adenovirus C. HHV8 D. JC E. EBV ```
C. HHV8 | E. EBV
308
Complications of measles in immunocompramised patient? (2)
Fatal 1. encephalitis 2. giant cell pneumonia
309
Please examine the following hepatitis B serology results, which profile is consistent with past hepatitis B infection? A. HBV sag (+), HBV core ab (+), HBV sab (-) B. HBV sag (-), HBV core ab (-), HBV sab>100mIU/ml C. HBV sag (-), HBV core ab (-), HBV sab (-) D. HBV sag (-), HBV core ab (+), HBV sab of 15mIU/ml
D. HBV sag (-), HBV core ab (+), HBV sab of 15mIU/ml
310
``` A patient who received a stem cell transplant recently has a transaminitis. What investigations would you request on blood? A. EBV serology B. Hepatitis B surface antigen C. Hepatitis C PCR D. Hepatitis E PCR E. CMV serology ```
B. Hepatitis B surface antigen C. Hepatitis C PCR D. Hepatitis E PCR
311
Toxoplasmosis association
Cats faeces
312
Common causative organisms in early onset sepsis (3)
1. GBS 2. E.Coli 3. Listeria
313
Maternal risk factors for early onset sepsis? (5)
1. PROM 2. Fetal distress 3. Mec 4. Fever 5. Previous hx
314
Fetal risk factors for early onset sepsis? (8)
1. birth asphyxia 2. acidosis 3. resp distress 4. low BP 5. hypoglycaemia 6. neutropenia 7. jaundice 8. hepatosplenomegaly 9. rash
315
Investigations in early onset sepsis? (7)
``` FBC Throat Swab Deep ear swab Surface swabs CSF CRP CXR ```
316
Management of early onset sepsis? (4)
1. ABC approach 2. Ventillation 3. Nutrition 4. Abx BenPen + Gentamycin Amoxicillin/Ampicillin if Listeria
317
Causative organism in late (>48hrs) onset sepsis? (4)
1. Staphylococcal 2. GBS 3. E.Coli 4. Listeria
318
Presentation in late onset sepsis (9)
``` Bradycardia Apnoea Poor Feeding Abdo distension Irritability Convulsions Jaundice Resp distress HIGH CRP ```
319
Investigations in late onset sepsis? (6)
``` FBC CRP Cultures Swabs from any infected areas ET secretions if ventilated Urine ```
320
Management in late sespis a) hospital b) community
a) Fluclocacillin + Gentamycin | b) Amoxicillin + Cefotaxime
321
Pyrexia of Unknown Origin definition
Fever higher than 38.3º C on several occasions, persisting without diagnosis for at least 3 weeks in spite of at least 1 weeks investigation in hospital
322
Commonest cause of fever in returning traveller?
Malaria
323
Causes of fever in the returning traveller? (10)
``` Malria Dengue Typhoid Rickettsia Bacterial diarrhoea UTI Pneumonia HIV seroconversion Brucella Viral haemorrhagic fevers ```
324
What is Rickettsia? | Where is it common?
``` "Spotted Fever" Gram -ve bacteria Zoonose Rocky Mountains USA India ```
325
Organism associated with unpasteurised milk?
Brucella
326
What is Sixth Disease? - causative organism - presentation - site of latency
"Roseola Virus" HHV-6 fever, 3/7, transient rash "exanthum subitum lymphocytes
327
Infectious Mononucelosis - what is it? - causative organism - triad - investigations
``` Glandular fever EBV 1. fever 2. pharyngitis 3. lymphadenopathy Paul Bunnel Test Monospot Agglutination ```
328
Types of PUO (4)
Classical PUO Health-care associated PUO Neutropenic PUO HIV-associated PUO
329
Differentials in classical PUO? (7) | Definition
> 3/7 in hospital with investigations or > 3 OP visits with ambulatory investigation 1. infection 2. malignancy incl myeloma 3. CTDs 4. Abscesses 5. IE 6. TB 7. Complicated UTIs
330
Differentials in Healthcare associated PUO? (6)
1. SSI 2. Drugs 3. Medical devices - catheters, IV line bacteraemia 4. LRTI 5. C.diff colitis 6. Immobilisation - bed sores
331
Differentials in Neutropenic PUO? (6)
1. Chemotherapy 2. Haematologiucal malignancies 3. Fungal 4. Bacterial 5. Mycobacteria 6. GVHD
332
Differentials in HIV associated PUO? (9)
1. Seroconversion 2. TB 3. Karposi's Sarcoma 4. Bacterial 5. PCP 6. CMV 7. Cryptococcus 8. Toxoplasmosis 9. Lymphoma
333
Clinical features of Typhoid/Enteric Fever? (7)
1. fever 2. headache 3. abdo pain 4. diarrhoea/constipation 5. rose spots 6. bradycardia 7. hepatosplenomegaly
334
Causative bacteria in eneteric fever? | Transmission?
Salmonella typhi/paratyphi | Food and water
335
Rose spots are associated with?...
Enteric Fever
336
Eosinophilia in the returning traveller?
worms
337
What is malaria spread by?
Female Anopheles mosquito
338
Types of malaria? (4)
Plasmodium falciparum Plasmodium vivax Plasmodium ovale Plasmodium malariae
339
Most severe malarial species?
P.falciparum
340
Investigations for suspected malaria (3)
``` Thick and thin blood film FBC - raised WCC - low platelets - anaemia LFTs - deranged ```
341
Benign malarial species?
P.malariae
342
Symptoms of malaria? Common (7) Uncommon (4)
``` Common flu-like symptoms fever rigors myalgia N&V headache back pain ``` ``` Uncommon diarrhoea Abdo cramps Cough Dark urine ```
343
Blood film findings in P.falciparum? (2)
``` young trophozoites (rings) Crescent-shaped gametocytes ```
344
Blood film findings in P.vivax (2)
Schuffner's dots | Merozites/Schizont
345
Blood film findings in P.ovale?
Schuffner's dots
346
Treatment of mild P.falciparum? (3 options)
1. Quinine + Doxycycline/Clindamycin 2. Malarone 3. Riamet
347
Treatment of severe P.falciparum? (2 options)
1. Quinine + Doxycycline/Clindamycin | 2. Artemisin Combination therapy
348
Treatment of P.vivax/P.ovale?
Chloroquine then Primaquine
349
Complications in Falciparum Malaria? (9)
``` Impaired conciousness Renal impairment Acidosis Hypooglycaemia Pulmonary oedema Spontaneous bleeding/DIC Anaemia Shock Haemoglobinuria ```
350
Infective Endocarditis
infection of the innermost layer of the heart, usually the valves
351
Most common areas for vegetations in IE?
Mitral valve | Aortic Valve
352
Risk factors associated with IE? (7)
1. IVDU 2. Poor dentition 3. Rheumatic Fever 4. congenital heart disease 5. Valve replacement 6. Long term lines 7. GI issues
353
Acute symptoms in IE? (9)
``` fever malaise anorexia weight loss rigors night sweats chest pain SOB weakness ```
354
Dukes Criteria for IE Diagnosis
1. 2 major criteria 2. 1 major + 3 minor criteria 3. 5 minor criteria
355
Major Criteria for IE (3)
1. persistant bacteraemia > 2 positive blood cultures 2. ECHO - vegetation seen 3. Serology - postivive for Bartonella/Coxiella/Brucella
356
Minor Criteria (7)
1. predisposing risk factor 2. fever >38*C 3. high CRP 4. evidence of immune complex formation (Janeway lesions, splinter haemorrhages) 5. vascular phenomena (stroke, PE) 6. positive ECHO that doesn't meet major criteria 7. positive serology that doesn't meet major criteria
357
Signs of subacute IE? (7)
``` clubbing splinter haemorrhages Osler's nodes Janeway lesions Roth spots Splenomegaly Haematuria ```
358
Investigations in IE? (9)
``` FBC - aneamia U+Es CRP - high ESR - high x3 blood cultures BEFORE Abx ECHO CXR Serology Urine analysis ```
359
Common causative agent in subacute endocarditis? | Onset
Strep viridans | mild - moderate illness
360
Common causative agent in acute endocarditis? | Onset
Staph aureus | days - weeks
361
Unusual causes of IE? HACEK
``` H - haemophilus parainfluenzae A - aggregatibacter/actinobacillus C - caridobacterium hominis E - eikenella corrodens K - kingella kingae ```
362
Right sided IE is common in who? Why?
IVDU, inject into venous system, bacteria goes into SVC into R side of the heart
363
Treatment of IE in prosthetic valve?
Vancomycin + Gentamycin + Rifampicin
364
Treatment of acute IE in native valve?
FLucloxacillin
365
Treatment of subacute IE?
Benzylpenicillin + Gentamycin
366
What is a zoonose?
pathogenic diseases and infections that are transmitted naturally between vertebrate animals and humans
367
Brucellosis - carriers (4) - incubation - transmission (2) - who is at risk? (2) - symptoms (5) - complications (2) - treatment
``` dogs, goats/sheep, cattle pigs 3-4 days direct contact or contaminated food e.g. unpasteurised dairy vets, farm workers 1. undulant fever 2. malaise 3. sweats 4. rigors 5. myalgia ``` 1. carditis 2. osteomyelitis Tetracycline/Doxycycline with Streptomycin
368
Rabies - carriers (2) - transmission - pathognomonic histology - prodrome (3) - acute symptoms (2) - management
- dogs, bats - bite - Negri bodies - headache, fever, sore throat - acute encephalitits, hyperactive state, fear of water - rabies IgG post-exposure
369
Plague - causative organism - carriers - transmission - types (2) - treatment
``` Yersinia pestis fleas on rats flea bites human 1. Bubonic - flea bites human 2. Pulmonary - human to human spread during epidemic Streptomycin/Doxy/Gent/Chloramphenicol ```
370
Leptospirosis - causative organism - transmission - who is at risk? - symptoms (6) - complications (3) - treatment
``` L.interrogans spirochaetes excreted in dog/rat urine, penetrates broken skin in contaminated water swimmers 1. headache 2. spiking temp 3. conjunctival haemorrhages 4. jaundice 5. malaise 6. myalgia ``` 1. carditis 2. renal failure 3. haemolytic anaemia Amoxicillin
371
Cutaneous anthrax presentation
painless round black lesions with rim of oedema
372
Pulmonary Antrax presentation (4)
1. lymphadenopthy 2. mediastinal haemorrhage 3. pleural effusion 4. resp failure
373
Lyme Disease - transmission - where - causative agent - three stages - diagnosis - treatment
``` tick bite woodland/gardens/parks Borrelia burgdo 1. Early localised 2. Early disseminated 3. Late persistant biopsy + ELISA for Lyme Abs Doxycycline ```
374
Symptoms of early localised Lyme Disease? (3)
1. Erythema Chronicum Migrans (ECM) "Bullseye Rash" 2. non-specific flu-like symptoms 3. cyclical fevers
375
What is erythema chronicum migrans associated with?
Lyme Disease
376
Symptoms of early disseminated Lyme Disease (6)
1. malaise 2. lymphadenopathy 3. hepatitis 4. carditis 5. arthritis 6. palsies
377
Symptoms of late persistent Lyme Disease? (4)
1. Arthritis 2. focal neurology 3. neuropsychiatric distrubance 4. acrodermatitis chronic atrophicans
378
What is acrodermatitis chronic atrophicans?
widespread atrophy of the skin most evident peripherally at first
379
Q fever - causative organism - vectors (2) - presentation (5) - treatment
``` Coxiella burnetti cattle/sheep 1. fever 2. dry cough 3. fatigue 4. pleural effusions 5. diarrhoea Doxycycline ```
380
``` Leishmania - vector - transmission - where? types of infection (4) ```
- sandfly - bite from sand fly - South & Central America, Middle East 1. Cutaneous 2. Diffuse Cutaneous 3. Muco-cutaneous 4. Visceral
381
Presentation of cutaneous Leischmania? | Type of hypersensitivity reaction?
skin ulcer at site of sandfly bite, heals after a year leaving a deep depigmented scar Type IV
382
Who gets diffuse cutaneous Leischmania?
immunocompramised | Lots of nodules
383
What are prion diseases?
rare, transmission encephalopathies in humans and adults, caused by protein-only infectious agents cause rapid neuro-degeneration in animals and humans
384
How does the prion embed in the brain? (3)
Prion protein gene is expressed on chromosome 20, predominantly expressed in the brain Normal PRP structure is alpha-helical, but the infected PRP abnormally fold into beta-sheet configuration and becomes insoluble
385
What is the commonest form of prion disease? a. Kuru b. Iatrogenic CJD c. Gerstmann-Straussler-Sheinker syndrome d. Variant CJD e. Sporadic CJD
e. Sporadic CJD
386
Features found of post-mortem in Sporadic CJD? (2)
1. spongiform vaculation | 2. PrP amyloid plaques
387
Sporadic CJD - onset - presentation (5) - prognosis
45-75 years 1. rapid, progressive dementia 2. myoclonus 3. cortical blindness 4. akinetic mutism - inability to move or speak 5. LMN signs
388
18 yr old woman LLL pneumonia Unwell Raised WCC + CRP What is the likely organism? a. Pseudomonas aeruginosa b. Mycobacterium tuberculosis c. Legionella pneumophilia d. Streptococcus pneumoniae e. Staphylococcus aureus
d. Streptococcus pneumoniae
389
56 yr old man LLL pneumonia Haemoptysis Cavitiation on CXR ``` What is the likely organism? A) Streptococcus pneumoniae B) Haemophilus influenzae C) Staphylococcus aureus D) Klebsiella pneumoniae E) Any of the above ```
B) Haemophilus influenzae
390
62 yr old smoker Confused Bilateral interstitial change Hyponatraemic what is the likely organism? a. Moraxella catarrhalis b. Mycobacterium tuberculosis c. Legionella pneumophilia d. Cytomegalovirus (CMV) e. Staphylococcus aureus
c. Legionella pneumophilia
391
``` What is the probable diagnosis? 74 year old woman RLL pneumonia On standard Abx Not getting better ``` a. Tuberculosis b. Empyema c. Mesothelioma d. MRSA pneumonia e. Aspiration pneumonia
b. Empyema
392
21 yr old from Ecuador Cough and weight loss RUZ shadowing on CXR What is the likely organism? a. Staphylococcus aureus b. Aspergillus fumigatus c. Mycobacterium tuberculosis d. Haemophilus influenzae e. Pneumocystis jiroveci
c. Mycobacterium tuberculosis
393
64 yr old man Treated for TB CXR shows bilateral ground-glass shadowing What is the likely organism? ``` A) Aspergillus fumigatus B) H1N1 Swine flu C) Mycoplasma pneumoniae D) Cytomegalovirus (CMV) E) Pneumocystis jiroveci ```
E) Pneumocystis jiroveci
394
22 year old man Chemotherapy for leukaemia Prolonged neutropenia (
b. Aspergillus
395
Pneumonia - what - presentation (7) - assessment of severity
inflammation of lung alveoli 1. fever 2. cough 3. sputum 4. SOB 5. pleuritic chest pain 6. fever 7. malaise 8. N&V CURB65
396
What is the CURB65 score?
Confusion Urea >7nmol RR >30 BP 65yrs
397
Most common organisms causing CAP?
1. Step pneumoniae | 2. H.influenzae
398
Strep pneumoniae pneumonia - where in the lungs? - microscopy - sputum colour?
lobar gram+ve diplococci rust-coloured sputum
399
H.influenzae pneumonia - associated with who? (3) - common sign - microscopy (2)
1. smokers 2, pre-existing lung conditionse.g. COPD 3. kids aged
400
M.catarrhalis pneumonia is associated with who?
smokers
401
Common cause of HAP?
Staph aureus
402
Staph. aureus pneumonia - association - EMQ - sign on CXR? - microscopy
- previous viral infection - post-influenza - cavitation on CXR - Gram +ve cocci "bunch of grape" clusters
403
Klebsiella pneumoniae - association (2) - common sign - sign on CXR - microscopy
1. alcoholics 2. elderly haemoptysis cavitation on CXR Gram -ve rod
404
First line treatment of moderate CAP?
Amoxicillin or Erythromycin/Clarithromycin if Pen allergic
405
Treatment of sever CAP?
Augmentin + Erythromycin/Clarithromycin
406
Common cause of atypical pneumonia in paediatrics?
Mycoplasma pneumoniae
407
Legionella pneumonia - who in EMQ - association (3) - presentation (4) - clinical features (3) - culture requires?
- travelling business men 1. travel 2. air conditioning 3. water towers 1. SOB 2. Confusion 3. Abdo pain 4. diarrhoea 1. hepatitis 2. HYPOnatremia 3. lymphocytopenia buffered charcoal yeast extract
408
Mycoplasma pneumonia - who - where - presentation (2) - specific test - complications (2)
- children 6months - 5 years - Mexico 1. erythema multiforme 2. joint pain - cold agglutinin test 1. SJS 2. AIHA
409
Signs associated with chlamydia pneumoniae?
ENT involvement
410
Chlamydia psittaci - who? clinical symptoms (3)
BIRD FANCIERS 1. hepatosplenomegaly 2. rash 3. haamolytic anaemia
411
Causative agent of whooping cough? | Who is at risk?
Bordatella pertussis | Unvaccinated e.g. travelling community
412
Treatment of atypical pneumonias? (2) | why?
Macrolides and Tetracyclines that work on protein synthesis because atypical organisms do not have a cell wall
413
Pneumonias that HIV-patients are susceptible to? (3)
1. P.jiroveci/Pneumocystis carinii pneumonia 2. TB 3. Crytococcus neoformans
414
P.jiroveni/PCP - sign on CXR? - onset - diagnosis (2) - microscopy
- ground-glass shadowing - insiduous 1. Silver stain 2. immunofluorescence - boat-shaped organisms
415
Common cause of pneumonia in chemotherapy patients with neutropenia? - presentation (2) - clinical feature
Fungus - Aspergillus 1. bronchiectasis 2. chronic wheeze - eosinophilia
416
Common cause of pneumonia in BMT patients? (2)
1. Aspergillus | 2. CMV
417
Caustaive organisms of pneumonia in splenoectomy patients? (3)
1. H.influenzae 2. S.pneumoniae 3. Neisseria meningitidis ENCAPSULATED BACTERIA
418
Common cuase of pneumonia in CF patients? (2)
1. Pseudomonas aeruginosa | 2. Burkholderia cepacia
419
What is bronchitis? - presentation (4) - association treatment (3)
1. SOB 2. increased sputum production 3. cough 4. fever smokers 1. Physiotherapy 2. broncodilation 3. Abx
420
Diagnostic test used in severe CAP?
Urine antigen tests to look for S.pneumoniae Legionella
421
Causative organism in cat scratch disease?
Bartonella henselae
422
A man was bitten by a rat in Asia. Ten days later he complains of fever, malaise, headache and myalgia
Haverhill Fever | caused by Spririllum minus
423
A zoonosis associated with hepatitis, jaundice, conjunctival injection and renal impairment. Transmission normally occurs by direct contact with either the urine or tissues of an infected animal.
Leptospirosis
424
A 45 year old male farmer presents with a raised, erythematous rash, with clearing in the centre. He also complains of headache, fever, athralgia and malaise
Borrelia burgdoferi | Lyme disease
425
A 22 year old student presented to her GP upon return from a biology field trip, with a lesion on her leg which was 3” in diameter and flat, with a red edge and dim centre. She also mentioned feeling tired and suffering from headaches. On examination, the GP noted a fever of 38.0°C and an irregular heartbeat.
Borrelia burgdoferi | Lyme Disease
426
A tanner on holiday from India presented to hospital with an ulcerating papule on his hand. On inspection of the ulcer, the centre was black and necrotic. Gram-positive rods grew on blood agar culture and responded to treatment with large doses of penicillin.
Bacillus anthracis
427
A 21 year old man presents at his GP complaining of an itchy, scaly rash on the soles of his feet. Skin scrapings are taken and sent away for microscopic examination. Which fungi might be identified?
Tricophyton rubrum -> tinea pedis
428
A 17 year old Nigerian girl presents at her GP with patches of hypopigmentation on her trunk. After an initial trial of steroid cream, the girl returns complaining that the rash is spreading. Woods lamp examination of the rash produces a yellow fluorescence. What is the causative fungus?
Pityriasis orbiculare
429
A 45 year old female whose main hobby was pigeon racing was noted by her GP to an enlarged lymph node in her neck. What is the most likely diagnosis?
Cryptococcus neoformans, is a pathogenic fungus commonly found in pigeon droppings and pigeon nests (and also soil). The predominant clinical process usually in immunocompromised pts, is a variably subacute meningitis with occasional patients showing features of brain abscess or inflammatory cerebral vasculitis, so the clinical feats are usually - headache, fever, nausea, neck stiffness, feats of raised ICP. Histoplasmosis, is also spread from bird droppings -but apparently not so specific to pigeons. Disseminated histoplasmosis, as you correctly state can cause lymphadenopathy (resembles disseminated TB - fever, weight loss, lymph nodes). PS. Remember India Ink staining for cryptococcus, which is often a clue in questions.
430
``` Superficial fungae (2) - diagnosis ```
1. Tinea 2. Pityriasis - Wood Lamp
431
Causative organism in Athlete's foot? | - yeats or mould?
Tricophyton rubrum | mould
432
Causative organism in seborrhoeic dermatitis? | yeats or mould?
Malessezia furfur | mould
433
Causative organism in Tinea versicolor? - presentation - yeast or mould
Malessezia globosa depigmented lesiosn in darker skin mould
434
Deep-seated fungae (3)
1. Candida 2. Aspergillus 3. Crytococcus
435
How to diagnose Candida infection? (2) | - yeast or mould?
1. Culture 2. Mannan Antibodies yeast
436
Aspergillus - yeats or mould? - who - associated - diagnosis (3)
``` yeast immunocompramised patients HCC 1. ELISA 2. PCR 3. beta-Glucan test ```
437
Crytococcus - yeast or mould? - who? - type of infection - where - diagnosis (2)
- yeast - immunocompramised - meningitis with insidious onset in HIV patients - pigeon poo 1. Cryptococcal antigen in serum 2. CSF
438
Mode of action of Amphotericin? - type of fungus - use
interupts cella membrane integrity Yeast Crytptococcus meningitis
439
Mode of action of Azoles? - type of fungus - use - e.g.
interupy cell membrane synthesis yeast candida fluconazole
440
Mode of action of Terbinafine? - type of fungus - use
targets cell membrane mould Tinea
441
Mode of action of Echinpcandin? - type of fungus - example
targets cell wall yeast Caspofungin
442
STIs causing discharge (5)
1. Gonorrhea 2. Chlamydia 3. Trichomonas 4. Candida 5. BV
443
STIs causing ulceration (5)
1. Syphilis 2. HSV 3. LGV 4. Chancroid 5. Donovanosis
444
STIs causing rashes/lumps/growths (4)
1. HPV 2. Molluscum contagiosum 3. Scabies 4. Pubic lice
445
Painful ulcers...
Herpes > Chancroid
446
Painless ulcers...
Syphilis > LGV + granuloma inguinale
447
Causative organism in opthalmia neonatorum (neonatal conjunctivitis) & microscopy (2)
1. Neisseria gonorrhoeae Gram negative diplococcus 2. Chlamydia trachomatis Gram negative
448
Gonorrhoea - presentation in men (3) - presentation in women (6)
``` Men - urethral discharge - dysuria - scrotal pain/swelling Women - vaginal discharge - itching/soreness - erythema/oedema - abdo pain - dyspareunia ```
449
Gonorrhoea - transmission - who is at risk? symptoms (3) - diagnosis - treatment
- sexual - during vaginal delivery through birth canal complement deficiencies - disseminated gonococcal infection - septicaemia - rash - arthritis Urethral/rectal smears Ceftriaxone IM/ Cefixime PO
450
Complications of Gonorrhoea a) Men b) Women
a) prostatitis | b) PID -> infertility
451
Which chlamydia serovars cause trachoma?
Serovars A, B, C | infection of the eyes which can lead to blindness
452
Which chlamydia serovars cause genital chlamydia infection and opthalmia neonatorum?
Serovars D - K
453
Chlamydia - who - causative organism - presentation - complications in women (7) - complication in men (3) - diagnosis - treatment
younger population, in the UK 10%
454
Side effects of azithromycin (2) | Contraindicated & why? (2)
1. N&V 2. photosensitivity Pregnancy bone growth disturbance & tooth discolouration in babies
455
What is Reiters Syndrome? - triad - who gets it?
1. conjunctivitis 2. urethritis 3. arthritis young men with chlamydia trachomitis infection
456
What is LGV?
Lympho-granuloma venereum | Lymphatic infection with chlamydia trachomatis
457
Which chlamydia serovars cause LGV?
L1, L2, L3
458
EMQ land who commonly gets LGV?
- developing world | - MSM
459
Presenting features of LGV? a) early day 3-12 primary stage b) late week 2-25 secondary stage c) late d) current outbreak
a) PAINLESS genital ulcer b) PAINFUL buboes (inguinal abscesses) c) inguinal lymphadenopathy, rectal strictures/fistulas d) rectal symptoms - pain, tenesmus, bleeding, discharge
460
Treatment of LGV?
Doxycycline BD 3 weeks
461
Causative organism in Syphilis?
Treponema pallidum | Gram negative spirochaete
462
Common co-infection with syphilis?
HCV
463
``` The course of syphilis? Primary Secondary Latent Tertiary ```
Primary - indurated painless ulcer appears 1-12 weeks following transmission Secondary - systemic bacteraemia within 6 months following transmission Latent - no signs but serological infection Tertiary - years after transmission
464
Primary syphilis features
PAINLESS indurated genital ulcer often solitary can persist for 4-6weeks -> chancre regional lymphadenopathy
465
Secondary syphilis features (9)
1. low grade fever 2. malaise 3. symmetrical, non-pruritic, widespread maculo-papular rash 4. mucosal "snail track" mucosal lesions 5. uveitis 6. choroidoretinitis 7. alopecia 8. genital warts "condyloma acuminate" 9. neurological involvement
466
Latent syphilis
no obvious signs, but serological infection
467
``` Tertiary syphilis 3 types (3) ```
1. Granuloma/Gumma 2. Cardiovascular 3. Neurosyphilis
468
Features of Gumma Syphilis (3) - onset - type of reaction
1. skin 2. bone 3. mucosa 2-40 years later delayed hypersensitivity reaction
469
Features of cardiovascular syphilis | - onset
aortitis +++ inflammation 10-30 years later
470
Features of neurosyphilis (4) - onset - who is most at risk? - CSF findings - type of reaction - pathgnomonic
1. meningovascular 2. general paresis of the insane 3. tabes dorsalis 4. gumma - 2-30 years later - HIV +ve - spirochaetes - small vessel vasculitis - Argyll-Robertson pupil
471
What is tabes dorsalis?
Slow degeneration of the nerves of the dorsal column leading to loss of proprioception/fine touch/vibration
472
What is an Argyll-Robertson pupil? | What is it pathgnomonic of?
pupil can accommodate to near objects but does not constrict in bright light Neurosyphilis
473
Treatment of Syphilis? | - side effects
IM Benzathine Penicillin Doxycyline is Pen allergic Jarisch-Heimer reaction - fever, headache, myalgia, exaccerbation of syphilic features
474
Congenital syphilis - transmission - features (5)
during pregnancy or birth 1. fever 2. rash 3. hepatosplenomegaly 4. neurosyphilis 5. pneumonitis
475
Chancroid - what - presentation (2) - causative organism - diagnosis - treatment
``` bacterial tropical ulcer disease multiple painful genital ulcers , painful lymphadenopathy Haemophilus ducreyi chocolate agar plate Azithromycin ```
476
Donovanosis - causative organism - where in the world (3) - presentation (3) - diagnosis - treatment
Klebsiella granulomatis 1. India 2. Africa 3. Australia aborigines 1. expanding ulcers 2. start as papule/nodule then break down 3. beefy red appearance - Giemsa stain showing Donovan bodies - Azithromycin
477
Tichomoniasis - causative organism - presentation in men - presentation in women - associated risk - treatment
``` trichomoniasis vaginalis asymptomatic or urethritis green malodorous discharge increased risk of HIV Metranidazole ```
478
Bacterial vaginosis - what - presentation - diagnosis (3) - complications (2)
``` change in vaginal flora, polymicrobial odour, discharge - MC + S - raised pH - clue cells ``` - preterm delivery - often recurrent
479
Candidiasis - causative organsim - presentation in women (5) - presentation in men - treatment (2) - association
candida albicans 1. vulvovaginitis 2. thick white discharge 3. itchiness 4. redness 5. soreness 1. Clotrimazole 2. Fluconazole immunosuppressed
480
Molluscum contagiosum - causative agent - who? (2) - where? (2) - transmission - treatment
``` Pox virus a) children - hands and face b) adults - genital lesions skin to skin contact cryotherapy ```
481
Genital warts - causative agent - which strains? - presentation (6) - incubation - treatment - contraindication
HPV 6 and 11 Warts 1. papular 2. planar 3. pedunculated 4. carpet 5. keratinised 6. pigmented 3 weeks -> 8 months Podophyllotoxin pregnant women
482
The antiviral which is given to untreated pregnant women with HIV to prevent vertical transmission of the virus during childbirth.
Nevirapine
483
A drug that is effective against influenza A but not influenza B
Amantidine
Pathology
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