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RACP 2022 Written > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

Which of the following is false about oseltamavir?

A. Reduces duration of symptoms by 1-2 days
B. More effective for Flue B than Flu A
C. Needs dose adjustment in renal impairment and elderly
D. Good for prophylaxis in exposed hospitalized patients

A

B - opposite, more effective for Flu A than B

Oseltamavir - neuramidase inhibitor

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2
Q

When should oseltamvir be prescribed?

A

Prophylaxis in exposed hospitalized patients
Symptoms <48hrs in influenza A or B

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3
Q

Which ambler class of antibiotic resistance is new delhi metallo beta lactamases?
How do they transmit resistance?

A

Class B - metalloBeta lactamses
Plasmid mediated.

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4
Q

Which drugs treat VRE?
Which is not effective against Van A?

A

Teicoplanin (useleless against Van A, which has a MIC >64)

Tigecycline
Daptomycin
Linezolid

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5
Q

What is the mechanism of action of triazoles?

A

Inhibits ergosteriol synthesis

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6
Q

Which antifungals are active against aspergillus?

A

Voriconazole
Caspofungin
Andulafungin

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7
Q

What is the mechanism of action of echinocandins?
Which drugs are in this class?

A

Caspiofungin, anidulafungin

Inhibits fungal cell wall synthesis

Noncompetitive inhibition of the enzyme 1,3-β glucan synthase –> results in inhibition of B glucan synthesis in the fungal cell wall

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8
Q

Risk factors for TB reactivation

A

HIV - greatest RF
DM
CKD
Steroids >15mg/1 month
Advanced age
TNF-a inhbitors
Malignant lymphoma
Smoking

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9
Q

Which of the following is a cause of painful gential ulcers?
A. Syphylis
B. Chancroid
C. Granuloma inguinale
D. Lymphogranuloma venereum

A

B. Chancroid

All others painless

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10
Q

Non-treponemal tests for syphyllis and treponemal tests.

Which is best for screening?

A

Non-treponemal:
- VRDL
- RPR
- Toluidine Red Unheated Serum Test (TRUST)

Treponemal:
- FT-Abs
- TP-EIA
- TPPA (TP particle agglutination assay)
- chemiluminescense immunoassay (CIA)
- microhemagllutination test for antibodies (MHA-TP)

EIA is best

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11
Q

What are the co-receptors used by HIV for entry into CD4 cells?

A

CCR5; R5 viruses) or CXC chemokine coreceptor 4 (CXCR4; X4 viruses)

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12
Q

Benefits of TAF over TDF?
Disadvantages?

A

Less renal toxicity and bone loss
More weight gain

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13
Q

Antibiotic classes with poor CNS penetration?

A

Aminoglycosides, erythromycin, tetracyclines, clindamycin, and first generation cephalosporins (cephalexin)

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14
Q

Which group of patients should recieve tetanus immunoglobulin when presenting with a traumatic wound?

A

Patient has received less than 3 doses of tetanus toxoid vaccine or vaccination history is unknown AND a dirty/major wound

All patients should have tetanus vaccine except if less than 5 years since last dose

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15
Q

Antibiotics that inhibit 30s ribosomal subunit

A

Aminoglycosides
Tetracyclines

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16
Q

Antibiotics that inhibit 50s ribosomal subunit

A

Macrolides
Linezolid
Lincosamides (lincomycin, clindamycin)
Chloramphenical

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17
Q

Daptomycin mechanism of action

A

Inhibits bacterial membrane function

Inserts into the membrane of gram positive bacteria–> disrupts membrane –> kills cell

18
Q

3 major causes of eosinophilic meningitis

A

3 major parasites:
- Angiostrongylus cantonensis
- Baylisascaris procyonis
- Gnathostoma spinigerum.

19
Q

Major side effects of abacavir
What class of drug?

A

Nucleoside reverse transcriptase inhbitoir

Major side effects - highest risk of MI, hypersensitivity reactions in patients with HLAB5701

20
Q

Which class of HIV drugs cause lactic acidosis?

A

NRTIs

21
Q

Which class of HIV drugs cause hyperlipidemia?

A

Protease inhibitors, -navirs (i.e. lopinavir)

22
Q

Which drugs can be used to treat aciclovir-resistant HSV?
Which cannot?

A

Foscarnet or cidofovir

Gancivlovir and valganciclovir also cannot be used as TK mutation inactivates them

23
Q

What drugs can be used to treat ESCAPM organisms? What ambler class are these organisms?

A

Carbapenems
Colistin
Amikacin
Fosfomycin for UTIs

Ambler C for cephalosporinases!

24
Q

Which populations need endocarditis prophylaxis and for which procedures?

A

Prosthetic cardiac valves (NOT defibs/ppms)
Previous IE
High risk RHD
Cyanotic heart disease with unrepaired shunts/conduits or partially repaired

Procedures involving
- teeth/gums
- infected skin/muscle
- ENT infections (i.e. tonsillectomy, abscess drainage)

GU/GI only if established infection

25
Q

List the live vaccines

Who are they contraindicated in?

A

MMR BOYZ japanese diarrhea
MMR, BCG, Oral polio, Yellow fever, VZV, japanese encephalitis, diarrhea - typhoid, rotavirus

Immunocompromise (high dose pred, HIV CD4 <200, transplant, DMARDs)
Pregnancy
Immunodeficiency
Aplastic anemia

26
Q

Drugs used for MDR TB

A

bedaquiline, pretomanid, and linezolid

27
Q

Which of the following is considered a positive mantoux test:

A. Tuberculin skin reaction 8mm from an endemic country
B. 9mm reaction in a prisoner
C. 6mm with abnormal CXR
D. 11mm in a healthy adult

A

C - correct, ≥5mm and CXR changes/close contact/HIV/immunosupressed = posigtive

A and B - incorrect, needs to be ≥10mm in people at risk of reactivation (i.e. IVDU, malignacy, diabetes, ckd), <4yo, forein country, high risk setting (prisoner, healthcare worker)

D - incorrect, needs to be ≥15mm in healthy individuals >4yo

28
Q

Which patient groups are at highest risk of developing invasive fungal infections?

A

Allogenic hematopoetic stem cell transplant
Acute myeloid leukemia
Solid organ transplant (excluding kidney)

29
Q

Diagnosis of acute Q fever

A

Isolation of C. Burnetti

Detection of C. Burnetti by NAAT

Seroconversion/4 fold increase in C. Burnetti antibody titre to phase II antigen by complement fixation assay OR indirect immunoflerscence IgG antibody assay (IFA)

30
Q

Prophylaxis for HIV

A

CD4 <50 - azithro weekly for MAC + TMP/SMX 3/wk

CD4 <200 - TMP/SMX 3/wk

CD4 <100 + T.Gondii IgG - TMP/SMX daily (full dose)

31
Q

During a contact trace, it is determined that Mr Jones was exposed to SARS-CoV-2 on Sept
18th (Day 0.) He interacted with Mr Smith on Day 5 before becoming symptomatic on Day 7
and receiving a positive result on Day 9. Mr Smith became symptomatic on Day 8 then was
tested and received a positive result on Day 12.

When assessing the transmission between
Mr Jones and Mr Smith, what is the serial interval?

What is the incubation period for each man?

A

Serial interval = 1 day
Incubation period = 7 days (MJ), 3 days (Smith)

Serial interval= time between symptom onset of primary case and symptom onset of secondary case (MJ symptomatic D7, Smith D8)

Incubation period is time from infection to symptom onset (D0–>7 MJ, D5–>8 Smith)

32
Q

A 59 year old male is admitted with febrile neutropaenia.
E. Coli was isolated in blood and urine cultures:

Resistant ampicillin/ceftriaxone

Sensitive ADF/pip-taz/mero/cefepime/gent/TMP-SMX

The best antibiotic treatment is:
A. Meropenem
B. Piperacillin/Tazobactam
C. Piperacillin/Tazobactam plus Gentamicin
D. Amoxicilin/Clavulonic acid plus Vancomycin

A

A - meropenem

Patient has an ESBL (resistant to ceftriaxone)
MERINO showed mero>pip-taz for ESBL bactermia

33
Q

When isolated from the blood stream which bacteria has the highest chance of concurrent IE?

a. staph aureus
b. staph mitis
c. staph. gallolyticus
d. e. faecalis

A

D. S. gallolyticus (bovis)

  • among patients with bacteremia due to S. bovis biotype I (S. gallolyticus subsp gallolyticus), IE has been observed in 43 to 100%of cases

s. aures = ~25%

34
Q

Kaposi sarcoma
- CD4 count
- treatment
- cause

A

HHV8 (herpes virus)
typically <200 or 150
HAART alone in most

35
Q

Treatment of strongyloides?
Risk factors?

A

RF = malignancy, HTLV1, AIDs, immunosupression, alcohol, malignancy

Treat with ivermectin

36
Q

Bacteria associated with rhomboencephalitis

A

Lysteria - inflammation of the brainstem with ataxia, nystagmus and CN palsies

37
Q

Bacteria that produce a lactamase penicillinase

A

Mechanism of staphs (mSSA), escapms (enterobacteracia) and ESBLs Klbeseall

38
Q

Bacteria with altered D-ala-D-ala in cell wall

A

Mechanism of VRE (Van genes)

39
Q

Bacteria that Altered penicillin-binding protein (PBP2) in cell wall

A

MRSA, PBP→ PBP2, recnoded by an acquired medA gene on staph cassette mobile

40
Q

Bacteria that produce efflux pumps

A

Pseudomonas
Tetracycline resistance in E.Coli
Macrolide resistance in strep pneumonia

41
Q

Microbe causing pseudoappendicitis syndrome

A

Yersinia enterolyticus

RACP 2022 Written (21 decks)

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