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Miscellaneous > Microbiology session > Flashcards

Microbiology session Flashcards

1
Q

What is the most common route of infection for meningitis and what is an example of this?

A

The ears e.g. otitis media

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2
Q

What is meningitis?

A

An infection of the meninges (the protective layers that surround the brain).

Usually inflammation in the context of infection.

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3
Q

Apart from the ears, what are other routes of infection for meningitis?

A

Nasopharynx

Parameningeal e.g. sinusitis

Haematogenous e.g. infective endocarditis

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4
Q

What is acute pyogenic meningitis?

A

Pyogenic means it forms pus so bacterial meningitis

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5
Q

What is aseptic meningitis?

A

Aseptic meningitis is the umbrella term for meningitis that comes back negative on culture.

Usually includes: viral and non-infectious meningitis.

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6
Q

What are the main triad of symptoms for meningitis?

A

Fever

Neck stiffness

Headache

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7
Q

What other symptoms can be associated with meningitis?

A

Photophobia

Vomiting

Altered consciousness

Sudden onset

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8
Q

What are the 2 signs that may be seen in meningitis?

A

Kernig’s sign

Brudzinski’s sign

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9
Q

What is Kernig’s sign?

A

Knee is flexed to 90 degrees

Hip is flexed to 90 degrees

Extension of the knee is painful or limited in extension

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10
Q

What is Brudzinski’s sign?

A

When lying down, passive flexion of the neck elicits flexion of the hips and knees.

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11
Q

What are features of meningococcal speticaemia?

A

Non-blanching, petechial rash

Purpuric

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12
Q

What is the pathology of pyogenic meninigitis?

A

The pia-arachnoid layer is congested with a thick layer of suppurative exudate (pus) that covers the leptomeninges (inner 2 meninges)

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13
Q

What is the organism for bacterial (pyogenic) meningitis in neonates?

A

Listeria monocytogenes

Group B strep

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14
Q

What is the organism for bacterial (pyogenic) meningitis in unvaccinated kids?

A

H.influenzae

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15
Q

What is the organism for bacterial (pyogenic) meningitis in ages 10-21?

A

Neisseria meningitidis

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16
Q

What is the organism for bacterial (pyogenic) meningitis in ages 21-64?

A

Strep. pneumoniae

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17
Q

What is the organism for bacterial (pyogenic) meningitis in ages 65+?

A

Strep. pneumoniae

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18
Q

What is the organism for bacterial (pyogenic) meningitis in immunocomprimised?

A

Listeria.monocytogenes

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19
Q

What is the organism for bacterial (pyogenic) meningitis with head trauma?

A

Staph.aureus

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20
Q

What is the organism for bacterial (pyogenic) meningitis with cribriform plate fracture?

A

Strep.pneumoniae

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21
Q

What complications can occur from bacterial meningitis?

A

Sensorineural hearing loss

Limb loss

Blindness

Cerebral palsy

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22
Q

What is the most common type of aseptic meningitis?

A

Viral meningitis

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23
Q

What are risk factors for viral meningitis?

A

Late summer/autumn

Travel

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24
Q

What are the viruses that can cause viral meningitis?

A

enterovirus

coxsackie

mumps

HSV

VZV

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25
Q

How is viral meningitis diagnosed?

A

stool PCR + culture

throat swab

LP PCR

HIV

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26
Q

What is typical treatment for viral meningitis?

A

Supportive treatment (the cause is usually enterovirus which includes ECHO virus which is self-limiting hence the reason why it is supportive treatment).

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27
Q

What are the risk factors for fungal meningitis?

A

Immunocompromised, HIV

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28
Q

What is the underlying causative organism for fungal meningitis?

A

Cryptococcus neoformans (an encapsulated yeast)

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29
Q

What are non-infectious causes of meningitis?

A

Behcet’s syndrome

Contrast

Carcinoma

Sarcoidosis

Vasculitis

Dural venous sinus thrombosis

Migraine

Drugs eg NSAID, sulfas, IVIg, co-trim

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30
Q

What is the characteristic CSF feature that would point to fungal meningitis?

A

Indian ink stain

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31
Q

Treatment for fungal meningitis?

A

IV amphotericin B or flucytosine

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32
Q

Can a lumbar puncture be bacteria -ve if the patient has already been given antibiotics?

A

Yes

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33
Q

When is a lumbar puncture contraindicated?

A

Lumbar puncture contraindicated if patient has raised ICP (intracranial pressure).

This is because it could cause shunting

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34
Q

When should a CT be carried out instead of a lumbar puncture for interpreting meningitis?

A

Papilloedema

GCS <13

Hx of CNS disease

Seizure /focal neuro deficit

Stroke

Immunocompromised

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35
Q

Treatment for bacterial meningitis?

A

Antibiotic + steroid

(particularly: ceftriaxone and dexamethasone)

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36
Q

Which steroid is usually given in bacterial meningitis?

A

Dexamethasone

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37
Q

When is dexamethasone started after administering antibiotics?

A

Immediately or 15 mins after starting antibiotics.

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38
Q

Why is dexamethasone given for bacterial meningitis?

A

Reduce cerebral oedema

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39
Q

What are contraindications to dexamethasone in bacterial meningitis?

A

Immunocompromised

Septic shock

Meningococcal (N. meningitidis)

Listeria

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40
Q

Antibiotics used for bacterial meningitis?

A

1st IV ceftriaxone

Pen allergy: IV chloramphenicol + vanc

Listeria: IV amoxicillin

Travel: IV vancomycin

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41
Q

Treatment for viral meningitis?

A

Usually supportive

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42
Q

Treatment for fungal meningitis?

A

IV amphotericin B or flucytosine

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43
Q

What is encephalitis?

A

An infection of the brain parenchyma

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44
Q

What is the aetiology (cause) of encephalitis?

A

VZV (varicella zoster virus)

HSV - in older patients

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45
Q

What is the typical onset for encephalitis?

A

Insidious onset (10 days)

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46
Q

What are the symptoms of encephalitis?

A

Psychosis & confusion

Seizures

Fever

Neck stiffness

Photophobia

Headache

Partial paralysis

Speech disturbance

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47
Q

What are the main investigations for encephalitis?

A

LP PCR, EEG, MRI

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48
Q

What is the typical MRI appearance for encephalitis?

A

Bright white (hyperdense), Bilateral temporal lobe involvement.

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49
Q

Treatment for encephalitis?

A

IV aciclovir

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50
Q

What is Guillian Barre syndrome?

A

Post infection (up to 4 weeks), acute autoimmune demyelinating neuropathy.

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51
Q

What is the aetiology of Guillian Barré syndrome?

A

Previous food poisoning

Campylobacter

CMV

EBV

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52
Q

Underlying pathology of Guillian Barre syndrome?

A

B cells secrete antibodies that attack pathogens, however the antigen on pathogens matches those on the myelin sheath

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53
Q

What are the signs of Guillian Barre syndrome?

A

Progressive paralysis

Ascending weakness

Pain

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54
Q

Investigations for Guillian Barre syndrome?

A

nerve conduction studies, LP, FEV1/FVC ratio (spirometry)

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55
Q

Complications of Guillian Barre syndrome?

A

Respiratory failure

Cardiac arrhythmia

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56
Q

What is treatment for Guillian Barre syndrome?

A

Ig infusion

Plasma exchange

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57
Q

What is Botulism?

A

A rare but serious illness caused by a toxin that attacks the body’s nerves.

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58
Q

Who does botulism typically affect?

A

PWID (people who inject drugs)

59
Q

What is the pathogen responsible for botulism?

A

Clostridium botulinum

60
Q

What are the typical sources for botulism?

A

Soil

Food

Contaminated wounds

61
Q

What is the underlying pathology of botulism?

A

Exotoxin acts on motor neuron terminals to block vesicle docking in presynaptic membrane, irreversibly inhibiting Ach release.

62
Q

What are the signs of botulism?

A

Rapid onset weakness w/out sensory loss

Ascending paralysis

63
Q

What are the leptomeninges?

A

Arachnoid and pia mater

64
Q

What age group is mostly affected by chlamydia?

A

20-24 years old

Female more common than male

65
Q

What is the pathogen for chlamydia?

A

Chlamydia trachomatis

Gram -ve intracellular anaerobe, doesn’t stain

66
Q

What is the incubation period for chlamydia trachomatis?

A

7-21 days

67
Q

Chlamydia is usually asymptomatic however what are some of the symptoms that it can still present with?

A

Vaginal: milky discharge, dyspareunia, dysuria

Penile: dysuria, cloudy discharge, testicular pain

Ano-rectal: procto-colitis + itch, discharge, bleeding

LGV: ulcers, gross unilateral lymphadenopathy

68
Q

How is chlamydia diagnosed?

A

NAAT

Vaginal: endocervical swab before speculum intro

Penile: first void urine or urethral swab
± anal or oral swabs depending on exposure

69
Q

Complications of chlamydia?

A

PID (pelvic inflammatory disease)

Reactive arthritis

Fitz Hugh Curtis

70
Q

Antibiotics used for chlamydia treatment?

A

1st doxycycline 7d

2nd/preg: azithromycin

LGV doxycycline 3w

71
Q

Treatment advice for chlamydia patient?

A

Partner notification

Abstain from sex for 7d

If pregnant, test for cure

72
Q

What age group is mainly affected by gonorrhoea?

A

15-49 y/o, M > F

73
Q

What is the pathogen for gonorrhoea and what type of bacteria is it?

A

gm -ve diplococci

Neisseria gonnorrhoeae

74
Q

Average incubation for gonorrhoea?

A

2-5 days

75
Q

Gonorrhoea is often symptomatic, what symptoms can it present with?

A

Vaginal: cervicitis, spotting, dysuria, discharge

Penile: yellow-green discharge, epididymo-orchitis, dysuria

Ano-rectal: tenesmus (recurrent inclination to clear the bowels), discharge, bleeding, proctitis

76
Q

What tests can be used for gonorrhoea?

A

NAAT

PCR w/ chocolate agar

Vaginal: endocervical swab before speculum intro

Penile: first void urine or urethral swab
± anal or oral swabs depending on exposure

77
Q

What are the complications of gonorrhoea?

A

PID (pelvic inflammatory disease)

Bartholin’s abscess

Endometritis (endometrial inflammation)

Epididymo-orchitis

78
Q

What are the antibiotic treatments for gonorrhoea?

A

1st single dose ceftriaxone IM

Allergy: cefixime + azithromycin

Sensitive: ciprofloxacin

79
Q

What treatment advice is given to patients with gonorrhoea?

A

Partner notification

Abstain from sex for 7d

Test for cure after 2-3 w

80
Q

What age group and people are usually affected by syphilis?

A

20-29 y/o, MSM (men sex with men)

81
Q

What is the causative pathogen of syphilis?

A

treponema pallidum which is a gm -ve spirochete

82
Q

What is the average incubation period for syphilis?

A

10-90 days (21 on average)

83
Q

Typical symptoms for stage 1 syphilis?

A

Single, painless primary chancre ± lymphadenopathy

84
Q

Typical symptoms of stage 2 syphilis?

A

condyloma lata, fever, pharyngitis, lymphadenopathy

Condyloma lata = raised growth on the skin resembling a wart, typically in genital region. Transmissible by contact.

85
Q

Typical symptoms of stage 3 syphilis?

A

Granulomas, behaviour change, sight/hearing loss

86
Q

What tests can be used to diagnose syphilis?

A
  1. Treponemal IgG and IgM
  2. Confirmatory test
  3. Treponema pallidum assay

Dark field microscopy - microscopy with dark field background.

87
Q

Treatment for syphilis?

A

One off benzylpenicillin double gluteal injection
Once every 3 weeks if tertiary syph

88
Q

What is the underlying pathology of bacterial vaginosis (BV)?

A

Occurs due to a High Ph and reduced number of lactobacilli (natural bacteria)

89
Q

Causative bacteria for BV?

A

Anaerobic bacteria:
- Gardenerella vaginalis
- Mycoplasma

90
Q

Symptoms of BV?

A

Fishy odour

Thin White/grey discharge

Itching/ irritation and pain

91
Q

How is BV diagnosed?

A

Vaginal swab /microscopy

Will show the presence of clue cells

ALSO TEST FOR STIS to exclude that as a diagnosis

92
Q

Treatment for BV?

A

Metronidazole

93
Q

Who is mostly affected by HIV?

A

MSM (men sex with men)

Black african

PWID (people who inject drugs)

Prisoners

94
Q

What is the underlying pathogen causing HIV?

A

RNA retrovirus targeting CD4

95
Q

What are symptoms of HIV?

A

Primary: flu-like ± macpap rash 2-4 weeks post-infection

Seborrheic dermatitis

Worsening psoriasis

Diarrhoea

Lymphadenopathy

Opportunistic infections

96
Q

How is HIV diagnosed?

A

HIV antibodies 45 d post-exposure

97
Q

What is the treatment for HIV?

A

HAART: 3 drugs w/ at least 2 antiviral classes

98
Q

If HIV is undetectable. It is also untransmittable. True/false?

A

True

99
Q

What type of pneumonia can occur due to HIV?

A

Fungal pneumonia cause by Pneumocystis jirovecii

100
Q

What is CD4 count?

A

A laboratory test that measures the number of CD4 T-cells.

A low CD4 count means that HIV has weakened your immune system.

CD4 of less than 200 indicates AIDS and involves risks of having more serious infections.

101
Q

At what CD4 count does pneumocytis jirovecii occur?

A

CD4 count<200

102
Q

Symptoms of HIV-related pneumonia?

A

SOB (shortness of breath)

Cough

103
Q

Diagnosis of HIV-related pneumonia?

A

Bronchoscopy + lavage (washing out of body cavity with water or medication).

104
Q

What skin complications can occur due to HIV?

A

HSV

HPV

VZV

105
Q

Cerebral toxoplasmosis can also occur due to HIV, what features does this have?

A

Cerebral abscess + chorioretinitis

106
Q

What CMV features can occur due to HIV?

A

Retinitis

Colitis

Oesophagitis

107
Q

How often is pre-exposure prophylaxis given for HIV?

A

On a daily basis

108
Q

Who is given pre-exposure prophylaxis for HIV?

A

High risk individuals

109
Q

When is post-exposure prophylaxis given for HIV?

A

Within 72 hrs of contact

Taken for 4 weeks

110
Q

Who is given post-exposure prophylaxis for HIV?

A

Individual had intercourse with a HIV-positive person

111
Q

What is done during pregnancy to prevent the baby from having HIV?

A

HAART during pregnancy

Vaginal delivery only if viral load is 0

Baby gets 2 weeks PEP

Cannot breastfeed

112
Q

What is PID (pelvic inflammatory disease)?

A

Inflammation and infection of the pelvic organs.

112
Q

What are the potential causes of pelvic inflammatory disease?

A

Often caused by STI:

  • 1st chlamydia
  • Severe gonorrhea
  • Mycoplasma
  • Gardnerella vaginalis
113
Q

What increased the risk of PID?

A

If the patient has a coil fitted

114
Q

What are the symptoms of PID?

A

Pelvic/lower abdominal pain

Purulent vaginal discharge

Post-coital or intermenstrual bleeding

Dyspareunia

Dysuria

115
Q

Examination features of PID?

A

Pelvic tenderness

Cervical excitation

Inflamed discharge

116
Q

Complications of PID?

A

Tubal infertility

Chronic pelvic pain

Ectopic pregnancy

Sepsis

117
Q

Investigations for PID?

A

Test for all STI’s

118
Q

Treatment of PID?

A

Ceftriaxone → covers gonorrhoea

Doxycycline → chlamydia + mycoplasma

Metronidazole → anaerobes

IV treatment if pregnant or septic

119
Q

What is the most common cause of Fitz-Hugh-Curtis syndrome?

A

Chlamydia infection

120
Q

What is the underlying pathology of Fitz-Hugh-Curtis syndrome?

A

Inflammation + infection of the liver capsule, leading to adhesions between the liver and peritoneum

121
Q

Symptoms of Fitz-Hugh-Curtis syndrome?

A

RUQ pain

Referred pain to right shoulder tip

122
Q

Investigation for Fitz-Hugh-Curtis?

A

Laparoscopy to visualise adhesions

123
Q

Treatment for Fitz-Hugh-Curtis?

A

Adhesiolysis (a minimally-invasive surgical procedure that breaks up adhesions (scar tissue) and treats the affected area with steroids and other medications).

124
Q

What is a commensal?

A

Organism present in body that doesn’t produce inflammatory response

125
Q

What is an infection?

A

Presence of an organism with inflammatory response

126
Q

What is bacteraemia?

A

Presence of organism in the blood

127
Q

What is sepsis?

A

Infection causing dysregulated host response

128
Q

What is septic shock?

A

Infection, dysregulated host response and evidence of end organ damage

129
Q

Who is at increased risk of sepsis?

A

Immunocompromised

Pregnant

Elderly

Baby

130
Q

Symptoms of sepsis?

A

Pain

SOB (shortness of breath)

Symptoms specific to source of infection

131
Q

Examination features of sepsis?

A

Tachycardia

Clammy or sweaty

Fever

132
Q

How is sepsis diagnosed?

A

NEWS scoring system

Find source
- Blood cultures
- Sputum/stool/urine cultures
- PCR

133
Q

What should be done within the first hour of suspected sepsis?

A

Sepsis 6

Give 3, take 3

134
Q

What are the components of the sepsis 6 (BUFALO)?

A

Mnemonic (BUFALO):

Blood tests

Urine output

Fluids

Antibiotics

Lactate

Oxygen

135
Q

What antibiotics are given for sepsis?

A

Amoxicillin + metronidazole + gentamycin

Vancomycin + metronidazole + gentamycin if penicillin allergy

136
Q

What NEWS score would raise suspicion of sepsis?

A

NEWS>5

137
Q

What are the components of the NEWS score?

A

RR
SaO2
Systolic BP
HR
AVPU
Temperature

138
Q

Treatment of bacterial meningitis?

A

Dexamethasone (steroid) and ceftriaxone (antibiotic)

139
Q

Treatment for severe community acquired pneumonia?

A

co-amoxiclav + doxycycline

140
Q

Treatment for severe hospital acquired pneumonia?

A

Amoxicillin + gentamycin

141
Q

Treatment for c.difficile infection?

A

Oral vancomycin

142
Q

What is chancre vs chancroid?

A

Chancres typically appear as painless, firm, round ulcers with a clean base and raised borders.

Chancroids typically appear as painful, soft ulcers or sores with irregular borders and a base covered with grey or yellow pus.

Miscellaneous (22 decks)

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