Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

From Flashcardlet > MI Stu > Flashcards

MI Stu Flashcards

1
Q

2 types of Staphylococcus and where do they colonise?

A

S.aureus (nasal flora) & coagulase neg staph (skin flora)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where does HSV remain dormant?

A

Dorsal root ganglion of spinal nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When would topical acyclovir be given?

A

cold sores for HSV infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What infection gives rise to a dermatomal distribution presentation?

A

Herpes Zoster Virus (shingles)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

To what type of patient would IV acyclovir be given to?

A

Severely immunosuppressed patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What common infection is caused by Poxvirus?

A

Molluscum Contagiosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

2 most common bacterial causative agents to infect skin?

A

S.aureus & group A Beta-haemolytic streptococci (aka S.pyogenes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which one is catalase negative out of S.aureus & group A Beta-haemolytic streptococci?

A

group A Beta haemolytic streptococci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Is teichoic acid a virulence factor for S.aureus or S.pyogenes?

A

S.aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hyaluronic acid capsule and adhesins are virulence factors for which bacterial organism?

A

S.pyogenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What type of infection is impetigo - deep or superficial?

A

superficial - only infects the epidermis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What infection gives Honey crusted lesions?

A

Impetigo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Complication of impetigo due to epidermolytic toxin production?

A

Staphylococcal scalded skin syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Fever, malaise, lymph node enlargement are features of what bacterial skin infection?

A

Eryseipelas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why would cellulitis generally occur unilaterally?

A

It’s generally caused where there has been skin penetration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What causative agent is most likely to give rise to orbital cellulitis?

A

Haemophilus influenzae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is also known as Fournier’s or synergistic gangrene?

A

Perineal necrotising fasciitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Type 1 Necrotising fasciitis is due to what organism?

A

Polymicrobial - enteric gram neg bacilli and anaerobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What condition is treated using Surgical debridement?

A

Necrotising fasciitis & Gas gangrene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

IV antibiotics used to treat NF?

A

meropenem and clindamycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Metronidazole used to treat which skin infection?

A

Gas gangrene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What antibiotics would you use if the patient was allergic to flucloxacillin in the treatment of S.aureus or S.pyogenes infections?

A

erythromycin, clarithromycin, Vancomycin, linezolid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Drug used to treat impetigo?

A

Fusidic acid or mupircon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is a dermatophyte infection of the nails called?

A

onychomycosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Dermatophyte infections are subject to what layer of the epidermis?

A

Stratum corneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Terbinafine is used to treat what?

A

Both skin, scalp and nail dermatophyte infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Antifungal agent to treat skin dermatophyte infections?

A

Clotrimazole & Terbinafine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Is T.pallidum a common STI causing bacteria in the UK?

A

No - uncommon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Is mycoplasma a common STI causing bacteria in the UK?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Is N.gonorrhoea a common STI causing bacteria in the UK?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Is Hepatitis B a common STI causing virus in the UK?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is PID?

A

Pelvic inflammatory disease (STI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

60% of women are asymptomatic in which STI?

A

Gonorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Fitz-Hugh-Curtis syndrome is a complication of what STI?

A

Gonorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Treatment of gonorrhoea: a) initially what beta lactams were used?

b) what cephalosporins?c) what fluoroquinolones?
d) other antibiotics ?

A

a) amoxicillin & benzylpenicillinb) oral cefixime & IV/IM ceftriaxonec) ciprofloxacind) spectinomycin & azithromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Which antibiotic to treat gonorrhoea now has widespread resistance?

A

Tetracycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Why is there a national chlamydia screening programme?

A

A lot of patients are asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Reiter’s syndrome is a complication of what STI & what are its features?

A

Chlamydia - arthritis, conjunctivitis, urethritis, skin lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Increase in the number of episodes of PID, increases the risk of what?

A

infertility (PID = Pelvic inflammatory disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Does HPV give you genital warts or genital herpes?

A

Genital warts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Which strains of HPV does Cervarix vaccinate against?

A

HPV 16 & 18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

HPV 6 & 11 give rise to what?

A

Genital warts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Complications of genital herpes?

A

dissemination, meningitis, encephalitis, sacral nerve parasthesiae, urinary retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is meant by constitutional symptoms?

A

Fever, malaise, weight loss, fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is tabes dorsalis and what STI is it a symptom of?

A

The demylination of posterior column of spinal cord resulting in lightening pains in the legs. Tertiary syphilis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What reaction can occur as a result of treatment in secondary syphilis?

A

Jarish-Herxheimer reaction - fever, chills, myalgia, hypersensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Is Trichomonas vaginalis a spirochete, protozoan or prion?

A

Protozoan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the most common type of Candidiasis?

A

Candida albicans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

In HIV, what CD4 count is classed as AIDS?

A

<200 cells/uL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

A nucleoside reverse transcriptase inhibitor for HIV?

A

Zidovudine or lamivudine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

To which two drugs is MDR-TB resistant to?

A

Isoniazid and rifampicin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are the two clinical manifestations of infection with mycobacterium leprae?

A

Tuberculoid and lepromatous leprosy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

SSPE is a complication of which disease?

A

Measles.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What type of animal carries schistosoma parasites?

A

Snail.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is the most common causative organism in osteomyelitis?

A

Staph. aureus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the major risk factor for septic arthritis?

A

Prosthetic joint/s.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Which bacterium causes whooping cough?

A

Bordetella pertussis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What informal term is used to describe persistent otitis media?

A

‘Glue ear’.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What organ is vulnerable to damage in glandular fever?

A

Spleen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Which virus is the most frequent cause of the common cold?

A

Rhinovirus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Neutrophil defects, what are the qualitative defects?

A

Loss of chemotaxisLoss of ability to kill - deficient in NADPH oxidase so hydrogen peroxidase is not formed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Febrile neutropenia is a medical emergency. >50% of those with what infection will die in 24 hours if not treated?

A

Pseudomonal infections <0.5x10^9/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Name a gram neg bacilli

A

E.coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

2 common fungal causative agents that cause infections in neutropenic patients?

A

Candida spp and aspergillus spp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Listeria monocytogenes is a a cause of what w.r.t opportunistic infections?

A

Bacterial cause of T cell deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Low antibodies due to them not working properly is called?

A

Hypogammaglobulinaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Giardia lamblia is a cause of what w.r.t antibodies?

A

Hypogammaglobulinaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Acquired causes of Hypogammaglobulinaemias?

A

Multiple myeloma, CLL, burns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Which complement factors does Neisseria meningitidis make deficient?

A

C5-C8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What organs removes opsonised bacteria from blood?

A

spleen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What does anti-rejection treatment in organ transplantation suppress? (type of immunity)

A

cell - mediated immunity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

In immunocompromised patients, live vaccines should be avoided to what patients?

A

T cell deficient patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What is the difference between immunosuppression & immunocompromised?

A

Immunosuppression = the immune system is suppressed by drugs. e.g from rejecting an organ transplant, treating graft-versus-host disease after a bone marrow transplant, or for the treatment of auto-immune diseases such as rheumatoid arthritis or Crohn’s disease.Immunocompromised = can result from immunosuppression. Reduction in Ig. AKA immunodeficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What are the different types of agents available for passive immunisation?

A

Pooled productsspecific Abs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What agents are available for active immunisation?

A

whole cell vaccineslive attenuated vaccinestoxinstoxoidsadjuvants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Why should we immunise?

A

Halt the carriage and transmission of disease to eliminate and eradicate it in order to protect communities from serious infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Which immune response is faster and more powerful?

A

Secondary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What is specific memory a hallmark for?

A

Adaptive immune response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Which type of immunisation is donating some IgG?

A

Passive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What type of immunisation is given for MMR?

A

Live attenuated bug = active

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What type of immunisation is given as a toxin?

A

Tetanus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Who was responsible for the invention of vaccinations?

A

Louis Pasteur - immunises against rabies, cholera and diptheria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Is BCG a live vaccine?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Pathogenic organism, reservoir, mode of exit and of transmission, portal of entry & susceptible host are the stages in what?

A

Chain of infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Main aim of infection prevention and control is to…?

A

Break the chain of infection at any point

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Complete killing or removal of all types of micro-organisms is what?Sterilisation?Disinfection?Washing?

A

Sterilisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What method of sterilisation is autoclave?

A

Moist heat - delivery of steam under high pressure in specific cycles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What is the Bowie-DICK test used for?

A

Steam PENETRATION test for the monitoring of autoclaves (doubt we need to know this but its funnay)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What is disinfection?

A

Removal or destruction of sufficient numbers of harmful micro-organisms to make an item safe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Difference between disinfection and antisepsis?

A

An antiseptic is a disinfectant used on damaged skin or living tissue as it requires minimal toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What is the least hazardous method of decontamination?

A

Heating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What decontamination method should be used for surgical instrument reprocessing?

A

Moist heat sterilisation due them being a high risk group

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Flexible endoscope decontamination would involve what?

A

High level disinfection. It’s classed as a high risk group but due to the sensitive and plastic parts it cannot undergo sterilisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What happens to syringe needles prior to use to decontaminate it?

A

Gamma irradiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What happens to syringe needles after use?

A

Disposal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What risk group are surgeon’s hands classed as?

A

Low risk. It is the clothes that they wear which will be high risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Measles can rarely give rise to what slow viral infection?

A

Subacute sclerosing panencephalitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What virus causes the fatal progressive multifocal leukoencephalopathy?

A

JC papovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What infection was due to ritual canabalism?

A

Kuru - transmissible spongiform encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Mean age of onset in sporadic CJD?

A

50-60 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

List 4 iatrogenic causes of CJD?

A

contaminated surgical instrumentscorneal transplantsGH from human pituitariesBlood transfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Gertsmann-Straussler-Scheinker syndrome is an inherited form of what?

A

CJD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Which has a longer survival - vCJD or sCJD?

A

vCJD = 14 mnths. sCJD = 6 mnths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

High homozygosity for what amino acid is seen in both sCJD and vCJD at codon 129?

A

methionine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What is scrapie?

A

Animal (sheep) infection with spongiform encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

How did humans get vCJD?

A

Ingestion of contaminated beef with BSE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Clinical feature of CJD?

A

pre-senile dementia, focal CNS signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Which antifungals require therapeutic drug monitoring?

A

Itraconazole5-fluorocytosine( + voriconazole)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What class of antifungal is Terbafine, and what does it treat?

A

AllyamineFor athlete’s foot (tinea pedis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Two classes of Azoles with an example of each …

A
  1. Imidazole (eg clotrimazole)2. Triazoles (eg flucanozole)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

What does HAART stand for and what does it consist of?

A

Highly active antiretroviral therapy Either:2 NRTIs and 1 NNRTI Or 2 NRTIs and a boosted PI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Which phase of viral replication does Oseltamivir and Zanamivir target?

A

“Release phase” of virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Name 4 classes of Protein Synthesis Inhibitors

A

Oxazolidinomes, tetracyclines, aminoglycasides, MLS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Most common causative organism in viral conjunctivitis

A

Adenovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Why is gonorrhoea not treated with quinolones ?

A

Increasing resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Which antibiotic can be used to eradicate H pylori ?

A

Amoxicillin (In combo with omeprazole)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

What type of equipment would ionising radiation be used to sterilise?

A

Disposable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Term used to describe the reduced virulence of a pathogen that can be used as a vaccine

A

Attenuated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

If first line treatment with amoxicillin has failed to resolve an infection (e.g. Sinusitis) what would the second line treatment be, why ?

A

Amoxicillin-clavulanate (co-amoxiclav) as has a broader range, adding gram negative cover,an d often treats infections resistant to amoxicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

People allergic to penicillins are also likely to be allergic to which other class of antibiotics ?

A

Cephalosporins (first generation)Some cross reactivity between the two classes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Why is erythromycin not commonly used ?

A

Significant GI side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Two most commonly used macrolides ?

A

Azithromycin, Clarithromycin

E.g. In mild to moderate pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Which part of the malaria life cycle does sexual reproduction take place?

A

In the mosquito(Human = asexual)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Which beta-lactams are wide spectrum ?

A

Carbapenems e.g. Meropenem, Amoxicillin, Co-amoxiclav (even more than amoxicillin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Why should co-amoxiclav never be used in CNS infections ?

A

The clavulinic acid doesn’t cross blood brain barrier (Can use amoxicillin instead e.g. In listerial meningitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Give an example of a flagellate Protozoa

A

Giardia lamblia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

How is ascariasis treated?

A

Single dose of albendazole, which prevents the worm from absorbing glucose, so it detaches and you poop it out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

Post transplant patients are particularly at risk of infection by this virus…

A

CMV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

For which bacterial meningitis cause is chemoprophylaxis currently unavailable?

A

Streptococcus pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Define “trismus”

A

Spasm of muscles of mastication in tetanus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Define pleocytosis

A

Presence of white cells in CSF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

Most common cause of viral meningitis

A

Enterovirus (eg echovirus, coxsachie, parecho, poliovirus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Clinical presentation of viral meningitis in children

A

Nuchal rigidity, bulging anterior fontanelle due to ⬆️ICP.(Meningeal signs may be absent - to little to talk)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

Most common cause of brain abscess?

A

Streptococci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

Possible complications of gastroentiritis

A

Dehydration, renal failure, HUS, toxic mega colon, GBS, disseminate to other parts of body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Most common cause of brain abscess AS A RESULT OF TRAUMA

A

S. Aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

What is the function of the integrate enzyme ?

A

Incorporate new DNA created by reverse transcriptase (virus) into host cell genome - becoming a provirusunique to retroviruses! good anti-viral target

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

If a turtle loses its shell, is it naked or homeless?

A

Naked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

Which classes if antivirals can treat influenza ?

A

M2 inhibitors Neurosminidase inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

What strain of influenza M2 inhibitors (e.g. Amantadine) treat ?

A

Influenza A ONLY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

Which antivirals can treat ALL strains of influenza ?

A

Neuroaminidase inhibitors E,g. Zanamivir, osteltamivir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

What is the use of ritonavir ?

A

Boost levels of other protease inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

Uses of acyclovir ?

A
  • HSV- VZV- CMV- EBV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

Uses for gancyclovir ?

A

CMV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

Side effects of gancyclovir?

A

Haematological adverse effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

Antiviral that may be used to Treat respiratory syncytial virus?

A

Ribavirin (NRTI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

In what cases would INF-alpha be used as treatment ?

A

Hep B,C
Hairy cell leukaemia
Kaposi’s sarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

HIV HAART therapy consists of:

A

2 NRTIs + protease inhibitors

Or 2 NRTIs + NNRTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

What are the 3 classes of newer HIV drugs ?

A 
Integrase inhibitors (raltegravir)
CCR5 inhibitors (maraviroc)
Fusion inhibitors (enfuvirtide)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

4 clinical settings in which brain abscesses can develop:

A

direct spread (from adjacent Suppuration focus)
Haematogenous spread (from distant focus)
Trauma
Cryptogenic (no focus recognised)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Why is Gentamycin not effective against anaerobic organisms?

A

aminoglycosides require an oxygen dependent active transport mechanism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

Mechanism by which strains of s. Aurues have become resistant e.g. to flucloxacillin (MRSA)

A

altered penicillin binding protein (PBP2’, encoded by MecA gene)
DOES NOT bind B-lactams

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

mehcanism by which vancomycin resistant enterbacteriae have developed

A

altered peptide sequence in Gram +ve peptideoglycan (D-ala D-ala -> D-ala D-lac)
This reduces binding of vancomycin 1000-fold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

Name the 6 mechanisms of developing antibiotic resistance:

A
  1. No target
  2. reduced permeability
  3. altered target
  4. over-expression of target (effect diluted)
  5. enzymatic degradation
  6. Efflux pump
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

Process by which resistance genes are transmitted between microorganisms

A

conjugation (mainly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

other name for cestodes ?

A

tape worm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

cestodes (tape worm) and trematodes (flukes) are both subdivisions of which type of helminth ?

A

platyhelminth (flatworm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

what is the other name for roundworm ?

A

nematode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

Name the 4 subdivisions of protozoa:

A
  • flagellates
  • amoeboids
  • sporosoans
  • trypanosomes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

Giardia Lamlia is an example of which type of protozoa subdivision ?

A

flagellates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

Leishmania is an example of which subdivision of protozoa ?

A

trypanosomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

Schistomiasis is what type of parasite ?

A

Macroparasite: trematode/fluke (platyhelminth, helminth)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

chronic infection with schistomiasis results in what conditions ?

A
  • bladder cancer

* liver cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

what is the causative agent of ‘river blindness’

A

Onchocerca volvulus (nematode) (leads to onchocerciasis, transmitted by bite of the black fly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

infection that can lead to amoebic dysentry/colitis + Liver abscesses (if gets into blood)

A

Amoebiasis (caused by amoeba entamoeba histolytica)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

explain the trasmission of toxoplasma gondii

A
  • food chain

* cat faeces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

common anti-protozoal drug treatments:

A
  • metronidazole
  • pentamidine
  • antimalarials
  • nitazoxanide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

Common anti-helminthic drug treatments:

A
  • albendazole
  • mebendazole
  • ivermectin
  • praziquantel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

What is the distinguishing factor between presentations of meningitis and encephalitis ?

A

level of consciousness:Meningitis = fully conscious, no focal neurological signsencephalitis = altered conscious level, seizures +/- focal neurological signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

A presentation of: Insidiousfever onset, headache, +/- neck stiffness +/- altered conscious level, seizures,focal neurological signsis suggestive of what condition ?

A

Brain abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

Treatment for bacterial meningitis (neisseria meningitidis)?

A

Ceftriaxone, cefotaxime (cephalosporin)+ penicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

What treatment should be given to individuals who have been in close contact (e.g. kissed) a patient with a neisseria meningitidis infection ?

A

Rifampicin (RNA synthesis inhibitor) Ciprofloxacin (quinolone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

What are the virulence factors of H. influenzae ?

A

Type b capsuleFimbriaeIgA proteases (outer membran proteins/LPS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

Name the 3 common causative agents in neonatal meningitis

A
  • Group B beta-haemolytic streptococci
  • E. coli
  • listeria monocytogenes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

2 common viruses causing meningitis ?

A
  • Enteroviruses

* Herpes simplex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

which type of meningitis is distinguished from others by aninsidiousonset ?Cryptococcus meningitis also insidious onset, but only common in patients in late stage HIV

A

TB meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

Most common viral cause of encephalitis?

A

HSV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

Clinical presentation of viral meningitis ?

A
  • Fever
  • meningism ~Viral prodomein infants meningeal signs may be absent - nuchal rigidity + bulging ant. fontanelleusually impossible to distinguish between viral + bacterial
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

Lumbar puncture + bloods findings in viral meningitis:

A
  • pleocytosis (white cells in CSF)
  • lymphocytic
  • protein= normal/mildly elevated
  • glusoce= normal/slightly low
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

what is acute disseminated encephalomyelopathy (ADEM)

A

immune-mediated CNS demyelination

  • similar clinical features to encephalitis
  • CFS findins = viral meningitis
  • can follow viral illness or vaccination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

Treatment for Herpes simplex encephalitis ?

A

MEDICAL EMERGENCY

Treat with high dose IV acyclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

Bacteria implicated in acute bronchitis?

A
  • Bordetella pertussis
  • mycoplasma pneumoniae
  • chlamydia pneumoniae
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

Features of bronchitis:

A
  • cough in the absence of fever, tachypnoea, tachycardia

* reduced pulmonary function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

Classical presentation of community acquired pneumonia ?

A

sudden onset chills, followed by fever, pleuritic chest pain and productive cough (sputum can be rusty coloured)- chest x ray shows parenchymal involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

most common cause ofcommunitiy ac

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

Most common cause ofcommunity accquiredpneumonia (CAP) ?

A

S pneumoniae (pneumococcal pneumonia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

what viruses are likely to cause pneumonia inchildren?

A
  • paraunfluenza

* RSV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

viruses likely to cause pneumonia in adults ?

A
  • Influenza A and B

* Adenovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

Viruses that may cause pneumonia in animmunocompromised host?

A
  • Measles
  • HSV
  • HHV-6
  • CMV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

Presentation ofatypical pneumonia?

A
  • Tracheobronchial-interstital inflammation (instead of alveolar) Central(substernal) pain (opposed to peripheral/pleuritic) Scanty, non-purulent sputum
  • Normac WBC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

What is CURB-65 ?

A

Clinical prediction rule for mortality in CAP:C= confusionU= Urea >7mmolLR= Resp. rate >/=30 per minB= BP systolic < 90mmHg or diastolic 65= ageone pint scored for each present feature:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

What does a score of 2 of the CURB-65 suggest ?

A

Increased risk of death - consider short stay inpatient or hospital supervised outpatient treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

What is chlamydia Psittaci ?

A

Usually infect birds (asymptomatic)- results in non-specific flu like symptoms, typhoidal illness or productive cough with striking radiograph findings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

Which GI microorganism is Haemolytic Ureamic syndrome associated with ?

A

E. Coli toxic producing microbes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

Most common cause of gastroenteritis inchildren?

A

Rotovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

Outline the mechanism of action of the E. Coli toxin:

A
  1. toxin activates G protein - inc. levels of cAMP2. cAMP activates ion channels3. causes overexcretion of chloride ions4. water follow Cl- ions into lumen - DIARRHOEA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
197
Q

Exception of gastroenteritis where antibiotic treatment may be used:

A
  • extremes of age
  • campylobacter (prolonged/severe symptoms)
  • invasion (e.g. +ve blood cultures)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
198
Q

Causes of Cholecystitis ?

A

Associated with obstructuib if cystic duct

  • malignancy
  • surgery
  • parasitic wormsRarely due to none obstructive causes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
199
Q

Presentation of cholecystitis:

A
  • Fever

* Right upper quadrant pain mildjaundice (Common bile duct remains patent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
200
Q

Bacterial count considered ‘significant bacteriuria’ in UTI ?

A

10^5cfu/mL(104-105= probable infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
201
Q

Most common causative agent in bone and infections ?

A

S. Aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
202
Q

complications of group A Streptococcal infection ?

A
  • acute glomerulonephritis
  • rheumatic fever
  • scarlet fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
203
Q

What is quinsy ?

A

peritonsillar abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
204
Q

Reaction caused by giving ampicillin in EBV infection ?

A

Mac-pap rash (not true allergy)therefore avoid ampicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
205
Q

Most common cause of epiglottitis ?

A

H. influenzae type B (before immunisation)now very rare, variety of other causes, esp. resp. bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
206
Q

causative agent of whooping cough ?

A

bordetella pertussis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
207
Q

Main organisms associated with otitis externa (acute) ?

A

S. Aureus Pseudomonas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
208
Q

treatment for otitis media ?

A

amoxicillin (ONLY if unwell - otherwise treat symptomatically)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
209
Q

What is continuing bacteriuria associated with in pregnancy ?

A

premature delivery, increased perinatal mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
210
Q

Clinical features of intra amniotic infection ?

A
  • maternal fever
  • uterine tenderness
  • malodorous amniotic fluid
  • materal/foetal tachycardia
  • raised WBC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
211
Q

risk factors for puerperal endometritis/sepsis ?

A
  • prolonged labour
  • caesarean
  • prolonged rupture of membranes
  • multiple vaginal examinations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
212
Q

causative agents of puerperal endometritis ?

A

E. ColiBeta-haemolytic streptococcianaerobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
213
Q

causative organisms of puerperal mastitis ?

A

S. Aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
214
Q

Treatment for neonatal sepsis/meningitis ?

A

Amoxicillin + gentamicin(broad spectrum)

215
Q

Describe the progression and characteristics of ameaslesrash

A
  • Starts at head & face then spreads down body over a few days ending on palms and soles
  • Starts macular-papular, then prgressive to become confluent (merge)
  • whitish-bluish papules near mouth
216
Q

Which disease is known as ‘first disease’ ?

A

Measles

217
Q

what is the incubation period for measles ?

A

10-12 days

218
Q

Clinical features of measles ?

A

remember the 3 c’s! conjunctivitis,coryza,cough+ prodome, fever + malaise, erthythematous, M-P rash

219
Q

where does the chicken pox rash begin on the body ? + what type of rash ?

A

the trunk, vesicular

220
Q

incubation period and infectivity of chicken pox ?

A
  • incubation: 14-15 days

* infectivity: 2 days before onset of rash until after vesicles dry up

221
Q

what treatment may be given to adults with chicken pox ?

A

aciclovir

222
Q

Rubella is also know as ?

A

The THIRD disease

223
Q

what virus is rubella caused by ?

A

togavirus

224
Q

Which virus is characterised by an incubation period of 14-21 days, and infectivity one week before rash appears to 4 days after ?

A

rubella

225
Q

what are the teratogenic effects of rubella ?

A
  • cataracts + eye defects
  • deafness
  • cardiac abnormailities
  • microcephalyCONGENITAL RUBELLA SYNDROME
226
Q

which virus causes ‘slapped cheek’?

A

parvovirus

227
Q

percentage of childhood respiratory infections caused by adenovirus ?

A

10%

228
Q

infectivity and incubation of mumps ?

A
  • infectivity:several days before parotid swelling to several days after
  • incubation: 16-18 days
229
Q

what is the most common extra salivary gland manifestation of mumps ?

A 
CNS involvement (children + adults overall)
epidydymo-orchitis (adults alone)
230
Q

How are mycobacteria different to all other bacterial genera ?

A
  • Unusual waxy cell wall (high lipid content)

* slow growing (different media requirements)

231
Q

What is ‘ghon focus’

A

Small area of granulomatous inflammation, usually in the the midzone of lung caused by primary TB infection (phagocytosed bacilli)

232
Q

What is ghon complex ?

A

When Ghon Focus involves the hilar lymph nodes

233
Q

First line Treatment for TB ?

A

2 months: Isoniazid, rifampicin, pyrazinamine, ethambutol

4 months: Isoniazid, rifampicin

234
Q

Second line agents for TB treatment ?

A
  • amikacin
  • ethionamide
  • cycloserine
  • fluoroquinolones (ciprofloxacin)
235
Q

Blood test for TB ?

A

Interferon-γ release assay (IGRA)

236
Q

What is mycobacterium avium complex ?

A

An Atypical mycobacterium, which usually infects people with low T-cells + CD4+ e.g. HIV patients

237
Q

Defining characteristics of necrotising fasiculitis?

A
  • Severe pain - out of proportion
  • rapid progression
  • systemic toxicity
  • necrosis
  • ecchymosis (subcut purpura)
238
Q

What is the causative agent of type 1 necrotising fasciculitis ?

A

polymicrobial : enteric gram -ve bacilli + anaerobes

239
Q

Causative agent of type 2 necrotising fasciculitis ?

A

S. pyogenes

240
Q

Causative organism of gas gangrene ?

A

C. perfringens - treat with metronidazole

241
Q

Effects of a gonorrhoea infection during pregnancy ?

A

spontaneous abortion, premature labour, conjunctivitis, can pass it onto neonates (opthalmia neonatorum)

242
Q

Presentation of Gonorhoea in neonates:

A

Opthalmia neonatorum

acute purulent conjunctivitis(can cause blindess if not appropriately treated)

243
Q

outline the unique lifecycle of chlamydia trachomatis - obligate intracellular pathogen

A
  • Extracellular infectious form: elementary body

* intracellular replicative form: reticulate body

244
Q

What are the target cells of chlamydia trachomatis ?

A

Squamocolumnar epithelial cells of endcervix/ upper genital tract (females) and conjunctiva, urethra, rectum (both sexes)

245
Q

What is reiter’s syndrome and what is it a rare complication of ?

A
  • reactive arthritis, autoimmne response to infection
  • arthritis, conjunctivitis, urethritis, skin lesions
  • complication of chlamydia infection
246
Q

what is condylomata accuminata?

A

genital warts

247
Q

what type of virus is herpes simplex ?

A

double stranded DNA virus

248
Q

Causative agent of syphilis ?

A

Treponema pallidum (spirochaete, protozoa)

249
Q

Histological characteristics of syphilis?

A
  • Obliterative endarteritis
  • concentric endothelial/ fibroblastic proliferation
  • microscopic vascular compromise
250
Q

presentation of the secondary phase of syphilis infection ?

A

skin:
* rash: M-P trunk, limbs, palms, soles
* condylomata lata - erythematous plaques
* mucous patches - silver/grey erosionsgeneralised lymphadenopthy, fever, malaise, weight loss, CNS involvement

251
Q

describe the primary phase of syphilis infection

A

painless induration lesion, heals spontaneously in 3-6 weeks

252
Q

Late (tertiary) phase of syphilis involves what?

A
  • Neurosyphilis:seizures, general paresis, tabes dorsalis
  • CV:aortitis
  • non-specific granulomatous reaction
253
Q

outcomes of congenital syphilis ?

A 
early = snuffles, rash, hepatospenomegaly
late = saddle nose, sabre shins, hutchinson's incisors, frontal bosses
254
Q

what are the changes in normal flora leading to bacterial (anaerobic) vaginosis ?

A
  • reduced vaginal lactobacilli

* increased gardnerella vaginalis + anaerobes

255
Q

treatment for bacterial vaginosis?

A
  • metronidazole (anaerobe)
  • ~amoxycillin ~
  • topical clindamycin
256
Q

How does HIV gain access to host cells ?

A

The viral gylcoprotein gp120interacts with cellular receptor CD4 and chemoking receptor CCR5

257
Q

Define each of the 4 stages in the WHO classification of HIV based on CD4 count:

A

stage 1: CD4 count >500cells/μL
stage 2: 349-499
stage 3 (Advanced HIV): 200-349
stage 4(AIDS): <200

258
Q

What is acute retroviral syndrome ?

A

flu-like symptoms occuring up to 6 weeks after initial infection, including:

  • fever
  • pharygnitis
  • lymphadenopathy
  • rash
259
Q

Outline the early symptoms of HIV

A
  • pulmonary TB
  • persistent oral candidiasis
  • unexplained chronic diarrhoea (>1 month)
  • unexplained persistent fever (>37.6 for >1 month)
  • severe bacterial infections (e.g. s. pneumoniae bacteraemia)
260
Q

name 3 slow virus infections:

A
  • progressive rubella panencephalitis
  • progressive multifocal leukoencephalopathy
  • subacute sclerosing panencephalitis (SSPE)
261
Q

what is gerstmann-straussler-sheinker syndrome?

A

Rare, familial, fatal, neurodegenerative disease (TSE) presents with: progressive ataxia pyramidal signs
adult onset dementia

262
Q

What is thought to be the cause of vCJD?

A

thought to be the consumption of foods contaminated with prions (which also cause BSE)

263
Q

Antiviral to treat HSV & VZV?

A

Aciclovir - Nucleoside viral DNA polymerase inhibitors

264
Q

What is ganciclovir use to treat?

A

CMV.

265
Q

Antiviral treatment of influenza?

A

Zanamavir or oseltamivir

266
Q

What is ribavarin used to treat?

A

Hepatitis C

267
Q

Antiviral treatment for Hep B & Hep C?

A

Interferons - inhibit viral replication

268
Q

Name 4 nucleoside reverse transcriptase inhibitors (NRTI)? (pyridine & purine analogues)

A 
Pyridine = Azidothymidine (zidovudine) & Lamivudine. 
Purine = Abacavir & Tenofovir
269
Q

Name 2 non-nucleotide reverse transcriptase inhibitors?

A

Efavirenz & Nevirapine

270
Q

Name 3 protease inhibitors used in antiviral treatment?

A

Saquinavir, Ritonavir, Lopinavir

271
Q

What type of antiviral is raltegavir?

A

Integrase inhibitor (HIV treatment)

272
Q

Antibiotic to treat s.aureus?

A

Flucloxacillin

273
Q

Antibiotic to treat strep pyogenes?

A

Benzylpenicillin

274
Q

Antibiotic class used to treat gram neg bacilli?

A

Cephalosporins (beta lactam) - cefuroxime

275
Q

Antibiotic to treat anaerobes?

A

Metronidazole

276
Q

Antibiotic to treat gram positive bacteria?

A

Vancomycin - glycopeptide

277
Q

2 key mechanisms by which the major classes of antibiotics work?

A

1) Inhibition of critical processes in bacterial cells

2) Protein synthesis inhibitors

278
Q

Mechanism of action of glycopeptides?

A

Inhibits binding of transpeptidases resulting in no peptidoglycan cross linking (cell wall synthesis inhibited)

279
Q

Mechanism of action of beta lactams?

A

Act by interfering with penicillin binding proteins which are enzymes involved in the synthesis and maintenance of peptidoglycan.

280
Q

4 main types of beta lactams? + examples

A

1) Penicillins - amoxicillin & flucloxacillin
2) Cephalosporins - cefuroxime, ceftriaxone
3) Carbapenems - meropenems
4) Monobactams - aztreonam

281
Q

4 main types of protein synthesis inhibitors with examples?

A

1) Aminoglycosides - gentamicin
2) Macrolides & lincosamide - Erythromycin & clindamycin
3) Tetracyclines - doxycycline
4) Oxazolidonones - Linezolid

282
Q

2 types of DNA synthesis inhibitors?

A

1) Trimethoprim

2) Quinolones & Fluoroquinolones - ciprofloxacin

283
Q

3 common precipitating antibiotics for clostridium infection?

A

3 C’s - Cephalosporins,

  • Clindamycin
  • Ciprofloxain
284
Q

What class of antibiotics cause nephrotoxicity on accumulation?

A

Aminoglycosides - Gentamicin

285
Q

Which antibiotic can cause bone marrow depression?

A

Linezolid

286
Q

Safe to use which classes of antibiotics in patients with non-severe penicillin allergy?

A

Cephalosporins & Carbopenems

287
Q

Which drug can you use in patients with penicillin allergy except for ceftazidime?

A

Aztreonam

288
Q

Examples of bactericidal antibiotics?

A

1) Rifampicin
2) Vancomycin (GP)
3) Fluoroquinolones (DNA)
4) Penicillins (Beta lactams)
5) aminoglycosides (PSI)
6) polymixins
7) macrolides (beta lactams)
8) bacitracin
9) cephalosporins
10) metronidazole

(Really very finely proficient at predicting many bacterial cell murders)

289
Q

Example of a RNA polymerase inhibitor?

A

Rifampicin - bactericidal

290
Q

Examples of Bacteriostatic antibiotics?

A

1) Erythromycin (PSI)
2) Chloramphenicol (PSI)
3) Sulfonamides
4) Tetracycline (PSI)
5) trimethoprim (DNA)
6) Clindamycin (PSI)

(ECSTaTiC about bacteriostatic)

291
Q

Example of an antibiotic which inhibits folate synthesis?

A

Trimethoprim & sulfonamides

292
Q

Example of antibiotic which is a plasma membrane agent which only works on gram positive bacteria?

A

Daptomycin

293
Q

What are fungal cell walls made out of?

A

Beta-1,3-glucan made by beta-1,3-glucan synthase

294
Q

What is found in fungal cell membranes that has a role in regulating membrane permeability?

A

Ergosterol

295
Q

5 main antifungal classes? + mechanism of action?

A

1) Polyenes - loss of membrane integrity by binding to sterols.
2) Allyamines - inhibit ergosterol synthesis (squalene epoxidase)
3) Azoles - Inhibit ergosterol synthesis (Lanosterol demethylase)
4) Echinocandins - Inhibits Beta-1,3-glucan synthase (shit cell wall)
5) Others - inhibition of protein synth, DNA synth & fungal mitosis

296
Q

2 examples of polyenes? + use?

A

1) Amphotericin B - broad spectrum (asp, candida, cryptocc)

2) Nystatin - topical use only for superficial infections (candidiasis)

297
Q

Example of an allyamine? + Use + adverse effects?

A 
Terbinafine - broad spectrum, main use for dermatophytes.
Liver toxicity (jaundice & hepatitis)
298
Q

Types of azoles? + adverse effects?

A

1) Imidazole - clotrimazole
2) Triazole - Fluconazole & Voriconazole

Hepatoxicity & inhibition of CYP450 so there can be an increase in drug concentrations.

299
Q

3 examples of imidazoles?

A

1) clotrimazole
2) miconazole
3) ketoconazole
- not use systemically only for superficial infections (candida)

300
Q

Which type of azole can be used systemically?

A

Triazoles

301
Q

Which triazole is the most broad spectrum? (can treat Yeasts, aspergillus, mucoracous moulds)

A

Posaconazole

302
Q

Which triazole can only treat yeast infections?

A

Fluconazole. (Voriconazole = yeasts and aspergillus)

303
Q

Antifungal which inhibits beta-1,3-glucan synthase?

A

Echinocandin

304
Q

Example of echinocandins?

A

1) CASPOFUNGIN
2) micafungin
3) anidulafungin

Systemic infections

305
Q

Antifungal which inhibits DNA & protein synthesis? + use + adverse effects?

A

5-fluorocytosine - candida & cryptococcal meningitis. + bone marrow suppression. was a an anti-cancer drug

306
Q

Which anti-fungal inhibits fungal mitosis?

A

Griseofulvin - dermatophyte infections

307
Q

6 mechanisms of antibiotic resistance?

A

1) No target
2) ALTERED TARGET (most common)
3) over expression of target
4) reduced permeability
5) efflux pump
6) ENZYMATIC DEGRADATION (most common)

308
Q

How is MRSA resistant to Flucloxacillin?

A

ALTERED binding protein which doesn’t bind beta lactams.

309
Q

How is Vancomycin resistant enterococcus resistant to vancomycin?

A

ALTERED gram positive peptidoglycan peptide sequence

310
Q

Why can gentamicin not be used on anaerobic organisms?

A

Gentamicin = amino glycoside therefore requires oxygen active transport for uptake.

311
Q

Two examples of enzymatic degradation resistant drugs?

A
  • Beta lactamases break down Penicillins and cephalosporins so become resistant.
  • Aminoglycoside modifying enzymes cause the bacteria to become resistant to gentamicin
312
Q

Symbiosis or parasitism? - non mutual relationship with host?

A

Parasitism

313
Q

List the 9 main medical parasites in the UK?

A

Malaria, schistosomiasis, Onchocerciasis, Giardia, Amoebiasis, Acanthamoeba, Toxoplasmosis, Leishmaniasis, Cryptosporidium

314
Q

5 Most common parasites encountered?

A

1) Ascariasis - intestinal nematode
2) Malaria - plasmodium (sporozoan)
3) Schistomiasis - trematodes (platyhelminths)
4) Cryptosporidiosis - sporozoan
5) Hydatid disease - Cestode (Platyhelminths)

315
Q

Brief life cycle of ascariasis?

A

Intestinal nematode - worm lives in SI. Eggs pass in faeces and embryonate and become infective (18 days). Infective eggs swallowed, invade intestinal mucosa and carried via portal, systemic circulation to lungs. Larvae mature further and hatch which then penetrate alveoli to ascend to the throat, so that they can be swallowed. Reach SI and develop into adult worms.

316
Q

What is Loefflers syndrome?

A

Involved in ascariasis. Dryg cough, dyspnoea, wheeze, haemoptysis.

317
Q

Diagnosis of ascariasis?

A

Stool exam. Blood test for inc number of eosinophils. Imaging to look for worms.

318
Q

Treatment of ascariasis?

A

Albendazole

319
Q

Life cycle of Malaria?

A

Female mosquito transmits sporozoite to human. Sporozoite travels through blood vessel to hepatocytes, reproducing asexually to form lots of merozoites. They infect new RBCs and multiply again. Fertilised mosquito bites infected person, gametocytes take up with blood and mature in mosquito. Development of new sporozoites which migrate to insects salivary gland ready to infect new vertebrae.

320
Q

What would suspect if a returning traveller had a fever?

A

Malaria

321
Q

Diagnosis of malaria?

A

Thick and thin microscopy. serology for detection of antigen in blood.
PCR for malarial DNA.

322
Q

Treatment for malaria?

A

Quinine, doxycycline, artesunate

323
Q

Life cycle of schistosomiasis?

A

aka bilharzia disease causes by trematode - platyhelminth

Sporocysts in snail release cercariae into water which penetrates skin and becomes schistosomula. Pass into circulation and migrate to GI, urinary and liver.

324
Q

Diagnosis of schistosomiasis?

A

Urinary - terminal stream

Hepatic/intestinal = stool microscopy, serology

325
Q

Treatment of schistosomiasis?

A

Praziquantel - extensive 1st pass metabolism

326
Q

Swimmers itch, katayama fever, haematuria, liver cirrhosis are features of what parasitic infection?

A

Schistosomiasis

327
Q

Life cycle of cryptosporidium?

A

After ingestion, oocysts exist in SI. release sporozoites which become trophozoites. They form type I merontes which form merozoites. Type II merozoites become macro and microgamonts. (female and male). Oocysts development by these two gamonts, some are excreted and some reinfect host.

328
Q

Diagnosis of cryptosporidosis?

A

Acid fast staining of faeces.

Antigen detecting by enzyme immunoassay.

329
Q

Treatment of cryptosporidosis?

A

Rehydration, Paromomycin (kills parasite), octreotide

330
Q

Life cycle of hydatid disease?

A

Caused by echinococcus. Cestode.

Human is accidental host as it is usually sheep and dogs, so can’t reproduce in humans. Hydatid cysts.

331
Q

Diagnosis of hydatid disease?

A

Imaging & serology.

332
Q

Treatment for hydatid disease?

A

Albendazole & mebendazole. Surgical removal of cysts.

333
Q

Difference in presentation between meningitis and encephalitis?

A

Meningitis = infection of the meninges & CSF = acute fever, headache, neck stiffness +/- rash but NO FOCAL NEURO SIGNS.

Encephalitis = infection of brain tissue = acute fever, headache, neck stiffness & ALTERED LEVEL OF CONSCIOUSNESS +/- FOCAL NEURO SIGNS

334
Q

Fungal meningitis is caused by what?

A

Cryptococcus = yeast.

335
Q

Diagnosis of cryptococcal meningitis?

A

Indian Ink stain of CSF - yeast seen

336
Q

Treatment of cryptococcal meningitis?

A

Amphotericin B, fluconazole, 5-fluorocytosine

337
Q

Cryptococcal meningitis is most common in patients with what other infection?

A

HIV

338
Q

What is Neisseria meningitidis and what does it cause?

A

Gram neg diplococcus. Meningococcal septicaemia and meningococcal meningitis.

339
Q

Treatment of bacterial meningitis caused by N.meningitidis, strep pneumoniae, H.influenzae, listeria monocytogenes?

A

Ceftriaxone or Cefotaxime (cephalosporins = beta lactams)

340
Q

Natural habitat of N.meningitidis?

A

Nasopharynx

341
Q

Chemoprophylaxis for meningococcal meningitis?

A

Rifampicin (RNA polymerase inhibitor) & ciprofloxacin (quinolone)

342
Q

What bacteria can cause meningitis?

A

Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, listeria monocytogenes.

343
Q

What type of bacteria is H.influenzae? what does it cause?

A

Gram neg coccobacilli, unable to grow without blood. Carried in the throat.
Capsulated strain type b can cause meningitis & epiglottitis. Non capsulated strains causes sinusitis, otitis media

344
Q

What is strep pneumoniae? What does it cause?

A

Gram positive cocci - requires blood (alpha haemolytic).
Human respiratory tract.
- Bacterial lobar pneumonia (commonest causes)
- Meningitis (children and elderly)

345
Q

What white cell count is defined as aseptic meningitis?

A

> 5x10^6/L in CSF

346
Q

Name the viruses that cause viral meningitis?

A

1) Enteroviruses (echoviruses, coxsackie virus)
2) Herpes viruses (HSV, CMV, EBV, VZV)
3) HIV
4) Mumps virus
5) arboviruses (jap E, dengue)

347
Q

Which HSV is more common in causing viral meningitis?

A

HSV 2

348
Q

Which HSV is more common in causing viral encephalitis?

A

HSV 1

349
Q

Most common cause of viral meningitis?

A

Enteroviruses (echovirus, coxsackie virus)

350
Q

Treatment of some viral meningitis cases?

A

Aciclovir - nucleoside viral DNA polymerase inhibitor for HSV & VZV cases. Otherwise no real specific treatment.

351
Q

Is it possible to distinguish between a viral or bacterial meningitis based on clinical features? If so what?

A

No, very hard!! Usually meningism in both.

Viral program of lethargy, myalgias, arthalgias, sore throat.

352
Q

Diagnosis of viral meningitis?

A

LP - microscopy, protein (0.2-0.4g/L), glucose (<60% CSF glucose:plasm glucose), viral PCR).
FBC, CRP, U&Es

353
Q

What are the focal neurological signs sometimes seen in viral encephalitis?

A
  • seizures
  • weakness
  • dysphasia
  • cranial nerve palsy
  • ataxia
354
Q

What is acute disseminated encephlomyelopathy?

A

Immune mediated CNS demyelination. Same clinical features as encephalitis.

355
Q

Aetiology of Viral encephalitis?

A 
HSV (HSV 1 = 90%)
VZV
EBV
Measles
Mumps
Enteroviruses
Unknown = 40%
356
Q

Mortality of untreated Herpes simplex encephalitis? and even with treatment after 18months?

A

70%. 27% -survivors have paralysis, speech loss and personality change.

357
Q

Treatment for viral encephalitis?

A

High dose IV aciclovir

358
Q

Which type of meningitis shows a very high cell count?

A

Bacterial >200 (normal <5). Viral, Tb & cryptococcus (20-200)

359
Q

Polymorphs are seen in what type of meningitis?

A

Bacterial.

Lymphocytes are seen in viral, tb and cryptococcus

360
Q

Is protein increased or decreased in meningitis? CSF sample.

A

Increased.

361
Q

What are the primary bacterial infections of the CNS?

A

Meningitis, encephalitis, ventriculitis, brain abscess, eye infections, subdural empyema, ventriculoperitoneal shunt infections

362
Q

What is a brain abscess?

A

Focal suppurative process within the brain parenchyma (pus in substance of brain)

363
Q

Causative organisms of a brain abscess?

A

Polymicrobial

  • Streptococci (70%)
  • s.aureus (15%) - most common pathogen after trauma or surgery
  • anaerobes (bacteroides)
  • Gram neg enteric bacteria (e.coli, pseudomonas)
  • others (fungi, tb, toxoplasma gondi)
364
Q

Pathogenesis of a brain abscess? (can develop from four clinical settings)

A

1) Direct spread - from contiguous suppurative focus, ear (40%), sinuses, teeth.
2) haematogenous spread - endocarditis, bronchiectasis.
3) trauma - open cranial fracture (s.aureus)
4) cryptogenic (no focus recognised)

365
Q

Clinical presentation of a brain abscess?

A

headache, focal neuro deficit, confusion, fever, nausea, seizure, neck stiffness, coma

366
Q

Treatment of brain abscess?

A

Drainage = first choice. reduces risk of spread to ventricles (ventriculitis 80% mortality), reduces ICP.

Antibiotics - ampicillin, penicillin (otogenic), cefuroxime (odontogenic), cefotaxime (gram neg, penetrates pussy well), ceftazidime (otogenic, pseudomonas), metronidazole (anaerobes, otogenic & odontogenic)

367
Q

What is a subdural empyema?

A

Infection enclosed between dura and arachnoid mata

368
Q

Causative organisms for a subdural empyema?

A

Polymicrobial.

  • anaerobes
  • streptococci
  • aerobic gram neg bacilli
  • step pneumoniae
  • H. influenzae
  • staph aureus
369
Q

Pathogenesis of a subdural empyema?

A

Spread of infection from

  • sinuses (70%)
  • middle ear or mastoid (20%)
  • haematogenous (5%)
  • surgery/trauma
370
Q

Clinical presentation of subdural empyema?

A

Headache, fever, focal neuro deficit, confusion, seizure, coma

371
Q

Treatment and management of a subdural empyema?

A

Urgent surgical drainage, culture of pus for guided antibiotic therapy.

372
Q

Most common cause of ventriculoperitoneal shiny and external ventricular drain infection?

A

Coagulase negative staphylococci

373
Q

Is acute bronchitis usually viral or bacterial?

A

Viral

374
Q

Clinical features of acute bronchitis?

A

Cough in the absence of fever, tachycardia and tachypnoea.

375
Q

What bacteria usually cause acute bronchitis?

A

1) Bordetella pertussis
2) mycoplasma pneumoniae
3) chlamydia pneumoniae

376
Q

What is pneumonia? + symptoms?

A

Inflammation of the alveoli and the lung parenchyma with consolidation and exudation.

Cough, fever, pleuritic pain, purulent sputum

377
Q

What is CURB-65?

A

Used for community acquired pneumonia (CAP)

Confusion
Urea >7mmol/L
R=resp rate >30/min
BP sys<60
65 or over

Score one point for each (score 3+ = severe pneumonia, risk of death)

378
Q

Most common cause of CAP?

A

Streptococcal pneumoniae = pnuemococcal pneumonia

379
Q

Which pneumonia present with pleuritic chest pain + productive cough (rusty sputum)?

A

Lobar pneumonia

380
Q

Bacterial causes of CAP?

A

1) Strep pneumoniae (gram pos diplococci),
2) H. influenzae (gram neg coccobacilli),
3) Moraxella catarrhalis (gram neg coccus)
4) Klebsiella pneumoniae (gram neg bacilli)
5) S.aureus (gram pos cocci)

381
Q

Causes of atypical CAP?

A

1) mycoplasma pneumoniae -(important cause of atypical)
2) Legionella (23% of CAP), severe pneumonia
3) Coxiella burnetti
4) chlamydia pneumoniae
5) chlamydia psittaci

382
Q

Difference between typical and atypical pneumonia?

A

Typical = alveolar inflammation, pleuritic pain, copious purulent sputum, elevated WBC.

Atypical = tracheobronchial-interstitial inflammation, central pain, scanty, non purulent sputum with normal WBC

383
Q

Viral causes of CAP? (adults, children & immunocompromised)

A

1) Adults - Influenza A&B + adenovirus
2) Children - RSV, parainfluenza
3) Immunocompromised- measles, HSV, CMV.

384
Q

What microbiology is done in diagnosis of CAP?

A

Blood cultures, sputum, PCR for viral pathogens, pneumococcal antigen detection, legionella serology, chlamydia antigen detection.

385
Q

Empirical antibiotics used in the treatment of CAP? 1st line, penicillin allergy & severe pneumonia cases?

A

Preferred agent = amoxicillin
Macrolide for allergy = erythromycin or claritrhomycin
Severe = co-amoxiclav, 2nd gen cefuroxime, 3rd gen cefotaxime or ceftriaxone.

386
Q

Are Bacteroides aerobic or anaerobic bacteria?

A

Obligate anaerobic bacteria - commensal bacteria. outnumber facultatively anaerobic coliforms

387
Q

2 examples of bacteroides?

A

Bifidobacteria (gram neg), clostridia (clostridium perfringens - gram pos bacilli)

388
Q

3 examples of facultatively anaerobic coliforms?

A

E.coli (gram neg bacilli), enterobacteriacea (gram neg bacilli) ,
enterococci (gram pos cocci)

389
Q

Complications of gastroenteritis?

A

Dehydration, toxic megacolon, renal failure, Guillan Barre syndrome (campylobacter infections), Haemolytic uraemic syndrome (e.coli), salmonella.

390
Q

What is Haemolytic uraemic syndrome?

A

Haemolytic anaemia,
Acute kidney failure,
Thrombocytopenia

391
Q

Bacterial causes of gastroenteritis?

A

1) Campylobacter (undercooked meat)
2) salmonella - adherence
3) shigella - adherence
4) e coli - enterotoxin + adherence
5) vibrio cholera - entertoxin production
6) s.aureus (bacillary dystentry, enterotoxin)
7) bacillus cereus - enterotoxin production

392
Q

Most common cause of bacterial gastroenteritis in the UK?

A

Campylobacter

393
Q

Most common cause of gut infections in the UK?

A

Norovirus - winter vomiting disease

394
Q

Treatment of norovirus gastroenteritis?

A

Illness lasts 24-48 hours so manage with drinking plenty of fluids. Stay away from work. hand hygiene.

395
Q

Name two viruses that cause viral gastroenteritis?

A

Norovirus & rotavirus

396
Q

Name 3 protozoa’s that cause protozoal gastroenteritis?

A

Cryptosporidium, enatmoeba histolytica, giardia lamblia

397
Q

How is cryptosporidium transmitted?

A

Water borne disease - swimming pools, contaminated drinking water

398
Q

Treatment for bacterial gastroenteritis?

A

Generally avoid giving antibiotics - may increase duration of salmonella carriage and may worsen HUS in E.coli infection.

EXCEPT - in the old and young
- severe symptoms of campylobacter

399
Q

Two antibiotics to treat Clostridium difficicle infection?

A

oral metronidazole & oral vancomycin. New drug out is oral fidaxomicin

400
Q

Faecal transplant can be used to treat what infection?

A

C.difficle

401
Q

What is cholangitis?

A

Inflammation/Infection of the bile duct (biliary tree)

402
Q

3 mechanisms of intra-abdominal infections?

A

1) Translocation of micro-organism from GIT lumen to peritoneal cavity
2) Translocation from an extra-intestinal source (trauma, haematogenous spread)
3) Translocation along a lumen (blockage, iatrogenic, hepatobilliary infections)

403
Q

Give 3 examples of how micro-organisms can get from the GIT lumen to the peritoneal cavity? (across the wall)

A

1) Perforation (appendix, diverticulum, neoplasm)
2) Loss of integrity (ischaemia & strangulation)
3) Surgery (anastomotic leak & seeding at operation)

404
Q

Microbiological causes of intra-abdominal infections? (break down by aerobic/anaerobic, gram -/+, cocci/bacilli)

A

1) Aerobic gram neg bacilli = coliforms (enterobacteriaceae & e.coli)
2) Anaerobic gram neg bacilli = bacteroides & Prevotella.
3) Aerobic gram pos cocci = enterococcus, streptococci milleri.
4) Anaerobic gram pos bacilli = clostridium

405
Q

Name two alpha haemolytic streptococci? & 2 beta haemolytic streptococci?

A

Alpha haemolytic - Strep pneumoniae & Strep viridans (+milleri).
Beta haemolytic - Strep pyogenes (group A) & strep agalactiae (group B).

All strep are gram positive cocci

406
Q

Antimicrobial therapy used to treat intestinal source of intra-abdominal infection?

A

‘Coliforms & anaerobes’

65 = Piperacillin & tazobactam (piptazobactam)

407
Q

Inflammation of the gallbladder is called?

A

Cholecystitis

408
Q

Most common cause of cholecystitis?

A

Gall stones (obstruction of cystic duct) leads to bile stasis and infection from e.coli and bacteroides

409
Q

2 conditions which may present with - fever, RUQ pain, possible jaundice?

A

Cholecystitis (mild jaundice) & Cholangitis (jaundice)

410
Q

Aetiology of pyogenic liver abscess?

A

1) Biliary obstruction
2) Haematogenous spread (mesenteric infection or systemic intravascular infection)
3) direct spread
4) penetrating trauma
5) idiopathic

411
Q

Predisposing factors for an intra-peritoneal abscess?

A

1) perforation
2) cholecystitis
3) mesenteric ischaemia
4) penetrating trauma
5) post op leak

412
Q

Name given to ‘localised area of peritonitis with a build up of pus’?

A

Intra peritoneal abscess

413
Q

An abdominal USS would be looking for what?

A

1) abdominal masses
2) free fluid
3) gallstones
4) dilated bile ducts

414
Q

Would LFTs be abnormal in hepatobiliary disease?

A

yes.

415
Q

Which LFTs indicate hepatocellular damage?

A

Transaminases (ALT & AST)

416
Q

Which LFTs indicate obstructive jaundice?

A

Alkaline phosphatase (can also be raised in hepatocellular damage)

417
Q

Which flora in the Urinary tract is sterile & considered sterile?

A

Kidneys, ureters (sterile) & bladder (considered sterile)

418
Q

What type of flora is found in the urethra?

A

Perineal flora - skin flora (coagulase negative staph), lower GIT flora (aerobic and gram pos cocci)

419
Q

Name a lower UTI & give its signs and symptoms?

A

Cystitis

  • dysuria, urgency polyuria, nocturia, haematuria, urinary freq, supra-pubic pain
420
Q

What is urethral syndrome?

A

Abacterial cystitis - symptoms of Lower UTU without signs of infection

421
Q

Is pyelonephritis a Upper or Lower UTI?

A

Upper but with symptoms of Lower UTI as well. Systemic infection would give rigours, vomiting, diarrhoea.

422
Q

What is significant bacteriuria?

A

> 10^5 organisms per mL of fresh MSU.
However there are limitations - many symptomatic females have counts less than 10^5. Lower counts are significant in males

423
Q

What is asymptomatic bacteriuria?

A

Significant bacteriuria with a single organism but with no symptoms of a UTI.

424
Q

What is sterile pyuria?

A

Pus cells in urine but no organisms grow

425
Q

Predisposing factors for sterile pyuria? (6)

A

1) Female
2) urinary stasis (preggo, stones, strictures)
3) instrumentation
4) sex
5) fistulae (recto-vesical or vesico-vaginal)
6) congenital abnormalities (vesico-ureteric reflux)

426
Q

Organisms that cause UTIs?

A

1) E.coli (70%)
2) staph saprophyticus
3) proteus mirabilis
4) enterococcus faecalis
5) klebsiella
6) other coliforms

427
Q

What does the coagulase negative staph saprophyticus cause?

A

UTIs

428
Q

Causes of sterile pyuria?

A

1) Inhibition of bacterial growth (unprescribed antibiotics)
2) Fastidious organisms (Myco Tb, Haemophilus, N.gonorrhoeae, anaerobes)
3) UT inflammation (renal or bladder stones, polycystic kidney)

429
Q

Dipstick for UTIs is looking at what key components?

A

Blood, protein, nitrite, WBC (leucocyte esterase)

430
Q

Suspected urinary TB - what microbial test should you do?

A

Early morning urine for 3 days

431
Q

Treatment of UTI?

A

Trimethoprim, nitrofurantoin.

Males need longer (1-2wks) Females (3 days)

432
Q

Treatment for pyelonephritis?

A

Cefuroxime, ciprofloxacin, Piptazobactam

433
Q

Who do you treat in asymptomatic bacteriuria?

A

Pregnant women, infants (prevention of pyelonephritis and renal damage), prior to urological procedures

434
Q

What is nitrofurantoin used to treat?

A

UTIs

435
Q

What name is given to infection of the bone?

A

Osteomyelitis

436
Q

Pathogenesis of osteomyelitis?

A
  • Haematogenous (bacteria in blood seed bone)
  • Contiguous focus (spread from adjacent area of infection - diabetic foot ulcers to bone)
  • Direct inoculation (trauma or surgery)
437
Q

Stage classification of osteomyelitis?

A

I - medullary content necrosis
II - superficial necrosis
III- localised = full thickness cortical sequestration
IV - diffuse = extensive unstable bone

438
Q

Most common causative organism of osteomyelitis?

A

S.aureus

439
Q

Causative organisms of osteomyelitis?

A

S.aureus (60%), Strep (A&B), enterococci, salmonella, klebsiella, anaerobes, TB

440
Q

Diagnosis of osteomyelitis?

A

1) Gold standard = cultures and histology of bone biopsy.
2) Blood cultures are only 50% +ve.
3) CRP raised

441
Q

Is leukocytosis diagnostic of osteomyelitis?

A

NO

442
Q

Treatment for osteomyelitis?

A

Clindamycin, ciprofloxacin, vancomycin, beta-lactams, gentamicin

443
Q

Causative organisms in native joint infections? (septic arthritis)

A

S.aureus, Streps, N.gonorrhoeae, N.meningitidis, H.influenzae, anaerobes, mycobacteria

444
Q

Causative organisms in prosthetic joint infections? (septic arthritis)

A

S.aureus, COAGULASE NEG STAPH, enterococci, corynebacteria, propinibacteria, bacillus

445
Q

Diagnosis of Septic arthritis?

A

Examination of joint aspirate - Total WCC >40,000/mm^3 during infection.

  • > 75% polymorphs
  • Gram stain 50% positive
446
Q

Treatment for septic arthritis?

A

Removal of purulent material, directed IV antimicrobial therapy depending on causative organism.
2-3wks on a native joint.
Infected prostheses often require removal.

447
Q

What bacteria are the normal flora of the URT?

A

1) Strep viridans,
2) commensal Neisseria,
3) diphteroids,
4) anaerobes

448
Q

Name 8 pathogenic Bacteria of the URT?

A

1) strep pneumoniae (asymp)
2) strep pyogenes (asymp)
3) moraxella catarrhalis (asymp)
4) s.aureus
5) h.influenzae (asymp)
6) bordetella pertussis
7) corynebacterium diphtheria
8) group F beta haemolytic strep

449
Q

Name 9 viral pathogens of the URT?

A

1) rhinovirus
2) adenovirus
3) HSV
4) RSV
5) EBV
6) influenza
7) Enterovirus
8) coronavirus
9) human metapneumovirus

450
Q

Aetiology of coryza?

A

1) RHINOVIRUS
2) coronovirus
3) RSV
4) Parainfluenza
5) enteroviruses
6) adenoviruses

451
Q

Do you give antibiotics for a common cold?

A

NO

452
Q

What URTI presents with a hoarse, husky voice?

A

Acute laryngitis - usually viral. NO need for antibiotics

453
Q

Complications of rhino-sinusitis?

A
  • osteomyelitis
  • meningitis
  • cerebral abscess
454
Q

Aetiology of rhino-sinusitis?

A 
Viral.
Bacterial - strep pneumoniae, h.influenzae, 
strep milleri, 
anaerobes, 
fungal
455
Q

Diagnosis & management of rhino-sinusitis?

A

Imaging for complications.

Viral = no antibiotics
Bacteria = amoxicillin
456
Q

Which URTI is a MEDICAL EMERGENCY?

A

Epiglottitis - cellulitis of epiglottis = airway obstruction

457
Q

Clinical features of epiglottitis?

A

Cellulitis of epiglottis.

Child (2-4), fever, difficult speaking and swallowing, leans forwards, drools, stridor, hoarse.

458
Q

What causes epiglottitis?

A

Used to be H.influenzae type B prior to immunisation. S.aureus.

459
Q

Diagnosis & treatment of epiglottitis?

A

DO NOT swab or examine epiglottis. Lateral neck X-ray.

Maintain airway
CEFOTAXIME

460
Q

URTI which is caused by bordetella pertussis?

A

Whooping cough

461
Q

Complications of whooping cough?

A
  • otitis media,
  • pneumonia
  • convulsions
  • subconjunctival haemorrhages
462
Q

Diagnosis & treatment of whooping cough?

A

Pernasal swab

Supportive therapy & erythromycin

IMMUNISATION

463
Q

Another name for acute laryngo-tracheobronchitis?

A

CROUP

464
Q

Two common causative organisms that cause croup?

A
  • Parainfluenzae type 2
  • RSV

DO NOT give antibiotics

465
Q

Complications of Group A strep infection (strep pyogenes) in pharyngitis?

A
  • acute glomerulonephritis
  • rheumatic fever
  • scarlet fever
466
Q

Aetiology of pharyngitis/tonsillitis?

A

Viral (RSV, influenza, adenovirus, EBV, HSV1)

Bacterial (strep pyogenes, N.gonorrhoeae, corynebacterium diptheriae)

467
Q

Clinical features of pharyngitis or tonsillitis?

A

Dysphagia, fever, red tonsils, +/- exudate. lymphadenopathy.

468
Q

3 main types of otitis externa?

A

1) Acute - infection of EAC
2) Chronic - irritation from drainage from perforated tympanic membrane
3) Malignant - Drainage of pus from canal. Severe necrotising.

469
Q

Aetiology of otitis externa?

A

Pseudomonas aeruginosa, s.aureus

470
Q

When is malignant otitis externa life threatening?

A

When the infection spreads to the temporal bone, base of skull, meninges and brain

471
Q

What aminoglycoside should be avoided in chronic otitis externa if there’s perforation?

A

gentamicin

472
Q

Treatment of malignant otitis externa?

A

4-6 wks with iv ceftazidime then ciprofloxacin po

473
Q

Aetiology of otitis media?

A

VIRAL.

H.influnzae, strep pneumoniae, M.catarrhalis.

474
Q

Treatment of otitis media?

A

If not unwell then just watch. Symptomatic then give amoxillin.

475
Q

What is mastoiditis?

A

Inflammation of the mastoid air cells after middle ear infection. Pus collects in cells and lead to bone necrosis.

476
Q

What is caused by untreated acute otitis media?

A

Mastoiditis

477
Q

Treatment for mastoiditis?

A

Co-amoxiclav

478
Q

What term is used to describe the few weeks following delivery during which the mother’s tissue return to their non preggo state?

A

Puerperium

479
Q

Which viral infections cause mild symptoms in pregnancy and puerperium?

A

CMV - do not give amoxicillin or ampicillin = rash

480
Q

VZV, HSV, measles, influenza can all cause mild/moderate/severe viral infections in pregnancy?

A

More Severe

481
Q

Name a virus which is teratogenic?

A

Rubella = togavirus

482
Q

What is continued bacteriuria in pregnancy associated with?

A

Premature delivery and increase in perinatal mortality

483
Q

What infection is a major cause of perinatal mortality?

A

Intra-amniotic infections

484
Q

What is chorioamnioitis?

A

Inflammation of umbilical cord, amniotic membranes and placenta.

485
Q

Clinical features on intra-amniotic infection?

A 
Maternal fever, 
uterine tenderness, 
malodorous amniotic fluid, 
maternal or foetal tachycardia, 
raised WCC
486
Q

Causative organisms of intra-amniotic infections?

A

Group B strep, enterococci, e.coli

487
Q

List some antimicrobials that are unsafe in pregnancy?

A

Cholamphenicol, tetracycline, fluoroquinolones, trimethoprim

488
Q

Name two safe antimicrobials that can be used in pregnancy?

A

Penicillins & cephalosporins

489
Q

What infection remains a major cause of maternal death?

A

Puerperal sepsis from puerperal endometritis.

490
Q

Clinical features of puerperal endometritis?

A

Fever,

uterine tenderness, purulent foul smelling lochi and general malaise and abdo pain

491
Q

causative organisms of puerperal endometritis?

A

E.coli, Beta-haemolytic strep, anaerobes

492
Q

What is the only cause of puerperal mastitis?

A

Staph aureus. Give flucloxacillin

493
Q

Name 5 childhood viral infections that cause a rash?

A 
Measles - Paramyxovirus
Chicken pox - VZV
Rubella - Togavirus
Slapcheek - Parvovirus
Enteroviruses - coxsackie, entero, echoviruses
494
Q

What infection causes a rash caused by paramyxovirus?

A

Measles

495
Q

What does togavirus cause?

A

Rubella

496
Q

Prodrome of measles?

A

3 C’s = coryza, conjunctivitis, cough

497
Q

What type of rash presents in measles?

A

Maculopapular rash

498
Q

Treatment of measles?

A

Vit A, antibiotics for superinfection, live MMR.

Immunise to prevent

499
Q

Koplik’s spots presents in which infection?

A

Measles

500
Q

Type of rash in chicken pox?

A

Vesicular

501
Q

Complications of chicken pox?

A 
Pneumonitis, 
CNS involvement,
thrombocytopenic purpura, 
foetal varicella syndrome, 
congenital varicella,
Zoster
502
Q

Clinical presentation of rubella?

A

Lymphadenopathy (post auricular & suboccipital), transient erythematous rash

503
Q

When is congenital rubella syndrome worse - contracted early or later in pregnancy?

A

Early

504
Q

What childhood viral infection presents with foetal disease, minor respiratory illness, arthalgia, aplastic anaemia and a rash?

A

Slapcheek - parvovirus

505
Q

Pneumovirus causes what respiratory virus?

A

Respiratory syncytial virus

506
Q

Treatment of RSV?

A

Oxygen, steroids, bronchodilators, ribavarin, palivizumab.

507
Q

What does RSV cause?

A

Bronchiolitis = can be life threatening in under 1 winter epidemics

508
Q

Paramyxovirus causes what two respiratory childhood infections?

A

Metapneumovirus, Parainfluenza

509
Q

How many types of paramyxovirus are there that cause parainfluenza?

A

1 in winter, 3 in summer = 4

510
Q

Clinical presentation of adenovirus?

A

mild URTI, conjunctivitis

511
Q

Clinical presentation of parainfluenza?

A

Croup, bronchiolitis, URTI

512
Q

2 main viruses that cause diarrhoea?

A

Rotavirus (reovirus) & norovirus

513
Q

Which virus is spread from person-person and by food? Norovirus or rotavirus.

A

Norovirus as rotavirus is spread feacal-oral route

514
Q

Treatment of norovirus and rotavirus diarrhoea?

A

Rehydration. To prevent rotavirus = vaccination

515
Q

Treatment of Mycobacterium leprae?

A

Rifampicin, dapsone, clofazimine

516
Q

Treatment of M.avium complex?

A

Macrolides - clarithromycin, azithromycin

517
Q

What nerves are involved in tuberculoid leprosy?

A

Ulnar & common peroneal

518
Q

What does the BCG vaccine contain?

A

Attenuated strain of M.bovis

519
Q

Two types of tuberculin skin test?

A

Heaf test & mantoux test

520
Q

What is disseminated gonococcal infection?

A

Bacteraemia, arthritis & dermatitis

521
Q

What causes non-gonococcalo urethritis?

A

Chlamydia trachomatis & ureaplasma urealyticum

522
Q

Treatment of non-gonococcal urethritis?

A

Doxycycline, macrolides (erythromycin & azithromycin)

523
Q

Which STI has a more purulent discharge? Chlamydia or gonorrhoea?

A

Gonorrhoea

524
Q

Opportunistic infections of HIV/AIDS?

A
  • HIV encephalopathy,
  • oesophageal candidiasis,
  • Pneumocystis jirovecii pneumoniae,
  • CMV disease,
  • Kaposi’s sarcoma,
525
Q

What infection could a patient have on presentation with unexplained diarrhoea and unexplained persistent fever with persistent oral candidiasis?

A

HIV

526
Q

Which HPV subtypes does gardasil vaccinate against?

A

HPV 6, 11, 16, 18

527
Q

Treatment of genital warts?

A

Burn (salicylic acid), freeze (liquid nitrogen), cut,

imiquimod (immune response modifier)

528
Q

Reactivation of genital herpes could be due to…

A

Stress, local trauma, menstruation

529
Q

Profuse greenish frothy vag discharge with mucosal inflammation is the presentation of what STI?

A

Trichomonas vaginalis - treat with metronidazole

530
Q

Treatment of candida albicans?

A

Fluconazole

531
Q

Causative agents of cellulitis?

A

S.aureus, s.pyogenes, Pasteurella multocida, H.influenzae

532
Q

What does Bacilus anthracis lead to ?

A

Anthrax - acquired from hair, wool and animal hides

533
Q

Renal tubule damage can be a serious side-effect of what class of antifungal agents ?

A

Polyenes

534
Q

What is zanamavir commonly used to treat?

A

Influenza

From Flashcardlet (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions