Case of the collapsed traveller

Question 1

gram positive colour and negative?

Answer 1

positive purple, negative pink

Question 2

gram positive?

Answer 2

thick peptiodglycan layer hold onto purple dye

Question 3

gram postive circular?

Answer 3

staphylcoccus

Question 4

grampositive diplococci

Answer 4

streptococcus pneumoniae

Question 5

gram negative rods or bacilli?

Answer 5

ecoli, escherichia

Question 6

gram negative coccus?

Answer 6

neisseria gonorrhoea

Question 7

streptococci species haemolysis on blood agar?

Answer 7

alpha- partial green
beta- complete so translucent
gamma- no haemolysis

Question 8

e.coli 0157:H7 causes?

Answer 8

food poisoning

Question 9

staphylcoccus aureus…?

Answer 9

commensal of nose 60%

Question 10

s.aureus is special because?

Answer 10

coagulase positive

Question 11

example of coagulase negative

Answer 11

staphycoccus epidermis

Question 12

cellulitis cause

Answer 12

strep pyogenes, staph aureus

Question 13

3 ways to classify streptocci?

Answer 13

1. haemolysis
2. lancefield groups- surface carbohydrate antigens
3. true species name

Question 14

which organisms cause alpha haemolysis?

Answer 14

viridans type streptococci, common comensals of mouth,
s.pneumoniae, s.milleri, s.mitis, s.sanguis

Question 15

necrotising fasciitis?

Answer 15

s.pyogenes infection of deep tissues, producing tissue destructive enzymes in stationary phase

Question 16

signs of necrotising fascitis?

Answer 16

pain out of proportion to physical signs
bruising and blistering
generalised toxaemia
renal impairment
high crp
raised CK

Question 17

streptococcus pyogenes levels?

Answer 17

superficial- pharyngitis, cellulitis
deep- necrotising fascitis/ myoitis
autoimmune sequelae- rheumatic fever, glomerulonephritis

Question 18

gram negative bacteria?

Answer 18

nesisseria meningitidis

Question 19

n.meningitidis blebbing?

Answer 19

lipopolysaccharide shedding (endotoxin)

Question 20

why are you likely to grow staph epidermis in someones blood?

Answer 20

someone didnt clean the skin before they took the blood

Question 21

endpoint of sepsis

Answer 21

purpura fulminans (bruising that comes on like lightening)

Question 22

concept of sepsis?

Answer 22

infection, host tries to contain and cures, dissemination can lead to cellular and organ damage

Question 23

SIRS definition?

Answer 23

fever more than 38, less than 36
tachypnoea more than 20
tachycardia more than 90bpm
leucocytosis/leucopenia more than 12000 or less than 4000

more than 2 out of 4 required

Question 24

proinflammatory cytokines cause?

Answer 24

increased vascular permeability and decreased vascular resistance

decreased cardiac contractility
fever diarrhoea, metabolic changes- insulin resistance(hyperglycaemic), protein catabolism

raised neutrophil, migration, adhesion, first high then low

increase coagulation

Question 25

sepsis shock?

Answer 25

early distributive shock- warm peripheries, peripheral vasolidilation hypovolaemic shock- cold peripheries cardiogenic shock

Question 26

LPS is recognised by?

Answer 26

TLR4, but can be macrophage scavenger receptor

Question 27

other PAMPS?

Answer 27

lipopolypeptides, peptidoglycans, flagellin microbial DNA/RNA

Question 28

other pattern recognition receptors?

Answer 28

CD15, TLRs1-11, NOD1/2, beta integrins

Question 29

gram positive bacteria can cause sepsis through?

Answer 29

lipotechoic acid, peptidoglycans

Question 30

superantigen exotoxins are released by?

Answer 30

staph aureus, streptococcus pyogenes- toxic shock syndrome

Question 31

toxic shock syndrome result?

Answer 31

skin desquamation

Question 32

superantigens cause?

Answer 32

huge t cell responses

Question 33

organ dysfunction score?

Answer 33

SOFA- six organ symptoms resp, coagulation, liver, cardiovascular, cns, kidney

Question 34

initial antibiotic treatment of sepsis

Answer 34

initate treatment in 1 hour iv antimicrobial from agreed local formulary

Question 35

deadliest malaria parasite in africa?

Answer 35

p.falciparum

Question 36

most dominant malaria parasite in sub saharan africa?

Answer 36

p.vivax

Question 37

what is injected into bloodstream?

Answer 37

sporozoites

Question 38

from liver stage what is released?

Answer 38

merozoite

Question 39

what happens in red blood cell?

Answer 39

ring- trophozoitem schizont, which bursts and release merozoites which infect more rbcs

Question 40

what is taken up by mosquito?

Answer 40

gametocytes

Question 41

why is there no malaria in UK?

Answer 41

parasite multiplication affected by temp, less than 16 no replication

Question 42

how can we control malaria?

Answer 42

insecticide treated nets indoor residual spraying malaria vaccination treatment prophylaxis

Question 43

prompts diagnosis of malaria?

Answer 43

fever, visited malaria endemic area,

Question 44

how do you test for malaria?

Answer 44

giema-stained blood film rapid diagnostic tests

Question 45

falciparum look like

Answer 45

ring trophozoite

Question 46

what does microscopy tell you

Answer 46

species, parasitemia, parasite stage

Question 47

presentation of malaria?

Answer 47

myalgia, headache, fever, abdominal pain, lethargy diarrhoea and vomiting

Question 48

severe malaria?

Answer 48

parasitaemia more than 2% or less than 2 but schizonts present or complications

Question 49

how does malaria affect rbcs?

Answer 49

1. malaria parasites inserts proteins PfEMP1 onto infected rbc surface 2. form adhesive knobs which

Question 50

how many var genes does malaria have?

Answer 50

60

Question 51

how to treat malaria?

Answer 51

drug susceptibility type of plasmodium prophylaxis how severe

Question 52

iv quinine side effects?

Answer 52

arrhythmias, hypoglycaemia potentially lethal hypotension

Question 53

treatment of severe malaria?

Answer 53

iv artesunate- kills circulating ring stage parasites as well as schizonts

Question 54

hypnozoites living in liver are due to?

Answer 54

p.vivax, p.ovale

Question 55

how to treat p.vivax and p.ovale?

Answer 55

primaquine

Question 56

activated charcoal should be given?

Answer 56

1st hour

Question 57

cocaine and amphetamine neutransmitters?

Answer 57

dopamine and noradrenaline

Question 58

diagnostic tests for cocaine/results?

Answer 58

ECG tachyarrhythmia metabolic acidosis increased creatnine kinase

Question 59

how to treat prolonged QRS?

Answer 59

iv sodium bicarbonate

Question 60

morphine toxicity sign?

Answer 60

pinpoint pupils, accumulating co2, bradycardia

Question 61

naloxone has?

Answer 61

short half life compared to the opiate you are giving it for

Question 62

benzodiazepine antagonist- reversal

Answer 62

flumazenil- can give seizure

Question 63

methylene blue

Question 64

aspirin overdose?

Answer 64

metabolic acidosis and respiratory alkalosis