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1
Q

what percentage of inpatients receive antibiotics

A

30%

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2
Q

what percentage of antibiotics are prescribed inappropriately in community?

A

30$

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3
Q

what percentage of surgical antibiotics prophylaxis is inappropriate?

A

30%

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4
Q

4 main mechanisms of antibiotics resistance?

A

enzymatic inactivation of drug
modified targets for drugs
reduced permeability to drugs
efflux of drug

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5
Q

chromosomally mediated resistance basis

A

mutation in gene coding for drug target or membrane transport system

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6
Q

binary fission refers to

A

DNA replicates
cell elongates
divides into 2
2 identical bacteria

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7
Q

plasmid mediated resistance mechanism?

A

plasmids are extra chromosomal strands of DNA, replicate independent of cell chromosome, carry genes for enzymes which degrade antibiotics and modify membrane transport systems.

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8
Q

medically important resistant organisms

A 
MRSA
VRE
ESBL
CPE
clostridium difficile
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9
Q

Methicillin is a

A

penicillinase resistant penicillin

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10
Q

VRE refers too

A

vancomycin resistant enterococci

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11
Q

VRE colonises when

A

GI tract exposed to multiple antibiotics

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12
Q

ESBL refers too

A

extended spectrum beta-lactamase

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13
Q

ESBL resistance is too

A

beta-lactams antibiotics, often cephalosporins and more associated with aminoglycosides and carbapenems.

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14
Q

CPE refers to

A

carbapenem producing Enterobacteriaceae

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15
Q

some non-penicillin containing alternatives

A

quinolones
macrolides
licosamide
Co-trimoxazole

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16
Q

what percentage of population visit GP because of GI infection each year?

A

2%

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17
Q

what is the most common foodborne pathogen?

A

campylobacter

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18
Q

what pathogen causes the most hospital admissions?

A

Salmonella

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19
Q

how much fluid can be lost through severe secretory diarrhoea?

A

1-7L

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20
Q

differential diagnosis for diarrhoea?

A

inflammatory bowel disease
spurious diarrhoea
carcinoma

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21
Q

how long can campylobacter Gastroenteritis remain dormant?

A

7 days

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22
Q

how any days does a routine bacterial culture take to complete?

A

3 days

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23
Q

what species of routine bacterial culture campylobacter the most infective?

A

C. jejuni

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24
Q

rota virus is common in what age group?

A

under the age of the 5yrs?

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25
seasonal flu effects what percentage of the population?
10-15%
26
incubation period for the flu
2-4 days
27
WHO definition for flu like illness
fever cough onset within 10 days
28
3 stages of transmission
transmission virus shedding virus survival
29
virus shedding occurs during
4 days of illness
30
virus survival on non-porous survival
24-48 hours
31
CURB 65
``` Confusion Urea >7mmol/l Respiratory Rate >30mm Blood Pressure (Diastolic <60 or systolic <90) >65 years ```
32
clinical presentation outside of lungs for invasive aspergillosis is
lungs, bones, spine, brain, abdominal
33
CT sign of pulmonary aspergillosis
Halo Sign and air crescent sign
34
CSF diagnosis of cryptococcal disease
Indian ink Preparation - high protein and low glucose
35
amphotericin and azoles focus on
ergosterol
36
echinocandins inhibit
glucan synthesis
37
flucytosine inhibit
fungal DNA synthesis
38
examples of live attenuated vaccines
BCG, yellow fever, smallpox, typhoid, polio
39
examples of inactivated vaccines
hepatitis, rabies, cholera, influenza
40
detoxified exotoxin vaccines
diptheria, tetanus
41
subunit vaccines examples
Pertussis, typhoid, anthrax, hepatitis
42
"6 in 1" vaccine: infanrix Hexa
``` D - purified diptheria T - tetanus Ap - Bordetella pertussis IPV - inactivated polio Hib - haemophilus influenzae b HBV - hepatitis B rDNA ```
43
passive immunisations
rabies, hepatitis, tetanus, varicella zoster
44
chemoprophylaxis against malaria options
doxycycline, mefloquine, chloroquine
45
HIV particularly destroys what cells?
T helper cells CD4+
46
where else can CD4+ receptors be found?
macrophages, monocytes, cell in the brain, skin
47
what CD4 count normal?
CD4 > 500
48
aids diagnosis often occurs below CD4?
<200
49
SOFA score >2 reflects
increased mortality risk of 10% to sepsis
50
septic shock represents a hospital mortality of
40%
51
qSOFA points for sepsis
hypotension (systolic <100mmHg), altered mental status, tachyopnoea RR>22, score of >2.
52
each hour's delay in administering antibiotics in septic shock, mortality increases by
7.6%
53
2 A's of sepsis 6
air enriched with CO2 | Antibiotics after blood culture
54
2 B's of sepsis 6
Blood culture | blood gas with lactate
55
2 C's of sepsis 6
crystalloid bolus | catheter
56
lactate is a marker of
generalised hypoperfusion/severe sepsis/ poorer prognosis
57
what percentage of blood cultures are positive?
30-50%
58
nosocomial pyrexia of unknown origin is
developed in hospital after 3 days undiagnosed
59
neutropenic pyrexia of unknown origin is
<500/mm cubed neutrophils
60
commonest Hospital Acquired Infection
surgical site infection then UTI from catheter
61
droplet description
>5um, spread 1cm, drops to ground
62
aerosol description
<5um, more widespread, remains suspended in air
63
golden crust superficial skin infection is a key sign of
impetigo
64
furuncles also known as
boils
65
carbuncle is known as
infection extends to involve multiple furuncles
66
type 1 necrotising fasciitis
mixed aerobic and anaerobic infection
67
typical organisms for necrotising fasciitis type 1 infection
streptococci, staphylococci, enterococci, gram negative bacilli, clostridium
68
necrotising fasciitis type 2 is
monomicrobial
69
necrotising fasciitis type 2 is associated with
strep pyogenes
70
antibiotics for necrotising fasciitis
flucloxacillin, gentamicin, clindamycin
71
commonest cause of pyomyositis
S. aureus
72
common cause of septic bursitis
S. Aureus
73
commonest causes of infectious tenosynovitis
Staph Aureus, streptococci
74
chronic infectious tenosynovitis are
mycobacteria, fungi
75
mechanism of Toxin mediated syndrome
super antigens bypass normal immunity and attach directly to T cell receptors resulting in massive cytokine burst
76
Panton-valentine leucocidin toxin is a
gamma haemolysin
77
panton-valentine leuococidin toxin can be transferred from what to what
S. aureus to another including MRSA
78
most common I.V catheter associated infection?
S. aureus
79
examples of water related infections
leptospirosis, schistosomiasis, liver flukes.
80
arthropod borne infections
malaria, dengue fever, leishmaniasis
81
potentially severe malaria species
plasmodium falciparum
82
complications of malaria
cerebral malaria, blackwater fever, pulmonary oedema, jaundice, severe anaemia, algid malaria
83
examples of viral haemorrhagic fevers
ebola, lassa fever, Marburg disease, congo-crimea haemorrhagic fever.
84
what percentage of a person may be transiently colonised by staph.
25-50%
85
most frequent site of colonisation for staph
anterior nares.
86
what fraction of S. Aureus bacteraemia develop local complications of distal and septic metastases
1/3rd
87
minimum duration treatment for uncomplicated S. aureus bacteraemia is for
flucloxacillin 14 days
88
is malaria a zoonoses?
no
89
anthroponosis refers to?
reverse zoonoses
90
examples of anthroponosis
influenza, strep throat, leishmaniasis
91
schistosomiasis a zoonoses?
no
92
of 1415 pathogens what percentage is a zoonose?
61%
93
is salmonella zoonoses?
yes
94
is shigella a zoonoses
yes
95
is elephantiasis is zoonoses?
no
96
is campylobacter a zoonoses?
yes
97
is rabies a zoonoses?
yes
98
yellow fever a zoonoses?
yes
99
is toxoplasmosis a zoonoses?
yes
100
is dermatophytes a zoonose?
yes
101
incubation of rabies
2 weeks to several months
102
cause of rabies?
virus travels to brain via peripheral nerves and can cause acute encephalitis
103
Brucella is what type of bacteria?
small, gram negative coccobacilli
104
incubation of brucellosis
5-30 days
105
Leptospirosis common in NE Scotland due to
fish workers
106
one of the most widespread zoonosis is
leptospirosis

infections (3 decks)

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