Micro/Abx

Question 1

What class of antibiotic is Cefuroxime?

Answer 1

A 2nd Generation Cephalosporin.
A very broad Abx

Question 2

What class of antibiotic is Meropenem?

Answer 2

Carbapenem

Question 3

What is the first line treatment for UTI treatment in infants (SCH), what administration route would you use and for how long would you give it?

What alternative antibiotic may the patient be swapped to?

Answer 3

IV cefuroxime for 7 days.

PO Trimethoprim, a full course of IV Cefuroxime may need to be finished first.

Question 4

What drug should be used in an ESBL E. Coli infection?

Answer 4

Meropenem

Question 5

A urine culture has grown E. Coli in a 2 year old, unwell child. They were started on IV cefuroxime 24 hours ago, yet are still unwell.

Why might this be?
Should we change treatment?
What to?

Answer 5

Extended Spectrum β-lactamase (ESBL) producer
- An E. Coli variant resistant to all penicillins and cephalosporins.

Yes.
Meropenem

Question 6

What is a common causative agent of Osteomyelitis?

Answer 6

Staphylococcus Aureus

Question 7

What does Staphylococcus Aureus look like on a gram stain?

Answer 7

Gram positive cocci in clusters

Question 8

What is the first line treatment for osteomyelitis/septic arthritis (>3 months old)?

Answer 8

IV Cefuroxime

Question 9

Why is Cefuroxime initially given instead of Flucloxacillin when treating Staph. Aureus?

Answer 9

Cefuroxime is a broader antibiotic compared to Flucloxacillin, it is unknown whether the Staph infection will be sensitive to Flucloxacillin until sensitivities have been carried out which takes time.

Treat with Cefuroxime and liaise with microbiology, if Fluclox sensitive then switch.

Question 10

What class of antibiotic is Cefotaxime?

Answer 10

A 3rd Generation Cephalosporin.
A very broad antibiotic.

Question 11

What is a common causative agent of meningitis?

Answer 11

Neisseria meningitidis

Question 12

What does N. meningitidis look like on a gram stain?

Answer 12

Gram negative diplococcus.

Question 13

Cefotaxime is given first line against N. meningitidis, name another 3rd Generation Cephalosporin which may be used.

Answer 13

Ceftriaxone.

Question 14

What may be given as prophylaxis for meningitis?

Answer 14

Ciprofloxacin OR Rifampicin (oral)

Question 15

What class of antibiotic is Ciprofloxacin?

Answer 15

A fluoroquinolone

Question 16

What class of antibiotic is Rifampicin?

Answer 16

A rifamycin - decreases the production of RNA by bacteria.

Question 17

What percentage of pneumonias are caused by S. pneumoniae?

Answer 17

60%

Question 18

A 6yr old boy has a blood culture taken due to a suspected pneumonia. It comes back and grows gram positive cocci in pairs.

What is the likely causative agent of the pneumonia?

Answer 18

Streptococcus pneumoniae.
(pneumococcus)

Question 19

What is the first line treatment for a mild community acquired pneumococcus pneumonia?

Answer 19

PO Amoxicillin

Question 20

What is the first line treatment for a severe community acquired pneumococcus pneumonia?

Answer 20

IV benzylpenicillin

Question 21

What determines the length of Abx treatment in pneumonia?

Answer 21

How well the patient responds to the treatment.

Question 22

A child not responding to PO Amoxicillin for CAP is switched to IV benzylpenicillin. After 24 hours the child’s improvement has once again slowed after initially working. Suggest what may be going on, explain how it happens and a definitive treatment.

NB answer not resistant bacteria.

Answer 22

Empyema.

Bacteria from infected lung parenchyma can get into the pleural space and form a collection. The plural space is avascular, so conventional therapies (Abx) do not make it to the empyema.

Definitive treatment is continue Abx to treat the pneumonia and prevent systemic infection, and insert a chest drain(s) to drain the collection(s) from the pleural space.

Question 23

What is nystatin?

Answer 23

An oral antifungal, often used to treat thrush.

Question 24

Give examples of infective causes of inadequate nutrient absorption (Chronic GI conditions)

Answer 24

Enteroviruses (rotavirus, adenovirus, picornavirus)
Bacterial:
- Toxins - C. diff, staphylococcal
- Secretagogues - cholera
- Inflammatory - salmonella, campylobacter
Parasitic (Giardia, entamoeba histolytica)
Other (TB, opportunistic in immunocompromised - herpes, CMV, HIV).

Question 25

What is the pickup rate for Giardia on stool examination?

Answer 25

20%

It may persist for years before being caught, foreign travel isn’t necessary.

Question 26

What is the gold standard investigation for Giardia?

Answer 26

Stool ELISA.

Question 27

What is the treatment for Giardia?

Answer 27

Empirically with metronidazole (15mg/kg) TD for 7 days.

Question 28

How can post-infective responses lead to diarrhoea and nutrient loss?

Answer 28

Infection-related mucosal dis-integrity -> Immunological antigen exposure -> Mucosal (allergic) inflammation -> Secondary disaccharidase deficiency -> diarrhoea and thus nutrient loss

Question 29

Give some features of Crohn’s disease.

Answer 29

Can affect the whole GI tract
Ulcers (commonly mouth but anywhere in GI tract)
Intermittent loose stools
Weight loss and poor appetite
Raised inflammatory markers

Question 30

What investigations may you do for Crohn’s disease?

Answer 30

Bloods (FBC, U&Es, ESR/CRP)
Upper and lower GI endoscopy
Wireless capsule enteroscopy

Question 31

What treatments may be used in Crohn’s disease?

Answer 31

Induction treatment: Exclusively enteral nutrition
Maintenance treatment: Infliximab (top down treatment)