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Year 5 😊✌🏼 > Microbio > Flashcards

Microbio Flashcards

1
Q

Why is Vit B6 given with TB treatment?

A

to protect against the SE of isoniazid

(to prevent peripheral neuropathy SE, isoniazid (promotes pyridoxine excretion)

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2
Q

Phases of TB infeection

A

Primary infection - initial infection, often in childhood, often asymptomatic
latent infection - suppressed, hangs around in foci
post-primary: reactivation of latent, often immunoupresseion - can disseminate

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3
Q

What is a ghon focus?

A

a granuloma typically located in the middle/lower lung lobes.(latent TB)

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4
Q

What is a ghon complex?

A

ghon focus with lymphadenopathy (latent TB)

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5
Q

ranky complex

A

ghon complex that became calcified (latent TB)

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6
Q

Presentation types of TB

A
  • constitutional sx (FLAWS)
  • pulmonary TB
  • TB lymphadenitis

military TB
Meningeal TB (presents as subacute meningitis)
Pott’s disease (TB of the spine)
genitourinary TB
serosa, GI, adrenal, cutaneous etc.

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7
Q

What is miliary TB?

A

pulmonary TB erodes into a blood vessle and disseminates across body

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8
Q

Meningeal TB

A

subacute presentation
add

often seen in HIV patients

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9
Q

Skin disease in TB

A

lupus vulgaris (pathognemonic)

erythema nodosum (common)

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10
Q

IX for TB

A

active
- sputum culture - gold standard (in Lowenstein Jensen media)
- sputum smear and Ziehl-Neelson stain for AFB (quicker, in reality used more often to make a dx. other stain is rhodamine auramine stain)

latent
- Mantoux test (will come back +ve if had BCG)
- IGRA ( can be used if previously vaccinated, only +ve in TB not BCG, more expensive)

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11
Q

Rhodamine vs rhodamine auramine stain

A

rhodamine - copper -> wilsons

RA - TB

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12
Q

Mx of TB

A

RIPE

R - rifampicin
I - isoniazid (+pyridoxine)
P - Pyrazinamide
E - Ethambutol

4 for 2m (RIPE) and continue 2 for 4m (RI)

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13
Q

Latent TB Mx

A

2 drugs (R+I) for 3 months

OR

1 drug (I) for 6 months

(double check)

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14
Q

Mx of DR TB

A

RIPE +

xxxx
fluoroquiolones?

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15
Q

name some mycobacterial diseases

A

Tuberculosis
Leprocy (skin changes and peripheral nerve disease)
MAC (mycobacterium avian complex, looks like pulm TB in pts with RF e.g. HIV, CF, bronchiectasis)
Swimming pool granuloma (superficial ulcers, exposed to fishtanks, aquarium)
Buruli ulcer (pt in tropics with slowly progressive, painless , ulcer)

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16
Q

Presentation of leprosy

A

hypo/hyperpigemnted nerve patches
peripheral nerve palsies
thickening of nerves

amyloidosis
median nerve palsies

150 cases annually - worldwide/USA?

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17
Q

Typical vs atypical pneumonia

A

typical presents with classic signs and symptoms of pneumonia and classic CXR changes

atypical pneumonia: no/atypical signs and symptoms, not in-keeping with CXR, don’t respond to penicillin abx because no cel wall

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18
Q

What abx do typical and atypical pneumonias generally respond well to?

A

typical - penicillins

atypical - macrolides

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19
Q

Strep pneumoniae pneumonia features

A

most common

rusty coloured sputum
gram +ve diplococcus
positive urine antigen test

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20
Q

H influenzae pneumonia

A

common in pts with COPD
gram -ve coccobacillus

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21
Q

Moraxella catarrhalis pneumonia

A

seen in smokers
gram -ve coccus

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22
Q

Buzzwords for Staphylococcus aureus pneumonia

A

post-influenza (2w bad influenza, better for 2d, then bad again)
cavitatiing lesions
gram positive cocci in grape like bunches

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23
Q

Klebsiella pneumonia buzzwords

A

alcoholics and aspiration
haemoptysis and cavitating lesion
alcoholics and post stroke (aspiration)

one more

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24
Q

chlamydia pneumoniae pneumonia

A

atypical pneumonia
3-4 w incubation

Chlamydia IgG and IgM serology
NAAT with sputum or nasopharyngeal swab.

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25
Legionella pneumonia buzzwords
exposed to air conditioning, plumbers, travellers vey unwell hepatitis, hyponatraemia, lymphopaemia, urine antigen test +ve
26
What pneumonia if urine antigen test is +ve
strep pneumoniae or legionella
27
Mycoplasma pneumoniae infection buzzwords
cold AIHA erythema multiforme - can progress to SJS young people in close proximity e.g. halls
28
psitacci
29
coxiella brunetti
gram -ve zoonotic infection (cattle, goats, sheep) Q-fever add information from slides
30
LRTIs in HIV immunocompromised
PCP TB Cryptococcus neoformans Nocardia
31
How does PCP present?
dry cough desaturation on exertion
32
What organisms are encapsulated?
SHiNS/NHS neisseria haemophilus strep
33
Reheated rice diarrhoea - which pathogen?
bacillus cereus
34
Staph aureus buzzwords (GI infection)
recent hx of bbq, short incubation because it is due to toxins, not bacteria dividing
35
traveller diarrhoea - organism
E coli usually non-haemorrhagic unless EHEC
36
rice water stool - pathogen?
cholera
37
Which pathogens cause dysentery?
CHESS campylobacter hemorrhagic e coli entamoeba histolytica salmonella enterirides shigella spp Yersinia enterolitica (often causes terminal ileitis and adenitism can reseblne appendicitis, can be bloody or non blody
38
How can you classify GI infections?
secretory inflammatory (cause dysentery) systemic symptoms
39
Yersinia - what kind of pathogen is it? How and where can you get it? Sx? Dx via? Mx?
Yersinia pestis (''plague'') gram-ve lactose fermenter reserviour in rats, transmitted by fleas still seen in some American national parks e.g. Yosemite Sx - bubonic plague: flea bites human -> swollen LN (bubo) - dry gangrene - pneimonic plague: usually seen during epidemics, person-person spread dx via PCR Mx: streptomycin, doxycycline, gentamicin, chloramphenicol (in meningitis)
40
Entamoeba histolyitca
presents with dysebtertm chronic t
41
Protozoal GI infections - examples
Entamoeba histolytica Giardia lamblia Cryptosporidium/
42
Giardia
43
Cryptosporidium
44
C diff diarrhoea buzzwords
- hx of abx - hospital inpatient admission
45
Which abx are associated with c diff?
cephalosporins clindamycin ciprofloxacin
46
How do you diagnose c diff?
stool c diff toxin visualise pseudomembrane
47
How do you manage c diff?
1st infection: oral vancomycin 1st recurrence (within 12 w of last episode) fidaxomicin further recurrence - consider faecal microbiota transplant fulminant infection - oral vancomycin + IV metronidazole
48
Pseudomembranous colitis
c difficile GI infection
49
1st line management of C diff
oral vancomycin
50
Pyelonephrosis
pyelonephritis with obstruction - insert nephrostomy tubes
51
What makes a UTI complicated?
abnormal UT pregnancy imunocompromised instrumentalisation
52
types of UTIs
cystitis pyelonephritis pyelonephrosis
53
When are nitrites +ve on urine dip
in coliform UTIs (i.e. E coli) they have an enzyme that reduces nitrates to nitrites
54
Urine MCS for UTI dx
>10^4 colony-forming units/ml is diagnostic >10^3 colony forming units/ml E coli or staph saprophyticus
55
What makes a urine sample
mixed growth squamous cells if not UTI sx
56
Struvite stones - what organism?
proteus mirabilis (because it makes the urine alkaline and makes it easier for these stones to form)
57
klebsiella
58
Which organisms causing UTI indicated renal tract abnormalities?
proteus klebsiella
59
Abx for UTI
lower UTI: nitrofurantoin, trimethoprim, cephalexin uncomplicated - 3d complicated or male - 7d
60
UTI in pregnancy - when not to use certain abx.
nitrofurantoin - not in 3rd TM because it causes haemolytic jaundice in the baby trimethoprim - don't use in 1st TM because it is a folate infection
61
What drug do you have to look out for when giving trimethoprim
methotrexate
62
Mx of pyelonephrits
IV co-amox + gent
63
asymptomatic UTI mx
do not treat unless they are pregnant
64
What is meningism?
stiff neck photophobia headache +ve ??? sign
65
What causes meningism but is not meningitis?
subarachnoid haemorrhage
66
Difference between meningitis and encephalitis in presentation?
altered mental state in encephalitis
67
Types of CNS infection
meningitis encephalitis brain infection
68
Bacterial causes of meningitis in neontaes
GBS listeria monocytogenes E coli
69
Bacterial causes of meningitis in adults
neisseria meningitis strep pneumoniae
70
Bacterial causes of meningitis in elderly
GBS listeria monocytogenes and as adults
71
Bacterial causes of meningitis in immunocompromised
TB
72
Viral causes of CNS infections
Enteroviruses HSV 2 - meningitis HSV 1 - encephalisits HIV seroconversions
73
Fungal CNS infections
74
Diagnosing meningitis
history and LP
75
Why do we worry about and LP in raised ICP
Coning we worry if they have raised ICP due to a SOL, then you cone.
76
signs to not do LP (in rase
seizures reduced GCS focal neurology papilloedema
77
Ix for CSF analysis in ?CNS infection
78
MX of meningitis in the hospital
empiric treatment (IV ceftraizone/cefotaxime (+ampicillin if baby/elderly) steroids (dex) are controversial - yes according to guidelines (just before the 1st dose, if strep or H flu then continue for 5/7 otherwise stop) give aciclovir if cannot rule out encephalitis
79
Mx of meningitis in community
IM benpen and call ambulance
80
Mx of TB meningitis
81
Commonest causes of encephalitis in the UK
HSV1
82
unvaccinated, measles as a child now encephalitis - diagnosis
SSPE subacute sclerosing pan encephalitis
83
HIV pt or just started monoclonal treatment now has encephalitis - dx?
PML caused by JC virus (progressivve ...
84
Management of encephalitis
empirically treat with aciclovir (MRI and CSF PCR to help identify organisms)
85
What organisms cause brain abscesses
mainly mixed growth -> broad spectrum and anaerobic coverage HIV - Toxoplasmosis
86
Mx of brain abscess
abx (wide spectrum + anaerobe coverage) surgical drainage steroids to reduce swelling and Kepra to prevent seizures
87
What is the commonest STI?
chlamydia trachomatis
88
What is the commonest STI?
chlamydia trachomatis
89
How can chlamydia STI present?
- STI sx e.g. dysuria - reactive arthritis - serovars L1-3 _> lymphogranuloma venereum (proctatis followed by very swollen groin lymphobuboles) - ophthalmia neonatorum, 1-2 w after birth can often be asymptomatic
90
can you culture chalmydia?
no
91
What STI causes reactive arthritis?
chlamydia
92
How does gonorrhoea present?
typical sti sx progressing to PID migratory arthritis disseminated gonococcal infection painful tendnds ophthalmia neonatirm - first few days after birth
93
How can you differentiate if neonatal conjunctivitis in gonorrhoea or chlamydia?
gonorrhoea - first few days chlamydia - 1-2 w post birth
94
Mx of gonorrhoea
IM cef
95
gold standard in dx gonorrhoea
?culture
96
Syphylis stages
1) painless chancre 2) unwell, condylomata lata (genitals or oral), lymphadenopathy, maculopapular rash 3) tertiary gummatous disease, aortitis, neurosyphilis, tabes dorsalis
97
What pathogen causes syphilis?
treponema pallidum
98
How do we manage syphylis?
IM benpen
99
How do we manage neurosyphilis?
100
Jarish Herxheimer reaction
when you treat syphilis they are more unwell for the first 1-2 days, can give paracetamol and maybe steroids if necessary
101
How do we test for primary syphlis?
darkfield microscopy of chancre sample looking for ?? or serology: non-treponemal tests: VDRL, RPR tests (non specific) treponema tests - TPHA, TP-EIA (stays positive in treated)
102
4x reduction in titre in non terponemal titre suggests resopsen to treatment
103
Chancroid - dx
haempphilus ducreyi painful ulcers, lypmhadenopathy patients often from tropical regions
104
What is the commonest pathogen causing pneumonia
streptococcus pneumoniae
105
In someone who has had the BCG vaccine, how can you test for latent TB?
IGRA -> only positive in infection, however, more expensive than Mantoux test. Mantoux test is positive for both BCG and infection
106
Culture medium for TB and duration of culture
Lowenstein-Jensen Medium for 6 weeks -> acid fast bacilli seen
107
What does IGRA stand for?
interferon gamma release assay
108
Reservoirs for mycobacterium leprae
humans 9 banded armadillos (in the USA)
109
What pathogen is likely to cause pneumonia in patients with COPD?
H influenzae
110
What pathogen is likely to cause pneumonia in smokers?
Moraxella catarrhalis Haemophilus influenzae
111
What pathogen is associated with pneumonia in alcoholics?
Klebsiella pneumoniae
112
What organism causes post-influenza bacterial pneumonia?
Staphylococcus aureus
113
Name pathogens that cause typical pneumonia
Strep pneumoniae Haemophilus influenzae Moraxella catarrhalis Staphylococcus aureus Klebsiella pneumoniae
114
Name pathogens that cause atypical pneumonia
Legionella pneumophilia (zircon, travel, water, hepatitis, low Na) Mycoplasma pneumoniae (uni student, AIHA, erythema multiforme) Chlamydia psitacci (associated with birds) Chlamydia pneumoniae
115
Name pathogens that cause atypical pneumonia
Legionella pneumophilia (zircon, travel, water, hepatitis, low Na) Mycoplasma pneumoniae (uni student, AIHA, erythema multiforme0 Chlamydia psitacci (associated with birds) Chlamydia pneumoniae
116
What pneumonia pathogen is associated with erythema multiforme?
mycoplasma pneumoniae

Year 5 😊✌🏼 (53 decks)

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