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Cross reference - year 5 > Microbiology > Flashcards

Microbiology Flashcards

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1
Q

what is the most common route of entry of pathogens into CNS?

A

haematogenous

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2
Q

what are the causes of meningitis?

A

neisseria meningitides (3 serotypes)
streptococcus pneumoniae
haemophillus influenzae

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3
Q

what is the most common infection of CNS?

A

coxsackie B

echovirus

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4
Q

which is becoming the leading cause of encephalitis worldwide?

A

West Nile Virus

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5
Q

what is pyogenic vertebral oseteomyelitis?

A

common vertebral infection

e.g. staph/strep

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6
Q

which is the best imaging modality in detecting parenchymal abnormalities?

A

MRI

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7
Q

normal cell count (x106/l) in CSF

A

0-5 leucocytes

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8
Q

normal protein level in CSF in g/l

A

0.15-0.40

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9
Q

normal glucose levels in CSF mmol/l

A

2.2-3.3

60% blood glucose levels

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10
Q

purulent meningitis CSF findings (bacterial)

A
  • turbid
  • 1000-2000 polymorphs
  • gram stain
  • 0.5-3.0g/l protein (high)
  • 0-2.2 mmol/l glucose (low)
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11
Q

aseptic meningitis CSF findings

A
  • clear, slightly turbid
  • 15-500 lymphocytes
  • -ve gram stain
  • 0.5-1.0g (protein)
  • normal glucose
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12
Q

differentials for aseptic meningitis

A
  • viral meningitis
  • partially Abx treated bacterial meningitis
  • brain abscess
  • TB/fungal meningitis
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13
Q

TB meningitis findings CSF

A
  • clear, slightly turbid
  • 30-500 lymphocytes/some polymorphs
  • -ve gram stain
  • 1.0-6.0g/l protein
  • 0-2.2. mmol/l glucose
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14
Q

gram stain colours

A

gram positive = more purple

gram negative = more pink

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15
Q

gram-negative diplocci meningitis

A

neisseria meningitis

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16
Q

Ziehl-Neelson stain coloir

A

red and blue

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17
Q

stain for cryptococcal

A

India Ink

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18
Q

how does Cryptococcal appear on India Ink?

A

orbit structure (yeast in middle, capsule around edge)

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19
Q

high opening pressure on LP

A

cryptococcal meningitis

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20
Q

what is early indication of HIV infection?

A

chronic swelling of parotids

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21
Q

what is lymphoid interstitial pneuominitis?

A

lung condition associated with HIV

lymphoproliferation due to immune activation

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22
Q

when is HIV most commonly transmitted in pregnancy?

A

end of pregnancy when placenta is tired

when placenta is unhealthy (e.g. malaria)

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23
Q

which drugs work to stop HIV entry?

A
  • fusion inhibitors e.g. Enfurvirtide

- CCR5 coreceptor antagonists e.g. Maraviroc

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24
Q

what HIV drugs affect the pretranscriptional stage?

A
  • NRTI e.g. Zidovudaine, Eruticutabine
  • NtRTI e.g. tenofavir
  • NNRTI e.g. Efavirenz
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25
what HIV drugs target postranscriptional ?
integrase inhibitors e.g. Raltegravir | PI e.g. ritonavir
26
what did the ARROW trial show?
no difference in outcome when clinical monitoring is compared to labaratory monitoring in HIV
27
what is immune reconstitution inflammatory syndrome (IRIS)?
revamping the immune system can lead to severe inflammatory response = deterioration in clinical state
28
features of PCP pneumonia clinically and X-ray
X-ray: widespread bilateral ground glass shadowing | reduced exercise tolerance, low sats
29
how to confirm PCP pneumonia?
bronchoalveolar lavage cytology | = cysts using silver stain (Grocott-Gomoti stain)
30
T cell defects result in..
- viral infections | - aggressive, opportunistic infections
31
B cell defects lead to..
- bacteria: staph, pseudomonas | - fungi: candida, aspergillus
32
what is actinomyces?
gram +ve rod that branches as grows basophillic sulphur granules = lung abscess in immunocompromised/alcoholics slow growing and difficult to treat
33
C. difficle severity score
1+ of - T > 38.5 - HR > 90 WCC > 15 - rising creatinine - clinical signs of severe colitis/ colitis on radiology - failure to respond to therapy at 72 hours
34
severe C. diff treatment
Vancomycin
35
what is C. diff ribotype 027?
associated with increased severity of disease | produces more toxin A + B
36
why do PPIs cause increase risk of C. diff?
raise pH of stomach | - more GI flora and C diff spores survive stomach and travel down to colon
37
what do the 2 toxins produced by C. diff do?
1. damages epithelial cells (cytotoxin) = neutrophil infiltration 2. disrupts tight junctions = lots of fluid loss
38
some lab findings in C. diff
High WCC | low CRP
39
what is 14-3-3 protein a marker of?
marker of rapid neurodegeneration
40
what Chr is normal prion gene found on? what is its role?
Ch20 | prion protein role in copper metabolism
41
what are the 3 polymorphisms of codon 129?
MM (predisposes to prion disease) MV VV
42
structure of normal prion protein vs abnormal?
``` normal = alpha-helical abnormal = beta pleated sheet ```
43
prion disease classification
- sporadic: Creutzfelt-Jakob Disease - acquired: Kuru, vCJD (BSE), iatrogenic CJD - genetic (PRNP mutation): Familial Fatal Insomnia, GSS syndrome
44
investigation results in sporadic CJD
EEG: triphasic complexes MRI: increase signal in basal ganglia increase 14-3-3 protein tonsillar biopsy = not useful
45
vCJD investigation results
- MRI: pulvinar sign - EEG: non specific slow waves - 14-3-3 normal - MM at codon 129 - tonsillar biopsy = 100% sensitivve
46
most common mutation in Gerstmann-Strausser-Sheinker Syndrome
PRNP P102L
47
features of Fatal Familial Insomnia
untreatable insomnia | BP/HR dyregulation. ataxia, thalamic degeneration
48
what is Kuru linked to?
cannabalism
49
symptomatic treatment of CJD
clonazepam for myoclonus
50
treatment of CJD - delaying prion conversion
quinacrine pentosan tetracycline
51
what is staphylococcus saprophyticus?
coag -ve infections in younger women virulence factor (P. fimbriae) = allows adhesion of epithelial
52
what are the neurogenic malfunction that can cause obstruction in renal tract?
- poliomyelitis - tabes dorsalis - diabetic neuropathy - spinal cord injuries
53
what does white cell pyuria?
indicative of infection
54
what does squamous epithelial cells in urine culture signify?
contamination
55
how many CFU do you need to identify a UTI?
>105 with urinary symptoms | organisms typical of UTI = >103 CFU/ml
56
what could cause a sterile pyuria (raised WCC but no growth)?
- prior treatment with Abx - chlamydia - TB - calculi - catheterisation - bladder - neoplasm
57
what culture is used for UTIs?
chromogenic agar
58
colours that the agar can turn and cause
- pink: E. coli - blue: other coliforms - light blue: gram +ve
59
what is the incubation period of Hep A?
2-6 weeks after get hepatitis
60
describe the Hep B virus
DNA virus | 4 overlapping reading frames
61
what are the treatment options for Chronic Hep B?
interferon alpha lamivudine tenofavir entevavir
62
what time of virus is Hep C
flavivirdiae virus
63
best way to check for Hep C
HCV RNA check for virus in blood
64
treatment for Hep C
early treatment with peginterferon alpha | response guided therapy
65
what to remember about treating genotype 1 Hep C?
high dose, longer lasting ribavirin needed
66
features of hep D infection
smallest virus needs presence of Hep B to replication Hep B + D = super infection
67
what type of virus of Hep E
hepeviridae family
68
genotypes of Hep E
1+2: human, epidemic | 3+4: swine and other
69
sources of Hep E
shellfish blood transfusion sausages
70
what are the rare complication of Hep E?
``` CNS disease (Bell's Palsy, GB) Chronic infection ```
71
Treatment of Hep E
supportive | ribavirin
72
type of virus is Hep G
Pegivirus
73
3 levels of SSIs
``` superficial incisional (skin and subcutaneous) deep incisional (fascial, muscle layer) organ/space infection ```
74
features of MRSA and tx
gram +ve cocci haemolytic Tx: Linezolid
75
preventing SSRs pre-operatively
- age - underlying issues (obesity, low albumin, smoking etc) - pre-operative showering (shower with soap on day) - hair removal (micro-abrasions = multiplication of bacteria) - nasal decontamination (if found to carry S. aureus) - Abx prophylaxis (at induction of prophylaxis)
76
preventing SSRs intra-operatively
``` +ve pressure ventilation sterilisation instruments aseptic prep normothermia (dec temp = dec oxygen) oxygenation >95% ```
77
pathophysiology of septic arthritis
- bacterial proliferation in synovial fluid = host inflammatory response - joint damage = host derived protein (e.g. fibronectin) exposed --> bacteria adhere
78
bacterial factors that influence in septic arthritis
- S. aureus: fibronectin-binding protein (recognises selected host proteins) - Kingella Kinga: bactieral pili (help adhere to synovium) - some S. aureus strains = cytotoxin PVL = fulminant infection
79
what joint is mostly affected in septic arthritis?
50% knee
80
rarer causes of septic arthritis
lyme disease brucellosis mycobacteria fungi
81
chronic osteomyeltiis presentation
pain brodies abscess sinus tract
82
treatment for chronic ostemyelitis
- radical debridement - remove sequestra (dead bony tissue) - Lautenbach technique - Papineau technique
83
Lautenbach technique
- debridement to healthy bleeding bone - double lumen irrigation system inserted - fluid and Abx irrigated for 3 weeks
84
Papineau technique
complete excision of infected tissue/necrotic bone | bone grafting of osseous defect
85
most common cause of prosthetic join infection
coagulase negative staphylocci
86
single stage revision of PJI
- remove dead bone/material | - replant new prosthesis with Abx impregnated cement
87
two stage revision of PJI
- remove, put in spacer - Abx for 6 weeks - re-debride - implant with Abx impregnated cement
88
what is the most common HAI?
pneumonia
89
features of C. difficle
gram +ve | spore forming anaerobe
90
features of S. aureus
gram +ve cocci in clusters
91
differentials for PUO
- infection - AI/ inflammatory, vasculitides - malignancy - medication
92
extra tests to remember to do in PUO
- HIV test - EBV/CMV test - extended serology tests (Q-fever, Bartonella, Brucella)
93
parasites that can cause PUO
- malaria - amoebic liver abscess - schistosomasis - toxoplasmosis - trypanosomiasis
94
fungi that can cause PUO
- cryptococcus | - histoplasmosis
95
EBV serology
- viral capsid antigen (appear quickly when symptomatic) | - EBNA-1 IgG appear late on in disease
96
how does a PET-CT scan work?
- fluoro-D glucose accumulates in cells with increased rate of glycolysis - kidney light up as where FDG is excreted
97
what is a very high ferritin associated with?
- adult onset Still's disease (salmon pink rash) | - macrophage activation syndrome
98
what is the test for latent TB?
IGRA
99
Duke's criteria for IE
2 major or 1 major + 3 minor
100
major criteria for IE
persistent bacteraemia (>2 BCs) echo - vegetations +ver serology for Bartonella, Coxiella or Brucella
101
minor criteria for IE
- predisposition (murmur, IVDU) - inflammatory markers (fever, CRP high) - immune complexes (splinters, haematuria) - embolic phenomena (janeway lesion, CVA) - atypical ECHO - 1 +ve BC`
102
reservoir, source and symptoms of Campylobacter
reservoir: poultry, cattle contaminated food Presentation: diarrhoea, bloating, cramps
103
salmonella reservoir, symptoms and management
reservoir: poultry symptoms: diarrhoea, vomiting, fever Mx: supportive, ciprofloxacin, azithromycin
104
Bartonella henselae: | reservoir, source, causes what
- reservoir: kittens > cats - scratches, bites - causes cat scratch disease or bacilliary angiomatosis - diagnosed via serology
105
cat scratch disease and management
- macule at site, becomes pustular - regional adenopathy - systemic Sx - Mx: erythromycin, doxycycline
106
bacilliary angiomatosis and Mx
- immunocompromised - skin papules - disseminated multi-organ and vasculature involvement - Mx: erythromycin + doxycycline + RIFAMPICIN
107
``` TOXOPLASMOSIS reservoir symptoms investigation management ```
cats/sheep fever, adenopathy, still birth, seizures serology Mx: spiramycin, pyrimethamine + sulfadiazine
108
``` BRUCELLOSIS reservoir symptoms investigation management ```
``` cattle/goats unpasturised milk, undercooked meat Px: fever, back pain, orchitis, focal absecess Blood culture Mx: doxycycline + gentamicin ```
109
``` COXIELLA BURNETII - Q FEVER reservoir symptoms investigation management ```
``` goats/sheep/cattle aerosolisation, unpasturised milk Px: flu like, pneumonia, hepatitis, endocarditis, focal absecess Serology Mx: doxycycline ```
110
``` RABIES (LYSSA VIRUS) reservoir symptoms investigation management ```
dogs/cats/bats seizures, excessive salivation, agitation, confusion serology Mx: Ig, vaccine
111
RAT BLUE FEVER organisms symptoms management
- streptobacillus moniliformis - fevers, polyarthralgia, rash - can progress to endocarditis - Mx; penicillin
112
causes of viral haemorrhagic fever
- ebola (bats) - lass (rats) - crimean congo haemorrhagic fever (ticks)
113
sail sign
double heart border | LLL collapse
114
features of strep pneumoniae
gram +ve cocci alpha-haemolytic optochin-sensitive
115
main organisms causing CAP
``` S. pneumoniae H. influenzae Moraxella catarrhalis Staph aureus Klebsiella pneumoniae ```
116
atypical causes of CAP
legionella mycoplasma Coxiella burnetti (Q fever) chlamydia psittaci
117
urea and RR cut offs in CURB
urea >7 | RR > 30
118
bronchitis causing organisms
viruses S. pneumoniae H. influenzae Moraxella catarrhalis
119
causes of cavitation on CXR
staph aureus Klebsiella pneumoniae TB
120
features of H. influenzae
gram -ve cocco bacilli | chocolate agar plate
121
what investigations in legionella pneumophilia?
grown on buffered charcoal yeast extract | urinary antigen
122
stains in TB and coloir
auramine stain + Ziehl Neelson stain | red rods = acid fast bacilli
123
causes of HAP
Enterobacteriae (e.g. E coli, K. pneumoniae) Staph aureus Pseudomonas sp
124
PCP type of organism and Ix
protozoan walk test = de sat on exercise CXR: bat wing shadowing
125
3 lung diseases caused by aspergillus fumigatus
- allergic bronchopulmonary aspergillosis (chronic wheeze, eosinophilia, bronchiectasis) - aspergilloma - invasive aspergillosis (immunocompromised)
126
treatment of invasive aspergillosis
amphotericin B
127
treatment of HAP
1. ciprofloxacin +/- vancomycin | 2. piptazobactum + vancomycin
128
MRSA and Pseudomonas treatment
MRSA: vancomycin Pseudomonas: Tazocin or cipro +/- gentamicin
129
what percentage of world population is infected with TB
30
130
categories of mycobacterium
- TB complex (TB, bovis) - avium complex (avium, intraceullare) - abscessus complex - ungrouped (leprae)
131
describe the features of mycobacteria
non motile rod shaped | mycolic acid, complex waves, glycoprotein cell wall
132
what stain is used for MTB screening?
auramine
133
types of slow growing Non-TB mycobacteria
- avium complex (disseminated in immunosuppressed) - marinum (swimming pool granuloma) - ulcerans (Brului ulcer)
134
2 types of mycobacterium leprae
1. Paucibacillary tuberculoid: few skin lesions, robust T cell response 2. Multibacillary lepromatous: lots of bacilli, multiple skin lesions, poor T cell response
135
what is primary TB?
Ghon focus | granuloma in lungs
136
what is post-primary TB?
- reactivation/ re-infection - >5 years after initial infection - pulmonary/ extra-pulmonary
137
forms of extra-pulmonary TB
- lymphadenitis (scrofula) - GI - peritoneal (ascitic or adhesions) - GU - bone and joint (Spine = Potts) - mililary TB - TB meningitis
138
investigation requirement for TB
3 sputum samples for culture
139
what does tuberculin skin test (TST) look for?
looks for previous exposure to bacteria
140
second line meds for TB
quinolones injectables e.g. amikacin linezolid ethionamide
141
rifampicin SEs
reduced transaminases induces CYP450 orange secretions
142
Isonaizid SEs
``` peripheral neuropathy (give with pyroxidine) hepatotoxicity ```
143
side effect of pyrazinamide
hepatotoxic
144
ethambutol SEs
visual disturbance
145
multi-drug resistant TB definition
resistant to rifampicin and isoniazid
146
extremely drug resistant TB
also resistant to fluoroquinolones and 1 injections
147
natural reservoir for influenza A
ducks
148
how does flu virus attaches to cell ?
sialic acid receptors
149
what is the purpose of the haemaglutinin protein?
- needs to be cleaved for virus to be able to fuse with endosome and release genome - human airway tryptase in lung capable of cleaving HA
150
what does the PB2 627K mutation allow?
mutation that allows bird flu to cross into human (polymerase protein)
151
amantadine target and use
M2 channel | influenza A
152
NA inhibitors
Oseltamivir (oral) | Zanamivir (inhaled/IV)
153
what does the seasonal flu vaccine contain?
NA + HA of inactivated virus
154
MoA of Aciclovir
- nucleoside analogue - gets incorporated into growing chain of viral DNA - chain termination - needs activation by viral thymidine kinase
155
what are the indications for treatment for VZV?
chicken pox in adults shingles in adults immunocompromised neonates
156
where does CMV remain latent?
blood, monocytes, dendritic cells
157
CMV appearance
Owl's eye inclusions
158
different treatment options for CMV
- ganciclovir - valganciclovir - foscarnet - cidofovir
159
how is ganciclovir activated? SE
activation UL97 kinase enzyme | SE: bone marrow toxic
160
what is valganciclovir?
prodrug of ganciclovir | can be taken PO
161
MoA of foscarnet
non-competitive inhibitor of viral DNA polymerase used when ganciclovir is contraindicated (e.g. neutropaenia) SE: nephrotoxic
162
MoA of cidofovir and SE
nucleotide analogue competitive inhibitor of viral DNA synthesis does not require activation SE: nephrotoxic
163
HA purpose
HA medicated virus binding and entry into target cell
164
NA purpose
allow release of progeny virus particles from host cell
165
RSV drugs
ribavirin (inhibits viral RNA synthesis) | IVIG
166
RSV prophylaxis
Palivizumab
167
BK virus effects in BM transplant and tx
haemorrhagic cystitis | Tx: cidofovir
168
BK virus effects in renal transplant
BK nephritis | Tx: reduce immunosuppression, IVIG
169
what is a quasispecies?
population of virus are genetically heterogenous rather than clonal
170
cause of HSV drug resistance
mutations in viral thymidine kinase
171
cause of CMV drug resistance
mutations in protein kinase gene (UL97)
172
what is R0?
number of people that 1 sick person will infect on average
173
what is the herd immunity threshold?
1 - 1/R0
174
examples of inactivated vaccines
influenza polio cholera
175
examples of toxoid vaccines
diptheria | tetanus
176
subunit vaccines
Hep B | HPV
177
which exams can cause anaphylaxis?
DTP T/DT/Td Hep B
178
side effect of measles and rubella vaccines
Measles: thrombocytopaenia Rubella: acute arthritis
179
congenital toxoplasmosis S/S
40% babies symptomatic at birth - chorioretinitis - microcephaly - intracranial calcifications - seizures - hepatosplenomegaly
180
congenital rubella triad
1. cataracts 2. congenital heart disease (PDA) 3. deafness
181
which is a particularly problematic E.coli in neonates?
E. coli K antigen
182
treatment of late onset neonatal sepsis
cefotaxime + vancomycin
183
pneumococcal conjugate vaccine number of serotypes
7
184
how do you classify streptococci?
alpha-haemolytic: blood agar turns green (partial haemolysis) e.g. strep pneumoniae, strep viridans beta-haemolytic: blood agar turns clear (full haemolysis) Lancefield grouping
185
Lancefield grouping
A: strep pyogenes B: strep agalactiae D: enterococci
186
H. influenza features
gram -ve | grows glossy colonies on blood agar
187
extra-pulmonary features of mycoplasma pneumoniae
- haemolysis (IgM Abs, cold agglutins) - neurological - polyarthralgia - otitis media - bullous myringitis (vesicles on tympanic membrane)
188
which are the yeasts?
candida cryptococcus histoplasma
189
what are the moulds?
aspergillus dermatophytes agents of mucormycosis
190
describe candida
form individuals cells | grow in colonies
191
which candida is sensitive to first line antifungals?
C. albicans
192
what are the problems with C. glabrata and C. krusei?
resistant to first line drug
193
what does candida albicans form on screening?
germ tube
194
what happens if candida affects eyes?
endopthalmitis
195
why should you give anti-fungal in upper GI perforation?
candida leaks into mediastinum = mediastinitis
196
agar and serology for Candida
sabouraud agar | Beta D Glucan assay (serology)
197
management of candida
2 weeks of antifungals flucanazole: C. albicans echinicandins: non C. albicans
198
features of crypotococcus
caused by cryptococcus neoformans primary pulmonary infections = subclinical dissemination = predilection to CNS
199
treatment of cryptococcus
choice: ambisome resistant to echinicandins susceptible to fluconazole, amphotericin
200
life cycle of cryptococcus
- birds excreta - spores inhaled - lodges into alveoli - disseminated into CNS
201
microscopy of cryptococcus
India Ink | Enzyme immunoassay
202
Management of cryptococcus
3 weeks of amphotericin +/- flucytosine
203
diseases caused by aspergillus
- mycotoxicosis (ingestion of contaminated food) - allergy - colonisation - invasive disease - systemic/fatal disseminated disease
204
diagnosis of aspergillosis
serology IgE allergic response = ABPA antigen detection = galactomannan
205
management of aspergillosis
amphotericin | at least 6 weeks
206
examples of dermatophyte infections
ringworm tinea nail infection
207
cause of tinea pedis
athletes foot | Trichophyton rubrum
208
cause of tinea cruris
groin area | trichophyton rubrum
209
tinea corporis
body | ring worm
210
cause of tinea capitis
head | trichophyton rubrum
211
cause and treatment of onychomycosis
Trichiphyton species | Tx: nail lacquers and terbinafine
212
Pityrasis versicolor
skin discolouration | malassezia furfur
213
symptoms of mucromycosis
severe/invasive disease cellulitis of orbit = discharge, black pus from palate/nose dec level of consciousness id brain involved (rhinocerebral)
214
cause of mucormycosis
Rhizopum spp Rhizomucor spp Mucor spp
215
Tx of mucormycosis
surgical emergency debridement | high dose amphotericin
216
MOA of Azole antifungals
- inhibit ergosterol production - accumulation of toxic steroids - cell death
217
issue with azoles
cross reactivity with human CYP450 enzymes (drug interactions)
218
Voriconazole coverage
candida, cryptococcus, aspergillus
219
itraconazole coverage
dermatophytes
220
posaconazole coverage
mucor
221
Echinocandin MOA
inhibit production of Beta-D GLucan (component of fungal cell wall) = osmotic fragility
222
Echinocandin examples and active against
e.g. caspofungin, andiulafungin | active against: candida, aspergillius
223
main Polyene
Amphotericin B | Ambisome = amphotericin within phospholipid bilayer
224
MOA of amphotericin
binds to ergosterol in fungal cell membrane | creates transmembrane channels = fungal cell death
225
which fungis are amphotericin not active against?
Aspergillus Terreus | Scedosporum spp
226
MOA of flucytosine
inhibits DNA in fungal cells restricted spectrum of activity monotherapy limited
227
type of virus: Rubella
Togovirdae family
228
Congenital Rubella Syndrome
most likely <12 weeks - sensorineural hearing loss - microcephaly - PDA - cataracts
229
congenital CMV
most common congenital infection 90% asymptomatic at birth leading cause of hearing loss - give audiology F/U
230
when is the highest risk of HSV neonatal infection? presentations?
primary HSV in 3rd trimester SEM disease CNS disease disseminated disease
231
VZV virus type
DNA virus
232
Congenital Varicella Syndrome
``` 13-20 weeks LBW Cutaneous scarring Limb hypoplasia Microcephaly Chorioretinitis ```
233
measles virus type and rash
RNA paramyxovirus | maculopapular rash = starts behind ears
234
what is the problem with measles in pregnancy? Tx?
measles in pregnancy = risk to mother (foetal loss, preterm delivery) no congenital abnormalities Tx: measles Ig within 6 days of exposure
235
Parvovirus B19 virus type and biggest risk
DNA virus | biggest risk <20 weeks
236
what does Parvovirus attack?
erythrocyte precursors | virus needs P blood antigen receptor to enter cell
237
inhibitors of cell wall synthesis (groups and examples)
- beta lactam (penicillins, cephalosporins, carbapenems) | - glycopeptide (vancomycin, teicoplanin)
238
glycopeptide coverage
only gram +ve
239
gram +ve vs gram -ve structure
gram +ve: thick peptidoglycan wall | gram -ve: outer membrane
240
what is the MOA of Beta-Lactam Abs?
inactivate transpeptidases/pen binding proteins involved in terminal stages of cell wall synthesis active against rapidly dividing bacteria
241
amoxicillin coverage
broad spec | extends coverage to enterococci and gram _ve
242
important to remember about flucloxacillin
does not get broken down by beta lactamases
243
piperacillin coverage
amoxicillin and coverage to Pseudomonas and other non-enteric gram -ve
244
1st gen cephalsporin
cephalaxin
245
2nd generation of cephalosporin
cefuroxime
246
3rd generation of cephalosporin
cefotaxime ceftriaxone ceftazidine
247
issue with cephalosporin
C. diff (esp Ceftriaxone)
248
Ceftazidine importance
good anti-pseudomonas
249
MOA of glycopeptides
large molecules binds to amino acid chain prevents glycoside bonds and crosslinks
250
use of glycopeptides
MRSA | but nephrotoxic
251
inhibitors of protein synthesis
``` aminoglycosides (gentamicin, amikacin) tetracyclines chloramphenicol oxazolidnoes (e.g. Linezolid) macrolides ```
252
aminoglycoside MOA and SE
30S subunit of ribosome | ototoxic, nephrotoxic
253
tetracycline MOA and danger
30S subunit of ribosome | do not give to children/ pregnancy
254
MOA of macrolides, warning
50S subunit | minimal activity against gram -ve
255
chloramphenicol MOA and SEs
50S subunit of ribosomes | SE: aplastic anaemia, grey Baby syndrome
256
Oxazilidinedions MOA and coverage
binds to 23S component of 50S subunit of ribosomes | gram +ve (MRSA, VRE)
257
inhibitors of DNA synthesis
- Fluroquinoles: ciprofloxacin | - Nitroimidazoles: metronidazole
258
Fluroquinoles MOA and cover
act of alpha subunit of DNA gyrase | broad cover: gram -ve and pseudomonas
259
MOA of nitroimidazole
DNA strand breakage in anaerobic conditions
260
Rifampicin MOA
inhibits protein synthesis | binds to DNA dependent RNA polymerase
261
SEs of rifampicin
monitor LFTs interactions with other drugs, metabolised in liver orange secretions
262
cell membrane toxin Abx
- daptomycin: cyclic lipopeptide (gram +ve) | - colisitin: polymyxin, gram -ve
263
inhibitors of folate metabolism
sulphinamides | diaminopyrimine (e.g. trimethoprim)
264
mechanism of resistance
chemicals modifications/inactivation of Abx modification/replacement of target dec antibiotic accumulation bypass Abx-sensitive sensitive step
265
which enzymes gain resistance through inactivation? exception
beta lactamases | exception pen-resistant pneumococcus + MRSA
266
how does MRSA get resistance?
altered targets | MRSA has mecA gene encodes PBP2a (low affinity for beta lactamases)
267
how does strep pneumoniae gain resistance?
mutations in PBP genes | can over come by increasing dose
268
how does macrolide gain resistance?
erm genes cause modification of 23S RNA | reduces binding or macrolide
269
what is the MIC?
minimum inhibitory concentration | minimum drug conc to inhibit growth of organism
270
aim of type I abx
maximise conc e.g. aminoglycosides (measure trough concentration)
271
aim of type II abx
maximise time above MIC e.g. penicillins need to take frequently
272
aim of type III abx
amount of drug above MIC is most important e.g. vancomycin (time and conc dependent effects)
273
what is haemophagocytic lymphtohistiocytosis>
perforin deficiency | increased incidence of EBV
274
what mutation is HHV8 associated with?
STIM1 mutation
275
when do you normally suffer from viral infections after solid organ transplant?
normally after 1 month
276
when do viral infections happen following BM transplant?
early due to intense immunosuppression
277
what are the different human herpes viruses?
``` HSV 1+ 2 VZV CMV HHV6 HHV8 EBV ```
278
what are Owl's eyes?
appearance of lung pneumocytes caused by inclusion bodies
279
when is the risk of reactivation of CMV greatest in solid transplant?
greatest risk is when donor has had past CMV but recipient is naive
280
when is the risk of reactivation of CMV greatest in BM transplant?
greatest risk of when recipient has had past CMV but donor is naieve
281
different disease HHV8 is associated with
Kaposi sarcoma Primary effusion lymphoma Multicentric Castleman disease
282
Histological findings of Kapsoi sarcoma
spindle cell proliferation neo-angiogenesis inflammation and oedema
283
what is JC virus associated with?
progressive multifocal leukoencephalopathy | = demyelination of white matter
284
what monoclonal Ab increasing risk of PML?
Natalizumab (used in MS)
285
BK virus
polyamivirus, dsDNA | BK cystitis, BK nephritis
286
HBV serology if infected
develop Ab against core and surface Ag
287
HBV serology if acute infection becomes chronic
HBsAg will persist
288
HBV serology if vaccinated
Ab against surface Ag (NOT core)
289
what is the classification of worms (based on shape)?
- cestodes (tape worm): hydatid disease, pork/fish/beef tapeworm - trematodes (flushes): e.g. schistosmasis - nematodes (roundworms): e.g. Hookwarms, Ascarids, Stronglyodides
290
when do pork/beef tapeworm become problems?
humans are definitive host | cause trouble when humans become accidental/immediate host
291
pork tapeworm and consequence
taenia solum | can invade human tissue causing cystericosis
292
beef tapeworm
taneia saginata
293
treatment and prevention of worms
``` treatment = praziquental prevention = hygiene ```
294
how do people get infected by Schistosomiasis and where can the eggs affect?
contaminated water with cercariae from snails damage caused by laying of eggs eggs to bladder = bladder cancer eggs to liver = cirrhosis
295
treatment of schistosomiasis
praziquantel
296
different soil transmitted helminths
- ascaris lumbricoides (eggs hatched in intestine = adult worm) - hookworm - stronglyoides stercoralis
297
important fact about strongyloids
only helminth capable of auto infection (via perineal skin) | Tx: Ivermectin
298
filariasis spread by
blackflies and mosquitoes
299
how is filariasis categorised
on where adult worm lives | lymphatic/ subcutanoues/serous cavity
300
symptoms of lymphatic filarisis
scotal swelling elephantasis oncho-nodule
301
what is myiasis
parasitisation of human flesh by fly larvae | e.g. Bot (S. America), Tumbu (Africa)
302
what is the most common cause of adult onset seizures in world?
Brain worms
303
how percentage of the population is infected with latent TB?
25%
304
what is taenia solium cystericosis?
infection of tissues with pork tapeworm brain worms = ingestion of eggs Sx manifest due to cyst degeneration
305
Neurocystericosis management
anticonvulsant VP shunt cestocidal drugs (e.g. Praziquantel) Steroids
306
RFs for TB
``` malnutrition HIV Poverty Underweight past TB ```
307
stain for malaria
Fields | Giemsa stain
308
treatment of Non-Falciparium
chloroquine | primaquine (check G6PD)
309
treatment of non-falciparium
oral malarone Artermisinin combination therapy quinine
310
treatment of severe falciparum
IV artesunate
311
cause and features of dengue
aedes mosquito | fever, headache, myalgia, erythrofermic rash, hepatitis
312
how does chikungunga present?
similar to dengue but worse arthralgia
313
what is Faget sign?
sphygomothermic dissociation | HR should go up with fever
314
Salmonella typhi organism and treatment
gram -ve rod | Tx: ceftriaxone + azithromycin

Cross reference - year 5 (22 decks)

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