Microbiology (All Topics) Flashcards by Alex Davidson

Respiratory infections:

Outline the main features of Pneumonia and Bronchitis

Pneumonia:

Mortality is 5 to 10%
20 to 40% are hospitalised
30 to 50% are Commuinity Acquired Pneumonia (CAP)

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Respiratory infections:

Outline the symptoms and microscopitc findings of:

S.Pneumonia
H.Influenza
M.Catarrhalis
S.Auerus
K.Pneumonia

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Respiratory infections:

Outline the symptoms and features of:

Legionella pneumophilia
Mycoplasma pneumonia
Chlamydia pneumonia
Chlymydia psittaci
Bordatella pertussis
TB
Coxiella Burnetti

Coxiella Burnetti:

Domestic/farm animals
Aerosol
Diagnose with serology
Treat with macrolides

Macrolide > Clarithromycin

Tetracycline > Doxycyline

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Respiratory infections:

Outline the resipiratory tract infections associated with:

HIV
Neutropenia
Bone Marrow transplant
Splenectomy
Cystic fibrosis

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Respiratory infections:

Outline the daignosis of respiratory tract infections

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Respiratory infections:

Outline the Antibiotics used for Community (Classical and Atypical) and Hospital Aquired Pneumonia

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Respiratory infections:

What is the simplistic antibiotic framework for respiratory tract infections?

To simplify:

Just Gram positive:

Amoxicillin
Flucloxacillin
Vancomycin

Mostly Gram positive, little gram negative:

Coamoxiclav
Cefuroxime

Clearly both:

Cafotaxime
Meropenem or Piperacillin & Tazobactam

Mostly Gram negative, little gram positive:

Ciprofloxacin

Just Gram negative:

Cefazidime
Gentamicin

Atypical Pneumonia:

Clarithromycin/doxycyline

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PUO & Fever in the returning traveller

What is the definition of Pyrexia of Unknown Origin?

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PUO & Fever in the returning traveller

What is the approach to Neutropenic fever?
What are the other key points to consider in PUO?

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PUO & Fever in the returning traveller

What are the main causes of fever in the returning traveller?

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PUO & Fever in the returning traveller

What are the Severity & Liver stage, Length of Rhythm, Blood film and treatment of P.Malaria

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PUO & Fever in the returning traveller

What are the symptoms, investigations and management options for Typhoid?

Antibiotics:

Cotrimidazole, Chloramphenicol or ampicillin
(Multi-drug resistance) >> 3rd gen cephalosporin or azithromycin

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PUO & Fever in the returning traveller

What are the Severity & Liver stage, Length of Rhythm, Blood film and treatment of P.Vivax

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PUO & Fever in the returning traveller

What insect carries malara?

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PUO & Fever in the returning traveller

What are the Severity & Liver stage, Length of Rhythm, Blood film and treatment of P.Ovale

P.Malaria

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PUO & Fever in the returning traveller

What are the Severity & Liver stage, Length of Rhythm, Blood film and treatment of P.Falciparum

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PUO & Fever in the returning traveller

What are the major features of sever or complicated Malaria?

IS PHARAOS:

I: Impaired concoiusness/Seizures
S: Shock
P: Pulmonary oedema or ARDS
H: Hypoglycaemia (<2.2mmol)/Haemoglobinueria
A: Anaemia (Hb <8)
R: Renal imapairement
A: Acidosis (ph <7.3)
O: Other indications
S: Spontaneous bleeding/DIC

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PUO & Fever in the returning traveller

What are the investigations for P.Falciparum?

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PUO & Fever in the returning traveller

What is the treatment for P.Falciparum?

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PUO & Fever in the returning traveller

What are the common signs of P.Falciparum?

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PUO & Fever in the returning traveller

What are the symptoms of P.Falciparum?

Uncommon signs:

DDACC

Diarrhoea
Dark Urine
Abdrominal pain
Confusion
Cough

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PUO & Fever in the returning traveller

What is the definition of Classical PUO and give some examples

PUO Definition:

>38.3⁰C fever on several occasions persisting >3/52 without diagnosis despite >1/52 of intensive Ix

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PUO & Fever in the returning traveller

What is the definition of Healthcare associated PUO and give some examples

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PUO & Fever in the returning traveller

What is the definition of Neutropenic PUO and give some examples

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**_PUO & Fever in the returning traveller_** What is the definition of HIV Associated PUO and give some examples

**_Gastrointestinal Infections_** What are the subtypes of the Microorganisms that causes Gastrointestinal Infections?

* **_Anaerobic:_** * Clostridia * Botulinum * Perefringes * Difficile * **_Aerobic:_** * Bacillus Cerus * Staph.Aureus * **_Lactose Fermenters:_** * **__**Gram negative Enterobacteriacae * E.Coli * ETEC * EIEC * EHEC HUS EPEC * **_Non-l_****_actose Fermenters:_****__** * **__**Salmonella * Typhi * Paratyphi * H2S Producers * Yersinia enterocoli * **_Miscellaneous:_** * Vibrosis * **__**Cholera * Parahaemolyticus * Vulnificus * Campylobacter jejuni * Listeria monocytogenes * **_Protozoa:_** * **__**Entamoeba Histolytica

**_Gastrointestinal Infections_** What are clinical symptoms and treatment of Clostridia Botulinum Gastrointestinal Infections?

**_Gastrointestinal Infections_** What are clinical symptoms and treatment of Clostridia Perfringes Gastrointestinal Infections?

**_Gastrointestinal Infections_** What are clinical symptoms and treatment of Clostridia Difficile Gastrointestinal Infections?

**_Gastrointestinal Infections_** What are clinical symptoms and treatment of Bacillus cereus Gastrointestinal Infections?

**_Gastrointestinal Infections_** What are clinical symptoms and treatment of Staph. Auerus Gastrointestinal Infections?

**_Gastrointestinal Infections_** What are clinical symptoms and treatment of E.Coli Gastrointestinal Infections?

**_Gastrointestinal Infections_** What are clinical symptoms and treatment of Salmonella Gastrointestinal Infections?

**_Gastrointestinal Infections_** What are clinical symptoms and treatment of Enteritides Gastrointestinal Infections?

**_Gastrointestinal Infections_** What are clinical symptoms and treatment of Shigella Gastrointestinal Infections?

**_Gastrointestinal Infections_** What are clinical symptoms and treatment of Yersinia enterocoli Gastrointestinal Infections?

**_"CEMENTR"_** * **C**old enrichment: prefers 4 Degrees C * **E**nterocolitis * **M**esenteric adenitis * **E**rythema Nodosum * **N**ectotising gramulomas * **T**ransmitted via animal comtaminated food * **R**eactive arthritis

**_Gastrointestinal Infections_** What are clinical symptoms and treatment of Cholera Gastrointestinal Infections?

**_Gastrointestinal Infections_** What are clinical symptoms and treatment of Parahaemolticus and Vulinficus Gastrointestinal Infections?

**_Gastrointestinal Infections_** What are clinical symptoms and treatment of Campylobacter jejuni Gastrointestinal Infections?

**_Gastrointestinal Infections_** What are clinical symptoms and treatment of Lysteria Gastrointestinal Infections?

**_Gastrointestinal Infections_** What are clinical symptoms and treatment of Entamoeba Histolytica Gastrointestinal Infections?

**_Gastrointestinal Infections_** What are clinical symptoms and treatment of Giardia lamblia Gastrointestinal Infections?

**_Gastrointestinal Infections_** . What are clinical symptoms and treatment of Cryptosporidium Parvum Gastrointestinal Infections?

**_Gastrointestinal Infections_** What are clinical symptoms of Mycobacteria Gastrointestinal Infections?

**_Gastrointestinal Infections_** What are the clinical features of Viral Gastrointestinal Infections?

**_"RAPHEN"_** * **R**otavirus * **A**deovirus * **P**olio * **H**ep A * **E**enterovirus * **N**orovius

**_Gastrointestinal Infections_** What is the board classification of Gastroenteritis?

**_Hospital acquired infections:_** What is the definition of a hospital acquired infection?

**_Hospital acquired infections:_** What is the transmission route range of symptoms/risk factors pathology and management of Clostridium Difficile?

**_Hospital acquired infections:_** What is the resistance profile of E.Coli? What are the main risk factors and causative organisms of UTI?

**_Hospital acquired infections:_** What are the causative organisms of Bacteraemia? What are the causative organisms of Surgical site infections?

**_Neonatal and Childhood infections:_** What are the key congenital infections, their investigations and management?

**_Neonatal and Childhood infections:_** What are the risk factors, symptoms, investigations and management of early onset sepsis in neonatal infections?

**_Neonatal and Childhood infections:_** What are the risk factors, symptoms, investigations and management of late onset neonatal infections?

**_Neonatal and Childhood infections:_** What are the key organisms in Childhood infections, Paediatric Bacterial Meningitis, Respiratory tract infections and UTIs?

**_CNS Infection and Meningitis:_** What is the subclassifications of meningitis and the causative organisms?

**_CNS Infection and Meningitis:_** What is the aetiology, presentation, diagnosis and management of bacterial meningitis?

**_Viral Hepatitis:_** What are the principles of CSF interpretation?

**_Viral Hepatitis:_** What is the transmission, diagnosis and management of: 1. Hep A 2. Hep B 3. Hep C What is the transmission route of Hepatitis D and E?

**_Hepatitis D:_** RNA Virus that can only infect Hepatitis B patients **_Hepatitis E:_** RNA Virus, transmitted by feacooral route. Common in india.

**_Viral Infections in Pregnancy:_** What is the aetiology, presentation, diagnosis and management of Parovirus B19 in Pregnancy?

**_Viral Infections in Pregnancy:_** What is the aetiology, presentation, diagnosis and management of Rubella in Pregnancy?

**_Viral Infections in Pregnancy:_** What is the aetiology, presentation, diagnosis and management of Influenza and Measles in Pregnancy?

Vaccines: What are the types of vaccine available?

**_Pandemic Flu:_** What is/are: 1. Antigenic drift 2. Antigenic shift 3. Pathogenesis 4. Causes of severe outcomes of flu 5. Antivirals for Influenza

**_Infective Endocarditis:_** What is the history of Infective Endocarditis?

**_Infective Endocarditis:_** What are the examination findings for Infective Endocarditis?

**_Infective Endocarditis:_** What are the Investigations for Infective Endocarditis?

**_Infective Endocarditis:_** What is the Dukes Criteria for Infective Endocarditis?

**_Infective Endocarditis:_** What are the Infective Agents in Infective Endocarditis?

**_Infective Endocarditis:_** What is the treatment for Infective Endocarditis?

**_Infective Endocarditis:_** What are the indications for surgery in Infective Endocarditis?

**_Infective Endocarditis:_** What precautions need to be taken in a patients suspected of Infective Endocarditis?

**_Wound, Bone and Joint Infections:_** Describe the aetiology, organisms, presentations and management of Surgical site infections

**_Wound, Bone and Joint Infections:_** Describe the aetiology, organisms, presentations and management of Septic Arthritis

**_Wound, Bone and Joint Infections:_** Describe the aetiology, organisms, presentations and management of Osteomyelitis

**_Wound, Bone and Joint Infections:_** Describe the aetiology, organisms, presentations and management of Prosthetic Joint Infection

**_Urinary Tract Infection:_** What are the common organisms, presentations and management of Urinary Tract Infections?

**_Fungal Infections_** Who are particularly vulnerable to fingal infections? Why can they be difficult to diagnose? What is the classification of fungal infections?

**_Antifungals_** What are the targets and indications of: 1. Polyene 2. Azole 3. Terbinafine 4. Flucytosine 5. Echinocandin

**_Fungal Infections_** What are the key **superficial** fungal infections and how are they diagnosed?

**_Herpes Infections_** What are the symptoms of the following: 1. Asymptomatic CMV 2. Congenital CMV

**_Congential: LIMITED JHCC:_** * **L**ate progressive sensorineural deafness * **I**UGR * **M**icrocephaly * **I**mpaired IQ * **T**hrombocytopenia * **E**ncephalitis * **D**eath * **J**aundice * **H**epatosplenomegaly * **C**horioretinitis * **C**ytomegalic inclusion disease (13%)

**_Herpes Infections_** What is/are the aetiology, investigations and treatment of Cytomegalovirus?

**_Investigtions: STICHH_** * **S**erology * _Immunocompromised:_ limited diagnostic value * _Immunocompitent:_ CMV IgM & IgG (IgG low avidity in first infection) * **T**issue * **I**mmunoflourescence * **C**ell culture * **H**istopathology * **H**eterphile Antibodies * Paul Bunnel monospot: clumping of sheep RBCs

**_Herpes Infections_** What are the symptoms investigations and management of Roseola infections?

**_Herpes Infections_** What are the features of oral HSV1/HSV 2 infections?

**_Herpes Infections_** What are the symptoms of Encephalitis from HSV1/HSV2 infections?

**_Herpes Infections_** What are the symptoms of skin infections from HSV1/HSV2 infections?

**_Herpes Infections_** What are the symptoms of Varicella Zoster infections?

**_Herpes Infections_** What are the symptoms, investigations and management of Shingles infections?

**_Herpes Infections_** What are the features of: 1. Infectious mononucleosis 2. Burkitt’s lymphoma

Alongside Nasopharyngeal Ca and Post-transplant lymphoproliferative disease, these are the possible causes of EBV.

**_Herpes Infections_** What are the features of HHV8 infections?

**_Herpes Infections_** What are the features of Neonatal HSV1/HSV2 infections?

**_Herpes Infections_** What are the symptoms of the following: 1. CMV Mononucelosis 2. Immunocompromised CMV

**_Immunocompromised CMV: "GRAPH/GRAF B"_** * **G**I: colitis * **R**etinitis (Retinitis=AIDS)/**R**adiculopathy * **A**ddisons disease * **P**neumonitis (in BMT patients) * **H**epatitis * **F**ever * **B**one Marrow supression

**_Herpes Infections_** What are the features of ocular HSV1/HSV 2 infections?

**_Herpes Infections_** What are the features of genital HSV1/HSV 2 infections?

**_Herpes Infections_** What are the investigations of skin infections from HSV1/HSV2 infections?

**_ELISA=_** HSV-2 IgG **e**nzyme-**l**inked **i**mmuno**s**orbent **a**ssay

**_Herpes Infections:_** What is the management of skin infections from HSV1/HSV2 infections?

**_Herpes Infections_** What are the investigations for Varicella Zoster infections?

**_Herpes Infections_** What is the management of Varicella Zoster infections?

**_Pregnancy:_** * Can give Aciclovir within 24hrs of exposure * IVIG VZV can be give up to 10 days post exposure

**_Herpes Infections_** What are features of Varicella Zoster infections in pregnancy?

**_Herpes Infections_** What is Mollarets Meningitis?

**_Herpes Infections_** What are the CT/MRI findings in Encephalitis from HSV1/HSV2 infections?

**_Herpes Infections_** What are the CSF findings in Encephalitis from HSV1/HSV2 infections?

**_Herpes Infections_** What is the management of Encephalitis from HSV1/HSV2 infections?

**_Herpes Infections:_** What are the features of: 1. Nasopharyngeal Ca 2. Post transplant lymphoproliferative disease

Alongside Infectious mononucleosis and Burkitt’s lymphoma, possible causes of EBV

**_Fungal Infections_** What are the symptoms, investigations and management of Candida infections?

**_Fungal Infections_** What are the symptoms, investigations and management of Crypotococcus infections?

**_Fungal Infections_** What are the symptoms, investigations and management of Aspergillus infections?

**_Herpes Infections_** What are the classifications of Herpes infections?

**_Herpes Infection Classifications:_** 1. **Epitheliotropic** 1. CMV 1. Infected cells swell (hence megavirus) 2. _Roseola virus_ 2. **Neurotropic** 1. _HSV1 & HSV2:_ dsDNA. No animal reservoir. Persistent latent phase in DRG. Lytic infection of fibroblasts + epithelial cells. Transmitted via muco-cutaneous contact 2. _VZV:dsDNA._ Droplet spread. Viral replication in LNs, then in liver + spleen then vesicular rash (rash ~48hrs after infection). 14/7 1. Shingles 2. Chickenpox 3. **Lymphocytic** 1. _EBV_ 2. _HHV8_

**_Fungal Infections_** What are the key **deep** fungal infections and how are they diagnosed?

**_Diagnosed:_** clinical details, lab results and imaging **_Main types:_** 1. **Candida** 2. **Aspergillus** 3. **Cryptococcus**

**_Gastrointestinal Infections_** What is/are the incubation period, duration and comments of E.Coli infections?

**_Gastrointestinal Infections_** What is/are the incubation period, duration and comments of Shigella infections?

**_Gastrointestinal Infections_** What is/are the incubation period, duration and comments of Salmonella (nontypoidal) infections?

**_Gastrointestinal Infections_** What is/are the incubation period, duration and comments of Vibrio parahaemolyticus infections?

**_Gastrointestinal Infections_** What is/are the incubation period, duration and comments of Bacillus Cereus infections?

**_Gastrointestinal Infections_** What is/are the incubation period, duration and comments of Staph Aureus infections?

**_Gastrointestinal Infections_** What is/are the incubation period, duration and comments of Vibrio Cholera infections?

**_Antimicrobial Agents:_** Outline the main targets of Antimicrobial Agents and their Classes

**_Antimicrobial Agents:_** What are the main narrow and broad spectrum antibiotics?

**_Antimicrobial Agents:_** What are the four mechanisms of action of antibiotic resistance?

**_Antimicrobial Agents:_** What are the typical Infective Organisms and Antibiotics for the following infections: 1. Skin 2. Pharyngitis 3. Community acquired pneumonia 4. Hospital acquired pneumonia 5. UTI 6. Spesis 7. Colitis

**_Reference Table of Common Bugs:_** What is the reference table for common bugs?

**_Antimicrobial Agents_** Outline the process of Bacterial wall synthesis

**_Antimicrobial Agents_** Outline the mechanism of action of RNA synthesis inhibitors

**_Anitmicrobial Agents:_** Outline the mechanism of action of Nitrofurantoin

**_Anitmicrobial Agents:_** Outline the mechanism of action of Glycopeptides

**_Anitmicrobial Agents:_** Outline the mechanism of action of Beta Lactams

**_Antimicrobial Agents_** What is/are an example and the indication for Beta Lactams?

**_Antimicrobial Agents_** What is/are an example and the indication for Glycopeptides?

**_Antimicrobial Agents_** What is/are an example and the indication for Aminoglycosides?

**_Antimicrobial Agents_** What is/are an example and the indication for Tetracyclines?

**_Antimicrobial Agents_** What is/are an example and the indication for Macrolides?

**_Antimicrobial Agents_** What is/are an example and the indication for Chloramphenicol?

**_Antimicrobial Agents_** What is/are an example and the indication for Oxazolidinone?

**_Antimicrobial Agents_** What is/are an example and the indication for Fluoroquinolones?

**_Antimicrobial Agents_** What is/are an example and the indication for Nitroimidazoles?

**_Antimicrobial Agents_** What is/are an example and the indication for Rifamycin?

**_Antimicrobial Agents_** What is/are an example and the indication for Polymyxin?

**_Antimicrobial Agents_** What is/are an example and the indication for Cyclic lipopeptide?

**_Antimicrobial Agents_** What is/are an example and the indication for Sulfonamides?

**_Antimicrobial Agents_** What is/are an example and the indication for Diaminopyrimidines?

**_Prion disease:_** What is the definition of Prion Disease?

**_Prion disease:_** What is the Prion Disease, Aetiology and Course of Sporadic CJD?

**_Prion disease:_** What is the Prion Disease, Aetiology and Course of Acquired **Variant** CJD?

**_Prion disease:_** What is the Prion Disease, Aetiology and Course of Acquired **Iatrogenic** CJD?

**_Prion disease:_** What is the Prion Disease, Aetiology and Course of Inherited Prion Disease?

**_Zoonoses_** What is the who definition of Zoonoses?

**_Zoonoses_** What is are the symptoms, investigations and management of Rabies?

**_Zoonoses_** What is the aetiology of Bubonic and Pneumonic Plague? What are the investigations and treatment?

**_Zoonoses_** What are the transmission routes, symptoms and management of Leptospirosis?

**_Zoonoses_** What are the symptoms of Anthrax?

**_Zoonoses_** What are the symptoms of Q fever?

**_Zoonoses_** What are the transmission routes and symptoms of Cutaneous Leishmania?

**_Zoonoses_** What are the transmission routes and symptoms of Diffuse cutaneous Leishmania?

**_Zoonoses_** What are the transmission routes and symptoms of Muco-cutaneous Leishmania?

**_Zoonoses_** What are the transmission routes and symptoms of Visceral Leishmania?

**_Zoonoses_** What are the diseases caused by Rats?

**_Zoonoses_** What are the diseases caused by Cats?

**_Zoonoses_** What are the diseases caused by Dogs?

**_Zoonoses_** What are the diseases caused by Small Ruminants?

**_Zoonoses_** What are the diseases caused by Cattle?

**_Zoonoses_** What are the diseases caused by Swine?

**_Zoonoses_** What are the diseases caused by Birds?

**_Zoonoses_** What are the diseases are Water Sports associated?

**_Zoonoses_** What are the diseases that are Water borne?

**_Zoonoses_** What are the diseases that are Food associated?

**_Zoonoses_** What is the microbiology and transmission of Brucellosis?

**_Zoonoses_** What are the symptoms and complications of Brucellosis?

**_Zoonoses_** What are the investigations for Brucellosis?

**_Zoonoses_** What is the treatment of Brucellosis?

**_Zoonoses_** What is/are the aetiology and symptoms of Lyme Disease?

**_Zoonoses_** What is/are the investigations and management of Lyme Disease?

**_Prion Disease_** What is the aetiology/definition of Prion disease?

**_Prion Disease_** What is/are the genetics and differentials of Prion Disease?

**_Prion Disease_** What is normal PrP structure and how is it affected in Prion disease?

**_Prion Disease_** What is CJD treatment?

**_Prion Disease_** What are the following findings in Sporadic CJD?: 1. EEG 2. MRI 3. CSF 4. PNRP 5. Genetics 6. Western Blot 7. Post Mortem

**_Prion Disease_** What are the following findings in Variant CJD?: 1. EEG 2. MRI 3. CSF 4. PNRP 5. Genetics 6. Western Blot 7. Post Mortem

**_Prion Disease_** What are the following findings in Iatrogenic CJD?: 1. EEG 2. MRI 3. CSF 4. PNRP 5. Genetics 6. Western Blot 7. Post Mortem

**_Prion Disease_** What are the following findings in Inherited Prion Disease?: 1. EEG 2. MRI 3. CSF 4. PNRP 5. Genetics 6. Western Blot 7. Post Mortem

**_Zoonoses_** What are the diseases caused by Mice?

**_"BELL H"_** * **B**artonella * **E**hrlichina * **L**yme borreliosis * **L**ymphocytic choriomenigitis * **H**atan vurus (fleas)

**_Prion disease:_** What is the Prion Disease, Aetiology and Course of Acquired **Kuru** CJD?

**_Pandemic Flu:_** What is the causative virus of flu? What are the 3 anti genetically different flus?

**_Pandemic Flu:_** What is a natural reservoir of Influenza A? What is H5N1? What are the ideal situations for flu to grow?

**_Pandemic Flu:_** What are the RNA segments? What is the effect of neuraminidase? What is the effect of haemogglutimin?

**_Pandemic Flu:_** What is Antigenic drift?

**_Antivirals:_** What is the mechanism of action of for: 1. Acyclovir 2. Ganciclovir What are the symptoms of CMV?

**_Antivirals:_** What is used if there is resistance to Ganciclovir?

**_Antivirals:_** What is the machoism of action of Cidofovir? What is the effect of Foscarnet & Cidofovir?

**_Antivirals:_** What is the treatment of Herpes Simplex Infection (HSV)?

**_Antivirals:_** What is the treatment for CMV in BMT?

**_Antivirals:_** What is the treatment for Hepatitis B Virus (HBV) based on?

**_Antivirals:_** What is is the treatment for Respiratory Viruses?

**_Opportunistic Viral Infections:_** Who is affected by opportunistic viral infections? What are the types of immunodeficiencies?

**_Opportunistic Viral Infections:_** What are the stages of PCR?

**_Opportunistic Viral Infections:_** What are the 3 origins of opportunistic viral infections?

**_Opportunistic Viral Infections:_** What are the most important characteristics of VZV?

**_Pandemic Flu:_** What is Antigenic shift?

HA = Haemagglutinin NA = Viral Neuraminidase

**_Pandemic Flu:_** What is the pathogenesis of Influenza?

**_Pandemic Flu:_** What is are the causes of sever outcomes in Flu?

**_Pandemic Flu:_** What are the antivirals used in Flu?

**_Antivirals:_** What are the goals in Hepatitis B treatment?

**_Antivirals:_** What are the drugs given in Hepatitis B treatment?

**_Nuceloside Analogues: "LEATT"_** * **L**amivudine * **E**ntecavir * **A**defovir dipivoxil * **T**elbivudine * **T**enofovir (Inhibitor of reverse transcriptase, the rest are inhibitors of viral polymerase) **_Preferred 1st line: "PET"_** * **P**egINF alpha 2a * **E**ntecavir * **T**enofovir

**_Antivirals:_** What are the treatment goals in Hepatitis C treatment?

**_Antivirals:_** What are the drugs given in Hepatitis C treatment?

**_Antivirals:_** What are the genotypes affecting outcomes in Hepatitis C treatment?

**_Opportunistic Viral Infections:_** What are the most important characteristics of VZV?

**_Opportunistic Viral Infections:_** What are the most important characteristics of CMV?

**_Opportunistic Viral Infections:_** What are the most important characteristics of EBV?

**_Opportunistic Viral Infections:_** What are the most important characteristics of HHV8?

**_Opportunistic Viral Infections:_** What are the most important characteristics of HHV6?

**_Opportunistic Viral Infections:_** What are the most important characteristics of Adenovirus?

**_Opportunistic Viral Infections:_** What are the most important characteristics of Measles?

**_Tuberculosis and other Mycobacteria_** Outline the microbiology Mycobacteria

**_Microbiology of Mycobacteria:_** 1. Gram positive 2. Aerobic 3. Acid alcohol fast 4. **Cell wall with long chain (mycolic) acids**, as well as **glycolipids** which is **Thick, waxy** and with complex immunogenics 5. Nonmotile **rod shaped bacteria** 6. Relatively **slow growing** for bacteria

**_Tuberculosis and other Mycobacteria_** Exaplain how the host's immune response shapes the clinical outcome

* **(Different types of disease with worse immune response going down)** * Healthy contact (LTBI) * Lymph node * Localised Extraplumonary * Pulmonary (localised) * Pulmonary (widespread) * Meningeal * Miliary

**_Tuberculosis and other Mycobacteria_** Outline the presentation of TB

**_Presentation:_** * Cough in 80% * Haemoptysis in 6 to 40% * Fever * Weight loss * Malaise

**_Tuberculosis and other Mycobacteria_** Outline the classification of Mycobacteria

**_Tuberculosis and other Mycobacteria_** Outline the first line treatment of TB

* 6 month treatemnt, RIPE for 2 months then just Rifampicin and Isonazid for 4 months

**_Tuberculosis and other Mycobacteria_** What are the main **types** of investigation for TB?

**_Types of TB Investigations_** * Imaging CXR/CT * Sputum microscopy * Cultures * Histology * Mantoux test: * Interferon gamma release assay (IGRA) * Nuclear Acid Amplification test (NAAT)

**_Tuberculosis and other Mycobacteria_** Outline the features of Extrapulmonary TB

**_Extrapulmonary TB:_** * **Lymphadenitis:** * Known as **scrofula or King's disease** * Cervical Lymph nodes are most common * Abscesses and sinuses * **GI:** * Swallowing of tubercules * Dominant form in children * **Peritoneal:** * Ascitis or adhesive * **Genitourinary:** * Can present with just epydidimytis * **Bone:** * **Spinal TB most common** * **MIliary:** * Millet seeds on CXR * Progressive disseminated haemtogenous TB * Increasing due to HIV * **Caridac:** * ****Pericarditis

**_Tuberculosis and other Mycobacteria_** Outline the pathopysiology, investigations and treamtent of Spinal TB

**_Pathophysiology:_** * Haematogenous spread * Initial discitis * Vertebral destruction and collapse * Anterior extension **_Investigations:_** * MRI/CT * Biopsy/Aspirate **_Treatment:_** * 12 months of anti-TB

**_Tuberculosis and other Mycobacteria_** Outline the main types of Non Tuberculous TB

**_Two types of NTMs:_** 1. **Slow growing** 1. M.Amvium 2. M.Marinum 3. M.Ulcerans 2. **Rapidly growing** 1. M.Abscessus, M.Chelonae. M.Foruitum 2. Skin and soft tissue infections 3. In hospital settings, isolated from blood cultures

**_Tuberculosis and other Mycobacteria_** Outline the features of TB Vaccination

* BCG= **Bacille Calmette-Guerin** * **Live** attenuated vaccine * Only given to babies in areas of \>10/100,000, since 2005 * Efficacy is 70 to 80% * Doesn't work well in adults * Treatment with biologics, **Infliximab:** Anti TNF, screens for latent TB before giving the vaccine.

**_Tuberculosis and other Mycobacteria_** Outline the 3 types of Leprosy

**_3 Types:_** * **Paucibacilliary: Tuberculoid leprosy** * Few bacilli * Large and vigorous cell mediated immune response * Develop peripheral neuropathy \> *lose limbs* * **Multibacilliary: Lepromatous leprosy** * ****Heavy bacterial loads * Smaller cell response * Develop lumps and bumps * **Boarderline (BB)** * ****Multiple plaques **_EMQ Buzzwords:_** Thickened sural nerve, Shaved outer eyebrows

**_Tuberculosis and other Mycobacteria_** Outline the presentation of TB in HIV

**_Tuberculosis and other Mycobacteria_** Outline the features of Primary TB

* Multiplies at the pleual surface **(Ghon focus)** * Rarely can get allergic reactions such as **erythema nodosum** * Taken to a lymph node (primary complex) * **Granulomata** is the characteristic lesion with **Langhan's giant cells** * Can be asymptomatic, especially in children

**_Tuberculosis and other Mycobacteria_** Outline the features of Post Primary TB

Post Primary: * Reactivation is over **5 years since last infection** * 5 to 10% lifetime risk * **Upper lobes affected** * Classic lesion = **caseating granuloma** * healing = **fibrosis and calcification** * Risk factors: * immunosupression, * alcoholism, * malnutrition, * aging

**_Tuberculosis and other Mycobacteria_** Outline the resistance of TB

**_Resistance:_** * **Mono=** 1 drug only * **MDRTB=** Rifampicin and Isonazid * **XDRTB=** Rifampicin and Isonazid + Injecatables and Quinolones

**_Tuberculosis and other Mycobacteria_** What are the side effects of Rifampicin?

**_Side effects:_** * Organge sectrations * Induce cP450 * Hepatoxtoicity * Increased transmaminases

**_Tuberculosis and other Mycobacteria_** What are the side effects of Isoniazid?

**_Side effects:_** * Peripheral neuropathy (give B6/pyridoxine) * Hepatotoxicity

**_Tuberculosis and other Mycobacteria_** What are the side effects of Ethambutol?

**_Side effects_** * Optic Neuritis * Visual disturbances

**_Tuberculosis and other Mycobacteria_** What is the treatment for TB Meningitis?

**_TB Meningitis Treatment:_** * RIPE for 4 months * R and I for 8-10 months

**_Tuberculosis and other Mycobacteria_** What is is 2nd line treatment for TB?

**_2nd Line treament for TB:_** * **Injectables** * Capreomycin * Kanamycin * Amikacin * **Quinolones** * Moxifloxacin * **Cycloserine** * **Ethionamide/Protionamide** * **PAS** * **Linelozid** * **Clofazamine**

**_Tuberculosis and other Mycobacteria_** What is the treatment for latent TB?

**_Latent TB treatment:_** * 6-9 months of **Isoniazid**

**_Tuberculosis and other Mycobacteria_** What is used for T Prophylaxis?

Just Isoniazid

**_Tuberculosis and other Mycobacteria_** What are the features of Sputum Microscopy and Cultures for TB?

* **Sputum Microscopy** * Zeihl Neelson/Auramine staining * Gram +ve rods, acid fast * **Cultures:** * Sputum: * on 3 different occasions * Bronchoalveolar lavage * Urine * **Gold standard = Pus in lowenstein jensen medium** * Can take 6 weeks (more like 1 to 3 though)

**_Tuberculosis and other Mycobacteria_** What are the features of the Mantoux for TB?

* **_Mantoux test:_** * Inject 2 units of **tuberculin** to check previous exposure * Looking for induration not erythema! * Poor sensitivity * **Positive result if:** * \>5mm in immunocompromised pateint * \>10mm if recent immigrant

**_Tuberculosis and other Mycobacteria_** What are the features of the IGRA and NAAT?

**_Interferon Gamma Release Assay:_** * Episilot quantification **_NAAT:_** * PCR-line probe analysis. tests for sensitivities

**_Tuberculosis and Other Mycobacteria_** What are the symptoms of TB Meningitis?

* **Subacute presentation** * (Classic TB) weight loss, fever, night sweats * **Signs of meningism:** * Headache * Neck stiffness * **Personality changes** * **Reduced GCS** * **Focal Neurological deficit**

**_Tuberculosis and Other Mycobacteria_** What are the investigations for TB Meningitis?

* CT: Tuberculomata * LP: Lymphocytic

**_Tuberculosis and Other Mycobacteria_** What are the treatment for TB Meningitis?

* 12 months of Anti-TB treatment * Steroids

**_Tuberculosis and other Mycobacteria_** What are the featutres of M.Avium?

* **_Children:_** * Pharyngitis/cervical adenitis * **_Pulmonary_** * Underlying lung disease * **_Disseminated_** * Cytotoxics, lymphoma * **_AIDS:_** * **__**Disseminated infection. * Mycobacteraemia * consider in HIV pateints with longstanding diarrhoea

**_Tuberculosis and other Mycobacteria_** What are the featutres of M.marinum?

* Also called **Fish tank granuloma** * Single or in clusters papules/plaques * Swimming pool/aquarium owners

**_Tuberculosis and other Mycobacteria_** What are the featutres of M.Ulcerance?

* Insect transmission (tropics/Australia) * Early: painless nodules * Usually slowly progressive leading to ulceration * Seldom fatal, hideous deformity

**_Tuberculosis and other Mycobacteria_** How is the TB vaccine contraindicated in HIV pateints?

* BCG is contraindicated in HIV pateints * **HIV -ve** * latent TB \> active * risk is 5 - 10% **lifetime risk** * **HIV +ve** * latent TB \> active * risk is 5 - 10% **YEARLY RISK**

**_Tuberculosis and other Mycobacteria_** What is the incubation period, transmission route and main damage site in Leprosy?

* Incubation 2-10 years * Poor transmission via nasal secretion * Most damage is secondary effects to nerves

**_Tuberculosis and other Mycobacteria_** What is the treatment of Leprosy?

* Rifampicin * Dapsone * Clofazimine (if multibacliliary)

**_Tuberculosis and other Mycobacteria_** What are the key manifestations of Leprosy?

* **Skin** * ****Depigmentation, macules, plaques, nodules, trophic ulcers * **Nerves** * Thickened nerves, sensory neuropathy * **Eyes** * Keratinitis, Irdocyclitis * **Bones** * Periositis nasecptic necrosis

**_Tuberculosis and other Mycobacteria_** Outline the features of "Progressive" Primary TB

* Progressive primary * **Rarely**, focus or node ulcerates into bronchus * causing * pneumonia * cavity formation * bronchiectasis * consolidation * collapse

**_Tuberculosis and other Mycobacteria_** Outline the features of Miliary TB

* **Miliary TB:** * progressive, disseminated haematogenous spread with **rich foci**

**_Sexually transmitted Infections_** 1. _Which diseases present with:_ 1. discharge 2. ulceration 3. rashes, lumps/growths 2. _How do you distinguish genital ulcers?_

1. **TB CCG** _(Tuberculosis in a Clinical Comissioning group)_ 1. **__Candida=**"Cottage cheese" discharge 1. Vulvitis 2. itch 2. T**richomonas =** Offensive yellow/green, frothy discharge 1. Vulvoganginitis 2. Strawberry cervix 3. **Bacterial vaginosis=** Offensive, thin, white/grey, "fishy" discharge 2. **CHLD** 3. **GMPS** (Grumps, without the r or u)

**_Sexually transmitted Infections_** What are the features and main types of investigation of Syphilis?

Main types of Investigations: * Non Treponemal * Treponemal

**_Sexually transmitted Infections_** What are the features, diagnosis and treatment of Trichomoniasis?

**_Sexually transmitted Infections_** What are the features, diagnosis and treatment of Bacterial Vaginosis?

**_Sexually transmitted Infections_** What are the features, diagnosis and treatment of Candidiasis?

**_Sexually transmitted Infections_** What are the features, diagnosis and treatment of Molluscum contagious?

**_Sexually transmitted Infections_** What are the features, diagnosis and treatment of Genital warts?

**_Sexually transmitted Infections_** What are the main viral STI?

**_Sexually transmitted infections_** Outline the features of primary Syphilis

**_Sexually transmitted infections_** Outline the features of secondary syphilis

**_Sexually transmitted infections_** Outline the features of tertiary syphilis and latent syphilis

**_Sexually transmitted infections_** Outline the treatment of Syphilis

**_Sexually transmitted Infections_** What are the miscroscopic features, symptoms and diagnosis of Chancroid?

**_Sexually transmitted Infections_** What are the miscroscopic features, symptoms, diagnosis and treatment of Donovanosis?

**_Sexually transmitted Infections_** What are the enteric pathogens (oro/anal contact)?

**_Sexually transmitted infections_** What are the microscopic features, subtypes, complications and epidemiological features of Chlamydia?

**_Sexually transmitted infections_** What are the investigations and management options for Clamydia?

**_Sexually transmitted infections_** What are the microscopic features, investigations and treatment for Gonorrhoea?

**_Sexually transmitted infections_** What are the features of uncomplicated and complicated Gonorrhoea for men and women?

**_Sexually Transmitted Infections_** What are the microscopic features and classifications of Lympho Granuloma Venerum (LGV)?

* **Early LGV (first stage):** 3 - 12 days * **Early LVG (second stage):** 2-25 weeks * **Late LGV** * **Current LGV Outbreak**

**_Sexually Transmitted Infections_** What are the investigations and management for Lympho Granuloma Venerum (LGV)?

**_Sexually Transmitted Infections_** What are the Non Treponemal tests of Syphilis?

**_Sexually Transmitted Infections_** What are the Treponemal tests of Syphilis?

**_Sexually Transmitted Infections_** What are the features of Early LGV (first stage)?

**_Sexually Transmitted Infections_** What are the features of Early LGV (second stage)?

**_Sexually Transmitted Infections_** What are the features of Late LGV?

**_Sexually Transmitted Infections_** What are the features of Current LGV infection?

Microbiology (All Topics) Flashcards

(276 cards)