microbiology/ID

Question 1

What is the first line abx for c.diff infection without sepsis? What is second line abx?

Answer 1

Oral vancomycin is the first line treatment option for C. difficile. A 10-day course is recommended. Intravenous metronidazole would be added if there was a life-threatening infection
Oral fidaxomicin is a second line therapy for C difficile infection. It may also be used for recurrent C. difficile cases.

Question 2

What abx are used in pregnancy for UTI? how long?

Answer 2

first-line: nitrofurantoin (should be avoided in third trimester)
second-line: amoxicillin or cefalexin

Need 7 day course

Question 3

What is first line abx for meningitis and what do you add in if elderly/ immunocomp?

Answer 3

IV cefotaxime (first line)

IV amoxicillin is reserved for scenarios where there is suspicion of Listeria monocytogenes

Question 4

First line abx for non-dessimated lyme diseae and length of course? Second line? In dessimated disease?

Answer 4

First line treatment of non-disseminated Lyme disease is a 21 day course of oral doxycycline,

Amoxicillin is 2 nd line

Ceftriaxone is used in disseminated disease.

Treatment should be started based on clinical suspicion as serology can take 3-8 weeks to become positive.

Question 5

What is the most common cause of bronchiectasis exacerbations?

Answer 5

Haemophilus influenzae

Question 6

What are the features of discitis? What is the most common causitive agent?

Answer 6

back pain
fever/ gen unwell
neurological features

Most common agent is bacterial (S.aureus)

Question 7

What is used as prophylaxis for contacts of patients with meningococcal meningitis?

Answer 7

Oral ciprofloxacin or rifampicin

Question 8

How do you treat latent TB? What is it?

Answer 8

Latent TB - asymptomatic and non-infectious. Have a positive tuberculin skin test/ Interferon-Gamma Release Assay (IGRA) combined with a normal CXR (can have calcified ghon complex)

3 months of isoniazid (with pyridoxine) and rifampicin, or
6 months of isoniazid (with pyridoxine)

Question 9

1st line vs 2nd line abx for lyme disease?

Answer 9

1st line - doxycycline
2nd line - amoxicillin

Question 10

management of Campylobacter jejuni?

Answer 10

usually self-limiting
the BNF advises treatment if severe or the patient is immunocompromised eg high fever, bloody diarrhoea, >8 stools a day or sx lasted >7 days
1st line = clarithromycin

Question 11

What are the most common micro organisms responsible for otitis media?

Answer 11

Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis

Question 12

1st line abx for msra?

Answer 12

vancomycin

Question 13

microorganism responsible for epiglottitis?

Answer 13

Hib - haemophilus influenza b

Question 14

What is diptheria?

Answer 14

Diphtheria is a bacterial infection caused by Corynebacterium diphtheriae which primarily infects the throat and upper airways, leading to difficulty in breathing and swallowing. A grey coating surrounding the tonsils, fever, and cervical lymphadenopathy are classic symptoms of this disease

Question 15

What is dengue fever?

Answer 15

viral illness
transmitted via mosquitoes
high fever, headache, pain behind the eyes, joint pain, rash, mild bleeding.

Question 16

What is typhoid/ paratyphoid? (enteric fever)

Answer 16

caused by different strains of Salmonella. Typhoid and Paratyphoid fevers present with prolonged high-grade fever associated with relative bradycardia, malaise, headache, cough, constipation, rose spots

Question 17

What is the most common causitive agent of COPD exacerbation

Answer 17

Haemophilus influenzae

Question 18

Mycoplasma pneumonia presentation?

Answer 18

Stereotypical history of mycoplasma pneumonia: worsening flu-like symptoms and a dry cough. Erythema multiforme is associated

Question 19

Legionella presentation?

Answer 19

Classic exam q - pick up on holidy via A/C
lymphopaenia
hyponatraemia
pleural effusion

Question 20

What commonly causes pneumonia post influenza?

Answer 20

Staphylococcus aureus

Question 21

Treatment can vary

What protozoan infections are associated with cat litter? Mx of this?

Answer 21

Toxoplasma gondii
Immunocompetent patients with toxoplasmosis don’t usually require treatment
metronidazole if immunocomp

Question 22

What features would you expect from campylobacter infection? mx of this?

Answer 22

Campylobacter infection is the most common bacterial cause of infectious intestinal disease in the UK. Typically have prodrome and bloody diarrhoea. The incubation period for Campylobacter is 1-6 days
Associated with bbqs
Campylobacter can mimic appendicitis

clarithromycin

Question 23

What GI infection causes fat malabsorption (greasy stools)?

Answer 23

giargia

Question 24

What causes infectious mono?

Answer 24

AKA glandular fever is caused by EBV

Question 25

Which malarial prophylaxis can cause neuropsychiatric issues?

Answer 25

Mefloquine

Question 26

What is used as a prophylactic abx in recurrent COPDE?

Answer 26

azithromycin

Question 27

Mx of legionella?

Answer 27

Macrolides such as clarithromycin are used to treat Legionella

Question 28

What is the abx of choice for pregnant women if they are penicillin allergic and being treated for eg cellulitis

Answer 28

Erythromycin is the antibiotic of choice for cellulitis in pregnancy if the patient is penicillin allergic CLarithromycin is CI!!!

Question 29

How does leptospirosis infection present?

Answer 29

AKA weils disease presents with fever, headache, chills, muscle aches and vomiting. It can also cause jaundice and AKI. It is associated with exposure to contaminated water or soil eg sewage worker, fisherman

Question 30

What is in co-trimaxazole?

Answer 30

Co-trimoxazole contins trimethoprim and therefore should never be prescribed with methotrexate used for Pneumocystis jiroveci pneumonia (PCP) - which is a fungal infection

Question 31

abx for shigella and salmonella?

Answer 31

ciprofloxacin

Question 32

Which gastrointestinal infection has the shorted incubation period?

Answer 32

staph aureus

Question 33

Characterisitics of shigella infection?

Answer 33

Salmonella enteritidis has an incubation period of 12 - 48 hours and is usually associated with severe vomiting and a high fever. It can cause bloody diarrhoea.

Question 34

What anitbodies are found for EBV on bloods?

Answer 34

heterophile antibodies

Question 35

What are the different SE of TB meds?

Answer 35

Rifampicin potent liver enzyme inducer hepatitis, orange secretions flu-like symptoms Isoniazid peripheral neuropathy: prevent with pyridoxine (Vitamin B6) hepatitis, agranulocytosis liver enzyme inhibitor Pyrazinamide hyperuricaemia causing gout arthralgia, myalgia hepatitis Ethambutol optic neuritis: check visual acuity before and during treatment dose needs adjusting in patients with renal impairment

Question 36

Features of malaria?

Answer 36

hepatospleenomegaly, jaundice, fever, low platelets

Question 37

What is chagos?

Answer 37

From the Americas from redulivid bugs get sx 10-20 yrs later: irregular HR, HF, cardiac arrest, can't swallow as oeseophagus enlarges, enlagred colon

Question 38

What is yellow fever?

Answer 38

Carried by mosquito in Africa and South america fever, muscle pain, N+V for 3 days slow pulse with elevated temp = fagets sign

Question 39

AIDs defining illnes?

Answer 39

Invasive cervical cancer Kaposi sarcoma Lymphoma: Burkitt Mycobacterial infections eg TB Recurrent bacterial pneumonia HIV-associated dementia coccidioidomycosis Pneumocystis jirovecil pneumonia (PCP) !!! histoplasmosis Cerebral toxoplasmosis Extrapulmonary cryptococcosis (especially cryptococcal meningitis) Cryptosporidiosis Esophageal candidiasis Herpes simplex virus causing any of the following: ulcer for >1m, bronchitis, pneumonitis, oeseophagitis Mycobacterium avium complex Cytomegalovirus infection of any of the following: retina/ colon, Any other organ, excluding the liver, spleen, or lymph nodes

Question 40

How does schistosomiasis present?

Answer 40

fever, flu sx, rash, cough, hepatosplenomegaly, in africa caused by flukes years later can cause cystitis, blood diarrhoea, lower limb paralysis

Question 41

What is onchocerciasis?

Answer 41

in subsaharan africa/ south america parasite causes blindness, skin changes, nodules, lichenification of skin

Question 42

notifiable diseases?

Answer 42

acute encephalitis Routine Acute infectious hepatitis (A/B/C) Urgent Acute meningitis Urgent Acute poliomyelitis Urgent Anthrax Urgent Botulism Urgent Brucellosis Routine. Urgent if acquired in UK Cholera Urgent COVID-19 Routine Diphtheria Urgent Enteric fever (typhoid or paratyphoid fever) Urgent Food poisoning Routine. Urgent if part of a cluster or outbreak Haemolytic uraemic syndrome (HUS) Urgent Infectious bloody diarrhoea Urgent Invasive group A streptococcal disease Urgent Legionnaires’ disease Urgent Leprosy Routine Malaria Routine. Urgent if acquired in UK Measles Urgent Meningococcal septicaemia Urgent Mpox (previously known as monkeypox) Urgent Mumps Routine Plague Urgent Rabies Urgent Rubella Routine Severe Acute Respiratory Syndrome (SARS) Urgent Scarlet fever Routine Smallpox Urgent Tetanus Routine. Urgent if associated with injecting drug use Tuberculosis Routine. Urgent if healthcare worker, or suspected cluster or multi-drug resistant Typhus Routine Viral haemorrhagic fever (VHF) Urgent Whooping cough Urgent if diagnosed in acute phase. Routine in later diagnosis Yellow fever

Question 43

Dengue?

Answer 43

A mosquito-borne tropical disease that causes fever, arthralgias, and headache. Onset of symptoms occurs 2 to 10 days after infection. A hemorrhagic phase characterized by bleeding, shock, and organ dysfunction can follow the initial phase. Treatment is largely supportive.

Question 44

Japanese encephalitis?

Answer 44

mosquito-borne viral disease endemic in Asia and the Western Pacific. range from asymptomatic disease to acute encephalitis/ neurological features, following a short period of non-specific febrile illness. Seizures are common, especially in children. acute psychosis and spastic or flaccid paralysis.

Question 45

Lassa?

Answer 45

A viral hemorrhagic fever caused by Lassa virus. Most cases are mild and cause fever, malaise, and headache. Can cause pharyngitis, cough, retrosternal chest pain, and severe bleeding. Deafness is a common complication.

Question 46

classical exam question features of strep pneumoniae?

Answer 46

rust coloured sputum lobular pneumonia

Question 47

What is tamiflu drug name?

Answer 47

oseltamivir

Question 48

Cause of gas gangrene?

Answer 48

There are multiple causes of gas gangrene but often clostrida species, particularly clostridium perfringens are implicated

Question 49

56 year old hill walker, rash, then bilateral wrist arthritis, other wise well ?cause

Answer 49

lymes disease