Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci*...

Year 2 Revision

* = best answer

These organisms are:

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1. Gram positive bacilli

2. Gram positive cocci*

3. Gram negative bacilli

4. Gram negative cocci

They are:

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1. Streptococci*

2. Staphylococci

3. Coliforms

4. Neisseria

These organisms are:

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1. Streptococci

2. Staphylococci

3. Coliforms*

4. Neisseria

Gastrointestinal infection

• A 21 year old medical student develops abdominal pain and diarrhoea 48 hours after eating a meal containing chicken and rice from a “dodgy” fast food shop. There is also blood the stool.

Which is the most likely infecting organism?

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1. Salmonella enteritidis

2. Campylobacter sp.*

3. E.coli O157

4. Shigella sonnei

Which treatment would you recommend?

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1. Metronidazole

2. Erythromycin

3. Ciprofloxacin

4. Symptomatic treatment only*

When would it be appropriate to prescribe an antibiotic?

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1. If the diarrhoea lasts longer than 1 week

2. If the patient has severe abdominal pain

3. If the patient's mother demands it

4. If there are signs of systemic illness*

What is the most likely vehicle of Campylobacter infection?

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1. Undercooked chicken*

2. Undercooked beef

3. Unpasteurised milk

4. Reheated rice

If the rice had been the vehicle of infection, which organism would you suspect?

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1. Clostridium perfringens

2. Staph aureus

3. Bacillus cereus*

4. E coli O157

When should the medical student return to his classes (which involve him examining

patients on the wards at Ninewells)?

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1. When the vomiting stops, even if he has mild diarrhoea

2. When all his symptoms have completely settled

3. 24 hours after his symptoms have settled

4. 48 hours after his symptoms have settled*

• An elderly lady on a care of the elderly ward develops diarrhoea 1 week after finishing a course of antibiotics for a chest infection

• No-one else on the ward has diarrhoea or vomiting

What is the most likely infecting organism?

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1. Clostridium difficile*

2. Salmonella typhimurium

3. Norovirus

4. Campylobacter sp.

Which antibiotic would you give?

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1. Ciprofloxacin

2. Vancomycin

3. Metronidazole*

4. No antibiotics

How should the antibiotic be given?

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1. Intravenously

2. Intramuscularly

3. Orally*

• A 20 year old student returns from his gap year travelling around the world with intermittent diarrhoea, abdominal discomfort and “bloating”. The organism shown is seen on microscopy of jejeunal aspirate

This organism is:

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1. A bacterium

2. A virus

3. A parasite*

4. A fungus

The recommended treatment is:

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1. Ciprofloxacin

2. Metronidazole*

3. Vancomycin

4. None

• A 30 year old male is admitted to hospital with jaundice and some R upper quadrant abdominal discomfort. His liver function tests show raised transaminases, but not an obstructive jaundice picture. Abdominal ultrasound rules out gallstones and liver abscesses. You suspect he may have infectious hepatitis.

• He visited India on business 1 month previously and this involved travel to rural areas

Which is the most likely cause?

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1. Hepatitis A*

2. Hepatitis B

3. Hepatitis C

4. Hepatitis E

By which route is this virus transmitted?

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1. Blood-blood spread

2. Direct contact

3. Faecal-oral route*

4. Vertical spread

What is the incubation period for Hepatitis A?

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1. 2 – 6 days

2. 2 – 6 weeks*

3. 2 – 6 months

Which viruses are NOT spread by the faecal oral route?

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1. Hepatitis A,B,C,D

2. Hepatitis B,C,D*

3. Hepatitis B,C,E

4. Hepatitis A,B,C,D

• A man who attends a hepatology out-patient clinic has Hepatitis B serology as follows: – HBsAg negative– HBsAb positive– HBcAb positive– (all other markers are negative)

These results mean:

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1. He has been immunised and is immune

2. He is a highly infectious carrier of Hep B

3. He is immune because he has had Hepatitis B in the past*

Which organisms make up bowel flora?

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1. Coliforms,enterococci,anaerobes*

2. Coliforms,streptococci,anaerobes

3. Coliforms,enterococci,aerobes

4. Coliforms,anaerobes

Which antibiotics are best for the

treatment of intra-abdominal sepsis?

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1. Cefuroxime and metronidazole

2. Cefuroxime,co-amoxiclav,metronidazole

3. Gentamicin and metronidazole

4. Amoxicillin,gentamicin,metronidazole*

Why are 3 antibiotics given?

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1. For their synergistic effect

2. To cover a wide range of organisms*

3. To prevent the development of resistance

Urinary tract infection

• A 30 year old female attends your GP complaining of dysuria and frequency for 2 days.

• Her urine dipstick test is positive for protein, leucocytes and nitrites and the organism shown is seen on urgent microscopy of her urine

What is the most likely infecting organism?

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1. Proteus sp.

2. Staph. saprophyticus

3. Escherichia coli*

4. Klebsiella sp.

Which antibiotic would you choose?

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1. Co-amoxiclav

2. Amoxicillin

3. Ciprofloxacin

4. Trimethoprim*

Which antibiotic would be suitable if the patient were penicillin

hypersensitive?

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1. Erythromycin

2. Trimethoprim*

3. Cefuroxime

4. Co-amoxclav

Where has the infection come from?

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1. Patient's own bacterial flora*

2. The normal bladder flora

3. Hands of nursing staff

4. From infected equipment

Which indicates a significant bacteriuia?

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1. 1,000 organisms per ml

2. 10,000 organisms per ml

3. 100,000 organisms per ml*

4. 1,000,000 organisms per ml

• A 45 year old man is admitted with fever acute onset severe R sided back pain and is thought clinically to have a kidney stone. This diagnosis is later confirmed by a imaging of his R kidney and ureter. Dipstick testing of his urine shows the presence of protein, blood leucocytes and nitrites and culture of urine confirms he has a UTI.

Which organism is particularly associated with renal calculi?

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1. Klebsiella sp.

2. Escherichia coli

3. Group B Streptococcus

4. Proteus sp.*

Which antibiotic treatment would you choose for this patient?

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1. Trimethoprim

2. Nitrofurantoin

3. Cephalexin

4. Amoxicillin and gentamicin*

• A 25 year old pregnant female attends for her first ante-natal appointment at hospital. She complains of no symptoms. A mid-stream specimen of urine is sent to the Microbiology lab and grows >105 organisms/ml of E. coli on culture.

Which of the following does she have?

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1. Urinary tract infection

2. Abacterial cystitis

3. Aymptomatic bacteriuria*

Should she receive antibiotic treatment?

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1. Yes*

2. No

3. Only if she develops symptoms of a UTI

Bone and Joint Infection

• A 60 year old previously healthy male is admitted to the orthopaedic ward with a fever and a hot swollen knee joint. You suspect he has septic arthritis and send a blood culture and an aspirate from the knee to Microbiology. The knee aspirate Gram film result is telephoned back to you as “Many polymorphs and a few Gram positive cocci in clusters seen”.

Which is the most likely infecting organism?

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1. Staphylococcus aureus*

2. Staphylococcus epidermidis

3. Streptococcus pneumoniae

4. Streptococcus pyogenes

Which antibiotic would you give?

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1. Penicillin

2. Flucloxacillin*

3. Vancomycin

4. Ciprofloxacin

How should the antibiotic be given initially?

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1. Orally

2. IV*

• A 78 year old man develops a hot swollen knee joint 12 weeks after a prosthetic joint has been inserted. You suspect infection in the prosthetic joint.

• Gram film of joint aspirate shows this organism

Which is the most likely infecting organism?

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1. Staphylococcus aureus

2. Staphylococcus epidermidis*

3. Streptococcus pneumoniae

4. Streptococcus pyogenes

Which antibiotic would you choose?

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1. Penicillin

2. Vancomycin*

3. Gentamicin

4. Flucloxacillin

Why are the coagulase negative Staphs particularly associated with infection in

prosthetic material?

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1. Because they produce toxins

2. Because they produce spores

3. Because they produce “slime”*

4. Because they are resistant to antibiotics

Respiratory

• An 80 year old male is admitted to hospital with a severe community-acquired pneumonia (CAP). The organism shown was seen on microscopy of sputum

Which is the likely infecting organism?

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1. Escherichia coli

2. Streptococcus pneumoniae*

3. Mycoplasma pneumoniae

4. Legionella pneumophila

Which is the best microbiology specimen to send in order to make this diagnosis?

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1. Blood culture*

2. Sputum*

3. Clotted blood for serology

4. Urine for antigen detection

Which antibiotic(s) would you use to treat severe CAP empirically?

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1. Amoxicillin

2. Co-amoxiclav and gentamicin

3. Co-amoxiclav and clarythromycin*

4. Clarythromycin and gentamicin

Why are 2 antibiotics given?

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1. For their synergistic effect

2. To cover a wide range of organisms*

3. To prevent the development of resistance

Which antibiotic would you choose if he is hypersensitive to penicillin?

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1. Gentamicin

2. Levofloxacin*

3. Erythromycin

4. Ciprofloxacin

Which is NOT an"atypical" pneumonia organism?

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1. Legionella pneumophila

2. Moraxella catarrhalis*

3. Mycoplasma pneumoniae

4. Chlamydia psittaci

• A 40 year old previously healthy female is admitted to hospital with a 3 day history of cough, fever and worsening shortness of breath.

• Her husband recently was diagnosed with influenza A and you suspect she now has it too

Which is the best specimen for rapid diagnosis?

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1. Throat swab*

2. Induced sputum specimen

3. Nasopharyngeal aspirate

4. Pernasal swab

Who should receive influenza vaccine?

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1. Healthy elderly patients

2. People with COPD

3. Patients with HIV

4. All of the above*

What do "H" and "N" stand for in H1N1?

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1. Haematinic and neurotoxin

2. Haemagglutinin and neuraminidase*

3. Hamolysin and neurotropic

• A 70 year old female has a 3 month history of chronic cough despite 2 courses of antibiotics, fever at night and has lost 10kg weight. You send sputum to the lab and the organism shown is seen on microscopy

What type of film is this?

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1. Gram film

2. Ziehl-Neelson film*

3. Haematoxylin and eosin

What is the name of the causal organism?

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1. Mycoplasma tuberculosis

2. Mycobacterium tuberculosis*

3. Mycobacterium tuberculi

4. Mycoplasma tuberculum

What is the best specimen for diagnosis?

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1. Blood culture

2. Sputum*

3. Throat swab

4. Early morning urine

Treatment of TB

• Having discussed this with colleagues, most patients now are started on 4 anti-TB drugs; rifampicin, isoniazid, pyrazinamide and ethambutol.

• (4for 2 followed by 4 for 4)

• Sorry for any confusion.

Why are 4 antibiotics given?

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1. For their synergistic effect

2. To cover a wide range of organisms

3. To prevent the development of resistance*