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

67
Year 2 Revision * = best answer

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

Page 1: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

Year 2 Revision

* = best answer

Page 2: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.
Page 3: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

These organisms are:

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1. Gram positive bacilli

2. Gram positive cocci*

3. Gram negative bacilli

4. Gram negative cocci

Page 4: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

They are:

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0% 0%0%0%

1. Streptococci*

2. Staphylococci

3. Coliforms

4. Neisseria

Page 5: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.
Page 6: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

These organisms are:

1 2 3 4

0% 0%0%0%

1. Streptococci

2. Staphylococci

3. Coliforms*

4. Neisseria

Page 7: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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.

Page 8: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

Which is the most likely infecting organism?

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1. Salmonella enteritidis

2. Campylobacter sp.*

3. E.coli O157

4. Shigella sonnei

Page 9: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

Which treatment would you recommend?

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1. Metronidazole

2. Erythromycin

3. Ciprofloxacin

4. Symptomatic treatment only*

Page 10: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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*

Page 11: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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

Page 12: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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

Page 13: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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*

Page 14: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

• 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

Page 15: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

What is the most likely infecting organism?

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1. Clostridium difficile*

2. Salmonella typhimurium

3. Norovirus

4. Campylobacter sp.

Page 16: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

Which antibiotic would you give?

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1. Ciprofloxacin

2. Vancomycin

3. Metronidazole*

4. No antibiotics

Page 17: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

How should the antibiotic be given?

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1. Intravenously

2. Intramuscularly

3. Orally*

Page 18: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

• 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

Page 19: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

This organism is:

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1. A bacterium

2. A virus

3. A parasite*

4. A fungus

Page 20: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

The recommended treatment is:

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1. Ciprofloxacin

2. Metronidazole*

3. Vancomycin

4. None

Page 21: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

• 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

Page 22: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

Which is the most likely cause?

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1. Hepatitis A*

2. Hepatitis B

3. Hepatitis C

4. Hepatitis E

Page 23: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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

Page 24: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

What is the incubation period for Hepatitis A?

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1. 2 – 6 days

2. 2 – 6 weeks*

3. 2 – 6 months

Page 25: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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

Page 26: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

• 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)

Page 27: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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*

Page 28: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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

Page 29: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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*

Page 30: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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

Page 31: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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

Page 32: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

What is the most likely infecting organism?

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1. Proteus sp.

2. Staph. saprophyticus

3. Escherichia coli*

4. Klebsiella sp.

Page 33: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

Which antibiotic would you choose?

1 2 3 4

0% 0%0%0%

1. Co-amoxiclav

2. Amoxicillin

3. Ciprofloxacin

4. Trimethoprim*

Page 34: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

Which antibiotic would be suitable if the patient were penicillin

hypersensitive?

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0% 0%0%0%

1. Erythromycin

2. Trimethoprim*

3. Cefuroxime

4. Co-amoxclav

Page 35: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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

Page 36: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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

Page 37: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

• 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.

Page 38: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

Which organism is particularly associated with renal calculi?

1 2 3 4

0% 0%0%0%

1. Klebsiella sp.

2. Escherichia coli

3. Group B Streptococcus

4. Proteus sp.*

Page 39: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

Which antibiotic treatment would you choose for this patient?

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1. Trimethoprim

2. Nitrofurantoin

3. Cephalexin

4. Amoxicillin and gentamicin*

Page 40: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

• 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.

Page 41: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

Which of the following does she have?

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1. Urinary tract infection

2. Abacterial cystitis

3. Aymptomatic bacteriuria*

Page 42: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

Should she receive antibiotic treatment?

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1. Yes*

2. No

3. Only if she develops symptoms of a UTI

Page 43: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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”.

Page 44: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

Which is the most likely infecting organism?

1 2 3 4

0% 0%0%0%

1. Staphylococcus aureus*

2. Staphylococcus epidermidis

3. Streptococcus pneumoniae

4. Streptococcus pyogenes

Page 45: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

Which antibiotic would you give?

1 2 3 4

0% 0%0%0%

1. Penicillin

2. Flucloxacillin*

3. Vancomycin

4. Ciprofloxacin

Page 46: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

How should the antibiotic be given initially?

1 2

0%0%

1. Orally

2. IV*

Page 47: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

• 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

Page 48: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

Which is the most likely infecting organism?

1 2 3 4

0% 0%0%0%

1. Staphylococcus aureus

2. Staphylococcus epidermidis*

3. Streptococcus pneumoniae

4. Streptococcus pyogenes

Page 49: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

Which antibiotic would you choose?

1 2 3 4

0% 0%0%0%

1. Penicillin

2. Vancomycin*

3. Gentamicin

4. Flucloxacillin

Page 50: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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

Page 51: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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

Page 52: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

Which is the likely infecting organism?

1 2 3 4

0% 0%0%0%

1. Escherichia coli

2. Streptococcus pneumoniae*

3. Mycoplasma pneumoniae

4. Legionella pneumophila

Page 53: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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

1 2 3 4

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1. Blood culture*

2. Sputum*

3. Clotted blood for serology

4. Urine for antigen detection

Page 54: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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

1 2 3 4

0% 0%0%0%

1. Amoxicillin

2. Co-amoxiclav and gentamicin

3. Co-amoxiclav and clarythromycin*

4. Clarythromycin and gentamicin

Page 55: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

Why are 2 antibiotics given?

1 2 3

0% 0%0%

1. For their synergistic effect

2. To cover a wide range of organisms*

3. To prevent the development of resistance

Page 56: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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

1 2 3 4

0% 0%0%0%

1. Gentamicin

2. Levofloxacin*

3. Erythromycin

4. Ciprofloxacin

Page 57: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

Which is NOT an"atypical" pneumonia organism?

1 2 3 4

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1. Legionella pneumophila

2. Moraxella catarrhalis*

3. Mycoplasma pneumoniae

4. Chlamydia psittaci

Page 58: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

• 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

Page 59: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

Which is the best specimen for rapid diagnosis?

1 2 3 4

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1. Throat swab*

2. Induced sputum specimen

3. Nasopharyngeal aspirate

4. Pernasal swab

Page 60: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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*

Page 61: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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

1 2 3

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1. Haematinic and neurotoxin

2. Haemagglutinin and neuraminidase*

3. Hamolysin and neurotropic

Page 62: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

• 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

Page 63: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

What type of film is this?

1 2 3

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1. Gram film

2. Ziehl-Neelson film*

3. Haematoxylin and eosin

Page 64: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

What is the name of the causal organism?

1 2 3 4

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1. Mycoplasma tuberculosis

2. Mycobacterium tuberculosis*

3. Mycobacterium tuberculi

4. Mycoplasma tuberculum

Page 65: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

What is the best specimen for diagnosis?

1 2 3 4

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1. Blood culture

2. Sputum*

3. Throat swab

4. Early morning urine

Page 66: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

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.

Page 67: Year 2 Revision * = best answer. These organisms are: 1.Gram positive bacilli 2.Gram positive cocci* 3.Gram negative bacilli 4.Gram negative cocci.

Why are 4 antibiotics given?

1 2 3

0% 0%0%

1. For their synergistic effect

2. To cover a wide range of organisms

3. To prevent the development of resistance*