4/2 micro Flashcards
(168 cards)
1
Q
Give HIV + mother what drug to prevent vertical transmission?
A
Zidovudine.
2
Q
Where is pH the lowest in the nephron?
A
DCT & collecting duct
3
Q
Hypertrphic cardiomyopathy
- what type of murmur?
- heard best where?
A
- Systolic due to LVOT obstruction.
- left sternal border.
4
Q
Aortic regurg murmur
-heard best where?
A
left sternal border.
5
Q
Aortic stenosis
-heard best where?
A
Aortic area
-right sternal border, 2nd intercostal space.
6
Q
Uremia: -PTT? -PT? -BT? whats the problem here?
A
- qualitative platelet problem.
- BT increased, everything else is normal.
7
Q
Pt. w/ESRD, dialysis catheter placed into IJ, and bleeding occurs around catheter site.
- whats the problem?
- abnormal test values?
A
ESRD => uremia => qualitative platelet problem.
- inc. BT.
- everything else is normal.
8
Q
Ehlers Danlos
-defect is in which protein?
A
Type 3 collagen defect.
9
Q
HMP shunt
-where does it occur?
A
cytoplasm
10
Q
HMP shunt
-primary enzymes involved in non-oxidative steps?
A
transaldolase & transketolase.
*transketolase req. thiamine as cofactor.
11
Q
All cells can synthesize ribose from which glycolysis intermediates w/help of transketolase & transaldolase?
A
F-6-P, G-3-P.
-they can do this even if oxidative reactions in HMP shunt not active in these cells.
12
Q
Where is collagen triple helix formed?
A
ER
13
Q
Which steps of collagen synth happen outside the cell?
A
Terminal propeptide removal, covalent cross links via lysyl oxidase.
*after propeptide removal, its called tropocollagen.
14
Q
Lysyl oxidase
- what does it do?
- what cofactor does it need?
A
Cross links collagen molecules in extracellular space.
-copper.
15
Q
Osteogenesis imperfecta
- which step of collagen synth is faulty?
- where does this step occur?
A
- formation of the triple helix.
- ER.
16
Q
Which quadrant of your ass should you not give injections so you dont damage sup. gluteal nerve?
A
superomedial.
17
Q
Which quadrants of your ass should you not inject so you dont damage sciatic n?
A
supermedial, inferomedial, inferolatera.
-basically everywhere except superolateral.
18
Q
Rash + post-auricular lymphadenopathy:
A
Rubella
19
Q
Congenital rubella
-Sxs:
A
PDA, cataracts, sensoneural deafness
20
Q
Paramyxoviruses
-why do you see multinucleated cells?
A
-All contain surface F (fusion) protein, which causes respiratory epithelial cells to fuse and form multinucleated cells.
21
Q
Palivizumab
- whats it do?
- whats it treat?
A
Palivizumab = mab against F protein.
- prevents pneumonia caused by RSV infection in premature infants.
- dont forget all paramyxoviridae have surface F-protein which causes resp. epithelial cells to fuse & form multinucleated cells.
22
Q
Measles
-is it blanchable?
A
yes
23
Q
measles
-do koplik spots occur before or after the rash?
A
Before
24
Q
Measles pts
-which vitamin will you give them?
A
vitamin A.
25
Measles
- Sxs before the rash?
- mnemonic?
3 Cs
- cough, coryza, conjuncitivits
* & koplik spots.
26
Pregnant mother w/measles
| -what can happen to baby?
No birth defects but can cause fetal death in 20% of cases.
27
Measles rash vs Rubella rash
| -which includes the limbs?
Measles
28
Mumps
- Sxs?
- mnemonic?
* what other Sx?
Mumps makes your parotid glands and testes as
big as POM-poms.
-Parotitis, Orchitis, & aseptic Meningitis. Can cause
sterility (especially after puberty).
*pancreatitis.
29
Mumps
| -one or both parotid glands affected?
-one or both.
30
Mumps pt. w/elevated serum lipase.
| -whats the problem?
Mumps can cause pancreatitis.
- serum amylase & lipase will be inc.
- parotids & pancreas both contribute to elevated amylase.
31
Negri body
- which disease
- what is it?
- where are they commonly found? which tissue?
Rabies
- site of viral assembly.
- Purkinje cells of cerebellum and in hippocampal neurons (both areas that are susceptible to ischemia).
32
Rabies
| -post-exposure Tx:
Wound cleansing and vaccination ± rabies immune globulin.
33
How does rabies virus get to CNS?
- where does it initially enter neurons?
- where does it reside?
Initially binds to nicotinic receptors at NMJ.
- travels retrograde up axon to neuron cell body.
- resides in salivary glands.
34
Common food associated w/HAV?
Shellfish.
35
HBV
| -what type of replicative intermediate does it have?
ssRNA
- starts w/partial, circular dsDNA.
- repaired in nucleus.
- (+) sense RNA made in nucleus, sent to cytoplasm.
- in cytoplasm, capsid made, and in capsid, the RNA => circular, partial dsDNA via its reverse transcriptase.
36
HBV
| -incubation period?
45-180 days.
37
After active viral replication has stopped, is there still inc. risk of HCC?
- in HBV:
- in HCV:
- yes in HBV - integrates into host genome.
| - no in HCV. - chronic inflammation led to inc. risk of HCC, so once infection contained, no more chronic inflam.
38
Most common outcome of HBV infection in adults (95%) =
-acute hepatitis w/mild or subclinical Sxs that eventually completely resolves.
39
HBV
| -what causes the hepatocyte damage?
Damage is caused by the CD8 Tcell response to the viral Ags on the cell surface.
40
post transfusion hepatitis
| -which one?
HCV
41
Which one usually goes chronic?
- hepB
- hepC
hepC goes chronic 80% of the time.
42
hepB
| -what will hepatocyte look like in histology?
Hepatocyte cytoplasm becomes full of HBsAg,
| will look like "ground glass".
43
anti-HCV IgG
| -is it protective?
NO
| *getting a "C" in school wont protect you from getting your ass beat. A "B" will though.
44
IV drug abusers w/acute viral hepatitis = which hep?
Most likely HCV.
45
which hep can cause cryoglobulin formation?
hepC.
46
HepD
- what is a superinfection?
- what is a co-infection?
* which one is more severe?
- Superinfection (HDV after HBV)—short
- Co-infection (HDV with HBV)—long
* superinfection = more severe.
47
HBV
| -whats special about the enzyme it carries with it?
The DNA pol. has both DNA and RNA-dependent activities. Upon entry into the nucleus, the polymerase completes the partial dsDNA. The host RNA polymerase transcribes mRNA from viral DNA to make viral proteins. The DNA polymerase then reverse transcribes viral RNA to DNA, which helps form new viral particles.
48
Anti-HAV (IgG)
| -is it protective?
yes
49
HIV
| -genome?
Diploid genome (2 molecules of RNA).
50
The 3 structural genes of HIV:
| -name them
gag, env, pol.
51
HIV: env gene (envelope)
- what proteins does it code for?
- what do these proteins do?
-env => gp120 and gp41 (envelope proteins).
* remember, envelope = most outer layer of virus. The part that interacts w/target cell.
- Formed from cleavage of gp160.
- gp120—attachment to host CD4+ T cell.
- gp41—fusion and entry.
52
HIV: gp120
- what gene codes for it?
- whats its protein product?
- env (envelope).
| - attachment to host CD4+ T cell.
53
HIV: gag gene
- what proteins does it code for?
- what do these proteins do?
-p24—capsid protein
54
HIV: gp41
- what gene codes for it?
- whats its protein product?
- drugs that bind it are what type of drugs?
- env (envelope)
- fusion and entry.
- drugs that bind gp41 = fusion inhibitors ie. enfuvirtide.
*Forty one = Fusion.
55
Env gene mutations: allow what?
Enable escape from host neutralizing Abs.
56
HIV: pol gene
- what proteins does it code for?
- what do these proteins do?
-reverse transcriptase, aspartate protease, integrase.
57
HIV
- binds what receptors on CD4 cells?
- binds what receptors on macros?
- CD4 + CCR5 (early) or CXCR4 (late) on T cells.
| - CCR5 and CD4 on macrophages.
58
Homogenous mutation in which gene provides immunity against HIV?
Homozygous CCR5 mutation = immunity.
59
HIV:Dx
- whats the sensitive screening test?
- whats this test typically looking for?
- ELISA
* the "rule out" test.
* ELISA is typically looking for Abs to p24 (capsid protein whos Abs show up early).
60
HIV:Dx
| -after a positive screen, whats the specific test?
- Western blot.
| * the "rule in" test.
61
Criteria for AIDS Dx:
- ≤ 200 CD4+ cells/mm3.
- HIV-positive with AIDS-defining condition.
- CD4 percentage < 14%.
62
Normal ratio of CD4:CD8?
normal ratio of CD4:CD8 = 2:1
63
ELISA/Western blot
- what do they look for?
- when are they usually not reliable? which periods?
- Both look for Abs to viral proteins
- These tests often are falsely negative in the first 1–2 months of HIV infection and falsely positive initially in babies born to infected mothers (anti-gp120 crosses placenta).
64
Relationship btwn CD4 count & HIV RNA conc. in plasma:
The CD4 count and HIV RNA count are directly inversely proportional.
65
CD4+ < 100 cells/mm3
- fevers, cough, hepatosplenomegaly, tongue ulcer.
- which bug?
Histoplasma capsulatum
66
Candida
- oral thrush @ what CD4 count?
- Esophageal candida @ what CD4 count?
- oral if CD4+ < 400 cells/mm3
- esophageal if CD4+ < 100 cells/mm3
*200 & less Sxs = AIDS defining.
67
Is oral thrush an AIDS defining lesion?
No
- happens when CD4+ < 400 cells/mm3.
- need sub 200 for AIDS defining lesion.
68
Cryptosporidium diarrhea
- @ what CD4 count?
- is it AIDS defining?
< 200 cells/mm3
| -yes it is.
69
Toxoplasma gondii: CNS assualt
- @ what CD4 count?
- is it AIDS defining?
< 100 cells/mm3.
| -yes.
70
JC virus reactivation (cause of PML)
- @ what CD4 count?
- is it AIDS defining?
< 200 cells/mm3
| -yes
71
Cryptococcus neoformans: meningitis
- @ what CD4 count?
- is it AIDS defining?
< 50 cells/mm3
| -yes
72
CMV: retinitis +/- esophagitis, interstitial pneumona.
- @ what CD4 count?
- is it AIDS defining?
< 50 cells/mm3
| -yes
73
Why do cancers show up when CD4 count drops in HIV pts?
- lot of these cancers caused by viruses that are typically being suppressed by the immune system.
- ie. EBV, HPV, HHV-8.
74
Pneumocystis jirovecii
- @ what CD4 count?
- is it AIDS defining?
< 200 cells/mm3
| -yes
75
HIV: > 200 cells/mm3
| -pnuemonia: most common cause?
S. pneumoniae
| -bc the count is still above 200!
76
Mycobacterium avium–intracellulare
- @ what CD4 count?
- is it AIDS defining?
< 50 cells/mm3
| -yes
77
Which problems show up at CD4 count < 50 cells/mm3?
- Mycobacterium avium–intracellulare
- CMV: retinitis +/- esophagitis, interstitial pneumona.
- Cryptococcus neoformans: meningitis
78
Inherited prioin disease =
Gerstmann-Sträussler-Scheinker
79
- normal flora of vagina?
| - what colonizes it?
- normal flora = Lactobacillus.
| - colonized by E. coli and group B strep.
80
Vibrio parahaemolyticus.
This organism is a marine bacterium that causes gastroenteritis after ingestion of uncooked seafood (sushi). This organism is the leading cause of diarrhea in Japan.
81
V. vulnificusa
This organism is a marine bacterium that causes gastroenteritis after ingestion of uncooked seafood (sushi). This organism is the leading cause of diarrhea in Japan.
-V. vulnificus can also cause wound infections from contact with contaminated water or shellfish.
82
pericardial knock
- when is it heard?
- heard in what type of pericarditis?
- shortly after S2.
| - constrictive (chronic) pericarditis.
83
PPIs
| -induce or inhibit P450 system?
inhibit.
84
"floppy baby", enlarged tongue, umbilical hernia, hypotonia.
| -whats the baby got?
congenital hypothyroidism.
85
Where is PDA murmur best heard?
-left infaclavicular region.
86
Pt is on niacin: will they have to:
- inc or dec. anti-HTN meds?
- inc or dec. DM meds?
- dec. HTN meds bc niacin causes vasodilation via prostaglandins.
- inc. DM meds bc niacin causes insulin resistance (can cause acanthosis nigricans).
87
Which part of duodenum is NOT retroperitoneal?
Only the first part.
88
Base Excision Repair
- order?
- mnemonic?
Get Every Little Detail, Lisa.
- glycosylase
- endonuclease
- lyase
- dna pol
- ligase
89
Why dont varicose veins commonly lead to thromboembolism/PE?
B/c these are superficial veins.
- yes there is inc. risk of superficial thrombosis, but PEs are from deep vein thromboses.
- ulcers are much more common.
90
Auer rods
| -seen in which disease?
AML
91
Thiamine
| -cofactor for which enzymes?
- Pyruvate DH
- alpha-KG-DH
- branched chain ketoacid DH
- transketolase.
92
Rate limiting step in TCA?
isocitrate DH
93
CSF finding in bacterial meningitis:
- glucose:
- protein:
- cells:
- opening pressure:
- dec. glucose.
- inc. protein.
- neutros
- inc. opening pressure
94
CSF finding in fungal meningitis:
- glucose:
- protein:
- cells:
- opening pressure:
- dec. glucose.
- inc. protein.
- inc lymphocytes
- inc. opening pressure
95
CSF finding in viral meningitis:
- glucose:
- protein:
- cells:
- opening pressure:
- normal glucose
- normal/inc protein
- inc. lymphocytes
- normal opening pressure
96
Osteomyelitis: diabetics and IV drug users
| -which bug?
Pseudomonas aeruginosa, Serratia
97
Osteomyelitis: Prosthetic joint replacement
| -which bug?
S. aureus and S. epidermidis
98
Osteomyelitis: Cat and dog bites
| -which bug?
Pasteurella multocida = gram negative rod.
99
Osteomyelitis: hematogenous spread
| -most common location in children:
metaphysis
100
Osteomyelitis: hematogenous spread
| -most common location in adults:
epiphysis or vertebral body.
101
sequestrum =
-dead piece of bone. With chronicity, a shell of reactive new bone, called involucrum, is formed around the dead bone.
102
Osteomyelitis
| -what type of necrosis?
liquefactive
103
UTI
| -nitrite (+): what does this tell you?
gram (-) bacterial UTI.
104
UTI
| -leukocyte esterase (+): what does this tell you?
bacterial UTI.
105
Big bug produces a red pigment?
serratia
106
"swarming" on agar plate
- what buy?
- why "swarming"?
Proteus bc its so motile.
107
What are non-specific findings in congenital infections? (ToRCHeS)
-hepatosplenomegaly, jaundice, thrombocytopenia, and growth retardation.
108
Congenital CMV
| -SXs:
Hearing loss, seizures, petechial rash, “blueberry muffin” rash.
*seizures = important.
109
Congenital HIV
| -SXs:
Recurrent infections, chronic diarrhea.
| -oral thrush, interstitial pneumonia, severe lymphopenia.
110
Congenital HSV-2
Encephalitis, herpetic (vesicular) lesions.
| *interesting bc HSV-1 causes the encephalitis in adults. Here its the HSV-2.
111
Congenital syphillis:
- Often results in stillbirth, hydrops fetalis
- if child survives, presents with facial abnormalities(notched teeth, saddle nose, short
maxilla) , saber shins, CN VIII deafness.
112
Vesicular rash on palms and soles; vesicles and ulcers in oral mucosa.
- whats this disease called?
- what causes it?
- Hand-foot-mouth disease
| - Coxsackievirus type A
113
A macular rash over body appears after several days of high fever. Can have febrile seizure.
- whats disease called?
- what causes it?
- Roseola
| - HHV-6
114
rubeola
| -aka?
measles
115
fifth disease
- aka?
- caused by?
- Erythema infectiosum.
| - parvovirus B19.
116
Fine truncal rash; postauricular lymphadenopathy.
| -cause?
Rubella.
117
The most common neoplasms seen in association with AIDS:
B cell non-Hodgkin lymphoma and Kaposi sarcoma.
118
PID
- which bug often caused subacute/undiagnosed PID?
- which bug causes acute PID thats often diagnosed?
- Chlamydia = subacute, goes undiagnosed.
| - Gonorrhea = acute, gets diagnosed.
119
Cervical motion tenderness + purulent cervical discharge.
| -sign of what?
PID
120
Nosocomial hyperalimentation can lead to what infection?
Candida albicans.
121
Which viruses are found in newborn nurseries?
CMV, RSV.
122
Nosocomial wound infection
| -most common cause?
S. aureus.
123
Work in renal dialysis unit
| -which bug are you exposed to?
HBV
124
Respiratory therapy equipment
| -associated w/which bug?
Pseudomonas aeruginosa
125
H. influenzae type B
| -can it also cause epiglottitis in immunized children?
yes!
126
Health care provider
| -which bug:
HBV (from needle stick).
127
Neutropenic patients
| -which bug?
Candida albicans (systemic), Aspergillus
128
Organ transplant recipient
| -which bug?
CMV
129
Pediatric infection
| -which bug?
Haemophilus influenzae (including epiglottitis)
130
Pus, empyema, abscess
| -which bug?
S. aureus
131
Sepsis/meningitis in newborn
| -which bug?
Group B strep
132
Traumatic open wound
| -which bug?
Clostridium perfringens
133
Anencephaly
| -risk factor?
maternal DM 1.
134
ubiquitin-proteasome system impairment can lead to which neuro diseases?
Neurodegen. diseases
| -ie. parkinsons & alzheimers.
135
Topo1 v topo2: which one makes ds breaks?
-topo2: 2 = 2 breaks.
136
tensor tympani
| -innervation?
V3
137
Reliability
| -aka?
precision, reproducibility.
138
which cells synthesize hepcidin?
hepatocytes
139
Spontaneous reaction
- delta G = +/-?
- Keq = >/< 1?
- delta G = (-)
| - Keq = > 1
140
Serotonin syndrome
| -Tx:
cyproheptadine
| -
141
How does rheumatic fever cause a murmur?
| -and which murmur?
Myocarditis may produce cardiac dilation that can evolve into functional mitral regurg.
142
Fatigue & new onset cardiac murmur in a young adult.
| -most common cause?
bacterial endocarditis
143
How are osteocytes connected to each other?
gap junctions
144
What part of the l.node are T cells?
paracortex
145
What part of l.node are B cells?
cortex
| BC: B cells, Cortex.
146
SVC syndrome w/no horners & no shoulder pain:
mediastinal mass
| -not pancoast tumor.
147
ataxia telangiectasia
| -which part of the brain will undergo atrophy?
cerebellum
148
Leads w/Q waves: V1-V4
- wheres the infarct?
- which vessel?
anterior wall
| -LAD
149
Leads w/Q waves: V1-V2
- wheres the infarct?
- which vessel?
anteroseptal
| -LAD
150
Leads w/Q waves: V4-V6
- wheres the infarct?
- which vessel?
anterolateral
| -LAD or LCX
151
Leads w/Q waves: I, aVL
- wheres the infarct?
- which vessel?
later wall
- LCX
* LCX = left circumflex from LCA
152
Leads w/Q waves: II, III, aVF
- wheres the infarct?
- which vessel?
inferior wall
| -RCA
153
anocutaneous reflex
| -which nerves?
S2-S4
154
Saddle anesthesia
| -damage to which nerves?
S3-S5
155
Only cell wall inhibitor thats not a lactam?
vanco
156
PCN
| -mechanism?
- Block transpeptidase cross-linking of peptidoglycan.
| - Activate autolytic enzymes.
157
PCN
| -s/e:
-Hypersensitivity reactions, hemolytic anemia.
158
amoxicillin v ampicillin
| -which has better oral bioavailability?
- amoxicillin.
| - amOxicillin = Oral.
159
Ampicillin, amoxicillin
- coverage:
- mnemonic:
```
ampicillin/amoxicillin HELPSS kill enterococci.
-H. influenzae
-E. coli
-Listeria
-Proteus
-Salmonella
-Shigella
Enterococci
```
160
penicillinase-resistant penicillins
- name them:
- what do they target?
- Oxacillin, nafcillin, dicloxacillin, methicillin.
| - S. aureus only. No MRSA.
161
Oxacillin, nafcillin, dicloxacillin, methicillin.
- target?
- tox:
- S. aureus only. No MRSA.
| - interstitial nephritis.
162
Which penicillins are NOT metabolized by the kidney?
nafcillin & oxacillin
| -so you dont need to dec. dose in renal impairment.
163
Ticarcillin, piperacillin
- target?
- susceptible to beta-lactamase?
- mnemonic?
- Pseudomonas spp. and gram-negative rods.
- susceptible to penicillinase.
- TP = like toilet paper. The woman in the pseudomonas video was in a bathroom.
164
Ampicillin, amoxicillin
| -use w/which β-lactamase inhibitor?
Clavulanic acid.
165
riboflavin
| -cofactor for which enzyme
succinate dehydrogenase
166
women & osteoporosis
| -whats the biggest factor in bone density?
genetics.
167
medial rotation of humerus:
subscapularis
168
adductor of humerus:
latissimus dorsi
