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Flashcards in 4/2 micro Deck (168):
1

Give HIV + mother what drug to prevent vertical transmission?

Zidovudine.

2

Where is pH the lowest in the nephron?

DCT & collecting duct

3

Hypertrphic cardiomyopathy
-what type of murmur?
-heard best where?

-Systolic due to LVOT obstruction.
-left sternal border.

4

Aortic regurg murmur
-heard best where?

left sternal border.

5

Aortic stenosis
-heard best where?

Aortic area
-right sternal border, 2nd intercostal space.

6

Uremia:
-PTT?
-PT?
-BT?
whats the problem here?

-qualitative platelet problem.
-BT increased, everything else is normal.

7

Pt. w/ESRD, dialysis catheter placed into IJ, and bleeding occurs around catheter site.
-whats the problem?
-abnormal test values?

ESRD => uremia => qualitative platelet problem.
-inc. BT.
-everything else is normal.

8

Ehlers Danlos
-defect is in which protein?

Type 3 collagen defect.

9

HMP shunt
-where does it occur?

cytoplasm

10

HMP shunt
-primary enzymes involved in non-oxidative steps?

transaldolase & transketolase.
*transketolase req. thiamine as cofactor.

11

All cells can synthesize ribose from which glycolysis intermediates w/help of transketolase & transaldolase?

F-6-P, G-3-P.
-they can do this even if oxidative reactions in HMP shunt not active in these cells.

12

Where is collagen triple helix formed?

ER

13

Which steps of collagen synth happen outside the cell?

Terminal propeptide removal, covalent cross links via lysyl oxidase.
*after propeptide removal, its called tropocollagen.

14

Lysyl oxidase
-what does it do?
-what cofactor does it need?

Cross links collagen molecules in extracellular space.
-copper.

15

Osteogenesis imperfecta
-which step of collagen synth is faulty?
-where does this step occur?

-formation of the triple helix.
-ER.

16

Which quadrant of your ass should you not give injections so you dont damage sup. gluteal nerve?

superomedial.

17

Which quadrants of your ass should you not inject so you dont damage sciatic n?

supermedial, inferomedial, inferolatera.
-basically everywhere except superolateral.

18

Rash + post-auricular lymphadenopathy:

Rubella

19

Congenital rubella
-Sxs:

PDA, cataracts, sensoneural deafness

20

Paramyxoviruses
-why do you see multinucleated cells?

-All contain surface F (fusion) protein, which causes respiratory epithelial cells to fuse and form multinucleated cells.

21

Palivizumab
-whats it do?
-whats it treat?

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

Measles
-is it blanchable?

yes

23

measles
-do koplik spots occur before or after the rash?

Before

24

Measles pts
-which vitamin will you give them?

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?

ƒ-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