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Review / Wrong Answers > DIT review - Micro 6 > Flashcards

DIT review - Micro 6 Flashcards

1
Q

Patients with what diseases should you be cautious giving beta-blockers to?

A

Diabetics (masks hypoglycemia)

Asthma (exacerbates asthma)

CHF (depression of cardiac contractility)

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2
Q

Most common viral causes of meningitis

A
  • Enterovirus (most common) – Coxsackievirus, Echovirus, Poliovirus
  • Arbovirus
  • Herpes simplex virus type 2
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3
Q

Most common bacterial cause of meningitis is neonates

A
  • Group B strep
  • Gram negative bacilli (E. coli)
  • Listeria
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4
Q

Most common bacterial cause of meningitis in adults

A
  • Strep pneumoniae
  • Neisseria meningitides
  • H. flu type B
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5
Q

Most common cause of bacterial meningitis in elderly

A
  • Strep pneumonia
  • Gram (-) rods
  • Listeria
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6
Q

Describe CSF findings of fungal/TB meningitis (opening pressure, WBC predominance, protien, glucose)

A

Same as bacterial except for WBC predominance:

  • Elevated opening pressure
  • Lymphocyte predominance (only difference between bacterial)
  • Increased protein
  • Low glucose
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7
Q

MOA of Sulfonamides and Trimeothoprim

A
  • Sulfonamides:
    • Inhibits dihydropteroate synthase (PABA à dihydrofolic acid)
      • Same mechanism as Dapsone (used for Leprosy)
  • Trimethoprim:
    • Inhibits dihydrofolate reductase (dihydrofolic acid à THF)
  • Bacteridical when used together
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8
Q

Uses of TMP/SMX

A
  • UTI’s, MRSA, Nocardia, Pneumocystis jirovecci
  • Prophylaxis:
    • PJP CD4 < 200
    • Toxoplasmosis CD4 < 100
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9
Q

Adverse effects of both TMP/SMX

A
  • Pancytopenia (due to folate deficiency)
  • Megaloblastic anemia
  • Teratogenic (neural tube defects)
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10
Q

Adverse effects of sulfa drugs

A
  • Sulfa-allergy – fever, rash, urticarial
  • Hemolytic anemia in G6PD deficiency
  • Stevens-Johnson syndrome
  • Type IV RTA
  • Interstitial nephritis
  • Photosensitivity
  • Kernicterus of neonate
  • Displace other drugs from albumin (e.g. Warfarin)
  • Drug-induced lupus
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11
Q

MOA of fluoroquinolones

A
  • Inhibits topoisomerase (e.g. DNA gyrase which normally relieves supercoiling)
  • Bactericidal
  • Decreased absorption when taken with divalent cations
    • Do not take with milk, antacids, or iron supplements
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12
Q

Uses of Fluoroquinolones

A
  • Mostly gram (-)
    • UTI’s (E. Coli, Proteus, Psuedomonas)
    • Pyelonephritis
    • GI bugs (Shigella, Salmonella, E. coli, Campylobacter)
    • Osteomyelitis (Salmonella)
  • Some gram (+)
    • Bacillus anthracis
    • Pneumonia (Strep pneumo, Mycoplasma pneumonia, legionella)
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13
Q

Adverse effects of fluoroquinolone

A
  • Prolonged QT interval
  • GI distress (N/V/D)
  • Tendon and cartilage damage
    • Tendon rupture in elderly and those taken steroids
  • Teratogenic
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14
Q

MOA of Metronidazole

A

Forms toxic free radical metabolites in the bacterial cell that damage DNA

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15
Q

Uses of Metronidazole

A
  • THINK: GET GAP on the Metro:
    • Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, Anaerobes (bacteroides, C. Diff), H. Pylori
  • Anaerobes below the diaphragm
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16
Q

What is the DNA virus that does not replicate in the nucleus

A

Poxvirus

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17
Q

What is the RNA virus that does not replicate in the cytoplasm

A

Influenza and retrovirus

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18
Q

What is the only ssDNA virus

A

Parvovirus

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19
Q

What is the only dsRNA virus

A

Reovirus

20
Q

What is viral recombination

A
  • Exchange of genes between 2 chromosomes by crossing over within region of significant base sequence homology
21
Q

What is viral reassortment

A
  • When viruses with segmented genomes (BOAR) exchange genetic material
22
Q

What is viral complementation

A
  • When 1 of 2 viruses that infects the cell has a mutation that results in a nonfunctional protein, the nonmutated virus “complements” the mutated one by making a functional protein that serves both viruses
23
Q

What is viral phenotypic mixing

A
  • Occurs wit simultaneous infection of a cell with 2 viruses; genome of virus A can be partially or completely coated with the surface proteins of virus B; Type B protein coat determines the tropism (infectivity) of the hybrid virus; however, the progeny from this infection have type A coat encoded by type A genetic material
24
Q

What are the different Herpesviruses?

A

HSV1

HSV2

VZV (HHV3)

EBV (HHV4)

CMV (HHV5)

Roseola (HHV6)

Kaposi (HHV8)

25
Q

What is a Tzank smear and what pathogens will have a positive Tzank smear

A
  • Scrape base of lesion and look under microscope for multinucleated giant cells
  • Can detect HSV-1, HSV-2, or VZV but cannot differentiate between the three
26
Q

What are Cowdry bodies and what disease are they seen in?

A
  • Intranuclear eosinophilic inclusions
  • Seen in HSV-1, HSV-2, and VZV
27
Q

Severe presentation of VZV primary infection in adults

A

Encephalitis, pneumonia

28
Q

Describe the role of B-cells and T-cells in EBV

A
  • Infects B-cells via CD21 then amounts a large CD8 T-cell response (atypical lymphocytes)
29
Q

What are Downey cells and what disease are they seen in?

A
  • T-cells that are responding to EBV
  • Have a foamy appearance
30
Q

What is the fear of confusing EBV with strep throat

A
  • Giving Aminopenicillins (Amoxicillin) will cause maculopapular rash on trunk and extremities)
31
Q

Describe presentation of CMV in the following populations:

  • Immunocompetent
  • Transplant patients
  • AIDs
  • Congenital
A
  • Immunocompetent patients:
    • Monospot (-) mononucleosis – sore throat, lymphadenopathy, fatigue
  • Immunocompromised patients:
    • Transplant patients – pneumonia
    • AIDs patients – Retinitis, esophagitis, colitis
  • Congenital:
    • Blueberry muffin rash, hepatosplenomegaly, jaundice, hearing loss, ventriculomegaly, ventricular calcifications, mental retardation, seizures
32
Q

In what cells does CMV maintain dormancy and what is the characteristic feature of infected cells

A
  • Latent in mononuclear cells (lymphocytes, monocytes, macrophages)
    • Infected cells have “owl eye” inclusions
33
Q

Describe presentation of HHV-6

A
  • Causes Roseola in children (aka exanthema subitum)
  • 3-5 days of high fever followed by diffuse maculopapular rash that spares the face
  • Can cause febrile seizures
34
Q

Transmission of HHV6

A

Saliva

35
Q

Transmission of HHV8

A

Kaposi

Sexual contact

36
Q

MOA, activation, and uses of Acyclovir

A
  • MOA:
    • Guanosine nucleoside analog
    • Incorporates into replicating DNA and inhibits viral DNA polymerase via chain termination
  • Activation:
    • Mono-phosphorylated by HSV/VZV thymidine kinase
      • Only effective in HSV/VZV
      • Only effective against infected cells
    • 2nd and 3rd phosphorylation via cellular kinases
  • Uses:
    • Treats symptoms of HSV but does not affect recurrence (treats encephalitis)
    • VZV (Famciclovir and Valacyclovir are preferred)
37
Q

Adverse effects of Acyclovir and related drugs

A
  • Intersitial nephritis, crystalline nephropathy
  • CNS effect – Delirium, confusion, vertigo, hallucination
38
Q

Uses of Valacyclovir

A
  • Prodrug of Acyclovir – same MOA
  • Better oral bioavailability
  • Uses:
    • Same as Acyclovir
    • Can be used as suppressive therapy for recurrence
    • Preferred over Acyclovir for VZV
39
Q

Uses of Famciclovir

A
  • MOA = same as Acyclovir
  • Uses:
    • Same as Acyclovir
    • Preferred over Acyclovir for VZV
40
Q

MOA, activation, uses, and adverse effects of Ganciclovir

A
  • MOA:
    • Guanosine nucleoside analog
    • Incorporates in to viral DNA, inhibiting viral DNA polymerase
  • Activation:
    • Mono-phosphorylated by CMV viral kinase
    • 2nd and 3rd phosphorylation via cellular kinase
  • Uses:
    • CMV (especially in immunocompromised)
  • Adverse effects:
    • Myelosuppression
41
Q

MOA and uses of Foscarnet

A
  • MOA:
    • Directly inhibits viral DNA/RNA polymerase
    • Does not require intracellular activation/phosphorylation
  • Uses:
    • CMV when Ganciclovir fails
    • Acyclovir-resistant HSV
42
Q

Adverse effects of Foscarnet

A
  • Adverse effects:
    • Nephrotoxicity, hypocalcemia, hypomagnesemia, hypokalemia, seizures (from electrolyte disturbance)
43
Q

MOA and uses of Cidofovir

A
  • Cidofovir
    • MOA:
      • Directly inhibits viral DNA/RNA polymerase
      • Does not require intracellular activation/phosphorylation
    • Uses:
      • CMV retinitis
      • Acyclovir-resistant HSV
44
Q

How do you prevent adverse effects of Cidofovir

A
  • Adverse effects:
    • Nephrotoxicity
      • Administer with Probenecid to block the tubular secretion of Cidofovir
45
Q
A

Review / Wrong Answers (140 decks)

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