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USLME Kiss my ass and pray > DIT Micro Bacteria > Flashcards

DIT Micro Bacteria Flashcards

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1
Q

lipoteichoic acid is found where and leads to what?

A

found in gram + cell walls and leads to, IL1 IL6, TNF alpha

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2
Q

Lipopolysacharide is found where and causes what?

A

found in gram -

Contains lipid A - lysed ->
and leads to IL1, IL6, and TNF alpha

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3
Q

Transpeptidase is?

A

an enzyme that is targeted that links peptide side chains together to make peptidylglycan wall

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4
Q

Ribosomal sub units of prokaryotes

A

30s and 50s -> 70s

s refers to sedimentation not units

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5
Q

Bacterial w/ capsules (8+1)

A

Even Some Nasty Killers Have Pretty Shiny Bodies

E Coli -some
Streptococcus pneumonia*
Nisseria meningitis*
Klebsiella
Hamophelis influenza*
Pseudomonas aerugenosa
Salmonella typhi
Group B strep

SHiN

Cryptococcus neoformis - fungi

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6
Q

Splenectomy leads to what concerns?

A

Of encapsulated bugs

Make sure vaccinated agains SHiN bugs

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7
Q

Only fungus that is encapsulated ?

Stain?

Causes?

A

Cryptococcus neoformis

India ink

meningitis in AIDS

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8
Q

Bacteria w/out a cell wall

A

myocplasma

  • high sterol count
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9
Q

Bacteria w. high lipid count in cell wall making it difficult to gram stain

A

Mycobacteria

contains mycolic acid

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10
Q

6 bugs that do not gram stain well

A 
Treponema - too thin - dark field instead
Ricketsia - intracellular
Chlamydia - intracellular
Mycobacteria - high lipid content
Mycoplasma - no cell wall
Legionella - intracellular
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11
Q

Silver stain useful for which 2 organisms

A

Legionella

Pneumocystis

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12
Q

Zeil neelsen positive organisms?(2)

A

Acid fast stain

Mycobacteria
Norcardia

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13
Q

Giemsa stain useful for? (5)

A 
Chlamydia
Borrelia
Ricketsia
Trypanosomes
Plamodium
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14
Q

Positive Quelleng Test in

A

Bugs w/ capsules

E Coli -some
Streptococcus pneumonia*
Nisseria meningitis*
Klebsiella
Hamophelis influenza*
Pseudomonas aerugenosa
Salmonella typhi
Group B strep
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15
Q

3 organisms capable of taking in naked DNA from the environment

A

SHiN can do Transformation

Streptococcus pneumonia
Hamophelous influenza
Nesseria meningitis

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16
Q

Spore forming bacteria (2 families)

A

gram +

Bacillus

  • anthacis
  • cereus

Clostridium

  • perfinges
  • botulinum
  • tetani
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17
Q

Lipid A endotoxin found where?

Leads to activation of what 3 pathways

A

in the LPS wall of gram -

Macrophage activation

  • IL1, IL6 -> fever
  • TNF alpha -> fever and hypotension
  • Nitric Oxide -> vasodialation

Complement

  • C3a -> hypotension/edema (histamine)
  • C5a -> PMN chemotaxis

Activates tissue factor -> coag + DIC

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18
Q

Macrophage activation post Lipid A encounter leads to (3)

A

Septic shock

  • IL1, IL6 -> fever
  • TNF alpha -> fever and hypotension
  • Nitric Oxide -> vasodialation

Also have complement and tissue factor activation

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19
Q

Complement activation in septic shock gram -

A
  • C3a -> hypotension/edema (histamine)
  • C5a -> PMN chemotaxis

Macrophage activation and tissue factor as well

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20
Q

Why is gram - septic shock lead to DIC?

A

Activates tissue factor -> coag + DIC

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21
Q

Two gram + bacteria associated w/ super antigens and their respective antigen

A

Staph aureous
-TSST1

Streptococaal pyrogenes
- pyrogenic toxin A-C

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22
Q

Superantigens binds to (2)

leads to?

A

MHC II and TCR

leads to polycolonal T cel activation

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23
Q

2 toxins associated w/ inactivation of E2F

A

Diptheria on Corynebacterium dipheriae

Exotoxin A on Pseudomonas aerugunosa

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24
Q

2 toxins that inactivate 60s ribosome leading to HUS

A

Shiga toxin in shigella

Shiga like toxin in EHEC

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25
Hemolytic uremic syndrome is characterized by what 3 symptoms and found w/which 2 bugs
thrombocytopenia hemolytoc anemia acute renal failure Shigella and EHEC (O157:H70
26
2 toxins -> Over activates adenylate cyclase -> increased cAMP -> Cl secretion and diarrhea
Cholera toxin in vibrio Toxin heat labile toxin in ETEC
27
heat stable toxin is found where and leads to what
found in ETEC also leads to diarrhea due to increase of guanate cyclase action and increasing cGMP and decreased NaCL reabsorbtion
28
Edema factor, lethal factor and protective antigen make up?
Bacillus anthra toxin -> edemotous border and black eschar
29
Activation of Gs via this toxin leads to 12-20 L of fluid loss per day
Cholera overactivationof adenylate cyclase -> increased cAMP and Cl excretion ~ HL toxin in ETEC
30
activation of Gi by this toxin leads to
Pertussis 100 day cough in adults and wooping in kids inactivation of Gi leads to increase adenylate cyclase and increased cAMP
31
Neurotoxins are secreted by which family. What are their 2 toxin and MOA
Clostridium, both cleave SNARE proteins holding vesicles of NT near the synapse Clostriudum tetani -> tetanospasim toxin, blocks GABA and glycine release (spasm) Clostridium botulinum -> butulinum toxin, blocks release of ACh (flaccid)
32
Clostridium botulinum has 2 food borne associations w/ dif mechanisms of action
spores in honey -> floppy baby Eneterotoxins in canned foods -> diarrhea in adults
33
Alpha toxin is found where and leads to what 2 problems
Clostridum perfinges degradation of phospholipid C -> - myonecosis - gas gangrene
34
Streptolysin O and S are associated w/ what organism and leads to what
Streptococcal pharynges hemolysis O being oxygen labile -ASO titre S being stable
35
Scarlet fever is due to differs from rheumatic fever how?
Streptococcal pyrogenes -> erythrogenic and pyrogenic toxins Rheumatic fever is an immune response weeks later due to cross reactivity to the M antigen
36
Spores are formed during what part of the bacterial graph
Stationary, plateau
37
Penicillins and cephasporins work best at what stage of infection
exponential growth phase
38
7 bugs that secrete enterotoxins(watery diarrhea/ electrolyte imbalances)
``` Staph aureus Vibrio cholera ETEC Shigella Yessernia enterolita Clostridium perfinges Clostridium difficle ```
39
Enterotoxin producing bacteria that may mimic appendicitis Prefers what environment
Yessernia enterocolitica colder temps - fridge, do not kill it
40
Leukocodin is what and found where
exotoxin made by Staph aureus that kills leukocytes 2 types - delta and panton valentine
41
Protein A is found where and responsible for what? (2)
Found in Staph aureus and associated w/ hemolysis also binds to Fc-IgG inhibiting opsonization and phagocytosis type of hemolysin along w/ Protein B
42
3 main branches of gram +
Cocci -Staph and Strep Rods - Clostridium - Bacillus - corynebacterium - Listeria - Mycobacterium Branching filaments - actinomyces - Nocardia
43
Catalase test is what and used to seperate
Breaks down H2O2 into CO2 and H20 Separates cocci Staph (+) and Strep (-)
44
Coagulase test is what and used to separate which 3 organisms how do you differentiate the last 2?
Whether gram + bunches together blood or not, also used to coat w/ fibrin to protect itself S. aurous is (+) S. epidermidis (-) -(novobiocin sensitive) S. straphrolyticus (-) -novobiocin resistant
45
S. saphrolyticus is known for causing
UTIS
46
common aerobic bug found complicating prosthetic valves and joints
S. epidermidis
47
Partial hemolysis streptococcus (2) differentiate how?
S pneumonia - Optochin + - Capsule (quelleng) S. mutans
48
Complete beta hemolysis strep (2) Differentiate how?
Group A -S pyrogenes -bacitracin sensitive Group B -S Agalactiae -bacitracin resistant
49
gamma hemoysis gram + organisms (3)
Enterococcus Group D E. faeceium E. faecalis S bolvis
50
Branching Filament Gram Positive organisms (2) differ how?
Actinomyces -anaerobic Nocardia -aerobic acid fast
51
Gram + rods (5)
Spore formers - Clostridium - Bacillus Nonspore - listeria - corynebacterium Mycobacteria - acid fast
52
Bug forming yellow sulfur ganules
Actinomyces israleii
53
Bug staining the bandages blue-green
Pseudomonas aergunosa Remember pseudo loves water
54
S aureous creates what colored pigment?
Yellow Au = gold
55
Serratia marcescens is associated w/ what pigment?
Red
56
Toxin mediated Staph aureous infections?(3)
Enterotoxin - fast food poisoning TSS1T - toxic shock syndrome exfolotoxin - scalded skin syndrome
57
Staph virulence factor that binds to Pc-Ig inhibiting obsinization
Protein A
58
Gram + dipplococci think
Strep pneumonia
59
Streptococcus pneumonia most commonly causes (4)
MOPS Meningitis - community aquired, elderly Otitis media - kids Pneumonia Sinusitis
60
IgA protease is found in ?
Staph aureus Nesseria meningitis H influenza
61
2 virulence factors of strep pneumo
Encapsulated | IgA protease
62
Rusty colored suptum
Pneumonia w/ Strep pneumo
63
Concern of sepsis w/ these 2 patients w/ S pneumonia
Splenectomy Sickle cell
64
3 classifications of diseases due to Strep pyrogenes- total of (8)
Pyrogenic - Impetigo - cellulitis - pharyngitis Toxin mediated - scarlet fever - Toxic shock - necrotizing fascitiis immunologic - rheumatic heart disease - glomerulonephritis
65
Cellulitis and impetigo most often due to(2)
S. pyrogenes S. aures
66
Glomerulonephritis can be seen a week after this infection
Strep pneumonia either pharyngitis or cellulite/impetigo
67
Rheumatic fever due to ? Diagnosed by?
Molecular mimicry to the M antigen of Strep pyrogens ``` J - joints, polyarthritis O - heart - pancarditis N - nodules - sub Q E - Erythema migratans S - sydenhams Chorea ```
68
ASO titer preformed to check for
S pyogenes
69
3 main worries w/ Group B in babies Test what?
Meningitis #1 Pneumonia Sepsis CAMP factor
70
Strep bovis in the blood be concerned w? Strep bovis also causes
Colon cancer Sub acute endocarditis
71
Enterococci Group D causes
UTI and sub acute endocarditis | resisitant to treatment when found where it shouldn't be
72
grows in 6.5% NaCl and bile
Enterococci Grop D - E facecalis - E Faecum
73
Grows in 6.5% NaCl but NOT bile
S bolvi
74
ADP ribosylation of EF2 is due to?
dyptheria exotoxin or pseudomonas exotocin A
75
Rx for dyptherisa(3)
ABx - erythromycin/penicillin - anti toxin - Vaccine
76
Club shaped baceria
corynebacterium
77
Obligate anaerobic bacteria (3)
Clostridium Bacteriodes Actinomyes lack catalase and/or superoxide dismutase Rx - metronidazole and clindamycin
78
Rx for obligate anaerobic bacteria(2)
Rx - metronidazole and clindamycin Clostridium Bacteriodes Actinomyes
79
Toxin A enterotoxin and Toxin B | causing cytotoxin destruction(kills enterocytes)
C difficile - leading to psudomembranous colitis due to binding
80
small papule leading to bleach eschar surrounded by edema due to?
Bacillus anthacis | - cutaneous
81
Woolsorter w/ flu like symptoms that rapidly progress to fever, pulmonary hemorrhage and shock caused by? CXR shows ?
Pulmonary bacillus anthacis ->mediastinal widening
82
Only bacterium w/ a polypeptide (D glutamate) capsule?
B anthracsis
83
B cereus cause what pathology(2)?
Emetic type - w/ rice and pasta w/in 1-5 hrs -due to a toxin diarrheal type -non bloody w/in 8-18 hrs Spores survive heating and -> toxin production
84
Neonatal disease bugs biggest concern (3)
Step B E coli listeria
85
listeria affects who (4)
Neonates inmmuncompromised elderly pregnant women -> neonatal death
86
Listeria monocytogens can reside in what cell?
Monocytes faculative intracellular move by actin rockets
87
Gram + anaerobe that has large branching filaments that cause oral/fascial abscesses? Characteristic color?
Actinomyces israllii yellow sulfur granules
88
Partially acid fast positive bacteria w/ large branching filaments that is aerobic? Causes?(2)
Nocardia pulmonary infection and cutaneous infection in the immune compromised
89
Gram - dipplocci
Nesseria Urease +
90
Gram - coccii (3)
Nesseria meningitidis, Nesseria gonorrhoeea Morallela catarrlis
91
Cocciod Rod (gram -) 4
Haemophilus influnezae Bordetella pertussis Pasturella Brucella
92
Gram - rods (10) Broken up by
Lactose fermenters- FAST - Klebsiella - E Coli - Enterococcii Lactose femermenters -SLOW -Citrobacter Serratia Lactose NON fermentors - Shigella - Salmonella - Protease - Pseudomonas* - H pylori*
93
Gram - rods Lactose nonfermentors(5) broken up by?
Oxidase - - Shigella - Salmonella - Proteus Oxidase + - Psuedomonas - H pylori
94
Gram - rods Lactose fermentors (5) Broken up by
Fast - Klebsiella - E coli - Enterobacter Slow - Citrobacter - Serratia
95
Gram - comma shaped (2) -Oxidase + Unique characteristic of each?
Camplobacter jejuni -grows at 42 degrees C Vibrio Cholera -grows in alkaline material
96
Nesseria that does not have a capsule?
gonococci and thus no vaccine
97
Prophylactiv Rx for N meningitidis (3) Definitive (2)
Prophylactic - rifampin - cipro - ceftriaxone Ceftriaxone definitive
98
Adrenal hemorrhage is due to this bug, Called?
waterhouse friderichsen syndrome due to N meningitis
99
sniffing dog position and thumb sign on CXR may indicate what by what organism?
Epiglotitis by Haemophilus influenza
100
Haemophilus influenza causes (5)
``` Epiglottis - Cherry red Meningitis Otisis media sinusitis Pneumonia ``` IgA protease chocolate agar w/ V and X
101
Culturing requires a chocolate agar w/ factors V and X
Haemophilus influenza Vaccine avaialable
102
Small painful lesion, solitary, on the genitalia?
Haemophilus ducreyi
103
Legionella can be detected through what 2 tests?
Silver stain | antigen in urine
104
Legionella pneumophila spreads via
aerosolized water | NOT person to person
105
Grows on a charcoal yeast extract culture w/ iron and cysteine
Legionella pneumophilia
106
atypical pneumonia w/ fever and GI symptoms that does not gram stain
legionella
107
Erythema gangreosum (black escar) seen w/ a sepsis think of? - may be a burn patient
PSeudomonas
108
Special victims of pseudomonas (3)
Burn victims CF Diabetics
109
Pseudomonas causes
``` Pneumonia- CF Spepsis External otitis - swimmer UTI Diabetic Osteomylitis ```
110
Triple Therapy in gram - nonlactose fermentor causing increased risk for Lymphoma and gastric adenocarcinoma
Helicobacter pylori Use - PPI - Clarithromycin - Amoxicillin/metronidazole
111
Breath test for gastric ulcer takes advantage of what feature of this organism
Urease + -> alkaline environment H pylori
112
osteromyolitis in sickle cell disease maybe after a diarrheal illness
Salmonella
113
diarrhea caused by gram - non motile organism that does not ferment lactose
shigella
114
diarrhea caused by gram - motile organism that doesn't ferment lactose
Salmonella
115
MacConkey agar turns pink w/ this enzyme
lactose fermenters | - like E coli, klebsiella etc
116
Heat labile and heat stabile toxin are produced by this bacteria and lead to the same result by different mech Rx
ETEC e coli - - floroquinolones Heat labile increase cAMP ~cholera Heat stabile increases cGMP
117
Has a shigella like toxin leading to HUS but is lactose fermenting
EHEC O157-H7 Does not ferment sorbitol HUS - anemia, thrombocytopenia and acute renal failure (mech hemolysis, low renal flow and platelet consumption)
118
Diarrhea seen in kids due to adherence, no invasion
EPEC
119
Diarrhea due to invasion causing necrosis and inflammation similar to shigella
EIEC Rx floroquinilones, TMP/SMX
120
Shigella presentation progression
Starts as water diarrhea that becomes bloody as the toxn does its work and then have invasion leading to fever No flagella, very virulent - food to water spread
121
produces hydrogen sulfide and has a flagella causing diarrhea
Salmonella
122
Picinic and egg salad or chicken was consumed causing diarrhea 1-3 days later
salmonella
123
Reactive arthritis seen it 2 GI bugs
Salmonella and Shigella In addition to Chlamydia
124
Salmonella typhi differs in that(3)
typhoid fever - rose spots on the abdomen - fever - HA - Nausea gallbladder is a carrier state
125
diarrhea w/ rose colored spots on the abdomen
salmonella typhi
126
Major cause of bloody diarrhea found in poultry, meat and unpasturized milk? 2 unique features?
camplobacter jejuni S shaped grows at 42 degrees C
127
Sequllea associated w/ camplobacter jejuni?
Guillain Barre
128
Grows in alkaline media and has a flagella to move around. Slight comma shape
Vibrio cholera activates Gs
129
Diarrhea associated w/ puppies also found in?(2)
yersernia enterocolitica contaminated milk or pork
130
Turtles can harbor
salmonella
131
mesenteric adenitis epidemic found in a daycare due to
yersernia enterocolitica - mimics appendicitis Found in cooler climates as well
132
Aspiration pneumonia in someone that is immune compromised may see on sputum
Klebsiella, especially in alcoholics and diabetics red current jelly from lobar pneumonia
133
oral vancomycin really only ever used for? another Rx if that does not work
C dif - no nephrotoxicity due to no oral absorption metronidazole
134
Post clindamycin or ampicillin Rx worry about How would you diagnose this disorder if suspected?
C dif C dif Toxin A or B A - enterotoxin B - cytotoxic to enterocytes
135
Contaminated seafood or shellfish due to
vibrio parahemolyticus and vulificans
136
Clostridium perfengiens enterotoxin can be found in?
reheated meat dishes
137
bulging food can may indicate contamination w.
C botulinum
138
Dysurea, increased frequency urgency and suprapubic pain, WBCs are all seen in
Cystitis
139
WBC casts are seen when and why?
Seen in pylonephritis or anytime the renal tubules are involved. Need the compression of the tubules to lead to cast formation
140
Positive leukocyte esterase test indicates in urine
bacterial UTI, enzyme is being expeller but can also just beinflammation
141
positive nitrite test in urine is indicative of
gram - bacteria UTI enterobacteriacea
142
4 most common causes of UTIs
E coli Staph saprophyticus Klebsiella pneumonia Proteus mirabilis others - Pseudomonas Serratia macescens -enterobacter cloacae
143
Urease is found in (2) What does it do?
Found in H pylori and Proteus mirabillis Splits urease into NH3 and Co2 to make the environment more hospitable
144
Motility causes swarming when trying to culture this UTI Associated feature?
Proteus mirabilis causes struvite stones
145
Green metallic sheen on EMB agar
E coli
146
Rx for UTIs
TMP-SMX* Aminopenicillins Floquinolines* Nitrofurantoin
147
Spirochetes are defined by?(2) 3 examples
spiral shape axial location of flagella (axial filaments) BLT Borrelia Leptospira interrogans Treponema
148
Weils Disease characterized by
Severe Leptospira interrogans infection - tropical disease jaundice, azotemia, kidney dysfunction, hemorrhage, fever and anemia
149
animal urine think of 2 organisms
leptospira interrogans rats - hanta virus
150
Leptospirosis symptoms (6)
1st -flu like 2nd - jaundice, photophobia, meningitis, liver damage and renal failure Severe form - Weil disease
151
question mark shaped organism
leptospira interogans
152
Tick carrying borrelia burdorferi Also carries?
Ixodes babesia microti -> babesiosis
153
3 Stages of lyme Disease 2 symptoms for 1st 2 3 for the last
1 - erythema migraines, - flu like symptoms 2 - neurologic (bi lateral bells palsy) - cardiac - AV block 3 - migratory polyarthritis - chronic monoarthritis (knee) - encephalopathy/polyneuropathy
154
Bilateral bells palsy think of
Lymes
155
Diseases w/ bells palsy associated?(5)
``` Lymes Herpes Zoster Sarcoidosis Tumors Diabetes ```
156
2 tests looking for syphilis antibodies False positives due to (5) Confirm w?
RPR or VDRL V- viruses (EBV, mono, hepatitis) D- drugs R- Rheumatic fever L- Lupes, leprosy FTA-ABS
157
condylomata lata
wart like lesion in moist areas associated w/ secondary syphilis
158
1st stage of syphilis
solitary painless ulcer
159
secondary stage of sphyilis has (3)
Maculopapular rash (hands/feet) conylomata lata fever/malaise/chills
160
3rd stage of syphilis has (4)
tabes dorsales/neurosyphilis gummas - anywhere aoritis - tree barking argyll robertson pupil
161
Congenital syphillis one may see? (4)
saber shins - anterior bowing hutchingsons teeth - notched incisors saddle nose - frontal bossing hearing loss
162
Argyll Robertson pupil is seen in what and defined by
tertiary syphilis defined by pupils that accommodate but do not react to light
163
tabes dorsales is ? signs and symptoms (3) associated w
degeneration of the dorsal column and roots leads to loss of pain and sensation leads to wide ataxic gait charcots joints positive rhomberg tertiary syphilis
164
Charcot joints found in (2)
Tabes dorsales in tertiary syphilis Diabetic neuropathy
165
bartonella causes? Found in?
cat scratch fever - regional LAD and angiomitosis in immune compromised cat scratch
166
borrelia burgdorferi causes? Found in
Lymes disease Ixodes ticks
167
Borreila recurrentis causes? Found in?
recurrent fever louse
168
brucella spp causes? found in
brucellosis/undulant fever (granulomatous caseating) unpasturized dairy (vets and ranchers)
169
Chlamydophila psittaci causes? found in?
psittacosis - severe pneumonia parrots/birds
170
coxiella burnetti causes? found in?
Q fever - severe flu, abrupt fever aerosols of cattle sheep amniotic fluid
171
erlichia caffeenis causes? Found in
ehrlichiosis (HA, muscle ache, fever) lone star tick
172
Francisella tularensis causes? Found in?
tularemia (LAD, ulcer and granuloma formation) Dermacator tick (rickettsia); rbabits and deer
173
Mycobacertium leprae causes? Found in
leprosy Armadillos
174
Pasteurella multocida causes? Found in?
Cellulitis, osteomyolitis Dog and Cat bites
175
Rickettsia prowazekki causes? Found in?
epidemic typhus louse
176
Rickettsia rickettsii causes? Found in
Rocky mountain spotted fever Dermencetor tick (franciella tularensis)
177
Rickettsia typhi causes? Found in
endemic typhus fleas
178
Yersernia pestis causes? Found in?
plague Fleas (rats/ praiare dogs)
179
Gohn complex
combination of hilar LAD and john focus - calcified lung scar mid to low lung lobe Primary TB
180
Gohn focus
Calcified lung scar in the mid to bottom lobe in primary TB
181
Primary TB most often becomes Complications of Primary TB (3)
healed by fibrosis leading to immunity and hypersensitivity, Tuberculin + progressive lung disease (HIV or malnutrition) -> infection/death bacteremia w/ hematogenous spread -> milady TB and death reactivation later in life leading to secondary TB
182
Secondary TB characterized by? Location of lesion?
fibrocasious cavitary lesion in the upper lobes Symptomatic w/ fever hemoptysis, weight loss and night sweats
183
lower back pain, nigh sweats, fever, hemoptysis think of?
Potts disease extra pulmonary TB
184
extra pulmonary TB locations(5)
CNS -> parenchymal tuberculoma or meningitis Vertebral bodies -> Potts disease Lymphadenitis Renal GI
185
PPD + test means (3)
Current infection past infection BCG vaccine
186
PPD - test means (2)
No infection Immune compromised to the point of anergic response (steroids,HIV, sarcoidosis, malnutrition)
187
Diagnosis of TB (2)
3 sputum cultures over 3 days -any one can be positive Culture takes 2-4 wks and should be done regardless
188
Acid fast + bacteria that causes pulmonary TB like symptoms in chronic bronchitis and emphysema
M kansaii
189
disseminated TB in AIDS patients w/ fever diarrhea, and malabsorbtion Prophylactic treatment w/ what, when?
M. avium Prophylactic treat Azythromycin when CD4 <50
190
Aquatic associated TB, seen in those that work at shipyard and aquarium workers
M marinum
191
Rx for active TB(4)
RIPE Rifampin Isoniazid - B6 pyradoxine Pyrazinamide Ethambutol
192
Rx for latent TB (2)
6-9 months of Isonizid
193
some virulence factors of mycobacterium tuberculosis(2)
cord factor - inhibits macrophage maturation, induces TNF alpha release sulfatides - inhibit phagolysosomal fusion
194
mycobacterium that prefers cool temperatures of skin and superficial nerves causes?
mycobacterium leprae Causes - lepramatous leprosy - tuberculoid leprosy
195
Lepramatous leprosy is due to?
m leprae communicable form of leprosy is due to an improper Th2 stimulation(humoral), Th1 response is low(cell mediated) diffuse skin involvement
196
Tuberculoid leprosy is due /
m leprae same pathogena as in lepromatous but immune response is primarily Th1 cell mediates and the disease is limited to few hypesthetic hairless plaques
197
Rx of lepromatous leprosy vs tuberculoid leprosy
lepromatous (2-5 yrs) -dapsone -rifambin clofazimine tuberculoid (12 months) - dapsone - rifampin
198
Dapsone is used in? (2) Concern?
leprosy - tuberculoid and lepromatous pneumocystis pneumonia prophylaxis (2nd line) Concern in G6PD patients
199
fishy nonpainful vaginal discharge (gray) Rx?
Gardenella vaginosis metronidazole
200
Clue cells are ? associated w?
Gardenella vaginosis vaginal epithelial cells covered in bacteria
201
Rickettisia triad?
Fever HA Rash
202
Rash starting at the wrists and ankles making its way to the trunk?
Rickettsia rickettsii - obligate intracellular
203
some obligate intracellular organisms(2)
Chlamydia | rickttsia
204
tick born rash that develops centrally and spreads out sparing the palms and soles (2)
R typhi - endemic R. prowazekii - rpidemic
205
Monocytes w/ morula (berry like inclusions) in cytoplasm - tick borne
Ehlichiosis - in Ehlichia NO rash
206
Granulocytes w. morula in cytoplasm tick born
Anaplasmosis w/ anaplasma NO rash
207
Coxiella burnetti causes? transmitted by?
Q fever - NO rash, - fever and interstital pneumonia aerosolized spores in tick feces and cattle placenta release
208
Weil felix reaction is? what is positive, what is negative
Test for rickettsia and tick borne illness Coxiella is negative the rest: rickettsia etc are positive
209
atypical pneumonia w/ a person that has a pet parrot
Chlamydophilia psittaci
210
pneumonia in a 20 something that presents w/ low grade fever, tachypnea, crackles/wheezing
chlamydia pneumonia or mycoplasma pneumonia
211
Chronic infection leading to blindness in Africa
Types A, B, C chlamydia trachomatis
212
neonatal pneumonia and conjunctivitis found in a subclinical mother w/ reticulate bodies Prevention and Rx?
Chlamydia D-K - May also cause PID/Urethritis Rx w/ azithromycin, Prevent w/ erythromycin eye drops
213
solitary painless chancre on the penis that may progress to rectal disease that is confused for IBD
Chlamydia tachmomatis L1, L2 L3 Painful LAD
214
Walking pneumonia due to (3) Rx for each
Mycoplasma pneumonia - (macrolide) Chlamydia pneumonia (azithromycin) Liegenella (macrolide or quinolone)
215
bacteria characterized by high sterol content in bacterial membrane
mycoplasma pneumonia leads to atypical pneumonia in <30s especially in prisons/military recruits
216
Cold agglutinin anemia seen sometimes w/ atypical m pneumonia is to what antibody?
IgM
217
Where is the major mode of resistance to penicillin located in gram -? what is another mech of resistance
Penicillinase is located in the periplasm Alteration of the penicillin binding protein also a mech of resistance
218
What drug given to a patient w/ mono leads to inappropriate assumption of allergy
Amoxicillin leads to rash when given to EBV + patients not a hypersensitivity reaciton
219
What are the concerns w/ penicillin (3)
hypersensitivity Rarely - thrombocytopenia - hemolytis uremia
220
ampicillin and amoxicllin spectrum?
Extended Gram + HELPSS ``` Haemophilus E Coli Listeria Proteus mirabilis Salmonella Shigella ``` URI, UTIs and neonatal
221
Penicillins used in pseudomonal infections (3)
Ticarcillin piperacillin Carbenicillin
222
MRSA reisistance due to ?
Changing of the penicillin binding protein target of Staph Aureus Use methicillin to test for not used clinically
223
Oral penicillin vs IV
Oral - Penicillin V IV - G
224
Organisms not covered by cephalsporins
LAME Listeria Atypical pneumonia - chlamydia, mycoplasma MRSA Enterococci
225
1st generation Cephalosporins(2) Coverage(4)
Cefazolin Cephalexin gram + and PEcK Proteus mirabilis E Coli Klebiella
226
2 Generation Cephalosporins (4) Coverage (8)
cefoxitin cefaclor cefuroxime cefprozile gram + and HEN PEcKS ``` Haemophilus Enterobacter nesseiria (not gon) Proteus mirabilis E Coli Klebsiella Serratia ```
227
3rd gen Cephalosporins(4) Coverage(10)
cefTriaxone* (Nesseria go to) cefoTaxime cefdinir cefTazidime * (anti pseudo) only gram + is strep pneumo serious gram - ``` Haemophilus Enterobacter nesseiria Proteus mirabilis E Coli Citrobacter (new) Klebsiella Serratia ```
228
4th Gen Cephalosporin(1) Coverage
Cefepime Pseudomonals and gram + - broad spectrem
229
Antipseudomonals Cephalosporins (2)
Ceftazidime | Cefepime
230
Increased nephrotoxicity is seen when these 2 ABx classes are paired together
Aminoglycocides and cephalosporins
231
Go to neisseria ABx Excreted?
Ceftriaxone Excreted in bile so safe for kidneys
232
UTI prevention prophylactically give
1st or 2nd gen cephalosporin
233
Cell wall inhibitor w/ No cross reactivity w/ penicillin allergies Spectrum
Aztreonam Gram -
234
Great drug to use in those w/ a gram - infection and have renal insufficiency
Aztreonam
235
Imipenem is always coadministed w/ what why?
cilastatin to prevent renal degradation of imipenem by renal dehydroppeptidase I
236
Broad spectrum beta lactamase inhibitor for maybe appendicitis?(2) Not used all the time why?
Carbapenems - Imipenem/cilastatin - meropenem not used to concern w/ serious side effects like seizures (imipenem), GI and skin rash
237
What is the one bug carbapenems do not hit
MRSA
238
Antipseudomonial drugs in general (4)
Cefepime Ceftiazdime Aztreonam Carbapenems
239
Red man syndrome w/ vancomycin Rx
pause the treatment, give an antihistamine and run again at a slower rate not an IgE mediated hypersensitivity; nonspecific mast cell degranulation
240
Protein synthesis inhbitors 2 acting on 30 s 5 on 50 s
buy AT 30 CCEL at 50 30s - Aminoglycoside - Tetracycline ``` 50s Clindamycin Choramphenicol Erythromycin (macrolides) Linezolid ```
241
Situation of Linezolid use?
When you want to oral outpatient Rx for MRSA instead of Vanco (IV) also used for VRE binds to 23s (50s) and interacts w/ bacterial initiation complex
242
Tetracyclines indicated for (9)
VACUUM THe BedRoom ``` Vibrio cholera Acne Clamydia Ureaplasma Ureayticum Mycoplasma Tularemia Helicobacter pylori e Borrelia urgdorferi ed Rickettsia Ricketsii ```
243
Why don't we give tetracycline to Kids?
teeth discoloration - yellow | premature epiphyseal plate closing
244
Taking a tetracycline can cause upset stomach. Why is this a bad coinicidence What other adverse effects are there?
because taking an antacid (Ca, Mg Fe, vitamins) will limit the effectiveness of the drug and lower absorption Photo toxicity, teratogen,
245
Chronic use of minocycline can lead to what unique toxicity
blue tinged skin
246
Clinical use of macrolides
Azithromycin, Erythromycin, Clindamycin Used in PUS - atypical Pneumonia, URIs( Strep pneumo and pyrogenes); STDs (Chlamydia)
247
Concern w/ macrolides w
prolonged QT acute cholestatic hepatitis - rare w/ erythromycin Rash p450 inhibitor (CRACK AMIGOS) -> increased concentrations of Warfarin and theophylline
248
Synergistic drug for a neonatal infection w/ ampicillin
aminoglycoside aminoglycosides used severe gram - infections Streptomycin, Amikacin, Gentamycin, Neomycin, Tobramycin
249
Toxicity of aminoglycosides(3)
Different kind of NOT vs vanco Nephrotoxicity Ototoxicity Teratogen*
250
Which drug class requires O2 limiting its effectiveness in anaerobes to 0 Indicated for what bacteria?
Aminoglycosides Severe gram - rods
251
Old drug used primarily for meningitis - very toxic but still used in developing countries Biggest concern (2)
Grey baby syndrome Anemia (aplastic, dose dependent)
252
Grey baby syndrome casued by what drug and why? Symptoms
Chloramphenicol - bacteriostatic due to decreased UDP gycouronyl transferase activity in neonates to take care of the toxic metabolites ashen grey colored baby, flaccid, cyanotic, refuse to suckle, abdominal distention
253
Go to drug for anaerobes w/ metronidazole Indicated for what else (3)
Clindamycin - bacteriostatic anaerobes but also MRSA(skin abcesses), protozoal infections, acne
254
Toxicity associated w/ Clindamycin
C dif infection w/ a psuedomembranous overgrowth
255
drug used topically more than iv due to sever nephrotoxic and neurotoxic effects Used for?
Polymyxin Used for severe last resort gram - infections
256
prophylaxis in meningococcal infection
Ciprofloxacin in adults | rifampin in kids
257
gonorrhea prophylaxis
ceftriaxone
258
syphillis prophylaxis
penicillin G
259
History of UTIs prophylaxis
TMP-SMX, nitrofurantoine, 1st and 2nd gen cephalosporins, amoxicillin
260
endocarditis w/ surgical or dental procedure prophilaxis
penicllins - aminopenicllins, cephalexins
261
Pregnant woman that is group B positive give
ampicillin
262
Prevention of gonorrhea and chlamydia conjunctivitis in newborns
erythromycin drops
263
H infleunzae meningicoccal exposure give
Rifampin
264
Pneumocystis jiroveci prophylaxis w/ CD4 <200
TMP-SMX if allergic - pentamidine, dapsone
265
Most common causes of pneumonia in neonates(2)
Group B strep E coli rx ampicillin w/ gentimicin
266
Pneumonia in 8wks -18yrs (5)
RSV Mycoplasma Chlamydia trachimonas- (infant -3) Chlamydophila pneumonia Strep pneumo
267
common cause of pneumonia in adults 18-40 (3)
``` Strep pneumo (older) Mycoplasma (younger) ``` Chlamydophila pneumonia
268
Common Cause of pneumonia in adults 40-65 (5)
Strep Pneumo H influenza anaerobes viruses mycoplasma
269
Pneumonia in the elderly >65
``` Strep pneumonia Influenza Anerobes H influenza gram - rods (new) ```
270
Nocosomial pneumonia (2)
staph aureus and enteric gram - rods
271
Immunocompromised pneumonia
pneumocystis jirovecii
272
Aspiration pneumonia
Anaerobes
273
pneumonia in alcoholics
klebsiella
274
Cystic fibrosisi pneumonia
pseudomonas S aureus S pneumonia
275
Atypical pneumonia (3)
Mycoplasma Chlamydiophila legionella
276
Common cause of meningitis in neonates
Group B strep #1 E coli Listeria
277
Causes of meningitis in children 6 months to 6 yrs (4)
Strep pneumonia #1 Nesseria Meningitidis - serious Hamophelous influenza type B Enteroviruses (echo and coxsackie)
278
Causes of meningitis ages 6 -60(4)
Strep pneumona N meningitidis (#1 in teens) enterovirus HSV (tempora encephalitis)
279
Causes of meningitis in elderly
S pneumonia Gram - rods Listeria
280
Rx for meningitis empirically? (2)
Vancomycin and ceftriaxone Dexamethosine to reduce inflammation
281
Most common cause of osteomyolitis
Staph aureous
282
Most common cause of osteomyolitis in a sickle cell patient
Salmonella
283
Most common cause of vertebral disease (infectious)
Mycobacterium tuberculosis (Potts)
284
Cat and dog bites that go deep to the bone worry about
Pateurella multocida - osteomyolitis
285
R/o osteomyolitis if you have negative what?
ESR or CRP can get MRI, plain radiographs, Bone biopsy = gold standard
286
Most common fungal infection of the lung in Texas/gulf
histoplamosis
287
Mist common fungal infection of the lung in SW Cali, Arizona, NM, Texas
cocciodes
288
Osteomyolitis concerns in an IV drug user(2)
Staph aureous and pseudomonas
289
painful indurates, ulcerated genital lesion w/ exudate
chancroid due to Haemophilus ducreyi
290
Stippled vaginal epithelial cells on a wet prep of vaginal discharge
clue cells
291
strawberry cervix
trichimonoa
292
infection of lymphatics, genital ulcers (painless) and rectal strictures (mimics IBD)
lymphogranuloma vereum due to chlamydia L1 - L3
293
Fitzs Hugh Curtis syndrome
infection of the liver capsule in PID ascending infection-> violin string adhesions of parietal peritoneum to liver
294
risks of exposure in a newborn nursery (2)
CMV | RSV
295
Risks w/ urinary catheterization (4)
E coli proteous mirabilis MRSA pseudomonas
296
Respiratory therapy equipment use linked to what infection
pseudomonas
297
Working in a renal dialysis unit and w/ sharps
HBV
298
Hyperalimentation (total parental feeding) have increased risk of what infection
Candida albicans
299
TORCHeS infections
``` Toxoplasma gondii O- other like parvovirus B19 R- Rubella C - CMV H- Herpes and HIV e S -syphilis ```
300
Congenital toxoplasmosis infection Risk Symptoms(3)
due to maternal exposure to cat feces or undercooked meat Choriorectinitis hydrocephalus intracranial calcifications
301
Congenital Rubella infection symptoms (3)
PDA Cataracts deafness +/- blueberry muffin appearance
302
Congenital CMV infection (3)
``` Hearing loss (unilateral) Seizures petechial rash (blueberry muffin) ```
303
Herpes simplex 2 congenital infection (2)
encephalitis - temporal lobe | herpetic lesions
304
Congenital syphilis infection complications - 5 early - 4 late
early - snuffles - hemolytic anemia - rash/desquamation - jaundice - radiographic changes(metatarsal dystrophy) late - saber shins (tibial bowing) - hutchingson's teeth (notched incisers) - Saddle nose - Frontal bossing
305
Congenital Parvo B19 exposure
Hydrops fetalis

USLME Kiss my ass and pray (33 decks)

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