Exam #3 Flashcards
(188 cards)
1
Q
Common cold 2 main causes
A
#1 Rhinovirus #2 Influenza virus
2
Q
rhinitis medicamentosa can occur when?
A
Decongestant should only be used for short term use bc can develop rhinitis medicamentosa (rebound congestion)
3
Q
Pharyngitis main viral causes
A
1 Adenovirus: can cause exudate like GAS (most common)
#2 Rhinovirus
#3 Coronaviruses
EBV
Coxsackie (hand foot and mouth / herpangina)
4
Q
Pharyngitis main bacterial causes
A
GAS Group C and G Neisseria Fusobacterium Diphtheriae Arcanobacterium haemolyticum
5
Q
How to tell the difference btw GAS and Arcanobacterium haemolyticum caused pharyngitis
A
Arcanobacterium haemolyticum: extremities -> trunk and spares palms/soles
GAS: head/neck -> trunk
6
Q
Trismus
A
can’t open mouth
7
Q
Dental Caries cause
A
strep mutans
8
Q
Acute Ulcerative Gingivitis cause
A
Fusobacterium
9
Q
Ludwig’s angina
A
cellulitis and abscesses on floor of mouth (leads to tongue elevation -> see under tongue when opens mouth)
-often descend down ant chest wall
10
Q
Sulfur granules are associate w
A
actinomycetes
11
Q
Cervicofacial actinomycosis
A
usually starts from other odontogenici infects (caused by actinomyces that form sulfur granules)
12
Q
Angular cheilitis common cause
A
Candida
13
Q
Candida stomatitis found in what patients
A
diabetics or immunocompromised
14
Q
most common cause of oral squamous cell carcinoma
A
HPV subtype 16
15
Q
Parotitis 2 cause and difference
A
Mumps Virus
Staph aureus: more acute and seen in a hospital setting in an elderly or debilitated patient who is mouth breathing
16
Q
duct drain submandibular and sublingual salivary glands under tongue
A
Wharton duct
17
Q
parotid gland duct
A
Stensen’s duct
18
Q
Sinusitis bacterial causes
A
Strep pneumonia (most common)
Haemophilus influenzae
Moraxella catarrhalis
19
Q
Sinusitis fungi cause, common symptoms, and common patient
A
Mucormycosis
- black necrotizing lesion on face
- diabetics
20
Q
Sinusitis symptoms
A
Facial pain that inc w bends forward or lies down
21
Q
Cavernous sinus thrombosis definition
A
occur from a spread of infection in the highly anastomotic venous system retrograde to the base of the skull (usually ethmoid or sphenoid sinusitis)
22
Q
Cavernous sinus thrombosis symptoms
A
loss of vision, photophobia, eye bulging
23
Q
Otitis Media causes
A
Strep pneumoniae (most common)
Haemophilus influenza
Moraxella catarrhalis
24
Q
Bullous myringitis
A
blistering of tympanic membrane
25
otitis externa in diabetics cause
pseudomonas
26
Erysipelas vs cellulitis
Cellulitis: defused borders
Erysipelas: bright read and sharp borders
27
sinusitis and Facial Cellulits can lead to .... which can cause lateral gaze palsy
cavernous sinus thrombosis
| -CN VI
28
Facial Cellulits cause pre-vaccine era
Haemophilus influenzae
29
Thumbprint Xray
epiglotitis
30
Epiglottitis causes
Strep pneumoniae
| Haemophilus influenzae
31
Steeple Sign on Xray
Croup (laryngotracheobronchitis)
32
Croup cause
Parainfluenza virus
33
Lemierre’s Syndrome cause and symptoms
Fusobacterium necrophorum
| Symptoms: soar throat followed by unilateral neck swelling
34
Cobble stone pattern on Xray
Infectious Esophagitis caused by Candida
35
Infectious Esophagitis causes
Candida (most common)
HSV (will show multinucleate cells)
CMV (will show owl’s eyes)
36
Infectious Cervical Lymphadenitis causes
Usually Strep or Staph
Bartonella henselae (Cat Scratch Disease)
Francisella tularensis (Tularemia)
** EBV, CMV, HIV, Toxoplasma, Rubella (posterior cervical)
37
Infectious Conjunctivitis cause
Adenovirus (most common)
| Trachoma (Chlamydia trchomatis) seen in neonatal via delivery
38
Infectious Keratitis bacterial causes
Staph aureus
| Pseudomonas aeruginosa: via contacts
39
Infectious Keratitis viral causes and THIER ASSOCIATION
Adenovirus: leads to subcorneal infiltrate
HSV: causes dendritic pattern
40
Diphtheria symptoms and associations
Barking cough
Bull neck
Pseudomembrane in nose or on tonsils
**peripheral neuropathy
41
Diphtheria agar
Blood agar
| Loeffler’s agar
42
Atelectasis trachea will deviate
towards side of atelectasis
43
Bronchiectasis causes
Cystic Fibrosis
Karagener Syndrome (Dyskinetic Cilia Syndrome)
Aspergillosis
Foreign body aspiration
44
signet ring sign on X-ray
Bronchiectasis
45
Bronchiectasis bacterial colonization
Haemophilus influenzae
| Pseudomonas aeruginosa
46
Tree in bud pattern on xray
Bronchiectasis
47
Kartagener Syndrome symptoms
Infertility (sperm flagella doesn’t work)
Bronchiectasis
Chronic Rhinossinusitis
Situs Inversus w Dextrocardia
48
Aspiration pneumonia locations
sup segment of RLL
| post segment of RUL
49
pneumonia phases
1. Pulmonary capillary congestion
2. Red hepatization (neutrophils and RBCs)
3. Gray hepatization (neutrophils and fibrin)
4. Resolution/consolidation (macrophage clear debri)
50
pneumonia clinical findings
```
Egophony (E to A changes)
Bronchophony (vocal fremitus by saying 99)
Percussion dullness
Rales
Pleural friction rub
```
51
Community Acquired Pneumonia Strep pneumoniae symptoms
Rusty sputum
| Elevated bilirubin and transaminases
52
Pneumonia in COPD patients is caused by
Haemphilus influenza
Moraxella catarrhalis
Legionella
53
Community Acquired Pneumonia Staph aureus is see in
patients following influenza infection, IV drug users, and cystic fibrosis
54
Cystic Fibrosis Pneumonia is caused by
Staph a
Pseudomonas
Burkholderia
55
Haemophilus influenzae is a
gram neg coccibacillus
56
Moraxella catarrhalis is a
gram neg coccibacillus
57
bulging fissure sign on xray
Klebsiella
58
Klebsiella is a
gram negative rods
59
Mycoplasma pneumoniae pneumonia is seen in
Adolescents and young adults living close quarters (college/military)
60
Chlamydophila pneumoniae pneumonia is associated w
Illness commonly associated with asthmatic bronchitis (bronchospasms) and wheezing
61
Legionella pneumophilia symptoms
Faget’s sign
| hyponatremia
62
Legionella pneumophilia agar
Buffered Charcoal Yeast Extract agar
63
Tularemia is associated w and is seen in
significant Hilar Lymphadenopathy
64
placenta of birthing animals
Q fever (Coxiella brunetii)
65
biological warfare
Tularemia
66
Viral atypical pneumonias causes
- children
- adults
- COPD
- children: Respiratory Syncytial Virus
- adults: Influenza virus
- COPD: Metapneumovirus
67
Severe Acute Respiratory Syndrome (SARS) arises where
China
68
Post-Influenza Bacterial Pneumonia are caused by
1. Strep pneumoniae
2. Staph a
3. Haemophilus influenzae
4. GAS
69
Associated w infected pet birds
Chlamydophila psittaci
70
Inc Procalcitonin
bacterial pneumonia
71
Pneumonia Treatment
- Healthy Person: Macrolide
- Chronic Disease/Immunosuppressive Patient: Quinolone
- Inpatient (non ICU setting): quinolone vs ceftriaxone/macrolide vs ceftriaxone/doxycycline
72
MIC >2 means
penicillin resistant
73
Bordetella pertussis agars
Bordet-Gengou agar
| Regan-Lowe Charcoal Blood agar
74
Bordetella pertussis (“Whooping Cough”) symptoms
- Prolonged cough
- Paroxysmal staccato cough w inspiratory whoop
- Tracheitis on bronchoscopy
- Subconjunctival Hemorrhage
75
Bordetella pertussis (“Whooping Cough”) symptoms
- Prolonged cough
- Paroxysmal staccato cough w inspiratory whoop
- Tracheitis on bronchoscopy
- Subconjunctival Hemorrhage
76
Staph and strep agar
blood agar
77
Haemophilus agar
chocolate agar
78
Klebsiella agar
MacConkey agar
79
Pseudomonas agar
MacConkey agar
80
Mycobacteria agar
Lowestein-Jensen agar
81
Bordetella agar
Bordet-gengon
| Regan-Lowe Charcoal blood agar
82
Pleural infection signs
Low pH
Low glucose
Inc LDH
83
Gohn and Ranke complexes are formed why?
Tb causes hypercalcemia leading to Ca2+ lesions
84
Milirary Tb definition
Tb disseminated into the blood stream
85
Tb skin test results
Healthy
High Risk Ind
Recent contact
Healthy: >15mm
High Risk Ind: >10mm
Recent contact: >5mm
86
PZA resistant Tb
M. kansasii
87
Actinomycosis often accompanied by
Aggregatibacter
88
Actinomycosis pathology
colonized in the oral cavity in nearly all people, pathogenesis begins w the disruption of a mucosal barrier via surgery, trauma, malignancy, or radiation therapy
89
Nocardia stain
Ziehl-Neelsen
Kinyoun AFB
**Actinomyces does not show up on
90
Actinomyces histo and gram stain
| -AFB
45 degree branching and bush like commonly on gram stain
- gram +
- AFB -
91
Nocardia histo and gram stain
| -AFB
90 degree branching that resemble beading appearanc on a gram stain
- gram +
- AFB +
92
Histo causes (location)
caves/bridge workers where birds
93
Histo plasma stains
Wright stain
| Silver stain
94
Urine Antigen test
legionella
histo
coccidioides
95
Histo associations
- Erythema nodosum
| - Oropharyngeal and GI ulcers in immunocomp patients
96
Blasto histo
broad based budding
97
blasto association
bone (osteomyelitis)
| skin lesions
98
Coccidioides histo
spherule
99
thin walled cavities
Coccidioides
100
CNS related pneumonias
nocardia
coccidiodes
cryptococcus
101
Cryptococcosis histo
Narrow based budding yeast
102
Cryptococcosis stain
Mucicarmine stain
103
if histo is found in GI think
AIDs
104
penicilliosis/talaromycosis
sausage form
105
Immunocompromised (AIDs) patients in SE Asian think
penicilliosis/talaromycosis
106
Paracoccidioidomycosis histo
Multiply budding yeast
107
Paracoccidioidomycosis associated lesions
Mullberry
108
HALO sign on Xray
aspergillosis fungus balls
109
aspergillosis stain
silver stain
110
aspergillosis histo
septate 45 degree
111
Mucomycosis (Zygomycosis) histo
non septate 90 degree
112
Pneumocystis pnuemonia stain
Gomori-Methomine Silver stain (sputum)
113
Pneumocystis pnuemonia histo
Resembles tea cups or crushed ping-pong balls
114
Pneumocystis pnuemonia compilations associtiaon
Spontaneous Pneumothorax
115
1,3 Beta-D-Glucan test for what and except what
Tests for fungal infections
- Zygomycets (mucor)
- Blasto
- Cryptococcus
116
Galactomannan test mainly for
aspergillus
117
Lung parasites
- ascaris
- ancyclostoma duodenal/americanus
- strongyloidiasis
118
Lung parasitic infiltration will have
Eosinophils in sputum w Charcot-Leygen crystals
| Larvae in sputum
119
Loeffler Syndrome
lung issues caused by pulmonary parasites
120
Paragonimiasis is found where in the world
- Eastern Asia and South America
| - Diagnosis: eggs in sputum and hemoptysis
121
Paragonimiasis diagnosis by
eggs in sputum
| hemoptysis
122
Strongyloidiasis histo
spiral worm
123
M. canettii vs M. africanum
M. canettii: East africa
| M. africanum: West africa
124
M. bovis is acquired by
cattle/bison/deer/elk and is spread to humans via unpasteurized milk and animal contact via handling, meat or milk (once common in humans, now uncommon, 2% of US cases)
125
smoking toxic chemicals
- Polycyclic Hydrocarbons
- Nicotine
- Arsenic
126
lung cancer activation mutations
```
KRAS
EGFR
cMET
cMYC
VEGF
```
127
Lung cancer inactivation mutations
p16
RASSF1A
p53
Rb
128
Central cancer growth can be
Squamous cell
| Small cell
129
Squamous cell carcinoma is described histologically how?
Intercellular bridges
| Keratinizing patterns
130
Chromogranin + lung cancers
Small cell
| Carcinoid cancer
131
Small cell cell association
Kulchisky cells
132
Peripheral lung cancer
Adenocarcinoma
133
Adenocarcinoma cells express
TTF-1
| Napsin A
134
Acinar scarring condition from adenocarcinoma is is appear how histologically?
Cavities that are lined w columnar cells
135
Carcinoid Tumor of the Lungs how described how histologically
- Delicate stromal septa that looks like nuclei are creating a fence between it and the rest of the tumor
- Palisading
136
Carcinoid Syndrome symptoms
Diarrhea
Flushing
Cyanosis
137
Lung Hamartoma
- nodules of connective tissue
| - intersected with epithelial cleft (lined w ciliated/unciliated cleft)
138
Mutation in TSC2 tumor supressor gene
Lymphangioleiomyomatosis
139
rearrangement of ALK gene
Inflammatory Myofibroblastic Tumor
140
Pleural Tumors
- expression
- cryptic inversion of chromosome 12
Expression: CD34+ and keratin negative
Association: cryptic inversion of chromosome 12
141
Malignant Mesothelioma
| -expression
- Asbestos exposure
| - Deletion of tumor suppressor CDKN2A/INK4a
142
Pancaost Tumor can cause
- Horner Syndrome
| - Miosis, ptosis, anhidrosis (no sweating), enothalmost (sunken eyeball)
143
Uncomplicated Cystitis symptoms
| -does this require a urine analysis?
1. Dysuria (pain during urination)
2. Increase frequency
3. NO VAGINAL DISCHARGE
-No, bc positive dipstick alone has 90% sensitivity
144
Complicated Cystitis includes
females w comorbid medical conditions, ALL males, patients w catheters or who are hospitalized
145
Pyelonephritis symptoms
All symptoms that apply to cystitis plus
- Fever
- Flank/back pain
- Abdominal pain
- Naseau, vomiting
**these patients appear very ill while cystitis patients are more or less irritated/uncomfortable
146
WBC/Grandular cast suggest
pyelonephritis
147
Prostatitis symptoms
- Pain (perineum, lower abdomen, testicles, penis, and with ejaculation)
- Bladder obstruction leading to dribbling
- Potentially blood in semen
- Inc PSA
148
what do you not want to do w an acute prostatitis patient?
DRE, could lead to sepsis due to aggravation
149
Epididymitis symptoms
- Acute onset of testicular pain
- History of urinary frequency, dysuria, and fever
- Scrotal erythema, edema, nodule
150
Sepsis qSOFA
Infection proven/suspected + 2 of the following
1. Altered mental status
2. Resp Rate > 22 breathes/min
3. Systolic BP <100 mmHg
151
Septic Shock qSOFA
1. vasopressors fail to maintain or are need to maintain MAP > 65 mmHg
2. Blood Lactate Acid > 2 mmol/L
152
Most sensitive UTI test
Leukocyte esterase
153
Most specific UTI test
Nitrite
154
+ Nitrite on urine test means
gram negative bacteria
| -rules out staph sap
155
pH 8-9 on urine test
proteus
156
Colonization is described as
patients who are negative for leukocyte esterase and nitrite, no symptoms, but have >100,000 cfu/mL bacteria
157
Want to treat pregnant women who are colonized why?
because they are at a 30% higher risk for a UTI
158
top 2 causes of community-acquired UTIs
1. E. coli (80% of cases)
| 2. Staph saprophyticus
159
Coagulase Neg Staphs and novobiocin test
- Staph saprophyticus (novobioicin resistant)
| - Staph epidermidis (novobiocin sensitive)
160
Proteus UTI results in
- Staghorn” kidney stone
- Converts urea to ammonia
- Urine of pH 8-9 diagnosis
- Swarming/bullseye on blood agar
161
Hematuria causing Trematode and where it is commonly found
Schistosoma haematobium
| -Commonly presents in young boys in Ghana (boy period)
162
Enterococcus spp can be identified by
Catalase neg
Gamma hemolysis
Grows on 6.5% NaCl media
163
Ferment: Positive (fast) bacteria
Escherichia coli
| Klebsiella ssp
164
Pseudomonas aeruginosa
- ferment
- oxidase
Ferment: Negative
Oxidase: Positive
165
Proteus ssp
- ferment
- oxidase
- pH
Ferment: Negative
Oxidase: Negative
pH: 8-9
166
Men <35 years old cause of prostatitis and epididymitis
STI
| Ureaplasma, Chlamydia, Neisseria
167
Men >35 years old cause of prostatitis and epididymitis
BPH (benign prostate hyperplasia)
168
Urine leukocytes appear in
cystitis and pyelonephritis
169
calcium oxalate crystals observed in urine analysis and metabolic acidosis suspect
Etholene Glycol (anitfreeze) consumption
170
Pyuria definition
urine containing WBCs
171
amount of WBCs/high powered field suggests UTI
10
172
Children infected w respiratory ... can present with hematuria
adenovirus
173
Sterile Pyuria suggests
Most likely indicates STI (Chlamydia trachomatis & Neisseria Gonorrhea)
174
Whiff Test
- Strong Positive
- Negative
- Positive
- Strong Positive: Gardnerella vaginosis
- Negative: vulvovaginal candidiasis
- Positive: Trichomonas vaginalis
175
Strawberry cervix
Trichomonas vaginalis
176
swim across urine microscopy
Trichomonas vaginalis
177
Clue cells - glitter epithelial cells covered in bacteria
Gardnerella vaginosis
178
Nephrotic symptoms
- Heavy, selective proteinuria (> 3 g/day)
- Hypoalbuminemia
- Edema (less plasma colloid pressure, salt and water retention)
- Hyperlipidemia
- Hypercoagulability (loss of AT-III in urine)
179
Nephritic symptoms
- Hematuria (cells, Hb or blood casts)
- Mild, non-selective proteinuria (< 3g/day)
- Hypertension (generally mild)
180
Immune complex deposition immunofluorescent
granular deposition
181
Anti-neutrophil cytoplasmic antibodies (ANCA)
P-ANCA
C-ANCA
P-ANCA: Churg-Strauss Syndrome
| C-ANCA: Wegenger's Granulomatosis
182
Anti-endothelial cell antibodies (EACA) result in
EACA increase the adhesiveness of leucocytes to the endothelial cells
183
Cell-mediated glomerular injury is characterized by
immunoglobulin-deficient GN
184
IgA nephropathy (Berger disease)
- IgA deposits in mesangium leading to mesangial cell proliferation
- Most common type of glomerulonephritis worldwide
185
IgA nephropathy often is associated with
frequent mucosal/celiac infections/diseases
186
Alport syndrome
X linked collagen type IV defect leading to splitting of glomerular BM
187
Thin basement membrane lesion
- GBM widths 150-225 nm
- Mild-moderate proteinuria
- most common cause of benign familial hematuria
188
Diffuse cortical necrosis often occurs
- after obstetric emergency like abruptio placentae
- septic shock
- extensive surgery
