Final Exam Flashcards
(230 cards)
1
Q
Tropism
A
the tendency of a pathogen to infect specific cells
2
Q
2 types of pathogenesis for viruses
A
latent and lytic
3
Q
genetic material of viruses
A
DNA or RNA
4
Q
viral causes of common cold
A
rhinovirus, coronavirus
5
Q
viral causes of pharyngitis
A
adenovirus, cocksackie virus
6
Q
croup virus
A
parainfluenza
7
Q
bronchiolitis virus
A
RSV
8
Q
pneumonia virus
A
influenza etc
9
Q
viral causes of ocular infections
A
herpes simplex, adenovirus
10
Q
infectious mononucleosis virus
A
Epstein-Barr virus
11
Q
viral causes of meningitis
A
enterovirus, HSV 2
12
Q
viral causes of infectious diarrhea
A
rotavirus (infants), norovirus
13
Q
measles virus
A
rubeola
14
Q
German measles virus
A
rubella
15
Q
viral cause of erythema infectiosum
A
parvovirus B19
16
Q
chicken pox/shingles virus
A
varicella zoster virus
17
Q
hand, foot and mouth disease virus
A
Coxsackie virus
18
Q
warts virus
A
papillomavirus
19
Q
molluscum virus
A
molluscum contagiosum
20
Q
indications for viral serology
A
when it’s difficult or impossible to culture the virus
21
Q
indications for viral culture
A
emergence of new viruses
22
Q
indications for detection of viral antigens
A
when rapid detection is needed
23
Q
indications for molecular viral diagnosis
A
when accurate diagnosis is necessary
24
Q
advantages of viral serology
A
can detect acute and past infection
25
disadvantages of viral serology
there can be a delay due to the time required to develop antibodies, IgG and IgM levels may not rise and fall "on schedule" and there may be confounding factors (immunocompromise, passive IgG in the newborn, etc)
26
advantages of viral culture
inexpensive
27
disadvantages of viral culture
time consuming
28
advantages of detection of viral antigens
rapid, inexpensive, specific
29
disadvantages of detection of viral antigens
lack of sensitivity
30
advantages of molecular detection of viruses
high sensitivity and specificity
31
disadvantages of molecular detection of viruses
expensive, must know target
32
Normal flora of the nasopharynx
moraxella catarrhalis, strep pneumoniae, h influenza
33
normal flora of the mouth
strep viridans, actinomyces, candida albicans
34
normal flora of the pharynx
strep pyogenes, kingella kingae (kids)
35
normal skin flora
staph aureus, staph epidermidis, strep pyogenes, p. acnes, candida albicans
36
normal GI flora
enterobacteriae (e. coli, enterobacter, klebsiella), enterococcus, candida
37
normal vaginal flora
strep agalactiae, actinomyces, gardnerella vaginalis, candida albicans
38
mutualism
both the host and microbe benefit
39
commensalism
one partner benefits, the other is neutral
40
parasitism
one partner benefits, the other is harmed
41
pathogenic
damage is caused to the host
42
common opportunistic infections in patients with T-cell compromise
pneumoncystis jerovecii pneumonia, cytomegalovirus colitis
43
frank pathogens
always cause disease
44
facultative pathogens
may cause disease or may not cause disease depending on circumstance (majority of pathogens)
45
opportunistic pathogens
only cause disease in immunocompromise
46
obligate anaerobes
B. fragilis, fusobacterium, all clostridia, actinomyces, peptostreptococcus
47
obligate aerobes
mycoplasma tuberculosis, pseudomonas, nocardia, bacillus
48
bacterial meningitis causes < 1 month
E. coli, group B strep, listeria
49
bacterial meningitis causes 1-23 months
Strep pneumonia, neisseria, Hib, group B strep, E. coli
50
bacterial meningitis causes teens/young adult
strep pneumonia, neisseria
51
bacterial meningitis older adults
strep pneumonia, neisseria, Hib, group B strep, Listeria
52
first line treatment for all bacterial meningitis
ceftriaxone
53
2nd line treatment for bacterial meningitis < 1 month
ampicillin
54
2nd line treatment for bacterial meningitis 1-23 months
vancomycin
55
2nd line treatment for bacterial meningitis teens/young adults
vancomycin
56
2nd and third line treatments for bacterial meningitis in older adults
vancomycin, ampicillin
57
bacteria not characterized by gram stain
Mycoplasma, mycobacteria, treponema, nocardia, chlamydia, rickettsia
58
reason no gram stain for mycoplasma and what to use instead
no cell wall, use PCR
59
reason no gram stain for mycobacteria and what to use instead
contains mycolic acids and lipids that don't allow for penetration of stain, use acid-fast stain
60
reason no gram stain for treponema and what to use instead
too small, use dark-field microscopy
61
reason no gram stain for nocardia and what to use instead
contains mycolic acids and lipids that don't allow for penetration of stain, use modified acid-fast stain
62
reason no gram stain for rickettsia and what to use instead
obligate intracellular organism, use antibody titer
63
reason no gram stain for chlamydia and what to use instead
obligate intracellular organism, use PCR
64
"lancet-shaped diplococci"
strep pneumoniae
65
significance of WBCs and epithelial cells in gram stain sample
high WBCs indicate infection, high epithelial cells indicate bad sample
66
lactose-fermenting gram negative rods
E. coli, klebsiella
67
non-lactose fermenting gram negative rods
pseudomonas, e. coli, proteus, salmonella
68
what is required for control of herpesviruses
cell-mediated immunity
69
HBsAg
HepB surface antigen, indicates active infection
70
HBsAb
Anti-HepB surface antigen, confers immunity, indicates prior infection or vaccination
71
HBcAg
HepB core antigen, not detectable in serum
72
HBcAb
Anti-HepB core antigen, seen in chronic infection or resolved infection. NOT present in vaccinated people
73
HBeAg
HepB "e" antigen, seen when viral load is high, indicates highly infectious
74
HBeAb
anti-HepB "e" antigen, can be seen in chronic infection
75
screening recommendations for HepC
all pregnant women, all adults at least once 18-79
76
initial test for HCV and what to do if positive
HCV antibodies, then HCV RNA (if positive, active infection)
77
treatment of HepA
supportive
78
treatment of HepB
lamivudine, tenofovir, entecavir, adefovir, interferon
79
treatment of HepC
ribavarin, directly acting agents, interferon
80
major side effect of ribavarin
hemolytic anemia
81
side effects of interferon
bone marrow suppression, flu-like illness, depression
82
side effects of directly acting agents
nausea, headache, fatigue
83
side effects of other HepB antivirals
nausea/vomiting, renal disease, lactic acidosis
84
single-dose antiviral drug for flu
baloxavir marboxil (Xofluza)
85
when should antiviral treatment for flu be initiated
within 48 hours of onset of symptoms
86
which influenza virus is most susceptible to antigenic shift
influenza A
87
what is antigenic shift
random recombination of RNA segments from different strains (from different species)
88
oseltamivir uses
treatment and exposure prophylaxis of influenza > 1 year old
89
oseltamivir side effects
nausea/vomiting
90
acyclovir uses
treatment and prophylaxis of HSV 1/2, HSV encephalitis, herpes zoster, genital/ocular herpes, varicella zoster (immunocompromised)
91
topical acyclovir side effects
irritation and burning sensation
92
oral acyclovir side effects
nausea, diarrhea, rash
93
IV acyclovir side effects
renal insufficiency, neurotoxicity
94
valacyclovir characteristics
prodrug, PO, increased bioavailability
95
valacyclovir uses
herpes zoster, genital herpes
96
valacyclovir side effects
nausea, diarrhea, rash
97
mechanisms of action of antivirals
replication inhibitors, attachment/fusion/entry inhibitors, uncoating inhibitors, integration/protease inhibitors
98
mechanisms of action for monoclonal antibodies in treatment of viral infections
block viral attachment or fusion/uncoating
99
how are protozoa different from bacteria
eukaryotes with intracellular organelles and complex life cycles
100
what are the two life stages of protozoa
trophozoite, cyst
101
what type of parasite if toxoplasma
CNS
102
what type of parasite is malaria
blood
103
successful vaccine
circulating high-affinity IgG, increased frequency of pathogen-specific B and T cells, rapid response to infection
104
clues of HIV infections
fatigue, weight loss, night sweats, recurrent candida or BV, frequent pulmonary infections
105
body fluids that are contagious in HIV
blood, breast milk, tissue, semen/vaginal, anal secretions
106
not contagious in HIV
urine, saliva, sweat, tears, nasal secretions, sputum, vomit, stool
107
screening for HIV
all 15-65 y/o, pregnant women, others that are high risk
108
3rd generation HIV test window period
6-8 weeks
109
3rd generation HIV test
antigens bind HIV antibodies in patient sample
110
4th generation HIV test
antigens bind HIV antibodies from patient and monoclonal antibodies to detect antigen
111
4th generation HIV test detection
12-26 days after exposure
112
when to start HIV treatment
all infected adults especifically if opportunistic infxns, pregnant women, hepatitis coinfection
113
HIV treatment
2 NRTI and integrase inhibitor
114
avoiding HIV drug interactions
careful with cytochrome P450
115
when to start HIV prep
at least 7 days prior to exposure
116
HIV prep regimen
daily 2-drug
117
when to start HIV pep
within 72 hours of expsure
118
HIV pep regimen
28 day course of 3-drug regimen
119
when to start prophylaxis for toxoplasma reactivation
CD4<100 and toxo IgG reactive
120
prophylaxis for toxoplasma reactivation
trimethoprim/sulfamethoxazole
121
ssx of toxomplasma reactivation
focal encephalitis, ring-enhancing brain lesion on CT
122
when to start prophylaxis for pnuemocystis
CD4<200
123
signs and symptoms of pneumocystis
progressive dyspnea, nonproductive cough, pleuritic chest pain, ground-glass opacities
124
prophylaxis for pneumocystis
trimethoprim-sulfamethoxazole
125
when to start prophylaxis for MAC
CD4<50
126
what is prophylaxis for MAC
azithromycin
127
ssx of MAC
disseminated multi-organ infection
128
bactrim aka
trimethoprim/sulfamethoxazole
129
what do you need before treating for HCV
HCV RNA
130
dendritic epithelial defect on slit-lamp exam indicates
ocular herpes
131
best treatment for ocular herpes
topical or oral acyclovir
132
Innate immune response is for what kind of bacteria
primarily extracellular
133
pneumococci resistance
capsule inhibits phagocytosis
134
staph resistance
catalse breaks down ROS to resist phagocytosis
135
neisseria resistance
resist complement activation
136
adaptive immunity response to extracellular bacteria involves which part of immune system
humoral (high-affinity IgG antibodies)
137
Innate response to viruses
NKCs, interferon, chemokines
138
adaptive response to viruses
antibody formation, cytotoxic T-cells
139
T-cell immunodeficiency causes difficulty with what type of infections
viruses
140
why do we add protein adjuvants to vaccines
to stimulate T-cell response to make high-affinity IgG antibodies
141
response to vaccines that include T-cell response characteristics
long-lived, memory cells, faster and higher magnitude of secondary responses
142
neutropenia is a defect of what part of immune system
innate
143
XLA is a defect of what part of immune system
humoral
144
infections seen with neutropenia
pyogenic infections, skin infections, visceral abscesses, bone injections
145
infections seen with XLA
encapsulated organisms, recurrent sinus/pulmonary infections
146
mechanism of innate immune deficiency
decreased chemotaxis, phagocytic capacity, intracellular killing, complement deficiency
147
organisms seen in neutropenia
skin flora, gut flora, staph
148
mechanism of humoral deficiency
fail to make antibodies, failure of lymphocyte maturation/activation
149
mechanism of immunocompromise in asplenia
suboptimal opsonization, low levels of circulating IgM
150
mechanism of immunocompromise in cell-mediate immunity
impact T-cell mediated responses
151
infections seen in cell-mediated immunodeficiency
intracellular organisms, viruses, opportunistic infections
152
examples of cell-mediated immunodeficiency
prednisone, CD4 deficiency, HIV, diGeorge syndrome
153
common organisms seen in asplenia
encapsulated: s. pneumoniae, h. influenzae, h. meningitidis
154
common organisms seen in cell-mediated immunodeficiency
opportunistic: listeria, pneumoncystis, nocardia, mycobacteria, histoplasma, coccidoides, aspergillus, toxoplasma, HSV, CMV
155
common organisms seen in humoral immunodeficiency
encapuslated, plus enteroviruses, shigella, giardia, campylobacter
156
common organisms seen in innate immunodeficiency
staph, strep viridans, enterococcus, e. coli, serratia, aspegillus, nocardia
157
neutropenia
<1500 neutrophils/microL
158
causes of neutropenia
chemotherapy, transplants, abx, congenital, hematologic malignancy, SLE, viral infections
159
severe neutropenia
<500
160
moderate neutropenia
between 500 and 1000
161
most common cause of neutropenic fever
Bacteria (esp gram negative bacilli, causes more severe disease)
162
most common GN and GP bacteria causing neutropenic fever
GN: pseudomonas,, GP: Staph epidermidis
163
treatment of neutropenic fever
start gram negative coverage with pseudomonas (piperacillin/tazobactam), can add vanc if gram positive also suspected
164
when is prophylaxis indicated for neutropenia
when neutrophils are expected to drop below 500
165
bacterial prophylaxis for neutropenia
cipro (covers psuedomonas)
166
fungal prophylaxis for neutropenia
flucanozole
167
viral prophylaxis for neutropenia
acyclovir
168
screening before inducing secondary neutropenia
TB, hep B, hep C
169
bacteria most likely to cause otitis media
strep pneumo
170
stages of TB
primary, latent, active (reactivation)
171
x-ray findings of latent TB
normal or granulomas/cavitary lesions
172
latent TB contagious
no, as long as no symptoms are present
173
x-ray findings of active TB
apical lobe lesions, consolidations, hilar lymphadenopathy
174
active TB contgious
airborne
175
when to read PPD
48-72 hours
176
type of hypersensitivy reaction PPD
delayed type-4
177
positive PPD over 15 mm
people without risk factors
178
positive PPD over 5 mm
immunocompromised, close contacts of active TB, x-ray changes
179
positive PPD over 10 mm
health care workers, IV drug users, congregate living situations, recent arrival sfrom endemic countries, comorbid condtions, peds under 5
180
4 drugs for TB
Rifampin, isoniazid, pyrazinamide, ethambutol
181
side effects of rifampin
reddish-orange secretions
182
side effects of isoniazid
peripheral neuropathy (give B6), hepatitis (avoid alcohol)
183
side effects of pyrazinamide
photosensitivity
184
side effects of ethambutol
vision changes
185
how to prevent drug-resistant TB
never add a single drug to a failing regimen
186
treatment for latent TB
9 months of INH
187
what viruses cause silent subclinical infection for life
CMV, EBV
188
virus causing hand foot mouth disease
coxsackie virus
189
what does molluscum look like
flesh-colored bumps with a central divet in a cluster
190
molluscum treatment
can scrape off but will go away in several months
191
fifth disease appearance
slapped cheek
192
chicken pox appearance
vesicles, scabbed, crusted (different stages)
193
hand foot and mouth
palms and soles (itchy)
194
IgM can rise when
after reactivation of latent viruses (herpesviruses)
195
viruses in herpes family
HSV 1/2, VZV, EBV, CMV
196
surface antigen positive HepB
active infection (acute or chronic)
197
surface antibody positive HepB
immune (either due to vaccination or infection)
198
surface antibody positive and core antibody positive
immune due to infection
199
surface antibody positive core antibody negative
immune due to vaccine
200
surface antigen positive and core antibody positive (IgM positive)
acute infection
201
surface antigen positive and core antibody positive (IgM negative)
chronic infection
202
genotypes of hep c
1a/1b (majority), 2
203
primary antivirals for flu
oseltamivir, zanamivir
204
antigenic shift
change in surface proteins
205
what are vaccines
harmless agents that elicit adaptive immune responses
206
what is the target for most vaccines against extracellular bacteria
capsular polysaccharides
207
what do live vaccine stimulate
humoral and T-cell responses
208
examples of live vaccine
varicella, MMR, flumist, rotavirus, yellow fever
209
what do inactivated vaccines stimulate
strong humoral response (IgG), poor T-cell mediated reponse: requires multiple doses
210
how to enhance immunogenicity of inactivated vaccines
adjuvants and conjugates
211
examples of inactivated vaccines
polio, hepatitis, rabies, pertussis, HPV, diphtheria, tetanus
212
examples of conjugated polysaccharide vaccines
HIB, pneumococcos, meningococcus
213
first-line treatment for chronic hep b
interferon, etecavir, tenofovir
214
viral causes of pneumonia
influenza, parainfluenza, RSV, adenovirus, SARS coronavirus
215
stye pathogen
staph aureus
216
chalazion pathogen
staph aureus
217
for which condition are abx drops more useful, chalazion or stye
chalazion
218
conjunctivitis usual etiology
adenovirus
219
conjunctivitis treatment
abx drops if no other URI symptoms
220
bacterial keratitis pathogen
staph or strep pneumo, possibly pseudomonas
221
preseptal cellulitis pathogen
staph aureus, strep pyogenes
222
preseptal cellulitis treatment
Keflex
223
orbital cellulitis pathogen
strep pneumo, Hib, moraxella (contiguous from sinus cavity)
224
orbital cellulitis treatment
emergent referral to specialist for IV ceftriaxone
225
most common pathogen in otitis media
strep pneumo
226
otitis externa pathogens
pseudomonas, aspergillus
227
preseptal cellulitis ssx
swollen, red eyelid
228
retropharyngeal abscess pathogen
GAS
229
what is ludwig's angina
infection of bilateral submandibular space (esp in HIV)
230
time it takes to grow mycobacteria cultures
4-6 weeks, 3 sputum samples
