IX - General Pathology of Infectious Diseases Flashcards Preview

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61

Lesion caused by this organism are typified by necrosis and exudative inflammation rich in neutrophils and macrophages and presence of large, boxcar-shaped gram-positive extracellular bacteria in chains.

Bacillus anthracis. (TOPNOTCH) Robbins Basic Pathology, 9th Ed p. 367

62

A 48 y/o male was admitted with a 4 month history of cough with purulent sputum, hremoptysis, and fever. He wa diagnosed with AIDS 2 years earlier and was on antiretivirals irregularly. On examination, HR=98bpm, RR= 26 /min. Chest auscultation revealed decreased breath sounds on the upper third of right hemithorax. CXR demonstrated consolidation in the upper lobe of the right lung. Bronchoscopy with lavage revealed presence of branching filamentous gram positive organism. The organism described is

Nocardia asteroides. (TOPNOTCH)

63

A 17 y/o college student presented with fever, chills, headache, joint pains and myalgia. On physical examination, she is tachycardic, febrile, with mild hypotension. There was noted petechial rashes on her trunk and legs. Gram stain revealed gram-negative coffee-bean shaped diplococci. The most likely cause of this condition is

Neisseria meningitidis. (TOPNOTCH)

64

A 25 y/o female complained of severe pelvic pain and fever. A greenish yellow cervical discharge was detected on physical examination. Gram negative diplococci were isolated from the endocervical swab. What is the most likely cause?

Neisseria gonorrhea (TOPNOTCH) Robbins Basic Pathology, 9th Ed p. 368

65

A 2-month old infant was admitted with fever, lymphocytosis, and bouts of violent coughing that often end in vomiting. Blood culture showed small gram-negative rods. The most likely diagnosis is:

Pertussis (TOPNOTCH)

66

Mechanism on how B. pertussis toxin impair host defenses.

Inhibits phagocytosis, inhibits neutrophils and macrophages and paralyzing cilia. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 369

67

Bacteria causing laryngotracheobronchitis with features of bronchial mucosal erosion, hyperemia, and copious, mucopurulent exudate. It may present with hypercellularity and enlargement of mucosal lymph follicles and peribronchial lymph nodes along side a marked peripheral lymphocytosis (up to 90%)

Bordetella pertussis. (TOPNOTCH) Robbins Basic Pathology, 9th Ed p. 369

68

A 67 y/o female was admitted with a 1 week history of cough and pleuritic chest pain. Physical examination revealed tachypnea, rhonchi in both upper lobes. The next day, patient's condition deteriorated and had severe respiratory distress. Autopsy revealed extensive bilateral bronchopneumonia and necrosis in the terminal airways in a fleur-de-lis pattern, with striking pale necrotic centers and red, hemorrhagic peripheral areas. The most likely cause of this disease is:

Pseudomonas aeruginosa (TOPNOTCH) Robbins Basic Pathology, 9th Ed p. 369

69

An opportunistic aerobic gram-negative bacillus that is frequent, deadly pathogen of people with cystic fibrosis, severe burns, or neutropenia.

Pseudomonas aeruginosa (TOPNOTCH) Robbins Basic Pathology, 9th Ed p. 369

70

A 32 y/o female on chronic immunosuppressive therapy was admitted for the management of her abdominal wound infection. On hospital day 18, patient developed erythematous papulovesicules on the left upper chest and right medial leg progressing rapidly to necrotic and hemorrhagic oval ulcers. What organism most likely cause this condition?

Pseudomonas aeruginosa (TOPNOTCH) Robbins Basic Pathology, 9th Ed p. 370

71

Organism that causes lymph node enlargement (buboes) with distinct histologic features of massive proliferation of organism, early appearance of effusions with few inflammatory cells, necrosis of tissues and blood vessels with hemorrhage and thrombosis, and neutrophilic infiltrates in necrotic areas.

Yersinia pestis (TOPNOTCH) Robbins Pathologic Basis of Disease, 9th Ed p. 370

72

A 25 y/o male initially presented with a tender erythematous papule on the penis which produce an irregular, painful, non-indurated ulcer over several days. The base of the ulcer is covered by shaggy, yellow-gray exudate. Microscopically, the ulcer contains a superficial zone of neutrophilic debris and fibrin, and an underlying zone of granulation tissue containing areas of necrosis and thrombosis. This infection is caused by:

Haemophilus ducreyi (causing Chancroid) (TOPNOTCH) Robbins Basic Pathology, 9th Ed p. 370

73

A 45 y/o sexually active male presented with a 3-month history of few painless ulcerated lesions on the penis and scrotum. The painless nodules slowly evolved to red ulcerated lesions over 1 month. Physical examination revealed multiple, raised, beefy-red nontender round ulcers on the shaft of penis and scrotum. The ulcers had clean friable granulating bases. Microscopic examination with Giemsa stain revealed numerous encapsulated coccobacilli in macrophages. The most likely diagnosis is:

Granuloma inguinale/donovanosis (Klebsiella granulomatis) (TOPNOTCH) Robbins Basic Pathology, 9th Ed p. 370

74

A 25 y/o male initially presented with a tender erythematous papule on the penis which produce an irregular, painful, non-indurated ulcer over several days. The base of the ulcer is covered by shaggy, yellow-gray exudate. Microscopically, the ulcer contains a superficial zone of neutrophilic debris and fibrin, and an underlying zone of granulation tissue containing areas of necrosis and thrombosis. This infection is caused by:

Klebsiella granulomatis (TOPNOTCH)

75

True or false. A positive tuberculin test differentiates active disease from infection.

False. A positive tuberculin test signifies T-cell mediated immunity to mycobacterial antigen. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 371

76

How many days or weeks after mycobacterium infection will it develop delayed hypersensitivity to M. tuberculosis as detected by Mantoux skin test?

2-4 weeks (TOPNOTCH) Robbins Basic Pathology, 9th Ed p. 371

77

The critical mediator that enables macrophages to contain M. tuberculosis infection by stimulating maturation of phagolysosome, stimulation of expression of inducible nitric oxide synthase and mobilization of defensins against bacteria.

IFN gamma(TOPNOTCH) Robbins Pathologic Basis of Disease, 9th Ed p. 372

78

True or False. Immunity to M. tuberculosis is primarily mediated by TH1 cells.

True. TH1 cells stimulate macrophages to kill the bacteria (TOPNOTCH) Robbins Basic Pathology, 9th Ed p. 373

79

Secondary pulmonary tuberculosis classically involves what part of the lungs?

Apex of the upper lobes of one or both lungs. (TOPNOTCH) Robbins Basic Pathology, 9th Ed p. 373

80

True or false. The absence of characteristic granulomas in tissues in HIV-positive patients precludes (rule out) the diagnosis of tuberculosis.

False. Atypical features of TB in HIV-positive patients include increase frequency of false-negative sputum smears, tuberculin tests, and absence of granuloma, particularly in the late stages of HIV.(TOPNOTCH) Robbins Basic Pathology, 9th Ed p. 374

81

A 1 to 1.5 cm area of gray-white inflammation with consolidation in primary tuberculosis.

Ghon focus (TOPNOTCH) Robbins Basic Pathology, 9th Ed p. 374

82

Most frequent presentation of extrapulmonary tuberculosis.

Lymphadenitis (TOPNOTCH) Robbins Basic Pathology, 9th Ed p. 376

83

A 42 y/o male nonsmoker with AIDS began to experience cough, mild hemoptysis, and progressive dyspnea. CD4 cell count was 45 cell/ul. A chest radiograph revealed hilar adenopathy and perihiral infiltrates. AFB smear was negative. Bronchoscopy was done and microscopic finding showed an abundnat acid-fast bacilli within macrophages. The organism causing the illness is:

Mycobacterium avium complex (TOPNOTCH)

84

Pattern of leprosy presenting with dry, scaly skin lesions that lack sensation and often have assymetric involvement of large peripheral nerves.

Tuberculoid leprosy (TOPNOTCH) Robbins Basic Pathology, 9th Ed p. 377

85

Pattern of leprosy causing symmetric skin thickening and nodules with widespread invasion of mycobacteria into Schwann cells and into endoneural and perineural macrophages damaging the peripheral nervous system.

Lepromatous leprosy (TOPNOTCH) Robbins Basic Pathology, 9th Ed p. 377

86

Pattern of leprosy characterized by TH1 response associated with production of IL-2 and IFN gamma

Tuberculoid leprosy (TOPNOTCH) Robbins Basic Pathology, 9th Ed p. 377

87

Pattern of leprosy associated with weak TH1 response and in some cases increase in TH2 response resulting to weak cell-mediated immunity.

Lepromatous leprosy (TOPNOTCH) Robbins Basic Pathology, 9th Ed p. 377

88

A 30 y/o male presented with a flat, red, anesthetic skin lesions on his left thigh extending to his knee which had been present for 2 years. These lesions enlarged and develop irregular shapes with indurated, elevated, hyperpigmented margins and depressed pale centers. On microscopic examination, all sites of involvement have granulomatous lesions. Bacilli are almost never found. This is a case of__.

Tuberculoid leprosy/Paucibillary leprosy (TOPNOTCH) Robbins Basic Pathology, 9th Ed p. 377

89

This disease presents with macular, papular, or nodular lesion on the face, ears, wrists, elbows and knees, progressing to coalescence of nodular, anesthetic lesions. (+) leonine facies. Morphologic findings of this disease reveals skin and peripheral nerve lesions containing large aggregates of lipid laden macrophages (lepra cells) often filled with asses (globi) of acid fast bacilli.

Lepromatous/multibacillary leprosy (TOPNOTCH) Robbins Basic Pathology, 9th Ed p. 378

90

A 19 y/o male presents to the clinic because of a lesion on his penis. Genital exam showed a red, solitary, raised , indurated, non-tender lesion on the ventral side of his penis. Neurologic exam was within normal limits. What is the most likely diagnosis?

Primary syphilis(chancre)(TOPNOTCH)