Micro

Question 1

systemic mycoses: (coccidioides/histoplasma/blastomyces/paracoccidioides) thermally dimorphic (mold-spherule), endemic to US southwest, mold grows in wet weather

Answer 1

coccidioides

Question 2

systemic mycoses: (coccidioides/histoplasma/blastomyces/paracoccidioides) thermally dimorphic (mold-multibud yeast), endemic to rural Latin America

Answer 2

paracoccidioides

Question 3

systemic mycoses: (coccidioides/histoplasma/blastomyces/paracoccidioides) thermally dimorphic (mold-yeast), endemic to eastern US

Answer 3

blastomyces

Question 4

systemic mycoses: (coccidioides/histoplasma/blastomyces/paracoccidioides) thermally dimorphic (mold-yeast), endemic to Ohio, Missouri, Mississippi river valleys, soil-based

Answer 4

histoplasma (infectious microconidia can be kicked up by construction projects)

Question 5

systemic mycoses: (coccidioides/histoplasma/blastomyces/paracoccidioides) releases infectious arthrospores in dry weather, spores are inhaled then they change form

Answer 5

coccidiodes

Question 6

systemic mycoses: (coccidioides/histoplasma/blastomyces/paracoccidioides) 60% Mild: asymptomatic or flulike clearance by innate or containment by CMI, moderate: valley fever/ desert rheumatism: pulmonary+EN, severe: major pneumonia or dissemination (either bare or in macrophages).

Answer 6

coccidioides

Question 7

systemic mycoses: (coccidioides/histoplasma/blastomyces/paracoccidioides) Risk factors: age, race, pregnancy, immunocompromise, occupational high exposure. Diagnose by exam, history, PPD, biopsy for spherules, culture for dimorphism, serology for dissemination.

Answer 7

coccidioides

Question 8

systemic mycoses: (coccidioides/histoplasma/blastomyces/paracoccidioides) Treat if predisposed to complications (oral azoles), meningitis (fluconazole), pregnant or disseminated (Amphotericin B).

Answer 8

coccidioides

Question 9

systemic mycoses: (coccidioides/histoplasma/blastomyces/paracoccidioides) causes pulmonary symptoms, previously-healthy usually clear or contain in granulomas, higher-dose infection produces TB mimic, CMI-deficient host disseminates in macrophages (yeast survive lysosomal fusion)

Answer 9

histoplasma

Question 10

systemic mycoses: (coccidioides/histoplasma/blastomyces/paracoccidioides) look for pancytopenia and ulcerations on tongue. Also for diagnosis: history (birds, bats, endemic area, immunocompromised, occupation), biopsy for yeast in macrophages, cultures for dimorphism, ELISA for antigen.

Answer 10

histoplasma

Question 11

systemic mycoses: (coccidioides/histoplasma/blastomyces/paracoccidioides) Treat serious lung w/ itraconazole, meningitis w/ fluconazole, disseminated w/ Amphotericin B.

Answer 11

histoplasma

Question 12

systemic mycoses: (coccidioides/histoplasma/blastomyces/paracoccidioides) Innate immunity clears most cases, destroys conidia easily, yeasts are harder to kill (BAD1), graulomatous response contains most, immunosuppression predisposes to hematogenous spread.

Answer 12

blastomyces

Question 13

systemic mycoses: (coccidioides/histoplasma/blastomyces/paracoccidioides) Moderate acute: pneumonia w/ purulent sputum, Moderate chronic: mimics TB, Severe acute: ARDS. May include EN or ulcerating skin lesions.

Answer 13

blastomyces

Question 14

systemic mycoses: (coccidioides/histoplasma/blastomyces/paracoccidioides) Diagnose by sputum microscopy for yeast, culture for hyphae w/ pear-shaped conidia, biopsy for yeast w/ supperating (not caseating) granulomas. Treat w/ itraconazole, fluconazole if meningitis, Amphotericin B if severe.

Answer 14

blastomyces

Question 15

systemic mycoses: (coccidioides/histoplasma/blastomyces/paracoccidioides) severe in children/immunocompromised, moderate in adults, usually men in agriculture or construction. Adult form has very long latency, skin&mucous lesions.

Answer 15

paracoccidioides

Question 16

systemic mycoses: (coccidioides/histoplasma/blastomyces/paracoccidioides) Diagnose by pus or tissue KOH mount for yeast with multiple buds, culture. Treat w/ itraconazole, Amphotericin B if severe, combine with healthier lifestyle (semi-opportunistic).

Answer 16

paracoccidioides

Question 17

opportunistic fungi: (fusarium/mucormycosis/cryptococcosis/aspergillosis) is widespread environmental, enabled by reduced CMI, suppresses host inflammatory response. Infection originates in lung but usually either clears or progresses to meningitis.

Answer 17

cryptococcosis

Question 18

opportunistic fungi: (fusarium/mucormycosis/cryptococcosis/aspergillosis) . Patient presents late in disease with meningitis and skin nodules or pulmonary symptoms. Diagnose by biopsy, CSF, crag. Treat with combinations of azoles and Amphotericin B.

Answer 18

cryptococcosis

Question 19

opportunistic fungi: (fusarium/mucormycosis/cryptococcosis/aspergillosis) presents as ABPA, aspergilloma, CNPA, or Invasive.

Answer 19

aspergillosis

Question 20

opportunistic fungi: (fusarium/mucormycosis/cryptococcosis/aspergillosis) caused by Rhizopus is a very rare deadly invasive vasculitis by environmental mold, causes infarction, invades brain from sinuses.

Answer 20

mucormycosis (also caused by mucor)

Question 21

opportunistic fungi: (fusarium/mucormycosis/cryptococcosis/aspergillosis) Predisposition by uncontrolled diabetes, iron overload, immunosuppression.

Answer 21

mucormycosis

Question 22

opportunistic fungi: (fusarium/mucormycosis/cryptococcosis/aspergillosis) Diagnose by biopsy for histo, treat with amphotericin B and aggressive surgical removal of diseased tissue, prognosis poor.

Answer 22

mucormycosis

Question 23

opportunistic fungi: (ABPA/aspergilloma/CNPA/Invasive) hypersensitivity rxn to infection complicating asthma or CF, diagnose on exam, tx with itraconazole, sinus surgery, Xolair

Answer 23

ABPA

Question 24

opportunistic fungi: (ABPA/aspergilloma/CNPA/Invasive) colonizing aspergillosis, fungus ball complicating cavitary lung dz, diagnose by air crescent on scan, treat with itraconazole or surgery

Answer 24

aspergilloma

Question 25

opportunistic fungi: (ABPA/aspergilloma/CNPA/Invasive) presents as respiratory distress with history of profound immunosuppression, diagnose by halo sign on scan, needle or tissue biopsy for histo

Answer 25

invasive

Question 26

opportunistic fungi: (ABPA/aspergilloma/CNPA/Invasive) mimics TB; try to diagnose by air crescent on scan, needle-aspirate lung fluid for microscopy

Answer 26

CNPA

Question 27

opportunistic fungi: Treat (ABPA/aspergilloma/CNPA/Invasive) (2) with voriconazole+AmphotericinB, but prognosis is poor.

Answer 27

CNPA and invasive

Question 28

opportunistic fungi: (fusarium/mucormycosis/cryptococcosis/aspergillosis) a ubiquitous environmental mold, infection is rare overall but frequently fatal in predisposed population.

Answer 28

fusarium

Question 29

opportunistic fungi: (fusarium/mucormycosis/cryptococcosis/aspergillosis) May cause mycotoxicosis (contaminated grain), local infection (burns, prosthetic implants, contaminated contact lens solution), or deadly disseminated infection (prolonged neutropenia, HSCT recipients).

Answer 29

fusarium

Question 30

opportunistic fungi: (fusarium/mucormycosis/cryptococcosis/aspergillosis) Diagnose by blood culture, histo, treat aggressively with surgery, amphotericin B, voriconazole, prognosis poor.

Answer 30

fusarium

Question 31

opportunistic fungi: (fusarium/mucormycosis/cryptococcosis/aspergillosis) Enters from sinus or wound site, circulates in blood, symptoms in skin, eye, lung.

Answer 31

fusarium

Question 32

TB: how does transmission occur

Answer 32

inhalation (then to elsewhere by hematogenous spread, to GI by swallowing infected sputum)

Question 33

TB: Hematogenous spread by intracellular infection of naive macrophages; activated ones clear it, (CD4/CD8) cells kill infected macrophages and establish caseating granulomas in which infection is contained.

Answer 33

CD8

Question 34

TB: what factor is important for containment

Answer 34

TNF alpha

Question 35

TB: (classic pulmonary/extrapulmonary/pediatric) scrofula (fine needle aspirate), genitourinary (intravenous urography, urine culture), CNS (MRI, spinal tap), skeletal (MRI, joint fluid culture), GI (Xray, CT of abdomen), miliary (chest Xray w/ bright spotlight, lateral Xray, chest CT)

Answer 35

extrapulmonary

Question 36

TB: (classic pulmonary/extrapulmonary/pediatric) must have been recently acquired (trace source), watch for miliary&meningitis, culture from gastric lavage

Answer 36

pediatric

Question 37

TB: (classic pulmonary/extrapulmonary/pediatric) (75%): cough, weight loss (“consumption”), fever, night sweats, hemoptysis, and chest pain, check sputum and chest Xray

Answer 37

classic pulmonary

Question 38

Determine _____ (disease) exposure by TST and/or IGRA, perform antibiotic resistance testing as soon as cultures grow (~2wks for cultures, another 3wks for resistance tests)

Answer 38

TB

Question 39

BCG vaccine (live attenuated M. bovis) is used abroad for ___ (disease), not cost-effective here, can create weak-moderate false positive TST.

Answer 39

TB

Question 40

Atypical mycobacterial infection in an immuno (compromised/competent) adult is usually cutaneous; scrofula in children

Answer 40

competent

Question 41

____ (disease) has no in vitro culture system, slowest growing human pathogen, prefers 30C to 37C

Answer 41

M leprae

Question 42

____ (disease) has an extremely long incubation period, doesn’t transmit easily, only 5-10% of humans believed susceptible to disease

Answer 42

M leprae

Question 43

_____ (disease) presents on a range from Tuberculoid (paucibacillary, vigorous CMI both contains infection and damages nerves, PPD+) to Lepromatous (multibacillary, weak CMI, extensive cutaneous symptoms, PPD-)

Answer 43

Hansen's Disease (leprosy)

Question 44

Hansen's: (tuberculoid/lepromatous) easily tested by skin smear, biopsy, molecular probe, serology

Answer 44

lepromatous

Question 45

Hansen's: (tuberculoid/lepromatous) may be detected by biopsy or serology but sensitivity is low – physical exam, history, &PPD

Answer 45

tuberculoid

Question 46

Lepromin PPD tests anti-leprosy (immunocompetence/exposure)

Answer 46

immunocompetence!

Question 47

_____ (disease) treatment is 2 years of dapsone and rifampin

Answer 47

M leprae

Question 48

(tuberculoid/lepromatous) patients when treated may develop erythema nodosum; severe cases can require immunomodulant treatment like thalidomide (teratogen!)

Answer 48

lepromatous

Question 49

Pseudomonas: (aeruginosa/B cepacia/B pseudomallei/B mallei) rare in US but can be lethal (2)

Answer 49

B pseudomallei and B mallei

Question 50

Pseudomonas: (aeruginosa/B cepacia/B pseudomallei/B mallei) a common and serious nosocomial pathogen

Answer 50

aeruginosa

Question 51

Pseudomonas: (aeruginosa/B cepacia/B pseudomallei/B mallei) common, serious in context of CF

Answer 51

B cepacia

Question 52

Pseudomonas: Gram (-/+), strict (anaerobes/aerobes)

Answer 52

gram - aerobes

Question 53

Pseudomonas: oxidase (-/+), nonfermenters, grow easily in culture

Answer 53

oxidase +

Question 54

Pseudomonas: (aeruginosa/B cepacia/B pseudomallei/B mallei) produces green pyocyanin in culture, extreme antibiotic resistance

Answer 54

aeruginosa (all have antibiotic resistance, from combo of low permeability outer membrane and efflux pumps)

Question 55

Pseudomonas: (aeruginosa/B cepacia/B pseudomallei/B mallei) have minimal growth requirements --> contaminate hospital solutions (2)

Answer 55

P aeruginosa and B cepacia

Question 56

Pseudomonas: (aeruginosa/B cepacia/B pseudomallei/B mallei) has a few community-acquired presentations: endocarditis in IV drug addicts, Otitis externa in underchlorinated hot tubs, Osteochondritis in sneaker punctures, corneal infections under contact lenses

Answer 56

aeruginosa

Question 57

Pseudomonas: (aeruginosa/B cepacia/B pseudomallei/B mallei) MC presents in hospitals

Answer 57

aeruginosa

Question 58

Pseudomonas: (aeruginosa/B cepacia/B pseudomallei/B mallei) MC presents in CF centers

Answer 58

B cepacia

Question 59

Pseudomonas: (aeruginosa/B cepacia/B pseudomallei/B mallei) presents in previously-ill travelers/immigrants or Vietnam veterans

Answer 59

B pseudomallei

Question 60

Pseudomonas: (aeruginosa/B cepacia/B pseudomallei/B mallei) presents in previously-ill travelers/immigrants with animal handling history.

Answer 60

B mallei

Question 61

Pseudomonas: two ways to make the diagnosis

Answer 61

culture and gram stain

Question 62

Pseudomonas: treat with antibiotics, test ____ sensitivity both before and during treatment

Answer 62

antibiotic

Question 63

Chlamydia: small, (intra/extra) cellular bacterium

Answer 63

intra (must use drugs that penetrate the human cell membrane)

Question 64

Chlamydia: replicate in a unique manner beginning with tiny, infectious, rugged, (reticulate/elementary) bodies which “unpack” into (elementary/reticulate) bodies after infection.

Answer 64

replicate in a unique manner beginning with tiny, infectious, rugged, elementary bodies which “unpack” into reticulate bodies after infection.

Question 65

Chlamydia: (Elementary/Reticulate) bodies form intracellular inclusions that are visible on microscopy; within the inclusions they multiply by binary fission, forming new reticulate bodies and later new elementary bodies.

Answer 65

reticulate

Question 66

Chlamydia: known virulence factor

Answer 66

T3SS

Question 67

Chlamydia: what complicates research

Answer 67

unusual life cycle

Question 68

C. pneumoniae, C. psittaci, and C. trachomatis can all cause ______ (disease)

Answer 68

PNA

Question 69

Chlamydia: treat with _____ except pregnant/pediatric/allergic patients, who get erythromycin

Answer 69

tetracyclines (doxy)

Question 70

Bacterial PNA: (C burnetti/mycoplasma/legionella) Opportunistic facultative intracellular pathogen with variable infection outcome, exposure is from aspiration or inhalation of contaminated water

Answer 70

legionella

Question 71

Bacterial PNA: (C burnetti/mycoplasma/legionella) survives endocytosis by monocytes&macrophages by altering endosomes so that it can multiply in them and then escape

Answer 71

legionella

Question 72

Bacterial PNA: (C burnetti/mycoplasma/legionella) disease outbreaks trace back to contaminated locations, NOT people

Answer 72

legionella

Question 73

Bacterial PNA: (C burnetti/mycoplasma/legionella) Optimal diagnosis is by BOTH urine antigen test and culture of respiratory secretions (fastidious, special media required)

Answer 73

legionella

Question 74

Bacterial PNA: (C burnetti/mycoplasma/legionella) For geriatric community-acquired pneumonias in general, take samples for culture/ELISA first, start treatment w/ levofloxacin second, get labs back third

Answer 74

legionella

Question 75

Bacterial PNA: (C burnetti/mycoplasma/legionella) Outbreaks in healthcare are common: vulnerable individuals exposed to bad plumbing

Answer 75

legionella

Question 76

Bacterial PNA: (C burnetti/mycoplasma/legionella) is a small coccus to short rod, zoonotic infection from ruminants.

Answer 76

C burnetti

Question 77

Bacterial PNA: (C burnetti/mycoplasma/legionella) transmitted by aerosols, grows in alveolar monocyte/macrophages

Answer 77

C burnetti

Question 78

Bacterial PNA: (C burnetti/mycoplasma/legionella) survives endolysosomal fusion, extremely infectious, long-lived in environment

Answer 78

C burnetti

Question 79

Bacterial PNA: (C burnetti/mycoplasma/legionella) causes pneumonia+hepatitis = Q Fever.

Answer 79

C burnetti

Question 80

Bacterial PNA: (C burnetti/mycoplasma/legionella) Diagnose by immunohistochemistry, treat with tetracyclines or fluoroquinolones.

Answer 80

C burnetti

Question 81

Bacterial PNA: (C burnetti/mycoplasma/legionella) are unique among bacteria in lacking a cell wall and including cholesterol in their cell membrane.

Answer 81

mycoplasma

Question 82

Bacterial PNA: (C burnetti/mycoplasma/legionella) causes walking PNA, mild and self limited

Answer 82

mycoplasma

Question 83

Bacterial PNA: (C burnetti/mycoplasma/legionella) CARDS exotoxin-induced ciliostasis, local inflammation, local tissue destruction

Answer 83

mycoplasma

Question 84

Bacterial PNA: (C burnetti/mycoplasma/legionella) Immunopathology: antibodies against mycoplasma cross-react with red blood cells (cold agglutinins) → anemia during infection.

Answer 84

mycoplasma

Question 85

Bacterial PNA: (C burnetti/mycoplasma/legionella) Persistence through slow growth and intracellular hiding, treat with tetracyclines or macrolides

Answer 85

mycoplasma

Question 86

(Haemophlius/Bordetella/both) human restricted, fastidious in culture, require factors X and V in vitro.

Answer 86

both

Question 87

(Haemophlius/Bordetella/both) Transmitted by respiratory droplets, mostly-pediatric contagious respiratory infection, vaccines available, treat with antibiotics and supportive care

Answer 87

both

Question 88

(Haemophlius/Bordetella/both) Gram(-) pleomorphic – may appear as cocci, rods, mixture on microscopy.

Answer 88

Haemophlius

Question 89

Haemophlius: (encapsulated/unencapsulated) H. influenzae (Hib) are more pathogenic, covered by vaccination, cause lethal meningitis. Bacteremia quickly follows upper respiratory infection and underlies all invasive disease: meningitis, cellulitis, epiglottitis, septic arthritis

Answer 89

encapsulated

Question 90

Haemophlius: (encapsulated/unencapsulated) H. influenzae (NTHi) are less pathogenic but not covered by vaccination. May be normal flora. Cause neonatal and postpartum sepsis, CF pneumonia, systemic complications after untreated local mucosal infections, particularly with respiratory or immune predisposition.

Answer 90

unencapsulated (lack capsule but still have IgA protease, pili, adhesins)

Question 91

________ is a highly contagious short Gram(-) rod, incidence and mortality increasing because of inadequate vaccine coverage. Acellular vaccine used in US has shorter-lived protection than killed-cell, used abroad.

Answer 91

Bordetella pertussis

Question 92

_____ (disease): Filamentous hemagglutinin attaches, exotoxin causes ciliary stasis and death of ciliated cells → cough for contagion. No bacteremia, prognosis good.

Answer 92

pertussis (pertussis toxin)

Question 93

______ (disease) is prolonged (~3mo) even with drug treatment, dangerous with underlying conditions, leukocytosis on bloodwork.

Answer 93

whooping cough

Question 94

viruses: (coronavirus/influenza/paramyxovirus/adenovirus) +ssRNA, cold like symptoms, SARS, MERS

Answer 94

coronavirus

Question 95

viruses: 2 modes of transmission for viral respiratory infections

Answer 95

fomites, aerosol

Question 96

viruses: which cells in the body are the first site of virus/host interaction

Answer 96

epithelial cells

Question 97

viruses: rhinovirus replicate preferentially where?

Answer 97

upper respiratory tract (temperature difference!)

Question 98

viruses: (upper/lower) resp tract infections: parainfluenza, resp syncytial virus, influenza, adenovirus affecting the trachea, bronchi, bronchioles

Answer 98

lower

Question 99

viruses: (upper/lower) resp tract infections: rhino, corona, parainfluenza, resp syncytial, influenza, adeno, HSV, EBV

Answer 99

upper

Question 100

viruses: (acute infection with replication confined to resp mucosal surface/persistent replication on resp mucosal surface/systemic replication-dissemination): EBV, adenovirus, papillomavirus

Answer 100

persistent replication on respiratory mucosal surface

Question 101

viruses: (acute infection with replication confined to resp mucosal surface/persistent replication on resp mucosal surface/systemic replication-dissemination): paramyxovirus (mumps, measles), HSV, rubella, picornavirus (polio)

Answer 101

systemic replication/dissemination

Question 102

viruses: (acute infection with replication confined to resp mucosal surface/persistent replication on resp mucosal surface/systemic replication-dissemination): rhinovirus=picornavirus, coronavirus, paramyxovirus=parainfluenza and resp syncytial, orthomyxovirus=influenza

Answer 102

acute infection with replication confined to resp mucosal surface

Question 103

virus: what does myxo mean

Answer 103

mucus (Greek)--these viruses bind to mucin protein on RBCs

Question 104

virus: (orthomyxoviridae/paramyxoviridae): influenzavirus A, B, and C

Answer 104

ortho

Question 105

virus: (orthomyxoviridae/paramyxoviridae): nuclear replication

Answer 105

ortho

Question 106

virus: (orthomyxoviridae/paramyxoviridae): segmented genome, (-)ssRNA

Answer 106

ortho

Question 107

virus: (orthomyxoviridae/paramyxoviridae): enveloped

Answer 107

both! syke

Question 108

virus: (orthomyxoviridae/paramyxoviridae): mumps, measles, pneumovirus-resp syncytial virus

Answer 108

paramyxo

Question 109

virus: (orthomyxoviridae/paramyxoviridae): cytoplasmic replication, non segmented genome (-)ssRNA

Answer 109

paramyxo

Question 110

virus: parainfluenza virus + RSV =

Answer 110

Croup=laryngotracheobronchitis

Question 111

virus: peak incidence in winter, starts like a cold, infants with a barking cough, treat at home with steam

Answer 111

croup. complications: PNA, resp distress

Question 112

viruses: (coronavirus/influenza/paramyxovirus/adenovirus) most infections are asymptomatic, or involve the resp/GI tracts, eye. persists in lymphoid tissue

Answer 112

adenovirus

Question 113

virus: who gets the adenovirus vaccine

Answer 113

military personnel