micro- clin Flashcards
1
Q
common clinical presentation of actinomyces infection
- what is the main differentiating factor from this infection vs the other bug that presents in the same region with a similar hx
A
- is an anaerobic bug that is naturally found in the gut flora
- cause disease when they get introduced into the submucosa during mechanical trauma i.e. a denal procedure
- infectious disease most commonly involves the cervicofacial region
- =chronic, nontender, indurated mass in the perimandibular area
- will grow and evolve over time –> multiple abscesses and draining sinus tracts
- HALL= sulfur granules (don’t actually contain sulfur, just look like it)
- the abscesses will drain a grainy, sand like yellow pus, it contains the Actinomyces filaments and necrotic tissue in it as well
vs Staph aureus -the leading cause of acute suppurative permandibular/parotid infection
- S. aureus will be firm, tender, and will progress rapidly
2
Q
how would you classify the following sx:
- “marked wknss in the distal M and moderate wkness in the proximal M of both legs. DTRs are absent”
what is the etiology of this presentation
A
this is describing symmetric, ascending weakness
- Guillan Barre
- endoneurial inflammatory infiltrate, as macrophages strip away myelin sheaths and the lipid laden macrophages are hanging out
3
Q
what are the 3 big oppurtunisitc infections in HIV
- when do you start prophylactic trx for each and what is the prophyaxis in each case
A
- P. jirovecci
- start @ CD4 < 200 OR after oral candida
- prophylaxix trx = TMP/SMX
- Toxoplasma gondii
- start @ CD4 < 100 or w (+) T. gondii IgG
- prophylaxix trx = TMP/SMX
- MAC (mycobacterium avium complex)
- start @ CD < 50
- prophylaxis trx = azithromycin/clarithromycin (macrolide) ± rifabutol
4
Q
what are the big four bugs who don’t need a high concentration of organisms to causes ds (aka a small incolulum)
A
- Shigella (10+)
- C jejuni (~500 cells min)
- E histolytica (1-10)
- Giardia (1-10)
5
Q
- what abnormality is seen on this blood smear? what is it composed of?
- what pathology is it often seen in?
A
reactive lymphocytes= atypical lymphocyte
- an active, cytotocix T cell/NK cell that has formed in response to a specific infection
- contains cytotoxic granzymes and perforins to kill (released in response to MHC I)
associated with infectious mono (EBV) >>>> HIV, CMV, toxo
6
Q
what cells are these? name them, and use histo words to describe them
A
7
Q
how does the influenza A virus undergo genetic shift?
what other viruses have this ability?
A
influenza A-
- gene segment reassortment: its genes are in segments so if two segmented viruses meet in the body, they can trade segments and create recombinant viruses very easily
- a lot easier to create new genetic changes than just point mutations in non-segmented viruses
- segment recomb can lead to change in the capsule = antigenic shift
other segmented viruses
- rotavirus = MC cause of diarrhea in kids and infants
- (a type of reovirus)
- orthomyxovirus = influenza viruses
- bunyaviridae
- arthropod viruses
- hemorrhagic fever
- hantavirus = fever, pulm edema, pulmonary fever
- arenavirus
- hemorrhagic fever, found in south america
8
Q
- what pathologic mechanism enables influenza to invade human cells
- mechanism of antigenic change in influenza
- how does an influenza strain that infects other animals become capable of infecting humans
A
influenza
- MOI- mechanism of invasion
- flu virus is an (-)RNA virus that is enveloped within a host derived plasma membrane
- in order to interact with human cells, it needs a hemagglutinin (viral surface glycoprotein) that will allow it to attach to human epithelial cells (i.e. in the RT)
- antigenic change
- poor proofreading (by RNAdep, RNApol) –> antigenic drift
- genetic segment rearrangment –> antigenic shift
- antigenic change in the hemagglutinin that creates a tissue tropism for human epithelial cells will make the virus capable of infecting humans
9
Q
which G+ species can cause impetigo?
which G+ species is PYR (+), which is PYR (-) ?
(pyrrolidonyl arylamindase)
A
impetigo
- Staph aureus >>> group a strep
PYR(+) = Grp A strep
PYR (-) = Grp B strep
10
Q
which two organisms use a toxin against elongation factor?
A
corynebacterium diptheriae
pseudomonas
=exotoxin A –> ribosylation of elongation factor
11
Q
ALBENDAZOLE is not an “azole” antifungal!!!
what is it??
A
an antihelminthic used against cutaneous larva migrans = cutaneous, red brown snake-like tracks on the skin
-often at the feet
12
Q
what is the MOA of the following:
- influenza vaccine
- amantadine
- zanamavir, oseltamavir
A
vaccine makes Abs–>prevent entry into the cell by blocking the binding of hemagglutinin to the host cell
13
Q
what organism is found on aniline dye
what process does its toxin prevent
A
C. diptheriae
-exotoxin A = an AB toxin that prevents protein synthesis via ribosylation of elongation factor 2
14
Q
what are the organisms that are associated with infection following
- cat bite
- dog bite
- human bite
- farm animals
A
farm animals
- brucella, coxiella,
15
Q
MOA of the following disinfectants
- alcohols
- chlorhexidine
- hydrogen peroxide
- iodine
A
16
Q
patients who undergo organ transplant followed by immunsuppressive therapy are at risk for developing what complication?
- how can it present
- what is the GI presentation, treatment, and AE of the trx
A
- re-activation of latent CMV infection with end organ ds
- this can present as CMV colitis, retininits, or pneumonitis
- CMV colitis
- fever, fatigue, LQ abd pain, diarrhea
- colonic mucosal ulcers w erythema
- histo= large cells w intranuclear inclusions (eosinophilic) and intracytoplasmic basophilic inclusions –>owl eye inclusions
- trx w IV ganciclovir
- AE= neutropenia and BM suppression
17
Q
what are the 4 anti-folate antimicrobials ?
-what is the difference in MOA between the 4 of them?
A
antifolates
- sulfanomides
- stop (PABA–> dihydrofolic acid)
- TMP
- stop (dihydrofolic acid –>THF) via inhibition of DHF-reductase
- works against bacterial cells
- MTX
- stop (dihydrofolic acid –>THF) via inhibition of DHF-reductase
- works against host cells
- pyrimethamine
- stop (dihydrofolic acid –>THF) via inhibition of DHF-reductase
- works against protozoa = malaria and toxoplasma
18
Q
describe what you are seeing
-most likely cause of fungal infection in an immunocompromised patient??
A
candida
= yeast and pseudohyphae on light microscopy
19
Q
how is EBV transmitted
A
through saliva
aka kissing
20
Q
treatment for gonorrhea vs chlamydia infection
A
gonorrhea = ceftriaxone
- GONE SWIFT(ceft)er than an AXE
chlamydia = doxycycline or azyithromycin
- lAZY day @ the CHLAM DOX (docks)
21
Q
corkscrew shaped spirochete = ?
- mechanism of transmission
- important diagnostic sx
A
leptospirae
- host in wild animals’ PCT and excreted in their urine –> transmitted to humans via contact w fresh water outdoors that has infected animal urine
- mostly a flu-like illness with conjunctival suffusion = looks like conjunctivitis but without inflammation
22
Q
discuss the specific pathology and etiology of cardiac complications of teritiary syphillis
A
tertiary syphillis (treponema infection)
- associated w aortic regurge (decscrescendo murmur heard on the right sternal border during diastole)
- start with vasa vasorum endarteritis –> aortic aneurysm –> aortic regurge + mediastinum widening
23
Q
- what is the mainstay trx of malaria
- what is the trx for strains that are resistant to the mainstay- associated with what subtypes of malaria
A
- mainstay = chloroquine
- chloroquine + primaquine = P falciparum + P ovale
- resistant to chloroquine = atovaquone + proguanil
24
Q
common sx/PE findings in hand-foot-and-mouth ds
what is the causative organism? what other pathologies can it cause?
A
HFaM Ds= rash on “extremities” with buccal mucosa and soft palate ulcers
25
what is procalcitonin and how is it useful
an acute phase reactant
_inc_ in response to _bacterial_ toxin : *dec* in response to *viral* toxin
**can be used to differentiate causes of CAP**
26
what NTs are inhibited by tetanis and botulinism
tetanus = inhibit GABA and glycine = rigid
botulinism = inhibit Ach = floppy baby
27
what organism is this
(arrow is a huge hint)
how will it present and what are the other three version
schistosoma mansoni = LATERAL spine
28
what pathologic finding is seen here? dx?
plasmodium falciparum = malaria
29
what is the bull's eye lesion associated with? what is the etiology?
what is the official PE finding?
lyme disease
spirochetes spreading through the dermis =
"annular erythematous lesion with central clearing" = erythema migricans
30
child with lacy, reticular rash on the trunk and extremities, develops red, flushed cheeks
red, flushed cheeks = slapped cheek rash
* lacy, reticular rash
parvovirus B19 infection = erythema infectiosum
* 5th disease= benign childhood ds
* parvovirus B19 replicates in erythrocyte precursors in the BM
31
who are the double stranded DNA viruses
* enveloped
* non-enveloped
32
* neonate born with hydrocephalus, jaundice, hepatosplenomegaly, retinal exudates
* histo= numerous intracellular crescent shaped organisms
dx? why did this happen ?
toxoplasma gondii
* pregnany women eat raw or undercooked meat --\> intracellular toxo infection can be spread cross the placenta
33
what are the two types of disease that can be seen with salmonella
- dif pathophysiologies that lead to the diff disease
- clinical manifestations
34
vibrio vulnificus
- transmission
- clin picture
- transmission= from consumption of raw oysters or wound contamination during water sports
- clin picture= asx in healthy patients : in those w liver ds or iron overload, can cause rapid necrotizing fasciitis, septic shock, and death
35
asplenia is associated with increased risk of infection by what organisms
those with a polysaccharide capsule
* Strep pneumoniae
* H. influenzae
* N. meningitidis
\*\*the three bacteria who tell you exactly what they are going to do\*\*
36
psuedomonas
- found where
- causes what clinical presentations
found in water sources like waterslides, hot tubs, etc.
* folliculitis= red papules all over the body with central pustules
* wound and burn infection
* pneumonia (especialy in CF pts)
* external otitis = swimmers ear
* osteomyelitis (esp in diabetic pts and IVdrug users)
* endotoxin--\> fever and shock
37
what organism is seen here
what skin findings can it cause
staph aureus= grape like clusters
=skin and ST abscesses- colonize the anterior nares --\> spread to the skin
* =localized pustule that evolves into a painful nodule with a necrotic, purulent center with surrounding indurated erythema
38
patients receiveing parenteral nutrition from an parenteral cathether are at increased risk of what infection
candida (show up as yeast)
39
parvovirus is common in what population and presents how in
* aduts
* children
* fetuses
* sickle cell
parvovirus B19 is most common in children and school teachers (School outbreaks)
* aduts
* arthralgias, arthritis
* with or without rash
* children
* slapped cheek rash that appears AFTER the break of fever
* aka "erythema infectiousum" or 'fifith ds"
* fetuses
* =TORCH
* hydrops fetalis
* x erythropoeisis --\> profound anemia + ascites
* sickle cell
40
what are the antifungal actions of
* amphotericin B
* nystatin
* azoles
* echinocandins
* pyrimidines
* griseoulvin
* amphotericin B
* bind to ergosterol--\> create pores--\> cell lysis
* nystatin
* bind to ergosterol--\> create pores--\> cell lysis
* azoles
* inhibit the synthesis of ergosterol
* echinocandins
* i.e. caspoFUNGIN
* inhibit synthesis of GLUCAN = in cell wall
* pyrimidines
* = flucytosine
* converted to 5-FU in the cell wall --\> interfere with fungal protein and RNA synthesis
* griseoulvin
41
differentiate between phenotype mixing and genetic reassortment vs recombination in viruses
phenotypic mixing: the F2 generation will go back to normal
reassortment: F2 maintains the mutations because there was actual GENETIC changes when two different SEGMENTED viruses coinfect a cell
recombination: non-segmented viruses infect the same host and HOMOLOGOUS genetic segments undergo recombination
42
zika virus
- family of viruses and transmission
- clinical features
- dx
43
most cases of gas gangrene from Clostridium are triggered by underlying what
colonic malignancy
44
the efficacy of maraviroc is dependent on the presence of what in the viral strain
how is enfuvirtide different
maraviroc stops the binding of virus to host cell but it requires the virus to target CCR5
* if the virus uses CXCR4, maraviroc is not effective
enfuvirtide = an HIV fusion inhibitor that works on both lymphocytes and macrophages and will work either way
45
first line antiretroviral therapy can lead to what complications
tenofovir-induced nephropathy
* hypophosphatemia, glucosuria proteinuria, abn biopsies
* --\> AKI and proximal tubule dysfunction
* --\> loss of brush border, stripping of the BM, giant mitochondria (look like giant eosinophilic inclusions)
46
AE of TMP-SMX
can cause
* drug induced lupus
* steven johnson
* hemoltic anemia in pts with G6PD
* folate deficiency with prologned use
* kidney damage
* x Na-K channels in distal tubule and collectid ducts --\> hyperK
* especially in eldery, those on K-sparing diuretics, and on ACE-inhibs/ARBs
47
which anti-retroviral drug is conraindicated in pt's with an HLA-B\*57.01 allele
what antiretrovirals can cause rash
certain HLA gene -\> ABACAVIR is contra
* --\>type IV delayed hypersensitivity rxn (cytotoxic T cell mediated)
* fever, malaise, GI sx, delayed rash
rash associatied with abacavir and emtricitabine
48
C.perfringens can cause what two clinical pictures
gas gangrene
transient, waterry diarrhea
49
histopath of syphillis induced gential lesions classically shows what
proliferative endarteritis of small vessels with surrounding plasma-cell rich infiltrate
50
mucor histo appearance and clin sx
fever, HA
eye pain/nasal pain = rhinocerebral infection
black necrotic eschars on inferior turbinates
MUCOSAL BIOPSY= shows ribbon like, NONseptate hyphae w 90 degree angle branching
51
(+) heterophile Ab test is highly specific for infection with what
EBV
=heterophile IgM Abs
52
long term PPI usage can inc risk for what type of bacteria
acid labile bacteria -
long term PPI --\> achlorydia = dec acidity in stomach
-better survivability of bacteria like **V. cholerae,** who would have been killed by acidic stomach conditions
53
adverse effects of anti-retroviral protease inhibitors
"navir"s
* lipodystrophy = central obesity and peripheral wasting
* hyperglycemia = inc insulin resistance
* inhib CYP450
54
rotavirus
* type
* clin presentation
* pathophys
rotavirus
* segmented, dsRNA, nonenveloped
* clin presentation=
* MC cause of infectious diarrhea worldwide
* associated with kids \<5 yo
* self-limited fever and waterry diarrhea, may lead to dehydration and electrolyte abnormalities
* pathophys
* invades villous epithelium of duodenum and proximal jejunum
* diarrhea associated with villous blunting, proliferation of secratory crypt cells, reduced brush border enzymes
55
toxic shock syndrome is caused by activation of what cells
T cells and macrophages
56
virulence factors of listeria
57
organism?
aspergillus
big arrow= acute angle branching
thin arrows= septations
58
treatment of atypical pneumoniea - MOA
need a bacterial protein synthesis inhibitor
* macrolide or tetracycline
* (bc these organisms don't have a cell wall - Listeria, chlamydiae, mycoplasma)
59
acyclovir, gancyclovir MOA
a nuceloside analog = inhibit incorporation of pyrimidines and purines into newly replicated DNA
60
tender "cauliflower-shaped, verrucous growths" on peri-anal skin with papillary squamous proliferation and perakeratosis irregularity
= ? : ds associations and risk factors?
condyloma acuminata = anogenital warts
61
what organisms requires a medium with vancomycin, colistin, nystatin, and trimethoprim to grow?
=thayer martin medium
= neisseria
62
differentiate the role of the liver in the life cycle of P vivax+ovale vs P falciparum
how does this effect trx
mefloquine prophylaxis needs to be started before going to Africa and for 4 weeks upon return as the bug is released from the liver and into the blood stream
* bc drug is inactivated in the liver and only works in RBCs
P v+o --\> liver is site of dormant hypnozoites
P f --\> liver is site of maturing, NONdormant schizonts
63
what types of cells are seen on stool microscopy in watery diarrhea vs dysentery vs enteric fever
64
what is the most important virulence factor of staph epidermidis
65
respiratory infection in an immunocompromised host and/or pt with neutropenia has high probabilty of being what?
how do you differentiate between the different possible agents?
oppurtunistic fungal infection of the respiratory tract
* yeast= single celled growth, replication = budding
* candida, crypto, pneumocystis,
* mold = filaments and hyphae
* aspergillus, mucor, rhizopus
66
which protozoa appear as appear as cysts and which appear as trophozoites on culture
= giardia : multinucleated trophozyte
= E. histolytica : trophozoite with engulfed RBC
= plasmodium= ring of trophozoites w/in an RBC
=babesia = maltese cross of trophozoites w/in an RBC
= trichomonas vaginalis= motile trophozoite
= naegleri fowleri = motile trophozoite
* present with primary amoebic meningoencephalitis, mostly fatal
67
increased risk of Neisseria is associated with defieciency in what immune process
formation of MAC
\*\*asplenia = n meningitidis SPECIFICALLY + H. influenzae + S. pneumo
68
clin use of trimethoprim-sulfamethoxazole
* MOA of TMP, SMX
* what other drug has the same MOA as SMX
* AE of TMP
* AE of SMX
CLIN USE=
* 1st line for UTIs + acute prostitis
* Shigella, Salmonella trx
* Pneumocystis jiroveci pneumonia trx AND prophylaxis
* toxo prophylaxis
* MOA of TMP, SMX
* anti-folates
* SMX= PABA analog, inhibit dihydropteroate synthase
* TMP= inhibit dihydrofolate reductase to stop dihydrofolic acid from become tetrahydrofolic acid
* what other drug has the same MOA as SMX
* dapsone= trx leprosy and prophylaxis for pneumocystis
* AE of TMP
* megaloblastic anemia, leukopenia, granulocytopenia
* AE of SMX
* hypersensitivity
* hemolysis in G6PD
* nephrotoxicity + T4 RTA
* photosensiticvity
* steven-johnson
* kernicterus in infants
* displace other drugs from albumin (i.e. warfarin)
69
doxycycline is indicated when
* borrelia burgdorferi lyme
* M. pnemoniae atypical pnuemoniea
* rickettsia
* chlamydia
* MRSA
* coxsackie
* tickborne ds and zoonotic ds
70
indication for chloramphenicol
meningitis IN THE DEVELOPING WORLD
=H. flu, N. meningitidis, S. pneumo
71
clindamycin clin indications
anaerobic infections ABOVE the diaphragm
vs. metronidazole= anaerobic infections below the diaphragm
* b. fragilis - oral infections + aspirations
* C. perfringens = infect open wounds
* acne caused be skin anaerobes
* ASPRIATION PNEUMONIA --\> LUNG ABSCESS
* v good for anaerobic infections because it is actively transported into Macrophages --\> lung abscesses
* invasiv Group A strep = skin and ST tissue infection/cellulitis
72
1st line drugs against MRSA
not 1st line drugs but work ...
vancomycin (PGP cell wall)
+ daptomycin (cell membrane integrity)
+ linezolid (50S inhib = translation)
not 1st line= doxycycline, clindamycin
73
H.pylori triple therapy =
clarithromycin, amoxicillin, PPI
74
linezolid indications
MRSA
VRE (vancomycin resistant enterococcus)
75
macrolides indication
i= ACE-mycin (azithro, clarithro, erythro)
* atypical pneumoniae (mycoplasma, chlamydia, legionella)
* STI (chlamydria urethritis/cerviticties)
* B. pertussis
* CAP = H. flu, S. pneumo, Moroxella, cattarhalis
76
gentamicin indication
what is an absolute contraindication to the use of gentamicin and other aminoglyclosides
most gentle teacher for most difficult kids
* enterobacter, serratioa, klebsiella - nosocomial infiection
* septicemia, complicated UTI, intra-abd infection, osteopmyelitis
* pseudomonas (along with tubramycin and amikicin)
* enterococcus caused endocarditis and UTI
absolute contra = myasthenia gravis (can cause neuromuscular blockade, which would be esp bad for an MG pt)
77
ceftriaxone indication
(3rd gen cephalosporin)
* neisseria meningitis and gonnorrhea
* neonatal meningitits
* -MC from H flu, Strep pneumo, or E Coli
78
which cephalosporin has activity against pseudomonas
cefepime
79
pts w CGD have inc infection with what organisms
catalase (+)
mona lisa and gillian, serenaded and staffed, playing cards and discussing their new band "Cats Gonna Dance"
* pseudomonas, aspergillus, serratia, staph aureus, nocardia,
80
RNA viruses
who are
* (+) helix?
* (+) icosohedral?
* (-) icosohedral\>
* dsRNA?
* (+) helix?
**coronavirus** (Rona, SARS)
* (+) icosohedral?
*_!!!!!! enveloped !!!!!_*
**retrovirus**= HIV, HTLV
**flavivirus**= HCV, yellow fever, dengue, zika, st.louis encephalitis + west nile
**toga virus** = rubella, arbociruses (equine), chicangunya
*_!!!!!!!naked!!!!!!!!!!!_*
**calicivirus** = norwalk
**hepevirus** = Hep E
**picornovirus** = rhinovirus (cold), polio, HAV, echovirus, coxsackie
* (-) icosohedral
*_!!!!!!!!!enveloped!!!!!!!!!!!_*
**bunyavirus** (CA encephalitis, hantavitus+congo fever --\> hemorrhagic fever)
**filovirus**= ebola, marburg
**arenavirus**= lassa fever encephalitis, lymphocytic choriomeningitis virus
**deltavirus**= HDV
**paramyxovirus**= rubeola (measles), mumps, RSV, parainfluenza (croup)
**rhabdovirus**= rabies
**orthomyxovirus**= influenza
* dsRNA?
**reovirus** = colorado tick fever and rotavirus (watery diarrhea in children, can be fatal)
81
causes of childhood rashes
**rubella = togavirus**
move head to feet, seperate spots
associated w cervical and periauricular LAD
**rubeola measles= paramyxovirus**
head to feet, coalescing
cough, conjunctiva, coryza (runny nose)
**roseola, HHV6**
infants = neck and face : adults= trunk and limbs
appears AFTER a fever that is broken
**parvovirus B19 = DNA parvovirus**
slapped cheek
**strep pyogenes --\> scarlet fever**
head and neck --\> trunk, sand paper like red rash
associated w sore throat
82
which 3 infections cause rashes that involve the hands hand feet
**secondary syphillis** - *_treponema pallidum_* (maculopapular rash all over and condyloma lata)
**rocky mountain spotted fever :** start at ankle and wrists and then spread to trunk, palms, and soles
**hand, foot, and mouth ds** : *_coxsackie A virus_*, sore throat+buccal vesicles --\> rash on hands, feet, and butt
83
which infections cause hemorrhagic fever
BUNYAVIRUS
* rift valley fever virus (mosquito bite)
* crimean-congo HF virus (tick)
* hantavirus (rodents)
FILOVIRUS
* ebola, marburg
ARENAVIRUS
* lassa fever virus (rats)
YELLOW FEVER/DENGUE can be a complication
84
encephalitis causing viruses
**flaviviruses** : st. louis encephalitis, west nile virus
* associated birds
**togavirus**: E+W equine virus
* birds
**bunyavirus**: california encephalitis
* rodents
85
which two bacteria are associated with gallbladder
salmonella and C. sinensis (SEAgull, Cgull)
* salmonella colonizes the GB--\> carrier state
* rose spots on abd, pea soup diarrhea,
* undercooked chicken
* C. sinensis --\> biliary tract inflammation
* pigmented gallstones, cholangiocarcinoma
* undercooked fish
86
what are the 3 structural genes in HIV, and the proteins they encode for (+function)
which are targeted by antiretroviral therapy
* env
* gp120 - attachment to host CD4 cell (along w with CCR5 on macrophage or CXCR4 on T cell)
* x maraviroc
* gp41= fusion and entry into host cells
* x enfuvirtide
* gag
* p24 capsid protein and p17 matrix protein
* pol
* reverse transcritase, aspartate protease, integrase
* x (rest of antiretroviral drugs)
87
which two serum markers can be seen during the window period of HBV
order of markers and what they mean?
anti-Hbe, antiHBc (IgM
SpECIES
88
what are the 5 stages of untrx HIV infection
1. window period (~ 1 month)
1. primary infection: when your CD4 cells first start t drop and HIV RNA replication begins
2. before sx
2. acute infection (~1 month)
1. flu-like sx
3. clinical latency (months to years)
1. virus is replicated in LNs
2. CD4 levels are above 200, Abs have formed against gp120,
4. falling count
1. CD4 levels plummet, HIV RNA skyrockets
2. skin and mucus membrane infections occur
5. final crisis
1. max HIV RNA, min CD4 count
2. AIDS defining illnesses occur,
3. lead to death
89
illnesses seen in AIDS with..
* CD4 \< 500
* CD4 \<200
* CD4 \<100
* CD4 \< 500
* oral candida, EBV, HHV-8, HPV
* CD4 \<200
* hisoplasma, HIV, JC virus, pneumocystis jiroveci
* CD4 \<100
* aspergillus, bartonella henslae, candida albicans, CMV, cryptococcus neoformans, cryptosporidium, EBV, MAC, toxoplasma gondii
90
which viruses replicate inside the nucleus? which outside?
exceptions
in general - DNA viruses replicate inside the nucleus, RNA viruses outside the nucleus
exceptions:
poxviridiae = DNA virus replicate OUTSIDE
orthomyxoviridaie and retroviridae = RNA viruses that replicate inside
* orthodontist: make octupus babies INSIDE the helmet
91
clin presentation of Coccidioidis immitis
"valley fever"
92
enterovirus is the cause of \>90% migraines
93
94
which organisms infect the nasopharynx (primary site of infection) and cause meningitis?
which species' primary site of infection is the oral cavity
oral cavity = candida
nasopharynx= strep pneumo, N meningitidis, H. influenzae
95
96
97
biopsy findings in
* primary TB
* latent TB
* secondary TB
* miliary TB
* primary TB
* lower lobe cavitation
* latent TB
* ghon complex= lower lobe calcification and hilar LB calcification
* secondary TB
* lung apex cavitation / upper lobe
* miliary TB
* caseous cavitations throughout lung and liver
98
