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Micro Review Flashcards

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1
Q

Branching rods on oral infection

A

Actinomyces israelii

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2
Q

HHV-8

A

Kaposi sarcoma

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3
Q

EBV associated iwth

A

Hodgkin lymphoma
(Reed-sternberg cells)

Burkitt lymphoma
(starry sky, 8;14)

Nasopharyngeal carcinoma

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4
Q

Streptococcus bovis assoc with

A

Colon cancer

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5
Q

Schistosoma haematobium assoc with

A

Squamous cell cancer of bladder

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6
Q

Clonorchis sinensis assoc with

A

Biliary cancer

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7
Q

Enveloped viruses spread

A

Droplets perientrally or sexually

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8
Q

Non-enveloped viruses spread

A

Fecal oral spread

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9
Q

Non-enveloped RNA viruses

A

“my Real Heavy Picture of California was Ruined without an Envelope”

Reovirus
Hepevirus
Picornavirus
Calicivirus

New ERs Helps People Receive Care

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10
Q

Non-enveloped DNA viruses

A

“PaPa and Aunt Poly Didnt have an Envelop”

Parvovirus
Papillomavirus
Adenovirus
Polyomavirus

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11
Q

DNA viruses typically replicate

A

In the nucleus

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12
Q

RNA viruses typically replicate

A

in the cytoplasm

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13
Q

DNA viruses that replicate in the cytoplasm

A

Smallpox virus

Molluscum contagiosum

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14
Q

RNA viruses that replicate in the nucleus

A

Orthomyxovirus (Influenza virus)

Retroviruses

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15
Q

Viral recombination where two viruses exchange entire segment

  • example
  • only what
A

Viral reassortment

RNA viruses only

Influenza virus

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16
Q

When two different viruses infect same host a genes are exchanged from two different chromosomes

A

Viral recombination

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17
Q

When two viruses infect a cell and one is non-functional so other virus makes a functional protein that serves both viruses

A

Viral Complementation

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18
Q

When two viruses infect the same host and the progeny receive surface proteins from either parent

A

Phenotypic mixing

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19
Q

Ploidy of viruses

A

All RNA and DNA viruses are haploid

Except: retroviruses (2) of ssRNA

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20
Q

DNA viruses

  • examples
  • typical features
  • exceptions
A

HAPPy HiPPo Dung

HHAPPPPy

Herpesvirus
Adenovirus
Parvovirus
Papillomavirus
Hepadnavirus
Polyomavirus
Poxvirus
DNA

Linear dsDNA
Icosahedral shape
Replicate in nucleus

Only parvoviridae (ssDNA)

Papillomarvirus (circular)
Polyomavirus (circular)
Hepadnavirus (circular)

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21
Q

RNA viral genomes

A

(+) stranded RNA viruses

I went to a RETRO TOGA party, where I drank FLAvored CORONA and ate HIPPIE CALIfornia PICkles

Retrovirus
Togavirus
Flavivirus
Coronavirus
Hepevirus
Calicivirus
Picornavirus

All ssRNA except reoviridae (dsRNA)

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22
Q

Negative-sense ssRNA

A

Not immediately translated

Can only be transcribed and not directly translated

Bring along viral transcriptase

Always Bring Polymerase Or Fail Replication

Arenaviruses
Bunyaviruses
Paramyxoviruses
Orthomyxoviruses
Filoviruses
Rhabdoviruses
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23
Q

dsRNA brings along what

A

Polymerase

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24
Q

Live attenuated vaccine

A

“Attention Teachers” Please Vaccinate Small Beautiful Young Infants with MMR Regularly

Adenovirus
Typhoid
Polio (Oral)
Varicella
Small pox
BCG
Yellow fever
Influena (intranasal)
MMR
Rotavirus
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25
Killed vaccine
RIP Always Rabies Influenza (injection) Polio (injectable) Hepatitis A
26
Subunit vaccines
Use specific viral antigens to stimulate immune response hepatitis B HPV
27
Egg allergy
Yellow fever Influenza (MMR)
28
When should live virus vaccines be considered for HIV positive patients
All infants with HIV - Rotavirus vaccine CD4 count > 200 - MMR - Varicella vaccine Not recommended - Live virus influenza vaccine - Herpes zoster vaccine
29
What condition is suggested by each of the following 1. Signet ring cells 2. Nutmeg liver 3. RBC casts in urine
1. Gastric adenocarcinoma, lobular carcinoma in situ of breast 2. Right sided heart failure and budd-chiari 3. Acute glomerulonephritis
30
Infects spindle cells
HHV-8 Kaposi sarcoma associated herpesvirus (KSHV)
31
Temporal lobe encephalitis
Herpes simplex virus 1 (HSV-1)
32
Tzanck smear
Multinucleated giant cells positive HSV-1, HSV-2, VZV Low specificity Low sensitivity
33
Intranuclear eosinophilic inclusions
Type A Cowdry bodies | HSV, VZV, CMV
34
EBV infects what cells causes what cell type seen
Infects B cells Causes T cell response Downey cells - Foamy appearing basophilic cytoplasm
35
Foamy appearing cells with basophilic cytoplasm
Downey cells T cells EBV
36
Fever Sorethroat LAD of posterior cervical nodes Splenomegaly (+) monospot test
Infectious mononucleosis EBV
37
Ab against antigens found on horse, sheep and beef RBCs
Monospot test Detects heterophiles EBV
38
Heterophile (-) mononucleosis
CMV infection | Acute HIV
39
Owl eye nuclear inclusions
CMV
40
Retinitis blind within days
CMV w/ AIDS
41
HIgh fever (102) 3-5 days Fever breaks Maculopapular rash all over body Seizures
Roseola Sixth disease Human Herpes virus -6
42
What group of patients is prone to esopahgitis caused by CMV
HIV patients (CD4 < 50)
43
Child with bright red rash on cheeks
``` Slap cheek rash Erythema infectiosum (fifth disease) ``` Parvovirus B19
44
Upper respiratory infection Then conjunctivitis Diarrhea
Adenovirus | dsDNA virus
45
Variola poxvirus vs vaccinia pox virus
Variola poxvirus - smallpox Vaccinia poxvirus - cowpox
46
Flesh colored dome shaped lesions with central dimple (umbilication)
Molluscum contagiosum In immunocompetent will resolve in less than a year
47
Demyelination of DNA due to destruction of oligodendrocytes AIDS Progressive Visial symptoms
Progressive Multifocal leukoencephalopathy JC virus Polyomavirus
48
Only Hepatitis virus dsDNA
Hepatitis B virus
49
Hepatitis B virus is what type of virus
Hepadnavirus
50
Hepatitis B virus replication
dsDNA virus Partially double-stranded circular DNA enter nucleus Host polymerase makes RNA intermediate from dNA Viral reverse transcriptase makes DNA from RNA intermediate
51
Hides in sensory ganglia of S2 S3 Hides in trigeminal ganglia Hides in dorsal root ganglia
HSV-2 HSV-1 VZV
52
Opacities seen on X ray on both sides of carina
Bilateral hilar lymphadenopathy Sarcoidosis
53
Common cold
Rhinovirus | Coronavirus
54
``` Severe diarrhea and vomiting Winter months Daycare center Non-enveloped dsRNA virus ```
Rotavirus | type of reovirus
55
Western US/ canada Hiker, Fisherman, camping Flu- like
Coltivirus (type of reovirus) Self limiting
56
Types of picornaviruses
PERCH Enterovirus - Poliovirus - Coxsackievirus - Echovirus - Hepatitis A virus Rhinovirus
57
Types of enteroviruses | - labeled as
Enterovirus falls under Picornaviruses Spread through enteric system 4 types - Poliovirus - Coxsackievirus - Echovirus - Hepatitis A virus
58
Poliovirus
Infects grey matter of the anterior horn of the spinal cord and motor neurons of the pons of the medulla Causes paralysis
59
Aseptic meningitis Myocarditis URIs Summer -Diagnosis?
Echovirus PCR of CSF
60
Hand foot and mouth disease
Coxsackievirus
61
Most common cause of viral myocarditis in US features of disease (5)
Coxsackievirus ``` Dilation of all chambers Dyspnea Chest pain Fever Arrhythmias ```
62
Mouth blisters, fever
herpangina Coxsackievirus
63
Coxsackievirus can cause
``` Myocarditis Aseptic meningitis Pericarditis herpangina (blisters mouth and fever) Hand, foot and mouth disease Febrile pharngitis ```
64
Picornavirus that is not an enterovirus
Rhinovirus Common cold
65
Vomiting and diarrhea | Cruise ship
Norovirus (caliciviruses) Fecal oral route
66
Types of flaviviruses
``` Yellow fever Dengue fever West nile virus St. Louis Encephalitis virus HCV ``` Most are arboviruses (spread by arthropod)
67
``` High fever, HA Epistaxis Gum bleeding petechial and purpura Black vomit Jaundice Africa ``` Spread by?
Yellow Fever Aedes mosquitoes Liver damage
68
Fever Severe musculoskeletal pain Retro-orbital headache Spread by? Can get? Test?
Dengue fever Mosquito Hemorrhagic fever Tourniquet test - field test for hemorrhagic fever - BP inflated leave 5 min - Excess petechiae
69
``` Headache Malaise Backpain Myalgia Anorexia Alteration in consciousness Neck stiffness ```
West Nile virus (WNV) Mosquito Serology for IgM anti-WNV antibodies Tx supportive
70
A 26-year-old woman has headaches for 4 weeks along with increasing malaise. Physical examination yields no remarkable findings. CT scan of the head shows no abnormalities. A lumbar puncture yields clear, colorless CSF with a normal opening pressure. Laboratory analysis of the CSF shows a normal glucose concentration and a minimally increased protein level. A few lymphocytes are present, but there are no neutrophils. A Gram stain and India ink preparation of the CSF are negative. Her condition gradually improves over the next 6 months. Serum serologic tests are most likely to show an elevated titer of antibodies to which of the following infectious agents? A Cryptococcus neoformans B Echovirus C Listeria monocytogenes D Neisseria meningitidis E Toxoplasma gondii
B. Echovirus Acute lymphocytic meningitis West nile Echovirus
71
Togaviruses
Rubella virus
72
Fever Lymphadenopathy Arthralgia Macuopapular rash
Rubella or german measles
73
Congenital rubella
Cardiac defects - PDA - Pulmonic stenosis Cataracts Deafness
74
11 A 6-year-old girl has a blotchy, reddish-brown rash on her face, trunk, and proximal extremities that developed over the course of 3 days. On physical examination, she has 0.2-cm to 0.5-cm ulcerated lesions on the oral cavity mucosa and generalized tender lymphadenopathy. A cough with minimal sputum production becomes progressively worse over the next 3 days. Which of the following viruses is most likely to produce these findings? A Epstein-Barr B Mumps C Rubella D Rubeola E Varicella zoster
D Rubeola Measles (rubeola) Rash Koplik spots Rubella: german measles, is a much milder infection than rubeola
75
7 term infant has initial Apgar scores of 8 and 10 at 1 and 5 minutes. On auscultation of the chest, a heart murmur is audible. There is hepatosplenomegaly. Cataracts of the crystalline lens are noted. The infant is at the 30th percentile for height and weight. Echocardiography shows a patent ductus arteriosus. Which of the following events is the most likely risk factor for the findings in this infant? A Congenital rubella infection B Dietary folate deficiency C Dispermy at conception D Erythroblastosis fetalis E Maternal thalidomide use F Paternal meiotic nondisjunction
A Rubella in first trimester
76
38 A family who recently emigrated from Romania brings their 7-year-old child to the pediatrician with complaints of conjunctivitis and periorbital swelling. The child has had coughing with a runny nose and high fever for 3 days. Small lesions with blue-white centers are seen in his oral cavity. Which of the following is the most likely cause of this child’s symptoms? (A) Diphtheria (B) Pertussis (C) Roseola (D) Rubella (E) Rubeola
E Rubeola
77
Retroviruses
Use reverse transcriptase HIV Human T cell Luekemia virus (HTLV)
78
What is the number one cause of fatal infantile gastroenteritis
Rotavirus
79
Posterior cervical adenopathy
EBV mononucleosis Cat scratch disease (bartonella) Acute otitis media
80
Avian influenza
H5N1 Spread only from bird to human 60% mortality Severe rapidly progressive couse Fever cough myalgias diarrhea, pancytopenia Tx: Oseltamivir
81
Swine flu - type - composed of - symptoms - tx
H1N1 Two swine strain One human strain One avian strain Flu and GI symptoms Tx: Oseltamivir or zanamivir
82
Influenza virus - type of virus - description of virus - two key features
Orthomyxoviruses Enveloped ssRNA Hemagglutinin - viral attachment to host cell Neuraminidase - release progeny virions
83
Barking seal cough child
Croup Parainfluenza virus - enveloped
84
Steeple sign
Croup Parainfluenza virus - enveloped
85
Winter months viruses
Influenza Rotavirus RSV
86
Summer months enterovirus
Poliovirus Echovirus Coxsackievirus
87
Summer months arbovirus
West Nile virus
88
Bronchiolitis Child Pneumonia in child
Infection of bronchioles RSV
89
Primary cause of penumonia in children
RSV
90
RSV virus has what
Transmembrane protein called Fusion protein (F protein) This allows infected cells to bond to near by uninfected cells Multinucleated giant cells
91
55 A 3-year-old boy has had a cough, headache, and slight fever for 5 days. He is now having increasing respiratory difficulty. On physical examination, his temperature is 37.8° C, pulse is 81/min, respirations are 25/min, and blood pressure is 90/55 mm Hg. On auscultation, there are inspiratory crackles, but no dullness to percussion or tympany. Respiratory syncytial virus is isolated from a sputum sample. Which of the following chest radiographic patterns is most likely to be present? A Hilar lymphadenopathy B Hyperinflation C Interstitial infiltrates D Lobar consolidation E Pleural effusions F Upper lobe cavitation
C Interstitial infiltrates RSV
92
Paramyxoviruses
RSV Parainfluenza virus Rubeola virus (measles) Mumps
93
Runny nose cough Conjunctivitis Blue grey specks on buccal mucosa surround by base of red Wide spread maculopapular rash that started on head and spread
Measles Enveloped Koplik spots
94
Parotits Orchitis Meningitis
Mumps enveloped Inflammation of parotid gland
95
Viral meningitis
Coxsackievirus Echovirus Enterovirus Mumps virus
96
``` Negri bodies Fever Nausea vomiting Strange behavior Hallucinations Hydrophobia Coma Death ```
Rabies virus (Rhabdovirus) Enveloped RNA
97
Eosinophilic cytoplasmic inclusions that contain viral nucleocapsids
Negri bodies | Rabies
98
Bullet shaped capsid
Rabies
99
Fever Progressive pulmonary edema Respiratory failure Exposure to mouse urine
Hantavirus
100
A 27-year-old man dies of acute respiratory distress syndrome 1 day after presenting to the hospital with shortness of breath and a fever of 38° C (100.4° F). On the second hospital day, he developed extreme pulmonary edema and hypotension before he died. His family says that he had recently gone hiking and caving in an area known to be heavily populated with rodents. Which of the following is the most likely cause of death? (A) Dengue virus (B) Ebola virus (C) Hantavirus (D) Marburg virus (E) Rhabdovirus
C. Hantavirus
101
Illnesses spread through animal urine
Hantavirus Lassa virus LCM virus Leptospirosis
102
``` Fever HA myalgias Followed by vomiting and diarrhea Multiorgan failure Shock Death ```
Ebola virus
103
A patient present with fever, vomiting and diarrhea. She was in west africa two weeks visiting family. What viral infection? Type of isolation
Ebola Contact and droplet precautions
104
Viral proteins of HIV
Gp120 | Gp41
105
Gp120
Grabs onto CD4 surface receptor on T cells and macrophages Once connected, changes shape and allows it to bind to coreceptor (CCR5 or CXCR4)
106
Tropsim
Which coreceptor HIV uses to enter cell only CXCR4: X4 viruses Only CCR5: R5 viruses Both : dual tropism
107
GP41
Fusion and entry into host cells
108
Three main structural genes in HIV genoma
Gag: encodes p24 capsid protein Env: gp120 and gp41 Pol: codes for reverse transcriptase
109
Diagnosis of HIV check
P24 antigen adn HIV antibodies Viral load (PCR test)
110
AIDS diagnosis
CD4 < 200 < 14% lymphocytes are Cd4 AIDs defining condition - Pneumocystis jirovecii pneumonia
111
Ring enhancing lesions
HIV associated Primary CNS lymphoma (solitary lesion) Toxoplasmosis (multiple lesions)
112
HIV < 200 opportunistic infections
Pneumocystis jirovecii pneumonia
113
HIV < 100 opportunistic infections
Histoplasmosis capsulatum Candida albicans
114
HIV < 50 opportunistic infections
Mycobacterium tuberculosis Mycobacterium avium complex CMV retinitis
115
Hepatosplenomegaly Fever Cough CD4 < 150
Histoplasmosis capsulatum
116
Chronic watery diarrhea HIV patient diagnosis
Cryptosporidium spp. (c.parvum) Oocytes on modified acid-fast stain of stool turns bright pink or red
117
HIV patient covered in what look likes cherry angiomas
Bacillary angiomatosis | Bartonella henselae
118
What four molds are considered dermatophytes (fungal species that invade superficial skin)
Trichophyton Microsporum Epidermophyton Malassezia furfur
119
Diaper rash | Satellite lesions
Candida albicans Shiny skin or eroded
120
Blood culture | Germ tubes have small projections on side of cell
Candida albicans
121
Narrow based budding yeast
Cryptococcal neoformans
122
India ink | Clear circle
Cryptococcal neoformatns
123
Soap bubble lesion on imaging
Cryptococcal meningoencephalitis
124
Silver stain Ground glass appearance of interstital infiltrates
Pneumocystis jirovecii (PCP)
125
Narrow septate hyphae that branch at acute angles (45 degrees)
Aspergillus fumigatus
126
Broad irregularly shaped, nonseptate hyphae branching at right angles (90 degrees)
Mucor and Rhizopus
127
``` Facial pain HA Large necrotic lesion, black escar Blindness CN deficits ```
Rhinocerebral mucomycosis
128
Most common type of dermatophytes with animal reservoir
Microsporium (dog or cat)
129
Hypopigmented or hyperpigmented lesion on body Scaling plaque Yeast
Tinea versicolor Malassezia furfur
130
KOH prep spaghetti and meatball appearance
Tinea versicolor | Malassezia furfur
131
What is associated iwth each clue 1. Cat scratch 2. Cat bite 3. Cat feces 4. Puppy feces 5. Animal urine
1. Bartonella henselae 2. Pasteurella multocida 3. Toxoplasma 4. Yersinia enterocolitica, campylobacter jejuni 5. Leptospira, hantavirus
132
Organisms associated with birds
Histoplasma capsulatum (bird/bat droppings) Cryptococcus neoformans (pigeon droppings) Chlamydophilia psittaci (parrots) H5N1 influenza West Nile virus
133
Mississippi ohio river valley Bird and bat droppings Spelunkers - Imaging - what happens to it
Histoplasma capsulatum Enters through lung Engulfed by macrophages Hyphae and spores on imaging Macrophage filled w/ 100 spores
134
Mississippi and ohio river basins Thick refractile wall around yeast broad based budding
Blastomyces dermatitidis Granulomatous nodules
135
Southwestern U.S Mexico Pneumonia Spherule -filled with endospores
Coccidioides immitis
136
A 46-year-old man from northern Mexico has had fever, nonproductive cough, and weight loss for 2 months. On examination his temperature is 37.5 ° C. A chest radiograph shows a miliary pattern of small nodules in all lung fields. Bronchoalveolar lavage is performed and microscopic examination of the fluid shows organisms averaging 50 microns in diameter with thick walls and filled with endospores. Which of the following infections is he most likely to have? A Blastomycosis B Coccidioidomycosis C Histoplasmosis D Mycobacteriosis E Nocardiosis F Paracoccidioidomycosis
B. Coccidioidomycosis
137
Pneumonia Granulomatos changes in mucous membranes Captain wheel Latin america
Paracoccidioides brasiliensis Paracocci parasails with a captains wheel all the way to Latin america
138
Gardner Dimorphic fungus Pustule on puncture site Nodules follow draining lymphatics Tx
Sporothrix schenckii Tx: Itraconazole (first line) potassium iodine
139
Mold form contains barrel shaped arthroconidia
Coccidioides immitis
140
Associated iwth dust storms
Coccidioides immitis
141
Multiple budding of yeast form
Paracoccidioides brasillensis
142
Councilman bodies
Apoptotic liver cells Viral hepatits yellow fever
143
Acute fatty foul smelling diarrhea Abdominal bloating - Diagnosis Tx
Giardia lamblia Pear-shaped trophozoites or cysts in stool Metronidazole Tinidazole
144
Pear-shaped trophozoites
Giardia lamblia Trichomonas (protozoal)
145
Bloody diarrhea Flask shaped ulcers RUQ pain - type organism - transmittered - diagnosis - tx
Entamoeba histolytica Liver abscesses Fecal-oral route - eating food or water contaminated with feces that contain cysts Trophozoites or cysts in stool Treatment - trophozoites= metronidazole or tinidazole - cysts= iodoquinol or paromomycin
146
Foul smelling vaginal discharge Motile -transmission - wet mount - vaginal pH - tx -
Trichomonas vaginalis Sexual transmission Pear shaped appearance Increase vaginal pH Metronidazole
147
Ring enhancing lesions in brain Tx
Toxoplasma gondii Pyrimethamine
148
Chorioretinitis Hydrocephalus Intracranial calcifications Tx
Toxoplasma gondii Pyrimethamine
149
Toxoplasma gondii acquired how
Cat feces or litter | Eating cyst in infected meat
150
Rapidly fatal meningoencephaltiis Swimming
Naegleria fowleri Swimming in freshwater lakes Enters nose passes through cribriform plate
151
A 40-year-old man goes on a camping vacation with his family. One day after swimming in a freshwater lake near the camp site, he develops nausea and vomiting and starts to behave irrationally. His family takes him to the emergency department, where blood samples are taken and a spinal tap is performed. He is diagnosed with a rapidly progressing meningoencephalitis and dies shortly thereafter. Which of the following protozoa was most likely the cause of the man’s illness? (A) Cryptosporidium species (B) Entamoeba histolytica (C) Leishmania donovani (D) Naegleria fowleri (E) Plasmodium falciparum
(D) Naegleria fowleri
152
55 A 9-year-old child who is living in a mud hut in Paraguay has a sore persisting on her face for 4 days. Physical examination shows an indurated area of erythema and swelling just lateral to the left eye, accompanied by posterior cervical lymphadenopathy. She has unilateral painless edema of the palpebrae and periocular tissues. Two days later, she has malaise, fever, anorexia, and edema of the face and lower extremities. On physical examination 1 week later, there is hepatosplenomegaly and generalized lymphadenopathy. Which of the following pathologic findings is most likely to develop in this patient? A Cerebral abscesses B Chronic arthritis C Dilated cardiomyopathy D Meningitis E Mucocutaneous ulcers F Paranasal bony destruction
C Dilated cardiomyopathy Trypanosoma cruzi Tx Nifurtimox
153
Trypanosoma brucei spp - sickness - vector - symptoms - later symptoms - blood smear - tx
African sleeping sickness tsetse fly Fever Enlarged LN Sleepiness Encephaltiis Coma and death Blood smear: long whispy organisms in blood Early: Suramin CNS involved: Melarsoprol
154
Dilated cardiomyopathy Megesophagus Megacolon
Trypanosoma cruzi Chagas disease Reduviid bug - painless bit - Feces scrated into skin Benznidazole Nifurtimox
155
Spiking fevers Hepatosplenomegaly Pancytopenia - transmission - diagnosis - tx
Leishmania donovani Visceral leishmaniasis Sandfly Amastigotes inside macrophages Liposomal amphotericin B
156
Ulcerating papules that are slow to heal
Leishmania donovani - Cutaneous leishmaniasis Sandyfly Sodium stibogluconate
157
Cyclic fever Headache Anemia Splenomegaly
Malaria Plasmodium species Mosquito
158
Malaria fever due to
RBCs rupture and release merozoites
159
Malaria that fever spikes every 48 hrs Every 72 hrs
48 hr - P. ovale - P. vivax 72 hr - P. malariae
160
Malaria - subtype - tx - Diagnosis
Plasmodium species P. vivax and P. ovale - dormant infection in liver Tx primaquine ``` P. falciparum - most severe - no dormant form - sequestration of RBCs --> occlusion of small vessels Tx: Chloroquine (SE: Retinopathy and pruritis ) ``` Blood smear - Merozoites - Trophozoite= diamond ring - Gametocytes: banana shaped
161
Two ring forms inside one erythrocyte
Trophozoite form Babesia Microti
162
Maltese cross
inside RBC merozoites Babesia Microti
163
Babesia Microti - symptoms - blood smear - transmission - tx
Fever Hemolytic anemia Progressive fatigue Two rings inside RBC Maltese cross Ixodes tick coinfection w/ lyme disease Tx Quinine + Clindamycin (atovaquone + azithromycin)
164
Names of following stages of malaria life cycle 1. Looks like diamond ring 2. Ruptures the cell host 3. Replicating intracellularly 4. Form injected from the anopheles mosquito 5. banana shaped
1. Early trophozoite 2. Merozoite 3. Schizont 4. Sporozoite 5. Gametocyte
165
Ingest helminths
"EAT" Enterobius vermicularis Ascaris lumbricoides Trichinella spiralis
166
Penetrating helminths
"Sand" Stronglyoides Ancylostoma Necator D
167
Worm lays eggs at anus tx
Enterobius vermicularis Nematode (round worm) Benzimidazoles - Albendazole - mebendazole Pyrantel pamoate
168
Giant round worm Eosinophilic pneumonitis - diagnosis - tx
Ascaris lumbricoides ``` Ingest eggs Hatch in intestines Release larvae penetrate bowel --> lungs Migrate up trachea and swallowed Mature worms in intestine ``` Eggs released in stool Benzimidazoles - Albendazole - mebendazole Pyrantel pamoate
169
Myositis Fever Eosinophilia Periorbital edema - acquired - diagnosis - tx
Trichinella spiralis Undercooked meat GI --> muscles Muscle biopsy: cysts with larvae in muscle tissues Bendzimidazoles
170
A 28-year-old woman from rural Guyana with a history of rheumatoid arthritis develops painful swelling of her hands and feet. She is treated with corticosteroid therapy. A month later, she develops profuse, watery diarrhea along with fever and cough. On examination, she has a temperature of 37.3° C. Laboratory studies show WBC count, 12,900/ mm3; and the WBC differential count shows 57% segmented neutrophils, 5% bands, 16% lymphocytes, 8% monocytes, and 14% eosinophils. Microscopic examination of a stool specimen shows ova and small rhabditoid larvae. Similar larvae are present in a sputum specimen. Which of the following infectious diseases is most likely to produce these findings? A Cysticercosis B Onchocerciasis C Schistosomiasis D Strongyloidiasis E Trichinosis
D. Strongyloidiasis
171
Rhabditiform larvae in feces tx
Strongyloides Threadworm Ivermectin Albendazole
172
Wound on feet Anemia Abdominal discomfort tx
Ancylostoma Necator Hook worms Benzimidazoles - Albendazole - mebendazole Pyrantel pamoate
173
Taenia solium - transmission - symptoms - tx
Cestodes (tapoworms) Ingestion of alrvae in undercooked port - GI tract infection by adult worm Ingestion of eggs in contaminated food or water - brain filled w/ cysts Tx Albendazole Praziquentel Dexamethaone: keep CNS symptoms from getting worse
174
Cestodes
Tape worms Taenia solium Diphyllobothrium latum Echinococcus granulosus
175
Brain filled with cysts | Seizures
Taenia solium Ingestion of eggs in contaminated food
176
Giant limbs - type - transmitted - tx
Wuchereria bancrofti Helminth, neomatoid Round worm in GI Mosquitoes Migrate to lymphatics Elephantiasis of limbs Hydrocele of scrotum Tx Diethylcarbamazine
177
Raw fish Megaloblastic anemia -def tx
Diphyllobothrium latum B12 deficiency Praziquantel
178
Hydatid cyst lesion in liver RUQ pain Well circumscribed circular lesion - transmitted - can find where in body - symptom - tx
Echinococcus granulosus dog feces Egg shell calcifications Form mature larval cysts in liver and lungs Anaphylaxis Surgical removal of cysts
179
A 23-year-old man presents to the physician with abdominal distention and tenderness with no vomiting or diarrhea. Physical examination shows hepatosplenomegaly. Bowel sounds are normal. On questioning, the patient says that he traveled to eastern South America 1 year ago. Several weeks after returning from his trip, he remembers having fever, diarrhea, weight loss, and “funny looking stools.” Ultrasonography shows ascites and hepatic periportal fi brosis. Which of the following is most likely responsible for this patient’s present symptoms? (A) Appendicitis (B) Bowel obstruction (C) Enterocolitis (D) Portal hypertension (E) Ruptured viscus
D. Portal hypertension Schistosoma mansoni
180
A 29-year-old man has had hematuria for the past month. On physical examination, he is afebrile. There is diffuse lower abdominal tenderness, but no palpable masses. An abdominal radiograph shows a small bladder outlined by a rim of calcification. Cystoscopy is performed, and the entire bladder mucosa is erythematous and granular. Biopsy samples are taken. Which of the following histologic findings is most likely to be seen in these samples? A Acid-fast bacilli of Mycobacterium avium complex B Eggs of Schistosoma haematobium C Larvae of Trichinella spiralis D Migrating Ascaris lumbricoides E Taenia solium cysts
B. Eggs of schistosoma haematobium
181
Deals with snails
Schistosoma
182
Portal HTN Splenomegaly Egyptian immigrant tx
Schistosoma - blood fluke Praziquantel
183
Chronic bronchitis Hemoptysis acquired -t x
Paragonimus westermani Adult fluke in lung Undercooked crab meat Praziquantel
184
Pigmented gallstones Cholangiocarcinoma - transmission - lives - Tx
Clonorchis sinensis - liver fluke undercooked fish Lives in biliary tract Praziquantel Albendazole
185
Swimmers itch
Schistosoma
186
Fluke associated iwth hematuria and bladder cancer
Schistosoma haematobium
187
Burns all over the body what will occur over the 7 day?
Increased metabolic rate Not - Increased extracellular volume - Not increase in serum cholesterol concentration - Not loss of B vitamins in skin
188
Testicular tumor with friend egg appearance
Seminoma Germ cell tumor
189
Umbilical cord compression of infant, monitoring shows a normal fetal heart rate of 150/ min with variable spontaneous decelerations to 110/min. Why the decrease in fetal heart rate
Increased fetal systemic vascular resistance Compressing vessel, decreases radius increase in resistance Cause reflex bradycardia
190
20 yr history of T1D uses insulin why hypoglycemia
Impaired release of glucagon
191
Erythematous scaly rings with central clearing From pet
Tinea corporis
192
White plaque on side of tongue what happens if dont tx
Hairy leukoplakia EBV Progress into submucosa
193
Black escar nose
Mucor
194
Ixodes deer tick
Borrelia burgdorferi Anaplasma Babesia
195
``` Fever Diarrhea Splenomegaly Muscle wasting Pancytopenia ```
Bitten sand fly Leishmania spp
196
Disease form bed bugs
Staph aureus
197
E coli makes many proteins how
mRNA contains sequence for many proteins
198
Scratches Vetarianian Parrot Tender regional lymphadenopathy
Bartonella henselae
199
Bartonella henselae can cause what in immunocompromised
Bacillary angiomatosis Red-purple papular skin lesions
200
Fever myalgias, malaise, and progressive fatigue over 2 week period No sore throat Splenomegaly No Lad or jaundice Fails to agglutinate horse erythrocytes
Mono (normally EBV0 but since no agglutination CMV
201
Dont gram stain
The Little Microbes May Unfortunately Lack Real Color But Are Everywhere Treponema, Leptospira - too thin Mycobacteria - high lipid Mycoplasma, Ureaplasma - no cell wall Legionella, Rickettsia, Chlamydia, Bartonella, Anaplasma, Ehrlichia - primarily intracellular
202
Giemsa Stain
``` Rickettsia Chlamydia Trypanosomes Plasmodium Borrelia Helicobacter pylori (Histoplasma) ``` Ricky got Chlamydia as he Tried to Please the Bored Hot Geisha Chinese Painted wHores Bow To Rich
203
PAS
Stains for glycogen Whipple disease Tropheryma whipplei
204
Ziehl Neelsen stain
Acid fast Mycobacteria Nocardia Mycolic acid in cell wall - Cryptosporidum oocytes
205
India ink
Cryptococcus neoformans
206
Silver stain
Fungi - Coccidioides - Pneumocytstis jirovecii - Legionella - H. pylori
207
Mycobacterium spp virulence factors
Cord factor - creates serpentine cord appearance in virulent M tuberculosis strains - activates macrophages -> release of TNF-alpha Sulfatides (surface glycolipids) inhibit phagolysosomal fusion
208
-bendazole
benzimidazole Mebendazole Albendazole Antiparasitic
209
-cillin
Penicillin Amoxicillin Methicillin
210
-conazole
Imidazole (antifungal) Fluconazole Ketoconzole
211
Penicillins MOA
Interact w/ transpeptidase and inhibit peptidoglycan cell wall synthesis
212
Inhibit DNA gyrase and topoisomerase (which participate in supercoiling)
Fluoroquinolones
213
Inhibit bacterial ribosome translational proofreeding
Aminoglycosides
214
Inhibits viral assembly
Amantadine Also inhibits viral release through interactions iwth the viral M2 protein No longer used due to resistance
215
Inhibits viral protein synthesis
Ribavirin inhibits viral RNA polymerase activity and rRNA fragment initiation and elongation leading to viral protein synthesis inhibition Used in Chronic Hep C infections and respiratory syncytial virus infection
216
Viral reverse transcriptase inhibitors
Lamivudine emtricitabine Tx HIV
217
Etoposide
Cancer drug Inhibits topoisomerse II Myelosuppression Alopecia
218
Bacterial resistance to fluoroquinoles (Ciprofloxacin)
Efflux pumps
219
Antibitoics that target protein synthesis 30s subunit
Tetracyclines (Doxycycline) | Aminoglycosides (Streptomycin)
220
Antibiotics that target 50s subunit
``` Chloramphenicol Clindamycin Macrolides (erythromycin) LInezolid Linocmycin Streptogramins ```
221
Anti-TNF alpha
Infliximab | Etanercept
222
TNF-alpha inhibitors
``` Etanercept Inflixumab Adalimumab Golimumab Certolizumab ```
223
Clostiridium difficle tx
Tx - Metronidazole - Oral vancomycin - Fidxomicin (recurrent)
224
Corynebacterium diphtheriae tx
Erythromycin or penicillin Antitoxin Vaccinate
225
Tx N. GOnorrhoeae
Ceftriaxone | Azithromycin
226
Tx N. Meningitides
Prophylaxis - Rifampin - Ciprofloxacin - Ceftriaxone Tx - Cefotaxime - Ceftriaxone
227
Legionella pneumophila tx
Macrolides | Fluoroquinole
228
Psudomonas aeruginosa tx
Oral: fluoroquinolones - Ciprofloxacin Levofloxacin ``` Ticardillin Pipercillin Cefepime ceftazidime Carbapenems - impenem - meropenem ```
229
H. pylori tx
``` Tx: Triple therapy - PPI - Clarithromycin - Amoxicillin or metronidazole ``` Quadruple therapy - PPI - Bismuth - Metronidazole - Tetracycline
230
Tx Shigella Tx Salmonella Tx Campylobacter Tx Yersinia enterocolitica Tx Vibero cholerae
Shigella (bloody) - Fluroquinolones - TMP-SMX - Azithromycin (macrolide) Salmonella (bloody) - Fluroquinoles - ceftriaxone Camppylobacter jejuni (bloody) - Supportive - Fluroquinoles - Azithromycin Yersinia enterocolitica (bloody) - Supportive - Fluroquinoles - TMP-SMX Vibero cholerae - rehydration
231
Tx Leptospira interrogens
Question mark shaped Rodent urine Pencillin Ceftriaxone Doxycycline
232
Tx Borrelia burgdorferi | lyme disease
Tx Doxycycline (early stage) Amoxicilin (children <8) Doxycycline or Ceftriaxone (late)
233
Syphilis tx
Penicillin G | allergy: doxycycline
234
Tx Tb
RIPE ``` 2 months Rifampin Isoniazid Pyrazinamide Ethambutol ``` 4 months Rifampin Isoniazid
235
what antibiotic is used for prevention of mycobacteriuma vium intracellulare (MAI) in AIDs patients? When is it began
Azithromycin Given once weekly Beginning when CD4 < 50
236
Rifampin
Tb tx RNA polymerase inhibitor Revs up cytochrome P450 Red orange body fluids Rapid Resistance used alone Hepatotoxicity
237
Isoniazid (INH)
Inhibits synthesis of mycolic acids Hepatotoxicity Peripheral neuropathy Give w/ B6
238
Ethambutol
Inhibits arabinosyl transferase Imparied cellw all synthesis Optic neuropathy Color blindness Decreased visual acuity
239
Mycobacterium leprae tx
Tuberculoid disease - Dapsone + rifampin (12 months) Lepromatous disease - Dapsone + rifampin + cloflazimine (24 months)
240
Dapsone uses
Leprosy Penumocystis jirovecii pneumonia Hemolysis in G6PD deficiency
241
Tx Gardnerella vaginalis
Oral metronidazole | Metronidazole cream
242
Rickettsial disease tx
Doxycycline
243
Tx Chlamydia
Azithromycin
244
Tx Atypical pneumonia
Azithromycin
245
Tx Chlamydophila pneumoniae
Doxycyline or azithromycin for atypical pneumoniae
246
Immunosuppressant mneumonic
I'm Supposed to cycle past tacos sir but my appetitie ``` Immuno Suppressant Cyclosporine Pimecrolimus Tacrolimus Sirlimus Basiliximab Mycophenolate mofetil Azathioprine ```
247
Cyclosporine - binds - inhibits - prevents SE (2)
Binds cyclophilins Inhibits calcineurin Prevents IL-2 production Nephrotoxicity HTN
248
Tacrolimus and Pimecrolimus - bind - inhibit - prevent SE (3)
FK506 Binds FK binding protein Inhibits calcineurin Prevents IL-2 production ``` Nephrotoxicity HTN Neurotoxicity - HA - Paresthesias ```
249
Sirolimus - aka - bind - inhibit - type inhibitor SE (1)
aka rapamycin Binds FK protein 12 Inhibits mTOR Inhibits T cell proliferation and response to IL-2 Not nephrotoxic
250
Azathioprine - is what - interferes - Se - Metabolized
Precursor of 6-mercaptopruine (cancer drug) Interferes w/ nucleic acid synthesis Bone marrow suppression Metabolized by xanthine oxidase (toxic effects increased by allopurinol)
251
Mycophenolate (mycophenolate mofetil) - inhibits - inhibits - prevents
Inhibits inosine monophosphate (IMP) dehydrogenase Inhibits guanine synthesis Prevents lymphocyte proliferation
252
Bacteria that increase efflux pump is resistant to
Tetracycline
253
Enterococci that substitute D-lactate for D-alanine in synthesis of pentapeptide proteoglycan precursors. Decreases binding of what antibiotic
Vancomycin
254
Drugs acting on microtubules (6)
Vincristine: block polymerization, prevent growing Vinblastine: block polymerization, prevent growing Taxanes: hypersensitize the microtuble, can grow but breask down Benzimidazoles Griseofulvin: antifungal Colchicine: anti-inflammatory gout
255
Tx acute otitis media
S. pneumoniae Nontypable H. influenzae Ml. catarrhalis Antibiotics - Amoxicillin - Amoxicillin + clavulanic acid - Cephalosporins
256
Tx for H. pylori
Triple therapy - PPI + clarithromycin + amoxicillin "-prazole" - PPI + clarithromycin + metronidazole Quadruple therapy - PPI + bismuth + metronidazole + tetracycline Clarithromycin: macrolide -50 S subunit Metronidazole - forms free toxic radical damages DNA Amoxicillin - AMPed up penicillin - D-Ala-D-Ala structural analog - Binds penicillin binding proteins (transpeptidases), blocks crosslinking of peptidoglycan in cell wall
257
Antibiotic | Red urine
Rifampin | red urine
258
Tx Chlamydia and chlamydophila species
Macrolides | Tetracyclines
259
Tx Hepatitis B
Tenofovir | Entecavir, telbivudine, lamivudine, adefovir
260
Resistance of Rifampin MOA
Altered structure of enzyme involved in bacterial RNA synthesis Inhibition of bacterial DNA-dependent RNA polymerase
261
Isoniazid MOA Ethamutol MOA
Isoniazid: inhibition of mycolic acid synthesis Ethambutol: inhibition of arabinosyl transferase
262
Prophylactic tx for neisseria meningitidis
Rifampin Tx: current infection - penicillin, ceftriaxone
263
Drug binds to cell wall glycoproteins Drug interferes with DNA replication proteins Drug binds to ribosomal proteins Drug binds to transpeptidases
Vancomycin Fluoroquinolones, binds DNA gyrase Macrolides, tetracyclines Pencillin, cephalosporins
264
Resistance to cephalosporins
Change in protein structure Inhibits binding
265
Antiretroviral target
inhibit HIV protease Inhibit production of functional viral encoded enzymes
266
Rabies vaccine
Inactivated vaccine
267
Tx Gonorrhea
Macrolide | Third generation cephalosporin
268
Tx Lung abscess
Clindamycin | - anaerobic oral organisms and aerobes
269
How do alcohol based disinfectants work?
Kills vegetative bacteria (not spores) fungus and enveloped viruses Dissolves their lipid bilayer membranes
270
Drug that block surface glycoproteins
Neuraminidase blocking Neuramindase inhibitors - Oseltamivir - Zanaamivir
271
Penicillin MOA
Bind to penicillin binding proteins Inhibit formation of corss linkages between peptidoglycan chains Cell lysis Upregulate autolysins
272
Penicillin coverage
``` Gram positive Spirochetes- syphilis Gram positive rods Gram negative cocci - neisseria ```
273
Penicillinase resistant penicillins
Bulky R group Methicillin Nafcillin Oxacillin Dixcloxacillin
274
Aminopenicillins - examples - inhibition - Use
Ampicillin (IV) Amoxicillin (greater oral bioavailability) Pencillinase sensitive ``` HHEELPSS H. influenzae H. pylori E. coli Enterococci Listeria Proteus mirabilis Salmonella Shigella ```
275
Beta lactamase inhibitors
CAST Clavulanic acid Avibactam Sulbactam Tazobactam Add to pencillinase sensitive drugs
276
Resistant otitis media
Amoxicillin + clavulanic acid Cefdinir (3rd generation)
277
Surgical infections
Sulbactam + ampicillin
278
Carboxypenicillins - examples - MOA - use
Ticarcillin Carbenicillin Piperacillin Attacking cell wall Pseudomonas Gram neg rods Suscpetible to penicillinase
279
Pseudomonas infxn treatment
``` CAMPFIRE Carbapenems Aminoglycosides Monobactams Polymyxins Fluroquinolones (ciprofloxacin, levofloxacin) thIRd and fourth generation cephalosporins - ceftazidime - cefepime Extended spectrum penicillins -Ticarcillin -Carbenicillin -Piperacillin ```
280
Cephalosporins - MOA - Coverage - Inhibition
Active against cell wall Bind to penicillin binding proteins Gram (+) Gram (-) Less susceptible to penicillases
281
1st generation cephalosporins
Cefazolin Cephalexin Gram + cocci PEcK Proteus mirabilis E. coli Klebsiella UTIs URIs Prophylaxis viridans strep endocarditis
282
1st line prophylaxis against viridans strep endocarditis
Amoxicillin
283
2nd generation cephalosporins
Cefoxitin Cefaclor Cefuroxime Cefprozil ``` HENS PEcK H. influenza Enterobacter Neisseria Serratia marcescens Proteus mirabilis Ecoli Klebsiella ``` Not used for gonorrhea
284
3rd generation cephalosporins
Ceftriaxone Cefotaxime Ceftazidime Cefdinir Serious gram - infections ``` HENS PEcK E.coli Proteus mirabilis Klebsiella Enterobacter Serratia Citrobacter Neisseria H. influenza Strep pneumoniae ** ```
285
Tx neisseria gonorrhoeae - details (3)
Ceftriaxone Longest 1/2 life GIve IV Excreted in bile (good for renal failure)
286
4th generation cephalosporin - use - coverage
cefepime broad spectrum Pseudomonas Gram + coverage
287
5th generation cephalosporin
Ceftaroline Broad spectrum MRSA
288
Cephalosporin for MRSA
Ceftaroline
289
Cephalosporins not effective against
``` LAME Listeria Atypicals (mycoplasma, chlamydia) MRSA Enterococci ```
290
Aztreonam - MOA - key feature - covers
Monocyclic beta lactam Inhibits cell wall synthesis Binds to penicillin binding protein 3 No sensitivity allergy ``` E. Coli Lebsiella Pseudomonas Serratia (Gram neg only) ```
291
Carbapenems - Examples - Coverage - MOA
Imipenem- cilastatin Meropenem Ertapenem Doripenem Gram + cocci Gram - rods Anaerobes Pseudomonas Binding penicillin binding proteins
292
Imipenem and cilastatin
Cilastatin inhibitor of renal dehydropeptidase 1 Decreased activation of imipenem in renal tubules
293
Vancomycin - MOA - Coverage - Toxic
Inhibit cell wall synthesis Inhibits cell wall mucopeptide formation by binding to the D-ala D-ala moieties of the cell wall precursors Inhibts cell wall glycopeptide polymerization ``` Gram positive only MRSA Enterococci Clostridium difficile (oral) Coagulase negative staph endocarditis ``` NOT Nephrotoxicity Ototoxicity Thrombophelbitis Redman syndrome - diffuse flushing - nonspecific mast cell degranulation pretreat w/ antihistamines
294
Protein synthesis inhibitors | mneumonic
Buy AT 30, CCELL at 50 30S inhibitors - Aminoglycosides - Tetracyclines 50S - Chloramphenicol - Clindamycin - Erythromycin, macrolides - Lincomycin - Linezolid
295
MRSA tx on outpatient basis MOA Can cause
Linezolid BInds 23S RNA and interacts with the bacterial initiation complex Serotonin syndrome
296
TCA - MOA - coverage - avoid with - toxicity
Binds 30S Prevents attachment of aminoacyl tRNA ``` VACUUM THe BedRoom Vibrio cholerae Acne Chlamydia Ureapolasma urelyticum Mycoplasma pneumoniae Tularemia Helicobacter pylori Borrelia burgdorferi Rickettsia ``` Avoid with - milk antiacids Iron, calcium, magnesium (inhibit absorption in gut) Discoloration teeth Inhibit bone growth kids Photosensitivity Blue skin (minocycline)
297
Patient presents with blue skin | antibiotic?
Minocycline (TCA)
298
Aminoglycosides - MOA - Ineffective against - Use - TOxicity
Mean GNATs can NOT kill anaerobes Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin Inhibits the formation of the initation complex and causes misreading of mRNA Ineffective against anaerobes Use - severe gram negative rod infections - bowel surgery (neomycin) "NOT" Nephrotoxicity Ototoxicity Tetatogenic
299
Macrolides - Examples - MOA - Coverage - Adverse effects - key feature - resistance
Azithromycin Clarithromycin Erythromycin -romycin Inhibits protein synthesis by blocking translocation Binds to the 23S rRNA of the 50S ribosomal subunit "PUS" Pneumonia -Mycoplasma Chlamydophilia, legionella URI - strep pyogenes - h. influenza STD - chlamydia - gonorrhea Prolonged QT Drug interaction w/ warfarin MACRO - Motility issues - Arrthymia (by prolong QT) - Cholestatic hepatitis (acute) - Rash - eOsinophilia Safe in pregnancy Methylation of the 23S rRNA binding site
300
Chloramphenicol - MOA - Coverage - Toxicity
Inhibits 50S peptidyltransferase activity Meningitis - H. influenza - N. meningitides - strep. pneumoniae Toxicity - Anemia - Aplastic anemia - Gray baby syndrome
301
``` Vomiting Grey color of skin Poor muscle tone Cyanosis CV collapse ``` Tx
Gray baby syndrome Chloramphenicol Phenobarbital
302
Streptogramins - MOA - Use - SE - Inhibit
Quinupristin Dalfopristin Bind 23S portion of 50S MRSA VRE Staph and Strep skin infxn Hepatotoxicity Pseudomembranous colitis Inhibit CYP450
303
Clindamycin - MOA - Use - Toxicity
Blocks peptide bond formation with the 50S subunit ``` Anaerobic infections ** MRSA Protozoal infections Topically acne Bacteroides fragilis Clostridium perfringens MRSA skin abscess ``` Toxicity: pseudomembranous colitis
304
Glycylcyclines - Example - MOA
Tigecycline | Binds to 30S
305
atypical pneumonia coverage
Macrolides | - romycin
306
Drugs with photosensitivity
SAT Sulfonamides Amiodarone Tetracycline
307
Side effects of aminoglycosdies
NOT Nephrotoxicity Ototoxicity Teratogenic
308
Redman syndrome
Vancomycin too quick infusion
309
Sulfonamides - examples - MOA - side effect
Sulfamethoxazole Sulfadiazine Folic acid inhibitors Competitive inhibitors of enzyme dihydropteroate synthetase ``` Hemolysis in G6PD def Nephrotoxicity Kernicterus (infants brain damage due to bilirubin build up) Photosensitivity Steven Johnson syndrome ```
310
Sulfa drug allergies
"Sulfa Pills Frequently Cause Terrible Allergy Symptoms" ``` Sulfasalazine Probenecid Furosemide Celecoxib Thaizide (TMP-SMX) Acetazolamide Sulfonyureas ```
311
TMP-SMX uses
``` UTIs Shigella Salmonella MRSA skin infections Pneumocystis jirovecii pneuonia ```
312
Inhibits dihydrofolate reductase
Trimethoprim | Methotrexate
313
Fluoroquinolones - Examples - MOA - Dont take with - Use - Side effect - Resistance
Levofloxacin Nalidixic acid Inhibits DNA gyrase (topisomerase II) Dont take w/ antiacids or supplements contains calcium, iron or magnesium ``` Gram negative infections Gram negative rods UTIs GI tract infections Pseudomonas Varying Gram positive coverage ``` Cartilage damage Tendonitis and tendon rupture QT interval prolongation Chromosome endoced mutation at the DNA gyrase
314
Drug to use in children iwth cystic fibrosis with pseudomonas
Fluorquinolones
315
Antibiotic that treats protozoal infections
Metronidazole
316
Metronidazole - MOA - Uses - Adverse reaction
Forms toxic radicals that damage DNA ``` "GET GAP on the Metro" Giardia lamblia Entamoeba histolytica Trichomonas GArdnerella vaginalis Anaerobic bacteria (clostridium spp, bacteriodes fragillis) Pylori ``` Disulfiram like reaction
317
Prophylaxis 1) meningococcal meningitis 2) H. influenza meningitis Tx 3) Gonorrhea 4) Syphilis 5) Recurrent UTIs 6) Pneumocystisi jirovecii (CD4<200) 7) Endocarditis (dental procedure) 8) Group B strep (pregnant) 9) Gonococcal/ chlamydial conjunctivitis 10) Legionella tx 11) Pseudomonas tx 12) Chlamydia trachomatis 13) Candida albicans 14) Cyroptococus neoformans 15) Toxoplasma gondii
1) Ciprofloxacin 2) Rifampin (prophylaxis) Tx: Ceftriaxone/ penicillin 3) Ceftriaxone (add doxycycline for c. trachomatis) 4) Penicillin G 5) TMP-SMX Amoxicillin 6) TMP-SMX 7) Penicillin, Amoxicillin, Cephalexin 8) Ampicillin 9) Erythromycin 10) Macrolides (azithromycin) 11) Piperacillin/ tazobactam, aminoglycosides, carbapenems 12) Doxycycline 13) Fluconazole, Caspofungin Amphotericin B 14) Amphotericin B and flucytosine Maintenance: fluconazole 15) Sulfadiazine + pyrimethamine
318
Identify antibiotic 1) Inhibit dihydropteroate syntherase 2) Inhibit dihydrofolate reductase 3) Inhibits DNA gyrase (topoisomerase III) 4) Inhibit bacterial ribosomes 5) Forms toxic free radicals that damages DNA 6) Acts like cationic detergent
1) Sulfonamides 2) Trimethoprim Methotrexate 3) Fluoroquinoles 4) Nitrofurantoin 5) Metronidazole 6) Polymyxin B
319
Empiric Tx Meningitis
Broad spectrum Ceftriaxone Vancomycin Ampicillin
320
Tx if exposed to bacillus anthracis
Ciprofloxacin | Doxycycline
321
HIV prophylaxis to newborn
Zidovudine
322
HSV prophylaxis for newborn
Mother: acyclovir starting at 36 weeks
323
Which antibiotic? 1) Inhibits prokaryotic RNA polymerase 2) Inhibits prokaryotic topoisomerase 3) Inhibits prokaryotic dihydrofolate reductase
1) Rifampin 2) Fluroquinoles 3) Trimethoprim
324
Macrolides effective against
"PUS" ``` Pneumonia (atypical) - mycoplasma pneu - Legionella - Chlamydophilia pneu ``` URI - Strep pyogenes - H. influenza STDS - Gonorrhea - Chlamydia
325
Topoisomerase inhibited by
Fluoroquinoles | Etoposide
326
Tetracyclines effective against
VACUuM THe BedRoom ``` Vibrio cholerae Ache Chlamydia Ureaplasma urelyticum Mycoplasma pneumoniae Tularemia H. pylori Borrelia burgdorferi RIckettsia rickettci ```
327
Rifampin
4 Rs Inhibits RNA polymerase Red secretions RREvs up cytochrome p450
328
Vaccines 1) 1st Given 2) Who gets flu shot 3) 2 months 4) 4 months 5) 6 months
1) Hep B- 1st given 2) Yearly from 6 months 2,4,6 (8) who do we appreciate STRIPPERS "Damn BaBy, ROTate that ass on the POLe" 3) Dtap, HepB, Hib, Rotavirus, Polio (IPV), PCV (pneumococcal) 4) DTaP, Hib, Polio, PCV, Rotavirus 5) DTAP, Hib, PCV, RV
329
Tx for neonatal infections
Ampicillin + gentimycin
330
Which class of antibiotics inhibits prokaryotic DNA topisomerase
Fluoroquinoles
331
Acyclovir - key feature - MOA - uses - resistance - adverse effect
Guanosine analog First phosphorylated by viral thymidine kinase Inhibits DNA polymerase HSV-1 HSV-2 VZV EBV Valacyclovir hydrolyzed to acyclovir Mutated viral thymidine kinase Obstructive crystalline nephropathy and acute renal failure if not adequately hydrated
332
Famciclovir - type - key feature - uses - preferred for - resistance - adverse effect
Prodrug of penciclovir - Acyclic guanosine nucleoside analog Relies on viral thymidine kinase HSV-1 HSV-2 VZV Preferred over acyclovir for VZV Mutated viral thymidine kinase Obstructive crystalline nephropathy and acute renal failure if not adequately hydrated
333
Tx VZV
Famiclovir
334
Tx HSV-1, HSV-2
Acyclovir | Famciclovir
335
Ganciclovir - activated by - MOA - side effects - resistance
Activated by CMV viral kinase Inhibits viral DNA polymerase Bone marrow suppression Renal toxicity mutated viral kinase
336
Tx CMV
Ganciclovir | Foscarnet (retinitis)
337
Herpes drug that doesnt require viral kinase activation MOA Uses SIde effects
Foscarnet Inhibits DNA polymerase Resistant HSV CMV retinitis Renal toxicity Anemia Electrolyte abnormalities --> seizures
338
Anti-influenza antivirals
Neuroaminidase inhibitors Zanamivir Oseltamivir Block release of virions from host cell
339
Treatment of Chronic Hepatits C
Ribavirin - inhibits syn of guanine nucleotides by competitively inhibiting inosine monophosphate dehydrogenase - SE: hemolytic anemia Sofosbuvir - Inhibits HCV RNA dep RNA polymerase acting as chain terminator Simeprevir - HCV protease inhibitor, prevents viral replication - SE: Photosensitivity, rash IFN-alpha
340
Ribavirin uses side effects
Guanosine analog RSV Hep C Teratogenicity Hemolytic anemai
341
Tx croup
One dose of dexamethasone | supportive
342
RSV immunization
Passive w/ palivizumab
343
HIV prophylaxis CD4 < 200
PCP prophylaxis TMP-SMX Dapsone (in sulfa allergy)
344
HIV prophylaxis CD4 < 100
Toxoplasmosis prophylaxis (if positive IgG before) TMP-SMX Dapsone + pentamidine + leucovorin
345
HIV prophylaxis CD4 < 50
MAC prophylaxis Azithromycin
346
saquinavir - example - MOA - adverse effects
-navir Protease inhibitors GI intolerance Inhibit cytochrome p450 Hyperlipidemia hyperglycemia Lipodystrophy
347
Protease inhibitor that can cause pancreatitis
Ritonavir
348
Protease inhibitor that can cause Nephrolithiasis
Kidney stone indinavir Atazanavir
349
Protease inhibitor that can increase bilirubin
Atazanavir
350
HAART
Combination of at least 3 different HIV medications 2 nucleoside reverse transcriptase inhibitors and a different class medication
351
Lamivudine
-vudine Nucleoside Reverse Transcriptase inhibitors (NRTIs) Didanosine Abacavir Emtricitabine Tenofovir (NtRTI)
352
Nucleotide reverse transcrptase inhibitor
Tenofovir
353
Nucleoside Reverse Transcriptase inhibitors (NRTIs) - examples - MOA - key feature - adverse effects
``` Lamivudine Zidovudine Didanosine Abacavir Emtricitabine Tenofovir (NtRTI) ``` Competitive inhibitors Have to be phosphorylated by thymidine kinase to work Bone marrow suppression Lactic acidosis anemia (zdv) pancreatitis (didanosine)
354
Tx Newborns born to HIV mothers
Zidovudine (AZT)
355
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) - examples - MOA - key feature - adverse effects
-vir, -virine ``` Nevirapine Delavirdine Efavirenz Etravirine Rilpivirine ``` non-competitively inhibit reverse transcriptase Do NOT require phosphorylation Rash Hepatotoxicity Vivid dreams (efavirenz) CNS symptoms (Efavirenz)
356
Which NNRTI must be taken with food and not w/ meds that decrease gastric acid
Rilpivirine
357
Fusion inhibitor
Enfuvirtide En envelop Fu fusion Binds Gp41 and blocks HIV fusion Given by injection
358
Raltegravir - example - MOA - adverse effect
-tegravir Integrase inhibitors Blocks integration into host DNA Increase creatine kinase
359
CCR-5 antagonist
Maraviroc CCR-5 on macrophages and CD4 T cells Inhibits gp120 conformational change Only in patients with all R5 virus
360
HIV drug causes 1. Bone marrow suppression 2. Pancreatitis 3. Hepatic steatosis 4. Hypersensitivity rxn 5. Rash 6. Nightmares, vivid dreams, depression 7. False-positive to drug test for cannabinoids 8. Teratogenic 9. Nephrolithiasis 10. Increases bilirubin 11. peripheral neuropathy
1. Zidovudine (NRTI) 2. Didanosine (NRTI) Ritonavir (PI) 3. Didanosine (NRTI) 4. Abacovir (NRTI) 5. NNRTIs 6. Efavirenz (NNRTI) 7. Efavirenz (NNRTI) 8. Efavirenz (NNRTI) 9. Indinavir, Atazanavir (protease inhibitor) 10. Atazanavir (protease inhibitor) 11. Didanosine
361
What are the two HIV envelope proteins and what drugs interfere with them
gp 41: Enfuvirtide Gp120: maraviroc (not directly CCR-5
362
Tx Candida albicans
Superficial - Nystatin - Clotrimazole (topical) - Fluconazole (oral) oral thrush Systemic - Fluconazole - Amphotericin B - Echinocandin
363
Tx Cryptococcal neoformans
Amphotericin B + flucytosine Followed by fluconazole
364
Tx Pneumocystis jirovecii (PCP)
TMP-SMX Sulfa allergy - Pentamidine Clindamycin + primaquine
365
Tx Aspergillus fumigatus
Voriconazole | Lipid formation of amphotericin B
366
Tx Mucor
Surgical debridement | Amphotericin B
367
Tx Dermatophytes
Topical terbinafine or azole Extensive skin infection or scalp/hair - Oral terbinafine or azole
368
Tx Tinea versicolor
Malassezia furfur Topical azole Topical selenium sulfide Oral azole
369
Antifungal that 1. Disrupts membrane 2. Disrupts microtubules 3. Blocks precursors to pyrimidines 4. Blocks Squalene to lanosterol 5. Blocks lanosterol to ergosterol
1. Nystatin, Amphotericin B 2. Griseofulvin 3. Flucytosine 4. Terbinafine 5. -azoles
370
Amphotericin B - MOA - uses - Side effects
Binds ergosterol (unique to fungi) forms membrane pores that allow leakage of electrolytes AmphoTEARicin " tears holes in membrane ``` Cryptococcosis Blastomycosis Coccidioidomycosis Aspergillosis Histoplasmosis Mucormycosis ``` Feverand chills Anemia Arrhythmias Nephrotoxicity
371
Tx cutaneous candidiasis Diaper rash Vulvogainitis MOA
Nystatin Pores in membrane Binds to ergosterol
372
Converted into 5-fluorouracil
Flucytosine by cytosine deaminase Inhibits DNA and RNA biosynthesis by conversion to 5-FU
373
Inhibits cell wall synthesis by inhibiting synthesis of beta-(1,3)-D-glucan - uses - toxicites
Caspofungin Invasive aspergillosis GI upset Flushing (histamine release)
374
First line tx for dimorphic fungi
Itraconazole ``` Blastomyces Coccidioides Paracoccidioides Histoplasma Sporothirx ```
375
Azole for aspergillus
Voriconazole
376
Azole for refractory fungi
Posaconazole
377
Azole for topical fungal infections
Clotrimazole | Micronazole
378
-azole side effects
Decreased production of cortisol and testosterone Gynecomastia Impotence Drug-drug interactions Increase hepatic enzymes
379
Terbinafine - use - side effects
Inhibits enzyme squalene epoxidase uses superficial fungal infections Hepatotoxicity GI symptoms Headache TASTE disturbance
380
Griseofulvin - mOA - deposits in - uses - side effects
Targets microtubule function --> inhibits mitosis Deposits in keratin containng tissues Tinea corporis Tinea capitis Onychomycosis ``` Tertatogenicity HA GI symptoms Confusion Cytochrome p450 ```
381
What antifungal would you use 1. Cell wall synthesis inhibitor used in invasive aspergillosis 2. "Swish and swallow" for oral candidiasis or thrush 3. Most common treatments for onychomycosis 4. Deposits in keratin-containing tissues to to treat tinea capitis adn onychomycosis 5. Used for cryptococcal meningitis in AIDs 6. Drug of choice for sporotrichosis
1. Caspofungin 2. Nystatin 3. Terbinafine, itraconazole, fluconazole 4. Griseofulvin 5. IV amphotericin B + flucytosine 6. Itraconazole
382
Which antifungal can be used intrathecally for fungal meningitis
Amphotericin B
383
Tx Giardia lamblia
Metronidazole | Tinidazole
384
Tx Entamoeba histolytica
Treatment - trophozoites= metronidazole or tinidazole - cysts= iodoquinol or paromomycin
385
Tx Trichomonas vaginalis
Metronidazole
386
Gardnerella vaginalis tx
Metronidazole
387
Tx Toxoplasma gondii
Sulfadiazine + pyrimethamine + folinic acid
388
Tx Naegleria fowleri
Amphotericin B
389
Tx Trypanosoma brucei | African sleeping sickness
Early: Suramin | CNS involved: Melarsoprol
390
Tx Trypanosoma cruzi
Benznidazole | Nifurtimox
391
Tx Leishmania donovani | - Visceral leishmaniasis
Liposomal amphotericin B
392
Tx Leishmania donovani | - cutaneous leishmaniasis
Sodium stibogluconate
393
Tx Malaria
P. vivax, P. ovale - primaquine P. falciparum - chloroquine (SE: retinopathy, pruritis)
394
Tx Babesia microti
Quinine + clindamycin Atovaquone + azithromycin
395
-romycin
macrolide
396
Tx Enterobius vermicularis
Benzimidazoles - Albendazole - mebendazole Pyrantel pamoate
397
Tx Ascaris lumbricoides
Benzimidazoles - Albendazole - mebendazole Pyrantel pamoate
398
Tx trichinella spiralis symptoms
Muscle inflammation Benzimidazoles - Albendazole - mebendazole
399
Tx strongyloides stercoralis symptoms
Vomiting Diarrhea Epigastric pain Ivermectin Albendazole
400
Tx Ancylostoma and Necator symptoms
Anemia Benzimidazoles - Albendazole - mebendazole Pyrantel pamoate
401
Tx Diphyllobothrium latum
Praziquantel
402
Tx Echinococcus granulosus
Surgical removal of cysts
403
Tx Taenia solium
Albendazole Praziquentel Dexamethaone: keep CNS symptoms from getting worse
404
Tx schistosoma
Praziquantel
405
Tx Paragonimus westermani
Praizquantel
406
Tx Clonorchis sinensis
Praziquantel | Albendazole
407
Tx Wuchereria bancrofti
Diethylcarbamazine
408
Tx Lice
Permethrin Pyrethrin | Malathion
409
Tx Scabies
Permethrin | Ivermectin
410
-Azole MOA
Inhibition of the cytochrome P450-dependent demethylation reaction
411
HIV tx and MOA
NRTIs main line - competitively inhibit nucleotide binding to reverse transcriptase and terminate the DNA chain Abacavir Didanosine Lamivudine Tenofovir
412
Tx Scabes
Topical permethrin Inhibits Na channel deactivation --> neuronal membrane depolarization
413
DNA viruses
HHAPPPPy ``` Hepadna Herpes Adeno Pox Parvo Papilloma Polyoma ```
414
Positive sense ssRNA virus (7)
Picornavirus (PERCH) - Poliovirus - Echovirus (meningitis) - Rhinovirus (cold) - coxsackie virus (meningitis, handfootmouth, myocarditis) - HAV (acute) Hepevirus - HEV Caliciviruses - Norovirus (gastroenteritis) Flaviviruses - HCV - Yellow fever - Dengue - West Nile (meningoencephalitis) - Zika Togaviruses - Rubella Retroviruses - HTLV ( T cell leukemia) - HIV Coronaviruses -common cold
415
Negative sense ssRNA virus (6)
Orthomyxoviruses - Influenza virus Paramyxoviruses - Parainfluenza (croup) - RSV (bronchiolits in babies) - Measles - Mumps Rhabdoviruses - Rabies Filoviruses -Ebola Bunyaviruses - Hantavirus (hemorrhagic fever, pneumonia) Delta virus -HDV
416
Spiking fever Hepatosplenomegaly Southeast Asia Pancytopenia Tx
Leishmania Sandfly Aphotericin B Sodium stibogluconate
417
``` Farmer Headache Cough Malaise Pneumonia Fever, aching muscles Dry cough Sore throat ``` No rash
Coxiella burnetii Q fever Spore forming Chronic assoc w/ endocarditis
418
Capsule of B anthracis
Poly-D-glutamate
419
Spiral Gram neg bacteria
Borrelia (Giemsa) Leptospira Treponema
420
Anaerobes
Anaerobes Cant Breath Fresh Air Clostridium Bacteroides Fusobacterium Actinomyces
421
Facultative intracellular
Some Nasty Bugs May Live FacultativeLY ``` Salmonella Neisseria Brucella Mycobacterium Listeria Francisella Legionella Yersinia pestis ```
422
Urease positive
Pee CHUNKSS ``` Proteus Cryptococcus H pylori Ureaplasma Nocardia Klebsiella S epidermidis S saprophyticus ```
423
Catalase positive organisms
Cats Need PLACESS to Belch their Hairballs Catalase ``` Nocrrdia Pseudomonas Listeria Aspergillus Candida E coli Staphylococci Serratia B cepacia H pylori ```
424
Streptococcus pneumoniae most common cause of (4)
MEningitis Otitis media Bacterial pneumonia SInusitis
425
Rusty sputum in patients with sickle cell or asplenic
Pneumococcus Streptococcus pneumoniae
426
Cereulide
Performed toxin of bacillus cereus
427
Listeria monocytogenes forms waht ____ which allows Tx
"Rocket Tails" via actin polymerization allow intracellular movement and cell to cell spread avoiding antibodies Ampicillin
428
Actinomyces tx
Penicillin
429
Nocardia - found in - symptoms - tx
Found in soil Pulmonary infections in IC (mimic Tb w/ negative PDD) Can spread to CNS TMP-SMX
430
Tx Tuberculoid form of Leprosy
Dapsone | Rifampin
431
Tx Lepromatous form leprosy
Clofazimine
432
Prophylaxis Neisseria meningococci Tx N. Meningococci
Rifampin Ciprofloxacin or Ceftriaxone Tx - Ceftriaxone Pencillin G
433
Haemophilus influenzae can be grown tx
Chocoalte agar w/ factor V and X or w/ S. aureus which provides factor V (NAD) through hemolysis of RBCs Tx: Amoxicillin +/- clavulanate (mucosal infxn) Ceftriaxone (meningitis) Rifampin prophylaxis
434
Pyocyanin
Blue green pigment of pseudomonas generates reactive oxygen species
435
S or comma shaped
Campylobacter jejuni - bloody diarrhea Vibrio cholerae - water diarrhea
436
``` Constipation Red spots of abdomen Abdominal pain Fever Followed by diarrhea ``` Tx
Salmonella typhi Ceftriaxone Fluroquinolone
437
H. pylori positive for Tx
Catalase Oxidase Urease Antibiotics Cure Pylori - Amoxicillin - Clarithromycin - PPI
438
Myalgia of calves Jaundice Photophobia Flu like Tx
Leptospira interrogans Water contaminated with animal urine Pencillin Ceftriaxone Doxycycline
439
First line tx Lyme disease
Borrelia burgdorferi Doxycycline
440
Tongue ulcers | Splenomegaly
Histoplasmosis
441
Severe diarrhea in AIDS
Cryptosporidium Oocytes in water Oocytes on acid fast Nitazoxaninde in IC hosts
442
Rapidly fatal meningoencephalitis Swimming - diagnosis - tx
Naegleria fowleri Enters via cribriform plate Amoebas in spinal fluid Amphotericin B
443
Tx Babesia
Atovaquone + azithromycin Quinine + clindamycin
444
Cowdry A inclusions
HSV-1, HSV-2, VZV
445
What viruses uses this receptor 1) Integrins 2) CD21 3) CD4, CXCR4, CCR5 4) P antigen on RBCs 5) Nicotinic AChR 6) ICAM-1
1) Integrins= CMV 2) CD21= EBV 3) CD4, CXCR4, CCR5= HIV 4) P antigen on RBCs= ParvoB19 5) Nicotinic AChR= Rabies 6) ICAM-1= Rhinovirus
446
Muscle pain Joint pain Retro orbital pain Rash all over body
Dengue fever ssRNA flavivirus Thrombocytopenia Spontaneous bleeding
447
Rotavirus - causes - type of virus - MOA
infantile gastroenteritis Segmented ds RNA virus (reovirus) Diarrhea - day care center Villous destruction with atrophy leads to decreased absorption of Na and loss K
448
Paramyxovirus Prophylaxis
Palivizumab paramyxovirus causes RSV, croup, mumps, measles
449
HCV lacks
3'-5' exonuclease activity no proofreading variation in antigenic structure of HCV envelope proteins
450
HBV - renal manifestation - vascular HCV - renal manifestation - risk of
HBV - membranous GN --> membranoproliferative GN - polyarteritis nodosa HCV - membranoproliferative GN --> membranous GN - risk of DM and autoimmune hypothyroidism
451
Strawberry cervix
Trichomoniasis Trichomonas vaginalis
452
Asplenic patient organisms
SHiN | S pneumoniae >> H. influenza type B >> N meingitidis
453
Health care provider needle stick
HBV
454
Trimethoprim adverse effects
TMP Treat Marrow Poorly Megaloblastic anemia Leukopenia Granuloctyopenia
455
TMP-SMX drug of choice for
Pneumocystis jiroveci Toxoplasma gondii Nocardia Stenotrophomonas maltophilla
456
Daptomycin - MOA - uses - adverse effects
Lipopeptide that disrupts the cell membrane of gram + cocci by creating transmembrane channels S aureus skin infections (MRSA), bacteremia, endocarditis, VRE Adverse - myopathy - rhabdomyolysis
457
Pyrazinamide
Tx mycobacterium tuberculosis Hyperuricemia hepatotoxicity
458
What do iodine and idophors do
Halogenation of DNA, RNA and proteins. Sporicidal
459
Bacteria that can do transformation
DNA is released from lysed cell adn taken up by living bacterium DNA fragment incorportated into chromosomal DNA - recombinant bacterium Streptococcus pneumonia Haemophilus influenza Neisseria meningitidies
460
S. aureus tissue destruction with MRSA uses what toxin ____ affects what two cell types
Panton-Valentine Leukocidin Neutrophils Macrophages
461
Gram positive rods
Clostridum (anaerobes) Corynebacterium Listeria Bacillus
462
Prophylaxis for dental procedures if prosthetic heart, history of endocarditis, or congenital heart disease
Amoxicillin
463
Elek test
Corynebacterium diphtheriae
464
Gram negative oxidase positive diplococci 1) sputum from COPD 2) Urethral discharge 3) CSF
1) sputum from COPD= Moraxella catarrhalis 2) Urethral discharge= N. gonorrhoeae 3) CSF= N. meningitis
465
Meningitis + purpura
N. meningitis
466
Sepsis DIC adrenal hemorrhage Gram negative organism
N. meningitis
467
Gram negative cocci Gram negative coccobacill
Cocci - N. meningitidis - N. gonorrhea - Moraxella catarrhalis Coccobacilli - H. influenza - Bordatella pertussis - Pasteurella - Brucella
468
Gram negative Lactose fermenting rods Gram negative non lactose fermenting rods
Lactose (Fast) - Klebsiella - E.coli - Enterobacter Lactose (slow) - Citrobacter - Settaria Non lactose fermenter - Shigella - Salmonella - Proteus - Yersinia - Pseudomonas (oxidase +)
469
Stages of Lyme disease
Stage 1: Early localized - Erythema migrans - Fever, HA, body ache, fatigue ``` Stage 2: Early disseminated - weeks to months - Multiple Erythema migrans lesions - Cardiac (AV block, myopericarditis) - Neurological (Bilateral facial nerve palsy) (Peripheral neuropathy) (Lymphocytic meningitis) ``` Stage 3: Late - arthritis (large joints chronic) - neurological findings
470
Inflammed and painful lymph nodes | Prarie dog
Yersinia pestis New mexico Safety pin on staining Bubonic plague Rodent or prarie dog Groin swelling
471
Primary vs reactive TB lung locations
Primary - perihilar or right sided infiltrates Reactive - apical posterior segments of upper lobes
472
Tx Rocky mountain spotted fever
Rickettsia ricksttsii Doxycycline
473
[Linezolid, Tetracycline, Aminoglycoside, Macrolides, Chloramphenicol, clindamycin] 1) Ototoxicity 2) Pseudomembranous colitis 3) Prolonged QT 4) Gray baby syndrome 5) PHotosensitivity 6) MRSA/ VRE coverage 7) Anaerobic coverage 8) Discolored teeth 9) Atypical pneumonia coverage
1) Aminoglycosides 2) Clindamycin 3) Macrolide 4) Chloramphenicol 5) Tetracycline 6) Linezolid 7) Clindamycin 8) Tetracycline 9) Macrolide
474
MOA of each drug 1) Sulfamethoxazole 2) Trimethoprim 3) Levofloxacin 4) Nitrofurantoin 5) Metronidazole 6) Polymyxin B
1) Sulfamethoxazole - Inhibit dihydropteroate synthetase 2) Trimethoprim - inhibit dihydrofolate reductase 3) Levofloxacin - Inhibit DNA gyrase (topoisomerase II) 4) Nitrofurantoin - Inhibit bacterial ribosomes 5) Metronidazole - Forms toxic free radicals that damages DNA 6) Polymyxin B - Acts like cationic detergent
475
1) Vomiting and watery diarrhea on cruise | 2) Watery diarrhea 12 hrs after eating meat or poultry from cafeteria
1) Norovirus | 2) Clostridium perfringens
476
Osteomylitiis involving vertbrae organism
Mycobacterium tuberculosis
477
Which RNA virus 1) Hand, foot, and mouth 2) Break bone fever 3) Common COld 4) Fever, jaundice, black vomit 5) Meningitis ins ummer months 6) Tourniquet test helps diagnose hemorrhagic disease 7) Infects motor neurons of anterior horn
1) Hand, foot, and mouth= coxsackievirus 2) Break bone fever= dengue 3) Common COld= rhinovirus, coronavirus 4) Fever, jaundice, black vomit= yellow fever 5) Meningitis in summer months= Echovirus, coxsackievirus, other enteroviruses 6) Tourniquet test helps diagnose hemorrhagic disease= dengue 7) Infects motor neurons of anterior horn= poliovirus, west nile virus
478
Which antiviral 1) Prophylaxis for influenza A 2) used to tx for chronic hep C 3) First line for herpes simplex virus or VZV 4) inhibits viral DNA polymerase when phosphorylated by viral thymidine kinase
1) Prophylaxis for influenza A= zonamivir, oseltamivir 2) used to tx for chronic hep C= ribavirin + IFN-alpha 3) First line for herpes simplex virus or VZV = acyclovir, valacyclovir, famiciclovir 4) inhibits viral DNA polymerase when phosphorylated by viral thymidine kinase= -cyclovirs (not ganciclovir)
479
Which antifungal to use 1) Cell wall synthesis inhibitor used in invasive aspergillosis 2) Swish and swallow for oral candidiasis or thrush 3) Most common tx for onychomycosis 4) Deposits in keratin-containing tissues to tx tinea capitis and onychomycosis 5) used for cryptococcal meningitis in AIDS 6) Drug of choice for sporotrichosis
1) Cell wall synthesis inhibitor used in invasive aspergillosis - Caspofungin 2) Swish and swallow for oral candidiasis or thrush - Nystatin 3) Most common tx for onychomycosis - Terbinafine, itraconazole, fluconazole 4) Deposits in keratin-containing tissues to tx tinea capitis and onychomycosis - griseofulvin 5) used for cryptococcal meningitis in AIDS - IV amphotericin B + flucytosine 6) Drug of choice for sporotrichosis - Itraconazole
480
Lymphatic filariasis
Elephantism of limbs Wuchereria bancrofti Helminth, neomatoid Round worm Tx: Diethylcarbamazine
481
Exacerbates COPD
Haemophilus influenza Strep. pneumonia Moraxella catarrhalis
482
63 y.o in ER with recent onset of high fever, confusion, headache, watery diarrhea and mildly productive cough. Smoked for 30 years and has bronchitis. Fever 104, Gram stain shows numerous neutrophils but no bacteria.
Legionella pneumoniae High fever w/ bradycardia Headache confusion Watery diarrhea Fluroquinoles Macrolide
483
Bilateral interstitial infiltrates Silver stain Tx
Pneumocystis jirovecii circular ring with clear center TMP-SMX
484
Budding yeast with thick capsule
Cryptococcus neoformans
485
HIV | Linear ulcerations
CMV
486
Flu vaccine against what part
Humoral response to hemaglutinin
487
Organisms that cause granulomatous disease - Bacteria - Fungal - Parasitic
Bacteria - Mycobacteria (tuberculosis, leprosy) - Bartonella henselae (cat scratch) - Listeria monocytogenes - Treponema pallidum (tertiary syphilis) Fungal - Histoplasmosis Parasitic - Schistosomiasis
488
Zoonotic bacteria 1) Cat scratch 2) Rodents to Tick 3) Cattle fluids 4) Birds and pigs 5) Birds 6) Infected placenta or contaminated fluid of newborn farm animals 7) Lone star tick 8) Rabbit or squirrel 9) Infected animal urine 10) Nine-banded armadillo 11) dog bit 12) Lice 13) Fleas 14) Tick, rash on palms 15) Fleas, prairie dogs
1) Cat scratch= Bartonella henselae 2) Rodent to tick= Borrelia burgdorferi 3) Cattle fluids= Brucellosis 4) Birds and pigs= Campylobacter 5) Birds= Chlamydophila psittaci 6) Infected placenta or contaminated fluid of newborn farm animal= Coxiella burneii 7) Lone star tick= Ehrlichia chaffeensis 8) Rabbit or squirrel= Francisella tularensis 9) Infected animal urine= Leptospira 10) Nine-banded armadillo= Mycobacterium leprae 11) Dog bite= Pasteurella multocida 12) Lice= Rickettsia prowazekii 13) Fleas= Rickettsia typhi 14) Tick, rash on palm= Rickettsia rickettsii (rocky mountain spotted fever) 15) Fleas, prairie dogs= Yersinia pestis
489
Obligate anaerobes (3) Tx
Clostridium species Actinomyces (Gram +) Bacteroides (Gram -) Tx metronidazole Clindamycin
490
Acute otitis media organisms
S. pneumonia Nontypable Haemophilius influenzae M. Catrrhalis
491
Headache Fever Rash on wrist and ankles moves to palms soles and trunk
Ricketta ricksttsii Rocky mountain spotted fever
492
What upper GI problem associated with findings 1) Biopsy of pt with esophagitis reveals large pink intranuclear inclusions and host cells chromatin that is pushed to the nucleus
HSV esophagitis
493
Fried rice Reheated rice
Bacillus cereus
494
Gram neg rod Green metallic sheen on eosin methylene blue agar Hemolysis on blood agar
Ecoli
495
What upper GI problem associated with findings Biopsy of a patient with esophagitis reveals enlarged cells, intranuclear and cytoplasmic inclusions, and a clear perinuclear halo
CMV esophagitis
496
Which organisms cannot be stained w/ gram stain
``` Treponema Rickettsia Chlamydia Legionella Mycoplasma Mycobacteria ```
497
Pseudoappendicitis
Yersinia enterocolitica Heat stable toxin Increase cGMP
498
Common infectious organism of tonsils and adenoids Common infectious organism of salivary gland
S. pyogenes S. aureus, viridans group streptococci
499
Small intestinal mucosa laden with distended macrophages in the lamina propria
Whipple disease
500
Bacteria vaccine - toxin - capsular polysaccharides - killed bacteria - live attenuated bacteria
Toxin - Tetanus toxoid Capsular polysaccharides - S. pneumoniae - H. influenzae Killed bacteria - Vibrio cholerae Live attenuated bacteria - Typhoid vaccine - BCG vaccine
501
Lactose non-fermenters Urease producing -Creates what
Proteus spp ``` Alkaline urine Struvite stones (Staghorn calculi) ```
502
What is the unique features of gram negative bacteria cell wall
Outer membrane - endotoxin (LPS) - induce IL-1, TNF alpha ``` Periplasmic space (between membranes) - beta lactamase ```
503
A PAS stain on a biopsy obtained from a patient with esophagitis reveals hyphate orgnaisms
Candida esophagitis
504
Spore forming bacteria
Bacillus anthracis Bacillus cereus Clostridum spp (perfringens, tetani, botulinum, difficle) Coxiella burnetti
505
Superantigens
Exotoxins that simulatenously bind MHC II receptor and T cell receptor Polyclonal expansion of T cells Large amounts of cytokines Staph Aureus Strep Pyogenes
506
Neurotoxins
Interfere with neural transmission Botulinum toxin Tetanus toxin
507
Positive sense ssRNA virus 1) Meningitis 2) common cold
Picornavirus Coronoavirus- cold
508
Hepatitis A - type - genus - family - transmission - infection type - signs
ssRNA virus non-enveloped Hepatovirus Picronavirus Fecal/oral, poor sanitation Acute
509
Hepatitis B - type - genus - family - transmission - infection type - Tx
ds DNA Orthohepadnavirus Hepadnaviridae Perinatally, sexual contact, blood Chronic Tenofovir
510
Hepatitis C - type - genus - family - transmission - infection type - Tx
ssRNA hepacivirus Flavivirdae Blood, sexual contact Chronic Ledipasvir-sofosbuvir Ombitasvir-paritaprevir-ritonavir + dasabuvir
511
Hepatitis E - type - genus - family - transmission - infection type - More likely to cause fulminant hepatic failure in
ssRNA Hepevirdae Orthohepevirus Fecal/oral route, contaminated water Acute Pregnant women
512
``` Weight loss Lymphadenopathy Hyperpigmentation Cardiac symptoms Arthralgias Neurlogic symptoms PAS+ Foamy macrophages in lamina propria ```
``` Whippe disease Tropheryma whipplei (Gram +) ``` Penicillin Ampicillin Tetracycline
513
HA | Fever, Rash centrally spreads to extremities
Rickettsia prowazekii -Lice Rickettsia typhi - Fleas
514
Whitish patch on posterior oropharynx, makes greyish membrane, will bleed if scrap off Tx
Corynebacterium diphtheriae Erythromycin or penicillin Antitoxin Vaccinate
515
WHich mycobacterium species fits each 1) Causes leprosy 2) Causes pulmonary TB-like symptoms in COPD patients 3) Causes cervical lymphadenitis in children 4) Cuases a disseminated disease in AIDS patients 5) Associated iwth hand infection in aquarium handlers
1) Myco. leprae 2) Myco. kansasii 3) Myco. scrofulaceum 4) Myco. avium intracellulure (MAI) Myco. avium complex (MAC) 5) Myco. Marinum
516
Septic aborption organisms
Staph aureus Ecoli Group B strep
517
Ecoli toxin
Verocytotoxin (Shiga toxin) - Bloody diarrhea - HUS ``` Heat labile toxin - stimulates adenylyl cyclase - Increase cAMP Heat stabile toxin -stimulate guanylyl cyclase - increase cGMP ETEC ```
518
Bordetella pertussis
Pertussis toxin binds and inactivates inhibitory G proteins --> increase cAMP
519
Nef | tat
HIV regulatory genes Nef: downregulates teh expression of class I major histocompatibility complex proteins on teh surface of infected cells, limits immune recognition by cytotoxic T cells tat: is a transcriptional activator that promotes viral gene expression
520
What is a feature of gram positive bacteria cell wall
Lipoteichoic acids Induce cytokine production IL-1, TNF-alpha
521
Rapid onset sepsis Altered consciousness Organ failure Petechial/ ecchymotic rash virulence factor
N. meningitidis Lipo-oligosaccharide (LOS)
522
``` Headache fever inattentiveness Chemotherapy Increased opening pressure Increased protein, low glucose Image: Cds ``` Tx.
Cryptococal meningoencephalitis Initial: Amphotericin B Flucytosine Long term maintenance therapy: Fluconazole
523
Acute otitis externa organisms
S. aureus | Pseudomonas aeruginosa
524
Chlamydophila psittaci Chlamydophila pneumoniae Chlamydia trachomatis - A, B, C - D-K - L1 L2 L3
Chlamydophila psittaci - bird exposure - pneumonia Chlamydophila pneumoniae - interstitial pneumoniae - walking pneumonia Chlamydia trachomatis - A, B, C (trachoma eye infxn) - D-K (PID, urethritis, conjunctivitis) - L1 L2 L3 (lymphogranuloma venerum, primary ulcer and LAD)
525
How HIV attaches
Attaches to host cells using the viral surface glycoprotein gp120 This glycoprotein bins to teh CD4 as the primary receptor and teh chemokine receptor CC45 as the coreceptor Conformation change in gp120 exposes teh underlying transmembrane glycoprotien gp41 which mediates viral fusion
526
Corynebacterium diphtheriae is virulent how
phage conversion permitting exotoxin production
527
``` Fever chills, fatigue, dyspnea Temp Ring shaped and Maltese cross Splenectomy Intraerythrocytic inclusions ```
Babesiosis Tick borne infection Babesia microti
528
5 y.o difficulty breathing dysphagia drooling fever Swollen and cherry red epiglottis sign
H. influenzae type B thumb sign
529
``` Headache Fever Malaise Cough Nodular infiltrates Clumping once room temp ```
Mycoplasma pneumoniae Walking pneumoniae Cross reactive IgM Activate complement --> erythrocyte lysis Cold agglutinins
530
COPD exacerbation due to
virus: rhinovirus, influenza virus, parainfluenza (most common) bacterial: h. influenza, moraxella catarrhalis, strep. pneumoniae
531
Which infectious agent fits 1) Common cause of pneumonia in immunocompromised patients 2) Most common cause atypical pneumonia 3) Agent for penumonia in alcoholics 4) Can cause an interstitial pneumonia in bird handlers 5) Pneumonia in pts w/ hx of exposure to bats and bat droppings 6) Pneumonia in pt who visited south california, new mexico, or west texas 7) Pneumonia associated iwth currant jelly sputum 8) Q fever 9) Assocaited with pneumonia acquired from air conditioners 10) Most common cause of pneumonia in children 1 year old or younger 11) Pneumonia in neonate 12) Pneumonia in children and young adults (college, militrary, prison inmates) 13) Viral pneumonia 14) Causes wool-sorter's disease (life-threatening pneumonia) 15) Common pneumonia in ventilator patients and those with CF 16) Pontiac fever
1) Common cause of pneumonia in immunocompromised patients = Pneumocystis jirovecii 2) Most common cause atypical pneumonia = Mycoplasma pneumoniae 3) Agent for penumonia in alcoholics = Klebsiella pneumoniae 4) Can cause an interstitial pneumonia in bird handlers = Chlamydophila psittaci 5) Pneumonia in pts w/ hx of exposure to bats and bat droppings = Histoplasma 6) Pneumonia in pt who visited south california, new mexico, or west texas = Coccidioides immitis 7) Pneumonia associated iwth currant jelly sputum = Klebsiella pneumoniae 8) Q fever = Coxiella burnetii 9) Assocaited with pneumonia acquired from air conditioners = Legionella pneumophilia 10) Most common cause of pneumonia in children 1 year old or younger = RSV 11) Pneumonia in neonate = Group B strep, E coli 12) Pneumonia in children and young adults (college, militrary, prison inmates) = Mycoplasma pneumoniae 13) Viral pneumonia = RSV 14) Causes wool-sorter's disease (life-threatening pneumonia) = Bacillus anthracis 15) Common pneumonia in ventilator patients and those with CF = Pseudomonas, MRSA 16) Pontiac fever= Legionella pneumophila
532
Green metallic sheen on eosin methylene blue agar
Ferments lactose
533
1) Parasite eggs in stool 2) Perianal egg deposition 3) Proglottids in the stool 4) Rhabdoitiform larvae in the stool 5) Trophozoites and cysts in the stool
1) Schistosoma mansoni or S. japonicum 2) Enterobius vermicularis (pinworms) 3) Intestinal tape worms (Taenia solium, T saginata, Diphyllobothrium latum) 4) Strongyloides stercoralis 5) Protozoal infections (Giardia lamblia, entamoeba histolyticsa)
534
Silver stain
Fungi - coccidoides - pneumocystis jirovecci Legionella Helicobacter pylori
535
Name the exotoxin 1) Causes scarlet fever 2) Inactivates EF-2 3) Blocks release of the inhibitory neurotransmitter glycine
``` 1) Erythogenic toxin Pyogenic toxins (s. pyogenes) ``` ``` 2) Diphtheria toxin Exotonin A (pseudomonas) ``` 3) Tetanospasmin (c. tetani)
536
scabes tx
topical permethrin
537
Most common cause of viral conjunctivitis
Adenovirus Ds non enveloped linear DNA virus
538
Four obligate aerobic bacteria
Nagging Pest Must Breathe Nocardia Pseudomonas aeruginosa Mycobacterium tuberculosis Bacillus
539
``` Fever Headache Nuchal rigidity Normal glucose elevated protein ```
Aseptic meningitis Enteroviruses - coxsackievirus - echovirus - poliovirus
540
``` Anorexia Nausea Dark-colored urine Trip to mexico Fever Right upper quadrant pain ``` liver biopsy?
Acute viral hepatitis HAV Hepatic swelling
541
N gonorrhoeae infection and repeat infections
High variability of gonococcal surface antigens (porins, opa proteins and lipooligosaccharide) limits effectiveness of antibody response Previous infections results in almost no protective immunity against future infections
542
H. influenzae type b virulence factor
Polysaccaride capsule composed of polyribosylribitol phosphate (PRP)
543
``` Man to ER Found unconscious Temp White patches on mucosa Bilateral crackles in lungs Bilateral interstitial infiltrates ``` Silver stain
Pneumocystisi pneumonia atypical fungal infection Opportunistic infection
544
``` Fever Malaise sore throat VERY tired Palatal petechiae cervical LAD Splenomegaly ``` -Assoc with
Mono | - EBV
545
Vaccine with virus-like particles Subunit type
Induces only the Ag that stimulate the immune system Hep B HPV
546
Toxic associated with Staph aureus - hemolysis - tissue destruction w/ mRSA affects both neutrophils and macrophages - food poisoning - release of cytokines, high fever, hypotension, diffuse rash - Scalded skin syndrome in newborns
Hemolysis - alpha-toxin (alpha hemolysin) - sphingomyelinase C (beta) - leukocidin (gamma) - delta-toxin Panton-Valentine leukocidin Enterotoxin (superantigen) Toxic shock syndrome toxin 1 (superantigen) Exfoliative toxin
547
Lung abscess bacteria Tx Complication of
Anaerobes ``` Peptostreptococcus Prevotella Bacteroids Fusobacterium S. aureus Klebsiella pneumoniae Gram negative bacteria ``` First line for anaerobe - Clindamycin Aspiration pneumonia - alcoholics - drug abusers - general anesthesia
548
Missouri caves histology
Histoplasma capsulatum Macropahges iwth intracellular small yeasts
549
Pig farmer
Loeffler syndrome Ascaris infection Eosinophilic invasion due to parasitic infection
550
Vesicular rash
Chicken pox
551
HIV process involving glycosylation
Only glycosylated HIV polyprotein is gp160 - product of the env gene gp160 is extensively glycosylated in the rough ER and golgi cleaved into envelope proteins gp120 and gp41 gp120: mediates viral attachment gp41: mediates viral fusion
552
``` Myalgia Fatigue HA Chills Fever ``` Sick and recovered Mild jaundice Hepatosplenomegaly Elevated indirect bilirubin Ringed inclusions
Malaria Trophozoites (ringed inclusions) on Giemsa Dormant hepatic phase
553
High fever Nasal discharge Bilateral conjunctival injection Several small white spots with an erythematous base on buccal mucosa No vaccines What else is seen
Measles Maculopapular rash
554
Goes with? Lecithinase M protein Protein A Trehalose dimycolate Polyribosylribitol phosphate (PRP)
Lecithinase: toxin A, clostridium perfringens - results in cell lysis and gas gangrene M protein: strep. pyogenes -Binds factor H to prevent opsonization and destruction by alternative complement pathway Protein A: staph aureus - prevent opsonization by binding Fc region of immunoglobulins Trehalose dimycolate: cellw all component , mycobacterium tuberculosis - protects from being killed by macrophages and stimulates granuloma formation Polyribosylribitol phosphate: Haemophilus influenzae type b - capsule protects against phagocytosis and complement mediated lysis by binding factor H (prevents complement C3b deposition on host cells
555
Endocarditis with negative blood cultures
HACEK - Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella Coxiella burnetii (Q fever) Bartonella Brucella
556
Meningitis gram negative coccobacilli
H. influenzae
557
1) Budding yeast with thick capsule 2) Macropahges with intracellular small yeast 3) Round spherules iwth multiple endospores 4) Septate hyphae with dichotomous branching 5) Yeasts with pseudohyphae and blastoconidia
1) Cryptococcus neoformans - bird droppings - immunocompromised - meningoencephalitis 2) Histoplasma capsulatum - Missouri caves - fever nonproductive cough 3) Coccidioides immitis - pulmonary disease 4) Aspergilus fumigatus - V shaped branching - AIDS 5) Candida species - immunocompromised
558
Ziehl neelsen stain
Acid fast organism
559
IPV vaccine
Poliomyelitis
560
HIV pol gene encodes for
reverse transcriptase integrase protease RT: ssRNA --> ds DNA Integrase: integrate into host genome Protease: cleave HIV polyproteins into individual proteins after trasncription in rough ER
561
Virus that infects by CD21 Virus that infects by glycoprotein gp120 Virus that infects via the blood group P antigen (globoside)
1) EBV 2) HIV 3) Parvovrus B19
562
What type of meningitis? 1) Unvaccinated child 2) Outbreak in dorm 3) Meningitis with petechial rash 4) Patient with HIV 5) RBCs in CSF + temporal lobe involvement on MRI
1) H. influenza type B 2) N. meningitis 3) N. meningitides 4) Cryptococcus neoformans 5) HSV encephalitis
563
Frothy yellow green Fishy odor pH > 4.5 Pear shaped Tx
Trichomonas vaginalis Metronidazole
564
negative sense ssRNA virus
Arenavirus- hemorrhagic fever
565
Perinuclear cytoplasmic clearing
Koilocytes HPV
566
Thick white cottage cheese like 4-4.5 pH Tx
Candida spp Azoles Nystatin
567
Congenital Rubella possible heart defect
PDA | Pulmonary artery stenosis
568
Multiple ulcers Mucosal erosions Large cells iwth basophili cintranuclear and intracytoplasmic inclusions`
CMV | herpesvirus
569
Pathologic finding of varicella zoster
Multinucleated cells with intranuclear inclusions
570
Rash followed by desquamation of hands and feet (sloughing of skin) Snuffles (blood tinged nasal secretions) Skeletal abnromalities Hepatomegaly
Early manifestations Congenital syphilis (during first 2 years)
571
Identify 1) Epithelial cells covered with gram-variable rods 2) Epithelial cells with rare leukocytes 3) Gram-negative intracellular diplococci 4) leukocytes and pear-shaped organisms 5) Pseudohyphae with leukocytes
1) Gardnerella 2) normal vaginal discharge 3) Gonorrhea 4) trichomonas vaginitis 5) Candida vaginitis
572
Identify 1) Multiple painful ulcers 2) Painful single ulcer 3) Painless ulcer, raised indurated edges 4) School of fish 5) Granulomatous lesions on skin ( large areas of dying flesh)
1) Herpes simplex 2) Haemophilus ducreyi 3) Syphilis 4) Haemophilus ducreyi 5) Tertiary syphilis - Gummatous syphilis
573
Variola virus
Pox virus Small pox Respiratory droplets Contaminated objects Rash around mouth --> spread to face --> trunk extremities
574
Painful red nodules on finger and toe pads Erythematous maculoes on palms and soles Splinter hemorrhages in fingernails Fever Organisms? Acute vs subacute
Endocarditis - inflammation of valves S. Aureus Viridans streptococci Enterococcus Coagulase neg staph Acute - s. aureus - days - normal valves Subacute - Viridans streptococci - wks --> months - previously damaged valves
575
Still get Haemophilus influenzae even though had vaccine how?
The strain responsible for the patients disease does not produce a capsule H. influenzae nontypeable Vaccine only against more invasive type b strain
576
Histopathologic evaluation of syphilis lesion
Intense plasma cell rich infiltrate with proliferative endarteritis
577
Anthrax toxin
Edema factor (adenylyl yclase) Lethal factor Protective antigen Bacillus anthracis
578
Red prominent bumps smooth dots
Baronella henselae Bacillary angiomatosis
579
Pear shaped organism Watery diarrhea Small bowel shows? Immune mechanism?
Giardia lamblia (parasite) Villus atrophy and crypt hyperplasia CD4 T cells and secretory IgA production
580
Thin gray-white fishy odor >4.5 pH Clue cells Tx
Gardnerella vaginalis Part of normal flora Metronidazole Clindamycin
581
Viridans streptococci
Colonizer of the oral cavity Cause infective endocarditis No capsule Partial hemolysis
582
Which causes of vaginal discharge/ vaginitis are associated iwth a high vaginal pH? Wjocj are associated iwth a low vaginal pH?
Low vaginal pH - physiologic dischrage Candida High vaginal pH - gardnerella Trichomonas
583
Vibrio cholerae
Cholera toxin stimulates adenylyl cyclase increase cAMP chloride and water cross lumen rice water stools
584
Bloody dirarrhea | Eosinophils
E. histolytica
585
Meningitis gram positive rod
LIsteria monocytogenes
586
Splenomegaly South asia Anemia thrombocytopenia
Malaria
587
Severe fetal anemia Ascites Pleural effusions
Hydrops fetalis Parvovirus B19
588
Positive VDRL w/ vulvar lesion
Tertiarty syphilis Gumma
589
Gram negative rod Swarming motility Urease positive Forms what
Proteus mirabilis Hydrolyzes urea to ammonia Urine more alkaline Struvite stones Magnesium ammonium phosphate stones Staghorn calculus
590
S. bovis risk of
Streptococcus gallolyticus Causes subacute bacterial endocarditis Part of normal flora of colon Associated with colon cancer
591
Ballooning multinucleated giant cells
Herpes simplex Enlarged cells w/ intranuclear inclusions, cell fusion produc giant cells
592
Inactivates EF-2
Exotoxin A - pseudomonas Diphtheria toxin
593
Clostridium perfringens toxins
Alpha toxin (phospholipase) - Gas gangrene - Myonecrosis Enterotoxin - Food poisoning - Food left out too long once cooked
594
Acute flu like illness w/ pneumoniae Works on farm - chronic assoc w/
Coxiella burnetii - Q fever - Spore forming - chronic assoc w/ endocarditis
595
Newborn Jaundice Hepatosplenomegaly Sensorineural hearing loss
CMV
596
Decaying vegetation | Infection in immunocompromised
Nocardia
597
Nosocomial infection 1) Catheter assoc UTI 2) Ventilator assoc pneumonia 3) Central lines infxn 4) Surgical wounds/ decubitus ulcers 5) Parenteral nutrition
1) E. coli Gram neg rods Pseudomonas Candida 2) Pseudomonas Staph aureus 3) Staph epidermdiis 4) Staph aureus 5) Candida
598
A patient with IL-12 receptor deficiency is at particualr risk for what type of infection?
Mycobacterial
599
``` Malaise, HA Low grade fever Nonproductive cough Diffuse interstitial infiltrates Coughing for weeks ``` CXR: patchy reticulonodular infiltrate Tx
Mycoplasma pneumonia College kids- dorms Military recruits Macrolide (azithromycin) Doxycycline (empiric) Fluroquinoles (empiric) Cold agglutinins - Nonspecific IgM Ab to erythrocytes
600
Question marked shaped Rodent urine Phase 1 Phase 2
Leptospira interrogans Phase 1 Fever chills Body ache HA Phase 2 Hyponatremia Renal failure Liver damage w/ jaundice
601
Pregnant lady and cat feces or undercooked meat - What happens
Toxoplasmosis Chorioretinitis Hydrocephalus Intarcranial calcifications
602
Liver abscess
E histolytic Protozoan Amebic dysentery
603
Bacteria w/ capsule pneumonic
Even Some Pretty Nasty Killers have Shiny Bodies ``` E coli Strep pneumonia Pseudomonas Neisseria meningitidis Klebsiella Haemophilius influenza type B Salmonella Group B strep ``` Cryptococcus neoformans - encapsulated yeast
604
Infects transfered through placenta or during birth
TORCHeS ``` Toxopolasmosis Other (parvovirus B19) Rubella CMV HIV/HSV Syphilis ```
605
Chlamydia Types 1) A-C 2) D-K 3) L1-L3 Tx
A-C - Acute eye infection - Can lead to scarring and blindness D-K - Urethritis, cervicitis, PID - Neonatal pneumonia and conjunctivitis L1-L3 - Lymphogranuloma venereum - Genital ulcer - Unilateral lymphadenopathy - Groove sign - Proctitis Tx: Azithromycin
606
Spiral shaped rod urease positive causes tx
Helicobacter pylori Gastric adenocarcioma ``` Tx: Triple therapy - PPI - Clarithromycin - Amoxicillin or metronidazole ``` Quadruple therapy - PPI - Bismuth - Metronidazole - Tetracycline
607
Herpes virus
dsDNA
608
``` Rapid onset Headache Fever Altered mental status Nuchal rigidity Pruritic rash ``` Type of vaccine?
Meningococcal meningitis Capsular polysaccharide Ag
609
Small ovoid yeast in lungs
Histoplasma capsulatum - dimorphic - inhaled as microconidia - pneumonia
610
Hepatitis B C D vs A E
BCD transmitter parenterally (IV, blood) AE: fecal oral
611
What can have painful inguinal lymphadenopathy
Bubo Lymphogranuloma venereum Chlamydia trachomatis
612
``` Bulls eye Fever HA Body ache Fatigue ``` Tx
Borrelia burgdorferi Ixodes tick Tx Doxycycline (early stage) Amoxicilin (children <8) Doxycycline or Ceftriaxone (late)
613
Bilateral facial nerve palsy Tx
Borrelia burgdorferi Ixodes tick Tx Doxycycline (early stage) Amoxicilin (children <8) Doxycycline or Ceftriaxone (late)
614
Diphtheria toxin
Inactivates EF-2 Inhibits protein synthesis Corynebacterium diphtheriae
615
Increases bidning to host tissues, induce coagulation or blood clotting
Coagulase
616
Common disease caused by Group A strep (pyogenes)
Acute pharyngitis Cellulitis Invasive infection Acute post-streptococcal glomerulonephritis Rheumatic fever Toxic shock syndrome
617
India ink
Fungus Crytococcus neoformans
618
S. epidermidis vs s. saprophyticus
S. epidermidis - Novobiocin sensitive - heart valves S. saprophyticus - Novobiocin resistant - UTI
619
Group A Strep immunologic complications
Body immune response to bacteria ``` Jones Joints Pancarditis (endo/myo/pericarditis) Nodules (SQ) Erthema marginatum Sydenham chorea ```
620
Splenomegaly South asia Progressive splenic enlargement WL over months
Leishmaniasis
621
Rash involving palms and soles | Maculopapular
Kawasaki disease Coxsackie A virus Rocky mountain spotted fever Syphillis Meningococcemia You drive Kawaski CARS with your hands and feet
622
Contaminated deli meat
Listeria
623
Neonatal sepsis
Group B strep Listeria Ecoli
624
Pigment producing bacteria (4)
Staph aureus - Large golden colonies Actinomyces israelii - yellow (sulfur) granules - yellow sand Pseudomonas aeruginosa - blue green pigment ``` Serratia marcescens (MARsecens) - red pigment ```
625
Egg based vaccines
Influenza Yellow fever (MMR) tiny amount
626
Mega-esophagus | Cardiomegaly
Chagas disease | - Trypanosoma cruzi
627
Bacteria cause subscute endocarditis
``` Coagulase neg Staph Viridans group streptococci Strep bovis Enterococci HACEK organisms ``` ``` HACEK - not gram (+) Haemophilus aphrophilus Aggregatibacter spp Cardiobacterium hominis Eilcenella corrodens Kingella kingae ```
628
Toxins secreted by Strep pyogenes
Streptolysin O - hemolysis (oxygen labile) Streptolysin S - hemolysis (oxygen stable) Streptococcal pyrogenic exotoxins Type A, B, C/ erythrogenic toxins - red rash (erythro-) and fever (pyro-) of scarlet fever (superantigen)
629
Potato salad
Staphyloccus aureus Rapid vomiting
630
Gram (+) cocci Catalase negative Dental plaque
S. mutans (most) S. sanguinis - preexisting heart flow problems
631
What three bacteria are obligate intracellular bacteria
Rickettsia Coxiella Chlamydia
632
Degrades H202 into H20 and O2
Catalase
633
Replicative process 1) DS dna --> DS dna template --> ds DNA progeny 2) DS dna -> +RNA template -> partially ds-DNA 3) ssDNA --> ds DNA template --> ss DNA progeny 4) ss +RNA --> ds DNA template --> ss +RNA progeny 5) ss +RNA --> - RNA template --> ss + RNA progeny 6) ss -RNA --> +RNA template --> ss -RNA progeny
1) Adenovius, herpesvirus, poxvirus 2) Hepatitis virus 3) Parvovirus B19 4) Retroviruses (HIV) 5) poliovirus 6) Influenza virua, measles virus, rabies virus
634
Cyst in brain Not IC Seizures
Taenia solium Pork tapeworm Feces contaminated food
635
Live Virus vaccinations pneumonic
Attention! Please Vaccinate Young Infants with MMR Regularly Attenuated virus vaccines ``` Polio (sabin, oral) Varicella Yellow fever Intranasal influenza MMR Rotavirus ```
636
Infection from puppy
Campylobacteri jejuni
637
meningitis in very young and old
Listeria
638
9 month old 2 minute general seizures Fever 3 days later afebrile Maculopapular rash on trunk
Human herpesvirus 6
639
Child sticking nose in air
Esophagitis | H. infuenzae type B
640
Vaginal discharge Grayish white Fishy smelling What is seen on microscopy?
Epithelial cells covered with gram-variable rods
641
What enzymes do obligate anaerobes lack
Catalse | Superoxide dismutase
642
Argyll robertson pupil
Pupil constricts with accomodation but doesnt react w/ direct light Neurosyphilis
643
``` Flaccid paralysis Hyporeflexia weakness Faciculations Fever, HA, malaise Lymphocytic pleocystois (increase lymphocytes in CSF) Slightly elevated protein Normal glucose ```
Polio
644
Gram positive diplococci
Strep. pneumoniae
645
Pneumonia in neonates (Birth to 28 days Pneumonia in children Pneumonia in adults
Neonates - Group B streptococcus - E coli - Chlamydia trachomatis - HSV Children - Viruses (RSV) - Streptococcus pneumoniae - Mycoplasma pneumoniae - Chlamydophila pneumoniae Adults - Streptococcus pneumoniae - H. influenza - Mycoplasma pneumoniae - Chlamydophila pneumoniae - Influenza virus Elderly - Streptococcus pneumoniae - H. influenza - Influenza virus - S. aureus - Gram negative rods (klebsiella )
646
Listeria is acquired how
Contaminated food Unpasteurized milk Uncooked meats
647
Spiral shaped bacteria
H. pylori
648
For viral particle to be coupled to MHC class I it first has to be involved with what
Ubiquitin ligase
649
6 month old gets flaccid paralysis after eating honey. Organism? MOA?
Clostridum botulinum Inhibits release of acetylcholine
650
Organism taht causes pneumonia in each of these patients 1) Alcoholic patient 2) Patient with decrased level of consciousness 3) Pt w/ cystic fibrosis 4) Pt w/ HIV and CD4<200 5) Post-influenza 6) Acquired from patio-cooling water mister 7) Travel to southwestern U.S. 8) Exposure to bird/ bat droppings in ohio missiissippi river 9) Patient with pet parrot
1) Klebsiella 2) Anaerobes 3) Pseudomonas 4) Pneumocystis jirovecii 5) Staphylococcus aureus 6) Legionella pneumophilia 7) Coccidioides immitis 8) Histoplasma capsulatum 9) chlamydophila psittaci
651
Meningococcal vaccine recommendation
11 or 12 yo | Boooster at 16
652
Diarrhea HIV patient Hemorrhagic nodules or polypoid masses Spindle cells
Kapsoi sarcoma | -HHV8
653
Vaccine with live attenuated organisms
"Attention Teachers! Please vaccinate SMALL, Beautiful Young INFants with MMR Regularly!" ``` Adenovirus Typhoid Polio Varicella Small pox BCG Yellow fever Influenza (intranasal) MMR Rotavirus ```
654
Strawberry cervix
Trichomoniasis
655
CSF findings in viral meningitis ``` Opening pressure WBC count Cell type Protein Glucose Gram stain ```
Normal or increased opening pressure WBC increased Lymphocytes Normal or increased protein Normal glucose No stain
656
Mutations in pol gene in HIV patient
Inconsistent use of antiretroviral--> antiretroviral resistance
657
What diarrheal illnesses should be reported
Salmonella | Shigella
658
Encapsulated bacteria? Test for encapsulated bacteria
Even Some Pretty Nasty Killers Have Shiny Bodies ``` E.coli Strep pneu. Pseudomonas Neisseria meningitis Klebsiella H. influenza Salmonella B Group B strep ``` Quellung rxn
659
CSF findings bacterial meningitis ``` Opening pressure WBC count Cell type Protein Glucose Gram stain ```
Increased pressure Increased WBC Neutrophils HIGH protein Decreased glucose Gram stain positive
660
Vaccine with inactivated (killed organisms)
RIP Always Rabies Influenza (injection) Polio (oral) Hep A
661
Cataracts and deafness
Rubella
662
Facial infection of jaw/mandible | Sinus tracts draining yellow pus
Actinomyces israelii
663
What bacteria secrete enterotoxins?
``` Vibrio cholerae Enterotoxigenic E.coli Staph aureua Shigella Yersinia Clostridium spp. ```
664
``` Frontal bossing Interstitial keratitis Hutchinson teeth Saddle nose Perforation of hard palate Sabershins ```
Late mnaifestation of congenital syphilis
665
CSF findins TB/ fungal meningitis ``` Opening pressure WBC count Cell type Protein Glucose Gram stain ```
Increased pressure INcreased WBC Lymphocytes Increased protein Decreased glucose No stain
666
Epiglottitis
Haemophilus influenza
667
Osteomelitis | Gangrene organism
Clostridium perfringens Alpha toxin
668
Meningitis by age Neonates Infants/children Adults Elderly adults
Neonates - Group B strep - E.coli - Listeria monocytogenes Infants/ children - Streptococcus pneumoniae - Neisseria meningitides - H. influenza type B - viruses (enteroviruses) Adults - strep pneumoniae - Neisseria meningitidis - enteroviruses Elderly - Streptococcus pneumoniae - Listeria - Gram negative rods (ecoli)
669
Clue cell - organism - characteristic (2) - change - tx (2)
Vaginale pithelial cell covered in coccobacilli Gardnerella vaginalia - gray vaginal discharge - fishy smell - elevated pH >4.5 Oral metronidazole Metronidazole cream
670
Meningitis gram positive diplococci
Streptococcus pneumoniae
671
Budding yeast and peudohyphae
Candidiasis
672
Shiga toxin
Cleaves host rRNA at adenine base in 60S ribosomal subunit Inhibition of protein synthesis Shigella
673
Diphtheria toxin and Exotoxin A (pseudomonas)
Inactivates EF-2 vis ribosylation, thus inhibiting host cell rpotein synthesis
674
Oval budding yeast forms germ tubes at 37 C
``` Candida albicans (true hyphae at 37) ``` Normal commensal of skin and GI
675
Chocolate agar | - requires
Haemophilus influenza Factor V and X
676
Broad, nonseptate hyphae that branch at wide 90 angles
Mucor Rhizopus Absidia
677
Measles vaccine is
Live attenuated
678
Clostiridum difficile - toxins - diagnosis - tx
Toxin A (enterotoxin) - binds brush border - secretion and inflammation ``` Toxin B (cytotoxin) - disruption actin cytoskeleton ``` Pseudomembrnaous colitis Stool toxin assay (PCR or ELISA) Tx - Metronidazole - Oral vancomycin - Fidxomicin (recurrent)
679
Firm flesh color papules on face with umbilicated center is
Molluscum contagiosum from Pox virus See Molluscum bodies: eosinophilic cytoplasmic inclusions
680
Meningitis Slightly increased protein Normal glucose Incrased opening pressure
Viral meningitis
681
``` Newborn Cataracts Harsh machine like murmur Deafness Blueberry muffin rash ```
Rubella
682
What zoonotic bacterium causes each 1) Cat scratch fever 2) Lyme disease 3) Recurrent fever from variable surface antigens 4) Bloody diarrhea 5) Q fever 6) Tularemia 7) Leptospirosis 8) Cellulitis and osteomyelitis from cat or dog bites
1) Cat scratch fever - Bartonella 2) Lyme disease - Borrelia burgdorferi 3) Recurrent fever from variable surface antigens - Borrelia recurrentis 4) Bloody diarrhea - Campylobacter (puppies, livestock, fecal oral, sexual) 5) Q fever - Coxiella burnetti (spores from tic feces, cattle placenta) 6) Tularemia - Francisella tularesis 7) Leptospirosis - Leptospira spp (animal urine) 8) Cellulitis and osteomyelitis from cat or dog bites - Pasteurella multocida
683
PAS stain for
Tropheryma whipplei Whipple disease
684
Child | Red rash on cheek spread to chest and shoulder
Parvovirus B19
685
Histoplasma capsulatum
Mississippi and ohio river valley Macrophages filled with histoplasma (smaller than RBC) (Oval yeast cells within macropahges) Bird/bat droppings ``` Palatal/ tongue ulcers Splenomegaly Pancytopenia Fever, WL, Fatigue Cough dyspnea, N/V, diarrhea ``` CD4 < 200 Caseous Necrosis Granuloma Erythema nodosum Chronic Mediastinitis - Fibrosing mediastinitis - due to increased formation of CT in mediastinum

AM- STEP1 (20 decks)

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