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Microbiology Flashcards

1
Q

Induces TNF and IL-1

A

Lipoteichoic acid (Gram +), Lipid A (portion of LPS in Gram -)

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2
Q

Where do Beta-lactamases live?

A

Periplasm

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3
Q

Site of endotoxin?

A

Outer membrane

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4
Q

Which bacteria have unusual cell membranes/wall?

A

Mycoplasma - sterols and NO cell wall; Mycobacteria - mycolic acid (long branched sat FA’s) (INH i.e. pyrodixine-like -| saturation!)

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5
Q

Bugs that do not Gram Stain well?

A

These Microbes May Lack Real Color - Tropenema, Mycobacteria, Mycoplasma, Legionella pneumophilia, Rickettsia, Chlamydia

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6
Q

Giemsa stain?

A

Certain Bugs Really Try My Patience - Chlamydia, Borrelia, Rickettsieae, Trypanosomes, Mycoplasma, Plasmodium

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7
Q

PAS stain?

A

Tropheryma whippelii; Stains glycogen

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8
Q

Ziel-Neelsen?

A

Acid-fast (Nocardia, Mycobacterium)

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9
Q

India Ink?

A

Cryptococus neoformans; India is Cryptic

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10
Q

Silver stain?

A

Fungi, Legionella, H. pylori; a Silver Pyle of Legions are Fun(gating)

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11
Q

Exotoxins that inhibit protein synthesis?

A

DAEF (Diptheria, Exotoxin A, EF): Diptheria toxin - EF-2, Exotoxin A (pseudomonas) - EF-2; Shiga toxin (ST) & Shiga-like toxin (SLT) act on 60S;

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12
Q

Exotoxins that increase fluid secretion?

A

Heat-labile toxin (LT), heat-stable toxin (ST) [ETEC], Edema factor (bacillus), cholera toxin. Fluids - Back ETtack Cholera.

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13
Q

Exotoxins that inhibit phagocytic ability?

A

Pertussis toxin - stimulates adenylate cyclase by disabling Gi.

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14
Q

Exotoxins that inhibit release of neurotransmitter?

A

Tetanospasmin, botulinum

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15
Q

Exotoxins that lyse cell membranes?

A

Alpha toxin (Staph, C. perfin, Pseudo), Streptolysin O (Streptococcus)

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16
Q

Exotoxins that are super antigens causing shock?

A

Toxic shock syndrome toxin (TSST-1), Exotoxin A. Superantigens cause non-specific widespread activation of T lymphocytes -> IL-1, IL2, TNF -> shock

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17
Q

Endotoxin function?

A

Edema, Nitric oxide, DIC/Death, Outer membrane, TNF-alpha, O-antigen, eXtremel yheat stable, IL-1, Neutrophil chemotaxis

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18
Q

Encapsulated bacteria? (Quellung reaction)

A

SHiNE SKiS = Strep pneumo, H. flu, N. meningitidis, E. coli, Salmonella, Klebs, Strep Group B

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19
Q

Obligate Anaerobes

A

Can’t Breathe Air = Clostridium, Bacteriodes, Actinomyces

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20
Q

Obligate Aerobes

A

Nagging Pests Must Breathe = Nocardia, Pseudomonas, MycoBacterium

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21
Q

Bacillus anthracis characteristics

A

Gram +, spore forming rod. Antiphagocytic D-glutamate capsule; Serpentine/medusa head on microscopy

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22
Q

Corynebacterium diphtheria characteristics

A

Gram + rod. Intracellular polyphosphate granules (stained with methylene blue; metachromatic)

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23
Q

Proteus mirabilis characteristics

A

Perithrichous flagella (meaning distributed evenly over cell)

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24
Q

Strep pneumo causes what?

A

MOPS - Meningitis, Otitis media, Pneumonia, Sinusitis

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25
Q

Optochin sensitive?

A

Strep pneumo

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26
Q

Cocci: + Catalase, + Coagulase

A

Staph aureus

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27
Q

S. aureus’ virulence factor?

A

Protein A - binds Fc-IgG -| complement activation and phagocytosis

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28
Q

Lactose-fermenting enteric bacteria?

A

macConKEE’S agar = Citrobacter, Klebsiella, E. coli, Enterobacter, Serratia; For Gram NEG rods. Black colonies, except E. coli which makes green.

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29
Q

Gram negative diplococci

A

Neisseria meningitidis and N. gonorrhoeae

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30
Q

Differentiate between Neisseria species?

A

Maltose fermenter = N. meningitidis; Maltose NF = N. gonorrhoeae

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31
Q

Farmer with SOB, fever, mediastinitis?

A

Pulmonary anthrax

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32
Q

Macrolides target what?

A

50S (Azithro, clarithro, erythro). 23S rRNA to prevent translocation

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33
Q

UA has nitrites positive, meaning

A

Gram NEG organism (So a gram + org like Staph saprophytic or enterococcus us would be nitrite NEG)

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34
Q

Chocolate Agar

A

H. flu. Factors V (NAD+) and X (hematin).

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35
Q

H. Flu - Distinguishing bacteriology? Diseases?

A

Chocolate (lysed RBC’s) agar req. Factors V (NAD+) and X (hematin). Gram NEG rod. Epiglottitis (Thumbprint sign), Meningitis, Otitis Media, Pneumonia. Can grow in blood agar with Staph, which will lyse RBC’s for X and V factor usage. Non-typable H. flu doesn’t have a capsule.

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36
Q

Optochin

A

OVRPS - Opthocin - Viridians is resistant. Pneumoniae is sensitive.

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37
Q

Bacitracin

A

B-BRAS - Bacitracin - Group B is resistent. Group A is sensitive.

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38
Q

EIEC

A

Invasive - necrosis and inflammation. dysentery-like. No toxin.

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39
Q

ETEC

A

Enterotoxigenic - produces heat-labile and heat-stable enterotoxins; Traveler’s diarrhea; no inflammation or invasion

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40
Q

EPEC

A

Enteropathogenic - No toxins. Flattens villi to prevent absorption. Diarrhea usu. in pediatrics

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41
Q

EHEC

A

Enterohemorrhagic - shiga-like toxin leading to HUS (micro thrombi leading to mechanical hemolysis and decreased renal blood flow; thrombocytopenia) O157:H7 is most common serotype

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42
Q

Two forms of Chlamydia

A

Elementary body - infectious, enters via endocytosis to become a Reticulate body - replicated in the cell by fission, then makes elementary bodies

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43
Q

Aminoglycosides attack what?

A

30S (bacteriacidal). Initiation complex formation and mRNA misread.

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44
Q

Tetracyclines attack what?

A

30S (bacteriostatic). A-site t-RNA binding.

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45
Q

Fluoroquinolones attack what?

A

DNA topoisomerases

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46
Q

Carbapenems attacks what?

A

Peptidoglycan cross-linking

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47
Q

Vanc attacks what?

A

Peptidoglycan synthesis by binding D-alanyl-D-alanine portion of cell wall precursors (which are glycoproteins). VRE has D-alanine-D-lactate

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48
Q

Sulfonamides attack what?

A

Folic acid synthesis (PABA to DHF)

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49
Q

Cephalosporins attack what?

A

Peptidoglycan cross-linking

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50
Q

Aminopenicillin coverage?

A

HELPSS kills enterococci - H flu, E coli, Listeria, Proteus, Salmonella, Shigella, enterococci

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51
Q

50S inhibitors

A

Buy AT 30, CCEL at 50 (Chloramphenicol - static, Clinda - static, Erythro - static, Linezolid)

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52
Q

30S inhibitors

A

Buy AT 30, CCEL at 50 (Aminoglycosides, Tetracyclines)

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53
Q

Aminoglycoside toxicity?

A

Neprhotoxicity, Neuromuscular blockade, Ototoxicity, Teratogen

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54
Q

Folate pathway abx?

A

Sulfonamides inhibit dihydropteroate synthase (PABA -> Dihydropteroic acid)Trimethoprim/pyrimethamine inhibit dihydrofolate reductase (Dihydrofolic acid to tetrahydrofolic acid)

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55
Q

Isoniazid toxicities?

A

INH = Injures neurons and hepatocytes; Vitamin B6 helps

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56
Q

Metronidazole coverage?

A

GET GAP on the Metro = Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, Anaerobes (Bacteroides, C. dificil), and w/ triple therapy for h. Pylori

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57
Q

Pseudomonas microbio?

A

Gram neg rod, Oxidase positive, non-LF, green-pigment producing. MOTILE

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58
Q

“Hot tub folliculitis”

A

Superficial Pseudomonal infection, usu. outbreaks at public swimming pools or hot tubs

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59
Q

Hepatitis D virus requires what exactly to replicate?

A

Must be encapsulated by HBsAg.

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60
Q

Organisms not typically covered by cephalosporins

A

LAME - Listeria, Atypicals (Chlamyida, Mycoplasma), MRSA, and Enterococci

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61
Q

Cephalosporin mech

A

Beta-lactam drug that inhibits cell wall synthesis but less susceptible to penicillinases; -cidal

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62
Q

Parvovirus presentation in adults?

A

Arthritis - mimicking RA but self-resolving

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63
Q

Enteric bacteria that can be transmitted via domestic animals?

A

Campylobacter jejuni - gram neg rod w/ filament (corkscrew movt)

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64
Q

3 main pathogens of HIV-associated esophagitis

A

Candida albicans - grey/white pseudomembranes; yeast cells and pseudohyphae
HSV-1 - small vesicles w/ punched out ulcers; eosinophilic intranuclear inclusions
CMV - linear ulcerations; intranuclear and cytoplasmic inclusions

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65
Q

Dimorphic fungi

A

Soporothrix (thorn prick SQ nodules), Coccidiodes, Histo, Blastomyces, Paracoccioides

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66
Q

What particular malarial schizonts are killed by Primaquine?

A

P. vivax and ovale.

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67
Q

Listeria microbio characteristics?

A

Gram + rod. Narrow zone of Beta-hemolysis on blood agar. Motility at 22 C and culture at 4 C. Tumbling motility. Cell-mediated immunity req, but neonates up to 3 months can’t. Tx = penicillin or ampicillin

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68
Q

3 types of schistosomiasis

A

Urinary (s. haematobium, Africa) - hematuria, dysuria, hydronephrosis, pyelo, bladder ca
Intestinal (mansoni or japonicum) - diarrhea, ulceration, Fe-def. anemia
Hepatic (mansonia, japonicum) - hepatosplenomegaly, portal htn

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69
Q

Diptheria toxin

A

AB-exotoxin. A subunit transfers ribose from NAD to His on EF-2 (peptide translocation) to inactivate it.

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70
Q

Pertussis toxin

A

Stimulates adenylate cyclase by disabling Gi, impairing phagocytosis; Whooping cough. Bordatella pertussis cultured on Bordet-Gengou.

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71
Q

Shiga toxin

A

Inactivate 60s ribosomal subunit

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72
Q

Defense against Giardia?

A

Secretory IgA impairs adherence of Giarda to duodenal and jejunal mucosa

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73
Q

What test differentiates staph aureus from the rest?

A

Coag POSitive staph aureus. Moses’ staph coagulated the Nile.

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74
Q

How is MRSA resistant to beta-lactamase resistant antibiotics?

A

Altered penicillin binding protein in peptidoglycan wall

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75
Q

Fried rice?

A

Bacillus cereus

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76
Q

Raw oysters

A

Vibrio parahaemolyticus - cholera like. Or Vibrio vulnificus - sepsis high mortality.

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77
Q

Raw eggs, raw chicken

A

Salmonella

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78
Q

Custard, mayo, salted meat

A

Staph aureus - heat stable enterotoxin; Your staff eat custard, salted meat, and mayonnaise

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79
Q

Transpeptidase?

A

Enzyme that cross-links peptide side chains for peptidoglycan

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80
Q

Composition of spore? What bacteria have them?

A

Keratin-like coat, dipicolinic acid, peptidoglycan. Bacillus anthraces, Clostridium perfringes, C. tetani

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81
Q

Composition and function of glycocalyx?

A

Mediates adherence to surfaces (esp. foreign surfaces like catethers). Made of polysaccharides

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82
Q

Where is the periplasm?

A

Between outer membrane and inner membrane in Gram-negatives.

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83
Q

Gram negative cocci

A

Neisseria

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84
Q

Gram positive rods

A

Clostridium, Corynebacterium, Bacillus, Listeria, Mycobacterium, Gardnerella; My Guard Listlessly Bakes Cor(y)n on the Cob

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85
Q

Branching filamentous bacteria

A

Actinomyces and Nocardia (weakly acid-fast); No Actin

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86
Q

Thayer-Martin?

A

VPN - Vanc, Polymyxin, Nystatin; Neisseria

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87
Q

Facultative intracellular

A

Some Nasty Bugs May Live FacultativeLY - Salmonella, Neisseria, Brucella, Mycobacterium Listeria, Francisella, Legionella, Yersinia pestis

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88
Q

Catalase + organisms

A

PLACESS for your Cat(s); Pseudomonas, Listeria, Aspergillus, Candida, E. coli, S. aureues, Serratia. Burkholderia cepacia.

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89
Q

Urease-positive organisms

A

(Cryptic) CHuck Norris Klebs Urease Positive w/ a Staph; Cryptococcus, h pylori, nocardia, klebsiella ureaplasma, Proteus, Staph epi/sapro

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90
Q

Yellow color associated organisms

A

Actinomyces israelii - granules; Staph aureus - pigment

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91
Q

Red pigment organism

A

Serratia marcescens. Serrated beef is RED

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92
Q

Green pigment organisms

A

Pseudomonas aeruginosa

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93
Q

What organisms secrete IgA protease?

A

Strep pnumo, H flu, Neiserria. IgA becomes ASHeN

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94
Q

ADP ribosylating A-B toxins?

A

Diptheria, exotoxin A, Shiga toxin, Shiga-like toxin, LT, Cholera toxin, Pertussis

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95
Q

Pseudomonas toxin and function

A

Exotoxin A; inactivates EF-2

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96
Q

ETEC toxin and function

A

Heat-labile (overactivates adenylate cyclase -> Cl- and water secretion). Heat-stable (overactivates guanylate cyclase -> reabsorption of NaCl and water); watery diarrhea

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97
Q

Bacillus toxin

A

Edema factor; mimics adenylate cyclase; Lethal factor - zinc-dependent protease that inhibits MAPK -> apoptosis

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98
Q

Cholera toxin

A

Overactivates -> Cl- secretion

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99
Q

Clostridium toxin

A

Tetanospasmin - spasticity, lockjaw, prevents release of inhibitory neurotransmitters; Botulinum toxin - flaccid paralysis, floppy baby, prevents stimulatory Ach signals at NMJ; Alpha toxin (perfingens) - lecinthinase that degrades cell membranes -> gas gangrene and hemolysis (dbl zone)

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100
Q

Strep toxins

A

Pyogenes has Streptolysin O (degrades cell membranes, Beta-hemolysis) and Exotoxin A (TSS) and Protein M (inhibits phagocytosis and activates complement)

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101
Q

Staph toxin

A

Toxic shock syndrome toxin (TSST01): MHC II and TCR brought in proximity outside of regular site -> overwhelming IFN-gamma and IL-2 release -> fever, rash, shock

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102
Q

Which bacteria will undergo transformation?

A

SHiN - Strep pneumo, H flu, Neisseria

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103
Q

What gene contains sex pills for conjugation?

A

F+

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104
Q

Genes for 5 toxins encoded in lysogenic phage

A

ABCDE - shigA-like toxin, botulinum, cholera, diphtheria, erythrogenic

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105
Q

Novobiocin?

A

Used to distinguish between coagulase NEG staph (cat +). No StRES - Novobiocin: Saprophyticus Resistant; Epidermidis Sensitive.

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106
Q

GAS characteristics

A

GAS = Strep pyogenes. Gram + cocci in chains. Catalase negative. Beta-hemolytic. B-BRAS. Bacitracin resistant. Pyrrolidonyl arylamidase (PYR)-positive. Impetigo, ARF, acute post-streptococcal glomerulonephritis, scarlet fever (sandpaper)

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107
Q

GBS characteristics

A

GBS = Strep agalactiae. Gram + cocci in chains. Catalase negative. Beta-hemolytic. B-BRAS. Bacitracin sensitive.

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108
Q

Strep pneumo characteristics

A

Gram + in chains. Catalase negative. alpha-hemolytic. OVRPS = Pneumo is optochin sensitive. Bile-soluble. Capsule is MAJOR virulence factor.

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109
Q

Viridians strep characteristics.

A

Gram + in chains. Catalase neg, alpha-hemolytic, optochin resistant. Bile INsoluble. NO capsule. Produce DEXTRANS (extracellular polysaccharides) via sucrose to adhere to FIBRIN. Therefore, viridians needs VALVE DAMAGE FIRST before it can attach to the fibrin clot on it to cause subacute bacterial endocarditis.

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110
Q

Gram + cocci in chains, catalase neg, gamma hemolysis

A

No hemolysis. Growth in Bile + 6.5% NaCl = Enterococcus. Bile w/o 6.5% NaCl = Nonenterococcus (e.g. Strep bovis)

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111
Q

Staph epidermidis clinical

A

Prostethic devies and intravenous catethers (glycocalyx?, biofilm production - extracellular polysaccharide matrix). Tx empirically w/ Van +/-rifampin/gent until sensitivities

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112
Q

Staph saprophyticus clinical

A

2nd most common uncomplicated UTI

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113
Q

Strep pneumo clinical

A

MOPS - Meningitis, Otitis media, Pneumonia, Sinusitis.

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114
Q

Viridians Strep clinical

A

Dental caries, bacterial endocarditis.

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115
Q

Strep pyogenes clinical

A

Pharyngitis, cellulitis, impetigo, scarlet fever, toxic shock0like syndrome, necro facitits, Rheumatic fever (Joints, heart, nodules, erythema marginatum, sydenham chorea), acute glomerulonephritis

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116
Q

Strep agalactiae clinical

A

Pneumonia, meningitis, sepsis (Babies). Produces CAMP factor (not cyclic AMP)

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117
Q

Enterococci (Group D) clinical

A

Normal colonic flora that are Pen G resistant. UTI, bilitary tract, subacute endocarditis. Bile + 6.5% NaCl

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118
Q

Strep bovis clinical

A

Group D strep. Bile w/o 6.5% NaCl. Bacteremia and endocarditis in colon ca patients.

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119
Q

Corynebacterium diphtheriae clinical

A

Diptheria - pseudomembranous pharyngitis (gray-white), pharyngitis, lymphadenopathy. Beta-prophage. Lab dx - blue and red granules and Elek test for toxin. Cysteine-tellurite agar (dark black, iridescent). Tx w/ antitoxin (passive immunity), Pen/erythromycin, DPT vaccine

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120
Q

C. tetani clinical

A

Tetanic paralysis blocking GABA release from Renshaw cells -> spastic paralysis, truisms, rises sardonicus.

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121
Q

C. botulinum clinical

A

Flaccid paralysis

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122
Q

C. perfingens clinical

A

Alpha toxin (lecinthase) -> gas gangrene and hemolysis. OR late-onset food poisoning w/ transient watery diarrhea.

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123
Q

C. difficile clinical

A

Toxin A - brush border of gut via neutrophils. Cytotoxin B - CYTOSKELETON (tight jx) disruption via actin depoly -> pseudomembranous colitis and diarrhea; Tx = metronidazle or oral vanc OR fidaxomicin (inhibits sigma unit of RNA pol)

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124
Q

Baccilus anthracis clinical

A

Cutaneous anthrax leads to boil-> ulcer w/ black eschar. Pulmonary anthrax -> flu-like to fever, pulmonary hemorrhage, mediastinisi, shock (Woolsorters’). Tx = Pen G or Doxy/cipro

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125
Q

Bacillus cereus clinical

A

Reheated rice syndrome. Spores. N/v within 1-5 hours by cereulide. Diarrheal type causes watery, nonbloody diarrhea and GI pain within 8-18 h.

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126
Q

Listeria monocytogenes clinical

A

Facultative intracellular. Only Gram + producing LPS. Amnionitis, septicemia, spontaneous abortion (That’s why NO unpasteurized cheese!) Meningitis. Gastroenteritis. Tx = penicillin, ampicilin.

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127
Q

Actinomyces clinical

A

Normal oral flora -> oral/facial ABSCESS that drain and form yellow granules; tx = pen + debridement. Gram +.

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128
Q

Nocardia clinical

A

Pulmonary infections in immunocompromised; of cut. infections in immunocompetent; tx = sulfa

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129
Q

TB clinical

A

Caseating granuloma w/ central necrosis and Langerhans giant cells. Ghon complex. Ghon focus in mid-zone. Reactivated fibrocaseous lesion in upper lobes. Fever, night sweats, wt loss, hemoptysis. Cord factor (my colic acid) correlates w/ virulence. Serpentine pattern.

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130
Q

M. leprae clinical

A

Lepromatous - lion-like facies, humoral Th2 response. Tuberculoid - few skin plaques with high cell-mediated immunity of Th1-response; Tx = dapsone and rifampin +/- clofazimine

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131
Q

Gram negative “coccoid” rods

A

H flu, Bordetella pertussis, Brucella, Pasteurella; Pastor Bruce Flu over-the Border.

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132
Q

Gram negative, oxidase POS

A

Campylobacter (42 C), Vibrio cholerae (alkaline), Helicobacter pylori (urease), or Pseudomonas (Gram - nrod)

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133
Q

N. gonoccoci clinical

A

STI. Gonorrhea, septic arthritis, neonatal conjuctivitis, PID, Fitz-Hugh-Curtis. Tx = Cef + (Azithro/doxy). Infection doesn’t provide resistance b/c of antigenic rearrangement of surface proteins.

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134
Q

N. meningococci clinical

A

Respi/oral secretions (using Pili). Meningitis, Waterhouse-Friderichsen. Tx = cef or Pen G. Ppx with RIFampin.

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135
Q

H flu clinical

A

Epiglottis, Meningitis, Otitis media, pneumonia.

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136
Q

Legionella pneumonphila clinical

A

Legionnaires’ disease = severe pneumonia with fever, GI, CNS, hyponatremia. dx = urine Ag test. No orbs on sputum. Pontiac fever = mild flu-like. Silver stain. Charcoal yeast culture with Fe and Cysteine. Aerosol from water. Tx = macrolide/quinolone

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137
Q

Pseudomonas aeruginosa clinical

A

PSEUDO = pneumonia, Sepsis, External otitis, UTI, Drug use + diabetic, Osteomyelitis, hot tub folliculitis, ecthyma gangrenosum (rapidly progressive necrotic cut lesions.) Tx = amino glycoside + extended spec Pen

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138
Q

Klebsiella clinical

A

4 A’s - Aspiration pneumonia, Abscess in lungs/liver, Alcoholics, di-A-betics. LF Gram Neg Rod. “Currant jelly” sputum.

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139
Q

Salmonella v. Shigella

A

Salmonella have flagella, hematogeneous, HS production, abx lengthen fecal excretion, can cause sepsis and typhoid fever. Shigella very low ID50, cell-to-cell, abx shorten duration of fecal excretion.

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140
Q

Campylobacter jejuni clinical

A

Bloody diarrhea. Comma oxidase + Gram - 42 C

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141
Q

Vibrio cholerae clinical

A

Rice-water diarrhea via enterotoxin that permanently turns on Gs. Sensitive to acid (less acidic = less organisms needed to infect) Common shaped, gram -, oxidase +, alkaline media

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142
Q

Yersinia enterocolitica clinical

A

Mesenteric adenines that looks like Crohn’s or appendicitis. “Pseudoappendicitis.” Pet feces, milk, pork. DAY-care.

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143
Q

H. pylori clinical

A

Gastritis, peptic ulcers. Gram - rod, catalase, oxidase, urease +. Tx = PPI + clarithro + amox/metro

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144
Q

Which are spirochetes?

A

BLT - Borrelia, leptospira, Treponema

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145
Q

Leptospira interrogans clinical

A

Flu-like, jaundice, photophobia w/ conjuctival suffusion. Surfers. Weil disease - more severe with kidney dysf(x). Tx w/ doxy.

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146
Q

Lyme disease clinical

A

FAKE a Key Lyme pie - Facial n. palsy (b/l), Arthritis, Kardiac block, Erythema migrans (red, ring-shaped w/ central clearing but often remains as patch); Tx = doxy, ceftriaxone

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147
Q

Syphilis stages

A

Primary - PAINLESS chancre. Dark-field, CLRL/RPR (non-specific). Secondary - disseminated disease with rash, condylomata lata. VDRL/RPR. Tertiary - Gummas (chronic granulomas that are PAINLESS -> ulcerate), Ascending aortic aneurysm (not dissection), neurosyphilis (tabes dorsalis), Argyl Robertson. Broad-based ataxia with romberg. Dx = spinal fluid w/ VDRL or RPR. Congenital - saber shins, saddle nose, VIII deafness, Hutchinson teeth.

148
Q

Argyl Robertson pupil

A

Accommodates but not reactive to light

149
Q

VDRL false positives

A

VDRL - viruses, drugs, rheumatic fever, lupus and leprosy

150
Q

Gardnerella vaginalis clinical

A

Vaginosis. Fishy. Clue cells. Tx = metronidazole or clinda.

151
Q

Treatment for Rickettsiae?

A

Doxy

152
Q

Rocky Mountain Spotted Fever clinical

A

Rickettsia ricketsii. Tick. S. Atlantic. Wrist and ankles to trunk, PALMS and SOLES.

153
Q

Typhus

A

Rickettsia typhi/prowazekii (flea or louse). TRUNK then spreads sparing palms and soles.

154
Q

Chlamydia trachomatis clinical; serotypes?

A

PID, Reactive arthritis (Reiter syndrome), follicular conjuctivitis; ABC = Africa/Blindness/Chronic; D-K = everything else. L1-3 = lymphogranuloma venereum - small painless ulcers on genitals -> swollen lymph nodes that ulcerates (buboes). Azithro/doxy

155
Q

Chlamydia pneumoniae/psittaci clinical?

A

Atypical pneumonia; aerosol. Azithro/doxy

156
Q

Mycoplasma pneumonia clinical?

A

Walking pneumonia - insidious onset, HA, nonproductive cough, patchy infiltrate. COLD agglutinins -> hemolytic anemia. Eaton agar. Military + prison. Tx = macrolide, doxy, fluoroquinolone. NO CELL WALL = no pen. Require cholesterol for growth on media.

157
Q

RF related to what organisms?

A

Group A Strep = Strep pyogenes

158
Q

Most common cause of aseptic meningitis?

A

Enteroviruses - coxsackie, echo, polio; fecal-oral

159
Q

Cryptococcus neoformans clinical

A

Meningitis is most common presentation (tx = amphotericin B, dx with CSF yeast). Immunosuppressed patients. Cryp pneumonia dx by MUCICARMINE or METHENAMINE silver staining of lung tissue and bronchoalveolar washings. Soil, pigeon. Sabouraud.

160
Q

What organism from dental work -> endocarditis?

A

Viridians strep. Produce dextrans to help adhere to fibrin. Damaged valve -> endocarditis

161
Q

H. flu vaccine composition?

A

Polyribosyl-ribitol-phosphate (PRP) a component of HiB capsule conjugated w/ deiphtheria or tetanus toxoid.

162
Q

Bartonella henselae

A

Cat scratch disease (low fever, lymphadenopathy, self-limited), bacillary angiomatosis, culture-neg endocarditis.

163
Q

Rubella

A

German measles. Maculopapular rash starting on head. Occipital and postAURICULAR lymphadenopathy. Congenital rubella = microcephaly, cataracts, deafness, patent ductus, pulmonic stenosis.

164
Q

Prevnar vs. Pneumovax?

A

Prevnar = pneumococcal conjugate vaccine 13. Capsular polysaccharides attached to recombinant, inactivated diphtheria, which induces active immunity via T-cell-dept B-cell response w/ MEMORY. Efficacy in elderly, children s.

165
Q

Most common cause of hydatid cysts?

A

Echinococcus granulosus (taepworm) - sheep, dog, foreign. Asymptomatic. UNIlocular. Hepatomegaly, RUQ, n/v. Eggshell calcification of liver. Aspiration of cyst = possible anaphylactic shock. Tx = albendazole

166
Q

Typhoid fever

A

Salmonella typhi/paratyphi. Penetrate mucosa by M-cells -> liver, spleen, bone marrow. Hepatosplenomegaly. Intestinal hemorrhage w/ potential perf. ROSE spots on abdomen.

167
Q

Scabies

A

Intense pruritic rash (usu. worse at night) on flexor surfaces of wrist, lat fingers, finger webs. Excoriation w/ small, crusted red papulse. Dx = skin scraping w/ mites, ova, feces

168
Q

SW fungi path and diseases?

A

Coccidioides immitis - dimorphic fungi, thick-walled spherules w/ endospore. Pneumonia, meningitis. Case INC after earthquakes.

169
Q

Ohio, Mississippi valleys valley - soil, bird, bat; path?

A

Histoplasma capsulatum - oval yeast cells w/in MACROPHAGES; hiSTOWaways in macrophages

170
Q

Ohio, Mississippi valleys, Great lakes - soil; path

A

Blastomyces dermatidis - large, round yeast with doubly refractile wall and SINGLE broad-based bud; BLAST the Broad Bud, I’m SINGLE. Inflammatory lung disease. Skin and bone.

171
Q

Latin America

A

Paracoccidioidomycosis. BUD, Take the Captain’s Wheel (Budding yeast in captain’s wheel). to Latin America!

172
Q

Tinea versicolor - path, tx?

A

Malassezia furfur. Lipid degradation -> acid that damages melanocytes -> hypo/hyperpigmented. Tx = miconazole, Selenium sulfide. Spaghetti and meatballs. Italian accent - MalasEEEEzia, have some spaghetti and meatbawls.

173
Q

Candida albicans

A

Systemic or superficial fungal infection. Tx = azole topical. Fluconazole, ampho, caspofungin for systemic. Pseudohyphae at 20 and Germ tubes at 37 (yeast grow hyphae).

174
Q

Aspergillus fumigatus

A

Invasive aspergillosis (primary lung involvement in immunosuppressed with necrotizing pneumonia), colonizing aspergillosis (in old lung cavities; often asymptomatic or mild cough), allergic bronchopulmonary aspergillosis (ABPA) w/ wheezing, fever, and migratory pulmonary infiltrates. ACUTE angle (45 deg) branch. Condiophore w/ radiating chains of spores.

175
Q

Mucor and Rhizopus pp.

A

Mucormycosis. Usu. DKA or leukemic patients. Proliferate in blood vessel wall -> penetrate CRIBiform plate -> brain -> frontal lobe abscess. Tx = amphotericin B. Sinuses. “Non-septate hyphae = wide-angle”

176
Q

Pneumocystis jirovecii

A

PCP pneumonia - diffuse interstitial pneumonia. Inhaled. Disc-shaped yeast on methenamine silver stain. Tx/ppx = TMP-SMX, pentamidine. PPx when CD <200! (dapsone, atovaquone)

177
Q

Sporotrichosis

A

SQ mycosis caused by sporothrix schenickii (dimorphic fungi; hyphae; cigar-shape; in plant material); thorn prick; reddish nodules -> ulcers; lymphatic spread!Dx - culture

178
Q

GI protozoa

A

Giardia, entamoeba, cryptosporidium

179
Q

Giardia

A

Giardiasis - malabsorption. Campers. Cysts in water. Dx - trophozoites or cysts in stool. Tx = metro. Maleficient Guards!

180
Q

Entamoeba histolytica

A

“Amebic dysentery.” BLOODY diarrhea, liver abscess, RUQ pain. Dx = serology or trophozoites or cysts in stool; MULTI-nucleate trophozoites. Tx = metronidazole or iodoquinol for asymptomatic cyst passers. Prevalent in homosexual community.

181
Q

Cryptosporidium

A

Severe diarrhea in AIDS. Dx = acid-fast ooctyes. Tx = prevention, nitazoxanide

182
Q

CNS protozoa

A

Toxo, Naegleria, Trypanosoma

183
Q

Toxoplasma gondii

A

Brain abscess (ring-enhancing) in HIV. Congenital toxo = chorioretinitis, hydrocephalus, intracranial calcifications. Meat, CAT feces. Dx = sero, tachyzoite. Tx = suilfadiazine + pyrimethamine

184
Q

Naegleria fowleri

A

Rapidly fatal meningoencephalitis. Nalgene freshwater -> cribriform plate. Dx = amoeba in spinal fluid. Tx = amphotericin B might be effective

185
Q

Trypanosoma brucei

A

African sleeping sickness - lymphadenopathy, fever, somnolence, coma. Transmitted by Tsetse fly. Dx = blood smear. Tx = Suramin for blood and melarsoprol for CNS

186
Q

Differences between malaria subspecies?

A

Malariae = 72 hours. Vivax/ovale = 48 hrs, dormant form in LIVER requiring primaquine. Falciparum - IRREGular. Severe. Brain caps occluded.

187
Q

Malaria treatment

A

Chloroquine - blocks Plasmodium heme polymerase -> mefloquine or atovoquone/proguanil. Quinidine if life-threatening but first check G6PD. Vivax/ovale sensitive for primaquine.

188
Q

Babesia

A

Fever and hemolytic anemia. NorthEAST U.S. Asplenia increases risk of disease. Ixodes (i.e. lyme). Dx = Maltese cross. PCR. Tx = atovaquone + azithro. Babe in manger will carry cross breaking his blood.

189
Q

Trypanosoma cruzi

A

Chagas disease - dilated cardiomyopathy, megacolon, megaesophagus. Reduviid bug feces. Dx - blood smear. Tx = benznidazole or nifurtimox.

190
Q

Leishmania donovani

A

Visceral leishmaniasis (kala-azar) - spikign fevers, hepatospleno, pancytopenia. Sandfly. Dx = macrophages containing amastigotes. Tx = amphotericin B, sodium stibogluconate (binds heme)

191
Q

Trichomonas vaginalis

A

Foul, green d/c. Strawberry cervix. Tx = metronidazole

192
Q

Nematodes?

A

Roundworms. Ingested = EAT (Enterobius [pin], Ascaris [giant], toxocara). Cutaneous = SANd (Strongyloides, Ancylostoma and Necator [hook]). Bites = LOW (Loa loa, Onchocerca volvulus, Wuchereria bancrofti)

193
Q

Enterobius vermicularis

A

Pinworm causing anal pruritis. Scotch Tape test. Tx = bendazole.

194
Q

Onchoerca volvulus

A

Black onyx. Black flies, Black skin nodules, Black sight. Tx = ivermectin

195
Q

Biliary tract disease, cholangiocarcinoma parasite

A

Clonorchis sinesis. Halabugi

196
Q

Brain cysts, sz parasite

A

Taenia solium (cysticercosis) - undercooked pork.

197
Q

Hematuria, bladder ca parasite

A

Schistosoma haematobium

198
Q

Liver (hyatid) cysts parasite

A

Echinococcus granulosus. Dog feces.

199
Q

Portal HTN parasite

A

Schistosoma mansoni/japonicum. Snails.

200
Q

B12 deficiency parasite

A

Diphyllobothrium - raw freshwater fish

201
Q

Microcytic anemia parasite

A

Ancylostoma, Necator

202
Q

Two types of viral capsids

A

Icosahedral and helical

203
Q

Phenotypic mixing vs complementation

A

Phenotypic mixing is mixed genome w/ coat. Complementation is that one virus’ functional protein helps another one that is co-infecting.

204
Q

Killed viral vaccines?

A

A salK was Killed. RIP. (HAV, Rabies, Injected influenza, Polio). Induce humoral immunity.

205
Q

Live attenuated vaccines

A

Humoral AND cell-mediated means NO booster. Live show! M(M)R. Sabin caught both the FLU and yellow fever. (smallpox, yellow, chicks)

206
Q

Recombinant viral vaccines?

A

HBV, HPV

207
Q

The only ssDNA virus. Only dsRNA virus.

A

Parvoviridae. Reoviridae. (Par’vn me, I’m single. I’m headed to Rio to get a double)

208
Q

Circular DNA viruses

A

Pappilloma, polyoma, hepadnavirus. Polly enter the circle with Pappy and Heather.

209
Q

+ssRNA viruses

A

Foggy morning?…“I’m POSitive that I went to a Retro(virus) Hepster (hepevirus) Toga(virus) party to eat Calcified(calicivirus) Pickles(picornavirus) and Flavored(flavirus) Corona(virus).”

210
Q

Where do viruses replicate?

A

DNA viruses replicate in nucleus (except pox). RNA viruses replicate in cytoplasm (except retros and influenza)

211
Q

Naked viruses?

A

Naked Hepster needs PAPP smears and CPR. PAPP = DNA (Papillomavirus, Adenovirus, Parvovirus, Polyomavirus). CPR = RNA (Calicivirus, PIcornavirus, Reovirus)

212
Q

DNA viruses

A

“Because I’m HHAPPPPY!” Clap along…if you feel… (Hepadna, Herpes, Adeno, Pox, Parvo, Papilloma, Polyoma).

213
Q

Pox virus is weird b/c

A

Well it’s DNA. But complex capsid and carries its own DNA-dependent RNA pol and doesn’t replicate in nucleus!

214
Q

HSV-1

A

oral, keratoconjuctivitis, temporal lobe encephalitis, herpes labialis, latent in trigeminal. ds linear

215
Q

HSV-2

A

Herepes genitalis, neonatal. Latent in sacral. Tzanck test of open skin vesicles - multinucleate giant cell.

216
Q

HHV-3

A

VZV - chickenpox (vesicular rash on trunk spreading to face/limbs), shingles. Latent in dorsal root or trigeminal.

217
Q

HHV-4

A

EBV - mononucleosis (fever, hepatosplenomegaly, pharyngitis, lymphadenoapthy). Infects B cells -> atypical lymphs. + monospot (heterophile ab’s aggultination of sheep or horse RBC’s to Ab’s in pt’s blood). Associated w/ hodgkin, Burkitt, nasopharyngeal ca. gp350 binds w/ CD21 (CR2) on B-cells

218
Q

HHV-5

A

CMV - congenital, mono(NEG monospot), pneumonia, retinitis. OWL-EYE inclusions. ENVEloped. Latent in mononuclear. Binds to cellular integrins.

219
Q

HHV-6/7

A

Roseola (Exanthem subitum). High fevers that can cause SEIZURE. Macular rash after fever.

220
Q

HHV-8

A

Kaposi sarcoma. Immunocompromised. Dark/violaecous flat/nodular lesions.

221
Q

Adenovirus

A

linear ds DNA virus that can cause acute pharyngitis, acute hemorrhagic cystitis, conjunctivitis, and pneumonia.

222
Q

Parvovirus

A

ss, linear (neg) DNA. 5th disease in children. Aplastic crises in SCD. In fetus -> hydrous fettles. RBC aplasia and RA-like in adults

223
Q

Polyomavirus

A

ds, circula. JC virus in PML for HIV. BK virus = bad kidney (transplant). Poly Letter viruses!

224
Q

Poxvirus

A

ds, linear (LARGE) DNA. Smallpox. Cowpox. Molluscum contagiosum - flesh-colored dome lesions w/ central dimple.

225
Q

Reovirus

A

ds RNA. Colorado tick fever (arbovirus), ROTAvirus (#1 fatal diarrhea in children, villous destruction w/ atrophy -> dec. Na+ absorption and loss of K+. Rio’s got lots of diarrhea)

226
Q

Picornavirus

A

ss+RNA. PERCH = poliovirus, echovirus (aseptic meningitis), rhinovirus (binds CD54/ICAM), coxsackievirus (aseptic, hand/foot/mouth, myocarditis, pericarditis), HAV. Proteases cleave ONE LARGE polypeptide. (Small virus, Big Polypeptide).

227
Q

Hepevirus

A

ss+RNA. Hepatitis E

228
Q

Calcivirus

A

ss+RNA. Norovirus = viral gastro; Nor Cal!

229
Q

Flavivirus

A

ss+RNA. HEP C. Yellow fever (high fever, BLACK vomitus, jaundice), dengue, St. louis, West nile

230
Q

Togavirus

A

ss+RNA. Rubella (German toga party! “German measles” - fever, post auricular adenopathy, arthralgia. Congenital = blueberry muffin, extra medullar hematopoiesis, microcephaly, cataracts, deafness). Eastern/western equine encephalitis.

231
Q

Retrovirus

A

ss+RNA. HTLV (T-cell leukemia), HIV

232
Q

Coronavirus

A

ss+RNA. Common cold + SARS.

233
Q

Orthomyxoviruses

A

ss-RNA. Influenza. Enveloped. HEMAGGLUTININ (viral entry, immunity gives Ab’s against these) and neuroaminidase (vision release). Disgusting orthopods, gave me the flu.

234
Q

Paramyxoviruses

A

ss-RNA. Parainfluenza (croup - seal-bark, steeple sign), RSV, Measles, Mumps. All contain suface F protein (fusion) -> fusion of resp epithelial cells = multinucleate cells. Palivizumab (ab against F protein) prevents RSV pneumonia.

235
Q

Rhabdoviruses

A

ss-RNA. Rabies; Rhabid animals = Rabies.

236
Q

Filoviruses

A

ss-RNA. Ebola/Marbug.

237
Q

Delta virus

A

ss-RNA. Circular.

238
Q

NEG stranded RNA

A

Negatives Always Bring Polymerase Or Fail Replication. Arena, Bunya, Paramyxo, Orthomyxo, Filo, Rhabdo

239
Q

Segmented viruses

A

Segment the BOAR to eat it! Bunya, Orthomyxo, Arena, Reo.

240
Q

Genetic shift/drift

A

A sudden shift is worse (pandemic) than a graDual drift (epidemics)

241
Q

Measles

A

Measles = Rubeola. Paramyxovirus. 3 C’s - Cough, coryza, conjuctivitis. Koplik spots of Buccal mucosa. Then comes a maculopapular rash from head down. Has hemagglutinin (surface adhesion) and matrix protein (viral assembly). Subacute sclerosing panecephalitis (SSPE) is a rare complications thought to be due to mutated measles (matrix protein) -> INTRACELLULAR replication and accumulation of viral nucelocapsis in neurons and oligo’s.

242
Q

Mumps

A

Paramyxovirus. POM - Parotitis, orchitis, aseptic Meningitis. NO RASH. Can cause Leydig cell atrophy.

243
Q

Rabies

A

Bullet-shaped virus. NEGRI bodies in purkinje cells of cerebellum and hippocampus. Long incubation. Retrograde. Fever, malaise -> agitation, photophobia, hydrophobia -> paralysis, coma, death. Bat, raccoon, skunk. Binds to Ach receptor

244
Q

Hepatitis viruses

A

HAV is RNA picorna (Asymptomatic, Acute, Alone). HBV is DNA hepadnavirus. HCV is RNA flavivirus (Chronic, Cirrhosis, Carcinoma, Carrier). HDV is RNA delta virus. HEV is RNA hepevirus (Enteric, Expectant mothers, Epidemic - waterborne)

245
Q

Hepatitis B serology

A

First HBsAg (incubation) w/ HBeAg=high transmission). Then high rise of Anti-HBc (core antibody, IgM -> IgG). Anti-HBe comes up = low transmission. Anti-HBs = immunity.

246
Q

Hepatitis A serology

A

Anti-HAV (IgM) is best for active HAV. IgG for prior vaccination or infection.

247
Q

Window period for Hep B?

A

Only Anti-HBe and Anti-HBc (IgM) shows up.

248
Q

Three structural HIV proteins

A

env (cleaved from gp160 -> gp120 [CD4+ DOCK] + gp41 [FUSION and entry, transmembrane glycoprotein]), gag (p24 capsid protein), pol (the RT, aspartate protease, and integrate)

249
Q

HIV binding and immunity

A

T-cells (CD4, CCR5early or CXCR4 late). Macrophages (CD4, CCR5). Homozygous CCR5 mut = immunity. Heterozygous = slower.

250
Q

How diagnosis HIV?

A

R/o test w/ ELISA (often falsely neg in first 1-2 months and falsely positive in babies born to infected mothers) Confirm with Western blot. PCR used to determine RNA viral load. AIDS <200 CD4+.

251
Q

AIDS with CD4<50

A

Meningitis (cryptococcus neoformans), CMV retinitis, MAC

252
Q

AIDS with CD4<100

A

Histoplasma (LG fever, cough, hepatospleno, tongue ulcer), Toxoplasma in brain; Plasma gut at 100%!

253
Q

AIDS with CD4<200

A

Cryptosporidium (chronic, watery diarrhea), PML (JC virus), PCP (Ground glass on imaging); Basline Crypt, PML, PCP danger

254
Q

HIV patient with vascular proliferation. Biopsy shows neutrophilic inflammation.

A

Neutrophilic = Bartonella henselae. Lymphocytic = HHV-8.

255
Q

Basic prion disease mech

A

Transmission of normal protein (alpha-helical) into Beta-pleated form

256
Q

After influenza, secondary bacterial pneumonia organisms

A

Strep pneumo, Staph aureus, Haemophilus influenzae

257
Q

Zidovudine

A

NRTI. Binds and inhibits mammalian cellular and mitochondrial DNA polymerases -> bone marrow suppression

258
Q

Rifampin

A

Inhibits bacterial DNA-dependent RNA polymerase

259
Q

Pneumonia in neonates (<4 weeks)

A

GBS, E.coli

260
Q

Pneumonia in children

A

Runts May Cough Chunky Sputum - RSV, Mycoplasma, Chlamydia trach, C. pneumo, Strep pneumo

261
Q

Pneumonia in adults <40

A

Mycoplasma, C. pneumonia, S. pneumonia

262
Q

Pneumonia in adults 40-65

A

Strep pneumo, H. flu, anaerobes (CBA), Viruses, Mycoplasma

263
Q

Pneumonia in elderly

A

Strep pneumo, influenza, anaerobes, H flu, Gram Neg rods

264
Q

Atypical pneumonia

A

Mycoplasma, Legionella, Chlamydia. A weird name: My Clam Legion!

265
Q

Postviral pneumonia

A

Staph, H flu, Strep pneumo

266
Q

Meningitis in <6 mo

A

E. coli, GBS, Listeria

267
Q

Meningitis in Children

A

Strep pneumo, N. meningitidis, H flu, Enterovirus

268
Q

Meningitis in adults

A

Strep pneumo, N. meningitidis, Enterovirus, HSV

269
Q

Meningitis in elderly

A

Strep pneumo, Gram neg rods, Listeria

270
Q

CSF in meningitis

A

Bacterial (high opening pressure, PMNs, high protein, low glucose). Viral (Normal/high pressure, high lymphs, normal/high protein, NORMAL sugar). Fungal/TB (high pressure, high lymphs, high protein, low sugar)

271
Q

Osteomyelitis - cause per RF

A

Baseline Staph. Sexually active N. gon. DM + IV = Pseudo + serratia. Sickle cell = salmonella. Prostethic = Staph aureus/epidermidis. Vertebral involvement = Potts. Cat/dog = Pasteurella.

272
Q

UTI w/ + urease

A

Klebsiella, Proteus

273
Q

Top UTI bugs

A

E. coli, Staph sapro, Klebs

274
Q

ToRCHeS

A

Toxo (cat, meat, chorio, hydro, intracranial calc), Rubella (resp droplets, PDA, cataracts, deafness, blueberry muffin), CMV (sexual contact, hearing loss, sz, petechial rash, blueberry muffin), HIV (sexual, recurrent infection and diarrhea), HSV-2 (skin or mucous, encephalitis, vesicular lesions), Syphilis (sexual, stillbirth, hydrops fetalis, Hutchinson, saddle, short maxilla, saber shins, VIII deaf)

275
Q

Coxsackievirus type A

A

Hand-foot-mouth; vesicular rash on palms and soles. Vesicles in oral mucosa

276
Q

Painful genital uncler w/ inguinal adenopathy

A

Chancroid = Haemophilus ducreyi; tx = azithro

277
Q

PID organisms

A

Chlamydia trachomatis (subacute) and N. gonorrhea (acute). Comps include salpingitis, endometritis, hydrosalpinx, tubo-ovarian abscess. Fitz-Hugh-Curtis syndrome = adhesions of peritoneum to LIVER.

278
Q

Hyperalminentation RF for what infection?

A

Candida

279
Q

Neutropenia –> infection?

A

Candida albicans (systemic), aspergillus

280
Q

Organ transplant -> infection?

A

CMV

281
Q

Hands and feet rash?

A

Coxsackie A, Treponema pallidum, Rickettsia ricketsii

282
Q

Most common organism associated with endocarditis in IV drug users?

A

Staph aureus. Tricuspid endocarditis

283
Q

Pen G,V - mech, use, tox, resistance

A

Binds penicillin-binding proteins (e.g. transpeptidase cross-linking of peptidoglyans), activate autloytic. Gram POS + N. meningitides and Treponema. Cidal for cocci and gram + rods and spirochetes. HS reaction, hemolytic anemia. Penicillinase can cleave Beta-lactam ring.

284
Q

Aminopencillins

A

Ampicillin, amoxicillin. HELPSSS kill enterococci. H flu, E coli, Listeria, Proteus, Salmonella, Shigella, entero. Hypersensitivity, rash, pseudomembranous colitis. Penicillinase.

285
Q

Pencillinase-resistant penicillins

A

Oxacillin, nafcillin, dicloxaxillin. Bulky R group blocks access of Beta-lactamase to ring. Use for Staph aureus except MRSA (altered penicillin bending protein). Hypersensitivity, interstitial NEPHRITIS.

286
Q

Antipseudomonals

A

Ticarcillin, piperacillin. Same mech as Pen. Susceptible to pencillinase so use with Beta-lactamase inhibitors. Hypersensitivity.

287
Q

Beta-lactamase inhibitors.

A

CAST = Clavulanic Acid, Sulbactam, Tazobactam. The CaST for Betas has been set.

288
Q

Cephalosporin coverage?

A

1st - PECK (Proteus, E coli, Klebs)..2nd - HEN PEcKS (H flu, Enterobacter, Neisseria, Klebs, Serratia)..Don’t cover LAME - Listeria, Atypicals, MRSA, and Enterococci

289
Q

Cephalosporin names

A

1st - cefazolin, cephalexin. 2nd - cefoxitin, cefaclor, cefuroxime. 3rd - ceftriaxone, cefotaxime, ceftazidime. 4th - cefepime (better against Pseudo and gram+). 5th - ceftaroline (broad + MRSA but NOT pseudo).

290
Q

Aztreonam

A

Monobactam resistant to Beta-lactamases. Synergistic w/ aminoglycosides. Only gram-NEG rods.

291
Q

Carbapenems

A

Imipenem, meropenem, ertapenem, doripenem. Always administerd with CILASTATIN (inhibitor of renal dehydropeptidase I) to dec. inactivation. Gram POS cocci, Gram-NEG rods, and anearobes. SE’s = GI, skin rash, Seizures

292
Q

Vanc usage and tox

A

Gram + ONLY (MRSA, enterococci, C. dificile). Tox = Nephro, oto, Thrombophlebitis, flushing.

293
Q

Macrolide specific mech

A

Translocation (50S) by binding 23S rRNA. Static. Same with Clinda. MacroSLIDES

294
Q

Aminoglycosides

A

Gentamicin, Neomycin (abd surgery), Amikacin, Tobramcin, StreptoMYCIN. cidal. Inhibit INITiation -> misread mRNA.. Req O2 for uptake! Severe Gram-NEG rod, synergistic w/ beta-lactam. Nephrotox, Neuromuscular, Ototox, Teratogen. Resistant - bacterial transferase enzymes inactivate. Do NNOT MISREAD aminoGlycosides. Enterococci resistance via modifying enzymes that transfer chemical groups to drug (plasmids/transposons)

295
Q

Tetracyclines

A

t for TRNA binding. Tetracyclnine, doxycycline, minocycline. Stati. Doxy helpful for RENAL failure. No milk or antacids. Prisoner in cell plays tetris! Used for Borrelia, Mycoplasma, Ricketsia, Chlamydia. SE - Discolored teeth, GI, photosensitivity. NO preg. Resistance via dec. uptake or increased efflux.

296
Q

Macrolides

A

Azithromycin, clarithromycin, erythromycin. Use for atypical pneumonias (Mycoplasma, Chlamydia, Legionella), STD, Strep. Tox = MACRO = gi Motility, Arrhythmia by long QT, Cholestatic hepatitis, rash, Eosinophilia. Resistant via methylation of 23S rRNA.

297
Q

Chloramphenicol

A

Blocks 50S peptidyltransferase. Static. In the Rockies, we use Gray Clorox for Meningitis. Meningitis (H flu, N. men, Strep pneumo) and RMSF. Tox = anemia, asplastic anemia, gray-baby. Resist by plasma-encoded acetyltransferase to inactive.

298
Q

Clindamycin

A

Blocks translocation of 50S. Static. Use for Anaerobes ABOVE diaphragm (aspiration pneumonia, lung abscess, oral infection) + GAS. Tox = C. dif

299
Q

Sulfonamides

A

Sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine. Inhibits folate synthesis (dihydropteroate synthase). Used for gram +, gram -, Nocardia, Chlamydia. Tox - hypersensitivity, G6PD hemolysis, nephro, photo, kernicterus in infants, displace drugs(like warfarin) from albumin. Resi - altered enzyme, dec. uptake, or inc. PABA synthesis.

300
Q

Trimethoprim

A

Inhibits dihydrofolate reductase. Static. TMP-SMX used for sequential folate synthesis block for UTIs, Shigella, Salmonella, PCP, toxo ppx. Tox - Megaloblastic anemia, leikpenia, granulocytopenia.

301
Q

Fluoroquinolones

A

Ciprofloxacin, norfloxacin, levofloxacin, etc. Inhibits topo II and topo IV. Cidal. DONT TAKE with PPIs. Use for Gram-neg rodss of urinary and GI, Neisseria, some gram POS. Tendon rupture, leg cramps, myalgias. Contra = pregnant, nursing, children). Resist - chromosome-encoded mutation in DNA gyrase, plasma for efflux

302
Q

Metronidazole

A

Forms free radicals to damage DNA. Cidal, antiprotozoal. GET GAP on the Metro. Anaerobics BELOW diaphragm. Tox - disulfiram-like reaction w/ alcohol. HA, metallic.

303
Q

PPx for Mycobacterium tuberuclosis, avium, leprae.

A

INH, Azithro/rifabutin, N/A

304
Q

Tx for Mycobacterium tuberculosis, avium, leprae.

A

RIPE, Azithro/clarithro + ethambutol, dapsone + rifampin +/- clofazimine

305
Q

INH

A

Dec. synthesis of mycolic acid (NEEDS bacterial catalase-peroxidase). Tox = INH - injures neurons and hepatocytes.

306
Q

Rifamycins

A

Rifampin and rifabutin. Inhibits DNA-dependent RNA polymerase. 4 R’s = RNA pol inhibitors, Ramps up microsomal P450, Red/orange body fluids, Rapid resistance if alone, RifAMPin ramps up P450 BUT rifaBUTin does not.

307
Q

Pyrazinamide

A

? mech. May acidify intracellular. Tox - hyperuricemia, hepato

308
Q

Ethambutol

A

Blocks arabinosyltransferase -> decreases carbohydrate polymerization of mycobacterium wall. Tox = OPTIC NEURITIS

309
Q

Endocarditis ppx w/ dental

A

Penicillins

310
Q

Gonorrhea ppx

A

Ceftriaxone

311
Q

Hx of UTI ppx

A

TMP-SMX

312
Q

Meningococcal inf. ppx

A

Cipro or rifampin (children)

313
Q

GBS POS pregnant women ppx

A

Ampicillin

314
Q

Newborn conjuctivitis 2/2 gonococcal/chlamydial

A

Erythromycin

315
Q

Post surgical ppx against Staph

A

Cefazolin

316
Q

Syphilis ppx

A

Benzathine pen G

317
Q

HIV Ppx

A

CD4 Azithromycin ppx for Myobacterium avium

318
Q

Sterol pathway for antifungals

A

Squalene -(squalene epoxidase, terbanifine)-> squalene epoxide -> lanosterol -(14-alpha-demethylase, azoles)-> ergosterol -> membrane

319
Q

Amphotericin B

A

Binds ergosterol and forms membrane pores. For serious systemic mycoses (Cryptococcus, Blasto, Coccidio, Histo, Candida, Mucor). Intrathecal available. K+ and Mg+ sup. Tox = NEPHROTOX, fever, chills, hypotension, arrhythmias, anemia, IV phlebitis.

320
Q

Nystatin

A

Binds ergosterol and forms pores. Only TOPICAL.

321
Q

Azoles

A

Inhibits P450 enzyme (14-alpha-demethylase) that forms ergosterol. Fluconazole for cryptococcal meningitis ppx in AIDS. Itracon for Blasto, COccidio, HIsto. Tox - testosterone synthesis inhibition (esp keto), liver

322
Q

Flucytosine

A

Converts to 5-FU (thymidylate synthase inhibitor). Cryptococcus meningitis. Used w/ amphotericin B.

323
Q

Echinocandins

A

Caspofungin, micafungin, anidulafungin. Inhibits synthesis of Beta-glucan to prevent CELL WALL synthesis. Used for invasive aspergillosis and Candida. Tox - GI and flushing.

324
Q

Terbinafine

A

Inhibits SQUALENE EPOXIDASE. Used for dermatophytoses. tox - GI, HA, hepato, taste.

325
Q

Griseofulvin

A

Interferes with MT. Oral tx for superficial infections (tines, ringworm). Teratogenic, carcinogenic, confusion, HA.

326
Q

Chloroquine

A

Blocks detoxification of heme into hemozoin -> heme accumulation to kill plasmodia. Used for species other than falciparum b/c of resistant via membrane pump. Tox - retinopathy, pruritus.

327
Q

Neruaminidase inhibitors

A

Zanamivir, olsetamivir. For influenza A and B.

328
Q

Ribavirin

A

Converted to 5’ phosphate derivative and then INHIBITS viral mRNA Capping and BLOCKS RNA-dept RNA pol. Modulates better immune response via Th1. Used for RSV (bronchiolitis) and chronic HCV. Tox - SEVERE teratogen. hemolytic anemia.

329
Q

Guanosine analogs

A

Acyclovir, famciclovir, valacyclovir, and ganciclovir.

330
Q

HSV/VZV guanosine analogs

A

Acyclovir, famciclovir, valacyclovir. Phosphorylated by viral thymidine kinase but not cellular cells. Inhibits viral DNA pol by chain termination. HSV and VZV. Weak against EBV and none against CMV. No effect on latent forms. Tox - crystalline ephropathy. Res - mutated viral thymidine kinase.

331
Q

Ganciclovir

A

5’ monophosphate framed by CMV viral kinase, with triphosphate formed by cellular kinases. Inhibits viral DNA pol. Tox - leukopenia, neutropenia, thrombocytopenia, renal. Resist - mutated pol or lack of viral kinase.

332
Q

Foscarnet

A

A pyrophosphate derivative that reversibly inhibits viral DNA and RNA pols via chain elongation. Doesn’t require activation. Used for CMV retinitis, acyclovir resistant HSV. Nephrotoxic. Rest - mut viral pol.

333
Q

Cidofovir

A

viral DNA pol, no activation. CMV retinitis or acyclovir-resistant HSV. Nephrotoxicity (Req. probenecid and IV saline)

334
Q

HAART therapy

A

2 NRTIs + 1 NNRTI/1 PI/1 Integrase inhibitor. Initiated with AIDS-defining illness, low CD <500, or high viral load.

335
Q

Nucleoside reverse transcriptase inhibitors (NRTIs)

A

All nucleosides except tenofovir (nucleotide) that competitively inhibits binding to RT to terminate DNA chain (lacking 3’ OH group). ABC, ddl, FTC, 3TC, d4T, TDF, ZDV=AZT. Tox - bone marrow suppression reversed with G-CSF and EPO, peripheral neuropathy, lactic acidosis, rash, anemia (ZDV)

336
Q

Protease Inhibitors

A

NAVIR tease a protease. HIV-1 protease (pol gene) inhibitor. Tox - hyperglycemia, n/d, lipodystrophy (Steroid-like redistribution of fat - buffalo), nephro and hematuria (indinavir)

337
Q

NNRTIs

A

Efavirenz, Nevirapine, Delavirdine.

338
Q

Integrase inhibitors

A

Raltegravir. Tox - hyperchol.

339
Q

Fusion inhibitors.

A

Enfuvirtide binds gp41. Maraviroc binds CCR5 on Tcells to inhibit gp120 interaction.

340
Q

Necrotizing fasciitis microbes

A

Strep pyogenes, Staph aureus, Clostridium perfinges.

341
Q

Strongyloidiasis

A

Filariform (infectious) larvae in soil (fecal). Penetrate skin, hematogenous spread to lungs, travel up tree to pharynx, GI -> adults lay eggs in mucosa -> rhabditiform (non-infectious) larvae. Tx = ivermectin.

342
Q

Alcohol, chlorhexidine, hydrogen peroxide, and iodine

A

Etoh (disrupt membrane, denature proteins), Chlorhexidine (disrupt membrane,coag cytoplasm), hydrogen peroxide (free radicals that oxidize cell), iodine (halogenation of proteins and nucleic acids). Only last two are sporicidal.

343
Q

What HPV serotypes associated with anal and cervical squamous cell carcinoma?

A

16, 18, 31

344
Q

E. coli virulence factors

A

LPS (bacteremia and septic shock), K1 polysaccharide (neonatal meningitis), Shiga-like, HL/HS, P fimbrae (UTI)

345
Q

Gram negative rods, Non-fermenters, Oxidase Positive —> how differentiate?

A

TSI agar (Triple sugar iron) agar. No H2S production = Shigella. Yes H2S prod. (black) = Salmonella or Proteus. Salmon is Sulfur Smellier!

346
Q

Acinetobacter baumanii

A

Gram - rod. Non-LF. Catalase +. Hospitalized or immunodeficient. Pneumonia, UTI.

347
Q

Bacteroides fragilis

A

Gram NEG anaerobic rod. Normal GI flora can cause abdominal abscess (e.g. recent surgery). Tx = Metro or Pip-Taz

348
Q

Reassortment vs. Recombination

A

Reassortment = changes in genomic composition during co-infection with two SEGMENTED viruses that exchange whole genome segments (e.g. influenza). Recombination = exchange of genes via crossing over between two viruses w/ NON-fragmented ds-DNA genomes. Phenotypic mixing is co-infection -> different nucleocapsid ONLY

349
Q

The most common cause of bacterial meningitis in all ages?

A

Strep pneumo = lancet-shaped Gram+ cocci in pairs (alpha, Opto sens)

350
Q

Only enveloped virus class that obtains its envelope from the nuclear membrane

A

Herpesviruses

351
Q

Staphylococcal Scalded Skin Syndrome (SSSS)

A

Staph species producing exfoliation exotoxin. Nikolsky’s sign (skin slippage w/ gentle pressure), epidermal necrolysis, fever, pain. Usu. infants and children.

352
Q

Inactivated influenza vaccine against?

A

Hemagglutinin Ag. Ab’s inhibit binding of hemagglutinin to sialyated receptors on host cell membrane to prevent endocytosis of live virus.

353
Q

Nasophryngitis, laryngotracheitis, and bronchiolitis etios?

A

Naso - Rhino, influenza, corona. Croup - parainfluenza. Bronchiolitis - RSV.

354
Q

Ototox abx

A

Aminoglycosides or vancomycine

355
Q

CBC should be checked for these abx

A

Chloramphenicol (aplastic anemia), dapsone (agranulocytosis), TMP-FMX (megaloblastic anemia)

356
Q

Optic neuritis causing abx?

A

Ethambutol

357
Q

Reactive arthritis

A

Reiter syndrome. “Can’t see, can’t pee, can’t climb a tree.” 80% HLA-B27. Chlamydia, Campy, Salmonella, Shigella, Yersinia inf. preceding by 2-6 weeks

358
Q

Only viruses capable of genetic shifts through reassortments?

A

Viruses with segmented genomes = orthomyxovirus (influenza), rotaviruses, bunyavirus

359
Q

Heat-killed bacteria vaccines?

A

Bordetella pertussis, Vibrio cholera, Yersinia pestis

360
Q

Recombinant bacterial outer surface protein vaccine?

A

Borrelia burgdorferi

361
Q

Inactivated toxin vaccines?

A

Corynebacterium diphtheria and Clostridium tetani

362
Q

Live attenuated vaccines?

A

BCG, Francisella tularensis, Salmonella typhi, flu (I think)

363
Q

Only RNA viruses that replicate in the nucleus?

A

Influenza (Orthomyxovirus) and Retroviruses like HIV

364
Q

Polysaccharide conjugated vaccines?

A

Strep pneumo, Neisseria meningitidis, H. flu. Carrier proteins include mutant nontoxic diptheria, tetanus toxoid, and N. meningitidis outer membrane protein complex

365
Q

Entecavir

A

Guanosine analog used for HBV infections.

366
Q

Lamivudine (is not Zidovudine)

A

Cytosine analog used for HBV DNA pol and HIV RT. Must be phosphorylated into triphosphate (active) form.

367
Q

Didanosine tox

A

Pancreatitis

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