Microbiology Flashcards Preview

FirstAID > Microbiology > Flashcards

Flashcards in Microbiology Deck (324):
1

Which part of the bacterial structure contains Beta-lactamases?

Periplasm = space between cytoplasmic membrane and peptidoglycan wall in gram (-) bacteria
*note: Beta-lactamases = hydrolytic enzymes, resistant to antibiotics

2

Which bacteria contain sterols, but have no cell wall?

Mycoplasma

3

Which bacteria has a cell wall/membrane with mycolic acid and a high lipid content?

Mycobacteria

4

Bugs that don't gram stain well?

"These Rascals May Microscopically Lack Color"
-Treponema (too thin)
-Rickettsia (intracellular)
-Mycobacteria (high lipid content in cell wall; need acid-fast stain)
-Mycoplasma (no cell wall)
-Legionella (mostly intracellular)
-Chlamydia (intracellular; and lacks muramic acid in cell wall)

5

Giemsa stain, stains:

-Borrelia
-Trypanosomes
-Chlamydia
-Plasmodium

6

PAS (periodic acid-Schiff): what structures does it stain? what's it used to dx?

"PAS the sugar" --> it stains glycogen and mucopolysaccharides!
--dx Whipple's disease (Tropheryma whippeli)

7

Ziehl-Neelson stain = carbol fushsin

stains acid-fast organisms (mycobacteria)

8

India ink--> what organism does it stain?

stains cryptococcus neoformas

9

silver stain:

-Fungi (ie pneumocystis)
-Legionella

10

chocolate agar with factors V (NAD+) and X (hematin)

H. influenza

11

Thayer-Martin/VPN media (Vancomycin, Polymyxin, Nystatin)

N. gonorrhea
-vancomycin --> inhibits gram +
-polymyxin --> inhibits gram -
-nystatin --> inhibits fungi

12

Bordet-Gengou agar (potato agar)

Bordetella pertussis

13

Lowenstein-Jensen agar

M. tuberculosis
--> takes 3-4 weeks to grow though! (can do acid-fast stain in mean time to help rule out...)

14

Eaton's agar

Mycoplasma pneumonia

15

pink colonies on MacConkey's agar

lactose-fermenters
*MacConkey's agar:
-biosalts and crystal violet--> inhibit gram +
-lactose--> only carb in agar
-neutral red stain--> lactose fermenters take up lactose and neutral red; form pink colonies

**non-pink growth on MacConkey's = gram (-), but not lactose fermenter

16

Tellurite plate, Loeffler's media

C. diphtheriae

17

Sabouraud's agar

Fungi

18

Obligate aerobes:

"Nagging Pests Must Breathe"
-Nocardia
-Pseudomonas
-Mycobacterium tuberculosis
-Bacillus

19

Obligate anaerobes:

"Can't Breathe Air"
-Clostridium
-Bacteroides
-Actinomyces

***Anaerobes lack catalase and/or superoxide dismutase, so susceptible to oxidative damage
***Aminoglycosides = ineffective against anaerobes!
***Treat anaerobes with:
-Metronidazole
-Clindamycin

20

Obligate intracellular bugs:

"stay inside (cells) when it's Really Cold"
-Rickettsia
-Chlamydia

21

Facultative intracellular bugs

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

22

bugs with a positive quellung rxn?
-who's at increased risk of infection with these organisms?

encapsulated bacteria:
*SHiN SKiS:
-S. pneumonia
-H. influenza
-Neisseria meningitidis
-Salmonella
-Klebsiella pneumonia
-group B strep

*asplenic pts --> increased risk of infection with encapsulated organisms

23

Catalase-positive organisms:
-which pts have recurrent infections with these organisms?

-S. aureus
-Serratia
-Pseudomonas
-Candida
-E. coli

*pts with chronic granulomatous disease (NADPH oxidase deficiency) have recurrent infections with these organisms

24

Urease-positive bugs

"K-PUNCH"
-Klebsiella
-Proteus
-Ureaplasma
-Nocardia
-Cryptococcus
-H. pylori

*Urease splits urea into ammonium, which binds Mg and P --> forms stones --> stones deposited in renal calyces

25

Protein A

S. aureus virulence factor; binds Fc region of Ig; prevents opsonization and phagocytosis

26

IgA protease

virulence factor of SHiN: S. pneumonia, H. influenza, Neisseria
--> enzyme that cleaves IgA in order to colonize respiratory mucosa

27

M protein

virulence factor of Group A Strep: helps prevent phagocytosis

*Note: antibodies to M protein enhance host defenses against GAS, but can give rise to Rheumatic fever...

28

Which 2 bacteria produce a toxin that inhibits protein synthesis by inactivating elongation factor, EF-2?

C. diphtheriae --> Diphtehria toxin
Pseudomonas aeruginosa --> Exotoxin A

29

Which 2 bacteria produce a toxin that inhibits protein synthesis by inactivating the 60S ribosome by cleaving rRNA?

Shigella --> Shiga toxin
EHEC (including O157:H7) --> Shiga-like toxin

30

List 5 bacteria that produce an ADP-ribosylating A-B toxin:

1) Corynebacterium diphtheriae
2) Pseduomonas aeruginosa
3) ETEC
4) Vibrio cholerae
5) Bordetella pertussis

***Mechanism: B-binding component binds host cell surface receptor, enabling endocytosis; A-active component attaches ADP-ribosyl to disrupt host cell proteins

31

Which 2 bacteria produce a heat stable toxin? What's the mechanism?

ETEC and Yersinia enterocolitica
*mechanism: increased cGMP --> decreased reabsorption of NaCl and H20 in gut --> increased fluid secretion

*note:
-ETEC --> watery diarrhea
-Yersinia --> bloody diarrhea

32

Which E. coli has a toxin that functions by the same mechanism as the cholera toxin? What's the mechanism?

ETEC - heat labile toxin
*mechanism: increased cAMP by permanently activating Gs --> increased Cl secretion in gut and H20 follows it --> so increased fluid secretion

33

Which bacteria has a toxin that mimics adenylate cyclase (toxin acts like the enzyme!)?

Bacillus anthracis: toxin= edema factor --> mimics adenylate cyclase --> increased cAMP --> increased fluid secretion

34

2 toxins produced by ETEC (enterotoxigenic E. coli) and their mechanisms?

-heat labile toxin: increases adenylate cylcase--> increased cAMP-->iincreased Cl secretion in gut --> increased H20 secretion
-heat stabile toxin: increases guanylate cyclase --> increased cGMP --> decreased reabsorption of NaCl and H20 in gut

35

Which 2 bacteria produce a toxin that cleaves SNARE protein required for neurotransmitter release (and thereby inhibit release of neurotransmitter)?

Clostridium tetani and Clostridium botulinum

36

Which bacterial toxin acts through this mechanism?
--> overactivates adenylate cyclase by inhibiting Gi--> increased cAMP --> thereby, impairs phagocytosis, permitting survival of microbe

Pertussis toxin (Bordatella pertussis)

37

Tetanospasmin toxin: which neurotransmitters does it affect and how? what are the manifestations?

-tetanospasmin prevents release of inhibitory neurotransmitters (GABA and glycine) --> get muscle rigidity and "lock jaw"

38

Botulinum toxin: which neurotransmitters does it affect and how? what are the manifestations?

botulinum toxin prevents the release of stimulatory (Ach) signals at neuromuscular junctions --> get flaccid paralysis, "floppy baby"

39

Which bacteria produces Alpha toxin/Lecithinase (degrades phophospolipids)

Clostridium perfringens
-degradation of phospholipids--> myonecrosis (gas gangrene) and hemolysis (double zone of hemolysis on blood agar)

40

Streptolysin O toxin: mechanism?

-Streptococcus pyogenes (Group A strep)
-toxin lyses RBCs, contributes to Beta-hemolysis
-ASO antibodies can be used to dx rheumatic fever

41

Which 2 organisms have superantigens? what are the toxins? superantigen mechanism?

-Group A strep (Strep pyogenes) --> Exotoxin A
-Staph aureus --> TSST-1 (toxic shock syndrome toxin)

*superantigens bind MCH II and TCR simultaneously to stimulate a huge release of IL-2 and IFN-gamma --> results in shock; both can cause toxic shock syndrome (fever, rash, shock)

42

bacterial "competence"
-which bacteria are "competent?

competence = ability to take up DNA from environment = transformation (in bacterial genetics)
-many bacteria can undergo transformation, but especially common in SHiN (S. pneum, H. infl, Neisseria)

43

Conjugation: (F+ X F-) vs (Hfr X F-)?

(F+ X F-): only plasmid DNA can be transferred this way
(Hfr X F-): Transfer of plasmid AND chromosomal genes (because F+ plasmid can become incorporated into bacterial chromosomal DNA --> "Hfr cell"

44

Transduction:

bacterial genetic term --> spread of bacterial DNA via lytic ("generalized transduction") or lysogenic ("specialized transduction") bacteriophage (virus that infects bacteria)

45

What makes MRSA resistant to Beta-lactams?

Altered penicillin-binding protein

46

rusty sputum

pneumococcus! (strep pneumonia)

47

Strep pneumonia = most common cause of:

-Meningitis
-Otitis media (in kids)
-Pneumonia
-Sinusitis

48

Bacteria that causes acute bacterial endocarditis?

Staph aureus

49

Bacteria that causes subactue bacterial endocarditis at damaged valves?

-Strep sanguis (viridans group strep)
(think of the sanguinistas in true blood :))

50

strawberry tongue

Scarlet fever --> toxigenic effect of group A strep

51

about 15% of colon cancer pts are colonized by which strep?

strep bovis (group D strep)

52

ABCDEFG of Corynebacterium diphtheriae

ADP ribosylation
Beta-prophage (encodes exotoxin)
Corynebacterium
Diphtheria
Elongation
Factor 2
Granules (dx by gram + rods with metachromatic -blue and red- granules)

*exotoxin encoded by a beta-prophage--> exotoxin inhibits protein synthesis via ADP ribosylation of EF2

53

Spore-forming bacteria:

certain gram + rods:
*main ones:
-Bacillus anthracis
-Clostridium perfringens
-Clostridium tetani

*also:
-Bacillus cereus
-Clostrium botulinum
-Coxiella burnetti

54

Prevents glycine and GABA and glycine release from Renshaw cells in spinal cord?

Tetanospasmin (Clostridium tetani toxin) --> blocks inhibitory neurotransmitters, so causes spastic paralysis, trismus (lockjaw) and risus sardonicus

55

Treatment of C. difficile?

metronidazole or oral vancomycin (only case in which vancomycin is given orally!)

56

2 toxins produced by C. difficile, and how do they act?

Toxin A = enterotoxin: binds brush border of gut
Toxin B = cytotoxin: destroys cytoskeletal structure of enterocytes, causing necrosis of colon epithelium = pseudomembranous colitis

57

Only bacterium with a polypeptide capsule (that contains D-glutamate)?

Bacillus anthracis

58

move from cell to cell via "actin rockets"; bacteria is acquired by ingestion of unpasteurized milk/cheese and deli meats, or by vaginal transmission during birth

Listeria monocytogenes

59

treatment of actinomyces vs nocardia?

"ooooh SNAP!"
-Sulfa for Nocardia
-Actinomyces - use Penicillin

60

Langhans giant cells --> see multiple peripheral nuclei organized in the shape of a horseshoe

characteristic of TB caseating granulomas

61

Extrapulmonary tuberculosis:

-CNS--> tuberculoma or meningitis
-Pott's disease in vertebral bodies
-lymphadenitis
-renal
-GI

62

Ghon complex =

-TB granulomas
= Ghon focus (calcified scar, usually in lower lobes) + lobar and perhilar lymph node involvement; reflects primary infection or exposure

63

Mycobacterium kansasii

pulmonary TB-like symptoms; more common in pts with COPD (chronic bronchitis or emphesyma)

64

Prophylactic treatment for Mycobacterium avium-intracellulare?

-Azithromycin
-->MAI is often resistant to many drugs; causes disseminated disease in AIDS pts.

65

Reservoir in US is armadillos?

Mycobacterium leprae (Leprosy = Hansen's disease)

66

Treatment for leprosy?

-long term oral Dapsone (but, toxicity = hemolysis and methemoglobinemia)
-alternatively: rifampin, or combination of clofazimine and dapsone

67

Lactose-fermenting bacteria (grow pink on MacConkey's agar)...

macConKEES or CEEKS:
-Citrobacter
-Klebsiella
-E. coli
-Enterobacter
-Serratia

*note: E. coli produces Beta-galactosidase--> breaks lactose into glucose and galactose!

68

Which class of bacteria are resistant to Penicillin G (or rather, which class can Penicillin G be used to treat)?

Gram (-) bacilli are resistant to Penicillin G (but, may be susceptible to penicillin derivatives)
Penicllin G and V are mostly used to treat gram (+) organsims, and syphilis!

69

Fitz-Hugh-Curtis syndrome

caused by N gonorrhea
-->stars in lower genital tract, ascends through upper genital tract, ultimately infects liver capsule

70

Treatment for N. gonorrhea?

ceftriaxone

71

Waterhouse-Friderichsen syndrome

caused by N. meningitidis
-->adrenal hemorrhage --> adrenal insufficiency --> hypotension + DIC + electrolyte abnormalities

72

Prophylaxis and treatment for N. meningitidis?

-Vaccine available (not for type B)
-Rifampin prophylaxis in close contacts
-Treatment: ceftriaxone or penicillin G

73

Why can H. influenza be grown with Staph aureus?

H. infl requires Factors V (NAD+) and X (hematin) for growth; S. aureus provides factor V!

74

Prophylaxis for H. influenza?
Treatment for meningitis caused by H. infl?

-Vaccine: type B capsular polysaccharide conjugated to diphtheria toxoid or other protein
-Prophylaxis in close contacts: Rifampin
-Treatment for meningitis: Ceftriaxone

75

Legionnaires disease vs Pontiac fever?

Both caused by Legionella pneumophila
-Legionnaires' disease = severe pneumonia and fever
-Pontiac fever - mild flu-like syndrome

***suspect Legionella in pts with recent exposure to contaminated water (ie cruise ship, hotel, etc...)

76

pt with Cystic Fibrosis + Pneumonia?

Pseudomonas

77

PSEUDOM of pseudomonas (presentations):

-Pneumonia (especially in cystic fibrosis pts)
-Sepsis (black lesions on skin--> ecthyma gangrenosum = cutaneous necrotic disease, common in imm-compromised pts)
-External otitis (swimmer's ear)
-UTI
-Drug use endocarditis and Diabetic Osteomyelitis
-Malignant otitis externa in diabetics
-->also: hot tub folliculits

-assoc with wound and burn infections
-water source
-produces pyocyanin = blue-green pigment
-grapelike odor

78

Treatment for Pseudomonas?

Aminoglycoside + extended-spectrum penicillin (ie piperacillin or ticarcillin)

79

E. coli virulence factors: What do they cause?
-Fimbriae?
-K capsule?
-LPS?

Fimbriae -->cystitis and pyelonephritis
K capsule --> pneumonia, neonatal meningitis
LPS --> septic shock

80

Anemia + Thrombocytopenia + Acute Renal Failure?

HUS = hemolytic uremic syndrome (EHEC O157:H7)

81

Which E. coli strain is the only one that does not ferment sorbitol?

EHEC

82

Which E. coli strains cause bloody diarrhea?

EIEC and EHEC

83

Which E. coli strain normally causes diarrhea in children?

EPEC (P for pediatrics :))--> doesn't produce toxin; adheres to apical surface, flattens villi, prevents absorption

84

Which E. coli strains produce a toxin (and what toxin is it?) Which do not produce toxin?

EIEC --> no toxin
ETEC --> heat labile and heat staible toxins
EPEC --> no toxin
EHEC --> shiga-like toxin

85

Which antibiotic should be used to treat Salmonella?

TRICK QUESTION! Do not treat Salmonella with antibiotics; antibiotics may prolong symptoms!

86

Osteomyelitis in a sickle cell patient?

Think Salmonella!

87

spots on abdomen + fever + headache + diarrhea?

Salmonella typhi (rose spots on abdomen)

88

Which is more virulent: Shigella or Salmonella?

Shigella is more virulent --> only takes
10^1 organisms for infection, vs Salmonella --> takes 10^5 organisms!

89

Which bacterial infection is associated with Reiter's syndrome/Reactive arthritis?

-Shigella flexneri
-Chlamydia

90

Causes mesenteric adenitis (which may mimc Crohn's or appendicitis)?

Yersinia enterocolitica! (transmitted from pet fecies, contaminated milk, pork; outbreaks of diarrhea in daycare centers...)

91

Triple therapy for H. pylori treatment:

1) PPI
2) Clarithromycin (macrolide)
3) Amoxicillin or Metronidazole

***Quadruple Therapy:
-Bismuth salicylate
-Metronidazole
-PPI
-Tetracylcine

92

flulike symptoms, jaundice, and photophobia with conjunctivitis, in person who was in contact with animal urine?

Leptospirosis (Leptospira interrogans)

--> severe form = Weil's disease

93

Weil's disease

=Icterohemorrhagic Leptospirosis
--> severe form of Leptospirosis (Leptospira interrogans): jaundice and azotemia (from liver and kidney dysfxn); fever, hemorrhage, anemia

94

water contaminated with animal urine? Think:

-Leptospira
-Hantavirus

95

Ixodes tick

vector for:
-Lyme disease (Borrelia burgdorferi)
-Babesia

96

3 stages of lyme disease:

"BAKE a key Lyme pie!" (Bell's palsy, Arthritis, Kardiac block, Erythema migrans)

Stage 1: erythema chronicum migrans (bull's eye rash), flu-like symptoms
Stage 2: Neurologic (bilateral or unilateral Bell's palsy) and Cardiac (AV nodal block) manifestations
Stage 3: chronic monarthritis and migratory polyarthritis

97

Treatment for Lyme disease: at early stages (1 and 2)? Later disease?

Doxycycline --> for early stages
Ceftriaxone --> later disease

98

Treatment of choice for Syphilis?

Penicillin G!

99

primary syphilis:

painless chancre (localized)

100

secondary syphylis:

(secondary = systemic) disseminated disease with constitutional symptoms
-maculopapular rash (palms and soles)
-condyloma lata
-visualize treponemes from chancres and condyloma lata by darkfield microscopy

101

tertiary syphilis

-gummas (chronic granulomas)
-aortitis (VASO VASORUM DESTRUCTION!)
-neurosyphilis = tabes dorsalis
-Argyll Robertson pupil
-Signs: ataxia, + Romberg, Charcot joint, stroke but no HTN

102

FTA-ABS

test used to confirm syphilis (screening test = VDRL)

103

CN VIII deafness in a neonate?

Congenital syphilis (other signs = saber shins (ant bowing of tibia), saddle nose (flat nasal bridge), Hutchinson's teetch (notching of upper incisors), mulberry molars)

104

What may cause a false positive VDRL (screening test for syphilis)?

Viruses (mono, hepatitis)
Drugs
Rheumatic fever
Lupus and Leprosy

*note: VDRL detects a nonspecific antibody that reacts with beef cardiolipin
*can confirm dx of syphilis with FTA-ABS

105

Transmitted by lice/louses?

Borrelia recurrentis and Rickettsia rickettsii

106

Transmitted by spores from tick feces and cattle placenta?

Coxiella burnetti --> causes Q fever

107

transmitted by animal/cat/dog bites? symptoms?

Pasteurella multocida --> cellulitis, osteomyelitis

108

Transmitted by fleas?

Rickettsia typhi, Yersinia pestis (Yersinia is also transmitted by rodents, prairie dogs...)

109

Treatment for all Rickettsial diseases?

Doxycycline

110

Headache + Fever + Rash that starts on palms and soles?

Rickettsia rickettsii = Rocky Mountain spotted fever (transmitted by tick)

111

Headache + Fever + Rash that starts centrally and spreads outward without involving palms or soles?

Rickettsia typhi = Rickettsia prowazekii (transmitted by louse) --> "Typhus on Trunk"

112

Q fever

-presents as pneumonia
-caused by Coxiella burnetti (part of Rickettsia)
*"Queer" b/c:
-no rash
-no vector (transmitted by inhaling aerosoles from ticks feces or cattle placenta)
-negative Weil-Felix
-no "Rickettsia" in genus name

113

Weil-Felix Reaction

DX Rickettsia (not Coxiella though)--> mix pt's serum (with anti-Rickettsial antibodies) with Proteus antigens --> antirickettsial antibodies cross-react to Proteus O antigens and agglutinate

114

Cytoplasmic inclusions seen on Giemsa or Fluorescent antibody-stained smear

Lab dx for Chlamydia

115

Treatment for Chlamydia?

-1st line = Azithromycin
-Or: Doxycyline

116

Chlamydia: What is associated with each types:
-A, B, C:
-D-K:
-L1, L2, L3

-A, B, C: blindness in Africa, chronic infection
-D-K: urethritis, PID, ectopic pregnancy, neonatal pneumonia, neonatal conjuctivitis
-L1, L2, L3: lymphogranuloma venereum (acute lymphadenitis)

117

3 main organisms that cause interstitial/atypical/walking pneumonia?

*Chlamydia pneumonia
*Mycoplasma pneumonia (most common)
*Legionella pneumophila

118

RBC agglutination or lysis in cold temperatures?

Mycoplasma pneumonia --> cold agglutinins (IgM)
--> this happens b/c Mycoplasma pneumonia shares antigens with human RBCs, so when body mounts a response against antigens, it also lyses RBCs, leading to anemia; antibodies that cause this RBC destruction = cold agglutinins

119

only bacterial membrane that contains cholesterol?

Mycoplasma pneumonia

120

Treatment for Mycoplasma pneumonia?

tetracycline or erythromycin

121

5 Infections associated with birds:

1) Histoplasmosis --> pneumonia
2) Cryptococcus --> meningitis in AIDS pts
3) Chlamydia psittaci --> atypical pneumonia
4) Avian influenza
5) West Nile Virus

122

Exotoxin A

2 organisms have an exotoxin A:
-Pseudomonas (similar to diphtheria toxin, inactivates EF2)
-Group A Strep (similar to TSST1of Staph aureus --> superantigen, causes shock)

*note: there's also an alpha toxin (lecithinase) that Clostridium perfringens has...

123

Pneumonia, after pt was in:
1) Mississippi or Ohio river valleys
2) States east of Mississippi River and Central America
3) Southwestern US, California
4) Latin America

1) Histoplasmosis
2) Blastomycosis
3) Coccicidomycosis
4) Paracoccidioidomycosis

124

Dimorphic fungi: List them. What do they all cause? What makes them dimorphic?

-all cause pneumonia and can disseminate
-dimorphic: mold in cold (20 degrees); yeast in heat (37 degrees); exception = coccidiomycoides = spherule (not yeast) in tissue
-Includes:
1) Histoplasmosis
2) Blastomycosis
3) Coccidioidomycosis
4) Paracoccidioidomycosis

125

pneumonia-causing fungi that forms spherules filled with endospores in tissues (much larger than RBCs)

Coccidioidomycosis

126

meningitis, pneumonia, and dissemination to bone and skin following an earthquake?

Coccidioidomycosis

127

Budding yeast with "captain's wheel" appearance?

Paracoccidioidomycosis

128

spaghetti and meatball appearance on KOH prep

Tinear versicolor (caused by Malassezia furfur); degrades lipids and produces acids that damage melanocytes --> so get hypopigmented and/or hyperpigmented patches

129

Dimorphic yeast: pseduohyphae and budding yeasts at 20 C; germ tubes at 37 C

Candida albicans

130

Branching septate hyphae that branch at acute angles, not dimorphic. Get a "fungus ball"

Aspergillus fumigatus (especially in immunocompromised pts or pts with Chronic granulomatous disease)

131

Heavily encapsulated yeast (budding yeast form only); have wide capsular halos and unequal budding

Cryptococcus

132

Meningitis in AIDS pt?

Cryptococcus

133

"soap bubble" lesions in brain?

Cryptococcus

134

How do you culture Cryptococcus? Stain?

Culture on Sabourad's agar
Stain with India ink

135

nonseptate hyphae that branch at wide angles?

Mucor and Rhizopus species (Mucormycosis)

136

Fungus that causes a black necrotic eschar on face?

Mucor and Rhizopus

137

Fungus that penetrates cribriform plate and enter brain --> get frontal lobe abscesses, headache, facial pain, maybe cranial nerve involvement?

Mucor and Rhizopus

138

disk-shaped yeast on methenamine silver stain?

Pneumocystis jiroveci

139

When do you start PCP prophylaxis in HIV pt?

when CD4 < 200 cells/mm3

140

Dimophic, cigar-shaped budding yeast that causes ascending lymphangitis

Sporothrix schenckii = rose gardner's disease

141

Severe diarrhea in AIDS pt?

Cryptosporidium

142

infant born with triad of: chorioretinitis, hydrocephalus, intracranial calcifications?

congenital toxoplasmosis

143

transmission by Tsetse fly; painful bite

-Trypanosoma brucei (gambiense, rhodesiense); causing African sleeping sickness (enlarged lymph nodes, recurring fever, somnolence, coma)

144

Transmitted by Anopheles mosquito

Plasmodium (malaria)

145

When do you give Primaquine and why?

Give to pts with Plasmodium vivax/ovale --> because there's a dormant form that lives in liver (hypnozoite) that chloroquine/mefloquine can't get.

146

"maltese cross" on blood smear?

Babesiosis (transmitted by Ixodes tick, same as Lyme disease)

147

transmitted by Reduviid bug (painless bite)

Trypanosoma cruzi = Chaga's disease

148

Achalasia (dilated esophagus and absent peristalsis in esophagus), and dilated cardiomyopathy

Chagas disease (also may have megacolon)

149

spiking fevers, hepatosplenomegaly, pancytopenia; and "amastigotes" within macrophages?

visceral Leishmaniasis = "kala-azar

150

transmitted by sandfly?

Leishmaniosis

151

most common nematode infection in US?

Enterobius vermicularis = pinworm! test with scotch tape test (best!!)

152

1/3rd of world's popl is infected with this worm?

Ascaris lumbricoides = giant roundworm

153

Nematodes that can cause anemia?

Ancylostoma, Necator (hookworms)

154

Treatment for Intestinal nematode infections?

-bendazoles
-pyrantel pamoate

155

transmitted by female blackflies?

-Onchocerca volvulus

156

causes hyperpigmented skin and river blindness?

Onchocerca volvulus (blackflies, black skin, black visions)

157

Treatment for Onchocerca volvulus?

Ivermectin (for river blindness!)

158

can see worm crawling in conjunctiva?

Loa Loa

159

Elephantiasis (appears about 1 year post bite by mosquito)

Wuchereria bancrofti

160

Transmitted by eating larvae in pork: get cysticercosis and neurocysticercosis, mass lesions in brain (with swiss cheese appearanc) --> seizures, altered mental status, coma...

Taenia solium

161

Ingest larvae in raw freshwater fish; causes B12 deficiency

Diphyloobothrium latum

162

causes anaphylaxis if organism's antigens are released from cysts (so must kill daughter cysts before attempting to remove surgically)

Echinococcus granulosus

163

snails are the host

Schistosoma

164

inflammation of spleen and liver; can lead to squamous cell carcinoma of bladder

Schistosoma

165

Nematodes routes of infection:
-ingested?
-cutaneous?

Ingested: "EAT" these:
-Enterobius
-Ascaris
-Trichinella

Cutaneous: get into your feet through the "SANd"
-Strongyloides
-Ancylost`oma
-Necator

166

Parasite hint: brain cysts, seizures

Taenia solium (cysticercosis)

167

Parasite hint: liver cysts

Echinococcus granulosus

168

Parasite hint: B12 deficiency

Diphyllobothrium latum

169

Parasite hint: Biliary tract disease, cholangiocarcinoma

Clonorchis sinensis

170

Parasite hint: portal hypertension

schisto

171

Parasite hint: hematuria, bladder cancer

schisto

172

Parasite hint: perianal pruritus

Enterobius

173

Live-attenuated vaccines:

"Live! see Small Yellow Chickens get vaccinated with Sabin's and MMR!"
-smallpox
-yellow fever
-chickenpox (VZV)
-Sabin's (polio)
-MMR
*also: intranasal influenza vaccine

174

Killed vaccines:

"RIP Always":
-Rabies
-Influenza (intramuscular)
-Polio -- salk (SalK = Killed)
-HAV

175

Recombinant vaccines

HBV (recombinant HBsAg angtigen)
HPV (types 6, 11, 16, 18)

176

What HPV strains are in the vaccine?

6, 11, 16, 18

177

Only DNA virus that is ssDNA (the rest are dsDNA)

Parvovirus (part-of-a-virus)

178

Only RNA virus that is dsRNA (the rest are ssRNA!)

Reovirus ("repeat-o-virus")

179

All viruses are haploid (1 copy of DNA or RNA) except?

Retroviruses: have 2 identical ssRNAs

180

Where do DNA viruses replicate? exception?

Nucleus (except poxvirus replicates in cytoplasm)

181

Where do RNA viruses replicate? Exception?

Cytoplasm (except influenza virus and retroviruses --> in nucleus)

182

Naked/Non-enveloped viruses:

"Naked CPR and PAPP smears!" (PAPP=DNA; CPR = RNA)

-Calcivirus
-Picornavirus
-Reovirus
-Parvovirus
-Adenovirus
-Papilloma
-Polyoma

183

List the DNA viruses

DNA viruses are "HHAPPPPy!"
-Hepadnavirus
-Herpesvirus
-Adenovirus
-Parvovirus
-Poxvirus
-Polyomavirus
-Papillomavirus

184

General rules about DNA viruses (and exceptions):

All DNA viruses are:
-dsDNA (except Parvovirus)
-liner (except Polyoma, Papilloma, and Hepadna)
-icosahedral (except Pox)
-replicate in nucleus (except Pox)

185

Acute hemorrhagic cystitis (hematuria + dysuria), febrile pharyngitis

Adenovirus

186

Aplastic crisis in sickle cell pt?

Parvovirus B19

187

Progressive multifocal leukoencephalopathy (PML) in HIV pts?

JC virus (Polyomavirus)

188

flesh-colored dome lesions with central lesion; resolves on own (usually)

molluscum contagiosum (poxvirus)

189

Where are these herpesviruses latent?:
-HSV1
-HSV2
-VZV
-EBV
-CMV

*HSV1--> trigeminal ganglia
*HSV2 --> sacral ganglia (S2 and S3)
*VZV --> trigeminal or dorsal root ganglia
*EBV--> B cells
*CMV --> mononuclear cells

190

Cancers associated with EBV?

-Burkitt's lymphoma, Hodgkin's lymphoma
-Nasopharyngeal carcinoma

191

Roseola

HHV-6 "sixth disease"
--> high fevers for several days, followed by diffuse macular rash

192

What are the atypical lymphocytes in EBV?

NOT infected B cells! They're activated CD8+ cytotoxic T-cells--> "Downy cells" with foamy cytoplasm

193

Which HPV strains are associated with warts? CIN, cervical cancer?

Warts: 1, 2, 6, 11
CIN/Cervical cancer: 16, 18

194

#1 cause of fatal diarrhea in kids? (fatal by dehydration)

Rotavirus (a Reovirus)

195

List the Picornaviruses:

"PERCH"
Poliovirus
Echovirus
Rhinovirus
Coxsackievirus
Hep A virus

196

Norwalk virus

A calcivirus
--> viral gastroenteritis

197

List the Flaviviruses:

HCV
Yellow Fever
Dengue
St. Louis encephalitis
West Nile virus
(all are arboviruses, except for HCV)

198

List the Togaviruses:

Rubella (German measles)
Eastern equine encephalitis
Western equine encephalitis

199

What does Coronavirus cause?

-Common Cold
-SARS

200

Influenza virus is part of what viral family?

Orthomyoxvirus

201

Paramyxoviruses

Parainfluenza = croup
RSV--> bronchiolitis in babies
Rubeola = Measles
Mumps

202

Negative-stranded viruses:

have to transcripe (-) strand to (+); so, bring their own RNA-dep-RNA-pol. Includes: "Always Bring Polymerase Or Fail Replication"
-Arenaviruses
-Bunyaviruses
-Paramyxoviruses
-Orthomyxoviruses
-Filoviruses
-Rhabdoviruses

203

Segmented viruses:

"BOAR"
-Bunyaviruses
-Orthomyxoviruses (influenza!)
-Arenaviruses
-Reoviruses

204

Most common cause of viral aseptic meningitis?

Enteroviruses (the Picornaviruses, minus Rhinovirus; specifically: Echovirus and Coxsackievirus)

205

Which part of spinal cord does poliovirus affect?

Affects MOTOR neurons of the ANTERIOR horn; causes paralysis

206

Transmitted by the Aedes mosquito?

Yellow Fever virus (a Flavivirus)

207

High fever + black vomitus (coffee-ground emesis) + Jaundice + red tongue with white center

Yellow Fever (Flavivirus, transmitted by Aedes mosquito)
--> black vomitus is from GI bleeding

208

How does Rotavirus lead to diarrhea?

Villous destruction with atrophy, leads to decreased absorption of Na+ and H2O
--> it's fatal by dehydration

209

Hemagglutinin and Neuraminidase

Influenza antigens:
-HA--> promotes viral entry
-NA--> promotes progeny virion release

210

F (fusion) protein

Surface protein of Paramyxoviruses --> causes respiratory epithelial cells to fuse and form multinucleated giant cells
--> Palivizumab = monoclonal antibody against F protein; prevents pneumonia in premature infants

211

Low-pitched cough vs High-pitched cough

Low-pitched --> Seal-like barking cough = Croup = Paraifluenza

High-pitched --> RSV

212

Palivizumab

monoclonal antibody against the F protein of Paramyxoviruses; given to premature infants to prevent pneumonia from RSV

213

Cough + Coryza (nasal, cold symptoms) + Conjunctivitis

Measles

214

Mumps causes:

"POM"
-Parotitis
-Orchitis
-aseptic Meningitis

--> may lead to infertility after puberty

215

cytoplasmic inclusions in Purkinje cells of cerebellum

Negri bodies of Rabies (commonly found in Purkinje cells of cerebellum)

216

virus travels to CNS by migrating in a retrograde fashion up nerve axons

Rabies virus

217

What kind of Polymerase does HBV carry?

DNA-dep-DNA-pol

218

HBsAg

Hepatitis B infection

219

anti-HBsAg

immunity to Hep B (vaccine or recovered from disease)

220

HBeAg

active viral replication; high transmissibility

221

anti-HBeAg

low transmissibility

222

HBcAg

can't see this in serum; but, indicates new disease

223

anti-HBcAg: IgM? IgG?

IgM --> acute/recent infection
IgG --> chronic disease
*Positive during window period
*not present if vaccinated; only if have/had disease

224

ALT:AST in viral hepatitis? alcholic hepatitis?

alcoholic hepatitis: AST>ALT
viral hepatitis: ALT>AST

225

HIV envelope proteins:

gp120 and gp41: acquired from budding through host cell plasma membrane:

gp120--> attachment to host cell; "docking glycoprotein"
gp41--> fusion and entry; transmembrane glycoprotein

226

HIV capsid protein

gag (p24)

227

HIV pol protein:

Reverse transcriptase (synthesizes dsDNA from RNA)

228

What does HIV bind on T-cells? on macrophages?

T-cells: HIV binds CXCR4 or CCR5 co-receptor and CD4
Macrophages: CCR5 and CD4

229

Why do ELISA/Western blot tests often give false-positives in babies born to HIV-infected mothers?

Because anti-gp120 can cross the placenta

230

HIV diagnosis: Which test is initially used? Then which test is used to confirm positive results?

1) ELISA --> high false positive rate (high sensitivity, low specificity; "Rule out" test)
2) Western blot assay (high false negative rate; high specificity, low sensitivity; "rule in" test)

231

3 ways to dx AIDS:

1) CD4 < or = 200
2) AIDS indicator condition in HIV + pt: ie PCP
3) CD4/CD8 ratio < 1.5

232

chronic watery diarrhea in AIDS pt

Cryptosporidium (see acid-fast cysts in stool, esp when CD4<200)

233

Encephalopathy in AIDS pt

JC virus reactivation (get demyelination)

234

Neuro Abscesses in AIDS pt

Toxoplasmosis (ring-enhancing lesions; CD4<100)

235

Meningitis in AIDS pt

Cryptococcus (may also cause encephalitis; india ink stain --> see yeast with narrow-based budding and large capsule; CD4<50)

236

Retinitis in AIDS pt

CMV (cotton-wool spots on funduscopic exam; may also have esophagitis; CD4<50)

237

Dementia in AIDS pt

Directly associated with HIV; but, rule out other causes

238

AIDS pt with superficial vascular proliferation: Biopsy shows neutrophilic inflammation? lymphocytic inflammation?

*Neutrophilic inflammation --> "Bacillary angiomatosis" --> Bartonella henselae
*Lymphocytic inflammation --> HHV-8 = Kaposi's sarcoma

239

low fevers, cough, hepatosplenomegaly, tongue ulcer (basically, systemic disease) in AIDS pt?

Histoplasmosis (see oval yeast cells within macrophages)

240

Hairy leukoplakia (white stuff on lateral part of tongue) in AIDS pt

EBV

241

Primary CNS lymphoma in AIDS pt

EBV

242

Interstitial pneumonia (with intranuclear inclusion bodies on biopsy) or regular pneumonia (esp with CD4<200) in AIDS pts?

*Interstitial pneumonia with owl's eye inclusion bodies --> CMV
*Pneumonia with CD4 PCP

243

Pleuritic pain, Hemoptysis, infiltrates on imaging in AIDS pt

Invasive Aspergillosis

244

TB-like disease in AIDS pts (esp CD4<50)

Mycobacterium Avium - Intracellulare

245

3 bugs that can cause mesenteric adenitis (so may mimic appendicitis):

-Yersinia enterocolitica
-Campylobacter
-non-typhoidal Salmonella

246

Bloody Diarrhea...

is SEEECSY!
-Salmonella
-EHEC
-EIEC
-Entamoeba
-Campylobacter
-Shigella
-Yersinia

247

Causes of watery diarrhea?

-ETEC
-C. diff
-C. perfringens
-Cholera
-Protozoa: Giardia and Cryptosporidium (in imm-compromised)
-Viruses: Rotavirus, Adenovirus, Norwalk virus

248

3 main causes of atypical pneumonia:

-Mycoplasma
-Legionella
-Chlamydia

249

Cause of osteomyelitis in most pts?

S. aureus

250

Cause of vertebral osteomyelitis?

M. tb (Pott's disease)

251

Cause of osteomyelitis in Sickle cell pt?

Salmonella

252

Elderly pt with delirium?

UTI or anti-cholinergic drugs side effects

253

Positive nitrite test

Specific for gram (-) bacterial UTI

254

Positive leukocyte esterase test

non-specific for bacterial UTI

255

UTI -causing bug; motile, so "swarms" on agar; produces urease, and associated with struvite stones

Proteus

256

Hydrops fetalis in utero cause?

Parvovirus B19

257

neonate with chorioretinitis + hydrocephalus + intracranial calcifications?

congenital Toxoplasma

258

Neonate with PDA (or pulmonary artery hypoplasia) + cataracts + deafness +/- "blueberry muffin" rash (purpura d/t thrombocytopenia)

congenital Rubella

259

Neonate with unliateral hearing loss + seizures + petechial rash + "blueberry muffin" rash

congenital CMV

260

Neonate with temporal encephalitis and vesicular lesions

congenital HSV-2

261

often results in stillbirth, hydrops fetalis; if infant is born: facial abnormalities, CN VIII deafness, teeth issues... etc...

congenital Syphilis

262

Rubella, Rubeola, Roseola

*Rubella = "German measles" --> rash begins at head and moves down; have a truncal rash; post-auricular lymphadenopathy

*Rubeola = Measles --> first: cough, coryz, conjunctivitis, Koplik spots on tongue; then: rash starts at head and moves down

*Roseola = HHV-6: macular rash over body after several days of high fever; usually in infants

263

Erythematous, sandpaper-like rash with fever and sore throat

Scarlet Fever (GAS)

264

vesicular rash on palms and soles; ulcers in mouth

Hand-Foot-Mouth disease (Coxsackie A virus)

265

strawberry-colored cervical mucosa, corkscrew motility on wet prep, vaginitis

Trichomoniasis

266

Koilocytes

look like fried eggs! (squamous cells with perinuclear cytoplasmic clearing)
--> HPV 6 and 11

267

Most common bacterial STD in US?

Chlamydia trachomatosis

268

Antibiotics/anti-microbials that should NOT be taken during pregnancy:

"Countless SAFe Moms Take Really Good Care"
-Clarithromycin
-Sulfonamides --> kernicterus
-Aminoglycosides --> ototoxicity
-Fluoroquinolones --> cartilage damage
-Metronidazole --> mutagenesis
-Tetracyclines --> discolored teeth, inhibition of bone growth
-Ribavirin (antiviral) --> teratogenic
-Griseofulvin (anti-fungal) --> teratogenic
-Chloramphenicol --> "gray baby"

269

Side effects: Hyperglycemia, Lipodystrophy (deposition of fat on back and abdomen), Nausea, Diarrhea

HIV: Protease inhibitors (all end in "-navir"

270

HIV drug that can cause nephrotoxicity and nephrolithiasis

Indinavir (protease inhibitor)

271

HIV drug that can cause pancreatitis

Ritonavir (protease inhibitor)

272

HIV drugs that lead to bone marrow suppression

NRTIs (nucleoside reverse transcriptase inhibitors) --> especially Zidovudine (ZDV), but all of them...

273

HIV drug that can cause megaloblastic anemia

ZDV (Zidovudine), a NRTI

274

Protease inhibitors mechanism:

Inhibit HIV-1-protease (pol gene) from cleaving the polypeptide products of HIV mRNA into functional parts, so can't assemble virions --> prevent maturation of new viruses

275

NRTIs vs NNRTIs

-NRTIs--> COMPETITIVELY inhibit nucleotide binding to reverse transcriptase; must be phosphorylated by thymidine kinase to be active

-NNRTIs --> NON-COMPETITIVELY bind to reverse transcriptase (site diff from NRTI's); don't need to be phosphorylate to be active.

276

Antimicrobial drugs that act on 50S ribosomal subunit to block protein synthesis:

-Chloramphenicol
-Macrolides
-Streptogramins
-Clindamycin
-Linezolid

277

Antimicrobials that block protein synthesis AT 30S ribosomal subunit?

-Aminoglycosides
-Tetracyclines

278

Vancomycin and Bacitracin mechanism?

-block peptidoglycan synthesis

279

Fluoroquinolone mechanism?

blocks DNA topoisomerase

280

Penicillin mechanism of action:

-block cell wall synthesis by inhibiting peptidoglycan cross-linking
-bind PBPs (penicillin-binding proteins)
-activate autoclytic enzymes

281

Penicillinase-Resistant Penicillins:
-list them
-why are they resistant to penicillinase (Beta-lactamase)?
-clinical use?

-Methicillin, Nafcillin, Dicloxacillin
-have a bulkier R group, so are resistant to penicillinase
-used to treat S. aureus (but, not MRSA, b/c altered penicillin-binding protein target site)

282

Clinical use for Aminopenicillins (Ampicillin and Amoxicillin):

"HELPSS kill Enterococci"
-H. influenza
-E. coli
-Listeria
-Proteus
-Salmonella
-Shigella
-Enterococci

283

Tibarcillin, Carbenicillin, Piperacillin

=Carboxypenicillins = anti-Pseudomonals
"Take Care of Pseudomonas"
-used to treat Pseudomonas!

284

Beta-lactamase inhibitors: CAST

-Clavulonic Acid
-Sulbactam
-Tazobactam

*can add to penicillinase-sensitive antibiotics to prevent destruction by Beta-lactamases (ie to aminopenicillins)

285

Beta-lactamase inhibitors: CAST

-Clavulonic Acid
-Sulbactam
-Tazobactam

*can add to penicillinase-sensitive antibiotics to prevent destruction by Beta-lactamases (ie to aminopenicillins)

286

Antimicrobials that block cell wall synthesis by inhibiting peptidoglycan cross-linking:

-Penicillin
-Methicillin
-Ampicillin
-Piperacillin
-Cephalosporins
-Aztreonam
-Imipenem

286

Antimicrobials that block cell wall synthesis by inhibiting peptidoglycan cross-linking:

-Penicillin
-Methicillin
-Ampicillin
-Piperacillin
-Cephalosporins
-Aztreonam
-Imipenem

287

Antimicrobials that block peptidoglycan synthesis

-Vancomyci
-Bacitracin

287

Antimicrobials that block peptidoglycan synthesis

-Vancomyci
-Bacitracin

288

Antimicrobial that blocks nucleotide synthesis

-sulfonamides
-trimethoprim

***given together at TMP-SMX

288

Antimicrobial that blocks nucleotide synthesis

-sulfonamides
-trimethoprim

***given together at TMP-SMX

289

Antimicrobial that blocks DNA topoisomerases

Fluoroquinolones
*contraindicated in pregnant women and kids, b/c may damage cartilage
*only exception = can give fluoroquinolones to kids with CF

289

Antimicrobial that blocks DNA topoisomerases

Fluoroquinolones
*contraindicated in pregnant women and kids, b/c may damage cartilage
*only exception = can give fluoroquinolones to kids with CF

290

Antimicrobial that blocks mRNA synthesis?

Rifampin

290

Antimicrobial that blocks mRNA synthesis?

Rifampin

291

Antimicrobial that damages DNA?

Metronidazole

291

Antimicrobial that damages DNA?

Metronidazole

292

Antimicrobials that block protein synthesis at the 50S ribosomal subunit? 30S subunit?

"but AT 30, CCEL at 50"

*30S subunit:
-Aminoglycosides
-Tetracyclines

*50S subunit:
-Chloramphenicol
-Clindamycin
-Erythromycin (macrolides)
-Linezolid

292

Antimicrobials that block protein synthesis at the 50S ribosomal subunit? 30S subunit?

"but AT 30, CCEL at 50"

*30S subunit:
-Aminoglycosides
-Tetracyclines

*50S subunit:
-Chloramphenicol
-Clindamycin
-Erythromycin (macrolides)
-Linezolid

293

Are cephalosporins bacteriostatic or bactericidal?

Bactericidal

294

Mechanism of Cephalosporins?

They're Beta-lactam drugs that inhibit bacterial cell wall synthesis (like Penicillin, by inhibiting peptidoglycan cross-linking), but less susceptible to penicillinases
-->Bactericidal

295

'Which organisms are NOT covered by cephalosporins?

"LAME" organisms:
-Listeria
-Atypicals (ie Mycoplasma, Chlamydia)
-MRSA
-Enterococci

296

Chlamydia treatment:

Azithromycin or Doxycycline

297

N. meningitis treatment?

Ceftriaxone or Penicillin G

298

Treatment for Pseudomonas:

-Aminoglycoside + extended spectrum penicillin (ie an anti-pseudomonal: Ticarcillin, Carbenicillin, Piperacillin)
--> can also treat with a 3rd gen cephalosporin (Ceftazidime) or 4th gen cephalosporin (Cefepime)

299

First generation cephalosporins coverage:

*gram (+) cocci
*"PEcK"
-Proteus
-E coli
-Klebsiella

300

Second generations cephalosporins coverage:

*gram (+) cocci
*"HEN PEcKS"
-H. influenza
-Enterobacter
-Neisseria
-Proteus
-E. coli
-Klebsiella
-Serratia

301

3rd generation cephalosporins coverage:

-serious gram (-) infections that are resistant to other Beta-lactams

*ceftriaxone: gonorrhea, meningitis, and late stage lyme disease (earlier, use doxycycline)

*ceftazidime: pseudomonas

302

4th generation cephalosporins coverage:

*increased activity against Pseudomonas and gram (+) organisms

303

Cefepime

4th generation cephalosporin; good for both gram (+) and gram (-) coverage
-->can be used to treat Pseudomonas

304

Ceftriaxone

3rd gen cephalosporin
-treats gonorrhea, meningitis, and late stage lyme disease

305

Ceftazidime

3rd gen cephalosporin
-can be used to treat Pseudomonas

306

Cefuroxime

2nd gen cephalosporin

307

Cefazolin

1st gen cephalosporin

308

cephalexin

1st gen cephalosporin

309

cefoxitin

2nd gen cephalosporin

310

cefaclor

2nd gen cephalosporin

311

cefotaxime

3rd gen cephaolosporin

312

3 Cephalosporin toxicities:

-may cross react with penicillins

-increased nephrotoxicity when given with Aminoglycosides

-Disulfiram-like reaction when take with ethanol

313

Mechanism and Clinical uses of Aztreonam:

*mechanism: inhibits cell wall synthesis by binding to PBP and inhibiting peptidoglycan cross-linking

*Clinical uses:
-ONLY gram (-) rods
-->give to pts who are allergic to penicillins or pts who can't tolerate aminoglycosides (b/c renal insuficiency; b/c side effect of aminoglycosides = nephrotoxicy, and aminoglycosides also treat gram (-) rods)

314

Imipinem:

broad-spectrum antibiotic

***Always given with Cilistatin (to prevent inactivation of Imipinem in renal tubules)

***only used for severe life-threatening conditions or after failure of other drugs, b/c has bad side effects (GI, CNS toxicities--> seizures)

315

Drugs that binds D-ala D-ala on bacterial cell wall precursors?

Vancomycin

316

Clinical use of vancomycin?

Gram (+) ONLY!
-->including: MRSA, C. diff (oral dose), enterococci

317

Toxicites of Vancomycin:

"NOT the Red Man!"
-Nephrotoxicity
-Ototoxicity
-Thrombophlebitis
-Red man syndrome = diffuse flushing