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Flashcards in Microbiology Deck (454)
1

What is the toxic component of LPS?

Lipid A

2

What does the pilus/fimbria do and give an example

Mediates adherence of bacteria to cell surface as in meningococcus colonizing the pharyngeal surface

3

Bacteria with unusual cell membranes/walls

Mycoplasma - membrane contains sterols, no cell wall. Mycobacteria - contain mycolic acid, high lipid content

4

Bugs that do not gram stain well

These Rascals May Microscopically Lack Color. Treponema, Rickettsia, Mycobacteria, Mycoplasma, Legionella, Chlamydia

5

Stain for legionella

Silver stain

6

Organisms seen with giemsa stain

Borrelia, plasmodium, trypanosomes, chlamydia

7

Organisms seen with PAS stain

Stains glycogen and mucopolysaccharides. Use to diagnose Whipples disease

8

Organisms seen with silver stain

Fungi and legionella

9

Culture requirements of h flu

Chocolate agar. Factor V (NAD) and Factor X (hematin). If grown with staph they will provide the needed NAD

10

Culture requirements of n gonorrhoeae

Thayer-Martin (VPN). Vancomycin, Polymyxin, Nystatin. Or Vanco, Colistin, Nystatin, Trimethoprim

11

Culture requirements of b pertussis

Bordet-Gengou (potato) agar

12

Culture requirements of c diphtheriae

Tellurite plate, Lofflers media

13

Culture requirements of m tb

Lowenstein-Jensen agar

14

Culture requirements of m pneumoniae

Eatons agar

15

Culture requirements of lactose-fermenting enterics

Will be pink on MacConkey. E coli also grown on Eosin-Methylene Blue (EMB) and will be green with metallic sheen

16

Culture requirements of legionella

Charcoal yeast extract agar buffered with cysteine and iron

17

Culture requirements of fungi

Sabourauds agar

18

What is another name for polymixin?

Colistin

19

What allows e coli to spread hematogenously and cause meningitis?

K-1 capsule

20

Encapsulated bacteria (6)

Strep pneumo, H flu type b, N meningitidis, Salmonella, Klebsiella, group B strep

21

What vaccines should you give an asplenic patient?

S pneumo, H flu, N meningitidis

22

Test of choice for encapsulated bacteria

Quellung (will see capsular swelling)

23

Catalase-positive organisms (5)

S aureus, Serratia, Pseudomonas, Candida, E coli

24

What is the antigen in the N meningitidis vaccine?

Capsular polysaccharide

25

Urease positive bugs (8)

Proteus, Ureaplasma, Nocardia, Cryptococcus, H pylori, Klebsiella, Staph saprophyticus, Staph epidermis

26

Protein A virulence factor

Staph aureus. Binds Fc of Ig. Prevents opsonization and phagocytosis

27

IgA protease

Cleaves IgA. Secreted by s. pneumoniae, h flu type b, and neisseria

28

M protein

Group A streptococcus. Helps prevent phagocytosis

29

Where are exotoxin and endotoxin genes respectively located?

Exotoxins - plasmid or bacteriophage, endotoxin - bacterial chromosome (remember that endotoxins are part of bacterial wall, thus part of bacteria themselves. Similarly the gene is in with bacterial genes)

30

Heat stability of exotoxins and endotoxins respectively

Exotoxins destroyed rapidly at 60 C (except staph enterotoxin), endotoxins stable at 100 C for 1 hour

31

Diseases caused by exotoxins and endotoxins respectively

Exotoxins - tetanus, botulism, diphtheria. Endotoxins - meningococcemia, gram negative sepsis

32

Diphtheria toxin

Inactivates EF-2 and thus inhibits protein synthesis

33

Exotoxin A

Pseudomonas. Inactivates EF-2 (like diphtheriae toxin) and thus inhibits protein synthesis

34

Shiga Toxin

Shigella. Inactivates 60S ribosome by cleaving rRNA (like EHEC toxin). Causes GI mucosal damage and triggers HUS

35

Shiga-like Toxin

EHEC (including O157H7). Inactivates 60S ribosome by cleaving rRNA. Enhances cytokine release, causes HUS but EHEC does not invade host cells (unlike shigella)

36

What are the properties of EHEC in culture?

Does not ferment sorbitol, does not produce glucuronidase

37

Heat-labile (cholera-like) toxin

ETEC. Overactivates adenylate cyclase increasing Cl secretion. Watery diarrhea.

38

Heat-stable diarrhea

ETEC and Yersinia enterocolitica. Overactivates guanylate cyclase. Decreases reabsorption of NaCl and water in gut. Watery diarrhea in ETEC, bloody in y entocolitica (invades)

39

Edema factor

Bacillus anthracis. Mimics adenylate cyclase (similar to pertussis toxin). Black eschar of cutaneous anthrax

40

Cholera toxin

Vibrio cholerae. Overactivates adenylate cyclase by permanently activating Gs. Increased Cl secretion. Rice-water diarrhea

41

Pertussis toxin

Bordatella pertussis. Overactivates adenylate cyclase by disabling Gi. Impairs phagocytosis.

42

Tetanospasmin

Clostridium tetani. Cleaves SNARE (required for NT release). Prevents release of inhibitory NTs in spinal cord (GABA and glycine). Rigidity and lockjaw

43

Botulinum toxin

Clostridium botulinum. Cleaves SNARE (required for NT release). Prevents stimulatory (Ach) signals at neuromuscular junction. Flaccid paralysis

44

Botulinum toxin

Clostridium botulinum. Cleaves SNARE (required for NT release). Prevents stimulatory (Ach) signals at neuromuscular junction. Flaccid paralysis

45

Alpha toxin

Clostridium perfringens. A phospholipase that degrades tissue and cell membranes. Causes gas gangrene and hemolysis

46

Streptolysin O

Strep pyogenes. Protein that degrades cell membranes. Lyses RBCs (beta hemolysis). Use ASO in diagnosis of rheumatic fever

47

Exotoxin A

Strep pyogenes. Superantigen (MHC 2 and TCR linking). Toxic shock syndrome

48

Toxic shock syndrome toxin (TSST-1)

Staph aureus. Superantigen (MHC 2 and TCR linking). Toxic shock syndrome

49

Transformation (including bacteria capable of it)

Ability to take up DNA from environment. Strep pneumo, h flu type b, neisseria

50

Conjugation

F+ to F- (plasmid DNA only) or Hfr to F- (plasmid and chromosomal genes)

51

Transposition

Transfer of genes between plasmids or between chromosome and plasmid. Plasmid DNA may then move between bacteria

52

Generalized transduction

Lytic phage infection with accidental packing of bacterial chromosome into viral capsid. Viral transfer

53

Specialized transduction

Lysogenic phage incorporates and takes bacterial DNA with it when it excises

54

What toxins are encoded in lysogenic phages (specialized transduction)?

Shiga-like toxin, Botulinum toxin, Cholera toxin, Diphtheria toxin, Erythrogenic toxin of strep pyogenes

55

Branching gram positive bacteria and what separates them

Actinomyces (anaerobe and not acid fast), Nocardia (aerobe, acid fast)

56

Catalase positive and negative gram positive cocci

Positive - Staph (clusters), Negative - Strep (chains)

57

Coagulase positive, catalase positive gram positive cocci

S aureus (beta hemolytic)

58

Coagulase negative, catalase positive, gram positive cocci

Novobiocin sensitive - staph epidermis, novobiocin resistant - staph saprophyticus

59

What do staph epidermis tend to infect?

Teflon coated surfaces (due to biofilm formation) such as IVs and other artifical surfaces

60

Alpha hemolytic catalase negative gram positive cocci

Optochin sensitive - strep pneumo (bile soluble - does not grow in bile). Optochin resistant - Viridans strep (eg strep mutans, insuluble in bile)

61

Beta hemolytic catalase negative gram positive cocci

Group A (Bacitracin sensitive) - Strep pyogenes (impetigo). Group B (bacitracin resistant) - Strep agalactiae

62

Gamma hemolytic catalase negative gram positive cocci

Enterococci (e faecalis) - grow in 6.5 pct NaCl and bile. Nonentercocci (strep bovis) - grow in bile but not 6.5 pct NaCl

63

Gram positive mnemonics

Staph (novobiocin) - On offices STAPH retreat there was NO StRES. Strep (optochin) - OVRPS. Strep (bacitracin) - B-BRAS

64

Hemolysis of listeria monocytogenes

Beta

65

What is the most common site of staph aureus colonization?

Anterior nares

66

What is strep pneumo the most common cause of?

Meningitis, Otitis media in children, Pneumonia, Sinusitis

67

Color of sputum in strep pneumo infection

Rust colored

68

Strep viridans infections

Dental caries (strep mutans), subacute bacterial endocarditis of damaged valves (strep sanguis)

69

What infection precipitates rheumatic fever?

Group A strep (strep pyogenes)

70

What is done to prevent group B strep infection in newborns?

Pregnant women screened at 35-37 weeks. Positive patients receive intrapartum penicillin

71

What do enterococci cause?

UTI and subacute endocarditis. Are normal colonic flora. Are penicillin G resistant

72

Strep bovis

Normal gut bacteria. Can cause bacteremia and subacute endocarditis in colon cancer patients

73

Gram positive rods with metachromatic (blue and red) granules and Elek test for toxin

Cornyebacterium diptheriae

74

Gram positive rods with metachromatic (blue and red) granules and Elek test for toxin

Cornyebacterium diptheriae

75

What is seen in diphtheriae pharyngitis

Grayish-white pseudomembrane and lymphadenopathy

76

What is needed to prevent clostridium tetani infection and what is the implication of this?

IgG. Breastmilk will not cut it. Vaccinate early

77

Path tetanospasmin travels

Wound to motor neuron axon to spinal cord

78

Toxin A and Toxin B

C difficile. A (enterotoxin) - binds brush border of gut. B (cytotoxin) - destroys enterocyte cytoskeleton, causing pseudomembranous colitis

79

How do you diagnose C difficile colitis?

Detection of Toxin A and/or B in the stool

80

Cause and treatment of C difficile

Commonly caused by clindamycin or ampicillin. Treat with metronidazole or oral vanco

81

What is given to prevent neonatal tetanus?

A maternal vaccine during pregnancy

82

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

Bacillus anthracis

83

Fever, pulmonary hemorrhage, mediastinitis, shock

Pulmonary anthrax

84

Microscopy of anthrax infection

Long chains (medussa head appearance)

85

People in what profession are susceptible to anthrax infection?

Woolsorters

86

Culture appearance of listeria monocytogenes

Narrow zone of beta hemolysis on sheep blood agar

87

Where does listeria monocytogenes live?

Facultative intracellular

88

Amnioitis, septicemia, and spontaneous abortion. Or granulomatosis infantiseptic. Or neonatal meningitis. Or meningitis in immunocompromise. Or mild gastroenteritis (healthy adult)

Listeria

89

Treatment for listeria

Usually self-limited. Ampicillin in infants and immunocompromised

90

Treatment for branching gram positive rods

SNAP. Sulfa for Nocardia, Actinomyces use Penicillin

91

Prophylactic treatment for MAIC in AIDS patients

Azithromycin

92

Fevers, weight loss, weakness, hepatosplenomegaly

MAI

93

Treatment for leprosy

Dapsone (toxicity is hemolysis and methemoglobinemia)

94

Outcomes of leprosy

Lepromatous (Th2 response), tuberculoid (Th1 response)

95

Gram negative cocci

Maltose fermenter - N meningitidis. Maltose nonfermenter - N gonorrhoeae

96

Gram negative coccoid rods

H flu, pasteurella, brucella, bordatella pertussis

97

Gram negative comma shaped (oxidase positive)

Grows at 42 C - campylobacter jejuni. Grows in alkaline media - vibriocholerae

98

Gram negative lactose fermenting rods

Fast fermenters - klebsiella, e coli, enterobacter. Slow fermenters - citrobacter, serratia, others

99

Gram negative non lactose fermenting rods

Oxidase negative - shigella (no H2S production), salmonella and proteus (H2S production). Oxidase positive - pseudomonas

100

Why dont you get lasting imunity from gonoccocal infection?

Due to rapid antigenic variation of pilus proteins (which is also why we dont have a vaccine)

101

What does meningococcus cause?

Meningococcemia, meningitis, and Waterhouse-Friderichsen syndrome

102

What does gonococcus cause?

Gonorrhea, septic arthritis, neonatal conjuctivitis, PID, and Fitz-Hugh-Curtis syndrome

103

What does meningococcus have that is analogous to LPS of enteric gram negatives?

LOS

104

Prophylaxis of meningococcus close contacts

Rifampin

105

Treatment of gonococcus and meningococcus respectively

Gonococcus - cetriaxone, meningococcus - ceftriaxone or penicillin G

106

What does h flu cause?

Epiglottitis (cherry red), Meningitis, Otitis media, and Pneumonia

107

Transmission of h flu

Aerosol

108

Treatment and prophylaxis for h flu

Ceftriaxone (treatment) and rifampin (close contact prophylaxis)

109

What is contained in the HiB vaccine?

PRP component of the HiB capsule conjugated to diphtheria toxoid (give between 2 and 18 months of age)

110

Test of choice for legionella

Urine assay for antigen

111

Transmission and habitat of legionella

Aerosol. Water source habitat

112

Treatment for legionella

Erythromycin

113

What presentation in a pneumonia case would suggest legionella over strep pneumo?

Pneumonia + GI + Neuro symptoms

114

High fever in smoker with diarrhea, confusion, cough, and chest pain

Legionella

115

Erythema gangrenosum

Necrotic skin condition due to pseudomonas exotoxin

116

What is pseudomonas associated with

Wound and burn infection, pneumonia (esp in CF), sepsis (black lesions on skin), swimmers ear, UTI, drug users and diabetic osteomyelitis, hot tub folliculitis, malignant otitis externa in diabetics

117

Smell of pseudomonas

Grape like odor

118

Treatment for pseudomonas

Aminoglycoside plus extended-spectrum penicillin (piperacillin, ticarcillin)

119

Most important virulence factor in e coli UTI

Fimbriae

120

E coli diarrhea in children

EPEC

121

Which e coli does not ferment sorbitol?

EHEC

122

Red currant jelly sputum

Klebsiella

123

Contrast DIC with TTP-HUS

1) Pts bleed in DIC. 2) Only platelets activated in TTP-HUS. 3) PTT and PT prolonged in DIC, 4) Low fibrinogen and increased FDP in DIC

124

Which populations are more common in TTP and HUS respectively

TTP - pts with mainly CNS symptoms. HUS - children with renal failure and mild CNS symptoms

125

Main differences betweeon salmonella and shigella

Salmonella have flagella and can disseminate hematogenously and produce H2S

126

What may prolong symptoms in salmonella infection?

Antibiotics

127

Rose spots on abdomen, fever, headache, diarrhea.

Salmonella typhi (typhoid fever). May remain in gallbladder in carrier state

128

How do shigella enter our cells?

They first enter antigen sample M (microfold) cells, then spread to epithelial cells

129

How do Shigella move?

Actin polymerization (they do not have flagella like salmonella do)

130

Most common cause of bloody diarrhea

Campylobacter jejuni. This is especially true in children

131

Transmission of campylobacter

Fecal-oral through poultry, meat, unpasturized milk

132

Common antecedent to Guillain-Barre

Pet feces (puppies), contaminated milk, or pork

133

Diarrhea outbreaks in day care centers. Can also cause mesenteric adenitis which can mimic Crohns or appendicits

Yersinia entercolitica

134

Spirochetes

Borrelia, Leptospira, Treponema

135

Flulike symptoms, jaundice, photophobia with conjunctivitis.

Leptospirosis. Found in water contaminated with animal urine, prevalent among surfers and in the tropics

136

Severe jaundice and azotemia, fever, hemorrhage, anemia

Weils disease (icterohemorrhagic leptospirosis) - liver and kidney dysfuntcion from severe leptospira infection

137

Stages of lyme disease

1 - erythema migrans, flulike symptoms. 2 - Bells palsy, AV nodal block. 3 - chronic monoarthritis and migratory polyarthritis

138

Treatment for lyme

Doxycycline, ceftriaxone

139

Stages of syphilis

1 - painless chancre, 2 - rash, condylomata lata. 3 - Gummas, aoritis, neurosyphilis, argyll-robertson pupil

140

Saber shins, saddle nose, CN 8 deafness, Hutchinsons teeth, mulberry molars

Congenital syphilis

141

Argyll-Robertson pupil

Reactive to accomodation but not light

142

Causes of VDRL false positives

VDRL. Viruses (mono, hepatitis), Drugs, Rheumatic fever, Lupus and leprosy

143

Histologic appearance of brucellosis and what is the source?

Chronic caseating granulomas similar to Tb endocarditis. Unpasteurized dairy (common in cattle ranchers)

144

Source and organism of Q fever

Coxiella burnetii. Spores from tick feces and cattle placenta

145

Source and organism of ehrlichiosis

Ehrlichiosis chaffeensis. Lone star tick

146

Vector for francisella tularensis

Ticks, rabbits, deer fly

147

Vector for pasteurella multocida

Animal bite, cats, dogs

148

Organism and vector for epidemic typhys

Rickettsia prowazekii. Louse

149

Vector and organism for endemic typhyus

Rickettsia typhi. Flease

150

Characteristic finding in garnderella vaginalis infection

Fishy odor on addition of kOH

151

What infection is associated with sexual activity but is not an STD?

Garnerella overgrowth

152

Clue cells

Gardnerella overgrowth. Vaginal epithelial cells covered with bacteria

153

Treatment for gardnerella

Metronidazole

154

Where do Rickettsia live and what do they need to survive?

Intracellularly. Need CoA and NAD+

155

Rash starting centrally and spreading out sparing palms and soles

Epidemic typhys. R prowazekii carried by human body louse

156

Headache, fever, rash (vasculitis) starting on palms and soles

Rickettsia (but not typhus type. Typhus rash starts on trunk and spreads out)

157

Rickettsial pneumonia with no rash, no vector, and negative Weil-Felix

Q fever (coxiella burnetti). Organism can survive outside for a long time

158

Weil-Felix

Mixing pts serum with proteus antigens and antirickettsial antibodies will cross react with Proteus O antigen and agglutinate (if they have had a rickettsial infection)

159

Rash on palms and soles migrating to wrist, ankles, then trunk, headache, fever

Rocky mountain spotted fever

160

In what infections is palm and sole rash seen?

Coxsackie A (hand foot and mouth), RMSF, Syphilis

161

Two main forms in chlamydia life cycle

Elementary body (infectious), and Reticulate body

162

Lab diagnois of chlamydiae

Cytoplasmic inclusions on Giemsa or floresecent antibody stained smear

163

Chlamydia trachomatis serotypes

ABC - blindness, africa, chronic. D-K - urethritis, PID, ectopic, neonatal pneumonia and conjunctivitis. L1L2L3 - Lymphogranuloma venerum

164

Cause of atypical pnuemonia, high titer of cold aggultinins (IgM), grown on Eatons agar

Mycoplasma pneumoniae

165

Treatment for mycoplasma pneumoniae

Tetracycline or erythromycin (do not use penicillins as they have no cell wall)

166

Atypical pneumonia outbreak in military recruits or prisons

Mycoplasma pneumoniae

167

Main fungus in New England and mid-atlantic

Blastomyces

168

Main fungus in midwest

Histoplasma

169

Main fungus in southwest

Coccidiodes

170

Main fungus in latin america

Paracoccidiodes

171

Symptoms of histoplasmosis

pneumonia

172

Dimorphic fungus in bird or bat droppings

Histoplasmosis

173

Treatment for systemic mycoses

Fluconazole or ketoconazole (local), amphotericin B (systemic)

174

Dimorphic broad based buds

Blastomyces

175

Symptoms of blastomycosis

Inflammatory lung disease, can disseminate to skin and bone. Granulomatous nodules

176

Symptoms of coccidiodomycosis

Pneumonia and meningitis, can disseminate to bone and skin

177

Dimorphic fungus which looks like a ball of grapes

Coccidiodes

178

Which systemic mycoses can become a spherule filled with endospores (much larger than an RBC)?

Coccidiodes

179

Dimorphic fungus with captains wheel appearance

Paracoccidiodes

180

How does malassezia furfur affect skin pigment?

Degrades lipids, which produces acids that damage melanocytes and cause hypopigmentation or hyperpigmented patches

181

What kind of weather is conducive to malassezia furfur?

Hot, humid weather

182

Treatment for tinea versicolor

Topical miconazole, selenium sulfide

183

Histologic appearance of malassezia furfur

Spaghetti and meatball look on KOH prep

184

What cells are responsible for preventing candidiasis?

Th cells suppress superficial candidiasis. Neutrophils prevent hematogenous spread

185

Forms of candida

Dimorphic. Psuedohyphae and budding at 20C, Germ tubes at 37C

186

Treatment for candidiasis

Topical azole (vaginal), fluconazole or caspofungin (oral/esophageal), amphotericin B, fluconazole, caspofungin (systemic)

187

Acute angle hyphae

Aspergillus

188

How do aflatoxins cause cancer?

They cause a GC to TA mutation in p53

189

Which opportunistic fungal infections are not dimorphic?

Aspergillus, cryptococcus, mucor and rhizopus (I think), PCP (I think)

190

Histologic appearance of cryptococcus

Heavily encapsulated yeast. Little balls with smaller balls in them

191

How is cryptococcus acquired?

Inhalation (which results in hematogenous dissemination) from yeast in soil and pigeon droppings

192

Characteristic brain lesion from cryptococcus

Soap bubble lesions

193

What patients tend to get mucor and rhizpus infections?

DKA pts and leukemia pts

194

Headache, facial pain, black necrotic eschar on face, possible cranial nerve involvement

Mucor and rhizopus infections

195

How is PCP acquired?

Inhalation of yeast

196

Treatment for PCP

TMP-SMX, pentamidine, dapsone. Prophylax at CD4 less than 200

197

Dimorphic, cigar-shaped budding yeast that lives on vegetation

Sporothrix schenkii

198

Treatment for sporothrix schenkii

Itraconazole or KI

199

Bloating, flatulence, foul-smelling fatty diarrhea in campers and hikers

Giardiasis

200

How are giardia, entamoeba, and cryptosporidum respectively transmitted?

All are cysts in water

201

Treatment for giardia

Metronidazole

202

Treatment for entamoeba histolytica

Metronidazole and iodoquinol

203

Treatment for cryptosporidium

Prevention (water treatment), nitazoxanide

204

Bloody diarrhea, liver abscess, RUQ pain, flask-shaped colonic ulcers

Entamoeba

205

Chorioretinitis, hydrocephalus, intracranial calcifications

Toxoplasmosis (usually in HIV)

206

Transmission of toxoplasma

Cysts in meat or cat feces

207

Treatment for toxoplasma

Sulfadiazine and pyrimethamine

208

Rapidly fatal meningoencephalitis in someone who swam in a fresh water pool

Naegleria fowleri

209

Where do you look for the amoeba in naegleria infection?

CSF

210

Organism and vector for sleeping sickness

Trypanosoma brucei, gambiense, rhodesiense. Tsetse fly (painful bite)

211

Treatment for sleeping sickness

Suramin (blood-borne), melarsoprol (CNS protection)

212

Cycle length of the various malarias

Vivax/Ovale - 48 hours, Falciparum - irregular, Malariae - 72 hours

213

Which malaria has a dormant form in the liver?

Vivax-ovale

214

Which malaria causes cerebral malaria and how?

Falciparum. Parasitized RBCs occlude capillaries in brain (also kidney and lungs)

215

Malaria treatment

Start with chloroquine (blocks plasmodium heme polymerase). If resistant, use mefloquine. Vivax/ovale - add primaquine for hypnozoites

216

Fever and hemolytic anemia, northeastern United States, asplenia in severe disease

Babesia

217

Treatment for babesia

Quinine, clindamycin

218

Organism and vector in Chagas disease

Trypanosoma cruzi. Reduviid bug (kissing bug, painless bite)

219

Treatment for Chagas disease

Nifurtimox

220

Dilated cardiomyopathy, megacolon, megaesophagus

Chagas disease (mostly in S america)

221

Spiking fevers, hepatosplenomegaly, pancytopenia

Visceral leishmaniasis

222

Organism and vector of leishmaniasis

Leishmania donovani. Sandfly

223

Treatment for leishmaniasis

Sodium stibogluconate

224

Treatment for trichomonas vaginalis

Metronidazole (for patient and partner)

225

Organism and treatment for pinworm

Enterobius vermicularis. Bendazoles or pyrantel pamoate

226

Transmission of pinworm

Food contaminated with eggs

227

Nematode that encysts in muscle, causes periorbital edema

Trichinella spiralis

228

Nematode that penetrates the skin, causes vomiting, diarrhea, anemia

Strongyloides stercoralis

229

Nematode that penetrates skin of feet, causes anemia

Ancylostoma duodenale and Necator americans (hookworms)

230

Transmission and treatment of dracunculus medinensis

Drinking water, niridazole

231

Loa Loa

Transmitted by deer flies, causing skin swelling. Treat with DEC

232

Wuchereria bancrofti

Transmitted by female mosquito. Causes elephantiasis. Treat with DEC

233

Toxocara canis

Food contaminated with eggs, causes granulomas (can cause blindness) and visceral larva migrans. Treat with DEC

234

Treatment for taenia solium

Praziquantel (use bendazoles for neurocysticercosis)

235

Appearance of t solium lesions in the brain

Swiss cheese appearance

236

Treatment for diphyllobothrium latum

Praziquantel

237

Cysts in the liver that can cause anaphylaxis if antigens are released during removal

Echinococcus granulosus. Acquired from eggs in dog feces. Treat with bendazoles

238

Treatment for trematodes (flukes)

Praziquantel

239

Trematodes (flukes) (3)

Schistosoma, clonorchis sinesis (pigmented gallstones, cholangiocarcinoma), paragonimus westermani (crab meat, hemoptysis)

240

Routes of nematode infection and the worms that use each (6 total)

Ingestion - Enterobius, Ascaris, Trichinella. Cutaneous - Strongyloides, Ancylostoma, Necator

241

Parasite of brain cysts and seizures

T solium

242

Parasite of liver cysts

Echinococcus granulosus

243

Parasite of B12 deficiency

Diphyllobothrium latum

244

Parasite of biliary tract disease, cholangiocarcinoma

Clonorchis sinesis

245

Parasite of hemotypsis

Paragonimus westermani

246

Parasite of portal hypertension

Schistosoma mansoni

247

Parasite of hematuria, bladder cancer

Schistosoma haematobium

248

Parasite of microcytic anemia

Ancylostoma, necator

249

Complementation and the requirement for it

When one virus uses another viruses protein product. Both viruses have to be infecting the same cell at the same time

250

Phenotypic mixing

Coating of a progeny virus of virus A with surface proteins of virus B. Have to be infecting the same cell at the same time. Surface protein determines infectivity, but progeny carry virus A genetic material

251

Live attenuated vaccines (5)

Lead to longer production of mucosal IgA than killed vaccines. Smallpox, yellow fever, chickenpox, Sabins polio, MMR

252

Killed vaccines (4)

Rabies, influenza, salk polio, HAV

253

Recombinant vaccines (2)

HBV, HPV

254

All DNA viruses are what and what is the exception?

Double stranded, except the parvoviruses

255

What are all RNA viruses and what is the exception?

Single stranded except Reoviruses

256

RNA viruses

I went to a RETRO (retrovirus) TOGA (togavirus) party where I drank FLAVored (flavivirus) CORONA (coronavirus) and ate HIPPY (hepevirus) CALIfornia (Calcivirus) PICKLES (picornavirus)

257

What naked viruses are infectious?

dsDNA (except pox and HBV) and +strand ssRNA

258

Where do viruses replicate

DNA viruses - nucleus (except pox). RNA - cytoplasm (except influenza and retroviruses)

259

Naked viruses (7)

Calcivirus, Picornavirus, Reovirus, Parvovirus, Adenovirus, Papilloma, Polyoma

260

Which viruses acquire their envelops from nuclear membrane?

Herpesviruses (other get them from the PM)

261

DNA viruses (7)

Hepadna, Herpes, Adenoa, Pox, Parvo, Papilloma, Polyoma

262

All DNA viruses are icosehedral except which?

Pox (complex)

263

HHV-6

Roseola (exanthem subitum)

264

Which hepatitis virus is a DNA virus?

Hep B (it is a hepadnavirus)

265

What virus is not a retrovirus but has reverse transcriptase?

HBV

266

Most common viral cause of acute cystitis (dysuria, hematuria) in kids

Adenovirus

267

Febrile pharyngitis, sore throat, acute hemorrhagic cystitis, pneumonia, conjunctivitis

Adenovirus

268

Erythema infectiosum (fifth disease)

Parvo B19. Slapped cheek rash, hydrops fetalis in utero, RBC aplasia and RA-like symptoms in adults

269

Causes of pure red cell aplasia

Parvo B19 and thymoma

270

Histology of VZV infection

Intranuclear inclusions, multinucleate giant cells

271

Tzanck test

Smear to detect HSV-1, HSV-2 and VZV

272

Fever, hepatosplenomegaly, pharyngitis, lymphadenopathy (especially posterior cervical nodes). 15-20 years of age

Mononucleosis

273

Family and symptomology of norwalk virus

Calcivirus. Viral gastroenteritis

274

Which Hepatitis viruses are RNA viruses and what is the family of each?

HAV - Picorna, HCV - Flavi, HDV - Delta, HEV - Hepe

275

Picornaviruses (5)

Polio, Echo (aseptic meningitis), Rhino, Coxsackie (aseptic meningitis, herpangina, febrile pharyngitis, hand foot mouth disease), HAV

276

Paramyxoviruses (4)

Parinfluenza (croup), RSV (briochilitis in babies, treat with ribavirin), Rubeola (Measles), Mumps

277

Negative stranded RNA viruses (6)

Always Bring Polymerase Or Fail Replication. Arenaviruses, Bunyaviruses, Paramyxoviruses, Orthomyxoviruses, Filoviruses, Rhabdoviruses

278

Segmented viruses (4)

BOAR. All are RNA viruses. Bunyaviruses, Orthomyxoviruses, Arenaviruses, Reoviruses

279

Protein synthesis in picornaviruses

RNA translated into 1 large polypeptide that is cleaved by proteases into functional viral proteins

280

Spread of picornaviruses

Fecal oral (except rhinovirus)

281

Why doesnt rhinovirus affect the GI tract?

It is acid labile

282

High fever, black vomitus, jaundice

Yellow fever (a flavivirus)

283

Diarrhea in day care centers due to villous destruction with atrophy. A segmented RNA virus.

Rotavirus (a reovirus)

284

Fever, postauricular adenopathy, lymphadenopathy, arthralgias, fine truncal rash that starts at head and moves down.

Rubella (a togavirus, also called german measles). Mild in children but serious if congenital

285

What do paramyxoviruses have, what does it do, and how does this relate to treatment?

F (fusion) protein. Causes respiratory epithelial cells to fuse and form multinucleated cells. Palivizumab is a monoclonal antibody against F protein

286

Palivizumab

Monoclonal antibody against F protein (paramyxoviruses). Prevents pneumonia in premature infants

287

Descending maculopapular rash including hands and feet, koplik spots.

Measles (rubeola, a paramyxovirus)

288

Difference between the rashes in rubella and rubeola

Rubeola (measles) rash includes hands and feet. Rubella (german measles) rash stays on trunk. Both spread down from head

289

Potential sequelae of measles (rubeola)

SSPE (many years later), encephalitis, giant cell pneumonia (typically only in immunosuppressed)

290

Cough, cold like symptoms, conjunctivitis

Measles

291

Parotitis, aseptic meningitis, orchitis

Mumps (a paramyxovirus)

292

Between measles (rubeola) and german measles (rubella), which contains hemagglutinin?

Measles (rubeola), as it is a paramyxovirus

293

Fever, malaise, agitation, photophobia, hydrophobia, paralysis, coma, death

Rabies (progresses in that order)

294

Histology of hepatitis A infection

Hepatocyte ballooning degeneration and apoptosis

295

Histology of Hep B infection

Fine, eosinophilic, cytoplasmic granules of HBsAg are visible, giving ground glass appearance

296

Transmission of HBV

Parenteral, sexual, maternal-fetal

297

Symptoms of HBV prodromal period

Serum-sickness like

298

What viral hepatitises predispose to cancer and which cancer?

HCC. HBV and HCV

299

Best test for active HAV infection

Anti-HAVAb (IgM)

300

Best test for prior HAV infection

Anti-HAVAb (IgG). Can also indicate prior vaccination

301

What Hep B serologic marker indicates high transmissibility?

HBeAg

302

HIV structural genes

Env (gp120 for attachment, gp41 for fusion and entry), Gag (p24 capsid), Pol (reverse transcriptase)

303

What receptors does HIV use for entry?

CXCR4 or CCR5 (CD4 cells), CCR5 and CD4 (macrophages)

304

Why are HIV tests initially falsely positive in babies born to infected mothers?

Anti-GP120 crosses placenta

305

Where does the HIV virus replicate during the latent phase?

Lymph nodes

306

What fungal infection is commonly picked up by spelunkers?

Histoplasma capsulatum (from bats)

307

Low-grade fever, cough, hepatosplenomegaly, tongue ulcer, only pulmonary symptoms if CD4 count greater than 100

Histoplasma

308

Encephalopathy and demyelination in pt with CD4 count below 200

JC virus reactivation

309

Ring-enhancing brain abscesses with CD4 count below 100

Toxoplasma

310

CD4 count for cryptococcus meningitis

Below 50

311

CD4 count for CMV retinitis

Below 50. Will see cotton-wool spots

312

CD4 ranges for PCP and MAI infections respectively

PCP - below 200, MAI - below 50

313

Bugs that can mimic appendicits (3)

Yersinia enterocolitica, campylobacter jejuni, non-typhoidal salmonella. Mimic appendicits by causing mesenteric adenitis

314

Bugs causing bloody diarrhea (7)

Campylobacter, salmonella, shigella, EHEC, EIEC, Yersinia enterocolitica, Entamoeba histolytica

315

Bugs causing watery diarrhea (4)

ETEC, Vibrio choleraea, C diff, C perfringens. Also protozoa - giardia, cryptosporidium, viruses - rota, adeno, norwalk

316

Most common causes of pneumonia (in order with most common first) in neonates

Group B strep, E coli

317

Most common causes of pneumonia (in order with most common first) in children 4 weeks to 18 years

Viruses (RSV), Mycoplasma, Chlamydia trachomatis, Strep pneumo

318

Most common causes of pneumonia (in order with most common first) in adults (18-40)

Mycoplasma, C pneumoniae, Strep pneumo

319

Most common causes of pneumonia (in order with most common first) in adults (40-65)

Strep pneumo, H flu, Anaerobes, Viruses, Mycoplasma

320

Most common causes of pneumonia (in order with most common first) in elderly

Strep pneumo, Influenza, Anaerobes, H flu, Gram negative rods

321

Most common causes of nosocomial pneumonia

Staph, enteric gram negative rods

322

Most common causes of aspiration pneumonia and treatment

Anaerobes. Clindamycin

323

Most common causes of pneumonia in alcoholics and IV drug users

Strep pneumo, Klebsiella, Staph

324

Most common causes of pneumonia in CF

Pseudomonas

325

Most common causes of atypical pneumonia

Mycoplasma, Legionella, Chlamydia

326

CSF findings in bacterial meningitis

WBC high (over 1000) predominantely neutrophils. Glucose low (below 70), protein high

327

Most common causes of meningitis (in order with most common first) in newborn

Group B strep, E Coli, Listeria

328

Most common causes of meningitis (in order with most common first) in children (6 mos to 6 years)

Strep pneumo, N meningitidis, HiB, Enteroviruses

329

Most common causes of meningitis (in order with most common first) in 6 to 60 years

Strep pneumo, N meningitidis (number 1 in teens), Enteroviruses, HSV

330

Most common causes of meningitis (in order with most common first) in elderly

Strep pneumo, GNRs, Listeria

331

Enteroviruses

Coxsackie, Echo, Polio, others

332

CSF findings in viral meningitis

WBC below 500 predominantely lymphocytes, glucose normal or near normal, protein elevated but below 70

333

Treatment of meningitis

Cetriaxone and vanco empirically. Add ampicillin if Listeria suspected

334

Fever, headache, photophobia, nuchal rigidity, painful extraocular movements

Meningitis

335

CSF findings in fungal/Tb meningitis

Very similar to bacterial except WBC predominance is lymphocytes instead of PMNs

336

Fever with positive gallium scan

Osteomyelitis

337

Most common causes of osteomyelitis in: all comers, sexually active, DM and IVDU, sickle cell, prosthetics, vertebral, animal bite

All - S aureus, Sexually active - N gonorrhoeae (rare), DM and IVDU - pseudomonas, Sickle - Salmonella, Prosthetics - S aureus and s epidermis, Vertebral - M Tb (potts disease), Animal bite - Pasteurella

338

Where in the bone does osteomyelitis typically occur

Metaphysis of long bones

339

Features seen in pyelonephritis but not cystitis

Fever, chills, flank (vs suprapubic) pain, CVA tenderness, hematuria, WBC casts (vs WBCs)

340

Predisposing factors to UTI

Female, obstruction, kidney surgery, catheterization, GU malformation, DM, pregnancy

341

Markers for UTI agents

Positive leukocyte esterase test - bacterial UTI, Positive nitrite test - gram negative bacterial UTI

342

Urease producing bugs that cause UTIs

Proteus, Klebsiella. Negative urease test suggests E coli, Strep, Enterococcus

343

ToRCHHeS

Toxoplasma, Rubella, CMV, HIV, HSV-2, Syphilis

344

Hepatosplenomegaly, jaundice, thrombocytopenia, growth retardation in newborn

Common features of ToRCHHeS infections

345

Which TORCHES infection often includes poor feeding?

Toxoplasma

346

Maternal symptoms for each of the ToRCHHeS infections

Toxo - asymptomatic or lymphadenopathy. Rubella - Rash, postauricular lymphadenopathy, polyarthritis. CMV - Asymptomatic or mono-like. HIV - variable. HSV-2 - Asymptomatic or herpetic lesions. Syphilis - Chancre, rash, or cardiac/neuro disease

347

PDA, cataracts, deafness, blueberry muffin rash (may or may not be present)

Congenital rubella

348

Hearing loss, seizures, petechial rash, blueberry muffin rash

Congenital CMV

349

Recurrent infections, chronic diarrhea in newborn

Congenital HIV

350

Temporal encephalitis, herpetic lesions in newborn

Congenital HSV-2

351

Stillbirth or facial abnormalities, saber shins, and CN 8 deafness

Congenital syphillis

352

Slapped cheek rash

Parvo B19

353

Vesicular rash on palms and soles. Ulcers in oral mucosa

Coxsackie Type A (hand-foot-mouth disease)

354

Urethritis, cervicitis, PID, prostatitis, epididymitis, arthritis, creamy purulent discharge

Gonorrhea

355

Painful genital ulcer, inguinal adenopathy

Chancroid (haemophilus ducreyi)

356

Painful penile, vulvar, or cervical vesicles and ulcers. With or without fever, headache, myalgia

HSV-2

357

Noninflammatory, malodorous discharge, positive whiff test, clue cells

Gardnerella vaginosis

358

Two most common causes of PID

Chlamydia trachomatis and N gonorrhoeae

359

Cervical motion tenderness, purulent cervical discharge

PID. May progress to salpingitis, endometritis, hydrosalpinx, and tubo-ovarian abscess

360

Fitz-Hugh-Curtis

Infection of the liver capsule and violin string adhesions of parietal peritoneum to liver. Caused by ascending PID (esp N gonorrhoeae)

361

Causes of meningitis in unimmunized children

HiB and polio

362

What bug should you associate with sulfur granules?

Actinomyces israelii

363

Action of penicillin and its dervitives

Block cell wall synthesis by inhibition of peptidoglycan cross linking

364

Drugs that block peptidoglycan synthesis

Bacitracin, vancomycin

365

Drugs that block nucleotide synthesis

Sulfonamides, trimethoprim

366

Drugs that block DNA topoisomerases

Fluoroquinolones

367

Drugs that block mRNA synthesis

Rifampin

368

How does metronidazole work?

Damages DNA

369

Dicloxacillin

A penicillin derivative related to methicillin and nafcillin

370

Which has greater oral bioavailability, amoxicillin or ampicillin?

Amoxicillin

371

Main uses of ampicillin and amoxicillin

H flu, E coli, Listeria, Proteus, Salmonella, Shigella, enterococci

372

Most important use of ticarcillin, carbenicillin, and piperacillin

Pseudomonas. Also covers GNRs

373

Clavulanic Acid, Sulbactam, Tazobactam

B-lactamase inhibitors

374

What do cephalosporins block?

Transpeptidases (also called penicillin binding proteins)

375

Organisms not covered by cephalosporins are LAME

Listeria, Atypicals (chlamydia, mycoplasma), MRSA, Enterococci

376

Toxicities of cephalosporins

Hypersensitivity reactions, Vitamin K deficiency, Disulfiram-like reaction

377

Aztreonam

Monobactam resistant to B-lactamases. Binds PBP3, no cross-allergenicity with penicillins. GNR coverage only.

378

Main use of aztreonam

Penicillin-allergic pts and those with renal insufficiency who cannot tolerate aminoglycosides

379

Imipenem/cilastatin and meropenem

Limited by side effects, use in life-threatening infections after other options exhausted.

380

Cilastatin

Inhibits renal dehydropeptidase to decrease inactivation of imipenem

381

What are penicillins structural analogs of in bacteria?

The D-Ala-D-Ala sequence (which vancomycin binds)

382

Toxicities of vancomycin

Nephrotoxicity, Ototoxicity, Thrombophlebitis, red man syndrome

383

What causes vancomycin resistance?

Change of D-ala-D-ala to D-ala-D-lac

384

Protein synthesis inhibitor targets

buy AT 30, CCEL at 50. 30S - Aminoglycosides, Tetracyclines. 50S - Chloramphenicol, Clindamycin, Erythromycin (macrolides), Linezolid

385

Aminoglycosides (5)

Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin

386

Action of aminoglycosides

Inhibit formation of initiation complex and cause misreading of mRNA (bactericidal)

387

What type of bacteria are aminoglycosides ineffective against and why?

Anaerobes, because they require O2 for uptake

388

Main use of aminoglycosides

Severe GNR infections

389

Toxicities of aminoglycosides

Nephrotoxicity, Ototoxicity, Teratogenic

390

Resistance of aminoglycosides

Transferase enzymes inactivate drug by acetylation, phosphorylation, or adenylation

391

Tetracyclines (4)

Tetracycline, doxycycline, demeclocycline, minocycline

392

Which tetracycline is used in a renal disorder and which disorder?

Demeclocycline (ADH antagonist) is used in SIADH

393

Action of tetracyclines

Bind 30S, prevent aminoacyl-tRNA attachment

394

Instructions for patients taking tetracyclines

Do not take with milk, antacids, or iron-containing preparations as these will inhibit tetracycline absorption

395

What makes tetracyclines so effective against Rickettsia and Chlamydia

They accumulate intracellularly

396

Action of macrolides

Bind 50S (23S rRNA subsubunit) and prevent translocation

397

Main uses of macrolides

Atypical pneumonias, URIs, STDs, gram positive cocci, Neisseria

398

Toxicities of macrolides

Prolonged QT, GI discomfort (most common cause of noncompliance), acute cholestatic hepatitis, eosinophilia, skin rashes

399

What drugs are increased in plasma concentration by macrolides?

Theophyllines and oral anticoagulants

400

Action of chloramphenicol

Binds 50S - blocks peptide bond formation

401

Resistance to chloramphenicol

Plasmid-encoded acetyltransferase inactivates drug

402

Action of clindamycin

Binds 50S - blocks peptide bond formation

403

Main uses of clindamycin

Anaerobic infections in aspiration pneumonia or lung abscesses

404

General principle for treating anaerobes

Above the diaphragm - clindamycin, Below the diaphragm - metronidazole

405

Sulfonamides (3)

Sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine

406

Action of sulfonamides

Inhibit dihydropteroate synthase (needed for DNA synthesis). Are PABA antimetabolites

407

Fluoroquinolones (9)

Ciprofloxacin, norfloxacin, levofloxacin, ofloxacin, sparfloxacin, moxifloxacin, gatifloxacin, enoxacin, nalidixic acid (a quinolone)

408

Uses for metronidazole

Giardia, Entamoeba, Trichomonas, Gardnerella, Anaerobes.

409

Toxicities of metronidazole

Disulfiram-like reaction, headache, metallic taste

410

Prophylaxis for Tb, MAI, and M leprae respectively

Tb - INH, MAI - Azithromycin, M leprae - None

411

What is responsible for acid fastness?

Mycolic acids

412

What is needed to activate INH?

Bacterial catalase-peroxidase (KatG)

413

Toxicities of INH

Neurotoxic, hepatotoxic, lupus. Pyridoxine (B6) can prevent neurotoxicity and lupus

414

What causes different INH half life in different individuals

Fast vs slow acetylators

415

4 Rs of Rifampin

RNA polymerase inhibitor, Revs up P-450, Red/orange body fluids, Rapid resistance if used alone

416

Pyrazinamide

Anti-tb. Inhibits mycolic acid production by blocking pyrazanamidase

417

Ethambutol

Anti-tb. Decreases carbohydrate polymerization of cell wall by blocking arabinosyltransferase. Can cause optic neuropathy (red-green color blindness)

418

Prophylaxis for each of the following: meningococcus, gonorrhea, syphilis, recurrent UTIs, endocarditis with surgical or dental procedures

Meningococcus - Cipro, rifampin or minocycline. Gonorrhea - Cetriaxone, Syphilis - Benzathine penicillin G, Recurrent UTI - Bactrim, Endocarditis - Penicillins

419

HIV prophylaxis at CD4 below: 200, 100, and 50

200 - Bactrim (PCP), 100 - Bactrim (PCP and Toxo), 50 - Above and Azithryomycin (MAI)

420

Treatment for VRE

Linezolid and quinupristin/dalfopristin

421

Empiric therapy for community-acquired pneumonias

Outpatient - macrolides, Inpatient - fluoroquinolones, ICU - B-lactam + (fluoroquinolone or azithromycin)

422

What antifungals affect each of the following: membrane function, cell wall synthesis, ergosterol synthesis, lanosterol synthesis, nucleic acid synthesis

Membrane - Amphotericin B, Cell wall - Caspofungin, Ergosterol - fluconazole, itraconazole, voriconazole, terbinafine, Lanosterol - naftitine, Nucleic Acids - 5-fluorocytosine

423

Action of amphotericin B

Binds ergosterol and forms pore that allow leakage of electrolytes

424

What do you have to supplement in amphotericin treatment and why?

K and Mg because of altered renal tubule permeability

425

Action and delivery of nystatin

Same as amphotericin (binds ergosterol and makes pores). Topical only because too topic systemically

426

Action of caspofungin

Inhibits cell wall synthesis by inhibiting synthesis of B-glucan

427

Action of terbinafine

Inhibits fungal enzyme squalene epoxidase (necessary for ergosterol synthesis)

428

Action of griseofulvin

Inhibits MT function, disrupting mitosis

429

Antiprotozoals (5)

Pyrimethamine (toxo and falciparum), suramin and melarsoprol (sleeping sickness), nifurtimox (Chagas), Sodium stibogluconate (leishmaniasis)

430

Action of chloroquine

Blocks plasmodium heme polymerase

431

Antihelminthic drugs

Mebendazole, pyrantel pamoate, ivermectin, DEC, praziquantel. They all immobilize helminths

432

Amantadine

Blocks viral penetration and uncoating (M2 protein). Causes release of dopamine from nerve terminals

433

Use and toxicity for amantadine

Influenza A, Parkinsons disease. Causes ataxia, dizziness, slurred speech. 90 pct of influenza A resistant to amantadine

434

Zanamivir and oseltamivir

Inhibit neuraminidase, decreasing release of progeny viruses. Use in both Influenza A and B

435

Ribavirin

Inhibits synthesis of guanine nucleotides by competitively inhibiting IMP dehydrogenase. Use in RSV and Hep C. Can cause hemolytic anemia, is teratogenic

436

Activation and Action of Acyclovir

Monophosphorylated by HSV/VZV thymidine kinase. Guanosine analog

437

Uses of acyclovir

HSV, VZV, EBV. Use famciclovir for herpes zoster

438

Toxicities of acyclovir

Can cause crystalline nephropathy if adequate hydration not provided

439

Uses of ganciclovir

CMV

440

Toxicities of gancicyclovir

Leukopenia, neutropenia, thrombocytopenia, renal toxicity. Much more toxic than acyclovir

441

Foscarnet

Viral DNA pol inhibitor (binds pyrophosphate-binding site, no activatoin required).

442

What effect does foscarnet have on electrolyte levels

Can chelate Ca and promote Mg wasting (leads to low Ca and Mg levels)

443

Cidofovir

Inhibits viral DNA pol. Does not require phosphorylation. Nephrotoxic (give with probenecid)

444

HAART regimens

2 NRTIs with 1 NNRTIs or 1 PI or 1 Integrase inhibitor

445

Lopinavir, atazanavir, darunavir, fosamprenavir, saquinavir, ritonavir, indinavir

Protease inhibitors

446

Toxicities of protease inhibitors

Hyperglycemia, GI intolerance, lipodystrophy (fat redistribution similar to Cushings)

447

NRTIs (7)

Tenofovir, Emtricitabine, Abacavir, Lamivudine, Zidovudine, Didanosine, Stavudine

448

Toxicities of NRTIs

Bone marrow suppression, peripheral neuropathy, lactic acidosis, rash, megaloblastic anemia

449

NNRTIs (3)

Nevirapine, Efavirenz, Delaviridine

450

Raltegravir

Integrase inhibitor. Inhibits HIV genome integration. Can cause hypercholesterolemia

451

Uses for each of the interferons

Alpha - Chronic Hep B and C, Kaposi sarcoma. Beta - MS. Gamma - NADPH oxidase deficiency

452

Toxicities of the interferons

Neutropenia

453

Antimicrobials to avoid in pregnancy

Countless SAFe Moms Take Really Good Care. Clarithromycin, Sulfonamides, Aminoglycosides, Fluoroquinolones, Metronidazole, Tetracyclines, Ribavirin, Griseofulvin, Chloramphenicol

454

What bacterium likes the gallbladder?

Salmonella typhi