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Multisystems Final Flashcards

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1
Q

Ethanol

A

Depressant that enhances the effects of GABA (GABAa agonist), induces the release of endogenous opioids, alters levels of serotonin and dopamine (NMDA antagonist) Chronic use a/w pancreatitis, fatty liver, alcoholic hepatitis, cirrhosis, fetal alcohol syndrome, Wernicke-Korsakoff syndrome, Mallory-Weiss syndrome Treat withdrawal with benzodiazepines Treat addiction with disufiram, naltrexone, acamprosate

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2
Q

Disulfiram

A

Inhibits aldehyde dehydrogenase leading to accumulation of acetaldehyde Resulting flushing, tachycardia, hyperventilation, and nausea leads to conditioned avoidance/aversion therapy in alcohol substance use

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3
Q

Naltrexone

A

Oral, long-acting opioid antagonist used for relapse prevention after opioid or ethanol detox

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4
Q

Acamprosate

A

Activates GABAa receptors and weak NMDA receptor antagonist (reduces Glu neurotransmission) Used to treat ethanol addiction

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5
Q

Heroin

A

Depressant opioid (µ receptor agonist) Leads to euphoria, miosis, respiratory depression Acute treatment with naloxone (opioid antagonist) Long-term treatment with methadone, buprenorphine/nalaxone, naltrexone

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6
Q

Naloxone

A

Opioid antagonist (IV, nasal spray) used to treat opioid overdose

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7
Q

Buprenorphine

A

Partial opioid agonist causes shorter and less severe opioid withdrawal Often combined with naloxone to prevent abuse

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8
Q

Amphetamines

A

Sympathomimetic stimulant Displaces monoamines via VMAT, inhibits MAO –> increased secretion of dopamine, NE, and serotonin Causes euphoria, hyperthermia, convulsions, seizures, cardiac arrest Treat with benzodiazepines

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9
Q

Cocaine

A

Sympathomimetic stimulant Inhibits reuptake of norepinephrine, dopamine, and serotonin Causes euphoria, hyperthermia, convulsions, seizures, cardiac arrest Treat with benzodiazepines

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10
Q

Lysergic acid diethylamide (LSD)

A

Partial agonist at 5-HT2A receptors Causes hallucinations, visual and auditory distortions, depersonalization

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11
Q

Tetrahydrocannbinol (THC)/Marijuana

A

Activation of CB1 cannabinoid receptors causes hallucination, physical relaxation, hyperphagia, impaired memory, decreased muscle coordination, conjuctivitis

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12
Q

Fomepizole

A

Inhibits alcohol dehydrogenase to prevent accumulation of toxic metabolites after ingestion of methanol or ethylene glycol

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13
Q

Clonidine

A

α2 receptor agonist reduces the severity of opioid withdrawal symptoms by reducing the activity of noradrenergic neurons in the locus ceruleus

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14
Q

Varenicline

A

Reduces central stimulation by nicotine and reduces dopamine release Side effects include liver injury and depression

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15
Q

Which malarial drugs can you use for prophylaxis?

A

Chloroquine (suppressive) Mefloquine (suppressive) Doxycycline (suppressive) Atovaquone-proguanil (causal)

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16
Q

Which malarial drug can prevent relapsing malaria from P. ovale or P. vivax?

A

Primaquine

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17
Q

Chloroquine

A

Prevents plasmodium from polymerizing heme to hemozoin –> accumulation of heme results in oxidative damage to membranes –> lysis of parasite and RBC First line treatment for all non-resistant plasmodium species (Central America, Haiti, Dominican Republic) Can be used as prophylaxis Can cause retinopathy, pruritis, and prolong QT interval

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18
Q

Mefloquine

A

Prevents plasmodium from polymerizing heme to hemozoin –> accumulation of heme results in oxidative damage to membranes –> lysis of parasite and RBC Use against malaria when other agents fail May cause vivid dreams, neuropsychiatric complications, and ECG abnormalities if taken with quinine/quinidine

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19
Q

Artemether/Lumefantrine

A

Heme iron cleaves the drug’s endoperoxide bridge producing free radicals Treatment of chloroquine-resistant P. falciparum

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20
Q

Quinidine

A

Interferes with heme polymerization –> lysis of parasite and RBC Used in the U.S. for life-threatening malaria May cause cinchonism (nausea, vomiting, tinnitus, vertigo, bitter taste, headache), hypoglycemia, QT prolongation

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21
Q

Quinine

A

Interferes with heme polymerization –> lysis of parasite and RBC Used outside the U.S. for life-threatening malaria Often given with doxycycline, tetracycline, or clindamycin May cause cinchonism (nausea, vomiting, tinnitus, vertigo, bitter taste, headache), hypoglycemia, QT prolongation

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22
Q

Artesunate

A

Heme iron cleaves the drug’s endoperoxide bridge producing free radicals Used to treat life-threatening malaria (IV)

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23
Q

Primaquine

A

8-aminoquinoline metabolites act as schizonticidal oxidants Eradicates tissue forms of plasmodia and prevents recurring malaria (P. vivax and P. ovale) Gametocytic –> prevents transmission Test for G6PD deficiency to prevent hemolytic anemia Contraindicated in prengnancy (don’t know G6PD status of fetus)

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24
Q

Sulfadoxine-Pyrimethamine

A

Inhibits dihydrofolate reductase and dihydropteroate synthase, respectively which inhibits nucleic acid synthesis Can be used to treat malaria during pregnancy Side effect include megaloblastic anemia –> leucovorin rescue

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25
Atovaquone-proguanil
Atovaquone inhibits mitochondrial electron transport Proguanil inhibits dihydrofolate reductase Used to treat malaria (chloroquine-resistant P. falciparum) and as prophylaxis Take with food/milk Reports of treatment failure if \> 220 lbs.
26
What is the WHO treatment guideline for uncomplicated malaria?
Aremether-lumefantrine Artesunate plus amodiaquine Artesunate plus mefloquine Artesunate plus sulfadoxine/pyrimethamine
27
What is the WHO treatment guideline for severe malaria?
IV Artesunate IV Quinine Okay during pregnancy
28
What is the CDC treatment guideline for uncomplicated malaria?
Atovaquone-Proguanil Artemether-Lumefantrine Quinine + doxy/clindamycin
29
What is the CDC treatment guideline for severe malaria?
Quinidine gluconate IV Artesunate Okay during pregnancy
30
Staphylococcus aureus
Gram + cocci in clusters Catalase + Coagulase + a/w acute endocarditis in IV drug abusers and diabetics Large vegetations that destroy the valve, commonly tricuspid Secondary bronchopneumonia, blepharitis, conjuctivitis, endophthalmitis (post-surgical, post-trauma, hematogenous), otitis externa, sinusitis, osteomyelitis in children, furuncle Characterized by focal destructiveness, puss, neutrophilic inflammation, and abscess formation Can cause scalded skin syndrome when exofoliative A and B toxins cleave desmoglein 1 Toxic shock syndrome
31
Staphylococcus epidermidis
Gram + cocci Catalase + Coagulase - Novoicin sensitive Less virulent than S. aureus a/w endocarditis with prosthetic valves, complicated catheter-associated UTI; makes biofilm Characterized by focal destructiveness, puss, neutrophilic inflammation, and abscess formation
32
Measles
Paramyxovirus Enveloped -ssRNA --\> must bring RNA-dependent RNA polymerase Helical Replicates in the cytoplasm F (fusion protein) causes respiratory epithelial cells to fuse (syncitia) Koplik spots (red spots with blue-white center on buccal mucosa) precede descending maculopapular rash (CTL response) Sequelae include: post-infectious encephalitis, acute disseminated encephalomyelitis (ADEM), measles inclusion body encephalitis (MIBE), subacute sclerosing panencephalitis (SSPE), giant cell pneumonia (in immunosuppressed/malnourished)
33
Mumps
Paramyxovirus Enveloped -ssRNA --\> must bring RNA-dependent RNA polymerase Helical Replicates in the cytoplasm F (fusion protein) causes respiratory epithelial cells to fuse (syncitia) Causes parotitis (elevated amylase), orchitis (usually unilateral, can cause infertility in teenagers), meningitis
34
Treponema pallidum
Spirochete Causes syphilis (painless ulcers, patches, rashes, disseminated), congenital syphilis (including tooth deformities) Diagnose with darkfield microscopy, nontreponemal and treponemal serology tests Treat with penicillin G
35
Entamoeba histolytica
Intestinal protozoan parasite Transmitted from ingestion of cysts from contaminated food or water Causes dysentery, liver abscess (anchovy-paste), flask-shaped ulcers Dx: trophozoites with RBCs Rx: metronidazole
36
Clostridium difficile
Gram + rod Spores resistant to heat Anaerobic Toxin A and B Can cause diarrhea, pseudomembranous colitis, and toxic megacolon Risk factor include older age, Caucasian female, recent hospitalization, recent antibiotic use
37
Clostridium perfringens
Gram + rod Spore-forming Alpha-toxin (lecithinase) hemolyzes RBCs Myonecrosis Gas gangrene Food poisoning
38
Schistosoma
Intestinal trematode parasite Blood fluke Snails release cercariae into water that can penetrate skin Can cause liver and spleen granulomas, fibrosis (S. mansoni and S. japonicum) and urinary bladder granuloma (S. haematobium) Rx: praziquantel
39
Taenia solium
Intestinal cestode (tapeworm) parasite Ingestion of encysted larvae in pork --\> intestinal disease Ingestion of eggs --\> cysticercosis Rx: prazinquantel
40
Echinococcus granulosus
Intestinal cestode (tapeworm) parasite Ingestion of eggs from dog feces Causes liver cysts with internal daughter cysts Rx: albendazole
41
Strongyloides stercoralis
Intestinal nematode (roundworm) parasite Larvae penetrate skin --\> lungs --\> GI tract Larvae in stool, not eggs Autoinfection possible Hyperinfection syndrome in immunocompromised states Rx: ivermectin, albendazole
42
Neisseria meningitides
Gram - diplococci Catalase + Oxidase + Lipooligosaccharide endotoxin IgA protease Common cause of meningitis in infants, children, and adults Cutaneous manifestations (non-blanching petechial, purpuric, or ecchymotic rash) Waterhouse-Friderichsen syndrome (acute hemorrhagic necrosis of adrenal glands) Long-term sequalae include amputations, hearing loss, skin scarring
43
What bacterial diseases are transmitted by ticks?
Lyme (Borrelia burgdorferi), STARI, endemic relapsing fever (Borrelia hermsii), RMSF (Rickettsia rickettsii), sometimes tularemia (Franciscella tularensis) and Q fever (Coxiella brunetti)
44
What bacterial diseases are transmitted by mites?
Scrub typhus (Orientia tsutsugamushu), Rickettsialpox (Rickettsia akari)
45
What bacterial diseases are transmitted by body louse?
Trench fever (Bartonella quintana), epidemic typhus (Rickettsia prowazekii), epidemic relapsing fever (Borrelia recurrentis)
46
What bacterial diseases are transmitted by fleas?
Murine endemic typhus (Rickettsia typhi), bubonic plague (Yersinia pestis), cat scratch fever (Bartonella henselae)
47
Ribavirin
Guanosine analog and nucleoside inhibitor prevents viral RNA synthesis Used to treat hepatitis C, RSV, arenaviruses (Lassa fever, S. American hemorrhagic fever, LCMV), bunyaviruses (Congo-Crimean Hemorrhagic Fever, Rift Valley Fever, Hantavirus)
48
Bacillus anthracis
Gram + boxcar rods in chains Spore-forming Polypeptide capsule of D-glutamate EF and LF (A toxins) PA (B toxin) Cutaneous: black eschar Inhalational: widened mediastinum Gastrointestional Treat with ciprofloxacin
49
Borrelia bergdoferi
Lyme disease Deer tick (Ixodes) Spirochete Stage 1: erythema migrans, fever, lymphadenitis Stage 2: annular skin lesions, meningoencephalitis, Bell's palsy, arthritis, carditis Stage 3: arthritis, neuropathy Treat with doxycycline
50
Leptospira
Transmitted through water infected with animal urine Leptospirosis: acute febrile illness with conjunctival suffusion, jaundice, renal failure Treat with doxycycline
51
Borrelia recurrentis
Transmitted by body louse Spirochete Epidemic relapsing fever
52
Borrelia hermsii
Soft-shelled tick Spirochete Endemic relapsing fever
53
Rickettsia rickettsii
Gram - coccobacillus Obligate intracellular in endothelial cells Actin polymerization American dog tick (Dermacentor) Rocky Mountain Spotted Fever (rash on palms and soles) Treat with doxycycline
54
Rickettsia akari
Gram - coccobacillus Mite-borne Rickettsialpox Black eschar mimics anthrax Treat with doxycycline
55
Orientia tsutsugamushi
Gram - coccobacillus Mite-borne Scrub typhus
56
Rickettsia prowazekii
Gram - coccobacillus Louse-borne Epidemic typhus fever
57
Rickettsia typhi
Gram - coccobacillus Flea-borne Murine endemic typhus
58
Clostridium tetani
Gram + rod (tennis racket) Spore-forming Anaerobic Tetanospasmin toxin prevents release of GABA Spastic paralysis, lock jaw
59
Clostridium botulinum
Gram + rod Spore-forming Anaerobic Botulinum toxin prevents release of acetylcholine Flaccid paralysis Floppy baby syndrome (honey)
60
Erhlichia chaffeensis
Gram - Obligate intracellular in hematopoetic cells Lone star tick Human Monocytic Erhlichiosis Cytoplasmic mulberry inclusion in leukocytes
61
Anaplasma phagocytophilum
Gram - Obligate intracellular in granulocytes Deer tick (Ixodes) Granulocytic ehrlichiosis
62
Coxiella burnetii
Gram - rod Obligate intracellular Aerosol Contact with goats or sheep Q fever, atypical pneumonia
63
Trichinella spiralis
Tissue invasive nematode Ingestion of cysts in raw or undercooked meat Encysts in striated muscle
64
Wuchereria bancrofti
Larvae enter skin through mosquito bite Adults: lymphatics Microfilaria: lymph and blood at NIGHT Lymphatic filariasis, elephantitis, tropical pulmonary eosinophilia Treat with DEC
65
Onchocera volvulus
Larva enter wound of female black fly bite Adults and microfilaria live in subcutaneous nodules Causes river blindness Treat with ivermectin + doxycycline to kill Wolbachia bacteria
66
Angiostrongylus cantonesis
Ingestion of snails, slugs Rat lungworm disease --\> peripheral and CSF eosinophilia
67
Toxocara canis and toxocara catis
Ingestion of eggs in dog or cat feces Visceral larva migrans Treat with albendazole or mebendazole
68
Anisakis simplex
Ingestion of raw or undercooked seafood Inhabits stomach Kill larvae by freezing
69
Actinomyces israelii
Gram + rods in filamentous chains Anaerobic Molar colonies, sulfur granules a/w poor dentition, lumpy jaw
70
Propionibacterium acnes
Gram + rod Anaerobic Causes acne and infection of prosthetic devices
71
Fusobacterium nucleatum
Gram - rod Anaerobic Causes periodontal disease, pleuropulmonary infection, linked to colorectal cancer
72
Eikenella corrodens
Gram - rod Anaerobic Human bite wounds Smells like bleach
73
Acinetobacter baumannii
Gram - coccobacillus a/w war wounds Nosocomial
74
Yersinia pestis
Gram - rod Flea-borne Causes bubonic plague (painful buboes) or pneumonic plague
75
Ebola Virus Marburg Virus
Filovirus -ssRNA Pleomorphic shape Hemorrhagic fever
76
Congo-Crimean Hemorrhagic Fever
Bunyavirus Circular genome of ambisense RNA Hemorrhagic fever Treat with ribavirin
77
Lassa fever
Arenavirus --\> grainy appearance 2 strands of ambisense RNA Contact with rats in W. Africa Hemorrhagic fever, hearing loss, pregnancy complications
78
Lymphocytic choriomeningitis virus
Arenavirus --\> grainy appearance 2 strands of ambisense RNA Contact with mouse, hamster excreta Biphasic illness
79
Hantavirus
Bunyavirus 3 segments of -ssRNA Contact with rodents
80
Smallpox
Poxvirus Large, dsDNA Replicates in cytoplasm Brick-shaped virions
81
Molluscum contagiosum
Poxvirus DNA Spreads in pools, gyms Wart-like lesions with central ulcerations
82
Rabies
Rhabdovirus -ssRNA Bullet-shaped Negri bodies
83
SARS
Coronavirus +ssRNA a/w masked palm civets, bats ARDS, atypical pneumonia
84
MERS
Coronavirus a/w camels
85
Nipah/Hendra virus
Paramyxovirus -ssRNA a/w bats, horses
86
West Nile Virus
Flavivirus +ssRNA Bird are reservoir, bite of Culex mosquito Flu-like symptoms, encephalitis
87
Japanese Encephalitis
Flavivirus +ssRNA Birds and pigs are reservoirs Bite of Culex mosquito Encephalitis Vaccine
88
Yellow fever
Flavivirus +ssRNA Aedes aegypti mosquito bite Black vomit Vaccine
89
Dengue
Flavivirus +ssRNA 4 serotypes --\> hemorrhagic fever Bite of Aedes aegypti mosquito
90
Equine Encephalitis
Togavirus +ssRNA Culex mosquito Flu-like illness, encephalitis
91
Colorado tick fever virus
Reovirus 12 segments of dsRNA Not enveloped Wood tick
92
Franciscella tularensis
Gram - coccobacilli Facultative intracellular pathogen lives in macrophages Requires cysteine in grow
93
Brucella
Gram - rod Facultative intracellular, lives in RES Consumption of infected milk or milk products, exposure to cattle, pigs Causes undulant fever
94
Bartonella henselae
Gram - rod Flea-born Cat reservoir Causes cat scratch fever or bacillary angiomatosis
95
Bartonella quintana
Gram - rod Body louse-bore Causes trench fever, bacillary angiomatosis
96
Bartonella bacilliformis
Gram - rod Sand fly-borne Limited to Andes in Peru Causes Carrion's disease Phase 1: Oroya fever with hemolytic anemia Phase 2: verruga peruana
97
Pasteurella multicodia
Gram - coccobacillus Cat \> dog bites Resistant to clindamycin
98
Capnocytophagia canimorsus
Gram - rod Dog \> cat bite Resistant to TMP/SMX, aminoglycosides
99
Streptobacillus moniliformis
Gram - rod, branching Rat bite fever
100
Mycobacterium marinum
Fish tank granuloma
101
Vibrio vulnificus
Wound exposure to shellfish or warm salt/brackish water Can cause hemorrhagic bullae
102
Leishmania
Protozoal parasite with kinetoplast, live in WBCs Transmitted from bite of female sand fly Cutaneous, mucosal, or visceral forms Treat with amphotericin B, sodium stibogluconate
103
Trypanosoma brucei gambiense
Protozoal parasite with kinetoplast Bite of Tsetse fly Found in W. Africa (rivers) African trypanosomiasis (sleeping sickness) More common among endemic population Chronic presentation Mott cells (unsecreted IgM) Treat with suramin or melarsoprol
104
Trypanosoma brucei rhodesiense
Protozoal parasite with kinetoplast Bite of Tsetse fly Found in E. Africa (savannah) African trypanosomiasis (sleeping sickness) More common among travelers Acute presentation Mott cells (unsecreted IgM) Treat with suramin or melarsoprol
105
Trypanosoma cruzi
Protozoal parasite that enters the host from the feces of the kissing bug (Reduviid bug) Causes Chagas disease/American trypaosomiasis Acute: Romana's sig (unilateral, painless, periorbital edema) Chronic: cardiomyopathy, GI disease Treat with benznidazole or nifurtimox
106
Loa loa
Tissue invasive nematode Larvae enter wound from Chrysops fly Adults: subcutaneous nodules Microfilaria: blood during DAY Causes calabar swelling, can be in eye Treat with DEC unless high microfilaria load
107
What diseases are caused by Ixodes ticks (deer ticks)?
Lyme disease Babesia Anaplamosis

Multisystems (2 decks)

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