NMBE 16 Notes

Question 1

Phylogeny Nocardia

Answer 1

gram pos filamentous branching rod (like actinomyces israelii)
BUT obligate aerobe (actinomyces isreaelii is obligate anaerobe)

weakly acid fast - mycolic acid in cell wall

Question 2

Where is nocardia found?

Answer 2

Soil, but does not make spores

Question 3

Nocardia, catalase ?

Answer 3

Positive

CGD patients are at increased risk of infection with cat pos organisms

Question 4

Immunocompromised status;
Men affected more than women;
pneumonis w/ lung abscess formation - cavitary lesions
affinity for neural tissue - brain abscesses;
cutaneous symptoms - pyogenic response with indurated lesions

Answer 4

Nocardiosis
dont have to have all the symptoms (ie cutaneoue nocardiosis can stand alone)

tx w/ sulfonamides

Question 5

Tx for actinomyces

Answer 5

Penicillin

Question 6

Large gram positive rods in chains

Answer 6

Bacillus anthracis
obligate aerobe
forms spores

Question 7

Strep pneumo, capsule?

Answer 7

Yes

Question 8

Capsule of bacillus anthracis is unique how?

Answer 8

Made of protein - poly-D-glutamate

Question 9

LF and EF (both must be present to cause symptoms)

Answer 9

Bacillus anthracis toxins
EF - increase in cAMP
LF - protease that cleaves MAP kinase –> tissue necrosis in black eschar

Question 10

Tx for anthrax

Answer 10

Fluoroquinolones or doxycycline

Question 11

Cestode is a fancy word for

Answer 11

tapeworm

Question 12

Intermediate for tenia saginata

Answer 12

cattle

t. solium - pig - characteristic hooks

Question 13

Ingest tenia eggs –>

Answer 13

neurocystercircosis
water contaminated with animal feces
swiss cheese on head CT, seizures or hydrocephalus

regular cysterciscosis –> can be cutaneous, or anywhere in the body

Question 14

Ingest tenia cysts –>

Answer 14

teniasis

GI problems or asymptomatic

Question 15

Tx tenia

Answer 15

Praziquantel

If neurocystercircosis –> add albendazole

Question 16

How to dx fish tapeworm

Answer 16

Proglottid segments on stool O&P

Question 17

Eggshell calcifications in liver mass

Answer 17

Echinochocis - sheep tapeworm

If cysts rupture –> anaphylaxis

Question 18

Main virulence factor for strep pneumo

Answer 18

Polysaccharide capsule

Other virulence factor is IgA protease –> invasion and colonization of mucosa

Question 19

Strep pneumo is optochin ___

Answer 19

sensitive

viridans is optochin resistant

Question 20

Lancet shaped gram positive diplococci

Answer 20

Strep pneumo

Question 21

Strep pneumo is bile ___

Answer 21

soluble

Question 22

MOPS

Answer 22

Strep pneumo pneumonic:
Meningitis
Otitis Media
Pneumonia
Sinusitis
#1 cause of all these diseases

Question 23

Tx strep pneumo

Answer 23

Erythromycin (Macrolide);

Ceftriaxone;

Question 24

Strep viridans capsule?

Answer 24

No (jester costume)

but he is bile resistant!

Question 25

Endocarditis of previously damaged heart valves

Answer 25

Strep viridans | adheres to fibrin and platelets - dextrans (glue)

Question 26

Defect in lysosomal trafficking enzyme; LYST gene MT dysfunction in phagosome-lysosome fusion; AR

Answer 26

Chediak-Higashi syndrome ``` peripheral neuropathy mild coagulation defects pancytopenia recurrent pyogenic infections partial abinism ```

Question 27

Delayed separation of umbilical cord

Answer 27

Leukocyte adhesion deficiency Absence of neutrophils at sites of infection Defect in LFA-1 integrin (CD18) protein in phagocytes AR Impaired migration and chemotaxis

Question 28

Cutaneous T-cell lymphoma Adults CD4+ T -cells with "cerebriform" nuclei Rash

Answer 28

Mycosis fungoides | May progress to Sezary syndrome (T-cell leukemia)

Question 29

Sideroblastic anemia | What vitamin deficiency as possible cause?

Answer 29

B6 (pyridoxine) --> activatef to pyridoxyl phosphate water soluble involved in heme synthesis and protein catabolism

Question 30

Main function of vitamin E (alpha-tocopherol)

Answer 30

free radical scavenger

Question 31

kallikrein

Answer 31

serine protease | unregulated action of kallikrein --> increase in bradykinin --> angioedema (hereditary w/ C1 esterase deficiency)

Question 32

Class and function - Lamivudine

Answer 32

NRTI competitively binds RT and terminates DNA chain HIV therapy Other NRTIs - Abacavir, Didanosine, Emtricitabine, Stavudine, Tenofovir, Zidovudine

Question 33

NRTI Didanosine for HIV has what notable SE?

Answer 33

Pancreatitis

Question 34

Class and Function - Nevipiramine

Answer 34

NNRTI HIV therapy Binds to RT at different site than NRTI, does not require phosphorylation to activate Other NNRTIs - Delavirdine, Efavirenz

Question 35

Class and function - Indapamide

Answer 35

thiazide-like diuretic sulfonamide HTN and decomp HF

Question 36

Function and indication - Clomiphene

Answer 36

Estrogen receptor antagonist in hypothalamus Prevents normal feedback inhibition of LH and FSH to stimulate ovulation Tx PCOS infertility

Question 37

Class and function - Phenoxybenzamine

Answer 37

Nonselective, irreversible alpha blocker | Tx Pheochromocytoma to prevent hypertensive/catecholamine crisis

Question 38

Indications for Clonidine

Answer 38

Sympatholytic - alpha-2 agonist --> reduces sympathetic outflow ADHD, Tourette limited application in hypertensive emergency

Question 39

Premature ovarian failure, FSH and LH levels?

Answer 39

High | Turner syndrome is one cause

Question 40

Cardiac anomalies in Turner syndrome

Answer 40

Bicuspid aortic valve (most common) Coarctation of the aorta Aortic root dilation w/ increased risk of aortic dissection

Question 41

"Seronegative" means

Answer 41

absence of rheumatoid factor | ie ankylosing spondylitis

Question 42

Aphasia Seizures, HA, fever Necrosis and hemorrhage of medial temporal lobes

Answer 42

Primary HSV-1

Question 43

S3 gallop

Answer 43

Mitral regurgitation | increased filling mid-diastole