POD E3 Flashcards
(323 cards)
1
Q
What is in fungi cell wall? cell membrane?
A
cell wall- chitin and glucan
cell membrane- ergosterol
2
Q
difference in mold and yeast?
A
yeast- unicellular, reproduce by budding
mold- multicellular filamentous; long filaments (hyphae) or a mat (mycelium)
3
Q
2 types of hyphae
A
coenocytic- non-septated
septate- single cells separated by cross walls
4
Q
what is dimorphism?
A
fungi exists in two diff forms (typically mold in the cold and yeast in the heat)
5
Q
what are the different classifications of fungal infections?
A
superficial- outermost layers of skin & hair
cutaneous- extends deeper into epidermis; invasive hair/nail diseases
subcutaneous- dermis, subcutaneous tissues, muscle, & fascia
systemic (deep seated)- originate primarily in lung, may spread to many organs
opportunistic- members of normal flora when host defenses compromised
6
Q
what lab technique provides digestion and clarity of the tissue so fungi can be observed?
A
KOH mount
7
Q
what stain detects fungal cell wall chitin by fluorescence?
A
calciflor white stain
8
Q
what fungal stain stains yeasts and hyphae, reacting with chitin and aldehyde?
A
periodic acid Schiff reagent
9
Q
what is the best stain for detecting all fungi? stains hyphae and yeast forms black against green background
A
GMS (gomori methanamine silver) stain
10
Q
can Gram stain be used for fungi?
A
yes, stains most yeasts and hyphal elements; however, fungi not classified as Gram +/-
11
Q
what organisms are the Giemsa stain useful?
A
Histoplasma capsulatum, Pneumocystis jirovecii; also stains others
12
Q
what is the most commonly used agar for culturing fungi?
A
Sabouraud’s agar
13
Q
this fungal species is a dimorphic fungi that produces pseudohyphae & is the fourth most common cause of nosocomial bloodstream infections? part of the normal human flora
A
Candida
14
Q
which fungus is known for forming germ tubes?
A
Candida albicans
15
Q
what are virulence factors of C. albicans?
A
adhesins, germtube/hyphal formation, gliotoxin (immunosuppressive toxin)
16
Q
where is Candida primarily found?
A
GI tract (From mouth to rectum); part of normal flora
17
Q
infections caused by Candida?
A
- thrush (white patches on oral mucosa)
- vaginal candidiasis: thick, white “cottage cheese/curd-like” discharge; itching/burning
- dermatitis: diaper rash; assoc w/ moisture
- onychomycosis & paronchia: nail tissue destruction
18
Q
how is Candida detected/diagnosed?
A
- KOH w/ calcifluor white stain detected under microscope (can see budding yeast and pseudohyphae)
- germ tube test- IDs C. albicans
19
Q
treatment of Candida?
A
- azoles for mucosal/cutaneous infections
- ampho B (IV) & flucytosine for systemic infection
20
Q
this fungus exists in mold form, is not dimorphic, and forms septate hyphae? forms acute branching angles and is responsible for allergic manifestations as well as pulmonary effects
A
aspergillus
21
Q
treatment for aspergillus
A
amphotericin B or 5-flucytosine; surgical removal of infected tissue
22
Q
this aseptate mold can cause rhinocerebral, pulmonary, and subcutaneous disease; fungi invade blood vessel walls, causing tissue necrosis
A
mucormycosis (Rhizopus, Mucor, & Absidia species)
23
Q
rhinocerebral mucormycosis penetrates the cribiform plate and invade surrounding tissue, causing necrosis. what patients are at increased risk for this?
A
diabetics, esp those with DKA; as well as severely burnt, and immunocompromised; treatment is amphotericin B and correction of underlying predisposing condition
24
Q
what is the most common cause of fungal meningitis?
A
Cryptococcus neoformans
25
which yeast-like fungi has an anti-phagocytic capsule? (only fungi w/ capsule!)
Cryptococcus
26
what stain is used for Cryptococcus? how is it identified
India ink-- appears as distinguishing "halos"; also capsular polysaccharide antigen test via latex agglutination test
27
treatment for cryptococcal meningtitis & other forms of cryptococcal infections?
amphotericin B plus flucytosine followed by consolidation therapy w/ fluconazole or itraconazole
28
this "round cup" shaped fungal organism looks like a protozoa and lacks ergosterol
Pneumocystis carini (jiroveci)
29
how is PJP diagnosed, and what is the treatment?
microscopy of biopsy or BAL fluid; has "ground glass" appearance on radiograph; use Gomori's methanamine silver stain-- see round cup shaped organism
Tx!: TMP-SMX (trimethoprim-sulfamethoxazole) or pentamidine isothionate in sulfa allergies
30
what type of macrophages are primarily involved in terminating inflammation and inducing repair?
M2 (alternatively activated) type
31
tissues are able to replace damaged components and return to normal state
regeneration
32
injured tissues are incapable of complete restitution, or supporting structures of tissue are severely damaged; repair occurs by laying down connective tissue; may result in scar; excessive deposition of collagen
fibrosis
33
what are the main components of connective tissue repair?
angiogenesis, formation of granulation tissue, and remodeling of CT
34
what are some factors that affect tissue repair?
infection***; diabetes; nutritional status; glucocorticoid use; poor perfusion; mechanical factors; foreign bodies; type/extent of tissue injury & location
35
what are the first type of cells involved in tissue repair? when are they replaced and by what?
neutrophils= 1st cell; replaced by macrophages by day 3; macrophages= main cell for repair
36
differences in 1st vs. 2nd intention healing
2nd intention: large wounds where cell/tissue loss is more extensive; form larger amounts of granulation tissue, inflammation more intense, greater scar tissue mass; involves contraction of myofibroblasts
37
compare/contrast keloid and hypertrophic scars
both due to excessive amounts of collagen, whose formation persists for a longer period of time than normal
keloids often extend beyond site of original injury, rarely regress, will recur if excised; have higher incidence among those with darker pigmented skin
38
what are the hallmarks of inflammation?
heat (calor), redness (rubor), swelling (tumor), pain (dolor); also loss of function (functio laesa)
39
what are the 5 R's of inflammation?
recognition; recruitment; removal; regulation; resolution/repair
40
features of acute vs. chronic inflammation
acute: short duration, hours-days; develops w/in minutes-hours; mostly neutrophils; mild & self-limited tissue damage; HALLMARK= increased vascular permeability/leakage; innate immunity
chronic: slow onset (days); longer duration; macrophages main cell; often severe & progressive tissue injury; adaptive immunity
41
3 main processes at site of (acute) inflammation
1) vasodilation (brief initial vasoconstriction followed by vasodilation
2) vascular leakage & edema (increased vascular permeability)
3) leukocyte emigration to extravascular tissues
42
exudate vs. transudate
exudate- extravascular fluid w/ high [protein] & cellular debris; presence implies an increase in permeability of blood vessels
transudate- fluid w/ low protein content (mostly albumin), little/no cellular material, & low specific gravity; result of osmotic or hydrostatic imbalance
43
what is the hallmark of acute inflammation?
increased vascular permeability (vascular leakage)
44
what are 2 mechanisms for increased vascular permeability?
```
-retraction of endothelial cells resulting in increased
interendothelial spaces (most common mechanism); mediated by histamine, bradykinin, leukotrienes; occurs rapidly and is short-lived
-increased transport of fluids & proteins (transcytosis) through the endothelial cell; may involve intracellular channels (stimulated by VEGF)
```
45
steps of leukocyte recruitment to sites of inflammation
- margination, rolling (selectins), & adhesion to endothelium (integrins)
- migration across endothelium & vessel wall (CD31/PECAM)
- migration in tissues toward chemotactic stimulus (chemotaxis; involves endogenous- IL-8, C5a, LTB4 and exogenous agents- LPS, N-formylmethionine)
46
3 steps of phagocytosis
1) recognition & opsonization of particle to be ingested
2) engulfment, w/ formation of phagocytic vacuole that then fuses w/ lysosomal granule (phagolysosome)
3) killing or degradation of ingested material
47
describe oxygen-dependent killing of ingested material
ROS are produced by assembly/activation of NADPH oxidase; ROS can act on ingested particles w/o damaging host cell; ROS converted to H2O2; H2O2 converted to hypochlorite (active ingredient in bleach) by myeloperoxidase; hypochlorite is a potent antimicrobial that destroys via halogenation or oxidation of proteins & lipids
48
what factors are involved in oxygen-independent killing of ingested material?
lysozyme, lactoferrin, & major basic protein
49
what is the role of NO in inflammation? what are the 3 types of NO?
relaxes vascular smooth muscle & promotes vasodilation; is an inhibitor of cellular component of inflammatory responses; 3 types- endothelial, neuronal, & inducible; eNOS & nNOS are constituitively expressed
50
describe characteristics of Chediak-Higashi disease
autosomal recessive; neutropenia w/ recurrent infections; aberrant granules in neutrophils & WBCs-- giant lysosomes; giant melanosomes
51
describe characteristics of Chronic Granulomatous disease
X-linked recessive (mostly); recurrent infections, esp. by catalase + organisms; defect in NADPH oxidase
52
distinguish between serous & fibrinous inflammation, and ulcer
serous- contains low MW proteins (mainly albumin); no cells; clear yellow fluid
fibrinous- contains larger proteins (esp. fibrin); no cells; often coats a surface
ulcer- local defect of surface of organ/tissue produced by necrosis of cells and sloughing/shedding of necrotic and inflammatory tissue
53
what is a hallmark of chronic inflammation?
tissue destruction
54
differentiate btwn the diff types of exudate
- purulent (suppurative): contain albumin, fibrin & other proteins as well as neuts (pus)
- eosinophils: eos are prominant; typically in type 1 HSR or parasite infections
- hemorrhagic: damage to endothelial cells & vessel walls allow RBCs to leak into surrounding tissue
55
a diffuse area of acute inflammation composed of edema fluid, bacteria, & neuts spread through tissue; typically in skin & sub-cu tissue
cellulitis
56
injury results in necrosis of affected tissue lining a surface; results in formation of a "membrane" composed of fluid, proteins, neuts, RBCs & necrotic tissue
pseudomembranous; seen in diptheria, enterocolitis
57
inflammation in tissue containing abundant mucin-secreting glands, likely to stimulate secretion
mucinous
58
a focus of acute inflammation composed of pyogenic exudate & necrotic tissue; can occur anywhere in body
abscess
59
a subcutaneous abscess
furuncle (boil)
60
coalesced furuncles
carbuncle
61
causes vasodilation, increased vascular permeability (principal mediator)
histamine; stored as preformed molecules in mast cells & basophils
62
what effect do cyclooxygenase inhibitors have?
inhibit both COX1 & COX2, inhibiting prostaglandin synthesis--treat pain & fever
63
what effect do lipoxygenase inhibitors have?
inhibit leukotriene production, useful in treating asthma
64
what effect do corticosteroids have?
broad-spectrum antiinflammatory agents; reduce transcription of genes coding for COX2, phospholipase A2, proinflammatory cytokines (TNF & IL1), & iNOS
65
what are prostaglandins (PGs)?
produced via COX1 & COX2; involved in pathogenesis of pain & fever in inflammation; come from mast cells, leukocytes
66
what are leukotrienes (LTs)?
produced by leukocytes & mast cells; involved in vascular & smooth muscle reactions and leukocyte recruitment; generated by lipoxygenase enzyme
67
what leukotrienes are responsible for vasoconstriction & bronchospasm?
LTC4, LTD4, LTE4
68
what leukotriene is a potent chemotactic agent & activator of neuts?
LTB4
69
what is platelet activating factor (PAF)?
phospholipid mediator generated by action of phospholipase A2; stimulates platelets, vasoconstriction, bronchoconstriction, vasodilation, increased vascular permeability; leukocyte activation
70
what are the functions of various complement proteins in inflammation?
C3a, C5a- anaphylatoxins; increase vascular permeability, cause vasodilation by binding mast cells & inducing histamine release
C5a- chemtactant; increases adhesiveness of neuts to endothelium; stimulates synthesis & secretion of AA metabolites
C3b, iC3b- opsonization & phagocytosis
71
what is Hageman factor?
protein synthesized by liver (aka clotting factor 12-inactive form); provides source of vasoactive mediators; activates prokallikrein to kallikrein, which is involved in kinin cascade
72
what is bradykinin?
short-lived vasoactive peptide; vasodilator, increases vascular permeability, bronchial smooth m. contraction, pain
73
what are the primary cells in acute and chronic inflammation?
acute- neutrophils; chronic- macrophages
74
what cytokine activates macrophages?
IFNy
75
what are the characteristics of granulomatous inflammation?
presence of granuloma; presence of macrophage, lymphocytes & epithelioid cells; presence or absence of giant cell; sometimes central necrosis
76
what are epithelioid cells?
activated macrophages w/ abundant cytoplasm that begin to resemble epithelial cells
77
what are giant cells?
fusion of activated macrophages; multinucleate cells
78
difference in foreign body giant cells & immune granulomas
foreign body giant cell- absence of T-cell mediated immune response; foreign material can be identified in center of granuloma
immune granuloma- caused by variety of agents capable of inducing persistent T-cell mediated immune response; produces granulomas when inciting agent is difficult to eradicate
79
difference btwn caseating & noncaseating granuloma
- caseous: coagulative + liquefactive center; TB & fungal infections; granular, cheesy appearance, necrosis in center; activated macrophages have pink granular cytoplasm w/ indistinct boundaries
- non-caseating: reaction to foreign material; talc, suture, Crohn's disease, cat scratch disease; non-necrotic centers
80
what are major cytokines released by macrophages?
IL12, IL6, IL23
81
what are some non-specific indicators of inflammation?
"left shift" of neuts, ESR, CRP
82
when the number/percentage of immature neutrophils (bands) is increased in certain infections (esp. bacterial)
left-shift; a leukemoid reaction is when you have a very high WBC w/ pronounced left-shift
83
the rate at which RBCs settle to bottom of a tube; determined by amount of protein in blood, esp. fibrinogen
erythrocyte sedimentation rate (ESR); increased in pts undergoing inflammatory response
84
glycoprotein synthesized by liver; non-specifically elevated in pts undergoing an inflammatory response
C-reactive protein (CRP)
85
substances that induce fever; what are exogenous & endogenous example?
pyrogens; exo- LPS; endo- IL1 & TNF
86
what is the role of prostaglandins in fever?
COX enzymes convert AA into PGs; in the hypothalamus, PGs (esp. PGE2) stimulate production of NTs that reset the temp set point at a higher level; NSAIDs reduce fever by inhibiting PG synthesis
87
what role does IL12 have in chronic inflammation?
increases production of IFNy; released from macrophages and dendritic cells
88
what chemokines are involved in pain?
bradykinin & prostaglandins
89
which drugs can be used to treat & prevent Influenza A? MOA= prevents virus from entering host cell
amantadine & rimantadine
| amantadine has more pronounced CNS ADR, rimantidine more likely to be safe in elderly
90
which drugs can be used to treat & prevent Influenza A AND B? MOA= inhibits neuroaminidase, which is required for release of virus from infected cell
osteltamivir (Tamiflu) & zanamivir; zanamir is a dry powder that must be inhaled, can cause bronchospasm
91
which viral Tx! is topical only and can be used for HSV cold sores?
penciclovir; MOA similar to acyclovir
92
this drug is phosphorylated to monophosphate form via HZV or VZV thymidine kinase
acyclovir; valacyclovir is a prodrug that converts to acyclovir via intestinal & hepatic metabolism (must be given orally); ADR= nephrotoxicity (crystal deposition in kidneys)
93
what is the DOC for viral encephalitis due to HSV?
IV acyclovir; can switch over to valacyclovir w/ improvement
94
what are some topical antiviral agents?
docosanol (Abreva), imiquimod, podofilox, podophyllin
95
what is Tx! for CMV?
ganciclovir & valganciclovir (prodrug); MOA similar to acyclovir; ADR= neutropenia, N/V, CNS effects; use for CMV retinitis prophylaxis & treatment
96
drug Tx! for AIDS pts w/ CMV retinitis?
valaganciclovir
97
prodrug used for HS/HZV infection w/ high oral bioavailability
famciclovir; MOA similar to acyclovir; best if started w/in 72 hours; renally excreted
98
2nd line Tx! for CMV; interacts w/ DNA pol as competitive inhibitor or alternate substrate
cidofovir; ADR: highly nephrotoxic--administer w/ normal saline to decrease ADR; must be administered w/ probenecid
99
2nd tier drug that competes for pyrophosphate in viral DNA pol; can be used for CMV or HSV in immunocompromised
foscarnet; ADR: electrolyte imbalance; seizures, EKG changes
100
topical Tx! for warts; induces local immuno-response (IFNs, TNF) to decrease viral load
imiquimod
101
what is Tx! for EBV?
rest, supportive care; no drug shortens symptoms; avoid strain if splenomegaly present
102
these drugs are CCNS; bind to guanine in DNA forming intrastrand crosslinks
platinum drugs (-platin ending); nephrotoxicity major ADR
103
drugs that bind tightly btwn base pairs in DNA; block activity of topoisomerase 2, & inhibit DNA repair; CCNS; can produce ROS
doxorubicin, daunorubicin, & related anthracyclines; unique ADR: cardiotoxicity
104
binds to DNA like doxorubicin; does not produce free radicals; lower cardiotoxicity risk
mitoxantrone
105
CCS drug that forms ternary complex w/ DNA topo2; kills in S & G2 phases
epipodophyllotoxins- etoposide & tenopside
106
CCS (S phase) inhibitors of topoisomerase 1
camptothecin, topotecan, & irinotecan (prodrug activated by tissue carboxyesterases)
107
drug mostly active in G2 phase; produces free radicals & breaks in DNA strand; unique toxicity of pulmonary fibrosis & pneumonitis
abx: bleomycins
108
CCNS drug that intercalates btwn DNA strands, preventing DNA transcription
dactinomycin (actinomycin D); most potent anti-tumor agent known; ADR- oral & GI ulceration, stomatitis
109
CCS (S phase) drugs that are folic acid analogs, inhibit dihydrofolate reductase
methotrexate, trimetrexate, pemetrexed; ADR- oral & GI ulcer, hepatotox, pulmonary tox
110
this drug is administered after MTX to minimize toxic effects of folate depletion in normal cells
leucovorin (citrovorum, folinic acid)
111
a pyrimidine antimetabolite that inhibits thymidylate synthase & decreases DNA synthesis; CCS at G1 & S
5-fluorouracil (5-FU)
112
pyrimidine antimetabolite that inhibits DNA pol alpha; CCS (S phase)
cytarabine
113
pyrimidine antimetabolite that inhibits DNA synthesis; CCNS
gemcitabine
114
purine antimetabolite that inhibits synthesis of A & G; CCS (S phase)
mercaptopurine (6-MP); inhibited by gout drug allopurinol
115
purine antimetabolite that inhibits synthesis of A & G; CCS (S phase)
thioguanine (6-TG)
116
adenosine deaminase inhibitors; decreases DNA synthesis; used in hairy cell leukemia, as well as other leukemias & lymphomas
pentostatin, cladribine**, & fludarabine
117
bind to soluble tubulin (key protein component of MTs), blocking polymerization & arrest cellular mitosis in metaphase (CCS- M phase)
vincristine, vinblastine, vinorelbine (think vines-- like tubules); ADR- peripheral neuropathy, alopecia, nephrogenic SIADH secretion
118
prevent MT depolymerization by binding & stabilizing tubulin; cells arrested in late G2 or M phase (CCS- M phase)
paclitaxel (Taxol) & Docetaxel (Taxotere); ADR- peripheral neuropathy
119
CCNS drug that blocks hormone production by adrenal gland
mitotane; ADR- fatigue, nausea; also destroys healthy adrenal tissue
120
CCNS drug that inhibits tumors by regulating host immune system; also have direct activity against cancer cells
IFN-alpha
121
used in estrogen receptor positive breast cancer; have weak estrogen activity
tamoxifen, toremefine
122
part of MOPP regimen; has anti-inflammatory properties & alters immune response; cause apoptosis in certain leukemic cells
prednisone
123
MOA of anti-androgens & the drug names
bicalutamide, flutamide, nilutamide; block androgen induced growth; combined w/ leuprolide or other LH releasing hormone; combo of anti-androgen w/ leuprolide facilitates total androgen ablation
124
CTLA4 inhibitors
ipilimumab, tremelimumab
125
PD1 inhibitors
nivolumab, pembrolizumab; ADR- fatigue, skin rash
126
blocks Bcr-Abl kinase
imatinib
127
drug that binds & inhibits Bcl-2 (an anti-apoptotic protein)
venetoclax
128
HDAC inhibitors
vorinostat & romidepsin
129
PARP-1 inhibitor (targets DNA repair process)
olaparib
130
most abundant & important precursor of eicosanoids; synthesized in liver from linoleic acid
arachidonic acid; phospholipases release AA from membrane
131
this enzyme produces prostanoids as their product from AA
cyclooxygenase; COX1= constitutive form, COX2= inducible form (inflammation & immune)
132
this molecule is a powerful vasodilator; inhibits platelet aggregation; inhibits gastric acid secretion & increases mucus secretion; & induces pain
PGI2
133
this molecule induces pain & fever; can contract & relax uterine smooth muscle
PGE2
134
this molecule is a major product of COX1; stimulates platelet aggregation; amplifies signal of thrombin & ADP
TXA2
135
this molecule is a vasoconstrictor; can terminate pregnancy; **decreases intraocular pressure--used for glaucoma
PGF2alpha
136
drug used to reduce ulcer formation; inhibits gastric acid secretion; contraindicated in pregnancy
misoprostol (PGE1 analog)
137
drug used for open angle glaucoma to reduce intraocular pressure
latanoprost (PGF2alpha analog)
138
temporarily maintains patent ductus arteriosus; can be used for ED
alprostadil (PGE1)
139
AA is converted by lipoxygenase enzyme to what molecules?
leukotrienes
140
what is the intermediate from AA to leukotrienes?
5-HPETE
141
what lipoxygenase products are chemotactic agents for leukocytes, eos, & monocytes?
5-HPETE & LTB4
142
these lipoxygenase products are potent bronchoconstrictors & can increase vascular permeability
LTC4, LTD4, LTE4
143
what drug is a 5-lipoxygenase inhibitor?
zileuton; prophylaxis for asthma; affect CYPs (drug-drug interactions); contraindicated in liver disease
144
what drugs are competitive LTD4 receptor antagonists?
zafirlukast & montelukast; inhibit LT effects of bronchoconstriction & vascular permeability; used for prophylactic asthma Tx!, allergic rhinitis
145
which is better, zafirlukast or montelukast, why?
montelukast- given once daily (instead of 2x); has less ADR & no drug-drug interactions; does not have to be taken on empty stomach; can be used in children
146
drugs that inhibit cycloxygenases; are antipyretics, analgesics & anti-inflammatory
aspirin & tNSAIDs (propionic acid, acetic acid)
147
this drugs are selective COX2 inhibitors
celecoxib, valdecoxib, rofecoxib
148
ADRs of aspirin & tNSAIDs
increased risk of GI ulcers & pain; increased risk of bleeding (inhibit platelet aggregation); fluid retention (inhibit PG effects in kidney); hypersensitivity w/ aspirin; drug-drug interactions w/ ACE inhibitors, glucocorticoids & warfarin
149
irreversible inhibitor of COX; acetylates serine residue on enzyme; used for antipyretic, anti-inflammatory & analgesic; prevents platelet aggregation (prolongs bleed time)
aspirin (acetyl salicylate); ADR- GI pain, bleeding, ulcers
150
fatal, fulminating hepatitis w/ cerebral edema in children
Reye's syndrome; do not use aspirin in children w/ viral infection
151
characterized by tinnitis, high frequency hearing loss, HA, N, & dimness of vision; reversible
salicylism; mild intoxication w/ aspirin, salicylates
152
competitive, reversible active site inhibitors of COX1/2; analgesic, antipyretic, anti-inflammatory; less GI problems
ibuprofen, naproxen
153
topical opthalmic preparation used for seasonal allergy & recovery from cataract Sx!; ADR of bleeding, hepatic effects
ketorolac; must stop before Sx!; cannot use w/ h/o peptic ulcer or GI bleeding; do not use w/ aspirin/other NSAIDs or w/ probenecid (gout drug)
154
most commonly used tNSAID in Europe; COX2 selectivity; contraindicated in pregnancy; metabolized by CYP2C9
diclofenac
155
specific for COX1; used to close patent ductus arteriosus--decreases PGE levels; use for arthritis, tendinitis, AS
indomethacin; ADR= renal toxicity, must monitor levels; displaces bilirubin from albumin
156
selective COX2 inhibitor; has increased risk for stroke & MI; used in arthritis, AS, primary dysmenorrhea; metabolized by CYP2C9
celecoxib; ADR- GI pain, nausea
157
risk of using of NSAIDs during pregnancy?
bleeding during delivery (if used in last trimester); premature closure of PDA; inhibit uterine motility
158
effect of PGs in kidney?
PGI2 & PGE2 increase GFR & RBF; PGE2 inhibits Cl- reabsorption in thick ascending LOH; NSAIDs lower renal PGI2 & PGE2-- result in decreased RBF & GFR, increased tubular reabsorption of water
159
what kidney hormones are effected by PGs?
PGE2 inhibits ADH effect; PGI2 & PGE2 stimulate renin release; NSAIDs lower PG levels-- result in enhanced ADH effect (water retention), decreased renin lowers aldosterone and leads to decreased K+ secretion (hyperkalemia- most likely in elderly, diabetics, or other diminshed renal function)
160
alternate drug in aspirin sensitive pts; not a NSAID; antipyretic & analgesic but weak anti-inflammatory; weak inhibitor of COX1/2; does not alter platelet function or uric acid levels
acetaminophen; ADR: #1 cause of drug induced liver failure in US; renal toxicity
161
what are DMARDs?
disease modifying anti-rheumatic drugs; immune modulators that restore normal immune environment w/in joint synovium; slow-acting; little analgesic or anti-inflammatory effect (not COX inhibitors); slow course of disease, prevent joint damage, preserve S&F of joints; used for active RA
162
what is the MOA of resistance to chloroquine?
polymorphisms in pfcrt gene codes for transport protein in acidic digestive vacuole membrane; resistant parasites actively transport chloroquine out of vacuole
163
what is the only drug available for treating exoerythrocytic hypnozoite forms of P vivax & P ovale in the liver
primaquine
164
what condition is primaquine contraindicated in?
G6PD deficiency--causes hemolysis
165
quinine has this ADR
cinchonism- dose related, reversible; tinnitus, dec hearing, HA, N/V, visual disturbances
166
this malarial drug causes vivid dreams & neuropsych symptoms; can be used for prophylaxis & Tx!
mefloquine
167
DOC for parenteral therapy in chloroquine resistant P. falciparum where quinine not available; can cause EKG changes & hypotension
quinidine
168
this malarial drug's MOA is to bind & reversibly inhibit dihydrofolate reductase; which can lead to anemia due to decreased folic acid (give leucovorin)
pyrimethamine +/- sulfadoxazine
169
this combo drug has minimal toxicity and is used for malaria chemoprophylaxis & Tx! of uncomplicated P. falciparum
atovaquone-proguanil (malarone)
170
this malarial drug may produce toxic heme adducts & oxidant stress; not used for chemoprophylaxis; derived from plant
artemisinin & derivatives
171
what is the most prevalent enteric parasite in the US?
giardia; Tx! metronidazole (most common), tinidazole or nitazoxanide
172
this amebicidic agent can cause a disulfiram-like effect and should not be taken with alcohol
metronidazole
173
what is the DOC for strongyloidiasis? what is its MOA?
ivermectin; GABA receptor agonist
174
what drug is most commonly used for strongyloidiasis but is not DOC?
thiabendazole
175
drug used to treat all forms of schistosomiasis
praziquantel
176
what differences btwn fungi & mammals are exploited in creating anti-fungal drugs
fungi cell wall contains chitin (gives strength) & ergosterol (instead of cholesterol)
177
MOA & ADR of amphotericin B
- binds to ergosterol of fungal plasma membrane, forms pores; broad spectrum
- ADR: nephrotoxicity!! (80% of people receiving drug); anemia; can cause infusion-related effect
178
what is flucytosine converted to & how?
deaminated to 5-FU by fungus specific enzyme, cytosine deaminase; acts as antimetabolite competing w/ uracil; co-administered w/ ampho B (resistance can be problem when used alone); ADR- bone marrow hypoplasia, elevated hepatic enzymes
179
MOA of azoles
interfere w/ fungal cyt P450 dependent enzyme used for demethylation of lanosterol & conversion to ergosterol
180
what anti-fungal drug can be used in treating Cushings? why?
ketoconazole; azoles depress serum testosterone & adrenocorticotropic hormone (ACTH) hormones
181
what is DOC for coccidioidomycosis, meningitis?
fluconazole due to great CSF penetration & less morbidity than intrathecal ampho B
182
this anti-fungal is an echinocandin that blocks cell wall synthesis- inhibits glucan synthesis; can increased LFTs & SrCr
caspofungin acetate
183
this anti-fungal disrupts cell mitotic spindle structure & arrests cell division in metaphase; administered orally
griseofulvin
184
this drug inhibits squalene epoxidase
terbinafine
185
which drug has an ADR of onychomycosis?
terbinafine
186
what drugs are used to treat oral candidiasis (thrush)?
nystatin oral (swish & swallow); clotrimazole troches; ampho B suspension
187
where does viral varicella zoster DNA reside?
dorsal root ganglia; majority are thoracic
188
characteristic of varicella chickenpox lesions
asynchronous development of lesions (successive crops of lesions)
189
what are characteristics of the varicella vaccine?
live attenuated (CMI & humoral immunity); must have TWO doses
190
is there a zoster vaccine?
yes; zostavax given to 60 yo & up, one dose; shingrix-recombinant (recommended) given in 2 doses
191
what syndrome can arise if pts w/ chickenpox are given aspirin?
Reyes syndrome; hepatic failure, encephalopathy
192
what type of virus is CMV?
dsDNA, icosahedral capsid, enveloped; beta genus of herpetoviridae
193
what is seen on microscopy that is diagnostic of CMV?
large "owl eye" inclusions in nucleus; enlargement of cell
194
what is unique about CMV genome?
has dsDNA genome PLUS viral messenger RNA
195
what is the most common virus caused congenital infection?
CMV; infects fetus in utero, mother is carrier
196
what defines CMV mononucleosis?
heterophile negative
197
how can CMV be transferred?
blood, breast milk, bodily secretions, sex, transfusions/transplants
198
how long can one have CMV infection before CPE becomes a prominent feature?
four-six weeks
199
what is the infectious process of CMV?
biological fluids are introduced into oral cavity (aerosol); an upper respiratory infection; infected lymphocytes & monocytes spread virus to secondary sites
200
characteristics of picornaviridae
ssRNA, icosahedral, NOT enveloped; positive stranded RNA
201
describe attachment & uncoating in picornavirus
- attachment: lose VP4 from capsid; penetrate via endocytosis (no envelope--cannot fuse)
- uncoating in cytoplasm (where replication occurs); remove VP1, 2, &3 to release genome
202
this structure is essential for picornavirus mRNA translation
internal ribosome entry site (IRES)
203
translation of picornavirus
+RNA w/o VPg (gets removed) translated to polyprotein P123, a precursor protein that is proteolytically cleaved to structural polypeptides & enzymes; cleavage products include: P1 [becomes VP1, VP3, VPo--> VP2, VP4], P2 (--> proteases), and P3 (--> VPg & 3D--RNA dependent polymerase + Hf)
204
replication of picornavirus
+RNA w/ VPg; occurs in cytoplasm; replicative intermediate (RI) formed due to +RNA being converted to many -RNAs
205
characteristics of orthomyxoviridae
includes influenza type A, B, C; ssRNA, negative polarity; helical nucleocapsid (must have envelope); RNA dependent RNA pol is part of nucleocapsid
206
what proteins are influenza strain-specific AgS?
hemagglutinin & neuraminidase
207
where does orthomyxoviridae replication occur?
nucleus
208
influenza replication
H protein binds sialic acid containing receptors; penetrates cell via endocytic process & is enclosed in acidic vacuole, which facilitates fusion of virus envelope & vacuole membrane, releasing genome into cytoplasm; viral RNA, RNA pol complex, & assessor proteins travel to nucleus; each -RNA copied to + strand
viral RNA pol (PB1) mediated in nucleus!; - strand RNA copied into full size + RNA through formation of replicative intermediate; + RNA strand serves as template for - RNA synthesis
209
influenza transcription/translation
viral mRNA transcribed from - strand RNA template in nucleus; viral mRNA has 3' poly A tail added & capped RNA at 5' end (capped RNA primer donated by cell mRNA); each mRNA leaves nucleus & is translated in assoc w/ ER or free in the cytoplasm
210
what virus forms an extracellular virus via budding?
influenza; facilitated by H & N proteins
211
____ is the major antigen for immunity in influenza
H (hemagglutinin); additive effect if N also changes
212
antigenic ____ refers to H&N varies antigenically due to point mutations; can lead to what?
antigenic DRIFT; epidemics
213
antigenic ____ refers to H&N varies antigenically due to gene reassortment btwn human & animal influenza virus; can lead to what?
antigenic SHIFT (presentation of entirely new antigens to population w/ no immunity); pandemics
214
______ refers to the propensity of the body's immune system to preferentially utilize immunological memory based on a previous infection when a second slightly different version of that foreign entity (e.g. influenza A) is encountered
antigenic sin
215
characteristics of retroviridae
```
complex structure (helical nucleocapsid + icosahedral, or cylindrical); 2 identical ssRNA strands joined by tRNAs-- "diploid genome"; RNA dependent- DNA pol (reverse transcriptase); enveloped
subfamilies: oncovirinae, lentivirinae, & spumavirinae
```
216
RNA genes of retroviridae
GAG- Pol- Env- ONC (+/-)
217
2 categories of cancers caused by retroviridae
chronic leukemia- lack ONC; no SRC gene
acute leukemia/sarcoma- usually lack Env (requires helper virus--supplies envelope), but have ONC; SRC or other oncogene present; exception- Rous Sarcoma has all genes
218
replication of retrovirus
- provirus formation takes place in cytoplasm, then transported to nucleus for integration in chromosomal DNA (mediated by integrase)
- conversion of genomic RNA to proviral DNA produces long terminal repeats- regulate expression
219
what viruses can transform cells AND produce progeny virus?
retroviruses; DNA tumor viruses can only do one or the other
220
modes of protooncogene activation
normally repressed & inactive in cell DNA, must be activated....
chemical carcinogens; insertion of provirus near protooncogene (regulatory LTR); translocation of protooncogene; oncogene (provirus) in cell DNA overdose cell w/ oncogene protein
221
what process changes activity of many proteins in viral cancer?
phosphorylation
222
what is RB gene & its function?
tumor suppressor gene; repress proto-oncogene; requires loss of both copies; normally phosphorylated-dephosphorylated during cell cycle; DNA tumor virus products can bind Rb & alter its control of cell cycle
223
passive vs. active immunotherapy
passive- does not rely on body to attack disease, employs immune system components created outside body; ex- administering antibodies
active- stimulates body's own immune system to fight tumor; ex- therapeutic vaccines
224
3 E phases of cancer immuno-editing
elimination- whether or not eliminated by host protective actions of immunity (immune system prevails)
equilibrium- maintained in dormant or equilibrium state (coexistence)
escape- escapes extrinsic tumor suppressor actions of immunity (tumor prevails, --> host death)
225
from greatest to least potential for immunogenicity, rank the types of monoclonal antibodies
-omab (fully mouse), -ximab, -zumab, -umab (fully human)
226
cytokines (IL2) promote differentiation of NK cells to what cell type capable of killing transformed & malignant cells?
lymphokine activated killer (LAK) cells
227
what should be done in order to increase effectiveness of TIL (tumor infiltrating lymphocytes) therapy?
depletion of lymphocytes prior to TIL infusion
228
what are two molecules that you can transfect a tumor cell with so they present antigens?
B7 (can activate TRA specific CD8 T cells w/ costimulatory signal), GMCSF (recruits DCs, which can present tumor antigens to T cells)
229
how does anti-CTLA4 antibody work as immunotherapy?
CTLA4 shuts off the immune response; is present on T cell & preferentially binds B7 on APC; by blocking CTLA4, does not shutoff immune response
230
what drug is anti-CTLA4 antibody?
ipilimumab
231
what CD marker does CAR T cell therapy utilize?
genetically modified CD19-targeted T cell (anti-CD19 CAR T cells)
232
what are ADR of CAR T cell therapy?
neurotoxicity, cytokine storm (monitor by IL6 levels); hypotension, hypoxia, & high-grade fevers
233
difference in tumor-specific & tumor-associated antigens
- tumor specific: only on tumor cells; mutated normal cellular proteins, oncogenic viral Ag
- tumor associated: found on both tumor & normal cells; re-expressed embryonic Ags or over-expressed low abundance self-protein
234
what cells are pro vs. anti-tumorigenic/cancer?
pro: M2 macrophages, Tregs, TH17, MDSCs
anti: DCs, M1 macrophages, CD4 & CD8 T cells
235
what type of cells prevent final assembly of MAC?
CD59
236
what 2 things do tumors rely on for success?
neovascularization (angiogenesis--involves VEGF) & immune evasion strategies (down-regulate MHC1 Ags, downregulate tumor assoc Ags, & release or induce release of suppressive factors--TGF beta & IL10)
237
what do MDSCs in cancer secrete?
arginase
238
what is the most common cancer in men by incidence and death?
incidence- prostate; death- lung & bronchus
239
what is the most common cancer in women by incidence and death?
incidence- breast; death- lung & bronchus
240
the greatest decline recently in cancer mortality has been seen in what demographic?
African Americans- better availability of care
241
what are the hallmarks of cancer?
avoid apoptosis; sustain proliferative signaling; evade growth suppressors; induce angiogenesis; enable replicative immortality; activate invasion & metastasis
242
what are some non-hereditary predisposing conditions to cancer?
chronic inflammation; immunodeficient/suppressed; age (old or really young); geography & environment; obesity
243
what are the top reasons for childhood mortality?
#1- accidents; #2- cancer
244
what are the effects of radiation on cancer?
- UV: UVB forms pyrimidine dimers, can overwhelm nucleotide excision repair (NER); UVC carcinogenic but filtered by ozone; increased risk of melanoma & nonmelanoma skin carcinoma
- Ionizing Radiation: directly fracture double helix (double strand breaks), can have chromosome translocations; most sensitive tissue- hematopoietic (leukemia), breast, lung, salivary gland, thyroid (in young)
245
what are some chemical carcinogens?
direct acting- do not require metabolic conversion (alkylating & acylating agents); indirect acting- require metabolic conversion (fossil fuels, cigarette smoke, nitrites); aflatoxin B1 from Aspergillus (mold grows on grains & nuts)
246
a false, but apparent, improvement in survival caused by earlier detection of the same inexorable disease is known as what?
lead time bias
247
what are some primary prevention strategies to cancer?
decrease alcohol/tobacco use; dec carcinogen exposure; dec radiation & sunlight exposure; safe sex; access to clean water & healthy food, avoid obesity; immunization & Tx! of infections
248
what is an example of secondary prevention to cancer?
mass population & selective cancer screening
249
what is the warburg effect?
cancer cells preferentially switch to aerobic glycolysis; generates less ATP, uses more glucose- basis for imaging scans
250
what are some lab diagnoses of cancer?
histology (biopsy/excision, frozen section)
cytology (fine needle aspirate, pap smear, body fluids; immunohistochemistry (stain specific antigens in a cell); electron microscopy;
flow cytometry (count individual cells & characterize); tumor markers (sample blood for byproducts of cancer; better used for monitoring Tx! effect);
molecular diagnostic tests (can detect characteristic translocations & mutations);
microarrays (molecular bio w/ microchip manufacture; can detect methylation & other DNA epigenetic modifications);
genetic (susceptibility) markers of cancer- identify specific genes/loci
251
proliferation of cells w/in organ/tissue
hyperplasia
252
substitution of one type of adult tissue for another when under stress
metaplasia
253
abnormality in cell size, appearance, w/ or w/o disorganized growth pattern
dysplasia
254
benign or malignant tumor growth; disease of cells characterized by alteration of normal growth regulatory mechanisms
neoplasia
255
general types of benign tumors
adenoma- epithelial; lipoma- mesenchymal
256
general types of malignant tumors
carcinoma- epithelial; sarcoma- mesenchymal; lymphoma/leukemia- neoplasm of lymphoid cells
257
types of DNA repair systems that can be defective in some cancer types
mismatch repair (HNPCC); nucleotide excision (XP); recombination repair (AT, bloom syndrome, Fanconi anemia)
258
growth-promoting genes that result in gain of function in protein product
oncogenes; work via overactivity mutation
259
growth inhibiting genes which result in loss of function
tumor suppressor genes; genes involved in apoptosis & DNA repair; ex- p53; work via underactivity mutation
260
normal human gene that can become an oncogene due to mutations or increased expression
proto-oncogene
261
what is the two-hit hypothesis?
normal cells have 2 undamaged chromosomes; it takes 2 hits in the same cell to cause cancer; people w/ hereditary susceptibility to cancer inherit a damaged chromosome, w/ the 1st hit at conception
262
explain RAS as an oncogene
normal cells- RAS protein regulated by GAP; RAS mutations reduce GTPase activity on RAS, allowing it to remain active all the time, stimulating cell growth continuously
263
what is the Bcr-Abl translocation?
"Philadelphia chromosome;" chrom 9 & 22 translocate, creating fusion gene that encodes active tyrosine kinase that is continuously active & results in unregulated cell division
264
what "Guardian" tumor suppressor gene that is a transcription factor is mutated in over 50% of human tumors?
p53
265
what anti-apoptotic protein is overexpressed in some cancers?
Bcl-2
266
cancers may have unlimited replicative potential do to upregulation of what enzyme?
telomerase
267
pro-angiongenic cytokines ____ & ____ promote angiogenesis
VEGF & bFGF
268
what hallmarks of cancer are universal & specific to solid tumors?
universal: uncontrolled proliferation; immortalization; protection from antiproliferative signaling; protection from apoptosis
solid tumors: angiogenesis; invasion & metastasis; occurs in later stage tumors
269
true or false- a tumor has a single-cell origin & thus the entire tumor always consists of a single type of isozyme for gene
true
270
what leads to proto-oncogene conversion to oncogene
mostly gain of function; increased expression, or loss of protein regulation w/ increased activity
271
compare/contrast familial vs sporadic retinoblastoma
familial- autosomal dom Mendelian transmission through germline; multiple tumors, often bilateral, early onset
sporadic- 60% of cases; not transmitted to progeny; single tumor; unilateral; later onset
272
what is the major determining factor of cancers?
how many times the stem cell divides
273
what are the various forms of hereditary colorectal syndromes?
- familial adenomatous polyposis (FAP)- germline mutation in APC, most common form; autosomal dom
- juvenile polyposis (JP)- autosomal dom; usually asymptomatic until puberty; less numerous polyps
- HNPCC- gene mutation in tumor suppressors in DNA mismatch repair; hereditary nonpolyposis
274
what are causes of chromosomal instability?
telomere attrition, aneuploidy, hypomethylation, double strand breaks, cellular stress (hypoxia, pH, high osmolarity), VDJ errors;
-mutations in genes for DNA replication, chromosome segregation, cell cycle check pts, & nucleotide metabolism
275
explain role of methylation in cancer
hypermethylation of tumor suppressors silences gene; oncogenes activated by hypomethylation; strongest risk factor for hypomethylation is age
276
etiology of glioblastoma
most common brain malignancy, one of most aggressive human cancers;
primary- manifests rapidly de novo w/o recognizable precursor lesions, more common (80%); rapid progression; more so in elderly; short survival time
-secondary: evolves from lower-grade gliomas, typically in younger pts
277
what is the basis for personalized medicine?
people respond differently to Tx! based on environment (exposure to carcinogens) & genetics (such as ability to deal w/ carcinogens)
278
Mendelian monogenic disorders vs. polygenic
monogenic- result from variation in single genes; phenotype driven by single genetic mutation; most individuals who possess mutant gene will exhibit the disease
complex- arise from interactions of several diff genes; each mutation contributes to risk of acquiring disease phenotype; % of risk due to any gene varies
279
parasites assoc w/ Loeffler's syndrome
Ascaris, hookworm, strongyloides (threadworm)
280
parasite assoc w/ autoinfection
pinworm, strongyloides
281
parasite assoc w/ anemia; can cause cutaneous larva migrans
hookworm
282
parasite assoc w/ hyperinfection w/ immunosuppression (gram negative sepsis)
strongyloides
283
parasite assoc w/ rectal prolapse
Trichuris trichiura (whipworm)
284
parasite assoc w/ eosinophilic meningitis
raccoon ascarid (roundworm); angiostrongylus cantonensis
285
parasite assoc w/ humans as aberrant/accidental host
CLM-cutaneous larva migrans, VLM-visceral larva migrans (toxocariasis), angiostrongyliasis
286
parasite assoc w/ skin eruption
CLM (slow), larva currens/strongyloides (fast)
287
parasite assoc w/ wild animal consumption
trichinella (esp pork consumption); has intestinal & muscle stage
288
most common helminth infection
Ascaris lumbricoides (roundworm); largest intestinal helminth
289
what helminth can have aberrant migration to appendix, bile duct, or pancreatic duct due to high fever or anesthesia?
ascaris lumbricoides
290
larva currens is a pathognomonnic rash around buttocks/groin caused by what organism?
strongyloides
291
what helminth can cause blindness, asthma-like attacks, urticarial rashes, N/V, etc.
toxocariasis; Toxocara canis or cati
292
this roundworm found in raccoons can cause ocular, visceral, or neural larva migrans; also can cause deadly eosinophilic meningitis
Baylisacaris procyonis
293
the Scotch tape test is used to diagnose this worm; causes intense anal itching, esp @ night
Enterobius vermicularis (pinworm)
294
nematode only found in Phillipines; can cause severe diarrhea, protein loss, & death from heart failure
Capillariasis phillippinensis
295
what are the stages of trichinella?
1) intestinal (1-7 days) 2) muscle invasion (1-8 wks) 3) myocardial involvement (1-2 mos)
296
most common cause of human eosinophilic meningitis
Angiostrongylus cantonensis (rat lungworm)
297
transmitted by direct skin-skin contact, fabrics, or sexual contact; caused by mite; severe form in immunocompromised
Scabies; severe form- Scabies Crustosa; do not treat w/o diagnosis; treat whole family
298
cause itchy scalp; can be visualized
head louse (Pediculus humanus)
299
vector of louse-borne typhus, trench fever, & relapsing fever; more common in colder regions, overcrowding, wars, famine, natural disasters
body louse (Pediculus humanus corporis)
300
sexually transmitted; "moving freckles"; directly visualize
crab louse (Phthirus pubis)
301
treatment for louse
permethrin, malathion
302
nocturnal creatures; can transmit disease; difficult to control infestations
bed bugs (Cimex lectularius)
303
cause of tungiasis (inflammatory skin condition); native to central/south america
jigger fleas
304
what is an infection by larva of "higher flies?"
myiasis; tumbu & mango fly only in Africa; human botfly in Latin America
305
unwarranted belief that pt is infested w/ live organisms or that inanimate objects are coming from their skin
delusional parasitosis; a diagnosis of exclusion--must rule out other diseases
306
cause of Chaga's disease; buzzword= CHF in Central/Latin American; can be transmitted congenitally
American Trypanosomiasis; vector= reduviid "kissing" bug
307
disease w/ characteristic Romana's sign & chagoma
Chagas
308
Tx! for Chagas
benznidazole; nifurtimox
309
cause of African sleeping sickness
African Trypanosomiasis; vector= tsetse fly; T. brucei gambiense (chronic) & T. b. rhodesiense (rapidly fatal, can cross BBB);
310
invasion of lymph nodes (Winterbottom sign) classic sign for what disease?
African trypanosomiasis
311
disease whose vector is sand fly; has 3 types of disease
leishmaniasis
312
describe 3 types of leishmaniasis
cutaneous- painless ulcer formation; diagnosis= travel history, amastigotes in smear or biopsy
mucocutaneous- "espundia"; untreated primary skin lesions can progress over years
visceral- can cause Kala-azar (black fever); hepatosplenomegaly, anemia (greying of skin); post-kala azar dermatitis (rash)
313
rapidly fatal, pts w/ freshwater exposure; causes primary amebic meningoencephalitis (PAM)
Naegleria fowleri
314
causes granulomatous amebic encephalitis; inhaled cysts or direct skin contact; brain abscesses, skin & nasal lesions, fever, HA/N/V
Balamuthia mandrillaris
315
inhibited by temps greater than 35C; also causes granulomatous amebic encephalitis; can cause keratitis due to corneal trauma/exposure
Acanthamoeba
316
found worldwide in soil/animal feces; causes encephalitis, sinusitis
Sappinia
317
intracellular parasite; vector is Ixodes tick; cause flu like symptoms; may develop hemolytic anemia
Babesiosis (Babesia macroti)
318
what are the 2 plasmodium hosts?
humans & female anopheles mosquito
319
what is plasmodium life cycle?
sporozoite- from mosquito, infects liver cells --> schizont- asymptomatic, ruptures & releases--> merozoites- infects RBCs, symptomatic--> ring stage trophozoite- asexual reproduction, release more merozoites or gametocytes--> gametocytes- sexual erythrocytic stage, taken up my mosquito
320
this is dormant in liver in P vivax & ovale for weeks to months after primary infections
hypnozoite
321
characterized by HA, chills, cyclical fever, travel history, anemia
malaria
322
what is the cause of cerebral malaria?
P. falciparum; poor prognosis; crosses BBB; obstructs brain vessels
323
protective factors against malaria
sickle cell trait; duffy antigen-negative blood type; immunity (repeat infections)
