Untitled Deck Flashcards
(405 cards)
1
Q
BLOOD COMPATIBILITY
A
WHOLE BLOODABO/Rh IdenticalRBC/Products containing RBCs: must be compatible with recipient’s plasma
O: O
A: A, O
B: B, O
AB: A, B, AB, O
Plasma/product containing plasma including cryoprecipitate and platelet: must be compatible with recipient’s RBC
O: O, A, B, AB
AB: AB
A: A, AB
B: B, AB
AB-type donor: universal plasma donor
O-type donor: universal RBC donor
2
Q
BLOOD RECIPIENT TESTING
A
ABO and RH
Forward and reverse (A1 and B) typing and D-test
Discrepancies: give O until resolved
Common cause of discrepancies: extreme age (elderly and neonate), inability to produce antibody (hematology malignancy, immunocompromised, immunosuppressive drugs)
ANTIBODY SCREEN
To detect unexpected alloantibodies
Using 2-4 phenotyped O type RBCs, that covers all 18 clinically significant antibodies
O type RBC reagent is reacted with recipient’s plasma/serum
IS, 37 degree and AHG
IS/room temp incubation is often skipped because it’s only detecting clinically significant antibodies (M, Lewis, I, P, N)
If negative, proceed to XM
If positive, full ABID using 14 O-type cell panels
CROSSMATCH
EXM, IS at room temperature, pre-warmed
Infant less than 4 months: XM is not needed
ABO/Rh type is tested like adult, but only need to be tested once (unless the patient 1) discharged and readmitted, 2) stays beyond 4 months of age)– infant or mother’s serum can be used for ABID
3
Q
BLOOD DONOR TESTING
A
ABO TESTINGABO forward and ABO reverse with A1 and B cellsRH TESTING
Anti-D test,
If D test is negative, perform weak D test including extended incubation and AHG step
If any D test is positive, label it as Rh+
ANTIBODY SCREENFor donor who was transfused or pregnant beforeINFECTIOUS DISEASE TESTING
All must be negative
Only one test is needed during each 30 days period
Must proof negative antibody and NAAT
HBV, HCV, HIV, Babesia, HTLV, WNV, Zika, T. cruzii
ANTIBACTERIAL FOR PLATELET
Prepared platelet culture is done after 24 hrs incubation and perform follow up culture after 3 days or negative bacterial antigen testing prior to transfusion
Large volume delayed sample (LVDS): culture after 36 hours after 12 hrs incubation
EXCEPTIONS
Infectious disease testing can be bypassed during emergency shortage with medical directors at both donor and transfusion centers release signature.
Must be done as soon as able
Omission is included on the label
False negative syphilis
4
Q
BLOOD DONOR ADVERSE REACTION
A
Hypotension (increased HR, syncope)– IV fluid
Vasovagal (dizziness, low BP, low HR, syncope)– elevated feet, cold compress
Hyperventilation– breath to paper bag
Hematoma/bleeding– compression
Citrate toxicity (hypocalcemia symptom)– calcium gluconate, slow infusion CG
5
Q
BLOOD COLLECTION SYSTEM
A
Correct labeling
If platelet is going to be harvested, diversion pouch must be attached: remove the first 30-45 mL blood consist of skin plug
Spiking: reduce the shelf life
Volume: 10.5 mL/Kg body weight, equal to ~15% total body weight
If plasma and platelet will be collected: the entire volume must be collected within 15 minutes
Typical bag: has anticoagulant appropriate for 450 +/- 45 mL blood
If only 350-404 mL collected in 450 mL bag or 333-449 mL in 500 mL bag: must be labeled with RBC low volume and cannot be used for preparation of other components.
Unit must be processed within 8 hour if plasma and platelet will be harvested
Transport: 1-10 degC
If platelet will be harvested: room temperature or 20-24 degC
6
Q
AUTOMATED APHERESIS DONATION
A
Platelet
Regular: <= 2x/week with minimum interval of 2 days
Non regular: 4 weeks apart
CBC: minimum of 150K plt count is required
RBCs
Single pheresis donation with platelet and/or plasma: defer 8 weeks
Double RBC donation: defer for 16 weeks
The volume of RBCs removed must not causing the donor H/H to be <= 10/30
7
Q
AUTOLOGUS DONOR REQUIREMENT
A
Physician’s order
Hgb >=11 g/dL, Ht >=33%
At least 72 hours prior to scheduled surgery
The unit is only for autologus donation
No potential of having bacteremia
8
Q
Dutasteride blood donation deferral
A
Dutasteride: 6 months from last dose
9
Q
BLOOD DONATION 3 MONTHS DEFERRAL
A
Receiving oral HIV PREP
CSW or having sexual relationship with CSW
New sex partner/multiple sex partner/anal sex
Positive screen/positive/treated for GO and syphilis
Tattoo or piercing
Sexual contact with HIV+ or HIV HR
Received blood product, human tissue or human derived clotting factor
Needle prick or mucous membrane exposure to blood
Use non-prescription injection drugs
Travel to malaria endemic area
10
Q
Live in malaria pandemic area for > 5 years blood donation deferral
A
3 Years:
11
Q
BLOOD DONATION INDEFINITE DEFERRAL
A
Family history of CJD
Clinical and laboratory proof of current or past T. cruzii and HTLV
Allogenic duramater transplant recipient and human pituitary growth hormone recipient
HIV+ (abs repeat or NAAT)
HBsAg+ or repeat HBcAg
Receiving HIV HAART
Recipient of live cells, tissue or non-human organ from animal source
12
Q
Blood pressure and HR DONOR REQS
A
Pulse between 50-100. Less than 50 is OK for healthy athlete
BP
13
Q
Lewis Blood Group
A
FUT3/Le encoded enzyme for fucosyl transferase, which adds fucose to Type 1 H antigen and make Le-a and Le-b
Le-a can be made if Le is present
Le-b is made only if both Le and Se are present
In Le(a-b+) individual, a minute amount of Le-a antigen is still made, so no anti-Le-a antibody is produced
Even though Lewis antigen is Type 1, it can be passively adsorbed onto RBCs
Le gene expression is increased with age
Lewis type cannot be determined until 2nd birthday
Le(a-b+) individuals: as neonates, they are Le(a-b-), then Le (a+b-), then Le (a+b+), and finally Le (a-b+)
Lewis antigen decreased during pregnancy and the Le (a-b-) can transiently expressed and the patient can produce antibody which is clinically insignificant
Lewis frequency notable for: Le(a-b-) among blacks and the rarity of Le(a+b+)
14
Q
BOMBAY BLOOD GROUP
A
Rare
Due to inherited h (an amorph) instead of H gene
Does not have H antigen– produces anti-H antibody
Can only receive donation from Bombay (H-) individuals
PARABOMBAY GROUP
In Bombay group, H produced in secretions if the Se gene is present
The H deficient secretor: para-Bombay
Still can only received blood from Bombay or para-Bombay
15
Q
ABO PHENOTYPES
A
O blood group
No A or B genes
Only H antigen presents
Produced naturally occurring anti-A and anti-B IgM antibody
Also produces anti-A,B IgG antibody: mild ABO-related HDFN in type O mother with non-O babies
A blood group
AA or AO gene
A1 and A2 subgroups– 80% A group are A1
H antigen is more abundant in A2 vs A1 groups
Anti-A1 can be found in the serum of 5% of A2 blood group and 35% of A2B individuals- usually clinically insignificant
Differentiating A1 and A2:
Anti-A1 from B group individuals: reacted with A1.
Dolichos biflorus: has anti-A1 activity
Ulex europeaus: has anti H-activity– reacts with A2 more than A1.
B and AB blood group
B group: BB or BO
AB group: AB
16
Q
ABO ANTIGENS AND ANTIBODIES
A
A and B antigens are made from H antigen by the enzyme products of the ABO gene.
All has H antigen:
Type 1: unbound, found in secretion
Type 2: bound to RBC surface
ABO gene– code the enzyme– the enzyme added NAG or GAL to H antigen resulting in A or B antigen
A allele produces N-acetyl galactosaminyl transferase –produce (NAG) to H– resulting in A antigen
B allele produces galactosyl transferase – produce (GAL) to H antigen– resulting in B antigen
O allele produces NO functional enzyme– produce abundant of unaltered H antigen
The relative amount of H antigen:
O»_space; A2 > B > A2B > A1 > A1B
ABO Antibodies:
Naturally occurring IgM
Detectable in infants at 3-4 months old but may not reach adult titers until 2 years old
ABO incompatibility: intravascular hemolysis, with complement activation
Major incompatibility: TRF with incompatible RBCs
Minor incompatibilities: TRF with incompatible plasma
17
Q
BLOOD GROUP I
A
Increased post natal i antigen:High turnover RBCsBlackfan-Diamond syndromeCongenital dyserithropoetic anemia (CDA)Anti-I antibody:Anti-I abs: associated with Mycopalsma infectionAnti-i abs: associated with EBV infection
18
Q
CARBOHYDRATE VS PROTEIN BLOOD GROUPS
A
CARBOHYDRATE
ABO, Le, I, P, M, N
Naturally occuring
IgM
React at room temp
React on IS
PROTEIN
All others including Kell, Duffy, Kidd, S
Acquired/require exposure
IgG
React at 37degC
React on AHG
19
Q
ABO DISTRIBUTION
A
From most common to less common:
OW: 45%, B: 50%, H: 55%AW: 40%, B: 25%, H: 30%BW: 10%, B: 20%, H: 10%ABW: 5%, B: 5%, H: 3%D+W: 82%, B: 92%, H: 92%D-W: 16%, B: 8%, H: 8%
20
Q
Birt-Hogg-Dube Syndrome
A
AD genodermatosis
Multiple fibrofolliculoma
Oncocytic neoplasm and chromophobe RCC
Lung cyst and spontaneous pneumothorax
Mutation of FLCN gene on chromosome 17, encoding protein folliculin
21
Q
BROOKE SPIEGLER SYNDROME
A
Multiple cylindromas
Trichoepithelioma
Spiradenoma
Milia
22
Q
COWDEN SYNDROME
A
PTEN (tumor suppressor) on chromosome 10Multiple hamartomas (mouth, GI)Thyroid follicular carcinomaBreast cancerEndometrial cancerMacrocephalyTrichilemmooooooma
23
Q
MUIR TORRE SYNDROME
A
AD form of Lynch syndrome
Multiple sebaceous adenoma in young patient
Mutation in one of the DNA MMR MLH1, MSH2, MSH6
Associated with AKs of the skin and GI carcinomas
24
Q
SWEET SYNDROME
A
Neutrophilic dermatosisInfections, neoplasia, pregnancy, and medications.
25
PLASMODIUM
26
BALANTIDIUM COLI
Largest protozoaThe only ciliated protozoa that can infect humanThe entire surface is covered with short ciliaFecal oral transmissionClose contact with pigDiarrhea, dysentery, and abscess formation
27
ROTAVIRUS
Non-enveloped, double layer capsid and dsRNA
28
EHRLICHIA. Area? vector? cell?
Transmitted by lone star tick/ white-tailed deer tickMidwest and coastal AtlanticInfect monocyte, intracellularLeukopenia, thrombocytopenia, elevated AST/ALTLow mortalitySimilar to ANAPLASMA- Anaplasma infect granulocytesSerologi: cross react with Rickettsia, Coxiella, Brucella, Borrelia, EBV
29
YERSINIA ENTEROCOLITICA
GNR, Catalase+, Oxidase-25-32 degC. Multiply in refrigerated conditionCIN agar: red bulls eye coloniesOtehr red bull eye on CIN: aeromonas, Oxidase+Enteric symptom, lymphadenitis, R sided abdominal pain, mistaken for appendicitisUnpasteurized milk, pork and pig intestine
30
LISTERIA MONOCYTOGEN
GPR short, Beta hemolytic, catalase positive, esculin+Environment, grow in refrigerator- deli meat, cheese, unpasteurized milk, hot dogsTransplacental transmission- stillbirthImmunocompromisedTumbling motility (umbrella) at room temperatureNo resistant-- no AST, treat with ampicillin or penicillinVirulence factors: actin for movement, hemolysin
31
NOROVIRUS
Most common cause of non-bacterial gastroenteritis in the USNon enveloped, single stranded RNA virusFecal oralCan be chronic in immunocompromisedHigh virulence, low titerD/: RT PCR from stool or emesis and IA
32
MAC: growth speed, disease
Slow grower, identification by 16spatients with preexisting respiratory diseaseAcquired by inhalation or ingestion and not by human-to-human transmission.Thrive in hot water, hot tubs.
33
FRANCISELLA TULARENSIS
Tularemia, highly infectious, high virulenceInfection: glandular, ulceroglandular, oculoglandular, systemic or pneumonicBiothreat agentsSmall, intracellular, faintly staining GN coccobacillusNon-motile, ox-Do NOT grow on McConkeyDx: PCR, DFA and serologic assayTransmission: ticks, animal bites, cuteneous inoculation, ingestion and handling infected animalsNO human to human transmission
34
ADRENAL SPORADIC NEUROBLASTOMA
MYCNAmplificationPrognosis
35
HEREDITARY ADRENAL PHEOCHROMOCYTOMA
SDHA, SDHB, SDHC, SDHDLoFRisk of hereditary cancer
36
SPORADIC ENDOMETRIAL CARCINOMA
MSI testing -- low/high/stable -- response to immunotherapyMLH1, MSH2, MSH6, PMS2 -- LoF -- response to immunotherapyMLH1 -- LoF and promoter hypermethylation -- somatic etiology (non Lynch)ERBB2 (HER2) -- amplification -- response to trastuzumab
37
HEREDITARY ENDOMETRIAL CARCINOMA
Lynch SyndromeMMR -- LoF -- 40-60% increased riskCowden syndromePTEN -- LoF -- 25% increased risk
38
SPORADIC ENDOMETRIAL UVEAL MELANOMA
GNAQ, GNA11Q209LDiagnosis
39
SPORADIC BILE DUCT CHOLANGIOCARCINOMA
IDH1MutationResponse to IDH1 inhibitor
40
CARNEY SYNDROME/COMPLEX
ADPRKAR1 gene or 2p16 abnormalitiesMultiple myxomas and pigmented lesions of skin and mucosaCardiac myxomaMyxoid breast FAEndocrine reactivity
41
BRCA ASSOCIATED CANCERS
Tumor suppressor gene involving homologous recombinant repair pathway
Higher among Ashkenazi Jewish
BRCA 140-90% risk for breast40-50% risk for ovarianPancreatic and colonRare maleCircumscribed and pushing borderTriple negative/basal likeBRCA 245-85% risk for breast10-20% risk for ovarianHigher in malePancreatic, prostateVariable morphologyLuminal A (ER/PR+, HER2-)
42
LI FRAUMENI SYNDROME TYPES
TYPE1TP53 (tumor suppressor gene)Broad spectrum cancerBreast >90% lifetime riskTYPE2CHEK2 (tumor suppressor)Heterologous low to medium penetrance30% risk for breast cancerIncreased risk for other cancer
43
PEUTZ-JEGHERS SYNDROME
AD
STK11 gene
Multiple hamartomatous polyps, mucocutaneous melanin pigmentation
Increased risk of breast, colon, stomach, pancreas and ovarian cancers
44
Lactate Dehydrogenase (LDH) isoenzymes
5 isoenzymes: LD2>LD1>LD3>LD4>LD5
45
Alkaline Phosphatase (AP)
(pH 9)
In bone, liver, intestine and placenta
Decrease: hypophosphatemia, malnutrition, hemolysis, Wilson disease, estrogen therapy
46
Gamma Glutamil Transferase (GGT)
Derived from biliary epithelial cell lining and hepatocyte of the limiting plate
Helpful in liver injury with AP
Increased in alcoholism
Increased with warfarin, dilantin, barbiturate, MTX and alcohol
47
Bilirubin
Conjugated: water soluble, measured with diazo colorimetric without accelerator (direct)
Unconjugated: water insoluble, measured by subtracting total by direct bilirubin
Total bilirubin: measured by diazo colorimetric and accelerator or directly by spectrophotometry (520 nm)
Unconjugated hyperbilirubinemia:Excess heme: hemolysis, ineffective hematopoiesis, large hematomaExcess delivery to the liver: shunt, right heart failurePoor uptake of the unconjugated bilirubin into the hepatocyte: Gilbert syndrome, rifampin and probenecidImpaired conjugation: Criggler-Najjar (lack of UDP glucuronidase), hypothyroidismConjugated hyperbilirubunemia:Impaired transmembrane secretion: Dubin-Johnson, Rotor, hepatic injury, estrogen, cyclosporin, pregnancy, endotoxinImpaired flow: Intrahepatic: PBC, medication, alcohol, pregnancy, sepsisExtrahepatic: PSC, cholangitis, tumor, stricture, AIDS, choledochopathy
48
Creatine Kinase (CK) fast to slow migrating
CKBB>CKMB>CKMM
49
SERUM PROTEIN ELECTROPHORESIS
Albumin and pre-albuminPre-albumin usually doesn't appear in PEPAlso called transthyterin-- binds to thyroxineNegative acute phase reactantAlbumin-a1 interfacea1 lipoprotein/HDLa1a1-anti trypsinNormal genome: PiM, most common PiMMAAT deficiency: homozygous PiZZNegative a1 on SPEPa1-a2 interfaceGc globulina1-antichymotrypsina2a2 macroglobulinHaptoglobinCeruloplasmina2-b1 interfaceHemoglobin (increased in hemolysis)b1Transferinb1-b2 interfaceBeta lipoprotein (LDL)b2IgA: fibrinogenC3: APRGammaAPR
50
SPEP M SPIKE LOCATION
IgG: gamma region
IgM: between beta and gamma
IgA: beta
51
SPEP ACUTE INFECTION
Slightly decreased albumin
Increased a1 and a2
52
SPEP CIRRHOSIS
hallmark: beta-gamma bridging due to increased serum IgA
Hypoalbuminemia
Blunted a1 and a2
53
Oligoclonal bands in CSF and no bands on serum PEP
multiple sclerosis
54
UPEP
Glomerular proteinuria:GN; unable to retain large size protein (>65,000 Kdal)Prominent albumin, a1 and a2Tubular proteinuria:renal tubules cannot retain smaller size proteinTwo bands in a2 regionProtein overflow:Unrelated to kidneyusually due to plasma cell neoplasm (Bence Jones protein)
55
CRYOGLOBULINEMIA
Immunoglobulin that precipitate at low temperature
Type I:Monoclonal immunoglobulinAssociated with plasma cell neoplasm or lymphomaMixed type (type II and III):Type II: mixed monoclonal IgM and polyclonal IgGType III: mixed polyclonal IgM and IgGMost common: Hep COther: lymphoproliferative disorder, chronic infection, chronic liver disease, autoimmue, especially SLERenal bx: MPGN, in acute phase might have thrombotic microangiopathyCryoglobulinemia: palpable purpura, arthralgia, hepatosplenomegaly, GN and sensorineural deficit
56
Scott Syndrome
Inadequate exposure of negatively charged phospholipids.
57
Platelet dysfunction in Chediak Higashi Syndrome
Dense granule defect
58
Platelet in Sebastian Syndrome
Macrothrombocytopenia.
59
Platelet in Fechter Syndrome
macrothrombocytopenia
60
Platelet in Epstein Syndrome
macrothrombocytopenia
61
Birdseed agar
Birdseed agar is differential for C. neoformans and C. gattii.
62
Dohle Bodies
Döhle bodies are seen in infective and inflammatory states (particularly burns), normal pregnancy, and congenital abnormalities such as the May-Hegglin anomaly.
Composed of piled-up rough endoplasmic reticulum, high RNA content.
63
Pelger Huet
Neutrophils with bilobed nuclei often connected by a thin strand of chromatin creating a pince-nez appearance.
The chromatin shows a dark mature chromatin pattern.
Can be associated with developmental delay, epilepsy, and skeletal abnormalities.
64
M. furfur is a yeast that requires long-chain fatty acids for growth. An olive oil overlay on top of the agar surface is necessary for culturing this organism.
Malassezia furfur is a component of the normal skin microbiota in most individuals.
Two major risk factors for infection with M. furfur are catheter-related fungemia in patients receiving total parenteral nutrition, which is high in lipids, and skin diseases, such as Pityrosporum folliculitis, pityriasis (tinea) versicolor, and atopic dermatitis.
KOH preparations of skin infections with M. furfur demonstrate hyphae and spherical yeast cells and demonstrate a “spaghetti and meatball” appearance.
65
The fluorescent polarization immunoassay (FPIA) interpretation
Competition between a fluorescent-labeled antigen (i.e., the drug; fluorescein is the most common fluorophore) and the antigen (i.e., free drug)
The amount of polarized light emitted is inversely related to the sample concentration of the analyte to be measured.
66
Aeromonas caviae complex
oxidase-positive, indole-negative, esculin-positive, gram-negative rod that can cause gastroenteritis.
do not grow on TCBS agar or in 6% NaCl, and they are string-test negative.
67
APL
atypical hypergranular promyelocytes with multiple Auer rods
Bilobed promyelocytes with "sliding plate" nuclei
promyelocytes predominate and there is little, if any, maturation beyond the promyelocyte stage due to the defining fusion gene PML::RARA which blocks maturation.
t(15;17).
68
Rickettsia rickettsii
Rocky Mountain spotted fever
Western Canada, the continental United States, Mexico, Panama, Argentina, Brazil, Bolivia, Colombia, and Costa Rica.
American dog tick (Dermacentor variabilis), the brown dog tick (Rhipicephalus sanguineus), and the wood tick (Dermacentor andersoni).
High fever and headache along with malaise, myalgias, nausea, vomiting, abdominal pain, and diarrhea.
Centripetal macular rash that starts on the ankles and wrists appears 3 days after the initial fever.
69
Trichinellosis
Ingesting meat containing encysted Trichinella larvae.
Gastric acid and pepsin lead to release of the larvae, which then invade the small bowel mucosa, where they develop into adult worms.
Trichinella antibodies can be detected by an enzyme immunoassay 3 to 5 weeks after infection.
Prompt treatment with albendazole or mebendazole is recommended to kill the adult worms before they release larvae.
70
inv(16) AML
Good prgnosis
CBFB::MYH11 fusion
abnormal marrow eosinophils
71
M. kansasii
Slow growing
Photochromogen
Pulmonary, symptoms mimic M Tb
72
AML t(8;21)
RUNX1::RUNX1T1
Neutrophilic differentiation
Myeloid Sarcoma at presentation
73
Inv(3) AML
EVI1 activation, GATA2, MECOM
High platelet count
Marrow dysplasia
Poor prognosis
74
AML +21
Megakaryoblastic
RBM15-MKL1 fusion protein
Infant and children
75
Toxoplasma gondii.
76
Campylobacter jejuni
Food-borne diarrheal disease
Curved gram-negative bacillus, gull-wing shaped
Growth requires microaerophilic conditions
77
Histoplasma
Thermally dimorphic fungus
Ohio and Mississippi River valleys
Necrotizing granuloma and the small, narrow-based yeast cells are found within histiocytes.
78
Alpha Thalassemia Trait
Microcytosis
Normal hemoglobin fractions (normal hemoglobin A2)
Normal iron studies.
79
Beta Thalassemia Trait
Microcytosis and an elevated hemoglobin A2
80
Arsenic Poisoning
Migrating paresthesia “bug-crawling” sensation.
Total arsenic is the summation of all fractionated arsenic compounds: organic, inorganic, and methylated.
Organic arsenic is less toxic and has fewer concerns than inorganic arsenic poisoning, and they are treated differently.
81
The unfertilized Ascaris (roundworm) egg is elongated and brown, with a bumpy (i.e., mammillated) shell.
82
Ascaris: The fertilized egg is ovoid and brown with a thick smooth shell
83
Diagnosis?
Dwarf megakaryocytes
CML
84
Blastomyces Dermatides
Mold phase is characterized by septate hyphae with short or long conidiophores and a round conidia at the apex (i.e., resembling a lollipop)
Slow-growing, thermally dimorphic fungus, which means that it grows as a mold at 25°C and as a yeast at 37°C
Southeast and Midwest
85
Enterobius
The nematode, or pinworm, E. vermicularis, is the most common helminthic infection in the United States.
86
Microscopically, F. nucleatum are long, slender, gram-negative bacilli; colonies are white, rough, and bread crumb-like.
87
S. pneumoniae
Gram-positive, lancet-shaped diplococci.
A rapid urine antigen assay is available for diagnosis.
88
Bug? Disease? Transmit by?
Relapsing Fever Borrelia
Tick-borne relapsing fever (TBRF) and are transmitted primarily by Ornithodoros soft ticks.
Transmit in less than a minute and typically stay attached to the human for only about 15 to 90 minutes
89
Mycobacterium species needing 25-30 degreeC cultures
Species associated with skin and soft tissue infections
MUCH: M. marinum, M. ulcerans, M. chelonae, and M. haemophilum
90
Trichophyton indotineae
Endemic to the Indian subcontinent and spreading worldwide.
Refractory to terbinafine treatment.
Fluffy white colonies with a tan reverse within 7 days
Large, multi-compartment macroconidia (red circles), round or teardrop-shaped microconidia (purple circles), and spiral hyphae (black circles)
T. indotineae is morphologically indistinguishable from Trichophyton mentagrophytes and Trichophyton interdigitale.
91
Sporothrix schenckii
Narrow, septate, branching hyphae.
Tear-shaped to round conidia ‘rosette-like’ cluster of conidia just off the conidiophore. Yeast phase when incubated on rich medium (such as brain heart infusion agar contain blood or chocolate agar) at warmer temperatures of 35-37°C; these colonies are cream to tan in color, smooth and waxy.
The filamentous mold is produced at lower temperatures (25-30°C), especially with extended duration. A yeast-like colony is often initially observed (no cottony aerial hyphae) during the first couple days of visible colony growth under standard fungal culture laboratory conditions, including 30°C.
As the colony ages, it becomes wrinkled, leathery, or velvety as aerial hyphae develop. A brown or salt and pepper colony color develops as the colony matures and melanized conidia are produced; the reverse is usually brownish to dark in the center and light at the periphery.
92
Aspergillus niger.
Black pigment conidia
Radiate biseriate phialides covering the entire vesical, and long conidiophores
93
P. westermani
Lung fluke, thick brown-yellow shell, and an operculum with opercular shoulders.
Asia, including China, the Philippines, Japan, Vietnam, South Korea, Taiwan, and Thailand.
Transmitted to humans by the ingestion of raw or undercooked crab or crayfish. Larva migrate within the body, and end up in the lungs. After 6 to 10 weeks, the larvae mature into adult flukes.
Paragonimus eggs can be found in feces and sputum.
94
P. vivax
P. vivax and P. ovale can demonstrate a dormant stage, referred to as hypnozoites, which persist in the liver.
P. vivax has a predilection for young red blood cells and infected cells are enlarged.
Mature P. vivax schizonts have 12 to 24 merozoites.
95
Fusarium spp.
96
Actinomyces spp.
Poor oral hygiene, smoking, heavy alcohol use, diabetes, and immunosuppression are risk factors for actinomycosis.
IUDs
sulfur granules
97
PFA-100 Collagen/Epi+
Drug induced (ASA)
98
Renal tubular cast
99
PLASMA CELL MYELOMA CRITERIA
Having ≥ 10% clonal plasma cells in the bone marrow is a criteria for myeloma.
Involved-to-uninvolved serum free light chain ratio ≥ 100 is one of the biomarker criteria for myeloma.
Biopsy-confirmed plasmacytoma and lytic bone lesions are also considered among the diagnostic criteria.
No level of serum or urine M protein is included as one of the diagnostic criteria of plasma cell myeloma. In fact, in nonsecretory plasma cell myelomas, an M protein can be absent. Cytologic atypia of plasma cells is also not considered one of the diagnostic criteria of plasma cell myeloma because the cells can be cytologically indistinguishable from normal plasma cells.
Manifestations of related end organ or tissue impairment are the most important diagnostic criteria for symptomatic plasma cell myeloma (CRAB: hyperCalcemia, Renal insufficiency, Anemia, lytic Bone lesions).
100
Diagnosis? IHC?
Monoblastic Leukemia
Positive for monocytic markers, such as CD11c, CD14, CD4, CD36, and CD64, as well as myelomonocytic markers such as CD33 and CD13. These cells are usually CD34 negative due to monocytic maturation of the acute leukemia cells.
101
Popcorn cells
NLPHL
102
McCune-Albright syndrome
Polyostotic fibrous dysplasia
café au lait spots
endocrine abnormalities such as pituitary hyperplasia, hyperthyroidism, adrenal hyperplasia, and precocious puberty.
Sporadic
GNAS1 gene located in 20q13.
Osteosarcoma and chondrosarcoma (conventional and dedifferentiated) appear to occur with increased frequency.
Patients with McCune-Albright syndrome are susceptible to endocrine tumors, such as adrenocortical and pituitary tumors.
103
Turcot syndrome
Colonic polyposis and central nervous system tumors, most often gliomas.
104
Gardner syndrome
Intestinal polyposis, multiple osteomas, fibromatosis, and epidermal cysts.
105
Maffucci syndrome
Cavernous hemangiomas (which may become thrombosed and calcified) are located in the skin and soft tissues overlying the multiple chondromas.
106
MEN Syndromes
MEN1 (Menin): Parathyroid, Pituitary, Pancreas
MEN2A (RET): Medullary thyroid, pheochromocytoma, parathyroid adenoma
MEN2B (RET): MTC, pheochromocytoma, mucosal neuroma
FMTC: only MTC
MEN 4: parathyroid, pituitary, GI
107
MLH1
Sporadic: hypermethylation
Germline: LoF (Lynch)
108
Bernard-Soulier Syndrome
Autosomal recessiveGp1B deficiencyGp1B is vWF receptorIncreased BT, normal PT and PTTThrombocytopenia with giant plateletPlatelet aggregate (SIMILAR RESPONSE WITH vWD Disease):Normal response to ADPNormal response to epinephrinNormal response to collagenABNORMAL response to ristocetin
109
Glanzman Thrombasthenia
GpIIa/IIIb deficeincyGpIIa/IIIb binds platelet aggregate to fibrinogenPlatelet aggregate:SIMILAR PATTERN TO HYPOFIBRINOGENEMIAAbnormal response to collagen, epi, and ADPNormal response to ristocetin (platelet can still aggregate to each other)
110
Pathologic Effect of COCAINE
Vasoconstriction
111
Pathologic Effect of Methadone
Same effect as other opiates: miosis
112
Pathologic Effect of ISOPROPANOLOL
Isopropanolol is metabolized to acetone Incrased acetone
113
Pathologic Effect of SALICYLATE
metabolic acidosisrespiratory alkalosis
114
Pathologic Effect of ETHYLENE GLYCOL
Urine oxalate crystal
115
Yersinia
Enterocolitica causes GI problemPestis causes bubonic plagueGNR, pinpoint colonies on SBACat+, Ox-, Urease-CIN selective agarGrows better at 28degMotility:Enterocolitica: non-motile at 37 and motile at 25Pestis: non-motile
116
Chlamydia Trachomatis serovars
Serovar A-C: eyesSerovar D-K: PID, urtheritis, cervicitis and associated conditionsSerovar L1-L3: lymphogranuloma venereum
117
IgA Deficiency
Most common primary immunodeficiencyFew patients have URI and UTI associated syndromesResponse well to vaccinationHas B cells that is expressing IgA that does not terminally differentiated to plasma cellsCan develop anaphylaxis if exposed to IgA containing blood products
118
FAP
Autosomal dominantMutation in APC gene causing beta catenin accumulation
119
LYNCH SYNDROME
Autosomal dominantHNPCC gene mutationMLH1 and MSH2 >> PMS2 and MSH6GI, Gyn, CNS and urinary tract cancersEPCAM mutation: hypermethylation and incativation of MSH2
120
Fomepizole is antidote for
Methanol and ethylene glycol
121
Amyl nitrite
Cyanide
122
Flumazenile
Benzos
123
N-acethylcystein
Acetaminophen
124
Atropine
Organophosphate: acetylcholinesterase inhibitor
125
CGB (canavanime-glycine-bromothymol) Agar
To differentiate Cryptococcus neoformans and gatii. Agar color: yellow-greenC. neoformans colony color stays the sameC. gatii colony color changed to blue
126
ABG pre-analytical interference
Air bubble: higher O2 concentration-- falsely high pO2Air bubble: lower CO2 concentration-- falsely low pCO2Excessive heparin: sample dilution-- falsely low CO2 and bicarbonateFever: right shift of the O2 curve-- raising pO2-- machine temp: 37deg-- left shift-- pO2 will be falsely low
127
Oxygen dissociation curve right shift
Increased oxygen release to the blood-- increased blood pO2Right shift: Increased temperatureAcidosisDPGpCO2
128
Diabetes Insipidus
Central:Lack of ADH: better with desmopressin injectionDispogenic ADH- extreme thirstNephrogenic:Failure of kidney to respond to ADH: lithium toxicity, PKD, amyloidosis, hypercalcemia
129
Complements anaphylatoxin
C4a, C3a, C5a
130
Acquired B
Blood type: AForward type: ABReverse type: AAssociated with: colon cancer, intestinal obstruction or gram negative sepsis Blood exposure to bacteria that can deacetylate the N-acetyl-galactosamine on the type A antigen.This makes the A antigen react like a B antigen on forward screen. The patient will have anti-B antibodies in the serumThe acquired by phenotype can be tested for by acidifying the serum, which will prevent agglutination with anti-B antibodies on forward screen
131
Autoantibody Positivity
Cold auto: positive on IS and 37 deg
Warm auto: positive on 37deg and AHG/IAT
37deg: positive for both IgM and IgG
132
vWF Multimer
Type 1: All presents but low
Type 3: absent
Type 2A: negative for large and medium size multimers
Type 2B: negative for large size multimer only
Type 2M: normal multimer
Type 2N: normal multimer
133
Rh null Phenotype
Lack expression of all of the Rh antigens: C, c, D, E, and e. Rh null red blood cells also lack LW and Fy5 and weakly express S, s, and U antigens The peripheral blood smear classically shows stomatocytes and sometimes spherocytes and are osmotically fragile, leading to chronic hemolytic anemiaIn the more common regulator type, patients have a defective RHAG gene. In the less common amorph type, patients have a mutated RHCE gene and a deleted RHD gene.
134
"Hymenolepis nana (“dwarf tapeworm")
135
The most common tapeworm infection in the U.S. (the most common worm infection in the U.S. is Enterobius vermicularis).
136
It is spread from the feces of mice or other humans.
137
Disease ranges from asymptomatic to causing mild diarrhea.
138
Eggs are 40 to 60 um. and have two poles.
139
The eggs have two layers, and 3 pairs of hook-like filaments spread out between the two layers. The oncosphere (larval stage) has six hooks inside the egg."
140
Multiple Sclerosis CSF Phenotype
Increased IgGElevated myelin basic proteinPresence of oligoclonal band
141
Martin-Lewis Agar
Neisseria gonorrhea and meningitidis
142
Thayer Martin Agar
Neisseria Gonorrhea and Meningitidis
143
Regan Lowe
Bordetella Pertussis
144
TCBS Agar
Vibrio
145
Lipoprotein
Lp(a): LDL
Apo B100: LDL
Apo A1: HDL
146
Tumor suppressors
Rb1
p53
APC
p16
NF1
BRCA
PTEN
CDKN2A
STK11
147
Pro Oncogenes
Ras
MYC
BRC-ABL
Her2
Cyclin D1
CDK4
EGFR
VEGF
148
Hermansky Pudlak Syndrome
Platelet Dense LAcKOculocutaneous albinismPulmonary fibrosisGranulomatous colitisLysosomal ceroid accumulation
149
Cocaine Metabolites
Benzoylecgonine and ecgonine methyl ester
Blocks dopamine, serotonin and NE reuptake
Block sodium chanel
150
Fanconi Syndrome
Defect in renal proximal tubule Loss of: bicarbonateHypokalemiaHyperphosphaturiaGlycosuriaHyperchloremiaProteinuriaCause: cystinosis in children, deposits such as amyloid, drugs, multiple myeloma, lead poisoning
151
DICOM
Digital Imaging and Communications in Medicine (DICOM) is more specific for imaging. It is a standard for handling, storing, printing, and transmitting information in medical imaging.
152
SNOMED
Systematized Nomenclature of Medicine (SNOMED) is a computer-processable collection of medical terms.
153
PACS
PACS, picture archiving and communication system, is a medical imaging technology.
154
Pseudohypoparathyroidism
Tissue resistance to PTH.
Mimics hypo PTH phenotype
Low calcium and high phosphate, but the PTH level will be high instead of low
Associated with dysfunctional maternally inherited alpha subunits of G proteins.
155
Bugs Causing CGD
Bugs that are catalase positive
Staphylococcus
Serratia
Pseudomonas
E. coli
156
Methanol metabolite
Formic acid
157
Ethylene glycol metabolite
Oxalic acid
Glycolic acid
158
Babesiosis deferral
2 years
159
Living with Hep B patient deferral
1 year
160
Gardasil deferral
1 year
161
Chagas disease deferral
Permanent
162
Window period
Time from infection to lab detection
163
Time from infection to lab detection
Window period
164
Incubation period
Time from exposure to clinical symptom
165
Alkaline electrophoresis gel
+(Anode) A F S C (Cathode) -
166
Acid electrophoresis gel
+(Anode) C S A F (Cathode)-
167
The most common isoform in cardiac muscle
CK-MM (98%)
CK-MB 2%
168
Nephrotic Syndrome SPEP Pattern
Low albumin
Increased Alpha2
169
FFP shelf life
12 months at -18deg
7 years at -65deg WITH FDA approval
24 hrs after thawing
5 days after thawing as Thawed Plasma
170
Rhinoscleroma
Young patients and is often associated with crowded conditions
Russell bodies (plasma cells with intracytoplasmic buildup of immunoglobulins)
Mikulicz cells (histiocytes with intracytoplasmic buildup of Klebsiella rhinoscleromatis)
A Warthin-Starry stain may aid in the diagnosis of Rhinoscleroma.
171
BUN:Cre ratio in Intrinsic Renal Failure
37184
172
BUN:Cre ratio in Pre-Renal Renal Failure
>20:1
173
Elek Test
C. dyphtheria
174
Total body fluid
Total body water: 60%
Intracell: 40%
Extracell: 20%Interstitial: 15%Plasma: 5%
175
Hyper IgM Syndrome
X-linked immunodeficiency with IgM (Hyper IgM syndrome) is most frequently caused by a defective CD40L (CD40L) in T cells causing them to be unable to communicate with B cells.
The CD40L on T cells normally binds to CD40 on B cells, enabling the B cells to switch immunoglobulin class from IgM and IgD to IgG, IgE and IgA.
Patients have high IgM and IgD, low IgG and absent IgE and IgA.
176
Factors that increase TBG
Pregnancy
OCP
177
Factors that decrease TIBG
Cirrhosis
Nephrotic syndrome
Testosterone
178
T Follicular Helper Cell Markers
CD10
Bcl6
ICOS
PD-1
CXCL-13
179
Increased urine formiminoglutamic acid
Folic acid deficiency
180
Hb Bart alpha genotype
--/--
181
Hb H alpha genotype
a-/--
182
Transmitted through ingestion of freshwater chestnut or bamboo
Fasciolopsis Buski
183
Marijuana half life
3-7 days
184
Cocaine half life
1 hour
185
Methadone half life
8 hours to 3 days
186
Morphine half life
3-4 hours
187
Heroin half life
Less than one hour
188
Candida with germ tube positive
Albicans
Dubliniensis
Stellatoidea
189
Peak absorbance of NADH
340nm
190
Peak absorbance of NAD+
259nm
191
Nucleic acid absorbance
260nm
192
Protein absorbance
280nm
193
CAMP positive arrow
GBS
194
CAMP positive rectangle
Listeria
195
Reverse CAMP
Against GBS
Clostridium perfringens
196
Specimen for pediatric TB
Gastric lavage
197
Molecule size broken down by GC-MS
Small
198
Molecule size broken down by LC-MS
Large
199
Sensitivity
The proportion of people with the disease who have a positive test result.
200
Specificity
The proportion of people without the disease who have a negative test result.
201
Negative predictive value
The probability that someone with a negative test result does not have the disease.
202
Positive predictive value
The probability that someone with a positive test result has the disease.
203
IgG subset that crosses the placenta the least
IgG2
204
Fasciolopsis Buski
Trematode
205
What type of worm is S. stercoralis?
Nematodes, round worm
206
What type of worm is Echinococcus granulosus?
Cestodes (flatworm)
207
Coagulation factor tested with urease test
Factor XIII
208
Bicarbonate in pregnancy
Decreased
209
Protein S in pregnancy
Decreased
210
Fibrinogen in pregnancy
Increased
211
Albumin in pregnancy
Decreased
212
Osmolality in pregnancy
Decreased
213
Most important HLA loci for transplant rejection prevention
A, B and DR
214
Cortisol antagonist
Metyrapone
215
Most common coagulation factor deficiency among patients with AL amyloidosis
Factor X
216
Low C4 and C2 and normal C3
Hereditary angioedema
217
What cause increased TBG
Estrogen, pregnancy, and oral contraceptives
218
What causes decreased TBG
Liver cirrhosis, nephrotic syndrome, testosterone, and major illnesses
219
Tetrads GPC and oxidase positive
Micrococcus
220
Bethesda Unit Interp
50:50 dilution-- correspond to the 50% activity of the coagulation factor
221
Phase I hepatic reaction
Small molecules: cytochrome P450 enzymes. Examples include cyclization, epoxide formation, deamination and redox reactions
222
Phase II hepatic reaction
Larger chemical groups, generally to promote hydrophilicity for renal elimination. This includes reactions such as glucuronidation, acetylation, sulphation, and glutathionylation
223
Gorlin Syndrome
Multiple OKCs
Multiple BCCs
Medulloblastoma
Skeletal abnormality
Palmar/plantar pits
AD
224
Gorlin Syndrom
Medulloblastoma
Jaw cyst (OKC)- Gorlin cyst
PTCH1 gene
225
Kostmann's Syndrome
AR
Mutation in gene coding for GCSF-- neutropenia
226
Schwachmann-Diamond Syndrome
Neutropenia
Thrombocytopenia
Short stature, mental retardation
Exocrine pancreatic insufficiency
227
Alport syndrome
X linked recessive
Collagen IV defect affecting inner ear, kidney and eye
COL4A3, COL4A4, COL4A5
Megathrombocytopenia and granulocyte abnormalities
228
Mazabraud syndrome
Fibrous dysplasia
Myxomas
229
VHL Syndrome
ccRCC
Hemangioblastoma
Angioma
Pheochromocytoma
Paraganglioma
Cysts in liver kidney, pancreas and epididymis
230
Carney's triad
Paraganglioma
Gastric GIST
Pulmonary chondroma
231
Morphine metabolite
6-MAM through heroine
232
Heroine metabolite
6-MAM
233
Fentanyl metabolite
4-ANPP
234
Codein metabolite
Morphine
235
The most common lymphoma of the GI tract
MALT
236
The most common lymphoma of the colon
DLBCL
237
T- LGL molecular
STAT3 (typically CD8+)
STAT5B, TRG rearrangement
238
T-LGL absolute count
>2000/uL
239
Triad Sezary syndrome
Erythroderma
Generalized LAD
Clonal skin neoplastic T cells, similar to MF
Absolute sezary cells in PB => 1000/uL
240
Lymphomatoid papulosis prognosis
Good, spontaneous regression
241
Lymphomatoid papulosis 4 types
Hodgkin-like
MF-like
ALCL-like
Primary aggressive epidermotropic CD8+ CTC T cell lymphoma like
242
4 AML with monocytic differentiation
RUNX1-RUNX1T1
Inv (16)
KMT2A-MLLT (9;11)
NPM1
243
BCR-ABL breakpoints
p120: CML classic
p190: B-ALL
p230: increased neutrophilic maturation and increased plt
p190: rare CMML
244
T-LGL PB profile
Neutropenia
245
Plasma cell leukemia criteria and profile
>= 5% plasma cells in the blood as counted by peripheral smear (not flow cytometry)
Younger patient, rare, aggressive, poor prognosis
Lymphadenopathy, organomegaly, anemia, and thrombocytopenia. Less likely to have lytic bone lesions and bone pain
CD56- CD20+
246
Tardieu spots
Purple to black spots on the skin that can develop along with lividity, from the rupture of capillaries
247
Sevelamer crystal
Two-toned with curved cracks on H&E
248
Bile sequestrant crystal
Yellow-brown on acid-fast stain and red on hematoxylin stain
249
Silica crystal
White birefringence on polarization
250
Kayexalate crystal
Variably purple on hematoxylin and eosin and have rectangular cracks
251
Syndromes associated with Wilm's tumor
Beckwith Wideman
Denys Drash
WAGR
252
Syndromes associated with Angiofibroma
TS (most common in TS)
Birt-Hogg Dube
MEN1
253
Tuberous sclerosis
Cortical tubers,
SEGA and subependymal nodules
PEComas
Cardiac rhabdomyomas
Skin tumors (angiofibromas, Shagreen patches - connective tissue nevus, ash-leaf patches and periungual fibromas).
Adenoma sebaceum
254
AITL IHC
Pan T cell positive (CD3, CD2, CD5, CD7)
CD4+, CD8-
Follicular dendritic meshwork expansion (CD21, 23, 35)
TFH cells marker positive (ICOS, Bcl6, CD10, CXCL3)
255
International standard for the transfer of clinical and administrative data between hospital information systems
Health Level 7
256
Computer-processable collection of medical terms
SNOMED
257
Standard for handling, storing, printing, and transmitting information in medical imaging
DICOM
258
Universal standard and database for identifying medical/clinical laboratory data or observations
LOINC
259
Lymph node. Diagnosis?
Kikuchi disease
260
What database structures utilizes multiple tables queried through Structured Query Language (SQL) with each row in a table having a unique identifier called a primary key?
Relational database
261
Warthin-Finkeldey bodies
Measles
262
Lung FNA
P. jirovecii
Aggregates that appear frothy or like collections of small soap bubbles
263
Blood culture contamination cutoff
Rate
264
Blood culture conditions
2 sets aerobe and anaerobe
5 days at 35degC
265
What causes Gram positive bacteria to have blue color
Peptidoglycan in the cell wall
266
Sputum adequacy criteria
25 WBCs per LPF
Not adequate: do NOT culture
267
Bacteria with clumping factor
S. aureus
268
Catalase positive reaction
Bubbles
269
S. aureus virulence (2)
Toxins (SST, food, ES)
Protein A (primary, bind to immunoglobulin)
270
MRSA Genes
MecA
PBP2A
271
MRSA antibiotic of choice
Vancomycin
272
Methods to detect MRSA
Old way: resistance to oxacillin
New way: resistance to cefoxitin
Molecular: detect PBP2a genes (mecA and mecC)
273
D test. Goal? mechanism? interpretation?
To test S. aureus susceptibility to clindamycin. S. aureus resistance to erthromycin can be induced and become resistant to clindamycin
KB plate: E and CD side by side
D+ (blunted) in CD clearance: resistance to clindamycin
D- (round) in CD clearance: susceptible to Clindamycin
274
CONS, resistance to Novobiocin
S. saphrophiticus
275
CONS sensitive to Novobiocin and PYR+
S. lugdunensis
276
GPC tetrad
Micrococcus.Cat+, Coag-, mustard yellow colonies
CONTAMINANT!
277
PYR+ bacteria
Strep Pyogenes
Staph lugdunensis
Enterococcus
278
Strep Pyogenes virulence factors
M protein- prevent phagocytosis
Hyaluronic capsule- prevent phagocytosis
Streptolysin O and Streptolysin A toxinsASO titerEvade immune systemO: labile, S: stable. Stab together: becomes beta hemolytic
279
Rheumatic fever cause and pathogenesis
S. pyogenes
Molecular mimicry
280
Two tests commonly used to detect GBS
Camp: S. aureus (has camp) streaked perpendicular to GBS -- 24 hr -- intensified arrow shaped hemolysis
Hippurate hydrolysis: positive: purple
281
GPC lancet, in pairs
S. pneumonia
282
Bile esculin-, Bile solubility-, Optochin resistant, Catalase- GPC
Viridans streptococci
283
Vitamin B6 deficient Streptococcus
Grow around S. aureus (supply B6):
Abiotrophia defectiva
Granulicatella adiacens
284
Gamma hemolytic, Cat-, GPC, PYR-, 6.5% No growth
Strep galloliticus (bovis)
285
Gamma hemolytic, Cat-, GPC, PYR+, 6.5% growth
Enterococcus
286
How to differentiate two common species of enterococcus
Arabinose fermentation
Positive: faecium
Negative: faecalis
287
Enterococcus is intrinsically resistant to which antibiotics
Cephalosporine
DOC: vancomycin
288
VRE genes
Van A: E. faecium
Van B: faecalis
289
Media to differentiate N. gonorrhea and meningitidis
5% blood sheep agar
N. GO will NOT grow
N. meningitidis will grow
290
Fermentation in Neisseria
GO: glucose only
Meningitidis: glucose and maltose
291
Culture media for N. GO
Thayer Martin or Martin Lewis agar
Transport: do NOT refrigerate
292
Gram negative cocci (2)
Neisseria spp
Moraxella catarrhalis
Small kidney bean cocci in pairs
293
Hockey puck colonies
Moraxella catarrhalis
294
Gram positive Rods (5)
Corynebacterium
Bacillus
Listeria
Erysipelothrix
Arcanobacterium
295
Corynebacterium hemolytic type
Gamma
296
Coryne catalase
Positive
297
Coryne specific media
Cystein tellurite and Tinsdale agar
298
Bacillus catalase
Positive
299
Medusa head in sheep blood agar
Bacillus anthracis
300
How to differentiate B. anthracis from other bacillus
Non-motile
Resistant to penicillin
301
Bacillus with gray dull crumbly colony and beta hemolytic
Cereus
302
GPR with tumbling and umbrella motility
Listeria monocytogen
303
GPR producing H2S
Erysipelothrix rhusiopathiae
304
Lactose fermenter Indole positive bugs
Klebsiella Oxytoca
E. coli
Citrobacter diversus
Edwardsiella tarda
305
Lactose fermenter, indole negative
Klebsiella pneumonia
Enterobacter (aerogenes, cloacae)
Hafnia
306
Lactose non-fermenter, oxidase positive
P. aer
Burkholderia spp
307
Lactose non-fermenter, oxidase negative
Acinetobacter
Stenotrophomonas
Proteus
Yersinia
Salmonella
Shigella
308
TSI, no gas, no H2S, red slant, red butt
Pseudomonas
309
TSI, no gas, no H2S, red slant, yellow butt
Shigella
310
TSI, + gas, no H2S, yellow slant, yellow butt
E. coli
311
TSI, + gas, + H2S, yellow slant, yellow butt
Citrobacter
312
TSI, + gas, + H2S, red slant, yellow butt
Salmonella
313
Indole in P. mirabilis vs. vulgaris
Vulgaris: indole +
Mirabilis: indole -
314
DOC for ESBL producing enterobacterales
Carbapenems
315
ESBL criteria
Resistance to Cephalosporins, Penicillins and Monobactams
316
Most common ESBL type
Plasmid mediated CTX-M beta lactamase (bla gene)
317
CREs types
KPC- common in the US
NDM1- New Delhi metallo beta lactamase
Other: IMP, OXA48, VIM
318
Moustache H2S in TSI
S. typhii
319
GNR causing mesenteric adenitis (mimic appendicitis)
Yersinia enterocolitica
320
Yersinia enterocolitica transmission
eating undercooked pork
321
Agar for Yersinia
CIN
Grows well at 4degC
322
GNR with bipolar staining like safety pin
Yersinia pestis
323
Gun metal gray pigment colony, super colonizer, nosocomial, ETT tube, intrinsically resistant to carbapenem
Stenotrophomonas maltophila
Non fermenter
324
2 nutritional factors needed to grow Haemophilus influenza
factor X: hemin
Factor V: NAD
Chocolate agar have both
325
HACEK
Dentition- bacteremia - endocarditis
Haemophilus/aggregatibacter
Actinobacillus (Aggretibacter)
Cardiobacterium
Eikinella
Kingella
326
HACEK that causes septic joint infection in children
Kingella Kingii
Hemolytic on blood agar
327
Sources of Brucella abortus
Raw cow milk
328
Sources of Brucella melitensis
raw goat milk, feta cheese
329
Sources of Brucella suis
infected pig exposure
330
Sources of Brucella canis
Infected dog exposure
331
Bugs causing hyponatremia
Legionella pneumophilla
332
Test for legionella
Urine EIA: detect type A during pulmonary infection
333
Ixodes tick
334
Anaplasma: in PMN
(vs. Echrlicia: in monocyte)
335
Name? Disease?
Soft tick (Ornithorodos hermsi)
Tick borne relapsing fever
336
Shepher's crook
Leptospira
337
Syphilis traditional algorithm
Non treponemal (VDRL, RPR) -- EIA/TPPA/FTA-ABS
High PPV, often missed primary and treated past infection
338
Syphilis reverse algorithm
Immunoassay abs screening -- RPR
Increased sensitivity
339
Reverse CAMP+ bug
Clostridium perfringens
340
Bug with double zone beta hemolysis on BAP
C. perfringens
341
6 Dimorphic Fungi
Histoplasma capsulatum
Blastomyces dermatitidis
Coccidiodes spp
Paracoccidioides spp
Talormyces marfenei
Sporothrix schenkii
342
Most common method to detect histoplasma
Urine EIA
343
Histoplasma
344
Vessel bx. Bug?
Histoplasma in vessels
345
Leishmania Donovani amastigote
346
Toxoplasma
347
Histoplasma CAPSULATUM
348
Blastomyces test in immunocompromised
Urine antigen
(vs. serum antibody EIA)
349
Blastomyces
Lollipop
350
Blastomyces mimic
351
Races common in coccidioidomycosis
Filipino, darker skin individuals
352
Coccidioides
353
Fungus with no yeast form in tissue
Coccidioides
354
Coccidioides in tissue (spherules)
355
Coccidioides
356
Paracoccidioides
357
Paracoccidioides
358
Sporothrix
359
Asteroid body
Sporothrix
360
Talormyces marneffei
361
Penucillium: Talormyces marneffei
362
Most common mycetoma: Nocardia
363
Nocardia (filamentous)
364
Bug? Stain type?
Nocardia, modified acid fast/Kinyoun
365
Nocardia
Crumble, dry
366
Eumycotic Mycetoma
Dermaticeous (black mold)
367
Acremonium spp (dematiceous)
368
Exophiala
(Dematiceous)
369
Chromoblastomycosis
copper penny
370
Bug? Disease?
Altenaria spp
Skin, sinus and nail infection
371
Bug? Disease? Population?
Curvularia lunata
Erythrematous skin, sinus, endocarditis. Immune suppressed
372
Exserohilum rostrum
Outbreak in pharma; steroid production
Meningitis, synovial, spinal infections
373
Scedosporium apiosperum
Eumycotic mycetoma
Pulmonary-- disseminated in immunospressed
Lollipop, branch at 45 degree angle
Intrinsically resistant to ampho B
374
Candida that does NOT form pseudohyphae and small in size
C. auris
C. glabrata
375
Candida instrinsically resistant to fluconazole
C. kruseii
376
Candida common in children and in IV line
C. parapsilopsis
377
Candida likely resistant to fluconazole
C. glabrata amd tropicalis
378
Candida chromagar: green
albicans
379
Candida chromagar: blue
tropicalis
380
Candida chromagar: pink
krusei
381
Candida chromagar: purple
glabrata
382
Candida chromagar: white
auris
383
Bug? Infection?
Trichosporon asahii
hair shaft (white piedra), onychomicosis, skin infection
384
Bug? Infection?
Malassezia furfur
Spaghetti and meatball
Oily skin
TPN infection in infants and adults
385
Microsporum canis
386
Microsporum gypseum
387
Trichophyton rubrum
388
Tryciphyton tonsurans
389
Epidermophyton floccosum
390
Galactomannan EIA
There is specific one for Aspergillus
391
Aspergillus fumigatus
Blue gree, 3-5 days
Conidia: colorless, upper third of vesicles
392
Aspergillus flavus
Grains
Brown gree,. 3-5 days
Green yellow conidia surround the swollen vescicle
393
Aspergillus niger
Black colony, 2-5 days
dark conidia, surround vesicle
394
Aspergillus terreus
Sandy color, 3-5 days
Conidia colorless, headed upward
Intrinsic resistant to AmphoB
395
Bug? Disease?
Fusarium solani
Banana boat, Fuscia colonies
Normal host: keratitis contact lens, nail, skin
Immuncompromised: sinusitis, PNA, fungemia (can be isolated from blood)
396
Scopulariopsis
Nail, sinusitis, PNA
Spiny chain conidia
Very resistant to Ampho B and other agents
397
Mucorales
398
Rhizopus
399
Mucor: no rhizoids
400
Absidia: distant rhizoid
401
Cuninghamella: mucorales
402
Entamoeba histolytica cyst. Up to 4 nuclei
403
Entamoeba histolytica trophozoite
ONE nucleus CENTRALLY placed karyosome
404
Entamoeba coli trophozoite
Eccentric nuclei and karyosome
COMTAMINANT
405
Entamoeba coli cyst
MORE THAN 4 nuclei
