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USMLE® Step 1 flashcards
1
Q

name the 6 components of the chain of infection

A 
.infectious agent
. reservoir
. portal of exit
. means of transmission
. portal of entry
. susceptible host
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2
Q

name 4 modes of disease transmission

A

. direct contact
. indirect contact
. droplet
. airborne

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3
Q

define virulence

A

the ability of microbe to cause disease

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4
Q

name 2 virulence factors

A

endotoxins and exotoxins

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5
Q

what is the name given to a pathogen that comes from an animal?

A

zoonosis

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6
Q

what are fomites?

A

contaminated objects, act as a a bridge but do not transmit infection themselves

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7
Q

what is the incubation period?

A

time between contamination and development of symptoms

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8
Q

what is the difference between infection and colonisation?

A

in infection the microbes make you sick whereas in colonisation the microbes are in your body but not making you sick

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9
Q

what is an endogenous flora?

A

own flora

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10
Q

what is an exogenous flora?

A

disease carried by microbe from external source

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11
Q

how may microbes exit ?

A

coughing, sneezing, dental hand piece aerosol, blood donation

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12
Q

what is an R0 in relation to an infection?

A

no. of cases one case generates on average over the course of its infectious period

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13
Q

an R0 of greater than 1 indicates what

A

infection will be able to spread in a population

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14
Q

an R0 of less than 1 indicates what

A

infection will die out in population

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15
Q

name the 3 typeof influenza?

A

A, B and C

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16
Q

which types of influenza result in major outbreaks

A

a and b

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17
Q

which 2 types hepatitis are a risk for dentists and patients?

A

b and c

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18
Q

describe the structure of hep a

A

. single stranded RNA genome

. non-enveloped

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19
Q

how is hep a most commonly transmitted?

A

. faecal oral

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20
Q

which form of hepatitis is not life threatening?

A

hep a

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21
Q

what is human normal immunoglobulin therapy?

A

the use of a mixture of antibodies to treat a number of health conditions.

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22
Q

how may you passively immunise against hep a?

A

human normal immunoglobulin

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23
Q

how may you actively immunise against hep a?

A

vaccination

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24
Q

why is vaccination for hep a preferred over normal immunoglobulin therapy?

A

vaccination is long term where as human normal immunoglobulin is only short term

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25
Q

which type of hepatitis inmost infectious?

A

Hep B

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26
Q

describe the structure of hep b

A

double sanded dna virus

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27
Q

hepatitis B is a hepadnavirus, what does this mean?

A

can cause acute/chronic liver failure

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28
Q

how many subtypes hep b are there?

A

8

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29
Q

what is the active component in the hep b vaccine?

A

surface antigen

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30
Q

which hepatitis virus has a very effective vaccine yet no treatment?

A

hep b

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31
Q

list some ways hep b can be transmitted

A 
. iv drug users
. healthcare workers
. haemodialysis patients
. sexually contacts of infected people
. infants born to infected mothers
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32
Q

infected children have an increased chance of being a long term hep b carrier, what condition may carriers be at risk of?

A

liver disease

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33
Q

if somebody has been infected by hep b, how would you passively treat this?

A

hep b immunoglobulin from pooled plasma within 48hrs

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34
Q

what does the hep b vaccine consist of?

A

hep b surface antigen and aluminium hydroxide adjuvant

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35
Q

describe the structure of hep c

A

enveloped rna

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36
Q

how may hep c be transmitted?

A 
. iv drug users
. blood contact
. organ/tissue transplant
. sexually
. vertically (mother to child)
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37
Q

how is hep c treated?

A 
medications including:
. ribavirin
. boceprevir
. sofosbvir
. ledipasvir
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38
Q

hep d requires which other hepatitis for replication?

A

hep b

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39
Q

name all hepatitis viruses

A

a, b, c, d and e

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40
Q

which BBV transmitted via sharps injury is most dangerous?

A

hep b

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41
Q

which BBVs can be transmitted via a sharps injury?

A

hep b, c and HIV

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42
Q

which BBV can be transmitted via saliva?

A

hep b

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43
Q

which BBV is most commonly transmitted via sharps injury?

A

hep c

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44
Q

which BBV is most least transmitted via sharps injury?

A

hep b

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45
Q

what does the first A in be sharps AWARE stand for?

A

apply pressure and allow to bleed

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46
Q

what does W in be sharps AWARE stand for?

A

wash don’t scrub

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47
Q

what does the second A in be sharps AWARE stand for?

A

assess type of injury

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48
Q

what does R in be sharps AWARE stand for?

A

risk of source of blood

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49
Q

what does E in be sharps AWARE stand for?

A

establish contact

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50
Q

in relation to a sharps injury, what does u=u means?

A

undetectable viral load = unable to transmit HIV

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51
Q

list some ways occupational health exposures can be reduced

A 
. sharps containers
. awareness
.  hand hygeine
. ppe
. vaccine
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52
Q

what requirements do employers have in relation to preventing sharps injuries?

A

. promote safe use and disposal of medical sharps
. provide info and training
. respond effectively if injury occurs
. review procedures regularly

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53
Q

what requirements do employees have in relation to preventing sharps injuries?

A

. notify employer as soon as practical after receiving injury
. info and training on what to do in event of injury

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54
Q

what is the definition of sepsis?

A

life threatening dysfunction caused by disregulated host response to infection

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55
Q

organ dysfunction in a patient suspected to have sepsis can be measured by what?

A

SOFA score greater than 2 points

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56
Q

is sepsis and infection?

A

no but it doesn’t not occur in the absence of infection

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57
Q

what differentiates infection from sepsis?

A

present of organ dysfunction in sepsis

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58
Q

the range of tests that test organ function are collectively known as?

A

qSOFA

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59
Q

which type of microbes cause sepsis?

A

. gram positive bacteria
. gram negative bacteria
. fungus

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60
Q

which type of microbe most commonly cause sepsis?

A

gram negative bacteria

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61
Q

which microbial factor may cause infection to progress to sepsis?

A

. virulence factors

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62
Q

which host factor may cause infection to progress to sepsis?

A 
. innate immunity (non specific)
. adaptive immunity
. immunocompromised
. pre existing chronic condition
. age
. genetics
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63
Q

which age group most commonly get sepsis?

A

elderly

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64
Q

describe the pathophysiology of sepsis?

A

. dysregulated, excessive systemic inflammation
. body-wide blood clotting and leaky vessels
. 1 or more organs begin to fail
.perisitent hypotension

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65
Q

in the event of inflammation, our innate immunity recognises PAMPs (pathogen associated molecular patters) and DAMPs (damage associated molecular patterns) via which which molecules?

A

PRRs

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66
Q

inflammation is triggered by the release which two immune cells?

A

cytokines and chemokine

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67
Q

what is used to treat sepsis?

A

. antibiotics
. fluids - colloids and crystalloids
. vasopressors

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68
Q

why do dentists need to be educated on sepsis?

A

. dental infections may cause sepsis

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69
Q

what are the red flag symptoms of a spreading dental infection?

A 
. temperature over 36
. elevated breathing
. increased or decreased heart rate
. facial swelling
. trismus
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70
Q

is the ICF negative or positive in relation to the ECF?

A

negative

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71
Q

which ion is most prominent in the ECF?

A

sodium

72
Q

which ion is most prominent in the ICF?

A

potassium

73
Q

at resting potential, is the membrane permeable or impermeable to sodium ions?

A

impermeable

74
Q

at resting potential, is the membrane permeable or impermeable to potassium ions?

A

very permeable

75
Q

what is the resting membrane potential mainly due to?

A

diffusion of potassium ions from inside the cell

76
Q

what is the AP threshold

A

-55mV

77
Q

during the upstroke of the AP, which ion enters the neuron?

A

sodium

78
Q

which ion is moved out of the neuron during the downstroke of the ap?

A

potassium

79
Q

volage gated sodium channels have two gates, name these

A

m gate and h gate

80
Q

describe the position go the m and h gate when the sodium channel is closed

A

. m gate closed

. h gate open

81
Q

describe the position go the m and h gate when the sodium channel is open

A

. m gate open

. h gate open

82
Q

describe the position go the m and h gate when the sodium channel its closed during refractory period

A

. m gate open

. h gate closed

83
Q

what happens when the AP threshold is met?

A

. sodium ion channels open
. sodium influx
. increased depolarisation
. potassium channels remain shut

84
Q

what happens when the AP reaches +35mV?

A

. sodium channels shut
. h gate is inactivated
. potassium channels open
. potassium reflux begins

85
Q

the refractory period is due to what?

A

inactivation of h gates on sodium channel

86
Q

what is the refractory period of an AP?

A

after AP is generated, neuron cannot generate another until the 1st has ended

87
Q

increasing axon diameter has what effect on speed of ap propagation?

A

increased speed

88
Q

which size of axons, small or large conduct impulses faster?

A

large

89
Q

which cells lay down myelin?

A

glial cells (oligodendrocytes in CNS and schwann cells in PNS)

90
Q

the myelin sheet is interrupted at intervals called?

A

nodes of ranvier

91
Q

the propagation of action potentials along myelinated axons from one node of Ranvier to the next node is called?

A

saltitory conduction

92
Q

which axon type is unmelinated?

A

c fibres

93
Q

what effect does LA have on a nerve?

A

blocks voltage gated sodium channels preventing sodium influx, therefore blocking AP generation and propagation

94
Q

list the nerves in order of most to least susceptible to LA block

A

a delta
c fibres
a beta
a alpha

95
Q

what is the sensory function of a alpha (group i) nerve fibres?

A

proprioception

96
Q

what is the sensory function of a beta (group ii) nerve fibres?

A

mechanoreceptors

97
Q

what is the sensory function of a delta (group iii) nerve fibres?

A

. mechanoreceptor,
. thermoreceptor,
. nociceptor,
. chemoreceptor

98
Q

what is the sensory function of c (group iv) nerve fibres?

A

. nociceptor,
. thermoreceptor,
. chemoreceptor

99
Q

why does LA have a risk of bradycardia and hypotension?

A

it also blacks sodium channels in other excitable tissues, for ex the heart muscle

100
Q

LA is an organic molecule consisting of 3 components, what are these?

A

. aromatic region (hydrophobic)
. ester or amide bond (intermediate)
. basic amine side chain (hydrophilic)

101
Q

which types of nerves are most easily blocked by LA?

A

small myelinated

102
Q

why are myelinated nerves more susceptible to LA block?

A

they only need blocked at nodes of ranvier

103
Q

list the following, autonomic nerves, sensory nerves and motor nerves in order of most susceptible to LA

A

. autonomic
. sensory
. motor

104
Q

in dental LA what is the base?

A

hydrochloride

105
Q

what is the ester in dental LA?

A

benzocaine

106
Q

what is the amide in dental LA?

A

lignocaine, prilocaine etc

107
Q

are LAs vasoconstrictor or vasodilators?

A

vasodilators

108
Q

name 2 common vasoconstrictors added to LA?

A

. adrenaline

. felypressin

109
Q

which 4 types of receptors does adrenaline act on?

A

. a receptors (vasoconstriction)
. beta 2 (vasodilation)
. beta 1 (cardiac muscle)
. ADH receptos

110
Q

given locally, adrenaline has what effect on BVs?

A

vasoconstriction

111
Q

how is the ester in LA broken down?

A

tissue esterases (short action)

112
Q

how is the amine in LA broken down?

A

liver amidases (long action)

113
Q

list 6 modes of LA administration

A 
. topical
. local infiltration
. regional nerve block
. injection
. nerve root block (epidural)
. IV
114
Q

what is the max dose for lignocaine?

A

4mg per kg body weight

115
Q

in ECF, the principle cation is _ and the principle anion is _?

A

cation - sodium

anion - chloride

116
Q

in ICF, the principle cation is _ and the principle anion is _?

A

cation - poatssum

anion - phosphate

117
Q

sodium and postassium may cross the membrane against the conc gradient via?

A

sodium potassium pump

118
Q

why r smaller axons more susceptible to LA?

A

they have less fewer voltage gated sodium channels permit of area

119
Q

which senses are blocker first by LA?

A

pain and thermal senses

120
Q

what is a high risk (critical) dental environment or piece of equipment?

A

items in contact with normal sterile body sites

121
Q

what is a medium risk (semi-critical) dental environment or piece of equipment?

A

items in contact with mucous membranes

122
Q

what is a low risk (non-critical) dental environment or piece of equipment?

A

items in contact with intact skin

123
Q

what is a minimal risk dental environment or piece of equipment?

A

not normally in contact with intact skin

124
Q

compare gingivitis and periodontitis

A 
gingivitis
- inflammation localised to gingivae
- acute inflammation
- normal physiological response to infection
periodontitis
- inflammation of all periodontal tissues
- chronic inflammation
pathological inflammation
125
Q

compare infection and colonisation

A

infection - micro-organisms causing damage to body tissues, usually in presence of acute inflammtion
colonisation - bacteria grow on body sites exposed to the environment causing infection

126
Q

name 3 periodontal pathogens

A

p. gingivalis
t. forsytha
t. denticola

127
Q

list some immune defences in the oral cavity?

A

gingival crevicular fluid - AMPSs, chemokine,cytokines, lactoferrin, IGA
oral mucosa - AMPs, cytokines, chemokine
saliva - IgA, lysosomes, peroxidase, lactoferrin, muffins, cystatins, histatins

128
Q

what is the initial predominant cell type in gingivitis?

A

neutrophil

129
Q

which ligand induces osteoclast differentiation?

A

RANKL

130
Q

which substance prevents RANKL binding RANK?

A

OPG

131
Q

all microbes in the human body are known as the?

A

microbiome

132
Q

a community of microbes that live together on a surface are known as?

A

biofilm

133
Q

which outnumbers which, microbes or body cells?

A

microbes out weigh body cells 10:1

134
Q

list these in order of smallest to largest, bacteria, helminth, virus and fungus

A

virus (smallest)
bacteria
fungi
helminth (largest)

135
Q

what are the benefits of normal flora?

A

synthesis and excrete vit k dan b12
prevent colonisation by pathogens
stimulate development of specific tissues

136
Q

list the 4 criteria for koch postulates?

A
  • microbe present in every case of disease
  • microbe isolated from host and grown in pure culture
  • disease reproduced when pure culture introduced to susceptible host
  • microbe recovered from experimentally infecting host
137
Q

name some methods of physical growth control of microbes?

A

heat sterilisation

radiation sterilaisation

138
Q

name some methods of chemical growth control of microbes?

A

antiseptics (biological) and disinfectants (inanimate)
natural antimicrobials
synthetic antimicrobials

139
Q

strong chemical agents that inhibit or kill microorganisms are known as?

A

disinfectants

140
Q

disinfectant agents with sufficiently low toxicity for host cells are known as?

A

antiseptics

141
Q

which are used on mucous and skin, disinfectants or antiseptics?

A

antiseptics

142
Q

describe selective toxicity in terms of antiseptics?

A

toxic to micro-organisms but not to human cells

143
Q

antiseptics can be classified in 2 ways, what are these and which is preferred?

A

cidal (preffered) or static

144
Q

describe what is meant by a cidal antiseptic?

A

denatures proteins

cause osmotic disruption of cell

145
Q

describe what is emanate by a static antiseptic?

A

interfere with specific metabolic processes

146
Q

which type of disinfectants oxidise SH groups of proteins and enzymes producing SS bonds which disrupt structure and function?

A

iodophors

147
Q

which disinfectant is most effective against gram positive cocci?

A

chlorohexidine

148
Q

are antibiotics naturally occurring or synthetically produced?

A

naturally occurring

149
Q

what is the definition of an antibiotic?

A

chemical substance produced by 1 organism that is destructive for another

150
Q

list some properties of an ideal antimicrobial?

A

selective toxicity against target
minimal host toxicity
cidal activity
long plasma 1/2 life

151
Q

what may antimicrobials target?

A

inhibit cell wall synthsis
inhibit protein synthesis
inhibit essential metabolite synthesis
injure plasma membrane

152
Q

for the bacteria S. aureus, give a description, its virulence factor and a disease it can cause

A

gram positive cocci
PVL toxin
impetigo, pneumonia

153
Q

for the bacteria S. pyogenes (group A strep), give a description, its virulence factor and a disease it can cause

A

gram postive in chains
super antigenic and toxic shock syndrome
meningitis, arthritis

154
Q

for the bacteria S. anginosus, give a description, its virulence factor and a disease it can cause

A

gram positive in chains
cytotoxin
dental abscess

155
Q

for the Herpes simplex virus, give a description, its virulence factor and a disease it can cause

A

fried egg virus
cause cell lysis
herpies labialis

156
Q

for the fungus candida albicans, give a description, its virulence factor and a disease it can cause

A

gram positive
phosoplipidase
candidiasis

157
Q

give an example of an infection of the epidermis and which organism(s) can cause it

A

impetigo - group a strep or staph aureus

angular chelitis - candida albicans

158
Q

give an example of an infection of the dermis and which organism(s) can cause it

A

erysipelas - group a strep

159
Q

give an example of an infection of the hair follicle and which organism(s) can cause it

A

folliculitis - staph aureus

160
Q

give an example of an infection of the subcutaneous fat and which organism(s) can cause it

A

cellulitis - group a strep

161
Q

give an example of an infection of the fascia and which organism(s) can cause it

A

necrotising fasciatis - group a strep and other bacteria

162
Q

give an example of an infection of the muscle and which organism(s) can cause it

A

myonecrosis - c perfinigens

163
Q

surgical wound infection are usually caused by which microorgansism?

A

staph aureus

164
Q

during the immune response, which is low specificity and high and which is procured 1st, IgM or IgG?

A

low specificity IgM produced fist

high specificity IgG takes longer as require T cell help

165
Q

which type of antibodies are responsible for secondary response to infection?

A

IgG

166
Q

a vaccination containing a live microorganism weakened via genetic manipulation is known as ?

A

live attenuated vaccine

167
Q

a vaccine containing a microorganism killed through chemical or physical processes is called?

A

inactivated vaccine

168
Q

a vaccine containing no live components is ?

A

subunit vaccine

169
Q

which type of vaccine gives best immunity?

A

live attenuated

170
Q

which substance is added to vaccinations to increase immune response?

A

adjuvant

171
Q

name some conventional immunosupressive drugs

A

corticosteroids
NSAIDs
methotrexate
biological therapies

172
Q

name synthetic cortisol

A

prednisolone

173
Q

name a disease modifying anti-rheumatic drug (DMARD)

A

methotrexate

174
Q

genetically engineered antibodies from human genes that target the immune response is what type of treatment?

A

biological therapy

175
Q

what is the aim of vaccination?

A

stimulate adaptive immunity and generate long-term immunological memory

biological and medical sciences 2 (11 decks)

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