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board review > board review microbiology bacteria > Flashcards

board review microbiology bacteria Flashcards

1
Q

cause of trench fever

A

Bartonella quintana

reservoir is humans

vector is lice.

self limited

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2
Q

Bartonella quintana

REservoir?

Vector?

is the disease self limited

A

human = reservoir

vector = lice

self limited

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3
Q

On the boards

painless violaceous nodule on the skin with fever in an HIV pt.

has a cat

A

Bacillary angiomatosis

dont confuse with kaposi sarcoma

TRICK:

BACILLARY ANGIOMATOSIS = neutrophilic infiltrate

Kapsoi sarcoma = Lymphocytic infiltrate

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4
Q

bacteroides fragilis

is a common normal Gi flora (strict anarobe) –>

periotonitis and serios anaerobic infections (GI and pelvic abscesses) no bowel sound.

tx?

A

metronidazole 1st line

clindamycin2nd line

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5
Q

two important microaerophilic

A

*H pylori

campylobacter jejuni

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6
Q

what is the only known microorganism that can thrive in the highly acidic environment of the stomach

A

H pylori

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7
Q

on the board.

pt with recurrent UTIand stag horn struvite kidney stone.

Ammonium magnesium phosphate (struvite stone)

A

Proteus mirabilis

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8
Q

Q on boards

Both klebsiella and Proteus mirabilis

can cause Stag horn struvite kidney stones.

how can you tell the difference bw the two?

A

question will tell you

Lactose fermenter (Klebsiella)

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9
Q

Q on boards

pt with Proteus mirabilis kidney stone. whats the treatment

A

ceftriaxone

or

TMP/SMX + gentamicin

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10
Q

Q on boards

a pt w/ recurrent UTIs, now presents with fever, N/V, flank pain, hematuria

whats the cause?

A

Proteus mirabilis

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11
Q

Q on boards

male pt with burning pee,

negative culture for ghonorrhea and chylamdia.

Urease +.

cause???

A

Ureaplasma urealyticum

urethritis in MALES (if neither gonococcus or chlamydia identified)

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12
Q

painful genital ulcer with exudate “pus” and unilateral painful swollen lymphadenopathy (bubo) draining pus.

what is STI

** whats the treatment??

A

Haemophilus ducreyi (chancroid)

TX: ***Azithromycin

or

cetriaxone

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13
Q

immigrant

child with drooling, hoarseness, sit in a “sniffing position” with

body leaned forward and head and nose tiled forward/upward

enriched chocolate agar.

diagnosis?

A

epiglottis

due to Haemophilus influenza type B

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14
Q

the polysaccharide b capsule vaccine induced immune response only works in a person over what age?

this is the H influ type B vaccine

A

only induces immune response in children > 18 months

this is why it was ineffecive in protecting children younger than 18.

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15
Q

for the boards

meningitis during the first 3 months (is due to microorganism acquired during passage) list most common

A

1, Grp B strept

  1. E. coli
  2. Listeria monocytogenes
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16
Q

on the boards

look for pt with sudden onset of headache, confusion, watery diarrhea, and severe pneumonia

cause?

A

legionella pneumophila

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17
Q

trick boards questions

where do legionella pneumophila multiply?

A

macrophages in the alveoli

phagocytosed by macrophages and multiple –> enter the alveoli –> pneumonia

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18
Q

Q on boards

pt with HA, confusion, watery diarrhea and severe pneumonia

labs: hyponatremia.

(legonella)

whats the tx?

A

*Erythromycin.

first aid: macrolides (azithromycin) and fluoroquinolones (levofloxacin)

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19
Q

Q on the boards

what is the SAFE immunization in pregnancy for bordetella pertussis?

A

DTAP

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20
Q

on the boards

pt from _eastern europ_e who is living on a farm and eating unpasteurized milk (usually goat cheese) is seen with a fever (going on for months) that rises in the morning and falls at night(undulant fever) with *sweating*,

muscle aches and arthritis (*** bilateral Sacroiliitis***)

A

Brucella

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21
Q

brucella

will invade the reticuloendothelial system and induce granuloma in the lymph nodes, liver, spleen and ?

A

bone marrow

diagnosis: bone marrow, blood culture, or positive bengal rose rxn (demonstration of antibodies w/ ELISA)

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22
Q

tx for brucella

and there side effects

A

tx with both

doxycycline (can cause drug induced lupus)

Gentamicin (nephrotoxicity, ototoxicity)

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23
Q

name the uresase pathogens for the boards

A

cryptococcus (an opportunistic meningitis in HIV pt, inc CSF opening pressure)

Klebsiella pneumonia –> red sputum- look for alcoholics, diabetics or pts w/ chronic lung disease

H pylori

Proteus mirabilis –> recurrent UTI –> staghorn stone

Ureaplasma urealyticum –> urethritis in Males ( if neither gonoccous or chlamydia identified)

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24
Q

on the boards

pt from arkansas (or oklahoma, missouri) presents with Black based ulcers on his arms and enlarged lymph nodes.

he is handling rabbit products

oculoglandular, typhoidal (mouth), pneumonic w/ the formation of granulomatous lesion in the lung, spleen liver.

what treatment should you do?

A. aspirate the LN

B. give streptomycin and dont aspirate

A

do NOT aspirate the LN - highly infectious

give streptomycin

diagnosis = tularemia

ulcers commonly present on hand.

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25
Q

first line tx for pasteurella multocida?

A

avoid suturing animal bite woulds

tx: amoxicillin clavulanate

from combank - if pt has sulfa or penicillin allergy give doxycyclin.

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26
Q

Yersinia pestis

Reservoir?

human gets infect how?

leading to 3 complications?

A

reservoir is rodents

flee bites human

pneumonic, septicemic, or the bubonic plaques

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27
Q

yersinia pestis

bubonic plaque presentation

Question! how would you treat?

A

enlarged LN

black necrotic skin lesions (black death)

invades lungs, liver, spleen also from combank: fever, cough, dyspnea, hemoptysis, painful lymphadenopathy.

can lead to DIC, necrosis of finger tips and tip of nose.

TX: streptomycin (aminoglycosides) , tetracycline

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28
Q

culture of the lymph gland aspirate shows

gram negative rod w/ bipolar staining (saftey pin appearance)

what organism

A

yersinia pestis

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29
Q

what is the route of transmission or infection with

yersinia enterocolitica

A

fecal oral route or raw unpasteurized milk.

  • may cuase diarrhea (enterotoxin in the ileum) in kids < 5
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30
Q

Q on boards

yersinia enterocolitica

can cause colonic ulceration –> dysentery (bloody diarrhea) in adults,

what complication will it cause if it spreads?

A

liver and splenic absecces

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31
Q

question on boards

what type of patients are susceptible to yersinia enterocolitica

A

hemochromatosis and hemolytic anemia pts

bc it is siderophilic (iron loving) bacteria

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32
Q

Q on boards

yersinia enterocolitica is associated with what type of arthritis?

A

reactive arthritis (reiters syndrome)

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33
Q

all of the following can cause reactive arthritis except?

(aspriate joint and not septic) how do you sterilize joint before aspriation?

yersinia

chlamydia trachomatis

shigella

campylobacter infection

gonorrhea.

A

gonorrhea

sterilize joint - chlorhexadine

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34
Q
A
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35
Q

H pylori

causes

intestine lgastric adenocarcinoma or diffuse type

A

​intestinal type gastric adenocarcinoma

not diffuse (linitis plastica)

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36
Q

trick Q on boards

pt that has H pylori infection, now diagnosed with MALT lymphoma

how shouuld you treat the lymphoma?

A. give chemo

B. give PPI

C. tx the H pylori infection

A

treat the H pylori infection

(amoxicillin, clarithromycin and PPI)

if pt allergic to penicillin use metronidazole.

which in turn will cure the MALT lymphoma

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37
Q

Q on boards

what bacterial infection precedes

reactive arthritis and guillian barre syndrome?

A

campylobacter jejuni

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38
Q

what two bacteria cause appendicitis like signs

A

yersinia enterocolitica

  • pet feces
  • dysentery (bloody diarrhea)
  • precedes reactive arthritis (reiters syndrome)

campylobacter jejuni

  • unpasteurized milk
  • diarrhea bloody
  • precedes guillain barre syndrome
39
Q
A
40
Q

Q : tx for bacteroides fragilis

a common normal GI flora (strict anerobe) –> peritonitis and serious anaerobic infections (GI and pelvic abscess)- no bowel sounds

A

metronidazole

if metronidazole isnt answer choose

clindamycin

41
Q

Q on boards (trick)

presents as a painless violaceous nodule on the skin with fever in a HIV patient.

examation of the nodule shows neutrophilic infiltrate .

nodule shown in exhibit below.

what is the cause?

A

bacillary angiomatosis in AIDS pt

dont confuse with kaposi sarcoma

(less acute than bacillary angiomatosis and usually macular)

Kaposi will have Lymphocytic infiltrate (not neutrophilic)

42
Q

tx of bacillary angiomatosis in AIDs pt?

A

erythromycin +/- rifampin

sketchy says azithromycin and doxycycline

43
Q

on boards

rash that is macular, papular, annular or follicular​

pt with a hx of painless gential ulcer healed 6 weeks ago and started to have generalized rash including the palms and soles

diagnosis ?

A

secondary syphilis

44
Q

on the boards

pt diagnosed with tiertary syphilis

Gummas (tumor like balls of inflammation/granulomas) involving: soft tissue, CNS, bone, cardiovascular

* pt develops an aortic aneurysm with no hx of cardiovascular risk.

what is the pathophysiology in the development of this?

A

syphilitic aoritits –> destruction of the VASA VASORUM (supplying nutrition to the aortic wall) –> aortic aneurysm

45
Q

on the boards

pt presents with loss of vibration sense, discriminative touch, and proprioception in the lower extremties as well as unsteadiness while eyes are closed + romberg sign

on further question he says he had a STI 10 years back and said it went away on its on

what is the cause

A

Tabes dorsalis ​

caused by untreated syphilis.

degeneration of nerves of the dorsal column (fasciculus gracilis)

note trick!!! romberg test is only positive in dorsal column damage not cerebellar.

46
Q

Q on boards

what is the only treatment for neurosyphilis?

PCN-G

*** what if the patient has allergy to PCN

A

desensitize and treat w/ PCN

47
Q

there will be a + quellung rxn in ?

A

capsulated bacteria

48
Q

epidermolytic toxin A and B (exfoliative toxin)

are responsible for what in gram + cocci

A

SSSS

staphylococcal scalded skin syndrome

49
Q

pt presents with

fever, septic shock, confusion, diffuse erythemaotus rash, desquamation on the palms and soles,

vomiting, diarrhea - hypotension

puritic maculopapular lesions on the extremities

you diagnose toxic shock syndrome toxin-1

what is the mechanism

A

superantigen activates CD4 Th cells which stimulate cytokine release

the above mechanism is caused by staph a. (lethal)

also can be caused by

Exotoxin A and C of strept pyogenes

50
Q

how does staph epidermidis

virulent factor work

A

produces Glycocalyx forms a hydrophobic biofilm which is adhesive to foreign surfaces (valves and catheters)

51
Q

for boards

the most common causative organism of cystitis in a young healthy pregant women

as well as postpartum endometritis/bacteremia is?

A

group B strept agalactiae

tx penicillin or ampicillin

52
Q

explain how protein A (virulence factor)

attributes to the pathogenicity of staph aureus

A

protein A binds ot the Fc portion of IgG at the complement binding site

preventing the activation of complement

53
Q

for the boards

community acquired MRSA

it colonizes the nasopharynx and skin in close contact setting.

look for pt with recurrent cellulitis or boils

(contact sports, military recruits, native americans, gays, iv drug user, prison.

what is the treatment

A

trimethoprim-sulfamethoxazole (FIRST LINE)

doxycycline

clindamycin

54
Q

what is the most important virulence factor of strept pyogenes (GRP A )

A

M protein

protects it from phagocytosis and inhibiting complement activation.

55
Q

on the boards

pt with redness and swelling of the extremity with bullae and enlarged lymph nodes

A

erysipelas

caused by strep pyogenes

56
Q

on the boards

look at a post-surgical patient in the icu with

fever, hypotension, skin rash, and implanted device

or

young women presented with these symptoms during menstruation and using tampon

diagnosis.

A

TSS ​

either caused by staph or strept.

57
Q

on the boards

blood cultures for Toxic shock sydrome are

____ for staph a.

____ for strept pyogenes

A

********NEGATIVE for staphylococcal TTS

positive = streptococcal TSS ​

58
Q

on the boards

severe infections with S. Pneumoniae

are seen in pts with (MM, Asplenia, SS) ** alcoholism or hypogammaglobulinemia

look for a pt with fatal pneumococcal bacteremia and disseminated intracappilary coagulopathy (DIC) due to ?

A

lack of IgG (required for opsonization).

59
Q

boards

pt with UTI, sepsis, endocarditis and traunsurethral resection of the prostate (TURP)

grows on 6.5% salt broth (NaCL) and bile

cause?

A

enterococci (Grp D streptocci)

60
Q

what is the leading cause of invasive bacterial respiratory disease in pts with HIV?

A

Stept pneumoniae

not PJP

61
Q

what are you IgA protease secreting bacteria

A

Strept pneumonia

N gonorrhea

N meningitidis

H influ type B

62
Q

High yield

which streptococcus viridans subtype produces

dextrans from sucrose –> bacteria adherence to FIBRIN -platelets aggregates on damaged heart valves what type of endocarditis

this causes

TX?

A

strept sanguinis

causes subacute endocarditis

it also can cause dental enamel caries

TX: penicillin and aminoglycosides

63
Q

strept mutans

can cause caries how?

A

fermentation of sugar –> lactic acid (deminieralization of enamal)

64
Q

Question on boards not in first aid

Peptostreptococcus

are anaerobic, multiform, gram + non-spore forming bacteria, commensal organism, mainly in mouth

look for pt with periodontal disease or difficulty in swallowing

(post stroke or ALS who presents with cavitary pneumonia)

what can this microbe cause?

A

***lung abscess***

brain, liver, breast abcesses in immunocompromised pts.

65
Q

true or false.

there is no increased risk for listeria infection in pt with immunoglobulin or complement deficiency ?

A

true

66
Q

for the boards

what microbe

gram + aerpboc rod “chinese letter appearance”

black colonies on potassium tellurite

cytoplasm contains metachromatic granules that stain with aniline dyes

A

corynebacterium diphtheria

67
Q

for the boards

diphtheria toxin works how?

and what other microbe uses the virulence factor exotoxin AB to do the same thing

A

ADP-ribosylate the host EF-2 –> inhibition of protein synthesis and cell death..

P. aeruginosa.

68
Q

contraceptive intrauterine devices inc the risk for GU infections with?

A

actinomyces israelii

69
Q

beaded branching filamentous and weakly acid fast.

first presents with lung infection (cavitary) then spread to form brain abscess in pts with cell mediated immunosuppression

know that this bacteria can also cause mycetoma (chornic foot infection –> bone and soft tissue sinuses

what bacteria does this

A

nocardia

70
Q

trick question

which neisseria has a capsule?

N meningitidis: (maltose and glucose oxidzer)

N. Gonorrhoeae: (only glucose oxidizer)

A
71
Q

Q on boards

the most common cause of ophthalmia neonatorum

occurs in the first five days.

bilateral purulent discharge

A

Neisseria gonorrhoeae

72
Q

currant jelly stool in a previously healthy 7-10 month infant

your thinking?

A

intussusception

73
Q

on boards

alcoholic pt with pneumonia in the upper lobe complaining of cough with a bloody “currant jelly” sputum

A

Klebsiella pneumonia

74
Q

pwhwich batteria is the only toxiicogenic bacterial diarrhea in which antibiotics significantly shorten the duration of the disease ?

A

vibrio cholerae

TX: tetracyclines, rehydration w/ glucose and sodium

75
Q

neutropenia –> pseudomonal bacteremia –> ecthyma gangrenosum (pseudomonal sepsis in very ill pt)

look for a rounded indurated black lesion with central ulceration

tx with ?

A

antipseudomonal antibiotics

76
Q

pyoderma gangrenosum.

asoociated with

vasculitis, RA, Myelofibrosis, multiple myelome, and crohns disease

TX with?

A

prednisone.

77
Q

the cause of pneumonia in

cystic fibrosis

or

nosocomial infections in pts with ventilatory support

your thinking the cause is?

A

pseudomonas

78
Q

TX of pseudomonas

which cepholosporins cant be used***

A

antipseudomonal penicillin (piperacillin) and aminoglycosides or ciprofloxacin (fluoroquinolones)

can use: ceftazidime, cefepine

canT use: ceftriaxone or cefuroxime

79
Q

on boards

pt living in new york and has spreading erythematous rash with raised border and central clearing at the site of a bite. erythemia chronicum migrans

what stage of lymes disease is this?

do you need to do serology test?

A

stage 1

do not need to do serology

tx with Doxycycline,

80
Q

on the boards

ptpresents with polyarthiritis, headache, meningitis, and cranial neuritis

and bells palsy

A

stage 2 lyme disease

81
Q

pt who lives in NY and presents with heart problems although he has no history of cardiac disease

he is diagnosis with lymes disease. what is the heart condition

A

3rd degree AV block

82
Q

on the boards.

pt with a fever that starts every 8 days then breaks with excessive sweat and rash

commonly have splenomegaly

what is the diagnosis and what are the symptoms and relapsing fever due to?

A

borrelia recurrentis

the relapse of the fever and symptoms is due to antigen variation (the immune system does not recognize the change antigen)

83
Q

what are the two intracellular parsites that require the host ATP for replication

A

chlamydia and rickettsia

84
Q

pt with recent hx of tick bite who has rash on palms and soles

spreading proximally to the trunk with fever, arthralgia, headache and inc LFTs

***what is the diagnosis

what is treatment?

A

rickettsia rickettsii

tx: doxycycline or chloramphenicol (during pregnancy)

85
Q

what are the 6 infections that cause

rash on the palm and soles

A

rocky mountain spotted fever

toxic shock syndrome

meningococcemia

coxsackie A

secondary syphilis

86
Q

on the boards

cattle farmer (cattle slaughterer, or around animals during delivery) who presents with a

sudden onset fever and dry cough (atypical pneumonia)

what is the severe complication of this infection?

A

diagnosis coxiella burnetii (Q fever)

develop endocarditis (chronic) evaluate with TEE

tx with tetracycline.

87
Q

pt with pneumonia that had a gradual onset, pharyngitis an hoarseness of voice

sinusitis frequently with the pneumonia.

you used what to diagnosis chlamydia pneumoniae

how would you treat this

A

diagnose with giemsa stain to identiy the intracytoplasmic inclusions -

however know that PCtR is the standard test

doxy or azithromycin

88
Q

Q on boards

pet shop worker or veterinarians (** with parrotts) with atypical pneumonia

what is diagnosis

and how would you treat

how does it spread

A

chlamydia psittaci

TX: doxxycyline

bacteria shed from feces of birds (parrots) to respiratory track

89
Q

TRICK ON BOARDS

you treat a pt for chlamydia psittaci with doxycycline

however the pt is not responding to doxy and still has symptoms of pneumonia

what is the new diagnosis

A

histoplasmosis

note if it was the other way around and the patient wasnt responding to amphoterin B

then it would be chlamydia psittaci

90
Q

mycoplasma pneumonia can cause -

hemolytic anemia.

what is the mechanism

A

B cell response –> antibodies (IgM cold agglutinins) react with “I” antigen on RBCs at low temp 4 degree C –> hemolysis

91
Q

what are some extrapulmonary manifestations of mycoplasma pneumonia

  1. on boards: pt with red ear drum and painful
A

1.Bullous myringitis

others

splenomegaly., arthritis, and

CNS changes mainly confusion.

92
Q

Q on boards

presents as cervical lymphadenitis in children.

localized to lymphatic tissue

possible exposure to mycobacterium

Q: diagnosis

Q: how do you treat?

A

M. Scrofulaceum

Node excision w/out chemo

93
Q

boards

pt who has a non healing skin ulcer on the hands following trauma and is working around

fish tanks (fish tank granuloma)

diagnosis?

tx?

A

M. marinum

rifampin and ethambutol (resistant to isoniazid)

94
Q
A

board review (20 decks)

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