Endo/Repro Exam 2 Flashcards

Question 1

Q

HPV

lab tests

Answer

A

Pilloma Bugs

DS DNA

Naked virus (No envelope!)

Pap smear and cervical cancer screening.
Koilocytes in squamous* cells (large, dense, wrinkled nucleus that may be binucleated).

* Detecting morphological changes; sampled from the transformation zone (where squamous eipthelium from outer ectocervix comes into contact with columnar epithelium in the inner endocervix).

Question 2

Q

HPV

know the main HPVs strains

Answer

A

Pilloma Bugs

100’s of HPV strains!

HPV 1 - 4
HPV 6 & 11**
HPV 16 & 18**
HPV 31 & 33

Question 3

Q

HPV

HPV 1 - 4

signs and symptoms

Answer

A

Pilloma Bugs

Verruca** (wart) **vulgaris (common)
aka “cutaneous common wart”
transmission requires direct physical contact
Children typically get on hands and feet

Question 4

Q

HPV

HPV 6** and **11

signs and symptoms

Answer

A

Pilloma Bugs

Laryngeal Papillomatosis (Recurrent respiratory papillomatosis): Tumors (papilloma’s) develop in airways. Typically seen in children, and often obtained during vaginal birth (but not considered an STD)
Anal genital warts (Condyloma acuminata*): seen in sexually active pts.

* ddx from secondary syphilis w/ Condylomata lata

Question 5

Q

HPV

HPV 16**, **18, 31, and 33

signs and symptoms

Sketchy Tip: Remember 16/18. add 15 to each to get 31/33

Answer

A

Pilloma Bugs

most common STD
Ano_genital_ carcinoma (Squamous Cell Carcinoma): Cervical, vulvar, vaginal, penile, anal
Buzzwords = “bleeding after sex” or “cancer”
In anal or penile cancer a major RF is immunosupression, especially in HIV* pts.

* HPV is an AIDS-defining illness)

Question 6

Q

HPV

HPV 16**, **18, 31, and 33

MOA

Sketchy Tip: Remember 16/18. add 15 to each to get 31/33

Answer

A

Pilloma Bugs

HPV upsets the cells normal cycle.
Tumor supressor proteins p53 and RB (Retinoblastoma protein) normally stop the cell cycle advancement from G1→S.
HPV encodes E6** and E7** to promote the proteolysis of p53 (E6) and **RB (E7**) → removal of tumor supressors ↑ risk of cancer!
AIDS-defining illness. Its thought HIV helps to enhance the E6/7 expression.

Question 7

Q

HPV

HPV Vaccine

Answer

A

Pilloma Bugs

HPV vaccine is Gardasil
Its an inactivated quadravalent vaccine
Used for strains 6, 11, 16, and 18*

* These 4 strains cause ~70% of cervical cancers

Question 8

Q

Pox Virus

lab tests

Answer

A

Pox in a Box

DS DNA
Enveloped virus
Dumbbell-shaped core
Largest known DNA virus
Guarneri inclusion bodies*

* (B-type intracytoplasmic bodies in infected cells, appear as blobs on stains) found on skin lesion / blister biopsy

Question 9

Q

Pox Virus

MOA

Answer

A

Pox in a Box

Pox Virus comes with everything it needs inside of it, including making their own envelopes.
Replicates in the cytoplasm (only DNA virus in sketchy that does).
Replication sites are seen on stains as Guarneri inclusion bodies
Brings its own DNA dependent RNA polymerase (reads DNA, produces primary transcript RNA!) to produce all of the proteins that it needs (including DNA polymerase)

Question 10

Q

Pox Virus

3 main Pox virus strains

Answer

A

Pox in a Box

Small pox virus
Cow pox virus
Molluscum contageosum virus

Question 11

Q

Small pox virus ( a Pox Virus)

signs and symptoms

Answer

A

Pox in a Box

Small pox virus: Raised skin on surfaces. Scattered ulcers and blisters that are the same age*

* (ddx Variola aka Chickenpox which also has scattered ulcers and blisters but of mixed ages and stages of healing.)

Cow pox virus: causes symptoms similar to small pox. transmitted by contact with infected cow udders.

Question 12

Q

Molluscum contageosum virus ( a Pox Virus)

signs and symptoms

Answer

A

Pox in a Box

Flesh colored, dome shaped, umbilicated (dimpled) lesions. Usually painless.
Most common in children. Found anywhere on body except palms** and **soles. Most often seen on trunk, axilla, anticubital fossa, and poplitial fossa.
In adults** usually presents as a **single lesion from sexual transmission. If it spreads diffusely it is due to immunosuppression (likely HIV).

Question 13

Q

Chlamydia Trachomatis, Pneumonia, and Psittaci

lab tests

Answer

A

The pirates of Calam Island

gram indeterminate (does not gram stain)

use Giemsa stain or NAAT test (aka PCR)

obligate intracellular (cannot create its own ATP, like ricketsia)

Lacks muramic acid in the cell wall.

Elementary and Reticulate bodies.

Question 14

Q

Chlamydia Trachomatis, Pneumonia, and Psittaci

Elementary vs. Reticulate bodies.

Answer

A

The pirates of Calam Island

Elementary bodies:

1st stage of life cycle outside of cell. The infectious form! Elementary enters the eukaryotic cell and is taken up by phagosomes.

Reticulate bodies:

Dividing form! Reticular replicates to form inclusion bodies seen under microscope in cells when infected.

*After bacteria replicate with its host cells, they leave the cell and become elementary stage again

Question 15

Q

Chlamydia Trachomatis

3 main groups of C. Trachomatis

Answer

A

The pirates of Calam Island

3 main groups of C. Trachomatis

A-C → Blindness
D-K → STI
L1-L3 → LGV

* “Can’t see, Can’t pee, Can’t climb a tree” (Reiter’s syndrome)

Question 16

Q

Chlamydia Trachomatis

Blindness group of C. Trachomatis

Answer

A

The pirates of Calam Island

C. trachomatis A-C → Blindness

Trachoma is the leading cause of blindness in the world!

Transmission is usually from hand to eye contact, but can also be from fomites (objects like clothes or phones)

* mnemonic “A-_C (see) with your eyes_”

Question 17

Q

Chlamydia Trachomatis

STI group of C. Trachomatis

Answer

A

The pirates of Calam Island

C. trachomatis D-K → STI

Most common bacterial STI in the U.S.
Watery discharge (vs. Gonorrhea with mucoprulent).
Can lead to PID w/o symptoms or ectopic pregnancies.
If mother has it during delivery can lead to neonatal conjunctivitis and pneumonia. Presents in 1-2 weeks (vs. Gonorrhea in 2-4 days) as possible staccato cough (short sudden bursts with breath inbetween) or conjunctivitis.

Question 18

Q

Chlamydia Trachomatis

LGV group of C. Trachomatis

Answer

A

The pirates of Calam Island

C. trachomatis L1-L3 → LGV (Lymphogranuloma Venerum)

(also is an STI)

Starts with painless genetial ulcer (similar to syphilis)
Presents as tender lymphadenopathy with draining lymph nodes.

Question 19

Q

Chlamydia Trachomatis

Reiter’s syndrome

Answer

A

The pirates of Calam Island

Reiter’s syndrome Triad

Cant see (Conjunctivitis)
Can’t pee (Urethritis)
Can’t climb a tree (Arthritis)

* Reactive arthritis due to cross reaction of antibodies fighting chlamydia hitting the knee or sacroiliac joint.

Question 20

Q

Chlamydia Trachomatis, Pneumonia, and Psittaci

treatment

Answer

A

The pirates of Calam Island

Macrolides - Azithromycin

Tetracycline - Doxycycline

* also tx for Co-infection of Chlamydia and Gonorrhea with cephtriaxone

Question 21

Q

Chlamydia Pneumonia

signs and symptoms

Answer

A

The pirates of Calam Island

Walking (atypical) pneumonia.

More commoin in the elderly.

Question 22

Q

Chlamydia Psittaci

signs and symptoms

Answer

A

The pirates of Calam Island

Transmitted by birds and bird droppings.

Causes pneumonia!

Question 23

Q

Strep pyogenes (Group A strep)

lab tests

Answer

A

The Pie Genies’ Bakery

gram (+) cocci

catalase (-)

ß hemolytic

Bacitracin sensitive

encapsulated (hyaluronic acid)

Question 24

Q

Strep pyogenes (Group A strep)

signs and symptoms

Answer

A

The Pie Genies’ Bakery

Impetigo

Red inflammed throat

Erysipelas (Red lesion with well demarcated border; S. Pyogenes is the most common cause)

Scarlet fever

Rheumatic fever

Post Strep Glomerulonephritis

Question 25

Q

Strep pyogenes (Group A strep)

Scarlett Fever

Answer

A

The Pie Genies’ Bakery

Strawberry tongue

pharyngitis

widespread rash that spares the face

Toxic Shock Like Syndrome (TSLS)

-mediated by super antigen SpeA, SpeC

Necrotizing Fasciitis

-mediated by super antigen SpeB

Question 26

Q

Strep pyogenes (Group A strep)

Rheumatic Fever

Answer

A

The Pie Genies’ Bakery

VF = M protein

-interferes with opsonization, antiphagocytic

Mimics antibodies in heart causing problems with Mitral Valve.

(molecular mimicry, elicits humoral response)

Pharyngitis precipitates RF (if not treated promptly) but NOT IMPETIGO

JONES symptoms

Question 27

Q

Strep pyogenes (Group A strep)

Post Strep Glomerulonephritis

Answer

A

The Pie Genies’ Bakery

Type III hypersensitivity reaction

(deposition of antibodies in glomerulus)

Puffy cheeks w/ nephritis

Cola colored urine

Occurs two weeks after strep infection

Can occur after pharyngitis AND impetigo

Question 28

Q

Strep pyogenes (Group A strep)

Rheumatic Fever J♥NES signs

Answer

A

The Pie Genies’ Bakery

J = Joints

♥ = Heart problems

N = Nodules on extensor surfaces

(often forearms, elbows, knees)

E = Erythema marginatum

(pink rings)a

S =Sydenham’s Chorea

(rapid involuntary movements of hands, feet, face)

Question 29

Q

Strep pyogenes (Group A strep)

Treatment

Answer

A

The Pie Genies’ Bakery

Penicillin

Question 30

Q

Strep pyogenes (Group A strep)

VF

Answer

A

The Pie Genies’ Bakery

Scarlet Fever: super antigen SpeA, SpeC**

Necrotizing Fasciitis: SpeB**

Rheumatic Fever: M protein

Other VF:

-Streptolysin O (allows ß hemolysis; we generate ASO antibodies to this)

-Streptokinase (converts plasminogen to plasmin; plasmin is fibrinolytic)

-DNA’ases (depolymerize DNA)

Question 31

Q

Strep agalactiae (Group B strep)

lab tests

Answer

A

Galactic Baby

gram (+) cocci

catalase (-)

ß hemolytic (⬆ zone when plated w/ S. aureus)

hippurate (+)

Bacitracin resistant

cAMP test (+) (ddx S. agalactiae from all other strep)

encapsulated (polysaccharide)

Question 32

Q

Strep agalactiae (Group B strep)

signs and symptoms

Answer

A

Galactic Baby

Major infection in newborns

Most likely to cause meningitis in neonates

Sepsis in neonates

Pneumonia

Question 33

Q

Strep agalactiae (Group B strep)

Treatment

Answer

A

Galactic Baby

Mother is cultured at 35 weeks

Penicillin given to mother intrapartum to prevent Group B Strep

Question 34

Q

Enterococcus

lab tests

Answer

A

Protest at the Caucus

gram (+) cocci

catalase (-)

6.5% NaCl Resistant (grows in 6.5% NaCl)

Bile resistant (grows in bile)

NOT encapsulated (ddx from S. Pneumonia)

Question 35

Q

Enterococcus

signs and symptoms

Answer

A

Protest at the Caucus

UTI’s

Endocarditis

Infection of biliary tree

Question 36

Q

Enterococcus

Treatment

Answer

A

Protest at the Caucus

Nosocomial infection resisant to almost every antibiotic we have.

Vancomycin resistant

Linezolid

Tigacycline

Question 37

Q

Neisseria species overview

lab tests

Answer

A

Noir Series

gram (-) Diplococci

Oxidase (+)

Grows on Chocolate agar

Inhibited on Blood agar

Thayer martin (AKA VPN) is selective agar enriched with vancomycin, polymixin, and nystatin

*Carbohydrate fermentation (+) ddx with Moraxella catarrhalis which is also gram (-) diplococci but is carb ferm (-)

Question 38

Q

Neisseria species overview

MOA

Answer

A

Noir Series

MAC defiency

Unable to form the MAC complex due to complex c5-c9 being inhibited, leads to increased Neisseria infections.

Question 39

Q

Neisseria species overview

VF

Answer

A

Noir Series

Pilli allow the attachment to surfaces and display antigenic variation

IgA protease will cleave IgA at its hinge point, facilitating survival along mucosal surfaces.

Question 40

Q

Neisseria meningitides

lab tests

Answer

A

A Shocking Death on Campus

gram (-) Diplococci

Oxidase (+)

Ferments maltose (Only meningitdes!)

Grows on Chocolate agar

Inhibited on Blood agar

Thayer martin (AKA VPN) is selective agar enriched with vancomycin, polymixin, and nystatin

Question 41

Q

Neisseria meningitides

MOA

Answer

A

A Shocking Death on Campus

found in nasal cavity

spreads in crowded areas via r_espiratory droplets_ (military, college dorms, etc)

N. Meningitides invades hemotogenously, leading to massive immune response generated by LOS proteins (lipooligiosaccharides)

-LOS outgrows surface area of bacteria and blebs off, leading to the massive inflammatory response

* think“LOS envelopes caught fire”

Question 42

Q

Neisseria meningitides

VF

Answer

A

A Shocking Death on Campus

Polysaccharide Capsule is the major VF

We have vaccine for A,C,D capsules but not B

* Sickle Cell disease more susecptible due to N. meningitides being encapsulated

Question 43

Q

Neisseria meningitides

Signs and symptoms

Answer

A

A Shocking Death on Campus

Inflammatory response

hypovolemia

Characteristic petechial rash → thrombocytopenia → DIC (Disseminated Intravascular coagulation)

Capillary leakage → shock

* Waterhouse fritter syndrome; when vasoconstriction goes to max to attempt to maintain BP, and adrenals can infarct contributing to shock

Question 44

Q

Neisseria meningitides

Waterhouse fritter syndrome

Answer

A

A Shocking Death on Campus

vasoconstriction goes to max to attempt to maintain BP, and adrenals can infarct contributing to shock

Question 45

Q

Neisseria meningitides

Treatment

Answer

A

A Shocking Death on Campus

3rd generation cephalosporin

-ceftriaxone

Close contacts (>8 hrs over 7 days prior) will need:

-rifampin

Question 46

Q

Neisseria gonorrhea

Treatment

Answer

A

The Violinists last Clap

3rd generation cephalosporin

-ceftriaxone

Treat for chlamydia coinfection

-macrolide Zpack

Question 47

Q

Neisseria gonorrhea

MOA

Answer

A

The Violinists last Clap

STI

NOT encapsulated

Facultative intracellular

Invade PMN’s

(Polymorphonuclear leukocytes; Neutrophils, eosinophils, and basophils)

Question 48

Q

Neisseria gonorrhea

Signs and symptoms

Answer

A

The Violinists last Clap

Effects genitalia first

May cause Polyarthritis, often in knee and is asymmetric

Males:

causes urethritis, prostatis, and orchiditis

Females:

PID (Pelvic Inflammatory DIsease) → purulent white discharge

Fitz Hugh Curtiss syndrome → Violin string like lesions in liver from spread into peritoneum

Question 49

Q

Neisseria gonorrhea

Delivery / Birth

Answer

A

The Violinists last Clap

Can be passed on to the baby during delivery

N. gonorrhea causes conjunctivitis within 5 days of birth

* vs chlamydia which is usually > 7 days after birth

Question 50

Q

Listeria monocytogenes

lab tests

Answer

A

Santa’s List

gram (+) bacilli

ß hemolytic

Catalase (+)

Question 51

Q

Listeria monocytogenes

MOA

Answer

A

Santa’s List

Facultative Intracellular: (“Actin Rocket”)

Rapidly polymerizes actin along the cell wall allowing it to move quickly inside the cell.

Extracellular:

Tumbling motility using flagella

Question 52

Q

Listeria monocytogenes

Source

Answer

A

Santa’s List

Listeria survives AND multiplies in near freezing temperatures and can contaminate food even if refrigerated.

* Milk and cheese

Question 53

Q

Listeria monocytogenes

Pregnancy

Answer

A

Santa’s List

Pregnant women are more likely to get listeria then anyone else. (adults over 60 also high risk)

May lead to termination or disease in the newborn.

Newborns can get meningitis from the mom.

Question 54

Q

Listeria monocytogenes

treatment

Answer

A

Santa’s List

Ampicillin

Question 55

Q

Gardnerella vaginalis

lab tests

Answer

A

The fish garden (Bacterial Vaginosis_)_

gram variable rod

Anaerobic

(+) Whiff Test with 10% KOH prep

Blue clue cells with dark blue spots (epithelial cells with diffuse coating of bacteria)

Question 56

Q

Gardnerella vaginalis

signs and symptoms

Answer

A

The fish garden (Bacterial Vaginosis_)_

Infection occurs at pH 4.5 and higher. (usually 5-6.5)

Thin greyish white malodous (fishy) discharge from the vagina.

* Normal vaginal flora is lactic bacilli. Overgrowth of anaerobic flora will get rid of normal flora.

Question 57

Q

Gardnerella vaginalis

treatment

Answer

A

The fish garden (Bacterial Vaginosis_)_

metronidazole

Question 58

Q

Mycobacterium tuberculosis

lab tests

Answer

A

Shoot out at the TB Corral

Acid fast (carbol fuschien stain; mycolic acids)
Lowenstein medium
Obligate Aerobe
Test for TB with PPD, BCG vaccine will always show (+) skin test.
Proliferates in macrophages
Clumping of bacteria into serpentine formation (cord factor)

Question 59

Q

Mycobacterium tuberculosis

VF

Answer

A

Shoot out at the TB Corral

Cord factor (Glycolipid responsible for clumping of bacteria into serpentine formation).
Sulfatides (prevent phagolysosome fusion).

Question 60

Q

Mycobacterium tuberculosis

MOA

Answer

A

Shoot out at the TB Corral

Human to human respiratory spread.
Cord factor ⬆ granuloma formation by ⬆ TNF-a.

(Allows TB to attract and hide in macrophage granulomas)

Sulfatides prevent phagolysosome fusion

(Allows TB to survive in macrophages by creating incompetent secondary lysosomes preventing fusion with phagosomes to prevent phagolysosome formation, thus avoiding exposure to the lysosomal hydrolases)

Question 61

Q

Mycobacterium tuberculosis

Paths of progression of TB after primary infection

Answer

A

Shoot out at the TB Corral

Healed latent infection
Systemic infection (Miliary TB)
Reactivation TB

Question 62

Q

Mycobacterium tuberculosis

Healed latent infection

Answer

A

Shoot out at the TB Corral

Primarily lower or middle lobes of lungs.
Usually in children
Long fever
usually resolves by fibrosis and becomes latent
GHON complex
TB resides in broken down necrotic macrophages (Langerhans giant cells) → Caseation Granulomas

Question 63

Q

Mycobacterium tuberculosis

GHON complex

Answer

A

Shoot out at the TB Corral

Visual calcification of lung parenchyma and hilar lymph nodes.

(Hilar lympadenopathy + peripheral granulomatous lesion in middle or lower lung lobe).

Lesion heals → eventually becomes fibrotic and calcifies, along with nearby draining (hilar) lymph nodes.

Question 64

Q

Mycobacterium tuberculosis

(+) TB PPD skin test

Answer

A

Shoot out at the TB Corral

Type 4 hyper sensitivity reaction

PPD will show positive for:

active infections
latent infections
prior BCG vaccine (attenuated)

Answer 65

A

Shoot out at the TB Corral

Multi-organ failure
Primarily bone, liver, and lymphatics, but can spread to any organ in the body
Can be lethal

Answer 66

A

Shoot out at the TB Corral

Usually in upper lobes
Associated with immunosuppression (HIV, old age, cancer) through the ⬇ regulation of TNF-a release
Always screen for PPD before using TNF inhibitors!!!
Cough, night sweats, hemoptysis (bloody cough)
Cachexia (body wasting)
Skeletal system: Pots disease
CNS involvement: meningitis or tuberculoma (cavitary lesion) in 10-15% of reactivations

Answer 67

A

Shoot out at the TB Corral

When TB infects the spinal column.

Usually multiple vertebrae.

Demineralization of the bone, spinal weakness, soft tissue swelling (swelling leads to pain).

Can lead to abcess formations, spinal deformities, and weakness due to loss of support.

Answer 68

A

Shoot out at the TB Corral

mnemonic RIPE

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

For prophylaxis: Rifampin and Isoniazid for 9 months

Answer 69

A

Pallidum Observatory

Spirochete (Do not gram stain)
Cannot be grown in culture (only in rabbit testes)
Dark field microscopy is needed for direct visualization of the bacteria
VDRL (Venereal Disease Research Lab) screening** test** (not specific)
RPR (Rapid plasmin reagent) screening test (high incidence of false (+) due to cross antigenicity)
FTA ABS is an antibody specific test to confirm a (+) screen. (fluorescent treponemal antibody absorption )

Answer 70

A

Pallidum Observatory

Painless* genital chancre

* Syphilis locally invades small blood vessels causing ischemic necrosis, taking out nerves and making it painless.

Heals in 3-6 weeks

Answer 71

A

Pallidum Observatory

Systemic maculopapular rash** that also occurs on the **palms and soles* of feet, weeks to months after infection.
Condoloma Latta, a lot of bumps that are flat topped.
Spirochetes can be visualized in the condoloma latta using dark field microscopy.

(* Only a few organisms cause rash on palms and soles of feet! )

Answer 72

A

Pallidum Observatory

Formation of Gummas (soft growth with a firm necrotic center). Can be anywhere, including skin, organs, and bone.
Aortitis → leading to an ascending pathologic aneurysm
Destroys the vasovasorum (that supply blood to the aorta) → leading to tree barking on aorta (thick and wrinkled)
Tabes Dorsalis
Argyle Robertson

Answer 73

A

Pallidum Observatory

Demyelination of nerves and posterior walls of the spinal cord.

Leads to loss of vibration sense, discriminating touch, and proprioception (can cause awkward gait).

Can also cause lancing pain and neurologic issues.

Answer 74

A

Pallidum Observatory

AKA Prostitutes pupil

Pupils will accommodate distance… but…

Will not react to light!

Answer 75

A

Pallidum Observatory

* TORCHeS** infection!

Saber shins (an anterior bowing of the tibia)
Saddle shaped nose
Hutchinson teeth (notched incisors)
Mulberry molars (molars with several enamel outgrowths)
Deafness

Answer 76

A

Pallidum Observatory

Penicillin

If allergic, desensitize them and use penicillin!

Answer 77

A

Pallidum Observatory

After treatment* for Syphilis (within an hour!)

Dying spirochetes release a bunch of cytokines that make people feel sick.

fever and chills

headache

* Indicates the tx is working!

Answer 78

A

Pallidum Observatory

Condoloma Latta is from 2º Syphilis.

Bumbs that are flat topped.

Condoloma acuminata is from HPV

Bumps are more wart like (rounded top)

Answer 79

A

TORCHeS Infections:

Toxoplasmosis

Other (HIV, VZV, Parvovirus B19, enteroviruses, others)

Rubella

Cytomegalovirus

Herpes

Syphilis

Answer 80

A

The god of the public restroom

gram (-) bacillus

Facultative Anaerobe

Swarming motillity when plated

urease (+)

H₂S (+)

Answer 81

A

The god of the public restroom

Stag horn calculi, kidney stones

(urease → ⬆ pH → kidney struvite stones → stag horn calculi on imaging)

Pain

UTI’s

FIshy Odor

Answer 82

A

The god of the public restroom

Sulfonamides

Answer 83

A

E. Cola’s soda fountain

gram (-) bacillus

Facultative Anaerobe

oxidase (-)

catalase (+)

Green metallic** sheen on **EMB agar

Ferments Lactose (+) → pink on MacConkey’s agar

Encapsulated

Answer 84

A

E. Cola’s soda fountain

Main VF are Capsular K antigen and Flagellar H antigens.

* causes neonatal meningitis only if has the K antigen

E. coli is leading cause of gram (-) sepsis by LPS endotoxin in outer cell membrane
Fimbriae lead to UTI’s (#1 cause of UTI’s)

Answer 85

A

E. Cola’s soda fountain

* Enterohemorrhagic E. coli (EHEC)

* Enterotoxigenic E. coli (ETEC)

Enteropathogenic E. coli (EPEC)

Enteroinvasive E. coli (EIEC)

Enteroaggregative E. coli (EAEC)

Adherent-Invasive E. coli (AIEC)

Answer 86

A

E. Cola’s soda fountain

Severe Hemorrhagic Colitis caused by strain 0157:H7.

Common cause is undercooked meat.

Causes bloody diarrhea with little to no fever but mucosal inflammation or invasion..

EHEC is the only E. Coli that does not ferment sorbital.

Shiga-like Toxin inhibits ribosomes at the 60s position → can cause hemolytic uretic syndrome (HUS)

Answer 87

A

E. Cola’s soda fountain

Shiga-like Toxin is from the Enterohemorrhagic (EHEC) strain of E. coli

Shiga-like Toxin inhibits ribosomes at the 60s position → can cause hemolytic uretic syndrome (HUS)

Shiga-like Toxin damages endothelial cells of capillaries in the glomerulus → platlets adhere to damaged endothelial cells → ⬇ platelet count → causing thrombocytopenia → platelet clumps hemolysis RBC’s

Answer 88

A

E. Cola’s soda fountain

“Traveler’s Diarrhea”

Heat Labile toxin → produces cAMP (symp effects)

Heat Stable toxin → produces cGMP (p.s. effects)

Watery DIarrhea

Answer 89

A

E. Cola’s soda fountain

TMP/SMX or fluoroquinolones

Answer 90

A

Hospital room scene

gram (-) bacilli

Ferments Lactose → turns pink on MacConkeys

Answer 91

A

Hospital room scene

Very motile

Answer 92

A

Hospital room scene

Very motile

Red pigment when cultured

(like a pink ring around shower or bright red)

Catalase (+)

Answer 93

A

Hospital room scene

* 3 A’s!!! (Alcoholics, Abscesses, Aspiration)

* sputum that is red color

Klebsiella is Immotile

Urease (+)

Polysaccharide capsule

Cavatary “TB like” lesions

Answer 94

A

Hospital room scene

Multi Drug Resistant Carbopenam

or

Clindamycin

Answer 95

A

The suiters of pseudo Mona

gram (-) bacillus

obligate Aerobe

oxidase (+)

catalase (+)

Blue green pigment when plated (from Pyocyanin and pyoverdin, may even turn wounds blue)

Encapsulated

Answer 96

A

The suiters of pseudo Mona

* Thrives in aquatic environments (HOT TUB FOLLICULITIS)

⬆ risk if pt has Chronic Granulomatous Disease
Fruity grape like odor
May turn wounds blue (from Pyocyanin and pyoverdin)
Most common gram (-) Nosocomial Pneumonia
Osteomyelitis in IV drug users and diabetics
UTI’s (catheters!)
Burn patients are especially susceptile
Ecthyma gangrenosum
Otitis Externa (Swimmers ear)

Answer 97

A

The suiters of pseudo Mona

Respiratory failure in CF patients.

Most common gram (-) Nosocomial Pneumonia.

(CL- channels dysfunctional in CF)

Answer 98

A

The suiters of pseudo Mona

Exotoxin A

Ribosolation of EF2** → inhibition of protein synthesis and cell death

Answer 99

A

The suiters of pseudo Mona

Piperacillin (penicillin)

amingoglycosides

and Fluoroquinolones

Answer 100

A

Tinea Tin Man (cause Tinea disease)

Hyphae seen on KOH prep of skin scrapings

Can diagnose microsporum strain (not others!) with Woods lamp (the microsporum will illuminate)

Answer 101

A

Tinea Tin Man (cause Tinea disease)

Dermatophytes live on skin.

Athletes are most at risk (swimming / wrestlers)

Animals are also a source of infection.

Answer 102

A

Tinea Tin Man (cause Tinea disease)

Ringworm!

Itchy.

Answer 103

A

Tinea Tin Man (cause Tinea disease)

Head = Tinea capitus
Body = Tinea corpus
Groin = Tinea cruris (crura connects base of penis to ischeal pubic rami)
Foot = Tinea pedis
Nails = Onchomycosis

Answer 104

A

Tinea Tin Man (cause Tinea disease)

For general inf: -azoles

Terbanifine

For more serious inf: Griseofulvin (GI side effects!)

Answer 105

A

Candid Canadians

Dimorphic (but not mold in cold!!!)

Budding yeast at 20º with pseudohyphae.
Mold form with true hyphae germ tubes at 37º

catalase (+)*

AIDS defining illness at CD4 < 100

White patches in mouth can be scraped off for KOH prep. (vs. leukoplakia where patches CANT be scraped off)

* Aspergillus also catalase (+). Catalase (+) ↑ risk of Chronic Granulomatous Disease (CGD).

Answer 106

A

Candid Canadians

Normal flora of the GI tract and Oral cavity.

Commonly contaminates sputum cultures.

Answer 107

A

Candid Canadians

Severe diaper rash (when exposed to heat and humidity)
Oral candidiasis (in immunocompromised or from inhaled steroids)
White patches in mouth (CAN be scraped for KOH prep)
Esophagitis and white pseudo membranes
Vaginal candidiasis
Endocarditis

Answer 108

A

Candid Canadians

AIDS defining illness at CD4 < 100

Answer 109

A

Candid Canadians

AIDS (CD4 < 100)
Diabetics
Birth control pills
Antibiotics (due to lowering the pH).

* Candida infections occur at a pH < 4 vs. gardenella at a pH > 4.5

IV drug users (Candida found in some heroine) infecting tricuspid valve.

Answer 110

A

Candid Canadians

For minor infections: Azoles

For major infections: AMP B

For oral or esophageal candiasis: Nystatin

For resistant candida: Capsofungin

Answer 111

A

Oh Hi, IZ makin sum Toxo

Ring enhancing lesions on MRI (usually many lesions vs. CNS lymphomas with a single lesion).
Biopsy will dx from CNS lymphoma.
(+) for IgG for toxo

Answer 112

A

Oh Hi, IZ makin sum Toxo

Consuming raw or undercooked meat containing tissue cysts.
Ingestion of water or vegetables contaminated with oocysts shed from the feces of infected animals*.
Through placenta from mother to fetus in utero.

* (T. gondii is an intracellular parasitic protozoa that infects almost any warm blooded animal.)

Answer 113

A

Oh Hi, IZ makin sum Toxo

Pregnant women & fetus (TORCHeS infection!)

Congenital toxo due to transplacental transfer.

*(Pregnant women should NOT change kitty litter!)

Immunocompromised

(HIV/AID’s pt. with CD4 < 100)

Answer 114

A

Oh Hi, IZ makin sum Toxo

Flu-like symptoms

Answer 115

A

Oh Hi, IZ makin sum Toxo

Ring enhancing lesions on MRI (usually many lesions vs. CNS lymphomas with a single lesion).
Toxoplasma encephalitis
Chorioretinitis

Answer 116

A

Oh Hi, IZ makin sum Toxo

Classic Triad:

Brain and intracranial calcifications
hydrocephalous
Chorioretinitis

Also seen: seizures and deafness

Answer 117

A

Oh Hi, IZ makin sum Toxo

For active infections:

Sulfadiazine and Pyramethamine

For prophylaxis when CD4 counts < 100 AND (+) for toxo IgG:

TMP/SMX

Answer 118

A

TORCHeS Infections:

Toxoplasmosis

Other (HIV, VZV, Parvovirus B19, enteroviruses, others)

Rubella

Cytomegalovirus

Herpes

Syphilis

Answer 119

A

Tricks for Money

Diagnosed with a wet mount* showing motile trophozoits.

pH of vaginal fluid > 4.5

* (Wet mount also used for Gardnerella and Candida. Gardnerella would show clue cells with a ph also > 4.5, while Candida would show pseudohyphea w/ budding yeasts and have a pH < 4.0)

Answer 120

A

Tricks for Money

Causes cervicitis. A speculum shows super red colored cervix due to vascular perfusion and punctuate lesions.

Burning, Itching.

Malodorous yellow green discharge.

Answer 121

A

Tricks for Money

STI, so treat both partners!!!

metronidazole

Answer 122

A

Screamatodes III: Return of the flesh eaters

Mosquitos are intermediate host → bite human and deposit larvae on skin → which enter the lymph system → lymphadenopathy
Elephantiasis (From long standing lower extremity lymphodema)
Microfilaria travel to the lungs and cause hypersensitivity rxn

Answer 123

A

Screamatodes III: Return of the flesh eaters

Organisms can be seen on thick blood smear
Eosinophilia
Tx with Diethylcarbamazine

Answer 124

A

The Hep Sea

Enveloped, single segment (non-segmented) POS** sense _S_S RNA** (Like all flavivirus!)
For acute Hep C infections: RNA in serum for first 6 months, ALT ↑ up to 10x normal levels before falling to a level still ↑ normal.
Cryoglobulins that precipitate out at colder temps and contain 5 sided like IgM**
Liver biospy will show lymphocytes in portal tract for chronic HCV
If recover from initial Hep C inf → anti-HCV will ↑ after a few months (anti-HCV also seen in chronic Hep C).

Answer 125

A

The Hep Sea

Exposure to infected blood
Blood transfusions in 70’s -90’s
IV drug use
Placental, sex*, and breast feeding

* (Hep B more likely through sex, but Hep C still possible)

Answer 126

A

The Hep Sea

Variation of antigenic structure on the envelope proteins.
Viron coated exonuclease lacks proofreading capacity in the 3’-5’ direction so the RNA is prone to frequent mutations.

Answer 127

A

The Hep Sea

Jaundice
RUQ pain
Inflammation of the liver
Enlarged liver
↑ liver enzymes

Answer 128

A

The Hep Sea

60-80% of HCV pt’s become chronic! (Chronic if viral RNA present after 6 months!)

Lymphocytes infiltrate portal tract → kiling hepatocytes → leading to fibrosis and cirrhosis.
Liver can go into a frenzy and become malignant → hepatocellular carcinoma.

Answer 129

A

The Hep Sea

Older tx:

Ribavirin w/ Interferon Alpha

Newer tx (use polymerase / protease inhibitors):

Sofosbuvir (polymerase inhibitor)

Answer 130

A

Toga-Toga-Togavirus

Enveloped POS sense SS RNA

Toga produces one long single protein that is cleaved by viral proteases into smaller active constituents. (like Picornaviruses!!!)

Replicates in the cytoplasm like all POS sense RNA.

Answer 131

A

Toga-Toga-Togavirus

1) 3 types of Arboviruses (Arthropod borne virus, Mosquitos vector)

Western equine encephalitis, Eastern equine encephalitis, Venezuelan equine encephalitis.

2) Rubella *** (Big buzzword = Immigrant) ***

AKA German measles, 3 day measles, or 3rd Disease

Answer 132

A

Toga-Toga-Togavirus

Congenital (TORCHeS infection!)
Childhood
Adult

Answer 133

A

Toga-Toga-Togavirus

* TORCHeS infection!

Classic traid of Congenital cataracts, Sensory-neural Deafness, PDA,
Blueberry muffin rash* (purpric)
Microcephaly, mental retardation
Pulmonary stenosis, jaundice.
Radiolucent bone lesions.

* Blueberry muffin rash also seen in CMV

Answer 134

A

Toga-Toga-Togavirus

Tender post-auricle** and **occipital lymphadenopathy
Distinct maculopapular rash that starts on face and spreads downward, moves faster then measles, lasts 3 days, and does NOT darken or coalesce
Respiratory drop transmission
Prodrom of Rubella: mild fever, lymphadenopathy, fatigue

Answer 135

A

Toga-Toga-Togavirus

Lymphadenopathy
Seizures
Knee pain, arthritis, and arthralgia
Respiratory drop transmission
Prodrom of Rubella: mild fever, lymphadenopathy, fatigue

Answer 136

A

Toga-Toga-Togavirus

MMR vaccine!
Live attenuated vaccine to induce humoral and cell mediated immunity.
Do NOT give to pregnant women.
HIV pt should only get the vaccine if CD4 count is > 200.

Answer 137

A

Toga-Toga-Togavirus

NO tx!

Answer 138

A

The Hep Sea

↑ ALT (Alanine aminotransferase from liver)
↑AST with AST>ALT (Aspartate aminotransferase from liver)
↑ ALP (Alkaline phosphatase from bile ducts)
↓ albumin
normal or ↑ biliruben
normal proteins (↓ albumin but ↑ in other proteins)

Answer 139

A

One Cane to rule them all

Enveloped POS sense SS RNA → DS DNA
Diploid nature** (**2 molecules of RNA in each viron!)

Answer 140

A

One Cane to rule them all

Binds: Attaches to the macrophage T-Cells via CCr5 (early stages) and CXCr4 (late stages) co-receptors
Enters the macrophage
Uncoats
Replication: undergoes reverse transcription (forms DS DNA intermediate “provirus”) → migrates to nucleus → gets incorporated into hosts chromosomes → hosts genome now transcribes and translates new viral proteins
Assembly: retrovirus capsids formed in hosts cell
Egress: envelope proteins of retroviruses are acquired by budding from the plasma membrane (cell surface) of the host
Maturation: Gag** and **Pol proteins of the retrovirus are cleaved by the retroviral protease → forming the mature and infectious form of the virus

Answer 141

A

One Cane to rule them all

Gag (p24): is a cone shaped capsule for the RNA strands
Env protein (codes for gp41 and 120): 41 is transmembrane protein and 120 is outer protein. (to help remember think 420, it’s 41+120 without the 1’s)
Pol: reverse transcriptase

Answer 142

A

One Cane to rule them all

Transmitted primarily through:

Sex
Blood transfusions
Verticle transmission (* TORCHeS infection! *)

Answer 143

A

One Cane to rule them all

Prodromal like flu (or mono-like) with cervical lymphadenopathy, tonsils may be enlarged, fever
May last for several weeks → Gets better on its own → But CD4 (+) cells are infected
HIV latent for 10 years → Replicating in lymph nodes → CD4 drops < 200 → progresses to AIDS
AIDS ↑ risk of B cell lymphoma, diffuse large B cell lymphoma

Answer 144

A

One Cane to rule them all

SCREEN for antibodies with ELIZA test (repeat screen throughout 6 months; takes time to make antibodies)
CONFIRM with Western Blot
Measure viral LOAD and CD4 using PCB
HIV → AIDs when CD4 < 200 OR CD4 > 200 w/ an AIDS defining illness

Answer 145

A

One Cane to rule them all

Use HIV RNA or HIV DNA amplification tests !!!

*** ELIZA and Western blot will always test (+) if mother has HIV or AIDS. They can give false (+) due to antibodies in the neonate that were passed on by the mother (giving the neonate passive immunity until it can make its own antibodies) ***

Answer 146

A

One Cane to rule them all

Highly Active Antiretroviral Therapy (HAART) anti-HIV “cocktail” — is a combination of three or more drugs.

Nucleoside Reverse Transcriptase Inhibitors (NRTI) are the backbone of HAART therapy.
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI)
Protease Inhibitors (PI)
Fusion Inhibitors

Answer 147

A

One Cane to rule them all

Nucleoside Reverse Transcriptase Inhibitors (NRTI) are nucleoside analogs that contain faulty versions of the building blocks (nucleotides) used by reverse transcriptase to convert RNA to DNA, halting prolonation.

Answer 148

A

One Cane to rule them all

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI) binds to and block HIV reverse transcriptase.

Answer 149

A

One Cane to rule them all

Protease Inhibitors (PI) prevent cleavage of proteins for viral replication.

Answer 150

A

One Cane to rule them all

Fusion Inhibitors act against HIV by preventing the virus from fusing with the inside of a cell, preventing it from replicating.

example is Miravoroc which is a CCr5 inhibitor

Answer 151

A

One Cane to rule them all

The NRTI Zidovudine is best for pregnant women, during labor, and post partum pts.

It can reduce the risk of transmision to the baby by 2/3 if taken from 14 weeks of gestation to 6 weeks post partum.

Answer 152

A

TORCHeS Infections:

Toxoplasmosis

Other (HIV, VZV, Parvovirus B19, enteroviruses, others)

Rubella

Cytomegalovirus

Herpes

Syphilis

Answer 153

A

Paranormal Mixer

NEG** sense _S_S RNA**

Enveloped non-segmented virus

Anti-measles antibodies in the CSF (SSPE from Measles) or Warthin–Finkeldey cells in lymphoid tissue (for Measles/Rubeola)

Syncytia (cells merged together from RSV)

Steeple radiographic sign on xray (for Parainfluenza)

Answer 154

A

Paranormal Mixer

*** Respiratory droplet transmission! ***

Measles (Rubeola) AKA 1st disease
Mumps
Respiratory Syncytial Virus (RSV)
Parainfluenza

Answer 155

A

Paranormal Mixer

Measles (Rubeola): HA & Fusion (no NA)
Mumps: HA, NA, & Fusion
Respiratory Syncytial Virus (RSV): Fusion (only)
Parainfluenza: HA, NA, & Fusion

Answer 156

A

Paranormal Mixer

Fever, muscle pain, headache, and feeling tired.
Usually followed by painful swelling of one or both parotid* salivary glands.
Orchitis* (inflammation of testicle tissue) unilaterally (more rarely bilaterally) → can lead to impaired fertility and testicular atrophy.
Meningitis*

* (Mumps replicates in the parotid glands, testes, and CNS)

Answer 157

A

Paranormal Mixer

Hemagglutinin (HA)
Fusion proteins
Neuraminidase (NA)

Answer 158

A

Herpes Virus Family

Herpes Simplex Virus 1 (HSV1) aka HHV1
Herpes Simplex Virus 2 (HSV2) aka HHV2
Varicella Zoster Virus (VZV) aka HHV3
Epstein–Barr Virus (EBV) aka HHV4
Cytomegalovirus (CMV) aka HHV5
Roseola aka HHV6
Kaposi’s sarcoma-associated herpesvirus (KSHV) aka HHV8

Answer 159

A

Herpes Virus Family

All of the Herpes Virus Family are:

*** Enveloped ***

Answer 160

A

Herpes Virus Family

Herpes Simplex Virus 1 (HSV1) in trigeminal ganglia
Herpes Simplex Virus 2 (HSV2) in sacral ganglia
Varicella Zoster Virus (VZV) in dorsal root ganglia
Epstein–Barr Virus (EBV) in B-cells
Cytomegalovirus (CMV) in mononuclear** cells** (lymphocytes and macrophages)
Roseola in monocytes
Kaposi’s sarcoma-associated herpesvirus (KSHV) in B-cells

Answer 161

A

Hermes, the god of herpes

Linear DS DNA
Enveloped virus
Replicates in nucleus (like most DNA viruses)
Cowdry bodies (intranuclear inclusions that look like targets; Large red and eosinophilic)
Tzanc smear (older test, scrape ulcer base) to look for multinucleated giant cells
PCR for herpes

Answer 162

A

Hermes, the god of herpes

HSV:

Cowdry bodies (intranuclear inclusions that look like targets; Large red and eosinophilic)

ddx vs. Pox virus:

Has similar inclusion bodies but located in the cytoplasm (Guarneri inclusion bodies)

Answer 163

A

Hermes, the god of herpes

Transmitted by Sex, saliva, and vertically (TORCHeS infection!)

HSV 1:

Usually confined to the upper half of the body

HSV 2:

Usually confined to the genital regions

Answer 164

A

Hermes, the god of herpes

Snake like ulcers
Herpes rash (rose petal & dew drops; clear vesicles on a erythema base)
Lip herpes; Cold sores!!!
Ocular herpes; Keratoconjuctivitis (* fluorescent stained slit lamp exam of cornea)
Temporal lobe encephalitis*w/bizarre behavior; Hemmorages and necrosis!
Herpetic whitlow; Herpes on finger (dentists!!!)
1-2 weeks after infection can cause an erythema multiforme rash.

* (#1 cause of sporadic encephalitis)

Answer 165

A

Hermes, the god of herpes

Painful vesicular lesions w/ inguinal lymphadenopathy
Can cause aseptic meningitides (mostly in adolescents and adults
Herpetic whitlow; Herpes on finger (dentists!!!)
1-2 weeks after infection can cause an erythema multiforme rash.

Answer 166

A

Hermes, the god of herpes

1-2 weeks after infection with HSV 1 or 2 (mostly 1)
looks like targets!
Starts on hands and feet and moves inwardly / centrally
Due to a hypersensitivity rxn.

Answer 167

A

Hermes, the god of herpes

NO CURE
Prevent breakouts with Acyclovir and / or valcyclovir

Answer 168

A

Cyto “Mega-Lo” Virus

DS DNA
Enveloped virus
Replicates in nucleus (like most DNA viruses)
Buffy coat culture with anti-CMV antibodies
“Owl eye” inclusion bodies

Answer 169

A

Cyto “Mega-Lo” Virus

Transmitted by:

Blood
Sexual contact
Congenital (TORCHeS infection!); ↑ risk 2^nd trimester
Breast milk
Saliva
Urine
Transplants, immunosuppression, HIV (CD4 < 50)

Answer 170

A

Cyto “Mega-Lo” Virus

* TORCHeS infection!

Congenital cataracts, Sensory-neural Deafness
Blueberry muffin rash; (thrombocytopenia) (similar rash also seen in Rubella)
Ventriculomegaly from periventricular** calcifications** (also seen in Toxoplasmosis)
mental retardation and seizures from the Intracranial calcifications
Hepatomegaly, jaundice.
Hydrops fetalis; Heart failure leading to severe edema

Answer 171

A

Cyto “Mega-Lo” Virus

Transplant pts at ↑ risk for CMV pneumonia!
CMV retinitis; Full thickness retinal necrosis (“Pizza pie retinopathy”) → Blind spots, flashing lights, vision loss (Typically unilateral but can be bilateral)
CMV esophagitis and colitis; Ulcerations are singular, deep, and linear (ddx HSV ulcers which are multiple and shallow)
CMV mononucleosis (similar to reg mono w/ sore throat, lymphadenopathy, and fatigue) but monospot test would be (-)

Answer 172

A

Cyto “Mega-Lo” Virus

Ganciclovir

or

Foscarnet (when UL97 gene mutation makes it resistant to Ganciclovir)

Answer 173

A

Varicella “Zeus” ster virus

DS DNA
Enveloped virus
Replicates in nucleus (like most DNA viruses)
Tzanc smear (older test, scrape) to look for multinucleated giant cells

Answer 174

A

Varicella “Zeus” ster virus

Congenital Varicella Syndrome (a TORCHeS infection!)

If infected in 1^st and 2^ndtrimesters

Chickenpox (Varicella)

Spread by respiratory droplets or ruptured vesicles

Shingles (Herpes Zoster)

Reactivation of previous VZV infection

Answer 175

A

Varicella “Zeus” ster virus

Headache and fever
Xanthem (“widespread rash”); itchy
Vesicular rash → Vesicular lesions w/ surrounding erythema (like HSV dew drops on rose petal)
All rashes are at different stages of healing (vs. smallpox w/ similar looking rash but all at same stage!)
Adults can get pneumonia (major cause of morbidity & mortality in adults w/ chicken pox)
Encephalitis

Answer 176

A

Varicella “Zeus” ster virus

Vesicular rash on erythema base travels down dorsal root (sensory nerves! painful!) in a dermatone pattern*, rarely crossing the midline.
Postherpetic neuralgia: pain after shingles!
Herpes Zoster opthalmicus if VZV infects the V₁ branch of trigeminal nerve → vision loss

* If rash crosses the midline it is Disseminated VCV and is a red flag of immunocompromisation! test for HIV if no Hx!!!

Answer 177

A

Varicella “Zeus” ster virus

Limb hypoplasia
Cutaneous scarring** in a **dermatomal pattern
Blindness

Answer 178

A

Varicella “Zeus” ster virus

Live attenuated Chickenpox (Varicella) vaccine
Shingles (Zoster) vaccine*, is simply a larger-than-normal dose of the vaccine used against chickenpox.

* Shingles (Zoster) vaccine recommended for adults over 60; HIV pts can get if CD4 > 200

Answer 179

A

Varicella “Zeus” ster virus

For chickenpox (Varicella):

Acyclovir

For shingles (Herpes Zoster):

Acyclovir or Famc_ycl_ovir or Valcyclovir

Answer 180

A

TORCHeS Infections:

Toxoplasmosis

Other (HIV, VZV, Parvovirus B19, enteroviruses, others)

Rubella

Cytomegalovirus

Herpes

Syphilis

Answer 181

A

Bombs Away

SS* DNA

* (The only SS DNA on sketchy!!!)

Naked virus (No envelope!)

“parvo” = small (It’s the smallest virus in sketchy)

Answer 182

A

Bombs Away

Transmitted by respiratory droplets
Transferred from mother to fetus (a TORCHeS Infection)

Answer 183

A

Bombs Away

Low grade fever that lasts a week → as fever breaks slapped cheek rash → Erythema (lacy) rash that begins on the face and goes down the body
Adults (Teachers!!!) can present with joint pain, arthritis, soreness, and edema
Transient aplastic anemia in sickle cell pts (due to depletion of bone marrow) looks like cobwebs in bone scans, and can fade out when virus clears.
Babies in utero exposed to Parvovirus in trimesters 1 or 2 (a TORCHeS Infection)→ hydrops fetalis (massive edema) → fatal

Answer 184

A

Bombs Away

Parvovirus b19 presents with a low grade fever that lasts a week → as fever breaks slapped cheek rash → Erythema (lacy) rash that begins on the face and goes down the body
Roseola which presents with a high grade fever for 3-4 days, can include febrile seizures, and is followed by a diffuse lacy rash that spares the face.

Answer 185

A

Hep B Love

Circular Partially* DS DNA

(becomes fully DS during replication)

Enveloped virus
Ground glass appearance (from HBsAg)
ALT↑ in acute infections then ↓ once symptoms end.
In neonates** initial phase of HBV, serum **ALT levels are normal!
SPECIES (mnemonic to determine phase of Hep B)

Answer 186

A

Hep B Love

Circular partially DS DNAbecomesfully DS during replication
Replicates both inside the nucleus and in the cytoplasm! (unique!!!)
Hep B contains its own reverse transcriptase (like HIV) and goes from SS DNA → SS RNA → DS DNA (but unlike HIV, Hep B does not integrate into hosts chromosomes)

Answer 187

A

Hep B Love

Spread via Sex and Drugs

(similar to Hep C vs. Hep A spread fecal orally)

Vertical transmission (a TORCHeS infection!) through blood* during child birth

* (Hep B is to large to cross placental wall, transmitted via blood during delivery)

Answer 188

A

Hep B Love

Purpuric rash → non-blanching dark macules
Arthritis, Arthralgia
Polyarteritis Nodosa (PAN)
Membranous glomerulonephritis (MGN)
Membranoproliferative glomerulonephritis (MPGN)

Answer 189

A

Hep B Love

Systemic vasculitis that affects medium to small arteries.
Small aneurysms are strung along the artieries like the beads of a rosary.
Beads on a string appearance.
Damages kidneys → ↓ GFR and Hypertension

Answer 190

A

Hep B Love

A type of glomerulonephritis caused by deposits in the kidney glomerular basement membrane* (GBM) thickening, and activating complement → damaging the glomeruli.

* (vs. MPGN** which is in **both the glomerular mesangium* AND basement membrane.)

By light microscopy, the basement membrane is observed to be diffusely thickened.
Using Jones’ stain, the GBM appears to have a “spiked” or “holey” appearance.

Answer 191

A

Hep B Love

A type of glomerulonephritis caused by deposits in the kidney glomerular mesangium* AND basement membrane (GBM) thickening, and activating complement → damaging the glomeruli.

* (vs. MGN which is only in the GBM.)

GBM is rebuilt on top of the deposits, causing a “tram tracking“ appearance under the microscope.

Answer 192

A

Hep B Love

SPECIES

S: Hep B Surface antigen (HBsAg)
E: Hep B E antigen (HBeAg)
C: Anti-Hep B Core antibody (anti-HBc or HBcAb)
E: Anti-Hep B E antibody (anti-HBe or HBeAb)
S: Anti-Hep B Surface antibody (anti-HBs or HBsAb)

Answer 193

A

Hep B Love

1^st clinically measurable
(+) for active infection (acute or chronic)
Leads to “ground glass appearance”

Answer 194

A

Hep B Love

Not enough time to create antibodies yet
Highly corelates with infectivity.

Answer 195

A

Hep B Love

(+) in the window period*

* (where the body starts producing Anti-Hep B Surface antibodies to bind the Hep B surface antigen.)

Either HNsAg or HBsAb may be also detected.

Answer 196

A

Hep B Love

Low infectivity

Answer 197

A

Hep B Love

Indicates recovery
Also used to check for immunization*

* (HBsAb will be the only antibody that is (+) in immunization pts, both HBcAb and HBeAb will be negative!)

Answer 198

A

Hep B Love

Only about 5-10% develop into chonic infection in adults. (vs. Hep C which is ↑)
Newborns have a 90-95% chance of chronic infection.
Long term Hep B → liver cancer (hepatocellular carcinoma)

Answer 199

A

Hep B Love

Lamivudine and NRTI’s
Interferon Alpha

Anti Hep B Ig w/ Hep B vaccine to neonates at risk

Answer 200

A

Hep B Love

Circular NEG sense RNA
Enveloped virus
NEEDS Hep B Surface antigen (HBsAg) to cause infection!
Can cause co-infection at same time as Hep B, or a super-infection* if transmitted on top of existing Hep B infection

* (Post infection has worse outcomes)

Answer 201

A

TORCHeS Infections:

Toxoplasmosis

Other (HIV, VZV, Parvovirus B19, enteroviruses, others)

Rubella

Cytomegalovirus

Herpes

Syphilis

Answer 202

A

Oh Hi, IZ makin sum Toxo

Ring enhancing lesions on MRI (usually many lesions vs. CNS lymphomas with a single lesion).
Biopsy will dx from CNS lymphoma.
(+) for IgG for toxo

Answer 203

A

Oh Hi, IZ makin sum Toxo

Consuming raw or undercooked meat containing tissue cysts.
Ingestion of water or vegetables contaminated with oocysts shed from the feces of infected animals*.
Through placenta from mother to fetus in utero.

* (T. gondii is an intracellular parasitic protozoa that infects almost any warm blooded animal.)

Answer 204

A

Oh Hi, IZ makin sum Toxo

Pregnant women & fetus (TORCHeS infection!)

Congenital toxo due to transplacental transfer.

*(Pregnant women should NOT change kitty litter!)

Immunocompromised

(HIV/AID’s pt. with CD4 < 100)

Answer 205

A

Oh Hi, IZ makin sum Toxo

Flu-like symptoms

Answer 206

A

Oh Hi, IZ makin sum Toxo

Ring enhancing lesions on MRI (usually many lesions vs. CNS lymphomas with a single lesion).
Toxoplasma encephalitis
Chorioretinitis