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Microbiology Exam 6 > Epidermis/Dermis Layers > Flashcards

Epidermis/Dermis Layers Flashcards

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1
Q

Most common agents in Tinea pedis

A
  1. Trichophyton mentagrophytes
  2. Trichophyton rubrum
  3. Epidermophyton floccosum
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2
Q

Most common agent in Tinea manuum

A
  1. Trichophyton rubrum
  2. Trichophyton mentagrophytes
  3. Epidermophyton floccosum
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3
Q

nails lose luster, become opaque/white, brittle, and have a crumbling consistency - commonly caused by?

A

White Superficial Onychomycosis (Leukonychia mycotica) is commonly caused by T. rubrum and T. metagrophytes

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4
Q

Most common agent in Tinea cruris

A
  1. Epidermophyton floccosum
  2. Trichophyton mentagrophytes
  3. Trichophyton rubrum
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5
Q

Most common agent in Tinea unguium

A

T. rubrum and T. metagrophytes

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6
Q

Most common fungal nail infection; nail thickens and often discolors

A

Distal Subungual Onychomycosis

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7
Q

Most common fungal nail infection in HIV pts; begins in nail fold

A

Proximal Subungual Onychomycosis

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8
Q

Nails hardened, thickened, brownish-green discoloration, w/ striated ridges or grooves; generally w/ cuticle involvement w/ or w/o pus

A

Paronychial or Onychomycotic Candidosis: AKA onychomycosis caused by Candida albicans

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9
Q

“weeping” or “scaled skin” lesion

A

Intertriginous Candidosis

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10
Q

Nonspecific febrile illness followed by rash w/ “slapped cheek” appearance

A

Erythema Infectiosum/Fifth Disease caused by HPV B19

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11
Q

HPV B19 - describe the genome and virus

A

ssDNA, non-enveloped virus w/ 1 serotype

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12
Q

socks and gloves maculopapular rash

A

Erythema Infectiosum/Fifth Disease caused by HPV B19

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13
Q

bone marrow biopsy reveals: presence of large pink or lilac colored inclusions in giant pronormoblasts

A

HPV B19 infection

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14
Q

HHV-6 uses __________ as a cellular receptor

A

CD46 - found on ALL human nucleated cells

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15
Q

Measles virus - describe the genome and virus

A

ssRNA, enveloped w/ 1 serotype

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16
Q

Which virus causes Giant cell formation

A

Measles virus

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17
Q

Complication of HPV B19

A

Aplastic Crisis

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18
Q

Rash and Fever

A

Measles

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19
Q

Measles rash is due to

A

immune system - T cell (HLA I and II on endothelial cells)

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20
Q

Describe a “Morbilliform rash” and what disease it exists with

A

symmetrical, non-pruritic, bright red maculopapular rash; Measles

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21
Q

Describe the rash appearance and disappearance with Measles

A

Begins on face and descends, ~1-2days later rash rapidly fades from top to bottom by fine briny desquamation

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22
Q

Giant Cell Pneumonia

A

Measles

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23
Q

Describe the genome and virus of VZV

A

Alpha herpesvirus: large, dsDNA virus, enveloped, encodes its own thymidine kinase w/ 1 serotype

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24
Q

VZV travels down nerves via

A

reverse axoplasmic flow

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25
Q

Primary infection with VZV, viral replication occurs

A

URT -> lymph nodes -> lymphoid tissue, liver, spleen, etc

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26
Q

Exfoliatin exotoxin mechanism

A

glutamate specific serine proteases highly specific to the cadherin desmoglein I

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27
Q

Exfoliatin exotoxin is produced by

A

Staph aureus

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28
Q

Exfoliatin exotoxin may cause

A

Bullous impetigo, SSSS, Ritter’s disease

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29
Q

dsDNA virus that replicates in the nucleus

A

Herpes

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30
Q

dsDNA virus that replicates in the cytoplasm

A

Variola major (Orthopox)

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31
Q

Candida pathogenic form

A

yeast, pseudohyphae, and hyphae

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32
Q

Risk Factors for Cutaneous Candidiasis

A

Female, young/old, diabetes, obesity (skin folds), pregnancy

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33
Q

Intertriginous Candidosis lesions

A

“weeping” or “scaled skin - Pruritic, erythematous w/ macerated edges

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34
Q

Paronychial or Onychomycotic Candidosis lesions

A

Chronic - Nails hardened, thickened, brownish-green discoloration, w/ striated ridges or grooves

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35
Q

Culture Candida on?

A

Sabouraud-Glucose agar

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36
Q

Definitive diagnosis for Candida?

A

Germ Tube Test

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37
Q

Cutaneous Candidosis Treatment

A

1% Crystal Violet

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38
Q

Paronychial Candidosis Treatment

A

Nystatin, Amphotericin B, Ketoconazole

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39
Q

HPV B19 has a predilection for

A

bone marrow and erythrocyte precursors

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40
Q

Is HPV B19 present in the rash?

A

No - immune-mediated

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41
Q

Biphasic course of HPV B19 is

A

-initial phase/prodrome caused by viremia at day8
FEVER BREAKS…
- Immune-mediated Rash (face->limbs/trunk->palms/soles)

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42
Q

Rash of Erythema Infectiosum is due to

A

Type III HSN rxn

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43
Q

Prodrome of Erythema Infectiosum begins on Day __ and lasts _____

A

Day 8 and lasts 2-3 days

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44
Q

Describe the course of the rash with Erythema Infectiosum

A

FEVER BREAKS….initially on the face as “slapped cheek” appearance w/ relative circumoral (around the mouth) sparing. Maculopapular rash may appear later on limbs, trunk, palms and soles (socks and gloves)… lasts 2-3 days

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45
Q

Does anything make the rash of Erythema Infectiosum worse?

A

exacerbated by exercise, emotion, hot baths, sunlight

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46
Q

Typical pt w/ Erythema Infectiosum

A

Late winter, early spring, endemic in 4-15 y/o, school or daycare outbreak

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47
Q

Erythema Infectiosum In Seronegative Adults causes

A

Prodrome: flu-like symptoms lasting 3-4 days

symmetric polyarthralgia of the hands and wrists, occasionally ankles and knees for 2-3 weeks

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48
Q

Erythema Infectiosum exposure in Pregnant female…

A

Treat w/ IVIG to prevent abortion

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49
Q

Complication of Erythema Infectiosum

A

Aplastic crisis (esp in anemic pts) for 7-10d

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50
Q

Immunity in Erythema Infectiosum

A

Humoral - Type III HSN

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51
Q

For Erythema Infectiosum, Bone marrow biopsy would reveal

A

large pink or lilac colored inclusions in giant pronormoblasts and absence of erythroid progenitor cells

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52
Q

Treatment for Erythema Infectiosum

A

Supportive – antipyretics, analgesics, NSAIDs

IVIG for immunocompromised/pregnant females

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53
Q

How does HHV-6 enter cells?

A

uses CD46 as a cellular receptor, glycoprotein expressed on the surface of all human nucleated cells

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54
Q

Clinically important serotype of HHV in Exanthem Subitum?

A

HHV-6B

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55
Q

HHV-6 - Life-long, active infection in

A

Salivary glands

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56
Q

HHV-6 - Persistent, latent infection in

A

macrophages and monocytes

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57
Q

Exanthem Subitum is biphasic, describe

A

Initial prodrome w/ HIGH fever
FEVER BREAKS…
Immune-mediated rash

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58
Q

Typical Patient w/ Exanthem Subitum

A

6mo - 3yrs

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59
Q

The prodrome of Exanthem Subitum begins ____ and lasts _____

A

4-7 days after exposure; lasts 4-6 days; characterized by HIGH fever

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60
Q

Exanthem Subitum Sx In Adults

A

Mononucleosis-like Sx: Fever, pharyngitis, cervical lymphadenopathy

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61
Q

Diagnosis of Exanthem Subitum

A

EIA IgM, but it cross-reacts w/ CMV

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62
Q

Treatment for Exanthem Subitum

A

Supportive

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63
Q

Measles virus initially replicates in

A

URT and draining lymph nodes

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64
Q

Measles in primarily controlled by what type of immunity

A

CMI

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65
Q

Is the rash of Measles infectious?

A

Yes

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66
Q

How does Measles cause malnutrition?

A

Desquamation of epithelium - GIT -> bloody diarrhea

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67
Q

Communicability of Measles?

A

Begins at prodrome and lasts until 4-5 after rash onset

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68
Q

Typical patient with Measles?

A

Winter/spring, nonvaccinated, 5-9

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69
Q

INcubation period of Measles

A

10-12 days

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70
Q

Prodromal Sx of Measles

A

High fever, coryza, conjunctivitis, brassy cough, cervical LAD, Koplik spots (secondary viremia)

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71
Q

Describe the rash of Measles

A

Fever and prodrome continue w/ rash appearance

“Morbilliform rash” symmetrical, non-pruritic, bright red maculopapular rash on face, confluent and descends to LE

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72
Q

Measles Rash clears by

A

desquamation from head –> toe

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73
Q

Atypical Measles patient population

A

people vaccinated b/w 1963-1967 w/ killed vaccine - vesicular and purpuric and starts on limbs

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74
Q

Complications of Measles

A

Otitis Media, Primary Viral Giant Cell Pneumonia, Diarrhea, encephalitis, Subacute Sclerosing Panencephalitis

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75
Q

Subacute Sclerosing Panencephalitis is caused by

A

defective measles virus

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76
Q

Subacute Sclerosing Panencephalitis is a condition where

A

fatal, slowly progressive, inflammatory, demyelinating disease of the CNS

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77
Q

Congenital Measles results in

A

stillbirth or fetal malformation

78
Q

Lab diagnosis of Measles

A

giant cell formation, FAT

79
Q

Treatment for Measles

A

Supportive, Vitamin A, Gamma globulin (IgG) for immunocompromised or unvaccinated pts w/in 6 days of exposure

80
Q

MMR live attenuated vaccine is administered

A

o Dose 1: 15-18 mo

o Dose 2: 4-6 years or 11-13 years

81
Q

lymph node enlargement (postauricular, suboccipital, and cervical) indicates

A

Rubella, German Measles, 3-day Measles

82
Q

Forschheimer Spots

A

enanthem, small red spots on soft palate associated w/ Rubella

83
Q

Incubation period for Rubella

A

14-21 days

84
Q

Communicability of Rubella begins and lasts?

A

Begins 5 days before rash and 5 days after appearance of rash

85
Q

Typical Rubella patient

A

Unvaccinated, older child/adolescent, winter/spring

86
Q

Describe the prodrome of Rubella

A

Minimal or Absent (low fever, lymph node enlargement)

87
Q

Describe the rash of Rubella

A

Discrete pink-red maculopapular rash lasting 3-5 days, initially on face -> trunk -> extremities; Forschheimer spots on soft palate

88
Q

Congenital Rubella Syndrome

A

first trimester -> teratogenic effects -> abortion

If survival -> isolate due to prolonged shedding, PDA, cataracts, hearing loss, CNS; recommend abortion

89
Q

Diagnosis for Congenital Rubella Syndrome is made by

A

STORCH - IgM in cord blood

90
Q

Treatment for Rubella

A

Supportive

91
Q

Post-exposre prophylaxis for pregnant female refusing abortion

A

IG w/in 72hr of exposure

92
Q

Scarlet fever is caused by

A

S. pyogenes, beta-hemolytic, lysogenized w/ a phage producing exotoxin, catalase negative

93
Q

Scarlet fever is mediated by S. pyogenes

A

SPE exotoxin - superantigen

94
Q

Virulence factors of S. progenes of Scarlet fever

A

M protein - antiphagocytic

SPE exotoxin

95
Q

Scarlet fever is preceded by

A

pharyngitis or impetigo

96
Q

Scarlet fever Sx

A

o Enanthem: hyperemia of the entire pharynx w/ petechial lesions; white strawberry -> red strawberry -> raspberry tongue
o Exanthem: diffuse macular erythroderma -> blanching scarlitiniform rash: fine, red, punctate, “sandpaper” like rash spreads from trunk -> periphery

97
Q

Pastia Lines

A

Scarlet Fever - petechiae in skin folds

98
Q

Scarlet Fever rash resolves by

A

desquamation 1-2 weeks after onset

99
Q

Fever and rash in summer/fall

A

Non-polio enterovirus

100
Q

Kaposi Sarcoma agent

A

HHV-8

101
Q

Site of latency for HHV-8

A

B cells

102
Q

Risk Factors for Kaposi Sarcoma

A

> 60, Male, Mediterranean and Middle Eastern descent, AIDS

103
Q

Kaposi Sarcoma lesions

A

Bluish-red or purple bumps (tumors) on the skin

104
Q

Treatment for Kaposi Sarcoma

A

Surgical excision, Radiation, Chemotherapy

105
Q

Describe the VZV genome

A

dsDNA virus, enveloped, encodes its own thymidine kinase w/ 1 serotype

106
Q

Latency of VZV occurs in

A

DRG or CN (CNV ganglia) after primary infection

107
Q

Communicability of VZV

A

Person is infectious 1-2d before rash and 4-5d after; once scabbed over, pt is no longer infectious

108
Q

Incubation period of VZV

A

14-16days

109
Q

Describe the prodrome of VZV

A

absent in young, 1-2days before rash in older

110
Q

Describe rash of VZV varicella

A

mild-high fever, fatigue, anorexia, HA, n/v, rash, centripetal pattern: more severe on head/trunk, thin-walled vesicle on a maculopapular base

111
Q

Describe the stages of VZV varicella

A

All stages seen bc new lesions appear each time the fever spikes 3-6d: vesicular, pustular, crusted, and scab

112
Q

Adult varicella infection typically has 1 or more:

A

Interstitial pneumonia, hepatitis, meningoencephalitis, thrombocytopenia

113
Q

Neonatal Varicella lesion

A

hemorrhagic lesion -> fatal

114
Q

Zoster Sx

A

Initially, tingling or pin-prick sensation

Followed by severe pain in dermatome

115
Q

Complications of Zoster

A

Opthalmic zoster or zoster oticus (Emerg)

Postherpetic Neuralgia, Facial palsy, Ramsey-Hunt Syndrome

116
Q

Lab Findings of VZV

A

Multinucleated giant cells w/ Cowdry type A

117
Q

Treatment of VZV

A

Supportive

118
Q

Treatment of VZV in Immunocompromised/Pregnant:

A

VZIG w/in 3-4 days

119
Q

Anergy occurs with

A

Measles and MMR vaccine

120
Q

Child vaccine for VZV

A

Varivax

121
Q

Adult vaccine for VZV Zoster

A

Zostavax

122
Q

Treatment for Zoster

A

acyclovir, famciclovir, valacyclovir given w/in 3 days of onset of rash

123
Q

Treatment for Postherpetic Neuralgia

A

Nortiptyline, Lidocain, Gabapentin, Opioid, Acyclovir

124
Q

Exfoliatin Exotoxin is produced by

A

S. aureus + phage

125
Q

Exfoliatin Exotoxin causes which diseases

A

Bullous impetigo, SSSS, Ritter’s Disease

126
Q

Exfoliatin Exotoxin mechanism

A

glutamate specific serine proteases highly specific to the cadherin desmoglein I: adhesion protein is the desmosomes of the stratum granulosum

127
Q

Clefts form in which layers in bullous impetigo

A

cleft formation b/w the stratum corneum and spinosum

128
Q

Bullous impetigo lesions

A

flaccid, paper-thin, white, serous fluid-filled sacks that rupture -> painful, moist, denuded erythematous lesions that dry in 1-2d the thin ”varnish-like” light-brown crusted lesions

129
Q

Is organism present in Bullous impetigo lesions?

A

Yes

130
Q

SSSS

A

Single, focal infection -> hematogenous dissemination of EXOTOXIN -> fever and sterile bullae

131
Q

SSSS lesions

A

Widespread, diffuse (scarlitiniform rash) that progresses in 1-3 days to extensive size, w/ spontaneous exfoliation of skin; w/in 5 days desquamation of total body

132
Q

Nikolsy Sign is positive in

A

SSSS

133
Q

Diagnosis of bullous impetigo and SSSS

A

CIE or gel diffusion assay for elevated anti-teichoic acid Ab’s

134
Q

Treatment for bullous impetigo

A

Mupirocin

135
Q

Treatment for SSSS

A

Cephalosporin

136
Q

Black piedra agent

A

piedra hortai

137
Q

White piedra agent

A

Trichosporon beigelii

138
Q

White piedra Sx

A

white nodules on the hair shaft

139
Q

Black piedra Sx

A

brown/black collar around the hair shaft; decreases hair luster and shine

140
Q

Treatment for White or Black Piedra

A

Cut/Shave hair, oral azole antifungals

141
Q

Tinea capitis etiologic agents

A
  1. Microsporum

2. Trichophyton

142
Q

Microsporum

A

Ectothrix

143
Q

Trichophyton

A

Endothrix

144
Q

In the US, Tinea capitis is caused primarily by

A

Microsporum audouinii and M. canis

145
Q

Tinea capitis due to Microsporum Sx

A

itchy, scaly, papules on scalp

Hair becomes dull and brittle breaking off 3-4mm above the scalp

146
Q

Tinea capitis due to Trichophyton Sx

A

Hair breaks off at scalp “black dot”

147
Q

Tinea capitis common Sx

A

scalp scaling, scalp pruritis, occipital LAD, patchy or diffuse alopecia

148
Q

Diagnosis of Tinea Capitis

A

Wood’s Lamp: Microsporum – ectothrix fluorescence

149
Q

P. acnes

A

GPR, non-motile, obligate anaerobic, diptheroid/pleomorphic rod (lacks catalase)

150
Q

Virulence Factors of P. acnes

A

Extracellular Lipase

151
Q

Inflammatory acne due to P. acnes infection

A

Inflammatory mediators: fatty acids resulting from microbial lipase breakdown of sebaceous gland products

152
Q

Treatment for Inflammatory acne due to P. acnes infection

A

Salicyclic Acid, Retinoid Acid, Azelaic Acid: antikeratinizing and decreased sebum production; Antibiotics, Benzoyl Peroxide

153
Q

Impetigo etiologic agents

A

S. aureus and S. pyogenes

154
Q

Impetigo lesions

A

Thickened honey-colored adhesive crust, purulent discharge on top of lesions resolves in a couple weeks w/o scarring

155
Q

Impetigo Treatment

A

Retapamulin: topical abx for MRSA
Mupirocin: topical abx

156
Q

Tinea favosa etiologic agent

A

Trichophyton schoenleinii

157
Q

Tinea favosa lesions

A

Formation of yellow crusts w/in the hair follicles (scutula) and cicatricial alopecia and scarring, w/ Mousey or cheesy odor present

158
Q

Tinea favosa

A

Chronic mycotic infection of the scalp or glaborous skin

159
Q

Tinea favosa Treatment

A

Oral antifungals

160
Q

Hot tub folliculitis agent

A

P. aeruginosa

161
Q

Refractory folliculitis agent

A

Malassezia furfur

162
Q

Folliculitis agent

A

S. aureus

163
Q

Tinea barbae agents

A

T. rubrum (anthropophilic)
T. mentagrophytes (zoophilic)
T. verrucosum (zoophilic)

164
Q

Hair removal is ___________ in tinea barbae, but _________ in bacterial infections

A

painless; painful

165
Q

Foruncle and carbuncle agent

A

S. aureus

166
Q

Foruncle lesion

A

boil/deep folliculitis are firm, painful, tender, discrete, red nodules

167
Q

Carbuncle lesion

A

several hair follicles, lesion is larger, deeper, indurated, erythematous, edematous, painful + SYSTEMIC SIGNS

168
Q

Treatment of Foruncle and carbuncle

A

Moist heat, incision/drainage

169
Q

Ecthyma common etiologic agent

A

S. pyogenes

170
Q

Ecthyma

A

nonbullous impetigo extending into dermis

171
Q

Ecthyma lesions

A

“punched out” ulcers w/ greenish-yellow crust and violaceous margin; scarring

172
Q

largest, dsDNA, replicates in cytoplasm of infected cell

A

Smallpox

173
Q

Smallpox incubation period

A

7-17days

174
Q

Prodrome of Smallpox Sx include

A

high fever (104 F) w/ chills, severe HA, back pain, delirium, prostration for 2-4 day

175
Q

Rash of Smallpox

A

Enanthem -> Exanthem on face -> extremities

Macules -> Papules -> Vesicles -> Pustules (umbilicate) -> Scabs (SAME SATGE)

176
Q

Smallpox Rash lasts

A

8 – 13 days before scabbing occurs

177
Q

Guarnieri bodies:

A

Smallpox - eosinophilic intracytoplasmic inclusions on smears or biopsies

178
Q

Diagnosis of Smallpox

A

CALL CDC

179
Q

Treatment of Smallpox

A

Cidofovir: nucleoside phosphonate - DNA polymerase inhibitor

180
Q

Smallpox lesions are located in what layer

A

deep dermis

181
Q

Normal reaction to Dryvax Vaccinia for Smallpox

A

pustular lesion at the injection site leaving a depigmented scar, flu-like Sx, regional LAD, satellite lesions

182
Q

Erysipelas agent

A

S. pyogenes

183
Q

Ersipelas location of infection

A

extremities (leg, feet) and face (cheeks, bridge of nose “butterfly” distribution)

184
Q

Recurrent erysipelas due to

A

lymphatic obstruction

185
Q

Ersipelas lesion

A

Burning, itching at site of infection w/ rapid spread (minutes/hours) -> bright red erythema
SHARPLY DEMARCATED

186
Q

Erysipelas

A

Involves the upper dermis and superficial lymphatics - lymphatic tracking

187
Q

Cellulitis lesion

A

Systemic S/S: fever, chills, malaise, leukocytosis

Inflammation: pain, erythema, edema, warmth, Rapidly advancing edge +/- elevation, Diffuse, NOT sharply demarcated

188
Q

Subcutaneous tissues palpation in Cellulitis

A

can be palpated

189
Q

Diagnosis of cellulitis

A

Xray, CT, MRI for gas presence

190
Q

Treatment for cellulitis

A

Cefazolin-probenecid, Nafcillin, Ceftriaxone, Clindamycin

MRSA: Vancomycin, Linezolid, Daptomycin

191
Q

Treatment for complicated cellulitis

A

Levofloxacin

Microbiology Exam 6 (5 decks)

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