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GRAM POSITIVE Flashcards

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1
Q

Gram positive bacteria that is catalase positive, coagulase positive, and causes beta hemolysis on blood agar.

A

Staphylococcus aureus

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2
Q

Virulence factor of S. aureus that prevents phagocytosis

A

Polysaccharide capsule

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3
Q

Virulence factor of S. aureus that inactivates penicillin derivatives.

A

Penicillinase

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4
Q

Mechanism of toxic shock syndrome toxin-1 (TSST-1)

A

T cell stimulation TSST-1 binds to major histocompatibility class (MHC) class II molecules , yielding T-cell stimulation , which promotes the protein manifestations of the toxic shock syndrome.

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5
Q

Bacteria causing acute endocarditis in IV Drug users.

A

Staphylococcus aureus

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6
Q

Site on long bones commonly affected in osteomyelitis caused by S. aureus.

A

Metaphysis
In osteomyelitis , the primary focus of S. aureus growth is typically in a terminal blood vessel of the metaphysis of a long bone , leading to necrosis of bone and chronic suppuration.

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7
Q

Mechanism of drug resistance against Vancomycin.

A

Reprogramming of D-ala-D-ala

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8
Q

Organism causing endocarditis involving prosthetic heart valves.

A

Staphylococcus epidermidis

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9
Q

Hemolysis pattern of the organism that produces streptokinase.

A

Beta / Complete hemolysis.
The organism is Strep. pyogenes , a beta-hemolytic streptococcus.

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10
Q

Titers used to document antecedent impetigo contagiosa.

A

anti-DNAse B

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11
Q

Bacillus cereus toxin that functions as a superantigen causing acute vomiting.

A

Heat stable enterotoxin

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12
Q

Type of paralysis caused by Clostridium botulinum.

A

Flaccid

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13
Q

Timing of appearance of symptoms of botulism after ingestion of toxic food.

A

18-24 hours

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14
Q

Organisms causing birth complicated by sepsis , multiorgan abscesses, and disseminated granulomas.

A

Listeria monocytogenes

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15
Q

Non-toxoid vaccines targeting common bacteria. (3)

A
  1. S. Pneumonia
  2. N. Meningitides
  3. H. Influenza type B
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16
Q

Indicator for strep throat.

A

ASO antibody titer. Peaks at around 3-5weeks , but may remain positive for several months.

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17
Q

Follow the algorithm:
Gram positive cocci , Gamma hemolytic , No growth in 6.5% NaCl.

A

NOnenterococcus: S. bovis

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18
Q

Follow the algorithm:
Gram positive cocci, Gamma hemolytic , positive growth in 6.5% NaCl

A

Group D enterococcus Strep
( E. faecium, E. faecalis )

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19
Q

Follow the algorithm:
Gram positive cocci, Beta hemolytic , Bacitracin sensitive

A

Streptococcus pyogenes
(Group A strep)

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20
Q

Follow the algorithm:
Gram positive cocci, Beta hemolytic, Bacitracin resistant

A

Streptococcus agalactiae
(Group B strep)

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21
Q

Follow the algorithm:
Gram positive cocci , Alpha hemolytic , Optochin resistant

A

Viridans streptococci
(S. mutans, etc.)

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22
Q

Follow the algorithm:
Gram positive cocci, alpha hemolytic , optochin sensitive.

A

Streptococcus pneumoniae

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23
Q

Follow the algorithm:
Initial test to differentiate strains of staphylococcus ?

A

Coagulase test

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24
Q

Follow the algorithm :
Next test to differentiate Coagulase negative staph?

A

Novobiocin Sensitivity Test

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25
Q

Most virulent staph species?

A

Staphylococcus aureus

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26
Q

Primary sites of human colonization with staphylococcus aureus?

A

Anterior nares & Oropharynx

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27
Q

Most common cause of surgical wound infection?

A

Staphylococcus aureus (HPIM)

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28
Q

Most common cause of osteomyelitis over all?

A

Staphylococcus aureus

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29
Q

Most common cause of septic arthritis in native joints?

A

Staphylococcus aureus

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30
Q

Urease expression of staphylococcal epidermidis?
( positive or negative)

A

Positive

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31
Q

Urease expression of staphylococcal Saprophyticus?
(Positive or Negative)

A

Positive

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32
Q

Novobiocin sensitivity of Staphylococcus saprophyticus ?

A

Resistant

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33
Q

Novobiocin sensitivity of Staphylococcus epidermidis?

A

Sensitive

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34
Q

Toxin of Staphylococcus aureus that causes rapid-onset food poisoning?

A

Preformed enterotoxin

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35
Q

Hemolysis pattern of Staphylococcus aureus?

A

Beta hemolytic

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36
Q

Staphylococcus can turn this agar yellow.

A

Mannitol salt agar

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37
Q

What mutation causes intermediate susceptibility to vancomycin in staphylococcus aureus? (VISA)

A

Cell wall alterations

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38
Q

What mutation causes vancomycin resistance in Staphylococcus aureus? (VRSA)

A

VanA gene from enterococci

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39
Q

What syndrome does staphylococcus aureus exfoliative toxin cause?

A

Scalded Skin Syndrome / Ritter Disease

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40
Q

What layer of epidermidis is most affected by staphylococcus aureus exfoliative toxin?

A

Stratum granulosum

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41
Q

What does the exfoliative toxin cleave in scalded skin syndrome?

A

Desmosomal cadherins (desmoglein)

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42
Q

Classic cutaneous sign seen in Scalded Skin Syndrome?

A

Nikolsky Sign

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43
Q

What virulence factor aureus is encoded by phages and can kill white blood cells?

A

PVL ( Panton Valentine Leukocidin)

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44
Q

Most important virulence factor for community acquired -MRSA?

A

PVL ( Panton Valentine Leukocidin)

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45
Q

Toxin responsible for toxic shock syndrome?

A

TSST-1 ( Toxic Shock Syndrome Toxin -1)

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46
Q

What makes staphylococcus aureus resistant to penicillins?

A

B-lactamase production

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47
Q

What makes staphylococcus aureus resistant to nafcillin ?

A

Staphylococcal cassette chromosome mec (SCCmec)

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48
Q

Treatment for MRSA?

A

Vancomycin

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49
Q

Hemolytic pattern of Staphylococcus aureus?

A

Beta hemolytic

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50
Q

Causes of patchy bacterial pneumonia after viral infection?

A

Staphylococcus aureus

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51
Q

Most common cause of septic arthritis overall?

A

Staphylococcus aureus

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52
Q

Lancefield classification of Streptococcus pyogenes?

A

Group A

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53
Q

Lancefield category of Streptococcus agalactiae?

A

Group B

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54
Q

Lancefield classification of Streptococcus bovis group?

A

Group D

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55
Q

What streptococcus pyogenes virulence factor is the culprit behind molecular mimicry in rheumatic fever ?

A

M protein

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56
Q

What childhood exanthem is caused by streptococcus pyogenes?

A

Scarlet fever

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57
Q

What titer is more specific for a recent Streptococcus pyogenes cutaneous infection?

A

Anti-DNase B

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58
Q

Streptococcus pyogenes is bacitracin ________ ?
(Resistant/ Sensitive)

A

Sensitive

B- BrAs
Bacitracin: Group B resistant, Group A sensitive
Group B : S. agalactiae
Group A: S. Pyogenes

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59
Q

What virulence factor from group A Strep depolymerizes DNA?

A

Streptococcal DNAses

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60
Q

What virulence factor from group A Strep converts plasminogen to plasmin?

A

Streptokinase

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61
Q

Immunity to Group A Strep infections is related to antibodies against this protein.

A

M protein

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62
Q

The viscosity of purulent exudates seen in group A strep infections are largely due to this virulence factor.

A

DNAses

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63
Q

What are the three pyrogenic exotoxin of S. Pyogenes?

A

SpeA , SpeB, SpeC

(Spe= Sterptococcal Pyogenic Exotoxins)

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64
Q

Which virulence factor of group A strep is largely responsible for hemolysis on blood agar?

A

Streptolysin S

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65
Q

PSGN is most commonly preceded by infection of the ______?

A

Skin

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66
Q

Rheumatic fever is most commonly preceded by infection of the ________?

A

Respiratory Tract (Pharyngitis)

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67
Q

Is rheumatic fever associated with cutaneous streptococcal infection?

A

No

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68
Q

What antibiotic is Streptococcus pyogenes uniformly susceptible to?

A

Penicillin G

PyoGenes

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69
Q

Most virulent pathogen in streptococcus family?

A

Streptococcus pyogenes

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70
Q

What toxin of Streptococcus pyogenes causes necrotizing fascitis?

A

SpeB

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71
Q

Group B strep hydrolyzes ____________?

A

Sodium hippurate resulting in positive CAMP test

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72
Q

The CAMP Test that shows an increasing zone of hemolysis when group B strep is plated with ________?

A

S. aureus

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73
Q

What factor produced by Group B strep enlarges the area of hemolysis around S. aureus ?

A

CAMP factor

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74
Q

What streptococcal bacteria must be treated when found in rectovaginal cultures of pregnant women?

A

Streptococcus agalactiae

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75
Q

What group D streptococcus causes endocarditis and is associated with colon Cancer?

A

Streptococcus galloyticus /
aka Streptococcus bovis

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76
Q

Are viridans streptococci soluble in bile?

A

No

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77
Q

Most prevalent member of the normal microbiota of the upper respiratory tract?

A

Viridans streptococci

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78
Q

Subacute endocarditis often involves ____________ valves?
(Normal vs Abnormal)

A

Normal

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79
Q

What is the classic “shape” used to describe S. pneumonia?

A

Lancet shaped

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80
Q

What reaction is used to visualize the encapsulation of S. pneumonia?

A

Quellung reaction

81
Q

Most important virulence factor of S. pneumonia?

A

Its Capsule ( prevents phagocytosis)

82
Q

Triad of severe sequelae from S. pneumonia bacteremia from pneumonia?

A

Meningitis, Endocarditis, Septic Arthritis

83
Q

Most common cause of bacterial pneumonia in general population?

A

S. pneumonia

84
Q

Oxygen metabolism of enterococci?

A

Anaerobic

85
Q

Can enterococci grow in 6.5% NaCl?

A

Yes

6.5% NaCl
Enterococcus: E. faecalis & E. faecum
Non-enterococcus : S. bovis

86
Q

Can enterococci grow in the presence of bile?

A

Yes

87
Q

The most commonly isolated enterococci species causing infections to humans?

A

E. faecalis and E. faecium

88
Q

What causes resistance of enterococci to penicillins?

A

Altered PBPs (Penicillin Binding Proteins)

89
Q

What change in the peptidoglycan layer structure is responsible for vancomycin resistance in Enterococcus infections?

A

Change pf D-ala D-ala conformation to D-ala D-lactate

90
Q

Which enterococcus species is MORE likely to be resistant to vancomycin?

A

E. faecium

91
Q

Most common form of anthrax infection?

A

Cutaneous anthrax

92
Q

Only bacterium with peptide capsule?

A

Bacillus anthracis

93
Q

Form of anthrax termed as “woolsorter’s disease”?

A

Inhalation anthrax
( inhaling spores from animal wool, hair, hide)

94
Q

Three components of anthrax toxins?

A
  1. Protective antigen (PA)
  2. Edema factor (EF)
  3. Lethal Factor (LF)

Ang protective antigen mo bind sa either Ef or Lf = effect

95
Q

Which component of anthrax toxin forms a membrane channel?

A

Protective antigen

96
Q

Which component of anthrax toxin is an adenylate cyclase?

A

Edema factor

97
Q

Which component of anthrax toxin cleaves MAPK?

A

Lethal factor

98
Q

What confers heat resistance in bacterial spores ?

A

Dipicolinic acid

99
Q

What bacteria produces a medusa head appearance on culture medium?

A

Bacillus anthracis

100
Q

Characteristic cutaneous lesion of cutaneous anthrax?

A

Eschar

101
Q

Classic chest X-ray finding of inhalation anthrax?

A

Mediastinal widening

102
Q

Most feared complication of inhalation anthrax?

A

Pulmonary hemorrhage

103
Q

DOC in cutaneous anthrax?

A

Ciprofloxacin

Cutaneous- Cipro

104
Q

What food is associated with B. cereus food poisoning?

A

Reheated rice

105
Q

Specific name of the enterotoxin that causes the emetic type of B. cereus food poisoning?

A

Cereulide

106
Q

Oxygen requirement of Bacillus cereus?

A

Obligate aerobe

107
Q

The emetic form of B. cereus infections is caused by what type of enterotoxin?

A

Heat-stable

108
Q

The diarrheal form of of B. cereus infections is caused by what type of enterotoxin?

A

Heat-labile

109
Q

Classic description of the morphology of C. tetani?

A

Tennis Racket appearance due to its terminal spore.

110
Q

Main habitat of C. tetani?

A

Soil

111
Q

What are the proteins that tetanospasmin cleaves?

A

SNARE proteins

112
Q

What cells are affected by the tetanus toxins in the spinal cord?

A

Renshaw cells

113
Q

Which neurotransmitters (2) are inhibited by tetanospasmin toxin?

A

GABA & Glycine (Inhibitory NTs)

114
Q

What is the name of the major SNARE protein cleaved by tetanospasmin cleaved by tetanus toxin ?

A

Synaptobrevin (VAMP2)

115
Q

First part of the body affected by tetanus?

A

Jaw ( presenting trismus / lock jaw)

116
Q

Which three SNARE proteins are affected by C. botulinum toxins?

A
  1. Synaptobrevin (VAMP)
  2. SNAP 25
  3. Syntaxin
117
Q

Most frequent vehicle of infection in infant botulism?

A

Honey

118
Q

Type of paralysis seen in botulism?

A

Flaccid paralysis

119
Q

Type of paralysis seen in tetanus?

A

Spastic paralysis

120
Q

Direction of paralysis in botulism?

A

Cranio-caudal (From head going down)

121
Q

Initial symptom of botulism?

A

Visual disturbances (Diplopia and Incoordination of Eye muscles)

122
Q

Which neurotransmitter’s release is inhibited by botulinum toxin?

A

Acetylcholine

123
Q

What bacteria causes floppy baby syndrome?

A

Clostridium botulinum

124
Q

What is the GI complication caused by overgrowth of C. difficile?

A

Pseudomembranous colitis

125
Q

Route of transmission of pseudomembranous colitis?

A

Feco-oral route

126
Q

Top culprit antibiotics for c. difficile overgrowth?

A
  1. Ampicillin
  2. 2nd & 3rd gen Cephalosporins
127
Q

Infections with C. difficile can cause flare-ups of this GI pathology?

A

Ulcerative colitis

128
Q

Which C. difficile toxin is a potent enterotoxin?

A

Toxin A

129
Q

Which C. difficile toxin is a potent cytotoxin?

A

Toxin B

130
Q

Most common presentation of C. difficile infection?

A

Non-bloody watery diarrhea

131
Q

Most common Clostridium that produces invasive disease?

A

Clostridium perfringens

132
Q

Which toxin of C. perfringens causes platelet aggregation and microthrombi?

A

Alpha toxin

133
Q

Which toxin of C. perfringens is a lecithinase ?

A

Alpha Toxin

134
Q

What conditions can C. perfringens cause?

A
  1. Gas gangrene
  2. Food poisoning
135
Q

Most important aspect of treating gas gangrene?

A

Early surgical debridement

136
Q

Characteristic motility of listeria in broth?

A

Tumbling motility

137
Q

Gram positive bacteria with tumbling motility in broth?

A

Listeria monocytogenes

138
Q

Gram positive bacteria that forms active actin rocket tails?

A

Listeria monocytogenes

139
Q

Complication of disseminated Listeria infection in neonates causing pyogenic granulomas.

A

Granulomatosis infantiseptica

140
Q

Which gram positive rod / bacillus is catalase - positive ?

A

Listeria monocytogenes

141
Q

Two routes of transmission of Listeria?

A
  1. Ingestion of contaminated food
  2. Transplacental
142
Q

What allows Listeria to move intra and trans-cellularly ?

A

Actin Rockets ( Actin Polymers)

143
Q

Is Listeria catalase positive or negative?

A

Positive

144
Q

What virulence factor promotes phagocytosis of Listeria into epithelial cells?

A

Internalins A and B

145
Q

Which Gram-positive aerobic rod produce sidrophores and uses iron as an important virulence factor?

A

Listeria monocytogenes

146
Q

If Listeria infection is suspected , what antibiotic must be added to a therapy regimen?

A

Ampicillin with or without Gentamycin

147
Q

What gram -positive bacteria has a chinese character appearance?

A

Corynebacterium diphtheriae

148
Q

What granules are seen on C. diphtheria cultures?

A

Metachromatic granules / Babes-Ernst or Volutin Granules

149
Q

What test is used to detect toxigenicity of C. diptheriae cultures?

A

Modified Elek Test

150
Q

What is the main mechanism of action of C. diphtheria exotoxin?

A

Inactivating elongation factor EF-2 via ADP ribosylation

151
Q

What is the classical finding in C. diphtheria infections?

A

Gray pseudomembranes

152
Q

What is the classic description of the neck in diphtheria infections?

A

Bull Neck ( Due to the marked neck edema and lymphadenopathy)

153
Q

What is the motility of C. diphtheria?

A

It’s non-motile

154
Q

Main mode of transmission of diphtheria?

A

Via aerosols

155
Q

Primary virulence factor of C. diphtheria?

A

Diphtheria toxin

156
Q

What are the two major systemic toxicities of diphtheria infections?

A

Demyelinating polyneuropathy & Myocarditis

157
Q

Nocardia is catalase ___________? (positive / negative)

A

Positive

158
Q

Actinomyces is catalase _____________? ( positive/ negative)

A

Negative

159
Q

Classic granules seen in Actinomyces abscesses.

A

Yellow “sulfur” granules

160
Q

Name the bacteria:
Gram positive, anaerobic, sinus tracts , yellow sulfur granules.

A

Actinomyces israelii

161
Q

Is Actinomyces aerobic or anaerobic?

A

Anaerobic

162
Q

Is Nocardia aerobic or anaerobic?

A

Aerobic

163
Q

What bacterial infection characteristically presents with”lumpy jaw “ after jaw trauma?

A

Actinomyces ( Cervicofacial mycetoma)

164
Q

What is the treatment for Nocardia spp infection?

A

Sulfonamides

Treatment is a SNAP:
Sulfonamides
Nocardia
Actinomyces
Penicillin

165
Q

What is the staining pattern of Nocardia?

A

Gram positive & weakly acid fast

166
Q

What is the urease expression of nocardia?

A

Positive

167
Q

What is the catalase expression of nocardia?

A

Positive

168
Q

What is the urease expression of Actinomyces?

A

Negative

169
Q

What is the catalase expression of Actinomyces?

A

Negative

170
Q

Gas gangrene is associated with what organism?

A

Clostridium perfringens

171
Q

Natural history of botulism

A

Previously healthy patient , usually ate canned foods several hours prior. Started with blurring of vision, difficulty swallowing, slurring of speech, progressive general weakening of upper and lower extremities, respiratory compromise, cardiac arrest.

172
Q

Sore throat, fever, inflamed tonsils , bilateral cervical lymph nodes , no white lesions on tongue or pharynx.

A

Strep throat S. Pyogenes (black/ gray lesions)

173
Q

Coagulase test is used to differentiate..

A

Staph aureus from other staphylococci

174
Q

Fibrinous pericarditis in a consequence of what disease?

A

Autoimmune disease like SLE & Rheumatic Fever

175
Q

Antigenic structure in S. pyogenes that plays a role in rheumatic fever?

A

M protein

176
Q

Pathogenic corynebacterium vs Normal flora diphtheroids.

A

Diphthamide

177
Q

Clinical features suggestive of acute rheumatic fever.

A

Migratory arthritis where in leg joints typically being involved first.

178
Q

Epidemiological factors increasing the risk of acute rheumatic fever? (3)

A
  1. Lack of access to healthcare
  2. Lower standards of living
  3. Poor oral hygiene
179
Q

Characteristics of rheumatic fever. (3)

A
  1. RF has the tendency to be reactivated by recurrent strep infection
  2. RF may be associated with cutaneous streptococcal infections
  3. RF is the most important cause of heart disease in young people in developing countries
180
Q

Most useful diagnostic examination to identify organism in septic arthritis.

A

Culture & Sensitivity

181
Q

True about staph aureus.

A

Methicillin, the commonly used antibiotic against it.

182
Q

Most common strep that causes acute & subacute endocarditis?

A

S. viridans

( V for <3 shape)

183
Q

Organs of predilection in S. aureus septicemia. (3)

A
  1. Endocarditis
  2. Osteomyelitis
  3. Meningitis
184
Q

Streptokinase is produced by ________?

A

S. pyogenes

185
Q

ECG finding indicative of pericarditis.

A

ST segment elevation

186
Q

Endocarditis infecting normal heart valves.

A

S. aureus

187
Q

Virulence factor of S. pyogenes. (3)

A
  1. Beta hemolysin
  2. Polysaccharide
  3. M protein
188
Q

Characteristic of C. diphtheria. (3)

A
  1. Gram positive, non-spore forming
  2. Club shaped rods with metachromatic granules with aniline dyes
  3. One colony, var gravis, is non-hemolytic and large
189
Q

Diphtheria is an example of _________?

A

Toxemia

190
Q

True about diphtheria vaccine.

A

It is only available in combination with other vaccines (TDaP)

191
Q

Patient who accidentally stepped their foot on a rusted nail along a construction site, then developed spasticity of his muscles on his right foot and leg and developed a locked jaw. What is the diagnosis?

A

Tetanus

192
Q

True about tetanus toxin?

A
  1. Toxin causes blocking of GABA & Glycine
  2. Blocks motor neurons
  3. Digests protein required by neurotransmitters
193
Q

Other diagnostic tests for tetanus.

A

Anaerobic culture of the contaminated tissue.

194
Q

Streptococcal evidences of infection. (2)

A
  1. Anti-Streptolysin O- antecedent pharyngitis , more often found in rheumatic individuals
  2. Anti-DNAse B - antecedent skin infections
195
Q

Disease process of diphtheria?

A

Involvement of heart , kidney, adrenals

196
Q

Other technique in diagnosis of whipworm infection other than fecal smear.

A

Saturated brine flotation technique

197
Q

Major virulence factor of S. pyogenes.

A

M protein

198
Q

Progressive general weakness (symmetric on bbilateral upper and lower extremities) , sudden diplopia, dysphagia, slurred speech. Afebrile, Respiratory distress , Cardiac arrest, death. Ingestion of leftover canned sardines. What’s the diagnosis?

A

Botulism

199
Q

Toxic shock syndrome. (3)

A
  1. TSST 1 super antigen
  2. Staph aureus
  3. Cytokine release

Microbiology (9 decks)

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