ID_Final Exam NTK Flashcards
1
Q
What is the MOA of Amphotericin and Nystatin?
A
Bind to ergosterol to form holes in the CELL MEMBRANE. Leaky –> Death!
2
Q
What are the main ADRs ~w/ Amphotericin?
A
CNS and seizures.
Hypotension and headaches
3
Q
Intrathecal administration of what drug can be used to Tx funal CNS infections?
A
Amphotericin
4
Q
Thromophlebitis, renal tubular acidosis type 1, HypoKalemia, and renal Mg+ wasting is ~w/ what anti-fungal drug?
A
Amphotericin
5
Q
Anemia d/t decrease EPO production is ~w/ what anti-fungal drug?
A
Amphotericin
6
Q
What is the MOA of Flucytosine?
A
fungal cytosine deaminase converts flucytosine (a fluorinated cytosine) into 5-FU (Flourouracil) ===> bacteriostatic
7
Q
What infections are Tx with Nystatin?
A
very active vs. Candida
- Topical: mucocutaneous candidiasis (vaginal candidiasis)
- Oral rinse: oral candidiasis
8
Q
________ class of anti-fungals block egrosterol synthesis.
A
Azoles.
Fucks with Linosterol –> ergosterol
9
Q
Azoles are ________ of the CYP-450
A
Azoles are INHIBITORS of the CYP-450
10
Q
Which Azoles is best used to Tx cryptococcal meningitis?
A
Fluconazole.
Can also Tx most/all Candida infections
11
Q
What azole is used to Tx onchymycosis and dermatophytosis?
A
itraconazole! used to Tx Tinea
onchymycosis: Nail fungus is a common condition that begins as a white or yellow spot under the tip of your fingernail or toenail.
dermatophytosis: Ringworm of the body is a fungal infection that develops on the top layer of your skin.
12
Q
Which Azole can Tx invasive Aspergillosis/oma?
A
Voriconizole
13
Q
Visual issues, changes in color vision is the ADRS ~w/ what Azole?
A
Voriconizole
14
Q
Which azole inhibits 17,20-desmolase, the first step of steroid synthesis from cholesterol, thereby inhibiting production of androgens and estrogens.
A
Ketoconazole
~/w GYNECOMASTIA!!!
15
Q
Other than an Azole, what drugs can be used to Tx dermatophytosis?
A
Oral Griseofulvin
16
Q
What anti-fungal is the first line drug for Tx of tinea corpis/capitis in Peds?
A
Oral Griseofulvin and Tarbanifine.
Also use this for dermatophytosis infection of the nails.
17
Q
Griseofulvin _________ CYP450
A
Griseofulvin ACTIVATES CYP450
18
Q
__________ inhibits fungal squalene epoxidase causing the accumulation of squalene.
A
Tarbanifine
19
Q
What is the major ADR of Tarbanifine?
A
Hepatotoxicity
20
Q
_____________ inhibits the beta,1-3 glucan of the CELL WALL?
A
Echinocandins.
Fucks with POLYSACCS not ergo!!!
Given IV for systemic Candida infections.
21
Q
What is the MOA of Griseofulvin?
A
Bings fungal microtubules and blocks metaphase
22
Q
Which INF is used to Tx Hepatitis B and C? HBV, HCV
A
Interferon Alpha
23
Q
Which INF is used to Tx Multiple Sclerosis?
A
Interferon Beta
24
Q
Interferon Gamma is used to Tx what diz?
A
GCD
25
Which INF is used to Tx Kaposi Sarcoma from HHV-8?
Interferon Alpha
26
What drug used in the Tx of Hepatitis (mainly C) is a guanosine nucleoside analog?
ribavirin;
Also used to Tx RSV infections.
27
___________ is a nucleoside analog that inhibits NS5B RNA polymerase?
Sofosabuvir
28
What is the MOA of of Simprevir?
NS3/4 protease inhibitor
*CYP450 inhibitor!*
29
What are the major ADRs ~w/ ribavirin?
- Dose-Dep hemolytic anemia
| - Teratogenic
30
Positive Serology of the following indicates what, w.r.t. HCV?
HCV antibodies ===> ???
HCV RNA (RT-PCR) ===> ???
(+) HCV antibodies ===> previous or ongoing infection
HCV RNA (RT-PCR) ===> Ongoing infection
31
Positive Serology of the following indicates what, w.r.t. HCV?
HBsAg ===> ???
Anti-HBsAg ===> ???
HBsAg ===> Infectious (ongoing infection)
Anti-HBsAg ===> past infection or vaccine (lifelong immunity)
32
What vaccine is used for HAV?
Passive (HBIG)
Active (Killed vaxx)
33
What vaccine is used for HBV?
Passive (HBIG) [Not recommended anymore.
Recombinant Subunit (HBsAg)
34
What vaccine is used for HDV?
*HBV vaxx protects vs. HDV, b/c HDV needs HBV to co-infect!!!*
35
What vaccine is used for HEV?
Not FDA approved in USA b/c of low prevalence. there is one in China
36
What does HBeAg and Anti-HbeAg indicate?
HBeAg ==> High transmissibilty
Anti-HBeAg ===> Low transmissibility
37
What are the AST and ALT patterns for viral hepatitis?
ALT > AST
38
What are the AST and ALT patterns for viral hepatitis?
ALT > AST
39
- Meningitis ~
- Latex agglutination test that detects CAPSULAR antigens ~
- Stains with India Ink
Is all ~w/ what bug?
Crypococcus neoformans
40
- Mold with irreg. non-septate wide angle hyphae.
- Causes black, facial lesions
- DKA
Is all ~w/ what bug?
Mucor and Rhizopus spp.
41
Is Aspergillus part of the normal human microbiome?
NO!!!
Candida is tho; mouth, vagina,
42
Pt. was playing or exposed to fresh water. non-bloody diarrhea. What is the highest bug on teh ddX?
Cryptosporidum parvum
43
Non-bloody diarrhea, fatty-smelly stools, bloated and gassy! recent travel/water exposure...THINK!?!?!
Giardia
44
Bloody diarrhea, liver abcess, anchovy paste, RUQ pain. water exposure...THINK!?!?
Entamoeba Histolytica
45
Severe watery diarrhea in AIDS pt.
Milder water diarrhea in normal pt.
THINK!?
Cryptosporidum parvum
46
Cyclic fever, headache, anemia.
ACUTE, recent travel, east Africa-->THINK!?
Malaria.
P. falcip
47
Cyclic fever, headache, anemia.
Sx show up LATER, Persistent!, liver issues, India travels --> THINK!?
Malaria
P. vivax- or-P. ovale
48
Typanosoma cruzi = what diz?
Chagas' disease.
~ dilated cardiomyopathy
~ megacolon
~ megaesophagus
49
What is kala-azar?
Visceral leishmaniasis
d/t Leishmania donovani
50
Which bug that causes African Sleeping Sleeping is human adapted and has a longer disease duration?
T. Brucei gambiense (West Africa)
51
Which bug that causes African Sleeping Sleeping is CATTLE-adapted and has a SHORTER disease duration?
T. Brucei rhodiense (East Africa)
52
Schistosomiasis:
• S. mansoni ~ ???
• S. haematobium ~ ???
Schistosomiasis:
• S. mansoni ~ fresh water
• S. haematobium ~ Asia- hematuria
53
Phylogeny: ?
Phylogeny: evolutionary relationship between organisms
54
Commensal: ?
Commensal: interaction between two species in which one benefits and one is unaffected
55
Mutualist: ?
Mutualist: interaction between two species in which both species benefit
56
Parasite: ?
Parasite: interaction between two species in which one benefits and one is harmed
57
Immune homeostasis: ?
Immune homeostasis: balance between hyper-reactive/unresponsive immune system.
58
Immune homeostasis: ?
Immune homeostasis: balance between hyper-reactive/unresponsive immune system.
59
What are some beneficial function of the microbiome?
Beneficial function:
- Pathogen exclusion
- Nutrient, receptor competition
- Antimicrobials: lactic acid, H2O2, pH, bacteriocins
60
What are some structural function of the microbiome?
Structural functions:
- Barrier functions
- Immune system development (IgA induction)
- Tight junctions
61
What are some metabolic function of the microbiome?
Metabolic functions:
- Ferment non-digestible polysaccharides and mucus
- Synthesize vitamins (B3, B5, B6, B12, K, Biotin, Folate)
- Sequester metals
62
What are examples of Actinobacteria? (2)
mycobacterium tuberculosis, corynebacterium diphtheriae
63
What is Dysbiosis and get two examples talked about in lecture?
Dysbiosis: abnormal composition of a microbiome
EX) IBS, antibiotic associated diarrhea, obesity, bacterial vaginosis, “non-bacterial” prostatitis, pouchitis, T1DM, Mother-to-child HIV transmission, MRSA colonization and infection
Bacterial vaginosis - caused by loss of protective species (lactobacilli) and gain of anaerobes (prevotella, gardnerella)
Crohn’s Disease: diminished levels of Clostridium and bacteroides species in the gut
64
What is the difference between airborne and droplet precautions?
Airborne precautions:
- Isolation of patients with organisms spread via airborne droplet nuclei.
- Private room + negative pressure + > 6-12 air changes per hour.
- N-95 mask worn by all persons entering the room
Used for M. TB, measles, primary infection for VZV
Droplet precautions:
- Isolation of patients infected with organisms that can be transmitted via droplets than can be generated by patient during coughing, sneezing, talking, or during procedures.
- Private room + mask + hand hygiene
- Influenza, RSV, Neisseria meningitidis
65
What is the process of an outbreak investigation in a hospital/clinic setting?
1) Prepare for investigation
2) Confirm existence of outbreak
3) Establish DX/ Verify agent
4) Search for addition cases, collect critical data, develop line listing
5) Characterize disease
6) Immediate control measures
7) Formulate tentative hypothesis
8) Test hypothesis
9) additional studies/specimen collection
10) Implementation and evaluate infection prevention measures and initiate surveillance
11) Communicate findings
66
What are the major causes of meningitis in Newborns (0-6 months)?
Newborn (0-6 months)
Group B strep
E. Coli
Listeria
67
What are the major causes of meningitis in Children (6 months - 6 years)?
Children (6 months - 6 years)
Strep pneumoniae
Neisseria meningitidis
Haemophilus influenzae type B
Enteroviruses
68
What are the major causes of meningitis in Adults (6-60 years)?
Adults (6-60 years):
N. Meningitidis
Enteroviruses
S. Pneumoniae
HSV
69
What are the major causes of meningitis in Older Adults (60+ years)?
Older Adults (60+ years):
S. Pneumoniae
Gram negative rods
Listeria
70
Why is it important to obtain a good travel history of patients when parasitic infections are suspected?
Because many parasites are endemic only in specific areas of the world. Also, as some parasites have long incubation periods, a detailed history extending back several years may be important. This organism may incubate for 10 days to many months.
71
How are humans are infected with trypanosomes?
Humans are infected with trypanosomes through an intermediate host insect vector. In the case of Chagas’ disease, humans are infected by a triatomid (cone-nosed) bug, which takes a blood meal, defecates, and the victim scratches, rubbing T. cruzi from the feces into the bite site.
72
What is Romaña’s sign?
Romaña’s sign (periorbital edema) occurs when the infection takes place in the ocular mucosa.
73
Regarding E. histolytica intestinal infections, what other organ can be affected?
liver may become infected, resulting in amoebic abscesses.
74
: Pear-shaped flagellate with an undulating membrane. Large nucleus and 3-5 flagella.
Most likely what organism?
Trichomonas vaginalis
BOTH the patient and her partner need to be treated with appropriate antibiotics for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis.
75
Cysts are rounded up. Notice the fibrils and 2-4 nuclei. The trophozoites have a sucking disc and 2 nuclei that look like a little mask. Flagella and axoneme support structure down the middle.
Most likely what organism?
Giardia
76
For Cryptosporidium, what animals play a major role in human infections?
Cryptosporidium, commonly associated with contaminated water supplies, generally was thought to be a commensal.
However, this organism has now been found to cause diarrhea and intestinal discomfort in immunocompromised patients, and in normal patients during large outbreaks (Milwaukee), and is now recognized as a human pathogen.
77
What organism are typically crescent shaped trophozoites…note the nucleus..no kinetoplast and no flagella (distinguishing them from the crescent-shaped Trypanosomes).
Toxoplasma
78
What is the definitive host for Toxoplasma?
Cats!
79
Three common types of nematode larvae may pass through the lung:
Ascaris lumbricoides,
Hookworm (Necator americanus and Ancylostoma duodenale)
Strongyloides stercoralis.
80
____________ is a tissue infection caused by the larval cysts of T. solium.
Cysticercosis;
when the nervous system is involved, the condition is termed neurocysticercosis.
It is the most common parasitic infection of the CNS. The cysts act as space-occupying lesions and can cause hydrocephalus and/or seizures. After many years these degenerate, evoking an inflammatory response that also can result in seizures or meningitis.
81
Cysticercosis is found ONLY with an infection with what organism???
T. solium (Pigs)
When humans eat pork with cysticeri, the heads evaginate from the larvae and attach to the walls of the gut to grow into a “tapeworm”. Eggs from the “tapeworm” may then autoinfect to cause cysticercosis. Alternatively, non-pork eaters may still develop cysticercosis if feces containing T. solium eggs are ingested without having a “tapeworm”.
82
Do the eggs of T. saginata cause autoinfections?
eggs of T. saginata do not cause autoinfections
83
Can non-pork eaters develop csyticercosis?
YES!
non-pork eaters may still develop cysticercosis if feces containing T. solium eggs are ingested without having a “tapeworm”.
Oral-Fecal Route
84
What is the arrangement of the hooklets of T. solium?
What is the arrangement of the hooklets of T. saginata?
T. solium has a double row of hooklets.
T. saginata does not have any hooks on its scolex.
85
T. solium & T. saginata are differentiated by counting the numbers of lateral branches of the uterus in a gravid proglottid via India ink, to make the branches visible.
T. solium = how many branches?
T. saginata = how many branches?
T. solium: 13 or fewer branches.
T. saginata: 15 or more branches.
86
The eggs of both Taenia saginata and T. solium have thick shells with radial striations. Inside there is a 6-hooked embryo. Taenia cannot be speciated using the ova, as ova from the two species are indistinguishable.
Eggs from T. solium are infectious or non-infectious???
T. saginata are infectious or non-infectious???
Eggs from T. solium are infectious.
T. saginata are NOT infectious. (from Cattle)
