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Pathology > Infectious Disease ( 10% ) > Flashcards

Infectious Disease ( 10% ) Flashcards

1
Q

In infectious diseases

  • Bacterial exotoxin is a mucoprotein on the inner cell wall
  • The molecular mechanisms of most exotoxins are unknown
  • Microbes that propagate in the lumen of the intestine are accessible to IgA antibodies
  • Macrophages in bronchi play a major role in protecting the lungs from bacterial infection
  • Bacterial adhesions that bind bacteria to host cells have a broad range of host cell specificity
A
  • Bacterial exotoxin are secreted by bacteria (endotoxins are LPS on the outer cell wall of GN bacteria)
  • Microbes that propagate in the lumen of the intestine are accessible to IgA antibodies
  • Macrophages in alveoli play a major role in protecting the lungs from bacterial infection
  • Bacterial adhesions that bind bacteria to host cells have a narrow range of host cell specificity
    • eg p-pilus on e coli binding to urothelium
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2
Q

Bacterial endotoxin

  • Is exemplified by streptokinase
  • Is the cause of the severe form of diphtheria
  • Is the cause of gas gangrene
  • Is from the outer wall of gram positive bacteria
  • Induces production of TNF
A

Induces production of TNF

  • Is exemplified by streptokinase (Pretty sure this is an exotoxin, if anything)
  • Is the cause of septic shock
  • Is not the cause of gas gangrene - this is caused by Clostridium perfringins, a gram-positive cocci (thus no endotoxin)
  • Is from the outer wall of gram negative bacteria (LPS)
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3
Q

All of the following cause a clinical effect via the production of exotoxin except

  • Clostridium difficile
  • Staph aureus
  • E coli
  • Pseudomonas aeruginosa
  • Vibrio cholera
A

Pseudomonas aeruginosa

  • Clostridium difficile - exotoxin causes inflammatory diarhhoea
  • Staph aureus - exotoxin breaks down links between epidermal cells
  • E coli - exotoxin causes secretory diarrhoea
  • Vibrio cholera - exotoxin causes secretory diarrhoea
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4
Q

Non-thrombocytopenic purpura is associated with

  • Aplastic anaemia
  • SLE
  • Meningococcaemia
  • HIV
  • EBV
A

Meningococcaemia

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5
Q
  1. Concerning host barriers to infection:
  • a. Skin infections generally require organisms of high virulence
  • b. Shigella gastroenteritis can occur with only 100 ingested organisms
  • c. Intact mucociliary apparatus is not required for host defence of the lung
  • d. Gastrointestinal infections occur with organisms of low virulence
  • e. Secretory products of mucosal surfaces are essential for host defence
A
  • a. Skin infections generally require organisms of low virulence (as they get in through cuts)
  • b. Shigella gastroenteritis can occur with only 100 ingested organisms
  • c. Intact mucociliary apparatus is required for host defence of the lung
  • d. Gastrointestinal infections occur with organisms of high virulence as there are multiple defense factors in play (motility, acid, pancreatic secretions, IgA etc)
  • e. Secretory products of mucosal surfaces are essential for host defence
    • urogenital tract relies on outflow of urine, vagina relies on acidic environment
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6
Q
  1. Abscesses:
  • a. Are focal localized collections of oedema fluid and red blood cells
  • b. Are caused by suppuration consisting of red blood cells, necrotic cells and oedema fluid
  • c. Are produced by deep seeding of virus into a tissue
  • d. Have a peripheral region of necrotic white cells
  • e. May be walled off by connective tissue that limits further spread
A
  • a. Are focal localized collections of WBC, neutrophils, necrotic cells
  • b. Are caused by suppuration consisting of red blood cells, necrotic cells and oedema fluid
  • c. Are produced by deep seeding of virus into a tissue
  • d. Have a peripheral region of ?alive white cells
  • e. May be walled off by connective tissue that limits further spread
    • ​-> cyst/granuloma
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7
Q
  1. Regarding viral killing of host cells:
  • a. Subacute sclerosing panencephalitis has a short latency period
  • b. HIV depletes CD4 and helper lymphocytes
  • c. Yellow fever virus lyses renal cells.
  • d. Viral proteins inhibit cell fusion in HIV and measles
  • e. Viruses promote host cell DNA, RNA and protein synthesis.
A
  • a. Subacute sclerosing panencephalitis has a short latency period
  • b. HIV depletes CD4 and helper lymphocytes
  • c. Yellow fever virus lyses liver cells.
  • d. Virus damage cell membranes during entry in HIV and measles
  • e. Viruses inhibit host cell DNA, RNA and protein synthesis
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8
Q
  1. CNS infections:
  • a. Caused by viral agents usually show elevated CSF sugar content
  • b. Do not result from axonal transport of agents
  • c. Most commonly occur by haematogenous spread
  • d. Are not a common feature of AIDS
  • e. In neonates are most commonly caused by H influenza
A
  • a. Caused by viral agents usually show normal CSF sugar content
    • Bacterial infections often lower it, but no pathological process causes a raised CSF glucose (except high BSLs)
  • b. Can result from axonal transport of agents (?eg rabies)
  • c. Most commonly occur by haematogenous spread
  • d. Are a common feature of AIDS (though the HIV does not directly infect neurons)
  • e. In neonates are most commonly caused by H influenza
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9
Q
  1. In aseptic meningitis
  • a. The glucose in the CSF is raised
  • b. The most commonly identified agent is an enterovirus
  • c. There is a more fulminant course than bacterial meningitis
  • d. Microscopically there is a large infiltration of lymphocytes
  • e. There is no brain swelling
A
  • a. The glucose in the CSF is normal
    • ​Low in bacterial meningitis, no pathology raises it
  • b. The most commonly identified agent is an enterovirus
  • c. There is a more fulminant course than bacterial meningitis
    • Often resolves without specific treatment
  • d. Microscopically there is a large infiltration of lymphocytes
    • Lymphocytes do not have access to the CNS through the BBB
  • e. There ?may be brain swelling
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10
Q
  1. An infection complication of transfusion
  • a. Is most commonly hepatitis C
  • b. Is most commonly hepatitis B
  • c. Is rarely transmission of HIV since screening was instituted
  • d. Never includes gonorrhoea or malaria
  • e. Can be clinically apparent mononucleosis in about 7% of cases
A

c. Is rarely transmission of HIV since screening was instituted

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11
Q

Mumps virus is a

  • Adenovirus
  • Herpes virus
  • Paramyxovirus
  • Pox virus
  • Picornavirus
A

Paramyxovirus

(Meales, Mumps, RSV, parainfluenza)

  • Adenovirus - 57 types in humans, cause variety of symptoms (resp, conj, GI), do not appear to be further classified clinically
  • Herpes virus - HSV, VZV, CMV, EBV; cause latent infections with potential for reactivation
  • Pox virus - molluscum contagiosum, smallpox, cowpow, pseudocowpox, yaba monkey tumour virus
  • Picornavirus - enterovirus (incl. rhino- and polio-virus), apthovirus (foot and mouth disease), hepatovirus (Hepatitis A [but not B])
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12
Q

Which virus causes molluscum contagiosum

  • Adenovirus
  • Herpes virus
  • Parvovirus
  • Pox virus
  • Picornavirus
A

Pox virus

Paramyxovirus - (Meales, Mumps, RSV, parainfluenza)

Adenovirus - 57 types in humans, cause variety of symptoms (resp, conj, GI), do not appear to be further classified clinically

Herpes virus - HSV, VZV, CMV, EBV; cause latent infections with potential for reactivation

Pox virus - molluscum contagiosum, smallpox, cowpow, pseudocowpox, yaba monkey tumour virus

Picornavirus - enterovirus (incl. rhino- and polio-virus), apthovirus (foot and mouth disease), hepatovirus (Hepatitis A [but not B])

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13
Q

The most common cause of traveller’s diarrheoa is

  • Rotavirus
  • E coli
  • Shigella
  • Giardia
  • Salmonella
A

E coli

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14
Q

All of the following are DNA viruses except

  • CMV
  • HIV
  • VZV
  • HSV
  • EBV
A

HIV

CMV, VZV, HSV, EBV are all herpes virsus (encapsulated dsDNA)

RNA viruses inclued influenza, measles, mumps, polio, ebola, HIV

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15
Q
  1. Which of the following links is FALSE?
  • a. Varicella Zoster virus – aerosol spread
  • b. Corynebacterium diphtheriae – toxin mediated myocardial damage
  • c. Polio virus – killed and live attenuated vaccine available
  • d. EBV – pancreatitis
  • e. Mumps – meningoencephalitis
A

d. EBV – pancreatitis

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16
Q

All of the following infectious disorders are associated with splenomegaly except

  • Leprosy
  • Toxoplasmosis
  • Tuberculosis
  • Typhoid fever
  • CMV
A

Leprosy

Miliary TB can go to the spleen

CMV (as well as EBV) causes a generalised lymphadenopathy and splenomegally (infecitous mononucleosis)

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17
Q
  1. Rickettsiae replicate in the cytoplasm of
  • a. endothelial cells
  • b. columnar epithelial cells
  • c. renal tubular cells
  • d. gastric mucosal cells
  • e. type I alveolar epithelial cells
A

a. endothelial cells

Typially vascular endothelial cells, primarily in the lungs and brain

Vascular damage -> vascular leakiness -> hypovolemic shock and widespread oedema (pulmonary + peripheral) in the worst cases

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18
Q

the pathogenicity of Mycoplasma TB is due to

  • impaired antibody response/cell mediated
  • hypersensitivity response to products of TB bacteria
  • due to expanding granuloma
  • due to caseous necrosis
  • direct host cell killing by the bacillus
A

hypersensitivity response to products of TB bacteria

pathological manifestations of Tb, such as caseating granulomas and cavitation, are result of hypersensitivity that is part of host immune response

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19
Q

In TB

  • Mycobacteria are aerobic, spore forming bacilli
  • CD4+ T cell result in formation of granulomas by killing macrophages
  • The major cause of tissue damage is granulomas
  • The granulomas in patients with AIDS are well formed
  • The CD8 T cells secrete cytokines inducing macrophage transformation
A

??

  • Mycobacteria are aerobic, non-spore forming, non-motile bacilli
  • CD4+ T cell result in formation of granulomas by killing macrophages
  • The major cause of tissue damage is granulomas
  • The granulomas in patients with AIDS are well formed
  • The CD8 T cells secrete cytokines inducing macrophage transformation
20
Q

Mycobacteria tuberculosis

  • Are aerobic, non-spore forming, non-motile cocci
  • Induce type II hypersensitivity.
  • Cause formation of epitheliod cell granulomae
  • Are killed by macrophages in primary infection
  • Induce formation of a Ghon complex after secondary infection.
A
  • Are aerobic, non-spore forming, non-motile Rods (bacilli)
  • Induce type IV hypersensitivity (cell-mediated)
  • Cause formation of caseating granulomae
    • monocytes differentiate into “epithelioid histiocytes” that characterize granulomatous response
  • Are killed by macrophages in primary infection
  • Induce formation of a Ghon complex after primary infection
    • Ghon complex is granulomas in the peripheral lung and perihilar lymphadenopathy, seen in latent TB infection
21
Q
  1. In pulmonary tuberculosis
  • a. The Ghon complex is a parenchymal perihilar lesion.
  • b. Bacilli establish themselves in sites of low oxygen tension
  • c. Liquefactive necrosis precedes granuloma formation.
  • d. Langhans cells occur in coaslescent granulomas
  • e. Primary TB causes more damage to lungs than secondary TB.
A
  • a. The Ghon complex is a parenchymal peripheral lesion with perihilar lymphadenopathy
  • b. Bacilli establish themselves in sites of high oxygen tension
    • Upper part of lower lobes, or lower parts of upper lobes
  • c. Caseous necrosis precedes granuloma formation.
  • d. Langhans cells occur in coaslescent granulomas
  • e. Primary TB is walled-off quickly, but secondary TB can cause cavitating pneumonia
22
Q
  1. The commonest site of primary TB lesion in lungs is
  • a. Apex
  • b. Base
  • c. Hilum
  • d. Lower zone of upper lobe.
  • e. Peripherally
A

d. Lower zone of upper lobe.

This is the answer given.

Generally located peripherally rather than peri-hilar, and in lower zones of upper lobes or upper zones of lower lobes.

So could also be e.

Active TB (1’ or 2’) causes cavitations mostly in the middle or lower lobes (1’) or apical posterior segments (2’)

23
Q
  1. Mycobacterium tuberculosis:
  • a. Infects about 5% of the world population
  • b. Stains blue with acid fast stains.
  • c. May primarily infect the tonsils
  • d. Takes 1-2 weeks to culture.
  • e. Resides in lysosomes.
A
  • a. Infects about 15% (1/7th) of the world population.
  • b. Stains red with acid fast stains.
  • c. May primarily infect the tonsils
  • d. Takes at least 2 weeks to culture.
  • e. Resides in Phagosomes
24
Q
  1. The Ghon focus is found in
  • a. The sub-pleural region
  • b. The lower part of the upper lobe
  • c. The hilum
  • d. The apex
A

b. The lower part of the upper lobe

25
Q
  1. In malaria
  • a. Plasmodium vivax causes severe anaemia.
  • b. Inoculated sporozoites immediately invade the spleen.
  • c. Parasites mature in red blood cells
  • d. Plasmodium infection initially causes hepatomegaly
  • e. Cerebral malaria is caused by parasites invading grey matter
A
  • a. Plasmodium vivax causes mild anaemia (as do ovale and malariae)
    • ​falciparum causes severe symptoms
  • b. Inoculated sporozoites immediately invade the liver
  • c. Parasites mature in red blood cells
  • d. Plasmodium infection initially causes splenomegally
  • e. Cerebral malaria is caused clumping of RBCs caused by PfEMP1, which in turn causes vessel blockage and ischaemia
    • ​Mechaniams also responsible for splenomegally and AKI
26
Q
  1. Toxoplasmosis:
  • a. Has a chronic mucocutaneous manifestation
  • b. Is more severe in patients who lack an intact humoral immune system
  • c. Can cause severe consequences if contracted during the 3rd trimester of pregnancy
  • d. Can destroy part of the retina
  • e. Is commonly destroyed by neutrophils
A

d. Can destroy part of the retina

  • a. Has a chronic cutaneous manifestation (not mucocutaneous)
  • b. Is more severe in patients who lack an intact humoral immune system - cannot find why this is wrong. It is more severe in patients wtih AIDS or otherwise immunosuppressed.
  • c. Can cause severe consequences if contracted during pregnancy (at any stage it seems)
  • e. Is commonly destroyed by neutrophils - cannot find information on this
27
Q

which skin antiseptic is commonly used

  • ethyl alcohol 70%.
  • ethanol 30%
  • isopropyl alcohol 10%
  • formaldehyde
  • boric acid 5%
A

ethyl alcohol 70%.

Alcohols used are ethanol (aka ethyl alcohol) and isopropyl alcohol. They are effective in concentrations between 60 and 90%. They are ineffective against spores, incl those of C diff

28
Q

The disinfectant active against Prions is

  • Alcohol
  • Iodine
  • Chlorhexidine
  • Hypochlorite
  • Aldehyde
A

Hypochlorite

29
Q

Bacterial endotoxin

  • Is exemplified by streptokinase
  • Is the cause of the severe form of diphtheria
  • Is the cause of gas gangrene
  • Is from the outer wall of gram positive bacteria
  • Induces production of TNF
A

Induces production of TNF

Found in cell wall of GNB

Causes septic shock

30
Q

Tetanus toxin

  • Is composed of a light and heavy chain
  • Acts directly on motor neurons.
  • Stimulates inhibitory neurons.
  • Never affects BP
  • Is produced by gram negative rods.
A

Is composed of a light and heavy chain

Inhibits inhibitory nerves that supply motor neurons (prevents GABA release) -> loss of inhibition -> spastic paralysis

Produced by Clostridium tetani (a gram positive rod/bacillus)

31
Q

regarding streptococcal infections

  • commonly cause boils.
  • do not produce glomerulonephritis
  • cause minimal destruction of host tissue
  • do not produce capsular virulence factors.
  • streptococcus pneumoniae is the commonest cause of meningitis in children.
A
  • commonly cause Erysipelas but , and can cause impetigo, carbuncles, furuncles (but R&C does not list boils) (cf S aureus)
  • Can produce glomerulonephritis (post-streptococcal GN)
  • cause minimal destruction of host tissue.
    • Listed as correct answer and is a direct quote from R&C but is noted elsewhere to cause nec fasc and produce pneumolysin, both of which cause significant tissue damage
  • Produce M protein, a capsular virulence factor which helps resist phagocytosis, and is also the cause of rheumatic fever (due to molecular mimicry causing a Type II HSR against heart valves)
  • streptococcus pneumoniae is the commonest cause of bacterial meningitis in children.
32
Q

regarding the Clostridium species

  • wound infections caused by C.perfringens generally occur 7-10 days following surgery.
  • C.tetani produces an endotoxin which causes muscle spasm.
  • The toxin of C.botulinum blocks serotonin and dopamine receptors
  • Vaccination against C.tetani has not significantly reduced the incidence of tetanus.
  • All are spore producing
A
  • wound infections caused by C.perfringens generally occur 1-3 days following surgery
  • C.tetani produces an exotoxin which causes muscle spasm.
  • The toxin of C.botulinum blocks ACh release from motor nerve endings
    • ​Tetanus blocks GABA release from inhibitory pre-synaptic neurons
  • Vaccination against C.tetani has significantly reduced the incidence of tetanus.
  • All are spore producing
33
Q

Streptococcus

  • Viridans is β haemolytic.
  • Produces an endotoxin which causes scarlet fever.
  • Causes erysipelas which involves significant tissue necrosis.
  • Causes 50% of community acquired lobar pneumonias.
  • Glomerulonephritis becomes chronic in less than 10% children
A
  • Viridans is alpha haemolytic.
    • beta haem = pyogenes, agalactiae, other Lancefield groups
  • Produces an exotoxin which causes scarlet fever.
  • Causes erysipelas which involves minimal tissue necrosis.
  • Causes 50% of community acquired lobar pneumonias.
    • Most common cause of CAP, and generally cause lobar pneumonia; however no organism identified in 50% of cases
  • Glomerulonephritis becomes chronic in less than 10% children
34
Q

Clostridia

  • Perfringins produces toxin A.
  • Tetani neurotoxin produces both a heavy and a light chain
  • Is a gram positive coccus that grows under both aerobic and anaerobic conditions
  • Botulinum releases a potent neurotoxin that causes convulsive contractions of skeletal muscles.
  • Clostridial cellulites causes severe myonecrosis.
A

Tetani neurotoxin produces both a heavy and a light chain

  • Perfringins produces alpha toxin
    • C. diff produces Toxins A+B, which cause pseudomembranous colitis.
  • Is a gram positive bacillus* that is an *obligate anaerobe.
  • Botulinum releases a potent neurotoxin that causes Flaccid paralysis
    • ​Blocks ACh release at NMJ
    • Tetanus causes convulsive contracts - inhibits GABA release at inhibitory pre-synaptic neurons
  • Clostridial gas gangrene causes myonecrosis, whereas clostridial cellulitis is just a faster spreading destructive cellulitis. Both are caused by C perfringens
35
Q

Clostridium perfringens (2 CORRECT)

  • Causes myonecrosis via theta toxin.
  • Is locally invasive
  • Produces a cytotoxin
  • Causes diarrhea.
  • Is spread nosocomially
A
  • Causes myonecrosis via Alpha toxin
  • Is locally invasive
  • Produces a cytotoxin
  • C. difficile causes diarrhea.
  • C. difficle is spread nosocomially
36
Q

With respect to streptococcal infection

  • May result in glomerulonephritis 3 weeks post infection
A

May result in glomerulonephritis 3 weeks post infection

37
Q
  1. Staph aureus
  • a. Has enterotoxins which stimulate emetic receptors in the abdominal viscera
  • b. Has a lipase which degrades lipids on the skin surface
  • c. Has a capsule that allows it to attach to artificial materials
  • d. Has receptors on its surface which allow binding to host endothelial cells
  • e. All of the above
A

e. All of the above

38
Q
  1. Staph aureus can cause all of the following EXCEPT:
  • a. Food poisoning
  • b. Osteomyelitis
  • c. Carbuncles
  • d. Scarlet fever
  • e. Scalded skin syndrome
A

d. Scarlet fever

caused by S. pyogenes, associated with pharyngitis

39
Q
  1. Streptococci
  • a. Are aerobic gram positive cocci that grow in clusters.
  • b. Possess multiple virulence factors including clumping factor and beta toxin
  • c. Are known to commonly cause erythema nodosum, dental caries and impetigo
  • d. Infections are characterized microscopically by neutrophillic infiltrate and wide tissue destruction.
  • e. Rarely cause infection in children under 15.
A
  • a. Are aerobic gram positive cocci that grow in pairs or chains
    • ​S. aureus grows in clusters.
  • b. Possess multiple virulence factors including capsules that resist phagocytosis, M protein (on pyogenes), C5a peptidase, and a phage-encoded pyrogenic exotoxin (that causes fever ands rash in scarlet fever; found in pyogenes)
  • c. Are known to commonly cause erythema nodosum, dental caries and impetigo
    • ​S pyogenes - pharyngitis, scarlet fever, impetigo, RF, erisypelas, PSGN, TSS
    • S. mutans - major cause of dental caries
    • S. viridans - endocarditis
    • S. agalactiae - sepsis and meningitis in neonates
    • S. pneumoniae - CAP in adults, meningitis in children
    • Post-infectious syndromes - RF, PSGN, erythema nodosum
  • d. Infections are characterized microscopically by neutrophillic infiltrate and minimal tissue destruction.
  • e. Often cause infection in children under 15.
40
Q
  1. Staph aureus enterotoxins:
  • a. Are not associated with food poisoning.
  • b. Do not bind MHC on macrophages.
  • c. Stimulate emetic receptors in abdominal viscera
  • d. Do not have an antigenic effect
  • e. Exhibit local effects only
A
  • a. Are associated with food poisoning.
  • b. Superantigens stimulate T cells by binding to macrophage MHC
  • c. Stimulate emetic receptors in abdominal viscera
  • d. Do have an antigenic effect
  • e. Exhibit systemic effects
41
Q
  1. Which is the most common cause of infection to complicate burns?
  • a. Staphylococcus aureus
  • b. Pseudomonas aeruginosa
  • c. Candida species
  • d. Actinomyces
  • e. Clostridium perfringens
A

b. Pseudomonas aeruginosa

42
Q

Staphylococci

  • Are typical encapsulated diplococci.
  • Produce multiple haemolytic toxins including α toxins
  • Rarely cause pyogenic infections in bone.
  • Are the most common cause of hospital acquired infections
  • Lung infections are rarely opportunisitic.
A
  • Are typical encapsulated Clusters
    • ​Streptococci are diplococci or chains
  • Produce multiple haemolytic toxins including α toxins
    • ​alpha -> pores in host cell membranes causing Ca influx
    • also beta, delta, gamma, exfoliative toxins, and superantigens
  • Often cause pyogenic infections in bone
  • Are the most common cause of hospital acquired infections
  • Lung infections are often opportunisitic, and follow damage to resp epithelium by viruses
43
Q

virulence factors of Staph include

  • surface proteins that adhere to host cell
  • enzymes that degrade host proteins
  • exfoliative toxins
  • enterotoxins that stimulate emetic receptors in abdominal viscera
  • all of the above
A

all of the above

44
Q

Pneumocystis carinii

  • Produces pneumocystis pneumonia in normal persons
  • Causes a Ghon’s focus in the lung
  • Causes a patchy atelectasis
  • Is a fungus
  • Attaches selectively to type II alveolar cells
A
  • Produces pneumocystis pneumonia in normal persons
  • Tuberculosis causes a Ghon’s focus in the lung
  • Causes a patchy atelectasis
  • Is a fungus
  • Attaches selectively to type II alveolar cells

Need to clarify others

45
Q

Neisseria

  • a. Colonise the oropharynx in around 10% of the population
  • b. Are gram negative rods.
  • c. Infection causing gonococcal arthritis is typically non purulent.
  • d. Gonorrhoeae infection is usually symptomatic in women
  • e. Meningitides has three serotypes.
A
  • a. Colonise the oropharynx in around 10% of the population
    • ​R&C doesnt give numbers but states it is a common coloniser
  • b. Are gram negative diplococci
  • c. Infection causing gonococcal arthritis is typically purulent.
  • d. Gonorrhoeae infection is usually asymptomatic in women (unless it is untreated and causes PID), but usually causes urethritis in men
  • e. Meningitides has ~17 serotypes, of which 5 commonly cause disease

Pathology (15 decks)

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