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Step 2 CK: UWorld Questions > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

During bacterial DNA replication, ________ functions to remove RNA primers via 5’-3’ exonuclease activity and replace them with DNA via 5’-3’ polyermase activity

______ binds dsDNA at origin or replication and unwinds it

_______ or topoisomerase II relieves tension created during unwinding by introducing negative supercoils in DNA

_______ synthesizes RNA primers

________ binds Okazaki fragments together

_________ has 5’ to 3’ polymerase activity and 3’ to 5’ exonuclease activity

A

DNA polymerase I

Helicase

gyrase

primase

ligase

DNA polymerase III

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2
Q

the key structural feature that enables _______ to undergo rapid genetic shifts through reassortment is the segmented nature of their genomes. Segmented viruses include orthomyxoviruses, rotaviruses, reoviruses, bunyaviruses, and arenaviruses

A

influenza

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3
Q

sexually active female with verrucous, skin colored genital lesion =

caused by

type of virus

types that result in warts

can infect stratified squamous epithelium, found in the anal canal, vagina, cervix, and __________

A

condylomata acuminatum

HPV

dsDNA

6 and 11

true vocal cords

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4
Q

encephalitis with hemorrhagic lymphocytic pleocytosis with increase protein and normal glucose, abnormal MRI signal in bilateral temporal lobes =

treatment

competes with dGTP for _______

A

Herpes simplex virus encephalitis

acyclovir

viral DNA polymerase

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5
Q

4 year old, tender perioral papules and pustules, covered with golden yellow crusts =

bugs =

treatment is topical abx like =

major complication =

ARF usually follows =

A

Nonbullous impetigo

S aureus, Grp A Beta hemolytic Strep (S pyogenes)

mupirocin

PSGN

untreated Strep Pharyngitis

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6
Q

low grade fever, high serum ALT and AST, +HBsAg =

most likely outcome =

chronic hepatitis with or without cirrhosis and risk of hepatocellular carcinoma, fulminant hepatitis with massive liver necrosis are

A

Hepatitis B infection

acute hepatitis with complete resolution

much less likely

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7
Q

boy with rapid and irregular movements of hands, funny faces, trouble controlling voice, new systolic murmur, circular faintly erythematous lesions on abdomen =

most likely mechanism for condition is cross reactivity of antibodies directed against GAS antigens, _______, and __________ subsequently attack myosin and lysoganglioside

A

ARF

M protein

N-acetyl-beta-D-glucosamine

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8
Q

_______ is a topical antifungal used for oral candidiasis and is a polyene antifungal like _________ that act by binding ergosterol in the fungal cell membrane

A

Nystatin

Amphotericin B

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9
Q

facial pain (eye pain), fever, headache, and black nasal eschar in patient with DKA are highly suggestive of _______ caused by _________. Most cases are rhinocerebral. These fungi appear as broad, ribbon like nonseptate hyphae with right angle branching

how to confirm

if narrow septate hypahe with sharp angle branching?

A

mucormycosis

Mucor or Rhizopus

mucosal biopsy

Aspergillus

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10
Q

Type I (a and B) ______ are synthesized in response to viral infections, resulting in transcription of antiviral enzymes that ________. These enzymes only become active in the presence of ________ in order to selectively inhibit virally infected cells

A

Interferons

halt protein synthesis

dsRNA

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11
Q

urethritis (dysuria with discharge) in a young man is likely due to _______ or _______. The standard treatment for the first presumes infection by both organisms. Therefore, ___________ is given for the first, and doxycycline or __________ is given for the second.

The first is a G- intracellular diplococci, the second is an obligate intracellular organism that does not gram stain well

A

Neisseria gonorrhoeae

Chlamydia trachomatis

ceftriaxone

azithromycin

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12
Q

most cases of IM (fever myalgias malaise, fatigue, splenomegaly) are due to _______ and associated with serum heterophile antibodies that agglutinate horse or sheep erythrocytes. This test is negative in the beginning and positive later. Negative on two separate occasions =

A

EBV

CMV

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13
Q

erythema infectiosum = red flushed cheeks (slapped cheeks)

virus can also cause aplastic crises in patients with SCD and hydrops fetalis in fetus

A

Parvovirus B19

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14
Q

IC patient with hemiparesis, visual field defects, and cognitive impairment =

caused by

A

Progressive multifocal leukoencephalopathy

JC virus

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15
Q

the -navirs (lopinavir) are ______ used in antiretroviral therapy that can cause metabolic complications such as _______

A

Protease inhibitors

insulin resistance, lypodystrophy, and inhibit p450

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16
Q

South Asia, cough for months, hemoptysis, 15 lb weight loss, acid fast bacilli =

Isoniazid monotherapy would most likely result in ________, so drug regimens with rifampin, streptomycin, ethambutol, and pyrazinamide are used

A

TB

selective survival of bacterial cells secondary to gene mutation

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17
Q

TB treatment

inhibition of bacterial RNA polymerase =
adverse effects are _____ and _____

inhibition of mycolic acid synthesis =
adverse effects are __________, give ________

unknown mechanism
adverse effect is hepatotoxicity and hyperuricemia

Inhibition of arabinosyl transferase =
adverse effect is

A

Rifampin
rash, red body fluids

Isoniazid
Neurotoxicity, give VitaminB6/pyridoxine

Pyrazinamide

Ethambutol
optic neuropathy

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18
Q

HIV in prison for 3 years, has TB meningitis, but TB shows significantly decreased activity of intracellular catalase peroxidase. Exhibits resistance to ________, which must be processed by mycobacterial catalase peroxidase to become active

A

Isoniazid (INH)

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19
Q

infection with Neisseria gonorrhoeae dose not appear to provide lasting protective immunity to reinfection due to the ___________ of microbial antigenic structure

A

high variability

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20
Q

malaise, fever, painful genital thin walled vesicles on erythematous base with shallow ulcers on labia and tender inguinal lymphadenopathy, Tzanck smear with multinucleated giant cells =

antiviral drugs = nucleoside analogs such as ______, which incorporate into the newly replicating viral DNA and ultimately terminate viral DNA chain synthesis

A

primary genital herpes, HSV2

acyclovir

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21
Q

2 day history of target rash, not painful, low grade fever, generalized myalgias, intermittent headaches, no LAD or other skin lesions =

rash called =

recent history of =

vector =

A

Lyme Disease: Borrelia burgdoferi

Erythema migrans

Camping

Ixodes tick

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22
Q

Vancomycin blocks _______ polymerization and can cause red man syndrome and ________

Daptomycin __________ by creating channels and can cause __________, but is inactivated by pulmonary surfactant

Linezolid inhibits _________ by binding the _____ subunit and can result in ________ and optic neuritis

all treatments for

A

glycopeptide polymerization; nephrotoxicity

depolarizes the cell membrane; myopathy and CK elevation

bacterial protein synthesis, 50S, serotonin syndrome

MRSA

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23
Q

Pt from Kazakhstan as a child, dog at home, hepatomegaly, US shows large liver mass with cystic lesions, dies during surgery to resect the mass

bug =

cyst type =

spilling of cyst contents can cause =

A

Echinococcus granulosus

hydatid cysts (eggshell calcification)

anaphylaxis

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24
Q

patient, HIV + from Botswana, painful single ulcer on penis, ragged borders, grey exudate, no penile discharge, tender enlarged inguinal lypmh node in right groin =

bug = curved G- rod in clumping pattern

A

Chancroid

Haemophilus ducreyi

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25
Q

the presence of ________ in a mother greatly increases the risk of vertical transmission to infant in Hepatitis B infection

A

HBeAg

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26
Q

INFy release assays test for latent _____ by measuring the amount of IFNy released by _________ when exposed to antigens unique to TB

A

TB

T cells

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27
Q

dental manipulation, hard mass under jaw, drains yellowish push through the overlying skin, sulfur granules, slow growing

treatmetn

A

Actinomyces israelii

penicillin treatment and surgical debridement

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28
Q

out break of hepatitis in New Delhi characterized by high incidence of fulminant hepatitis in pregnant women=

type of virus =

spread =

A

HepE

ssRNA unenveloped

Fecal oral

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29
Q

multiple episodes of diarrhea in a single night during hospital stay =

need appropriate hand hygiene (___________), ________gloves, ________, private room

A

C diff

soap and water

nonsterile

gown

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30
Q

missionary to Latin America, fever, HA, abdominal pain, 1 week history of watery diarrhea that recently became bloody, fever, HSM, several faint erythematous (salmon colored) maculopapular lesions on chest and abdomen =

transmission

risk of

A

typhoid fever, Salmonella typhi

fecal oral

bowel perforation

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31
Q

outdoor exposure in northeastern US, flue like symptoms, severe fatigue, coarse crackles bilateraly on lungs, soft and mildly tender abdomen with palpable splenomegaly, peripheral blood smear shows intraerythrocytic ring forms or Maltese cross with short incubation period=

vector

area

A

Babesia microti

Ixodes tick

NE US

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32
Q

______ commonly infects B cells, stimulating them to proliferate continuously while maintaining the capacity to secrete Igs. The _______ test is sensitive and highly specific

A

EBV

heterophile Antibody

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33
Q

sore on shoulder, ulcer with central black eschar surrounded by edema, exudate reveals chains of large G+ rods =

helpful in diagnosis =

A

Cutaneous Anthrax: Bacillus anthracis

occupation with livestock

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34
Q

young girl with fever, HA, seizures, aphasia, personality changes

autopsy of brain shows edema and hemorrhagic necrosis of the temporal lobe =

from primary oropharyngeal infection and travels from olfactor nerve or from _______

A

HSV1 encephalitis

reactivation of latent virus

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35
Q

IgA protease is produced by Neisseria meningitidis, gonorrhoeae, S pneumo, and H influenza, and cleaves IgA at its hinge region. This enzyme facilitates

A

mucosal adherence of bacteria

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36
Q

Raltegravir is an ______ that disrupts HIV genome integration, preventing synthesis of ________

A

Integrase inhibitor

viral mRNA

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37
Q

the presence of a central vascular catheter and receipt of parenteral nutrition are risk factors for _______, which display the morphology of branching pseudohyphae with blastoconidia

A

Candida

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38
Q

azoles inhibit _______, changing the composition of the fungal cell membrane. They suppress human and fungal _______, resulting in many drug drug interactions

A

ergosterol synthesis

cytochrome P450 enzymes

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39
Q

polyarthritis, synovial fluid analysis notable for neutrophilic predominance and intracellular organisms =

prevented with

A

Neisseria gonorrhoeae

condom use

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40
Q

patient grew up in Guatemala with no underlying IC conditions had a seizure and is found to have a cystic lesion on MRI that is not ring enhancing is most consistent with __________ caused by ________ and ingestion of eggs from the stool of the bug. In the brain they form cysticeri, which are fluid filled larval cysts surrounding the invaginated scolex

A

neurocysticercosis

Taenia solium: pork tapeworm

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41
Q

_________ is characterized by gastroeteritis, septicemia, and meningocenphalitis. It most commonly affects patients with depressed cell mediated immunity (chemo, post op, hospital), and outbreaks have been associated with contaminated dairy products

examination of CSF would show

A

Listeria monocytogenes

intracellular gram + bacilli

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42
Q

______ refers to gene exchange that occurs through the crossing over of 2 dsDNA molecules. _______ describes the mixing of genome segments in segmented viruses that infect the same host

A

Recombination

Reassortment

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43
Q

superficial Candida infection (oral/esophagus, cutaneous) is prevented by _______, while hematogenous spread or disseminated candidiasis is prevented by _______

A

T cells

neutrophils

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44
Q

thin, off white discharge with fishy odor in vaginitis =
labs?
Treatment?

thin, yellow green, malodorous, frothy discharge =
labs
treat?

thick, cottage cheese discharge =
lab
treat?

A

gardnerella vaginalis, clue cells, positive KOH whiff test, metronidazole or clindamycin

Trichomonas vaginalis, motile trichomonads, metronidazole

candida albicans, pseudohyphae, fluconazole

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45
Q

Patient with HIV, duration of pain, itching, rectal bleeding with visible ulcerative mass =

due to

A

anal squamous cell carcinoma

HPV types 16 and 18

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46
Q

G(-) sepsis (septic shock) results from release of LPS. The toxic component of LPS is ______, which causes activation of macrophages leading to widespread release of IL1, TNF-a, which causes fever, hypotension, diarrhea, oliguria, vascular compromise, and DIC

A

Lipid A endotoxin

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47
Q

the presence of anti-hepatitis A virus IgG suggest this patient is _________

individuals who are successfully immunized against hepatitis B virus develop protective ________. Individuals who recover from HepB infection however, have _______ and ___________ antibodies. The presence of circulating __________ indicates active infection

A

protected from acute HAV

anti-HBsAb

anti-HBsAb and anti-HBcAb

HBeAb

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48
Q

penicillins and cephalosporins function by irreversibly binding to penicillin-binding proteins such as _______

A

transpeptidases

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49
Q

a change in _________ that prevents cephalosporin binding is one mechanism of bacterial resistance to cephalosporins

A

penicillin binding proteins

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50
Q

__________ of children against HBV would likely cause a steep decline in the worldwide incidence of -_________

A

Universal vaccination

hepatocellular carcinoma

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51
Q

small shallow ulcers, large painful, coalesced inguinal lymph nodes (buboes), intracytoplasmic inclusion bodies in epithelial cells and leukocytes =

due to =

A

lymphogranuloma venereum

Chlamydia trachomatis

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52
Q

hypersensitivity reaction that develops in patients with HLA-B*57.01 and HIV, which drug

A

Abacavir

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53
Q

Clavulanic acid, subactam, and tazobactam are ________ administered concurrently with amoxicillin in order to include strains of Beta-lactamase synthesizing bacteria that are resistant to amoxicillin alone

A

beta-lactamase inhibitors

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54
Q

skin and soft tissue infection at the site of a dog or cat bite within 24 hours and a characteristic mouse like odor

A

Pasteurella multocida

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55
Q

_________ is the most important virulence factor that uropathogenic (UTI) E. coli express

A

Fimbrial antigen

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56
Q

the aminoglycoside _________ used in TB therapy inhibits protein synthesis by inactivating the _______ ribosomal subunit

A

streptomycin

30S

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57
Q

_______ classically presents with fever for 3-5 days, seizure, followed by a truncal rash =

A

HHV6 infection: roseola

58
Q

Thayer-Martin agar that contains, vancomycin, colistin, nystatin, and trimethoprim used to isolate

A

Neisseria species

59
Q

a virion that buds through and acquires their envelope from the host cell nuclear envelope most likely belongs to the _______ family, including ______

A

herpesviruses

CMV

60
Q

______ is a highly contagious disease that presents with an intensely pruritic rash worse at night in the flexor surfaces of the hands and wrist. Patients have excoriations with small crusted red papules scattered around the affected areas. Diagnosis by skin scrapings that show mites, ova, and feces under LM

A

Sarcoptes Scabies

61
Q

_______ inhibits mycolic acid synthesis, which is required for the unique mycobacterial peptidoglycan cell wall

A

Isoniazid

62
Q

painless ulcer near the glans penis with no surrounding erythema and no inguinal LAD, college student =

sensitive to ______ which are structurally similar to D alanine D alanine

A

chancre due to primary syphillis

penicillin

63
Q

many children in close quarters with acute onset fever, cough, congestion, pharyngitis, conjunctivitis; disease is self limiting and year round

A

Adenovirus

64
Q

patients with profound and prolonged neutropenia (100/mm3 in this case), dense infiltrate right upper lobe, unaffected by broad spectrum abx, bronchoscopy grows mold, most likely ___________. __________ respiratory infections are very uncommon, while bloodstream infections can occur in patients who have an indwelling central venous catheter.

_____________ is a fungus that most frequently causes opportunistic infections in patients with immunosuppression especially in HIV/AIDs. The most common presentation is meningoencephalitis while pneumonia is rare

__________ can present in patients with HIV/AID with fulminant respiratory failure and chest radiographs reveal diffuse, bilateral interstitial infiltrates

___________ can lead to mucormycosis which common presents with a sinus infection that spreads rapidly to orbits and brain (patients with diabetes)

A

Aspergillus fumigatus

Candida

Crytopcoccus neoformans

Pneumocystis jiroveci

Rhizopus oryzae

65
Q

multiple painful ulcers and constitutional symptoms in a sexually active patient is highly suggestive of _________. Diagnosis can be established by ______, direct fuorescence antibody testing, viral culture, or Tzanck smear

A

HSV

PCR

66
Q

H influenza type b is the most invasive strain of H influenzae and can causes _________, pneumonia, ________, and sepsis

the PRP capsule serves as an important ________ factor, facilitating invasion by _________

A

meningitis

epiglottitis

virulence

evading mucosal immunity

67
Q

optic neuropathy after TB treatment due to

A

Ethambutol

68
Q

white oral plaques that can be easily scraped off revealing and erythematous mucosal surface underneath =

in an otherwise healthy individual, this is suggestive of immunosuppession and is a common presentation of ______

A

oral thrush, Candida yeast

HIV infection

69
Q

___________ is a combination of extended spectrum penicilin with Beta lactamase inhibitor. It is effective against most G(-) enteric rods (including P aeruginosa) and against _______________

case presented was diabetic foot ulcer with infection

A

piperacillin-tazobactam

Bacteroides fragilis

70
Q

Gram negative cocci, patient with meningitis =

brother shares a room, should be given =

vaccination is important, but not useful for post exposure prophylaxis

A

N. meninigitidis

prophylactic rifampin

71
Q

If ________ persists for several months and host antibodies to this antigen remain low or undetectable, suspect chronic HepB infection with ______ infectivity

A

HBeAg

high

72
Q

clavulanic acid, sulbactam, tazobactam are all

A

beta lactamase inhibitors

73
Q

70% isopropanol antiseptic properties lie in its ability to ___________, it ______ sporicidal

chlorhexidine does the same, along with _____ of the cytoplasm, it ________ sporicidal

Hydrogen peroxide produce destructive _______ and is sporicidal

Iodine _________ proteins and nucleic acids and is sporicidal

A

disrupt cell membranes, is not

coagulates the cytoplasm, is

free radicals

halogenates

74
Q

gardnernella vaginalis shows _________ covered with Gram _____ rods on microscopy

A

epithelial cells

variable

75
Q

Zidovudie (AZT) is an NRTI used to treat HIV. It competitively binds to reverse transcriptase and is incorporated into the viral genome as a _______ analog. AZT dose not have a 3’-OH group, making ____________ bond formation impossible

A

thymidine

3’-5’ phosphodiester

76
Q

fever, chills, night sweats that occur every 48 hours after trip to India

RBC inclusions on ______ smear

_______ is the treatment of choice, while ________ is added in the treatment of infections with P vivax and P ovale to eradicate the intrahepatic stages (hypnozoites) of these malarial species, which are responsible for relapses

A

tertian malaria

Giemsa

Chloroquine

Primaquine

77
Q

4 year old with fever, irritability, oral lesions, refusal to eat or drink, painful ulcers on tongue, gingiva, swollen gums, cervical LAD, multinucleated giant cells on Tzanck smear =

this a _________ that results in gingivostomatitis

incontrast, reactivation of latent infection in the trigeminal ganglia results in mild _______ vesciles

A

HSV-1

primary infection

perioral

78
Q

Oseltamivir is a __________ inhibitor useful in the treatment and prevention of both Influenza A and B virus infections. It impairs _________ from infected host cells

A

neuraminidase inhibitor

release of newly formed virions

79
Q

Amphotericin B binds ______ in the fungal cell membranes to form holes. It is notorious for _______ toxicity and severe _________ and _________ are commonly seen during treatment

A

ergosterol

renal toxicity

hypokalemia, hypomagnesemia

80
Q

Trimethoprim, __________, and pyrimethamine inhibit dihydrofolate reducatase. Trimethoprim works well in conjunction with ________ which inhibits an earlier step in the bacterial folic acid pathway

A

methotrexate

sulfonamide

81
Q

vague chest pain, cough, from Taiwan, decresendo type diastolic murmur over RSB, normal breath sounds, treponemal antibody absorption test is positive, CXR shows medialstinal widening =

murmur from =

widening suggest =

pathologic process of widening

A

tertiary syphilis

aortic regurg

aortic aneurysm

vasa vasorum endarteritis and obliteration

82
Q

guanosine analog anti viral =

EBV or CMV infected cells do not produce the same virally encoded thymidine kinase, and cannot easily convert the drug to its _________ because of a much lower phosphorylation rate

A

acyclovir

active form

83
Q

stuporous after trip to Mexico, high grade fever, HA, severe myalgias and joint pain, developing shock, marked thrmbocytopenia, leukopenia, elevated liver aminotransferases =

due to ______, a ssRNA _________ with 4 different serotypes

bone break fever, retro orbital pain, rash of white islands on a sea of red =

A

Dengue hemorrhagic fever

Dengue virus, flavivirus

Classic Dengue fever

84
Q

Step _______ is bile soluble and optochin susceptible

Strep ______ is beta hemolytic, bacitracin susceptible, and pyrrolidonyl arylamidase +

Streptococci are catalase _____, Staphylococci are catalase _______

A

pneumo

pyogenese

negative, positive

85
Q

the overrall increase in staphylococcal bloodstream infections over the last 30 years is most likely related to the increased use of

A

intravascular devices

86
Q

HBV +, liver mass with increased AFP =

preceded by

__________ triggers neoplastic changes

A

hepatocellular carcinoma

liver cirrhosis

integration of viral DNA into the genome of host hepatocytes

87
Q

Immunosuppressed with thin, sharp branching hyphae =

can cause

A

Aspergillus

invasive aspergillosis (Amph B to treat), aspergillomas (surgery to treat), and allergic pulmonary aspergillosis(patients with asthma and migratory pulmonary infiltrates, treat corticosteroids)

88
Q

elderly patient with fever, hypotension, altered mental status, and E coli bacteremia has ________ most likley due to ________

A

septic shock

UTI

89
Q

__________ is a comma shaped oxidase + G(-) bacillus that causes watery diarrhea and is endemic in southern Asia, parts of Africa, and Latin America. It grows well on highly alkaline selective media such as TCBS agar, hence it is very sensitive to gastric acidity. Patients who have been on chronic _______ therapy would likely require the smallest infectious dose to initiate infection

A

Vibrio cholerae

omeprazole

90
Q

Hepadna, Herpes, Pox are all _________

Adenovirus, Papova(HPV), and Polyoma (JC, BK) are all _______

A

dsDNA enveloped

dsDNA nonenveloped

91
Q

Traveler’s diarrhea is often self resolving and is characteristic of ______, due to the LT enterotoxin that is similar to _______ in mode of action, increases intracellular cAMP in gut mucosa

A

ETEC

cholera toxin

92
Q

_______ is a replication defective RNA virus that is only capable of causing infection when encapsulated with HBsAg

A

Hepatitis D

93
Q

Recurrences of gential herpes (HSV2) can be reduced through daily treatment with oral __________

A

valacyclovir, acyclovir, famciclovir

94
Q

_______ work by interfering with the 30S ribosomal subunit. An important mechanism of resistance is the methylation of the _________ binding portion of the ribosome, which inhibits the ability of aminoglycoside to interfere with protein translation

A

Aminoglycosides

aminoglycoside

95
Q

unvaccinated child with fever, cough congestion, conjunctivitis followed by maculopapular rash is consistent with =

type of virus

the classic exanthema starts on the face and spreads cephalocaudal and centrifugal

_______ is recommended, especially in patients with deficiency, as this acute infection depletes vitamin A stores resulting in a risk of keratitis and corneal ulceration

A

Measles

paramyxovirus

Vitamin A

96
Q

7 year old girl with lace like erythematous rash after first developing red flushed cheeks with congestion, HA, and low grade fever, last week her younger brother had similar symptoms that resolved spontaneously =

caused by

replicates in the _________ in the bone marrow

A

Erythema infectiosum

Parvovirus B19, ssDNA

erythrocyte precursors

97
Q

the HCV is genetically unstable because it lacks ________ in its RNA polymerase. Its enveloped glycoprotein sequences also contain a hypervariable region prone to frequent genetic mutation

A

proofreading 3’-5’ exonuclease activity

98
Q

changes in host range are most commonly caused by mutation in the viral encoded _______ that mediates virion attachment to target host cell plasmalemma receptors

A

surface glycoprotein

99
Q

a _______ response with antibodies directed against ______ is generally the most important source of protection against Influenza A outbreak

A

humoral

hemagglutinin

100
Q

vomiting and watery diarrhea outbreak in a school/cruiseship/nursing home most likely =

in undeveloped or unvaccinated areas, could be

A

Norovirus, nonenveloped, ssRNA

Rotavirus

101
Q

virus with ds circular DNA =

A

Hepatitis B

102
Q

lesion in primary syphilis

secondary syphilis

tertiary syphilis

A

chancre painless

condylomata lata, large wart like growth, diffuse macular rash

painless gumma, neurosyphilis, ascending aortic aneurysms, aortic valve insufficience

103
Q

severe pharyngitis with exudates and cervical LAD, neck swelling, difficulty swallowing, one died from severe heart failure, unknown vaccination status indicates =

this toxin acts in a similar manner to exotoxin A, which is produced by

A

Diphtheria

Pseudomonas aeruginosa

104
Q

Mosquitos transmit the viruses that cause ______ and _________

A

dengue fever

chikungunya

105
Q

infants of HBeAg positive mothers have high levels of HBV replication but are usually _______

A

asymptomatic

106
Q

the presence of antiHBc and antiHBs Abs in the serum without detectable viral Ags indicates _________

A

recovery from acute HepB infection

107
Q

intense perianal itching at night, presence of eggs on cellulose adhesive tape that are asymmetrically flattened on one side =

treatment?

in pregnant patients?

A

Enterobius vermicularis (pinworm)

Albenazole

pyrantel pamoate

108
Q

_________ is a nonmotile non lactose fermenting organism that does not produce H2S when grown on triple sugar iron agar. ________ of the M cells that overlie Peyer’s patches is an essential pathogenic mechanism for this bug. It escapes the phagosome and spreads laterally to other epithelial cells via _________

A

Shigella

mucosal invasion

actin polymerization

109
Q

NNRTIs such as ______ are antiretroviral drugs that due not require activation via intracellular phosphorylation and are structurally unrelated to nucleosides. These drugs act within the cytoplasm of infected cells to inhibit the synthesis of viral DNA.

Adverse effects

A

Nevirapine, efavirenz

Hepatic failure

110
Q

fetal infection with _____ can lead to profound anemia, ascites, fetal hydrops, and still birth. This virus is a __________ with an increased incidence in children and teachers during school outbreaks. Infections in adults can present with acute symmetric ________ without rash

A

Parvovirus

nonenveloped ssDNA

arthralgias/arthritis

111
Q

nephrotoxicity of AmphB is due to its binding to human

A

cell membrane cholesterol

112
Q

echinocandins such as _________ are antifungal medications that inhibit synthesis of polysaccharide glucan, an essential component of the fungal cell ______

A

caspofungin, micafungin

wall

113
Q

patient develops tinnitus and hearing loss attributed to this type of antibiotic

affects

A

aminoglycoside (ototox and nephrotox)

mRNA genetic code reading (30S ribosomal subunit)

114
Q

young sexually active male with dysuria and yellow penile discharge with intracellular diplococci =

treat with __________ like azithromycin for coinfection with _____________ and a 3rd gen cephalosporin like ceftriaxone

A

Gonorrhea

macrolide

Chlamydia

115
Q

fever, CSF pleocytosis, irritability in an infant suggestive of ________, which is resistant to cephalosporins like cefotaxime, but is susceptible to ________

A

Listeria monocytogenes

ampicillin

116
Q

alcoholic with cavitary lesion and foul smelling sputum =

most common cause =

A

Lung abscess aspiration pneumonia

anaerobic bacteria from gingivodental sulcus

117
Q

elderly post op patient that was intubated and dehydrated, swelling that extends to the mandible with fever and right jaw pain =

bug =

lab =

A

suppurative parotitis

S aureus

elevated serum amylase w/o pancreatitis because parotid gland secretes amylase

118
Q

growth of _________ on sheep blood agar can be achieved by cross streaking the medium with S aureus because the latter actively secretes V factor (____) into the medium and facilitate the release of X factor hematin from B hemolysis induced erythrocyte lysis

A

H influenzae

NAD+

119
Q

UTI in older women that is lactose fermenting, indole positive G(-) rod

A

E coli

120
Q

trismus, spasms, clenched fists, dorsiflexed feet, arched back in a 6 day old infant exposed to dirt with unknown vaccination status mother most likely

prevented by _________ and hygenic delivery and cord care

A

neonatal tetanus

immunization of pregnant women

121
Q

fever, cough, rhinorrhea, conjunctivitis, Koplik spots (small white, blue, gray specks on erythematous base in mouth) in unvaccinated child =

these symptoms procede the

transmission

A

Measles virus (rubeola), enveloped RNA paramyxovirus

maculopapular rash

airborne person to person

122
Q

meningitis in IC patient with G- rods and tumbling motility at room temperature =

due to

A

Listeria monocytogenes

contaminated food (unpasteurized milk)

123
Q

aminoglycoside resistance such as _______ develops through the bacterial production of aminoglycoside modifying enzymes that transfer different chemical groups (acetyl) to the aminoglycoside molecule outside of the bacterium, thereby decreasing the ability of the antibiotic to bind the ribosomes

A

gentamicin

124
Q

______ infection caused by an RNA picornavirus with acute onset of malaise, fatigue, anorexia, nausea, and aversion to smoking after a 30 day incubation period

vector

A

HAV

contaminated water/food, raw or steamed shellfish

125
Q

fever, vomiting, diarrhea, muscle pains, and erythroderma (macular rash resembling a sunburn) are manifestations of _______ associated with ______. S aureus strains producing TSST are responsible for most cases. TSST acts as a super antigen that activates large numbers of Th cells and macrophages, who release IL2 and IL1/TNFa respectivley

A

TSS

tampons

126
Q

_______ is responsible for almost half of all UTIs in sexually active young women. This bug is catalase positive, gram positive, coagulase negative, ______ resistant

A

Staph saprophyticus

novobiocin

127
Q

extended spectrum beta lactamases can be produced by G- bacteria, rendering cephalosporins inactive. These drug resistant genes are transmitted between organisms in

A

plasmid vector conjugation

128
Q

African american with osteomyelitis, nonlactose fermenting, oxidase negative, motile organisms =

virulence mechanism contributing to the current presentation

underlying condition

A

Salmonella

capsule resistant to opsonization and phagocytosis

SCD

129
Q

fusion inhibitors such as ________ inhibit HIV fusion with target cell membrane by binding to HIV gp41

A

Enfuvirtide

130
Q

genetic variations created during _____ replication result in a marked variety of _______ of the envelope protein. THe production of host Abs lags behind that of new mutant strains, preventing infected individuals from mounting an effective immune response

A

HCV

antigenic structure

131
Q

severe retroorbital headaches, myalgias, pneumonia, elevated liver enzymes, thrombocytopenia, dairy farm waste =

due to

chronically can cause

A

Acute Q fever

Coxiella burnetii

endocarditis and valvular disease

132
Q

patient with latent TB started on isoniazid therapy now has fever, anorexia, and nausea due to

A

INH hepatotoxicity

133
Q

Diphtheria exotoxin inhibits ________ by catalyzing the ADP ribosylation of host cell EF2

A

cell protein synthesis

134
Q

17 year old boy, lots of contacts with different animals, recent onset insomnia, HA, periodic agitation, dysphagia, develops painful spasms, progressive paralysis, and coma and dies =

intervention that would have prevented this illness

A

Human Rabies virus (bat cave)

postexposure prophylaxic INACTIVATED vaccine

135
Q

antecedent nasal congestion/discharge, and cough, wheezing/crackles, respiratory distress (tachypnea, retractions, nasal flaring) before the age of 2 =

due to

A

viral bronchiolitis

RSV

136
Q

C diphtheriae is cultured on ________ agar and results in black colonies

A

cysteine tellurite

137
Q

only the HIV gene polyprotein product _____ is glycosylated to gp160 and proteolytically cleaved within the ER and Golgi apparatus to from the envelope glycoproteins ______ and ________

A

env

gp120 and gp41

138
Q

________, known as woolsorters disease is caused by inhalation of spores. Patients present with fever, chest pain, hemoptysis, widened mediastinum, large gram + rods that form _______ colonies on standard media. These bacteria produce an _______ that is required for pathogenicity that contains _____ instead of polyaccharide

A

Pulmonary anthrax

medusa head

antiphagocytic capsule

D glutamine

139
Q

patient with untreated HIV (CD4 38/mm3) fever, abdominal pain, explosive diarrhea, erosions and ulcerations, viral intranuclear and intracytoplasmic inclusions treated with a drug that inhibits DNA polymerase and reverse transcrpitase, administered via IV in patients who are acyclovir resistant. The drug used does not require intracellular activation

condition?

drug?

A

CMV induced colitis

Foscarnet

140
Q

elderly patient who recently underwent GU procedure (cystoscopy) with a UTI caused by______ which is a G+ cocci in pairs and chains and when grown on blood agar reveals no hemolysis (called ______). It is PYR + and grows in bile and in 6.5% NaCl

A

Enterococcus

gamma hemolysis

141
Q

Babesiosis and Lyme disease are transmitted by the _____ and coinfection is common

A

Ixodes tick

Step 2 CK: UWorld Questions (20 decks)

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