Micro Flashcards
1
Q
Low risk condylomas are?
A
HPV 6+11
2
Q
High risk HPV 16 + 18 have what two proteins that play in the pg of cervical cancer?
A
E6 + E7–> bind and inactivate two tumor suppressor proteins p53 and Rb
3
Q
Where does HPV remain over time?
A
Basal cell layer
4
Q
What is the anti-cancer HPV vaccine available?
A
Subunit vaccine consisting of L1 capsid
5
Q
What is the genome/makeup of HPV?
A
Small DS DNA virus
Non enveloped capsid
6
Q
What is the difference btwn virus in permissive and non permissive cells?
A
Permissive for virus growth= replicates and assembles in nucleus
non-permissive= late gene expression does NOT occur–> TRANSFORMS the cell= produce tumor
7
Q
Genomic location differences btwn benign and malignant tumors?
A
Benign= extrachromosomal Malignant= genome integrated into host chromosome
8
Q
What are the features of a transformed cell?
A
immortal
no longer contact inhibited
no longer require serum-derived GF in cell culture
no longer anchorage dependent for growth
Can lead to tumor formation in syngeneic animals
9
Q
What are the late and early genes in HPV used for?
A
Late (L1+L2)= capsid proteins
Early= replication proteins and transformation
10
Q
What is the function of E6 and E7 proteins?
A
E6= binds and degrades p53 E7= binds and inactivates Rb
11
Q
What is the initial infection of HPV?
A
infect Germinal cells= non-permissive cells–> virus particles not produced but cells transform
12
Q
What happens to the Germinal cells after infection?
A
mature + migrate to surface + keratinize + become Permissive + shed virus
13
Q
Why do warts return after treatment?
A
because destroying the wart does not Eliminate the genome in the non-permissive Germinal cells
14
Q
Describe HPV?
A
circular DS DNA
NON enveloped icosahedral capsid (L1+L2)
Rep + assembly in nucleus of permissive cells
NO virus production in non-permissive cells, but virus genome maintained and cells transform
E6 degrades p53 + E7 inactivates Rb
over-expression of E6 + E7= malignant
Differentiated keratinocytes are permissive=wart
Virus maintained in Germinal cells
15
Q
What are the disease caused by HPV?
A
verruca vulgairs= common/ plantar warts
Conyloma acuminata/plana= Anogenital warts 6+11
Subclinical papilloma inf= HPV 16, 18, 31
Cervical penile, anal, oral, neck cancer= 16, 18,31
Infantile laryngeal papillomas: 6+11
16
Q
Which HPV cause Anogenital warts?
A
HPV 6 + 11
17
Q
Which HPV cause sub-clinical papilloma infections (SPI)?
A
HPV 16, 18, 31
18
Q
Which HPV cause cervical, penile, anal, oral, neck cancer?
A
HPV 16, 18, 31
19
Q
Which HPV cause infantile laryngeal papillomas?
A
HPV 6 + 11
20
Q
What is laryngeal papillomas associated with?
A
Respiratory distress and 3% die annually
21
Q
How can SPI be detected?
A
Brushing infected area with 5% acetic acid which turns the area WHITE
22
Q
What would a positive pap smear show?
A
Koliocytes (vacuolated cytoplasm) Squamous epithelial cells
23
Q
What is does HPV cause in the cervix?
A
Causes 90% of cervical dysplasias= lead to invasive cancer
24
Q
What is the range of HPV in women in US?
A
15-60%
25
What are some other cofactors of Cervical cancer along with HPV (16,18,31)?
Smoking
| Herpes Simplex
26
Which type of papillomas are acquired at birth?
Laryngeal --> HPV 6+11
27
What is necessary for Dx of HPV?
Clinical presentation
Pap smear
Colppscopy
FDA approved HPV DNA detection test
28
What is Gardasil?
Recombinant capsid protein (L1) from 6,11, 16,18
29
What are the methods for removing Warts?
Bichloroacetic acid
Trichloroacetic acid
Cryotherapy
LEEP (loop electrosurgical excision procedure)
Podofilox (anti mitotic)
Imiquimod ( stimulates IFN and cytokine product)
30
What accounts for 60-70% of STIs with dysuria and penile and vaginal exudation?
Chlamydia trochamatis
| Neisseria gonorrhoeae
31
What is the most serious sequela for both Ct and GC (gonococcus)?
lower genital tract infection spreading up and causing PID = sterility and ectopic pregnancy
32
What are the complications associated with new borns of Ct and GC infected mothers?
```
Ct= Conjunctivitis + Pneumonia
GC= Conjunctivitis
```
33
What are the chances that someone with GC has Ct?
50%
34
Chlamydia trachomatis description?
Obligate intracellular parasite
G- but deficient in peptidoglycans
replication via EB and RB
Isosmotic intracellular environment-> Beta lactams DO NOT work for Tx
35
What are the two main VFs of Ct?
Intracellular growth
| Ability to cause inflammation (heat shock protein or LPS induced)
36
What are EB and RB?
```
EB= metabolically inert but infectious elementary body
RB= Larger, grows within membrane bound vacuole in cytoplasm of mucosal epithelial cells
```
37
What happens during lysis of cell during Ct infection?
EBs released infect nearby cells or sexually transmitted to new host
38
Describe GC?
No capsule
LPS= shed, invokes inflammatory response
Antigenic variation (pili + outer membrane surface proteins for attachments)
Extracellular= phagocytosed by PMNs
secrete IgA1
39
Ct strains that causes urethritis and cervicitis are restricted to what?
mucosal epithelia and DO NOT disseminate into Blood or lymph
40
Some strains of GC can do what that Ct doesnt?
Disseminate= septicemia + Rash
41
Ureaplasma is a significant cause of what?
UTIs
42
What organisms cause Cervicitis and urethritis?
Ct + GC
43
What bacterial organism causes Prostatitis/ pharyngitis?
GC
44
What bacterial organism causes Infant pneumonia and conjunctivitis?
Ct
45
What bacterial organism often Disseminates causing sepsis, Rash, Aseptic arthritis, Meningitis?
GC
46
Urethritis with Purulent penile discharge + dysuria?
GC
47
Urethritis with penile milky discharge + dysuria?
Ct
48
Dull to severe lower abdominal pain, cervicitis, adnexal tenderness, Cervical motion tenderness, Fever?
PID--> Ct, GC, Mycoplasma, anaerobes
49
Serious infection often requiring hospitalization, Tubo-ovarian abscesses, sterility, ectopic pregnancy, Chronic pelvic pain results from?
PID
50
Fever, Rash (fingers, toes, and feet), septic arthritis?
GC
51
1-4 months postpartum, afebrile, repetitive staccato cough with tachypnea, hyperinflated chest of CXR?
Infant pneumonia--> Ct only
52
Gram stain of penile exudate shows G- cocci and PMN infiltration?
GC
** without PMNs= non-gonorrheal urethritis (Ct)
53
What can GC colonies be grown on?
Thayer Martin medium
54
What is Thayer Martin medium?
Chocolate blood agar
With antibiotics (vanco, nystatin, colistin)
Only GC growth
55
Organism that is G- diplococcus, Oxidase positive?
GC
56
MC Dx tool for Ct infections?
NAAT on urine and cervical/urethral exudates
57
What is the DOC for GC infections?
IM Ceftriaxone
**Fluoroquinolones--> Organism now resistant
58
DOC for Ct infections?
Azithromycin
| 2nd--> Doxycyline
59
Urethritis/ cervicitis with Swollen lymph nodes, Suppuration of lymph nodes, ulceration at site of entry?
Lymphogranuloma venereum
60
Potentially blinding disease, high prevalence in Asia, Middle East, Africa?
Trachoma (non STD Ct infection)
61
HSV structure?
Large
DS DNA
Capsid + lipid Envelope
62
HSV replication?
```
Attachment + pH dependent fusion
nucleocapsid migrates to nucleus
Translation of immediate early genes (replication proteins)
Late protein translation
Viral assembly in nucleus
FORM SYNCYTIAs
```
63
What are the prominent early proteins translated by HSV?
Thymidine kinase
| DNA polymerase
64
What are the diagnostic tests for HSV infections?
Tzanck smear--> look for Multinucleated cells
65
What is the function of the only gene expressed during latency?
LAT--> prevent apoptosis of infected neuron
| NO virus particles are produced
66
Causes Fever blisters, herpetic whitlow, Keratitis, Conjunctivitis, Encephalitis?
HSV 1 --> ABOVE BELT
67
Causes cervicitis, Vulvular/ penile vesicles, MENINGITIS?
HSV 2
68
What limits the duration of HSV lesions?
Neutralizing Antibodies
69
What are prodrome symptoms of HSV primary or recurrent genital infections?
Flu like
Itching or burning skin
Muscle aches
70
What are the ocular complications of HSV?
Blepharitis and conjunctivitis
71
What are the indications of neonatal infection?
95% transfered during delivery
primary= 30% risk of transmission
Recurring= 2-3% risk of transmission
Herpetic lesions at deliver= MUST DO C-section
72
What are the typical diagnostic tools for HSV?
```
culture showing Cytopathic effect (CPE)
Fluorescent antibody screening
PCR
Serology to distinguish serotypes of past infections
TZANCK SMEAR
```
73
Patient with neck stiffness and CSF is cultured to differentiate btwn what?
Bacterial or HSV (showing CPE)
74
What diagnostic test can rule out herpes encephalitis?
normal EEG and confirmation by PCR from CSF
75
What diagnostic tests should be performed for Neonatal or congenital HSV infection?
Skin, eye, mouth, or CNS samples
| LIVER enzymes for signs of Dissemination
76
What is the DOC for HSV?
Acyclovir
77
What is the MOA of acyclovir?
Inhibits Viral DNA polymerase
| Requires phosphorylation by Viral Thymadine kinase
78
What are the AE of Acyclovir?
```
Nausea
Rash
Diarrhea
Renal Failure (high does causes precipitation)
SEIZURES
```
79
MAO of Foscarnet?
Pyrophosphate analog blocks viral DNA pol.
80
MOA of Docosanol?
Over the counter medication for cold sores:
| Modifies host cell membrane to inhibit viral fusion to limit spread
81
What is the MC way to Dx infectious agents of Vaginitis and vaginosis?
Microscopically
| Rapid examination of Discharge
82
What are the factors that allow for overgrowth of Candidia and other agents of bacterial vaginitis?
Disturbance of Normal flora (esp G+ Lactobacilli)
| Other organisms tat Maintain LOW pH and produce Hydrogen Peroxide
83
SIngle cell protozoan that is considered the pathogen causing sexually transmitted Trichomoniasis?
T vaginalis
84
What are the agents of Bacterial Vaginosis?
Gardnerella vaginalis
Mobiluncus
Anaerobes
85
Agents of Candidiasis?
Candidia albicans
C glabrata
Fungi
86
A protozoan species causes what Female infection?
Trichomoniasis
87
Pt with Abnormal scant, White, Clumped vaginal discharge, external dysuria, vulvar itching, pain and irritation?
Vulvovaginal Candidiasis
88
Microscopy shows: Leukocytes, epithelial cells, mycelia, or pseudo mycelia?
Vulvovaginal Candidiasis
89
Profuse Yellow frothy vaginal discharge, dysuria, vulvar itching, erythema, colipitis macularis, and Amine odor with KOH?
Trichomonal Vaginitis
Amine= Fishy
90
Loss of normal vaginal Lactobacilli, associated with Gardnerella vaginalis; increased anaerobic bacteria and mycoplasmas?
Bacterial Vaginosis
91
Increased White/gray, Malodorous discharge that is Adherent uniformly to vagina, and has Amine odor with KOH?
Bacterial Vaginosis
92
Dysuria, Suprapubic pain, Polys in urine, SIgnificant # of bacteria in urine is characteristic of?
Cystitis
93
Cystitis, Significant fever, Flank pain and WBC/RBC casts in urine?
Pyelonephritis
94
Dysuria, Mucopurulent discharge, pruritis, lower abdominal pain, fever?
Cervicitis
95
How is trichomoniasis transmitted?
Sexually
96
```
Foul odor (KOH whiff test)
Dirty white Discharge
pH above 4.5
Presence of CLUE cells (vaginal epi with adherent bacteria in wet mounts or gram stains)
NO DYSURIA
no inflammation?
```
Bacterial Vaginosis
97
```
Vaginal itching
Patchy white adherent clumpy discharge (cottage cheese exudate)
Discharge w/ foul smell
pH 4.5 or less
Branching hyphae seen in wet mount?
```
Candidiasis
98
```
Yellow homogenous Frothy discharge
Whiff test Positive
pH above 4.5
Dysuria
Wet mount shows twitching motility and PMNs?
```
Tichomonas
99
DOC for Trichomonasis?
Metronidazole
100
DOC for candidiasis?
Azoles
101
Which STI organism cannot be grown in lab but can be propagated in rabbit testes?
Syphilis (T. pallidum)
102
What is the Hallmark of Primary syphilis?
NON PAINFUL ulcer= CHANCRE
103
Hallmark of Secondary syphilis?
```
Systemic infection
Fever
Swollen Lymph nodes
Mucous membrane lesions
Rash on PALMS & SOLES
maybe warts in perineum or anal region
```
104
Hallmarks of Congenital syphilis?
Saddle nose
Sabre shins
bifid Incisor teeth
105
MC Tx of Syphilis?
Penicillin G
106
What are the characteristics of T. palladium?
Helical bacterium= Spirochete
Too thin to be seen on Gram stain or microscopy
USE DARKFIELD microscopy
107
What method can be used to Dx early syphilis disease process?
Darkfield microscopy
108
What are the inner and outer membranes of T. palladium made of?
```
Inner= periplasm with peptidyglycan + flagella
outer= lipoproteins and lipids
```
109
What is responsible for controlling syphilis infections and contributes to its pathology?
Cellular immune response
**Spirochetes have LATENT phase
110
Pt with painless ulcer and non tender inguinal LAD?
Primary Syphilis
111
Pt with Hyperpigmented rash over entire body that extends into his hands and feet, Snail track lesions in mucous membranes, and condylomata lata, NON tender LAD, mild Meningeal symptoms?
Secondary Syphilis
112
DDx for Rash on Palms and Soles?
Secondary syphilis
RMSF
Hand foot and mouth disease (CMV)
113
What is tertiary Syphilis considered?
Endarteritis
114
Pt with characteristic skin and bone granulomatous lessons, aortic regurgitation, meningeal signs (Tabes dorsalis) ?
Tertiary syphilis
115
Causes still births or abortions, often transmitted across placenta in 1st trimester hematogenously. Infant with Snuffles, Bulllous rash, enlarged liver and spleen?
Early Congenital syphilis
116
How does late Congenital syphilis present?
Bone abnormalities
Frontal bossing + sabre shins
Vision defects
117
what is Hutchinson's triad and what disease is it seen in?
Triad: Notched incisors, keratitis, Deafness
| Congenital syphilis
118
What are the Dx tests for Syphilis?
Non-treponemal serology= RPR and VDRL
| Treponemal= FTA-ABS
119
What are the non-Treponemal serological tests?
Using beef heart mito cardiolipin
Rapid Plasma Reagin (RPR)
Venereal Disease Research Lab test (VDRL)
120
RPR and VDRL tests are Cheap and sensitive but have many False positive because of the Cardiolipin including with?
Viral Hepatitis
Mono
Lupus
rarely Pregnancy
121
What is the Treponemal specific tests?
Fluorescent Treponemal Antigen-Absorbed test
FTA-ABS
* Cumbersome + expensive + but cured slides last for years
