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Reproductive > Micro > Flashcards

Micro Flashcards

1
Q

Low risk condylomas are?

A

HPV 6+11

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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

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3
Q

Where does HPV remain over time?

A

Basal cell layer

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4
Q

What is the anti-cancer HPV vaccine available?

A

Subunit vaccine consisting of L1 capsid

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5
Q

What is the genome/makeup of HPV?

A

Small DS DNA virus

Non enveloped capsid

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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

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7
Q

Genomic location differences btwn benign and malignant tumors?

A 
Benign= extrachromosomal 
Malignant= genome integrated into host chromosome
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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

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9
Q

What are the late and early genes in HPV used for?

A

Late (L1+L2)= capsid proteins

Early= replication proteins and transformation

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10
Q

What is the function of E6 and E7 proteins?

A 
E6= binds and degrades p53
E7= binds and inactivates Rb
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11
Q

What is the initial infection of HPV?

A

infect Germinal cells= non-permissive cells–> virus particles not produced but cells transform

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12
Q

What happens to the Germinal cells after infection?

A

mature + migrate to surface + keratinize + become Permissive + shed virus

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13
Q

Why do warts return after treatment?

A

because destroying the wart does not Eliminate the genome in the non-permissive Germinal cells

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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

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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

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16
Q

Which HPV cause Anogenital warts?

A

HPV 6 + 11

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17
Q

Which HPV cause sub-clinical papilloma infections (SPI)?

A

HPV 16, 18, 31

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18
Q

Which HPV cause cervical, penile, anal, oral, neck cancer?

A

HPV 16, 18, 31

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19
Q

Which HPV cause infantile laryngeal papillomas?

A

HPV 6 + 11

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20
Q

What is laryngeal papillomas associated with?

A

Respiratory distress and 3% die annually

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21
Q

How can SPI be detected?

A

Brushing infected area with 5% acetic acid which turns the area WHITE

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22
Q

What would a positive pap smear show?

A

Koliocytes (vacuolated cytoplasm) Squamous epithelial cells

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23
Q

What is does HPV cause in the cervix?

A

Causes 90% of cervical dysplasias= lead to invasive cancer

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24
Q

What is the range of HPV in women in US?

A

15-60%

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25
Q

What are some other cofactors of Cervical cancer along with HPV (16,18,31)?

A

Smoking

Herpes Simplex

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26
Q

Which type of papillomas are acquired at birth?

A

Laryngeal –> HPV 6+11

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27
Q

What is necessary for Dx of HPV?

A

Clinical presentation
Pap smear
Colppscopy
FDA approved HPV DNA detection test

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28
Q

What is Gardasil?

A

Recombinant capsid protein (L1) from 6,11, 16,18

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29
Q

What are the methods for removing Warts?

A

Bichloroacetic acid
Trichloroacetic acid
Cryotherapy
LEEP (loop electrosurgical excision procedure)
Podofilox (anti mitotic)
Imiquimod ( stimulates IFN and cytokine product)

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30
Q

What accounts for 60-70% of STIs with dysuria and penile and vaginal exudation?

A

Chlamydia trochamatis

Neisseria gonorrhoeae

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31
Q

What is the most serious sequela for both Ct and GC (gonococcus)?

A

lower genital tract infection spreading up and causing PID = sterility and ectopic pregnancy

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32
Q

What are the complications associated with new borns of Ct and GC infected mothers?

A 
Ct= Conjunctivitis + Pneumonia 
GC= Conjunctivitis
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33
Q

What are the chances that someone with GC has Ct?

A

50%

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34
Q

Chlamydia trachomatis description?

A

Obligate intracellular parasite
G- but deficient in peptidoglycans
replication via EB and RB
Isosmotic intracellular environment-> Beta lactams DO NOT work for Tx

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35
Q

What are the two main VFs of Ct?

A

Intracellular growth

Ability to cause inflammation (heat shock protein or LPS induced)

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36
Q

What are EB and RB?

A 
EB= metabolically inert but infectious elementary body
RB= Larger, grows within membrane bound vacuole in cytoplasm of mucosal epithelial cells
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37
Q

What happens during lysis of cell during Ct infection?

A

EBs released infect nearby cells or sexually transmitted to new host

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38
Q

Describe GC?

A

No capsule
LPS= shed, invokes inflammatory response
Antigenic variation (pili + outer membrane surface proteins for attachments)
Extracellular= phagocytosed by PMNs
secrete IgA1

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39
Q

Ct strains that causes urethritis and cervicitis are restricted to what?

A

mucosal epithelia and DO NOT disseminate into Blood or lymph

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40
Q

Some strains of GC can do what that Ct doesnt?

A

Disseminate= septicemia + Rash

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41
Q

Ureaplasma is a significant cause of what?

A

UTIs

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42
Q

What organisms cause Cervicitis and urethritis?

A

Ct + GC

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43
Q

What bacterial organism causes Prostatitis/ pharyngitis?

A

GC

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44
Q

What bacterial organism causes Infant pneumonia and conjunctivitis?

A

Ct

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45
Q

What bacterial organism often Disseminates causing sepsis, Rash, Aseptic arthritis, Meningitis?

A

GC

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46
Q

Urethritis with Purulent penile discharge + dysuria?

A

GC

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47
Q

Urethritis with penile milky discharge + dysuria?

A

Ct

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48
Q

Dull to severe lower abdominal pain, cervicitis, adnexal tenderness, Cervical motion tenderness, Fever?

A

PID–> Ct, GC, Mycoplasma, anaerobes

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49
Q

Serious infection often requiring hospitalization, Tubo-ovarian abscesses, sterility, ectopic pregnancy, Chronic pelvic pain results from?

A

PID

50
Q

Fever, Rash (fingers, toes, and feet), septic arthritis?

A

GC

51
Q

1-4 months postpartum, afebrile, repetitive staccato cough with tachypnea, hyperinflated chest of CXR?

A

Infant pneumonia–> Ct only

52
Q

Gram stain of penile exudate shows G- cocci and PMN infiltration?

A

GC

** without PMNs= non-gonorrheal urethritis (Ct)

53
Q

What can GC colonies be grown on?

A

Thayer Martin medium

54
Q

What is Thayer Martin medium?

A

Chocolate blood agar
With antibiotics (vanco, nystatin, colistin)
Only GC growth

55
Q

Organism that is G- diplococcus, Oxidase positive?

A

GC

56
Q

MC Dx tool for Ct infections?

A

NAAT on urine and cervical/urethral exudates

57
Q

What is the DOC for GC infections?

A

IM Ceftriaxone

**Fluoroquinolones–> Organism now resistant

58
Q

DOC for Ct infections?

A

Azithromycin

2nd–> Doxycyline

59
Q

Urethritis/ cervicitis with Swollen lymph nodes, Suppuration of lymph nodes, ulceration at site of entry?

A

Lymphogranuloma venereum

60
Q

Potentially blinding disease, high prevalence in Asia, Middle East, Africa?

A

Trachoma (non STD Ct infection)

61
Q

HSV structure?

A

Large
DS DNA
Capsid + lipid Envelope

62
Q

HSV replication?

A 
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
Q

What are the prominent early proteins translated by HSV?

A

Thymidine kinase

DNA polymerase

64
Q

What are the diagnostic tests for HSV infections?

A

Tzanck smear–> look for Multinucleated cells

65
Q

What is the function of the only gene expressed during latency?

A

LAT–> prevent apoptosis of infected neuron

NO virus particles are produced

66
Q

Causes Fever blisters, herpetic whitlow, Keratitis, Conjunctivitis, Encephalitis?

A

HSV 1 –> ABOVE BELT

67
Q

Causes cervicitis, Vulvular/ penile vesicles, MENINGITIS?

A

HSV 2

68
Q

What limits the duration of HSV lesions?

A

Neutralizing Antibodies

69
Q

What are prodrome symptoms of HSV primary or recurrent genital infections?

A

Flu like
Itching or burning skin
Muscle aches

70
Q

What are the ocular complications of HSV?

A

Blepharitis and conjunctivitis

71
Q

What are the indications of neonatal infection?

A

95% transfered during delivery
primary= 30% risk of transmission
Recurring= 2-3% risk of transmission
Herpetic lesions at deliver= MUST DO C-section

72
Q

What are the typical diagnostic tools for HSV?

A 
culture showing Cytopathic effect (CPE)
Fluorescent antibody screening 
PCR
Serology to distinguish serotypes of past infections
TZANCK SMEAR
73
Q

Patient with neck stiffness and CSF is cultured to differentiate btwn what?

A

Bacterial or HSV (showing CPE)

74
Q

What diagnostic test can rule out herpes encephalitis?

A

normal EEG and confirmation by PCR from CSF

75
Q

What diagnostic tests should be performed for Neonatal or congenital HSV infection?

A

Skin, eye, mouth, or CNS samples

LIVER enzymes for signs of Dissemination

76
Q

What is the DOC for HSV?

A

Acyclovir

77
Q

What is the MOA of acyclovir?

A

Inhibits Viral DNA polymerase

Requires phosphorylation by Viral Thymadine kinase

78
Q

What are the AE of Acyclovir?

A 
Nausea
Rash
Diarrhea
Renal Failure (high does causes precipitation) 
SEIZURES
79
Q

MAO of Foscarnet?

A

Pyrophosphate analog blocks viral DNA pol.

80
Q

MOA of Docosanol?

A

Over the counter medication for cold sores:

Modifies host cell membrane to inhibit viral fusion to limit spread

81
Q

What is the MC way to Dx infectious agents of Vaginitis and vaginosis?

A

Microscopically

Rapid examination of Discharge

82
Q

What are the factors that allow for overgrowth of Candidia and other agents of bacterial vaginitis?

A

Disturbance of Normal flora (esp G+ Lactobacilli)

Other organisms tat Maintain LOW pH and produce Hydrogen Peroxide

83
Q

SIngle cell protozoan that is considered the pathogen causing sexually transmitted Trichomoniasis?

A

T vaginalis

84
Q

What are the agents of Bacterial Vaginosis?

A

Gardnerella vaginalis
Mobiluncus
Anaerobes

85
Q

Agents of Candidiasis?

A

Candidia albicans
C glabrata
Fungi

86
Q

A protozoan species causes what Female infection?

A

Trichomoniasis

87
Q

Pt with Abnormal scant, White, Clumped vaginal discharge, external dysuria, vulvar itching, pain and irritation?

A

Vulvovaginal Candidiasis

88
Q

Microscopy shows: Leukocytes, epithelial cells, mycelia, or pseudo mycelia?

A

Vulvovaginal Candidiasis

89
Q

Profuse Yellow frothy vaginal discharge, dysuria, vulvar itching, erythema, colipitis macularis, and Amine odor with KOH?

A

Trichomonal Vaginitis

Amine= Fishy

90
Q

Loss of normal vaginal Lactobacilli, associated with Gardnerella vaginalis; increased anaerobic bacteria and mycoplasmas?

A

Bacterial Vaginosis

91
Q

Increased White/gray, Malodorous discharge that is Adherent uniformly to vagina, and has Amine odor with KOH?

A

Bacterial Vaginosis

92
Q

Dysuria, Suprapubic pain, Polys in urine, SIgnificant # of bacteria in urine is characteristic of?

A

Cystitis

93
Q

Cystitis, Significant fever, Flank pain and WBC/RBC casts in urine?

A

Pyelonephritis

94
Q

Dysuria, Mucopurulent discharge, pruritis, lower abdominal pain, fever?

A

Cervicitis

95
Q

How is trichomoniasis transmitted?

A

Sexually

96
Q 
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?
A

Bacterial Vaginosis

97
Q 
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?
A

Candidiasis

98
Q 
Yellow homogenous Frothy discharge
Whiff test Positive
pH above 4.5
Dysuria
Wet mount shows twitching motility and PMNs?
A

Tichomonas

99
Q

DOC for Trichomonasis?

A

Metronidazole

100
Q

DOC for candidiasis?

A

Azoles

101
Q

Which STI organism cannot be grown in lab but can be propagated in rabbit testes?

A

Syphilis (T. pallidum)

102
Q

What is the Hallmark of Primary syphilis?

A

NON PAINFUL ulcer= CHANCRE

103
Q

Hallmark of Secondary syphilis?

A 
Systemic infection
Fever
Swollen Lymph nodes 
Mucous membrane lesions
Rash on PALMS & SOLES 
maybe warts in perineum or anal region
104
Q

Hallmarks of Congenital syphilis?

A

Saddle nose
Sabre shins
bifid Incisor teeth

105
Q

MC Tx of Syphilis?

A

Penicillin G

106
Q

What are the characteristics of T. palladium?

A

Helical bacterium= Spirochete
Too thin to be seen on Gram stain or microscopy
USE DARKFIELD microscopy

107
Q

What method can be used to Dx early syphilis disease process?

A

Darkfield microscopy

108
Q

What are the inner and outer membranes of T. palladium made of?

A 
Inner= periplasm with peptidyglycan + flagella 
outer= lipoproteins and lipids
109
Q

What is responsible for controlling syphilis infections and contributes to its pathology?

A

Cellular immune response

**Spirochetes have LATENT phase

110
Q

Pt with painless ulcer and non tender inguinal LAD?

A

Primary Syphilis

111
Q

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?

A

Secondary Syphilis

112
Q

DDx for Rash on Palms and Soles?

A

Secondary syphilis
RMSF
Hand foot and mouth disease (CMV)

113
Q

What is tertiary Syphilis considered?

A

Endarteritis

114
Q

Pt with characteristic skin and bone granulomatous lessons, aortic regurgitation, meningeal signs (Tabes dorsalis) ?

A

Tertiary syphilis

115
Q

Causes still births or abortions, often transmitted across placenta in 1st trimester hematogenously. Infant with Snuffles, Bulllous rash, enlarged liver and spleen?

A

Early Congenital syphilis

116
Q

How does late Congenital syphilis present?

A

Bone abnormalities
Frontal bossing + sabre shins
Vision defects

117
Q

what is Hutchinson’s triad and what disease is it seen in?

A

Triad: Notched incisors, keratitis, Deafness

Congenital syphilis

118
Q

What are the Dx tests for Syphilis?

A

Non-treponemal serology= RPR and VDRL

Treponemal= FTA-ABS

119
Q

What are the non-Treponemal serological tests?

A

Using beef heart mito cardiolipin
Rapid Plasma Reagin (RPR)
Venereal Disease Research Lab test (VDRL)

120
Q

RPR and VDRL tests are Cheap and sensitive but have many False positive because of the Cardiolipin including with?

A

Viral Hepatitis
Mono
Lupus
rarely Pregnancy

121
Q

What is the Treponemal specific tests?

A

Fluorescent Treponemal Antigen-Absorbed test
FTA-ABS

  • Cumbersome + expensive + but cured slides last for years

Reproductive (6 decks)

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