Micro Flashcards
ampicillin/amoxicillin coverage
G(+) and HELPSS Haemophilus E. coli Listeria Proteus Salmonella Shigella
organisms not covered by cephalosporins
LAME Listeria atypicals (chlamydia, mycoplasma) MRSA Enterococci
first gen cephalosporins
cefazolin, cephalexin
PEcK and G(+)
Proteus, E. coli, Klebsiella
second gen cephalosporins
cefoxitin, cefaclor, cefuroxime HENS PEcK Haemophilus Enterobacter Neisseria (not gonorrhea) Serratia Proteus, E. coli, Klebsiella
third gen cephalosporins
ceftriaxone (excreted in bile), cefotazime, ceftazidime
G(-) bad guys
meningitis and gonorrhea
ceftazidime for pseudomonas
fourth gen cephalosporins
cefepime
good pseudomonas and broad G(+)
toxicity of cephalosporins
increased nephrotoxicity with aminoglycosides
disulfiram like reaction
given prior to surgery to prevent s. aureus infections
cefazolin (1st gen)
side effects of vancomycin
red man syndrome (mast cell degranulation)
NOT: nephrotoxicity, ototoxicity, thrombophlebitis
resistance to vancomycin
change of D-ala-D-ala to D-ala-D-lac
protein synthesis inhibitors
Buy AT 30, CELL at 50
30s: aminoglycosides, tetracyclines
50s: chloramphenicol, clindamycin, erythromycin (macrolides), linezolid
use for tetracyclines
VACUUM THe BedRoom vibrio cholera acne chlamydia ureaplasma urealyticum mycoplasma pneumoniae tularemia H. pylori Borrelia burgdorferi Rickettsia
photosensitivity
SAT:
sulfonamides, amiodarone, tetracyclines
what to avoid with tetracyclines
milk, antacids, iron because they inhibit the absorption of tetracyclines
given for bowel surgery
neomycin
toxicity of aminoglycosides
nephrotoxicity, ototoxicity, teratogenic
clinical uses for macrolides
PUS
Pneumonia: mycoplasma, chlamydia, legionella
URI: strep pneumoniae, strep pyogenes
STD: chlamydia, gonorrhea
resistance to macrolides
mehtylation of 23S RNA subunit of 50S
clinical use for chloramphenicol and toxicity
use: meningitis (H. flu, N men, strep pneum)
tox: gray baby syndrome, aplastic anemia
clinical use of clindamycin and toxicity
use: MRSA abscess
tox: C. difficile
streptogramins
quinupristin and dalfopristin
bind 23s subunit of 50s
use: MRSA, VRE, staph and strep skin infections
SE: hepatotoxicity, pseudomembranous colitis, inhibits cP450 system
what causes:
gray baby
gray man
red man
baby: chloramphenicol
man: amiodarone
red man: vancomycin
prophylaxis for meningococcal infection
coprofloxacin
rifampin for children
prophylaxis for gonorrhea
ceftriaxone
prophylaxis for syphilis
benzathine penicillin G
prophylaxis for history of recurrent UTI
TMP-SMX, nitrofurantoin, amoxicillin
prophylaxis for pneumocystic jiroveci
TMP-SMX if CD4<200, dapsone if sulfa allergic
prophylaxis for endocarditis (surgery or dental procedure)
penicillins, aminopenicillins, cephalexin
prophylaxis for pregnant women with Group B strep
ampicillin during pregnancy
prophylaxis for strep pharyngitis in child with prior rheumatic fever
oral penicillin
prophylaxis for postsurgical infection of s. aureus
cefazolin
prophylaxis for gonococal or chlamydial conjunctivitis in newborn
erythromycin ointment
antibiotics to avoid in pregnancy
SAFe Children Take Really Good Care Sulfonamides (kernicterus) Aminoglycosides (ototoxicity) Fluoroquinolones (cartilage damage) Clarithromycin (embryotoxic) Tetracylines (discolored teeth) Ribavirn (teratogenic) Griseofulvin (teratogenic) Chlorammphenicol (Gray baby) also metronidazole (mutagenesis 1st trimester)
antiplatelet antibodies
ITP: immunothrombocytopenia
newborn with chronic diarrhea, failure to thrice, and chronic Candida
SCID
child with eczema, coarse facial features, and cold abscesses
heyperimmunogloculinemia E syndrome (Job syndrome)
child with partial albinism, peripheral neuropathy, and recurrent infections
Chediak-Higashi
oropharynx colonized by
viridans streptococci
dental plaque
strep mutans
colon
Bacteroides fragilis>E. coli
vagina
lactobacillus; E. coli and group B strep sometimes
common cause of pneumonia in neonates
Group B strep
E. coli
Tx: ampicillin and gentamicin
common cause of pneumonia in children
RSV Mycoplasma Chlamydia S pneumoniae Tx: azithromycin or ceftriaxone
common cause of pneumonia in adults (<40)
Mycoplasma
C. pneumoniae
S. pneumoniae
Tx: azithromycin and ceftriaxone
common cause of pneumonia in adults (40-65)
S. pneumoniae
H influenzae
Tx: clarithromycin
common cause of pneumonia in elderly
S. pneumoniae influenza virus anaerobes H. influenzae Tx: cephapime or carbapenam
common cause of pneumonia in IV drug users
S. pneumoniae, Klebsiella, Staphylococcus
common cause of pneumonia cystic fibrosis
Pseudomonas, S. aureus, S pneumoniae
atypical pneumonia
Mycoplasma, Legionella, Chlamydia
postviral pneumonia
Staphylococcus, H flu, S pneumoniae
common cause of meningitis 0-6 months
Group B strep, E. coli, Listeria
common cause of meningitis <6
Strep pneumoniae, N. meningitidis, H flu, enterovirus (coxsackie A)
common cause of meningitis 6-60
S pneumoniae, n. meningitids, enterovirus, HSV
common cause of meningitis over 60
S. pneumoniae, G- rods, Listeria
common cause of meningitis in HIV
cryptococcus
osteomyelitis
S. aureus sexually active: N. gonorrhea Db and IV drugs: Pseudomonas, serratia Sickle cell: salmonella prosthetic replacement: S. aureus, S epidermidis vertebral disease: TB cat/dog bite: Pasteurella multocida
CSF findings in meningitis
bacterial: increased pressure, PMN, protein and decreased glucose
fungal: increased pressure, lymphocytes, protein and decreased glucose
viral: normal or increased pressure, increased lymphocytes and protein, normal glucose
most common etiology of bacterial meningitis
Group B strep
most common etiology of bacterial meningitis in kids
strep pneumoniae
n. meningitidis
most common bacterial meningitis in adults
S. pneumoniae
osteomyelitis in IV drug user
S. aureus or Pseudomonas
osteomyelitis in sickle cell
Salmonella
pt presents with vertigo, tinnitus, and hearing loss
Meneiere’s disease
TORCHeS infections
Toxoplasma gondii Other: parvovirus B19, meningitis Rubella CMV Herpes 2/HIV Syphilis
STD with clue cells
bacterial vaginosis
painless genital ulcer
syphilis
flagellated cells
trichomonas
strawberry cervix
trichomonas
most common reportable STD
Chlamydia
non-painful, indurated, ulcerated genital lesion
primary syphilis
painful, indurated, ulcerated genital lesion, with exudate
chancroid
stippled vaginal epithelial cells on a wet prep of vaginal discharge
bacterial vaginosis (clue cells)
common treatment for syphilis
penicillin G
common treatment for Trichomonas
metronidazole
common treatment for Chlamydia
doxycycline or azithromycin
common treatment for gonorrhea
ceftriaxone
toxoplasma gondii triad
chorioretinitis
hydrocephalus
intracranial calcifications
rubella triad
PDA
cataracts
deafness
CMV
hearing loss, seizures, blueberry muffin rash
vaginal discharge
young girl (puberty): physiological
cottage cheese: candidiasis
very itchy: trichomonas
fishy smell, clue cells: bacterial vaginosis
newborn nursery
CMV, RSV
urinary cath
E. coli, pseudomonas
respirator
Pseudomonas
renal dialysis
HBV
IV nutrition (hyperalimentation)
candida albicans
water aerosols
legionella
antibiotics safe during pregnancy
penicillins and aminopenicillins piperacillin cephalosporins macrolides metronidazole (after 1st trimester) nitrofurantoin
RUQ pain and symptoms of PID
Fitz-Hugh-Curtis syndrome
follows PID episode and is sudden onset RUQ pain and may show violin string adhesions on laparoscopy
do not take Gram stain
Treponema Rickettsia Mycobacteria (high lipid content) Mycoplasma (no cell wall) Legionella pneuomophila Chlamydia
Giemsa stain
Chlamydia, Borrelia, Rickettsiae, Trypanosomes, Pasmodium
PAS (peiodic acid-Schiff) stain
stains glycogen, mucopolysaccharides
Whipple’s disease (Tropheryma whipplei)
Ziehl-Neelsen (carbol fuchsin)
acid fact organisms
Nocardia and Mycobacterium
India ink stain
Cryptococcus neoformans
Silver stain
fungi, legionella, H. pylori
encapsulated bacteria
Strep pneumoniae Haemophilus influenzae N. meningitidis E. coli Pseudomonas Klebsiella Salmonella typhi
organism in balanitis
candida albicans
balanitis is inflammation of glans penis
obligate aerobes
Nocardia, Pseudomonas, Mycobacterium tuberculosis, Bacillus
obligate anaerobes
Clostridium, Bacteroides, Actinomyces
lack superoxide dismutase
endotoxin
ENDOTOXIN edema nitric oxide DIC/death outer membrane TNF-a O-antigen eXtremely heat stable IL-1 Neutrophil chemotaxis
transformation
take up naked DNA
conjugation
plasmid passing
transposition
transfer genes from plasmid to chromosome and vice versa
transduction
packaging of DNA in phages
what 7 bacteria secrete enterotoxins (exotoxins in GI system)
vibrio cholera, E. coloi, s. aureus, shigella, yersinia, c. difficile, clostridium perfringens
skin pathogen that infects indwelling foreign devices
s. epidermidis
organisms most likely in subacute endocarditis
viridans strep, enterococci, s. bovis, coagulase neg. staph and HACEK
Haemophilus, actinobacillus, cardiobacterium, eikenella, kingella
streptococcus pyogenes disease
superficial/invasive: pharyngitis, impetigo, cellulitis, blood strema
toxin-mediated: toxic shock syndrome
immune-mediated: post-streptococcal glomerulonephritis, rheumatic fever
causes scalded skin syndrome
s. aureus
gray-white membrane in posterior pharynx of an unvaccinated child
corynebacterium diptheriae
pharyngitis resulting in glomerulonephritis
group A strep (s. pyogenes)
most common cause of meningitis in G+
strep pneumoniae
most common G+ cause of osteomyelitis
s. aureus
serious newborn infections
Group B strep, listeria, E. coli
infant with poor muscle tone
clostridium botulinum
diarrhea after using antibiotics
clostridium difficile
respiratory distress in a postal worker
B. anthracis
otitis media in children
S. pneumoniae
cellulitis
s. aureus and s. pyogenes
one hour after eating potato salad, entire family is vomitting
staph aureus
susceptible to Listeria monocytogenes
infants, elderly, immunocompromised, pregnant
spore forming bacteria
bacillus and clostridium species
also coxiella burnetti
branching, filamentous G+ rods with sulfur granules
actinomyces israeli
G- oxidase positive diplococci
N. gonorrhoeae or N. meningitidis
smoker has cough and sputum gram stain shows nothing. silver stain shows rods
legionella pneumophila
sepsis, DIC, adrenal hemorrhage and G-
N. meningitidis
5 year old with pharyngitis, drooling, and x-ray has thumb sign
H. influenzae
life threatening meningitis and purpura
N. meningitidis
septic arthritis in young, sexually active patients
n. gonoorhoae
antibiotics to treat c. difficile pseudomembranous colitis
metrinidazole and oral vancomycin
food poisoning as a result of mayonnaise sitting out too long
s. aureus
diarrhea caused by G- nonmotile organism that does not ferment lactose
shigella
diarrhea caused by an S-shaped organism
campylobacter jejuni
diarrhea transmitted from household pets
yersinia
food poisoning resulting from reheated rice
bacillus cereus
diarrhea caused by G- motile organism that doesn’t ferment lactose
salmonella
most common cause of traveler’s diarrhea
ETEC
food poisoning due to exotoxin
s aureus and bacillus cereus
osteomyelitis in sickle cell pt
salmonella
drugs cause Stevens-Johnson syndrome
penicillins, sulfas, allopurinol, seizure drugs (ethosuximide, lanotrigine, carbamazepine, phenobarbital, phenytoin)
most common cause of UTI
E. coli
staph saprophyticus
klebsiella
proteus mirabilis
most common medication used for UTI prophylaxis
TMP-SMX
most common bacteria in a patient with struvite kidney stones
proteus
standard treatment for T. pallidum
penicillin
cellulitis from a dog or cat bite
pasteurella multocida
non-painful, indurated, ulcerated genital lesion
chancre of 1 syphilis
moist, smooth, flat, white genital lesion
condylomata of late 2 syphilis
large bull’s eye rash
erythema migrans of lyme disease
ghon complex
ghon focus (fibrosing nodule in lung) and hilar lymphadenopathy
negative PPD
never been exposed to TB
immunocompromised, steroids, sarcoidosis, malnourishment
“keeps lungs healthy but I have to take b vitamin to keep from hurting nerves”
isoniazid
calcified granulomas in the lung, plus hilar lymphadenopathy
ghon complex
back pain, fever, night sweats, and weight loss
pott’s disease
standard treatment regimen for TB
RIPE rifampin isoniazid pyrazinamide ethambutol
rickettsial triad
headache, fever, rash
antibiotic of choice for
mycoplasma pneumoniae
Rocky mountain spotted fever
bacterial vaginosis
macrolide or tetracycline
doxycyline
metronidazole
live vaccines
smallpox, yellow fever, herpes zoster, chickenpox, Sabin’s poli (oral), MMR, nasal influenza
where does herpesvirus get envelope
nuclear membrane
unenveloped viruses
adenovirus, calicivirus, papilloma, parvovirus, picornavirus, polyomavirus, reovirus, hepevirus
where do viruses replicate
DNA in nucleus except poxvirus
RNA in cytoplasm except influenza and retroviruses
virus ploidy
haploid except retroviruses are diploid
DNA viruses
normally double stranded, linear, icosahedral, and replicate in nucleus
treatment for herpes viruses
HSV-1, 2, zoster (VZV): acyclovir, valacyclovir, famciclovir
CMV: ganciclovir, foscarnet
latent herpes infection sites in body
HSV-1: trigeminal ganglia HSV-2: sacral ganglia VZV: dorsal root or trigeminal ganglia EBV: B cells CMV: mononuclear cells
dark purple nodules on the skin in an HIV patient
Kaposi sarcoma
temporal lobe encephalitis
HSV-1
Owl’s eye inclusions in organ tissue
CMV
intranuclear eosinophilic droplets
Cowdry A inclusions
HSV, CMV
parvovirus B19
smallest DNA virus, ssDNA
aplastic crisis in sickle cell disease
“slapped cheek” rash in children (fifth disease)
hydrops fetalis and death in pregnancy
adenovirus
conjunctivitis: pink eye
can cause diarrhea
poxvirus
smallpox
vaccinia: cowpox
molluscum contagiousm: dome lesions with central dimples
JC virus
PML (progressive multifocal leukoencephalopathy) in HIV
hand, foot, and mouth disease
coxsackie
break bone fever
dengue
common cold
rhinovirus and coronavirus
fever, jaundice, black vomit
yellow fever
meningitis in summer months
echovirus or coxsackievirus
Tourniquet test helps diagnose hemorrhagic disease
dengue
infects motor neurons of the anterior horn
west nile and poliovirus
infantile gastroenteritis
rotavirus
antiplatelet antibodies
ITP (immune thrombocytopenia)
painful, raised lesions on finger pads + fever
Osler’s nodes in infective endocarditis
prophylaxis for influenza A
zanamivir and oseltamivir
treatment of chronic hepatitis C
ribavirin and IFN-a
first line for herpes simplex viruses or varicella-zoster virus
acyclovir, vancyclovir, fanciclovir
characteristic barking seal cough
parainfluenza virus (croup)
asthma-sounding infection in infants (esp premies)
RSV (Respiratory syncytial virus)
bronchiolitis with cough and wheezing in babies
RSV
Downey cells
seen in EBV
aseptic meningitis
enteroviruses (echovirus, coxsackievirus) and mumps
fever, runny nose, cough, conjunctivitis, and diffuse rash
measles (rubeola)
small irregular blue-gray spots on the buccal mucosa, surrounded by a base of red
Koplik’s spots in measles
HIV genes
env (gp120 and gp41)
gag (p24: capsid protein)
pol (reverse transcriptase)
envelope proteins in HIV
gp120: attachment to host CD4 T-cell
gp41: fusion and entry into cell
dark purple nodule on skin in an HIV patient
kaposi sarcoma
treatment for CMV
ganciclovir
most common opportunistic infection in HIV patients
Pneumocystis jirovecii pneumonia
drug used to prevent pneumocystis pneumonia
TMP-SMX
when to start HAART
Highly active antiretroviral therapy is started with:
AIDS defining illness
CD4<350
high HIV viral load
components of HAART
2 NRTIs and
1 NNRTI or 1 protease inhibitor or 1 integrase inhibitor
protease inhibitors
-navir GI intolerance inhibit cytochrome P450 (esp ritonavir) hyperlipidemia/hypertriglyceridemia lipodystrophy pancreatitis: ritonavir nephrolithiasis: indinavir and atazanavir increased bilirubin: atazanavir
NRTI
zidovudine, didanosine, stavudine, abacavir
zidovudine: bone marrow suppression
didanosine pancreatitis and peripheral neuropathy
hepatic steatosis: didanosine and stavudine
hypersensitivity rxn: abacavir
NNRTI
efavirenz, delavirdine, nevirapine
Rash is all
neuropsychotic symp, false positive drug test, teratogenic are all efavirenz
HIV drug SE pancreatitis
didanosine, ritonavir
HIV drug SE anemia
zidovudine
HIV drugs that interact with envelope proteins
enfuvirtide: gp41 (inhibits fusion to T cell)
maraviroc: gp120 (CCR5 antagonist)
fungus causes diaper rash
candida albicans
opportunistic mold with septate hyphae that branch at a 45 angle
aspergillus
opportunistic mold with irregular nonseptate hyphea that branch at wide angles (>90)
mucor, rhizopus (mucormycosis)
causes thrush in immunocompromised patients and vulvovaginitis in women
candida
causes pneumonia in immunocompromised
pneumocystis jirovecii
treatment for oral candidiasis
nystatin, fluconazole
most common opportunistic infection in HIV
pneumocystis jirovecii
prophylaxis for cryptococcus in AIDS
fluconazole
treatment for systemic candidiasis
fluconazole, amphotericin B, echinocandin
appearance of KOH skin scraping of tinea versicolor
spaghetti and meatballs
the tinea species (other than versicolor) have what type of lesion
pruritic lesion with central clearing resembling a ring
KOH prep and are not dimorphic
organisms associated with birds
histoplasmosis cryptococcus neoformans chlamydophila psittaci H5N1 influenza west nile virus
found in rural Latin America
paracoccidioidomycosis
plant thorns and cutaneous injury
sporathrix schenckii
states east of Mississippi
blastomycosis
bird and bat droppings
histoplasmosis
mold form contains barrel-shaped arthroconidia
coccidioidomycosis
broad-based budding yeast
blastomycosis
multiple budding of yeast form
paracoccidioidomycosis
“swish and swallow” for oral candidiasis
nystatin
cell wall synthesis inhibitor used in invasive aspergillosis
caspofungin
most common treatment for onychomycosis
terbinafine, itraconazole, fluconazole
SE arrythmias and nephrotoxicity
amphotericin B
deposits in keratin-containing tissues
griseofulvin
drug of choice for sporotrichosis
itraconazole
severe diarrhea in AIDS
cryptosporidium
bloating flatulence, foul-smelling, fatty diarrhea
Giardia lamblia
bloody diarrhea with RUQ pain
entamoeba histolytica
cause of malaria
plasmodium
most common protozoal infection in US
trichomonas vaginalis
cause of chagas disease
trypanosoma cruzi
amoebic dysentery
entamoeba hystolytica
African sleeping sickness
trypanosoma brucei
transmitted in raw meat or infected cat feces
toxoplasma
transmitted by sandflies
Leishmania donovani
bloody diarrhea with cysts in stool
entamoeba hystolytica
diarrhea with RUQ pain and fever
entamoeba hystolytica
stages of malaria life cycle
injected form: sporozoite
replicating intracellularly: schizont
rupture of cells: merozoite
ring-enhancing brain lesion in an HIV patient
toxoplasma gondii
treatment for Trichomonas vaginalis
metronidazole
most common protozoal diarrhea
Giardia lamblia
most common helminthic infection in US
enterobius vermicularis (pinworms)
one-quarter of the world infected with
ascaris lumbricoides
second most common helminthic infection in US
ascaris lumbricoides
snail host, “swimmer’s itch”
schistosoma species
most common predisposing factor for bladder cancer in third world countries
schistosoma haematobium
contracted by eating undercooked fish and causes an inflammation of the biliary tract
clonorhcis
soil -> enters through foot -> lungs -> swallowed after coughing
strongyloides
ascaris is ingested initially
hookworms
ancylostoma, necator
giant roundworm
ascaris lumbricoides
contracted by eating undercooked crabmeat and causes inflammation of the lung
Pargonimus westermaris
pork tapeworm
taenia solium
responsible for lympatic filariasis
elephantitis caused by
Wuchereria bancrofti
adult patient from Mexico with new onset seizures and brain calcifications
taenia solium
hematuria in patient from a developing country
schistosoma haematobium
med for most flukes and tapeworms
praziquantel
med for hookworms, pinworm, roundwom
benzimidazoles
med for chagas disease
benznidazole, nifurtimox
med for leishmaniasis
sodium stibogluconate or liposomal amphotericin B
treatment of pediculosis capitis and pubis
permethrin, pyrethrin
why is lindane not used for lice
neurotoxicity and resistance