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Micro 3 Flashcards

1
Q

What are the envelope proteins of HIV

A

gp41 (transmembrane glycoprotein) and gp120 (docking glycoprotein) whic hare acquired through budding from host cell plasma membrane

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2
Q

What is p24 in HIV?

A

Capside protein

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3
Q

What is p17 in HIV?

A

Matrix protein

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4
Q

HIV Genome?

A

diploid (2 molecules of RNA)

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5
Q

3 genes of HIV and products

A

env (gp160=gp120 and gp41) gp120 attaches to CD4 cell and gp41 is for fusion and entry

gag (p24): capsid protein

pol is reverse transcriptase, aspartate protease, integrase

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6
Q

Replication of HIV genome

A

reverse transcriptase makes dsDNA which integrates into the host genome

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7
Q

What receptors does virus bind to?

A

On CD4+ cells: CD4 and CCR5 (early) or CXCR4 (late) co-receptor

On macrophages: CCR5 and CD4

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8
Q

What people have immunity

A

CCR5 negative homozygotes. heterozygotes have a slwoer course

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9
Q

What are the rule out and rule in tests of HIV?

A

Rule out is ELISA because of high sens, low spec.

Rule in is Western blot because of high spec., low sens.

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10
Q

What are the thresholds for CD4 counts

A

Normal is 500-1500 cells/mm3.

AIDS is either <14%

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11
Q

Where can you find false positives and false negatives in HIV?

A

Lots of false positives in babies because of anti-gp120 crossing the placenta.

False negatives in first 1-2 mo. of HIV infection

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12
Q

Natural history of HIV mnemonic

A

4 F stages: Flu-like (acute), feeling fine (latent), falling count, final crisis

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13
Q

Where does HIV replicate in latent phase

A

Lymph nodes

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14
Q

What kind of cancer increases with HIV?

A

Non-Hodgkin lymphoma (large cell type) Often on oropharynx (waldeyer ring)

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15
Q

HIV low-grade fevers, cough, hepatosplenomegaly, tongue ulcer

A

Histoplasma capsulatum (only pulmonary sxs in immunocompetent hosts)

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16
Q

Derm and HIV

A

Candida, hairy leukoplakia, superficial vascular proliferation, superficial neoplastic proliferation of vasculature

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17
Q

What causes vascular proliferation

A

Nonmalignant: Bartonella henselae (causes bacillary angiomatosis)

Malignant: HHV-8 (Kaposi’s sarcoma)

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18
Q

HIV diarrhea

A

Cryptosporidium

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19
Q

Neurologic and HIV

A

Abscesses, dementia, encephalopathy, meningitis, retinitis

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20
Q

HIV abscess

A

Toxo

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21
Q

HIV demenia

A

Directly associated with HIV

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22
Q

HIV encephalopathy

A

JC virus reactivation (PML)

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23
Q

HIV meningitis

A

Cryptococcus neoformans

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24
Q

HIV retinitis

A

CMV

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25
Q

HIV associated cancers and pathogen

A

Non-Hodgkin lymphoma, Primary CNS lymphoma (both associated with EBV)
Squamous cell carcinoma of anus (HPV)

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26
Q

Difference between toxo and Lymphoma

A

Toxo has multiple ring-enhancing lesions

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27
Q

HIV respiratory issues

A 
Interstitial pneumonia
invasive aspergillosis
PCP
Typical PNA
Tuberculosis like disease
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28
Q

Biopsy of bartonella vs. kaposis

A

Bartonella has PMN inflammation, Kaposi’s has lymphocytic inflammation

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29
Q

Normal prion protein name and conformation

A

alpha-helical prion protein (PrP^c) to pathological Beta-pleated form (PrP^sc) that is transmissible

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30
Q

Sporadic spongiform encephalopathy

A

Creutzfeldt-Jakob disease

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31
Q

Inherited prion disease

A

Gerstmann-Straussler-Scheinker

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32
Q

Acquired prion disease

A

Kuru

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33
Q

Day-care diarrhea

A

Yersinia enterocolitica

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34
Q

Salmonella and shigella lactose

A

Both NONfermenters

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35
Q

PNA in neonates (<4 wks)

A

Group B strep, E. coli

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36
Q

Most common PNA in children 4 wk-18 yr

A

RSV, Mycoplasma, C. trachomatis (infants-3yr), C. pneumoniae (school children), S. pneumo Runts May Cough Chunky Sputum

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37
Q

PNA Adults (18-40 yrs)

A

Mycoplasma, C. PNA, S. PNA

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38
Q

PNA Adults (40-65 yrs)

A

S. pna, H. flu, anaerobes, viruses, mycoplasma

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39
Q

PNA elderly

A

S. pneumo, flu, anerobes, h. flu, gram negative rods

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40
Q

Congenital Toxo

A

Classic triad: Chorioretinitis, hydrocephalus, and intracranial calcifications

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41
Q

Congenital Rubella

A

Classic triad: PDA (or pulm. artery hypoplasia), cataracts, and deafness +/- “blueberry muffin” rash

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42
Q

Congenital CMV

A

Hearing loss, seizures, petechial rash, “blueberry muffin” rash

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43
Q

Congenital HIV

A

Recurrent infections, chronic diarrhea

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44
Q

Congenital HSV-2

A

Encephalitis, herpetic lesions

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45
Q

Congenital Syphilis

A

Often stillbirth, hydrops fetalis; if child survives, facial abnormalities: notched teeth, saddle nose, short maxilla. Saber shins, CN VIII deafness

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46
Q

What is a saber shin

A

Anterior bowing of the tibia

47
Q

What is hydrops fetalis?

A

Fluid accumulation in at least two fetal compartments like the pleural space, pericardium, peritoneum, subQ tissues

48
Q

Fifth disease name and cause

A

Erythema infectiosum (Parvo B19) Slapped cheeks

49
Q

Roseola cause

50
Q

Roseola rash presentation

A

Macular rash over body after several days of high fever, can have febrile seizures, usually in infants

51
Q

Measles rash

A

Paramyxovirus; begins at head and mvoes down; rash preceded by cough, coryza, conjunctivitis and blue-white Koplik spots on buccal mucosa

52
Q

Rubella rash

A

Rash at head and moves down; leads to fine truncal rash; postauricular lymphadenopathy

53
Q

Scarlet fever rash

A

Erythematous, sandpaper-like rash with fever and sore throat

54
Q

Parvo B19 congenital

A

Can cause hydrops fetalis

55
Q

Genital Chlamydia serotype

56
Q

Lymphogranuloma venereum cause

A

C. trachomatis L1-L3

57
Q

Strawberry cervix

A

Trichomoniasis

58
Q

Lymphogranuloma venereum presentation

A

Infection of lymphatics; painless genital ulcers, painful lymphadenopathy (i.e. buboes)

59
Q

Chancroid presentation

A

Painful genital ulcer, inguinal adenopathy

60
Q

Fitz-Hugh-Curtis syndrome

A

Infection of liver capsule and “violin string” adhesions. Classically associated with gonorrhea, but actually more often due to Chlamydia

61
Q

Unimmunized children neurologic disease

A

Meningitis due to HiB. It colonizes nasopharynx.

62
Q

order of prevalence of encapsulated organism infection

A

S. pneumo&raquo_space;> HiB > meningococcus

63
Q

MOA trimethoprim

A

Inhibits dihydrofolate reductase

64
Q

MOA of sulfamethoxazole (sulfonamides)

A

Inhibits PABA to DHF

65
Q

What targets DNA topoisomerases

A

Fluoroquinolones and quinolones

66
Q

MOA of nalidixic acid

A

Quinolone inhibits DNA topoisomerase

67
Q

What are Streptogramins

A

Quinupristin and Dalfopristin: They inhibit 30S ribosome, used in treating vancomycin resistant s. aureus and vancomycin resistant enterococcus.

68
Q

What are penicillin binding proteins

A

Transpeptidases

69
Q

Penicillin bactericidal or bacteriostatic

A

Bactericidal (for gram-positive cocci and rods, gram-negative cocci, and spirochetes.

70
Q

Penicillin G, V use

A

Gram positivies like pneumococcus, s. pyogenes, actinomyces, and meningococcus, and syphilis

71
Q

Penicillin side effects

A

allergy, hemolytic anemia

72
Q

Aminopenicillins susceptible bacteria

A

H. flu, e. coli, listeria, proteus, salmonella, shigella, enterococci.

73
Q

Aminopenicillin mnemonic

A

ampicillin/amoxicillin HELPSS kill enterococci (H.flu, E. coli, Listeria, Proteus, Salm., Shig., enterococci

74
Q

What are the penicillinase resistant penicillins

A

Oxacillin, nafcillin, dicloxacillin. They are narrow spectrum.

75
Q

What makes penicillinase resistant penicillins resistant to penicillinase?

A

Bulky R group prevents access to beta-lactam ring

76
Q

Side effects of oxacillin, etc. ?

A

Interstitial nephritis, hypersensitivity reactions

77
Q

Antipseudomonals description

A

Extended spectrum: Pseudomonas and gram-negative rods, susceptible to penicillinase

78
Q

What organisms are not typically covered by cephalosporins?

A

LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA, and Enterococci.

79
Q

Cephalosporins description

A

Less susceptible to penicillinases. Bactericidal

80
Q

Name 1st gen. cephalosporins and targets

A

Cefazolin, cephalexin: PEcK; Proteus, E.coli, Klebsiella.

81
Q

2nd gen cephs. and targets

A

Cefoxitin, cefaclor, cefuroxime: HEN PEcKS: H.flu, enterobacter aerogenes, Neisseria, Proteus, E. coli, Kleb, Serratia

82
Q

3rd gen cephs. and targets

A

Ceftriaxone, cefotaxime, ceftazidime: serious gram-negative infections resistant to other beta-lactams:

83
Q

Ceftriaxone for what infections specifically

A

Meningitis and gonorrhea

84
Q

Ceftazidime indication

A

Pseudomonas

85
Q

4th gen cephs. and targets

A

Cefepime: active against pseudomonas and gram-positives

86
Q

5th gen cephs. and targets

A

Ceftaroline; broad gram-positive and gram-negative, including MRSA, no Pseudomonal coverage

87
Q

Cephalosporin side effects

A

Vit. K deficiency, low cross-reactivity with penicillins, increases nephrotoxicity of aminoglycosides.

88
Q

Monobactams MOA

A

Aztreonam: resistant to beta-lactamases, binds penicillin-binding protein 3. Synergistic with aminoglycosides. No cross-allerginicity with penicillins.

89
Q

Aztreonam clinical use

A

Gram-negative rods only: no activity against gram-positives or anaerobes. Penicillin-allergy patients and renal insufficiency who can’t tolerate aminoglycosides

90
Q

Aztreonam side effects

A

Usually nontoxic; occasional GI upset

91
Q

Carbapenems examples

A

Imipenem, meropenem, ertapenem, doripenem

92
Q

Imipenem MOA

A

Borad-spectrum, beta-lactamase resistant carbapenem. Always give with cilastatin (inhibitor of renal dehydropeptidase I) to decrease inactivation of drug in renal tubules. “with imipenem, the kill is lastin with cilastatin’

93
Q

Ertapenem activity

A

Limited pseudomonal coverage

94
Q

Carbapenems clinical use

A

Wide spectrum: Gram-positive cocci, gram-negative rods, and anerobes.

95
Q

Carbapenem side effects

A

GI distress, skin rash, seizures at high plasma levels

96
Q

Meropenem benefits

A

Decreased risk of seizures and stable to dehydropeptidase I

97
Q

Vancomycin MOA

A

Inhibits cell wall peptidoglycan formation by binding D-ala D-ala portion of cell wall precursors. Bactericidal.

98
Q

Vancomycin clinical use

A

Gram positives only: MRSA, enterococcus, C. diff

99
Q

Vancomycin side effects

A

NOT trouble free: nephrotoxicity, ototoxicity, thrombophlebitis: red man syndrome (give benadryl to prevent)

100
Q

Vancomycin resistant MOA

A

Turn D-ala D-ala to D-ala D-lac

101
Q

Ribosomal antibiotic mnemonic

A

Buy AT 30, CCEL at 50. Aminoglycosides, Tetracyclines, Clindamycin, Chloramphenicol, Erythromycin (Macrolides), Linezolid

102
Q

Are protein synthesis inhibitors bactericidal or bacteriostatic

A

All are bacteriostaic except for aminoglycosides that are bactericidal. linezolid is variable.

103
Q

Linezolid MOA

A

Blocks ribosome formation

104
Q

Aminoglycosides MOA

A

Binds to 30S, prevents initiation complex formation

105
Q

Chloramphenicol MOA

A

Binds 50S, blocks peptidyl transferase

106
Q

Macrolides and Clindamycin MOA

A

Bind 50S, blocks translocation

107
Q

Tetracyclines MOA

A

Binds 30S, blocks A-site tRNA binding

108
Q

Aminoglycosides examples

A

Gentamicin, neomycin, amikacin, tobramycin, streptomycin

109
Q

Aminoglycosides MOA

A

block formation of initiation complex and cause misreading of mRNA, also blocks translocation. Require O2 for uptake; cannot be used against anaerobes

110
Q

Aminoglycosides clinical use

A

Severe gram-negative rod infections. Synergistic with beta-lactams.

111
Q

Neomycin use

A

For bowel surgery

112
Q

Aminoglycosides toxicity

A

Nephrotoxicity (with cephalosporins), Neuromuscular blockade, Ototoxicity (especially with loop diuretics), Teratogen

113
Q

Aminoglycosides resistant MOA

A

Bacterial transferase enzymes inactivate the drug by acetylation, phosphorylation, or adenylation

114
Q

What is the integrase inhibitor for HIV

A

Raltegravir

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