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Shelf Prep > Micro > Flashcards

Micro Flashcards

1
Q

Name the organism that causes a pneumonia with: typically upper lobar consolidation; currant jelly sputum; frequent in alcoholics; gram (-), oxidase (-); Bacillus

A

Klebsiella pneumonia

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2
Q

Give the phylogeny of Klebsiella pneumonia.

A

Gram negative, oxidase negative bacillus

member of the Enterobacteriacae

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3
Q

Name the organism that causes: coughing and choking spells; Posttussive emesis; CBC shows leukocytosis with high % lymphocytes; encapsulated, gram negative

A

Bordatella pertussis

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4
Q

Culture Bordatella pertussis on:

A

Blood agar

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5
Q

Whooping cough (Bordatella pertussis) also causes:

A

Hypoglycemia; Lymphocytosis; Blockade of immune effector cells; Increased histamine sensitivity

***ADP ribosylates Gi and inhibits it –> cAMP rises

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6
Q

Severe infection in immunocompromised persons consisting of bloody stool and spherical cysts in the stool with up to four nuclei is caused by:

A

Entamoeba histolytica

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7
Q

Entamoeba histolytica has what ROT?

A

Fecal-oral

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8
Q

What organism has nuclei with sharp karyosome and fine chromatin spokes?

A

Entamoeba histolytica

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9
Q

Give the organism:

Severe watery diarrhea in the immunocompromised population; intracellular spheres or arc-spahed merozoites under normal mucosa; Stool cysts are acid-fast and very small (oocysts)

A

Cryptosporidium Parvum

Infects brush border of the intestine - direct killing of brush border cells

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10
Q

Give the organism: Self-limiting diarrhea that can last weeks to months; Mostly tropical; Stool borne cysts are large and assymetrical (almond-shaped)

A

Isospora belli

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11
Q

LFA-1, expressed on the surface of WBCs, interacts with ____ to promote the arrest of WBCs on the surface of the endothelium, where they can travel to inflammation sites.

A

ICAM-1

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12
Q

LFA-1, expressed on the surface of WBCs, interacts with ____ to promote the arrest of WBCs on the surface of the endothelium, where they can travel to inflammation sites.

A

ICAM-1

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13
Q

CR3 is an integrin that binds to:

A

fibrinogen, ICAM-1 and iC3b encourages phagocytosis

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14
Q

Name the organism: Gram positive, gamma hemolytic cocci; vancomycin-resistant; grow in high salt environment;

A

VRE - Vancomycin-resistant enterococci

ie Enterococcus faecium, Enterococcus faecalis

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15
Q

Name the organism: Common in burn victims, catheterized patients, CF patients; gram negative, encapsulated oxidase positive; Bacillus

A

Pseudomonas aeruginosa

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16
Q

How does Pseudomonas aeruginosa resist aminoglycosides?

A

Enzymatically inactivate the drug via acetylation

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17
Q

Name the dx: Malformation of the 3rd and 4th pharyngeal pouches leading to thymic aplasia; cardiac anomalies

A

DiGeorge syndrome lack of mature T- cells lots of fungal infections

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18
Q

DiGeorge syndrome involves what genetic anomaly?

A

22q11 microdeletion

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19
Q

What accounts for the hypocalcemia seen in DiGeorge syndrome?

A

Lack of parathyroid glands

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20
Q

Rheumatic fever is what type of hypersensitivity reaction?

A

Type II (aka cytotoxic) IgG and IgM;

Autoantibodies bind antigens on tissues Strep pyogenes

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21
Q

What is the pathogenesis of rheumatic fever?

A

Infection with group A strep (Strep pyogenes) –> GAS incited antistreptococcal antibodies which cross-react with antigens of heart, dermis, joints etc.

Valvular heart disease is a common permanent complication.

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22
Q

Give the dx:

Pancarditis; Arthritis; Subcutaneous nodules; Chorea; Erythema marginatum

A

Rheumatic fever

Group A strep - Strep pyogenes

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23
Q

F+ to F- conjugation conferring antibiotic resistance is especially common in what kinds of bacteria?

A

Gram negative bacilli

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24
Q

Staph aureus and Pseudomonas aeruginosa are known to confer antibiotic resistance through what mechanism?

A

Transduction generalized - lytic phage specialized - temperate phage

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25
Q

Hives in type I hypersensitivity reactions are known to release what mediators?

A

leukotrienes B4, C4, D4; histamine

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26
Q

MG and Graves disease are noncytotoxic forms of what type of hypersensitivity rxn?

A

Type II

IgG only

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27
Q

Low glucose, and mostly lymphocytes in the CSF means what kind of meningitis?

A

Fungal ie Cryptococus neoformans

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28
Q

Name the organism:

Monomorphic, encapsulated, yeast; causes meningitis in immunocompromised patients

A

Cryptococcus neoformans

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29
Q

Rh incompatibility is what kind of hypersensitivity reaction?

A

Type II

cytotoxic 1st pregnancy no problems,

2nd pregnancy, erythroblastosis fetalis

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30
Q

How do you diagnose candida infection?

A

Germ tube test

demonstration of pseudohyphae in animal serum

Tx with fluconazole

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31
Q

CAMP test distinguishes between:

A

Group A and Group B Strep;

tests for bacitracin sensitivity

Identifies a partial hemolytic agent made by Strep agalactiae (group B)

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32
Q

Give the organism:

Beta-hemolytic, inhibited by bacitracin, causes PSGN

A

Group A strep, most likely Strep pyogenes

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33
Q

Strep pyogenes can cause what type of hypersensitivity reaction?

A

Type III - circulating immune complexes PSGN

Type II - Rheumatic fever

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34
Q

Herpes simplex encephalitis localizes to what part of the brain?

A

Temporal lobe

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35
Q

What is the drug of choice for uncomplicated S. pyogenes infection?

A

Beta lactam drugs, such as penicillins, cephalosporins

Prevent cell wall synthesis, prevent log phase

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36
Q

What drug class is indicated for people who allergic to beta lactams?

A

Macrolides

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37
Q

Give the organism:

Mini-epidemics; Common in kids; Pseudo-appendicitis; Bloody diarrhea with mucous

A

Yersinia enterocolitica

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38
Q

Shigella dysenteriae and Entamoeba histolitica share what invasion mechanism?

A

Invasion into the submucosa

Bloody diarrhea with neutrophils

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39
Q

Give the organism: Ulcer with black base; regional lymph node involevement; fever, chills, myalgias and arthralgias

A

Francisella tularensis - tularemia

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40
Q

Associate undulating fever with:

A

Brucella

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41
Q

Cowdry bodies

A

Herpes simplex virus type 1 (HSV-1) encephalitis is the most common cause of sporadic viral encephalitis in the United States.

The diagnosis of viral encephalitis is aided by demonstrating elevated lymphocytes in the cerebrospinal fluid. HSV-1 encephalitis is specific to the temporal lobes of the brain.

Cowdry type A inclusions can be seen in neurons and glia in HSV-1 encephalitis.

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42
Q

EBV Mononucleosis

A

Infectious mononucleosis is manifested in young adults by fever, malaise, lymphadenopathy, and splenomegaly.

Diagnosis is made by the heterophile antibody test (Monospot). Heterophile-positive mononucleosis is caused by the Epstein-Barr virus (EBV).

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43
Q

Enterococcus - E. faecalis and E. Faecium

Location

A

GI tract

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44
Q

Enterococcus - E. faecalis and E. Faecium

Gram stain

A

Gram positive

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45
Q

Enterococcus - E. faecalis and E. Faecium

Bile?

A

Resistant

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46
Q

Enterococcus - E. faecalis and E. Faecium

Plate on

A

Can grow on 6.5% NaCl

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47
Q

Enterococcus - E. faecalis and E. Faecium

Virulence factor

A

B. Faecium resistant to almost every antibiotic we have (VRE)

Faecalis more common;

Faecium more dangerous

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48
Q

Enterococcus - E. faecalis and E. Faecium

Diseases

A

UTI

Endocarditis

Biliary tree infection

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49
Q

Enterococcus - E. faecalis and E. Faecium

Treatment

A

If VRE, tx with Linezolid or Tigecycline

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50
Q

Staph aureus

Location

A

Colonizes nares

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51
Q

Staph aureus

Catalase

A

pos

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52
Q

Staph aureus

Coagulase

A

pos

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53
Q

Staph aureus

Hemolysis

A

Beta-hemolytic

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54
Q

Staph aureus

Appearance

A

bundle of grapes

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55
Q

Staph aureus

Ferments

A

Mannitol

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56
Q

Staph aureus

Plate on

A

looks yellow (aur) on blood agar;

turns mannitol yellow on mannitol salt agar

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57
Q

Staph aureus

Virulence factor

A

Protein A

Binds IgG

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58
Q

Staph Aureus

Diseases

A

Inflammatory - pneumonia - patchy infiltrates - most commonly a postviral superinfection

Inflammatory - Septic arthritis

nflammatory - Abscesses

Rapid-onset acute endocarditis - IV drug users - tricuspid valve

Osteomyelitis

Scalded skin syndrome - exfoliative toxin (a protease)

TSS - TSST (superantigen –> cytokine storm)

rapid onset food poisoning - vomiting - ingested preformed toxin Impetigo

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59
Q

Staph aureus

Treatment

A

If methicillin-sensitive, use a penicillin ie Nafcillin

MRSA - altered penicillin-binding proteins –> resistance –> tx with vancomycin

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60
Q

Staph Epidermidis Location

A

Infects artificial joints and hardware; indwelling catheters; covers skin as normal flora; prosthetic heart valves

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61
Q

Staph Epidermidis

Gram stain

A

Pos

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62
Q

Staph Epidermidis

Catalase

A

Pos

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63
Q

Staph Epidermidis

Coaguluase

A

Neg

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64
Q

Staph Epidermidis

Urease

A

Pos

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65
Q

Staph Epidermidis

Novobiocin

A

Sensitive

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66
Q

Staph Epidermidis

Shape and Appearance

A

Coccus, clusters

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67
Q

Staph Epidermidis

Virulence Factor

A

Produces copius adhesive biofilms (polysaccharides)

Coating protects it from immune cells

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68
Q

Staph Epidermidis

Diseases

A

Most common cause of endocarditis of prosthetic valves

Commonly contaminates blood cultures

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69
Q

Staph Epidermidis

Treatment

A

Vancomycin;

replace infected prosthesis

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70
Q

Staph Saprophyticus

gram stain

A

Pos

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71
Q

Staph Saprophyticus

Catalase

A

Pos

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72
Q

Staph Saprophyticus Coagulase

A

Neg

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73
Q

Staph Saprophyticus Urease

A

Pos

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74
Q

Staph Saprophyticus Novobiocin

A

Resistant

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75
Q

Staph Saprophyticus Shape and Appearance

A

Coccus, clusters

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76
Q

Staph Saprophyticus Diseases

A

UTIs in sexually active females

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77
Q

Step Pyogenes (Group A) Gram stain

A

Pos

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78
Q

Step Pyogenes (Group A) Bacitracin

A

Sensitive

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79
Q

Step Pyogenes (Group A) Hemolysis

A

Beta-hemolytic

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80
Q

Step Pyogenes (Group A) Shape and Appearance

A

Coccus, chains

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81
Q

Step Pyogenes (Group A) Virulence Factors

A

Encapsulated by hyaluronic acid (non-immunogenic) M protein - highly antigenic - in cell wall - 1. Interferes with opsonization and is anti-phagocytic; 2. Very antigenic and elicits strong humoral response - our antibodies created cross-react with myosin (MOLECULAR MIMICRY) Streptolysin O - Lyses RBCs (beta-hemolytic) Streptokinase - Converts plasminogen to plasmin –> lyses clots DNA-ases (DNAase B) - Depolymerize DNA

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82
Q

Step Pyogenes (Group A) Diseases

A

Impetigo - honeycrusted Pharyngitis Cellulitis and Erysipela Scarlet fever - strawberry tongue, pharyngitis, widespread rash that spares the face - Strep pyogenic exotoxin (SPE) Toxic-shock-like syndrome (superantigen) - SPE (Spe A and C) Necrotizing fasciitis - SPE (SpeB - protease) Rheumtaic fever - Type II hypersensitivity rxn - M protein - mitral valves –> mitral stenosis - occurs after untreated pharyngitis - JONES criteria: J Joints (polyarthritis) O (heart) valvular damage, myocarditis, pericarditis, N Nodules (subcutaneous) E Erythema marginatum S Sydenham’s chorea PSGN - Type III hypersensitivity rxn - circulating antigen-antibody immune complexes - cola-colored urine and facial swelling from edema - 2-3 weeks after initial infection - can occur after pharyngitis or superficial infection ie impetigo

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83
Q

PSGN

A

PSGN - Type III hypersensitivity rxn - circulating antigen-antibody immune complexes - cola-colored urine and facial swelling from edema - 2-3 weeks after initial infection - can occur after pharyngitis or superficial infection ie impetigo Early tx with penicillin prevents RF but not PSGN

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84
Q

Rheumatic fever

A

Rheumtaic fever - Type II hypersensitivity rxn - M protein - mitral valves –> mitral stenosis - occurs after untreated pharyngitis - JONES criteria: J Joints (polyarthritis) O (heart) valvular damage, myocarditis, pericarditis, N Nodules (subcutaneous) E Erythema marginatum S Sydenham’s chorea Early tx with penicillin prevents RF but not PSGN

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85
Q

JONES Criteria for rheumatic fever

A

JONES criteria: J Joints (polyarthritis) O (heart) valvular damage, myocarditis, pericarditis, N Nodules (subcutaneous) E Erythema marginatum S Sydenham’s chorea

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86
Q

ASO titers and Strep A

A

ASO titers can tell us if a pt has recently had a Strep A infection (ab’s to Streptolysin O)

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87
Q

Strep Agalactiae (Group B) Diseases

A

1 cause of meningitis in neonates Sepsis in neonates Pneumonia

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88
Q

Strep Agalactiae (Group B) Bacitracin

A

Bacitracin resistant; CAMP positive

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89
Q

Strep Agalactiae (Group B) Hemolysis

A

Beta-hemolytic

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90
Q

Strep Agalactiae (Group B) Virulence Factor

A

polysaccharide capsule

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91
Q

Strep Agalactiae (Group B) Location

A

Vaginal canal (test at 35wk)

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92
Q

Interstitial opacities on chest x-ray are common in

A

Atypical pneumonia Legionella species, Mycoplasma pneumoniae, and Chlamydia pneumoniae

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93
Q

Tx atypical pneumonia

A

macrolides (azithromycin, clarithromycin) or doxycycline. Beta-lactams (penicillins, cephalosporins) are ineffective in the treatment of this condition since the organism lack peptidoglycan.

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94
Q

The Dieterle silver stain is used to identify

A

Legionella pneumophila Smokers, alcoholics Elderly, immunocomprimised

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95
Q

The Quellung reaction is a technique used to identify the capsular serotype of

A

Streptococcus pneumoniae

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96
Q

Requirement for cysteine is a characteristic of four genera of bacteria:

A

Francisella, Legionella, Brucella, and Pasteurella

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97
Q

Requirement for factors X and V is characteristic of:

A

Haemophilus

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98
Q

acid-fast oocysts 4-6 microns in diameter; AIDS patient

A

Cryptosporidium The most common causes of diarrhea in AIDS include Microsporidium, Cryptosporidium, Cytomegalovirus, Salmonella, Campylobacter and AIDS enteropathy.

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99
Q

Genetic shift

A

When viruses from animals and man infect a single cell and accidentally reassort the segments of their genomes, drastic changes in the virus can occur (genetic shift) causing pandemics.

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100
Q

Genetic Drift

A

Accumulated mutations in the RNA genome cause genetic drift, necessitating yearly revaccination against the current influenza strains.

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101
Q

Phylogeny: Influenza virus

A

Orthomyxoviridae, 8 segments ss RNA Negative sense

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102
Q

Toxoplasmosis in infants

A

chorioretinitis, intracranial calcifications, and encephalitis leading to hydrocephalus, possibly resulting in mental retardation, seizures, blindness, deafness, and death.

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103
Q

Hydrops fetalis is a common consequence of fetal infection with:

A

Parvovirus B19 infects immature erythrocytes

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104
Q

Patent ductus arteriosus and pulmonary stenosis are aspects of

A

congenital rubella syndrome, caused when rubella virus crosses the placenta.

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105
Q

ring-enhancing lesions in the brain, and in an AIDS patient, this is extremely suggestive of infection with:

A

Toxoplasma gondii

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106
Q

Most common mode of transmission for toxo

A

The most common means of transmission of toxoplasmosis in the United States is the ingestion of cysts from undercooked pork.

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107
Q

How can toxo present in AIDS patients?

A

Toxoplasma necrotizing encephalitis is very common among AIDS patients.

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108
Q

How does Chagas affect the heart?

A

Cardiac involvement manifests with ventricular dilatation and congestive heart failure secondary to myocyte necrosis and fibrosis. In Chagas disease, any type of atrial or ventricular arrhythmia may occur.

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109
Q

Yersinia pestis Vector

A

Flea Bubonic plague

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110
Q

Rickettsia prowazekii Vector

A

Louse Epidemic typhus

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111
Q

Trypanosoma Cruzi

A

Trypanosoma cruzi is an intracellular protozoan that localizes mainly in the heart and nerve cells of the myenteric plexus, leading to acute myopericarditis as well as chronic fibrosing myocarditis as well as dysmotility of hollow organs, such as the esophagus, colon, and ureter.

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112
Q

Listeriosis Treatment

A

The treatment of choice is intravenous administration of ampicillin or penicillin, often in combination with an aminoglycoside. Trimethoprim-sulfamethoxazole has been used successfully in patients with penicillin allergy.

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113
Q

Silver stain to diagnose

A

Silver stain (choice D) is used to diagnose Pneumocystis jiroveciipneumonia. Silver-staining cysts in bronchial alveolar lavage fluids or biopsy is diagnostic for Pneumocystis jirovecii.

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114
Q

Use the Tzanck smear to diagnose

A

Tzanck smear (choice E) is used to diagnose herpesvirus infections. It involves touching a slide or coverslip to a lesion to lift off the multinucleated giant cells caused by the infection.

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115
Q

Strep toxin in scarlet fever

A

The fever and rash in this disease are due to the production of pyrogenic exotoxins A-C, which are phage-encoded.

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116
Q

C. perfringens toxin

A

Lethicinase

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117
Q

Pneumonic plague can manifest with

A

Pneumonic plague can manifest with chest pain, difficulty breathing, and a productive cough that can be blood-tinged.

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118
Q

Congenital rubella syndrome

A

Congenital rubella syndrome also consists of patent ductus arteriosus, pulmonary stenosis, microcephaly, cataracts, and deafness.

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119
Q

How to identify entamoeba histolytica

A

The trophozoite of E. histolytica can be identified by the “cart-wheel” distribution of chromatin in the nucleus and the presence of ingested red blood cells.

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120
Q

How does Trich present?

A

Trichomonas vaginalis is a sexually transmitted protozoan that causes a frothy, yellow-green, malodorous vaginal discharge. It is a flagellated protozoan and has corkscrew motility on a wet mount.

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121
Q

Pertussis Toxin

A

Pertussis toxin (A and B component), which ADP ribosylates Gi (thus inhibiting the negative regulator of adenylate cyclase) leading to increased cAMP. Multiple effects are produced by interrupting activities regulated by cAMP. As a result, it causes: Increased insulin production leading to hypoglycemia Lymphocytosis promotion Blockade of immune effector cells Increased histamine sensitivity

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122
Q

Lymphogranuloma venereum:

A

The primary lesion is usually a self-healing papule or shallow ulcer. Painful, enlarged, abscessed lymph nodes termed “buboes” contain stellate abscesses. The causative organism is Chlamydia trachomatis. In contrast, granuloma inguinale (caused by Klebsiella granulomatis) is characterized by painless ulcers.

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123
Q

Phylogeny Parvovirus B19

A

Naked Smallest DNA virus ssDNA

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124
Q

Parvovirus B19 Mode of transmission

A

Respiratory droplets; Vertical transmission (TORCH)

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125
Q

Parvovirus B19 Diseases

A

Slapped cheek disease aka Fifth disease aka Erythema Infectiosum Fever –> rash on face –> lacey rash spreads down body Adults: joint pain, transient aplastic anemia (SCD)

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126
Q

Parvovirus B19 can cause what in SCD patients?

A

Aplastic anemia - adipocytes in bone marrow have a cobweb look

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127
Q

Mothers who contract Parvovirus B19 during the first or second trimesters of pregnancy fear what complication?

A

Hydrops fetalis

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128
Q

Phylogeny CMV

A

DNA replicate inside nucleus Herpesvirus family (CMV remains latent in B and T cells and macrophages)

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129
Q

What is the most common fetal viral infection?

A

CMV - mostly asymptomatic; biggest cause of mental retardation and sensorineural hearing loss in children blueberry muffin rash, hepatosplenomegaly, jaundice intracranial calcifications (like toxo) –> seizures ventriculomegaly hearing loss

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130
Q

Which trimester of pregnancy is associated with the highest risks of congenital CMV?

A

Second hydrops fetalis possible

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131
Q

CMV tx

A

Ganciclovir, Foscarnet when UL97 gene mutation

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132
Q

How does CMV present in immunocompetent?

A

Mono But Monospot is negative

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133
Q

Phylogeny Poxvirus

A

Largest knownn DNA virus Makes own envelope replicates completely in the cytoplasm; has a special DNA-dependent RNA polymerase

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134
Q

What kind of inclusions dows Poxvirus form?

A

Guarnieri inclusion bodies - sites of replication in the cytoplasm

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135
Q

What shape is associated with poxvirus?

A

Dumbbell shaped core

136
Q

How to tell the lesions in smallpox apart from the lesions in chicken pox

A

Chicken pox lesions all of different ages; Small pox lesions all the same age

137
Q

Molloscum contagiosum is caused by:

A

Poxvirus

138
Q

Diffuse molloscum contagiosum infection in adults suggests

A

HIV infection

139
Q

Phylogeny Papillomavirus

A

dsDNA naked

140
Q

High yield Papillomaviruses

A

1-4 - verruca vulgaris - cutaneous common wart; 6, 11 - laryngeal papillomatosis, a recurrent respiratory papillomatosis (children), vertical (at birth) - anogenital warts, “condyloma acuminata” 16, 18, 31, 33 - anogenital squamous cell carcinomas

141
Q

Condyloma LATA

A

Syphilis

142
Q

HPV vaccine covers

A

6, 11, 16, 18 inactivated subunit vaccine

143
Q

Most common STD

A

HPV

144
Q

HPV E6 and E7

A

proteolysis tumor suppressors and growth checkpoints by Rb (E7) and p53 (E6)

145
Q

If post-coital bleeding, think

A

Cervical cancer Invasive cervical/penile cancer is an AIDS defining illness

146
Q

Phylogeny Treponema Pallidum

A

Spirochete

147
Q

What is needed for direct vizualization of Treponema Pallidum?

A

Darkfield microscopy Use VDRL or RPR screening tools, use FTA-ABS specifically for treponema

148
Q

Maculopapular rash occurs on palms and soles weeks to months after infection - organism?

A

Treponema pallidum - Secondary syphilis along with condyloma lata on mucous membranes

149
Q

Aortitis of ascending thoracic aorta –> “tree barking” appearance

A

Part of tertiary syphilis Destroys vasa vasorum - aneurism formation Along with tabes dorsalis, gummas, Argyll-Robertson pupil

150
Q

Tabes dorsalis involves what part of the spinal cord?

A

Posterior

151
Q

Saber shins - anterior bowing of tibia; saddle nose; Notched incisors and molars with enamel outgrowths; Deafness

A

Congenital syphilis

152
Q

Jarisch-Herxheimer Reaction

A

Dying spirochetes releasing stuff activating cytokines fever and chills

153
Q

Phylogeny Leptospira

A

Spirochete Hawaii excreted in urine of animals

154
Q

Flu-like symptoms, fever, conjunctival suffusion, no exudate, renal dysfx jaundice from liver damage

A

WEILS disease - leptospirosis seeds many organs

155
Q

Borrelia burgdorferi Geographic distribution

A

Northeastern US

156
Q

Borrelia burgdorferi Vector

A

Ixodes scapularis - transmits Lyme, Babesiosis and Erlichiosis

157
Q

How to visualize Borellia

A

Giemsa stain Wright’s stain

158
Q

Stage 2 Lyme disease

A

bilateral facial nerve palsy myocarditis –> heart block

159
Q

Stage 3 Lyme disease

A

arthritis of large joints - migratory polyarthritis; memory difficulty, or lymphocytic meningitis

160
Q

Treat severe or later presentations of Lymes with

A

Ceftriaxone

161
Q

Rickettsia use eukarytic host:

A

NAD+ and CoA for replication

162
Q

Phylogeny All Rickettsiae

A

weakly gram negative coccobacillary obligate intracellular

163
Q

Use Weil-Felix agglutination test to identify:

A

Rickettsia

164
Q

Ricketssia Prowazekii rash

A

Starts on trunk and spreads outwards; Spares hands, feet, and head

165
Q

Ricketssia Prowazekii Population

A

POW Military recruits Louse poops on skin, we scratch

166
Q

Ricketssia Prowazekii Disease

A

Epidemic typhus rampant outbreak arthralgia, myalgia, pneumonia, rash, encephalitis, coma

167
Q

Rickettsia Rickettsii How to visualize

A

Giemsa stain

168
Q

Rickettsia Rickettsii Transmission

A

Dermacentor tick - direct biting

169
Q

Rickettsia Rickettsii Rash

A

incubation period 2-14 days; Extremeties, working to trunk

170
Q

Rickettsia Rickettsii Disease

A

RMSF Rash, headache, fever, myalgias

171
Q

Phylogeny Neisseria gonorrheae

A

gram-negative, oxidase-positive diplococcus.

172
Q

Chlamydia trachomatis Phylogeny

A

non-Gram staining intracellular pathogen

173
Q

Neisseria gonorrheae Treatment

A

Treat Neisseria gonorrhoeae with dual therapy of ceftriaxone plus azithromycin.

174
Q

Treatment Tularemia

A

Streptomycin

175
Q

Phylogeny Francisella tularensis

A

a gram-negative coccobacillus facultative intracellular –> can spread in body

176
Q

Mode of transmission Francisella tularensis

A

Tick Direct handling of rabbits Can be aerosolized

177
Q

Francisella tularensis Disease

A

Painful ulcer at infection site –> macrophages –> lymph nodes –> caseating necrosis; regional lymphadenopathy

178
Q

Brucella Reservoir

A

Farm animals

179
Q

Brucella At risk populations

A

Veterinarians, ranchers, farmers, recent consumption of milk or cheese products

180
Q

Phylogeny Brucella

A

Facultative intracellular –> macrophages –> can travel throughout the reticuloendothelial system gram negative

181
Q

Brucellosis symptoms

A

fever, chills, anorexia undulating fever hepatosplenomegaly osteomylelitis (chronic)

182
Q

Brucellosis Treatment

A

Doxycycline and rifampin adjunctive therapy

183
Q

Pneumocystis jirovecii Transmission

A

Respiratory droplets

184
Q

Pneumocystis jirovecii Infection in immunocompetent

A

Asymptomatic

185
Q

Pneumocystis jirovecii What kind of pneumonia

A

Diffuse, interstitial pneumonia Ground glass appearance in both lungs NO productive cough

186
Q

Pneumocystis jirovecii Diagnosis

A

Bronchoalveolar lavage –> methamine silver stain Oval shaped

187
Q

Phylogeny Herpes simplex 2

A

Double-stranded DNA, enveloped with nuclear membrane, icosahedral

188
Q

The coagulase test is used to differentiate

A

The coagulase test (choice B) is used to differentiate Staphylococcus aureus from the other staphylococcus species. Staphylococcus aureus is coagulase-positive; the others are coagulase-negative.

189
Q

Strep pneumo and Strep viridans Hemolysis

A

Alpha-hemolytic (green hue)

190
Q

Optochin Strep pneumo

A

Optochin sensitive

191
Q

Phylogeny and shape Strep pneumo

A

Lancet shaped diplococci Gram positive Bile soluble Capsule

192
Q

Strep pneumo Disease

A

Lobar pneumonia Lower lobes Rust-colored sputum MOPS - Meningitis, Otitis Media, Pneumonia, Sinusitis

193
Q

Strep pneumo Virulence factor

A

Protease that cleaves IgA –> mucosal invasion

194
Q

Strep pneumo At risk population

A

SCD pts

195
Q

Strep pneumo Treatment

A

Ceftriaxone, Macrolides

196
Q

Strep pneumo Vaccine

A

for adults - 23 valent, only IgM response; for kids - 7 valent, IgG response

197
Q

When is spore formation most occurring?

A

In the growth curve of bacteria, toxins build up in the stationary phase The stationary phase will be the time of maximal spore production

198
Q

Phylogeny RSV

A

RSV is a paramyxovirus with negative single-stranded RNA, helical shape, and an envelope.

199
Q

Mode of transmission Paramyxoviruses - RSV and measles

A

Respiratory droplets

200
Q

Measles Symptoms

A

Rubeola Paramyxovirus 4 Cs: Cough, coryza (runny nose), conjunctivitis, Koplik spots; fever then, maculopapular rash starting on ears, neck then rest of body, itchy, then rash becomes confluent then SSPE 5-15 years later

201
Q

Measles Virulence Factors

A

HA - RBCs stick together in test tubes Fusion protein - formation of syncitia (multinucleated giant cells)

202
Q

Use what vitamin to reduce morbidity in measles?

A

Vitamin A

203
Q

Parotitis, Orchitis

A

Mumps Paramyxovirus Complication - meningitis

204
Q

Mumps Virulence factors

A

HA - RBCs stick together in test tubes Fusion protein - formation of syncitia (multinucleated giant cells) NA

205
Q

Pathogenesis RSV

A

RSV Paramyxovirus Attached to G protein in respiratory endothelium Pneumonia, Bronchiolitis Fusion protein

206
Q

Treatment RSV

A

Ribavirin don’t use in pregnant women and children Use Palivizumab for kid prophylaxis

207
Q

Croup

A

Paramyxovirus aka Laryngotracheobronchitis

208
Q

Croup Virulence factors

A

HA - RBCs stick together in test tubes Fusion protein - formation of syncitia (multinucleated giant cells) NA

209
Q

Chickenpox Complications

A

Chickenpox may be complicated by secondary bacterial infection, pneumonia, systemic spread (immunosuppressed patients), neurologic involvement (rare), Reye syndrome (rare), and/or hemolytic anemia (rare)

210
Q

Bacteria that commonly produce pneumonia that develops in the context of influenza include:

A

S. aureus, Haemophilus influenzae, and Streptococcus pneumoniae. Of these, S. aureus is the most destructive to lung tissue and likely to cause cavitary lesions. S. aureus is a gram-positive, catalase-positive, coagulase-positive coccus.

211
Q

Treatment of symptomatic neurocysticercosis

A

Treatment of symptomatic neurocysticercosis involves the use of albendazole, praziquantel, or both with or without corticosteroids.

212
Q

Mode of transmission Cystercercosis

A

Cysticercosis is a parasitic infection caused by the larval cysts of the tapeworm Taenia solium. Patients acquire the infection by ingesting the eggs, either through ingestion of human feces-contaminated water or food or by autoinfection of a person infected with the adult worm who transmits the eggs from the perianal area to the mouth via contaminated fingers.

213
Q

Bartonella henslae

A

In the immunocompromised patient, it can cause bacillary angiomatosis, which is the vascular proliferative form of infection and can affect any organ system, although it most commonly affects the skin and subcutaneous tissue.

214
Q

Bartonella henslae Phylogeny

A

Gram negative Zoonotic

215
Q

Bartonella henslae Special stain

A

Warthin-Starry stain (a silver stain)

216
Q

Bartonella henslae Diseases

A

Cat scratch disease - fever, regional (axillary) lymph nodes) Bacillary angiomatosis - immunocomprimised - vascular lesions in addition to the above

217
Q

Bartonella henslae Treatment

A

Doxycycline in immunocomprimised Azithromycin in cat scratch disease if severe, otherwise, self-limiting

218
Q

Neisseria gonorrhoeae Virulence Factor

A

Pili mediate attachment, protection from phagocytosis, antigenic variation, and adherence.

219
Q

Legionella Culture

A

Facultative intracellular pathogen; requires cysteine and iron in media (provided in buffered charcoal yeast extract [CYE]). This medium also contains antimicrobial drugs including colistin and vancomycin to inhibit the growth of other Gram-negative and Gram-positive bacteria, respectively.

220
Q

Diagnosis SSPE

A

EEG (periodic activity), marked elevation of immunoglobulins in CSF, and alteration of the white matter of both hemispheres and the brain stem. Symptoms develop gradually and consist of behavioral changes, myoclonus, ataxia, ocular abnormalities, spasticity, and coma.

221
Q

Immunosuppressed patients with owl’s-eye inclusion bodies in cells in urine sediment:

A

CMV

222
Q

Painful, soft ulcer on the genitals:

A

Haemophilus ducreyi.

223
Q

Haemophilus ducreyi Phylogeny

A

a pleomorphic, gram-negative rod that displays a characteristic pattern (“school of fish”) on Gram-stained slides.

224
Q

Haemophilus ducreyi Plate on

A

It grows on chocolate agar or on whole blood agar with a satellite phenomenon (around Staphylococcus aureus).

225
Q

Site specific recombination

A

Site-specific recombination is the integration of one DNA molecule into another DNA molecule with which it has no homology except for a small site on each DNA.

226
Q

Acute HBV infection is characterized by

A

a positive serology for HBsAg, HBeAg, and anti-HBc-IgM antibody, but absence of HBsAb and HBeAb.

227
Q

Diseases that can cause reactive arthritis

A

Shigella, Salmonella, Yersinia, Campylobacter, Chlamydia

228
Q

Catalase

A

Abscesses are commonly produced by catalase-positive organisms. Catalase is an enzyme that converts hydrogen peroxide into water and oxygen. Hydrogen peroxide is one of the toxic oxygen compounds generated by the action of NADPH oxidase in phagocytes and it acts as the substrate for myeloperoxidase. Producing catalase, therefore, allows bacteria to survive longer intracellularly. Catalase-positive organisms include the staphylococci, Pseudomonas, Candida, Aspergillus, and the Enterobacteriaceae.

229
Q

Viruses with segmented genome:

A

ROBA (Reoviridae, Orthomyxoviridae, Bunyaviridae, Arenaviridae)

230
Q

HSV-1 Phylogeny

A

Herpesviridae: double-stranded icosahedral DNA viruses with nuclear membrane envelope

231
Q

H. Pylori Pathogenesis

A

Urease production raises the pH of the stomach and allows invasion of the stomach lining

232
Q

Clostridium perfringens Hemolysis

A

Double zone of hemolysis on blood agar

233
Q

Clostridium perfringens Phylogeny

A

Obligate anaerobe gram pos

234
Q

Clostridium perfringens Treatment

A

IV Pen G

235
Q

Clostridium perfringens Toxin

A

Alpha toxin works on cell membrane (RBC –> hemolysis)

236
Q

Clostridium perfringens Food Poisoning

A

Late onset

237
Q

Actinomyces israelii Phylogeny

A

Branching (filamentous) rod Gram pos Obligate anaerobe Normal flora of the oral cavity

238
Q

Nocardia Phylogeny

A

Obligate aerobe Gram pos Filamentous rod

239
Q

Actinomyces israelii Disease

A

Cervicofacial actinomyces infection draining sulfur sinus tracts

240
Q

Actinomyces israelii

A

Pen G

241
Q

Legionella Phylogeny

A

Use silver stain, but technically gram neg Oxidase pos

242
Q

Legionella Plate on

A

Buffered charcoal yeast extract with cysteine and iron added

243
Q

Legionella Diseases

A

Pontiac fever Legionnaires disease - smokers, atypical pneumonia - patchy infiltrate w/ consolidation of 1 lobe, neurologic symptoms, diarrhea, HIGH fever *hyponatremia*

244
Q

Legionella Diagnose

A

Urine antigen test sputum culture

245
Q

Legionella Treatment

A

Macrolides, fluoroquinolones better

246
Q

Histoplasma capsulatum Location

A

Midwest and southish cave, farm

247
Q

Histoplasma capsulatum Transmission

A

Inhalation

248
Q

Histoplasma capsulatum Diagosis`

A

KOH prep culture rapid serum/urine antigen test- ovoid bodies are macrophages filled with histoplasma

249
Q

Histoplasma capsulatum Size

A

Smaller than RBC

250
Q

Histoplasma capsulatum Dimorphic

A

Mold in the cold Yeast in the heat

251
Q

Histoplasma capsulatum Diseases

A

Pneumonia - granulomas - cavitary lesions and calcified lesions with fibrotic scarring Can be asymptomatic Erythema nodosum

252
Q

Histoplasma capsulatum In Immunocomprimised

A

Dissemination to liver and spleen - calcifications Skin and neuro findings

253
Q

Histoplasma capsulatum Treatment

A

Mild - Azole - Fluconazole, Ketoconazole Severe - Amphotericin B

254
Q

Blastomyces Dermatitidis Location

A

Great Lakes, Ohio River Valley, some souther US

255
Q

Blastomyces Dermatitidis Treatment

A

Mild - Azole - Fluconazole, Ketoconazole Severe - Amphotericin B

256
Q

Blastomyces Dermatitidis Diseases

A

Hazy lung CXR - patchy alveolar infiltrate Can be acute or chronic Asymptomatic possible

257
Q

Blastomyces Dermatitidis Dimorphic

A

Yes

258
Q

Blastomyces Dermatitidis Transmission

A

Inhalation of spores

259
Q

Blastomyces Dermatitidis Appearance

A

Broad based budding

260
Q

Blastomyces Dermatitidis Size

A

Same size as RBC

261
Q

Blastomyces Dermatitidis Immunocomprimised

A

Osteomyelitis Skin problems

262
Q

Blastomyces Dermatitidis Diagnosis

A

KOH prep Culture Urine antigen test

263
Q

Coccidiodes Immitis Location

A

California and southwestern US

264
Q

Coccidiodes Immitis Treatment

A

Mild - Azole - Fluconazole, Ketoconazole Severe - Amphotericin B

265
Q

Coccidiodes Immitis Diseases

A

“San Jaquin Valley fever” Asymptomatic Self limited acute pneumonia Some cavities or conodules on CXR (not always) Erythema nodosum = robust immune response = only seen in healthy people

266
Q

Coccidiodes Immitis Size

A

larger than RBC

267
Q

Coccidiodes Immitis Transmission

A

Inhalation of spores in dust; Earthquakes are risk factors

268
Q

Coccidiodes Immitis Dimorphism

A

Mold in cold Spherules of endospores in heat

269
Q

Coccidiodes Immitis Immunocomprimised

A

Skin Osteomyelitis Meningitis

270
Q

Coccidiodes Immitis Diagnosis

A

KOH prep Culture Serology for ab titers (as with all fungi)

271
Q

Paracoccidiodes Brasilliensis Location

A

Brazil, South America

272
Q

Paracoccidiodes Brasilliensis Size and Appearance

A

Captains wheel Much bigger than RBC

273
Q

Paracoccidiodes Brasilliensis Treatment

A

Mild - Azole - Fluconazole, Ketoconazole Severe - Amphotericin B

274
Q

Paracoccidiodes Brasilliensis Diseases

A

Cervical lymphadenopathy –> lungs, granulomas, mucosal ulcers in mouth

275
Q

Paracoccidiodes Brasilliensis Dimorphic

A

Yes

276
Q

Paracoccidiodes Brasilliensis Transmission

A

Respiratory droplets

277
Q

Malassezia furfur Disease

A

Pityriases versicolor - dermatologic annoyance (not itchy) - lipid degradation destroys melanocytes - stays in stratum corneum

278
Q

Malassezia furfur Appearance

A

Spaghetti and meatballs on KOH prep

279
Q

Malassezia furfur Location

A

hot and humid conditions

280
Q

Malassezia furfur Immunocomprimised

A

Neonates and TPN

281
Q

Malassezia furfur Treatment

A

Selenium sulfate

282
Q

Naegleria fowleri

A

Naegleria fowleri is a free-living amoeba found in warm, freshwater lakes. Diving into such lakes causes changes in pressure that can force the organism through the cribriform plate and result in the production of necrotic lesions spreading from the olfactory lobes. The tissue form of the organism is a flagellated trophozoite.

283
Q

Lipid A

A

Gram-negative septic shock is caused by endotoxin (lipopolysaccharide, LPS) in the outer membrane of gram-negative organisms. Lipid A is the toxic component of LPS. Endotoxin acts by direct stimulation of macrophages to secrete large amounts of IL-1, IL-6 and TNF-alpha, which will then cause excessive vasodilation and ultimately, shock.

284
Q

Generalized transduction

A

The mechanism involving transfer of bacterial DNA from cell to cell using a lytic phage as a vector is called generalized transduction.

285
Q

Conjugation

A

Conjugation is one of the three methods whereby DNA is transferred from one cell to another. In this process, there is a gene transfer from donor (F+ or Hfr cell) to recipient (F– cell) during cell-to-cell contact. The sex pili (genes on F factor) play a role in establishing cell-to-cell contact. Then a single strand (or a portion thereof) of the double helix of DNA is transferred from the donor (or male) cell to the recipient or female cell. Chromosomal genes transferred in by conjugation have to be stabilized by homologous recombination (in an Hfr X F– cross).

286
Q

Cause of malignant otitis externa

A

Pseudomonas aeruginosa causes malignant otitis externa, which is a severe necrotizing infection of the external ear canal. Infection tends to spread to the mastoid bone, temporal bone, sigmoid sinus, base of the skull, meninges, and brain. Patients at increased risk include the elderly, people with diabetes, and the immunocompromised.

287
Q

Ecthyma gangrenosum

A

Ecthyma gangrenosum is a black, necrotic skin lesion that is seen in septicemic patients. Pseudomonas aeruginosa

288
Q

On biopsy, the characteristic appearance is crescent-shaped protozoa adjacent to the brush border. Organism?

A

Giardia

289
Q

PJP How to visualize

A

The sample is then submitted to the direct fluorescent antibody test or stained with Gomori methenamine silver stain to visualize the organisms.

290
Q

How does Protein A (staph aureus) work?

A

Protein A inhibits opsonization by binding to the Fc component of IgG

291
Q

Syphilis Diagnosis

A

During secondary syphilis, VDRL is the best test to order for this patient. It must then be confirmed by the FTA-ABS. During primary syphilis, biopsy of a chancre is examined with darkfield microscopy. During tertiary syphilis, a specific treponemal serologic test such as the FTA-ABS or microhemagglutination test is necessary because the VDRL will frequently revert to negative in this phase.

292
Q

Poxvirus

A

All DNA viruses are icosahedral, except for Poxviruses, which are described as brick-shaped complexes. Poxvirus DNA is enveloped. All DNA viruses replicate their DNA in the nucleus, except for Poxvirus, which replicates in the cytoplasm via a virion-associated transcriptase.

293
Q

Ascaris lumbricoides

A

Ascaris lumbricoides infection, the only helminth infection caused by a cylindrical white worm of this remarkably large size. It is acquired directly, with no intermediate host, from fecal contamination from other human beings, and the stage of the life cycle that is transmitted is the egg. The eggs hatch into larvae in the intestine. The larvae penetrate the intestinal wall and migrate to the lungs, at which time they can cause pulmonary symptoms. The larvae are then swallowed, and mature and mate in the gastrointestinal tract, where they lay eggs that can be passed on to another person. Most infections are asymptomatic, but early infection may be marked by respiratory symptoms (cough, dyspnea, wheezing) and fever. In later stages, gastrointestinal symptoms are often prominent,

294
Q

short, germinating hyphae on the germ-tube test.

A

Candida albicans

295
Q

Hyphae with rosettes of microconidia

A

the environmental form for Sporothrix schenckii. This fungus causes rose-gardener’s disease, which is a cutaneous mycetoma associated with traumatic implantation while gardening.

296
Q

bacteria that are capable of natural transformation include:

A

Haemophilus influenzae, Streptococcus pneumoniae species, and Neisseria species.

297
Q

progressive multifocal leukoencephalopathy (PML)

A

progressive multifocal leukoencephalopathy (PML), which is a rapidly progressive demyelinating disorder in which the JC virus (a polyomavirus) infects oligodendroglial cells in the brain. The eosinophilic inclusions represent accumulations of JC virus. PML occurs in about 1% of AIDS patients, and is the AIDS-defining illness in half of the patients who develop the condition. Symptoms include aphasia, hemiparesis, cortical blindness, ataxia, and conjugate gaze abnormalities. The condition can progress to quadriparesis and coma. There is no effective treatment for this disorder. JC virus is ubiquitous and seropositivity reaches about 70% by adulthood. Thus, reactivation is seen with immunosuppressed hosts. JC infections are usually asymptomatic in immunocompetent individuals.

298
Q

Toxo treatment

A

sulfadiazine and pyrimethamine

299
Q

The most common bacterial pathogens of conjunctivitis include

A

Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, and Moraxella spp.

300
Q

Haemophilus influenzae Plate on

A

Haemophilus influenzae requires factors X and V: growth on chocolate agar

301
Q

Hepatitis E infection in _________ has a high mortality.

A

pregnant women

302
Q

Hep E virus

A

single-stranded, positive-sense RNA.

303
Q

All RNA positive viruses replicate in the:

A

Cytoplasm

304
Q

There is an important association between colon cancer and endocarditis due to

A

Streptococcus bovis. S. bovis is a group D Streptococcus whose cell wall has glycerol teichoic acid.

305
Q

Corneybacterium diptheriae Plate on

A

Tellurite and Loeffler’s media

306
Q

Corneybacterium diptheriae Plate on

A

Tellurite and Loeffler’s media; Elek’s test to see if the strain is toxic

307
Q

Adenovirus #1 cause of

A

tonsillitis

308
Q

Adenovirus phylogeny

A

DNA naked

309
Q

Adenovirus transmission

A

respiratory droplets; fecal-oral

310
Q

Adenovirus transmission

A

respiratory droplets; fecal-oral

311
Q

Adenovirus Population

A

Close quarters public pools kids

312
Q

Adenovirus Diseases

A

hemorrhagic cystitis tonsillitis conjunctivitis

313
Q

Window period

A

During the “window period” of hepatitis B infection, neither hepatitis B surface antigen (HBsAg) nor its antibody (HBsAb) can be detected in the serum of the patient. This is due to precipitation of antigen-antibody complexes in their zones of equivalence and, thereby, their removal from the circulation. Serologic tests conducted during the window period will be positive for HBcAb and HBeAb.

314
Q

Symptoms and cause of infective endocarditis

A

acute infective endocarditis secondary to intravenous drug use, as evidenced by the bruising in the right antecubital fossa. Peripheral cutaneous or mucocutaneous lesions of infective endocarditis include petechiae, splinter hemorrhages, Janeway lesions, Osler’s nodes, and Roth spots. Patients with infective endocarditis can also have septic embolic, including pulmonary embolic, which would show up as patchy infiltrates in both lungs. The most common cause of acute bacterial endocarditis is Staphylococcus aureus.

315
Q

Trypanosoma Brucei

Disease

A

African sleeping sickness - Coma

Parasite: lymphadenopathy, recurrent fevers

316
Q

Trypanosoma Brucei

Vector

A

Tse Tse Fly

317
Q

Trypanosoma Brucei

Location

A

West and South Africa

318
Q

Trypanosoma Brucei

Diagnosis

A

Trypomastigotes seen on blood smear

319
Q

Trypanosoma Brucei

Description

A

Variable surface glycoproteins undergoing constant antigenic variation, enabling chronic infection

Motile, single flagella

320
Q

Trypanosoma Brucei

Treatment

A

Suramin for peripheral blood infection

Melarsoprol for CNS infection - highly toxic side effect profile

321
Q

Naegleria Fowleri

Location

A

Lakes, freshwater, standing water

322
Q

Naegleria Fowleri

Diseases

A

Rapidly fatal meningioencephalitis

Trophozoite enters CNS through cribiform plate

323
Q

Naegleria Fowleri

Diagnosis

A

Lumbar puncture

324
Q

Naegleria Fowleri

Treatment

A

Amphotericin B

325
Q

Babesiosis

Symptoms

A

Hemolytic anemia

Hemoglobinuria

Jaundice

Irregularly cycling Fevers

*most are asymptomatic

326
Q

Babesia

Vector

A

Ixodes tick

327
Q

Babesia

At risk population

A

SCD patients

HIgher risk of severe disease

328
Q

Babesia

Diagnosis

A

Thick blood smear;

Maltese cross appearance in RBCs made of trophozoites

329
Q

Babesia

Location

A

Northeastern US

330
Q

Babesia

Treatment

A

Atovaquone;

Azithromycin

331
Q

Leishmania donovani

Location

A

Mediterranean, Middle East, Africa

332
Q

Leishmania braziliensis

Host

A

Humans, other vertebrates

sandFly - vector

333
Q

Leishmania braziliensis

Disease

A

Cutaneous leishmaniasis

ulcers

334
Q

Leishmania braziliensis

Diagnosis

A

Amastigote is intracellular form seen within macrophages;

Requires aspirates from lymph node, spleen, skin lesions

335
Q

Leishmania donovani

Disease

A

Visceral leishmaniasis aka black fever aka kala-azar

Fatal if untreated

Pancytopenia

Hepatosplenopegaly, fever, weakness

336
Q

Leishmaniasis

Treatment

A

Stibogluconate for cutaneous

Ampho B for visceral

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