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Micro Bacteria Flashcards

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USMLE® Step 1 flashcards
1
Q

Gram+ Cocci lab algorithm

A 
Cocci --> Catalase test 
Catalase -: Streptococcus 
Catalase +: Staph
Staph --> Coagulase test 
Coagulase +: S aureus
Coagulase -: Do Novobiocin test 
"NO StRESs at the staph retreat" 
Novobiocin sensitive: S epidermidis 
Novobiocin resistant: S saprophyticus
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2
Q

Gram+ rods

A 
Clostridium (anaerobe)
Corynebacterium
Listeria
Bacillus (aerobe)
Mycobacterium (acid fast)
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3
Q

Gram+ with branching filaments

A

Anaerobe, not acid fast: Actinomyces

Aerobe, acid fast: Nocardia

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4
Q

Streptococcus algorithm

A

Hemolysis test
Partial hemolysis –> green on blood agar–> α
Complete hemolysis –> clear on blood agar –> β
No hemolysis on blood agar –> γ

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5
Q

α Hemolytic Strep Algorithm

A

“OVRPS”
Capsule, +Quellung, Optochin sensitive –> Strep pneumoniae
No capsule, Optochin resistant –> Viridans streptococci (S mutans)

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6
Q

β Hemolytic Strep Algorithm

A

“B-BRAS”
Group A: Bacitracin sensitive –> S pyogenes
Group B: Bacitracin resistent –> S agalactiae

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7
Q

γ Hemolytic Strep Algorithm

A 
Group D (Enterococcus): Growth in bile and 6.5% NaCl (E faecalis)
Nonenterococcus: Growth in bile, not 6.5% NaCl (S bovis)
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8
Q

β-Hemolytic Bacteria

A 
Staphlococcus aureus (catalase+, coagulase+)
Streptococcus pyogenes (GAS: Catalase-, Bacitracin sensitive)
Streptococcus agalactiae (GBS: Catalase-, Bacitracin resistent)
Listeria Monocytogenes (tumbling motility, meningitis in newborns, unpasteurized milk)
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9
Q

Staphyloccus aureus
Gram, Shape, Arrangement, Marker
Weapon
Diseases it causes?

A

Gram+ Cocci in Clusters, Catalase+, Coagulase+
Protein A binds FcIgG and inhibits complement fixation and phagocytosis
TSST –> fever, vomiting, rash, desquamation, shock, end organ failure
Skin infection, Organ abscess (coagulase forms fibrin clot around self), Pneumonia, Endocarditis, Osteomyelitis, Food poisoning (preformed toxins), TSS, Scalded skin syndrome (exfoliative toxin)

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10
Q

MRSA
What is it?
Resistent to…

A

Methicillin Resistent Staph Aureus

Resistent to β-lactams because of altered penicillin binding protein

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11
Q

Staphylococcus epidermidis
Where is it normally located
Contaminates what?
What does it infect?

A

Part of normal skin flora
Contaminates blood cultures
Infects prosthetic devices and IV catheters by producing adherent biofilms

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12
Q 
Streptococcus pneumoniae 
Gram, Shape, Arrangement
Weapons 
Markers  
Most common cause of...
Presentation
A

Gram+, Lancet Shaped, Diplococci
Encapsulated, IgA protease
α hemolytic, Optochin sensitive
“MOPS are Most OPtochin Sensitive”
Meningitis, Otitis media (in children), Pneumonia, Sinusitis
Rusty sputum, sepsis in sickle cell anemia and splenectomy

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13
Q 
Viridans Group Streptococci 
Markers
Where are they normally
What do they cause?
What does it adhere to?
A

α hemolytic, Optochin Resistent, Produces Dextran from Sucrose
Normal flora of oropharynx
Dental caries (S mutans) and Subacute bacterial endocarditis (S sanguis) - stick to prosthetic valve via glycocalyx
Adheres to Fibrin-Platelet Aggregates

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14
Q 
Streptococcus pyogenes 
Markers
Versions w/ diseases
Diagnosis  
Significant protein marker
A

Gram+ Cocci, β-Hemolytic, bacitracin sensitive
Pyogenic: pharyngitis, cellulitis, impetigo
Toxigenic: scarlet fever, TSLS, Necrotizing fasciitis
Immunologic: Rheumatic fever, acute glomerulonephritis
ASO titers
M protein enhances host defense but gives rise to rheumatic fever

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15
Q

Diagnosis of RF

What causes it?

A 
GAS
"JONES"
Joints - polyaarthritis 
Carditis 
Nodules (subcutaneous)
Erythema marginatum 
Sydenham's chorea
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16
Q

Scarlet Fever Presentation

A

Scarlet rash sparing face, Strawberry (scarlet) tongue, Scarlet throat

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17
Q

What GAS presentations can lead to other problems?

A

Pharyngitis –> RF and Glomerulonephritis

Impetigo more commonly precedes glomerulonephritis than pharyngitis

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18
Q 
Streptococcus agalacgtiae 
Markers 
What does it produce?
Colonizes where?
What diseases does it cause? In whom?
Screen
Treatment
A

“GBS: B is for babies”
Gram+ Cocci, β-Hemolytic, bacitracin resistent, Hippurate test +
Produces CAMP factor which enlarges area of hemolysis formed by S aureus
Vagina
Pneumonia, Meningitis, and Sepsis in babies
Screen pregnant women at 35-37 weeks
Pt’s with + cultures receive intrapartum penicillin prophylaxis

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19
Q 
Enterococcus 
Names
Markers 
Where are they normally?
Resistant to?
What do they cause?
Bad version?
A

GDS: E. faecalis and E. faecium
Gram+ cocci Non-hemolytic and growth in bile and 6.5% NaCl
Normally in colonic flora
Penicillin G resistent
UTI, Biliary tract infections, Subacute endocarditis
VRE important in nosocomial infection

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20
Q

Lancefield Grouping based on?

A

Difference in C carbohydrate in cell wall

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21
Q

Streptococcus bovis
Markers
Where does it colonize
What can it cause?

A

GDS: S bovis
Gram+ cocci Non-hemolytic and growth in bile but not 6.5% NaCl
Colonizes the gut
Bacteremia and subacute endocarditis in colon cancer patients

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22
Q

GDS

A

S bovis, E. faecalis, E. faecium

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23
Q 
Corynebacterium diphtheriae 
Markers 
Plating 
Toxin test?
Stains 
Diseases it causes? How?
Symptoms 
Vaccine
A

Gram+ rods with metachromatic (blue and red) granules
Black colonies on Cystine-Tellurite agar
Elek’s test for toxins
+ Aniline dyes
Diphtheria via exotoxin encoded by β prophage. Inhibits protein synthesis by ADP-ribosylation of EF2
Pseudomembranous pharyngitis (gray-white membrane), lymphadenopathy, myocarditis, arrhythmias
Toxoid vaccine prevents diphtheria

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24
Q

Spores
What do have in their core?
How do you kill spores?

A

Dipicolinic acid in the core

Autoclave @ 121 degrees C for 15 minutes

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25
Q

Clostridia
Markers
What do they form?
Types

A

Gram+ rods that are obligate anaerobes. Spore forming

Tetani, Botulinum, Perfringens, Difficile

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26
Q

Clostridium tetani
Markers
Toxin
Presentation

A

Gram+ rods that are obligate anaerobes. Spore forming
Tetanospasmin is an exotoxin. Cleaves SNARE protein required for NT release of GABA and Gly neurons (Renshaw cells in spinal cord)
Muscle rigidity, lock jaw, Risus sardonicus

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27
Q

Clostridium botulinum
Markers
Toxin
Presentation

A

Gram+ rods that are obligate anaerobes. Spore forming
Botulinum toxin
Cleaves SNARE protein required for NT release of ACh from neurons
Baby who ate honey has Flaccid paralysis (floppy baby)

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28
Q

Clostridium perfringens
Markers
Toxin
Presentation

A

Gram+ rods that are obligate anaerobes. Spore forming
Alpha toxin (lecithinase)
Phospholipase that degrades tissues and cell membranes
Degradation of phospholipid C –> myonecrosis (gas gangrene) and hemolysis (double zone of hemolysis on blood agar)
Gas Gangrenous Leg

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29
Q 
Clostridium difficile 
Markers 
Toxin
Presentation 
Diagnosis 
Treatment
A

Gram+ rods that are obligate anaerobes. Spore forming
Toxin A (enterotoxin) binds brush border of gut
Toxin B (cytotoxin) destroys cytoskeletal structure of enterocytes causing pseudomembranous colitis
Diarrhea after antibiotic use (clindamycin or ampicillin)
Detection of toxin in stool
Metronidazole or oral vancomycin

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30
Q 
Anthrax 
Markers 
What is special about it?
What does it produce?
Types
A

Gram+ spore forming rod
Only bacteria with polypeptide capsule (with D-glutamate)
Antrax toxin
Cutaneous vs Pulmonary

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31
Q

Cutaneous Anthrax

A

Contact –> black eschar (painless ulcer); can progress to bacteremia and death
Black skin lesion - black eschar (necrosis) surrounded by edematous ring
Caused by Lethal factor and Edema factor (Mimics AC and increases cAMP)

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32
Q

Pulmonary Anthrax

A

Inhalation of spores –> flu-like symptoms that rapidly progresses to fever, pulmonary hemorrhage, mediastinitis, and shock

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33
Q

Woolsorters’ Disease

A

Inhalation of Anthrax spores from contaminated wool

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34
Q

Bacillus cereus
Markers
How is it contracted
Types with presentation

A

Gram+ aerobic rods
Food poisoning. Spores survive cooking rice and keeping it warm results in germination of spores and enterotoxin formation
Emetic type: Rice and pasta. Nausea and vomiting for 1-5 hours caused by cereulide (a preformed toxin)
Diarrheal type causes watery non-bloody diarrhea and GI pain for 8-18 hours

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35
Q 
Listeria Monocytogenes 
Markers 
Where can it live?
How is it acquired?
How do they travel?
A

Gram+ rods
Facultative intracellular microbe
Ingestion of unpasteurized milk/cheese or deli meats. Vaginal transmission during birth
Forms actin rockets to move from cell to cell with characteristic tumbling motility

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36
Q

Listeria Monocytogenes
Diseases caused by them?
Treatment

A

Amnionitis, Septicemia, and Spontaneous abortion in pregnant women
Granulomatosis infantiseptica, Neonatal meningitis
Meningitis in immunocompromised pts
Mild gastroenteritis in health individuals
Gastroenteritis is self limiting
Ampicillin for infants, immunocompromised and elderly

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37
Q 
Actinomyces 
Markers 
Air?
Acid Fast?
Where is it found?
Presentation 
Treatment
A 
Gram+ branching filaments 
Anaerobic 
Not Acid Fast
Normal oral flora 
Oral/facial abscesses that drain through sinus tracts forming yellow sulfur granules 
Penicillin
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38
Q 
Nocardia  
Markers 
Air?
Acid Fast?
Where is it found?
Presentation 
Treatment
A

Gram+ branching filaments
Aerobe
Acid Fast
Soil
Pulmonary infections in immunocompromised
Cutaneous infections after trauma in normals
Sulfonamides

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39
Q

PPD+ vs PPD-

A

+: Current infection, Past exposure, BCG vaccinated

-: No infection, anergic (steroids, malnutrition, immunocompromised), or Sarcoidosis

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40
Q

Mycobacteria
Stain
Names

A 
Acid Fast
Tuberculosis 
Kansaii (pulmonary TB-like symptoms)
Avium-Intracellulare (disseminated nonTB disease in AIDS resistant to multiple drugs. Treat prophylactically with azithromycin)
Leprae
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41
Q

Mycobacterium tuberculosis
Symptoms
Weapons
Histo

A

Fever, Night sweats, Wt loss, Hemoptysis
Cord Factor: inhibits macrophage maturation and induces release of TNFα
Sulfatides (surface glycolipids) inhibit phagosysosomal fusion
Caseating granuloma w/ multinuclear Langhan’s giant cells

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42
Q

Primary TB
Who is at risk?
Course

A

Non immune host (usually a child)
Hilar nodes + Ghon focus (usually in mid zone of lung) = Ghon Complex
Heals by fibrosis –> immunity and hypersensitivity –> Tuberculin+
Progressive disease
Bacteremia –> miliary TB
Preallergic lymphatic or hematogenous dissemination –> dormancy in several organs –> reactivation in adult life

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43
Q

Secondary TB
Who is at risk?
Initial Course
Reactivation

A

Partially immune hypersensitized host (adult)
Fibrocaseous cavitary lesion usually in upper lobes
Reactivation in the lungs
CNS (parenchymal tuberculoma or meningitis)
Vertebral body (Pott’s Disease)
Lymphadenitis, Renal, GI

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44
Q 
Mycobacterium leparae 
Temperatures 
Growth in vitro 
Reservoir in US
Forms  
Treatment
A 
Likes cool temps: infects skin, superficial nerves (glove and stocking loss of sensation)
Cannot be grown in vitro
Armadillos 
Lepromatuous vs Tuberculoid 
Dapsone + Rifampin
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45
Q 
Lepromatous Leprosy 
Presentation 
Communicable?
Host response?
Treatment
A

Presents diffusely over skin
Communicable
Low cell-mediated immunity with a humoral Th2 response
Dapsone + Rifampin + Clofazimine for 2-5 years

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46
Q

Tuberculoid Leprosy
Presentation
Host response?
Treatment

A

Limited to a few hypoesthetic hairless skin plaques
High cell-mediated immunity with Th1 cell response
Dapsone + Rifampin for 6 months

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47
Q

Gram- algorithm

A

Oxidase+, comma shaped: Campylobacter jejuni or Vibrio cholerae
Diplococci –> Maltose test
M+: Neisseria meningitidis. M-: N. gonorrhoeae
Coccoid rods –> Haemophilus influenzae, Pasturella, Brucella, Bordetella pertussis
Rods –> Lactose fermentation test
L+: Klebsiella, E coli, Enterobacter
L-: Oxidase test
O+: Pseudomonas, H pylori
O-: Shigella, Salmonella, Proteus

48
Q

Lactose-fermenting enteric bacteria
Test
Enzyme
Examples

A

“test with MacConKEES agar”
Pink colonies on MacConkey’s agar
Purple/black colonies on EMB
E coli grows with purple colonies with green sheen
E coli produces β-galactosidase breaks lactose into glucose and galactose
Citrobacter, Klebsiella, E coli, Enterobacter, Serratia

49
Q

Gram- and penicillin

A

Gram- outer membrane layer inhibits entry of penicillinG and vancomycin
May be susceptible to penicillin derivatives (ampicillin, amoxicillin)

50
Q

Algorithm for Lactose fermenting, Gram- rods

A

Fast fermenters: Klebsiella, E coli, Enterobacter

Slow fermenters: Citobacter, Serratia

51
Q

Algorithm for non-Lactose fermenting, Gram- rods

A

Do Oxidase Test
Oxidase+: Pseudomonas, H pylori
Oxidase-: Shigella, Salmonella, Proteus

52
Q

Algorithm for oxidase+, Comma shaped Gram-

A

Grows @ 42: Campylobacter jejuni

Grows in alkaline media: Vibrio Cholerae

53
Q 
Neisseria
Markers 
Fermentation?
Product?
Kinds?
A

Gram- diplococci
Both ferment glucose
Produce IgA proteases
Gonococci vs Meningococci

54
Q 
Neisseria Gonococci 
Capsule
Fermentation 
Vaccine
Transmission 
Residence?
A 
No polysaccharide capsule 
Only Glucose fermentation 
No vaccine (due to antigenic variation of pilus proteins)
Sexual transmission 
Polymorphonuclear leukocytes
55
Q

Neisseria Gonococci
Disease it causes?
Treatment

A

Gonorrhea, Septic arthritis, Neonatal conjunctivitis, PID, Fitz-Hugh-Curtis syndrome
Ceftriaxone + (azithromycin or doxycycline) for possible chlamydia coinfection

56
Q 
Neisseria Meningococci  
Capsule
Fermentation 
Vaccine
Transmission
A

Polysaccharide capsule
Ferments Glucose and Maltose
Vaccine (none for type B)
Respiratory and oral secretions

57
Q

Neisseria Meningococci
Disease it causes?
Prophylaxis
Treatment

A

Meningococcemia, Meningitis, Waterhouse-Friderichsen syndrome
Rifampin, Ciprofloxacin, Ceftriaxone
Ceftriaxone or PenicillinG

58
Q 
Haemophilus influenzae 
Markers 
Transmission 
Most invasive kind?
Non-typeable strains?
Weapon
Vaccine
A

Gram- coccoid rods
Aerosol transmission
Most invasive is capsular type B
Cause mucosal infections (otitis media, conjunctivitis, bronchitis)
IgA protease
Vaccine contains B capsular polysaccharide (polyribosylribitol phosphate) conjugated to diphtheria toxoid and other proteins. Give @ 2-18 months

59
Q 
Haemophilus influenzae 
Growth 
What diseases does it cause?
Prophylaxis 
Treatment
A

“When child has the flu, mom goes to V and X store to buy some chocolate”
Chocolate agar requires V (NAD) and X (hematin). Can also grow with S aureus (provides V)
“haEMOPhilus”
Causes Epiglottitis (cherry red in children), Meningitis, Otitis media, Pneumonia
Rifampin
Ceftriaxone

60
Q 
Legionella pneumophila 
Markers 
Stains
Growth
Diagnosis, Labs
Transmission 
Diseases caused by it?
Treatment
A

Gram- rods but stain poorly. Use Silver stain
“French Legionnaire with Silver helmet, sitting around a Charcoal fire with his Iron dagger. He’s no Sissy (cysteine)”
Charcoal yeast extract with iron and cysteine
Ag in urine. Hyponatremia
Aerosol transmission from water source. No person-to-perosn
Legionnaires disease, Pontiac fever
Macrolide or Quinolone

61
Q

Legionnaires disease
Caused by…
Presentation

A

Legionella pneumophila

Severe pneumonia, Fever, GI, CNS symptoms

62
Q

Pontiac fever
Caused by…
Presentation

A

Legionella pneumophila

Mild flu-like symptoms

63
Q 
Pseudomonas aeruginosa 
Markers 
Gross
Source 
Weapons 
Classic pt that gets it?
A

Gram- rod. Aerobic (“think AERuginosa - Aerobic”). Non-lactose fermenting, Oxidase+
Produces pyocyanin (blue-green) pigment. Grape-like odor
Water source
Endotoxin (fever, shock), Exotoxin A (inactivates EF2)
Burn victims, CF pt

64
Q

Pseudomonas aeruginosa
Presentation
Treatment

A

“PSEUDOmonas”
Wound and burn infections. Hot tub folliculitis. Malignant Otitis externa in diabetics.
Pneumonia (in CF pt), Sepsis (black lesions on skin), External otitis (swimmers ear), UTI, Drug use, and Diabetic Osteomyelitis
Aminoglycoside + extended spectrum penicillin (piperacillin, ticarcillin)

65
Q

E coli
Weapons
Types

A

Fimbriae (cystitis and pyelonephritis)
K capsule (pneumonia, neonatal meningitis)
LPS endotoxin (septic shock)
EIEC, ETEC, EPEC, EHEC

66
Q

EIEC
What does it invade?
What does it cause?
Presentation

A

“I = Invades Intestines”
Invades intestinal mucosa
Necrosis and inflammation
Presents like Shigella

67
Q

ETEC
What does it cause?
Toxin
Course

A

“T = Travelers”
Travelers Diarrhea (watery)
Labile toxin, Stable toxin
No inflammation or invasion

68
Q

EPEC
Presentation
Toxins
What does it do?

A

“P = Pediatrics”
Diarrhea in children
No toxin produced
adheres to apical surface, flattens villi, and prevents absorption

69
Q 
EHEC
Most common serotype 
Markers
PathoPhys
What does it lead to?
Toxin
Presentation
A

O157:H7
Does not ferment sorbitol (distinguish it from other E coli)
Swells endothelium –> narrowed lumen –> hemolysis, reduced renal blood flow. Damaged endothelium consumes platelets
Hemolytic Uremic Syndrome: Anemia, Thrombocytopenia, Acute Renal Failure
Shiga-like toxin. Dysentery (toxin alone causes necrosis and inflammation)

70
Q 
Klebsiella 
Markers 
Where is it normally?
What does it cause?
Classic presentation
A

“4As”
Aspiration pneumonia, Abscess in lungs and liver, Alcoholics, diAbetics
Gram- Rods. Lactose fermenter
Intestinal flora
Lobal pneumonia in alcoholics and diabetics when aspirated. Nosocomial UTIs
Red currant jelly sputum from polysaccharide capsule

71
Q 
Salmonella 
Markers, Flagella, Dissemination 
Reservoirs, Produces...
Antibiotic, Invasion?
Host response?
Presentation
A

Gram- rods. NonLactose fermenting Oxidase-
Flagella+, Disseminated hematogenously
Many animal reservoirs. Produces Hydrogen sulfide
Antibiotics prolong symptoms
Invades intestinal mucosa. Causes Monocytic response
Can cause bloody diarrhea

72
Q 
Shigella  
Markers, Flagella, Dissemination 
Reservoirs, Produces...
Antibiotic, Invasion?
Host response?
Presentation
A

Gram- rods. NonLactose fermenting Oxidase-
Flagella-. Cell-to-cell transmission. no hematogenous spread
Human and primate reservoirs. Does not produces Hydrogen sulfide
Antibiotics shorten excretion of organisms in feces
Invades intestinal mucosa. Causes PMN infiltration
Often cause bloody diarrhea

73
Q 
Salmonella Typhi
What does it cause?
Found in...
Presentation 
Carrier state?
A

Typhoid fever
Only in humans
Rose spots on the abdomen, fever, headache, diarrhea
Can remain in gallbladder and causes carrier state

74
Q 
Campylobacter jejuni 
Markers 
Presentation 
Transmission 
What follows it?
A

Gram- comma shaped oxidase+ that grows at 42 degs C
Bloody diarrhea in children
Fecal-oral transmission
Guillain Barre Syndrome and Reactive Arthritis

75
Q 
Vibrio Cholerae 
Markers
MoA 
Presentation 
Treatment
A

Gram- comma shaped oxidase+ that grows in alkaline media
Produces toxin that permanently activates Gs –> ↑cAMP
Rice-water diarrhea endemic in developing countries
Oral rehydration

76
Q

Yersinia enterocolitica
Markers
Transmission
Presentation

A

Gram- coccobacillus
Pet feces, contaminated milk, pork
Mesenteric adenitis that mimics Crohn’s or Appendicitis

77
Q 
Helicobacter pylori 
Markers 
What does it cause?
Increases risk for...
MoA
Treatment
A

Gram- rods. Doesn’t ferment lactose. Oxidase+, Urease+ (breath test)
Gastritis and duodenal ulcers
Risk factor for Peptic Ulcers, Gastric Adenocarcinoma, Lymphoma
Creates alkaline environment
PPI, Clarithromycin, Amoxicillin, or Metronidazole

78
Q

Spirochetes
Shape
Names
Visualization

A

Spiral shaped bacteria with axial filaments
“BLT”
Borrelia (big size), Leptospira, Treponema
Only Borrelia can be visualized using aniline dyes (Wright’s or Giemsa stain) in light microscopy
Treponema can be visualized by dark-field microscopy

79
Q

Leptospira Interrogans
Where is it found?
Presentation
Who gets it?

A

Water contaminated with animal urine
Leptospirosis: flu-like symptoms Jaundice, Photophobia w/ conjunctivitis
Surfers and in tropics (Hawaii)

80
Q

Weil’s Disease

A

Icterohemorrhagic leptospirosis: Severe jaundice and Azotemia from liver and kidney dysfunction, Fever, Hemorrhage and anemia

81
Q 
Lyme Disease 
Caused by...
Visualization 
Transmission 
Reservoir 
Location 
Presentation 
Treatment
A 
Borrelia burgdorferi 
Aniline dyes (Wright's or Giemsa stain) in light microscopy 
Tick Ixodes 
Mouse
NE USA
"FAKE a key lyme pie"
Facial nerve palsy (bilaterally), Arthritis, Cardiac Block, Erythema Migrans 
Doxycycline, Ceftriaxone
82
Q

Stages of Lyme Disease

A

1: Erythema chronicum migrans (bull’s eye) and flu like symptoms
2: Neurologic (facial nerve palsy) and cardiac (AV block) manifestations
3: Musculoskeletal (chronic monoarthritis and migratory polyarthritis), Neurological (encephalopathy and polyneuropathy), and cutaneous manifestations

83
Q

Syphilis
Caused by…
Visualization
Treatment

A

Spirochete Treponema pallidum
Dark field microscopy
PenicillinG

84
Q

Primary Syphilis
Presentation
Diagnosis

A

Localized disease presenting with painless chancre (with Treponema inside)
Screen with VDRL and confirm with FTA-ABS

85
Q

Secondary Syphilis
Presentation
Diagnosis

A

Disseminated disease w/ constitutional symptoms, maculopapular rash (palms and soles), Condylomata lata (with Treponema inside)
Screen with VDRL and confirm with FTA-ABS

86
Q

Tertiary Syphilis
What does it cause?
Presentation
Diagnosis

A

Gummas (chronic granulomas), Aortitis (vasa vasorum destruction), Neurosyphilis (tabes dorsalis), Argyll Robertson pupil
Broad-based ataxia, +Romberg, Charcot joint, Stroke w/o HTN
Test spinal fluid with VDRL

87
Q

Congenital Syphilis
Presentation
When does it happen?

A

Saber shins, Saddle nose, CNVIII deafness, Hutchinson’s teeth, Mulberry molars
After first trimester

88
Q

Argyll Robertson Pupil

A

Pupils constrict with accommodation but is not reactive to light
Associated with tertiary syphilis
“Prostitute’s pupil” accommodates but doesn’t react

89
Q

VDRL
What is it?
False+

A

VDRL detects non-specific antibodies that react with beef cardiolipin
“VDRL”
Viruses (mono, hepatitis), Drugs, RF, Lupus, Leprosy

90
Q

Jarisch-Herxheimer Reaction

A

Flu like syndrome in Syphilis pt immediately after antibiotics are started due to killed bacteria releasing pyrogens

91
Q

Cat Scratch

A

Cat scratch disease from Bartonella Spp

92
Q

Louse

A

Recurrent fevers from Borrelia recurrentis

Epidemic Typhus from Rickettsia Prowazekii

93
Q

Unpasteurized dairy

A

Brucellosis/Undulant fever from Brucella Spp

94
Q

Parrots and other birds

A

Psittacosis from Chlamydophila psittaci

95
Q

Cattle/sheep amniotic fluid

A

Q fever from Coxiella burnetii

96
Q

Lone Star Tick

A

Ehrlichiosis from Ehrlichia chaffeensis

97
Q

Ticks, Rabbits, Deer Fly

A

Tularemia from Francisella tularensis

98
Q

Animal bite, cats or dogs

A

Cellulitis, Osteomyelitis from Pastuerella multocida

99
Q

Dermacentor tick bite

A

Rocky Mountain Spotted Fever from Rickettsia Rickettsii

100
Q

Fleas

A

Endemic typhus from Rickettsia typhi

Plague from Yersinia pestis

101
Q 
Gardnerella vaginalis 
Markers 
Presentation 
Associated w/...
Histo
Treatment
A

“I don’t have a CLUE why I smell FISH in the VAGINA”
Pleomorphic gram variable rods
Vaginosis: gray vaginal discharge with fishy smell. Non painful
Associated with sexual activity but not an STD
Clue cell or vaginal epithelial cells covered with bacteria
Metronidazole

102
Q

Bacterial vaginosis

A

Overgrowth of certain bacteria in the vagina

103
Q 
Rickettsia rickettsii 
Gram
Where do they live 
Distribution 
What does it cause?
Presentation
A 
Gram-
Obligate intracellular that need CoA and NAD
All over USA
Rocky Mountain Spotted Fever 
Rash that starts at wrists and ankles
104
Q

Rickettsia
Markers
Where do they live?

A

Gram-. rod-to-coccoid shaped

Obligate intracellular organisms

105
Q

Rickettsia typhi
What kind of outbreak?
Vector
Presentation

A

Endemic
Fleas
Headache, fever, rash on trunk

106
Q

Rickettsia prowazekii
What kind of outbreak?
Vector
Presentation

A

Epidemic
Human body louse
Rash starts centrally and spreads out sparing soles and palms

107
Q

Palm and Sole Rash

A

“CARS driving with your palms and soles”

Coxsackievirus A, Rocky Mountain Spotted Fever, Secondary Syphilis

108
Q 
Ehrlichiosis 
Caused by...
Presentation 
Vector 
Histo
A

Ehrlichia (a kind of rickettsia)
No rash
Ticks
Monocytes with morula (berry-like inclusions) in cytoplasm

109
Q 
Anaplasmosis 
Caused by...
Presentation 
Vector 
Histo
A

Anaplasma (a kind of rickettsia)
No rash
Tick
Granulocytes with morula in cytoplasm

110
Q

Q fever
Vectors
What causes it?
Presentation

A

Tick feces and cattle placenta release spores that are inhaled by aerosols as spores. No arthropod vectors
Coxiella burnetii (closely related to rickettsia - obligate intracellular parasite)
Presents as pneumonia

111
Q 
Chlamydiae 
Markers 
Cell wall
What kind of infections 
Lab diagnosis?
Forms 
Treatment
A

Gram- Obligate intracellular parasite
Lacks Muramic Acid and Peptidoglycans
Mucosal infections
Cytoplasmic inclusions seen on Giemsa or Fluorescent Ab-stained smear
Elementary body (small, dense) is infectious and Enters cell via Endocytosis
Reticulate body Replicates in cell by fission. Form seen on tissue culture
Azithromycin (favored) or doxycycline

112
Q

Chlamydia trachomatis

A

Causes reactive arthritis, conjunctivitis, non-gonococcal urethritis, and PID

113
Q

Chlamydia pneumoniae and Chlamydia psittaci
Presentation
Transmission
Reservoir

A

Atypical pneumonia
Aerosol.
Psittaci notable for avian reservoir

114
Q

Chlamydia trachomatis

Serotypes

A

A,B,C: Africa, Blindness (follicular conjunctivitis), Chronic infections
D-K: Urethritis/PID, Ectopic pregnancy, Neonatal pneumonia (staccato cough), neonatal conjuntivitis
Neonatal acquired by passage through birth canal
L1,L2,L3: Lymphogranuloma venereum

115
Q 
Mycoplasma pneumoniae 
Markers 
Cell wall
Growth 
Titer
A

No Gram stain. No cell wall, Membrane contains sterols for stability
Eaton’s agar
Cold agglutinins (IgM) which can agglutinate or lyse RBCs

116
Q

Mycoplasma pneumoniae
Presentation
XR
Outbreaks

A

Walking pneumonia: insidious onset, headache, non-productive cough, diffuse interstitial infiltrate
XR looks worse than pt
Outbreaks in military recruits and prisons. Pts under 30

117
Q 
Bordetella pertussis
Markers 
Presentation 
Growth 
Treatment
A 
Gram - coccobacillus 
Whooping cough (staccato cough with deep inspirations)
Bordet-Gengou Agar
Pre whooping cough: Erythromycin 
Post whooping cough: Supportive care

USMLE (25 decks)

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