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First Aid, UWorld sets > micro- clin > Flashcards

micro- clin Flashcards

1
Q

common clinical presentation of actinomyces infection

  • what is the main differentiating factor from this infection vs the other bug that presents in the same region with a similar hx
A
  • is an anaerobic bug that is naturally found in the gut flora
  • cause disease when they get introduced into the submucosa during mechanical trauma i.e. a denal procedure
    • infectious disease most commonly involves the cervicofacial region
    • =chronic, nontender, indurated mass in the perimandibular area
    • will grow and evolve over time –> multiple abscesses and draining sinus tracts
    • HALL= sulfur granules (don’t actually contain sulfur, just look like it)
      • the abscesses will drain a grainy, sand like yellow pus, it contains the Actinomyces filaments and necrotic tissue in it as well

vs Staph aureus -the leading cause of acute suppurative permandibular/parotid infection

  • S. aureus will be firm, tender, and will progress rapidly
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2
Q

how would you classify the following sx:

  • “marked wknss in the distal M and moderate wkness in the proximal M of both legs. DTRs are absent”

what is the etiology of this presentation

A

this is describing symmetric, ascending weakness

  • Guillan Barre
    • endoneurial inflammatory infiltrate, as macrophages strip away myelin sheaths and the lipid laden macrophages are hanging out
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3
Q

what are the 3 big oppurtunisitc infections in HIV

  • when do you start prophylactic trx for each and what is the prophyaxis in each case
A
  1. P. jirovecci
    1. start @ CD4 < 200 OR after oral candida
    2. prophylaxix trx = TMP/SMX
  2. Toxoplasma gondii
    1. start @ CD4 < 100 or w (+) T. gondii IgG
    2. prophylaxix trx = TMP/SMX
  3. MAC (mycobacterium avium complex)
    1. start @ CD < 50
    2. prophylaxis trx = azithromycin/clarithromycin (macrolide) ± rifabutol
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4
Q

what are the big four bugs who don’t need a high concentration of organisms to causes ds (aka a small incolulum)

A
  1. Shigella (10+)
  2. C jejuni (~500 cells min)
  3. E histolytica (1-10)
  4. Giardia (1-10)
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5
Q
  • what abnormality is seen on this blood smear? what is it composed of?
  • what pathology is it often seen in?
A

reactive lymphocytes= atypical lymphocyte

  • an active, cytotocix T cell/NK cell that has formed in response to a specific infection
  • contains cytotoxic granzymes and perforins to kill (released in response to MHC I)

associated with infectious mono (EBV) >>>> HIV, CMV, toxo

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6
Q

what cells are these? name them, and use histo words to describe them

A
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7
Q

how does the influenza A virus undergo genetic shift?

what other viruses have this ability?

A

influenza A-

  • gene segment reassortment: its genes are in segments so if two segmented viruses meet in the body, they can trade segments and create recombinant viruses very easily
  • a lot easier to create new genetic changes than just point mutations in non-segmented viruses
  • segment recomb can lead to change in the capsule = antigenic shift

other segmented viruses

  • rotavirus = MC cause of diarrhea in kids and infants
    • (a type of reovirus)
  • orthomyxovirus = influenza viruses
  • bunyaviridae
    • arthropod viruses
    • hemorrhagic fever
    • hantavirus = fever, pulm edema, pulmonary fever
  • arenavirus
    • hemorrhagic fever, found in south america
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8
Q
  • what pathologic mechanism enables influenza to invade human cells
  • mechanism of antigenic change in influenza
  • how does an influenza strain that infects other animals become capable of infecting humans
A

influenza

  • MOI- mechanism of invasion
    • flu virus is an (-)RNA virus that is enveloped within a host derived plasma membrane
    • in order to interact with human cells, it needs a hemagglutinin (viral surface glycoprotein) that will allow it to attach to human epithelial cells (i.e. in the RT)
  • antigenic change
    • poor proofreading (by RNAdep, RNApol) –> antigenic drift
    • genetic segment rearrangment –> antigenic shift
  • antigenic change in the hemagglutinin that creates a tissue tropism for human epithelial cells will make the virus capable of infecting humans
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9
Q

which G+ species can cause impetigo?

which G+ species is PYR (+), which is PYR (-) ?

(pyrrolidonyl arylamindase)

A

impetigo

  • Staph aureus >>> group a strep

PYR(+) = Grp A strep

PYR (-) = Grp B strep

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10
Q

which two organisms use a toxin against elongation factor?

A

corynebacterium diptheriae

pseudomonas

=exotoxin A –> ribosylation of elongation factor

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11
Q

ALBENDAZOLE is not an “azole” antifungal!!!

what is it??

A

an antihelminthic used against cutaneous larva migrans = cutaneous, red brown snake-like tracks on the skin

-often at the feet

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12
Q

what is the MOA of the following:

  • influenza vaccine
  • amantadine
  • zanamavir, oseltamavir
A

vaccine makes Abs–>prevent entry into the cell by blocking the binding of hemagglutinin to the host cell

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13
Q

what organism is found on aniline dye

what process does its toxin prevent

A

C. diptheriae

-exotoxin A = an AB toxin that prevents protein synthesis via ribosylation of elongation factor 2

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14
Q

what are the organisms that are associated with infection following

  • cat bite
  • dog bite
  • human bite
  • farm animals
A

farm animals

  • brucella, coxiella,
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15
Q

MOA of the following disinfectants

  • alcohols
  • chlorhexidine
  • hydrogen peroxide
  • iodine
A
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16
Q

patients who undergo organ transplant followed by immunsuppressive therapy are at risk for developing what complication?

  • how can it present
  • what is the GI presentation, treatment, and AE of the trx
A
  1. re-activation of latent CMV infection with end organ ds
  2. this can present as CMV colitis, retininits, or pneumonitis
  3. CMV colitis
    1. fever, fatigue, LQ abd pain, diarrhea
    2. colonic mucosal ulcers w erythema
    3. histo= large cells w intranuclear inclusions (eosinophilic) and intracytoplasmic basophilic inclusions –>owl eye inclusions
  4. trx w IV ganciclovir
    1. AE= neutropenia and BM suppression
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17
Q

what are the 4 anti-folate antimicrobials ?

-what is the difference in MOA between the 4 of them?

A

antifolates

  1. sulfanomides
    1. stop (PABA–> dihydrofolic acid)
  2. TMP
    1. stop (dihydrofolic acid –>THF) via inhibition of DHF-reductase
    2. works against bacterial cells
  3. MTX
    1. stop (dihydrofolic acid –>THF) via inhibition of DHF-reductase
    2. works against host cells
  4. pyrimethamine
    1. stop (dihydrofolic acid –>THF) via inhibition of DHF-reductase
    2. works against protozoa = malaria and toxoplasma
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18
Q

describe what you are seeing

-most likely cause of fungal infection in an immunocompromised patient??

A

candida

= yeast and pseudohyphae on light microscopy

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19
Q

how is EBV transmitted

A

through saliva

aka kissing

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20
Q

treatment for gonorrhea vs chlamydia infection

A

gonorrhea = ceftriaxone

  • GONE SWIFT(ceft)er than an AXE

chlamydia = doxycycline or azyithromycin

  • lAZY day @ the CHLAM DOX (docks)
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21
Q

corkscrew shaped spirochete = ?

  • mechanism of transmission
  • important diagnostic sx
A

leptospirae

  • host in wild animals’ PCT and excreted in their urine –> transmitted to humans via contact w fresh water outdoors that has infected animal urine
  • mostly a flu-like illness with conjunctival suffusion = looks like conjunctivitis but without inflammation
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22
Q

discuss the specific pathology and etiology of cardiac complications of teritiary syphillis

A

tertiary syphillis (treponema infection)

  • associated w aortic regurge (decscrescendo murmur heard on the right sternal border during diastole)
  • start with vasa vasorum endarteritis –> aortic aneurysm –> aortic regurge + mediastinum widening
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23
Q
  • what is the mainstay trx of malaria
  • what is the trx for strains that are resistant to the mainstay- associated with what subtypes of malaria
A
  • mainstay = chloroquine
    • chloroquine + primaquine = P falciparum + P ovale
    • resistant to chloroquine = atovaquone + proguanil
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24
Q

common sx/PE findings in hand-foot-and-mouth ds

what is the causative organism? what other pathologies can it cause?

A

HFaM Ds= rash on “extremities” with buccal mucosa and soft palate ulcers

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25
Q

what is procalcitonin and how is it useful

A

an acute phase reactant

inc in response to bacterial toxin : dec in response to viral toxin

can be used to differentiate causes of CAP

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26
Q

what NTs are inhibited by tetanis and botulinism

A

tetanus = inhibit GABA and glycine = rigid

botulinism = inhibit Ach = floppy baby

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27
Q

what organism is this

(arrow is a huge hint)

how will it present and what are the other three version

A

schistosoma mansoni = LATERAL spine

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28
Q

what pathologic finding is seen here? dx?

A

plasmodium falciparum = malaria

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29
Q

what is the bull’s eye lesion associated with? what is the etiology?

what is the official PE finding?

A

lyme disease

spirochetes spreading through the dermis =

“annular erythematous lesion with central clearing” = erythema migricans

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30
Q

child with lacy, reticular rash on the trunk and extremities, develops red, flushed cheeks

A

red, flushed cheeks = slapped cheek rash

  • lacy, reticular rash

parvovirus B19 infection = erythema infectiosum

  • 5th disease= benign childhood ds
  • parvovirus B19 replicates in erythrocyte precursors in the BM
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31
Q

who are the double stranded DNA viruses

  • enveloped
  • non-enveloped
A
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32
Q
  • neonate born with hydrocephalus, jaundice, hepatosplenomegaly, retinal exudates
  • histo= numerous intracellular crescent shaped organisms

dx? why did this happen ?

A

toxoplasma gondii

  • pregnany women eat raw or undercooked meat –> intracellular toxo infection can be spread cross the placenta
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33
Q

what are the two types of disease that can be seen with salmonella

  • dif pathophysiologies that lead to the diff disease
  • clinical manifestations
A
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34
Q

vibrio vulnificus

  • transmission
  • clin picture
A
  • transmission= from consumption of raw oysters or wound contamination during water sports
  • clin picture= asx in healthy patients : in those w liver ds or iron overload, can cause rapid necrotizing fasciitis, septic shock, and death
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35
Q

asplenia is associated with increased risk of infection by what organisms

A

those with a polysaccharide capsule

  • Strep pneumoniae
  • H. influenzae
  • N. meningitidis

**the three bacteria who tell you exactly what they are going to do**

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36
Q

psuedomonas

  • found where
  • causes what clinical presentations
A

found in water sources like waterslides, hot tubs, etc.

  • folliculitis= red papules all over the body with central pustules
  • wound and burn infection
  • pneumonia (especialy in CF pts)
  • external otitis = swimmers ear
  • osteomyelitis (esp in diabetic pts and IVdrug users)
  • endotoxin–> fever and shock
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37
Q

what organism is seen here

what skin findings can it cause

A

staph aureus= grape like clusters

=skin and ST abscesses- colonize the anterior nares –> spread to the skin

  • =localized pustule that evolves into a painful nodule with a necrotic, purulent center with surrounding indurated erythema
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38
Q

patients receiveing parenteral nutrition from an parenteral cathether are at increased risk of what infection

A

candida (show up as yeast)

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39
Q

parvovirus is common in what population and presents how in

  • aduts
  • children
  • fetuses
  • sickle cell
A

parvovirus B19 is most common in children and school teachers (School outbreaks)

  • aduts
    • arthralgias, arthritis
    • with or without rash
  • children
    • slapped cheek rash that appears AFTER the break of fever
    • aka “erythema infectiousum” or ‘fifith ds”
  • fetuses
    • =TORCH
    • hydrops fetalis
    • x erythropoeisis –> profound anemia + ascites
  • sickle cell
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40
Q

what are the antifungal actions of

  • amphotericin B
  • nystatin
  • azoles
  • echinocandins
  • pyrimidines
  • griseoulvin
A
  • amphotericin B
    • bind to ergosterol–> create pores–> cell lysis
  • nystatin
    • bind to ergosterol–> create pores–> cell lysis
  • azoles
    • inhibit the synthesis of ergosterol
  • echinocandins
    • i.e. caspoFUNGIN
    • inhibit synthesis of GLUCAN = in cell wall
  • pyrimidines
    • = flucytosine
    • converted to 5-FU in the cell wall –> interfere with fungal protein and RNA synthesis
  • griseoulvin
41
Q

differentiate between phenotype mixing and genetic reassortment vs recombination in viruses

A

phenotypic mixing: the F2 generation will go back to normal

reassortment: F2 maintains the mutations because there was actual GENETIC changes when two different SEGMENTED viruses coinfect a cell
recombination: non-segmented viruses infect the same host and HOMOLOGOUS genetic segments undergo recombination

42
Q

zika virus

  • family of viruses and transmission
  • clinical features
  • dx
A
43
Q

most cases of gas gangrene from Clostridium are triggered by underlying what

A

colonic malignancy

44
Q

the efficacy of maraviroc is dependent on the presence of what in the viral strain

how is enfuvirtide different

A

maraviroc stops the binding of virus to host cell but it requires the virus to target CCR5

  • if the virus uses CXCR4, maraviroc is not effective

enfuvirtide = an HIV fusion inhibitor that works on both lymphocytes and macrophages and will work either way

45
Q

first line antiretroviral therapy can lead to what complications

A

tenofovir-induced nephropathy

  • hypophosphatemia, glucosuria proteinuria, abn biopsies
  • –> AKI and proximal tubule dysfunction
  • –> loss of brush border, stripping of the BM, giant mitochondria (look like giant eosinophilic inclusions)
46
Q

AE of TMP-SMX

A

can cause

  • drug induced lupus
  • steven johnson
  • hemoltic anemia in pts with G6PD
  • folate deficiency with prologned use
  • kidney damage
    • x Na-K channels in distal tubule and collectid ducts –> hyperK
    • especially in eldery, those on K-sparing diuretics, and on ACE-inhibs/ARBs
47
Q

which anti-retroviral drug is conraindicated in pt’s with an HLA-B*57.01 allele

what antiretrovirals can cause rash

A

certain HLA gene -> ABACAVIR is contra

  • –>type IV delayed hypersensitivity rxn (cytotoxic T cell mediated)
  • fever, malaise, GI sx, delayed rash

rash associatied with abacavir and emtricitabine

48
Q

C.perfringens can cause what two clinical pictures

A

gas gangrene

transient, waterry diarrhea

49
Q

histopath of syphillis induced gential lesions classically shows what

A

proliferative endarteritis of small vessels with surrounding plasma-cell rich infiltrate

50
Q

mucor histo appearance and clin sx

A

fever, HA

eye pain/nasal pain = rhinocerebral infection

black necrotic eschars on inferior turbinates

MUCOSAL BIOPSY= shows ribbon like, NONseptate hyphae w 90 degree angle branching

51
Q

(+) heterophile Ab test is highly specific for infection with what

A

EBV

=heterophile IgM Abs

52
Q

long term PPI usage can inc risk for what type of bacteria

A

acid labile bacteria -

long term PPI –> achlorydia = dec acidity in stomach

-better survivability of bacteria like V. cholerae, who would have been killed by acidic stomach conditions

53
Q

adverse effects of anti-retroviral protease inhibitors

A

“navir”s

  • lipodystrophy = central obesity and peripheral wasting
  • hyperglycemia = inc insulin resistance
  • inhib CYP450
54
Q

rotavirus

  • type
  • clin presentation
  • pathophys
A

rotavirus

  • segmented, dsRNA, nonenveloped
  • clin presentation=
    • MC cause of infectious diarrhea worldwide
    • associated with kids <5 yo
    • self-limited fever and waterry diarrhea, may lead to dehydration and electrolyte abnormalities
  • pathophys
    • invades villous epithelium of duodenum and proximal jejunum
    • diarrhea associated with villous blunting, proliferation of secratory crypt cells, reduced brush border enzymes
55
Q

toxic shock syndrome is caused by activation of what cells

A

T cells and macrophages

56
Q

virulence factors of listeria

A
57
Q

organism?

A

aspergillus

big arrow= acute angle branching

thin arrows= septations

58
Q

treatment of atypical pneumoniea - MOA

A

need a bacterial protein synthesis inhibitor

  • macrolide or tetracycline
  • (bc these organisms don’t have a cell wall - Listeria, chlamydiae, mycoplasma)
59
Q

acyclovir, gancyclovir MOA

A

a nuceloside analog = inhibit incorporation of pyrimidines and purines into newly replicated DNA

60
Q

tender “cauliflower-shaped, verrucous growths” on peri-anal skin with papillary squamous proliferation and perakeratosis irregularity

= ? : ds associations and risk factors?

A

condyloma acuminata = anogenital warts

61
Q

what organisms requires a medium with vancomycin, colistin, nystatin, and trimethoprim to grow?

A

=thayer martin medium

= neisseria

62
Q

differentiate the role of the liver in the life cycle of P vivax+ovale vs P falciparum

how does this effect trx

A

mefloquine prophylaxis needs to be started before going to Africa and for 4 weeks upon return as the bug is released from the liver and into the blood stream

  • bc drug is inactivated in the liver and only works in RBCs

P v+o –> liver is site of dormant hypnozoites

P f –> liver is site of maturing, NONdormant schizonts

63
Q

what types of cells are seen on stool microscopy in watery diarrhea vs dysentery vs enteric fever

A
64
Q

what is the most important virulence factor of staph epidermidis

A
65
Q

respiratory infection in an immunocompromised host and/or pt with neutropenia has high probabilty of being what?

how do you differentiate between the different possible agents?

A

oppurtunistic fungal infection of the respiratory tract

  • yeast= single celled growth, replication = budding
    • candida, crypto, pneumocystis,
  • mold = filaments and hyphae
    • aspergillus, mucor, rhizopus
66
Q

which protozoa appear as appear as cysts and which appear as trophozoites on culture

A

= giardia : multinucleated trophozyte

= E. histolytica : trophozoite with engulfed RBC

= plasmodium= ring of trophozoites w/in an RBC

=babesia = maltese cross of trophozoites w/in an RBC

= trichomonas vaginalis= motile trophozoite

= naegleri fowleri = motile trophozoite

  • present with primary amoebic meningoencephalitis, mostly fatal
67
Q

increased risk of Neisseria is associated with defieciency in what immune process

A

formation of MAC

**asplenia = n meningitidis SPECIFICALLY + H. influenzae + S. pneumo

68
Q

clin use of trimethoprim-sulfamethoxazole

  • MOA of TMP, SMX
  • what other drug has the same MOA as SMX
  • AE of TMP
  • AE of SMX
A

CLIN USE=

  • 1st line for UTIs + acute prostitis
  • Shigella, Salmonella trx
  • Pneumocystis jiroveci pneumonia trx AND prophylaxis
  • toxo prophylaxis
  • MOA of TMP, SMX
    • anti-folates
    • SMX= PABA analog, inhibit dihydropteroate synthase
    • TMP= inhibit dihydrofolate reductase to stop dihydrofolic acid from become tetrahydrofolic acid
  • what other drug has the same MOA as SMX
    • dapsone= trx leprosy and prophylaxis for pneumocystis
  • AE of TMP
    • megaloblastic anemia, leukopenia, granulocytopenia
  • AE of SMX
    • hypersensitivity
    • hemolysis in G6PD
    • nephrotoxicity + T4 RTA
    • photosensiticvity
    • steven-johnson
    • kernicterus in infants
    • displace other drugs from albumin (i.e. warfarin)
69
Q

doxycycline is indicated when

A
  • borrelia burgdorferi lyme
  • M. pnemoniae atypical pnuemoniea
  • rickettsia
  • chlamydia
  • MRSA
  • coxsackie
  • tickborne ds and zoonotic ds
70
Q

indication for chloramphenicol

A

meningitis IN THE DEVELOPING WORLD

=H. flu, N. meningitidis, S. pneumo

71
Q

clindamycin clin indications

A

anaerobic infections ABOVE the diaphragm

vs. metronidazole= anaerobic infections below the diaphragm

  • b. fragilis - oral infections + aspirations
  • C. perfringens = infect open wounds
  • acne caused be skin anaerobes
  • ASPRIATION PNEUMONIA –> LUNG ABSCESS
    • v good for anaerobic infections because it is actively transported into Macrophages –> lung abscesses
  • invasiv Group A strep = skin and ST tissue infection/cellulitis
72
Q

1st line drugs against MRSA

not 1st line drugs but work …

A

vancomycin (PGP cell wall)

+ daptomycin (cell membrane integrity)

+ linezolid (50S inhib = translation)

not 1st line= doxycycline, clindamycin

73
Q

H.pylori triple therapy =

A

clarithromycin, amoxicillin, PPI

74
Q

linezolid indications

A

MRSA

VRE (vancomycin resistant enterococcus)

75
Q

macrolides indication

A

i= ACE-mycin (azithro, clarithro, erythro)

  • atypical pneumoniae (mycoplasma, chlamydia, legionella)
  • STI (chlamydria urethritis/cerviticties)
  • B. pertussis
  • CAP = H. flu, S. pneumo, Moroxella, cattarhalis
76
Q

gentamicin indication

what is an absolute contraindication to the use of gentamicin and other aminoglyclosides

A

most gentle teacher for most difficult kids

  • enterobacter, serratioa, klebsiella - nosocomial infiection
  • septicemia, complicated UTI, intra-abd infection, osteopmyelitis
  • pseudomonas (along with tubramycin and amikicin)
  • enterococcus caused endocarditis and UTI

absolute contra = myasthenia gravis (can cause neuromuscular blockade, which would be esp bad for an MG pt)

77
Q

ceftriaxone indication

A

(3rd gen cephalosporin)

  • neisseria meningitis and gonnorrhea
  • neonatal meningitits
    • -MC from H flu, Strep pneumo, or E Coli
78
Q

which cephalosporin has activity against pseudomonas

A

cefepime

79
Q

pts w CGD have inc infection with what organisms

A

catalase (+)

mona lisa and gillian, serenaded and staffed, playing cards and discussing their new band “Cats Gonna Dance”

  • pseudomonas, aspergillus, serratia, staph aureus, nocardia,
80
Q

RNA viruses

who are

  • (+) helix?
  • (+) icosohedral?
  • (-) icosohedral>
  • dsRNA?
A
  • (+) helix?

coronavirus (Rona, SARS)

  • (+) icosohedral?

!!!!!! enveloped !!!!!

retrovirus= HIV, HTLV

flavivirus= HCV, yellow fever, dengue, zika, st.louis encephalitis + west nile

toga virus = rubella, arbociruses (equine), chicangunya

!!!!!!!naked!!!!!!!!!!!

calicivirus = norwalk

hepevirus = Hep E

picornovirus = rhinovirus (cold), polio, HAV, echovirus, coxsackie

  • (-) icosohedral

!!!!!!!!!enveloped!!!!!!!!!!!

bunyavirus (CA encephalitis, hantavitus+congo fever –> hemorrhagic fever)

filovirus= ebola, marburg

arenavirus= lassa fever encephalitis, lymphocytic choriomeningitis virus

deltavirus= HDV

paramyxovirus= rubeola (measles), mumps, RSV, parainfluenza (croup)

rhabdovirus= rabies

orthomyxovirus= influenza

  • dsRNA?

reovirus = colorado tick fever and rotavirus (watery diarrhea in children, can be fatal)

81
Q

causes of childhood rashes

A

rubella = togavirus

move head to feet, seperate spots

associated w cervical and periauricular LAD

rubeola measles= paramyxovirus

head to feet, coalescing

cough, conjunctiva, coryza (runny nose)

roseola, HHV6

infants = neck and face : adults= trunk and limbs

appears AFTER a fever that is broken

parvovirus B19 = DNA parvovirus

slapped cheek

strep pyogenes –> scarlet fever

head and neck –> trunk, sand paper like red rash

associated w sore throat

82
Q

which 3 infections cause rashes that involve the hands hand feet

A

secondary syphillis - treponema pallidum (maculopapular rash all over and condyloma lata)

rocky mountain spotted fever : start at ankle and wrists and then spread to trunk, palms, and soles

hand, foot, and mouth ds : coxsackie A virus, sore throat+buccal vesicles –> rash on hands, feet, and butt

83
Q

which infections cause hemorrhagic fever

A

BUNYAVIRUS

  • rift valley fever virus (mosquito bite)
  • crimean-congo HF virus (tick)
  • hantavirus (rodents)

FILOVIRUS

  • ebola, marburg

ARENAVIRUS

  • lassa fever virus (rats)

YELLOW FEVER/DENGUE can be a complication

84
Q

encephalitis causing viruses

A

flaviviruses : st. louis encephalitis, west nile virus

  • associated birds

togavirus: E+W equine virus

  • birds

bunyavirus: california encephalitis

  • rodents
85
Q

which two bacteria are associated with gallbladder

A

salmonella and C. sinensis (SEAgull, Cgull)

  • salmonella colonizes the GB–> carrier state
    • rose spots on abd, pea soup diarrhea,
    • undercooked chicken
  • C. sinensis –> biliary tract inflammation
    • pigmented gallstones, cholangiocarcinoma
    • undercooked fish
86
Q

what are the 3 structural genes in HIV, and the proteins they encode for (+function)

which are targeted by antiretroviral therapy

A
  • env
    • gp120 - attachment to host CD4 cell (along w with CCR5 on macrophage or CXCR4 on T cell)
      • x maraviroc
    • gp41= fusion and entry into host cells
      • x enfuvirtide
  • gag
    • p24 capsid protein and p17 matrix protein
  • pol
    • reverse transcritase, aspartate protease, integrase
    • x (rest of antiretroviral drugs)
87
Q

which two serum markers can be seen during the window period of HBV

order of markers and what they mean?

A

anti-Hbe, antiHBc (IgM

SpECIES

88
Q

what are the 5 stages of untrx HIV infection

A
  1. window period (~ 1 month)
    1. primary infection: when your CD4 cells first start t drop and HIV RNA replication begins
    2. before sx
  2. acute infection (~1 month)
    1. flu-like sx
  3. clinical latency (months to years)
    1. virus is replicated in LNs
    2. CD4 levels are above 200, Abs have formed against gp120,
  4. falling count
    1. CD4 levels plummet, HIV RNA skyrockets
    2. skin and mucus membrane infections occur
  5. final crisis
    1. max HIV RNA, min CD4 count
    2. AIDS defining illnesses occur,
    3. lead to death
89
Q

illnesses seen in AIDS with..

  • CD4 < 500
  • CD4 <200
  • CD4 <100
A
  • CD4 < 500
    • oral candida, EBV, HHV-8, HPV
  • CD4 <200
    • hisoplasma, HIV, JC virus, pneumocystis jiroveci
  • CD4 <100
    • aspergillus, bartonella henslae, candida albicans, CMV, cryptococcus neoformans, cryptosporidium, EBV, MAC, toxoplasma gondii
90
Q

which viruses replicate inside the nucleus? which outside?

exceptions

A

in general - DNA viruses replicate inside the nucleus, RNA viruses outside the nucleus

exceptions:

poxviridiae = DNA virus replicate OUTSIDE

orthomyxoviridaie and retroviridae = RNA viruses that replicate inside

  • orthodontist: make octupus babies INSIDE the helmet
91
Q

clin presentation of Coccidioidis immitis

A

“valley fever”

92
Q
A

enterovirus is the cause of >90% migraines

93
Q
A
94
Q

which organisms infect the nasopharynx (primary site of infection) and cause meningitis?

which species’ primary site of infection is the oral cavity

A

oral cavity = candida

nasopharynx= strep pneumo, N meningitidis, H. influenzae

95
Q
A
96
Q
A
97
Q

biopsy findings in

  • primary TB
  • latent TB
  • secondary TB
  • miliary TB
A
  • primary TB
    • lower lobe cavitation
  • latent TB
    • ghon complex= lower lobe calcification and hilar LB calcification
  • secondary TB
    • lung apex cavitation / upper lobe
  • miliary TB
    • caseous cavitations throughout lung and liver
98
Q
A

First Aid, UWorld sets (15 decks)

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