micro- clin Flashcards
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
- 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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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
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
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
- P. jirovecci
- start @ CD4 < 200 OR after oral candida
- prophylaxix trx = TMP/SMX
- Toxoplasma gondii
- start @ CD4 < 100 or w (+) T. gondii IgG
- prophylaxix trx = TMP/SMX
- MAC (mycobacterium avium complex)
- start @ CD < 50
- prophylaxis trx = azithromycin/clarithromycin (macrolide) ± rifabutol
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what are the big four bugs who don’t need a high concentration of organisms to causes ds (aka a small incolulum)
- Shigella (10+)
- C jejuni (~500 cells min)
- E histolytica (1-10)
- Giardia (1-10)
- what abnormality is seen on this blood smear? what is it composed of?
- what pathology is it often seen in?
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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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what cells are these? name them, and use histo words to describe them
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how does the influenza A virus undergo genetic shift?
what other viruses have this ability?
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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- 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
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
which G+ species can cause impetigo?
which G+ species is PYR (+), which is PYR (-) ?
(pyrrolidonyl arylamindase)
impetigo
- Staph aureus >>> group a strep
PYR(+) = Grp A strep
PYR (-) = Grp B strep
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which two organisms use a toxin against elongation factor?
corynebacterium diptheriae
pseudomonas
=exotoxin A –> ribosylation of elongation factor
ALBENDAZOLE is not an “azole” antifungal!!!
what is it??
an antihelminthic used against cutaneous larva migrans = cutaneous, red brown snake-like tracks on the skin
-often at the feet
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what is the MOA of the following:
- influenza vaccine
- amantadine
- zanamavir, oseltamavir
vaccine makes Abs–>prevent entry into the cell by blocking the binding of hemagglutinin to the host cell
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what organism is found on aniline dye
what process does its toxin prevent
C. diptheriae
-exotoxin A = an AB toxin that prevents protein synthesis via ribosylation of elongation factor 2
what are the organisms that are associated with infection following
- cat bite
- dog bite
- human bite
- farm animals
farm animals
- brucella, coxiella,
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MOA of the following disinfectants
- alcohols
- chlorhexidine
- hydrogen peroxide
- iodine
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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
- re-activation of latent CMV infection with end organ ds
- this can present as CMV colitis, retininits, or pneumonitis
- CMV colitis
- fever, fatigue, LQ abd pain, diarrhea
- colonic mucosal ulcers w erythema
- histo= large cells w intranuclear inclusions (eosinophilic) and intracytoplasmic basophilic inclusions –>owl eye inclusions
- trx w IV ganciclovir
- AE= neutropenia and BM suppression
what are the 4 anti-folate antimicrobials ?
-what is the difference in MOA between the 4 of them?
antifolates
- sulfanomides
- stop (PABA–> dihydrofolic acid)
- TMP
- stop (dihydrofolic acid –>THF) via inhibition of DHF-reductase
- works against bacterial cells
- MTX
- stop (dihydrofolic acid –>THF) via inhibition of DHF-reductase
- works against host cells
- pyrimethamine
- stop (dihydrofolic acid –>THF) via inhibition of DHF-reductase
- works against protozoa = malaria and toxoplasma
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describe what you are seeing
-most likely cause of fungal infection in an immunocompromised patient??
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candida
= yeast and pseudohyphae on light microscopy
how is EBV transmitted
through saliva
aka kissing
treatment for gonorrhea vs chlamydia infection
gonorrhea = ceftriaxone
- GONE SWIFT(ceft)er than an AXE
chlamydia = doxycycline or azyithromycin
- lAZY day @ the CHLAM DOX (docks)
corkscrew shaped spirochete = ?
- mechanism of transmission
- important diagnostic sx
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
discuss the specific pathology and etiology of cardiac complications of teritiary syphillis
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
- 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
- mainstay = chloroquine
- chloroquine + primaquine = P falciparum + P ovale
- resistant to chloroquine = atovaquone + proguanil
common sx/PE findings in hand-foot-and-mouth ds
what is the causative organism? what other pathologies can it cause?
HFaM Ds= rash on “extremities” with buccal mucosa and soft palate ulcers
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what is procalcitonin and how is it useful
an acute phase reactant
inc in response to bacterial toxin : dec in response to viral toxin
can be used to differentiate causes of CAP
what NTs are inhibited by tetanis and botulinism
tetanus = inhibit GABA and glycine = rigid
botulinism = inhibit Ach = floppy baby
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what organism is this
(arrow is a huge hint)
how will it present and what are the other three version
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schistosoma mansoni = LATERAL spine
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what pathologic finding is seen here? dx?
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plasmodium falciparum = malaria
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what is the bull’s eye lesion associated with? what is the etiology?
what is the official PE finding?
lyme disease
spirochetes spreading through the dermis =
“annular erythematous lesion with central clearing” = erythema migricans
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child with lacy, reticular rash on the trunk and extremities, develops red, flushed cheeks
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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who are the double stranded DNA viruses
- enveloped
- non-enveloped
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- neonate born with hydrocephalus, jaundice, hepatosplenomegaly, retinal exudates
- histo= numerous intracellular crescent shaped organisms
dx? why did this happen ?
toxoplasma gondii
- pregnany women eat raw or undercooked meat –> intracellular toxo infection can be spread cross the placenta
what are the two types of disease that can be seen with salmonella
- dif pathophysiologies that lead to the diff disease
- clinical manifestations
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vibrio vulnificus
- transmission
- clin picture
- 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
asplenia is associated with increased risk of infection by what organisms
those with a polysaccharide capsule
- Strep pneumoniae
- H. influenzae
- N. meningitidis
**the three bacteria who tell you exactly what they are going to do**
psuedomonas
- found where
- causes what clinical presentations
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
what organism is seen here
what skin findings can it cause
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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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patients receiveing parenteral nutrition from an parenteral cathether are at increased risk of what infection
candida (show up as yeast)
parvovirus is common in what population and presents how in
- aduts
- children
- fetuses
- sickle cell
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