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AM- STEP1 > Micro Review > Flashcards

Micro Review Flashcards

1
Q

Branching rods on oral infection

A

Actinomyces israelii

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2
Q

HHV-8

A

Kaposi sarcoma

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3
Q

EBV associated iwth

A

Hodgkin lymphoma
(Reed-sternberg cells)

Burkitt lymphoma
(starry sky, 8;14)

Nasopharyngeal carcinoma

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4
Q

Streptococcus bovis assoc with

A

Colon cancer

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5
Q

Schistosoma haematobium assoc with

A

Squamous cell cancer of bladder

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6
Q

Clonorchis sinensis assoc with

A

Biliary cancer

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7
Q

Enveloped viruses spread

A

Droplets perientrally or sexually

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8
Q

Non-enveloped viruses spread

A

Fecal oral spread

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9
Q

Non-enveloped RNA viruses

A

“my Real Heavy Picture of California was Ruined without an Envelope”

Reovirus
Hepevirus
Picornavirus
Calicivirus

New ERs Helps People Receive Care

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10
Q

Non-enveloped DNA viruses

A

“PaPa and Aunt Poly Didnt have an Envelop”

Parvovirus
Papillomavirus
Adenovirus
Polyomavirus

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11
Q

DNA viruses typically replicate

A

In the nucleus

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12
Q

RNA viruses typically replicate

A

in the cytoplasm

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13
Q

DNA viruses that replicate in the cytoplasm

A

Smallpox virus

Molluscum contagiosum

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14
Q

RNA viruses that replicate in the nucleus

A

Orthomyxovirus (Influenza virus)

Retroviruses

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15
Q

Viral recombination where two viruses exchange entire segment

  • example
  • only what
A

Viral reassortment

RNA viruses only

Influenza virus

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16
Q

When two different viruses infect same host a genes are exchanged from two different chromosomes

A

Viral recombination

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17
Q

When two viruses infect a cell and one is non-functional so other virus makes a functional protein that serves both viruses

A

Viral Complementation

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18
Q

When two viruses infect the same host and the progeny receive surface proteins from either parent

A

Phenotypic mixing

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19
Q

Ploidy of viruses

A

All RNA and DNA viruses are haploid

Except: retroviruses (2) of ssRNA

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20
Q

DNA viruses

  • examples
  • typical features
  • exceptions
A

HAPPy HiPPo Dung

HHAPPPPy

Herpesvirus
Adenovirus
Parvovirus
Papillomavirus
Hepadnavirus
Polyomavirus
Poxvirus
DNA

Linear dsDNA
Icosahedral shape
Replicate in nucleus

Only parvoviridae (ssDNA)

Papillomarvirus (circular)
Polyomavirus (circular)
Hepadnavirus (circular)

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21
Q

RNA viral genomes

A

(+) stranded RNA viruses

I went to a RETRO TOGA party, where I drank FLAvored CORONA and ate HIPPIE CALIfornia PICkles

Retrovirus
Togavirus
Flavivirus
Coronavirus
Hepevirus
Calicivirus
Picornavirus

All ssRNA except reoviridae (dsRNA)

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22
Q

Negative-sense ssRNA

A

Not immediately translated

Can only be transcribed and not directly translated

Bring along viral transcriptase

Always Bring Polymerase Or Fail Replication

Arenaviruses
Bunyaviruses
Paramyxoviruses
Orthomyxoviruses
Filoviruses
Rhabdoviruses
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23
Q

dsRNA brings along what

A

Polymerase

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24
Q

Live attenuated vaccine

A

“Attention Teachers” Please Vaccinate Small Beautiful Young Infants with MMR Regularly

Adenovirus
Typhoid
Polio (Oral)
Varicella
Small pox
BCG
Yellow fever
Influena (intranasal)
MMR
Rotavirus
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25
Q

Killed vaccine

A

RIP Always

Rabies
Influenza (injection)
Polio (injectable)
Hepatitis A

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26
Q

Subunit vaccines

A

Use specific viral antigens to stimulate immune response

hepatitis B
HPV

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27
Q

Egg allergy

A

Yellow fever
Influenza

(MMR)

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28
Q

When should live virus vaccines be considered for HIV positive patients

A

All infants with HIV
- Rotavirus vaccine

CD4 count > 200

  • MMR
  • Varicella vaccine

Not recommended

  • Live virus influenza vaccine
  • Herpes zoster vaccine
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29
Q

What condition is suggested by each of the following

  1. Signet ring cells
  2. Nutmeg liver
  3. RBC casts in urine
A
  1. Gastric adenocarcinoma, lobular carcinoma in situ of breast
  2. Right sided heart failure and budd-chiari
  3. Acute glomerulonephritis
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30
Q

Infects spindle cells

A

HHV-8 Kaposi sarcoma associated herpesvirus (KSHV)

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31
Q

Temporal lobe encephalitis

A

Herpes simplex virus 1 (HSV-1)

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32
Q

Tzanck smear

A

Multinucleated giant cells positive

HSV-1, HSV-2, VZV

Low specificity
Low sensitivity

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33
Q

Intranuclear eosinophilic inclusions

A

Type A Cowdry bodies

HSV, VZV, CMV

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34
Q

EBV infects what cells

causes what

cell type seen

A

Infects B cells

Causes T cell response

Downey cells
- Foamy appearing basophilic cytoplasm

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35
Q

Foamy appearing cells with basophilic cytoplasm

A

Downey cells

T cells

EBV

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36
Q

Fever
Sorethroat
LAD of posterior cervical nodes
Splenomegaly

(+) monospot test

A

Infectious mononucleosis

EBV

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37
Q

Ab against antigens found on horse, sheep and beef RBCs

A

Monospot test

Detects heterophiles

EBV

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38
Q

Heterophile (-) mononucleosis

A

CMV infection

Acute HIV

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39
Q

Owl eye nuclear inclusions

A

CMV

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40
Q

Retinitis blind within days

A

CMV w/ AIDS

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41
Q

HIgh fever (102) 3-5 days
Fever breaks
Maculopapular rash all over body
Seizures

A

Roseola
Sixth disease

Human Herpes virus -6

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42
Q

What group of patients is prone to esopahgitis caused by CMV

A

HIV patients (CD4 < 50)

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43
Q

Child with bright red rash on cheeks

A 
Slap cheek rash
Erythema infectiosum (fifth disease)

Parvovirus B19

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44
Q

Upper respiratory infection
Then conjunctivitis
Diarrhea

A

Adenovirus

dsDNA virus

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45
Q

Variola poxvirus vs vaccinia pox virus

A

Variola poxvirus
- smallpox

Vaccinia poxvirus
- cowpox

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46
Q

Flesh colored dome shaped lesions with central dimple (umbilication)

A

Molluscum contagiosum

In immunocompetent will resolve in less than a year

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47
Q

Demyelination of DNA due to destruction of oligodendrocytes

AIDS

Progressive

Visial symptoms

A

Progressive Multifocal leukoencephalopathy

JC virus
Polyomavirus

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48
Q

Only Hepatitis virus dsDNA

A

Hepatitis B virus

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49
Q

Hepatitis B virus is what type of virus

A

Hepadnavirus

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50
Q

Hepatitis B virus replication

A

dsDNA virus

Partially double-stranded circular DNA enter nucleus

Host polymerase makes RNA intermediate from dNA

Viral reverse transcriptase makes DNA from RNA intermediate

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51
Q

Hides in sensory ganglia of S2 S3

Hides in trigeminal ganglia

Hides in dorsal root ganglia

A

HSV-2

HSV-1

VZV

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52
Q

Opacities seen on X ray on both sides of carina

A

Bilateral hilar lymphadenopathy

Sarcoidosis

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53
Q

Common cold

A

Rhinovirus

Coronavirus

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54
Q 
Severe diarrhea and vomiting
Winter months
Daycare center
Non-enveloped
dsRNA virus
A

Rotavirus

type of reovirus

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55
Q

Western US/ canada
Hiker, Fisherman, camping
Flu- like

A

Coltivirus
(type of reovirus)

Self limiting

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56
Q

Types of picornaviruses

A

PERCH

Enterovirus

  • Poliovirus
  • Coxsackievirus
  • Echovirus
  • Hepatitis A virus

Rhinovirus

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57
Q

Types of enteroviruses

- labeled as

A

Enterovirus falls under Picornaviruses

Spread through enteric system

4 types

  • Poliovirus
  • Coxsackievirus
  • Echovirus
  • Hepatitis A virus
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58
Q

Poliovirus

A

Infects grey matter of the anterior horn of the spinal cord and motor neurons of the pons of the medulla

Causes paralysis

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59
Q

Aseptic meningitis
Myocarditis
URIs

Summer

-Diagnosis?

A

Echovirus

PCR of CSF

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60
Q

Hand foot and mouth disease

A

Coxsackievirus

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61
Q

Most common cause of viral myocarditis in US

features of disease (5)

A

Coxsackievirus

Dilation of all chambers
Dyspnea
Chest pain
Fever
Arrhythmias
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62
Q

Mouth blisters, fever

A

herpangina

Coxsackievirus

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63
Q

Coxsackievirus can cause

A 
Myocarditis
Aseptic meningitis
Pericarditis
herpangina (blisters mouth and fever)
Hand, foot and mouth disease
Febrile pharngitis
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64
Q

Picornavirus that is not an enterovirus

A

Rhinovirus

Common cold

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65
Q

Vomiting and diarrhea

Cruise ship

A

Norovirus (caliciviruses)

Fecal oral route

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66
Q

Types of flaviviruses

A 
Yellow fever
Dengue fever
West nile virus
St. Louis Encephalitis virus
HCV

Most are arboviruses
(spread by arthropod)

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67
Q 
High fever, HA
Epistaxis
Gum bleeding
petechial and purpura
Black vomit
Jaundice
Africa

Spread by?

A

Yellow Fever

Aedes mosquitoes

Liver damage

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68
Q

Fever
Severe musculoskeletal pain
Retro-orbital headache

Spread by?
Can get?
Test?

A

Dengue fever

Mosquito

Hemorrhagic fever

Tourniquet test

  • field test for hemorrhagic fever
  • BP inflated leave 5 min
  • Excess petechiae
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69
Q 
Headache
Malaise
Backpain
Myalgia
Anorexia
Alteration in consciousness
Neck stiffness
A

West Nile virus (WNV)

Mosquito

Serology for IgM anti-WNV antibodies

Tx supportive

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70
Q

A 26-year-old woman has headaches for 4 weeks
along with increasing malaise. Physical examination yields
no remarkable findings. CT scan of the head shows no
abnormalities. A lumbar puncture yields clear, colorless CSF
with a normal opening pressure. Laboratory analysis of the
CSF shows a normal glucose concentration and a minimally
increased protein level. A few lymphocytes are present,
but there are no neutrophils. A Gram stain and India ink
preparation of the CSF are negative. Her condition gradually
improves over the next 6 months. Serum serologic tests are
most likely to show an elevated titer of antibodies to which
of the following infectious agents?
A Cryptococcus neoformans
B Echovirus
C Listeria monocytogenes
D Neisseria meningitidis
E Toxoplasma gondii

A

B. Echovirus

Acute lymphocytic meningitis

West nile
Echovirus

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71
Q

Togaviruses

A

Rubella virus

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72
Q

Fever Lymphadenopathy
Arthralgia
Macuopapular rash

A

Rubella or german measles

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73
Q

Congenital rubella

A

Cardiac defects

  • PDA
  • Pulmonic stenosis

Cataracts
Deafness

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74
Q

11 A 6-year-old girl has a blotchy, reddish-brown rash
on her face, trunk, and proximal extremities that developed
over the course of 3 days. On physical examination, she has
0.2-cm to 0.5-cm ulcerated lesions on the oral cavity mucosa
and generalized tender lymphadenopathy. A cough with
minimal sputum production becomes progressively worse
over the next 3 days. Which of the following viruses is most
likely to produce these findings?
A Epstein-Barr
B Mumps
C Rubella
D Rubeola
E Varicella zoster

A

D Rubeola

Measles (rubeola)

Rash
Koplik spots

Rubella: german measles, is a much milder infection than rubeola

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75
Q

7 term infant has initial Apgar scores of 8 and 10 at 1
and 5 minutes. On auscultation of the chest, a heart murmur
is audible. There is hepatosplenomegaly. Cataracts of the crystalline
lens are noted. The infant is at the 30th percentile for
height and weight. Echocardiography shows a patent ductus
arteriosus. Which of the following events is the most likely
risk factor for the findings in this infant?
A Congenital rubella infection
B Dietary folate deficiency
C Dispermy at conception
D Erythroblastosis fetalis
E Maternal thalidomide use
F Paternal meiotic nondisjunction

A

A

Rubella in first trimester

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76
Q

38 A family who recently emigrated from Romania
brings their 7-year-old child to the pediatrician
with complaints of conjunctivitis and periorbital
swelling. The child has had coughing
with a runny nose and high fever for 3 days.
Small lesions with blue-white centers are seen
in his oral cavity. Which of the following is the
most likely cause of this child’s symptoms?
(A) Diphtheria
(B) Pertussis
(C) Roseola
(D) Rubella
(E) Rubeola

A

E

Rubeola

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77
Q

Retroviruses

A

Use reverse transcriptase

HIV
Human T cell Luekemia virus (HTLV)

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78
Q

What is the number one cause of fatal infantile gastroenteritis

A

Rotavirus

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79
Q

Posterior cervical adenopathy

A

EBV mononucleosis
Cat scratch disease (bartonella)
Acute otitis media

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80
Q

Avian influenza

A

H5N1

Spread only from bird to human

60% mortality

Severe rapidly progressive couse

Fever cough myalgias
diarrhea, pancytopenia

Tx: Oseltamivir

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81
Q

Swine flu

  • type
  • composed of
  • symptoms
  • tx
A

H1N1

Two swine strain
One human strain
One avian strain

Flu and GI symptoms

Tx: Oseltamivir or zanamivir

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82
Q

Influenza virus

  • type of virus
  • description of virus
  • two key features
A

Orthomyxoviruses

Enveloped ssRNA

Hemagglutinin
- viral attachment to host cell
Neuraminidase
- release progeny virions

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83
Q

Barking seal cough child

A

Croup

Parainfluenza virus
- enveloped

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84
Q

Steeple sign

A

Croup

Parainfluenza virus
- enveloped

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85
Q

Winter months viruses

A

Influenza
Rotavirus
RSV

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86
Q

Summer months enterovirus

A

Poliovirus
Echovirus
Coxsackievirus

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87
Q

Summer months arbovirus

A

West Nile virus

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88
Q

Bronchiolitis
Child
Pneumonia in child

A

Infection of bronchioles

RSV

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89
Q

Primary cause of penumonia in children

A

RSV

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90
Q

RSV virus has what

A

Transmembrane protein called Fusion protein (F protein)

This allows infected cells to bond to near by uninfected cells

Multinucleated giant cells

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91
Q

55 A 3-year-old boy has had a cough, headache, and slight
fever for 5 days. He is now having increasing respiratory difficulty.
On physical examination, his temperature is 37.8° C,
pulse is 81/min, respirations are 25/min, and blood pressure
is 90/55 mm Hg. On auscultation, there are inspiratory crackles,
but no dullness to percussion or tympany. Respiratory
syncytial virus is isolated from a sputum sample. Which of
the following chest radiographic patterns is most likely to be
present?
A Hilar lymphadenopathy
B Hyperinflation
C Interstitial infiltrates
D Lobar consolidation
E Pleural effusions
F Upper lobe cavitation

A

C Interstitial infiltrates

RSV

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92
Q

Paramyxoviruses

A

RSV
Parainfluenza virus
Rubeola virus (measles)
Mumps

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93
Q

Runny nose
cough
Conjunctivitis
Blue grey specks on buccal mucosa surround by base of red
Wide spread maculopapular rash that started on head and spread

A

Measles
Enveloped

Koplik spots

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94
Q

Parotits
Orchitis
Meningitis

A

Mumps enveloped

Inflammation of parotid gland

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95
Q

Viral meningitis

A

Coxsackievirus
Echovirus
Enterovirus
Mumps virus

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96
Q 
Negri bodies
Fever
Nausea vomiting
Strange behavior
Hallucinations
Hydrophobia
Coma 
Death
A

Rabies virus
(Rhabdovirus)
Enveloped RNA

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97
Q

Eosinophilic cytoplasmic inclusions that contain viral nucleocapsids

A

Negri bodies

Rabies

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98
Q

Bullet shaped capsid

A

Rabies

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99
Q

Fever
Progressive pulmonary edema
Respiratory failure

Exposure to mouse urine

A

Hantavirus

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100
Q

A 27-year-old man dies of acute respiratory distress syndrome 1 day after presenting to the hospital with shortness of breath and a fever of 38° C (100.4° F). On the second hospital day, he developed extreme pulmonary edema and
hypotension before he died. His family says
that he had recently gone hiking and caving in an area known to be heavily populated with rodents.
Which of the following is the most likely
cause of death?
(A) Dengue virus
(B) Ebola virus
(C) Hantavirus
(D) Marburg virus
(E) Rhabdovirus

A

C. Hantavirus

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101
Q

Illnesses spread through animal urine

A

Hantavirus
Lassa virus
LCM virus
Leptospirosis

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102
Q 
Fever HA myalgias
Followed by vomiting and diarrhea
Multiorgan failure
Shock 
Death
A

Ebola virus

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103
Q

A patient present with fever, vomiting and diarrhea. She was in west africa two weeks visiting family. What viral infection? Type of isolation

A

Ebola

Contact and droplet precautions

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104
Q

Viral proteins of HIV

A

Gp120

Gp41

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105
Q

Gp120

A

Grabs onto CD4 surface receptor on T cells and macrophages

Once connected, changes shape and allows it to bind to coreceptor (CCR5 or CXCR4)

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106
Q

Tropsim

A

Which coreceptor HIV uses to enter cell

only CXCR4: X4 viruses
Only CCR5: R5 viruses
Both : dual tropism

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107
Q

GP41

A

Fusion and entry into host cells

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108
Q

Three main structural genes in HIV genoma

A

Gag: encodes p24 capsid protein

Env: gp120 and gp41

Pol: codes for reverse transcriptase

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109
Q

Diagnosis of HIV check

A

P24 antigen adn HIV antibodies

Viral load (PCR test)

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110
Q

AIDS diagnosis

A

CD4 < 200
< 14% lymphocytes are Cd4

AIDs defining condition
- Pneumocystis jirovecii pneumonia

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111
Q

Ring enhancing lesions

A

HIV associated Primary CNS lymphoma
(solitary lesion)

Toxoplasmosis
(multiple lesions)

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112
Q

HIV < 200 opportunistic infections

A

Pneumocystis jirovecii pneumonia

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113
Q

HIV < 100 opportunistic infections

A

Histoplasmosis capsulatum

Candida albicans

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114
Q

HIV < 50 opportunistic infections

A

Mycobacterium tuberculosis

Mycobacterium avium complex

CMV retinitis

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115
Q

Hepatosplenomegaly
Fever
Cough
CD4 < 150

A

Histoplasmosis capsulatum

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116
Q

Chronic watery diarrhea
HIV patient

diagnosis

A

Cryptosporidium spp. (c.parvum)

Oocytes on modified acid-fast stain of stool turns bright pink or red

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117
Q

HIV patient covered in what look likes cherry angiomas

A

Bacillary angiomatosis

Bartonella henselae

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118
Q

What four molds are considered dermatophytes (fungal species that invade superficial skin)

A

Trichophyton
Microsporum
Epidermophyton
Malassezia furfur

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119
Q

Diaper rash

Satellite lesions

A

Candida albicans

Shiny skin or eroded

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120
Q

Blood culture

Germ tubes have small projections on side of cell

A

Candida albicans

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121
Q

Narrow based budding yeast

A

Cryptococcal neoformans

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122
Q

India ink

Clear circle

A

Cryptococcal neoformatns

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123
Q

Soap bubble lesion on imaging

A

Cryptococcal meningoencephalitis

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124
Q

Silver stain

Ground glass appearance of interstital infiltrates

A

Pneumocystis jirovecii (PCP)

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125
Q

Narrow septate hyphae that branch at acute angles (45 degrees)

A

Aspergillus fumigatus

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126
Q

Broad irregularly shaped, nonseptate hyphae branching at right angles (90 degrees)

A

Mucor and Rhizopus

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127
Q 
Facial pain 
HA
Large necrotic lesion, black escar
Blindness
CN deficits
A

Rhinocerebral mucomycosis

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128
Q

Most common type of dermatophytes with animal reservoir

A

Microsporium (dog or cat)

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129
Q

Hypopigmented or hyperpigmented lesion on body
Scaling plaque
Yeast

A

Tinea versicolor

Malassezia furfur

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130
Q

KOH prep spaghetti and meatball appearance

A

Tinea versicolor

Malassezia furfur

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131
Q

What is associated iwth each clue

  1. Cat scratch
  2. Cat bite
  3. Cat feces
  4. Puppy feces
  5. Animal urine
A
  1. Bartonella henselae
  2. Pasteurella multocida
  3. Toxoplasma
  4. Yersinia enterocolitica, campylobacter jejuni
  5. Leptospira, hantavirus
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132
Q

Organisms associated with birds

A

Histoplasma capsulatum (bird/bat droppings)
Cryptococcus neoformans (pigeon droppings)
Chlamydophilia psittaci (parrots)
H5N1 influenza
West Nile virus

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133
Q

Mississippi ohio river valley
Bird and bat droppings
Spelunkers

  • Imaging
  • what happens to it
A

Histoplasma capsulatum

Enters through lung
Engulfed by macrophages

Hyphae and spores on imaging

Macrophage filled w/ 100 spores

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134
Q

Mississippi and ohio river basins

Thick refractile wall around yeast

broad based budding

A

Blastomyces dermatitidis

Granulomatous nodules

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135
Q

Southwestern U.S
Mexico

Pneumonia

Spherule
-filled with endospores

A

Coccidioides immitis

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136
Q

A 46-year-old man from northern Mexico has had fever,
nonproductive cough, and weight loss for 2 months. On examination
his temperature is 37.5 ° C. A chest radiograph shows
a miliary pattern of small nodules in all lung fields. Bronchoalveolar
lavage is performed and microscopic examination of
the fluid shows organisms averaging 50 microns in diameter
with thick walls and filled with endospores. Which of the following
infections is he most likely to have?
A Blastomycosis
B Coccidioidomycosis
C Histoplasmosis
D Mycobacteriosis
E Nocardiosis
F Paracoccidioidomycosis

A

B. Coccidioidomycosis

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137
Q

Pneumonia
Granulomatos changes in mucous membranes

Captain wheel

Latin america

A

Paracoccidioides brasiliensis

Paracocci parasails with a captains wheel all the way to Latin america

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138
Q

Gardner
Dimorphic fungus

Pustule on puncture site

Nodules follow draining lymphatics

Tx

A

Sporothrix schenckii

Tx: Itraconazole (first line)
potassium iodine

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139
Q

Mold form contains barrel shaped arthroconidia

A

Coccidioides immitis

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140
Q

Associated iwth dust storms

A

Coccidioides immitis

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141
Q

Multiple budding of yeast form

A

Paracoccidioides brasillensis

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142
Q

Councilman bodies

A

Apoptotic liver cells

Viral hepatits
yellow fever

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143
Q

Acute fatty foul smelling diarrhea
Abdominal bloating

  • Diagnosis
    Tx
A

Giardia lamblia

Pear-shaped trophozoites or cysts in stool

Metronidazole
Tinidazole

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144
Q

Pear-shaped trophozoites

A

Giardia lamblia

Trichomonas (protozoal)

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145
Q

Bloody diarrhea
Flask shaped ulcers
RUQ pain

  • type organism
  • transmittered
  • diagnosis
  • tx
A

Entamoeba histolytica

Liver abscesses

Fecal-oral route
- eating food or water contaminated with feces that contain cysts

Trophozoites or cysts in stool

Treatment

  • trophozoites= metronidazole or tinidazole
  • cysts= iodoquinol or paromomycin
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146
Q

Foul smelling vaginal discharge
Motile

-transmission
- wet mount
- vaginal pH
- tx
-

A

Trichomonas vaginalis

Sexual transmission

Pear shaped appearance

Increase vaginal pH

Metronidazole

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147
Q

Ring enhancing lesions in brain

Tx

A

Toxoplasma gondii

Pyrimethamine

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148
Q

Chorioretinitis
Hydrocephalus
Intracranial calcifications

Tx

A

Toxoplasma gondii

Pyrimethamine

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149
Q

Toxoplasma gondii acquired how

A

Cat feces or litter

Eating cyst in infected meat

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150
Q

Rapidly fatal meningoencephaltiis

Swimming

A

Naegleria fowleri

Swimming in freshwater lakes

Enters nose passes through cribriform plate

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151
Q

A 40-year-old man goes on a camping vacation
with his family. One day after swimming in a
freshwater lake near the camp site, he develops
nausea and vomiting and starts to behave irrationally.
His family takes him to the emergency
department, where blood samples are taken
and a spinal tap is performed. He is diagnosed
with a rapidly progressing meningoencephalitis
and dies shortly thereafter. Which of the following
protozoa was most likely the cause of
the man’s illness?
(A) Cryptosporidium species
(B) Entamoeba histolytica
(C) Leishmania donovani
(D) Naegleria fowleri
(E) Plasmodium falciparum

A

(D) Naegleria fowleri

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152
Q

55 A 9-year-old child who is living in a mud hut in Paraguay
has a sore persisting on her face for 4 days. Physical examination
shows an indurated area of erythema and swelling just
lateral to the left eye, accompanied by posterior cervical lymphadenopathy.
She has unilateral painless edema of the palpebrae
and periocular tissues. Two days later, she has malaise, fever,
anorexia, and edema of the face and lower extremities. On
physical examination 1 week later, there is hepatosplenomegaly
and generalized lymphadenopathy. Which of the following
pathologic findings is most likely to develop in this patient?
A Cerebral abscesses
B Chronic arthritis
C Dilated cardiomyopathy
D Meningitis
E Mucocutaneous ulcers
F Paranasal bony destruction

A

C Dilated cardiomyopathy

Trypanosoma cruzi

Tx Nifurtimox

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153
Q

Trypanosoma brucei spp

  • sickness
  • vector
  • symptoms
  • later symptoms
  • blood smear
  • tx
A

African sleeping sickness

tsetse fly

Fever
Enlarged LN
Sleepiness

Encephaltiis
Coma and death

Blood smear: long whispy organisms in blood

Early: Suramin
CNS involved: Melarsoprol

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154
Q

Dilated cardiomyopathy
Megesophagus
Megacolon

A

Trypanosoma cruzi

Chagas disease

Reduviid bug

  • painless bit
  • Feces scrated into skin

Benznidazole
Nifurtimox

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155
Q

Spiking fevers
Hepatosplenomegaly
Pancytopenia

  • transmission
  • diagnosis
  • tx
A

Leishmania donovani

Visceral leishmaniasis

Sandfly

Amastigotes inside macrophages

Liposomal amphotericin B

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156
Q

Ulcerating papules that are slow to heal

A

Leishmania donovani
- Cutaneous leishmaniasis

Sandyfly

Sodium stibogluconate

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157
Q

Cyclic fever
Headache
Anemia
Splenomegaly

A

Malaria
Plasmodium species

Mosquito

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158
Q

Malaria fever due to

A

RBCs rupture and release merozoites

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159
Q

Malaria that fever spikes every 48 hrs

Every 72 hrs

A

48 hr

  • P. ovale
  • P. vivax

72 hr
- P. malariae

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160
Q

Malaria

  • subtype
  • tx
  • Diagnosis
A

Plasmodium species

P. vivax and P. ovale
- dormant infection in liver
Tx primaquine

P. falciparum
- most severe
- no dormant form
- sequestration of RBCs --> occlusion of small vessels
Tx: Chloroquine
(SE: Retinopathy and pruritis )

Blood smear

  • Merozoites
  • Trophozoite= diamond ring
  • Gametocytes: banana shaped
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161
Q

Two ring forms inside one erythrocyte

A

Trophozoite form

Babesia Microti

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162
Q

Maltese cross

A

inside RBC
merozoites

Babesia Microti

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163
Q

Babesia Microti

  • symptoms
  • blood smear
  • transmission
  • tx
A

Fever
Hemolytic anemia
Progressive fatigue

Two rings inside RBC
Maltese cross

Ixodes tick
coinfection w/ lyme disease

Tx
Quinine + Clindamycin
(atovaquone + azithromycin)

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164
Q

Names of following stages of malaria life cycle

  1. Looks like diamond ring
  2. Ruptures the cell host
  3. Replicating intracellularly
  4. Form injected from the anopheles mosquito
  5. banana shaped
A
  1. Early trophozoite
  2. Merozoite
  3. Schizont
  4. Sporozoite
  5. Gametocyte
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165
Q

Ingest helminths

A

“EAT”

Enterobius vermicularis
Ascaris lumbricoides
Trichinella spiralis

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166
Q

Penetrating helminths

A

“Sand”

Stronglyoides
Ancylostoma
Necator
D

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167
Q

Worm lays eggs at anus

tx

A

Enterobius vermicularis
Nematode (round worm)

Benzimidazoles
- Albendazole
- mebendazole
Pyrantel pamoate

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168
Q

Giant round worm

Eosinophilic pneumonitis

  • diagnosis
  • tx
A

Ascaris lumbricoides

Ingest eggs
Hatch in intestines
Release larvae penetrate bowel --> lungs
Migrate up trachea and swallowed
Mature worms in intestine

Eggs released in stool

Benzimidazoles
- Albendazole
- mebendazole
Pyrantel pamoate

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169
Q

Myositis
Fever
Eosinophilia
Periorbital edema

  • acquired
  • diagnosis
  • tx
A

Trichinella spiralis

Undercooked meat

GI –> muscles

Muscle biopsy: cysts with larvae in muscle tissues

Bendzimidazoles

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170
Q

A 28-year-old woman from rural Guyana with a history
of rheumatoid arthritis develops painful swelling of her
hands and feet. She is treated with corticosteroid therapy.
A month later, she develops profuse, watery diarrhea along
with fever and cough. On examination, she has a temperature
of 37.3° C. Laboratory studies show WBC count, 12,900/
mm3; and the WBC differential count shows 57% segmented
neutrophils, 5% bands, 16% lymphocytes, 8% monocytes,
and 14% eosinophils. Microscopic examination of a stool
specimen shows ova and small rhabditoid larvae. Similar
larvae are present in a sputum specimen. Which of the following
infectious diseases is most likely to produce these
findings?
A Cysticercosis
B Onchocerciasis
C Schistosomiasis
D Strongyloidiasis
E Trichinosis

A

D. Strongyloidiasis

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171
Q

Rhabditiform larvae in feces

tx

A

Strongyloides
Threadworm

Ivermectin
Albendazole

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172
Q

Wound on feet
Anemia
Abdominal discomfort

tx

A

Ancylostoma
Necator

Hook worms

Benzimidazoles
- Albendazole
- mebendazole
Pyrantel pamoate

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173
Q

Taenia solium

  • transmission
  • symptoms
  • tx
A

Cestodes (tapoworms)

Ingestion of alrvae in undercooked port
- GI tract infection by adult worm

Ingestion of eggs in contaminated food or water
- brain filled w/ cysts

Tx
Albendazole
Praziquentel
Dexamethaone: keep CNS symptoms from getting worse

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174
Q

Cestodes

A

Tape worms

Taenia solium
Diphyllobothrium latum
Echinococcus granulosus

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175
Q

Brain filled with cysts

Seizures

A

Taenia solium

Ingestion of eggs in contaminated food

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176
Q

Giant limbs

  • type
  • transmitted
  • tx
A

Wuchereria bancrofti

Helminth, neomatoid
Round worm in GI

Mosquitoes

Migrate to lymphatics

Elephantiasis of limbs
Hydrocele of scrotum

Tx
Diethylcarbamazine

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177
Q

Raw fish
Megaloblastic anemia

-def
tx

A

Diphyllobothrium latum

B12 deficiency

Praziquantel

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178
Q

Hydatid cyst lesion in liver
RUQ pain
Well circumscribed circular lesion

  • transmitted
  • can find where in body
  • symptom
  • tx
A

Echinococcus granulosus

dog feces

Egg shell calcifications

Form mature larval cysts in liver and lungs

Anaphylaxis

Surgical removal of cysts

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179
Q

A 23-year-old man presents to the physician
with abdominal distention and tenderness with
no vomiting or diarrhea. Physical examination
shows hepatosplenomegaly. Bowel sounds are
normal. On questioning, the patient says that
he traveled to eastern South America 1 year
ago. Several weeks after returning from his trip,
he remembers having fever, diarrhea, weight
loss, and “funny looking stools.” Ultrasonography
shows ascites and hepatic periportal fi brosis.
Which of the following is most likely
responsible for this patient’s present symptoms?
(A) Appendicitis
(B) Bowel obstruction
(C) Enterocolitis
(D) Portal hypertension
(E) Ruptured viscus

A

D. Portal hypertension

Schistosoma mansoni

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180
Q

A 29-year-old man has had hematuria for the past
month. On physical examination, he is afebrile. There is diffuse
lower abdominal tenderness, but no palpable masses. An
abdominal radiograph shows a small bladder outlined by a
rim of calcification. Cystoscopy is performed, and the entire
bladder mucosa is erythematous and granular. Biopsy samples
are taken. Which of the following histologic findings is
most likely to be seen in these samples?
A Acid-fast bacilli of Mycobacterium avium complex
B Eggs of Schistosoma haematobium
C Larvae of Trichinella spiralis
D Migrating Ascaris lumbricoides
E Taenia solium cysts

A

B. Eggs of schistosoma haematobium

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181
Q

Deals with snails

A

Schistosoma

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182
Q

Portal HTN
Splenomegaly
Egyptian immigrant

tx

A

Schistosoma
- blood fluke

Praziquantel

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183
Q

Chronic bronchitis
Hemoptysis

acquired
-t x

A

Paragonimus westermani

Adult fluke in lung

Undercooked crab meat

Praziquantel

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184
Q

Pigmented gallstones
Cholangiocarcinoma

  • transmission
  • lives
  • Tx
A

Clonorchis sinensis
- liver fluke

undercooked fish

Lives in biliary tract

Praziquantel
Albendazole

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185
Q

Swimmers itch

A

Schistosoma

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186
Q

Fluke associated iwth hematuria and bladder cancer

A

Schistosoma haematobium

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187
Q

Burns all over the body what will occur over the 7 day?

A

Increased metabolic rate

Not

  • Increased extracellular volume
  • Not increase in serum cholesterol concentration
  • Not loss of B vitamins in skin
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188
Q

Testicular tumor with friend egg appearance

A

Seminoma

Germ cell tumor

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189
Q

Umbilical cord compression of infant, monitoring shows a normal fetal heart rate of 150/ min with variable spontaneous decelerations to 110/min. Why the decrease in fetal heart rate

A

Increased fetal systemic vascular resistance

Compressing vessel, decreases radius increase in resistance

Cause reflex bradycardia

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190
Q

20 yr history of T1D uses insulin

why hypoglycemia

A

Impaired release of glucagon

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191
Q

Erythematous scaly rings with central clearing

From pet

A

Tinea corporis

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192
Q

White plaque on side of tongue

what happens if dont tx

A

Hairy leukoplakia

EBV

Progress into submucosa

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193
Q

Black escar nose

A

Mucor

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194
Q

Ixodes deer tick

A

Borrelia burgdorferi
Anaplasma
Babesia

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195
Q 
Fever
Diarrhea
Splenomegaly
Muscle wasting
Pancytopenia
A

Bitten sand fly

Leishmania spp

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196
Q

Disease form bed bugs

A

Staph aureus

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197
Q

E coli makes many proteins how

A

mRNA contains sequence for many proteins

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198
Q

Scratches
Vetarianian
Parrot

Tender regional lymphadenopathy

A

Bartonella henselae

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199
Q

Bartonella henselae can cause what in immunocompromised

A

Bacillary angiomatosis

Red-purple papular skin lesions

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200
Q

Fever myalgias, malaise, and progressive fatigue over 2 week period

No sore throat

Splenomegaly

No Lad or jaundice

Fails to agglutinate horse erythrocytes

A

Mono

(normally EBV0

but since no agglutination
CMV

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201
Q

Dont gram stain

A

The Little Microbes May Unfortunately Lack Real Color But Are Everywhere

Treponema, Leptospira
- too thin

Mycobacteria
- high lipid

Mycoplasma, Ureaplasma
- no cell wall

Legionella, Rickettsia, Chlamydia, Bartonella, Anaplasma, Ehrlichia
- primarily intracellular

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202
Q

Giemsa Stain

A 
Rickettsia
Chlamydia
Trypanosomes
Plasmodium
Borrelia
Helicobacter pylori (Histoplasma)

Ricky got Chlamydia as he Tried to Please the Bored Hot Geisha

Chinese Painted wHores Bow To Rich

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203
Q

PAS

A

Stains for glycogen

Whipple disease

Tropheryma whipplei

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204
Q

Ziehl Neelsen stain

A

Acid fast

Mycobacteria
Nocardia

Mycolic acid in cell wall
- Cryptosporidum oocytes

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205
Q

India ink

A

Cryptococcus neoformans

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206
Q

Silver stain

A

Fungi

  • Coccidioides
  • Pneumocytstis jirovecii
  • Legionella
  • H. pylori
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207
Q

Mycobacterium spp virulence factors

A

Cord factor

  • creates serpentine cord appearance in virulent M tuberculosis strains
  • activates macrophages -> release of TNF-alpha

Sulfatides (surface glycolipids) inhibit phagolysosomal fusion

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208
Q

-bendazole

A

benzimidazole

Mebendazole
Albendazole

Antiparasitic

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209
Q

-cillin

A

Penicillin

Amoxicillin
Methicillin

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210
Q

-conazole

A

Imidazole (antifungal)

Fluconazole
Ketoconzole

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211
Q

Penicillins MOA

A

Interact w/ transpeptidase and inhibit peptidoglycan cell wall synthesis

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212
Q

Inhibit DNA gyrase and topoisomerase (which participate in supercoiling)

A

Fluoroquinolones

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213
Q

Inhibit bacterial ribosome translational proofreeding

A

Aminoglycosides

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214
Q

Inhibits viral assembly

A

Amantadine

Also inhibits viral release through interactions iwth the viral M2 protein

No longer used due to resistance

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215
Q

Inhibits viral protein synthesis

A

Ribavirin inhibits viral RNA polymerase activity and rRNA fragment initiation and elongation leading to viral protein synthesis inhibition

Used in Chronic Hep C infections and respiratory syncytial virus infection

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216
Q

Viral reverse transcriptase inhibitors

A

Lamivudine
emtricitabine

Tx HIV

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217
Q

Etoposide

A

Cancer drug

Inhibits topoisomerse II

Myelosuppression
Alopecia

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218
Q

Bacterial resistance to fluoroquinoles (Ciprofloxacin)

A

Efflux pumps

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219
Q

Antibitoics that target protein synthesis 30s subunit

A

Tetracyclines (Doxycycline)

Aminoglycosides (Streptomycin)

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220
Q

Antibiotics that target 50s subunit

A 
Chloramphenicol
Clindamycin
Macrolides (erythromycin) 
LInezolid
Linocmycin
Streptogramins
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221
Q

Anti-TNF alpha

A

Infliximab

Etanercept

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222
Q

TNF-alpha inhibitors

A 
Etanercept
Inflixumab
Adalimumab
Golimumab
Certolizumab
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223
Q

Clostiridium difficle tx

A

Tx

  • Metronidazole
  • Oral vancomycin
  • Fidxomicin (recurrent)
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224
Q

Corynebacterium diphtheriae tx

A

Erythromycin or penicillin
Antitoxin
Vaccinate

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225
Q

Tx N. GOnorrhoeae

A

Ceftriaxone

Azithromycin

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226
Q

Tx N. Meningitides

A

Prophylaxis

  • Rifampin
  • Ciprofloxacin
  • Ceftriaxone

Tx

  • Cefotaxime
  • Ceftriaxone
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227
Q

Legionella pneumophila tx

A

Macrolides

Fluoroquinole

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228
Q

Psudomonas aeruginosa tx

A

Oral: fluoroquinolones
- Ciprofloxacin
Levofloxacin

Ticardillin
Pipercillin
Cefepime
ceftazidime
Carbapenems 
- impenem
- meropenem
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229
Q

H. pylori tx

A 
Tx:
Triple therapy
- PPI
- Clarithromycin
- Amoxicillin or metronidazole

Quadruple therapy

  • PPI
  • Bismuth
  • Metronidazole
  • Tetracycline
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230
Q

Tx Shigella

Tx Salmonella

Tx Campylobacter

Tx Yersinia enterocolitica

Tx Vibero cholerae

A

Shigella (bloody)

  • Fluroquinolones
  • TMP-SMX
  • Azithromycin (macrolide)

Salmonella (bloody)

  • Fluroquinoles
  • ceftriaxone

Camppylobacter jejuni (bloody)

  • Supportive
  • Fluroquinoles
  • Azithromycin

Yersinia enterocolitica (bloody)

  • Supportive
  • Fluroquinoles
  • TMP-SMX

Vibero cholerae
- rehydration

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231
Q

Tx Leptospira interrogens

A

Question mark shaped
Rodent urine

Pencillin
Ceftriaxone
Doxycycline

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232
Q

Tx Borrelia burgdorferi

lyme disease

A

Tx Doxycycline (early stage)
Amoxicilin (children <8)
Doxycycline or Ceftriaxone (late)

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233
Q

Syphilis tx

A

Penicillin G

allergy: doxycycline

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234
Q

Tx Tb

A

RIPE

2 months
Rifampin
Isoniazid
Pyrazinamide
Ethambutol

4 months
Rifampin
Isoniazid

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235
Q

what antibiotic is used for prevention of mycobacteriuma vium intracellulare (MAI) in AIDs patients? When is it began

A

Azithromycin

Given once weekly

Beginning when CD4 < 50

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236
Q

Rifampin

A

Tb tx

RNA polymerase inhibitor
Revs up cytochrome P450
Red orange body fluids
Rapid Resistance used alone

Hepatotoxicity

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237
Q

Isoniazid (INH)

A

Inhibits synthesis of mycolic acids

Hepatotoxicity
Peripheral neuropathy

Give w/ B6

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238
Q

Ethambutol

A

Inhibits arabinosyl transferase
Imparied cellw all synthesis

Optic neuropathy
Color blindness
Decreased visual acuity

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239
Q

Mycobacterium leprae tx

A

Tuberculoid disease
- Dapsone + rifampin (12 months)

Lepromatous disease
- Dapsone + rifampin + cloflazimine (24 months)

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240
Q

Dapsone uses

A

Leprosy
Penumocystis jirovecii pneumonia

Hemolysis in G6PD deficiency

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241
Q

Tx Gardnerella vaginalis

A

Oral metronidazole

Metronidazole cream

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242
Q

Rickettsial disease tx

A

Doxycycline

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243
Q

Tx Chlamydia

A

Azithromycin

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244
Q

Tx Atypical pneumonia

A

Azithromycin

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245
Q

Tx Chlamydophila pneumoniae

A

Doxycyline

or azithromycin for atypical pneumoniae

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246
Q

Immunosuppressant mneumonic

A

I’m Supposed to cycle past tacos sir but my appetitie

Immuno
Suppressant
Cyclosporine
Pimecrolimus
Tacrolimus
Sirlimus
Basiliximab
Mycophenolate mofetil
Azathioprine
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247
Q

Cyclosporine

  • binds
  • inhibits
  • prevents

SE (2)

A

Binds cyclophilins
Inhibits calcineurin
Prevents IL-2 production

Nephrotoxicity
HTN

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248
Q

Tacrolimus and Pimecrolimus

  • bind
  • inhibit
  • prevent

SE (3)

A

FK506

Binds FK binding protein
Inhibits calcineurin
Prevents IL-2 production

Nephrotoxicity
HTN
Neurotoxicity 
- HA 
- Paresthesias
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249
Q

Sirolimus

  • aka
  • bind
  • inhibit
  • type inhibitor

SE (1)

A

aka rapamycin

Binds FK protein 12

Inhibits mTOR

Inhibits T cell proliferation and response to IL-2

Not nephrotoxic

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250
Q

Azathioprine

  • is what
  • interferes
  • Se
  • Metabolized
A

Precursor of 6-mercaptopruine (cancer drug)

Interferes w/ nucleic acid synthesis

Bone marrow suppression

Metabolized by xanthine oxidase (toxic effects increased by allopurinol)

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251
Q

Mycophenolate (mycophenolate mofetil)

  • inhibits
  • inhibits
  • prevents
A

Inhibits inosine monophosphate (IMP) dehydrogenase

Inhibits guanine synthesis

Prevents lymphocyte proliferation

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252
Q

Bacteria that increase efflux pump is resistant to

A

Tetracycline

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253
Q

Enterococci that substitute D-lactate for D-alanine in synthesis of pentapeptide proteoglycan precursors.

Decreases binding of what antibiotic

A

Vancomycin

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254
Q

Drugs acting on microtubules (6)

A

Vincristine: block polymerization, prevent growing

Vinblastine: block polymerization, prevent growing

Taxanes: hypersensitize the microtuble, can grow but breask down

Benzimidazoles

Griseofulvin: antifungal

Colchicine: anti-inflammatory gout

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255
Q

Tx acute otitis media

A

S. pneumoniae
Nontypable H. influenzae
Ml. catarrhalis

Antibiotics

  • Amoxicillin
  • Amoxicillin + clavulanic acid
  • Cephalosporins
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256
Q

Tx for H. pylori

A

Triple therapy
- PPI + clarithromycin + amoxicillin
“-prazole”
- PPI + clarithromycin + metronidazole

Quadruple therapy
- PPI + bismuth + metronidazole + tetracycline

Clarithromycin: macrolide
-50 S subunit

Metronidazole
- forms free toxic radical damages DNA

Amoxicillin

  • AMPed up penicillin
  • D-Ala-D-Ala structural analog
  • Binds penicillin binding proteins (transpeptidases), blocks crosslinking of peptidoglycan in cell wall
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257
Q

Antibiotic

Red urine

A

Rifampin

red urine

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258
Q

Tx Chlamydia and chlamydophila species

A

Macrolides

Tetracyclines

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259
Q

Tx Hepatitis B

A

Tenofovir

Entecavir, telbivudine, lamivudine, adefovir

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260
Q

Resistance of Rifampin

MOA

A

Altered structure of enzyme involved in bacterial RNA synthesis

Inhibition of bacterial DNA-dependent RNA polymerase

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261
Q

Isoniazid MOA

Ethamutol MOA

A

Isoniazid:
inhibition of mycolic acid synthesis

Ethambutol: inhibition of arabinosyl transferase

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262
Q

Prophylactic tx for neisseria meningitidis

A

Rifampin

Tx: current infection
- penicillin, ceftriaxone

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263
Q

Drug binds to cell wall glycoproteins

Drug interferes with DNA replication proteins

Drug binds to ribosomal proteins

Drug binds to transpeptidases

A

Vancomycin

Fluoroquinolones, binds DNA gyrase

Macrolides, tetracyclines

Pencillin, cephalosporins

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264
Q

Resistance to cephalosporins

A

Change in protein structure

Inhibits binding

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265
Q

Antiretroviral target

A

inhibit HIV protease

Inhibit production of functional viral encoded enzymes

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266
Q

Rabies vaccine

A

Inactivated vaccine

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267
Q

Tx Gonorrhea

A

Macrolide

Third generation cephalosporin

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268
Q

Tx Lung abscess

A

Clindamycin

- anaerobic oral organisms and aerobes

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269
Q

How do alcohol based disinfectants work?

A

Kills vegetative bacteria (not spores) fungus and enveloped viruses

Dissolves their lipid bilayer membranes

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270
Q

Drug that block surface glycoproteins

A

Neuraminidase blocking

Neuramindase inhibitors

  • Oseltamivir
  • Zanaamivir
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271
Q

Penicillin MOA

A

Bind to penicillin binding proteins

Inhibit formation of corss linkages between peptidoglycan chains

Cell lysis

Upregulate autolysins

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272
Q

Penicillin coverage

A 
Gram positive
Spirochetes- syphilis
Gram positive rods
Gram negative cocci
- neisseria
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273
Q

Penicillinase resistant penicillins

A

Bulky R group

Methicillin
Nafcillin
Oxacillin
Dixcloxacillin

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274
Q

Aminopenicillins

  • examples
  • inhibition
  • Use
A

Ampicillin (IV)
Amoxicillin (greater oral bioavailability)

Pencillinase sensitive

HHEELPSS
H. influenzae
H. pylori
E. coli
Enterococci
Listeria
Proteus mirabilis
Salmonella
Shigella
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275
Q

Beta lactamase inhibitors

A

CAST

Clavulanic acid
Avibactam
Sulbactam
Tazobactam

Add to pencillinase sensitive drugs

276
Q

Resistant otitis media

A

Amoxicillin + clavulanic acid

Cefdinir (3rd generation)

277
Q

Surgical infections

A

Sulbactam + ampicillin

278
Q

Carboxypenicillins

  • examples
  • MOA
  • use
A

Ticarcillin
Carbenicillin
Piperacillin

Attacking cell wall

Pseudomonas
Gram neg rods

Suscpetible to penicillinase

279
Q

Pseudomonas infxn treatment

A 
CAMPFIRE
Carbapenems
Aminoglycosides
Monobactams
Polymyxins
Fluroquinolones (ciprofloxacin, levofloxacin)
thIRd and fourth generation cephalosporins
- ceftazidime
- cefepime
Extended spectrum penicillins
-Ticarcillin
-Carbenicillin
-Piperacillin
280
Q

Cephalosporins

  • MOA
  • Coverage
  • Inhibition
A

Active against cell wall
Bind to penicillin binding proteins

Gram (+)
Gram (-)

Less susceptible to penicillases

281
Q

1st generation cephalosporins

A

Cefazolin
Cephalexin

Gram + cocci

PEcK
Proteus mirabilis
E. coli
Klebsiella

UTIs
URIs

Prophylaxis viridans strep endocarditis

282
Q

1st line prophylaxis against viridans strep endocarditis

A

Amoxicillin

283
Q

2nd generation cephalosporins

A

Cefoxitin
Cefaclor
Cefuroxime
Cefprozil

HENS PEcK
H. influenza
Enterobacter
Neisseria
Serratia marcescens
Proteus mirabilis
Ecoli
Klebsiella

Not used for gonorrhea

284
Q

3rd generation cephalosporins

A

Ceftriaxone
Cefotaxime
Ceftazidime
Cefdinir

Serious gram - infections

HENS PEcK
E.coli
Proteus mirabilis
Klebsiella
Enterobacter
Serratia
Citrobacter
Neisseria
H. influenza
Strep pneumoniae **
285
Q

Tx neisseria gonorrhoeae

  • details (3)
A

Ceftriaxone

Longest 1/2 life
GIve IV
Excreted in bile (good for renal failure)

286
Q

4th generation cephalosporin

  • use
  • coverage
A

cefepime
broad spectrum
Pseudomonas

Gram + coverage

287
Q

5th generation cephalosporin

A

Ceftaroline
Broad spectrum

MRSA

288
Q

Cephalosporin for MRSA

A

Ceftaroline

289
Q

Cephalosporins not effective against

A 
LAME
Listeria
Atypicals (mycoplasma, chlamydia)
MRSA
Enterococci
290
Q

Aztreonam

  • MOA
  • key feature
  • covers
A

Monocyclic beta lactam

Inhibits cell wall synthesis
Binds to penicillin binding protein 3

No sensitivity allergy

E. Coli
Lebsiella
Pseudomonas
Serratia
(Gram neg only)
291
Q

Carbapenems

  • Examples
  • Coverage
  • MOA
A

Imipenem- cilastatin
Meropenem
Ertapenem
Doripenem

Gram + cocci
Gram - rods
Anaerobes
Pseudomonas

Binding penicillin binding proteins

292
Q

Imipenem and cilastatin

A

Cilastatin inhibitor of renal dehydropeptidase 1

Decreased activation of imipenem in renal tubules

293
Q

Vancomycin

  • MOA
  • Coverage
  • Toxic
A

Inhibit cell wall synthesis
Inhibits cell wall mucopeptide formation by binding to the D-ala D-ala moieties of the cell wall precursors

Inhibts cell wall glycopeptide polymerization

Gram positive only
MRSA
Enterococci
Clostridium difficile (oral) 
Coagulase negative staph endocarditis

NOT
Nephrotoxicity
Ototoxicity
Thrombophelbitis

Redman syndrome
- diffuse flushing
- nonspecific mast cell degranulation
pretreat w/ antihistamines

294
Q

Protein synthesis inhibitors

mneumonic

A

Buy AT 30, CCELL at 50

30S inhibitors

  • Aminoglycosides
  • Tetracyclines

50S

  • Chloramphenicol
  • Clindamycin
  • Erythromycin, macrolides
  • Lincomycin
  • Linezolid
295
Q

MRSA tx on outpatient basis

MOA

Can cause

A

Linezolid

BInds 23S RNA and interacts with the bacterial initiation complex

Serotonin syndrome

296
Q

TCA

  • MOA
  • coverage
  • avoid with
  • toxicity
A

Binds 30S
Prevents attachment of aminoacyl tRNA

VACUUM THe BedRoom
Vibrio cholerae
Acne
Chlamydia
Ureapolasma urelyticum
Mycoplasma pneumoniae
Tularemia
Helicobacter pylori
Borrelia burgdorferi
Rickettsia

Avoid with
- milk antiacids
Iron, calcium, magnesium
(inhibit absorption in gut)

Discoloration teeth
Inhibit bone growth kids
Photosensitivity
Blue skin (minocycline)

297
Q

Patient presents with blue skin

antibiotic?

A

Minocycline (TCA)

298
Q

Aminoglycosides

  • MOA
  • Ineffective against
  • Use
  • TOxicity
A

Mean GNATs can NOT kill anaerobes

Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin

Inhibits the formation of the initation complex and causes misreading of mRNA

Ineffective against anaerobes

Use

  • severe gram negative rod infections
  • bowel surgery (neomycin)

“NOT”
Nephrotoxicity
Ototoxicity
Tetatogenic

299
Q

Macrolides

  • Examples
  • MOA
  • Coverage
  • Adverse effects
  • key feature
  • resistance
A

Azithromycin
Clarithromycin
Erythromycin

-romycin

Inhibits protein synthesis by blocking translocation

Binds to the 23S rRNA of the 50S ribosomal subunit

“PUS”
Pneumonia
-Mycoplasma Chlamydophilia, legionella

URI

  • strep pyogenes
  • h. influenza

STD

  • chlamydia
  • gonorrhea

Prolonged QT
Drug interaction w/ warfarin

MACRO

  • Motility issues
  • Arrthymia (by prolong QT)
  • Cholestatic hepatitis (acute)
  • Rash
  • eOsinophilia

Safe in pregnancy

Methylation of the 23S rRNA binding site

300
Q

Chloramphenicol

  • MOA
  • Coverage
  • Toxicity
A

Inhibits 50S peptidyltransferase activity

Meningitis

  • H. influenza
  • N. meningitides
  • strep. pneumoniae

Toxicity

  • Anemia
  • Aplastic anemia
  • Gray baby syndrome
301
Q 
Vomiting
Grey color of skin
Poor muscle tone
Cyanosis
CV collapse

Tx

A

Gray baby syndrome

Chloramphenicol

Phenobarbital

302
Q

Streptogramins

  • MOA
  • Use
  • SE
  • Inhibit
A

Quinupristin
Dalfopristin

Bind 23S portion of 50S

MRSA
VRE
Staph and Strep skin infxn

Hepatotoxicity
Pseudomembranous colitis

Inhibit CYP450

303
Q

Clindamycin

  • MOA
  • Use
  • Toxicity
A

Blocks peptide bond formation with the 50S subunit

Anaerobic infections **
MRSA
Protozoal infections
Topically acne
Bacteroides fragilis
Clostridium perfringens
MRSA skin abscess

Toxicity: pseudomembranous colitis

304
Q

Glycylcyclines

  • Example
  • MOA
A

Tigecycline

Binds to 30S

305
Q

atypical pneumonia coverage

A

Macrolides

- romycin

306
Q

Drugs with photosensitivity

A

SAT
Sulfonamides
Amiodarone
Tetracycline

307
Q

Side effects of aminoglycosdies

A

NOT

Nephrotoxicity
Ototoxicity
Teratogenic

308
Q

Redman syndrome

A

Vancomycin

too quick infusion

309
Q

Sulfonamides

  • examples
  • MOA
  • side effect
A

Sulfamethoxazole
Sulfadiazine

Folic acid inhibitors
Competitive inhibitors of enzyme dihydropteroate synthetase

Hemolysis in G6PD def
Nephrotoxicity
Kernicterus (infants brain damage due to bilirubin build up) 
Photosensitivity
Steven Johnson syndrome
310
Q

Sulfa drug allergies

A

“Sulfa Pills Frequently Cause Terrible Allergy Symptoms”

Sulfasalazine
Probenecid
Furosemide
Celecoxib
Thaizide (TMP-SMX)
Acetazolamide
Sulfonyureas
311
Q

TMP-SMX uses

A 
UTIs
Shigella
Salmonella
MRSA skin infections
Pneumocystis jirovecii pneuonia
312
Q

Inhibits dihydrofolate reductase

A

Trimethoprim

Methotrexate

313
Q

Fluoroquinolones

  • Examples
  • MOA
  • Dont take with
  • Use
  • Side effect
  • Resistance
A

Levofloxacin
Nalidixic acid

Inhibits DNA gyrase (topisomerase II)

Dont take w/ antiacids or supplements contains calcium, iron or magnesium

Gram negative infections
Gram negative rods
UTIs
GI tract infections
Pseudomonas
Varying Gram positive coverage

Cartilage damage
Tendonitis and tendon rupture
QT interval prolongation

Chromosome endoced mutation at the DNA gyrase

314
Q

Drug to use in children iwth cystic fibrosis with pseudomonas

A

Fluorquinolones

315
Q

Antibiotic that treats protozoal infections

A

Metronidazole

316
Q

Metronidazole

  • MOA
  • Uses
  • Adverse reaction
A

Forms toxic radicals that damage DNA

"GET GAP on the Metro"
Giardia lamblia
Entamoeba histolytica
Trichomonas
GArdnerella vaginalis
Anaerobic bacteria (clostridium spp, bacteriodes fragillis) 
Pylori

Disulfiram like reaction

317
Q

Prophylaxis

1) meningococcal meningitis

2) H. influenza meningitis
Tx

3) Gonorrhea
4) Syphilis
5) Recurrent UTIs
6) Pneumocystisi jirovecii (CD4<200)
7) Endocarditis (dental procedure)
8) Group B strep (pregnant)
9) Gonococcal/ chlamydial conjunctivitis
10) Legionella tx
11) Pseudomonas tx
12) Chlamydia trachomatis
13) Candida albicans
14) Cyroptococus neoformans
15) Toxoplasma gondii

A

1) Ciprofloxacin

2) Rifampin (prophylaxis)
Tx: Ceftriaxone/ penicillin

3) Ceftriaxone (add doxycycline for c. trachomatis)
4) Penicillin G

5) TMP-SMX
Amoxicillin

6) TMP-SMX
7) Penicillin, Amoxicillin, Cephalexin
8) Ampicillin
9) Erythromycin
10) Macrolides (azithromycin)
11) Piperacillin/ tazobactam, aminoglycosides, carbapenems
12) Doxycycline

13) Fluconazole, Caspofungin
Amphotericin B

14) Amphotericin B and flucytosine
Maintenance: fluconazole

15) Sulfadiazine + pyrimethamine

318
Q

Identify antibiotic

1) Inhibit dihydropteroate syntherase
2) Inhibit dihydrofolate reductase
3) Inhibits DNA gyrase (topoisomerase III)
4) Inhibit bacterial ribosomes
5) Forms toxic free radicals that damages DNA
6) Acts like cationic detergent

A

1) Sulfonamides

2) Trimethoprim
Methotrexate

3) Fluoroquinoles
4) Nitrofurantoin
5) Metronidazole
6) Polymyxin B

319
Q

Empiric Tx Meningitis

A

Broad spectrum

Ceftriaxone
Vancomycin
Ampicillin

320
Q

Tx if exposed to bacillus anthracis

A

Ciprofloxacin

Doxycycline

321
Q

HIV prophylaxis to newborn

A

Zidovudine

322
Q

HSV prophylaxis for newborn

A

Mother: acyclovir starting at 36 weeks

323
Q

Which antibiotic?

1) Inhibits prokaryotic RNA polymerase
2) Inhibits prokaryotic topoisomerase
3) Inhibits prokaryotic dihydrofolate reductase

A

1) Rifampin
2) Fluroquinoles
3) Trimethoprim

324
Q

Macrolides effective against

A

“PUS”

Pneumonia
(atypical)
- mycoplasma pneu
- Legionella
- Chlamydophilia pneu

URI

  • Strep pyogenes
  • H. influenza

STDS

  • Gonorrhea
  • Chlamydia
325
Q

Topoisomerase inhibited by

A

Fluoroquinoles

Etoposide

326
Q

Tetracyclines effective against

A

VACUuM THe BedRoom

Vibrio cholerae
Ache
Chlamydia
Ureaplasma urelyticum
Mycoplasma pneumoniae
Tularemia
H. pylori
Borrelia burgdorferi 
RIckettsia rickettci
327
Q

Rifampin

A

4 Rs

Inhibits RNA polymerase
Red secretions
RREvs up cytochrome p450

328
Q

Vaccines

1) 1st Given
2) Who gets flu shot
3) 2 months
4) 4 months
5) 6 months

A

1) Hep B- 1st given
2) Yearly from 6 months

2,4,6 (8) who do we appreciate STRIPPERS

“Damn BaBy, ROTate that ass on the POLe”

3) Dtap, HepB, Hib, Rotavirus, Polio (IPV), PCV (pneumococcal)
4) DTaP, Hib, Polio, PCV, Rotavirus
5) DTAP, Hib, PCV, RV

329
Q

Tx for neonatal infections

A

Ampicillin + gentimycin

330
Q

Which class of antibiotics inhibits prokaryotic DNA topisomerase

A

Fluoroquinoles

331
Q

Acyclovir

  • key feature
  • MOA
  • uses
  • resistance
  • adverse effect
A

Guanosine analog

First phosphorylated by viral thymidine kinase

Inhibits DNA polymerase

HSV-1
HSV-2
VZV
EBV

Valacyclovir hydrolyzed to acyclovir

Mutated viral thymidine kinase

Obstructive crystalline nephropathy and acute renal failure if not adequately hydrated

332
Q

Famciclovir

  • type
  • key feature
  • uses
  • preferred for
  • resistance
  • adverse effect
A

Prodrug of penciclovir
- Acyclic guanosine nucleoside analog

Relies on viral thymidine kinase

HSV-1
HSV-2
VZV

Preferred over acyclovir for VZV

Mutated viral thymidine kinase

Obstructive crystalline nephropathy and acute renal failure if not adequately hydrated

333
Q

Tx VZV

A

Famiclovir

334
Q

Tx HSV-1, HSV-2

A

Acyclovir

Famciclovir

335
Q

Ganciclovir

  • activated by
  • MOA
  • side effects
  • resistance
A

Activated by CMV viral kinase

Inhibits viral DNA polymerase

Bone marrow suppression
Renal toxicity

mutated viral kinase

336
Q

Tx CMV

A

Ganciclovir

Foscarnet (retinitis)

337
Q

Herpes drug that doesnt require viral kinase activation

MOA
Uses
SIde effects

A

Foscarnet

Inhibits DNA polymerase

Resistant HSV
CMV retinitis

Renal toxicity
Anemia
Electrolyte abnormalities –> seizures

338
Q

Anti-influenza antivirals

A

Neuroaminidase inhibitors

Zanamivir
Oseltamivir

Block release of virions from host cell

339
Q

Treatment of Chronic Hepatits C

A

Ribavirin

  • inhibits syn of guanine nucleotides by competitively inhibiting inosine monophosphate dehydrogenase
  • SE: hemolytic anemia

Sofosbuvir
- Inhibits HCV RNA dep RNA polymerase acting as chain terminator

Simeprevir

  • HCV protease inhibitor, prevents viral replication
  • SE: Photosensitivity, rash

IFN-alpha

340
Q

Ribavirin

uses

side effects

A

Guanosine analog

RSV
Hep C

Teratogenicity
Hemolytic anemai

341
Q

Tx croup

A

One dose of dexamethasone

supportive

342
Q

RSV immunization

A

Passive w/ palivizumab

343
Q

HIV prophylaxis CD4 < 200

A

PCP prophylaxis

TMP-SMX
Dapsone (in sulfa allergy)

344
Q

HIV prophylaxis CD4 < 100

A

Toxoplasmosis prophylaxis (if positive IgG before)

TMP-SMX
Dapsone + pentamidine + leucovorin

345
Q

HIV prophylaxis CD4 < 50

A

MAC prophylaxis

Azithromycin

346
Q

saquinavir

  • example
  • MOA
  • adverse effects
A

-navir

Protease inhibitors

GI intolerance
Inhibit cytochrome p450
Hyperlipidemia hyperglycemia
Lipodystrophy

347
Q

Protease inhibitor that can cause pancreatitis

A

Ritonavir

348
Q

Protease inhibitor that can cause Nephrolithiasis

A

Kidney stone

indinavir
Atazanavir

349
Q

Protease inhibitor that can increase bilirubin

A

Atazanavir

350
Q

HAART

A

Combination of at least 3 different HIV medications

2 nucleoside reverse transcriptase inhibitors and a different class medication

351
Q

Lamivudine

A

-vudine

Nucleoside Reverse Transcriptase inhibitors (NRTIs)

Didanosine
Abacavir
Emtricitabine
Tenofovir (NtRTI)

352
Q

Nucleotide reverse transcrptase inhibitor

A

Tenofovir

353
Q

Nucleoside Reverse Transcriptase inhibitors (NRTIs)

  • examples
  • MOA
  • key feature
  • adverse effects
A 
Lamivudine
Zidovudine
Didanosine
Abacavir
Emtricitabine
Tenofovir (NtRTI)

Competitive inhibitors

Have to be phosphorylated by thymidine kinase to work

Bone marrow suppression
Lactic acidosis
anemia (zdv)
pancreatitis (didanosine)

354
Q

Tx Newborns born to HIV mothers

A

Zidovudine (AZT)

355
Q

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

  • examples
  • MOA
  • key feature
  • adverse effects
A

-vir, -virine

Nevirapine
Delavirdine
Efavirenz
Etravirine
Rilpivirine

non-competitively inhibit reverse transcriptase

Do NOT require phosphorylation

Rash
Hepatotoxicity
Vivid dreams (efavirenz)
CNS symptoms (Efavirenz)

356
Q

Which NNRTI must be taken with food and not w/ meds that decrease gastric acid

A

Rilpivirine

357
Q

Fusion inhibitor

A

Enfuvirtide

En envelop
Fu fusion

Binds Gp41 and blocks HIV fusion

Given by injection

358
Q

Raltegravir

  • example
  • MOA
  • adverse effect
A

-tegravir

Integrase inhibitors

Blocks integration into host DNA

Increase creatine kinase

359
Q

CCR-5 antagonist

A

Maraviroc

CCR-5 on macrophages and CD4 T cells

Inhibits gp120 conformational change

Only in patients with all R5 virus

360
Q

HIV drug causes

  1. Bone marrow suppression
  2. Pancreatitis
  3. Hepatic steatosis
  4. Hypersensitivity rxn
  5. Rash
  6. Nightmares, vivid dreams, depression
  7. False-positive to drug test for cannabinoids
  8. Teratogenic
  9. Nephrolithiasis
  10. Increases bilirubin
  11. peripheral neuropathy
A
  1. Zidovudine (NRTI)
  2. Didanosine (NRTI)
    Ritonavir (PI)
  3. Didanosine (NRTI)
  4. Abacovir (NRTI)
  5. NNRTIs
  6. Efavirenz (NNRTI)
  7. Efavirenz (NNRTI)
  8. Efavirenz (NNRTI)
  9. Indinavir, Atazanavir (protease inhibitor)
  10. Atazanavir (protease inhibitor)
  11. Didanosine
361
Q

What are the two HIV envelope proteins and what drugs interfere with them

A

gp 41: Enfuvirtide

Gp120: maraviroc (not directly CCR-5

362
Q

Tx Candida albicans

A

Superficial

  • Nystatin
  • Clotrimazole (topical)
  • Fluconazole (oral) oral thrush

Systemic

  • Fluconazole
  • Amphotericin B
  • Echinocandin
363
Q

Tx Cryptococcal neoformans

A

Amphotericin B + flucytosine

Followed by fluconazole

364
Q

Tx Pneumocystis jirovecii (PCP)

A

TMP-SMX

Sulfa allergy
- Pentamidine
Clindamycin + primaquine

365
Q

Tx Aspergillus fumigatus

A

Voriconazole

Lipid formation of amphotericin B

366
Q

Tx Mucor

A

Surgical debridement

Amphotericin B

367
Q

Tx Dermatophytes

A

Topical terbinafine or azole

Extensive skin infection or scalp/hair
- Oral terbinafine or azole

368
Q

Tx Tinea versicolor

A

Malassezia furfur

Topical azole
Topical selenium sulfide
Oral azole

369
Q

Antifungal that

  1. Disrupts membrane
  2. Disrupts microtubules
  3. Blocks precursors to pyrimidines
  4. Blocks Squalene to lanosterol
  5. Blocks lanosterol to ergosterol
A
  1. Nystatin, Amphotericin B
  2. Griseofulvin
  3. Flucytosine
  4. Terbinafine
  5. -azoles
370
Q

Amphotericin B

  • MOA
  • uses
  • Side effects
A

Binds ergosterol (unique to fungi) forms membrane pores that allow leakage of electrolytes

AmphoTEARicin “ tears holes in membrane

Cryptococcosis
Blastomycosis
Coccidioidomycosis
Aspergillosis
Histoplasmosis
Mucormycosis

Feverand chills
Anemia
Arrhythmias
Nephrotoxicity

371
Q

Tx cutaneous candidiasis
Diaper rash
Vulvogainitis

MOA

A

Nystatin

Pores in membrane
Binds to ergosterol

372
Q

Converted into 5-fluorouracil

A

Flucytosine

by cytosine deaminase

Inhibits DNA and RNA biosynthesis by conversion to 5-FU

373
Q

Inhibits cell wall synthesis by inhibiting synthesis of beta-(1,3)-D-glucan

  • uses
  • toxicites
A

Caspofungin

Invasive aspergillosis

GI upset
Flushing (histamine release)

374
Q

First line tx for dimorphic fungi

A

Itraconazole

Blastomyces
Coccidioides
Paracoccidioides
Histoplasma
Sporothirx
375
Q

Azole for aspergillus

A

Voriconazole

376
Q

Azole for refractory fungi

A

Posaconazole

377
Q

Azole for topical fungal infections

A

Clotrimazole

Micronazole

378
Q

-azole side effects

A

Decreased production of cortisol and testosterone

Gynecomastia

Impotence

Drug-drug interactions

Increase hepatic enzymes

379
Q

Terbinafine

  • use
  • side effects
A

Inhibits enzyme squalene epoxidase

uses superficial fungal infections

Hepatotoxicity
GI symptoms
Headache
TASTE disturbance

380
Q

Griseofulvin

  • mOA
  • deposits in
  • uses
  • side effects
A

Targets microtubule function –> inhibits mitosis

Deposits in keratin containng tissues

Tinea corporis
Tinea capitis
Onychomycosis

Tertatogenicity
HA
GI symptoms
Confusion
Cytochrome p450
381
Q

What antifungal would you use

  1. Cell wall synthesis inhibitor used in invasive aspergillosis
  2. “Swish and swallow” for oral candidiasis or thrush
  3. Most common treatments for onychomycosis
  4. Deposits in keratin-containing tissues to to treat tinea capitis adn onychomycosis
  5. Used for cryptococcal meningitis in AIDs
  6. Drug of choice for sporotrichosis
A
  1. Caspofungin
  2. Nystatin
  3. Terbinafine, itraconazole, fluconazole
  4. Griseofulvin
  5. IV amphotericin B + flucytosine
  6. Itraconazole
382
Q

Which antifungal can be used intrathecally for fungal meningitis

A

Amphotericin B

383
Q

Tx Giardia lamblia

A

Metronidazole

Tinidazole

384
Q

Tx Entamoeba histolytica

A

Treatment

  • trophozoites= metronidazole or tinidazole
  • cysts= iodoquinol or paromomycin
385
Q

Tx Trichomonas vaginalis

A

Metronidazole

386
Q

Gardnerella vaginalis tx

A

Metronidazole

387
Q

Tx Toxoplasma gondii

A

Sulfadiazine + pyrimethamine + folinic acid

388
Q

Tx Naegleria fowleri

A

Amphotericin B

389
Q

Tx Trypanosoma brucei

African sleeping sickness

A

Early: Suramin

CNS involved: Melarsoprol

390
Q

Tx Trypanosoma cruzi

A

Benznidazole

Nifurtimox

391
Q

Tx Leishmania donovani

- Visceral leishmaniasis

A

Liposomal amphotericin B

392
Q

Tx Leishmania donovani

- cutaneous leishmaniasis

A

Sodium stibogluconate

393
Q

Tx Malaria

A

P. vivax, P. ovale
- primaquine

P. falciparum
- chloroquine
(SE: retinopathy, pruritis)

394
Q

Tx Babesia microti

A

Quinine + clindamycin

Atovaquone + azithromycin

395
Q

-romycin

A

macrolide

396
Q

Tx Enterobius vermicularis

A

Benzimidazoles
- Albendazole
- mebendazole
Pyrantel pamoate

397
Q

Tx Ascaris lumbricoides

A

Benzimidazoles
- Albendazole
- mebendazole
Pyrantel pamoate

398
Q

Tx trichinella spiralis

symptoms

A

Muscle inflammation

Benzimidazoles

  • Albendazole
  • mebendazole
399
Q

Tx strongyloides stercoralis

symptoms

A

Vomiting
Diarrhea
Epigastric pain

Ivermectin
Albendazole

400
Q

Tx Ancylostoma and Necator

symptoms

A

Anemia

Benzimidazoles
- Albendazole
- mebendazole
Pyrantel pamoate

401
Q

Tx Diphyllobothrium latum

A

Praziquantel

402
Q

Tx Echinococcus granulosus

A

Surgical removal of cysts

403
Q

Tx Taenia solium

A

Albendazole
Praziquentel
Dexamethaone: keep CNS symptoms from getting worse

404
Q

Tx schistosoma

A

Praziquantel

405
Q

Tx Paragonimus westermani

A

Praizquantel

406
Q

Tx Clonorchis sinensis

A

Praziquantel

Albendazole

407
Q

Tx Wuchereria bancrofti

A

Diethylcarbamazine

408
Q

Tx Lice

A

Permethrin Pyrethrin

Malathion

409
Q

Tx Scabies

A

Permethrin

Ivermectin

410
Q

-Azole MOA

A

Inhibition of the cytochrome P450-dependent demethylation reaction

411
Q

HIV tx and MOA

A

NRTIs main line
- competitively inhibit nucleotide binding to reverse transcriptase and terminate the DNA chain

Abacavir
Didanosine
Lamivudine
Tenofovir

412
Q

Tx Scabes

A

Topical permethrin

Inhibits Na channel deactivation –> neuronal membrane depolarization

413
Q

DNA viruses

A

HHAPPPPy

Hepadna
Herpes
Adeno
Pox
Parvo
Papilloma
Polyoma
414
Q

Positive sense ssRNA virus (7)

A

Picornavirus (PERCH)

  • Poliovirus
  • Echovirus (meningitis)
  • Rhinovirus (cold)
  • coxsackie virus (meningitis, handfootmouth, myocarditis)
  • HAV (acute)

Hepevirus
- HEV

Caliciviruses
- Norovirus (gastroenteritis)

Flaviviruses

  • HCV
  • Yellow fever
  • Dengue
  • West Nile (meningoencephalitis)
  • Zika

Togaviruses
- Rubella

Retroviruses

  • HTLV ( T cell leukemia)
  • HIV

Coronaviruses
-common cold

415
Q

Negative sense ssRNA virus (6)

A

Orthomyxoviruses
- Influenza virus

Paramyxoviruses

  • Parainfluenza (croup)
  • RSV (bronchiolits in babies)
  • Measles
  • Mumps

Rhabdoviruses
- Rabies

Filoviruses
-Ebola

Bunyaviruses
- Hantavirus (hemorrhagic fever, pneumonia)

Delta virus
-HDV

416
Q

Spiking fever
Hepatosplenomegaly
Southeast Asia
Pancytopenia

Tx

A

Leishmania

Sandfly

Aphotericin B
Sodium stibogluconate

417
Q 
Farmer
Headache
Cough
Malaise
Pneumonia
Fever, aching muscles
Dry cough
Sore throat

No rash

A

Coxiella burnetii

Q fever

Spore forming

Chronic assoc w/ endocarditis

418
Q

Capsule of B anthracis

A

Poly-D-glutamate

419
Q

Spiral Gram neg bacteria

A

Borrelia (Giemsa)
Leptospira
Treponema

420
Q

Anaerobes

A

Anaerobes Cant Breath Fresh Air

Clostridium
Bacteroides
Fusobacterium
Actinomyces

421
Q

Facultative intracellular

A

Some Nasty Bugs May Live FacultativeLY

Salmonella
Neisseria
Brucella
Mycobacterium
Listeria
Francisella
Legionella
Yersinia pestis
422
Q

Urease positive

A

Pee CHUNKSS

Proteus
Cryptococcus 
H pylori
Ureaplasma
Nocardia
Klebsiella
S epidermidis
S saprophyticus
423
Q

Catalase positive organisms

A

Cats Need PLACESS to Belch their Hairballs

Catalase

Nocrrdia
Pseudomonas
Listeria
Aspergillus
Candida
E coli
Staphylococci
Serratia
B cepacia
H pylori
424
Q

Streptococcus pneumoniae most common cause of (4)

A

MEningitis
Otitis media
Bacterial pneumonia
SInusitis

425
Q

Rusty sputum in patients with sickle cell or asplenic

A

Pneumococcus

Streptococcus pneumoniae

426
Q

Cereulide

A

Performed toxin of bacillus cereus

427
Q

Listeria monocytogenes forms waht ____ which allows

Tx

A

“Rocket Tails”

via actin polymerization

allow intracellular movement and cell to cell spread avoiding antibodies

Ampicillin

428
Q

Actinomyces tx

A

Penicillin

429
Q

Nocardia

  • found in
  • symptoms
  • tx
A

Found in soil

Pulmonary infections in IC

(mimic Tb w/ negative PDD)

Can spread to CNS

TMP-SMX

430
Q

Tx Tuberculoid form of Leprosy

A

Dapsone

Rifampin

431
Q

Tx Lepromatous form leprosy

A

Clofazimine

432
Q

Prophylaxis Neisseria meningococci

Tx N. Meningococci

A

Rifampin
Ciprofloxacin
or Ceftriaxone

Tx
- Ceftriaxone
Pencillin G

433
Q

Haemophilus influenzae can be grown

tx

A

Chocoalte agar w/ factor V and X

or w/ S. aureus which provides factor V (NAD) through hemolysis of RBCs

Tx: Amoxicillin +/- clavulanate (mucosal infxn)
Ceftriaxone (meningitis)
Rifampin prophylaxis

434
Q

Pyocyanin

A

Blue green pigment of pseudomonas

generates reactive oxygen species

435
Q

S or comma shaped

A

Campylobacter jejuni
- bloody diarrhea

Vibrio cholerae
- water diarrhea

436
Q 
Constipation
Red spots of abdomen
Abdominal pain
Fever
Followed by diarrhea

Tx

A

Salmonella typhi

Ceftriaxone
Fluroquinolone

437
Q

H. pylori positive for

Tx

A

Catalase
Oxidase
Urease

Antibiotics Cure Pylori

  • Amoxicillin
  • Clarithromycin
  • PPI
438
Q

Myalgia of calves
Jaundice
Photophobia
Flu like

Tx

A

Leptospira interrogans

Water contaminated with animal urine

Pencillin
Ceftriaxone
Doxycycline

439
Q

First line tx Lyme disease

A

Borrelia burgdorferi

Doxycycline

440
Q

Tongue ulcers

Splenomegaly

A

Histoplasmosis

441
Q

Severe diarrhea in AIDS

A

Cryptosporidium

Oocytes in water

Oocytes on acid fast

Nitazoxaninde in IC hosts

442
Q

Rapidly fatal meningoencephalitis

Swimming

  • diagnosis
  • tx
A

Naegleria fowleri

Enters via cribriform plate

Amoebas in spinal fluid

Amphotericin B

443
Q

Tx Babesia

A

Atovaquone + azithromycin

Quinine + clindamycin

444
Q

Cowdry A inclusions

A

HSV-1, HSV-2, VZV

445
Q

What viruses uses this receptor

1) Integrins
2) CD21
3) CD4, CXCR4, CCR5
4) P antigen on RBCs
5) Nicotinic AChR
6) ICAM-1

A

1) Integrins= CMV
2) CD21= EBV
3) CD4, CXCR4, CCR5= HIV
4) P antigen on RBCs= ParvoB19
5) Nicotinic AChR= Rabies
6) ICAM-1= Rhinovirus

446
Q

Muscle pain
Joint pain
Retro orbital pain
Rash all over body

A

Dengue fever
ssRNA flavivirus

Thrombocytopenia
Spontaneous bleeding

447
Q

Rotavirus

  • causes
  • type of virus
  • MOA
A

infantile gastroenteritis

Segmented ds RNA virus (reovirus)

Diarrhea
- day care center

Villous destruction with atrophy leads to decreased absorption of Na and loss K

448
Q

Paramyxovirus Prophylaxis

A

Palivizumab

paramyxovirus causes RSV, croup, mumps, measles

449
Q

HCV lacks

A

3’-5’ exonuclease activity

no proofreading

variation in antigenic structure of HCV envelope proteins

450
Q

HBV

  • renal manifestation
  • vascular

HCV

  • renal manifestation
  • risk of
A

HBV

  • membranous GN –> membranoproliferative GN
  • polyarteritis nodosa

HCV

  • membranoproliferative GN –> membranous GN
  • risk of DM and autoimmune hypothyroidism
451
Q

Strawberry cervix

A

Trichomoniasis

Trichomonas vaginalis

452
Q

Asplenic patient organisms

A

SHiN

S pneumoniae&raquo_space; H. influenza type B&raquo_space; N meingitidis

453
Q

Health care provider needle stick

A

HBV

454
Q

Trimethoprim adverse effects

A

TMP
Treat
Marrow
Poorly

Megaloblastic anemia
Leukopenia
Granuloctyopenia

455
Q

TMP-SMX drug of choice for

A

Pneumocystis jiroveci
Toxoplasma gondii
Nocardia
Stenotrophomonas maltophilla

456
Q

Daptomycin

  • MOA
  • uses
  • adverse effects
A

Lipopeptide that disrupts the cell membrane of gram + cocci by creating transmembrane channels

S aureus skin infections
(MRSA), bacteremia, endocarditis, VRE

Adverse

  • myopathy
  • rhabdomyolysis
457
Q

Pyrazinamide

A

Tx mycobacterium tuberculosis

Hyperuricemia
hepatotoxicity

458
Q

What do iodine and idophors do

A

Halogenation of DNA, RNA and proteins.

Sporicidal

459
Q

Bacteria that can do transformation

A

DNA is released from lysed cell adn taken up by living bacterium

DNA fragment incorportated into chromosomal DNA
- recombinant bacterium

Streptococcus pneumonia
Haemophilus influenza
Neisseria meningitidies

460
Q

S. aureus tissue destruction with MRSA uses what toxin ____ affects what two cell types

A

Panton-Valentine Leukocidin

Neutrophils
Macrophages

461
Q

Gram positive rods

A

Clostridum (anaerobes)
Corynebacterium
Listeria
Bacillus

462
Q

Prophylaxis for dental procedures if prosthetic heart, history of endocarditis, or congenital heart disease

A

Amoxicillin

463
Q

Elek test

A

Corynebacterium diphtheriae

464
Q

Gram negative oxidase positive diplococci

1) sputum from COPD
2) Urethral discharge
3) CSF

A

1) sputum from COPD= Moraxella catarrhalis
2) Urethral discharge= N. gonorrhoeae
3) CSF= N. meningitis

465
Q

Meningitis + purpura

A

N. meningitis

466
Q

Sepsis
DIC adrenal hemorrhage

Gram negative organism

A

N. meningitis

467
Q

Gram negative cocci

Gram negative coccobacill

A

Cocci

  • N. meningitidis
  • N. gonorrhea
  • Moraxella catarrhalis

Coccobacilli

  • H. influenza
  • Bordatella pertussis
  • Pasteurella
  • Brucella
468
Q

Gram negative Lactose fermenting rods

Gram negative non lactose fermenting rods

A

Lactose (Fast)

  • Klebsiella
  • E.coli
  • Enterobacter

Lactose (slow)

  • Citrobacter
  • Settaria

Non lactose fermenter

  • Shigella
  • Salmonella
  • Proteus
  • Yersinia
  • Pseudomonas (oxidase +)
469
Q

Stages of Lyme disease

A

Stage 1: Early localized

  • Erythema migrans
  • Fever, HA, body ache, fatigue
Stage 2: Early disseminated
- weeks to months
- Multiple Erythema migrans lesions
- Cardiac
(AV block, myopericarditis)
- Neurological
(Bilateral facial nerve palsy)
(Peripheral neuropathy)
(Lymphocytic meningitis)

Stage 3: Late

  • arthritis (large joints chronic)
  • neurological findings
470
Q

Inflammed and painful lymph nodes

Prarie dog

A

Yersinia pestis

New mexico
Safety pin on staining

Bubonic plague

Rodent or prarie dog

Groin swelling

471
Q

Primary vs reactive TB lung locations

A

Primary
- perihilar or right sided infiltrates

Reactive
- apical posterior segments of upper lobes

472
Q

Tx Rocky mountain spotted fever

A

Rickettsia ricksttsii

Doxycycline

473
Q

[Linezolid, Tetracycline, Aminoglycoside, Macrolides, Chloramphenicol, clindamycin]

1) Ototoxicity
2) Pseudomembranous colitis
3) Prolonged QT
4) Gray baby syndrome
5) PHotosensitivity
6) MRSA/ VRE coverage
7) Anaerobic coverage
8) Discolored teeth
9) Atypical pneumonia coverage

A

1) Aminoglycosides
2) Clindamycin
3) Macrolide
4) Chloramphenicol
5) Tetracycline
6) Linezolid
7) Clindamycin
8) Tetracycline
9) Macrolide

474
Q

MOA of each drug

1) Sulfamethoxazole
2) Trimethoprim
3) Levofloxacin
4) Nitrofurantoin
5) Metronidazole
6) Polymyxin B

A

1) Sulfamethoxazole
- Inhibit dihydropteroate synthetase

2) Trimethoprim
- inhibit dihydrofolate reductase

3) Levofloxacin
- Inhibit DNA gyrase (topoisomerase II)

4) Nitrofurantoin
- Inhibit bacterial ribosomes

5) Metronidazole
- Forms toxic free radicals that damages DNA

6) Polymyxin B
- Acts like cationic detergent

475
Q

1) Vomiting and watery diarrhea on cruise

2) Watery diarrhea 12 hrs after eating meat or poultry from cafeteria

A

1) Norovirus

2) Clostridium perfringens

476
Q

Osteomylitiis involving vertbrae organism

A

Mycobacterium tuberculosis

477
Q

Which RNA virus

1) Hand, foot, and mouth
2) Break bone fever
3) Common COld
4) Fever, jaundice, black vomit
5) Meningitis ins ummer months
6) Tourniquet test helps diagnose hemorrhagic disease
7) Infects motor neurons of anterior horn

A

1) Hand, foot, and mouth= coxsackievirus
2) Break bone fever= dengue
3) Common COld= rhinovirus, coronavirus
4) Fever, jaundice, black vomit= yellow fever
5) Meningitis in summer months= Echovirus, coxsackievirus, other enteroviruses
6) Tourniquet test helps diagnose hemorrhagic disease= dengue
7) Infects motor neurons of anterior horn= poliovirus, west nile virus

478
Q

Which antiviral

1) Prophylaxis for influenza A
2) used to tx for chronic hep C
3) First line for herpes simplex virus or VZV
4) inhibits viral DNA polymerase when phosphorylated by viral thymidine kinase

A

1) Prophylaxis for influenza A= zonamivir, oseltamivir
2) used to tx for chronic hep C= ribavirin + IFN-alpha
3) First line for herpes simplex virus or VZV = acyclovir, valacyclovir, famiciclovir
4) inhibits viral DNA polymerase when phosphorylated by viral thymidine kinase= -cyclovirs (not ganciclovir)

479
Q

Which antifungal to use

1) Cell wall synthesis inhibitor used in invasive aspergillosis
2) Swish and swallow for oral candidiasis or thrush
3) Most common tx for onychomycosis
4) Deposits in keratin-containing tissues to tx tinea capitis and onychomycosis
5) used for cryptococcal meningitis in AIDS
6) Drug of choice for sporotrichosis

A

1) Cell wall synthesis inhibitor used in invasive aspergillosis
- Caspofungin

2) Swish and swallow for oral candidiasis or thrush
- Nystatin

3) Most common tx for onychomycosis
- Terbinafine, itraconazole, fluconazole

4) Deposits in keratin-containing tissues to tx tinea capitis and onychomycosis
- griseofulvin

5) used for cryptococcal meningitis in AIDS
- IV amphotericin B + flucytosine

6) Drug of choice for sporotrichosis
- Itraconazole

480
Q

Lymphatic filariasis

A

Elephantism of limbs

Wuchereria bancrofti
Helminth, neomatoid
Round worm

Tx: Diethylcarbamazine

481
Q

Exacerbates COPD

A

Haemophilus influenza
Strep. pneumonia
Moraxella catarrhalis

482
Q

63 y.o in ER with recent onset of high fever, confusion, headache, watery diarrhea and mildly productive cough. Smoked for 30 years and has bronchitis. Fever 104, Gram stain shows numerous neutrophils but no bacteria.

A

Legionella pneumoniae

High fever w/ bradycardia
Headache confusion
Watery diarrhea

Fluroquinoles
Macrolide

483
Q

Bilateral interstitial infiltrates

Silver stain

Tx

A

Pneumocystis jirovecii

circular ring with clear center

TMP-SMX

484
Q

Budding yeast with thick capsule

A

Cryptococcus neoformans

485
Q

HIV

Linear ulcerations

A

CMV

486
Q

Flu vaccine against what part

A

Humoral response to hemaglutinin

487
Q

Organisms that cause granulomatous disease

  • Bacteria
  • Fungal
  • Parasitic
A

Bacteria

  • Mycobacteria (tuberculosis, leprosy)
  • Bartonella henselae (cat scratch)
  • Listeria monocytogenes
  • Treponema pallidum (tertiary syphilis)

Fungal
- Histoplasmosis

Parasitic
- Schistosomiasis

488
Q

Zoonotic bacteria

1) Cat scratch
2) Rodents to Tick
3) Cattle fluids
4) Birds and pigs
5) Birds
6) Infected placenta or contaminated fluid of newborn farm animals
7) Lone star tick
8) Rabbit or squirrel
9) Infected animal urine
10) Nine-banded armadillo
11) dog bit
12) Lice
13) Fleas
14) Tick, rash on palms
15) Fleas, prairie dogs

A

1) Cat scratch= Bartonella henselae
2) Rodent to tick= Borrelia burgdorferi
3) Cattle fluids= Brucellosis
4) Birds and pigs= Campylobacter
5) Birds= Chlamydophila psittaci
6) Infected placenta or contaminated fluid of newborn farm animal= Coxiella burneii
7) Lone star tick= Ehrlichia chaffeensis
8) Rabbit or squirrel= Francisella tularensis
9) Infected animal urine= Leptospira
10) Nine-banded armadillo= Mycobacterium leprae
11) Dog bite= Pasteurella multocida
12) Lice= Rickettsia prowazekii
13) Fleas= Rickettsia typhi
14) Tick, rash on palm= Rickettsia rickettsii (rocky mountain spotted fever)
15) Fleas, prairie dogs= Yersinia pestis

489
Q

Obligate anaerobes (3)

Tx

A

Clostridium species
Actinomyces (Gram +)
Bacteroides (Gram -)

Tx metronidazole
Clindamycin

490
Q

Acute otitis media organisms

A

S. pneumonia
Nontypable Haemophilius influenzae
M. Catrrhalis

491
Q

Headache
Fever
Rash on wrist and ankles moves to palms soles and trunk

A

Ricketta ricksttsii

Rocky mountain spotted fever

492
Q

What upper GI problem associated with findings

1) Biopsy of pt with esophagitis reveals large pink intranuclear inclusions and host cells chromatin that is pushed to the nucleus

A

HSV esophagitis

493
Q

Fried rice Reheated rice

A

Bacillus cereus

494
Q

Gram neg rod
Green metallic sheen on eosin methylene blue agar
Hemolysis on blood agar

A

Ecoli

495
Q

What upper GI problem associated with findings

Biopsy of a patient with esophagitis reveals enlarged cells, intranuclear and cytoplasmic inclusions, and a clear perinuclear halo

A

CMV esophagitis

496
Q

Which organisms cannot be stained w/ gram stain

A 
Treponema
Rickettsia 
Chlamydia 
Legionella 
Mycoplasma 
Mycobacteria
497
Q

Pseudoappendicitis

A

Yersinia enterocolitica

Heat stable toxin

Increase cGMP

498
Q

Common infectious organism of tonsils and adenoids

Common infectious organism of salivary gland

A

S. pyogenes

S. aureus, viridans group streptococci

499
Q

Small intestinal mucosa laden with distended macrophages in the lamina propria

A

Whipple disease

500
Q

Bacteria vaccine

  • toxin
  • capsular polysaccharides
  • killed bacteria
  • live attenuated bacteria
A

Toxin
- Tetanus toxoid

Capsular polysaccharides

  • S. pneumoniae
  • H. influenzae

Killed bacteria
- Vibrio cholerae

Live attenuated bacteria

  • Typhoid vaccine
  • BCG vaccine
501
Q

Lactose non-fermenters
Urease producing

-Creates what

A

Proteus spp

Alkaline urine 
Struvite stones (Staghorn calculi)
502
Q

What is the unique features of gram negative bacteria cell wall

A

Outer membrane

  • endotoxin (LPS)
  • induce IL-1, TNF alpha
Periplasmic space (between membranes) 
- beta lactamase
503
Q

A PAS stain on a biopsy obtained from a patient with esophagitis reveals hyphate orgnaisms

A

Candida esophagitis

504
Q

Spore forming bacteria

A

Bacillus anthracis
Bacillus cereus

Clostridum spp
(perfringens, tetani, botulinum, difficle)

Coxiella burnetti

505
Q

Superantigens

A

Exotoxins that simulatenously bind MHC II receptor and T cell receptor

Polyclonal expansion of T cells

Large amounts of cytokines

Staph Aureus
Strep Pyogenes

506
Q

Neurotoxins

A

Interfere with neural transmission

Botulinum toxin
Tetanus toxin

507
Q

Positive sense ssRNA virus

1) Meningitis
2) common cold

A

Picornavirus

Coronoavirus- cold

508
Q

Hepatitis A

  • type
  • genus
  • family
  • transmission
  • infection type
  • signs
A

ssRNA virus
non-enveloped

Hepatovirus

Picronavirus

Fecal/oral, poor sanitation

Acute

509
Q

Hepatitis B

  • type
  • genus
  • family
  • transmission
  • infection type
  • Tx
A

ds DNA

Orthohepadnavirus

Hepadnaviridae

Perinatally, sexual contact, blood

Chronic

Tenofovir

510
Q

Hepatitis C

  • type
  • genus
  • family
  • transmission
  • infection type
  • Tx
A

ssRNA

hepacivirus

Flavivirdae

Blood, sexual contact

Chronic

Ledipasvir-sofosbuvir
Ombitasvir-paritaprevir-ritonavir + dasabuvir

511
Q

Hepatitis E

  • type
  • genus
  • family
  • transmission
  • infection type
  • More likely to cause fulminant hepatic failure in
A

ssRNA

Hepevirdae

Orthohepevirus

Fecal/oral route, contaminated water

Acute

Pregnant women

512
Q 
Weight loss 
Lymphadenopathy 
Hyperpigmentation 
Cardiac symptoms 
Arthralgias 
Neurlogic symptoms 
PAS+ Foamy macrophages in lamina propria
A 
Whippe disease
Tropheryma whipplei (Gram +)

Penicillin
Ampicillin
Tetracycline

513
Q

HA

Fever, Rash centrally spreads to extremities

A

Rickettsia prowazekii
-Lice

Rickettsia typhi
- Fleas

514
Q

Whitish patch on posterior oropharynx, makes greyish membrane, will bleed if scrap off

Tx

A

Corynebacterium diphtheriae

Erythromycin or penicillin
Antitoxin
Vaccinate

515
Q

WHich mycobacterium species fits each

1) Causes leprosy
2) Causes pulmonary TB-like symptoms in COPD patients
3) Causes cervical lymphadenitis in children
4) Cuases a disseminated disease in AIDS patients
5) Associated iwth hand infection in aquarium handlers

A

1) Myco. leprae
2) Myco. kansasii
3) Myco. scrofulaceum

4) Myco. avium intracellulure (MAI)
Myco. avium complex (MAC)

5) Myco. Marinum

516
Q

Septic aborption organisms

A

Staph aureus
Ecoli
Group B strep

517
Q

Ecoli toxin

A

Verocytotoxin (Shiga toxin)

  • Bloody diarrhea
  • HUS
Heat labile toxin 
- stimulates adenylyl cyclase 
- Increase cAMP 
Heat stabile toxin 
-stimulate guanylyl cyclase 
- increase cGMP 
ETEC
518
Q

Bordetella pertussis

A

Pertussis toxin binds and inactivates inhibitory G proteins –> increase cAMP

519
Q

Nef

tat

A

HIV regulatory genes

Nef: downregulates teh expression of class I major histocompatibility complex proteins on teh surface of infected cells, limits immune recognition by cytotoxic T cells

tat: is a transcriptional activator that promotes viral gene expression

520
Q

What is a feature of gram positive bacteria cell wall

A

Lipoteichoic acids

Induce cytokine production

IL-1, TNF-alpha

521
Q

Rapid onset sepsis
Altered consciousness
Organ failure
Petechial/ ecchymotic rash

virulence factor

A

N. meningitidis

Lipo-oligosaccharide (LOS)

522
Q 
Headache fever inattentiveness
Chemotherapy 
Increased opening pressure 
Increased protein, low glucose 
Image: Cds

Tx.

A

Cryptococal meningoencephalitis

Initial:
Amphotericin B
Flucytosine

Long term maintenance therapy:
Fluconazole

523
Q

Acute otitis externa organisms

A

S. aureus

Pseudomonas aeruginosa

524
Q

Chlamydophila psittaci

Chlamydophila pneumoniae

Chlamydia trachomatis

  • A, B, C
  • D-K
  • L1 L2 L3
A

Chlamydophila psittaci

  • bird exposure
  • pneumonia

Chlamydophila pneumoniae

  • interstitial pneumoniae
  • walking pneumonia

Chlamydia trachomatis

  • A, B, C (trachoma eye infxn)
  • D-K (PID, urethritis, conjunctivitis)
  • L1 L2 L3 (lymphogranuloma venerum, primary ulcer and LAD)
525
Q

How HIV attaches

A

Attaches to host cells using the viral surface glycoprotein gp120

This glycoprotein bins to teh CD4 as the primary receptor and teh chemokine receptor CC45 as the coreceptor

Conformation change in gp120 exposes teh underlying transmembrane glycoprotien gp41 which mediates viral fusion

526
Q

Corynebacterium diphtheriae is virulent how

A

phage conversion permitting exotoxin production

527
Q 
Fever chills, fatigue, dyspnea
Temp 
Ring shaped and Maltese cross 
Splenectomy 
Intraerythrocytic inclusions
A

Babesiosis
Tick borne infection

Babesia microti

528
Q

5 y.o difficulty breathing
dysphagia
drooling fever
Swollen and cherry red epiglottis

sign

A

H. influenzae type B

thumb sign

529
Q 
Headache
Fever 
Malaise 
Cough 
Nodular infiltrates 
Clumping once room temp
A

Mycoplasma pneumoniae

Walking pneumoniae
Cross reactive IgM
Activate complement –> erythrocyte lysis

Cold agglutinins

530
Q

COPD exacerbation due to

A

virus: rhinovirus, influenza virus, parainfluenza (most common)
bacterial: h. influenza, moraxella catarrhalis, strep. pneumoniae

531
Q

Which infectious agent fits

1) Common cause of pneumonia in immunocompromised patients
2) Most common cause atypical pneumonia
3) Agent for penumonia in alcoholics
4) Can cause an interstitial pneumonia in bird handlers
5) Pneumonia in pts w/ hx of exposure to bats and bat droppings
6) Pneumonia in pt who visited south california, new mexico, or west texas
7) Pneumonia associated iwth currant jelly sputum
8) Q fever
9) Assocaited with pneumonia acquired from air conditioners
10) Most common cause of pneumonia in children 1 year old or younger
11) Pneumonia in neonate
12) Pneumonia in children and young adults (college, militrary, prison inmates)
13) Viral pneumonia
14) Causes wool-sorter’s disease (life-threatening pneumonia)
15) Common pneumonia in ventilator patients and those with CF
16) Pontiac fever

A

1) Common cause of pneumonia in immunocompromised patients = Pneumocystis jirovecii
2) Most common cause atypical pneumonia = Mycoplasma pneumoniae
3) Agent for penumonia in alcoholics = Klebsiella pneumoniae
4) Can cause an interstitial pneumonia in bird handlers = Chlamydophila psittaci
5) Pneumonia in pts w/ hx of exposure to bats and bat droppings = Histoplasma
6) Pneumonia in pt who visited south california, new mexico, or west texas = Coccidioides immitis
7) Pneumonia associated iwth currant jelly sputum = Klebsiella pneumoniae
8) Q fever = Coxiella burnetii
9) Assocaited with pneumonia acquired from air conditioners = Legionella pneumophilia
10) Most common cause of pneumonia in children 1 year old or younger = RSV
11) Pneumonia in neonate = Group B strep, E coli
12) Pneumonia in children and young adults (college, militrary, prison inmates) = Mycoplasma pneumoniae
13) Viral pneumonia = RSV
14) Causes wool-sorter’s disease (life-threatening pneumonia) = Bacillus anthracis
15) Common pneumonia in ventilator patients and those with CF = Pseudomonas, MRSA
16) Pontiac fever= Legionella pneumophila

532
Q

Green metallic sheen on eosin methylene blue agar

A

Ferments lactose

533
Q

1) Parasite eggs in stool
2) Perianal egg deposition
3) Proglottids in the stool
4) Rhabdoitiform larvae in the stool
5) Trophozoites and cysts in the stool

A

1) Schistosoma mansoni or S. japonicum
2) Enterobius vermicularis (pinworms)
3) Intestinal tape worms (Taenia solium, T saginata, Diphyllobothrium latum)
4) Strongyloides stercoralis
5) Protozoal infections (Giardia lamblia, entamoeba histolyticsa)

534
Q

Silver stain

A

Fungi

  • coccidoides
  • pneumocystis jirovecci

Legionella

Helicobacter pylori

535
Q

Name the exotoxin

1) Causes scarlet fever
2) Inactivates EF-2
3) Blocks release of the inhibitory neurotransmitter glycine

A 
1) Erythogenic toxin
Pyogenic toxins (s. pyogenes) 
2) Diphtheria toxin 
Exotonin A (pseudomonas)

3) Tetanospasmin (c. tetani)

536
Q

scabes tx

A

topical permethrin

537
Q

Most common cause of viral conjunctivitis

A

Adenovirus

Ds non enveloped linear DNA virus

538
Q

Four obligate aerobic bacteria

A

Nagging Pest Must Breathe

Nocardia
Pseudomonas aeruginosa
Mycobacterium tuberculosis
Bacillus

539
Q 
Fever 
Headache 
Nuchal rigidity 
Normal glucose 
elevated protein
A

Aseptic meningitis

Enteroviruses

  • coxsackievirus
  • echovirus
  • poliovirus
540
Q 
Anorexia
Nausea 
Dark-colored urine 
Trip to mexico 
Fever 
Right upper quadrant pain

liver biopsy?

A

Acute viral hepatitis
HAV

Hepatic swelling

541
Q

N gonorrhoeae infection and repeat infections

A

High variability of gonococcal surface antigens (porins, opa proteins and lipooligosaccharide) limits effectiveness of antibody response

Previous infections results in almost no protective immunity against future infections

542
Q

H. influenzae type b virulence factor

A

Polysaccaride capsule

composed of polyribosylribitol phosphate (PRP)

543
Q 
Man to ER
Found unconscious 
Temp 
White patches on mucosa 
Bilateral crackles in lungs 
Bilateral interstitial infiltrates

Silver stain

A

Pneumocystisi pneumonia

atypical fungal infection
Opportunistic infection

544
Q 
Fever 
Malaise 
sore throat 
VERY tired 
Palatal petechiae 
cervical LAD 
Splenomegaly

-Assoc with

A

Mono

- EBV

545
Q

Vaccine with virus-like particles

Subunit type

A

Induces only the Ag that stimulate the immune system

Hep B
HPV

546
Q

Toxic associated with Staph aureus
- hemolysis

  • tissue destruction w/ mRSA affects both neutrophils and macrophages
  • food poisoning
  • release of cytokines, high fever, hypotension, diffuse rash
  • Scalded skin syndrome in newborns
A

Hemolysis

  • alpha-toxin (alpha hemolysin)
  • sphingomyelinase C (beta)
  • leukocidin (gamma)
  • delta-toxin

Panton-Valentine leukocidin

Enterotoxin (superantigen)

Toxic shock syndrome toxin 1 (superantigen)

Exfoliative toxin

547
Q

Lung abscess bacteria

Tx

Complication of

A

Anaerobes

Peptostreptococcus 
Prevotella 
Bacteroids 
Fusobacterium 
S. aureus 
Klebsiella pneumoniae 
Gram negative bacteria

First line for anaerobe
- Clindamycin

Aspiration pneumonia

  • alcoholics
  • drug abusers
  • general anesthesia
548
Q

Missouri caves

histology

A

Histoplasma capsulatum

Macropahges iwth intracellular small yeasts

549
Q

Pig farmer

A

Loeffler syndrome
Ascaris infection

Eosinophilic invasion due to parasitic infection

550
Q

Vesicular rash

A

Chicken pox

551
Q

HIV process involving glycosylation

A

Only glycosylated HIV polyprotein is gp160
- product of the env gene

gp160 is extensively glycosylated in the rough ER and golgi

cleaved into envelope proteins gp120 and gp41

gp120: mediates viral attachment
gp41: mediates viral fusion

552
Q 
Myalgia
Fatigue 
HA 
Chills 
Fever

Sick and recovered

Mild jaundice
Hepatosplenomegaly
Elevated indirect bilirubin

Ringed inclusions

A

Malaria

Trophozoites (ringed inclusions) on Giemsa

Dormant hepatic phase

553
Q

High fever
Nasal discharge
Bilateral conjunctival injection
Several small white spots with an erythematous base on buccal mucosa

No vaccines

What else is seen

A

Measles

Maculopapular rash

554
Q

Goes with?

Lecithinase

M protein

Protein A

Trehalose dimycolate

Polyribosylribitol phosphate (PRP)

A

Lecithinase: toxin A, clostridium perfringens
- results in cell lysis and gas gangrene

M protein: strep. pyogenes
-Binds factor H to prevent opsonization and destruction by alternative complement pathway

Protein A: staph aureus
- prevent opsonization by binding Fc region of immunoglobulins

Trehalose dimycolate: cellw all component , mycobacterium tuberculosis
- protects from being killed by macrophages and stimulates granuloma formation

Polyribosylribitol phosphate: Haemophilus influenzae type b
- capsule protects against phagocytosis and complement mediated lysis by binding factor H (prevents complement C3b deposition on host cells

555
Q

Endocarditis with negative blood cultures

A

HACEK

  • Haemophilus
  • Actinobacillus
  • Cardiobacterium
  • Eikenella
  • Kingella

Coxiella burnetii (Q fever)
Bartonella
Brucella

556
Q

Meningitis gram negative coccobacilli

A

H. influenzae

557
Q

1) Budding yeast with thick capsule
2) Macropahges with intracellular small yeast
3) Round spherules iwth multiple endospores
4) Septate hyphae with dichotomous branching
5) Yeasts with pseudohyphae and blastoconidia

A

1) Cryptococcus neoformans
- bird droppings
- immunocompromised
- meningoencephalitis

2) Histoplasma capsulatum
- Missouri caves
- fever nonproductive cough

3) Coccidioides immitis
- pulmonary disease

4) Aspergilus fumigatus
- V shaped branching
- AIDS

5) Candida species
- immunocompromised

558
Q

Ziehl neelsen stain

A

Acid fast organism

559
Q

IPV vaccine

A

Poliomyelitis

560
Q

HIV pol gene encodes for

A

reverse transcriptase
integrase
protease

RT: ssRNA –> ds DNA

Integrase: integrate into host genome

Protease: cleave HIV polyproteins into individual proteins after trasncription in rough ER

561
Q

Virus that infects by CD21

Virus that infects by glycoprotein gp120

Virus that infects via the blood group P antigen (globoside)

A

1) EBV
2) HIV
3) Parvovrus B19

562
Q

What type of meningitis?

1) Unvaccinated child
2) Outbreak in dorm
3) Meningitis with petechial rash
4) Patient with HIV
5) RBCs in CSF + temporal lobe involvement on MRI

A

1) H. influenza type B
2) N. meningitis
3) N. meningitides
4) Cryptococcus neoformans
5) HSV encephalitis

563
Q

Frothy yellow green
Fishy odor
pH > 4.5
Pear shaped

Tx

A

Trichomonas vaginalis

Metronidazole

564
Q

negative sense ssRNA virus

A

Arenavirus- hemorrhagic fever

565
Q

Perinuclear cytoplasmic clearing

A

Koilocytes

HPV

566
Q

Thick white cottage cheese like
4-4.5 pH

Tx

A

Candida spp

Azoles
Nystatin

567
Q

Congenital Rubella possible heart defect

A

PDA

Pulmonary artery stenosis

568
Q

Multiple ulcers
Mucosal erosions
Large cells iwth basophili cintranuclear and intracytoplasmic inclusions`

A

CMV

herpesvirus

569
Q

Pathologic finding of varicella zoster

A

Multinucleated cells with intranuclear inclusions

570
Q

Rash followed by desquamation of hands and feet (sloughing of skin)
Snuffles (blood tinged nasal secretions)
Skeletal abnromalities
Hepatomegaly

A

Early manifestations Congenital syphilis (during first 2 years)

571
Q

Identify

1) Epithelial cells covered with gram-variable rods
2) Epithelial cells with rare leukocytes
3) Gram-negative intracellular diplococci
4) leukocytes and pear-shaped organisms
5) Pseudohyphae with leukocytes

A

1) Gardnerella
2) normal vaginal discharge
3) Gonorrhea
4) trichomonas vaginitis
5) Candida vaginitis

572
Q

Identify

1) Multiple painful ulcers
2) Painful single ulcer
3) Painless ulcer, raised indurated edges
4) School of fish
5) Granulomatous lesions on skin ( large areas of dying flesh)

A

1) Herpes simplex
2) Haemophilus ducreyi
3) Syphilis
4) Haemophilus ducreyi

5) Tertiary syphilis
- Gummatous syphilis

573
Q

Variola virus

A

Pox virus
Small pox

Respiratory droplets
Contaminated objects

Rash around mouth –> spread to face –> trunk extremities

574
Q

Painful red nodules on finger and toe pads

Erythematous maculoes on palms and soles

Splinter hemorrhages in fingernails

Fever

Organisms?

Acute vs subacute

A

Endocarditis
- inflammation of valves

S. Aureus
Viridans streptococci
Enterococcus
Coagulase neg staph

Acute

  • s. aureus
  • days
  • normal valves

Subacute

  • Viridans streptococci
  • wks –> months
  • previously damaged valves
575
Q

Still get Haemophilus influenzae even though had vaccine how?

A

The strain responsible for the patients disease does not produce a capsule

H. influenzae nontypeable

Vaccine only against more invasive type b strain

576
Q

Histopathologic evaluation of syphilis lesion

A

Intense plasma cell rich infiltrate with proliferative endarteritis

577
Q

Anthrax toxin

A

Edema factor (adenylyl yclase)
Lethal factor
Protective antigen

Bacillus anthracis

578
Q

Red prominent bumps smooth dots

A

Baronella henselae

Bacillary angiomatosis

579
Q

Pear shaped organism

Watery diarrhea

Small bowel shows?

Immune mechanism?

A

Giardia lamblia
(parasite)

Villus atrophy and crypt hyperplasia

CD4 T cells and secretory IgA production

580
Q

Thin gray-white fishy odor
>4.5 pH
Clue cells

Tx

A

Gardnerella vaginalis

Part of normal flora

Metronidazole
Clindamycin

581
Q

Viridans streptococci

A

Colonizer of the oral cavity
Cause infective endocarditis
No capsule

Partial hemolysis

582
Q

Which causes of vaginal discharge/ vaginitis are associated iwth a high vaginal pH?

Wjocj are associated iwth a low vaginal pH?

A

Low vaginal pH
- physiologic dischrage
Candida

High vaginal pH
- gardnerella
Trichomonas

583
Q

Vibrio cholerae

A

Cholera toxin

stimulates adenylyl cyclase
increase cAMP
chloride and water cross lumen

rice water stools

584
Q

Bloody dirarrhea

Eosinophils

A

E. histolytica

585
Q

Meningitis gram positive rod

A

LIsteria monocytogenes

586
Q

Splenomegaly
South asia
Anemia
thrombocytopenia

A

Malaria

587
Q

Severe fetal anemia
Ascites
Pleural effusions

A

Hydrops fetalis

Parvovirus B19

588
Q

Positive VDRL w/ vulvar lesion

A

Tertiarty syphilis

Gumma

589
Q

Gram negative rod
Swarming motility
Urease positive

Forms what

A

Proteus mirabilis

Hydrolyzes urea to ammonia
Urine more alkaline
Struvite stones

Magnesium ammonium phosphate stones

Staghorn calculus

590
Q

S. bovis risk of

A

Streptococcus gallolyticus

Causes subacute bacterial endocarditis

Part of normal flora of colon

Associated with colon cancer

591
Q

Ballooning multinucleated giant cells

A

Herpes simplex

Enlarged cells w/ intranuclear inclusions, cell fusion produc giant cells

592
Q

Inactivates EF-2

A

Exotoxin A - pseudomonas

Diphtheria toxin

593
Q

Clostridium perfringens toxins

A

Alpha toxin (phospholipase)

  • Gas gangrene
  • Myonecrosis

Enterotoxin

  • Food poisoning
  • Food left out too long once cooked
594
Q

Acute flu like illness w/ pneumoniae
Works on farm

  • chronic assoc w/
A

Coxiella burnetii

  • Q fever
  • Spore forming
  • chronic assoc w/ endocarditis
595
Q

Newborn
Jaundice
Hepatosplenomegaly
Sensorineural hearing loss

A

CMV

596
Q

Decaying vegetation

Infection in immunocompromised

A

Nocardia

597
Q

Nosocomial infection

1) Catheter assoc UTI
2) Ventilator assoc pneumonia
3) Central lines infxn
4) Surgical wounds/ decubitus ulcers
5) Parenteral nutrition

A

1) E. coli
Gram neg rods
Pseudomonas
Candida

2) Pseudomonas
Staph aureus

3) Staph epidermdiis
4) Staph aureus
5) Candida

598
Q

A patient with IL-12 receptor deficiency is at particualr risk for what type of infection?

A

Mycobacterial

599
Q 
Malaise, HA
Low grade fever 
Nonproductive cough 
Diffuse interstitial infiltrates 
Coughing for weeks

CXR: patchy reticulonodular infiltrate

Tx

A

Mycoplasma pneumonia

College kids- dorms
Military recruits

Macrolide (azithromycin)
Doxycycline (empiric)
Fluroquinoles (empiric)

Cold agglutinins
- Nonspecific IgM Ab to erythrocytes

600
Q

Question marked shaped
Rodent urine

Phase 1
Phase 2

A

Leptospira interrogans

Phase 1
Fever chills
Body ache
HA

Phase 2
Hyponatremia
Renal failure
Liver damage w/ jaundice

601
Q

Pregnant lady and cat feces or undercooked meat

  • What happens
A

Toxoplasmosis

Chorioretinitis
Hydrocephalus
Intarcranial calcifications

602
Q

Liver abscess

A

E histolytic
Protozoan
Amebic dysentery

603
Q

Bacteria w/ capsule pneumonic

A

Even Some Pretty Nasty Killers have Shiny Bodies

E coli 
Strep pneumonia 
Pseudomonas 
Neisseria meningitidis 
Klebsiella 
Haemophilius influenza type B 
Salmonella 
Group B strep

Cryptococcus neoformans
- encapsulated yeast

604
Q

Infects transfered through placenta or during birth

A

TORCHeS

Toxopolasmosis 
Other (parvovirus B19) 
Rubella 
CMV 
HIV/HSV 
Syphilis
605
Q

Chlamydia Types

1) A-C
2) D-K
3) L1-L3

Tx

A

A-C

  • Acute eye infection
  • Can lead to scarring and blindness

D-K

  • Urethritis, cervicitis, PID
  • Neonatal pneumonia and conjunctivitis

L1-L3

  • Lymphogranuloma venereum
  • Genital ulcer
  • Unilateral lymphadenopathy
  • Groove sign
  • Proctitis

Tx: Azithromycin

606
Q

Spiral shaped rod
urease positive

causes

tx

A

Helicobacter pylori

Gastric adenocarcioma

Tx: 
Triple therapy 
- PPI 
- Clarithromycin 
- Amoxicillin or metronidazole

Quadruple therapy

  • PPI
  • Bismuth
  • Metronidazole
  • Tetracycline
607
Q

Herpes virus

A

dsDNA

608
Q 
Rapid onset
Headache 
Fever 
Altered mental status 
Nuchal rigidity 
Pruritic rash

Type of vaccine?

A

Meningococcal meningitis

Capsular polysaccharide Ag

609
Q

Small ovoid yeast in lungs

A

Histoplasma capsulatum

  • dimorphic
  • inhaled as microconidia
  • pneumonia
610
Q

Hepatitis B C D vs A E

A

BCD transmitter parenterally (IV, blood)

AE: fecal oral

611
Q

What can have painful inguinal lymphadenopathy

A

Bubo

Lymphogranuloma venereum

Chlamydia trachomatis

612
Q 
Bulls eye
Fever 
HA 
Body ache 
Fatigue

Tx

A

Borrelia burgdorferi

Ixodes tick

Tx Doxycycline (early stage)
Amoxicilin (children <8)
Doxycycline or Ceftriaxone (late)

613
Q

Bilateral facial nerve palsy

Tx

A

Borrelia burgdorferi

Ixodes tick

Tx Doxycycline (early stage)
Amoxicilin (children <8)
Doxycycline or Ceftriaxone (late)

614
Q

Diphtheria toxin

A

Inactivates EF-2

Inhibits protein synthesis

Corynebacterium diphtheriae

615
Q

Increases bidning to host tissues, induce coagulation or blood clotting

A

Coagulase

616
Q

Common disease caused by Group A strep (pyogenes)

A

Acute pharyngitis
Cellulitis
Invasive infection

Acute post-streptococcal glomerulonephritis

Rheumatic fever

Toxic shock syndrome

617
Q

India ink

A

Fungus

Crytococcus neoformans

618
Q

S. epidermidis vs s. saprophyticus

A

S. epidermidis

  • Novobiocin sensitive
  • heart valves

S. saprophyticus

  • Novobiocin resistant
  • UTI
619
Q

Group A Strep immunologic complications

A

Body immune response to bacteria

Jones 
Joints 
Pancarditis (endo/myo/pericarditis) 
Nodules (SQ) 
Erthema marginatum 
Sydenham chorea
620
Q

Splenomegaly
South asia
Progressive splenic enlargement
WL over months

A

Leishmaniasis

621
Q

Rash involving palms and soles

Maculopapular

A

Kawasaki disease
Coxsackie A virus
Rocky mountain spotted fever
Syphillis

Meningococcemia

You drive Kawaski CARS with your hands and feet

622
Q

Contaminated deli meat

A

Listeria

623
Q

Neonatal sepsis

A

Group B strep
Listeria
Ecoli

624
Q

Pigment producing bacteria (4)

A

Staph aureus
- Large golden colonies

Actinomyces israelii

  • yellow (sulfur) granules
  • yellow sand

Pseudomonas aeruginosa
- blue green pigment

Serratia marcescens (MARsecens) 
- red pigment
625
Q

Egg based vaccines

A

Influenza
Yellow fever
(MMR) tiny amount

626
Q

Mega-esophagus

Cardiomegaly

A

Chagas disease

- Trypanosoma cruzi

627
Q

Bacteria cause subscute endocarditis

A 
Coagulase neg Staph
Viridans group streptococci 
Strep bovis 
Enterococci 
HACEK organisms 
HACEK 
- not gram (+) 
Haemophilus aphrophilus 
Aggregatibacter spp 
Cardiobacterium hominis 
Eilcenella corrodens 
Kingella kingae
628
Q

Toxins secreted by Strep pyogenes

A

Streptolysin O
- hemolysis (oxygen labile)

Streptolysin S
- hemolysis (oxygen stable)

Streptococcal pyrogenic exotoxins Type A, B, C/ erythrogenic toxins
- red rash (erythro-) and fever (pyro-) of scarlet fever
(superantigen)

629
Q

Potato salad

A

Staphyloccus aureus

Rapid vomiting

630
Q

Gram (+) cocci
Catalase negative
Dental plaque

A

S. mutans (most)

S. sanguinis
- preexisting heart flow problems

631
Q

What three bacteria are obligate intracellular bacteria

A

Rickettsia
Coxiella
Chlamydia

632
Q

Degrades H202 into H20 and O2

A

Catalase

633
Q

Replicative process

1) DS dna –> DS dna template –> ds DNA progeny
2) DS dna -> +RNA template -> partially ds-DNA
3) ssDNA –> ds DNA template –> ss DNA progeny
4) ss +RNA –> ds DNA template –> ss +RNA progeny
5) ss +RNA –> - RNA template –> ss + RNA progeny
6) ss -RNA –> +RNA template –> ss -RNA progeny

A

1) Adenovius, herpesvirus, poxvirus
2) Hepatitis virus
3) Parvovirus B19
4) Retroviruses (HIV)
5) poliovirus
6) Influenza virua, measles virus, rabies virus

634
Q

Cyst in brain
Not IC
Seizures

A

Taenia solium
Pork tapeworm
Feces contaminated food

635
Q

Live Virus vaccinations pneumonic

A

Attention! Please Vaccinate Young Infants with MMR Regularly

Attenuated virus vaccines

Polio (sabin, oral) 
Varicella 
Yellow fever 
Intranasal influenza 
MMR 
Rotavirus
636
Q

Infection from puppy

A

Campylobacteri jejuni

637
Q

meningitis in very young and old

A

Listeria

638
Q

9 month old
2 minute general seizures
Fever

3 days later
afebrile
Maculopapular rash on trunk

A

Human herpesvirus 6

639
Q

Child sticking nose in air

A

Esophagitis

H. infuenzae type B

640
Q

Vaginal discharge
Grayish white
Fishy smelling

What is seen on microscopy?

A

Epithelial cells covered with gram-variable rods

641
Q

What enzymes do obligate anaerobes lack

A

Catalse

Superoxide dismutase

642
Q

Argyll robertson pupil

A

Pupil constricts with accomodation but doesnt react w/ direct light

Neurosyphilis

643
Q 
Flaccid paralysis
Hyporeflexia 
weakness 
Faciculations 
Fever, HA, malaise 
Lymphocytic pleocystois (increase lymphocytes in CSF) 
Slightly elevated protein 
Normal glucose
A

Polio

644
Q

Gram positive diplococci

A

Strep. pneumoniae

645
Q

Pneumonia in neonates (Birth to 28 days

Pneumonia in children

Pneumonia in adults

A

Neonates

  • Group B streptococcus
  • E coli
  • Chlamydia trachomatis
  • HSV

Children

  • Viruses (RSV)
  • Streptococcus pneumoniae
  • Mycoplasma pneumoniae
  • Chlamydophila pneumoniae

Adults

  • Streptococcus pneumoniae
  • H. influenza
  • Mycoplasma pneumoniae
  • Chlamydophila pneumoniae
  • Influenza virus

Elderly

  • Streptococcus pneumoniae
  • H. influenza
  • Influenza virus
  • S. aureus
  • Gram negative rods (klebsiella )
646
Q

Listeria is acquired how

A

Contaminated food

Unpasteurized milk
Uncooked meats

647
Q

Spiral shaped bacteria

A

H. pylori

648
Q

For viral particle to be coupled to MHC class I it first has to be involved with what

A

Ubiquitin ligase

649
Q

6 month old gets flaccid paralysis after eating honey. Organism? MOA?

A

Clostridum botulinum

Inhibits release of acetylcholine

650
Q

Organism taht causes pneumonia in each of these patients

1) Alcoholic patient
2) Patient with decrased level of consciousness
3) Pt w/ cystic fibrosis
4) Pt w/ HIV and CD4<200
5) Post-influenza
6) Acquired from patio-cooling water mister
7) Travel to southwestern U.S.
8) Exposure to bird/ bat droppings in ohio missiissippi river
9) Patient with pet parrot

A

1) Klebsiella
2) Anaerobes
3) Pseudomonas
4) Pneumocystis jirovecii
5) Staphylococcus aureus
6) Legionella pneumophilia
7) Coccidioides immitis
8) Histoplasma capsulatum
9) chlamydophila psittaci

651
Q

Meningococcal vaccine recommendation

A

11 or 12 yo

Boooster at 16

652
Q

Diarrhea
HIV patient
Hemorrhagic nodules or polypoid masses
Spindle cells

A

Kapsoi sarcoma

-HHV8

653
Q

Vaccine with live attenuated organisms

A

“Attention Teachers! Please vaccinate SMALL, Beautiful Young INFants with MMR Regularly!”

Adenovirus 
Typhoid 
Polio 
Varicella 
Small pox 
BCG 
Yellow fever 
Influenza (intranasal) 
MMR 
Rotavirus
654
Q

Strawberry cervix

A

Trichomoniasis

655
Q

CSF findings in viral meningitis

Opening pressure 
WBC count 
Cell type 
Protein 
Glucose 
Gram stain
A

Normal or increased opening pressure

WBC increased

Lymphocytes

Normal or increased protein

Normal glucose

No stain

656
Q

Mutations in pol gene in HIV patient

A

Inconsistent use of antiretroviral–> antiretroviral resistance

657
Q

What diarrheal illnesses should be reported

A

Salmonella

Shigella

658
Q

Encapsulated bacteria?

Test for encapsulated bacteria

A

Even Some Pretty Nasty Killers Have Shiny Bodies

E.coli 
Strep pneu. 
Pseudomonas 
Neisseria meningitis 
Klebsiella 
H. influenza 
Salmonella 
B Group B strep

Quellung rxn

659
Q

CSF findings bacterial meningitis

Opening pressure 
WBC count 
Cell type 
Protein 
Glucose 
Gram stain
A

Increased pressure

Increased WBC

Neutrophils

HIGH protein

Decreased glucose

Gram stain positive

660
Q

Vaccine with inactivated (killed organisms)

A

RIP Always

Rabies
Influenza (injection)
Polio (oral)
Hep A

661
Q

Cataracts and deafness

A

Rubella

662
Q

Facial infection of jaw/mandible

Sinus tracts draining yellow pus

A

Actinomyces israelii

663
Q

What bacteria secrete enterotoxins?

A 
Vibrio cholerae
Enterotoxigenic E.coli 
Staph aureua 
Shigella 
Yersinia 
Clostridium spp.
664
Q 
Frontal bossing
Interstitial keratitis 
Hutchinson teeth 
Saddle nose 
Perforation of hard palate 
Sabershins
A

Late mnaifestation of congenital syphilis

665
Q

CSF findins TB/ fungal meningitis

Opening pressure 
WBC count 
Cell type 
Protein 
Glucose 
Gram stain
A

Increased pressure

INcreased WBC

Lymphocytes

Increased protein

Decreased glucose

No stain

666
Q

Epiglottitis

A

Haemophilus influenza

667
Q

Osteomelitis

Gangrene organism

A

Clostridium perfringens

Alpha toxin

668
Q

Meningitis by age

Neonates

Infants/children

Adults

Elderly adults

A

Neonates

  • Group B strep
  • E.coli
  • Listeria monocytogenes

Infants/ children

  • Streptococcus pneumoniae
  • Neisseria meningitides
  • H. influenza type B
  • viruses (enteroviruses)

Adults

  • strep pneumoniae
  • Neisseria meningitidis
  • enteroviruses

Elderly

  • Streptococcus pneumoniae
  • Listeria
  • Gram negative rods (ecoli)
669
Q

Clue cell

  • organism
  • characteristic (2)
  • change
  • tx (2)
A

Vaginale pithelial cell covered in coccobacilli

Gardnerella vaginalia

  • gray vaginal discharge
  • fishy smell
  • elevated pH >4.5

Oral metronidazole
Metronidazole cream

670
Q

Meningitis gram positive diplococci

A

Streptococcus pneumoniae

671
Q

Budding yeast and peudohyphae

A

Candidiasis

672
Q

Shiga toxin

A

Cleaves host rRNA at adenine base in 60S ribosomal subunit

Inhibition of protein synthesis

Shigella

673
Q

Diphtheria toxin and Exotoxin A (pseudomonas)

A

Inactivates EF-2 vis ribosylation, thus inhibiting host cell rpotein synthesis

674
Q

Oval budding yeast forms germ tubes at 37 C

A 
Candida albicans 
(true hyphae at 37)

Normal commensal of skin and GI

675
Q

Chocolate agar

- requires

A

Haemophilus influenza

Factor V and X

676
Q

Broad, nonseptate hyphae that branch at wide 90 angles

A

Mucor
Rhizopus
Absidia

677
Q

Measles vaccine is

A

Live attenuated

678
Q

Clostiridum difficile

  • toxins
  • diagnosis
  • tx
A

Toxin A (enterotoxin)

  • binds brush border
  • secretion and inflammation
Toxin B (cytotoxin) 
- disruption actin cytoskeleton

Pseudomembrnaous colitis

Stool toxin assay (PCR or ELISA)

Tx

  • Metronidazole
  • Oral vancomycin
  • Fidxomicin (recurrent)
679
Q

Firm flesh color papules on face with umbilicated center is

A

Molluscum contagiosum from Pox virus

See Molluscum bodies: eosinophilic cytoplasmic inclusions

680
Q

Meningitis
Slightly increased protein
Normal glucose
Incrased opening pressure

A

Viral meningitis

681
Q 
Newborn
Cataracts 
Harsh machine like murmur 
Deafness 
Blueberry muffin rash
A

Rubella

682
Q

What zoonotic bacterium causes each

1) Cat scratch fever
2) Lyme disease
3) Recurrent fever from variable surface antigens
4) Bloody diarrhea
5) Q fever
6) Tularemia
7) Leptospirosis
8) Cellulitis and osteomyelitis from cat or dog bites

A

1) Cat scratch fever
- Bartonella

2) Lyme disease
- Borrelia burgdorferi

3) Recurrent fever from variable surface antigens
- Borrelia recurrentis

4) Bloody diarrhea
- Campylobacter (puppies, livestock, fecal oral, sexual)

5) Q fever
- Coxiella burnetti (spores from tic feces, cattle placenta)

6) Tularemia
- Francisella tularesis

7) Leptospirosis
- Leptospira spp (animal urine)

8) Cellulitis and osteomyelitis from cat or dog bites
- Pasteurella multocida

683
Q

PAS stain for

A

Tropheryma whipplei

Whipple disease

684
Q

Child

Red rash on cheek spread to chest and shoulder

A

Parvovirus B19

685
Q

Histoplasma capsulatum

A

Mississippi and ohio river valley

Macrophages filled with histoplasma (smaller than RBC)
(Oval yeast cells within macropahges)

Bird/bat droppings

Palatal/ tongue ulcers
Splenomegaly
Pancytopenia
Fever, WL, Fatigue
Cough dyspnea, N/V, diarrhea

CD4 < 200

Caseous Necrosis
Granuloma

Erythema nodosum

Chronic Mediastinitis

  • Fibrosing mediastinitis
  • due to increased formation of CT in mediastinum

AM- STEP1 (20 decks)

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