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Micro Review Flashcards

1
Q

What are the four most common causes of pneumonia in a neonate (birth-28 days)?

A

Group B strep
E. coli
Chlamydia trachomatis
HSV

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2
Q

What are the four most common causes of pneumonia in children?

A

RSV
S. pneumoniae
Mycoplasma pneumoniae
Clamydophila pneumoniae

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3
Q

What are the five most common causes of pneumonia in adults?

A 
S. pneumoniae
H. influenzae
Mycoplasma pneumoniae
Chlamoydophila pneumoniae
Influenza virus
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4
Q

What are the five most common causes of pneumonia in elderly adults?

A 
S. pneumoniae
H. influenzae
Influenza virus
S. aureus
Gram negative rods (Klebsiella)
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5
Q

What could be the cause of pneumonia in an alcoholic?

A

Klebsiella

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6
Q

What could be the cause of pneumonia in a patient with decreased level of consciousness?

A

S. aureus

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7
Q

What could be the cause of pneumonia in a patient with cystic fibrosis?

A

pseudomonas

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8
Q

What could be the cause of pneumonia in a patient with HIV and CD4 count <200?

A

pneumocystis jirovecii

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9
Q

What could be the cause of pneumonia in a patient post-influenza?

A

S. pneumo or S aureus (fatal)

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10
Q

What could be the cause of pneumonia acquired from patio-cooling water mister?

A

legionella

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11
Q

What could be the cause of pneumonia acquired from travel to the southwestern US?

A

coccidiodes immitis

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12
Q

What could be the cause of pneumonia after exposure to bird/bat droppings in Ohio/Mississippi River valleys?

A

Histoplasma capsulatum

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13
Q

What could be the cause of pneumonia in a patient with a pet parrot?

A

Chlamoydophila psittaci (associated with birds)

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14
Q

What are the 3 most common causes of meningitis in neonates?

A

Group B strep
E. coli
Listeria monocytogenes

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15
Q

What are the 4 most common causes of meningitis in infants and children?

A

S. pneumo
N. meningitidis
H. influenzae
Viruses (enterovirus)

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16
Q

What are the 3 most common causes of meningitis in adults?

A

S. pneumoniae
N. meningitidis
Enteroviruses

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17
Q

What are the 3 most common causes of meningitis in the elderly?

A

S. pneumoniae
Listeria monocytogenes
gram-negative rods (E. coli)

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18
Q

What organism should be considered as the cause of meningitis in an unvaccinated child?

A

H. influenza type B

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19
Q

What organism should be considered as the cause of meningitis in an outbreak in a dormitory?

A

N. meningitidis

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20
Q

What organism should be considered as the cause of meningitis with a petechial rash?

A

N. menigitidis

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21
Q

What organism should be considered as the cause of meningitis in a patient with HIV?

A

cryptococcus neoformans

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22
Q

What organism should be considered as the cause of meningitis with RBCs in CSF and temporal lobe involvement on MRI?

A

HSV encephalitis

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23
Q

What are the CSF findings in bacterial meningitis?

A 
Opening pressure increased
WBC very increased
Differential: neutrophils
Protein very increased
Glucose decreased
Gram stain positive
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24
Q

What are the CSF findings in fungal/TB meningitis?

A 
Opening pressure increased
WBC increased
Differential: lymphocytes
Protein: increased
Glucose: decreased
Gram stain negative
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25
Q

What are the CSF findings in viral meningitis?

A 
Opening pressure normal or increased
WBC increased
Differential: lymphocytes
Protein: normal or increased
Glucose: normal
Gram stain: negative
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26
Q

Management of anthrax exposure

A
  1. remove clothing and wash patient with soap and water
  2. ciprofloxacin or doxycycline
  3. vaccination
  4. raxibacumab - monoclonal Ab that neutralizes anthrax toxins (edema factor and lethal factor) - use when other prophylaxis is not available
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27
Q

Smallpox presentation and management of exposure

A
  1. remove clothing and wash patient with soap and water
  2. vaccine available from CDC
    Presentation: rash on mouth and face -> spreads to trunk and extremities -> becomes vesicular/pustular
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28
Q

What are the three possible presentations of anthrax?

A
  1. cutaneous anthrax - necrotic ulcer with eschar
  2. pulmonary anthrax - mediastinal LAD -> hemorrhagic mediastinitis (widening on CXR) -> bacteremia -> death
  3. anthrax meningitis (hemorrhagic)
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29
Q

What infection causes green, frothy vaginal discharge and flagellated cells on wet prep?

A

trichomonas

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30
Q

What infection causes kilobytes on biopsy of lesion?

A

condyloma accuminatum caused by HPV (6&11)

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31
Q

What infection causes multiple tender vesicles -> shallow ulcers?

32
Q

What infection causes a painless genital ulcer followed by rash that involves plasma and soles?

A

syphilis (treponema)

33
Q

What infection causes mucopurulent discharge and cervical motion tenderness?

A

PID - most commonly caused by chlamydia and gonorrhea

34
Q

What urinalysis findings would help to confirm the diagnosis of cystitis?

A 
positive nitrites
positive leukocyte esterase
bacteriuria
pyuria
hematuria
35
Q

What organism causes strawberry cervix?

A

trichomonas

36
Q

What organism has clue cells?

A

Gardnerella vaginalis

37
Q

What organism has bacteria with “school of fish” appearance?

A

Haemophilus ducreyi

38
Q

What are the ToRCHeS infections?

A

Toxoplasma gondii, other (Parvovirus B19), Rubella, CMV, HIV, HSV2, Syphilis

39
Q

Toxoplasma gondii in neonates

A

spread through cat feces or ingestion of undercooked meat

neonatal symptoms: classic triad: chorioretinitis, hydrocephalus, and intracranial calcifications

40
Q

Parvovirus B19 in neonates

A

can cause hydrops fetalis in fetus -> fluid accumulation throughout fetus’ body

41
Q

Rubella in neonates

A

spread through respiratory droplets
neonatal symptoms: classic triad: cataracts, deafness, PDA
could have blueberry muffin rash

42
Q

CMV in neonates

A

most common congenital infection

neonatal symptoms: hearing loss, seizures, petechial rash, periventricular calcifications

43
Q

HIV in neonates

A

recurrent infections; chronic diarrhea

44
Q

How should pregnant women with HIV be treated?

A

Mom should be on HAART during pregnancy
given intrapartum zidovudine
Delivery via C-section

45
Q

Herpes Simplex virus 2 in neonates

A

meningoencephalitis, herpetic (vesicular) lesions

46
Q

How should pregnant women with HSV-2 be treated?

A

give acyclovir at 36 weeks gestation

C-section if active infection

47
Q

Syphilis in neonates

A

often results in stillbirth, hydrops fetalis

If child survives: facial abnormalities, Hutchison teeth, saddle nose, short maxilla, saber shins, CN VIII deafness

48
Q

What is the treatment for syphilis in pregnant patients? What about with an allergy to that drug?

A

Tx = penicillin

With penicillin allergy = desensitize to penicillin and then give penicillin again

49
Q

What is the most likely cause of food poisoning with vomiting 1-6 hours after eating potato salad at a picnic?

50
Q

What is the most likely cause of food poisoning with vomiting 1-6 hours after eating reheated rice?

A

Bacillus cereus

51
Q

What is the most likely cause of food poisoning with vomiting and watery diarrhea on a cruise?

52
Q

What is the most likely cause of food poisoning with watery diarrhea 12 hours after eating meat or poultry from a cafeteria?

A

salmonella

53
Q

What is the most likely cause of food poisoning with inflammatory diarrhea after eating undercooked hamburger meat, followed by acute kidney injury?

A

E. coli 0157:H7

54
Q

What is the most likely cause of food poisoning with inflammatory diarrhea after eating raw seafood?

A

vibrio parahemolyticus

55
Q

What is the most likely cause of food poisoning with inflammatory diarrhea followed by ascending paralysis?

A

Campylobacter jejuni

56
Q

What is the most likely cause of food poisoning with descending paralysis after ingestion of homemade canned goods?

A

Clostridium botulinum (symmetrical flaccid descending paralysis)

57
Q

What organism is the most likely cause of osteomyelitis in a patient with sickle cell disease?

A

Salmonella

58
Q

What organism is the most likely cause of osteomyelitis in a patient with a prosthetic device?

A

Staph epidermidis

59
Q

What organism is the most likely cause of osteomyelitis with involvement of the vertebrae?

A

mycobacterium tuberculosis

60
Q

What organism is the most likely cause of osteomyelitis following a cat bite?

A

Pasteurella multocida

61
Q

What organism is the most likely cause of osteomyelitis in an IV drug user?

A

S. aureus, Pseudomonas, serrate, candida

62
Q

What organism is the most likely cause of osteomyelitis in a diabetic with a foot ulcer?

A

polymicrobial, Pseudomonas, anaerobes

63
Q

What organism is the most likely cause of osteomyelitis with a puncture wound to foot through the sneaker?

A

Pseudomonas

64
Q

What is the gold standard for diagnosis of osteomyelitis?

A

bone biopsy and culture

65
Q

What is the most common overall cause of osteomyelitis?

66
Q

What nosocomial infection should you think of with a patient on a mechanical ventilator?

A

Pseudomonas

67
Q

What nosocomial infection should you think of with a patient with decubitus ulcers?

68
Q

What nosocomial infection should you think of with a patient with intravascular catheters?

A

S. epidermidis

69
Q

What nosocomial infection should you think of with a patient with urinary catheterization?

A

E. coli, Klebsiella, Proteus spp.

70
Q

What nosocomial infection should you think of with a patient on parenteral nutrition?

71
Q

What toxin does bacillus anthracis produce? What two factors does it contain? How do they work?

A

Anthrax exotoxin -> edema factor and lethal factor
Edema factor: increase cAMP by acting as an adenylate cyclase, causing edema and phagocyte dysfunction
Lethal factor: zinc-dep protease that inhibits mitogen-activated protein kinase signaling, causing apoptosis and multi system disruption

72
Q

What toxins does Bordatella pertussis produce? How do they work?

A

Pertussis toxin and Adenylate cyclase toxin
Pertussis toxin: disinherits adenylate cyclase through Gi ADP-ribosylation, increasing cAMP levels; causes edema and phagocyte dysfunction
Adenylate cyclase toxin: functions as adenylate cyclase, increasing cAMP levels; causes edema and phagocyte dysfunction

73
Q

What toxin does Clostridium botulinum produce? How does it work?

A

Botulinum toxin - blocks presynaptic release of ACh at the NMJ, resulting in flaccid pralysis

74
Q

What toxins do Clostridium difficile release? How do they work?

A

Toxin A & B
Toxin A - recruits and activates neutrophils, leading to release of cytokines that cause mucosal inflammation, fluid loss, and diarrhea
Toxin B - Induces actin depolymerization, leading to mucosal cell death, bowel wall necrosis & pseudomembrane formation

75
Q

What toxin does Shigella dysenteriae produce? How does it work?

A

Shiga toxin - halts protein synthesis by disabling the 60S ribosomal subunit, leading to interstitial epithelial cell death and diarrhea

76
Q

What toxins does Streptococcus pyogenes produce? How do they work?

A

Pyrogenic exotoxin & Streptolysin O & S
Pyrogenic exotoxin - acts a s asuperantigen, inducing fever and shock; associated with scarlet fever and streptococcal toxic shock syndrome
Streptolysin O&S - damages erythrocyte membranes, causing beta hemolysis

DIT Cards (16 decks)

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