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LAST EXAMMMMMM Year I > micro- spirochetes, mycobacterium, mycoplasma > Flashcards

micro- spirochetes, mycobacterium, mycoplasma Flashcards

1
Q

what are the unique additions to spirochetes besides that LPS outer layer

A

additional phospholipid rich outer membrane with few exposed proteins
axial flagella that come out of the ends of spirochete cell wall rather thatn from outer membrane and the flagella runs under the outer membrane sheath
“periplasmic flagella”

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2
Q

how do we visualize apirochetes

A

dark field microscopy, immunofluorescence and silver stains

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3
Q

What are the 3 genera of spirochetes

A

Treponema
Borrelia
Leptospira

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4
Q

Describe primary syphilis

A

painless chancre erupts 3-6 weeks after contact
chancre is firm, ulcerated painless lesion with punched out base and rolled edges
resolves 4-6 weeks without scar
regional nontender lymph node swelling

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5
Q

Describe secondary syphilis

A

6 weeks after original chancre healed
systemic widespread rash with lymphadenopathy
fever, weight loss

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6
Q

paatiend presens with small red macular (flat) lesions symmetrically over body, palms and soles and mucous membranes of oral cavity
become bumpy and pustular

A

syphilis

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7
Q

What is condyloma latum and what infection is it manifested in

A

painless wartlike lesion in warm moist areas like vulva or scrotum
ulcerates
syphilis
resolves over 6 weeks and enters latent phase

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8
Q

Describe latent syphilis

A

asymptomatic usually
sometimes more lesions
most will remain asymptomatic but some may progress to tertiary syphilis (1/3 unTx)

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9
Q

When does tertiary syphilis develop and what are the 3 categories

A

6-40 years
gummatous
cardiovascular
neurosyphilis

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10
Q

What is Gummatous syphilis

A

3-10 yrs after infection
granulomatous lesions Gummas necrose and become fibrotic in skin and bones
skin-painless with sharp borders
bone- deep pain

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11
Q

What is CV syphilis

A

10 yrs after infection
aneurysm in ascending aorta or aortic arch
from chronic inflammation

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12
Q

What are the 5 common presentations or neurosyphilis

A 
asymptomatic- CSF is +
subacute meningitis
meningovascular syphilis
tabes dorsalis
general paresis
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13
Q

presentation subacute meningitis from syphilis

A

fever, stiff neck, HA

high lymphocyte, high protein, low glucose + syphilis

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14
Q

describe process behind meningovascular syphilis

A

spirochetes attack blood vessels in brain and meninges causing infarction and neurologica impairments

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15
Q

describe tabes doralis from syphilsi

A

affects post column spinal cord
loss os vibration and proprioception
ataxia
loss of reflexes and pain and temp from DRG

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16
Q

What form of syphilis leads to progeressive nerve cell death in brain and mental deterioration

A

general paresis

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17
Q

What is the argyll-robertson pupil

A

no reactive pupil to light from midbrain lesion

seen in syphilis

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18
Q

what is early congenital syphilis

A

within 2 yrs
widespread rash and condyloma latum
runny nose
lymph node, HSM and bone infection are common

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19
Q

patient has saddle nose(sunken in nose) and saver shins(bowing of tibias)
widely spaced incisors with central notch and the molars have too many cusps(mulberry)
what is this assoc with

A

congenital syphilis

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20
Q

when is the window to treat pregnant mother with antibiotic therapy for syphilis

A

before the 4th month of gestation

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21
Q

What is the best way to Dx syphilis active and latent

A

active is through visualization of spirochetes

serologic for latent

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22
Q

what titers do we pull for syphilis

A

anti-lecithin and cardiolipin which are Ag from cell damage

also used on CSF detection for neurosyphilis

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23
Q

What are the two most common nonspecific treponemal tests

A

VDRL and RPR

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24
Q

what are the specific treponemal tests and what are they detecting

A

Ab againts spirochetes

Indirect Imunofleurescent Trepnemal Ab-Absorptions FTA-ABS

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25
If a patient after contracting syphilis has a drop in VDRL or RPR while FTA-ABS is still +, was tx successful?
yes
26
Immediately after Tx with syphilis patient has mild fever, chills, malaise and HA with muscle aches what is going on
Jarisch-Herxheimer phenomenon
27
What treponema does not cause gummas
treponema carateum
28
patient from desert zone in Africa or Middle east has skin lesions in oral mucosa ang gummas in skin and bone Dx?
treponema endemicum
29
patient is from tropical area with disfigured face and open ulcers Dx?
yaws | treponema pertenue
30
if a hispanic patient comes in and has red skin lesions that become blue in the sun Dx?
treponema carateum
31
What diseases are caused by the Borrelia spp
lymes and relapsing fever
32
What are the 3 stages of lymes
early localized stage, early disseminated stage and late stage
33
what is the time period for early localized stage lymes and what occurs
10 days after tick bite lasts 4 weeks | skin lesion at site- erythema chronicum migrans with flulike symptoms
34
What does the skin lesion erythema chronicum migrans look like
starts red round rash then spreads and the outer border stays red and the center is clear, blue or necrose
35
What occurs in the early disseminated stage of lymes
skin, nervous system, heart and joints many lesions cranial nerve and motor sensory nn involved0 cranial nn palsies especially Bells and peripheral neuropathies AV nodal block and sometimes myocarditis and L ventricular dysfunction arthritis that is hot swollen and painful
36
describe late stage lymes
10% untreated have chronic arthritis assoc with HLA DRB1*0401, HLA-DRB1*0101 chronic neurologic damage, encephalopathy
37
What part of the lymes rash is biopsied
the leading edge
38
What techniques are used to Dx lymes
ELISA and western immunoblotting of CSF
39
Describe symptoms of Borrelia recurrentis
high fever, chills, HA muscle aches rash with drenching sweats that last 3-6 days then relapse 8 days later progressive shorter and milder each relapse
40
What causes the relapsing symptoms of Borrelia
antigenic variation
41
When ust you pull blood cultures in someone with Borrelia recurrentis
during active febrile period. negative when afebrile
42
what are the phases from leptospirosis
leptospiremic phase- high temp, HA, malaise and muscle aches | immune phase- IgM Ab, meningismus and elevated WBC count in CSF
43
What is Weils disease and what causes it
renal failure, hepatitis with jaundice, mental status changes and hemorrhages Leptospirs interrogans
44
What lab results lead towards leptospirosis
elevated liver function tests, protein in urine and clinical history of animal contact or swimming in areas shared by animals
45
What are the 2 species of Mycobacterium
TB | leprae
46
What are mycosides
mycolic acid- large fatty acid mycoside- mycolic acid bound to a carb cord factor- mycoside formed by union of 2 mycolic acids and disaccharide sulfatides- sulfate attached to disaccharide inhibiting phagolysosomal fusion wax D- activates protective cellular immune system
47
What component of mycosides is only found in virulent Mycobacterium TB
cord factor
48
What is the pneumonic for remembering mycosides for mycobacterium TB
Mike(mycosides) waxes (Wax D) his SUrfboard (sulfatides) and has a surfboard cord (cord factor)
49
What type of organism is mycobacterium TB
acid fast | facultative intracellular growth
50
What cells does M TB infect first
macrophages
51
What causes the caseous necrosis seen in M TB
the cell mediated immunity of the macrophages eating everything
52
what type of DTH is ppd test for M TB
IV
53
what diseases could lead to a false negative ppd
steroid use, malnutrition, AIDS | because do not have normal immune response
54
What is the best Dx screening for M TB
new IGRAS from whole blood
55
presentation of primary TB
asymptomatic lung infection | middle and lower lobes- neutrophils and edema
56
presentation of symptomatic TB
children usually | enlargement of mediastinal lymph nodes and lower/middle lung infiltrates
57
What is ghon focus and complex
focus is calcified tubercle in middleor lower lung zone | complex is ghon focus plus perihilar lymph node calcified granulomas
58
what is presentation of reactive pulmonary TB
infection in apices around clavicles | fever, night sweats, weight loss and productive cough sometimes with blood
59
What other organ sysmtems can be affected by secondary TB
``` pleural and pericardial spaces lymph node infections kidney- sterile pyuria skeletal- invertebral discs joints- chronic arthritis of 1 joint CNS-subacute meningitis and granulomas in brain Miliary TB- tubercles all over body ```
60
What is sterile pyuria and what infection does it occur in
RBC and WBC in urine but no bacteria | M TB
61
What is the best Dx tool for M TB active infection
sputum culture
62
M leprae is common where
India, Brazil, Burma, Indonesia, MAdagascar and Nepal
63
Why does M leprae like the skin
likes cooler areas of the body | also attacks superficial nn, eyes nose and testes
64
What is Lepromatous Leprosy
severest leprosy form no cell mediated immune response defective T CD8 cells
65
What is presentation of lepromatous leprosy
``` thickened face- leonine facies saddle nose deformity internal testicular damage- infertility blindness loss of sensation ```
66
What is presenation of Tuberculois leprosy
localized superficial unilateral skin and nerve involvement 1-2 hypopigmented skin lesions enlarged nerves
67
what is a common cause of Fever of unknown origin in AIDS patients
M avium complex | MAC
68
What form of leprosy will have a negative lepromin skin test
the lepromatous leprosy because cannot mount DTH
69
What is the presentation of AIDS patient with MAC
unexplained fevers, weight loss, diarrhea and general malaise elevated alkaline phosphatase
70
What is confirmatory Dx for MAC
growth in mycobacterial blood cultures
71
Describe structure of mycoplasma organisms
no peptidoglycan cell wall | just cell membrane with sterols to help shield organelles
72
What are the pathogenic spp of mycoplasma
pneumoniae and Ureaplasma urealyticum
73
What is the number one cause of bacterial bronchitis and pneumonia in teenagers
mycoplasma pneumoniae
74
What are the virulence factors of mycoplasma pneumoniae
Protein P1 an adhesin
75
What is walking pneumonia
gradual onset, fever sore throat, malaise and peristent dry hacking cough
76
what is presentation of CXR walking pneumonia
streaky infiltrate
77
What is erythema multiforme or Stevens-johnson syndrome
severe skin run with erythematous vesicles and bullae over mouth eyes and skin caused with mycoplasma pneumonia sometimes
78
What is a rapid way to test someone for Mycoplasma pneumoniae
put their blood in test tube then on ice and if the blood clumps then has cold agglutinins which are in mycoplasma pneumoniae
79
what does a mycoplasma culture look like
tiny dome fried egg appearance | like a mulberry
80
what bacteria cause atypical pneumoniae
Mycoplasma, legionella and chlamydia
81
What is T strain mycoplasma
Ureaplasma urealyticum
82
What could cause a young sexually active woman to have burning while peeing and yellow mucoid discharge
N gonorrhea, Chlaymydia | Ureaplasma urealyticum!

LAST EXAMMMMMM Year I (24 decks)

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