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Reproductive > Micro: Things I don't know > Flashcards

Micro: Things I don't know Flashcards

1
Q

HPV

  1. genome
  2. capsid
  3. envelope
A
  1. small circular dsDNA
  2. icosahedral capsid: self assemble
  3. non-enveloped: contributes stability of virus on skin and fomites
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2
Q

L1

A

protein capsid of HPV used for vaccine

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3
Q

laryngeal papilloma

A

HPV 6 and 11
infants/young children
benign warts in respiratory tract
complication: respiratory distress leading to death
Tx: multiple surgeries
prevention: remove genital warts in pregnancy

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4
Q

epidermodysplasia verruciformis

A

HPV infection in someone with inherited defect in cellular immunity
warts on face, trunk, limbs throughout life and non-metastatic tumors

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5
Q

HPV genital warts

A

condyloma acuminata

condyloma plana

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6
Q

SPI

A

subclinical papilloma infection

HPV infection that can lead to CA

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7
Q

5% acetic acid

A

HPV
brush on infected area to detect SPI: turns warts white
reveals dysplasia: use to take colposcopy

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8
Q

pap smear

A

HPV

detects koilocytotic squamous epithelial cells

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9
Q

cofactors in the development of cervical cancer in women with HPV

A

smoking

co-infection with herpes simplex

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10
Q

Dx of HPV

A

CANNOT be grown in cell culture

  1. clinical appearance
  2. abnormal Pap, colposcopy to look for dysplasia
  3. HPV DNA detection test
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11
Q

Tx of HPV: methods for removal

A

remove warts (does NOT eradicate virus so can return)

  1. BCA, TCA
  2. cryotherapy
  3. LEEP
  4. podofilox
  5. imiquimod
  6. intralesional IFN injections
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12
Q

BCA: bichloroacetic acid
TCA: trichloroacetic acid

A

brush on warts: denatures proteins
Tx: HPV
AE: irritated/burned surrounding skin

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13
Q

cryotherapy

A

liquid nitrogen to physically disrupt wart (be careful not to freeze to deep: causes scarring)
Tx: HPV

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14
Q

LEEP (loop electrosurgical excision procedure)

A

removes dysplastic cervical cells

Tx: HPV

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15
Q

HSV

  1. genome
  2. capsid
  3. envelope
A
  1. large: dsDNA (has viral DNA pol)
  2. icosohedral
  3. yes
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16
Q

Where does HSV reside in latency?

  1. HSV 1
  2. HSV 2
A

peripheral sensory neurons: maintained EXTRACHROMOSOMALLY

  1. trigeminal ganglia
  2. sacral ganglia
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17
Q

HSV replication cycle

A
  1. viral attachement
  2. pH-independent plasma membrane fusion
  3. release of nucleocapsid that migrates to the nucleus
  4. genome is released
  5. IMMEDIATE EARLY transcription/translation: makes transcriptional regulators to modify host RNA pol
  6. production of EARLY PROTEINS: replicate viral genome: include viral THYMIDINE KINASE and viral DNA POL
    7: LATE PROTEINS: capsomeres, envelope, STRUCTURAL proteins
  7. virus assembly in NUCLEUS (NUCLEAR INCLUSIONS)
  8. virus buds from plasma membrane
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18
Q

syncitia

A

HSV
infected cells fuse with adjacent non-infected cells to form giant cells with more than one nucleus
Mechanism: viral glycoproteins are also present on plasma membrane of infected cells late in infection

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19
Q

Dx of HSV

A

Tzanck smear

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20
Q

Tzanck smear

A

HSV

cells from ulcerous lesion reveal multinucleated giant cells with nuclear inclusion bodies

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21
Q

LAT (latency-associated transcript)

A

HSV
only gene expressed in latency
prevents apoptosis of infected neuron

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22
Q

What causes HSV to reactivate?

What effect does this have?

A

decline in cell mediated immunity

kills infected neuron and recurrent epithelial infection occurs

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23
Q

HSV 1 diseases

A
  1. gingivostomatitis
  2. herpes labialis (FEVER BLISTER)
  3. herpetic whitlow (finger vesicle)
  4. KERATITIS
  5. conjunctivitis
  6. blepharitis
  7. ENCEPHALITIS
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24
Q

HSV 2 diseases

A
  1. CERVICITIS
  2. VULVAR VESICLES
  3. vaginal vesicles
  4. urethritis
  5. PENILE VESICLES
  6. perianal vesicles
  7. MENINGITIS
  8. encephalitis
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25
Q

gingivostomatitis

A

PRIMARY HSV
vesicles on lips, tongue, facial skin around mouth
FEVER, HEADACHE

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26
Q

fever blister

A

RECURRENT HSV
vesicles in some of the same sites as primary after stress
FEVER, HEADACHE

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27
Q

How do you determine primary from recurrent HSV genital vesicles?
Sx of both?

A

difficult; Hx

recurrent: fewer lesions that heal more quickly; more frequent soon after primary infection (diminishes over time)

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28
Q

genital HSV Sx

A
  1. vesicles (penis, external/internal vagina; can cause urethritis, cervicitis, vaginitis)
  2. flu like
    3 itching, buringin in infected area
  3. muscle aches of legs, buttocks
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29
Q

prodrome symtoms

A

Sx that can tip HSV sufferer of an impending recurrent infection

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30
Q

Can you get HSV if partner doesn’t have vesicles?

A

yes

virus sheds in absence of recurrent vesicles ant after lesions are unapparent

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31
Q

HSV blepharitis, conjunctivitis

A

PRIMARY ocular HSV infection
CHILDREN
Sx: small vesicles/pustules around eye lid

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32
Q

HSV keratitis

A

SECONDARY ocular HSV infection
Sx: red painful eye, blurred vision, photophobia
if untreated: corneal scarring

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33
Q

HSV encephalitis

A 
RARE (not more common in immune compromised)
adults: recurrent HSV1 
neonates: primary HSV2 
Sx: headache, fever, CONFUSION, SEIZURES
high MORTALITY
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34
Q

HSV meningitis

A

PRIMARY HSV2
Sx: headache, STIFF NECK, vomiting
usually resolves

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35
Q

Neonatal HSV

A

1st/2nd week postpartum
best outcome: infection limited to SKIN, MOUTH, EYES
severe: most DIE or have significant sequelae
1. ENCEPHALITIS: SEIZURE, IRRITABILITY, COMA
2. disseminated: organ failure (check liver enzymes)

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36
Q

When do neonates get infected with HSV?

What is the chance of transmission if mother is undergoing a primary vs. secondary infection?

What precautions should be taken to prevent transmission from mother to infant?

A

most: DELIVERY
5%: transplacental

primary: 30%
secondary: 2-3% (maternal Ab are protective)

C-section if herpatic lesions are present

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37
Q 
Dx of HSV
1-4: general
5: keratitis
6: meningitis
7: encephalitis
8: neonatal
A
  1. PCR of vesicles (most important)
  2. culture (7-10 days): CYTOPATHIC EFFECT (CPE); old gold standard
  3. serology (only indicates past infection unless Ig-type specific)
  4. TZANCK smear
  5. keratitis: slit lamp examination
  6. meningitis (aimed at ruling out bacterial origin): CSF used for PCR/culture
  7. encephalitis: PCR/SOUTHERN BLOT (normal EEG rules out HSV as cause)
  8. neonatal: check liver enzymes for disseminated disease
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38
Q

HSV Tx

A

NO cure

  1. ACYCLOVIR
  2. vidarabine, trifluorodine
  3. FOSCARNET
  4. DOCOSANOL
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39
Q

foscarnet

A

MOA: pyrophosphate analog: blocks viral DNA pol
NO phosphorylation required
Tx: HSV when ACV fails

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40
Q

docosanol

A

OTC for cold sores
MOA: moodiness host cell membrane so virus envelope cannot fuse with PM
Tx: oral HSV

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41
Q

vidarabine, trifluorodine

A

eye drops
MOA: inhibit DNA pol
Tx: HSV keratitis

42
Q

When do you give oral vs. IV acyclovir?

A

Tx: HSV
oral: genital outbreak/prevention
IV: encephalitis, neonatal

43
Q

Treponema pallidum

  1. disease
  2. type of microbe
  3. source of antigen for serological test
  4. pathology
A
  1. syphilis
  2. motile spirochete: thin peptidoglycan with inner/outer membrane (outer has mostly lipoproteins and lipids rather than LPS)
  3. rabbit testes
  4. host cellular inflammatory response (also humoral response that is not able to eliminate infection); LATENCY
44
Q

primary syphilis

A

PAINLESS hard CHANCRE at site of entry

non-tender INGUINAL LYMPHADENOPATHY

45
Q

secondary syphilis

A

1-2 months later
systemic: disseminated
Sx: fever, headache, non-tender DIFFUSE SWOLLEN NODES, mouth and genital lesions (SNAIL TRACK), RASH that eventually includes SOLES and PALMS and/or wart lesions (CONDYLOMATA LATA) on perineum/anal region

may have ALOPECIA, MILD MENINGITIS, liver involvement

46
Q

tertiary syphilis

A 
ENDARTERITIS
almost any organ system
1. CV: AORTIC VALVE REGRUGITATION
2. skin/bone: GUMMA
3. CNS: meningitis (asymptomatic or acute syphilitic), meningovascular (can infarct cerebral vessels), paresis (many spirochetes in cerebral cortex/meninges: personality changes, INSANITY, paranoia), TABES DORSALIS (demylization of posterior columns/dorsal roots): SHUFFLES when walking, lightening pains
patient is NOT infectious
few spirochetes detected in lesions
47
Q

syphilis Dx

A
  1. serology: RPR, VDRL, FTA–ABS
  2. dark field microscopy of chancre
    CANNOT: culture
48
Q

Syphilis Tx

A

PENICILLIN: Pen G
pregnant women: desensitize her and give PENICILLIN)
ALT (resistance): macrolides, azithromycin

49
Q

congenital syphilis

A

can have still birth or spontaneous abortion; may have symptoms at birth, may develop years later

  1. disseminated infection
  2. late congenital syphilis
50
Q

early latent syphilis

  1. Sx
  2. serology
  3. relapse?
  4. infectious?
A

1-2 yr period after secondary infection

  1. no
  2. positive
  3. may relapse to secondary syphilis
  4. pregnant woman may pass infection in utero
51
Q

late latent syphilis

  1. Sx
  2. serology
  3. relapse?
  4. infectious?
A

follows early latent syphilis: 1-2 years post infection and may last lifetime

  1. no
  2. positive
  3. no
  4. not infectious even to fetus
52
Q

disseminated congenital syphilis

A

transmitted transplacentally after 1st trimester via blood

Sx: SNUFFLES, SNAIL TRACK lesions, CONDYLOMA LATA, HEPATOSPLENOMEGALY, BULLOUS RASH

53
Q

late congenital syphilis

A

develops over years: starts around age 2
Sx: bone abnormalities (frontal bossing, SABER SHINS), vision defects (GUN BARREL SIGHT), HUTCHINSON’S TRIAD (notched incisors, keratitis, deaf)

54
Q

rapid plasma reagin (RPR) test

A

syphilis: SENSITIVE
antigen: cardiolipin
mix serum with cardiolipin: look for agglutination (pos. test)
decreases with Tx (can see antibiotic efficacy)

55
Q

fluorescent treponemal antigen-absorbed (FTA-ABS) test

A

syphilis: SPECIFIC
antigen: pathogenic T. pallidum
1. Pt. serum is mixed with non-pathogenci treponemes to remove cross reacting Abs against normal spirochete flora
2. mix serum with T. pallidum fixed on slide
3. add fluorescent dye tagged with goat-antihuman Ig
4. positive: fluorescent staining spirochetes using fluorescence microscope in dark
stays elevated after Tx

56
Q

general disease research laboratory (VDRL) test

A

syphilis
antigen: cardiolipin
cheap and sensitive serology test

57
Q

Haemophilis ducreyi

A

PAINFUL SOFT CHANCRE

ragged, raised

58
Q

Chlamydia trachomatis (Ct)

  1. microbe type
  2. forms
  3. virulence
A
  1. obligate INTRACELLULAR G (-) parasite
  2. two forms: EB, RB
  3. intracellular, causes INFLAMMATION (HSP)
59
Q

Neiserria gonorrhoeae (gonococcs, GC)

  1. microbe type
  2. pathology/virulence
A
  1. NO capsule

2. LPS causes INFLAMMATION, PILI and outer membrane surface proteins (antigenic variation), IgA1ase

60
Q

Ureaplasma urelyticum

A

mycoplasma: NO cell wall

urethritis/cervicitis

61
Q

Dx of Ct and GC

A

NAAT (nucleic acid amplification test) on urine or exudates

62
Q

sequela for Ct and GC

A

PID

63
Q

newborn infection of

  1. Ct
  2. GC
A
  1. conjunctivitis, PNA

2. conjunctivitis (rare due to prophylaxis)

64
Q

EB (elementary body)

A

C. trachomatis

metabolically inert but infectious

65
Q

RB (reticulate body)

A

C. trachomatis

grows in membrane bound vacuole (inclusion body) in CYTOPLASM of MUCOSAL EPITHELIAL cells

66
Q

pili

A

GC
attachement
antigenic variation: varying pilS insert into pilE

67
Q

pilS

A

GC
vary
silent with no promoter

68
Q

pilE

A

GC

expression locus with promoter

69
Q

GC, Ct lower genital tract infections

A

cervicitis, urethritis (GC can disseminate from this, Ct can’t)

70
Q

GC, Ct upper genital tract complications

A
  1. SALPINGITIS, PID
  2. epididymitis
  3. perihepatitis (FITZ-HUGH-CURTIS: VIOLIN STRING adhesions of liver)
  4. prostatitis (GC only?)
71
Q

Other sites of: GC, Ct

A
  1. rectal
  2. conjunctivitis
  3. Reiters’ syndrome
    GC only: PHARYNGITIS, DISSEMINATED
72
Q

disseminated GC

A

SEPSIS with RASH, FEVER, SEPTIC ARTHRITIS

also can have: endocarditis, meningitis

73
Q

Reiters’ syndrome

A

Ct mostly, occasionally GC

reactive, non-septic arthritis (immune response related) following bacterial enterocolitis

74
Q

Sx of urethritis in men

  1. GC
  2. Ct
  3. both
A

need lab Dx to differentiate

  1. purulent penile discharge
  2. less purulent, milky discharge
  3. DYSURIA, itching at distal urethra
75
Q

Sx of cervicitis

A

GC, Ct

dysuria, white discharge from endocervix

76
Q

PID

  1. organisms
  2. organs effected
  3. Sx
  4. Tx
  5. complications
A
  1. GC, Ct, mycoplasma, Non-STD anaerobes
  2. endometritis, salpingitis, tubo-ovarian abscess, pelvic peritonitis
  3. Sx: lower abdominal pain (dull to severe), adnexal tenderness, cervical motion tenderness, fever, may have cervicitis or vaginal bleeding
  4. Tx: DOXYCYLINE and CEFOXITIN
  5. ectopic pregnancy, chronic pelvic pain
77
Q

Ct: infant pneumonia

A

afebrile, STACCATO cough with TACHYPNEA
CXR: hyperinflation with bilateral infiltrates
eosinophilia, elevated IgM
conjunctivitis at same time suggests Ct

78
Q

Dx of Ct

A
  1. GOLD STANDARD: NAAT
  2. gram stain: no cocci, PMNs (only accurate in males, not females)
  3. culture in tissue rarely done
  4. rapid antigen test
79
Q

Dx of GC

A
  1. gram stain: G- in PMNs (only accurate in males, not females)
  2. GOLD STANDARD: THAYER-MARTIN medium for complicated infections: grows GC (antibiotics to get rid of other organisms); also gram stain, OXIDASE POS.
  3. NAAT
  4. rapid antigen test
80
Q

Tx of GC

A

must treat for GC and Ct
IM CEFTRIAXONE and AZT (for Ct)
CANNOT give fluoroquinolone

81
Q

Tx of Ct

A

AZITHROMYCIN

ALT: doxycycline (CI in infant, children, pregnancy; 10 day regimen decreases compliance); erythromycin

82
Q

How can you prevent GC in eyes of newborn?

A

silver/nitrate topical antibiotics

does NOT work for Ct

83
Q

lymphogranuloma venereum (LGV)

A

Ct: L1-3
Sx: SWOLLEN LYMPH NODES with suppuration, ULCER at site of entry
RARE in US

84
Q

trachoma

A

non-STD Ct infection
can cause blindness
Asia, Middle East, Africa

85
Q

Dx of vaginitis and vaginosis

A

microscopic

rapid examination of discharge

86
Q

candidiasis: candida albicans and C. glabrata
1. microbe type
2. discharge type
3. disease

A

MOST COMMON

  1. fungus
  2. scant, white, clumped
  3. vaginitis
87
Q

gardnerella vaginalis

  1. microbe type
  2. discharge type
  3. disease
A
  1. bacteria
  2. GRAY, adherent (coats vagina); FISHY odor
  3. bacterial vaginitis (BV)
88
Q

mobiluncus spp.

  1. microbe type
  2. disease
A
  1. bacteria

2. bacterial vaginitis (BV)

89
Q

What is the key factor allowing overgrowth of Candida and bacterial vaginosis (BV)?

A

disturbance of normal flora that maintain low pH and produce H2O
ex: antibiotics, DM, sex, douching, initial use of IUD, menses, pregnancy, tight fitting undergarments

90
Q

Trichomoniasis vaginalis

  1. microbe type
  2. discharge type
  3. disease
A
  1. single cell protozoan: FRANK PATHOGEN
  2. profuse FROTHY YELLOW, FISHY odor
  3. urethritis, vaginitis
91
Q

Which microbe that causes vaginalis is sexually transmitted not part of the normal flora?

A

Trichomoniasis vaginalis

reason it is a FRANK pathogen

92
Q

bacterial vaginosis (BV)

A

NO single causative agent: caused by combination of anaerobes

93
Q

Sx of vaginosis

A 
VAGINAL DISCHARGE (malodorous for BV)
dysuria, itching (in Trichomonal or candidiasis; not mentioned for BV)
94
Q

cystitis Sx

A

dysuria, suprapubic pain, leukocytes in urine, significant bacteria in urine

95
Q

pyelonephritis Sx

A

cystitis Sx
PLUS: FEVER, FLANK PAIn
CASTS in urine

96
Q

Dx of bacterial vaginosis (BV)

  1. odor
  2. discharge
  3. pH
  4. micro
  5. Sx
  6. inflammation
A
  1. whiff test: FOUL odor after KOH addition (FISHY)
  2. dirty white or GRAY (homogeneously coats vaginal wall)
  3. above 4.5
  4. CLUE cells
  5. NO dysuria or vaginal discomfort
  6. no
97
Q

Dx of candidiasis vaginosis

A
  1. pungent but not foul
  2. COTTAGE CHEESE (white and clumped)
  3. 4.5 or below (normal)
  4. KOH: BRANCHING HYPHAE
  5. extreme ITCHING, dysuria
  6. leukocytes
98
Q

Dx of Trichomonas vaginosis

A
  1. whiff test: may be malodorous
  2. FROTHY YELLOW(GREEN)
  3. above 4.5
  4. TWITCHING TRICHOMONADS (size of PMNs); PMNs
  5. itching, dysuria
  6. leukocytes
    STRAWBERRY CERVIX
99
Q

Tx of Trichomonal vaginitis

A

oral metronidazole

Tx partner too

100
Q

Tx of BV

A

oral metronidazole for 7 days

101
Q

Tx of vaginal candidiasis

A

topical and oral azoles

Reproductive (12 decks)

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