microbio Flashcards
1
Q
Clinical disinfectants: Alcohol MOA
A
Disruption of cell membrane, protein denaturation
2
Q
Clinical disinfectants: Chlorhexidine MOA
A
Disruption of cell membrane, protein denaturation, coagulation of cytoplasm
3
Q
Clinical disinfectants: Hydrogen peroxide MOA
A
Destructive free radicals that oxidize cellular components; can clear spores
4
Q
Clinical disinfectants: Iodine MOA
A
Halogenation of proteins, nucleic acids; can clear spores
5
Q
HIV pol gene mutations
A
Underlie drug resistance to protease inhibitor, NNRT, NRT
6
Q
HIV env gene mutations
A
Change structural glycoproteins used in viral envelope, allowing virus to evade humoral response
7
Q
Bee venom contains what, induces what response?
A
Hyaluronidase, phospholipase, protein; induce IgE response
8
Q
EBV pw
A
infectious mono, nasopharyngeal carcinoma, lymphoma (esp. Burkett’s)
9
Q
EBV mechanism for binding to B cells, nasopharyngeal epithelial cells
A
gp350 binds to C3d complement receptor (CR2, CD21)
10
Q
Parvovirus binds to what molecule on erythroid cells?
A
Blood group P antigen (present in immature cells, thus adult BM and fetal liver are susceptible)
11
Q
HIV binds to what molecule?
A
glycoprotein 120, which is on CD4 transmembrane glycoprotein and coreceptor (CXCR4 on T cells, CCR5 on macrophages)
12
Q
RPR checks for what molecules
A
Cardiolipin, lecithin
13
Q
Acute hemorrhagic cystitis in children
A
Adenovirus (11, 21)
14
Q
Norwalk agent
A
Calcivirus that causes viral gastroenteritis
15
Q
Aseptic meningitis, most common bug in children
A
WBC < 500 with lymphocytic predominance; nl glucose, elevated protein but <150; no organism on gram stain or culture; enterovirus (e.g. echovirus)
16
Q
In vaccines against encapsulated bugs, why do we attach bacterial antigens to diptheria/tetanus protein?
A
Improves infant response to induce T-cell dependent stimulation of B-cells to undergo class-switching from IgM to IgG
17
Q
Chronic granulomatous disease MOA
A
NADPH oxidase deficiency leads to impaired oxidative burst, reducing PMN ability to kill intracellularly; pw recurrent infection w/ catalase+ bacteria/fungi (s. aureus, burkholderia capacia, serratia marcescens, nocardia, aspergillus); dx with measurement of PMN superoxide production (DHR, NBT)
18
Q
Enterovirus
A
Single-stranded RNA; echovirus, coxsackievirus, poliovirus; FO transmission (but no gastroenteritis)
19
Q
Exfoliative toxin MOA
A
Act as proteases and cleave desmoglein in desmosomes; cause SSSS and bullous impetigo
20
Q
GN septic shock mediated by what toxin?
A
Endotoxin, Lipid A
21
Q
Candida pw, microscopic appearance
A
Oral thrush in IC pts, cutaneous candida in humid areas, and vulvovaginal; KOH-treated scrappings show yeast + pseudohyphae
22
Q
Leukoplakia
A
Precancerous lesion on tongue that cannot easily be scraped off, 2/2 smoking
23
Q
Pityriasis versicolor
A
hypo/hyperpigmented patches at stratum corneum on back/chest; malassezia spp, “spaghetti and meatballs” with “cigar butt”; rx with topical antifungal or selenium; degradation of lipids produces acids tht damage melanocytes
24
Q
Mycobacteria cell wall contains:
A
Mycolic acid
25
Anthrax is the only bacteria with this capsule composition
Polypeptide (D-glutamate)
26
Botulism neurotoxin requires what environment, remains intracellular until what event, and dies under what conditions
Anaerobic; autolysis; heating
27
Chancroid ulcer
Haemophilus ducreyi; multiple, deep painful ulcers with gray-yellow exudate; organisms in parallel lines (school of fish)
28
Genital herpes
HSV 1, 2; multiple, small, shallow, grouped, painful ulcers on erythematous base; multinucleated giant cells with intranuclear inclusions (Cawdry Type A)
29
Granuloma inguinale
Klebisella inguinale; extensive, progressive, painless ulcer with granulomatous base; GN intracytoplasmic cysts (Donovan bodies)
30
Syphillis
Treponema pallidum; single, indurated, well-circumscribed with clean base; thin, delicate cork-screw organism found on darkfield microscopy
31
Lymphogranuloma venerum
Chlamydia trichamonis (L1-L3); small, shallow ulcers that heal rapidly, followed by painful, swolen LN that coalesce, ulcerate and rupture ("buboes"); intracytplasmic inclusion that binds epithelial cells and leukocytes. Mixed granulomatous, inflammatory
32
Monospot test
EBV has serum heterophil anbibodies wihch agglutinate sheep erythrocytes
33
What non-EBV organisms cause infectious mononucleosis?
CMV, HHV-6, toxoplasmosis
34
Coxsackie A in children manifests as
Aseptic meningitis, herpangina, hand/foot/mouth syndrome
35
JC causes what disease?
PML: CNS demyelination, hemiparesis, visual field defect, cognitive impairment
36
Bronchitis bugs
influenza, cornonavirus, RSV
37
Necrotizing fascitis
S. pyogenes (GAS), s. aureus, c. perfringens, polymicrobial
38
Cryptococcus neoformans
Yeast form only, with thick polysaccharide capsule, stains india ink, culture in Sabaud's agar; present in soil and pidgeon droppings; enters via resp. tract and infects lungs as primary nydus
39
Why does cryptococcus prefer the CNS?
CSF does not have the alternate complement pathway
40
Pulmonary cryptococcus dx
Bronchopulmonary washing shows red mucicarmine stain; stains with india ink, culture on sabouraud agar
41
Cryptococcal meningitis rx
Amphotericin B + flucytosine; fluconazide for prophylaxis
42
Herpez zoster opthalmicus
VZV infection of trigeminal ganglion of CNV, leads to visual impairment
43
Paromyxovirus examples
Parainfluenza (laryngotracheobronchitis/croup!); RSV (bronchiolitis); measles; mumps
44
Arenavirus
Lymphocytic choriomeningitis virus (LCV), an aseptic meningitis + mild flu after mice exposure
45
Killed vaccines vs live attenuated
Former activates only humoral system (includes Hep A, rabies); latter activates humoral and cell-mediated (MMR)
46
Endocarditis after GI/GU procedure in women
Enterococci; rx with penicillin and aminoglycoside; may need vanc or linezolid
47
Fungi microscopic characteristics for mucor/rhizopus, germ candida albicans, coccidiodes
Nonseptated hyphae that branch at wide angle; germ tubes that sproud from true hyphae); spherules
48
Diarrhea-causing exotoxins
Preformed: s. aureus, b. cereus (cereulide); post-ingestion: watery: ETEC, vibrio cholera; inflammatory EHEC, shigella
49
Traveler's diarrhea, associated toxins
ETEC: LT (similar to cholera, stimulate Gs, adeylate cyclase, cAMP), ST (stimulate guanylate cylcase, cGMP)
50
Central venous catheters needed for meds that cannot be given peripherally
Vasopressors, TPN, chemo
51
Shigella inoculum requirement, attachment site
highly adapated to survive in stomach/bile, thus veyr low inoculum requirement; unique binding site on intestinal mucosal M cells (covering peyer's patches)
52
Bacterial transfer of genes has 3 methods
Transformation (direct uptake of naked DNA from environment); conjugation (1-way transfer using F-factor derived sex pilus); transduction (bacteriophage driven)
53
Picornovirus: difference between two types and effect on habitat
Enterovirus (acid stable); rhinovirus (acid-labile)
54
Hot tub folliculitis
Superficial infection by pseudomonas
55
Scarlet fever presentation and bug
Pyogenic toxin of S. pyogenes; strep pharyngitis, strawberry tongue, and after 2 days, rash appears in neck, armpit, groin that generalizes "sandpaper" "boiled lobster
56
Why do influenza and rotavirus have frequent genetic shifts?
Segmented genes
57
Hep A
RNA picornavirus, FO transmission; pw smoking aversion, support treatment, complete recovery in 3-6 wks; close contacts given IG, and prophylactic treatment for travelers, liver dz, MSM
58
Clostridium perfringens 2 presentations
transient water diarrea (delayed), and gas gangrene (metabolizes carbohydrates to produce gas)
59
Histoplasmosis microscopic description, clinical presentation
Dimorphic, with hyphae, infects macrophages, lives intracellular; pw splenomegaly and ulcerated tongue in immunocompetent; in IC, resembles TB with cavitary lesions, hilar LN
60
Blastomycosis microscopic description
Round yeast with single broad-basedbuds
61
Actinomycosis presentation and treatment
Throat infection/swelling, rx with penicillin, surgical debridement
62
CMV viral description
Enveloped virus with dsDNA, enlarged centrally located epithelial cells with intranuclear and intracyctoplasmic inclusions
63
Catalase
3% H2O2, differentiates between staph and strep
64
Coagulase
ability to coagulate blood, differentiates between aureus, epidermis
65
Shigella buzz-words
Non-motile, no H2S (vs salmonella), produces acid (vs e coli)
66
Pseudomonas rx
pip-tazo, cephalosporin (3rd, 4th), aminoglycoside, fluoroquinolnes (cipro, levo), carbapenem
67
Rotavirus genetic structure
dsRNA; thus needs RNA polymerase
68
Positive sense RNA
5' to 3'; functions as mRNA, directly translates into protein
69
Negative sense RNA
3' to 5'; RNA polymerase has to make viral mRNA first, then translates; influenza A, paramyxovirus
70
Vibrio cholera and ETEC share what?
Heat labile toxin that activates adenylate cyclase, increase cAMP, and increase efflux of NaCl in epithelial cells only (no luekocytes, RBC)
71
Viridans MOA
Use surose to produce dextrans, an extracellular polysaccharide that helps it adhere to fibrin (thus, allows it to bind to endocarditis with pre-existing damage)
72
Bacterial cell wall is made up of:
Peptidoglycan, made by transpeptidase (or penicilling binding protein)
73
Diptheria rx
Diptheria antitoxin, penicillin/erythromycin, DPT vaccine
74
Protein A
s. aureus; binds with Fc portion of IgG, preventing complement activation and decreased C3b (IgG/C3b both oopsonins
75
Shiga/EHEC: AB toxin
Shiga/EHEC; B binds, A catalyzes removal of single adenine residue that prevents binding of 60s ribosomal subunit to tRNA
76
Parvovirus
non-enveloped, ssDNA
77
e coli virulence factors and their related conditions
LPS (lowers MO activation, IL-1,6, TNF-alpha release), causes bacteremia and septic shock; K1 polysaccharide capsule (prevents phagocytosis/complement) causes neonatal meningitis; shiga-like toxin, causes gastroenteritis; P fimbriae (adhesion to uroepithelium) causes UTI
78
Mycoplasma requires what substrate to grow?
Cholesterol
79
TB major virulence factor
Cord factor: promotes growth of thick, rope-like cords, mycoside-mycolic acid binding, and inactivates PMN (dmg mito, induce release of TNF)
80
Acute rheumatic fever occurs only after:
GAS pharyngitis, NOT skin infection
81
Acute post-strep GN occurs after
pharyngitis, skin infection
82
Schistosomiasis natural habitat, two kinds and manifestations
snails! 1. haemotobium: pw terminal hematuria, dysuria/frequency, hydronephrosis, pyelo, can lead to SCC; 2. s. mansoni/s. japonicom: intestinal (diarrhea, ab pain, ulceration, fe deficiency anemia) or hepatic (HSM, portal HTN, periportal fibrosis); TH2-mediated response leads to ulceration and scarring
83
Acid fast stain MOA
1. carbolfushin stain: red dye binds mycolic acids; 2. ETOH dissolves non-TB outer cell membrain (mycolic acid protects mycobacteria); and 3. methlene blue: stains non-TB bacteria
84
Mycolic acid
Waxy, LC fatty acid covalently bound to sugars within cell wall
85
Blastomycosis: organism description, presentation, MOA
encapsulated yeast with a single, broad-based bud; endemic to Wisconsin; inhalation of aerosolized fungi, induces granulomatous response; pw disseminated dz (systemic, lung, skin, and bone lesions) in IC
86
Coccidio: organism description, presentation, MOA
mold/endospore form; southwest, infect lungs; pw lung dz, pulmonary nodules, erythema nodosum in immunocompetent, and extrapulmonary dz or meningitis in IC
87
OM: children
hematogenous spread, s. aureus, femur
88
OM: SCD
hematogenous spread, salmonella, femur
89
OM: Pott dz
hematogenous from lung, TB, vertebra
90
OM: DM
continguous from ulcer, polymicrobial, foot
91
Histoplasmosis: organism description, presentation
dimorphic shape, ovoid cells within MO (thus reticuloendothelial cells affected, causing HSM); TB-like dz in immunocompetent, disseminated dz in IC
92
Hep C
Enveloped, SS+ RNA
93
Hep E
Non-enveloped, Ss+ RNA
94
Listerosis: organism, presentation, setting
GP rod with tumbling motility, able to multiply in cold temperature; in IC pt, pw fever, HA, vomiting with LP showing CSF pleocytosis with normal glucose; ingestion of contaminated foods like unpasterurized milk (pregnant women be careful)
95
Thyer-Martin composition, use
Vancomycin, colistin (for GN), nyastatin (for fungi); identify N. gonorrhea and other GN diplococci within leukocytes
96
Culture medims: enrichment, differential, reducing
enrichment: H flu (X,V factors), clostridium (anaerobic environment); reducing: organisms that reduce Fe or S
97
What is the most common cause of bacterial meningitis in adults?
S. pneumo (GP, lancet-shaped cocci in pairs)
98
Congenital toxoplasmosis presents with:
ydrocephalus, intracranial calficiations, chorioretinitis; thats why pregnant women should avoid cat litter
99
Activate adenylate cyclase, increase cAMP
Diarrhea (ETECT, campylobacter, b. cereus, v. cholera); b. pertussus, b. anthrax
100
Activate guanylate cyclase
ETECT, yersinia, enterococcus
101
Inactivate EF-2
Diptheria, pseudomonas
102
Congenital rubella
Sensineural defects, cateracts, cardiac manifestations (PDA), microcephaly
103
Trypanosoma cruzi: carrier, MOA
redoviid bug; toxin destroys the mesenteric plexus and cause denervation of smooth muscle
104
Babesia
Transmiatted by tick bites in NE, causes bubesiosis (malaria-like illness in asplenic pts); "maltese cross" on blood smear
105
Isospira belli presentation in who?
Chronic, water, profuse diarrhea in IC pt
106
Brucella RF, presentation
Drinking milk, touching sheep/goats; pw fever, malaise, LN, HSM "brucellosis"
107
B anthrax RF, MOA, presentation
Associated with wold processing, goat hair, animal hair; enter via lungs, ingested by macrophages, then move to LN in mediastiunum: pw systemic symptoms, hemorrhagic mediastinitis plus bloody pleural effusion, 3. septic shock and death
108
B anthrax organism characteristics
capsule contains protein, D-lutamate, important for pathogenesis; aerobic, long-chains that are "serpentine"/"medusa-headed"
109
Typhoid fever: organism, MOA, pw
salmonella typhi, paratyphi; enter gut mucosa via enterocyte transporters or M cells in Peyer's patches, once phagocytized, carried to liver, splee, marrow, gallbladder. w/i gut, cause drammatic inflammation of Peyer's patches and cause intestinal hemorrhage (potential performation); pw low fever, diarrhea, ab cramping at first, then salmon-colored "rose spots" in abdomen, then gut recolonization leads to hemorrhagic diarrhea and sepsis
110
parainfluenza pw
Croup, significant upper airway obstruction, inflammed subglottic tissue
111
N. gonorrhea virulence factor
Pili/hair-like protein that allow it to bind to susceptible tissue, high propensity to undergo recombination
112
Salmonella virulence factor
Vi antigen, which protects bacteria against oopsonization and phagocytosis
113
Strongyloidosis
Roundworm that penetrate skin, travel thru blood to alveoli then pharynx/Gi tract; at GI tract, lays egg into mucosa that hatch into rhabditiform larvae (excreted into stool, molt into filamiform that re-enters intestinal wall or perianal skin); leads to autoinfection, hyperinfection, multi-organ dysfunction and shock; most common in IC pt HTLV-1 infection (impaired TH2-directed cellular immunity)
114
dx methods for different worms (schistosomiasis, pinworm, intestinal tapeworm, protozoa)
parasitic eggs in stool, eggs on scotch-tape test on anus; proglotted in stool; trophozoites/cysts in stool
115
Legionella presentation, diagnosis, organism characteristics
Fever + bradycardia; dx with urine antigen test; silver stain, slow growth on buffered charcoal yeast extract + L cysteine + iron
116
N. meningitis virulance factor
Endotoxin, lipooligosaccharide (LOS) (different form LPS of enteric GN in that there is no repeating O-antigen), growth/lysis of bacteria releases outer membrane vesicls and attached LOS into blood, which binds with TLr-4 and release IL-1, IL-6, IL-8 and TNF-alpha to induce SIRS, cause cutaneous/hemorrhagic bullae, Waterhouse-Friderchson syndrome
117
Stain for HSV
Tzack smear, wright-giemsa stain for mutinucleated giant cell
118
Hemagluttin MOA
High affinity for RBC
119
Benefits of conjugate vaccine
Increased efficiency in eldery/children; increased mucosal immunity; imcreased immunogenic memory
120
Mycoplasma pneumonia c/b
MAHA 2/2 cold-agglutinin antibodies
121
intracellular survival strategies
1. blocking phagolysosome-lysozome binding (salmonella, TB via sulfatides); 2. inhibiting phagolysosone acidification (TB); 3. escaping from phagosome into cytosole(listeria, shigella)
122
Listeria escape MOA
Listerolysin, pore-forming toxin activated by acidic environment (phagolysozome); "rocket tails" via actin polymerization that allow intracellular movement
123
Complement deficies increases susceptibility to
Neisseria
124
Klebsiella pneumonia
ETOH-related, upper lobe, thick/mucoid/"current juelly" sputum with lung tissue necrosis/abscess
125
Malignant OM
Diabetic elderly, pw exquisite ear pain and drainage, granulomatous tissue w/ clear TMs
126
Malaria two forms
Schint (pre-devision), merozoites (post-division)
127
HTLV-1
T-cell leukemia, lymphoma
128
BK virus
Nephropathy or hemorrhagic cystitis
129
CMV receptor
cellular integrins
130
EBM receptors
CD21/CR2
131
HIV receptors
CD4 + CXCR 4/CCR5
132
Rabies receptor
Nicotinic ACh receptor
133
Rhinovirus receptor
ICAM/CD-65
134
Diptheria medium
Cystine-tellurite agar (dark black colonies)
135
P. aeroginosa
ecthyma gangrenosum: perivascular invasion of blood vesselsin skin with release of following exotoxins (exotoxin A - inhibit protein synthesis, elastase, phospholipase, pyocyanin)
136
Diptheria ABCDEFGH
ADP-ribosylation, beta-prophage, cornebacterium diptheriae, EF-2, granules (blue/red), heart (mycorditis/arrhythmias)
137
Tetanospasmin and botulinum toxin MOA
Proteases that cleave SNARe proteins for NT (tetanus: inhibitor NT like GABA, glycine in Renshaw cells in spinal cord; botulinum: ACH release at NMJ)
138
C. perfringens alpha-toxin MOA
Also called lecithinase, degrades membrane phospholipid and cause myonecrosis (gas gangrene) and hemolysis
139
C. difficile MOA
Toxin A binds to brush border; toxin B depolarizes actin and disrupts cytoskeleton
140
Leprosy reservoir, ambient temperature, dz forms, rx
Armadillos; prefers cool temperature, thus skin and superficial nerves ("glove and stocking"); tuberculoid (milder, higher TH1-immune response): few hypoesthetic, hairless skin plaques; lepromatous (severe, less cell-meditated more humoral TH2 response) with diffuse skin involvement and lion-like facies; dapson/rifampin
141
How to differentiate EHEC from other E. coli?
Does not ferment sorbitol
142
Antibiotic effect on salmonella
Prolongs duration of fecal excretion
143
Leptospirosis
Flu-like symptoms, calf myalgia, photophobia with conjunctival suffusion, prevalent amount surfers andin trops; Weil disease: severe form with jaundice and azotemia
144
Tertiary syphilis
Gummas, aortitis (vasa vasorum destruction), neurosyphilis, argyll robertson pupils
145
Congenital syphilis
Rhagades (linear scars at angle of mouth), snuffles, notched teeth/mulberry molars, short maxilla, deafness
146
Jarisch-Herxeimer reaction
Flu-like symptoms after antiobitcs started 2/2 killed bacteria releasing endotoxins
147
Allergic bronchopulmonary aspergillosis
a.w. asthma, CF; may cause bronchietasis and eosinophilia
148
Aflatoxin
HCC risk
149
PCP form
Disc-shaped yeast forms on methenamine silver stain of lung tissue
150
Rx for malaria
chloroquine for sensitive species (blocks plasmodium heme polymerase); mefloquine or atovaquone/proguanil; if life threatening, use IV quinidine or artesunate (and test for G6PD deficiency)
151
Amebiasis
Entamoeba histolytica: bloody diarrhea, liver abscess ("anchovy paste" exudate), RUQ pain; dx with serology or trophozoites (with RBCs in cytoplasm) or cysts (up to four nuclei) in stool; rx with metronidazole
152
Cryptosporidium presentation, dx, rx
Severe diarrhea in AIDS patient; dx with oocytsts on acid fast stain; rx with nitazoxanide
153
Trypanosoma bruci presentation
recurring fever, LN, somnolence, coma; rx with suramin for blood dz, melarsoprol for CNS
154
Babesiosis presentation, dx, rx
Fever in hemolytic anemia; ring form "maltese cross" on blood smeer; atovaquone + azithromycin
155
Trypanosoma cruzi presentation, dx, rx
Chagas disease (DCM, megaesophagus, megacolon, unilateral periorbital swelling); blood smear; benznidazole or nifurtimox
156
Visceral leishmaniasis pw, dx, rx
Spiking fevers, HSM, pancytopenia; dx with macrophages containing amastigotes; amphotericin B
157
Pinworms / enterobius vermicularis pw, rx
pw anal pruritus (tape test); bendazole
158
Giant roundworm / ascaris lumbricoides pw, dx, rx
intestinal infection with obstruction at ileocecal valve; eggs visible in feces under microscope; bendazole
159
Strongyloides stercoralis pw, dx, rx
Intestinal infection causing epigastric pain (like peptic ulcer); bendazole or ivermectin
160
Hookworm / ancyclostoma, necator pw, rx
Anemia by sucking blood from intestinal walls; bendazole or pyrantel pamoate
161
Trichinella spiralis transmission, pw, rx
undercooked pork; inflammation of muscle, periorbital edema, fever, nausea, vomiting; bendazole
162
Onchocerca volvulus transmission, pw, rx
Female blackfly bite; hyperpigmented skin and river blindness ("black flies, black skin nodules, black sight); ivermectin
163
Loa loa transmission, pw, rx
Deer/horse/mango fly; worm in conjunctiva; diethylcarbamazine
164
wuchereria bancrofti transmission, pw, rx
female mosquito; elephantiasis (blocks lymphatics); diethylcarbamazine
165
Taenia solium mot, pw, rx
ingestion of eggs, undercooked pork; intestinal infection, cysticercosis, neurocysticercosis (brain cysts); praziquantel or albendazole for neurocysticercosis
166
Diphyllobothrium latum mot, pw, rx
ingestion of larvae from raw freshwater fish; vitamin B12 deficiency and megaloblastic anemia; praziquantel
167
Echinococcus granulosus mot, pw, rx
ingestion of eggs from dog feces; hyadatid cysts in liver (inject before with etoh or NaCl to prevent anaphylaxis); albendazole
168
Fluke that causes biliary tract inflammation, pigmented gallstones, cholangiocarcinoma risk
clonorchis sinensis, transmitted by undercookedfish, rx with prazinquantel
169
Schistosoma mansoni/japonicum
HSM, portal inflammation/fibrosis, portal HTN
170
S. haematobium
SCC of bladder, pulmonary HTN
171
Only virus with dsRNA
Rotavirus
172
Only virus with ssDNA
Parvovirus
173
DNA viruses HHAPPP
Herpes, hepadna, adeno, papova, parvo, pox
174
DNA viruses generally
Double stranded, icosahedral symmetry, replicate in nucleus
175
RNA viruses generally
Single stranded, helical capsid, replicate in cytoplasm
176
Positive strand RNA: "the calcificed old emperor pico is wearing his crown and toga and is eating flavorful grapes from a retro bowel"
Calici, pico, corona, toga, flavi, retroviridae
177
Negative strand RNA: "old pete's rabid dog filo fights paul bunyun in the arena"
Orthomyxo, paramyxo, rhabdo, filo, bunya, arenaviridae
178
Amantadine MOA, limitations
M2 ion channel inhibitor (blocks acidification of the interior of the virion necessary for normal viral uncoating within the cell); only effect with strain A and now most viruses are resistant
179
Oseltamivir, zanamivir MOA
Neuraminidase inhibitor that interfers with the release of the progeny from the infected host cells; must give within 2 days, can reduce severity and duration
180
RSV prophylaxis
Palivizumab, monoclonal antibody against RSV
181
Differences between orthomyxoviridae and paramyxoviridae
Non-segmented RNA, HA/NA part of same glycoprotein; fusion (F) protein that cause infected host cell to fuse together into multinucleated giant cells
182
Subacute sclerosing panencephalitis (SSPE) is a complication of what disease?
Measles (years after initial infection)
183
Hepatitis D mot, types of infections
Requires HBV infection for envelop; co-infection: has the chance to be eliminated by HBsAg; superinfection of chronic HBV infection: severe, higher incidence of fulminant hepatitis, cirrhosis, and mortality
184
New hep C rx, moa
telaprevir, boceprevir; protease inhibitors of hep C protease NS3
185
HIV genome components
long-terminal repeat sequences (sticky ends recognized by integrase for insertion into host DNA and promotor function); gag sequences for structural proteins (nucleocapsid, capdis, matrix proteins); pol (protease, integrase, reverse transcriptase); env (codes for envelope proteins glycoprotein 120 (hypervariable region), 41)
186
Protease
enzyme that cleaves gag and pol proteins from larger precursor molecules
187
TORCH infections
TOxoplasmosis, Rubella, Cmv, Herpes/Hiv, Syphilis
188
Differences between chicken pox and smallpox
Latter with deep hard lesions, umbilicated lesions, same stage of development, more common in extremities
189
Congenital CMV
microcephaly, deafness, seizures
190
CMV in AIDS, in BM pts?
AIDS: retinitis, colitis; BM: pneumonia, pneumonitis
191
EBV binds to what receptor on what cell? and does what?
C3d receptor on B-cells, transform cells to proliferate and pass on viral copies
192
Atypical lymphocytes in EBV are:
Larged, activated T-cells
193
Poxviridae morphology, clinical presentations
complex coat, linear dsDNA, only DNA virus to replicate in cytoplasm; smallpox, molluscum contagiosum
194
Papovaviridae morphology, clinical presentation
naked icosahedral, circular dsDNA; HPV, BK (kidney disease in renal transplant pt, hemorrhagic cystitis in BM pts), JC (Progressive multifocal leukoencephalopathy)
195
Adenoviridae
Naked icosahedral, linear dsDNA; childhood URI, pink eye, diarrheal illness in infants and children
196
parvoviridae
only ssDNA (negative); erythema infectiosum; transient aplastic anemia crisis
197
The three groups within arbovirus
togaviridae, flaviviridae, bunyaviridae
198
Togaviridae
Alpha virus (western, eastern, venezuelen equine encephilitis) and rubivirus (rubella)
199
Congenital rubella
PDA, cataracts/chorioretinitis, mental retardation/deafness/microcephaly
200
Flaviviridae
Encephalitis (st. louis, japanese, russian, west nile virus); yellow fever (hepatitus with jaundice, fever, n/v, backache); dengue fever ("break-bone" fever = severe painful backache, muscle/joint pain, severe HA);
201
Picornaviridae 4 groups
Enterovirus, rhinovirus, hepatovirus, echovirus
202
Enterovirus 4 groups
Poliovirus, coxsackie A (herpangina - fever, sore throat, vesicles on back of throat; hand, foot, and mouth), coxsackie B (myocarditis, pericarditis)
203
Pros and cons of oral polio virus
Pros: oral, formation of IgG in blood and secretory IgA in GI tract, attenuated virus spread to contacts; cons: vascine-associated paralytic poliomyelitis
204
Diarrhea viruses
Calicivirus (Norwalk, norovirus), rotavirus, adenovirus (major cause of infant mortality worldwide)
205
Chances of developing paralytic poliomyelitis increases or decreases as one gets older?
Increases
206
Rabies: dz progression
Prodrome (fever, Ha, sensitive nerves around wound site); acute encephalitis (hyperactivity, agitation, confusion, seizures); brain stem encephalitis (Cn dysfunction, painful contraction of pharyngeal muscles); death (2/2 respiratory failure)
207
Rabies: rx
Clean wound; passive immunization with IG, active immunization with killed rabies virus (still effective)
208
Filoviridae presentations
ebola, marburg
209
Arenaviridae
Lymphocytic choriomenigitis (influenza like illness with viral meningitis), virus (fever, sore throat, ab pain with intractable vomiting and hypotension)
210
4 mechanisms by which bacteria evade penicillin
1. altering porins so drug cannot enter; 2. change the binding site of transpeptidase/penicilling-binding protein; 3. penicillinase; 4. efflux pump
211
listeria rx of choice
Amoxicillin
212
Cloaxacillin/dicloxacillin MOA
Oral beta-lactamase resistant penicillin
213
Anti-pseudomonal penicillin names, coverage
Ticarcillin, piperacillin; expanded gram-negative coverage (including pseudomonas), anaerobes, and gram-positives
214
Amoxicillin vs ampicillin
AmOxicillin has greater Oral bioavailability than ampicillin
215
How do penicillinase-resistant penicillins work?
Bulky R-group block acess to beta-lactam ring
216
Beta-lactamase (CAST)
Clavulanic Acid, sulbactam, tazobactam
217
Cephalosporin 1st generation
Cefazoline, cephalexin; GP cocci, GN PEcK
218
Cephalosporin 2nd generation
"F"; HEN PEcKS
219
Cephalosporin 3rd generation
Cetriaxone (meningitis, gonorrhea, dis. Lyme); cetazidime (pseudomonas)
220
Cephalosporin 4th generation
Cefepime, increased activity against pseudomonas
221
Cephalosporin 5th generation
Ceftaroline, includings MRSA but not pseudomonas
222
Cephalosporin SE
Hypersensitivity reaction, autoimmune hemolytic anemia, disulfiram-like reaction, vita K eficiency, increase nephrotoxocity of aminoglycosides
223
Carbapenem always administered with:
Cilastatin (inhibitor of renal dehydropeptidase I) to decrease inactivation of drug in renal tubules
224
Carbapenem SE
GI distress, skin rash, seizures
225
Aztreonam MOA
Binds to penicillin binding protein 3, prevents peptidoglycan cross-linking; no cross-allergenicity with penicillin; gran-negative rods only, for penicillin-allergic patients or people with renal insufficiency who cannot tolerate aminoglycosides
226
Vanc MOA
Binds D-ala D-ala portion of cell wall precursors, inhibits cell wall formation; not susceptible to beta-lactamases
227
Vanc SE
nephrotoxicity, ototoxicity, red man syndrome (pre-treat with anti-histamines, slow drip)
228
Aminglycosides MOA, method of drug resistance
Irreversible binding of 30S, causes misreading of mRNA and blocks translocation. Requires O2 for uptake, thus ineffective against anaerobes; bacteria develop transferase enzymes that inactivate the drug by acetylation, phosphorylation, or adenylation
229
Aminoglycoside SE (NNOT)
Nephrotoxicity, neuromuscular blockade, ototoxicity (esp with loop diuretics), teratogen
230
Tetracycline (e.g. doxycycline) MOA, impt indications; method of drug resistance
Bind to 30S, prevent attachment of aminoacyl-tRNA; limited CNS pentration; fecally eliminated, thus OK with renal failure pts; do not take with milk, antacids, or Fe because divalent cations inhibit absorption; lyme; Plasmid-encoded transport pumps
231
Tetracycline SE
Discoloration of teetn and inhibition of bone growth in childre, photosensitivity; contraindicated in pregnancy
232
Chloramphenicol MOA, impt indications; drug resistance
Blocks peptidyltransferase at 50S; meningitis (big three), RMSF (esp. young children and pregnant women); plasmid-encoded acetyltransfer inactivates drug
233
Chloramphenicol SE
Significant: dose-dependent anemia, dose-independent aplastic anemia, gray baby syndrome
234
Clindamycin MOA, impt indications, toxicity
Blocks peptide transfer at 50S; anaerobic infections (bacteroids, clostridium perfringens) in aspiration pneumonia, lung abscess, oral infection. also good against skin infections; added to rx for toxic shock syndrome to limit protein synthesis; pseudomembranous colitis, diarrhea
235
linezolid MOA, impt indications, SE, resistance method
Binds to 50S subunit; prevents formation of the initiation complex; GP (MRSA, VRE); BM suppression, peripheral neuropathy, 5-HT syndrome; point mutation on ribosomal RNA
236
Macrolides MOA, impt indications
Binds to 23S rRNA of 50S subunit, blocks translocation; atypical pneumonias (mycoplasma, chlamdia, legionella), STIs (chlamydia), gram-positive cocci (strep in penicillin-allergic pt), and B. pertussis;
237
Macrolides SE (MACRO)
Motility (GI), Arrythmia (prolonged QT), Cholestatic hepatitis, Rash, eOsinophilia; inhibit cytocrhome P450 (increase serum concentration of theophyllines, anticoagulations)
238
Macrolides mechanism of resistance
Methylation of 23S rRNA-binding site
239
Trimethoprim MOA, impt indications
Inhibits bacterial dihydrofolate reductase; with sulfamethoxazole, used for UTI, PCP, shigella, salmonella
240
Trimethoprime SE
Megaloblastic anemia, leukopenia, granulocytopenia
241
Sulfonamide MOA, SE
PABA antimetabolite inhibit dihydropteroate synthase and inhibit folate synthesis; hypersensitivity reaction, hemolysis if G6PD deficiency, nephrotoxicity, photosensitivity, kernicterus in infants, displaces other drugs from albumin; altered enzyme to reduce uptake or increase PABA synthesis
242
Fluoroquinolones MOA, resistence
inhibit prokaryotic enzyme topoisomerase II (DNA gyrase) and IV (must not take with antacids); GN rods of urinary and GI tracts (pseudomonas), Neisseria; chromosome-encoded mutation in DNA gyrase, plasmid-mediated resistance, efflux pumps
243
Fluoroquinolones SE
Contraindicated in pregnant women, nursing mothers, and children due to damage to cartilage; may cause tendonitis or tendon rupture in elderly/steroid patients; may prolong QT interval
244
Daptomycin MOA, impt indications, toxicity
Lipopeptide that disrupts cell membrane of gram-positive cocci; MRSA, VRE, bactermia, endocarditis; myopathy, rhabdomyolysis (check CK)
245
Metronidazole MOA, impt indications (GET GAP), SE
Forms toxic free radical metabolites in the bacterial cell that damages DNA (also effective against some antiprotozoal); Giardia, entamoeba, trichomonas, gardnerella vaginalis, anaerobes, pylori); disulfam-like reaction (severe flushing tachycardia, hypotension), metallic taste
246
Aspergillus 3 forms
ABPA, aspergilloma, invasive aspergillus
247
Aspergillus produces a toxin that causes what disease
Aflatoxin, HCC
248
Actinomycetes produces what kind of granules
Sulfur granules
249
Polyenes like amphotericin B MOA, SE
Binds to ergosterol, disrupts fungal plasma membrane; renal toxicity (dose-dependent azotemia), acute febrile reaction (common, give aspirin/acetaminophen), anemia, phlebitis
250
Antimetabolites like flucytosine MOA, SE
Inhibits DNA/RNA synthesis; add to amphotericin B for cryptococcal meningitis; BM depression, N/V/diarrhea
251
Azole MOA, SE
inhibit cytochrome P-450 enzyme system needed for ergosterol synthesis; inhibition of cytochrome P450, testosterone synthesis (gyncomastia, impotence, decreased libid, decreased sperm production)
252
Griseofulvin MOA
Disrupt spindle formation, prevent mitosis; effective for dermatophyte plaques
253
Potassium Iodide MOA
Rx for sporotrichosis (Rose pot)
254
Terbinafine MOA
Blocks formation of squalene epoxide in ergosterol synthesis; accumulate in nails (not metabolized by cytochrome p450)
255
Echinocandin MOA
inhibit cell wall synthesis by inhibiting synthesis of beta-glucan; rx for invasive aspergillosis, candida; flushing (by histamine release)
256
Giemsa stain "Certain bugs really try my patients)
Chlamydia, borrelia, ricketsia, trypanosomes, plasmodium
257
PAS stain what, in what organism?
Glycogen, diagnose Whipple disease
258
Carbol fuchsin
Acid-fast bacteria, protoza (cryptosporidium)
259
India ink
Cryptococcus neoformas
260
Silver stain
Fungi (PCP), legionella, H. pylori
261
e. coli culture
Eosin-methylene blue (EMB) agar (green metallic sheen)
262
lactose-fermenting enterics culture
MacConkey agar (fermentation produces acid, turns pink)
263
m. pneumoniae culture
eaton agar (with cholesterol)
264
m. tuberculosis culture
lowestein-jensen agar
265
Encapsulated (SHiNE SKiS)
S. pneumo, H. flu, N. meningitis, E. coli, Salmonella, Klebsiella, group b Strep
266
Three leading causes of UTI
E. chol (green metallic sheen on EMB agar), s. saprophyticus (esp. sexually active women), klebsiella (positive urea test, along with proteus)
267
Toxoplasmosis rx
pyramethamine, sulfadiazine
268
Trypanosoma brucei rx
suramin, melarsoprol
269
T. cruzi rx
nifurtimox
270
Leishmaniasis rx
sodium stibogluconate
271
Anti-mite therapy/moa: permethrin, malathion, lindane
permethrin (blocks na channels), malathion (ACh inhibitor), lindane (blocks GABA channels)
272
Chloroquine moa
Blocks detoxification of heme into hemozoin; accuulates and kills plasmodia
273
Acyclovir, valacyclovir, famciclovir moa, indications
Guanosine analogs, chain terminates and inhibits viral DNA polymerase; requires HSV/VZV thymidine kinase to monophosphorylate and render active; acyclovir (iv)/valacyclovir (oral) for HSV, famciclovir: herpes zoster
274
Ganciclovir moa, indications
Guanosine analog, also chain terminates and inhibits viral DNA polymerase; activated by CMV viral kinase; CMV
275
Foscarnet moa, indications, se
Binds to pyrophosphate-binding site of DNA/RNA viral polymerase, does not require activation by viral kinase; 2nd line rx (CMV retinitis after ganciclovir, HSV after acyclovir); nephrotoxicity, electrolyte abnormalities
276
Protease inhibitor: name ends with
end in -navir "navir tease a protease"
277
NRTI: moa, se
competitively inhibits nucleotide binding to reverse transcriptase and temrinate DNA chain (lack 3' OH group); tenofovir is nucleotide, all others are nucleosides and need to be phsophylrated to be active; Bm suppression, periphera neuropathy
278
NNRTI moa, se
Binds to reverse transcriptase at other sites, no need for phosophorylation; rash/hepatotoxicity
279
Integrase inhibitor moa, se
Raltegravir; reversibly inhibit HIV integrase; check creatinine kinase
280
Fusion inhibitor moa
Enfuvirtide: binds gp41, inhibits entry; maraviroc: binds CCR-5 on T cells inhibit interaction with gp120
281
IFN-beta
Multiple sclerosis
282
IFN-gamma
Chronic granulomatous disease
283
IFN-alpha
Hep B, C, Kaposi, condyloma acuminatum, RCC, melignant melanoma
284
Ribavarin moa, use, se
Competitively inhbits inosine monophosphate dehydrogenase, inhibits synthesis of guanine nucleotides; use in HCV; hemolytic anemia, severe teratogen
285
Simeprivir moa, use, se
HCV protease inhibitor; HCV; photosensitivity
286
Sofosbuvir moa, use
Inhibits RNA-dependent RNA polymerase; HCV
287
Live attenuated vaccine (Live, one night only! see small yellow rotating chickens get vaccinated with Sabin and MMR! It's incredible!"
Smallpox, yellow fever, rotavirus, polio, MMR, influenza
288
Most purified dsDNA and positive strand ssRNA are:
Infectious
289
HBV is not a retrovirus but has a:
reverse transcriptase
290
Picornavirus (PERCH)
Polio, echo, rhino, coxsackie, HAV
291
Yellow fever
Flavivirus; transmitted by Aedes mosquito (human, monkey reservoir); sx: high fever, black vomit, jaundice; may see Councilman bodies (eosinophilic apoptotic globules) on liver biopsy
292
Flavivirus
HCV, yellow fever, dengue, st. louis encephalitis, west nile virus
293
Hep E
Enteric, Expectant mothers, and Epidemic (high mortality in pregnant women)
294
HBV
partial DNA; DNA polymerase completes partial dsDNA and host RNA polymerase transcribes mRNA from viral DNA to make viral proteins; DNA polymerase then reverse transcribes viral RNA to DNA
295
CMV retinitis finding on fundoscopy
cotton-wool spots
296
CMV esophagitis/colitis findings on endoscopy
linear ulcers
297
Roseola
Rose colored macules appear on body after several days of high fever, can present with febrile seizures
298
mechanical ventilation/endotracheal intubation
P. aeruginos (sweet odor), klebsiella, acinetobacter, s. aureus;
299
Rifampin four Rs
RNA polymerase inhibitor, ramps up cytochrome P450, red body fluids, rapid resistance
300
isoniazid MOA
Decreased synthesis of mycolic acids; bacterial catalase peroxidase (encoded by KatG) needed to convert to active metabolite
301
B pertussis toxins
Pertussis toxin (disables Gi, overactivates AC, impairs phagocytosis) and adenylate cyclase toxin (increase cAMP, edema, phagocyte dysfunction)
302
Candida vaginitis RF
Antibiotics, OCP, steroids, DM
303
Infants infected with HBV exhibit:
High viral replication, high risk of chronic infection, but low lab markers for liver injury because their immune system is undeveloped and unable to attack infected cells
304
Subacute bacterial endocarditis after dental work
Strep viridans
305
Culture-negative bacterial endocarditis
Bartonella, mycoplasma, chlamydia, HACEK organism
306
S. epidermis endocarditis after valve replacement
Vanc with gent or rifampin
307
B anthrax two toxins, moa
edema factor (increases cAMP cyclase) and lethal factor (zinc-dependent protease that inhibits MAPK signaling, cause apoptosis)
308
C. difficil toxin A/B
Toxin A (activate PMN, cause inflammation, diarrhea); toxin B (induces actin depolymerization, cell death, bowel wall necrosis)
309
MacConkey agar
BS-containing agar that inhibits GP growth
310
M. pneumoniae mechanism for hemolysis
Shares antigen with RBC, thus antibody response leads to cold MAHA
311
Herpes virus gets its envelope from the:
nuclear membrane
312
S. pneumo organism characteristics
Optochin sensitive, bile salt soluble, alpha hemolytic
313
encapsulated bacteria: capsule function
anti-phagocytic
314
s. pyogenes main virulence factor and moa
m protein; inhibits phagocytosis and complement activation, mediates bacterial adherence
315
streptolysin-containing bacteria, moa
s. pyogenes, lyses RBC
316
Fidomycin moa, indications
Inhibits RNa polymerase, recurrent c. difficile
317
Bacterial toxins that stimulate AC
b. pertussis (pertussis toxin), b. anthracis (edema factor), ETEC (LT toxin), b. cererus, v. cholera
318
Bacteria that produce toxins that inactivate EF-2
diptheria (diptheria toxin), psueodomonas (exotoxin a)
