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microbio Flashcards

1
Q

Clinical disinfectants: Alcohol MOA

A

Disruption of cell membrane, protein denaturation

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2
Q

Clinical disinfectants: Chlorhexidine MOA

A

Disruption of cell membrane, protein denaturation, coagulation of cytoplasm

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3
Q

Clinical disinfectants: Hydrogen peroxide MOA

A

Destructive free radicals that oxidize cellular components; can clear spores

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4
Q

Clinical disinfectants: Iodine MOA

A

Halogenation of proteins, nucleic acids; can clear spores

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5
Q

HIV pol gene mutations

A

Underlie drug resistance to protease inhibitor, NNRT, NRT

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6
Q

HIV env gene mutations

A

Change structural glycoproteins used in viral envelope, allowing virus to evade humoral response

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7
Q

Bee venom contains what, induces what response?

A

Hyaluronidase, phospholipase, protein; induce IgE response

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8
Q

EBV pw

A

infectious mono, nasopharyngeal carcinoma, lymphoma (esp. Burkett’s)

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9
Q

EBV mechanism for binding to B cells, nasopharyngeal epithelial cells

A

gp350 binds to C3d complement receptor (CR2, CD21)

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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)

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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)

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12
Q

RPR checks for what molecules

A

Cardiolipin, lecithin

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13
Q

Acute hemorrhagic cystitis in children

A

Adenovirus (11, 21)

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14
Q

Norwalk agent

A

Calcivirus that causes viral gastroenteritis

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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)

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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

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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)

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18
Q

Enterovirus

A

Single-stranded RNA; echovirus, coxsackievirus, poliovirus; FO transmission (but no gastroenteritis)

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19
Q

Exfoliative toxin MOA

A

Act as proteases and cleave desmoglein in desmosomes; cause SSSS and bullous impetigo

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20
Q

GN septic shock mediated by what toxin?

A

Endotoxin, Lipid A

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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

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22
Q

Leukoplakia

A

Precancerous lesion on tongue that cannot easily be scraped off, 2/2 smoking

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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

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24
Q

Mycobacteria cell wall contains:

A

Mycolic acid

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25
Q

Anthrax is the only bacteria with this capsule composition

A

Polypeptide (D-glutamate)

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26
Q

Botulism neurotoxin requires what environment, remains intracellular until what event, and dies under what conditions

A

Anaerobic; autolysis; heating

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27
Q

Chancroid ulcer

A

Haemophilus ducreyi; multiple, deep painful ulcers with gray-yellow exudate; organisms in parallel lines (school of fish)

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28
Q

Genital herpes

A

HSV 1, 2; multiple, small, shallow, grouped, painful ulcers on erythematous base; multinucleated giant cells with intranuclear inclusions (Cawdry Type A)

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29
Q

Granuloma inguinale

A

Klebisella inguinale; extensive, progressive, painless ulcer with granulomatous base; GN intracytoplasmic cysts (Donovan bodies)

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30
Q

Syphillis

A

Treponema pallidum; single, indurated, well-circumscribed with clean base; thin, delicate cork-screw organism found on darkfield microscopy

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31
Q

Lymphogranuloma venerum

A

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

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32
Q

Monospot test

A

EBV has serum heterophil anbibodies wihch agglutinate sheep erythrocytes

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33
Q

What non-EBV organisms cause infectious mononucleosis?

A

CMV, HHV-6, toxoplasmosis

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34
Q

Coxsackie A in children manifests as

A

Aseptic meningitis, herpangina, hand/foot/mouth syndrome

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35
Q

JC causes what disease?

A

PML: CNS demyelination, hemiparesis, visual field defect, cognitive impairment

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36
Q

Bronchitis bugs

A

influenza, cornonavirus, RSV

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37
Q

Necrotizing fascitis

A

S. pyogenes (GAS), s. aureus, c. perfringens, polymicrobial

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38
Q

Cryptococcus neoformans

A

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

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39
Q

Why does cryptococcus prefer the CNS?

A

CSF does not have the alternate complement pathway

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40
Q

Pulmonary cryptococcus dx

A

Bronchopulmonary washing shows red mucicarmine stain; stains with india ink, culture on sabouraud agar

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41
Q

Cryptococcal meningitis rx

A

Amphotericin B + flucytosine; fluconazide for prophylaxis

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42
Q

Herpez zoster opthalmicus

A

VZV infection of trigeminal ganglion of CNV, leads to visual impairment

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43
Q

Paromyxovirus examples

A

Parainfluenza (laryngotracheobronchitis/croup!); RSV (bronchiolitis); measles; mumps

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44
Q

Arenavirus

A

Lymphocytic choriomeningitis virus (LCV), an aseptic meningitis + mild flu after mice exposure

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45
Q

Killed vaccines vs live attenuated

A

Former activates only humoral system (includes Hep A, rabies); latter activates humoral and cell-mediated (MMR)

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46
Q

Endocarditis after GI/GU procedure in women

A

Enterococci; rx with penicillin and aminoglycoside; may need vanc or linezolid

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47
Q

Fungi microscopic characteristics for mucor/rhizopus, germ candida albicans, coccidiodes

A

Nonseptated hyphae that branch at wide angle; germ tubes that sproud from true hyphae); spherules

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48
Q

Diarrhea-causing exotoxins

A

Preformed: s. aureus, b. cereus (cereulide); post-ingestion: watery: ETEC, vibrio cholera; inflammatory EHEC, shigella

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49
Q

Traveler’s diarrhea, associated toxins

A

ETEC: LT (similar to cholera, stimulate Gs, adeylate cyclase, cAMP), ST (stimulate guanylate cylcase, cGMP)

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50
Q

Central venous catheters needed for meds that cannot be given peripherally

A

Vasopressors, TPN, chemo

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51
Q

Shigella inoculum requirement, attachment site

A

highly adapated to survive in stomach/bile, thus veyr low inoculum requirement; unique binding site on intestinal mucosal M cells (covering peyer’s patches)

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52
Q

Bacterial transfer of genes has 3 methods

A

Transformation (direct uptake of naked DNA from environment); conjugation (1-way transfer using F-factor derived sex pilus); transduction (bacteriophage driven)

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53
Q

Picornovirus: difference between two types and effect on habitat

A

Enterovirus (acid stable); rhinovirus (acid-labile)

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54
Q

Hot tub folliculitis

A

Superficial infection by pseudomonas

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55
Q

Scarlet fever presentation and bug

A

Pyogenic toxin of S. pyogenes; strep pharyngitis, strawberry tongue, and after 2 days, rash appears in neck, armpit, groin that generalizes “sandpaper” “boiled lobster

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56
Q

Why do influenza and rotavirus have frequent genetic shifts?

A

Segmented genes

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57
Q

Hep A

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

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58
Q

Clostridium perfringens 2 presentations

A

transient water diarrea (delayed), and gas gangrene (metabolizes carbohydrates to produce gas)

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59
Q

Histoplasmosis microscopic description, clinical presentation

A

Dimorphic, with hyphae, infects macrophages, lives intracellular; pw splenomegaly and ulcerated tongue in immunocompetent; in IC, resembles TB with cavitary lesions, hilar LN

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60
Q

Blastomycosis microscopic description

A

Round yeast with single broad-basedbuds

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61
Q

Actinomycosis presentation and treatment

A

Throat infection/swelling, rx with penicillin, surgical debridement

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62
Q

CMV viral description

A

Enveloped virus with dsDNA, enlarged centrally located epithelial cells with intranuclear and intracyctoplasmic inclusions

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63
Q

Catalase

A

3% H2O2, differentiates between staph and strep

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64
Q

Coagulase

A

ability to coagulate blood, differentiates between aureus, epidermis

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65
Q

Shigella buzz-words

A

Non-motile, no H2S (vs salmonella), produces acid (vs e coli)

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66
Q

Pseudomonas rx

A

pip-tazo, cephalosporin (3rd, 4th), aminoglycoside, fluoroquinolnes (cipro, levo), carbapenem

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67
Q

Rotavirus genetic structure

A

dsRNA; thus needs RNA polymerase

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68
Q

Positive sense RNA

A

5’ to 3’; functions as mRNA, directly translates into protein

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69
Q

Negative sense RNA

A

3’ to 5’; RNA polymerase has to make viral mRNA first, then translates; influenza A, paramyxovirus

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70
Q

Vibrio cholera and ETEC share what?

A

Heat labile toxin that activates adenylate cyclase, increase cAMP, and increase efflux of NaCl in epithelial cells only (no luekocytes, RBC)

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71
Q

Viridans MOA

A

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)

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72
Q

Bacterial cell wall is made up of:

A

Peptidoglycan, made by transpeptidase (or penicilling binding protein)

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73
Q

Diptheria rx

A

Diptheria antitoxin, penicillin/erythromycin, DPT vaccine

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74
Q

Protein A

A

s. aureus; binds with Fc portion of IgG, preventing complement activation and decreased C3b (IgG/C3b both oopsonins

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75
Q

Shiga/EHEC: AB toxin

A

Shiga/EHEC; B binds, A catalyzes removal of single adenine residue that prevents binding of 60s ribosomal subunit to tRNA

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76
Q

Parvovirus

A

non-enveloped, ssDNA

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77
Q

e coli virulence factors and their related conditions

A

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

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78
Q

Mycoplasma requires what substrate to grow?

A

Cholesterol

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79
Q

TB major virulence factor

A

Cord factor: promotes growth of thick, rope-like cords, mycoside-mycolic acid binding, and inactivates PMN (dmg mito, induce release of TNF)

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80
Q

Acute rheumatic fever occurs only after:

A

GAS pharyngitis, NOT skin infection

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81
Q

Acute post-strep GN occurs after

A

pharyngitis, skin infection

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82
Q

Schistosomiasis natural habitat, two kinds and manifestations

A

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

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83
Q

Acid fast stain MOA

A
  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
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84
Q

Mycolic acid

A

Waxy, LC fatty acid covalently bound to sugars within cell wall

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85
Q

Blastomycosis: organism description, presentation, MOA

A

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

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86
Q

Coccidio: organism description, presentation, MOA

A

mold/endospore form; southwest, infect lungs; pw lung dz, pulmonary nodules, erythema nodosum in immunocompetent, and extrapulmonary dz or meningitis in IC

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87
Q

OM: children

A

hematogenous spread, s. aureus, femur

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88
Q

OM: SCD

A

hematogenous spread, salmonella, femur

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89
Q

OM: Pott dz

A

hematogenous from lung, TB, vertebra

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90
Q

OM: DM

A

continguous from ulcer, polymicrobial, foot

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91
Q

Histoplasmosis: organism description, presentation

A

dimorphic shape, ovoid cells within MO (thus reticuloendothelial cells affected, causing HSM); TB-like dz in immunocompetent, disseminated dz in IC

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92
Q

Hep C

A

Enveloped, SS+ RNA

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93
Q

Hep E

A

Non-enveloped, Ss+ RNA

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94
Q

Listerosis: organism, presentation, setting

A

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)

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95
Q

Thyer-Martin composition, use

A

Vancomycin, colistin (for GN), nyastatin (for fungi); identify N. gonorrhea and other GN diplococci within leukocytes

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96
Q

Culture medims: enrichment, differential, reducing

A

enrichment: H flu (X,V factors), clostridium (anaerobic environment); reducing: organisms that reduce Fe or S

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97
Q

What is the most common cause of bacterial meningitis in adults?

A

S. pneumo (GP, lancet-shaped cocci in pairs)

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98
Q

Congenital toxoplasmosis presents with:

A

ydrocephalus, intracranial calficiations, chorioretinitis; thats why pregnant women should avoid cat litter

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99
Q

Activate adenylate cyclase, increase cAMP

A

Diarrhea (ETECT, campylobacter, b. cereus, v. cholera); b. pertussus, b. anthrax

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100
Q

Activate guanylate cyclase

A

ETECT, yersinia, enterococcus

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101
Q

Inactivate EF-2

A

Diptheria, pseudomonas

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102
Q

Congenital rubella

A

Sensineural defects, cateracts, cardiac manifestations (PDA), microcephaly

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103
Q

Trypanosoma cruzi: carrier, MOA

A

redoviid bug; toxin destroys the mesenteric plexus and cause denervation of smooth muscle

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104
Q

Babesia

A

Transmiatted by tick bites in NE, causes bubesiosis (malaria-like illness in asplenic pts); “maltese cross” on blood smear

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105
Q

Isospira belli presentation in who?

A

Chronic, water, profuse diarrhea in IC pt

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106
Q

Brucella RF, presentation

A

Drinking milk, touching sheep/goats; pw fever, malaise, LN, HSM “brucellosis”

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107
Q

B anthrax RF, MOA, presentation

A

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

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108
Q

B anthrax organism characteristics

A

capsule contains protein, D-lutamate, important for pathogenesis; aerobic, long-chains that are “serpentine”/”medusa-headed”

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109
Q

Typhoid fever: organism, MOA, pw

A

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

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110
Q

parainfluenza pw

A

Croup, significant upper airway obstruction, inflammed subglottic tissue

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111
Q

N. gonorrhea virulence factor

A

Pili/hair-like protein that allow it to bind to susceptible tissue, high propensity to undergo recombination

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112
Q

Salmonella virulence factor

A

Vi antigen, which protects bacteria against oopsonization and phagocytosis

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113
Q

Strongyloidosis

A

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)

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114
Q

dx methods for different worms (schistosomiasis, pinworm, intestinal tapeworm, protozoa)

A

parasitic eggs in stool, eggs on scotch-tape test on anus; proglotted in stool; trophozoites/cysts in stool

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115
Q

Legionella presentation, diagnosis, organism characteristics

A

Fever + bradycardia; dx with urine antigen test; silver stain, slow growth on buffered charcoal yeast extract + L cysteine + iron

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116
Q

N. meningitis virulance factor

A

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

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117
Q

Stain for HSV

A

Tzack smear, wright-giemsa stain for mutinucleated giant cell

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118
Q

Hemagluttin MOA

A

High affinity for RBC

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119
Q

Benefits of conjugate vaccine

A

Increased efficiency in eldery/children; increased mucosal immunity; imcreased immunogenic memory

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120
Q

Mycoplasma pneumonia c/b

A

MAHA 2/2 cold-agglutinin antibodies

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121
Q

intracellular survival strategies

A
  1. blocking phagolysosome-lysozome binding (salmonella, TB via sulfatides); 2. inhibiting phagolysosone acidification (TB); 3. escaping from phagosome into cytosole(listeria, shigella)
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122
Q

Listeria escape MOA

A

Listerolysin, pore-forming toxin activated by acidic environment (phagolysozome); “rocket tails” via actin polymerization that allow intracellular movement

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123
Q

Complement deficies increases susceptibility to

A

Neisseria

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124
Q

Klebsiella pneumonia

A

ETOH-related, upper lobe, thick/mucoid/”current juelly” sputum with lung tissue necrosis/abscess

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125
Q

Malignant OM

A

Diabetic elderly, pw exquisite ear pain and drainage, granulomatous tissue w/ clear TMs

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126
Q

Malaria two forms

A

Schint (pre-devision), merozoites (post-division)

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127
Q

HTLV-1

A

T-cell leukemia, lymphoma

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128
Q

BK virus

A

Nephropathy or hemorrhagic cystitis

129
Q

CMV receptor

A

cellular integrins

130
Q

EBM receptors

A

CD21/CR2

131
Q

HIV receptors

A

CD4 + CXCR 4/CCR5

132
Q

Rabies receptor

A

Nicotinic ACh receptor

133
Q

Rhinovirus receptor

A

ICAM/CD-65

134
Q

Diptheria medium

A

Cystine-tellurite agar (dark black colonies)

135
Q

P. aeroginosa

A

ecthyma gangrenosum: perivascular invasion of blood vesselsin skin with release of following exotoxins (exotoxin A - inhibit protein synthesis, elastase, phospholipase, pyocyanin)

136
Q

Diptheria ABCDEFGH

A

ADP-ribosylation, beta-prophage, cornebacterium diptheriae, EF-2, granules (blue/red), heart (mycorditis/arrhythmias)

137
Q

Tetanospasmin and botulinum toxin MOA

A

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
Q

C. perfringens alpha-toxin MOA

A

Also called lecithinase, degrades membrane phospholipid and cause myonecrosis (gas gangrene) and hemolysis

139
Q

C. difficile MOA

A

Toxin A binds to brush border; toxin B depolarizes actin and disrupts cytoskeleton

140
Q

Leprosy reservoir, ambient temperature, dz forms, rx

A

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
Q

How to differentiate EHEC from other E. coli?

A

Does not ferment sorbitol

142
Q

Antibiotic effect on salmonella

A

Prolongs duration of fecal excretion

143
Q

Leptospirosis

A

Flu-like symptoms, calf myalgia, photophobia with conjunctival suffusion, prevalent amount surfers andin trops; Weil disease: severe form with jaundice and azotemia

144
Q

Tertiary syphilis

A

Gummas, aortitis (vasa vasorum destruction), neurosyphilis, argyll robertson pupils

145
Q

Congenital syphilis

A

Rhagades (linear scars at angle of mouth), snuffles, notched teeth/mulberry molars, short maxilla, deafness

146
Q

Jarisch-Herxeimer reaction

A

Flu-like symptoms after antiobitcs started 2/2 killed bacteria releasing endotoxins

147
Q

Allergic bronchopulmonary aspergillosis

A

a.w. asthma, CF; may cause bronchietasis and eosinophilia

148
Q

Aflatoxin

A

HCC risk

149
Q

PCP form

A

Disc-shaped yeast forms on methenamine silver stain of lung tissue

150
Q

Rx for malaria

A

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
Q

Amebiasis

A

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
Q

Cryptosporidium presentation, dx, rx

A

Severe diarrhea in AIDS patient; dx with oocytsts on acid fast stain; rx with nitazoxanide

153
Q

Trypanosoma bruci presentation

A

recurring fever, LN, somnolence, coma; rx with suramin for blood dz, melarsoprol for CNS

154
Q

Babesiosis presentation, dx, rx

A

Fever in hemolytic anemia; ring form “maltese cross” on blood smeer; atovaquone + azithromycin

155
Q

Trypanosoma cruzi presentation, dx, rx

A

Chagas disease (DCM, megaesophagus, megacolon, unilateral periorbital swelling); blood smear; benznidazole or nifurtimox

156
Q

Visceral leishmaniasis pw, dx, rx

A

Spiking fevers, HSM, pancytopenia; dx with macrophages containing amastigotes; amphotericin B

157
Q

Pinworms / enterobius vermicularis pw, rx

A

pw anal pruritus (tape test); bendazole

158
Q

Giant roundworm / ascaris lumbricoides pw, dx, rx

A

intestinal infection with obstruction at ileocecal valve; eggs visible in feces under microscope; bendazole

159
Q

Strongyloides stercoralis pw, dx, rx

A

Intestinal infection causing epigastric pain (like peptic ulcer); bendazole or ivermectin

160
Q

Hookworm / ancyclostoma, necator pw, rx

A

Anemia by sucking blood from intestinal walls; bendazole or pyrantel pamoate

161
Q

Trichinella spiralis transmission, pw, rx

A

undercooked pork; inflammation of muscle, periorbital edema, fever, nausea, vomiting; bendazole

162
Q

Onchocerca volvulus transmission, pw, rx

A

Female blackfly bite; hyperpigmented skin and river blindness (“black flies, black skin nodules, black sight); ivermectin

163
Q

Loa loa transmission, pw, rx

A

Deer/horse/mango fly; worm in conjunctiva; diethylcarbamazine

164
Q

wuchereria bancrofti transmission, pw, rx

A

female mosquito; elephantiasis (blocks lymphatics); diethylcarbamazine

165
Q

Taenia solium mot, pw, rx

A

ingestion of eggs, undercooked pork; intestinal infection, cysticercosis, neurocysticercosis (brain cysts); praziquantel or albendazole for neurocysticercosis

166
Q

Diphyllobothrium latum mot, pw, rx

A

ingestion of larvae from raw freshwater fish; vitamin B12 deficiency and megaloblastic anemia; praziquantel

167
Q

Echinococcus granulosus mot, pw, rx

A

ingestion of eggs from dog feces; hyadatid cysts in liver (inject before with etoh or NaCl to prevent anaphylaxis); albendazole

168
Q

Fluke that causes biliary tract inflammation, pigmented gallstones, cholangiocarcinoma risk

A

clonorchis sinensis, transmitted by undercookedfish, rx with prazinquantel

169
Q

Schistosoma mansoni/japonicum

A

HSM, portal inflammation/fibrosis, portal HTN

170
Q

S. haematobium

A

SCC of bladder, pulmonary HTN

171
Q

Only virus with dsRNA

A

Rotavirus

172
Q

Only virus with ssDNA

A

Parvovirus

173
Q

DNA viruses HHAPPP

A

Herpes, hepadna, adeno, papova, parvo, pox

174
Q

DNA viruses generally

A

Double stranded, icosahedral symmetry, replicate in nucleus

175
Q

RNA viruses generally

A

Single stranded, helical capsid, replicate in cytoplasm

176
Q

Positive strand RNA: “the calcificed old emperor pico is wearing his crown and toga and is eating flavorful grapes from a retro bowel”

A

Calici, pico, corona, toga, flavi, retroviridae

177
Q

Negative strand RNA: “old pete’s rabid dog filo fights paul bunyun in the arena”

A

Orthomyxo, paramyxo, rhabdo, filo, bunya, arenaviridae

178
Q

Amantadine MOA, limitations

A

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
Q

Oseltamivir, zanamivir MOA

A

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
Q

RSV prophylaxis

A

Palivizumab, monoclonal antibody against RSV

181
Q

Differences between orthomyxoviridae and paramyxoviridae

A

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
Q

Subacute sclerosing panencephalitis (SSPE) is a complication of what disease?

A

Measles (years after initial infection)

183
Q

Hepatitis D mot, types of infections

A

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
Q

New hep C rx, moa

A

telaprevir, boceprevir; protease inhibitors of hep C protease NS3

185
Q

HIV genome components

A

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
Q

Protease

A

enzyme that cleaves gag and pol proteins from larger precursor molecules

187
Q

TORCH infections

A

TOxoplasmosis, Rubella, Cmv, Herpes/Hiv, Syphilis

188
Q

Differences between chicken pox and smallpox

A

Latter with deep hard lesions, umbilicated lesions, same stage of development, more common in extremities

189
Q

Congenital CMV

A

microcephaly, deafness, seizures

190
Q

CMV in AIDS, in BM pts?

A

AIDS: retinitis, colitis; BM: pneumonia, pneumonitis

191
Q

EBV binds to what receptor on what cell? and does what?

A

C3d receptor on B-cells, transform cells to proliferate and pass on viral copies

192
Q

Atypical lymphocytes in EBV are:

A

Larged, activated T-cells

193
Q

Poxviridae morphology, clinical presentations

A

complex coat, linear dsDNA, only DNA virus to replicate in cytoplasm; smallpox, molluscum contagiosum

194
Q

Papovaviridae morphology, clinical presentation

A

naked icosahedral, circular dsDNA; HPV, BK (kidney disease in renal transplant pt, hemorrhagic cystitis in BM pts), JC (Progressive multifocal leukoencephalopathy)

195
Q

Adenoviridae

A

Naked icosahedral, linear dsDNA; childhood URI, pink eye, diarrheal illness in infants and children

196
Q

parvoviridae

A

only ssDNA (negative); erythema infectiosum; transient aplastic anemia crisis

197
Q

The three groups within arbovirus

A

togaviridae, flaviviridae, bunyaviridae

198
Q

Togaviridae

A

Alpha virus (western, eastern, venezuelen equine encephilitis) and rubivirus (rubella)

199
Q

Congenital rubella

A

PDA, cataracts/chorioretinitis, mental retardation/deafness/microcephaly

200
Q

Flaviviridae

A

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
Q

Picornaviridae 4 groups

A

Enterovirus, rhinovirus, hepatovirus, echovirus

202
Q

Enterovirus 4 groups

A

Poliovirus, coxsackie A (herpangina - fever, sore throat, vesicles on back of throat; hand, foot, and mouth), coxsackie B (myocarditis, pericarditis)

203
Q

Pros and cons of oral polio virus

A

Pros: oral, formation of IgG in blood and secretory IgA in GI tract, attenuated virus spread to contacts; cons: vascine-associated paralytic poliomyelitis

204
Q

Diarrhea viruses

A

Calicivirus (Norwalk, norovirus), rotavirus, adenovirus (major cause of infant mortality worldwide)

205
Q

Chances of developing paralytic poliomyelitis increases or decreases as one gets older?

A

Increases

206
Q

Rabies: dz progression

A

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
Q

Rabies: rx

A

Clean wound; passive immunization with IG, active immunization with killed rabies virus (still effective)

208
Q

Filoviridae presentations

A

ebola, marburg

209
Q

Arenaviridae

A

Lymphocytic choriomenigitis (influenza like illness with viral meningitis), virus (fever, sore throat, ab pain with intractable vomiting and hypotension)

210
Q

4 mechanisms by which bacteria evade penicillin

A
  1. altering porins so drug cannot enter; 2. change the binding site of transpeptidase/penicilling-binding protein; 3. penicillinase; 4. efflux pump
211
Q

listeria rx of choice

A

Amoxicillin

212
Q

Cloaxacillin/dicloxacillin MOA

A

Oral beta-lactamase resistant penicillin

213
Q

Anti-pseudomonal penicillin names, coverage

A

Ticarcillin, piperacillin; expanded gram-negative coverage (including pseudomonas), anaerobes, and gram-positives

214
Q

Amoxicillin vs ampicillin

A

AmOxicillin has greater Oral bioavailability than ampicillin

215
Q

How do penicillinase-resistant penicillins work?

A

Bulky R-group block acess to beta-lactam ring

216
Q

Beta-lactamase (CAST)

A

Clavulanic Acid, sulbactam, tazobactam

217
Q

Cephalosporin 1st generation

A

Cefazoline, cephalexin; GP cocci, GN PEcK

218
Q

Cephalosporin 2nd generation

A

“F”; HEN PEcKS

219
Q

Cephalosporin 3rd generation

A

Cetriaxone (meningitis, gonorrhea, dis. Lyme); cetazidime (pseudomonas)

220
Q

Cephalosporin 4th generation

A

Cefepime, increased activity against pseudomonas

221
Q

Cephalosporin 5th generation

A

Ceftaroline, includings MRSA but not pseudomonas

222
Q

Cephalosporin SE

A

Hypersensitivity reaction, autoimmune hemolytic anemia, disulfiram-like reaction, vita K eficiency, increase nephrotoxocity of aminoglycosides

223
Q

Carbapenem always administered with:

A

Cilastatin (inhibitor of renal dehydropeptidase I) to decrease inactivation of drug in renal tubules

224
Q

Carbapenem SE

A

GI distress, skin rash, seizures

225
Q

Aztreonam MOA

A

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
Q

Vanc MOA

A

Binds D-ala D-ala portion of cell wall precursors, inhibits cell wall formation; not susceptible to beta-lactamases

227
Q

Vanc SE

A

nephrotoxicity, ototoxicity, red man syndrome (pre-treat with anti-histamines, slow drip)

228
Q

Aminglycosides MOA, method of drug resistance

A

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
Q

Aminoglycoside SE (NNOT)

A

Nephrotoxicity, neuromuscular blockade, ototoxicity (esp with loop diuretics), teratogen

230
Q

Tetracycline (e.g. doxycycline) MOA, impt indications; method of drug resistance

A

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
Q

Tetracycline SE

A

Discoloration of teetn and inhibition of bone growth in childre, photosensitivity; contraindicated in pregnancy

232
Q

Chloramphenicol MOA, impt indications; drug resistance

A

Blocks peptidyltransferase at 50S; meningitis (big three), RMSF (esp. young children and pregnant women); plasmid-encoded acetyltransfer inactivates drug

233
Q

Chloramphenicol SE

A

Significant: dose-dependent anemia, dose-independent aplastic anemia, gray baby syndrome

234
Q

Clindamycin MOA, impt indications, toxicity

A

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
Q

linezolid MOA, impt indications, SE, resistance method

A

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
Q

Macrolides MOA, impt indications

A

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
Q

Macrolides SE (MACRO)

A

Motility (GI), Arrythmia (prolonged QT), Cholestatic hepatitis, Rash, eOsinophilia; inhibit cytocrhome P450 (increase serum concentration of theophyllines, anticoagulations)

238
Q

Macrolides mechanism of resistance

A

Methylation of 23S rRNA-binding site

239
Q

Trimethoprim MOA, impt indications

A

Inhibits bacterial dihydrofolate reductase; with sulfamethoxazole, used for UTI, PCP, shigella, salmonella

240
Q

Trimethoprime SE

A

Megaloblastic anemia, leukopenia, granulocytopenia

241
Q

Sulfonamide MOA, SE

A

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
Q

Fluoroquinolones MOA, resistence

A

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
Q

Fluoroquinolones SE

A

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
Q

Daptomycin MOA, impt indications, toxicity

A

Lipopeptide that disrupts cell membrane of gram-positive cocci; MRSA, VRE, bactermia, endocarditis; myopathy, rhabdomyolysis (check CK)

245
Q

Metronidazole MOA, impt indications (GET GAP), SE

A

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
Q

Aspergillus 3 forms

A

ABPA, aspergilloma, invasive aspergillus

247
Q

Aspergillus produces a toxin that causes what disease

A

Aflatoxin, HCC

248
Q

Actinomycetes produces what kind of granules

A

Sulfur granules

249
Q

Polyenes like amphotericin B MOA, SE

A

Binds to ergosterol, disrupts fungal plasma membrane; renal toxicity (dose-dependent azotemia), acute febrile reaction (common, give aspirin/acetaminophen), anemia, phlebitis

250
Q

Antimetabolites like flucytosine MOA, SE

A

Inhibits DNA/RNA synthesis; add to amphotericin B for cryptococcal meningitis; BM depression, N/V/diarrhea

251
Q

Azole MOA, SE

A

inhibit cytochrome P-450 enzyme system needed for ergosterol synthesis; inhibition of cytochrome P450, testosterone synthesis (gyncomastia, impotence, decreased libid, decreased sperm production)

252
Q

Griseofulvin MOA

A

Disrupt spindle formation, prevent mitosis; effective for dermatophyte plaques

253
Q

Potassium Iodide MOA

A

Rx for sporotrichosis (Rose pot)

254
Q

Terbinafine MOA

A

Blocks formation of squalene epoxide in ergosterol synthesis; accumulate in nails (not metabolized by cytochrome p450)

255
Q

Echinocandin MOA

A

inhibit cell wall synthesis by inhibiting synthesis of beta-glucan; rx for invasive aspergillosis, candida; flushing (by histamine release)

256
Q

Giemsa stain “Certain bugs really try my patients)

A

Chlamydia, borrelia, ricketsia, trypanosomes, plasmodium

257
Q

PAS stain what, in what organism?

A

Glycogen, diagnose Whipple disease

258
Q

Carbol fuchsin

A

Acid-fast bacteria, protoza (cryptosporidium)

259
Q

India ink

A

Cryptococcus neoformas

260
Q

Silver stain

A

Fungi (PCP), legionella, H. pylori

261
Q

e. coli culture

A

Eosin-methylene blue (EMB) agar (green metallic sheen)

262
Q

lactose-fermenting enterics culture

A

MacConkey agar (fermentation produces acid, turns pink)

263
Q

m. pneumoniae culture

A

eaton agar (with cholesterol)

264
Q

m. tuberculosis culture

A

lowestein-jensen agar

265
Q

Encapsulated (SHiNE SKiS)

A

S. pneumo, H. flu, N. meningitis, E. coli, Salmonella, Klebsiella, group b Strep

266
Q

Three leading causes of UTI

A

E. chol (green metallic sheen on EMB agar), s. saprophyticus (esp. sexually active women), klebsiella (positive urea test, along with proteus)

267
Q

Toxoplasmosis rx

A

pyramethamine, sulfadiazine

268
Q

Trypanosoma brucei rx

A

suramin, melarsoprol

269
Q

T. cruzi rx

A

nifurtimox

270
Q

Leishmaniasis rx

A

sodium stibogluconate

271
Q

Anti-mite therapy/moa: permethrin, malathion, lindane

A

permethrin (blocks na channels), malathion (ACh inhibitor), lindane (blocks GABA channels)

272
Q

Chloroquine moa

A

Blocks detoxification of heme into hemozoin; accuulates and kills plasmodia

273
Q

Acyclovir, valacyclovir, famciclovir moa, indications

A

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
Q

Ganciclovir moa, indications

A

Guanosine analog, also chain terminates and inhibits viral DNA polymerase; activated by CMV viral kinase; CMV

275
Q

Foscarnet moa, indications, se

A

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
Q

Protease inhibitor: name ends with

A

end in -navir “navir tease a protease”

277
Q

NRTI: moa, se

A

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
Q

NNRTI moa, se

A

Binds to reverse transcriptase at other sites, no need for phosophorylation; rash/hepatotoxicity

279
Q

Integrase inhibitor moa, se

A

Raltegravir; reversibly inhibit HIV integrase; check creatinine kinase

280
Q

Fusion inhibitor moa

A

Enfuvirtide: binds gp41, inhibits entry; maraviroc: binds CCR-5 on T cells inhibit interaction with gp120

281
Q

IFN-beta

A

Multiple sclerosis

282
Q

IFN-gamma

A

Chronic granulomatous disease

283
Q

IFN-alpha

A

Hep B, C, Kaposi, condyloma acuminatum, RCC, melignant melanoma

284
Q

Ribavarin moa, use, se

A

Competitively inhbits inosine monophosphate dehydrogenase, inhibits synthesis of guanine nucleotides; use in HCV; hemolytic anemia, severe teratogen

285
Q

Simeprivir moa, use, se

A

HCV protease inhibitor; HCV; photosensitivity

286
Q

Sofosbuvir moa, use

A

Inhibits RNA-dependent RNA polymerase; HCV

287
Q

Live attenuated vaccine (Live, one night only! see small yellow rotating chickens get vaccinated with Sabin and MMR! It’s incredible!”

A

Smallpox, yellow fever, rotavirus, polio, MMR, influenza

288
Q

Most purified dsDNA and positive strand ssRNA are:

A

Infectious

289
Q

HBV is not a retrovirus but has a:

A

reverse transcriptase

290
Q

Picornavirus (PERCH)

A

Polio, echo, rhino, coxsackie, HAV

291
Q

Yellow fever

A

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
Q

Flavivirus

A

HCV, yellow fever, dengue, st. louis encephalitis, west nile virus

293
Q

Hep E

A

Enteric, Expectant mothers, and Epidemic (high mortality in pregnant women)

294
Q

HBV

A

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
Q

CMV retinitis finding on fundoscopy

A

cotton-wool spots

296
Q

CMV esophagitis/colitis findings on endoscopy

A

linear ulcers

297
Q

Roseola

A

Rose colored macules appear on body after several days of high fever, can present with febrile seizures

298
Q

mechanical ventilation/endotracheal intubation

A

P. aeruginos (sweet odor), klebsiella, acinetobacter, s. aureus;

299
Q

Rifampin four Rs

A

RNA polymerase inhibitor, ramps up cytochrome P450, red body fluids, rapid resistance

300
Q

isoniazid MOA

A

Decreased synthesis of mycolic acids; bacterial catalase peroxidase (encoded by KatG) needed to convert to active metabolite

301
Q

B pertussis toxins

A

Pertussis toxin (disables Gi, overactivates AC, impairs phagocytosis) and adenylate cyclase toxin (increase cAMP, edema, phagocyte dysfunction)

302
Q

Candida vaginitis RF

A

Antibiotics, OCP, steroids, DM

303
Q

Infants infected with HBV exhibit:

A

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
Q

Subacute bacterial endocarditis after dental work

A

Strep viridans

305
Q

Culture-negative bacterial endocarditis

A

Bartonella, mycoplasma, chlamydia, HACEK organism

306
Q

S. epidermis endocarditis after valve replacement

A

Vanc with gent or rifampin

307
Q

B anthrax two toxins, moa

A

edema factor (increases cAMP cyclase) and lethal factor (zinc-dependent protease that inhibits MAPK signaling, cause apoptosis)

308
Q

C. difficil toxin A/B

A

Toxin A (activate PMN, cause inflammation, diarrhea); toxin B (induces actin depolymerization, cell death, bowel wall necrosis)

309
Q

MacConkey agar

A

BS-containing agar that inhibits GP growth

310
Q

M. pneumoniae mechanism for hemolysis

A

Shares antigen with RBC, thus antibody response leads to cold MAHA

311
Q

Herpes virus gets its envelope from the:

A

nuclear membrane

312
Q

S. pneumo organism characteristics

A

Optochin sensitive, bile salt soluble, alpha hemolytic

313
Q

encapsulated bacteria: capsule function

A

anti-phagocytic

314
Q

s. pyogenes main virulence factor and moa

A

m protein; inhibits phagocytosis and complement activation, mediates bacterial adherence

315
Q

streptolysin-containing bacteria, moa

A

s. pyogenes, lyses RBC

316
Q

Fidomycin moa, indications

A

Inhibits RNa polymerase, recurrent c. difficile

317
Q

Bacterial toxins that stimulate AC

A

b. pertussis (pertussis toxin), b. anthracis (edema factor), ETEC (LT toxin), b. cererus, v. cholera

318
Q

Bacteria that produce toxins that inactivate EF-2

A

diptheria (diptheria toxin), psueodomonas (exotoxin a)

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