Microbiology Flashcards
1
Q
anaplasmosis [,ænəplæz’məusis] pathogen vector involved immune cells/ 病理特征
A
边虫病；无形体病 pathogen: Anaplama vector: tick involved immune cells/ 病理特征: Granulocytes with morulae in cytoplasm [diff with ehrlichiosis!!!] 边虫病(Anaplasmosis)又称无浆体病，是由立克次体目(Rickettsiales)无浆体科（Anaplasmataceae）无浆体属（Anaplasma）中各种病原寄生于牛羊红细胞内引起的一种疾病，呈急性或慢性病程，表现为发热、贫血、黄疸和渐进性消瘦，严重时常引起死亡。
↑ ↓ ⟹
1
Q
Adenoviruses - envelope? - DNA or RNA? 基因组structure? -cause diseases?
A
- envelope: No - DNA or RNA? 基因组structure? dsDNA, linear - cause diseases: 1. sore throat 2. acute hemorrhagic cystitis 3. pneumonia 4. pink eye - conjunctivitis
2
Q
Ascaris lumbricoides 什么虫 Cx? transmission? Dx: Rx
A
蛔虫 - giant roundworm Ascaris lumbricoides 肠子里面开小轿车As(car)is，拉着大虫子，蛔虫 vs: (entero肠子，bius公车），肠子里面开bus，拉着一群小虫子[pinworm] Cx: intestinal infection transmission: fecal-oral Dx: eggs visible in feces under microscope Rx: bendazoles （albendazole, or mebendazole） or pyrantel pamoate 双羟萘酸噻嘧啶 - 和pinworm治疗是一样的
2
Q
Ancylostoma duodenale necator americanus 什么虫 Cx? transmission? Dx: Rx
A
钩虫属 Ancylostoma duodenale: 十二指肠钩虫 necator americanus: 美洲钩虫
3
Q
Aspergillus fumigatus: 特殊的形态？ cause which diseases? associated with? specific test? brain lesion 形态？
A
烟曲霉菌 特殊的形态： V-shaped at 45° angles 广泛存在，吸入肺里，由肺纤毛排出 cause which diseases: 1. Aspergillomas - NOT invade the lung tissue, but grow INSIDE old cavities formed by TB, CF or asthma -CXR: “radiopaque, shifts when pt changes position” 2. ABPA: wheezing, fever, migratory pulmonary infiltrates; in 5- 10% steroid-dependent asthmatics; ↑ serum IgE, eosinophilia, Ab against IgG+ IgE [考过诊断：哮喘病人，全血嗜酸性细胞↑， CXR见支气管扩张】 3. invasive aspergillosis - in immunosuppressed or neutropenic pts 肺部和肺外表现都多 associated with： hepatocellular carcinoma with the aflatoxins
4
Q
babesia： disease? Cx? transmission? Dx Rx
A
巴贝西虫 - “Captain Babesia”
5
Q
baby botulinum: Dx? Cause? Cx?
A
often due to honey consumption (12% honey samples contain botulinum spores). symptoms caused by toxin release into stool and in blood; toxin inhibits Ach release at neuromuscular junction Cx: 特征性neuromuscular paralysis; 其他症状包括weakness, reduced feeding, weakened suck, swallowing, etc; severe case： generalized muscle weakness + loss of head control “floppy baby” 注意与成人botulinum重要区别：成人case因为是直接吃入preformed toxin (typically from canned food), 都会非常严重；婴儿case可比较轻 Rx: ELISA and PCR for toxin
6
Q
Bacillus anthracis G? 下面的分类？ colonies? on microscope 致病因素？Mx (2nd messager) history Cx, -分类 -特征性病灶？ -扩散途径
A
炭疽杆菌 Large G+ rods; aerobic, form non-hemolyzing adherent colonies; on microscope: “serpentine” 蜿蜒的, or “medusa head” 致病因素: edema factor, - mimic the AC to ↑ cAMP history: contact with animal (extremely important) !!! Cx: 1.MC form is cutaneous anthrax; edematous wound with central necrosis - form black eschar sore: adj. 疼痛的，n. 溃疡 eschar [‘eskɑː] 痂; 焦痂（烧伤后的疮痂） 扩散途径： spread via lymphatics to the bloodstream, multiply in the blood and tissue 2. pulmonary anthrax accounts for 5%) : “wool sorters disease” - 接触动物皮毛病史 spore is very small - ingested by macrophage in the alveoli - move to mediastinal lymph nodes - cause hemorrhagic mediastinitis 肺炭疽的致病因素：anti-phagocytic capsule, unique in that it contains D-glutamate instead of polysaccharide Cx: myalgia, fever, malaise, - rapid progress to hemorrhagic mediastinitis (widened mediastimun on CXR), spetic shock and death
7
Q
bacterial vaccine对应的细菌： 1. heat-killed bac 2. bacterial outer membrane protein 3. capsular polysaccharide 4. inactivated toxin (toxoid) 5. live attenuated bacteria (LAB)
A
- Hk (香港)有很多PCP: heat-killed bacteria: Pertusiss (百日咳), Cholerae, Yersinia pestis (鼠疫） 2. bacterial outer membrane protein: Borrelia burdgorferi (包柔氏螺旋体， 引起Lyme disease) - 螺旋体螺旋起来水泼不进，只能target outer membrane protein 3. capsular polysaccharide: neiserria meningococca 4. inactivated toxin (IT): 搞IT的都是Day trader (diphtheriae, 白喉）， tetani 5. LAB里培养3个T: TB和伤寒(typhi), Francisella tularensis
7
Q
Bacillus cereus G? form spore or not? cause what syn 起病速度？
A
蜡样芽胞杆菌 Gram-positive rod, motile, beta hemolytic bacterium food poisoning 重要的致病源： “reheated rice syn” 起病速度很快，吃完rice or pasta之后几小时就恶心呕吐，由于”preformed toxin - cereulide”引起，所以发病这么快
8
Q
Bordetella pertussis G? 下面的分类？ 致病因素？Mx (2nd messenger) Cx, 引起什么疾病？
A
G- “coccoid” rods 致病因素: pertussis toxin: inhibit phagocytic ability Mx (2nd messenger): disable Gi - over reactivate AC - ↑ cAMP - impair phagocytosis Cx, 引起什么疾病: “Whooping cough”
8
Q
blastomycosis cause which disease? 流行区域 病理细胞和特征 diff
A
芽生菌病 dimorphic fungi: cause which disease: 肺炎，可以血行扩散到bone and skin； form granulomatous nodules in immunocompromised pts 免疫缺陷病人，出现慢性肺炎，肺部有肉芽肿，要考虑blastomycosis 流行区域: Missisippi, central America (和Histoplasmosis 组织胞浆菌病流行区域一样）/ found in soil 病理细胞和特征： 25 C - branching hyphae: large, round yeast, doubly refractive wall and single broad-base budding (BBB)
8
Q
bloody diarrhea, daycare outbreaks, pseudoappentitis: caused by?
A
Y. enteroclitica [Yersinia enterocolitica, 小肠结肠炎耶尔森氏菌 G分类: G- rods, lactose non-fermentor, oxidase - 通常来自于: pet feces
8
Q
bug hints: asplenic pts
A
外科切除脾脏，或者sickle cell anemia SHiN
9
Q
bug hints: branching rods in oral infection + sulfur granules
A
Actinomyces israelli
10
Q
bug hints: Currant jelly sputum 醋栗冻痰
A
Klebsiella
11
Q
bug hints: dog and cat bite
A
Pasteurella multocida 多杀巴斯德菌 出血败血性巴斯德氏菌 注意！！在美国被猫狗咬并不容易得狂犬病，而是容易得多杀巴斯德菌
11
Q
bug hints: organ transplant recipient
A
CMV
12
Q
bug hints: PAS +
A
Periodic acid–Schiff (PAS) Whipple disease
13
Q
bug hints: sepsis/meningitis in newborn
A
Group B strep
14
Q
C. perfringens致病机制？
A
产气荚膜杆菌 produce Lecithinase卵磷脂酶 (also known as “alpha toxin”, to degrade lecithin (component of cell phospholipid membranes) - lead to membrane destruction, necrosis and hemolysis
15
Q
Catalase+ organisms: 包括哪些？口诀
A
You need PLACESS for your cat (catalase 过氧化氢酶) catalase degrades H2O2 Pseudomonas Listeria Aspergillus Candid E. coli S. aureus Serratia 灵杆菌 考点是CGD (chronic granulomatous disease - NAPDH oxidase deficiency)
15
Q
Campylobacter jejuni: G? 下面的分类特点 cause which disease transmission from? 是什么疾病的前驱？
A
空肠弯曲杆菌 G-， comma shaped, oxidase+, grow at 42 C (“camp-fire”) cause which disease: MC of bloody diarrhea, especially in children fecal-oral transmission from food 是什么疾病的前驱 (考点）: 格林巴利，reactive arthritis (HLA-B27)
15
Q
Candida albicans: 特点？ local/superficial or systemic各自是那种免疫细胞削弱？ 引起什么病？各自怎么治疗？
A
白色念珠菌 - 典型的机会病原体，免疫削弱的病人 特点：dimorphic yeast [20 C: pseudohyphae 假菌丝 and budding yeast; 37C: germ tubes (真菌丝） - “念珠菌所具有产生胚芽管(germ tubes)的能力，可作为拟予确认的标志”】 superficial: deficient Th (especially Th1) - 艾滋病人中特别多见，杨芳都收过一个白色念珠菌性食管炎的病人 1. thrush in oral and esophageal in immunocompromised 2. diaper rash 3. vulvovaginitis 外阴阴道炎 [DM, use of antibiotics] [“cottage cheese” discharge] - 阴道酸性减弱 systemic: deficient in neutrophils 4. disseminated candidiasis 5. endocarditis in IV drug users （right-sided) 6. chronic mucocutaneous candidiasis 7. liver and kidney abcesses Rx: 1. oral/esophageal: fluconazole, caspofungin [卡泊芬净(Caspofungin)是第一个批准用于抗真菌的一线药物,也被称作棘白菌素.近来被FDA批准其用于治疗曲霉属真菌和念珠菌病的感染.] 2. vaginal: topic azole 3. systemic: amphotericin B, fluconazole, caspofungin,
17
cestodes
绦虫
18
Chagas disease - caused by?
Trypanosoma cruzi 客氏锥虫 流行于南美， transferred by "kissing bug", neurotoxin paralysed SMCs; cause secondary achalasia, megacolon, megaureter
19
Chlamydia (summary) intra- or extra- cellular? cell wall unusual in? forms? major types? lab Rx:
衣原体(Chlamydia)是一类专性细胞内寄生，有奇特发育周期，能通过细菌滤器的原核细胞性微生物。 intra- or extra- cellular：intracellular 【can't make ATP] cell wall unusual: lack muramic acid 胞壁酸 forms: 1. Elementary body 2. Reticulate body major types? 1. Chlamydia trachomatis 沙眼衣原体 - Reactive arthritis (Reiter syn), conjunctivitis, urethritis, PID 2. C. pneumoniae 肺炎衣原体, chlamydia psittaci 鹦鹉热衣原体: - atypical pneumonia, transmitted by aerosol 鹦鹉热衣原体 - avian reservoir lab: cytoplasmic inclusions on Giemsa or fluoresencet Ab-stained smear Rx: Azithromycin or doxycycline
19
chancroid pathogen
软性下疳 STD haemophilus ducreyi 杜克雷嗜血杆菌
20
Chlamydia trachomatis: G intra or extra- cellular 分型和常见疾病
沙眼衣原体 G - obligate intracellular 分型和常见疾病： 1. serotypes A - C: ocular infection (trachoma) in children 2. serotypes D - K: urogenital (STD) infection, inclusion conjuctivitis 3. serotypes L1 - L3: LGV (lymphogranuloma venereum 性病性淋巴肉芽肿) ; Rx with doxycycline 强力霉素
20
Clonorchis sinensis 什么虫 transmission Cx? Rx
华支睾吸虫 胆结石，胆管癌
21
Clostridia with exotoxins: 包括哪些？ G? do they form spore? 有氧还是无氧菌？
梭状芽胞杆菌 包括哪些： C. tetani, botulinum, perfringens, diffcile G+ do they form spore - yes "ATP" A: anthracis T: tetani （Clostridia 梭状芽胞杆菌） P: C. perfringens Clostridia 梭状芽胞杆菌） 有氧还是无氧菌: 严格无氧菌
22
Clostridium botulinum G? 下面的分类？ 致病因素？Mx Cx, 引起什么疾病？
G? 下面的分类： 致病因素：botulinum toxin Mx: (和破伤风杆菌毒素一样）：protease to cleave SNARE - inhibit neurotransmitter release Cx, 引起什么疾病: flaccid paralysis, floppy baby - inhibit stimulatory (Ach) signal
23
Clostridium difficile - colitis risk factors? Pathogenesis? Cx Dx Rx
risk factors: 1. recent antibiotics; 2. hospitalization; Pathogenesis: 2 toxins are produced: cytotoxin B: most important pathogenetic factor, causes colonic epithelial cell necrosis & fibrin deposition; Enterotoxin A causes watery diarrhea Cx: fever, abdominal pain, watery diarrhea + leukocytosis; 可出现fulminant colitis (toxic megacolon); 结肠镜检查有特征性"white/yellow pseudomembranes" Dx: PCR of toxin genes in the stool Rx: metronidazole, oral vancomycin, or fidaxomicin (bactericidal)
23
Clostridium perfringens 致病因素？Mx Cx, 引起什么疾病？
产气荚膜梭状芽胞杆菌 G+ Rods (bracilli) [MLCB之一】 致病因素？Mx - exotoxin (Alpha toxin) : phospholipase (lecithinase) degrades tissue and cell membranes Cx, 引起什么疾病？ - gas gangrene - double zone of hemolysis on blood agar - delayed watery diarrhea (caused not by toxin but spores germinating in the GI) - 当考到“水样腹泻”时和S. aureus, B. cereus的鉴别点！
24
Clostridium tetani: 致病因素？Mx Cx, 引起什么疾病？
致病因素：tetanospamin Mx: (和肉毒杆菌毒素一样）：protease to cleave SNARE - inhibit neurotransmitter (GABA, glycine) release from Renshaw cells in spinal cord bac cell lyse - release toxin to travel from wound - motor neurons - spinal cord and medulla Cx, 引起什么疾病: -"Lock jaw - trismus", -characteristic smile - risus sardonicus - backward arching - opisthotonos [,ɔpis'θɔtənəs] 角弓反张
25
Coccidiodomycosis cause which disease? 流行区域 病理细胞和特征 (和什么病鉴别）
Coccidiodomycosis 球孢子菌病 cause which disease: pneumonia, meningitis 流行区域: Southwestern US, CA [非常特别的一点：↑ after earthquakes - House里紧追house的一个加州小姑娘的case] 病理细胞和特征: - "thick-walled spherule filled with endospores" much larger than RBC 【diff: Histoplasma capsulatum 荚膜组织胞浆菌 - smaller than RBC; blastomycosis: same size as RBC Paracoccidioidomycosis: much larger than RBC]
27
conjugation: 2种方式？
1. F+ / F- 2. Hfr / F-
27
condylomata acuminata pathogen
尖锐湿疣 HPV-6, 11
28
Cryptococcus neoformans 特殊的形态? agar? 染色？ specific test? brain lesion 形态？
新型隐球菌 土壤中广泛存在,鸽子是自然宿主,培养呈酵母样,外有宽厚荚膜,经呼吸道感染,可引起隐球菌性肺炎和脑膜炎组图 特殊的形态： very thick capsules agar: Sabouraud agar 染色: India ink, mucicarmine 粘蛋白胭脂红 specific test: Latex 乳胶 agglutination test brain lesion 形态: "soap bubble"
29
cryptosporidium Cx Dx见？ prevention
隐孢子虫 人兽共患的寄生性原虫，主要寄生于人和动物的胃肠道，由其引起的疾病称为隐孢子虫病，该病的主要临床症状为持续性腹泻 Dx见：oocysts [无脊椎] 卵囊on acid-fast stain
29
CSF viral pattern
lymphocytic pleocytosis, normal glucose, elevated protein levels (e.g.: HSV-1脑炎）
30
Diphyllobothrium latum 什么虫 Cx? transmission? Rx
阔节裂头绦虫 (di, both = 2, phyllo= 头，2个头 = 阔节裂头) raw freshwater fish, ingest larvae 幼虫 VitB 12 deficiency!!!! Rx: Praziquantel 吡喹酮
31
DNA vs. RNA viral genomes: 1. ss or ds? 2. linear?
DNA: 1. all ds (except parvo is ss) 2. HHAPPPP viruses 3. linear (except PP are circular supercoiled - 屁股是圆的） 4. icosahedral 二十面体的 5. replicated in the nucleus (except pox) RNA: 1. all are ssRNA (except reovirus 呼肠病毒(一组抗醚性RNA病毒) 2. "I went to a retro toga party to drink flavored Corona and ate hippy California pickles"
32
Dx: 34-yr immigrant from Africa, skin anesthesia + hypo pigmentation ; bac. in Schwaan cells 病原体？哪种免疫？传染途径？Cx?
Dx: Leprosy (Hansen disease) 病原体：Mycobacterium leprae cell (Th1)-mediated immune response route: respiratory, maybe skin contact; armadillo contact in southwest US Cx: diffuse skin thickening, cutaneous hypo pigmentation in plaques (with hair loss), leonine face, paresis, regional anesthesia of both motor and sensory nerves
32
Dx: viral esophagitis + pneumocystis pneumonia 卡氏肺囊虫性肺炎 - pt很有可能什么感染？
HIV
33
E.coli 总领 G? virulence factor 4 types, 分别cause diseases?
G- rods, lactose fast fermenter (MacConkey agar) virulence factor: 1. fimbriae 菌毛；伞毛 - cystitis, pyelonephritis 2. K capsule - pneumonia, neonatal menigitis 3. LPS endotoxin - septic shock 4 types, 分别cause diseases? ITPH 1. EIEC: invasive dysentery 痢疾 2. ETEC: t = traveler's diarrhea 3. EPEC: p = pediatrics, 小儿腹泻 4. EHEC: h = hemolytic (HUS) O157: H7
33
EBV：又名 DNA or RNA v? disease? associated with transmission Dx
又名HPV-4 DNA or RNA v: HPV (herpes)都是ds DNA, linear disease: mononucleosis 单核细胞增多症 - infect B.c [fever, 颈后淋巴结肿大，肝脾肿大，咽炎】 associated with ↑ 1) Hodgkin lymphoma, 2) endemic Burkitt lymphoma,3) nasopharyngeal carcinoma transmission： respiratory -"kissing disease" Dx:
34
Echinococcus granulosus 什么虫 Cx? transmission? Rx
细粒棘球绦虫 tapeworm ingest eggs from dog feces Cx: liver cyst - 治疗非常特殊！先用酒精注入cysts
36
EHEC: G? 下面的分类？ 致病因素？Mx Cx, 引起什么疾病？
Enterohemorrhagic E. coli 肠出血性E.coli including O157: H7 strain G? 下面的分类: Gram-negative rod, lactose fast fermenter (MacConkey's agar fermenter) Mx: Shiga-like toxin (ST: aToxin) - inactivated 60S ribosome by removing adenine from rRNA [与白喉毒素的机制区别！！diphtheria toxin: inactivate EF-2] O157:H7 Shiga-like toxin-producing E.coli strains和别的E. Coli有2大区别： 1）do NOT ferment orbital -containing MacConkey agar, (different from other other ~ 80% E. coli strains) 2） do not produce glucuronidase Cx, 引起什么疾病： 1. enhance cytokine release to cause HUS （Cx: HUS is the MCC for ARF in children: diarrhea + hemolytic/anemia + oliguria/anuria) note: unlike Shigella: not invade host GI mucosa
36
ehrlichiosis pathogen vector involved immune cells/ 病理特征
埃立克体病(Ehrlichiosis)是由埃立克体感染引起的人畜共患的新发现传染病,通过蜱叮咬传播。主要表现为不明诱因发热、肌肉酸痛、恶心。 pathogen：Ehrilichia vector: tick involved immune cells/ 病理特征: monocytes with marolae (berry-like inclusion)
38
Encapsulated bacteria: 口诀 Why is capsule important? 这类细菌怎么清除？如果这个清除机制受损，怎么预防感染？
“SHiNE SKiS" Strep. pneumina H. influenza Neisseria menigitidis E. coli Salmonella Klebisiella pneunomia group B Strep Why is capsule important - capsule serve as anti-phagocytic virulence factor capsule + protein conjugate serves as Ag in vaccines 这类细菌怎么清除： opsonized, then cleared by spleen 如果这个清除机制受损，怎么预防感染: Asplenics have ↓ opsonizing ability; risk for severe infection; give S. pneumo + H.influ + N. menig vaccines
39
Endotoxin: define involve 炎性介质？作用？ Cx?
Endotoxin: LPS in outer mem of G- bac (both cocci and rods) involve 炎性介质: 1. activate macrophage: IL-1, TNF, NO 2. activate complement: C3a, C5a 3. activate tissue factor: DIC Cx: “ENDOTOXIN"
40
Entamoeba histolytica disease transmission Dx Rx
痢疾阿米巴 disease: Amebiasis 1.bloody diarrhea - dysentery 痢疾 2. liver abscess "anchovy paste" exudate 凤尾鱼汁样的渗液 3. RUQ pain transmission：cysts in water Dx: 1. serology and/or trophozoites with RBCs in the cytoplasm (阿米巴吞噬红细胞）， 2. or cysts in stool Rx: metronidazole 灭滴灵; iodoquinol for asymptomatic cyst passers
41
Enterobius vermicularis: 什么虫 Cx? transmission? Dx: Rx
pinworm 蛲虫 （nematodes - roundworm) (entero肠子，bius公车），肠子里面开bus，拉着一群小虫子[pinworm]，用阿苯达唑，两片 vs: Ascaris lumbricoides 肠子里面开小轿车As(car)is，拉着大虫子，蛔虫 Cx: 孩子肛门瘙痒，尤其是晚上 transmission：粪口 Dx: scotch tape test Rx: 一线药： bendazoles （albendazole, or mebendazole） or pyrantel pamoate 双羟萘酸噻嘧啶 in pregnant women
42
Enterococci (Group D Streptococcus ): G? 下面的分类？ Cx, 引起什么疾病 notes: VRE
G+ cocci, catalase - (chains), no-hemolysis; grow in bile and 6.5% NaCL 肠道正常菌群，penicillin G-resistant 引起什么疾病: - UTI 2. bilitary tract infection 3. subacute endocarditis [和Virindans strep引起的亚急性心内膜炎鉴别：后者常常是瓣膜已经有损伤！】 VRE: vancomycin-resistant, important cause of nosocomial infection
44
ETEC: G? 下面的分类？ 致病因素？Mx Cx, 引起什么疾病？
G? 下面的分类: Gram-negative rod, lactose fast fermenter (MacConkey's agar fermenter) Mx: LT vs. ST "traveler's diarrhea" - watery, self-limited, abdominal cramping, nausea, vomiting, possibly low fever in infants and poor countries bugs have to cololize in the small intestine, and subsequent ↑ the LT and/or ST enterotoxin (exotoxins) - both are plasmids encoded LT: similar to cholera toxin! (Gs- increase cAMP) ST: ↑ cGMP Fimbriea (pili) are responsible for bac adhesion to gut mocusoa
46
floppy baby syn - caused by?
Clostridia botulinum 肉毒杆菌 preformed, heat-labile toxin to inhibit Ach release at the neuromascular junction In adults: disease caused by ingestion of preformed toxin in babies: ingestion of SPORES in honey causes disease
48
foul-smelling discharge from vagina: differential?
1. Gardnerella vaginalis 阴道加德菌: caused by gram-variable rod; gray vaginal discharge, fishy smell, non-painful, NOT a STD; 特征性“clue cells: vaginal epithelial cells covered with bact. 显微镜下可见。 口诀："I don't have a clue why I smell fish in the vagina garden!" Rx: metro 2. Trichomonas vaginalis: 毛滴虫性阴道炎 foul-smelling, greenish discharge, STD, itching and burning; 性传播， Dx: trophozoites 滋养体(原虫) on wet mount Rx: metronidazole for patient and partner (prophylaxis)
49
genome of Coxsackie virus?
Picornaviridae family icosahedral nucleocapsid + ss RNA genome This RNA has 5' protein acting as the primer for RNA-dependent RNA pol
50
genome of HBV?
partially ds, circular DNA genome released into host cytoplasm and then enter into nuclei - repair the partially ds DNA - transcribe into mRNA - encapsulation - RT of RNA template into partially dsDNA - envelop required via budding into ER
50
Giardia lamblia disease buzz word Dx Rx
贾第鞭毛虫 bloating, flatulence, foul-smelling, fatty diarrhea ["fat-rich Giardia" chocolate] "campers/hikers" Dx: Trophozoites 滋养体 or cysts in stool (这2个要会看） Rx： metronidazole 灭滴灵；甲硝哒唑
51
Haemophilus influenzae: G? 传播途径 virulence factor / vaccine agar cause disease? Rx 预防
G- "cocciod" rods, small 传播途径: air virulence factor: capsular type B vaccine: capsular type B polysaccharide 【注意！这是多糖类疫苗】conjugated with a protein such as diphtheria toxoid agar: chocolate agar + factor NAD+ and factor X (hematin) cause disease: heEMOPhilus, NOT FLU! Rx: 1. muscosal: amoxicillin +/- clavulanate 克拉维酸 [做成一个药：诺可（NUOKE）每瓶装有500mg阿莫西林（Amoxicillin）和100mg克拉维酸(Clavulanate)无菌粉末】 2. meningitis: ceftriaxone 预防: rifampin in close contact
51
HAV： 哪种病毒 transmission carrier incubation HCC risk Notes
哪种病毒: RNA picronaviruses (微小病毒；肝炎病毒只有乙肝是DNA病毒！） transmission： 粪口（甲肝和戊肝） carrier- no incubation: short (wks) HCC risk: no Notes: AAA for HAV (asymptomatic), acute, alone
52
HBV： 哪种病毒 transmission carrier incubation HCC risk
哪种病毒: DNA hepadnavirus (微小病毒；肝炎病毒只有乙肝是DNA病毒！） transmission： - sexual - parenteral, - maternal-fetal carrier- yes incubation: long HCC risk: yes (嵌入宿主基因组，act on oncogenes)
53
HCV： 哪种病毒 transmission carrier incubation HCC risk note
哪种病毒：RNA flavivirus transmission: blood carrier: yes incubation: long HCC risk: yes notes: CCCC chronic, cirrhosis, carcinoma, carrier
54
HDV 哪种病毒 transmission carrier incubation HCC risk note
哪种病毒: RNA delta virus (HDV = delta, deficient, dependent on HBV) transmission: [same as HBV, 常常和乙肝一起感染] - sexual - parenteral, - maternal-fetal carrier: yes incubation： - after HBV: superinfection - 很短的incubation - co-infection with HBV: long (和乙肝的潜伏期一样） HCC risk： yes note: 和乙肝一起感染，预后差
55
Helicobacter pylori G分类？ 引起哪个部位溃疡？ risk factor for Dx Rx
G分类: G - rods, curved, 3个酶阳性: catalse +, oxidase +, urease + (诊断） 引起哪个部位溃疡： 十二指肠（不是胃溃疡！！！）年轻病人，空腹痛，PUD \>95% 是由幽门螺旋杆菌引起，5%由NSAID引起 cause alkaline environment (note: 不是酸性环境！！） risk factor for：gastritis, peptic ulcer, gastric adenocarcinoma, lymphoma Dx: urease breath test (13C-labeled urea) Rx: 3联疗法：proton pump inhibitor + clarithromycin 克拉霉素 + amoxicillian (or metronidazole) 其中最能provide long-term relief 是antibiotics
55
Herpadnaviruses - envelope? - DNA or RNA? 基因组structure? - 包括哪些？cause diseases? - 特点？
- envelope: yes - DNA or RNA? 基因组structure? DNA, partially DS, linear - 包括哪些？cause diseases? HBV - 特点：虽然不是retrovirus, 却有自己的RT酶
56
Histoplasmosis： cause which disease? 流行区域 病理细胞和特征
组织胞浆菌病 考过 Histoplasma capsulatum 荚膜组织胞浆菌： Cause pulmonary sym in only immunocompetent hosts - low grade fever, cough, hepatosplenomegaly, tongue ulcer 流行区域：Missisippi, Ohio river valleys, in birds/bats droppings (buzz words: "explore caves") 病理细胞和特征: macrophage filled with Histoplasma - 考点是一定要认出“石榴子样的巨噬细胞”
56
Herpesviruses - envelope? - DNA or RNA? 基因组structure? - 包括哪些？cause diseases?
疱疹病毒 - envelope: yes - DNA or RNA? 基因组structure: ds, linear - 包括哪些？cause diseases 1. HSV-1: oral, spontaneous temporal lobe encephalitis, 角膜结膜炎 2. HSV-2 : genital 3. VZV （= HSV-3) 4. EBV (= HSV-4) 5. CMV (= HSV-5) 6. HHV 6-8
56
HEV： 哪种病毒 transmission carrier incubation HCC risk note
哪种病毒: RNA hepevirus transmission: 粪口【肝炎病毒里甲肝和戊肝是粪口传播】 carrier : no incubation: short HCC risk: no note: high mortality in pregnant women
56
HIV :encephalopathy caused by
encephalopathy caused by 以前感染的病毒激活
57
HIV Dx: 1. CD4+ normal range? Dx for AIDS 2. Rule-out/in tests? FP in? FN in? 3. which test to determine to viral load? viral load can monitor?
1. CD4+ normal range: 500 - 1500 CD4+/mm3 Dx for AIDS: \< 200 2. Rule-out test： ELISA Rule-in test：WB both FP in: neonates born to infected mother (anti-gp120 透过胎盘） FN in： 感染的头1 - 2个月（针对病毒的抗体还没出来） 3. which test to determine to viral load? viral load can monitor? - PCR， monitor drug therapy
58
HIV: chronic, watery diarrhea caused by Dx
chronic, watery diarrhea caused by cryptosporidium spp. 隐孢子虫 人兽共患的寄生性原虫，主要寄生于人和动物的胃肠道，由其引起的疾病称为隐孢子虫病，该病的主要临床症状为持续性腹泻 (chronic, water diarrhea in AIDs vs. non-immunocompromised) Dx见：oocysts [无脊椎] 卵囊on acid-fast stain
58
HIV: brain abbesses caused by
Toxoplasma gondii
58
HIV: dementia caused by
dementia: directly associated with HIV 要把其他病因排除
59
HIV: genome and structure proteins how many structural genes, encode which protein? which protein is responsible for - attachment to host cells - fusion and entry capsid protein virus binds to which Rs on CD4+ Tc? on macrophage?
how many structural genes, encode which protein? 3 1. env: gp160 precursor cut into gp120 (docking protein on mem.; responsible for attachment) and gp41 (fusion) 2. gag: p24 caspid protein 3. pol: RTase, asparte protease, integrase which protein is responsible for - attachment to host cells: gp120 - fusion and entry: gp41 capsid protein: p24 virus binds to which Rs on CD4+ Tc： CCR5 (early) or CXCR4 (late) co-R with CD4+ on macrophage: CCR5 + CD4 CCR5非常重要！-/- mutation = immunity; +/- mutation = slower course
60
HIV: hairy leukoplakia caused by
[口腔] 毛状白斑 hairy leukoplakia caused by EBV
61
HIV: stages of untreated infection
Four stages of untreated infection
61
HIV: superficial vascular proliferation caused by biopsy
HIV: superficial vascular proliferation caused by: Bartonella hensae biopsy: neutrophilic inflam
62
HSV-1: DNA or RNA v? disease? transmission Dx
HPV (herpes)都是ds DNA, linear 1. oral \> genital 【HSV-1考小孩的口唇炎，年轻人的颞叶脑炎多，HSV-2考年轻人的生殖器疱疹多】 - gingivostomatitis - herpes labialis 口唇疱疹 2. keratoconjunctivitis 3. MCC for sporadic encephalitis in US!!!! - temporal lobe 是特征性的 （aphasia, olfactory hullicination, personality change; CSF viral pattern: lymphocytic pleocytosis, normal glucose, elevated protein levels 【考点】 note: latent in trigeminal ganglia transmission: respiratory, saliva Dx: 1. skin/genitalia: 1) viral culture; 2) Tzanck - smear of skin: "multinucleate giant cells" HSV1-, HSV-2都可以 2. CSF: PCR 3. Cowdry A inclusion
62
HIV： meningitis caused by detect
meningitis caused by cryptococcus neoformans detection: India ink , CD4+ \< 50
62
HIV：retinitis caused by detect
HIV：retinitis caused by CMV detect: Cotton-wool spots
62
HIV：non-Hodgkin lymphoma caused by 分型 location
EBV
63
HSV-2: DNA or RNA v? disease? transmission Dx Rx
HPV (herpes)都是ds DNA, linear disease: 1. Herpes genitalis 【latent in sacral ganalia] 2. neonatal herpes transmission: 1. sexual contact 2. perinatally Dx: 1. skin/genitalia: 1) viral culture; 2) Tzanck - smear of skin: "multinucleate giant cells" HSV1-, HSV-2都可以 2. CSF: PCR 3. Cowdry A inclusion Rx: nucleoside analogs (acyclovir - incorporated into new DNA chain and terminate chain synthesis )
65
In HIV pt: headache, confusion, inflammatory CSF- MC Dx?
Cryptococcus neoformans
65
Influenza viruses: 哪种病毒？ 2种重要蛋白质 disease: 哪2种mutation，各导致什么流行 vaccine分类
哪种病毒 - 正粘液，enveloped, ss- RNA v, with 8 segments 2种重要蛋白质： 1. hemagglutinin: viral entry 2. neuraminidase 神经氨酸苷酶：progeny release disease: 哪2种mutation，各导致什么流行: 流感 + risk for fatal bac. superinfection 1. Genetic shift = "Sudden Shift" - more deadly 全部基因组重组，Hrf, 引起全球大流行 2 Genetic drift = "graDual drift" minor Ag changes - random mutation vaccine分类: 1. killed viral - 最常用的 2. live attenuated - 经鼻腔
67
Klebsiella: G 什么地方的正常菌群 在什么人群中易感 cause what? sputum buzz words
encapsulated G- rods, lactose fast fermenter (MacKonkey agar: pink-colored mucoid类黏蛋白 colonies) thick capsule 什么地方的正常菌群: intestinal 在什么人群中易感: alcoholics, 昏迷病人等 cause what： 1. aspiration pneumonia (upper lobar) 2. nosocomial UTIs sputum buzz words: "red currant jelly" 醋栗冻果酱状
69
Lactose fermentors: 包括哪些 以什么agar鉴别
G- bac: KcEEs Klebsiella, Citrobacter 枸橼酸杆菌属 E. coli [特别：b-galactosidase to break down lactose to galactose and glucose; 在EMB上是purple colony + green sheen] Enterobacter Serratia 沙雷氏菌属 1. MacConKEE's agar: + ： pink colony 2. EMB agar: +: purple/black note: E. coli 在EMB上是purple colony + green sheen]
71
Legionella pneumophila: G 特殊stain grow culture condition lab 检测方法？对血钠影响？ CXR 传播途径？有无接触传染 Rx 引起2个疾病
G- rods, facultative intracellular； 医源性肺炎最要病原体 特殊stain: silver grow culture condition：charcoal yeast extract + iron + cysteine 半胱氨酸 "A french legionnaire with silver helmet sits around a campfire (charcoal) with iron dagger - sissy" lab 检测方法: detect Ag in urine； 痰培养见很多neutrophils, 但是没有细菌 CXR：unilobar infiltrate that progresses to consolidation 对血钠影响: hyponatremia 传播途径: 水源孵育，空气传播 [AC, hot water tanks] 有无接触传染: no Rx: macrolide or quinolone 喹诺酮 引起2个疾病： 1. severe: Legionnaire's disease = severe pneumonia, CNS, GI， fever [systemic infection; 如果病人有最近接触水源病史（比如坐游轮） -【一定要会诊断这个病】 2. mild: Pontiac fever
73
Leishmania donovani cause? transmission? Dx? Rx?
杜氏利什曼原虫 cause "Kala-azar"- 黑热病（热带脾大）， visceral leishmaniasis: spiking fevers, hepatosplenomegaly, pancytopenia transmitted by sandfly Dx: macrophages containing amastigotes Rx: sodium stibogluconate 葡萄糖酸锑钠
74
Leishmania donovani 引起什么病？ Cx? transmission? Dx: 特征细胞 Rx
利什曼[原]虫属, 肠道感染 引起什么病- 黑热病 （kala-azar) ,内脏利什曼病,热带脾大 Cx： spiking fever, 肝脾肿大，pancytopenia transmission: sandfly Dx ：macrophages contain amastigote 无鞭毛体,无鞭毛型 Rx: sodium stibogluconate 葡萄糖酸锑钠
75
Coccidioides immitis 存在形式？ 流行地区？ 传播途径 Cx RX
粗球孢子菌,粗球类芽生菌 存在形式： dimorphic fungus: 1) mold form (hyphae [`haifi:]〔单hypha〕菌丝) at 25 - 30 C, 2) endospore form (containing endospores - 对于孢子菌非常特异）at bood T (37 - 40 C) 流行地区： Southern and central CA, AZ, NM, western TX, central and south America 传播途径： spore inhalation to lung, spore turn into spherules which rupture to release endospores, 然后弥散到其他器官 Cx: flu-like lung sym, + erythema nodosum Rx: Amphotericin B, Itraconazole
76
Leprosy (Hansen disease): G? Cx特征 Reservoir in US 2 forms? 是否有传染性？immune cells involved? Rx
G+ mycobacterium leprae, acid-fast Cx特征: "glove and stocking" loss of sensation Reservoir in US: armadillos 犰狳 2 forms: 1. lepromatous [lə'prɔmətəs] 麻风结节的 （severe form) 有传染性 low cell-mediated immunity, + humoral Th2 response (所以症状厉害） 2. Tuberculoid 类似结节的 high cell-mediated immunity, + large Th1 response： 因为免疫反应强，所以感染者症状比较轻 Rx: 联合抗菌
77
Leptospira interrogans cause? Cx found where? 在哪些地方流行？ severe form?
肾脏钩端螺旋体 cause: Leptospirosis 细螺旋体病 Cx: flu-like syn, jaundice, photophobia with conjunctival suffusion found where: water contaminated with animal urine 在哪些地方流行: surfers and in tropics severe form: Weil disease [icterohemorrhagic 出血性黄疸的]
78
Corynebacterium diphtheriae: G? 致病因素？Mx 本来不致病的毒株，用什么机制变得致病？ 传播途径 Cx: - buzz word - target organs? 人群？ Rx:
白喉杆菌 G+ rod 致病因素: diphtheria toxin [ADP ribosylating A-B toxin: B (= binding) component binds to host cell receptor to enable endocytosis; A (= active) component attaches ADP-ribosyl to disrupt hot cell proteins Mx: inactivated EF-2 本来不致病的毒株，用什么机制变得致病： phage-mediated Tox gene incorporating into the bac genome ("lysogenization") 传播途径： respiratory droplets Cx: pharyngitis with pseudomembranes in throat, severe lymphadenopathy (bull neck) target organs: neural and cardiac tissues 人群: “eastern European"
78
loa loa 什么虫 Cx? transmission? Dx: Rx
罗阿丝虫, 眼丝虫 是一种引起罗阿罗阿丝虫病的寄生虫，分布于非洲和印度的热带地区。 主要临床表现是局部暂时性肿胀，常发生在腕部和踝部。成虫常移行于眼睑，潜行于眼结膜、角膜下，引起严重的结膜炎症、眼球水肿等症状，使感染者出现眼部奇痒、异物感。 Rx: diethylcarbamazine 乙胺嗪
79
Lyme disease: 病原体？ 传播途径 natural reservoir 在哪些地方流行 Cx: initial / later sym Rx buzz word
病原体: Borrelia burgforferi 博氏疏螺旋体 传播途径: tick Ixode 硬蜱属 natural reservoir: mice 在哪些地方流行: northeastern US (New Hemisphere, etc， 通常考camping等有可能被tick bite的活动 Cx: - initial: erythema chronicum migrans 慢性游走性红斑 [buzz word: "bulls eye"]， flu-like, +/- facial nerve palsy - later sym:erythema chronicum migrans, migratory polyarthrits, cardiac, CNS Rx: doxycycline 强力霉素, ceftriaxone 头孢曲松钠 (考点；诊断明确后治疗很容易）
80
Measles: 哪种病毒？ Cx sequalae prevention
paramyxovirus 副粘液 具包膜之RNA病毒，人類為唯一的宿主 Cx: 3Cs of measles: cough, coryaz 鼻炎 進入前驅期，此時會出現一些呼吸道的症狀：如高燒、咳嗽、結膜炎、鼻炎(所謂3C：cough、conjunctivitis、coryza)並持續2~4天，口腔內頰側黏膜上出現柯氏斑點(Koplik spots)。之後即為出疹期，於耳後開始出現斑丘疹,再擴散至整個臉面，然後向下移至軀幹和四肢，並持續4-7日。皮疹之間還會有融合現象，之後發燒漸漸退去,皮疹會出現鱗屑性脫皮及留下褐色沉著。 sequalae： 麻疹之所以受到重視，主要因其會引發嚴重的併發症 - SSPE - encephalitis - giant cell pneumonia prevention: VitA (for exfoliative dermatitis)
81
meningitis Common cause in: 1. 0- 6 m 2. 6 m - 6 yrs 3. 6- 60 yr 4. \> 60 empirically use? If suspect Listeria, add?
1. 0- 6 m: Group B strep; E.coli [也是新生儿肺炎最常见的病原体】 2. 6 m - 6 yrs： S. pneumonia, etc empirically use: cefriaxone + vanco If suspect Listeria, add: ampi
81
meningitis: CSF findings in bac, fungi/TB, viral,
If sugar normal: viral
82
Mononucleosis: detect by which test? if negative, which virus? if positive, which virus?
Mononucleosis: detect by which test: Monospot test (heterophil Ab, e.g.: agglutinate sheep/horse RBC) if negative, which virus: CMV if positive, which virus: EBV
83
MRSA resistant to ? antibiotics? Mechanism?
MRSA resistant to all beta-lactam antibiotics (oxacillin, nafcillin, methicillin) Mechanism: these S. aureus strain has altered penicillin binding protein in its peptidoglycan cell wall that does not bind beta-lactam effectively
84
Mucor and Rhizopus spp. 传播途径？ 形态 Cause what? 好发人群？ Rx
抟霉菌属, 酒曲箘属 毛霉菌病(Mucormycosis)是一种危及生命的侵袭性真菌感染.其通常发生在糖尿病患者、器官或造血干细胞移植受体、中性粒细胞减少症患者及恶性肿瘤患者中. 传播途径：proliferate in blood stream with excess glucose and ketone - penetrate cribriform plate 筛状板 , enter into brain 形成frontal lobe abcesses 形态: irregular, broad, nonseptate hyphen branching at wide angles (这一点和黄曲霉区别，后者45度角） DM 酮症酸中毒、白血病多发 Rx: amphotericin B
85
Mumps 哪种病毒？ Cx
流行性腮腺炎, 和measles 同属副粘液病毒 Cx: Mumps makes your parotid glands as testes as big as POM-poms Parotitis, Orchitis 睾丸炎 Meningitis (如果在青春期后发生，可导致不育）
86
Mycobacteria: FA讲到3 大类，是哪3类？各引起什么疾病？ virulence factors?
分枝杆菌全部抗酸 1. TB: fever, night sweat, weight loss, hemoptysis 2. M. kansassi 堪萨斯分枝杆菌：引起肺部类似结核症状 3. M. avium: intracellular ! 在AIDS病人中引起disseminated 散播性的 non-TB disease; 耐药性强； AIDS pts要预防性使用azithromycin virulence factors: 1. cord factor: inhibit macrophage maturation, induce release of TNFa 2. Sulfatides 脑硫脂: inhibit phagolysosomal fusion
87
Naegleria fowleri disease transmission Dx Rx
福式阿米巴， brain-eating amebas disease: rapidly fatal meningoencephaltitis transmission: swimming in freshwater lakes, enter from cribriform plate Dx: amoebas in spinal fluids Rx: Amphotericin in a few
88
Naked viral genome infectivity
有传染性：naked dsDNA, + ssRNA 无传染性：naked dsRNA, - ssRNA
89
Naked viruses include?
Give PAPP smears and CPR to naked Heppy DNA viruses = PAPP RNA viruses = CPR and hepevirus 肝炎病毒
90
negative-stranded viruses: 包括哪些？
负链RNA病毒都自带干粮：Always Bring Polymerase Or Fail Replication
92
Neisseria gonorrhoeae： Gram? 形态？culture with which medium? 引起的常见疾病？Rx？复发
Gram? 形态？： gram-neg, diplococci culture with which medium: "selective" (contain vancomycin + colistin + nystatin) 1. 引起PID (常和chlamydia trachomatis）一起， 2. UTI Rx: 一定要同时治疗衣原体（Azithromycin or doxycycline) + 淋球菌 （3rd generation cephalosporin), 否则会复发 复发的原因： N. Gonorrhoeae can modify their outer membrane by "antigenic variation"
93
Neisseria: G? 产生一个特征性酶（对削弱宿主防御有重要作用） which medium to isolate Neisseria from clinical specimens? 2大bug对比： 1. ferment which sugar 2. 有无capsule 3. 有无vaccine? 4. 传播途径？ 5. cause what disease? 6. 预防和治疗
G- diplocci 产生一个特征性酶（对削弱宿主防御有重要作用: IgA protease which medium to isolate Neisseria from clinical samples: "Thayer-Martin medium" containing 1) vancomycin (kill G+), 2) colistin 粘菌素 (i.e., polymyxin) to kill G- bac except for Neisseria; 3) nystatin 制霉菌素 to kill yeast, 4) trimethoprim 甲氧苄氨嘧啶 to kill Proteus
94
Nosocomial infections: 1st and 2nd leading cause
E. coli (UTI, 留置导管） S. aureus - wound infection
95
Nosocomial infections: if hyperalimentation 静脉输入营养液（尤指对无法通过消化道摄取食物的病人所进行的）
Candida albicans
96
Nosocomial infections: in newborns nursery
CMV, RSV
97
Nosocomial infections: water vs. air -borne
water: Legionella Air: Pseudomonas aeruginosa
98
Novobiocin: which bac is sensitive to it? / resistant?
[,nəuvə'baiəsin] 新生霉素 which bac is sensitive to it: Staphylococci. epidermidis 表皮葡萄球菌 resistant： Staphylococci saprophyticus "On the office's staph retreat, there was NO StRESS [SR; ES]
99
onchocerca volvulus 什么虫 Cx? transmission? Dx: Rx
盘尾丝虫 蟠尾絲蟲症主要發生在西非河川沿岸，是全球僅次於沙眼、可造成失明之第二大感染症。 許多沿河村落的居民陸續失明，因此又稱河川盲、河盲症（River blindness）。
101
Optochin: 奥普托欣 which bac is sensitive to it? / resistant?
which bac is sensitive to Optochin: Strep. pneumonia 肺炎葡萄球菌 resistant to Optochin：Strep. viridans 草绿色链球菌 "OVeR-PsAA"
102
osteomyelitis: 好发人群？ location MC bug
好发人群: children, esp. boys location: long bones MC bug - S. aureus
103
owl's eye - which pathogen? its character?
CMV : enveloped ds, linear DNA virus
104
papillomavirus - envelope? - DNA or RNA? 基因组structure? -cause diseases?
乳头瘤病毒 - envelope: no - DNA or RNA? 基因组structure: dsDNA, linear -cause diseases 1. HPV 1, 2, 6, 11: warts 2. HPV 16, 18: CIN, cervical cancer [vaccine available]
106
Paracoccidioidomycosis cause which disease? 流行区域 病理细胞和特征
南美芽生菌病 [Captain's wheel in latin America; 海盗船长在拉美出没】 cause which disease: 粘膜和表皮溃疡，可以progress to lymph nodes and lungs 流行区域: Latin America 病理细胞和特征 : budding yeast, "Captain wheel" much larger than RBC]
107
parvovirus - envelope? - DNA or RNA? 基因组structure? -cause diseases?
细小病毒(Parvovirus)是一类无囊膜单链DNA病毒,因病毒粒子较小而得名。 - envelope: no - DNA or RNA? 基因组structure: ss and linear -cause diseases: 1. B19 - aplastic anemia in sickle cell disease 3. RBC apasia and RA-like in adults 3. fifth disease ("slapped cheeks") 4. hydrops fetalis 胎儿水肿
109
pathogen for subacute endocarditis?
Viradans Streptococci stick to the damaged valve by making glycocyxle; also the normal flora in mouse (live in the mouse because not afraid of-the-chin - Optochin resistant: 与 S. pneumonia区分）
110
pathogenesis of Corynebacterium diphtheriae?
exotoxin AB, which inactivate the host EF-2 elongation factor to inhibit intracellular protein ribosylation; non-pathogenic strains can acquire pathogenicity by phage conversion permitting exotoxin production. Phage Corynephage beta infects a host bacteria and integrate its Tox gene into the host genome (lysogenization". Cx: 咽喉假膜, grayish pharyngeal exudate; enlarged lymph, soft palate paralysis
112
Penicillin bugs: 哪些 why?
G- bacilli, their out men layer inhibit entry of peni. G and vancomycin may be susceptible to peni-derivatives such as Amp and amoxicillin
113
pertussis
百日咳
114
PID (pelvic inflammatory disease) MC bugs? Cx associated sym, its unique patho Rx特点？ 复发的原因？ Most serious permanent damage?
MC bugs: 1. chlamydia trachomatis 沙眼衣原体 - subacute 2. Neisseria gonorrhoeae - acute Cx: cervical motion tenderness (触痛，压痛), cervical purulent discharge, associated sym, its unique patho: "Fitz-Hugh-Curtis sym" - infection of liver capsule; "violin string" Rx特点： 一定要同时治疗衣原体（Azithromycin or doxycycline) + 淋球菌 （3rd generation cephalosporin), 否则会复发 复发的原因： N. Gonorrhoeae can modify their outer membrane by "antigenic variation" Most serious permanent damage: infertility
115
Plasmodium: P. vivax/ovale P. falciparum P. malariae transmission Dx Rx
malaria 疟疾, 血液传播原虫病 - Plasmodium. malariae(马），发音三声，三日虐 - P.falciparum (fatal) 最厉害，日日虐 【入脑】 - P.vivax 二日虐，要用amazon的prime（primaquine)，2日邮寄到达， 火速寄来的还是肝脏里面dormant 的hypnozoite 休眠子 transmission：蚊子 Dx： 1. 血涂片见trophozoite ring form 环状体（Ring form） 此期被寄生的红细胞尚无改变。疟原虫的细胞质呈环状，红色的核为点状，在环的一边，很象一个宝石戒指。环状体的大小约占红细胞直径的l/3~l/4左右。 2. RBC schizont 裂殖体 with merozoites 裂体性孢子 Rx 1. 最先用chloroquine 氯喹（疟疾特效药的一种）- block Plasmodium heme polymerase 2. if resistant: use mefloquine 甲氟喹 3. if life-threatening: quinidine [note: test for G6PD 1st) 4. Vivax: add primaquine 伯氨喹, 杀 hypnozoite
116
Pneumocystis
肺囊虫
117
Pneumocystis jirovecii 好发人群？ 传播途径？ stain, 形态 Cause what? Dx Rx
卡氏肺囊虫性肺炎 (PCP) 好发人群: immunosuppressed (AIDS) 传播途径: inhaled stain, 形态: disc-shaped yeast forms on methenamine [乌洛托品；六亚甲基四胺] silver stain of lung tissue Cause what: diffused, bilateral CXR apperaance Dx: lung biopsy or lavage Rx: TMP-SMX, pentamidine 戊烷脒 [于1941年发现，用于治疗 布氏冈比亚锥虫昏睡病的第一阶段。尽管有不可忽 视的不良作用，但病人一般能很好地耐受。] for Prophylaxis: dapsone, atovaquone 阿托伐醌
118
Pneumonia: Common cause in: 1. \< 4 wks 2. 4 wks - 18 yrs 3. 18- 40 yr 4. 40 - 65 5. elderly
1. \< 4 wks: Group B strep; E.coli [也是新生儿脑膜炎最常见的病原体】 2. 4 wks - 18 yrs: RSV, Mycoplasma, C. trachomatis 【Chlamydia trachomatis， 沙眼衣原体】 3. 18- 40 yr： Mycoplasma， C. pneumonia 肺炎衣原体（Chlamydia pneumonia), S. pneumonia 4. 40 - 65 : 5. elderly
119
polyomavirus - envelope? - DNA or RNA? 基因组structure? -cause diseases?
多瘤病毒 - envelope: no - DNA or RNA? 基因组structure: dsDNA and circular -cause diseases： JC: PML in HIV BK: target kidney in transplant pts
120
Pott's disease?
veterbral TB, hematogenous seeding from lungs
121
poxvirus - envelope? - DNA or RNA? 基因组structure? -包括哪些？cause diseases?
痘病毒 - envelope： yes - DNA or RNA? 基因组structure: dsDNA, linear (largest DNA virus) -包括哪些？cause diseases 1. smallpox 天花 2. cowpox 牛痘(Cowpox)疫苗可以预防天花病毒(smallpox) 主要是因为天花和牛痘具有相同抗原, 3. molluscum contagiosum:
121
Prions: cause disease by types: 1. sporadic - its Dx 2. inherited 3. acquired
cause disease by PrPc (alpha-helical) to PrPsc (beta-pleated) types: 1. sporadic - Creutzfeldt-Jakob syn [↑ 14-3-3 in CSF] 2. inherited - Gerstmann-Straussler-Scheinker syn 3. acquired - kuru
123
pseudomonas aeruginosa G? 下面的分类？ 致病因素？Mx 传播途径
绿脓杆菌；绿脓假单胞菌 Gram-negative, oxidase +, non-lactose fermenting (MacConkey's agar nonfermenter), motile rods that produce pigment. 致病因素/Mx: Exotoxin A (A= active); inactivate EF-2 Cx: host cell death - “hot tub folliculitis”, superficial and self-limited; P. aeruginosa infection of the hair follicles, minor outbreaks following exposure to a pool or a spa 传播途径: water culture of pustule (脓）： Gram-negative, oxidase +, non-lactose fermenting, motile rods that produce pigment. papulopustular:丘疹脓疱性的
125
Q fever: pathogen vector Cx
pathogen: Coxiella burnetii 伯纳特氏立克次氏体; Q热立克次体，是人和动物Q热的病原体，为革兰氏染色阴性的严格胞内寄生菌。 vector：no arthropod vector!!!!! but spores can be release from tick feces and cattle placenta Cx: 叫做Q热，但是不发热！表现为肺炎
126
Rabies: 形状 特性性结构 被感染的细胞 潜伏期 怎么进入CNS postexposure Rx type of vaccine, /哪种免疫 病程 US得病是被什么bite?
杆状病毒 (Rhabdovirus, ss- RNA) 形状： rod 特性性结构: "Negri bodies" -buzz 被感染的细胞: Cerebellar Purkinje cells, hippo neurons 潜伏期: long, wks to months 怎么进入CNS: bind to acetylcholine receptors, retrograde in axons postexposure Rx: wound cleansing + vaccination +/- rabies immune globulin type of vaccine: killed/ passive immunity的典型例子 病程: non-specific, flu-like sym , 然后出现急性神经症状, 再后出现全身性软瘫和昏迷。 fever, malaise - photo and hydrophobia - hydrophobia (喉头肌肉强直），paralysis, coma -death US得病是被什么bite: bats, skunk, racoon （考点是有caves等接触史，30 - 50天后起病）
127
Red rashes of childhood: if "slapped cheek" - cause what
5th disease (感染性红斑） - House里Cuddy第一个要领养的孩子，母亲就发生了腕部红斑 cause hydrops fetalis in pregnant women
128
Red rashes of childhood: if appears on trunk, then to face and extremities [和rubeola, rubella相反】
chickenpox, VZV
129
Red rashes of childhood: if begin at head, move down；先发生cough, coryaza, conjuctivtis,
Measles (3C)
130
Red rashes of childhood: if over body, appear AFTER several days of high fever
Roseola (HHV-6) 玫瑰疹
131
Red rashes of childhood: if rash begins at head, move down; fine truncal rash, 耳后淋巴结肿大
Rubella [和麻疹鉴别】
132
Red rashes of childhood: if rash on palms and soles
hand-foot-mouth disease (Coxaskie)
133
Red rashes of childhood: if sand-paper like rash + sore throat
scarlet fever, by S. pyogenes
133
Rheumatic fever (RF): pathogen 病理基础 Cx long-term sequelae
pathogen： GAS (Strep. pyogenes = group A strep; G+ cocci, catalos -, beta-hemolysis, bactracin sensitive) 病理基础: antigenic similarity between bacterial Ag and "self" Ag in heart and CNS - formation of anti-self Ab Cx: - acute phase: throat pain, fever and malaise, swollen cervical lymph nodes (pharyngitis), arthritis, subcutaneous nodules, characteristic rash (erythema marginatum); note: 在急性风湿热之前还可能先出现猩红热：scarlet fever: 首先发咽喉炎，几天后出现躯干的游走性红斑，压的时候会变白（blance with pressure), 1-2mm papules; gray-white tonsillar 扁桃体 exudates, tongue is bright red long-term sequelae: Sydenham chorea, myocarditis (insufficiency of the mitral or aortic valves)
135
Rocky mountain spotting fever pathogen、细胞内细胞外? why? vector 流行地区 Cx Rx
pathogen、细胞内细胞外? why? - Rickettsia richettsii, obligated intracelluar: can't make ATP, need CoA and NAD+ from host cells [贱到不行的一个病！】 vector: tick 流行地区：NC等south Atlantic states, despite its name [贱到不行的一个病！】 Cx: triad: rash (vasculits), headache, fever 【diff: palms and soles rash seen: - 手口足病（Coxsackievirus) - 落基山斑点热 - secondary syphilis Rx: doxycycline
137
Rotavirus: 哪种病毒？ disease
segmented dsRNA (a reovirus) MC of infantile diarrhea in daycare 大量腹泻导致↓ Na+, ↓ K+
139
rubella
风疹： 通常为一种良性的急性传染病，由披膜病毒(Togavirus)引起，最常侵害儿童和未免疫的年轻人。病毒通过飞沫进入呼吸道，并传播至淋巴系统。本病的表现为轻度畏寒、咽喉炎、发热，继之耳后、枕下和颈淋巴结肿大，并出现首先见于头部并波及全身的细小粉红色皮疹。妊娠头三个月母体感染引起的经胎盘胎儿感染，可使孕体死亡或使新生儿发生严重发育异常 特征：maculopapular rashes 斑丘疹 spreading from head and neck downward, generalized lymphadenopathy (particular post auricular and occipital); sequalae in adult women: polyarthritis, polyarthralgia fetal infection in the 1st trimester：deafness, cataracts, cardiac malformations with PDA
140
Rx for all rickettsial disease and vector-bone illness
doxycycline 立克次体（Rickettsia），或者称立克次氏体是一类细菌，但许多特征和病毒一样，如不能在培养基上培养，可以通过瓷濾器过滤，只能在动物细胞内寄生繁殖等。直径只有0.3-1μm，小于绝大多数细菌。立克次体有细胞形态，除恙虫病立克次体外，细胞壁含有细菌特有的肽聚糖[1]。细胞壁为双层结构，其中脂类含量高于一般细菌，无鞭毛。同时有DNA和RNA两种核酸，但没有核仁及核膜，属于适应了寄生生活的α-变形菌。革兰染色呈阴性，效果不明显。立克次体取名是为了纪念美国病理学家霍華德·泰勒·立克次（Howard Taylor Ricketts，1871年2月9日 - 1910年5月3日），立克次在芝加哥大学工作期间发现了落磯山斑點熱和鼠型斑疹伤寒的病原体（立克次体）和传播方式，由于工作原因，他自己也死于斑疹伤寒。他所发现的病原体被命名为立克次体属。
142
S. aureus: G? 下面的分类？ 致病因素？Mx Cx, 引起什么疾病
G? 下面的分类: G+ cocci, catalase + (cluster), coagulase + [引起beta hemolysis - clear area on blood agar] 致病因素？Mx -1. Protein A is the virulence factor: bind Fc-IgG 2. ”exotoxin" released by S. aureus 1) TSST (super -Ag, binds to MHC II and Tc Receptor; - toxic shock syn; 例如用tampon) 2) scalded syn 3) gastroenteritis 引起什么疾病: 1. inflammation [小孩的骨髓炎，flu之后几天继发的肺炎】 2. S. aureus food poisoning [特点是起病时间短，吃了cook不熟的食物或者sala，2-6小时内就出现恶心、呕吐； 起病时间快是因为preformed enteretoxin] 2. Toxic shock syn, scalded skin syn 3. MRSA - 成因是altered penicillin-binding protein
143
Salmonella vs. Shigella G flagella how to spread animal reserviors produce hydrogen sulfide? antibiotics对病原菌从粪便的排出有什么作用？ cause response of which cell when invading GI mucosa? bloody diarrhea? forment lactose? buzz word for typhi buzz word for Shigella
G- rods, lactose non-fermenter (white colony on MacConkey) buzz word for typhi: "rose spots", "travel to 亚非拉“ buzz word for Shigella：mucosal invasion, robust host inflammation by neutrophils
145
scabies: Cx: 由什么病原体引起？ 传染途径？ 几型超敏反应？ Dx: skin scraping from excoriated lesion that shows mites, ova, and feces under light microscope
疥疮，疥螨病：一种由疥螨引起的人、野生动物及家畜(见mange)的接触性皮炎。疥螨由密切接触而传播，其特征为皮肤上形成小丘疹，及由雌螨在表皮浅层(角质层)掘沟而产生的隆起的纡曲皮下通道(疥隧)，伴有剧痒，有时可因搔抓而致湿疹和继发细菌感染 sarcoptes scabiei 疥螨 mite: 螨 Cx: rapidly spreading, pruritic rash with erythematous papules and excoriation [eksˌkɔ:ri`eiʃn] 表皮脱落 on the extremities; 夜晚瘙痒更严重 传染途径：person-to-person contact 几型超敏反应： type IV
146
Schistomsoma 什么虫 host/transmission Cx? transmission? Rx
裂体吸虫属, 血吸虫属 flukes host: snail transmission: cercariae 无尾尾蚴 Cx: liver/spleen granulomas, fibrosis, inflammation; SCC of the bladder Rx: Praziquantel 吡喹酮
147
segmented viruses: 包括哪些？
BOAR All are RNA viruses
149
serratia
灵杆菌,粘质沙雷(氏)菌
150
Shigella spp. G? 下面的分类？ 致病因素？Mx 传播途径 Cx, 引起什么疾病？
志贺氏菌 G? 下面的分类: Gram-negative rod, non-lactose fermenting (MacConkey's agar nonfermenter), oxidase - (One of "PuSSY") 致病因素？Mx: Shiga toxin (ST: aToxin) - inactivated 60S ribosome by removing adenine from rRNA 传播途径 Cx, 引起什么疾病： 1. invade host GI mucosa - dysentery ['dɪs(ə)nt(ə)rɪ] 痢疾 2. enhance cytokine release to cause HUS （Cx: HUS is the MCC for ARF in children: diarrhea + hemolytic/anemia + oliguria/anuria)
151
Spirochetes: 3大类 哪一种可以染色、用显微镜观察？ 别的用什么特殊显微镜？
3大类： 1. Borrelia 包柔氏螺旋体属, 疏螺旋体属 (Big) 2. Leptospira 钩端螺旋体属,细螺旋体属 3. Treponema 密螺旋体属,梅毒螺旋体 哪一种可以染色、用显微镜观察: Borrelia 别的用什么特殊显微镜: dark-field
153
spores: have what in the core？ Which G+ bac can form spores other spore formers include
have what in the core: dipicolinic acid 吡啶二羧酸 芽胞含有丰富的吡啶二羧酸(dipicolinic acid,DPA),是造成芽胞具有高度耐热性的主要因素之一 Which G+ bac can form spores: "ATP" A: anthracis T: tetani （Clostridia 梭状芽胞杆菌） P: C. perfringens Clostridia 梭状芽胞杆菌） other spore formers include: - B. cereus 蜡样芽胞杆菌 - C. botulinum 肉毒杆菌 - Coxiella burnetii 俗称Q热立克次体，是人和动物Q热的病原体，为革兰氏染色阴性的严格胞内寄生菌
155
sporothrix schenckii
申克孢子丝菌
157
sporotrichosis
孢子丝菌病（rose gardeners' disease), caused by Sporothrix schenckii 申氏孢子菌 dimorphic , cigar-shaped budding yeast; 沿着“throne prick"刺破的皮肤里沿淋巴管扩散，形成皮下红色的nodules or ulcers Dx: culture the affected area and isolate Sporothrix schenskii
158
Staphylococcus epidermidis
G? 下面的分类: G+ cocci, catalse + clusters, coagulase -, novobiocin (新生霉素) sensitive normal skin flora 致病因素？Mx: infect prothetic devices and catheters by forming biofilm
159
Staphylococcus saprophyticus: G catalase +/- 以下分类？ 对 哪种抗生素sensitive or resistant? 常见引起的疾病
腐生性葡萄球菌 G: + catalase: + 以下分类: coagulase - 对novobiocin sensitive： 新生霉素：主要对葡萄球菌和其他革兰阳性菌有效 常见引起的疾病： UTI
161
Strep. pyogenes G? 下面的分类？ 致病因素？Mx Cx, 引起什么疾病
化脓性链球菌 G? 下面的分类： G+, oxidase -, beta-hemolysis, group A 致病因素: streptolysin O [,streptə'laisin] 链球菌溶血素 (exotoxin) Mx: degrade cell mem, lyse RBC (这就是beta-hemolysis的机制）； 要点：ASO used to Dx RA!!! Cx, 引起什么疾病: 1. Acute RA!! Ag on group A. Strep ("M protein) activate B and T cells - auto reactive against self-Ag in the heart and CNS -细菌抗原与自身抗原的相似性引起autoimmune 2. Toxic shock syn 预防与治疗：penicillin (考了无数遍）
163
Streptococcus agalactiae (Group B strep): G? 下面的分类？ Cx, 引起什么疾病 notes
无乳链球菌 G? 下面的分类？ G+ cocci, catalase - (chains), beta-hemolysis; resistant to bacterin Cx, 引起什么疾病: - colonize vagina, 在经阴道分娩的婴儿中引起pneumonia, meningitis, sepsis (MCC in neonatal)，如果产妇+， 必须给penicllin预防！ notes: Group B for babies!
165
streptococcus pyogenes G catalase +/- 以下分类？ 对 哪种抗生素sensitive 常见引起的疾病
化脓性链球菌, G + catalase - 以下分类: catalase - 对 哪种抗生素sensitive: bacitracin 杆菌肽 常见引起的疾病： minor skin infection (impetigo 脓疱病：由于A簇链球菌或金黄色酿脓葡萄球菌直接侵入表皮磨损部或受损的皮肤而致的一种接触感染性化脓性皮肤病). 后续引起Rheumatic fever, APSGN (acute post-strep glomerulonephritis)
166
Streptococus pneumonia引起？
MOPS (meningitis, otitis media, sinusintis, pneumonia) "Mostly are Optochin -Sensitive"
167
Strongyloids stercoralis 什么虫 Cx? transmission? Dx: Rx
粪类原线虫 伊佛霉素(Ivermectin): 驱虫保健类抗生素, 主要用于防治猪的胃肠道线虫病和疥螨病。
168
Superantigens causing shock? 哪些细菌的哪些毒素？ which cytokines play major roles?
1. S. aureus : TSST-1 2. S. pyogenes: Exotoxin A which cytokines play major roles： IL-2 and INFg
169
Syphilis: 病原体 分期和特点 Dx Rx
病原体: spirochete Tremonema pallidum [用什么特殊显微镜: dark-field] 分期和特点 1. 一期：local, painless chancre 2. 二期：systemic 3. 三期：慢性，或者神经梅毒 [累及dorsal roots (薄束+楔束）, 4. 先天性：必须治疗母亲，1st trimester之后通过胎盘 Dx： VDRL / RPR (non-specific); FTA-ABS: confirmatory Rx: Penicillin G
171
systemic mycoses： all cause? 存在形态 Rx Diff
系统性真菌病（mycosis 的复数） vs. cutaneous mycoses HBCP: - Histoplasmosis 组织胞浆菌病 - Blastomycosis 芽生菌病 - Coccidiodomycosis 球孢子菌病 - Paracoccidiodomycosis 副球孢子菌病（Paracoccidioidomycosis）又名南美（巴西）芽生菌病 [Captain's wheel in latin America; 海盗船长在拉美出没】 all cause: pneumonia, can be disseminate 存在形态： dimorphic fungi (20C = mold; 37C = yeast) - ONLY exception: Coccidiodomycosis [spherule, not yeast in tissue] Rx: 1. local infection: fluconazole, itraconazole 依曲康唑 2. systemic: amphotericin B Diff: systemic象TB, but no person-person transmission
172
Taenia solium 什么虫 Cx? transmission? Rx
猪肉绦虫 tapeworm 1. ingest larvae 幼虫 encysted in undercooked pork: intestinal infection 2. injest eggs: - cysticercosis [,sistisə'kəusis] 囊尾幼虫病 - neurocysticercosis 脑囊虫病 Rx: Praziquantel 吡喹酮
173
tinea versicolor pathogen: Cx Mx 流行区域 病理特征 Rx
cutaneous mycoses 皮肤真菌病（vs. systemic) pathogen: 糠疹馬拉色氏真菌(Malassezia furfur)造成花斑癬(又稱汗斑). Cx: hypo- and/or hyper-pigmented patches Mx: degrade lipids - produce acid to damage melanocytes 流行区域: hot, humid weather 病理特征: "spaghetti and meatball" Rx: - topical miconazole 咪康唑；霉康唑, - selenium sulfide (Selsun) 硫化硒
176
Toxacara canis
犬弓蛔虫 犬蛔虫症主要是人类误食到或触摸到犬蛔虫的卵所导致的感染，感染严重者可以致命
177
Toxoplasma gondii disease lab transmission Dx Rx
刚地弓形虫, CNS protozoa infection 1. Brain abscess in HIV “ring-enhancing lesions” on CT/contrast MRI; If patients also show oral thrush and lymphadenopathy - HIV-associated toxoplasmosis; seizures are a common complication of such brain lesions 2. congenital toxoplasmosis: classic triad 1) chorioretinitis 脉络膜视网膜炎 2) hydrocephalus 3) intracranial calcifications [孕检时脑部有钙化】 transmission： 猫粪cysts; 透过胎盘 Dx： serology, biopsy Rx: sulfadiazine 磺胺嘧啶 + pyrimethamine乙胺嘧啶 treatment: Sulfadiazine(磺胺嘧啶）黄忠 + pyrimethamine (乙嘧啶）乙（如弓） 黄忠用弓箭 射靶心（ring-enhancing） 射箭时要用眼睛（chorioretinitis）+戴着钙化的头盔（intracranial calcifications) + 压肿了头颅（hydrocephalus)
178
Transformation: define? which bac can use this mechanism to gain pathogenicity?
Transformation: define- take up naked DNA which bac can use this mechanism to gain pathogenicity? "SHiN" S. pneumonia H.influenza Neisseria
179
transposition: define 方式 哪些细菌用这种方式获得致病性
define：由phage在细菌间传播chromosome DNA 方式: 1. generalized - "packaging" 2. specialized: - "excision" 哪些细菌用这种方式获得致病性: ABCDE - ShigA-like toxin - Botulinum - Cholera - Diphtheria - Erythrogenic toxin of S. pyogenes 化脓性链球菌
180
transposition: gene transferred from what to what? Example
gene transferred from what to what: between plasmids and chr Example: antibiotic resistance genes on R plasmid
181
Treponema pallidum: G detected by? 常见引起的疾病
苍白螺旋体，引起梅毒 G+， very thin wall (无法用一般显微镜识别） detected by： 1） ulcer exudate microscopy with darkfield illumination - if can be done immediately after collection 2) 梅毒诊断一般靠serologic testing: - screen: VDRL, RPR; - confirm: FTA-ABS, MHA-TP
182
trypanosoma
锥虫 T. cruzi: 克氏锥虫 - 引起Chaga's disease, 多发于南美，dilated cardiomyopathy, megacolon, megaesophagus, "kissing bug"- painless kiss; Dx: blood smear; Rx: nifurtimox
183
Trypanosoma brucei, T. gambiense T. rhodesiene disease transmission Dx Rx
锥虫 brucei (不如适，不舒服）困，african sleeping sickness Tsetse fly, 疼死 fly（锥子），才能叫醒 治疗：suramin 苏醒吧 [note: 不要和T. cruzi - 引起南美巨结肠的病原体搞混了！！！ brucei = (不如适，不舒服）困】 disease: African sleeping sickness Cx: enlarged lymph nodes, recurring fever (Ag variation), somnolence, coma transmission: tsetse fly 采采蝇 Dx: blood smear Rx: 1. suramin 苏拉明 2. melarsoprol -昏睡病 第二阶段的治疗： 美拉胂醇（Melarsoprol）：于1949年发现，用于两种类型 的感染。该药由砷衍生，有多种不良副作用。
184
Trypanosoma cruzi (注意不是T. Brucei; 各引起什么病）？ Cx? transmission? Dx Rx
Chaga's disease. 南美巨结肠 【Trypanosoma brucei (不如适，不舒服）困，african sleeping sickness； 别记混了！！！】 Cx：扩张性心肌病 transmission： Dx Rx： 硝呋噻氧[抗锥虫药] 汤姆克鲁斯，去南美洲，路上要加油（chagas），大豪车，大人物，用大管子（ megacolon结肠管子，megaesophagus食管管子），大油泵（cardiomyopathy心泵）加油 （大大大） Reduviid bug (kissing bug) 汤姆克鲁斯（大红人），帅哥，到处kiss treatment：Nifurtimox 你ni，furti未来，mix（max） 嫁给明星了，你的未来max
185
typhus pathogen and vector 流行地区 Cx Rx
斑疹伤寒症 pathogen/vector: 1. endemic: 地方性的: Rickettsia typhi 伤寒立克次体： fleas 2. epidemic 流行的: human body louse 虱子: R. prowazekii 普氏立克次体 流行地区 Cx Rx 立克次体（Rickettsia），或者称立克次氏体是一类细菌，但许多特征和病毒一样，如不能在培养基上培养，可以通过瓷濾器过滤，只能在动物细胞内寄生繁殖等。直径只有0.3-1μm，小于绝大多数细菌。立克次体有细胞形态，除恙虫病立克次体外，细胞壁含有细菌特有的肽聚糖[1]。细胞壁为双层结构，其中脂类含量高于一般细菌，无鞭毛。同时有DNA和RNA两种核酸，但没有核仁及核膜，属于适应了寄生生活的α-变形菌。革兰染色呈阴性，效果不明显。立克次体取名是为了纪念美国病理学家霍華德·泰勒·立克次（Howard Taylor Ricketts，1871年2月9日 - 1910年5月3日），立克次在芝加哥大学工作期间发现了落磯山斑點熱和鼠型斑疹伤寒的病原体（立克次体）和传播方式，由于工作原因，他自己也死于斑疹伤寒。他所发现的病原体被命名为立克次体属。
186
UTIs: 膀胱炎和肾盂肾炎的鉴别 Dx markers for bac UTI? for G- bac. UTI MCC? MCC in dwelling catheter? MCC for acute hemorrhagic cystitis in children Rx
膀胱炎和肾盂肾炎的鉴别： 膀胱炎: WBC in urine, but no casts! (没有经过肾小管） Dx markers for bac UTI： leukocyte esterase test + for G- bac. UTI: nitrite test + MCC: E.coli (\>80%) MCC in dwelling catheter: Pseudomonas MCC for acute hemorrhagic cystitis in children: adenovirus Rx: 3-d fluoroquiolone, or TMP-SMX
187
vaginal infection: 分哪3类 各自的signs, sym, 特征性finding 阴道pH Rx
1. 细菌性（阴道加德菌）：No inflammation! [这和其他阴道感染不一样]!!! clue cells, fishy odor, thin-white charges; Rx: metrozidazole， pH \> 4.5 2. 沙眼衣原体：grey-green, foul-smell; motile trichomonads, pH \> 4.5; Rx: metrozidazole, also treat partner 3. 念珠菌性：thick "cottage-cheese", 假菌丝， pH normal; Rx: azole,
188
ToRCHeS: define Cx
母婴之间的感染，一般是通过胎盘 Toxo Rubella CMV HIV Herpes (HSV-2) Syphilis Cx: 非特异性症状有肝脾肿大，黄疸，全血细胞减少，生长迟缓
189
VDRL false +: detect what? false + seen
detect non-specific Ab that reacts with beef cardiolipin 心磷脂 false + seen
190
Vibro cholerae G? 下面的分类？ 致病因素？Mx (2nd messenger) Cx, 引起什么疾病？
G? 下面的分类？: G- comma shaped, oxidase+; grow in alkaline media 致病因素？Mx: cholera toxin: permanently activate Gs - to ↑ cAMP Cx, 引起什么疾病: "rice-water" diarrhea
191
viral genetics: reassortment: define, examples
segmented genomes exchange genomes: 大规模地重组, cause "genetic shift" e.g.: 1. influenza virus (属于orthomyxoviruses) 全球大流行， 2. rotavirus (#1 cause for daycare diarrhea)
192
viral vaccines: 哪几种？各自包括哪些病毒疫苗？各自激起什么免疫反应？
1. live attenuated： - both humoral + cell-mediated immunity "Live! See small yellow chickens get vaccinated with Sabin's and MMR! It's incredible" measles 麻疹 mumps: 腮腺炎 rubella: 风疹 [MMR = 马先锋（麻腺风）】 2. killed: RIP Always humoral immunity only 3. recombinant: HBV, HPV
193
Viridans group streptococci: G? 下面的分类？ Cx, 引起什么疾病 notes
G? 下面的分类: G+ cocci, catalase - (chains), alpha-hemolysis: 这大类包括S. pneuomonia and S. viridans, 区别在于 Viridans are resistant to Optochin 奥普托欣 Cx, 引起什么疾病: - dental caries - subacute endocarditis at damaged valves notes: 1. can produce dextrans from sucrose; dextrans facilitate bac. to adhere to fibrin - form "valvular vegetation"
194
VZV: 又名 DNA or RNA v? disease? transmission Dx Rx
VZV: varicella 水痘 - Zoster 带状疱疹 virus - varicella 水痘 (小孩时候）又名chickenpox - zoster ( 带状疱疹， 一般是成人）：shingles DNA or RNA v: HPV (herpes)都是ds DNA, linear disease: 1. in children: chickenpox, 高度传染性，fever, malaise, pharyngitis, generalized vesicular and pruritic rash; 水泡在起病后6天内连续见于面部、躯干然后四肢。一般将来不会再得水痘 （第一次得了水痘之后就有circulating Ab)，但是可能得带状疱疹 - 打水痘疫苗预防 2。 in adults: 多见于老人和免疫削弱的人，是潜伏在DRG or trigeminal gangalia, 中的病毒"reactivation", 很容易复发 - 躯干不超过中线、按体节分布的水泡 (shingles) - encephalitis - pneumonia - MC complication of shingles: post-herpetic neuralgia transmission: respirotary Dx: anti-varicella IgG (IgG 要病毒感染超过10天以上才开始出现）表明是VZV复发 Rx
195
Waterhouse-Friderichsen syndrome (WFS, what-the-fuck sym)
Acute primary adrenal insufficiency due to hemorrhage of adrenal glands associated with bacterial meningococcus infection (i.e., Neiserria meningitides). Waterhouse–Friderichsen syndrome (WFS) or hemorrhagic adrenalitis or Fulminant meningococcemia, is defined as adrenal gland failure due to bleeding into the adrenal glands, caused by severe bacterial infection (most commonly the meningococcus Neisseria meningitidis). The bacterial infection leads to massive hemorrhage into one or (usually) both adrenal glands.It is characterized by overwhelming bacterial infection meningococcemia leading to massive blood invasion, organ failure, coma, low blood pressure and shock, disseminated intravascular coagulation (DIC) with widespread purpura, rapidly developing adrenocortical insufficiency and death. Treatment: Benzylpenicillin was once the drug of choice with chloramphenicol as a good alternative in allergic patients. Ceftriaxone is an antibiotic commonly employed today. Hydrocortisone can sometimes reverse the hypoadrenal shock. Sometimes plastic surgery and grafting is needed to deal with tissue necrosis
196
Which bacteria grow on blood, MacConkey, and EMB (eosin methylene blue) agar to form green metallic sheen?
E. coli EMB agar is a selective and differential medium used to identify enteric pathogens that ferment lactose to bind to dye in the agar and produce colonies with the distinct green metallic sheen
197
Woolsorter's disease: wool worker, flu-like sym, rapidly progress into fever, pulmonary hemorrhage, mediastinitus and shock: Dx?
Pulmonary anthrax - inhale spores
198
Wuchereria bancrofti
斑氏线虫,班(克罗夫特)氏吴策线虫 致淋巴管炎 Rx: diethylcarbamazine 乙胺嗪
199
Yersinia enterocolitica G分类？ 通常来自于？ diff
小肠结肠炎耶尔森氏菌 G分类: G- rods, lactose non-fermentor, oxidase - 通常来自于: pet feces diff: Crohn disease, appendicitis
200
Amoxicillin, Ampicillin 氨苄青霉素 [和Pen G, V是一类】
Mx，和什么联用可以增加抗菌谱
Use
Toxicity
Mx for resistance
