Microbiology Flashcards
1
Q
What is the toxic component of LPS?
A
Lipid A
2
Q
What does the pilus/fimbria do and give an example
A
Mediates adherence of bacteria to cell surface as in meningococcus colonizing the pharyngeal surface
3
Q
Bacteria with unusual cell membranes/walls
A
Mycoplasma - membrane contains sterols, no cell wall. Mycobacteria - contain mycolic acid, high lipid content
4
Q
Bugs that do not gram stain well
A
These Rascals May Microscopically Lack Color. Treponema, Rickettsia, Mycobacteria, Mycoplasma, Legionella, Chlamydia
5
Q
Stain for legionella
A
Silver stain
6
Q
Organisms seen with giemsa stain
A
Borrelia, plasmodium, trypanosomes, chlamydia
7
Q
Organisms seen with PAS stain
A
Stains glycogen and mucopolysaccharides. Use to diagnose Whipples disease
8
Q
Organisms seen with silver stain
A
Fungi and legionella
9
Q
Culture requirements of h flu
A
Chocolate agar. Factor V (NAD) and Factor X (hematin). If grown with staph they will provide the needed NAD
10
Q
Culture requirements of n gonorrhoeae
A
Thayer-Martin (VPN). Vancomycin, Polymyxin, Nystatin. Or Vanco, Colistin, Nystatin, Trimethoprim
11
Q
Culture requirements of b pertussis
A
Bordet-Gengou (potato) agar
12
Q
Culture requirements of c diphtheriae
A
Tellurite plate, Lofflers media
13
Q
Culture requirements of m tb
A
Lowenstein-Jensen agar
14
Q
Culture requirements of m pneumoniae
A
Eatons agar
15
Q
Culture requirements of lactose-fermenting enterics
A
Will be pink on MacConkey. E coli also grown on Eosin-Methylene Blue (EMB) and will be green with metallic sheen
16
Q
Culture requirements of legionella
A
Charcoal yeast extract agar buffered with cysteine and iron
17
Q
Culture requirements of fungi
A
Sabourauds agar
18
Q
What is another name for polymixin?
A
Colistin
19
Q
What allows e coli to spread hematogenously and cause meningitis?
A
K-1 capsule
20
Q
Encapsulated bacteria (6)
A
Strep pneumo, H flu type b, N meningitidis, Salmonella, Klebsiella, group B strep
21
Q
What vaccines should you give an asplenic patient?
A
S pneumo, H flu, N meningitidis
22
Q
Test of choice for encapsulated bacteria
A
Quellung (will see capsular swelling)
23
Q
Catalase-positive organisms (5)
A
S aureus, Serratia, Pseudomonas, Candida, E coli
24
Q
What is the antigen in the N meningitidis vaccine?
A
Capsular polysaccharide
25
Urease positive bugs (8)
Proteus, Ureaplasma, Nocardia, Cryptococcus, H pylori, Klebsiella, Staph saprophyticus, Staph epidermis
26
Protein A virulence factor
Staph aureus. Binds Fc of Ig. Prevents opsonization and phagocytosis
27
IgA protease
Cleaves IgA. Secreted by s. pneumoniae, h flu type b, and neisseria
28
M protein
Group A streptococcus. Helps prevent phagocytosis
29
Where are exotoxin and endotoxin genes respectively located?
Exotoxins - plasmid or bacteriophage, endotoxin - bacterial chromosome (remember that endotoxins are part of bacterial wall, thus part of bacteria themselves. Similarly the gene is in with bacterial genes)
30
Heat stability of exotoxins and endotoxins respectively
Exotoxins destroyed rapidly at 60 C (except staph enterotoxin), endotoxins stable at 100 C for 1 hour
31
Diseases caused by exotoxins and endotoxins respectively
Exotoxins - tetanus, botulism, diphtheria. Endotoxins - meningococcemia, gram negative sepsis
32
Diphtheria toxin
Inactivates EF-2 and thus inhibits protein synthesis
33
Exotoxin A
Pseudomonas. Inactivates EF-2 (like diphtheriae toxin) and thus inhibits protein synthesis
34
Shiga Toxin
Shigella. Inactivates 60S ribosome by cleaving rRNA (like EHEC toxin). Causes GI mucosal damage and triggers HUS
35
Shiga-like Toxin
EHEC (including O157H7). Inactivates 60S ribosome by cleaving rRNA. Enhances cytokine release, causes HUS but EHEC does not invade host cells (unlike shigella)
36
What are the properties of EHEC in culture?
Does not ferment sorbitol, does not produce glucuronidase
37
Heat-labile (cholera-like) toxin
ETEC. Overactivates adenylate cyclase increasing Cl secretion. Watery diarrhea.
38
Heat-stable diarrhea
ETEC and Yersinia enterocolitica. Overactivates guanylate cyclase. Decreases reabsorption of NaCl and water in gut. Watery diarrhea in ETEC, bloody in y entocolitica (invades)
39
Edema factor
Bacillus anthracis. Mimics adenylate cyclase (similar to pertussis toxin). Black eschar of cutaneous anthrax
40
Cholera toxin
Vibrio cholerae. Overactivates adenylate cyclase by permanently activating Gs. Increased Cl secretion. Rice-water diarrhea
41
Pertussis toxin
Bordatella pertussis. Overactivates adenylate cyclase by disabling Gi. Impairs phagocytosis.
42
Tetanospasmin
Clostridium tetani. Cleaves SNARE (required for NT release). Prevents release of inhibitory NTs in spinal cord (GABA and glycine). Rigidity and lockjaw
43
Botulinum toxin
Clostridium botulinum. Cleaves SNARE (required for NT release). Prevents stimulatory (Ach) signals at neuromuscular junction. Flaccid paralysis
44
Botulinum toxin
Clostridium botulinum. Cleaves SNARE (required for NT release). Prevents stimulatory (Ach) signals at neuromuscular junction. Flaccid paralysis
45
Alpha toxin
Clostridium perfringens. A phospholipase that degrades tissue and cell membranes. Causes gas gangrene and hemolysis
46
Streptolysin O
Strep pyogenes. Protein that degrades cell membranes. Lyses RBCs (beta hemolysis). Use ASO in diagnosis of rheumatic fever
47
Exotoxin A
Strep pyogenes. Superantigen (MHC 2 and TCR linking). Toxic shock syndrome
48
Toxic shock syndrome toxin (TSST-1)
Staph aureus. Superantigen (MHC 2 and TCR linking). Toxic shock syndrome
49
Transformation (including bacteria capable of it)
Ability to take up DNA from environment. Strep pneumo, h flu type b, neisseria
50
Conjugation
F+ to F- (plasmid DNA only) or Hfr to F- (plasmid and chromosomal genes)
51
Transposition
Transfer of genes between plasmids or between chromosome and plasmid. Plasmid DNA may then move between bacteria
52
Generalized transduction
Lytic phage infection with accidental packing of bacterial chromosome into viral capsid. Viral transfer
53
Specialized transduction
Lysogenic phage incorporates and takes bacterial DNA with it when it excises
54
What toxins are encoded in lysogenic phages (specialized transduction)?
Shiga-like toxin, Botulinum toxin, Cholera toxin, Diphtheria toxin, Erythrogenic toxin of strep pyogenes
55
Branching gram positive bacteria and what separates them
Actinomyces (anaerobe and not acid fast), Nocardia (aerobe, acid fast)
56
Catalase positive and negative gram positive cocci
Positive - Staph (clusters), Negative - Strep (chains)
57
Coagulase positive, catalase positive gram positive cocci
S aureus (beta hemolytic)
58
Coagulase negative, catalase positive, gram positive cocci
Novobiocin sensitive - staph epidermis, novobiocin resistant - staph saprophyticus
59
What do staph epidermis tend to infect?
Teflon coated surfaces (due to biofilm formation) such as IVs and other artifical surfaces
60
Alpha hemolytic catalase negative gram positive cocci
Optochin sensitive - strep pneumo (bile soluble - does not grow in bile). Optochin resistant - Viridans strep (eg strep mutans, insuluble in bile)
61
Beta hemolytic catalase negative gram positive cocci
Group A (Bacitracin sensitive) - Strep pyogenes (impetigo). Group B (bacitracin resistant) - Strep agalactiae
62
Gamma hemolytic catalase negative gram positive cocci
Enterococci (e faecalis) - grow in 6.5 pct NaCl and bile. Nonentercocci (strep bovis) - grow in bile but not 6.5 pct NaCl
63
Gram positive mnemonics
Staph (novobiocin) - On offices STAPH retreat there was NO StRES. Strep (optochin) - OVRPS. Strep (bacitracin) - B-BRAS
64
Hemolysis of listeria monocytogenes
Beta
65
What is the most common site of staph aureus colonization?
Anterior nares
66
What is strep pneumo the most common cause of?
Meningitis, Otitis media in children, Pneumonia, Sinusitis
67
Color of sputum in strep pneumo infection
Rust colored
68
Strep viridans infections
Dental caries (strep mutans), subacute bacterial endocarditis of damaged valves (strep sanguis)
69
What infection precipitates rheumatic fever?
Group A strep (strep pyogenes)
70
What is done to prevent group B strep infection in newborns?
Pregnant women screened at 35-37 weeks. Positive patients receive intrapartum penicillin
71
What do enterococci cause?
UTI and subacute endocarditis. Are normal colonic flora. Are penicillin G resistant
72
Strep bovis
Normal gut bacteria. Can cause bacteremia and subacute endocarditis in colon cancer patients
73
Gram positive rods with metachromatic (blue and red) granules and Elek test for toxin
Cornyebacterium diptheriae
74
Gram positive rods with metachromatic (blue and red) granules and Elek test for toxin
Cornyebacterium diptheriae
75
What is seen in diphtheriae pharyngitis
Grayish-white pseudomembrane and lymphadenopathy
76
What is needed to prevent clostridium tetani infection and what is the implication of this?
IgG. Breastmilk will not cut it. Vaccinate early
77
Path tetanospasmin travels
Wound to motor neuron axon to spinal cord
78
Toxin A and Toxin B
C difficile. A (enterotoxin) - binds brush border of gut. B (cytotoxin) - destroys enterocyte cytoskeleton, causing pseudomembranous colitis
79
How do you diagnose C difficile colitis?
Detection of Toxin A and/or B in the stool
80
Cause and treatment of C difficile
Commonly caused by clindamycin or ampicillin. Treat with metronidazole or oral vanco
81
What is given to prevent neonatal tetanus?
A maternal vaccine during pregnancy
82
Only bacterium with a polypeptide capsule (contains D-glutamate)
Bacillus anthracis
83
Fever, pulmonary hemorrhage, mediastinitis, shock
Pulmonary anthrax
84
Microscopy of anthrax infection
Long chains (medussa head appearance)
85
People in what profession are susceptible to anthrax infection?
Woolsorters
86
Culture appearance of listeria monocytogenes
Narrow zone of beta hemolysis on sheep blood agar
87
Where does listeria monocytogenes live?
Facultative intracellular
88
Amnioitis, septicemia, and spontaneous abortion. Or granulomatosis infantiseptic. Or neonatal meningitis. Or meningitis in immunocompromise. Or mild gastroenteritis (healthy adult)
Listeria
89
Treatment for listeria
Usually self-limited. Ampicillin in infants and immunocompromised
90
Treatment for branching gram positive rods
SNAP. Sulfa for Nocardia, Actinomyces use Penicillin
91
Prophylactic treatment for MAIC in AIDS patients
Azithromycin
92
Fevers, weight loss, weakness, hepatosplenomegaly
MAI
93
Treatment for leprosy
Dapsone (toxicity is hemolysis and methemoglobinemia)
94
Outcomes of leprosy
Lepromatous (Th2 response), tuberculoid (Th1 response)
95
Gram negative cocci
Maltose fermenter - N meningitidis. Maltose nonfermenter - N gonorrhoeae
96
Gram negative coccoid rods
H flu, pasteurella, brucella, bordatella pertussis
97
Gram negative comma shaped (oxidase positive)
Grows at 42 C - campylobacter jejuni. Grows in alkaline media - vibriocholerae
98
Gram negative lactose fermenting rods
Fast fermenters - klebsiella, e coli, enterobacter. Slow fermenters - citrobacter, serratia, others
99
Gram negative non lactose fermenting rods
Oxidase negative - shigella (no H2S production), salmonella and proteus (H2S production). Oxidase positive - pseudomonas
100
Why dont you get lasting imunity from gonoccocal infection?
Due to rapid antigenic variation of pilus proteins (which is also why we dont have a vaccine)
101
What does meningococcus cause?
Meningococcemia, meningitis, and Waterhouse-Friderichsen syndrome
102
What does gonococcus cause?
Gonorrhea, septic arthritis, neonatal conjuctivitis, PID, and Fitz-Hugh-Curtis syndrome
103
What does meningococcus have that is analogous to LPS of enteric gram negatives?
LOS
104
Prophylaxis of meningococcus close contacts
Rifampin
105
Treatment of gonococcus and meningococcus respectively
Gonococcus - cetriaxone, meningococcus - ceftriaxone or penicillin G
106
What does h flu cause?
Epiglottitis (cherry red), Meningitis, Otitis media, and Pneumonia
107
Transmission of h flu
Aerosol
108
Treatment and prophylaxis for h flu
Ceftriaxone (treatment) and rifampin (close contact prophylaxis)
109
What is contained in the HiB vaccine?
PRP component of the HiB capsule conjugated to diphtheria toxoid (give between 2 and 18 months of age)
110
Test of choice for legionella
Urine assay for antigen
111
Transmission and habitat of legionella
Aerosol. Water source habitat
112
Treatment for legionella
Erythromycin
113
What presentation in a pneumonia case would suggest legionella over strep pneumo?
Pneumonia + GI + Neuro symptoms
114
High fever in smoker with diarrhea, confusion, cough, and chest pain
Legionella
115
Erythema gangrenosum
Necrotic skin condition due to pseudomonas exotoxin
116
What is pseudomonas associated with
Wound and burn infection, pneumonia (esp in CF), sepsis (black lesions on skin), swimmers ear, UTI, drug users and diabetic osteomyelitis, hot tub folliculitis, malignant otitis externa in diabetics
117
Smell of pseudomonas
Grape like odor
118
Treatment for pseudomonas
Aminoglycoside plus extended-spectrum penicillin (piperacillin, ticarcillin)
119
Most important virulence factor in e coli UTI
Fimbriae
120
E coli diarrhea in children
EPEC
121
Which e coli does not ferment sorbitol?
EHEC
122
Red currant jelly sputum
Klebsiella
123
Contrast DIC with TTP-HUS
1) Pts bleed in DIC. 2) Only platelets activated in TTP-HUS. 3) PTT and PT prolonged in DIC, 4) Low fibrinogen and increased FDP in DIC
124
Which populations are more common in TTP and HUS respectively
TTP - pts with mainly CNS symptoms. HUS - children with renal failure and mild CNS symptoms
125
Main differences betweeon salmonella and shigella
Salmonella have flagella and can disseminate hematogenously and produce H2S
126
What may prolong symptoms in salmonella infection?
Antibiotics
127
Rose spots on abdomen, fever, headache, diarrhea.
Salmonella typhi (typhoid fever). May remain in gallbladder in carrier state
128
How do shigella enter our cells?
They first enter antigen sample M (microfold) cells, then spread to epithelial cells
129
How do Shigella move?
Actin polymerization (they do not have flagella like salmonella do)
130
Most common cause of bloody diarrhea
Campylobacter jejuni. This is especially true in children
131
Transmission of campylobacter
Fecal-oral through poultry, meat, unpasturized milk
132
Common antecedent to Guillain-Barre
Pet feces (puppies), contaminated milk, or pork
133
Diarrhea outbreaks in day care centers. Can also cause mesenteric adenitis which can mimic Crohns or appendicits
Yersinia entercolitica
134
Spirochetes
Borrelia, Leptospira, Treponema
135
Flulike symptoms, jaundice, photophobia with conjunctivitis.
Leptospirosis. Found in water contaminated with animal urine, prevalent among surfers and in the tropics
136
Severe jaundice and azotemia, fever, hemorrhage, anemia
Weils disease (icterohemorrhagic leptospirosis) - liver and kidney dysfuntcion from severe leptospira infection
137
Stages of lyme disease
1 - erythema migrans, flulike symptoms. 2 - Bells palsy, AV nodal block. 3 - chronic monoarthritis and migratory polyarthritis
138
Treatment for lyme
Doxycycline, ceftriaxone
139
Stages of syphilis
1 - painless chancre, 2 - rash, condylomata lata. 3 - Gummas, aoritis, neurosyphilis, argyll-robertson pupil
140
Saber shins, saddle nose, CN 8 deafness, Hutchinsons teeth, mulberry molars
Congenital syphilis
141
Argyll-Robertson pupil
Reactive to accomodation but not light
142
Causes of VDRL false positives
VDRL. Viruses (mono, hepatitis), Drugs, Rheumatic fever, Lupus and leprosy
143
Histologic appearance of brucellosis and what is the source?
Chronic caseating granulomas similar to Tb endocarditis. Unpasteurized dairy (common in cattle ranchers)
144
Source and organism of Q fever
Coxiella burnetii. Spores from tick feces and cattle placenta
145
Source and organism of ehrlichiosis
Ehrlichiosis chaffeensis. Lone star tick
146
Vector for francisella tularensis
Ticks, rabbits, deer fly
147
Vector for pasteurella multocida
Animal bite, cats, dogs
148
Organism and vector for epidemic typhys
Rickettsia prowazekii. Louse
149
Vector and organism for endemic typhyus
Rickettsia typhi. Flease
150
Characteristic finding in garnderella vaginalis infection
Fishy odor on addition of kOH
151
What infection is associated with sexual activity but is not an STD?
Garnerella overgrowth
152
Clue cells
Gardnerella overgrowth. Vaginal epithelial cells covered with bacteria
153
Treatment for gardnerella
Metronidazole
154
Where do Rickettsia live and what do they need to survive?
Intracellularly. Need CoA and NAD+
155
Rash starting centrally and spreading out sparing palms and soles
Epidemic typhys. R prowazekii carried by human body louse
156
Headache, fever, rash (vasculitis) starting on palms and soles
Rickettsia (but not typhus type. Typhus rash starts on trunk and spreads out)
157
Rickettsial pneumonia with no rash, no vector, and negative Weil-Felix
Q fever (coxiella burnetti). Organism can survive outside for a long time
158
Weil-Felix
Mixing pts serum with proteus antigens and antirickettsial antibodies will cross react with Proteus O antigen and agglutinate (if they have had a rickettsial infection)
159
Rash on palms and soles migrating to wrist, ankles, then trunk, headache, fever
Rocky mountain spotted fever
160
In what infections is palm and sole rash seen?
Coxsackie A (hand foot and mouth), RMSF, Syphilis
161
Two main forms in chlamydia life cycle
Elementary body (infectious), and Reticulate body
162
Lab diagnois of chlamydiae
Cytoplasmic inclusions on Giemsa or floresecent antibody stained smear
163
Chlamydia trachomatis serotypes
ABC - blindness, africa, chronic. D-K - urethritis, PID, ectopic, neonatal pneumonia and conjunctivitis. L1L2L3 - Lymphogranuloma venerum
164
Cause of atypical pnuemonia, high titer of cold aggultinins (IgM), grown on Eatons agar
Mycoplasma pneumoniae
165
Treatment for mycoplasma pneumoniae
Tetracycline or erythromycin (do not use penicillins as they have no cell wall)
166
Atypical pneumonia outbreak in military recruits or prisons
Mycoplasma pneumoniae
167
Main fungus in New England and mid-atlantic
Blastomyces
168
Main fungus in midwest
Histoplasma
169
Main fungus in southwest
Coccidiodes
170
Main fungus in latin america
Paracoccidiodes
171
Symptoms of histoplasmosis
pneumonia
172
Dimorphic fungus in bird or bat droppings
Histoplasmosis
173
Treatment for systemic mycoses
Fluconazole or ketoconazole (local), amphotericin B (systemic)
174
Dimorphic broad based buds
Blastomyces
175
Symptoms of blastomycosis
Inflammatory lung disease, can disseminate to skin and bone. Granulomatous nodules
176
Symptoms of coccidiodomycosis
Pneumonia and meningitis, can disseminate to bone and skin
177
Dimorphic fungus which looks like a ball of grapes
Coccidiodes
178
Which systemic mycoses can become a spherule filled with endospores (much larger than an RBC)?
Coccidiodes
179
Dimorphic fungus with captains wheel appearance
Paracoccidiodes
180
How does malassezia furfur affect skin pigment?
Degrades lipids, which produces acids that damage melanocytes and cause hypopigmentation or hyperpigmented patches
181
What kind of weather is conducive to malassezia furfur?
Hot, humid weather
182
Treatment for tinea versicolor
Topical miconazole, selenium sulfide
183
Histologic appearance of malassezia furfur
Spaghetti and meatball look on KOH prep
184
What cells are responsible for preventing candidiasis?
Th cells suppress superficial candidiasis. Neutrophils prevent hematogenous spread
185
Forms of candida
Dimorphic. Psuedohyphae and budding at 20C, Germ tubes at 37C
186
Treatment for candidiasis
Topical azole (vaginal), fluconazole or caspofungin (oral/esophageal), amphotericin B, fluconazole, caspofungin (systemic)
187
Acute angle hyphae
Aspergillus
188
How do aflatoxins cause cancer?
They cause a GC to TA mutation in p53
189
Which opportunistic fungal infections are not dimorphic?
Aspergillus, cryptococcus, mucor and rhizopus (I think), PCP (I think)
190
Histologic appearance of cryptococcus
Heavily encapsulated yeast. Little balls with smaller balls in them
191
How is cryptococcus acquired?
Inhalation (which results in hematogenous dissemination) from yeast in soil and pigeon droppings
192
Characteristic brain lesion from cryptococcus
Soap bubble lesions
193
What patients tend to get mucor and rhizpus infections?
DKA pts and leukemia pts
194
Headache, facial pain, black necrotic eschar on face, possible cranial nerve involvement
Mucor and rhizopus infections
195
How is PCP acquired?
Inhalation of yeast
196
Treatment for PCP
TMP-SMX, pentamidine, dapsone. Prophylax at CD4 less than 200
197
Dimorphic, cigar-shaped budding yeast that lives on vegetation
Sporothrix schenkii
198
Treatment for sporothrix schenkii
Itraconazole or KI
199
Bloating, flatulence, foul-smelling fatty diarrhea in campers and hikers
Giardiasis
200
How are giardia, entamoeba, and cryptosporidum respectively transmitted?
All are cysts in water
201
Treatment for giardia
Metronidazole
202
Treatment for entamoeba histolytica
Metronidazole and iodoquinol
203
Treatment for cryptosporidium
Prevention (water treatment), nitazoxanide
204
Bloody diarrhea, liver abscess, RUQ pain, flask-shaped colonic ulcers
Entamoeba
205
Chorioretinitis, hydrocephalus, intracranial calcifications
Toxoplasmosis (usually in HIV)
206
Transmission of toxoplasma
Cysts in meat or cat feces
207
Treatment for toxoplasma
Sulfadiazine and pyrimethamine
208
Rapidly fatal meningoencephalitis in someone who swam in a fresh water pool
Naegleria fowleri
209
Where do you look for the amoeba in naegleria infection?
CSF
210
Organism and vector for sleeping sickness
Trypanosoma brucei, gambiense, rhodesiense. Tsetse fly (painful bite)
211
Treatment for sleeping sickness
Suramin (blood-borne), melarsoprol (CNS protection)
212
Cycle length of the various malarias
Vivax/Ovale - 48 hours, Falciparum - irregular, Malariae - 72 hours
213
Which malaria has a dormant form in the liver?
Vivax-ovale
214
Which malaria causes cerebral malaria and how?
Falciparum. Parasitized RBCs occlude capillaries in brain (also kidney and lungs)
215
Malaria treatment
Start with chloroquine (blocks plasmodium heme polymerase). If resistant, use mefloquine. Vivax/ovale - add primaquine for hypnozoites
216
Fever and hemolytic anemia, northeastern United States, asplenia in severe disease
Babesia
217
Treatment for babesia
Quinine, clindamycin
218
Organism and vector in Chagas disease
Trypanosoma cruzi. Reduviid bug (kissing bug, painless bite)
219
Treatment for Chagas disease
Nifurtimox
220
Dilated cardiomyopathy, megacolon, megaesophagus
Chagas disease (mostly in S america)
221
Spiking fevers, hepatosplenomegaly, pancytopenia
Visceral leishmaniasis
222
Organism and vector of leishmaniasis
Leishmania donovani. Sandfly
223
Treatment for leishmaniasis
Sodium stibogluconate
224
Treatment for trichomonas vaginalis
Metronidazole (for patient and partner)
225
Organism and treatment for pinworm
Enterobius vermicularis. Bendazoles or pyrantel pamoate
226
Transmission of pinworm
Food contaminated with eggs
227
Nematode that encysts in muscle, causes periorbital edema
Trichinella spiralis
228
Nematode that penetrates the skin, causes vomiting, diarrhea, anemia
Strongyloides stercoralis
229
Nematode that penetrates skin of feet, causes anemia
Ancylostoma duodenale and Necator americans (hookworms)
230
Transmission and treatment of dracunculus medinensis
Drinking water, niridazole
231
Loa Loa
Transmitted by deer flies, causing skin swelling. Treat with DEC
232
Wuchereria bancrofti
Transmitted by female mosquito. Causes elephantiasis. Treat with DEC
233
Toxocara canis
Food contaminated with eggs, causes granulomas (can cause blindness) and visceral larva migrans. Treat with DEC
234
Treatment for taenia solium
Praziquantel (use bendazoles for neurocysticercosis)
235
Appearance of t solium lesions in the brain
Swiss cheese appearance
236
Treatment for diphyllobothrium latum
Praziquantel
237
Cysts in the liver that can cause anaphylaxis if antigens are released during removal
Echinococcus granulosus. Acquired from eggs in dog feces. Treat with bendazoles
238
Treatment for trematodes (flukes)
Praziquantel
239
Trematodes (flukes) (3)
Schistosoma, clonorchis sinesis (pigmented gallstones, cholangiocarcinoma), paragonimus westermani (crab meat, hemoptysis)
240
Routes of nematode infection and the worms that use each (6 total)
Ingestion - Enterobius, Ascaris, Trichinella. Cutaneous - Strongyloides, Ancylostoma, Necator
241
Parasite of brain cysts and seizures
T solium
242
Parasite of liver cysts
Echinococcus granulosus
243
Parasite of B12 deficiency
Diphyllobothrium latum
244
Parasite of biliary tract disease, cholangiocarcinoma
Clonorchis sinesis
245
Parasite of hemotypsis
Paragonimus westermani
246
Parasite of portal hypertension
Schistosoma mansoni
247
Parasite of hematuria, bladder cancer
Schistosoma haematobium
248
Parasite of microcytic anemia
Ancylostoma, necator
249
Complementation and the requirement for it
When one virus uses another viruses protein product. Both viruses have to be infecting the same cell at the same time
250
Phenotypic mixing
Coating of a progeny virus of virus A with surface proteins of virus B. Have to be infecting the same cell at the same time. Surface protein determines infectivity, but progeny carry virus A genetic material
251
Live attenuated vaccines (5)
Lead to longer production of mucosal IgA than killed vaccines. Smallpox, yellow fever, chickenpox, Sabins polio, MMR
252
Killed vaccines (4)
Rabies, influenza, salk polio, HAV
253
Recombinant vaccines (2)
HBV, HPV
254
All DNA viruses are what and what is the exception?
Double stranded, except the parvoviruses
255
What are all RNA viruses and what is the exception?
Single stranded except Reoviruses
256
RNA viruses
I went to a RETRO (retrovirus) TOGA (togavirus) party where I drank FLAVored (flavivirus) CORONA (coronavirus) and ate HIPPY (hepevirus) CALIfornia (Calcivirus) PICKLES (picornavirus)
257
What naked viruses are infectious?
dsDNA (except pox and HBV) and +strand ssRNA
258
Where do viruses replicate
DNA viruses - nucleus (except pox). RNA - cytoplasm (except influenza and retroviruses)
259
Naked viruses (7)
Calcivirus, Picornavirus, Reovirus, Parvovirus, Adenovirus, Papilloma, Polyoma
260
Which viruses acquire their envelops from nuclear membrane?
Herpesviruses (other get them from the PM)
261
DNA viruses (7)
Hepadna, Herpes, Adenoa, Pox, Parvo, Papilloma, Polyoma
262
All DNA viruses are icosehedral except which?
Pox (complex)
263
HHV-6
Roseola (exanthem subitum)
264
Which hepatitis virus is a DNA virus?
Hep B (it is a hepadnavirus)
265
What virus is not a retrovirus but has reverse transcriptase?
HBV
266
Most common viral cause of acute cystitis (dysuria, hematuria) in kids
Adenovirus
267
Febrile pharyngitis, sore throat, acute hemorrhagic cystitis, pneumonia, conjunctivitis
Adenovirus
268
Erythema infectiosum (fifth disease)
Parvo B19. Slapped cheek rash, hydrops fetalis in utero, RBC aplasia and RA-like symptoms in adults
269
Causes of pure red cell aplasia
Parvo B19 and thymoma
270
Histology of VZV infection
Intranuclear inclusions, multinucleate giant cells
271
Tzanck test
Smear to detect HSV-1, HSV-2 and VZV
272
Fever, hepatosplenomegaly, pharyngitis, lymphadenopathy (especially posterior cervical nodes). 15-20 years of age
Mononucleosis
273
Family and symptomology of norwalk virus
Calcivirus. Viral gastroenteritis
274
Which Hepatitis viruses are RNA viruses and what is the family of each?
HAV - Picorna, HCV - Flavi, HDV - Delta, HEV - Hepe
275
Picornaviruses (5)
Polio, Echo (aseptic meningitis), Rhino, Coxsackie (aseptic meningitis, herpangina, febrile pharyngitis, hand foot mouth disease), HAV
276
Paramyxoviruses (4)
Parinfluenza (croup), RSV (briochilitis in babies, treat with ribavirin), Rubeola (Measles), Mumps
277
Negative stranded RNA viruses (6)
Always Bring Polymerase Or Fail Replication. Arenaviruses, Bunyaviruses, Paramyxoviruses, Orthomyxoviruses, Filoviruses, Rhabdoviruses
278
Segmented viruses (4)
BOAR. All are RNA viruses. Bunyaviruses, Orthomyxoviruses, Arenaviruses, Reoviruses
279
Protein synthesis in picornaviruses
RNA translated into 1 large polypeptide that is cleaved by proteases into functional viral proteins
280
Spread of picornaviruses
Fecal oral (except rhinovirus)
281
Why doesnt rhinovirus affect the GI tract?
It is acid labile
282
High fever, black vomitus, jaundice
Yellow fever (a flavivirus)
283
Diarrhea in day care centers due to villous destruction with atrophy. A segmented RNA virus.
Rotavirus (a reovirus)
284
Fever, postauricular adenopathy, lymphadenopathy, arthralgias, fine truncal rash that starts at head and moves down.
Rubella (a togavirus, also called german measles). Mild in children but serious if congenital
285
What do paramyxoviruses have, what does it do, and how does this relate to treatment?
F (fusion) protein. Causes respiratory epithelial cells to fuse and form multinucleated cells. Palivizumab is a monoclonal antibody against F protein
286
Palivizumab
Monoclonal antibody against F protein (paramyxoviruses). Prevents pneumonia in premature infants
287
Descending maculopapular rash including hands and feet, koplik spots.
Measles (rubeola, a paramyxovirus)
288
Difference between the rashes in rubella and rubeola
Rubeola (measles) rash includes hands and feet. Rubella (german measles) rash stays on trunk. Both spread down from head
289
Potential sequelae of measles (rubeola)
SSPE (many years later), encephalitis, giant cell pneumonia (typically only in immunosuppressed)
290
Cough, cold like symptoms, conjunctivitis
Measles
291
Parotitis, aseptic meningitis, orchitis
Mumps (a paramyxovirus)
292
Between measles (rubeola) and german measles (rubella), which contains hemagglutinin?
Measles (rubeola), as it is a paramyxovirus
293
Fever, malaise, agitation, photophobia, hydrophobia, paralysis, coma, death
Rabies (progresses in that order)
294
Histology of hepatitis A infection
Hepatocyte ballooning degeneration and apoptosis
295
Histology of Hep B infection
Fine, eosinophilic, cytoplasmic granules of HBsAg are visible, giving ground glass appearance
296
Transmission of HBV
Parenteral, sexual, maternal-fetal
297
Symptoms of HBV prodromal period
Serum-sickness like
298
What viral hepatitises predispose to cancer and which cancer?
HCC. HBV and HCV
299
Best test for active HAV infection
Anti-HAVAb (IgM)
300
Best test for prior HAV infection
Anti-HAVAb (IgG). Can also indicate prior vaccination
301
What Hep B serologic marker indicates high transmissibility?
HBeAg
302
HIV structural genes
Env (gp120 for attachment, gp41 for fusion and entry), Gag (p24 capsid), Pol (reverse transcriptase)
303
What receptors does HIV use for entry?
CXCR4 or CCR5 (CD4 cells), CCR5 and CD4 (macrophages)
304
Why are HIV tests initially falsely positive in babies born to infected mothers?
Anti-GP120 crosses placenta
305
Where does the HIV virus replicate during the latent phase?
Lymph nodes
306
What fungal infection is commonly picked up by spelunkers?
Histoplasma capsulatum (from bats)
307
Low-grade fever, cough, hepatosplenomegaly, tongue ulcer, only pulmonary symptoms if CD4 count greater than 100
Histoplasma
308
Encephalopathy and demyelination in pt with CD4 count below 200
JC virus reactivation
309
Ring-enhancing brain abscesses with CD4 count below 100
Toxoplasma
310
CD4 count for cryptococcus meningitis
Below 50
311
CD4 count for CMV retinitis
Below 50. Will see cotton-wool spots
312
CD4 ranges for PCP and MAI infections respectively
PCP - below 200, MAI - below 50
313
Bugs that can mimic appendicits (3)
Yersinia enterocolitica, campylobacter jejuni, non-typhoidal salmonella. Mimic appendicits by causing mesenteric adenitis
314
Bugs causing bloody diarrhea (7)
Campylobacter, salmonella, shigella, EHEC, EIEC, Yersinia enterocolitica, Entamoeba histolytica
315
Bugs causing watery diarrhea (4)
ETEC, Vibrio choleraea, C diff, C perfringens. Also protozoa - giardia, cryptosporidium, viruses - rota, adeno, norwalk
316
Most common causes of pneumonia (in order with most common first) in neonates
Group B strep, E coli
317
Most common causes of pneumonia (in order with most common first) in children 4 weeks to 18 years
Viruses (RSV), Mycoplasma, Chlamydia trachomatis, Strep pneumo
318
Most common causes of pneumonia (in order with most common first) in adults (18-40)
Mycoplasma, C pneumoniae, Strep pneumo
319
Most common causes of pneumonia (in order with most common first) in adults (40-65)
Strep pneumo, H flu, Anaerobes, Viruses, Mycoplasma
320
Most common causes of pneumonia (in order with most common first) in elderly
Strep pneumo, Influenza, Anaerobes, H flu, Gram negative rods
321
Most common causes of nosocomial pneumonia
Staph, enteric gram negative rods
322
Most common causes of aspiration pneumonia and treatment
Anaerobes. Clindamycin
323
Most common causes of pneumonia in alcoholics and IV drug users
Strep pneumo, Klebsiella, Staph
324
Most common causes of pneumonia in CF
Pseudomonas
325
Most common causes of atypical pneumonia
Mycoplasma, Legionella, Chlamydia
326
CSF findings in bacterial meningitis
WBC high (over 1000) predominantely neutrophils. Glucose low (below 70), protein high
327
Most common causes of meningitis (in order with most common first) in newborn
Group B strep, E Coli, Listeria
328
Most common causes of meningitis (in order with most common first) in children (6 mos to 6 years)
Strep pneumo, N meningitidis, HiB, Enteroviruses
329
Most common causes of meningitis (in order with most common first) in 6 to 60 years
Strep pneumo, N meningitidis (number 1 in teens), Enteroviruses, HSV
330
Most common causes of meningitis (in order with most common first) in elderly
Strep pneumo, GNRs, Listeria
331
Enteroviruses
Coxsackie, Echo, Polio, others
332
CSF findings in viral meningitis
WBC below 500 predominantely lymphocytes, glucose normal or near normal, protein elevated but below 70
333
Treatment of meningitis
Cetriaxone and vanco empirically. Add ampicillin if Listeria suspected
334
Fever, headache, photophobia, nuchal rigidity, painful extraocular movements
Meningitis
335
CSF findings in fungal/Tb meningitis
Very similar to bacterial except WBC predominance is lymphocytes instead of PMNs
336
Fever with positive gallium scan
Osteomyelitis
337
Most common causes of osteomyelitis in: all comers, sexually active, DM and IVDU, sickle cell, prosthetics, vertebral, animal bite
All - S aureus, Sexually active - N gonorrhoeae (rare), DM and IVDU - pseudomonas, Sickle - Salmonella, Prosthetics - S aureus and s epidermis, Vertebral - M Tb (potts disease), Animal bite - Pasteurella
338
Where in the bone does osteomyelitis typically occur
Metaphysis of long bones
339
Features seen in pyelonephritis but not cystitis
Fever, chills, flank (vs suprapubic) pain, CVA tenderness, hematuria, WBC casts (vs WBCs)
340
Predisposing factors to UTI
Female, obstruction, kidney surgery, catheterization, GU malformation, DM, pregnancy
341
Markers for UTI agents
Positive leukocyte esterase test - bacterial UTI, Positive nitrite test - gram negative bacterial UTI
342
Urease producing bugs that cause UTIs
Proteus, Klebsiella. Negative urease test suggests E coli, Strep, Enterococcus
343
ToRCHHeS
Toxoplasma, Rubella, CMV, HIV, HSV-2, Syphilis
344
Hepatosplenomegaly, jaundice, thrombocytopenia, growth retardation in newborn
Common features of ToRCHHeS infections
345
Which TORCHES infection often includes poor feeding?
Toxoplasma
346
Maternal symptoms for each of the ToRCHHeS infections
Toxo - asymptomatic or lymphadenopathy. Rubella - Rash, postauricular lymphadenopathy, polyarthritis. CMV - Asymptomatic or mono-like. HIV - variable. HSV-2 - Asymptomatic or herpetic lesions. Syphilis - Chancre, rash, or cardiac/neuro disease
347
PDA, cataracts, deafness, blueberry muffin rash (may or may not be present)
Congenital rubella
348
Hearing loss, seizures, petechial rash, blueberry muffin rash
Congenital CMV
349
Recurrent infections, chronic diarrhea in newborn
Congenital HIV
350
Temporal encephalitis, herpetic lesions in newborn
Congenital HSV-2
351
Stillbirth or facial abnormalities, saber shins, and CN 8 deafness
Congenital syphillis
352
Slapped cheek rash
Parvo B19
353
Vesicular rash on palms and soles. Ulcers in oral mucosa
Coxsackie Type A (hand-foot-mouth disease)
354
Urethritis, cervicitis, PID, prostatitis, epididymitis, arthritis, creamy purulent discharge
Gonorrhea
355
Painful genital ulcer, inguinal adenopathy
Chancroid (haemophilus ducreyi)
356
Painful penile, vulvar, or cervical vesicles and ulcers. With or without fever, headache, myalgia
HSV-2
357
Noninflammatory, malodorous discharge, positive whiff test, clue cells
Gardnerella vaginosis
358
Two most common causes of PID
Chlamydia trachomatis and N gonorrhoeae
359
Cervical motion tenderness, purulent cervical discharge
PID. May progress to salpingitis, endometritis, hydrosalpinx, and tubo-ovarian abscess
360
Fitz-Hugh-Curtis
Infection of the liver capsule and violin string adhesions of parietal peritoneum to liver. Caused by ascending PID (esp N gonorrhoeae)
361
Causes of meningitis in unimmunized children
HiB and polio
362
What bug should you associate with sulfur granules?
Actinomyces israelii
363
Action of penicillin and its dervitives
Block cell wall synthesis by inhibition of peptidoglycan cross linking
364
Drugs that block peptidoglycan synthesis
Bacitracin, vancomycin
365
Drugs that block nucleotide synthesis
Sulfonamides, trimethoprim
366
Drugs that block DNA topoisomerases
Fluoroquinolones
367
Drugs that block mRNA synthesis
Rifampin
368
How does metronidazole work?
Damages DNA
369
Dicloxacillin
A penicillin derivative related to methicillin and nafcillin
370
Which has greater oral bioavailability, amoxicillin or ampicillin?
Amoxicillin
371
Main uses of ampicillin and amoxicillin
H flu, E coli, Listeria, Proteus, Salmonella, Shigella, enterococci
372
Most important use of ticarcillin, carbenicillin, and piperacillin
Pseudomonas. Also covers GNRs
373
Clavulanic Acid, Sulbactam, Tazobactam
B-lactamase inhibitors
374
What do cephalosporins block?
Transpeptidases (also called penicillin binding proteins)
375
Organisms not covered by cephalosporins are LAME
Listeria, Atypicals (chlamydia, mycoplasma), MRSA, Enterococci
376
Toxicities of cephalosporins
Hypersensitivity reactions, Vitamin K deficiency, Disulfiram-like reaction
377
Aztreonam
Monobactam resistant to B-lactamases. Binds PBP3, no cross-allergenicity with penicillins. GNR coverage only.
378
Main use of aztreonam
Penicillin-allergic pts and those with renal insufficiency who cannot tolerate aminoglycosides
379
Imipenem/cilastatin and meropenem
Limited by side effects, use in life-threatening infections after other options exhausted.
380
Cilastatin
Inhibits renal dehydropeptidase to decrease inactivation of imipenem
381
What are penicillins structural analogs of in bacteria?
The D-Ala-D-Ala sequence (which vancomycin binds)
382
Toxicities of vancomycin
Nephrotoxicity, Ototoxicity, Thrombophlebitis, red man syndrome
383
What causes vancomycin resistance?
Change of D-ala-D-ala to D-ala-D-lac
384
Protein synthesis inhibitor targets
buy AT 30, CCEL at 50. 30S - Aminoglycosides, Tetracyclines. 50S - Chloramphenicol, Clindamycin, Erythromycin (macrolides), Linezolid
385
Aminoglycosides (5)
Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin
386
Action of aminoglycosides
Inhibit formation of initiation complex and cause misreading of mRNA (bactericidal)
387
What type of bacteria are aminoglycosides ineffective against and why?
Anaerobes, because they require O2 for uptake
388
Main use of aminoglycosides
Severe GNR infections
389
Toxicities of aminoglycosides
Nephrotoxicity, Ototoxicity, Teratogenic
390
Resistance of aminoglycosides
Transferase enzymes inactivate drug by acetylation, phosphorylation, or adenylation
391
Tetracyclines (4)
Tetracycline, doxycycline, demeclocycline, minocycline
392
Which tetracycline is used in a renal disorder and which disorder?
Demeclocycline (ADH antagonist) is used in SIADH
393
Action of tetracyclines
Bind 30S, prevent aminoacyl-tRNA attachment
394
Instructions for patients taking tetracyclines
Do not take with milk, antacids, or iron-containing preparations as these will inhibit tetracycline absorption
395
What makes tetracyclines so effective against Rickettsia and Chlamydia
They accumulate intracellularly
396
Action of macrolides
Bind 50S (23S rRNA subsubunit) and prevent translocation
397
Main uses of macrolides
Atypical pneumonias, URIs, STDs, gram positive cocci, Neisseria
398
Toxicities of macrolides
Prolonged QT, GI discomfort (most common cause of noncompliance), acute cholestatic hepatitis, eosinophilia, skin rashes
399
What drugs are increased in plasma concentration by macrolides?
Theophyllines and oral anticoagulants
400
Action of chloramphenicol
Binds 50S - blocks peptide bond formation
401
Resistance to chloramphenicol
Plasmid-encoded acetyltransferase inactivates drug
402
Action of clindamycin
Binds 50S - blocks peptide bond formation
403
Main uses of clindamycin
Anaerobic infections in aspiration pneumonia or lung abscesses
404
General principle for treating anaerobes
Above the diaphragm - clindamycin, Below the diaphragm - metronidazole
405
Sulfonamides (3)
Sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine
406
Action of sulfonamides
Inhibit dihydropteroate synthase (needed for DNA synthesis). Are PABA antimetabolites
407
Fluoroquinolones (9)
Ciprofloxacin, norfloxacin, levofloxacin, ofloxacin, sparfloxacin, moxifloxacin, gatifloxacin, enoxacin, nalidixic acid (a quinolone)
408
Uses for metronidazole
Giardia, Entamoeba, Trichomonas, Gardnerella, Anaerobes.
409
Toxicities of metronidazole
Disulfiram-like reaction, headache, metallic taste
410
Prophylaxis for Tb, MAI, and M leprae respectively
Tb - INH, MAI - Azithromycin, M leprae - None
411
What is responsible for acid fastness?
Mycolic acids
412
What is needed to activate INH?
Bacterial catalase-peroxidase (KatG)
413
Toxicities of INH
Neurotoxic, hepatotoxic, lupus. Pyridoxine (B6) can prevent neurotoxicity and lupus
414
What causes different INH half life in different individuals
Fast vs slow acetylators
415
4 Rs of Rifampin
RNA polymerase inhibitor, Revs up P-450, Red/orange body fluids, Rapid resistance if used alone
416
Pyrazinamide
Anti-tb. Inhibits mycolic acid production by blocking pyrazanamidase
417
Ethambutol
Anti-tb. Decreases carbohydrate polymerization of cell wall by blocking arabinosyltransferase. Can cause optic neuropathy (red-green color blindness)
418
Prophylaxis for each of the following: meningococcus, gonorrhea, syphilis, recurrent UTIs, endocarditis with surgical or dental procedures
Meningococcus - Cipro, rifampin or minocycline. Gonorrhea - Cetriaxone, Syphilis - Benzathine penicillin G, Recurrent UTI - Bactrim, Endocarditis - Penicillins
419
HIV prophylaxis at CD4 below: 200, 100, and 50
200 - Bactrim (PCP), 100 - Bactrim (PCP and Toxo), 50 - Above and Azithryomycin (MAI)
420
Treatment for VRE
Linezolid and quinupristin/dalfopristin
421
Empiric therapy for community-acquired pneumonias
Outpatient - macrolides, Inpatient - fluoroquinolones, ICU - B-lactam + (fluoroquinolone or azithromycin)
422
What antifungals affect each of the following: membrane function, cell wall synthesis, ergosterol synthesis, lanosterol synthesis, nucleic acid synthesis
Membrane - Amphotericin B, Cell wall - Caspofungin, Ergosterol - fluconazole, itraconazole, voriconazole, terbinafine, Lanosterol - naftitine, Nucleic Acids - 5-fluorocytosine
423
Action of amphotericin B
Binds ergosterol and forms pore that allow leakage of electrolytes
424
What do you have to supplement in amphotericin treatment and why?
K and Mg because of altered renal tubule permeability
425
Action and delivery of nystatin
Same as amphotericin (binds ergosterol and makes pores). Topical only because too topic systemically
426
Action of caspofungin
Inhibits cell wall synthesis by inhibiting synthesis of B-glucan
427
Action of terbinafine
Inhibits fungal enzyme squalene epoxidase (necessary for ergosterol synthesis)
428
Action of griseofulvin
Inhibits MT function, disrupting mitosis
429
Antiprotozoals (5)
Pyrimethamine (toxo and falciparum), suramin and melarsoprol (sleeping sickness), nifurtimox (Chagas), Sodium stibogluconate (leishmaniasis)
430
Action of chloroquine
Blocks plasmodium heme polymerase
431
Antihelminthic drugs
Mebendazole, pyrantel pamoate, ivermectin, DEC, praziquantel. They all immobilize helminths
432
Amantadine
Blocks viral penetration and uncoating (M2 protein). Causes release of dopamine from nerve terminals
433
Use and toxicity for amantadine
Influenza A, Parkinsons disease. Causes ataxia, dizziness, slurred speech. 90 pct of influenza A resistant to amantadine
434
Zanamivir and oseltamivir
Inhibit neuraminidase, decreasing release of progeny viruses. Use in both Influenza A and B
435
Ribavirin
Inhibits synthesis of guanine nucleotides by competitively inhibiting IMP dehydrogenase. Use in RSV and Hep C. Can cause hemolytic anemia, is teratogenic
436
Activation and Action of Acyclovir
Monophosphorylated by HSV/VZV thymidine kinase. Guanosine analog
437
Uses of acyclovir
HSV, VZV, EBV. Use famciclovir for herpes zoster
438
Toxicities of acyclovir
Can cause crystalline nephropathy if adequate hydration not provided
439
Uses of ganciclovir
CMV
440
Toxicities of gancicyclovir
Leukopenia, neutropenia, thrombocytopenia, renal toxicity. Much more toxic than acyclovir
441
Foscarnet
Viral DNA pol inhibitor (binds pyrophosphate-binding site, no activatoin required).
442
What effect does foscarnet have on electrolyte levels
Can chelate Ca and promote Mg wasting (leads to low Ca and Mg levels)
443
Cidofovir
Inhibits viral DNA pol. Does not require phosphorylation. Nephrotoxic (give with probenecid)
444
HAART regimens
2 NRTIs with 1 NNRTIs or 1 PI or 1 Integrase inhibitor
445
Lopinavir, atazanavir, darunavir, fosamprenavir, saquinavir, ritonavir, indinavir
Protease inhibitors
446
Toxicities of protease inhibitors
Hyperglycemia, GI intolerance, lipodystrophy (fat redistribution similar to Cushings)
447
NRTIs (7)
Tenofovir, Emtricitabine, Abacavir, Lamivudine, Zidovudine, Didanosine, Stavudine
448
Toxicities of NRTIs
Bone marrow suppression, peripheral neuropathy, lactic acidosis, rash, megaloblastic anemia
449
NNRTIs (3)
Nevirapine, Efavirenz, Delaviridine
450
Raltegravir
Integrase inhibitor. Inhibits HIV genome integration. Can cause hypercholesterolemia
451
Uses for each of the interferons
Alpha - Chronic Hep B and C, Kaposi sarcoma. Beta - MS. Gamma - NADPH oxidase deficiency
452
Toxicities of the interferons
Neutropenia
453
Antimicrobials to avoid in pregnancy
Countless SAFe Moms Take Really Good Care. Clarithromycin, Sulfonamides, Aminoglycosides, Fluoroquinolones, Metronidazole, Tetracyclines, Ribavirin, Griseofulvin, Chloramphenicol
454
What bacterium likes the gallbladder?
Salmonella typhi
