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NBDE PART 1 MICRO/PATH > Mosby's Micro/Path: Immune System and Antibiotics > Flashcards

Mosby's Micro/Path: Immune System and Antibiotics Flashcards

1
Q

Name the cells involved in the acute inflammation stage of the innate immune response

A 
neutrophils 
(polymorphnuclear leukoctyes)
basophils
mast cells
natural killer cells (T cells) that kill tumor/viruses
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2
Q

Explain the inflammation types in the innate immune response

A

Acute inflammation
Chronic inflammation
Granulomatous inflammation (a form of chronic inflammation characterized by the presence of granulomas)

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3
Q

The result of acute inflammation is

A

a. complete resolution
b. scarring
c. abscess formation

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4
Q

if abscess enters soft tissue it is called

A

cellulitis

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5
Q

2 dentally significant formations of cellulitis include

A

Ludwig’s angina and cavernous sinus thrombosis

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6
Q

granulomas are areas the immune system walls off if phagocytes fail to destroy particles or microbes present in them.

  1. Tubercles are associated with granulomas involved in what infection ___
  2. Gumma are granulomas associated with what infection?
A
  1. TB Mycobacteria

2. Syphilis (treponema pallidum)

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7
Q
  1. Granulocytes are a category of white blood cells characterized by the presence of granules in their cytoplasm. They are also called _____ because of the varying shapes of the nucleus, which is usually lobed into ___segments. This distinguishes them from the mononuclear agranulocytes. In common parlance, the term polymorphonuclear leukocyte often refers specifically to neutrophil granulocytes,the most abundant of the granulocytes; the other types (eosinophils, basophils, and mast cells) have lower numbers. Granulocytes are produced via granulopoeisis in the bone marrow.
A 
polymorphonuclear leukocytes (PMN, PML, or PMNL)
three
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8
Q

monocytes are granular/agranular? how many lobes?

A

agranular and one lobe.

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9
Q

name the monocytes

A

All WBCs: macrophages, lymphocytes: T, B, natural killer cells,

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10
Q

the 2 types of acquired (specific) immunity are

A

cell mediated - t lymphocytes

humoral immunity- mediated by antibodies made by B cells

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11
Q

CD4+ T cells are __ cells

A

helper cells

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12
Q

CD8 T cells are __ cells

A

cytotoxic cells

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13
Q
  1. natural killer cells are found in __ immune system

2. cytotoxic T cells are found in __ immune system

A

1 innate

2. acquired

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14
Q

(CD4) helper t cells release which interleukins after it interacts with MHC class II

A

IL-4 and IL-5. This stimulates B cells and growth = to make antibodies.

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15
Q

CD8 cytotoxic and suppressor T cells recognize which MHC class

A

class I MHC molecules on antigen presenting cells

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16
Q

CD __ T cells are mainly for the recognition of bacterial antigens

A

CD4

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17
Q

CD __ T cells are mainly for the recognition of viral antigens

A

CD8

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18
Q

T cells are made in __ and mature in __

A

made by haematopoietic stem cells in the bone marrow

most mature in thymus, some in tonsils

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19
Q

mononuclear cells: called __ in the blood and __ in the tissues

A

monocytes in blood and macrophage in tissue. when monocytes enter into tissue they mature into macrophages

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20
Q

mononuclear cells are produced in the

A

bone marrow

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21
Q

the presence of macrophages indicates __ inflammation

A

chronic

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22
Q

the body has an extensive network of ___ known as the reticuloendothelial system.

A

macrophages (REL system)

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23
Q

reticuloendothelial system: macrophage in the ___ are called dust cells/heart-failure cells

A

lungs

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24
Q

reticuloendothelial system: macrophage in the ___ are called Kupffer cells

A

liver

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25
Q

reticuloendothelial system: macrophage in the ___ are called microglia

A

CNS

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26
Q

reticuloendothelial system: macrophage in the ___ are called mesangial

A

kidneys

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27
Q

reticuloendothelial system: macrophage in the ___ are called macrophages

A

lymph nodes

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28
Q

reticuloendothelial system: macrophage in the ___ are called monocytes

A

blood

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29
Q

reticuloendothelial system: macrophage in the ___ are called histocytes

A

CT

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30
Q

reticuloendothelial system: macrophage in the ___ are called spleenocytes

A

spleen

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31
Q

Mast cells have surface antigen receptors including __ antibody receptor

A

IgE

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32
Q

IgE plays important role in type _ hypersensitivity rxn

A

1

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33
Q

Histamine released by mast cells causes __ (vaso__)

and broncho ___

A

vasodilation and bronchoconstriction

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34
Q

There are two kinds of Histamine receptors:

  1. H1 receptors cause
  2. H2 receptors play role in
A
  1. bronchoconstriction and vasodilation

2. gastric acid and pepsin secretion

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35
Q

Prostoglandins and leukotrienes are mediators of inflammatory response. The are metabolites of __

A

arachidonic acid

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36
Q

Prostoglandins and leukotrienes are produced by __ pathways

A

cyclooxygenase (prostaglandins) and lipoxygenase (leukotrienes) pathways

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37
Q

Prostoglandins and leukotrienes cause broncho___

A

bronchoconstriction and vasodilation

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38
Q

Macrophages release this cytokine: IL-#

A

IL-1 stimulate activity/production of cells including lymphocytes, macrophages, endothelial cells. also cause fever

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39
Q

Helper T cells release cytokine: IL -# that activates other helper T cells and cytotoxic T cells

A

IL2

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40
Q

Activated T cells release IL# that stimulates production of RBC in bone marrow

A

IL3

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41
Q

Helper T cells secrete IL # stimulates B cell growth and production of IgE and IgG

A

IL-4

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42
Q

Helper T cells IL # stimulate B cell differentiation into plasma cells and activity of eosinophils and production of IgA

A

IL-5

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43
Q

Name the two types of cytokines

A

interleukins (ILs) and interferons (INFs)

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44
Q
  1. ___ are cytokines (mediators) that affect lymphocytes

3. __ are cytokines that are important for antiviral immunity

A
  1. inteleukins

2. interferons

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45
Q

opsonin is

A

any molecule that enhances phagocytosis by marking an antigen for an immune response

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46
Q

the most abundant immunoglobulin we have

A

IgG (75%)

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47
Q

The first responder immunoglobulin

A

IgM

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48
Q

The second responder immunoglobulin

A

IgG

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49
Q

the only immunoglobulin that can cross the placenta and is present in newborns

A

IgG

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50
Q

which antibody activates complement and therefore plays a key role in pathogenesis of adult periodontitis

A

IgG

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51
Q

list the antibodies in order or abundance

A

IgG (75%) > IgA (15%) > IgM (9%) > IgD (0.2%) > IgE (0.004%) GAMDE

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52
Q

which antibody is associated w immunity of mucous membranes, found in mucous secretions in respiratory tract, intestinal tract, genitourinary, tears, saliva, and colostrum (mammary glands)

A

IgA

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53
Q

Which antibody is associated w body’s primary immune response?

A

IgM

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54
Q

which immunoglobulin acts as an antigen receptor for B cells that induces B cell activation

A

IgM

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55
Q

which antibody acts as a receptor for granulocytes including basophils and mast cells and stimulates their degeneration

A

IgE

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56
Q

IgE plays an impt role in type _ hypersensitivity reaction

A

1

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57
Q

treatment of anaphylaxic shock

A

epinephrine (vasoconstrictor and bronchodilator) or antihistamine

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58
Q

what antibody is involved with type I hypersensitivity reactions

A

IgE - histamine release…anaphylaxis…asthma hayfever

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59
Q

what antibody involved with type II hypersensitivity rxn

A

IgM and IgG = complement system, MAC

ex erythroblastosis fetalis, blood transfusions

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60
Q

what antibody involved with type III hypersensitivity rxn

A

IgG

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61
Q

in type __ hypersensitivity, the antigen antibody interactions form immune complexes that become trapped along vascular walls damaging BV’s from phagocytosis by reticuloendothelial system

A

3

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62
Q

Arthus reaction (injecting antigen into patient with high IgG already in blood), serum sickness (injection of drug serum/antigens), Rheumatoid arthritis, systemic lupus are all type __ hypersensitivity reactions

A

type 3

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63
Q

erythroblastosis fetalis and blood transfusion can cause type __ hypersensitivity reactions

A

type 2

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64
Q

there are NO antibody mediators in which type of hypersensitivity reaction

A

type 4.

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65
Q

in type 4 delayed cell mediated hypersensitivity reactions, __ are the main mediators

A

Helper T cells (CD4) think CD4 = type 4

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66
Q

List the antibody mediators:

  1. type 1 hypersensitivity
  2. type 2 hypersensitivity
  3. type 3 hypersensitivity
  4. type 4 hypersensitivity
A
  1. type 1 hypersensitivity = IgE (think asthma)
  2. type 2 hypersensitivity = IgG and IgM (think 2 means 2 antibodies)
  3. type 3 hypersensitivity = IgG
  4. type 4 hypersensitivity = no antibody. helper T cells
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67
Q

Bruton’s agammaglobulinemia =

  1. deficiency/low levels of ____
  2. ___ immunity is unaffected
  3. these patients get recurrent __ infections
  4. treatment is
A
  1. low antibodies
  2. cell mediated not affected. It is a failure of B cells to differentiate = low level of plasma cells and antibody production
  3. bacterial/pyogenic
  4. administer IgG
    think Bruton’s = B cell problem
68
Q

Transient hypogammaglobulinemia =

  1. seen in infants/adults
  2. decreased amount of __
  3. treatment is
A
  1. infants
  2. antibodies bc slow production of antibody
  3. administer IgG after the first 6 months
69
Q

Di George’s Syndrome:

  1. deficiency in __ cells
  2. results from a failure of the __ brachial (pharyngeal pouches) to develop
  3. symptoms include
A
  1. T cells
  2. 3rd and 4th = leads to a lack of thymus and parathyroid development. mandibular development is also affected.
  3. tetany
    recurrent viral and fungal infections
70
Q

What disease is characterized by a deficiency in both T and B cells, severe, recurrent opportunistic infections common in infants. Treatment bone marrow transplant/gene therapy

A

severe combined immunodeficiency (SCID)

71
Q

what disease causes microstomia of the mouth (decreased opening of the mouth), abnormal deposition of collagen leading to development of fibrosis in certain organs which can result in organ failure.

A

Scleroderma

systemic sclerosis

72
Q

what disease is characterized by the presence of antinuclear antibodies (ANA). These ANA’s include anti-DNA, anti-RNA, and anti-Sm antigen.

A

Systemic lupus erythematous (SLE)

73
Q

most significant problems with SLE

A
  1. kidney = most sig bc can lead to kidney failure
  2. skin - butterfly rash along the malar and nose area
  3. heart - increased risk of endocarditis due to vegetations found on heart valves
  4. joints - causing arthritis like symptoms
74
Q

what disease causes butterfly rash

A

Lupus

75
Q

most ___ plaque made of aerobes and facultative anaerobes

A

suprgingival

76
Q

most __ plaque made of anaerobes

A

subgingival

77
Q

Bacteria shapes:

  1. cocci =
  2. streptococci
  3. staphylococci
  4. diplococcic
A
  1. round/circular
  2. circular and appear in chains
  3. circular and appear in clusters
  4. circular and occur in pairs
78
Q

bacteria shape:

bacilli are

A

rods

79
Q

spirochetes are __ shape

A

spiral shaped

80
Q

pleomorphic bacteria

A

appear with different inconsistent shapes

81
Q

gram ____ bacteria stain blue

A

positive (thick) holds stain

82
Q

gram __ bacteria stain red

A

negative

83
Q

gram staining is used for what 2 purposes

A

determining what antibiotic to use and for identification purposes

84
Q

How we gram stain:

  1. we stain with ___. this causes ALL bacteria to turn blue
  2. we use a __ solution- all bacteria retain the blue color
  3. we then rinse with __ or __
  4. when we rinse with the alcohol/acetone gram ___ will lose it’s color because it is thin
  5. then we stain with ___
A
  1. crystal violet
  2. iodine
  3. acetone or alcohol
  4. negative (gram positive stays blue bc thick)
  5. safranin - gram - turn red (take up color), gram + stay blue
85
Q

How we acid-fast stain:

  1. used for __
  2. stain with ___ all bacteria stain red
  3. wash with __
  4. stain with ___
  5. mycobacteria will be what color
A
  1. mycobacteria which cant be gram stained
  2. carbolfuchsin
  3. acid alcohol
  4. methylene blue
  5. mycobacteria will stain red (retain the carbolfucshin color). all others will stain blue
86
Q

In the first step of ___stain we use crystal violet.

in the first step of __ stain we us carbolfuchsin

A
  1. gram stain (all bacteria turn blue)

2. acid fast stain (all bacteria turn red)

87
Q

After we wash the bacteria we use safranin in ___ stain

and use methylene blue in ___stain

A

gram stain

acid fast stain

88
Q

all bacteria are surrounded by a cell wall except:
mycoplasma
mycobacteria?

A

MYCOPLASMA! Don’t confuse with mycobacteria (TB)

89
Q

Cell wall of gram +/- bacteria contains teichoic acid. what is the purpose?

A

positive (think + = t-eichoic = thick peptidoglycan)
it is an antigen.
it is outside the Thick peptidoglycan wall)

90
Q
  1. The periplasm is a space bordered by two selective permeable barriers, the inner membrane (i.e., cytoplasmic membrane) and the outer membrane in Gram-___ bacteria.
A

negative:

inner cytoplasmic membrane ==> cell wall in the periplasmic space ==> outer membrane ==> LPS attached to outer membrane

91
Q

there is no periplasmic space in Gram-positive bacteria because there is only

A

1 biological membrane, the cytoplasmic membrane.

92
Q

some gram ___ bacteria have ____ in the periplasmic space that will degrade penicillins

A

beta lactaminases

93
Q

LPS is found in the ___ of gram negative bacteria (endotoxin).

A

outer membrane

94
Q

the toxicity of LPS is attributed to the presence of

A

lipid A

95
Q

the outer membrane of the LPS contains the __antigen

A

O

96
Q

LPS is found in dental __ and inflammation

A

plaque

97
Q

Mycolic acid in acid-fast bacteria are able to resist __

A

decolorization with acid alcohol therefore they can’t be gram stained.

98
Q

name a bacteria that can’t be gram stained

A

mycobacterium tuberculosis

99
Q

Capsule: gelatinous layer surrounds the cell walls of certain bacteria. generally made of polysaccharides, functions:
antiphagoctyic, identification purposes (when treated with antiserum they swell - allowing identification) and adherence to

A

tooth surfaces (caries)

100
Q

spore forming bacteria include the genus

A

bacillus and clostridium

101
Q

nucelocapsid are seen in

A

viruses: NUCLEO: viral genome nucleic acid DNA OR RNA, CAPSID (protein coat)

102
Q

some viruses have envelopes. which one are more sensitive to environmental conditions

A

enveloped more sensitive bc can dry out and pop. non enveloped (naked) are hardy

103
Q

the virus binds to the host via ___

A

specific surface proteins

104
Q

the virus enters the host cell by __

A

receptor-mediated endocytosis, or by fusing its viral envelope with the host membrane, or translocation of the entire virus across host membrane

105
Q

detection of viral growth:
1. ___ This lasts for 10-12 hours, and it corresponds to the period during which the input virus becomes uncoated. As a result, no infectious virus can detected during this time. no progeny virons are assembled. The period of time between infection by a virus and the appearance of the mature virus within the cell

A

eclipse

106
Q

___ period is the time bw the initial viral infection to when the virus can be detected

A

latent

107
Q

fungi are dimorphic meaning they can exist as

A

mold or yeast

108
Q

mold/yeast:

  1. __ grows as long filaments in a free living state at ambient temperature (room temp)
  2. __ grow as single cells in host tissue at body temperature
A
  1. mold

2. yeast

109
Q

Some fungi are spore producing. Medically significant spores:

  1. blastospores formed by
  2. chlamydospores have thick walls making them resistant to environment changes
  3. arthrospores-formed from the ends of __
  4. sporangiospored formed by __
A
  1. budding
  2. hyphae
  3. mold
110
Q

Penicillins are bactericidal and inhibit what enzyme that catalyzes the final crosslinking in peptidoglycan cell wall

A

transpeptidase

111
Q

fungal infections generally initiate a type __hypersensitivity reaction

A

IV delayed (cell mediated)

112
Q

formation of ___ is common in response to fungal infections

A

granulomas

113
Q

adverse reactions to what antibiotic include allergic (hypersensitivity), seizures, and platelet dysfunction

A

penicillin

114
Q

___ penicillin is effective against gram + bacteria and gram - cocci. limited aeffect against gram negative bacilli bacteria

A

natural penicillins

115
Q

penicillin G and V are what type of penicillin

A

natural (good for gram +) and (gram - cocci)

116
Q

which penicillin would you use for gram negative bacilli because they are more effective.

A

extended spectrum penicillins

ex. amoxicillin and ampicillin

117
Q
  1. Penicillin V and G are ___ penicilins

2. ampicillin and amoxicillin are __ penicilins

A
  1. natural (gram + and gram - cocci)

2. extended spectrum (gram - bacillus)

118
Q

are natural and extended spectrum penicillin susceptible to beta lactaminase?

A

yes

119
Q

penicillin resistant penicilins are called

A

antistaphylococcal penicillins - resistant to degradation by beta lactaminases.

120
Q

penicillin resistant penicillins are used to treat

A

staph aureus (produce penicillinase)

121
Q

name the penicillin resistant penicilins

A

cloxacillin, dicloxacillin, methicillin nafcillin oxacillin

122
Q
  1. Penicillin V and G are ___ penicilins
  2. ampicillin and amoxicillin are __ penicilins
  3. cloxacillin, dicloxacillin, methicillin nafcillin oxacillin
A
  1. natural (gram + and gram - cocci)
  2. extended spectrum (gram - bacillus)
  3. penicillin resistant penicilins (bacteria that make penicillinase) -staph aureus
123
Q

cephlasporins are __ cidal like penicillin

A

bactericidal

124
Q

cephlasporins are __ spectrum

A

broad

125
Q

cephlasporins action?

A

similar to penicillin but more resistant to beta lactaminases than penicilin

126
Q

adverse rxn w/cephlasporins

A

with alcohol - disulfiram-like rxn

127
Q

can patient who are allergic to penicillin be cross allergic to cephlasporins

A

yes. 10% are

128
Q

name cephlasporins

A

cephalexin, cefadroxil, and cefazolin

129
Q

Bacitracin is inhibitor of

A

cell wall synthesis (like cephlasporins and penicillin)

130
Q

Bacitracin can only be used

A

topically because highly nephrotoxic if given systemically

131
Q

what bactericidal antibiotic is produced by streptococcus orientalis

A

Vancomycin

132
Q

Vancomycin is effective against gram _ bacteria

A

positive (think V - positiVe)

133
Q

Vancomycin has limited effect on gram negative bacteria except

A

Flavobacterium

134
Q

which antibiotic is used for multi-drug resistant bacteria like methicillin-resistant Staph aureus or treatment of endocarditis

A

Vancomycin

135
Q
  1. Penicillin V and G are ___ penicilins
  2. ampicillin and amoxicillin are __ penicilins
  3. cloxacillin, dicloxacillin, methicillin nafcillin oxacillin
  4. vancomycin
  5. all of them are inhibitors of __
A
  1. natural (gram + and gram - cocci)
  2. extended spectrum (gram - bacillus)
  3. penicillin resistant penicilins (bacteria that make penicillinase) -staph aureus
  4. gram + - MRSA and endocarditis
  5. cell wall synthesis
136
Q
  1. Aminoglycosides are antibiotics that inhibit
  2. they are effective against aerobic/anaerobic bacteria
  3. they are also useful for many gram __ rods and enterococci
A

protein synthesis of bacteria (block 30S)

  1. aerobic, ineffective against anaerobic
  2. negative (tuberculosis)
137
Q

the aminoglycoside named Streptomycin is used for

A

TB

138
Q

the aminoglycoside named gentamicin is used for

A

enterococci

139
Q

Aminoglycosides are administered by

A

IM injection or IV

140
Q

adverse reactions to aminoglycosides may be

A

ototoxicity = toxic to the ear(via damage to CN 8) = may cause deafness
nephrotoxicity - kidney damage

141
Q
  1. penicillin, cephalosporins, aminoglycosides are all bacteri___
  2. tetracycline is bacteri
A
  1. cidal

2. static

142
Q

tetracycline blocks

A

30S protein synthesis

143
Q

tetracycline is __ spectrum and targets

A

broad (like cephlasporins)

gram + and - and other organisms such as Rickettsia, mycoplasma and chlamydiae

144
Q

tetracycline should be avoided in

A

pregnant women and young children

145
Q

adverse tetracycline reaction to

A

liver - hepatotoxic

146
Q
  1. MRSA give
  2. TB give
  3. Rickettsia, chlamydiae, mycoplasma
  4. staph aureus
  5. endocarditis
A
  1. Vancomycin
  2. aminoglycoside = streptomycin
  3. tetracycline (think to treat all 3) c and r in the name
  4. oxacillin/methicillin/dicloxacillin/cloxacillin/naflacillin (CD-MON)
  5. vancomycin
147
Q

Someone with liver failure, pregnant, or young child don’t give

A

tetracycline

148
Q

for someone with kidney failure don’t give

A

aminoglycosides (streptomycin = TB), gentamicin

149
Q
  1. erythromycin and clarithromycin are ___ and are bacteriostatic
  2. for gram
A
  1. macrolides.

2. positive

150
Q

don’t give an alcoholic

A

cephlasporin

151
Q

which antibiotics treat both gram positive and gram negative

A
  1. penicillin, tetracycline, chloramphenicol
152
Q

only gram positive antibiotics

A

erythromycin, clarithromycin, vancomycin (except flavobacterium is gram -),

153
Q
  1. which antibiotic is effective against aerobic bacteria

2. which is for anaerobic

A
  1. aminoglycosides: gentamicin, streptomycin

2. clindamycin

154
Q

clindamycin is for gram

A

positive and negative anaerobic bacteria

155
Q

clindamycin is bacteriostatic/cidal

A

both. cidal at higher concentrations

156
Q

which would you give to treat Bacteriodes Fragilis and Fusobacterium

A

clindamycin

157
Q

pseudomembranous colitis is caused by what bacteria

A

clostridium difficile in the gut

158
Q

which antibiotic has an adverse reaction that may cause pseudomembranous colitis

A

clindamycin (C = clindamycin, clostridium difficile)

159
Q

Chloramphenicol is broad spectrum against

A

gram positive and negative aerobic and anaerobic

160
Q

chloramphicol is used as a last resort bc

A

severe adverse reactions and toxicity: anemia, aplastic anemia, reversible anemia, gray baby syndrome which can lead to death

161
Q

both bacteria and humans require __ for DNA synthesis

A

folate

162
Q

unlike bacteria humans cant make their own folate. we rely on exogenous folate. This is why __ drugs have affect on bacteria and not our cells

A

sulfa drugs block metabolic folic acid synthesis in bacteria

163
Q

Sulfonamides (sulfa drugs) are bacterio__

A

static

164
Q

quinolones inhibit __ and are bacterio__

A

inhibit DNA replication. static. inhibit DNA gyrase (topoisomerase) include

165
Q

ciprofloxacin is a

A

quinolone

166
Q

the only FDA approved mouthwash that has been shown to decrease __ and __ associated with gingivitis is Chlorhexidine

A

supragingival plaque and gingival inflammation = antimicrobial affect
after rinsing some stays in mouth and is gradually released over time.

NBDE PART 1 MICRO/PATH (20 decks)

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