My Questions.Codename:Thrilla In The Manila Flashcards
1
Q
Immunoglobulin in charge of allergic reactions
A
IgE. Release of histamine, enlargement of vessels and decrease BP. Epinephrine counteract histamine.
2
Q
Hormone causing immunosuppression in the first 3 months of pregnancy
A
Progesterone.
3
Q
Cortisone 4 effects
A
Immunosuppressor
Higher food consumption
Hyperglycemia
Hair growth
4
Q
What is SKID?
A
Genetic disease causing permanent immunosuppression
5
Q
Which types of bacteria don’t have cell wall?
A
Mycoplasma(pneumonia) and ureaplasma(urethritis).
Urethritis is the inflammation of the urethra.
6
Q
2 types of bacteria that makes spores?
A
Bacillus and Clostridium.
Transmitted through rusty material or soil.
7
Q
Endotoxins produced by 1
Exotoxins produced by 2
A
1-G negative LPS
2-G positive
8
Q
Enterotoxins?
A
Acting on intestinal cells, pumps out water and electrolytes causing diarrhea or dysentery.
9
Q
Neurotoxins made by ( bacteria that makes spores)
A
Clostridium tetani and C. botulinum. Spores from soil or rusted iron.
10
Q
What does tetanus neurotoxin
A
Block acetylcholine recapture so neurotransmitters stuck in the synaptic space and keep giving signals causing spastic paralysis. Paralysis of the jaw is the first symptom.
11
Q
How does botulinum neurotoxin works ?
A
Block the release of acetylcholine from presynaptic neuron. Impulse present but not transmitted. Flaccid paralysis. Muscles are not responding to stimuli.
Botox
12
Q
What is penicillin’s upgraded form?
A
Cephalosporins
13
Q
How does glycopeptides target cell wall
A
Prevents the addition of new units to peptidoglycan. Tersten
14
Q
Glycopeptides are
A
Ototoxic if administered IV hearing loss or impairment.
15
Q
ABs acting on cell membrane
A
Toxic. Polymyxins group; colistin, daptomycin.
Last hope
16
Q
Azithromycin is
A
Used for patients allergic to penicillin. Good AB. In macrolides class.
17
Q
Chloramphenicol cause
A
Grey baby syndrome if used in the pregnant women. Heavily hepatotoxic.
18
Q
Tetracyclines are able to
A
Stain teeth and bones avoid in pediatrics and pregnant women.
19
Q
Fluoroquinolones target
A
Topoisomerases which unwinds DNA in replication.
20
Q
Give 3 examples for fluoroquinolones
A
Ciprofloxacin, levofloxacin, moxifloxacin.
21
Q
Fluoroquinolones used to treat (5)
A
Pneumonia, chlamydia, STDs and abdominal infections and cystitis( bladder infection)
22
Q
Fluoroquinolones side effects 3
A
Stick to cartilage, tendon rupture prolonged QT waves.
23
Q
ABs targeting RNAs synthesis
A
Rifamycins such as rifampin. Good ABs used for TB and they can pass BBB thus used for meningitis.
24
Q
ABs targeting bacterial metabolism inhibit what
A
Folic acid synthesis. Important for cell replication and spinal development. Sulfonamides (izoniazid-TB)
25
In pregnancy or pediatric setting avoid (5)
Chloramphenicol (grey baby)
Tetracyclines( stains teeth and induce bone deformities)
Aminoglycosides (ototoxicity)
Sulfonamides (blocks folic acid)
Quinolones ( tendon rupture and bone damage)
26
ABs that are safe to use during pregnancy (4)
Penicillin, Amoxiclav, cephalosporins, Azithromycin.
27
What is an Antibiogram?
Test to determine the effectiveness of an AB against a specific microbe.
28
What is MIC?
Minimum concentration of an AB preventing the visible growth of bacteria.
29
What is MBC?
Minimum bactericidal concentration. Min amount of an AB to kill that kind of bacteria.
30
True or false?
MBC always lower than the MIC.
False. MBC always greater than the MIC or at least same.
31
Fungi’s cell wall composed by
Chitosan.
32
Fungal do not have … in their cell wall so they have ….. instead.
They don’t have cholesterol and have ergosterol instead. Most of the antifungal drugs target ergosterol.
33
Fungal cells have similar ribosomes to human’s ribosomes. True or false
True
34
Fungal cell produce mycotoxins such as
Aflatoxins, ochratoxins,fumonisins, trichothecenes, citrinin. Which contaminates our food.
35
Mycotoxins can lead to
Hepato/nephro toxicity and cancer. Some Mycotoxins have hallucinogenic properties.
36
Fungi can make allergic reactions such as
Penicillin
37
Fungi infection which part of the skin?
Cutaneous involving nails, hairs, feet, hands and soft skin.
38
Infections caused by fungi are called (1)
Whereas skin infections caused by fungi are called (2)
1- mycoses
2-tinea
39
Candida?
Vaginal infection of yeast cells which yields in milky discharge.
40
Mycoses can cause 2 different types of infections which are
Superficial infections: cutaneous infections, oral infections and vulvovaginal candidadis, tineas,ringworm.
Systemic infections: spread by bloodstream. Candidadis, crytococcal meningitis, aspergillosis, blastomycosis.
41
Patients at risk for systemic mycoses are
Immunocompromised patients 99% of the cases. Pulmonary infections caused by fungi are the main cause of death in Immunocompromised patients.
42
Which drugs are used for inhibiting biosynthetic pathway of ergosterol?
Azoles(vaginal candida) and allylamines.
Azoles: clotrimazole fluconazole, Itraconazole, miconazole, voriconazole.
43
Describe polyenes?
Bind to ergosterol, disrupts the cell membrane leading to leakage and cell death. Extremely toxic only used in ICU for systemic infections.
44
Amphotericin B is (polyenes)
Administered parenterally and highly nephro/neuro toxic at high dosage.
45
Nystatin is meant for
Topical use only, to treat oral and esophageal candidadis.
46
Echinocandis how does it act? (Antifungal)
Inhibits biosynthetic pathway of glucan. Disrupts cell wall integrity. Used in ICU IV. To treat Aspergillus and candida spp.
47
Flucytosine (antifungal)
Inhibits nucleic acid synthesis, used in systemic infections and chemotherapy.
48
Flucytosine+ Amphotericin B used for
Cryptococcal meningitis which is transmitted by pigeons.
49
What happens in a serology test for CMV in pregnant woman as follows;
IgG reactive
IgM reactive
IgG avidity high
No primary infection, low risk for in-utero transmission.
50
What is hemoculture?
A test used to detect the presence of bacteria or other microbes in patients blood. Always collect before administering medications. Very important for sepsis.
51
Risk factors for STDs?
Multiple sexual partners, unprotected sexual intercourse, young age.
52
Most STDs can be transmitted to fetus during the birth by the contact of maternal blood. T or F?
True
53
STDs can cause
Cancer(HPV), infertility(chlamydia and Neisseria gonorrhea), arthritis(Neisseria gonorrhea) or multiorgan conditions(syphilis).
54
What are the symptoms of arthritis caused by STDs?
Arthritis is the inflammation of the joints generally unilateral meaning affecting the joints in the same side asymmetric. Generally affecting lower limbs. Pain while urinating might be present.
55
Syphilis caused by which gram negative bacteria? And how many stages does it have?
Caused by Treponema pallidum. 3 stages.
56
What is 1° syphilis
Right after sexual intercourse (3-90)
Ulcerations in vagina/penis/mouth.
Not painful(can spread the disease)
57
What is 2° syphilis?
4-10 weeks after primary infection. Hard to recognize looks like varicella but varicella doesn’t infects the palm of the hands but syphilis does.
Disease spread all over the body( heart, liver, lungs, spleen etc)
Life expectation isn’t high.
58
3° syphilis
Appear after 20 years of infection in 20-30% of infected individuals.
Also called neurosyphilis because infection attacking the nerves in the brain that make people go crazy.
Diagnosis made by IgG and IgM serology for TPHA( Treponema pallidum Hemoagglutinin)
59
Therapy for the syphilis?
Early diagnosis very important. 1° syphilis should be treated with penicillin IM or IV. Bacteria is not resistant.
In case of 2° or 3° syphilis; IV Ceftriaxone( cephalosporins). Large release of antigens causing inflammation. Patient may manifest symptoms like: high fever, chills, hypotension, headache, tachycardia, hyperventilation.
60
Neisseria gonorrhea asymptomatic in women and symptomatic in men. Bel soğukluğu
True, continuous flow of pus from the penis.
61
In women N.gonorrhea can lead to a disease which is also caused by chlamydia trachomatis?
PID( pelvic inflammatory disease). Egg stucks in the inflammated fallopian tubules causing fatal rupture of the womb. Even when treated causes infertility.
62
Fitz-Hugh-Curtis disease
Caused by either N. gonorrhea or chlamydia trachomatis. Bilateral abdominal pain. Adhesions between liver capsule and peritoneum. Causing great pain.
63
Can N. gonorrhea cause arthritis?
Yes
64
If not treated N. gonorrhea and c. trachomatis the newborn can get
Neonatal conjunctivitis, can lead to blindness. Suspected neonates from Ng conjunctivitis should treated with ceftriaxone with Azithromycin IV
65
Why does Chlamydia trachomatis is a special germ? Gram positive or negative
Gram negative
No cell wall
Intracellular meaning b-lactams and penicillin totally ineffective.
66
For treatment of Chlamydia trachomatis which ABs can be used (2)
Azithromycin or erythromycin (acting on ribosomes)
Doxycycline.
67
What are the symptoms of Chlamydia trachomatis?
Most of the time it is asymptomatic but pain in urination and discharge from genitals(in women whitish and sticky), blood spotting not associated with menstrual cycle, painful sexual intercourse(testicle pain in men) can be present.
Remember it doesn’t have cell wall.
68
How can you diagnose chlamydia trachomatis?
Serology or PCR.
It can lead to urethritis, cervictis, salpingitis(inf. of fallopian tubes) and PID.
69
Which is more frequent chlamydia trachomatis or Neisseria gonorrhea?
C. trachomatis
70
Lymphogranuloma venerum caused by specific germs of Chlamydia trachomatis.
T or F?
True
71
What are the symptoms of Lymphogranuloma venerum?
Swelling in the pelvic area caused by infection&inflammation also fever. Affects both male&female.
If not treated infection can lead to third stage causing fibrosis, fistulas and elephantiasis( fil bacak)
72
Bacterial vaginosis is a STD.
T or F?
False. Dysbiosis of vagina favors the manifestation of bacterial vaginosis thus not STD.
73
Bacterial Vaginosis easily recognized by smell and color of discharge which are
Grey color and dead fish smell.
74
Which bacteria associated with acidic ph of vagina?
Lactobacilli. Prevents candida and BV.
75
Which are the bacteria’s associated with BV?
Gardnerella vaginolis and Mobiluncus spp.
76
Symptoms of BV?
Itching, pain and difficulty in urination and vaginal discharge
77
Diagnosis of BV?
Measure ph of the vagina(>4,5)
Ask about smell of the discharge.
78
What do you suggest eating a woman with BV?
Yogurt and cheese which are rich in lactobacilli.
79
Candida albicans causing vaginal infection is a STD. True or false?
False, it’s a result of dysbiosis causing yeast overgrowth.
80
Symptoms of vaginal yeast infection?
Vaginal itching and discharge(white discharge).
Also white patches in the mouth
81
Vaginal yeast infection common in which patients?
People with diabetes because glucose in the urine make a favorable environment for the yeast. Same for the children because of GH release glucose in the blood.
Menopause
Pregnancy
Immunocompromised women
After an AB treatment(lactobacilli decreased)
82
How to treat VYI?
Probiotics, intravaginal miconazole, nystatin.
83
Why UTIs are more common in women?
Short urethra facilitating contamination.
84
Why are UTIs common in people using catheters?
Urine is not flushing the microbes causing infections. Sooner or later patients with catheters will develop infections.
85
What is the pathway of UTIs?
Urethritis-cystitis-prostatitis-pyelonephritis-nephritis-sepsis.
86
Microhematuria can be common in children that have sore throat caused by
Streptococci; Post Streptococcal glomerulo nephritis. This is caused by immunocomplexes arriving to the kidneys and binding to the complement system causing damage and blood.
87
High concentration of neutrophils in urine blood or CSF caused by
Bacterial infection
88
High concentration of lymphocytes in urine blood or CSF caused by
Viral infection
89
High concentration of eosinophils in urine blood or CSF caused by
Fungal infection
90
Risk factors for UTIs?
Being female
Benign prostatic hyperplasia
Obstruction(catheters, kidney stones)
Poor hygiene
Pregnancy
Diabetes mellitus type2
91
What is oliguria?
Limited urination(50-400 mL), can be seen in patients about to die.
In healthy patients (800-2000mL)
92
Sepsis can be seen in patients (patient types)
Immunocompromised patients, severe burnt patients, UTI, catheters, uncompensated diabetes.
93
Sepsis symptoms
Fever(may not be present in the babies)
Low BP
High blood lactate
Oliguria( low urine )
Tachycardia(heartbeat over 100 bpm)
Tachypnea(rapid breathing >16)
High levels of CRP and procalcitonin.
Pale skin
94
High CRP levels in the blood test indicates
Inflammation in the body. It can be autoimmune, fungal, bacterial, viral or heart attack.
95
In case of sepsis why do we need to inject crystalloids?
In order to increase the blood volume to help kidneys. Generally brain and kidneys are the first ones suffering from sepsis.
96
In the second step of the sepsis hypoperfusion can be seen what is that?
Reduced amount of blood flow. Less oxygen to the tissues especially brain and kidneys. Cause confusion in the patient.
97
For the treatment of sepsis what is the first thing you must do?
Obtain hemoculture and send it to the lab.
98
What is the Second step in the sepsis treatment
Restore blood pressure at least 65mmHg. Inject crystalloids and maybe even adrenaline shots.
99
3rd step of the treatment of sepsis
Empiric AB therapy. Use broad spectrum of ABs.
Quinolones targeting nucleic acids
Rifampin targeting RNAP
Azithromycin targeting ribosomes
Streptomycin target cell membrane.
100
Symptoms of neonatal sepsis?
Jaundice(sarılık)
Lethargy(baby not moving)
Fever might be present or not.
Cyanosis
Apnea(baby stop breathing for few second)
Increased respiratory rate. Tachypnea
Tachycardia followed by bradycardiac episodes.(Racing heart followed by a slowed period)
Hypotension
Petechia(distinctive rash)
Abdominal distension and vomitting.
101
Neonatal sepsis generally occur babies born with
Natural birth as they come in contact with the birth canal differently from C-section.
102
Main risks for neonatal sepsis?
Mothers with STDs(N. gonorrhea) and premature birth.
103
Microbes causing early onset sepsis(first 48 hours)
Group B streptococcus(GBS) like S. Agalactiae found in colon it can be transmitted to the baby during childbirth.
Gram negative bacteria
S.Pneumonia or S.aureus
Remember high risk of mortality(10-30%)
Listeria monocytogenes.
104
Which microbes are causing Late onset sepsis(after 48 hours)?
Staphylococcus aureus.
Candida spp
105
3 class of patients that are under risk for endocarditis?
Heroin takers IV with contaminated syringe
People with heart problems whose valves are not closing properly. Before going dentist these patients should take amoxiclav or amoxicillin.
People who have catheter CVC
106
Symptoms for endocarditis?
Fever
Septic symptoms
Heart murmur
Abnormal ECG
107
What is biofilm?
A bacterial slime don’t block ABs like a sheet. For example in the teeth and heart valves.
108
Staphylocci is gram (1)
And it looks like (2)
1-gram positive
2-spherical, looks like bunch of grapes
109
What is coagulase test?
Coagulase enzyme able to form blood clots. If they adhere each other in the serum we see coagulation. Very pathogenic and dangerous.( S.aureus)
110
Staphylococcus aureus is
Gram (1)
Coagulase and catalase (2)
Positive
Positive
111
What is catalase test why it is important?
Performed by adding H2O2 to bacterial colonies if they form bubbles they ar positive .
Catalase enzyme breaks down H2O2 to H2O+O2.
H2O2 important for the hosts immune system so it’s a defense mechanism for bacteria.
112
Staphylococcus aureus can produce toxins. T or F?
True. Dangerous for Immunocompromised patients in hospitals.
113
What happens if S.aureus infect skin
Abscesses or sepsis. Especially MRSA. It is the main cause of skin infections
114
S.aureus target which skin tissue?
Hypodermis is rich in adipose, microbes target and consume it especially colonize the hair follicles.
115
Sebum production is favored by what?
Estrogen and testosterone hormones. Or birth control pill.
116
How do we treat skin infections?
Starvation therapy: removing the excess of fats by using soap containing sulfur or Azoles(ketoconazole), antifungal drugs inhibit androgen production.
117
What is SSSS?(soyulma, kırmızı bebek)
Staphylococcus caused scalded skin syndrome.
Common in pediatric age and infants under 6yo.
118
SSSS caused by which microbe and toxin?
S.aureus
Exfoliative toxin causing skin to peel.
Scalded means boiled thus the skin is red.
119
Why babies are more susceptible to SSSS?
Because they have IgG but not IgA.
Condition is much more common in babies who weren’t breastfeed enough.
Because IgA comes from IgA.
120
What is the therapy for SSSS?
IV ABs B-lactams such as augmentin.
Painkillers because skin is inflamed
Creams to protect raw exposed skin and hydration.
Improvement in 24-48 hours and full recovery in 5-7 days.
121
Restitutio ad Integrum means
Full recovery
122
Streptococci
Gram
Looks like
Shape of a necklace and gram positive
S.pyogenes GAS
S.agalactiae GBS(sepsis and pneumonia in newborns)
123
Streptococcus pyogenes infects which parts in the body?
Skin and soft tissue such as strep throat or impetigo,erysipelas,cellulitis.
124
What is Strep throat?
White patches on the tonsils.
Throat pain, redness and swelling of the tonsils, enlarged lymph nodes in the neck, pain while swallowing.
125
How to distinguish strep throat from sore throat?
Sore throat is caused by viral infection accompanied by cough(lungs are affected) common cold.
Strep throat characterized by;
Fever
White patches on the tonsils
Absence of cough
Swollen and tender lymph nodes.
Strep throat is more dangerous than the sore throat.
Cola urine might be present in the kid.
126
What is PSGN?
After 7-10 days of S.pyogenes infection microhematuria can be seen in kids. Cola urine
127
What microbe causing Scarlett Fever?
Streptococcus pyogenes.
Mostly seen in pediatrics.
Red patches and rashes on the skin accompanied by fever.
Tongue is very important it’s like strawberry.
Caused by pyrogenic exotoxins secreted by S.pyogenes.
128
Therapy for Scarlett fever?
Penicillin or macrolides(Azithromycin)
129
What does pyrogenic means?
Induce fever such as in the Scarlett fever caused by S.pyogenes
130
Strep impetigo caused by
Streptococcus pyogenes. Generally affecting babies most common bacterial skin infection. Superficial skin infection.
131
Strep impetigo localized in the which areas of the baby?
Mouth and nose area but it’s contagious it can spread by scratch. It can be caused by viruses with same effects.
132
What is the therapy for the strep impetigo?
IV ABs and anticoagulants.
ChatGPT response: both topical and oral antibiotics.
For topical Mupirocin
For oral Penicillin or amoxicillin. Cephalexin(if resistant, it is a cephalosporin.)
133
What is erysipelas? Which microbe?
Affecting epidermis and dermis so higher parts of skin. Caused by Strep.pyogenes S.aureus or Strep.epidermis.
134
What is cellulitis?
Kırmızı bacak
Inner layers of skin infected dermis and subcutaneous fat. Be careful after an injury or working in the garden.
It can cause necrotic conditions.
135
What is necrotizing fasciitis?
Flesh eating bacteria.NF caused by the strep.pyogenes but also S.aureus
Seen in immunodepressive or people with severe distress.
136
How to treat sinusitis?
Removal of mucus so starvation therapy. Take medicine no later than 2pm.
Patients may have fever
Aerosol works immediately.
137
Children can get pneumonia very easily but it’s not bacterial generally viral. What are viral agents causing pneumonia in children?
Parainfluenza virus
Human metapneumovirus
Respiratory syncetial virus (RSV)
Generally handled with supportive measures.
138
What are agents causing pneumonia in adults?
Streptococcus pneumonia
Mycoplasma pneumonia(intracelullar)
Chlamydophila pneumonia(intracellular)
Haemophilus influenza
Legionella pneumophila
Bordetella pertussis(causing whooping cough)
Chlamydia psittaci(parrots)
139
Chlamydia pneumonia strictly related to a condition named
Chlamydia trachomatis which also cause PID
140
Streptococcus pneumonia shape look like
Flame. Gram positive
80% of CAP caused by it.
141
Streptococcus pneumonia can affect (parts of body)
Pneumonia, lobar pneumonia, meningitis, otitis media.
Other infections can be; bronchitis, rhinitis, sinusitis, conjunctivitis,sepsis, osteomyelitis.
142
How to diagnose pneumonia caused by streptococcus pneumonia?
Look at the sputum if it’s pink to a rusty color.
Green if pseudomonas aeruginosa.( can be caused by IV ABs because they injected with a catheter)
143
How to treat strep pneumonia?
Penicillin, augmentin if severely Immunocompromised we can use cephalosporins.
Vaccine available for elderly people.
144
How to diagnose pneumonia from X-ray?
Lung congested by a kind of fluid called exudate. Air normally seen as black in the films but in this case there is no air in the lobe because it’s whiteish.
More important flattened diaphragm.
145
What is emphysema?
Alveoli’s wall degraded and surface are decreased.
146
Hippocratic or clubbing fingers can be seen in
Heavy smokers make candle experiment.
147
What is croup or Laryngotracheobronchitis?
(Babies)
Affecting children younger than 6 yo.
Severe respiratory distress which creates dog barking cough and stridor(due to obstruction in the upper respiratory tract)
It causes costal retractions which is soft tissue move towards thorax. Also cyanosis one of the symptoms
No sufficient oxygen.
Baby must be vaccinated in the first year.
148
Diphtheria caused by
Corynebacterium diphtheria which can release toxin to bloodstream causing necrosis. In the past death rate was very high. Vaccine available.
149
Clinical symptoms of diphtheria?
Lymph nodes in the neck swollen
Racing heart(respiratory distress causes heart to suffer)
White patches
If toxin reach blood circulation it can lead to multi organ failure.
150
How to treat diphtheria
Penicillin
151
Haemophilus Influenza
Gram negative.
Sepsis, pneumonia,epiglottitis, meningitis.
For treatment penicillin or ceftriaxone and cefotaxime(Immunocompromised, cephalosporins)
152
What are some factors which are predisposing to the worst conditions in the respiratory tract?
Tobacco smoke(long run emphysema)
Allergens
Work exposure to dust/vapors/chemicals.
Look for flat diaphragm.
153
Explain the lung sound of following conditions
Crackles, laryngotracheobronchitis, pleural rub,stridor
Crackles-slurping the last part of your drink
Expiratory wheezing from a horn-laryngotracheabronchitis
Pleural rub-33 bone sound
Ronchi-lower lobe infection like snorkeling
Stridor-obstruction in the upper tract
154
Lobar pneumonia caused by
Streptococcus pneumonia.
155
Remember
Even a small amount of fluid or inflammation in the lungs cause dramatic changes in the saturation of the blood with oxygen.
156
Legionella pneumophila
Likes hot environments;termal water, water pipes, AC’s carbon filters.
Generally occurring in the summertime from AC
Most of the time undiagnosed-runny nose and light cough.
157
What is Pontiac disease?
A mild upper respiratory tract infection most of the time goes undiagnosed.
Runny nose and light cough is present.
Caused by legionella bacterium.
158
Two conditions caused by legionella pneumophila
Pontiac disease and Legionnaire’s disease.
159
What are the symptoms for Legionnaires disease?
Severe respiratory distress
High fever
Muscle pain
Headache
Potentially deadly
Only seen in Immunocompromised patients
160
Where does legionnaire’s disease infect? lower or upper lobes of the lungs?
Lower lobes, patients can’t infect other patients.
161
Legionella intracellular or extracellular parasite?
Intracellular
162
Can we use penicillin to treat legionnaires disease?
Nope it is intracellular
163
How to treat legionnaires disease?
Strong ABs because it is affecting immunocompromised patient.
Quinolones(ciprofloxacin or levofloxacin)
Macrolides Azithromycin
Worst case tetracyclines(doxycycline).
164
What is Bordetella pertussis and its symptoms?
(Special type of coughing)
Gram negative capsulated bacteria
Causes whooping sound when person is breathing.(severe cough that people cannot breath normally)
Mostly seen in children under 1YO
preventable thanks to the DTP vaccine
165
Mycobacteria is a special germ because
Neither gram positive or negative
They have mycolic acids and arabinoglactan on their cell wall
It creates an impermeable layer of wax around bacteria
Little ABs used against mycobacteria
Mostly toxic. Intracellular pathogens.
166
TB caused by which bacteria?
Mycobacteria tuberculosis
It is an aerobic bacteria that’s why it localized in the upper lobes of the lungs
Bacteria get phagocytized by macrophages however unsuccessful in killing them.
167
Which immune cells in the body has a crucial role in keeping TB latent.
Cd4+ T-cells
Immunocompromised patients depleted in the T cells that’s why they develop Active TB.
168
People with latent TB can or cannot spread the disease?
No symptoms and Cannot spread the disease
169
Why CD4 T cells are important to fight against TB?
CD4+ cells secrete interleukins to instruct macrophages to kill phagocytized bacteria.
In Immunocompromised patients T cells are depleted thus causing M.tuberculosis not only to survive inside but start replicating and eventually kill the cell.
170
What is the vicious cycle of active TB?
Monocytes keep phagocytizing the mycobacteria, bacteria in turn kill them. Leading to the recruitment of more and more macrophages along with the constant replication of the bacteria.
171
How can we diagnose active TB from X-ray?
Caseous lesions(cheesy) in the upper lobes of the lungs indicating the necrosis of the lungs.
Accumulation of dead monocytes and bacteria that create pus-like formations.
Pulmonary cavitation.
172
Symptoms of active TB?
Paleness
Weight loss or cachexia
Loss of appetite
Hemoptysis(blood in the sputum) rusty-red color.
Fever
Persistent Cough
Chest pain
Swollen lymph nodes in the neck
173
How to diagnose Active TB?
(Tests)
TB ELISPOT
TB QuantiFERON
Positive test doesn’t mean that patient currently has TB, patient is exposed to Mycobacteria we X-rays.
So for diagnosis:
First look for clinical symptoms
Secondly run lab exams
Thirdly chest X-ray
174
Therapy for active TB?
Isoniazid(INH) inhibit mycolic acid synthesis in the bacterial cell wall. Nephro toxic.
Rifampin(RIF) rna polymerase
Ethambutol(EMB) target arabinogalactan
Pyrazinamide(PZA)(metabolism)
175
How long does TB treatment last?
240 days. People quit using the medications causing drug resistant TB. We use more than one drug to prevent that.
176
We have a vaccine for TB named BCG vaccine but it is not that effective so we use it to treat
Bladder cancer. Inject to tumors later flushing out the cancer.
177
Leprosy is a neglected disease caused by
Mycobacterium leprae.
Generally seen in India and Brazil.
178
Bacterial meningitis infects where specifically
Arachnoid, subarachnoid space and pia mater.
179
Bacterial meningitis can or cannot affect immunocompetent patients.
Can affect it is a nasty disease we need to take action ASAP.
180
Rachicentesis or lumbar puncture made on
L4. If the csf fluid is turbid it’s bacterial.
If it is clear it can be viral, fungal or normal.
181
If the CSF pressure is elevated it is
Generally bacterial infections.
Viral meningitis doesn’t affect the pressure.
182
Low glucose levels in the CSF indicates
Bacterial infection of
183
Viral meningitis CSF test
Normal pressure
CSF clear
Elevated lymphocyte levels
Protein levels are reduced
Glucose levels are normal
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If the CSF test as follows we can predict that infection origin is:
Turbid, pressure elevated, neutrophil presence, elevated protein levels, glucose reduced
Bacterial infection
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In case of fungal meningitis CSF test as follows
Pressure is normal or little elevated
Elevated protein levels and eosinophils
Glucose normal or low.
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Rarely clear CSF in case of which bacterial infection?
Mycobacterium tuberculosis
Listeria monocytogenes
Treponema pallidum
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Meningococcus is
Gram negative
Diplococcus bacterium(2 tane top)
N.meningitidis can be found in the nasopharynx
Different serotypes B and C most dominant.
It may cause septicaemia, fulminant death, diffuse intravascular coagulation with necrosis and adrenal gland failure.
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For the treatment of Neisseria meningitidis
(Oppenheimer)
Use the atomic bomb.
Ceftriaxone, cefotaxime. Very strong cephalosporins(B-lactams) and have broad spectrum.
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Meningitis can be caused by which agents?
Pneumococcus 40%
N.meningitis 40%
Streptococcus, cryptoccus neoformans(fungal) and listeria monocytogenes, Haemophilus influenzae.
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Listeria monocytogenes can cause
And found in foods like
Meningitis or sepsis especially in neonates.
Quite rare but high mortality rate 70%
Adopted to grow in cold. Can be present in the raw milk, homemade cheese, raw meat or fish.
Meningitis caused by this represent 1-2% of the total cases.
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Meningitis caused by fungi. What’s the name of the agent
Cryptococcal neoformans. Transmitted by pigeons.
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Cryptococcal meningitis(1%) can be treated with
Amphotercin B and flucanazole which are very toxic for humans.
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Before treating bacterial meningitis with antibiotics you must give …. to the patient to overcome brain edema
Steroids such as dexamethasone.
Steroids reduce the inflammation.
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Listeria monocytogenes can infect pregnant women causing
Intra utero transmission it can be deadly, mother generally survives.
Avoid raw meat and fish, homemade cheese and unpasteurized milk.
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Neisseria meningitidis(meningococcal disease) can cause a distinct rash named
Petechia. Caused by bleeding of capillaries and they are non-blanching(doesn’t fade away)
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What is Brudzinski’s neck sign?
When a baby get meningitis this maneuver can be helpful. Gently flex the neck if response is involuntarily flexing their hips and knees it is a sign for meningitis.
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Can traumatic injuries develop meningitis
Not common but yes bacteria in the nasopharynx can enter CNS.
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True or False ?
Most of time viral infections do not develop meningitis instead develop encephalitis.
True.
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Neonatal causes of meningitis (4)
1-Escheria coli. If mother has a contaminated colon can be transmitted during childbirth.
2-Listeria monocytogenes. Contaminated foods
3-streptococcus pneumonia. Otitis media then meningitis
4-Streptococcus agalactiae. Preventable if mother receives AB treatment before birth.
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1-3 months of the baby, meningitis caused by (4)
1-Haemophilus influenza (also cause pneumonia)
2-listeria monocytogenes
3-Neisseria meningitidis
4-streptococcus pneumonia
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Later ages which agents cause pneumonia >18
1-Neisseria meningitidis
2-Haemophilus influenza
3-listeria monocytogenes
4-Streptococcus pneumonia.
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What is shingles?
(Same virus as chickenpox)
Viral infection caused by Varicella-zooster virus(VZV) which also cause chickenpox.
Target nerve cells a rash or blisters around the path of the nerve. Linear belt-like path.
Rash progress from red patches to blisters.
Rash is unilateral meaning only appear one side of the body.
Treated by clovirs
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Ligament of Treitz defines the border between
Upper and lower intestine. Last component of the upper part is duodenum.
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Grapefruit itself and its juice causing
Inhibits cytochrome enzymes at liver leading to disrupted metabolism of ABs. Drugs would be totally ineffective.
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Licorice
Interferes with enzymes at adrenal gland causing hypertension.
Meyan kökü
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Hypertension can lead 3 severe conditions;
1-Myocardial infarction
2-ictus or stroke
3-atherosclerosis( vessels are blocked by cholesterol plaques.)
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To lower Blood pressure quickly we can use
Diuretics like Lasix, increase urination in order to lower BP.
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Giordano maneuver
With ulnar edge of the hand, strike to the renal loggia if violent pain is present it indicates kidney stones.
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What happens a patient eat a thing which contains intolerant substances
It stretches intestinal villi, which causes bloating(siskinlik) pain and diminished absorptive power of intestinal wall.
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Diarrhea?
Liquid feces(colon does not do the thing) common in babies, because they tend to touch to the floor and put their hands to their mouth
In babies generally viral.
Cause dehydration
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Dysentery
Watery stools+mucus+blood or pus. More severe and dangerous. Indicates damage to the intestinal wall.l due to bacteria.
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GI tract infections generally not occurring in Europe that’s why we need to ask patient about
Their travel history in the anamnesis.
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What are some symptoms of GI tract infections?
Nausea, vomiting, dehydration,electrolytic imbalance.
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If dehydration cause electrolytic imbalance the first organ affected would be
Heart. Pacemaker. Undergoes arrhythmia
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Bacillus cereus causing
Be careful with Bacilli and Clostridium because
Food intoxication. Make spores. Unpasteurized milk(which can also transmit mycobacterium bovis), raw meat and vegetables.
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Can Staphylococcus aureus make food intoxication?
Yes which causes vomiting and diarrhea.
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What is ergotism? What is the main agent causing it? What is the name of the toxin?
Annemin hastalık,
Claviceps purpurea(fungus)
Occurs after ingesting contaminated cereal(rye or çavdar). It contains lysergic acid or LSD. It remains unaffected in high temperatures.
Hallucinogenic
Saint Anthony abbot
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Aflatoxins are produced by which species and what is the target for these toxins?
Carcinogens and mutagens produced by Aspergillus spp.
Cause Liver cancer in the long run
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What is melena?
It is the black feces caused by stercobilin in the feces. Stercobilin is released by hydrolysis of hemoglobin.
So when there is bleeding in the upper GI tract we ended up with melena.
Also iron supports can cause melena.
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What is hematochezia
Massive release of blood in the fecal matter.
Best case scenario-hemorrhoids
Worst case-colon cancer (takes several years to develop and once developed it spreads around the body)
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Sticky or oily feces indicates that
Lipases weren’t secreted by pancreas. Stone or cancer.
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NSAIDs how do they affect the stomach?
Interfere with mucus production.
Block an enzyme called cyclooxygenase type2. When type 2 is blocked synthesis of arachidonic acid(ARA) and prostaglandin blocked. Presence of mucus dependent on the PGE2
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Which drugs interfere with mucus production in the stomach?
Aspirin, ibuprofen, indomethecin
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First reason of gastritis?
Inflammation of gastric wall caused by abuse of aspirin or NSAIDs.
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How do the formation of ulcers in the stomach happen?
Low amount of mucus, stomach ingest itself and makes holes.
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Reflux(a mild burning sensation in the midchest)
Can be treated with
Omeprazole, pantoprazole. They affect the HCl production in the stomach.
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2 main ways to avoid reflux?
Avoid coffee or lemon juice which accelerate the hcl formation
Sleeping position.
Long time reflux can cause Barnet’s esophagus or cancer.
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Prazoles targets which cells?
Proton pumps in parietal cells. Reduces the acidity of the stomach.
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Parietal cells under control of which signalling molecules?
Histamine
Gastrin hormone
Acetylcholine
So nervous systems control GI tract, people under heavy stress and nervous pressure can face gastritis they get acid production without food.
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Postprandial somnolence?
Feeling sleepy after a meal. Caused by carbonate ion. How?
When carbonate enters the blood it stimulates the nerves that are associated with sleeping.
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Importance of B12?
DNA synthesis, RBC formation, maintenance of myelin sheath, metabolism and mood of the patient.
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Second cause of the ulcers
Helicobacter pylori.
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How to distinguish 2 types of ulcers? Duodenal and stomach
Experiencing immediate pain after a meal is a sign for stomach ulcer, pain after 2-3 hours indicates duodenum ulcers.
Gastric ulcers can cause vomiting whereas duodenum can cause melena(rare)
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What happens if we elevate the pH of the stomach to 3?
B12 absorption is affected causing anemia.
Food not properly digested causing fermentation by microbes. Microbes produce gases causing stretching stomach walls.
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Does Helicobacter pylori produce toxins?
Yes it produces toxins leading to irritation and destruction of the epithelial cells and mucus of the organ.
If untreated, this bacterium associated with increased risk of stomach cancer.
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What can be the cause of the stomach cancer?
1-Food or genetics. For example in japan stomach cancer common in even young people.
2-untreated Helicobacter pylori
3-consuming burnt food like BBQ or pizza with burnt crust.
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Helicobacter pylori produces an enzyme which cannot be seen in a healthy patient. What is this enzyme?
Urease enzyme. Which breaks down urea to CO2 and ammonia, which makes a buffer solution in the stomach. This buffer reacts with strong acids in the stomach and a neutralized area for H.pylori.
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How can we diagnose ulcers in the stomach caused by Helicobacter pylori?
-Gastroscopy. Patient needs benzodiazepines and sedation so it is troublesome.
-Rapid urease test. Patient blow to a balloon then we measure the radioactivity. Then patient takes a urea pill which is marked by carbon13 then he blows again we measure the radioactivity again.
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True or false?
Helicobacter pylori loves acidic environment.
True
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How can we treat Helicobacter pylori
For 10 days we use triple therapy(OAC). Which is Omeprazole+Amoxicillin+Clarithromycin. Triple therapy includes one proton pump inhibitor and 2 ABs.( In this case omeprazole is the PPI)
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What is the alternative therapy for H.pylori
Omeprazole, bismuth subsalicylate(mide koruyucu) and Iansoprazole.
Which are not ABs but can be used against H.pylori to increase the pH of the stomach.
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What are the 2 toxins produced by H.pylori
VacA - Vacuolating factor A
CagA- Cytotoxin associated gene
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Prolonged consumption of IPPs can cause anemia why?
Because IPPs such as omeprazole and pantoprazoles elevates the pH in the stomach. Causing reduced absorption of B12 and Iron
That’s why it is important to ask to the patient which medications taking recently during the anamnesis.
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Escheria coli in the human body if pathogenic can cause 3 different conditions which are?
1- Diarrhea(EPEC&ETEC) while others can cause dysentery.
2-meningitis
3-cystitis
E.coli is a commensal bacteria living in the gut but some strains are pathogenic.
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What is Mountezuma revenge?
Typical condition for travelers who go to the Africa, India or South America. They eat from local stores and get diarrhea due to E.coli infection and their trip ended up in the toilet.
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What is Trousseau sign? Which ion is depleted in the body?
Low calcium levels due to diarrhea or osteoporosis.
When we inflate the sphygmanometer and patient contract their muscles in the hand and fingers it is a typical sign of Hypocalcemia.
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What is Shigella? (Different from shingles which makes chickenpox)
Causing Dysentery, nausea, vomiting, abdominal cramps and fatigue.
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What is Hemolytic-uremic syndrome or HUS?
HUS is a deadly condition in pediatric settings 5%. It is associated with kidney failure due to shigella. After a kidney stop functioning, we get high levels of urea in the blood which is highly toxic for the baby. Also the platelet levels are low.
It can be caused by also salmonella and E.coli.
Remember: ask to the patient that name, gender,meds and travel history.
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True or false?
We treat diarrhea by antibiotics.
False ABs make it worse, rehydration or injecting drips.
250
Having high amount of platelets called(1) and low amount called(2)
1-thrombocytosis
2-thrombocytopenia
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Campylobacter jejuni can be found in which type of food?
Poultry foods like eggs and milk and contaminated water. Typically caused by undercooked poultry meat. Prevalent worldwide. Symptoms are similar to other infections such as diarrhea nausea etc.
Symptoms more severe in babies such as all GI tract infections.
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Vibrio species can be transmitted by
Sea foods like crabs, prawns and shellfish. Hepatitis A can be transmitted by sea foods which is hepatotoxic.
V.cholerae, V.parahaemolyticus and V.vulnificus include some species.
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A man is swimming near a sewage dump and he had a scar in this arm and he get sepsis due to which microbe? (Think about microbes in contaminated water)
Vibrio vulnificus
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When colon is infected what does it make?
Diarrhea because when it is infected it makes the quite opposite job normally it absorbs water but in case of infection it pumps out water causing diarrhea. Because of intoxication.
255
Salmonella is extracellular pathogens. True or false?
False they are intracellular
256
There are 2 types of salmonella infections which are
Typhoidal and non-typhoidal. Typhoidal is the severe form of the salmonella. S.typhi and S.paratyphi cause typhoid infections.
257
Symptoms of salmonella infection?
Diarrhea, vomiting, abdominal pain and cramps. Infections generally caused by typhoidal types. Typhoidal ones are dangerous because they can penetrate the intestinal wall and cause sepsis. Typhoidal ones are not seen in the western world.
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Can salmonella cause cutaneous rash in babies?
Yes. Most of the gastroenteric infections in babies cause cutaneous rash.
259
Is there any vaccines for salmonella?
Yes one IV and one in forms of pills. Pills make IgA immunity.
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Clinical case: a mother bring her baby and baby has cutaneous rash what are you asking to the mother?
Rash in babies can indicate several cases. Firstly i would ask about medications. Some medications can induce allergic reactions in babies.
Ask about travel history or baby might have eaten sth unusual.
Most important one is the how long ago did the rash appear.
Be careful about dogs, cats and birds.
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Clinical case: 80 yo patient who is hospitalized for last 6 months. Suddenly she gets diarrhea what could be the reason?
Clostridium difficile. Prolonged usage of ABs cause dysbiosis in the patient microbiota. C.difficile not affected from ABs because it can make spores. After other commensal bacteria died C.difficile takes control in the colon.
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Clostridium difficile cause in the colon
Pseudomembranous colitis and the perforation of the colon. Once the colon is perforated we get sepsis and in the past most of the patients have died because of this nasty disease.
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How can we treat C.difficile
Fecal transplantation to restore microbiota. Commensal bacteria will take care of it by competing against space and nutritients.
A pill which contains commensal bacteria.
264
What is Erythema migrans?
What is the agent causing this?
Erythema migrans(EM) is a distinct type of rash, one circle in inside the other looks like a bulls eye. They tend to enlarge by time and disappear.
Caused by Borrelia burgdorferi which is transmitted by ticks.
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What is Lyme disease?
It is a disease transmitted by ticks which carries Borrelia burgdoferi. Erythema migrans is one of the main symptoms. The rash is smooth unlike fungal infections.
Borrelia burgdoferi causes severe problems with the heart,lungs,liver, paralysis of the face, spleen and finally brain fog(10%).
266
What is the therapy for the Lyme disease?
Doxycycline, in case of pregnancy we can use amoxicillin/azithromycin.
267
When we remove the tick do we use or don’t use chemicals?
We don’t use chemicals, because chemicals make the tick vomit inside the bite.
Remember that tick secrete anticoagulants.
268
What happens if Borrelia burgdoferi reaches the brain?
Neuroborreliosis(end stage 10-15%) which affects cognitive functions, blurred vision, vocal cords(Justin bieber) mood or memory.
269
What is Rickettsiosis?
Transmitted by ticks, intracellular bacteria Rickettsia.
Therapy doxycycline
Ruptures on the skin, look like a lot of pimples.
270
What is TBE?
Tick borne encephalitis, present in throughout Europe. TBE pretty much asymptomatic but in 2-3% of cases might develop meningitis or mixed condition called meningoencephalitis.
Can be seen in elderly or Immunocompromised patients.
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What is brucellosis?
B.melitenis for example
Also known as undulant fever
Especially be careful which foods?
Transmitted from cattles, cows or dogs. Very common in farmers or people working with animals.
Brucellosis caused by ingestion of unpasteurized milk, homemade cheese or undercooked meat from infected animals.
Also known as undulant fever, Malta fever, and Mediterranean fever associated with sweating at night(same symptoms as Hodgkin lymphoma), joint and muscle pain, nausea, vomiting, weight loss, abdominal pain.
Undulant fever- bir inen bir çıkan ateş.
2% brucellosis can cause meningitis.
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What is the most important symptom of the Brucellosis?
Undulant fever or night sweats.
273
How to treat Brucellosis?
Gentamicin IM injection.
Remember Gentamicin is ototoxic patient may fell pain in the injection area. It targets 30S bacterial ribosome.
274
Cat scratch disease caused by
Bartonella henselae. Gram negative bacteria found in cat’s saliva.
275
Bartonella henselae causing symptoms in which type of patients?
Pediatric settings.
276
What are the symptoms for cat scratch disease?
Abscess on the side where scratch happened(unilateral)
Fever might be present
Abscess found in the neck or behind of the ear or in the armpits.
277
How to treat Bartonella henselae infection or cat scratch disease?
Azithromycin. In adults infection resolve spontaneously like legionella pneumophila.
278
What is Toxoplasma gondii?
Eukaryotic parasite, has a complex life cycle. Transmitted by cat’s feces. If feces contaminate soil or a food it can be transmitted to humans. Real risk factor is pregnant women in first trimester(because they are immunosuppressed).
If mother transmit the parasite to the fetus it can cause malformations in the fetus. But fetus doesn’t have to present symptoms it is dependent to mother’s immune system.
279
Immunodepressed patients such as HIV what happens if they get T.gondii?
Brain lesions can be seen in CT scan. When the infection reaches the CNS symptoms are hemiparesis(partial paralysis) and epileptic episodes.
280
Can a patient with T.gondii infection spread the disease?
No. It is a one way infection such as legionella pneumophila.
281
What can be preventative measures for pregnant women?
-avoid undercooked meat
-always wash vegetables before eating
-avoid touching cat’s litter.
282
How can we assess the immune system of the pregnant woman against toxoplasma gondii?
Serology testing like in the case of CMV.
283
What are the antibiotics that can be prescribed to pregnant woman?
-amoxicillin
-azithromycin
Penicillin
You can prescribe folic acid supplements for the fetus’s development of CNS.
284
What is neonatal jaundice?
Babies hematocrit levels are so high meaning the percentage of RBC to all blood cells is higher than adults. After delivery they destroy RBC and releasing the bilirubin. It can stick to the skin or in rare cases attaches to the brain stem. It can even cause a condition like Parkinson’s.
285
A type of medications to treat hypertension but it cause dry cough?
Ramipril or Captopril inhibiting ACE2. This medications are used to treat hypertension or post-myocardial infarction.
286
Mycobacterium bovis
Cause tuberculosis but it is zoonotic meaning transmitted from animals such as cows or cattle’s. It is similar to tuberculosis.
Such symptoms can be caoughing, chest pain, difficulty in breathing, and night sweats.
287
TB treated with 4 drugs which are
Isoniazid(INH)
Rifampin(RIF)
Pyrazinamide(PZA)
Ethambutol(EMB)
288
What is lymphadenopathy?
Swollen lymph nodes especially in the neck or groin area.
289
An antidiarrheal agent commonly found in over-the counter medications?
Bismuth subsalicylate used to relieve symptoms of acute diarrhea. It works by reducing the inflammation in the intestine and slowing down the movement of fluids through the bowel. Can be used in a combination therapy for helicobacter pylori.
Travelers may use it to overcome traveller’s diarrhea.
290
Listeria monocytogenes cause infection of listeriosis which generally affecting
GI tract-diarrhea nausea, and abdominal pain.
In vulnerable patients it can cause meningitis and sepsis.
291
Haemophilus influenzae is a bacterium that can cause various infections in humans such as
1-meningitis
2-Pneumonia
3-Otitis media
292
Agents causing pneumonia in babies. They are viral
-Respiratory syncytial virus RSV
-Human metapneumovirus
-Parainfluenza virus.
