My Questions.Codename:Thrilla In The Manila Flashcards
Immunoglobulin in charge of allergic reactions
IgE. Release of histamine, enlargement of vessels and decrease BP. Epinephrine counteract histamine.
Hormone causing immunosuppression in the first 3 months of pregnancy
Progesterone.
Cortisone 4 effects
Immunosuppressor
Higher food consumption
Hyperglycemia
Hair growth
What is SKID?
Genetic disease causing permanent immunosuppression
Which types of bacteria don’t have cell wall?
Mycoplasma(pneumonia) and ureaplasma(urethritis).
Urethritis is the inflammation of the urethra.
2 types of bacteria that makes spores?
Bacillus and Clostridium.
Transmitted through rusty material or soil.
Endotoxins produced by 1
Exotoxins produced by 2
1-G negative LPS
2-G positive
Enterotoxins?
Acting on intestinal cells, pumps out water and electrolytes causing diarrhea or dysentery.
Neurotoxins made by ( bacteria that makes spores)
Clostridium tetani and C. botulinum. Spores from soil or rusted iron.
What does tetanus neurotoxin
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.
How does botulinum neurotoxin works ?
Block the release of acetylcholine from presynaptic neuron. Impulse present but not transmitted. Flaccid paralysis. Muscles are not responding to stimuli.
Botox
What is penicillin’s upgraded form?
Cephalosporins
How does glycopeptides target cell wall
Prevents the addition of new units to peptidoglycan. Tersten
Glycopeptides are
Ototoxic if administered IV hearing loss or impairment.
ABs acting on cell membrane
Toxic. Polymyxins group; colistin, daptomycin.
Last hope
Azithromycin is
Used for patients allergic to penicillin. Good AB. In macrolides class.
Chloramphenicol cause
Grey baby syndrome if used in the pregnant women. Heavily hepatotoxic.
Tetracyclines are able to
Stain teeth and bones avoid in pediatrics and pregnant women.
Fluoroquinolones target
Topoisomerases which unwinds DNA in replication.
Give 3 examples for fluoroquinolones
Ciprofloxacin, levofloxacin, moxifloxacin.
Fluoroquinolones used to treat (5)
Pneumonia, chlamydia, STDs and abdominal infections and cystitis( bladder infection)
Fluoroquinolones side effects 3
Stick to cartilage, tendon rupture prolonged QT waves.
ABs targeting RNAs synthesis
Rifamycins such as rifampin. Good ABs used for TB and they can pass BBB thus used for meningitis.
ABs targeting bacterial metabolism inhibit what
Folic acid synthesis. Important for cell replication and spinal development. Sulfonamides (izoniazid-TB)
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)
ABs that are safe to use during pregnancy (4)
Penicillin, Amoxiclav, cephalosporins, Azithromycin.
What is an Antibiogram?
Test to determine the effectiveness of an AB against a specific microbe.
What is MIC?
Minimum concentration of an AB preventing the visible growth of bacteria.
What is MBC?
Minimum bactericidal concentration. Min amount of an AB to kill that kind of bacteria.
True or false?
MBC always lower than the MIC.
False. MBC always greater than the MIC or at least same.
Fungi’s cell wall composed by
Chitosan.
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.
Fungal cells have similar ribosomes to human’s ribosomes. True or false
True
Fungal cell produce mycotoxins such as
Aflatoxins, ochratoxins,fumonisins, trichothecenes, citrinin. Which contaminates our food.
Mycotoxins can lead to
Hepato/nephro toxicity and cancer. Some Mycotoxins have hallucinogenic properties.
Fungi can make allergic reactions such as
Penicillin
Fungi infection which part of the skin?
Cutaneous involving nails, hairs, feet, hands and soft skin.
Infections caused by fungi are called (1)
Whereas skin infections caused by fungi are called (2)
1- mycoses
2-tinea
Candida?
Vaginal infection of yeast cells which yields in milky discharge.
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.
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.
Which drugs are used for inhibiting biosynthetic pathway of ergosterol?
Azoles(vaginal candida) and allylamines.
Azoles: clotrimazole fluconazole, Itraconazole, miconazole, voriconazole.
Describe polyenes?
Bind to ergosterol, disrupts the cell membrane leading to leakage and cell death. Extremely toxic only used in ICU for systemic infections.
Amphotericin B is (polyenes)
Administered parenterally and highly nephro/neuro toxic at high dosage.
Nystatin is meant for
Topical use only, to treat oral and esophageal candidadis.
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.
Flucytosine (antifungal)
Inhibits nucleic acid synthesis, used in systemic infections and chemotherapy.
Flucytosine+ Amphotericin B used for
Cryptococcal meningitis which is transmitted by pigeons.
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.
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.
Risk factors for STDs?
Multiple sexual partners, unprotected sexual intercourse, young age.
Most STDs can be transmitted to fetus during the birth by the contact of maternal blood. T or F?
True
STDs can cause
Cancer(HPV), infertility(chlamydia and Neisseria gonorrhea), arthritis(Neisseria gonorrhea) or multiorgan conditions(syphilis).
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.
Syphilis caused by which gram negative bacteria? And how many stages does it have?
Caused by Treponema pallidum. 3 stages.
What is 1° syphilis
Right after sexual intercourse (3-90)
Ulcerations in vagina/penis/mouth.
Not painful(can spread the disease)
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.
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)
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.
Neisseria gonorrhea asymptomatic in women and symptomatic in men. Bel soğukluğu
True, continuous flow of pus from the penis.
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.
Fitz-Hugh-Curtis disease
Caused by either N. gonorrhea or chlamydia trachomatis. Bilateral abdominal pain. Adhesions between liver capsule and peritoneum. Causing great pain.
Can N. gonorrhea cause arthritis?
Yes
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
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.
For treatment of Chlamydia trachomatis which ABs can be used (2)
Azithromycin or erythromycin (acting on ribosomes)
Doxycycline.
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.
How can you diagnose chlamydia trachomatis?
Serology or PCR.
It can lead to urethritis, cervictis, salpingitis(inf. of fallopian tubes) and PID.
Which is more frequent chlamydia trachomatis or Neisseria gonorrhea?
C. trachomatis
Lymphogranuloma venerum caused by specific germs of Chlamydia trachomatis.
T or F?
True
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)
Bacterial vaginosis is a STD.
T or F?
False. Dysbiosis of vagina favors the manifestation of bacterial vaginosis thus not STD.
Bacterial Vaginosis easily recognized by smell and color of discharge which are
Grey color and dead fish smell.
Which bacteria associated with acidic ph of vagina?
Lactobacilli. Prevents candida and BV.
Which are the bacteria’s associated with BV?
Gardnerella vaginolis and Mobiluncus spp.
Symptoms of BV?
Itching, pain and difficulty in urination and vaginal discharge
Diagnosis of BV?
Measure ph of the vagina(>4,5)
Ask about smell of the discharge.
What do you suggest eating a woman with BV?
Yogurt and cheese which are rich in lactobacilli.
Candida albicans causing vaginal infection is a STD. True or false?
False, it’s a result of dysbiosis causing yeast overgrowth.
Symptoms of vaginal yeast infection?
Vaginal itching and discharge(white discharge).
Also white patches in the mouth
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)
How to treat VYI?
Probiotics, intravaginal miconazole, nystatin.
Why UTIs are more common in women?
Short urethra facilitating contamination.
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.
What is the pathway of UTIs?
Urethritis-cystitis-prostatitis-pyelonephritis-nephritis-sepsis.
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.
High concentration of neutrophils in urine blood or CSF caused by
Bacterial infection
High concentration of lymphocytes in urine blood or CSF caused by
Viral infection
High concentration of eosinophils in urine blood or CSF caused by
Fungal infection
Risk factors for UTIs?
Being female
Benign prostatic hyperplasia
Obstruction(catheters, kidney stones)
Poor hygiene
Pregnancy
Diabetes mellitus type2
What is oliguria?
Limited urination(50-400 mL), can be seen in patients about to die.
In healthy patients (800-2000mL)
Sepsis can be seen in patients (patient types)
Immunocompromised patients, severe burnt patients, UTI, catheters, uncompensated diabetes.
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
High CRP levels in the blood test indicates
Inflammation in the body. It can be autoimmune, fungal, bacterial, viral or heart attack.
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.
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.
For the treatment of sepsis what is the first thing you must do?
Obtain hemoculture and send it to the lab.
What is the Second step in the sepsis treatment
Restore blood pressure at least 65mmHg. Inject crystalloids and maybe even adrenaline shots.
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.
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.
Neonatal sepsis generally occur babies born with
Natural birth as they come in contact with the birth canal differently from C-section.
Main risks for neonatal sepsis?
Mothers with STDs(N. gonorrhea) and premature birth.
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.
Which microbes are causing Late onset sepsis(after 48 hours)?
Staphylococcus aureus.
Candida spp
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
Symptoms for endocarditis?
Fever
Septic symptoms
Heart murmur
Abnormal ECG
What is biofilm?
A bacterial slime don’t block ABs like a sheet. For example in the teeth and heart valves.
Staphylocci is gram (1)
And it looks like (2)
1-gram positive
2-spherical, looks like bunch of grapes
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)
Staphylococcus aureus is
Gram (1)
Coagulase and catalase (2)
Positive
Positive
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.
Staphylococcus aureus can produce toxins. T or F?
True. Dangerous for Immunocompromised patients in hospitals.
What happens if S.aureus infect skin
Abscesses or sepsis. Especially MRSA. It is the main cause of skin infections
S.aureus target which skin tissue?
Hypodermis is rich in adipose, microbes target and consume it especially colonize the hair follicles.
Sebum production is favored by what?
Estrogen and testosterone hormones. Or birth control pill.
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.