NMBE 16 Notes

Question 1

Phylogeny Nocardia

Answer 1

gram pos filamentous branching rod (like actinomyces israelii)
BUT obligate aerobe (actinomyces isreaelii is obligate anaerobe)

weakly acid fast - mycolic acid in cell wall

Question 2

Where is nocardia found?

Answer 2

Soil, but does not make spores

Question 3

Nocardia, catalase ?

Answer 3

Positive

CGD patients are at increased risk of infection with cat pos organisms

Question 4

Immunocompromised status;
Men affected more than women;
pneumonis w/ lung abscess formation - cavitary lesions
affinity for neural tissue - brain abscesses;
cutaneous symptoms - pyogenic response with indurated lesions

Answer 4

Nocardiosis
dont have to have all the symptoms (ie cutaneoue nocardiosis can stand alone)

tx w/ sulfonamides

Question 5

Tx for actinomyces

Answer 5

Penicillin

Question 6

Large gram positive rods in chains

Answer 6

Bacillus anthracis
obligate aerobe
forms spores

Question 7

Strep pneumo, capsule?

Answer 7

Yes

Question 8

Capsule of bacillus anthracis is unique how?

Answer 8

Made of protein - poly-D-glutamate

Question 9

LF and EF (both must be present to cause symptoms)

Answer 9

Bacillus anthracis toxins
EF - increase in cAMP
LF - protease that cleaves MAP kinase –> tissue necrosis in black eschar

Question 10

Tx for anthrax

Answer 10

Fluoroquinolones or doxycycline

Question 11

Cestode is a fancy word for

Answer 11

tapeworm

Question 12

Intermediate for tenia saginata

Answer 12

cattle

t. solium - pig - characteristic hooks

Question 13

Ingest tenia eggs –>

Answer 13

neurocystercircosis
water contaminated with animal feces
swiss cheese on head CT, seizures or hydrocephalus

regular cysterciscosis –> can be cutaneous, or anywhere in the body

Question 14

Ingest tenia cysts –>

Answer 14

teniasis

GI problems or asymptomatic

Question 15

Tx tenia

Answer 15

Praziquantel

If neurocystercircosis –> add albendazole

Question 16

How to dx fish tapeworm

Answer 16

Proglottid segments on stool O&P

Question 17

Eggshell calcifications in liver mass

Answer 17

Echinochocis - sheep tapeworm

If cysts rupture –> anaphylaxis

Question 18

Main virulence factor for strep pneumo

Answer 18

Polysaccharide capsule

Other virulence factor is IgA protease –> invasion and colonization of mucosa

Question 19

Strep pneumo is optochin ___

Answer 19

sensitive

viridans is optochin resistant

Question 20

Lancet shaped gram positive diplococci

Answer 20

Strep pneumo

Question 21

Strep pneumo is bile ___

Answer 21

soluble

Question 22

MOPS

Answer 22

Strep pneumo pneumonic:
Meningitis
Otitis Media
Pneumonia
Sinusitis
#1 cause of all these diseases

Question 23

Tx strep pneumo

Answer 23

Erythromycin (Macrolide);

Ceftriaxone;

Question 24

Strep viridans capsule?

Answer 24

No (jester costume)

but he is bile resistant!

Question 25

Endocarditis of previously damaged heart valves

Answer 25

Strep viridans

adheres to fibrin and platelets - dextrans (glue)

Question 26

Defect in lysosomal trafficking enzyme;
LYST gene
MT dysfunction in phagosome-lysosome fusion;
AR

Answer 26

Chediak-Higashi syndrome

peripheral neuropathy
mild coagulation defects
pancytopenia
recurrent pyogenic infections
partial abinism

Question 27

Delayed separation of umbilical cord

Answer 27

Leukocyte adhesion deficiency
Absence of neutrophils at sites of infection
Defect in LFA-1 integrin (CD18) protein in phagocytes
AR
Impaired migration and chemotaxis

Question 28

Cutaneous T-cell lymphoma
Adults
CD4+ T -cells with “cerebriform” nuclei
Rash

Answer 28

Mycosis fungoides

May progress to Sezary syndrome (T-cell leukemia)

Question 29

Sideroblastic anemia

What vitamin deficiency as possible cause?

Answer 29

B6 (pyridoxine) –> activatef to pyridoxyl phosphate
water soluble
involved in heme synthesis and protein catabolism

Question 30

Main function of vitamin E (alpha-tocopherol)

Answer 30

free radical scavenger

Question 31

kallikrein

Answer 31

serine protease

unregulated action of kallikrein –> increase in bradykinin –> angioedema (hereditary w/ C1 esterase deficiency)

Question 32

Class and function - Lamivudine

Answer 32

NRTI
competitively binds RT and terminates DNA chain
HIV therapy

Other NRTIs - Abacavir, Didanosine, Emtricitabine, Stavudine, Tenofovir, Zidovudine

Question 33

NRTI Didanosine for HIV has what notable SE?

Answer 33

Pancreatitis

Question 34

Class and Function - Nevipiramine

Answer 34

NNRTI
HIV therapy
Binds to RT at different site than NRTI, does not require phosphorylation to activate

Other NNRTIs - Delavirdine, Efavirenz

Question 35

Class and function - Indapamide

Answer 35

thiazide-like diuretic
sulfonamide
HTN and decomp HF

Question 36

Function and indication - Clomiphene

Answer 36

Estrogen receptor antagonist in hypothalamus
Prevents normal feedback inhibition of LH and FSH to stimulate ovulation
Tx PCOS infertility

Question 37

Class and function - Phenoxybenzamine

Answer 37

Nonselective, irreversible alpha blocker

Tx Pheochromocytoma to prevent hypertensive/catecholamine crisis

Question 38

Indications for Clonidine

Answer 38

Sympatholytic - alpha-2 agonist –> reduces sympathetic outflow
ADHD, Tourette
limited application in hypertensive emergency

Question 39

Premature ovarian failure, FSH and LH levels?

Answer 39

High

Turner syndrome is one cause

Question 40

Cardiac anomalies in Turner syndrome

Answer 40

Bicuspid aortic valve (most common)
Coarctation of the aorta
Aortic root dilation w/ increased risk of aortic dissection

Question 41

“Seronegative” means

Answer 41

absence of rheumatoid factor

ie ankylosing spondylitis

Question 42

Aphasia
Seizures, HA, fever
Necrosis and hemorrhage of medial temporal lobes

Answer 42

Primary HSV-1

Question 43

S3 gallop

Answer 43

Mitral regurgitation

increased filling mid-diastole