NMBE 16 Notes Flashcards
Phylogeny Nocardia
gram pos filamentous branching rod (like actinomyces israelii)
BUT obligate aerobe (actinomyces isreaelii is obligate anaerobe)
weakly acid fast - mycolic acid in cell wall
Where is nocardia found?
Soil, but does not make spores
Nocardia, catalase ?
Positive
CGD patients are at increased risk of infection with cat pos organisms
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
Nocardiosis
dont have to have all the symptoms (ie cutaneoue nocardiosis can stand alone)
tx w/ sulfonamides
Tx for actinomyces
Penicillin
Large gram positive rods in chains
Bacillus anthracis
obligate aerobe
forms spores
Strep pneumo, capsule?
Yes
Capsule of bacillus anthracis is unique how?
Made of protein - poly-D-glutamate
LF and EF (both must be present to cause symptoms)
Bacillus anthracis toxins
EF - increase in cAMP
LF - protease that cleaves MAP kinase –> tissue necrosis in black eschar
Tx for anthrax
Fluoroquinolones or doxycycline
Cestode is a fancy word for
tapeworm
Intermediate for tenia saginata
cattle
t. solium - pig - characteristic hooks
Ingest tenia eggs –>
neurocystercircosis
water contaminated with animal feces
swiss cheese on head CT, seizures or hydrocephalus
regular cysterciscosis –> can be cutaneous, or anywhere in the body
Ingest tenia cysts –>
teniasis
GI problems or asymptomatic
Tx tenia
Praziquantel
If neurocystercircosis –> add albendazole
How to dx fish tapeworm
Proglottid segments on stool O&P
Eggshell calcifications in liver mass
Echinochocis - sheep tapeworm
If cysts rupture –> anaphylaxis
Main virulence factor for strep pneumo
Polysaccharide capsule
Other virulence factor is IgA protease –> invasion and colonization of mucosa
Strep pneumo is optochin ___
sensitive
viridans is optochin resistant
Lancet shaped gram positive diplococci
Strep pneumo
Strep pneumo is bile ___
soluble
MOPS
Strep pneumo pneumonic: Meningitis Otitis Media Pneumonia Sinusitis #1 cause of all these diseases
Tx strep pneumo
Erythromycin (Macrolide);
Ceftriaxone;
Strep viridans capsule?
No (jester costume)
but he is bile resistant!
Endocarditis of previously damaged heart valves
Strep viridans
adheres to fibrin and platelets - dextrans (glue)
Defect in lysosomal trafficking enzyme;
LYST gene
MT dysfunction in phagosome-lysosome fusion;
AR
Chediak-Higashi syndrome
peripheral neuropathy mild coagulation defects pancytopenia recurrent pyogenic infections partial abinism
Delayed separation of umbilical cord
Leukocyte adhesion deficiency
Absence of neutrophils at sites of infection
Defect in LFA-1 integrin (CD18) protein in phagocytes
AR
Impaired migration and chemotaxis
Cutaneous T-cell lymphoma
Adults
CD4+ T -cells with “cerebriform” nuclei
Rash
Mycosis fungoides
May progress to Sezary syndrome (T-cell leukemia)
Sideroblastic anemia
What vitamin deficiency as possible cause?
B6 (pyridoxine) –> activatef to pyridoxyl phosphate
water soluble
involved in heme synthesis and protein catabolism
Main function of vitamin E (alpha-tocopherol)
free radical scavenger
kallikrein
serine protease
unregulated action of kallikrein –> increase in bradykinin –> angioedema (hereditary w/ C1 esterase deficiency)
Class and function - Lamivudine
NRTI
competitively binds RT and terminates DNA chain
HIV therapy
Other NRTIs - Abacavir, Didanosine, Emtricitabine, Stavudine, Tenofovir, Zidovudine
NRTI Didanosine for HIV has what notable SE?
Pancreatitis
Class and Function - Nevipiramine
NNRTI
HIV therapy
Binds to RT at different site than NRTI, does not require phosphorylation to activate
Other NNRTIs - Delavirdine, Efavirenz
Class and function - Indapamide
thiazide-like diuretic
sulfonamide
HTN and decomp HF
Function and indication - Clomiphene
Estrogen receptor antagonist in hypothalamus
Prevents normal feedback inhibition of LH and FSH to stimulate ovulation
Tx PCOS infertility
Class and function - Phenoxybenzamine
Nonselective, irreversible alpha blocker
Tx Pheochromocytoma to prevent hypertensive/catecholamine crisis
Indications for Clonidine
Sympatholytic - alpha-2 agonist –> reduces sympathetic outflow
ADHD, Tourette
limited application in hypertensive emergency
Premature ovarian failure, FSH and LH levels?
High
Turner syndrome is one cause
Cardiac anomalies in Turner syndrome
Bicuspid aortic valve (most common)
Coarctation of the aorta
Aortic root dilation w/ increased risk of aortic dissection
“Seronegative” means
absence of rheumatoid factor
ie ankylosing spondylitis
Aphasia
Seizures, HA, fever
Necrosis and hemorrhage of medial temporal lobes
Primary HSV-1
S3 gallop
Mitral regurgitation
increased filling mid-diastole
