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DERM EXAM 2 > OLD MICRO > Flashcards

OLD MICRO Flashcards

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1
Q

Which dermatologic virus is vaccinated using a vaccine containing a different virus than that which is being vaccinated against?

A

Smallpox is vaccinated for with a live cowpox vaccine

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2
Q

Where do most of the subcutaneous mycoses come from?

A

soil

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2
Q

What viral family is measles in?

A

paramyxoviridae

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3
Q

Define papule

A

discrete, pus-filled, raised lesion

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3
Q

What may staph folliculitis progress to?

A

First a furuncle which is essentially a boil or abscess, then a carbuncle which is a furuncle that has gone deeper and spread laterally through the fascia

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3
Q

What kind of systemic infections can Trichosporon cause? What enzyme is it positive for in the lab?

A

Endocarditis of prosthetic valve or on native valve if IVDU; urease

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3
Q

Which dermatophytoses are most common in A) Men and B) Women?

A

A) tinea capitis, tinea pedis, and tinea cruis B) tinea unguinum

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3
Q

How does Sporothrix spread?

A

along the chain of lymphatics

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3
Q

What is contained in the granules of a Mycetoma?

A

microcolonies of the agent embedded

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4
Q

How is staph aureus transmitted?

A

direct contact or fomites

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4
Q

An antibody to what is being detected in the non-treponemal test?

A

cardiolipin

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4
Q

How are HPV and MCV transmitted?

A

direct contact and fomites

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4
Q

When did routine smallpox vaccinations stop in America? When was it GLOBALLY eradicated?

A

1972, 1979

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4
Q

What is the most common complication of shingles?

A

post-herpetic neuralgia

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5
Q

Compare the rash of RMSF to Scrub typhus. What are the causal agents, respectively?

A

RMSF is a centripetal rash from palms and feet to trunk. Scrub typhus is trunk and outward; Ricketsia rickettsii and Orentia Tsutsugamushi (the greatest name in all of microbiology)

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5
Q

Gram stain and virulence factor for Clostridium perfringens

A

Gram positive anaerobic rod, alpha toxin = lecithinase (lecithinase breaks down lipids in the cell membrane leading to cell death)

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6
Q

Define vesicle

A

fluid-filled, raised lesion 5 mm or less

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8
Q

What is the most common zoophilic cause of tinea capitis worldwide?

A

Microsporum canis

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9
Q

What is a kerion?

A

an intense, painful, and boggy suppurative reaction often on the back of the neck and associated with cervical lymphadenopathy.

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9
Q

What immune response is needed to control Candidal infections?

A

T cell

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9
Q

What is the most important historical feature of HHV-6?

A

Extremely high fever that abruptly stops and then there is a maculopapular rash

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9
Q

If you are not vaccinated against VZV, what is the probability you will be infected when exposed to someone with it?

A

90%

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10
Q

Which strains of HPV are responsible for dysplasia of the cervix and white plaques

A

16 and 18

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11
Q

What virus causes herpangina?

A

Coxsackie A–this is basically hand, foot, and mouth without the hand and foot. And it isn’t caused by the same serotype? So I guess it’s actually completely different. Whatever.

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12
Q

How does staphylococcal protein A work?

A

Binds Fc portion of IgG to inhibit complement activation

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12
Q

Why is possible to achieve lifelong immunity with measles?

A

there is only 1 antigenic type of measles

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13
Q

What is the causal agent of rat bite fever?

A

Streptobacillus moniliformis

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13
Q

What is infected by Ricketsia ricketsii?

A

vascular endothelial cells, it is obligate intracellular

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14
Q

What family is molluscum contagiosum in?

A

poxviridae

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15
Q

How would you differentiate between the two causes of tinea capitis that fluoresce?

A

HISTORY, Microsporum canis is from an animal and Microsporum andouini is from a human

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16
Q

Regarding the appearance of the rash (not evolution of) how is measles different from german measles?

A

Germn measles is lighter in color (pink)

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17
Q

What is associated with leonine facies?

A

Lepromatous leprosy

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17
Q

What is a dermatophytid?

A

It is a secondary rash to the dermatophyte, it is caused by the immune system so there are no fungi present

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18
Q

Where do the following replicate A) HPV B) HHV-6 C) B19 D) HHV-8

A

A) mature keratinocytes (infects basal) B) T and B cells C) erythroid precursor cells D) vascular endothelial cells

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19
Q

What bugs cause impetigo? Bullous impetigo?

A

Impetigo is both staph aureus and group A strep; bullous impetigo is staph aureus only

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20
Q

Above what age must a child be to receive the Menomune vaccine to meningococcus?

A

2

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20
Q

Name the 3 enveloped DNA families

A

Hepadnaviridae, herpesviridae, and poxviridae

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21
Q

What is unique of the cell walls of Hortae werneckii?

A

They are melanized, it is a dematiaceous fungus

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22
Q

What is the major demographic you are concerned about in terms of complications, for B19?

A

sickle cell (and, though not mentioned, thalassemias as well)

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23
Q

Who would be most at risk of a dermatophyte becoming a chronic issue?

A

Can happen in anyone but HIV and IC

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25
Q

Gram stain of Pastuerella multocida?

A

Bipolar gram negative rods and oxidase positive

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26
Q

T/F: a Vibrio vulnificus infection can be contracted from warm seawater and is an extremely painful but self-limiting infection

A

False, it is from warm seawater and it is painful but it is rapidly progressive and can lead to shock/death in 50% of cases

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27
Q

Which strains of HPV are most responsible for genital warts

A

6 and 11

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29
Q

Gram stain and shape of Proprionibacterium acnes

A

Gram positive rods

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31
Q

Name the 3 naked DNA virus families

A

Papovaviridae, Adenoviridae, and Parvoviridae

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32
Q

If a woman has rubella while pregnant, what is the likely outcome for the baby?

A

low birth weight, cataracts, deafness, MR, heart defects, diabetes (mulberry muffin)

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32
Q

What cells are infected by HPV? B19?

A

HPV infects basal cells of skin, B19 infects erythroid progenitor cells

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32
Q

What virus causes herpetic whitlow? Population at risk?

A

HSV; dental hygenists who don’t understand the concept of a glove

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33
Q

Why do people with lepromatous leprosy have flat noses?

A

Mycobacterium leprae destroys the septum of the nose

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33
Q

What profession may be likely to get Orf infections?

A

Taxidermists

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34
Q

What 2 bugs may cause impetigo?

A

Staph and strep pyogenes

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35
Q

What is significant about Neisseria spp. Pili?

A

They undergo antigenic variation

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35
Q

How would you differentiate between erythrasma and tinea cruis?

A

erythrasma = corynebacterium minutissimum fluoresces coral red with Wood’s lamp, tinea cruis does not fluoresce

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36
Q

What are the 3 types of Bacillus anthracis infection?

A

Pulmonary (mediastinal widening), GI, and cutaneous which is the most common

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38
Q

How is smallpox transmitted? How does it spread throughout the body?

A

Respiratory droplets, spreads via lymphatics

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40
Q

What causes white piedra? Black piedra?

A

White piedra = trichosporon spp; black piedra = piedraia hortae

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40
Q

Which mycetoma granules are dark red to black?

A

M. mycetomatis

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41
Q

What kind of virus is smallpox?

A

small pox = enveloped dsDNA

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42
Q

What is Ritter’s Disease? What is the major concern with it?

A

Scalded Skin Syndrome from the exfoliative toxins of staphylococcus; the main concern is dehydration and/or secondary infections

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43
Q

Where is the most likely location of hyphae in a tinea infection?

A

Stratum corneum; these are dermatophytes

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43
Q

Name the 4 dermatologic viruses that have systemic spread and an infectious rash

A

HSV-1,2, VZV, Variola, and Coxsackievirus

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45
Q

Between chickenpox and smallpox, which has lesions that would more closely resemble molluscum?

A

smallpox because they are often umbilicated

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46
Q

Name the 3 dermatologic viruses that do not involve systemic spread

A

Molluscum contagiosum (can be a marker of HIV), HPV, and ORF

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47
Q

Name 2 derm viruses that may result in the formation of syncytia

A

Herpes and measles

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48
Q

What is the genetic makeup for HHV-6 and HHV-8?

A

ds DNA, enveloped

49
Q

Where will you find a Cowdry Type A body? What does it tell you about the entirety of the herpesviridae family?

A

Intranuclear, HERPES VIRUSES REPLICATE IN THE NUCLEUS

50
Q

Which bug creates a rash that looks a bit like the lupus rash?

A

Streptococcus pyogenes–erysipelas

50
Q

Explain what determines whether a person who contracts Mycobacterium leprae will develop tuberculous leprosy or lepromatous leprosy

A

It is all dependent on the CMI, so if that is good they will only have tuberculoid leprosy (less severe). If they have poor CMI, they will develop lepromatous leprosy

51
Q

How do ya differentate smallpox from chickenpox clinically?

A

synchronous lesions in smallpox, variable staged lesions in chickenpox

53
Q

What are the bacterial agents to cause mycetoma (starred organisms)?

A

Actinomyces and Nocardia

54
Q

What are the 2 major complications of measles?

A

Pneumonia and Subacute Sclerosing Panencephalitis

55
Q

How do you get Sporothrix schencki? What area of the body is most commonly involved?

A

Usually from a thorn prick, often the hands

57
Q

What is Hansen’s disease?

A

Leprosy

58
Q

What is the difference between dermatophytoses and dermatomycoses?

A

Dermatophytoses are superficial cutaneous infections that only invade superficial layers; Dermatomycoses are similar but they go deeper than just the epidermis

59
Q

What disease may occur with Malassezia furfur in the presence of a catheter?

A

Catheter Associated Sepsis

60
Q

Please describe the evolution of the measles illness

A

Starts with a cold/flu like Sx 9-10 d after infection, in this they will have the classic cough, conjunctivitis, coryza, and PHOTOPHOBIA? Then they will get the rash behind ears and down (with koplick spots in mouth) 3 days later and it will progress to the feet by 6 d

62
Q

How do you get a chromoblastomycosis?

A

generally in tropical and subtropical areas on FEET exposed to infected soil? Agricultural workers and mine workers

63
Q

What is the name given to pigmented fungal cells in the pustules of a chromoblastomycosis?

A

Medlar body

65
Q

What is present in the blisters from scalded skin syndrome and bullous impetigo? What is different between these two?

A

Staphylococcal exfoliative toxins but NO BUGS. Bullous impetigo is a localized version of scalded skin syndrome

66
Q

What bug and virulence factor causes toxic shock syndrome?

A

Staphylococcus aureus; TSST-1

67
Q

How often does Clostridium perfringens divide?

A

every 12 minutes! Very rapid progression!

68
Q

Why does Pseudomonas cause hot tub folliculitis?

A

The heat opens up the pores and lets the bug in

69
Q

How does Dr. Kell pronouce “rash”?

A

Raysh

71
Q

Why is tinea versicolor a misnomer for pityriasis versicolor?

A

Tinea describes ringworm type infections, Malassezia furfur is NOT a ringworm

72
Q

Define macule

A

flat and circular lesion 5 mm or less in diameter

74
Q

What derm lesion is pathognomonic for Pseudomonas aeruginosa?

A

Ecthyma gangrenosum

76
Q

Genetic makeup of A) Measles B) rubella and C) B19

A

A) enveloped ssRNA B) enveloped ssRNA C) naked ss DNA

77
Q

Which strains of HPV are responsible for warts on fingers and knees?

A

2, 3, 10

78
Q

What does it mean for a fungus to be dematiaceous?

A

The hyphae and/or spores are darkly pigmented because they contain melanin granules

79
Q

Name the 4 superficial fungi (not the dermatophytes)?

A

Malassezia furfur (pityriasis versicolor); Horatea werneckii (tinea nigra); Trichosporon spp. (white piedra); Piedraia hortae (black piedra)

81
Q

What bug looks like a tennis racket on light microscope? What should you think if you see tennis rackets on EM?

A

Clostridium perfringens; Birbeck granules of Langerhans Histiocytosis

82
Q

T/F: both Piedraia hortae and Hortae werneckii are dematiaceous fungi?

A

True these are black piedra and tinea nigra, respectively

84
Q

Which gene allows for MRSA to be resistant to methicillin?

A

mecA (also resistant to nafcillin, dicloxacillin, and oxacillin)

85
Q

What exactly is entering the skin in a cutaneous anthrax infection?

A

endospores, not gram positive rods

87
Q

What is the major opportunist of the normal skin flora?

A

Staph epidermidis on prosthetic devices esp. > 3 months

87
Q

Genetic makeup of A) B19 B) HHV-6

A

A) naked ssDNA B) enveloped ds DNA

89
Q

What is the main virulence factor of s. epidermidis?

A

biofilm

90
Q

What are the names for the asexual and sexual forms of pityriasis versicolor?

A

Asexual = Malassezia furfur; Sexual = Pityrosporum orbiculare

92
Q

When a person has a mycetoma, which two organisms are most likely to cause a superinfection?

A

staph and strep (NF of the skin = most likely)

92
Q

If you have a biopsy with syncytia (and it is a derm question) how can you differentiate between herpes and measles WITHOUT clinical Hx?

A

Look for a Cowdry Type A body in the newclaus

93
Q

Define bulla

A

vesicle greater than 5 mm

95
Q

Describe the 3 basic mechanisms of pathogenesis that organisms can use to infect the skin or have skin manifestations

A

1) infection from a break in the skin 2) a skin manifestation of systemic infection (meningococcemia) or 3) toxin that circulates to infect the skin

96
Q

Where does the name Propionibacterium acnes come from?

A

The fact that they metabolize sebum into propionic acid

96
Q

What does Malassezia furfur look like on Wood’s lamp? On KOH?

A

Wood’s lamp = fluoresce bright yellow; KOH = spaghetti and meatballs

98
Q

What virus causes a blistering “rash” and is a picornavirus?

A

Coxsackie A and A16

99
Q

Name the 3 major dermatophytes

A

Microsporum, trichophyton, and epidermophyton floccosum

101
Q

How would you differentiate between tinea cruis and candida for jock itch?

A

Candida affects both the scrotum and thigh; Tinea cruis only affects the thigh? Yes I’m sure never in the history of the world has tinea cruis ventured to the scrotum

102
Q

Who gets Cat Scratch disease and who gets Bacillary angiomatosis? Caused by?

A

Cat scratch is Bartonella henselae in immune competent pt and Bacillary angiomatosis is Bartonella henselae in IC pts

103
Q

What is the most common dermatophyte fungus?

A

Trichophyton rubrum

104
Q

What is the difference in appearance between endothrix lesions and ectothrix lesions?

A

Endothrix = fungi inside hair shaft, hair breaks and does not leave black dots; Ectothrix = fungi outside of hair, hair breaks and leaves little black dots

105
Q

How is HPV transmitted?

A

direct contact and fomites

107
Q

Name the 4 dermatologic viruses that have systemic spread and a non-infectious rash

A

HHV-6, HHV-8, measles, and rubellla

108
Q

Why do teens get acne more so than other age groups?

A

Hormones trigger the production of sebum which results in “food” for Propionibacterium acnes (to metabolize into propionic acid)

110
Q

What are some ways (4) that the hyphal form of Malassezia furfur can be induced?

A

Increased temperature, high humidity, greasy skin (teens), hyperhidrosis

111
Q

What kind of virus are the Coxsackie viruses?

A

naked ss RNA picornaviruses

112
Q

In what sense is the rash of B19 similar to that in lupus?

A

It is on the face and is sensitive to sunlight

113
Q

Name the classic 5 childhood exanthems

A

rubella (german measles), rubeola (normal measles), roseola (HHV-6), chickenpox (VZV), and 5th disease or Parvovirus B19

114
Q

What antigen is missing from LOS in comparison to LPS?

A

the O antigen

116
Q

How do you get a mycetoma? What kind of inflammation?

A

Traumatic inoculation; granulomatous (subset of chronic)

117
Q

Discuss the 3 types of necrotizing fasciitis

A

Type I: polymicrobial, at least 1 anaerobe in combination with more than 1 facultative bacteria; Type II: streptococcus pyogenes with or without staph; Type III–gas gangrene, Clostridium perfringens

117
Q

How is the location of white piedra different from that of black piedra?

A

White piedra is facial, axillary, and pubic hair whereas black piedra is only on the face and scalp

118
Q

What are 2 important areas to look for the rash of secondary syphilis?

A

palms of hands and soles of feet

119
Q

What kind of capsule does B. anthracis have?

A

Poly D-glutamic acid

120
Q

Which strains of HPV are responsible for plantar warts?

A

1 and 4, flat and grow inward

121
Q

Which of the childhood exanthems will have a multinucleate giant cell under microscopy?

A

measles

Herpes is a derm virus with giant cells. But, thankfully, not a childhood exanthem.

122
Q

How can you treat necrotizing fasciitis? (3)

A

Surgical debridement and/or amputation; combination antibiotics; hyperbaric chamber

123
Q

Severe complications of viral infection of eczematous skin occur with ________

A

HERPES!

124
Q

Causal agent of the infamous fish tank granuloma

A

Mycobacterium marinum

125
Q

How can you differentiate (lab-wise) N. gonorrhea and N. meningitidis?

A

Meningitidis metabolizes maltose as well as glucose only whereas gonorrhea metabolizes glucose only (carty misspoke)

127
Q

Compare and contrast the incubation period of measles and german measles

A

German measles is 2-3 weeks, measles is only 9 days

128
Q

What is the key feature of ALL herpes viruses?

A

latency! i.e. nerve ganglia for HSV and VZV, B cells for EBV, etc? B/T cells for HHV-6

129
Q

What is erythema infectiosum? Exanthem subitum?

A

B19, HHV-6

130
Q

What is the vaccine type for measles?

A

MMR, live-attenuated

131
Q

In general, what is the most important virulence factor for Strep pyogenes?

A

M protein, it evades phagocytosis

132
Q

How do you grow Malassezia furfur? What is the likely significance of the fact that lesions occur in the distribution of sebaceous glands?

A

On solid media with olive oil since it requires long chain fatty acids to grow; sebum contains fatty acids!

133
Q

What is the transmission of A) measles B) rubella and C) B19

A

ALL = RESP DROPLETS

134
Q

How does a wart actually form in HPV infections?

A

when the virus infects basal cells (stratum basale) it stimulates cell division

135
Q

How does cutaneous anthrax present?

A

PAINLESS black eschar

136
Q

What family of virus is measles? German measles?

A

rubeola = paramyxoviridae, rubella = togaviridae

137
Q

What is the most likely cause of tinea capitis in the U.S?

A

Trichophyton tonsurans

138
Q

What kind of virus is measles? What family? What is the transmission? Incubation period?

A

enveloped ssRNA, paramyxoviridae, respiratory droplets, 9-10 d

139
Q

Regarding Mycobacterium leprae describe 1) Temperature requirements 2) Gram stain 3) Incubation period

A

1) grows in lower temps 32-34 C 2) No gram stain, it is acid fast rod 3) YEARS

140
Q

What kind of virus is molluscum contagiosum?

A

enveloped DS DNA virus (complex shape)

141
Q

What virus causes hand, foot, and mouth? What kinda, sorta, but not really all that similar disease is caused by fungus?

A

Coxsackie A16; two foot, one hand which is a tinea infection

142
Q

What is the most important virulence factor of the tineas?

A

keratinases to get through the stratum corneum

143
Q

Define patch

A

a macule (or group of macules that has coalesced) to become greater than 5 mm in diameter

145
Q

What kind of virus is orf and how is it transmitted?

A

enveloped DS DNA virus; sheep, goats, and reindeer

146
Q

How is smallpox transmitted? Chickenpox?

A

RESPIRATORY DROPLETS

148
Q

What 3 bugs should be on the differential for “jock itch”?

A

Erythrasma = Corynebacterium minutissimum; Tinea cruis, and candida

149
Q

Which mycetoma granules are white?

A

Pseudallescheria boydii

150
Q

How does one get Erysipelothrix rhusiopathiae? G stain?

A

GI tract of animals–causes erysipeloid; gram positive rods

151
Q

Which causal agent of a mycetoma may disseminate in HIV or IC pts?

A

P. boydii (white granules)

152
Q

What is the danger of tinea pedis? Why does the normal flora change?

A

Secondary infection from itching and–the normal flora changes because there are antibiotics produced by the fungus, this may also impact the secondary infection risk

154
Q

Describe how HPV infects

A

it is a naked dsDNA virus that infects the basal layers of skin but replicates in the mature layers

155
Q

T/F: the sandpaper rash of scarlett fever contains catalase negative cocci in chains

A

false, the sandpaper rash is formed from the pyrogenic exotoxins of strep, there are no bugs (Spe)

156
Q

What is the goal of the human microbiome project?

A

To determine ALL of the normal flora of the human body

157
Q

What is the causal agent behind Tinea nigra?

A

Hortae werneckii

158
Q

What will be the key piece of information in the H&P of a necrotizing fasciitis case?

A

The pain will be disproportionate to the appearance of the infected area

159
Q

What is the most common mode of transmission for a systemic mycosis?

A

respiratory (i.e. coccidiodes etc.)

160
Q

What causes erysipelas? Erysipeloid?

A

Erysipelas = Strep pyogenes; Erysipeloid = Erysipelothrix rhusiopathiae

161
Q

Which mycetoma granules are black?

A

M. grisea and E. jeanselmei

DERM EXAM 2 (7 decks)

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