Our Clues 2 Flashcards by HM Beyea

What are the infections that cause cold agglutination?
(Elev IgM titers)

Cryoglobulinemia

I AM HE
- Influenza
- Adenovirus
- Mycoplasma
- Hepatitis B & C
- EBV

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Most common viral cause of bronchiolitis/croup

Most severe viral cause of bronchiolitis/croup

Other viral causes of bronchiolitis/croup

Parainfluenza (80%) - mild

RSV (15%) - severe, hospitalized

Adenovirus & influenza

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Most common causes of cystitis

Adenovirus
- virus always #1 cause

E. coli
Proteus
Klebsiella

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Most common viral cause of gastroenteritis
- adults
- children
- recent travel

Adenovirus

Rotavirus (not immunized)
Norovirus (immunized)

Norwalk agent

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Most common viral cause of myocarditis and pericarditis

Coxsackie B

Myo
- leads to loss of contractility (S3 murmur)
- diffuse ST depression

Peri
- causes friction or triphasic rub
- may lead to cardiac tamponade
- diffuse ST elevation

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Which hepatitis is the only DNA virus?

Hepatitis B
- DNA hepadnavirus

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Which hepatitis is associated with high mortality in pregnant women?

Hepatitis E
- RNA HepEvirus

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Which hepatitis is associated with shellfish?

Hepatitis A
- RNA picornavirus
- Councilman bodies on liver biopsy

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Why does hepatitis D require coinfection with hepatitis B?

Hep D uses Hep B surface antigen

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How would you differentiate chronic hepatitis C from active vs persistent?
Treatment?

Chronic Active Hep C
- pos inflammation
- pos fibrosis
- incr risk cirrhosis & cancer

Treatment: Ledipsavir/sofosbuvir combo

Chronic Persistent Hep C
- elevated liver enzymes or persistent symptoms >6 mo
- neg inflammation
- neg fibrosis

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What stage of hepatitis B?
- neg HBeAg
- pos anti-HBc
- neg active inflammation
- neg fibrosis
- pos elevated liver enzymes >6 mo

Transmission risk?

Chronic persistent hepatitis

Transmission: No, b/c no HBsAg or HBeAg

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What stage of hepatitis B?
- pos anti-HBs
- pos HBsAg
- pos anti-HBc
- pos HBeAg
- pos symptoms >6 mo
- pos active inflammation
- pos fibrosis

Transmission risk?

Chronic active hepatitis

Transmission: yes, has both HBeAg and HBsAg

Incr risk of cancer & cirrhosis

Treatment: interferon & lamivudine

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What stage of hepatitis B?
- pos HBsAg >6 mo
- neg active inflammation
- neg fibrosis

Transmission risk?

Chronic carrier state

Yes, still pose a threat to others
d/t pos HBsAg, which is the infective antigen

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Which hepatitis B serum marker(s) indicate infectivity?
Abbreviation?

Hepatitis envelope antigen
(HBeAg)

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Which hepatitis B serum marker(s) indicate a current infection?
Abbreviation?

Surface antiGEN (HBsAg)
- infective antigen

Core antiBODY (anti-HBc)

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Which hepatitis B serum marker(s) indicate a previous infection?
Abbreviation?

Core antiBODY (anti-HBc)

Does it go away?
Once positive, it’s present for life, so it alone does NOT indicate a current infection, only previous infection

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Which hepatitis B serum marker(s) indicate immunity?
Abbreviation?

Surface antiBODY (anti-HBs)

Core antiBODY (anti-HBc)

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Which hepatitis B serum marker is indicative of vaccination?
Abbreviation?

Surface antibody (anti-HBs)

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Which hepatitis B serum marker shows up first?
Abbreviation?

Core antigen (HBc)

Rises and falls before any symptoms arrive

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DA-CEP
What are the bacteria that are ADP-ribosylaters?

EF 2
- Diphtheria
- Aeruginosa

G subunit
- Cholera (Gs)
- E. coli = ETEC (Gs)
- Pertussis (Gi)

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What is the only Gram pos cocci in clusters?

Staphylococcus family
- aureus -> coag pos, gold pigment
- epidermitis -> white pigment
- saprophyticus -> no pigment

Enzymes
- catalase -> separates strep

What bacteria looks like Chinese letters?

Corynebacterium Diphtheriae

Dx of bacteria that has a toxin, allowing the ADP to ribosylate EF2

Corynebacterium diphtheriae
Pseudomonas aeruginosa

What bacteria are spore farmers?

Be Careful (of spores)
- Bacillus
- Clostridium

How do you remove spores?

Autoclave (121 C vaporized heat for at least 15 minutes)

Dx of Wool Sorters’ Disease - membrane component? - contains what toxins?

Bacillus anthracis (anthrax) - membrane -> poly D-Glu - toxins 1) lethal factor 2) edema factor 3) protective factor

Dx of GI upset within 8 hours of eating fried rice

Bacillus cereus - self-limiting - hydration

Dx of gas gangrene

Clostridium perfringens (Associated w/ holiday ham or turkey) (Increased risk in diabetics)

What are the encapsulated bugs that have IgA protease?

Strep pneumo H influenzae Neisseria (Moraxella) catarrhalis Influenza (virus)

Dx of only Gram neg pleomorphic rods

Haemophilus (Also described as a school of fish)

What diseases affect the apex of the heart?

Takotsubo cardiomyopathy Chagas’ disease

What constipation meds promote peristalsis?

Bisacodyl Dulcolax

What is a gram pos anaerobe?

Propionibacterium acne

What is the only bacteria that releases endotoxin while dividing? What phase?

Neisseria meningitidis Log phase (b/c it has the largest capsule) “Neisseria is not so nice”

In what phase of bacterial life cycle is the most endotoxin released? Except?

Decline phase Except Neisseria meningitidis - endotoxin released in log phase

What are the important catalase positive bacteria?

Staph aureus Pseudomonas Neisseria Listeria

What bacteria stain with Ziehl-Neilson (acid-fast)?

Completely acid fast - Mycobacterium Partially acid fast - gram pos -> Nocardia - Protozoa -> cryptosporidium

What is the most abundant granulocyte?

Neutrophils - arrive: 4.5 hours - predominate: 24 hours - peak at: 3 days Contains myeloperoxidase and NADPH oxidase

Abscess culture bacteria? Day 1-3 Day 3-7 After day 7

Staph aureus Strep pyogenes Anaerobes

What is the antibiotic of choice… - above the diaphragm? - below the diaphragm?

- Clindamycin - metronidazole

Clues to anaerobic infections

Malodorous smell Gas formation -> on imaging: “fluid-gas levels” or “air-fluid levels”

What does a CD4 marker indicate?

Monocytes (Which are in circulation)

What does a CD14 marker indicate?

Macrophages (Which are monocytes that have now entered into tissues) (Mediated by interferon gamma)

Most common cause of monocytosis

Monocytosis >15% - salmonella - tuberculosis - EBV (anti-heterophile pos) - CMV (anti-heterophile neg) - listeria - syphilis

What is the 1st antibody made by B cells? In allergies?

IgM Can only get IgE from IgM from class switching

What is most severe bronchoconstrictor? (What is drug to stop?) (What is enzyme to stop?)

SRS-A = slow-reacting substance of anaphylaxis Most potent bronchoconstrictor and vasoconstrictor Drug to stop? Steroids Enzyme to stop? Arylsulfatase

What enzyme is needed to make any fluid in body? (And what is the drug that blocks it?)

Carbonic anhydrase Acetazolamide

Which H2 blocker blocks p450?

Cimetidine (Incr estrogen causing gynecomastia)

Which H2 blocker is associated with colon cancer?

Ranitidine

Causes of eosinophilia

NAACP - neoplasias, especially lymphoma - allergies - Addison’s disease - collagen vascular diseases - parasites