Our Clues 2 Flashcards
What are the infections that cause cold agglutination?
(Elev IgM titers)
Cryoglobulinemia
I AM HE
- Influenza
- Adenovirus
- Mycoplasma
- Hepatitis B & C
- EBV
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
Most common causes of cystitis
Adenovirus
- virus always #1 cause
E. coli
Proteus
Klebsiella
Most common viral cause of gastroenteritis
- adults
- children
- recent travel
Adenovirus
Rotavirus (not immunized)
Norovirus (immunized)
Norwalk agent
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
Which hepatitis is the only DNA virus?
Hepatitis B
- DNA hepadnavirus
Which hepatitis is associated with high mortality in pregnant women?
Hepatitis E
- RNA HepEvirus
Which hepatitis is associated with shellfish?
Hepatitis A
- RNA picornavirus
- Councilman bodies on liver biopsy
Why does hepatitis D require coinfection with hepatitis B?
Hep D uses Hep B surface antigen
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
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
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
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
Which hepatitis B serum marker(s) indicate infectivity?
Abbreviation?
Hepatitis envelope antigen
(HBeAg)
Which hepatitis B serum marker(s) indicate a current infection?
Abbreviation?
Surface antiGEN (HBsAg)
- infective antigen
Core antiBODY (anti-HBc)
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
Which hepatitis B serum marker(s) indicate immunity?
Abbreviation?
Surface antiBODY (anti-HBs)
Core antiBODY (anti-HBc)
Which hepatitis B serum marker is indicative of vaccination?
Abbreviation?
Surface antibody (anti-HBs)
Which hepatitis B serum marker shows up first?
Abbreviation?
Core antigen (HBc)
Rises and falls before any symptoms arrive
DA-CEP
What are the bacteria that are ADP-ribosylaters?
EF 2
- Diphtheria
- Aeruginosa
G subunit
- Cholera (Gs)
- E. coli = ETEC (Gs)
- Pertussis (Gi)
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
