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T14 MF4 > Pathology > Flashcards

Pathology Flashcards

1
Q

How can the gut flora lead to vitamin and fat malabsorption?

A

Overgrowth of anaerobic bacteria can allow them to deconjugate bile acids, as well as bind available vitamin B12.

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2
Q

What bacteria type is most responsible for prosthetic joint infections? Give 2 examples.

A

Gram-positive aerobic cocci

  1. Staphylococcus epidermidis (hydrophobic biofilm)
  2. Corynebacterium (less common)
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3
Q

What are some general systemic signs of fever?

A
  1. Fever, chills, sweats
  2. Stiff neck
  3. Malaise and altered appetite
  4. New onset pain
  5. Tachycardia and hypotension
  6. LOC
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4
Q

What are signs of infection of the:

  1. Respiratory tract
  2. GI tract
  3. Urinaty tract
  4. Vagina
A
  1. Change in cough / new cough, sore throat, SOB, nasal congestion
  2. Diarrhea, vomiting, abdominal/rectal pain
  3. Dysuria, nocturia, frequency/urgency
  4. Discharge, irritation, itchiness
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5
Q

What are the 5 “classic” signs of wound infection?

A
  1. Redness
  2. Pain
  3. Swelling
  4. Warmth
  5. Loss of function
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6
Q

How do we acquire a fever and what happens when we do?

A
  1. Pyrogens (often made by bacteria) cause release of PGE2
  2. PGE2 acts on the hypothalamus, increasing its set point
  3. The body undergoes changes to increase blood temp to match this new set point (peripheral vasoconstriction, thermogenesis in BAT, increased metabolic rate, muscle shivering)
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7
Q

What are 5 reasons a fever is useful to the body?

A
  1. Increases leukocyte mobility
  2. Enhances leukocyte phagocytosis
  3. Decreases bacterial endotoxin effects
  4. Increases T cell proliferation
  5. May kill heat-sensitive pathogens
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8
Q

What are 3 ways to acquire a post-operative (surgical site) infection?

A
  1. Failure to properly adminster prophylactic antibiotics when indicated
  2. Unsterile operative procedures
  3. Poor wound hygiene, antibiotic compliance, and smoking during recovery
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9
Q

What are 2 common bacteria causing surgical site infections?

A
  1. Group A streptococcus
  2. Staphylococcus aureus
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10
Q

What is a nosocomial infection?

What are the 4 most commone ones?

A

An infection acquired in a hospital or other health care facility

  1. UTIs (catheter associated)
  2. Surgical-site infection
  3. Bloodstream infection (IV associated)
  4. Pneumonia (ventilator associated)
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11
Q

What 2 bacteria are most often responsible for causing nosocomial infections?

A
  1. Acinetobacter baumannii
  2. MRSA
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12
Q

What are 2 types of superficial fungal infections? What causes them? What happens to the skin?

A
  1. Pityriasis/Tinea Versicolor –> Malassezia furfur; chronic hypo or hyper-pigmented patches on skin
  2. Tinea Nigra –> Exophiala Werneckii; xdark brown to black painless patches on skin
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13
Q

What is the name for “cutaneous fungal infections” of the skin, hair, and nails? Give 5 examples and what they look like.

A

Dermatophytoses –> caused by 30+ fungal species

  1. Tinea Corporis = ring shape with red raised border on body (ring worm)
  2. Tinea Cruris = groin and scrotum (jock itch)
  3. Tinea Pedis = between toes (athlete’s foot)
  4. Tinea Capitis = red, ring-expanding lesions of scalp causing loss of hair
  5. Tinea Unguium = nails becoming thick, brittle, and discolored (onychomycosis)
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14
Q

What are 2 types of subcutaneous fungal infections? What causes them? What happens to the skin?

A
  1. Sporotrichosis = subcutaneous nodules along lymphatic tracts that necrotize and ulcerate; caused by Sporothrix schenckii (roses)
  2. Chromoblastomycosis = wart-like lesions spreading over months to years; caused by Phialophora and Cladosporium (soil)
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15
Q

What 3 dimorphic fungi are responsible for systemic fungal infections? Where do they exist and how are they transmitted?

A
  1. Histoplasma capsulatum = Mississippi River; bird/bat droppings
  2. Blastomyces dermatidis = Mississippi River; soil/rotten wood
  3. Coccidioiddes Immitis = Southwest US
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16
Q

What 3 different clinical pictures may systemic fungal infections present as?

A
  1. Asymptomatic
  2. Pneumonia –> fever, cough, CXR infiltrates, granulomas
  3. Disseminated –> meningitis, bone lytic granulomas, skin granulomas, organ lesions
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17
Q

What are 3 types of opportunistic fungal infections?

A
  1. Candida Albicans Infections (yeasts)
  2. Aspergillus Infections (fumigatus species)
  3. Zygomycota infections (Mucor, Rhizopus, Rhizomucor molds)
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18
Q

What are 3 diseases caused by opportunistic aspergillus?

A
  1. Allergic bronchopulmonary aspergillosis (IgE-mediated)
  2. Aspergilloma (pre-formed cavity)
  3. Invasive aspergillosis (invasive infection)
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19
Q

What are complications of an aspergillus infection?

A

Mycotoxins produced by the fungi can cause liver damage and liver cancer.

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20
Q

What infection is caused by zygomycota?

A

Mucormycosis = an infection affecting the sinuses, cranial bones, and blood vessels

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21
Q

What are 3 diseases caused by candida in a healthy person?

What are 2 diseases caused by candida in an immunocompromised person?

A

Healthy = oral thrush, diaper rash, candida vaginitis

Immunocompromised = esophagitis, disseminated candidiasis

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22
Q

What are 13 risk factors for opportunistic fungal infections and why?

A
  1. Antibiotics = kill helpful bacteria, ollowing opportunistic fungi to colonize
  2. Corticosteroids = reduce immune repsonses keeping fungi at bay
  3. Diabetes = harder for neutrophil migration, extra sugars for yeast
  4. Obesity = folds of skin trapping heat and moisture
  5. Leukemia (acute myeloid) = immunocompromised
  6. Immunocompromised for some other reason (AIDS, chemo, etc.)
  7. Environment = moisture
  8. Hereditary factors = unknown exactly why
  9. Exposure to affected individuals = some infections can travel
  10. Medical devices = place for infection to grow
  11. Poor hygiene = more favourable environment
  12. Wearing tight shoes = trauma to nails
  13. Pregancy/OCP/menstruation = altered flora affecting vaginal pH
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23
Q

What is an immunodeficiency disease? What is the difference between congenital and primary?

A

Disorders caused by defective immunity.

Congenital = genetic abnormality is the cause

Acquired = results from infection, nutrition, or medical treatment

24
Q

What are 3 serious consequences of immunodeficiencies:

A
  1. Increased susceptibility to new infections
  2. Reactivation of latent infections
  3. Inreased incidence of some cancers
25
Q

List 2 types of B cell maturation immunodeficiencies and what is going on in them

A
  1. X-linked agammaglobulinemia
    - Btk mutation preventing B cells to mature past pre-B cells
    - Results in decreased or absent mature B lymphocytes and serum Ig
  2. Ig Heavy chain deletions
    - The gene for heavy chainis missing
    - No functional BCRs and thus antibodies
26
Q

List 1 type of T cell maturation immunodeficiencies and what is going on in it.

A

DiGeorge syndrome (thymic aplasia)

  • Incomplete thymus (and PT) gland maturation
  • Lack of mature T cells
27
Q

What is SCID?

A

SCID = Severe Combined Immunodeficiency = an immunodeficiency with a deficit in both B and T cells

28
Q

Fill in the following chart concerning SCIDs.

A
29
Q

Fill in the following chart concerning immunodeficiencies affecting T and B cell activation/function:

A
30
Q

What are some possible treatments for adaptive immunodeficiencies? (3)

A
  1. Bone marrow transplantation
  2. Ig replcaement therapy
  3. Replacement gene therapy
31
Q

What are 4 factors that may allow reactivation of a latent virus?

A
  1. Other viral infections
  2. Nerve trauma
  3. Physiologic/physical changes (ex. fever, sunlight, menstruation)
  4. Immunosuppression
32
Q

What is pharyngitis?

A

An infection or irritation of the pharynx or tonsils

33
Q

What are some causes of pharyngitis? (6)

A
  1. Viral infection = most common
    - Adeno, Orthomyxo, EBV, Herpes, Measles, Rhino, Corona, RSV, Parainfluenza, CMV
  2. Bacterial infection = group A streptococcus pyogenes
    - More common cause in children than adults
  3. Possible Candidal fungal origin from spread of oral thrush
  4. Allergy
  5. Trauma/toxins/chemical irritation/thermal irritation/acid reflux
  6. Medications (ex. pramipexole for PD and antipsychotics)
34
Q

What are 4 routes of transmission of Group A Streptococcus?

A
  1. Inhalation of respiratory droplets
  2. Skin contact
  3. Contact with objects/surface/dust that is contaminated
  4. Transmission through food
35
Q

Describe the presentation for bacterial pharyngitis vs. viral pharyngitis.

A

Bacterial =

  • Sudden onset with headache, vomiting, rash, and worsening sore throat
  • Contact with GAS or rheumatic fever
  • Tonsillopharyngela/palatal petechiae and/or exudate

Viral =

  • Sore throat following days of coughing and/or runny nose
  • No fever but general body aches
  • Tonsillopharyngeal exudate
  • Older age
36
Q

What is the Centor Criteria used for and how does it work?

A

To determine the likelihood of a bacterial infection in those with a sore throat.

Criteria = absence of cough, fever, tonsillar exudates, tender anterior cervical adenopathy, age under 15

Score = one point for each factor present and one point off if age >44

  • -1 to 1 indicates no antibiotic or throat culture
  • 2-3 indicates throat culture and antibiotics if positive
  • 4-5 indicates rapid strep testing and/or culture and anitibiotics if positive
37
Q

What are investigations for pharyngitis?

A
  1. Group A beta-hemolytic streptococcal rapid antigen detection test
  2. Throat swab and culture
  3. Mono spot
  4. Peripheral blood smear
  5. Gonococcal culture
  6. Lateral neck film if epiglottitis is suspected
  7. Soft tissue neck CT if abscess is suspected
38
Q

What are some complications of pharyngitis? (8)

A
  1. Epiglottitis
  2. Peritonsillar abscess
  3. Post-infectious acute glomerulonephritis (if bacterial)
  4. Lemierre’s syndrome
  5. Rheumatic fever
  6. Scarlet fever
  7. Necrotizing fasciitis
  8. Invasive pneumonias
39
Q

What are 4 possible reasons to treat a patient with pharyngitis with antibiotics?

A
  1. Positive culture for GAS
  2. Positive rapid antigen detction test result
  3. All 4 Centor criteria are met
  4. Live in a house with a known GAS and showing symptoms
40
Q
  1. What bacteria can cross the BBB?
  2. What viruses can cross the BBB?
  3. What fungi can cross the BBB?
  4. What parasites can cross the BBB?
A
  1. E. Coli, Strep Pneumo, Listeria Monocytogenes, N. Meningitidis, GBS, Myco Tb, HIB, Treponema pallidum
  2. West Nile Virus, HIV
  3. Candida albicans, Cryptococcus Neoformans, Histoplasma Capsulatum
  4. Trypanosoma, Acanthomoeba, Toxoplasma Gondii, Plasmodium Falciparum
41
Q

Where is Meningitis most prevalent (areas of the world)?

A
  1. African Meningitis belt –> sub-Saharan Africa
  2. South America –> Brazil, Ecuador
  3. Middle East –> Saudi Arabia, India
42
Q

What are risk factors for acquiring meningitis?

A
  1. Age <2 years
  2. Crowded conditions (for the first time)
  3. Immunological susceptibility of a population
  4. Locations with a lot of travel
  5. Poor living conditions
  6. Dry and dusty climate
  7. COoncurrent infections
43
Q

What are 3 possible triggers of meningitis and which is the most common?

A
  1. Autoimmune disease
  2. Adverse reaction to medication
  3. Infection

Infection is the most common trigger.

44
Q

How can an infectious meningitis be acquired?

A
  1. Direct spread through the overlying skin, through the nose, through a congenital anatomical defect (spina bifida, sinus opening) or through an acquired anatomical defect (skull fracture)
  2. Hematological spread from the blood, through the BBB, and into the brain
45
Q

What happens in the brain during menigitis?

A
  1. Fluid levels increase from increased permeability leading to raised ICP (>200mmH2O)
  2. Local destruction of healthy tissue by wbc trying to clear the infection
  3. Glucose levels fall, used up by the wbc (<2/3 blood glucose)
  4. Protein levels increase (>50 mg/dL)
46
Q

What bacteria cause meningitis in:

  1. Newborns (3)
  2. Children and Teens (2)
  3. Adults and Elderly (2)
  4. Tick-Borne (1)
A
  1. GBS, E. Coli, L. Monocytogenes
  2. N. Meninigitidis, S. Pneumoniae
  3. S. Pneumonia, L. Monocytogenes
  4. Borrelia Burgdorferi (Lyme Disease)
47
Q
  1. What are 3 viruses that more commonly cause viral meningitis?
  2. What are 3 viruses that less commonly cause viral meningitis?
A
  1. Enteroviruses, Herpes Simplex, HIV
  2. Mumps, Varicella Zoster, Lymphocytic Choriomeningitis
48
Q

What 2 fungi have been known to cause chronic meningitis?

What parasite has been shown to cause meningitis?

A

Fungi:

  1. Cryptococcus
  2. Coccidioides

Parasite:

  1. P. Falciparum
49
Q
A
50
Q

Fill in the following chart concerning CSF findings during meningitis:

A
51
Q

How does meningitis present?

A

Classic Triad

  1. Headaches
  2. Fever
  3. Nuchal Rigidity

Other

  1. Photophobia/phonophobia
  2. Altered mental state and seizures
  3. Rashes
52
Q
  1. What are physical exam manevers for meningitis? (2)
  2. What are lab investigations for meningitis (4)
  3. What is an imaging modality that can be used in meningitis? What is it used for?
A
  1. Kernig’s Sign (back pain limiting passive knee extension while supine)

Brudzinski’s Sign (neck flexion while supine automatic flexes leg

  1. LP (ICP, wbc/protein/glucose in CSF), PCR (HIV, enterovirus, HSV, Tb), Western Blot (Borrelia Burgdorferi), thin blood smear (malaria)
  2. CT –> contraindictions and complications
53
Q

What does the management for acute menigitis look like?

A
  1. Steroids
  2. Antibiotics
  3. LP
  4. Culture for organisms
  5. Adjust antibiotics
54
Q

What are 4 infectious causes of meningitis that can be vaccinated against?

A
  1. Neisseria Meningitidis

2 Strep Pneumo

  1. Viral mumps
  2. Listeria Monocytogenes
55
Q

What is an Arthus Reaction?

A

A localized Type III hypersensitivity induced by high levels of IgG antibodies causing inflamation

T14 MF4 (7 decks)

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