Resp Exam 1 Flashcards

Question

**_Actinomyces israaelii_** signs and symptoms

Answer 1

**_Israeli Soldier_** "_Cervical facies actinomyces infection_" **\*** Associated with **_jaw trauma_** or **recent _dental work_** (due to being **normal flora** of **oral** cavity) **Jaw** trauma or **dental** work → **Non-tender** **lumps** → abcess → **sinus tracts** → drains infection site through the skin → **think yellow pus** filled with **sulfur granules**

Answer 2

**_Israeli Soldier_** penicillin

Answer 3

_**POS** sense **RNA**_ **replication MOA** * Viral RNA **structured like** hosts **mRNA** * **_POS_** **sense** ****_R_**NA** **uses** the **_hosts_ transcription factors!** (since it's the SAME SENSE as the host cell) * It **only _needs_ hosts** **_RNA polymerase_** (vs. NEG sense that brings its own RNA polymerase) * **_ALL_ RNA POS** (and most RNA NEG) **_replicate_ in** the **_cytoplasm_** (where host cell RNA polymerase is located! makes sense!)

Answer 4

**_The Peak-orna Animal Nursery_** **_POS_** sense ****_S_**S** ****_R_**NA** **Naked** virus (No envelope!) **_CSF_ findings** of **viral** (****_a_**septic**) **_meningitis_**: **Normal** glucose, nothing (**aseptic**) when plated, and **_↑ protein_**

Answer 5

**_The Peak-orna Animal Nursery_** * **Hep _A_** * ****_Entero_**viruses** (**_Polio_**, **_Cocksackie_ A** & **B**, ****_Echo_**virus**) * ****_Rhino_**virus\*** **All picornavirus** are transmitted **_fecal-orally_** (acid-stable) **except Rhino**virus which is transmitted **respiratorily** (acid-labile)

Answer 6

**_The Peak-orna Animal Nursery_** **Picorna**virus **RNA** is tansmitted into: A **_long_ protein** product that **contains viral _proteases_** to **cleave it** into **_active_ viral _subunits_**.

Answer 7

**_Rhino Petting Zoo_** (common **cold\***) * **Transmitted** via **inhalation** (acid labile) or through **fomites** (like hands!!!). * **Attaches to _I-CAM1_** **to** **enter** host cells * Needs to **keep cool** → grows best at **33°c** → **_upper respiratory_ tract** cooler due to movement of fresh air. * **113 serotypes!** So **no vaccine!** **\*Rhinovirus** and **Coronavirus** are the 2 **_major causes**_ of common _**cold_.**

Answer 8

**_Kingdom of SARS_** **En**_capsulated_** _helical_ _POS**_ sense _****S**_S **_R_**NA** **Test for** **_antibodies_** to SARS (or other strain) **or _PCR_** to confirm. **(-) finding** **if absence** of **antibodies after 28 days**.

Answer 9

**_Kingdom of SARS_** * Cause of **common cold!** (along with Rhinovirus!) * **Severe Acute Respiratory Syndrome** (**_SARS_**) * **Middle East Respiratory Syndrome** (**_MERS_**) * **_Acute_ bronchitis** → can lead to **Acute Respiratory Distress Syndrom** (**_ARDS_**, **wet lung**)

Answer 10

**_A Den-O lions_** **_D_****S **_D_**NA** **Naked** virus (No envelope!)

Answer 11

**_A Den-O lions_** * Transmitted by **respiratory _droplets_** and **_fecal-orally_**. * **Most at risk** are **little _children**_, _**military_ recruits**, and **public _pools_**.

Answer 12

**_A Den-O lions_** _3 major disease processes_: 1. **_Tonsillitis_** (**most common** cause of **infection** in **adenoids** and **tonsils**). 2. **_Hemorrhagic cystitis_****\*** 3. **Viral _conjuctivitis_** aka **"_Pink Eye_"** (common cause) **\* DDX _BK_ Virus** (a **_Polyoma_****virus**) which **also has hemorrhagic cystitis**, but is more common in **immunocompromised** (**transplant** pts, or pts with **AIDS**)

Answer 13

**_A Den-O lions_** **_Military**_ recuits get a _**live_** vaccine

Answer 14

**_Paranormal Mixer_** **_NEG**_ sense _****S**_S **_R_**NA** **_Enveloped_ non**-segmented virus Anti-measles **antibodies** in the **CSF** (**SSPE** from Measles) or **Warthin–Finkeldey** **cells** in **lymph**oid tissue (for **_Measles/Rubeola_**) **_Syncytia_** (cells merged together from **_RSV_**) **_Steeple_** radiographic sign on **xray** (for **_Parainfluenza_**)

Answer 15

**_Paranormal Mixer_** **\*\*\* Respiratory droplet** transmission! **\*\*\*** * **Measles** (Rubeola) AKA **1st** disease * **Mumps** * **Respiratory Syncytial Virus** (RSV) * **Parainfluenza**

Answer 16

**_Paranormal Mixer_** * **Prodromal (early) symptoms (_4 C's!!!_)**: include ****_C_**ough**, ****_C_**onjunctivitis**, ****_K_**oplic signs** (_blue spots_ on red near molars on _bucal mucosa_), ****_C_**oryza** (runny/stuffy nose) * **Fever** of 104º F (40º C) * **1-2 days later**, after Koplic spots, a **late maculopapular rash** **_starts_ on** **_head_** and **works down** (like rubella), but is a **_confluence_ rash** (vs. rubella which does not coalesce) * **Complications** including viral or bacterial **pneumonia**

Answer 17

**_Paranormal Mixer_** ****_S_**ubacute **_s_**clerosing **_p_**an**_e_**ncephalitis** (**SSPE**) AKA **_Dawson_ disease** * Rare and chronic form of **progressive brain inflammation** * **1-15 years** **after** initial Measles (Rubeola) **infection** * Symptoms include **personality changes**, **seizures**, **myoclonus**, **ataxia**, **coma**, and possibly **death**. * **_Buzzwords_:** **"Measles as a child"** or **"Immigrants"**

Answer 18

**_Paranormal Mixer_** 1. **_Hemagglutinin_ (HA):** causes **RBC** to **stick** together 2. **_Fusion proteins_:** Causes ****_multi_**nucleated _giant_ cells** and **_red_** (eosinophilic) **_inclusion_ bodies** → found **in **_lymph_**oid** tissue (AKA **_Warthin–Finkeldey_** **cell**) **\*\*\* _NO_** Neuraminidase (NA)**!!! \*\*\***

Answer 19

**_Paranormal Mixer_** * **_Measles_ (Rubeola):** **HA** **&** **Fusion** (_no NA_) * **_Mumps_: HA, NA, & Fusion** * **_Respiratory Syncytial Virus_ (RSV):** **Fusion** (_only_) * **_Parainfluenza_:** **HA, NA, & Fusion**

Answer 20

**_Paranormal Mixer_** Vitamin A can **reduce mortality** and **complications**

Answer 21

**_Paranormal Mixer_** * **_MMR_ vaccine!** * **Live attenuated** vaccine to induce humoral and cell mediated immunity. * **Do _NOT_ give to _pregnant_** women. * **_HIV_ pt** should **only** get the vaccine if **CD4 count** is \> **_200_.**

Answer 22

**_Paranormal Mixer_** * **Fever**, muscle **pain**, **headache**, and feeling **tired**. * Usually **followed by _painful swelling_** of **one** or **both** **_parotid_\* _salivary_ glands**. * **_Orchitis_****\*** (inflammation of testicle tissue) **unilaterally** (more rarely bilaterally) → can lead to **impaired fertility** and **testicular atrophy.** * **Meningitis\*** **\*** (**Mumps** **_replicates_ in** the **parotid** glands, **testes**, and **CNS**)

Answer 23

**_Paranormal Mixer_** 1. **Hemagglutinin** (**_HA_**) 2. **Fusion** proteins 3. **Neuraminidase** (**_NA_**)

Answer 24

**_Paranormal Mixer_** * **Attaches to _G protein_** to **infect respiratory** **epithelial** cells * **_Bronchiolitis_** and **_Pneumonia_** (**_most_ common cause** of these **in _infants_!!!**) * **Rhinitis** and **Pharyngitis**

Answer 25

**_Paranormal Mixer_** * **_Fusion_ proteins** (NO HA or NA for RSV) **Fusion proteins** on the surface of the virus **cause** the **cell membranes** on **nearby giant** multinucleated **cells** **to merge** and **stick** together, **forming _syncytia_**.

Answer 26

**_Paranormal Mixer_** * ****_Rib_**avirion** for **adults**.**\*** **\*** (**_Not_** _children_ or _pregnant_ women!!!) * **_Palivisumab_**, a **monoclonal antibody** (**Ig**_G_****) **against** the **_F protein_** of RSV, is used for **high risk children** and **premies**.

Answer 27

**_Paranormal Mixer_** **_Croup_!** * AKA **_seal bark_ cough**, ****_in_**spiratory strider**, or **_L_**aryngo**_t_**racheo**_b_**ronchitis. * characterized by a **"barking" cough**, **stridor**(harsh or grating sound), **hoarseness**, and **difficulty breathing** which usually **worsens at night**. * **_Steeple_** radiographic sign **on xray** due to **narrowing** of the **_subglottic_ region** from **swelling**.

Answer 28

**_Paranormal Mixer_** Mainly affects **children!!!** (Adults usually get a severe "cold") 1. **Hemagglutinin** (**_HA_**) 2. **Fusion** proteins 3. **Neuraminidase** (**_NA_**)

Answer 29

**_Mu Car Auto Shop_** Biopsy is needed for diagnosis. Hyphae have **_right angle_** branching (**90º**) and are **_non_-septate** (ddx Aspergillus which have **_a_**cute branching \< 45º and have **s**eptations "**_As_**pergillus") **Broad, irregular,** and **ribbon-**like**.**

Answer 30

**_Mu Car Auto Shop_** **Mucormycoses** is found nearly **everywhere** in **soil** and **decaying plants** (like compost heaps), and generally won't infect healthy people. Transmitted via **spore _inhalation_**.

Answer 31

**_Mu Car Auto Shop_** **Invade** through **cribriform plate** in the skull → cause **_necrosis_** of **tissues** and **frontal cortex _abscesses_**. * Presents as a **_black_ _eschar_** and **necrosis** of **nasal cavity** and **eyes**, causing **neuro deficits** and **death** (**_Rhinocerebral mucormycosis_**)

Answer 32

**_Mu Car Auto Shop_** * **Immunocompromised** (leukemia, **neutropenia**, etc) * **Diabetes** patients * **_Diabetic Ketone acidosis_** (**DKA**) is the **most common predisposing factor**. (Mucormycoses likes to **proliferate** in **blood vessel walls**, especially where there is **↑ glucose** and **↑ keytones**)

Answer 33

**_Mu Car Auto Shop_** Most **common cause** of **Mucormycosis**. Rhizopus is a **_bread mold_**.

Answer 34

**_Mu Car Auto Shop_** 1. **_Debridement_ first**: Surgically remove dead tissue. 2. **_AMP B_**

Answer 35

**_Ye Olde Epstein Bar_** * ****_D_**S **_D_**NA** * **_Enveloped_** virus * ****_Cyto_**toxic** (**CD8+**) **T-cell _reactive_\* lymphocytes** **\*** (**_Downy cells**_ AKA _**atypical cells_**; **Very** **large**, lots of cytoplasm, have **oval**, **indented**, **or folded nucleus**) * **_Monospot_ Ig\* test** to diagnose during **_acute_ infections** → activates **B cells** to **secrete _heterophile_ sheep _antibodies_** that **agglutinate sheep** or horse **RBC's**. **\*** (**IgM** for **current** or recent infection, **IgG** for **prior** infections)

Answer 36

**_Ye Olde Epstein Bar_** * **EBV envelope** (**glycoprotein**) **binds** to **_CD21 receptor_** (**Complement receptor** type 2 aka **_CR2_**; on the surface of B cells) to **_infect B cells_**. * **T-cells proliferate** → causing **spleno**_megaly_**\*** * Most are **_reactive cytotoxic_ CD**_8_**+ T cells** (_reactive lymphocytosis_) aka **_downy_ cells** or **_atypical_ cells** but can also be NK cells. **\*** (Must **_avoid contact sports_** due to **risk of _splenic rupture_**)

Answer 37

**_Ye Olde Epstein Bar_** * _Triad of symptoms_**:** 1. **_fever_** 2. **_pharyngitis_** (**_mono_ pharyngitis** often in **teens** and **adults**, vs. _strep_ pharyngitis more often in children) 3. **_lymphadenopathy_** (often **tender** **lymphadenopathy** in **posterior cervical** region) * Can also see **Spleno**_megaly_****

Answer 38

**_Ye Olde Epstein Bar_** 1. **_Hodgkin's_** **lymphoma (HL)**; **_mixed_ cellularity** 2. **_Non_****-Hodgkin's lymphoma (NHL); _Burkett_ lymphoma** 3. ****_Naso_**pharyngeal carcinoma (NPC)** * Also **↑ risk** of **_Oral Hairy leukoplakia_** (but its **NOT** a **precancerous** lesion)

Answer 39

**_Ye Olde Epstein Bar_** * **_Intense itchy_ maculopapular** or **morbilliform _rash_**. * Appears on **extensor surfaces** and **pressure points 7 to 10 _days after treatmen_t** with **beta-lactam antibiotics** (such as ampicillin, amoxicillin and cephalosporins). * This rash indicates a ‘**_hypersensitivity_ reaction**’ **to** the **_antibiotic_.** * It is **_not_ a true allerg**y and does not occur if the antibiotic is given later on in the absence of EBV infection.

Answer 40

**_Ye Olde Epstein Bar_** * Spread through **mouth secretions** * **"_KISSING_ DISEASE!!!"** * Causes **infectious _mononucleosis_** ("**mono**")

Answer 41

**_Ye Olde Epstein Bar_** * **_Weakend_ immune systems** **develop _B cell lymphoma_**. * The **cancerous B cells** are an **abnormal** type called **_Reed-Sternberg_ cells** (**_giant_ cells** that resemble "**_owl eyes_**"). * **_Mixed_ cellularity** is the **second most common type** **of HL** and is seen **mostly in older adults** (although it can occur at any age). * It **can start in any lymph node** but **most often occurs** in the **_upper_ half of** the **body**.

Answer 42

**_Ye Olde Epstein Bar_** * **Burkitt lymphoma** is a form of **non-Hodgkin's lymphoma** in which cancer **_starts_ in _B-cells_**. * Especially **likely to develop in** people infected with **HIV**. * Common **translocation** is **_t8:14_** * **_Endemic_** (**_African_**) **Burkitt lymphoma** is common in young **children** who have **both** **malaria** and **EBV**. It usually **starts as _tumors_ of the _jaw_** or other facial bones. It also can affect the GI tract, ovaries, and breasts and can spread to the CNS * The types more common **in the _U.S_**_._ (**_sporadic_** and **_immunodeficiency_-associated**) usually **start in the bowel** and **form a _bulky tumor_ mass in** the **_abdomen_**, often with massive involvement of the liver, spleen, and bone marrow.

Answer 43

**_Ye Olde Epstein Bar_** * Commonly in **_asian_** people. * It is most common in **_males_**. * It is a **squamous cell carcinoma** or an **undifferentiated\* type** **\*** (Undifferentiated cells are cells that do not have their mature features or functions.)

Answer 44

**_Ye Olde Epstein Bar_** * it is **_NOT_** a **precancerous** lesion * **Primarily affects** people whose **immune systems** have been **weakened** **by disease**, especially **HIV/AIDS**. * ****_Thick_**ened**, **_white patches_** on **gums**, insides **cheeks**, bottom of **mouth** and sometimes **tongue**. * These patches **_can't_ be scraped off\***. \* (**ddx** with **_candida_** which _can be scraped_ off!)

Answer 45

**_Ye Olde Epstein Bar_** * No tx! * **rest** and **fluids**

Answer 46

**_Pilloma Bugs_** **_D_****S **_D_**NA** **Naked** virus (No envelope!) * **Pap smear** and **cervical** cancer **screening**. * **_Koilocytes_** in **squamous\*** cells (**large**, **dense**, **wrinkled nucleus** that may be **binucleated**). **\* Detecting** morphological **changes**; sampled **from the _transformation_ zone** (where **squamous** eipthelium from **outer** **ecto**cervix comes into **contact with columnar** epithelium in the **inner endo**cervix).

Answer 47

**_Pilloma Bugs_** 100's of **HPV strains!** * HPV **_1_ - _4_** * HPV **_6_ & 1**_1_**** * HPV **_16_ & 1**_8_**** * HPV **_31_ & _33_**

Answer 48

**_Pilloma Bugs_** * **_Verruca**_ (wart) _**vulgaris_** (common) * aka "**_cutaneous_ common wart**" * transmission requires **direct physical contact** * **_Children_** typically get on hands and feet

Answer 49

**_Pilloma Bugs_** * **_Laryngeal_ Papillomatosis** (**Recurrent respiratory papillomatosis**): Tumors (papilloma's) develop in airways. Typically seen in **children**, and often obtained during **vaginal birth** (but **not** considered an STD) * **_Anal_ _genital_ warts** (**Condyloma _acuminata_\***): seen in **sexually active** pts. **\* ddx** from **secondary syphilis** w/ Condylomata _lata_

Answer 50

**_Pilloma Bugs_** * most common **STD** * ****_An_**o_genital_ carcinoma** (**_Squamous_ Cell _Carcinoma_**): Cervical, vulvar, vaginal, penile, anal * Buzzwords = "**bleeding after sex**" or "cancer" * In anal or penile cancer a **major RF** is **immunosupression**, especially in **HIV\*** pts. **\*** HPV is an **AIDS-defining illness**)

Answer 51

**_Pilloma Bugs_** * HPV upsets the cells normal cycle. * **Tumor supressor proteins** **_p53_** and **_RB_** (Retinoblastoma protein) **normally** **stop** the cell cycle advancement from **G1→S**. * **_HPV encodes_ E**_6_** and E**_7_**** to **promote** the **proteolysis** of **_p53_** (**E**_6_****) and **_RB_** (**E**_7_****) → removal of tumor supressors ↑ risk of cancer! * **AIDS-defining** i**llness**. Its thought HIV helps to enhance the E6/7 expression.

Answer 52

**_Pilloma Bugs_** * HPV vaccine is **_Gardasil_** * Its an ****_in_**activated **_quad_**ravalent** vaccine * Used for strains **6**, **11**, **16**, and **18\*** \* These 4 strains cause ~70% of cervical cancers

Answer 53

**_Varicella "Zeus" ster virus_** * ****_D_**S **_D_**NA** * **_Enveloped_** virus * Replicates in **nucleus** (like most DNA viruses) * **_Tzanc smear_** (older test, scrape) to look for **multinucleated giant cells**

Answer 54

**_Varicella "Zeus" ster virus_** * **Congenital Varicella Syndrome** (a **T**_O_**RCHeS** infection!) If infected in 1^st and 2^ndtrimesters * **Chickenpox (Varicella)** Spread by respiratory droplets or ruptured vesicles * **Shingles (Herpes Zoster)** Reactivation of previous VZV infection

Answer 55

**_Varicella "Zeus" ster virus_** * **Headache** and **fever** * **Xanthem** ("**widespread** **rash**"); **itchy** * **Vesicular rash** → Vesicular lesions w/ surrounding erythema (like HSV dew drops on rose petal) * All **rashes** are **at _different_ _stages_** of **healing** (**vs. smallpox** w/ similar looking rash but all _at same stage_!) * **_Adults_** can get **pneumonia** (major cause of morbidity & mortality in adults w/ chicken pox) * **_Encephalitis_**

Answer 56

**_Varicella "Zeus" ster virus_** * **Vesicular rash** on **erythema base** travels down **_dorsal root_** (**sensory nerves! _painful_!**) in a **_dermatone_ _pattern_\***, **rarely crossing** the **midline**. * ****_Post_**herpetic _neuralgia_**: pain after shingles! * **Herpes Zoster _opthalmicus_** if VZV infects the **V₁ branch** of **trigeminal** nerve → **_vision loss_** \* **If rash crosses** the **midline** it is **_Disseminated_ VCV** and is a **_red flag_** of immunocompromisation! **test for HIV** if no Hx!!!

Answer 57

**_Varicella "Zeus" ster virus_** * **Limb **_hypo_**plasia** * **Cutaneous _scarring**_ in a _**dermatomal_ pattern** * **_Blindness_**

Answer 58

**_Varicella "Zeus" ster virus_** * **_Live_** attenuated **Chickenpox (_Varicella_)** vaccine * **Shingles (_Zoster_) vaccine\***, is simply a larger-than-normal dose of the vaccine used against chickenpox. **\* Shingles (_Zoster_) vaccine** recommended for **adults _over 60_**; **HIV pts** can get **if CD4 \> _200_**

Answer 59

**_Varicella "Zeus" ster virus_** **For _chickenpox_ (Varicella)**: A**_cycl_**ovir **For _shingles_ (Herpes Zoster):** A**_cycl_**ovir or **_Fam_**c_ycl_ovir or **_V_**al**_cycl_**ovir

Resp Exam 1 Flashcards

(83 cards)