SPIROCHETES

Question 1

coiled spirochete

CANNOT be cultured in vitro - lacks Krebs cycle

MICROAEROPHILIC

Answer 1

Treponema pallidum

Question 2

PRIMARY SYPHILIS

Answer 2

PAINLESS chancre

highly INFECTIOUS, heals spontaneously in 3-6 wks

Question 3

SECONDARY SYPHILIS

Answer 3

palmar rash
lymphadenopathy
CONDYLOMA LATA

occurs after 1-3 mos

Question 4

TERTIARY SYPHILIS

Answer 4

occurs years after inoculation

NEUROSYPHILIS

• asymptomatic
• meningovascular
• tabes dorsalis
• general paresis
• Argyll-Robertson pupil/Prostitute pupil
• dementia paralytica

AORTITIS

• aneurysms
• aortic regurgitation

GUMMAS

• hepar lobatum
• skin, bone others

Question 5

CONGENITAL SYPHILIS

Answer 5

snuffles/saddle nose
mulberry molars

HUTCHINSON TRIAD: Hutchinson teeth, deafness, keratitis

saber shins

rhagades (angle of mouth)

HIGOUMENAKIS SIGN (clavicle) - unilateral enlargement of the sternoclavicular portion of the clavicle

CLUTTON’S JOINTS (SYNOVITIS)

PULMONARY HEMORRHAGE

Question 6

MOST SPECIFIC test. when an active chancre or condyloma latum is predent

Answer 6

DARK FIELD MICROSCOPY

Question 7

Nontreponemal

used for SCREENING

cardiolipin, cholesterol and purified lecithin

Answer 7

VDRL
RPR

decreased sensitivity in EARLY PRIMARY SYPHILIS and LATE SYPHILIS

for MONITORING TREATMENT

Question 8

Treponemal Specific

Answer 8

EIA
TPHA
FTA-ABS

used to confirm the diagnosis in px w/ positive VDRL/RPR

higher sensitivity/specificity

FOREVER POSITIVE

Question 9

FALSE POSITIVE VDRL RESULTS

Answer 9

Virus
Drugs (marijuana)
Rheumatic fever, RA
Lupus, Leprosy

Question 10

Influenza like symptoms few hours after receiving penicillin d.t. lysis of treponemes

Answer 10

Jarisch-Herxheimer reaction

Question 11

FALSE POSITIVE (FTA-ABS)

Answer 11

Lupus

Lyme Disease

Question 12

MOST SPECIFIC, EARLIEST POSITIVE, REMAINS POSITIVE LONGEST

Answer 12

FTA-ABS

Question 13

31/M, treated w/ Pen G in a case of Syphilis. On day 2 of treatment he had fever, chills, tachycardia, hypotensive and profuse sweating. What do you call this condition?

A. anaphylaxis
B. tachyphylaxis
c. Stevens-Johnson
D. Jarisch- Herxheimer

Answer 13

D. Jarisch-Herxheimer

Question 14

T. pallidum pallidum

Answer 14

Venereal syphilis

Question 15

T. pallidum pertenue

Answer 15

Yaws

Question 16

T. pallidum endemicum

Answer 16

endemic syphilis (bejel)

Question 17

T. carateum

Answer 17

Pinta

Question 18

Transmitted by HUMAN BODY LOUSE (Pediculus humanus)

Answer 18

Borrelia recurrentis

Question 19

Fever characteristic of Borrelia recurrentis

Answer 19

Relapsing Fever

rapid antigenic changes d.t. PROGRAMMED REARRANGEMENTS of bacteria DNA encoding surface proteins

Question 20

Largest medically important bacterium

Answer 20

Borrelia burgdorferi

Question 21

Reservoir of Borrelia burgdorferi

Answer 21

White footed mouse

White tailed deer

Question 22

Vectors of Borrelia burgdorferi

Answer 22

Deer ticks (Ixodes ticks)

Question 23

Lyme Disease

Stage 1 (early localized stage)

Answer 23

Erythema Chronicum Migrans (ECM) - target like lesion

Question 24

Lyme Disease

Stage 2 (early disseminated stage)

Answer 24

multiple smaller ECM

neurologic: aseptic meningitis, CN palsies (BELL’S PALSY) and peripheral neuropath
cardiac: transient AV block or myocarditis

DOXYCLINE
Amoxicillin
Cefuroxime

Question 25

Lyme Disease

Stage 3 (late stage)

Answer 25

autoimmune migratory polyarthritis (ONION SKIN LESION)

acrodermatitis chronica atrophicans

encephalopathy

IV PENICILLIN
CEFTRIAXONE

Question 26

Borrelia burgdorferi is cultured on

Answer 26

Barbour-Stoenner-Kelly (BSK) medium

Question 27

The LARGEST BACTERIA ever discovered (not medically important)

Answer 27

Thiomargarita namibiensis

Question 28

Direct contact w/ infected urine or animal tissue

History of wading in flood water

History of exposure to animals (butcher)

Answer 28

Leptospira interrogans

Question 29

The resting site for leptospires jn the natural host

Answer 29

Lumen of the Nephron Tubules

Question 30

Obligate aerobe (Other spirochetes - microaerophiles)

Answer 30

Leptospira interrogans

Question 31

Organisms in BLOOD and CSF

High spiking temp, chills, intense headache

Answer 31

ACUTE LEPTOSPIREMIC PHASE

• rapid multiplication of leptospires in MUSCLES w/ HIGH OXYGEN TENSION – CALF TENDERNESS
• damaged and leaky conjuctival vessels - CONJUNCTIVAL SUFFUSION (painful and itchy but w/ minimal tearing)

Question 32

Correlates w/ emergence of IgM

Answer 32

IMMUNE LEPTOSPIRURIC PHASE

*ASEPTIC MENINGITIS
CSF pleocytosis w/ or w/o meningeal symptoms
coincides w/ appearance of antibody titer

*PULMONARY INVOLVEMENT
snowflake lesions on CXR

• HEPATIC NECROSIS
• GLOMERULONEPHRITIS

Question 33

Main pathophysiology of Leptospirosis

Answer 33

Systemic Vasculitis

Question 34

Most severe form of leptospirosis

Answer 34

WEIL’s SYNDROME

• bleeding
• jaundice
• uremia

respiratory failure d.t. massive pulmonary hemorrhage - MCC of DEATH

Question 35

Spiral shaped w/ HOOKS ON BOTH ENDS (“ice tongs”) – SHEPHERD CROOK APPEARANCE

Answer 35

Leptospira interrogans

Question 36

Leptospira interrogans is grown in

Answer 36

Ellinghausen-McCullough-Johnson-Harris (EMJH) or Fletcher’s medium

Question 37

Treatment for MILD Leptospirosis

Answer 37

Doxycycline 100 mg BID

Ampicillin

Amoxicillin

Question 38

Treatment for SEVERE leptospirosis

Answer 38

Penicillin G

Ampicillin

Ceftriaxone 1 g IV

Cefotaxime