Tom wagners high yield - micro Flashcards
1
Q
Inflammatory component of gram negative LPS
A
G-: Lipid A.
G+: Lipoteichoic acid induces TNFa and IL-1 from G+
2
Q
Novobiocin–
A
Sensitive: Staph epidermidis
Resistant: Staph saprophyticus
3
Q
Quellung Reaction
A
Strep Pneumo. Strep pneumo capsule swells when bound by Ab (specific); Lancet shaped diplococci
4
Q
Bacitracin:
A
Sensitive: Strep Pyogenes,
Resistant: Strep agalactiae
5
Q
Endocarditis following GI/GU procedures? grows on?
A
Enterococcus. Can grow in bile and 6.5% NaCl
6
Q
Gram Positive Rods with Metachromatic (blue and red) granules. grows on? mech?
A
Corynebacterium diptheriae. Black colonies on cystine-tellurite agar; ADP Ribosulates EF-2; ELEK test for toxin
7
Q
tetanospasmin block GABA and glycine release from?
A
Renshaw cells in the spinal cord. trismus (lockjaw), Risus Sardonicus, and Opisthonotos (eyes locked)
8
Q
Serpentine chains of G+ rods?
A
Bacillus anthracis. spore forming; edema factor inc cAMP; + lethal toxin
9
Q
Only G+ that produces LPS? grows in?
A
Listeria. Tumbling motility and can grow at 4 degrees celcius (cold enrichment)
10
Q
Acid fast+ and G+, causes pulmonary infections. tx?
A
Nocardia. weakly acid fast (carbolfuschin); TX with sulfonamides
11
Q
Oxidase+, G- that grows at 42 degrees. structure? spread via? diseases?
A
Camplyobacter. Comma shaped, undercooked chicken; Guillane-Barre and Reactive Arthritis
12
Q
Oral abscess or facial abscess (draining through sinus tract) with yellow sulfur granules. structure? tx?
A
Actinomyces. Branched G+ bacteria; TX with penecillin
13
Q
Asthma and CF pts at risk for this infection causing bronchiectasis and Eosinophilia
A
Allergic Bronchopulmonary Aspergillosis (ABPA). Leads to bronchiectasis
14
Q
Bacteria that causes Lymptocytic Leukocytosis
A
Bordetella pertussis. Lympthocytosis promiting factor that blocks lymphocyotes from leacing blood for LNs
15
Q
Grows in both bile and 6.5% NaCl (G+ coccus)
A
Enterococcus
16
Q
Only bacteria with a polypeptide capsule
A
Bacillus anthracis. D-glutamate; Cutaneous- ulcer with black eschar
17
Q
Gonorrhea immune evasion
A
Rapid Ag variation of Pilus proteins. Intracellular in PMNs. Culture negative. UTI
18
Q
Chlamydia/Gonorrhea Tx regimen
A
Ceftriaxone + Azithromycin/doxycycline
19
Q
G- coccobacillus causing otitus media, bronchitis, conjunctivitis
A
Nontypable Haemophilus influenze. No capular Ag
20
Q
Pneumonia with Hyponatremia, watery diarrhea, heachahe and GI pain. grows on?
A
Legionella. can cause SIADH and decreased tubular reabsorption; Charcoal Yeast Extract
21
Q
Key E coli virulence factor for: UTI? Pneumonia? Neonatal Meningitis? Sepsis?
A
UTI- Fimbrae/P-pili; Shock-LPS
Pneumonia/Meningitis- K Capsule
22
Q
E. Coli strain that does not ferment sorbitol or produce glucuronidase
A
EHEC. O157:H7, Shiga-like/Verotoxin causes microthrombi to form on toxin-damaged endothelium–>HUS
23
Q
Woolsorter’s disease
A
Bacillus anthracis. inhalation of SPORES from contaiminated wool; flu-like with rapid progression to fever, hemorrhage, mediastinitis and shock
24
Q
Two toxins that inhibit EF-2
A
Diptheria toxin and Pseudomonas Exotoxin A
25
Gardener with skin ulcer on arm and nodules traced up the arm; CIGAR-shaped budding yeast
Sporothrix Schenkii. Ascending lymphangitis
26
Optochin-
Sensitive: Strep Pneumo (bile solube);
Resistant: viridans strep (bile insoluble). Strep pneumo also has a capsule and is bile soluble (lysed by bile)
27
Bacteria grown in culture w/ Staph aureus (which provides Factor V/NAD+
Haemophilus influenza. otherwise grown on chocolate agar-->NAD/Factor V and Hemitin/Factor X
28
Bloody diarrhea w/ bacteria that invades @ M cells in Peyer's patch and spreads cell to cell (not hematogenous spread)
Shigella. does not produde H2S; Invasion of intestinal mucosa is the most important virulence factor
29
Diarrhea after eating raw oysters
Vibrio vulnificus
30
Appendicitis-like mesenteric adenitis from a puppy (2bugs)
Yersinia enterocolitica. bloody diarrhea with puppy may also be campylobacter
31
Flu, Jaundice, and Photophobia after contact with animal urine in Hawaii. can also cause what dz?
Leptospira interrogans. Can cause Weil disease-->severe jaundice with azotemia, anemia, fever and hemorrhage
32
Screen and confirm tests for Syphilis
VDRL/RPR screen; FTA-ABS confirms. Can also try to visualize the spirochete on Darkfield microscopy; CSF for VDRL/RPR for tertiary
33
Bacteria that causes Kaposi like purpura after cat scratch
Bartonella (Bacillary angiomatosis)
34
Deer hides/pelts in Arkansas/Missouri, Rabbits
Francisella tularensis
35
Osteomyelitis/cellulitis after a dog/cat bite
Pasteurella multocida
36
Dermacentor tick spreads these bacteria
Ricketsia and Francisella
37
Monocytes with morulae
Erlichiosis. blue, berry like inclusions
38
Granulocytes with morulae
Anaplasmosis. Ixodes tick with Borrelia and Babesia.
there is no rash with anaplasmosis compared to rocky moutain spotted fever.
39
Infectious form of Chlamydia? Intracellular form?
Elemenatary is infectious, Reticulate is intracellular. Cannot make own ATP; Visualized on Giemsa stain
40
Atypical pneumonia with bird exposure
Chlamydophila psittaci (C. pneumoniae also causes atypical pneumonia)
41
Cold agglutinin Immune hemolytic anemia
Mycoplasma, infectious mononucleosis. IgM
42
Dimorphic fungus intracellular in Macrophages
Histoplasmosis. Immunocomprimised patients can have hepatosplenomegaly and ulcerated tongue lesions
43
Spaghetti and Meatball appearence, damage melanocytes
Malassezia furfur. Tinea Versicolor, spot that does not tan
44
Yeast that branch at 45deg? 90deg?
45-Aspergillus; 90-Mucor/Rhizopus
45
Germ Tubes at 37 deg
Candida
46
Key immune cell to prevent Candida superficial vs systemic
Superficial--T lymphocyte; Systemic-Neutrophils
47
Pt in North Carolina with rash that starts at wrists. spread via?
Rocky Mountain Spotted Fever/Rickettsia. Starts are wrists and ankles then spreads to the palms/soles and trunk; Dermacentor Tick
48
This is the site of cryptococcus initial infections
LLUNGS (not nasopharynx). inhalation of yeast, pidgeon droppings
49
Most specific test for Cryptococcus
Latex Agglutination. detects polysaccharide capsular Ag; India Ink is also characteristic but a shittier test, Mucicarmine stains red
50
Fungus that causes frontal lobe abscesses after penetrating cribiform plate in Ketoacidotic diabetic or leukemia pt. structure of this fungi?
Mucor/Rhizopus. Black, necrotic eschar on face; Branch at 90, nonseptate;
51
Fungal infection that can be treated with Potassium Iodide. what else do you need to add to tx regimen?
Sporothrix Schenkii. Also with itraconazole-->Rose Gardener's disease
52
Liver abscess w/ anchovy paste exudate and flask shaped ulcer. tx? compared size to RBC?
Entamoeba histolytica. Metronidazole/Iodoquinol; RBC in entamoeba
53
AIDS pt with amoeba infection in brain causing focal deficits, dementia and coma; no lake exposure
Ancanthamoeba
54
IgE mechanisms to block/kill parasites
Antibody-Dependent Cellular Cytotoxicity via Eosinophils. binds FcER1 on eosinophils causing Major Basic Protein release
55
Green nasal discharge after jumping in a lake. what dz does it cause?
Naeglaria fowleri. enters cribiform plate causing rapidly fatal meningoencephalitis w/ amoeba in CSF
56
African Sleeping Sickness TX
Trypanosoma brucei
Suramin (Blood) and Melarsoprol (CNS)
57
Winterbottom's sign-->swollen lymph nodes on back of the neck
African Sleeping Sickness/Trypanosoma brucei TX: Suramin (Blood) and Melarsoprol (CNS)
58
Chorioretinitis, Hydrocephalus, and intracranial calcifications. And TX?
Toxoplasma gondii. tachyzoite on biopsy;
Sulfadiazine and Pyrimethamine
59
Hemolytic anemia with "Maltese cross" in RBC on smear. tx?
Babesia. Ixodes tick with Lyme/Borrelia and Anaplasma-->Atovaquone+azithromycin
60
Trophozoites with RBC in cytoplasm or Cysts w/ 4 nuclei. tx?
Entamoeba histolytica. Metronidazole/Iodoquinol; Entamoeba is the only amoeba that phagocytizes RBC
61
Chagas Tx. s/s
Nifurtimox. mega colon, megaesophagus, dilated cardiomyopathy
62
Macrophage with Amastigotes. s/s? spread?
Leishmania donovani. Sandfly bite; spiking fever, hepatomegaly, pancytopenia
63
TX for Leishmania
Sodium Stibogluconate
64
TX for anal pruritis/Scotch tape test +. What is the organism?
Mebendazole or Pyrantel Pamoate (Enterobius vermincularis/Pinworm (nematode))
65
Filiform larvae in soil penetrate skin after rhabdiform larve lost in stool
Strongyloides. Can have autoinfection if rhabdiform becomes filiform in the gut
66
TX for Strongyloides
Ivermectin or Albendazole
67
Black skin nodules and blindness
Onchocerca volvulus. "River" blindness due to RXN to bacteria inside onchocerca (Wolbachia intracellular bacteria within filarial nematodes)
68
TX for Riverblindness
Ivermectin (Onchocerca volvulus. )
69
Elephantiasis organism and TX
Wucheria bancrofti; Diethycarbamazine (takes 9mo-1year; blocks lymphatics)
70
Scabes (skin lesions on hand) TX
Permethrin or Ivermectin
71
Forms cysts in liver than require ethanol injection prior to surgery to prevent anaphylaxis. Organism? Tx?
Echinococcus. Hydatid cyst; Ingestion of eggs from dog feces;
TX with albendazole;
sheep Dog is definitive host
72
TX for Taenia solium
Praziquantel. Albendazole for neurocystacercosis-->ingestion of eggs (not cysts in pork-->tapeworm)
73
Organism that causes Squamous Cell carcinoma of bladder and can lead to bilateral hydronephrosis. Organism? Tx?
Schistosoma. Cercariae leave snails and penetrate skin; Egypt and China; Praziquantel
74
Cholangiocarcinoma and pigment gallstone association. tx?
Clonorchis sinensis. China, undercooked fish, liver fluke, Praziquantel
75
Pt with brain cysts and Seizures
Neurocystacercosis
76
Parasite causing Microcytic Anemia? Macrocytic? Tx for each?
Microcytic: Hookworm (Necator americanus/Ancylostoma. larvae penetrate skin (Bendazole or pyrantel pamoate)
Macrocytic: Diphyllobothrium latum. Undercooked fish (Praziquantel)
77
Parasites treated with Ivermectin
Strongyloides and Onchocerca
78
Undercooked crabmeat
Paragonimus Westernmanii
79
Inflammation of the liver capsule by Neisseria gonorrhea
Fitz-Hugh Curtis Syndrome. due to ascention of the gonorrhea, can also cause salpingitis/PID leading to infertility
80
Comma shaped bacteria that grows in alkaline medium
Vibrio cholera
81
Rabies binds to this recepter to cause infection
Nicotinic Ach Receptor. Replicates initially in muscle and connective tissue-->Retrograde transport in axons to CNS
82
Bartonella TX
Azithromycin. G- but very fastidious (difficult to grow and test for susceptability)
83
Live Vaccines
```
VZV,
Polio
MMR.
small pox and
yellow fever
```
(Live polio vaccine allows production of gut IgA against polio (unlike killed)
84
DNA virus with reverse transcriptase. Also tx?
HepB. Circular partially dsDNA; can cause HCC via integration into host genome (no cirrhosis first). Lamivudine and Tenofovir TX (HIV NRTI)
85
RNA viruses that do not replicate in the cytoplasm
influenza and HIV
86
Killed Vaccines
Rabies, Influenze, HAV, polio
87
Herpes virus envelope are from?
nuclear membrane
88
Pts immune to HepB will not have what Ab if vaccinated
Anti-HBcAg
89
Recombinant vaccines
HepB (HbsAg) and HPV
90
Pt has punch out lesions in the esophagus
HSV-1. CMV also causes esophageal lesions-->linear ulcers
91
Most common cause of acute hemorrhagic cystitis in kids
Adenovirus. dsDNA linear, also causes pink eye, febrile pharyngitis, and pneumonia
92
Temporal lobe encephalitis with acute mood, memory, and behavioral changes and Cowdry Type A Inclusions
HSV-1
93
JC viurs genome type. Name similar virus
dsDNA circular (Polyomavirus). similar to BK virus that infects the kidney in transplant patients
94
Pts with infectious mononucleosis are at risk for rupture of what organ? S/s of mono?
spleen. hepatosplenomegaly with fever, pharyngitis, and lymphadenopathy (poster cervical especially)
95
EBV receptor
CD21. Infects B cells and blood smear shows atypical CD8+ T cells (Downey cells)
96
Virus that can cause high fevers/febrile seizures followed by a diffuse macular rash on the body after several days
Roseola. HHV6; Febrile SEIZURES key for differentiating from other Rashes of Childhood
97
Where is VZV latent? Spread?
Dorsal root or trigeminal ganglia. Single dermatome, transmitted by respiratory secretions
98
Characteristic test for genital herpes
Tzanck test. detects multinuclear giant cells in opened skin vesicle
99
Immature Squamous cell with Dense pink cytoplasm and a perinuclear halo
Koilocyte. HPV, Nucleus may be enlarged with undulating membrane
100
dsRNA with linear, segmented genome
Reovirus (rotavirus). Most common cause of fatal diarrhea in children, more common in winter
101
Hepatitis with high mortality in pregant women. Describe structure of virus?
Hep E. Hepevirus->ssRNA+ linear
102
4 virus in Paramyxovirus (ssRNA- linear)
Parainfluenza, RSV, Measles, Mumps
103
Key TX for RSV
Ribavirin: Inhibits duplication of viral genome via inhibiting IMP dehydrogenase; #1 cause of respiratory death in infants, causes fusion of respiratory epithelial cells and giant cells via Fusion (F) protein. Ribavirin also used for chronic HepC. Ribavirin is not used that much for RSV anymore, not effiacious.
104
Rabies virus genome
Rhabdovirus--ssRNA (-) linear
105
Hepatitis B vaccination protects against what additional virus
HepD/Delta agent. HepD must use HBsAg to replicate/spread
106
Picornaviruses that cause meningitis
Echovirus, Poliovirus, Coxsackievirus: summer months, late fall.
107
Main virulence factor of rhinovirus (common cold)
>100 serotypes
108
Segmented viruses
Orthomyxovirus, reovirus, bunyavirus, hantavirus
109
black vomit, high fever, jaundice. Describe structure of organism?
Yellow fever virus. SS+RNA
110
Post Auricular lymphadenopathy in a child with a fine rash on body that started at head and moved down
Rubella. Deafness, PDA, blindness, blueberry muffin rash in neonate
111
mAb that blocks F protein in RSV
Palivizumab. prevents fusion of respiratory epithelial cells to for multinucleated cells
112
Child with white spots with erythematous background on buccal mucosa with maculopapular rash. what do you give to decrease severity of dx?
Measles. Koplik Spots; Vitamin A used to prevent severe exfoliation
113
Pt is delirious with hypersalivation and laryngeal spasms
Rabies
114
What determines the incubation period length in rabies
Distance of inoculation site from CNS. Bites near head and neck progress rapidly
115
Postexposure TX of rabies
Wound cleansing + Active and Passive immunization. rabies immune globulin injected
116
What causes HepC immune evasion?
RNA-dependent-RNA-Polymerase has No 3'-5' exonuclease proofreading function. hypervariable envelope glycoprotein
117
Positive serology in the window period of HepB
Anti-HBc IgM
118
What HepB Ag indicates active infection/high transmissability
HBeAg/HBV DNA. Also indicated likelihood of a mother passing to a child-->95% chance with high HBeAg
119
Progression of Ag&Ab in HepB
SECES. SE Ag, CES Ab
120
Pol gene in HIV genome contains? Drug that inhibits one of the products incoded by gene?
Reverse Transcriptase, aspartate Protease, Integrase. raltegravir blocks integrase, which prevents production of HIV mRNA by host enzymes
121
Homozygous mutation of what surface molecule provides HIV immunity. Drug that blocks this surface molecule?
CCR5. bound by gp120; Blocked with Maraviroc
122
HIV Screen and Confirmatory Tests
Screen: ELISA; Confirm: Western Blot (+ for 3 proteins). AIDS when CD4<14%
123
Child develps progressive dementia, ataxia, myoclonus, and visual problems; had a rash on body about 6 years ago; Oligoclonal bands in CSF
Subacture Sclerosing Panencephalitis. Occurs about 6 years after having measles
124
Vesicular lesion on trunk with lesions of different ages in child
VZV Chickenpox. "Dew on a Rose"
125
How can newborns of HIV mothers be falsely positive for HIV?
IgG against HIV cross the placenta. ELISA and Western Blot test for HIV Ab, confirm exposure to actual virus w/ HIV PCR
126
During the latent phase of HIV, why is blood level of HIV low?
Replication in the lymph nodes
127
Tongue ulcer and hepatosplenomegaly in AIDS pt
Histoplasma capsulatum
128
White material on lateral tongue that can't be scraped off, HIV
Hairy Leukoplakia/EBV
129
Visual Impairment in HIV pt with cotton wool spots on fundoscopic exam? Tx?
CMV Retinitis. TX with ganciclovir/Foscarnet (Foscarnet can cause seizures--chelates Ca2+ and Mg2+)
130
Spongiform Encephalopathy with rapid dementia and ataxia
Prions/Creutzfedt-Jakob
131
Characteristic finding in HIV CNS invasion
Microglial nodules with Multinucleated Microglial cells
132
Primary CNS Lymphoma in AIDS associated with what
EBV. B lymphocytes, can be focal or multiple periventricular ring enhancing lesions
133
Pt with AIDS has purple papules diffuse across skin (give 2)
Bacillary Angiomatosis- Bartonella--Neutrophil infiltrate
| Kaposi Sarcoma- HHV-8-Lymphocyte infiltrate
134
Key normal flora bacterium of the vagina
Lactobacillus
135
Pseudoappendicitis associated with daycare
Yersinia enterocolitica
136
Gas gangrene and watery diarrhea organism. Mechanism?y
Clostridium perfringens. spore forming G+ rod, Alpha toxin=phospholipids = lecithinase. Causes double zone of hemolysis on blood agar.
Degrades phospholipids --> myonecrosis
137
Osteomyelitis most common
Staph Aureus
138
Osteomyelitis in Diabetic/IV drug user
Pseudomonas or Serratia. Serratia ferments lactose
139
Signs you went from cystitis/UTI to acute pyelonephritis
WBC Casts, Fever, flank pain, CVA tenderness. UTI has WBC in urine but NOT casts
140
Urease positive UTI?
Nitrate +?
Urease +: Proteus, Klebsiella, s. saprophyticus
E. coli and enterococcus is urease negative;
Proteus, Klebsiella, e.coli, enterococcus are all Nitrate +
staph saprophyticus is nitrite negative
141
Newborn with PDA, cataracts, and deafness, what infection
Rubella
142
Seizures and hearing loss in a newborn
CMV. Often with blueberry muffin rash and petechial rash
143
Meningitis with a petechial rash
Neisseria meningitidis. LOS mediated (meningococcus has LOS instead of LPS); Purpura Fulminans
144
Chronic Diarrhea and recurrent infections in a newborn
HIV. If HIV negative and infections are viral, bacterial, and fungal, think SCID
145
Congenital Syphilis findings
Notched/Hutchinson teeth, saber shins, saddle nose, short maxilla, CN8 deafness. often results in still birth or hydrops fetalis
146
Possible cause of infertility in women with HX of PID
Failure to TX both Gonorrhea and Chlamydia in co-infected pt. Look out for Infertility Questions where the woman had PID and was only tx with Ceftriaxone OR doxycycline/Azithromycin
147
Pt with purulent cervical discharge and adhesion from peritoneum to liver
Fitz-Hugh Curtis Syndrome
148
Child with sickle cell at risk for what infection(s)
Strep pneumo, Haemophilus and Salmonella osteomyelitis (encapsulated organisms SHiNE SKiES). Autosplenectomy in SCD makes susceptable to encapsulated microbes
149
In osteomyelitis, what is the devitalization of bone called
sequestra
150
In osteomyelitis, reactive bone formation in the periosteum
Involucrum
151
Muscle pain with calcified cyst in skeletal muscle, splinter hemorrhages in nails and periorbital edema, Eosinophilia. Tx?
Trichinella spiralis. Due to eating undercooked pork; Tx with albendazole, larvae encyst in striated muscle and often have dystrophic calcification
152
Does the rash in Measles or Rubella become confluent?
Measles
153
Erythematous rash that begins on the cheeks then extends to trunk and proximal extremities
Parvovirus B19--Erythema infectosum. Arthritis in adults
154
When are children with VZV/Chickenpox infectious
1 week BEFORE the rash appears. Macules, vesicles and pustules all present at the same time
155
How must you treat onychomycosis/tinea unguium
Oral agents--terbinafine or itraconazole
156
What technique can be used to help identify tinea versicolor
Wood's Lamp (Malassezia furfur). Fungus derived acids inhibit tyrosinase (hypopigmentation) --> does not tan
157
Newborn with "cradle cap" seborrheic dermatitis, what tx
shampoo (selenium sulfide, zinc pyrithione. (Malassezia furfur)
158
Kid plays in sandbox with cat/dog, Serpiginous tunnels in skin with intense pruritis and eosinophilia. TX?
Cutaneous Larval Migrans. Ancylostoma --> dog/cat hookworm, larvae migrate in skin; TX with Ivermectin. Visceral Larval migrans is Toxoplasma canis
159
Intensely pruritis lesion inbetween fingers. Tx?
Scarptes scabiei. Intense pruritis caused by the EGGS; TX with permethrin cream
160
Bedbug organism
Cimex lectularius. feed on human blood, active just before dawn, intensely pruritic
161
Hepatitus C is associated with what dermatologic condition
Lichen Planus. Polygonal Purple Planar papules and plaques + Wickham's Striae + Sawtooth Dermal-Epidermal junction.
162
Infections associated with Erythema Multiforme
Mycoplasma and HSV. Targetoid rashes on palms soles and extensor surfaces
163
Infections associated with Erythema Nodosum
Coccidioidomycosis, Histoplasma, TB, Strep pharyngitis, Yersinia Enterocolitica
164
Hepatitis B has a prodrome including what type of rash
Uticaria. Type 3 Hypersensitivity --> Serum Sickness-like prodrome
165
Pt with sinopulmonary infection also has eczema and thrombocytopenia
Wiscott Aldrich Syndrome. X linked progressive deletion of B and T cells; Dec IgM and G; Inc Ig A and E
166
Hepatitis B is associated with what Vasculitis
Polyarteritis nodosa. typically effects the renal and mesenteric arteries-->Transmural inflammation w/ fibrinoid necrosis
167
What is the major virulence factor for Strep pyogenes
M Protein. Inhibits phagocytosis and complement activation, cytotoxic for neutrophils, and mediates adhesion
168
TB growth in parallel chains/sepentine cords signifies:
Cord Factor +. Cord factor is TB's key virulence factor and is needed for infection
169
Toxin produced by Listeria to exit phagosome in macrophage
Listerolysin O. facultatice intracellular G+ rod; tumbling motility and growth at 4 deg C
170
Child with a Pink upper body and Cyanotic lower body had what infection transmitted from the mother
Rubella (Rubella associated with PDA, which causes differential cyanosis when the shunt reverses)
171
Most common cause of myocarditis and pericarditis
Coxsackie virus (also dilated cardiomyopathy (via myocarditis))
172
Metachromatic granules in a clustered Gram +
Corynebacterium diptheriae (Red and Blue granules, toxin inhibits EF-2 (protein synthesis), ELEK test for toxin)
173
Most common infection transmitted by blood transfusion (currently)
CMV. In the past HepC was the big one, but now PCR makes that rare; CMV in donor lymphocytes
174
Most common extrapulmonary site for Miliary TB
Kidney
175
Inspiratory stridor and brassy cough in a child
Parainfluenza virus/Croup. Steeple sign on X-ray, Brassy=barking
176
Transplant pt or AIDS pt with pneumonia; Histology shows enlarged macrophages w/ inclusions and surrounded by halo
CMV
177
Staccato (choppy) cough in a newborn with pneumonia 2 weeks after birth
Chlamydia trachomatis
178
Dairy Farmer/Veternarian has atypical pneumonia
Coxiella burnetii. associated with livestock birthing process. Q fever
179
Yellow sputum in pt w/ pneumonia 5 days after viral pneumonia
Staph Aureus
180
Hypersensitivity Pneumonitis is a restrictive lung disease caused by thermophilic actinomyces; What type of Hypersensitivity
Type III hypersensitivity (IgG mediated). Farmer's Lung; Silo Filler's Disease is due to inhalation of N2O from silo's, also causes restrictive disease
181
Inhalation of bacterial endotoxin in cotton, linen, and hemp cause what disease that improves over the weekend
Byssinosis. Workers feel better over the weekend then dyspnea reoccurs during the week
182
Pt presents with diarrhea 3 hours after a picnic, what do you culture and what do you give for TX
Culture: Food -- especially if mayo containing
TX: Supportive
183
Foamy, PAS+ macrophages in the GI lamina propria
Tropheryma whippelii
184
"Healthy" vs Infective Chronic carrier of HepB
Infective is HBeAg/HBV DNA positive. Both are HBsAg positive
185
Fever, Jaundice, and RUQ pain
Ascending Cholangitis (charcots triad). If septic shock and AMS--> Reynold's Pentad
186
How is clonorchis contracted
encysted larvae in undercooked fish. high risk of cholangiocarcinoma; Chinese liver fluke
187
Responsible for the green pigment of sputum in lobar pneumonia
Myeloperoxidase. from neutrophils
188
Epididymitis/Orchitis/Prostatitis bacteria by age
Child/teenager with or orchitis: mumps
35: E. coli or Pseudomonas. In epididymitis, elevation of the scrotum Relieves the pain (Prehn's sign)
189
Red Inclusions in cervical metastatic squamous cells
Reticulate bodies of Chlamydia trachomatis
190
Yeast with germ tubes
Candida
191
TX for oral thrush
Nystatin. Same mechanism as amphotericin B; swish and swallow because not absorbed
192
Classic Galactosemia is associated with what infection in neonate
E. coli Sepsis. Deficiency of Galactose-1-P Uridyltransferase
193
previously healthy person in the Southwest US who develops rapid septic shock and/or severe pulmonary disease
Yersinia pestis. Prarie dogs and rats; Plague; (Coccidioides would not cause disease this severe in immunocompetant person)
194
Thayer Martin contains Vancomycin, Polymyxin/Colistin (g-) and nystatin, used to isolate what
Neisseria meningitidis and gonorrhea. Used for carrier screening from pharyngeal samples
195
Obligate Intracellular bacteria
Rickettsia and Chlamydia. Cannot produce ATP
196
In toxic shock syndrome, what is released by the TH1 cell?
INF-gamma. That induces cytokine release from the APC
197
Specialized transduction involves what type of virus
Lysogenic bacteriophage. General transduction is lytic phage; Specialized: Shiga-like, Botulinum, Cholera, Diptheria toxins
198
Strep viridans endocarditis mediated by binding what on valves
Bind fibrin-platelet aggregates. produces dextrans from sucrose to facilitate binding
199
Palor around the mouth with a sandpaper type rash in a kid
Scarlet Fever. Step Pyogenes, toxin mediated
200
Prevention of Tetanus in newborns
Vaccination of the mother (IgA/G in breastmilk/placenta). Or on a large scale, vaccinate young adults
201
Mechanism of Gram neg resistance to penecillin G and Vanco
Outer membrane layer inhibits entry
202
Neisseria meningitidis contains what instead of LPS
Lipo-oligosaccharide (LOS). Levels of LOS in plasma corrolated with severity of disease, essentially the same as LPS. LOS also causes petechiae w/ meninigitis
203
Rifampin monotherapy is used for prophylaxis in contacts for what
Meningococcus (N. meningitidis) or Haemophilus. never used alone for TB
204
Gray vaginal discharge, fishy smell, clue cells
Gardnerella vaginalis "Bacterial vaginosis". Tx w/ metronidazole or clindamycin; KOH "whiff test" worsens fishy smell
205
Treatment for all vector borne bacterial diseases
Doxycycline
206
Painless ulcers on genitals with painful, ulcerated inguinal nodes
Lymphogranuloma venereum. Chlamydia trachomatis serotypes L1, L2, and L3
207
TX for Toxoplasmosis
Sulfadiazine + pyramethamine +/- leucovorin
208
Green vaginal discharge with itching and burning
Trichomonas vaginalis. Metronidazole for pt and partner
209
Used to prevent severe exfoliative dermatitis in measles infection
Vitamin A
210
Organisms for AIDS Encephalitis vs Meningitis
Enceph: JC virus; Meningitis: Cryptococcus
211
Pneumonia in an AIDS pt with CD4 count >200
Strep Pneumoniae. presents as normal community acquired lobar streph pneumo
212
Nucleoside Reverse Transciptase inhibitor used in pregnancy
Zidovudine
213
C. diff toxin causes pseudomembranous colitis via what action
Actin Depolymerization. Damages cytoskeletal integrity
214
Gastric Biopsy shows a positive urease test (becomes more basic when urea added to biopsy
Helicobacter pylori infection. H. pylori converts urea to CO2 and NH3-->NH3 increases pH, changing the color of the indicator
215
Measured in serum to test for Anaphylaxis
Tryptase
216
Main manifestation of Parvovirus in adults
Arthralgia. symmetric in PIPs, wrists, knees, and ankles
217
G- oxidase +, lactose non-fermenter
Pseudomonas
218
Reassortment can only occur in what type of virus
Segmented Virus
219
How does Silicosis (pneumoconiosis) increase TB risk
Silica impairs phagolysosome formation by macrophages
220
Bacteria that release toxins that lyse cell membranes
Clostridium perfringens and Step pyogenese (streptolysin O)
221
Flu-like symptoms after onset of Syphilis tx
Jarish-Herxheimer reaction. killed bacteria release pyrogens
222
Person presents w/ erythemia migrans after camping and fever/hemolytic anemia
Borrelia/Lyme Disease AND Babesiosis. Babesia is parasite that causes hemolytic anemia and fever; Maltese cross on blood smear
223
Cephalosporins active against Pseudomonas
Ceftazidime (3rd) and cefepime (4th). {Ceftaroline (5th) is active against MRSA}
224
Antibiotic class contraindicated in Myasthenia gravis-->neuromusclular blockade.? How is this drug inactivated?
Aminoglycosides. Drug inactivated via acetylation, phosphorylation, and adenylation
225
Used to treat strep infections in pts allergic to penecillin. SEs?
Macrolides. SE: Prolong QT, acute cholestatic hepatitis, increase serum concentration of theophyllines and anticoagulants
226
Abx that can cause kernicterus in newborns.
Sulfonamides. displace bilirubin from albumin
227
Needed to convert isoniazid to active form
Catalase-peroxidase. Chemically similar to Pyridoxine/vitamin B6; Neurotoxicity (dec w/ B6 supp), hepatotoxicity, Drug-Lupus
228
TB drug effective in the acidic pH of Phagolysosome
Pyrazinamide. works in macrophages where intracellular TB is
229
TX for Schistosomiasis, Clonorchis, and Taenia solium
Praziquantel. Increases permability to Ca, causing muscle paralysis
230
Pts w/ late compliment (C5-9) deficiency are susceptable to
Neisseria meningitidis infections
231
Resistance to aminoglycosides is via:
conjugation of the drug at the bacteria surface. acetylation, adenylation, phosphorylation
232
Abx that prolong QT
Macrolides and fluoroquinolones
233
Tetracycline derivative that is effective against MRSA
Tigecycline
234
Main side effect of acyclovir? Ganciclovir?
Acyclovir can crystallize in urine-->Nephrotoxic
| Ganciclovir causes myelosuppresion
235
What two drugs are associated w/ Fanconi Syndrome
Tenofovir and expired Tetracyclines. also Wilson's disease can cause Fanconi syndrome
236
Nephrogenic strains of Strep Pyogenes cannot cause rheumatic fever because they lack:
M protein. RF is type 2 hypersensitivity against M protein (molecular mimicry)
237
Treatment for Rheumatic Fever
Penicillin, aspirin and corticosteroids (if murmur present)
238
Non-caseating granulomas in the axillary lymph nodes
Cat Scratch disease (Bartonella hensae)
239
Splinter hemorrhages & dystrophic calcification in striated muscle
Trichinosis (Trichinella spiralis). Undercooked pork
240
Swollen, painful apocrine glands in axilla and groin infected w/ Staph aureus
Hidradenitis supperativa. hallmark is presence of sinus tracts
241
Pharyngitis w/ erythematous rash the spares circumoral region, sandpaper feeling
Scarlet Fever (Strep pyogenes w/ erythrogenic toxin)
242
Dermatophytes by location
Tinea Capitis: Blacks-Trichophyton tonsurans,
Tinea Capitis: Whites-Microsporum canis/audouinii
Corporis/pedis/cruris-Trichophyton rubrum
Unguium-Trichophyton rubrum
243
Organisms at risk in Chronic Granulomatous Disease
Staph aureus, Pseudomonas cepacia, Nocardia, Serratia, Aspergillus. Nitroblue tetrazolium test; Nocardia is a branched gram positive
244
Infection associated w/ non-caseating granulomas
Bartonella henselae--cat scratch disease. often in axillary lymph nodes due to scratches on arms
245
Pts who undergo splenectomy should be vaccinated against
Strep Pneumo (most important). Haemophilus influenza and Neisseria vaccination is also important but Strep pneumo is #1
246
Most common bacteria in aspiration pneumonia
Oral anaerobes- Bacteroides, Fusobacterium, Peptococcus. Right lower lobe abscess; Think Klebsiella if currant jelly sputum
247
Potential Complication of lymphogranuloma venereum
Rectal stricture. Chlamydia trachomatis L1-L3
248
TX for gram - rod in penecillin allergic pt with renal disease
Aztreonam. No cross reactivity to penecillins, cannot use aminoglycoside in renal dz
249
Imipenem/Carbapenems are broad spectrum and B-lactamase resistant, why not used more?
CNS toxicity--seizures
250
Abx that binds the 23S rRNA of 50S subunit
Macrolides
251
Pneumocystis infection in a person w/o AIDS, what genetic dz?
Hyper IgM Syndrome. X-linked defect in CD-40L-->no isotype switching
252
DNA viruses w/ circular genomes
Papillomavirus and Papovavirus (JC virus) and Hepadnavirus
253
What drug can be given w/ Abx to absorb C. diff Toxin A and B
Cholestyramine
254
Best body fluid to culture for CMV
Urine
255
Sarcoidosis pts will not produce a response on what test
PPD skin test for TB. INF-gamma test is more specific
256
Of DNA viruses, which have envelopes
Herpes, Hepadna, and Pox viruses
257
TX for Vanco-resistant Enterococcus (VRE)
Linezolid or Streptogramins (Quinupristin/dalfopristin)
258
LPS receptor on Macrophages
CD14
259
Splenomegaly in EBV infectious mononucleosis is due to:
T cell hyperplasia in the PALS. Lymphadenopathy due to T cell hyperplasia in lymph node paracortex
260
Treatment for Kaposi's Sarcoma
AIDS: Retroviral therapy
Transplant: decrease immunosuppresion
261
Non-lung manifestations of Mycoplasma pneumonia
Cold-Agglutinins hemolytic anemia, Erythema multiforme. Anemia is due to IgM against I antigen
