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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+

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2
Q

Novobiocin–

A

Sensitive: Staph epidermidis
Resistant: Staph saprophyticus

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3
Q

Quellung Reaction

A

Strep Pneumo. Strep pneumo capsule swells when bound by Ab (specific); Lancet shaped diplococci

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4
Q

Bacitracin:

A

Sensitive: Strep Pyogenes,
Resistant: Strep agalactiae

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5
Q

Endocarditis following GI/GU procedures? grows on?

A

Enterococcus. Can grow in bile and 6.5% NaCl

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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

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7
Q

tetanospasmin block GABA and glycine release from?

A

Renshaw cells in the spinal cord. trismus (lockjaw), Risus Sardonicus, and Opisthonotos (eyes locked)

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8
Q

Serpentine chains of G+ rods?

A

Bacillus anthracis. spore forming; edema factor inc cAMP; + lethal toxin

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9
Q

Only G+ that produces LPS? grows in?

A

Listeria. Tumbling motility and can grow at 4 degrees celcius (cold enrichment)

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10
Q

Acid fast+ and G+, causes pulmonary infections. tx?

A

Nocardia. weakly acid fast (carbolfuschin); TX with sulfonamides

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11
Q

Oxidase+, G- that grows at 42 degrees. structure? spread via? diseases?

A

Camplyobacter. Comma shaped, undercooked chicken; Guillane-Barre and Reactive Arthritis

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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

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13
Q

Asthma and CF pts at risk for this infection causing bronchiectasis and Eosinophilia

A

Allergic Bronchopulmonary Aspergillosis (ABPA). Leads to bronchiectasis

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14
Q

Bacteria that causes Lymptocytic Leukocytosis

A

Bordetella pertussis. Lympthocytosis promiting factor that blocks lymphocyotes from leacing blood for LNs

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15
Q

Grows in both bile and 6.5% NaCl (G+ coccus)

A

Enterococcus

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16
Q

Only bacteria with a polypeptide capsule

A

Bacillus anthracis. D-glutamate; Cutaneous- ulcer with black eschar

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17
Q

Gonorrhea immune evasion

A

Rapid Ag variation of Pilus proteins. Intracellular in PMNs. Culture negative. UTI

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18
Q

Chlamydia/Gonorrhea Tx regimen

A

Ceftriaxone + Azithromycin/doxycycline

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19
Q

G- coccobacillus causing otitus media, bronchitis, conjunctivitis

A

Nontypable Haemophilus influenze. No capular Ag

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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

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21
Q

Key E coli virulence factor for: UTI? Pneumonia? Neonatal Meningitis? Sepsis?

A

UTI- Fimbrae/P-pili; Shock-LPS

Pneumonia/Meningitis- K Capsule

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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

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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

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24
Q

Two toxins that inhibit EF-2

A

Diptheria toxin and Pseudomonas Exotoxin A

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25
Q

Gardener with skin ulcer on arm and nodules traced up the arm; CIGAR-shaped budding yeast

A

Sporothrix Schenkii. Ascending lymphangitis

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26
Q

Optochin-

A

Sensitive: Strep Pneumo (bile solube);
Resistant: viridans strep (bile insoluble). Strep pneumo also has a capsule and is bile soluble (lysed by bile)

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27
Q

Bacteria grown in culture w/ Staph aureus (which provides Factor V/NAD+

A

Haemophilus influenza. otherwise grown on chocolate agar–>NAD/Factor V and Hemitin/Factor X

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28
Q

Bloody diarrhea w/ bacteria that invades @ M cells in Peyer’s patch and spreads cell to cell (not hematogenous spread)

A

Shigella. does not produde H2S; Invasion of intestinal mucosa is the most important virulence factor

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29
Q

Diarrhea after eating raw oysters

A

Vibrio vulnificus

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30
Q

Appendicitis-like mesenteric adenitis from a puppy (2bugs)

A

Yersinia enterocolitica. bloody diarrhea with puppy may also be campylobacter

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31
Q

Flu, Jaundice, and Photophobia after contact with animal urine in Hawaii. can also cause what dz?

A

Leptospira interrogans. Can cause Weil disease–>severe jaundice with azotemia, anemia, fever and hemorrhage

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32
Q

Screen and confirm tests for Syphilis

A

VDRL/RPR screen; FTA-ABS confirms. Can also try to visualize the spirochete on Darkfield microscopy; CSF for VDRL/RPR for tertiary

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33
Q

Bacteria that causes Kaposi like purpura after cat scratch

A

Bartonella (Bacillary angiomatosis)

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34
Q

Deer hides/pelts in Arkansas/Missouri, Rabbits

A

Francisella tularensis

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35
Q

Osteomyelitis/cellulitis after a dog/cat bite

A

Pasteurella multocida

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36
Q

Dermacentor tick spreads these bacteria

A

Ricketsia and Francisella

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37
Q

Monocytes with morulae

A

Erlichiosis. blue, berry like inclusions

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38
Q

Granulocytes with morulae

A

Anaplasmosis. Ixodes tick with Borrelia and Babesia.

there is no rash with anaplasmosis compared to rocky moutain spotted fever.

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39
Q

Infectious form of Chlamydia? Intracellular form?

A

Elemenatary is infectious, Reticulate is intracellular. Cannot make own ATP; Visualized on Giemsa stain

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40
Q

Atypical pneumonia with bird exposure

A

Chlamydophila psittaci (C. pneumoniae also causes atypical pneumonia)

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41
Q

Cold agglutinin Immune hemolytic anemia

A

Mycoplasma, infectious mononucleosis. IgM

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42
Q

Dimorphic fungus intracellular in Macrophages

A

Histoplasmosis. Immunocomprimised patients can have hepatosplenomegaly and ulcerated tongue lesions

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43
Q

Spaghetti and Meatball appearence, damage melanocytes

A

Malassezia furfur. Tinea Versicolor, spot that does not tan

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44
Q

Yeast that branch at 45deg? 90deg?

A

45-Aspergillus; 90-Mucor/Rhizopus

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45
Q

Germ Tubes at 37 deg

A

Candida

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46
Q

Key immune cell to prevent Candida superficial vs systemic

A

Superficial–T lymphocyte; Systemic-Neutrophils

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47
Q

Pt in North Carolina with rash that starts at wrists. spread via?

A

Rocky Mountain Spotted Fever/Rickettsia. Starts are wrists and ankles then spreads to the palms/soles and trunk; Dermacentor Tick

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48
Q

This is the site of cryptococcus initial infections

A

LLUNGS (not nasopharynx). inhalation of yeast, pidgeon droppings

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49
Q

Most specific test for Cryptococcus

A

Latex Agglutination. detects polysaccharide capsular Ag; India Ink is also characteristic but a shittier test, Mucicarmine stains red

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50
Q

Fungus that causes frontal lobe abscesses after penetrating cribiform plate in Ketoacidotic diabetic or leukemia pt. structure of this fungi?

A

Mucor/Rhizopus. Black, necrotic eschar on face; Branch at 90, nonseptate;

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51
Q

Fungal infection that can be treated with Potassium Iodide. what else do you need to add to tx regimen?

A

Sporothrix Schenkii. Also with itraconazole–>Rose Gardener’s disease

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52
Q

Liver abscess w/ anchovy paste exudate and flask shaped ulcer. tx? compared size to RBC?

A

Entamoeba histolytica. Metronidazole/Iodoquinol; RBC in entamoeba

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53
Q

AIDS pt with amoeba infection in brain causing focal deficits, dementia and coma; no lake exposure

A

Ancanthamoeba

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54
Q

IgE mechanisms to block/kill parasites

A

Antibody-Dependent Cellular Cytotoxicity via Eosinophils. binds FcER1 on eosinophils causing Major Basic Protein release

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55
Q

Green nasal discharge after jumping in a lake. what dz does it cause?

A

Naeglaria fowleri. enters cribiform plate causing rapidly fatal meningoencephalitis w/ amoeba in CSF

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56
Q

African Sleeping Sickness TX

A

Trypanosoma brucei

Suramin (Blood) and Melarsoprol (CNS)

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57
Q

Winterbottom’s sign–>swollen lymph nodes on back of the neck

A

African Sleeping Sickness/Trypanosoma brucei TX: Suramin (Blood) and Melarsoprol (CNS)

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58
Q

Chorioretinitis, Hydrocephalus, and intracranial calcifications. And TX?

A

Toxoplasma gondii. tachyzoite on biopsy;

Sulfadiazine and Pyrimethamine

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59
Q

Hemolytic anemia with “Maltese cross” in RBC on smear. tx?

A

Babesia. Ixodes tick with Lyme/Borrelia and Anaplasma–>Atovaquone+azithromycin

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60
Q

Trophozoites with RBC in cytoplasm or Cysts w/ 4 nuclei. tx?

A

Entamoeba histolytica. Metronidazole/Iodoquinol; Entamoeba is the only amoeba that phagocytizes RBC

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61
Q

Chagas Tx. s/s

A

Nifurtimox. mega colon, megaesophagus, dilated cardiomyopathy

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62
Q

Macrophage with Amastigotes. s/s? spread?

A

Leishmania donovani. Sandfly bite; spiking fever, hepatomegaly, pancytopenia

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63
Q

TX for Leishmania

A

Sodium Stibogluconate

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64
Q

TX for anal pruritis/Scotch tape test +. What is the organism?

A

Mebendazole or Pyrantel Pamoate (Enterobius vermincularis/Pinworm (nematode))

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65
Q

Filiform larvae in soil penetrate skin after rhabdiform larve lost in stool

A

Strongyloides. Can have autoinfection if rhabdiform becomes filiform in the gut

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66
Q

TX for Strongyloides

A

Ivermectin or Albendazole

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67
Q

Black skin nodules and blindness

A

Onchocerca volvulus. “River” blindness due to RXN to bacteria inside onchocerca (Wolbachia intracellular bacteria within filarial nematodes)

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68
Q

TX for Riverblindness

A

Ivermectin (Onchocerca volvulus. )

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69
Q

Elephantiasis organism and TX

A

Wucheria bancrofti; Diethycarbamazine (takes 9mo-1year; blocks lymphatics)

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70
Q

Scabes (skin lesions on hand) TX

A

Permethrin or Ivermectin

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71
Q

Forms cysts in liver than require ethanol injection prior to surgery to prevent anaphylaxis. Organism? Tx?

A

Echinococcus. Hydatid cyst; Ingestion of eggs from dog feces;
TX with albendazole;

sheep Dog is definitive host

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72
Q

TX for Taenia solium

A

Praziquantel. Albendazole for neurocystacercosis–>ingestion of eggs (not cysts in pork–>tapeworm)

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73
Q

Organism that causes Squamous Cell carcinoma of bladder and can lead to bilateral hydronephrosis. Organism? Tx?

A

Schistosoma. Cercariae leave snails and penetrate skin; Egypt and China; Praziquantel

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74
Q

Cholangiocarcinoma and pigment gallstone association. tx?

A

Clonorchis sinensis. China, undercooked fish, liver fluke, Praziquantel

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75
Q

Pt with brain cysts and Seizures

A

Neurocystacercosis

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76
Q

Parasite causing Microcytic Anemia? Macrocytic? Tx for each?

A

Microcytic: Hookworm (Necator americanus/Ancylostoma. larvae penetrate skin (Bendazole or pyrantel pamoate)
Macrocytic: Diphyllobothrium latum. Undercooked fish (Praziquantel)

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77
Q

Parasites treated with Ivermectin

A

Strongyloides and Onchocerca

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78
Q

Undercooked crabmeat

A

Paragonimus Westernmanii

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79
Q

Inflammation of the liver capsule by Neisseria gonorrhea

A

Fitz-Hugh Curtis Syndrome. due to ascention of the gonorrhea, can also cause salpingitis/PID leading to infertility

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80
Q

Comma shaped bacteria that grows in alkaline medium

A

Vibrio cholera

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81
Q

Rabies binds to this recepter to cause infection

A

Nicotinic Ach Receptor. Replicates initially in muscle and connective tissue–>Retrograde transport in axons to CNS

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82
Q

Bartonella TX

A

Azithromycin. G- but very fastidious (difficult to grow and test for susceptability)

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83
Q

Live Vaccines

A 
VZV, 
Polio
MMR.
 small pox and 
yellow fever

(Live polio vaccine allows production of gut IgA against polio (unlike killed)

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84
Q

DNA virus with reverse transcriptase. Also tx?

A

HepB. Circular partially dsDNA; can cause HCC via integration into host genome (no cirrhosis first). Lamivudine and Tenofovir TX (HIV NRTI)

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85
Q

RNA viruses that do not replicate in the cytoplasm

A

influenza and HIV

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86
Q

Killed Vaccines

A

Rabies, Influenze, HAV, polio

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87
Q

Herpes virus envelope are from?

A

nuclear membrane

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88
Q

Pts immune to HepB will not have what Ab if vaccinated

A

Anti-HBcAg

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89
Q

Recombinant vaccines

A

HepB (HbsAg) and HPV

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90
Q

Pt has punch out lesions in the esophagus

A

HSV-1. CMV also causes esophageal lesions–>linear ulcers

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91
Q

Most common cause of acute hemorrhagic cystitis in kids

A

Adenovirus. dsDNA linear, also causes pink eye, febrile pharyngitis, and pneumonia

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92
Q

Temporal lobe encephalitis with acute mood, memory, and behavioral changes and Cowdry Type A Inclusions

A

HSV-1

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93
Q

JC viurs genome type. Name similar virus

A

dsDNA circular (Polyomavirus). similar to BK virus that infects the kidney in transplant patients

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94
Q

Pts with infectious mononucleosis are at risk for rupture of what organ? S/s of mono?

A

spleen. hepatosplenomegaly with fever, pharyngitis, and lymphadenopathy (poster cervical especially)

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95
Q

EBV receptor

A

CD21. Infects B cells and blood smear shows atypical CD8+ T cells (Downey cells)

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96
Q

Virus that can cause high fevers/febrile seizures followed by a diffuse macular rash on the body after several days

A

Roseola. HHV6; Febrile SEIZURES key for differentiating from other Rashes of Childhood

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97
Q

Where is VZV latent? Spread?

A

Dorsal root or trigeminal ganglia. Single dermatome, transmitted by respiratory secretions

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98
Q

Characteristic test for genital herpes

A

Tzanck test. detects multinuclear giant cells in opened skin vesicle

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99
Q

Immature Squamous cell with Dense pink cytoplasm and a perinuclear halo

A

Koilocyte. HPV, Nucleus may be enlarged with undulating membrane

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100
Q

dsRNA with linear, segmented genome

A

Reovirus (rotavirus). Most common cause of fatal diarrhea in children, more common in winter

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101
Q

Hepatitis with high mortality in pregant women. Describe structure of virus?

A

Hep E. Hepevirus->ssRNA+ linear

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102
Q

4 virus in Paramyxovirus (ssRNA- linear)

A

Parainfluenza, RSV, Measles, Mumps

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103
Q

Key TX for RSV

A

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.

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104
Q

Rabies virus genome

A

Rhabdovirus–ssRNA (-) linear

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105
Q

Hepatitis B vaccination protects against what additional virus

A

HepD/Delta agent. HepD must use HBsAg to replicate/spread

106
Q

Picornaviruses that cause meningitis

A

Echovirus, Poliovirus, Coxsackievirus: summer months, late fall.

107
Q

Main virulence factor of rhinovirus (common cold)

A

> 100 serotypes

108
Q

Segmented viruses

A

Orthomyxovirus, reovirus, bunyavirus, hantavirus

109
Q

black vomit, high fever, jaundice. Describe structure of organism?

A

Yellow fever virus. SS+RNA

110
Q

Post Auricular lymphadenopathy in a child with a fine rash on body that started at head and moved down

A

Rubella. Deafness, PDA, blindness, blueberry muffin rash in neonate

111
Q

mAb that blocks F protein in RSV

A

Palivizumab. prevents fusion of respiratory epithelial cells to for multinucleated cells

112
Q

Child with white spots with erythematous background on buccal mucosa with maculopapular rash. what do you give to decrease severity of dx?

A

Measles. Koplik Spots; Vitamin A used to prevent severe exfoliation

113
Q

Pt is delirious with hypersalivation and laryngeal spasms

A

Rabies

114
Q

What determines the incubation period length in rabies

A

Distance of inoculation site from CNS. Bites near head and neck progress rapidly

115
Q

Postexposure TX of rabies

A

Wound cleansing + Active and Passive immunization. rabies immune globulin injected

116
Q

What causes HepC immune evasion?

A

RNA-dependent-RNA-Polymerase has No 3’-5’ exonuclease proofreading function. hypervariable envelope glycoprotein

117
Q

Positive serology in the window period of HepB

A

Anti-HBc IgM

118
Q

What HepB Ag indicates active infection/high transmissability

A

HBeAg/HBV DNA. Also indicated likelihood of a mother passing to a child–>95% chance with high HBeAg

119
Q

Progression of Ag&Ab in HepB

A

SECES. SE Ag, CES Ab

120
Q

Pol gene in HIV genome contains? Drug that inhibits one of the products incoded by gene?

A

Reverse Transcriptase, aspartate Protease, Integrase. raltegravir blocks integrase, which prevents production of HIV mRNA by host enzymes

121
Q

Homozygous mutation of what surface molecule provides HIV immunity. Drug that blocks this surface molecule?

A

CCR5. bound by gp120; Blocked with Maraviroc

122
Q

HIV Screen and Confirmatory Tests

A

Screen: ELISA; Confirm: Western Blot (+ for 3 proteins). AIDS when CD4<14%

123
Q

Child develps progressive dementia, ataxia, myoclonus, and visual problems; had a rash on body about 6 years ago; Oligoclonal bands in CSF

A

Subacture Sclerosing Panencephalitis. Occurs about 6 years after having measles

124
Q

Vesicular lesion on trunk with lesions of different ages in child

A

VZV Chickenpox. “Dew on a Rose”

125
Q

How can newborns of HIV mothers be falsely positive for HIV?

A

IgG against HIV cross the placenta. ELISA and Western Blot test for HIV Ab, confirm exposure to actual virus w/ HIV PCR

126
Q

During the latent phase of HIV, why is blood level of HIV low?

A

Replication in the lymph nodes

127
Q

Tongue ulcer and hepatosplenomegaly in AIDS pt

A

Histoplasma capsulatum

128
Q

White material on lateral tongue that can’t be scraped off, HIV

A

Hairy Leukoplakia/EBV

129
Q

Visual Impairment in HIV pt with cotton wool spots on fundoscopic exam? Tx?

A

CMV Retinitis. TX with ganciclovir/Foscarnet (Foscarnet can cause seizures–chelates Ca2+ and Mg2+)

130
Q

Spongiform Encephalopathy with rapid dementia and ataxia

A

Prions/Creutzfedt-Jakob

131
Q

Characteristic finding in HIV CNS invasion

A

Microglial nodules with Multinucleated Microglial cells

132
Q

Primary CNS Lymphoma in AIDS associated with what

A

EBV. B lymphocytes, can be focal or multiple periventricular ring enhancing lesions

133
Q

Pt with AIDS has purple papules diffuse across skin (give 2)

A

Bacillary Angiomatosis- Bartonella–Neutrophil infiltrate

Kaposi Sarcoma- HHV-8-Lymphocyte infiltrate

134
Q

Key normal flora bacterium of the vagina

A

Lactobacillus

135
Q

Pseudoappendicitis associated with daycare

A

Yersinia enterocolitica

136
Q

Gas gangrene and watery diarrhea organism. Mechanism?y

A

Clostridium perfringens. spore forming G+ rod, Alpha toxin=phospholipids = lecithinase. Causes double zone of hemolysis on blood agar.

Degrades phospholipids –> myonecrosis

137
Q

Osteomyelitis most common

A

Staph Aureus

138
Q

Osteomyelitis in Diabetic/IV drug user

A

Pseudomonas or Serratia. Serratia ferments lactose

139
Q

Signs you went from cystitis/UTI to acute pyelonephritis

A

WBC Casts, Fever, flank pain, CVA tenderness. UTI has WBC in urine but NOT casts

140
Q

Urease positive UTI?

Nitrate +?

A

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
Q

Newborn with PDA, cataracts, and deafness, what infection

A

Rubella

142
Q

Seizures and hearing loss in a newborn

A

CMV. Often with blueberry muffin rash and petechial rash

143
Q

Meningitis with a petechial rash

A

Neisseria meningitidis. LOS mediated (meningococcus has LOS instead of LPS); Purpura Fulminans

144
Q

Chronic Diarrhea and recurrent infections in a newborn

A

HIV. If HIV negative and infections are viral, bacterial, and fungal, think SCID

145
Q

Congenital Syphilis findings

A

Notched/Hutchinson teeth, saber shins, saddle nose, short maxilla, CN8 deafness. often results in still birth or hydrops fetalis

146
Q

Possible cause of infertility in women with HX of PID

A

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
Q

Pt with purulent cervical discharge and adhesion from peritoneum to liver

A

Fitz-Hugh Curtis Syndrome

148
Q

Child with sickle cell at risk for what infection(s)

A

Strep pneumo, Haemophilus and Salmonella osteomyelitis (encapsulated organisms SHiNE SKiES). Autosplenectomy in SCD makes susceptable to encapsulated microbes

149
Q

In osteomyelitis, what is the devitalization of bone called

A

sequestra

150
Q

In osteomyelitis, reactive bone formation in the periosteum

A

Involucrum

151
Q

Muscle pain with calcified cyst in skeletal muscle, splinter hemorrhages in nails and periorbital edema, Eosinophilia. Tx?

A

Trichinella spiralis. Due to eating undercooked pork; Tx with albendazole, larvae encyst in striated muscle and often have dystrophic calcification

152
Q

Does the rash in Measles or Rubella become confluent?

A

Measles

153
Q

Erythematous rash that begins on the cheeks then extends to trunk and proximal extremities

A

Parvovirus B19–Erythema infectosum. Arthritis in adults

154
Q

When are children with VZV/Chickenpox infectious

A

1 week BEFORE the rash appears. Macules, vesicles and pustules all present at the same time

155
Q

How must you treat onychomycosis/tinea unguium

A

Oral agents–terbinafine or itraconazole

156
Q

What technique can be used to help identify tinea versicolor

A

Wood’s Lamp (Malassezia furfur). Fungus derived acids inhibit tyrosinase (hypopigmentation) –> does not tan

157
Q

Newborn with “cradle cap” seborrheic dermatitis, what tx

A

shampoo (selenium sulfide, zinc pyrithione. (Malassezia furfur)

158
Q

Kid plays in sandbox with cat/dog, Serpiginous tunnels in skin with intense pruritis and eosinophilia. TX?

A

Cutaneous Larval Migrans. Ancylostoma –> dog/cat hookworm, larvae migrate in skin; TX with Ivermectin. Visceral Larval migrans is Toxoplasma canis

159
Q

Intensely pruritis lesion inbetween fingers. Tx?

A

Scarptes scabiei. Intense pruritis caused by the EGGS; TX with permethrin cream

160
Q

Bedbug organism

A

Cimex lectularius. feed on human blood, active just before dawn, intensely pruritic

161
Q

Hepatitus C is associated with what dermatologic condition

A

Lichen Planus. Polygonal Purple Planar papules and plaques + Wickham’s Striae + Sawtooth Dermal-Epidermal junction.

162
Q

Infections associated with Erythema Multiforme

A

Mycoplasma and HSV. Targetoid rashes on palms soles and extensor surfaces

163
Q

Infections associated with Erythema Nodosum

A

Coccidioidomycosis, Histoplasma, TB, Strep pharyngitis, Yersinia Enterocolitica

164
Q

Hepatitis B has a prodrome including what type of rash

A

Uticaria. Type 3 Hypersensitivity –> Serum Sickness-like prodrome

165
Q

Pt with sinopulmonary infection also has eczema and thrombocytopenia

A

Wiscott Aldrich Syndrome. X linked progressive deletion of B and T cells; Dec IgM and G; Inc Ig A and E

166
Q

Hepatitis B is associated with what Vasculitis

A

Polyarteritis nodosa. typically effects the renal and mesenteric arteries–>Transmural inflammation w/ fibrinoid necrosis

167
Q

What is the major virulence factor for Strep pyogenes

A

M Protein. Inhibits phagocytosis and complement activation, cytotoxic for neutrophils, and mediates adhesion

168
Q

TB growth in parallel chains/sepentine cords signifies:

A

Cord Factor +. Cord factor is TB’s key virulence factor and is needed for infection

169
Q

Toxin produced by Listeria to exit phagosome in macrophage

A

Listerolysin O. facultatice intracellular G+ rod; tumbling motility and growth at 4 deg C

170
Q

Child with a Pink upper body and Cyanotic lower body had what infection transmitted from the mother

A

Rubella (Rubella associated with PDA, which causes differential cyanosis when the shunt reverses)

171
Q

Most common cause of myocarditis and pericarditis

A

Coxsackie virus (also dilated cardiomyopathy (via myocarditis))

172
Q

Metachromatic granules in a clustered Gram +

A

Corynebacterium diptheriae (Red and Blue granules, toxin inhibits EF-2 (protein synthesis), ELEK test for toxin)

173
Q

Most common infection transmitted by blood transfusion (currently)

A

CMV. In the past HepC was the big one, but now PCR makes that rare; CMV in donor lymphocytes

174
Q

Most common extrapulmonary site for Miliary TB

A

Kidney

175
Q

Inspiratory stridor and brassy cough in a child

A

Parainfluenza virus/Croup. Steeple sign on X-ray, Brassy=barking

176
Q

Transplant pt or AIDS pt with pneumonia; Histology shows enlarged macrophages w/ inclusions and surrounded by halo

A

CMV

177
Q

Staccato (choppy) cough in a newborn with pneumonia 2 weeks after birth

A

Chlamydia trachomatis

178
Q

Dairy Farmer/Veternarian has atypical pneumonia

A

Coxiella burnetii. associated with livestock birthing process. Q fever

179
Q

Yellow sputum in pt w/ pneumonia 5 days after viral pneumonia

A

Staph Aureus

180
Q

Hypersensitivity Pneumonitis is a restrictive lung disease caused by thermophilic actinomyces; What type of Hypersensitivity

A

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
Q

Inhalation of bacterial endotoxin in cotton, linen, and hemp cause what disease that improves over the weekend

A

Byssinosis. Workers feel better over the weekend then dyspnea reoccurs during the week

182
Q

Pt presents with diarrhea 3 hours after a picnic, what do you culture and what do you give for TX

A

Culture: Food – especially if mayo containing
TX: Supportive

183
Q

Foamy, PAS+ macrophages in the GI lamina propria

A

Tropheryma whippelii

184
Q

“Healthy” vs Infective Chronic carrier of HepB

A

Infective is HBeAg/HBV DNA positive. Both are HBsAg positive

185
Q

Fever, Jaundice, and RUQ pain

A

Ascending Cholangitis (charcots triad). If septic shock and AMS–> Reynold’s Pentad

186
Q

How is clonorchis contracted

A

encysted larvae in undercooked fish. high risk of cholangiocarcinoma; Chinese liver fluke

187
Q

Responsible for the green pigment of sputum in lobar pneumonia

A

Myeloperoxidase. from neutrophils

188
Q

Epididymitis/Orchitis/Prostatitis bacteria by age

A

Child/teenager with or orchitis: mumps

35: E. coli or Pseudomonas. In epididymitis, elevation of the scrotum Relieves the pain (Prehn’s sign)

189
Q

Red Inclusions in cervical metastatic squamous cells

A

Reticulate bodies of Chlamydia trachomatis

190
Q

Yeast with germ tubes

A

Candida

191
Q

TX for oral thrush

A

Nystatin. Same mechanism as amphotericin B; swish and swallow because not absorbed

192
Q

Classic Galactosemia is associated with what infection in neonate

A

E. coli Sepsis. Deficiency of Galactose-1-P Uridyltransferase

193
Q

previously healthy person in the Southwest US who develops rapid septic shock and/or severe pulmonary disease

A

Yersinia pestis. Prarie dogs and rats; Plague; (Coccidioides would not cause disease this severe in immunocompetant person)

194
Q

Thayer Martin contains Vancomycin, Polymyxin/Colistin (g-) and nystatin, used to isolate what

A

Neisseria meningitidis and gonorrhea. Used for carrier screening from pharyngeal samples

195
Q

Obligate Intracellular bacteria

A

Rickettsia and Chlamydia. Cannot produce ATP

196
Q

In toxic shock syndrome, what is released by the TH1 cell?

A

INF-gamma. That induces cytokine release from the APC

197
Q

Specialized transduction involves what type of virus

A

Lysogenic bacteriophage. General transduction is lytic phage; Specialized: Shiga-like, Botulinum, Cholera, Diptheria toxins

198
Q

Strep viridans endocarditis mediated by binding what on valves

A

Bind fibrin-platelet aggregates. produces dextrans from sucrose to facilitate binding

199
Q

Palor around the mouth with a sandpaper type rash in a kid

A

Scarlet Fever. Step Pyogenes, toxin mediated

200
Q

Prevention of Tetanus in newborns

A

Vaccination of the mother (IgA/G in breastmilk/placenta). Or on a large scale, vaccinate young adults

201
Q

Mechanism of Gram neg resistance to penecillin G and Vanco

A

Outer membrane layer inhibits entry

202
Q

Neisseria meningitidis contains what instead of LPS

A

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
Q

Rifampin monotherapy is used for prophylaxis in contacts for what

A

Meningococcus (N. meningitidis) or Haemophilus. never used alone for TB

204
Q

Gray vaginal discharge, fishy smell, clue cells

A

Gardnerella vaginalis “Bacterial vaginosis”. Tx w/ metronidazole or clindamycin; KOH “whiff test” worsens fishy smell

205
Q

Treatment for all vector borne bacterial diseases

A

Doxycycline

206
Q

Painless ulcers on genitals with painful, ulcerated inguinal nodes

A

Lymphogranuloma venereum. Chlamydia trachomatis serotypes L1, L2, and L3

207
Q

TX for Toxoplasmosis

A

Sulfadiazine + pyramethamine +/- leucovorin

208
Q

Green vaginal discharge with itching and burning

A

Trichomonas vaginalis. Metronidazole for pt and partner

209
Q

Used to prevent severe exfoliative dermatitis in measles infection

A

Vitamin A

210
Q

Organisms for AIDS Encephalitis vs Meningitis

A

Enceph: JC virus; Meningitis: Cryptococcus

211
Q

Pneumonia in an AIDS pt with CD4 count >200

A

Strep Pneumoniae. presents as normal community acquired lobar streph pneumo

212
Q

Nucleoside Reverse Transciptase inhibitor used in pregnancy

A

Zidovudine

213
Q

C. diff toxin causes pseudomembranous colitis via what action

A

Actin Depolymerization. Damages cytoskeletal integrity

214
Q

Gastric Biopsy shows a positive urease test (becomes more basic when urea added to biopsy

A

Helicobacter pylori infection. H. pylori converts urea to CO2 and NH3–>NH3 increases pH, changing the color of the indicator

215
Q

Measured in serum to test for Anaphylaxis

A

Tryptase

216
Q

Main manifestation of Parvovirus in adults

A

Arthralgia. symmetric in PIPs, wrists, knees, and ankles

217
Q

G- oxidase +, lactose non-fermenter

A

Pseudomonas

218
Q

Reassortment can only occur in what type of virus

A

Segmented Virus

219
Q

How does Silicosis (pneumoconiosis) increase TB risk

A

Silica impairs phagolysosome formation by macrophages

220
Q

Bacteria that release toxins that lyse cell membranes

A

Clostridium perfringens and Step pyogenese (streptolysin O)

221
Q

Flu-like symptoms after onset of Syphilis tx

A

Jarish-Herxheimer reaction. killed bacteria release pyrogens

222
Q

Person presents w/ erythemia migrans after camping and fever/hemolytic anemia

A

Borrelia/Lyme Disease AND Babesiosis. Babesia is parasite that causes hemolytic anemia and fever; Maltese cross on blood smear

223
Q

Cephalosporins active against Pseudomonas

A

Ceftazidime (3rd) and cefepime (4th). {Ceftaroline (5th) is active against MRSA}

224
Q

Antibiotic class contraindicated in Myasthenia gravis–>neuromusclular blockade.? How is this drug inactivated?

A

Aminoglycosides. Drug inactivated via acetylation, phosphorylation, and adenylation

225
Q

Used to treat strep infections in pts allergic to penecillin. SEs?

A

Macrolides. SE: Prolong QT, acute cholestatic hepatitis, increase serum concentration of theophyllines and anticoagulants

226
Q

Abx that can cause kernicterus in newborns.

A

Sulfonamides. displace bilirubin from albumin

227
Q

Needed to convert isoniazid to active form

A

Catalase-peroxidase. Chemically similar to Pyridoxine/vitamin B6; Neurotoxicity (dec w/ B6 supp), hepatotoxicity, Drug-Lupus

228
Q

TB drug effective in the acidic pH of Phagolysosome

A

Pyrazinamide. works in macrophages where intracellular TB is

229
Q

TX for Schistosomiasis, Clonorchis, and Taenia solium

A

Praziquantel. Increases permability to Ca, causing muscle paralysis

230
Q

Pts w/ late compliment (C5-9) deficiency are susceptable to

A

Neisseria meningitidis infections

231
Q

Resistance to aminoglycosides is via:

A

conjugation of the drug at the bacteria surface. acetylation, adenylation, phosphorylation

232
Q

Abx that prolong QT

A

Macrolides and fluoroquinolones

233
Q

Tetracycline derivative that is effective against MRSA

A

Tigecycline

234
Q

Main side effect of acyclovir? Ganciclovir?

A

Acyclovir can crystallize in urine–>Nephrotoxic

Ganciclovir causes myelosuppresion

235
Q

What two drugs are associated w/ Fanconi Syndrome

A

Tenofovir and expired Tetracyclines. also Wilson’s disease can cause Fanconi syndrome

236
Q

Nephrogenic strains of Strep Pyogenes cannot cause rheumatic fever because they lack:

A

M protein. RF is type 2 hypersensitivity against M protein (molecular mimicry)

237
Q

Treatment for Rheumatic Fever

A

Penicillin, aspirin and corticosteroids (if murmur present)

238
Q

Non-caseating granulomas in the axillary lymph nodes

A

Cat Scratch disease (Bartonella hensae)

239
Q

Splinter hemorrhages & dystrophic calcification in striated muscle

A

Trichinosis (Trichinella spiralis). Undercooked pork

240
Q

Swollen, painful apocrine glands in axilla and groin infected w/ Staph aureus

A

Hidradenitis supperativa. hallmark is presence of sinus tracts

241
Q

Pharyngitis w/ erythematous rash the spares circumoral region, sandpaper feeling

A

Scarlet Fever (Strep pyogenes w/ erythrogenic toxin)

242
Q

Dermatophytes by location

A

Tinea Capitis: Blacks-Trichophyton tonsurans,
Tinea Capitis: Whites-Microsporum canis/audouinii
Corporis/pedis/cruris-Trichophyton rubrum
Unguium-Trichophyton rubrum

243
Q

Organisms at risk in Chronic Granulomatous Disease

A

Staph aureus, Pseudomonas cepacia, Nocardia, Serratia, Aspergillus. Nitroblue tetrazolium test; Nocardia is a branched gram positive

244
Q

Infection associated w/ non-caseating granulomas

A

Bartonella henselae–cat scratch disease. often in axillary lymph nodes due to scratches on arms

245
Q

Pts who undergo splenectomy should be vaccinated against

A

Strep Pneumo (most important). Haemophilus influenza and Neisseria vaccination is also important but Strep pneumo is #1

246
Q

Most common bacteria in aspiration pneumonia

A

Oral anaerobes- Bacteroides, Fusobacterium, Peptococcus. Right lower lobe abscess; Think Klebsiella if currant jelly sputum

247
Q

Potential Complication of lymphogranuloma venereum

A

Rectal stricture. Chlamydia trachomatis L1-L3

248
Q

TX for gram - rod in penecillin allergic pt with renal disease

A

Aztreonam. No cross reactivity to penecillins, cannot use aminoglycoside in renal dz

249
Q

Imipenem/Carbapenems are broad spectrum and B-lactamase resistant, why not used more?

A

CNS toxicity–seizures

250
Q

Abx that binds the 23S rRNA of 50S subunit

A

Macrolides

251
Q

Pneumocystis infection in a person w/o AIDS, what genetic dz?

A

Hyper IgM Syndrome. X-linked defect in CD-40L–>no isotype switching

252
Q

DNA viruses w/ circular genomes

A

Papillomavirus and Papovavirus (JC virus) and Hepadnavirus

253
Q

What drug can be given w/ Abx to absorb C. diff Toxin A and B

A

Cholestyramine

254
Q

Best body fluid to culture for CMV

A

Urine

255
Q

Sarcoidosis pts will not produce a response on what test

A

PPD skin test for TB. INF-gamma test is more specific

256
Q

Of DNA viruses, which have envelopes

A

Herpes, Hepadna, and Pox viruses

257
Q

TX for Vanco-resistant Enterococcus (VRE)

A

Linezolid or Streptogramins (Quinupristin/dalfopristin)

258
Q

LPS receptor on Macrophages

A

CD14

259
Q

Splenomegaly in EBV infectious mononucleosis is due to:

A

T cell hyperplasia in the PALS. Lymphadenopathy due to T cell hyperplasia in lymph node paracortex

260
Q

Treatment for Kaposi’s Sarcoma

A

AIDS: Retroviral therapy
Transplant: decrease immunosuppresion

261
Q

Non-lung manifestations of Mycoplasma pneumonia

A

Cold-Agglutinins hemolytic anemia, Erythema multiforme. Anemia is due to IgM against I antigen

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