1A: Dt 2 - 1

Front 1

Carbachol:
Drug class

Back 1

Direct cholinergic agonist

Front 2

Atropine:
Drug Class

Back 2

Cholinergic antagonist

Front 3

Ipratroprium:
Drug Class

Back 3

Cholinergic antagonist

Front 4

Benztropine:
Drug Class

Back 4

Cholinergic antagonist

Front 5

Oxybutynin:
Drug Class

Back 5

Cholinergic antagonist

Front 6

Glycopyrrolate:
Drug Class

Back 6

Cholinergic antagonist

Front 7

Epinephrine:
Receptors affected

Back 7

alpha1, alpha2
beta1, beta2

Front 8

Norepinephrine:
Receptors affected

Back 8

alpha1, alpha2
beta1

Front 9

Dopamine:
Receptors affected

Back 9

D1=D2 > beta1 > alpha 1

Front 10

Tertbutaline:
Receptors affected

Back 10

Beta2>beta1 (AGONIST)

Front 11

Phenylephrine:
Receptors affected

Back 11

alpha1>alpha2

Front 12

Doenepezil:
Drug class

Back 12

AChE-inhibitor (indirect cholinergic agonist)

Front 13

Hexamethonium:
Drug class

Back 13

Nicotinic antagonist

Front 14

Pralidoxime:
Drug class

Back 14

Regenerates cholinesterase ; impt for organophosphate poisoning

Front 15

Agents that inhibit presynaptic uptake of NE

Back 15

Cocaine
TCAs
Amphetamines

Front 16

Loss of forearm pronation

Back 16

Median nerve

Front 17

Cannot abduct or adduct fingers

Back 17

Ulnar nerve

Front 18

Weak lateral rotation of arm

Back 18

Suprascapular nerve (infraspinatus muscle)

Axillary nerve (via deltoid) contributes too

Front 19

Unable to abduct arm initial 10 degrees

Back 19

Suprascapular nerve

Front 20

Peptidoglycan:
Function

Back 20

Provides support, protects against osmotic pressure

Present in both gram poz and neg bacteria

Front 21

Crystal violet stain: purple

What is this staining?
What does it identify?

Back 21

Gram-positive bacteria; stains peptidoglycan

Front 22

Safranin counterstain: pink

What is this staining?
What does it identify?

Back 22

Gram-negative bacteria; stains peptidoglycan

Front 23

Acute phase cytokines:
Which are they?

Back 23

IL-1
IL-6
TNFalpha

Front 24

Bacterial cell wall serves as a surface antigen in ________ bacteria.

Back 24

Gram positive

Front 25

LPS acts as a surface antigen in _______ bacteria.

Back 25

Gram negative

Note: LPS aka outer membrane aka Endotoxin

Front 26

Role of plasma membrane in bacteria.

Back 26

Oxidative and transport enzymes

Front 27

What is a periplasm?

Which class of bacteria has it?

Back 27

Periplasm = space between cytoplasmic membrane and peptidoglycan wall

Location of beta-lactamases!

GRAM NEGS

Front 28

Beta-lactamases are located in ________.

Back 28

Periplasm of gram negative bacteria

Front 29

Function of capsules in bacteria.

Which specific bacteria have a capsule?

Back 29

Protects against phagocytosis

Some Killers Have Nice Shiny Bodies

Step pneumo
Klebsiella
Haemophilus influenzae (B)
Neisseria meningitdis
Salmonella
Group B Strep

Front 30

______ serves as antigens in vaccines.

Back 30

Bacterial Capsules

Front 31

Quelling test

Back 31

Determines whether bug is encapsulated; if encapsulated bug present, capsule swells (Quelling-->swelling)

Front 32

Role of pilus/fimbriae in bacteria.

Back 32

Mediates adhesion of bacteria to cell surface

Sex pilus forms attachment b/t 2 bacteria during conjugation (exchange DNA)

Front 33

Organisms that form spores.

Back 33

Bacillus (anthracis)
Clostridium (perfringens, tetanus)
Coxiella burnetti

Front 34

Role of plasmids in bacteria.

Back 34

DNA particles present in cytoplasm--contain genes for abx resistance, toxins

This DNA is separate from main DNA

Exchanged during conjugation

Front 35

Role of glycocalyx in bacteria.

Back 35

Mediates adherence to surfaces, esp foreign surfaces (indwelling catheters)

Front 36

Teichoic acid is found in _____ and causes release of _____.

Back 36

Teichoic acid found in gram positive bacteria

Induces TNF-alpha and IL-1 release

Front 37

Endotoxin is found in _____ and causes release of _____.

Back 37

Endotoxin is unique to gram neg organisms and induces release of TNF-alpha and IL-1

Front 38

How are bacteria that produce spores killed?

Back 38

Autoclaving

Front 39

Endotoxin:
Which bacteria have it?
Region of endotoxin that mediates immune response
What is the immune response?

Back 39

Endotoxin = LPS
cell wall of gram neg bacteria and listeria (exception bc it's gram poz!)

Lipid A component of LPS-->macs act'd and release IL-1 (fever);
TNF (fever, hemorrhagic necrosis),
NO (vasodilation-->shock!)

Complement:
C3a-->releases histamine (hypotn, edema due to vasc perm-->anaphylaxis)

C5a-->nphil chemotaxis

Hageman factor-->DIC

Front 40

Endotoxin vs Exotoxin:
Location
Site of DNA coding for it
Fatality (low/high)
Antigenicity (poor/good)

Back 40

Endotoxin vs Exotoxin:
Endotoxin: surface of gram neg and listeria; LPS
Encoded by bacterial chromosome
Low fatality (fever, shock, edema)
Poorly antigenic

Exotoxin: proteins that bacteria spit out; polypeptides
Encoded by plasmid/bacteriophage (virus that infects bacteria)
Highly fatal
Highly antigenic (used as vaccines)

Front 41

Super antigens:
What are they?
Which organisms exhibit superantigens?

Back 41

Superantigens are exotoxins that bind directly to MHC II and T-cell receptor-->activate large numbers of T cells to stimulate IFN-gamma and IL-2 release

Superantigens:
Staph aureus
Strep pyogenes

Front 42

Sperantigens of staph aureus.
Effects?

Back 42

Staph aureus:
alpha-toxin-->hemolysis
beta-toxpin-->sphingomyelinase (degrades portion of cell membrane)
gamma-toxin-->A+B proteins of it-->hemolysin; B+C-->leukocidin
Enterotoxins A-E-->food poisoning
TSST-1-->cytokine release-->toxic shock
Epidermolytic/exfoliative-->epithelial cell lysis-->scalded skin syndrome

Front 43

Superantigens of strep pyogenes.
Effects?

Back 43

Strep pyogenes (Group A Strep)
Streptolysin O: hemolysis
Streptolysin S: hemolysis
Erythrogenic/pyrogenic toxins-->skin rash, fever of scarlet fever (respectively)

Front 44

ADP Ribosylating Exotoxins:
Effect

Back 44

B component (Binding) binds host cell, enables endocytosis
A (active) component attaches ADP-ribosyl (ADP ribosylation) to host cell protein, altering its function

Front 45

This bug's exotoxin inactivates elongation factor 2 (EF-2).

Effects?

Back 45

Corynebacterium diphteriae

Causes pharyngitis, pseudomembrane in throat

This is an ADP-Ribosylating Exotoxin (alters fn of a protein)

Front 46

This bug's exotoxin stimulates adenylyl cyclase.

Effect?

Back 46

Vibrio cholerae

Stimulate adenylyl cyclase-->Inc'd Cl- into gut, dec'd Na+ absorption-->rice-water diarrhea


This is an ADP-Ribosylating Exotoxin (alters fn of a protein)

Front 47

This bug's exotoxins stimulates adenylate and guanylate cyclase.

Effect?

Back 47

E. coli

Causes watery diarrhea

Labile like the Air, Stable like the Ground:
Heat-labile toxin-->Adenylate cyclase stimulation
Heat-stable toxin-->Guanylate cyclase stimulation


This is an ADP-Ribosylating Exotoxin (alters fn of a protein)

Front 48

This bug's exotoxin inhibits the alpha subunit of Gi receptors.

Effect?

Back 48

Bordetella pertussis

Leads to inc'd cAMP-->whooping cough; inhibits chemokine receptor-->lymphocytosis


This is an ADP-Ribosylating Exotoxin (alters fn of a protein)

Front 49

This bug's exotoxin is a bacterial adenylate cyclase.

Back 49

Bacillus anthracis

DIRECTLY increases cAMP

Front 50

Clostritidum perfringens:
Exotoxin
Effect

Back 50

alpha toxin (lecithinase)

Gas gangrene

Front 51

C. tetani:
Exotoxin effects

Back 51

Blocks GABA release-->lockjaw

Front 52

C. botulinum:
Exotoxin effects

Back 52

Blocks release of Ach-->Dry as a bone, hot as hare, bloated as toad

Elevated HR, elevated temp

Front 53

Bug found in canned food

Back 53

C botulinum

Front 54

Honey causes floppy baby. Why?

Back 54

C botulinum

Front 55

Bacillus anthracis:
Exotoxin effects

Back 55

Exotoxin = Edema factor (a bacterial adenylate cyclase)-->inc'd cAMP

Front 56

Shigella:
Exotoxin effects

Back 56

Shiga toxin-->cleaves host rRNA (inactivates 60S ribosome)-->enhances cytokine release causing hemolysis, uremia (hemolytic uremic syndrome)

Front 57

Inhibits ACh release:
Toxin

Back 57

Botulinum

Front 58

Lecithinase:
Toxin

Back 58

C perfringens (gas gangrene)

Front 59

Inhibits inhibitor of adenylate cyclase:
Toxin

Back 59

Pertussis

Front 60

Stimulates adenylate cyclase:
Toxin

Back 60

Cholera
Heat labile E Coli (ETEC: enterotoxic E Coli)

Front 61

Destroys leukocytes

Back 61

Leukocidin (staph aureus)

Front 62

Edema factor, lethal factor, protective antigen

Back 62

Bacillus anthracis

Front 63

Rice-water diarrhea

Back 63

Cholera
Heat labile enterotoxin

Front 64

Scarlet Fever

Back 64

Strep pyogenes

Front 65

Toxic shock syndrome

Back 65

TSST1 of staph aureues

Front 66

Inactivates EF-2

Back 66

Diphtheria

Front 67

Blocks releases of glycine

Back 67

Tetanus

Front 68

What 5 bacteria secrete enterotoxins?

Back 68

Cholera
ETEC (heat labile toxin)
Staph aureus
Salmonella
Shigella

Front 69

This bug requires dark field microscopy to identify.

Why?

Back 69

Treponemes--too thin to be visualized

Front 70

Which bugs don't appear on gram stain?

Back 70

These Rascals May Microscopically Lack Color

Treponema
Rickettsia (intracell parasite)
Mycobacteria (high-lipid content of cell wall requires acid fast stain)
Mycoplasma (no cell wall)
Legionella (intracellular)
Chlamydia (intracellular)

Front 71

This bug requires a silver stain to identify.

Why?

Back 71

Legionella

bc it's primarily intracellular

Front 72

Which bugs are obligately intracellular?

Back 72

Stay inside when it's Really Cold

Rickettsia
Chlamydia

can't make their own ATP :(

Front 73

Which bugs are facultatively intracellular?

Back 73

Legionella

(don't worry about others)

Front 74

Ziehl-Neelsen stain

Back 74

AKA Acid-fast stain (mycobacteria)

Front 75

India ink stain

Back 75

Cryptococcus

Front 76

Silver stain

Back 76

Legionella
Fungi (pneumocystis)

Front 77

Congo Red Stain

Back 77

Stains amyloid; amyloidosis

Front 78

Chocolate agar

Back 78

H flu

Front 79

Löwenstein-Jensen Agar

Back 79

Mycobaterium tuberculosis--takes 3-4 weeks to culture!

Should really do acid fast stain.

Front 80

Patients with this bug should be in airborne isolation.

Back 80

TB

Front 81

MacConkey's agar

Back 81

Gram poz WILL NOT GROW

Lactose fermenters turn pink

Non-lactose fermenters stay white

BOTH ARE GRAM NEGZ

Front 82

Blue-black colonies with metallic sheen.

Back 82

E. coli

Front 83

Label this bacterial growth curve.
Describe events.

Back 83

A = lag; metabolic activity, no division

B = Log phase; rapid cell division

C = Stationary phase; nutrient depletion, slow growth. SPORE formation

D = death phase: prolonged nutrient depletion, waste buildup

Front 84

Define bacterial transformation.

Bacteria that utilize this?

Back 84

Take up DNA from environment.

Seen in SHiN bacteria:
S pneumoniae
H flu
Neisseria

Front 85

Generalized vs Specialized Transduction

Back 85

Generalized transduction:
Lytic phage infects bacterium-->cleave bact DNA and synthesize viral proteins. Parts of bact chromosomal DNA may become packaged into viral capsid. Phage infects another bacterium and transfers these genes.

Specialized: lysogenic phage infects bacterium, viral DNA integrated into bact chromosome; when phage DNA excised, flanking bact genes excised with it. Phage can infect other bacterium and transfer these flanking genes.

Front 86

Define bacterial transposition.

Back 86

Segment of DNA excised and reincorporated from plasmid to chromosome and vice versa.

Flanking DNA may follow when excised in this process.

Front 87

Gram stain:
Purple

Back 87

Gram Positive

Can also appear blue!

Front 88

Gram stain:
Pink

Back 88

Gram Negative

Front 89

Gram positive algorithm

Back 89

Gram (+): Purple/blue

Cocci and Rods (bacilli):

If cocci:
Catalase (+)--Clusters or Catalase (-)--Chains

Catalase (+): Staph
If Staph:
Coag (+): Staph aureus
Coag (-): Staph epidermidis; Staph saphrophyticus

If Catalase (-): Strep
----
If rods (bacilli):
Clostridium
Listeria
Bacillus

Front 90

Function of bacterial catalase.

Which bacteria make it?

Back 90

Catalase degrades H2O2 before it can be converted to micorbicidal products by myeloperoxidase

Staph make catalase, strep do not.

Staph make catalase because they have more staff.

Front 91

Function of bacterial coagulase.

Which bacteria make it?

Back 91

Coagulase: converts fibrinogen to fibrin; allows staph aureus to hang out in blood clotting

Made by Staph aureus; not S epidermidis, not S saprophyticus

Front 92

What population is at risk of repetitive infections with catalase-producing microbes? Why?

Back 92

Those with chronic granulomatous dz; catalase-producing microbes (Staph) easily degrade what little H2O2 is present

Front 93

Describe how catalase negative bacteria are classified.

Back 93

Catalase neg (gram poz cocci) = strep
Categorized by hemolysis

Partial hemolysis (green/alpha)-->S. pneumoniae (most common)

Complete hemolysis (clear/beta)-->S pyogenes (GAS); Group B strep

No hemolysis (gamma)-->Enterococcus faecalis

Front 94

This streptococcus exhibits a positive quelling test.

Back 94

S. pneumoniae

Positive quelling means encapsulated!

Front 95

Gram-positive diplococci

Back 95

Strep pneumo

Front 96

Gramp-positive cocci in clusters

Back 96

Staph aureus

Grapes!

Front 97

Bacillus is [aerobic/anaerobic].

Back 97

Aerobic

Front 98

Clostridium is [aerobic/anaerobic].

Back 98

Anaerobic

Front 99

Bacteremia vs Sepsis (General)

Back 99

Bacteremia: bacteria in blood
Sepsis: bacteremia with signs of infection

Front 100

What toxin-mediated diseases are associated with staph aureus?

Back 100

Toxic Shock Syndrome (TSST-1)
Scalded skin syndrome (epidermolytic/exfoliative toxin)
Gastroenteritis/food-poisoning (enterotoxins)

Front 101

Protein A:
Effects of this virulence factor
Which bacteria exhibit this?

Back 101

Binds Fc region of Ig and prevents opsonization

Exhibited by Staph aureus

Front 102

IgA Protease:
Effects of this virulence factor
Which bacteria exhibit this?

Back 102

Cleaves IgA

Secreted by S pneumo, H flu B, Neisseria in order to colonize respiratory mucosa (SHiN bacteria)

Front 103

This bacteria infects prosthetic devices and IV catheters by producing adherent biofilms.

Back 103

Staph epidermidis

Component of normal skin flora!

Front 104

This bacteria is normally present on the skin but can cause endocarditis.

Back 104

Staph epidermitis

Front 105

Strep pneumo:
Associated illnesses
Virulence factor

Back 105

MOPS

Meningitis
Otitis media (in kids)
Pneumonia
Sinusitis

Has IgA protease!

Front 106

M protein:
Effect of this virulence factor
Bacteria that produce this?

Back 106

Prevents phagocytosis

Group A Strep

Front 107

Rusty sputum

Back 107

Strep pneumo

Front 108

Sepsis in sickle cell anemia and splenectomy

Back 108

Strep pneumo

Front 109

Pneumococcal vaccine:
Who gets it?

Back 109

65+
Asplenic
Sickle Cell
HIV poz
Chronic lung dz (asthma, COPD)

Front 110

This is the most common organism of dental caries.

Back 110

Viridans group strep-->Strep mutans

Front 111

Viridans strep is ___-hemolytic.

Back 111

Alpha

Front 112

This bacteria is optochin resistant.

Back 112

Viridans strep (mutans, sanguis)

Front 113

This bacteria causes subacute bacterial endocarditis.

Back 113

Strep sanguis (sanguis = blood; there's lots of blood in the heart)

Front 114

This bacteria may enter circulation during dental procedures and cause heart problems for those with _________.

Back 114

Strep mutans/sanguis

May cause subacute endocarditis in those w/turbulent flow heart problems (pre-existing(!!) endothelial damage)

Front 115

What skin infections can be caused by both strep pyogenes and staph aureus?

Back 115

Folliculitis
Cellulitis
Impetigo (honeycomb lesion)

Front 116

Strawberry tongue

Back 116

Scarlet fever-->strep pyogenes

Front 117

Pharyngitis:
Most common cause?
Concern if untreated?

Back 117

Pharyngitis caused by strep pyogenes (Group A Strep)

If untreated-->autoimmune mediated glomerulonephritis (PHritis), rheumatic fever (PHever)

Front 118

Why is group B strep so common in neonates?
Types of infections caused?
How can this be prevented?

Back 118

Normal vaginal flora in 25% of women!

Meningitis
Sepsis
Pneumonia

(B is for babies!)

Must give PCN or ampicillin DURING labor

Front 119

What are the most common BACTERIAL causes of neonatal death?

Back 119

Group B strep
E coli
Listeria

Front 120

Enterococci:
Gram -/+
Location
Associated infections

Back 120

Gram (+)
Normal flora of gut

Biliary tract infection
UTI

Note this is group D strep.

Front 121

Which bacteria are obligate anaerobes?

Back 121

Clostridia
Bacteroides (in gut)
Actinomyces

Anaerobes Can't Breathe Air

Front 122

Lecithinase:
Effects
Bug

Back 122

C. perfringens (alpha toxin)

Gas gangrene

Front 123

Drugs of choice for anaerobes

Back 123

Metronidazole
Clindamycin

Front 124

Flaccid vs Spastic Paralysis:
Causes

Back 124

Flaccid Paralysis: C. botulinum (floppy baby after honey)
Spastic Paralysis: C. tetani

Front 125

Bacillus anthracis:
Gram -/+
Aerobe/Anaerobe
Cutaneous vs Pulmonary

Back 125

Gram positive
Obligate aerobe

Cutaneous: painless black skin lesion (eschar)-->bacteremia and death

Pulmonary: inhalation of spores-->flu syx-->shock

Front 126

Which bacteria are obligate aerobes?

Back 126

Bacillus
Nocardia
Pseudomonas
Mycobacterium tb

Front 127

Listeria:
Sources
Associated illness

Back 127

Unpasteurized milk/cheese--pregnant women should avoid soft cheese
Vaginal transmission

Neonatal (or immunocomp'd) meningitis
Spontaneous abortion
Amnionitis

Front 128

Actinomyces vs Nocardia:
Features
Presentation
Treatment

Back 128

Both are gram poz rods with long branching filaments; RESEMBLE fungi

Actinomyces israeli (yellow granules; Israel has yellow sand)-->oral/facial abscess, normal oral flora

Nocardia--pulm infection in immunocomp' pts

Treatment is a SNAP.
Sulfa for Nocardia
Actinomyces use PCN

Front 129

What organisms are most commonly implicated in subacute endocarditis?

Back 129

Staph epidermitis
Enterococci
Veridans group strep

Front 130

What organisms are most commonly implicated in acute endocarditis?

Back 130

Staph aureus

Front 131

A woman that is breast-feeding develops redness and swelling of her right breast over a period of 2 hours. Examination reveals a warm, fluctuant mass.

What's the diagnosis?

Back 131

Mastitis due to staph auerues

Front 132

What is the most common aerobic skin flora?

Back 132

Staph epidermitis

Front 133

White membrane on pharynx

Back 133

Diphtheria

Front 134

Most common cause of meningitis

Back 134

Strep pneumo

Front 135

Most common cause of osteomyelitis

Back 135

Staph aureus

Front 136

Otitis media in children

Back 136

Strep pneumo

Front 137

Cellulitis

Back 137

Strep pyogenes OR staph aureus

Front 138

One hour after eating potato salad at a picnic, an entire family began to vomit. After 10 hours, they were better.

What's the organism?

Back 138

Staph aureus made exotoxins in potato salad, family digested toxins, but didn't develop infection.

Front 139

What infections are caused by strep pyogenes?

Back 139

Strep pyogenes = Group A Strep, so:

Pharyngitis
Endocarditis
Skin infections
Necrotizing fasciitis, bacteremia
Toxin-mediated dz
Autoimmune-mediated dz