1A: Dt 5 - 3

Front 1

Candida albicans:
Presentation
Populations affected

Back 1

Thrush in immunocomp'd (steroids, DM, babies, HIV)

Vulval vaginitis (esp in women post-Abx)

Candida intertrigo in folds of obese people

Front 2

Diaper dermatitis:
Cause

Back 2

Candida albicans

Front 3

Back 3

Candida albicans:
Note branched budding and pseudohyphae

Front 4

Candida:
Treatment

Back 4

Nystatin--topical
-azoles--topical

Amphotericin B--systemic

Front 5

Cryptoccus neoformans:
Presentation

Back 5

C. meningitis common in AIDS patients

Front 6

Soap bubble lesion in brain

Back 6

Cryptococcus

Front 7

Pneumocystic jiroveci:
Presentation

Back 7

Diffuse interstitial pneumonia in immunocompromised pts

Front 8

Back 8

Pneumocystis jiroveci (silver stain--numerous small, disk-shaped organisms)

Front 9

Back 9

Pneumocystic pneumonia--note bilateral confluent air-space opacities in central distribution (DIFFUSE)

Front 10

Pneumocystis pneumonia:
Treatment
Prophylaxis Guidelines

Back 10

TMP-SMX

Start prophylaxis in AIDS pts at CD4+ below 200

Front 11

Aspergillus fumigatus:
Presentation

Back 11

Acute angle branching

Front 12

Fungus ball

Back 12

Aspergillus

Front 13

Acute angle branching septate

Back 13

Aspergillus (angle <45º)

Front 14

Which fungi are dimorphic?
What does this mean?

Back 14

Candida albicans: exists as yeast w/pseudohyphae in culture at 20º, but forms germ tubes (look like balloons/sperm cells) at 37º.

Remember: cold-->mold, hot-->yeast

Histo
Blasto
Paracoccidiomycosis

Front 15

Mucor:
Presentation

Back 15

Ketoacidotic diabetic and leukemic pts; proliferate in blood vessel walls (whn excess ketone and glucose)-->enter brain

Frontal lobe ascesses

HA, facial pain,

Front 16

Wide angle branching nonseptate

Back 16

W upside down = M-->Mucor

Front 17

Spaghetti and meatballs

Back 17

Tinea versicolor

Front 18

How does systemic mycosis resemble TB? How is it different?

Back 18

Systemic mycoses can result in granuloma formation, however, there is no person-person contact.

Also, fungal granuloma is NON-caseating.

Front 19

Histoplasmosis:
Location
Reservoirs

Back 19

Mississippi and Ohio river valleys

Bird or bat droppings

Front 20

This fungus fills macrophages.

Back 20

Histoplasmosis (hides in macs)

Front 21

Mycoses associated with birds

Back 21

Histo
Crypto
Chlamydia psittavi
Avian influenza
West Nile Virus

Front 22

Blastomycosis:
Location
Presentation

Back 22

East of Mississippi river; Central America

Inflammatory lung dz and can disseminate to bone/skin

Front 23

Broad-based budding

Back 23

Blastomycosis

Front 24

Coccidiomycosis:
Location
Presentation

Back 24

Southwestern US, California

Causes pneumonia, meningitis; disseminates to bone/skin (case rate inc'd after earthquakes--spherules in dust are thrown up in air)

Front 25

Spherule filled with endospores

Back 25

Coccidiomycosis

Front 26

Back 26

Coccidiomycosis--endospore filled with spherules

Front 27

Captain's wheel appearance
Location?

Back 27

Paracoccidiomycosis; Latin America

Front 28

Transmitted via flower thorns

Back 28

Sporotrichosis

Front 29

Sporotrichosis:
Location
Presentation

Back 29

Vegetation

Presents with local pustule or ulcer with nodules along draining lymphatics (ascending lymphangitis)
Little systemic illness

Tx w/azole

Front 30

Which fungus:
Found in SW US including Texas and California

Back 30

Coccidiosis

Front 31

Which fungus:
Found in Mississippi and Ohio River basins

Back 31

Histo

Front 32

Which fungus:
Causes San Joaquin Valley Fever

Back 32

Cocciodiosis

Front 33

Which fungus:
Found in rural Latin America

Back 33

Paracoccidio

Front 34

Which fungus:
Associated with plant thorns and cutaneous injury

Back 34

Sporotrix

Front 35

Which fungus:
Found in states east of the Mississippi river

Back 35

Blasto

Front 36

Which fungus:
Found in bird and bat droppings

Back 36

Histo

Front 37

Which fungus:
Mold form contains barrel-shaped arthroconidia

Back 37

Coccidio

Front 38

Which fungus:
Associated with dust storms

Back 38

Coccidio

Front 39

Which fungus:
Broad based budding of yeast

Back 39

Blasto

Front 40

Which fungus:
Multiple budding of yeast form

Back 40

Paracoccid

Front 41

Which fungus:
Causes diaper rash

Back 41

C. albicans

Front 42

Which fungus:
Opportunistic mold with septate hyphae that branch at 45 degree angle

Back 42

Aspergillus

Front 43

Which fungus:
Opportunistic mold with irregular nonseptate hyphae that branch at wide angles

Back 43

Mucor

Front 44

Which fungus:
Causes thrush in immunocompromised patients and vulvovaginitis in women

Back 44

C. albicans

Front 45

Which fungus:
Known for causing pneumonia in AIDS patients; start Bactrim prophylaxis when CD4<200

Back 45

P. jiruveci

Front 46

Which fungus:
Yeast known for causing meningitis in AIDS patients

Back 46

Crypto

Front 47

4 molds considered dermatophytes

Back 47

Dermatophytes invade superficial layers of skin FYI

Epidermophytan
Microsporum
Trichophyton
Tinea _____

Front 48

Patient returns from trip to New Mexico and now has pneumonitis.

Fungal cause?

Back 48

Coccidiodes

Front 49

A 30-year old woman has cauliflower skin lesions. Tissue biopsy shows broad-based budding yeasts.

Likely organism?

Back 49

Blasto

Front 50

An HIV+ patient with CSF showing 75/mm^3 lymphocytes suddenly dies. Yeast is identified in CSF.

Likely diagnosis?

Back 50

Cryptoccal meningitis

Front 51

Patient presents with thorn prick and ulcers along lymphatic drainage.

Organism?

Back 51

Sporothrix

Front 52

Amphotericin B:
MOA
Indication
AE

Back 52

MOA: Binds ergosterol (unique to fungi cell wall)--amphoTERicin TEaRs holes in fungal membranes by forming pores

Used in systemic mycoses--can be delivered intrathecally (doesn't pass BBB)

AE: nephrotoxicity, IV phlebitis, fever/chills

Front 53

Nystatin:
MOA
Use

Back 53

MOA: Binds ergosterol (unique to fungi cell wall)

Use: topical (too toxic for systemic use); swish and swallow for thrush

Front 54

Azoles:
MOA
Use
AE

Back 54

Inhibits fungal ergosterol synthesis (by inhibiting its p450 enzyme; NOT CYTOCHROME p450)

Use: systemic mycoses, can cross BBB, all candidal infections

AE: hormone synthesis inhibition (can lead to gynecomastia)

Front 55

Flucytosine:
MOA
Use

Back 55

Inhibits DNA synthesis by conversion to 5-fluorouracil (competes with uracil)

Use: systemic fungal infections in combn w/ampho B

Front 56

Caspofungin:
Use

Back 56

cASPofungin-->invasive aspergillosis

Front 57

Terbinafine:
MOA
Use

Back 57

Inhibits fungal enzyme squalene epoxidase

Use: dermatophytoses (toenail and fingernail infections)

Front 58

Griseofulvin:
MOA
Use
AE

Back 58

Interferes w/MT fn, disrupts mitosis

Deposits in keratin-containing tissues (nails)

Use: Oral tx of superficial infections; inhibits growth of dermatophytes (tinea, ringworm)

Tox: Teratogenic, inducer of p-450

Front 59

Which antifungal:
Interferes with microtubule formation

Back 59

Griseofulvin

Front 60

Which antifungal:
Swish and swallow for thrush

Back 60

Nystatin

Front 61

Which antifungal:
Cell wall synthesis inhibitor used in invasive aspergillosis

Back 61

cASPofungi

Front 62

Which antifungal:
Binds ergosterol-->membrane pores

Back 62

Nystatin, Ampho B

Front 63

Which antifungal:
Most common treatment for onychomycosis

Back 63

Terbinafine, Griseofulvin

(these are nail infections btw)

Front 64

Which antifungal:
Arrhythmias and nephrotoxicity

Back 64

Ampho B

Front 65

Which antifungal:
Deposits in keratin-containing tissues

Back 65

Griseofulvin

Front 66

Which antifungal:
Inhibits hormone synthesis and cytochrome P450

Back 66

Azoles

Front 67

Which antifungal:
Liver dysfunction

Back 67

Azoles and griseofulvin

Front 68

Which antifungal:
Teratogenic, carcinogenic

Back 68

Griseofulvin

Front 69

Which antifungal:
Used for cryptococcal meningitis in AIDS

Back 69

Fluconazole or intrathecal ampho B

Front 70

Which antifungal:
Converted to fluorouracil, inhibits DNA synthesis

Back 70

Flucytosine

Front 71

Which antifungal:
Drug of choice for sporotrichosis

Back 71

Itraconazole

Front 72

Which antifungal can be used intrathecally for fungal meningitis?

Back 72

Ampho B

Front 73

What is the clinical use and side effects of griseofulvin?

Back 73

SUperficial fungal infections (dermatophytes)
Tinea capitis and unguium

Teratogen, Carcinogenic, induces cyp450

Front 74

Giardia:
Presentation
Transmission
Treatment

Back 74

Flatulence, foul-smelling fatty diarrhea

Transmitted via cysts in water

Tx: Metro

Front 75

Back 75

Giardia

Front 76

Entamoeba:
Presentation
Transmission
Treatment

Back 76

Bloody diarrhea (dysentery)
Liver abscess, RUQ pain

Cysts in water

Tx: Metronidazole

Front 77

Cryptosporidium:
Presentation
Transmission

Back 77

Severe diarrhea in AIDS
Mild dz in non-immunocomp'd

Cysts in water

No tx

Front 78

Toxoplasmosis:
Presentation
Transmission
Treatment

Back 78

Brain abscess in HIV

Cysts in meat or cat feces; crosses placenta (pregnant women should avoid cats)

Sulfadiazene, pyrimethamine

Front 79

Naegleria fowleri:
Presentation
Transmission
Treatment

Back 79

Rapidly fatal meningoencephalitis

Swimming in freshwater lakes (Nalgene bottle filled w/freshwater); enter via cribriform plate

Ampho B effective for a few survivors (rapidly fatal)

Front 80

Trypanosoma brucei:
Presentation
Transmission
Treatment

Back 80

African sleeping sickness; enlarged LNs, recurring fever (due to antigenic variation); Tsetse fly (painful bite)

SURe is nice to go to sleep; MELAtonin helps with sleep:
Suramin: blood-borne dz
Melarsopol for CNS penetration

Front 81

Trypanosome cruzi:
Presentation
Transmission

Back 81

Chagas' dz--dilated cardiomyopathy, megacolon, megaesophagus

Reduviid bug (painless)

Front 82

Leishmania:
Presentation
Transmission

Back 82

Visceral leishmaniasis--spiking fevers, HSM, pancytopenia

Transmitted by sandfly

Front 83

Plasmodium falciparum:
Presentation
Transmission
Treatment

Back 83

Severe, daily cycles of fever

Parasitized RBCs occlude capillaries in brain (cerebral malaria), kidneys, lungs

Transmitted by anopheles mosquito

Tx: begin w/chloroquine, if resistant, use mefloquine

Front 84

Plasmodium vivax/ovale:
Presentation
Transmission
Treatment

Back 84

Cycles of fever every other day; dormant form in liver treated w/primaquine

Transmitted by mosquito

Tx: begin with chloroquine; if resistant use mefloquine. add primaquine for dormant forms in liver (hypnozoite)

Front 85

Babesia:
Presentation
Transmission

Back 85

Fever, hemolytic anemia in NE US

Transmitted by ixodes tick (same as Borrelia burgdorferi)

Front 86

Back 86

Trichomonas vaginalis

Front 87

Trichomonas vaginalis:
Presentation
Treatment

Back 87

Vaginitis
Foul-smelling, greenish discharge
Itching, burning

Sexual transmission

Tx: Metro

Front 88

Which protozoan:
Cause of Chagas disease

Back 88

T. Cruzi

Front 89

Which protozoan:
Amoebic dysentery

Back 89

Entamoeba

Front 90

Which protozoan:
African sleeping sickness

Back 90

T. rodensis/gabenzi (sp?)

Front 91

Which protozoan:
Diarrhea in campers and hikers

Back 91

Giardia lambia

Front 92

Which protozoan:
Transmitted in raw meat or infected cat feces

Back 92

Toxoplasmosis

Front 93

Which protozoan:
Transmitted by sandflies

Back 93

Leishmania

Front 94

Which protozoan:
Causes vaginitis

Back 94

Trichomonas vaginalis

Front 95

A patient who visited Mexico presents with bloody diarrhea.

Infectious organism found in stool?

Back 95

Cyst of entamoeba histolytica

Front 96

32-year old male patient went camping in California 2 weeks ago, had a 2 day stint of diarrhea and now presents with symptoms of liver damage and jaundice.

Diagnosis?

Back 96

Entamoeba histolytica--amebiasis causing liver abscess

Front 97

Stage of malaria life cycle:
Looks like diamond ring

Back 97

Trophozoite

Front 98

Stage of malaria life cycle:
Ruptures cell host

Back 98

Merozoite

Front 99

Stage of malaria life cycle:
Replicates intracellularly

Back 99

Schizont

Front 100

Stage of malaria life cycle:
Form injected from Anopheles mosquito

Back 100

Sporozoite

Front 101

Stage of malaria life cycle:
Banana shaped

Back 101

Gametocytes of T. falciparum

Front 102

Patient returning from 2 week vacation in west Africa presents with typical malaria presentation and recurrent fever.

Mechanism responsible for patient's recurrent fever?

Back 102

Rupturing of merozoite (repetitive rupturing of RBCs)

Front 103

Enterobius vermicularis:
Presentation
Transmission
Treatment

Back 103

Most common helminthic infection

Children playing outside with infected feces, ingest eggs

Causes intestinal infections

Scotch tape test--apply to anus

Tx: Bendazoles (worms are bendy)

Front 104

Trichinella spiralis:
Presentation
Transmission
Treatment

Back 104

Undercooked meat, usually pork

Inflammn of muscle

Tx w/bendazoles

Front 105

Strongyloides stercoralis:
Presentation
Transmission
Treatment

Back 105

Larvae in soil penetrate skin
Intestinal infection
Vomiting, diarrhea, anemia

Bendazoles

Front 106

Nematodes routes of infection (ingested vs cutaneous): List

Back 106

You'll get sick if you EAT these!

These get into your feet from the SANd.

Ingested: Enteobius, Ascaris, Trichinella

Cutaneous: Strongyloides, Ancylostoma, Necator

Front 107

Wuchereia bancrofti:
Presentation
Transmission
Treatment

Back 107

Female mosquito; causes blockage of lymphatic vessels (elephantiasis)

Takes 9 mos to a year to get elephantiasis syx

Front 108

Taenia solum:
Presentation
Transmission
Treatment

Back 108

Ingestion of larvae encysted in undercooked pork leads to intestinal tapeworms

Ingestion of eggs causes cysticercosis and neurocysticercosis (swiss cheese brain)

Tx: Praziquantel

Front 109

Schistosoma:
Presentation
Transmission
Treatment

Back 109

Snails = host
Penetrate skin of humans

-->granulomas, fibrosis, inflammn of spleen and liver

Chronic-->squamous cell carcinoma of bladder

Tx: Praziquantel

Front 110

Which helminth:
Most common helminthic infection in US

Back 110

Enterobius vernicularis

Front 111

Which helminth:
One-third of world infected with it

Back 111

Ascaris lumbricoides

Front 112

Which helminth:
Snail host, swimmer's itch

Back 112

Schistosoma

Front 113

Which helminth:
Most common predisposing factor for bladder cancer in 3rd world

Back 113

Schistosoma

Front 114

Which helminth:
Contracted by undercooked fish, causes biliary tract inflammation

Back 114

Clonorchis

Front 115

Which helminth:
Soil-->enters through skin-->venous blood-->lungs-->coughed into pharynx-->swallowed into intestines where they reside

Back 115

Strongyoides

Front 116

Which helminth:
Hookworm

Back 116

Ancylostoma duodenale

Front 117

Which helminth:
Roundworm

Back 117

Ascaris lumbricoides

Front 118

Which helminth:
Contracted by undercooked crab meat, causes inflammn and secondary bacterial infection of lung

Back 118

Paragonimus westermani

Front 119

Which helminth:
Pork tapeworm

Back 119

Taenea solium

Front 120

Which helminth:
Lymphatic filiariasis

Back 120

Wuchereria bancrofti

Front 121

Which helminth:
Adult patient from Mexico with new onset seizures and brain calcifications

Back 121

Tinea solium (Swiss cheese)

Front 122

Hematuria in patient from 3rd world country

Back 122

Schistosoma

Front 123

Treatment:
Giardia

Back 123

Metro

Front 124

Treatment:
Entamoeba

Back 124

Metro

Front 125

Treatment:
Trichomonas

Back 125

Metro

Front 126

Treatment:
Most malarias

Back 126

Choloruine

Front 127

Treatment:
Plasmodium vivax/ovale

Back 127

Choloruine + primoquine

Front 128

Treatment:
Resistant malarias

Back 128

Mefloquine

Front 129

Treatment:
Most all flukes and tapeworms

Back 129

Praziquantel

Front 130

Treatment:
Hookworm, pinworm, roundworm

Back 130

bendazoles

Front 131

Treatment:
Chagas' Disease

Back 131

Nifuramox

Front 132

Treatment:
Roundworms

Back 132

Bendazoles