1A: Dt 7-3

Front 1

HIV:
Structure
GPs and roles
RR5 vs X4

Back 1

RNA virus (uses reverse transcriptase)

Diploid genome--2 molecules of RNA
p24--capsid protein

gp41: fusion and entry
gp120--attachment to host T cell (these gp 's are envelope proteins)

RR5--binds CCR5 and and CD4 on MACS

X4--binds CXCR4 and CD4 on T cells

Front 2

Viral tropism

Back 2

Which viruses cells can infect

Front 3

Homozygous CCR5 vs Heterozygous CCR5 Hosts

Back 3

Homozygous CCR5 hosts-->immune against HIV

Heterozygous CCR5 mutation-->Slower course

Front 4

HIV:
Diagnosis

Back 4

Screen: ELISA
Confirmatory: Western Blot

Front 5

Structural genes in HIV.

What do they code for?

Back 5

env: gp120 and gp41
gag: p24
pol: reverse transcriptase

Front 6

Diagnosis of AIDS

Back 6

CD4+ <200 (normal 500-1500)

RIsk pneumocystis jiroveci infection!

Front 7

Classic opportunistic infections in patients with AIDS

Back 7

Cryptococcal meningitis
Toxoplasmosis
CMV encephalopathy
CMV retinitis
Thrush
PCP pneumonia
Shingles
KAPOSI'S SARCOMA (HSV-8)

Front 8

Antibiotics given to AIDS patients based on CD4 count.

What are you trying to prevent?

Back 8

CD4+ at 200-->Bactrim to prevent PCP pneumonia (or Dapsone)
CD<100: Add azitrhomycin; worry about thrush, toxo, histo
CD<50: Fluconazole if develop cryptococcal meningitis (?)

Front 9

Highly active antiretroviral therapy:
What is it?
When is it used?

Back 9

2 nucleoside reverse transcriptase inhibitors (NRTIs) + 1 protease inhibitor
OR
2 NRTIs + 1 non-nucleoside reverse transcriptase inhibitor

AIDS-defining illness (PCP pneumonia)
CD4+ below 350

Front 10

Viral Proteases:
Suffix
MOA
AE

Back 10

NAVIR TEASE a proTEASE
-vir (saquinavir, ritonavir, etc.)

HIV-1 protease cleaves mRNA into functional parts is inhibited by these drugs

AE: GI intolerance, inhibit cyp450 (making HAART drugs last longer!)
Lipodystrophy
Thrombocytopenia

Front 11

Nucleoside reverse transcriptase inhibitors:
MOA
Examples
AEs

Back 11

Competitively inhibit nucleotide binding to reverse transcriptase; need to be phosphorylated (activated) by thymidine kinase

Ex: Zidovudine (AZT), didanosine, zalcitabine

AEs: BM suppression (reversed with EPO, G-CSF), peripheral neuropathy, lactic acidosis, rash, hepatosteatosis

Front 12

Non-nucleoside reverse transcriptase inhibitors:
MOA
Examples
AEs

Back 12

Nevirapine, Efavirenz, Declaviridine

Binds reverse transcriptase at site different from NRTIs; do not require phosphorylation

Never Ever Deliver nucleosides (NED)

AEs the same as NRTIs: AEs: BM suppression (reversed with EPO, G-CSF), peripheral neuropathy, lactic acidosis, rash, hepatosteatosis

Front 13

Fusion inhibitor:
MOA
Examples
AEs

Back 13

Only one drug: EnFUvirtide (FU --> fusion)

Binds viral Gp41 subunit; inhibits fusion with CD4 cells (thus preventing entry and replication)

AE: Hypersens rxn, inc'd risk bact pneumonia...

Front 14

Which antiretroviral:
SE: lactic acidosis

Back 14

NRTIs

Front 15

Which antiretroviral:
SE: GI intolerance

Back 15

Protease inhibitors

Front 16

Which antiretroviral:
SE: pancreatitis

Back 16

Ritonavir
Didenosine
Zalcitabine
Stavudine

Front 17

Which antiretroviral:
SE: megaloblastic anemia

Back 17

Zidovudine

Front 18

Which antiretroviral:
SE: rash

Back 18

NNRTIs

Front 19

Which antiretroviral:
SE: hyperglycemia, DM, lipid abnormalities

Back 19

Saquinavir
Indinavir

Front 20

Which antiretroviral:
SE: Bone marrow suppression

Back 20

Zidovudine

Front 21

Which antiretroviral:
Give to pregnant women with HIV

Back 21

Zidovudine

Front 22

Which antiretroviral:
Regimen for occupational HIV exposures

Back 22

Zidovudine

Front 23

Which antiretroviral:
Combination of different classes of medication used to attack HIV at different point in its replication/infection cycle in order to control the infection and avoid resistance

Back 23

HAART

Front 24

Which class of HIV drugs causes redistribution of fat into a buffalo hump on the back of the neck?

Back 24

Protease inhibitors; saquinavir, ritonavir

Front 25

Which virus:
Conjunctivitis or diarrhea

Back 25

Adenovirus

Front 26

Which virus:
Fever, jaundice, black vomit

Back 26

Yellow Fever

Front 27

Which virus:
Enlarged cell with owl's eye inclusions

Back 27

CMV

Front 28

Which virus:
Identified with Pap smear

Back 28

HPV

Front 29

Which virus:
Barking seal cough

Back 29

Croup/parainfluenza

Front 30

Which virus:
Brassy cough

Back 30

RSV

Front 31

Which virus:
Negri bodies

Back 31

Rabies

Front 32

Which virus:
Hides in trigeminal ganglia

Back 32

HSV-1/2
VZV

Front 33

Which virus:
Diarrhea in children during winter months

Back 33

Rotavirus

Front 34

Which virus:
Cause of common cold

Back 34

Rhinovirus
Coronavirus

Front 35

Which virus:
Downey cells

Back 35

EBV

Front 36

Which virus:
Aseptic meningitis

Back 36

Echovirus
Coxsackie virus

Front 37

What causes a steeple sign on x-ray?

Back 37

Parainfluenza

Front 38

What causes a thumb sign on x-ray?

Back 38

H. flu B (not seen a lot bc of immunizations)

Front 39

What is the treatment for the different herpes viruses?

Back 39

HSV1, HSV2, EBV, VZV all treated with cyclovir

CMV: ganciclivir, but if doesn't work, use foscarnet

Front 40

For what infections is interferon used?

Back 40

HBV, HCV, Kaposi's

Front 41

Which antiviral:
Inhibits CMV DNA polymerase

Back 41

Ganciclovir
Foscarnet

Front 42

Which antiviral:
Used in treatment for chronic HCV

Back 42

Ribavirin

Front 43

Which antiviral:
Blocks viral penetration and uncoating

Back 43

amantidine and ramantidine

Front 44

Which antiviral:
Treats both influenza A and B

Back 44

Zanamivir
Oseltamivir

These inhibit neuraminidase (cell entry?)

Front 45

Which antiviral:
Second-line for CMV retinitis

Back 45

Foscarnet

Front 46

Identify HBV status:
HBsAg Negative
HBsAb Positive
HBcAb Positive

Back 46

Recovery

Front 47

Identify HBV status:
HBsAg Negative
HBsAb Negative
HBcAb Positive

Back 47

Window Phase

Front 48

Identify HBV status:
HBsAg Positive
HBsAb Negative
HBcAb Positive IgM

Back 48

Acute

Front 49

Identify HBV status:
HBsAg Positive
HBsAb Negative
HBcAb Positive IgG

Back 49

Chronic

Front 50

Identify HBV status:
HBsAg Negative
HBsAb Positive
HBcAb Negative

Back 50

Immunized

Front 51

Prion diseases:
What are they?

Back 51

Infectious protein particles
Mad cow, ataxia

Front 52

Normal flora:
Skin

Back 52

Staph epidermidis

Front 53

Normal flora:
Nose

Back 53

S. epidermidis, Staph aureus

Front 54

Normal flora:
Oropharynx

Back 54

Strep viridans

Front 55

Normal flora:
Dental plaque

Back 55

Strep mutans (viridans)

Front 56

Normal flora:
Colon

Back 56

Bacteroides > E coli

Front 57

Normal flora:
Vagina

Back 57

Lactobacillus, colonized by E coli and Group B Strep

Front 58

Which bug:
Ocean water shellfish
Diarrhea

Back 58

Vibrio cholera

Front 59

Which bug:
Reheated rice

Back 59

Bacillus

Front 60

Which bug:
Meats, mayonnaise, custard
Preformed toxin

Back 60

Staph aureus

Front 61

Which bug:
Reheated meat

Back 61

Clostridium perfringens

Front 62

Which bug:
Improperly canned foods (bulging cans)

Back 62

Clostridium botulinum

Front 63

Which bug:
Undercooked meat

Back 63

E. coli

Front 64

Which bug:
Poultry, meat, eggs

Back 64

Salmonella

Front 65

Which bugs cause bloody diarrhea?

Back 65

Campylobacter
Salmonella
Shigella

Enterohemorrhagic E coli
Enteroinvasive E coli
Yersinia enterocolitica

C. diff
Entamoeba histolytica

Front 66

Which bugs cause watery diarrhea?

Back 66

Enterotoxigenic E Coli
Vibrio Cholera
C. perfringens
Protozoa (Giardia, cryptosporidium--in immunocomp'd)
Viruses (rotavirus, adenovirus, Nowralk virus--notovirus)

Front 67

Which infectious agent:
Food poisoning as a result of mayonnaise sitting out too long

Back 67

Staph aureus

Front 68

Which infectious agent:
Diarrhea caused by Gram negative nonmotile organism that does not ferment lactose

Back 68

Shigella

Front 69

Which infectious agent:
Rice water stools

Back 69

V. cholera or enterotoxigenic E coli

Front 70

Which infectious agent:
Diarrhea caused by a C or S-shaped organism

Back 70

Campylobacter

Front 71

Which infectious agent:
Diarrhea transmitted from pet feces

Back 71

Yersinia

Front 72

Which infectious agent:
Food poisoning resulting from reheated rice (Chinese food)

Back 72

Bacillus cereus

Front 73

Which infectious agent:
Diarrhea caused by Gram negative motile organisms that don't ferment lactose

Back 73

Salmonella

Front 74

Which infectious agent:
Most common cause of traveler's diarrhea

Back 74

Enterotoxic E coli

Front 75

Which infectious agent:
Diarrhea caused by gram negative lactose fermenting bacteria, no fever

Back 75

E Coli

Front 76

Which infectious agent:
Diarrhea caused by gram negative comma-shaped organism, no fever

Back 76

V cholera

Front 77

Which infectious agent:
Diarrhea
Recept ingestion of water from a stream

Back 77

Giardia or entameba histolytica

Front 78

Which infectious agent:
Food poisoning from undercooked hamburger

Back 78

E coli O57A7

Front 79

Treatment for anaerobic pneumonia.

Back 79

Clindamycin

Front 80

Which infectious agent:
Common cause of pneuomnia in immunocompromised patients

Back 80

PCP

Front 81

Which infectious agent:
Most common cause of atypical/walking pneumonia

Back 81

Mycoplasma pneumonia

Front 82

Which infectious agent:
Most common fungal infection of lung in Texas/Gulf Coast region

Back 82

Histo

Front 83

Which infectious agent:
Common causative agent for pneumonia in alcoholics

Back 83

Klebsiella

Front 84

Which infectious agent:
Can cause interstitial pneumonia in bird handlers

Back 84

Chlamydia psittaci

Front 85

Which infectious agent:
Often cause of pneumonia in patient with history of exposure to bats and bat droppings

Back 85

Histo

Front 86

Which infectious agent:
Fungal cause of pneumonia in a patient who has recently visited Southern California, New Mexico, or West Texas

Back 86

Coccidioides

Front 87

Which infectious agent:
Pneumonia associated with currant jelly sputum

Back 87

Klebsiella

Front 88

Which infectious agent:
Q fever

Back 88

Coxiella burnetti

Front 89

Which infectious agent:
Associated with pneumonia acquired from air conditioners

Back 89

Legionella

Front 90

Which infectious agent:
Most common cause of pneumonia in children 1 year old or younger

Back 90

RSV

Front 91

Which infectious agent:
Most common cause of pneumonia in neonate (birth-28 days)

Back 91

E coli or GBS

Front 92

Which infectious agent:
Most common cause of pneumonia in children and young adults, including college students, military recruits, and prison inmates

Back 92

Mycoplasma pneumoniae

Front 93

Which infectious agent:
Common cause of pneumonia in patients with other health problems

Back 93

Klebsiella

Front 94

Which infectious agent:
Most common cause of viral pneumonia

Back 94

RSV

Front 95

Which infectious agent:
Causes a wool-sorter's disease (life-threatening pneumonia)

Back 95

Bacillus anthracis

Front 96

Which infectious agent:
Endogenous flora in 20% of adults

Back 96

Strep pneumoniae

Front 97

Which infectious agent:
Common bacterial cause of COPD exacerbation

Back 97

H flu

Front 98

Which infectious agent:
Common pneumonia in ventilator patients and those with cystic fibrosis

Back 98

Psueudomonas

Front 99

Which infectious agent:
Pontiac fever

Back 99

Legionella

Front 100

CSF findings of:
bacterial meningitis

Back 100

Inc'd pressure
PMNs
Inc'd protein
Dec'd sugar

Front 101

CSF findings of:
Fungal meningitis

Back 101

Inc'd pressure
Lymphocytes
Inc'd protein
Dec'd sugar

Front 102

CSF findings of:
Viral meningitis

Back 102

Normal or inc'd pressure
Lymphocytes
Normal or inc'd protein
Normal sugar

Front 103

CSF findings of:
TB meningitis

Back 103

Inc'd pressure
Inc'd lymphocytes
Inc'd protein
Dec'd sugar

Front 104

Which bugs are urease positive?

Back 104

Paricular Killerse Have Urease:
Proteus
Klebsiella
H pylori
Ureaplasma

Front 105

Back 105

Struvite crystal
UREASE positive bacteria

Front 106

What is a ToRCH infection?

Specific bugs? Presentation?

Back 106

Microbes that pass from mother to fetus and result in deformation.

Toxoplasma--chorioretinitis, hydrocephalus, intracranial calcifications

Rubella--PDA, cataracts, deafness, purpura

CMV: *MOST COMMON*--asyx but develop unilateral hearing loss

HIV: recurrent infections, chronic diarrhea

HSV: Temporal encephalitis, herpetic (vesicular) lesions

Syphilis--stillbirth, hydrops, facial abnlts (notched teeth, saddle nose, short maxilla)

O for Parvo: hydrops

Front 107

Causes of pelvic inflammatory disease.

Risks?

Back 107

Starts with cervicitis-->salpingitis (fallopian tubes), works its way upward

Risk of ectopic pregnancy, infertility, adhesions.

TOp bugs:
Chlamydia
Neisseria

Front 108

Adolescent presents with cough and rust-colored sputum.

What does gram stain of sputum show?

Back 108

Typical strep pneumo; gam positive diplococci

Front 109

HIV+ patient with a CD4 count of 25 presents with signs of meningitis. Examination of the CSF reveals a heavily encapsulated organism.

What is the organism?

Back 109

Cryptococcus

Front 110

An older male patient has blood in his urine and renal stones.

Organism responsible for stones?

Back 110

Proteus

Front 111

50 year-old patent recovered from abdominal surgery performed 2 days ago and has had an internal catheter in place since that time.

He now has a fever of 100º.

Cause?

Back 111

UTI

Front 112

What are the most common causes of UTI?

Back 112

E coli
Proteus
Staph saprophyticus
Klebsiella

Front 113

What are the most common causes of pneumonia for the following patient populations:
6w-18y
18y-40y
40y-65y
Elderly

Back 113

6w-18y: strep pneumo, chlamydia pneumonia, RSV
18y-40y: mycoplasma, strep pneumo, chlamydia
40y-65y: strep pneumo, h flu, anaerobes
Elderly: strep pneumo, gram neg rods, anaerobes

Front 114

Pathology:
Signet ring cells

Back 114

Gastric adenoca

Front 115

Pathology:
Nutmeg liver

Back 115

Right sided HF

Front 116

Pathology:
Maternal elevations of AFP

Back 116

Anencephaly
Spina bifida
Omphalocele
Gastrischesis

Front 117

Pathology:
RBC casts in urine

Back 117

Acute GN

Front 118

Pathology:
Currant-jelly sputum

Back 118

Klebsiella

Front 119

Pathology:
Dog or cat bite

Back 119

Pasturella

Front 120

What are the TORCH infections?

Back 120

Toxoplasma
O--parvo
Rubella
CMV
HIV/HSV
Syphilis

Front 121

STD:
Clue cells

Back 121

Bact vaginosis

Front 122

STD:
Painless genital ulcer

Back 122

Syphilis

Front 123

STD:
Flagellated cells

Back 123

Trichomonas

Front 124

STD:
Strawberry cervix

Back 124

Trichomonas

Front 125

What CSF findings would you see in a patient with TB meningitis?

Back 125

Inc'd Pressure, inc'd protein, dec'd sugar
Inc'd lymphocytes

Front 126

Most common cause of atypical/walking pneumonia.

Back 126

Mycoplasma

Front 127

Common causative agent for pneumonia in alcoholics.

Back 127

Klebsiella
Anaerobes if aspiration pneumonia

Front 128

Can cause interstitial pneumonia in bird handlers.

Back 128

Chlamydia psitecci

Front 129

Often cause of pneumonia in patient with history of exposure to bats and bat droppings.

Back 129

Histo

Front 130

Fungal cause of pneumonia in patient who has recently visited Southern California, New Mexico, or West Texas.

Back 130

Cocciodes

Front 131

Pneumonia associated with currant jelly sputum.

Back 131

Klebsiella

Front 132

Most common cause of pneumonia in children 1 year or younger.

Back 132

RSV

Front 133

Most common cause of pneumonia in neonate (birth-28 days).

Back 133

Group B Strep
E coli

Front 134

Most common cause of pneumonia in children and young adults--including college students, military recruits, and prison inmates.

Back 134

Mycoplasma

Front 135

Drug class:
Ritonavir

Back 135

Protease Inhibitor

Front 136

Drug class:
Didanosine

Back 136

NRTI

Front 137

Drug class:
Declaviridine

Back 137

NNRTI

Front 138

Drug class:
Zidovudine

Back 138

NRTI

Front 139

Drug class:
Abacavir

Back 139

NRTI

Front 140

Drug class:
Lamivudine

Back 140

NRTI

Front 141

Drug class:
Nelfinavir

Back 141

PI

Front 142

Drug class:
Efavirenz

Back 142

NNRTI