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279 Cards in this Set
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- Back
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If you have a positive Ziehl Neelsen stain, what bacteria are you staining for and what type of cell wall does it have?
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acid fast stain --> bacteria with a waxy cell wall --> Mycobacteria tuberculosis
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What type of staining is India Ink used for and what bacteria does it stain and how does this appear?
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used for "negative staining" - everything but the organism is stained black
used to detect Cryptococcus bc the ink is not taken up by the Cryptococcus capsule so the capsule appears as a halo |
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What bugs stain well in Giemsa stains?
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"Certain Bugs Really Try my Patience"
Chlamydia Borrelia Rickettsia Trypansioma Plasmodium |
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What does a PAS test for? What is the bacteria you think of with this and what color does the test turn?
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polysaccharides, glycoge, mucopolysaccharides
Tropheryma whipplei (Whipple's Disease) --> reddish violet color |
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What does the Prussian Blue Test look for?
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presence of iron
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What type of microscopy is Osmic Acid fixative and stain for?
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electron microscopy
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What color do Gram + organisms stain? gram -?
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gram positive = blue-violet
gram negative = pink-red |
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What steps are involved in gram staining?
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1) add crystal violet which stains the bacteria blue-purple
2) add Gram's iodine which is mordant (helps facilitate formation of covalent bonds) 3) add alcohol which is a decolorizer 4) add sarfarin which stains a red-pink |
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What are the two major functions of our normal flora?
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1) stimulate our immune system to maintain immune system health and surveillance ability
2) interfere with colonization by pathogens |
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What bacteria does not a cell wall and therefore what stain do you have to use with it?
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Mycoplasma --> use the Ziehl Neelsen stain!
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What bacteria do NOT have a peptidoglycan cell wall?
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Mycoplasma (because it has no cell wall)
Chlamydia |
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What are the two protective layers of gram positive bacteria?
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thick peptidoglycan wall and techoic acid
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What are the three protective layers of gram-negative bacteria?
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thin peptidoglycan wall encased by an outer membrane
outer membrane contains LPS (endotoxin A) outer membrane has porins |
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What type of bacteria (gram + or -) has the "O Ag"?
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Gram -
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What type of bacteria (gram + or -) has Lipid A?
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Gram -
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What type of bacteria (gram + or -) has endotoxin?
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Gram -
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What is the difference in the cell walls of mycoplasma and mycobacteria?
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mycobacteria - waxy cell walls containing mycolic acid
mycoplasma - no cell wall - just a membrane (but has cholesteria in it like ours!) |
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What do spores contain that allows them to survive for thousands of years and what are the only two bacteria that can be spores?
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dipicolinic acid
Clostridium and Bacillus |
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What type of bacteria do you have if you have a positive Quellung reaction?
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encapsulated bacteria
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What are the encapsulated bacteria?
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SHINE SkiS
-Strep pneumo -HIB -Neisseria meningitidis -E. coli -Salmonella -Klebsiella pneumoniae -GBS |
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If a patient was asplenic, what types of bacteria could infect them and what are the vaccinations that could be given?
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encapsulated bacteria
Pneumococcal vaccine - Strep Pneumo Meningococcal vaccine - Neisseria meningitidis HIB - H. influenza type B |
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What 3 things do endotoxins activate and what is the result?
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Macs --> fever, vasodilation (decreased BP)
Complement (alternative pathway) --> decreased BP and exudation Hageman --> DIC |
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What is an exotoxic and is it antigenic and heat labile?
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polypeptide (proteinaceous) that is produced and released by the bacterium
very antigenic because it IS a protein and the body has the most vigorous immune response to it --> will even produce antibodies usually heat labile because it IS a protein |
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What bacteria produces Tetanus toxin, how does it present and what is the MOA?
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Clostridium tetani
tetany iwth lockjaw, risus sardonicus (tetany of facial muscles --> creepy smile, opisthotonus, tetanic paralysis of respiratory muscles blocks glycine and GABA release in interneurons of the spinal cord |
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What bacteria produces botulinum toxin, how does it present and what is the MOA?
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Clostridium botulinum
blocks release of Ach at neuromuscular junctions flaccid paralysis --> constipation and descending flaccid paralysis, flaccid paralysis of respiratory muscles |
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What bacteria produces diptheria toxin, how does it present and what is the MOA?
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Corynebacterium diptheria
inhibits protein synthesis in throat, heart and neural tissue by modifying elongation factor-2 pharyngeal pseudomembrane development and myocarditis with arrhythmias, life-threatening circulatory collapse and muscle weakness or paralysis, paralysis of pharyngeal msucles leading ot regurgitation of fluids through nose and peripheral neuritis/ neuropathy |
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What are the two bacteria that produce alpha toxin and how do they differ in their MOA and what they cause?
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Staphylococcus aureus
-creates holes in cell membranes which leads to eventual cell death -causes necrosis of the skin and hemolysis Clostridium perfringens -lecithinase which digests lecithin which is a phospholipid in the cell membrane that results in massive cell membrane damage and eventual cell death - causes necrosis of deep tissues, esp muscle and hemolysis |
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What produces TSST and how does it work and how does it present?
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Staph Aureus
binds to class II MHC proteins (HLA) DIRECTLY WITHOUT intracellular processing aka = superantigen and induces cytokines -fever, rash, desquamation, diarrhea THEN hypotension THEN shock |
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What bacteria produces Cholera toxin and how does it work?
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Vibrio Cholerae toxin
binds to gangliosides in intestinal cell membranes which stimulates Gs protein --> stimulates adenylate cyclase --> overproduction of cAMP --> secretion of chloride ions and water --> massive watery diarrhea (WITHOUT inflammatory cells (WBCs) in stool) |
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What bacteria produces Pertussis toxin and how does it work?
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Bordetella pertussis
toxin binds to ciliated respiratory tract epithelial cells and to LYMPHOCYTES --> inhibits Gi protein, stimualtes adenylate cyclase --> overproduces cAMP and inhibits chemokine receptors which disables lymphocyte ability to interact with lymphoid tissue and causes a lymphocytosis and ALSO inhibits ciliary movement --> cilated epithelial death --> copious respiratory mucus |
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What is an enterotoxin? What is a major example of a bacteria that produces this?
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ANY toxin that causes DIRECT GI pathology with concomitant symptoms (ie choleragen)
E. coli! |
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What are the two major types of enterotoxins produced by E. coli?
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heat labile --> similar to how cholera toxin works -- stimulates adenylate cyclase via binding to enterocyte gangliosides and Gs proteins
heat stabile --> actives guanylate cyclase --> increased cGMP --> blocks ion movement and water is "drawn" in |
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Does heat labile or heat stabile enterotoxin of E. coli stimulate adenylate cyclase? guanylate cyclase?
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heat labile --> adenylate cyclase
heat stabile --> guanylate cyclase |
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If a bacteria need oxygen to surivie and uses glycolysis, then Krebs cycle, then ETC and possesses many enzymes for removing the damage of oxygen species, what type of bacteria is it?
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Obligate aerobe
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If a bacteria has NO oxygen requirement and relies on fermentation for metabolism and is able to "tolerate" low concentrations of oxygen, what do they contain to be able to do this and what are they?
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contain superoxide dismutase
microaerophilics |
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If a bacteria has NO oxygen requirement, and relies on non-oxygen dependent mechanisms for metabolism including fermentation and/or other mech and cannot tolerate ANY oxygen exposure because they possess NO enzymes for removal of oxygen radicals and will die upon oxygen exposure, they are?
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oligate anaerobes
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What type of bacteria will use oxygen if it is available, but will utilize other metabolic mechanisms when it is not available and when oxygen is available it is will function like an obligate aerobe metabolically and possess many enzymes for the removal of damaging radicals and when oxygen is not available they rely on fermentation?
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facultative anerobes
*includes the largest number of bacteria* |
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What organism causes diarrhea occurs 6+ hours after ingestion and is a severe, watery diarrhea that is associated with traveling?
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ETEC
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What organism causes diarrhea that has fever, WBCs in stool, bloody diarreha and leukocytosis and is aquired via fecal-oral contamination?
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EIEC
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What organism is associated with a watery diarrhea that is acquired via fecal-oral contamination that produces a "stacked brick" adherence pattern in cultures?
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EAEC
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What organism is associated with a "shiga-like toxin (inhibits enterocyte protein synthesis resulting in cell death)" that results in a bloody diarrhea and abdominal craps that that is produced after ingestion in the bowel (~6 hrs after ingestion)?
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EHEC
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What organism that causes a bloody diarrhea with abdominal cramps is associated with HUS, especially in peds?
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E. coli 0157:H7
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What organism is asscoated with a diarrhea that is aquired via fecal-oral contamination and the organism adheres to bowel wall but does not invade and and causes a severe, watery diarrhea that occurs almost exclusively in children <2?
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EPEC
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What organism is associated with skin infectiouns, abscesses, food poisoning, scalded skin syndrome, TSST, and osteomyelitis?
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S. aureus
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What organism is associated with infection of prosthetic heart valves and hips?
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S. epidermidis
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What organism is associated with staghorn renal calculi and UTIs?
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S. saprophyticus
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What are the 4 major exotoxins associated with Staph Aureus?
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Enterotoxin A-F
TSST-1 Exfoliatin Toxin Alpha toxin |
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What is a preformed toxin that is responsible for Staph aureus food poisoning and causes diarrhea and abdominal pain (12-24 hrs) and ats as a SuperAg that binds MHC-II directly and causes massive T cell stimulation and cytokine release resulting in fever and hypotension?
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Enterotoxin A-F
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What toxin of Staph Aureus is a power Super Ag that causes fever, hypotension (eventual shock), n, v, watery diarrhea and may damage the liver, kidneys, CNS, muscle or blood cells and after a few days of symptoms, a red macular rash occurs that subsequently undergoes desquamation?
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Toxin Shock Syndrome Toxin (TSST-1)
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What is the Staph Aureus toxin that is responsible for Scalded Skin Syndrome and causes fever, bullae, and red macular rash (skin, nails, and hair may slough off with a recovery in 7-10 days)?
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Exfoliatin Toxin
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What is the Staph Aureus toxin that forms pores in cell membranes and causes cellular death and tissue necrosis and a hemolytic anemia?
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alpha toxin
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What organism is associated with otitis media, pnemonia, and meningitis?
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Strep pneumoniae (the "pneumococcus")
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What organism is associated with sepsis or meningitis in the neonate with teh recut of of the adults being frequently asymptomatically colonized and is the source in females for potential contamination of the vulva and infant during delivery?
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strep agalactiae (GBS)
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What organisms is associated iwth pharyngitis, tonsillitis, impetigo, scarlet fever, immunologic diseases (ie post-strep glomerulonephritis or acute rheumatic fever, necrotizing fasciitis, cellulitis/skin infections?
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strep pyogenes (group A strep)
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What organism is associated with sub-acute infectious endocarditis and is also a marker of colon cancer if present in the patient?
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strep bovis (group D strep)
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What organism is associated with UTI, endocarditis, cholecystitis, ascending colonangitis?
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enterococcus faecalis (group D strep)
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What are the 4 organisms associated with infections of the biliary tree?
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EEEK!
e. coli enterobacter enterococcus klebsiella |
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What organism is associate with subacute infectious endocarditis?
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strep mutans (a viridans strep)
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What antigen is a component of the cell wall of all beta-hemolytic strep (A, B, C) and determines the "group" (ie A, B, etc)?
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C antigen = Lancefield antigen
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What organism is in group A beta-hemolytic strep and what 3 possible diseases can it cause?
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strep pyogenes
pyogenic disease --> purulent lesions toxigenic disease --> due to toxins the bacteria can elaborate ie high fever with hypotension, necrotizing fasciits, scarlet fever, tissue necrosis immunologic disease --> rheumatic fever with later rheumatic heart disease OR post-strep glomerulonephritis |
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What is the virulence factor that determines the type of Group A beta-hemolytic strep and what else does it determine?
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M protein
also determines whether the bacteria will be rheumatogenic or nephritogenic |
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What are the 8 major exotoxins of group A beta-hemolytic strep?
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streptokinase
streptodornase hyaluronidase erthyrogenic toxin streptolysin O streptolysin S pyrogenic exotoxin A exotoxin B |
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What exotoxin of group A beta-hemolytic strep is associated with activating plasminogen which dissolves clots and is produced commercially as a thrombolytic?
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streptokinase
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What exotoxin of group A beta-hemolytic strep is associated with DNAase and is produced comercially for use in CFR and bronchiectasis patients to decrease thickness of sputum and respiratory secretions by decrading DNA released by dying neutrophils?
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streptodornase
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What exotoxin of group A beta-hemolytic strep is "spreading factor" and digests cellulites (a major component of CT) and is a major contributor to the development of cellulitis?
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hyaluronidase
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What exotoxin of group A beta-hemolytic strep causes the rash of scarlet fever, is a super antigen and is ONLY produced by Strep, that is itself infected with a particular type of bacteriophage?
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erythrogenic toxin
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What causes a fever, rough, erythematous diffuse rash, strawberry tongue, and focal infection?
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scarlet fever --> strep pyogenes --> erythrogenic toxin
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What exotoxin of group A beta-hemolytic strep is inactived by oxygen and is antigenic and stimulates the production of Abs (ASO) which will always be (+) in RF even after the infection has gone?
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Streptolysin O
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What exotoxin of group A beta-hemolytic strep is not inactived by oxygen and is not clinically significant?
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Streptolysin S (oxygen Stabile)
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What exotoxin of group A beta-hemolytic strep is a super antigen that acts a lot like TSST-1?
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pyrogenic exotoxin A
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What exotoxin of group A beta-hemolytic strep is a protease that is responsible for necrotizing fasciitis (the infection caused by the "flesh-eating bacteria")?
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Exotoxin B
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Are Neisseria oxidase + or - and what type of medium do they need to be grown on?
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oxidase +
chocolate medium |
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What causes fever, cyanosis, petechiae, bilateral adrenal hemorrhage?
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Neisseria meningitidis (Waterhouse-Friderichsen Syndrome)
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What is an encapsulated, IgA (+) protease that cause initially causes meningococcemia then migrates to the meninges to cause rapidly life-threatening meningitis?
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Neisseria meningitidis
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What is a non-encapsulated, IgA (+) protease that causes purulent dischage and may infect the eyes or joints?
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neisseria gonorrhea
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Is neisseria meningitidis encapsulated? neisseria gonorrheae?
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n. meningitidis - encapsulated
n. gonorrheae - not encapsulated |
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What can untreated gonorrhea in females lead to (2)?
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PID --> Fitz-Hugh-Curtis Sydnrome
salpingitis |
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What causes RUQ pain, +/- fever, and violin-string adhesions from the liver to either the adnexa or abdominal wall and what is the name of this sydnrome?
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untreated gonorrhea or chlamydia
this is Fitz-Hugh-Curtis Syndrome |
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What are the three compontes of anthrax toxin and what produces it?
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edema factor
protective antigen (forms pores in cell membranes to allow edema and lethal factors to enter and it is antigenic bc a protective AB is formed to it) lethal factor (blocks the messenger system necessary for cell growth) bacillus anthrax |
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What is a gram + rod (bacilli), that is a spore fomer (2)
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bacillus
clostridium |
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What is a non-spore forming gram (+) bacilli (rod) (2)?
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corynebacterium
listeria |
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What are the 3 types of anthrax?
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cutaneous anthrax - eschar as site of entry with local edema
pulmonary anthrax - flu-like sx and mediastinal widening on xray gastrointestinal antrax - ab pain, bloody diarrhea |
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What is the DOC for bacillus anthracis but what do prophylax with until results come back? How long do you treat for bioterrorism-related infections compared to endemic cutaneous anthrax
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DOC = pen G if proven Pen-sensitive
prophylax with ciprofloxacin or doxycycline PLUES clindamycin and/or rifampin bioterrorism = 60 days endemic = 7-10 days |
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What does the vaccine for bacillus anthracis carry the risk of?
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high risk for Guillain-Barre recurrence in those with Guillain-Barre history
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What two bacteria can be described as "chinese characters" and how can you distinguish between them?
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corynebacterium diptheriae
listeria moncytogenes - has tumbling movements |
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What is cultures on Loeffler's telluride, causes pseudomembrane in throat, fever, myocarditis, and paralysis and when view microscopically looks like chinese characters and how do you treat and prevent this?
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Corynebacterium diphteriae
treat with antitoxin and pen G or erythromycin prevent with DPT immunization (diphtheria, pertussis, tetanus) |
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What bacteria affects primarily neonates, immunosuppressed and pregnant and causes a watery diarrhea, fevere, myalgia, ab cramps and is caused by unpastuerized dairy products (esp cheese), undercooked hot dogs/processed meats and undercooked chicken?
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listeria monocytogenes
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What type of clostridium is assocaited with tetanus?
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clostridium tetani
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What type of clostridium is assocaited with botulism?
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clostridium botulinum
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What type of clostridium is assocaited with gas gangrene?
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clostridium perfringens
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What type of clostridium is assocaited with food poisoning?
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clostridium perfingens
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What type of clostridium is assocaited with pseudomembranous colitis?
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clostridium difficle
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What bacteria can be found in yogurt that causes dental caries via polymicrobial infection and produces lactic acid and protects the GI tract and vaginal tract by maintaining an acidic environment (<4.5) that is inhospitable to many pathogens?
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lactobacillus
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What is the most likely cause of a non-bloody, watery diarrhea that occurs ~6 hrs after eating beef, chicken (esp in stews) or Mexican foods that spontaneously resolves in ~24 hrs?
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C. perfringens
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What is the DOC for gas gangrene C. perfringens?
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surgical debridement AND pen G + clindamycin +/- hyperbaric oxygen
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What is the DOC to treat pseudomembranous colitis from C. dificile?
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withdrawl of antibiotic
metronidazole (DOC) or vancomycin + cholestyramine |
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What are the top three bacteria that cause pseudomembranous colitis?
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clindamycin
cephalosporins ampicillin (also chemo can predispose people to develop it) |
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What are the three major clinical forms of botulism and how do you treat them?
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botulism (regular aka food) = #1 type = purge GI tact + administer trivalent equine antitoxin +/- pen G
wound botulism = (mud pack on umbilical stump and skin-popping with heroin) = surgical debridement + trivalent equine antitoxin infant botulism = (honey) = human immunoglobulin (antibiotics + antitoxin are CI) |
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What are the three things that botulism toxin is used to treat?
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1) remove wrinkles
2) treat torticollis 3) treat blepharospasm |
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What is the H antigen and which Enterobacteriaseace have it?
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antigen on the flagella
Escheria Salmonella |
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Escheria, Enterobacter, Salmonella, Shigella, Vibrio, Helicobacter, Campylobacter, Klebsiella, Proteus, Yersinia are all part of which group?
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enterobacteriaceae - gram negative bacteria
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What is K antigen and which enterobacteriaceae have it?
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polysaccaride antigen of the bacterial capsule, so all encapsulated bacteria have it
Klebsiella Escherichia Salmonella (K is referred to as Vi) |
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What is the most common cause of diarrhea that is 1-3 days and self-limited?
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ETEC
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What bacteria has an O and H antigen and is very motile with a + phenylalanine deaminase test that can use staghorn renal calculi and what do you use to treat this?
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Proteus
treat with ciprofloxacin or piperacillin-tazobactam |
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How do you distinguish between Proteus and Klebsiella based on antigens and motility?
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Proteus = O, H antigen and motile
Klebsiella = O, K antigen and non-motile |
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What bacteria has O, K antigens and is non-motile and causes pneumonia and UTI's and has a "current jelly" sputum?
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Klebsiella pneumoniae
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What is the #1 cause of nursing home pneumoniae and how do you treat it?
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Klebsiella pneumoniae
any carbapenem |
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What has an O antigen and causes rice-water diarrhea and what is the first line treatment for this?
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vibrio cholerae
treatment = PO and IV fluids and one dose of azithromycin |
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What has an O antigen and is transmitted by raw or undercooked seafood (esp oysters) and is a major cause of diarrhea in Japan?
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Vibrio parahaemolyticus
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What bacteria causes a watery, foul-smelling diarrhea, fever, severe abdominal pain, +/- blood and is invasive and is associated with development of Guillain-Barre or Reiter's Syndrome and how do you treat it?
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Camplyobacter jejuni
azithromycin or ciprofloxacin |
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What bacteria is urease (+) and causes gastritis, duodenitis, PUD and is associated with a high risk of gastric CA?
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Helicobacter pylori
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What is the only anaerobic gram-negative rod NOT to have "regular" LPS and is the most commmon cause of serious anaerobic infections often in the form of abscesses and intraabdominal and infections are often acquired endogenously?
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Bacteriodes fragilis
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What is the DOC and prophylaxis for military for yersinia pestis and what are the two diseases it causes and the major effects of those?
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DOC = Streptomycin
prophylaxis = Doxycycline -bubonic plaque - DIC with cutaneous hemorrhages, shock, and pneuomia - fatal within days - pulmonary plaque - pneumonia, DIC, cutaneous hemorrhages ad shock - fatal within hours |
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What does Yersinia enterocolitica cause and what can it lead to?
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watery diarrhea +/- blood + stool WBCs * 2 weeks
may lead to Reiter's Syndrome |
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What causes wound infections/cellulits and is acquired via cat and dog bites?
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pasterurella multicida
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What is associated with unpasteurized diary products and has an incubation of 1-3 weeks and the bacteria localize in lymph nodes, liver, spleen, and bone marrow and causes undulant fever?
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brucella (fever = brucellosis)
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What causes fever, flu-like aches and pains, constipation +/- lymphadenopathy and hepatomegaly and the temperature is normal in the am but high in the afternoon and evening, daily and what is the number 1 complication?
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undulant fever (Brucella)
osteomyelitis |
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What type of Brucella is aquired from goats and sheeps and causes the most severe infections?
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brucella melitensis
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What type of brucella is acquired from cattle and tends to cause the least severe infections?
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brucella abortus
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What type of brucella is acquired from pigs?
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brucella suis
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What bacteria causes a granuloma, regional lymphadenopathy, then flu-like symptoms? How do you treat it?
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Francisella tularensis (tularemia)
streptomycin (doxycycline for contact prophylaxis) |
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What is an obligate aerobe that is oxidse + with a slime layer that colonizes the lungs of most CF patients and has a musty odor, greenish blue pus due to pyocyanin?
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pseudomonas aeruginosa
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What 4 things is pseudomonas aerguinosa the number 1 cause of?
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#1 cause of osteomyelitis in IV drug users
#1 cause of infection in burn patients #1 cause of pneumonia in CF patients >6 months old #1 cause of malignant otitis externa |
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What does H. infleunzae cause?
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URIs, pneumonia, meningitis, epiglottitis
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What does H. ducreyi cause?
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chancroid
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What does H. hemolyticus cause and what can it be confused with?
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may be confused with strep pyogenes because of the type of pharyngitis it causes
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During what stage is bordetella pertussis the sensitive to treatment and what is that treatment?
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catarrhal stage
erythromycin |
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What are the three stages of pertussis (whooping cough)?
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catarrhal stage (1-2 weeks): rhinoorrhea, malaise, fever, URI - only stage that erythromycin works during
paroxysmal (coughing) stage (2-4 weeks): up to 50 severe episodes/day + LRI convalescent stage (several months): mild cough 1/3 recover fully 1/3 have perisstent neuro problems 1/3 have severe neuro problems (coma, seizure disorder, blindness, paralysis) due to anoxia |
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What is a gram - rod that is a facultative, intracellular parasite that causes Pontiac fever or Legionnaire's disease and is catalase + and what can you treat it with?
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Legionella pneumophila
treat with azithromycin or clarithromycin or doxycycline |
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What is the difference between Legionnaire's Disease and Pontiac disease?
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Legionnaire's disease - high fever, relative bradycardia, severe atypical pneumonia, diarrhea, hyponatremia
Pontiac disease - like Legionnaires but without the pneumonia and with milder concomitant symptoms + brnchitis and loose stools |
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How is an acid-fast stain done?
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carbol fuschin added --> microbe heated --> acid alcohol poured over it --> methylene blue
acid fast bacteria stain red-pink non-acid fast bacteria become blue |
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What is a Ghon complex and what is it associated with?
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calcified tubercles (ganulomas of M. tuberculosis)
this plus Ranke complex demonstrate primary TB |
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How do you treat + PPD test and if resistant?
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INH for 9 months
if resitant to INH --> rifampin for 4 months |
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What is most of the morbidity of TB due to?
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reactivation of TB (this occurs secondary to immune weakening) and leads to secondary secondary TB
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A patient has weight loss, low-grade fever, night sweats, and symptoms related to whatever system is affected, how do you treat them?
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They have TB
isolate them treat them with isoniazid, ethmabutol, pyrazinamide, rifampin |
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What is vertebral TB called?
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Pott's disease
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What is cutaneous TB called?
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scrofuloderma
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What is widespread HEMATOLOGIC dissemination TB yielding "shot gun pellet" type lesions in the lung, CNS, GI, kidney, bones, or any other organ?
|
miliary TB
|
|
|
What type of deficiency does ioniazid cause and what do you need to treat this with?
|
vitamin B6 def
must get pyridoxine |
|
|
What type of TB is spread via unpasturized milk and causes GI TB?
|
m. bovis
|
|
|
What type of TB preferentially grows in cooler areas of the body and has a (+) feather test and has a reservoir in armadillos, cannot be cultured on pertri dishes and only on mice foot pads?
|
m. leprae
|
|
|
What type of TB is associated with swimming pool granuloma with skin granulomas at the sites of the abrasions?
|
m. marinum
|
|
|
What type of TB occurs primarily in immunosuppressed patients and is a chronic wasting illness that starts as a broncho-pulmonary disease and eventually disseminates everywhere in the body? When and what do you prophylax with?
|
m. avium-intracellulare
CD4 count of <50-100 with azithromycin or clarithromycin |
|
|
What type of TB is saprophytic and causes skin abscesses at trauma sites, corneal ulcers in areas of corneal damage and pulmonary infection?
|
m. fortuitum
|
|
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What is a gram + rod that at sites of infection form sulfur granules with bright yellow pus draining from abscesses of the mouth and avidly forms sinuses and tunnels in tissues?
|
actinomyces israelii
|
|
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What is a gram +, AFB that frequently causes brain abscesses and avidly forms sinuses and usually occurs in the immunocompromised?
|
Nocardia asteroides
|
|
|
What are the three types of spirochetes and which is only one that can be visualized under an ordinary light microscope?
|
treponema, borrelia, leptospira
only borrelia can be seen under a normal light microscope |
|
|
What is the causative agent of syphilis and how do you treat it?
|
Treponema pallidum
treat: Pen G |
|
|
If a patient presents with a painless hard chancre what do they have?
|
primary syphilis
|
|
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If a patient presents with with a rash, condyloma lata, and low grade fever, malaise, headache, what do they have?
|
seconday syphilis
|
|
|
What is the difference between condyloma lata and condyloma accuminata?
|
lata - from secondary syphilis
accuminata - from HPV |
|
|
If a patient presensts with gummas, luetic aneursym, aortic insufficiency, dementia, psychosis, tabes dorsalis and Argyll-Robertson pupil, and Charcot's joint, what do they have?
|
tertiary syphilis
|
|
|
If an infant presents with liver dysfunction, rash, saddle nose, Hutchinson teeth, mulberry molars and saber shins, what does the infant have and what was the most likely time of transmission?
|
congenital syphilis (test mom and if she is +, then treat both mom and infant)
after 3rd month of gestation |
|
|
What treponema is Yaws and is found in humid, tropical areas:
primary = ulcerative skin lesions at site of initial infection secondary = coninuation of thesame ulcers with additional widespread lesions, with granuloma formations tertiary = gummas of the skin and bone |
treponema pertenue
|
|
|
What treponema is the "endemic syphilis" aka Bejel and is like Yaws in deserts of Africa and Middle East?
|
Treponema pallidum subspecies endemicum
|
|
|
What treponema is Pinta and is like Yaws except that the lesions are red, eventually turn blue, and there are no gummas in the tertiary stage - instead there is skin depigmentation and is found in Rural Central and South America?
|
Treponema carateum
|
|
|
What is the most common vector-born disease in the US and what is the causative agent of it?
|
Lyme Disease
causative agent: Borrelia burgdorferi |
|
|
What is the reservoir and vector of Borrelia burgdorferi?
|
reservoir = white-footed mouse
vector = tick Ixodes (deer tick) |
|
|
If a patient presents with erythema chronicum migrans and arthragias, what do they have/
|
Stage I Lyme Disease
|
|
|
If a patient presents with multiple ECMs, neurological problems (meningitis, Bells palsy, tic douloureux), myocarditis and arthralgia, what do they have?
|
Stage 2 Lyme Disease
|
|
|
If a patient presents with chronic arthritis (especially of the knees), and a progressive CNS disease that often mimics MS, what do they have?
|
Stage 3 Lyme Disease
|
|
|
How do you treat Lyme Disease?
|
In PA, NY, CT, NJ --> prophylax with doxycycline without testing if tick attached for >48 hours
acute (stage I or II) --> doxycycline (if pregnant amoxicillin) chronic (stage III) --> PCN G or ceftriaxone |
|
|
If a pateints presents with a relapsing fever ~ every 8 days, then the fevers break with drenching sweats and a rash and splenomegaly what do they have? what cause it and what is the treatment?
|
relapsing fever from borrelia recurrentis
treat with tetracycline (will see large spirochetes on blood smear to dx) |
|
|
What are the two things Leptospira interrogans can cause and how do you treat these?
|
Leptospira and Weil's Disease
Treat: Penicillian G |
|
|
How do you usually get Leptospira?
|
water contaminated with rat, mouse, cat, or dog urine and usually established from swimming in contaminated water
|
|
|
If a patient presents with a high spiking fever, headache, conjunctival reddening, SEVERE muscle aches of thighs and low back, what do they have?
|
Phase I Leptospirosis
|
|
|
If a patient presents with a high spiking fever, headache, conjunctival reddening, SEVERE muscle aches of thighs and low back AGAIN AND meningismus, what do they have?
|
Phase II Leptospirosis
|
|
|
If a patient presents with a high spiking fever, headache, conjunctival reddening, SEVERE muscle aches of thighs and low back AGAIN AND meningismus AND LIVER damage with jaundice, pulmonary hemorrhage, and uremia from renal failure, what do they have?
|
Weil's disease
|
|
|
What reaction can occur with treatment for any spirochetal infection and occurs most commonly during the treatment of syphilis and Lyme disease? IT is due to the lysis of spirochetes and the release of endotoxin-LIKE moelcuels and features fever, myalgias, chills, and flu-like feelings and lasts for up to 24 hours after the initiation of antibiotics?
|
Jarisch-Herxheimer reaction
|
|
|
What is an obligate intracellular pathogen that has cell walls without peptidoglycan?
|
Chlamydia
|
|
|
What form of chlamydia is the infective form?
|
elementary body
|
|
|
What form of chlamydia is sexually transmitted and is a painless papule that ulcerates and heals spontaneously and 2 months later lymph nodes swell +/- ulceration and how do you treat this?
|
Lymphogranuloma venereum (L1, L2, L3)
doxycycline |
|
|
What form of chlamydia causes blindness to develop over 10-15 years from this chronic for and is endemic to Asia and Africa and how do you treat it?
|
Trachoma (A, B, C)
azithromycin |
|
|
What form of chlamydia cause conjunctivitis of neonates, is acquired vertically and has a yellow purulent discharge that beings 5-12 days after birth and how do you prophylax and treat it?
|
nronsysl inculsion conjunctivitis
treat and prophylax with erythromycin |
|
|
If a patient acquires chlamydia has the HLA-B27 gene , what can be stimulated to develop after chlamydial genital tract infections and is an immunological disease?
|
Reiter's Syndrome
|
|
|
What form of pneumonia can be accompanied by hepatitis and is from bird feces, especially parrots and how do you treat it?
|
Chlamydia psittaci
treat: tetracycline (preferably doxycycline) |
|
|
What is an obligate intracellular organism and invades the cells of blood vessels producing a rash and is diagnosed by ELISA and what is the DOC for it?
|
Rickettsia
DOC = doxycycline |
|
|
What is organism, reservior and vector of epidemic typhus (rash, menignal problems, and later vascular collapse or bacterial pnemonia)?
|
organism = Rickettsia prowazekii
reservoir = flying squirrels and humans vector = lice |
|
|
What is organism, reservior and vector of endemic typhus (rash, menignal problems, and later vascular collapse or bacterial pnemonia)?
|
organism = Rickettsia typhi
reservoir = rats vector = fleas |
|
|
What is organism, reservior and vector of scrub typhus (rash, menignal problems, and later vascular collapse or bacterial pnemonia)?
|
organism = Rickettsia tsutsugamushi
reservoir = rodents vector = mites |
|
|
What is the organism, reservoir and vector of the disease that starts with an abrupt fever, headache, chills, and rash starts on the extremitites and spreads to the trunk that has a very high predilection for capillary endothelium resulting in extreme endothelial damage?
|
this is Rocky Mountain Spotted Fever
organism = Rickettsia Rickettsiae reservoir = dogs, rodents vector = tick |
|
|
What is the organism, reservoir, and vector of the disease that has fever, chills, pneumonitis WITHOUT rashh and produces an atypical pneumonia with hepatitis and is transmitted by inhalation?
|
Q fever and has NO vector
reservoir = cattle, sheep organism = coxiellla burnetti |
|
|
What starts 2-4 weeks after lous contact with fevers every 5 days and chills and headache, SEVERE bone pain, and rash is usually self limited? Also, what is the vector, reservoir and transmission mode of this?
|
Trench Fever
vector = lice transmission = inhalation of lice feces reservoir = humans |
|
|
What 3 things occur if you stimulate alpha 1 receptors?
|
vasoconstriction -->increased PVR -->increased BP
mydriasis (dilated pupils) increased internal bladder sphincter tone |
|
|
What two things occur if you stimulate alpha 2 receptors?
|
decreased NE release
dereased insulin release |
|
|
What 3 things occur if you stimulate beta 1 receptors?
|
tachycardia
increased cardiac contractility increased lipolysis |
|
|
What 6 things occur if you stimlate beta-2 receptors?
|
vasodilation (in vessels of skeletal muscles and cardiac muscle) --> small decrease in PVR
bronchodilation increased gluconeogenesis increased glycogen release relaxation of the uterus |
|
|
What 2 things occur with D1 stimulation?
|
renal and mesenteric vasodilation
|
|
|
What 1 thing occurs with D2 stimulation?
|
decreased NE release
|
|
|
What three chemicals are known as catecholamines?
|
NE
epi dopamine |
|
|
What are the 4 ADRs of alpha blockers?
|
orthohypotension
reflex tachycardia vertigo decreased ejaculation |
|
|
What is a non-selective alpha blocker that can be used in a hypertensive crisis AND in the diagnosis of pheochromocytoma?
|
Phentolamine
|
|
|
What 2 alpha 1 blockers are used for hypertension and have a common first dose AE of syncope and can be used for BPH
|
Prazosin
Terazosin |
|
|
What is a central alpha 2 agonist that is usually used for hypertensive people suffering from opiate or benzodiazepine withdrawl?
|
Clonidine
|
|
|
Can alpha or beta blockers be used in migraine prophylaxis and why? What about glaucoma and why?
|
beta blockers because chronic treatment with them results via indirect means in decreased vasodilation in the CNS
beta blockers because chronically used will block ciliary body secretion of aqueous humor and decrease pressures |
|
|
What are 2 beta-2 agonists that good for asthma and which one can be used to decrease premature uterine contractions in pregnancy?
|
terbutaline and albuterol
pregnancy = terbutaline |
|
|
What are 3 reasons that dopamine is the drug of choice for certain types of shock?
|
increases ionotrophy and chronotrophy
increases BP maintains renal and splanchnic blood flow |
|
|
What drug that is used for hypertension prevents NE and dopamine from getting packaged into vesicles and therefore, these molecules remain in cell cytoplasm and are degraded by MAO and never released?
|
Reserpine
|
|
|
What drug has the same MOA as as reserpine but ALSO blocks NE release of any NE already in vesicular stores and can be used with hypertension and has AE of decreased male sexual function and orthostatic hypotension?
|
Guanethidine
|
|
|
What are cholinesterase inhibitors?
|
drugs that inhibit the enzymes that degrades acetlycholine and allows acetylcholine to have prolonged action
|
|
|
What are two drugs that can be used to treat myasthenia gravis?
|
physostigmine and neostigmine (cholinesterase inhibitors)
also cause increased GI and bladder motility |
|
|
What drug can treat myasthenia gravis and OD with tricyclic antidepressanst and atropine?
|
physostigmine
|
|
|
What drug that treats myasthenia gravis has an ADR of spastic paralysis?
|
neostigmine
|
|
|
What is the antidote to edrophonium and what is epdrophonium used for?
|
antidote: atropine
used to diagose myasthenia gravis |
|
|
What are the 2 antidotes to organophosphate poisoning and type of glaucoma can organophosphates be used to treat?
|
antidote: atropine or 2-PAM (pralidoximine)
used to treat closed angle glaucoma due to their strong miotic effect |
|
|
What do cholinergic drugs do?
|
stimulate cholinergic receptors (parasympathetic) responses in body
|
|
|
What are the 5 major ADRs of all direct cholinergic drugs?
|
diaphoresis (sweating)
flushing increased urinary urgency nausea diarrhea |
|
|
What cholinergic drug is used for atonic bladder esp postpartum to increase the bladder's tonicity?
|
bethanechol
|
|
|
What cholinergic drug is used via eyedrops for acute angle glaucoma and serves to causes miosis which allows for better drainage of aqueous humor through the canals of Schlemm?
|
pilocarpine
|
|
|
What cholinergic drug is similar to pilocarpine and is only used via eyedrops for glaucoma but has a very long duration with a very high potency?
|
carbachol
|
|
|
How do anti-muscarinic drugs work?
|
prevent ACh from binding
|
|
|
What anti-muscarinic is used to reverse bradycardia and decrease a hyperactive bladder and can cause dryness everywhere and tachycardia?
|
atropine
|
|
|
What anti-muscarinic drug is used for motion sickness and at low dose has an ADR of sedation?
|
scopolamine
|
|
|
What is the primary use of antinicotinic drugs and why?
|
primary use in surgery because they produce complete muscle relaxation
|
|
|
What are antidotes to Tubocurarine OD?
|
neostigmine or edrophonium
|
|
|
How does Tubocurarine work?
|
It prevents ACh binding and affects the small, rapid muscles first and then the larger ones and then the limbs, neck, trunk, then intercostal muscles and finally the diaphragm
|
|
|
What is a non-depolarizing antinicotinic drugs that causes less histamine release than tubocurarine and has more favorable side effect profile? And what is its major ADR?
|
Pancuronium
ADR = vagolysis with resultatn dangerous tachycardia |
|
|
What drug can causes malignant hyperthermia and what is the antidote to it?
|
succinylcholine
antidote = dantrolene (blocks calcium rlease from the SR) |
|
|
Where are the type I sites for nicotinic receptors?
|
SNS and PNS ganglia
|
|
|
Where are the type II sites for nicotinic receptors?
|
skeletal muscles
|
|
|
What are the 4 M1 sites?
|
ANS ganglia
brain gastric partietal vascular smooth muscle |
|
|
What is the M2 site?
|
heart
|
|
|
What are the M3 sites (2)?
|
glands
bronchial smooth muscle |
|
|
What is the M4 site?
|
CNS
|
|
|
What is the M5 site?
|
CNS
|
|
|
How do M1, M3, and M5 work?
|
stimulates PLC which produces IP3 and DAG which results in increased intracellular calcium
|
|
|
How do M2 and M4 work?
|
inhibit adenylate cyclase which results in decreased cAMP which cauess potassium efflux and sodium influx
|
|
|
How do beta receptors work?
|
stimulates adenylate cyclase which yields high cAMP (opp of M2 and M4)
|
|
|
How do alpha 1 receptors work?
|
stimulates PLC, yielding high DAG and IP3 which results in activated PKC and high calcium (similar to M1,3,5)
|
|
|
How do alpha 2 receptors work?
|
inhibits adenylate cyclase which yields low cAMP
|
|
|
What sex hormone greatly increases the risk of clear cell carvical or vaginal carcinoma in the daughters of women who took it?
|
DES
|
|
|
What types of drugs are diethylstilbestrol, ethinyl estradiol, estrone, mestranol?
|
estrogens
|
|
|
What types of drugs are hydroxyprogesterone, norethindrone, norgestrel?
|
progesterone
|
|
|
What are the two primary indications for use of progesterone?
|
contraception and endometriosis
|
|
|
What is ethyinyl estradiol-levonogestrol and what is their primary purpose?
|
combination pill
contraception and decreases the menstrual cycles from once/month to once every three months |
|
|
What is the primary hip extensor?
|
gluteus maximus
|
|
|
What is the primary hip flexor?
|
iliopsoas
|
|
|
What is the primary knee extensor?
|
quadriceps
|
|
|
What are the two the primary knee flexors?
|
semimembranousis and semitendinosis
|
|
|
What is the largest joint in the body?
|
femoroacetabular joint (knee joint)
|
|
|
What is the hip joint called and what type of joint is it?
|
femoroacetabular joint - ball and socket joint
|
|
|
What 3 joints is the knee joint comprised of?
|
tibiofemoral joint
patellofemoral joint tibiofibular joint |
|
|
What 4 liagments is the femoroacetabular joint supported by?
|
iliofemoral ligament
ischiofemoral ligament pubofemoral ligament capitis femoris |
|
|
What ligament of the knee prevents hyperextension and where is it connected?
|
ACL
anterior tibia to posterior femor |
|
|
What ligament of the knee prevents hyperflexion and where is it connected?
|
PCL
connects the posterior tibia to the anterior femur |
|
|
What ligament of the knee is physically connected to the medial meniscus?
|
MCL aka the tibial collacteral ligament
|
|
|
What does Apley's Compression Test test for? What about the distraction test?
|
compression - meniscal tear (pt lies prone and flexes knee to 90 degrees)
distraction - ligamentous injury |
|
|
What does Lachman's Test test for?
|
stability of ACL
|
|
|
What does McMurray's Test test for?
|
existance of tears of the posterior aspect of the menisci
|
|
|
What does the Patellar Femoral Grinding TEst test for?
|
the integrity of the posterior patellar surface and the trochlear groove of the femur
|
|
|
What branches make up the femoral nerve and what is the sensory innervation and motor innervation?
|
L2-L4
sensory = anterior thigh and medial thigh motor = quadriceps, iliacus, sartorius, pectineus |
|
|
What branches make up the sciatic nerve?
|
L4-S3
|
|
|
What are the two division of the sciatic ner and what are their sensory and motor innervations?
|
tibial division
sensory = lower leg and plantar foot motor = hamstrings (minus short head of biceps femoris), most plantar flexors, toe flexors, and foot invertors peroneal (common fibular) sensory = lower leg and dorsum of foot motor = short head of biceps femoris, evertors and invertors and dorsiflexors of foot and most toe extensors |
|
|
What things must always be included in the neuro exam?
|
muscle strength
sensation reflex testing |
|
|
What nerve root is the patellar reflex testing?
|
L4
|
|
|
What nerve root is the achilles reflex testing?
|
S1
|
|
|
At the femur, what angle is considered coxa valgum? coxa varum?
|
valgum >135
varum <120 |
|
|
What is considered genu valgum and varum with regard to the Q Angle?
|
genu valgum >12
genu varum <10 |
|
|
What does pronation of the foot/ankle mean?
|
dorsiflexion, eversion, and abduction of the foot
|
|
|
What does supination of the foot/ankle mean?
|
plantar flexion, inversion, and adduction of the foot
|
|
|
With pronation of the foot, does the fibular head move anteriorly or posteriorly?
|
anteriorly
|
|
|
With supination of the foot, does the fibular head move anteriorly or posteriorly?
|
posteriorly
|
|
|
What part of the lower leg most commonly has compartment syndrome?
|
anterior
|
|
|
Does muscle injury or ligamentous injury lead to sprain? to strain?
|
strain = muscle injury
sprain = ligamentous injury |
|
|
What syndrome is associated with a strong vastus lateralis and weak vastus medialis resulting in a large Q angle found in women which will result in lateral deviation of the patella and they present with deep knee pain exacerbated by climbing stairs?
|
lateral femoral patellar tracking syndrome
|
|
|
What is the Terrible Triad that involves the ACL, MCL, and medial meniscus and results from being struck on the lateral side of the knee (valgus stressed)?
|
O'Donahue's Triad
|
|
|
What is an enlargment of the semimebranosis bursa that can be a result of a meniscal tear, RA, or other joint dysfunction and is located lateral to the medial hamstring in the popliteal fossa?
|
Popliteal (Baker's) Cyst
|
|
|
This disease involves the tibial tuberosity and is more common in those 11-15 years old and is accompanied by pain and swelling over the tibial tuberosity?
|
Osgood-Schlatter Disease
|
|
|
What disorder is characterized by softening and fraying of the patellar cartilage and causes anterior knee pain that is usually bilateral and is usally exacerbated by climbing hills or stairs?
|
Chrondromalacia patellae
|
|
|
What are the two most important joints in the foot and ankle?
|
talocrural joint
subtalar joint |
|
|
What are the lateral stabilizers that help to prevent excessive supination?
|
anterior talofibular ligament
posterior talofibular ligament calcaneofibular ligament |
|
|
What is the medial stabilizer and that prevents excessive pronation?
|
deltoid ligament
|
|
|
What are the two important Plantar Ligaments?
|
Spring Ligament
Plantar Aponeurosis |
|
|
What is the ankle more stable in, dorsiflexion or plantarflexion?
|
dorsiflexion
|
|
|
What can chronic irritation or inflammation of the plantar aponeurosis result in?
|
calcium deposition resulting in heel spurs
|
|
|
What ligament is the most frequently injured in an ankle sprain?
|
anterior talofibular
|
|
|
What ankle sprain classification is a sprained anterior talofibular ligament?
|
Type I
|
|
|
What ankle sprain classification is a sprained anterior talofibular and calcaneofibular ligament?
|
Type II
|
|
|
What ankle sprain is a sprained anteior talofibular, calcaneofibular, and posterior talofibular ligament?
|
Type III
|
