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145 Cards in this Set
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pt presents with weakness, blurry vision and is immunocompromised. If PML is suspected, what virus may be implicated?
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JC virus
FYI JC virus only affects IC. 75% of healthy humans have abs to JC |
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Virus that tends to cause:
respiratory infections atypical pneumonia conjunctivitis gastroenteritis hemorrhagic cystitis |
adeno
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parvo
papova adeno pox hepadnavirus are all apart of what viral family |
DNA viruses
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what is the specific cell that HSV 1+2 multiply within (contained in the DRG)
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fibroblasts
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infectious mono
Burkitt's lymphoma (africa) nasopharyngeal carcinoma (Asia) during latency, virus resides in B lymphocytes |
EBV
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Child presents with runny nose, sore throat, and eye redness. Wicked high fever of 105, resides, followed by a 3 day rash. Where does this virus reside in the latency period?
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T lymphocytes
HHV-6 Roseola (6th disease) |
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the virus that cause the common cold belongs to what family of viruses?
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Rhinovirus
Picorna family |
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Influenza A,B, and C are apart of what family of viruses and have what 2 antigens?
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Orthomyxovirus
H antigen: hemagglutinin N antigen: neurominidase |
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Picornavirus (rhino, Cox AB, polio)
Reovirus (Rotavirus) Orthomyxovirus (Flu ABC) Paramyxovirus (Rubeola, paraflu, RSV) Togavirus (Rubella) all belong to what family of viruses? |
RNA viruses
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T/F: the mosquito is the vector for alphavirus, flavivirus, and bunyayvirus
alphavirus - Eastern Equine Virus flavivirus - yellow fever, dengue fever bunyavirus - California encephalitis |
T
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PRIONS:
Kuru and CJ infect ______________, while Scrapie infect _________ and BSE (mad cow disease) infect ___________. |
humans
sheep hamsters (just kidding its cows) |
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HTLV-1 (human T cell leukemia) causes malignancy how?
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activates existing cellular genes like protooncogenes
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The HIV genome has only three major genes encoded on two identical single strands of RNA, env, gag, and pol. What to each do?
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env - gp41 mediates cell fusion; gp120 binds to CD4 receptor
gag - core capsid protein = p24 serologic marker pol - reverse transcriptase , integrase, protease |
en-fu-vir-tide - block gp41
ma-rav-ir-oc - CCR5 antagonist on CD4 cells so gp120 can't bind NRTIs (-osine/udine) and NNRTIs - block RT raltegravir blocks integrase ritonavir, indinavir, nelfinavir all block protease |
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Mold that causes farmers lung, fungus ball in lung, especially in IC, septae branch at acute angles
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aspergillus
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dimorphic fungi that causes pulmonary infection, hides within macrophages, found in bat droppings in the Mississippi and Ohio river valleys?
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Histo hides in macrophages
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dimorphic fungi that causes URI and can disseminate into skin and bone, has broad buds, forms granulomatous nodules, found in Mississippi and Central America?
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Blasto buds broadly
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dimorphic fungi that causes pneumonia and meningitis, can disseminate to bone and skin, increased rate after earthquake?
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Coccido Crowds, valley fever
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yeast that causes meningitis , found in pigeon droppings, cultured on SABOURAUD'S agar, stains with India ink, "soap bubble" lesions in brain
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cryptococcus
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dermatophytosis (ringworm) and tinea versicolor cause infection where?
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cutaneous
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Mycetoma and sporotrichosis (rose Gardner's disease) cause infection where and have what features under scope?
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subcutaneous
mycetoma - tree shaped spor - cigar shaped budding yeast |
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Regarding malaria, the sexual cycle takes place in ________ forming ______. While the asexual cycle takes place in ______ forming ______.
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mosquitos; sporozoites
humans; schizonts |
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Life cycle of MALARIA. Guaranteed COMLEX question.
Sporozoites into blood from mosquito-->sporozoites become merozoites-->merozoites settle in liver-->liver releases merozoites-->merozoites infect RBCs-->ringed shaped trophozoites matures-->forms multinucleated schizonts-->RBC release 10-20 merozoites |
cold
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Name where the following sporozoa of malaria are found:
sporozoites merozoites trophozoites |
introduced into blood via mosquito
found in liver within RBCs |
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Sudden onset fever, dyspnea, tachypnea caused by a fungus, common in AIDS pts. Tx?
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P. carinii
treatment - TMP/SMX or pentamidine |
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Cysts invade GI wall, muscles, and brain. Infection via cat turds or undercooked pork. Severe fetal defects. Tx?
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toxoplasma gondii
treatment - sulfonamide in 1st trimester, sulfonamide-pyrmethamine all others |
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"black sickness", GI bleeding, transmitted by insects in tropical areas. tx?
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Leishmania donovani (Kala-Azar)
sodium stibogluconate Donovan kinda sounds like a black guys name. "Hello, my name is Donavan Leishmania and I'm a black guy." Also, "black sickness" is synonymous for visceral Leishmaniasis |
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transmitted by insects in the tropics, affects mucous membranes (nose, mouth) resulting in grossly destructive changes (like seriously fucked up). tx?
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Leishmania brasiliensis (alien face)
sodium stibogluconate |
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transmitted by insects in the tropics, causes cutaneous red papules, immune response at bite, ulcerating skin lesions. tx?
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Leishmania tropica
sodium stibogluconate |
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protozoa causes chagas', dilated cardiomyopathy , megacolon/esophagus, in south america. tx?
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T. cruzi
Reduviid bug (kissing bug) treat with nifurtimox |
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fly bite that causes enlarged lymph nodes, recurring fever, somnolence, and coma. tx?
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T. gambiense/T.rhodesiense (more severe)
Tsetse fly (African sleeping sickness) treat with Suramin, melarsoprol (Sure I'm melatonin...like something a stoner med student would say before going to sleep) |
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intestinal protozoa, cysts in water, cyst has 4 nuclei, trophozoites have 1 nuclei within RBCs, causes bloody, mucousy diarrhea, forms liver abscesses and can be transmitted sexually. tx?
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Entamoeba histolytica
metronidazole (collects electrons that destroy DNA and proteins) |
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Intestinal protozoa, cysts in water, cysts have 4 nuclei, trophozoites have 2 nuclei and 4 pairs of flagella, escapes the cyst envelope in the duodenum, greasy non-bloody, foul smelling diarrhea. tx?
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Giardia lamblia
metronidazole |
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Intestinal protozoa, cysts in water, excystation in small intestines, trophozoites do not invade gut wall, severe diarrhea in IC, no effective tx.
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Cryptosporidium
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Parasite with1 nucleus, 4 flagella, asx urethritis in male, foul-smelling, watery, green discharge in female. tx?
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Trichomonas
metronidaxzole |
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immediate host is the snail-->releases larvae (cercariae)-->penetrate human skin-->enter small veins-->pass through right heart and lung-->systemic circulation-->intestinal capillaries-->sexually mature in the portal vein
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that my friend is the life cycle of the famous blood fluke (schistosoma)
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Given the veins of the colon, small intestine, or bladder. Identify which blood fluke (Schistoma) settles there:
japonicum mansoni hematobium |
colon - mansoni
small intestine - japonicum bladder - hematobium |
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Tissue flukes are endemic to where? aka question stem will most likely include "...recent travel to ______."
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South East Asia
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Tissue fluke from eating raw fish, settles in the liver and causes bile stones, blockage, and possibly ductal carcinoma
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Clonorchis sinensis
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Tissue fluke from eating raw crab meat, settles in the lung and causes eosinophilic inflammation and prob a bunch of other pulmonary problems
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paragonimus westermani (P for pulmonary)
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DOC flukes
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praziquantel
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Difference in infection of tapeworms (crestodes) based on whether a larvae or egg is ingested
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larvae - human becomes the primary host and huge worms chills in gut lumen
egg - human becomes the intermediate host and larvae invade tissue and cause serious disease |
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T. solium (tapeworm) can be ingested from either undercooked pork (larvae form) or from human poopies (egg form). Where do each eventually settle?
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larvae - intestine
egg - brain and eyes (cysticerci) |
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T. saginata (tapeworm) infects humans that consume undercooked ________ in the ________ form and eventually settle in the _________.
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beef; larvae; intestines
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D. latum (tapeworm) infects humans that consume raw ______ in the _____ form, that eventually settle in the ______.
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fish; larvae; intestines
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Tapeworm that infects humans d/t ingestion eggs in dog turds. Cysts can form in liver, anaphylaxis if cysts rupture. 3rd year note: surgeons inject ethanol before removal to neutralize antigens
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Echinococcus granulosus
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Eliminates tapeworms (rapid review)
DOC tapeworms (first aid) |
niclosamide
-bendazoles |
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intestinal roundworms (nematodes) are found in _______ where ________ _____ are deposited or used as fertilizer
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soil; human feces
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pinworm infection d/t ingestion of eggs. pruritis ani and night and + scotch tape test
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enterobius vermicularis
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roundworm infection d/t ingestion of eggs. worms live in colon, larvae migrate to lung, and eggs are visible in feces
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ascaris lumbricoides
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hookworm infection d/t penetration of skin by larvae. Intestinal infection can cause anemia (blood sucker)
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necator americanus
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roundworm infection d/t larvae in soil that penetrate skin and can cause vomiting, diarrhea, and anemia. Can cause hyperinfective syndrome in IC pts (Tends to migrate to lung adult stage ~2 weeks)
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strongyloides stercoralis
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roundworm infection d/t consumption of undercooked pork. Larvae invade skeletal mm (encyst) and can cause periorbital edema.
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trichinella sprialis
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roundworm infection d/t ingestion of dry goods contaminated with eggs. May cause bloody diarrhea and iron deficiency anemia and rectal prolapse in severe infections.
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Trichuris trichiura (whip whorm, trichi trichi)
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roundworm infection d/t mosquito bite. Adult worms live in lymph nodes and blockage occurs, leading to elephantitis after aboot a year
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wuchereria bancrofti
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Roundworm infection d/t bite from female black fly. Causes hyperpigmented skin and river blindness, Microflariae in tissue and eye can cause allergic reaction
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onchocerca volvulus
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Roundworm infection d/t drinking contaminated water. Sx are skin inflammation and ulceration.
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dracunculus medinensis
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Roundworm infection d/t bite from deer, horse, or mango fly. Causes swelling in skin and worm can be visualized crawling in conjunctiva. Gross.
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loa loa
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Roundworm infection d/t consuming food contaminated with eggs. Causes granulomas. Can lead to blindness and visceral larva migrans
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toxocara canis
NOW YOU CANIS SEE ANYMO' |
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Parasite infection d/t bite from ixodes tick (same vector as Borrelia burgdorferi) found in the Northeastern US. Sx are fever and hemolytic anemia. Blood smear shows RBCs with "Maltese cross"
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Babesia (babesiosis)
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Infection with measles before age two may lead to which rare progressive encephalitis?
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subacute sclerosing panencephalitis
neuro-degeneration followed by death |
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mycobacterium TB in AIDS likely at a CD4 count above__________and CXR shows
myobacterium avium-intracelluare affects CD4 less than_______. |
400
initially normal d/t impaired immune response 100 |
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Apparently the plague (Yersinia pestis) is still endemic to the Southwestern US, New Mexico area
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what you didn't know that?
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For a post-influenza bacterial pneumonia with cavity lesions, think of staph. aureus. What does that look like again?
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gram-positive, catalase postive, coagulase positive coccus
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Apparently S. saprophyticus is resistant to ciprofloxin and the mechanism is d/t chromosomal mutations (topo 4 and dyrase)
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Shoulda became a mayor.
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Spirochete that is question mark shaped, found in water contaminated with animal urine. Fluke-like sxs fever, headache, abdominal pain. Hawaii has the highest incidence
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leptospira interrogans
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For the following, describe the toxic mechanism:
anthrax botulinum cholera C. perfringens (alpha toxin) diptheria E. coli (labile toxin) pertussis shigatoxin streptococcal erythrogenic toxins tetanus |
edema factor (adenylate cyclase->fluid loss, lethal factor->apoptosis
prevents release of ACh increase adenylate cyclase ribosylates GTP-binding protein alpha toxin is a lecithinase Inhibits EF-2 Activates Adenylate cyclase Increases cAMP via activating Gαi decreases protein synthesis by inhibiting 60s superantigens increase cytokine production inhibits the release of glycine and GABA |
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Identify the following:
Gram-negitive curved rods isolated on alkaline medium Gram-negative curved rods that grow at 107 degrees Gram-negative, non-fermenting rods Gram-negative rods, ferment lactose Gram-negative rods, non lactose fermenters, H2S positive |
Vibrio vunificus
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A patient infected with schistosoma haematobium will likely present how?
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hematuria
S. haematobium has a predilection for the bladder veins chronic infection leads to fibrosis of the bladder and can lead to squamous cell carcinoma |
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What do the following have in common:
M. tuberculosis B. anthracis N. asteroides B. pertussis P. aeruginosa N. meningitidis/gonorrheae |
They are obligate aerobes
MUST have a plentiful oxygen supply |
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What do the following have in common:
B. abortus C. jejuni Strep species Spirochetes (treponema, borreila and leptospira) |
All are Microaerophillic
No O2 requirement, rely on fermentation, and can tolerate low concentrations of O2 via superoxide dismutase |
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What do the following have in common:
Clostridium species Actinomyces israelii Bacterodies fragilis |
All are obligate anaerobes
They CANNOT tolerate ANY O2 bc they do not posses any cellular mechanisms to remove radicals |
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What do the following have in common:
staph species corynbacterium diphtheriae |
Facultative anaerobe
Their good anywhere |
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Diarrhea cha, cha, cha. Most likely causes in the following age groups:
Acute infectious -adult -children -bloody -parasitic Chronic infectious + WBC in stool - WBC in stool Food associated |
Norwalk virus
Rotavirus Campylobacter jujuni Giardia lamblia (US) Campylobacter jujuni Norovirus and rotavirus Salmonella |
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Describe the bacteria that tends to cause the following:
Otitis media pneumonia meningitis |
Gram positive, catalase negative cocci in chains that produces α hemolysis
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Describe the bacteria that tends to cause the following:
sepsis/meningitis in neonates colonizes the rectum of the adult |
Gram positive, catalase negitive cocci in chainsthe produces ß hemolysis (clear), bacitracin resistant
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Describe the bacteria that tends to cause the following:
pharyngitis tonsillitis impetigo scarlet fever PSGN |
Gram positive, catalase negative cocci in chains, produces ß hemolysis (clear), bacitracin sensitive
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Describe the bacteria that tends to cause the following:
Sub-acute endocarditis Marker for colon cancer if present in any patient |
Strep bovis
Gram positive, catalase negative cocci in chains |
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Three toxins produced by Bacillus anthracis
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Edema factor
Protective antigen - pores in cell membranes to allow entry of EF and LF (protective anti-body formed to protective antigen) Lethal factor - blocks the messenger system for cell growth |
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Farmer presents with dry cough, severe respiratory distress, fever, and is tired. X-ray shows widened mediastinum and blood in the pleural cavity
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Pulmonary anthrax most likely from the wool of a beast
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Farm hand presents with vomiting, abdominal pain, bloody diarrhea, Recently consumed a very well done porterhouse steak.
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GI anthrax
spores are heat resistant, so don't eat cheap steak |
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DOC regimen for anthrax
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DOC penicillin (only after strain is proven sensitive)
until then: ciprofloxin or doxycyline + clindamycin and/or rifampin AND continue regimen or penicllin for 60 days for bioterrorsim related or 7-10 days for non-bioterrorism |
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Risk for anthrax vaccine?
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Guillain-Barre recurrence in those with a hx of the disease
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Immunocompromised Pt presents with watery diarrhea, fever, myalgia, and abdominal cramps. Cytology shows chinese lettering.
How does organism move from cell to cell? Common source? |
Listeria monocytogenes
moves via actin rockets dairy products, undercooked hotdogs tx with parental penicillin or TPM/SMX if pen allergic |
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Ingestion of spores that germinate in beef or chicken, spores germinate and become bacterial cells that proliferate and produce α toxin (lecithinase) that disrupts membranes with phospholipase C activity. When will the diarrhea be seen? Other infections possible?
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C. perfringins
6 hours, resolves in 24 hours gas gangrene and myonecrosis |
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Best way to confirm infection with C. dif?
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Toxin ELISA for toxins A and B
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Pt presents with Kussmaul respirations, hyperthermia, NV, dehydration and altered mental state. He complains of facial pain. What he be worked up for and result if not?
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pt is in DKA
Facial pain may indicate mucor sinusitis, Dx with sinus CT, and treat with amphotericin B mortality is 50% |
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Bacterial meningitis in neonates, elderly, and IC
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Gram positive rod
Listeria |
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Bacteria that causes meningitis and also the ability to cause hemorrhagic destruction of the adrenal cortex
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Gram negative diplococci, + capsule, + oxidase, cultured on chocolate agar
Nesseria WFS |
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Most common cause of meningitis in adults that can progress from otitis media, sinusitis, or bacteremia
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Gram positive diplococci, + capsule, catalase -, α hemolysis
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Most common cause of neonatal meningitis
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Gram positive cocci in chains, catalase -, ß hemolysis, bacitracin resistant
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Common cause of neonatal meningitis, pink colonies on MacConkey's agar
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Gram negative rod, motile, ferments lactose
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Bacterial meningitis that may present like aseptic meningitis d/t difficult gram staining and culturing out of CSF. Seen in IC, neonates, and elder;y
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Gram positive rod
Listeria start ampicillin |
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Chronic meningitis, acid fact bacillus stain negative, culture negative for TB. Two possible options to make the dx
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MRI for TB and all granulomatous meningitisshows "basliar meningitis"
or + PCR |
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AIDS patient presents with sxs of meningitis and CD4 count is less than 100. ML causes will show what on India ink stain
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shows large halo around the organism, which is the capsule, that does not take up the ink
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Buzzwords:
Congenital encephalitis transmitted across the placenta Causes neonatal hydrocephalus, MR, periventricular calcifications Multiple, ring-enhancing lesions AIDS pt with CD4 < 200 get TMP/SMX prophylaxis Cat turds |
Toxoplasma
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Viral encephalitis
Affects the temporal lobe causing hemorrhagic encephalitis Cowdry intranuclear inclusion bodies sx olfactory hallucinations |
double-stranded, enveloped, linear DNA virus
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Viral encephalitis in IC
Infection in pregnancy-->miccoencephaly, MR, HSM, retinitis Giant cells with eosinophilic inclusions in cytoplasm and nucleus |
Double stranded linear enveloped DNA virus
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Penetrates BBB by living in monocytes causing progressive dememtia
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Single stranded + sense linear, enveloped icosahedral RNA togavirus
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Viral encephalitis in children
Affects gray and white matter Damsons inclusion bodies |
Measles
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Neuro syphilis d/t 2 or 3 syphilis
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2 - d/t lymphocyte meningitis
Tertiary Meningovascular syphilis: Causes meningeal adhesions Argyll Robertson pupil Heubner's arteritis Parenchymal syphilis: Tabes dorsalis - bilateral demyelination of posterior spinal cord dementia paralytica - cortical atrophy (psychosis and personality change) |
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Number one cause of brain abcesses
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Gram positive catalase negative cocci in chains
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Eosinophilic granulomas in the brain
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schistosomiasis
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Small, pink papules, white core, with an indented center. If seen in kids genitals think sex abuse
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Mulluscum contagiosum
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Neonate born with brain calcifications, seizures, MR, nerve deafness, and heart defects. Mom was asx throughout pregnancy
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Cytomegliac inclusion disease (CMV)
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MC cancer in AIDS
inactivates RB uncontrolled cell growth malignancy of vascular endothelium B cells become neoplastic-->primary effusion lymphome |
HHV-8
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What do the following have in common:
RSV Flu A B C parainfluenza virus RSV Measles Mumps Rubella Rabies Hepatitis HTLV HIV Arbovirus |
Enveloped RNA viruses
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What do the following have in common:
Polio Cox A and B echovirus Hep A Rhinovirus Rotavirus Norwalk virus |
Naked RNA viruses
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Flu that is endemic because of the surface glycoproteins H and N
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Flu A
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Barking cough and stridor d/t subglottitis and steeple sign d/t swelling of soft tissue around the trachea
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Parainfluenza virus
Enveloped RNA virus |
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Enveloped RNA virus
#1 cause LRTI of infants #1 otitis media and pneumonia in elderly tx with ribavrin |
RSV
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How to distinguish btw Rubella (German measles) and Rubeloa (measles)
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Rubella and Rubeloa both show fever, malaise, rash on face that spreads downward, BUT Rubella has classic auricular lymphadenopathy. Own the diagnosis. BECOME THE DIAGNOSIS
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Atypical pneumonia with high fever, non-productive cough, headache and hypoxia. CXR homogeneous translucency infiltrates without cavitation
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SARS
"ground glass" |
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Southeast US
encephalitis mosquito vector bird reservoir hosts are human and horses |
EEE
Alphavirus WEE is the exact same except Western US |
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South America
Fever, headache, sx free, fever again, jaundice, hematemesis and hematochezia Reservoir monkeys |
Yellow fever
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Warm humid enviroments
High fever, rash, bone and joint pain, sx free, fever and rash again Mosquito vector |
Dengue fever
Dengue hemorrhagic fever is re-exposure sxs high fever, shock d/t hemorrhage, SEVERE |
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Area is diffuse
Fever, confusion, ascending mm weakness and paralysis (elderly) Mosquito vector Crow reservoir |
West Nile Encephalitis (flavivirus)
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Rocky mountains
High fever, headache, retro-eye pain, severe muscle pain, remission days, fever for several weeks wood tick (dermacentor) vector |
Colorado tick fever
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Western US
Flu-like sxs-->acute respiratory failure, high mortality rate even with hospitalization Deer mouse vector and reservoir |
Hantavirus (Bunyavirus)
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Fever, HA, diarrhea, vomit, hemorrhage and shock, DIC
100% mortality rate Bio-warfare agent |
Ebola hemorrhagic fever (Filovirdiae; RNA virus)
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Myoclonal jerks, seizures, death 1-3 years
Caused by Rubeola (measles) |
subacute sclerosing panencephalitis
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memory deficits, ataxia, rigidity
terminal state = akinesia and mute Human tissue |
CJD
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Ataxia, memory impairment
sheep brains |
Scrapie
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Lymphadenopathy, HSM, lytic bone lesions, skin lesions
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Adult human T cell leukemia/lymphoma
HTLV-1 retrovirus |
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Routine blood count shows unexpectedly low numbers of one or more kinds of normal blood cells, or after unexplained bruises or recurrent infections in an otherwise apparently healthy patient.
Malignant B lymphocytes |
HCL
HTLV-2 |
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Natrual immunity to HIV is d/t rapid mutation of what
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env gene - surface glycoproteins gp41 and 120
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Pneumonia in kids, elderly, IC
acute onset with rigors # CAP ↑AIDS and asplenic |
Gram positive cocci, catalase - α hemolysis optochin sensitive
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TB of spine
Presents with multiple compression fractures |
Pott's disease
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TB causing cervical lymphadenopathy
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Scrofula
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Sunburn rash with goosebumps
Appears initially on trunk, becomes generalized within a few days Strawberry tongue Rash worse in pits and groin |
Scarlet fever
Gram positive cocci in chains, ß hemolysis, bacitracin resistant |
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Red/purple rash in HIV patients
Transmission via young cats and fleas |
Bartonella henselae
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Seen in typhoid fever
High fever, weakness, myalgias, splenomegaly, constipation. High fever with relative bradycardia Small pink papules in groups of 1-2 dozen on trunk tx for chronic carrier state = removal of gallbladder (S. typhi hangs here) |
Rose spots
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Initial ↑PCO2, followed by ↑HCO3
Sedation, COPD |
resp acidosis
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Primary ↓HCO3 followed by ↓PCO2
Ketoacidosis, lactic acidosis |
Metabolic acidosis
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Initial ↓PCO2 followed by ↓ HCO3
anxiety, mountain climbing |
Respiratory alkalosis
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Initial ↑HCO3 followed by ↑PCO2
Loops, vomiting |
metabolic alkalosis
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site of active resorption of glucose, aa
Active secretion of protons |
PCT
CAse inhibitors work here |
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Main absorption at the following:
Duodenum/jejunum Duodenum Terminal ilium |
Carbs and amino acids
Iron B12 and bile salts |
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Gastrin
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released by vagus n, EtOH, basic pH in stomach
-->HCL secretion, ↑motility, ↓emptying |
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Secretin
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released in response to acidic pH in duodenum
-->HCO3 release from pancreas |
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GIP
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Released in response to glucose and fat in duodenum
-->insulin release |
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Hypokalemia with hypertension
not hypernatremic |
Conn's (hyperaldesterone)
|
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Hypotension (Na+ loss)
Hyperkalemia metabolic acidosis pigmentation |
ADDISONS (hypoaldesterone)
|
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Kiddos milestones:
chin up chest up knee push sits alone, stands with help crawls on stomach stands holding furniture walks when led stands alone walks alone |
1
2 6 7 8 10 11 14 15 month |
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Amoeba that causes keratitis in healthy contact lens users
|
Acanthamoeba castellanii
|
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MC tape worm in the US
No intermediate animal needed One infection results in 100s-1000s of worms Southeast US |
Hymenolepsis nana
|
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