Clinical Micro - Cardiovascular

Front 1

What is toxemia?

Back 1

A type of septicemia where the bacteria stays fixed at a certain location but releases toxins into the blood stream.

Front 2

What characterized lymphangitis?

Back 2

red streaks under the skin

Front 3

Septicemia can progress to _

Back 3

septic shock

A condition of low blood pressure
Decrease in body temp, decreased urine output, rapid breathing, aberrant blood clotting, increased heart rate, anxiety

Front 4

Exotoxins are released from ___

Endotoxins released from ___

Back 4

living microbes

dying gram-neg bacteria (only one! Lipid A LPS)

Front 5

What are some examples of exotoxins?

Back 5

Neurotoxins
Enterotoxins
Cytotoxins
Membrane damaging
Superantigens

Front 6

_: Organisms that colonize the GI tract

What are some examples?

Back 6

Enterotoxins

Vibrio cholerae, E coli

Front 7

Corynebacterium diptheriae, Shigella dysenteriae, strains of E. coli (0157:H7)
These are examples of what type of exotoxin?

Back 7

Cytotoxins

They inhibit protein synthesis in eukaryotic cells leading to cell death

Front 8

What are some examples of neurotoxins?

Back 8

Clostridium tetani - blocks inhibitory neurons
Clostridium botulinum - blocks nerve signals to muscle (lethal)

Front 9

What is the mechanism behind membrane damaging toxins?

Back 9

Streptolysin O released from Streptococcus pyogenes inserts into membranes forming pores.

Alpha toxin by clostridium perfringens cleaves off the phospholipid heads.

Front 10

Both Gram + and Gram - are capable of producing _.

Only gram - can produce _

Back 10

exotoxins

endotoxins

Front 11

Nosocomial infections are typically (gram -/+)

Back 11

gram negative

they are also responsible for opportunistic infections (but so is gram +)

Front 12

What are the three different types of bacteremia?

Back 12

Transient, Intermittent, Continuous

Front 13

Continuous bacteremia implies _

Transient follows _

Back 13

intravascular source. (intravascular cath)

dental procedures (here, immunocompetent individuals rapidly clear microbes)

Front 14

Intermittent bacteremia is _

Back 14

manipulation of an extravascular site

abscess that gets out of hand

Front 15

Wide QRS means…

Back 15

Bundle Branch Block

Front 16

Mr. Jones is a 61 yo man complaining of palpitations, You put him on a holter monitor for 24 hours, and he has six 12-beat runs of ventricular tachycardia. What do you treat him with?

Back 16

nothing. (non sustained - less than 30 beats is NOT treated, only sustained is treated)

Front 17

Septicemia is typically an example of _, they produce an _ and as a result can activate the complement system

Back 17

Gram negatives, endotoxin

Front 18

Exotoxins are released from _

Back 18

living microbes

Front 19

"Endotoxins released from _
"

Back 19

dying gram-neg bacteria (only one - Lipid A portion of LPS

Front 20

It is the _ that can induce septic shock

Back 20

Endotoxin (lipid A portion of LPS- gram neg)

Front 21

Vibrio chloreae and E Coli can produce what type of exotoxin?

Back 21

Enterotoxin: Regulatory protein in intestinal cells is modified to induce cells to secrete electrolytes and water --> Diarrhea

Front 22

"Corynebacterium diptheriae, Shigella dysenteriae, strains of E. coli (0157:H7) can produce what type of exotoxin?
"

Back 22

"Cytotoxin - Inhibits protein synthesis in eukaryotic cells leading to cell death
"

Front 23

"_ creates the characteristic β-hemolysis when grown on blood agar medium
"

Back 23

Streptolysin O

Front 24

Clostridium perfringes produces _ which causes gas gangrene

Back 24

Alpha toxin

Front 25

What are some examples of Gram Positives that are associated with opportunistic causes of septicemia?

Back 25

Staph aureus, Strep pneumoniae, Strep pyogenes

Front 26

Cellulitis is most commonly associated with what organisms?

Back 26

Strep pyogenes, Strep agalactiae

Front 27

Endocarditis caused by Viridans streptococci is commonly seen following _. What type of hemolysis do they have?

Back 27

dental procedures ; alpha hemolysis(so does Strep pneumonia - so to tell the difference s pneumonia is optochin sensitive)

Front 28

What population is at particular high risk of initial and recurring infective endocarditis?

Back 28

IV drug abusers

Front 29

How many blood collections are needed when you suspect endocarditis?

Back 29

3-4, multiple sites are drawn to rule out contamination from the skin

Front 30

Why would a CBC be ordered? What is It all measuring?

Back 30

To determine anemia and infection, RBC, WBC, platelet count, Hb, hematocrit, MCV, MCH, MCHC, RDW

Front 31

What is a Normal RBC count? WBC?

Back 31

"Normal: 4.8x106 /mL for men

Normal: 4.3x106 /mL for women .

WBC Normal: 4500-10,500 /mL

Front 32

What is a normal WBC differential? (neutrophils, lymphocytes, monocytes, eosinophils, basophils, bands)

Back 32

N: 40-60%, L: 20-40%, M: 2-8; E: 1-4%, Basophils 0.5-1%, Bands: 0-3%

Front 33

CBC shows WBC count 12,000, with 70% neutrophils. What does this tell you?

Back 33

Bacterial Infection (WBC norm 4.5-10.5 thousand, N = 40-60%) Elevated Neutrophils indicates a bacterial infection

Front 34

CBC shows WBC count 4000, with 55% lymphocytes. What does this tell you?

Back 34

Viral Infection (WBC norm 4.5-10.5 thousand, L = 20-40%)

Front 35

CBC shows WBC count 18,000, with 12% monocytes. What does this tell you?

Back 35

Severe Infections, phagocytosis. (WBC norm 4.5-10.5 thousand,

Front 36

CBC shows WBC count 16,000, with 12% eosinophils. What does this tell you?

Back 36

Allergic Rxn - or possibly a parasitic infection(WBC norm 4.5-10.5 thousand, E = 1-4%) Elevated eosinophils mean two things: either allergies or parasites

Front 37

CBC shows WBC count 18,000, with 4% basophils. What does this tell you?

Back 37

Parasitic infection (some allergies) (WBC norm 4.5-10.5 thousand,Basophils = 0.5-1%) Elevated basophils typically means a parasitic infection

Front 38

Leukocytosis is considered above _ /mL, and occurs in _. Leukopenia is below _, and occurs in _

Back 38

11,000, in acute infections. 4000, viral infections and overwhelming bacterial infections (prodcution can't keep up)

Front 39

Vacuolization occurs in either _ or _, and is indicative of what portion of the immune system?

Back 39

Neutrophils, Monocytes. Innate Immune system. "Swiss cheese" in cytoplasm

Front 40

What is a normal Mean corpuscular Volume?

Back 40

Average size of blood cell - useful in classifying anemias. Normal = 82-98

Front 41

The MCV in your patient is 110, this is indicative of _ meaning she has a _ deficiency

Back 41

Macrocytic anemia - B12 or folate. A larger than normal MCV (norm 82-98) is indicative of Macrocytic anemia caused by B12 or folate deficiency

Front 42

The MCV in your patient is 62, this tells you she has a _ deficiency causing _

Back 42

Iron deficiency, microcytic anemia. (smaller than normal MCV (ie. Less than 82) is indicative of microcytic anemia

Front 43

Upon microscopic examination of a peripheral blood smear, you find that resting lymphocytes are smaller than the surrounding blood cells. Is this normal? If not, what does it mean?

Back 43

No, the patient has a microcytic anemia (iron deficiency). If the surrounding lymphocytes are the same size or larger than the RBCs, that would be indicative of macrocytic anemia (B12 or folate)

Front 44

What is the normal Hb value for males? Females? What about Hematocrit?

Back 44

"Women: 12-16 g/dL
Men: 14-17.4 g/dL Hematocrit --Women: 36-48% (35-45)
Men: 42-52% (45-55)

"

Front 45

What is the normal MCH level? MCHC?

Back 45

MCH (monitors hemoglobin amount): 26-34.


MCHC (Hemoglobin Concentration): 32-36

Front 46

"Larger than normal variation in RBC sizes is called _
"

Back 46

anisocytosis

Front 47

A variation in the size and shape of RBC is called )

Back 47

Poikilocytosis

Front 48

What is the most common cause of sepsis and meningitis in newborns? (And frequent cause of pneumonia)

Back 48

Group B Streptococcus (Streptococcus agalactiae)

Front 49

Rheumatic fever primarily affects children between the ages of _ and _

Back 49

6 and 15

Front 50

Rheumatic fever occurs because there is antigenic simularity between _ and _

Back 50

M protein of group A Strep and myosin

Front 51

The bubonic plague is caused by _

Back 51

Yersinia Pesitis. Which is a nonmotile, nonspore forming, gram neg rod that grows at 28 degrees C

Front 52

_ are the primary reservoir of Yersinia. How is it spread?

Back 52

Rodents (rats), spread by fleas Xenopsylla cheopis

Front 53

What bacteria clogs the GI tract of Xenopsylla cheopis?

Back 53

Yersinia Pestis.

Front 54

The Bubo refers to _

Back 54

an enlargement and tenderness of the lymph nodes (usually in groin area). Caused by Y pestis

Front 55

Y Pestis is carried to the _ and then replicates _. Ultimately the bacteria ends up in the _

Back 55

lymph nodes, and then is taken up by the macrophages and replicates inside them. After invading the blood stream, the infection ends up in the lungs (pneumonic plague)

Front 56

What's the difference between primary and secondary pneumonic plague

Back 56

Secondary is when the patient originally had the bubonic plague (got bit by a flea, large lymph nodes, etc) that got into the blood stream and landed in the lungs. Primary is when the patient inhaled aerosolized Y pestis from another pt (rapidly spread through coughing). In this case there are no bubos present, and no bite marks or swollen lymph nodes

Front 57

A previously healthy 33 y/o comes down with cough with watery sputum, shortness of breath, chest pain, nausea, diarrhea. She develops severe cyanosis and expires shortly after. What suspicion should you at least consider?

Back 57

Pneumonic plague (or inhalation anthrax)

Front 58

Mumps is a (bacteremia/viremia). It is caused by _

Back 58

viremia. Paramyxovirus infected respiratory droplets

Front 59

How many serotypes are there of paramyxovirus? What does it infect?

Back 59

only one serotype, only infects humans (nasopharynx and lymph nodes) This is the virus that causes mumps

Front 60

How does a paramyxovirus infection present clinically? And how is it managed?

Back 60

Mumps - bilateral parotitis, accompanied by fever. Other sxs include myalgia, anorexia, malaise, headache, low-grade fever, earache or tenderness to jaw. Typically resolves within a week or 10 days (tough it out)

Front 61

Coxsackie virus is transmitted via _

Back 61

fecal-oral route. They have capsids that are resistant to harsh environments such as sewage systems and gi tracts.

Front 62

Group A coxsackie virus is associated with _. Group B is associated with _

Back 62

Type A: vesicular lesions (herpangia, hand-foot-mouth disease).

Type B: - Bornholm disease: pleurodynia "devil's grip" pleuritic chest pain that’s unilateral

Front 63

23 yo male presents to the ER with acute onset chest pain on left side and vomiting. He is clutching his chest screaming in pain. The pain gets worse when he breaths in. What do you suspect? What is the prognosis?

Back 63

Group B Coxsackie virus. Pleurodynia - bornholm disease. He characteristically has the "Devil's grip". Mortality is extremely high in these cases, autopsy reveals involvement in other organs such as the brain, liver, and pancreas

Front 64

What is so important regarding CMV (-) blood?

Back 64

Most people have cytomegalovirus +, but (-) CMV blood is rare and highly valued because newborns cannot receive (+) CMV blood

Front 65

The "owl's eye cell" is diagnostic for what infection?

Back 65

Cytomegalovirus - microscopy detects the presence of abnormally enlarged cells with inclusions in the nuclei

Front 66

19 yo college student donates blood on campus. While screening her blood, microscopy reveals the presence of abnormally enlarged cells with inclusions in the nuclei. What is the dx?

Back 66

Cytomegalovirus. This is the typical "owl's eye cell" of a CMV infection

Front 67

Infectious mononucleosis is characterized by _, and caused by _

Back 67

an increase in mononuclear leukocytes (LYMPHOCYTES not Monocytes). EBV (Ebstein Barr Virus -- a ds DNA from the herpes family) - which has an affinity for B lymphocytes

Front 68

EBV has a high affinity for what type of cells?

Back 68

B lymphocytes

Front 69

The heterophile antibody is produced by _, and is a charcteristic of what dz?

Back 69

infected B lymphocytes, Infectious mononucleosis

Front 70

What are the 3 types of IM antibodies?

Back 70

Heterophile, EBV, autoantibodies

Front 71

Burkitt's lymphoma is related to what infection?

Back 71

EBV

Front 72

Yellow fever is caused by what infection

Back 72

flavivirus - from a mosquito bite

Front 73

The term "yellow jack" describes what?

Back 73

third phase of yellow fever characterized by jaundice due to degeneration of liver, kidneys, and heart . Hemorrhaging of the intestines results in black vomit

Front 74

Dengue fever is caused by _. It occurs in _ phases separted by _

Back 74

flavivirus (mosquitoes). 2 phases separated by a 24 hr remission period. Phase 1 "breakbone fever" characterized by fever, severe pain in head and muscles. Phase 2 is return of the fever and a bright red rash

Front 75

IV drug users are prone to _ endocarditis

Back 75

Candida (mc is Candida albicans)

Front 76

C parapsilosis has an affinity for what type of patients? C Krusei??

Back 76

pediatric ; bone marrow transplant pts

Front 77

There are 4 overlapping forms of invasive candidiasis. What are they?

Back 77

"Catheter related candidemia
Acute disseminated candidiasis
Chronic disseminated candidiasis
Deep organ candidiasis
"

Front 78

With regards to malaria: A mosquito bites a human, transferring _ from the saliva of the mosquito to the human. They travel to the _ where they replicated many times into _

Back 78

sporozoites; liver; merozoites


(plasmodium)

Front 79

Regarding malaria _ leave the liver and invade _

Back 79

merozoites, invade RBCs


(plasmodium)

Front 80

What is the most severe form of malaria?

Back 80

Plasmodium flaciparum. Parasites infect all erythrocytes, RBC membrane becomes rigid

Front 81

Plasmodium vivax and plasmodium ovale cause _

Back 81

a relapsing malaria

Front 82

"P. falciparum – _incubation periods
P. malariae – _ incubation periods
"

Back 82

Shorter; longer. This card is talking about Malaria, which has an incubation period anywhere from 7-30 days.

Front 83

A microscopic finding of "schuffner's dots" which are RBCs displaying small purplish red granules with Wright's stain are found in what dz?

Back 83

Malaria


(plasmodium)

Front 84

Child presents with weakness, fever, mild jaudice, RR of 24, and splenomegaly. Microscopy of the blood stains with Wright's stain reveal small purplish red granules within RBCs. What do you suspect lab results to show?

Back 84

This is talking about a Malaria infection (P flaciparum). Lab results reveal mild anemia, thrombocytopenia, elevated bilirubin, albuminuria, and urinary casts.

Front 85

Give some examples of people who are resistant to malaria

Back 85

Sickle cell pts, Hemoglobin C homozygotes, G6P DH deficiency, Lack of Duffy A and Duffy B

Front 86

"Swimmer's itch" is characteristic of _

Back 86

schistosomiasis "blood flukes"

Front 87

Chagas' disease refers to _

Back 87

Trypanosomiasis , and infection by Trypanosoma cruzi primarily affeting the nervous system and heart

Front 88

"Trypanosoma brucei gambiense causes _

Trypanosoma brucei rhodesiense causes _

"

Back 88

Chronic form of African sleeping sickness.

Acute African sleeping sickness

Front 89

Romana's sign is _, and characteristic of _ disease

Back 89

eye on one side swells (at the location of triatomine bug fecal matter gets rubbed in). Chagas disease - Trypanosoma cruzi

Front 90

Why do relapses occur in African sleeping sickness?

Back 90

D/t antigenic variation of trypanosomal surface. Trypanosoma life cycle exhibits different morphologies

Front 91

Leishmania is a _ protozoa

Back 91

obligate intracellular protozoa.

Front 92

Patient presents with facial edema, and bleeding gums, diarrhea and breathing difficulties. Spleen smear shows amastigotes inside macrophages

Back 92

Leishmaniasis

Front 93

Filariasis is caused by infections with _. Lymphatic filariasis presents as _

Back 93

nematodes (roundworms), Elephantitis - usually in lower extremities

Front 94

Causative agent of river blindness?

Back 94

Onchocerca volvulus - nematode (this is a filariasis found typically in africa)

Front 95

S2 normally splits during _

Back 95

inspiration

Front 96

Babesiosis is characterized by the presence of intraerythrocytic parasites identified as

Back 96

Tetrads

Front 97

"Romana’s sign is a characteristic of
"

Back 97

Chaga’s disease - trypanosma cruzii

Front 98

A unique histological feature of CMV infection is the

Back 98

Owl’s eye cell

Front 99

A bacteremia which manifests itself in the formation of buboes is caused by

Back 99

Yersinia pestis

Front 100

A term used to describe an increase in the number of bands (immature neutrophils) is

Back 100

Shift to the left

Front 101

A syndrome resulting from the infection of endothelial surfaces of the heart is called

Back 101

"
Endocarditis"

Front 102

The etiologic agent for group B streptococcal disease is

Back 102

"
Streptococcus agalactiae"

Front 103

Blood cultures are collected into which 2 different types of media

Back 103

"
Anaerobic and Aerobic"

Front 104

The etiologic agent responsible for Infectious Mononucleosis is

Back 104

Epstein Barr virus

Front 105

In a CBC, the RDW measures

Back 105

The size distribution of the red blood cells

--> Larger than normal variation in RBC size is called anisocytosis which is a typical characteristic of anemias

Front 106

Infectious mononucleosis manifests itself in an activation of

Back 106

Lymphocytes

Front 107

"
Endotoxins specifically involve the"

Back 107

Lipid A portion of the lipopolysaccharide outer cell membrane

Front 108

Lymphatic filariasis presents with

Back 108

lymphedema, elephantitis. Eosinophilia

Front 109

Chronic disseminated candidiasis occurs almost exclusively following _

Back 109

Prolonged episodes of bone marrow dysfunction and neutropenia


--treatment for leukemia