Fa - Microbiology

Front 1

What is the screening test for HIV?

Back 1

ELISA which detects antibodies to HIV proteins.

Front 2

A positive HIV ELISA test is confirmed by what test?

Back 2

Western Blot which detects antibodies to HIV proteins.

Front 3

What are the limitations to the HIV ELISA and Western Blot tests?

Back 3

False negatives in the first 1-2 months following infection, and false positives in neonates born to HIV positive mothers)

Front 4

What test is currently used to monitor HIV therapy effects on viral load? It can also be used to detect infection within the first 2 months of infection.

Back 4

PCR/Viral load test

Front 5

A CD4+ count less than what is diagnostic for AIDS?

Back 5

<200

Front 6

What are the 4 stages of HIV infection?

Back 6

Flulike (acute), Feeling fine (latent), Falling CD4+ count, Final crisis (= the four F's)

Front 7

Where does HIV replicate during the latent phase infection?

Back 7

Lymph nodes

Front 8

What opportunistic infections affect the brain in AIDS?

Back 8

Cryptococcal (meningitis), toxoplasmosis, CMV (encephalopathy), PML (JC virus)

Front 9

What opportunistic infections affect the eyes in AIDS?

Back 9

CMV (retinitis)

Front 10

What opportunistic infections affect the mouth and throat in AIDS?

Back 10

Thrush (Candida albicans), HSV, CMV, EBV (hairly leukoplakia)

Front 11

What opportunistic infections affect the lungs in AIDS?

Back 11

P. jiroveci (carnii)pneumonia, TB, histoplasmosis

Front 12

What opportunistic infections affect the GI in AIDS?

Back 12

Cryptosporidium, Mycobacterium avium, CMV, EBV (non-Hodgkin's lymphoma)

Front 13

What opportunistic infections affect the skin in AIDS?

Back 13

Shingles (VZV), Kaposi's sarcoma (HHV-8)

Front 14

What opportunistic infections affect the genitals in AIDS?

Back 14

Herpes, warts, cervical cancer (HPV)

Front 15

What types of infections are AIDS patients at risk for with CD4+ counts less <400

Back 15

Thrush, tinea pedis, shingles, TB, and other bacterial infections

Front 16

What types of infections are AIDS patients at risk for with CD4+ counts less <200

Back 16

HSV, cryptosporidium, coccidiodomycosis, Pneumocystis pneumonia

Front 17

What types of infections are AIDS patients at risk for with CD4+ counts less <100

Back 17

Candidal esophagitis, toxoplasmosis, histoplasmosis

Front 18

What types of infections are AIDS patients at risk for with CD4+ counts less <50

Back 18

CMV retinitis, M. avium, cryptococcal meningitis

Front 19

How does HIV gain access to the brain causing HIV encephalitits? What are the histological characteristics of HIV encephalitis?

Back 19

Virus gains access via infected macrophges. Appears as microglial nodules with multinucleated giant cells

Front 20

What is a prion?

Back 20

A infectious particle containing only protein (NO genetic material) encoded my cellular genes

Front 21

What is the difference in protein structure between normal prions and pathological prions?

Back 21

Normal are alpha helices, pathological are beta-pleated sheets

Front 22

What are some of the diseases caused by prions?

Back 22

Creutzfeldt-Jakob disease, kuru, scrapie (sheep), and mad cow disease

Front 23

Spongiform encephalopathy is associated with what type of infection?

Back 23

Prion

Front 24

Normal flora of the skin?

Back 24

Staph. epidermidis

Front 25

Normal flora of the nose?

Back 25

Staph. epidermidis and colonized by S. aureus

Front 26

Normal flora of the oropharynx?

Back 26

Strep. viridans

Front 27

Normal flora of dental plaque?

Back 27

Strep. mutans

Front 28

Normal flora of the colon?

Back 28

Bacteroides fragilis > E. coli

Front 29

Normal flora of the vagina?

Back 29

Lactobacillus, and colonized by E. coli, and group B Strep

Front 30

Common causes of pneumonia in neonates (<4wks)

Back 30

Group B strep and E. coli

Front 31

Common causes of pneumonia in children (4wk-18yr)

Back 31

RSV, Mycoplasma, Chlamydia pneumonia, Strep. Pneumoniae (Runts My Cough Sputum)

Front 32

Common causes of pneumonia in adults (18yr-40yr)

Back 32

Mycoplasma, Chlamydia pneumonia, Strep. Pneumoniae

Front 33

Common causes of pneumonia in adults (40yr-65yr)

Back 33

Strep. Pneumoniae, H. influenzae, anaerobes, viruses, Mycoplasma

Front 34

Common causes of pneumonia in the elderly (65+)

Back 34

Strep. Pneumoniae, viruses, anaerobes, H. influenzae, gram- rods

Front 35

Nosocomial pneumonia is caused by what organisms?

Back 35

Staph, and enteric gram- rods

Front 36

Pneumonia in immunocompromised patients is caused by what organisms?

Back 36

Staph, enteric gram- rods, fungi, viruses, P. jiroveci (in HIV)

Front 37

What organism is typically associated with pneumonia in a patient with cystic fibrosis?

Back 37

Pseudomonas

Front 38

What are the organisms that cause atypical pneumonia?

Back 38

Mycoplasma, Legionella, Chlamydia

Front 39

What are the three most common bacterial causes of newborn meningtitis?

Back 39

Group B strep, E. coli, and Listeria

Front 40

What are some of the common bacterial causes of meningitis in children?

Back 40

Strep.pneumoniae, N. meningitidis, H. influenzae

Front 41

What are some of the common bacterial causes of meningitis in adults?

Back 41

N. meningitidis, enteroviruses, S. pneumoniae

Front 42

What are some of the common bacterial causes of meningitis in the elderly?

Back 42

S. pneumoniae and gram- rods

Front 43

What group of enteroviruses is a common cause of meningitis?

Back 43

coxsackievirus

Front 44

Compared to normal what would be the CSF findings in a patient with bacterial meningitis in regards to Pressure, Cell type present, Protein, and Sugar?

Back 44

Pressure - increased
Cell type - PMNs
Protein - increased
Sugar - decreased

Front 45

Compared to normal what would be the CSF findings in a patient with fungal/TB meningitis in regards to Pressure, Cell type present, Protein, and Sugar?

Back 45

Pressure - increased
Cell type - lymphociytes
Protein - increased
Sugar - decreased

Front 46

Compared to normal what would be the CSF findings in a patient with viral meningitis in regards to Pressure, Cell type present, Protein, and Sugar?

Back 46

Pressure - normal/increased
Cell type - lymphocytes
Protein - normal/increased
Sugar - normal

Front 47

Osteomyelitis is most commonly caused by which organism?

Back 47

S. aureus

Front 48

Osteomyelitis in a patient with sickel cell disease is usually caused by which organism?

Back 48

Salmonella

Front 49

Osteomyelitis in the vertabrae (i.e. Pott's disease) is most commonly caused by which organism?

Back 49

M. tuberculosis

Front 50

In osteomyelitis, which two inflammatory tests are classicly seen to be elevated, although they are not specific?

Back 50

CRP and ESR

Front 51

What are the symptoms of a UTI?

Back 51

Dysuria, polyuria, increased urgency, suprapubic pain

Front 52

What are the symptoms of pyelonephritis?

Back 52

fever, chills, flank pain, and CVA tenderness

Front 53

The most common cause of UTIs are by ascending infections. What organism most frequently the cause?

Back 53

E. coli

Front 54

What are some predisposing factors to developing a UTI?

Back 54

obstruction, kidney surgery, catheters, gynecologic abnormalities, diabetes, and pregnancy

Front 55

Fact Card on UTI diagnosis

Back 55

A positive leukocyte esterase test = bacterial UTI

Front 56

Fact Card on UTI diagnosis

Back 56

A positive nitrite test = gram negative bacterial UTI

Front 57

What organisms are part of ToRCHeS infections?

Back 57

Toxoplasma gondii, Rubella, CMV, HIV, HSV-2, Syphilis

Front 58

What is the classic triad in neonatal Toxoplasma gonii infection?

Back 58

Chorioretinitis, intracranial calcifications, and hydrocephalus. May be asymptomatic at birth.

Front 59

A neonate presents with deafness, cataracts, and patent ductus arteriosis, microcephaly, mental retardation, and blueberry muffin rash. What are they infected with?

Back 59

Rubella

Front 60

What are the symptoms of CMV infection in neonates?

Back 60

petechial rash, intracranial calcifications, mental retardation, hepatosplenomegaly, microcephaly, and jaundice. 90% are asymptomatic at birth.

Front 61

How is HSV-2 transmitted to the fetus?

Back 61

During birth

Front 62

What are some of the symptoms associated with HSV-2 infections in a newborn?

Back 62

Encephalitis, conjuctivitis, and vesicular skin lesions

Front 63

Syphilis in a newborn presents as what?

Back 63

skin lesions, jaundice, saddle nose, saber shins, CN VIII deafness, rhinits

Front 64

Clinical features of gonorrhea are?

Back 64

urethritis, cervicitis, PID, prostatitis, epididymitis, arthritis, and a purulent discharge

Front 65

What stage of syphilis do you see painless chancre?

Back 65

Primary

Front 66

Seconday syphilis has what clinical features?

Back 66

Fever, skin rashes, lymphadenopathy, condylomata lata

Front 67

Gummas, tabes dorsalis, and aortits of characteristic of which stage of syphilis?

Back 67

Tertiary

Front 68

What agent is responsible for genital herpes?

Back 68

HSV-2

Front 69

What are the symptoms of active genital herpes ?

Back 69

painful ulcers…Systemic symptoms MAY include fever, headache, myalgia

Front 70

Reiter's syndrome, urethritis, cervicitis, conjuctivitis are all symptoms of what STD?

Back 70

Chlamydia

Front 71

Lymphogranuloma venereum is caused by what organism?

Back 71

Chlamydia

Front 72

A strawbery-colored cervix with corskscrew motility on wet prep indicates infection with what?

Back 72

Trichomonas vaginalis

Front 73

What diagnostic type of cells would you see in the epithelium of someone infected with HPV6 or HPV11?

Back 73

koilocytes

Front 74

Chancroid is characterized by painful genital ulcers and inguinal adenopathy. What is the offending organism?

Back 74

Haemophilus ducreyi

Front 75

Bacterial vaginosis is caused by what organism? What are clinical features?

Back 75

Gardnerella vaginalis -- malodorous discharge (fishy), positive whiff test

Front 76

Fact Card on Salpingitis and what it is a Risk Factor For

Back 76

Ectopic pregnancy, infertility, chronic pelvic pain, and adhesions

Front 77

What is the most common STD in the U.S.?

Back 77

C. trachomatis

Front 78

Nosocomial UTIs are caused by what organism most often?

Back 78

E. coli

Front 79

Nosocomial wound infections are caused by what organism most often?

Back 79

S. aureus

Front 80

Which bug causes a nosocomial infection by living in respiratory therapy equipment?

Back 80

Pseudomonas

Front 81

Bug Hints for the Boards (if all else fails) -- Pus, empyema, abscess

Back 81

S. aureus

Front 82

Bug Hints for the Boards (if all else fails) -- Pediatric infection

Back 82

H. influenzae

Front 83

Bug Hints for the Boards (if all else fails) -- Branching rods in oral infection

Back 83

Actinomyces israelii

Front 84

Bug Hints for the Boards (if all else fails) -- Traumatic open wound

Back 84

Clostridium perfringes

Front 85

Bug Hints for the Boards (if all else fails) -- Surgical wound

Back 85

S. aureus

Front 86

Bug Hints for the Boards (if all else fails) -- Dog or cat bite

Back 86

Pasturella multocida

Front 87

Bug Hints for the Boards (if all else fails) -- Currant jelly sputum

Back 87

Klebsiella

Front 88

Bug Hints for the Boards (if all else fails) --Sepsis/meningitis in newborn

Back 88

group B strep

Front 89

What nematodes infect orally (ingested)?

Back 89

Enterobius, Ascaris, Trichinella (mnemonic: EAT)

Front 90

What nematodes infect through the skin (cutaneous)?

Back 90

Stongyloides, Ancylostoma, Necator

Front 91

What parasite causes brain cysts and seizures?

Back 91

Taenia solium (cysticercosis)

Front 92

What parasite causes liver cysts?

Back 92

Echinococcus granulosus

Front 93

What helminth causes vitamin B12 deficiency?

Back 93

Diphyllobothrium latum

Front 94

What trematode causes biliary tract disease?

Back 94

Clonorchis sinensis

Front 95

What clinical findings are associated with Schistosoma haematobium?

Back 95

Hematuria and Bladder cancer

Front 96

What nematodes causes microcytic anemia?

Back 96

Ancylostoma and Necator

Front 97

What nematode causes perianal pruritus?

Back 97

Enterobius (pinworm)

Front 98

What organism causes Typhoid fever?

Back 98

Salmonella typhi

Front 99

What organism causes Typhus?

Back 99

Rickettsia rickettsii (endemic) and Rickettsia prowazekii

Front 100

What is the most common STD?

Back 100

Chlamydia trachomatis

Front 101

What flagellated protozoan causes greenish vaginal discharge?

Back 101

Trichomonas vaginalis

Front 102

What organism causes Chagas' disease?

Back 102

Trypanosoma cruzi

Front 103

What nematode can be found in undercooked meat?

Back 103

Trichinella spiralis

Front 104

What is the only DNA virus that is single stranded?

Back 104

Parvovirus

Front 105

What are the 3 DNA viruses with circular DNA?

Back 105

Papilloma, Polyoma, Hepadnavirus

Front 106

What is the only virus with double stranded DNA?

Back 106

Reovirus

Front 107

What are the naked (non-enveloped) viruses?

Back 107

RNA: Calcivirus, Picornavirus, Reovirus DNA: Parvovirus, Adenovirus, Papilloma, Polyoma

Front 108

What is the only virus that does not acquire its envelope from the host plasma membrane? Where does it acquire its membrane?

Back 108

Herpesviruses acquired envelopes from nuclear membrane of host cell.

Front 109

What is the only class of virus that is diploid?

Back 109

Retroviruses (contain 2 identical ssRNA molecules)

Front 110

Where do DNA viruses replicate?

Back 110

Nucleus

Front 111

Where do all but 2 RNA viruses replicate?

Back 111

Cytoplasm

Front 112

What 2 RNA viruses replicate in the nucleus?

Back 112

Influenza and Retroviruses

Front 113

What is the name of the structure that contains the nucleic acid in an enveloped virus?

Back 113

Capsid

Front 114

What is the only DNA virus that is NOT icosahedral?

Back 114

Poxvirus

Front 115

What is the only DNA virus that does not replicate in the nucleus?

Back 115

Poxvirus

Front 116

What causes zoster (shingles)?

Back 116

Varicella Zoster Virus (VZV)

Front 117

What causes heterophile antibody positive mononucleosis?

Back 117

Epstein Barr Virus (EBV)

Front 118

What infection is most common in transplant recipients?

Back 118

CMV

Front 119

What virus is associated with Kaposi's sarcoma?

Back 119

HHV-8

Front 120

What STD remains latent in sensory ganglia and causes genital vesicles?

Back 120

HSV-2

Front 121

What virus can be visualized using a Tzanck preparation?

Back 121

HSV-2

Front 122

What causes pink eye (conjunctivitis)?

Back 122

Adenovirus

Front 123

What virus is a common causes of febrile pharyngitis?

Back 123

Adenovirus

Front 124

What virus causes aplastic crises in sickle cell disease?

Back 124

Parvovirus B19

Front 125

What virus causes erythema infectiosum (fifth disease)? What is the physical finding associated with this disease?

Back 125

Parvovirus B19; Slapped cheek appearance

Front 126

What virus is associated with condylomata acuminata (venereal warts)?

Back 126

HPV types 6 and 11

Front 127

What virus is associated with cervical cancer?

Back 127

HPV types 16 and 18

Front 128

What disease does JC virus cause?

Back 128

Progressive Multifocal Leukoencephalopathy (PML) in HIV patients

Front 129

What virus causes molluscum contagiosum?

Back 129

Poxvirus

Front 130

What killed vaccine is used to prevent polio?

Back 130

Salk

Front 131

Is the measles/mumps/rubella vaccine live attenuated or killed?

Back 131

MMR vaccine is live attenuated

Front 132

What vaccines are killed?

Back 132

Rabies, Influenza, Salk Polio, HAV (mnemonic: RIP Always)

Front 133

What vaccine is recombinant?

Back 133

HBV (HBsAg)

Front 134

What causes worldwide influenza pandemics?

Back 134

Reassortment (exchange of segments between genomes)

Front 135

What is recombination?

Back 135

Exchange of genes between 2 chromosomes by crossing over

Front 136

How is Varicella Zoster Virus (VZV) transmitted?

Back 136

Respiratory secretions

Front 137

What causes negative heterophile antibody mononucleosis?

Back 137

CMV

Front 138

What virus is often cultured from urine and whose cells have owl's eye appearance?

Back 138

CMV

Front 139

What test is used to assay HSV-1, HSV-2 and VZV?

Back 139

Tzanck test (intranuclear eosinophilic inclusions can be seen)

Front 140

What cells does EBV infect?

Back 140

B cells

Front 141

What are the signs and symptoms of mononucleosis caused by EBV?

Back 141

Fever, hepatosplenomegaly, pharyngitis, lymphadenopathy

Front 142

What virus is associated with Burkitt's Lymphoma (t8;14)?

Back 142

EBV

Front 143

What three virus families do not have envelopes?

Back 143

Picornavirus, Calcivirus, and Reovirus

Front 144

What virus family has double stranded RNA?

Back 144

Reovirus

Front 145

What virus family does SARS belong to?

Back 145

Coronavirus

Front 146

What viruses are in the picornavirus class?

Back 146

Poliovirus, Echovirus, Rhinovirus, Coxsackievirus, HAV (PERCH)

Front 147

Mechanism of picornavirus replication?

Back 147

RNA translated into large polypeptide that is cleaved by proteases

Front 148

Cause of the common cold?

Back 148

Rhinovirus, sometimes Coronavirus

Front 149

Symptoms of yellow fever virus?

Back 149

High fever, black vomitus, jaundice

Front 150

What virus family is Rubella virus in?

Back 150

Togavirus

Front 151

Cause of German (3-day) measles?

Back 151

Rubella virus

Front 152

Major cause of acute diarrhea and gastroenteritis in infants?

Back 152

Rotavirus

Front 153

Genome of rotavirus?

Back 153

dsRNA

Front 154

What virus family are the influenza viruses in?

Back 154

Orthomyxoviruses

Front 155

Genome of influenza viruses?

Back 155

ssRNA

Front 156

Influenza vaccine type?

Back 156

Killed viral vaccine

Front 157

Major antigens on influenza viruses (2)?

Back 157

Hemagglutinin and neuraminidase

Front 158

What is reassortment of viral genomes called (e.g. human flu A + swine flu A)?

Back 158

Genetic shift

Front 159

What are minor changes in flu genomes called (based on random mutations)?

Back 159

Genetic drift

Front 160

Treatment/prophylaxis of influenza A?

Back 160

Amantadine & rimantadine

Front 161

Treatment of both influenza A & B?

Back 161

Oseltamivir & zanamivir

Front 162

Viruses in the paramyxovirus class?

Back 162

Parainfluenza (croup), mumps, measles, RSV

Front 163

What are Koplik spots?

Back 163

Diagnostic finding in measles (red spots with blue-white center on buccal mucosa)

Front 164

What are the 3 C's of measles (clinical findings)?

Back 164

Cough, Coryza, and Conjunctivitis

Front 165

Symptoms of mumps virus?

Back 165

Parotitis, Orchitis, and Meningitis (Parotid/testes as big as POMs)

Front 166

What virus family does rabies virus belong to?

Back 166

Rhabdovirus

Front 167

Characteristic cytoplasmic inclusions found in rabies?

Back 167

Negri bodies

Front 168

What is the time course for rabies infection?

Back 168

Long incubation period of weeks-months

Front 169

What class of virus is typically transmitted by arthropods?

Back 169

Arboviruses

Front 170

What is the primary transmission route of HAV?

Back 170

Fecal-oral

Front 171

What virus class is HAV?

Back 171

RNA picornavirus

Front 172

What virus class is HBV?

Back 172

DNA hepadnavirus

Front 173

How is HBV typically spread?

Back 173

Parenteral, sexual, or maternal-fetal

Front 174

Mechanism of HBV replication?

Back 174

DNA-->RNA via RNA polymerase; RNA-->DNA via reverse transcriptase

Front 175

What virus class is HCV?

Back 175

RNA flavivirus

Front 176

Which hepatitis virus most likely causes chronic hepatitis and hepatic cancer?

Back 176

HCV

Front 177

What virus must be present for hepatitis D virus to infect?

Back 177

HBV

Front 178

Which hepatitis virus causes high mortality in pregnant women?

Back 178

HEV

Front 179

What serologic test indicates prior infection with hepatitis A?

Back 179

IgG HAVAb

Front 180

What serologic test indicates current infection/carrier state with hepatitis B?

Back 180

HBsAg

Front 181

What antibody provides immunity from hepatitis B?

Back 181

HBsAb (antibody to surface antigen)

Front 182

What does the antibody against hepatitis B core antigen show?

Back 182

Window period: IgM HBcAb shows recent disease and IgG HBcAb shows chronic disease

Front 183

What enzyme creates dsDNA from RNA in HIV?

Back 183

Reverse transcriptase

Front 184

What two envelope proteins does HIV use to gain entry into human cells?

Back 184

gp41 and gp120

Front 185

What proteins does HIV bind to on human cells?

Back 185

CXCR4 and CCR5

Front 186

Name the fluoroquinolones

Back 186

Ciprofloxacin, norfloxacin, ofloxacin, sparfloxacin, moxifloxacin, gatifloxacin, enoxacin. Nalidixic Acid is a quinolone

Front 187

Mechanism of fluoroquinolones

Back 187

Inhibit DNA Gyrase (topoisomerase II). Bactericidal. DON'T TAKE WITH ANTACIDS

Front 188

Clinical Use of fluoroquinolones

Back 188

gram neg. rods of urinary and GI tracts - Pseudomonas, Neisseria; some gm. Positives

Front 189

Toxicity of fluoroquinolones

Back 189

GI upset, superinfection, skin rash, headache, dizziness. Contraind. In pregnancy and children (damage to cartilage). Causes tendonitis in adults, leg cramps in children

Front 190

Mechanism of Metronidazole

Back 190

Forms toxic metabolites in the bacterial cell that damage DNA. Bactericidal.

Front 191

Clinical Use of metronidazole

Back 191

Antiprotozoal. GET GAP - Giardia, Entamoeba, Trichomonas, Gardnerella, Anaerobes (Bacteriodes, Clostridium). Use with bismuth and amoxicillin for triple therapy vs. H Pylori

Front 192

Toxicity of metronidazole

Back 192

Disulfiram-like reaction with alcohol, headache, metallic taste

Front 193

Mechanism of polymixins (E+B)

Back 193

Binds to cell membranes of bacteria and disrupts their osmotic properties. Cationic, basic proteins = act like detergent

Front 194

Clinical use of polymixins

Back 194

reistant gm. Neg. infections

Front 195

Toxicity of polymixins

Back 195

Neurotoxicity, acute renal tubular necrosis

Front 196

Mycobacterium Prophylaxis and Treatment

Back 196

Proph - Isoniazid; Treat - Isoniazid, rifampin, ethambutol, pyrazinamide

Front 197

M. avium-intracellulare Prophylaxis and Treatment

Back 197

Proph - Azithromycin; Treat - Azithromycin, rifampin, ethambutol, streptomycin

Front 198

M. leprae Prophylaxis and Treatment

Back 198

Proph - N/A; Treat - Dapsone, rifampin, clofazimine

Front 199

Anti TB Drugs

Back 199

INH-SPIRE - Streptomycin, Pyrazinamide, Isoniazid, rifampin, ethambutol. Cycloserine 2nd line. Impt SE of ethambutol = optic neuropathy, SE of others = hepatotoxicity

Front 200

Mechanism of Isoniazid

Back 200

Decrease synth of mycolic acids

Front 201

Clinical use of isoniazid

Back 201

Mycobact. Tuberculosis. Only agent used solo as prophylaxis

Front 202

Toxicity of isoniazid

Back 202

Hemolysis if G6PD defic, neurotoxicity, hepatotoxicity, SLE-like symps. PYRIDOXINE (vit B6) can prevent neurotoxicity

Front 203

Mechanism of rifampin

Back 203

Inhibit DNA-dep. RNA polymerase

Front 204

Clinical Use of rifampin

Back 204

Myco. TB, delay resistance to dapsone when used for leprosy. Used for meningococcal prophylaxis and chemoprophylaxis in contact of children with H. Influenze B

Front 205

Toxicity of rifampin

Back 205

Minor hepatotoxicity and drug interactions (inc. P450s); orange body fluids

Front 206

Resistance to penicillins/cephalosporins

Back 206

beta-lactamase cleavage of beta-ring, or altered PBP (MRSA)

Front 207

Resistance to Aminoglycosides

Back 207

modification via acetylation, adenylation, or phosphorylation

Front 208

resistance to vancomycin

Back 208

terminal D-Ala of cell wall replaced with D-lac = decr. Affin

Front 209

resistance to chloramphenicol

Back 209

modification via acetylation

Front 210

resistance to macrolides

Back 210

methylation of rRNA near erythromycin's ribosome-binding site

Front 211

resistance to tetracycline

Back 211

decr. Uptake or incr. transport out of cell

Front 212

resistance to sulfonamides

Back 212

altered enzyme, decr. Uptake or incr. PABA synth

Front 213

resistance to quinolones

Back 213

altered gyrase of reduced uptake

Front 214

Meningococcal prophylaxis

Back 214

rifampin, minocycline

Front 215

gonorrhea prophylaxis

Back 215

ceftriaxone

Front 216

syphilis prophylaxis

Back 216

benzathine penicillin G

Front 217

History of recurrent UTI prophylaxis

Back 217

TMP-SMX

Front 218

Pneumo. Jiroveci prophylaxis

Back 218

TMP-SMX (drug of choice), aerosolized pentamidine

Front 219

Endocarditis with surg/dental procedure prophylaxis

Back 219

penicillins

Front 220

treatment of resistant MRSA/VRE

Back 220

MRSA - vancomycin; VRE - linezolid and streptogramins

Front 221

mechanism of amphotericin B

Back 221

binds ergosterol, forms membrane pores that allow leakage of electrolytes

Front 222

clinical use of amphotericin B

Back 222

wide spectrum of systemic mycoses (Cryptococcus, Blastomyces, Cocciodes, Aspergillus, Histoplasma, Candida, Mucor. Intrathecal for fungal meningitis. Does not cross BBB

Front 223

toxicity of amphotericin B

Back 223

fever/chills, hypotension, nephrotoxic (decr. With hydration), arrhythmias, anemia, IV phlebitis. Use LIPOSOMAL amphoB to decr. toxicity

Front 224

mechanism of nystatin

Back 224

binds ergosterol, disrupt fungal membranes. Too toxic for systemic use

Front 225

clinical use of nystatin

Back 225

swish and swallow for oral candidiasis, topical for diaper rash/vaginal candidiasis

Front 226

Azoles

Back 226

fluconazole, ketoconazole, clotrimazole, miconazole, itraconazole, voriconazole

Front 227

mechanism of azoles

Back 227

inhibit fungal steroid synthesis (ergosterol)

Front 228

clinical use of azoles

Back 228

systemic mycoses. Fluconazole - cryptococcal meningitis in AIDS and all candidal infections. Ketoconazole - blastomyces, cocciodes, histoplasma, candida albicans, hypercortisolism. Clotrimazole and miconazole - topical fungal infections

Front 229

toxicity of azoles

Back 229

hormone synthesis inhibition (gynecomastia), liver dysfunction (inhib CYP450), fever and chills

Front 230

mechanism of flucytosine

Back 230

inhibit DNA synth by conversion to fluorouracil - compete with uracil

Front 231

clinical use of flucytosine

Back 231

systemic fungal infections (candida, cryptococcus) and in combo with ampB

Front 232

toxicity of flucytosine

Back 232

naus/vomit, diarrhea, BM suppression

Front 233

mechanism of caspofungin

Back 233

inhibit cell wall synthesis

Front 234

clinical use of caspofungin

Back 234

invasive aspergillus

Front 235

toxicity of caspofungin

Back 235

GI upset, flushing

Front 236

mechanism of terbinafine

Back 236

inhibit fungal enzyme squalene epoxidase

Front 237

clinical use of terbinafine

Back 237

dermatophytoses (onchomycoses specifically)

Front 238

mechanism of griseofulvin

Back 238

interfere with microtubule function, disrupt mitosis. Deposits in keratin-containing tissues (nails)

Front 239

clinical use of griseofulvin

Back 239

oral treatment of superficial infections, inhib growth of dermatophytes (tinea, ringworm)

Front 240

toxicity of griseofulvin

Back 240

teratogenic, carcinogenic, confusion, headaches, inc. P450 and warfarin metabolism

Front 241

mechanism of amantadine

Back 241

block viral penetration/uncoating (M2 prot), may buffer pH of endosome. Also causes release of dopamine from intact nerve signals

Front 242

clinical use of amantadine

Back 242

prophylaxis and treatment for Influenza A, Parkinsons Dz

Front 243

toxicity of amantadine

Back 243

ataxia, dizziness, slurred speech - fewer SEs with Rimantidine

Front 244

resistance to amantadine

Back 244

mutated M2 protein. 90% of influenza strains resistant = NOT USED ANYMORE

Front 245

mechanism of zanamivir/oseltamivir

Back 245

inhibit influenza neuraminidase = decr. Release of progeny virus

Front 246

clinical use of zanamivir/oseltamivir

Back 246

Influenza A & B

Front 247

mechanism of ribavirin

Back 247

inhib synth of guanine nucleotides by competitively inhibiting IMP dehydrog.

Front 248

clinical use of ribavirin

Back 248

RSB, chronic HCV

Front 249

toxicity of ribavirin

Back 249

hemolytic anemia. SEVERE TERATOGEN

Front 250

mechanism of acyclovir

Back 250

monophosphorylation by HSV/VZV thymidine kinase. Triphosphate formed by cellular enzymes. Preferentially inhib viral DNA polymerase by chain termination

Front 251

clinical use of acyclovir

Back 251

HSV, VZV, EBV. HSV-induced mucocutaneous and genital lesions as well as encephalitis. Prophylaxis in immunocomp pts. VZV = use FAMCICLOVIR. No effect on latent HSV/VZV

Front 252

toxicity of acyclovir

Back 252

well tolerated

Front 253

resistance to acyclovir

Back 253

lack thymidine kinase

Front 254

mechanism of ganciclovir

Back 254

5'-monophosphate formed by a CMV viral kinase or HSV/VZV thymidine kinase. Triphosphate formed by cellular kinases. Preferentially inhib viral DNA polymerase

Front 255

clinical use of ganciclovir

Back 255

CMV, especially in immunocomp pts

Front 256

toxicity of ganciclovir

Back 256

leukopenia, thrombocytopenia, renal toxicity. More toxic to host enzymes than acyclovir.

Front 257

resistance to ganciclovir

Back 257

mutated CMV DNA polymerase or lack of viral kinase

Front 258

mechanism of foscarnet

Back 258

viral DNA polymerase inhibitor that binds to the pyrophosphate binding site of the enzyme. Does not require activation by viral kinase

Front 259

clinical use of foscarnet

Back 259

CMV retinitis in immunocomp pts when ganciclovir fails, acyclovir-resistant HSV.

Front 260

toxicity of foscarnet

Back 260

nephrotoxicity

Front 261

resistance to foscarnet

Back 261

mutated DNA polymerase

Front 262

Which bacteria are gram positive cocci?

Back 262

Staphyylococcus, Streptococcus, Enterococcus

Front 263

How do you distinguish S. aureus from S. epidermis and S. saprophyticus?

Back 263

Staph aureus is catalase positive, coagulase positive. The other 2 are catalase positive and coagulase negative.

Front 264

Describe Streptococcus vs. Staphyloccocus characteristics microscopically.

Back 264

Strep is gram positive (purple/blue) chains. Staph is gram positive clusters (like grapes)

Front 265

Which Bacteria are gram positive rods (bacilli)?

Back 265

Clostridium (anaerobe), Corynebacterium, Listeria, and Bacillus

Front 266

Which bacteria are alpha hemolytic?

Back 266

S. pneumoniae and Viridans streptococci--plate is green (partial hemolysis)

Front 267

Which bacteria are beta hemolytic?

Back 267

Group A strep: S. pyogenes--plate is clear (complete hemolysis)

Front 268

Which gram positive cocci can cause no hemolysis, alpha or beta hemolysis?

Back 268

Enterococci (E. faecalis)

Front 269

What bacteria are quellung positive, optochin sensitive and bile soluble?

Back 269

S. pneumoniae Note: OVRPS (overpass) = Optochin Viridans is resitant, pneumoniae is sensitive.

Front 270

What is a defining microscopic characteristic of Strep pneumoniae?

Back 270

Lancet diplococci

Front 271

What bacteria are optochin resistant and not bile soluble?

Back 271

Viridans streptococci

Front 272

How do you distinguish Group A Strep from Group B strep?

Back 272

Grp A is bacitracin sensitive, GpB is bacitracin resistant Note: B-BRAS = Bacitracin- grp B strep resistant; gp A strep sensitive

Front 273

Which Streptococcus has a capsule?

Back 273

Strep pneumoniae (quellung positive)

Front 274

What bacteria are Novobiocin Resistant? Novobiocin senstive?

Back 274

Staph saprophyticus is Resistant; Staph epidermis is Sensitive; NOTE: NO StRES

Front 275

What does an alpha hemolytic plate look like? Beta-hemolytic?

Back 275

Alpha forms a green ring around colonies on blood agar; Beta form a clear area of hemolysis on blood agar.

Front 276

What are the qualities of Listeria monocytogenes microscopically?

Back 276

Listeria monocytogenes are gram positive rods with tumbling motility.

Front 277

What characteristic of Staph aureus allows it to evade the immune system?

Back 277

Protein A (virulence factor) binds Fc-IgG, inhibiting fixation and phagocytosis

Front 278

Which organisms cause Toxic shock syndrome?

Back 278

Caused by either Staph aureus TSST-1 toxin or Strep pyogenes.

Front 279

What toxins does Staph aureus produce and what diseases do they cause?

Back 279

TSST-1 superantigen: Toxic shock syndrome; Exfoliative toxin: scalded skin syndrome; Enterotoxins (preformed): rapid-onset food poisoning.

Front 280

Which inflammatory disease can Staph aureus produce?

Back 280

Skin infections, organ abscesses and pneumonia. Also causes acute bacterial endocarditis and osteomyelitis.

Front 281

How does TSST-1 produce it effects?

Back 281

It is a superantigen that binds to MHC II and T-cell receptor, resulting in polyclonal T-cell activation

Front 282

What is the mechanism of resistance of a MRSA infection?

Back 282

Methicillin Resistant S. aureus is resistant to B-lactams due to altered penicillin-binding proteins. *Important cause of serious nosocomial and community-acquired infections

Front 283

How does rheumatic fever present and who is the culprit?

Back 283

No rheum for SPECCulations: Subcutaneous nodules, Polyarthritis, Erythema margination, Chorea, Carditis. **Strep pyogenes.

Front 284

What test can be used to detect recent S. pyogenes infection?

Back 284

ASO titer

Front 285

Antibodies to what part of S. pyogenes can enhance host defenses but also give rise to a serious infection?

Back 285

M protein. Antibodies can give rise to rheumatic fever.

Front 286

What complications can occur due to a Strep pyogenes pharyngitis?

Back 286

Rheumatic fever and glomerulnephritis. Note: Pharyngitis gives you rheumatic PHever and glomerulonePHritis.

Front 287

What pyogenic, toxigenic and immunologic diseases can Strep pyogenes cause?

Back 287

Pyogenic: Pharyngitis, cellulitis, impetio; Toxigenic: scarlet fever, toxic shock syndrome; Immunologic: rheumatic fever and acute glomerulonephritis.

Front 288

What are the 4 main diseases does Strep pneumoiae causes?

Back 288

MOPS: Meningitis, Otitis media, Pneumonia, Sinusitis. It is also associated with rusty sputum, sepsis in sickle cell anemia and splenectomy

Front 289

What characteristics of Strep pneumoniae help it evade the immune system?

Back 289

Encapsulated and IgA protease

Front 290

What are 3 main diseases Gp B streptococci is associated with?

Back 290

Pneumonia, meningitis, and sepsis; mainly in babies

Front 291

What diseases does Enterococci cause?

Back 291

UTIs and subacute meningitis. Vancomycin resistant enterococci (VRE) are an important cause of nosocomial infections.

Front 292

What are enterococci resistant to?

Back 292

Penicillin G and some are Vancomycin resistant

Front 293

What is Lancefield grouping based on and what is included in Lancefield group D?

Back 293

It is based on differences in the C carbohydrate on the bacterial wall. Group D includes enterococci and nonenteroccal gp D streptococci.

Front 294

Where can Staphylococcus epidermidis be found?

Back 294

Component of normal skin flora, infects prosthetic devices, catheters, and blood cultures.

Front 295

How is Listeria monocytogenes spread?

Back 295

Ingestion of unpasteurized milk/cheese or by vaginal transmission during birth.

Front 296

How does Listeria monocytogenes move from cell to cell?

Back 296

They form actin rockets

Front 297

What diseases/complications can Listeria monocytogenes cause in pregnant women?

Back 297

amnionitis, speticemia, and spontaneous abortion

Front 298

What disease can Listeria monocytogenes cause in infants?

Back 298

Granulomatosis infantseptica, neonatal meningitis

Front 299

What disease can Listeria monocytogenes cause in the immunocompromised? How about healthy individuals?

Back 299

Immunocompromised: meningitis; Healthy: mild gastroenteritis

Front 300

What is unique about Actinomyces and Nocardia microscopically?

Back 300

They are both gram positive rods that form long branching filaments resembling fungi

Front 301

What does Actinomyces israelii cause?

Back 301

It is a gram positive anaerobe that causes oral/facial abscesses that may drain through sinus tracts in skin. **Normal oral flora

Front 302

Where is Nocardia asteroides found and what disease can it cause?

Back 302

It is found in the soil. It is a weakly acid-fast gram-positive aerobe that causes pulmonary infections in immunocompromised.

Front 303

What can Actinomyces and Nocardia be treated with?

Back 303

SNAP: Sulfa for Nocardia Actinomyces use Penicillin.

Front 304

What pathological findings distinguish Primary Tuberculosis from Secondary TB?

Back 304

Primary TB: Ghon Complex=TB granulomas (Ghon Focus- usually lower lobes) with lobar and perihilar lymph node involvement. Secondary TB has fibrocaseous cavitary lesions.

Front 305

Where is extrapulmonary tuberculosis found?

Back 305

CNS (parenchymal tuberculoma or meningitis), vertebral body, lymphadenitis, renal or GI

Front 306

What is Pott's disease?

Back 306

Extrapulmonary TB in the vertebral bodies

Front 307

What does PPD+ signify?

Back 307

The patient either has a current Tuberculosis infection, past exposure or BCG vaccination

Front 308

What is a distinguishing microscopic characteristic of Mycobacteria?

Back 308

They are all acid-fast organisms

Front 309

What are the symptoms of Tuberculosis?

Back 309

Fever, night sweats, weight loss, and hemoptysis

Front 310

What are the two types of Leprosy and which has a worse Prognosis?

Back 310

Tuberculoid (self-limited) and Lepromatous (due to failed cell-mediated immunity--its worse). Note: LEpromatous = LEthal

Front 311

What are the main treatments for Leprosy?

Back 311

Long term Dapsone (#1), alternates: rifampin, clofazimine/dapsone combo.

Front 312

What are the side effects/toxicity of dapsone?

Back 312

Hemolysis and methemoglobinemia

Front 313

Where does Mycobacterium leprae infect and what is the reservoir in the U.S?

Back 313

Infects the skin and superficial nerves. Armadillos are the reservoir in the U.S.

Front 314

How does Mycobacterium kansaii present?

Back 314

pulmonary TB-like symptoms

Front 315

How does Mycobacterium scrofulaceum present and what age group?

Back 315

Cervical lympadenitis in kids

Front 316

What population does Mycobacterium avium-intracellulare present in and how?

Back 316

Disseminated disease in AIDS, often multi-drug resistant.

Front 317

are fungal spores asexual or sexual?

Back 317

most asexual

Front 318

budding yeast with pseudohyphae at 20 ⁰C and germ tube formation at 37⁰C

Back 318

candida albicans

Front 319

treatment for fungus that causes esophagitis in immunocompromised, endocarditis in IV drug users, vaginitis

Back 319

candida albicans. nystatin if superficial infection; amphotericin B for systemic

Front 320

tiny yeast inside macrophages in bat droppings causes?

Back 320

pnemumonia. Histoplasmosis

Front 321

fungi with broad-based budding that causes lung disease that can disseminate

Back 321

Blastomycosis

Front 322

Fungus endemic to SW US and California. Causes pneumonia and meningitis

Back 322

Coccidiodomycosis

Front 323

fungus with spherule filled with endospores

Back 323

Coccidiodomycosis

Front 324

budding yeast with Captain's wheel formation

Back 324

Paracoccidiodomycosis

Front 325

treatment for systemic fungal infection with granulomas?

Back 325

amphotericin B

Front 326

treatment for histo, blasto, or coccidiodomycosis that has not disemminated

Back 326

fluconazole, ketoconazole

Front 327

Malassezia furfur causes? Treatment?

Back 327

tinea versicolor. Topical miconazole

Front 328

treatment for pruritic annular lesions caused by dermatophytes

Back 328

topical azoles

Front 329

diagnostic test for thrush, vulvovaginitis, disseminated candidiasis

Back 329

germ tube test

Front 330

mold with septate hyphae that branch at 45⁰ angles

Back 330

apergillus fumigatus

Front 331

what does aspergillus cause?

Back 331

bronchopulmonary aspergillosis, fungus ball in lung, invasive aspergillosis in immunocompromised with Chronic granulomatous disease

Front 332

opportunistic fungal infections

Back 332

Candida albicans, Aspergillus, Cryptococcus neoformans, Mucor and Rhizopus

Front 333

encapsulated yeast that causes meningitis

Back 333

cryptococcus neoformans

Front 334

yeast found in soil or pigeon droppings. Identified by India ink stain

Back 334

cryptococcus neoformans

Front 335

mold with nonseptate hypahe braching at wide angles

Back 335

mucor and rhizopus

Front 336

who gets mucormycosis?

Back 336

ketoacidotic diabetic and leukemic patients

Front 337

diabetic patient with black necrotic tissue in nasal cavity and frontal lobe abscesses. What fungus is the cause?

Back 337

mucor and rhizopus

Front 338

yeast that causes diffuse interstitial pneumonia, especially in AIDS patients

Back 338

pneumocystis jiroveci

Front 339

patient has diffuse bilateral infiltrates on CXR and you suspect a fungal cause. Treatment?

Back 339

TMP-SMX, pentamidine, dapsone for P. jiroveci

Front 340

thorn prick causes pustule with ascending lymphangitis. Cause?

Back 340

sporothrix schenckii

Front 341

treatment for sporotrichosis?

Back 341

itraconazole or potassium iodide

Front 342

person went camping and now has diarrhea. Organism and treatment?

Back 342

giardia lamblia. Metronidazole

Front 343

green vaginal discharge with itching and burning. Organism and treatment?

Back 343

trichomonas vaginalis. Metronidazole

Front 344

cause of Chagas' disease

Back 344

trypanosoma cruzi

Front 345

characteristics of Chagas' disease?

Back 345

dilated cardiomyopathy, megacolon, megaesophagus

Front 346

Reduviid bug transmits?

Back 346

Trypansoma cruzi to cause Chagas disease

Front 347

African sleeping sickness carrier

Back 347

tsetse fly

Front 348

organisms that cause African sleeping sickness

Back 348

Trypansoma gambiense and rhodesiense

Front 349

person has spiking fevers, hepatosplenomegaly, and pancytopenia. Disease and organism?

Back 349

Visceral leishmaniasis (kal-azar) caused by Leishmania donovani

Front 350

transmits leishmaniasis

Back 350

sandfly

Front 351

treatment for leishmaniasis

Back 351

sodium stibogluconate

Front 352

cyclic fever with headache, anemia and splenomegaly

Back 352

malaria

Front 353

diagnosis of malaria

Back 353

blood smear

Front 354

treatment of malaria

Back 354

cholorquine (primaquine if have P. Vivax or P ovale), sulfadoxine + pyrimethamine, mefloquine, quinine

Front 355

malaria organisms with dormant forms in liver

Back 355

Plasmodium vivax and P. Ovale

Front 356

organism in northeastern US that causes fever and hemolytic anemia

Back 356

babesia, transmitted by Ixodes tick

Front 357

blood smear shows Maltese crosses. Causative protozoa?

Back 357

babesia, transmitted by Ixodes tick

Front 358

treatment of babesiosis

Back 358

quinine, clindamycin

Front 359

causes severe diarrhea in AIDS patients

Back 359

cryptosporidium

Front 360

causes brain abscesses in AIDS patients. Also causes birth defects

Back 360

toxoplasma gondii

Front 361

treatment for toxoplasma gondii

Back 361

sufadiazine + pyrimethamine

Front 362

why should pregnant women avoid cats?

Back 362

to avoid toxoplasma gondii, found in cat feces

Front 363

bloody diarrhea/dysentery, liver abscess, RUQ pain

Back 363

Entamoba histolytica

Front 364

treatment for amebiasis?

Back 364

metronidazole and iodoquinol

Front 365

protozoan that causes rapidly fatal meningoencephalitis?

Back 365

Naegleria fowleri

Front 366

transmission of Naegleria fowleri?

Back 366

swimming in freshwater lakes; enters through cribriform plate

Front 367

worm that causes anal pruritis and treatment

Back 367

enterobius vermicularis (pinworm). Mebendazole/pyrantel pamoate

Front 368

treatment for intestinal infection caused by ascaris lumbricoides?

Back 368

mebendazole/pyrantel pamoate

Front 369

roundworm found in pork. Muscle inflammation and periorbital edema

Back 369

trichinella spiralis

Front 370

treatment for trichinella spiralis

Back 370

thiabendazole

Front 371

worm that penetrates skin. Treatment?

Back 371

strongyloides. Ivermectin/thiabendazole

Front 372

worm found in drinking water that causes skin ulcerations and inflammation

Back 372

dracunculus medinensis. Treat with niridazole

Front 373

cause of river blindness

Back 373

onchocerca volvulus, transmitted by blackfly

Front 374

treatment for river blindness?

Back 374

ivermectin

Front 375

transmits loa loa?

Back 375

deer fly, horse fly, mango fly

Front 376

worm that blocks lymphatics?

Back 376

wuchereria bancrofti

Front 377

treatment for wuchereria bancrofti and toxocara canis

Back 377

diethylcarbamazine

Front 378

undercooked pork worm

Back 378

taenia solium

Front 379

taenia solium causes what?

Back 379

cysticercosis and neurocysticercosis

Front 380

treatment for neurocysticercosis?

Back 380

albendazole

Front 381

helminth in dog feces that causes liver cysts

Back 381

Echinococcus granulosus

Front 382

Schistosoma presentation?

Back 382

granulomas, fibrosis, and inflammation of spleen and liver

Front 383

worm in undercooked fish that causes pigmented gallstones and cholangiocarcinoma

Back 383

clonorchis sinensis

Front 384

worm in undercooked crab meat that causes inflammation and bacterial infection of the lung

Back 384

Paragonimus westermani

Front 385

treatment of Schistosoma, clonorchis sinensis, and Paragonimus westermani

Back 385

Praziquantel

Front 386

General mechanism of action of penicllins and cephalosporins?

Back 386

Block cell wall synthesis by inhibition of peptidoglycan cross-linking

Front 387

Which drug class acts by disrupting bacterial cell membranes?

Back 387

Polymyxins

Front 388

What bacterial enzymes do quinolones block?

Back 388

DNA topoisomerases

Front 389

Which drugs block peptidoglycan synthesis?

Back 389

Bacitracin, Vancomycin

Front 390

Which bacterial process is blocked by sulfonamides and trimethoprim?

Back 390

Nucleotide synthesis

Front 391

Which drugs block protein synthesis at 50S ribosomal subunit?

Back 391

Chlormaphenicol, acrolides, clindamycin, streptogramins (quinupristin, dalfopristin), linezolid

Front 392

Where do aminoglycosides and tetracyclines act?

Back 392

30S ribosomal subunit

Front 393

Clinical use of penicillin?

Back 393

Bactericidal for Gram-pos cocci, rods; Gram-neg cocci and spirochetes.

Front 394

Toxicity of penicillin?

Back 394

Hypersensitivity reactions, hemolytic anemia

Front 395

Mechanism of penicillin?

Back 395

Bind PBPs, block transpeptidase cross-linking of cell wall, activate autolytic enzymes

Front 396

Which penicillins are penicillinase-resistant?

Back 396

Methicillin, nafcillin, dicloxacillin

Front 397

Clinical use of penicllinase-resistant penicillins?

Back 397

Staph aureus (except MRSA)

Front 398

Are ampicillin and amoxicillin penicillinase-resistant?

Back 398

No (penicillinase-sensitive; use with clavulanic acid)

Front 399

Clinical use of ampicillin and amoxicillin?

Back 399

Haemophilus influenzae, E. coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, enterococci

Front 400

Toxicity of ampicillin and amoxicillin?

Back 400

Hypersenstivity, ampicllin rash, pseudomembranous colitis

Front 401

Clinical use of ticarcillin, carbenicillin, piperacillin?

Back 401

Pseudomonas and Gram-neg rods (penicillinase sensitive; use with clavulanic acid)

Front 402

Mechanism of cephalosporins?

Back 402

beta-lactams, inhibit cell wall synthesis, less sensitive to penicillinase, bactericidal

Front 403

Clinical use of 1st generation cephalosporins?

Back 403

Gram-pos cocci (Proteus, E.coli, Klebsiella)

Front 404

Names of 1st generation cephalosporins?

Back 404

Cefazolin, cephalexin

Front 405

Names of 2nd generation cephalosporins?

Back 405

Cefoxitin, cefaclor, cefuroxime

Front 406

Clinical use of 2nd generation cephalosporins?

Back 406

Gram-pos cocci (Haemophilus, Enterobacter aerogenes, Neisseria, Proteus, E.coli, Klebsiella, Serratia)

Front 407

Names of 3rd generation cephalosporins?

Back 407

Ceftriaxone, cefotaxime, ceftazidime

Front 408

Clinical use of 3rd generation cephalosporins?

Back 408

Serious Gram-neg infections resistant to other beta-lactams- meningitis, Psuedomonas, gonorrhea

Front 409

Name of 4th generation cephalosporin?

Back 409

Cefepime

Front 410

Clinical use of 4th generation cephalosporin?

Back 410

Increased activity against Pseudomonas and Gram-pos organisms

Front 411

Toxicity of cephalosporins?

Back 411

Cross hypersenstivity with penicillins, increased nephrotoxicity of aminoglycosides, disulfiram-like reaction with EtOH

Front 412

Mechanism of aztreonam?

Back 412

Monobactam resistant to beta-lactamases; inhibits cell wall synthesis; synergistic with aminoglycosides

Front 413

Clinical use of aztronam?

Back 413

Gram-neg rods (Klebsiella, Pseudomonas, Serratia) For penicillin-allergic patients and those with renal insuff (can't use aminoglycosides)

Front 414

Toxicity of aztreonam?

Back 414

Occasional GI upset; well-tolerated

Front 415

What drug is always co-administered with imipenem? Why?

Back 415

Cilastatin- an inhibitor of renal dihydropeptidase I to reduce imipenem inactivation in renal tubules

Front 416

Is imipenem beta-lactamase resistant?

Back 416

Yes

Front 417

Clinical use of imipenem and meropenem?

Back 417

Gram-pos cocci, Gram-neg rods and anaerobes. Drug of choice for Enterobacter.

Front 418

Toxicity of imipenem and meropenem?

Back 418

GI distress, skin rash and CNS toxicity (seizures) at high plasma levels (less with meropenem)

Front 419

Mechanism of vancomycin?

Back 419

Inhibits cell wall mucopeptide formation by binding D-ala-D-ala portion of precursors. Bactericidal

Front 420

Mechanism of resistance to vancomycin?

Back 420

Amino acid change of D-ala-D-ala to D-ala-D-lac

Front 421

Clinical use of vancomycin?

Back 421

Serious Gram-pos multidrug-resistant organisms (S.aureus, C.diff)

Front 422

Toxicity of vancomycin?

Back 422

Nephrotoxicity, ototoxicity, thrombophlebitis, red man syndrome (pretreat with antihistamines)

Front 423

Names of aminoglycosides?

Back 423

Gentamicin, neomycin, amikacin, tobramycin, streptomycin

Front 424

Mechanism of aminoglycosides?

Back 424

Inhibit formation of initiation complex and cause misreading of mRNA. Bactericidal

Front 425

Why are aminoglycosides ineffective against anaerobes?

Back 425

Require oxygen for uptake

Front 426

Clinical use of aminoglycosides?

Back 426

Severe Gram-neg rod infections. Synergistic with beta-lactams

Front 427

Toxicity of aminoglycosides?

Back 427

Nephrotoxicity (esp if used with cephalosporins), ototoxicity (esp when used with loop diuretics), teratogenic

Front 428

Names of tetracyclines?

Back 428

Tetracycline, doxycycline, demclocycline, minocycline

Front 429

Mechanism of tetracyclines?

Back 429

Bind to 30S and prevent attachment of aminoacyl-tRNA

Front 430

What inhibits tetracycline absorption in the gut?

Back 430

Divalent cations (calcium, iron)

Front 431

Use of demeclocylcine?

Back 431

Diuretic in SIADH because ADH antagonist

Front 432

Clnical use of tetracyclines?

Back 432

Vibrio cholerae, acne, Chlamydia, Ureasplasma, Urealyticum, Mycoplasma, Tularemia, H.pylori, Borrelia, Rickettsia

Front 433

Toxicity of tetracyclines?

Back 433

GI distress, discoloration of teeth, inhibition of bone growth in kids, photosensitivity, teratogen

Front 434

Names of macrolides?

Back 434

Erythromycin, azithromycin, clarithromycin

Front 435

Mechanism of macrolides?

Back 435

Inhibit protein synthesis by blocking translocation; bind to the 23S rRNA of the 50S ribosomal subunit. Bacteriostatic

Front 436

Clinical use of macrolides?

Back 436

URIs, pneumonias, STDs--Gram-pos cocci (strep), Mycoplasma, Legionella, Chlamydia, Neisseria

Front 437

Toxicity of macrolides?

Back 437

GI discomfort, acute cholestatic heptatitis, eosinophilia, skin rashes. Drug interations (increased plasma conc) with theophyllines, oral anticoags

Front 438

Mechanism of chloramphenicol?

Back 438

Inhibits 50S peptidyltransferase activity. Bacteriostatic

Front 439

Clinical use of chloramphenicol?

Back 439

Meningitis (H.influenze, N.meningitidis, S.pneumoniae)

Front 440

Toxicity of chlormphenicol?

Back 440

Anemia, aplastic anemia, gray baby syndrome

Front 441

Mechanism of clindamycin?

Back 441

Blocks peptide bond formation at 50S ribosomal subunit. Bacteriostatic

Front 442

Clinical use of clindamycin?

Back 442

Treat anaerobic infections (Bacteroides fragilis, C.perfringens)

Front 443

Toxicity of clindamycin?

Back 443

Pseudomembranous colitis, fever, diarrhea

Front 444

Names of sulfonamides?

Back 444

Sulfamethoxazole (SMX), sulfisoxazole, triple sulfas, sulfadiazine

Front 445

Mechanism of sulfonamides?

Back 445

PABA antimetabolites inhibit dihydropteroate synthetase. Bacteriostatic

Front 446

Clnical use of sulfonamides?

Back 446

Gram-pos, Gram-neg, Nocardia, Chlamydia, UTI

Front 447

Toxicity of sulfonamides?

Back 447

Hypersensitivity reactions, hemolysis if G6PD deficient, nephrotoxicity, photosensitivity, kernicterus, displace other drugs from albumin

Front 448

Mechanism of trimethoprim?

Back 448

Inhibits bacterial dihydrofolate reductase. Bacteriostatic

Front 449

Clinical use of trimethoprim?

Back 449

Used in combo with SMX- causing sequential block of folate synthesis. Recurrent UTIs, Shigella, Salmonella, Penumocystis jiroveci

Front 450

Toxicity of trimethoprim?

Back 450

Megaloblastic anemia, leukopenia, granulocytopenia (supplement folic acid)

Front 451

Which drugs should be avoided in pts with sulfa drug allergies?

Back 451

Sulfonamides, sulfasalazine, sulfonylureas, thiazide diuretics, acetazolamide, furosemide

Front 452

Which bugs do not gram stain well?

Back 452

Treponema, Rickettsia, Mycobacteria, Mycoplasma, Legionella pneumophila, Chlamydia (pneumonic: These Rascals May Microscopically Lack Color)

Front 453

Why doesn't Treponema gram stain well?

Back 453

too thin to be visualized

Front 454

Why doesn't Rickettsia gram stain well?

Back 454

intracellular parasite

Front 455

Why doesn't Mycobacteria gram stain well?

Back 455

high-lipid-content cell wall requires acid-fast stain

Front 456

Why doesn't Mycoplasma gram stain well?

Back 456

no cell wall

Front 457

Why doesn't Legionella pneumophila gram stain well?

Back 457

primarily intracellular

Front 458

Why doesn't Chlamydia gram stain well?

Back 458

intracellular parasite; lacks muramic acid in cell wall

Front 459

How can you visualize treponemes?

Back 459

darkfield microscopy & fluorescent Ab staining

Front 460

How can you visualize Mycobacteria?

Back 460

acid fast

Front 461

How can you visualize Legionella?

Back 461

silver stain

Front 462

Describe the phases of the bacterial growth curve?

Back 462

lag phase, log phase, stationary phase, death phase (graph is shown on a log scale)

Front 463

What is the lag phase?

Back 463

period of little bacterial growth-- metabolic activity without division

Front 464

What is the log phase?

Back 464

linear bacterial growth on the log scale- rapid cell division

Front 465

What is the stationary phase?

Back 465

no growth- nutrient depletion slows growth, spore formation in some bacteria

Front 466

What is the death phase?

Back 466

linear decrease in number of bacterial cells on log scale- prolonged nutrient depletion and buildup of waste products lead to death

Front 467

What is the source of exotoxins?

Back 467

certain species of gram+ and gram- bacteria

Front 468

What is the source of endotoxins?

Back 468

outer cell membrane of most gram- bacteria and listeria

Front 469

Are exotoxins secreted from the cell?

Back 469

YES

Front 470

Are endotoxins secreted from the cell?

Back 470

NO

Front 471

What is the chemistry of exotoxins?

Back 471

polypeptide

Front 472

What is the chemistry of endotoxins?

Back 472

lipopolysaccharide

Front 473

Where is the location of genes for an exotoxin?

Back 473

plasmid or bacteriophage

Front 474

Where is the location of genes for an endotoxin?

Back 474

bacterial chromosome

Front 475

What is the toxicity of an exotoxin?

Back 475

high (fatal dose is about 1ug)

Front 476

What is the toxicity of an endotoxin?

Back 476

low (fatal dose is hundreds of micrograms)

Front 477

What are the clinical effects from an exotoxin?

Back 477

Various

Front 478

What are the clinical effects from an endotoxin?

Back 478

fever, Shock

Front 479

What is the mode of action of an exotoxin?

Back 479

various modes

Front 480

What is the mode of action of an endotoxin?

Back 480

includes TNF and IL-1

Front 481

What is the antigenicity of an exotoxin?

Back 481

induces high-titer antibodies called antitoxins

Front 482

What is the antigenicity of an endotoxin?

Back 482

poorly antigenic

Front 483

What are vaccines to an exotoxin?

Back 483

toxoids used as vaccines

Front 484

What are vaccines to an endotoxin?

Back 484

No toxoids formed and no vaccine available

Front 485

What is the heat stability of an exotoxin?

Back 485

destroyed rapidly at 60 deg Celsius (except Staphylococcal enterotoxin)

Front 486

What is the heat stability of an endotoxin?

Back 486

stable at 100 deg Celsius for 1 hr

Front 487

What are typical diseases from an exotoxin?

Back 487

Tetanus, botulism, diptheria

Front 488

What are typical diseases from an endotoxin?

Back 488

meningococcemia, sepsis by G- rods

Front 489

What is the definition of bacterial virulence factors?

Back 489

Promote evasion of host immune response

Front 490

Describe the virulence of protein A? What bacteria is it part of?

Back 490

Binds Fc region of Ig; S. aureus

Front 491

Describe the virulence of IgA protease? What bacteria is it secreted by?

Back 491

Enzyme that cleaves IgA; polysaccharide capsules also inhibit phagocytosis; secreted by S. pneumoniae, H. influenza, Neisseria

Front 492

Describe the virulence of Group A streptococcal M protein?

Back 492

helps prevent phagocytosis

Front 493

Describe the action of superantigens?

Back 493

bind directly to MHC II and T-cell receptor simultaneously, activating large numbers of T cells to stimulate release of IGN-gamma and IL-2

Front 494

Describe the S. aureus superantigen. Is it an exotoxin or endotoxin?

Back 494

TSST-1 superantigen causes toxic shock syndrome (fever, rash, shock). EXOTOXIN

Front 495

What are the other S. aureus toxins?

Back 495

enterotoxins that cause food poisoning, exfoliatin that causes staphylococcal scalded skin syndrome

Front 496

Describe the S. pyogenes superantigen. Is it an exotoxin or endotoxin?

Back 496

scarlet fever- erythrogenic toxin causes toxic shock-like syndrome. EXOTOXIN

Front 497

What does an ADP ribosylating A-B toxin do?

Back 497

interferes with host cell function. B (binding component) binds to receptor on surface of host cell, enabling endocytosis. A (active component) then attaches an ADP-ribosyl to a host cell protein (ADP-ribosylation), altering protein function.

Front 498

Describe the cornebacterium diphtheriae ADP ribosylating A-B toxin. Is it an exotoxin or endotoxin?

Back 498

inactivates elongation factor (EF-2)- similar to Psuedomonas exotoxin A; causes pharyngitis and pseudomembrane in throat; EXOTOXIN

Front 499

Describe the Vibrio cholerae ADP ribosylating A-B toxin. Is it an exotoxin or endotoxin?

Back 499

ADP ribosylation of G protein stimulates adenylyl cyclase; incresase pumping of Cl- into gut and decreased Na+ absorption. Water moves into gut lumen; causes voluminous rice-water diarrhea. EXOTOXIN

Front 500

Describe the E. coli ADP ribosylating A-B toxin. Is it an exotoxin or endotoxin?

Back 500

heat-labile toxin stimulates Adenylate cyclase. Heat-stable toxin stimulates Guanylate cyclase. Both cause watery diarrhea. Labile like the Air, stable like the Ground. EXOTOXIN

Front 501

Describe the Bordetella pertussis ADP ribosylating A-B toxin. Is it an exotoxin or endotoxin?

Back 501

Increases cAMP by inhibiting G-alpha-inhibitory; causes whooping cough; inhibits chemokine receptor causing lymphocytosis. EXOTOXIN

Front 502

Describe the action of clostridium perfringens toxin? Is it an exotoxin or endotoxin?

Back 502

alpha toxin causes gas gangrene; get double zone of hemolysis on blood agar. EXOTOXIN

Front 503

Describe the action of C. tetani toxin? Is it an exotoxin or endotoxin?

Back 503

blocks the release of inhibitory neurotransmitters GABA and glycine; causes lockjaw; SPASTIC paralysis; EXOTOXIN

Front 504

Describe the action of C. botulinum toxin? Is it an exotoxin or endotoxin?

Back 504

blocks the release of Ach; causes anticholinergic symptoms, CNS paralysis, especially cranial nerves; spores found in canned food, honey (causes floppy baby); FLACCID paralysis; EXOTOXIN

Front 505

Describe the action of bacillus anthracis toxin? Is it an exotoxin or endotoxin?

Back 505

1 toxin in the toxin complex is an adenylate cyclase; EXOTOXIN

Front 506

Describe the action of Shigella toxin? Is it an exotoxin or endotoxin?

Back 506

shiga toxin (also produced by E. Coli O157:H7) cleaves host cell rRNA; also enhances cytokine release, causing HUS. EXOTOXIN

Front 507

Describe the action of S. pyogenes toxin? Is it an exotoxin or endotoxin?

Back 507

Streptolysin O is a hemolysin; antigen for ASO Ab, which is used in the diagnosis of rheumatic fever. EXOTOXIN

Front 508

What is the definition of an endotoxin?

Back 508

A lipopolysaccharide found in the cell wall of G- bacteria (N-dotoxin is an integral part of gram-Negative cell wall.)

Front 509

Endotoxin is heat___________ (labile/ stable?)

Back 509

stable

Front 510

What is an example of an endotoxin?

Back 510

lipid A

Front 511

What does an endotoxin do?

Back 511

activates macrophages, activates complement (alternative pathway), activates Hageman factor

Front 512

After an endotoxin activates macrophages, what important components are released?

Back 512

IL-1, TNF, Nitric oxide

Front 513

What does IF-1 cause?

Back 513

fever

Front 514

What does TNF cause?

Back 514

Fever, hemorrhagic tissue necrosis

Front 515

What does nitric oxide cause?

Back 515

hypotension (shock)

Front 516

After an endotoxin activates complement, what is released?

Back 516

C3a, C5a

Front 517

What does C3a cause?

Back 517

hypotension, edema

Front 518

What does C5a cause?

Back 518

neutrophil chemotaxis

Front 519

After an endotoxin activates Hageman factor, what occurs?

Back 519

the coagulation cascade--> DIC

Front 520

How do you differentiate Neisseria species?

Back 520

on the basis of sugar fermentation

Front 521

What do Neisseria meningococci ferment?

Back 521

maltose and glucose (MeninGococci)

Front 522

What do Neisseria gonococci ferment?

Back 522

Glucose (Gonococci)

Front 523

What color is the pigment produced by S. aureus?

Back 523

yellow

Front 524

What color is the pigment produced by Pseudomonas aeruginosa

Back 524

blue-green

Front 525

What color is the pigment produced by Serratia marcescens?

Back 525

red

Front 526

What gram (-) cocci is a Maltose and Glucose fermenter?

Back 526

Neisseria meningitidis (MeninGococci)

Front 527

What gram (-) cocci only ferments Glucose?

Back 527

Neisseria gonorrhoeae (Gonococci)

Front 528

What are 2 gram (-) coccoid rods?

Back 528

Haemophilus influenzae and Bordetella pertussis

Front 529

What 2 gram (-) rods are fast fermenters of lactose?

Back 529

Klebsiella and Escherichia coli (Enterobacteriaceae)

Front 530

What gram (-) rod is a lactose nonfermenter and oxidase (+)?

Back 530

Pseudomonas

Front 531

What 3 gram (-) rods are lactose nonfermenters and oxidase (-)?

Back 531

Shigella, Salmonella, and Proteus (Enterobacteriaceae)

Front 532

What Neisseria species has a polysaccharide capsule, ferments maltose, and has a vaccine?

Back 532

N. meningitidis

Front 533

What are 4 pathologies caused by N. gonorrhoeae (Gonococci)?

Back 533

Gonorrhea, septic arthritis, neonatal conjunctivitis, and Pelvic Inflammatory Disease (PID)

Front 534

What are 2 pathologies caused by N. meningitidis (Meningococci)?

Back 534

Meningitis (meningococcemia) and Waterhouse-Friderichsen syndrome (hemorrhagic adrenalitis)

Front 535

What gram (-) cocci ferment glucose and produce IgA proteases?

Back 535

Neisseria (gonorrhoeae and meningitidis)

Front 536

What 4 pathologies can HaEMOPhilus cause?

Back 536

Epiglottitis, Meningitis, Otitis media, and Pneumonia

Front 537

What factors do H. influenzae require when cultured on chocolate agar?

Back 537

Factors V (NAD) and X (hematin)

Front 538

What does the H. influenzae type B vaccine contain and is it given?

Back 538

Type B capsular polysaccharide conjugated with diphtheria toxoid; between 2-18 months of age

Front 539

Name 7 species of Enterobacteriaceae.

Back 539

E. coli, Salmonella, Shigella, Klebsiella, Enterbacter, Serratia, and Proteus

Front 540

What antigen is the endotoxin of Enterobacteriaceae?

Back 540

Somatic (O) antigen

Front 541

What antigen determines virulence of Enterobacteriaceae?

Back 541

Capsular (K) antigen

Front 542

What antigen is found in motile species of Enterobacteriaceae?

Back 542

Flagellar (H) antigen

Front 543

Name 4 characteristics of Enterobacteriaceae.

Back 543

COFFEe: Capsular, O antigen, Flagellar antigen, Ferment glucose, Enterobacteriaceae

Front 544

What causes pneumonia in alcoholics and diabetics with red currant jelly sputum?

Back 544

Klebsiella

Front 545

What are the 3 A's of Klebsiella?

Back 545

Aspiration pneumonia, Abscess in lungs, Alcoholics

Front 546

What agar is used to culture pink colonies of lactose-fermenting enteric bacteria?

Back 546

MacConkey's agar (Lactose is KEE. MacConKEE's agar)

Front 547

What non-lactose-fermenting Enterobacteriaceae invade intestinal mucosa and cause bloody diarrhea?

Back 547

Salmonella and Shigella

Front 548

How is Salmonella's motility different from Shigella's?

Back 548

Salmonella: flagella; Shigella: actin polymerization

Front 549

Which produces H2S, Salmonella or Shigella?

Back 549

Salmonella

Front 550

Which is more virulent, Salmonella or Shigella?

Back 550

Shigella

Front 551

What are 4 symptoms of Salmonella typhi (typhoid fever)?

Back 551

Fever, diarrhea, headache, and rose spots on abdomen

Front 552

How is Salmonella and Shigella transmitted?

Back 552

Food, Fingers, Feces, Flies

Front 553

Where are outbreaks of Yersinia enterocolitica common?

Back 553

Day-care centers

Front 554

How is Y. enterocolitica transmitted?

Back 554

Pet feces, contaminated milk, and pork

Front 555

What 2 pathologies can Y. enterocolitca mimic?

Back 555

Crohn's disease or appendicitis

Front 556

What gram (-) rod is urease (+) and creates an alkaline environment?

Back 556

Helicobacter pylori (urease breath test)

Front 557

What are 2 common pathologies caused by H. pylori?

Back 557

Gastritis and 90% of duodenal ulcers

Front 558

What 3 things is H. pylori a risk for?

Back 558

Peptic ulcer, gastric adenocarcinoma, and lymphoma

Front 559

Name a genus of obligate intracellular parasites that need CoA and NAD and have an arthropod vector.

Back 559

Rickettsiae

Front 560

What is the triad of symptoms for rickettsiae?

Back 560

Headache, fever, and rash (vasculitis)

Front 561

What rickettsia causes Q fever (pneumonia), is transmitted by aerosol, has no rash, and has no vector?

Back 561

Coxiella burnetii

Front 562

Compared to typhus, where do rickettsial rashes start?

Back 562

Hands and feet (Rickettsia on the wRists, Typhus on the Trunk)

Front 563

What pathology, caused by Rickettsia rickettsii, presents with rash on palms and soles, headache, and fever?

Back 563

Rocky Mountain spotted fever (tick vector)

Front 564

What 3 pathologies present with rash on palms and soles?

Back 564

Rocky Mountain spotted fever, syphilis, and coxsackievirus A (hand, foot, and mouth disease)

Front 565

What does R. typhi cause?

Back 565

Endemic typhus (flea vector)

Front 566

What does R. prowazekii cause?

Back 566

Epidemic typhus (louse vector)

Front 567

What is the vector for Ehrlichia?

Back 567

Tick (Ehrlichiosis)

Front 568

What does the Weil-Felix reaction assay for?

Back 568

Antirickettsial antibodies (cross-react with Proteus antigen)

Front 569

What rickettsial disease has a (-) Weil-Felix?

Back 569

Q fever (Coxiella)

Front 570

What can be seen on Giemsa or fluorescent antibody-stained smear for Chlamydiae?

Back 570

Cytoplasmic inclusions

Front 571

What 4 things can C. trachomatis cause?

Back 571

Reactive arthritis, conjunctivitis, urethritis, and PID

Front 572

What can C. pneumoniae and C. psittaci cause?

Back 572

Atypical pneumonia

Front 573

What is unusual about the Chlamydial cell wall?

Back 573

Lacks muramic acid

Front 574

What form of Chlamydia Enters cell via endocytosis?

Back 574

Elementary body

Front 575

What form of Chlamydia Replicates in cells?

Back 575

Reticulate body

Front 576

What does C. trachomatis serotypes A, B, and C cause?

Back 576

ABC: Africa/Blindness/Chronic infection

Front 577

What does C. trachomatis serotypes L1, 2, and 3 cause?

Back 577

L1-3: Lymphogranuloma venereum

Front 578

What does C. trachomatis serotypes D-K cause?

Back 578

Urethritis/PID, ectopic pregnancy, neonatal pneumonia or conjunctivitis

Front 579

What are 3 spirochetes?

Back 579

BLT: Borrelia (B is Big), Leptospira, and Treponema

Front 580

Which spirochete is the only one that can be visualized by dyes in light microscopy?

Back 580

Borrelia

Front 581

Which spirochete is visualized with dark-field microscopy?

Back 581

Treponema

Front 582

How are spirochetes mobile?

Back 582

Axial filaments

Front 583

What question mark-shaped spirochete can cause Weil's disease (icterohemorrhagic leptospirosis)?

Back 583

Leptospira interrogans (Weil's: jaundice, azotemia, fever, hemorrhage, and anemia)

Front 584

What can Borrelia burgdorferi cause and via what vector?

Back 584

Lyme disease (Ixodes tick)

Front 585

What 2 symptoms are found during Stage 1 of Lyme disease?

Back 585

Erythema chronicum migrans (bull's eye rash) and flu-like symptoms

Front 586

What 2 manifestations are found during Stage 2 of Lyme disease?

Back 586

Neurologic and cardiac manifestations

Front 587

What 2 symptoms are found during Stage 3 of Lyme disease?

Back 587

Chronic monoarthritis and migratory polyarthritis

Front 588

What does Treponema pallidum cause?

Back 588

Syphilis

Front 589

What does T. pertenue cause?

Back 589

Yaws (tropical infection with + VDRL test)

Front 590

What is characteristic of primary syphilis?

Back 590

Painless chancre (localized)

Front 591

What is characteristic of secondary syphilis?

Back 591

Maculopapular rash on palms and soles and condylomata lata (Secondary=Systemic)

Front 592

What is characteristic of tertiary syphilis?

Back 592

Gummas, aortitis, neurosyhphilis (tabes dorsalis), and Argyll Robertson pupil

Front 593

What 4 things are characteristic to congenital syphilis?

Back 593

Saber shins, saddle nose, CN VIII deafness, and Hutchinson's teeth

Front 594

What is characteristic of an Argyll Robertson pupil?

Back 594

Prostitute's pupil: accomodates but does not react to light (tertiary syphilis)

Front 595

What is the FTA-ABS test specific for?

Back 595

Treponemes; FTA-ABS: Find the Ab-ABSolutely; most specific, earliest (+), long (+) duration

Front 596

Interpret +VDRL and +FTA.

Back 596

Active Treponema infection

Front 597

Interpret +VDRL and -FTA.

Back 597

Probably false positive Treponema infection

Front 598

Interpret -VDRL and +FTA.

Back 598

Successfully treated Treponema infection

Front 599

What does VDRL detect?

Back 599

Nonspecific Ab reacts with beef cardiolipin (Dx: syphilis, Viruses [mononucleosis and hepatitis), Drugs, Rheumatic fever, SLE, and Leprosy)

Front 600

zidovudine (AZT)

Back 600

thymidine nucleoside analog phosphorylated by cellular kinases to tri-P active form (host thymidine kineses are S-phase specific inhibiting RT; also acts as DNA chain terminator (b/c N3 group on 3'OH)

Front 601

lamivudine (3TC) See above

Back 601

nucleoside analog inhibitor of RT, phosphorylated by cell enzymes to active Rx

Front 602

tenofovir

Back 602

like AZT inhibits RT by competing w/dATP for incorporation into DNA, causing chain termination; unlike AZT it is a nucleotide prodrug (adenosine monophosphate analog that is hydrolyzed to tenofovir phosphonate, which is further phosphorylated by cellular enzymes be active at inhibiting RT

Front 603

Emtricitabine

Back 603

Fluorinated analog of 3TC that inhibits RT by competing for dCTP incorporation into DNA; chain termination

Front 604

efavirenz

Back 604

non-nucleoside/non-competitive inhibitor or RT that does not require phosphorylation for activity

Front 605

lopinavir

Back 605

prevents viral protease from cleaving gag-pol polypeptide into separate functional proteins; fits into protease active site and acts as a competitive inhibitor; results in non-infectious viral particles

Front 606

ritonavir

Back 606

Used to boost levels of ther Protease Inhibitors

Front 607

enfuvirtide

Back 607

inhibits the fusion of viral (HIV-1) and cellular (CD4+) membrances to block initial entry; binds gp41 subunit of HIV glycoprotein

Front 608

Maraviroc

Back 608

Chemokine co-receptor (CRR5) antagonist to block entry of HIV into cells

Front 609

Raltegravir

Back 609

Inhibitis HIV-1 integrase, prevents integration into the genome

Front 610

Mechanism of Interferon

Back 610

Block stages of viral RNA and DNA synthesis, induce ribonuclease

Front 611

Alcoholic vomits gastric contents and has foul-smelling sputum. Organism? Etiology? Treatment?

Back 611

Anaerobes (aspiration pneumonia). Rx: Ceftriaxone + azithromycin/moxifloxacin.

Front 612

Middle-aged male presents with acute onset monoarticular joint pain and bilateral Bell's palsy. Disease? Transmission? Organism? Rx?

Back 612

Lyme disease. Ixodes (tick)--> Borrelia burgdorferi (spirochete). Rx: doxycycline

Front 613

Patient's UA shows WBC casts. Disease/problem? Organism? Rx?

Back 613

Pyelonephritis. Org: E. coli (most common), Enterococcus, Staph, Proteus. Rx: TMP/SMX (Quinolone if Enterococcus).

Front 614

Patient presents with 'rose gardener's' scenario (thorn prick with large ulcers along lymphatic drainage). Organism?

Back 614

Sporothrix schenckii (rare fungus. House episode: guy gives his wife roses because he cheated and got critically ill.)

Front 615

Med student has a burning feeling in his gut after meals. Gastric mucosa biopsy=G- rods. Diagnosis (test?)? Tx? Pathogenicity factors (of organism)?

Back 615

H. pylori (peptic ulcer disease, stomach CA (risk)). Urea breath test. Pathogen: cagA (type 4 secr syst->makes IL-8), NAP (activates neutrophils), VacA (vacuolizing toxin). Pathogenicity=inflammation!

Front 616

32-y/o M has 'cauliflower' skin lesions. Biopsy=broad-based budding yeast. Organism? Rx?

Back 616

Blastomyces. Rx=Itraconazole

Front 617

Breast-feeding F suddenly develops redness & swelling of right breast. PE=fluctuating mass. Diagnosis?

Back 617

Mastitis caused by S. aureus.

Front 618

20-y/o college student presents w/ lymphadenopathy, fever & hepatosplenomegaly. His serum agglutinates sheep RBCs. What cell is infected? Etiology?

Back 618

B cells (infectious mononucleosis; EBV ('owl eye inclusions').

Front 619

3 hrs after eating custard at a picnic, a whole family began vomiting (awesome)! 10 hrs later they were better. Organism? Pathophysiology?

Back 619

S. aureus (preformed enterotoxin (superantigen) caused vomiting w/in hours…heat stable)

Front 620

Infant becomes flaccid after eating honey. Organism? Mechanism? Compare to a related (same genus) spp.?

Back 620

Clostridium botulinium (Clostridia=G+ anaerobes, 'drumstick-shaped' (spores)). Mech: inhibits vSNAREs->ACh release into post-synaptic cleft blocked). C. tetani-->inhib GABA release at inh interneurons in CNS (retroaxonal transport). Tetanus=immunization (Px) / TT IgG (acute, sx). Botox=anti-toxin.

Front 621

Male presents with squamous cell carcinoma on his penis. Etiology? Tx?

Back 621

HPV. No treatment (for HPV). Immunizaiton for women.

Front 622

Patient develops endocarditis 3 wks after receiving a prosthetic heart valve. Organism (be specific down to species)? Tx?

Back 622

S. epidermidis. Rx: Vancomycin (or resistance analysis d/t MDR).

Front 623

55-y/o smoker & heavy drinker presents with a (new) cough and flu-like sx. Gram stain=no organisms. Silver stain=G- rods. Diagnosis? Tx?

Back 623

Legionella pneumophila (pleomorph, b-lactamase(+), prevent vacuole<->lysosome fusion, sources: pools, water towers). Rx=Rifampin + erythromycin.

Front 624

After taking clindamycin, patient develops toxic megacolon and diarrhea. Organism? Tx?

Back 624

Clostridium difficile (Enterocolitis). Rx=metronidazole or vancomycin. 'Q: How do you get off the C. diff train? A: take the metro or a van.'

Front 625

25-y/o presents with 3 days fever, chills & a painful, swollen knee. Diagnosis? Tx?

Back 625

Septic arthritis (key: unilat/asymmetrical; many etiologies, common=N. gonorrheae). Rx=ceftriaxone (if etio uncertain), Pen G if certain N. gonorrheae.

Front 626

19-y/o F college student presents with vaginal pruritis and a thick, curdy discharge. Etiology? Tx?

Back 626

Candida albicans. Clotrimazole (topical or oral, but oral C/I with alcohol consumption (consideration)).

Front 627

30-y/o F returns from a camping trip and complains of watery diarrhea and cramps. Organism? Tx?

Back 627

Giardia lamblia (Traveler's diarrhea; 2nd most common (parasitic) cause of diarrhea (#1=cryprosporidium)). Rx: Metronidazole (adults), Nitazoxanide (peds), Paromomycin (pregnant F). Pathophys: d/t hosts own immune rxn. Immunity: IgA (in endemic areas-contam water).

Front 628

Bacterial peptidoglycan: composition and function? What class of antibiotics targets this structure?

Back 628

Carb backbone (N-Ag~N-Am) + x-linked peptide side chains (thin in G-/thick in G+); support, resists osmotic pressure. Beta-Lactams target the x-link D-Ala-D-Ala (last 2 of pentapeptide).

Front 629

Bacterial cell wall: composition, function & clinical significance?

Back 629

Supported by peptidoglycan (inner), techoic acid induces IL-1/TNF-a (Fxn: surface antigen). Only G+.

Front 630

Bacterial outer membrane (& periplasm): composition, function & significance?

Back 630

Lipid A induces IL-1/TNF-a (Antigen=polysaccharide). Fxn: site of LPS/endotoxin (surface Ag)=only G-. Periplasm=only in G- (space btw. outer & inner membrane).

Front 631

Bacterial plasma membrane: composition & function?

Back 631

Lipoprotein bilayer. Site of oxidative & transport enzymes.

Front 632

Bacterial ribosomes: structure & function, clinical significance, examples?

Back 632

50S + 30S = 70S (protein synthesis from mRNA). Different from eukaryotic ribosomes=Rx target (Aminoglycosides, tetracyclines, tigecycline, chloramphenicol, macrolides, clindamycin & linezolid).

Front 633

Bacterial capsule: structure, function, clinical significance & examples?

Back 633

Polysaccharide (except: B. anthracis D-Glutamate=glycoprotein); protects against phagocytosis=immune evasion/chronic infections. Examples: S. pneumoniae, H. influenzae (b), Klebsiella pneumoniae, P. aeruginosa, N. meningitidis, Cryptococcus neoformans ('Some killers have pretty neat capsules'). Hib and Strep vaccines are directed at capsule.

Front 634

Bacterial pilus/fimbriae: structure/function?

Back 634

Glycoprotein (mostly CHO); adherence, sex pilus forms during conjugation.

Front 635

Bacterial flagellum: structure/function?

Back 635

Protein/motility (Notably: H. pylori).

Front 636

Bacterial spore: structure, function, clinical significance?

Back 636

Keratin-like coating--resistance to env't stressors. B. anthracis, Clostridium spp.

Front 637

Bacterial plasmids: structure, function, clinical significance?

Back 637

DNA (circular)-contains variety of genes for antibiotic resistance (beta-lactamase), enzymes and toxins (shigella toxin).

Front 638

Bacterial glycocalyx: structure, function, clinical significance?

Back 638

Polysaccharide-mediates adherence to surfaces (esp. foreign). Catheters, medical implants (P. aeruginosa, S. epidermidis).

Front 639

Bacteria with unusual structures: Mycoplasma vs. Mycobacteria

Back 639

Mycoplasma: sterols (no cell wall)-->'walking pneumonia'. Mycobacteria: mycolic acid (high lipid content)--> TB, leprosy, MAC complex (AIDS).

Front 640

Common structures to G+ and G- (name 5). 1 unique structure of each (G+, G-)?

Back 640

Common: flagellum, pilus, capsule, peptidoglycan (G+ >> G-), cytoplasmic membrane. G- only: LPS/endotoxin, outer membrane. G+: cell wall (techoic acid).