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223 Cards in this Set

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Which organisms are found in macrophages?
Histoplasma capsulatum, Listeria monocytogenes, Legionella pneumophila, Mycobacterium tuberculosis, Neisseria gonorrhoeae
Which organism is catalase +?
Staphylococcus
Which organism is catalase -?
Streptococcus
Which organisms are B- hemolytic?
Streptococcus pyogenes, streptococcus, agalactiae
What are the ATYPICAL causes of CAP?
Chlamydia pneumonia, Mycoplasma pneumonia, Legionella pneumophila
What are the five causes of CAP?
Strep pneumo, H. influenza, chlamydia pneumonia, mycoplasma pneumonia, legionella pneumophila
Which organisms are found in macrophages?
Histoplasma capsulatum, Listeria monocytogenes, Legionella pneumophila, Mycobacterium tuberculosis, Neisseria gonorrhoeae
Which organisms are encapsulated?
Strep pneumo
Strep pyogenes
Strep agalactiae
Bacillus anthracis
Neisseria meningitidis
Salmonella
Klebsiella pneumophilia, oxytoca
Haemophillus influenzae
Pseudomonas aeruginosa
Cryptococcus neoformans
Which organism is catalase +?
Staphylococcus
Which organism is catalase -?
Streptococcus
Which organisms are B- hemolytic?
Streptococcus pyogenes, streptococcus, agalactiae
What are the ATYPICAL causes of CAP?
Chlamydia pneumonia, Mycoplasma pneumonia, Legionella pneumophila
What are the five causes of CAP?
Strep pneumo, H. influenza, chlamydia pneumonia, mycoplasma pneumonia, legionella pneumophila
Which organism is coagulase positive?
Staphylococcus aureus
Which organisms are coagulase negative?
Staph epidermidis, Staph saprophyticus
Which organisms can cause endocarditis?
Staph aureus, Staph epidermidis, Strep agalactiae, Strep viridans, Strep bovis, Enterococcus faecalis, Enterococcus faecium, Corynebacterium jeikeium, Salmonella, Candida,
True or false? Staph epidermidis causes pneumonia.
FALSE
Which reagent is used to separate S. epidermidis from S. saphrophyticus?
Novobiosin. S. sap is resistant to novobiosin.
How can you treat Staph epidermidis?
SMX/TMP, Ampicillin, Nitrofurantoin
Which organism is alpha hemolytic?
Streptococcus pneumonia
What does autolysin in Strep pneumoniae do?
Found in the cell wall, activation triggers cell lysis releasing virulence factors
What does pneumolysin in Strep pneumoniae do?
It is a virulence factor that damages cell membranes/matrix
How is macrolide resistance mediated by strep pneumo?
Alteration in ribosomal target or Efflux
How is quinolone resistance mediated by strep pneumo?
Efflux or parC mutations (alteration in DNA gyrase target)
Which bacteria has a capsule made of hyaluronic acid?
Strep pyogenes
What are the toxic extracelluar components produced by Strep pyogenes?
Pyrogenic exotoxins, streplysin O, streptolysin S, streptokinase
What is the capsule of S. agalactiae made of and what is its significance?
Polysaccharide capsule, anti-phagocytic
90% of enterococcus infections are caused by which species?
Enterococcus faecalis
The most common infection caused by peptostreptococcus is?
Aspiration pneumonia
Peptostreptococcus is often found with this organism…
Bacteroides fragilis
Which organism makes edema factor and lethal factor? Are these endo or exotoxins?
Bacillus anthracis; exotoxins
What can be used to treat bacillus anthracis?
Cipro
How do you treat Listeria monocytogenes?
Ampicillin +/- aminoglycoside or SMX/TMP
Which organism causes rhomboencephalitis?
Listeria monocytogenes
How does Neisseria gonorrhoeae attach to epithelial cells?
pili
Can you use Penicillin to treat Neisseria gonorrhoeae? Why or why not?
No because of PPNG (penicillinase producing neisseria gonorrhea)
What can you use to treat Neisseria gonorrhea?
Rocephin (ceftriaxone) for gonorrhea, Azithromycin 1mg for Chlamydia
Can you use Quinolones to treat Neisseria gonorrhea?
No because of quinolone resistance
1% silver nitrate solution is used for…
Prophylaxis or treatment for newborn ophthalmic infections caused by Neisseria gonnorhoeae
Rifampin can be used for prophylaxis upon for which organism?
Neisseria meningitidis
Waterhouse-Friderichsen Syndrome is caused by?
Neisseria meningitidis
What are the characteristics of Waterhouse-Friderichsen Syndrome?
Sepsis +/- meningitis with meningococcal emboli, Disseminated Intravascular Clotication (DIC), adrenal gland hemorrhage
How does E. coli generate energy?
Reduces nitrates to nitrites
True or false? E. Coli can ferment lactose.
TRUE
Which organism causes hemorrhagic colitis?
E. Coli serotype 0157 and H7
Which strain of E. coli produces verotoxin?
Enterohemorrhagic E. coli (EHEC)
Can E. coli be combated with beta lactamase inhibitors?
No
True or false? Salmonella ferments lactose
FALSE. Salmonella does not ferment lactose.
What kind of infections does Salmonella cause?
Gastroenteritis, enteric fever Typhoid (rare)
True or False? Klebsiella ferments lactose
TRUE
True or False? Enterobacter ferments lactose
TRUE
True or False? Proteus ferments lactose
FALSE, proteus does not ferment lactose
What features does proteus have to move in the urinary tract?
Flagella and fimbriae
Which organism produces urease which hydrolyzes area to ammonium hydroxide increasing the urinary pH the result is often renal stones with UTI?
Proteus
What are the infections caused by proteus?
UTI, pneumonia, sepsis, surgical wound infectious in hosp. patients
True or False? Providencia ferments lactose
FALSE, providencia does not ferment lactose
How does Haemophilus influenzae attach to the mucosa?
IgA protease
How would you classify the shape of Haemophilus influenze?
coco-bacilli
How would you classify the shape of Neisseria gonorrhoeae and meningitidis?
Diplococci
How would you classify the shape of Moraxella catarrhalis?
Diplococci
What does Moraxella catarrhalis normally cause?
Sinusitis, bronchitis, COPD exacerbation, otitis media
Where is Moraxella catarrhalis normally found?
Respiratory tract flora
Which bacteria produces pyocyanin?
Pseudomonas aeruginosa
What kind on infections does Pseudomonas aeruginosa cause?
Ventilator pneumonia, post-surgical and ICU infections, otitis media
True or False: Septra is a good agent to treat Pseudomonas aeruginosa.
False. Septra doesn't work for pseudomonas in the body. It does work in test tubes where it doesn't have folic acid.
What infection does Legionella pneumophilia cause?
Community Acquired Pneumonia (Atypical)
What are the symptoms of "warm month pneumonia"?
Pneumonia with hyponatremia
Fever >40 degrees
Nonproductive cough
Diarrhea
Myalgia
Bradycardia
Unilateral-lower lobe pneumonia
What agents should not be used to treat Legionella pneumophilia?
Beta-lactams
How is a Legionella pneumophilia infection diagnosed?
Culture or
Direct fluorescent antibody testing
Which organisms are cocobacilli?
Hemophillus influenzae
Actinetobacter baumannii
Legionella pneumophilia
Which organism is known for causing Valley Fever?
Coccidioides immitis
How can Coccidioides immitis be diagnosed?
CAT scan
Antigenic skin testing
Serology for IgM or IgG antibodies
How can Coccidioides immitis be treated?
Amphotericin B infusion
What can be used to diagnose histoplasmosis?
Cultures
Antibody titer
Skin reaction
Penicillins: Bacteriostatic or Bactericidal
Bactericial for the most part
Site of action of penicillins
PBP's
Mechanism of action of penicillins
inhibit certain enzymes required to make the cell wall
Penicilins are synergistic and additive with
Synergistic: aminoglycosides Additive: quinolones (organism specific)
Mechanism of resistance for penicillins
Altered cell wall penetration due to PBP affinity alteration
If you have strep pneumo and you give ampicillin, what happens?
You get resistant to ALL penicillins and all first and second generation cephalosporins. Only 3d generation ceph's will work
What is the most potent ceph for strep pneumo?
Ceftriaxone (Rocephin)
What drug's excretion into urine is blocked by probenecid?
Natural Penicillins
Natural penicillins penetrate all tissues, except for what? Any exceptions?
prostate, eyes, and CSF unless inflammation occurs
What do you use to treat syphilis
Pen G benzathine
What dose of Pen G benzathine do you use to treat S. pneumoniae (pharyngitis)?
1.2 - 2.4 M units Q week
What is the PO formulation of Penicillin? What are the doses?
Pen V, 125, 250, 500mg QID (tablets or solution)
Which drug has high N. meningitis (non ppng) susceptibility, and what is the preferred admin route? Dosing?
Pen G, IV most preferred (PO and IM also available). 2-4 M units IV q4-6h
LFT increase and thrombophlebitis are problems with what drugs?
Nafcillin and oxacillin
What does the acyl side chain do in penicillinase resistant organims?
it prevents beta lactamase from destroying the ring
Which penicillin is hepatically metabolized?
Penicillinase resistant penicilins
What types of organisms would Cloxacillin be inefficiant towards?
Enterococcus, listeria, and streptococcus
T or F: Dicloxacillin 200mg PO TID with food
False, food decreases absorption and dosing is 125, 250, 500 mg Po QID
Amoxicillin is more active against which gram type of bacT?
gram -
What bacT are aminopenicillins effective against?
E. coli, H. flu, klebsiella, Listeria, enterococcus
If a patient has a strep infection, what drug would you avoid?
ampicillin, amoxicillin
If you give ampicillin and allopurinol, what happens?
you get a rash, which is a non allergic rxn
Renal adjustment is required in which penicillins?
aminopenicillins, carboxypenicillins (ticarcillin), Ureidopenicillins (piperacillin)
What is the IV dose of ampicillin
1-3g q4-6h
Which penicillin can you take food with
amoxicillin
what drug is ineffective toward SPACE organisms?
Ticarcillin
which drugs are ineffective toward strep?
amox, penicillin
Which drugs must be adjusted in renal impairement
ampicillin, ticarcillin, piperacillin
Platelet dysfunction occurs with which drug
ticarcillin
Which drugs are effective against enterobactericiae
ticarcillin, pipercillin
Ticarcillin Dose
2-4g IV q4-6h
What electrolyte problems does ticarcillin cause?
Na overload, hypokalemia
Which drug has a zwitter ion, and what does that mean for the drug?
Piperacillin, it has good gram - penetration
What drugs are effective against enterococcus?
aminopencillins, ureidopenicillins
Which drug is the BEST against P. aeruginosa?
piperacillin
Which drug causes neutropenia?
piperacillin
Ampicillin + sulbactam
unasyn
augmentin
amox + clavulanic acid
ticarcillin + clavulanic acid
timentin
Zosyn
piperacillin + tazobactam
which drug is good against moraxella and klebsiella?
any combo drug (unasy, augmentin…)
what does e.coli, H flu, b frag, moraxell and klebsiella have in common
they all are treated with combo drugs.
What are tazobactam, sulbactam and clavulanic acid?
beta lactamase inhibitors (NOT antibiotics)
What is ineffective against SPACE and ESBL producers
Zosyn
Zosyn dose
3.375 - 4.5g IV q4-6h
Timentin Dose
3.1g IV q4-6h
Which patients are susceptivle to the pulmonary reactivation disease caused by histoplasma capsulatum?
Smokers
COPD
Emphysema
Name the four types of candida:
Candida albicans
Candida krusei
Candida tropicalis
Candida glabrata or torulopsis
How can you distinguise candida on culture?
Candida is seen as an oval budding yeast with pseudohyphae.
Cream colored
What are the common infections caused by Candida?
Candidemia
Thrush
Vulvovaginitis
Diaper rash
Onychomycosis
Urosepsis
Meningitis
Valvular endocarditis
Which Candida species is the most resistant to drugs?
C. glabrata or torulopsis
How is Cryptococcus neoformans transmitted?
Pigeon feces are aerosolized by the wind
How can Cryptococcus neoformans be seen?
India ink- used to dissolve other stuff so spherical budding yeast can be seen
With normal immune function, Cryptococcus neoformans presents as
normal flu or cold like syndrome
What effects does Cryptococcus neoformans have on the CSF?
Increased pressure, protein, WBC
Decreased glucose
Which patients are at risk for Aspergillis fumigates infections?
Immunocompromised:
AIDS
Transplant
Steroids
Leuks
Heavy Smokers
Diabetics (sometimes)
What are the problems associated with Aspergillis fumigates?
Allergic aspergillosis asthma
Invasive Aspergillosis
What are the complications of invasive aspergillosis?
Invasive pneumonia progresses to dyspnea and apnea--> hemoptysis, thrombosis, necrosis of tissue, necrotic pneumonia
Can also travel to the groin, bowel, kidney and liver.
Which systemic fungi are considered opportunists?
Aspergillis
Candida
Cryptococcus
Pneumocystis
Rhizopus
Which organisms are anti-phagocytic?
Streptococcus pneumonia
Streptococcus pyogenes
Streptococcus agalactiae
What infections does Corynebacteria diphtheriae cause?
Conduction abnormalities
Diphtheria
Pneumonia
Heart Failure
Where is corynebacterium jeikeium normally found and what are it's implications?
Skin organism (like stratum corneum)
Opportunistic infections
Which organisms are diplococci?
Neisseria gonorrhea
Neisseria meningitidis
Moraxella catarrhalis
Listeria monocytogenes
What kind of infectious is caused by Entamoeba histolytica?
Amoebic dysentery
How is amoebic dysentery diagnosed?
Endoscopy
Colonoscopy
Swallow string
Describe some of the characteristics of entamoeba histolytica:
Feeds and moves by engulfing food via pseudopodia.
Found as cysts in foods and water.
Once ingested, attach to large intestines as trophozoites (mobile).
Feed on intestinal bacteria, secrete enzymes --> local ulceration and necrosis
What is the most common parasitic disease diagnosed in the U.S?
Giardia lamblia
What kind of infection does Giardia lamblia cause?
Foul smelling, watery diarrhea (no blood)
Which part of the GI tract does Giardia inhabit?
Duodenum
How is Giardia lamblia transmitted?
Fecally contaminated food or water
Which intracellular parasite lives in the epithelial cells of the small intestines?
Cryptosporidium
How does a Cryptosporidium infection occur?
Ingestion of oocytes found in the feces of house pets and dairy cows.
Which parasite is named the "love bug"?
Trichomonas vaginalis
How does a Trichomonas vaginalis infection present in females?
Yellow/green
Foul smelling discharge
How does a Trichomonas vaginalis infection present in males?
White discharge or
asymptomatic carriers
Which organisms have flagella?
Proteus
Giardia lamblia
Trichomonas vaginalis
Which parasite causes malaria?
Plasmodium
Whar are the signs and symptoms of malaria?
Increased BP and RR
Shortness of breath
Heart failure
What is the most dangerous form of malaria?
P. falciparum
How can you treat malaria?
Chloroquine
Atovaquone
Mefloquin
Primaquin
Which organism produces a "mono-like" disease in adults and brain lesions and encephalitis in newborns and HIV patients?
Toxoplasmosis gondii
What can be done to prevent a toxoplasmosis gondii infection?
Prophylaxis with CD4 count<100
Bactrim DS or Septra QD
Which individuals are most sensitive to toxoplasmosis gondii infections?
Pregnant women (fetus
HIV patients has no IgE)
What is the presentation of toxoplasmosis gondii in healthy adults?
Asymptomatic
Which gram negative bacteria produces IgA protease?
Haemophillus influenzae
Neisseria gonorrhoeae
Neisseria meningitidis
Which organisms ferment lactose?
E. coli (except EIEC strain)
Klebsiella pneumophilia, oxytoca
Enterobacter
Which organisms are non-lactose fermenters?
Salmonella
Proteus
Providencia
Pseudomonas aeruginosa
Actinetobacter baumannii
Which organisms are oxidase positive?
Pseudomonas aeruginosa
Which organisms are oxidase negative?
E. coli
Enterobacter
Klebsiella
Proteus
Providencia
Salmonella
Which organisms have no cell wall and what are the implications?
Mycoplasma pneumoniae
Ureplasma urealyticum

Cannot be treated with cell wall active antibiotics (beta-lactam antibiotics such as penicillins, cephalosporins)
What causes bloody diarrhea?
Entamoeba histolytica
What causes non bloody, super smelly and watery diarrhea?
Giardia lamblia
Where do entamoeba histolytic live in the body, and in what form?
large intestine as trophozoites
Which protozoa can you diagnose by swallowing a string?
Giardia lamblia and entamoeba histolytica
Why can a fecal exam yield a false negative in giardia lamblia?
the cysts inhabit the duodenum
Which protozoa is a flagellate?
Giardia lamblia
What are oocysts from?
Cryptosporidium
What lives in the small intestine?
Cryptosporidium
Cryptosporidium causes serious infections in which type of patients?
HIV patients
Metronidazole is used to treat which protozoas
Trichomonal vaginalis, entamoeba histolytica
Where can trichomonas vaginals infect to cause problems in men and women
cervix, seminal vesicles, and prostate
Which plasmodium is considered the most dangerous?
P. falciparum
How do you diagnose malaria?
parasite in the RBC
How do you use to treat malaria?
chloroquine, atovaquone, primaquin, mefloquin
What can chronic malaria cause?
heart failure due to lack of o2, which causes bp to increase. Makes the heart work too hard for too long
What are mild plasmodiums?
P. malariae, vivax, and ovale
Why is toxoplasmosis gondii bad for fetuses?
Mom has high level of IgE, and so baby fetus gets it too but you cant treat their anaphylactic reaction.
how do you get infected?
cat poo and infected or undercooked meat
what are symptoms of toxoplasmosis gondii
mono like. Newborns/HIV patients develop brain lesions, encephalitis. Can die
What do you use to prophylax t. gondii?
bactrim DS once a day. Also covers pneumocystic pneumonia
What is kaposi's sarcoma?
herpes
How can you treat a Clostridium botulinum infection?
Horse antiserm
What organism causes flaccid paralysis?
Clostridium botulinum
Which organisms are anaerobic, spore-forming, gram positive rods?
Clostridium botulinum
Clostridium difficile
Clostridium perfringens
Clostridium tetani
Which organism produces toxin A and B? What do these toxins cause?
Clostridium difficile produces toxins A and B.
Cause diarrhea and side effects
Which infections are caused by Clostridium difficile?
Antibody associated diarrhea
Pseudomembranous colitis
Acute abdomen and sepsis
How do you treat a Clostridium difficile infection?
Probiotics for little kids
Clindamycin
Oral metronidazole
Oral vancomycin
What is the suspicious finidng of a Clostridium difficile infection?
Spinach green diarrhea without signs of infection (fever, immune response)
What is the clinical significance of the BI/NAP1/027 strain of Clostridium difficile?
Higher relapse rates
Greater mortality rate
Which organism produces a Binary toxin and what does this toxin do?
Binary toxin is produced by BI/NAP1/027 strain of Clostridium difficile.
Binary toxin helps new toxin bind to your intestines.
How is the BI/NAP1/027 strain of Clostridium difficile diagnosed?
Restriction endonuclease analysis
PCR ribotyping or toxinotyping to identify tcdC deletions
What kind of resistance does the BI/NAP1/027 strain of Clostridium difficile cause?
Fluoroquinolone resistance
Which gene mutation prevents toxin production inhibition in C. diff?
tcdC gene
What causes gas gangrene?
Clostridium perfringens
Which anaerobic bacteria causes gas gangrene and food poisoning?
Clostridium perfringens
Which patients are at risk for getting Clostridium perfringens infections?
Diabetics with bad foot wounds
Which toxin is produced by Clostridium tetani? What does it do?
Tetanospasmin toxin
inhibits lysine release --> all muscles flex at the same time. Patient can die of lactic acidosis
What is the treatment of Clostridium tetani?
Antitoxin
Antibiotics
Ventilation
Muscle relaxants
Analgesics
What agent can be used to treat Bacteroides fragilis?
Metronidazole
What enzyme does Bacteroides fragilis produce and what is it's significance?
Beta lactamase --> beta lactams are ineffective
Which organism causes primarily intra-abdominal infections?
Bacteroides fragilis
Which organism causes syphillis?
Treponema pallidum
What assays can be used for treponema pallidum?
Fluorescent Treponemal Antibody Absorption (FTA-ABS)
Microhemagglutinin Treponema Pallidum (MHA-TP) tests
What are the characteristics of the primary stage of syphillis?
Genial lesion (chancre), usually painless and disappears in 2-6 weeks
Lymphadenopathy
What lab values do you look for when diagnosing syphillis?
RPR
VDRL
What are the characteristics of the secondary stage of syphillis?
Up to two years of:
fatigue, fever, myalgia, small oral sores on and off, local or regional alopecia, rash on palms of hand and soles of feet
What are the characteristics of the latent stage of syphillis?
+/- symptoms that are mild
Transmission via sexual contact still possible
+ serology
What are the characterisitics of the tertiary stage of syphillis?
Neuro-syphillis
Cardiovascular syphillis
Which organism is a large spirochete that causes wheal and muscle pain that comes and goes?
Borrelia Burgdoferi
How is lyme disease diagnosed?
serology
What are the characteristics of the 3 stages of lyme disease?
Stage 1: erythema migrans
Stage 2: arthritis, arthralgia, cardiac conduction disturbances, meningitis
Stage 3: progressive CNS dysfunction, fatigue
How can you treat Lyme disease?
IV Rocephin
Chlamydia trachomatis has two distinct forms. What are they and what are their characteristics?
Elementary body: extracellular living, cannot replicate
Reticulate body: intracelluar, divides by binary fusion
How can Chlamydia trachomatis be diagnosed?
Giemsa stain
How do you treat an mycobacterium avium intracellulare infection?
Biaxin 250mg QD-TID or 2000mg Qweek w/12 refills
Which patients are at risk for a MAC (mycobacterium avium complex)?
AIDS patients
Impaired immunity
What are the common symptoms of mycobacterium avium intracellulare infection?
fever, chills, diarrhea, night sweats
fatigue, weight loss
lymphadenopathy
When should you start prophylaxis for mycobacterium avium intracellulare infection?
If CD4 cont <50cells/mm3, then start prophylaxis with azithromycin or clarithromycin
How can mycobacterium avium intracellulare be stained?
Heat or detergent