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197 Cards in this Set
- Front
- Back
- 3rd side (hint)
viruses consist of either
______or _________ wrapped w/in a protein nucleocapsid |
DNA or RNA
|
|
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VIRUSES ARE COVERED BY AN ENVELOPE OF _______AND_______
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GLYCOPROTEINS AND LIPIDS
|
|
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T/F VIRUSES POSSESS NO METABOLIC MACHINERY
|
TRUE
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|
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entirely dependent on host cells for _________and__________and are therefore obligate intracellular parasites
|
protein synthesis and replication
|
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All must attach to receptors on the host cell and achieve entry into the cell through mechanisms that include: (3)
|
receptor-mediated endocytosis, fusion, and pinocytosis
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Once within the cells, the virus uncoats, allowing its nucleic acid to utilize host cellular machinery to reproduce (___________) or to integrate into the host cell (___________).
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productive infection
latent infection |
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influenza virus, cause disease by ________of infected cells
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lysis
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_____________, do not directly cause cell destruction but may involve the host immune responses in the pathogenesis of disease
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hepatitis B virus
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_____________, promote neoplastic transformation of infected cells
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human T-lymphotropic virus type 1(HTLV-1)
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By multiplying within host cells, viruses can avoid ____________antibodies
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neutralizing
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Some viruses can spread to uninfected cells by
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intercellular bridges
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viruses capable of persisting latently for prolonged periods
(2) |
HSV
HIV |
|
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CAPABLE OF GENE REARRANGEMENT
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INFLUENZA
|
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___________ : proteins that are responsible for a number of progressively fatal neurologic diseases in humans, such as kuru, Creutzfeldt-Jakob disease (CJD), and familial fatal insomnia, and animal diseases such as scrapie and bovine spongiform encephalopathy ("mad cow disease").
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PRIONS
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Prions are encoded by
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host genes
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some prion diseases (e.g., familial CJD) are ________, others, including kuru and new variant CJD are acquired through consumption of infected ____________. There is no known treatment for these disorders
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inherited
neural tissue |
|
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varied group of organisms that are generally capable of cell-free growth, although some produce disease as intracellular parasites
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BACTERIA
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COMMON STD CAUSED BY A BACTERIUM WHICH CAN DAMAGE A WOMAN'S REPRODUCTIVE ORGANS
|
CHLAMYDIA TRACHOMATIS
|
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S/S OF CHLAMYDIA IN MALES
|
DISCHARGE FROM PENIS
|
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T/F CHLAMYDIA CAN CAUSE "SILENT" INFERTILITY BEFORE A WOMEN RECOGNIZES THE PROB
|
TRUE
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MOST FREQUENTLY REPORTED STD
IN 2004= 929,462 REPORTS |
CHLAMYDIA
|
|
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HOW MANY PEOPLE ARE INFECTED W/ CHLAMYDIA EACH YEAR?
|
2.8 MILLION
|
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Chlamydiae are also obligate intracellular parasites; they always contain both DNA and RNA, divide by ___________(rather than multiplying by assembly
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binary fission
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Chlamydia trachomatis causes _________, the major cause of _____________in the developing world, and a variety of sexually transmitted genitourinary disorders
|
trachoma
blindness |
|
|
Chlamydia pneumoniae is a common cause of :(3)
|
atypical pneumonia, bronchitis,
sinusitis |
|
|
the cause of a common infectious disease of birds, can produce a serious systemic illness with prominent pulmonary manifestations in humans
|
Chlamydia psittaci
|
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Chlamydiae are susceptible to ________AND ________ antibiotics
|
tetracyclines and the macrolide
|
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obligate intracellular parasites. They are primarily animal pathogens that generally produce disease in humans through the bite of an insect vector, such as a tick, flea, louse, or mite
|
Rickettsiae and ehrlichiae
|
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With the exception of Q fever and human ehrlichiosis, _________________is a prominent manifestation of these often disabling febrile illnesses
|
rash caused by vasculitis
|
|
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Rickettsiae and ehrlichiae are susceptible to:
|
tetracyclines and chloramphenicol
|
|
|
smallest free-living organisms and have no cell walls
|
MYCOPLASMAS
|
|
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Mycoplasma pneumoniae is an agent of (2)
|
pharyngitis and pneumonia
|
|
|
primarily agents of genitourinary disease
|
Mycoplasma hominis Ureaplasma urealyticum
|
|
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Mycoplasmas are sensitive to
|
erythromycin, tetracycline
|
|
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organisms that are not readily seen under the microscope unless stained with silver or viewed under darkfield illumination
|
SPIROCHETES
|
|
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4 genera of spirochetes cause disease in humans. Treponema species include the pathogens of :
|
YAWS
PINTA BEJAL SYPHILIS |
Y PBS
|
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The illnesses caused by these organisms are chronic and characterized by:
|
prolonged latency in the host
|
|
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t/f Penicillin is active against Treponema.
|
TRUE
|
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LEPTOSPIRA CAUSES:
|
ACUTE AND SUBACUTE FEBRILE ILLNESSES
|
|
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BORRELIA ARE ARTHROPOD BORNE THAT CAUSE:
|
LYME DISEASE
|
|
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organisms that cannot grow in atmospheric oxygen tensions
|
ANAEROBES
|
|
|
cause well-defined systemic illnesses such as food poisoning, tetanus, and botulism
|
Clostridium
|
|
|
Clues to the presence of anaerobic infection include (2)
|
(1) a foul odor
(2) the presence of gas, which may be seen radiographically |
|
|
Many pathogenic anaerobes are sensitive to penicillin. exceptions are:
|
Clostridium difficile, which is almost always sensitive to metronidazole and vancomycin
|
|
|
pink on a properly prepared Gram stain
|
gram negative bacteria
|
|
|
Gram-negative bacteria are the most common cause of:
|
cystitis
pyelonephritis |
|
|
Haemophilus species are common pathogens of the respiratory tract and cause:
|
otitis media, sinusitis, and pneumonia
|
|
|
cause of meningitis, particularly in children
|
Haemophilus
|
|
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Except for Haemophilus species, ___________are uncommon causes of community-acquired pneumonia but are common causes of nosocomial pneumonia.
|
gram-negative bacteria
|
|
|
Enterobacteriaceae include:
(these are large gram - rods) |
Escherichia coli,
Klebsiella, Enterobacter, Serratia, Salmonella, Shigella, Proteus |
PKSE
|
|
The Enterobacteriaceae can be thought of as ____________
|
gut-related or genitourinary pathogens
|
|
|
cause of enteritis
|
salmonella
|
|
|
agent of bacterial dysentery
|
shigella
|
|
|
can cause staghorn calculi (renal stones)
|
proteus
|
|
|
gram neg cocci
|
neissaria and moraxella
|
|
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Neisseria meningitidis is an important cause of _______, and Neisseria gonorrhoeae causes _________
|
meningitis
gonorrhea |
|
|
appear deep purple on Gram stain
|
GRAM-POSITIVE BACTERIA
|
|
|
can infect any organ system. It is a common cause of bacteremia and sepsis. The organism often colonizes the anterior nares
|
staph aureus
|
|
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Hospital workers colonized with S. aureus have been responsible for __________
|
hospital epidemics
|
|
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Staphylococci tend to form ____________
|
abscesses
|
|
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Staphylococcal toxins also mediate the scalded skin syndrome and the multisystem manifestations of :
|
toxic shock syndrome
|
|
|
GRAM + BACTERIA:
INCREASING PROPORTION IS _____ RESISTANT _________REMAINS ACTIVE |
PEN
VANCOMYCIN |
|
|
CAUSES UTI'S
|
S SAPROPYTICUS
|
|
|
CAUSES SKIN INFECTIONS AND PHARYNGITIS
|
STREPTOCOCCI
|
|
|
the most common cause of bacterial pneumonia and an important cause of meningitis and otitis media; use high dose PCN
|
strept pneumoniae
|
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acid fast and retain dye when washed
|
mycobacteria
|
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slow-growing (some require up to 6 weeks to demonstrate growth on solid media), obligate aerobes
|
TB
|
|
|
an important cause of disseminated infection among patients with AIDS
|
M. avium complex (MAC)
|
|
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disease of skin and peripheral nerves
|
leprosy
|
|
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produce osteomyelitis and abscess, pneumonia
|
Nocardia and Actinomyces
|
|
|
tx Nocardia w/:
|
sulfonamides
|
|
|
oval yeasts that often colonize the mouth, gastrointestinal tract, and vagina of healthy individuals
|
CANDIDA
|
|
|
may produce disease by overgrowth and/or invasion.
_______often occurs in individuals who are receiving antibiotic or corticosteroid therapy |
Candida stomatitis (thrush)
|
|
|
FUNGI COMMONLY CAUSE:
CANDIDA IN THE BLOOD CAN CAUSE: |
YEAST INFECTIONS
SEPSIS |
|
|
Mucosal candidiasis can be treated with
|
fluconazole
|
|
|
fungus endemic to the Ohio and Mississippi River valleys. Mild febrile syndromes tx w/ ____________
|
Histoplasma capsulatum
amphotericin B |
|
|
most common clinical manifestation of infection with this fungus is a chronic meningitis; seen in immunocompressed
|
Cryptococcus neoformans
|
|
|
mold that causes pneumonia
|
aspergillus
|
|
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This organism causes life-threatening pneumonia in patients with impaired cell-mediated immunity; it is the most common major opportunistic pathogen in persons with AIDS
|
Pneumocystis carinii
|
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Diseases caused by __________are among the most prevalent diseases in the developing world but are uncommon causes of illness in North America.
|
helminths
|
|
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HELMINTHS
HOOKWORMS CAUSE: PINWORMS CAUSE: |
GI BLOOD LOSS
ANAL PRURITIS - SCOTCH TAPE TEST |
|
|
as a result of infection from a microbial parasite, pathological harm to the host becomes evident
|
infectious disease
|
|
|
groups of host defense mechanisms:
|
1. constitutive
2. inducible |
|
|
common to all healthy animals; provide general protection;
~"natural or innate" resistance |
constitutive
|
|
|
defense mechanism that must be induced; not immediate after host is exposed to parasite
involves the immune responses to pathogen causing infection |
inducible
|
|
|
skin and mucosal surfaces;
cough and gag reflexes to expel aspirated secretions; chemical agents such as acids and defensins with antimicrobial properties. |
ANATOMIC DEFENSES
|
|
|
These defenses are primarily located at sites with proximate environmental contact
|
ANATOMIC DEFENSES
|
|
|
interference with anatomic defense mechanisms may increase the risk of:
|
infection
|
|
|
One of the most important of these humoral defenses is the
|
complement system
|
|
|
Complement activity results from the sequential interaction of a large number of:
|
plasma and cell membrane interactive proteins.
|
|
|
The classic complement pathway is activated by:
|
antibody-coated targets or antigen-antibody complexes
|
|
|
COMPLEMENT ENZYMES ARE INVOLVED IN:
|
-LYSIS OF CERTAIN BACTERIA, VIRUSES, AND OTHER MICROORGANISMS
-PHAGOCYTIC CHEMOTAXIS -OPSONIZATION -INFLAMMATORY RESPONSE |
|
|
Ig_ AND _ CAN "FIX COMPLEMENT" B/C OF A BINDING SITE ON THE Fc
|
IgG
IgM |
|
|
IgG AND Ag "CASCADE REACTION"
|
1. generate inflammatory factors(C3a, C5a)
2. attract phagocytes 3. enhance phagocytic engulfment 4. lysis of bacterial cells or virus infected cells |
|
|
Persons with complement deficiencies, particularly deficiencies in terminal components, are especially at risk for repeated infections with gram-negative encapsulated bacteria, especially _________species.
|
Neisseria
|
|
|
large Y shaped protein
|
antibody
|
|
|
antibodies are used by the ________system to identify ________and________
|
immune system
bacteria and viruses |
|
|
production of antibodies is the main function of:
|
humoral immune system
|
|
|
immunoglobins are
-found in: -synthesized and secreted by: |
blood,tissue fluids,secretions
plasma cells that are derived from B cells |
|
|
B cells are activated upon binding to their specific antigen and differentiate into
|
plasma cells
|
|
|
cells that ingest microorganisms via phagocytosis; also involved with _______
|
phagocyte
apoptosis |
|
|
phagocytes are useful in ________ RESPONSE TO TISSUE DAMAGE
|
IMMUNE SYSTEM
|
|
|
T cells are a type of ______that play a role in __________
|
WBC
CELL MEDIATED IMMUNITY |
|
|
PART OF THE INNATE IMMUNE SYS; ATTACK CELLS INFECTED BY MICROBES, BUT NOT MICROBES THEMSELVES
|
NATURAL KILLER CELLS
|
|
|
PROTEINS PROD BY IMMUNE SYS IN RESPONSE TO VIRUSES, BACTERIA, PARASITES, AND TUMOR CELLS
|
INTERFERONS
|
|
|
INTERFERONS BELONG TO TO THE LARGE CLASS OF ______KNOWN AS ________
|
GLYCOPROTEINS
CYTOKINES |
|
|
IMMUNE RESPONSE NOT INVOLVING Ab BUT MACS AND NK CELLS, AG SPECIFIC T LYMPHOCYTES, AND RELEASE CYTOKINES
|
CELL MEDIATED IMMUNITY
|
|
|
BRANCH OF IMMUNE SYS W/
PROTECTIVE FX FOUND IN SERUM: ASSOC W/ CELLS: |
HUMORAL
CELLULAR |
|
|
Streptococcus pneumoniae
The type-specific polysaccharide capsule is a major virulence factor because of its __________properties |
antiphagocytic
|
|
|
T/F In the absence of immunity, pneumococci reaching the alveoli are not effectively contained by the host
|
TRUE
|
|
|
___________ of s. pneumo promotes oxidative burst activity causing destruction of the organism
|
Opsonization
|
|
|
Capsular polysaccharide also represents an important virulence factor for meningococci
|
Neisseria meningitidis
|
|
|
pathogenic Neisseria species produce an ___ protease that dissociates the ___ molecule;
|
IgA
IgA |
|
|
patients lacking__________ are suceptible to meningococcal infection
|
C6, C7, or C8
|
|
|
escape intracellular digestion by secreting products that inhibit phagolysosomal fusion
|
MYCOBACTERIUM TUBERCULOSIS
|
|
|
any agent that can cause trouble to the immune sys
|
pathogen
|
|
|
first line of defense against dz. not directed at particular pathogen:
defend against particular pathogen: |
nonspecific
specific |
|
|
most important nonspecific defense
|
skin
|
|
|
tissues that protect the interior surfaces of body;
sticky fluid that traps pathogens |
mucous membranes
mucus |
|
|
trap viruses and bacteria in nose and throat
|
mucus, cilia, hairs
|
|
|
enzyme breaks down cell wall of bacteria
|
lysozyme
|
|
|
most common phagocyte (WBC)
|
neutrophil
|
|
|
substance that triggers the specific defenses of the immune sys
|
antigen
|
|
|
organs involved in immune response
|
bone marrow
thymus lymph nodes tonsils adenoids spleen |
|
|
manufactures WBCs:
filter pahtogens from lymph: filters pathogens from blood: |
bone marrow
lymph nodes spleen |
|
|
T cells mature in _______
_____ directly kill invaders _____ help B & T cells |
Thymus
Cytotoxic Ts Helper Ts |
|
|
B and Ts develop capability to prod Abs:
response to similar antigen is faster b/c B cells remember: |
primary response
sedondary response |
|
|
can det harmful or not and self from nonself:
no central control: infinite possible Abs: remembers antigens: nonused cells are discarded, new cells created continuous: |
Recognition
Distrib.& Self Regulate Diversity Learning & Memory Metadynamics |
|
|
TESTS FOR PRESENCE OF CRYPTOCOCCUS *MOST COMMON CNS FUNGUS*
causes pneumonia and can cause meningitis; seen in immunocompressed |
INDIA INK
|
|
|
DET PRESENCE OF FUNGI IN SKIN, NAILS OR HAIR
|
KOH PREP
|
|
|
Herpes blister scrapings are placed on a glass slide, air dried, and stained with Wright stain
|
TZANCK PREPARATION
"TZANCK god i don't have HERPES" |
|
|
herpes background looks like ground glass and has dark spots called ________
|
inclusion bodies
|
|
|
Diseases Often Diagnosed by Detection of Microbial Antigens:
Meningitis Resp tract infection GU tract infection Hep B |
Latex agglutination
Immunoflourescence Enzyme immunoassay Radioimmunoassay |
|
|
Examine Host Response:
PMN's Lymphocytic infiltrates Eos Granulomas |
Acute Bac.Infection
Virus,Fungal, and mycobac. Helminthic infection Fungal Infection |
|
|
all viral pathogens that can be cultured require ___________in which to grow
|
eukaryotic cells
|
|
|
**Strep Pneumo**
H flu Less common: Staph, strep pyogenes, pseudomonas, moraxella |
acute sinusitis
|
|
|
bacteria causing CAP
|
strep pneumo
|
|
|
Hepatitis
liver complications: pregnancy risk: fecal-oral: Has vaccine: |
C
E A,E A,B |
|
|
Chronic Hep C tx:
|
Interferon
Ribaviron |
|
|
Gram negative bacteria that form a normal part of the human flora. They are a frequent cause of _________in children.
|
endocarditis
|
|
|
HACEK
|
Haemophilus aphrophilus and Haemophilus paraphrophilus
Actinobacillus actinomycetemcomitans Cardiobacterium hominis Eikenella corrodens Kingella kingae |
|
|
normal bac flora in
skin nose mouth plaque |
skin - staph epidemidis
nose - staph aureus mouth - streptococci plaque - strept mutans |
|
|
normal flora for
gingival crevices: throat: colon: vagina: |
gingiva - anaerobes
throat - streptococci colon - fragilis, E coli vagina - bacillus, E coli |
|
|
The classical triad of meningitis are:
|
fever, headache, and nuchal rigidity ("neck stiffness")
|
|
|
Bacterial meningitis is usually caused by:
|
**Streptococcus pneumoniae and Neisseria meningitidis
|
|
|
a medical history, a chest X-ray, and a physical examination. It may also include a skin test, a serological test, microbiological smears and cultures
|
dx tests for TB
|
|
|
Transmission occurs most commonly through blood and blood products, contaminated needles, and sexual contact. High-risk transmission groups include the following: sexual partners of acutely and chronically infected persons, with male homosexuals being at particularly high risk, intravenous drug abusers, infants of infected mothers
|
HBV
|
|
|
isoniazid, rifampicin, pyrazinamide and ethambutol for two months, then isoniazid and rifampicin alone for a further four months
|
tx for TB
|
|
|
Rheumatic fever Jones Criteria
|
JONES crITERIA:
· Major criteria: Joint (arthritis) Obvious (Cardiac) Nodule (Rheumatic) Erythema marginatum Sydenham chorea · Minor criteria: Inflammatory cells (leukocytosis) Temperature (fever) ESR/CRP elevated Raised PR interval Itself (previous Hx of Rheumatic fever) Arthralgia |
|
|
to dx RF, Need 2 major or 1 major and 2 minor criteria, plus evidence of recent ___infection
|
GAS
|
|
|
mnemonic that can be used to remember the bacteria that cause UTIs is SEEK PP
|
Staph saprophyticus, E. coli, Enterococcus, Klebsiella, Proteus, Pseudomonas
|
|
|
Lyme Dz. symptoms
1.Acute(early) 2.Chronic |
1.Erythema migrans rash
2. Bell's Palsy or meningitis 3. Recurrent arthritis |
|
|
Rocky Mountain spotted fever is the most severe and most frequently reported ________illness
|
rickettsial
|
|
|
If allergic to PCN, use:
|
clindamycin
azithromycin clarithromycin |
|
|
Some studies reported a correlation between use of aspirin or other salicylates in children and adolescents who have a viral infection such as influenza or chicken pox and causes liver failure
|
Reye's syndrome
|
|
|
these bact are assoc w/:
botulinum C perfringen |
clostridium botulinun dz
gas gangrene seen on x-rays |
|
|
vaccine for hep B
hep A |
0,3,6 mo
0,6 mo |
|
|
10 mil cfu/ml
|
Bacteremia
|
|
|
+ leukocyte esterases suggests
|
UTI
|
|
|
Gram - causes ______in hospital pts
|
sepsis
|
|
|
______ are resistant to gram stains.
|
mycobacterium
|
|
|
early stage tx: doxycyclin, amoxacillin, cefuroximine, clarithromyacin, azithromyacin
Tx = 14-21 days late state tx: ceftriaxone 3rd gen cephalosporine |
tx for Lyme dz
|
|
|
dental extraction in high risk pt w/ bacterial endocarditis tx w/
|
amoxicillan or a macrolide: erythromycin
azithromycin (Zithromax®) clarithromycin (Biaxin®) dirithromycin (Dynabac®) roxithromycin (Rulid®, Surlid®) |
|
|
__________ has replaced pcn and ampicilin for tx of gonorrhea
|
ceftriaxone
|
|
|
Chlamydiae are susceptible to:
|
tetracyclines and the macrolide antibiotics(azithromycin)
|
|
|
how do you get g- salmonella/shigella
tx: |
water, food, fecal oral, and sex
tx = bactrim or fluoroquinolone |
|
|
immunocompromised
advanced age alcohol |
risk factors for CAP
|
|
|
immunocompetent are recommeded to get pneumovac at age ___ every _____yrs
|
65
6 |
|
|
causes nosocomial hospital acquired pneumonia
|
staph
|
|
|
prob cause of septic arthritis of one joint in young female
labs: |
gonococcal
joint tap |
|
|
# 1 cause of bac meningitis in a kid < 1
|
s pneumo
|
|
|
immunoglobin assoc w
early response: mast cell and paracytic infx: |
IgM
IgE |
|
|
Silver stain for ________ and tx with _________
|
PCP in aids pts
tx = bactrim |
|
|
walking pneumo causes
|
chlamydia and mycoplasm
|
|
|
tx of C Difficile:
|
1. flagyl (AKA Metronidazole)
2. vancomycin 3. stool transplant ? |
|
|
With the exception of aminoglycosides and certain azalide and macrolide antibiotics, agents (TCN) inhibiting protein synthesis at ribosomal sites are generally ___________.
_______ destroy the cell wall ex: PCN |
bacteriostatic
bactericidal |
|
|
bacteriostatic
buy AT 30s: CEll at 50s: |
30:aminoglycosides
tetracyclines 50:clarithromycin chloramphenicol, clindamycin, erythromycin |
|
|
fever >101 for 3 wks.
>105.5 |
FUO
hyperthermia |
|
|
name the cause
Q fever: Lyme dz: Toxoplasmosis from cat feces: Leptospirosis from urine of infected dogs, cats, animals: Brucellosis/Undulant fever: |
coxiella burnetii
borrelia burgdorferi toxoplasma gondii leptospira interrogans brucella (cattle,pigs,goats unpasteurized dairy prods) |
|
|
causes of
malaria TSS syphilis and tx |
plasmodium
staph aureus treponema pallidum tx 2.4 mill Units of PCN |
|
|
measles assoc with _____ spots:
|
copplex spots
|
|
|
most common opportunistic pathogen in persons w/ AIDS:
seen in SW;produces pneumonia in immunocompromised pts; treat w/ ampho B: |
PCP
coccidioides immitis |
|
|
Name the organism;
obligate intracell parasite, always have DNA and RNA, divide by binary fission, depend on host for survival: leading cause of blindnes in developing world: |
chlamydiae
C. Trachomatis |
|
|
Name the bacteria;
toxin mediates the multi system manifestations of TSS, Abcess formers: G - causes renal stones: |
Staph aureus
Proteus |
|
|
prion dz acquired from consumption of infected neural tissue
|
Kuru
|
|
|
Pneuococcus is assoc w/ what color sputum?
Rice water stools are assoc w/ which pathogen? |
rusty
vibrio cholerae |
|
|
plague causing organism uses rodents and prairie dogs as its vector:
|
Yersinia Pestis
|
|
|
this animal kills the most humans worldwide:
preferred tx for pneumococcal pneumonia? |
mosquitos
PCN G or 3rd gen cephalosporin |
|
|
agar in which N gonorrhea is grown on?
tx for gonococcal urethritis: |
chocolate
250mg IM ceftriaxone 100mg doxycycline po x 7d |
|
|
Antibodies are large polypeptides that are produced by B lypocytes and plasma cells which may facilitate ingestion of the microbe by phagocytes in a process named?
|
opsonization
|
|
|
name the Ig;
role in allergy by triggering mast cell activation,mediates responses in parasitic infections: comprises the earliest immune response: most prevelent in blood: |
IgE
IgM IgG |
|
|
people w/ complement deficiencies are at risk for repeated infections w/ which bug?
woman + gonorrhea, + painful cervicitis present w/ what sign? |
Neisseria
chandelier sign |
|
|
_________ means eating cell from greek word 'phagein'
|
phagocytosis
|
|
|
grey baby
red man syndrome orange-red urine, tears |
chloramphenicol
vancomycin rifampin |
|
|
pseudomembranous colitis
tx leprosy |
clindamycin
dapson |
|
|
butterfly appearance
rash on hands |
SLE
syphilis |
|
|
SW
MISS AND OHIO RIVER VALLEYS STATES EAST OF MISS RIVER AND CENTRAL AMERICA |
COCCIDIOIDOMYCOSIS
HISTOPLASMOSIS BLASTOMYCOSIS |
|