Micro 1-Liners Cns & Immuno

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357a. Hx: fever, headache, neck stiffness, and altered mental status; Kernig's/Brudzinski's sign other focal neurologic findings, rash, headache, seizures + myalgia; CSF: WBC > 2000 or PMNs > 1200; glucose < 34, protein > 220

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Acute bacterial (pyogenic) meningitis (ABM).

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357b. CSF gram stain of the most likely pathogen of Acute Bacterial Meningitis in a 6 mos-6yr old (or adults > 50 years) should reveal

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Gram-positive diplococcus

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357c. CSF gram stain of the most likely pathogen of Acute Bacterial Meningitis in an older child or young adult should reveal

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Gram-negative diplococcus

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358. Most common cause of sepsis/meningitis in newborns/neonates?

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Streptococcus agalactiae

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359. Cause of fever, headache, photophobia, nausea/vomiting, rash, diarrhea, meningeal signs, in older children in the summer months; CSF with 10-<1,000 WBC typical, mostly monos, moderately elevated protein?

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Enteroviruses (aseptic meningitis)

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360. Cause of aseptic meningitis in men with exposure to rodents?

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Leptospira interrogans

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361. Cause of aseptic meningitis with hx of tick bite and erythema migrans?

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Borrelia burgdorferi

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362. Cause of aseptic meningitis with hx of sex with multiple partners; CSF PCR(+)?

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HSV-2 > 1

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363. Cause of fever, headache, photophobia, meningismus, in pts w/ solid organ transplant, malignancy, corticosteroid use. CSF glucose < 2/3 serum glucose, elevated protein, WBC > 5 with PMNs?

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Listeria monocyotgenes

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364. How does Listeria monocytogenes differ from other β-hemolytic bacteria?

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Gram-positive rods; tumbling motility

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365. Cause of chronic meningoencephalitis in a pt, who uses infliximab or native from endemic region; PE: papilledema. CXR (+). Lab: elevated monocytes on differential, low CSF glucose?

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Mycobacterium tuberculosis

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366. Test to confirm subacute meningoencephalitis in a, immunocompromised pt (CD4 <100); vesicular skin lesions [CSF profile: protein 30-150mg/dl, monos 10-100]?

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CSF India ink

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367. Cause of meningoencephalitis after a hx of respiratory illness after travel to SW USA?

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Coccidioides immitis

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368. Test to confirm CNS pathology with fever, cognitive deficits, focal neurologic signs, seizures; temporal lobe involvement on MRI. Lab: no papilledema, CT (no brain lesion)?

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CSF PCR (+)

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369. Cause of fever, cognitive deficits, focal neurologic signs, seizures, abnormal mental status with ataxia, hemi-paresis, in a pt w/ AIDS?

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JC virus > HHV-6

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370. Cause of fever, cognitive deficits, focal neurologic signs, seizures or abnormal mental status with ataxia in an adult during outdoor activity?

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West-Nile virus > SLE

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371. Cause of fever, cognitive deficits, focal neurologic signs, seizures, in a pt w/ AIDS (CD4 < 100). Brain CT or MRI: multifocal (ring-enhancing) lesions, affecting basal ganglia; Pt receives pyrimethamine + leucovorin + sulfadiazine for life

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Toxoplasma gondii (TE)

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372. Cause of confusion, stiff neck, irritability over wks to months, in immunocompromised pts; CT or MRI = multifocal lesions in midbrain, brain stem, & cerebellum; wet mount CSF = motile macrophage-like organisms.

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Acanthamoeba spp. (GAE)

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373. Cause of severe headache and other meningeal signs, fever, vomiting, and focal neurologic deficits, frequently progressing to coma, in a healthy boy (summer diving activity)?

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Naegleria fowleri (PAM)

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374. Cause of seizures, chronic headache, symptomatic hydrocephalus, in immigrants from Mexico, Central or S. America); pt. successfully responds to praziquantel + anti- convulsant drug?

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Taenia solium (neurocysticercosis)

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375. Hx of fever, lymphadenopathy, chancre, and pruritus weeks ago, in a pt from Africa, progressing to headaches, somnolence, abnormal behavior; pt. responds slowly to pentamidine isothionate or suramin. TOW?

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Trypanosoma brucei (sleeping sickness)

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376. Hx of rigidity, muscle spasm, and autonomic dysfunction. Trismus or lock jaw due to masseter spasm in an infant w/ umbilical stump infection (secondary to poor birth delivery hygiene). Clostridial toxin interferes w/

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GABA and glycine

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377. Hx of foodborne (chili) afebrile illness w/ diplopia, dysarthria, dysphoria, dysphagia, alert, and descending flaccid paralysis in a pt w/ IDU skin poppers with black tar heroin. Clostridial toxin blocks the release of

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acetylcholine

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378. Immediate treatment of a male infant w/ constipation, a weak cry, and drooling, hypotonea and cranial neuropathy, after ingestion of home-processed honey.

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Equine immune globulin (infant botulism)

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379. Ingestion of a raw potato delivers a new vaccine protein to elicit an immune response. The immune structure to interact with the vaccine protein?

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Lamina propria mucosae

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380. Inflammation and the resulting increase in vascular permeability permit leakage into damaged or infected sites are effected by

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Phagocytic cells and acute phase proteins

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381. The serum of a pt, who has IgG and IgM deficiency, appears to fix complement in an assay for tetanus antibodies. What is the explanation?

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Activation of the alternate pathway

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382. A 3-year-old boy with genetic C3 deficiency has recurrent ear and lung infections due to pyogenic bacteria. Deficiency of what?

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B lymphocytes

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383. A very young child, w/ recurrent infections due to Staphylococcus aureus, now has numerous granulomas. TOW?

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Chronic granulomatous dz

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384. Treatment with which protease enzyme causes decrease in avidity of IgG w/o changing the specificity of the antibody?

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Papain

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385. Cells activated by both γ-IFN and CD40 are

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Macrophages

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386. High-dose chemo has caused severe bone marrow suppression in a pt with hematologic malignancy. Reversal is plausible with what?

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GCSF

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387. Function of the T-lymphocyte receptor (CD3) complex of transmembrane proteins?

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Signal transduction

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388. The MHC class I pathway presents an antigen directly to what?

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CD8+ T lymphocytes

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389. HSV infection can block the transfer of antigenic peptides from the cytoplasm to the ER of the infected cells. As a result of this, action of what cell type is compromised?

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CD8+ T cells

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390. Infection of the thyroid gland can induce the expression of MHC II molecules. Which cell types would initiate an autoimmune response, leading to Hashimoto's thyroiditis?

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CD4+ T cells.

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391. PPD skin test (+) in a pt , who was vaccinated against turberculosis in his native country, reflects response of what cell type?

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CD4+ T lymphocytes (Th1 response → γ-IFN)

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392. A man with hx of MI is given a morphine injection for a new episode of chest pain; 10 mins later, he has itching and urticaria. Mechanism of this reaction?

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mediators from sensitized mast cells

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393. Loss of skin pigments, sense of touch, inability to feel objects and pain in a pt from Africa, whose skin scraping contains AFB (Acid-fast bacteria), is caused by

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Th1-mediated DTH (delayed-type hypersensitivity) reactions

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394. A man with polycystic kidney dz, who receives a renal transplant and cyclosporine, develops a high temp and swelling and tenderness in the grafted kidney. TOW?

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Immunity to the donor MHC antigens.

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395. A man who now has progressive stupor and laryngeal spasms for 3 days after pt was being attacked by a wild bat in a cave a month ago should have received

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Inactivated rabies virus vaccine

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396. Alternative and lectin pathways of complements activated by

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bacterial surfaces

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397. Classic complement pathway is activated by antibody- antigen complexes involving antibody class type

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IgM >> IgG

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398. Chemotactic and anaphylotoxic complements are

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C3a, C5a

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399. Successful opsonization of all non-encapsulated bacteria are by complement

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C3b

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400. Defects or deficiency of which complements predisposes individuals to infections caused by Neisseria spp., the causative agents of gonorrhea and meningitis

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C5-C8

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401. Antimicrobial (immune) response important for intracellular bacterial infections involves cell type

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Th1 CD4 T cells

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402. Immune response important for viral infections involves cell type

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CD8 cytolytic T cells

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403. Major antibody in secretions and plays a significant role in first-line defense at the mucosal level is

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IgA

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404. Main antibody in the initial "primary" immune response and allows good complement activation is

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IgM

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405. Fc region of this immunoglobulin binds to eosinophils, basophils and mast cells and is significant mediator of allergic (hypersensitivity) reactions

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IgE

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406. What on macrophages enables them to sense that the material is microbial in origin, and must therefore be eliminated quickly?

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Toll-like receptor

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407. These oxygen-dependent enzymes: NADPH oxidase, superoxide dismutase, and myeloperoxidase are involved in killing of what?

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Gram-positive bacteria

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408. These oxygen-independent enzymes/proteins: lysosome, lactoferrin, defensins and other cationic proteins are involved in killing of what?

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Gram-negative bacteria

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409. Infections persist, because mφ [macrophage] activation is defective, leading to chronic stimulation of CD4+ T cells in what dz?

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Chronic granulomatous Dz

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410. Defective respiratory burst, predisposing to chronic bacterial infection is associated with deficiency of what?

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Glucose-6-phosphate dehydrogenase (G6PD)

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411. All nucleated cells express MHC I antigens

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HLA-A, B, C

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412. Antigen-presenting cells express MHC II antigens

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HLA-DP, DQ, DR

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413. Lymphocyte proliferation (T, B) and NK → cytotoxicity are undertaken by what cytokine?

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IL-2

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414. B-cell activation, IgE and IgG4 switch, ↓ TH1 cells/ Mφ, ↓ IFN-γ, TH0 → TH2 are all undertaken by what cytokine?

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IL-4

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415. Mφ [Macrophage] activation; elevated expression of MHC and FcRs molecules on B cells, IgG2 class switching, increased IL-4 and TH2 are all undertaken by what cytokine?

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IFN-γ

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416. The Th1 response, driven primarily by IFN-γ leads to the activation of

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macrophages

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417. The Th2 response, driven primarily by IL-4 and IL-5, leads to the production of IgE and IgG4 and to the activation of

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mast cells and eosinophils.

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418. Variable T and B cells in DiGeorge's syndrome is associated with

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Thymic aplasia

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419. No B cells and immunoglobulins in X-linked agammaglobulinemia (Bruton's) is associated with

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Loss of Btk tyrosine kinase

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420. Lack of anti-polysaccharide antibody and impaired T-cell activation causing Wiskott-Aldrich syndrome is associated with

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X-linked-defective WASP gene

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421. Inability to control B cell growth in X-linked lympho- proliferative syndrome is associated with

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SH2D1A mutant

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422. Glomerulonephritis, pulmonary hemorrhage in Goodpasture's syndrome is caused by what autoantigen?

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basement membrane (collagen type IV)

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423. Hyperthyroidism in Grave's disease is caused by what autoantigen?

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TSH

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424. Progressive muscle weakness in Myasthenia gravis is caused by what autoantigen?

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Acetylcholine receptor

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425. Brain degeneration, paralysis in Multiple sclerosis (MS) is caused by what autoantigen?

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Myelin basic protein, proteolipid protein

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426. Localized allergies (e.g., drug allergy, asthma, hay fever) and anaphylaxis (food, drug) w/ systemic inflammation throughout circulation are associated with reaction?

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Type I hypersensitivity

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427. Autoimmune hemolytic anemia: Ab’s produced vs RBC membrane Ag’s, mismatched blood (transfusion rxn), and allergies to antibiotics (e.g., penicillins, sulfa drugs) are associated with reaction?

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Type II hypersensitivity

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428. Grave's Disease, Myasthenia Gravis, Goodpasture's syndrome are all associated with reaction?

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Type II hypersensitivity

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429. Post-streptococcal glomerulonephritis, serum sickness to horse diphtheria anti-toxin, systemic lupus erythematosis (SLE), and rheumatoid arthritis are all associated with reaction?

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Type III hypersensitivity

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430. Poison ivy, erythematous induration in tuberculin skin test, and transplantation/graft rejection are all associated with reaction?

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Type IV hypersensitivity