Micro Exam 2 Winter

Front 1

Where is Tinea barbae located?

Back 1

beard

Front 2

Where is Tinea capitis located?

Back 2

scalp

Front 3

Where is Tinea corporis located?

Back 3

arm, leg, and torso

Front 4

Where is Tinea cruris located?

Back 4

groin

Front 5

Where is Tinea manus located?

Back 5

hand

Front 6

Where is Tinea pedis located?

Back 6

foot

Front 7

Where is Tinea unguium located?

Back 7

nail

Front 8

Where should the specimen of dermatophytes be taken from?

Back 8

under the nails if the patient will tolerate it

Front 9

What do you culture dermatophytes on?

Back 9

sabouraud agar (1-4 weeks)
or
Dermatophyte test medium (DTM) for early detection (within 3 days) because it is based on a rapid phenol red color change

Front 10

What is the infective stage of dermatophytes?

Back 10

arthroconidium

Front 11

What does a lack of delayed-type reaction in a dermatophyte infection indicate?

Back 11

more likely the person will develop a chronic infection

Front 12

What is the most prevalent dermatophyte of humans?

Back 12

T rubrum

Front 13

What is the second most prevalent dermatophyte of humans?

Back 13

T mentagrophytes

Front 14

How do azoles help with fungal infection?

Back 14

interfere with sterol synthesis

Front 15

How does griseofulvin help with fungal infections?

Back 15

interferes with microtubule function and mitosis

Front 16

What do you treat Tinea Capitis with?

Back 16

Griseofulvin

Front 17

Which Trichinela bug causes most human cases in the US?

Back 17

T. spiralis

Front 18

What is the infective stage of Trichinella?

Back 18

larvae

Front 19

What is Fournier's Gangrene?

Back 19

Subtype of Type 1 Necrotizing fasciitis of male or female genitalia

Front 20

What microbes are found in nonclostridial myonecrosis?

Back 20

Anaerobes:
Bacteroides fragilis
Peptostreptococcus
Aerobes:
Gram + - Staph aureus

Front 21

Do anaerobes prefer acidic or alkaline conditions?

Back 21

acidic (and low oxygen tension)

Front 22

If it is below the diaphragm and gram negative what is a pretty good guess as to what the microbe is?

Back 22

Bacteroides fragilis

Front 23

What does Metronidazole do to bacteria to destroy it?

Back 23

disrupts DNA structure

Front 24

What does Clindamycin do to bacteria to destroy it?

Back 24

inhibits protein synthesis

Front 25

What are some clues for diagnosing anaerobic infections?

Back 25

infection contiguous to a mucosal surface
foul or sickly sweet smelling dishcarge
severe tissue necrosis with fasciitis
abscess formation or gangrene
gas production - blebs/bullae or crepitant skin
gram-stain of exudate shows mixed populations or unique morphology (fusobacterium)

Front 26

Which antibiotics can NOT be used in treatment of anaerobic infections?

Back 26

aminoglycosides - not effective acidic environment - oxidative enzymes
Sulfa drugs - lysed human cells release folic acid
Penicillin - B. fragilis & strains of Prevotella - beta lactamase

Front 27

Which antibiotics CAN be used in treatment of anaerobic infections?

Back 27

Clindamycin
Metronidazole - reduced in anaerobes, interacts with DNA
Combination drug therapy - cover both Gram (-) and Gram (+) genera
Polymicrobic infections are collectively resistant to multiple antibiotics

Front 28

What is the "first" disease of childhood?

Back 28

measles (rubeola)

Front 29

What is the second disease of childhood?

Back 29

scarlet fever

Front 30

What is the hallmark of Rubeola/Measles that allows for direct cell-to-cell infection?

Back 30

Formation of infected cell syncytia (Giant cells) due to cell fusion

Front 31

What are the 3 C's of Measles?

Back 31

Coryza
persistent Cough
Conjunctivitis

Front 32

What is a diagnostic clinical manifestation of measles?

Back 32

Koplik's spots on buccal mucosa

Front 33

How does the rash of measles appear/spread?

Back 33

starts below ears, spreads over forehead, to faces, to neck, trunk, and extremities in 3 days

Front 34

How does the rash of measles fade?

Back 34

in same order that it appears

Front 35

Who gets atypical measles?

Back 35

Patients who received the fomalin-inactivated vaccine who are later exposed to mild type virus or newer generation vaccines

Front 36

Where does the rash of atypical measles form? What is the pattern?

Back 36

Rash on palms/soles with a centripetal spread that spares the face

Front 37

What do the sx of atypical measles resemble?

Back 37

RMSF

Front 38

What is the most frequent life-threatening measles complication?

Back 38

pneumonia

Front 39

What kind of virus is measles?

Back 39

paramyxovirus - genus mobillivirus

Front 40

Who is at greatest risk for complications of measles?

Back 40

malnourished and aged

Front 41

What is a rare but fatal complication of measles?

Back 41

SSPE

Front 42

What might contribute to development of complicating secondary infections in measles?

Back 42

virus-induced immunosuppression

Front 43

A substantial number of measles patients will have one complication? (0.5%)

Back 43

acute symptomatic encephalitis

Front 44

What feature of the actual measles virus is actually good for us to make vaccines?

Back 44

linear non-segmented genome

Front 45

Where does measles virus replication occur?

Back 45

in the host cytoplasm

Front 46

What does the measles virus bring along with it to the party ?

Back 46

RNA polymerase in it's capsid (because it is negative sensed!!!!!)

Front 47

What does the F protein of measles virus do?

Back 47

fusion proteins responsible for infection spreading

Front 48

What does the H protein of measles do?

Back 48

hemagglutinin needed for attachment to host cell

Front 49

How is measles transmitted?

Back 49

via respiratory droplets

Front 50

When and how long are measles patients contagious?

Back 50

during prodrome until 4-5 days after rash erupts

Front 51

How is measles primarily diagnosed? What is wrong with this now?

Back 51

By clinical findings but many physicians now lack experience with this disease

Front 52

What would an FA on cells obtained from swabs of the pharynx, buccal mucosa, nasal cavity show in a case of measles?

Back 52

multinucleated giant cells!! (remember this virus forms infected cell syncytia due to cell fusion)

Front 53

What kind of vaccine is the MMR?

Back 53

live attenuated

Front 54

When is the first dose, and subsequent doses of MMR given?

Back 54

first at 12-15 mos of age then 4-6 years for second dose (or anytime 1 month after 1st dose)

Front 55

What is no longer a concern due to the MMR vaccine?

Back 55

atypical measles

Front 56

What can increase measles severity? (especially in developing countries)

Back 56

Nutritional imbalances especially Vitamin A deficiency - vitamin A supplementation could reduce measles mortality by up to 50%

Front 57

In whom is the MMR vaccine contraindicated?

Back 57

neomycin and/or egg sensitivity
pregnancy
immunocompromise of any sort

Front 58

What is the 3rd disease of childhood?

Back 58

Rubella/German Measles

Front 59

What kind of virus is the Rubella virus ?

Back 59

Togavirus (with unique attribute - the only togavirus spread by respiratory route that we talk about and also lacks cytopathic effects)

Front 60

How does the rash of German Measles appear?

Back 60

maculopapular rash appears first on face and spreads downward

Front 61

What is Rubella sometimes confused as?

Back 61

scarlet fever

Front 62

How does German measles spread?

Back 62

respiratory droplets (Which is weird because it is a togavirus!)

Front 63

When are both Measles and German Measles prevalent (what time of year)

Back 63

Spring

Front 64

When and how long are Rubella virus released?

Back 64

7 days prior to 14 days following rash

Front 65

When and how long are Rubella pts communicable?

Back 65

5 days prior to 5 days after rash appears (**close and prolonged contact probably needed for infection)

Front 66

What is congenital rubella syndrome (CRS)?

Back 66

Maternal infection (viremia) may lead to placental infection and fetal infection. Substantial risk to feus - the real danger - it's unremarkable at other times in life!

Front 67

What led to the initial recognition of congenital defects with rubella infection?

Back 67

eye defects - cataracts, glaucoma in the neonate

Front 68

What are the manifestations of CRS?

Back 68

Cardiac defects (pulmonary artery stenosis, PDA)
Eye defects (cataracts, glaucoma)
Hearing loss (may be profound)
CNS involvment (canlead to autism)

Front 69

How is rubella commonly diagnosed?

Back 69

detection of antibody

Front 70

What is special about the viremia/communicable effect of a CRS pt?

Back 70

can transmit the virus up to 20 months instead of 5 days for postnatal patients

Front 71

What is the BEST way to diagnose Rubella?

Back 71

Anti-Rubella IgM (4x increase in titer)

Front 72

How long are infants with CRS considered to be contagious?

Back 72

at least 1 year

Front 73

What is the key goal of Rubella vaccination?

Back 73

to avoid infection in pregnancy (first trimester)

Front 74

Which HSV virus is acyclovir sensitive?

Back 74

HSV-alpha

Front 75

Which HSV virus is gancyclovir sensitive?

Back 75

HSV-gamma
(CMV)

Front 76

What is the hallmark of all herpesviruses?

Back 76

They establish permanent latency after primary infection

Front 77

When does the chickenpox rash appear?

Back 77

When the virus is replicating in the spleen and liver - about 10-14 days after infection

Front 78

Is VZV an RNA or DNA virus?

Back 78

single, linear dsDNA virus that replicates in host cell nucleus (b/c it's DNA)

Front 79

What is the season for chickenpox?

Back 79

Winter-Spring

Front 80

How is chickenpox diagnosed?

Back 80

clinical findings are distinctive and normally sufficient

Front 81

What can be found in the vesicles of chickenpox (microscopically) ?

Back 81

presence of multinucleated giant cells and intranuclear inclusions in vesicles

Front 82

What drug should be avoided during chickenpox in children? Why?

Back 82

Aspirin - risk of Reye's Syndrome

Front 83

What is a complication of Chickenpox?

Back 83

Bacterial infection of vesicles with GABHS

Front 84

What is an absolute prerequisite for shingles?

Back 84

prior case of varicella (or vaccination)

Front 85

What does the word "zoster" mean and what is its significance?

Back 85

refers to "belt" or "Stripe" and is significant b/c shingles rash is in a unilateral dermatomal or striped distribution

Front 86

What do 10% of Shingles pts have?

Back 86

involvement of the ophthalmic branch of CN-V

Front 87

What do 20% of Shingles pts have?

Back 87

ocular involvement

Front 88

What is the most common complication of shingles?

Back 88

Postherpetic neuralgia

Front 89

What is considered the 6th disease of childhood?

Back 89

HHV-6 (Cause of Exanthem subitum/ Roseola Infantum)

Front 90

What is the natural course of HHV-6?

Back 90

sequence of high fever followed by a eruption of a rose-colored
rash that involves the trunk and neck

Front 91

How is HHV-6 spread?

Back 91

virus may be reactivated and shed in saliva of immunosuppressed adults - this is unproven

Front 92

It is hypothesized that many pediatric ER visits due to high fever w/o any obvious
source are due to what?

Back 92

HHV-6 infections

Front 93

What is the 5th disease of childhood?

Back 93

Parvovirus B19

Front 94

What is another name for Parvovirus B19?

Back 94

Erythema Infectiosum

Front 95

What childhood disease can cause arthralgia/arthritis?

Back 95

Parvovirus B19

Front 96

What are 2 complications of Parvovirus B19?

Back 96

Anemia - due to virus attacking erythroid progenitor cells
Hydrops fetalis*

Front 97

What 2 clinical manifestations help to diagnose Parvovirus B19?

Back 97

slapped cheek rash on face
lacey rash on body

Front 98

What are orthopoxviruses shaped like?

Back 98

large, brick-shaped virions

Front 99

When was Smallpox eradicated?

Back 99

1977

Front 100

Where is Monkeypox found?

Back 100

Africa only

Front 101

What is the natural reservoir for Monkeypox? (think about this!)

Back 101

Squirrels are the natural reservoir - transmission to humans via monkeys is normal
route

Front 102

What are the characteristics of intact epidermis?

Back 102

low pH
low moisture
low surface temperature

Front 103

What factors enhance entrance and establishment of bacteria in skin?

Back 103

excessive moisture
damage to skin
foreign objects
immunocompromise
blood supply compromise

Front 104

What enzymes does Staph aureus have?

Back 104

Coagulase
Hemolysins
Leukocidin
Hyaluronidase
Staphylokinase (= fibrolysin)

Front 105

What is Barber's Itch?

Back 105

AKA: Impetigo of Bockhart
Folliculitis of the bearded-area -upper lip near nose
Erythematous follicular-based papules or pustules
Rupture and leave yellow crust
Common in nasal carriers of S. aureus

Front 106

What is a Sty?

Back 106

Folliculitis of eyelid
Hair follicle of eyelid (external)
Meibomian gland (internal)

Front 107

What do boils/furuncles involve?

Back 107

skin and SubQ tissues

Front 108

What is a Carbuncle?

Back 108

aggregate of connected furuncles
several pustular openins
found around neck, back, thighs

Front 109

What is the most frequent streptococcal skin pathogen?

Back 109

Strep pyogenes

Front 110

What causes acute rheumatic fever in Strep infections?

Back 110

M antibodies cross-react with host cells in a Type II HS

Front 111

What causes post-streptococcal glomerulonephritis?

Back 111

M antibodies create An-Ab complexes and lodge in the glomeruli (Type III HS)

Front 112

What 3 enzymes does Strep pyogenes have?

Back 112

DNase
Hyaluronidase
Streptokinase

Front 113

What may be the initial trigger for follicluar epidermal hyperproliferation in abscesses?

Back 113

androgen hormones

Front 114

How does Propionibacterium acnes cause abscesses?

Back 114

produces proinflammatory mediators - diffuses through follicular wall

Front 115

What is a closed comedo?

Back 115

whitehead
a sebum plug in the follicular canal

Front 116

what is an open comedo?

Back 116

blackheads
content reaches surface, follicle opening dilates, compacted melanin, keratinocytes & oxidized lipids = black appearance

Front 117

What are papules?

Back 117

mildest form of lesions
small firm pink bump
intermediate noninflammatory and flammatory acne

Front 118

What are pustules?

Back 118

clearly inflamed lesions
contain visible pus (zits)
chemical irritation - sebum

Front 119

What are nodules?

Back 119

large and very painful
inflamed pus-filled lesions
lodged deep within the skin
The most severe form of acne

Front 120

What has to happen if you place a patient on isotretinoin for her acne?

Back 120

avoid pregnancy! iPledge registry

Front 121

How does Benzoyl Peroxide work to help treat acne?

Back 121

it is a oxidizing and peeling agent - increase skin turnover, cleans pores, antibacterial

Front 122

What topical antibiotics can be used to treat acne?

Back 122

erythromycin and clindamycin

Front 123

What systemic antibiotics can be used for treatment of acne?

Back 123

tetracyclines
doxycycline
minocycline

Front 124

What causes Wetsuit/Hot Tub folliculitis?

Back 124

Pseudomonas aeruginosa

Front 125

What topical antibiotics are used for treatment of folliculitis, furuncles, and carbuncles?

Back 125

Mupirocin (Bactroban) applied to nares, axillae, and perineum w/ or w/po oral Clindamycin

Front 126

What is a pyoderma?

Back 126

a bacterial skin inflammation marked by pus-filled lesions.
Spreading infection confined to the epidermis and dermis

Front 127

What is nonbollous impetigo?

Back 127

single erythematous macule
rapidly evolves to vesicle/pustule that when it ruptures leave yellow crusted exudate over erosion

Front 128

Who gets nonbollous impetigo?

Back 128

all ages with highest incidence in children <6 years

Front 129

What is the pathogen of bollous impetigo?

Back 129

Staph aureus

Front 130

Who gets bollous impetigo ?

Back 130

common in young children <2 years

Front 131

What is the pathogen(s) for nonbollous impetigo?

Back 131

Staph aureus and GABHS

Front 132

What is ecythyma?

Back 132

ulcerative pyoderma
extends into dermis
ulcers with greenish/yellow crust

Front 133

What does Ecthyma result from?

Back 133

untreated impetigo
preexisting tissue damage
immunocompromised state (DM)
poor hygiene

Front 134

What is the hallmark of cellulitis?

Back 134

HEET:
Heat
Erythema
Edema
Tenderness

Front 135

Why do you want to avoid NSAIDs in symptomatic relief of cellulitis?

Back 135

b/c it can mask indicators of worsening disease
Inhibit PMN - cytokine release

Front 136

What pathogen should be suspected in the event of a cellulitis due to a dog/cat bite?

Back 136

Pasteurella multocida

Front 137

What 2 pathogens cause cellulitis and are associated with fresh water?

Back 137

Aeromonas hydrophilia
Legionella spp

Front 138

What pathogen causes cellulitis and is associated with salt water?

Back 138

Vibrio vulnificus

Front 139

How does one contract Clostridial/Non-Clostridial cellulitis?

Back 139

SubQ injection of illegal drugs

Front 140

What is Erysipelas?

Back 140

a special form of cellulitis

Front 141

Where do 10% of the rashes occur in Erysipelas?

Back 141

butterfly rash on face

Front 142

What is a risk factor for Erysipelas?

Back 142

preexisting lymphedema

Front 143

Where does necrotizing fasciitis usually develop?

Back 143

trunk, abdomen, perineum

Front 144

What is Fournier's gangrene?

Back 144

necrotizing fasciitis of the male or female genitalia

Front 145

What causes monomicrobic necrotizing fasciitis?

Back 145

GABHS (strep pyogenes)

Front 146

Does Type I or Type II Necrotizing Fasciitis cause crepitus?

Back 146

Type I

Front 147

Will necrotizing fasciitis have pus?

Back 147

no true pus upon surgery - only thin brownish exudates

Front 148

What is myonecrosis?

Back 148

a life-threatening

Front 149

What pathogen causes 90% of gangrene infections?

Back 149

Costridium perfringens Type A

Front 150

What kind of gangrene is often associated with malignancy? How does it occur?

Back 150

Spontaneous (non-traumatic) gas gangrene - hematogenous spread from GI tract
C. septicum is most frequent pathogen

Front 151

Which toxin is primarily responsible for clostidial myonecrosis symptoms?

Back 151

alpha-toxin - Phospholipase C
(Leithinase)

Front 152

What may explain poor host inflammatory response and the absence of inflammatory cells in biopsies of Clostridial Myonecrosis?

Back 152

Theta-toxin (Perfringolysin)

Front 153

What antibiotics are recommended for a definitive C. perfringens myonecrosis infection?

Back 153

combination penicillin and clindamycin

Front 154

Where is ET-A carried?

Back 154

on chromosome

Front 155

Where is ET-B carried?

Back 155

on plasmid

Front 156

What is the action of the ET in SSSS?

Back 156

cleavage of desmoglein-1
- important protein of desmosomes
mediates keratinocyte adhesion

Front 157

What is Nikolsky's sign? What disease is it regarding?

Back 157

When pressure is applied to skin with finger separation of the upper epidermis occurs. Found in SSSS

Front 158

Where is the cleavage plane for SSSS?

Back 158

intraepidermal (no dermal involvment - no scarring)

Front 159

What lab test is a key indicator in TSS?

Back 159

soft tissue necrosis & elevated creatinine kinase levels

Front 160

What is the most common non-sporeforming opportunistic anaerobic pathogen?

Back 160

Bacteroides spp

Front 161

What is the only anaerobic Gram (+) coccus seen in clinical infections?

Back 161

Peptostreptococcus

Front 162

How are subQ mycoses introduced into the tissue?

Back 162

traumatically

Front 163

What is the vector for epidemic typhus?

Back 163

Bite irritation and body louse of PEdiculus humanus

Front 164

What is Cimex lectularis?

Back 164

bedbug

Front 165

What is the vector for Chagas Disease?

Back 165

Triatoma spp (kissing bugs) found in US and Latin America

Front 166

What is the vector for Plague?

Back 166

Zenopsylla cheopis (rat flea)
(also Pulex irritans - human flea)

Front 167

What does Simulium spp of fly transmit?

Back 167

onchocerciasis (black fly)

Front 168

What does Phebotomus spp of fly transmit?

Back 168

leishmaniasis

Front 169

What does Chrysops spp of fly transmit?

Back 169

tularemia and loasiasis

Front 170

What does Glossina spp of fly transmit?

Back 170

African Sleeping Sickness (Tsetse flies)