Micro/ Immuno Finals Review

Front 1

Ceftriaxone

Back 1

3rd Gen Cephalosporin

Front 2

3 diseases that cause rash on palms and soles

Back 2

CARS
Coxsackie A
Rocky Mtn Spotted Fever
Syphilis

Front 3

What is plasmapharesis?

Back 3

Drug to remove maternal IgG
antibodies

Use: Graves Disease (anti-TSHR)

Front 4

What is Lupus?

Back 4

Autoimmune disorder
Auto-antibody usually against DS DNA (and ribonucleoproteins)

Immune complexes are formed and trap in kidney, synovial tissue. (Glomerulonephritis and arthritis)

Type III insensitivity

Front 5

What is the role of C3A and C5A?

Back 5

Anaphylatoxins. Creates an early flare.
Activate endothelial cells and enhances migration of cells to site of infection. (monocytes, macrophages)

Front 6

Role of antibodies against encapsulated bacteria

Back 6

Coat encapsulated bacteria with complement (since they avoid neutrophils). IgG antibodies bind to encapsulated bacteria - (C3b)

Strep Pneumo, H Influenzae, neisseria, group b strep, etc.

Front 7

Role of Bruton Tyrosine kinase

Back 7

B cell maturation/differentiation. BTK deficiency causes agammaglobulinemia.
Req'd for bone marrow development of heavy and light chains

Front 8

Deficiency in TAP 2

Back 8

Lack of MHC1 due to inability to transport peptides into the ER and load the MHC.

Bare Leukocyte syndrome (A form of SCID)

Front 9

Why you don't immunize newborns

Back 9

1) Immune system not mature enough to generate a proper response
2) still has circulating Maternal IgG that would rapidly remove antigen from body

Front 10

FOXP3

Back 10

Master regulator in development of Treg Cells.

Dysfunction would lead to auto-immune disease: IPEX

Front 11

Treg function

Back 11

Has high affinity for IL-2. Regulates T cell proliferation by regulating IL-2 cytokine

Front 12

Viral Antigenic Drift vs
Antigenic Shift

Back 12

Drift- mutation

Shift - recombination

Front 13

Antibiotics to Avoid in Pregnancy

Back 13

“SAFE Moms Take Really Good Care”
Sulfonamides – kernicterus (rare neurological disorder in babies- severe jaundice)
Aminoglycosides - ototoxicity
Erythromycin – acute cholestatic hepatitis in mom
Metronidazole - mutagenesis
Tetracyclines – inhibition of bone growth
Ribavirin (antiviral – teratogenic)
Griseofulvin (antifungal) – teratogenic
Chloramphenicol – gray baby

Front 14

Treatment of Traveler's Diarrhea (ETEC)

Back 14

Rifaximin

Front 15

Which drug inhibits squalene epoxidase, enzyme in ergosterol synthesis?

Back 15

Terbinafine (Dermatophyte Infections)

Front 16

Which drugs inhibit 14-alpha demethylase, preventing conversion of lanosterol into ergosterol?

Back 16

Voriconazole / Fluconazole - (triazoles)

Miconazole (imidazole)

Use: Invasive Aspergillus, coccidiomycoses

Front 17

Mechanism of Amphotericin B / Nystatin

Back 17

Bind to membrane sterol, increase permeability (pores)

*These are polyene macrolides

Ampho is IV
Nystatin topical (use for thrush and topical candida)

Front 18

Toxicity of Chloroquine, Mefloquine, Primaquine

Back 18

All causes pruritis.

Chloroquine is a teratogen and also may cause hemolysis in G6PD deficiency

Front 19

When is Quinine used?

Back 19

Reserved for severe or drug resistant P. Falciparum malarial infections.
More toxic than chloroquine

Front 20

Mechanism of chloroquine / mefloquine

Back 20

Inhibit malarial heme polymerase. Accumulate toxic free heme molecules.

Front 21

Toxicity of Cyclospoine and Tacrolimus

Back 21

Nephrotoxic

Front 22

Side effect of Sirolimus

Back 22

Anemia, leukopenia, thrombocytopenia ;

Diarrhea, nausea

Front 23

Side effect of antithymocyte globulin

Back 23

Fever, chills, thrombocytopenia, leukopenia, respiratory distress.

Diphenhydramine

Front 24

Trade name of Diphenhydramine and its side effects?

Back 24

Benadryl - an anti-histamine.

Causes drowsiness

Front 25

Mechanism of Ivermectin

Back 25

bind/activate glutamate gated chloride channels to induce neuromuscular paralysis

Front 26

Mechanism of Mebendazole/ albendazole

Back 26

Inhibits synthesis of Microtubules and blocks glucose uptake to cause glycogen depletion

Front 27

Mechanism of Praziquantel

Back 27

Increases permeability of membrane towards calcium ions (paralysis in contracted state)

Front 28

Mechanism of Metronidazole

Back 28

Creating toxic metabolites that incorporate into DNA

(Anaerobes: C. Diff, Entamoeba histolytica, Giardia lamblia)

Front 29

"Vir" HIV drugs

Atazanivir, Darunavir, Ritonavir

Back 29

Prevent assembly/maturation of virions by binding to HIV protease that is necessary for cleaving products of HIV mRNA

Front 30

"INE" HIV drugs

Back 30

Zidovudine, Lamivudine, Emtricitabine

Are NRTI (nucleoside reverse transcriptase inhibitors)

Which inhibit infection of new cells within host

Front 31

Efavirenz (HIV drug)

Back 31

NNRTI - non nucleoside RT inhibitor

Front 32

Raltegravir (HIV drug)

Back 32

Integrase inhibitor which prevents HIV genome from being inserted into a host cell chromosome.

Front 33

Foscarnet use?

Back 33

For CMV retinitis in immunocompromised patients when ganciclovir fails

Toxicity: Nephrotoxic

Front 34

Griseofulvin

Back 34

Interferes with Microtubule function; disrupts mitosis.

Use: Oral treatment of dermatophytoses

Very toxic: Tertatogenic, carcinogenic, increases P450 metabolism

Front 35

Capsofungin

Back 35

Inhibits synthesis of Beta-glucan in cell wall synthesis

Use: Invasive aspergillosis

Front 36

Flucytosine

Back 36

Inhibits DNA synthesis by conversion to 5-fluorouracil

Use: Systemic fungal infections (Candida, crypto, etc) in combo with amphotericin B

Toxic: Bone marrow suppression, N & V, diarrhea

Front 37

Tetracycline toxicity

Back 37

GI distress, discoloration of teeth, inhibits bone growth in children, photosensitivity.

Don't use in pregnancy

Front 38

Chloramphenicol Toxicity

Back 38

Anemia, Aplastic anemia, gray baby syndrome

Front 39

Vancomycin toxicitiy

Back 39

Nephrotoxic, ototoxic,

Red Man syndrome (prevent with antihistamines and slower infusion rate)

Front 40

Purpose of Cilistatin in administration with Imipenem

Back 40

To decrease inactivation of Imipenem in the renal tubules (by inhibiting renal dihydropeptidase I)

Front 41

Use of Nafcillin, Methicillin, Dicloxacillin

Back 41

Staph Aureus (except MRSA)

(Penicillinase-resistant penicillins)

"Use Naf for Staph"

Front 42

Clinical use of Ampicillin/Amoxicillin

Back 42

Certain gram + ans some gram negative rods (H. Infuenza, E.coli, Listeria Monocyto, Salmonella, Enterococci)

Amoxicillin= ampicillin + clavulanic acid

"AMPed up Penicillin"

Front 43

Use of Ticarcillin /carbenicillin / Piperacillin

Back 43

Most Gram - bacteria
Including Pseudomonas and Enterobacter ; Klebsiella

Given in synergy with Tazobactam (beta lactamase inhibitor)

TCP - takes care of pseudomonas

Front 44

Buzz words: Acid fast cysts seen in stool

Back 44

Cryptospordium

Presentation: chronic diarrhea (watery)

Front 45

Buzz words: Cotton wool spots on fundoscopic exam. Retinitis.

Back 45

CMV

Tx: Foscarnet

Front 46

BW: Koplik spots on buccal mucosa, conjunctivitis, rash moving from head down (preceded by cough)

Back 46

Measles virus "rubeola"

Front 47

Rash which begins at head, moves down, with postauricular lymphadenopathy

Back 47

Rubella Virus

Front 48

Pneumonia which affects immunocompromised

Back 48

Pneumocystis jiroveci

Front 49

Pneumonia in cystic fibrosis patient

Back 49

Pseudomonas Aeruginosa

Front 50

Branching rods in oral infection, sulfur granules

Back 50

Actinomyces Israeli

Front 51

Dog or cat bite: suspect

Back 51

Pasteuralla Multocida

Front 52

Currant jelly sputum

Back 52

Klebsiella pneumoniae

Front 53

Asplenic patient susceptible

Back 53

Encapsulated microbes: SHiN (S. Pneumo, H. Inf, Neisseria meningitidis)

Salmonella can cause Osteomyelitis

Front 54

Neurologic problem showing India Ink stain that has narrow-based budding

Back 54

Crypto Neoformans

-Causes Encephalitis

Front 55

Fluffy white cottage-cheese lesions on buccal mucosa

Back 55

Candida Albicans

(Nystatin swish to cure)

Front 56

"Slapped Cheek" rash on face which later appears over body

"lace like " pattern

Back 56

Parvovirus B19
Erythema Infectiosum

--Can cause hydrops fetalis in pregnancy

Front 57

Hand-foot-mouth disease

Ulcers in oral mucosa
Vesicular rash on palms and soles

Back 57

Coxsackievirus Type A

Front 58

Vaginitis with strawberry colored mucosa

Back 58

Trichomoniasis Vaginalis

Front 59

Sexually transmitted disease causing Jaundice

Back 59

Hepatitis B

Front 60

Noninflammatory, malodorous discharge (KOH stain is fishy) ; clue cells

Back 60

Bacterial Vaginosis caused by

Gardnerella Vaginalis (Gram - rod)

Not an STI

Front 61

Yellow/green purulent vaginal discharge with vaginitis, dysuria, dysparunia. Erythema of vagina and cervix

Back 61

Trichomonas Vaginalis (Sexually transmitted)

Dx: wet mount

Tx: Metronidazole

Front 62

3 Stages of Syphilis (Treponema Palladium)

Back 62

1) single firm nontender chancre

2) maculopapules, scales, including palms and soles

3) (rare if untreated)
Cardiovascular aortic dilatation ; Neurologic changes ;

Front 63

Tx of Neisseria Gonorrhoeae

Back 63

Ceftriaxone

Front 64

Most common HPV type

Back 64

HPV 6/11 which are low malignant risk

-
HPV 16/18 is high malignant risk due to viral proteins E6 and E7 which degrade P53 and inactivates Tb

Front 65

Most common sexually transmitted disease and treatment

Back 65

Chlamydia ( Chlamydia tracomatis - aerobic abligate intracellular)

Gram - rod that doesn't stain well

Tx: Azithromycin or doxycyline

Front 66

Life cycle of Chlamydia

Back 66

Infectious elementary body form reticulate body, which divide by binary fission and proliferates in new cell

Front 67

Bacterial Cystitis

Risk group and Sx

Back 67

Women (sexually active, pregnant)
Men with enlarged prostates.

Organisms: Negative gut flora, Esp E.coli

Sx: dysuria, frequency, urgency, cloudy/blood in urine, suprapubic pain

Front 68

Diagnosis of Cystitis

Back 68

check midstream urine for pyuria and positive leukocyte esterase, nitrite, and a positive culture (more than 1000 colonies/mL)

Front 69

Flaviviruses
(SS, RNA)

Back 69

Yellow Fever, Dengue fever, St. Louis Encephalitis, West Nile Virus

Front 70

Togaviruses
(SS, RNA)

Back 70

Eastern Equine Encephalitis, Western Equine Encephalitis, Rubella

Front 71

Deltavirus

Back 71

Hepatitis D Virus - SS- circular RNA

Front 72

Tzanck test

Back 72

Non-specific detection of HSV-1, HSV-2, VZV

Requires scraping of opened vesicle which show "Cowdry Inclusions" in smear

Front 73

List of DNA viruses

Back 73

Hepadna, Herpes, Adeno, Pox, Parvo, Papilloma, Polyoma

HHAPPPPY

All are DS but Parvo

Front 74

Tx for Schistosoma and Clonorchis Sinensis

Back 74

Praziquantel

Front 75

Parasite which causes brain cysts, seizures

Back 75

Taenia solium

Front 76

Parasite which causes biliary tract disease

Back 76

Clonorchis sinensis (Undercooked fresh water fish)

Front 77

Perianal Pruritis caused by Parasite

Back 77

Enterobius Vermicularis (pinworm)

Scotch Tape Test

Front 78

Cause of Tinea Versicolor DX and TX

Back 78

Malassezia furfur - damages melanocytes causing hypopigmented patches

Tx: topical miconazole and selenium sulfide

Dx: KOH prep "Spaghetti and Meatballs"

Front 79

Pneumonia common in patients <30 years ; "Walking Pneumonia"

Back 79

Mycoplasma pneumoniae

Difficult to stain due to no cell wall

Tx: Tetracycline or erythromycin

Sx: nonproductive cough

Dx: Eaton's agar

Front 80

Klebsiella diseases (2)

Back 80

Pneumonia in alcoholics and diabetics (aspiration)

UTIs (nosocomial)

Front 81

Lactose fermenting Enteric Bacteria

Back 81

"KEE"
Klebsiela, E.Coli, Enterobacter

Also: Serratia and Citrobacter

Grown on Macconkey's Agar

Front 82

What is a Ghon Complex?

Back 82

TB granuloma associated with lobar and perihilar lymph nodes.

Seen in primary TB

Front 83

Strep Agalactiae - beta hemolysis - bacitracin resistant

Back 83

Group B Strep

Meningitis, Sepis, Pneumonia in babies

Front 84

Staph - catalase positive - determine the other strains

Back 84

Coagulase + is Staph Aureus

Coagulase - :
Novobiocin sensitive is Staph Epidermidis
Novobiocin resistant is Staph Saprophyticus

Front 85

Gram Positive RODS

Back 85

Clostridium, Listeria, Bacillus, Corynebacterium

Front 86

Bugs with Superantigen Exotoxins

Back 86

Staph Aureus (TSST-1) and Strep pyogenes (Scarlet fever Toxic shock like syndrome)

Other toxins: Exfoliatin (From Staph)

Front 87

Urease - positive bugs

Back 87

Proteus, Klebsiella, H. pylori, Ureaplasma

"Particular Kinds Have Urease"

Front 88

Fitz Hugh Curtis Syndrome

Back 88

Hepatitis caused by movement of infected peritoneal fluid. Typically

"violin string" adhesions seen in laparoscopic exam

Front 89

pH >4.5 in Vagina

Back 89

Suspect Gardernella or bacterial infection
What about trichomoniasis vaginalis?

Normal pH in Candida

Front 90

What can't chlamydia trachomatis be cultured

Back 90

It is an obligate intracellular organism
Perform PCR

(Elementary and reticulate body)

Front 91

Celiacs Disease

Back 91

Type III Hypersensitivity

Gluten - causes malabsorption

Front 92

Why do you avoid NSAID, aspirin, naproxen when developing kidney failure, or had kidney transplant

Back 92

Can get constriction at afferent tubule - decreased circulation to kidney, leads to elevated blood presure

Front 93

Klebsiella pneumoniae Carbapenemase-Producing Bacteria

Back 93

Inactivates drugs in carbapenem class. In clinical lab: presence of enzymes in vitro: they look susceptible but it's actually resistant.

Front 94

Brudzinski sign

Back 94

patient lies supine, lift their head.
if their hips/legs lift up also it is a positive sign for meningeal irritation.

Front 95

Kernig sign

Back 95

is positive when the leg is bent at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful (leading to resistance)

Front 96

Physical exam to perform when suspecting meningitis? Lab orders?

Back 96

Brudzinski sign, Kernig sign, stiff neck, Lymph nodes, MMSE (Encephalitis test)

Lab: CSF PCR, CSF culture, CT of Brain, EEG

Front 97

Aspirin Overdosing

Back 97

Cause Metabolic acidosis (Salicyclic Acid)

Front 98

Toxoplasma Gondii Encephalitis

Back 98

Protozoan. Exposure to kitty litter, cat, raw pork

Pregnant women susceptible

Front 99

A Mexican man presents to the hospital seizures: suspect...

Back 99

Taenia Solium

Front 100

Katayama Fever, Dermitis

Back 100

Schistosoma

Tx: Praziquantel

Front 101

Valley Fever, "Spherules"

Back 101

Coccidiomycoses, seen in southwest U.S.

Tx: Azoles

Front 102

BW: Strawberry Tongue, Sandpaper rash

Back 102

Scarlet Fever (Strep A)

Front 103

"Cold abscesses", coarse facies, Hyper IgE, Th17 issue

Back 103

Job Syndrome (Staph Aureus)

Front 104

Cause of Gaseous Gangrene

Back 104

Clostridium Perfringes (sometimes Staph)

Front 105

MecA Gene

Back 105

MRSA carries this gene making it immune to methicillin, penicillin, erythromycin, tetracycline

Front 106

BW: Strawberry Tongue, Sandpaper rash

Back 106

Scarlet Fever (Strep A)

Front 107

"Cold abscesses", coarse facies, Hyper IgE, Th17 issue

Back 107

Job Syndrome (Staph Aureus)

Front 108

Cause of Gaseous Gangrene

Back 108

Clostridium Perfringes (sometimes Staph)

Front 109

MecA Gene

Back 109

MRSA carries this gene making it immune to methicillin, penicillin, erythromycin, tetracycline

Front 110

Kaposi's Sarcoma

Back 110

Cancerous tumor of connective tissue. Cause by herpesvirus 8 in the immunocompromised (HIV)

Front 111

Cast cells

Back 111

Diagnostic of pyelonephritis (casts in tubular lumens)

Front 112

Where can syphilis chancres be found

Back 112

Mouth , penis, vulva, vagina, anus

Front 113

Which vaginal disorder creates a fishy smell on KOH?

Back 113

Bacterial Vaginosis (anaerobic bacteria, mycoplasmas or **Gardnerella vaginalis)

Front 114

Bubonic plague : vector, tx, organism

Back 114

Spread by rodents to humans by fleas.

Gram - bacilli, Yersenia Pestis
Treatment: 30 S

Front 115

Meningitis with petechial rash

Back 115

Neisseria meningitidis

Gram - diploccocci with PMNs

Tx: Ceftriaxone

Vaccines available

Front 116

what can Staph saprophyticus cause

Back 116

UTI, Cystitis

TX: TMP- SMX

(novobiocin resistant)

Front 117

Meningitis with petechial rash

Back 117

Neisseria meningitidis

Gram - diploccocci with PMNs

Tx: Ceftriaxone

Vaccines available

Front 118

what can Staph saprophyticus cause

Back 118

UTI, Cystitis

TX: TMP- SMX

(novobiocin resistant)

Front 119

Elevated AST / ALT and high bilirubin

Back 119

Suspect Viral Hepatitis

Front 120

Hepatitis B puts you at risk for

Back 120

Fibrosis, Cirrhosis, Hepatocellular Carcinoma

Front 121

What are councilman bodies?

Back 121

Apoptotic hepatocytes

Front 122

what is the HPV vaccine?

Back 122

Gardisal

Protects 6,11,16,18

Front 123

3 parasitic worms which can cause pneumonia

Back 123

Hookworm (necator americanus)

Strongloides Stercorlis

Ascaris lumbricoides (Roundworm)