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434 Cards in this Set
- Front
- Back
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Potato salad, mayonnaise
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Staph aureus
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Staph food poisoning due to
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enterotoxin
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Tx staph food poisoning
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rehydration
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reheated rice
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Bacillus cereus
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what makes bacterial spores heat resistant
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dipicolinic acid core
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reheated meat or gravy
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C. perfringens
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dyspepsia w/o NSAIDs
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H. pylori
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risk gastric adenoCA and MALT lymphoma
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H pylori
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indication to treat H pylori associated PUD?
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presence of H pylori
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1st line DOC for H pylori PUD
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PPI + clarithromycin + amoxacillin
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rice water stools, dehydration
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Vibro cholerae
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cholera due to
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AB toxin = inc cAMP
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cholera isolated on thiosulfate citarate buffered sucrose agar. Why?
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differential fermentation by V cholerae on sucrose
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comma shaped cholera looks similar to
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Campylobacter
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Tx cholera
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rehydrate
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secretory diarrhea, fever, vomiting during travel
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ETEC
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secretory diarrhea
fatty, foul stool in campers, day care |
Giardia lamblia
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ingest 15-25 cysts
trophozoites w/ flat ventral surface adhere to brush border malabsorption |
Giardiasis
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Dx giardiasis?
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stool Ag
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Tx giardiasis
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metronidazole
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protracted secretory diarrhea in AIDS
acid fast |
cryptosporidium > cyclospora > isospora
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frank bloody diarrhea
undercooked meat fruit drinks |
E coli O157:H7
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mech of blood loss in hemorrhagic enterocolitis
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shiga toxin (cytotoxin)
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complication of hemorrhagic enterocolitis in children
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HUS
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diarrhea, fever, vomiting, dehydration
infants |
rotavirus
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mech of rotaviral diarrhea
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villus destruction
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infantile watery diarrhea/fever
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Adenovirus 40, 41
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outbreak nausea, vomit, fever
adults |
Norovirus
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diarrhea +/- blood
eggs, poultry, peanut butter |
Non typhoidal Samonella
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progress to chronic carrier state of Samonella in bile ducts due to
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antibiotic use
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Tx septic phase salmonella
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ciprofloxacin
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little diarrhea, macular rose colored spots
bradycardia travel |
S. typhi
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occult bloody diarrhea
2 days after salad from meat contaminated cutting boards |
C jejuni
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Tx campylobacter enteritis in preggo and HIV
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erythromycin
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dysentery like
tenesmus, blood, mucus children |
shigella sonnei
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Tx Shigella flexneri or S. dysenteriae in elderly
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cipro
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dysentery like
cheese pseudoappendicitis/pseudoCrohns |
Yersinia enterocolitica
Boom |
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dysentery in pt w/ broad spectrum ab
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C diff
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C diff diarrhea due to
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Toxin A (enterotoxin)
Toxin B (cytotoxin) |
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C diff confirmed by
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EIA for stool toxins
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Tx C diff
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PO vanco > metronidazole + ORS (oral rehydration solution?)
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health care assoc spread of C diff
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contact of spores
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dysentery, tenesmus, mucus/blood
travel to tropics eosinophilia |
Entamoeba histolytica
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+ stool test
trophozoites w/ intracellular RBCs |
Amebic dysentery
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Tx amebic dysentery
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metronidazole + iodoquinol
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liver abscesses
peritonitis traveler confirm Dx via |
serology for E. histolytica
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liver abscess
southern states O&P for eggs (oval, thick, coarse shell) |
Ascaris lumbricides
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O&P for oval eggs w/ thick/coarse shell
Dx |
ascariasis
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pearl colored earthworm like in stool
immune response? |
IgE
|
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DOC ascariasis
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mebendazole
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vomit, cramp, epigastric pain
immigrant from developing country |
Strongyloides stercoralis
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DOC strongyloides
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ivermectin
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high dose steroids
HIV/AIDS pulm infiltrates eosinophilia |
invasive strongyloidosis
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weakness, fatigue
pruritis, pallor Fe deficient anemia elevated eosinos |
hookworm infection
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subconjunctival hemorrhage, muscle weakness
undercooked pigs/wild game inc CPK/LDH, eosinophilia |
trichinellosis
|
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vague abd pain
altered appetite sushi megaloblastic anemia, eosinophilia |
diphyllobothriasis
(fish tapeworm) |
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Dx tapeworm
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proglottids in stool
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Tx tapeworm
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praziquantel
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hepatosplenomegaly
itch a day after fresh water African/Oriental immigrant |
Africa: Schistosoma mansoni
Orient: S. japonicum |
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stool in chronic schistosomiasis
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large eggs w/ lateral spine
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Tx chronic schisto
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praziquantel
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acute jaundice
HAV IgM+ family prophylaxis? |
inactivated HAV vaccine
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HBsAg+
Anti HBc IgM+ |
acute HBV infection
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multiple sex partners
IDU (IV drug use) infants born to infected moms which hepatitis? |
HBV
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enveloped
dsDNA ss-break body fluid transmission |
HBV
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asymptomatic
HBsAg- Anti HBs+ Anti HBc IgG+ Anti HBc IgM- |
resolved hep B
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jaundice
HBsAg+ (> 6 mo) Anti HBs+ Anti HBc IgG+ HBV DNA > 20,000 |
chronic active hep B
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chronic active hep
necroinflammation Tx? |
Peg-IFNa 2a + lemivudine
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no jaundice
HBsAg+ (>6 mo) nl ALT |
Inactive HBsAg carrier
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Anti HBs+, other markers -
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HBV vaccination
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virologic confirmation of chronic jaundice w/ IDU or hemodialysis based on
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HCV RNA > HCV IgG
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immune evasive quasispecies of hep C causes
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chronicity in HCV
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fulminant hep
HBsAg+ HBcIgM- fatal due to |
HDV superinfection
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acute jaundice
hepatomegaly pregnant Indian |
HEV infection
|
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arthralgia, carditis, chorea, erythema marginatum
confirm Dx? |
rising ASO titer
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Type II hypersensitivity due to molecular mimicry w/ strep
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acute rheumatic fever
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Tx ARF
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benzathine PenG
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conjunctival hemorrhage
Janeway lesions Osler nodes Roth spots Tricuspid vegetations |
S aureus
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impacted tooth
subacute mitral valve endocarditis |
strep viridans
|
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St. Jude bypass 2 months ago
bact endocarditis |
Staph epidermidis
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AIDS, UTI
endocarditis |
Enterococcus faecalis/faecium
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Tx methicillin sensitive staph aureus acute endocarditis
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Nafcillin + gentamicin
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Tx MRSA acute endocarditis
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Vanco + rifampin
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Tx strep viridans endocarditis
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PenG + gentamicin
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Tx prosthetic valve epidermidis endocarditis
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Vanco
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Tx faecalis/faecium endocarditis
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high dose ampicillin + gentamicin
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enterococcal bacteremia fails to respond to vanco
why? |
D ala D ala changed to D ala D lac
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catheter related endocarditis
budding yeast no response to amphoB or fluconazole Tx? |
caspofungin
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colon cancer
bacteremia Dx |
strep bovis
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febrile, malaise, palpitations
ST/T wave change heart block cardiomegaly |
cocksackievirus > echovirus > T. cruzi
|
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rhinorrhea
red throat nasal pus |
rhinovirus
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rhinovirus differ from enterovirus on
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growth at 22°C
noninvasive |
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rhinovirus receptor
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ICAM-1
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rhinovirus, influenza, parainfluenza, corona, RSV... all cause
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upper resp infection
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sinusitis, otitis, laryngitis, exacerbation of bronchitis, asthma
secondary to |
viral URI's
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HEENT
strep pneumo, nontypable H influenza, M catarrhalis causes |
acute otitis media
sinusitis |
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Tx acute otitis media and sinusitis w/ amox + clavulanate. Why clavulanate?
|
haemophilius and moraxella are B lactamase producers
|
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pharyngeal pain, dysphagia, red throat
purulent exudate respond to PCN |
strep pyogenes (group A)
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Group A B-hemolytic strep differs from group B by
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Group A = bacitracin sensitivity
(group A hAtes bAcitrAcin) |
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how to get strep pyogenes (group A) URI?
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infective droplets
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maj virulence factor S. pyogenes (antiphago function)
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M protein
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damage in post pharynx/tonsils due to pyogenes assoc w/ host rxn
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pyogenic inflammation
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DOC acute bact pharyngitis w/ PCN allergy
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erythromycin > clindamycin
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pyogenic complication of strep pharyngitis
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tonsillar abscess
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toxigenic complication of strep pharyngitis
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scarlet fever >> TSS
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immuno complication of strep pharyngitis
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ARF (acute rheumatic fever)
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pseudomembrane w/ lymphadenopathy
Russian |
C dip
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stain of C dip reveals
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G+ rods w/ metachromic granules
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virulence of C dip acquired by
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transduction (phage mediate transfer of exotoxin gene)
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tellurite agar for C dip confirmed via
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Immunodiffusion (ELEK) assay for toxin
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MOA of C dip exotoxin
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ADP ribosylation of EF2 (block protein synth)
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damage caused by C dip due to
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cytotoxicity of AB toxin
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URI symptoms
fever, red throat, purulent hep/spleen megaly lymphadenopathy teenager confirm via |
heterophile antibody+
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host cells preferred by EBV
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B cells
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EBV similar to what class of virus
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herpes
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immune system controls EBV by
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CD8 T lymphos
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Tx mono w/ antibiotic. Get rash. which ab?
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amoxicillin
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Burkitt lymphoma in Africans due to
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EBV
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Nasopharyngeal carcinoma
oriental preserved fish due to |
EBV
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heterophile negative mono
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CMV
|
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G+ bact AOM (acute otitis media)
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S pneumo
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G- diplococci AOM
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M. catarrhalis
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G- coccobacilli AOM
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H influenza
|
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>7 days nasal obstruction, rhinorrhea, purulent nasal drainage
frontal pain/tenderness Tx |
amoxicillin + clavulanate
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DOC for acute mastoiditis in young child is amox + clavulanate. Why?
|
same etiology as AOM (strep, morax, haemophilius)
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seal like barking cough
aphonia child |
parainfluenza
|
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G stain nonreactive
red, purulent lid margin newborn |
Chlamydia trachomatis
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most common cause of redness, tenderless, hyperpurulent eye that's stuck shut in the morning
lid edema G+ |
S aureus
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conjunctivitis, pharyngitis, rhinitis
cervical adenitis in child |
adenovirus
|
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burning, gritty eyes
diffuse injection/tearing preauricular lymph node |
adenovirus
|
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foreign body sensation in eye
photophobia ulceration |
HSV2 > 1
|
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pain/skin lesions
dermatomal ophthalmic division of CN5 |
VZV
|
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conjunctival hemorrhage
swelling outbreak |
enterovirus
|
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chorioretinitis in AIDS
CMV Ag- |
Toxoplasma gondii
|
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painful keratitis
chronic corneal ulcers in contact lens |
Acanthamoeba
|
|
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infant
paroxysmal cough inspiratory whoop, post-tussive emesis |
Bordatella pertussis
|
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pertussis toxin inhibits chemotaxis via downreg of C3a/C5a receptor, resulting in
|
lymphocytic leukocytosis
|
|
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3 major virulence factors of whooping cough
|
ADP ribosylating toxin
tracheal cytotoxin hemolysin |
|
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fever, drooling, stridor
appears septic child |
H influenza B
|
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major virulence factor of H influenza
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capsular polysaccharide
|
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pre-exposure prophlaxis prior to elective splenectomy
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Hib immunization
|
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acute exacerbation of chronic bronchitis
needs NAD and hematin B lactamase+ DOC? |
ceftriaxone > amox+clavulanate
|
|
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most common cause of lower resp infection in neonates
|
S agalactiae (group B)
|
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complicated illness of newborn of group B colonized mom
|
sepsis, meningitis
|
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GBS colonized mom
DOC? |
ampicillin
|
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elderly
flu in winter how to prevent? |
annual flu vaccine
|
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annual flu vaccine is composed of
|
A:H1N1
A:H3N2 B |
|
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secondary spread of flu via
|
resp droplets
|
|
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antigenic drift due to
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mutation
|
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antigenic shift due to
|
reassortment of 8 genomic segments
|
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flu < 48 hrs
Tx |
oseltamivir
|
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bact superinfection (pneumonia) after flu in elderly due to
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S pneumo > S aureus
|
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necrotizing pneumo, poor vanco response
Tx |
linezolid
|
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febrile, bronchiolitis in infant
BAL viral culture+ |
RSV
|
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seasonal pneumonia spread by healthcare workers
|
RSV
|
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MOA of RSV asthmatic symptoms
|
type III hypersensitivity
|
|
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inhaled drug for infantile bronchiolitis (questionable efficacy)
|
ribavirin
|
|
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insidious fever, dry cough, malaise, sore throat
anemia diffuse lung infiltrates young adults |
mycoplasma pneumoniae
|
|
|
how to Dx walking pneumonia while waiting for serology
|
cold agglutinin titer > 1:32
(IgM Ab's against RBCs) |
|
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why are B lactams ineffective for mycoplasma?
|
wall-less bacteria
|
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mycoplasma pneumo + systemic rash
|
erythema multiforme (SJS)
|
|
|
upper resp symptoms
slow onset cough (laryngitis) > 2 weeks patchy infiltrate viral serology+ |
Chlamydophila pneumoniae
|
|
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rapid onset
sputum, dyspnea, tachypnea lobar infiltrate neutrophilic leukocytosis, left shift |
S pneumo
|
|
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G+ diplococci
lobar pneumonia a-hemolytic confirm? |
Quelling reaction (capsular swelling)
|
|
|
differentiate a-hemo S pneumo from viridans
|
optochin sensitivity
(viridans is always in your mouth and not afraid "of the chin") |
|
|
population w/ inc pneumococcal pneumonia
|
AIDS
|
|
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in very young and old
follows viral URI (inc PAF receptors) fall/winter |
S pneumo
|
|
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transmission of S pneumo
|
droplets
|
|
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nasopharyngeal mucosal colonization via
|
IgA protease
|
|
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S pneumo gets to lungs post nasopharyngeal colonization via
|
aspiration
|
|
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S pneumo major virulence factor for invasion/dissemination
|
polysaccharide capsule
|
|
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S pneumo peptidoglycans and teichoic acid elicits
|
inflammation
|
|
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lung cell injury, bact growth, bacteremia caused by
|
pneumolysin (a-hemolysin)
|
|
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multiple myeloma, C3 deficiency, agammagoblinemia, asplenia, Hg SS, chronic disease = inc mortality due to
|
pneumococcal pneumonia
|
|
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pneumococcal pneumo poor prognosis
|
leukopenia
|
|
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empiric DOC for community pneumo in Pt's w/ risk/comorbidity
|
azithromycin or levofloxacin + ceftriaxone
|
|
|
PCN resistant S pneumo pneumonia Tx?
|
moxifloxacin or vanco
|
|
|
mech of S pneumo PCN resistance
|
PBP alteration by mutation
|
|
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agammaglobulinemia, aplenia, sickle cell, decreased C3
vaccinate them w/ |
pneumococcal polysaccharide vaccine (PPSV: 23 valent)
|
|
|
ventilator
bronchopneumonia > 72 hrs post hosp |
Pseudomonas
|
|
|
necrotizing pneumonia after hosp stay
|
MRSA
|
|
|
seizures
cough over 2-4 wks pulm infiltrate polymicrobic gram stain |
anaerobes
|
|
|
empiric DOC: necrotizing pneumonia w/seizures
|
clindamycin + levofloxacin
|
|
|
G+ diplococci pneumo in homeless/alcoholic
|
S pneumo
|
|
|
G- rod pneumo in homeless/alchy
|
Klebsiella pneumoniae
|
|
|
pulm embolism, IV drug use
|
S aureus
|
|
|
pneumonia, CF
|
P aeruginosa
|
|
|
hosp acquired pneumo
G- rod oxidase+ pyocyanin+ |
P aeruginosa
|
|
|
external otitis from hot tub (warm, wet)
|
P aeruginosa
|
|
|
diabetes
osteomyelitis post penetrating foot injury |
P aeruginosa
|
|
|
most widely used anti P aeruginosa PCN
|
piperacillin > imipenem
|
|
|
most widely used anti P aeruginosa AG
|
tobramicin > gentamicin
|
|
|
> 50 yr old smoker
pneumonia urine antigen+ responds to azithro |
legionella pneumophila
|
|
|
why is PCN ineffective against legionnaire's?
|
intracellular
|
|
|
defective cell mediated immunity response = poor legionella prognosis. Why?
|
intracellular
|
|
|
asymptomatic, PPD+
|
latent Tb infection
|
|
|
cough > 2 weeks
night sweat, weight loss, hemoptysis upper lobe infiltrate |
active Tb infection
|
|
|
Tx Tb
|
R ifampin
I soniazid P yrazinamide E thambutol and Vit B6 |
|
|
Why pyridoxine (B6) for Tb Tx?
|
INH neuropathy
|
|
|
Tb fails to respond to 4 drug regimen w/ INH and RIF because
|
multiple drug resistant Tb
|
|
|
Multiple drug resistant Tb doesn't respond to INH + RIF + fluoroquinolone + injectable drug. Why?
|
Extremely drug resistant Tb
|
|
|
AIDS
Tb-like disease, doesn't respond to Tb DOC |
Mycobacterium avium intracellulare (MAC)
|
|
|
Cancer, cytotoxic chemo
halo/crescent lung chronic pneumo due to |
aspergillus fumigatus
|
|
|
lung biopsy: hyphae 2-4um wide, septate, acute angle branch
|
aspergillus
|
|
|
Tb-like lower resp infection
outdoors Giemsa+ 2-5um yeast |
histoplasma capsulatum
|
|
|
AIDS w/ histoplasmosis
MOA of DOC? |
ergosterol in CM
|
|
|
Tb-like
ulcerative skin leasions large yeast, broad based budding DOC? |
itraconazole
|
|
|
decreased cell mediated immunity
large sac of endospores DOC? hahahaa sac |
fluconazole
|
|
|
aspiration pneumonia
cervico-facial lesion DOC? |
PenG
|
|
|
granular, anaerobic specimen
draining fistula LRI |
Actinomyces israelii
|
|
|
AIDS, transplant
indolent pneumonia w/o CNS abscess or granuloma |
Nocardia
|
|
|
G+ branching, beaded, filamentous rod
weakly acid fast |
Nocardia
|
|
|
pulm hemorrhage
woolsorting mediastinitis |
Anthrax
|
|
|
nonproductive cough 2-4 wks
B/L interstitial infiltrates hypoxemia CD4 < 200 gay |
Pneumocystis pneumonia
|
|
|
pneumocystis pneumonia DOC
|
TMP/SMX
|
|
|
urinary urgency, freq
pyuria+ nitrite+ |
E coli cystitis
|
|
|
MSU (midstream urine) culture threshold for significant UTI
|
> 1000
|
|
|
mode of uropathogen acquisition
|
endogenous
|
|
|
factor favoring bact persistence/colonization and UTI
|
bacterial binding via fimbriae
|
|
|
factor favoring bact colonization and UTI despite high osmolarity, [urea], and low pH
|
high growth rate
|
|
|
host factor favoring bact colonization and UTI
|
urinary stasis
|
|
|
host factor favoring bact colonization and UTI despite voiding and high urinary flow
|
absence of bactericidal effects of secreted proteins
|
|
|
G- complicated UTI inflammation due to
|
LPS
|
|
|
empiric DOC for community UTI in adults
|
cipro
|
|
|
inhib DNA topoisomerase/gyrase
|
fluoroquinolones
|
|
|
DOC for empiric UTI in pregnant women
|
Nitrofurantoin
|
|
|
G+ uncomplicated UTI
sexually active young women |
Staph saprophyticus
|
|
|
saprophyticus vs epidermidis
|
novobiocin resistance (sapro)
remember the o's: nOvObiOcin got nOthing on saprO |
|
|
elderly or risk urinary stasis
flank pain, CVA tenderness pyuria, casts, nitrite+ |
E coli pyelonephritis
|
|
|
hospitalized pt
foul smelling urine catheter G- rod except #5 1. fermenter, encapsulated, intrinsic ampicillin resistance 2. slow fermenter, red, intrinsic resistance 3. swarming growth, motile, slow fermenter, intrinsic resistance 4. non fermenter, oxidase+, blue, intrinsic resistance 5. G+ cocci in chains, catalase-, grow in Na, PCN resist |
1. Klebsiella pneumo
2. serratia marcescens 3. proteus mirabilis 4. P aeruginosa 5. entercoccus faecalis |
|
|
complicated UTI
doesn't improve w/ therapy rapid test of choice? |
renal ultrasound
|
|
|
complicated UTI
get culture/sensitivity now what? |
narrow spectrum antibiotic
|
|
|
genital papule --> single painless clean based ulcer
Dx |
1° syphilis (treponema pallidum)
|
|
|
PCN allergy, non preggo female
copper penny macular lesions on palms/soles RPR+ DOC? |
doxycycline
|
|
|
PCN allergy
pregnant RPR+ tabes dorsalis, iritis, uveitis, Argyll-Robertson management? |
desensitization
|
|
|
painful clustered vesicles
erythematous base |
HSV2 > 1
|
|
|
herpetic lesion Giemsa stain shows
|
multinucleated giant cells
|
|
|
genital herpes, no response to acyclovir
why? |
thymidine kinase deficient HSV
|
|
|
preggo, 1° symptomatic HSV2
baby is at risk for |
neonatal/congenital herpes
|
|
|
painful genital ulcers, not indurated
dirty grey base painful inguinal adenitis |
H ducreyi
|
|
|
fastidious
within granulocytic infiltrate of penile ulcer neutros, fibrin, chancroid |
H ducreyi
|
|
|
all sex partners of pt w/ chancroid should be treated w/
|
azithro > ceftriaxone
|
|
|
most common cause of mucopurulent endocervical exudate, no gram stain
|
Chlamydia trachomatis D-K
|
|
|
mucopurulent urethral discharge
penile pruritis lol @ itchy cock how to Dx? |
NAAT of urethral specimen or urine
|
|
|
DOC of most common cause of nongonococcal urethritis
|
azithro > doxycycline
|
|
|
rare genital ulcers
multinucleated giant cell NEGATIVE RPR NEGATIVE |
Chlamydia L1-3
|
|
|
cervical motion tenderness
tubo-ovarian abscess |
PID
|
|
|
G- diplococci copopulated w/ PMN's
mucopurulent urethritis |
N gonorrhoeae
|
|
|
frequent gonorrhea, disseminated gonococci
deficiency in... |
terminal complements
|
|
|
Neisseria evades immune system how?
|
antigenic variation of pili
|
|
|
auxotrophic gonococcus (need arginine) and serum complement resistance will cause
|
septic arthritis
|
|
|
most freq complication of gonoccocal infection in males
|
epididymitis
|
|
|
bull headed clap
urethral stricture prostatitis |
gonococcus
|
|
|
why treat urethritis with both ceftriaxone and azithro?
|
concurrent GC and chlam
|
|
|
older woman w/ PID and tubo-ovarian abscess receives ceftriaxone, azithro, and metronidazole because...
|
polymicrobic endogenous infection
|
|
|
anogenital warts
koilocytes |
HPV 6 and 11
|
|
|
atypical squamous cells on pap smear
no clinical signs of infection |
HPV 16 and 18
|
|
|
koilocytotic cells
may progress to squamous cell ca |
HPV 16 and 18
|
|
|
atypical squamous cells of undetermined significance on pap smear of female > 29yr
next step? |
colposcopy > HPV DNA in biopsy
|
|
|
vaginal pruritis
ectocervical erythema (strawberry cervix) whorish sex habits wet prep shows... |
motile tissue flagellate
|
|
|
fishy odor
no erythema normal cervix what will you see under the microscope? |
SECs (squamous epithelial cells?) stippled w/ Gram variable organisms
|
|
|
DOC bacterial vaginosis
|
metronidazole
|
|
|
disrupt normal vag flora
depleted lactobacilli bacterial vaginosis overgrowth of anaerobic Mobilucus and... |
Gardnerella vaginalis
|
|
|
odorless curdy discharge
recent UTI, severe vag pruritis wet prep shows |
budding yeasts w/ pseudohyphae
|
|
|
normal commensal of skin, GI and GU
endogenous overgrowth of budding yeast can cause > 10 diseases |
candida albicans
|
|
|
MOA of DOC for vulvovaginal candidiasis
|
block C14a-lanosterol demethylase (so you don't convert 14a methylsterol to ergosterol)
|
|
|
flu-like illness, maculopapular rash
bisexual male lymphopenia serology/monospot NEGATIVE |
acute retroviral syndrome
|
|
|
time from infection to acute seroconversion detected by HIV serology (ELISA/western blot)
|
6-12 weeks
|
|
|
mono-like illness in a fag
serology negative HIV viral load is... |
> 10,000
|
|
|
host receptor for HIV-1
|
CD4
|
|
|
homozygous deletion = resist HIV infection and some protection against progression
what gene? |
CCR5
|
|
|
host cells that trap HIV and mediate CD4 infection
|
dendritic cells
|
|
|
a fag has HIV ab's (ELISA and blot), but is asymptomatic. why?
|
clinical latency
|
|
|
acute retroviral syndrome progresses to clinical latency. What happens to HIV1?
|
continue to replicate at low level
|
|
|
fag is HIV1 serology+
symptomatic infections/cancer (any combo of 2) expected CD4 count? |
< 200/uL
|
|
|
HIV
oral thrush, herpes expected CD4? |
50
|
|
|
most common cause of HIV assoc peripheral skin/mucosal ulcers
|
HSV1 > histoplasmosis > CMV > VZV > syphilis
|
|
|
HIV assoc nodules (neoplasia)
|
HHV8 (kaposi sarcoma)
|
|
|
AIDS
fatigue, chills, night sweats, dry cough, weight loss PPD- acid fast bacilli |
MAC complex
|
|
|
AIDS
retinitis, viral pneumonitis, esophagitis |
CMV
|
|
|
AIDS
progressive CNS (visual, ataxia, aphasia, etc) ring enhancing lesions toxoplasmosis Ab negative |
JC virus
|
|
|
definitive indication for HAART therapy
|
CD4 350/mm
|
|
|
ARV (acute retrovirus??) Tx objective?
|
< 50 copies RNA/mL
|
|
|
initial regimen of anti retroviral therapy
|
emtricitabine + tenofovir + efavirenz
|
|
|
abacavir, emtricitabine, lamivudine, zidovudine, tenofovir
class of drug? |
NRTI's
|
|
|
efavirenz, nevirapine
class of drug? |
NNRTI's
|
|
|
atazanavir, lopinavir, saquinavir
class of drug? |
protease inhibitor
|
|
|
bind gp41, prevent conformational change
|
enfuvirtide
|
|
|
inhib integrase (thing that inserts HIV proviral DNA into host genome)
|
raltegravir
|
|
|
AIDS
CD4 <200, thrush antibacterial prophylaxis (besides HAART) is? |
TMP-SMX for PCP
|
|
|
AIDS
Toxo IgG+ prophylaxis? |
TMP-SMX
|
|
|
AIDS
PPD+ (>5mm induration) prophylaxis? |
INH + pyridoxine
|
|
|
AIDS
CD4 < 50 prophylaxis? |
azithro (for MAC)
|
|
|
AIDS
pustule at cat scratch Warthin-Starry stain+ Bacillary angiomatosis |
Bartonella henselae
|
|
|
Mnemonic for leading causes of congenital infections
|
ToRCH3S-List
To: toxoplasma R: rubella C: CMV H: HSV2 H: HIV H: HBV S: syphilis List: listeria |
|
|
chorioretinitis
intracranial calcification neonatal hydrocephalus Mom had mono-like illness after eating raw meat |
toxoplasma gondii
|
|
|
deafness, cataracts, heart defects
microcephaly, mental retardation exposure to blueberry muffin baby |
congenital rubella
|
|
|
microcephaly, seizures
sensorineural hearing loss petechial rash, hep/splenomegaly, jaundice in neonate PCR of urine shows |
CMV
|
|
|
Neonate, low CD4
freq infections, neuro abnormalities mom should have received |
nevirapine
|
|
|
vesicular skin lesions, conjunctivitis in child
asymptomatic at birth |
HSV2
|
|
|
cutaneous lesions, jaundice
saddle nose saber shins Hutchinson teeth CN8 deafness in neonate |
3° syphilis
|
|
|
neonatal septicemia/meningitis
mom ate imported cheese (soft cheeses) |
Listeria monocytogenes
|
|
|
6 red rashes of childhood (acute, febrile, exanthema, maculopapular unless stated otherwise)
1. off white lesions on buccal, vaccine prevantable virus 2. vaccine preventable virus (thanks for being so specific...) 3. scarlatina rash, post pharyngitis 4. vesicular rash, moderate pain 5. slapped face 6. generalized symptoms, immunocompromised |
1. measels
2. rubella 3. group A strep scarlet fever 4. VZV chicken pox 5. Parvovirus B19 6. HHV-6 |
|
|
scaly and/or crusted patches/plaques
scalp/beard area |
dermatophytes
|
|
|
cutaneous mycoses
KOH prep of scales and plucked hairs show |
hyphae and spores
|
|
|
most common cause of cutaneous mycoses
|
trichophyton
|
|
|
cutaneous mycoses w/ animal contact
|
microsporum
|
|
|
PO DOC for cutaneous mycoses
|
itraconazole
|
|
|
Topical DOC for cutaneous mycoses
|
terbinafine
|
|
|
slow lymph spread, nodules
gardening, rose thorn |
sporotrichosis
|
|
|
dimorphic fungus
37°C cigar shape 25°C septate hyphae and daisy conidia |
sporothrix schenckii
|
|
|
DOC sporotrichosis
|
itraconazole
|
|
|
interconnecting subcu abscesses
infection of several hair follicles |
S aureus carbuncle
|
|
|
small superficial pustules --> erosions
honey colored crusts surrounded by erythematous halo |
S aureus >> S pyogenes
(non bullous impetigo) |
|
|
mecA (SCC) genes that encodes PBP2a
low affinity for B lactams This makes S aureus resistant to... |
nafcillin
|
|
|
bullae/blisters --> denuded --> varnish like brown crust
Dx? |
bullous impetigo
|
|
|
bullae/blisters --> denuded --> varnish like brown crust
G+ cocci in chains DOC |
Pen G
|
|
|
bullae/blisters --> denuded --> varnish like brown crust
G+ cocci in clusters DOC |
Nafcillin
|
|
|
spreading butterfly wing
responds to empirical PCN |
S pyogenes (erysipelas)
|
|
|
knee injury
tender, red, severe pain blood culture yields? |
S pyogenes (cellulitis)
|
|
|
factor that binds factor H (serum B globulin factor) and promotes degradation of C3b
|
M protein
|
|
|
Cellulitis, cat/dog bite
|
Pasteurella multocida/capnocytophaga canimorous
|
|
|
Cellulitis, salt water
|
vibrio vulnificus
|
|
|
Cellulitis, fresh water
|
aeromonas hydrophilia
|
|
|
Cellulitis, neutropenia
|
P aeruginosa
|
|
|
Cellulitis, human bite
|
Eikenella corrodens
|
|
|
local pain/swelling/red
elevated CRP, WBC, platelets Periosteal elevation most common cause |
S aureus (osteomyelitis)
|
|
|
Antiphagocytic virulence factor of drug resistant organism in osteomyelitis
|
Protein A
|
|
|
Neutrophil damaging virulence factor of drug resistant organism in osteomyelitis
|
Penton-valentine leukocydin
|
|
|
vertebral, sternoclavicular, pelvic bone infections (IV drug)
osteochondritis of foot (penetrating injury) |
P aeruginosa
|
|
|
osteomyelitis + sickle cell
blood culture+ |
Salmonella typhimurium
|
|
|
chronic vertebral osteomyelitis
blood culture- |
Tb
|
|
|
G- rod
fastidious growth osteomyelitis cat bite |
Pasteurella multicoda
|
|
|
fever, chills, malaise, joint pain
erythema, swelling decreased ROM joint aspirate: no crystals, bacteria+ 1. sex, blood culture-, ceftriaxone 2. RA 3. IV Drug 4. unpasteurized dairy 5. Diabetes, group B strep |
septic arthritis
1. N gonorrhea 2. S aureus 3. S aureus, P aeruginosa 4. brucella 5. Group B Strep |
|
|
Arthritis in up to 6 joints, low back pain, irritable eyes +/- red/conjunctivitis/iritis/malaise. This is called?
1. sex acquired 2. non sex acquired |
Reactive arthritis
1. C trachomatis, N. gonorrhea 2. Campylobacter, Salmonella |
|
|
neutropenic
central line, prosthetics, catheters coag- blood culture+ |
Staph epidermidis
|
|
|
intraabdominal abscess, putrid pus
trauma, solid GI tumor anaerobic bact |
Bacteroides fragilis
|
|
|
high fever, systolic BP < 90
sunburn like rash, desquamation Blood culture- |
Staph TSS
|
|
|
toxin assoc w/ staph TSS
|
TSST-1
|
|
|
severe watery diarrhea assoc w/ TSS
|
enterotoxin (co-regulated w/ TSST-1)
|
|
|
cause of TSS, responds to vanco and clinda
|
MRSA
|
|
|
necrotizing fasciitis/myositis/gangrene
systolic BP <90 sunburn like rash, desquamation blood culture+ |
Strep TSS
|
|
|
toxin assoc w/ strep TSS
|
SpeA
|
|
|
DOC strep TSS
|
PenG + clinda
|
|
|
fever, chill, hypoTN
G- rod, oxidase- lactose fermenting on MacConkey What immunologic mediators of sepsis? |
IL-1, TNF
|
|
|
Line-assoc infection
B-D-glucan antigen blood culture+ DOC |
fluconazole
|
|
|
Line assoc infection
B-D-glucan antigen blood culture+ immune suppressed pt (ca, transplant, chemo, etc) DOC |
caspofungin
|
|
|
transplant pt
abnormal LFT mono-like myalgia, arthralgia |
CMV
|
|
|
large cells, nuclear inclusions (Cowdry owl eyes)
AIDS, interstitial pneumonia |
CMV
|
|
|
DOC for CMV antigenemia in transplant pt
|
gangcyclovir
|
|
|
immunocompromised
hematuria, hemorrhagic cystitis, ureteric stenosis, interstitial nephritis |
BK virus
|
|
|
tropical travel
anemia, hypoglycemia enlarged RBC Schuffner dot DOC |
mefloquine + primaquine
|
|
|
Liver form of malaria
G6PD deficiency contraindicated drug? |
primaquine
|
|
|
tropical travel, high fever
hyperparasitemia (> 2.5% RBC) pulm edema, renal failure, severe anemia DOC |
quinidine + doxycyline
|
|
|
malaria-like
immunocompromised, no travel Cross-over rings in RBC |
Babesia
|
|
|
South America
myocarditis nodular lesion |
T. cruzi
|
|
|
South America
chronic stage systemic disease: cardiomyopathy, megaesophagus, megacolon does not respond to nifurtimox |
T. cruzi
|
|
|
protracted fever, Crohn's, celiac
ocular problems foamy macrophages in lamina propria |
T. whippeli
|
|
|
bacteremia assoc w/ foreign device in hosp pts?
|
Staph epidermidis
|
|
|
ventilator support in hosp
|
P aeruginosa
|
|
|
Kernig/Brudzinski
headache, seizures CSF: WBC > 2000, PMN > 1200 low glu, inc protein 1. 6mo-6yr or >50yr 2. older child, young adult |
Acute bact meningitis
1. G+ diplococci 2. G- diplococci |
|
|
sepsis/meningitis in newborn/neonate
|
Strep agalactiae (Group B)
|
|
|
photophobia, headache, nausea/vomit, meningeal signs
older children in summer CSF: monos, moderate protein |
enteroviruses
|
|
|
aseptic meningitis
rodents |
leptospira interrogans
|
|
|
aseptic meningitis
tick bite, erythema migrans |
Borrelia burgdorferi
|
|
|
aseptic meningitis
whorishness CSF PCR+ |
HSV2 > 1
|
|
|
photophobia, meningismus
transplant, malig, steroid CSF glu < 2/3 serum glu inc protein |
Listeria
|
|
|
Listeria vs other B hemolytic bacteria
|
G+ rods
tumbling motility |
|
|
chronic meningoencephalitis
from endemic region or on infliximab CXR+ inc monos, low CSF glu |
Tb
|
|
|
confirm subacute meningoencephalitis
CD4 <100 vesicular skin lesions |
CSF india ink
|
|
|
meningoencephalitis
southwest US, resp |
coccidioides immitis
|
|
|
cognitive deficits, temporal involvement, no papilledema, CT neg
test? |
CSF PCR+
|
|
|
AIDS
fever, seizures, cognitive deficits, ataxia, hemiparesis |
JC virus > HHV-6
|
|
|
fever, cognitive deficits,ataxia
adult outdoors |
West Nile virus > SLE
|
|
|
AIDS, CD4 < 100
multifocal ring enhancing lesions basal ganglia pyrimethamine + leucovorin + sulfadiazine for life |
toxo
|
|
|
immunocompromised
multifocal lesions in midbrain, brain stem, cerebellum macrophage-like organisms |
Acanthamoeba
|
|
|
previously healthy, diving/water
headache --> focal deficits --> coma |
Naegleria fowleri
|
|
|
Mexico, Central/South America
seizure, chronic headache hydrocephalus responds to praziquantel/anticonvulsant |
Taenia solium (neurocysticercosis)
|
|
|
African
chancre, pruritus weeks ago headache, somnolence responds slowly to pentamidine isothionate or suramin |
Trypanosoma brucei (African sleeping sickness)
|
|
|
Clostridial toxin that causes lockjaw, trismus, and spasm interferes w/
|
GABA and glycine
|
|
|
Clostridium toxin that causes dysphagia, diplopia, and descending flaccid paralysis in IV drug users blocks release of...
|
ACh
|
|
|
infant w/ constipation, weak cry, drooling, hypotonia, cranial neuropathy after eating home processed honey.
Tx? |
equine immune globulin
|
|
|
raw potato deliver vaccine
structure that interacts w/ vaccine? |
lamina propria mucosa
|
|
|
inflammation and increased vascular permeability is affected by
|
phagocytic cells
acute phase proteins |
|
|
Pt w/ IgG and IgM deficiency
Serum can fix complement for tetanus ab's. Why? |
alternate pathway activation
|
|
|
genetic C3 deficiency
recurrent pyogenic ear/lung infection deficiency of...? |
B lymphos
|
|
|
recurrent S aureus infection --> numerous granulomas
this is called... |
Chronic granulomatous disease
|
|
|
decrease avidity of IgG w/o changing Ab specificity
which protease enz? |
papain
|
|
|
cells activated by both IFNy and CD40
|
macros
|
|
|
reverse BMS due to chemo in lymphoma pt via
|
G-CSF
|
|
|
function of TCR CD3 complex?
|
signal transduction
|
|
|
MHC-1 presents Ag to
|
CD8
|
|
|
HSV blocks transfer of Ag peptides from cytoplasm to ER of infected cells.
Cell that is compromised? |
CD8
|
|
|
thyroid gland infection --> MHC-2 --> Hashimoto
cell type initiating AI response? |
CD4
|
|
|
PPD+
what cell response? |
CD4 (Th1 --> IFNy)
|
|
|
MI pt
morphine injection itching/urticaria 10 min later mech? |
sensitized mast cells --> mediators
|
|
|
African
loss of skin pigment, touch, and pain skin scrapings contain acid fast bacilli (AFBs) MOA? |
TH1 cell mediated DTH (delayed type hypersensitivity) reactions
|
|
|
transplant kidney
swelling/tenderness in grafted kidney MOA? |
immunity to donor MHC Ag's
|
|
|
bat attack 3 days ago, now in stupor and laryngeal spasms
should have gotten |
inactivated rabies virus vaccine
|
|
|
alternative and lectin pathways activated where?
|
bacterial surface
|
|
|
classic pathway Ab class type?
|
IgM >> IgG
|
|
|
chemotactic, anaphylotoxic complements
|
C3a, C5a
|
|
|
opsonization of non-encapsulated bacteria via
|
C3b
|
|
|
Neisseria predisposition = which complements
|
C6-9
|
|
|
immune response for intracellular bacteria requires which cell?
|
TH1 CD4 T cells
|
|
|
immune response for viral infections need
|
CD8 cytolytic T's
|
|
|
Ab in secretions
1st line at mucosal level |
IgA
|
|
|
Ab in primary immune response, allows complement activation
|
IgM
|
|
|
Fc region binds eosinos, basos, mast cells
mediate allergic reactions |
IgE
|
|
|
what enables macros to sense material that is microbial and must be eliminated?
|
toll like receptor
|
|
|
O2 dependent enz (NADPH oxidase, superoxide dismutase, myeloperoxidase)
kills... |
G+ bact
|
|
|
O2 independent enz (lysosome, lactoferrin, defensin, etc) kills...
|
G- bact
|
|
|
persistent infection (defective macros activation)
chronic stimulation of CD4 Dx? |
chronic granulomatous disease
|
|
|
defective respiratory burst due to
|
G6PD deficiency
|
|
|
all nucleated cells express which MHC-1 Ag's?
|
HLA-A/B/C
|
|
|
Ag-presenting cells express which MHC-2 Ag's?
|
HLA-DP/DQ/DR
|
|
|
Lympho (B/T) prolif, NK cytotoxicity due to
|
IL-2
|
|
|
B activation, IgE/IgG switching
Decreased: TH1, macros, IFNy TH0 --> TH2 which cytokine does this? |
IL-4
|
|
|
Macro activation
Increased: IL-4, TH2's, expression of MHC, Fc receptors on B's, IgG class switching which cytokine? |
IFNy
|
|
|
IFNy --> TH1 --> activates?
|
macros
|
|
|
IL-4 + IL-5 --> TH2 --> IgE + IgG --> activates?
|
mast cells, eosinos
|
|
|
Variable B and T's
DiGeorge |
thymic aplasia
|
|
|
No B's, no Ig's in X-Linked agammaglobulinemia (Bruton's)
due to |
loss of Btk tyrosine kinase
|
|
|
Lack anti-polysaccharide Ab
impaired T activation Wiskott-Aldrich |
X linked defective WASP gene
|
|
|
inability to control B cell growth in X linked lymphoproliferative syndrome
|
SH2D1A mutant
|
|
|
Glomerulonephritis + pulm hemorrhage
|
Anti BM type 4 collagen
|
|
|
hyperthyroid in myasthenia gravis caused by what autoantigen?
|
TSH (wtf?!)
|
|
|
Progressive muscle weakness in Grave's disease due to what autoAg?
|
ACh receptor
|
|
|
multiple sclerosis due to what autoAg?
|
myelin basic protein
proteolipid protein |
|
|
localized (drug, asthma, hayfever) allergies, anaphylaxis (food, drug) w/ systemic inflammation
|
Type 1
|
|
|
autoimmune hemolytic anemia
transfusion rxn antibiotic allergies |
Type II
|
|
|
Grave's disease
Myasthenia gravis Goodpasture's |
Type II
|
|
|
Post strep glomerulonephritis
serum sickness to diphtheria antitox SLE RA |
Type III
|
|
|
Poison ivy
PPD transplant/graft rejection |
Type IV
|
