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76 Cards in this Set
- Front
- Back
How does urine protect the urinary tract?
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low pH, Urea, Osmolarity, high force expulsion
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Other urinary tract protectors?
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sphincter, mucus, tamm-horsfall glycoprotein, Lewis antigen (ABO)
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How does Tamm Horsfall work
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blocks adherence of organisms
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How can someone be predisposed to UTI?
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people that don't secrete Lewis Antigen
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Are males more likely to get UTI
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NO!! Females 14:1
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At what ages are males and females equally likely to get UTI?
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less than 1 years old
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Is the ratio of female to male UTI higher in old age or lower
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Much higher 40:1 in over 60yo
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Can men get UTI?
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yes, especially if they have predisposing problem (prostatitis, congenital malformation)
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How can organisms bypass protection?
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Sex, Antibiotics kill normal flora, CATHETERS
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Nosocomial Infections
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10% of catheter patients get UTI; often antibiotic resistant, WASH YOUR HANDS. Staph epidermidis usually cause catheter problems
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do UTI usually get 100% identified?
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No, just assume it is E. Coli
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How does UPEC attach to urinary epithelia?
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fimbriae
Pap-->kidney and upper ureter 1-->urethra and bladder |
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E. Coli UTi cycle
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Type 1 fimbriae-->bladder epithelia-->cystitis(inflamm response)-->bladder exfoliates-->some bacteria invade-->pyelonephritis(kidney)
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what allows long term e.coli infection
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Pods-they are antibiotic resistant too
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How does proteus stay in urniary tract
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excellent swimmer; swims upstream
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Proteus Mirabilis
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prolific swimmer, 3% of UTI; has its own urease; precipitates satls-->struvite or apatite stones
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Dx Proteus
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significant bacteria in urine; dipsticks for leukocyte esterase and nitrate reductase; gram (-), oxidase (-)
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Tx Proteus
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fluoroquinolones, amoxicillin, trimeth-sulfa, ??FimH immunization to prevent attachment??
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How does body keep vaginal organisms out of uterus
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cervyx w/ mucus plug
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Normal Flora of Urethra and bladder
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Nothing-it's sterile
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external genitalia and distal urethra flora
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small # intestinal flora
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Vaginal flora
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Lactobacillus, bacteroides, candida, strep and staph, gardnerella vaginalis
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Uterine Flora
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Nothing or else baby in trouble
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Toxic Shock Syndrome
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staph aureus grew like crazy in old tampons-->TSST-1 produced-->fever, "sunburn"-->hypotension, desquamations
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Rank the STDs on prevalence
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Trichomoniasis, Papillomavirus, Chlamydia, HSV-2(genital), Gonorrhea, Hep B, Syphilis, HIV, Bacterial vaginosis
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STD epidemiology
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1 in 4 has STD in US; $10 billion/yr; blacks much more likely
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Is chlamydia higher in men or women?
Gonorrhea |
Women
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What makes an STD
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Human specific; no environment exposure; often asymptomatic; increase HIV transmission
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What effect does STD have on HIV spread
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Lesions, increased CD4 cells, T cell activation, risky business-->HUGE increase
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Neisseria Gonorrhea
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Gram (-) diplocoocci
grows on chocolate agar in candle jar men-->urethra Women-->CERVYX purulent discharge, PMNs, can become systemic |
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Dx Neisseria Gonorrhoeae
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classic-gram stain (-)
Modern-Ligase chain reaction |
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Neisseria Gonorrhoeae virulence
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Pili, OPA, LOS Sialic Acid, Serum resistance, invades epithelium, survive in PMNs, sIgA protease, Iron uptake
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What is the best animal model for N. Gonorrhoeae
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There isn't one- volunteers only
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Gene variation in Neisseria Gonorrhoeae
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N terminal conserved; pilE switches
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Cx of Neisseria Gonorrhoeae
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PID;
systemic(1-3%)-->arthritis, endocarditis, meningitis; Perinatal Infection-->blind prevent with antibac eye drops |
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Chlamydia trachomatis
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obligate intracellular
human pathogen no protective imminity inflamm discharge gram (-) like w/o peptidoglycan LPSs and OMPs |
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Dx Chlamydia trachomatis
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classic- PMN w/o diplococi
Ligase Chain Reactions |
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why isn't Chlamydia trachomatis well-studied
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hard to grow
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Life cycle of Chlamydia trachomatis
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enter-->elementary body in vacuole-->reticulate body-->mature reticular body-->release
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Cx of Chlamydia trachomatis
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PID
60-70% of perinatal seroconvert 17% pneumonia 33% conjunctivitis (blindness) lymphogranloma venereun 40% lead to chlamydia |
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Pelvic Inflammatory Disease (PID)
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lead cause of infertility and ectopic
can be caused by normal flora recurrent in common infertility risk increases w/ recurrence chlamyida damages cervyx so block lost between vag and uterus |
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how do we treat gonorrhea?
chlamydia? why? |
gonorrhea-->penicllin
chlamydia--> not penicillin bc it does not have peptidoglycan |
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Ligase Chain Reaction
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just like PCR but extra primers that must be ligated before extension
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Treponema Pallidum
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spirochete
gram (-) like too small to see in scope for gram humans only enters through small lesions |
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Who gets more syphilis
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Men by a lanslide
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1ary syphilis
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14-21 d post innoculation
red painless papule at site can form ulcerated chancre enlarged lymph node bacteria present in chancre 3-8 weeks healed |
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2ary syphilis
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4-10 weeks
spread through lymphatics and blood like low temps rash soles of feet and palms flu-like, itch, swollen nodes, mild hepatitis |
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Latent syphilis
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immune gaisn control
2ary symptoms resolved in 3-12 wks not infectious 1/3 clear infection on own |
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3ary syphilis
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years or decades hidden
granulomas CNS neurosyphlis meningitis, optic nerve, deafness |
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Neurosyphilis and HIV
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Rapid transition from 1ary syphilis to CNS damage
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What causes syphilis?
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Treponema Pallidum
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Treponema Pallidum
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congenital- crosses placenta
gram (-) flagella in periplasm OMPs are immunogenic LPS not recognized by TLR4 only cultures in rabbit nuts no capsule or toxins small inoculum modulates immune response |
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Treponema Pallidum Dx
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serological for anti-cardiolipin
most successful in 2ary syphilis good indicator of current infection |
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Treponema Pallidum Dx
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MHATP-microhemagglutinin assay
positive for life can't tell how long they have had it |
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Treponema Pallidum Tx
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Does NOT become peniccillin resistant
procain penicillin for HIV neurosyph rapid resistance to azithromycin |
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What is most common Vaginal flora
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Lactobacillus 95%
long gram (+) rods aerotolerant anaerobes |
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how does lactobacillus help vagina
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ferments glycogen to lactic acid to lower pH
produce H peroxide and antimicrobials |
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how does vagina help lactobacillus
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secretes glycogen
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How to avoid harming vaginal flora
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Minimize antibiotics
No Douching |
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Should women Douche?
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DON'T EVER DOUCHE
Tell patients not to do it |
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Vaginosis-overgrowth of resident microflora
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gram (-) anaerobe usually;
discomfort, itching, gray discharge; fish smell; high pH |
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Cx of vaginosis
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PID
preterm delivery/ low birthweight increased HIV susceptibility |
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Tx of vaginosis
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clindamycin or metronidazole
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Candida Albicans
Yeast Infection |
cutaneous infections, oral thrush, burns, catheter UTI;
intense itch, thick white discharge, no odor |
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Yeast Infection TX
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Miconazole-OTC
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Virulence Factors of C. Albicans
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adherence factors, mimicry, hydrolytic enzymes, hyphal transition
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Trichomonas Vaginalis
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7.4 million cases/yr
protozoa-no cyst; trophozoite only male urethral infxn x 10 days |
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diagnosing T Vaginalis
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wet mount of vag swab
jumpy, twitchy movement |
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Trichomonas Vaginalis Sx
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Yellowish-green frothy discharge
itching/burning "strawberry" cervix premature rupture of membrane, PID |
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Trichomonas Vaginalis Tx
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metronidazole
treat partner too to prevent passing back and forth |
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Normal
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Long G+ rods
Ph <4.5 |
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Gonorrhea
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PMN, diplococci
pH <4.5 Ligase Chain Rxn |
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NGU
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PMNs
pH <4.5 Ligase Chain Reaction |
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Bacterial Vaginosis
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Short G- rods
Clue Cells-epi cells shed with G- rods pH >5 Fishy odor |
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Candida Vaginits
Yeast Infection |
Long G+ rods Candida
pH , 4.5 hyphae in wet mount and 10% KOH very large |
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Trichomoniasis
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Long G+ rods Trichomnad
pH <4.5? jerky motility in wet mount |