Microbio/immunology

Front 1

Bacterial Virulence Factors

Prot. A

IgA protease

M protein

Back 1

-help evade host immune response

Protein A: staph aureus
-binds Fc region of Ig to prevent opsonization and phagocytosis

IgA protease: SHiN (S. pneumoniae, H. influenza B, Neisseria)
-cleaves IgA allowing colonization of respiratory mucosa

M protein: group A strep
-helps prevent phagocytosis

Front 2

pseudomembranous colitis

-presentation
-treatment

Back 2

-greenish, foul smelling watery diarrhea
-abdominal cramps, fever, leukocytosis, lethargy
-follows clindamycin rx

Treatment:
metronidazole or vancomycin

Front 3

cAMP inducers

Back 3

Vibrio + E.Coli (ETEC)= activates AC via Gs

Pertusus= inhibits Gi, causing AC to remain active

Bacillus anthracis= toxin itself is an AC

Front 4

which organisms do not take gram stain?

Back 4

"These Rascals May Microscopically Lack Color"

1. Treponema
2. Ricketsia
3. M. TB
4. Mycoplasma
5. Legionella
6. Chlamydia

Front 5

SHiN bacteria

Back 5

Strep pneumonia
H. Influenza
Neisseria

1. are ENCAPSULATED
2. acquire AB resistance via transformation (take up DNA from environment)
3. IgA protease: cleaves IgA allowing organisms to colonize mucosal surfaces (esp. respiratory surfaces)

Front 6

Encapsulated Bacteria

Back 6

Kapsules Shield the SHiN

Klebsiella
Salmonella
S. pneumonia
H. influenza
Neisseria

Front 7

Staphylococcus organisms

Back 7

-Catalase positive
-found in CLUSTERS

Coagulase + = staph aureus
Coagulase - :
1. S. epidermidis: novobiocin sn; endocarditis
2. S. saprophyticus: novobiocin rs; UTI's

Front 8

Streptococcus

Back 8

-Gram Positive Cocci in CHAINS
-Catalase -

3 groups:
alpha: partial hemolysis (green)
beta: complete hemolysis (clear)
gamma: no hemolysis (red)

Front 9

alpha strep

Back 9

does not completely hemolyze hb so shows up as green

1. S. pneumonia: encapsulated, optochin sn, bile soluble

2. S. viridians: NOT encapsulated, optochin RS, NOT bile soluble

Front 10

beta strep

Back 10

complete hemolysis of hb-->bili-->clear

1. S. pyogenes (Group A) : bacitracin sn

2. Group B: bacitracin RS

Front 11

gamma strep

Back 11

NO HEMOLYSIS-->RED

1. enterococcus
2. peptostreptococcus (anaerobe)

Front 12

Gram positive RODS

Back 12

1. clostridium (anaerobe)
2. corynebacterium
3. listeria
4. bacillus (aerobe)

Front 13

Gram + branching filaments

Back 13

1. actinomyces
2. nocardia

Front 14

Skin Infections caused by both Staph aureus and Strep pyogenes?

Back 14

1. Folliculitis
2. Cellulitis
3. Impetigo

Front 15

Gram + infections that cause neonatal death

Back 15

1. group B
2. E. Coli
3. Listeria

Front 16

Gram + Obligate Aneorobes

Back 16

anaerobes Cant Breath Air

1. Clostridium
2. Bacteroides
3. Actinomyces

Front 17

Obligate Aerobes Gram +

Back 17

Nagging Pests Must Breathe

1. Nocardia
2. Pseudomonas aeruginosa
3. M. tb
4. bacillus

Front 18

components of adaptive immunity

Back 18

1. B cells-->plasma cells
2. T cells
3. antibodies

Front 19

components of innate immunity

Back 19

1. neutrophils
2. monocytes-->macrophages
3. dendritic cells
4. NK cells
5. mast cells
6. basophils
7. eosinophils
8. complement

Front 20

antigen presenting cells

Back 20

1. macrophages
2. B cells
3. dendritic cells

Front 21

neutrophil chemotaxis stimulated by:

Back 21

1. IL-8
2. Leukotriene B4
3. complement C5a

Front 22

Uses of interferons

alpha, beta, gamma

Back 22

alpha, beta: inhibit viral protein synthesis by inducing ribonuclease production (degrades viral mRNA)

gamma: incr. expression of MHC I (all cells), MCH Il (APCs)

Front 23

need to give preformed antibodies (passive immunity) after exposure to the following toxins in addition to vaccination

Back 23

To Be Healed Rapidly:

1. tetanus
2. botulinum
3. HBV
4. Rabies
5. RSV (for premature babies in winter months!)

Front 24

Positive ANA

Back 24

SLE
Sjogren's
scleroderma
poly/dermatomyositis
rheumatoid arthritis
juvenile arthritis
mixed connective tissue dz

Front 25

Bruton's Agammaglobulinemia

Back 25

-X linked (BOYS)
-B cell def (def. tyrosine kinase gene: low levels of all Ig's)
-recurrent Bacterial infections after 6mos (passive immunity gone)

Front 26

Thymic aplasia (DiGeorge)

Back 26

-3rd/4th pouches fail to develop: no thymus (no T cell maturation); no PTH (hypoCa, tetany)
-congenital defects in heart/great vessels
-recurrent viral, fungal, protozoal infxns
-90% have 22.q11 deletion

Front 27

SCID

Back 27

-defect of early stem cell differentiation
-most commonly d/t adenosine deaminase deficiency
-last defense is cytotoxic NK cells
-no thymic shadow on newborn CXR

Presentation:
1. severe recurrent infxns w/ weird organisms
2. chronic diarrhea
3. failure to thrive

Front 28

Chronic mucocutaneous candidiasis

Back 28

-T cell dysfunction against candida albicans
-treat w/ ketoconazole

Front 29

X linked immunodeficiencies

Back 29

1. Wiskott-Aldrich
2. Bruton's agammaglobulinemia
3. Chronic Granulomatous dz
4. Hyper IgM syndrome (inc. IgM, dec. IgG):
-->X linked (no CD ligand)
-->AR (no CD40)
-->NEMO deficiency

Front 30

Wiskott-Aldrish

Back 30

-thrombocytopenia and purpura
-eczema (TRUNCAL)
-recurrent pyogenic infections: no IgM against capsular polysaccharides of bacteria
-low IgM, high IgA
-X linked

Front 31

Ataxia Telangiectasia

Back 31

-IgA def
-cerebellar Ataxia, poor smooth pursuit of moving target w/ eyes
-telangiectasias of face (>5yo)
-defective DNA repair gene:
1. inc.lymphoma/acute leukemia
2. radiation sn (avoid XRAYS)
-usually inc AFP at >8 mos
-avg. age of death = 25 yo

Front 32

Selective Ig deficiencies

Back 32

-IgA most common
-most appear healthy except for frequent sinus and lung infections, atopy, asthma
-1/600 european descent
-Most impt feature is possible anaphylaxis to blood transfusions and blood products!!

Front 33

IL-12 receptor deficiency

Back 33

increased mycobacterial infections!

Front 34

Phagocyte deficiencies

Back 34

1. Chronic granulomatous dz
2. Chediak-Higashi dz
3. Job's syndrome (hyperIgE syndrome)
4. leukocyte adhesion def. syndrome

Front 35

Chronic Granulomatous Dz

Back 35

-X linked!
-lack NADPH oxidase: impotent phagocytes
1. can engulf things but cannot produce O2 radicals
2. dx w/ a negative NBT test (phagocyte cannot oxidize yellow dye to blue-black)
-susceptible to organisms w/ catalase
-prophylaxis: bactrim, INF-gamma

Front 36

Chediak-Higashi dz

Back 36

-defective LYST gene (lysosomal transport)
-defective phagocyte lysosome resulting in GIANT cytoplasmic granules in PMNs

Presentation:
1. partial albinism
2. recurrent respiratory tract and skin infxns
3. neuro d/o (seizures, periph. neuropathy, etc)

Front 37

Job's syndrome (hyperIgE syndrome)

Back 37

-T cells don't produce IFN-gamma; therefore PMN's fail to respond to chemotactic stimuli
-hi levels of IgE and Eosinophils

Presentation:
1. Eczema
2. Recurrent cold staph aureus abscesses (cold b/c fail to produce appropriate inflamm. responses)
3. course facial features: broad nose, frontal bossing, deep set eyes, doughy skin
4. commonly retains primary teeth (get 2 rows of teeth)

Front 38

leukocyte adhesion defect syndrome

Back 38

-Abnormal integrins (cannot integrate into tissues): phagocytes cannot exit circulation
Presentation:
1. delayed separation of umbilicus
2. recurrent bacterial infxns

Front 39

Deficient C5-C9

Back 39

Neisseria bacteremia (gonococcal and meningococcal)

Front 40

germ tube test

Back 40

-tests for pseudohyphae formation
-dxic of candida albicans

Front 41

CAMP test

Back 41

distinguish between Group A and Group B strep

-Group B has + CAMP test (ids partial hemolytic agent produced by group B strep)

Front 42

Diplococci

Gram -?
gram +?

Back 42

gram negative diplococci: neisseria

gram positive diplococci: strep pneumo

Front 43

causes of meningitis

1. most common
2. most severe
3. etc

Back 43

most common: strep pneumo
most severe: n. meningitis
etc: h. influenza

Front 44

Interstitial pneumonia (atypical)

1. organisms
2. treatment

Back 44

1. legionella, mycoplasma, chlamydia pneumonia (also chlamydia psittaci)

2. macrolides (erythromycin, azithromycin)

Front 45

first and second most common cause of gram - sepsis

Back 45

1. E.coli
2. Klebsiella

Front 46

urease + gram negatives

Back 46

1. h. pylori
2. proteus

Front 47

infections associated w/ pseudomonas

Back 47

PSEUDOmonas:
1. pneumonia
2. sepsis
3. external otitis (swimmers)
4. UTI
5. diabetic and drug use osteomyelitis

Front 48

bilateral bell's palsy

seen in?
1.
2.

Back 48

1. lyme disease
2. guillan barre

Front 49

antibiotics for ANAEROBES

Back 49

1. metronidazole
2. clindamycin

Front 50

Organisms that don't gram stain

Back 50

1. Spirochetes: Borrelia, Leptospira, Treponema (BLT)
2. Gardnerella vaginalis (gram variable)
3. Rickettsiae
4. Chlamydia
5. Mycoplasma pneumoniae

Front 51

Resistance Mechanisms

PCN
Aminoglycosides
Vancomycin

Back 51

PCN: B-lactamase cleaves of B lactam ring; or altered PBP in MRSA and PCN resistant s. pneumo

Aminoglycosides: modification via acetylation, adenylation, phosphorylation

Vancomycin: terminal D ala of cell wall component replaced w/ D-lac; dec. afficinity

Front 52

Resistance Mechanisms

Chloramphenicol
Macrolides
Tetracyclines

Back 52

Chloramphenicol: modification via acetylation

Macrolides: methylation of rRNA near erythromycin's ribosome binding site

Tetracycline: dec. uptake or inc. transport out of cell

Front 53

Resistance Mechanisms

Sulfonamides
Quinolones
Cephalosporins

Back 53

Sulfonamides: altered EZ (bacterial dihydropteroate synthetase), dec. uptake or inc. PABA synthesis

Quinolones: altered gyrase or reduced uptake

Cephalosporins: B-lactamase or altered PBP site (MRSA, pcn resistant s. pneumo)

Front 54

What are the macrolides and what are they used for?

MOA?

Back 54

MACE causes "PUS"
Azithromycin, clarithromycin, erythromycin

Pneumonia, URIs, STDs

MOA: 50S protein inhibitor/blocks translocation

Front 55

photosensitivity causing drugs

Back 55

SAT for Photo

Sulfonamides
Amiodarone
Tetracyclines

Front 56

Legionella pneumophilia

Back 56

1. gram - rod; stain w/ SILVER
2. Legionnaire's dz= severe atypical pneumonia and fever
3. pontiac fever: mild flulike syndrome
4. grow on charcoal yeast extract w/ iron and cystein
5. detect ag in urine
6. no person to person transmission
7. treat w/ erythromycin

Front 57

Haemophilus influenza :

diseases

Back 57

haEMOPhilus

Hint 57

epiglottitis

meningitis

otitis media

pneumonia

Front 58

Pseudomonas aeuriginosa :

diseases

Back 58

PSEUDOmonas

Hint 58

pneumonia (esp. CF)
sepsis (black lesions on skin)
External otitis media (swimmer's ear)
UTIs
Diabetic and Drug use Osteomyelitis

Front 59

EF2 inactivation by which organisms

Back 59

1. Corynebacterium
2. Pseudomonas aeruginosa

via EXOTOXIN

Front 60

capsular K antigen

Back 60

virulence factor of enterobactericeae:

COFFEe

E. coli, salmonella, shigella, klebsiella, enterobacter, serratia, proteus

Hint 60

Capsular
O antigen
Flagellar antigen
Ferment glucose
Enterobactericiae

Front 61

Klebsiella

Back 61

gram - rod
intestinal flora
red currant jelly sputum
also causes UTIs
4 A's of klebsiella:

Hint 61

1. Aspiration pneumonia
2. Abscess in lungs
3. Alcoholics
4. di-A-betics

Front 62

Virulence of Shigella vs. Salmonella

Back 62

Shigella > Salmonella
(10 org vs. 100000 org)

Front 63

Spirochetes

1. Members
2. Staining

Back 63

Borrelia (wright's or giemsa stain)
Leptospira
Treponema (dark-field microscopy)

Front 64

Organisms found in animal urine

Back 64

1. leptospira
2. hantavirus

what does leptospira cause?

Hint 64

-flulike sx
-fever
-h/a
-abdominal pain
-JAUNDICE (weil's dz: severe form->icterohemorrhagic, liver and kidney dysfxn, fever, hemorrhage and anemia)
-photophobia w/ conjunctivitis

Front 65

Lyme Disease

Back 65

-borrelia, ixodes tick vector
-stain w/ giemsa or wright
-treatment: doxy, ceftriaxone

BAKE a key LYME pie

Hint 65

B: bell's palsy (stage 2)
A: arthritis (Stage 3)
K: kardiac block (stage 2)
E: erythema migrans (stage 1)

Front 66

VDRL positive but not an STD

Back 66

T. Pertenue

Causes?

Hint 66

Yaws: infection of skin, bone and joints

heal with KELOIDS (excess collagen): limb and nasal deformities
disease of the tropics

Front 67

rash on palms and soles

Back 67

1. syphilis (maculopapular rash)
2. rickettsiae
3. coxsackie virus (migrates to wrist, ankles and then TRUNK)

Front 68

argyll robertson pupil

Back 68

prostitute's pupil:

accomodates but does not react (to light)

assoc. w/ tertiary syphilis

other sx of tertiary syphilis?

Hint 68

1. neurosyphilis (tabes dorsalis) : loss of proprioception; positive rombert
2. gummas (chronic granulomas)
3. aortitis (vasa vasorum destruction-->tree barking)

Front 69

disease associated with clue cells

treated w?

Back 69

Gardnerella vaginalis
-gram variable ROD
-causes vaginosis

treated w/ METRONIDAZOLE

Sx:

Hint 69

1. gray vaginal discharge with fishy odor
2. not painful
3. polymicrobial infection (assoc. w/ other infections)

Front 70

Rickettsial disease transmitted by:

1. tick
2. fleas
3. human body louse

Back 70

Tick: Rocky mountain fever (rickettsia rickettsii) and ehrlichiosis (ehrlichia)

Fleas: endemic typhus (r. typhi)

Louse: epidemic typhus (r. prowazekii)

difference between rickettsial rash and typhus rash

Hint 70

Rickettsial rash: soles and palms--> trunk

typhus rash: trunk-->outward spread; does not involve palms and soles

Front 71

agent that causes Q fever

Back 71

Rickettsiae: Coxiella burnetii

How is it diff. from the other rickettsia bacteria?

Hint 71

1. does not have classic triad (fever, h/a, rash); instead causes FEVER and interstitial pneumonia
2. can form spores
3. has negative weil-felix reaction
4. has NO vector (aerosol transmission)

Front 72

Weil-felix reaction

how does it work?
what organism does it test for?

Back 72

px serum with rickettsia antibodies reacts with proteus antigens--> agglutination

which rickettsia agent does not have a positive weil-felix reaction?

Hint 72

Coxiella burnetti

Front 73

why are rickettsia and chlamydia OBLIGATE intracellular organisms?

Back 73

Rickettsia: need CoA and NAD+

Chlamydia: cannot make their own ATP

Treatment for either organism?

Hint 73

Tetracycline (also erythromycin for chlamydia)

Front 74

what makes chlamydial cell wall unique?

Back 74

lacks muramic acid

Front 75

chlamydia trachomatis SEROTYPES

Back 75

A-C: africa, blindness, chronic infection

D-K: PID, urethritis, ectopic pregnancy, neonatal pneumonia or conjunctivitis

L1-L3: lympogranuloma venereum (acute lymphadenitis): first present as ulcers then get inguinal lymphadenitis, and can cause rectal dz (may be confused w/ IBD!)

Front 76

Upper limb, lateral breast lymph drainage

Back 76

axillary

Front 77

stomach lymph drainage

Back 77

celiac

Front 78

duodenum, jejunum lymph drainage

Back 78

super mesenteric

Front 79

sigmoid colon lymph drainage

Back 79

colic--> inf. mesenteric

Front 80

rectum, anal canal above pectinate line lymph drainage

Back 80

internal iliac

Front 81

anal canal below pectinate line lymph drainage

Back 81

superficial inguinal

Front 82

testes lymph drainage

Back 82

superficial and deep plexus-->para aortic

Front 83

scrotum lymph drainage

Back 83

superficial inguinal

Front 84

thigh (superficial) lymph drainage

Back 84

superficial inguinal

Front 85

lateral side of dorsum of foot lymph drainage

Back 85

popliteal

Front 86

right side of head and right arm lymph drainage

Back 86

right lymphatic duct

Front 87

thoracic duct

Back 87

drains entire body except right half of head and right arm

Front 88

acute phase reactants

Back 88

IL-1: pyogenic, activates endothelium to expression adhesion molecules
IL-6: stimulate acute phase reactants and immunoglobulins
TNF-alpha: septic shock, leukocyte recruitment, vascular leake

-secreted by what?

Hint 88

macrophages

Front 89

C3a, C5a

what do they mediate?

Back 89

anaphylaxis

C3a: activates mast cells and basophils
C5a: activates neutrophil chemotaxis

what else activates neutrophil chemotaxis

Hint 89

Neutrophil chemotaxis:

IL-8
C5a
leukotriene B4

Front 90

C1 esterase deficiency

Back 90

hereditary angioedema
(inc. bradykinin)

Front 91

C3 deficiency

Back 91

severe and recurrent pyogenic sinusy and resp. tract infections

inc. susceptibility to type III hyperSN reactions

why incr. susceptibility to type III?

Hint 91

C3 responsible for removing IC from bloodstream!

Front 92

C5-C9 deficiency

Back 92

Neisseria bacteremia

Front 93

DAF (GPI anchored ez) deficiency

Back 93

complement mediated lysis of RBCs and PNH

Front 94

To Be Healed Rapidly, give preformed ab following exposure to the following:

Back 94

Tetanus
Botulinum
HBV
Rabies

Front 95

IL2

secreted by?
stimulates what?

Back 95

secreted by Th1:

stimulates Th1 cells (+ FB)
stimulates CD8 cells

Front 96

CD18 deficiency

Back 96

causes leukocyte adhesion deficiency

-neutrophilia since the neutrophils cannot exit circulation
-cannot get to site of infection either--> reuccrent bacterial infections, absent pus formation, delayed separation of umbilicus

Front 97

Ig that activates complement

Back 97

IgG, IgM

Front 98

first antibody to be produced in any antigen reaction

Back 98

IgM

Front 99

sterols in cell membrane

Back 99

mycoplasma

what does mycoplasma cause? treatment?

Hint 99

causes atypical pneumonia

treat with tetracycline or azithromycin (pcn resistant b/c no cell wall)

Front 100

lack muramic acid in cell wall

Back 100

chlamydia

what are its two forms

Hint 100

Elementary body: for Enfecting and Entering via Endocytosis

Reticulate body: replicates in cell by fission

Front 101

cell wall contains mycolic acid

Back 101

Mycobacterium

what is the treatment for mycobacterium tb?

MAC?

Leprosy?

Hint 101

tb:
RIPE for treatment:
rifampin, isoniazid, pyranizamide, ethambutol,

MAC:
azythromycin, rifampin, ethambutol, streptomycin

Leprosy: dapsone, rifampin, clofazimine