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705 Cards in this Set
- Front
- Back
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An alcoholic vomits gastric contents and develops foul smelling sputum, what organisms are most likely
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Anaerobes
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Middle aged male presents with acute onset mono-articular joint pain and bilateral Bell’s palsy. What’s the likely disease and how did he contract it
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Lyme disease
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Pt with mycoplasma pneumoniae exhibits cryoagglutinins during recovery phase. What type of immunoglobulins are reacting?
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IgM
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Urinalysis of pt shows WBC casts, what’s the DX
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Pyelonephritis
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Young child presents with tetany and candidiasis. Hypocalcemia and immunosuppression are also found – what cell is deficient
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T-cell (DiGeorge’s syndrome)
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Pt presents with rosegardener’s scenario (thorn prick with ulcers along lymphatic drainage)
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Sporothrix schenckii
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Burning feeling in gut after meals – its an ulcer, what’s the bug and classify it
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H. Pylori
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32 y/o male with cauliflower skin lesions. Tissue biopsy shows broad-based budding yeasts. What’s the organism
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Blastomyces
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Breast feeding woman with redness and swelling of breast – likely organism
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S.aureus
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Young child with recurrent lung infections and granulomatous lesions, what is the defect in neutrophils
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NADPH oxidase (chronic granulomatous disease)
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20 y/o college student with lymphadenopathy, fever, hepatosplenomegaly. His serum agglutinate sheep RBCs. What cell is infected
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B-cells
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Infant becomes flaccid after eating honey, what’s the organism
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C. botulinium
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Classify it
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Gram positive rod
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What’s the mechanism
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Inhibits release of AcH
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What exposure leads to squamous cell carcinoma of penis
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HPV
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Pt develops endocarditis three weeks post prosthetic heart valve insertion, what’s the organism(s)
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S.aureus or S.epidermidis
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Pt visits Mexico and gets bloody diarrhea, what RBC ingesting trophozoite will be found in stool
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E.histolytica
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Glossy photo of heart valve w/cauliflower growth, DX?
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Bacterial endocarditis
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Adolescent with cough and rusty sputum, what does gram stain of sputum show
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Gram positive diplococci
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HIV pt with lymphocyte infiltration of CSF. Yeast found in meninges, DX?
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Crypto
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Give the function of the following:
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Peptidoglycan
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Rigid support, protects against osmotic pressure
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Cell wall / cel membrane (gram (+))
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Major surface antigen
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Outer membrane (gram (-) only)
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Site of endotoxin (LPS)
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Plasma membrane
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Site of oxidative and transport enzymes
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Periplasm
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Space between cytoplasmic membrane and outer membrane in Gram(-) bacteria
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Capsule
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Protects against phagocytosis
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Pilus / fimbria
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Adherence of bacteria to cell surface, also used as sex pilus
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Spore
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Resistance to dehydration, heat and chemicals
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Glycocalyx
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Mediates adherence to surfaces, esp. foreign surfaces such as indwelling catheters
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Which acid of the cell wall activates TNF and IL-1
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Teichoic acid (unique to gram +)
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What’s the equivalent on the outer membrane
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Lipid-A
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What’s in the periplasm
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Many hydrolytic enzymes, including beta-lactamases
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The capsule is constructed from
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Polysaccharide (except bacillus anthracis which is D-glutamate)
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What protects the spore
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A keratin-like coat, dipicolinic acid
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Which cell-wall layer is much thinner on the gram (-) bacteria
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Peptidoglycan
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Name the four phases on the bacterial growth curve
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Lag phase, log phase, stationary phase, death phase
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Endotoxins are unique to
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Gram (-) organisms
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_____ are secreted from the cell
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Exotoxins
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Endotoxins are lipopolysaccarhides, what are exotoxins
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Polypeptides
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endotoxin
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Which is more toxic
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Exotoxins
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Gram negative endotoxin known to cause
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Fever and shock
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Which has the possibility of a vaccine
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Exotoxin only
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Heat stability
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Exotoxin – heat at 60 degrees celsius to destroy
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Tetanus, botulism and diptheria are typical diseases involving
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Extoxins
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Name something caused by endotoxins
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Gram negative sepsis
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Name the gram(+) bugs that have exotoxins
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Diptheriae, all the clostridiums, anthrax, staph and strep (pyogenes)
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Characteristic presentation of pt w/diphtheria
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Pharyngitis and pseudomembrane
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How does clostridium tetani affect its victims
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Blocks release of inhibitory transmitter glycine
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How about C. botulinium
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Blocks acetylcholine
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Which clostridium causes gas gangrene
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C. perfringens
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What does its growth look like on blood agar
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Double zone of hemolysis
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The toxin of S.aureus is a
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Superantigen
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What does it bind to
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MHC class-II and T-cell receptors
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What does it induce in TSS
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IL-1,2
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Which bacteria is erythrogenic and causes rash of Scarlet fever
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Strep. Pyogenes
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What titer is used in detecting rheumatic fever
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Anti-ASO
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Which three gram negative bugs have exotoxins
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E.coli, Vibrio cholerae, Bordatella pertussis
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How does the heat labile toxin of e.coli work
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Stimulates adenylate cyclase by ADP ribosylating G-protein
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How does the heat stabile toxin of e.coli work
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Directly stimulates guanylate cyclase
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What’s the end result of both toxins
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Watery diarrhea
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Vibrio also ADP-ribosylates G-protein. How does it cause rice-water diarrhea
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↑pumping of Cl- and water into gut
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Pertussis also does the ADP-ribosylation, and its end result disease is
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Whooping cause
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Is endotoxin of gram(-) bugs heat stable or labile
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Stable
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Endotoxin (esp. Lipid-A) actiavtes three important ‘pathways’, describe the result of each:
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Activates macrophages:
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↑IL-1 fever
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Activates alternate complement pathway:
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↑c3a hypotension, edema
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Activates Hageman factor:
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Coag. Cascade DIC
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Name the best stain to use:
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Legionella
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Silver stain
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Mycobacteria
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High lipid content of cell wall requires acid-fast staining
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Treponema
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Dark field microscopy and fluor. Antibody staining
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Rickettsia, Chlamydia
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Intracellular – no staining possible?
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Why can’t mycoplasma be stained
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No cell wall
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The pathogenic Nesseria species are differentiated on the basis of
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Sugar fermentation
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MeniGococci ferment
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Maltose and Glucose
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Gonnococci ferment
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Glucose
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Some bacteria produce a pigment:
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S. aureus
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Yellow
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Pseudomonas aeruginosa
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Blue-green
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Serratia marcescens
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Red (like maraschino cherries)
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What allows the following organisms to colonize mucosal surfaces: Strep pneumoniae, Neisseria, H.influenza
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They all have IgA proteases
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Gram Positive algorithm:
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What’s the first branch point
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Cocci or rods
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If rods – we only have a few choices
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Clostridium, Listeria, Bacillus, Corynebacterium
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If cocci – what’s the next test
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Catalase
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What are our cocci choices
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Strep vs. Staph
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How does the catalase test help us
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Cat(+) = staph
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So, it comes up Cat(+) and we have staph., what’s the next step
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Coagulase test
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Coagulase (+) means we have
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S.aureus
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Coagulase (-) means
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S. epidermidis (novobiocin sensitive)
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And, if it comes up Cat(-), what’s the next step
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Determining what type of hemolysis we have
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What are our choices
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Green (partial hemolysis)
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Alpha hemolytic is which ‘color’
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Green
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Beta hemolytic
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Clear
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Gamma hemolytic
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No hemolysis
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What two bacteria fall under alpha hemolytic
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Strep pneumoniae (optochin sensitive, bile soluble, +quellung)
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Which bugs are beta hemolytic? effect bacitracin?
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GAS - Strep pyogenes (bacitracin sensitive)
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Who’s left under gamma hemolytic
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Enterococcus (E. faecalis) and Peptostreptococcus (anaerobe)
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Gram (-) algorithm:
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Oddly, there are three choices once we get a Gram (-) result
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Rods, cocci, and ‘coccoid’ rods
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Who are these coccoid-rods
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H.influenzae
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If we get gram(-) cocci, what are the choices
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Neisseria meningitidis or gonnerhoera
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How do we differentiate
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Sugar fermentation
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Which ferments maltose
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N. meningitidis (recall: both ferment glucose)
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All we’re left with are rods – what’s the next test
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Lactose fermentation
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Name the important lac(+) bugs
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Klebsiella, e.coli and enterobacter (fast fermenter)
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The lac(-) bugs must be further separated using what test
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Oxidase test
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Who are the lac(-), oxidase (-) bugs
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Shigella
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And the lac(-), oxidase (+) bug
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Pseudomonas
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Some bugs require special media:
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H.influenza
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Chocalate agar w/factor V (NAD)/X (hematin)
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N. gonorrhea
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Thayer-Martin media
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B. perutssis
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Bordet-Gengou (potato) agar
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C. diphtheria
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Tellurite agar
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M. tuberculosis
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Lowenstein-Jensen agar
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Legionella pneumophila
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Charcoal yeast extract buffered w/iron+cysteine
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Which bugs form PINK colonies on MacConkey’s
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Lactose fermenting enterics (E.coli, enterobacter, and klebsiella)
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What do we grow fungi on
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Sabouraud’s agar (sourdough bread)
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What special stain is used for the following:
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Amyloid
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Congo Red (apple-green birifringence)
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Borrelia, Chlamydia, Plasmodium, Trypanosomes
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Giemsa’s
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Cryptococcus neoformans
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India Ink
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Acid-fast bacteria
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Ziehl-Neelsen
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Glycogen (mucopolysaccarrhides)
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PAS
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Thus, this stain is used to DX _____ Disease
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Whipple’s
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What do we stain electrodense substrates with
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Osmium tetroxide
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Fungi, PCP, Legionella
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Silver stain
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_____ involves the transfer of DNA from one cell to another by a virus
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Transduction
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What is it called when the process takes place directly between two bacteria
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Conjugation
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Thus, ____ is when purified DNA is taken up by any cell (pro- or eukaryote)
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Transformation
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What do M. tuberculosis and Pseudomonas AERuginosa have in common
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Obligate aerobes
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Name two more
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Nocardia and Bacillus
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Where is pseudomonas aeruginosa commonly seen in the hospital
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In burn wounds, CF kid’s pneumonia and nosocomila pneumonia
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Why are clostridium, bacteroides and actinomyces obligate ANaerobes
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They lack catalase / superoxide dismutase
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Anaerobes are considered normal flora in the ____ but abnormal elsewhere
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GI tract
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Which antibiotics require oxygen to enter the bacterial cell wall, thus are ineffective against anaerobes
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Aminoglycosides
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What ‘sense’ is best used to identify an anaerobic infection
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Sense of smell – FOUL
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What is the capsule of encapsulated bacteria
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Polysaccarrhide / antiphagocytic virulence factor
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What’s the test to test for encapsulated bacteria
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Quellung reaction
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Describe a positive reaction
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If encapsulated bug is present, capsule SWELLS when specific anticapsular antisera are added
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What are some examples of encapsulated bacteria (hint – think lung related)
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Strep. Pneumoniae, klebsiella, H.influenza, neisseria meningitidis
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Who is at ↑risk for infection w/encapsulated bugs
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Sickle cell pts
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What type of bacteria can form spores
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Only gram(+) rods
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What do spores have in their core
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Dipicolinic acid
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Give three examples of gram(+) soil bugs that form spores
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Clostridium tetani / perfringens
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Name the alpha-hemolytic bacteria
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Strep. Pneumoniae (CAT(-), optochin sens.)
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The beta-hemolytic bacteria include S.aureus, Strep. Pyogenes, Strep. Agalactiae, and Listeria:
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Which is cat(-) bacitracin resistant
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Strep. Agalactiae
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Which is cat(-) bacitracin sensitive
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Strep. Pyogenes
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Which is cat(+) and coagulase(+)
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S.aureus
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Which exhibits tumbling mobility, causes meningitis in newborns and is found in unpasteurized milk
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Listeria
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What is the function of catalase anyway
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Degrades hydrogen peroxide – a PMN antimicrobial product
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What is hyd. Peroxide a substrate for
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Myeloperoxidase
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We know that staph makes catalase and strep does not, but who makes coagulase and who does not
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Staph aureus makes coagulase
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Name the S.aureus virulence factor that binds Fc-IgG, thereby inhibiting complement fixation
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Protein-A
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Name three big conditions cause by S.aureus
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TSS
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Which strep. Subspecies is Group-A beta hemolytic
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Strep. Pyogenes (SP)
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What are the ‘pyogenic’ illnesses caused by SP
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Pharyngitis, cellulitis, skin infection
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Toxigenic illnesses?
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Scarlet fever, TSS
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Immunologic illnesses?
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Rheumatic fever, acute glomerulonephritis
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What antibody in particular enhances host defenses against SP
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Anti-M Protein
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Pneumonic for rheumatic fever = PECCS
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Polyarthritis
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Who are the enterococci
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E. faecalis and E.faecium
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They are Pen-G resistant and are known to cause
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UTI
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Lansfield grouping method is based on the _____ in the bacterial cell wall
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C-carbohydrate
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Enterococci are hardier than nonenterococci group-D, thus can grow in
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6.5% NaCl (lab test)
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____ are normal flora of the oropharynx and cause dental caries (mutans) and endocarditis (sanguis)
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Viridians streptococci
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The strep viridians group is resistant to ____, which differentiates them from _____
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Optochin, S.pneumoniae
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_____: gram(+), spore forming, anaerobic bacilli
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Clostridia
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C.perfringens produces a ______ that causes myonecrosis / gas gangrene
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Alpha-toxin
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Cdifficile causes diarrhea (pseudomembranous colitis), esp. following what antibiotics
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Ampicillin, clindamycin
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So instead, treat with
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Flagyl, vancomycin
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What does the exotoxin of diptheria inhibit
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Protein synthesis – it does this via ADP-ribosylation of EF-2
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Symptoms
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Grayish-white membrane in throat and lymphadenopathy
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Lab DX is based on Gram(+) rods with _____ granules
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Metachromatic
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‘Coryn’ means
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Club-shaped
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Grows on ____ agar
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Tellurite
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Anthrax (inhalation type) is aka
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Woolsorter’s disease
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Aren’t actinomyces and nocardia both fungi?
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The mistake is easy, but no. both are gram(+) rods forming long branching filaments resembling fungi
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Which is a normal oral flora that can cause sulfur granules that drain through the sinus tract
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Actinomyces
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What is Nocardia notorious for
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Causing pulmonary infection in immunocompromised pts
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The gram negative outer membrane inhibits entry of which drugs
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Penicillin and vancomycin
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Some bugs commonly cause certain food poisonings:
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Vibrio
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Contaminated seafood
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Staph aureus
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Meats, mayo, custard
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Bacillus cereus
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Reheated rice
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C.perfringens
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Reheated meat dishes
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e.coli O157-H7
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Undercooked meat
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Salmonella
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Poultry, eggs, meat
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Name the species causing the diarrhea:
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No fever / leukocytosis, but ferments lactose
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e.coli
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No fever / leukocytosis, comma shaped
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Vibrio cholerae
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Fever and leukocytosis, does not ferment lactose, motile
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Salmonella
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Same – but, nonmotile, low ID-50
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Shigella
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Fever and leukocytosis, growth at 42 degrees, comma or S-shaped organism
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Campylobacter jejuni
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Fever, leukocytosis, transmitted by seafood
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Vibrio parahemolyticus
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Fever and leukocytosis, transmitted by dog poop
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Yersinia enterocolitica
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Which bugs cause watery diarrhea
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Vibrio cholerae, ETEC
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Which viruses
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Rotaviruses
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Which protozoans
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Crypto, giardia
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Which bugs cause bloody diarrhea
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Salmonella, shigella, campylobacter, EIEC, EHEC, yersinia
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Which protozoan
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E.histolytica
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The enterobacteriacae family includes e.coli, salmonella, klebsiella, enterobacter, serratia, proteus. How do they all have COFFEe in common
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Capsular
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What is the O-antigen
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It is the polysaccarrhide of endotoxin
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What is the K (capsular) antigen
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Related to the virulence of the bug
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What is the flagellar antigen
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H-antigen (only in motile species)
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In addition to all fermenting glucose, these bugs are all also ____ negative
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Oxidase
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HaEMOPhilus Influenzae causes
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Epiglottitis
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Note that H.influenza does not cause
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The flu! Influenza A/B does that
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Classify H.influenza
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Small gram(-) coccobacillary rod
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How to remember the required factors added to agar
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When child has the ‘flu’, mom goes to V and X to buy some chocolate
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Describe H.influenza vaccination
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Between 2-18 months, contains type-b capsular polysaccarrhide
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What does H.influenza produce
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IgA protease
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TX meningitis with
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Ceftriaxone
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_____ prophy for close contacts
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Rifampin
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Grows on:
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Legionella
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Transmitted?
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Aerosol water contact (A/C units and ventilation) NOT person-to-person
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TX with ______
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Erythromycin
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Besides anthrax, what causes black skin lesions
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Pseudomonas aeruginosa
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Keeping in that PSEUdomonas AERuginosa is AERobic, name some key infections
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Pneumonia (CF kids)
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What is the common connection?
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Water source
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Think of water and algae….what color comes to mind
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Blue-green pigment
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TX
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Anti-pseudomonas antibiotic (pip-tic-carb) and aminoglycoside
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Classify H.pylori
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Gram(-) rod, UREASE (+)
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How does this help us
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We can test with a urease breath test
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What does urease(+) mena
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Cleaves urea to ammonia
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Who else is urease positive
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Proteus
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Lactose is KEE?
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Lactose fermenting bacteria grow pink colonies on MacConkey’s agar. Klebsiella, E.coli, Enterobacter
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How is salmonella different than shigella
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Salmonella is motile and has an animal reservoir
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Which G-proteins do cholera and pertussis effect
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Cholera permanently activates Gs
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Both toxins act via_______ that permanently activates ______ resulting in ↑______
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ADP-ribosylation
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Pneumonic for which bacteria are zoonotic
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Bugs From Your Pet
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The Brucella species undulates, and unpasteurized dairy gives you
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Undulant fever
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Which of the above comes from a flea bite, rodents and esp. prairie dogs
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Yersinia pestis
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The resultant infection is
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The Plague
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Which of the above causes cellulitis and is caused by animal bites (cat, dog)
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Pasteurella
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_____ is a coccobacillus that causes green / fishy vaginal discharge
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Gardnerella vaginalis
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What clues us in on this DX
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Why are Rickettsia and Chlamydia obligate intracellular bugs
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They can’t make their own ATP
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Primary TB usually occurs in ____
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Child, non-immune host
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Secondary occurs in
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Normally adults, partial-immunity
|
|
|
Who gets the Ghon complex
|
Primary infections
|
|
|
Where in the lung is the Ghon complex
|
Lower lobes
|
|
|
Secondary infection shows up where in the lung
|
Apex
|
|
|
What does it look like
|
Fibrocaseous cavitary lesion
|
|
|
TB in the vertebral body is aka
|
Pott’s disease
|
|
|
Stain for mycobacteria?
|
Acid-fast
|
|
|
Hansen’s disease is aka
|
Leprosy
|
|
|
What are the two forms of this disease
|
Lepromatous (worse, cell-mediated immunity failure)
|
|
|
Hansen’s is caused by
|
M. leprae
|
|
|
Why does the nose fall off?
|
M.leprae likes cool temperatures (ie superficial skin)
|
|
|
Is there a reservoir in the US
|
Armadillos
|
|
|
TX
|
Dapsone
|
|
|
Kid shows up with headache, fever, and rash (vascultis). Which intracellular organism are you worried about
|
Rickettsiae
|
|
|
TX
|
Tetracycline
|
|
|
Name the subspecies of Rickettsia:
|
|
|
|
RMSF
|
R.rickettsii
|
|
|
Endemic typhus (fleas)
|
R.typhi
|
|
|
Endemic typhus (human body louse)
|
Rprowazekii
|
|
|
Q-fever
|
Coxiella burnetti
|
|
|
The rash spread is characteristic:
|
|
|
|
Typhus rash spreads
|
Outward from trunk
|
|
|
RMSF rash spreads
|
Inward from extremeties
|
|
|
Why is Q-fever Queer
|
It has no assoc. rash and no vector
|
|
|
In spite of its name, RMSF is endemic to
|
East Coast US
|
|
|
What two other disease have palm/sole rashes
|
Hand, foot, and mouth disease of COX virus
|
|
|
What is the reaction assay used to detect anti-rickettsial antibodies
|
Weil-Felix reaction
|
|
|
Positive rxn for RMSF and typhus, but (-) for
|
Q-fever (remember, its queer)
|
|
|
This reaction can cross-react with
|
Proteus species
|
|
|
Who causes walking pneumonia
|
Mycoplasma pneumoniae
|
|
|
Signs/symptoms
|
Insiduous onset, non-productive cough
|
|
|
High titer of
|
Cold agglutinins (IgG) on Eaton agar
|
|
|
Why use erythromycin or tetracycline
|
Bugs are pen-resistant b/c no cell wall
|
|
|
Mycoplasma is also the ONLY bacterial with a membrane that contains
|
Cholesterol
|
|
|
|
|
|
|
Name the two forms of chlamydiae
|
Elementary body – small, dense, Enters cell via Endocytosis
|
|
|
Causes arthritis, conjunctivitis, pneumonia and ______ urethritis
|
Non-gonnococcal
|
|
|
Why is its cell wall unusual
|
Lacks muramic acid
|
|
|
TX
|
Ery or tet
|
|
|
Which chlamydia has an avian reservoir
|
Psittacii
|
|
|
Which causes atypical pneumona (hint:easy one)
|
C.pneumoniae
|
|
|
Lab DX of chlamydia infection
|
Cytoplasmic inclusions seen on Giesma stain
|
|
|
Chlamydia trachomatis and pneumoniae only infect humans. Trachomatis has several serotypes. What are types-A,B, and C known for
|
ABC = Africa, Blindness, Chronic infection
|
|
|
The L1-3 types are known for
|
Lymphogranuloma venereum
|
|
|
D-K types
|
Everything else (PID, neonatal pneumonia and conjunctivitis)
|
|
|
Name the spirochetes
|
BLT. B is Big.
|
|
|
Which spirochetes can be visualized with aniline dyes (Wright’s or Giesma)
|
Borrelia
|
|
|
How is treponema visualized
|
Dark field microscopy
|
|
|
Erythema chronicum migrans is assoc. with
|
Lyme disease
|
|
|
Describe the three stages
|
1.
|
|
|
2.
|
Neurologic and cardiac manifestations
|
|
|
3.
|
Autoimmune migratory polyarthritis
|
|
|
Deer are required for Ixodes lifecycle, but ____ are important reservoirs
|
Mice
|
|
|
TX
|
Tetracycline
|
|
|
Who causes syphilis
|
Treponema palladium
|
|
|
T.pertenue causes tropical infection that causes VRDL(+) test, but it is NOT a STD, aka
|
Yaws
|
|
|
Primary syph.
|
Painless chancre
|
|
|
Secondary syph.
|
Constitutional symptoms
|
|
|
Tertiary syph.
|
Aortitis, gummas (granulomas), neruosyphilis (tabes dorsalis), Argyl-Robertson pupil
|
|
|
Which test is specific for syphilis, earliest positive and longest positive (ie better test than VRDL)
|
FTA-ABS
|
|
|
VRDL detects antibodies that react with
|
Beef cardiolipin
|
|
|
Which viruses give a false positive
|
Mono, hepatitis
|
|
|
What diseases give a false positive
|
SLE, leprosy, rheumatic fever/arthritis
|
|
|
|
|
|
|
What two fungal infections are spread via inhalation of asexual spores
|
Histio and Coccidio
|
|
|
What is the characteristic appearance of Candida
|
Budding yeast with pseudohyphae
|
|
|
Germ tube formation occurs at what temp?
|
37 degrees
|
|
|
We know it causes diaper rash, vaginitis and thrush, but what does it cause in IV drug users
|
Endocarditis
|
|
|
Systemic infection?
|
Nystatin
|
|
|
|
|
|
|
Systemic mycoses:
|
|
|
|
What are the B’s of blasto
|
Big, broad-based budding yeast
|
|
|
Endemic where
|
Mississippi river (and eastward)
|
|
|
San Joaquin Valley Fever or desert bumps caused by
|
Coccidiomycosis
|
|
|
Bird or bat drippings carry
|
Histoplasmosis – often seen INSIDE macrophages
|
|
|
Who is endemic in rural Latin America and has a Captain’s Wheel appearance
|
Paracoccidiomycosis
|
|
|
All of the above are DIMORPHIC fungi – what does this mean
|
Mold in soil at lower temperatures
|
|
|
TX
|
Local infection – use an –azole
|
|
|
Ear fungus is caused by
|
Aspergillus
|
|
|
Aspergillus is a mold with what appearance
|
Septate hyphae that branch at V-shaped 45 degrees
|
|
|
What characteristic appearance does candida have
|
Pseudohyphae and budding yeasts
|
|
|
The germ tubes that form at 37 degrees actually look like
|
Little sperms!
|
|
|
Crypto is a heavily encapsulated ____
|
Yeast
|
|
|
Found in
|
Soil and pidgeon droppings
|
|
|
Cultured on
|
Sabouraud’s agar
|
|
|
Stained with
|
India Ink
|
|
|
What test detects polysaccharide capsular antigen
|
Latex agglutination
|
|
|
____ is a mold with irregular, wide, empty looking septae branching at wide angles
|
Mucor(mycosis) and Rhizopus species
|
|
|
Mucormycosis usually only occurs in
|
Diabetics and leukemia pts
|
|
|
Start prophy for when CD4<?
|
|
|
|
____ is a dimorphic fungus that lives on vegetation
|
Sporothrix schenkii
|
|
|
Rose gardeners disease consists of
|
Pustule on hand with nodules along draining lymphatics
|
|
|
Detection?
|
Cigar-shaped budding yeast visible in pus
|
|
|
TX
|
Itraconazole or KI
|
|
|
|
|
|
|
Protozoans
|
|
|
|
Which causes bloody diarrhea and is TX w/flagyl
|
E. histolytica
|
|
|
What organ can it also damage
|
Liver (RUQ pain is hallmark)
|
|
|
Bloating, flatulence and foul smelling diarrhea caused by
|
Giardia (also TX w/flagyl)
|
|
|
Brain abcesses and birth defects assoc. with
|
Toxoplasmosis
|
|
|
Contracted from
|
Meat or cat feces
|
|
|
___ inhalation causes diffuse interstitial pneumonia in HIV pts
|
PCP
|
|
|
TX
|
TMP-SMX, dapsone or pentamidine
|
|
|
Name the plasmodium
|
Vivax, malariae, ovale, falciparum
|
|
|
Transmitted by
|
Anopheles
|
|
|
Of all the –quines, which is used for vivax and ovale
|
Primaquine
|
|
|
How to DX trichomonas vaginalis
|
Trophozoites on wet mount
|
|
|
TX
|
Flagyl
|
|
|
Trypanosoma cruzi causes
|
Chaga’s disease
|
|
|
Contracted by
|
Reduviid bug
|
|
|
TX
|
Nifurtimox
|
|
|
Tryp. Gambiense / rhodiense cause
|
African sleeping sickness
|
|
|
TX
|
Suramin
|
|
|
Contracted by
|
Tsetse fly
|
|
|
Cysticercosis caused by
|
Taenia solium
|
|
|
TX
|
Albendazole
|
|
|
Trematodes are aka
|
Flukes
|
|
|
The TX for all flukes is
|
Praziquantel
|
|
|
Schistosoma comes from
|
Snails
|
|
|
Clonorchis sinensis comes from
|
Undercooked fish
|
|
|
Paragonimus westermani comes from
|
Undercooked crab meat
|
|
|
Mebendazole / pyrantel pamoate are TX for what three roundworms
|
Ascaris, hookworm, pinworm
|
|
|
Which penetrates skin of feet
|
Hookworm
|
|
|
You eat undercooked meat, get periorbital edema and muscle inflammation, you probably have
|
Trichenella spiralis
|
|
|
Loa loa transmitted by
|
Deer fly
|
|
|
TX
|
Diethylcarbamazine
|
|
|
_____: transmitted by blackflies, causes river blindness
|
Onchocerciasis
|
|
|
TX
|
Ivermectin
|
|
|
Elephantiasis caused by ___ and TX with ___
|
Wucheria bancrofti (blocks lymphatics)
|
|
|
Of all the DNA viruses, only ____ is single stranded
|
Parvoviridiae
|
|
|
All are linear except
|
Hepadnavirus and papovirus (circular)
|
|
|
In contrast to DNA viruses, all RNA viruses are ssRNA except
|
Reoviridiae
|
|
|
As far as shape – all DNA viruses are
|
Icosahedral
|
|
|
The DNA viruses are HHAPPPy
|
Hepadna, herpes, adeno, parvo, papo, pox
|
|
|
Which causes hep-B
|
Hepadno
|
|
|
Which herpes virus causes mono
|
EBV
|
|
|
Which causes Roseola
|
HSV-6
|
|
|
Which virus causes sore throat and pink eye
|
Adenovirus
|
|
|
Parvovirus known for
|
B-19
|
|
|
Which virus known for PML in HIV pts
|
Papovirus (JC virus)
|
|
|
Which is the largest DNA virus
|
POX
|
|
|
|
|
|
|
What ‘shape’ are MOST of the RNA viruses
|
ss-linear
|
|
|
Which are ss-circular
|
Arena- and bunyaviruses
|
|
|
Picornaviruses like to PERCH on their victims
|
Polio
|
|
|
Colorado tick fever caused by
|
Reovirus
|
|
|
Biggest cause of fatal diarrhea in kids
|
Rotavirus
|
|
|
Hep-C caused by
|
Flavivirus
|
|
|
What else do flaviviruses cause
|
Yellow fever, Dengue, St. Louis
|
|
|
The equine encephalitis (east and west) is caused by
|
Togaviruses
|
|
|
Which two are retroviruses
|
HIV, HTLV
|
|
|
Measles, mumps, RSV and parainfluenza (croup) =
|
Paramyxoviruses
|
|
|
Rabies is a
|
Rhabdovirus
|
|
|
What’s scary about filoviruses
|
Hemorrhagic (ebola, marburg etc), often fatal
|
|
|
Sandfly, rift valley fever, hantavirus and crimea-congo are all
|
Bunyaviruses
|
|
|
What does it take for naked viral genomes to be infective
|
Must be (+) stranded (either ssRNA or dsDNA)
|
|
|
What does naked mean
|
Non-enveloped
|
|
|
How to remember which RNA viruses are naked
|
Naked CPR
|
|
|
Where do most enveloped viruses get their envelope from
|
From the plasma membrane of host cell upon exit
|
|
|
Name the exception
|
Herpes virus – gets envelope from nuclear membrane
|
|
|
All viruses are haploid (single copy of RNA or DNA) except
|
Retroviruses – they have two identical copies of ssRNA (diploid)
|
|
|
All DNA viruses replicate in the ____ except ___
|
Nucleus, Pox virus
|
|
|
All RNA viruses replicate in the ___ except ___
|
Cytoplasm, influenza virus/retroviruses
|
|
|
______ vaccines induce both humoral AND cell mediated immunity
|
Live attenuated (but they have been known to revert)
|
|
|
Killed vaccines induce ____ immunity
|
Humoral (only)
|
|
|
Name the single recombinant vaccine
|
HBV (antigen = recombinant HbS-Ag)
|
|
|
Name the 4 killed vaccines
|
HIRPs: Hep-A, Influenza, Rabies, Polio (Salk)
|
|
|
So, which are live attenuated
|
MMR, VZV, Yellow fever, Polio (Sabin)
|
|
|
Recombination is a result of what process
|
Crossing-over
|
|
|
If virus A is coated with surface protein from virus B, the infectivity is determined by ___ but the progeny are of virus __
|
Virus B
|
|
|
Name two slow virus infections
|
JC virus in immunocompromised pts (PML)
|
|
|
All of the segmented viruses are ___ viruses
|
RNA
|
|
|
Imagine a segmented BOAR running around the barnyard
|
Bunya, Ortho, Arena, Reoviruses
|
|
|
|
|
|
|
What does pico-RNA virus help us remember
|
Picovirus RNA is translated into one large peptide and then cleaved into many smaller ones
|
|
|
Which virus is the most important cause of global infantile gastroenteritis
|
Rotavirus
|
|
|
It is the major cause of ____ in the US in winter
|
Acute diarrhea
|
|
|
Name the common paramyxoviruses
|
MMR, parainfluenza, RSV
|
|
|
Paramyxoviruses are known to cause diseases in
|
Children (esp. RSV in infants)
|
|
|
What is parainfluenza known to cause
|
Croup
|
|
|
Meningitis, orchitis, and parotitis means you have
|
The Mumps
|
|
|
What sign is for measles
|
Koplik spots on buccal mucosa (bluish-gray)
|
|
|
Name the three C’s of measles:
|
Cough
|
|
|
What drugs are useful against influenza A but NOT against influenza B/C
|
Amantadine / rimantadine
|
|
|
Cytoplasmic inclusions seen in rabies virus infected cells
|
Negri bodies
|
|
|
What does the capsid look like
|
A bullet
|
|
|
What viruses are transmitted by arthropods
|
Arboviruses
|
|
|
Give two examples
|
Yellow fever and Denque fever
|
|
|
Name all the subtypes of arboviruses
|
Flavi, Toga, Bunya
|
|
|
____ is an arbovirus (flavivirus) caused by Aedes mosquitos. Symptoms include high fever, black vomitus and jaundice
|
Yellow fever (the jaundice should give it away)
|
|
|
HHV-8 best known for
|
Kaposi’s Sarcoma in HIV pts
|
|
|
Give the warnings signs of mononucleosous
|
Fever, hepatosplenomegaly, pharyngitis and lymphadenopathy ESP. post auricular nodes
|
|
|
Peak incidence age
|
15-20 y/o
|
|
|
Mono DX test
|
Heterophil antibodies agglutinate w/sheep RBCs
|
|
|
How does the Tzanck test detect Herpes
|
Smear of open skin vesicle
|
|
|
Name the type of virus for each hepatitis virus:
|
|
|
|
HAV
|
RNA, picoRNAvirus
|
|
|
HBV
|
DNA, hepaDnavirus
|
|
|
HCV
|
RNA, flavivirus
|
|
|
HDV
|
Delta agent
|
|
|
HEV
|
RNA, calcicivirus
|
|
|
Which hepatitis viruses predispose a patient to hepatocellular carcinoma
|
HBV and HCV
|
|
|
____ is transmitted PRIMARILY via BLOOD
|
HCV
|
|
|
____ is transmitted parenterally, SEXUALLY and maternal-fetal routes
|
HBV
|
|
|
____ is transmitted enterically and causes water-borne epidemics
|
HEV
|
|
|
____ has a high mortality rate in pregnant women
|
HEV
|
|
|
The vowels hit your bowels?
|
HEP A and E transmitted fecal-oral
|
|
|
There are a number of serologic markers to detect hepatitis based on time period of infection:
|
|
|
|
Best test to detect active HAV infection
|
IgM HAV-Ab
|
|
|
What do the following tell us:
|
|
|
|
HBsAG
|
Surface marker for HBV, continues presence indicates carrier state
|
|
|
HBsAb
|
Antibody to HbsAG: provides immunity to HBV
|
|
|
HBcAg
|
Antigen assoc. with core of HBV
|
|
|
HBcAb
|
Positive during window period. IgM HBcAb is an indicator of recent infection
|
|
|
HBeAg
|
Second antigenic determinant in the HBV core. Indicates transmissibility (BEware!)
|
|
|
HBeAb
|
Antibody to e-Ag, indicates low transmissibility
|
|
|
|
|
|
|
So, during incubation period, what is present
|
HBsAg
|
|
|
And during prodrome, acute disease
|
HBsAg (anti-HBc)
|
|
|
During early convalescence
|
Anti-HBc
|
|
|
Late convalescence
|
Anti-HBs / anti-HBc
|
|
|
The ‘window’ period is between
|
The fall-off of HBsAg and growth of anti-HBs
|
|
|
What is detectable during this window period
|
Anti-HBe
|
|
|
|
|
|
|
The HIV genome is diploid, with 2 copies of
|
RNA
|
|
|
What is the designator for the rectangular nucleocapsid protein
|
p24
|
|
|
And what are the designators for the envelope proteins
|
gp41 and gp120
|
|
|
What does the rev. transcriptase do
|
Creates dsDNA from RNA so that it can be incorporated into host genome
|
|
|
Presumptive DX made with which test
|
ELISA (high sensitivity), SNout
|
|
|
Positive ELISA confirmed with
|
Western Blot, high specificity, SPin
|
|
|
What antibodies are present in the serum during latent phase that help us detect HIV
|
Anti-gp24 / gp120 antibodies
|
|
|
____ consist only of proteins – no DNA or RNA
|
Prions
|
|
|
Known to cause
|
CJD, kuru, scrapie (sheep), and mad-cow
|
|
|
Prions are assoc. with
|
spongiform encephalopathy
|
|
|
|
|
|
|
Name the normal flora:
|
|
|
|
Skin
|
S. epidermidis
|
|
|
Nose
|
S.aureus
|
|
|
Oropharynx
|
Viridians strep.
|
|
|
Dental plaque
|
S.mutans
|
|
|
Colon
|
B.fragilis > E.coli
|
|
|
Vagina
|
Lactobacillus, E.coli
|
|
|
|
|
|
|
Name the common causes of pneumonia:
|
|
|
|
Children 6wk-18yr
|
RSV, mycoplasma, chlamydia, S.pneumoniae
|
|
|
Young adults 18-40 y/o
|
Mycoplasma, C.pneumoniae, S.pneumoniae
|
|
|
Adults 40-65
|
S.pneumoniae, H.influenza, Anaerobes
|
|
|
Elderly
|
S.pneumoniae, viruses, anaerobes
|
|
|
Nosocomial
|
Staph, gram(-) rods
|
|
|
Immunocompromised
|
Staph, PCP
|
|
|
Aspiration
|
anaerobes
|
|
|
Alcoholic / IV drug user
|
Strep. Pneumoniae, Klebsiella
|
|
|
Neonate
|
Group B strep (B for Baby)
|
|
|
Atypical pneumonia
|
Mycoplasma, legionella, chlamydia
|
|
|
|
|
|
|
Name the causes of menigitis:
|
|
|
|
Newborn (up to 6 months)
|
Group-B strep, E.coli
|
|
|
Children (6mo-6yr)
|
Strep. Pneumoniae, N.meningitidis
|
|
|
Children / adults (6yr-60yr)
|
N.meningitidis
|
|
|
60+ yr
|
S.pneumoniae
|
|
|
Note that _____ also falls into very young and very old categories
|
Listeria
|
|
|
What about HIV pts
|
Crypto
|
|
|
|
|
|
|
What are the CSF findings in meningitis for:
|
|
|
|
Bacterial
|
Pressure↑, ↑PMNs, ↑protein, ↓sugar
|
|
|
Fungal / TB
|
Pressure↑, ↑lymphs, ↑protein, ↓sugar
|
|
|
Viral
|
Pressure↑/nl, ↑lymphs, nl ,nl
|
|
|
|
|
|
|
What causes osteomyelitis in:
|
|
|
|
Most people
|
S.aureus
|
|
|
Sickle cell pts
|
Salmonella
|
|
|
Drug addicts
|
P.aeruginosa
|
|
|
Prosthetic replacement
|
S.aureus and S.epidermidis
|
|
|
Vertebral
|
TB
|
|
|
|
|
|
|
UTI’s, name the cause:
|
|
|
|
Ambulatory
|
e.coli, klebsiella
|
|
|
Second most common cause in ambulatory women
|
Staph. Saprophyticus
|
|
|
Hospital acquired
|
e.coli, proteus, klebsiella, serratia, pseudomonas
|
|
|
|
|
|
|
What is condyloma accuminata
|
Genital warts (HPV 6,11)
|
|
|
Sexually transmitted hepatitis with jaundice
|
HBV
|
|
|
Subacute, undiagnosed PID caused by
|
Chlamydiae trachomatis
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Acute PID with high fever caused by
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N.gonorrhea
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____ is the most common STD in US
|
C.trachomatis
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Certain sign involved?
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Chandelier sign
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Recall: gardnerella vaginitis DX made by
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Clue cells
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Trichomonas DX made by
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Motion on wet mount
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Wound infections
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But, you can presume ____ when AIR or BURNS
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Pseudomonas aeruginosa
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And you can assume ___ when water-source
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Legionella
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What about in newborn nurseries
|
CMV, RSV
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What if you work in a renal dialysis unit
|
HBV
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|
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Bug Hints:
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|
|
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Pediatric infection (including epiglottitis)
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H.influenza
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Branching rods in oral infection
|
Actinomyces israelli
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Traumatic open wound
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C.perfringens (PERForated abdomen)
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|
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Surgical wound
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S.aureus
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Dog or cat bite
|
Pasteurella multocida
|
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Currant-jelly sputum
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Klebsiella (Kurrant jelly)
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Immunology
|
|
|
|
Variable part of ______ recognizes antigen
|
Heavy and light chains
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|
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Whereas only the constant part of ___ chain of IgG and IgM fixes complement
|
Heavy
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|
|
Light chain contributes only to the
|
Fab fragment
|
|
|
What are the four C’s of the Fc fragment
|
Constant
|
|
|
Immunoglobulin Isotypes:
|
|
|
|
Most common
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IgG
|
|
|
Mucous membranes
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IgA
|
|
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Primary response to antigen
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IgM
|
|
|
Crosses the placenta
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IgG
|
|
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Main antibody in secondary response (ie following IgM primary response)
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IgG
|
|
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Found in secretions
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IgA
|
|
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Monomer or pentamer form
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IgM
|
|
|
Unclear function
|
IgD
|
|
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Induces release of mediators from mast cells and basophils in response to allergen
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IgE
|
|
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Shortest lived
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IgE
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|
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Mediates immunity to worms
|
IgE
|
|
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IgG1, IgG2 are examples of
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Allotypes
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TH1 cells activate both ___ and ___ cells
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Macrophages, Tc
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|
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TH1 cells also produce what two chemicals
|
IL2 and gamma interferon
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|
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Then, what do TH2 cells do?
|
Help B-cells make antibody
|
|
|
What do they produce
|
IL-4,5
|
|
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Microorganisms get captured and presented to naïve T-cells, which IL causes TH1 vs TH2 differentiation
|
IL-12 – TH1
|
|
|
What happens to TH2 cells subsequently
|
Turns into B-cells / plasma cells
|
|
|
And TH1 cells?
|
Under gamma-interferon influence activated macrophage
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|
|
Host defense against infection (esp. bacteria), allergy, and autoimmunity is/are the role of
|
B-cells
|
|
|
Cell mediated immunity has some overlap in function, but what is important to transplant pts
|
CD8 cells play role in graft rejection
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|
|
CD8 cells also play role in host defense against what organisms
|
M. tuberculosis, fungi, and viruses
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|
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|
Human vaccines contain what type of adjuvants
|
AlOH or lipids
|
|
|
Name the class I genes of MHC
|
A, B, C
|
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|
And the class II
|
DP, DR, DQ
|
|
|
All nucleated cells have Class __ MHC proteins
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I
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APCs and ____ also have Class II MHC proteins
|
Dendritic cells
|
|
|
What are the main determinants of organ rejection
|
Class II
|
|
|
MHC I Ag loading occurs in the
|
Rough ER (viral antigens)
|
|
|
MHC II Ag loading occurs in
|
Acidified endosome
|
|
|
Helper T-cell aka
|
CD4 cells
|
|
|
CD4 cells bind MHC-??
|
II (on APC cells)
|
|
|
Cytotoxic T-cells aka
|
CD8 cells
|
|
|
What do they bind
|
MHC-I on VIRUS infected cells
|
|
|
Who qualifies as an APC
|
B-cells
|
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|
Describe IL-1,2,3,4,5 in terms of Hot T-Bone EA
|
IL-1 fever (hot)
|
|
|
Who are the ACUTE phase cytokines
|
IL-1, IL-6, TNF-alpha
|
|
|
Which interferon secreted by Helper T-cells helps to activate macrophages
|
Gamma
|
|
|
What does TNF-alpha (and effectively beta) do
|
↑IL-2 receptor synthesis
|
|
|
Describe the effect of the acute phase cytokines on the following organs:
|
|
|
|
Liver
|
Acute phase protein production (C-reactive protein)
|
|
|
Hypothalamus
|
↑temperature
|
|
|
Fat/muscle
|
Mobilization of energy reserves to ↑temp
|
|
|
Bone marrow
|
↑CSF leukocytosis
|
|
|
|
|
|
|
Complement system defends against
|
Gram (-) bacteria
|
|
|
Which pathway is activated by IgG or IgM
|
Classic (GM makes classic cars)
|
|
|
What activates the alternate pathway
|
Endotoxin, aggregated IgA
|
|
|
Which two complement components cause anaphylaxis
|
C3a and C5a
|
|
|
What is the BEST opsonizer
|
C3b
|
|
|
C5b-C9
|
MAC
|
|
|
Deficiency of MAC results in
|
Neisseria sepsis
|
|
|
___ responsible for neutrophil chemotaxis
|
C5a
|
|
|
Deficiency of __ leads to severe recurrent pyogenic sinus and respiratory infections
|
C3
|
|
|
Deficiency of ___ leads to paroxysmal nocturnal hemoglobinuria
|
DAF – decay accelerating factor
|
|
|
Recall: alternate pathway starts with __ and classic with __
|
C3
|
|
|
Convertases?
|
C3 convertase and C5 convertase
|
|
|
____ are proteins that place UNINFECTED cells in an antiviral state
|
Interferons
|
|
|
They do this by
|
Inducing a second protein that inhibits viral protein synthesis
|
|
|
They also ↑expression of MHC class-???
|
Class-I
|
|
|
And they ALSO activate
|
NK cells to kill virus infected cells
|
|
|
Hypersensitivity RXNS:
|
|
|
|
Why is Type-I so fast
|
Mast cells are pre-sensitized and have preformed antibody
|
|
|
What does the antigen do to the IgE on the mast cell
|
Cross-links it
|
|
|
Types I,II, and III are all _____ mediated
|
Antibody
|
|
|
Type-??: IgG and/or IgM bind to antigen on ‘bad’ cell and lead to lysis (by complement) or phagocytosis
|
II
|
|
|
Autoimmune hemolytic anemia, Rh disease (erythroblastosis fetalis) and Goodpasture’s are all
|
Type II
|
|
|
What is another name for Type-II rxn
|
Cytotoxic
|
|
|
What does an ‘immune complex’ consist of
|
Ag-Ab-Complement all stuck together
|
|
|
Since there are three things stuck together, this must be Type ? Rxn
|
III
|
|
|
Name two common diseases that result from immune complex deposition
|
PAN, GN
|
|
|
______: fever, urticaria, arthralgia, proteinuria, lymphadenopathy 5-10 days post-Ag exposure
|
Serum Sickness (Type III rxn)
|
|
|
An Arthus rxn is like serum sickness but is _____
|
Local (in skin)
|
|
|
And is only caused by
|
Ag-Ab complex
|
|
|
So, what’s Type IV
|
Delayed, cell mediated RXN
|
|
|
Seeing as how it is cell-mediated, it must not be transferable by
|
Serum
|
|
|
Give examples
|
TB skin test
|
|
|
Type IV relies on _____ interacting with antigen
|
Sensitized T-cells
|
|
|
Pneumonic to identify the four types
|
Anaphylactic
|
|
|
Name some common ‘infections’ where patients will be given pre-formed antibody injections (ie passive immunity)
|
Rabies
|
|
|
Genetic drift yields:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Immune Deficiencies – given the name of the disease, state the deficiency:
|
|
|
|
Bruton’s agammaglobulinemia
|
B-cell deficiency in Boys (x-linked recessive)
|
|
|
Thymic Aplasia (DiGeorge’s syndrome)
|
T-cell deficiency
|
|
|
DiGeorge’s is due to failure of development of _______ pharyngeal pouches
|
3rd and 4th
|
|
|
Causes recurrent
|
Viral, fungal and protozoal infections
|
|
|
Sometimes seen with what other congenital defects
|
Defects of heart and great vessels
|
|
|
Chronic mucocutaneous candidiasis caused by
|
T-cell dysfunction (specifically against Candida)
|
|
|
SCID
|
Both B-cell and T-cell deficiency. Recurrent infections of ALL types.
|
|
|
Name three causes:
|
Failure to synthesize MHC-II antigens
|
|
|
Wiskott-Aldrich syndrome
|
Also a combined B and T-cell deficiency. Failure to mount IgM response to encapsulated bacteria
|
|
|
Associated with elevated ___ levels and normal ___ levels
|
IgA
|
|
|
Triad of symptoms?
|
Recurrent pyogenic infections
|
|
|
There’s a third combined B and T cell deficiency, but this one has IgA deficiency
|
Ataxia-Telangectasia
|
|
|
Chronic granulomatous disease is due to
|
Failure in phagocytosis of neutrophils
|
|
|
Presents with marked ↑susceptibility to opportunistic infections, esp. _________
|
S.aureus, E.coli, and Aspergillus
|
|
|
Chediak-Higashi disease
|
Auto-recessive
|
|
|
Which syndrome is due to neutrophilic failure to respond to chemotactic stimulus
|
Job’s Syndrome
|
|
|
Associated with high levels of
|
IgE
|
|
|
Pt presents with recurrent
|
“cold”
|
|
|
What do the following antibodies test for:
|
|
|
|
ANA
|
Lupus
|
|
|
Anti-dsDNA
|
Lupus (highly specific)
|
|
|
Anti-histone
|
Drug-induced lupus (hydralizine, procainamide)
|
|
|
Anti-centromere
|
Scleroderma (CREST)
|
|
|
Anti-mitochondira
|
Primary biliary jaundice
|
|
|
Anti-gliadin
|
Celiac disease
|
|
|
Anti-BM
|
Goodpasture’s
|
|
|
Anti-neutrophil
|
Vasculitis
|
|
|
Anti-epithelial
|
Pemphigus vulgaris
|
|
|
|
|
|
|
Transplant rejections:
|
|
|
|
Hyperacute
|
Antibody mediated (preformed), minutes
|
|
|
Acute
|
Cell mediated due to T-cells reacting against foreign MHCs (within weeks)
|
|
|
Chronic
|
Antibody mediated vascular damage (fibrinoid necrosis), months to years after transplant
|
|
|
Graft vs. Host disease
|
Immunocompetent cells in the graft reject the host
|
|
|
Yersinia enterocolitica presentation
|
frequently presents with bloody diarrhea and right lower quadrant pain which can mimic Crohn's disease and appendicitis. Peritoneal signs are not present, which can help distinguish it from appendicitis. In some patients, mesenteric lymphadenitis is present. Furthermore, in some patients with the HLA-B27 serotype, this infection can result in seronegative arthritis.
|
|
|
Goodpasture's presentation. type hypersensitivity? immunoflourescene?
|
Hemoptysis and hematuria are two of the presenting symptoms of Goodpasture's syndrome. This condition develops via a type II hypersensitivity reaction with antibodies to the glomerular basement membrane. The finding of linear depositis on immunoflourescence helps to confirm the diagnosis.
|
|
|
examples of type 1-4 sensitivity
|
goodpastures and rheumatic fever are type II hypersensitivity reaction. Contact dermatitis due to poison ivy and a positive PPD test are examples of type IV delayed hypersensitivity. Henoch-Schonlein purpura is an immune complex type III hypersensitivity with IgA depositis in blood vessels. The reaction to a bee sting would be an example of an anaphylactic reaction which is a type I hypersensitivity.
This is a classical type I hypersensitivity reaction (food allergy). Cell mediated hypersensitivity is a Type IV. Hypergammaglobulinemia is plasma cell mediated. Complement C3B is a Type III. Immune complex deposition is also Type III. This represents an IgE-mediated (also called anaphylactic or type I) hypersensitivity reaction, where mast cells release histamine and other substances that result in vasodilation and increased vascular permeability, resulting in urticaria (hives) and angioedema (the same mechanism as urticaria, but affecting subcutaneous tissue). |
|
|
universal donor/acceptor blood types
|
AB+ is the universal donor for PLASMA because it does not contain any ANTIBODIES. You may remember that O- is the universal donor for RBC because it does not contain any ANTIGENS.
|
|
|
FFP contains what clotting factors? can be used for what purpose?
|
FFP contains clotting factors that are deficient in patients on warfarin (namely II, V, VII, IX).
|
|
|
differentiate strep pneumo, strep pyo and staph org
|
Strep pneumonia is the only gram positive diplococci. Streptococcus pyogenes are gram positive beta hemolytic cocci. Staphylococcus organisms are catalase positive and are gram positive cocci.
|
|
|
PID most common org? gram, shape?
|
PID is a chronic inflammatory state resulting from sexually transmitted infections, most commonly N. gonorrhea and C. trachomatis. Neisseria organisms are gram negative diplococci.
|
|
|
tightening of skin around hands and htn
|
progressive systemic sclerosis (PSS), or scleroderma. PSS can affect much of the GI tract, with the esophagus being the most common portion affected, frequently resulting in dysphagia. Findings on lung exam may represent an early finding of interstitial pulmonary fibrosis, a complication of PSS that can be fatal.
|
|
|
A 22-year-old college student that is confused and lethargic is brought to the emergency room. His roommates say he was complaining of a severe headache and neck stiffness last night. Vital signs are remarkable for a temperature of 104.3, blood pressure of 80/60 and heart rate of 120. Physical exam reveals a purpuric rash on the patient's chest. Lumbar puncture reveals a high neutrophil count. What treatment should be given to his roommates as prophylaxis?
|
patient described has acute bacterial meningitis, the cause of which is most likely N. meningitidis (given the patients age, clinical history, and the characteristic purpuric rash of DIC.) Rifampin is indicated for prophylaxis of close contacts of patients with meningococcal meningitis. Ceftriaxone is indicated for the treatment of meningococcal meningitis, but not the prophylaxis of contacts.
|
|
|
A 42-year old male patient presents with fever, pain in his knees, tingling and numbness of the extremities, cough, and a diffuse rash. He reports having low appetite and weight loss over the last several weeks. Laboratory tests reveal increased C-reactive protein, leukocytosis, and the presence of Hepatitis B surface antigen. A muscle biopsy shows necrotic vasculitis of small artery walls. His condition is mediated by which immunological mechanism?
|
ag-ab complexes. presentation is a classical case of polyarteritis nodosa (PAN) which is an antigen-antibody complex mediated vasculitis. The fact that the patient is male, Hepatitis B cell surface antigens, and necrotic vasculitis of small artery walls are all classic signs of PAN.
|
|
|
Mitral valve transplant, pt postop 5d later is hypotensive, tachycardic, and febrile. MCC?
|
gm+, Catalase positive, coagulase negative. The most likely bacterium is Staphylococcus epidermidis. This bacterium is a freuqent contaminant in hospitals and tends to infect tissue and organ grafts, IV lines, and respirators. It is a frequent cause of acute endocarditis on recently transplanted valves. After a few months, the most likely cause of acute endocarditis of a valve graft is the same as a native valve.
|
|
|
young male was recently diagnosed with a sexually transmitted infection in which kidney-shaped, Gram-negative diplococci were found in cytoplasmic inclusions of neutrophils. tx? if young male is allergic to penicillin, tx?
|
The patient has Neisseria gonorrhoeae. The current therapy of choice is ceftriaxone, but because of his allergy to penicillin, ciprofloxacin is the best alternative treatment. However, the patient should also be treated with azithromycin for Chlamydia trachomatis because up to 50% of patients will be concurrently infected. Azithromycin & Ciprofloxacin
|
|
|
child receives several vaccinations before the start of the school year. Shortly thereafter, he experiences a fever, joint pains, a rash and itching. The parents insist on a blood test, which reveals multinucleated giant cells with eosinophilic cytoplamic and nuclear inclusion bodies. This is most likely a reaction to which vaccine?
|
live measles vaccine. The live measles vaccine can cause mild measles symptoms, including multinucleated giant cells (a laboratory test for measles virus).
|
|
|
SDE meningitis vaccine?
|
Meningitis vaccine may cause pain and redness at the infection site.
|
|
|
SDE tetanus vaccine?
|
Tetanus vaccine may cause a type IV allergic reaction at the infection site 24-48 hours after injection.
|
|
|
SDE flu vaccine?
|
Flu vaccine may cause flu-like symptoms. Some individuals may have a type I anaphylactic reaction to an egg protein used in the vaccine; persons with egg allergies should not get the flu vaccine.
|
|
|
SDE pneumococcal vaccine?
|
Pneumococcal vaccine may cause tenderness or redness at the injection site, fever, and joint aches.
|
|
|
diptheria exotoxin MOA
|
potent inhibitor of protein syn via ADP ribosylation of EF-2
|
|
|
anthrax sxs
|
malignant pustule (painless ulcer), black skin lesion vesicular papules covered by black eschar, progress to bacteremia and death
|
