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705 Cards in this Set

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An alcoholic vomits gastric contents and develops foul smelling sputum, what organisms are most likely
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
Lyme disease
Pt with mycoplasma pneumoniae exhibits cryoagglutinins during recovery phase. What type of immunoglobulins are reacting?
Urinalysis of pt shows WBC casts, what’s the DX
Young child presents with tetany and candidiasis. Hypocalcemia and immunosuppression are also found – what cell is deficient
T-cell (DiGeorge’s syndrome)
Pt presents with rosegardener’s scenario (thorn prick with ulcers along lymphatic drainage)
Sporothrix schenckii
Burning feeling in gut after meals – its an ulcer, what’s the bug and classify it
H. Pylori
32 y/o male with cauliflower skin lesions. Tissue biopsy shows broad-based budding yeasts. What’s the organism
Breast feeding woman with redness and swelling of breast – likely organism
Young child with recurrent lung infections and granulomatous lesions, what is the defect in neutrophils
NADPH oxidase (chronic granulomatous disease)
20 y/o college student with lymphadenopathy, fever, hepatosplenomegaly. His serum agglutinate sheep RBCs. What cell is infected
Infant becomes flaccid after eating honey, what’s the organism
C. botulinium
Classify it
Gram positive rod
What’s the mechanism
Inhibits release of AcH
What exposure leads to squamous cell carcinoma of penis
Pt develops endocarditis three weeks post prosthetic heart valve insertion, what’s the organism(s)
S.aureus or S.epidermidis
Pt visits Mexico and gets bloody diarrhea, what RBC ingesting trophozoite will be found in stool
Glossy photo of heart valve w/cauliflower growth, DX?
Bacterial endocarditis
Adolescent with cough and rusty sputum, what does gram stain of sputum show
Gram positive diplococci
HIV pt with lymphocyte infiltration of CSF. Yeast found in meninges, DX?
Give the function of the following:
Rigid support, protects against osmotic pressure
Cell wall / cel membrane (gram (+))
Major surface antigen
Outer membrane (gram (-) only)
Site of endotoxin (LPS)
Plasma membrane
Site of oxidative and transport enzymes
Space between cytoplasmic membrane and outer membrane in Gram(-) bacteria
Protects against phagocytosis
Pilus / fimbria
Adherence of bacteria to cell surface, also used as sex pilus
Resistance to dehydration, heat and chemicals
Mediates adherence to surfaces, esp. foreign surfaces such as indwelling catheters
Which acid of the cell wall activates TNF and IL-1
Teichoic acid (unique to gram +)
What’s the equivalent on the outer membrane
What’s in the periplasm
Many hydrolytic enzymes, including beta-lactamases
The capsule is constructed from
Polysaccharide (except bacillus anthracis which is D-glutamate)
What protects the spore
A keratin-like coat, dipicolinic acid
Which cell-wall layer is much thinner on the gram (-) bacteria
Name the four phases on the bacterial growth curve
Lag phase, log phase, stationary phase, death phase
Endotoxins are unique to
Gram (-) organisms
_____ are secreted from the cell
Endotoxins are lipopolysaccarhides, what are exotoxins
Which is more toxic
Gram negative endotoxin known to cause
Fever and shock
Which has the possibility of a vaccine
Exotoxin only
Heat stability
Exotoxin – heat at 60 degrees celsius to destroy
Tetanus, botulism and diptheria are typical diseases involving
Name something caused by endotoxins
Gram negative sepsis
Name the gram(+) bugs that have exotoxins
Diptheriae, all the clostridiums, anthrax, staph and strep (pyogenes)
Characteristic presentation of pt w/diphtheria
Pharyngitis and pseudomembrane
How does clostridium tetani affect its victims
Blocks release of inhibitory transmitter glycine
How about C. botulinium
Blocks acetylcholine
Which clostridium causes gas gangrene
C. perfringens
What does its growth look like on blood agar
Double zone of hemolysis
The toxin of S.aureus is a
What does it bind to
MHC class-II and T-cell receptors
What does it induce in TSS
Which bacteria is erythrogenic and causes rash of Scarlet fever
Strep. Pyogenes
What titer is used in detecting rheumatic fever
Which three gram negative bugs have exotoxins
E.coli, Vibrio cholerae, Bordatella pertussis
How does the heat labile toxin of e.coli work
Stimulates adenylate cyclase by ADP ribosylating G-protein
How does the heat stabile toxin of e.coli work
Directly stimulates guanylate cyclase
What’s the end result of both toxins
Watery diarrhea
Vibrio also ADP-ribosylates G-protein. How does it cause rice-water diarrhea
↑pumping of Cl- and water into gut
Pertussis also does the ADP-ribosylation, and its end result disease is
Whooping cause
Is endotoxin of gram(-) bugs heat stable or labile
Endotoxin (esp. Lipid-A) actiavtes three important ‘pathways’, describe the result of each:
Activates macrophages:
↑IL-1  fever
Activates alternate complement pathway:
↑c3a  hypotension, edema
Activates Hageman factor:
Coag. Cascade  DIC
Name the best stain to use:
Silver stain
High lipid content of cell wall requires acid-fast staining
Dark field microscopy and fluor. Antibody staining
Rickettsia, Chlamydia
Intracellular – no staining possible?
Why can’t mycoplasma be stained
No cell wall
The pathogenic Nesseria species are differentiated on the basis of
Sugar fermentation
MeniGococci ferment
Maltose and Glucose
Gonnococci ferment
Some bacteria produce a pigment:
S. aureus
Pseudomonas aeruginosa
Serratia marcescens
Red (like maraschino cherries)
What allows the following organisms to colonize mucosal surfaces: Strep pneumoniae, Neisseria, H.influenza
They all have IgA proteases
Gram Positive algorithm:
What’s the first branch point
Cocci or rods
If rods – we only have a few choices
Clostridium, Listeria, Bacillus, Corynebacterium
If cocci – what’s the next test
What are our cocci choices
Strep vs. Staph
How does the catalase test help us
Cat(+) = staph
So, it comes up Cat(+) and we have staph., what’s the next step
Coagulase test
Coagulase (+) means we have
Coagulase (-) means
S. epidermidis (novobiocin sensitive)
And, if it comes up Cat(-), what’s the next step
Determining what type of hemolysis we have
What are our choices
Green (partial hemolysis)
Alpha hemolytic is which ‘color’
Beta hemolytic
Gamma hemolytic
No hemolysis
What two bacteria fall under alpha hemolytic
Strep pneumoniae (optochin sensitive, bile soluble, +quellung)
Which bugs are beta hemolytic? effect bacitracin?
GAS - Strep pyogenes (bacitracin sensitive)
Who’s left under gamma hemolytic
Enterococcus (E. faecalis) and Peptostreptococcus (anaerobe)
Gram (-) algorithm:
Oddly, there are three choices once we get a Gram (-) result
Rods, cocci, and ‘coccoid’ rods
Who are these coccoid-rods
If we get gram(-) cocci, what are the choices
Neisseria meningitidis or gonnerhoera
How do we differentiate
Sugar fermentation
Which ferments maltose
N. meningitidis (recall: both ferment glucose)
All we’re left with are rods – what’s the next test
Lactose fermentation
Name the important lac(+) bugs
Klebsiella, e.coli and enterobacter (fast fermenter)
The lac(-) bugs must be further separated using what test
Oxidase test
Who are the lac(-), oxidase (-) bugs
And the lac(-), oxidase (+) bug
Some bugs require special media:
Chocalate agar w/factor V (NAD)/X (hematin)
N. gonorrhea
Thayer-Martin media
B. perutssis
Bordet-Gengou (potato) agar
C. diphtheria
Tellurite agar
M. tuberculosis
Lowenstein-Jensen agar
Legionella pneumophila
Charcoal yeast extract buffered w/iron+cysteine
Which bugs form PINK colonies on MacConkey’s
Lactose fermenting enterics (E.coli, enterobacter, and klebsiella)
What do we grow fungi on
Sabouraud’s agar (sourdough bread)
What special stain is used for the following:
Congo Red (apple-green birifringence)
Borrelia, Chlamydia, Plasmodium, Trypanosomes
Cryptococcus neoformans
India Ink
Acid-fast bacteria
Glycogen (mucopolysaccarrhides)
Thus, this stain is used to DX _____ Disease
What do we stain electrodense substrates with
Osmium tetroxide
Fungi, PCP, Legionella
Silver stain
_____ involves the transfer of DNA from one cell to another by a virus
What is it called when the process takes place directly between two bacteria
Thus, ____ is when purified DNA is taken up by any cell (pro- or eukaryote)
What do M. tuberculosis and Pseudomonas AERuginosa have in common
Obligate aerobes
Name two more
Nocardia and Bacillus
Where is pseudomonas aeruginosa commonly seen in the hospital
In burn wounds, CF kid’s pneumonia and nosocomila pneumonia
Why are clostridium, bacteroides and actinomyces obligate ANaerobes
They lack catalase / superoxide dismutase
Anaerobes are considered normal flora in the ____ but abnormal elsewhere
GI tract
Which antibiotics require oxygen to enter the bacterial cell wall, thus are ineffective against anaerobes
What ‘sense’ is best used to identify an anaerobic infection
Sense of smell – FOUL
What is the capsule of encapsulated bacteria
Polysaccarrhide / antiphagocytic virulence factor
What’s the test to test for encapsulated bacteria
Quellung reaction
Describe a positive reaction
If encapsulated bug is present, capsule SWELLS when specific anticapsular antisera are added
What are some examples of encapsulated bacteria (hint – think lung related)
Strep. Pneumoniae, klebsiella, H.influenza, neisseria meningitidis
Who is at ↑risk for infection w/encapsulated bugs
Sickle cell pts
What type of bacteria can form spores
Only gram(+) rods
What do spores have in their core
Dipicolinic acid
Give three examples of gram(+) soil bugs that form spores
Clostridium tetani / perfringens
Name the alpha-hemolytic bacteria
Strep. Pneumoniae (CAT(-), optochin sens.)
The beta-hemolytic bacteria include S.aureus, Strep. Pyogenes, Strep. Agalactiae, and Listeria:
Which is cat(-) bacitracin resistant
Strep. Agalactiae
Which is cat(-) bacitracin sensitive
Strep. Pyogenes
Which is cat(+) and coagulase(+)
Which exhibits tumbling mobility, causes meningitis in newborns and is found in unpasteurized milk
What is the function of catalase anyway
Degrades hydrogen peroxide – a PMN antimicrobial product
What is hyd. Peroxide a substrate for
We know that staph makes catalase and strep does not, but who makes coagulase and who does not
Staph aureus makes coagulase
Name the S.aureus virulence factor that binds Fc-IgG, thereby inhibiting complement fixation
Name three big conditions cause by S.aureus
Which strep. Subspecies is Group-A beta hemolytic
Strep. Pyogenes (SP)
What are the ‘pyogenic’ illnesses caused by SP
Pharyngitis, cellulitis, skin infection
Toxigenic illnesses?
Scarlet fever, TSS
Immunologic illnesses?
Rheumatic fever, acute glomerulonephritis
What antibody in particular enhances host defenses against SP
Anti-M Protein
Pneumonic for rheumatic fever = PECCS
Who are the enterococci
E. faecalis and E.faecium
They are Pen-G resistant and are known to cause
Lansfield grouping method is based on the _____ in the bacterial cell wall
Enterococci are hardier than nonenterococci group-D, thus can grow in
6.5% NaCl (lab test)
____ are normal flora of the oropharynx and cause dental caries (mutans) and endocarditis (sanguis)
Viridians streptococci
The strep viridians group is resistant to ____, which differentiates them from _____
Optochin, S.pneumoniae
_____: gram(+), spore forming, anaerobic bacilli
C.perfringens produces a ______ that causes myonecrosis / gas gangrene
Cdifficile causes diarrhea (pseudomembranous colitis), esp. following what antibiotics
Ampicillin, clindamycin
So instead, treat with
Flagyl, vancomycin
What does the exotoxin of diptheria inhibit
Protein synthesis – it does this via ADP-ribosylation of EF-2
Grayish-white membrane in throat and lymphadenopathy
Lab DX is based on Gram(+) rods with _____ granules
‘Coryn’ means
Grows on ____ agar
Anthrax (inhalation type) is aka
Woolsorter’s disease
Aren’t actinomyces and nocardia both fungi?
The mistake is easy, but no. both are gram(+) rods forming long branching filaments resembling fungi
Which is a normal oral flora that can cause sulfur granules that drain through the sinus tract
What is Nocardia notorious for
Causing pulmonary infection in immunocompromised pts
The gram negative outer membrane inhibits entry of which drugs
Penicillin and vancomycin
Some bugs commonly cause certain food poisonings:
Contaminated seafood
Staph aureus
Meats, mayo, custard
Bacillus cereus
Reheated rice
Reheated meat dishes
e.coli O157-H7
Undercooked meat
Poultry, eggs, meat
Name the species causing the diarrhea:
No fever / leukocytosis, but ferments lactose
No fever / leukocytosis, comma shaped
Vibrio cholerae
Fever and leukocytosis, does not ferment lactose, motile
Same – but, nonmotile, low ID-50
Fever and leukocytosis, growth at 42 degrees, comma or S-shaped organism
Campylobacter jejuni
Fever, leukocytosis, transmitted by seafood
Vibrio parahemolyticus
Fever and leukocytosis, transmitted by dog poop
Yersinia enterocolitica
Which bugs cause watery diarrhea
Vibrio cholerae, ETEC
Which viruses
Which protozoans
Crypto, giardia
Which bugs cause bloody diarrhea
Salmonella, shigella, campylobacter, EIEC, EHEC, yersinia
Which protozoan
The enterobacteriacae family includes e.coli, salmonella, klebsiella, enterobacter, serratia, proteus. How do they all have COFFEe in common
What is the O-antigen
It is the polysaccarrhide of endotoxin
What is the K (capsular) antigen
Related to the virulence of the bug
What is the flagellar antigen
H-antigen (only in motile species)
In addition to all fermenting glucose, these bugs are all also ____ negative
HaEMOPhilus Influenzae causes
Note that H.influenza does not cause
The flu! Influenza A/B does that
Classify H.influenza
Small gram(-) coccobacillary rod
How to remember the required factors added to agar
When child has the ‘flu’, mom goes to V and X to buy some chocolate
Describe H.influenza vaccination
Between 2-18 months, contains type-b capsular polysaccarrhide
What does H.influenza produce
IgA protease
TX meningitis with
_____ prophy for close contacts
Grows on:
Aerosol water contact (A/C units and ventilation) NOT person-to-person
TX with ______
Besides anthrax, what causes black skin lesions
Pseudomonas aeruginosa
Keeping in that PSEUdomonas AERuginosa is AERobic, name some key infections
Pneumonia (CF kids)
What is the common connection?
Water source
Think of water and algae….what color comes to mind
Blue-green pigment
Anti-pseudomonas antibiotic (pip-tic-carb) and aminoglycoside
Classify H.pylori
Gram(-) rod, UREASE (+)
How does this help us
We can test with a urease breath test
What does urease(+) mena
Cleaves urea to ammonia
Who else is urease positive
Lactose is KEE?
Lactose fermenting bacteria grow pink colonies on MacConkey’s agar. Klebsiella, E.coli, Enterobacter
How is salmonella different than shigella
Salmonella is motile and has an animal reservoir
Which G-proteins do cholera and pertussis effect
Cholera permanently activates Gs
Both toxins act via_______ that permanently activates ______ resulting in ↑______
Pneumonic for which bacteria are zoonotic
Bugs From Your Pet
The Brucella species undulates, and unpasteurized dairy gives you
Undulant fever
Which of the above comes from a flea bite, rodents and esp. prairie dogs
Yersinia pestis
The resultant infection is
The Plague
Which of the above causes cellulitis and is caused by animal bites (cat, dog)
_____ is a coccobacillus that causes green / fishy vaginal discharge
Gardnerella vaginalis
What clues us in on this DX
Why are Rickettsia and Chlamydia obligate intracellular bugs
They can’t make their own ATP
Primary TB usually occurs in ____
Child, non-immune host
Secondary occurs in
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
What does it look like
Fibrocaseous cavitary lesion
TB in the vertebral body is aka
Pott’s disease
Stain for mycobacteria?
Hansen’s disease is aka
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
Kid shows up with headache, fever, and rash (vascultis). Which intracellular organism are you worried about
Name the subspecies of Rickettsia:
Endemic typhus (fleas)
Endemic typhus (human body louse)
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
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
Name the two forms of chlamydiae
Elementary body – small, dense, Enters cell via Endocytosis
Causes arthritis, conjunctivitis, pneumonia and ______ urethritis
Why is its cell wall unusual
Lacks muramic acid
Ery or tet
Which chlamydia has an avian reservoir
Which causes atypical pneumona (hint:easy one)
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)
How is treponema visualized
Dark field microscopy
Erythema chronicum migrans is assoc. with
Lyme disease
Describe the three stages
Neurologic and cardiac manifestations
Autoimmune migratory polyarthritis
Deer are required for Ixodes lifecycle, but ____ are important reservoirs
Who causes syphilis
Treponema palladium
T.pertenue causes tropical infection that causes VRDL(+) test, but it is NOT a STD, aka
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)
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
Systemic infection?
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
Bird or bat drippings carry
Histoplasmosis – often seen INSIDE macrophages
Who is endemic in rural Latin America and has a Captain’s Wheel appearance
All of the above are DIMORPHIC fungi – what does this mean
Mold in soil at lower temperatures
Local infection – use an –azole
Ear fungus is caused by
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 ____
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
Cigar-shaped budding yeast visible in pus
Itraconazole or KI
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
Contracted from
Meat or cat feces
___ inhalation causes diffuse interstitial pneumonia in HIV pts
TMP-SMX, dapsone or pentamidine
Name the plasmodium
Vivax, malariae, ovale, falciparum
Transmitted by
Of all the –quines, which is used for vivax and ovale
How to DX trichomonas vaginalis
Trophozoites on wet mount
Trypanosoma cruzi causes
Chaga’s disease
Contracted by
Reduviid bug
Tryp. Gambiense / rhodiense cause
African sleeping sickness
Contracted by
Tsetse fly
Cysticercosis caused by
Taenia solium
Trematodes are aka
The TX for all flukes is
Schistosoma comes from
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
You eat undercooked meat, get periorbital edema and muscle inflammation, you probably have
Trichenella spiralis
Loa loa transmitted by
Deer fly
_____: transmitted by blackflies, causes river blindness
Elephantiasis caused by ___ and TX with ___
Wucheria bancrofti (blocks lymphatics)
Of all the DNA viruses, only ____ is single stranded
All are linear except
Hepadnavirus and papovirus (circular)
In contrast to DNA viruses, all RNA viruses are ssRNA except
As far as shape – all DNA viruses are
The DNA viruses are HHAPPPy
Hepadna, herpes, adeno, parvo, papo, pox
Which causes hep-B
Which herpes virus causes mono
Which causes Roseola
Which virus causes sore throat and pink eye
Parvovirus known for
Which virus known for PML in HIV pts
Papovirus (JC virus)
Which is the largest DNA virus
What ‘shape’ are MOST of the RNA viruses
Which are ss-circular
Arena- and bunyaviruses
Picornaviruses like to PERCH on their victims
Colorado tick fever caused by
Biggest cause of fatal diarrhea in kids
Hep-C caused by
What else do flaviviruses cause
Yellow fever, Dengue, St. Louis
The equine encephalitis (east and west) is caused by
Which two are retroviruses
Measles, mumps, RSV and parainfluenza (croup) =
Rabies is a
What’s scary about filoviruses
Hemorrhagic (ebola, marburg etc), often fatal
Sandfly, rift valley fever, hantavirus and crimea-congo are all
What does it take for naked viral genomes to be infective
Must be (+) stranded (either ssRNA or dsDNA)
What does naked mean
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
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
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
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
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:
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
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:
RNA, picoRNAvirus
DNA, hepaDnavirus
RNA, flavivirus
Delta agent
RNA, calcicivirus
Which hepatitis viruses predispose a patient to hepatocellular carcinoma
____ is transmitted PRIMARILY via BLOOD
____ is transmitted parenterally, SEXUALLY and maternal-fetal routes
____ is transmitted enterically and causes water-borne epidemics
____ has a high mortality rate in pregnant women
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
What do the following tell us:
Surface marker for HBV, continues presence indicates carrier state
Antibody to HbsAG: provides immunity to HBV
Antigen assoc. with core of HBV
Positive during window period. IgM HBcAb is an indicator of recent infection
Second antigenic determinant in the HBV core. Indicates transmissibility (BEware!)
Antibody to e-Ag, indicates low transmissibility
So, during incubation period, what is present
And during prodrome, acute disease
HBsAg (anti-HBc)
During early convalescence
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
The HIV genome is diploid, with 2 copies of
What is the designator for the rectangular nucleocapsid protein
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
Known to cause
CJD, kuru, scrapie (sheep), and mad-cow
Prions are assoc. with
spongiform encephalopathy
Name the normal flora:
S. epidermidis
Viridians strep.
Dental plaque
B.fragilis > E.coli
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
S.pneumoniae, viruses, anaerobes
Staph, gram(-) rods
Staph, PCP
Alcoholic / IV drug user
Strep. Pneumoniae, Klebsiella
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)
60+ yr
Note that _____ also falls into very young and very old categories
What about HIV pts
What are the CSF findings in meningitis for:
Pressure↑, ↑PMNs, ↑protein, ↓sugar
Fungal / TB
Pressure↑, ↑lymphs, ↑protein, ↓sugar
Pressure↑/nl, ↑lymphs, nl ,nl
What causes osteomyelitis in:
Most people
Sickle cell pts
Drug addicts
Prosthetic replacement
S.aureus and S.epidermidis
UTI’s, name the cause:
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
Subacute, undiagnosed PID caused by
Chlamydiae trachomatis
Acute PID with high fever caused by
____ is the most common STD in US
Certain sign involved?
Chandelier sign
Recall: gardnerella vaginitis DX made by
Clue cells
Trichomonas DX made by
Motion on wet mount
Wound infections
But, you can presume ____ when AIR or BURNS
Pseudomonas aeruginosa
And you can assume ___ when water-source
What about in newborn nurseries
What if you work in a renal dialysis unit
Bug Hints:
Pediatric infection (including epiglottitis)
Branching rods in oral infection
Actinomyces israelli
Traumatic open wound
C.perfringens (PERForated abdomen)
Surgical wound
Dog or cat bite
Pasteurella multocida
Currant-jelly sputum
Klebsiella (Kurrant jelly)
Variable part of ______ recognizes antigen
Heavy and light chains
Whereas only the constant part of ___ chain of IgG and IgM fixes complement
Light chain contributes only to the
Fab fragment
What are the four C’s of the Fc fragment
Immunoglobulin Isotypes:
Most common
Mucous membranes
Primary response to antigen
Crosses the placenta
Main antibody in secondary response (ie following IgM primary response)
Found in secretions
Monomer or pentamer form
Unclear function
Induces release of mediators from mast cells and basophils in response to allergen
Shortest lived
Mediates immunity to worms
IgG1, IgG2 are examples of
TH1 cells activate both ___ and ___ cells
Macrophages, Tc
TH1 cells also produce what two chemicals
IL2 and gamma interferon
Then, what do TH2 cells do?
Help B-cells make antibody
What do they produce
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
Host defense against infection (esp. bacteria), allergy, and autoimmunity is/are the role of
Cell mediated immunity has some overlap in function, but what is important to transplant pts
CD8 cells play role in graft rejection
CD8 cells also play role in host defense against what organisms
M. tuberculosis, fungi, and viruses
Human vaccines contain what type of adjuvants
AlOH or lipids
Name the class I genes of MHC
A, B, C
And the class II
All nucleated cells have Class __ MHC proteins
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
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
What does TNF-alpha (and effectively beta) do
↑IL-2 receptor synthesis
Describe the effect of the acute phase cytokines on the following organs:
Acute phase protein production (C-reactive protein)
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
Deficiency of MAC results in
Neisseria sepsis
___ responsible for neutrophil chemotaxis
Deficiency of __ leads to severe recurrent pyogenic sinus and respiratory infections
Deficiency of ___ leads to paroxysmal nocturnal hemoglobinuria
DAF – decay accelerating factor
Recall: alternate pathway starts with __ and classic with __
C3 convertase and C5 convertase
____ are proteins that place UNINFECTED cells in an antiviral state
They do this by
Inducing a second protein that inhibits viral protein synthesis
They also ↑expression of MHC class-???
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
Type-??: IgG and/or IgM bind to antigen on ‘bad’ cell and lead to lysis (by complement) or phagocytosis
Autoimmune hemolytic anemia, Rh disease (erythroblastosis fetalis) and Goodpasture’s are all
Type II
What is another name for Type-II rxn
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
Name two common diseases that result from immune complex deposition
______: 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
Give examples
TB skin test
Type IV relies on _____ interacting with antigen
Sensitized T-cells
Pneumonic to identify the four types
Name some common ‘infections’ where patients will be given pre-formed antibody injections (ie passive immunity)
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)
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
Triad of symptoms?
Recurrent pyogenic infections
There’s a third combined B and T cell deficiency, but this one has IgA deficiency
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
Which syndrome is due to neutrophilic failure to respond to chemotactic stimulus
Job’s Syndrome
Associated with high levels of
Pt presents with recurrent
What do the following antibodies test for:
Lupus (highly specific)
Drug-induced lupus (hydralizine, procainamide)
Scleroderma (CREST)
Primary biliary jaundice
Celiac disease
Pemphigus vulgaris
Transplant rejections:
Antibody mediated (preformed), minutes
Cell mediated due to T-cells reacting against foreign MHCs (within weeks)
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