Microbiology/immunology/immune Disease Stuff

Front 1

Gram stain colorings?

Back 1

Gram + is PURPLE (p-p!)

Gram - is RED

Front 2

Bacterial binary fission (reproduction) stages

Back 2

1. I (initiation) period - cell elongates

2. C period - chromosome replicates and proteins needed for division produced

3. D (division) period - plasma membrane pinches inward and pulls cell wall with it - wall thickens and becomes a divider for new bacterium

Front 3

Bacterial lag vs log phases

Back 3

Lag = no division, just growth

Log = exponential division; antibiotics most effective at this stage!

Front 4

Facultative anaerobes

Back 4

Do not require O2 for growth, but do better when it's present

Front 5

Bacterial spore formation

Back 5

Gram + rods can for endospores w/o metabolic activity in times of stress (heat, UV, chemicals, dehydration) - like bacterial "hibernation"

Front 6

Approximately ____% of all ocular infections are caused by S. aureus

Back 6

50%!

S. aureus is a Gram (+) coccus found in much lower concentrations than S. epidermidis but is more pathogenic

Conjunctivitis, blepharitis, hordeola, keratitis

S. aureus is catalase + AND coagulase +

Front 7

Most common bacterial cause of acute posteroperative endophthalmitis?

Back 7

S. epidermidis!

Gram + coccus
Catalase + but coagulase -
More prevalent than S. aureus but less pathogenic

Front 8

Which bacterium commonly causes pediatric conjunctivitis and corneal ulcers?

Back 8

Streptococcus pneumoniae!

Gram + coccus, classically grows in pairs
Catalase -

Also most common cause of OTITIS MEDIA

Front 9

T/F: Strep pyogenes commonly causes ocular infections

Back 9

F

Gram + coccus, catalase -
Common cause of strep throat

Front 10

Catalase test differentiates which two types of bacteria?

What does coagulase test identify?

Back 10

Staph and strep

Staph are catalase +
Strep are catalse -

Coagulase test identifies S. aureus from others - S. aureus is coagulase + and all others are coagulase -

Front 11

T/F: Gram (+) rods are common sources for ocular infection

Back 11

F

Bacillus anthracis - anthrax

Clostridium - botulism, gangrene, tetanus (these are motile bacteria!)

Corynebacterium diptheriae - diphtheria

Front 12

Which Gram (-) rod is most common in CL-related corneal ulcers?

Back 12

Pseudomonas aeruginosa

-Motile, oxidase +, aerobic rod
-Grape juice odor and produces blue/green pigment
-Also common in burn victims and immunocompromised patients

Front 13

Aside from pseudomonas, what is another Gram (-) rod that causes ocular infection (esp in kids!)

Back 13

Haemophilus influenzae

-Upper respiratory tract infections, otitis media, sinusitis, pneumonia, meningitis
-Common infection in kids - otitis media + conjunctivitis!
-Incidence has DECREASED due to vaccine
-Classic violacious hue to skin infections
-Culture using chocolate agar

Front 14

Neisseria is a Gram (-/+) (rod/coccus)

Back 14

Neisseria is a Gram (-) coccus

*N. gonorrhea can cause sight-threatening corneal ulceration
*N. gonorrhea conjunctivitis is a rare, bilateral condition characterized by hyperacute onset and excessive pus

*N. meningitidis grows on blood agar (aerobic) while N. gonoccus grows on chocolate agar

Front 15

Chocolate agar vs blood agar

Back 15

Both are NON-SELECTIVE

Both contain blood

Chocolate agar contains extra nutrients to help "finicky" bacteria grow

Chocolate agar can be made selective for Neisseria or for Hemophilus based on addition of certain antibiotics

Front 16

T/F: E. coli is a Gram (-) rod that can cause conjunctivitis, corneal ulceration, and endophthalmitis

Back 16

T

Front 17

GI bacteria

Back 17

E. coli
Klebsiella pneumoniae
Proteus mirabilis
Serratia marcescens (characteristic RED pigment)

Front 18

T/F: Mycobacteria are Gram (-)

Back 18

F!

Mycobacteria do not stain w/ Gram stain - they are classified as ACID FAST

M. tuberculosis, M. leprae

Front 19

Treponema is a ______ (bacterial class) that causes ________.

Back 19

Treponema pallidum is a SPIROCHETE that causes SYPHILLIS

*FTA-ABs (exposure), VDRL (active), and RPR (active) are all tests for syphillis

*Recall syphillis has 3 stages:
1. Primary - chancre sore at entry site
2. Secondary - fever, sore throat, skin rash, hepatitis, CONJUNCTIVITIS
3. Tertiary - neurological and/or cardiovascular abnormalities; can cause blindness, deafness, insanity

Front 20

Argyll-Robertson pupils and interstitial keratitis are both ocular findings in what infection?

Back 20

Syphillis

Front 21

T/F: Chlamydia is an obligate intracellular PARASITE

Back 21

T

-Causes mucosal infections
-Similar to bacteria b/c contain DNA, RNA, and are inhibited by antibiotics
-Similar to viruses since they are obligate intracellular parasites!
-Chlamydial inclusion conjunctivitis is sexually transmitted and is usually unilateral (OD of young males!); characterized by folliclular reaction
-Trachoma is prevalent in countries where hygiene is poor and is the LEADING CAUSE OF PREVENTABLE BLINDNESS in the world

Front 22

Young male patient presents with red eye OD that he says has been going on for weeks. You find large, inferior palpebral follicles. What should this patient be tested for?

Back 22

Chlamydia

Front 23

Leading cause in the U.S. of ophthalmic neonatorum?

Back 23

Chlamydia infection

(acute conjunctivitis in the newborn)

Front 24

T/F: mycoplasma are resistant to antibiotics targeting the cell wall

Back 24

T!

Mycoplasma have no cell wall

*Mycoplasma pneumonia causes "walking pneumonia" and is treated w/ macrolide antibiotics

Front 25

Structure of a virus

Back 25

DNA/RNA within a protein coat (capsid)

Front 26

Viral recombination vs viral reassortment

Back 26

Viral recombination occurs when genes are exchanged btwn chromosomes of similar base sequences

Viral reassortment occurs in viruses w/ segmented genomes - entire segments are exchanged between viruses; cause of worldwide epidemics (e.g. influenza)

Front 27

EKC results from what virus?

Back 27

Adenovirus!

Non-enveloped DNA virus
Serotypes 8 and 19 cause EKC

Front 28

Herpesvirus is a (DNA/RNA) virus

T/F: Only HSV-1 causes keratoconjunctivitis

Back 28

DNA

F - both types cause keratoconjunctivitis

Front 29

What viral infection is the leading cause of blindness in AIDS patients?

Back 29

CMV

-10-34% of AIDS patients develop CMV retinopathy
-CD4 count < 50
-Characterized by CWS

Front 30

Which virus cause molluscum contagiosum?

Multiple, sudden molluscum lesions should raise suspicion for what?

Back 30

Poxvirus (enveloped DNA virus)

HIV

Front 31

Which Hepatitis virus is the only one that's a DNA virus?

Which Hepatitis virus has no vaccine?

Back 31

Hep B is a DNA virus

Hep C has no vaccine

*Hep B and C have the same effects - e.g. liver damage

Front 32

Fungi (yeasts and molds) are (eukaryotic/prokaryotic) organisms that use (glucose/glycogen) as a primary food source and are usually (aerobic/anaerobic).

Back 32

Eukaryotic

Glycogen

Aerobic (though some are facultative anaerobes)

Front 33

T/F: Yeast is unicellular while mold is multicellular

T/F: Yeas can reproduce both sexually and asexually

T/F: Fungi can shift between yeast and mold forms to inhabit a host organism or the soil, respectively

Back 33

T

T

T

Front 34

(Spore formation / transverse fission / budding) is the most common form of asexual production in fungi.

Back 34

Spore formation

Front 35

T/F: Spores are produced in both asexual and sexual fungus reproduction

Back 35

T

Sexual spores aid in survival in extreme environmental conditions

Front 36

Histoplasmosis is caused by what type of microorganism?

Back 36

Fungus - exists as a mold in the environment and a yeast in the body

Endemic in the Mississippi and Ohio River Valleys

Acute-nonprogressive form presents as fever and weigh loss

Chronic progressive form resembles TB

*Classic triad of histo in the eye:
1. Peripapillary atrophy of the ON
2. Histo spots (punched-out peripheral lesions)
3. Maculopathy

Front 37

Which fungus is the most common cause of corneal ulceration?

Back 37

Candida albicans

Front 38

River blindness is caused by what microorganism?

Loa loa is what type of microorganism?

Back 38

Onchocerca volvus and loa loa are both ROUNDWORMS (nematodes)

Nematodes are intestinal parasites found in contaminated food, water, mosquitoes, soil, feces, etc

Loa loa causes skin and conj swelling and one can see worms crawling in the conj

Front 39

(Toxo/histo) infection starts in the retina and can spread to the choroid.

Back 39

Toxo shows retinochoroidal infection

Histo shows chorioretinal infection

Front 40

Pneumocystic pneumonia occurs mostly in which types of patients?

Back 40

Immunocompromised

Pneumocystic jirovecci is a YEAST

Front 41

What type of culture should be used in acanthamoeba detection?

Back 41

Non-nutrient agar w/ heat-killed E. coli

Front 42

T/F: parasites are detected in the laboratory via direct examination of blood, fecal, or skin samples under the microscope

Back 42

T

Front 43

Which are DNA viruses and which are RNA viruses?

HSV, VZV, CMV, EBV, HepB, smallpos

Adenovirus, HPV, parvovirus

HIV, measles, mumps, rabies, influenza

Enteroviruses (poliovirus, coxsackievirus, echovirus, HepA, rhinovirus, rheovirus)

Back 43

DNA (enveloped)

DNA (non-enveloped)

RNA (enveloped)

RNA (non-enveloped)

Front 44

The bacterium causes TSS?

Back 44

S. aureus

Front 45

3 locations where antigens are primarily found?

Back 45

Blood - monocytes acting as APC's

CT - diffuse lymphatics; T and B cells

Lymph - antigens from blood also circulate here, destroyed by B and T cells in nodes

Front 46

T/F: The Fc portion of an antibody is constant for antibodies within the same class

T/F: Complement binds the Fab portion

T/F: The Fab portion is variable

Back 46

T

F - complement binds the Fc portion

T - to allow for binding of various antigens

Front 47

Function of interferons?

Types of interferons?

Which interferons are used to Tx which diseases?

Back 47

Produced by cells upon viral infection

Renders virus unable to reproduce further (no effect on ability to penetrate cell)

Nonspecific, BRIEF resistance to virus

Alpha- and beta-interferon made by almost all cells

Gamma-interferon made by some lymphocytes and NK cells for cessation of TUMOR growth

B-interferon is used to Tx relapsing MULTIPLE SCLEROSIS

Alpha-interferon is used to Tx Hep C, hairy-cell leukemia, and Kaposi's sarcoma

Gamma-interferon used to Tx granulomatous disease

Front 48

NK cell function

Back 48

Non-specific lymphocytes that can act as FIRST-LINE defense (unlike other lymphocytes)

Found in virally-infected or tumor cells in particular

DO NOT REQUIRE APC's for activation!

Front 49

Complement p'way destroys invaders in using 4 mechanisms:

Back 49

1. Direct cell lysis
2. Chemotaxis of neutrophils, macrophages
3. Opsonization
4. Degranulation of mast cells

Front 50

_____ (antibody) in the tears activates _____ (complement protein) to initiate the alternate pathway.

Back 50

IgA

C1

Front 51

Classical complement p'way

Back 51

1. C1 is activated upon binding Fc portion of IgM or IgG

2. C1 enzymatically cleaves C4 into two fragments, which cleaves C2, etc

3. "Membrane attack complex" (MAC) is formed which creates holes in the bacterial membrane

4. Bacterial lysis due to osmotic dysregulation

Front 52

Alternate complement p'way

Back 52

*Differs from classical p'way only in how the process is initiated

1. Initiated by C1 binding to IgA or bacterial endotoxins

2. C1 enzymatically cleaves C4 into two fragments, which cleaves C2, etc

3. "Membrane attack complex" (MAC) is formed which creates holes in the bacterial membrane

4. Bacterial lysis due to osmotic dysregulation

Front 53

T cells mature in the _____. B cells mature in the _____. Both B and T cells are made in the ________.

Back 53

Thymus

Bone marrow

Bone marrow

Front 54

T-helper cells recognize MHC class _____ receptors on APC's.

T-cytotoxic cells recognize MHC class _____ receptors on APC's.

Th cells have CD__+ receptors

Tc cells have CD__+ receptors


T/F: MHC class 2 receptors are found on all body cells

Back 54

Th = MCH class 2

Tc = MHC class 1

F - MCH 2 are found only on lymphocytes

Th = CD4+
Tc = CD8+

Front 55

Monocytes in the blood become ________ once they enter CT.

Back 55

Macrophages

Front 56

An HIV patient is considered to have AIDS when:

Back 56

(1) CD4 count drops below 200

OR

(2) CD4 count is above 200 but the patient has an opportunistic infection (e.g. pneumocystis jirovechii)

Front 57

CMV retinitis is treated first-line with ______ and second-line with _______.

Back 57

IV ganciclovir

foscarnet

Front 58

T/F: Both mast cells and basophils contain histamine

Back 58

T

Front 59

Normal development results in ____ (number) of chromosomes.

Kleinfelter has one (more/less) X- chromosome and results in a more (masculine/feminine) phenotype.

Turner has one (more/less) X-chromosome and results in a more (masculine/feminine) phenotype.

Back 59

46 (44 autosomal, 2 sex)

extra, feminine

less, masculine

Front 60

IL-1 vs IL-2

Which is released by macrophages? By Th cells?

Restasis inhibits production of which IL?

Back 60

IL-1 is produced by macrophages - stimulates T cells, B cells, neutrophils, fibroblasts to grow & produce products

IL-2 is produced by Th cells - stimulates Th growth and plasma and memory cell production

Restasis inhibits production of IL-2 and thus T-cell activation.

Front 61

Upon first exposure to an antigen, the body makes _____ antibodies slowly. Measurable amounts of Ab appear in the blood w/in (5-10 or 1-2?) days.

Back 61

IgM

5-10

Front 62

The second exposure to an antigen elicits a much faster immune response than the primary exposure. The body begins making _____ antibodies (type?) in less than 2 (hours, day?).

Back 62

IgG

2 hours

Front 63

Donor tissue is rejected through a Type ___ hypersensitivity reaction.

Hyperacute tissue rejection begins w/in minutes and is mediated by (antibodies orT-cells?).

Acute transplant rejection is mediated by (antibodies or T-cells?) weeks later.

Chronic transplant rejection is mediated by (antibodies or T-cells?) and is irreversible.

Back 63

Ab's

T-cells

Ab's

Front 64

How does IL-2 work against cancer?

Back 64

Stimulates host killer T and B cells to fight the tumor

Front 65

CBC measures _____, ______, and _______.

CBC w/ differential?

Back 65

WBC's, RBC's platelets

"CBC with diff" differentiates the types of WBC's present

Front 66

CRP is protein produced by the _____. Levels are raised in acute inflammation.

Back 66

Liver

Front 67

HLA-B27 and HLAB54 tests?

Back 67

HLA = human leukocyte antigen

B27 tests for ankylosing spondylitis, Reiter's syndrome, and other autoimmunes

B54 tests for gene that causes glaucomatocyclitic crisis - a.k.a. Posner-Schlossman syndrome (PSS):

-Recurrent episodes of mild cyclitis
-Uniocular involvement
-Duration of attack varying from a few hours to several weeks
-Signs of a slight decrease in vision, elevated IOP with open angles, corneal edema with a few keratic precipitates, heterochromia with anisocoria, and a large pupil in the affected eye
-Normal visual fields
-Normal optic disc
-Normal IOP and outflow facility, and all provocative tests normal between episodes

Front 68

Antinuclear antibody (ANA) test?

Back 68

Presence of auto-antibodies. ANA's only present when immune system attacks body tissues

Front 69

Acute inflammation is characterized by rubor, calor, dolor, and tumor. Define these.

Back 69

Rubor = redness

Calor = heat

Dolor = pain

Tumor = swelling

Front 70

Acute inflammation is characterized by infiltration of _____ (WBC type) while chronic inflammation is chararcterized by infiltration of ______ (WBC type).

Back 70

PMN's (neutrophils)

Mononuclear cells (macrophages, lymphocytes, plasma cells).T

Front 71

PPD tests are (+) w/ ____mm of induration. For healthcare workers? For immunocompromised patients?

Back 71

15mm

10mm

5mm

Front 72

Rh disease, Goodpasture's syndrome, and rheumatic fever are all examples of Type ____ immune reactions.

Back 72

Type II (cytotoxic)

Goodpasture’s syndrome (also known as Goodpasture’s disease and anti-glomerular basement antibody disease) is a rare disease characterized by glomerulonephritis and hemorrhaging of the lungs. Occurs when the immune system attacks Goodpasture's antigen in the kidneys and lungs.

Rheumatic fever = scarlet fever; occurs s/p S. pyogenes infection when antibodies against the bacteria also attack peri-arteriolar CT of the large joints, heart, skin, and brain.

Front 73

SLE and RA are examples of Type ____ immune reactions.

Back 73

Type III

Front 74

In Type IV hypersensitivity, T-lymphocytes release _______ which leads to macrophage activation.

Back 74

Leukokinin

Front 75

Phlyctenulosis, TB skin test, contact dermatitis, and corneal transplant rejection are all Type ____ hypersensitivity reactions.

Back 75

Type IV

Front 76

T/F: SLE can cause neuro-ophthalmic conditions, leading to optic disc edema and papilledema.

T/F: SLE patients usually complain of joint pain.

Back 76

T

T - 90% SLE patients have joint pain; malar (butterfly) rash, photosensitivity, renal disease, hemolytic anema are other Sx

Front 77

SLE commonly affects which organs/body areas?

Back 77

Skin, kidneys, joints, heart

Front 78

RA patients have a life expectancy that's reduced by ____ years.

Back 78

4-10

Front 79

What is the most common cause of uveitis in kids?

Back 79

JRA

Female w/ bilateral, chronic, non-granulomatous anterior uveitis is classic presentation

Front 80

T/F: Sjogren's usually affects young females (under 40).

Back 80

F - usually affects females age 40-60

Front 81

Gout occurs due to monosodium urate crystal deposition in the joints, in response to increased levels of _______.

What corneal degeneration may occur due to gout?

Back 81

Uric acid

Band keratopathy

Front 82

Sarcoid is most common in what gender and race?

Characterized by increased serum levels of _____ and noncaseating granulomas.

Back 82

Black females

ACE

*Note that sarcoid is associated w/ restrictive lung disease and Bell's palsy

*75% of those with ocular manifestations (25% of all cases) will have anterior granulomatous uveitis.

Front 83

Ankylosing spondylitis occurs in what gender and age range?

Characterized by what 4 features?

Back 83

10-30 yo males

"Bamboo spine", sacroilitis, uveitis, aortic regurgitation.

*Inflammation of spinal joints!*

Front 84

Reiter's syndrome is characterized by what classic triad?

Back 84

Conjunctivitis or anterior uveitis
Urethritis
Arthritis

"Mr Reither can't see, can't pee, can't climb a tree"

Front 85

Patients w/ suspected ankylosing spondylitis should have what diagnostic tests done?

Back 85

Lower back X-ray

HLA-B27

Front 86

T/F: osteoarthritis is an autoimmune disorder.

Back 86

F

Breakdown of cartilage in large joints - usu hips, knees

Front 87

RA is worse in the ____ while osteoarthritis is worse in the _____. (AM or PM?)

Back 87

AM

PM

Front 88

Bone density test (DEXA) is important Dx test for what condition?

Back 88

Osteoporosis

Front 89

Fibromyalgia

-what age/gender?
-etiology?
-Dx tests?
-Tx?

Back 89

Fibromyalgia affects females age 20-50.

Chronic pain in multiple locations called "trigger points" (joints, muscles, tendons, other soft body parts)

-Lab tests and clinical exam are all WNL!

-Exercise and antidepressants

Front 90

_____ is the most common primary immunodeficiency disease.

Back 90

IgA deficiency

Significant decreases in serum IgA and secretions.

Most people show no Sx

Can suffer from recurrent respiratory tract infections, keratinization of the cornea, weight loss, diarrhea

Front 91

Name 6 common opportunistic infections in HIV/AIDS patients.

Back 91

-Pneumocystic pneumonia (fungus)
-Toxoplasmosis (fungus)
-Mycobacterium tuberculosis (bacteria)
-CMV (virus)
-Kaposi's sarcoma (virus)
-Progressive multifocal leukoencephalopathy (PML) - demyelinating disease of CNS, in which homonymous hemianopsia is present 45% of the time

Front 92

Cellular edema occurs in hypoxic conditions because....

Back 92

ATP production is decreased.

Disruption Na+/K+ transport leads to edema

Chronic edema due to accumulation of Na+ w/in cell damages the cell membrane = irreversible cell damage

Front 93

Liquefactive vs coagulative vs caseous necrosis

Back 93

Liquefactive = well-defined cellular boundary containing dull, gray/white remains; e.g. fungual lung infections

Coagulative - intact cellular boundary but w/ integral structural protein denaturation; e.g. s/p MI

Caseous = "cheesy" central necrotic tissue; e.g. TB