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118 Cards in this Set
- Front
- Back
Classic triad of meningitis
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Fever, headache, nuchal rigidity
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The most common cause of meningitis is ___, which are associated with ____ meningitis syndrome
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Viruses, aseptic
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Life-threatening meningitis is caused primarily by a small group of ____
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bacterial pathogens
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_____ is the common evasive mechanism among meningeal pathogens
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Encapsulation
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What is a frequently seen feature of bacterial meningitis versus viral
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altered mental status
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When do you NOT do a lumbar puncture to assess meningitis?
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focal mass lesions (risk brain herniation)
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LP results for bacterial meningitis
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WBC >1000/uL Protein >100mg/dL glucose LOW <40mg/dL
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____ and certain fungi can produce meningeal enhancement that can be seen on MRI studies
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Mycobacterium
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_____ organism in menginitis can by dx with India Ink stain
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Cryptococcus
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____ characterized by fever, headache,and early alteration of mental status
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Encephalitis
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_____ are the most common cause of viral encephalitis and occur primarily in late ___
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Enteroviruses, summer to fall
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Which encephalitis is seen year long
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Herpes virus
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Which encephalitis has hydrophobia
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Rabies virus
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____ encephalitis is associated with temporal lobe disease, particularly hemorrhagic lesions
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HSV
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20 y/o male, January 12hour history of high fever, chills, HA. Confused and mad,purpuric skin lesions.
BP 71/54 with neck stiffness |
Neisseria meningitidis (meningococcal meningitis)
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Gram negative and found in pairs (diplococci) coffee bean shape, LOS endotoxin, oxidase positive
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Neisseria meningitidis (meningococcal meningitis)
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Acid is produced from fermentation of glucose and maltose, but NOT lactose
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Neisseria meningitidis (meningococcal meningitis)
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____ leading cause of bacterial meningitis in kids and teens
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Neisseria meningitidis (meningococcal meningitis)
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A congenital deficiency of terminal _____ predisposes individuals to meningococcemia
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complement components C5-C9
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Meningococcal pili allow colonization of nasopharynx, and ___ enhances colonization of upper repiratory tract
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IgA protease
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What in N. meningitidis is antiphagocytic
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polysaccharide capsule
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What causes the purpuric rash in N. meningitidis?
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LOS-associated endotoxin into the blood stream leads to thromnocytopenia, DIC
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possible permanent sequelae of meninggococcal meningitis
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mental retardation, deafness, and hemiparesis
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Acute adrenal gland failure in children younger 12 due to bleeding by meningococcal is associated with _____
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Waterhouse-Friderichsen syndrome
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DOC for Neisseria meningitidis
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Penicillin G
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Polyvalent vaccine against capsular polysaccharide groups _, _, _, and ___ is available for children older than 2 years for N. meningitidis
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A, C , Y, and W135
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3 week old baby boy, 24hour history fever, poor feeding, irritability, and a seizure. Baby born preterm with very low birth weight normal vaginal delivery. BP 90/42 with nuchal rigidity
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Streptococcus agalactiae (group B) type III
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____ gram positive, cocci in chains, exhibits group B carbohydate antigen. Encapsulated. B-hemolysis. Catalase negative and bacitracin resistant.
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Streptococcus agalactiae (group B) type III
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_____ leading bacteria cause of disease and death among newborns
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GBS infection
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Pathogenesis of GBS is dictated by ____ with GBS strain with enhanced virulence
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maternal colonization
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The ____ of GBS is the major virulence factor, which interferes with ingestion by phagocytes.
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type III capsular polysaccharides
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DOC for Streptococcus agalactine
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Penicillin G
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64 y/o women, 5 day fever, HA, confusion. Diarrhea 2 day, history of RA with tx prednisone. No nuchal rigidity or focal defects. Meningeal enhancement on MRI
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Listeria monocytogenes (Listeria meningitis)
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____ gram positive, small (nonspore-forming) rod with rounded ends. Facultatively anaerobic. Narrow zone of B-hemolysis. "Tumbling motility" somatic "O" and flagellar "H" antigen
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Listeria monocytogenes (Listeria meningitis)
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_____ causes food borne illness in adults and meningitis in newborns, found in soil and animal reservoirs, processed meats and cheese.
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Listeria monocytogenes (Listeria meningitis)
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Major risk groups for L. monocytogenes
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pregnant, fetuses, neonates, IMMUNOCOMPROMISE
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What does L. monocytogenes have that permits escape from phagosomes
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listeriolysin O (B-hemolysin) and phospholipases
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L. monocytogenes cell to cell spread occurs via pseudopods that extend into adjacent host cells, cellular ___
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actin "tails"
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DOC for Listeria monocytogenes
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Ampicillin with aminoglycoside
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August, 29 people ages 9-15 rapid onset of fever, HA, stiff neck, photophobia, some diarrhea before HA. Negative Kernig sign. Normal BP
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Echovirus type 9 (enteroviral meningitis)
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___ belongs to enteroviruses (Picornaviridae), small either-resistant, nonenveloped virus. RNA single stranded and (+) sense
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Echovirus type 9
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___ virus are acid stable and have low density
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Enteroviruses
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___ virus are acid labile, multiply better at 33C and have higher density than do enteroviruses
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Rhinoviruses
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What months have the highest incidence of Enteroviral illness
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summer and fall
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Transmission of enteroviruses usually is ___, through either the ___ or ___ routes
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person-to-person; fecal-oral or oral-oral
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Where do enteroviruses multiplication take place in the body
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oropharynx and small intestine
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Which meningitis doesn’t requires hospitalization?
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aseptic meningitis
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Tx for viral meningitis
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symptomatic, maintain respiration and hydration
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July, 61 y/o homeless man. Fever, malaise, worsening HA for 3 days. Nausea, vomiting, and diarrhea. Confused. Hard to control mosquito population. Tremors of the face and extremities.
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St. Louis encephalitis virus
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____ are leading cause of viral encephalitis
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Arthropod-borne (arbo-) viruses
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____ are spherical or pleomorphic enveloped viruses. Triple-segmented, circular, single-stranded, negative-sense RNA
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Bunyaviridae
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___ and ___ are enveloped virons (45-60nm), single strand RNA with positive polarity
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Togaviridae and Flavivirdae
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Which viron causes St. Louis virus encephalitis, yellow fever, and dengue
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Flaviviruses
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Which virus types are associated with trashfilled drainage system and artificial containers, mosquitoes and birds and rodents
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Arboviruses
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____ is the vector for St. Louis virus in rural WESTERN and CENTRAL United States
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Culex TARSALIS
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___ is the vector for St. Louis virus in URBAN Central and EASTERN United States
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Culex PIPIENS
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Where do Arboviruses replicate?
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endothelial cells
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What in Arboviruses trigger a complement activation process, leading to DIC
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virus-antibody complexes
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Complications of St. Louis viral encephalitis include ___, __ and ___
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cranial nerve palsies, hemiparesis, and convulsions (20% cause of death in elderly)
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Which Flavivirus has antigenic clinical syndrome of Febrile illness, rash, hemorrhagic shock syndrome
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Dengue
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Which Flavivirus has antigenic clinical syndrome of Hemorrhagic fever, hepatitis (jaundice)
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Yellow Fever
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56 y/o man notes change in personality over several days, more irritable and confused. Fevers and HA with decreased Daily activities. At ED now with left-sided weakness and seizure. MRI shows hemorrhagic necrosis of right temporal lobe
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Herpes simplex virus (HSV) type 1 (herpes simplex encephalitis [HES])
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Icosahedral nucleocapsid, linear ds-DNA genome, lipoprotein envelope. Multinucleated giant cells.
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All herpesviruses
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___ after primary infection is characteristic feature of all herpesviruses, including HSV-1
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LATENCY
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____ and ___ are most frequent clinical manifestation of first-episode HSV-1
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Oral lesion (gingivostomatitis) and pharyngitis (kids and teens)
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____ most frequent clinical manifestation of HSV-1 in young adults
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herpes labialis
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how does HSV-1 damage the brain parenchyma
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direct damage (necrosis)
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How does HSV-1 contribute to perivascular inflammation, resulting in hemorrhage usually in the right temporal lobe
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Virus-specific T-cell response
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TX for HSV-1
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Acyclovir for 21 days
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45y/o homosexual man at ED for fever, HA, nausea, vomiting, and mental status change that is progressive over 2 weeks. Has HIV 2 years and NOT on tx. Nuchal rigidity with positive Kernig sign
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Cryptocccus neoformans (cryptococcal meningitis)
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___ is a yeast-like fungus (not dimorphic) with oval, budding yeast cell (4-6um). Think gelatinous capsule. India Ink shows budding cells, surrounded by refractile, sharply demarcated capsule.
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Cryptocccus neoformans (cryptococcal meningitis)
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Grows on Sabouraud-dextrose agar
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Cryptocccus neoformans (cryptococcal meningitis)
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A latex agglutination test shows polysaccharide antigen in CSF and serum
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Cryptocccus neoformans (cryptococcal meningitis)
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found in soil and PIGEON droppings
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Cryptocccus neoformans (cryptococcal meningitis)
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C. neoformans causes a deep mycosis in AIDS patients with ____
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CD4 count <100
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Cryptococci cross the BBB and accumulate in the perivascular areas of _____
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cortical gray matter
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Where do C. neoformans replicate?
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brain parenchyma resulting in macroscopically visible gelatinous pathology
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tx for ACUTE C.neoformans meningitis
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Amphotericin B with Flucytosine (5-FC)
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Tx for maintence therapy of C. neoformans
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Fluconazole
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30 y/o women at ED for 2-week history of HA, nausea and vomiting, seizures past 2 days. Has HIV with poor compliance. Mild right side weakness. MRI shows ring-enhancing lesions in left parietal lobe and right frontal lobe
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Toxoplasma gondii (Toxoplasma encephalitis)
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Proliferative form is banana-shaped tachyzoites. Resting form is slow-growing bradyzoites found in muscle and brain
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Toxoplasma gondii (Toxoplasma encephalitis)
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Why is there no Toxoplasmosis on some isolated Pacific Islands
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NO CATS!!!
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How do humans get Toxoplasmosis?
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1. Eat pseudocysts in undercooked meat
2. ingestion of contaminated cat feces containing OOCYST |
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Why is Toxoplasmosis a "Torch" of pregnancy?
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Transplacental crossing of parasite causes congenital infections
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In AIDS patients ___ is the most common cause of intacerebral mass lesions
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Toxoplasma gondii (Toxoplasma encephalitis)
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In patients with AIDS, what is the CD4 count for bradyzoites to reactivate and transform into tachyzoites
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less than 200
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How do you DX Toxoplasmosis
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High level of IgG for T. gondii (>1:256)
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DOC for Toxoplasmosis
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Sulfadiazine and primethamine
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Seronegative pregnant women with Toxoplasmosis may present with __ and ___
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mononucleosis or flu-like symptoms
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Infants born with toxoplasmosis are typically ___ but then develop ___, ___ , ___
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asymptomatic; chorioretinitis, epilepsy, and psychomotor
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How do you check if a newborn has Toxoplasmosis infection
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cord blood for IgM
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28 y/o man at ED for HA, two generalized seizure w/o history of seizure. Immigrant of Mexico. CBC did had 12% eosinophils. CT shows intracranial calcified cyst and a scolex in right occipital lobe
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Taenia Solium (neurocysticerosis) tapeworm
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How do humans acquire Taenia solium?
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eating uncooked meat with larvae
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Where in the world has the highest prevalence of Cysticercosis?
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Africa, Latin America, SE Asia, and Eastern Europe
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What causes seizures in Neurocysticercosis?
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mass effect of larval cyst on the brain parenchyma
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Scolex on MRI scan
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Neurocysticerocosis
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how do you confirm DX of cycstiercosis
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IgG for T. solium
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Possible TX for Taenia solium (neurocysticecosis)
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Praziquantel or albedazole
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How does Taenia Solium cause hydrocephalus?
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Intraventricular cysts
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31 y/o white man ED for Fever and visual hallucinations. 4day history of malaise and back pain while working on roadside clean up. Complains of muscle plain, vomiting, abdominal cramps tx with acetaminophen. Hyperesthesia over entire right side body. increasing agitated. developed hydrophobia. Hypersalivation and wide body fluctuations of temperature and BP
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Rabies virus
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bullet-shaped nucleocapsid surrounded by lipoprotein. Envelope glycoproteins in knob-like structure. ssRNA with negative polarity
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Rabies virus
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Can you get rabies from organ transplant
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YES
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Incubation period of rabies
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3-8 weeks(big wound can make it 9 days)
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Viral glycoproteins bind to ___, contributing to neurovirulence of rabies virus
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Ach receptor
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Where do rabies virus replicate?
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Exclusively in gray matter
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Characteristic pathologic finding for rabies
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intracytoplasmic inclusions call NEGRI BODIES
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how does rabies cause encephalitis
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cytotoxic Tcells kill virus infected neurons
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How to TX rabies bite?
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3step. 1clean soap water 2. passive immunization 3. active immunization with antirabies HDCV
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9 day newborn at ED for inability to nurse due to difficulty opening jaw. Foul smelling discharge from umbilical cord. Trismus, opisthotonus and hyper-responsiveness to external stimuli. Yellow-green discharge from umbilical cord. WBC up
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C. Tentani (Tetanus)
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Gram positive anaerobic rod. Forms terminal spores. Potent exotoxin.
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C. Tentani (Tetanus)
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How do you get Tetanus?
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injury or trauma with contamination with soil full of spores.
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____ is a Zn-dependent endopeptidase, cleaves synaptobrevin, a vesicl associated membrane protein critical to the "docking and fusion" apparatus of neuroexoctosis
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Tetanospasmin
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How does Tetanospasmin leave the LMN uninhibited leading to muscle rigidity
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blocks release of glycine and GABA in descending inhibitory neurons
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trismus
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lockjaw
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risus sardonicus
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sardonic smile
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TX for Tetanus
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maintain airway and intubate, BZ for spasms and rigidity. B-Blocker for sympathetics hyperactivity. Passive immunization with IgG + Active immunization. Metronidazole
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DOC for Tetanus
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Metronidazole
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normal prevention of Tetanus
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Full series vaccine (adult Td, child DPT) booster 10 years
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