Ppal99 Dissecting The Usmle 1,2,3 Atypicals/rick/myco/spiro

Front 1

Atypicals
describe
what arm of the immune system attacks it?

Back 1

no cell wall -> cell mediated immunity.

Front 2

Chlamydia Pneumonia: 2 bodies and Sx

Back 2

• Elementary body - infectious phase "evil elementary body"
• Reticulate body - resting phase, can't divide
• Sx: stacatto coughing

Front 3

Chlamydia Psittaci:
associated with what animals
presentation
tx

Back 3

parakeets and parrots
• Pneumonia, splenomegaly, meningoencephalitis
• Tx: Doxycycline

Front 4

Chlamydia Trachomatis:
how does it make energy?
disease in infants

Back 4

can't make ATP
Neonatal blindness (intured eyelashes=> cornea ulcer)

Front 5

Legionella Pneumonia:
Sx
how is it acquired?
agar
how it looks like

Back 5

"Old silver AC duct''
• Sx: disorientation, pneumonia, N/V/D, ⇧LFTs
• Loves heating and air-conditioning duets (standing water) = ''highrise building syndrome"
• Silver stains in lung, grows on charcoal yeast agar extract (CYAE)

Front 6

Legionella Pneumonia: tx and diseases

Back 6

Pontiac fever = mild fever alone
legionnaire's disease = full blown pneumonia
• Tx: Erythromycin

Front 7

Walking Pneumonia: sx, tx and name all of them

Back 7

Sx: dry cough
Tx: Fluoroquinolones
"Come My Love for a walk"
0-2 mo: Chlamydia pn.
10-30 y: Mycoplasma pn.
> 40 y: Legionella -pn.
AIDS/Premies: Pneumo Jirovecii

Front 8

Mycoplasma Pneumoniae:
type of bacteria
cell wall, size
attachment
presentation (2)
xray
tx

Back 8

(obligate aerobe):
mycolic acid, no cell wall
• Smallest extracellular bacteria, can't make cholesterol
• Attaches via P1 protein
• Cryoglobulinemia, erythema multiforme
• CXR: interstitial, ground-glass, reticulo-nodular pattern •
• Tx: Erythromycin

Front 9

Bullous myngitis

Back 9

Mycoplasma Pneumoniae bullae on eardrum

Front 10

Silver Stainers:
Lung (2)
lymphnode

Back 10

PCP-lung
Bartonella - lymph node
legionella - lung

Front 11

describe Mycobacteria cell wall

Back 11

non-bacteria with mycolic acid and a peptidoglycan wall

Front 12

Phantom lesion of Mycobacteria

Back 12

hyaline cartilage calcification

Front 13

Mycobacterium ulcerans

Back 13

ulcers

Front 14

Mycobacterium marinum

Back 14

fish tanks

Front 15

Mycobacterium scrofulaceum
describe and tx

Back 15

supraclavicular lymph nodes,
+ PPD
(Tx: excise LN)

Front 16

Mycobacterium leprae: clues and tx

Back 16

leprosy (Hanson's disease)=> hypopigmentation + no sensation
• Tx: Rifampin + Dapsone - inhibits PABA

Front 17

Mycobacterium avium intracellulare: clues and tx

Back 17

AIDS pt w/ gastroenteritis ⇨SOB
Tx: clarithromycin, Azithromycin

Front 18

Mycobacterium tuberculosis sx

Back 18

night sweats, hemoptysis, weight loss

Front 19

1° TB:
symptoms
what would one see on biopsy
what is it called when it is spread to the lymphnodes

Back 19

asymptomatic => perihilar Ghon focus (Ghon complex if it has spread to lymph)

Front 20

how is ghon's focus made?

Back 20

MP lysosomal fusion impaired b/c of "cord factor" => MP calls for IL-1
• IL-1 recruits cell-mediated TH1
• Forms "granuloma" = MP w/ TH1 cells around it=> INF to transform MP
• IL-2 recruits more MP
• IL-12 promotes cell-mediated recruitment
• INF interferes with protein synthesis ⇨ cells die, then calcify
• MP and T cells=> TNF-α

Front 21

2° TB:

Back 21

apex cavitation
• T cells are decreased (poor nutrition, steroids, chemo)
• TB breaks from granuloma ⇨ airway (more O2)⇨ cough up blood to upper lobes

Front 22

Miliary TB: pathogenesis

Back 22

(Bacteria Explodes out of its cavitary lesion again hoping to get back to GI tract.
• Cough and swallow
• Causing obstruction in ileum (bacteria gets absorbed
because it's fat soluble) where all lymphoid tissue exists
and tries to stop infection
• But it cannot ~> Ileum swells up = Obstruction)

Front 23

Miliary TB: Brain
what part of the brain does it live?
what cranial nerves are affected?
what does this lead to?

Back 23

loves post fossa
(CN3, then CN9-12) => hydrocephaly

Front 24

Miliary TB: Spinal cord:

Back 24

"Pott's disease" => compression fractures

Front 25

Miliary TB: kidney:

Back 25

sterile pyuria (WBC in urine w/ negative cultures => didn't test for TB)

Front 26

Miliary TB: Psoas muscle:

Back 26

"cold abscess", no pus

Front 27

Miliary TB: Adrenal gland:

Back 27

dies: adrenal insufficiency

Front 28

Miliary TB: Heart:

Back 28

constrictive pericarditis

Front 29

PPD test: when is a patient can be considered non infectious?
Test #1
Test #5
Test #250

Back 29

negative AFB x 3 ⇨ non infectious
• Test #1 (dilute)- if has sx, need to prove TB •
• Test #5 - for screening •
• Test #250 (conc)- for AIDS pts

Front 30

5 bugs that cause Granulomas:
common symptom

Back 30

Sx: erythema nodosum
TB
Sarcoidosis
Syphilis
Histiocytosis x
The Ellas

Front 31

how do we check for a positive PPD?

Back 31

Positive PPD:
(induration, not erythema)
check 24-48 hrs (T cells here)

Front 32

what is a considered a positive PPD

Back 32

• 15mm (normal population)
• 10 mm (overcrowding: prisons/NY city, health care workers, IV drug-users)
• 5 mm (immunosuppressed/steroids, kids<4 y/o, TB-household members)

Front 33

TB Drugs:

Back 33

"RIPE" -> all cause liver failure
Rifampin
INH
Pyrazinamide
Ethambutol

Front 34

Rifampin: MOA
SE (3)

Back 34

inhibits RNA Pol = > orange secretions, revs up p450 and myositis

Front 35

INH: MOA, uses and 5 SE

Back 35

inhibits mycolic acid synthesis
use for prophylaxis if > 35 or high risk
SE: Fat soluble =>myositis, depletes Vit B6, SLE, inhibits p450, seizures

Front 36

Pyrazinamide

Back 36

⇧uric acid

Front 37

Ethambutol

Back 37

inhibits arabinogalactan (cell wall) => impaired color vision

Front 38

(+)PPD/ (-)CXR or BCG history: management

Back 38

Latent TB Tx:
• INH/Vit B6 X 9 months

Front 39

Active TB Tx:

Back 39

"RIPE" x 2mo ⇨ check CXR ⇨ "RI" x 4mo

Front 40

Miliary TB tx

Back 40

"RIPE" x 12mo

Front 41

HIV (+): TB treatment

Back 41

Replace Rifampin with Rifabutin

Front 42

Pregnant: TB treatment

Back 42

Replace Pyrazinamide with Ofloxacin,(check LFTs monthly)

Front 43

Leprosy: Tx and source

Back 43

armadillos (Tx: Dapsone)

Front 44

Tuberculoid leprosy
what cell is affected?
stain
location of infection

Back 44

• TH1, Langerhan's/ epithelioid
• No acid fast stain
• Local infection

Front 45

Lepromatous leprosy
what Tcell does it affect
describe the MP
how does it spread
presentation (2)

Back 45

• TH2, foamy MP
• Acid fast stain
Hematogenous spread
• Sensory neuropathy of eats/nose/ distal extremities
• Erythema nodosum

Front 46

Treponema Pallidum "rule of 6's"

Back 46

1° syphilis: painless chancre (1-6 wks)
• 2° syphilis: palm/sole rash, ischemic stroke, transverse myelitis (6 wks)
• 3° syphilis: painful neuropathy/cardiopathy (6 yrs)

Front 47

3° syphilis: what are the three things it attacks in the body and what would you see?

Back 47

Attacks dorsal columns⇨ Tabes dorsalis "lancinating/ shooting pain"
o Attacks Edinger-Westphal nucleus⇨Argyll-Robertson pupil: reacts poorly to light, but well to accommodation
o Attacks aorta⇨ Obliterative endarteritis "tree bark appearance"

Front 48

Neonatal syphilis presentation

Back 48

loves bones
o Flat forehead
o Snuffles - nasal bone gone "saddle nose"
o Hutchinson's teeth- sharp
o Saber tooth shins - anterior leg bowing
o Rhagade's - mouth fissure

Front 49

Syphilis testing:
most sensitive and specific

Back 49

• Dark field microscopy - most specific/sensitive
• Blood tests: FTA-ABS or TPI- specific. IgM (IgG can stay positive forever)
RPR/VRDL- sensitive => use for screening (can stay positive for 1 year)

Front 50

Syphilis Tx:
• 1° Syphilis
• 2° syphilis
• 3° syphilis
• Neonatal

Back 50

• 1° Syphilis: Benzathine Penicillin G IM.1.2 million units x 1
• 2° syphilis: Benzathiine Penicillin G IM 2.4 million units x 1 )"double it"
• 3° syphilis: Benzathine Penicillin G 1M 2.4 million units x 3wk "give it three times"
• Neonatal: 50,000 units/kg/ day

Front 51

Jarisch-Herxheimer

Back 51

⇧fever after treating syphilis with penicillin due to released spirochetes

Front 52

Treponema Pallidum Variant

Back 52

⇨ Bijel: non-venereal condyloma lata in kids

Front 53

Treponema Pertenue

Back 53

⇨Yaws: raspberry ulcers "you yawn when you pretend"

Front 54

Treponema Carateum

Back 54

⇨Pinta: red scaly patches change into white spots "Carry the' the Pintas"

Front 55

Borrelia Borgdorfori: vector
• 1° stage
• 2° stage
• 3° stage

Back 55

ixodes tick=> Lyme disease
• 1° stage: rash = erythema chronicum migrans (only disease with this rash)
• 2° stage: neuro/carditis: heart block, Bell's palsy, meningitis ⇨ do LP (Tx: Ceftriaxone)
• 3° stage: arthritis

Front 56

2° stage lyme disease tx

Back 56

(Tx: Ceftriaxone)

Front 57

test for lyme disease: test and tx

Back 57

>>Test Synovial Fluid ELISA ⇨ Ab to Borrelia (IgM and IgG)
>>Tx: doxycycline x 30 days (or Amoxicillin for kids)

Front 58

Borrelia Recurrentis:
disease

Back 58

cyclic fever (1/wk for 5 wk)
• Brill-Zinsser disease = pathogen hides in lymphnodes, comes out 1/wk slightly mutated

Front 59

Leptospira Interrogans: who gets its and source of infection

Back 59

rat/ wild boar urine => sewage workers

Front 60

Leptospira Interrogans:
shape
diseses (2)
Dx
Tx

Back 60

Shepherd's crook shape
• Fort Brag's fever
• Weil's disease = infectious nephritis and hepatitis
• Dx: (+) Macroscopic slide agglutination test
• Tx: Penicillin

Front 61

Rickettsia
what does it like to invade?
tx

Back 61

likes to invade blood vessels and tx is chloramphenicol

Front 62

Rickettsia Rickettsii
vector
disease
presentation

Back 62

tick => Rocky mountain spotted fever (palm/sole rash)

Front 63

Rickettsia Akari
vector
disease
presentation

Back 63

mites => Rickettsial pox (fleshy papules and vesicles)

Front 64

Rickettsia Typhi
vector
where does it start
disease

Back 64

fleas, starts in armpit => Endemic typhus "tyflea"

Front 65

Rickettsia Prowazekii
vector
where does it start
disease

Back 65

lice, starts on body=> ePidemic typhus

Front 66

Rickettsia Tsutsugamushi
vector
disease

Back 66

mites => scrub typhus

Front 67

Coxiella Brunetii
how is it aquired?
presentation

Back 67

dusty barn=> Q fever, lung disease