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119 Cards in this Set

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"white yellow membrane like plaques" with fibrin deposits (caused by enterotoxin B)
C. diff - can present up to 4 wks after antibiotics
envelope glycoprotein 22 nm in diameter forming spheres & tubules
infected hepatocytes may excrete enormous quanities
HBsAg
bacteria transmitted from animals (pets, farms, lab workers)
campylobacter can be
necrotic skin wound with erythematous & edematous border, necrotic center
gram positive rods
cutaneous anthrax -
acute bacterial arthritis - in sexually active --> ______ , in children/non-active --> ______
in sexually active --> n. gonnorhea, in children/non-active --> staph aureus
ETEC toxin is similar to what other toxin?
LT is similar to cholera toxin ETEC causes diarrhea, LT & ST toxins

Labile in the Air (cAMP) Stable on the Ground (cGMP)
latex agglutination tests for polysaccharide capsule
cryptococcus will show budding yeast
does not have mold form
Cryptococcus meningitis in HIV patients
endocarditis
catalase negative, grows in 6.5% NaCl & bile (think enteric, bile) --> ______
what kind of procedure might this be associated with
enterococcus, endocarditis (distinguish this from mutans by 6.5% NaCl)
"genitourinary manipulation has been known to cause enterococcal endocarditis"
necrotic skin patches in pt receiving chemo
presents w/fever, chills, sob
ecthyma gangrenosum - occurs in neutropenic patients, pseudomonas colonizes perivascular area, toxins destroy & cause vascular insufficiency,
african immigrant - patchy areas of skin anesthesia, hypopigmentation of UE, nerve biopsy many bacteria invading shwann cells -->
Mycobacterium Tuberculosis
Tuberculoid TB --> skin thickening, patchy hypopigmentation, lionine facies, paresthesis / regional anesthesia, testicular destruction, blindness
gram neg sepsis
LPS causes gram neg sepsis not actively excreted but released w/lysis,Lipid A is the toxic part
activates macrophages to release TNF-alpha & IL-1 widespread
tetanus - what route does toxin take?
toxins travel retrograde in motorneurons to the spinal cord (Tetanus goes to the Top) to inhibit release of inhibitory neurotransmitters
Tzank test positive -->
Tx w/what drug? What is MOA?
herpes
tx active flairs with nucleoside analogs (acyclovir), which incorporate themselves into the viral DNA & terminate replication
phosphorylation by viral thymidine kinase required for activity
Serum testing for treponema -->
screening with nontreponema test looking for cardiolipin (VRDL, RPR)
confirmatory test with treponemous test for antigen (FTA-ABS, MHA-TP)
facial pain, headache, black necrotic eschar in nasal cavity of diabetic --> ? How do you confirm dx / what will you see?
mucormycosis
confirm dx w/mucosal biopsy
broad non-septate hyphae w/rt angle branching (WIDE branching in diabetics [associate w/overweight])
foreign child w/febrile maculopapular rash starting head spreads to trunk & extremities -->
rubella or rubeola
add postauricular lymphadenopathy --> rubella (german measles)
rubella is a togavirus (togas rub horses)
HBV vaccine - what do you see?
ppl vaccinated for HBV are positive for anti-HBsAg, negative for HBsAg
if they had actually contracted HBV and cleared it would also have anti-HBcAg IgG
DIC & bilateral hemmorhagic destruction of adrenal glands -->
Waterhouse Friedrichson Syndrome
meningococcal sepsis (neisseria)
Pseudomons & Diphtheria toxin both act by:
ribosylating and inactivating elongation factor 2 (exotoxin A)
Strept bovis endocarditis is associated with:
GI lesions (colon cancer
flat red skin lesion with central clearing
erythema chronica migrans
borrelia burgdorferi
hyper or hypo-pigmented skin patches becoming more noticeable after tanning
malesthesia furfur
pityriasis (aka tinea) versicolor
KOH scraping --> "spaghetti & meatball" hyphae "cigar butt"
selenium shampoo
MCC acute otitis media, sinusitis, & bacterial conjunctivitis in childhood:
1.) stept pneumo, 2.) Non-typable haemoph infl, 3.) moraxella cataralis
Haemophilus influenza B vaccine reduces:
meningitis, pneumonia, sepsis, epiglotitis in children
given at 2 mos
cherry red epiglottitis
haemophilus influenza B
fever, sore throat, drooling, progressive airway obstruction, & stridor in infant
presenting sx of epiglottitis
haemophilus influenza B
Shigella vs Salmonella vs E. Coli
Shigella is non-motile (where Salmonella is motile & produces H2S)
Shigella produces acid (where E. Coli produces gas)
penile lesions, draining ulcers, painful inguinal lymph nodes, fever, red eyes
cell scrapings --> inclusion bodies
chlamydia trachomatis, lymphogranuloma venerum (L1-L3 serotypes)
Africa, Asia, Carribean, South America
gram positive clustered bacteria (oropharynx)
POLAR GRANULES staining with ANILINE dye
Corynebacterium Diphtheria
young male w/joint / long bone pain
hematogenous osteomyelitis
staph aureus most commonly in kids, followed by strept group A
CSF: high WBC, lymphocyte predominant, glucose nl or slightly decreased, protein elevated but < 150
Viral Meningitis
MCC Viral Meningitis
Enteroviruses (Coxsackievirus, Echovirus, Poliovirus, Enterovirus)
HBV is in what body secretions?
All except stool
When does anti-HBsAg ab level rise?
After virus is cleared, once HBsAg levels have dropped
asymptomatic
HDV requires HBV for?
envelop coating
once acquired it can penetrate hepacocytes & replicate
Picornoviridae - Rhinovirus, Coxsackie, Echo, Polio, Hep A - which is acid sensitive?
rhinovirus is acid sensitive
picornoviridae = rhinovirus & enteroviruses (others)
enteroviruses can withstand acid, colonize GI
22 yo male, atypical lymphocytes, fever & joint pain
partially dbl stranded circular DNA virus w/RNA dependent DNA polymerase
HBV
HIV viral protein glycosylated & cleaved into 2 smaller prtns
what is it responsible for?
absorption by target cells (gp160 --> gp120 + gp41)
gp120 binds CD4 for absorption
gp41 stabilizes gp120
6 day old infant w/HBsAg & HBeAg positive
risk for chronicity, replication speed, and liver damage?
high risk for chronic infection, high replication rate, histologically mild liver damage
typically transmission from mother occurs in birth canal, may occur transplacentally
where do Kaposi's sarcomas first present?
HIV associated
present as multiple blue-violet plaques on feet & legs before spreading proximally
can also develop on mucosal membranes of face & genitals
34 yo female 2 days postpartum via spontaneous vaginal delivery
lower abdominal pain, temp 37.9, BP 110/70, pulse 110, resp 18, tender uterus & foul-smelling discharge - what's going on? What organism?
Endometritis
Bacteroides most common organism, but can be mixed aerobic/anaerobics
can complicate both spontaneous & C-sections
painful erupted vesicles on an erythematous base
herpes zoster, reaction of VZV in dorsal root ganglion
neuropathic pain & isolated to single dermatome
meningitis w/sx of seizures, personality changes, & psychosis?
temporal lobe encephalitis
MCC is HSV-1
may also have seizure/olfactory hallucination
tx: IV acyclovir
MCC infectious arthritis? In kids < 2? Teenagers? Sickle cell?
N. gonorrhoeae, Staph, strept, haem inf, gram - bacilli (e coli, salmonella, pseudomonas)
kids <2 - Haem influ, kids > 2 staph aureus
teenagers & early adulthood (espec women) - N gon
sickle cell - salmonella
bacterial resistance to antibiotic is diminished by addition of protons, what mechanism?
drug efflux pump
usually coupled to H+ moving along concentration gradient OUT of the cell (some use Na or ATP though)
rapid infusion of IV drug for endocarditis causes immediate pruritis & rash
this drug characteristically has a linear relationship between rate of infusion & histamine release, what drug?
Vancomycin
"red man syndrome"
NOT IgE mediated, prevented by slower infusion rate
56 yo woman on recent cruise, 2 days fever, productive cough, crackle in left lung, lobar consolidation -- what is it?
Legionella
suspect legionella in water supplies - cruise, hotel
cough high fever confusion, diarrhea
Characteristic lab finding with legionella?
Hyponatremia
2nd to inappropriate secretion of ADH
3 mos infant - irritable, feeds poorly, frequently vomits
wt 45% head circ 96%
CT - enlarged ventricles, scattered intracranial calcifications
fundoscopy - white-yellow chorioretinal lesions both eyes
Congenital toxoplasmosis (in utero)
triad - hydrocephalus, intracranial calcifications, chorioretinitis
fungus in pigeon droppings?
Cryptococcus neoformans
fungus in lungs showing "spherules packed with endospores"?
Coccidioides imiitis
(spherules rupture, endospores disseminate, each can form new spherule) - mold form at 25-30 C, endospore at 37-40 C
where is coccidioidomycosis found?
Arizone, New Mexico, western Texas, central California, northern Mexico, some regions of South & Central America
how is coccidiodis immitis transmitted?
spore inhalation
Histoplasma capsulatum associations?
River Basins - Ohio & Mississippi, hx of cleaning bird coops or caving
fungus that colonizes old lung cavities? (hx of TB)
Aspergillus fumigatus, forms fungal ball (aspergilloma)
what fungus are long hx of asthmatics at risk for?
aspergillus fumigatus
motile gram positive rods w/beta hemolysis?
Lysteria
cell mediated immunity is necessary to eliminate
infant born to 25 yo IV drug users develops prominent oral thrush, interstitial pneumonia, & severe lymphopenia during 1st year life - what would have prevented this condition?
baby has HIV
viral enzyme inhibitor would have helped
mucicarmine staining of lung tissue in immunocompromised pt w/cough & chest pain, turns red?
Cryptococcus neoformans
why does penicillin tx of group A strep prevent RF but not APSGN?
rheumatic fever (antigen mimicry)
NOT post-strept glomerulonephritis (immune complex deposition)
septate hyphae 45 degree angle?
aspergillus fumigatus
what gram positive cocci produces dextrans from glucose?
Viridins streptococci
this helps them attach to damaged valves
mayonaisse associated food poisoning?
Staph aureus
usually getting at preformed heat-stable exotoxin
what CV defects are seen in tertiary syphillus?
AORTIC - aortitis, aortic aneurysm, aortic regurgitation
what defense protein does staph aureus have? How does it work?
Protein A - binds the Fc portin of IgG at the complement binding site, preventing complement activation
what is done to minimize risk of transmission of active Hep B from mother to fetus?
passive immunization of all newborns w/HBIG, followed by active immunization w/recombinant HBV
typically transmission occurs in birth canal (but can cross placenta), HBeAg increases risk (from 20% to 95%)
if fetus is infected 80% chance to progress to chronic
infection characteristic of sickle cell patients? Why?
salmonella osteomyelitis - b/c fxnlly asplenic (followed by e. coli)
bacteria - Vi antigen? K antigen?
capsule antigens
Vi - salmonella (virulence)
K - E. coli
why are envelop IgG antibodies not protective against HCV?
envelop proteins vary their antigenic structure
HCV has hypervariable region, also lacks 3'-5' exonuclease proofreading (virion encoded RNAP)
bacillus anthracis toxin is similar to what other bacterial toxin?
lethal factor & edema factor
edema factor is adenylate cyclase causing massive increases in intracellular cAMP

similar to bordetella pertussis toxin called "extracellular adenylate cyclase"
2 MC sites of flora that cause infection of central venous catheters?
patient's skin flora and bacteria on health care worker's hands
what are motile gram negative rods turning pink on MacKonkey? What is their virulence factor?
E. Coli - (context of meningitis)

capsule of E. Coli, K-1 antigen (present in 20-40% of intestinal E. coli isolates)
virulence factor that aloows bacteria to survive hematogenous spread, establish meningeal infection
what is verotoxin?
another name for the shiga-like toxin of EHEC
what is the O antigen (bacteria)?
cell wall Outer membrane polysaccharide used to classify gram-negative bacteria
MCC of viral acute hemorrhagic cystitis outbreaks in children?
Adenovirus (males in particular)
what mediates liver injury in HBV?
cytotoxic CD8 t lymphocytes responding to viral antigen on cell surface

virus does not have direct cytotoxic effect (though in integrative phase integration of DNA increases risk of HCC)
acute orchitis bacterial cause?
young adults - c. trachomatis, n. gonorrhoeae

older pts - e. coli
MCC e coli bacteremia in 72 yo man from skilled nursing facility?
UTI
MCC of bacteria infecting biliary tree?
E. Coli, Klebsiella, Enterobacter, Enterococci
wound with a fruity odor?
Pseudomonas aeruginosa
gram negative rod

pigments would also give wound exudates in a blue-green hue
what is the morphology of Haemophilus influenza? What makes its capsule different from other encapsulated H. influenza?
gram negative rod

capsule contains RIBOSE instead of hexose for it's carbohydrate component

PRP capsule
polyribosyl-ribitol-phosphate
bug grown on special medium, colonies appear black in color, intracellular polyphosphate granules detected on microscopy after methylene blue staining?
C. diphtheria
metachromatic granules
grown on cysteine-tellurite agar (or Loffler's medium)
use of blood agar containing bile & hypertonic saline?
culture enterococci - E. faecalis & E. faecium

differentiates these from non-enterococci Group D strep including Strep bovis & Strep equinus
(grow in bile but NOT hypertonic saline)
what is a viral capsid?
nucleocapsid protein surrounds viral genome
Tzank smear positive indicates?
HSV or VZV

must obtain from base of vesiculoulcerative lesion
epithelial cells scraped prepared w/Wright-Giemsa & examined for multinucleated giant cells & intranuclear inclusions
papanicolaou smear positive indicats?
HPV, "pap" smear
cryoglobulins indicate?
HCV most commonly

cryoglobulins are cold-precipitable serum proteins containing immunoglobulins
hemadsorption indicates?
suggests hemagglutinins or glycoproteins w/high affinity for RBC being expressed on host cell surface

characteristic of influenza & parainfluenza viruses
continuous proliferation of B-cells while maintaining ability to secrete immunoglobulin?
EBV

immortalization, or transformation
controlled by T-cell response
what is tazobactam? Sulbactam?
beta-lactamase inhibitors, like clavulanic acid
proximal bronchiectasis in 34 yo woman w/recurrent transient pulmonary infiltrates who suffers from bronchial asthma?
Aspergillus fumigatus (Allergic Bronchopulmonary Aspergillosis - ABPA)

occurs w/hypersensitivity reaction, very high IgE and eosinophilia

5-10% of steroid dependent asthmatics
parasite that causes cough, asthma-like bronchospasm, and hemoptysis?
Strongyloidiasis

transient pneumonia also, as larvae migrate thru lungs on way to laryngopharynx
HIV pt lost to follow up 3 yrs returns, pain & itching in perirectal area, exam shows ulcerative mass?
Squamous cell carcinoma of the anus
(anal cancers ulcerative in > 50% cases)

HPV associated
fever w/GI upset, hepatosplenomegaly, & "rose spots" on abdomen?
typhoid fever - Salmonella typhi & paratyphi
travel associated

can have possible hemorrhagic enteritis w/bowel perforation later in course

salmonella penetrate both enterocyte transporters & via phagocytosis by M cells in Peyer's patches
phagocytosed by macrophages and survive intracellularly
can go to liver, spleen, & bone marrow
MCC of bacteriemia in sickle cell patients? Osteomyelitis?
Streptococcus pneumo
followed by hemophilus influenza

(asplenic)

MCC of osteomyelitis is salmonella > s aureus or e coli
"rust colored sputum"?
strept pneumo

"lancet-shaped gram positive diplococci"
optichin sensitive (?)
what is expected to accompany blue/white spots on buccal mucosa in immigrant child?
this is measles, rubeola

CCCK - cough, coryza, conjunctivities, koplik spots
people w/active leprosy have what response to heat killed M. leprae injection? (lepromin skin test)
if tuberuloic leprosy will have positive test
-well contained, good Th1 CD4 response (& macrophages)

if lepromatous leprosy, won't be positive?
-poor cell mediated response, get limbs falling off and so on
mutation of the HIV pol and env genes confer what?
pol mutation - resistance to reverse transcriptase and protease inhibitors

env (structural glycoproteins) - enables escape from host neutralizing antibodies
metallic sheen on eosin methylene blue agar, & hemolysis on blood agar? Motile
E. coli
most important virulence factor for e. coli causing UTI? Meningitis?
UTI - fimbriae, adhesion to uroepithelial cells

meningitis - K-1 capsular antigen
what is the O antigen?
cell wall Outer membrane polysaccharide used to classify gram-negative bacteria
CMV causing the following conditions are present in which populations?

mononucleosis
retinitis
hepatitis
pneumonia
odynophagia
mononucleosis - MC manifestation of CMV in immunocompetent hosts (but still less common than EBV)

retinitis - CMV in HIV patients

diarrhea & hepatitis - disseminated CMV in immunocompromised

CMV pneumonitis - organ transplant

esophagitis - HIV pts
growth media for telling what strep is what?
all strep are gram positive cocci, catalase negative

Alpha Hemolytic
--optochin resistant, grows in bile --> Strep Viridans
--optochin sensitive, NOT grow in bile --> Strep pneumo

Beta Hemolygic
--bacitracin resistant --> Group B strep
--bacitracin sensitive --> Group A strep

Gamma (no) Hemolysis
--grows in bile AND NaCl --> Enterococci (E. faecium)
--grows in bile, NOT NaCl --> Non-Enterococci (S. bovis)
common cause & route of a hepatic abscess?
staph aureus thru hematogenous seeding

other routes include:
-portal vein
-arterial supply
-ascending biliary tract infection (usually enteric gram neg bacilli & enterococci)
-direct invasion from adjacent source (usually enteric gram-negative bacilli & enterococci)
-penetrating injury
patient w/mycoplasma pneumonia is tx and develops sequelae, what might that be? Pathophys?
can get mild anemia

some antigens are shared between RBC and m. pneumoniae wall

antibodies that cross react are called "cold agglutinins" - able to agglutinate RBCs in vitro at low temp

steven johnson syndrome & joint pain are other rare sequelae
pseudomonas toxin is similar to? Shiga toxin is similar to?
Pseudomons & Diptheria exotoxin A act on EF-2

Shig-like toxins (vero toxins) are produced by EHEC, they inhibit the 60S ribosomal subunit preventing tRNA binding
deficiency in forming complement membrane attack complex exposes particular risk to what infection?
Neisseria (meningitidis)
petechial skin rash on trunk, spreading to include palms & soles?
Neisseria-induced small-vessel vasculitis
especially affects palms & soles
Echinococcus is? Causes? Tx? Risk w/tx?
MCC hydatid cysts in humans
-sheep & dog exposure, part of tapeworm life cycle

encapsulated calcified cyst "eggshell calcification"

surgery to remove cyst could result in spillage --> ANAPHYLAXIS

adjunctive chemo w/mebendazole or albendazole then surgery is tx of choice
-also they talk about injecting et-OH
where does HSV-1 encephalitis occur? What signs are noticed? If fatal, what does autopsy show?
occurs in TEMPORAL lobe

sx - aphasia, olfactory hallucinations, personality changes

macroscopic examination shows edema & hemorrhagic necrosis
23 yo male 2 day hx of fevere, confusion - impaired speech, change in personality, and olfactory hallucinations?
temporal lobe encephalitis --> HSV-1
the lesions of syphilis?
Primary - chancre - painless ulceration

Secondary - condylomata lata - large gray wart like growths

Tertiar - Gummas - begin as painless indurated granulomatous lesions progressing to white-gray rubbery lesion, may ulcerate
condylomata acuminata vs condylomata lata?
condylomata acuminata - anogenital warts caused by HPV

condyloma lata - wart-life genital lesion caused by syphilis
essential virulence factor for nesseriea?
pili

also has capsule, but pili are essential for establishing infeciton
homosexula man w/abdominal pain & diarrhea, guiac positive, occasional trophozoites w/phagocytosed RBCs seen?
Entamoeba histolytica

usually bloody

common in homosexual population b/c can be transmitted oral-anally
E coli that does not ferment sorbitol nor produce glucoronidase?
E. coli O157:H7
bacteria producing toxins that…

-activate adenylate cyclase?

-activate guanylate cyclase?

-inactivate EF2?

-disrupt cytoskeleton?
active adenylate cyclase - b. pertussis (pertussis toxin), B. anthracis (edema factor), ETEC (heat labile), campylobacter, bacillus cerus (heat labile) & v cholera

activate guanylate cyclase - ETEC (heat stable), Yersinia enterocolitica

inactivate EF2 - corynebacterium diphtheriae, Pseudomonas aeruginosa (ADP-ribosylation)

disrupt cytoskeleton - C difficile (toxin B, cytotoxin)
what RNA viruses replicate inside the nucleus? (only a few)
Influenza A (orthomyxovirus)

Retroviruses