Session 2

Front 1

What is Nuchal rigidity?

Back 1

Restriction in flexion of the neck (concern for CNS infection)

Front 2

Pleocytosis

Back 2

Increase cells in the CSF

Front 3

AST

Back 3

Liver enzyme (hepatocellular inflammation)

Front 4

moreulae

Back 4

Tinny inclusions within the cytoplasm of cells.

Front 5

Pancytopenia

Back 5

All blood cells are low

Front 6

Leukopenia

Back 6

Low white cells

Front 7

what does a morulae in a vacule tell us?

Back 7

that it is in the cytoplasm.

Front 8

Which disease has central nervous system involvment? (confusion)

Back 8

HME

Front 9

What causes HME?
(Human Monocytic Ehrlichiosis)

Back 9

Ehrlichia chafeensis

Front 10

HGA

Back 10

Human granulocytic anaplasmosis

Front 11

What causes HGA

Back 11

Anaplasma phagocytophilum

Front 12

CNS involvement uncommon in

Back 12

HGA

Front 13

meningitis or meningoencephalitis is a neurologic manifestation of

Back 13

HME (Human Monocytc Ehrlichiosis)

Front 14

HEE

Back 14

human ewingii ehrlichiosis

Front 15

What is the target cell for
E. ewingii

Back 15

Nuetrophils

Front 16

Test to differentiate HGA from HEE

Back 16

PCR

Front 17

HGA vector

Back 17

Ixodes scapularis

Front 18

HME vector

Back 18

Amblyomma americanum

Front 19

Ixodes scapularis transmits

Back 19

Anaplasma phagocytophilum

Front 20

Amblyomma americanum (lone star tick) transmits

Back 20

Ehrlichia chafeensis

Front 21

What is the drug of choice for ehrlichiosis and anaplasmosis?

Back 21

Doxycycline
should see a huge improvement in 24 hours

Front 22

what will doxycycine not treat?

Back 22

babesiosis

Front 23

How do Ehrlichia and Anaplasma enter the cell

Back 23

through receptor-mediated endocytosis
(glycophosphoinositol anchored receptor)

Front 24

Where do Ehrlichia and Anaplasma multiply

Back 24

within endosomes

Front 25

Cardinal features of CNS infection (20% cases)

Back 25

Nuchal rigidity, confusion, fever

Front 26

Pleocytosis and elevated protein in CSF

Back 26

Abnormal -> this patient has CNS disorder

Front 27

Monocytes cytoplasm

Back 27

Bluish – no granulocytes
Nucleus takes up a lot of space

Front 28

Epidemiology of HME

Back 28

Southeast/central (ambyloma americanum – lone star tick)

Front 29

Epidemiology of HGA

Back 29

North (ixodes scapularis)

Front 30

If patients don’t respond to Doxycycline

Back 30

Possibly coinfected with babesiosis

Front 31

If someone is pregnant use

Back 31

Rifampin

Front 32

Atypical lymphocytes

Back 32

Lots of basophilic cytoplasm
Nucleus is elongated
Ratio of nucleus to cytoplasm

Front 33

Mononucleosis S/S

Back 33

Posterior cervical lymph nodes, age, atypical lymphocytes, splenomegaly (common), pharyngitis

Front 34

Group A strep

Back 34

No atypical lymphocytes
No splenomegaly

Front 35

Confirm diagnosis of Group A strep

Back 35

Throat swab – culture
Rapid strep test

Front 36

CMV

Back 36

2nd most common Infectious mononucleosis

Front 37

Risk factors for CMV

Back 37

Daycare (exposure to children less than 2 yo) /immunocompromised

Front 38

Difference between CMV and EBV

Back 38

Higher AST (disseminated disease compared to EBV) -> prolonged fever

Less prominent localized (less lymphadenopathy)

Front 39

EBV affects which cells

Back 39

Epithelial
B cells

Front 40

HIV

Back 40

Diffuse and non tender lymphadenopathy*
Mucocutaneous ulcers*
Rash (all can present with rash)
Other risk factors

Front 41

Laboratory tests for EBV

Back 41

Atypical lymphocytes

Front 42

Monospot test

Back 42

Heterophile antibody cross agglutinates with horse RBC
Sensitivity 75%
Specificity – if it is negative even in infection (early in infection b/c body hasn’t made antibodies)

Front 43

Management of EBV

Back 43

Rest, supportive care
Intervene: airway/autoimmune hemolytic rxn use prednisone
Acylovair – no role currently

Front 44

Common complications with EBV

Back 44

Meningitis/encephalitis
Ruptured spleen (3 wks can’t participate in non contact sport/4 wks for contact activity)

Front 45

EBV

Back 45

Oral hairy leukoplakia (differential oral thrush)
Happens on side of tongue not scrapable easily like candidasis.

Front 46

Cancers associated with EBV

Back 46

Nasal pharyngeal carcinoma (asia, china)
Burkitts lymphoma (africa)
Hodgkin’s lymphoma/hairy cell leukemia (US)

Front 47

HIV 1

Back 47

T tropic – primarily affects T cell lines (receptor uses CCR4)
M tropic - ** most common infection of cells is through macrophages. (uses CCR5 receptor)
Dual tropic
*assay can tell you which one the pt is infected with.

Front 48

Oral candidasis

Back 48

Not oral hairy leukoplakia b/c not on side of tongue/scraping possible

Front 49

CCR5 receptors

Back 49

Have genetic variance

Front 50

Life cycle of HIV

Back 50

Affects mucosal surface
DC goes to lymph nodes and starts to infect CD4 cells
Step 1 : attachment, CD4 and chemokine receptor depending on HIV virus type
Step 2: uncoating
Step 3: RT (two major classes NRTI and NNRTI – nucleoside RT inhibitor and non nucleoside)
Step 4: integration
Integrase enzyme
Step 5: proviral transcription
Step 6: Translation
Step 7: protease cleavage
Protease inhibitor stops the making of protein (another class of drugs)
Step 8: assembly, maturation, release

Front 51

Tests for HIV acute

Back 51

HIV RNA – PCR*
p24 antigen (ELISA?)
Immunoflorescent assay

Front 52

Confirm HIV diagnosis via

Back 52

Western Blot measures
Proteins gp160/120/p24/POL/GAG/ENV

Front 53

ARS

Back 53

Acute retroviral syndrome : flu like
Fever (slightly prolonged), chills, Sore throat, myalgias, arthralgias, headache, malaise, nausea, rash more likely in HIV than others.

*ARS is not common clinical scenario, HIV pts come in with extremely low CD4 count.

Front 54

Initial test for HIV

Back 54

ELISA (both HIV 1 and 2)

Front 55

CD4+ Tcell

Back 55

Normal: 800-1000

Front 56

When is HIV considered AIDS

Back 56

CD4+ lower than 200 cells/micro l

Front 57

When would you start Tx for an AIDS patient?

antiretroviral therapy (ART)

Back 57

AIDS defining illness – oral candidasis is one of them.
CD4 = 350-500
Pregnant women – start ART regardless of CD4 count b/c risk of transmission is high
HIV associated nephropathy
Hep B co infection – also treat for Hep B

Front 58

Major side effects of NRTI (Nucleoside/Nucleotide Reverse Transcriptase Inhibitors)

Back 58

Bone marrow suppression
Peripheral neuropathy
Pancreatitis
Abacavir – hypersensitivity

Front 59

NNRTI (Non-Nucleoside Reverse Transcriptase Inhibitors) side effects

Back 59

Lots of drug-drug interaction
Severe skin rash
Hepatitis
Rapid resistance if dose missed. ***

Front 60

PI (Protease Inhibitors) side effect

Back 60

Parestehsias
Hypertriglyceridemia
Hypercholesterolemia
*so not good for 45 yo diabetic