Step 1 Last Day Review Cards 2

Front 1

What is periplasm?
significance?

Back 1

space b/t the cytoplasmic membrane and outer membrane in gram negative bacteria

contains hydrolytic enzymes including B-lactamses

Front 2

What is the composition of histone octamer?

Where does H1 histone protein belong?

Back 2

4 pairs to form a nucleosome, which bind to negatively charged DNA

H1 is not part of the octamer; it binds nucleosome octomers in a string.

Front 3

What is the composition of bacterial capsule?

exception?

Back 3

polysaccharide

exception: Bacillus anthracis: contains D-glutamate

Front 4

Euchromatin vs heterochromatin

Back 4

Heterochromatin: not accessible for transcription ("Highly Condensed)

Euchromatin: accesible for transcription

Front 5

What do pilus/fimbria adhere to?

exception?

Back 5

adhere to cell surface

Strep mutans (viridan) attaches to fibrin

Front 6

Acetylation vs hypermethylation of histone.

Back 6

acetylation: weakens DNA-Histone bond --> more transcription

hypermethylation: prevent transcription

Front 7

Elaborate on the following bacteria's cell membrane/walls:

mycoplasma
mycobacteria

Back 7

mycoplasma: contains sterol and no cell wall
mycobacteria: contains mycolic acid. high lipid content in the cell wall

Front 8

Required components for:

1. Purine

2. Pyridmidine

Back 8

1. Purine: glycine, aspartate, glutamate ("GAG")

2. pyrimidine: Carbamoyl phosphate and Aspartate

Front 9

gram positive cocci in clusters?

gram positive cocci in chains?

spirochtes? (3)

Back 9

clusters: staph
chains: strep
spirochetes: Borrelia, Leptospira, Treponema (BLT)

Front 10

Carbamoyl phosphate

What 2 metabolic pathways is this involved in?

Back 10

Urea cycle

De novo pyrimidine synthesis

Front 11

6 bacteria that don't gram stain.

Back 11

These Rascals May Microscopically Lack Color

Treponema
Rickettsia
Mycoplasma
Mycobacteria
Legionella
Chlamydia

Front 12

Increased orotic acid, Megaloblastic anemia (does not improve with vit B12 or folate).

disease?
inheritance pattern?

Back 12

Orotic aciduria: defect in either ortic acid phosphoribosyl transferase or orotidine 5-phosphate decarboxylase

Autosomal recessive

Front 13

What organisms are stained with following dyes?

1. Giema
2. PAS
3. Carbol-fulschin
4. Silver

Back 13

1. Giema: Borrelia, Plasmodium, trypanosomes, Chlamydia

2. PAS: Whipple's disease (Tropheryma whippelii)

3. Carbol-fulschin: acid-fast organisms

4. Silver: fungi and Legionella

Front 14

Orotic acid + hyperammonemia.

Disease?
inheritance pattern?

Back 14

OTC (ornithin transcarbamoylase) deficiency

X-linked recessive

Front 15

Thayer-Martin or VPN media

What organism?

Back 15

N. gonorrhea

Front 16

Hydroxyurea

MOA?
indication?

Back 16

inhibits ribonucleotide reductase --> inhibits de novo pyrimidine synthesis

for sickle cell anemia (increase HbF)

Front 17

Lactose-fermenting enterics.

What special culture is used?

Back 17

"CEEKS"

Citrobacteria
E.Coli
Enterobacter
Klebsiella
Serratia

cultured in MacConkey Agar

Front 18

Methotrexate and Trimethprime

MOA?
difference?

Back 18

inhibits dihydrofolate reductase

MTX: eukaryotic cells
TMP: prokaryotic cells

Front 19

4 Obligate aerobes?

3 obligate anaerobes?

Back 19

aerobes: Nocardia, Pseudomonas aeurignosa, Mycobacterium tuberculosis, and Bacillus

Anaerobes: Clostridium, Bacteriodes, and Actinomyces

Front 20

Adenosine deaminase deficiency

defective pathway?
pathogenesis?
associated disorder?

Back 20

Purine salvage pathway

Excess ATP and dATP imbalances nucleotide pool via feedback inhibition of ribonucleotide reductase -> prevents DNA synthesis and thus lower lymphocyte count. One of the major causes of SCID (severe combined immunodefieciency disease)

Front 21

2 obligate intracellular bugs

Back 21

"stay inside when it is Really Cold"

Rickettisa and Chlamydia

Front 22

Lesch-Nyhan syndrome

defect?
inheritance pattern?
sxs?

Back 22

deficiency in HGPRT (used in purine salvage pathway) --> increased uric acid

X-linked recessive

retardation, self-mutilation, aggression, hyperuricemia, gout, choreoathetosis

Front 23

urease positive bugs

Back 23

"Particular Kinds Have Urease"
Proteus
Klebsiella
H. Pylori
Ureaplasma

Front 24

DNA topoisomerase

fxn?
what antimicrobial blocks this enzyme?

Back 24

uncoils DNA

flouroquinolone

Front 25

Yellow sulfur granule, what bacteria?

red pigment, what bacteria?

Back 25

yellow sulfur: Actinomyces israelii

red: Serratia marcescens

Front 26

DNA polymerase I vs DNA polymerase III

Back 26

DNA pol I: 5 --> 3 DNA exonuclease activity; degrades RNA primers

DNA pol III: 3 --> 5 DNA exonuclease activity; elongates both leading and lagging strands

both are only in prokaryotes

Front 27

Quellung bacteria (6)

Back 27

K S SHiN: encapsulated --> avoid phagocytosis

Klebsiella
Salmonella
Strep pneumoniae
Haemophilus influenza B
Neisseria meningitidis

Front 28

Xeroderma pigmentosum

defect?

Back 28

defective endonuclease that removed damaged base (or thymidine dimers in this case)

Front 29

"SHiN" Bacteria

Back 29

Strep pneumoniae
Haemophilus influenza B
Neisseria meningitidis

IgA protease
transformation
encapsulated

Front 30

Lynch syndrome

defect?

Back 30

HNPCC (hereditary nonpolyposis colorectal cancer)

defective mismatch repair gene

Front 31

Protein A

what bacteria?
fxn?

Back 31

Staph aureus

binds Fc region of Ig --> prevent opsonization and phagocytosis

Front 32

How does radiation damage DNA?

Back 32

breaks DNA double strands and forms O2 free radicals, which further damages it

Front 33

M protein

what bacteria?
fxn?

Back 33

Group A strep (pyogene)

prevent phagocytosis

Front 34

3 main types of RNA and feature of each

Back 34

RMT (Rampant, Massive, Tiny)
rRNA: most abundant
mRNA: longest
tRNA: smallest

Front 35

what is the only gram + bacteria with endotoxin?

Back 35

Listeria

Front 36

What is added at the 3 end of mRNA post trascriptionally? its fxns?

Back 36

poly A tails

prevent degradation
signal to exit nucleus

Front 37

superantigens (exotoxin)

2 associated bacteria and the toxins

Back 37

S aureus: TSST-1 (toxic shock syndrome), enterotoxin, exfoliatin (SSSS)

S. pyogene: Erythrogenic toxin causes toxic-shock like syndrome

Front 38

TATA or CAAT box

what is it?

Back 38

promoter region on DNA

Front 39

ADP ribosylating AB toxins.

components of toxin?
4 associated bacteria?

Back 39

A: active compound --> alter host's protein fxn
B: binding component

Corynebacterium diphtheria
Vibrio cholerae
E coli
Bordetella pertusis

Front 40

RNA polymerase I, II, III

fxn?

Back 40

I: rRNA
II: mRNA
III: tRNA

in order of products produced

Front 41

Inactivation of EF2

what bacteria?
sxs?

Back 41

Corynebacterium diphtheriae
pharyngitis and pseudomembrane in throat

Front 42

alpha-amanitin

Back 42

found in death cap mushrooms

inhibit RNA polymerase II
causes liver failure

Front 43

2 types of toxins in E coli (ETEC)?

Back 43

Heat-labile stimulates Adenylate cyclase

Heat-stable toxins stimulate Guanylate cyclase

both cause watery diarrhea

Front 44

hnRNA

what is it?
fxn?

Back 44

hetergenous nuclear RNA

mRNA before post-transcription

Front 45

how does pertussis toxin increase cAMP?

Back 45

increases cAMP by inhibiting Gi

Front 46

snRNP

what is it?
fxn?
related diseases?

Back 46

snRNPs and other proteins form spicesome, which splice out intron and spice in exons.

mixed connective disorder and lupus pts make antibodies aginst snRNPs.

Front 47

what toxin causes HUS?

Back 47

shiga toxin from Shigella
shiga-like toxin from E coli O157:H7

Front 48

Mischarged tRNA

defect?

Back 48

reads the usual codon but carries a wrong AA

Front 49

4 cAMP inducers?

Back 49

Vibrio cholerae
Pertussis
E. Coli (ETEC) - heat labile toxin
Bacillus anthracis

Front 50

enzyme responsible for adding amino acid to tRNA?

where on tRNA?
what is the common code at the site?

Back 50

aminoacy-tRNA synthase

AA added on the 3 end and has CCA code on it

Front 51

what 3 immune components are activated by the endotoxin (especially lipid A)?

Back 51

1. activated macrophages: IL-1, TNF, NO

2. complement (alternative pathway): C3a and C5a --> anaphylaxis

3. Hageman factor: DIC

Front 52

3 sites of ribosome complex and their fxns?

Back 52

A site: incoming Aminoacyl tRNA
P site: accomodates growing Peptide
E site: holds Empty tRNA as it exits

Front 53

5 bacterial toxins encoded in a lysogenic phage?

Back 53

ABCDE

ShigA-like toxin
Botulinum toxin
Cholera toxin
Diphtheria toxin
Erythrogenic toxin from Strep pyogene

(due to specialized transduction)

Front 54

energy requirement for translation of each amino acid.

Back 54

tRNA aminoacylation: ATP --> AMP
Loading tRNA onto ribosome: GTP --> GDP
translocation: GTP --> GDP

total 4 high energy Pi

Front 55

Identify gram + cocci by the following categories:

1. Novobiocin
2. Optochin
3. Bile acid solubility
4. Bacitracin

Back 55

1. Novobiocin: "NO StRES"
Staph saprophyticus: resistant
Staph epidermis: sensitive

2. Optochin: "OVRPS"
Strep viridan group: resistant
Strep pneumoniae: sensitive

3. Bile acid
Strep pneumoniae: soluble
Strep vidian group: insoluble

4. Bacitracin: "B-BRAS"
group B (S. agalactiae): resistant
Group A (S. pyogene): sensitive

Front 56

ubiquitin

what is it?
fxn?

Back 56

attached to defective protein for degradation

Front 57

4 beta hemolytic bacteria?

Back 57

Strep pyogene (group A)
Strep agalactiae (group B)
Staph aureus
Listeria monocytogenes

Front 58

telomerase

what is it?
fxn?

Back 58

reverse transcriptase that adds TTAGGG repeats to the 3 end of DNA

a RNA-dependent DNA polymerase

Front 59

chronic granulomatous disease pts are more prone to what bacteria? why?

Back 59

Staph aureus b/c catalase positive

CGD: NADPH oxidase deficiency --> little H2O2

Front 60

cyclin-CDK complex

fxn?

Back 60

both must be activated or inactivated for the cell cycle to progress

Front 61

List 3 toxin mediated diseases of S aurues.

Back 61

TSST-1: toxic shock syndrome
exfoliative toxin: SSSS
enterotoxin: food poisoning (mayonnaise)

Front 62

Rb or P53

what are they?

Back 62

tumor suppressor genes

inhibits G1 to S progression

Front 63

infection of prosthetic devices and IV catherer.

organism?

Back 63

staph epidermidis

Front 64

Permanent, stable or labile?

Lymphocyte

Back 64

stable

Front 65

Strep pneumoniae is the most common cause what 4 disorders?

Back 65

MOPS

Meningitis in adults
Otitis media in children
Pneumonia
Sinusitis

Front 66

Permanent, stable or labile?

RBC

Back 66

permanent

Front 67

rusty sputum, sepsis in sickle cel anemia and splenctomy.

organism?

Back 67

strep pneumoniae

Front 68

Nissl bodies

what are they?
fxn?

Back 68

RER in neurons

produces peptide neurotransmitters

Front 69

what organism causes dental caries?

subacute bacterial endocarditis?

Back 69

Viridan group strep: normal flora of the mouth

dental caries: Strep mutans
subacute endocarditis: Strep sanguis

Front 70

Give 2 examples of cells that are rich in RER.

rich in smooth ER?

Back 70

rich in RER: mucous-secreting goblet cells, plasma cells

rich in smooth ER: hepatocytes and adrenal cortical cells

Front 71

Pathogenesis of rheumatic fever?

sxs?

Back 71

antibodies to M protein of Strep pyogene (group A)

No "rheum" for SPECCulation
SubQ plaques
Polyarthritis
Erythema marginatum
Chorea
Carditis

Front 72

I cell disease

defect?
sxs?

Back 72

failure of addition of mannose-6-phsphate to lysosome protein

lysosomal proteins are secreted

coarse facial features, clouded corneas, restricted joint movement, and high plasma levels of lysosomal enzymes

Front 73

list 3 pyogenic disease caused by group A strep.

Back 73

pharyngitis
cellulitis
impetigo

Front 74

Clathrin protein

fxn?

Back 74

trafficking protein:
trans-golgi --> lysosomes
plasma membrane --> endosomes (receptor-mediated endocytosis)

Front 75

causes pneumonia, meninigitis, and sepsis mainly babies.

what bacteria?
tx?

Back 75

strep agalactiae (group B)

prophylactic tx with intrapartum penicillin or ampicillin

Front 76

List 2 drugs that inhibit microtubule polymerization.

List 1 drug that hyperstabilize microtubule.

Back 76

inhibit polymerization: vincristine/vinblastine, colchicine

hyperstabilization; Paclitaxel/taxols

Front 77

group D strep

name?
location?

Back 77

Enterococci: normal colonic flora

Strep bovis: can cause bacteremia and subacute endocarditis in colon cancer pts

Front 78

Chediak-Higashi syndrome

defect?
sxs?

Back 78

microtubule polymerization defect --> decreased phagocytosis

recurrent pyogenic infections (staph, strep)
partial albinism
peripheral neuropathy

Front 79

pseudomembranous pharyngitis

causative bacteria?
pathogenesis?

Back 79

Corynebacterium diptheria

via exotoxin encoded by beta-prophage --> inhibit protein synthesis via ADP ribosylation of EF-2

Front 80

Cilia structure
what protein is incorporated?

Back 80

9+2 microtubule arrangement

dynein

Front 81

List spore forming bacteria. (5)

which ones are found in soil

Back 81

gram positive rods

soil: Bacillus anthracis, Clostridium perfirngens, C. tetani

others: B. cereus and C botulinum

Front 82

Kartagener's syndrome

defect?
sxs?

Back 82

immotile cilia due to a dynein arm defect

male/female infertility
bronchietasis
recurrent sinusitis
situs inversus

Front 83

which bacteria?

1. spastic paralysis, trismus, risus sardonicus
2. floppy baby syndrome
3. gas gangrene and hemolysis
4. pseudomembranous colitis

Back 83

1. C tetani
2. C botulinum
3. C perfrigens
4. C difficile

Front 84

What tissue is associated following IHC markers?

Vimetin
Desmin

Back 84

Vimetin: connective tissue
Desmin: muscle

Front 85

Bacterium with polypeptide capsule

Back 85

Bacillus anthracis
contains D-glutamate

Front 86

2 drugs that disrupt Na/K pump.

Back 86

Ouabain

Cardiac glycosides (digoxin, and digitoxin): blocks Na/K --> increase Ca/Na antiport action --> increase intracellular Ca

Front 87

Woolsorter's disease

bacteria?
sxs?

Back 87

Bacillus anthracis

black eschar (painless ulcer) --> bacteremia and death
pulmonary sxs: flulike sxs --> fever, pulmonary hemorrhage, mediastinitis, and shock

Front 88

List 4 types of collagen and associated tissues.

Back 88

Be (So Totally) Cool, Read Books

Type I: bone, skin, tendon
type II: cartilage
type III: reticullin (skin, blood vessels, uterus, fetal tissue, granulation tissue)
type IV: Basement membrnae

Front 89

tumbling motility and endotoxin

bacteria?
modes of transmission? (2)

Back 89

Listeria monocytogenes

unpasteurized milk/cheese and deli meats
vaginal transmission during birth

Front 90

What disease(s) is associated following deficiency?

type I collagen
type III collagen
type IV collagen
fibrillin

Back 90

type I collagen: Osteogenesis imperfecta
type III collagen: Ehlers-Danlos syndrome
type IV collagen: Goodpasture's, Alport's
fibrillin-1: Marfan's

Front 91

aminionitis, speticemia and spontaneous abortion in pregnant women
granulomatosis infantiseptica, neonatal meningitis

bacteria?

Back 91

Listeria monocytogenes

Front 92

What 3 AAs are most abundant in collagen chains?

What vitamin is needed for collagen synthesis? if deficient?

Back 92

Glycine-proline-lysine

Vitamin C; Scurvy if deficient

Front 93

List 2 bacteria with long branching filaments.

tx for each?

Back 93

Actinomyces israelii
Nocardia asteroides

SNAP:
Sulfa for Nocardia
Actinomyces use Penicillin

Front 94

What enzyme cross-links tropocollagen to make collage fibrils? What does it link?

Back 94

links lysine and hydroxylysine by lysyl oxidase

Front 95

Ghon complex? its significance?

Back 95

Ghon complex = TB granulomas (Ghon focus) + hilar node involvement

reflects primary infection or exposure

Front 96

What accounts for elastin's ability to recoil?

What enzyme is responsible for making this property?

Back 96

due to desmosine cross-linking b/t lysyl residues with elastin chains

lysyl hydroxylase cross-links the elastin

Front 97

PPD+ in what group?

PPD- in what group?

Back 97

PPD+: current infection, past exposure, BCG vaccinated

PPD-: no infection or anergic (steroids, malnutration, immunocompromised, sarcodosis)

Front 98

Ehlers-Danlos syndrome

defect?
sxs?

Back 98

type III collagen deficiency

hyperextensible skin, easy bruising, hypermobile joint, berry aneurysm

Front 99

fibrocaseous cavitary lesion in the upper lobes.

In terms of TB infection, what is the clinical significance?

Back 99

secondary TB by either reinfection or reactivation

Front 100

Osteogenesis imperfecta

defect?
sxs?
genetic pattern?

Back 100

type I collagen deficiency

Multiple fractures with minimal trauma
blue sclerae
hearing loss
dental imperfection

autosomal dominant (most common)

Front 101

M. Avium-intracellulares

affected group?
prophylactic tx?

Back 101

presents in AIDS pts with CD4 < 50
prophylactic tx with Azithromycin

Front 102

Alport's syndrome

defect?
sxs?
genetic pattern?

Back 102

type IV collagen

deafness, nephritis

X-linked recessive

Front 103

2 forms of Hansen's disease?

why are they different?

Back 103

Lepromatous: diffusely over skin and communicable; can be lethal; due to defective Th1 activation

Tuberculoid: limited to a few hypoesthetic nodules

Front 104

Microarrays

What is this used for?

Back 104

used to detect single nucleotide polymorphism or to profile gene expression levels

Front 105

tx of Hansen's disease?
its toxicity?

Back 105

Dapsone
can cause hemolysis and methemoglobinemia

Front 106

RNAi

What is it?
used for?

Back 106

dsRNA complementary to mRNA.

when transfected into human cells, dsRNA separates and promotes degradation of target mRNA, knocking down gene expression

Front 107

What 2 antibiotics do most gram negative bacillis are resistant to?

Back 107

penicillin G
Vancomycin

Front 108

Pleiotropy

Back 108

one gene, multiple phenotypes

Front 109

What correlates with mortality and morbidity when infected with N. Menigococcus?

Back 109

lipooligosacharrides (LOS)

Front 110

Imprinting

Back 110

differences in phenotype depend on whether the mutation is maternal or paternal origin

Front 111

List 3 diseases associated with N. menigococcus.

affected group?

Back 111

meningococcemia
meningitis
Waterhouse-Friderischsen syndrome

occurs in close quarters such as college dorms and military barracks.

Front 112

loss of heterozygosity

Back 112

If a pt inherits or develops a mutation in a tumor suppressor gene, the complementary allele must be deleted/mutated before cancer develops.

not true of oncogenes

Front 113

List 5 diseases associated with N. gonorrhea.

Back 113

gonorrhea
septic arthritis
neonatal conjunctivitis
PID
Fitz-Hugh-Curtis syndrome

Front 114

Heteroplasmy

Back 114

presence of both normal and mutated mtDNA, resulting in variable expression of mitochondria inherited disease

Front 115

List 4 diseases associated with haemophilus influenzae.

Back 115

haEMOPhilus
Epiglottitis ("cherry red" in children)
Meningitis
Otitis media
Pneumonia

Front 116

Hardy-Weinberg equation

how do you calculate prevalence of X-linked recessive diseases?

Back 116

p^2 +2pq + q^2 = 1
p + q =1

in X-linked recessive disease
p = disease prevalence in male
q^2 = disease prevalence in female

Front 117

Chocolate agar with factors V and X are needed for culture of what organism?

Back 117

Haemophilus influenza

Front 118

Prader-Willi syndrome

defect?
sxs?

Back 118

delection of normally active Paternal allele on chrom 15

MR, hyperphagia, obesity, hypogonadism, hypotonia

Front 119

type B Haemophilus influeza vaccine is conjugated with what?

Back 119

diptheria toxoid to improve immune system recognition of polysacchride and promote class switching

Front 120

Angelman's syndrome

defect?
sxs?

Back 120

deletion of normally active maternal allele on chrom 15

MR, seizures, ataxia, inappropriate laughter

Front 121

Rimfapin monotherapy is used for? (2)

Back 121

prophylactic tx for haemophilus influenza and meningococcal infection

also used with Dapsone in Hansen's disease to slow resistance to Dapsone

Front 122

List 3 examples of mitochondral inheritance pattern diseases.

Back 122

Myoclonic epilepsy with ragged red fibers (MERRF)

Leber's hereditary optic neuropathy

Mitochondrial encephalopathy with stroke-like episodes and lactic acidosis (MELAS)

Front 123

Culture for Legionella pneumophilia?

habitat?

Back 123

charcola yeast extract culture with iron and cysteine

water source habitat

Front 124

Hypophosphatemic rickets

inhertiance pattern?
presenation?

Back 124

x-linked dominant
rickets-like presentation due to increased PO4 wasting

Front 125

Pseudomonas aeruginosa is associated with?

Back 125

"PSEUDOmonas"
wound and burn infection
Pneumonia (in CF pts)
Sepsis
External otitis (Swimmer's ear)
UTI
Drug use and Diabetic Osteomyelitis
hot tub folliculitis
Malignant otitis externa in diabetics

Front 126

What inheritance pattern is associated with the following:

defective structural genes
enzyme deficiencies

Back 126

defective structural genes: autosomal dominant

enzyme deficiencies: autosomal recessive

Front 127

pyocyanin

what is it?
what organism produces it?

Back 127

blue-green pigment by Pseudomonas

Front 128

Marfan's syndrome

defect?
sxs?
complications?

Back 128

fibrillin gene mutation

tall with long extremities, pectus excavatum, hyperextensive joints, and long, tapering fingers/toes (arachnodactyly)

dissecting aneurysm (due to cystic medial necrosis of aorta)
floppy mitral valve
subluxation of lenses

Front 129

Feature of Enterobacteriaceae

Back 129

COFFEe

Capsular
O antigen
Flagellar antigen
Ferment glucose
Enterobacteriaceae

Front 130

Neurofibromatosis 2

genetic defect?
associated diseases?

Back 130

NF2 gene mutation on chrom 22

bilateral Schwanomma, juvenile cataracts

Front 131

What type of E coli causes...
1. dysentery?
2. Traveler's diarrhea?
3. diarrhea?

Back 131

1. EIEC and EHEC
2. ETEC
3. EPEC

Front 132

Cystic fibrosis

genetic defect?
cellular changes in the lung and sweat glands?
how you so dx?

Back 132

AR, CFTR gene defect on chrom 7 (deletion of Phe) --> defective chlorine channels

Lungs (epithelial tissues): decreased Cl secretion --> increased Na/H20 reabsorption --> dry

Sweat glands: decreased Cl- reabsorption and Na reabsorption

dx via sweat test

Front 133

HUS is caused by what organism?
triad?
pathogenesis?

Back 133

by EHEC producing Shiga-like toxin

triad of hemolytic anemia, thrombocytopenia and acute renal failure

Endothelium swells due to toxins --> narrows the lumen --> mechanical hemolysis and reduced renal blood flow; damaged endothelium consumes platelets

Front 134

Pseudohypertrophy of calf muscles, Gower's maneuever

dx?
defective gene?
inheritance?

Back 134

Duchenne's muscular dystrophy

deletion of dystrophin gene

X-linked recessive

Front 135

4 disorders associated with Klebsiella

Back 135

4 A's
Aspiration pneumonia
Abscess in lungs
Alcoholics
di-A-betics

Front 136

List X-linked recessive disorders.

Back 136

Be Wise, Fool's GOLD Heeds Silly Hope

Bruton's agammaglobulinemia
Wiskott-Aldrich
Fabry's disease
G6PD deficiency
Ocular albinism, ornithine transcarbamolyase deficiency
Lesch-Nyhan syndrome
Duchenne's (Becker's)
Hunter's Syndrome
Hemophilia A and B

also, Alport's syndrome

Front 137

fever, diarrhea, headache, rose spots on abdomen, and can remain in gallbladder chronically.

organism?

Back 137

Salmonella typhi

Front 138

Fragile X syndrome

defective gene?
genetic findings?
findings?

Back 138

defective FMR1 gene
CGG trinucleotide repeat disorder

2nd most common cause of MR (after Down's)
macro-orchidim, long face with a large jaw, large everted ears, autism, mitral valve prolpase

Front 139

Salmonella and Shigella

common sxs?
virulence?

Back 139

both invade intestinal mucosa and cause bloody diarrhea

shigella is more virulent than salmonella

Front 140

List 4 trinucleotide repeat expansion diseases.

What genetic feature do they all share?

Back 140

Try hunting for my friend eggs (X)

Huntington's (CAG)
myoTonic dystrophy (CTG)
Fragile X syndome (CGG)
Freidreich ataxia (GAA)

genetic anticipation

Front 141

causes gastritis and duodenal ulcers.

organism?
tx?

Back 141

Helicobacter pylori

triple therapy 1: metronidazole, bismuth, either tetracycline or amoxicillin

triple therapy 2: metronidazole, omeprazole, and clarithroycin

Front 142

Down's syndome

genetic defects?
causes of genetic defects (3)?
findings?

Back 142

trisomy 21 due to meiotoic nondisjuction (95%), robertosonian translocation (4%), Down mosaicism (1%)

MR (most common cause), epicanthal folds, simian crease, duodenal atresia, congenital heart disease (most commonly septum primum ASD)

Decreased AFP, estriol and increased beta-hCG and inhibin A in amniocentesis

Front 143

visualized by dark-field microscopy?

Back 143

Treponema

Front 144

Edward's

genetic defect?
findings?

Back 144

trisomy 18

severe MR, rocker-bottom feet, micrognathia, clenched hands

usually die within 1 year of birth

Front 145

Weil's disease

organism?
sxs?

Back 145

Leptospira interrogans (a spiorchetes

sxs: severe form with jaundice and azotemia from liver and kidney dysfxn; fever, hemorrhage and anemia

Front 146

Patau's

genetic defect?
findings?

Back 146

trisomy 13

severe MR, rocker-bottom feet, cleft lip/palate, holoProsecephaly, Polydactyly

usually die within 1 yr of birth

Front 147

Bell's palsy, Arthritis, Cardiac block, Erythema migrans

dx?
causative organism?
vector?

Back 147

Lyme disease
("BAKE a key Lyme pie)

Borrelia burgdorferi
tick Ixodes

Front 148

Robertsonian translocation

what is it?
affected chromosomes?

Back 148

occurs when the long arms of 2 acrocentric chromosomes fuse at the centromere and the 2 short arms are lost

13, 14, 15, 21, and 22

Front 149

sxs of stage 2 lyme disease?

Back 149

Bell's palsy
AV nodal block (third degree)

Front 150

Cri-cu-chat syndrome

genetic defects?
findings?

Back 150

congenital microdeletion of 5p

microcephaly, MR, high-pitched crying/mewing, epicanthal folds, cardiac abnormalities

Front 151

Gummas, aortitis, broad-based ataxia, positive Romberg, Charcot joint.

dx?
causative organism?

Back 151

tertiary syphilis caused by Treponema pallidum

Front 152

Williams syndrome

genetic defects?
findings?

Back 152

congenital microdeletion of 7q

"elfin" facies, MR, hypercalcemia, well-developed verbal skills, extreme freindliness with strangers, cardiovascular problems

Front 153

Saber shins, saddle nose, CN VIII deafness, Hutchinson's teeth, mulberry molars.

dx?
causative organism?

Back 153

congenital syphilis caused by Treponema pallidum.

Front 154

2 syndromes associated with 22q11 deletion?

defects for each?

Back 154

DiGeorge syndrome: thymic, parathyroid, and cardiac defects (truncus arteroisus, tet of Fallots)

Velocardiofacial syndrome: palate, facial, cardiac defects

Front 155

Most specific test for syphillis?

Back 155

FTA-ABS

Front 156

List water soluble vitamins.

Which ones stay in the system for a while? (2)

Back 156

B1 (Thiamine: TPP)
B2 (riboflavin: FAD, FMN)
B3 (niacin: NAD+)
B5 (panthothenic acid: CoA)
B6 (pyridoxine: PLP)
B7 (biotin)
B12 (cobalamin)
C (ascorbic acid)
folate

B12 and folate stay in the system b/c they are stored in the liver

Front 157

List factors that can cause false positives in VDRL test for detecting syphillis.

Back 157

VDRL
Viruses (mono, hepatitis)
Drugs
Rhematic fever
Lupus and leprosy

Front 158

List common sxs of vitamin B complex deficiency.

Back 158

dermatitis, glossitis, and diarrhea

Front 159

causes bacillary angiomatosis and from cat scratch.

causative organism?

Back 159

Bartonella spp.

Front 160

Isoretinoin

indication?
requirement before using it? why?

Back 160

indicated for acne

pregnancy test before using it b/c it is a form of Vit A, which is teratogenic

Front 161

Brucella spp.

causes what?
transmission?

Back 161

causes undulant fever

transmission via dairy products, contact with animals

Front 162

TPP

what vitamin?
cofactor what enzymes? (4)

Back 162

B1 (thiamine)

Pyruvate dehydrogenase (glycolysis)
alpha-ketoglutarate (TCA cycle)
Transketolase (HMP shunt)
branched-chain AA dehydrogenase

Front 163

Yersinia pestis

disease?
transmission and source?

Back 163

Plague

fleabite, rodents, especially prairie dogs

Front 164

Wernicke-Korsakoff syndrome

what causes it?
sxs?
irreversible sxs?

Back 164

due to thiamine (B1) deficiency; usually associated with chronic alcoholism and malnutrition

Wernicke: confusion, opthalmoplegia, ataxia
Korsakoff: memory loss, confabulation, personality change

Korsakoff sxs are irreversible b/c the damage to medial dorsal nucleus of thalamus is permanent

Front 165

what are Clue cells?
associated disease?

Back 165

clue cells are vaginal epithelial cells covered with bacteria

associated with bacterial vaginosis

Front 166

Niacin

what vitamin?
what AA is it made from?
cofactor for what type of reaction?

Back 166

vitamin B3
made from tryptophan

constituent of NAD+, NADP+, which are used in redox rxns

Front 167

headache, fever, rash on palms and soles, which migrate to the trunk.

dx?
causative organism?

Back 167

Rocky mountain spotted fever caused by Rickettsia rickettsii infection

Front 168

vitamin B3 deficiency

List 3 causes.
sxs?

Back 168

1. Hartup disease (decreased tryptophan reabsorption in the proximal tubule)
2. carcinoid syndrome (increased tryptophan metabolism; used as serotonin)
3. INH (decrease vit B6, which is required to make B3)

sxs: Pellagra (diarrhea, dementia, dermatitis) and glossitis

Front 169

pneumonia, negative Weil-Felix reaction, no rash, due to inhaled aerosole.

dx?
causative organism?

Back 169

Q fever by Coxiella burnetii

Front 170

Pyridoxine

what vitamin?
fxns? (6)

Back 170

vitamin B6

used as a cofactor for:
1. transmination
2. decarboxylation
3. glycongen phosphorylase
4. cystathione synthesis
5. heme synthesis
6. synthesis of niacin from tryptophan

Front 171

Chlaymydia trachomatis types L1-3

causes?

Back 171

lymphogranuloma venereum

Front 172

Drugs that decrease pyridoxine (2)

Back 172

INH
oral contraceptives

Front 173

This bacteria has choleterol in the membrane.

which bacteria?
associated disease?
infected group?

Back 173

Mycoplasma pneumonia

atypical "walking" pneumonia

frequent outbreaks in military recruits and prisons

Front 174

Which one has a larger reserve pool: cobalamin or folate?

clinical significance of having a small or large reserve pool?

Back 174

cobalamin: very large reserve pool in the liver

folate: small reserve pool in the liver; most common vitamin deficiency in US (remember, small reserve pool)

Front 175

What is the function of following forms of Chlamydiae?

1. Elementary body
2. Reticulate body

Back 175

elementary body: infectious and enters cell via endocytosis

reticulate body: replicates in cell by fission

Front 176

What parasite can cause vitamin B12 deficiency?

What are 2 elevated serum markers for B12 deficiency?

Back 176

Diphyllobothrium latum --> Vit B12 deficiency

Elevated homocysteine, and methymalonylic acid

Front 177

Histoplasmosis

endemic location?
pathological features?

Back 177

Mississipi and Ohio river valleys
Causes pneumonia
Macrophage filled with Histoplasma (smaller than RBC)

Front 178

increased anion gap acidosis, hypoglycemia, ketosis, increased methymalonylic acid.

suspect?

Back 178

Methylmalnonylic acidemia due to deficiency in Isomerase

Isomerase: methylmalony-Coa --> succinyl-CoA

Front 179

Blastomycosis

endemic location?
pathological features?

Back 179

Southeast and Central America
Broad-base budding (same size as RBC)
inflammatory lung disease and can disseminate to skin and bone. forms granulmatous nodules

Front 180

S-adenosyl-methinoine (SAM)

fxn?
regeneration of SAM requires?

Back 180

SAM transfers methylunit; required for NE --> E nad methionine to homocysteine

regeneration requires Vit B12 and folate

Front 181

Coccidioiodomycosis

endemic location?
pathological features?

Back 181

Southwestern US, California; increased rate after earthquakes

pneumonia and meningitis
can disseminate to bone and skin

Spherule filled with endospores

Front 182

What general reaction uses biotin as a cofactor?

What 3 pathways utilize biotin?

Back 182

cofactor carboxylation enzymes (add 1 carbon goup)

1. generation of oxaloacetate (for TCA or gluconeogenesis)
2. synthesis of FA chain
3. odd # FA beta oxidation

Front 183

Paracoccidioidomycosis

endemic location?
pathological features?

Back 183

latin America

Budding yeast with "captain's wheel" formation (much large than RBC)

Front 184

List 4 functions of ascorbic acid.

Back 184

ascorbic acid = vitamin C

1. antioxidant
2. facilitate Fe absorption by keeping it at reduced state (Fe2+)
3. for hydroxylation of proline and lysine in collagen synthesis
4. for dopamine Beta-hydroxylase, which converts dopamine to NE

Front 185

list 4 dimorphic fungi.
how is the morphology determined?

Back 185

Histoplasmosis
Blastomycosis
Cocciciomycosis
paracoccidioidomycosis

Cold = mold
Heat = yeast; exception is coccidioidomyocosis, which is a spherule (not yeast) in tissue

Front 186

Vitamin K

Biochemical action?
necessary for synthesis of what substances?

Back 186

catalyzes gamma-carboxylation of glutamine acid residues on various proteins concerned with blood clotting

coagulation factors II, VII, XI, X, proteins C and S

Front 187

Malassezia furfur

presentation?
histology?

Back 187

Tinea Vesicolor

degradation of lipids produces acids that damage melanocytes and cause hypopigmented patches.
Occurs in hot, humid weather.

"Spaghetti and meatball" looking

Front 188

What is the pathogenesis of hepatocellular steatosis seen in chronic alcoholics?

Back 188

ethanol metabolism --> increased NADH/NAD+ in liver

not enough NAD+ to drive TCA cycle and beta oxidation -> TG accumulation

Front 189

List 3 fungi that are dermatophytes.

morphology?

Back 189

Microsporum, Trichophyton, Epidermophyton

mold hyphae in KOH prep, not dimorphic

Front 190

Kwashiorkor

cause?
sxs?

Back 190

protein malnutrtion

MEAL
Malnutrition (protien)
Edema (swollen belly)
Anemia
Liver (fatty) due to decreased apolipoprotein synthesis

Front 191

List 5 opportunistic fungal infections.

Back 191

Candida albicans
Aspergillus fumigatus
Cryptococcus neoformans
Mucor and Rhizopus spp
Pneumocystis jiroveci

Front 192

Marasmus

cause?
sxs?

Back 192

overall energy malnutrtion

tissue and muscle wastign
loss of subQ fat
variable edema

Front 193

Candida albicans

morphology?
tx?

Back 193

pseudohyphae + budding yeast at 20C
germ tubes at 37 C

nystatin for superficial infection
amphotericin B for serious systemic infection

Front 194

List 3 metabolic pathways that take place in both mitochondria and cytoplasm

Back 194

HUG

Heme synthesis
Urea cycle
Gluconeogenesis

Front 195

Aspergillus fumigatus

morphology?

Back 195

mold with septate hyphae with acute branching (<45 degrees) + rare fruiting bodies

not dimorphic

Front 196

Metabolism of one glucose molecule results in how many ATPs?

Back 196

30 ATPs in muscle (via glycerol-3-phosphate shuttle)

32 ATPs in heart and liver (via malate-aspartate shuttle)

Front 197

Cryptococcus neoformans

morphology?
found in?

Back 197

yeasts with wide capsular halo, narrow-based unequal budding (seen with India Ink stain)

found in soil, PIGEON droppings

Front 198

List 4 processes that utilize NADPH.

Back 198

1. anabolic process
2. respiratory burst
3. P450
4. glutatione reductase

Front 199

Mucor and Rhizopus spp

morphology?
affected goup?

Back 199

irregular board nonseptate hyphae, wide-angle branching mold

in ketoacidotic diabetic and leukemic patients

Front 200

Hexokinase vs Glucokinase in terms of:

1. fxn
2. location
3. Km, Vmax
4. action of insulin

Back 200

1. both add Pi to glucose

2. Hexokinase is ubiquitous, glucokinase is in liver and beta cells of pancreas

3. Hexokinase: low Km, low Vmax
Glucokinase: high Km, High Vmax

4. only glucokinase is induced by insulin

Front 201

Soup Bubble lesions in brain

what fungus?

Back 201

Cryptococcus neoformans

Front 202

What is the fxn of:

1. Hexokinase
2. glucokinase

Back 202

Hexokinase: trap glucose in the tissue

glucokinase: to sequester excess glucose in the liver (glucose "buffer"); induced by insulin

Front 203

Pneumocystis jiroveci

affected group?
associated disorder?
when do you start prophylactic tx?

Back 203

immunocompromised (e.g. AIDS)
start prophylaxis when CD4 < 200

diffuse interstitial pneumonia

Front 204

List 5 cofactors for pyruvate dehydrogenase.

What 2 other enzyme complexes use the same set cofactors?

Back 204

1. pyrophosphate (B1, thiamine; TPP)
2. FAD (B2)
3. NAD (B3)
4. CoA (B5)
5. Lipoic acid

alpha-ketoglutarate dehydrogenase complex
alpha-ketoacid dehydrogenase

Front 205

rose gardener's disease?
sxs?

Back 205

Sporothrix schenckii (yeast form)

local pustule or ulcer with nodules along draining lymphatics

Front 206

What is the rate-limiting enzyme for glycolysis?

list 2 inducers and 2 inhibitors

Back 206

Phosphofructokinase-1

Inducers: F-2,6-P, AMP
Inhibitors: ATP, citrate

Front 207

Giardia lamblia

causes?
often seen in?

Back 207

bloating, flatulence, foul-smelling fatty diarrhea
NOT INVASIVE

seen in campers/hikers

Front 208

Describe how F-2,6-BP is regulated.

Back 208

F-2,6-BP induces PFK-1, which is the rate-limiting enzyme for glycolysis.

Fed state: insulin -> high PFK-2 activity, low FBP-2 activity -> more F-2,6-P -> glycolysis

fasting state: glucagon -> high FBpase-2 activity, low PFK-2 activity --> less F-2,6-P --> gluconeogenesis

Front 209

Entamoeba histolyica

sxs?
histology?
dx?

Back 209

dysentery, liver abscess (reddish brown), RUQ pain

flash-shaped ulcer in the colon if the submucosal abscess ruptures

serology and/or trophozoites or cysts in stool; RBCs in cytoplasm of enamoeba

Front 210

Pyruvate kinase deficiency

sxs?

Back 210

Pyruvate kinase is used for making pyruvate

hemolytic anemia due to inability to maintain Na/K pump

Front 211

Toxoplasma gondii

affected population?
causes?
transmission?

Back 211

HIV: brain abscess (ring-enhancing lesions on CT/MRI)

congenital toxo: chorioretinitis, hydrocephalus, and intracranial calcification

cysts in meat or CAT feces

Front 212

What inhibits lipoic acid, presents with vomiting, rice water stools, garlic breath?

Back 212

Arsenic poisoning

Front 213

African sleeping sickness

organism?
sxs?
transmission?

Back 213

Trypanosoma gambiense or T. rhodesiense

enlarged lymph nodes, recurring fever, somnolence, coma

Tsetes fly, a painful bite

Front 214

Pyruvate dehydrogenase deficiency

what is increased in the serum?
findings?
tx?

Back 214

increased lactic acid
neurologic defects

tx with high ketogenic nutrients (Lys, Leu, high fat diet)

Front 215

Chaga's disease

organism?
sxs?
transmission?

Back 215

Trypanosoma cruzi

dilated cardiomyopathy, megacolon, achalasia

Reduviid bug ("kissing bug") a painless bite

Front 216

Cori cycle

fxn?
energy cost?

Back 216

Transfers Lactate from muscle, RBC to the liver for gluconeogenesis. Glucose produced is moved back the tissue for glycolysis.

costs 4 ATPs

Front 217

Visceral leishmaniasis

organism?
sxs?
transmission?

Back 217

Leishmania donovani

spiking fevers, hepatosplenomegaly, pancytopenia

sandfly

Front 218

TCA cycle

how many ATPs are generated per cycle?
list 2 irreversible enzymes

Back 218

3 NADH, 1 FADH, 1 GTP = 12 ATPs per cycle

alpha-ketoglutarate dehydrogenase
Isocictrate dehydrogenase

Front 219

Most severe form of plasmodium infection? why?

2 forms that are dormant in the liver? tx?

Back 219

P. falciparum: most severe b/c parasitized RBCs occlude capillaries of brain, kidney and lungs

P. Vivax and P. ovale: dormant form in the liver; tx with primaquine

Front 220

How is the NADH made from glycolysis is transferred for electron transport chain?

Back 220

Muscle: glycerol-3p shuttle

Heart, liver: malate-aspartate shuttle

Front 221

fever, hemolytic anemia, blood smear shows Maltese cross and ring forms.

causative organism?

Back 221

Babesia

Front 222

Oligomycin

what is it?
what metabolic process is halted?

Back 222

mitochondrial ATPase inhibitor

halts oxidative phosphorylation; increased proton gradient but no ATP is produced

Front 223

protozoa that causes foul-smelling vaginitis?

Back 223

Trichomonas vaginalis

Front 224

CN-, CO poisoning

How do they affect oxidative phosphorylation?

Back 224

direct electron transport inhibitors

a decrease in proton gradient and block ATP synthesis

Front 225

Transmitted by female blackflies
causes hyperpigmented skin and river blindness.

causative organism?

Back 225

Onchocerca volvulus (a nematode)

Front 226

2,4 DNP

how does it affect oxidative phosphorylation?
what endogenous substance has a similar property?

Back 226

uncoupling agent

increased permeability of membrane --> decreased proton gradient but increased O2 consumption.
ATP synthesis stops but electron transport chain continues --> generates heat

thermogenin in brown fat

Front 227

causes elephantiasis, transmission via female mosquito

causative organism?

Back 227

Wuchereria bancrofti (a nematode)

Front 228

List 3 potential substrates for gluconeogenesis.

Back 228

Propyl-CoA (from odd-chain FA)
Oxaloacetate
Alanine

Front 229

3 nematode infections via ingetion?

Back 229

EAT

Enterobius
Ascaris
Trichinella

Front 230

List 4 Irreversible enzymes for gluconeogenesis.

Back 230

Pathway Produces Fresh Glucose

Pyruvate carboxylase (biotin)
PEP carboxylase
Fructose-1,6-bisphosphatase
Glucose-6-phosphatase

Front 231

3 nematode infections via cutaneous lesions (skin of feet)?

Back 231

SANd

Strogyloides
Ancylostoma
Necator

Front 232

What type of FA can enter gluconeogenesis? why

Back 232

Odd-chain FA b/c it produces propyl-CoA, which can enter TCA and converted to oxaloacetate.

even-chain FA produces acetyl-CoA, which can't enter gluconeogenesis

Front 233

What parasite?

1. brain cysts, seizures
2. Liver cysts
3. B12 deficiency, anemia

Back 233

1. brain cysts, seizures: Taenia solium (cysticercosis)

2. Liver cysts: Echinococcus granulosus

3. B12 deficiency, anemia: Diphyllobothrium latum

Front 234

What is the purpose of HMP shunt

Energy cost?

Back 234

aka Pentose phosphate pathway

to generate NADPH for various reactions and F6P, G3P for glycolysis

zero ATP used

Front 235

what parasite?

1. biliary tract disease, cholangiosarcoma
2. hemoptysis
3. portal HTN

Back 235

1. biliary tract disease, cholangiocarcinoma: Clonorchis sinesis (also causes pigmented gallstones)

2. hemoptysis: Paragonimus westermani (due to secondary bacterial infection in the lung)

3. portal HTN: Schistosoma mansoni (Snails as hosts)

Front 236

List 2 main enzymes for HMP shunt?

Rate limiting step?
cofactor used?

Back 236

Glucose-6-phosphate dehydrogenase (G6PD): rate-limiting

transketolase: requires B1

Front 237

What parasite?

1. Hematuria, bladder SCC?
2. microcytic anemia?
3. Perianal pruirits, scotch tape test for dx?

Back 237

1. Hematuria, bladder SCC? Shcistosoma haematobium

2. microcytic anemia? Ancyclostoma and necator (by sucking blood)

3. Perianal pruirits, scotch tape test for dx? Enterobius

Front 238

Glucose-6-phosphate dehydrogenase (G6PD) is used for what 2 processes?

Back 238

pentose phosphate pathway (HMP shunt)

detoxification of oxidative free radicals (esp in macrophages)

Front 239

Hydatid disease

causative organism?
transmission?
complication?

Back 239

Echinococcus granulosus

eggs in dog feces

causes anaphylaxis if echinococcal antigens are released from cysts in the liver

Front 240

NADPH deficiency

what disease?
findings?

Back 240

chronic granulomatous disease

recurrent infection with catalase + organisms (Staph aureus, E coli, aspergeillus etc)

Front 241

List Live attenuated viral vaccines.

What immune response is induced?

Back 241

small pox, yellow fever, chickenpox (VZV), Sabin's polio virus (oral), MMR (measles, mumps, and rubella)

Induces cell-mediated and humoral responses

Front 242

G6PD defiency

findings?
inheritance pattern?

Back 242

Intrinsic hemolytic anemia (normocytic), bite cells, Heinz bodies

due to inability to detoxify free radicals

X-linked recessive

Front 243

List killed viral vaccines

What immune response is induced?

Back 243

RIP Always

Rabies, Influenza, Salk's Polio (IV), HAV

Only humoral response is induced.

Front 244

Aldolase B deficiency

accumulated substance?
sxs?
milder form?

Back 244

Fructose-1-p
hypoglycemia, jaundice, cirrhosis, vomiting

Milder form: defect in fructokinase; frutose in urine and blood

Front 245

List recombinant viral vaccines.

Back 245

HBV (HBsAg antigen), HPV (types 6, 11, 16, and 18)

Front 246

Infantile cataracts, jaundice, hepatomegaly, Mental retardation

dx?
defect?
milder form?

Back 246

Galatosemia due to galactose-1p uridyl transferase defiency

galatokinase deficiency: milder form

Front 247

What DNA virus is single stranded?

Back 247

Parvovirus (ssDNA, (-) strand)

Front 248

solbitol dehydrogenase

accumulated substance?
affected tissues?
unaffected tissues?
affected group?

Back 248

Sorbitol accumulation (glucose -> sorbitol by aldolase reductase)

affected tissues: kidney, peripheral nerves, retina, lens
unaffected tissue: liver, ovaries, seminal vesicles

common in chronic DM pts

Front 249

What RNA virus is double stranded?

Back 249

Reoviridae (Reovirus and Rotavirus)

all RNA viruses are ssRNA excepto Reoviridae

Front 250

why are liver, ovaries, and seminal vesicles unaffected by sorbitol accumulation?

Back 250

due to sorbitol dehydrogenase, which converts sorbitol to fructose

Front 251

What viruses replicate in the nucleus?

Back 251

all DNA viruses except poxvirus
RNA: Retrovirus and influenza (orthomyxo)

Front 252

lactase deficiency

sxs?
where is the enzyme located?

Back 252

lactase is a brush-border enzyme in the small intestine

bloating, cramps, osmotic diarrhea

Front 253

what viruses replicate in the cytoplasm?

Back 253

all RNA viruses except for retrovirus and influenza virus (orthomyxo)

Front 254

List 4 glucogenic amino acids.

Back 254

MAV H
Met
Arg
Val
His

Front 255

What viruses are not enveloped?

Back 255

Naked CPR and PAPP smear

CPR = RNA viruses
Calicivirus
Picornavirus
Reovirus

PAPP: DNA virus
Parvovirus
Adenovirus
Papilloma
Polyoma

Front 256

List 4 amino acids that are both glucogenic and ketogenic.

Back 256

PITT
Phe
Ile
Thr
Trp

Front 257

Where do viruses retain their envelop?

Back 257

from plasma membrane except herpesviruses, which aqcuire envelopes form nuclear membrane.

Front 258

List 2 amino acids that are ketogenic

Back 258

Lysine, Leucine

Front 259

List all DNA viruses.

Back 259

HHAPPPPy viruses

Herpes
Hepadna
Adeno
Parvo
Papilloma
Polyoma
Pox

Front 260

What 2 amino acids are needed for growth?

Back 260

Arg and His

Front 261

DNA virus with reverse transcriptase?

Back 261

Hepadnavirus B

Front 262

List 2 amino acids that are major components of histone.

Back 262

Arg and Lys (+ molecules)

Front 263

DNA virus, causes: febrile pharyngitis, pneumonia, conjunctivits ("pink eye")

Back 263

Adenovirus

Front 264

List 2 sources of nitrogen groups on urea.

Back 264

Ammonium (NH4+)
Aspartate

Front 265

Causes aplstic crises in sickle cell disease

what virus?

Back 265

Parvovirus

Front 266

NAG synthase defiency.

What metabolic pathway is affected? how?

Back 266

urea cycle

NAG activates carbamoyl phosphate synthetase I, which is the rate-limiting enzyme for the urea cycle

Front 267

Molluscum contagiousm

Back 267

Poxvirus

Front 268

what 2 urea cycle enzymes are in the mitochondria?

Back 268

Carbamoyl phosphate synthetase I

Ornithine transcarbamoylase

Front 269

Most common cause of sporadic encephalitis (temporal lobe) in the US

what virus?

Back 269

HSV-1

Front 270

What transports NH3 from peripheral tissue to liver for eventual metabolism and excretion?

Back 270

alanine

Front 271

Herpes genitalis, neonatal herpes?

virus?

Back 271

HSV-2

Front 272

what amino acid acts as an NH3 carrier inside the cell?

Back 272

glutamate

Front 273

causes roseola.

organism?
sxs?

Back 273

HHV-6
high fevers for several days that cause seizures, followed by a diffuse macular rash

Front 274

Hyperammonemia

What metabolic pathway is inhibited as a result of increased NH3? why?

Back 274

TCA cycle is inhibited b/c excess NH4+ depletes alpha-ketoglutarate

Front 275

Tzanck test

used for?
finding?

Back 275

used to assay for HSV-1, HSV-2, VZV.

a smear of an opened skin vesicle to detect multinucleated giant cells. can also have intranuclear Cowdry A inclusions

Front 276

2 drugs used to tx hyperammonemia.

Back 276

Benzoate
Phenybutyrate

both bind to AA and lead to excretion

Front 277

EBV

infected cells?
causes?
dx?

Back 277

infects B cells
causes mononucleosis: fever, hepatosplenomagly, pharyngitis, and lymphadenopathy

positive Monospot test

Front 278

Increased orotic acid

list 2 ddx.

Back 278

defect in orotic acid -> IMP in de novo pyrimidine synthesis

ornithine transcarbamoylase deficiency (OTC)

Front 279

What virus can replicate in both nucleus and cytoplasm?

Back 279

Influenza virus (Orthomyxovirus)

Front 280

Ornithing transcarbamoylase deficiency (OTC)

inhibited metabolic process?
findings?

Back 280

urea cycle is inhibited

increased orotic acid, hyperammonemia, decreased BUN

Front 281

List Inclusion bodies associated viruses (4)

Back 281

Rabies – Negri bodies – intracytoplasmic
Pox virus – Guarnieri – intracytoplasmic & acidophilic
CMV – Owl’s eyes – intracytoplasmic & intranuclear
HSV/VZV – Cowdry bodies – intranuclear

Front 282

4 amino acid derivatives that require B6 as a cofactor?

Back 282

Niacin
Histamine
Porphyrin --> heme
GABA

Front 283

Nonenveloped, +ssRNA viruses.

dsRNA virus?

Back 283

Picorna
Hepevirus (HEV)
Calici

dsRNA: reo/rota

Front 284

What AA is the precursor to following AA derivatives?

1. Heme
2. melatonin
3. GABA
4. NO

Back 284

1. Heme: glycine
2. melatonin: tryptophan
3. GABA: glutamate
4. NO: arginine

Front 285

Enveloped, +ssRNA viruses

Back 285

Flavi
Toga
Retro (HIV, HTLV)
Corona

Front 286

What are the enzyme and cofactor used for the following synthesis?

1. Dopamine -> NE
2. NE -> epinephrine

Back 286

1. Dopamine -> NE: dopamine beta hydroxylase; requires vit C

2. NE -> epinephrine: PNMT, requires SAM

Front 287

enveloped, -ssRNA viruses

Back 287

Paramyxo
Rhado
Filo
Arena
Bunya
Delta

Front 288

Mental retardation, growth retardation, fair skin, eczema, musty body odor

dx?
tx?

Back 288

Phenyketouria

decreased phenylalanine and increased tyrosine in the diet

Front 289

Segmented viruses

significance?

Back 289

BOAR

Bunya (3 segments)
Orthomyxo (8 segments)
Arena (2 segments)
Reo/Rota (10-12 segments)

can undergo reassortment, causing antigenic shifts that lead to worldwide pandemics of the flue

Front 290

List 2 causes of phenylketouria.

Back 290

decreased phenylalanine hydroxylase

decreased BH4 (a cofactor for Phe hydroxylase)

Front 291

Piconarvirus

Back 291

PERCH

Poliovirus
Echovirus
Rhinovirus
Coxsackivirus A/B
HAV

Front 292

Alkaptouria

deficiency?
what pathway is affected?

Back 292

congenital deficiency in homogenistic acid oxidase in the degradative pathway of tyrosine

Front 293

aseptic viral meningitis

causative organisms?

Back 293

Echovirus
Coxackievirus

Front 294

List 3 causes of albinism.

associated complication?

Back 294

1. tyrosinase deficiency
2. defective tyrosine transporter
3. lack of migration of neural crest cells

associated with increased risk of skin cancer due to no melanin

Front 295

common cold

causative organism?

Back 295

Rhinovirus (a picornavirus)

Front 296

what special genetic feature does albinism have?

Back 296

variable inheritance due to locus heterogeneity

Front 297

yellow fever

cause?
sxs?

Back 297

a flavivirus

high fever, black vomitus, and jaundice. Councilman bodies may be seen in liver

Front 298

Congenital disease with MR, increased homocystine in urine, osteoporosis, tall stature, kyphosis, lens subluxation, and atherosclerosis

dx?
defects?

Back 298

Homocytinuria due to:

Cystathionine synthase deficiency
decreased affinity cystathione synthase for B6 OR
homocysteine methylase transferase deficiency

Front 299

Major cause of acute diarrhea in the US during winter, especially in day-care centers, kindergartens.

organism?

Back 299

Rotavirus (a reovirus)

Front 300

Cystic kidney stone

common cause?
tx?

Back 300

hereditary defect of renal tubular AA transporters for cysteine, ornithine, lysine, and arginine in the PCT

tx: acetazolamide to alkaline the urine

Front 301

2 antigens of influenza viruses and their fxns?

Back 301

Hemagglutinin: promote viral entry
neuraminidase: promotes progeny virion release

Front 302

Maple syrup disease

defect?
findings?

Back 302

blocked degradation of branched AA (Ile, Leu, Val) due to decreased alpha-ketoacid dehydrogenase

Urine smells like maple syrup ("burned sugar" smell)
severe CNS defects, MR and death

Front 303

Reassortment of viral genome is called?

Back 303

genetic shift

Front 304

Hartnup disease

defect?
findings?

Back 304

defective neutral AA transporter on renal and intestinal epithelial cells

pellagra (diarrhea, dementia, dermatitis)

Front 305

Rubella virus as congenital infection.

sxs?

Back 305

A togavirus

Encephalopathy, deafness, blindness, PDA
Maculopapular rash: from head to toe
postauricular/occipital lymphadenpathy

Front 306

What is the rate-limiting enzyme for glycogenolysis.

List inducers (3) and an inhibitor (1).

Back 306

Glycogen phophorylase

Inducers: Glucagon (liver), Epi (liver/muscle), Ca++/calmodulin (muscle); all phosphorylate the enzyme

inhibitor: insulin (dephosphorylates the enzyme)

Front 307

List 4 paramyxoviruse

Back 307

Parainfluenza
measles
mumps
respiratory syncytial virus (RSV)

Front 308

What is the first step of glycogenolysis? main product?

2nd step?

Back 308

1st step: glycogen phosphorylase to cleave 1,4 bonds until 4 glucose residues are left (limit dextran)

2nd step: debranching enzyme

Front 309

Palivizumab

indication?
MOA?

Back 309

blocks surface F (fusion) protein of RSV (a paramyxovirus)

Front 310

List 4 important glycogen storage diseases.

Back 310

Very Poor Carb Metabolism

Von Gierke's (type I)
Pompe's disease (type II)
Cori's disease (type III)
McArdle's disease (type V)

Front 311

measles

sxs?

Back 311

3 C's + K

cough
coryza
conjunctivitis
Koplik spots

Front 312

What enzyme is alternatively used to cleaven glycogen to glucose molecules (minor pathway)?

associated disease if deficient?

Back 312

Lysosomal alpha1,4 glucosidase (acid maltase)

Pompe's disease (type II)

Front 313

mumps

sxs?

Back 313

POM

parotitis
orchitis
aseptic meningitis

Front 314

Von Gierke's disease

defect?
findings?

Back 314

glucose-6-phosphatase deficiency
type II

severe fasting hypoglycemia, increased glycogen in liver, high blood lactate, hepatomegaly

Front 315

Rabies

mode of transmission?
morphology?
affected cells?

Back 315

bites from bat, raccoon and skunk in the US (dogs also)

bullet-shaped capsid
negri bodies

travel to the CNS by migrating in a retrograde fashion up nerve axons

Front 316

congenital, increased glycogen in liver, cardiomegaly

dx?
defect?

Back 316

Pompe's disease

defective lysosomal alpha 1,4 glucosidase (acid maltase)

Front 317

HAV

transmission?
class?

Back 317

fecal-oral route of transmission
a RNA picornavirus

Front 318

congenital, increased, glycogen in muscle, painful muscle cramping and myogloburia with exercise

dx?
defect?

Back 318

McArdle's disease

skeletal muscle glycogen phosphorylase deficiency

Front 319

Which hepatic virus integrates into host's genome?

Back 319

hep B (a DNA virus)

Front 320

List X-linked recessive lysosomal storage disorders (2)

Back 320

Fabry's disease

Hunter's syndrome

Front 321

which hepatic virus requires coinfection with other virus? What does it require?

Back 321

hep D requires coinfection with hep B virus.
requires HBsAg as its envelope

Front 322

List 3 lysosomal storage diseases common in Ashkenazi jews.

Back 322

Niemann-Pick
Tay-Sachs
Gaucher's disease

Front 323

which hep virus causes high mortality in pregnant women but usually asymptomatic in healthy individuals?

Back 323

hep E

Front 324

Peripheral neuropathy of hands/feet, angiokeratomas, CV and renal disease

increased ceramide trihexoside in blood

dx? defect?

Back 324

Fabry's disease

alpha-galactosidase A deficiency

Front 325

Interpret the following 3 separate results:

1. HBsAb
2. IgM HBcAb
3. IgG HBcAb

Back 325

1. HBsAb: immunized or cured

2. IgM HBcAb: positive during window period, recent disease

3. IgG HBcAb: positive during wndow period, chornic disease

Front 326

Hepatosplenomegaly, aspectic necrosis of femur, bone crises, increases glucocerebroside.

dx?
defect?
hallmark cell?

Back 326

Goucher's disease
defective Beta-glucocerebrosidase
Gaucher's cells (macrophages that look like crumpled tissue paper)

Front 327

What serum marker indicates high transmissiblity in hep B infection? how about low transmissibility?

Back 327

high: HBeAg

low: HBeAb

Front 328

Niemann-Pick disease vs Tay-Sachs disease

common findings?
difference?
defect and accumulated substance?

Back 328

common findings: progressive neurodegeneration, developmental delay, cherry-red spot on macula

difference: hepatosplenomegaly ONLY IN Niemann-Pick

Niemann-Pick: deficiency in sphongomyelinase and accumulated sphingomyelin

Tay-Sachs("SaX): deficiency in HeXosaminidase A and accumulated GM2 ganglioside

Front 329

ALT > AST vs AST>ALT

Back 329

ALT > AST: viral hepatitis

AST>ALT: alcoholic hepatitis

Front 330

2 diseases with heparin sulfate, dermatan sulfate accumulation?

Back 330

Mucopolysaccharidoses

Hurler's syndrome
Hunter's syndrome

Front 331

What proteins are associated with the following HIV genes?

1. env
2. gag
3. pol

Back 331

1. env: gp42, gp 120 (envelop proteins involved in fusion of virus)

2. gag: p24 (capsid protein)

3. pol: reverse transcriptase

Front 332

Hurler's syndrome

defect?
findings?
accumulated substance?

Back 332

alpha-L-iduronidase deficiency
accmuluated heparan sulfate and dermatan sulfate

developmental delay, gargoylism, airway obstruction, corneal clouding, hepatosplenomegaly

Front 333

what surface antigens do HIV bind to on host cells?

Back 333

CXCR4 and CD4 on T cells

CCR5 and CD4 on macrophages

Front 334

What shuttle is used to transport FA for FA synthesis? Where is it transported to?

for beta-oxidation?

Back 334

FA synthesis: citrate shuttle; out of mitochondria to cytoplasm

Beta oxidation: Carnitine shuttle: into the mitochondria

Front 335

How do you dx HIV infection?

Back 335

ELISA/Western blot tests to look for antibodies to viral proteins

ELISA to rule out first (highly sensitive)
Western blot to rule in (highly specific)

Front 336

Carnitine deficiency

What process is halted?
findings?

Back 336

beta oxidation due to lack of carnitine shuttle, which transport FA into mitochondria

hypoketotic hypoglycemia
weakness, hypotonia

Front 337

how do you dx AIDS?

Back 337

CD4+ < 200 (normal 500-1500) or

CD4/CD8 ratio < 1.5

Front 338

Acyl-CoA dehydrogenase deficiency

findings?

Back 338

decreased ability to oxidize fatty acid

increased dicarboxylic acids
hypoglycemia after fasting with decreased ketones

Front 339

When do HIV dx tests result in high false positives?

how about high false negatives?

Back 339

high false positives: in babies born to infected mothers due to anti-gp120 crossing the placenta

high false negatives: first 1-2 months of HIV infection

Front 340

List 2 examples of ketone bodies.

How and where are they formed? where are they used primarily?

Back 340

acetoacetate and beta-hydroxybutyrate
in the liver, fatty acids and amino acids are metabolized
to be used in muscle and brain

Front 341

List 4 neoplasms associated with HIV.

Back 341

Kaposi's sarcoma (HHV-8)
invasive cervica carcinoma (HPV)
primary CNS lymphoma (EBV associated)
non-Hodgkin's lymphoma

Front 342

List 3 states that causes high ketone levels.

Why do ketones form in each state?

Back 342

starvation: depletion of oxaloacetate
diabetic keoacidosis: depletion of oxaloacetate
chronic alcoholism: NADH shunts oxaloacetate to malate

all stall TCA cycle --> ketone generation

Front 343

What infections are associated with the following scenarios:

1. CD < 400

2. CD < 50

Back 343

1. CD < 400: oral thrush, tinea pedis, reactivation of TB, VZV, other bacterial infections

2. CD < 50: CMV retinitis, disseminated M. avium-intracellulare, cryptococcal meningoencephalitis

Front 344

List 4 sources of hepatic gluconeogenesis when starving for 2 days.

Back 344

1. glycerol (as glycerol phosphate but has to be delivered to the liver b/c adipocytes cannot convert glycerol to glycerol-p)
2. lactate (via Cori cycle)
3. Amino acids (as oxaloacetate and a-ketoglutarate)
4. propionyl-CoA (from odd # FA)

Front 345

What determines increased risks of following infections in HIV pts?

1. Pneumocytisi pneumonia
2. toxoplamosis
3. histoplasmosis

Back 345

1. Pneumocystis pneumonia: CD < 200
2. toxoplamosis: CD < 100
3. histoplasmosis: CD < 100

Front 346

Apolipoprotein A-I

associated lipoprotein?
fxn?

Back 346

associated with HDL

activates LCAT, which esterifies the trapped cholesterol in the HDL

Front 347

What is the diseased form of prion proteins?

Back 347

beta-pleated form: PrPsc

Front 348

Apolipoprotein B-100

associated lipoproteins?
fxn?

Back 348

VLDL, IDL, LDL

binds to LDL receptor, mediates VLDL secretion

Front 349

What is the normal flora of the following sites?

1. skin
2. nose
3. oropharynx
4. colon
5. vagina

Back 349

1. skin: staph epidermidis
2. nose: staph epidermidis and colonized by staph aureus
3. oropharynx: viridans group strep
4. colon: Bacteriodes fragilis > E coli
5. vagina: lactobacillus, colonized by E coli and group B strep

Front 350

Apolipoprotein E

associated lipoproteins?
fxn?

Back 350

chylomicron, chylomicon remnant, VLDL, IDL

mediates Extra (remnant) uptake; delivers chylomicron remnant, IDL back to liver after distributing TGs in the peripheral tissue

Front 351

What bug causes food poisoning in following scenarios?

1. contaminated seafood
2. reheated rice
3. Mayonnaise, custard

Back 351

1. contaminated seafood: Vibrio parahaemolyticus and V. vulnificus

2. reheated rice: Bacillus cereus

3. Mayonnaise, custard: Staph aureus

Front 352

Apolipoprotein CII

associated lipoproteins?
fxn?
what protein has the opposite fxn?

Back 352

chylomicron, chylomicron remnant, VLDL

increases lipoprotein lipase activity

apo C-III has the opposite fxn

Front 353

What bug causes food poisoning in following scenarios?

1. undercooked meat (beef)
2. poultry, meat and eggs

Back 353

1. undercooked meat (beef): EHEC (O157:H7)
2. poultry, meat and eggs: salmonella

Front 354

HDL

fxn and route?

Back 354

mediates reverse cholesterol transport form periphery to liver.

act as a repository for apoC and apoE, which are needed for chylomicron and VLDL metabolism

secreted from both liver and intestine

Front 355

What bug causes dysentery and pseudoappendicitis that is usually due to Day-care outbreaks?

Back 355

Yersinia enterocolitica

Front 356

LDL

fxn and route?

Back 356

delivers hepatic cholesterol to peripheral tissues.

formed by lipoprotein lipase modifacation of VLDL in the peripheral tissue

taken up by target cells via receptor-mediated endocytosis

Front 357

Dysentery, causes flask-shaped ulcer in the colon submucosally.

causative bug?

Back 357

Entamoeba histolytica

Front 358

LCAT and CETP

fxn?

Back 358

LCAT: catalyzes esterification of cholesterol

CETP: mediates transfer of cholesterol esters to other lipoprotein particles (VLDL, LDL, IDL)

Front 359

Aspiration pneumonia + lung abscess

causative bugs?

Back 359

anaerobe organisms

Front 360

Increased chylomicron, TG, and choleterol?

what type of dyslipidemia?
defect?

Back 360

hyerpchylomicronemia (type I)

lipoprotein lipase deficiency or altered apolipoprotein C-II

Front 361

pneumonia in alcoholics and IV drug users

causative bugs?

Back 361

S pneumoniae
Klebsiella
Staph

Front 362

Absent or LDL receptor

dx?
findings?

Back 362

familial hypercholeterolemia (type IIa)

accelerated atherlsclerosis, tendon xanthomas, corneal arcus

Front 363

Most common cause of atypical pneumonia? 2nd most common?

Back 363

most common: Mycoplasma
2nd: Chlamydia pneumoniae

Front 364

type IV dyslipidemia

cause?
findings?

Back 364

hepatic overproduction of VLDL

causes pancreatitis
increased VLDL and TG

Front 365

Postviral pneumonia

causative bugs?
affected population?

Back 365

in the elderly

Staph, H. influenza, Strep pneumoniae

Front 366

Abetalipoproteinemia

deficiencies?
findings?

Back 366

inability to synthesize lipoproteins due to deficiencies in apoB-100 and apoB-48

failure to thrive, steatorrhea, acanthocytosis, ataxia, nightblidness

Front 367

Most common cause of meningitis in the newborn?

2nd most common?

Back 367

most common: group B strep

2nd: E coli

Front 368

HMG-CoA reductase

3 side effects

Back 368

hepatotoxicity (increased LFTs)
rhabdomyolysis
teratogenic

Front 369

Most common cause of meningitis in adults?

Back 369

Strep pneumoniae

Front 370

Niacin

MOA?
4 side effects?

Back 370

MOA:
inhibit lipolysis in adipose tissue
reduces hepatic VLDL secretion into circulation

side effects
1. red, flushed face, which is decreased by aspirin or long-term use
2. hyperglycemia (acanthosis nigricans)
3. hyperuricemia (exacerbates gout)
4. hepatitis

Front 371

Most common causative organism of osteomyelitis?

how about in diabetics and drug addicts?

Sickle cell pts?

Back 371

Most people: staph aureus

diabetics/ drug addicts: Pseudomonas aeruginosa

Sickle cell: Salmonella

Front 372

2 lipid lowering agents that increase the risk of cholesterol gallstones

Back 372

bile acid resins (cholestyramine, colestipol, colesevelam)

Fibrates (gemfibrozil, clofibrate, bezafibrate, fenofibrate)

Front 373

osteomyelitis after cat/dog bites or scratch?

what bug?

Back 373

Pasteurella multocida

Front 374

what lipid lowering agent is best at lowering TG?

Back 374

Fibrates (gemfibrozil, clofibrate, bezafibrate, fenofibrate)

Front 375

Risk factor for UTI in:

1. male newborns
2. male elderly

Back 375

1. male newborns: congenital defects (hypospadias), vesicoureteral reflux

2. male elderly: enlarged prostate

Front 376

Positive urine leukocyte test indicates?

positive nitrate test indicates?

Back 376

leukocyte: bacterial UTI

nitrate: gram negative bacterial UTI

Front 377

List UTI causing bugs.

most common?
2nd most common?

Back 377

SSEEK PP
Serratia marcescens
Staph saprophyticus: 2nd most common
E coli: most common
Enterobacter cloacae
Klebsiella pneumoniae
Proteus mirabilis
Pseudomonas aeruginosa

Front 378

UTI, struvite stones

what bug?

Back 378

proteus mirabilis

Front 379

TORCH infection?

Back 379

Toxoplasmosis
Rubella
CMV
HIV
HSV-2
Syphilis

Front 380

Toxo triad in infants?

Back 380

CHI

chorioretinitis
hydrocephalus
Intracranial calcification

Front 381

Classic triad of Rubella

Back 381

PDA (or pulmonary artery hypoplasia)
cataracts
deafness +/-
blueberry muffin rash

Front 382

What TORCH infection presents with hearing loss and seizures?

Back 382

CMV

Front 383

Erythema infectiosum

cause?
sxs?

Back 383

Parvovirus B19

"Slapped cheek" rash on face later appears over body in reticular, "lace-like" pattern
can cause hydrops fetalis in pregnant women

Front 384

Scarlet fever

cause?
sxs?

Back 384

Strep pyogenes

erythematous, sandpaper-like rash with fever and sore throat

Front 385

Hand-foot-mouth disease in newborns

cause?
sxs?

Back 385

Coxsackievirus type A

vescicular rash on palms and soles; ulcers in oral mucosa

Front 386

Chancroid

cause?
sxs?

Back 386

Haemophilus ducreyi

painful genital ulcer, inguinal adenopathy

Front 387

Lymphogranuloma venereum

cause?
sxs?

Back 387

Chlamydia trachomatis (L1-L3)

ulcers, lymphadenoapthy, rectal strictures

Front 388

condylomata acuminanta

cause?
sxs?

Back 388

genital warts, koilocytes

HPV 6, 11

Front 389

PID

2 most common cause?
sxs?
complications?

Back 389

Chlamydia trachomatis (D-K), N. gonorrhea

chandelier sign (cervical motion tenderness), purulent cervical discharge.

can lead to Fitz-Hugh-Curtis syndrome ("violin string" adhesions of parietal peritoneum to liver), ectopic pregnancy, infertility, and chronic pelvic pain

Front 390

urinary catherization prediposes to infection caused by what organism?

Back 390

E coli (most common)
Proteus mirabilis

Front 391

Respiratory therapy unit predisposes to infection caused by what organism?

Back 391

Pseudomonas aeurginosa

Front 392

Newborn nursery prediposes to infection caused by what 2 organisms?

Back 392

CMV
RSV

Front 393

What 2 dermatological complications are often confused in advanced AIDS pts?

how do you differentiate the two?

Back 393

Bacillary angiomatosis caused by Bartonella henselae
Kaposi's sarcoma caused by HHV-8

Biopsy results
Bacillary angiomatosis: neutrophilic inflammation
Kaposi: lymphocytic inflammation

Front 394

Cotton-wool spots on funduscopic exam in AIDS pts with CD4 <50.

dx?

Back 394

retinitis due to CMV

Front 395

What 2 bugs cause Rash in unimmunized children beginning at head and moving down?

How do you differentiate the two?

Back 395

Rubella virus (German Measle, togavirus): with postauricular lymphadenopathy

Measles virus (Rubeola): with Koplik spots on buccal mucosa, cough, conjunctivitis, and coryza

Front 396

Bug hints (if all else fails):

Pus, empyema, abscess

Back 396

Staph aureus

Front 397

Bug hints (if all else fails):

traumatic open wound

Back 397

Clostridium perfringens

Front 398

Bug hints (if all else fails):

Surgical wound

Back 398

Staph aureus

Front 399

Bug hints (if all else fails):

currant jelly sputum

Back 399

Klebsiella

Front 400

Bug hints (if all else fails):

healthcare provider

Back 400

HBV from needle stick

Front 401

Bug hints (if all else fails):

fungal infection in diabetic

Back 401

Mucor or Rhizopus spp.

Front 402

Bug hints (if all else fails):

Asplenic pts

Back 402

encapsulated bacteria, esp SHiN

Strep pneumoniae
Haemophilus influeza type B
N. meningitidis

Front 403

Bug hints (if all else fails):

chronic granulomatous disease

Back 403

catalase-positive microbes

Staph aureus
Nocardia spp
Serratia marcescens
Pseudomonas cepacia
Aspergillus spp
E coli

Front 404

Bug hints (if all else fails):

Bilateral Bell's palsy

Back 404

Borrelia burgodorferi (Lyme disease)

Front 405

Bug hints (if all else fails):

pediatric infection

Back 405

Haemophilus influenzae (including epiglottitis)

Front 406

List beta lactams.

MOA?

Back 406

Penicillin
Methicillin
Ampicillin
Ticarcilln, pipercillin
Cephalosporins
Aztreonam
Imipenem

blocks peptidoglycan cross-linking

Front 407

List 30S inhibitors

Back 407

AT

Aminoglcosides: Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin ("GNATS")

Tetracycline (all the"-cyclines")

Front 408

List 50S inhibitors.

What is the common feature?

Back 408

Macrolides: Erythromycin, azithromycin, clrithrymycin

Chloramphenicol
Clindamycin

all are bacteriostatic

Front 409

What antibiotic blocks DNA topoisomerases?

blocks mRNA synthesis?

Back 409

Flouroquinolones: blocks topoisomerase

Rifampin: blocks mRNA synthesis

Front 410

Methicillin, nafcillin

spectrum?
toxicity?

Back 410

a beta lactamase resistant

Staph aureus except MRSA

toxicity: interstitial nephritis

Front 411

Ampicillin

adjunctive therapy?
indication?

Back 411

combine with clavulanic acid (penicillinase inhibitor) to enhance spectrum

Gram positives + gram negative rods (HELPS)
Haemophilus influezae
E coli
Listeria
Proteus
Salmonella
Enterococci

Front 412

list 3 antipseudomonals

adjunctive therapy?

Back 412

Take Care of Pseudomonas

Ticarcillin
Carbenicillin
Piperacillin

adjunct with clavulanic acid (penicillinase inhibitor)

Front 413

1st generation cephalosporin

2 prototypes?
specturm?

Back 413

Cefazolin, cephalexin

gram+ and "PEcK"
Proteus
E coli
Klebsiella

Front 414

2nd generation cephalosporin

3 prototypes?
spectrum?

Back 414

cefoxitin, cefaclor, cefuroxime

gram + and "HEN PEcKS"
Haemophilus
Enterobacter aerogenes
Neisseria spp.
Proteus
E coli
Klebsiella
Serratia marcescens

Front 415

3rd generaiton cephalosporin

3 prototypes?
spectrum?

Back 415

ceftriaxone, cefotaxime, ceftazidime

serious gram-negative infections resistant to other beta-lactams; meningitis (most penetrate BBB)

Front 416

Aztreonam

spectrum?
indication?

Back 416

gram negative rods: Klebsiella, Pseudomonas, Serratia
NO activity against gram positives or anaerobes

for penicillin-allergic pts and those with renal insufficiency who cannot tolerate aminoglycosides

Front 417

Imipenem

MOA?
adjunctive therapy?

Back 417

B-lactamse resistant carbapenem

always administered with cilastatin (inhibitor of renal dihydropeptidase I) to decrease inactivation in renal tubules

Front 418

Imipenem

indication?
side effects?
better alternative?

Back 418

drug of choice for Enterobacter
causes seizures, GI stress, skin rash

Meropenum has a reduced risk of seizures and is stable for dihydropeptidase I

Front 419

Vancomycin

MOA?
toxicity?
resistance?

Back 419

blocks D-ala D-ala cell wall mucopeptide formation

NOT
Nephrotoxicity
Ototoxicity
Thrombophlebitis
diffusing flushing (red man syndrome)

resistance develops when mucopeptide changes to D-ala D-lac

Front 420

Aminoglycosides

requirement?
indication?
toxicity?

Back 420

require O2 uptake (ineffective against anaerobes)

severe gram negative rod infections

NOT
Nephrotoxicity
Ototoxicity
Teratogen (CN VIII toxicity)

Front 421

Tetracycline

special direction for administration?
toxicity?

Back 421

must NOT take with milk, antacids, or Fe-containing preps b/c divalent cations inhibit its absorption in the gut

discoloration of teeth and inhibition of bone growth in children
photosensitivity
contraindicated in pregnancy

Front 422

Doxycycline

class?
indicaiton?

Back 422

a tetracycline (30s inhibitor)

fecally eliminated so indicated for pts with renal failure

Front 423

Erythromycin

MOA?
toxicity?

Back 423

blocking translocation by binding to 23S rRNA of the 50S ribosomal subunit.

prolonged QT interval

Front 424

Chloramphenicol

indication?
toxicities?

Back 424

menigitis

Anemia, aplastic anemia
Gray baby syndrome (in premature infants b/c lack live UDP-glucoronyl transferase)

Front 425

Clindamycin

indication?
toxicity?

Back 425

treat anaerobic infections

pseudomembranous colitis (C. difficile overgorwth)

Front 426

Sulfamethoxazole

MOA?
toxicity?

Back 426

PABA antimetabolites inhibit dihydropterate synthase --> decreased THF

hemolysis in G6PD deficient
kernicterus in infants
displace other drugs from albumin

Front 427

Trimethoprim

MOA?
toxicity?

Back 427

inhibit bacterial dihydrofolate reductase

megaloblastic anemia, leukopenia, granulocytopenia

Front 428

Ciprofloxacin

class and MOA?
toxicity?

Back 428

a flouroquinolone
inhibit DNA gyrase (topoisomerase II)

damage cartilage (contraindicated in pregnant women and children)
tendonitis and tendon rupture in adults

Front 429

Metronidazole

MOA?
indication?
toxicity?

Back 429

toxic metabolites in bacterial cell that damage DNA

GET CAP on the Metro
Giardia
Entamoeba
Trichomonas
Gardnerella vaginalis
Anaerobes (bacteroides, Clostridium)
h Pylori

Front 430

polymyxins

MOA?
clinical use?

Back 430

disrupts cell membrnae

for resistant gram-negative infections

Front 431

List 5 anti-TB drugs and their toxicity.

Back 431

INH-SPiRE
INH (Isoniazid)
Streptomycin
Pyrazinamide
Rifampin
Ethambutol: red-green color blindness

all others cause hepatotoxicity

Front 432

prophylactic tx for M. tuberculosis

prophylactic tx for M avium-intracellulare?

Back 432

MTb: Isoniazid

M. Avium-intracellulare: Azithromycin

Front 433

INH (Isoniazid)

MOA?
toxicity?
metabolism?

Back 433

decreased synthesis of mycolic acid

neurotoxicity (prevent with vit B6) and hepatotoxicty

Bimodal distribution of metabolism due to different INH half-lives in fast vs slow acetylators

Front 434

Rifampin

MOA?
Toxicity?

Back 434

4 R's
RNA polymerase inhibitor
Revs up microsomal p450
Red/orange body fluids
Rapid resistance if used alone

Front 435

prophylactic tx for menigococcal infection?

Back 435

Rifampin

Front 436

Prophylactic tx for Pneumocystis jiroveci pneumonia?

Back 436

TMP-SMX

Front 437

Treament for MRSA?

Treament for VRE?

Back 437

MRSA: vancomycin

VRE: linezolid and streptogramins

Front 438

Amphotericin B

MOA?
toxicity?

Back 438

binds ergosterol --> pore formation

Nephrotoxicity (reduced with hydration)
arrhythmias due to hypokalemia and hypomagnesia

Front 439

Nystatin

MOA?
clinical use?

Back 439

binds to ergosterol

for oral candidiasis (thrush)
topical for diaper rash or vaginal candidiasis

Front 440

Azoles

MOA?
toxicity?

Back 440

inhibit fungal ergosterol synthesis
hormone synthesis inhibition (gynecomastia), liver dysfxn

Front 441

what drug is used to tx cryptococcal meningitis in AIDS pts?

Back 441

Fluconazole

can cross BBB

Front 442

Caspofungin

MOA?
clinical use?

Back 442

inhibit beta-glucan --> inhibit cell wall synthesis of fungus

invasive aspergillosis

Front 443

Terbinafine

MOA?
clinical use?

Back 443

inhibit fungal enzyme squalene epoxidase

used to tx dermatophytoses (especially onychomycosis)

Front 444

Amantadine

MOA?
clincal use?

Back 444

blocks viral penetration/uncoating (M2 protein)
also causes the release of DA from intact nerve terminals

prophylactic tx for influenza A
Parkinson's disease

Front 445

Amatadine vs Rimantidine

compare

Back 445

both block viral uncoating (M2 protein)

Rimantidine does not cross BBB, so fewer CNS side effects

Amatadine causes cerebellar problems (ataxia, dizziness, slurred speech)

Front 446

what 2 drugs inhibit influenza neuraminidase?

Back 446

Zanamivir, oseltamivir

Front 447

Acyclovir

clinical use?
MOA?
Requirement?

Back 447

for HSV, VZV, EBV

monophosphorylated by HSV/VZV thymidine kinase. Guanosine analog --> inhibit viral DNA polymerase

Front 448

Ganciclovir

clinical use?
MOA?
Requirement?

Back 448

for CMV, esp. immunocompromised pts

Guianosine analog --> inhibit viral DNA polymerase
activated by CMV kinase or HSV/VZV thymidine kinase

Front 449

Which one is more toxic: Acyclovir or Ganciclovir?

Back 449

Ganciclovir
can cause leukopenia, neutropenia, throbocytopenia, renal toxicity.

Front 450

Foscarnet

MOA?
Clinical use?

Back 450

viral DNA polymerase inhibitor; does not require activation by viral kinase

CMV retinitis in immunocompromised pts when ganciclovir fails
in acyclovir-resistant HSV

Front 451

Protease inhibitor

common postfix?
toxicity?

Back 451

all end in -navir; e.g. Squinavir, indinavir

hyperglycemia, lipodystrophy (sunken cheeks and buffalo humps)
thrombocytopenia (indinavir)

Front 452

Enfuvirtide

MOA?

Back 452

fusion inhibitor by binding to viral gp41 subunit

Front 453

Zidovudine

MOA?
toxicity?

Back 453

nucleosides reverse transcriptase inhibitors

lactic acidosis
megalobalstic anemia

Front 454

HAART

indication?

Back 454

highly active antiretroviral therapy

initiated when pts have low CD4 counts (< 500) or high viral load.
also used as prophylactic tx in general population and during pregnancy

Front 455

Nevirapine, Efavirenz, Delavirdine

class?

Back 455

non-nucleoside reverse transcriptase inhibitor used in HIV therapy

Front 456

List antibiotics to avoid in pregnancy (9).

Back 456

SAFE Moms Take Really Good Care

Sulfonamides: kernicterus
Aminoglycosides: ototoxicity
Fluoroquinolone: cartilage damage
Erythromycin: acute cholestatic hepatitis in mom (and clarithromycin is embryotoxic)
Metronidazole: mutagenesis
Tetracycline: discolored teeth, inhibition of bone growth
Ribavirin: teratogenic
Griseofulvin: teratogenic
Chloramphenicol: gray baby syndrome

Front 457

Rifampin

clinical use?

Back 457

1. Mtb (must use with other agents such as INH, Prayzinamide Ethambutol)
2. delays resistance to dapsone when used for leprosy
3. prophylaxis for meningococcal infection
4. chemoprophylaxis for contacts with children with Haemophilus influenzae type B