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368 Cards in this Set
- Front
- Back
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2. Staphylococcal food poisoning is mediated by what?
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Enterotoxin
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6. Cause of nausea, vomiting, watery diarrhea w/ rapid onset (6-12 hr) after eating reheated meat or gravy implicated. TOW?
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Clostridium perfringens
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9. Indications to treat H. pylori-associated PUD
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Presence of organism
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13. Cholera pathogen is isolated from stool by culture on thiosulfate- citrate-buffered sucrose (TCBS) agar. Why sucrose (and not glucose)?
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Differential fermentation (+) by V. cholerae on sucrose
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18. Following ingestion of 15-25 cysts and excystation, trophozoites with flat ventral surface adhere at brush border of enterocytes and contribute to malabsorption. TOW?
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Giardiasis
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21. Protracted, secretory diarrhea w/ large fluid loss in AIDS is caused by (clue: acid-fast organisms)
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Cryptosporidium >> Cyclospora > Isospora
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23. Mechanism of blood loss in hemorrhagic enterocolitis involves
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Shiga toxin (a cytotoxin)
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26. Mechanism of rotaviral diarrhea involves
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Villus destruction
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27. Infantile watery diarrhea and fever are caused by
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Adenovirus 40,41
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29. Cause of nausea/vomiting, abdominal cramps, diarrhea +/- bloody 8-48h after eating eggs or poultry or peanut butter?
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Non-typhoidal Salmonella
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30. Primary gastroenteritis progressing to chronic carrier state of Salmonella in bile ducts is common due to
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Abx use
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31. Abx used to treat septic phase salmonella gastroenteritis is
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ciprofloxacin
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32. Cause of fevers (>103°) abdominal pain, headaches; little diarrhea; macular rash. PE: bradycardia; hepatosplenomegaly (+/-) in a pt with hx of travel (to tropics)?
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Salmonella typhi
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33. Cause of occult-bloody diarrhea, abdominal cramping and fever, 2d after ingestion of salad from meat-contaminated cutting-boards?
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Campylobacter jejuni
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34. Abx for campylobacter enteritis with prolonged, high fevers in pregnancy, and HIV is
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Erythromycin
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35. Cause of dysentery-like illness with fever + abdominal cramps, tenesmus + blood & mucus in children?
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Shigella sonnei
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36. Tx of dysentery due to Shigella flexneri or S. dysenteriae in elderly involves
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ciprofloxacin
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37. Cause of dysentery-like illness in the northern region after eating cheese; RLQ pain
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Yersinia enterocolitica
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43. Cause of dysentery involving abdominal pain, tenesmus, stools with mucus + blood in a patient, who recently traveled to tropics; CBC: eosinophilia?
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Entamoeba histolytica
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44. Positive stool test using microscopy for trophozoites w/ intracellular RBCs confirms
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Amebic dysentery
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45. Rx of amebic dysentery involves
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Metronidazole + iodoquinol
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46. Abscesses in liver or peritonitis in travelers w/ or w/o hx of dysentery is confirmed by
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Serology for E. histolytica
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47. Chronic abdominal pain, diarrhea; follows intestinal obstruction; cholangitis; liver abscess, in children in Southern States. Lab: O & P (+) for eggs (oval with a thick coarse shell). TOW?
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Ascaris lumbricides
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48. Oval eggs (with a thick coarse shell) in stool confirms what?
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ascariasis
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50. DOC of ascariasis is
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Mebendazole
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51. Vomiting, cramping, diarrhea, epigastric pain, weight loss in an immigrant from developing country is caused by
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Strongyloides stercoralis
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52. DOC of strongyloidosis is
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Ivermectin
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53. Pt w/ high dose steroids or HIV/AIDS develops pulmonary infiltrates (+ eosinophilia) and/or recurrent gram negative sepsis. TOW?
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Invasive strongyloidosis
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54. Weakness, fatigue, lightheadedness, dyspnea; pruritis; pallor, iron-deficiency anemia. CBC: eosinophilia. TOW?
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Necator / Anylostoma (Hookworm)
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55. Fever, periorbital edema, subconjunctival hemorrhages, muscle weakness, rash. Lab: ↑ CPK, LDH & eosinophilia. TOW?
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Trichinellosis
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56. Adominal pain, bloating, altered appetite after ingestion of sushi. CBC: megaloblastic anemia; eosinophilia; mild leukocytosis. TOW?
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Diphyllobothriasis (fish tapeworm)
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57. Dx of tape worm infection is confirmed by
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proglottids in stool
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59. Fever, lymphadenopathy, hepatosplenomegaly in an immigrant from Africa or Orient; pt recalls an itch within a day of fresh water exposure. RUQ ultrasound (+); CBC: eosinophilia. TOW?
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Schistosoma mansoni (Africa) S. japonicum (Far East)
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60. Stool in chronic stage of schistosomiasis yields
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large eggs with lateral spine.
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61. Rx of chronic stage of schistosomiasis involves
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praziquantel
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62. Patient with acute jaundice is HAV IgM (+).
Should contacts receive prophylaxis? If so, what? |
Inactivated HAV vaccine
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64. Multiple sex partners, IDU, infants born to infected mothers are risk groups for which hepatitis virus
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HBV
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66. This asymptomatic man has hep serology:
HBsAg (-), Anti-HBs (+) Anti-HBc IgG (+), Anti-HBc IgM (-). TOW? |
Cleared hepatitis B infection
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67. This man has jaundice and:
HBsAg (+) > 6 months, Anti-HBs (-) HBeAg (+) Anti-HBc IgG (+) HBV DNA > 20,000 IU/ml. TOW? |
Chronic active (infectious) hepatitis B
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68. A pt w/ chronic active Hep B with evidence of necroinflammation should receive
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Peg-IFNα 2a + lamivudine (or cidofovir)
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69. This man has no jaundice:
HBsAg (+) >6 months, Anti-HBs (-) Anti-HBc IgG (+) HBeAg (-) persistently normal ALT. TOW? |
Inactive HBsAg carrier
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71. Chronic jaundice in a pt w/ IDU or hemodialysis; vasculitis and glomerulonephritis
What is Dx test of choice? |
HCV RNA > HCV IgG
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72. Heterogeneous, immune-evasive quasispecies generated during replication of virus in blood causes
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Chronicity / lack of vaccine in HCV
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73. Fulminant hepatitis, multiple sexual partners
HBsAg (+) HBcIgM (-) Can be fatal due to what? |
HDV superinfection.
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74. Acute onset of jaundice, nausea, right-upper quadrant pain, hepatomegaly in pregnant women in India. TOW?
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HEV infection
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76. Type II hypersensitivity due to molecular mimicry is the mechanism of this immunological sequel of GAS infection
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Acute rheumatic fever
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78. A man with IDU has flu-like symptoms;1-3 minor peripheral signs: (conjunctival hemorrhage, Janeway lesions, Osler nodes, Roth spots). vegetation in tricuspid valve) Blood Cx (BC) should yield
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S. aureus
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81. A pt with AIDS and recent hx of UTI has subacute (native- mitral valve) endocarditis.
BCx should yield |
Enterococcus faecalis (or faecium)
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82. Tx of acute MSSA endocarditis in patient with IDU
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Nafcillin +/- gentamicin
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83. Tx of acute MRSA endocarditis in patient with IDU
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Vanco + rifampin
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84. Tx of subacute (native valve) endocarditits due to viridans streptococci.
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PenG + gentamicin
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85. Tx of subacute (prosthetic-valve) endocarditis due to CoNS
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Vanco
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86. Tx of subacute (native valve) endocardits due to Enterococcus
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Ampicillin (high dose) + gentamicin
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87. Mechanism of VRE resistance?
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D-Ala-D-Ala -> D- Ala-D-lac
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88. Hx of catheter-related endocarditis involving prosthetic & native valves. WBC >9,000. BC (+) for budding yeast. Pt does not respond to AmphoB or fluconazole. Tx now?
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Caspofungin
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90. Fever, malaise, arthralgia, dyspnea, edema, palpitations.
EKG: ST/T wave change, heart block, dysrhythmias. CXR: cardiomegaly. TOW? |
Coxsackie A > Echovirus > Trypanosoma cruzi (Chagas)
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92. Rhinoviruses and enteroviruses belong to picornavirus family, but the rhinoviruses differ from enteroviruses on
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Growth at 22°C/noninvasive
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93. Rhinovirus host receptor in upper airways?
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ICAM-1
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97. AOM and sinusitis are empirically treated with amoxicillin + clavulanate. Why use clavulanate?
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Haemophilus and Moraxella are β-lactamase producers
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98. Cause of pharyngeal pain, dysphagia, fever; red throat + purulent exudate that responds to penicillin
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Streptococcus pyogenes (GABHS)
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102. Damage in posterior pharynx and tonsils due to Streptococcus pyogenes is associated with what host reaction?
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Pyogenic inflammation
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103. DOC of acute bacterial pharyngitis in a pt w/ Pen allergy
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azithromycin > clindamycin
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105. Toxigenic complication of streptococcal pharyngitis
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Scarlet fever >> TSS (rare)
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110. Diphtheria Dx is confirmed by
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Immunodiffusion (ELEK) assay for toxin
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111. Mechanism of action of exotoxin of Corynebacterium diphtheriae
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ADP ribosylation of EF-2 (protein synthesis block).
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112. Damage to pharynx and cardiomyocytes due to Corynebacterium diphtheriae is mediated by
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Cytotoxicity of A-B toxin
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114. Host cells preferentially infected by EBV are
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B cells
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119. Nasopharyngeal carcinoma, a B-cell tumor that is common in the Oriental population that consumes preserved fish, is due to oncogenesis by
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EBV
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122. Gram-negative diplococci that cause AOM
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Moraxella catarrhalis
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123. Gram-negative coccobacilli that cause AOM
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Haemophilus influenzae
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124. > 7 days of nasal obstruction, rhinorrhea; purulent nasal drainage + frontal pain/tenderness.
Tx of choice? |
Amoxicillin/Clavulanate
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125. DOC for acute mastoiditis in a young child?
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Amoxicillin/Clavulanate
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126. cough + episodic aphonia w/ symptoms of URI in a child
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parainfluenza virus (croup) ("seal-like barking cough")
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127. Gram-stain-nonreactive organism; causes erythema and purulent discharge at lid margin in a newborn
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Chlamydia trachomatis
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128. Most common cause of eye redness; tenderess; hyper-purulent d/c; eye stuck shut in AM, lid edema.
Gram stain (+) |
Staph aureus (blepharitis)
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129. #1 cause of fever, conjunctivitis, pharyngitis with rhinitis, cervical adenitis in a child.
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Adenovirus
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130. Cause of burning, gritty feeling in eyes; diffuse conjunctival injection & profuse tearing; + preauricular LN.
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Adenovirus
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131. Cause of foreign body sensation, lacrimation, photophobia, conjunctival hyperemia, and ulceration
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HSV-2>>1
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133. Cause of painful, swollen, red eyes, with conjunctival hemorrhaging and excessive tearing, occurs in outbreaks
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Enterovirus (viral pink eye)
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134. Cause of chorioretinitis in AIDS, but CMV antigen (-)
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Toxoplasma gondii
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135. Cause of painful keratitis, chronic corneal ulcers in contact lens users, unresponsive to abx.
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Acanthamoeba spp.
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137. Pertussis:
CBC finding? Mechanism of this? |
lymphocytosis (NOT PMNs!)
toxin inhibits chemotaxis via downregulation of C3a/C5a receptor |
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138. Three major virulence factors of "whooping cough" pathogen?
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1 ADP-ribosylating toxin
2 tracheal cytotoxin 3 hemolysin |
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140. Major virulence factor of Haemophilus influenzae?
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Capsular polysaccharide (antiphagocytic and anti-C3b)
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142. Acute exacerbation of chronic bronchitis. Organism that needs NAD and hematin for growth; β-lactamase (+).
DOC? Organism? |
Ceftriaxone (severe) > Amoxicillin-clavulanate
[Haemophilus influenzae (non-typeable)] |
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143. Most common cause of lower-respiratory infections in neonates < 4 wks?
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Streptococcus agalactiae (GBS)
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144. Complicated illness in a newborn of a GBS-colonized mother is
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Sepsis or meningitis
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145. A pregnant woman colonized w/ GBS.
Tx? |
Ampicillin
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147. Annual influenza vaccine contains what?
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A:H1N1 + A:H3N2 + B
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149. Annual vaccine to prevent influenza is needed due to antigenic drift. This occurs due to what genetic mechanism?
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Point mutations
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150. Occasionally serious pandemic of influenza occurs due to antigenic shift. This occurs due to what genetic mechanism?
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Reassortment of 8 genomic segments
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152. Bacterial superinfection, causing pneumonia, after influenza occurs in elderly (in LTCF) due to what bugs?
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S. pneumoniae > S. aureus
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153. A seriously ill young adult w/ necrotizing pneumonia, poorly responding to vancomycin, should get
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Linezolid (or Dapto?)
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156. Mechanism of asthmatic S/Sx w/ pathology in bronchioles in high-risk infants due to RSV is
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type III hypersensitivity
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158. Insidious onset of fever, dry cough, malaise and sore throat in young adults.
TOW? Complication? |
Mycoplasma pneumoniae
cold agglutinins AIHA (IgM against RBC titer ≥1:32) |
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161. A male child with Mycoplasma pneumonia now has systemic rash covering 10% of his body.
TOW? |
erythema multiforme (SJS)
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162. Cause of upper respiratory Sx, slow onset of cough (laryngitis) >2wks
CXR: patchy infiltrate Viral serology (+) TOW? |
Chlamydophila pneumoniae (?)
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164. Gram-positive diplococci yield α-hemolytic colonies.
What other test confirms dx? |
Quelling rxn +
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166. Population w/ ↑ incidence of pneumococcal pneumonia
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AIDS
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167. ↑ incidence of colonization of what organism is seen in very young and elderly, crowding, following viral URI (b/c ↑ PAF [Platelet Activating Factor] receptors), fall/winter season?
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Streptococcus pneumoniae
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169. Nasopharyngeal mucosal colonization is facilitated by
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IgA protease
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170. Streptococcus pneumoniae reaches lungs after nasopharyngeal colonization via
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aspiration
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173. ↑ lung cell injury, bacterial growth, and bacteremia in pneumococcal pneumonia are caused by what virulence factor?
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Pneumolysin (α-hemolysin)
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174. Name risk factors for mortality due to Pneumococus
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-Multiple myeloma, agammaglobulinemia
-C3 deficiency -Asplenia (SCA) -COPD, cancer, DM -EtOH-ism, smoking |
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175. Risk factor for poor prognosis of pneumococcal pneumonia
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Leukopenia
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176. Emipiric DOC for CAP in pts w/ risk or comorbidity?
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Azithromycin or levofloxacin + ceftriaxone
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177. Pneumonia due to highly penicillin-resistant Streptococcus pneumoniae (MIC >8) should receive
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moxifloxacin or vancomycin
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179. Pt w/ agammaglobulinemia or asplenia or sickle-cell anemia or ↓C3 should be vaccinated with
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Pneumococcal polysaccharide vaccine (23-valent)
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180. Hx: a patient w/ serious CAD now on a ventilator, acquires VAP >72 hrs after hospitalization.
Organism? |
Pseudomonas aeruginosa (VAP)
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181. Cause of necrotizing pneumonia >72 hrs after hospitalization of complicated viral illness
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MRSA, MSSA
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182. Patient w/ seizure d/o now has fever and cough evolving over 2-4 wks;
CXR infiltrate (+) TOW? |
Anaerobes (aspiration)
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183. Empiric DOC of necrotizing pneumonia in a patient with seizure illness
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Clindamycin + levofloxacin
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186. Cause of pulmonary embolism in a pt with IVDU
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Staphylococcus aureus
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193. This pt >50 years, smoking hx, CMI↓ has pneumonia; diarrhea, renal failure. Urine antigen (+) for pathogen.
Tx? |
Azithromycin
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196. Asymptomatic patient with PPD (+)
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Latent TB
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201. Pt w/ MDR-TB
Tx? |
R + I + FQ + amikacin/kanamycin/capreomycin
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203. Cause of chronic pneumonia in a patient with cancer, receiving cytotoxic chemotherapy (neutropenic)
lung-CT: halo/crescent sign (+)? |
Aspergillus fumigatus
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204. Hx of chronic pneumonia w/ lung bx (+) for hyphae 2-4μm wide, septate, acute-angle branching. TOW?
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Aspergillus fumigatus
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205. TB-like LRI in a pt with outdoor activity;
bronchoscopy: Giemsa (+) 2-5 μm yeasts (intracellular). TOW? |
Histoplasma capsulatum
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206. Pt with AIDS has blood cx (+) for histoplasmosis.
DOC has effects on |
Ergosterol in cell membrane
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207. TB-like Dz w/ ulcerative skin lesions.
lung bx (+) large yeast w/ broad-based bud. DOC? |
itraconazole
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208. Hx of acute onset of cough, fever, infiltrate in a Pt with CMI↓ from southern California;
lung bx (+) for a large sac of endospores. DOC? |
Fluconazole (indefinite)
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209. Pt w/ aspiration pneumonia with cervico-facial lesion should respond to
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Penicillin G
(Actinomyces) |
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210. Granular specimen from draining fistulae from a pt with LRI on anaerobic culture should yield
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Actinomyces israelii
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211. Pt with AIDS or organ transplant has indolent pneumonia, w/ or w/o CNS abscess or granuloma.
TOW? |
Nocardiosis
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212. Organism w/ characterization of G+ branching, beaded, filamentous rod, weakly acid-fast is
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Nocardia asteroides
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*** CONTINUE EDITS HERE ***
213. Hx of fever, cough, progressing to pulmonary hemorrhage in a pt who works at a wool-sorting factory; CXR: mediastinitis. TOW? |
Anthrax (Bacillus anthracis)
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214. Hx of non-productive cough, fever and dyspnea evolving over 2-4 wks. CXR (+): bilateral interstitial infiltrates, hypoxemia; ↑LDH, CD4 count <200/mm3 in a man who has sex with man (MSM). TOW?
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Pneumocystis pneumonia
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215. DOC of pneumocystis pneumonia (PCP)
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TMP-SMX
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216. Pt has urinary urgency, frequency, dysuria; lab: pyuria (+) or nitrite (+). TOW?
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Cystitis due to E. coli
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217. Significant UTI is confirmed by semiquantitative MSU culture based on the threshold of
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> 1,000 cfu/mL
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218. Mode of acquisition of uropathogen is
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Endogenous
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219. Microbial (structure) factor favoring bacterial persistence /colonization and UTI is
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bacterial binding via fimbriae
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220. Factor favoring bacterial persistence/colonization and UTI despite high osmolarity and urea concentrations and low pH is
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high bacterial growth rates
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221. Host factor favoring bacterial persistence/colonization and UTI is
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Urinary stasis
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222. Host factor favoring bacterial persistence/colonization and UTI despite frequent voiding and high urinary flow is
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Absence of bactericidal effects of secreted proteins
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223. Pyogenic inflammation in complicated UTI due to Gram- negative bacteria is due to
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Lipopolysaccharide
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224. Empiric DOC to treat community-acquired UTI in adults is
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ciprofloxacin
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225. These drugs inhibit DNA topoisomerases (DNA gyrase and topoisomerase IV) by binding to DNA-enzyme complexes, thereby interfering with bacterial DNA replication. What?
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Fluoroquinolones
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226. Avoid fluoroquinolones for the empiric Tx of UTI in pregnant women; alternative is
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Nitrofurantoin
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227. Gram-positive bacteria that cause uncomplicated UTI in sexually active, young women are
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Staphylococcus saprophyticus
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228. Differentiation of Staphylococcus saprophyticus from S. epidermidis (both coagulase negative) is based on
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novobiocin resistance [i.e., S. saprophyticus is resistant, S. epidermidis is not]
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229. In elderly or pt with risks of urinary stasis, fever, chills, flank pain, and CVA tenderness; Lab: pyuria, casts, nitrite+. TOW?
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Pyelonephritis due to E. coli
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230a. Pt hospitalized > 72 h for comorbidity has urinary frequency, dysuria and foul-smelling urine; w/ flank pain, fever and chills, in the presence of a urinary catheter: Clue: GNR; fermenter; encapsulated; intrinsic ampicillin resistance)
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Klebsiella pneumoniae
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230b. Pt hospitalized > 72 h for comorbidity has urinary frequency, dysuria and foul-smelling urine; w/ flank pain, fever and chills, in the presence of a urinary catheter: Clue: GNR; slow fermenter; red pigment; intrinsic drug resistance)
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Serratia marcescens
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230c. Pt hospitalized > 72 h for comorbidity has urinary frequency, dysuria and foul-smelling urine; w/ flank pain, fever and chills, in the presence of a urinary catheter: Clue: GNR; swarming growth [very motile]; slow fermenter; intrinsic drug resistance)
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Proteus mirabilis
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230d. Pt hospitalized > 72 h for comorbidity has urinary frequency, dysuria and foul-smelling urine; w/ flank pain, fever and chills, in the presence of a urinary catheter: Clue: GNR; non fermenter; oxidase+, blue pigment; intrinsic drug resistance)
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Pseudomonas aeruginosa
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230e. Pt hospitalized > 72 h for comorbidity has urinary frequency, dysuria and foul-smelling urine; w/ flank pain, fever and chills, in the presence of a urinary catheter: Clue: GPC in chains; catalase-neg; grows in high salt; penicillin resistance)
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Enterococcus faecalis
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231. If a patient with complicated UTI is severely ill or not improving with therapy, do what rapid test next?
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renal ultrasound (to rule out urinary tract obstruction)
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232. For a patient with complicated UTI, once culture and sensitivity available, switch to what?
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Narrow-spectrum abx
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233. Genital chancre begins as a papule, ulcerates to form a single, painless, clean-based ulcer. TOW?
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Primary (1°) syphilis
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234. Cause of genital chancre, begining as a papule, ulcerating to form a single, painless, clean-based ulcer.
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Treponema pallidum
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235. Hx of pen-allergy in a non-pregnant woman, who has fever, "copper penny" macular lesions on the palms and/or soles; RPR(+). DOC?
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Doxycycline
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236. Hx of pen-allergy in a pregnant woman, who is RPR(+) and has tabes dorsalis (10-20yrs), or iritis, uveitis, iridocyclitis, Argyll- Robertson pupils. Manage how?
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Desensitization
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237. Hx of painful clustered vesicles with an erythematous base; urinary retention in a promiscuous woman. TOW?
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HSV-2 >> 1
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238. Giemsa stain of fluid from a herpetic lesion should reveal
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Multinucleated giant cells
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239. Patient with genital herpes does not respond to acyclovir because pt is infected with
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thymidine kinase deficient HSV
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240. A pregnant woman with 1° symptomatic HSV-2 infection is at risk of her baby developing
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neonatal (congenital) herpes
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241. Cause of painful genital ulcers (no induration); purulent, dirty grey base; painful inguinal adenitis (bubos), in a man with multiple sexual partners
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Haemophilus ducreyi
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242. Fastidious organism found within the granulocytic infiltrate of the penile ulcer and co-localized with neutrophils and fibrin, in a pt w/ chancroid is
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Haemophilus ducreyi
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243. All sex partners of pt with chancroid, regardless of symptoms, should be examined and treated with
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Azythromycin > ceftriaxone
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244. Most common cause of mucopurulent endocervical exudate (Gram stain non revealing) in a sexually promiscuous woman
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Chlamydia trachomatis D-K
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245. Dx of mucopurulent urethral discharge, dysuria, penile pruritis is based on
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NAAT of urethral specimen or urine (+)
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246. DOC of most frequent cause of nongonococcal urethritis
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Azythromycin > doxycycline
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247. Cause of rare genital ulcers, inguinal lymphadenopathy in men with cytology(-) for multi-nucleated giant cells, RPR (-) is:
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Chlamydia trachomatis L1-L3
|
|
|
248. Hx of systemic Sx/Sn w/ cervical motion tenderness in a woman with turbo-ovarian abscess. TOW?
|
PID
|
|
|
249. Cause of mucopurulent urethritis, dysuria, penile pruritis [Smear (+):Gram-negative diplococci co-populated w/ PMNs] is
|
Neisseria gonorrhoeae
|
|
|
250. Hx of frequent gonorrhea and disseminated gonococcal infection in a woman is due to deficiency in serum factors?
|
Terminal complements
|
|
|
251. Immune evasion of Neisseria gonorrhoeae in frequent mucosal infection is due to
|
Antigenic variation of pili.
|
|
|
252. Auxotrophic strains of N. gonorrhoeae (needing arginine for growth) and also with serum (complements) resistance are likely to cause
|
Septic arthritis (aka: DGI - disseminated gonococcal infection)
|
|
|
253. Most frequent complication of gonococcal (GC) infection in men
|
Epididymitis
|
|
|
254. Cause of "bull headed clap", urethral stricture, prostatitis is
|
Neisseria gonorrhoeae
|
|
|
255. Urethritis is treated with ceftriaxone + azythromycin because
|
Concurrent GC + Chlamydia
|
|
|
256. An older woman with PID and tubo-ovarian abscess receives ceftriaxone, azythromycin, and metronidazole because
|
Polymicrobic (endogenous) infection
|
|
|
257. Cause of anogenital warts w/ histology (+): koilocytes is
|
HPV 6 and 11
|
|
|
258. Cause of atypical squamous cells of undetermined significance (ASCUS) on pap smear w/ no clinical signs of infection is
|
HPV 16 and 18
|
|
|
259. Cause of koilocytotic cells and possible progression to squamous cell carcinoma
|
HPV 16 and 18
|
|
|
260. Next step to identify viral cause of ASCUS on pap smear w/ and further management in a woman of age > 29 years is
|
Colposcopy > HPV DNA in bpsy
|
|
|
261. Wet prep of vaginal discharge from a sexually promiscuous woman w/ vaginal pruritis; ectocervical erythema ("strawberry cervix") should reveal
|
motile tissue flagellate
|
|
|
262. Gram stain of vaginal discharge w/ fishy odor from a sexually promiscuous woman w/ vaginal pruritis but no erythema and normal cervix should reveal
|
SECs stippled with Gram- variable organisms.
|
|
|
263. DOC of bacterial vaginosis (BV) is
|
metronidazole
|
|
|
264. Disruption of normal vaginal flora and depletion of lactobacilli in pt with BV cause overgrowth of anaerobic Mobiluncus species and
|
Gardnerella vaginalis
|
|
|
265. Wet prep of curdy discharge (no odor), adhering to vaginal walls, from a pregnant woman w/ recent UTI, who now has severe vaginal pruritis; vulvovaginal area - erythematous should reveal
|
budding yeasts with pseudohyphae
|
|
|
266. Normal commensal of skin, GI & GU tracts; endogenous overgrowth of budding yeast, capable of >10 diseases. TOW?
|
Candida albicans
|
|
|
267. Mechanism of action of a PO DOC of vulvovaginal candidiasis is
|
blocks C14α-lanosterol demethylase
[The DOC for vulvovaginal candidiasis is an Azole medication] |
|
|
268. Hx of flu-like illness, lymphadenopathy, maculopapular rash in a bisexual man. Lab: lymphopenia and transaminase elevations; monospot/all serology (-). TOW?
|
Acute retroviral syndrome
|
|
|
269. Time from infection (acquisition) to acute seroconversion detected by HIV serology (ELISA/ WBlot) is
|
6-12 weeks.
|
|
|
270. Hx of mononucleosis-like illness and lymphadenopathy in a man with MSM. Serology (-). What is HIV viral load?
|
>10,000 copies/ml
|
|
|
271. Host-cell receptor for HIV-1 infection
|
CD4
|
|
|
272. Homozygous for deletions in what gene renders resistance to infection and some protection against progression.
|
CCR5
|
|
|
273. Host cells that trap HIV and mediate the efficient transinfection of CD4+ T cells are
|
Dendritic cells
|
|
|
274. A man, who practices "sex with another man" has antibodies to HIV (ELISA and WB) but asymptomatic. TOW?
|
Clinical latency
|
|
|
275. What happens to HIV-1 virus when acute retroviral syndrome progresses to clinical latency?
|
Virus continues to replicate low level.
|
|
|
276. CD4 count of a man/woman who is HIV-1 (+) and has 2 of: Candidiasis, Invasive cervical CA, Coccidiodomycosis, Cryptococcosis, Cryptosporidiosis, CMV retinitis, HIV encephalopathy, HSV ulcers, histoplasmosis, isosporiasis, Kaposi sarcoma, Burkitt lymphoma, primary brain lymphoma, MAC or Myco. kansasii infection, Myco. tuberculosis, pneumocystis, progressive multifocal leukoencephalopathy, Toxoplasmosis of brain, HIV-wasting syndrome
|
CD4+ < 200/μL
|
|
|
277. A man with HIV infection has lymphadenopathy, chronic diarrhea, oral thrush + herpes lesions. Expected CD4+ count is
|
50 cells/μL.
|
|
|
278. Most common cause of HIV- associated peripheral skin or mucosal ulcers
|
HSV-1 (>> Histo > CMV > VZV > Syphilis)
|
|
|
279. Most common cause of HIV- associated nodules (neoplasia)?
|
HHV-8 (aka KSHV)
|
|
|
280. Hx of fatigue, nausea, abdominal pain, diarrhea, fever, chills, night sweats, dry persistent cough w/ SOB and weight loss in a man with AIDS. Lab: PPD (-); blood culture (+) for AFB [Acid-Fast Bacilli]. TOW?
|
Mycobacterium avium- intracellulare complex
|
|
|
281. Common cause of retinitis, viral pneumonitis or esophagitis in AIDS
|
CMV
|
|
|
282. Hx: progressive CNS dz in a pt w/ AIDS: hemiparesis, visual, ataxia, aphasia, cranial nerves, sensory. MRI: ring- enhancing lesions. Toxo antibody (-). TOW?
|
JC virus
|
|
|
283. Definitive indication for initial HAART (CD4+ count) is
|
CD4+ 350/mm3.
|
|
|
284. Objective of ARV Tx is to reduce viremia to what level of genomic RNA/mL
|
< 50 copies RNA/mL.
|
|
|
285. Initial regimen of anti-retroviral therapy is
|
Emtricitabine + Tenofovir + Efavirenz
|
|
|
286. Abacavir, emtricitabine, lamivudine, zidovudine, tenofovir belong to what class of antiretrovirals?
|
NRTIs
|
|
|
287. Efavirenz, nevirapine belong to what class of antiretrovirals?
|
NNRTIs
|
|
|
288. Atazanavir, Lopinavir, Saquinavir belong to what class of antiretrovirals?
|
Protease inhibitors
|
|
|
289. This drug binds to gp41 and prevents conformational change required for viral fusion and entry into cells.
|
enfuvirtide
|
|
|
290. This drug inhibits integrase, responsible for insertion of HIV proviral DNA into the host genome.
|
raltegravir
|
|
|
291. A man has AIDS and CD4 <200cells/μL or thrush. Antibacterial prophylaxis needed besides HAART is
|
TMP-SMX (for PCP)
|
|
|
292. A man has AIDS and CD4 <100 + pos toxo IgG. Chemoprophylaxis needed besides HAART is
|
TMP-SMX (for Toxoplasma encephalitis)
|
|
|
293. A man has AIDS and CD4 <100 + PPD >5mm induration. Antibacterial prophylaxis needed besides HAART is
|
INH + pyridoxine
|
|
|
294. A man has AIDS and CD4 <50. Antibacterial prophylaxis needed besides HAART is
|
azithromycin (for MAC)
|
|
|
295. Hx of fever, a pustule at a cat scratch site, adenopathy, hepatosplenomegaly in a pt w/ AIDS. Warthin-Starry stain tissue (+). TOW (clue: bacillary angiomatosis)?
|
Bartonella henselae
|
|
|
296. Mnemonic of the leading causes of congenital infections
|
ToRCH3eS-List -- To = Toxoplasma gondii, R = Rubella, C = CMV, H = HSV-2, H = HIV, H = HBV, S = Syphilis, List = Listeria monocytogenes
|
|
|
297. Cause of chorioretinitis, intracraneal calcifications, and hydrocephalus in a neonate (mom at pregnancy had mono-like illness after eating raw meat) is
|
Toxoplasma gondii
|
|
|
298. Hx of deafness, cataracts, heart defects, microcephaly, or mental retardation in a child (of a seronegative mom, exposed to "Blueberry muffin baby" in a very poor neighborhood). TOW?
|
congenital rubella syndrome
|
|
|
299. Microcephaly, seizures, sensorineural hearing loss, feeding difficulties, petechial rash, hepatosplenomegaly, or jaundice in a neonate. PCR of urine should yield
|
CMV
|
|
|
300. Hepatosplenomegaly, neurologic abnormalities, frequent infections in a neonate w/ low CD4+ counts. Woman before birthing should have received
|
Nevirapine
|
|
|
301. Cause of vesicular skin lesions + conjunctivitis in a child (asymptomatic at birth)
|
HSV-2
|
|
|
302. Hx of cutaneous lesions, hepatosplenomegaly, jaundice, saddle nose, saber shins. Hutchinson teeth, + CN VIII deafness in a neonate (mom is a prostitute). TOW?
|
3° syphilis
|
|
|
303. Neonatal septicemia or meningitis (mom had flu-like Sx and ate imported cheese during pregnancy). TOW?
|
Listeria monocytogenes
|
|
|
304a. 1 of the SIX red rashes of childhood (acute, febrile exanthema illnesses)? (Clue1: maculopapular rash; off-white lesions on buccal mucosa, vaccine preventable virus)
|
Measles
|
|
|
304b. 1 of the SIX red rashes of childhood (acute, febrile exanthema illnesses)? (Clue2: maculopapular rash; vaccine preventable virus)
|
Rubella
|
|
|
304c. 1 of the SIX red rashes of childhood (acute, febrile exanthema illnesses)? (Clue3: scarlatina rash post pharyngitis)
|
Scarlet fever (GAS)
|
|
|
304d. 1 of the SIX red rashes of childhood (acute, febrile exanthema illnesses)? (Clue4: vesicular rash, moderate pain)
|
Chicken pox (VZV)
|
|
|
304e. 1 of the SIX red rashes of childhood (acute, febrile exanthema illnesses)? (Clue5: maculopapular "slapped face" appearance)
|
Parvovirus B19
|
|
|
304f. 1 of the SIX red rashes of childhood (acute, febrile exanthema illnesses)? (Clue6: maculopapular rash and generalized sx/sn in an immunocompromised pt)
|
HHV-6
|
|
|
305. Cause of single or multiple scaly and/or crusted patches and/or plaques, affecting the scalp or beard area +/- inflammation.
|
Dermatophytes
|
|
|
306. KOH prep of scales from the scalp and plucked hairs from cutaneous mycoses may reveal?
|
hyphae and spores
|
|
|
307. Most common cause of cutaneous mycoses
|
Trichophyton spp.
|
|
|
308. Common cause of cutaneous mycosis with animal contact
|
Microsporum spp.
|
|
|
309. Oral DOC of cutaneous mycoses
|
itraconazole
|
|
|
310. Topical DOC of cutaneous mycoses
|
terbinafine
|
|
|
311. Dz w/ subcutaenous lesions w/ slow spread by lymphatic
|
Sporotrichosis
|
|
|
312. Cause of subcutaenous lesions w/ slow spread by lymphatic system producing nodules in a gardener, or from rose-thorn injury.
|
Sporothrix schenckii
|
|
|
313. Dimorphic fungus that grows at 37°C as cigar-shaped yeast, and produces septate hyphae and conidia (in daisy arrangement) at 25°C is
|
Sporothrix schenckii
|
|
|
314. DOC of sporotrchosis
|
itraconazole.
|
|
|
315. Cause of deeper and wider lesions with interconnecting subcutaneous abscesses arising from infection of several neighboring hair follicles, in young children.
|
Staphylococcus aureus (Carbuncle)
|
|
|
316. Cause of single or multiple, isolated or coalescent, small, superficial pustules progressing to erosions covered by stuck-on, honey-colored crusts, surrounded by erythematous halo, in young children.
|
Staphylococcus aureus >> Streptococcus pyogenes (non- bullous impetigo)
|
|
|
317. mecA (SCC) genes which encode PBP2a, w/ low affinity for β-lactams; confers resistance in Staphylococcus aureus against what?
|
Nafcillin
|
|
|
318a. Dz characterized by bullae and denuded areas after the blisters rupture, covered by thin, varnish-like light brown crusts; regional lymphadenopathy, in children.
|
Bullous impetigo
|
|
|
318b. DOC for bullous impetigo if lab: gram stain and culture of pus or base of the lesions yields GPC in chains.
|
Penicillin G
|
|
|
318c. DOC for bullous pemphigoid if: gram stain and culture of pus or base of the lesions yields GPC in clusters.
|
Nafcillin
|
|
|
319. Cause of spreading (butterfly-wing) erythema on the face that responds to empirical penicillin.
|
Streptococcus pyogenes (Erysipelas)
|
|
|
320. Cause of severe pain on his knee w/ site of injury is tender and erythematous. Blood culture may yield?
|
Streptococcus pyogenes. (Cellulitis)
|
|
|
321. What is the microbial factor that promotes degradation of C3b by binding to factor H, the serum β globulin factor
|
M protein
|
|
|
322a. Other causes of cellulitis: Clue1: cat/dog bite. What?
|
Pasteurella multocida / Capnocytophaga canimorous
|
|
|
322b. Other causes of cellulitis: Clue2: Salt water exposure. What?
|
Vibrio vulnificus
|
|
|
322c. Other causes of cellulitis: Clue3: Fresh water exposure. What?
|
Aeromonas hydrophila
|
|
|
322d. Other causes of cellulitis: Clue4: Neutropenia. What?
|
Pseudomonas aeruginosa
|
|
|
322e. Other causes of cellulitis: Clue5: Human bite. What?
|
Eikenella corrodens
|
|
|
323. Most common cause of Dz characterized by fever/chills/ night sweats, localizing pain/tenderness or swelling/erythema; elevated ESR, CRP; elevated WBC and platelets. Radiology: periosteal elevation.
|
Staphylococcus aureus (Osteomyelitis)
|
|
|
324. Major antiphagocytic virulence factor of drug-resistant organism that causes osteomyelitis is
|
protein A
|
|
|
325. Major neutrophil-damaging virulence factor of drug- resistant organism that causes osteomyelitis is
|
Penton-Valentine leukocydin
|
|
|
326. Cause of vertebral, sternoclavicular or pelvic bone infections (in pt w/ IVDU) or osteochondritis of foot (following penetrating injuries through tennis shoes)?
|
Pseudomonas aeruginosa
|
|
|
327. Cause of osteomyelitis in pt w/ underlying sickle cell Dz (blood culture +)?
|
Salmonella typhimurium
|
|
|
328. Cause of chronic, vertebral osteomyelitis (blood culture negative)?
|
Mycobacterium tuberculosis
|
|
|
329. Cause of osteomyelitis in pt. w/ hx of cat bites; GNSR; fastidious growth of wound culture?
|
Pasteurella multocida
|
|
|
330a. Dz is characterized by fever, chills, malaise, joint pain, swelling. PE: tenderness, erythema, heat, swelling, decreased ROM. CBC: leukocytosis w/ neutrophils predominating; joint aspirate: no crystals; yields bacteria. TOW?
|
Septic arthritis
|
|
|
330b. Septic Arthritis pathogen associations: Clue1: sexually active; blood culture negative; responds to ceftriaxone
|
Neisseria gonorrhoeae
|
|
|
330c. Septic Arthritis pathogen associations: Clue2: Rheumatoid arthritis?
|
S. aureus
|
|
|
330d. Septic arthritis pathogen associations: Clue3: IVDU?
|
S. aureus, P. aeruginosa
|
|
|
330e. Septic arthritis pathogen associations: Clue4: Unpasteurized dairy products
|
Brucella spp.
|
|
|
330f. Other septic arthritis pathogen associations: Clue5: Diabetes
|
GBS (Group B Strep)
|
|
|
331a. Dz is characterized by arthritis in up to 6 joints (especially knees, feet), low back pain/stiffness, irritable eyes w/ or w/o redness, conjunctivitis, iritis, malaise. TOW?
|
Reactive arthritis
|
|
|
331b. Reactive Arthritis: Clue1: sexually acquired
|
C. trachomatis, N. gonorrhoeae
|
|
|
331c. Reactive Arthritis: Clue2: non-sexually acquired
|
Campylobacter, Salmonella
|
|
|
332. Cause of bacteremia in neutopenic pts with central line or pts with prosthetic devices and catheters; blood culture (+) coagulase-negative bacteria.
|
Staphylococcus epidermidis
|
|
|
333. Cause of intraabdominal abscess w/ putrid pus; anaerobic bacteremia in pt with trauma or solid GI tumor?
|
Bacteroides fragilis.
|
|
|
334. A woman with obstetric infection has fever > 102°F, SBP < 90; diffuse sunburn-like rash or desquamation of palms and soles; multisystem Sx/Sns; vomiting, and diarrhea; blood culture negative. TOW?
|
Staphylococcal Toxic shock Syndrome
|
|
|
335. What is the toxin associated with staphylococcal toxic shock syndrome?
|
TSST-1 (a superantigen)
|
|
|
336. Cause of severe, watery diarrhea in a woman with toxic shock syndrome?
|
Enterotoxin (coregulated with TSST-1)
|
|
|
337. Cause of toxic shock syndrome, which responds to vancomycin and clindamycin?
|
MRSA
|
|
|
338. Hx: in a man w/ necrotizing fasciitis or myositis or gangrene, fever > 38.9°C (102°F), SBP < 90 ; diffuse sunburn-like rash or desquamation of palms and soles.. Multisystem involvement. Blood culture positive. TOW?
|
Streptococcal toxic shock syndrome
|
|
|
339. What is the toxin associated with streptococcal toxic shock syndrome?
|
SpeA (superantigen)
|
|
|
340. DOC for streptococcal toxic shock syndrome
|
PenG + clindamycin
|
|
|
341. Hx: Fever, chills, and hypotensive. Blood culture yields a GNR, oxidase (-), lactose fermenting organism on MacConkey agar. Immunological mediators of sepsis.
|
IL-1 and TNF
|
|
|
342. DOC for a line-associated infection in a pt w/ GI tumor; lab: positive blood cultures and β-D-glucan antigenemia?
|
Fluconazole
|
|
|
343. DOC for a neutropenic pt w/ line-associated infection w/ immune suppression (hematologic malignancy, organ or hematopoietic stem cell transplantation, chemotherapy); w/ positive blood cultures and β-D-glucan antigenemia?
|
Caspofungin
|
|
|
344. Cause of mononucleosis-like dz with fever, myalgia/ arthralgia w/ lab: leukopenia, LFT abnls, in a pt w/ solid organ transplant?
|
CMV
|
|
|
345. Lung biopsy reveals large cells with nuclear inclusions (Cowdry owl's eyes inclusion bodies) in a pt with AIDS and interstitial pneumonia. TOW?
|
CMV
|
|
|
346. DOC for CMV antigenemia in a febrile pt with solid organ tansplant?
|
Gancyclovir
|
|
|
347. Cause of hematuria, hemorrhagic cystitis, or ureteric stenosis, or interstitial nephritis in a severly immunocompromised pt?
|
BK virus
|
|
|
348. DOC for a pt w/ travel hx (back from the tropics), who has flu-like symptoms; splenomegaly; lab: CBC: anemia, thrombocytopenia, hypoglycemia. Blood smear: enlarged RBCs and Schuffner dots.
|
mefloquine + primaquine
|
|
|
349. Which drug is contraindicated in specific Tx of liver form of malaria in pts w/ G6PD deficiency?
|
Primaquine
|
|
|
350. DOC for a pt w/ travel hx (back from the tropics), who has flu-like symptoms (fever > 103°F), seizure, hyperparasitemia (>2.5% of RBC), pulmonary edema, or renal failure, or severe anemia??
|
quinidine and doxycycline.
|
|
|
351. Cause of malaria-like illness in an immunosuppressed pt w/o travel hx; lab: blood smear has cross-over rings in the RBCs?
|
Babesia spp.
|
|
|
352. A pt from S. America has a week-long fever, anorexia, lymphadenopathy, mild hepatosplenomegaly, and myocarditis; a nodular lesion on the arm. Blood smear should reveal motile species of what?
|
Trypanosoma cruzi
|
|
|
353. Cause of a chronic-stage systemic dz w/ cardiomyopathy, megaesophagus, megacolon, and weight loss in a pt from S. America, who does not respond to nifurtimox.
|
Trypanosoma cruzi
|
|
|
354. Cause of protracted fever and Crohn's, celiac dz, ocular problems, and lymphadenopathy; duodenal biopsy demonstrating foamy macrophages in lamina propria?
|
Tropheryma whipplei
|
|
|
355. What is the most common cause of bacteremia associated w/ foreign device (prostheses, intravenous cathether, or central lines) in co-morbid, hospitalized pts?
|
Staphylococcus epidermidis
|
|
|
356. What is the cause of infections associated w/ ventilator support of respiration in co-morbid pts in the ICU?
|
Pseudomonas aeruginosa
|
|
|
357a. Hx: fever, headache, neck stiffness, and altered mental status; Kernig's/Brudzinski's sign other focal neurologic findings, rash, headache, seizures + myalgia; CSF: WBC > 2000 or PMNs > 1200; glucose < 34, protein > 220
|
Acute bacterial (pyogenic) meningitis (ABM).
|
|
|
357b. CSF gram stain of the most likely pathogen of Acute Bacterial Meningitis in a 6 mos-6yr old (or adults > 50 years) should reveal
|
Gram-positive diplococcus
|
|
|
357c. CSF gram stain of the most likely pathogen of Acute Bacterial Meningitis in an older child or young adult should reveal
|
Gram-negative diplococcus
|
|
|
358. Most common cause of sepsis/meningitis in newborns/neonates?
|
Streptococcus agalactiae
|
|
|
359. Cause of fever, headache, photophobia, nausea/vomiting, rash, diarrhea, meningeal signs, in older children in the summer months; CSF with 10-<1,000 WBC typical, mostly monos, moderately elevated protein?
|
Enteroviruses (aseptic meningitis)
|
|
|
360. Cause of aseptic meningitis in men with exposure to rodents?
|
Leptospira interrogans
|
|
|
361. Cause of aseptic meningitis with hx of tick bite and erythema migrans?
|
Borrelia burgdorferi
|
|
|
362. Cause of aseptic meningitis with hx of sex with multiple partners; CSF PCR(+)?
|
HSV-2 > 1
|
|
|
363. Cause of fever, headache, photophobia, meningismus, in pts w/ solid organ transplant, malignancy, corticosteroid use. CSF glucose < 2/3 serum glucose, elevated protein, WBC > 5 with PMNs?
|
Listeria monocyotgenes
|
|
|
364. How does Listeria monocytogenes differ from other β-hemolytic bacteria?
|
Gram-positive rods; tumbling motility
|
|
|
365. Cause of chronic meningoencephalitis in a pt, who uses infliximab or native from endemic region; PE: papilledema. CXR (+). Lab: elevated monocytes on differential, low CSF glucose?
|
Mycobacterium tuberculosis
|
|
|
366. Test to confirm subacute mengoencephalitis in a, immunocompromised pt (CD4 <100); vesicular skin lesions [CSF profile: protein 30-150mg/dl, monos 10-100]?
|
CSF India ink
|
|
|
367. Cause of meningoencephalitis after a hx of respiratory illness after travel to SW USA?
|
Coccidioides immitis
|
|
|
368. Test to confirm CNS pathology with fever, cognitive deficits, focal neurologic signs, seizures; temporal lobe involvement on MRI. Lab: no papilledema, CT (no brain lesion)?
|
CSF PCR (+)
|
|
|
369. Cause of fever, cognitive deficits, focal neurologic signs, seizures, abnormal mental status with ataxia, hemi-paresis, in a pt w/ AIDS?
|
JC virus > HHV-6
|
|
|
370. Cause of fever, cognitive deficits, focal neurologic signs, seizures or abnormal mental status with ataxia in an adult during outdoor activity?
|
West-Nile virus > SLE
|
|
|
371. Cause of fever, cognitive deficits, focal neurologic signs, seizures, in a pt w/ AIDS (CD4 < 100). Brain CT or MRI: multifocal (ring-enhancing) lesions, affecting basal ganglia; Pt receives pyrimethamine + leucovorin + sulfadiazine for life
|
Toxoplasma gondii (TE)
|
|
|
372. Cause of confusion, stiff neck, irritability over wks to months, in immunocompromised pts; CT or MRI = multifocal lesions in midbrain, brain stem, & cerebellum; wet mount CSF = motile macrophage-like organisms.
|
Acanthamoeba spp. (GAE)
|
|
|
373. Cause of severe headache and other meningeal signs, fever, vomiting, and focal neurologic deficits, frequently progressing to coma, in a healthy boy (summer diving activity)?
|
Naegleria fowleri (PAM)
|
|
|
374. Cause of seizures, chronic headache, symptomatic hydrocephalus, in immigrants from Mexico, Central or S. America); pt. successfully responds to praziquantel + anti- convulsant drug?
|
Taenia solium (neurocysticercosis)
|
|
|
375. Hx of fever, lymphadenopathy, chancre, and pruritus weeks ago, in a pt from Africa, progressing to headaches, somnolence, abnormal behavior; pt. responds slowly to pentamidine isothionate or suramin. TOW?
|
Trypanosoma brucei (sleeping sickness)
|
|
|
376. Hx of rigidity, muscle spasm, and autonomic dysfunction. Trismus or lock jaw due to masseter spasm in an infant w/ umbilical stump infection (secondary to poor birth delivery hygiene). Clostridial toxin interferes w/
|
GABA and glycine
|
|
|
377. Hx of foodborne (chili) afebrile illness w/ diplopia, dysarthria, dysphoria, dysphagia, alert, and descending flaccid paralysis in a pt w/ IDU skin poppers with black tar heroin. Clostridial toxin blocks the release of
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acetylcholine
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378. Immediate treatment of a male infant w/ constipation, a weak cry, and drooling, hypotonea and cranial neuropathy, after ingestion of home-processed honey.
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Equine immune globulin (infant botulism)
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379. Ingestion of a raw potato delivers a new vaccine protein to elicit an immune response. The immune structure to interact with the vaccine protein?
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Lamina propria mucosae
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380. Inflammation and the resulting increase in vascular permeability permit leakage into damaged or infected sites are effected by
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Phagocytic cells and acute phase proteins
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381. The serum of a pt, who has IgG and IgM deficiency, appears to fix complement in an assay for tetanus antibodies. What is the explanation?
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Activation of the alternate pathway
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382. A 3-year-old boy with genetic C3 deficiency has recurrent ear and lung infections due to pyogenic bacteria. Deficiency of what?
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B lymphocytes
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383. A very young child, w/ recurrent infections due to Staphylococcus aureus, now has numerous granulomas. TOW?
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Chronic granulomatous dz
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384. Treatment with which protease enzyme causes decrease in avidity of IgG w/o changing the specificity of the antibody?
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Papain
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385. Cells activated by both γ-IFN and CD40 are
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Macrophages
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386. High-dose chemo has caused severe bone marrow suppression in a pt with hematologic malignancy. Reversal is plausible with what?
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GCSF
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387. Function of the T-lymphocyte receptor (CD3) complex of transmembrane proteins?
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Signal transduction
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388. The MHC class I pathway presents an antigen directly to what?
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CD8+ T lymphocytes
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389. HSV infection can block the transfer of antigenic peptides from the cytoplasm to the ER of the infected cells. As a result of this, action of what cell type is compromised?
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CD8+ T cells
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390. Infection of the thyroid gland can induce the expression of MHC II molecules. Which cell types would initiate an autoimmune response, leading to Hashimoto's thyroiditis?
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CD4+ T cells.
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391. PPD skin test (+) in a pt , who was vaccinated against turberculosis in his native country, reflects response of what cell type?
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CD4+ T lymphocytes (Th1 response → γ-IFN)
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392. A man with hx of MI is given a morphine injection for a new episode of chest pain; 10 mins later, he has itching and urticaria. Mechanism of this reaction?
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mediators from sensitized mast cells
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393. Loss of skin pigments, sense of touch, inability to feel objects and pain in a pt from Africa, whose skin scraping contains AFB (Acid-fast bacteria), is caused by
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Th1-mediated DTH (delayed-type hypersensitivity) reactions
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394. A man with polycystic kidney dz, who receives a renal transplant and cyclosporine, develops a high temp and swelling and tenderness in the grafted kidney. TOW?
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Immunity to the donor MHC antigens.
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395. A man who now has progressive stupor and laryngeal spasms for 3 days after pt was being attacked by a wild bat in a cave a month ago should have received
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Inactivated rabies virus vaccine
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396. Alternative and lectin pathways of complements activated by
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bacterial surfaces
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397. Classic complement pathway is activated by antibody- antigen complexes involving antibody class type
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IgM >> IgG
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398. Chemotactic and anaphylotoxic complements are
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C3a, C5a
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399. Successful opsonization of all non-encapsulated bacteria are by complement
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C3b
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400. Defects or deficiency which complements predisposes individuals to infections caused by Neisseria spp., the causative agents of gonorrhea and meningitis
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C6-C9
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401. Antimicrobial (immune) response important for intracellular bacterial infections involves cell type
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Th1 CD4 T cells
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402. Immune response important for viral infections involves cell type
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CD8 cytolytic T cells
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403. Major antibody in secretions and plays a significant role in first-line defense at the mucosal level is
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IgA
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404. Main antibody in the initial "primary" immune response and allows good complement activation is
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IgM
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405. Fc region of this immunoglobulin binds to eosinophils, basophils and mast cells and is significant mediator of allergic (hypersensitivity) reactions
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IgE
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406. What on macrophages enables them to sense that the material is microbial in origin, and must therefore be eliminated quickly?
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Toll-like receptor
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407. These oxygen-dependent enzymes: NADPH oxidase, superoxide dismutase, and myeloperoxidase are involved in killing of what?
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Gram-positive bacteria
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408. These oxygen-independent enzymes/proteins: lysosome, lactoferrin, defensins and other cationic proteins are involved in killing of what?
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Gram-negative bacteria
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409. Infections persist, because mφ [macrophage] activation is defective, leading to chronic stimulation of CD4+ T cells in what dz?
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Chronic granulomatous Dz
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|
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410. Defective respiratory burst, predisposing chronic bacterial infection is associated with deficiency of what?
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Glucose-6-phosphate dehydrogenase (G6PD)
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|
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411. All nucleated cells express MHC I antigens
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HLA-A, B, C
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|
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412. Antigen-presenting cells express MHC II antigens
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HLA-DP, DQ, DR
|
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413. Lymphocyte proliferation (T, B) and NK → cytotoxicity are undertaken by what cytokine?
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IL-2
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|
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414. B-cell activation, IgE and IgG4 switch, ↓ TH1 cells/ Mφ, ↓ IFN-γ, TH0 → TH2 are all undertaken by what cytokine?
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IL-4
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415. Mφ [Macrophage] activation; elevated expression of MHC and FcRs molecules on B cells, IgG2 class switching, increased IL-4 and TH2 are all undertaken by what cytokine?
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IFN-γ
|
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416. The Th1 response, driven primarily by IFN-γ leads to the activation of
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macrophages
|
|
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417. The Th2 response, driven primarily by IL-4 and IL-5, leads to the production of IgE and IgG4 and to the activation of
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mast cells and eosinophils.
|
|
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418. Variable T and B cells in DiGeorge's syndrome is associated with
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Thymic aplasia
|
|
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419. No B cells and immunoglobulins in X-linked agammaglobulinemia (Bruton's) is associated with
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Loss of Btk tyrosine kinase
|
|
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420. Lack of anti-polysaccharide antibody and impaired T-cell activation causing Wiskott-Aldrich syndrome is associated with
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X-linked-defective WASP gene
|
|
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421. Inability to control B cell growth in X-linked lympho- proliferative syndrome is associated with
|
SH2D1A mutant
|
|
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422. Glomerulonephritis, pulmonary hemorrhage in Goodpasture’s syndrome is caused by what autoantigen?
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basement membrane (collagen type IV)
|
|
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423. Hyperthyroidism in Myasthenia gravis is caused by what autoantigen?
|
Thyroid-stimulating hormone
|
|
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424. Progressive muscle weakness in Grave's Dz is caused by what autoantigen?
|
Acetylcholine receptor
|
|
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425. Brain degeneration, paralysis in Multiple sclerosis (MS) is caused by what autoantigen?
|
Myelin basic protein, proteolipid protein
|
|
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426. Localized allergies (e.g., drug allergy, asthma, hay fever) and anaphylaxis (food, drug) w/ systemic inflammation throughout circulation are associated with reaction?
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Type I hypersensitivity
|
|
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427. Autoimmune hemolytic anemia: Ab’s produced vs RBC membrane Ag’s, mismatched blood (transfusion rxn), and allergies to antibiotics (e.g., penicillins, sulfa drugs) are associated with reaction?
|
Type II hypersensitivity
|
|
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428. Grave's Disease, Myasthenia Gravis, Goodpasture's syndrome are all associated with reaction?
|
Type II hypersensitivity
|
|
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429. Post-streptococcal glomerulonephritis, serum sickness to horse diphtheria anti-toxin, systemic lupus erythematosis (SLE), and rheumatoid arthritis are all associated with reaction?
|
Type III hypersensitivity
|
|
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430. Poison ivy, erythematous induration in tuberculin skin test, and transplantation/graft rejection are all associated with reaction?
|
Type IV hypersensitivity
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