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189 Cards in this Set
- Front
- Back
How do you distinguish strep pneumoniae from viridans (both alpha hemolytic)?
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S. pneumoniae is optochin sensitive. Viridans (S. mutans, sanguis) are optochin resistant.
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How do you distinguish group A strep from group B (both beta hemolytic)?
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Group A is bacitracin sensitive. Group B is bacitracin resistant.
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Bacteria that can cause bacteremia and subacute endocarditis in colon cancer patients
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S. bovis (group D streptococci, non-enterococci)
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Gram positive bacteria with endotoxin?
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Listeria
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What do actinomyces, bacteroides, and clostridium have in common?
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They are all obligate anaerobes.
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E. coli heat stable vs heat labile toxin?
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Stable increases cGMP. Labile increases cAMP. Net result is secretion and inhibited reabsorption of NaCl from gut epithelium.
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How do you distinguish N. meningitidis from N. gonorrhoeae?
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N. meningitidis: metabolizes maltose. N. gonorrhoeae does not metabolize maltose.
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What happens if you scrape off the pseudomembrane of a patient with diphtheria?
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It will bleed and the exotoxin will be systemically absorbed.
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Which exotoxin is considered a "human antibiotic"?
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Diphtheria toxin: inactivates elongation factor (EF2) (A subunit), B subunit provides entry into cardiac and neural tissue
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Which organism shows a tumbling motility?
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Listeria
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What do you NOT do after a cat or dog bite?
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Don't close the wound with sutures (creates an environment good for Pasteurella multocida growth). Treat with penicillin or doxycycline.
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What 3 organisms do you want treatment to cover in a patient with urethritis?
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Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum (tx: Ceftriaxone, Azithromycin)
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2 organisms transmitted by lice?
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Rickettsia prowazekii (epidemic typhus) and Bartonella quintana (trench fever)
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Treatment for the rickettsial infections?
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Doxycycline
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What are the 3 types of tertiary syphilis?
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Gummatous, Cardiovascular (aortitis), and Neurosyphilis (asymptomatic, subacute meningitis, meningovascular, or tabes dorsalis)
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What do Treponema pallidum endemicum, pertenue, and carateum cause?
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Bejel (endemicum), Yaws (pertenue) (gangosa = disfiguring lesions), Pinta (carateum) (red/blue lesions)
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4 organ systems affected with early disseminated Borrelia burgdorferi?
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Skin (ECM), nervous system (Bell's palsy, meningitis), heart (AV block), and joints (migratory arthritis)
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What is the more severe form of Leptospira infection?
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Weil's disease: infectious jaundice, renal failure, hepatitis, mental status changes, hemorrhage
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How does Borrelia recurrentis cause relapsing fever?
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By antigenic variation (outer membrane Vmp lipoproteins)
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Which organism has a non-polysaccharide capsule?
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Bacillus anthracis (D-glu polymer)
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What tests can detect the presence of a capsule?
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India Ink (mucicarmine - turns red) or Quellung reaction (capsule swells w/ anticapsular antisera)
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What is the cell membrane of mycoplasma made of?
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Sterols! (NO cell wall)
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How can treponema be visualized?
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Darkfield microscopy or fluorescent antibody staining (they're too thin/small for gram stain)
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What is a PAS stain used for?
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To diagnose Whipple's disease (Tropheryma whippelii). It stains glycogen and mucopolysaccharides.
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Which organisms are visualized with a Giemsa stain?
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Borrelia, Plasmodium, trypanosomes, Chlamydia
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Urease-positive bugs?
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Proteus, Klebsiella, H. pylori, Ureaplasma
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Examples of obligate aerobes?
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Nocardia, Pseudomonas, Mycobact TB, Bacillus
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Obligate anaerobes?
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Clostridium, Bacteroides, Actinomyces (lack SOD and catalase)
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Medium to culture M. TB?
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Lowenstein-Jensen agar
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Medium to culture B. pertussis?
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Bordet-Gengou (potato) agar ("Bordet" for Bordetella)
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Medium to culture M. pneumoniae?
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Eaton's agar (round, bumpy "mulberry" colonies)
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Medium to culture fungi?
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Sabouraud's agar
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Medium to culture C. diphtheriae?
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Tellurite plate, Loeffler's media
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Is endotoxin or exotoxin fatal at a lower dose?
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EXOtoxin (about several hundred times lower concentration needed than endotoxin)
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What cytokines does endotoxin induce?
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TNF-alpha and IL-1 (also stimulates NO, C3a, C5a, and Hageman factor/XII)
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Streptolysin O vs S?
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O is antigenic (ASO Abs). S is oxygen-stabile.
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Toxins transmitted by lysogenic phage?
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ABCDE:
ShigA-like toxin Botulinum toxin Cholera toxin Diphtheria toxin Erythrogenic toxin (GAS) |
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Beta hemolytic bacteria?
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S. aureus, S. pyogenes (GAS), S. agalactiae (GBS), Listeria (tumbling motility)
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How are Staph saprophyticus and epidermidis distinguished?
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Saprophyticus is novobiocin resistant.
Epidermidis is sensitive. |
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S. pneumoniae is the most common cause of what 4 conditions?
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Meningitis, Otitis media (in children), Pneumonia, Sinusitis
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What are spores chemically composed of?
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Dipicolinic acid, keratin-like coat
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Where does tetanus toxin (tetanospasmin) act?
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At the Renshaw cells in the spinal cord. It blocks glycine and GABA release.
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What do C. diphtheria look like?
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Gram positive rods with metachromatic (blue and red) granules
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Which aspect of S. pyogenes is related to the development of rheumatic fever?
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Antibodies to the M protein
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Which bacteria exhibit a tumbling motility?
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Listeria monocytogenes
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Lepromatous vs tuberculoid leprosy?
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Lepromatous: presents diffusely over skin, communicable, lack good cell-mediated immunity
Tuberculoid: few skin nodules, intact T-cell response |
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2 toxins that inhibit EF-2?
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Pseudomonas and Diphtheria
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Which type of E. coli doesn't produce a toxin?
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EPEC
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What is Waterhouse-Friderichsen syndrome and what causes it?
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Bilateral adrenal gland hemorrhage. Caused by fulminant meningococcemia.
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Gram negative comma shaped oxidase positive organisms?
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Campylobacter (grows at 42C) and cholera (grows in alkaline media)
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Gram negative rods: lactose nonfermenter, oxidase (+)?
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Pseudomonas
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Gram negative rods: lactose nonfermenter, oxidase (-)?
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Salmonella, Shigella, Proteus
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Gram negative rods: lactose fermenters?
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Klebsiella, E. coli (grows at 45C), Enterobacter, Citrobacter, Serratia, & more
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Features of secondary syphilis?
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Maculopapular rash (palms and soles), constitutional symptoms, condyloma lata
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Triple therapy for H. pylori?
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PPI, Clarithromycin, and Amoxicillin or Metronidazole
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What can Yersinia enterocolitica infection mimic?
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Mesenteric adenitis --> can mimic Crohn's or appendicitis
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Which GI infection can be an antecedent to Guillain-Barre syndrome?
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Campylobacter
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How is a rickettsial rash distinguished from a typhus rash?
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RMSF (R. rickettsii): starts on hands and feet, Typhus (R. typhi or prowazekii): starts on trunk and spares palms & soles
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How is Coxiella different from the other Rickettsia?
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No rash, no vector, no Weil-Felix rxn, and can survive outside for a long time
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List 3 beta-lactamase inhibitors.
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Clavulanic acid, sulbactam, tazobactam
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What does a Tzanck prep reveal and indicate?
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Shows multinuclear giant cells and intranuclear inclusion bodies. Indicates HSV1/2 or VZV infection.
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What does HHV-6 cause?
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Roseola (exanthum subitum): high fever for 3-5 days followed by rash on trunk for 1-2 days
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Which DNA virus replicates in the cytoplasm?
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Poxviridae
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Timing of lesion development in chickenpox vs smallpox?
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Chickenpox: see lesions at different stages of development
Smallpox: synchronous lesions (all develop at the same time) |
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Key finding of lesions in molluscum contagiosum?
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White bumps, 1-2mm in diameter, with central dimple/induration (umbilicated)
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Cause of erythema infectiosum (fifth disease)?
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Parvovirus, strain B19 (get fever and "slapped cheek" appearance)
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Which virus causes epidemic keratoconjunctivitis (pink eye)?
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Adenovirus
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Which virus causes a transient aplastic anemic crisis?
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Parvovirus, strain B19
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Outcome of congenital rubella?
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Heart (PDA, VSD, PA stenosis), Eye (cataracts, chorioretinitis), and CNS (mental retardation, microcephaly, deafness)
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Leading cause of epidemic viral encephalitis in the US?
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St. Louis encephalitis (flavivirus)
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What does "break-bone fever" refer to?
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Dengue fever, because of the severe painful backache, muscle/joint pain, and severe headache
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What cells can poliovirus infect?
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Peyer's patches in the intestine and motor neurons --> explains fecal-oral transmission and paralytic disease
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Most common cause of aseptic meningitis in the US?
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Enteroviruses (picornaviruses)
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Most deadly virus?
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Rabies: highest case fatality of any infectious disease (Naegleria is also an extremely deadly organism)
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What causes the intermittent fevers by trypanosoma?
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variable surface glycoproteins (VSGs) (thousands of different ones)
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What is xenodiagnosis used to diagnose?
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Trypanosoma cruzi (Chagas disease). Reduviid bugs feed on the patient, and the bugs' intestinal contents are examined one month later for the presence of the parasite.
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Which 3 worms involve a cough/swallow life cycle?
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Necator americanus, Strongyloides stercoralis, Ascaris lumbricoides
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What is autoinfection?
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Strongyloides stercoralis: filariform larvae penetrate intestine directly (without leaving) and then go to the lung to continue the cycle.
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Which parasites do NOT produce eosinophilia?
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Enterobius and Trichuris
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Stain to detect PCP?
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Methenamine silver stain of lung tissue.
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HIV infections with CD4 < 50?
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CMV retinis, esophagitis, disseminated MAI, cryptococcal meningoencephalitis
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HIV infections with CD4 < 100?
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Candidal esophagitis, toxo, histo
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HIV infections with CD4 < 200?
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Reactivation HSV, cryptosporidia, Isospora, disseminated coccidioidomycosis, PCP
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HIV infections with CD4 < 400?
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Oral thrush, tinea pedis, reactivation VZV, reactivation TB, bacterial infections (H. inf, S. pneumo, Salmonella, etc)
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Bugs that don't stain well on gram stain?
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Treponema, Rickettsia, Mycobacteria, Mycoplasma, Legionella, Chlamydia
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What organisms does a silver stain show?
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Fungi (eg: Pneumocystic), Legionella
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How can lactose fermenting organisms be detected?
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MacConkey agar: turn pink, EMB (for E. coli, turns metallic blue-black)
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Facultative intracellular organisms?
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Salmonella, Neisseria, Brucella, Mycobacterium, Listeria, Francisella, Yersinia
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C. perfringens toxin?
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alpha toxin (a lecithinase): acts as phospholipase that cleaves cell membranes and causes gas gangrene
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Which bacteria are especially good at transformation?
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S. pneumo, H. influenzae (type B), Neisseria (SHiN)
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Bile solubility of Strep pneumo vs Viridans?
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S. pneumoniae is bile soluble (but doesn't grow in bile). Viridans is NOT bile soluble.
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Which speces of Strep Viridans causes dental caries and which causes subacute endocarditis?
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S. mutans causes dental caries. S. sanguis causes endocarditis.
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Hypersensitivity types of immunologic consequences of group A strep?
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Rheumatic fever: type II hypersens (Abs to M protein)
Acute glomerulonephritis: type III |
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What does CAMP factor of group B strep do?
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It enlarges the area of hemolysis formed by staph aureus.
* Different than cAMP |
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Cause of granulomatosis infantiseptica?
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Listeria. (pyogenic granulomas all throughout body)
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Treatment for nocardia and actinomyces?
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Sulfa for Nocardia. Actinomyces --> use Penicillin. (SNAP)
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Gram negative "coccoid" rods?
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Haemophilus influenzae, Pasteurella, Brucella, Bordetella pertussis
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What are cord factor and sulfatide and what do they do?
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Both are virulence factors of Mycobacterium tuberculosis. Sulfatide inhibits phagosome/lysosome fusion. Cord factor allows growth in a cord/serpent-like manner.
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Prophylaxis for MAI?
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Azithromycin
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Triad of findings in HUS?
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Thrombocytopenia, anemia, and acute renal failure
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How can EHEC be distinguished from other E. coli?
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EHEC does not ferment sorbitol (and is glucuronidase negative).
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Disorder? Saber shins, saddle nose, CN VIII deafness, Hutchinson's teeth, mulberry molars
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Congenital syphilis
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Babesia can often co-exist with what other infection?
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Lyme disease (Borrelia burgdorferi) (also transmitted by Ixodes tick)
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List 3 spirochetes.
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Borrelia, Leptospira, Treponema
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Symptoms of what bacteria can be prolonged with antibiotic treatment?
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Salmonella
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Classic triad of rickettsiae signs/symptoms?
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Fever, headache, and rash (vasculitis)
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What causes undulating fever?
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Brucella species
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Saucer shaped yeast forms?
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Pneumocystis jiroveci
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Cigar-shaped yeast forms with unequal budding?
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Sporothrix schenckii
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Potassium iodide is treatment for...?
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Sporothrix schenckii ("plant a rose in the pot")
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What is the more specific test to detect the capsule of cryptococcus?
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Latex agglutination (detects polysaccharide capsular antigen)
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How do mucor and rhizopus enter the brain?
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Through the cribiform plate. Often form rhinocerebral and frontal lobe abscesses. Naegleria also enter through the cribiform plate.
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What can be seen in the cytoplasm of entamoeba?
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RBCs
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What is trichomonas sometimes confused with?
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Gardnerella vaginalis (vaginosis). Discharge in trichimonas (vaginitis) is greenish and foul smelling.
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Findings in visceral leishmaniasis?
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Hepatosplenomegaly, pancytopenia, and spiking fevers
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DIfferent treatments for Trypanosoma brucei (African sleeping sickness)?
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Suramin for blood-borne disease. Melarsoprol for CNS penetration.
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Which worm can be seen crawling in the conjunctiva?
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Loa loa (tissue nematode)
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Which worm can ulcerate through the skin?
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Dracunculus medinensis (treat with Niridazole)
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Which worm can cause biliary tract inflammation, pigmented gallstones, and lead to cholangiocarcinoma?
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Clonorchis sinensis (trematode/fluke)
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Which parasitic organism can lead to secondary bacterial infection of the lung and hemoptysis?
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Paragonimus westermani (trematode/fluke)
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Which DNA viruses have circular genomes?
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Polyoma, hepadna, and papilloma
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Naked virus classes?
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Calicivirus, Picornavirus, Reovirus, Parvovirus, Adenovirus, Papilloma, and Polyoma
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Live attenuated vaccines?
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Smallpox, yellow fever, chickenpox, Sabin's polio virus, MMR
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Killed vaccines?
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Rabies, influenza, Salk polio, HAV
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Segmented viruses?
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Bunya, Orthomyxo, Arena, Reo
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Mosquito that transmits yellow fever?
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Aedes mosquito.
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What family are lymphocytic choriomeningitis virus and lassa fever encephalitis in?
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Arenaviruses (neg ssRNA enveloped)
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What does Pavalizumab do to help treat paramyxoviruses?
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It neutralizes the F protein, which causes respiratory epithelial cells to fuse and form multinucleated cells.
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3 kinds of prion disease?
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Sporadic (Creutzfeldt-Jakob), inherited (Gerstmann-Straussler-Scheinker), acquired (kuru)
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Neonatal manifestations of congenital CMV?
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Hearing loss, seizures, and petechial rash
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Neonatal manifestations of congenital Rubella?
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PDA (or pulmonary artery hypoplasia), cataracts, and deafness, +/- "blueberry muffin" rash
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NNRTIs?
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Nevirapine, Efavirenz, Delavirdine
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NRTIs?
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Zidovudine (ZDV/AZT), Didanosine (ddI), Stavudine (d4T)
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Protease inhibitors?
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Saquinavir, Ritonavir, Indinavir, Nelfinavir
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Toxicity of ganciclovir (used for CMV)?
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Leukopenia, neutropenia, thrombocytopenia, renal toxicity (more toxic to host enzymes than acyclovir)
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Rimantidine has fewer of what type of side effect than amantadine?
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Fewer CNS effects. Amantadine can cause ataxia, dizziness, and slurred speech.
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Treatment for cryptococcal meningitis?
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FLUconazole (because it can cross the blood-brain barrier)
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"4 R's" of Rifampin?
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RNA polymerase inhibitor, Revs up P450, Red/orange body fluids, Rapid resistance if used alone
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How is HBV a risk for cancer?
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HBV incorporates its genome into the genome of hepatocytes and produces growth promoting genes.
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What will prevent babies from getting tetanus in utero?
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Tetanus vaccine for pregnant women! IgG Abs are created and cross the placenta.
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What infection are people in DKA particularly susceptible to?
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Mucormycosis, because of the extra glucose and ketones. Nonseptate, 90 degree branching.
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What do edema factor (anthrax) and exotoxin (B. pertussis) both have in common?
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Both increase cAMP and inhibit neutrophil function.
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Component of gram (+) and gram (-) that induce TNF and IL-1?
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Gram (+): teichoic acid
Gram (-): Lipid A |
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What does the Ziehl-Neelsen stain show?
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Acid fast organisms
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What is VPN?
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Vancomycin (inhibit gm+)
Polymyxin (inhibit gm-) Nystatin (inhibit fungi) Used to culture N. gonorrhoeae |
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Examples of encapsulated bugs?
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S. pneumoniae
Klebsiella pneumoniae Haemophilus influenzae type B Neisseria meningitidis Salmonella Group B Strep |
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Obligate intracellular bugs? Why are they that way?
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Rickettsia & Chlamydia
Can't make their own ATP |
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Why are aminoglycosides ineffective against anaerobes?
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AGs require O2 to enter bacterial cells
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Characteristics of obligate anaerobes?
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Foul smelling (short chain FAs)
Difficult to culture Produce gas in tissue (CO2, H2) |
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Difference between Bacillus anthracis and other cAMP inducers?
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Anthrax edema factor IS an adenylate cyclase.
Cholera, pertussis, and E. coli toxins act to activate endogenous adenylate cyclase to increase cAMP. |
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Bacteria with AB toxins?
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C. diphtheriae
Vibrio cholerae E. coli B. pertussis |
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What does C. perfringens do on blood agar?
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Causes a double zone of hemolysis
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4 stages of bacterial growth curve?
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Lag
Log Stationary (sometimes w/ spore formation) Death |
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"ABCDEFG" of C. diphtheria?
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ADP ribosylation
Beta-prophage Corynebacterium Diphtheria Elongation Factor-2 Granules |
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Causes of negative PPD/anergy?
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Steroids
Malnutrition Immunocompromise Sarcoidosis |
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Fast vs slow gram (-) lactose fermenters?
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Fast: Klebsiella, E. coli, Enterobacter
Slow: Citrobacter, Serratia, etc |
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Pseudomonas treatment?
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Aminoglycoside plus extended-spectrum penicillin (piperacillin, ticarcillin)
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"PSEUDO" of pseudomonas?
|
Pneumonia (esp CF)
Sepsis (black skin lesions) External otitis media (malignant in DM) UTI Drug use Diabetic Osteomyelitis |
|
Key E. coli virulence factors for cystitis, pyelonephritis, pneumonia, neonatal meningitis, and septic shock?
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Cystitis& pyelonephritis: fimbriae
Pneumonia & neonatal meningitis: K capsule Septic shock: LPS endotoxin |
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What beta lactam are gram negative bacilli sensitive to?
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Ampicillin & other penicillin derivatives
Resistant to penicillin G and vancomycin |
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What is Rifampin given as prophylaxis for?
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Neisseria meningitidis and Haemophilus influenzae
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In what skin lesions are many treponemes present?
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Chancres of primary syphilis
Condylomata lata of secondary |
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What species is Salmonella typhi found in?
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Only humans (no animal reservoir)
Other Salmonella have an animal reservoir |
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Immune response to salmonella infection?
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Monocytic response
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Yersinia enterocolitica toxin?
|
Enterotoxin like E coli ST (increases cGMP)
|
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Disease common among surfers and in the tropics?
|
Leptospirosis
- Question mark-shaped bacteria found in water contaminated with animal urine |
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Disease acquired from tick feces and cattle placenta?
|
Q fever (Coxiella burnetii)
- atypical pn, myocarditis, granulomatous hepatitis |
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Granulocytes with berry cluster organisms. Disease?
|
Ehrlichiosis (tick-borne). Ehrlichia.
- One of the Rickettsial diseases but does NOT have a rash |
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Transmission of Coxiella vs other Rickettsiae?
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Coxiella: transmitted by aerosol
Other Rickettsiae: transmited by arthropod vector |
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Transmission of Borrelia burgdorferi vs recurrentis?
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Borrelia burgdorferi: tick bite (Ixodes ticks on deer and mice)
Borrelia recurrentis: louse |
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Yersinia pestis transmission?
|
Flea bite (rodents, prairie dogs)
|
|
Francisella tularensis transmission?
|
tick bite (rabbits, deer)
|
|
Lab diagnosis of chlamydia?
|
Cytoplasmic inclusions seen on Giemsa or fluorescent antibody-stained smear
|
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Dermatophytes?
|
Microsporum
Trichophyton Epidermophyton |
|
Treatment for tinea versicolor?
|
Miconazole or Selenium sulfide (Selsun)
- caused by Malassezia furfur |
|
Life form of Candida, Aspergillus, Cryptococcus, and Mucor/Rhizopus?
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Candida: yeast (20C), germ tubes (37C)
Aspergillus: mold Cryptococcus: yeast Mucor/Rhizopus: mold |
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Diethylcarbamazine is treatment for what 3 parasites?
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Loa loa
Wuchereria bancrofti Toxocara canis |
|
Treatment for Taenia solium and Diphyllobothrium latum?
|
Praziquantel
Exception: -bendazoles for neurocysticercosis |
|
Where do DNA and RNA viruses usually replicate and what are the exceptions?
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DNA: in nucleus (except poxvirus)
RNA: in cytoplasm (except influenza and retroviruses) |
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Purified nucleic acids of which dsDNA viuses are NOT infectious?
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Poxviruses and HBV
|
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Where do herpesviruses acquire their envelopes from?
|
From the nuclear membrane (as opposed to plasma membrane like most enveloped viruses do)
|
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Where does CMV remain latent?
|
Mononuclear cells
|
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Symptoms of mumps virus?
|
Parotitis
Orchitis aseptic Meningitis |
|
Rash of Rubella (German measles) vs Rubeola (measles)?
|
Rubella: truncal rash
Measles: includes hands and feet Both begin at head and move downward |
|
Progression of rabies disease?
|
Fever, malaise --> agitation, photophobia, hydrophobia --> paralysis, coma --> death
|
|
3 structural genes of HIV genome?
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gag (p24)
pol (reverse transcriptase) env (gp120 and gp41) |
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Normal flora of the nose, oropharynx, and dental plaques?
|
Nose: S. epidermidis (colonized by S. aureus)
Oropharynx: Strep viridans Dental plaque: Strep mutans |
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Traumatic open wound --> infection?
|
C. perfringens
|
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Neutropenic patients are especially susceptible to what?
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Systemic Candida albicans, Aspergillus
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