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148 Cards in this Set

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What is T cell independent activation
T cell independent activation type 1 is when a B cell binds to an antigen and receives secondary activation by toll-like receptors; type 2 is when the antigen is a molecule with multiple repeating subunits which can simultaneously cross link enough b cell receptors to fully activate the b cell.
What is the dietary form of coenzyme A?
Pantothenic Acid
What reactions need pantothenic acid?
Oxaloacetate --> citrate --> succinyl-CoA

ANYTHING that needs acetyl-CoA
Important in synthesis of vitamin A, vitamin D, cholesterol, steroids, heme A, fatty acids, amino acids and proteins.
TCA Cycle
Method to test for Syphilis
RPR or VDRL then confirm with FTA-ABS.

RPR - Mixture of cardiolipin, lecithin and cholesterol -- indirect method that tests for antibodies released into bloodstream AFTER cell destruction by trep.pallidum.
Cold agluttinins are characteristic of?
Mycoplasma infection
Presentation with drooling
H.Flu
Travel related mycobacterial infections
Coccidioides -- California
paracoccidioides -- latin america
Histoplasma -- Mississipi/Ohio rivers
Blastomyces -- East of Mississipi/Central America
fever, chills, cough, left sided chest pain and bronchial breath sounds over left lower lung indicates?

most common cause?
Focal lobar pneumonia

Most common cause is Strep Pneumonia
If HIV patient has CD4 count <200 then consider PCP
What organism has a mold form and an endospore form?
Coccidioides Immitis

Spores that turn into spherules when inhaled that are fileld with endospores.
pigeon droppings?
Cryptococcus neoformans + immunocompromised
Central America
Blastomyces
Mississippi/Ohio River
Histoplasma
fungus ball
Aspergillosus
Opportunistic mycoses
Candida, Aspergillus, Cryptococcus neoformas, Mucor/Rhizopus, PCP, Sporothrix Schenkii
Treatment for primary Herpes infection
Acyclovir, valacyclovir and famciclovir

MOA -- nucleoside analogues that are converted via VIRUS-encoded thymidine kinase to acyclovir monophosphate, upon which cells convert to a triphosphate that incorporates and halts DNA synthesis.
Enfuvirtide
HIV drug that prevents viral attachment to target cells
Indinavir
HIV drug that inhibits viral protease activity
Neuraminidase inhibitors
Early treatment of influenza, MOA is prevention of virion release from infected cells

hemagluttin - binds to sialic acid and allows entry
neuraminidase - cleaves sialic acid and allows exit
upregulation of interferon synthesis in infected cells accomplished by...?
interleukins
water systems contamination?
Legionella
Legionella culture requirements?
Silver stain,
Iron, Cysteine, Charcoal yeast

Think of the silver armored soldier with his iron sword around the charcoal fire, he ain't no sissy!
Ventilator associated pneumonias
E.Coli, Klebsiella, Acinetobacter and Pseudomonas
an infant under two years develops coughing, wheezing or SOB
RSV, Bronchiolitis, Paramyxovirus
Barracks virus
Adenovirus
Self-limited viral febrile pharyngitis only seen in barracks
Adenovirus

self limited, febrile pharyngitis, cough, nasal congestion, conjunctivits, enlarged cervical lymph nodes

rodent association
viral gastroenteritis
norwalk virus, calicivirus
aplastic crisis in sickle cell anemia
Parvovirus B19
edema in fetus
Parvovirus B19 causing hydrops fetalis

hydrops fetalis also caused by syphilis
rash on the face of an infant spreading to the trunk
Parvovirus B19, fifth disease
viral infection from humans exposed to rodent
Lymphocytic choriomeningitis virus(LCV) which is an arenavirus

causes febrile septic meningoencephalitis or mild systemic influenza like illness
no organisms/bacteria found in CSF with high fever and neck stiffness
febrile aseptic meningoencephalitis caused by LCV, which is an arenavirus
Molluscum contagiosum
poxvirus
bacterial meningitis in people living in close quarters, method of transmission

and route of infections
neisseria meningitis, spread by respiratory droplets.
Meningococci are maltose fermenters, capsular, vaccine available(except for type B) organisms.

Prophylaxis to close contacts is Rifampin

pharynx --> blood --> choroid plexus --> meninges
routes of infection of organisms
Haemophilus influenza
S. pneumoniae
S. aureus
Mycobacterium Tuberculosis or S. pneumoniae
H. Flu
Pharynx --> lymphatics --> meninges

S. pneumoniae
middle ear --> contiguous tissues --> meninges

S. Aureus
Traumatic wound --> leaking csf --> meninges

M. TB/S. Pneum
primary lung focus --> blood --> meninges
bilateral adrenal hemorrhage
Neisseria meningitis infection causing Waterhouse-Friderichsen syndrome leading to adrenal insufficiency, brisk hypotension and death
Cottage cheese vaginal discharge
candida, usually secondary to antibiotic administration that destroys normal flora(gram + lactobacilli)
decreased thickness of vaginal epithelium and decreased glycogen concentration
secondary to decrease in estrogen in postmenopausal women

WA - atrophic vaginitis
Elevated pH of vaginal secretions
Trichomonas vaginitis and bacterial vaginitis
uncontrolled diabetes mellitus in woman can lead to...
candida infection
contraceptive(oral/topical) in woman can lead to...
candida infection
corticosteroid therapy can lead to in a woman...
candida infection
parvovirus replicates where?
marrow mostly

mature erythrocytes, erythroid precursors, fetal liver, heart.
Rash that follows parvovirus B19 infection caused by?
Immune complex deposition which would be...
Type III hypersensitivity
Most upper respiratory infections caused by...
Viruses
Mostly Rhinovirus or influenza(orthomyxovirus)
Brassy cough, difficulty breathing
Croup, paramyxovirus
What's in Thayer-Martin medium? What does it culture?
Vancomycin, colistin, nystatin, trimethoprim

Vanco - blocks gram +
Colistin(or polymyxin) - blocks most gram -
Nystatin - blocks yeast
Trimethoprim - blocks proteus

cultures neisseria meningitidis
raw or steamed shellfish
Hepatitis A, picornavirus
if viral gastroenteritis, think calicivirus and norwalk fever
Which TCA reactions need NAD+
Isocitrate --> oxalosuccinate
alpha-ketoglutarate --> Succinyl-CoA
malate --> oxaloacetate
Oxaloacetate --> Citrate
Needs Acetyl-CoA
Tay-sachs
Ganglioside accumulation due to defective hexosaminidase A.
Autosomal Recessive
Nieman-Pick
Sphingomyelin accumulation due to defective sphingomyelinase.
Autosomal Recessive
bilateral failure to adduct eyes is commonly A/W
multiple sclerosis

this is internuclear ophthalmoplegia
Which type of OI fatal in neonates?
OI Type II
Defect in OI?
Type I Collagen
osteogenic sarcoms risk factor?
Paget disease of bone
cat scratch a/w
bartonella henselae
bacillary angiomatosis
mycoplasma pneumoniae a/w
autoimmune lysis of rbc's due to antigen mimicry
mva a/w
splenectomy
rubella vaccine
live attenuated
sickle cell associated infxn's
salmonella and parvovirus
Corynebacteria Diphtheria treatment after infection
Anti-toxin first
Penicillin or erythromycin
DPT Vaccine
Chlamydia treatment
Erythromycin or Doxycycline
Neisseria treatment
Ceftriaxone(3rd gen cephalosporin)
Staph Aureus Virulence factor MOA
Protein A binds Fc portion of IgG causing reduced activation of complement (particularly C3b)
gram positive rod that is beta hemolytic
Listeria monocytogenes
Gram positive cocci that is beta hemolytic
Staph aureus
gram positive produces LPS
Listeria
virulence factor of gram negatives, induces Acute phase reactants
Lipid A
ophthalmoplegia neonatorum
N. gonorrhea, Chlamydia

prophylactic Erythromycin eye drops in all neonates
Tetanus vaccine
formalin inactivated toxin(toxoid). Cannot administer to neonates, start regimen at 2 months.
mycoplasma pneumonia has this in its plasma membrane...
cholesterol

macrolides, tetracyclines will work against these organisms. Any of the anti-bacterials that work against cell walls will NOT.
EBV test
heterophil antibody test. Check if patient serum IgM antibodies agglutinates horse antigens. Very specific for EBV. Also called monospot test
Cryoglobulins a/W
Hep C
pharyngeal colonization
N. meningitidis

meningococci commonly isolated from oro/nasopharynx of asymptomatic carriers
special capsule
bacillus anthracis has a poly-d-glutamate capsule
Most common cause of hematogenously spread osteomyelitis
Staph. Aureus

Strep. Pyogenes (Group A Strep)
Pioglitazone drug class, MOA
Thiazoledinedones work via transcription regulation of the PPAR-gamma gene.
transactivation a/w
Thiazoledinedones MOA of transcription modulation.

That is the TZD binds to the PPAR-gamma receptor and allows another coactivator to bind which then causes the downstream transcription regulation. This is "transactivation"
Adiponectin modulated by
TZD's

they increase the levels of adiponectin.

Adiponectin inversely proportional to body fat percentage.
Reed-Sternberg Cells
Hodgkin's Lymphoma

AKA Lacunar Histiocytes for certain cells. "Owl's Eye"

CD30 CD15 POSITIVE

CD20 CD45 negative
Most common opportunistic mycosis
candida
germ tubes at 37 degrees. yeast at 20.

can affect any organ.
ellipsoidal cysts with smooth well defined walls and 2+ nuclei
Giardia
Mode of infection of Giardia
drinks infected water
where does giardia infect
duodenal and jejunal lining
stool containing blood and mucus treated with?
Ciprofloxacin, or another fluoroquinolone

inflammatory traveler's diarrhea
produces liver cysts and cysts elsewhere. treat with?
Tapeworm(cestode), Echinococcus granulosus

Albendazole
C. jejuni common medication. What do you use if it's resistant to this?
Commonly used fluoroquinolones. If resistant use Erythromycin.
Mode of resistance of MRSA
mutation in PBP's, therefore NO penicillin will work. NO beta-lactam will work. NO CEPHALOSPORIN WILL WORK BIATCH. New fortress!
mechanism of resistance to tetracyclines and sulfonamides
decreased uptake/increased efflux
resistance to rifampin?
mutation in RNA polymerase
escape mutants of HIV correlated with which gene?
env gene. Has to do with a mutation in the glycoprotein coat of the virion that evades humoral immunity. Usually develops slightly after primary infection
what cultures C. diptheria?
cysteine-tellurite
What cultures in Bordet-gengou medium?
Bordetella Pertussis

blood, potato extract, and glycerol, with an antibiotic such as cephalexin or penicillin and sometimes nicotinamide
Thayer Martin contains what? cultures what?
Vancomycin, Colistin(polymyxin), and Nystatin(AKA VCN medium) and grows neisseria
What's special about Hep D?
It is an unenveloped negative sense RNA virus in a helical capsid. It can ONLY coinfect with Hep B because it needs to the second external coat to enter host cells.
Action of ether on viruses
Ether makes kills the infectivity of enveloped viruses, not so much non-enveloped viruses.

Ether and organic solvents destroy the cell membrane overlying viral capsids that are enveloped.
What enzyme is upregulated during inflammation?
COX-2 specifically. COX-1 is not present in inflamed tissues.
Infliximab MOA
monoclonal antibody that irreversibly binds to TNF-alpha, a cytokine involved in the inflammatory response.
Isolated Systolic Hypertension A/W
Age related aortic stiffness(loss of compliance).

Normal DIASTOLIC pressure but elevated SYSTOLIC pressure
Anti-dsDNA
Lupus
Anti-centromere
CREST Scleroderma

C -- Anti-Centromere/Calcinosis
R -- Raynauds
E -- Esophageal Dysmotility
S -- Sclerodactyly
T -- Telangiectasias of the skin
Anti-ribonucleoprotein
Sjogren's Disease
Anti-histone
drug induced lupus
Anti-Sm
Lupus
Anti-U1RNP
Mixed Connective Tissue Disease
Base Excision Repair process
Glycosylase cleave the altered base leaving an AP site(Apurination or Apyrimidination).
Endonuclease cleaves the 5' end and lyase cleaves the 3' sugar phosphate
DNA polymerase and ligase fill the single nucleotide gap
Metabolism of 1g protein yields how many calories? 1g carb? 1g fat?
1 g protein = 4 calories
1 g carb = 4 calories
1 g fat = 7 calories
Colicky abdominal pain, constipation, irritability and headaches with occupasional exposure.
PMI of iron deficiency anemia, depression and illicit drug use
Lead poisoning
Microcytic hypochromic anemia and basophilic stippling
presentation of lead poisoning
Four stages of iron poisoning
1.) Nausea, Diarrhea and abdominal pain. Hemorrhage, hypovolemia and shock.
2.) GI symptoms resolve, temporarily better.
3.) Metabolic acidosis, hepatic dysfunction, and hypoglycemia
4.) Scarring of recovered GI tract
Commons site of gastric ulcers
lesser curvature of stomach
Common complication of gastric ulcers causing bleeding
infiltration into the left or right gastric arteries
Where do the gastro-omental arteries arise from?
left gastro-omental <--- splenic artery <--- celiac trunk

right gastro-omental <--- Gastroduodenal <--- hepatic artery <--- celiac trunk
What stimulates bicarb secretion into the duodenum?
The S cells of the duodenum secrete secretin which signal the exocrine pancreas to secrete a high bicarb, low chloride solution in response to HCl from stomach entering the duodenum
What cells of the pancreas does secretin not influence?
pancreatic acinar cells
Major hormones produced by pancreas
Insulin, Glucagon and somatostatin
Major hormone secreted by gastric mucosa
gastrin - produced by G cells of the gastric antrum. Stimulates parietal cells to make more acid
Hormones secreted by kidneys
Erythropoietin and renin. Vitamin D activated in kidney
young child with recurrent diarrhea
think of IgA deficiency that is causing either Giardia or other bacterial/viral diseases
Where do IgG antibodies bind complement?
Towards the middle of the antibody near the disulfide bond. Not where the Fc portion binds macrophages or the Fab portion binds antigen.
Which is more effective at activating complement?
IgM. C1 needs to bind Fc'ish region of complement of atleast two antibodies, and since IgM circulates in pentamer form...yeah.
CHF activates what physiologic response?
CHF decreases blood flow to kidney which releases Renin, causing the creation of Angiotensin II and Aldosterone.
Angiotensin II causes vasoconstriction and Aldosterone increases blood volume, both of which exacerbate the heart failure.
Hypermethylation of histones
Methylation of amino acids in histones increase their ability to repress transcription
DNA acetylation
weakens the DNA histone bond making DNA more accessible for transcription
Mechanism by which subacute endocardial infecion occurs
Fibrin-platelet aggregates form on damaged tissue(through the whole homeostatic mechanism).

Subacute endocarditis can be caused by Viridens Strep which man synthesize dextran from sucrose which mediates adherence to fibrin. Without this fibrin, they cannot adhere to anything.
Catalase positive organisms
Staph. Aureus
Pseudomonas Cepacia
Serratia Marcescens
Nocardia species
Aspergillus species
Light reflex pathway
1.) Light hits eye travels down optic nerve(afferent pathway) to the ipsilateral pretectal nucleus located in superior colliculus.
2.) Ipsilateral pretectal nucleus projects fibers to both edinger-westphal nuclei.
3.) Neurons(preganglionic parasympathetic) from Edinger-Westphal nucleus of each side project to their respective ciliary ganglions(post-panglionic parasympathetic) via the oculomotor nerve(III)
light enters one eye, both pupils constrict. This is called?
consensual response
elevation of blood urea nitrogen indicates?
Kidney failure.
Hepatic encephalopathy is secondary to?
increased levels of ammonia in circulation
Genetic linkage describes?
alleles that are inherited together due to close proximity on gene
Pleiotropy is...?
multiple phenotypic manifestations due to a single gene defect
What disease demonstrates low levels of AFP during pregnancy?
Down's Syndrome(Trisomy 21)

Multiple Gestation, Omphalocoele and Neural tube defects all have increased AFP
What is the triple test?
A test of beta-HCG, AFP and estriol
What findings present on the triple test for Edward's syndrome
Trisomy 18 or Edwards syndrome presents with low AFP AND low beta-HCG in a triple test.
Normal Chest A-P Radiograph
1.) Superior Vena Cava
2.) Right Atrium
3.) Right Ventricle
4.) Aortic Knuckle
5.) Pulmonary Artery
6.) Left Ventricle
7.) Apex
red-colored urine
acute post-streptococcal glomerulonephritis
most common nephritic syndrome
acute post-streptococcal glomerulonephritis
lumpy bumpy appearance on immunofluorescence
acute post streptococcal glomerulonephritis
Acute post streptococcal glomerulonephritis hypersensitivity?
It is immune complex mediated and is therefore

Type III Hypersensitivity
Parvovirus B19
risk for aplastic crisis in...

Beta Thalassemia
Hereditary Spherocytosis
Sickle Cell Anemia
Asplenic Patients
Osteomyelitis in Sickle Cell...
Salmonella
Most common cause of death in children with Sickle Cell
H. Flu infection
African American child 6 monthsish with dactylitis
Think sickle cell anemia
Most common pediatric malignancy?
Acute Lymphoblastic Leukemia(ALL), can present with anterior mediastinal mass
Pre-B lymphoblast cell surface markers
CD10+, CD19+, CD20+
Pre-T lymphoblast cell surface markers
CD2+, CD3+, CD4+, CD5+, CD7+, CD8+