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148 Cards in this Set
- Front
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What is T cell independent activation
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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.
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What is the dietary form of coenzyme A?
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Pantothenic Acid
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What reactions need pantothenic acid?
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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. |
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TCA Cycle
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Method to test for Syphilis
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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. |
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Cold agluttinins are characteristic of?
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Mycoplasma infection
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Presentation with drooling
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H.Flu
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Travel related mycobacterial infections
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Coccidioides -- California
paracoccidioides -- latin america Histoplasma -- Mississipi/Ohio rivers Blastomyces -- East of Mississipi/Central America |
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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 |
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What organism has a mold form and an endospore form?
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Coccidioides Immitis
Spores that turn into spherules when inhaled that are fileld with endospores. |
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pigeon droppings?
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Cryptococcus neoformans + immunocompromised
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Central America
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Blastomyces
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Mississippi/Ohio River
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Histoplasma
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fungus ball
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Aspergillosus
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Opportunistic mycoses
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Candida, Aspergillus, Cryptococcus neoformas, Mucor/Rhizopus, PCP, Sporothrix Schenkii
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Treatment for primary Herpes infection
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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. |
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Enfuvirtide
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HIV drug that prevents viral attachment to target cells
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Indinavir
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HIV drug that inhibits viral protease activity
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Neuraminidase inhibitors
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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 |
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upregulation of interferon synthesis in infected cells accomplished by...?
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interleukins
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water systems contamination?
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Legionella
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Legionella culture requirements?
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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! |
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Ventilator associated pneumonias
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E.Coli, Klebsiella, Acinetobacter and Pseudomonas
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an infant under two years develops coughing, wheezing or SOB
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RSV, Bronchiolitis, Paramyxovirus
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Barracks virus
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Adenovirus
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Self-limited viral febrile pharyngitis only seen in barracks
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Adenovirus
self limited, febrile pharyngitis, cough, nasal congestion, conjunctivits, enlarged cervical lymph nodes rodent association |
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viral gastroenteritis
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norwalk virus, calicivirus
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aplastic crisis in sickle cell anemia
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Parvovirus B19
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edema in fetus
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Parvovirus B19 causing hydrops fetalis
hydrops fetalis also caused by syphilis |
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rash on the face of an infant spreading to the trunk
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Parvovirus B19, fifth disease
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viral infection from humans exposed to rodent
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Lymphocytic choriomeningitis virus(LCV) which is an arenavirus
causes febrile septic meningoencephalitis or mild systemic influenza like illness |
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no organisms/bacteria found in CSF with high fever and neck stiffness
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febrile aseptic meningoencephalitis caused by LCV, which is an arenavirus
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Molluscum contagiosum
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poxvirus
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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 |
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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 |
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bilateral adrenal hemorrhage
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Neisseria meningitis infection causing Waterhouse-Friderichsen syndrome leading to adrenal insufficiency, brisk hypotension and death
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Cottage cheese vaginal discharge
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candida, usually secondary to antibiotic administration that destroys normal flora(gram + lactobacilli)
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decreased thickness of vaginal epithelium and decreased glycogen concentration
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secondary to decrease in estrogen in postmenopausal women
WA - atrophic vaginitis |
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Elevated pH of vaginal secretions
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Trichomonas vaginitis and bacterial vaginitis
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uncontrolled diabetes mellitus in woman can lead to...
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candida infection
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contraceptive(oral/topical) in woman can lead to...
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candida infection
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corticosteroid therapy can lead to in a woman...
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candida infection
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parvovirus replicates where?
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marrow mostly
mature erythrocytes, erythroid precursors, fetal liver, heart. |
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Rash that follows parvovirus B19 infection caused by?
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Immune complex deposition which would be...
Type III hypersensitivity |
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Most upper respiratory infections caused by...
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Viruses
Mostly Rhinovirus or influenza(orthomyxovirus) |
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Brassy cough, difficulty breathing
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Croup, paramyxovirus
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What's in Thayer-Martin medium? What does it culture?
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Vancomycin, colistin, nystatin, trimethoprim
Vanco - blocks gram + Colistin(or polymyxin) - blocks most gram - Nystatin - blocks yeast Trimethoprim - blocks proteus cultures neisseria meningitidis |
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raw or steamed shellfish
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Hepatitis A, picornavirus
if viral gastroenteritis, think calicivirus and norwalk fever |
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Which TCA reactions need NAD+
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Isocitrate --> oxalosuccinate
alpha-ketoglutarate --> Succinyl-CoA malate --> oxaloacetate |
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Oxaloacetate --> Citrate
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Needs Acetyl-CoA
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Tay-sachs
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Ganglioside accumulation due to defective hexosaminidase A.
Autosomal Recessive |
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Nieman-Pick
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Sphingomyelin accumulation due to defective sphingomyelinase.
Autosomal Recessive |
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bilateral failure to adduct eyes is commonly A/W
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multiple sclerosis
this is internuclear ophthalmoplegia |
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Which type of OI fatal in neonates?
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OI Type II
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Defect in OI?
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Type I Collagen
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osteogenic sarcoms risk factor?
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Paget disease of bone
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cat scratch a/w
bartonella henselae |
bacillary angiomatosis
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mycoplasma pneumoniae a/w
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autoimmune lysis of rbc's due to antigen mimicry
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mva a/w
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splenectomy
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rubella vaccine
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live attenuated
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sickle cell associated infxn's
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salmonella and parvovirus
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Corynebacteria Diphtheria treatment after infection
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Anti-toxin first
Penicillin or erythromycin DPT Vaccine |
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Chlamydia treatment
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Erythromycin or Doxycycline
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Neisseria treatment
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Ceftriaxone(3rd gen cephalosporin)
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Staph Aureus Virulence factor MOA
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Protein A binds Fc portion of IgG causing reduced activation of complement (particularly C3b)
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gram positive rod that is beta hemolytic
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Listeria monocytogenes
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Gram positive cocci that is beta hemolytic
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Staph aureus
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gram positive produces LPS
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Listeria
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virulence factor of gram negatives, induces Acute phase reactants
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Lipid A
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ophthalmoplegia neonatorum
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N. gonorrhea, Chlamydia
prophylactic Erythromycin eye drops in all neonates |
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Tetanus vaccine
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formalin inactivated toxin(toxoid). Cannot administer to neonates, start regimen at 2 months.
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mycoplasma pneumonia has this in its plasma membrane...
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cholesterol
macrolides, tetracyclines will work against these organisms. Any of the anti-bacterials that work against cell walls will NOT. |
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EBV test
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heterophil antibody test. Check if patient serum IgM antibodies agglutinates horse antigens. Very specific for EBV. Also called monospot test
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Cryoglobulins a/W
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Hep C
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pharyngeal colonization
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N. meningitidis
meningococci commonly isolated from oro/nasopharynx of asymptomatic carriers |
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special capsule
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bacillus anthracis has a poly-d-glutamate capsule
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Most common cause of hematogenously spread osteomyelitis
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Staph. Aureus
Strep. Pyogenes (Group A Strep) |
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Pioglitazone drug class, MOA
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Thiazoledinedones work via transcription regulation of the PPAR-gamma gene.
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transactivation a/w
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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" |
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Adiponectin modulated by
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TZD's
they increase the levels of adiponectin. Adiponectin inversely proportional to body fat percentage. |
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Reed-Sternberg Cells
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Hodgkin's Lymphoma
AKA Lacunar Histiocytes for certain cells. "Owl's Eye" CD30 CD15 POSITIVE CD20 CD45 negative |
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Most common opportunistic mycosis
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candida
germ tubes at 37 degrees. yeast at 20. can affect any organ. |
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ellipsoidal cysts with smooth well defined walls and 2+ nuclei
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Giardia
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Mode of infection of Giardia
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drinks infected water
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where does giardia infect
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duodenal and jejunal lining
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stool containing blood and mucus treated with?
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Ciprofloxacin, or another fluoroquinolone
inflammatory traveler's diarrhea |
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produces liver cysts and cysts elsewhere. treat with?
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Tapeworm(cestode), Echinococcus granulosus
Albendazole |
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C. jejuni common medication. What do you use if it's resistant to this?
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Commonly used fluoroquinolones. If resistant use Erythromycin.
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Mode of resistance of MRSA
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mutation in PBP's, therefore NO penicillin will work. NO beta-lactam will work. NO CEPHALOSPORIN WILL WORK BIATCH. New fortress!
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mechanism of resistance to tetracyclines and sulfonamides
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decreased uptake/increased efflux
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resistance to rifampin?
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mutation in RNA polymerase
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escape mutants of HIV correlated with which gene?
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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
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what cultures C. diptheria?
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cysteine-tellurite
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What cultures in Bordet-gengou medium?
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Bordetella Pertussis
blood, potato extract, and glycerol, with an antibiotic such as cephalexin or penicillin and sometimes nicotinamide |
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Thayer Martin contains what? cultures what?
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Vancomycin, Colistin(polymyxin), and Nystatin(AKA VCN medium) and grows neisseria
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What's special about Hep D?
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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.
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Action of ether on viruses
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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. |
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What enzyme is upregulated during inflammation?
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COX-2 specifically. COX-1 is not present in inflamed tissues.
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Infliximab MOA
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monoclonal antibody that irreversibly binds to TNF-alpha, a cytokine involved in the inflammatory response.
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Isolated Systolic Hypertension A/W
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Age related aortic stiffness(loss of compliance).
Normal DIASTOLIC pressure but elevated SYSTOLIC pressure |
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Anti-dsDNA
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Lupus
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Anti-centromere
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CREST Scleroderma
C -- Anti-Centromere/Calcinosis R -- Raynauds E -- Esophageal Dysmotility S -- Sclerodactyly T -- Telangiectasias of the skin |
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Anti-ribonucleoprotein
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Sjogren's Disease
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Anti-histone
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drug induced lupus
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Anti-Sm
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Lupus
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Anti-U1RNP
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Mixed Connective Tissue Disease
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Base Excision Repair process
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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 |
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Metabolism of 1g protein yields how many calories? 1g carb? 1g fat?
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1 g protein = 4 calories
1 g carb = 4 calories 1 g fat = 7 calories |
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Colicky abdominal pain, constipation, irritability and headaches with occupasional exposure.
PMI of iron deficiency anemia, depression and illicit drug use |
Lead poisoning
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Microcytic hypochromic anemia and basophilic stippling
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presentation of lead poisoning
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Four stages of iron poisoning
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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 |
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Commons site of gastric ulcers
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lesser curvature of stomach
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Common complication of gastric ulcers causing bleeding
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infiltration into the left or right gastric arteries
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Where do the gastro-omental arteries arise from?
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left gastro-omental <--- splenic artery <--- celiac trunk
right gastro-omental <--- Gastroduodenal <--- hepatic artery <--- celiac trunk |
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What stimulates bicarb secretion into the duodenum?
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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
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What cells of the pancreas does secretin not influence?
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pancreatic acinar cells
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Major hormones produced by pancreas
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Insulin, Glucagon and somatostatin
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Major hormone secreted by gastric mucosa
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gastrin - produced by G cells of the gastric antrum. Stimulates parietal cells to make more acid
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Hormones secreted by kidneys
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Erythropoietin and renin. Vitamin D activated in kidney
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young child with recurrent diarrhea
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think of IgA deficiency that is causing either Giardia or other bacterial/viral diseases
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Where do IgG antibodies bind complement?
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Towards the middle of the antibody near the disulfide bond. Not where the Fc portion binds macrophages or the Fab portion binds antigen.
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Which is more effective at activating complement?
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IgM. C1 needs to bind Fc'ish region of complement of atleast two antibodies, and since IgM circulates in pentamer form...yeah.
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CHF activates what physiologic response?
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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. |
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Hypermethylation of histones
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Methylation of amino acids in histones increase their ability to repress transcription
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DNA acetylation
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weakens the DNA histone bond making DNA more accessible for transcription
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Mechanism by which subacute endocardial infecion occurs
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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. |
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Catalase positive organisms
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Staph. Aureus
Pseudomonas Cepacia Serratia Marcescens Nocardia species Aspergillus species |
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Light reflex pathway
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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) |
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light enters one eye, both pupils constrict. This is called?
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consensual response
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elevation of blood urea nitrogen indicates?
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Kidney failure.
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Hepatic encephalopathy is secondary to?
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increased levels of ammonia in circulation
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Genetic linkage describes?
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alleles that are inherited together due to close proximity on gene
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Pleiotropy is...?
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multiple phenotypic manifestations due to a single gene defect
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What disease demonstrates low levels of AFP during pregnancy?
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Down's Syndrome(Trisomy 21)
Multiple Gestation, Omphalocoele and Neural tube defects all have increased AFP |
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What is the triple test?
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A test of beta-HCG, AFP and estriol
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What findings present on the triple test for Edward's syndrome
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Trisomy 18 or Edwards syndrome presents with low AFP AND low beta-HCG in a triple test.
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Normal Chest A-P Radiograph
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1.) Superior Vena Cava
2.) Right Atrium 3.) Right Ventricle 4.) Aortic Knuckle 5.) Pulmonary Artery 6.) Left Ventricle 7.) Apex |
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red-colored urine
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acute post-streptococcal glomerulonephritis
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most common nephritic syndrome
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acute post-streptococcal glomerulonephritis
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lumpy bumpy appearance on immunofluorescence
acute post streptococcal glomerulonephritis |
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Acute post streptococcal glomerulonephritis hypersensitivity?
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It is immune complex mediated and is therefore
Type III Hypersensitivity |
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Parvovirus B19
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risk for aplastic crisis in...
Beta Thalassemia Hereditary Spherocytosis Sickle Cell Anemia Asplenic Patients |
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Osteomyelitis in Sickle Cell...
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Salmonella
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Most common cause of death in children with Sickle Cell
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H. Flu infection
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African American child 6 monthsish with dactylitis
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Think sickle cell anemia
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Most common pediatric malignancy?
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Acute Lymphoblastic Leukemia(ALL), can present with anterior mediastinal mass
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Pre-B lymphoblast cell surface markers
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CD10+, CD19+, CD20+
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Pre-T lymphoblast cell surface markers
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CD2+, CD3+, CD4+, CD5+, CD7+, CD8+
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