Week 1 - Day 3 Notes

Front 1

What are the other complications other than infant pneumonia,urethritis, trachoma of Chlamydia infection?

Back 1

1. PID (usu. asymmptomatic - important to treat because it can scar falopian tube -cause ectopic pregnancy etc)
2. Epididmyitis in men
3.Reiter's syndrome - inflamm. arthritis of large joints, young men,uveitits,conjunctivitis.
4. Fitz-Hugh-Curtis Syndrome : inflamm. of liver capsule
5. Lymphogranuloma Verereum: similar to Haemophilus ducreyi.

Front 2

what is Lymphogranuloma Venereum? how is it different from Haemophilus ducreyi-which cause Chancroid?

Back 2

1.Sexually transmitted disease of C. trachomatis (L1-3 serotypes)
2.Painless ulceration on genital-heals spontaneously
3. Then,Regional Lymph node enlarge in 2months - tender and may bust,drain pus

(All these occur quicker in H. Ducreyi-unilateral lymphnodes as well and Ulcer and enlarged lymph node co-exist)

Front 3

1.What is the difference between typical pneumonia(Strep pneumonia) and atypical pneumonia?
2.List causes of Atypical?

Back 3

1. In typical-sicker pt, hacking cough, yellow sputum with pus, Consolidated lung -WBC - heard on lung exam and seen on x-ray
Atypical- no sputum,lung exam close to normal, dry hacking cough, lung x-ray inflitrates, (fever,headache)
2. viruses, Mycoplasma, Chlamydia psittaci, Chlamydia pneumoniae

Front 4

Route of transmission of these 2 pneumoniae causing bugs - Chlamydia Psittaci and Chlamydia Pneumoniae?

Back 4

C. Psittaci - Birds
C. Pneumoniae - person to person

Front 5

Describe Rickettsia (the other small bug)?

Back 5

1. g-rod non motile obligate intracellular organism (like Chlamydia)

Front 6

How is Rickettsia different from Chlamydia?

Back 6

1. Uses vectors (except for Q fever)
2. Replicates freely in cytoplasm (not endosomes)
3. Tropism for Endothelial (unlike Columnar epithelium)
4. Causes Rash, high fevers,bad headaches

Front 7

Name the Rickettsia vectors and their disease?

Back 7

1. Tick - Rocky Mountain Fever
2. Louse- Epidemic typhus
3. Flea - Endemic typhus

Front 8

what is Brill Zinsser disease?

Back 8

Latent form of Rickettsia Prowazeki infection that was untreated with Antibiotics.

Front 9

What is the vector and the disease caused by Rickettsia Prowazekii?

Back 9

1. Louse
2. Epidemic typhus (killed 1/3 of napoleon's men)

Front 10

Define Epidemic and Endemic diseases?

Back 10

1. Epidemic - Sudden onset and rapid spread infection to a large population.
2. Endemic - Infectious disease that is persistent in a population.

Front 11

What disease does Rickettsia Typhi cause and what is the vector, reservoir?

Back 11

1. Endemic typhus
2. Flea -vector
3. Rodents -Reservoir
Like bubonic plague - kill the fleas and rats (not just the rats)

Front 12

Clinical sx of Rickettsia typhi (endemic typhus), Tx?

Back 12

1. fever,headache, maculopapular rash, serious but not as bad as T.prowazekii(epidemic typhus)
2. Doxycycline or Cloramphenicol

Front 13

Cause of Scrub Typhus,Vector and what part of the world found in?

Back 13

1. Rickettsia Tsutsugamushi-rash,scrab at bite site, high fever
2. Larvae of mite
3. Asia

Front 14

Cause of Trench fever, Vector,Sx and Why is not named as part of the Rickettsia genus?

Back 14

1. Bartonella quintana(5)
2. Lice (like R. prowazekii)
3. High fevers, rash, headache,back and leg pain. Relaspe 5dys
4.Rickettsia like but no an obligate intracellular organism

Front 15

Cause of Cat-scratch disease, Sx, and name another disease caused by bug in AIDs patient?

Back 15

1. Bartonella Henselae
2.Cat bite or scratch
3. Sx: enlarged regional lymph node,low-grade fever, resolves -n months
4. Bacillary Angiomatosis - small blood vessel formed in skin and organs of AIDs pt.

Front 16

What does Coxiella burnetti (Rickettsia group) cause, Sx, transmission? This bug is similar to what other bugs?

Back 16

1. Q-fever
2. The only rickettsial infection to cause pneumonia. Also cause sudden fevers, soaking sweats, NO RASH!
3. Forms endospores - so inhaled rather than bites from tick

Front 17

1.What disease is Ehrilichiosis similar to?
2. Disease to what other animal (loves to lick)
3. Vector

Back 17

1. Similar to Rocky Mountain fever - rash is rare only about 20% of time.
2. Disease of dogs (and humans)
3. Tick

Front 18

Obligate intracellular bacterium that is tropic for columnar epithelial cells of conjunctiva, cervix, and lung.

Back 18

chlamydia

Front 19

two forms of chlamydia during its life cycle.

Back 19

Elementary body (extracellular) / initial body (intracellular form)

Front 20

Treatment for chlamydial infections

Back 20

tetracycline / erythromycin

Front 21

leading cause of preventable blindness in the world. Causes blindness over years

Back 21

Trachoma

Front 22

Chlamydia trachomatis primarily affects what two areas of the body?

Back 22

eyes, genitals.

Front 23

Most common cause of urethritis

Back 23

chlamydia

Front 24

Why will penicilin not work against chlamydia.

Back 24

it has no peptidoglycan layer

Front 25

Chlamydia infection is associated with ------- ------, an inflammatory arthritis of large joints commonly occuring in young men. Also uveitis, conjunctivitis, urethritis is seen with this condition.

Back 25

Reiter's syndrome

Front 26

Fitz-Hugh-Curtis syndrome is an infection of what?

Back 26

liver capsule (perihepatitis)

Front 27

Chlamydia species found in birds. Causes atypical pneumonia in humans.

Back 27

Chlamydia psittaci

Front 28

Rickettsia require arthropod vectors except for ------ ----.

Back 28

Q fever agent (Coxiella burnetti)

Front 29

While chlamydia parasitize columnar epithelium, rickettsia have a tropism for ------- cells. That's why you get rashes with rickettsial diseases.

Back 29

endothelial (hence the rashes)

Front 30

Name the the test for rickettsial infection using antigens from strains of Proteus

Back 30

Weil-Felix reaction

Front 31

Name that disease: Severe headache, conjunctival redness, fever, rash on palms, soles spreading to trunk. Hx of camping in Georgia.

Back 31

RMSF

Front 32

Agent of RMSF

Back 32

Rickettsia ricketsii

Front 33

Rickettsia akari causes -------. There is a dramatic response to what drug?

Back 33

rickettsial pox . Doxycycline

Front 34

Cause of endemic typhus

Back 34

Rickettsia typhi

Front 35

Cause of epidemic typus

Back 35

Rickettsia prowazekii

Front 36

Cat scratches pt --> regional lymphadenopathy --> low grade fever, malaise --> usu resolves in a few months without complications. What is the organism?

Back 36

Bartonella (Rochalimaea henselae)

(also causes Bacillary angiomatosis in AIDs patients)

(same group with Rickettsia, Trench fever (bartonella quintana)- this transmitted by louse as well)

Front 37

In contrast to the other rickettsia, the agent that causes Q fever is acquired by ------ ------ and not by an arthropod bite.

Back 37

spore inhalation from tick feces and cattle hide

Front 38

A disease like RMSF, but in which the rash is not common

Back 38

Ehrlichiosis

Front 39

How do spirochetes replicate?

Back 39

transverse fission

Front 40

If untreated, patients with syphilis will progress through 3 stages, with a latent period between stages -- and --.

Back 40

2(secondary) and 3(tertiary)

Front 41

Name the stage of syphilis.- Gummas of skin and bone, aortitis, neurosyphilis

Back 41

Tertiary

Front 42

Name the stage of syphilis. Painless chancre, nontender lymphadenopathy (regional)

Back 42

Primary stage

Front 43

What are the manifestations of secondary syphilis?

Back 43

rash on palms and soles, condyloma latum, CNS, eyes, bones, kidneys, and/or joints may be involved.

Front 44

Painless, solitary, granulomatous lesions on skin

Back 44

gummas. Also occur in bone.

Front 45

How do aortic dissections occur as a result of syphilis?

Back 45

syphilis destroys small arterioles (vasa vasorum) --> tunica media necroses --> dissection

Front 46

1.Name two bacteria that cause subacute meningitis?
2.Describe subacute meningitis as opposed to acute meningitis?

Back 46

1.Treponema(syphillis), Mycobacterium (TB)
2.
Subacute: High lymphocyte*,low glucose,high protein.
Acute: High PMN, low gluc.,high protein.

Subacute there is a predominance of lymphocytes.

Front 47

If the posterior columns are damaged in tabes dorsalis, what will the the clinical sign?

Back 47

ataxia from loss of proprioception and vibratory sense.

Front 48

What will result from the loss of DRG in neurosyphilis?

Back 48

loss of reflexes, pain and temp sensation

Front 49

Describe the argyl-robertson pupil.

Back 49

constricts during accommodation, but does not react to light

Front 50

What condition is this: 1 year old presents with osteitis, (seen on X ray); widespread rash; condyloma latum

Back 50

Early congenital syphilis

Front 51

Which cranial nerve is classically affected in late congenital syphilis?

Back 51

8th nerve

Front 52

The bone and teeth are involved in late congenital syphilis. What is the deformity of the nose called?

Back 52

saddle-nose deformity

Front 53

If the VDRL is negative, but the FTA-ABS is positive, what does that indicate?

Back 53

successfully treated syphilis

Front 54

What is this: after treatment for syphilis, a pt develops mild fever, chills, malaise, headache, and muscle aches. This condition resolves on its own.

Back 54

Jarisch-Herxheimer reaction

Front 55

Endemic syphilis is transmitted by sharing eating utensils in what part of the world?

Back 55

desert regions of mid east and africa

Front 56

----- nerve palsy may be seen in early disseminated lyme dz.

Back 56

7th nerve palsy (bell's )

Front 57

Most common heart abnormality in Lyme disease.

Back 57

heart block (av block)

Front 58

Treatment for syphilis

Back 58

penicillin

Front 59

What do you give for syphilis if the pt is allergic to penicillin?

Back 59

erythromycin or doxycycline

Front 60

What do you give for syphilis if the pt is pregnant and allergic to penicillin?

Back 60

erythromycin (don't give doxy)

Front 61

Tx for Lyme

Back 61

Doxycycline, penicillin

Front 62

The rashes from rickittesia are due to what inflammatory process?

Back 62

Vasculitis

Front 63

What are the requirements of Rickettsia as an obligate intracellular bacteria?

Back 63

NAD and CoA (except for Coxiella -Qfever)

Front 64

What is the best Tx for Rickettesial infections

Back 64

Tetracycline

Front 65

What are the key differences of Coxiella (Q fever) other than not being an intracellular bacteria?

Back 65

1. No Rash
2. Aerosol (instead of tick bite)
3. Negative Weil-Felix (proteus antigenic rxn)
4. Does not have Rickettsia as genus name. Coxiella burnetii

Front 66

Difference in Rash distribution in Rocky spotted mountain fever (R. rickettsia) and the Typhus fevers?

Back 66

RSMF - centripetal (out--> in)
Typhus -CentrPHugal (in -->out)

Front 67

Name the 3 genera of Spirochetes and example for each?

Back 67

1. Treponema - syphillis
2. Borrelia - Lyme disease
3. Leptospira - Weil's disease

all have 6 axial filaments,transverse fission, very small(except for Borrelia-big),g-

Front 68

C. Trochomatis D,K serotype causes?

Back 68

1. urethritis
2.PID
3.Neonatal pneumonia and conjunctivitis

Front 69

Which is a better test for Treponemes (e.g syphillis) - FTA-ABS or VDRL?

Back 69

1.FTA-ABS (find the antibody- ABSolutely)
VDRL -less specific, false + (mono,hepatitis,drugs,Rheumatic fever,RA,SLE,and leprosy)

FTA-ABS
1. Sensitive (early detection)
2. + for long time
3. Most specific

Front 70

What are associated with late congenital syphillis?

Back 70

1. Neurosyphillis - same as adults (8nerve common)
2. Saddle nose (bone involvement)
3. Saber Shins
4. Hutchinson's teeth
5. Mulberry molars
6. Eye disease

Front 71

When can you prevent congenital syphillis?

Back 71

Tx of mother with Abx before the fourth month of gestation

Front 72

what is the bacteria that causes syphillis?

Back 72

Treponema pallidum

Front 73

There are 3 subspecies of T.pallidum that are non-veneral. Name them and what they cause?

Back 73

T. endemicum - Endemic syphillis (middle east)
T. pertenue- Yaws
T. Carateum -Pinta (dicoloration, no gummas)

T.E and T.P cause gummas of skin, skin ulcers in all even T.Carateum.
The tertiary stage dont involve the aorta and CNS

Front 74

What causes lyme disease?
How many stages are there in lyme disease?

Back 74

1. Borrelia burgdorferi
2. 3 Stages
a. Early localized stage
b. Early desseminated stage
c. Late stage

Front 75

Clinically define the 3 stages of lyme disease?

Back 75

Stage 1: Erythema chronium migrans
Stage 2:
i.muliple ECM
ii. Neulogic - aseptic meningitis, cranial nerve palsies (bell's), peripheral neuropathy
iii. Cardiac: transient Heart block
iv. Brief Arthritis attacks
3.Late stage:
i. Chronic Arthritis
ii.Encephalopathy

Front 76

Borrelia genus cause lyme disease, name another disease by this genus and the complete bug name?

Back 76

Borrelia Recurrentis - Relasping fever
(due to antigenic variation during infection)

Front 77

The only two genera that are acid fast bacteria

Back 77

Mycobacteria, Nocardia

Front 78

Acid fast bacteria stain in ------ color.

Back 78

red

Front 79

What is Mtb's oxygen requirement?

Back 79

obligate aerobe

Front 80

The name for a mycolic acid bound to a carbohydrate, forming a glycolipid

Back 80

mycoside

Front 81

A mycoside formed by the union of 2 mycolic acids with a disaccharide. Only found in virulent strains of Mtb?
What is the virulence activity of this factor?

Back 81

1.cord factor
2. Cord factor inhibits neutrophil migration and damages mitochrondria
3. Also activates TNF in mice

Front 82

If cord factor is injected into mice, ----- (a cytokine) is released, leading to rapid weight loss.

Back 82

TNF or cachectin. In people, this cachexia may be confused with malignancy related cachexia

Front 83

Mycobacterium leprae like cooler temperatures, so the infection is primarily of the ----.

Back 83

skin. Spares warm areas of skin (axillae, groin)

Front 84

What determines the severity of the disease cauased by M. leprae?

Back 84

Host's cell-mediated immunity

Front 85

Most severe form of leprosy, in which hosts cannot mount an immune response.

Back 85

Lepromatous leprosy.

Front 86

What will be the result of the lepromin skin test in tuberculous leprosy? In lepromatous leprosy?

Back 86

TL = positive. LL = negative

Front 87

Size of +PPD skin induration in normal patients?in immunocomprimised patients?

Back 87

1. 10mm
2. 5mm

Front 88

To rule out false negative PPD? how can you test for the Hypersensitivity type IV rxn in a patient?

Back 88

1.Inject with Chlamydia or mumps antigens.
2. In an anergic patient will still test negative therefore confirming the PPD test is not reliable)

Front 89

Lymph node TB is called?

Back 89

Scrofula (most common extrapulmonary manifestation of TB)- location normally at the cervical lymph node

Front 90

What is Pott's disease?

Back 90

TB infection of the skeletal body of the vertebra (discs destroyed)

Front 91

What are the manifestation of TB in the CNS?

Back 91

1.Subacute meningitis (other bug-Treponema)
2. Granuloma in brain

Front 92

List the organ system involved in TB?

Back 92

1. Pulmonary
2. Miliary (disseminated - every organ possible even lung- millet seed granulomas)
3.Skeletal (pott)
4. Lymph
5. Pericardial and pleural infection
6.Kidney - sterile pyuria (hard to culture), RBC and WBC in urine
7. Joints

Front 93

What animal holds the reserve of M. Leprae that causes Hansen's disease(leprosy)in the U.S.? Tx?

Back 93

1.Armadillos
2. long term oral dapsone (toxicity: hemolysis, methemoglobinema)
alt. Tx: Rifampin or clofazimine and dapsone

Front 94

why will penicillin not work against mycoplasma?

Back 94

no peptidoglycan cell wall

Front 95

Two species of mycoplasma

Back 95

Mycoplasma pneumonia, Ureaplasma urealyticum

These guys have no cell wall (just a cell membrane) and they are really small, smaller than the largest viruses.

Front 96

Mycoplasma pneumonia causes what kind of pneumonia?

Back 96

walking (atypical)

Front 97

Does walking pneumonia cause a dry or productive cough?

Back 97

atypical pneumonias cause a dry cough

Front 98

What simple bedside test can be performed to test for the presence of antibodies to mycoplasma?
How does it work?

Back 98

1.cold agglutinin test
2. Cold agglutinin antibodies to RBC cross react at 4oC with antigens found on mycoplasma pneumonia.
Clumps in the cold, unclumps in warm temp
Normally, AB to Antigens to RBC are not made.

Front 99

To grow mycoplasma, the medium must be rich in ----?
Describe mycoplasma colonies on agar?

Back 99

1.cholesterol and nucleic acids
2. It grows and gives a fried egg appearance(tiny dome colonies).

Front 100

Ureaplasma urealyticum breaks down urea into CO2 and ammonia, just like what other bacterium?

Back 100

Proteus mirabilis, H.pylori

Front 101

In addition to U. urealyticum, what other bacteria cause urethritis?

Back 101

N. gonorrhea, Chlamydia trachomatis

Front 102

Define the cell membrane of mycoplasma?

Back 102

Stocked with sterols (like cholesterol)

Front 103

Name the two Rickettsia related bugs that cause disease carried by louse?

Back 103

1. Rickettsia Prowazekii (Epidemic typhus)
2. Bartonella quintana (trench fever)

Front 104

What are gummmas in Syphillis?

Back 104

These are granulomas in skin and bone which necrose and become fibrotic.

Front 105

What are the Rule of sixes for Syphillis?

Back 105

1.6axail filaments
2. 6week incubation b4 chancre
3. 6week for chancre to heal
4. 6weeks for secondary stage
5. 66% of patient resolve after secondary stage
6. 6years for tertiary to develop

Front 106

Is Syphillis part of the TORCHES disease? These are bugs that can cross the placenta.

Back 106

Yes.
The rest are
Toxoplasmosis
Rubella
CMV
HSV/HIV
Syphilis