Week 7

Front 1

What drug has the following MOA? Inhibits transcription of IL-2 -> inhibition of T-cell activation

Back 1

(Calcineurin inhibitors) Cyclosporine

Front 2

What drug's absorption is very erratic (pka issue), so we must do therapeutic drug monitoring?

Back 2

Cyclosporine

Front 3

What drug has the following MOA? Binds to FKBP-12 --> binding and inhibition of mTOR --> inhibition of G1-S phase progression? (CELL CYCLE ARREST), cells are then not responsive to IL-2

Back 3

(Antimetabolite class) Sirolimus/Rapamycin

Front 4

What drug is used for prophalaxis of organ rejection in patients receiving renal transplants?

Back 4

Sirolimus/Rapamycin

Front 5

What drug has the following MOA? The active metabolite MPA inhibits inosine monophosphate (IMPDH) --> inhibition of de novo guanosine nucleotide synthesis --> inhibition of T and B lymphocyte proliferation

Back 5

(Antimetabolite class) Mycophenolate Mofetil

Front 6

Which drug is used therapeutically for -prophylaxis of organ rejection concomitantly with Cyclosporine and corticosteroids in patients receiving allogeneic renal (CellCept, Myfortic), cardiac (CellCept), or hepatic (CellCept) transplants

Back 6

(Antimetabolite class) Mycophenolate Mofetil

Front 7

Which immunopharm drug has adverse effects on bone marrow?

Back 7

Mycophenolate mofetil

Front 8

Which drug has the following MOA? Binds to the CD3 cell surface receptor on thymocytes and T cells --> disruption of IL-2 signaling?

Back 8

Muromonab-CD3

Front 9

Which drug has the following MOA? A composition of cytotoxic antibodies directed against T-cells and inhibits lymphocyte function and direct cytotoxicity of lymphocytes?

Back 9

Anti-thymocyte globin (Thymoglobulin)

Front 10

What is another name for lesions that produce purpura (small hemorrhages) in skin?

Back 10

Petechiae

Front 11

Discontinuities in skin; complete loss of epidermis & often depressed in center (e.g. chancre of primary syphilis)

Back 11

Ulcers

Front 12

Large, blister-like, fluid filled vesicles

Back 12

Bullae (bullous impetigo lesions)

Front 13

Nodules consisting of lumpy & swollen accumulations of tissue

Back 13

Nodular eruptions (e.g. some disseminated fungal diseases)

Front 14

Proliferations of epithelial tissue caused by HPV

Back 14

Warts

Front 15

What is the causative agent of Pityriasis (Tinea)Versicolor?

Back 15

Malassezia furfur

Front 16

What condition is diagnosed by visualization of yeast cells and short hyphae "spaghetti and meatballs" in KOH-treated scrapings from lesion? (Lesions fluoresce yellow on exposure to UV light)

Back 16

Pityriasis (Tinea) Versicolor (Malassezia furfur)

Front 17

What pathogen leads to irregular pigmented (brown-black) lesions, usually on the palms or soles?

Back 17

Tinea Nigra (Hortaea wernecki)

Front 18

While still rare what is the only common subcutaneous mycosis in the US?

Back 18

Sporotrichosis: Sporothrix schencki

Front 19

What is a common name for the most common cutaneous mycoses?

Back 19

Tinea or ring worm infections dermatophyte fungi ; Most important genera: Trichophyton & microsporum

Front 20

With microscopic evaluation of tinea infections what are you looking for?

Back 20

Septate fungal hyphae in KOH-treated scraping from lesion

Front 21

What are the 7 types of tinea infections.

Back 21

1. Tinea corporis 2. Tinea capitis (scalp) 3. Tinea Unguium 4. tinea pedis (athletes foot). 5. Tinea barbae (reingworm of the face and/or neck

Front 22

What is the term for sloughing of the epidermal tissue?

Back 22

Positive Nikolsky sign

Front 23

What virulence factors are serine proteases that cleave desmoglein 1? They disrupt intercellular bridges in stratum granulosum epidermis (destabilizing epithelium)

Back 23

ETA, ETB (Exfoliative toxins) of S. Aureus

Front 24

Abrupt onset of perioral erythema that spreads over entire body within 2 days. Bullae form, desquamation of epithelium. ETB mostly, What is the causative pathogen and what is the syndrome called?

Back 24

SSSS (staphylcoccal scaled skin syndrome) Ritter disease

Front 25

Localized form of SSSS, mostly associated with ETA,

Back 25

Bullous impetigo

Front 26

LasA & LasB are enzymes that degrade elastin, cause hemorrhagic lesions(ecthyma gangrenosum) that develop in disseminated infections

Back 26

Pseudomonas Aeruginosa

Front 27

Hot tub folliculitis, fingernail infections, osteochondritis

Back 27

Pseudomonas Aeruginosa

Front 28

External otitis (swimmers ear), malignant external otitis**

Back 28

Pseudomonas Aeruginosa

Front 29

P. Aeruginosa

Back 29

Aztreonam, 4th gen pens (Ticarcillin, piperacillin)

Front 30

Pathogen grows in sebaceous follicles, secretes peptides that attract leukocytes, local inflammatory response

Back 30

Acne Vulgaris/ Propionibacterium acnes

Front 31

What are 2 forms of leprosy?

Back 31

Tuberculoid and Lepromatous

Front 32

Associated with strong cellular immune response, erythematous or hypopigmented plaques on skin, peripheral nerve damage and sensory loss, low infectivity, confirmed by skin test

Back 32

Tuberculoid leprosy

Front 33

What is confirmed by a skin test to Lepromin?

Back 33

M. Leprae

Front 34

Which type of immune response is predominate in Tuberculoid leprosy?

Back 34

Th1 cells (granuloma formation, disease progresses slowly)

Front 35

Which type of immune response is predominate in

Back 35

Th2 cells predominate (depressed cell-mediated) growth of bacteria in macrophages

Front 36

Associated with strong antibody response, erythematous macules, papules, nodules on skin, patchy sensory loss Histo: "Foamy" macrophages, few lymphocytes, NUMEROUS acid-fast rods HIGH infectivity

Back 36

M. Leprae, lepromatous leprosy

Front 37

Which drug has the following MOA? Competitive antagonist of PABA --> inhibition of folic acid synthesis

Back 37

Dapsone

Front 38

What anti-Tb drug has agranulocytosis and hemolysis as adverse effects?

Back 38

Dapsone

Front 39

What are the 2 pathogens of the spotted fever diseases and their disease names?

Back 39

Rickettsia Rickettsii - Rocky Mountain Spotted Fever Rickettsia Akari - Rickettsialpox

Front 40

Which disease starts with a rash on the wrists, arms, ankles then moves into the trunk?

Back 40

Rocky Mountain spotted Fever (Rickettsia Rickettsii)

Front 41

What pathogen/disease is associated with a "cosmopolitan" disease?

Back 41

Rickettsial Pox/ Rickettsia akari

Front 42

Papulovesicular rash, eschars*

Back 42

Rickettsial Pox/ Rickettsia akari

Front 43

What type of extrachromosomal elements sometimes occasionally incorporate into the chromosome?

Back 43

Episomes

Front 44

What are the 5 main things plasmids code for?

Back 44

1. Resistance to heavy metals (Hg, Cr, etc) 2. Ability to degrade complex organic compounds 3. Pili that aid in attachment to tissue surfaces 4. Toxins & other virulence factors (e.g. anthrax) 5. Antibiotic resistance and multiple resistance

Front 45

This type of bacteriophage can replicate in the bacterial cell, eventually causing the cell to lyse

Back 45

Lytic infection

Front 46

This type of bacteriophage integrates into the host cell's chromosome w/o killing the host cell

Back 46

Lysogenic infection

Front 47

What are mobile genetic elements?

Back 47

transposons "jumping genes"

Front 48

What are clusters of genes that code for virulence factors that can move within the chromosome or into the plasmid and be transferred to other cells?

Back 48

Pathogenicity (virulence) islands

Front 49

The uptake of naked DNA from the environment, can acquire plasmids, drug-resistant genes, etc

Back 49

Transformation

Front 50

What are the 4 clinically important bacteria that transfer genes by transformation?

Back 50

1. H. Influenzae (meningitis, otitis media), 2. S. Pneumoniae, 3. Bacillus spp (Anthrax, etc.), 4. Neisseria spp (gonorrhea, meningitis)

Front 51

Direct one-way transfer of DNA from cell to cell

Back 51

Conjugation

Front 52

Cells with F plasmid & F pilus

Back 52

F+ cells (donor cell)

Front 53

Cells without F plasmid

Back 53

F- cells (recipient cell)

Front 54

F plasmid integrates into chromosome of host cell -> Single strand of HFR chromosome mobilized and starts to move into recipient cell (Only part of chromosome transferred in typical conjugation event

Back 54

Hfr cell (High freq. of recombination)

Front 55

Why does an F- cell stay F-?

Back 55

Only part of the F plasmid is transferred because the conjugation bridge is fragile

Front 56

Genetic transfer mediated by bacteriophages

Back 56

Transduction

Front 57

What are the 3 ways bacteria develop resistance?

Back 57

1. Decrease access of drug to target site 2. Export of drug from bacterial cell 3. Modify drug target in bacterial cell

Front 58

Modification in 30S subunit of bacterial ribosome leads to resitance to:

Back 58

Aminoglycosides

Front 59

Modification in Replacement of alanine with lactate in bacterial peptidoglycan leads to resitance to:

Back 59

Vancomycin

Front 60

Modification in DNA gyraseleads to resitance to:

Back 60

Quinolones

Front 61

Modification in RNA polymeraseleads to resitance to:

Back 61

Rifampin

Front 62

Modification in catalase peroxidase leads to resitance to:

Back 62

Isoniazid

Front 63

Modification in penicillin-binding proteins leads to resitance to:

Back 63

Penicillins

Front 64

Chickenpox, shingles (What is the common viral name and classification?)

Back 64

HHV3, Varicella-zoster

Front 65

Mononucleosis, lymphomas, carcinoma

Back 65

HHV4, EBV

Front 66

Congenital & opportunistic infections

Back 66

HHV5, CMV

Front 67

Roseola, mono-like syndrome, etc

Back 67

HHV6, Herpes lymphotophic virus

Front 68

Roseola, mono-like syndrome, etc

Back 68

HHV7

Front 69

Kaposi sarcoma

Back 69

HHV8

Front 70

Cold sores/Fever blisters, lesions around and/or throughout mouth

Back 70

HSV-1 (most) or HSV-2

Front 71

Massive outbreak of cold sores in mouth area (primarily in children or immunocompromised)

Back 71

Gingivostomatitis (HSV-1 &2)

Front 72

Infection of finger, nurses, physicians, thumb sucking childrend

Back 72

Herpetic Whitlow(HSV-1 &2)

Front 73

Infection of the body, often acquired during wresting or playing rugby

Back 73

Herpes Gladiatorum (HSV-1 &2)

Front 74

Occurs in children with active eczema; relatively rare in adults

Back 74

Eczema Herpaticum (HSV-1 &2)

Front 75

Lesions typically involve a single dermatone

Back 75

Shingles/ HHV3 (Varicella-Zoster)

Front 76

Latent infection can be established in dorsal root or cranial nerve ganglia and be reactivated later in life , transmission is by droplet infection with skin vesicles

Back 76

Shingles/ HHV3 (Varicella-Zoster)

Front 77

Leads to chronic pain syndrome in older people who develop shingles, what is the prevention for?

Back 77

Postherpetic Neuralgia, vaccinate (Zostavax)

Front 78

Sudden fever (high 103-106), rash numerous pale, pink, almond-shaped macules, fade in few hours to 2 days (no scaling)

Back 78

Roseola Infantum (HHV-6& HHV-7)

Front 79

Large brick-shaped nucleocapsides, only DNA viruses that replicate in cytoplasm of host cells

Back 79

Poxviruses

Front 80

Virus with 2-8 wk incubation period, papules, pearl-like or wart-like nodules, easily expressed central plug, more common in children than adults

Back 80

Molluscum Contagiosum (Poxvirus)

Front 81

Non-enveloped virus, icosahedral capsids and DS DNA genome, warts, mucous membrane infections

Back 81

Papillomaviridae

Front 82

Causative agent, family of Rubella (german measles), transmitted by respiratory droplet

Back 82

Rubella virus, togaviridae, enveloped, icosahedral capsid, (+) ssRNA

Front 83

Virus has a prodromal period, can cross the placenta and infect fetus

Back 83

Rubella virus, togaviridae

Front 84

Fever, sore throat, pain on swallowing, vomiting, ulcerated lesions around soft palate and uvula, self limiting, viral

Back 84

Herpangina (Coxsackie A)

Front 85

Vesicular lesions on hands, feet, mouth and tongue, self resolves in a few days

Back 85

Hand-Foot-and mouth disease (Coxsackie virus A15)

Front 86

"Slapped Cheek" appearance

Back 86

Fifth Disease (Erythema infectiosum) Parovirus B19

Front 87

What viral infection can cause a sudden aplastic crisis in patients with sickle cell anemia, proxsomal nocturnal hemoglobinuria, etc?

Back 87

Parovirus B19

Front 88

What is the difference between German measles and regular measles?

Back 88

German measles: Rubella Regular measles: rubeola

Front 89

Rash developsbehind the patient’s ears, spread to the forehead, and then rapidly covers the rest of the body with high fever

Back 89

Measles - Rubeola

Front 90

Poor hygiene, papules, crusty, honey-comb like crust,

Back 90

Non-bullous impetigo (Strep pyogenes, staph aureus)

Front 91

causes a skin disease with rapidly enlarging, blister-like lesions that break down and leave paper thin crusts

Back 91

Bullous impetigo (staph. Aureus)

Front 92

What is the causative agent of cellulitis?

Back 92

Strep pyogenes and Staph Aureus >90% of cases

Front 93

What produces a superficial, expanding, erythematous, warm rash on the skin that looks like, but is not, cellulitis? Differ from cellulitis in that they are indurated with elevated margins, and their margins generally are sharply demarcated from the surrounding unaffected skin

Back 93

Erysipelas caused by Strep pyogenes

Front 94

Tinea Capitis (ringworm of the scalp)

Back 94

Griseofulvin (Oral)

Front 95

Tinea Pedis treament (athletes foot)

Back 95

Terbinafine & Naftifine

Front 96

Tinea Corporis

Back 96

Oral terbinifine, itraconazole, or fluconazole

Front 97

Tinea Cruris

Back 97

Most topical antifungals nystatin is not effective

Front 98

SSSS (MSSA)

Back 98

Naficillin or Oxacillin

Front 99

SSSS (MRSA)

Back 99

Vancomycin

Front 100

Bullous Impetigo

Back 100

Topical: Mupirocin; MSSA: dicloxacillin or cephalexin; MRSA: TMP-SMX or Clindamycin or Minocycline

Front 101

Erysipelas cellulitis

Back 101

IV: Pen G or Oxacillin or Nafcillin or Cefazolin or Oral Dicloacillin

Front 102

Facial erysipelas cellulitis or where MRSA is a concern

Back 102

IV: Vanco or Dapto or Linezolid

Front 103

Acne

Back 103

Topical retinoids, topical antimicrobials

Front 104

Mycobacterium leprae

Back 104

Dapsone, rifampin

Front 105

Rickettsia Rickettsii

Back 105

Doxy, Chloramphenicol

Front 106

Rickettsia Akari

Back 106

Mild illness - don't treat

Front 107

VSV Shingles

Back 107

Oral: Acyclovir, Valacyclovir & Famciclovir Topical: Penciclovir & Acyclovir