Y2B2 Micro- Cardiovascular Diseases Part 1

Front 1

what is seticemia?

Back 1

Presence of microbial infection in the blood that causes illness

Front 2

what is lymphangitis characterized by?

Back 2

red streaks under the skin

Front 3

what are the sxs of septicemia?

Back 3

fever, chills, nausea, vomiting, dirrhea, SOB, malaise, changes in mental state, petechiae

Front 4

what can septicemia progress to?

Back 4

septic shock

Front 5

what releases exotoxins? what releases endotoxins?

Back 5

exotoxins-- living microbes
endotoxins-- dying gram-neg bacteria

Front 6

what are the five categories of exotoxins?

Back 6

neurotoxins, enterotoxins, cytotoxins, membrane damaging, superantigens

Front 7

what are the three endotoxins?

Back 7

LPS, septic shock, heat stable

Front 8

what type of toxin does vibrio cholerae and strains of E. coli have? what does it cause?

Back 8

enterotoxin: regulatory protein in intestinal cells is modified to induce cells to secrete electrolytes and water

Front 9

what type of toxin does corynebacterium diptheriae, shigella dystenteriae, and strains of E. coli have? what does it cause?

Back 9

cytotoxins: inhibits protein synthesis in eukaryotic cells leading to cell death

Front 10

what type of toxin does clostridium tetani and clostridium botulinum have? what does it cause?

Back 10

neurotoxins

clostridium tetani: blocks inhibitory neurons
clostridium botulinum: blocks nerve signals to muscle

Front 11

what are the two mechanisms of membrane-damaging toxins?

Back 11

1) insert into membranes forming pores;
2) polar heads of phospholipid molecules are removed by phospholipases thus damaging the membrane.

Front 12

what type of bacteria is more commonly associated with septicemia?

Back 12

gram-negative bacteria

Front 13

what type of bacteria is also associated with opportunistic causes of septicemia?

Back 13

Gram-positive bacteria

Front 14

what are the two gram negative bacteria that are associated with opportunistic septicemia?

Back 14

e. coli and bacteroides

Front 15

what are the two gram negative bacteria that are associated with nosocomial septicemia?

Back 15

pseudomonas aeruginosa, neisseria meningitidis

Front 16

what are the three gram-positive bacteria associated with opportunistic causes of septicemia?

Back 16

S. aureus, S. pneumoniae, S. pyogenes

Front 17

what is transient bacteremia?

Back 17

follows procedures such as dental, colonoscopic, or cystoscopic; natural defenses rapidly clears microbes.

Front 18

what is intermittent bacteremia?

Back 18

manipulation of an extravascular site

Front 19

what is continous bacteremia?

Back 19

implies intravascular source

Front 20

What is responsible for 17% of bacteremias?

Back 20

UTIs

Front 21

what type of catheters leads to infected intravascular catheter bacteremia?

Back 21

semi-permanent catheters

Front 22

what are the seven associated clinical syndromes that cause bacteremia?

Back 22

infected intravascular catheters, UTIs, Pneumonias, intra-abdominal infections, skin infections, CNS infections, and Musculoskeletal infections

Front 23

75% of these infections develop bacteremia, what type of infection?

Back 23

Intra-abdominal infections

Front 24

what are the four bacterial causes of primary peritonitis?

Back 24

e. coli, klebsiella pneumoniae, S. pneumoniae, enterococci

Front 25

what are the three bacterial causes of secondary peritonitis?

Back 25

e. coli, anaerobes, enterococci

Front 26

what usually causes acute bacterial meningitis?

Back 26

transient bacteremia due to S. pneumoniae, N. meningitidis

Front 27

how can osteomyelitis lead to bacteremia?

Back 27

microbes seed end loop capillaries in bone from minor skin infections--> blood flow is slow allowing bacteria to multiply causing destruction of bone and intermittent bacteremia

Front 28

what are the two bacteria specimens that can lead to bacteremia d/t contaminated prosthetic joints?

Back 28

S. aureus, GAS

Front 29

Bacterial colonization of the endocardium triggers what? forming what?

Back 29

triggers inflammation forming vegetations (bulky masses of platelets and clotting proteins that surround the bacteria)

Front 30

what is the purpose of vegetations?

Back 30

protects bacteria from defensive cells, antibodies and antimicrobials

Front 31

what are the sxs of endocarditis?

Back 31

fever, extreme malaise, breathing difficulty, tachycardia, murmurs

Front 32

what are the complications of endocarditis

Back 32

blood clots, stroke, heart valve destruction

Front 33

what pathogen (s) can cause endocarditis after a dental procedure?

Back 33

Viridans streptococci

Front 34

what pathogen(s) can cause endocarditis d/t to skin infection or skin contamination?

Back 34

S. aureus and S. epidermidis

Front 35

what pathogen(s) can cause endocarditis due to pharyngitis?

Back 35

S. pneumoniae

Front 36

what pathogen(s) can cause endocarditis d/t contamination from the GI tract?

Back 36

enterococcus, E.scherichia

Front 37

what are the atypical pathogens that can cause endocarditis?

Back 37

neisseria, pseudomonas, bartonella, mycobacterium, mycoplasma

Front 38

what are the demographics of bacterial endocarditis?

Back 38

45-65 yoa, >25% of cases seen in those 60 yoa and older. M> F x2.

Front 39

what are the risk factors for bacterial endocarditis?

Back 39

immunosuppression, diabetes mellitus, chronic renal dz, dental procedures, IVDA, infected tooth, skin lesion or contaminated intravascular catheter

Front 40

how do you rule out bacteremia?

Back 40

you order blood cultures collected by aseptic venipuncture from multiple sites. That blood is culture in medium designed to grow bacteria.

Front 41

what medium should be used first when you draw blood for a blood culture? why?

Back 41

aerobe first because there is air in the tube so bacteria that like air will grow better. anaerobe should be take second because everything should be evacuated very nicely.

Front 42

what will antibiotics in the pt's blood do to microbial growth in blood culture bottles? how do you fix this?

Back 42

inhibit it; fix it via antimicrobial removal device (ARD) or Fastidious antimicrobial neutralization (FAN)

Front 43

what does a CBC contain?

Back 43

RBC, WBC (+diff), platelet count, hgb, hct, MCV, MCH, MCHC, RDW

Front 44

what is the normal RBC for men and women? what is the normal WBC?

Back 44

RBC for men--> 4/8 x 10^6
RBC for women --> 4.3 x 10 ^6

WBC normal 4500-10,500

Front 45

what is the order of cell types in a WBC differential from greatest to least?

Back 45

Neutrophils, lymphocytes, monocytes, eosinophils, basophils, bands

Front 46

what type of infections have high neutrophils?

Back 46

bacterial

Front 47

what type of infections/ disorders have high lymphocytes?

Back 47

viral

Front 48

what type of infections/ disorders have high monocytes?

Back 48

severe infections, phagocytosis

Front 49

what type of infections/ disorders have eosinophils?

Back 49

allergic disorders, parasitic infections

Front 50

what type of infections/ disorders have basophils?

Back 50

parasitic infections, some allergic disorders

Front 51

when does leukocytosis occur? at what ml is considered leukocytosis? does it usually involve an increase in one or many types of leukocytes?

Back 51

occurs in acute infections
>11,000 /ml
usually increase in only one type of leukocyte

Front 52

At what ml is it considered leukopenia? what is leukopenia indicative of?

Back 52

<4000ml
viral infections or overwhelming bacterial infections

Front 53

what do the granules of white cells look like in toxic granulation? what does toxic granulation mean?

Back 53

dark and prominent; means that these neutrophils are incredibly active

Front 54

what are two signs on a blood smear that show that the innate immune system is in full gear?

Back 54

vacuolization and toxic granulation

Front 55

what does vacuolization look like?

Back 55

swiss cheese that is engulfing other cells

Front 56

what cell is indicative of multiple myeloma? why?

Back 56

mott cell because multiple myeloma is an overproduction of ab and the vacuoles are actually abs in the cytoplasm.

Front 57

what is MCV good for? what does it mean is if the MCV is large? small?

Back 57

MCV is good for classification of anemias
- large--> macrocytic anemias like B12 or folate deficiency
-small --> microcytic anemias- iron deficiency

Front 58

what are the normal levels of hgb for women and men?

Back 58

women: 12-16 g/ dL
Men: 14-17.5 g/dL

Front 59

what is the use of hgb tests?

Back 59

aids in the diagnosing of anemias and in monitoring therapy for anemias

Front 60

what is hematocrit? what is the use of measuring hematocrit? what are the normal levels?

Back 60

volume of packed RBCs: total volume of whole blood.
use is to aid in the diagnosing of anemias
women: 36-48%
men: 42-52%

Front 61

what is MCH? what is it useful in?

Back 61

MCH is mean corpuscular hgb. It measures the average amount of hgb/RBC. It is useful in diagnosing pts w/ severe forms of anemia

Front 62

what is MCHC? what is useful in?

Back 62

Mean corpuscular hgb concentration is the average hgb concentration/ RBC volume. It is useful for monitoring therapy in txing anemias

Front 63

what is RDW? what is a larger than normal RDW called? what is it indicative of?

Back 63

red blood cell distribution width.
larger than normal RDW is called anisocytosis which is characteristic of anemias and stressed erythropoiesis.

Front 64

what is poikilocytosis?

Back 64

variation in shape and size

Front 65

what is the most common cause of sepsis and meningitis in newborns?

Back 65

S. agalactiae

Front 66

what are the two types of group B streptocococcal dz?

Back 66

early onset (in utero) --> newborns <7 days old
late onset (out in the real world )--> newborns >7 days old

Front 67

approximately 25% of neonatal Group B streptococcal dz occurs in what type of pts?

Back 67

premature infants

Front 68

what can group B streptococcal dz cause in adults? what about in pregnant women?

Back 68

sepsis, soft tissue infections.
preggers: amnioitis, spesis, UTIs, stillbirth

Front 69

who is considered high risk for group b stretptoccal dz?

Back 69

-infants born to women colonized with group B streptococci or anti GBS capsular ab
- infants born to women <20 yoa
- infants born to black women
- prolonged rupture of membranes
- preterm delivery

Front 70

what age group is most affected by Rheumatic fever?

Back 70

5-15

Front 71

what is the most likely antigen to be stimulating ab production? what is its job? what is this antigen similar to? what does that cause?

Back 71

M protein- adhesin molecule for streptococci.
Similarity btwn M protein and myosin which can cause autoreactive to heart tissue and muscles

Front 72

what are the complications of rheumatic fever?

Back 72

endocarditis, arrhythmias, pericarditis, heart failure

Front 73

what bacteria is responsible for the bubonic plague? what temperature does it grow at?

Back 73

yersinia pesitis- 28 deg C

Front 74

what is believed to be the origin of the bubonic plague?

Back 74

northern india, central asia--> china

Front 75

what is the main source of bubonic plague infection in the southwest US?

Back 75

rock squirrels and their fleas

Front 76

T/F

Humans are accidental hosts in the bubonic plague.

Back 76

True

Front 77

what flea spreads the bubonic plague?

Back 77

Xenopsylla cheopis

Front 78

how does the flea infect its victim?

Back 78

fleas are hungry and repeatedly bite their victim and regurgitate infected material into the wounds.

Front 79

why is the bubonic plague called the bubonic plague?

Back 79

because the acute inflammatory rxn to the flea causes enlargement and tenderness of the LNs--> called bubo

Front 80

where is the painful bubo usually located for bubonic plague pts?

Back 80

groin area

Front 81

progression of the bubonic plague leads to what two types of infection?

Back 81

blood and lung

Front 82

when bubonic plague spreads to the lungs, what can occur?

Back 82

some pts can develop a second pneumonia by bacteremic spread to the lungs called pneumonic plague

Front 83

how quickly can death occur due to pneumonic plague? why is it called the black death?

Back 83

death can occur on the 2nd or 3rd day of illness. Its called the black death because terminal cyanosis is seen w/ pneumonic plague

Front 84

what are the sxs of primary pneumonic plague? what are the worries associated with this?

Back 84

sxs: bloody, watery and sometimes purulent sputum; nausea, vomiting, abdominal pain, diarrhea. Main worry is that this can be used as an agent of biological warfare and be missed because it looks like any other bacterial and viral pneumonia.

Front 85

what is the main difference bwtn primary and secondary pneumonic plague?

Back 85

no bubboes present w/ primary pneumonic plague

Front 86

what virus is responsible for causing mumps?

Back 86

paramyxovirus virus

Front 87

where does the virus replicate before the pt becomes symptomatic? what are the clinical manifestations of mumps?

Back 87

nasopharynx and regional LN, bilateral parotitis (w/ or w/o pain) + fever

Front 88

what percentage of Mumps pts have CNS involvement?

Back 88

50%

Front 89

after 12-25 days, where can mumps spread to?

Back 89

areas such as the meninges, salivary glands, pancreas, testes, ovaries

Front 90

what quickly do the sxs of mumps resolve? what are the possible complications of mumps?

Back 90

1 week to 10 days; aseptic meningitis, ovarian, testicular inflammation (sterility), pancreatitis, or deafness

Front 91

what three locations can you recover the parvovirus from in mumps? what is their individual time limit? what serologic testing is used to detect the parvovirus?

Back 91

salvia (up to 5 days), urine (up to 2 weeks), CSF (?). Testing: ELISA, immunofluorescence, hemagglutination inhibition

Front 92

what genus of the coxsackie virus causes coxsackie virus infections? what makes this genus special?

Back 92

enterovirus: its capsids are resistant to harsh environmental conditions and are transmitted via fecal-oral route

Front 93

what are the viruses associated with group A coxsackie virus?

Back 93

Herpangia and hand-foot-and-mouth dz

Front 94

what is pleuodynia? what are the associated sxs?

Back 94

bornholm disease--> group B coxsackie virus. Sxs: sudden onset fever, unilateral pleuritic chest pain which can be extremely painful, abdominal pain and vomiting (acute illness)

Front 95

what does acute benign pericarditis in young adults?

Back 95

resemble MI w/ fever

Front 96

what are the two types of infections/ diseases that can be caused by group B coxsackie virus?

Back 96

pleurodynia, myocardial and pericardial infections

Front 97

T/F

Myocardial and pericardial infections caused by group B coxsackie virus has a fairly low mortality rate.

Back 97

FALSE

autopsy usually reveals involvement of other organs (brain, liver, pancreas)

mortality is HIGH.

Front 98

what type of blood can newborns not accept?

Back 98

CMV positive blood

Front 99

what three populations are at high risk for complications due to cytomegalovirus? what are those complications?

Back 99

1) fetuses- teratogenic causing birth defects, mental retardation, hearing/ visual defects, death
2) Newborns- congenitally infected can dev enlarged livers and spleens, jaudice, anemia
3) AIDS/ immunodeficient pts: blindness, pneumonia, and a type of infectious mononucleosis.

Front 100

where is CMV carried? what percentage of neonates is infected? how can transmission occur?

Back 100

bodily secretions can carry CMV.
7.5% of neonates is infected.
transmission can occur during sexual intercourse, but also through in utero, vaginal birth, blood transfusions, organ transplants

Front 101

what is the most prevalent viral infection for neonates?

Back 101

CMV

Front 102

what is the typical diagnosis of CMV on microscopy? what other techniques are used for diagnosis?

Back 102

"owl's eye cell"; elisa and dna probes