Comlex: Kaplan : Immuno & Ch2 Micro

Front 1

what is the "Help me" MHC? "Kill Me"

Back 1

MHC II-- Help me

MHC I- Kill me

Front 2

What factors will differentiate a cell towards TH1 and TH2 respectively?

Back 2

TH1: INF Gamma and IL12

TH2: IL4

Front 3

TH1 vs TH2:

Kills intracellular virus, fungus, bacteria

Back 3

TH1

Front 4

TH1 vs TH2:

humoral response, making b-cells and killing extracellualr antigens

Back 4

TH2

Front 5

TH1 vs TH2:

will lead to the formation of Plasma cells

Back 5

TH2

will make B cells (Abs, that become plasma cells when they reach their target tissue)

Front 6

TH1 vs TH2:

will lead to macrophage activation, CD8 cells, and NK cells

Back 6

TH1

Front 7

what factor is responsible for differentiating TH1 cells into macrophages?

Back 7

IFN gamma

Front 8

What type of virus has a decoy molecule that allows it to escape from normal immune response? How is it destroyed?

Back 8

CMV

ADCC (macrophage+NK+eosinophils)

Front 9

What virus has nuclear membranes and is immunologically invisible (has no MHC)

Back 9

herpes

Front 10

TH1 vs TH2:

leads to abscess formation

leads to granuloma

Back 10

TH1: granuloma (from intrinsic things being walled off by macrophages)

TH2: abscess (from extrinsic things getting engulfed)

Front 11

Bottom line, what must a vaccine have in it in order to provide adequate immune response?

Back 11

PROTEIN

this leads to B and T cell co-operation

T cells only see protein
B cells can only see things that fit their receptors

Ex:
H. influenza was bound to diptheria because it was known that diptheria could be bound by B cells

B cells take up the combo bug and start cleaving it up to present to T-cells

T cell then gets to see the H. Influenza protein and can start forming memory

Front 12

What is the defect in Chronic Granulomatous Disease? Sx?

Back 12

Failure of ability to make NADPH oxidase--> cant make myeloperoxidase to kill foreign substances

sx: recurrent infections with CATALSE POSITIVE BACTERIA and fungi

* Staphylococcus aureus.
* Serratia marcescens.
* Salmonella species.
* Klebsiella species.
* Pseudomonas cepacia, a.k.a. Burkholderia cepacia.
* Nocardia.

Front 13

mother brings in her child with the 4th infection in a rather short period of time. The child appears to have a portion of the umbilical cord stump still present. What does this kid have? Cause?

Back 13

Leukocyte adhesion deficiency

Absence of CD18--common B chain of leukocyte integrins

Front 14

pt has recurrent infections such as pneumonia, abscesses, and bacteremia with staph. What additional finding would tell you that this was NOT CGD but instead G6PD deficiency?

Back 14

ANEMIA

otherwise presents the same

Front 15

pt presents with recurrent bacterial infections and has absent NK activity and partial Albinism. What is this?

Back 15

Chediak Higashi syndrome

Front 16

what is the molecular defect in Bruton X linked hypogamma globulinemia?

what type of cells will you/wont you see?

Back 16

Deficiency of tyrosine kinase

LOW IGs of ALL CLASSES

b- cell maturation in bone marrow stopped at PRE-B stage

Front 17

what is the molecular defect in X-linked hyper IgM syndrome?

Back 17

Deficiency of CD40 on activated T cells

high serum IgM without others

Front 18

pt presents with repeated sinopulmonary and GI infections. What is a likely cause?

Back 18

Selective IgA deficiency

on places where IgA is used

Front 19

what will lead to recurrent meningococcal and gonococcal infections?

Back 19

Deficiency of the MAC

C5, C6, C7, C8

Front 20

pt presents with allergy like symptoms but no rise in IgE, what is likely going on?

Back 20

Overuse of C1, C4, or C2 at mucosal surfaces

Front 21

Embryo defect in DiGeorge?

Back 21

failure of formation of the 3rd and 4th pharyngeal pouches

CATCH 22

Front 22

pt has recurrent viral infections with low CD8 cells, CD4 are normal...what is going on?

Back 22

Failure of TAP1 molecules to transport peptides to ER

this is MHC Class I deficiency

Front 23

What cells will be decreased in MHC II deficiency?

Back 23

CD4 T cells (HELP ME!)

Front 24

What is seen in Wiskott-Aldrich syndrome?

Back 24

defected response to bacterial infection

loss of humoral and cellular responses

Thrmobocytopenia and ECZEMA

Front 25

pt comes in with ataxia telangiectasia, what will be deficient?

Back 25

IgA and IgE

Front 26

early AIDs infection uses what receptor?

late?

Back 26

early: CCR5

Late: CXCR4

Front 27

in AIDS reverse transcriptase is very error prone due to lack of proofreading, so each viron has a different appearance. The immune response tries to change to kill it, but this simply clones the viral DNA perpetuating the disease...this is an example of what?

Back 27

Antigenic Drift

Front 28

An individual who is homozygous for this receptor cannot be infected with HIV

Back 28

CCR5

Front 29

what is diagnostic of AIDs early in its course?

Back 29

Ab to p24

Front 30

what shows how symptomatic an AIDS pt is?

Back 30

Viral load

Front 31

At what CD4 count is there total collapse of the immune response?

Back 31

less than 200

pt will get all sorts of infections they would have never gotten normally

note: sx will start ~600

Front 32

What is your normal CD4:8 ratio? What is like when an AIDS pt becomes symptomatic? what about when they are getting serious ass infections

Back 32

normal: 2:1

Sx: 1:1

full blow AIDS: 1:2

Front 33

how does HIV destroy both cell mediated and humoral immune resopnse

Back 33

kills undifferentiated TH cells

Front 34

What type of HS RXN is the following characteristic of?

IgE

Back 34

Type I

Front 35

What type of HS RXN is the following characteristic of?

Mast cells cause injury

Back 35

Type I

Front 36

What type of HS RXN is the following characteristic of?

Igm and IgG

Back 36

Type II

Front 37

What type of HS RXN is the following characteristic of?

Opsonazation and phagocytocis of cells

Back 37

Type II

Front 38

What type of HS RXN is the following characteristic of?

Immune Complexes

Back 38

Type III

Front 39

What type of HS RXN is the following characteristic of?

CD4 + TH1 cells

Back 39

Type IV

Front 40

What type of HS RXN is the following characteristic of?

Delayed

Back 40

Type IV

Front 41

What type of HS RXN is the following characteristic of?

Macrophage activation and granuloma formation

Back 41

Type IV

Front 42

Typical vs Atypical pneumonia:

lobar (localize infiltrate)

Back 42

Typical

Front 43

Typical vs Atypical pneumonia:

Granuloma (is this TH1 or TH2)

Back 43

Atypical

TH1

Front 44

Typical vs Atypical pneumonia:

abscess (is this TH1 or TH2?)

Back 44

Typical

TH2

Front 45

Typical vs Atypical pneumonia:

homogenous infiltrate on x ray

Back 45

atypical

Front 46

What type of HS RXN is the following characteristic of?

CD8 cell mediated cytolysis

Back 46

Type IV

Front 47

What type of HS RXN is the following characteristic of?

minutes of the rexposure to anigen

Back 47

Type I

Immediate

Front 48

What type of HS RXN is the following characteristic of?

Autoimmune hemolytic anemia

Back 48

Type II

Front 49

What type of HS RXN is the following characteristic of?

Rh incompatibility

Back 49

Type II

Front 50

What type of HS RXN is the following characteristic of?

Acute Rheumatic fever

Back 50

type II

Target antigen: streptococcal cell wall

Clinical manifestation: Myocarditis and arthritis

Front 51

What type of HS RXN is the following characteristic of?

Goodpastures

Back 51

Type II

will attack Type IV collagen

Front 52

What type of HS RXN is the following characteristic of?

MG and Graves Dz

Back 52

Type II

autoimmune tend to be II (not SLE or RA though)

Front 53

Describe Rh incompatibility. What type HS rxn was this?

Back 53

fetal Rh blood cells enter maternal circulation (of a Rh negative mom) at birth mounting a T-cell response and memory

Subsequent birth with Rh+ will cause maternal IgG to cross placenta and attack the baby's RBCs

hit mom up with RhoGAM after first pregnancy

Front 54

What type of HS RXN is the following characteristic of?

tends to be systemic

Back 54

Type III

Front 55

What type of HS RXN is the following characteristic of?

SLE

What antigen is involved?

Back 55

Type III

dsDNA

Front 56

What type of HS RXN is the following characteristic of?

Rheumatoid arthritis

Back 56

Type IV

Front 57

What type of HS RXN is the following characteristic of?

Post strep glomerulonephritis

deposits?

Back 57

Type III

lumpy bumpy

Front 58

What type of HS RXN is the following characteristic of?

soreness following tetanus booster

what is this called?

Back 58

Type III

Arthus rxn

Front 59

What type of HS RXN is the following characteristic of?

Tuberculin test

Back 59

Type IV

Front 60

What type of HS RXN is the following characteristic of?

contact dermatitis

Back 60

Type IV

(nickel, poison ivy)

Front 61

What type of HS RXN is the following characteristic of?

Multiple Slcerosis

Back 61

Type IV

Front 62

What type of HS RXN is the following characteristic of?

Hashimoto thyroiditis

Back 62

Type IV

Front 63

Please list the HLA allele associate with the following:
RA

Back 63

DR4

Front 64

Please list the HLA allele associate with the following:

Insulin dependent diabetes mellitus

Back 64

DR3/4

Front 65

Please list the HLA allele associate with the following:

Multiple sclerosis, goodpastures

Back 65

DR 2

Front 66

Please list the HLA allele associate with the following:

SLE

Back 66

DR2/3

Front 67

Please list the HLA allele associate with the following:

Ankylosing spondylitis

Back 67

B27

Front 68

Please list the HLA allele associate with the following:

Psoriasis

Back 68

B27

Front 69

Please list the HLA allele associate with the following:

Reiters

Back 69

B27

Front 70

HLA assoc with

Celiac Dz

Back 70

DQ 2 or DQ8

Front 71

Please list the HLA allele associate with the following:

Graves

Back 71

B8

Front 72

what is the target for penicillin and cephalosporins for breakdown of bacteria

Back 72

Peptidoglycan cell wall

Front 73

What is the membrane of fungi made of?

cell wall?

Back 73

membrane: ergosterol

wall: chitin

Front 74

what is the cell wall of parasites made of?

membrane?

Back 74

NO CELL WALL

sterols

Front 75

what bacteria have sterols in their cellular membrane?

Back 75

Mycoplasma

Front 76

What are the encapsulated bacteria?

Back 76

Strep pnuemo
Klebsiella pneumonaie
Haemophalius influenzae
Pseudomonas aerguinosa
Neisseria meningitidis
Cryptococcus neoformans

Some Killers Have Pretty Nice Capsules

Front 77

What bacteria have IgA proteases (which leads to destruction of mucosal IgA)

Back 77

Neisseria

Haemophilus

S. pneumoniae

Front 78

What to bacteria are able to survive intracellularly by evading phagocytes

Back 78

M. tuberculosis

Listeria (escapes phagosome into cytoplasm before phagosome-lysosome fusion)

Front 79

What type of bacteria have ENDOTOXIN?

***

Back 79

Gram negative

=Lipopolysaccharide=LPS

part of the outer membrane

normally not released until death of the cell

Front 80

LPS activates what cells, leading to release of TNF alpha, IL1 and IL6?

Back 80

remember LPS=Endotoxin

they activate macrophages

Front 81

How can G- bacteria lead to shock?

Back 81

LPS/Endotoxin can lead to damage of the endothelium from brady-kinin induced vasodialation

SHOCK

Front 82

most EXOTOXINS are on what type of bacteria

Back 82

Gram +

Front 83

what is the major exotoxin from corneybacterium diptheriae?

MOA?

Back 83

Diptheria Toxin

ADP ribosyl transferase inactivates eEF-2

targets heart/nerves/epithelium

Front 84

what is the major exotoxin from Clostridium botulinum?

MOA?

Back 84

Botulinum toxin

Blocks release of ACh--FLACCID PARALYSIS

Front 85

what is the major exotoxin from clostridium tetani?

MOA?

Back 85

tetanus toxin

blocks release of the inhibitory transmitters

Front 86

what is the major exotoxin from Staph aureus?

MOA?

role in dz?

Back 86

TSST

Super antigen

role in dz: fever, increased susceptibility to LPS, rash, shock, capilary leakage (CYTOKINE STORM)

Front 87

what is the major exotoxin from Strep pyogenes?

MOA?

role in dz?

Back 87

Exotoxin A (aka erythrogenic or pyrogenic form)

Super Antigen (similar to staph a TSS1)

role in dz: fever, increased susceptibility to LPS, rash, shock, capilary leakage (CYTOKINE STORM)

Front 88

what is the major exotoxin from Enterotoxogenic E. Coli?

MOA?

role in dz?

Back 88

Heat labile toxin (LT)

Stimualtes an adenylate cyclase by ADP ribosylation of GTP binding protein

role in dz: promote secretion of fluit and electrolytes from intestinal epithelium

Front 89

what is the major exotoxin from Vibrio cholerae?

MOA?

role in dz?

Back 89

Cholera Toxin

Stimualtes an adenylate cyclase by ADP ribosylation of GTP binding protein (similar to E. Coli LT/heat labile)

role in dz: profuse watery diarrhea

Front 90

what is the major exotoxin from clostridium perferingens?

MOA?

role in dz?

Back 90

Alpha Toxin

MOA: lecithinase

role: damages cell membranes

note: staph a also has an Alpha toxin that causes pores in cell membranes leading to leakiness

Front 91

Teichoic acids are found on what kind of bacteria?

Back 91

Gram + only

Front 92

which bacteria, gram -/+/both have and outer membrane

Back 92

Gram negative only

Front 93

what plays a role in the rigid support of bacteria

Back 93

Cell wall=peptidoglycan

Front 94

Bacillus and Clostridium are endospores, what are their mechanism of resistance?

Back 94

New enzymes (dipicolinic acid synthetase, heat resistant catalase

Front 95

you have an anaerobic bacteria that you want to grow in culture. What do you use?

Back 95

Thioglycolate

Front 96

What do you grow dyptheria on?

Back 96

Tellurite agar

grows black colonies

Front 97

Pt comes in with severe watery diarrheam you suspect vibreo cholera. What will this grow on? what type of medium is this?

Back 97

lies ALKALINE growth medium

TCBS

Front 98

What does legionella grow on?

Back 98

Charcoal-yeast extract agar (CYE)

Front 99

A young college student presents to your office with mailase and stiff neck. based on this alone you know what you will grow your suspected agent on...

Back 99

Chocolate agar

this is likely Neisseria meningococcus

chocolate agar will grow meisseria from normally sterile sites (like the CSF) and Haemophilus

Front 100

What do you grow Neisseria that comes from sites with normal flora on?

Back 100

Thayer-Martin selective medium

Front 101

What bugs require Cysteine for growth?

Back 101

Francisella
Brucella
Legionella
Pasteurella

the four sisters "Ella" worship in the "Cysteine" Chapel

Front 102

A person comes in with a bacterial infection that requires culturing. You are told that the bug used a CO2 incubator to grow. What 2 bugs could this be?

Back 102

Campylobacter

Helicobacter

-both require low but not full oxygen tension

Front 103

what type of bugs stain purple on a gram stain?

Back 103

Gram Positive

Positive = Purple

Front 104

What type of bugs stain red/pink on a gram stain/

Back 104

Gram Negative

Front 105

With the exception of Neisseria, Moraxella, and Veilllonella, all cocci are gram...

Back 105

Positive

Front 106

All spore formers are gram...

Back 106

Positive

Front 107

What bug is Acid fast?

Back 107

Mycobacterium

Front 108

Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):

Staphlyococcus

Back 108

Gram +

Cocci

Front 109

Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):

Streptococcus

Back 109

Gram +

Cocci

Front 110

Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):

Corynebacterium

Back 110

Gram +

Rod

Aerobic or facultative anaerobic

Front 111

Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):

Mycobacterium

Back 111

Gram Positive

Rod

aerobic or facultative anaerobic

note: mycobacterium does not stain well with the gram stain due to its waxy cell wall, but it is considered gram positive

Front 112

Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):

Clostridium

Back 112

Gram +

Rod

Anaerobic

Front 113

Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):

Mycoplasma

Back 113

Trick question! this is a non gram staining bacteria!

Front 114

Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):

Neisseria

Back 114

Gram -

Cocci

Aerobic

Front 115

Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):

Bordetella

Back 115

Gram -

Rod

Aerobic

Front 116

Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):

Escherichia

Back 116

Gram -

Rod

Facultative anaerobic rod

note: this is considered an enterobacteriaceae

Front 117

Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):

Salmonella

Back 117

Gram -

Rod

Facultative anaerobic rod

note: this is considered an enterobacteriaceae

Front 118

Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):

Yersinia

Back 118

Gram -

Rod

Facultative anaerobe

note: this is considered an enterobacteriaceae

Front 119

Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):

Haemophilus

Back 119

Gram -

Pasteurellaceae

Front 120

Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):

Treponema

Back 120

Gram -

Spirochete

Front 121

Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):

Rickettsia

Back 121

Gram -

note: they don't really stain because they are so thin, but they have G- walls

Front 122

Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):

Chlamydia

Back 122

G-

note: so thin that the color of the gram stain cannot be seen, but has G- wall

Front 123

how can you distinguish Staph from Strep considering they are both Gram + cocci? (2)

What type of hemolysis do each undergo?

Back 123

Staphylococcus: Catalase positive, Coagulase Positive, Beta hemolysis

Streptococcus: Catalase Negative, Coagulase negative, B hemolysis

you can spell cat out of staphylococcus

Front 124

What bug is commonly the cause of acute infective endocarditis?

give catalase, coagulase, and hemolysis

Back 124

Staph Aureus

Catalase +
Coagulase +
B hemolysis

Note: pt will have been fine and suddenly feels so bad they are in the hospital

Front 125

What bug is commonly the cause of Endocarditis in IV drug users?

distinguishing feature of this bug

Back 125

Staph epidermidis

Novobiocin

ok, i don't know where I got this card from, but I would go with staph a....

Front 126

Honeymoon cystitis =

Back 126

Staph saprophytic us

Front 127

This bug is responsible for pharyngitis, scarlet fever, pyodermia, RF, and acute glomerulonephritis

Back 127

strep progenies (group A)

remember this is B hemolytic

Front 128

this bug causes neonatal septicemia and meningitis...what hemolysis does it undergo?

Back 128

Strep agalactiae (group B)

undergoes Beta hemolysis

Front 129

what type of hemolysis does strep pneumonia undergo?

Back 129

alpha

Front 130

what type of hemolysis does strep viridans undergo

Back 130

alpha

Front 131

What bug is commonly seen with dental caries? what hemolysis does it undergo?

Back 131

s. viridans

alpha

Front 132

List a distinguishing factor for the following (plus another name for them)

Group A strep
Group B strep
Group D strep
Strep pneumococcus

Back 132

Group A (pyogenes): Bacitracin
Group B (agalactia): CAMP test
Group D (Enterococcus): Esculin agar
Pneumococcus=Optochin

Front 133

Salty foods and custards can lead to infections with what bacteria? Why?

Back 133

Staph a.

Ferments mannitol

Front 134

Coagulase -
Gram + cocci
Novobiocin sensitive
Infections of catheters

what bug

Back 134

S. Epidermidis

Front 135

Gastroenteritis 2-6 hour onset after salty food at a picnic. What would coagulase look like?

Back 135

Coagulase +

this is Staph a.

Front 136

#1 cause of osteomyelits unless HbS is mentioned

Back 136

Staph a

Front 137

causes toxic shock syndrome: desquamatizing rash, fever, hypotension

Back 137

staph a

Front 138

cause of impetigo bullous

Back 138

staph a

Front 139

Osteomylitis in a sickle cell pt is caused by what?

Back 139

Salmonella

Front 140

2 toxins found in staph a

Back 140

Enterotoxins (A-E-->food poisoning

Toxic shock syndrome toxin 1 (TSST1): superantigen

Front 141

DOC for tx of staph a?

Back 141

Naficillin/oxacillin

Vancomycin for MRSA

Front 142

this bug is B-hemolytic, bacitracin sensitive, and pyrrolidony arylamidase (PYR) positive

Back 142

Strep progenies (group A strep)

Front 143

what are 2 of the major pathogenic factors for strep pyogenes?

Back 143

Hyaluronic acid

M-protein: antiphagocytic, M12 strains associated with acute glomerulonephritis

Front 144

pt presents with abrupt onset of sore throat, fever, malaise, and headache. Furthermore they have tonsillar abscesses and tender anterior cervical lymph nodes. What would a catalase test show

Back 144

this would be a group a strep infection

so Catalase negative

Front 145

pt presents with sore throat, enlarged cervical lymph nodes, and a blanching sandpaper rash with a strawberry tongue. What hemolysis does the causative agent undergo and what is it?

Back 145

B- hemolysis

this is group a strep

Front 146

pt presents with honey-crusted lesions. What is the cause and what is this called?

Back 146

strep pyogenes

Impetigo

Front 147

pt recently had strep pharyngitis, and you are worried about what possibly developing? What would be elevated in this?

Back 147

Rheumatic fever (auto antibodies to the heart, especially valves)

elevated ASO

Front 148

the following are distinguishing features of what:

beta hemolysis
Bacitracin resistant
hydrolyze hippurate
CAMP test positive

Back 148

Strep agalactiae (group B strep)

Front 149

person comes in with suspected pneumonia. They spit up salmon colored sputum. Cause?

Back 149

Staph a

Front 150

The following are distinguishing features of what?

alpha hemolytic
optochin sensitive
lancet shaped diplocci
lysed by bile

Back 150

Strep pneumonia

Front 151

Most common cause of pneumonia with blood-tinged rusty sputum...what type of hemolysis?

Back 151

strep pneumo

alpha

Front 152

Most common cause of adult meningitis

Back 152

strep pneumo

look for lots of PMNs, decreased glucose, increase protein in CSF

Front 153

most common cause of otitis media and sinusitis in children

Back 153

strep pneumo

Front 154

Pneumonia buzzword quiz:

Rust colored sputum:
Current jelly sputum:
Salmon colored sputum:
Elderly smoker with none of the above clues:

Back 154

Rust colored sputum: s. pneumo
Current jelly sputum: kleb
Salmon colored sputum: s. aureus
Elderly smoker with none of the above clues: Legionella pneumophilus

Front 155

this type of pneumonia causes lobar pneumonia with productive cough

Back 155

typical (Pneumococcus)

Front 156

what bugs cause typical pneumonia and atypical respectively

Back 156

typical:
s. pneumo
k. pneumonia
h. influenzae
s. aureus

atypical:
legionella pneumophilia
mycoplasma pneumonia
chylamidia pneumonia

Front 157

pt presents with malaise, fatigue, anorexia, night sweats, weight loss, and splitter hemorrhages. In his history you see that he had his mitral valve replaced 2 years prior. You suspect what? In questioning the pt, what procedure would he have likely undergone recently that led to this? what bug is responsible

Back 157

Subacute infective endocarditis

due to viridans streptococci

prostatic heart valve + dental work without prophylactic ABX or really bad oral hygiene

Front 158

tx for strep viridans subacute endocarditis

Back 158

pen G with Aminoglycosides for endocarditis

Front 159

the following are distinguishing features of what?

PRY test positive
catalase negative
hydrolyze esculin

Back 159

Enterococcus faecalis/faecium

Front 160

Elderly man presents with subacute bacterial endocarditis after a GI/GU surgery. What bug was the likely the cause

Back 160

Enterococcus faecalis/faecium

Front 161

what are 2 spore forming G+ rods

Back 161

Bacillus

Clostridium

Front 162

what 2 gram positive rods are facultative intracellular bugs that affect immunocompromised hosts?

Back 162

Listeria

Mycobacterium

Front 163

the following are distinguishing factors for what bug:

large boxcar like G+ spore forming rod

what is a potential use of this?

Back 163

Bacillus anthracis

BIOWARFARE

Front 164

a man comes to your office with a black eschar. He says that he works as a leather worker, in which he takes raw hides and makes leather belts and whatnot. What bug are you worried about

Back 164

bacillus anthracis

Front 165

a mail worker comes into your office with a life threatening pneumonia with cough fever, dyspnea and medicastinal hemorrhagic lymphadenitis...what bug? tx?

Back 165

Bacillus anthracis

mediastinal widening!

TX: Ciprofloxacin or doxycycline

Front 166

man comes in with rapid onset of gastroenteritis after eating fried rice at the China Buffet. What toxin was responsible from what bug

Back 166

Bacillus cereus

emetic toxin: preformed fast (1-6 hours)

Front 167

a man is brought in by his wife with a dirty puncture wound. He is very rigid and having difficulty moving. Was the bug gram positive or negative? what was it?

Back 167

large gram positive spore forming rod

Clostridium tetani

RIGID PARALYSIS from tetanus toxin: blocks release of inhibitory mediators (glycine and GABA) at spinal synapses

Front 168

pt comes in with a dirty crusted wound. You see dirt and saliva in the wound and the pt says it has been longer than 6 hours since the wound was obtained from blunt trauma. What should you do to tx this pt?

Back 168

This is a tetanus prone wound (blunt/missle, burn, frostbit, 1 cm deep; devialized tissue present + contaminants (dirt/saliva); any wound greater than 6 hours old)

must give Vaccine AND TIG (hyperimmune human globulin)

Front 169

mother brings her child in because she is terrified he fell and is permanently paralyized. The mother says she didn't see the fall but insists that is what must have happened. In the history you mark that the child is often given food that was home canned or vacuum packed. What are some of the distinguishing features of the responsible bug

Back 169

this is clostridium botulinum

anaerobic, gram + spore forming rod

Front 170

how does clostridium cause flaccid paraylsis? what is a food product you must consider as a cause?

Back 170

absorbed by gut and carried to peripheral nerve synapses

blocks release of ACh-->flaccid paralysis

Foods: HONEY, home canned vegetables, vacuum packaged food

Front 171

what bug is identified by Nagler reactions and is a cause of gas gangrene after contamination of a wound with soil or feces?

Back 171

Clostridium perferenges

Front 172

Reheated meat dishes can lead to food poisoning from what bug? what toxin does this bug have

Back 172

Clostridium perfringens

Alpha toxin (lecithinase, disrupts membranes and damages all sorts of stuff)

Front 173

You are on your IM rotation and have been visiting a pt who has been in the hospital for a few weeks now being treated with ABX. He now complains of massive diarrhea and GI irritation. What does he have? Classic cause?

Back 173

pseudomembranous colitis due to infection with clostridium diff

due to abx tx with clindamycin (also cephalosporins, amoxicillin, etc)

you will find yellow plaques on the colon

Front 174

pt comes in with diarrhea after eating only deli foods for a week. Where does the bug that caused this reside?

Back 174

Inside macrophages

facultative intracellular

LISTERIA

could also be from unpasteurized milk

Front 175

What is the most common cause of meningitis in renal transplant pts and adults with cancer?

Back 175

Listeria meningitis

Front 176

Mother brings in her boy claiming he is having difficulty breathing. She is upset because they had to leave in the middle of their religious service, one you have never heard of. You look in the boys mouth and see dirty gray pseudomembranes. What will happen if you try to knock them loose? What is the cause of this?

Back 176

They will bleed like crazy

Corynebacterium diphtheria

Elek test will document toxin production

tx with erythromycin

Front 177

what genus of bug is anaerobic, gram positive branching rods that are non acid fast?

Back 177

Actinomyces

Front 178

pt presents with a lesion on the jaw line that drains with sulfur granules...what is the cause? What is another way you can get this?

Back 178

Actinomyces Israelii

Spread from IUD

Front 179

this bacterial genus is unique in that it has a high conc of lipids, is an obligate aerobe, and is acid fast

Back 179

Mycobacterium

Front 180

Pt presents with a chronic cough and weight loss. You obtain an x ray and see a diffuse pattern not localized to any one lobe. You culture the bug and see that it produces Niacin. What bug is this?

Back 180

Mycobacterium tuberculosis

THIS IS THE ONLY BUG THAT PRODUCES NIACIN

acid fast

Front 181

What are the 4 virulence factors of m. TB?

**********

Back 181

1. Facultative intracellular organism (lives in macrophage)

2. sulfatides (inhibit phagosome-lysosome fusion, allowing intracellular survival

3. Cord factor (causes serpentine growth and inhibits leukocyte migration, messes up mitochondrial OXPHOS)

4. Tuberculin (delayed hypersensitivity and cell mediated immunity)

Front 182

What is a Ghon complex? what is it seen in?

Back 182

macrophages transport bacilli to a regional lymph node

this is seen in primary pulmonary TB

Front 183

what CD will macrophages have on them in TB?

based on what you know about TH1 responses, what is commonly seen in TB?

Back 183

CD14

caseating Granuloma

Front 184

what do the following have in common:

atypical mycobacteria
m. leprae
Nocardia
cryptosporidium
isospora

Back 184

ACID FAST

I left TB off this list so you wouldn't just recognize that one

Front 185

What is a positive PPD skin test in the following pts:

HIV:
High risk (poor, IV drug abuser, immigration from TB area)
low risk:

Back 185

HIV: >5mm zone of induration at 48-72 hrs
High risk (poor, IV drug abuser, immigration from TB area): >10mm
low risk: >15mm

Front 186

a man comes into your office saying that he has sensory loss in his extremities. He recently immigrated from mexico. How can you distinguish tuberculoid from lepromatous leprosy?

Back 186

Tuberculioid:
TH1
+ lepromin test
Granuloma formation

Lepromatous:
TH2
- Lepromin test

Front 187

What is the key virulence factor in neisseria meningitides?

Back 187

Endotoxin (LPS): fever, septic shock, overproduction of outer membrane

Front 188

A college student shows up to your office with stiff neck and fever. What do you expect to see in the CSF?

Back 188

Gram - diploccous

Neisseria Meningitis

signs of endotoxin meningococcemia: fever, chills, malaise, prostration, and a rash that is petecihal

note: can also lead to adrenal bleed out (Waterhouse Frederichsen syndrome)

Front 189

A young sexually active pt comes to your office with vaginal discharge. She also complaints of joint pain in her knee, and it is a bit swollen. What are 3 important virulence factors of what she has? what is it? tx?

Back 189

She has Neisseria Gonorrhoeae infection

1. Pili (attachment)
2. IgA protease
3. Invades mucosal surfaces to cause inflammation

tx: ceftriaxone

Front 190

gram negative diplocci in PMNs from urtheral smear from a male suggests N. Gonorrhea. Is this sufficient for females? Why/why not? What should you use?

Back 190

NO

They have similar normal flora in the vag

Thayer-Martin medium kills normal flora to confirm diagnosis

Front 191

pt is in the burn unit. They end up getting a blue green pus that leads to septicemia. The wound smells fruity. What was the cause? Where does this bug normally target?

Back 191

Pseudomonas (g- rod, oxidase +, aerobe)

Liver

If you see water think pseudomonas

Front 192

Pt with cystic fibrosis is highly susceptible to infection with what?

Back 192

Pseudomonas

Front 193

this bug causes atypical pneumonia and is associate with air conditioning systems or shower facilities...What type of people are commonly affected?

Back 193

Legionella pneumophilia

elder smokers, heavy drinkers, immunocompromised

Front 194

a man comes into your office with atypical pneumonia after a long rabbit hunting trip. .

Back 194

tularemia

Francisella tularensis

Front 195

a pt brings in her child with a paroxysmal cough. You look in the chart and see no history of vaccination due to religious objectioin. What is the bug and what are 3 toxins it has?

Back 195

Bordetella pertussis

1. adenylate cyclase toxin (impairs leukocyte chemotaxis)

2. Tracheal cytotoxin (kills cilia)

3. Pertussis toxin (ADP ribosylation of Gi, inhibiting negative regulator of adenylate cyclase)

Front 196

What are the 3 stages of whooping cough? sx? amount of bacteria on culture?

Back 196

Catarrhal: Rhinorrhea, malaise, sneezing anorexia; HIGH

Paroxysmal: Cough/Whoop; Downward decline

Convalescent: diminished cough, development of 2ndary complications (pneumonia, seizure, encephalopathy); low

Front 197

this is the number 1 cause of bacterial diarrhea and is highly associated with poultry, what does it look like on gram stain?

Back 197

this is Campylobacter Jejuni

Gram-negative curved rods with polar lamella ("gulls wings")

Front 198

Guillain-Barre syndrome is associated with what bacteria? What is interesting about its growth?

Back 198

Campylobacter jejuni

grows at 42 degrees

Front 199

What bugs are urease positive?

Back 199

PUNCH

Proteus
Ureaplasma
Nocardia
Cryptococcus
Helicobacter

Front 200

this bug is urease positive, diagnosed by the breath test, and is CLASSIFIED AS A TYPE I CARCINOGEN. What bacteria is this? What cancer can it lead to?

*

Back 200

Helicobacter pylori

Stomach cancer

Front 201

This bug is commonly responsible for gastritis and duodenal ulcers.

Back 201

H. Pylori

Type B cause

Front 202

A natural disaster hits New York city causing damage to the water treatment plant. Suddenly patents start coming in with massive rice water stool. What is the pathogenesis of this bug?

Back 202

This is vibrio cholera

Cholera enterotoxin (similar to E coli LT): ADP ribosylates activating adenylate cyclase--> INCREASED cAMP--> EFFLUX OF Cl AND H2O

Tremendous fluid loss give them fluid

Front 203

how can you separate shigella from salmonella by lab considering they are both non-lactose fermenters?

Back 203

Shigella: nonmotile non-H2S producer

Salmonella: Motile, H2S producer

Shigella does nothing but shit!

(note: yersina is simialar to shigella in this way, while proteus is similar to salmonella)

Front 204

What are 2 important lactose fermenters?

Back 204

Escherichia
Klebsiella

Front 205

Most common cause of UTI?

Back 205

E. Coli

due to motility

Front 206

group B strep is normally the cause of neonatal septicemia, but this is the second most common cause due to a capsule that has K1 serotype endotoxins

Back 206

E. Coli

Front 207

What 2 toxins make ETEC so bad?

Back 207

this is travelers' diarrhea

LT: heat labile toxin: increases cAMP, leads to dump of Cl and H2O

ST: Heat stable toxin, stimulates guanylate cyclase

Front 208

person goes to mexico and comes back with terrible diarrhea...cause?

Back 208

Enterotoxic ecoli (ETEC)

travelers

Front 209

second most common cause of infantile diarrhea due to adherence to M cells, leaing to effacement of brush border

Back 209

EPEC

ecoli

Front 210

pt comes in with bloody diarrhea. They have no fever, no PMNs, but report having eaten hamburgers at a picnic. What are 2 names for this bug?

Back 210

Enterohemorrhagic Ecoli (EHEC)

O157

can also be from cow feces, or petting zoos

Front 211

Elderly homeless alcoholic man with typical pneumonia and currant jelly sputum

Back 211

Klebsiella pneumonia

distinguishing feature: MAJOR CAPSULE (large polysaccharide)

Front 212

Pt comes in with acute blood diarrhea. ON culture you have a gram negative bacilli that does not produce H2S. Is it motile or not? What is it? If we are in the US what is it specifically?

Back 212

Nonmotile

Shigella (sit and shit)

Shigella Sonnei

Front 213

this bug has a toxin that lets it invade M cells and polymerize actin jet trails to go laterally without going back out into the extracellular milieu. It produces blood diarrhea

Back 213

Shiga toxin

from Shigella dysenteriae

Front 214

pt presents with high fever, swelling of the lymph nodes (buboes) conjunctivitis and pneumonia. What was the bug? what are 2 important virulence factors?

Back 214

Yersinia Pestis (this is bubonic plague!!)

Endotoxin

Envelope antigen (F1) inhibits phagocytosis

Front 215

yersinia enterocolitica likes to grow in what type of environment

Back 215

cold

Front 216

pt has a UTI but the pain he has is really bad. You get an X-ray and see that he has a stag horn renal calculi. What bug caused this? What virulence factor allowed for this to happen?

Back 216

Proteus (mirabilis/vulgaris)

Urease positive raises urine pH to cause struvite stones (stag horn)

Front 217

pt presents with fever headache abdominal pain and bloody diarrhea. Widal test is positive in the pts serum and the bug is shown to produce H2S gas. What is it? Where does this infection begin? What could you see on the abdomen?

Back 217

this is Salmonella (typhi)

starts in the ileocecal region then moses to mesenteric lymph nodes and blood

on the abdomen you can see ROSE SPOTS: red spots on the belly

reservoir is chickens and turtles

Front 218

What bug causes osteomylitis in pts who are HbS?

Back 218

Salmonella

normally it is caused by staph a!

Front 219

pt presents with high fever, swelling of the lymph nodes (buboes) conjunctivitis and pneumonia. What was the bug? what are 2 important virulence factors?

Back 219

Yersinia Pestis (this is bubonic plague!!)

Endotoxin

Envelope antigen (F1) inhibits phagocytosis

Front 220

yersinia enterocolitica likes to grow in what type of environment

Back 220

cold

Front 221

pt has a UTI but the pain he has is really bad. You get an X-ray and see that he has a stag horn renal calculi. What bug caused this? What virulence factor allowed for this to happen?

Back 221

Proteus (mirabilis/vulgaris)

Urease positive raises urine pH to cause struvite stones (stag horn)

Front 222

pt presents with fever headache abdominal pain and bloody diarrhea. Widal test is positive in the pts serum and the bug is shown to produce H2S gas. What is it? Where does this infection begin? What could you see on the abdomen?

Back 222

this is Salmonella (typhi)

starts in the ileocecal region then moses to mesenteric lymph nodes and blood

on the abdomen you can see ROSE SPOTS: red spots on the belly

reservoir is chickens and turtles

Front 223

What bug causes osteomylitis in pts who are HbS?

Back 223

Salmonella

normally it is caused by staph a!

Front 224

3 mo-2 y unvaccinated child with meningitis

Back 224

Haemophilus influenzae

Front 225

what are the 2 virulence factors of H infuenzae?

Back 225

polysaccharide capsule (type b capsule is polyribitol phosphate)

IgA protease (mucosal colonizing factor)

Front 226

besides meningitis, what can H. influenzae cause in unvaccinated kids? (2)

Back 226

Otitis media

Epiglottitis (croup)

Front 227

What 3 drugs have IgA protease?

Back 227

Strep pneumo

Haemophilus

Neisseria (men/gon)

Front 228

pt presents with a soft painful chancre on their genitals. what was the cause?

Back 228

Haemophilus ducreyi

DO CRY

open lesions can lead to increased likelihood of HIV infection

Front 229

woman comes in with thin gray vaginal discharge. What might you see in culture? What test could you do to give you a hint about what this was? What is it?

Back 229

Clue cells

Whiff test: fishy amine odor

ugh.

Front 230

What do you have to worry about with cat bites?

Back 230

Pasteurella multocida

Front 231

in the colon, this is the predominant anaerobe

Back 231

Bacteroides Fragilis

Front 232

describe the 3 types of Syphillis?

cause of all of them?

Back 232

primary: non tender painless chancre

Secondary: maculopapular rash (hits soles), condylomata lata (wart like lesions in perianal area)

Tertiary: Gummas in CNS and CV system

cause: Treponema pallidum (spirochete)

Front 233

nontreponemal antibody is a screening test for syphilis, but it is not confirmatory. What is?

Back 233

FTA-ABS

specific test for treponemal antibody

Front 234

Tx for syphillis?

Back 234

Pen G

Front 235

What is the screen for HIV? Confirmatory?

Back 235

Screen: ELISA

Confirm: Western Blot (protein)

Front 236

What drug screens TB? confirm?

Back 236

Screen: auramine rhodamine

Confirm: acid fast

Front 237

pt presents with influenza-like sx and erythema migrans. What was the cause?

Back 237

Borrelia burgdorferi

Ixodes (deer) tick

Lyme Dz

Front 238

what is the major pathogenesis of Lyme dz? what causes it? what is the rash you get?

Back 238

invades skin, spreads via blood to involve primarily the heart, joints, and CNS

Borrelia burgdorferi

Erythema migrans

Front 239

pt presents with Bells palsy, meningitis, arrhythmia, and mycarditis. Cause?

Back 239

lyme dz

Borrelia burgdorferi

Front 240

triathalon swimmers in Lake Utah all come down with flu like symptoms. two of them have their gallbladders taken out.

Back 240

Leptrospira interrogans

this can also be in hawaii in animal whizz

Front 241

Compare Rickettsiaceae and Chlamydiaceae in the following ways

Obligate intracellular parasite?
Make ATP?
Peoptidoglycan layer in cell envelope?

Back 241

Obligate intracellular parasite?
Rick: Yes
Chlam: Yes

Make ATP?
Rick: Limited ATP
Chlam: NO ATP

Peoptidoglycan layer in cell envelope?
Rick: Normal peoptidoglycan
Chlam: modified peptidoglycan (lacks muramic acid and is considered by some as modified, others say it is absent)

Front 242

what are the two forms of chlamydia trachomatis? what are they each doing?

Back 242

Reticulate: cells are metabolically active, replicating

Elementary body: infective form, inactive, and extracellular

Front 243

what is a key to diagnose to Chlamydia trachomatis?

Back 243

Cytoplasmic inclusion bodies in scrapings

Front 244

What serotype causes STDs with chlamydia?

Back 244

D-K

Most common bacterial STD in US!

can cause urethritis, cervicitis and conjunctivitis

Front 245

What bug, and of what serotypes lead to trachoma, a cause of blindness?

Back 245

chlamydia A, B, Ba, and C

THIS IS THE LEADING CAUSE OF PREVENTABLE INFECTIOUS BLINDNESS

note: serotypes L1,2,3 cause lymphogranuloma venereum

Front 246

Tx for chlamydia?

Back 246

doxycycline or azithromycin

Front 247

What bug is associated with bird handlers? (parrots, turkeys, etc)

Back 247

chlamydophila psittaci

Front 248

what bug will cause atypical "walking" pneumonia, that affects a single lobe with dry cough and hoarseness.

Back 248

Chlamydia pneumonia

Front 249

A man from North Carolina comes in with a rash on his ankles. You give him some cream and tell him to come back in if it is still there. He comes back in a few days later and the rash has spread to his trunk, soles, and face. What was the vector for this dz?

Back 249

Dermacentor (tick)

this is Rickettsia rickettsii--Rocky Mountain Spotted Fever

confirmed by Weil-Felix test

Front 250

this bug causes leukopenia, with low platelets and morulae (mulberry like structures inside infected cells)

Back 250

Ehrlichia Phagocytophila

Front 251

Young adult presents with atypical pneumonia and a positive cold agglutins test. What type of drugs can you NOT use in the tx of this?

Back 251

this guy has Mycoplasma pneumonia

It does not have a cell wall, so you cannot use cephalosporins or penicillins!

Must use a Macrolide (erythromycin)

Front 252

what is the only extracelluar bug that causes atypical pneumonia? what are 2 virulence factors?

Back 252

Mycoplasma pneumonia

1. Inhibits ciliary action
2. Produces hydrogen peroxide (damages respiratory epithelium, leading to hacking cough)

Front 253

Positive cold agglutins will give you the diagnosis of what? what will it show on an RBC?

Back 253

mycoplasma pneumonia

IgM Abs on RBC