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35 Cards in this Set

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Classic signs & Sxs: Fever, headache, nuchal rigidity and low Glasgow coma score
Along w CSF findings (inc neutrophils, elevated protein, and red glucose)

Elderly - Strep. pneumo & Listeria

Neonates - Group B strep & E.coli

Infants & children - H.influ

Adolescents & young adults - N.meningitidis
Stomach with a perforated peptic ulcer

Sxs: Voluminous vomiting of blood

- perforation of a peptic ulcer is potentially fatal b/c of either peritonitis w/ sepsis or sudden exsanguination (if the perforation damages one of the many arteries of the stomach).

PUD, gastritis, gastric carcinoma and gastric lymphoma are assoc with H.pylori colization of the mucus layer covering the gastric mucosa.
Endocarditis - tricuspid valve?
1. Drug users! - most common. S.aureus. Tricuspid valve - usual site.

2. Endocarditis assoc with congential heart disease usually either involves damaged valves or atrial/ventricular septal defects. Tricuspid valve not prtclrly vulnerable.

3. Rheumatic fever - commonly damages mitral and aortic valves.

4. SLE can produce small, aseptic vegetations on valves, but is not associated with bacterial endocarditis.
Toxins encoded in Lysogenic Phage genome
1. C.botulinum (Flaccid baby - Cbotulinum blcoks Ach release)

2. Strep pyogenes (can cause Scarlet fever)

3. Diptheira toxin

4. O antigen of Salmonella (mobile, can cause hematogenous dissemination)
Yersinia Pesis - Disease?
Plague - suspect in any previously healthy person from SW US/Mexico who devleops septic shock or severe pulmonary disease.
Sporadic cases are still common.
Diff forms of plague
1) pestis minor (minor lymphadenopathy)
2) bubonic plague (prominent lymphadenopathy)
3) pneumonic plague (severe bronchopenumonia)
4) septicemic plague
Strep bovis
S.bovis - Group D streptococcus. Significant assoc between S.bovis bacteremia & endocarditis with colon cancer and other colonic diseases.
Bacterial enzymes (toxins)
1. Hemolysin - toxins that lyse erythrocytes

2. Catalase - breaks down peroxide. Produced by Staph, pseudomonas, Candida, Aspergillus and the Enterobacteriaceae

3. Hyaluronidase - Splits hyaluronic acid in ground substance. Group A strep (S.pyogenes)

4. Streptokinase - streptococcal enzyme that transforms plasminogen into plasmin.

5. Tentanospasmin - clostridiual neurotoxin which inhibits GABA and glycine and causes rigid paralysis. C.tetani.
Young children - H.infl

Young adults - mycoplasma pneumonia (causes atypical pneumonia)

Klebsiella pneumniae - causes pneumonia and pulmonary absscesses but is not considered a pathogen in Upper respiratory tract (like pharyngitis, epiglottitis)

Adults - Legionella pneumophilla. Could be mild or a fulminating disease with a high mortality (30%)
Protozoan disease caused by Entamoeba histolytica
Amebiasis: Bloody diarrhea (dysentery), liver abscess

Balantidium coli - a ciliated organism that occassinally causes dysentery resembling Entomeba histolytica

Rx. Metronidazole adn iodoquinol
A protozoan disease caused by Giardia lambia
Dz: the flagellated (pear shaped, owl-eye appearance) infects the small intestine --> flatulence, bloating, foul-smelling diarrhea.

Rx: Metronidazole
Protozoan disease caued by Babesia (Maltese crosss appearnce)
Transmitted by a tick Ixodes ("woods by the eastern shore"
Protozoan seen within RBCs on smear.

Babesiosis - fever and anemia

Rx: Quinine, clindamycin
Francisella tularensis

Most common in Arkansas and Missouri.

Usually presents with a papule progressing to a necrotic ulcerative lesion. Assoc with fever, chills and malaise but NO rash
Rocky Mountain Spotted Fever
Ricketssia ricketssi

- common in Eastern US
Organism has a predilection for infecting endothelial cells, thus causing a vasculitis that damages many tissues including the skin and the kidney.

Signs & Sxs: Fever, severe headache, confusion. Swelling of the ankles and wrists & a maculopapular rash.
Leukocyte esterase test
A pos test indicates the presence of neutrophils in the urine - suggesting a bacterial infection.

Nitrite test - Most enterobacteria are able to make NITRITE from nitrate. Thus used to diagnose UTI's.
Eg: E.coli, Pseudomonas aeurginosa, Klebsilla pneumoniae.

Exception to Nitrite test - Enterococci (Gut streptoccoi) that can still cause UTI.
Toxoplasma gondii
Pregnant women and immunocompromised pts.

Infection is limited to the CNS.

Forms intracerebral Toxoplasma abscesses - RING ENHANCING lesions on MRI/CT
Stress activated secondary disease caused by reactivation of Herpes Zoster virus (VZV)

- Multiple small vesicular lesions with an erythematous base. Some lesions are fluid filled while some are crusty.
Chest region

Stress eg: Chemo for prostate
Most common bacterial gastroenteritis inthe US.
Campylobacter jejuni: Comma-or S shaped Gram neg organism, grows at 42degrees, Oxidase positive.

Contaminated poultry or poultry products

Water diarrhea with some blood. Abdominal cramping, fever.
33 yrold woman begins seeing a new boyfriend. Several weeks later, a week after her menstrual pd, she develops a painful, swollen right knee. Causative organism?
Can live within neutrophils - N.gonorrhoeae.

Gram neg cocculs that can live in phagocytic vacuoles in MCs and neutrophils.
Most common cause of Septic arthritis in otw. sexually active adults.
Diagnosing acute infection in a newborn
check for IgM antibodies (eg against Toxoplasma). IgM is the first ab that a baby can form.

IgG is the only Ab that can cross the placenta. A high IgG in a a newborn is indicative that the mother was infected.
Erytrhomycin (interactions)
Erythromycin - a macrolide used commonly for Upper resp and skin/subQ infections.
-its a POTENT hepatic microsomal inhibitor.

THus, can potentiate the effects of drugs that are cleared by the liver.
Eg: Theophyline (used for prophylaxis and symptomatic relief of asthma and COPD) is extensively metabolized by the CYP450 enzymes.
Zygomatic bone
Forms the cheekbone
Cavernous sinus
Cavernous sinuses are located on either side of the sphenoid bone. Are a potential route of infection b/c they receive blood from both the face and some of the cerebral veins.

Zygomycosis(mucor sp) - a destructive fungal infection of the sinuses, spreads to the brain/CNS via cavernous sinus.
CMV Congenital disease
"blueberry muffin baby"
1. Cutaneous hemorrhages
2. Deafness
3. Periventricular calcifications.

CMV infection - common cause of intrauterine fetal viral infection.
Congenital rubella
MR, heart abn, blindness, encephalitis, motor abnormalities (abn)
Examof the skin reveals a diffuse, erythematous, symmetrical rash that blanches on pressure. Has a slightly rough SANDPAPER like texture and is most prominent on the neck, chest, and folds of the axilla, elbow and groin. Disease?
Scarlet fever Rash.

- caused by Group A (beta-hemolytic) Strep that carries a phage.
- scarlet fever can result from a complicaiton of streptococcal sore throat or strep wound infection.
Pt. presents with urinay retention 2dary to prostatic hyperplasia. Now develops a spiking fever. Bilateral inspiratory crackles. X-ray shows bilateral interstitial and alveolar infiltrates. Organism?
Escherichia coli! - common cause of cystits and UTI. Its a normal part of GI tract.

Pts with cystitis develop bactermia and subseq septic shock and Adult Respiratory Distress syndrome!!!

(E.coli - a gram neg rod)
Viruses infecting white matter only?
Measles --> SSPE (subacute sclerosing panencephalitis), usually occurs b4 age 18

JC virus - cuasing CML in immunocompromised. (GIANT oligodendrocytes)
Abn large amounts of amniotic fluid.
Result when the Fetal swallowing of the fluid (a normal event) slows down or is blocked:
1) Absence of swallowing
2) Blocakge of fetus' GI tract (intestinal atresia) can result in polyhydramnios.

Leads to congenital malformation (GI system usually), CNS (disorders that affect swallowing) or cardiovascular system.
Autoabs to SS-A (ro)
Sjogren's syndrome.

-Autoimmune inflammation of the lacrimal and salivary glands.
CREST variant of Scleroderma
Anti-centromere Abs.

C- calcinosis (hard calcified, SubQ nodules of the buttocks)
Raynauds phenomenon
Esophageal dysmotility (difficulty swallowing)
Sclerodactyly (scleroderma involving the fingers)
Telangiectasia (small vascular lesions of the skin)

- has a dramatic decrease in availablity when taken with antacids secondary to the binding of the two medications in the intesttinal tract.
- Used to treat upper and lower Resp infections as well as GU tract infections.
Autoabs to IF - Disease?
Association with which Class II antigen?
Penicious Anemia

- Assoc with DR5
DR5 - also assoc with juvenile Rheumatoid arthritis.
Anti-mitochondrial abs - disease?
Biliary cirrhosis!
- biliary cirrhosis is assoc with systemic scleroderma
- It characteristically affects intrahepatic bile ducts more than the hepatic parenchyma, atleast in the earlier stages, and conseq. causes a disproportionate inc in Serum AlkPhos compared to AST and ALT.
Cat scratch disese?

Dog/Cat bites?
Bartonella henselae- cat scratch disease. Pustule and lymphadenopathy

Pasteurella mutocida - dog and cat bites. Cellulitis spreads from the site of bite.
HLA - what? for lyme disease