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119 Cards in this Set
- Front
- Back
"white yellow membrane like plaques" with fibrin deposits (caused by enterotoxin B)
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C. diff - can present up to 4 wks after antibiotics
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envelope glycoprotein 22 nm in diameter forming spheres & tubules
infected hepatocytes may excrete enormous quanities |
HBsAg
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bacteria transmitted from animals (pets, farms, lab workers)
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campylobacter can be
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necrotic skin wound with erythematous & edematous border, necrotic center
gram positive rods |
cutaneous anthrax -
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acute bacterial arthritis - in sexually active --> ______ , in children/non-active --> ______
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in sexually active --> n. gonnorhea, in children/non-active --> staph aureus
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ETEC toxin is similar to what other toxin?
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LT is similar to cholera toxin ETEC causes diarrhea, LT & ST toxins
Labile in the Air (cAMP) Stable on the Ground (cGMP) |
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latex agglutination tests for polysaccharide capsule
cryptococcus will show budding yeast does not have mold form |
Cryptococcus meningitis in HIV patients
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endocarditis
catalase negative, grows in 6.5% NaCl & bile (think enteric, bile) --> ______ what kind of procedure might this be associated with |
enterococcus, endocarditis (distinguish this from mutans by 6.5% NaCl)
"genitourinary manipulation has been known to cause enterococcal endocarditis" |
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necrotic skin patches in pt receiving chemo
presents w/fever, chills, sob |
ecthyma gangrenosum - occurs in neutropenic patients, pseudomonas colonizes perivascular area, toxins destroy & cause vascular insufficiency,
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african immigrant - patchy areas of skin anesthesia, hypopigmentation of UE, nerve biopsy many bacteria invading shwann cells -->
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Mycobacterium Tuberculosis
Tuberculoid TB --> skin thickening, patchy hypopigmentation, lionine facies, paresthesis / regional anesthesia, testicular destruction, blindness |
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gram neg sepsis
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LPS causes gram neg sepsis not actively excreted but released w/lysis,Lipid A is the toxic part
activates macrophages to release TNF-alpha & IL-1 widespread |
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tetanus - what route does toxin take?
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toxins travel retrograde in motorneurons to the spinal cord (Tetanus goes to the Top) to inhibit release of inhibitory neurotransmitters
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Tzank test positive -->
Tx w/what drug? What is MOA? |
herpes
tx active flairs with nucleoside analogs (acyclovir), which incorporate themselves into the viral DNA & terminate replication phosphorylation by viral thymidine kinase required for activity |
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Serum testing for treponema -->
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screening with nontreponema test looking for cardiolipin (VRDL, RPR)
confirmatory test with treponemous test for antigen (FTA-ABS, MHA-TP) |
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facial pain, headache, black necrotic eschar in nasal cavity of diabetic --> ? How do you confirm dx / what will you see?
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mucormycosis
confirm dx w/mucosal biopsy broad non-septate hyphae w/rt angle branching (WIDE branching in diabetics [associate w/overweight]) |
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foreign child w/febrile maculopapular rash starting head spreads to trunk & extremities -->
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rubella or rubeola
add postauricular lymphadenopathy --> rubella (german measles) rubella is a togavirus (togas rub horses) |
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HBV vaccine - what do you see?
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ppl vaccinated for HBV are positive for anti-HBsAg, negative for HBsAg
if they had actually contracted HBV and cleared it would also have anti-HBcAg IgG |
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DIC & bilateral hemmorhagic destruction of adrenal glands -->
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Waterhouse Friedrichson Syndrome
meningococcal sepsis (neisseria) |
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Pseudomons & Diphtheria toxin both act by:
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ribosylating and inactivating elongation factor 2 (exotoxin A)
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Strept bovis endocarditis is associated with:
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GI lesions (colon cancer
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flat red skin lesion with central clearing
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erythema chronica migrans
borrelia burgdorferi |
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hyper or hypo-pigmented skin patches becoming more noticeable after tanning
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malesthesia furfur
pityriasis (aka tinea) versicolor KOH scraping --> "spaghetti & meatball" hyphae "cigar butt" selenium shampoo |
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MCC acute otitis media, sinusitis, & bacterial conjunctivitis in childhood:
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1.) stept pneumo, 2.) Non-typable haemoph infl, 3.) moraxella cataralis
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Haemophilus influenza B vaccine reduces:
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meningitis, pneumonia, sepsis, epiglotitis in children
given at 2 mos |
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cherry red epiglottitis
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haemophilus influenza B
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fever, sore throat, drooling, progressive airway obstruction, & stridor in infant
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presenting sx of epiglottitis
haemophilus influenza B |
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Shigella vs Salmonella vs E. Coli
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Shigella is non-motile (where Salmonella is motile & produces H2S)
Shigella produces acid (where E. Coli produces gas) |
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penile lesions, draining ulcers, painful inguinal lymph nodes, fever, red eyes
cell scrapings --> inclusion bodies |
chlamydia trachomatis, lymphogranuloma venerum (L1-L3 serotypes)
Africa, Asia, Carribean, South America |
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gram positive clustered bacteria (oropharynx)
POLAR GRANULES staining with ANILINE dye |
Corynebacterium Diphtheria
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young male w/joint / long bone pain
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hematogenous osteomyelitis
staph aureus most commonly in kids, followed by strept group A |
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CSF: high WBC, lymphocyte predominant, glucose nl or slightly decreased, protein elevated but < 150
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Viral Meningitis
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MCC Viral Meningitis
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Enteroviruses (Coxsackievirus, Echovirus, Poliovirus, Enterovirus)
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HBV is in what body secretions?
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All except stool
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When does anti-HBsAg ab level rise?
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After virus is cleared, once HBsAg levels have dropped
asymptomatic |
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HDV requires HBV for?
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envelop coating
once acquired it can penetrate hepacocytes & replicate |
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Picornoviridae - Rhinovirus, Coxsackie, Echo, Polio, Hep A - which is acid sensitive?
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rhinovirus is acid sensitive
picornoviridae = rhinovirus & enteroviruses (others) enteroviruses can withstand acid, colonize GI |
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22 yo male, atypical lymphocytes, fever & joint pain
partially dbl stranded circular DNA virus w/RNA dependent DNA polymerase |
HBV
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HIV viral protein glycosylated & cleaved into 2 smaller prtns
what is it responsible for? |
absorption by target cells (gp160 --> gp120 + gp41)
gp120 binds CD4 for absorption gp41 stabilizes gp120 |
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6 day old infant w/HBsAg & HBeAg positive
risk for chronicity, replication speed, and liver damage? |
high risk for chronic infection, high replication rate, histologically mild liver damage
typically transmission from mother occurs in birth canal, may occur transplacentally |
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where do Kaposi's sarcomas first present?
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HIV associated
present as multiple blue-violet plaques on feet & legs before spreading proximally can also develop on mucosal membranes of face & genitals |
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34 yo female 2 days postpartum via spontaneous vaginal delivery
lower abdominal pain, temp 37.9, BP 110/70, pulse 110, resp 18, tender uterus & foul-smelling discharge - what's going on? What organism? |
Endometritis
Bacteroides most common organism, but can be mixed aerobic/anaerobics can complicate both spontaneous & C-sections |
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painful erupted vesicles on an erythematous base
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herpes zoster, reaction of VZV in dorsal root ganglion
neuropathic pain & isolated to single dermatome |
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meningitis w/sx of seizures, personality changes, & psychosis?
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temporal lobe encephalitis
MCC is HSV-1 may also have seizure/olfactory hallucination tx: IV acyclovir |
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MCC infectious arthritis? In kids < 2? Teenagers? Sickle cell?
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N. gonorrhoeae, Staph, strept, haem inf, gram - bacilli (e coli, salmonella, pseudomonas)
kids <2 - Haem influ, kids > 2 staph aureus teenagers & early adulthood (espec women) - N gon sickle cell - salmonella |
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bacterial resistance to antibiotic is diminished by addition of protons, what mechanism?
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drug efflux pump
usually coupled to H+ moving along concentration gradient OUT of the cell (some use Na or ATP though) |
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rapid infusion of IV drug for endocarditis causes immediate pruritis & rash
this drug characteristically has a linear relationship between rate of infusion & histamine release, what drug? |
Vancomycin
"red man syndrome" NOT IgE mediated, prevented by slower infusion rate |
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56 yo woman on recent cruise, 2 days fever, productive cough, crackle in left lung, lobar consolidation -- what is it?
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Legionella
suspect legionella in water supplies - cruise, hotel cough high fever confusion, diarrhea |
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Characteristic lab finding with legionella?
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Hyponatremia
2nd to inappropriate secretion of ADH |
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3 mos infant - irritable, feeds poorly, frequently vomits
wt 45% head circ 96% CT - enlarged ventricles, scattered intracranial calcifications fundoscopy - white-yellow chorioretinal lesions both eyes |
Congenital toxoplasmosis (in utero)
triad - hydrocephalus, intracranial calcifications, chorioretinitis |
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fungus in pigeon droppings?
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Cryptococcus neoformans
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fungus in lungs showing "spherules packed with endospores"?
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Coccidioides imiitis
(spherules rupture, endospores disseminate, each can form new spherule) - mold form at 25-30 C, endospore at 37-40 C |
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where is coccidioidomycosis found?
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Arizone, New Mexico, western Texas, central California, northern Mexico, some regions of South & Central America
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how is coccidiodis immitis transmitted?
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spore inhalation
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Histoplasma capsulatum associations?
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River Basins - Ohio & Mississippi, hx of cleaning bird coops or caving
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fungus that colonizes old lung cavities? (hx of TB)
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Aspergillus fumigatus, forms fungal ball (aspergilloma)
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what fungus are long hx of asthmatics at risk for?
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aspergillus fumigatus
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motile gram positive rods w/beta hemolysis?
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Lysteria
cell mediated immunity is necessary to eliminate |
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infant born to 25 yo IV drug users develops prominent oral thrush, interstitial pneumonia, & severe lymphopenia during 1st year life - what would have prevented this condition?
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baby has HIV
viral enzyme inhibitor would have helped |
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mucicarmine staining of lung tissue in immunocompromised pt w/cough & chest pain, turns red?
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Cryptococcus neoformans
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why does penicillin tx of group A strep prevent RF but not APSGN?
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rheumatic fever (antigen mimicry)
NOT post-strept glomerulonephritis (immune complex deposition) |
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septate hyphae 45 degree angle?
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aspergillus fumigatus
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what gram positive cocci produces dextrans from glucose?
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Viridins streptococci
this helps them attach to damaged valves |
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mayonaisse associated food poisoning?
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Staph aureus
usually getting at preformed heat-stable exotoxin |
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what CV defects are seen in tertiary syphillus?
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AORTIC - aortitis, aortic aneurysm, aortic regurgitation
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what defense protein does staph aureus have? How does it work?
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Protein A - binds the Fc portin of IgG at the complement binding site, preventing complement activation
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what is done to minimize risk of transmission of active Hep B from mother to fetus?
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passive immunization of all newborns w/HBIG, followed by active immunization w/recombinant HBV
typically transmission occurs in birth canal (but can cross placenta), HBeAg increases risk (from 20% to 95%) if fetus is infected 80% chance to progress to chronic |
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infection characteristic of sickle cell patients? Why?
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salmonella osteomyelitis - b/c fxnlly asplenic (followed by e. coli)
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bacteria - Vi antigen? K antigen?
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capsule antigens
Vi - salmonella (virulence) K - E. coli |
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why are envelop IgG antibodies not protective against HCV?
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envelop proteins vary their antigenic structure
HCV has hypervariable region, also lacks 3'-5' exonuclease proofreading (virion encoded RNAP) |
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bacillus anthracis toxin is similar to what other bacterial toxin?
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lethal factor & edema factor
edema factor is adenylate cyclase causing massive increases in intracellular cAMP similar to bordetella pertussis toxin called "extracellular adenylate cyclase" |
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2 MC sites of flora that cause infection of central venous catheters?
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patient's skin flora and bacteria on health care worker's hands
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what are motile gram negative rods turning pink on MacKonkey? What is their virulence factor?
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E. Coli - (context of meningitis)
capsule of E. Coli, K-1 antigen (present in 20-40% of intestinal E. coli isolates) virulence factor that aloows bacteria to survive hematogenous spread, establish meningeal infection |
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what is verotoxin?
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another name for the shiga-like toxin of EHEC
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what is the O antigen (bacteria)?
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cell wall Outer membrane polysaccharide used to classify gram-negative bacteria
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MCC of viral acute hemorrhagic cystitis outbreaks in children?
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Adenovirus (males in particular)
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what mediates liver injury in HBV?
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cytotoxic CD8 t lymphocytes responding to viral antigen on cell surface
virus does not have direct cytotoxic effect (though in integrative phase integration of DNA increases risk of HCC) |
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acute orchitis bacterial cause?
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young adults - c. trachomatis, n. gonorrhoeae
older pts - e. coli |
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MCC e coli bacteremia in 72 yo man from skilled nursing facility?
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UTI
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MCC of bacteria infecting biliary tree?
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E. Coli, Klebsiella, Enterobacter, Enterococci
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wound with a fruity odor?
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Pseudomonas aeruginosa
gram negative rod pigments would also give wound exudates in a blue-green hue |
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what is the morphology of Haemophilus influenza? What makes its capsule different from other encapsulated H. influenza?
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gram negative rod
capsule contains RIBOSE instead of hexose for it's carbohydrate component PRP capsule polyribosyl-ribitol-phosphate |
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bug grown on special medium, colonies appear black in color, intracellular polyphosphate granules detected on microscopy after methylene blue staining?
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C. diphtheria
metachromatic granules grown on cysteine-tellurite agar (or Loffler's medium) |
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use of blood agar containing bile & hypertonic saline?
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culture enterococci - E. faecalis & E. faecium
differentiates these from non-enterococci Group D strep including Strep bovis & Strep equinus (grow in bile but NOT hypertonic saline) |
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what is a viral capsid?
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nucleocapsid protein surrounds viral genome
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Tzank smear positive indicates?
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HSV or VZV
must obtain from base of vesiculoulcerative lesion epithelial cells scraped prepared w/Wright-Giemsa & examined for multinucleated giant cells & intranuclear inclusions |
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papanicolaou smear positive indicats?
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HPV, "pap" smear
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cryoglobulins indicate?
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HCV most commonly
cryoglobulins are cold-precipitable serum proteins containing immunoglobulins |
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hemadsorption indicates?
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suggests hemagglutinins or glycoproteins w/high affinity for RBC being expressed on host cell surface
characteristic of influenza & parainfluenza viruses |
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continuous proliferation of B-cells while maintaining ability to secrete immunoglobulin?
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EBV
immortalization, or transformation controlled by T-cell response |
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what is tazobactam? Sulbactam?
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beta-lactamase inhibitors, like clavulanic acid
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proximal bronchiectasis in 34 yo woman w/recurrent transient pulmonary infiltrates who suffers from bronchial asthma?
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Aspergillus fumigatus (Allergic Bronchopulmonary Aspergillosis - ABPA)
occurs w/hypersensitivity reaction, very high IgE and eosinophilia 5-10% of steroid dependent asthmatics |
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parasite that causes cough, asthma-like bronchospasm, and hemoptysis?
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Strongyloidiasis
transient pneumonia also, as larvae migrate thru lungs on way to laryngopharynx |
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HIV pt lost to follow up 3 yrs returns, pain & itching in perirectal area, exam shows ulcerative mass?
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Squamous cell carcinoma of the anus
(anal cancers ulcerative in > 50% cases) HPV associated |
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fever w/GI upset, hepatosplenomegaly, & "rose spots" on abdomen?
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typhoid fever - Salmonella typhi & paratyphi
travel associated can have possible hemorrhagic enteritis w/bowel perforation later in course salmonella penetrate both enterocyte transporters & via phagocytosis by M cells in Peyer's patches phagocytosed by macrophages and survive intracellularly can go to liver, spleen, & bone marrow |
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MCC of bacteriemia in sickle cell patients? Osteomyelitis?
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Streptococcus pneumo
followed by hemophilus influenza (asplenic) MCC of osteomyelitis is salmonella > s aureus or e coli |
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"rust colored sputum"?
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strept pneumo
"lancet-shaped gram positive diplococci" optichin sensitive (?) |
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what is expected to accompany blue/white spots on buccal mucosa in immigrant child?
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this is measles, rubeola
CCCK - cough, coryza, conjunctivities, koplik spots |
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people w/active leprosy have what response to heat killed M. leprae injection? (lepromin skin test)
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if tuberuloic leprosy will have positive test
-well contained, good Th1 CD4 response (& macrophages) if lepromatous leprosy, won't be positive? -poor cell mediated response, get limbs falling off and so on |
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mutation of the HIV pol and env genes confer what?
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pol mutation - resistance to reverse transcriptase and protease inhibitors
env (structural glycoproteins) - enables escape from host neutralizing antibodies |
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metallic sheen on eosin methylene blue agar, & hemolysis on blood agar? Motile
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E. coli
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most important virulence factor for e. coli causing UTI? Meningitis?
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UTI - fimbriae, adhesion to uroepithelial cells
meningitis - K-1 capsular antigen |
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what is the O antigen?
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cell wall Outer membrane polysaccharide used to classify gram-negative bacteria
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CMV causing the following conditions are present in which populations?
mononucleosis retinitis hepatitis pneumonia odynophagia |
mononucleosis - MC manifestation of CMV in immunocompetent hosts (but still less common than EBV)
retinitis - CMV in HIV patients diarrhea & hepatitis - disseminated CMV in immunocompromised CMV pneumonitis - organ transplant esophagitis - HIV pts |
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growth media for telling what strep is what?
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all strep are gram positive cocci, catalase negative
Alpha Hemolytic --optochin resistant, grows in bile --> Strep Viridans --optochin sensitive, NOT grow in bile --> Strep pneumo Beta Hemolygic --bacitracin resistant --> Group B strep --bacitracin sensitive --> Group A strep Gamma (no) Hemolysis --grows in bile AND NaCl --> Enterococci (E. faecium) --grows in bile, NOT NaCl --> Non-Enterococci (S. bovis) |
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common cause & route of a hepatic abscess?
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staph aureus thru hematogenous seeding
other routes include: -portal vein -arterial supply -ascending biliary tract infection (usually enteric gram neg bacilli & enterococci) -direct invasion from adjacent source (usually enteric gram-negative bacilli & enterococci) -penetrating injury |
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patient w/mycoplasma pneumonia is tx and develops sequelae, what might that be? Pathophys?
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can get mild anemia
some antigens are shared between RBC and m. pneumoniae wall antibodies that cross react are called "cold agglutinins" - able to agglutinate RBCs in vitro at low temp steven johnson syndrome & joint pain are other rare sequelae |
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pseudomonas toxin is similar to? Shiga toxin is similar to?
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Pseudomons & Diptheria exotoxin A act on EF-2
Shig-like toxins (vero toxins) are produced by EHEC, they inhibit the 60S ribosomal subunit preventing tRNA binding |
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deficiency in forming complement membrane attack complex exposes particular risk to what infection?
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Neisseria (meningitidis)
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petechial skin rash on trunk, spreading to include palms & soles?
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Neisseria-induced small-vessel vasculitis
especially affects palms & soles |
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Echinococcus is? Causes? Tx? Risk w/tx?
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MCC hydatid cysts in humans
-sheep & dog exposure, part of tapeworm life cycle encapsulated calcified cyst "eggshell calcification" surgery to remove cyst could result in spillage --> ANAPHYLAXIS adjunctive chemo w/mebendazole or albendazole then surgery is tx of choice -also they talk about injecting et-OH |
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where does HSV-1 encephalitis occur? What signs are noticed? If fatal, what does autopsy show?
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occurs in TEMPORAL lobe
sx - aphasia, olfactory hallucinations, personality changes macroscopic examination shows edema & hemorrhagic necrosis |
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23 yo male 2 day hx of fevere, confusion - impaired speech, change in personality, and olfactory hallucinations?
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temporal lobe encephalitis --> HSV-1
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the lesions of syphilis?
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Primary - chancre - painless ulceration
Secondary - condylomata lata - large gray wart like growths Tertiar - Gummas - begin as painless indurated granulomatous lesions progressing to white-gray rubbery lesion, may ulcerate |
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condylomata acuminata vs condylomata lata?
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condylomata acuminata - anogenital warts caused by HPV
condyloma lata - wart-life genital lesion caused by syphilis |
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essential virulence factor for nesseriea?
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pili
also has capsule, but pili are essential for establishing infeciton |
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homosexula man w/abdominal pain & diarrhea, guiac positive, occasional trophozoites w/phagocytosed RBCs seen?
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Entamoeba histolytica
usually bloody common in homosexual population b/c can be transmitted oral-anally |
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E coli that does not ferment sorbitol nor produce glucoronidase?
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E. coli O157:H7
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bacteria producing toxins that…
-activate adenylate cyclase? -activate guanylate cyclase? -inactivate EF2? -disrupt cytoskeleton? |
active adenylate cyclase - b. pertussis (pertussis toxin), B. anthracis (edema factor), ETEC (heat labile), campylobacter, bacillus cerus (heat labile) & v cholera
activate guanylate cyclase - ETEC (heat stable), Yersinia enterocolitica inactivate EF2 - corynebacterium diphtheriae, Pseudomonas aeruginosa (ADP-ribosylation) disrupt cytoskeleton - C difficile (toxin B, cytotoxin) |
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what RNA viruses replicate inside the nucleus? (only a few)
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Influenza A (orthomyxovirus)
Retroviruses |