Step 1 Sketchy Micro Bacteria

Front 1

How is Bordatella pertussis spread?

Back 1

Respiratory droplets

Front 2

How does Bordatella pertussis spread attach to the respiratory epithelium?

Back 2

Filamentoushemagglutinin (pili)

Front 3

Describe the Filamentoushemagglutinin (pili) of Bordatella pertussis

Back 3

1.

allowsattachment to respiratory epithelium

2.

Antibodies against it prevent infection

Front 4

What causes the symptoms in a Bordatella pertussis infection?

Back 4

Toxins because it doesn't invade

Front 5

What are the three toxins in Bordatella pertussis?

Back 5

1. Pertussis toxin
2. Adenylate cyclase toxin
3. Tracheal toxin

Front 6

Pertussistoxin of Bordatella pertussis (function/mechanism) (2)

Back 6

1. causes ADP ribosylation of Gi => inhibits (disabled) Gi=> increases cAMP => edema

2. ribosylationalso causes => disables chemokine receptors of lymphocytes => lymphocytesunable to enter blood stream => lymphocytosis

Front 7

Adenylatecyclase toxin of Bordatella pertussis (function/mechanism)

Back 7

(actslike Anthracis EF toxin aka acts like adenylate cyclase) => increases cAMP=> edema

Front 8

Trachealtoxin of Bordatella pertussis (function/mechanism)

Back 8

part of the peptidoglycan wall that damages ciliated cellsin respiratory epithelium

Front 9

Three phases of Bordatella pertussis infection

Back 9

1. Catarrhal phase
2. Paraoxysmal phase
3. Convolescent phase

Front 10

Catarrhalphase of Bordatella pertussis

1. Length
2. Symptoms (3)

Back 10

1. Lasts 1-2 weeks

2. Most contagious stage
3. nonspecificsymptoms
4. conjunctival injection
5. lacrimation

Front 11

What is the most contagious phase of whooping cough?

Back 11

Catarrhal phase

Front 12

Paroxysmal phase of Bordatella pertussis

1. Length
2. Feature

Back 12

1. Lasts 2wks - 2 months
2. characteristiccough aka whooping cough, usually in childrenD

Front 13

Convolescent phase of Bordatella pertussis

Back 13

1. Lasts up to 3 months
2. Gradual improvement of symptoms

Front 14

Disease that Bordatella pertussis causes

Back 14

Whooping cough

Front 15

Another name for whooping cough

Back 15

100 day cough

Front 16

How do you treat whooping cough

Back 16

Macrolides, but symptoms won't improve till toxin goes away

Front 17

What type of vaccine is Bordatella pertussis and what is it in?

Back 17

1. Acellular vaccine (purified antigen of the bacteria)

2. DTaP

Front 18

Is Haemophilus influenza gram negative, positive, or other?

Back 18

Gram negative

Front 19

What is the shape of Haemophilus influenza?

Back 19

Coccobaccilliary shape

Front 20

What media do you use to grow Haemophilus influenza?

Back 20

Grown on Chocolate agar with Factor V which is NAD(nicotinamide) and Factor X which is hematin

Front 21

What factors are required to grow Haemophilus influenza?

Back 21

1. Factor V which is NAD (nicotinamide)

2. Factor X which is hematin

Front 22

How is Haemophilus influenza transmitted

Back 22

Aerosol transmission

Front 23

What are the clinical presentations of Haemophilus influenza? (4)

Back 23

1. Pneumonia
2. Epiglottitis
3. Otitis Media
4. Meningitis

Front 24

What is the most likely cause of bacterial epiglottis?

Back 24

Haemophilus influenza

Front 25

Haemophilus influenza epiglottis (4)

Back 25

1. inflamedepiglottis
2. inspiratory stridor
3. drooling
4. cherry red epiglottis

Front 26

What is the most dangerous complication of inflamed Haemophilus influenza?

Back 26

Meningitis

Front 27

What strain of Haemophilus influenza causes Meningitis?

Back 27

Type B capsule strain

Front 28

What patient population is particularly vulnerable to Haemophilus influenza and can present with what additional symptoms?

Back 28

1.

sicklecell or asplenia patients

2.

Sepsis

3.

Septic arthritis

Front 29

Describe the vaccine for Haemophilus influenza

1. What strains covered
2. Consists of?
3. Administer when?

Back 29

1. Covers Type B capsule only (prevents meningitis)

2. consistsof polysaccharide of Haemophilus capsule conjugated to diphtheria toxoid thatincreases immunigencity of capsule so body produces strong IgG response

3. Administer 2-18 months

Front 30

How do you treat Haemophilus influenza?

Back 30

Generally treat with beta-lactam

Front 31

How do you treat a systemic infection or meningitis caused by Haemophilus influenza?

Back 31

Ceftriaxone

Front 32

If you have a case of meningitis caused by Haemophilus influenza, in addition to treating the patient with ceftriaxone, what additional thing do you need to do?

Back 32

Treat with rifampin for prophylaxis of meningitis in closecontacts

Front 33

Is Legionella gram negative, positive, or other

Back 33

1. Gram negative, but doesn’t take up gram stain very well

2. Need silver stain to visualize

Front 34

How do you visualize Legionella

Back 34

Silver stain

Front 35

How do you grow Legionella?

Back 35

Grows on buffered charcoal yeast agar extract in presencecysteine and iron

Front 36

What two diseases does Legionella cause and which is more severe?

Back 36

1. Pontiac Fever (self-limited)

2. Legionnaire's Disease (severe)

Front 37

Pontiac fever

1. Cause
2. Symptoms
3. Treatment

Back 37

1.

Caused by Legionella

2.

Fever

3.

Malaise

4.

Self limited

Front 38

Legionnaire's Disease

1. More common in?
2. Features (4.5)
3. Treatment

Back 38

1. More common in smokers
2. Features: Atypical pneumonia
3. xray shows patchy infiltrate with consolidationof one lobe
4. pneumonia may presentwith hyponatremia / neurologic symptoms such as headache and confusion /diarrhea
5. high fever > 40 degrees C
6. Treat with fluoroquinolones or macrolides

Front 39

Is Legionella oxidase positive?

Back 39

Yes

Front 40

How do you treat Legionnaire's disease?

Back 40

Fluoroquinolones OR Macrolides

Front 41

What specific presentation would point to Legionnaire's disease

Back 41

pneumonia may presentwith hyponatremia and/or neurologic symptoms such as headache and confusion and/or diarrhea

Front 42

How do you diagnose Legionnaire's Disease quickly?

Back 42

Rapid urine antigen test

Front 43

Is Bartonella henslae gram negative, positive, or other?

Back 43

Gram negative, but requires a Warthin-Starry stain, a typeof silver stain to be visualized

Front 44

What type of stain do you need to visualize Bartonella henslae?

Back 44

Warthin-Starry stain, a type of silver stain to be visualized

Front 45

What disease is caused by Bartonella henslae in immunocompetent people?

Back 45

Cat Scratch fever

Front 46

What disease is caused by Bartonella henslae in immunocompromised people?

Back 46

Bacillary angiomatosis

Front 47

Cat Scratch Fever

1. Cause
2. Transmitted by
3. Symptom
4. Occurs in what patient population
5. Treatment

Back 47

1. Caused by Bartonella henselae
2. Transmitted by cat scratches
3. Symptom: Painful enlarged lymph nodes (axillary lymphadenitis)
4. Occurs in immunocompetent people
5. Usually self-limiting, but if severe can use Macrolides (Azithromycin)

Front 48

How do you treat Cat Scratch Fever?

Back 48

Usually self-limiting, but if severe can use Macrolides (Azithromycin)

Front 49

Bacillary angiomatosis

1. Cause
2. Transmitted by?
3. Occurs in what patient population?
4. Symptoms (3)
5. Treatment (2)

Back 49

1. Caused by Bartonella henselae
2. transmitted by cat scratches
3. Occurs inimmunocompromised people, especially HIVFevers
4. Symptoms: Chills
5. Headaches
6. Raisedred vascular lesions (Similar presentation to Kaposi Sarcoma)
7. Treatwith Doxycycline or Macrolides

Front 50

How is Bacillary angiomatosis transmitted?

Back 50

Cat scratch

Front 51

How do you treat Bacillary angiomatosis?

Back 51

Treatwith Doxycycline or Macrolides

Front 52

Is Brucella gram negative, positive or other?

Back 52

Gram negative

Front 53

What is the reservoir or Brucella?

Back 53

farmanimals including cows, goats, sheep, pigs

Front 54

How is Brucella transmitted?

Back 54

1. Person with direct contact with animals such as vet,butcher, or rancher

2. Person with indirect contact: ingestion of unpasteurizeddairy products such as cheese or milk

Front 55

Is Brucella facultative intracellular?

Back 55

Yes: Facultative intracellular organism in macrophages – preventphagolysosome fusion

Front 56

Brucellosis

1. Symptoms (5)

Back 56

1. Undulant Fever (fever rises and falls)
2. Chills
3. Anorexia
4. Spreads to the reticuloendothelial organs causingenlargement of the spleen, liver, lymph nodes then can spread systemically

5. Osteomyelitis in chronic brucellosis infections

Front 57

Where does Brucella spread to after infection?

Back 57

Spreads to the reticuloendothelial organs causing enlargement of the spleen, liver, lymph nodes then can spread systemically

Front 58

What type of fever is caused by Brucellosis

Back 58

Undulant fever

Front 59

What can you get after chronic Brucellosis?

Back 59

Osteomyelitis

Front 60

How do you treat Brucellosis?

Back 60

Doxycycline AND Rifampin used for adjunctive therapy

Front 61

Is Francisellatularensis gram negative, positive or other?

Back 61

Gram negative

Front 62

What is the main reservoir for Francisella tularensis?

Back 62

Rabbits

Front 63

How do you get Francisella tularensis? (3)

Back 63

1. Direct contact with rabbits or eating rabbit
2. Indirect transmission through dermacentor tick
3. Can be aerosolized, potential bioterrorist weapon, mustreport to CDC

Front 64

What type of tick transmits Francisella tularensis?

Back 64

Dermacentor tick

Front 65

Is Francisella tularensis facultative intracellular?

Back 65

Yes facultative intracellular in macrophages

Front 66

Pathogenesis of Francisella tularensis

Back 66

Painful ulcer at site of infection (often tick bite) =>macrophages => lymph systems (regional lymphadenapthy => reticuloendothelial organs =>Granulomas with caseating necrosis in reticuloendothelial organs (ie lymphnodes, spleen, liver)

Front 67

Where does Francisella tularensis spread to in the body and what does it cause at these sites?

Back 67

1. Reticuloendothelial organs

2. Granulomas with caseating necrosis in reticuloendothelial organs (ie lymph nodes, spleen, liver)

Front 68

How do you treat Francisella tularensis?

Back 68

Streptomycin or other aminoglycosides

Front 69

Where is Pasteurella multocida found naturally?

Back 69

Respiratory tract of small mammals like cats and dogs (pets)

Front 70

How is Pasteurella multocida transmitted?

Back 70

Cat and dog bites

Front 71

What is the initial presentation of Pasteurella multocida?

Back 71

Cellulitis within 24 hours of infection

Front 72

Where can a Pasteurella multocida infection spread to?

Back 72

Bones => Osteomyelitis

Front 73

Is Pasteurella multocida catalase positive?

Back 73

Yes

Front 74

Is Pasteurella multocida oxidase positive?

Back 74

Yes

Front 75

What is the most important virulence factor in Pasteurella multocida?

Back 75

Capsule

Front 76

How do you grow Pasteurella multocida?

Back 76

5% Sheep's blood agar

Front 77

What does Pasteurella multocida look like on staining?

Back 77

Bipolar staining (safety pin staining)

Front 78

How do you treat Pasteurella multocida?

Back 78

Empiric treatment is Penicillin with possible addition ofB-lactamase inhibitor

Front 79

What type of stain is an acid fast stain and what does it stain?

Back 79

1. Carbol fuschin stain
2. High concentrations of mycolic acid (two waxy side chains)

Front 80

What type of stain do you use to look at Mycobacterum tuberculosis?

Back 80

Acid fast (Carbol fuschin stain)

Front 81

How long does Mycobacterum tuberculosis take to culture?

Back 81

2 to 6 weeks (slow)

Front 82

What type of media do you use to grow Mycobacterum tuberculosis?

Back 82

Lowenstein-Jensen media

Front 83

Is Mycobacterum tuberculosis an obligate aerobe?

Back 83

Yes

Front 84

How is Mycobacterum tuberculosis transmitted?

Back 84

Respiratory droplets

Front 85

Where does Mycobacterum tuberculosis reside/proliferate?

Back 85

Inside macrophages

Front 86

What is an essential virulence factor for Mycobacterum tuberculosis?

Back 86

Cord factor

Front 87

Cord factor of Mycobacterum tuberculosis function (2)

Back 87

1. Glycolipids in the cell wall involved with clumpingof bacteria into serpentine like formation
2. Protects bacteria from being destroyed byeliciting granuloma formation by increasing TNF-alpha + cytokines =>activating other macrophages => allows it to be walled off in granuloma by macrophages

Front 88

Sulfatides of Mycobacterium tuberculosis function

Back 88

allowsTB to survive inside macrophages by preventing phagolysosome fusion

Front 89

What are the three paths of progression after primary TB infection?

Back 89

1. Healed latent infection
2. Systemic infection (miliary TB)
3. Reactivation TB

Front 90

Primary TB infection pathogenesis

Back 90

affectslower or middle lobes of lungs => heals => fibrotic lesion => lesioncalcification + hilar lymph node calcification => Ghon complex (visiblecalcifications seen on chest xray of lung parenchyma and hilar lymph nodes) =hilar lymphadenopathy + peripheral granulomatous lesion in middle or lower lunglobe

Front 91

What part of the lungs does a primary TB infection target?

Back 91

Hilar region (lower/middle lobes)

Front 92

What stage of a TB infection do you see Ghon complexes?

Back 92

Primary infection

Front 93

Ghon complex

1. When do you see this
2. Features (2)
3. Imaging

Back 93

1. Primary TB infection
2. Hilar lymphadenopathy
3. Peripheral granulomatous lesion in middle or lower lung lobe
4. Visible calcifications of lung parenchyma and hilar lymph nodes see on xray

Front 94

Describe the tubercles seen in TB

Back 94

Ceaseating type of granulomas – Langerhan giant cells(activated macrophages) attempt to wall off infection with central area ofcaseating necrosis surrounded by fibrosis and scarring

Front 95

Primary TB infection symptoms and progression

Back 95

Prolonged fever, most commonly inchildren with most cases resolving, healing by fibrosis and calcification andbecoming latent => positive PPD shown as a wheel on the skin do to type IVhypersensitivity

Front 96

BCG vaccine

Back 96

1. BCG vaccine from attenuated Mycobacterium bovis can causepositive PPD even if patient never exposed to TB

2. 0-80% effective against TB

Front 97

What do you call systemic TB?

Back 97

Miliary TB

Front 98

Miliary TB

Back 98

1. Bacteremia (systemic) => multiorgan failure
2. Potentially lethal

Front 99

Reactivation of latent TB

1. Associated with?
2. Affects which lung lobes
3. Symptoms (5.5)

Back 99

1. Associated with immunosuppression through down regulation ofTNF-alpha release => uncontained infection

2. Affects upper lobes of lungs

3. Symptoms: Cough

4. night sweats

5. hemoptysis
6. Cachexia and weight loss often seen due to TNF-alphasecreted by cord factor

Front 100

Before starting TNF-alpha inhibitors such as Infliximab, what should you do first and why?

Back 100

Screen for TB or else at risk for reactivation

Front 101

Which lung lobes are affected in reactivated TB?

Back 101

upper lung lobes

Front 102

Pott's disease

Back 102

TBinfected spinal column on multiple vertebra => demineralization of the bonewith soft tissue swelling => pain, spinal deformities, spine weakness

Front 103

What is TB of the spine called?

Back 103

Pott's disease

Front 104

Why is Cachexia and weightloss often seen in TB?

Back 104

Due to TNF-alpha secreted by cord factor

Front 105

Describe CNS TB infection

Back 105

Meningitiswith possible formation of cavitary lesion or Tuberculoma

Front 106

How do you treat active TB infection?

Back 106

1. Treat with combination of RIPE:

2. Rifampin

3. Isoniazid

4. Pyrazinamide

5. Ethambutol

Front 107

How do you treat latent TB prophylaxis?

Back 107

Rifampin or Isoniazid for 9 months

Front 108

What type of environment does Mycobacterium leprae thrive in?

Back 108

Cold temperatures, giving it predilection for extremities of the body

Front 109

What part of the body does Mycobacterium leprae like to go?

Back 109

extremities

Front 110

What type of stain do you use to visualize Mycobacterium leprae?

Back 110

Acid fast (Carbol fuschin stain)

Front 111

What is the US reservoir for Mycobacterium leprae?

Back 111

Armadillo

Front 112

What is another name for Leprosy

Back 112

Hansen's disease

Front 113

What are the two forms of Mycobacterium leprae infection and which is more severe?

Back 113

1. Tuberculoid leprosy

2. Lepromatous leprosy (more severe)

Front 114

What type of immune response leads to Tuberculoid leprosy?

Back 114

TH1 cell response with cell mediated immunity

Front 115

What type of immune response to Lepromatous leprosy?

Back 115

TH2 cell response with humoral immunity

Front 116

Tuberculoid leprosy

1. Immune response
2. Containment?
3. Lepromin test result?
4. Symptoms
5. Treatment

Back 116

1. TH1 cell response with cell mediated immunity
2. Body can contain bacteria within macrophages
3. Positive Lepromin test
4. Minimal symptoms except Well-demarcated hairlesshypoesthetic skin plaque such as bald scalp but can occur anywhere on body
5. Treatment: Multidrug Treatment with Dapsone and Rifampin for 6 month

Front 117

Lepromin skin test

1. Define
2. Positive result indicates?

Back 117

1. intradermal injection of antigens similar to TB PPD test with positive Lepromin skin test demonstrating good cell mediated response

2. Positive => TH1 cell dominant response => Tuberculoid Leprosy

Front 118

What does a biopsy of Tuberculoid leprosy show?

Back 118

small amount of bacteria

Front 119

Lepromatous leprosy

1. Immune response
2. Containment
3. Lepromin skin test result
4. Transmission
5. Symptoms (3+)
6. Treatment (3) + how long

Back 119

1. TH2 mediated response with humoral responseL
2. imited containment of infection – are not able to becontained in macrophages
3. Lepromin skin test negative
4. Human to human transmission
5. Symptoms: Symmetric glove and stocking neuropathy (extremities)
6. Poorly demarcated raised lesions most notably on extensorsurfaces (face away from body = cooler)
7. Facial deformity including thickening of skin, loss ofeyebrows and eyelashes, collapse of nose, formation of nodular ear lobes =>leonine facies (lion face)
8. Treatment: Multidrug Treatment with Dapsone, Rifampin, and Clofaziminefor 2 to 5 years with deformities that may not be reversible even withtreatment

Front 120

What would biopsy of Lepromatous leprosy show?

Back 120

lots of bacteria

Front 121

Where are the lesions located in Lepromatous leprosy?

Back 121

Extensor surfaces

Front 122

Where is the neuropathy located in Lepromatous leprosy?

Back 122

Extremities (Symmetric glove and stocking)

Front 123

What shape are spirochetes?

Back 123

Spiral shaped

Front 124

Do spirochetes gram stain well?

Back 124

No because of thin walls, except Borrelia with a special stain

Front 125

What class of bacteria is Borrelia burgdorferi?

Back 125

Spirochete

Front 126

Where do you find Borrelia burgdorferi?

Back 126

Northeast US

Front 127

Typical history of Borrelia burgdorferi?

Back 127

Hiking/camping in forest

Front 128

What tick transmits Borrelia burgdorferi?

Back 128

Ixodes Scapularis

Front 129

Describe Ixodes Scapularis life cycle and its relation to Borrelia (reservoir, hosts, vector, etc)

Back 129

1. Larvae in white-footed mouse (main reservoir)
2. Adults in white-tailed deer (obligatory host)
3. Vector: Tick
4. Incidental/dead end host: humans

Front 130

How do you visualize Borrelia burgdorferi? (2)

Back 130

1.

Wright's Stain

2.

Giemsa stain

Front 131

What disease does Borrelia burgdorferi cause?

Back 131

Lyme diseae

Front 132

Lyme disease

1. Cause
2. Vector
3. Stages (3)

Back 132

1. Borrelia burgdorferi
2. Spread via Ixodes Scapularis tick
3. Stage 1: erythema chronicum migrans- bull's eye rash - not painful, not pruritic, fever/chills, occurs within a month of bite
4. Stage 2: heart block caused by myocarditis + bilateral facial nerve palsies (Bell's palsies)
5. Stage 3: Arthritis of large joints, such as knee, migratory polyarthritis, CNS effects - subtle encephalopathy
6. Treatment: Doxycycline if early, ceftriaxone if severe or late

Front 133

Stage 1 of Lyme disease

1. Main symptom (description (2))
2. Other symptoms (1.5)
3. When does it occur?

Back 133

Bull's eye rash: erythema chronicum migrans

1. Not painful
2. Not pruritic
3. Fever/chills
4. Occurs within a month of bite

Front 134

Stage 2 of Lyme disease - symptoms (2)

Back 134

1. Heart block caused by myocarditis

2. bilateral facial nerve palsies (Bell's palsies)

Front 135

Stage 3 of Lyme disease -symptoms (3)

Back 135

1. Arthritis of large joints, such as knee

2. migratory polyarthritis

3. CNS effects - subtle encephalopathy

Front 136

How do you treat Lyme disease? (2)

Back 136

Treatment: Doxycycline if early, ceftriaxone if severe or late

Front 137

What class of bacteria is Leptospira interrogans

Back 137

Spirochete

Front 138

Can you visualize Leptospira interrogans under microscope?

Back 138

No

Front 139

Where do you find Leptospira interrogans regionally?

Back 139

Endemic in tropical regions such as Hawaii

Front 140

How would you describe how Leptospira interrogans looks?

Back 140

Small thin, spiral, question mark/hooked shape

Front 141

Where do you find Leptospira interrogans in nature?

Back 141

Rodent and dog excreted urine

Front 142

How is Leptospira interrogans transmitted to humans?

Back 142

Transmitted to humans when they swim in contaminated water

Front 143

What is associated with Leptospira interrogans infections?

Back 143

Water sports

Front 144

Early Leptospria interrogans infection symptoms (4)

Back 144

1. Flu like symptoms

2. Fever

3. intenseheadaches

4. Conjunctival suffusion – diffuse reddening of the eyes withoutinflammatory exudate (no pus)

Front 145

What is the most severe form of Leptospirosis called?

Back 145

Weil's disease

Front 146

Weil's disease

1. Define
2. How does it spread in body and to where?
3. Symptoms (2)

Back 146

1.

Severe Leptospirosis infection

2.

Travels through bloodstream => multiple organs, particularly kidneys and liver

3.

Kidney dysfunction

4.

Liver dysfunction and jaundice

Front 147

What disease does Treponema pallidum cause?

Back 147

Syphillus

Front 148

What type of bacteria is Treponema pallidum?

Back 148

Spirochete

Front 149

How is Treponema pallidum spread?

Back 149

STD

Front 150

How do you visualize Treponema pallidum?

Back 150

Dark field microscopy needed for direct visualization

Front 151

What are two screening tests for Treponema pallidum?

Back 151

1. VDRL screening test (not specific)

2. RPR screening test

Front 152

What molecule does the VDRL screening test specificially look for? What disease does it screen for, thought not specific?

Back 152

1. Antibodies to Cardiolipin cholesterol lecithin
2. Treponema pallidum

Front 153

What could potentially create false positive on VDRL or RPR screening test for syphilis?

Back 153

1. Mono
2. RF
3. SLE
4. LEP
5. DRG (IV drug user)

Front 154

How do you confirm Treponema pallidum?

Back 154

FTA antibody test

Front 155

Describe the primary stage of Syphilis

1. Symptoms

2. Timeline

Back 155

1. Painless genital chancre that appears a fewweeks after innoculation (invades small blood vessels => ischemia, necrosis,nerve damage aka painless)

2. heals in 3-6 weeks, but if left untreatedprogresses to next stage

Front 156

Describe the secondary stage of Syphilis (4) (Symptoms and timeline)

Back 156

1. Systemicdisease

2. maculopapular rash occurs on palms and soles weeks to months afterinfection (occurs generally entire body but including palms and soles)

3. condyloma latum on mucous membranes – lot a bumps (flat topped, less wart like)

4. can visualize spirochetes within condyloma latum via darkfield microscope

Front 157

Describe the symptoms and pathogenesis/mechanism of each symptom of Tertiary Syphilis (3)

Back 157

1. Formationof gummas – soft growths with firm necrotic center that can occur anywhere inany tissue

2. aortitis of the ascending thoracic aorta => ascending thoracicaneurysm that looks like tree-barking (looks thick and wrinkled) via destroythe vaso vasorum (small vessels that supply blood to aorta)

3. Tabes dorsalis –demyelination of the dorsal column of the spinal cord => loss of vibration,proprioception, and discriminating touch, and odd gait, lancinating pain

4. Argyll Robertson pupils - react to accomodatioin but no reaction to light aka "Prostitutes's pupil"

Front 158

What are Argyll Robertson pupils and when do you see these?

Back 158

1. react to accomodatioin but no reaction to light aka "Prostitutes's pupil"

2. Tertiary Syphilis

Front 159

Condyloma lata

1. Disease
2. Stage

Back 159

Secondary Syphilis (indicates systemic infection)

Front 160

gummas

1. Describe
2. Disease/Stage

Back 160

1. soft growths with firm necrotic center that can occur anywhere in any tissue

2. Tertiary Syphilis

Front 161

Congenital Syphilis Symptoms (5)

Back 161

1. Saber shins - anterior bowing of the tibia
2. Saddle nose (stubby nose with indented bridge)
3. Hutchinson's teeth - notched incisors
4. Mulberry molars - molars with severe enamel outgrowths
5. Deafness

Front 162

How do you treat Syphilis?

Back 162

Penicillin for everyone in all stages

Front 163

Jarisch-Herxheimer reaction

Back 163

1. mayoccur hours after treatment – dying spirochetes release LPS that leads tocytokines release => fevers, chills, headache

2. Sign of working Syphilis treatment

Front 164

Is Pseudomonas aeruginosa, gram positive, negative or other?

Back 164

Gram negative

Front 165

What is the shape of Pseudomonas aeruginosa?

Back 165

Rod

Front 166

What environment does Pseudomonas aeruginosa thrive in?

Back 166

Aquatic environments

Front 167

Is Pseudomonas aeruginosa oxidase positive or negative?

Back 167

Oxidase positive

Front 168

Is Pseudomonas aeruginosa catalase positive?

Back 168

Yes

Front 169

What happens when Pseudomonas aeruginosa is plated?

Back 169

Produces blue-green pigment, sometimes will even turn wounds blue

Front 170

What bacteria turns wounds blue through a pigment?

Back 170

Pseudomonas aeruginosa

Front 171

What pigments does Pseudomonas aeruginosa

Back 171

Pyocyanin/pyoverdin pigments

Front 172

What infection produces a fruity grape-like odor?

Back 172

Pseudomonas aeruginosa

Front 173

Is Pseudomonas aeruginosa an obligate aerobe, obligate anaerobe or facultative?

Back 173

obligate aerobe

Front 174

What is the #1 cause of gram negative nosocomial pneumonia?

Back 174

Pseudomonas aeruginosa

Front 175

What patient population is particularly vulnerable to Pseudomonas aeruginosa pulmonary infections

Back 175

CF

Front 176

What is the #1 cause of respiratory failure in CF patients?

Back 176

Pseudomonas aeruginosa

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What are IV drug users most likely to develop with Pseudomonas aeruginosa?

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Osteomyelitis

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What are diabetics with Pseudomonas aeruginosa likely to develop?

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Osteomyelitis

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What two patient populations are likely to develop Osteomyelitis with Pseudomonas aeruginosa?

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1.

IV drug users

2.

Diabetics

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Is Pseudomonas aeruginosa encapsulated?

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Yes

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A burn patient is likely to get what infection?

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Pseudomonas aeruginosa

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Pseudomonas aeruginosa infections (main symptoms/presentations) (5)

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1.

Nosocomial Pneumonia

2.

Nosocomial UTI

3.

Hot tub faculitis

4.

Ecthyma gangrenosum - sepsis which causes black cutaneous necrosis

5.

Swimmer's ear - otitis externa

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Hot tub faculitis

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1. Caused by Pseudomonas aeruginosa
2. Pruritic papular /pustular fascilulitis associated with under chlorinated hot tubs

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Pseudomonas aeruginosa Exotoxin A

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Ribosylates EF2 causing inhibition of protein synthesis and cell death

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How do we treat Pseudomonas aeruginosa?

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1.

Piperacillin + Tazobactam

2.

Aminoglycosides

3.

Fluoroquinolones

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Is Proteus mirabilis gram negative, positive or other?

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Gram negative

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Is Proteus mirabilis obligate aerobe, obligate anaerobe, facultative aerobe, or facultative anaerobe?

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Facultative anaerobe

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What does Proteus mirabilis show when plated?

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Swimming motility

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What does Proteus mirabilis smell like?

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Fishy odor

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How do you treat Proteus mirabilis?

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Sulfonamides

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Describe the kidney stones formed by Proteus mirabilis

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Staghorn caliculi

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How does Proteus mirabilis promote struvite stone formation?

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Urease positive => NH3 + CO2 => alkaline environment

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Two clinical presentations of Proteus mirabilis?

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1. Kidney stones
2. UTI

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What group of bacteria is Coxiella burnetti closely related to?

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Rickettsia

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What is a major difference between Coxiella burnetti and Rickettsia

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Coxiella burnetti does not cause rash

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Is Coxiella burnetti gram negative, positive, or other?

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Gram Negative

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What disease does Coxiella burnetti cause?

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Q fever

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Is Coxiella burnetti facultative intracellular, obligate intracellular or neighter?

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Obligate intracellular

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How is Coxiella burnetti transmitted?

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Spore like structure can survive digestive tract and appear in feces of animals => dirt => aerosol transmission of fecal matter in dirt => inhaled

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What is the major reservoir for Coxiella burnetti?

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Farm animals

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People likely to get Coxiella burnetti and how?

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1.

Famers from farm animals

2.

Vet delivering baby farm animals gets exposed to Placental Excretion

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Symptoms of Coxiella burnetti (4)

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1. Pneumonina
2. Headache
3. Fever
4. Hepatitis

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How do you treat Coxiella burnetti? (2)

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1. Self-limiting infection within 2 weeks
2. Rarely can progress to cause endocarditis in chronic infection in immunocompromised or in previous valvular damage

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How do you prevent Coxiella burnetti infection?

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1. Pasteurize milk

2. Vets can have an acellular vaccine

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What type of pneumonia does Mycoplasma pneumoniae cause? (2)

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1. Atypical pneumonia - can't readily culture or isolate microbe

2. Walking pneumonia- Xray shows severe pneumonia but patient still doesn't appear super clinically sick and can walk about

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Does Mycoplasma pneumoniae gram stain?

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No cell wall, therefore doesn't appear on gram stain

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What is special about Mycoplasma pneumoniae's cell membrane?

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Has Cholesterol

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What is the only bacteria with cholesterol in its cell membrane?

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Mycoplasma pneumoniae

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How is Mycoplasma pneumoniae infection described on xray?

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Reticulonodular or patchy infiltrate

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Who is particularly at risk for Mycoplasma pneumoniae? (2)

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1. Young adults in close contact
2. Military recruits

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How do you culture Mycoplasma pneumoniae?

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Eaton's agar (takes a long time)

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What is a test for Mycoplasma pneumoniae?

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1-2 weeks into infection develop IgM molecules thatagglutinate erythrocytes in cold temperatures (cold aggultinins) => possiblyleading to RBC lysis

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Which bacterial infection causes cold aggultinins?

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Mycoplasma pneumoniae

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How do you treat Mycoplasma pneumoniae?

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Macrolides (can't use anything that works on cell walls)