Microbiology
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| Mechanism of action of Streptococcus agalactiae (GBS) | inhibits phagocytosis
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| Cause of an immunodeficiency with a high IgM | defect in isotype switching
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| Cyclosporine necessary in identical twin transplant because: | there are some difference in MHC sites from crossover of chromosomes in meiosis
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| Major drift with influenza | major changes in reassortment of genome pieces indicating a need for a new vaccine each year; only protects against "A;" egg based vaccine; killed virus vaccine
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| Receptor for HIV | CD4 molecule on helper T cells (also MQs and dendritic cells)
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| Graft versus host reaction | common inTcell defiencies; must irradiate donor blood to destroy lymphocytes (also destroys CMV)
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| DiGeorge syndrome | Tetany at birth; a pure T cell deficiency d/t absence of 3rd and 4th pharyngeal pouches (3 = inferior parathyroids + thymus; 4 = superior parathyroids); absent thymic shadow on xray
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| CD common to both B and T cells | CD45 - common to all leukocytes
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| Hanta virus | carried in rodents (deer mice); ARDS; hemorrhage, renal failure; viral RNA in lung tissue; do PCR
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| Staphylococcus aureus | protein A attaches to Fc receptor of MQs; blocks opsonization of bacteria
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| Proteus mirabilis | moves w/flagella; urease producer
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| C. diphtheria | toxin inhibits elongation factor 2 by ADP-ribosylation; blocks protein synthesis
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| Mycoplasma pneumoniae | requires sterols
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| Pneumonitis (larval transmigration) and ova in stools | Ascaris or hookworm; not Strongyloides
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| Rhabditiform larvae in stool | Strongyloides
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| Latex agglutination reaction | antibody to capsular antigens attach to the beads
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| Location of B cells in lymph node | follicles
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| Location of T cells in lymph node | paracortex
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| Location of histiocytes in lymph node | sinuses
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| Cells that attach protozoans | CD4 T cells
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| What gives bacteria their shape | peptidoglycan layer in cell wall
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| Tumbling motility, Gram positive rod | Listeria monocytogenes; invades mononuclear cells, beta-hemolysis in blood agar, transplacental infxn in fetus or renal transplant; may be contracted from eating unpasteurized cheeses
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| Gray membrane that bleeds when removed | Diphtheria
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| Dengue | transmitted by mosquito (Aedes aegypti; same as yellow fever); "breakbone fever;" may be hemorrhagic
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| Infection a/w premature rupture of membranes | Group B strep (S. agalactiae); CAMP test
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| IL-1 fxn on B lymphocytes | activates B cells
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| Location for S. aureus carriers | anterior nares
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| River blindness | Onchocerca; bite of blackfly; do skin biopsy; Tx = Ivermectin
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| Rhinovirus | common cold occurs more often in fall/winter; person to person droplet infxn and contaminated hands; acid-labile (does not cause gastroenteritis b/c of this)
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| Virus responsible for a cold in spring/summer | Adenovirus
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| Lactobacillus in vagina | responsible for acidic pH
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| Pruritid skin lesion in Gulf War veteran | cutaneous Leishmaniasis d/t sandfly bite
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| Hib (haemophilus influenza type B) vaccine | antibody against capsular polysaccharide
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| In addition to normal childhood immunizations, what additional immunizations are indicated for sickle cell and cystic fibrosis? | Pneumococcus and influenza (Pneumovax given after 2yo)
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| Which live vaccine can be given to a pt with AIDS | MMR (only b/c natural measles infxn is worse than rxn from attenuated virus)
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| List of the live vaccines | MMR, varicella, OPV (oral polio), BCG (TB), smallpox, yellow fever
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| List of the polysaccharide vaccines | Pneumococcus, Hib, Meningococcal
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| List of the killed vaccines | Influenza, Rabies, SALK (polio)
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| Immunizations contraindicated in pts with anaphylactic rxns to eggs | MMR, influenza, yellow fever
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| Immunizations contraindicated in pts with anaphylactic rxns to neomycin | MMR, Varicells, (it is a preservative)
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| Verrucoid lesion in lower extremity in pt returning from S. America | S.A. blastomycosis (yeast with a ships wheel appearance)
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| North american blastomycosis | broad based bud appearance
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| AIDS pt with 2 peaks in the natural history of the disease | p24 antigen
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| ELISA test for HIV | anti-gp 120 Abs; confirm with western blot
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| Best test for detecting HIV viral burden in blood | HIV RNA by PCR
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| Newborn baby in HIV positive mom | newborn has anti-gp 120 in serum (IgG Ab); usu prevent HIV in fetus by giving mom AZT
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| Animal a/w toxoplasmosis | cat
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| MCC of diarrhea in kids | rotavirus
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| E. coli | attaches to urogenital epithelium; #1 cause of UTIs
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| Bruton's agammaglobulinemia | SXR; defect in pre-B to B cells; prone to respiratory infxns; need IV gamma globulin
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| SCID | first immunodeficiency treated with gene therapy; replacement of adenosine deaminase
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| Wiskott Aldrich | SXR; triad of sinopulmonary infxns, eczema, thrombocytopenia; B and T cell deficiency; inc incidence of leukemia/lymphoma
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| Part of a vaccine that is antigenic | polysaccharide capsule
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| Person working with animal hides develops lung disease | Bacillus anthrax
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| Cryptococus | evades host destruction via polysaccharide capsule; pigeons
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| Child with anemia and diarrhea d/t a parasite | hookworm produces iron deficiency
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| Lymphocutaneous nodules in rose gardener | Sporotrichosis; Tx = Potassium iodide
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| Elderly male smoker w/non-productive cough, bacteria fails to grow on ordinary media (supplement w/iron and cysteine); Identify with Dieterle silver stain | Legionella; Tx = erythromycin
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| Macrophage activation | gamma-interferon secreted by helper T cells
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| IgA deficiency | sinupulmonary dz; mc genetic immunodeficiency
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| AIDS | mc acquired immunodeficiency
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| HLA system is coded on what chromosome? | Chromosome 6
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| Hyperacute rejection of a transplant | ABO incompatibility or pt had anti-HLA Abs against HLA Ag in graft
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| HLA-A, B, C code for | Class I antigens; recognized by CD8 cytotoxic T cells
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| HLA-D codes for | class II antigent; Recognized by CD4 helper Tcells and macrophages
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| Graft vs host reaction | NK cells mediate; common in bone marrow and liver transplants; rash, jaundice (necrosis of bile ducts), diarrhea, danger in Tcell deficienct pts
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| Anti-acetylcholine receptor antibody (AChR) | present in generalized myasthenia gravis (90%); a/w thymoma (60%); Responsible for defect in neuromuscular transmission; Correlates with activity of dz
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| Anti-centromere antibody | a/w CREST syndrome (60%) and PSS/progressive systemic sclerosis (10%)
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| Anti-gliadin antibody | a/w Celiac disease (95%); alcohol extract of gluten in wheat
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| Anti-glomerular basement membrane antibody | present in Goodpasture's syndrome (>90% sensitive/specific); Ab is against epitope of type IV collagen in glomerular and pulmonary capillaries
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| Anti-insulin antibodies | develop in pre-type I diabetes mellitus (before insulin is used in treatment); they also develop in pts taking bovine or porcine insulin but NOT human insulin
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| Anti-islet cell antibodies | noted in 60-90% of type I DM pts; NOT present in type II DM
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| Anti-microsomal antibody | a/w Hashimoto's autoimmune thyroiditis (97%) and Autoimmune hepatitis (70%)
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| Anti-mitochondrial antibody | present in Primary Biliary Cirrhosis (90-100%)
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| Cytoplasmic anti-neutrophil cytoplasmic antibody (c-ANCA) | present in Wegener's granulomatosis (>90%) and is a marker of dz activity; Ab is against myeloperoxidase
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| Perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) | a/w polyarteritis nodosa (>80%) and other inflammatory conditions (ulcerative colitis, cresenteric glomerulonephritis; Ab is against myeloperoxidase
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| Anti-parietal cell antibody | present in 90% of pts with pernicious anemia, but also noted in chronic atrophic gastritis, thus limiting its specificity
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| Anti-intrinsic factor antibodies | Type I (blocks antibody that prevents B12 from binding to IF) and Type II (binding antibody that binds to IF or IF-B12 complex); the former has greatest specificity for diagnosing PA
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| Anti-smooth muscle antibody | a/w autoimmune hepatitis (70%)
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| Anti-thyroglobulin antibody | present in Hashimoto's thyroiditis (85%) and Graves disease (30%); less sensitive than anti-microsomal for Hashimoto's
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| Hemochromatosis | a/w HLA-A3
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| Myasthenia gravis | a/w HLA-B8
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| Celiac dz | a/w HLA-B8 and HLA-DR3
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| Ankylosing spondylitis | a/w HLA-B27
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| Multiple sclerosis | a/w HLA-DR2
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| Type I DM | a/w HLA-DR3 and HLA-DR4
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| Rheumatoid arthritis | a/w HLA-DR4
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| Destroy C. difficile from bedpan | autoclave
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| Blastomycosis | spores a/w beaver dams and inland waterways
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| Impetigo | more commonly caused by S. aureus than group A strep
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| Direct fluorescent antibody test | the only way to visualize organisms in a sample from a patient; treat tissue sample w/labeled Abs against a causitive agent and evaluate under scope
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| ELISA | test for Abs in a pt; link Ags to a microwell plate, add pt serum, then add enzyme-linked Ab conjugate; a color change indicates that the Ag was present in the pt
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| Indirect fluorescent Ab test | test for presence of Abs in a pt; take lab-raised pathogen and treat it w/pt's serum then add labeled Abs against human Ig; if Abs are present, the sample fluoresces
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| Radioimmunoassay | test for Abs in a patient; similar to ELISA but instead of a fluorescent label it uses radioactivity
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| Western blot | detects Abs in a pt; great for HIV dx, though it is expensive and time consuming
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| Brucellosis (brucella abortus) | mc species to cause endocarditis; a/w occupational exposure in vets, ranchers and those handling carcasses (malaise, drenching sweats, fatigue, lymphadenopathy, petechiae, cardiac murmur (aortic valve > mitral valve))
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| recurrent infxn with S. aureus and Aspergillus | suggestive of chronic granulomatous disease (a defect in NADPH oxidase of neutrophils, resulting in inability to make toxic oxygen metabolites following phagocytosis); other bugs are Nocardia and Salmonella
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| Deficiency of C5 | makes pts prone to infxn by G(-) bacteria, especially Neisseria
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| IgA deficiency | most common immunodeficiency w/inc predisposition for autoimmune disorders, respiratory infxns and milk allergy
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| Thymic hypoplasia | d/t defective development of 3rd and 4th pharyngeal pouches; dec Tcell levels = more prone to viral and fungal infxns, hypocalcemia and parathyroid insuffiencies
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| LFA-1 | responsible for binding btw monocytes, Tcells, MQs, PMNs and dendritic cells and injured endothelium; it is a b2 integrin that interacts with ICAM-1 (has 5 Ig-like domains); the interaction promotes adhesion necessary for diapedesis in acute inflammation
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| CD28 and B7 | complementary molecules expressed on Tcells and APCs; role in Tcell activation
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| CR3 and ICAM-1 | promotes movement through ECM and encourages phagocytosis
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| MAdCAM-1 and L-selectin | responsible for homing lymphocytes to mucosal surfaces
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| P selectin and addressins | complementary molecules found on endothelium and platelets; initiate clotting process in area of acute inflammation
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| HLA-DR4 (class II MHC complex) | present in pts with persistant arthritis d/t Lyme disease
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| Interferon alpha | product of leukocytes that inhibits viral replication
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| Interferon beta | product of fibroblasts that inhibits viral replication
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| Interferon gamma | a product of TH1 cells that act on macrophages to enhance their microbicidal activities (intracellular killing in phagocytes)
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| Interleukin 2 | a product of TH cells that causes proliferation (cloning) of other lymphocytes
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| Tumor necrosis factor alpha | a product of MQs and NK cells; it is cytotoxic for tumor cells, induces cytokine production and causes cachexia of chronic inflammation
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| Specificity | how many people do not have the disease in question; (true negatives)/(true negatives + false positives)
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| Sensitivity | how many people with the disease test positive
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| Predictive value of a positive or negative test | take the number of positive or negative tests and divide it by the total number who did or did not have the dz
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| Efficiency of a test | the proportion of all subjects who were correctly classified by the test
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| Single-stranded positive sense RNA viruses | Coxsackie viruses (Poliovirus, Echovirus, Rhinovirus) and Picornoviruses
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| Double stranded DNA viruses | Pox viruses, Herpes viruses, Adenoviruses
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| Double stranded RNA viruses | Reoviruses, HIV
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| single stranded negative sense RNA viruses | Orthomyxoviruses
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| Single Stranded DNA virus | Parvoviruses
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