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Infectious Diseases

UWORLD Infectious Diseases and Immunology Review

QuestionAnswer
What is a common infection seen in persons with complement inability to form the MAC? Neisseria species
End-product of antibody complement fixation Membrane Attack Complex (MAC)
How does the MAC work? Creates pore in the cell membrane, which causes an electrolyte disturbance, as there is inflow of free water causing eventually cell lysis.
The MAC defends against _________________- bacteria Gram Negative
C5b - C9 Membrane Attack Complex (MAC)
Terminal complement deficiencies C5-C9 lead to easier infection by Neisseria species
What is the most common opportunistic infection in HIV? Candidmia
Single-celled budding yeast with PSEUDOHYPHAE Candida albicans
Production of + Germ Tubes Candida albicans
Normally where is Candida albicans found in the human body? Skin and mucosal flora
From which type of C. albicans manifestation do T-cells defend us? Prevention of SUPERFICIAL INFECTIONS, such as, oral/esophageal, cutaneous, or vulvovaginal candidiasis
Oral candidiasis is prevented by action of the ____________. T Helper cells
Role of Neutrophils in C. albicans infection? Prevent the hematogenous spread of Candida.
Failure of Neutrophil protection against C. albican infection lead to? Disseminated Candidiasis, manifested with Candidemia and Endocarditis
What is the MC treatment for disseminated Candidiasis? Amphotericin B
Vaginal Candidiasis treatment Oral fluconazole/ or topical azole
Oral/esophageal Candidiasis treatment is? Nystatin, Fluconazole, or echinocandins
Which marker is seen before symptoms appear in suspected HBV infection? HBsAg
SECES Order of appearance of HBV infection markers. Antigens (HBsAg, HBeAg, HBcAg) Antibodies (HBeAb and HBsAb)
Active viral replication of HBV is signaled with which marker? HBeAg
Which marker is made with IgM and IgG? Anti HBcAg
What is the organism that causes Lyme disease? Borrelia burgodferi
Borrelia burgdorferi causes _________________. Lyme Disease
The ________ tick carries __________________________, which is the causative organism of _____________________. Ixodes tick; Borrelia burgdorferi; Lyme Disease
What disease is associated with Erythema migrans? Lyme Disease
What is Erythema migrans? Rash seen in Lyme disease, with a Target distribution , resembling a "Bull's Eye" pattern.
What kind of activities are often associated with development of Lyme Disease? Camping and Hiking
Stage 1 symptoms of Lyme disease Erythema migrans and flu-like symtoms
What are the common Stage 2 symptoms of Lyme Disease? Carditis, 3 degree AVB, Facial Nerve (Bell's) palsy, migratory myalgias/transient arthralgias.
Development of 3 AVB is seen in secondary stage of what disease? Lyme Disease
Encephalopathy and Chronic arthritis are symptoms of Lyme disease, that appreat in Stage ______. Stage 3
What is the first line of treatment of Lyme disease? Doxycycline
How is Lyme Disease treated in pregnant women and children? Amoxicillin and cefuroxime
What is the MC mechanism of resistance shown by Penicillins? 1. Mutated PBP 2. Beta - lactamase, ESBL, 3. Mutated porin protein
Vancomycin mode of resistance is by: 1. Impaired influx/ increased efflux
Mutated DNA gyrase Mode of resistance seen in Quinolones
Three ways that aminoglycosides obtain drug resistance: 1. Aminoglycoside-modified enzyme 2. Mutated ribosomal subunit protein 3. Mutated poin protien
What is the main form by which tetracyclines obtain drugs resistance? Impaired influx and increased efflux
Mutated RNA polymerase Form by which Rifamycin develops drugs resistance
What is gingivostomatitis? Development of vesicles on lips and hard palate, fever and lymphadenopathy by HSV-1 reinfection.
How is recurrent HS-1 infection manifested? Development of Gingivostomatitis
Which lobe is most affected by HSV 1 infection? Temporal lobe
What is a common neurological manifestation of HSV-1 recurrent infection? Temporal meningoencephalitis
Which are the main 3 families of dsDNA enveloped viruses? 1. Hepadnaviridae 2. Herpesviridae 3. Poxviridae
Hepatitis B is part of the ___________________ which is an _____________ ____-_______________ virus. Hepadnaviridae family; ENVELOPED; dsDNA
Herpes virus description: double stranded - DNA, enveloped
Varicella, SHingles, HSV1, HSV2 Herpes family viruses
HSV-3 also known as: Varicella zoster
Small Pox is an __________________ ds_______ virus. ENVELOPED dsDNA virus
Which dsDNA viruses are NON-ENVELOPED (NAKED)? Adenovirus, Polova, and Polyoma virus families.
HPV is an example of? Naked, dsDNA virus of the Parvoviridae family.
Which are the most commonly used Polyoma viruses? JC and BK
Erythema migrans is associated with _______________________. Lyme Disease
Erythema Marginatum is associated with ____________________. Acute Rheumatic Fever
Erythema Nodosum is associated with ____________________. Infection, autoimmune, medications, pregnancy, and neoplasm
Erythema Multiforme is associated with ______________________. (Autoimmune mediated) ; Infections and medications
Crohn's disease and UC are often found with erythema ___________________. Nodosum
Lofgren syndrome and Behcet syndrome develop erythema ________________. Nodosum
Untreated Group A streptococcal pharyngitis may develop: Acute Rheumatic Fever
Which components cross react in pathogenesis of RF? The anti-group A antibodies, which are anti-M protein and anti-NABDG.
The cross reaction between anti-group A antibodies cause an attack on which two tissues? Cardiac and CNS
What organism has M-protein as bacterial virulence factor? Streptococcus pyogenes
What organisms is known as the group A streptococcus Streptococcus pyogenes
M-protein enhances the infection by S. pyogenes by: Preventing phagocytosis
S. pyogenes has _________________, and S. aureus has _______________, as virulence factors. M-protein; Protein A
Promote evasion of immune response Bacterial virulence factors
What are some common virulence factors? Protein A, IgA protease, and M-protein
Protein A is is found in __________________________. Staphylococcus aureus
Bind to Fc region of IgG Protein A
Protein A: Prevents Opsonization and phagocytosis
M-protein only prevents ___________________________, while the Protein A prevents _____________ and ___________________. Phagocytosis: Phagocytosis and complement
Cleaves IgA, allowing bacteria to colonize mucosal membrane IgA protease
Virulence factor of S. pneumoniae, H. influenzae type B, and Neisseria. IgA protease
SHiN Mnemonic for Strep pneumoniae, H. influenzae type B, and Neisseria.
What is the JONES criteria? Set of clinical manifestations seen in Acute Rheumatic Fever.
JONES criteria J-migratory polyarthritis ❤- cardiac - MR N- skin Nodules E - Erythema marginatum S- Sydenham chorea
Non-rhythmic movements seen in RF? Sydenham chorea
Rash in trunk and extremities that "comes and goes"; often associated with untreated group A strep pharyngitis. Erythema marginatum
What is the main treatment for HSV-1 infection? Acyclovovir
WHat is a common side effect of IV Acyclovir? Nephrotoxicity after 3 days of IV Acyclovir
MoA of Acyclovir? Inhibition of viral DNA polymerase
Inhibition of viral DNA polymerase is the mode of action seen in: Acyclovir
Crystalline nephropathy is seen with prolonged IV treatment with ___________________. Acyclovir
Mode of prevention for acyclovir-induced crystal nephropathy Adequate and aggressive hydration
Which vaccine induces ANTICAPSULAR antibodies to facilitate complement-mediated phagocytosis of offending agent H. influenzae B vaccine
What is a key response component of H. influenzae b vaccine? The presence of ANTI-CAPSULAR antibodies
Hib vaccine leads to prevention of: Hib meningitis, bacteremia, pneumonia, and EPIGLOTITIS
Most commonly a case of Epiglottitis is due to MIssed H. influenzae type b vaccination
What organism is the MCC of liver hydatid cysts? Echinococcus granulosus
Why is the surgical removal of LIver hydatid cysts to be performed very carefully? The accidental spill of these cysts can cause ANAPHYLACTIC SHOCK.
What is the most common treatment for liver hydatid cysts caused by Echinococcus granulosus? Albendazole
Albendazole is the first line of treatment for ___________________ infection. Echinococcus granulosus
Which region of the world, and USA are more prone to a Echinococcus granulosus infection? East Mediterranean, MIddle East, and South America, as well Sub-Saharan Africa. The US --> Southwestern region
Which kind of fauna carries higher changes of infecting human with Echinococcus granulosus? Dog and Sheep ownses in the SW of the USA
Besides the Liver, which are other less commonly affected organs by Echinococcus granulosus? Lungs and then Muscle
Another name for Genetic SHIFT Reassortment
Exchange of entire genomic segments is known as Genetic shift
Which causes a more dramatic change, Genetic Shift or Genetic Drift? Genetic Shift
Genetic _______________ is more dramatic athen genetic _______________. SHIFT; drift
Pandemics and epidemics are caused by a genetic _______________ SHIFT
Which viruses are more susceptible to suffer of genetic shift? Segmented Viruses
Which are the SEGMENTED viruses? Rotavirus, Orthomyxovirus, Reovirus, Bunyavirus, and Arenaviruses.
Antigenic Drift: Occurs slowly and progressively and mostly responsible of Epidemics
Antigenic Shift: Sudden occurrence and may cause epidemics and Pandemic
Reassortment ----->___________________ --->__________ SHIFT --> Pandemcics
Mutations -------> ___________________ ----->_____________ DRIFT ---> Epidemics
Which type of genetic event may produce proper annual vaccines? Genetic drift
What are the two main presentations of Dengue Fever? 1. Classic Dengue Fever 2. Dengue Hemorrhagic Fever
Which type of Dengue is associated with RETRO ORBITAL pain, white-islands in red sea rash, and flu-like symptoms Classic Dengue Fever
Dengue fever characterized by increased vascular permeability, thrombocytopenia, and spontaneous bleeding leading to shock Dengue Hemorrhagic Fever
Mosquito that transmits the Dengue-causative virus? AEDES mosquito
Viral organism causing Dengue ssRNA Flavivirus
Flaviviridae family viruses are: 1. HCV 2. Yellow Fever 3. Dengue 4. St. Louis Encephalitis 5. West Nile virus - meningoencephalitis 6. Zika virus
ssRNA +, linear, and icosahedral, describes which viral family Flaviviridae
Which genital ulcer conditions cause a PAINFUL ulcer? 1. HSV genital ulcer and, 2. Chancroid caused by Haemophilus ducreyi
Painless genital ulcer are seen in: 1. Syphilis by Treponema pallidum 2. Granuloma inguinale by Klebsiella granulomatosis 3. Lymphogranuloma venereum by Chlamydia trachomatis
Single, painless genital ulcer, with headed-up border and clean base. Syphilis genital ulcer
Genital herpes ulcer is described as: MULTIPLE, painful , superficial vesicles ulceration with ERYTHEMATOUS base
The CHANCROID is caused by _____________________________, and it is clinically described as: Haemophilus ducreyi Deep, purulent, painful ulcers with mottled suppurative lymphadenitis (gram exudate)
Painless, progressive, red SERPENTINE ulcer lesions without lymphadenopathy Granuloma inguinale
Lymphogranuloma venerenum Small, shallow ulcers, painless
Clean base genital ulcer Syphylis
Erythematous base genital ulcer Genital Herpes
Genital ulcer with pus Chancroid by Hemophilus ducreyi
Mottle suppurative lymphadenitis Chancroid by Haemophilus ducreyi
Serpent (snake-like) genital ulcer is most likely seen caused by what organism? Granuloma inguinale by Klebsiella granulomatis
What types of C. trachomatis cause Lymphogranuloma venereum? L1 - L3
Which type of HSV causes most commonly genital ulcers? HSV-2 >>>> HSV-1
Painless, red beefy ulcer that bleeds easily with contact? Granuloma inguinale
Which type of genital ulcer is seen with bipolar staining? Why? Granuloma inguinale due to Donovan bodies
Donovan bodies (ulcerative relation) Granuloma inguinale
Increased amylase and NO PANCREATITIS is a strong indicative of: Adult Parotitis
Common Parotiditis risk factors: Elements that decreased salivary flow: 1. Medications such as anticholinergics 2. Obstruction as seen in calculi and neoplasms 3. Dehydration, post-surgical intubation
Patient complain of ear pain and swelling, mouth way to dry even after drinking plenty of fluids. Patient possibly has? Adult Parotitis
What are common bacterial organisms that cause Adult Parotitis? S. aureus > anaerobes
Firm, erythematous, pre/post-auricular ear pain and swelling, with trismus and dysphagia, are common finding seen in: Adult Parotitis
What are the imaging findings of Adult Parotitis> Ductal inflammation and obstruction, trunk abscess. (mostly likely US or CT)
X-ray Thumbprint sign is indicative of: Epiglottitis
What is the most common side effect of Amphotericin B? Nephrotoxicity
Amphotericin B side effects include: 1. Nephrotoxicity 2. Hypokalemia --> arrhythmias 3. Hypomagnesemia
Why does Amphotericin B lead to Hypokalemia and hypomagnesemia? Increases the tubular permeability leading to increase leakage of K+ and Mg2+.
What kind of anemia is caused by Amphotericin B toxicity? Normocytic, normochromic anemia, with decreased levels of EPO.
Binding to ERGOSTEROL in fungal membrane to form holes, thus, increasing permeability. Amphotericin B mode of action
What medical therapy may lead to development of rhabdomyolysis with elevated Cr phosphokinase? Dapsone
Dapsone is used in the treatment of? Leprosy of Tuberculoid form
Dapsone is is used as prophylaxis of _______________. PCP
What is phenotypic mixing? The co-infection of a HOST cell by 2 VIRAL STRAINS resulting in progeny virions with the nucleocapsid proteins of one strain and the UNCHANGED parental genome of the other strain.
Reverting to original, unmixed genoes after 1st generation progeny virions is seen in : Phenotypic mixing
Antifungal that affects the process of mitosis? Griseofulvin
Griseofulvin acts in 2 different ways: 1. Disrupts mitosis 2. Interferes with microtubule function
What is the clinical use of Griseofulvin? Superficial fungal infections such as ringworm and tinea.
What are some important side effects of Griseofulvin? 1. Disulfiram-like reaction 2. CYP450 inducer 3. Teratogenic
Caspofungin is an antifungal that destroys the _______________. Cell wall
What is a common Echinocandin? Caspofungin and micafungin
Inhibition of B-glucan in cell wall of fungal cell Mode of action caspofungin (Echinocandins)
What are the common uses for Echinocandins? Invasive aspergillosis, Candida
Which antifungal cause flushing due to Histamine release? Caspofungin
Which antifungals work by destroying or inhibiting growth of fungal cell membrane? Amphotericin B, Nystatin, and the azoles
What is the mechanism of action of Azoles? Inhibit the synthesis of Ergosterol by inhibiting a CYP450 enzyme that converts lanosterol into Ergosterol
Nystatin shares its MoA with __________________________. Amphotericin B
Common azoles Fluconazole, itraconazole, ketoconazole, clotrimazole
Nephrotoxic, arrhythmias, hypokalemia, lifelong supplementation of K and Mg, IV phlebitis Amphotericin B adverse effects
Most commonly used antifungal, despite its many adverse effects, for serious systemic mycoses. Amphotericin B
What is an embarrassing adverse effect on males with the use of ketoconazole? Gynecomastia (due to Testosterone synthesis inhibition)
Flucytosine works by altering or disruption which process of the fungal cell? DNA/RNA synthesis
What enzyme is used by Flucytosine? Cytosine deaminase
Flucytosine main use? Cryptococcal meningitis
Bone marrow suppression is seen in ________________________, (fungal therapy). Flucytosine
Agent used in treatment of dermatophytosis Terbinafine
Inhibition of fungal Squalene Epoxidase Terbinafine
"Swish and Swallow" Nystatin treatment for oral candidiasis
ETEC Traveler's diarrhea
Enterotoxigenic E. coli ETEC
Bacteria that produces a heat labile (LT) toxin and a Heat-stable (ST) enterotoxins ETEC
LT: activates adenylyl cyclase --> increase in cAMP
ST: activates guanylyl cyclase ----> increase in cGMP
Watery diarrhea by a person with a recent trip Traveler's diarrhea by ETEC
cAMP is elevated in _______ enterotoxin of ETEC LT
cGMP is elevated in ________ enterotoxin of ETEC ST
LT uses the ____ pathway Gs
Increase chloride secretion in gut and water efflux LT
Decrease reabsorption of sodium chloride (NaCl) and water in gut ST
LT and Cholera toxin, both share what characteristic? Increase adenylyl cyclase leading to an increase in cAMP
Only ____ -toxin seen in ETEC is seen with an elevation in c______. ST-toxin; cGMP
Which two bacteria inhibit elongation factor -2 (EF-2)? Corynebacterium diphtheriae and Pseudomonas aeruginosa
EHEC and Shigella Inactivate 60S ribosome by removing adenine from rRNA
Inhibit EF-2 C. diphtheriae and Pseudomonas aeruginosa
Inactivate 60S ribosome Shigella and EHEC
What pathway is disabled in a Bordetella pertussis infection? Gi pathway, leading to overexpression of adenylyl cyclase leading to increased cAMP ---> impaired phagocytosis and allow microbe to survive
What are inhibitory neurotransmitters affected in C. tetani? GABA and Glycine
Which are the stimulatory neurotransmitters involved in Botulism? ACh signals
MCC of atypical pneumonia? Mycoplasma infection
Kind of bacterial organism that does not gram stain well due to lack of cell wall? Mycoplasma
What antibiotics are useless in treatment of Mycoplasma infection? B-lactam antibiotics (penicillins, cephalosporins)
What is the best treatment options for Mycoplasma infections? Macrolides and Tetracyclines
MoA macrolides and tetracyclines Protein synthesis inhibition
Patient presents with low-grade fever, sore throat, and persistent cough. X-ray shows bilateral, patchy infiltrate. Treatment with typical penicillin does not show any improvement. Dx? Atypical Pneumonia by Mycoplasma
Staph aureus is commonly found to exist in the _______________ __________. Anterior nares
MRSA and MSSA are both commonly found to be colonized in the _____________________ Anterior nares
What HIV drugs is used to prevent fetal transmission of HIV? Zidozuvide (ZDT)
ZDT is a _______________________. It is a _________________ analogue, that has an ABNORMAL _________ group o the ________________. Nucleoside Reverse Transcriptase inhibitor; Thiamine; 3-(OH) group; Thiamine.
Reverse transcription in HBV replication process allows the: Conversion of +RNA template into dsDNA progeny
dsDNA ---> +RNA template --> dsDNA progeny Replication process of HBV
Hepatitis B virus is an: dsDNA, enveloped virus
Which kind of patients are more susceptible to infection of Aspergillus and developing infective aspergillosis? Neutropenic
LM view demonstrates septate with narrow hyphae that branch at 45 degrees. Aspergillosis
Reason of using Clavulanic acid Provides some antibiotics (Penicillins) the ability to overcome those bacteria with B-lactamase resistance
Protect antibiotic (penicillin) destruction by B-lactamase Clavulanic acid
Antibiotic protection against B-lactamase is done by: Clavulanic acid
What are some common B-lactamase inhibitors? Clavulanic acid, Tazobactam, Sulbactam, and Avibactam
Another name for Beta-lactamase Penicillinase
NRTI are ________________ inhibitors Competitive
NNRTI are __________________ inhibitors Allosteric
Inhibition of HIV DNA synthesis from a + RNA template by termination chain elongation NRTI and NNRTI MoA
What are the 3 main NNRTIs? Delavirdine, Efavirenz, and Nevirapine
Delavirdine, Efavirenz, Nevaripine NNRTI
________________ require phosphorylation, while the ____________ do not. NRTI; NNRTI
Which NNRTI may cause vivid dreams? Efavirenz
What are common adverse effects of all NNRTIs? Rash and Hepatotoxicity
Which is the only Nucleotide NRTI? Tenofovir
Which HIV medication is used in pregnancy? Zidovudine (ZDV)
NRTI adverse effect of Pancreatitis is often seen with use of: Didanosine
Anemia is a common adverse effect seen with which HIV drug? Zidovudine (ZDV)
Most common side effect of NRTIs> Bone marrow suppresion
What is the substance used to revert bone marrow suppression by NRTIs? Granulocyte colony-stimulating factor
What adverse effects are seen in common by Protease inhibitors? Hyperglycemia, GI intolerance, and Lipodystrophy
Indinavir is a _______________ inhibitor. It is associated with _____________________________ adverse effects. Protease inhibitor; Nephropathy, hematuria, and thrombocytopenia
Elevated creatine kinase is seen with which kind of HIV antivirals? Integrase inhibitors
Enfuvirtide binds to ______, and prevents viral _________. gp41; Viral entry
Binds to CCR5 on T-cell surface inhibiting the reaction with gp120. Mechanism of action of MARAVIROC
Fusion inhibitor Enfurvitide
Treatment of HBV positive pregnant mothers HBIG and recombinant HBV vaccine
Azole mechanism of action Inhibition of the DEMETHYLATION of Lanosterol into Ergosterol.
Azoles are CYP450 _________________ Inhibitors
CYP450 inhibitors increase the: Risk of drug-drug interactions
What is the MCC of opportunistic mycosis? C. albicans infection
Failure of neutrophil function or protection in Candidiasis is manifested with the development of: Disseminated candidemia
What 3 common manifestations of T-cell failure to respond to Candida albicans infection? 1. Oral thrush 2. Vulvovaginal candidiasis 3. Cutaneous candidiasis
White plaque on oral mucosa and presence of Positive Germ tubes Oral thrush by C. albicans
Oral thrush in candidiasis is ___________________ removed, and cause bleeding. Easily
C. albicans is at 20 degrees C is a _______________, and at 37 degrees it forms ____________. Yeast; Germ tubes
gp41 blockage prevents the _________________- FUSION
gp120 blockage prevents the ________________ ENTRY
What is a severe condition caused by Parvo B19 in a fetus? Hydrops fetalis
Parvo B19 infection on healthy children causes? The "Fifth Disease"
What is the key characteristic of the Fifth Disease? "Slapped Cheek" rash
What type of patients are in risk of developing Aplastic crisis by a Parvo B19 infection? Sickle Cell paitents
Which is the SMALLEST DNA virus? Parvovirus
Another name for "Fifth Disease"? Erythema infectiosum
What is the largest DNA virus? Pox virus
Where do all DNA viruses replicate? Which is the exception? All DNA viruses replicate in the nucleus, except for Poxviridae
Parvo virus is unique to DNA viruses in: 1. Smallest DNA virus 2. Single stranded (ss)
Which 3 DNA virus families have circular genomes? Papilloma, Polyoma (complete), and Hepad (incomplete)
Poxviruses replicate in the _____________________, as they have a ____________________________. Cytoplasm; DNA-dependent RNA polymerase
All segmented viruses are __________ genome. RNA genome
BOAR Mnemonic for Segmented viruses
Which are the segmented viruses? Bunyavirus, Orthomyxovirus (influenzae), Arenavirus, Reovirus
What enzyme is used to transcribe from (-) stranded to (+) stranded RNA virus? RNA-dependent RNA polymerase
Which are the negative stranded viruses? Arenavirus, Bunyavirus, Paramyxovirus, Orthomyxovirus, Filovirus, and Reovirus
Arenavirus, Bunyavirus, Paramyxovirus, Orthomyxovirus, Filovirus, and Reovirus Negative stranded RNA viruses
Bunyavirus, Orthomyxovirus (influenzae), Arenavirus, Reovirus Segmented Viruses
All RNA viruses are single stranded except for: Reovirus
10-12 segments virus Reovirus
8 segments RNA virus Orthomyxovirus
Arenavirus has _____ segments 2
How many segments are in Bunyavirueses? 3
Coltivirus and Rotavirus are: Reoviruses
Colorado Tick Fever is caused by: Coltivirus
Fatal diarrhea in children Rotavirus
PERCH Mnemonic of all Picornaviruses
What viruses are represented in PERCH, and these pertain to which viral family? Poliovirus, Echovirus, Rhinovirus, Coxsackievirus, HAV; all are PICORNAVIRUS family.
Aseptic meningitis is often caused by: Echovirus (Picornavirus)
Common cold is caused most often by which Picornavirus? Rhinovirus
What is caused by the virus represented by the letter "C" in the PERCH mnemonic? Coxsackievirus: - Aseptic meningitis, herpangina (mouth blisters, fever); hand, foot, and mouth disease; myocarditis; pericarditis
Norovirus is a _________________________, associated to develop ____________________________. Calicivirus; viral gastroenteritis
Which are the medically relevant Togavirus? Rubella, Chikungunya, and Eastern and Western equine encephalitis.
Parainfluenza, RSV, Measles and Mumps Paramyxoviruses
What are the 3 most significant toxicity of Amphotericin B? 1. Nephrotoxicity --> elevated Cr levels 2. Hypokalemia --> development of cardiac arrhythmias 3. Hypomagnesemia
Amphotericin B may bind to __________________ causing human tissue toxicity. Cholesterol
Anemia in patients taking ZDV and thrombophlebitis at injection site Minor adverse effects of Amphotericin B toxicity
Gummas are associated with: Tertiary syphilis
Valvular lesion described as necrotizing granuloma Gumma
Where can gummas present? Skin mucosa and subcutaneous tissue, bones, and other organs.
At what stage is can Neurosyphilis present? Not stage specific
Cardiovascular Syphilis presents with: Asymptomatic murmur, loud S2, and ascending aortic arch calcification
Key feature of second stage of syphilis Condylomata mata
What is seen in 1st stage of syphilis Chancre
What lesion is associated with HPV infection? Condyloma acuminata
What strains of HPV cause development of Condyloma acuminata? Strains 6 and 8
Anogenital warts Condyloma acuminata
What is meant with "immortalization" of B cells? Infection with EBV causes B-cell continuous proliferation, leading to the cells transformation and immortalization
EBV is a: oncogenic virus, that promotes polygonal B cell proliferation, and HETEROPHILE antibody production.
Absence of the normal immune response to particular antigen or allergen Anergy
Common antibiotic that disrupt the peptidoglycan cell wall of gram positive and gram negative organisms. Cefuroxime
Cefuroxime mechanism action is shared with ________________ and ____________________. Penicillins and Vancomycin
What is the purpose of the Peptidoglycan cell wall? Provides the organism to survive osmotic stress.
What is the most common treatment for genital herpes? Acyclovir
Nucleoside analogue used in treatment of genital herpes? Acyclovir
Treatment of uncomplicated malaria? Chloroquine
Primaquine is added to chloroquine, to eradicate? P. vivax/ ovale
What malaria medication is used in the treatment of P. vivax and P. ovale? Primaquine
Which malarial spps are responsible for RELAPSES? P. vivax/ovale
P. vivax and P. ovale are ________________________, responsible for ______________________. HYPNOZOITES; Relapses
Most common organism that would cause septic arthritis in young, sexually active person? N. gonorrhea
The triad of: Polyarthritis, Vesiculopapular skin rash, and Tenosynovitis, and a STD Hx. Dx? Septic Arthritis by N. gonorrhoeae
Gram negative diplococci N. gonorrhea
How is neonatal tetanus prevented, besides vaccination? Hygienic delivery and proper umbilical cord care
At what age can neonates receive active immunization against Tetanus? 2 months
What is the outer enveloped made of in enveloped viruses? Lipid bilayer
Lipid bilayer may be dissolved with? Ether and organic solvents
What is the result virus' lipid bilayer dissolution? Loss of infectivity
In the HIV replication cycle, which precursor gene is the only one that can be glycosylated? Env gene
The env gene polyprotein is cleaved into: gp120 and gp41
At which organelle does the cleavage of env gene occurs? Golgi apparatus
gp120 receptors allow the _________________ of virus. ENTRY
gp41 receptors allow the ______________________ of the HIV. FUSION
Common systemic inflammation cytokine? TNF-a
Elevated levels of TNF-a may present with? Septic shock and cachexia
What cell type activates TNF-a? Macrophages
3 common systemic inflammatory cytokines: IL-1, IL-6, and TNF-a
HBV infected adult diagnosed with acute hepatitis has____________ % chance of complete recovery. 95%
RIPE Mnemonic sued to list drugs used in TB treatment
Rifampin, Isoniazid, Pyramizamine, and Ethambutol RIPE; Medications for TB infection.
What drug exhibits inhibition of bacterial DNA-dependent RNA polymerase? Rifampin
Rifampin side effects? GI symptoms, rash, RED-ORANGE body fluids, and cytopenias
Neurotoxicity prevented with Pyridoxine Isoniazid
Which TB medication inhibits the synthesis of mycolic acids? Isoniazid
Isoniazid MoA? Inhibition of mycolic acid synthesis
Hepatotoxicity and Hyperuricemia is often seen in TB patients treated with ____________________. Pyrazinamide
Which TB drug acts by inhibiting arabinosyl transferase? Ethambutol
What is the main adverse effect associated with Ethambutol? Optic Neuropathy (Red-green vision)
Patient with night sweats and persistent cough, is treated with new medication. Few weeks later patient complains of Red-green vision deficit. Most commonly treated with? Ethambutol
Burning sensation of feet in patients in TB treatment Toxicity by Isoniazid
What ribosomal subunit is inhibited in protein synthesis by aminoglycosides? 30S
Which organisms commonly require contact precautions? MRSA, VRE, and C. difficile
What is included in Contact Precautions? Hand hygiene, Non-sterile gloves, gown, and private room.
Exchange of DNA material by a Plasmid Plasmid Conjugation
What type of antibiotics often develop resistance by plasmid conjugation? Extended-Spectrum B-lactamases (ESBL)
F+ cell means? Cell with F plasmid inside
During conjugation, the plasmid travels from _______ to ______ cell. F+ to F-
Transpeptidases Penicillin-binding proteins (PBP)
PBP and cephalosporins bind _________________________. Irreversibly
Gene mutations, resulting in PBP structural changes, leads to__________________________. Drug resistance
Infection by Parvo B19 in healthy children, results in? Fifth Disease
Parvovirus is highly trophic for ____________ precursor. Erythoid
Where is Parvovirus usually replicated? Bone marrow
Essential protein for IL-2 activation? Calcineurin
What are 2 immunosuppressants that inhibit calcineurin? Cyclosporine and Tacrolimus
Example of underdeveloped ss-RNA virus Hepatitis E virus
What population is in fatal risk of Hepatitis E infection? Pregnant women
Novobiocin sensitive S. epidermidis
Staph epidermidis Catalase +, Coagulase (-), and Novobiocin sensitive
Novobiocin resistant S. saprophyticus
S. saprophyticus Catalase +, Coagulase (-), and Novobiocin resistant
What antibiotic difference is used to distinguish between S. saprophyticus and S. epidermidis? S. epidermidis is Novobiocin sensitive, and S. saprophyticus is Novobiocin resistant.
What kind of hemolysis is found in Staph aureus? Beta-hemolysis
UTI i sexually active young women S. saprophyticus
Common organism causing diseases in patients with prosthetics? S. epidermidis
Production of adherent BIOFILMS S. epidermidis
Difference in fermentation between S. aureus and S. epidermidis? S. epidermidis does NOT ferment MANNITOL
S. Epidermidis is: Catalase +, Coagulase (-), Novobiocin sensitive, and urease (+).
Patient developing bacterial endocarditis after a hip implant or Heart valve replacement, suspect organism? S. epidermidis
What is the MCC of uncomplicated UTI? the second? 1. E. coli (MC) 2. S. saprophyticus
Where is S. saprophyticus found in normal human flora? Female genital tract and perineum
B-hemolytic bacteria (3): 1. S. aureus 2. Strep pyogenes 3. Strep agalactiae
Complete lysis of RBCs Beta-Hemolysis
Vancomycin directly binds to: D-ala-D-ala
Red man syndrome Adverse effect of Vancomycin
Gram (+) organism only Vancomycin
Oral dose of _____________________ is used to treat pseudomembranous colitis. Vancomycin
What is the mode of resistance of Vancomycin? amino acid transformation of D-ala-D-ala, into D-ala-D-lac.
D-ala-D-lac Transformation in amino acid leading to Vancomycin resistance
Dress syndrome is seen with what interaction? Vancomycin and Eosinophilia, leading to systemic symptoms
How is Red Man syndrome prevented? 1. Pretreatment with Antihistamines 2. Slow infusion rate
Adverse effects of Vancomycin? 1. Nephrotoxicity 2. Ototoxicity 3. Thrombophlebitis 4. Diffuse flushing -----> Red Man syndrome
Common bacteria that predisposes Vancomycin acquired resistance? Enterococcus
Where does HBV replication occurs? On the newly synthesized capsid
What is the purpose and composition of HBV capsid? Site of HBV replication. It contains: 1. Reverse transcriptase (RT) which is a RNA and DNA-dependent DNA polymerase
RNA & DNA-dependent DNA-polymerase Reverse transcriptase found on HBV
Common organism of Perianal disease in children? Enterobius vermicularis
What is the treatment for Perianal disease caused by E. vermicularis? Albendazole with Pyrantel Pamoate
Albendazole with Pyrantel Pamoate is used for infection by? Enterobius vermicularis
Diagnosis is done via test tape? Perianal disease by E. vermicularis
Pinworm Enterobius vermicularis
Pinworm infection MC causes? Perianal prutitus
Organism responsible for Roseola infantum HSV-6
3-5 days of fever, followed by a BLANCHING maculopapular rash in the truck first, which then spreads to the face and extremities. Roseola Infantum by HSV-6 infection
Mode of Transmission of HSV-6 Saliva
Another, less common name for Roseola infantum? Exanthem subitum
HSV-6 causes a diffuse maculopapular rash, and may cause _______________ in severe cases after days of severe FEVER. Seizures
Roseola infantum is more commonly cause by __________ than with ________. HSV-6 >>>>>>HSV-7
HSV-8 Cause of Kaposi Sarcoma in HIV patients. Transmitted via sexual contact.
HSV-8 may infect or damage which tissues/organs? Kaposi Sarcoma can affect the Skin> GI tract and Lungs
Negative monospot Test CMV infection (HSV-5)
Positive monopost Test EBV infection (HSV-4)
Fever, hepatosplenomegaly, pharyngitis and lymphadenopathy of the Posterior cervical nodes Mononucleosis
What two organisms are causative of Mononucleosis? EBV and CMV
Posterior cervical lymphadenopathy Lymph nodes commonly affected by Mononucleosis
EBV is associated with: 1. Burkitt Lymphoma 2. Nasopharyngeal Carcinoma (mostly in Asian adults) 3. Lymphoproliferative disease in transplant patients
EBV infects ____ cells thought CD____. B-cells; CD21
Why patients with EBV infection are discourage to practice contact sports? Risk of splenic rupture
Positive Monospot Test is seen with? Seen with EBV infection.
Heterophile antibodies detected by agglutination of sheep or horse RBCs Positive (+) Monospot Test
Which drug may cause a rash as it is used for the treatment of EBV Mononucleosis? Amoxicillin
"Kissing Disease" EBV (HSV4) Monucleosis
What is a characteristic description of infected CMV cells? "Owl eye" intranuclear inclusions
CMV infection in AIDS patients often results in: CMV retinitis
CMV retinitis of AIDS patient has what fundoscopic findings? Hemorrhage, cotton-wool exudates, and vision loss.
Cotton-wool exudates in AIDS patients often indicate? CMV infection causing retinitis
Organism causing Mononucleosis with a (-) Monospot Test? CMV
Gingivostomatitis, keratoconjunctivitis, herpes labialis, herpetic whitlow on finger, temporal lobe encephalitis, esophagitis and erythema multiforme, are all caused by? HSV-1
Latent in trigeminal ganglia HSV-1
Most common cause of sporadic encephalitis HSV-1
Latent in sacral ganglia HSV-2
HSV-1 is latent in ________________ ganglia, and HSV-2 is latent in _________________ ganglia. HSV-1 ----- Trigeminal HSV-2 ------ Sacral
Which is a more common cause of Viral meningitis, HSV-1 or HSV-2? HSV-2
Herpes genitalis seen with HSV______ infection HSV-2
HHV-3 (Herpes 3) is known as? Varicella-Zoster virus
Where is VZV latent ganglia? Dorsal root and Trigeminal ganglia.
What are common clinical presentations of VZV? Varicella-zoster (chickenpox, shingles), encephalitis, and pneumonia
Chickenpox is caused by infection with? Varicella-Zoster virus
WHat is the MC complication of Shingles? Post-herpetic neuralgia
Infection with VZV to which cranial nerve can cause herpes zoster ophthalmicus? CN V1
Which of the nephron is affected the most by adverse effects of Amphotericin B? Distal tubule epithelium
The nephrotoxicity seen with use of Amphotericin B causes? 1. Anemia due to decrease in EPO synthesis 2. Electrolyte imbalances (Hypokalemia and Hypomagnesemia)
What is the MC presentation of Hepatitis A infection in children? Asymptomatic or Aneric
In adults HAV infection is self-limited, but while symptomatic it presents with a clinical profile described as? Jaundice, malaise, fatigue, ANOREXIA, nauras, vomit ,and RU! pain, with aversion to smoking.
AVERSION to smoking is seen or associated with? HAV infection
Hepatitis A Virus: 1. NO carrier state 2. Self-limited infection 3. NO risk chronic disease, cirrhosis or HCC
Common opportunist infections in HIV patients PCP, Toxoplasma gondii, and Mycobacterium Avium complex (MAC)
What is the Prophylaxis of both, PCP and Toxoplasma gondii infections, in HIV patients? TMP-SMX
What antibiotics is used as prophylaxis fro MAC infection in HIV? Azythromycin
PCP often is developed in HIV patient as the CD4+ count reaches? CD4+ < 200
What infection is seen in HIV patient with a CD4+ < 100? CD4+<50) Toxoplasma gondii; MAC
MAC infection presentation is very similar to which other type of infection profile? TB disease profile
Granulomas with foamy epithelioid cells and Langerhans Multinucleated cells are seen in ? MAC infections
Facultative, intracellular gram (+) rod, which produces very narrow B-hemolysis? Listeria monocytogenes
Tumbling motility in Listeria is seen at ________________ temperature, and it shows growth in ________________ temperature. Room temperature; Refrigerated temperature
Commonly mentioned bacteria that grows in refrigerated temperatures. Listeria monocytogenes
Spontaneous abortion in woman is often caused by? Listeria monocytogenes
What is the MC treatment for Listeria monocytogenes? Ampicillin
"cold enrichment" often used to describe growth of __________________________. Listeria moncytogenes
Intracellular fungi 1. Cryptococcus neoformans 2. Histoplasma capsulatum
Intracellular protozoa 1. Cryptosporidium 2. Leishmania 3. Plasmodium 4. Toxoplasma 5. Trypanosoma
Common intracellular bacteria? Chlamydia, Francisella Tularensis, Legionella, Listeria monocytogenes, Mycobacterium, Neisseria, Nocardia, Rickettsia, Salmonella, and Yersinia pestis
Chlamydia, Francisella Tularensis, Legionella, Listeria monocytogenes, Mycobacterium, Neisseria, Nocardia, Rickettsia, Salmonella, and Yersinia pestis Intracellular bacteria
Chlamydia, Neisseria, Rickettsia all are ______________________ bacteria. Intracellular
Salmonella is considered an ______________________ bacteria, and Shigella is not. Intracellular
CXR - bilateral, ground glass opacities, with pneumatoceles PCP
Disc-shaped yeast seen on methenamine silver stain of lung tissue PCP
Dapsone in PCP is used as _________________________________. Prophylaxis only
Common diffuse interstitial pneumonia seen in HIV patients PCP
Most common (organism) cause of pneumonia in HIV patient PCP by Pneumocystis jirovecii
BIOFILM synthesis S. epidemidis
Role of Biofilm in infection? Barrier antibiotic penetration and interferes with host defenses, including opsonization , neutrophil migration, and even T-cell activation.
Herpes simplex 1, 2, and 3 are ________________________ by a _______________________, which differs in ____________ to HSV-4 and HSV-5. Phosphorylated; Tyrosine Kinase; Rate (of phosphorylation)
Which TK is slower to phophorylize, HSV1-3, or HVS 4-5? HSV-4 and HSV-5 Tyrosine kinases has a slower phosphorylation rate.
E. coli virulence factors: Liposaccharide, K1 capsular Polysaccharide, Verotoxin, LT-stable and ST-stable enterotoxins, P-fimbriae
LPS found on E. coli causes which conditions? Bacteremia and Septic Shock
Mechanism of Action seen in LPS of E. coli Macrophage activation cause widespread release of IL-1, IL-6, and TNF-a
Prevents phagocytosis and complement-mediated lysis, is the mechanism of action of? K1 capsular polysaccharide virulence factor of E. coli
E. coli's virulence factor that inactivates 60S ribosomal component, halting protein synthesis and causing cell death? Verotoxin
Verotoxin causes ___________________________ in E. coli infection Bloody gastroenteritis
E. coli neonatal meningitis is facilitated by ___________________ virulence factor. K1 capsular polysaccharide
Watery gastroenteritis is associated with which E. coli virulence factors? Heat-stable/Heat-labile enterotoxins
Promotion of fluid and electrolyte secretion form interstitial epithelium, causing watery diarrhea in E. coli infection Heat-stable/Heat-labile enterotoxins
Which virulence factor is associated by developing of E.coli UTI? P-fimbriae
P-fimbriae mechanism of action Allow adhesion to uroepithelium
Vesicular or ulcerative disease following a primary infection with HSV-1. Herpetic Gingivostomatitis
What structures are affected by HSV-1 gingivostomatitis? Gingiva, tongue, and palate
Reactivation of _______________________ is seen in herpetic stomatitis by HSV_____. Trigeminal ganglia; HSV-1.
Perioral vesicles HSV-1 Herpetic Gingivostomatitis
Thin, septate hyphae with acute V-shaped angle branching Aspergillus fumigatus
MCC of Invasive aspergillosis and Aspergilloma? Aspergillus fumigatus
Histological view of a organism with a 45-degree angle branching and septate hyphae Aspergillus fumigatus
Gram (-) rods that can ferment Lactose include: Klebsiella, E. coli, Enterobacter, Citrobacter, and Serratia
Pseudomonas aeruginosa is a gram ______ rod, lactose ______________, and with a _____________ oxidase test. Gram (-) rod; Lactose Non-fermenter; Positive Oxidase test
Gram negative bacteria, with oxidase negative and positive TSI agar test? Stain black color; Salmonella, Proteus, and Yersenia
Shigella is a: Gram (-) rod, negative oxidase and negative on TSI agar (Non-sulfur producer)
Which cells are affected by a Shigella infection? Mucosal invasion of the M-cells that overlie the Peyer's Patches
M-cells are located in the _______________________. Peyer's patches
How does shigella evades the immune system? Escapes phagosome and spreads laterally to other epithelial cells via actin polymerization
Actin polymerization helps Shigella in: Spreading laterally to other epithelial cells
M-cells: specialized epithelial cells of the mucosa-associated lymph nodes, that transport antigens from lumen to immune cell, thereby initiating response.
Candida albicans pose a greater risk of infection to ____________ patients. Neutropenic
Oropharyngeal lesions, that can easily be scrapped off and cause severe bleeding, are usually caused by ______________________. Candida albicans
Oropharyngeal lesions that cannot be scrapped off easily are seen in _______________. Leukoplakia
How does the diphtheria toxin acquires it virulence? Bacteriophage-mediated infection with the Tox gene.
What is Lysogenization? Virulence aquirence via bacteriophage.
What type of Transduction uses a lysogenic phage? Specialized transduction
A virus infects a bacteria Specialized transduction
An "excision" event Specialized transduction
Which bacterial toxins are encoded by a Lysogenic phage? Group A strep erythrogenic toxin, Botulinum toxin, Cholera toxin, Diphtheria toxin, and Shiga toxin
Mnemonic to remember the 5 Lysogenic encoded bacteria ABCD'S
ABCD'S Group A strep erythrogenic toxin, Botulinum toxin, Cholera toxin, Diphtheria toxin, and Shiga toxin
Packaging "error"describes Generalized Transduction; use of Lytic phage
Lytic phage infects bacteria leading to cleavage of bacterial DNA Lytic phage Transduction
Parts of bacterial DNA becomes packaged into capsid, which then goes and infect another bacterium Lytic phage Transduction
The incorporation of viral DNA into bacterial chromosome is the mechanism of action seen in? Lysogenic phage Transduction or Specialized Transduction
Tenofovir causes damage to the _________________ tubule of the kidney, leadon to nephrotoxicity. Proximal
Which NRTI is recognized to cause nephrotoxicity due to damage to the Proximal Tubule of the kidney? Tenofovir
Neurocysticercosis is caused by ______________________________. T. solium
Common name for Tanea solium Pork tapeworm
What is the incubation period for T. solium? Months to years
Neurocysticercosis is seen clinically with: Seizures, focal neurologic symptoms, and intracranial HTN
What is the primary treatment for T. solium infection? Albendazole
How is Dx of T. solium infection (pork tapeworm) done? CT/MRI shows cyst and scolex
Anterior end of a tapeworm Scolex
Multiple ring enhancing lesions on CT/MRI of head are associated with an infection with? Toxoplasma gondii
Defective CD40L-CD40 interactoin Hyper - IgM Syndrome
What is the MCC of Hyper IgM syndrome? Absence of CD40 Ligand
Elevated IgM and decreased IgA and IgE levels are seen in Hyper - IgM Syndrome
What antibiotic is used in as prophylaxis for Neisseria meningitidis? Rifampin
The M-protein is found in _____________________, and it has a structural homology to _____________________ and _________________. Strep pyogenes; Tropomyosin and Myosin
Inhibition of mycolic acids is seen in: Isoniazid
What are the 2 main organisms that cause Non Bullous impetigo? Staph aureus and Strep pyogenes
Painful, non-itchy postues and honey-crust lesions, describe? Impetigo
What is a common complication of poorly treated impetigo? PSGN seen with facial edema, and dark colored urine, HTN, and Hematuria
What organism causes Q-fever? Coxiella burnetii
Coxiella burnetii infection causes? Q-fever
Fatigue, myalgias, and fever over (>) ten days, and retro orbital headache. Dx? Q-fever
How is the leukocyte count seen in Q-fever? Normal
Farmers with prolonged fever and heachache behind the eye. Dx? Q-fever
Q-fever is commonly seen in? Farmers working with waste product of cattle and sheep.
Borrelia burgdorferi Lyme Disease
Relapsing fever is caused by: Borrelia recurrentis
What organism causes Undulant fever? Brucella spps
Created by: rakomi