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Microbiology
FA complete review
| Question | Answer |
|---|---|
| What is the function of flagellum? | Motility |
| What is the function of Pilus/fimbriae? | Mediate adherence of bacteria to cell surface; sex pilus forms during conjugation |
| What is the chemical composition of a spore? | Keratin-like coat; dipicolinic acid; peptidoglycan , DNA |
| Which type of bacteria have spores? | Gram (+) only |
| What is the main function or purpose of a spore? | Survival: resists dehydration, heat, and chemicals |
| What is the composition of a CAPSULE? | Organized, discrete polysaccharide layer |
| What it the function of a capsule? | Protects against phagocytosis |
| What cellular structure is in charge of protecting against phagocytosis? | Capsule |
| Composed of loose network of polysaccharides? | Glycocalyx |
| What is the function of Glycocalyx? | Mediates adherence to surface, especially foreign surfaces |
| What is the the exception of Capsule? | Poly-D-glutamate on B anthracis |
| What are the 3 main components of the Outer membrane? | 1. Outer leaflet 2. Embedded proteins 3. Inner leaflets |
| What is the composition of outer leaflets of the outer membrane? | Endotoxin (LPS/LOS) |
| Phospholipids is the main component of which part of the outer membrane? | Inner leaflet |
| What kind of bacteria is the only one with outer membrane? | Gram negative only |
| What are the role of porins in the outer membrane? | Transport across the membrane |
| What is the role of Lipid A? | Induces TNF and IL-1 |
| What is the space between cytoplasmic membrane and outer membrane in gram (-) bactria? | Periplasm |
| What is in the middle of the Periplasm? | Peptidoglycan |
| What is the function of the periplasm? | Accumulates components exiting gram (-) cells, including hydrolytic enzymes |
| What is the composition of the Cell wall? | Peptidoglycan is a sugar backbone with peptide side chains cross-linked by transpeptidase |
| What is the main function of the cell wall? | Net-like structure gives rigid dsupport, protects against osmotic pressure damage |
| What are the two roles of the Cytoplasmic membrane? | 1. Site of oxidative and transport enzymes; PBPs involved in cell wall synthesis 2. Lipoteichoic acids induce TNF-alpha and IL-1. |
| What are the main components of the cytoplasmic membrane? | - Phospholipid bilayer sac with embedded proteins and other enzymes - Lipoteichoic acids (gram (+) only) extend from membrane to exterior |
| What cell envelope structures are exclusive of gram (-) bacteria? | Outer membrane (Endotoxin/LPS, porin), and Periplasmic space |
| Lipoteichoic acid is unique to gram _________ bacteria. | Positive |
| What is another way to refer to spherical morphology? | Coccus |
| Coccus gram negative bacteria: | 1. Moraxella catarrhalis 2. Neisseria |
| What are common pleomorphic (no cell wall) gram negative bacteria? | Anaplasma, Ehrlichia, Chlamydiae, Rickettsiae, Mycoplasma, and Ureaplasma |
| Which bacteria is identified with Giemsa stain? | Rickettsia, Chlamydia, Trypanosomes, Plasmodium, Borrelia |
| A bacteria with a thick peptidoglycan layer will stain what color? | Violet |
| Thin peptidoglycan wall bacterial stains __________________, in color. | Pink or red |
| Which bacteria do not stain well do to lack of peptidoglycan wall due to decreased muramic acid? | Legionella, Rickettsia, Chlamydia, Bartonella, Anaplasma, and Ehrlichia |
| What is similar in Mycoplasma and Ureaplasma? | NO cell wall |
| Cell wall too thin to be visualised is seen in: | Treponema and Leptospira |
| Mycobacteria does not stain well because: | Cell wall has high lipid content |
| What condition is diagnosed with Periodic acid-Schiff stain? | Whipple disease |
| What is primarily stained with Periodic acid-Schiff stain? | Glycogen and mucopolysaccharides |
| Acid-fast bacteria most commonly include: | Mycobacteria and Nocardia |
| Ziehl-Neelsen stain is also known as: | Carbol fuchsin |
| What substance is stained with Ziehl-Neelsen stain? | Mycolic acid in cell wall |
| What bacteria or organism are stained with Ziehl-Neelsen stain? | Acid-fast bacteria and Protozoa |
| Identification of Cryptosporidium oocysts with stain is done with: | Ziehl-Neelsen stain |
| What stain is used in Cryptococcus neoformans identification? | India ink stain |
| What stain is used in fungi? | Silver stain |
| For what is Silver stain used? | Fungi, Legionella, and H. pylori |
| What is the main function of Selective media? | Favors the growth of particular organisms while preventing growth of other organisms |
| What is a common example of a Selective media? | Thayer-Martin agar |
| What is Indicator (differential) media function? | Yields color change in response to the metabolism of certain organisms |
| MacConkey agar is an example of ___________________media. | Indicator (diffencital) |
| How is the color change indicated by a differential media? | Due to changes in pH |
| What is the media used in H. influenzae? | Chocolate agar |
| What are components of Chocolate agar? | Factors V (NAD+) and X ( hematin) |
| Media made of Factor V (NAD+) and X (hematin). | Chocolate agar |
| What type of media is used for Neisseria species? | Thayer-Martin agar |
| In Thayer-Martin media, the growth of gram positive organism is done with _______________. | Vancomycin |
| What antibiotics are included in Thayer Martin agar to inhibit growth of gram negative bacteria, except Neisseria? | Trimethoprim and Colistin |
| Nystatin is used to inhibit __________ growth in Thayer Martin agar. | Fungi |
| Media used for B. pertussis | Bordet-Gengou agar |
| What is the component of Bordet-Gengou agar? | Potato extract |
| What is the components of Regan-Lowe medium? | Charcoal, blood, and antibiotic |
| What organism uses Regan-Lowe medium? | B. pertussis |
| Tellurite agar + Loffer medium are used for _________________ growth. | C. diphtheriae |
| Agar used to M. tuberculosis? | Lowenstein-Jensen agar |
| M. pneumoniae uses ___________ agar and requires _____________. | Eaton agar; Cholesterol |
| What media is used by Lactose-fermenting enterics? | MacConkey agar |
| Fermentation caused in a MacConkey agar culture, turns colonies __________ (color) | Pink |
| What media is often used by E. coli growth? | Eosin-methylene blue (EMB) |
| What is the color of E. coli colonies been cultured with EMB? | Green metallic sheen |
| What characteristic media is used by Legionella? | Charcoal yeast extract agar buffered with cysteine and iron |
| Sabouraud agar is used to grow cultures of __________. | Fungi |
| What are common examples of Anaerobes? | Clostridium, Bacteroides, Fusobacterium, and Actinomyces israelii. |
| What are enzymes are lacking in Anaerobic? | Catalase and/or superoxide dismutase |
| What are some key features used to describe and identify anaerobes? | 1. Foul-smelling (short-chain FAs) 2. Difficult to culture 3. Produce gas in tissue |
| Where in the body are anaerobes usually part of the normal flora? | GI tract |
| Which class of antibiotics are ineffective to anaerobes? | Aminoglycosides |
| What is the characteristic definition of Facultative anaerobes? | May use O2 as a terminal electron acceptor to generate ATP, bu can also use fermentation and other O2-independent pathways |
| Which class of bacteria are a mixed of anaerobes and anaerobes? | Facultative anaerobes |
| What are some common Facultative anaerobes? | Streptococci, staphylococci, and enteric gram (-) bacteria |
| What are the two classes of INTRACELLULAR bugs? | Obligate and Facultative |
| What organisms are Obligate intracellular? | RIckettsia, Chlamydia, Coxiella |
| Which class of organism rely on host ATP? | Obligate intracellular |
| List of Facultative intracellular bacteria: | 1. Salmonella 2. Neisseria 3. Burcella 4. Mycobacterium 5. Listeria 6. Francisella 7. Legionella 8. Yersinia pestis |
| Salmonella, Mycobacterium, Listeria, Legionella, and Yersinia pestis are examples of _______________________ bacteria | Facultative intracellular |
| What are the most common Encapsulated bacteria? | Streptococcus pneumoniae, H. Influenzae type b, Neisseria meningitidis, E. coli, Salmonella, Klebsiella pneumoniae, and group B Strep |
| What is the role of the capsules of "Encapsulated" bacteria? | Serve as antiphagocytic virulence factor |
| Capsular polysaccharide + protein conjugate = | Antigen in vaccines |
| What mnemonic is used for Encapsulated bacteria? | Please SHINE my SKiS |
| how are encapsulated bacteria cleared from body? | Opsonized and cleared by the spleen |
| Which type of patients are at higher risk of encapsulated bacterial infections? | Asplenics |
| Available vaccines for Encapsulated bacteria (3): | 1. N. meningitidis 2. S. pneumoniae 3. H. influenzae type b |
| What is the purpose of Encapsulated bacteria vaccines composition? | Polysaccharide capsule is conjugated to carrier protein, in order to enhance immunogenicity by promoting T-cell activation and subsequent class switching |
| Mnemonic used for Urease- positive organisms: | Pee CHUNKSS |
| Pee CHUNKS stands for: | Proteus, Cryptococcus, H. pylori, Ureaplasma Nocardia Klebsiella S. epidermidis S. saprophyticus |
| Urease positive organism predispose to which type of kidney stone? | Struvite |
| Which urease (+) organism most commonly predisposes to Struvite formation? | Proteus |
| What is the function of Urease? | Hydrolyses urea to release ammonia and CO2 ---> increase in pH |
| What is the function of Catalase? | Degrades H2O2 into H2O and bubbles of O2 before it can be converted to microbicidal products by the enzyme myeloperoxidase |
| What immunodeficiency is often have higher risk of catalase (+) organism infections? | Chronic granulomatous disease |
| Examples of Catalase (+) organisms: | Nocardia, Pseudomonas, Listeria, Aspergillus, Candida, E. coli, Staphylococcus, Serratia, B cepacia, and H pylori |
| Nocardia, Pseudomonas, E. coli, H. pylori, Serratia, and H. pylori are all ___________ positive organisms | Catalase |
| C cepacia is __________ positive | Catalase |
| Yellow "sulfur" granules seen with: | Actinomyces israelii |
| What color pigment is seen with S. aureus? | Yellow |
| Blue-green pigment is associated with: | P. aeruginosa |
| Color pigment associated with Serratia? | Red |
| What infections are associated with S. epidermidis biofilm production? | Catheter and prosthetic device infections |
| What are some biofilm-producing bacteria? | S. epidermidis, Viridans streptococci, P. aeruginosa, and nontypeable H. influenzae. |
| Dental plaques, infective endocarditis ar due to biofilms produced by ______________________. | Viridans streptococci |
| What conditions are associated with P. aeruginosa biofilm production? | 1. Ventilator-associated pneumonia 2. Contact lens-associated keratitis 3. Respiratory tree colonization in CF patients |
| What is the purpose of Bacterial virulence factors? | Promote evasion of host immune response |
| What organism has Protein A virulence factor? | S. aureus |
| IgA protease is a virulence factor seen with: | S. pneumoniae, H. influenzae type b, and Neisseria |
| Which virulence factor binds to Fc region of IgG? | Protein A |
| After binding, what actions are prevented by Protein A? | Opsonization and phagocytosis |
| What is the function virulence factor IgA protease? | Enzyme that cleaves IgA, allowing bacteria to adhere to and colonize mucous membranes |
| M protein helps prevent _____________. | Phagocytosis |
| What kind of bacteria expresses M protein virulence factor? | Group A streptococci |
| What is a possible underlying reason for the autoimmune response seen in acute rheumatic fever? | M protein |
| Shares similar epitopes to human cellular proteins (molecular mimicry) | M protein |
| What is another name for Type III secretion system? | Injectisome |
| What is an injectisome? | Needle-like protein appendage facilitating direct delivery of toxins from certain gram (-) bacteria to eukaryotic host cell |
| What is the process of bacterial Transformation? | Competent bacteria can bind and import short pieces of environmental naked bacterial chromosomal DNA |
| Besides IgA protease virulence factor, the SHiN bacteria, undergo ______________________ readily. | Transformation |
| What can prevent transformation? | Adding deoxyribonuclease degrades naked DNA |
| What are the two types of conjugation? | 1. F+ x F- 2. Hfr x F- |
| Which plasmid contains genes for sex pilus and conjugation? | F+ |
| What is transferred via the sex pilus? | Single strand of plasmid DNA |
| What is a plasmid? | Small, extrachromosomal DNA molecule within a cell |
| What kind of DNA is NOT transferred in Conjugation? | Chromosomal DNA |
| What is Hfr? | Plasmid that has incorporated the F+ plasmid |
| How is conjugation of chromosomal DNA possible? | Using Hfr only |
| What are the two modes of Transduction? | Generalized and Specialized |
| What mode of Transduction is referred as a packing "error"? | Generalized |
| What is generalized transduction? | Lytic phage infects bacterium, leading to clava of bacterial DNA. |
| Which transduction mode is referred as an "excision" event? | Specialized |
| What kind of phage is used in Specialized transduction? | Lysogenic |
| Transduction mode in which host and phage DNA break into little pieces? | Generalized |
| Newly formed phage capsids in Generalized transduction contain bacterial DNA , which then: | Infects other bacteria and creates then a recombinant DNA |
| In Specialized Transduction, instead of cleavage of bacterial DNA, it: | Viral DNA from the lysogenic phage incorporates in bacterial DNA |
| What is the difference in newly created phage capsids between Generalized and Specialized transduction? | In specialized, all the new phage capsids contain recombinant bacterial and viral DNA, which creates genes different from donor and recipient |
| Which are the 5 bacterial toxins aht are encoded in a lysogenic phage? | Group A strep erythrogenic toxin Botulinum toxin Cholera toxin Diphtheria toxin Shiga toxin |
| What is Transposition? | Segment of DNA that can "jump" from one location to another, can transfer genes form plasmid to chromosome and vice versa |
| What is the most common way to transfer plasmid with multiple antibiotic resistance among species? | Transposition |
| What are some key features of Spores? | 1. Lack metabolic activity 2. Highly resistant to heat and chemicals 3. Core contains dipicolinic acid |
| What temperature of an autoclave should be in other to kill spores? | 121 C for 15 minutes |
| Where are the endotoxins most likely located? | Outer cell membrane of most gram (-) bacteria |
| What is the main component of Endotoxins? | Lipid A component of LPS |
| Where are the genes located in a Endotoxin? | Bacterial chromosome |
| What are the most common clinical effects of an endotoxin? | Fever, shock (hypotension), and DIC |
| What is the MOA of endotoxins? | Induce TNF, IL-1, and IL-6 |
| What are the most typical diseases produced by Endotoxins? | Meningococcemia; Sepsis by gram (-) rods |
| Which are more toxic, Exotoxins or Endotoxins? | Exotoxins |
| Do exotoxins or endotoxins, produce antitoxins? | Exotoxins |
| Which can resist higher temperatures, exotoxins or endotoxins? | Endotoxins |
| How are exotoxins used in vaccines? | Toxoids produced are used as vaccines |
| What are the most typical exotoxin produced diseases? | Tetanus, botulism, and diphtheria |
| Which exotoxin producing organism inhibit protein synthesis? | Corynebacterium diphtheriae, Pseudomonas aeruginosa, Shigella spp., and Enterohemorrhagic E. coli. |
| Which bacteria's exotoxins inactivate elongation factor 2 (EF-2)? | Corynebacterium diphtheriae and Pseudomonas aeruginosa |
| What is C. diphtheriae clinical manifestation? | Pharyngitis with pseudomembranes in throat and severe lymphadenopathy (bull neck), myocarditis |
| What is P. aeruginosa exotoxin? | Exotoxin A |
| What is the clinical manifestation of Endotoxin A? | Host cell death |
| What is the mechanism of action of EHEC and Shigella spp toxins? | Inactivate 60S ribosome by removing adenine form rRNA |
| Which organisms' toxin inhibit protein synthesis by inactivating the 60S ribosome? | Shigella spp and EHEC |
| Which organism has Shiga-like toxin? | EHEC |
| What is the clinical manifestation of Shiga toxin? | 1. GI mucosal damage --> dysentery 2. Enhance cytokine release, causing HUS |
| What is a clinical difference of how Shigella and EHEC toxins act? | EHEC does not invade host cells |
| HUS is caused by which two organisms? | Shigella spp and EHEC |
| Which endotoxin containing organisms act by increase in fluid secretion? | ETEC, Bacillus anthracis, and Vibrio cholerae |
| What are the two exotoxins found in Enterotoxigenic E. coli? | 1. Healt-LABILE 2. Heat- STABLE |
| MOA of Heat-Labile ETEC exotoxin? | Over activates adenylate cyclase (increase cAMP --> increase Cl- secretion in gut and water efflux |
| Overactivates guanylate cyclase (increase cGMP) --> decrease resorption of NaCl and water n gut. | Heat-stable toxin of ETEC |
| What is the mode of action of Anthrax toxin? | Mimics adenylate cyclase |
| Which toxin is know to permanent activating Gs? | Cholera toxin |
| What organism is responsible for edematous border of black eschar in cutaneous anthrax? | Bacillus anthracis |
| Voluminous "rice-water" diarrhea | Vibrio cholerae infection |
| What organism causes Whooping cough? | Bordetella pertussis |
| What is the mode of action of Pertussis toxin? | Inactivates the inhibitory Gi --> activation of adenylate cyclase and increase of cAMP. |
| What is the analogue condition of Whooping cough in adults, called? | "100-day cough" |
| Pertussis toxin inhibits the _______________ ability. | Phagocytic |
| Which exotoxin interferes with optimal phagocytic activity? | Pertussis toxin |
| Which two common exotoxins inhibit the release of neurotransmitters? | Tetanospasmin and Botulinum toxin |
| What is the MOA of C. tetani and C. botulinum neurotoxins? | Proteases that cleave SNARE, a set of protein required for NT release via vesicular fusion |
| What NT release is inhibited by Tetanospasmin? | Inhibitory (GABA and glycine) NTs form Renshaw cells in spinal cord |
| GABA and glycine release is inhibited by _________________. | Tetanospasmin |
| What are the classic signs of Tetanus? | Spastic paralysis, risus sardonicus, and trismus (lockjaw) |
| What NT release is inhibited by Botulinum toxin? | Stimulatory ACh signal at Neuromuscular junction |
| What are the clinical findings of Botulism? | Flaccid paralysis |
| Which organisms' toxins lyse cell membranes? | Clostridium perfringens and Streptococcus pyogenes |
| What are the two associated exotoxins with Strep pyogenes? | 1. Streptolysin O 2. Erythrogenic exotoxin A |
| What is the MOA of alpha toxin in C. perfringens? | Phospholipase that debrades tissue and cell membranes |
| What is the name of the enzyme used in Alpha toxin? | Lecithinase |
| What organism causes "gas gangrene"? | Clostridium perfringens |
| What are the most common clinical manifestations of Clostridium perfringens? | 1. Degradation of phospholipids --> myonecrosis ("gas gangrene") 2. Hemolysis ("double zone") |
| What are antibodies against Streptolysin O? | ASO |
| What titer levels are used to Dx rheumatic fever caused by S. pyogenes? | ASO titers |
| Streptococcus pyogenes ANTIBODIES cause ________________. | Rheumatic fever |
| Streptococcus pyogenes immune complexes cause _______________________. | Poststreptococcal glomerulonephritis |
| What organisms have supertantiges causing shock exotoxins? | S. aureus and S. pyogenes |
| What is the mode of action of TSST-1 and Erythrogenic exotoxin A? | Cross-links B region of TCR to MHC class II on APCs outside ot the antigen binding site |
| What is the result of the cross link process of TCR and MHC II in superantigens? | Overwhelming release of IL-1, IL-2, IFN-gamma, and TNF-alpha ----> shock |
| What are the clinical manifestation of S. aureus Toxic shock syndrome? | Fever, rash and shock |
| Exfoliative toxin of S. aureus causes ---> | Scalded Skin Syndrome |
| What is characteristic manifestation of S. pyogenes Toxic Shock syndrome? | Fever, rash, shock, and Scarlet fever |
| What is the composition of LPS? | O antigen + core polysaccharide + lipid A |
| What is the toxic component of LPS composition? | Lipid A |
| What are the 3 main effects of LPS? | 1. Macrophage activation (TLR4/CD14), 2. Complement activation 3. Tissue factor activation |
| ENDOTOXINS is a menemoconc to remember what characteristic of endotoxins? | E- edema N- nitric oxide D- DIC/Death O- outer membrane T- TNF-alpha O- O antigen + core polysaccharide + lipid A X - eXtremely heat stable I- IL-1 and IL-6 N- neutrophil chemotaxis S- Shock |
| Scarlet Fever is caused by which bacteria exotoxin? | S. pyogenes |
| Gram positive Aerobic Bacilli: | LIsteria, Bacilus, and Corynebacterium |
| Clostridium is an important represent of: | Anaerobic Gram positive bacili |
| Nocardia is: | Aerobic gram positive branching filamentous bacteria |
| Which is the most common Gram (+) branching filament anaerobic bacteria? | Actinomyces |
| Which bacteria have NOVOBIOCIN sensitivity testing? | S. saprophyticus and S. epidermidis |
| Which specie of Staphylococcus is Novobiocin positive? | S. epidermidis |
| Group A strepto: | S. pyogenes |
| What is the MC representant of Group B strep bacteria? | S. agalactiae |
| Which are the 2 most common representations of Viridans streptococci? | S. mutans and S. mitis |
| Viridans streptococci has no_____________. | Capsule |
| Which streptococci categorie has Optochin testing? | Partial hemolytic streptococcus |
| S. pneumonia is Opsonin ____ or positive. | Sensitive |
| What type of sensitivity is used in Group A and Group B streptococci? | Bacitracin sensitivity |
| Partial reduction of hemoglobin causes greenish or brownish color without clearing around growth on blood agar. | Alpha-hemolytic anemia |
| Which bacterial is included in Alpha-hemolytic bacteria? | 1. Streptococcus pneumoniae 2. Viridans streptococci |
| Which a-hemolytic bacteria is Optochin resistant? | Viridans streptococci |
| Complete lysis of RBCs --> clear area surrounding colony on blood agar. | Beta-hemolytic bacteria |
| What are the 3 most common bacterial denomited Beta-hemolytic? | 1. Staphylococcus aureus 2. Streptococcus pyogenes 3. Streptococcus agalactiae |
| Catalase (-), bacitracin sensitive, gram + | Strept pyogenes |
| Which beta-hemolytic bacteria is bacitracin resistant? | Streptococcus agalatiae |
| Group A streptococcus = | Strep pyogenes |
| Complete bacterial description of S. aureus | Gram (+), B-hemolytic, catalase (+), coagulase (_) cocci in clusters |
| What virulence factor is seen in S. Aureus? | Protein A |
| Where are the common locations for S. aureus colonization? | Nares, ears, axilla, and groin |
| What are common complications of an S. aureus infection? | 1. Inflammatory disease 2. Toxin-mediated disease 3. MRSA |
| What is the clinical manifestation of description of S. aureus - induced inflammatory disease? | Skin infections, organ abscesses, pneumonia, endocarditis, septic arthritis, and osteomyelitis |
| What are Toxin-mediated diseases by S. aureus? | TSST-1, scalded skin syndrome, rapid-onset food poisoning |
| What is MRSA? | Methicillin-resistant S. aureus |
| What are common complications of MRSA infection? | Serious nosocomial and community-acquired infects |
| Why is MRSA resistant to methicillin and nafcillin? | Altered penicillin-binding protein |
| Where does the TSST-1 superantigen bind to? | MHC II and T cell receptors --> polyclonal T cell activation |
| Main signs and symptoms of Staphylococcal toxic shock syndrome (TSS)? | Fever, vomiting, rash, desquamation, shock, and endo-organ failure |
| What are common causative association of Staphylococcus TSS? | Prolonged use of vaginal tampons or nasal packaging |
| Streptococcus TSS is associated with an __________________, unlike Staphylococcal TSS. | Painful skin infection |
| Staph epidermidis description | Gram (+), catalase (+), coagulase (-), urease (+) cocci in clusters |
| S. epidermidis is Novobiocin ______________________ and it does not ferment ______________. | Sensitive; Mannitol |
| Which staph specie ferments Mannitol? | Aureus |
| What is commonly infected by S. epidermidis? | Prosthetic devices (hip implant, heart valve), and IV catheters by proeicudn adherent biofilms |
| What aids in the infections of S. epidermidis? | Biofilm production |
| Novobiocin resistant. | Staph saprophyticus |
| Which staphylococcal specie is found in normal flora of female genital tract and perineum? | Staph saprophyticus |
| S. saprophyticus is: | The 2nd MCC of uncomplicated UTI in young women |
| Gram (_), lancet-shaped diplococci | Streptococcus pneumoniae |
| S. pneumoniae is ____________________ and ______________________. | Encapsulated and Optochin sensitive |
| What mnemonic is often used to summarize some clinical manifestations of S. pneumoniae? | MOPS |
| What does MOPS stand for? | M. meningitis O. Otitis media (in children) P. Pneumonia S. Sinusitis |
| Pneumococcus is associated with _____________ sputum. | "rusty" |
| What kind of patients have increased risk of sepsis by S. pneumoniae? | Sickle cell disease patients and those asplenic patients |
| A S. pneumoniae losses it capsule. It means? | NO virulence |
| Which alpha-hemolytic gram (+) bacteria is Optochin resistant? | Viridans group streptococci |
| Which species of Viridans cause dental caries? | S. mutans and S. mitis |
| What viridian streptococci specifically creates dextrans? | S. sanguinis |
| S. sanguinis creation of Dextrans causes: | Dextrans to bind to fibrin-platelet aggregates on damaged heart valves causing Subacute bacterial endocarditis |
| What type of endocarditis is associated with S. sanguinis? | Subacute Bacterial endocarditis |
| A Group A strep infection causes: | 1. Pyogenic manifestations 2. Toxigenic conditions 3. Immunologic diseases |
| What are the clinical manifestation of Pyogenic Group A infection? | Pharyngitis, cellulitis, impetigo ("honey-crusted" lesion), and erysipelas |
| Scarlet fever, toxic shock-like syndrome, and necrotizing fasciitis, are: | S. pyogenes toxigenic manifestations |
| What thow Immunologic conditions are associated with S. pyogenes infection? | Rheumatic fever and PSGN |
| S. pyogene-induced pharyngitis can cause __________________ if left untreated. | Rheumatic fever |
| Rheumatic fever is often preceded by: | Pyogenic Pharyngitis |
| What is the most common preceding S. pyogenes manifestation leading to PSGN? | Impetigo |
| What is Scarlet Fever? | Blanching, sandpaper-like body rash, strawberry tongue, and circumoral pallor i the setting of group A streptococcal pharyngitis (erythrogenic toxin (+). |
| Gram (+) cocci, bacitracin resistant, B-hemolytic, colonizes vagina. | Streptococcus agalactiae (group B streptococci) |
| What are the possible results of a S. agalactiae infection in a baby? | Pneumonia, Meningitis, and sepsis |
| Which factor is produced by Group B streptococcus? | CAMP |
| What is the role of CAMP? | Enlarges the area of hemolysis form by S. aureus |
| Hippurate test (+). PYR (-) | Streptococcus agalactiae (group B streptococci) |
| Woman intrapartum, (+) S. agalactiae should be given? | Intrapartum penicillin prophylaxis |
| Which weeks are usual times for screening pregnant mother for S. agalactiae infection? | 35-37 weeks |
| S. gallolyticus is a subspecies of: | Streptococcus bovis |
| What conditions or diseases are associated to S. gallolyticus? | Bacteremia and Subacute endocarditis |
| What cancer type is associated with S. gallolyticus? | Colon cancer |
| What area is colonized by Strep bovis? | Gut |
| What are the 2 most common species of Enterococci? | E. faecalis and E. faecium |
| What are some features of Enterococci? | - Resistant to penicillin G - Cause: UTI, biliary tract infections, and subacute endocarditis |
| Catalase (-), PYR (+), and variable hemolysis. | Enterococci |
| What does VRE stand for? | Vancomycin-resistant enterococci |
| VRE are a imporntac cause of: | Nosocomial infections |
| Entero = | intestine |
| Which are more resilient, Streptococci or Enterococci? | Enterococci |
| Strepto = | Twisted (chains) |
| What organism is gram (+), spore-forming rod that produces anthrax toxin? | Bacillus anthracis |
| What is caracheirstic of B. anthracis' capsule? | Only one with a polypeptide capouse that contains D-glutamate |
| The description of colonies as "Medusa head" refers to: | Bacillus anthracis |
| What are the tow types of B. anthracis? | 1. Cutaneous anthrax 2. Pulmonary anthrax |
| What is th clinical presentation of Cutaneous anthrax? | Painless papules surrounded by vesicles --> ulcer with black eschar --> not common to progress to bacteria and death |
| What is another name given to Pulmonary anthrax? | Woolsorter's disease |
| CXR may show a widened mediastinum. Dx? | Pulmonary anthrax |
| Pathogenesis of Pulmonary anthrax: | Inhalation of spores --> flu-like symptoms that rapidly progress to fever, pulmonary hemorrhage, mediastinitis, and shock |
| Common gram positive rod that causes food poisoning? | Bacillus cereus |
| Spores of which organism are often seen in Cooking rice? | Bacillus cereus |
| What causes reheated rice syndrome? | Spore infection by B. cereus |
| What is the preformed toxin of B. cereus? | Cereulide |
| What is the clinical presentation of the B. cereus infection of diarrheal type? | Waterry, nonbloody diarrhea and GI pain within 8-18 hr |
| Clostridia (all) are: | Gram (+), spore-forming, obligate anaerobic rods |
| Where is GABA and glycine secreted from? | Renshaw cell in Spinal cord |
| What is trismus? | Lockjaw |
| What is sardonicus? | Raised eyebrows and open grin |
| What is Opisthotonos? | Spasms of spinal extensors |
| What condition is seen with Trismus, Sardonicus, and Opisthotonos? | Tetanus |
| Heat-labile toxin that inhibits ACh release at the NMJ causing botulism. Organism? | C. botulinum |
| What is the a common mode of ingestion of Botulinum toxin in babies? | Ingestion of spores in honey |
| What are the 4 D's of Botulism? | Diplopia, Dysarthria Dysphagia Dyspnea |
| What specific symptoms of Botulism are treated with local botox injections? | Dystonia, achalasia, and muscle spasms. |
| What is a better description of the alpha toxin produced by C. perfringens? | Lecithinase, a phospholipase |
| What are the clinical manifestations of C. perfringens? | 1. Myonecrosis (gas gangrene) which presents with tissue crepitus and hemolysis |
| How many toxins are produced by C. difficile? | 2 toxins |
| What is Toxin A of C. difficile? | An enterotoxin, which binds to brush border of gut and alters fluid secretion. |
| What is the action of Toxin B of C. difficile? | Cytotoxin, which disrupts cytoskeleton via actin depolymerization |
| How does Toxin B of C. difficile causes disruption of the cytoskeleton? | Via actin depolymerization |
| What organism causes Pseudomembranous colitis? | C. difficile |
| What is the MCC of Pseudomembranous colitis? | Secondary use of antibiotic, especially clindamycin or ampicilin |
| Which are often the most associated antibiotics that cause Pseudomembranous colitis? | Clindamycin and Ampicillin |
| What is the treatment of C. difficile infection? | Metronidazole or oral vancomycin |
| Treatment for recurrent cases of Pseudomembranous colitis (C. diff infection)? | Fidaxomicin, or fecal microbiota transplant |
| What encodes for the diphtheria exotoxin? | B-prophage |
| Coryne = | Club shaped |
| Color of Corynebacterium diphtheriae colonies on cysteine-tellurite agar? | Black |
| What are the clinical manifestations of C. bacterium? | 1. Pseudomembranous pharyngitis (grayish-white membrane) 2. Lymphadenopathy, myocarditis, and arrhythmias |
| Common test for Corynebacterium diphtheriae toxin | (+) Elek test |
| What type of vaccine is made from Corynebacterium diphtheria? | Toxoid |
| What are the ABCDEFG of Corynebacterium diphtheria? | A. ADP-ribosylation B. Beta-prophage C. Corynebacterium D.- Diphtheriae E. Elongation Factor 2 G. Granules (blue and red) |
| What color are granules found in C. diphtheriae? | Blue and red |
| What biochemical process causes the elongation of factor 2 by C. diphtheriae exotoxin? | ADP-ribosylation |
| Listeria is an __________________________________. | Gram (+), facultative intracellular rod |
| What are the MC modes of acquiring Listeria monocytogenes? | 1. Ingestion of unpasteurized dairy products and cold deli meats 2. Transplacental transmission 3. Vaginal transmission during birth |
| Which bacteria grows well at refrigerator temperatures 4-10 C ? | Listeria monocytogenes |
| How are the "rocket tails" in Listeria made? | Via actin polymerization that allow intracellular movement and cell-to-cell spread across cell membranes, thereby avoiding antibody |
| Tumbling motility | Listeria monocytogenes |
| "Cold enrichment" | Listeria monocytogenes |
| What is caused by L. monocytogenes infection? | 1. Amnionitis, septicemia, and spontaneous abortion in pregnant women 2. Granulomatosis infantiseptica 3. Neonatal meningitis, 4. Meningitis in immunocompromised |
| What is the treatment for Listeria monocytogenes infection? | Ampicillin |
| Nocardia and Actinomyces both are: | Gram (+) and form long, branching filaments resembling fungi |
| Nocardia is: | Anaerobe, acid fast (weak), and is found in soil |
| Where is Nocardia often or most commonly found? | Soil |
| What is caused by a Nocardia infection? | - Immunocompromised --> Pulmonary infections (mimic TB) - Immunocompetent --> Cutaneous infections after trauma |
| Common spread of Nocardia infection is to the _______. | CNS |
| What is the treatment for Nocardia infections? | TMP-SMX (sulfonamides) |
| Where is Actinomyces often found? | Normal oral, reproductive, and GI flora |
| Actinomyces is _______________________ and not __________________. | ANAerobe ; acid fast |
| What are some clinical manifestation of Actinomyces infection? | 1. Oral/facial abscesses that drain through sinus tracts 2. Yellow "sulfur granules" 3. PID with IUDs |
| What organism is associated with dental caries/extraction ian dother maxillofacial trauma, along with oral abscesses? | Actinomyces |
| Yellow "sulfur granules" | Actinomyces |
| SNAP | Sulfonamides --------Nocardia Actinomyces ------- Penicillin |
| Common subtypes of Mycobacterium? | 1. M. tuberculosis 2. M. avium-intracellulare 3. M. scrofulaceum 4. M. marinum |
| Which mycobacteria is often resistant to multiple drugs? | M. tuberculosis |
| Which mycobacteria specie causes disseminated non-TB disease in AIDS? | M. avium-intracellulare |
| What antibiotic is used in prophylaxis of M. avium intracellulare infection in AIDS patients? | Azithromycin |
| M. scrofulaceum causes: | Cervical lymphadenitis in children |
| Hand infection in aquarium handlers is often due to __________________ infection. | M. marinum |
| All mycobacteria are _____________________ organisms. | Acid-fast |
| What are the most significant TB symptoms? | Fever, night sweats, weight loss, cougu (non productive or productive), and hemoptysis |
| Shape of the Cord factor in Mycobacteria? | Serpentine cord |
| "Serpentine cord" indicates: | M. Tuberculosis infections |
| What is the role of the Cord factor of M. tuberculosis? | 1. Activates macrophages (promote granuloma formation) 2. Induces release of TNF-alpha |
| What are the components of the Ghon complex? | Hilar nodes and Ghon focus |
| Where in the lung are Ghon focus most commonly located? | Mid/lower lobes |
| Which lung lobes usually develop secondary tuberculosis cavitary lesions? | Upper lobes |
| What does a PPD (+) indicate? | Current infection or past exposure |
| What does a negative PPD test indicate? | NO infection and in sarcoidosis or HIV infection |
| Which pathological conditions can produce a negative PPD test? | 1. Sarcoidosis 2. HIV infection (especially with low CD4+ count) |
| What is an important characteristic of Secondary TB? | Caseating granulomas with central necrosis and Langerhans giant cell |
| Caseating granulomas with central necrosis are key sign of ___________. | Secondary Tuberculosis |
| Secondary TB that is disseminated into the vertebrae. Dx? | Pott Disease |
| Another name for Leprosy? | Hansen disease |
| Why bacteria causes Leprosy? | Mycobacterium leprae |
| What are some features of M. leprae? | 1. Acid-fast bacillus 2. Likes cool temperatures 3. Produces a "glove and stocking" loss of sensation 4. Cannot be grown in vitro |
| Which two lab techniques are used to Dx Leprosy? | Skin biopsy and PCR |
| What is the MC reservoir of M. leprae in the U.S.A? | Armadillos |
| What are the 2 forms of Hansen disease? | 1. Lepromatous 2. Tuberculoid |
| Lepromatous leprosy: | Presents diffusely over skin, with leonine facies, and is communicable. It can be lethal Low cell-mediated immunity with a humoral Th2 response |
| What are the characteristics of Tuberculoid leprosy? | Few hypoesthetic, hairless skin plaques; High cell-mediated immunity with Th1 immune response and low bacterial load |
| What is the treatment for Leprosy? | Tuberculoid form: Dapsone and Rifampin Lepromatous form : Dapsone and Rifampin + CLOFAZIMINE |
| Gram negatives are stained _________________. (color) | Pink |
| What characteristic have all gram (-) comma-shaped rods? | Oxidase (+) |
| What are the 3 comma shaped gram negative organisms? | 1. Campylobacter jejuni 2. Vibrio cholerae 3. Helicobacter pylori |
| Grown in 42 C. | C. jejuni |
| C. jejuni features: | Gram negative, Comma shaped Oxidase (+) Grows in 42 Celsius |
| What is a key characteristic of V. cholera growth? | Grows in alkaline media |
| What organism, gram negative, grown in basic media? | Vibrio cholerae |
| H. pylori is ___________-shaped, oxidase _________, and produces ________________. | Comma-shaped; Oxidase (+); Urease |
| Which gram negative comma-shaped rod produces urease? | H. pylori |
| What are the 4 MC shpates of gram negative bacteria? | Diplococci, Coccobacilli, Bacilli, and Comma-shaped |
| WHich are the gram (-) diplococci? | N. gonorrhoeae and N. meningitidis |
| N. meningitis is: | Gram negative, diplococci, Aerobic, and (+) Maltose fermentation |
| N. gonorrhoeae does not ferment _________________. | Maltose |
| Which a lesser known Maltose negative gram (-) diplococci? | Moraxella |
| N. gonorrhoeae shares most laboratory characteristics with? | Moraxella |
| Which are the 2 MC gram negative coccobacilli? | 1. H. influenzae 2. Bordetella pertussis |
| Which are 3 not so common gram negative coccobacilli? | Pasteurella, Brucella, and Francisella tularensis |
| What is the first test done to different gram negative bacilli? | Lactose fermentation |
| Lactose (+) fermenters then are divided into: | Fast and slow fermenters |
| Which are the most common gram negative fast lactose fermenters? | E. coli and Klebsiella |
| What is a key distinguish features of Citrobacter and Serratia? | Slow lactose fermenters |
| If bacilli are Lactose negative (non-fermenters), which is the next applied test to differentiate bacteria? | Oxidase |
| Which bacteria is a lactose non fermenter, oxidase positive, gram negative bacilli? | Pseudomonas |
| Oxidase positive lactose fermenter bacilli, are finally categorized as: | H2S producers or non produces |
| Salmonella is a H2S __________________. | Producers |
| Which are the 2 H2S non-production? | Shigella and Yersinia |
| According to the Gram (-) algorithm, E. coli is: | Gram negative bacilli, Fast Lactose fermenter |
| What characteristics are shared by all Neisseria species? | Metabolize glucose and produce IgA proteases. 2. Contain lipooligosaccharides (LOS) with strong endotoxin activity |
| N. gonorrhoeae is often intracellular, as it is found within ___________________. | Neutrophils |
| N. meningitidis ferments _______________ and _______________. | Glucose and Maltose |
| Which Neisseria species has a polysaccharide capsule? | Meningococci |
| Which features are present in N. meningococci and not in N. gonorrhoeae? | Polysaccharide capsule, maltose fermentation, and Vaccine |
| Mode of transmission of N. meningitidis? | Respiratory and oral secretions |
| What are conditions caused by N. meningococci? | 1. Meningococcemia with petechial hemorrhages and gangrene of toes 2. Meningitis 3. Waterhouse-Friderichsen syndrome |
| What is the prevention or prophylaxis of N. meningococcal infection? | Rifampin, ciprofloxacin, or ceftriaxone |
| Most commonly used treatment of N. meningococci infection? | Ceftriaxone or penicillin G |
| What penicillin is used to treat N. meningitidis? | Penicillin G |
| What are the most common complications due to N. gonorrhoeae infection? | Gonorrhea, septic arthritis, neonatal conjunctivitis, PID, and Fitz-Hugh-Curtis syndrome |
| N. gonococci causes which important syndrome? | Fitz-Hugh-Curtis syndrome |
| N. meningococci causes with important syndrome? | Waterhouse-Friderichsen syndrome |
| What is seen in Waterhouse-Friderichsen syndrome? | Adrenal insufficiency, fever, DIC, and shock |
| What measures are taken to prevent or reduce N. gonorrhoeae infections? | Condoms in sexual transmission, and erythromycin eye ointment prevent neonatal blindness |
| What is the treatment of N. gonorrhoeae infection? | Ceftriaxone |
| Which antibiotic is often co-adiminter with Ceftriaxone in N. gonorrhea infections? | Azithromycin or doxycycline |
| Why is azithromycin added to treatment of N. gonorrhoeae? | Due to possible chlamydia coinfection |
| Which a common small gram negative coccobacillary rod? | Haemophilus influenzae |
| Which type or form of H. influenzae is most common to cause disease? | Nontypeable (unencapsulated) |
| Which type of H. influenzae has a vaccine developed? | Type b |
| What type of virulence factor is produced by H. influenzae? | IgA protease |
| Which common gram positive bacteria can be co-cultured with H. influenzae to promote its growth? | S. aureus |
| Why is Staph aureus co-cultured with H. influenzae? | Provides factor V via RBC hemolysis |
| What factors are needed for culture growth of H. influenzae? | Factors V (NAD+) and X (hematin) |
| What are some common conditions caused by H. influenzae infection? | EMOP: E - epiglottitis M - Meningitis O - Otitis media P - pneumonia |
| What signs are seen in Epiglottitis? | 1. Epiglottis appears "cherry red" 2. Lateral neck X-ray shows the "thumb sign" |
| What is the treatment for H. influenzae mucosal infections? | Amoxicillin +/- clavulanic acid |
| H. influenzae meningitis is treated with ______. | Ceftriaxone |
| What is H. influenzae vaccine conjugated with: | Diphtheria toxin or other protein |
| At what age is H. influenzae type b vaccine applied? | Between 2-18 months of age |
| What are the virulence factors of Bordetella pertussis? | 1. Pertussis toxin 2. Adenylate cyclase toxin 3. Tracheal cytotoxin |
| What is the function of Pertussis toxin? | Disables Gi |
| Why is Bordetella pertussis infection often confused by a viral infection? | Due to lymphocytic infiltrate results in form immune response |
| Which vaccines prevent Bordetella pertussis infection? | Tdap and DTaP |
| What is the 1st stage of Bordetella pertussis infection? | Catarrhal -- low-grade fever, and Coryza |
| The "whooping cough" in B. pertussis infection is seen in which stage of the infection? | Paroxysmal (2nd) |
| Describe the Paroxysmal stage of B. pertussis infection: | Paroxysms of intense cough followed by inspiratory "whoop", posttussive vomiting |
| What stain is used for Legionella? | SIlver stain. Grow on charcoal yeast extract medium with iron and cysteine. |
| What is the most common way to detect legionella? | Antigen in the urine |
| What important electron imbalance is seen in Legionella pneumophila? | Hyponatremia |
| What is the MC mode of transmission of Legionella? | Aerosol transmission from environmental water source habitat (AC systems, hot water tanks) |
| Legionella pneumophila treatment? | Macrolide or quinolone |
| What is Legionnaires' disease? | Severe pneumonia (often unilateral na lobar), fever, GI, an CNS symptoms. |
| Mild flu-like syndrome due to Legionella pneumophila infection? | Pontiac disease |
| Low sodium levels in the blood is a key characteristic of ____________________________ infection. | Legionella pneumophila |
| What gram negative oxidase (+) organism is often described to produce a grape-like odor? | Pseudomonas aeruginosa |
| What is Ecthyma gangrenosum? | Rapidly progressive, necrotic cutaneous lesion caused by Pseudomonas bacteremia. Most likely seen in immunocompromised |
| What does the mnemonic PSEUDOMONAS describe? | Condition and features caused by Pseudomonas aeruginosa: P- Pnuemonia S- Sepsis E- Ecthyma grangrenosum U- UTIs D - Diabetes O- Osteomyelitis M- Mucoid polysaccharide capsule O - Otitis externa N - Nosocomial infections A - Addicts to drugs S - Skin infections |
| What is a common skin infection due to Pseudomonas aeruginosa? | Hot tub folliculitis |
| Common skin condition in which hair follicles become inflamed? | Folliculitis |
| What time of Otitis is associated with Pseudomonas infection? | Externa |
| Which patients are at higher risk of pseudomonas pneumonia? | Cystic fibrosis patients due to Mucoid polysaccharide capsule and biofilm production |
| What are some features produced by Pseudomonas aeruginosa? | 1. Phospholipase C 2. Exotoxin A 3. Endotoxin 4. Pigments |
| What pigments are produced by Pseudomonas aeruginosa? | Pyoverdin and Pyocyanin (blue-green pigment) |
| Swimmers ear is: | Otitis externa caused by P. aeruginosa |
| What are some common treatments for Pseudomonas? | 1. Carbapenems 2. Aminoglycosides 3. Monobactams 4. Polymyxins 5. Fluoroquinolones 6. Third and Fourth generation cephalosporins 7. Extended-spectrum penicillins |
| How do Shigella and Salmonella invade the GI tract? | Via the M cells of Peyer patches |
| How is the spread of all Salmonella types? | Hematogenously |
| How does Shigella spread? | Cell to cell |
| Salmonella has a _______________, and Shigella does not. | Flagella |
| Salmonella has an ________________ and Shigella has an ____________. | Salmonella ---- endotoxin Shigella ----- Exotoxin (Shiga toxin) |
| Which is more infectious, Salmonella or Shigella? | Shigella; requires a very small inoculum |
| What is the GI manifestation of Shigella infection? | Bloody diarrhea (or bacillary dysentery) |
| What is the pathogenesis of Salmonella infection affecting the GI tract? | Constipation, followed by diarrhea |
| What is the vaccine of Salmonella typhi? | Oral vaccine contains live attenuated S. typhi IM vaccine contains Vi capsular polysaccharide |
| Typhoid fever is caused by: | Salmonella typhi |
| What are the clinical features of Typhoid fever? | Rose spots on abdomen, constipation, abdominal pain, fever |
| What is the normal treatment of Typhoid fever? | Ceftriaxone or fluoroquinolone |
| What are the 4 F's associated with Shigella? | Fingers, Flies, Food, and Feces |
| Which the most severe subtype of Shigella? | Shigella dysenteriae |
| What defines the severity of Shigella species? | The amount of toxin produced |
| Order of Shigella species severity: | S. dysenteriae > S. flexneri > S. boydii > S. sonnei |
| What are possible developments of Yersinia enterocolitica infection? | Acute diarrhea or Pseudoappendicitis |
| What is Pseudoappendicitis? | Right lower abdominal pain due to mesenteric adenitis and/or terminal ileitis. |
| Lactose fermenting enteric bacteria have pink colonies when cultured in _________________. | MacConkey agar |
| What enzyme is produce by E. coli that breaks down Lactose? | B-galactosidase |
| Lactose is broken down by E. coli's beta galactosidase into: | Glucose and Galactose |
| What color do all lactose fermenters, except E. coli, when cultured in EMB agar? | Purple/black colonies |
| E. coli on EMB agar produces: | Colonies with a green sheen |
| What are E. coli virulence factors? | 1. Fimbriae 2. K capsule 3. LPS endotoxin |
| What is caused by fimbriae of E. coli? | Cystitis and Pyelonephritis |
| K-capsule in E. coli causes: | Pneumonia and Neonatal meningitis |
| What Virulence factor of E. coli is responsible for septic shock development? | LPS endotoxin |
| Which E. coli strain is a microbe that invades intestinal mucosa an causes necrosis and inflammation? | Enteroinvasive E. coli |
| EIEC ahs similar clinical presentation to: | Shigella |
| Enterotoxigenic E. coli: | Produces heat labile and heat-stable enterotoxins No inflammation or invasion |
| Whe E. coli strain is responsible for Traveler's diarrhea? | ETEC |
| What is the toxin and mechanism of Enteropathogenic E.coli? | NO toxin produced Adheres to apical surface, flattened villi, prevents absorption |
| What E. coli strain causes diarrhea in children? | EPEC |
| What is the most common E. coli strain in the United States? | Enterohemorrhagic E. Coli (O157:H7) |
| How is EHEC transmitted? | Via undercooked meat, raw leafy vegetables |
| What is the toxin name of EHEC? | Shiga-like toxin |
| Shiga-like toxin in EHEC cause? | Hemolytic-uremic syndrome (HUS) |
| What is HUS? | Triad of anemia, thrombocytopenia, and acute renal failure due to microthrombi forming on damaged endothelium |
| What kind of RBCs are seen in HUS? | Schistocytes |
| Dysentery toxin ca cause: | Necrosis and inflammation |
| What fermentation features is different in strain EHEC than other E. coli presentations? | EHEC does NOT ferment sorbitol |
| What are the 5 Ks of Klebsiella? | Aspiration pneumonia Abscess in lungs and liver Alcoholics diAbetes "currAnt jelly" sputum |
| Found in intestinal flora that causes lobar pneumonia in alcoholics and diabetics when aspirated. What is the most likely bacteria? | Klebsiella |
| Why Klebsiella produces very mucoid colonies? | Due to abundant polysaccharide capsules |
| What is the description of sputum in a Klebsiella patient? | Dark red "currant jelly" |
| What organism is the MCC of bloody diarrhea in children? | Campylobacter jejuni |
| C. jejuni infection is a common antecedent to: | Guillain-Barre syndrome and reactive arthritis |
| Which animal contact may cause a C. jejuni infection? | Dogs, cats, pigs |
| Gram (-) , comma or "S" shaped, oxidase (+), grown at 42 Celsius | Campylobacter jejuni |
| What is the most common mode of transmission of vibrio cholerae? | Contaminated water or undercooked food (raw shellfish) |
| What is the mechanism of action of V. cholerae toxin? | Permanently activates Gs, leading to increase in cAMP. |
| Grows in alkaline media? | V. cholerae |
| How is it possible for H. pylori to survive in gastric acidic mucosa? | It is Urease positive which produces ammonia, creating an alkaline environment |
| What part of the stomach is most likely colonized by H. pylori? | Antrum of stomach |
| What are the most common type of peptic ulcers caused by H. pylori infection? | Duodenal ulcers |
| H. pylori is a risk factor for: | Peptic ulcer disease, gastric adenocarcinoma, and MALT lymphoma |
| What lymphoma is associated with H. pylori infection? | MALT |
| What is the term or therapy denomination for H. pylori infection? | Triple therapy |
| What is the composition or parts of the Triple therapy in treatment of H. pylori? | Amoxicillin (metronidazole if penicillin allergy), + Clarithromycin + Proton pump inhibitor (PPI) |
| Category of bacteria of spiral-shaped and with axial filaments? | Spirochetes |
| What are common spirochetes? | Borrelia, Leptospira, and Treponema |
| How can treponema be visualized? | Dark-field microscopy or direct fluorescent antibody (DFA) microscopy |
| What organism causes Lyme disease? | Borrelia burgdorferi |
| What transmits BOrrelia burgdorferi? | Ixodes deer tick |
| The Ixodes deer tick is a vector for: | 1. Borrelia burgdorferi 2. Anaplasma spp. 3. Protozoa Babesia |
| Which area of the USA is Borrelia burgdorferi commonly found? | Northeastern United States |
| Description of Stage 1 of Lyme Disease: | Early localized; erythema migrans and flu-like symptoms |
| What is the description of Erythema migrans? | "Bulls-eye" configuration |
| Stage 2 Lyme disease is seen with: | Early disseminated; Secondary lesions, carditis, AV block (3), facial nerve (Bell) palsy, and migratory myalgias/transient arthritis |
| 3 AVB and Bell palsy are part of the ________________ stage of Lyme disease. | Second |
| What are the symptoms seen in the Third and last stage of Lyme disease? | Encephalopathy and chronic arthritis |
| What is the 1st line of treatment in Lyme disease? | Doxycycline |
| What are secondary treatment options of Lyme disease? | Amoxicillin and cefuroxime in pregnant women and children |
| Leptospira interrogans is: | Spirochete with hook-shaped ends found in water contaminated with animal urine |
| Animals urinating in bodies of water. Which is a common bacteria to be found? | Leptospira interrogans |
| What are the two conditions due to Leptospira interrogans infection? | 1. Leptospirosis 2. Weil Disease |
| What is Weil disease? | Icterohemorrhagic leptospirosis; Severe form with jaundice and azotemia from liver and kidney dysfunction, fever, hemorrhage, and anemia |
| What is a key clinical finding of Leptospirosis? | Photophobia with conjunctival suffusion (erythema without exudate) |
| What condition is common or prevalent among surfers ? | Leptospirosis |
| What organism causes syphilis? | Treponema pallidum |
| What is the main characteristic of Primary syphilis? | Genital painless chancre |
| Is the chancre in Primary syphilis painful? | NO |
| Which stage of syphilis is seen with condylomata lata? | Secondary |
| What are the key features of Secondary syphilis? | Maculopapular rash, condylomata lata, lymphadenopathy, and patchy hair loss |
| What is Condylomata lata? | Smooth, painless, wart-like white lesions on genitals |
| Gummas are found in? | Tertiary syphilis |
| What are "gummas"? | Chronic granulomas in tertiary syphilis |
| What are some key features of Tertiary syphilis? | Gummas, aortitis, neurosyphilis, Argyll Robertson pupil, broad-based ataxia, and positive Romberg, Charcot joint, stroke without hypertension |
| What is seen with aortitis in syphilis? | Vasa vasorum destruction |
| Tabes dorsalis and "general paresis" are part of _________________ | Neurosyphilis in Tertiary stage |
| What fluid is tested to Dx for Neurosyphilis? | Spinal fluid |
| What are some key features of Congenital syphilis? | Facial abnormalities such as rhagades, snuffles, saddle nose, notched (Hutchinson) teeth, mulberry molars, and short maxilla |
| What Cranial Nerve cause deafness in congenital syphilis? | CN VIII |
| What are rhagades? | Linear scars at angle of mouth |
| What are conditions that can produce VDRL false positives? | Pregnancy, Viral (EBV) infection, Drugs, Rheumatic fever, and Lupus and Leprosy |
| What is detected by VDRL? | Nonspecific antibody atha reacts with beef cardiolipin |
| Flu-like syndrome after antibiotics are started. MC Dx? | Jarisch-Herxheimer reaction |
| What does a Jarisch-Herxheimer reaction occurs? | Due to killed bacteria (usually spirochetes) releasing toxins |
| A pleomorphic, gram-variable rod involved in bacterial vaginosis. | Gardnerella vaginalis |
| What is the most common presentation of Gardnerella vaginalis? | Gray vaginal discharge with a fishy smell; nonpainful |
| What histoloigical finding is key for Gardenela vaginosis? | Clue cells |
| What are Clue cells? | Vaginal epithelial cells covered with Gardnerella |
| What is the best treatment option of Gardnerella vaginalis? | Metronidazole or clindamycin |
| What is the Amine whiff test? | Mixing vaginal discharge with 10% KOH enhances fishy odor |
| When is the Amine whiff test often used? | To diagnose bacterial vaginosis by Gardnerella vaginalis |
| What are the 2 forms of Chlamydiae? | 1. Elementary body 2. Reticulate body |
| What of Chlamydiae is infectious? | Elementary body |
| Reticulate body of Chlamydiae serves to: | Replicate in cell by fission |
| Chlamydia psittaci causes: | Atypical pneumonia |
| What is the preferred treatment for chlamydia infection? | Azithromycin or doxycycline |
| Why does chlamydia lack the classic peptidoglycan wall? | Due to reduced muramic acid rendering B-lactam antibiotics ineffective. |
| What are the cytoplasmic inclusions seen with Chlamydia? | Reticulate bodies |
| Chlamydia trachomatis causes: | Reactive arthritis (Reiter's syndrome), neonatal and follicular adult conjunctivitis, nongonococcal urethritis, and PID |
| Chlamydia pneumoniae and Chlamydophila psittaci cause: | Atypical pneumonia |
| Which species of chlamydia is the most important? | Chlamydia trachomatis |
| What is caused by C. trachomatis Types A, B, and C? | Chronic infection, cause blindness due to follicular conjunctivitis in Africa |
| What conditions are associated to C. trachomatis types D-K? | Urethritis/PID, ectopic pregnancy, neonatal pneumonia (staccato cough) with eosinophilia, neonatal conjunctivitis (1-2 weeks after birth) |
| What condition is associated to C. trachomatis types L1, L2, and L3? | Lymphogranuloma venereum |
| What is Lymphogranuloma venereum? | Small, painless ulcers on genitals --> swollen, painful ighilan lymph nodes atha ulcerate (boubous). |
| What is the treatment for Lymphogranuloma venereum? | Doxycycline |
| Ulcer due to C. trachomatis type L1-L3 are ___________________. | Painless |
| Bartonella spp causes? | Cat scratch disease and Bacillary angiomatosis |
| Relapsing fever is caused by: | Borrelia recurrentis |
| What condition is due to a Borrelia recurrentis infecion? | Relapsing fever |
| What conditions are due to Brucella infection? | Brucellosis and Undulant fever |
| Q fever is due to _____________________ infection. | Coxiella burnetii |
| What condition is due to Francisella tularensis? | Tularemia |
| What is the source animal of Francisella tularensis? | Ticks, rabbits, and deer flies |
| Dog bites often cause a _____________ infection. | Pasteurella multocida |
| What some associated condition to Pasteurella multocida infection? | Cellulitis and Osteomyelitis |
| Rickettsia rickettsii infection causes | Rocky Mountain spotted fever |
| Dermacentor is: | Source of Rickettsia rickettsii |
| What is the name of a dog tick? | Dermacentor |
| What are the common sources of Salmonella species, except for Salmonella typhi? | Reptiles and poultry |
| The plague is due to _________________ infection. | Yersinia pestis |
| What is the main treatment Rickettsial diseases and vector-borne illnesses? | Doxycycline |
| Description of rash of RMSF? | Rash starts at wrist and ankles and then spreads to trunk, palms, and soles |
| RMSF rash is similar in spread to: | Secondary syphilis, Coxsackievirus A infection |
| Typhus rash: | Start centrally and spreads out, sparing palms and soles |
| Systemic mycoses, all this can cause: | Pneumonia and can disseminate |
| All mycoses are: | Dimorphic fungi |
| Which is the only systemic mycoses that is not eyats at 37 Celcius? | Coccidioides |
| Systemic mycoses are ________________ at 20 C. | Mold |
| At 37 C, all systemic mycoses are in _____________ form. | Yeast |
| What is a common characteristic between systemic mycoses and TB? | Can form granules |
| What i the treatment for local infections of systemic mycoses? | Fluconazole or Itraconazole |
| Disseminated infection of a systemic mycoses is treated with: | Amphotericin B |
| What is the Endemic location of Histoplasmosis? | Mississippi and Ohio River Valleys |
| What is the pathologic features of Histoplasmosis? | Macrophage is filled with Histoplasma |
| Which systemic mycose is smaller than RBC? | Histoplasma |
| Histoplasma is often associated with: | Bird or bat droppings |
| What are the unique clinical signs of Histoplasmosis? | Palatal/ tongue ulcers, and splenomegaly |
| Person with oral ulcer. Which is the most likely responsible systemic mycoses? | Histoplasma |
| What is nte endemic region of Blastomycosis cases? | Eastern and Central United States |
| Broad-based budding of Blastomyces | Pathologic features of Blastomycosis |
| What are the unique signs of Blastomycosis? | Inflammatory lung disease, can disseminate to skin/bone. Verrucous skin lesions can stimulate SCC Forms granulomatous nodules |
| What systemic mycoses is same size as RBC? | Blastomyces |
| Endemic region of Coccidioidomycosis? | Southwestern US, and California |
| Pathologic features of Coccidioidomycosis? | Spherule filled with endospores of Coccidioides |
| Endospores association with which systemic mycosis? | Coccidioidomycosis |
| Coccidioides is ________________________ than an RBC. | Much larger |
| "Captain's wheel" | Paracoccidioidomycosis |
| Latin America Is the endemic region for cases of whcat type f systemic mycosis? | Paracoccidioidomycosis |
| Paracoccidioidomycosis is more ofnen in ___________ than _______. | Males >>> Females |
| Which two systemic mycoses are much larger than an RBC? | Paracoccidioides and Coccidioides |
| What are the most common dermatophytes? | Microsporum, Trichophyton, and Epidermophyton |
| Branching hyphae visible on KOH preparation with blue fungal stain. Associated with pruritus. | Dermatophytes |
| What area of the body is Tinea capitis referred to? | Head and scalp |
| What are the associated conditions or symptoms of Tinea capitis? | Lymphadenopathy, alopecia, and scaling. |
| Tinea corporis occurs on the _______________. | Torso |
| What are some characteristics by Tinea corporis? | Erythematous scaling ringins ("ringworm") and central clearing |
| What type of Tinea occurs in the inguinal area? | Tinea cruris |
| What are the varieties of Tinea pedis? | 1. Interdigital 2. Moccasin distribution 3. Vesicular type |
| Associated to Tinea ungutum? | Onychomycosis; occurs on nails |
| Which cutaneous mycoses occurs in the nails? | Tinea ungutum |
| What causes Tinea (Pityriasis) versicolor? | Malassezia spp |
| "Spaghetti and meatballs" appearance on microscopy. | TInea (pityriasis) versicolor |
| What is the MC treatment of Tinea versicolor? | Selenium sulfide, topical and/or oral antifungal medications |
| List of Opportunistic fungal infections: | 1. Candida albicans 2. Aspergillus fumigatus 3. Cryptococcus neoformans 4. Mucor and Rhizopus spp. 5. Pneumocystis jirovecii 6. Sporothrix schenckii |
| alba = | white |
| Which opportunistic fungal infection forms a pseudohyphae and budding yeast at 20 C , germ tus at 37 C. | Candida albicans |
| A candida albicans in immunocompromised usually causes: | Oral and Esophageal thrush |
| What type of patients get a vulvovaginitis by c. albicans infection? | Diabetics and those with of antibiotics |
| What condition/patients have increased risk of disseminated candidiasis? | Neutropenic patients |
| What are some pathologic associations with c. albicans? | - Oral and Esophageal thrush - Vulvovaginitis - Diaper rash - Endocarditis (IV drug users) - Disseminated candidiasis - Chronic mucocutaneous candidiasis |
| WHat is the most treatment for vaginal c. .albicans infections? | Oral fluconazole/topical azole |
| Oral/esophageal thrush candidiasis is treated with: | Nystatin, fluconazole, or echinocandins |
| Systemic disseminated candidiasis is treated with: | Fluconazole, echinocandins, and amphotericin B |
| Monomorphic septate hyphae that branch at 45 Acute angle. | Aspergillus fumigatus |
| Invasive aspergillosis in immunocompromised causes: | Neutrophil dysfunction |
| What is the associated risk of Aspergillus fumigatus infection in those with TB history? | Aspergillosis in pre-existing lung cavities |
| What is produced by Aspergillus fumigatus that is associated with development of Hepatocellular carcinoma? | Aflatoxins |
| WHat is ABPA? | Allergic bronchopulmonary aspergillosis |
| What is the pathogenesis of ABPA? | Hypersensitivity response associated with asthma and cystic fibrosis; may cause bronchiectasis and eosinophilia. |
| 45 degree angle sepate? | Aspergillus fumigatus |
| Aflatoxins are associated with which opportunistic fungus? | Aspergillus fumigatus |
| Fungal opportunistic infection with narrow budding? | Cryptococcus neoformans |
| Narrow budding, heavy encapsulated yeast, not dimorphic, and found in soil and pigeon droppings? | Cryptococcus neoformans |
| How is Cryptococcus neoformans mostly found? | In soil and bird droppings |
| C. neoformans travels via the blood system into the ____________. | Meninges |
| What agar is used to culture C. neoformans? | Sabouraud agar |
| Which opportunistic fungus is highlighted with India ink, creating a clear halo? | Cryptococcus neoformans |
| What are pathologies caused by Cryptococcus neoformans infection? | 1. Cryptococcosis 2. Cryptococcal meningitis 3. Cryptococcal encephalitis |
| "Soap bubbles" in the brain of an AIDS patient? | Cryptococcus neoformans infection |
| What is the treatment for Cryptococcal meningitis? | Amphotericin B + Flucytosine |
| Description of Mucor and Rhizopus spp. | Irregular, broad, nonseptate hyphae branching at wide angles |
| Ir septate is at wide angles, which is the most common opportunistic fungal infection reference? | Mucor and Rhizopus spp |
| Acute angle branching of septate is seen with______________ opportunistic fungal infection. | Aspergillus fumigatus |
| What is the most common pathology caused by Mucor and Rhizopus spp infection? | Mucormycosis |
| What patients are at increased risk of Mucormycosis? | Ketoacidotic diabetic and/or neutropenic patients |
| After Mucor and Rhizopus species proliferate in the blood vessel walls, what is the course of the infection followed by? | Penetrate Cribriform plate and then enter the brain. |
| Areas affected by CNS mucor and rhizopus infection? | Rhinocerebral, frontal lobe abscess Cavernous sinus thrombosis |
| What are clinical signs of Mucor and Rhizopus infection? | Headache, facial pain, black necrotic eschar on face, with or without cranial nerve involvement. |
| Black necrotic eschar in face is most commonly associated with which opportunistic fungal infection? | Mucor and Rhizopus spp infection |
| What is the indicated treatment for Mucor and Rhizopus spp infection? | Surgical debridement and then amphotericin B or isavuconazole |
| What is the abbreviation for Pneumocystis jiroveci pneumonia? | PCP |
| What is PCP? | Pneumocystis pneumonia, a diffuse interstitial pneumonia, caused by Pneumocystis jirovecii. |
| What is CRX/CT description of PCP? | Diffuse, BILATERAL ground-glass, opacities, with pneumatoceles. |
| Disc-shaped yeast seen in methenamine silver stain of lung tissue. Dx? | PCP |
| What is the treatment for PCP? | TMP-SMX, pentamidine, dapsone (prophylaxis only), and atovaquone. |
| What is the drug used for PCP prophylaxis? | Dapsone |
| Prophylaxis treatment in AIDS patient for PCP starts when CD4+ T cell count drops below: | 200 cells/mm3 |
| What fungal organism causes Sporotrichosis? | Sporothrix schenckii |
| What is the description of Sporothrix schenckii? | Dimorphic, cigar-shaped budding yeast that grows in branching hyphae with rosettes of conidia; |
| Which fungal organism lives in vegetation? | Sporothrix schenckii |
| What disease is due to trauma (break of skin) by a thorn with S. schenckii? | Rose gardener's disease |
| What is the treatment for Rose Gardener's disease? | Itraconazole or Potassium iodide |
| S. schenckii infection is drains along with lymphatics causing? | Ascending lymphangitis |
| Most common Protozoal GI infectious organisms are: | Giardia lamblia, Entamoeba histolytica, and Cryptosporidium |
| What disease is caused by Giardia lamblia? | Giardiasis |
| What is Giardiasis? | Infection with Giardia lamblia; bloating, flatulence, foul-smelling, fatty diarrhea |
| Which type of people are often at higher risk of Giardiasis? | Campers and/or hikers |
| What is the treatment for Giardia lamblia infection? | Metronidazole |
| How is the diagnosis of Giardiasis made? | Multinucleated trophozoites or cysts in stool, antigen detection |
| Oocysts in water. Transmission of? | Cryptosporidium |
| What is the mode of transmission of Giardia lamblia and Entamoeba histolytica? | Cysts in water |
| What disease is due to Entamoeba histolytica infection? | Amebiasis |
| What is the clinical presentation of Amebiasis? | Bloody diarrhea (dysentery), liver abscess ("anchovy paste" exudate), RUQ pain |
| What is the histology of Entamoeba histolytica? | Colon biopsy shows flask-shaped ulcers |
| What is the treatment of Entamoeba histolytica and Giardia lamblia? | Metronidazole |
| Severe diarrhea in AIDS due to Protozoal GI infection? | Cryptosporidium |
| Diagnosis of Cryptosporidium | Oocysts on acid-fast stain , antigen detection |
| Cysts with up to 4 nuclei in stool. Dx? | Entamoeba histolytica |
| Trophozoites with engulfed RBCs in the cytoplasm? | Entamoeba histolytica |
| What is the treatment for Cryptosporidium for healthy individuals? | Nitazoxanide |
| Filtering city water supplies is a mode of prevention of what organism infection? | Cryptosporidium |
| Protozoa-- CNS infection list: | 1. Toxoplasma gondii 2. Naegleria fowleri 3. Trypanosoma brucei |
| Mode of transmission of Toxoplasma gondii | 1. Cysts in meat (most common); 2. Oocysts in cat feces |
| Why do pregnant women should avoid contact with cat feces? | May be contaminated with Toxoplasma gondii oocysts which can cross the placenta |
| What is congenital toxoplamois presented? | Triad of: 1. Chorioretinitis 2. Hydrocephalus 3. Intracranial calcifications |
| Tachyzoite, often seen to diagnose infection with: | Toxoplasma gondii |
| What is the treatment for Toxoplasma gondii infection? | Sulfadiazine + Pyrimethamine |
| Sulfadiazine co administer with Pyrimethamine. Most likely infection? | Toxoplasmosis |
| Brain abscesses; seen as multiple enhancing ring lesions on MRI. Dx? | Toxoplasmosis |
| What are the labs seen by Toxoplasma infection to a immunocompetent individual? | 1. Mononucleosis-like symptoms 2. (-) heterophile antibody test |
| Rapidly fatal meningoencephalitis is caused by an infection with: | Naegleria fowleri |
| Amoebas in CSF is diagnostic for infection with: | Naegleria fowleri |
| Where is the typical place/area for a possible Naegleria fowleri infection? | Swimming in warm freshwater |
| What is "freshwater"? | Water from rivers, lakes, reservoirs, underground streams, and other sources. |
| Infection with Trypanosoma brucei causes which disease? | African sleeping sickness |
| What organism causes African sleeping sickness? | Trypanosoma brucei |
| What is "African sleeping sickness"? | Enlarged lymph nodes, recurring fever, somnolence, and coma due to T. brucei infection |
| Reason for recurring fever in African sleeping sickness? | Due to antigenic variation |
| What is the transmission mode of Trypanosoma brucei? | Tsetse fly, a painful bit |
| How is the diagnosis for Trypanosoma brucei infection made? | Trypomastigote in blood smear |
| What is the treatment for blood-borne Trypanosoma brucei infection? | Suramin |
| Melarsoprol is used for: | Treatment of Trypanosoma brucei infection for CNS penetration |
| What are the main two protozoa that cause hematological infections? | Plasmodium (species) and Babesia |
| What is the most common disease caused by Plasmodium infection? | Malaria |
| What are the main clinical signs of Malaria? | Fever, headache, anemia, and splenoagay |
| Which type of Plasmodium specie causes a 48-hr cycle of fever? | P. vivax/ovale |
| Which plasmodium type causes a tertian cycle? | Pl vivax/ovale |
| What does a tertian cycle of fever by P. vivax/ovale means? | Fever on first day and third day, thus been 48 hours apart from each other |
| WHat is the form name of the dorman P. vivax/ovale in the liver? | Hypnozoite |
| P. falciparum cause an__________ fever pattern. | Irregular |
| Which plasmodium causes a quatrain or (72-hr) fever cycle or pattern> | P. malariae |
| What is the mode of transmission of the Plamodium? | Anopheles mosquito |
| Anopheles mosquito transmits what organism? | Plasmodium spps |
| What medication is used for sensitive Plasmodium infection? | Chloroquine |
| What is the MOA of chloroquine? | Blocks Plasmodium heme polymerase |
| Which Plasmodium enzyme is blocked by Chloroquine? | Heme polymerase |
| In case of Plasmodium been resistant to Chloroquine, what is an alternative treatment option? | Mefloquine or atovaquone/proguanil |
| What test should be done to patients about to be treated with IV quinidine or artesunate? | Test for G6PD deficiency |
| When should IV quinidine or Artesunate should be used? | In life-threatening situations only, and hth previous test for G6PD deficiency. |
| What treatment is added to P. vivax/ovale infecton? | Primaquine for hypnozoite |
| What drug is used to treat Hypnozoite found in liver of patient with a P. vivax/ ovale infection? | Primaquine |
| What organism causes Babesiosis? | Babesia |
| What is the presentation of Babesiosis? | Fever and hemolytic anemia; predominantly Northeastern United States |
| MOde of transmission Babesi? | Ixodes tick |
| Blodo semar shows: ring form, "Maltese cross". Dx? | Babesiosis |
| What is the characteristic finding of Babbeiosis in order to make dx? | "Maltese cross" in blood smear |
| Treatment of Babesia infection | Atovaquone + azithromycin |
| Ixodes tick carries which two organisms? | Babesia and Borrelia burgdorferi |
| Babesiosis and Lyme disease share the same ___________________. | Ixodes tick |
| What are some common findings in Blood smear of Plasmodium sp? | 1. Trophozoite ring form within RBC 2. Schizont containing merozoites 3. Red granules throughtout RBC in P. vivax/ovale |
| What are Schuffner stippling? | Red granules found in Blood smear of Plasmodium infection. |
| Common protozoan visceral infectious organisms: | Trypanosoma cruzi and Leishmania donovani |
| What disease is caused by T. cruzi infection? | Chagas disease |
| What are some symptoms and signs of Chagas disease? | 1. Dilated cardiomyopathy with apical atrophy 2. Megacolon 3. Megaesophagus 4. (+) Romana sign |
| Big heart, big esophagus, and big colon. Dx? | Chagas disease |
| What is the endemic region for Chagas disease? | South America |
| What is the Romana sign? | Unilateral periorbital swelling |
| (+) Romana sign. Dx. | Chagas disease |
| "Kissing" bug causes | Chagas disease |
| THe kissing bug is a type of ______________ bug, which carries ___________________, causing __________________ diseases. | Reduviid bug; Trypanosoma cruzi ; Chagas disease |
| What is the common treatment for Chagas disease caused by T. cruzy? | Benznidazole or Nifurtimox |
| Patient on Nifurtimox. Dx? | Chagas disease |
| Suspect Chagas disease or T. cruzi infection in a person that: | 1. Traveled recently to South America (Brazon MC) 2. Shows enlarged heart (DCM) 3. Complains of unilaerl eye swelling |
| The Sandfly transmit: | Leishmania donovani |
| What two pathologies are due to Leishmania donovani infection? | 1. Visceral leishmaniasis 2. Cutaneous leishmaniasis |
| Waht is hantoher name for Visceral leshimanisis? | Kala-azar |
| What is the clinical presentation of Kala-azar? | Spiking fevers, hepatosplenomegaly, and pancytopenia |
| What is the treatment for Leishmania donovani infection? | Amphotericin B, and sodium stibogluconate |
| Macrophages containing amastigotes. Dx? | Leishmania donovani infection |
| What is the most common sexually transmitted protozoan infection? | Vaginitis due to Trichomonas vaginalis infection |
| What is Trichomonas vaginalis? | Sexually transmitted protozoan |
| Clinical profile of Trichomonas vaginalis vaginitis? | Foul-smelling, greenish discharge; itching and burning; |
| How is Trichomonas vaginal s infection diagnosed? | Motile trophozoites on wet mount; "strawberry cervix" |
| The term "strawberry cervix" most likely indicate: | Trichomonas vaginalis infection |
| What the treatment for patient and partner with Trichomonas vaginalis infection? | Metronidazole |
| Which is nematodes are ingested? | Enterobius, Ascaris, Toxocara, Trichinella, and Trichuris |
| Which nematodes enter body via cutaneous? | Strongyloides, Ancylostoma, and Necator |
| Which nematodes are acquired through a bite? | Loa Loa, Onchocerca volvulus, and Wuchereria bancrofti |
| Common name for nematodes | Roundworms |
| What is the common name for Enterobius vermicularis? | Pinworm |
| What disease is caused by Enterobius vermicularis? | Anal pruritus |
| How is anal pruritus caused by E. vermicularis diagnosed? | By the tape test |
| What is the treatment of Enterobius vermicularis infection? | Pyrantel pamoate or Bendazoles |
| Giant roundworm scientific name is: | Ascaris lumbricoides |
| What is the common name for Ascaris lumbricoides? | Giant roundworm |
| What disease is caused by Ascaris lumbricoides? | 1. Obstruction of ileocecal valve, 2. Biliary obstruction 3. Intestinal perforation |
| From where does Ascaris lumbricoides migrate? | Nose/mouth |
| What is the best treatment option for Ascaris lumbricoides? | Bendazoles |
| Threahewromd = | Strongyloides stercolaris |
| Larva in soil penetrate skin; rhabditiform larva seen under microscope. | Strongyloides stercolaris |
| Autoinfection is most likely seen with which roundworm infection? | Strongyloides stercolaris |
| What is the treatment for Strongyloides stercoralis infection;? | Ivermectin or bendazoles |
| How does Ancylostoma duodenale, Necator americanus cause anemia? | Sicking bloood form interinal (duodena) wall |
| Cutaneous larva migrans is due to what infection? | Ansylostoma doudenale, na ENcator Amricansis infcherion |
| Pruritic, serpiginous rash from walking barefoot on contaminated beach | Cutaneous larva migrans |
| In which tissue does trichinella spiralis takes home when it penetrates the host? | Striated muscle |
| Which disease is caused by Trichinella spiralis infection? | Trichinosis |
| Trichinella and Trichuris are both treated with _________________. | Bendalzoles |
| Whipworm is known as: | Trichuris trichiura |
| Hookworms are: | Ancylostoma duodenale and Necator americanus |
| List of Intestinal Nematodes | 1. Enterobius vermicularis 2. Ascaris lumbricoides 3. Strogyloides stercolaris 4. Ancylostoma duodenale, Necator americanus 5. Trichinella spiralis 6. Trichuris trichiura |
| A list of Tissue nematodes | 1. Toxocara canis 2. Onchocerca volvulus 3. Loa loa 4. Wuchereria bancrofti |
| What condition is due to Toxocara canis infection? | Visceral larva migrans |
| What causes Visceral larva migrans? | Toxocara canis infection |
| What important effects of Visceral larva migrans? | Myocarditis, liver damage, and eye damage (visual impairment, and blindness), and CNS symptoms (seizures, coma) |
| What is the best treatment for Toxocara canis? | Bendazoles |
| What are clinical features of Onchocerca volvulus infection? | Skin changes, loss of elastic fibers, and river blindness |
| Black flies, black skin nodules, "black sight" is a mnemonic to describe what infection? | Onchocerca volvulus |
| What is the treatment for Onchocerca volvulus? | Ivermectin |
| The clue "river blindness" refers to _________________________ infection. | Onchocerca volvulus |
| What organism is transmitted by the Female Backfly? | Onchocerca volvulus |
| What two tissues are affected mainly by Loa loa? | 1. Swelling of the skin 2. Worm in conjunctivitis |
| Which flies transmit Loa loa? | Deer, horse, and mango flies |
| What is the best treatment option for Loa loa and Wuchereria bancrofti? | Diethylcarbamazine |
| Diethylcarbamazine is used to treat which tissue nematodes? | Loa loa and Wuchereria bancrofti |
| What condition is commonly caused by Wuchereria bancrofti? | Lymphatic filariasis (elefantiasis) |
| What is the common name of the condition caused by W. bancrofti? | Elephantiasis |
| Describe the cause of lymphedema in Elephantiasis? | Wuchereria bancrofti organisms (worms) invade the lymph nodes leading to inflammation and subsequent lymphedema |
| How long after initial infection does Elephantiasis present clinically? | After 9 months to a 1 year. |
| What is the vector for Wuchereria bancrofti? | Female mosquito |
| Female backfly -----> Female mosquito ------> | Onchocerca volvulus Wuchereria bancrofti |
| Common name for cestodes | Tapeworms |
| Which are the most relevant cestodes? | 1. Taenia solium 2. Diphyllobothrium latum 3. Echinococcus granulosus |
| Treatment for Taenia solium? | Praziquantel |
| Which is the mode of transmission bo the T. solium? | 1. Ingestion of larvae encysted in undercooked pork (intestinal tapeworm) 2. Ingestion of eggs in food contaminated with human feces |
| What conditions are related to the acquisition of T. solium by ingestion of eggs in contaminated food? | Cysticercosis, neurocysticercosis |
| What is the specific treatment option for Neurocysticercosis? | Albendazole |
| What is neurocysticercosis? | CNS infection with T. solium due to ingestion of eggs in human feces contaminated food |
| What are the CNS symptoms seen with Neurocysticercosis? | Cystic CNS lesions and seizures |
| What disease is due to Diphyllobothrium latum infection? | Megaloblastic anemia due to Vitamin B12 deficiency. |
| Why does D. latum infection causes a Vitamin B12 deficiency? | Tapeworm competes for B12 in intestine --> megaloblastic anemia |
| What is the MC mode of transmission of Diphyllobothrium latum? | Ingestion of larvae in raw freshwater fish |
| Which tapeworms are treated with Praziquantel? | Diphyllobothrium latum and Taenia solium |
| What conditions are associated with Echinococcus granulosus infection? | 1. Hydatid cysts ("eggshell calcification") in liver 2. Cyst rupture can cause anaphylaxis |
| Why are E. granulosus cysts handled with extreme care during surgery? | Rupture can cause anaphylaxis |
| What animal is the intermediate host for Echinococcus granulosus? | Sheep |
| What is the MC mode of transmission of E. granulosus? | Ingestion of eggs in food contaminated with dog feces |
| Another name for flukes? | Trematodes |
| What are the most common Flukes? | 1. Schistosoma 2. Clonorchis sinensis |
| What organism is associated by ingestion of undercooked fish? | Clonorchis sinensis |
| What is the treatment option for all trematodes? | Praziquantel |
| Snails are the intermediate host for ____________________. | Schistosoma |
| What are common actions that predispose Schistosoma infections? | Swimming or bathing in contaminated fresh water |
| What are the two most referred subspecies of Schistosoma? | S. mansoni and S. haematobium |
| What is caused by S. mansoni? | Liver and spleen enlargement, fibrosis, inflammation , and portal hypertension |
| What are the two most significant symptoms of Schistosoma mansoni infection? | Portal hypertension and Hepatosplenomegaly |
| What Schistosoma spp is associated with development of Squamous cell carcinomas of the bladder? | S. haematobium |
| Painless hematuria may be a sign of: | Squamous cell carcinoma of the bladder due to chronic S. haematobium infection. |
| What type of hypertension is associated with S. haematobium infection? | Pulmonary hypertension |
| Scabies are due to __________________________ infection. | Sarcoptes scabiei |
| Describe Scabies? | Pruritus and serpinginous burrows in webspace of hands and feet. |
| What areas of the body are classically seen with serpiginous burrows in Scabies? | Hands and feet |
| What are treatment options for Scabies? | 1. Permethrin cream 2. Washing/drying all clothing/bedding |
| What are common Ectoparasites? | Sarcoptes scabiei and Pediculus humanus/ Phthirus pubis |
| What are Pediculus humanus/ Phthirus pubis? | Blood-sucking lice that cause intense pruritus with associated excoriations, commonly on scalp and neck or waistband and axilla. |
| Epidemic typhus is caused by: | Rickettsia prowazekii |
| Trench fever is caused by: | Bartonella quintana |
| What is the common treatment for Pediculus humanus/ Phthirus pubis? | Pyrethroids, malathion, or ivermectin lotion, and nit combing. |
| What parasite is associated with Biliary tract disease and cholangiocarcinoma? | Clonorchis sinensis |
| Brain cysts, seizures are associated with: | Taenia solium (neurocysticercosis) |
| Hematuria, squamous cell bladder cancer is seen with: | Schistosoma haematobium |
| What is the the most common associates of Echinococcus granulosus? | Liver (hydatid) cystss |
| Microcytic anemia can be caused by: | Ancylostoma, Necator |
| What type of anemia is seen with Ancylostoma, Necator? | Microcytic anemia |
| What are common associations (symptoms) of Trichinella spiralis? | Myalgias, periorbital edema |
| Swelling around the eye is often associated with which parasite? | Trichinella spiralis |
| What is the organism responsible for Perianal pruritus? | Enterobius |
| Enterobius causes: | Perianal disease |
| Portal hypertension is caused by: | Schistosoma mansoni and Schistosoma japonicum |
| Vitamin B12 deficiency is seen with: | Diphyllobothrium latum |
| What parasite can cause a megaloblastic anemia? | Diphyllobothrium latum |
| Viral recombination: | Exchange of genes between 2 chromosomes by crossing over within regions of significant base sequence homology |
| Which type of viral genomes undergo viral reassortment most readily? | Segmented genomes |
| What is a very common virus to undergo viral reassortment? | Influenza virus |
| Viruses with segmented genomes exchange genetic material. What is the name of this genetic viral process? | Viral reassortment |
| Viral reassortment can cause ____________________ shift. | Antigenic |
| What is viral complementation? | When 1 of 2 viruses that infect the cell has a mutation that results in a nonfunctional protein, the non mutated virus "complements" the mutated one by making a functional protein that serves both viruses |
| In case that one virus gets mutated and produces a nonfunctional protein, but another virus picks the problem and creates a protein for both viruses to work. This process is called_________________. | Complementation |
| What is a common association or example of viral complementation? | Hepatitis D virus requires Hepatitis B for survival |
| When does Phenotypic mixing occurs? | In simultaneous infection of a cell with 2 viruses |
| In phenotypic mixing of 2 viruses, which virus determines the tropism (infectivity)? | VIrus B (one with the surface proteins reacting to Virus A) |
| Which is the only DNA virus with single stranded DNA? | Parvoviridae |
| Which are the circular DNA viruses? | Papilloma-, polyoma-, and hepadna viruses |
| Which is the only RNA virus with a double stranded RNA? | Reoviridae |
| Reoviridae is the only RNA virus with: | Double stranded RNA |
| List of (+) stranded RNA viruses: | 1. Retrovirus 2. Togavirus 3. Flavivirus 4. Coronavirus 5. Hepevirus 6. Calicivirus 7. Picornavirus |
| How many (+) stranded RNA viruses exist (USMLE important)? | 7 |
| What conditions are known to always produce a non infectious virus? | Naked nucleic acids of (-) ssRNA and dsRNA viruses |
| All (+) strand ssRNA and most dsDNA virus have _____________nucleic acids, which makes them __________. | Purified; infectious |
| Naked DNA viruses are: | Papillomavirus, Adenovirus, Parvovirus, adn Polyomavirus |
| Naked RNA viruses are: | Calicivirus, Picornavirus, Reovirus, and Hepevirus |
| The PAPP mnemonic is used to remember: | Non Enveloped DNA viruses |
| CPR and hepevirus (mnemonic) | Used to remember non-enveloped RNA viruses |
| All DNA viruses are ___________________, except for: | ICOSAHEDRAL; Pox (complex) |
| What is the shape of most (except Pox) DNA viruses? | ICOSAHEDRAL |
| Which is the only DNA virus that does NOT replicate in the nucleus? | Poxvirus |
| Where do all DNA viruses, except Pox, replicate? | In the nucleus |
| What are the most common DNA viruses? | Hepadna, Herpes, Adeno, Pox, Parvo, Papilloma, and Polyoma. |
| Poxvirus structure: | Enveloped, dsDNA linear virus |
| Associated conditions with Poxvirus: | 1. Smallpox 2. Cowpox 3. Molluscum contagiosum |
| What virus causes Molluscum contagiosum? | Poxvirus infection |
| Which is the largest DNA virus? | Poxvirus |
| Poxvirus is the _________________ DNA virus. | Largest |
| Flesh-colored papule with central umbilication caused by Pox virus. | Molluscum contagiosum |
| Which is the only DNA hepatitis virus? | Hepatitis B |
| What is the structure of Hepadnavirus? | Enveloped, partially double stranded and circular DNA virus |
| Which DNA viral family has a partially ds DNA? | Hepadnavirus |
| Associated conditions with Adenovirus: | 1. Febrile pharyngitis - sore throat 2. Acute hemorrhagic cystitis 3. Pneumonia 4. Conjunctivitis - "pink eye" 5. Gastroenteritis 6. Myocarditis |
| What is the most common viral family responsible for viral sore throat? | Adenovirus |
| Adenovirus a a ______________________________________ virus. | Naked, linear, dsDNA |
| Common viral cause of "pink eye"? | Adenovirus |
| HPV pertains to which viral family? | Papillomavirus |
| What is the structure of Papillomavirus? | Naked, double-stranded circular DNA |
| What conditions/pathologies are associated with Papillomavirus? | 1. HPV - warts 2. CIN 3. Cervical cancer |
| Which papilloma stereotypes are most commonly associated with HPV warts? | 1, 2, 6, 11 |
| Cervical cancer serotypes of Papillomavirus are: | 16 and 18 |
| Naked, double stranded circular DNA describes which DNA viruses? | Papillomavirus and Polyomavirus |
| What are associated medical conditions of Polyomavirus? | 1. JC virus --> Progresive multifocal leukoencephalopathy (PML) in HIV 2. BK virus --> transplant patients, commonly targets the kindney |
| Which organ is most affected/targeted by BK virus? | Kidney |
| JC virus causes what condition in HIV patients? | Progressive multifocal leukoencephalopathy (PML) |
| What is the unique structure of Parvovirus? | Naked, single stranded, and linear DNA virus |
| Which is the smallest DNA virus? | Parvovirus |
| Parvo = | Small |
| What subtype of Parvovirus is very important? | B19 virus |
| What causes B19 Parvovirus infection? | Aplastic crisis in sickle cell disease, "slapped cheek" rash in children |
| What condition(s) are associated with "slapped cheek" rash in children? | Erythema infectiosum or (fifth disease) |
| What is another name for Erythema infectiosum? | Fifth disease |
| How does Parvovirus cause Hydrops fetalis in pregnant women? | It promotes RBC destruction in fetus |
| What is the possible result of parvovirus infection in healthy adult? | Pure RBC aplasia and rheumatoid arthritis- like symptoms |
| Which population, other than children, is in high risk of an B19 virus infection? | Sickle cell disease patients |
| What is the structure description of Herpesviruses? | Envelope, DS, and linear DNA viruses |
| Herpesviruses are DNA or RNA? | DNA |
| What is the clinical significance of Herpes simplex virus-1? | Gingivostomatitis, keratoconjunctivitis, herpes labialis, herpetic whitlow on finger, temporal lobe encephalitis, esophagitis, and erythema multiforme |
| Erythema multiforme is seen with what type of Herpes virus? | HSV 1 |
| What type of encephalitis is often seen with HSV 1 infection? | Temporal lobe encephalitis |
| Which cranial lobe is most commonly affected by HSV 1? | Temporal lobe |
| Herpes labialis, Temporal lobe encephalitis and erythema multiforme are all due to HSV _____ infection. | 1 |
| Which ganglia is most commonly seen with LATENT HSV 1? | Trigeminal ganglia |
| What is the most common cause of Sporadic Encephalitis? | HSV-1 infection |
| What are common symptoms of HSV-1 induced sporadic encephalitis? | Mental status changes, seizures, and/or aphasia |
| What are the two conditions seen with HSV -2 infections? | 1. Herpes genitalis 2. Neonatal herpes |
| Genital ulcers due to __________ are painful. | HSV-2 |
| Route of transmission of HSV-2? | Sexual contact and Perinatal |
| Zoster virus refers to which herpes type? | HHV-3 |
| What is the MC complication of Varicella-Zoster-shingles? | Post-herpetic neuralgia |
| What are common conditions caused by HHV-3 infection? | Varicella-zoster (chickenpox, shingles), encephalitis, and pneumonia |
| What ganglia are associated with latent HHV-3? | Dorsal root and trigeminal ganglia |
| Associated ganglia of HSV-2? | Sacral ganglia |
| Viral meningitis is more common with HSV-1 or HSV-2? | HSV-2 |
| What CN V branch is responsible for Herpes zoster ophthalmicus? | V1 |
| Infection to CNV1 with Varicella-Zoster virus causes? | Herpes zoster ophthalmicus |
| What is the common name of HHV-4? | Epstein-Barr virus |
| "Kissing disease" is due to infection with: | EBV |
| EBV is the same as ______________ . | HHV-4. |
| What is the Monospot test? | Form of the heterophile antibody test. |
| Rapid test for infectious mononucleosis due to Epstein–Barr virus (EBV) | Monospot test |
| A positive Monospot test indicates? | Mononucleosis due to EBV |
| CMV mononucleosis has a _______________ Monospot test. | Negative |
| What are clinical features of EBV mononucleosis? | Fever, hepatosplenomegaly, pharyngitis, and lymphadenopathy |
| Which lymph nodes are most affected by EBV mononucleosis? | Posterior cervical nodes |
| Posterior cervical node enlargement is most likely due to: | Mononucleosis due to EBV infection |
| Malignancies associated with EBV are: | 1. Lymphoma (Burkitt) 2. Nasopharyngeal carcinoma (Asian adults) 3.. Lymphoproliferative disease in transplant patients |
| What cells are most affected by EBV? | B cells through CD21 |
| What receptor is use by EBV in B cells to better infect? | CD21 |
| What is the result of treating EBV mononucleosis with amoxicillin? | Characteristic maculopapular rash |
| Burkitt lymphoma is commonly seen with _______________ infection. | EBV |
| What is the mode of transmission of CMV? | Congenital transfusión, sexual contact, saliva, urine and transplant |
| Which kind of patients are more susceptible for (-) monospot mononucleosis? | Immunocompetent |
| Which population is at risk of severe complications with CMV infection? | ImmunoCOMPROMISED |
| What are some conditions associated with CMV infection in those immunocompromised? | 1. Pneumonia -- transplant patients 2. Esophagitis 3. AIDS ---> Retinitis |
| Which cells keep latent form of CMV? | Mononuclear cells |
| What is the histologic key feaute of CMV infected cells? | "Owl eye" intranuclear inclusions |
| What is the common name for HHV-5? | Cytomegalovirus |
| How is CMV retinitis presented? | Hemorrhage, cotton-wool exudates, and vision loss |
| Cotton-wool exudates is a key finding for: | CMV-retinitis |
| Which two forms of herpesvirus give rise to Roseola? | HHV-6>> HHV-7 |
| How is Roseola clinically described? | Fever first, Rosy (rash later) |
| Another name for Roseola infantum? | Exanthem subitum |
| High fevers for several days that can cause seizures, followed by diffuse macular rash. | Roseola infantum |
| Key fever for Roseola infantum? | High fever for several days |
| Kaposi Sarcoma is due to what infectious agent? | HHV-8 |
| Neoplasm of endothelial cells due to HHV-8 infection in HIV patient. | Kaposi sarcoma |
| What is the description of Kaposi sarcoma? | Dark/violaceous plaques or nodules representing vascular proliferations |
| What organs are most affected by Kaposi sarcoma? | Skin>>>> GI tract and lungs |
| What HSV identification is used for herpes encephalitis? | CSF PCR |
| What virus is identified with the Tzanck test? | Herpes simplex |
| A smear of an opened skin vesicle detect multinucleated giant cells commonly seen in HSV-1, HSV-2, and VZV infection. | Tzanck test |
| What histological finding is seen in HSV-1, HSV-2, and VZV? | Intranuclear eosinophilic Cowdry A inclusions |
| What receptors are used by CMV? | Integrins (heparan sulfate) |
| Heparan sulfate or integrins are used as receptor by __________. | CMV |
| CD 21 are the receptors used by __________. | EBV |
| Which receptors are used by EBV? | CD21 |
| What are the receptors used by HIV? | CD4, CXCR4, and CCR5 |
| What receptors are used by Parvovirus B19? | P antigen on RBCs |
| Where is the P antigen used by Parvovirus B19 located? | On the RBCs |
| Which virus used Nicotinic AChR (receptor) for infection? | Rabies |
| The ICAM-1 serves as receptor for which virus? | Rhinovirus |
| What is the receptor used by Rhinovirus? | ICAM-1 |
| Which are the exceptions to RNA viruses all replicating in the cytoplasm? | Retrovirus and Influenza virus |
| What are the medically relevant conditions associated with Reovirus infection? | 1. Coltivirus - Colorado tick fever 2. Rotavirus - cause of fatal diarrhea in children |
| What virus is responsible for the Colorado tick fever? | Coltivirus |
| The Rotavirus is part o the _______________ viral family. | Reoviridae |
| What is the structure of Reovirus? | Naked, ds-stranded, linear RNA virus |
| What is the capsid shape of reoviruses? | Icosahedral (double) |
| How many segments does Reoviruses usually have? | 10-12 |
| NOn-enveloped, (+) single-stranded, linear RNA viral families? | Picornavirus, Hepevirus, Caliciviruses |
| What mnemonic is used to recall the associated pathologies due to Picornaviruses? | PERCH |
| PERCH stands for: | P- Poliovirus -polio Salk/Sabin vaccines - IPV/OPV E- Echovirus - aseptic meningitis R- Rhinovirus - "common cold" C- Coxsackievirus - aseptic meningitis; herpangina; hand, foot, and mouth disease, myocarditis; pericarditis H- HAV - acute viral hepatitis |
| Which two Picornaviruses are causative of aseptic meningitis? | Echovirus and Coxsackie virus |
| What is herpangina? | Mouth blisters and fever |
| What virus causes Hand, foot, and Mouth disease? | Coxsackievirus |
| The Rhinovirus is the most common cause of the _______________. | Common cold |
| What is the organism that causes the common cold? | Rhinovirus |
| HEV is part of the _____________ viral family. | Hepeviridae |
| What is the most common Calicivirus? | Norovirus |
| What is the result a Norovirus infection? | Viral gastroenteritis |
| Enveloped, SS (+) linear, Icosahedral capsid. Seen with which RNA viruses? | Flaviviruses and Togavirus |
| What is the difference between the structure of Togaviruses and Flaviviruses, to that of Coronavirus? | Coronavirus family have a helical caspied while Togaviruses and Flaviviruses have a Icosahedral capsid symmetry |
| What are the Medical relevant Flaviviruses pathologies? | 1. HCV 2. Yellow fever 3. Dengue 4. St. Louis encephalitis 5. West Nile virus - meningoencephalitis 6. Zika virus |
| HCV is a _______________________. | Flavivirus |
| What is the molecular shape of HCV and Yellow fever? | Enveloped SS(+), linear icosahedral |
| Rubella is caused by _______________ viral family | Togavirus |
| What are the 3 main associated conditions of Togaviruses? | Rubella, Western and Eastern equine encephalitis, and Chikungunya virus |
| Chikungunya virus is part of the _________ viral family. | Togaviridae |
| What is very special about retroviruses? | Have reverse transcriptase |
| What are two common Retroviruses? | HTLV ---> T-cell leukemia HIV ----> AIDS |
| Coronavirus is : | Enveloped, single stranded (+) sense, linear and with a helical capsid |
| What are common Coronavirus conditions? | "Common cold", SARS, MERS, and COVID-19. |
| SARS and MERS are both _______________. | Coronaviruses |
| How many segments are in Orthomyxoviruses? | 8 segments |
| What is the most common Orthomyxovirus? | Influenza virus |
| The influenza virus is an ____________________, that replicates in the ____________. | Orthomyxovirus; nucleus |
| What are the 4 main Paramyxoviruses? | Parainfluenza, RSV, and Measles, Mumps |
| Parainfluenza virus is an ___________________ that causes _________. | Paramyxovirus; Croup |
| MCC of bronchiolitis in babies? | RSV |
| RSV is an _________________. | Paramyxovirus |
| Measles and Mumps, both are _______________. | Paramyxoviruses |
| What the genomic structure of Rhabdoviruses? | Enveloped, SS (-) linear, helical RNA virus |
| What is the condition caused by Rhabdoviruses? | Rabies |
| Common types of Filovirus? | Ebola/Marburg hemorrhagic fever |
| Ebola is a type of __________. | Filovirus |
| How many segments are in Arenavirus? | 2 |
| 2 Conditions due to Adenovirus? | 1. LCMV- Lymphocytic choriomeningitis virus 2. Lassa fever encephalitis |
| What animals spread the Lassa fever encephalitis virus? | Rodents |
| Viral genome of Bunyaviruses is seen in _______ segments | 3 |
| What are 4 conditions/viruses of the Bunyaviridae family? | 1. California encephalitis 2. Sandfly/Rift Valley fevers 3. Crimean-Congo hemorrhagic fever 4. Hantavirus - hemorrhagic fever, pneumonia |
| HDV is a ____ virus | Delta |
| Which is known as a "defective" virus | HDV |
| Negative stranded viruses must ---> | Transcribe (-) strand to (+) |
| What is "brought by negative stranded virions" in order to transcribe into (+ ) strand? | RNA-dependent RNA polymerase |
| Which are the negative stranded viruses? | Arenavirus, Bunyaviruses, Paramyxoviruses, Orthomyxoviruses, Filoviruses, and Rhabdoviruses |
| BOAR stands for: | Bunyavirus, Orthomyxoviruses, Arenaviruses, and Reoviruses |
| Which mnemonic is used to remember the Segmented viruses? | BOAR |
| What are the common symptoms of the Yellow fever virus? | High fever, black vomit, and jaundice |
| What the key histological findings of liver bx in a patient with Yellow fever virus? | Councilman bodes |
| What are the Councilman bodies? | Eosinophilic apoptotic globules |
| What condition is seen with the appearance of Councilman bodies on liver biopsy? | Yellow Fever |
| What are the two most common reservoirs of Yellow fever virus? | Monkeys and humans |
| Flavi = | Yellow, jaundice |
| Yellow fever virus is an ________________________. | Flavivirus |
| What is the most important cause of infantile gastroenteritis? | Rotavirus |
| A rotavirus is recommended for all infants except for those with: | Hx of Intussusception or SCID |
| What virus is the MCC of acute diarrhea in winter in places such as day care centers and kindergartens? | Rotavirus |
| What is the result of the villous destruction with atrophy caused by Rotavirus? | Decreased absorption of Na+ and loss of K+ |
| Rotavirus is a ___________________________________. | Segmented dsRNA virus (a reovirus) |
| Influenza viruses are: | Orthomyxovirus. Enveloped, (-) ssRNA viruses with 8-segment genome. |
| What are two important antigens in the Influenza viruses? | 1. Hemagglutinin 2. Neuraminidase |
| What is the role of Hemagglutinin in the influenza virus? | Binds sialic acid and promotes viral entry |
| What influenza antigen promotes viral entry? | Hemagglutinin |
| What is the function of the Neuraminidase antigen in Influenza viruses? | Promotes progeny virion release |
| Which influenza virus antigen promotes the release of progeny virion? | Neuraminidase |
| A coinfection with some bacteria and the Influenza virus leads to a: | Fatal bacterial superinfection |
| Which are the most common bacteria that produce a fatal bacterial superinfection as they are co-infectious with influenza virus? | S. aureus, S. pneumoniae, and H. influenzae |
| What does the"flu shot" contain? | Viral strains most likely to appear during the flu season, due to virus' rapid genetic change |
| The "flu shot" is a vaccine for what organism? | Influenza virus |
| What route is used for the Live attenuated Influenza vaccine? | Intranasal |
| What is special about the Live attenuated influenza vaccine? | Contains a temperature-sensitive mutant that replicates in the nose bu not in the lung. |
| What type of antigenic change are responsible for PANDEMICS? | Genetic/antigenic shift |
| What is a antigenic shift? | Reassortment of viral genome segments |
| What is an antigenic drift? | Minor changes based on random mutation in hemagglutinin or neuraminidase genes |
| The combination of human flu A virus reassortant with swine flu A virus. | Antigenic shift |
| An antigenic shift or antigenic drift is more severe? | Antigenic shift |
| What was the old name of Rubella? | German (3-day) measles |
| What are the clinical symptoms of Rubella? | Fever, postauricular and other lymphadenopathy, arthralgias, and fine, maculopapular rash that starts on face and spreads centrifugally to involve trunk and extremities |
| How is the rash seen in Rubella spread? | Starts on face; Spreads centrifugally to involve trunk and extremities |
| German (3-day) measles is also known as: | Rubella |
| What are some important features of Congenital Rubella? | "blueberry muffin" appearance due to dermal extramedullary hematopoiesis. |
| What is the expression of dermal extramedullary hematopoiesis in Rubella? | "blueberry muffin" appearance |
| What population is most affected by Paramyxoviruses? | Children |
| What diseases are caused by Paramyxoviruses? | Parainfluenza (croup), mumps, measles, RSV, and human metapneumovirus, which causes bronchiolitis or pneumonia in infantas |
| What is the function of surface F (fusion) protein in Paramyxoviruses? | Respiratory epithelial cells to fuse and form multinucleated cells |
| What is the best treatment for RSV infection in infants? | Palivizumab |
| Palivizumab is n: | Monoclonal antibody against F protein |
| What condition is treated with Palivizumab? | Infant-bronchiolitis caused by RSV |
| What is the typical description of cough seen in Croup? | "seal-like" barking cough and inspiratory stridor |
| What are classign findings on x-ray of Croup? | Narrowing of upper trachea and subepiglottic leads to characteristic steeple sign |
| X-ray finding --> "Steeple sign". Dx? | Croup |
| What is a possible complication of severe croup? | Pulsus paradoxus secondary to upper airway obstruction |
| What are the 3 C's of measles? | Cough Coryza Conjunctivitis |
| What vitamin supplementation has proven to reduce morbidity and mortality of Meals (rubeola)? | Vitamin A |
| What is another name used for Measles? | Rubeola |
| What are the bright red spots with blue-white center on buccal mucosa seen in Measles? | Koplik spots |
| What is happens 1-2 days later appearance of Koplik spots in a Measles patient? | Maculopapular rash that starts at the head/neck and spreads downward |
| How does the measles (rubeola) rash spreads? | Downward |
| What are histological findings in the lymphadenitis caused by Measles? | Warthin-Finkeldey giant cells in background of paracortical hyperplasia. |
| What are three possible sequelae of Measles virus infection? | 1. SSPE (Subacute Sclerosing Panencephalitis) 2. Encephalitis 3. Giant cell pneumonia |
| What viral family causes Mumps? | Paramyxovirus |
| What vaccine is used to prevent mumps? | MMR vaccine |
| What are the most significant signs and symptoms of mumps? | Parotitis, Orchitis, aseptic Meningitis, and Pancreatitis |
| If mumps happen after ____________________-, it is much highly probable to cause infertility. | Puberty |
| What is severe complication of mumps after puberty? | Infertility |
| What is orchitis? | Inflammation of testes |
| Bulle-shaped virus. | Rabies virus |
| Which virus has Negri bodies (cytoplasmic inclusions)? | Rabies virus |
| Where are Negri bodies found in the patient infected with Rabies? | Purkinje cells of cerebellum and in hippocampal neurons |
| What is post exposure prophylaxis to Rabies virus? | Wound cleaning plus immunization with killed vaccine and rabies immunoglobulin. |
| What is the incubation period of Rabies virus? | Weeks to months |
| Rabies virus travels to the CNS in a ______________________ fashion. | Retrograde |
| What receptors do Rabies virus bind to in order to retrogradely travel to the CNS? | ACh receptors |
| What is the progression of Rabies? | Fever, malaise --> agitation, photophobia, hydrophobia, hypersalivation --> paralysis, comma --> death. |
| Patient with too much saliva, bothered by lights and refuse to drink water. Dx? | Rabies |
| What are the most common animal bites that transmit rabies? | Bat, raccon, and skunk |
| Person in a bat cave is possible to contract what via aerosol transmission? | Rabies virus |
| What is the target of the Ebola virus? | Endothelial cells, phagocytes, hepatocytes. |
| What are some severe complications of Ebola virus infection? | DIC, diffuse hemorrhage, shock |
| Ebola's mode of transmission. | Requires direct contact with bodily fluids, fomites, infected bats or primates. |
| What is the incubation period (time) of Ebola? | 21 days |
| What laboratory technique is used to diagnose Ebola? | RT-PCR within 48 hours of symptoms onset |
| What is the mosquito that transmits ZIka virus? | Aedes mosquito bites |
| Common flavivirus | Zika virus |
| What are fetal complications of Zika virus infection? | Congenital microcephaly or miscarriage |
| What areas are most commonly affected by Zika virus? | Tropical and subtropical climates |
| Besides Aedes mosquito bites, how else is Zika virus transmitted? | Sexual and vertical transmission |
| What are common symptoms of Zika virus infection? | Conjunctivitis, low grade pyrexia, and possible itchy rash |
| What are the signs and symptoms of all hepatitis viruses? | 1. Episodes of fever 2. Jaundice 3. Elevated ALT and AST |
| Which two hepatitis viruses are NOT destroyed by the gut? | HAV and HEV |
| Why are HAV and HEV not destroyed by the gut? | They lack envelope |
| What is a unique activity or feature of HBV? | HBV DNA polymerase has DNA- and RNA-dependent activities |
| Why is there variation in antigenic structures of HCV envelope proteins? | HCV lacks 3'-5' exonuclease activity --> no proofreading ability |
| HAV belongs to which viral family? | RNA picornavirus |
| WHat is the viral family of HBV? | DNA hepadnavirus |
| Which is the only DNA hepatitis virus? | HBV |
| Which hepatitis virus is of RNA flavivirus family? | HCV |
| HDV is part of the _______________________ viral family. | RNA deltavirus |
| RNA hepevirus gives rise to which hepatitis virus? | HEV |
| Which two hepatitis viruses have long incubation periods? | HBV and HCV |
| Which hepatitis infection ins seem clinically mostly asymptomatic and acute? | HAV |
| Clinical presentation of HBV infection. | Initially like serum sickness (fever, arthralgias, rash); then may progress to carcinoma |
| HCV is clinically presented with: | Possible progression to cirrhosis or carcinoma |
| Which Hepatitis virus a similar clinical view as HBV? | HDV |
| Fulminant hepatitis in expectant (pregnant) women? | HEV |
| Which hepatitis infection has a high mortality in pregnant women? | HEV |
| What is the most common prognosis of an HAV infection? | Good prognosis |
| Hepatitis infection associated with Superinfection? | HDV infection after HBV |
| Coinfection of HDV and HBV produces a ____________ incubation period. | Long |
| Which hepatitis viruses carry HCC development risk? | HBV, HCV, and HDV |
| HAV and HEV have short incubation periods and both do not ---> | Progress to HCC |
| What are the findings in HAV liver biopsy? | Hepatocyte swelling, monocyte infiltration, and Councilman bodies |
| What histologic finings is characterisctic of HAV infection ? | Councilman boides |
| What is the description to liver biopsy in a HBV (+) patient? | Granular eosinophilic "ground glass" appearance; cytotoxic T cell mediated damage |
| Lymphoid aggregates with focal areas of macrovesicular steatosis | HCV liver biopsy |
| Which hepatitis liver bx finding is described as "ground glass" appearance? | HBV infection |
| Macrovesicular steatosis is found in _______ liver biopsy | HCV |
| Description of HEV liver biopsy. | Patchy necrosis |
| Which two hepatitis have carrier states? | HBV and HCV |
| What is the hematologic extrahepatic manifestation of Hepatitis B infection? | Aplastic anemia |
| What are the most common hematological manifestations of HCV infection? | 1. Essential mixed cryoglobulinemia 2. Increased risk B-cell NHL 3. Autoimmune hemolytic anemia |
| Which are the renal extrahepatic manifestations of HBV and HCV infections? | 1. Membranous GN 2. Membranoproliferative GN |
| HBV infection has more cases of __________________________ as an renal extrahepatic manifestation. | Membranous GN |
| What is the most common vascular extrahepatic manifestation of Hepatitis B infection? | Polyarteritis nodosa |
| Leukocytoclastic vasculitis is often associated with HBC as: | Vascular extrahepatic manifestation |
| Which infection, HBV or HCV, has more extrahepatic manifestations? | HCV |
| How are some forms of cutaneous manifestation of HCV infection? | Sporadic porphyria cutanea tarda, and lichen planus |
| What are endocrine manifestations of HCV infection? | Increased risk of diabetes mellitus and autoimmune hypothyroidism. |
| Serologic marker for acute hepatitis A | Anti-HAV (IgM) |
| IgG antibody indicates prior HAV infection and/or prior vaccination. | Anti-HAV (IgG) |
| Which hepatitis A serologic marker indicates protection against reinfection? | Anti-HAV (IgG) |
| Which HBV antigen indicates Hepatitis B infection? | HBsAg |
| Where is HBsAg found? | On surface of HBV |
| What does Anti-HBs indicate? | Immunity to hepatitis B due to vaccination or recovery from infection |
| Which hepatitis serologic marker is associated with core of HBV? | HBcAg |
| What is Anti-HBc? | Antibody to HBcAg |
| IgM Anti-HBc indicates: | Acute/recent infection |
| IgG Anti-HBc indicates: | Prior exposure or chronic infection |
| What is the sole marker during the window period of HBV infection? | IgM anti-HBc |
| Which Hepatitis B serum marker indicates active viral replication and high transmissibility? | HBeAg |
| Anti-HBe indicates? | Low transmissibility |
| What hepatitis B serum marker is secreted by infected hepatocyte into circulation? | HBeAg |
| Active HBV replication is indicated by which serologic marker? | HBeAg |
| Which serum marker is (+) in an immunized Hepatitis B virus? | Anti-HBs |
| Acute infection with HBV is positive for the following serum markers: | HBsAg + HBeAg + IgM anti-HBc |
| HBsAg + HBeAg + IgG anti-HBc | Chronic HBV (high infectivity) |
| A patient in HBV infection recovery is seen with (+) serum markers: | Anti-HBs + Anti-HBe + IgG anti-HBc |
| What patient HBV infection status has (+) for all antibodies? | Recovery |
| Which serum marker distinguishes a patient with low and high HBV infectivity? | Low infectivity is (+) Anti-HBe, and high is (+) for HBeAg |
| Which are the 2 HIV envelope proteins? | gp41 and gp120 |
| In HIV, which protein is the "Docking glycoprotein"? | gp120 |
| How are gp41 and gp120 (HIV envelope proteins) acquired? | Budding from host cell plasma membrane |
| How is the HIV genome? | Diploid genome (2 molecules of RNA) |
| What doe it mean the HIV has a diploid genome? | 2 molecules of RNA |
| What are the 3 structural genes of HIV? | 1. env (gp120 and gp41) 2. gag (p24 and p17) 3. pol |
| The gag gene in HIV is: | Composed of p24 and p17, which code for capsid and matrix proteins respectively. |
| gag p24 component codes for: | Capsid of HiV |
| What are the components (enzymes) of the HIV structural gene "pol"? | Reverse transcriptase, aspartate protease, and integrase |
| What is the primary receptor for HIV? | CD4 |
| What are co receptors used by the HIV? | 1. CCR5 on macrophages (early infection) 2. CXCR4 on T cells (late infection) |
| The binding of HIV to CCR5 indicates: | 1. Early infection 2 Binding to macrophages |
| HIV binds to CXCR4 on which cells? | T cells |
| HIV binding to CXCR4 on T cells indicaties: | Late infection |
| What does a homozygous CCR5 mutation produce? | Immunity to HIV |
| What mutation is needed to create a slower course for HIV infection? | Heterozygous CCR5 mutation |
| What lab technique is used to diagnose Presumptive HIV? | HIV-1/2 Ag/Ab immunoassays |
| What is detected with HIV-1/2 Ag/Ab immunoassay? | Viral p24 Ag capsid protein and IgG Abs to HIV-1/2 |
| What is the confirmatory test for HIV? | HIV-1/2 Ab-differentiation immunoassays |
| Four stages of untreated HIV infection: | 1. Flu-like (acute) 2. Feeling fine (latent) 3. Falling count 4. Final crisis |
| What happens during latency phase of HIV? | Virus replicates in lymph nodes |
| When does a an AIDS-defining illnesses emerge? | < 200 CD4+ cells/mm3 |
| What is the presentation of candida albicans infection when the CD4+ count is < 500? | Oral thrush; a scrapable white plaque, pseudohyphae on microscopy . |
| Describe Oral hairy leukoplakia | Un-scrapable white plaque on lateral tongue |
| Which oral plaque is unscrapable? | Oral hairy leukoplakia |
| Which opportunistic organisms cause Oral hairy leukoplakia in HIV patients with CD4+ count < 500? | EBV |
| List of organisms that cause opportunistic infections in HIV patients with CD4+ count < 500? | Candida albicans, EBV, HHV-8, and HPV |
| Kaposi sarcoma? | Caused by HHV-8 in AIDS patients with CD4+< 500 |
| What is the presentation of HPV infection when CD4+ count is < 500 cells? | Squamous cell carcinoma, commonly in anus ( men who have sex with men) or cervix (women) |
| HPV affects homosexual men in the ______________. | Anus |
| Which anatomical part is affected in females with HPV infection and CD4+ cell count less than 500? | Cervix |
| What are common organisms that produce disease in HIV patients with a CD4+ count < 200? | Histoplasma capsulatum, HIV, JC virus, and Pneumocystis jirovecii |
| Presentation of Histoplasma capsulatum infection in HIV patient? | Fever, weight loss, fatigue, cough, dyspnea, nausea, vomiting ,and diarrhea |
| AIDS patient with CD4+ of 198, shows clear signs of dementia. MC affecting organism? | HIV |
| What organism (virus) presents with this finding "Non Enhancing areas of demyelination on MRI" | JC virus (reactivation) |
| "Ground-glass" opacities on CXR | Pneumocystis jirovecii |
| What are the findings of Aspergillus fumigatus infection in AIDS patient with CD4 + cell count of < 100? | Cavitation or infiltrates on chest imaging |
| What organism causes Bacillary angiomatosis in AIDS patient? | Bartonella henselae |
| What is the clinical presentation and findings of C. albicans infection in an AIDS patient with CD4+ count <100? | Esophagitis; White plaques on endoscopy; yeast and pseudohyphae on biopsy |
| CMV causes an opportunistic infection with the CD4+ count is less than: | 100 |
| What are the clinical presentation of CMV infection in a patient with AIDS? | Retinints, esophagitis, colitis, pneumonitis, and encephalitis |
| Linear ulcers on endoscopy + cotton-wool spots on fundoscopy? | Retinitis and esophagitis caused by CMV in AIDS patient |
| EBV clinical presentation in patient with CD4+ cell count of 99? | B-cell lymphoma (non-Hodgkin lymphoma, CNS lymphoma) |
| CNS lymphoma caused by EBV is found on MRI as: | Solitaire ring enhancing lesion |
| Multiple ring-enhancing lesions on MRI. | Toxoplasma gondii infection AIDS patient |
| What organism causes the development of brain abscesses in AIDS patient with a CD 4+ < 100? | Toxoplasma gondii |
| What are three common Prion diseases? | 1. Creutzfeldt-Jakob disease 2. Bovine spongiform encephalopathy 3. Kuru |
| Rapidly progressive dementia, typically sporadic, caused by prions. Dx? | Creutzfeldt-Jakob disease |
| What is another name for Bovine spongiform encephalopathy? | Mad Cow disease |
| Which population is commonly seen to develop Kuru? | Human cannibals |
| What condition is an acquired prion disease noted in tribal population practicing human cannibalism? | Kuru |
| What is the main reason for Prion disease development? | Conversion of a normal (predominantly a-helical) protein termed prion protein (PrpP c) to a B-pleated form. |
| What are the shared clinical manifestation of all prion disease? | Spongiform encephalopathy and dementia, ataxia, and death |
| Which form of prion protein is resistant to protease degradation? | B-pleated form (PrP sc) protein |
| What is the most common normal flora in the skin? | S. epidermidis |
| What microorganism are the MC flora in the nose? | S. epidermidis; colonized by S. aureus |
| What gram positive bacteria is known to readily colonize the nose? | S. aureus |
| What is the dominant flora found in the Oropharynx? | Viridans group streptococci |
| Viridans group streptococci are dominant flora in the __________________. | Oropharynx |
| Which microorganism is found normally in dental plaque? | S. mutans |
| What are the two dominant microorganisms that colonize the colon? | B. fragilis > E. coli |
| Normal dominant flora of the vagina? | Lactobacillus |
| What microoganism are nkonw to colonize the vagina floara? | E. coli and group B strep |
| What delivery method gives neonates no flora? | C-section |
| Which microorganisms are known to cause food poisoning that starts quickly and ends quickly? | S. aureus and B. cereus |
| Source of infection of B. cereus? | Reheated rice |
| What kind of microorganism is associated with reheated rice? | B. cereus |
| Which are some source os C. botulinum infection? | Improperly canned food (toxins), raw honey (spores) |
| Which food type commonly provides spore form of C. botulinum? | Raw honey |
| What form of C. botulinum is found in improperly canned foods? | C. botulinum toxins |
| Reheated meat? | C. perfirengs |
| What organism is found to be causing disease in undercooked meat? | E. coli O157: H7 |
| Which food type is classically known wth cause an E. coli O157:H7 infection? | Undercooked meat |
| L. monocytogenes causes foodborne illness by the consumption of : | Deli meats and soft cheeses |
| What are common sources of food-illness caused by Salmonella? | Poultry, meat, and eggs |
| Meats, mayonnaise, custard; preformed toxin. MC microorganism? | S. aureus causing food-borne illness |
| Contaminated seafood causes an foodborne illness by the infection with: | V. parahaemolyticus and V. vulnificus |
| V. vulnificus can cause: | 1. Foodborne illness by ingestion 2. Wound infections by contact with contaminated water or shellfish. |
| List of bugs that cause BLOODY diarrhea | 1. Campylobacter jejuni 2. E. histolytica 3. Enterohemorrhagic E. coli 4. Enteroinvasive E. coli 5. Salmonella (non-typhoidal) 6. Shigella 7. Y. enterocolitica |
| Which comma-or S-shaped organism that grows at 42 C causes bloody diarrhea? | C. jejuni |
| What are some features of E. histolytica? | Protozoan; amebic dysentery; liver abscess |
| Which is a protozoan cause of bloody diarrhea? | E. histolytica |
| Amebic dysentery is caused by: | E. histolytica |
| O157:H7; can cause HUS; makes Shiga-like toxin | Enterohemorrhagic E. coli |
| Which type of E. coli invades the colonic mucosa? | Enteroinvasive E. coli |
| Why type of Salmonella causes bloody diarrhea? | Non-typhoidal |
| Features of nontyphoidal Salmonella: | Lactose (-); flagellar motility; has animal reservoir, especially poultry and eggs |
| What bloody causing microorganism produces the Shiga toxin? | Shigella |
| What type of dysentery is seen with Shigella? | Bacillary |
| Bacillary dysentery. MC infective microorganism? | Shigella |
| Common cause of Daycare bloody diarrhea outbreaks? | Y. enterocolitica |
| What infection is responsible for bloody diarrhea and pseudoappendicitis? | Y. enterocolitica |
| List of bugs that are known to cause Watery diarrhea | 1. C. difficile 2. C. perfringens 3. Enterotoxigenic E. coli 4. Giardia and Cryptosporidium (protozoans) 5. V. cholerae 6. Viruses (rotavirus, norovirus, enteric adenovirus) |
| C. difficile causes diarrhea? | Watery mostly but sometimes bloody |
| Pseudomembranous colitis is due to infection with: | C. difficile |
| What organism causes watery diarrhea and gas gangrene? | C. perfringens |
| What E. coli type causes Travelers' diarrhea? | Enterotoxigenic E. coli |
| What are the types of protozoa that cause watery diarrhea? | Giardia and Cryptosporidium |
| Rice water diarrhea is due to ___________________ infection. | V. cholerae |
| What are the common viruses that provoke watery diarrhea? | Rotavirus, Norovirus, and enteric adenovirus |
| Viruses are more prone to cause ________________ diarrhea. | Watery |
| What are the two main causes of pneumonia in neonates (<4wk)? | 1. Group B streptococci 2. E. coli |
| MCC of Pneumonia in children of 4 weeks old to 18 years? | 1. Viruses (RSV) 2. Mycoplasma 3. C. trachomatis (infants - 3 year old) 4. C. pneumoniae (school aged children) 5. S. pneumoniae |
| What is the MCC of pneumonia in an adult of 18-40 yr? | Mycoplasma |
| What is the MCC of pneumonia in adults over 40 and elderly? | S. pneumoniae |
| Which virus is most common shared causes of pneumonia in all adults over 18 years of age? | Influenza virus |
| What is the second MCC of pneumonia in an 50 year old adult? | H. influenzae |
| What are the most common causes of pneumonia in alcoholics? | 1. Klebsiella 2. Anaerobes due to aspiration |
| IV drug user MCC of pneumonia are: | S. pneumoniae and S. aureus |
| Anaerobes are the MCC of pneumonia due to ______________. | Aspiration |
| What are the MCC of atypical pneumonia? | Mycoplasma, Chlamydophila, Legionella, viruses (RSV, CMV, influenza, adenovirus) |
| A patient with Cystic fibrosis most commonly will develop pneumonia due to the following infections: | Pseudomonas, S. aureus, S. pneumonie, and Burkholderia cepacia |
| Pseudomonas infection often causes pneumonia in _____________ patients. | Cystic fibrosis |
| What are the MCC of nosocomial acquired pneumonia? | S. aureus, Pseudomonas, and other enteric gram (-) rods |
| What are the MCC of pneumonia to the immunocompromised? | S. aureus, enteric gram (-) rods, fungi, viruses, P. jirovecii |
| An HIV patient MCC of pneumonia is due to _______________ infection. | P. jirovecii |
| What are post viral causes of pneumonia? | S. pneumoniae, S. aureus, and H. influenzae |
| Top 3 causes of Meningitis in the Newborn | 1. Group B streptococci 2. E. coli 3. Listeria |
| Top causes of meningitis in children between 6 months and 6 years old | S. pneumoniae N. meningitis H. influenzae type b Enteroviruses |
| What is the #1 causes of meningitis in teens? | Neisseria meningitidis |
| What is the most common cause of meningitis for any person over the age of 6 years old, except for teens? | S. pneumoniae |
| What is the second MCC of meningitis in the elderly? | Gram (-) rods |
| What is the empiric treatment of bacterial meningitis? | Ceftriaxone and vancomycin |
| What medication is added to the empiric treatment of bacterial meningitis if Listeria is suspected to be the cause of the infection? | Ampicillin |
| What are the most common causes of viral meningitis? | Enteroviruses, HSV-2, HIV, West Nile virus, and VZV |
| Which is the most common enterovirus that causes viral meningitis? | Coxsackievirus |
| MCC of meningitis in HIV patient | Cryptococcus spp |
| As of today, most cases of H. influenzae type b meningitis, are due to: | Unimmunized children |
| What cell type is predominant in Bacterial meningitis? | PMNs |
| Decreased levels of glucose are seen in which type(s) of meningitis causes? | Bacterial and fungal/TB |
| Increased lymphocytes in CSF are found in ____________ and ____________ causes of meningitis. | Viral and Fungal/TB |
| Which are the two distinguish CSF findings for Bacterial meningitis? | 1. Predominant PMNs in CSF 2. Decreased glucose levels in CSF |
| CSF findings of Fungal/TB meningitis are distinctive due to: | Increased levels of lymphocytes and decreased glucose level |
| Elevated protein levels are seen in which type of meningitis? | All have increased protein levels |
| What are the MCC of infections cause brain abscesses? | Viridans streptococci and Staphylococcus aureus |
| What is the most common reason for multiple brain abscesses due to infections? | Due to bacteremia |
| Toxoplasma gondii reactivation in HIV patients causes? | Multiple brain abscesses |
| What lobe is often affected by multiple brain abscess in cases of Otitis media and mastoiditis? | Temporal lobe and cerebellum |
| What conditions lead to appearance of multiple brains abscesses in the frontal lobe? | Sinusitis or dental infection |
| In healthy individual, what is the MCC of Osteomyelitis? | S. aureus |
| MCC of osteomyelitis in sexually active individual? | Neisseria gonorrhoeae |
| What is the MCC of Osteomyelitis in a patient with Sickle cell disease? | Salmonella and S. aurus |
| What infections are prone to cause osteomyelitis in a patient with a prosthetic joint replacement? | S. aureus and S. epidermidis |
| What microorganisms are involved in infections of osteomyelitis when there in vertebral involvement? | S. aureus, M. tuberculosis |
| What is Pott disease? | Osteomyelitis with M. TB reactivation and vertebral involvement |
| What risk factor is commonly seen in Pasteurella multocida-osteomyelitis? | Cat and dog bites |
| What are the most common causes of Osteomyelitis in IV drug users? | S. aureus; also Pseudomonas and Candida |
| What is the best diagnostic tool for diagnosing Osteomyelitis? | MRI |
| What two inflammatory proteins are elevated in osteomyelitis but are not specific enough for diagnosis? | Elevated C-reactive protein (CRP) and ESR |
| What are the main presenting signs of cystitis? | Dysuria, frequency, urgency, suprapubic pain, and WBCs (not WBC casts) in urine. |
| What is the main reason for development of cystitis? | Ascension of microbes from urethra to bladder |
| The ascension of microbe from bladder to kidney results in development of: | Pyelonephritis |
| What are the presenting signs of Pyelonephritis? | Fever, chills, flank pain, costovertebral angle tenderness, hematuria, and WBC casts. |
| Which urinary disorder presents with WBC casts, cystitis or pyelonephritis? | Pyelonephritis |
| Key: Costovertebral angle tenderness and WBC casts. Dx? | Pyelonephritis |
| Which gender is more common to develop an URI? | Women |
| What is the main reason women are more prone to develop an URI? | Shorter urethras colonized by fecal flora |
| What are the diagnostic markers of URIs? | 1. (+) Leukocyte esterase 2. (+) Nitrite test 3. (+) Ureae test |
| A positive leukocyte esterase test indicates: | Evidence of WBC activity in the urine sample |
| (+) Nitrite test indicates ---> | Reduction of urinary nitrates by bacterial species (E. coli) |
| Which bacterial infections produce an (+) Urease test in urine sample? | S. saprophyticus, Proteus, and Klebsiella |
| What is the leading cause of UTIs? | E. coli infection |
| What is the second leading cause of UTI in sexually active women? | S. saprophyticus infection |
| What is the third MCC of UTI? | Klebsiella infection |
| What organism produces a red pigment, and is often seen in nosocomial and drug resistant UTIs? | Serratia marcescens |
| What are the features of UTI due to Proteus mirabilis infection? | Motility causes "swarming" on agar; associated with struvite stones |
| Blue-green pigment and fruity odor; usually nosocomial and drug resistant? | Pseudomonas aeruginosa |
| What are the signs and symptoms of Bacterial vaginosis? | - No inflammation - Thin, white discharge with fishy odor |
| What some key lab findings of bacterial vaginosis? | Clue cells pH > 4.5 |
| What is the treatment of Gardenella vaginosis? | Metronidazole or clindamycin |
| What are the most significant signs and symptoms of Trichomonas vaginitis? | 1. Inflammation ("strawberry cervix") 2. Frothy, yellow-green, foul-smelling discharge |
| What are some lab findings in Trichomonas vaginitis? | Motile trichomonads and pH > 4.5 |
| What is the treatment for patient and patient's partner of Trichomonas vaginitis? | Metronidazole |
| Candida vulvovaginitis is clinically presented with: | 1. Inflammation 2. Thick, white, "cottage cheese" discharge |
| What are lab findings in Candida vulvovaginitis? | - Pseudohyphae - pH normal (4.0-4.5) |
| What is the best treatment option for Candida vulvovaginitis? | Azoles |
| Thin, white discharge with fishy odor | Bacterial (gardenella) vaginosis |
| Frothy, yellow-green, foul-smelling discharge | Trichomonas vaginitis |
| Thick, white, "cottage cheese" discharge | Candida vulvovaginitis |
| Which common vaginal infection is seen with pH> 4.5? | Bacterial vaginosis and Trichomonas vaginitis |
| How is the pH in Candida vulvovaginitis? | Normal (4.0-4.5) |
| Clue cells are seen in : | Bacterial vaginosis |
| Metronidazole is the best option to treat which common vaginal infections? | Bacterial vaginosis and Trichomonas vaginitis |
| "Strawberry cervix" | Trichomonas vaginitis |
| Which vaginal infection is seen histologically, with Pseudohyphae? | Candida vulvovaginitis |
| Azoles are the main option to treat which vaginal infection? | Candida vulvovaginitis |
| Microbes that may pass from mother to fetus, produce ___________ infections. | Torches |
| What is the most common type of transmission of TORCHES infections? | Transplacental, except for HSV-2 which is via delivery |
| What are the nonspecific signs and symptoms of TORCHES infections? | Hepatosplenomegaly, jaundice, thrombocytopenia, and growth retardation |
| What are some common organisms that cause meningitis in neonates? | Strepto agalactiae, E. coli, and Listeria monocytogenes |
| Parvovirus B19 infection in fetus causes: | Hydrops fetalis |
| Neonatal manifestations of Toxoplasma gondii infection: | Classic triad: 1. Chorioretinitis 2. Hydrocephalus 3. Intracranial calcifications +/- "blueberry muffin" rash |
| Modes of maternal transmission of Toxoplasma gondii | Cat feces or ingestion of undercooked meat |
| What are the maternal manifestations of Toxoplasma gondii infection? | Usually asymptomatic; lymphadenopathy (rarely) |
| How is the maternal transmission of Rubella? | Respiratory droplets |
| What are the maternal manifestations of Rubella? | Rash, lymphadenopathy, polyarthritis, and polyarthralgia |
| What are the neonatal manifestations of Rubella infection? | Classic triad of: Abnormalities of eye (cataract) and ear (deafness and congenital heart disease (PDA). +/- "blueberry muffin" rash |
| Cataracts, deafness, and PDA, plus "blueberry muffin" rash. Dx? | Rubella infection neonatal manifestations (Torches) |
| How is CMV (torches) maternally transmitted? | Sexual contact and/or organ transplant |
| Which TORCHES infection cause the mother to present mononucleosis-like illness? | Cytomegalovirus |
| What are the most common neonatal features with CMV infection? | Hearing loss, seizures, petechial rash, "blueberry muffin" rash, chorioretinitis, periventricular calcifications |
| What are the most common ways a mother can acquire HIV? | Sexual contact and needlestick |
| What are neonatal presentation of HIV infection? | Recurrent infections and chronic diarrhea |
| What are , if any, the clinical manifestations of a mother with HSV-2 infection? | Herpetic (vesicular) lesions |
| Meningoencephalitis, herpetic (vesicular) lesions. | Neonatal manifestations of HSV-2 infection |
| What syphilis stages are the most common to cause neonatal syphilis infection manistains? | Primary and secondary |
| What are neonatal manifestations of a TORCHES infection due to Syphilis? | Often result in stillbirth, hydrops fetalis. If child survives, presents with: facial abnormalities, saber chin, and CN VIII deafness |
| What are some facial abnormalities seen in a neonatal syphilis? | Notched teeth, saddle nose, short maxilla |
| What type of deafness is produced in a child with neonatal syphilis? | CN VIII (8) deafness |
| Saddle nose, saber chin, deafness, and notched teeth. Represents what? | Neonatal manifestations of Syphilis |
| What are the TORCHES infections? | Toxoplasma gondii Rubella CMV HIV HSV-2 Syphilis |
| What is the syndrome or disease of Coxsackievirus type A? | Hand-foot-mouth disease |
| Rash seen in Hand-foot-mouth disease? | Oval-shaped vesicles on palms and soles; vesicles and ulcers in oral mucosa. |
| Red oval-shaped vesicles in hands (palms) and foot (soles), plus vesicles and ulcer in the oral mucosa. Associated disease? | Hand-foot-mouth disease |
| What is the associated conditions of HHV-6? | Roseola (exanthem subitum) |
| Descrioption of Roseola rash | Asymptomatic rose-colored macules appear on body after seveal days of high fever; can present with fevrile seizures; usually afect infants |
| Which population is at highest risk of HHV-6 Roseola? | Infants |
| A new red rash appears after 3-4 days of high fever. Dx? | Roseola due to HHV-6 infection |
| Common name for exanthem subitum | Roseola |
| What is another name for measles? | Rubeola |
| Description of measles rash | Confluent rash beggining at head and moving down |
| What are preceding symptoms and signs to the appearance of the red rash of measles? | Cough, coryza, conjunctivitis, and blue-white (Koplik) spots on buccal mucosa |
| Koplik spots. Dx? | Measles |
| Where in the body do Koplik spots appear? | Buccal mucosa |
| What is the old name of Erythema infectiosum? | Fifth disease |
| What is the description or clinical presentation of the rash caused by Parvobirus B19? | "Slapped cheek" rash on face |
| What is the most severe risk of Parvovirus B19 infection to a pregnant women? | Hydrops fetalis |
| Suspect infection of Rubella with which important clinical sign? | Postauricular lymphadenopathy |
| Where does Rubella and Rubeola rashes start and move? | Start at head and move down |
| Fine desquamating truncal rash, that began at the head and moved down. Dx? | Rubella |
| Which rash, Rubella or Measles, start at the hairline? | Rubeola |
| Rubella's red rash starts at the _____________ and moves down. | Face |
| German measles = | Rubella |
| What mouth feature is seen with Rubella? | Forchheimer spots on soft palate |
| Forchheimer spots appear on _______________________________ infection. | Soft palate of Rubella |
| What is the associated rash syndrome of Strep pyogenes? | Scarlet fever |
| Describe the rash seen in Scarlet fever. | Flushed cheeks and circumoral pallor on the face; erythematous, sandpaper-like rash from neck to trunk and extremities and sore throat. |
| If the red rash starts at the neck and moves down to the trunk and arms, it can be suspected to be? | Scarlet fever |
| Scarlet fever is due to infection with: | Strep pyogenes |
| What is the disease that causes a red rash in VZV infection? | Chickenpox |
| Vesicular rash begins on trunk; spreads to face and extremities with lesions of different stages. | Chickenpox |
| Where does the Chickenpox rash starts? | Trunk |
| Red rash, with lesions of different stages. | Chickenpox |
| What virus produces a chancroid? | Haemophilus ducreyi |
| What is a chancroid? | Painful genital ulcer with exudate, and inguinal adenopathy |
| What are the clinical fatures of chlamydia infection? | Urethritis, cervicitis, epididymitis, conjuntivitis, reactive arthritis, and PID |
| Which subtypes of Chlamydia are the ones causing sexually transmitted diseases? | Chlamydia trachomatis (D-K) |
| Condylomata acuminata is seen with with organism infection? | HPV-6 and -11 |
| What is condylomata acuminata? | Genital warts; seen with Koilocytes |
| Clinical features of Genital herpes: | Painful penile, vulvar, or cervical vesicales and ulcers |
| Which, HSV-2 or HSV-1, is more common to cause genital herpes? | HSV-2 |
| What conditions are associated with Gonorrhea? | Urethritis, cervicitis, PID, prostatitis, epididymitis, arthritis, creamy purulent discharge |
| What is the description of the discharge often seen with N. gonorrhoeae infection? | Creamy purulent discharge |
| Another name for Granuloma inguinale? | Donovanosis |
| Painless, beefy red ulcer that bleeds readily on contact. | Granuloma inguinale |
| What organisms are associated in the development of Granuloma inguinale? | Klebsiella granulomatis; |
| What are histological findings in Granuloma inguinale due to Klebsiella granulomatis infection? | Cytoplasmic Donovan bodies (bipolar staining) |
| What organism causes Lymphogranuloma venereum? | Chlamydia trachomatis (L1-L3) |
| Infection of lymphatics; painless genital ulcers, painful lymphadenopathy (buboes) | Lymphogranuloma venereum |
| Painless chancre | Primary syphilies |
| What are the clinical features seen in secondary syphilis? | Fever, lymphadenopathy, skins rashes, and condylomata lata |
| Condylomata lata is seen in: | Secondary syphilis |
| What organism causes syphilis? | Treponema pallidum |
| What are the main features of Tertiary syphilis? | Gummas, tabes dorsalis, general paresis, aortitis, Argyll Robertson pupil |
| Gummas are seen in: | Tertiary syphilis |
| Tabes dorsalis is a neurological manifestation often seen in: | Tertiary syphilis |
| What are the main bugs causing Pelvic inflammatory disease? | Chlamydia trachomatis and N. gonorrhoeae |
| What organism is the MCC of bacterial STI in the United States? | C. trachomatis |
| What are the signs of PID? | Cervical motion tenderness, adnexal tenderness, purulent cervical discharge |
| What are some conditions that may be part of PID? | Salpingitis, endometritis, hydrosalpinx, and tubo-ovarian abscess. |
| Salpingitis is a risk factor for which disorders? | Ectopic pregnancy, infertility, chronic pelvic pain, and adhesions. |
| What is another name for perihepatitis? | Fitz-Hugh-Curtis syndrome |
| What is Fitz-Hugh-Curtis syndrome? | Infection and inflammation of liver capsule and "violin string" adhesions of peritoneum to liver. |
| What organism is causative of development of Fitz-Hugh-Curtis syndrome? | C. trachomatis |
| What is the risk factor for nosocomial infection with Clostridium difficile? | Antibiotic use |
| What are the unique signs/symptoms of Nosocomial infection by C. difficile? | Watery diarrhea and Leukocytosis |
| What are the 2 MCC of nosocomial infections? | E. coli (UTI) and S. aureus (wound infection) |
| Hospital infections due to aspirations are due infections of which pathogen? | Polymicrobial, gram (-) bacteria, often anaerobes |
| Clinical presentation of nosocomial infection due to aspiration issues? | Right lower lobe infiltrate or right upper/middle lobe (patient recumbent); purulent malodorous sputum |
| What are common infectious agents in patients in intravascular catheters? | S. aureus (including MRSA), S. epidermidis (long term), Enterobacter |
| Infection with Poliovirus to an unvaccinated child will lead to: | Lead to myalgia and paralysis |
| Asplenic patient are highly susceptible to which organisms? | Encapsulated microbes |
| Branching rods in oral infection , sulfur granules | Actinomyces israelii |
| Chronic granulomatous disease | Catalase (+) microbes, especially S. aureus |
| "Currant jelly" sputum | Klebsiella |
| Dog or cat bite | Pasteurella multocida |
| Facial nerve palsy (typically bilateral) | Borrelia burgdorferi (Lyme disease) |
| Fungal infection in diabetic or immunocompromised patient | Mucor or Rhizopus spp. |
| Health care provider | HBV, HCV (from needlestick) |
| Neutropenic patients | Candida albicans (systemic), Aspergillus |
| Organ transplant recipient | CMV |
| PAS (+) | Tropheryma whipplei (Whipple disease) |
| Pediatric infection | Haemophilus influenza (including epiglottis) |
| Pneumonia in cystic fibrosis, burn infection | Pseudomonas aeruginosa |
| Pus, empyema, abscess | S. aureus |
| Rash on hands and feet | Coxsackie A virus, Treponema pallidum, and Rickettsia rickettsii |
| Sepsis/meningitis in newborn | Group B strep |
| Surgical wound | S. aureus |
| Traumatic open wound | Clostridium perfringens |
| What are the most common Sulfonamides? | Sulfamethoxazole (SMX), Sulfisoxazole, and Sulfadiazine |
| Trimethoprim is: | Folic acid synthesis and reduction (DNA methylation) |
| What two categories of antibiotics disrupt the cell wall? | 1. Peptidoglycan synthesis 2. Peptidoglycan cross-linking |
| What two common Glycopeptides? | Vancomycin and Bacitracin |
| Common Penicillinase-sensitive penicillins: | Penicillin G, V Ampicillin Amoxicillin |
| Which are some Penicillinase-resistant penicillins? | Oxacillin Nafcillin Dicloxacillin |
| Common Antipseudomonas? | Ticarcillin and Piperacillin |
| What is the most common Monobactam? | Aztreonam |
| What are common Carbapenems? | Imipenem, Meropenem, Ertapenem, and Doripenem |
| The 30S subunit ribosomes is attacked by: | Aminoglycosides, Glycylcycline, and Tetracyclines |
| What are the most common aminoglycosides? | Gentamicin Neomycin Amikacin Tobramycin Streptomycin |
| Three tetracyclines | Tetracycline, Minocycline, and Doxycycline |
| Which ribosomal subunit do Tetracyclines attack? | 30S |
| Which antibiotic categories act by inhibiting protein synthesis through inactivation of the 50S ribosomal subunit? | Chloramphenicol, Clindamycin, Linezolid, Macrolides, and Streptogramins |
| What are the MC streptogramins? | Quinupristin and Dalfopristin |
| Common macrolides? | Azithromycin, Clarithromycin, and Erythromycin |
| Common antibiotic that disrupts DNA integrity via free radicals? | Metronidazole |
| Rifampin works by: | Inhibition of mRNA synthesis by the use of an RNA polymerase |
| Which are the two types of Gyrase antibiotic categories? | Fluoroquinolones and Quinolones |
| Common Fluoroquinolones | Ciprofloxacin, Levofloxacin |
| Nalidixic acid is an _________________ | Quinolone |
| Daptomycin works by inhibiting the ______________ _____________. | Membrane integrity |
| The 50S ribosomal subunit is attacked by: | Chloramphenicol, Clindamycin, Linezolid, Macrolides, and Streptogramins |
| What medication prevents the formation of THF? | TMP |
| Which antibiotics are known to inhibit PABA? | Sulfonamides |
| DNA gyrase is inhibited by _____________________. | Fluoroquinolones |
| Which antibiotics work on the Cell Wall? | Penicillins and Glycopeptides (vancomycin andbacitrancin) |
| What forms is Penicillin G found? | IV and IM forms |
| Penicillin V is only found in the ____________ form. | Oral |
| Which penicillin, G or V, is administered orally only? | Penicillin V |
| What are the prototype B-lactam antibiotics? | Penicillin G, V |
| What is the mode of action of Penicillin G and Penicillin V? | Binds penicillin-binding proteins --> blocks transpeptidase cross-linking of peptidoglycan in cell wall. Activate autolytic enzymes |
| What are the clinical uses for Penicillin G, V? | 1. Mostly gram (+) organisms (S. pneumoniae, S. pyogenes, Actinomyces) 2. Gram (-) cocci (mainly N. meningitidis) 3. Spirochetes (T. pallidum) |
| Penicillin G, V, is bactericidal or bacteriostatic? | Bactericidal |
| What are the adverse effects associated with Penicillin G, V? | 1. Hypersensitive reactions 2. Direct Coombs (+) hemolytic anemia 3. Drug-induced interstitial nephritis |
| Mode of resistance of Penicillin G, V? | B-lactamase cleaves the B-lactam ring. ---> MUTATIONS in PBP |
| Another name for Penicillin-binding proteins? | Transpeptidases |
| The MOA is same as Penicillin. Wider spectrum; penicillinase sensitive; combine with clavulanic acid to protect against destruction by B-lactamase. | Penicillinase-sensitive penicillins |
| Which hver wider spectrum of action, Penicillin G, V or Penicillinase-sensitive penicillins? | Penicillinase-sensitive penicillins |
| What are the clinical uses of Penicillinase-sensitive penicillins? | H. influenzae, H. pylori, E. coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, Shigella, and enterococci. |
| What mnemonic is used to remember the coverage of Penicillinase-sensitive penicillins? | HHELPSS |
| HHELPSS stands for: | H. influenzae H. pylori E. coli Listeria monocytogenes Proteus mirabilis Salmonella Shigella Enterococci |
| What are common adverse effects of Penicillinase - sensitive penicillins? | Hypersensitive reactions, rash, and Pseudomembranous colitis |
| Amoxicillin is an | Penicillinase-sensitive penicillin |
| What is the mode of acquired resistance of Amoxicillin and ampicillin? | Penicillinase (a type of B-lactamase) cleaves B-lactam ring. |
| Which type of penicillins are of narrow spectrum? | Penicillinase-resistant penicillins |
| What makes Penicillinase-resistant penicillins "resistant"? | The bulky R group blocks access of B-lactamase to B-lactam ring. |
| What is the use for Penicillinase-resistant penicillins? | S. aureus only |
| Why is MRSA not treated with Dicloxacillin? | It is resistant to Penicillinase-resistant penicillins due to altered PBP. |
| What are the main adverse effects of Nafcillin, Oxacillin, and Dicloxacillin? | Hypersensitivity reactions and Interstitial nephritis |
| What nephrotic disorder is seen as adverse effect of Penicillinase-resistant penicillins? | Interstitial nephritis |
| Which type of penicillins may have interstitial nephritis as an adverse effect? | Penicillin G, V and Penicillinase-resistant penicillins |
| Spectrum type of each: 1. Penicillinase-sensitive penicillins 2. Penicillinase-resistant penicillins 3. Antipseudomonal penicillins | 1. Broad 2. Narrow 3. Extended |
| Antipseudomonal are penicillinase __________________. | Sensitive |
| What is often added to anti pseudomonal to protect them from B-lactamase destruction? | B-lactamase inhibitors |
| What are the clinical uses (infections) treated with Antipseudomonal penicillins? | Pseudomonas spp. and gram (-) rods |
| What are the most (4) B-lactamase inhibitors? | Clavulanic acid, Avibactam, Sulbactam, and Tazobactam |
| What mnemonic is used to summarize the B-lactamase inhibitors? | CAST Clavulanic acid, Avibactam Sulbactam Tazobactam |
| What is the function of B-lactamase inhibitors? | Added to penicillin antibiotics to protect the antibiotic from destruction by B-lactamase |
| What is another name for B-lactamase? | Penicillinase |
| What is prevented by adding Clavulanic acid to Piperacillin? | Destruction of Piperacillin with B-lactamase |
| Cephalosporins are _________________. | Bactericidal |
| Mechanism of action of Cephalosporins | B-lactam drugs that inhibit cell wall synthesis but ar less susceptible to penicillinases. |
| Which are more susceptible to penicillinases, penicillins or cephalosporins? | Penicillins |
| Which organisms are NOT covered with generations 1st-4th Cephalosporins? | LAME Listeria Atypicals (Chlamydia, Mycoplasma) MRSA Enterococci |
| What mnemonic is used to remember the organisms not covered by generations 1-4 of cephalosporins? | LAME |
| What are the two main 1st generation cephalosporins? | Cefazolin and Cephalexin |
| Cefazolin is a _______ generation cephalosporin. | 1st |
| What cephalosporin is generation is Cephalexin? | 1st |
| Cefazolin and Cephalexin are both _______ generation cephalosporins? | 1st |
| What organisms are covered by 1st generation cephalosporins? | PEcK Proteus mirabilis E. coli Klebsiella pneumoniae |
| What is the common use for Cefazolin? | Used prior to surgery to prevent S. aureus wound infections |
| HENS PEcK | Mnemonic used for organisms covered by 2nd Gen cephalosporins |
| What are the most common 2nd Generation Cephalosporins? | Cefaclor, Cefoxitin, Cefuroxime, and Cefotetan |
| Cefaclor is ______ gen cephalosporin. | 2nd |
| Cefoxitin and Cefuroxime are both _____ generation cephalosporins. | 2nd |
| What generation of cephalosporins are Cefaclor, Cefoxitin, Cefuroxime, and Cefotetan? | 2nd |
| What mnemonic is used to summarize the organisms covered by 2nd generation cephalosporins? | HENS PEcK |
| What organisms are covered by 2nd Generation cephalosporins? | 1. Gram (+) cocci 2. H. influenzae 3. Enterobacter aerogenes 4. Neisseria spp 5. Serratia marcescens 6. Proteus mirabilis 7. E. coli 8 . Klebsiella pneumoniae |
| Which cephalosporins can cross the BBB? | 3rd generation cephalosporins |
| What are the 3rd generation cephalosporins? | Ceftriaxone, Cefotaxime, Cefpodoxime, and Ceftazidime |
| What is the main use for 3rd generation cephalosporins? | Serious gram (-) infections resistant to other B-lactams |
| What re the most common uses for Ceftriaxone? | Meningitis, gonorrhea, disseminated Lyme disease |
| Which cephalosporin is often used to treat disseminated Lyme disease? | Ceftriaxone |
| What generation of cephalosporin is Ceftriaxone? | 3rd generation |
| Which 3rd gen Cephalosporin is used to treat Pseudomonas? | Ceftazidime |
| Ceftazidime is a _____ generation cephalosporin | 3rd |
| What type or generation of cephalosporins are used in seriums gram (-) infections? | 3rd |
| Cefotaxime is a ______ generation cephalosporin | 3rd |
| What is the MC 4th generation cephalosporin? | Cefepime |
| What are the clinical uses of Cefepime? | Gram (-) organisms, with increased activity against Pseudomonas and gram (+) organisms |
| Besides gram negative activity, what other infections can be treated with 4th generation cephalosporins? | Pseudomonas and gram (+) organisms |
| What is the most commonly referred 5th generation Cephalosporin? | Ceftaroline |
| What is the coverage of 5th generation cephalosporins? | Broad gram (+) and gram (-) organism |
| Unlike generations 1st --- 4th, the ______ generation of cephalosporins cover: | 5th; Listeria, Atypicals (Chlamydia and Mycoplasma), MRSA, and Enterococci |
| MRSA is covered by ______ generation cephalosporins | 5th |
| What is covered by the 4th generation cephalosporins, but NOT by the 5th generation? | Pseudomonas |
| List of adverse effects seen with Cephalosporins: | 1. Hypersensitivity reactions 2. Autoimmune hemolytic anemia 3. Disulfiram-like reaction 4. Vitamin K deficiency 5. Low rate of cross-reactivity even in penicillin-allergic patients 6. Increase nephrotoxicity with aminoglycosides |
| What kind of anemia may be seen with Cephalosporin therapy? | Autoimmune hemolytic anemia |
| What common Vitamin deficiency is a possible adverse effect of prolonged use of Cephalosporins? | Vitamin K |
| A disulfiram-like reaction is seen with all generations of __________________. | Cephalosporins |
| What other type of antibiotics increase the risk of nephrotoxicity seen in Cephalosporin therapy? | Aminoglycosides |
| What kind of antibiotics should be avoided in patients on Cephalosporin? | Aminoglycosides |
| What is always coadministered with Imipenem? | Cilastatin |
| What is the MOA of Cilastatin? | Inhibition of renal dehidropeptidasa I |
| Inhibitor of renal dehydropeptidase I | Cilastatin |
| Which are the newer Carbapenems? | Ertapenem and Doripenem |
| What is the purpose of using Cilastatin with Imipenem? | Decrease inactivation of drugs in renal tubules |
| What are the main uses for Carbapenems? | 1. Gram (+) cocci 2. Gram (-) rods 3. Anaerobes |
| What is the safest carbapenem? | Meropenem |
| What enzyme is inactivated in renal tubules by the use of Carbapenems? | Dehydropeptidase I |
| What are the adverse effects of carbapenems? | GI distress, rash, and CNS toxicity (seizures) at high plasma levels |
| What is the most significant side effect seen with Carbapenems? | CNS toxicity ---> seizures |
| Aztreonam is an ________________________. | Monobactam |
| Monobactam are less susceptible to ___________________. | B-lactamases |
| How does Aztreonam prevent peptidoglycan cross-linking? | Binding to Penicillin-Binding protein 3 |
| What kind of antibiotics act by binding to PBP-3? | Monobactam |
| Monobactams are synergistically with ____________________. | Aminoglycosides |
| What is the use of Aztreonam? | Gram (-) rods only |
| Which patients are the ones usually treated with Monobactams? | Penicillin-allergic patients and those with renal insufficiency who cannot tolerate aminoglycosides |
| Inhibits cell wall peptidoglycan formation by binding D-Ala-D-Ala portion of cell wall precursors. | Vancomycin |
| Vancomycin is not susceptible to ______________________. | B-lactamases |
| What bugs are treated with Vancomycin? | Gram (+) bugs |
| Examples of gram (+) bugs treated with Vancomycin? | Serious, multi resistant organisms, including MRSA, S. epidermidis, sensitive Enterococcus species, and C. difficile |
| Vancomycin is bactericidal except for: | C. difficile |
| What is the main syndrome due adverse reaction to Vancomycin? | Red man syndrome |
| What is the cause of Red man syndrome? | Adverse effect to Vancomycin |
| What is the Red man syndrome? | Diffuse flushing due to vancomycin toxicity |
| What are the most common adverse effects of Vancomycin? | Nephrotoxicity, Ototoxicity, Thrombophlebitis, diffuse flushing (red man syndrome), drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) |
| DRESS syndrome and Red man syndrome are commonly associated with: | Vancomycin toxicity |
| What is the amino acid modification that causes Vancomycin resistance? | D-Ala-D-Ala ----> D-Ala-D-Lac |
| D-Ala-D-Lac | Amino acid change causing Vancomycin resistance |
| How is Red man syndrome prevented? | 1. Pretreatment with antihistamines 2. Slow rate of infusion of Vancomycin |
| What are the bacterial ribosomes targeted by protein inhibitors? | 30S and 50S |
| 30S +50S = | 70S bacterial ribosome |
| All protein inhibitors are _______________________, except for: | Bacteriostatic; Aminoglycosides (bactericidal) LInezolid (variable) |
| Which kind of protein inhibitors are the only bactericidal? | Aminoglycosides |
| Linezolid is bactericidal or bacteriostatic? | Variable (both) |
| Aminoglycosides and Tetracyclines target the _______ ribosomal subunit. | 30S |
| What are the main protein inhibitors that target bacterial 50S ribosomal subunit? | Chloramphenicol, Clindamycin, Erythromycin (macrolides) Linezolid |
| What protein inhibitors directly affect Translocation? | Macrolides and Clindamycin |
| What is the mechanism of action of Aminoglycosides? | 1. Irreversible inhibition of initiation complex through binding of the 30S subunit 2. Cause misreading of mRNA 3. Block translocation |
| Why are aminoglycosides ineffective against anaerobes? | They require Oxygen to work |
| What is the result of aminoglycosides inhibition of the initiation complex by binding to the 30S subunit? | Misreading of mRNA |
| What is the main use of aminoglycosides? | Severe gram (-) rod infections |
| What aminoglycoside is used for bowel surgery? | Neomycin |
| Aminoglycosides work synergistic with? | B-lactam antibiotics |
| What are the most common adverse effects of aminoglycosides? | Nephrotoxicity Neuromuscular blockade Ototoxicity Teratogen |
| Ototoxicity by Aminoglycosides is increased if used with: | Loop diuretics |
| What kind of antibiotic should be avoided in case a patient is on Furosemide? | Aminoglycosides |
| What is the mechanism of resistance presented by aminoglycosides? | Bacterial transferase enzymes inactivate the drug by acetylation, phosphorylation, or adenylation. |
| Which protein inhibitor drug class targets/inhibits the A-site tRNA binding? | Tetracyclines |
| Peptidyl transferase is inhibited by _____________________. | Chloramphenicol |
| Linezolid inhibition of 50S subunit prevents _____________ to integrate. | Initiator tRNA |
| Bind to 30S and prevent attachment of aminoacyl-tRNA. | Tetracyclines |
| Tetracyclines have limited ______ penetration. | CNS |
| How is Doxycycline eliminated from the body? | Fecally |
| Why is doxycycline used in renal failure patients? | It is fecally excreted |
| Which products, meds or preparations must be avoided when taking tetracyclines? | 1. Milk (Ca2+) 2. Antacids (Ca2+ and Mg2+) 3.. Iron-containing preparations |
| What kind of cations can inhibit tetracycline absorption in the gut? | Divalent (2+) |
| A person with severe GERD is taking OTC antacids, which protein inhibitor antibiotic should be avoided? | Tetracyclines |
| What are the clinical uses for Tetracyclines? | 1. Borrelia burgdorferi 2. M. pneumoniae 3. RIckettsia and Chlamydia 4. Acne 5. Doxycycline is effective against MRSA |
| Which tetracycline is used for MRSA infection? | Doxycycline |
| Why are tetracyclines especially against Rickettsia and Chlamydia? | Drug's' ability to accumulate intracellularly |
| What are common adverse effects of Tetracyclines? | 1. GI distress 2. Discoloration of teeth and inhibition of bone growth in children 3. Photosensitivity 4. Contraindicated in pregnancy |
| Discolored teeth due a medication. | Tetracycline toxicity |
| What is the mechanism of resistance? | Decrease uptake or increase effeflux out of bacterial cells by plasmid-encoded transport pumps |
| Tigecycline is a _____________________. | Glycylcyclines |
| What are a type of tetracycline derivatives? | Glycylcycline |
| What are the clinical uses of Glycylcyclines? | 1. Broad-spectrum anaerobic, gram (-), and gram (+) coverage 2. MRSA and VRE 3, Infection requireing deep tissue penetration |
| What is the mechanism of action of Chloramphenicol? | Blocks peptidyltransferase at 50S ribosomal subunit. Bacteriostatic |
| What are the MC uses of Chloramphenicol? | 1. Meningitis (H. influenzae, N. meningitidis, Strep pneumoniae) 2. Rickettsial diseases (Rocky Mountain spotted fever) |
| What are the adverse effects of Chloramphenicol? | 1. Anemia (dose dependent) 2. Aplastic anemia (dose independent) 3. Gray baby syndrome |
| Why do infants develop gray baby syndrome in Chloramphenicol? | They lack liver UDP-glucuronosyltransferase |
| What is the mode of resistance of Chloramphenicol? | Plasmid-encoded acetyltransferase inactivates the drug |
| MOA of Clindamycin: | Blocks peptide transfer (translocation) at 50S ribosomal subunit. Bacteriostatic |
| What are common uses of Clindamycin? | - Anaerobic infections in aspiration pneumonia, lung abscess, and oral infections. - Also effective against invasive group A streptococcal infetion |
| What are adverse effects associated with Clindamycin? | Pseudomembranous colitis (C. difficile overgrowth), fever and diarrhea. |
| Clindamycin treats infections _________________________ diaphragm. | Above |
| What is the most common Oxazolidinones? | Linezolid |
| What type of antibiotic is Linezolid? | Oxazolidinones |
| What is the mode of action of Linezolid? | Inhibit protein synthesis by binding to 50S subunit and preventing formation of the initiation complex. |
| What organisms are commonly treated with Linezolid? | Gram (+) species including MRSA and VRE |
| What are most important adverse effects of Linezolid? | 1. Bone marrow suppression (especially thrombocytopenia) 2. Peripheral neuropathy 3. Serotonin syndrome |
| What syndrome is adversely seen in the use of Linezolid? | Serotonin syndrome |
| How can Linezolid acquire resistance? | Point mutation of ribosomal RNA |
| What are the MC macrolides? | Azithromycin, clarithromycin, and erythromycin |
| What cell process is inhibited by Macrolides? | Translocation |
| What is the mechanism of action of Macrolides? | Inhibit protein synthesis by blocking translocation; bind to the 23S rRNA of the 50S ribosomal subunit |
| Where do macrolides bind to prevent protein synthesis? | 23S of the 50S ribosomal subunit |
| What are the MC clinical uses of Macrolides? | 1. Atypical pneumonias (Mycoplasma, Chlamydia, Legionella) 2. STIs (Chlamydia) 3. Gram (+) cocci (streptococcal infections in patients allergic to penicillin), 4. B. pertussis |
| What antibiotics can be used to treat atypical pneumonias? | Macrolides |
| Mnemonic of adverse effects seen in macrolides | MACRO |
| What are the most common adverse effects of Macrolides? | 1. Gastrointestinal Motility issues 2. Arrhythmia caused by prolonged QT interval 3. acute Cholestatic hepatitis 4. Rash 5. eOsinophilia |
| What macrolides inhibit cytochrome P-450? | Clarithromycin and Erythromycin |
| Methylation of 23S rRNA-binding site prevents binding of drug. | Mechanism of resistance of macrolides |
| What are the most common Polymyxins? | Colistin (polymyxin E), polymixin B |
| MOA of Polymyxins | Cation polypeptides that bind to phospholipids on cell membrane of gram (-) bacteria. |
| What is the clinical use for Polymyxins? | Salvage therapy for multidrug-resistant gram (-) bacteria (P. aeruginosa, E. coli, Klebsiella pneumoniae). |
| What is a common use for Polymyxin B? | Component of a triple antibiotic ointment used for superficial skin infections |
| What are the most significant adverse effects seen with Polymyxins? | Nephrotoxicity, Neurotoxicity (slurred speech, weakness, paresthesias), and respiratory failure. |
| What enzyme is primarily blocked or inhibited by Sulfonamides? | Dihydropteroate synthase |
| What is the end result of inhibition of dihydropteroate synthase by sulfonamides? | Inhibition of folate synthesis |
| When are sulfonamides bactericidal? | When combined with TMP |
| Sulfonamides are bacteriostatic or bactericidal, when used alone? | Bacteriostatic |
| What are the most significant clinical uses of Sulfonamides? | Gram (+), gram (-), Nocardia |
| TMP-SMX is used in treating? | Simple UTI |
| What is a problems seen in a G6PD deficiency patient on Sulfonamides? | Hemolysis |
| What are some adverse effects seen with Sulfonamides? | - Hypersensitivity reactions - Hemolysis (in G6PD deficiency) - Nephrotoxicity (Tubulointerstitial nephritis) - Photosensitivity -Stevens-Johnson syndrome - Kernicterus in infants - Displacement of other drugs form albumin |
| What is the teratogenic adverse effect of Sulfonamides? | Kernicterus |
| Which patients are at higher risk of hemolysis by using sulfonamides? | G6PD deficient |
| What is the way of resistance of Sulfonamides? | Altered enzyme (bacterial dihydropteroate synthase), decrease uptake, or increase PABA synthesis |
| What acid is prevented from forming by the use of Sulfonamide and/or Dapsone? | Dihydropteroic acid |
| What is the MC use for Dapsone? | 1. Leprosy, 2. Pneumocystis jirovecii prophylaxis |
| Two serious adverse effects of Dapsone therapy? | 1. Hemolysis of G6PD deficient 2. Methemoglobinemia |
| What does TMP stand for? | Trimethoprim |
| What is the mechanism of action of TMP? | Inhibits bacterial dihydrofolate reductase; Bacteriostatic |
| What antibiotic combination cause a sequential block of folate synthesis? | TMP-SMX |
| What infections are treated with TMP in combination with Sulfonamides? | UTIs, Shigella, Salmonella, Pneumocystis jirovecii pneumonia, and toxoplasmosis prophylaxis |
| What is a common treatment for Toxoplasmosis prophylaxis? | TMP-SMX |
| List of TMP adverse effects: | 1. Megaloblastic anemia 2. Leukopenia 3. Granulocytopenia |
| How can granulocytopenia seen with TMP can be avoided? | Coadministration of folinic acid |
| What is the common suffix seen fluoroquinolone nomenclature? | -floxacin |
| Mechanism of action of fluoroquinolones | Inhibit prokaryotic enzymes topoisomerase II (DNA gyrase) and topoisomerase IV. |
| What should never be taken with fluoroquinolones? | Antacids |
| Antacids should be avoided when also taking: | Fluoroquinolones and Tetracyclines |
| Clinical uses of Fluoroquinolones: | 1. Gram (-) rods of urinary and GI tracts 2. Some gram (+) organisms 3. Otitis externa |
| Why pregnant women cannot take fluoroquinolones? | May cause cartilage damage |
| What populations are at risk of cartilage damage by Fluoroquinolone use? | Pregnant women, nursing mothers, and children < 18 years old. |
| What is a possible ECG adverse effect of fluoroquinolones? | QT prolongation |
| What is a risk of fluoroquinolone therapy in persons over 60 years old or those using prednisone? | May cause Tendonitis or tendon rupture |
| Which two organs or tissues are at risk of damage in Fluoroquinolone therapy? | Cartilage and tendos |
| What effect does ciprofloxacin have on the CYP450 system? | Inhibits |
| How do fluoroquinolones acquired resistance? | Chromosome-encoded mutation in DNA gyrase, plasmid-mediated resistance, efflux pumps |
| What is the mode of action of Dapsone? | Lipopeptide that disrupts cell membranes of gram (+) cocci by creating transmembrane channels |
| What drug is known to destroy cell membrane by creating transmembrane channels? | Daptomycin |
| What are the most common uses for Daptomycin? | 1. S. aureus skin infections (especially MRSA) 2. Bacteriemia 3. Endocarditis 4. VRE |
| VRE and MRSA can be treated with ________________, by disrupting the cell membrane. | Daptomycin |
| Why is Daptomycin not used in pneumonias? | It tends to avidly bind to and is inactivated by surfactant |
| What medication is known to bind to surfactant and also by inactivated by surfactant as well? | Daptomycin |
| Adverse effects seen in Daptomycin? | Myopathy and rhabdomyolysis |
| What is the mechanism of action of Metronidazole? | Forms toxic free radicals metabolites in the bacterial cell that damage DNA |
| Metronidazole is ______________ and _______________. | Bactericidal and antiprotozoal |
| GET GAP | Mnemonic used to summarize organisms trated with Metronidazole |
| What does GET GAP stand for: | G- Giardia E- Entamoeba T- Trichomonas G- Gardnerella vaginalis A- Anaerobios (Bacteroides, C. diff) P. H. Pylori |
| What medication can substitute Amoxicillin in triple therapy for H. pylori infection? | Metronidazole |
| Metronidazole treat ANAEROBIC infections _________ the diaphragm. | Below |
| Clindamycin treats anaerobic infections ______________ the diaphragm. | Above |
| What adverse effect is seen with Metronidazole + ETOH? | Disulfiram-like reaction |
| What is disulfiram-like reaction presented? | Severe flushing, tachycardia, and hypotension |
| What are the lesser adverse effects of Metronidazole? | Headache and metallic taste |
| What DNA damaging antibiotic may provoke a disulfiram -like reaction if combined with alcohol? | Metronidazole. |
| What is used for prophylaxis is use for M. tuberculosis? | Isoniazid |
| What is the common treatment for M. tuberculosis? | Rifampin, Isoniazid, Pyrazinamide, and Ethambutol |
| RIPE | Mnemonic for M. tuberculosis treatment |
| What drugs are use for prophylaxis for M. avium-intracellulare? | Azithromycin, rifabutin |
| What is the empiric treatment for M. avium-intracellulare? | Azithromycin or clarithromycin + ethambutol. Can add rifabutin or ciprofloxacin |
| What is the long-term treatment of Tuberculoid M. leprae? | Dapsone and rifampin |
| What drug is added to leprae treatment in the Lepromatous form? | Clofazimine |
| What are the two most common Rifamycins? | Rifampin and Rifabutin |
| What is the mechanism of action of Rifamycin? | Inhibit DNA-dependent RNA polymerase |
| What are some clinical uses for Rifamycins? | 1. Mycobacterium tuberculosis 2. Delay resistance to dapsone when used for leprosy 3. Meningococcal meningitidis prophylaxis 4. Chemoprophylaxis in contacts of children with H. influenzae type b. |
| Why is are rifamycins used with Dapsone in treating Leprosy? | It helps delay the resistance to Dapsone |
| What drug causes orange body fluids? | Rifampin |
| Which rifamycin is favored in HIV? | Rifabutin |
| Why is rifabutin used in HIV patients and not Rifampin? | RIfabutin has less cytochrome P-450 stimulation |
| What are the adverse effects seen with Rifamycins? | 1. Minor hepatotoxicity 2. Induction of CYP450 system 3. Orange body fluids |
| What is the mode of resistance of Rifamycins? | Mutations reduce drug binding to RNA polymerase |
| What is a risk of rifampin monotherapy? | Rapid development of resistance to medication |
| What is the mode of action of Isoniazid? | Decreased synthesis of mycolic acids |
| Enzyme required to convert Isoniazid into active metabolite | Bacterial catalase-peroxidase |
| What is encoded by KatG? | Bacterial catalase-peroxidase |
| A deficiency or mutation to KatG gene can result in: | Defective function of INH due to inactivation |
| What is the main infection treated with Isoniazid? | M. tuberculosis |
| Which is the only agent (RIPE), that can be used in monotherapy prophylaxis of TB? | Isoniazid |
| Monotherapy for latent TB? | Isoniazid |
| What defines INH half-lives? | Fast vs Slow acetylators |
| Fast and slow acetylators. Association? | Represent possible Isoniazid half-lives |
| List of Isoniazid adverse effects: | 1. Hepatotoxicity 2. P-450 inhibition 3. Drug-induced SLE 4. Vitamin B6 deficiency --->Neuropathy and Sideroblastic anemia |
| What vitamin may be depleted by use of Isoniazid? | Vitamin B6 |
| What are clinical manifestations of Vitamin B6 deficiency due to INH toxicity? | Peripheral Neuropathy and Sideroblastic anemia |
| What anemia may be seen as side effect of INH toxicity? | Sideroblastic anemia |
| What is co administered with Isoniazid in order to prevent Vitamin B6 deficiency? | Pyridoxine |
| Mutations leading to underexpression of KatG | Mechanism of resistance of Isoniazid |
| What two cell types are most affected by Isoniazid? | Neurons and Hepatocytes |
| What does RIPE stand for? | Rifampin Isoniazid Pyrazinamide Ethambutol |
| What is the clinical use for Pyrazinamide? | M. tuberculosis |
| Which are the two associated adverse effects of Pyrazinamide? | Hyperuricemia and hepatotoxiciy |
| What is the best pH level for Pyrazinamide to function properly? | Acidic |
| What is the mechanism of action of Ethambutol? | Decreased carbohydrate polymerization of mycobacterium cell wall by blocking arabinosyltransferase |
| What is the associated adverse effects of Ethambutol? | Optic neuropathy |
| Description of the Optic Neuropathy due to Ethambutol use? | Red-green color blindness |
| Which RIPE drug works by blocking arabinosyltransferase? | Ethambutol |
| Inhibition of mycolic acids in Mycobacterium tuberculosis is done with ___________________. | Isoniazid |
| Decrease the carbohydrate polymerization of mycobacterium cell wall. | Ethambutol |
| What is a second line drug for the treatment of M. tuberculosis? | Streptomycin |
| Which ribosome component is interfered by Streptomycin? | 30S |
| What are associated side effects of Streptomycin? | Tinnitus, vertigo, ataxia, and nephrotoxicity. |
| Agent used as prophylaxis in cases of high risk for endocarditis and undergoing surgical or dental procedures? | Amoxicillin |
| Prophylaxis in cases of exposure to gonorrhea? | Ceftriaxone |
| What agent is used in prophylaxis o recurrent UTIs? | TMP-SMX |
| Ceftriaxone, Ciprofloxacin, or rifampin, are used as prophylaxis in: | Cases of exposure to meningococcal infection |
| What is the prophylaxis for pregnant women (+) group B strep? | Intrapartum penicillin G or ampicillin |
| Erythromycin ointment on eyes. Prophylaxis? | Prevention of gonococcal conjunctivitis in newborn |
| Which cases is Cefazolin used as prophylaxis measure? | Prevention of postsurgical infection due to S. aureus |
| Benzathine penicillin G is used a prophylaxis of: | Syphilis |
| What can be used as prophylaxis measures for strep pharyngitis in child with prior rheumatic fever? | Benzathine penicillin G or oral penicillin V |
| What is the most most common infection in HIV patient with CD4+ count < 50, and what is the prophylaxis drug? | Mycobacterium avium complex (MAC); Azithromycin or clarithromycin |
| TMP-SMX is used as prophylaxis in HIV patients with which possible infections? | Pneumocystis pneumonia and toxoplasmosis |
| Medications for MRSA? | Vancomycin, daptomycin, linezolid, tigecycline, ceftaroline, and doxycycline |
| What medications can be used to treat VRE? | Linezolid and streptogramins |
| What is the most common medication used for Multi-drug resistant P. aeruginosa? | Polymyxins B and E (colistin) |
| What enzyme is inhibited by Terbinafine? | Squalene epoxidase |
| What enzyme is inhibited by Azoles? | 14-a-demethylase |
| Which antifungals interfere in Ergosterol synthesis? | Azoles |
| Antifungals that disrupt cell wall synthesis | Ehinocandins |
| What are some importnat echinocandins? | Anidulafungin, Caspofungin, and Micanfungin |
| What is the common ending in nomenclature azoles? | -azole |
| What antifungal disrupts nucleic acid synthesis? | Flucytosine |
| What are common Polyenes? | Amphotericin B and Nystatin |
| What kind of antifungals inhibited cell membrane integrity? | Polyenes |
| What is the MOA of Amphotericin B? | Binds ergosterol; forms membrane pores that allow leakage of electrolytes |
| What cell structure is unique to fungi? | Ergosterol |
| Forms membrane pores that allow leakage of electrolytes. MOA of? | Amphotericin B |
| What important antifungal is used in serious, systemic mycoses? | Amphotericin B |
| What are some organism treated with Amphotericin B? | Cryptococcus, Blastomyces, Coccidioides, Histoplasma, Candida, Mucor. |
| What electrolytes should be supplemented in a patient on Amphotericin B? | K+ and Mg2+ |
| Why is K+ and Mg2+ supplemented in a patient on Amphotericin B? | Due to altered renal tubule permeability |
| What are adverse effects of Amphotericin B? | Fever/chills, hypotension, nephrotoxicity, arrhythmias, anemia, IV phlebitis |
| IV phlebitis is associated with: | Amphotericin B |
| What are the most important adverse effects of Amphotericin B? | Nephrotoxicity, arrhythmias, andmia and phleblitis. |
| Which antifungal is used topically and not as toxic as Amphotericin B, and with the same mechanism action of Amphotericin B? | Nystatin |
| What is the clinical use of Nystatin? | "Swish and swallow" for oral candidiasis (thrush); topical for diaper rash or vaginal candidiasis. |
| What is a common medication for diaper rash or vaginal candidiasis? | Nystatin |
| What are 3 common Azoles? | Ketoconazole, Itraconazole, fluconazole |
| Inibito fungal sterol (ergosterol) synthesis by inhibiting that CYP450 enzyme that converts lanosterol to ergosterol | Azole mechanism of action |
| Associated adverse effects of Azoles | 1. Testosterone synthesis inhibition 2. Liver dysfunction |
| Which azole is the most likely to cause Gynecomastia? | Ketoconazole |
| Which antifungals are used for local and less serious systemic mycoses? | Azoles |
| What is the MOA of Terbinafine? | Inhibits the fungal enzyme squalene epoxidase |
| What is the most common use for Terbinafine? | Dermatophytosis |
| What is the most common dermatophytose treated with Terbinafine? | Onychomycosis |
| What is Onychomycosis? | Fungal infection of finger or toe nails |
| What are some adverse effects associated with Terbinafine? | GI upset, headaches, hepatotoxicity, and taste disturbance. |
| What is the MOA of Echinocandins? | Inhibit cell wall synthesis by inhibiting synthesis of B-glucan |
| Decrease synthesis is B-glucan is achieved by which kind of antifungals? | Echinocandins |
| What are the most common uses for Echinocandins? | 1. Invasive aspergillosis 2. Candida |
| Why is there flushing in the use of Caspofungin? | Echinocandins release histamine --> flushing |
| What process of the cell cycle is disrupted by Griseofulvin? | Mitosis |
| What is the MOA of Griseofulvin? | Interferes with microtubule function; disrupts mitosis. |
| Where is Griseofulvin commonly deposited? | Keratin-containing tissues (nails) |
| What kind of infection is often treated with Griseofulvin? | Dermatophytes (tinea, ringworm) |
| What is the most significant adverse effect of Griseofulvin therapy? | Disulfiram-like reaction |
| What are the effects on CYP450 and Warfarin, by the use of Griseofulvin? | Increase the metabolism of both |
| Suramin and melarsoprol are used to treat: | Trypanosoma brucei |
| T. cruzi is treated with: | Nifurtimox |
| Nifurtimox is a antiprotozoal agent used to treat _____________. | T. cruzi infection |
| Pyrimethamine is used in treating ___________________. | Toxoplasmosis |
| What is a common treatment option for Leishmaniasis? | Sodium Stibogluconate |
| List of common anti-mite/louse drugs: | 1. Permethrin 2. Malathion 3. Oral Ivermectin |
| What is the use for Permethrin? | Scabies and lice infection |
| Mode of action of Permethrin? | Inhibits Na+ channel deactivation --> neuronal membrane depolarization |
| MOA of Malathion | Acetylcholinesterase inhibitor |
| What is the mode of action of Chloroquine? | Blocks detoxification of heme into hemozoin |
| The accumulation of heme due to Chloroquine, is toxic to which organism spp? | Plasmodia |
| What is a common drug used to treat plasmodial species other than P. falciparum? | Chloroquine |
| Why is Chloroquine not used in treating P. falciparum? | Frequency of resistance is too high |
| What are some common adverse effects seen with Chloroquine? | Retinopathy; pruritus |
| List of anti-helminthic therapy drugs | Pyrantel pamoate Ivermectin Mebendazole Praziquantel Diethylcarbamazine |
| Which is a antihelminthic medication that works as an microtubule inhibitor? | Mebendazole |
| What is the mode of action of Praziquantel? | Increased Ca2+ permeability and increased vacuolization |
| HIV Reverse transcriptase include: | NRTIs and NNRITs |
| Common NRTIs | Abacavir (ABC), Didanosine (ddI), Emtricitabine (FTC), Lamivudine (3TC), Stavudine (d4T), Tenofovir (TDF), Zidovudine (ZDV) |
| Commn NNRTIs include: | Delavirdine, Efavirenz, and Nevirapine |
| ABC | Abacavir |
| ddI | Didanosine |
| Emtricitabine | FTC |
| 3TC | Lamivudine |
| Lamivudine | 3TC |
| d4T | Stavudine |
| Stavudine | d4T |
| TDF | Tenofovir |
| Tenofovir is a common HIV ___________________. | NRTI |
| Tenofovir is abbreviated as _______. | TDF |
| Zidovudine | ZDV |
| Which to HIV antivirals prevent the entry of the virus? | Maraviroc and Enfuvirtide |
| What action does Maraviroc prevent that does not allow for entry of HIV to host cell? | Attachment |
| Maraviroc prevents ______________ of HIV to the cell. | Attachment |
| Penetration of HIV to host cell is prevented with ___________. | Enfuvirtide |
| What HIV antiviral prevents entry of HIV by blocking its penetration? | Enfurvitide |
| List of HIV integrase inhibitors | Dolutegravir Elvitegravir Raltegravir Bictegravir |
| What suffix is shared by all HIV integrase inhibitors? | -- tegravir |
| --tegravir | Integrase inhibitor |
| -tegravir is _______________ inhibitor, and --navir is _____________ inhibitor. | Integrase; Protease |
| Raltegravir is a very common ______________________. | HIV integrase inhibitor |
| What process in HIV replication/infection process is disrupted by Integrase inhibitors? | DNA integration |
| DNA integration occurs right after______________________ and before _____________. | Reverse transcription ; Transcription |
| What are 3 common protease inhibitors used in HIV therapy? | Indinavir, Saquinavir, and Lopinavir |
| -- navir | Protease inhibitor |
| What common suffix identifies all or most of HIV Protease inhibitors? | - navir |
| What process in HIV replication in the CD4+ cell is disrupted by Protease inhibitors? | Proteolytic processing |
| HIV proteolytic processing is inhibited with _____________ inhibitors. | Protease |
| Which are categories of antivirals (non-HIV), that disrupt Nucleic Acid synthesis? | 1. Guanosine analogs 2. Viral DNA polymerase inhibitors 3. Guanine nucleotide synthesis |
| Name two common Guanosine analogs (antivirals): | Acyclovir and Ganciclovir |
| Acyclovir is a _____________________________ | Guanosine analog |
| What action is disrupted by Acyclovir? | Nucleic acid synthesis |
| Cidofovir and Foscarnet both are ________________________. | Viral DNA polymerase inhibitors |
| What are common viral infections treated with Foscarnet and Cidofovir? | HSV and CMV |
| What type of nucleic acid synthesis inhibitor is Ribavirin? | Guanine nucleotide synthesis inhibitor |
| Which are the two most common Neuraminidase inhibitors? | Oseltamivir and Zanamivir |
| What are common antivirals used to treat Influenza A and B? | Oseltamivir and Zanamivir |
| Oseltamivir and Zanamivir are: | Neuraminidase inhibitors |
| What is prevented by the use of Neuraminidase inhibitors? | Release of progeny virus |
| Inhibit influenza neuraminidase | Mechanism of action of Oseltamivir and Zanamivir |
| What are the main uses for Acyclovir and other Guanosine analogs? | HSV and VZV |
| Which Guanosine analog has the best oral bioavailability? | Valacyclovir |
| What are the most significant adverse effects of Acyclovir and other Guanosine analogs? | 1. Obstructive crystalline nephropathy 2. Acute renal failure if not adequately hydrated |
| What is the mechanism of resistance? | Mutated viral thymidine kinase |
| What conditions are most commonly treated with acyclovir? | HSV-induced mucocutaneous and genital lesions as well as for encephalitis. |
| Prodrug of acyclovir? | Valacyclovir |
| Why is there few adverse effects with acyclovir and its derivatives? | It monophosphorylated HSV/VZV infected cells by thymidine kinase |
| What is the mechanism of action of Ganciclovir? | 5'- monophosphate formed by a CMV viral kinase |
| What is the most common use for Ganciclovir? | CMV, especially in immunocompromised patients |
| What is the prodrug of Ganciclovir? | Valganciclovir |
| Adverse effects of Ganciclovir | 1. Bone marrow suppression (leukopenia, neutropenia, thrombocytopenia) 2. Renal toxicity |
| What is the MOA of Foscarnet? | Viral DNA/RNA polymerase inhibitor and HIV reverse transcriptase inhibitor. |
| Where does the Foscarnet binds? | Pyrophosphate-binding site of enzyme |
| Which antiviral does not require any kinase activation | Foscarnet |
| Pyrophosphate analog | Foscarnet |
| 1. Viral DNA/RNA polymerase inhibitor 2. HIV reverse transcriptase inhibitor | Mechanisms of action of Foscarnet |
| What are the two most common uses for Foscarnet? | 1. CMV retinitis in immunocompromised patients when Ganciclovir fails 2. Acyclovir-resistant HSV |
| List of adverse effects Foscarnet: | 1. Nephrotoxicity 2. Electrolyte abnormalities ----> seizures |
| What are the common electrolyte abnormalities of Foscarnet? | Hypo-or-Hypercalcemia, hypo/hyperphosphatemia, hypokalemia, and hypomagnesemia |
| What is severe consequence seen in Foscarnet-induced electrolyte abnormalities? | Seizures |
| What is the mode of resistance of Foscarnet? | Mutated DNA polymerase |
| Mechanism of action of Cidofovir? | Inhibits viral DNA polymerase |
| What is the main adverse effect seen with Cidofovir? | Nephrotoxicity |
| What does HAART stand for? | Highly active antiretroviral therapy |
| What are the strongest indications for HAART? | 1. AIDS-defining illness 2. Low CD4+ cell counts (<500 cells/mm), 3. High viral load |
| What is the regimen that composes HAART? | A total of 3 drugs; 2 NRTIs + 1 Integrase inhibitor |
| What is the mechanism of action of NRTIs? | Competitively inhibit nucleotide binding to reverse transcriptase and terminate the DNA chain |
| All NRTIs are nucleosides, except for ___________________. | Tenofovir (nucleoTide) |
| What are some unique ZDV clinical uses? | 1. General prophylaxis 2. During pregnancy to decrease risk of fetal transmission |
| What are the associated adverse effects of NRTIs? | 1. Bone marrow suppression 2. Peripheral neuropathy 3. Lactic acidosis 4. Anemia 5. Pancreatitis |
| What NRTI is contraindicated in a patient with HLA-B*5701 mutation? | Abacavir |
| How is bone marrow suppression due to NRTI toxicity reversed? | Co-administer granulocyte colony-stimulating factor [G-CSF] and erythropoietin |
| What is an associated adverse effect of ZDV? | Anemia |
| What is the associated adverse effect of Didanosine? | Pancreatitis |
| What adverse effect is seen with all nucleoside NRTIs? | Lactic acidosis |
| Efavirenz is a _____________. | NNRTI |
| Nevirapine and Delavirdine are both, _____________. | NNRTIs |
| What is the mechanism of action of NNRTIs? | Bind to reverse transcriptase at site different from NRTIs. |
| What are some differences of in mechanism of action between NRTIs and NNRTIs? | 1. Bind different site in the reverse transcriptase 2. NNRTIs do NOT require phosphorylation |
| What are all the common to all NNRTIs adverse effects? | Rash and hepatotoxicity |
| What are adverse effects seen with Efavirenz? | Vivid dreams and CNS symptoms |
| Which NNRTIs are contraindicated in pregnancy? | Delavirdine and Efavirenz |
| What is the mechanism of action of Protease inhibitors? | Assembly of virions depends on HIV-1 protease, which cleaves the polypeptide products of HIV mRNA into their functional parts. |
| Which HIV antivirals prevent the maturation of new viruses? | Protease inhibitors |
| Which Protease inhibitor "boost" other drug concentrations by inhibiting CYP450 system? | Ritonavir |
| Which rifamycin is can be use with Protease inhibitors? | Rifabutin |
| What are shared adverse effects of Protease inhibitors? | Hyperglycemia, GI intolerance, lipodystrophy (Cushing-like syndrome) |
| What are associated side effects of Indinavir? | Nephropathy, hematuria, thrombocytopenia |
| What is the result of Protease inhibitors and Rifampin? | Reducts protease inhibitors concentrations, since Rifampin is potent CYP/UGT inducer. |
| Integrase inhibitor mechanism of action | Inhibits HIV genome integration into host cell chromosome by reversibly inhibiting HIV integrase |
| Adverse effect of Integrase inhibitors | Increased creatine kinase |
| What HIV antiviral is associated with increased levels creatine kinase? | Integrase inhibitors |
| What is the mechanism of action Enfuvirtide? | Binds gp41, inhibiting viral entry. |
| Binds CCR-5 on surface of T cells/monocytes, inhibiting interaction with gp120. | Mechanism of action Maraviroc |
| What is the associated adverse effect of Enfuvirtide? | Skin reaction at injection sites |
| _____________ inhibits fusion. | Enfuvirtide |
| _____________ inhibits docking. | Maraviroc |
| What is the mechanism of action interferons? | Glycoproteins normally synthesized by virus-infected cells, exhibiting a wide range of antiviral and antitumoral properties. |
| Adverse effects associated Interferons? | Flu-like symptoms, depression, neutropenia, and myopathy. |
| List of clinical uses for interferon therapy. | 1. Chronic HBV and HCV 2. Kaposi sarcoma 3. Hairy cell leukemia 4. Condyloma acuminatum 5. RCC 6. Malignant melanoma 7. Multiple sclerosis 8. Chronic granulomatous disease |
| What drug is used with Hepatitis C virus and RSV? | Ribavirin |
| What drugs are commonly used HCV infection? | Ledipasvir, Ribavirin, Simeprevir, and Sofosbuvir. |
| What is MOA of Ledipasvir? | Viral phosphoprotein (NS5A) inhibitor |
| Ribavirin mechanism of action | Inhibitors synthesis of guanine nucleotides by competitively inhibiting inosine monophosphate dehydrogenase |
| What are adverse effects of Ribavirin? | Hemolytic anemia and severe teratogen |
| What is the mechanism of action Simeprevir? | HCV protease (NS3/4A); prevents viral replication |
| Adverse effects of Simeprevir? | Photosensitivity reactions |
| Which HCV antiviral works by inhibiting HCV RNA-dependent RNA polymerase (NS5B) acting as a chain terminator? | Sofosbuvir |
| What is the teratogenic effect of Sulfonamides? | Kernicterus |
| Teratogenic effect of Aminoglycosides? | Ototoxicity |
| Cartilage damage is teratogenic effect of: | Fluoroquinolones |
| Associated teratogenic effect of Tetracyclines | Discolored teeth, inhibition of bone growth |
| Gray baby syndrome is the teratogenic result of ______________ in pregnant women. | Chloramphenicol |
Created by:
rakomi
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