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Non-gram staining

Day 4 (includes anti-TB drugs)

QuestionAnswer
ghon focus calcified scar in lower lobe of lung
ghon complex perihilar and lobar lymph node involvement + Ghon focus
primary or secondary TB: Ghon focus primary
primary or secondary TB: caseating granulomas secondary
primary or secondary TB: cavitation secondary
TB in vertebral body Pott's disease
TB in CNS parenchymal tuberculoma or meningitis
A primary TB infection that progresses to severe bacteremia gives rise to what form of TB? Miliary TB (seeds organs; can lead to death)
TB vaccine BCG (not given in US b/c it causes a + PPD)
Why might a TB-exposed patient get a negative PPD test? If they're anergic (can't generate an immune response due to things like steroids, malnutrition, immunocompromise, or sarcoidosis)
What type of hypersensitivity is a PPD skin test? Type 4
What factor allows mycobacteria to live inside phagocytes? Sulfatides (inhibit fusion of lysosomes to phagosomes)
Name the mycobacteria that causes pulmonary TB-like symptoms, esp in COPD patients. M. kansasii
Name the mycobacteria that causes disseminated disease in AIDS patients MAC (M avium-intracellulare)
What is the prophylactic treatment of choice for MAC? Azithromycin
Name the mycobacteria that might cause a hand infection from exposure to an aquarium? M marinum
Name the mycobacteria that causes leprosy (Hansen's disease)? M leprae
What is the reservoir in the US for M leprae? Armadillos (prefers the cool environment in their foot pads)
What is the treatment for leprosy? What are the side effects? Long-term oral dapsone; can cause hemolysis and methemoglobinemia
How does M leprae present differently in those with an active T cell response and those without? With T cell response: tuberculoid form that is limited to a few skin nodules that lose sensation (hypoesthetic) No T cell response: lepromatous form which presents diffusely over the skin and is communicable
What medium is required to grow Mycobacteria? Lowenstein-Jensen agar (3-4 weeks)
The only drug used in isolation for TB prophylaxis. Isoniazid
4 drug therapy for TB Rifampin, Isoniazid, Pyrazinamide, Ethambutol (RIPE for treatment)
5 drug therapy for TB Isoniazid (INH), Streptomycin, Pyrazinamide, Rifampin, Ethambutol (INH-SPIRE)
When are AIDS patients started on azithromycin prophylaxis for MAC? CD4 ct <100
What is the prophylaxis for M leprae? There isn't one! hahaha
In addition to dapsone and rifampin, what other drug can be used to treat M leprae? Clofazimine
What is the main toxicity of anti-TB drugs? Hepatotoxicity
What is the second line therapy for TB? Cycloserine
Which anti-TB agent causes red-green color blindness (optic neuropathy)? Ethambutol
What is the mechanism of pyrazinamide Effective in acidic pH of phagolysosomes where TB engulfed by macrophages are located
What is the mechanism of ethambutol? Blocks arabinosyltransferase (decreased carbohydrate polymerization of mycobacterium cell wall)
What is the specific toxicity of isoniazid? hepatoxocity, neurotoxicity, and drug induced lupus (INH Injures Neurons and Hepatocytes)
What can be used to prevent neurotoxicity in isoniazid therapy? Pyridoxine (B6)
What antibody would be seen with drug-induced lupus? Anti-histone antibody
What are the 4 R's of rifampin? RNA polymerase inhibitor, Revs up microsomal P450 (inducer), red/orange body fluids, rapid resistance if used alone
Rifampin is used as a prophylaxis in what two infections? Meningococcal and contacts of kids w/Haemophilus influenza type B (B for bad)
What is the prophylaxis for meningococcal infection (2)? Rifampin (drug of choice) or minocycline
What is the prophylaxis for gonorrhea that is commonly used in rape patients? Ceftriaxone
What is the prophylaxis for syphilis? Benzathine penicillin G
What is the prophylaxis for a history of recurrent UTIs? TMP-SMX (also nitrofurantoin, amoxicillin, cephalexin; looking to cover E coli)
What is the prophylaxis for pneumoncystis jiroveci (PCP) pneumonia in AIDS patients? TMP-SMX, aerosolized pentamidine
When should AIDS patients be prophylaxed for pneumocystis jiroveci? CD4 ct <200
What is the prophylaxis for endocarditis with surgical or dental procedures? Penicillins
What is the prophylaxis for MAC? Azithromycin
What is the treatment for MRSA? Vancomycin
What is the treatment for VRE (Vancomycin Resistant Enterococcus) Linezolid and streptogramins (quinupristin/dalfopristin)
How are treponema visualized since they don't gram stain very well? Darkfield microscopy and fluorescent Ab staining
What are the chronic granulomas of syphilis called? With what stage of syphilis are they associated? Gummas; tertiary
What are the CV, neurologic, and musculoskeletal signs of tertiary syphilis? Aortitis (tree bark aorta; vasa vasorum destruction), neurosyphilis (tabes dorsalis), Argyll Robertson pupils (accomodate but don't react), stroke without HTN, positive Romberg sign, and Charcot joint
What test do you use to screen for syphilis? What test confirms? VDRL (non-treponemal; also RPR; Ab reacts with beef cardiolipin) to screen. FTA-ABS (treponemal) to confirm.
What diseases cause a false VDRL? Viruses (mono, hepatitis), Drugs, Rheumatic fever, Lupus and Leprosy (VDRL)
Found in water contaminated with animal urine (seen in surfers in the tropics) Leptospira interorogans (also Hanta virus)
What are some symptoms of leptospirosis? flulike symptoms, fever, headache, abdominal pain, *jaundice*, and photophobia w/conjunctivitis
What is Weil's disease? A severe form of leptospirosis with jaundice and azotemia from liver and kidney dysfunction; also fever, hemorrhage, and anemia
With what stage of syphilis are painless chancres associated? Primary
With what stage of syphilis are condylomata lata and maculopapular rash on palms and soles associated? Secondary
Very high fever in a smoker accompanied by diarrhea, confusion, and cough causing chest pain; evidence of pneumonia on CXR. Legionella pneumophila
What stain must be used for Legionella? silver stain
What culture can be used to grow Legionella? Grow on charcoal yeast extract with iron and cysteine (French Legionnaire with his silver helmet sitting around a charcoal campfire with his iron dagger-- he is no sissy/cysteine)
Classic cause of atypical pneumonia Mycoplasma (also legionella and chlamydia pneumonia and chlamydia psittaci)
Mycoplasma is the only bacterial membrane containing ______; it requires this to grow in culture. Cholesterol
Walking pneumonia outbreaks usually occur in what age group and in which situations? <30yo; outbreaks in military and prisons (young men living together)
A high titer of what cold agglutinins can agglutinate or lyse RBCs with mycoplasma pneumoniae? IgM
What is the treatment for walking pneumonia caused by mycoplasma? Tetracyclin or erythromycin
Is penicillin used to treat walking pneumonia caused by mycoplasma? No! Mycoplasma have no cell wall so they are not susceptible to penicillin.
What is mycoplasma pneumoniae grown on? Eaton's agar (eatypical pneumonia)
What is the classic rickettsial triad? Headache, fever, and rash (vasculitis).
Why must Rickettsia live inside other cells? Needs CoA and NAD+.
Why is coxiella burnetti an atypical Rickettsial organism? Causes pneumonia, spore former, has a negative Weil-Felix reaction, has no rash, has no vector (aerosol transmission), doesn't have Rickettsia in the name
What organism causes Q fever? Coxiella burnetti
What is the treatment for Rickettsial diseases? Doxycycline
What causes Rocky Mountain spotted fever? Rickettsia rickettsii.
What are the symptoms of Rocky Mtn spotted fever? Rash on palms and soles (migrates to wrists, ankles, then trunk), headache, and fever
What is the differential for a rash on the palms and soles? Coxsackievirus A infection (hand, foot, and mouth disease), Rocky Mountain spotted fever, and Syphilis (you drive CA.R.S. using your palms and soles)
What is the Weil-Felix reaction? When the serum of a Rickettsia-infected patient is mixed with Proteus antigens, antirickettsial Ab cross-react to Proteus O antigens and agglutinate
In what Rickettsial infection is the Weil-Felix reaction absent? Coxiella burnettii
Why doesn't Chlamydia gram stain well? lacks muraminc acid in cell wall
Why is Chlamydia an obligate intracellular organism? It can't make it's own ATP. =( so sad
What stain can be used to visualized Chlamydia? Giemsa stain (also borrelia, plasmodium, and trypanosomes)
Patient with pet parrot comes in with symptoms of pneumonia. What organism is involved? Chlamydia psittaci-- notable for an avian reservoir
Name that Chlamydia! Reactive arthritis, conjunctivitis, nongonococcal urethritis, and PID. Merry Christmas to you too! Chlamydia trachomatis
Name that Chlamydia! Atypical pneumonia C pneumoniae and C psittaci; transmitted via aerosol
What is the treatment for chlamydial infections? Azithromycin or doxycycline
Name that Chlamydia trachomatis serotype! Lymphogranuloma venereum L1, L2, L3
Name that Chlamydia trachomatis serotype! chronic infection, causes blindess due to follicular conjunctivitis in Africa A, B, C
Name that Chlamydia trachomatis serotype! Urethritis/PID, ectopic pregnancy, neonatal pneumonia (staccato cough) D-K (you get STDs from a guy's D--K!)
What kind of eyedrops are given to neonates to prevent neonatal conjunctivitis from passing through a Chlamydia-infected birth canal? Azithromycin
Created by: sarah3148