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Non-gram staining
Day 4 (includes anti-TB drugs)
| Question | Answer |
|---|---|
| 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
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