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Microbiology
| Question | Answer |
|---|---|
| When is hepatitis most infective? | Prodrome period. 2-10 days, flu-like, fever, n/v. Blood, stool, and semen |
| What part of hepatitis has dark urine? | Acute illness, along with pale stools, RUQ discomfort, fatigue and anorexia |
| What type of virus is Hepatitis A? | Picornavirus, a single stranded RNA virus |
| How is hepatitis A transmitted? | Fecal oral |
| What is the approximate incubation of hepatitis A? | About a month (2-6 weeks) |
| What type of hepatitis has no chronic phase? | Hep A |
| Post -exposure prophylaxis for HAV needs to be given in what time frame? | Within 2 weeks. IgG is needed for ICH or over 40 |
| What kind of virus is hepatitis E? | Single stranded RNA, zoonotic with resoviors in swine |
| What type of Hepatitis causes fulminant hepatitis and death in 20% of Pregnant women? | Hepatitis E |
| When the hepatitis B surface antigen persists after acute infection, this means what? | Chronic HBV carrier |
| How is Hepatitis B transmitted? | Blood borne: IVDU and sexual contact, vertical if mom has high viremia in 3rd trimester |
| What are two institutional risk factors for HBV transmission? | dialysis and jails |
| What are the serum findings for Hepatits-B recovery? | Anti-HbS+ |
| What is the serology for chronic HBV? | HbS-Ag+ |
| Hepatitis delta is what kind of virus? | Defective RNA virus. Needs HBV for infection and replication |
| What type of virus is Hepatitis C? | Single stranded RNA virus |
| What is the approximate incubation for HepC? | Long, about 2 months |
| HCV co-infection with what causes rapid progression to cirrhosis? | HIV |
| For patients who recover from HepC, what is their serology? | Anti-HCV+, HCV-RNA- |
| What is the serology for chronic HCV? | Anti-HCV+ and HCV-RNA+ |
| What hepatitis viruses have high prevalence in Africa, Mediterranean, Amazon, Russia and SE asia | HBV and HDV (SE asia is HBV only) |
| What type of hepatitis causes hepatocellular carcinoma? | Hepatitis B and Hepatitis C |
| What kind of virus is HIV | Lentivirus, slow and indolent retrovirus |
| Causative agent of nausea, vomiting (onset < 6 hr) after eating cold cuts, or potato salad, or mayonnaise, or custards? | Staphylococcus aureus |
| Rapid-onset food poisoning is mediated by what component of staphylococcus? | Enterotoxin |
| Tx of staphylococcal food poisoning? | Rehydration |
| Microbial cause of nausea and vomiting, +/- diarrhea (onset < 6 hr) after eating reheated rice? | Bacillus cereus |
| Bacterial spores are resistant to heat due to what component? | dipicolinic acid core |
| Microbial cause of nausea, vomiting, watery diarrhea w/ rapid (onset >6 hr) after eating reheated meat or gravy? | Clostridium perfringens |
| Most likely cause of persistent dyspepsia in a pt not receiving NSAIDs is | Helicobacter pylori |
| Increased risk of gastric adenocarcinoma and MALT lymphoma | H. pylori colonization |
| Indications to treat H. pylori-associated PUD | Presence of organism |
| Standard first-line abx for PUD due to H. pylori is | PPI + clarith + amox |
| Cause of acute onset of diarrhea with rice-water stools, vomiting, dehydration during travel to South America | Vibrio cholerae |
| Pathophysiology of cholera is due to what mechanism? | A-B toxin causes increased cAMP |
| Cholera pathogen is isolated from stool by culture on selective medium called | thiosulfate-citrate-buffered sucrose (TCBS) agar |
| The comma-shaped cholera organisms are microscopically similar to | Campylobacter |
| Tx of cholera involves | Rehydration |
| Secretory diarrhea, fever and vomiting during travel are caused by | Enterotoxic E. coli |
| Secretory diarrhea w/ fatty, foul-smelling stools in campers, hikers; also day-care outbreaks is caused by | Giardia lamblia |
| Following ingestion of 15-25 cysts, excysted trophozoites adhere at brush border of enterocytes and contribute to malabsorption. | Giardiasis |
| Dx of giardiasis is confirmed by | Stool antigen (+) |
| Giardiasis is specifically treated with | Metronidazole |
| Protracted, secretory diarrhea w/ large fluid loss in AIDS is caused by | Cryptosporidium >> Cyclospora > Isospora |
| rank bloody diarrhea, after eating undercooked meats or drinking fruits drinks, is caused by prepared foods or water, contaminated w/ | E. coli O157:H7 |
| Pathogenesis of hemorrhagic enterocolitis caused by E. coli involves | Shiga toxin (a cytotoxin) |
| Complication of hemorrhagic enterocolitis in children | hemolytic uremic syndrome |
| Profuse diarrhea, fever, vomiting, and dehydration in infants is caused by | Rotavirus |
| Mechanism of rotaviral diarrhea involves | Villus destruction |
| Infantile watery diarrhea and fever are caused by | Adenovirus 40,41 |
| Outbreak of nausea, vomiting, fever in adults is caused by | Norovirus |
| Cause of nausea/vomiting, abdominal cramps, diarrhea +/- bloody 12-48h after eating eggs or poultry or peanut butter? | Non-typhoidal Salmonella |
| Abx treatment in acute gastroenteritis due to Salmonella spp. is not warranted to avoid | carrier (in bile ducts) state |
| Abx used only to treat septic phase of salmonella gastroenteritis is | ciprofloxacin |
| Cause of fevers (>103°), headaches; macular rash on torso (““rose spots””) abdominal pain and little diarrhea later; PE: bradycardia; hepatosplenomegaly (+/-) in a pt with hx of travel (to tropics)? | Salmonella typhi |
| Cause of diarrhea w/ occult blood, abdominal cramping and fever, 2d after ingestion of poultry-contaminated salad | Campylobacter jejuni |
| Abx to treat campylobacter enteritis with high fevers in pregnancy, and HIV is | Erythromycin |
| Cause of dysentery-like illness with fever + abdominal cramps, tenesmus + blood & mucus in children? | Shigella sonnei |
| Dysentery due to invasive Shigella spp. in elderly is treated with | Ciprofloxacin |
| Cause of dysentery-like illness (+/- pseudoappendicitis or pseudo- crohn syndrome) in the northern region after eating cheese | Yersinia enterocolitica |
| Cause of dysentery-like illness in a patient w/ hx of broad-spectrum abx use | Clostridium difficile |
| Clostridium difficile-associated diarrhea (CDAD) is mediated by toxins | A (enterotoxin) + B (cytotoxin). |
| Lab confirmation of CDAD does not require stool Cx, but is based on | EIA for stool toxins A or B |
| Besides rehydration and cessation of inciting meds, CDAD is treated with | Metronidazole (mild) or oral vancomycin (severe/relapse) |
| Health-care associated (nosocomial) spread of Clostridium difficile diarrhea and protracted outbreak is due to | Fecal-oral and/or contact w/ environmental spores |
| Hx of abdominal pain, tenesmus, stools with mucus + blood in a patient, who recently traveled to tropics; CBC: eosinophilia. | Amebic dysentery |
| Stool microscopy to confirm amebic dysentery should reveal characteristic trophozoites of Entamoeba histolytica w/ | endocytosed RBCs (distinction from luminal ameba) |
| Rx of amebic dysentery involves | Metronidazole + iodoquinol |
| Abscesses in liver or peritonitis in travelers w/ or w/o hx of amebic dysentery is confirmed by | Serology for E. histolytica |
| A boar hunter develops dysentery after eating meat at campsite; O & P test should reveal a ciliate parasite, known as | Balantidium coli |
| Most likely cause of chronic abdominal pain, diarrhea; intestinal obstruction; cholangitis; liver abscess, in children | Ascaris lumbricides |
| Ova & Parasite test using microscopy for oval eggs (with a thick coarse shell) in stool confirms | ascariasis |
| A child has stomach ache, distended abdomen, poor appetite. “Pearl-colored earthworm”-like organisms in the stool. Major immune response against this infection? | IgE |
| DOC of ascariasis is | Mebendazole |
| Vomiting, cramping, diarrhea, epigastric pain, weight loss in an immigrant from developing country is caused by | Strongyloides stercoralis |
| DOC of strongyloidosis is | Ivermectin |
| Pt w/ AIDS (low CD4+ counts) develops pulmonary infiltrates (+ eosinophilia) and/or gram negative sepsis. | Invasive strongyloidosis |
| Weakness, fatigue, lightheadedness, dyspnea, pruritis; pallor; iron- deficiency anemia; eosinophilia (hx of outdoor activity). | Hookworm (Necator americanas) infection |
| Fever, periorbital edema, subconjunctival hemorrhages, muscle weakness, and rash, after eating undercooked pork (Lab: eosinophilia., ␣CPK, ␣LDH &). | Trichinellosis |
| Abdominal pain, bloating, altered appetite after ingestion of sushi. CBC: megaloblastic anemia; leukocytosis/eosinophilia | Diphyllobothriasis (fish tapeworm) |
| Dx of tape worm infection is confirmed by | Proglottids in stool |
| Tape worm infections are treated with broad-spectrum agent | Praziquantel |
| Cause of fever, lymphadenopathy, hepatosplenomegaly in an immigrant from Africa or Orient; pt recalls wading in stagnant water. RUQ ultrasound (+); CBC: eosinophilia. | Schistosoma mansoni (Africa) S. japonicum (Far East) |
| Microscopy of stool in chronic stage of schistosomiasis reveals | Large eggs with lateral spine. |
| Chronic stage of schistosomiasis is treated with | Praziquantel |
| Patient with acute jaundice is HAV IgM (+); household contact should receive for prophylaxis | Inactivated HAV vaccine |
| Patient with jaundice for < 1 week has HBsAg (+), Anti-HBc IgM (+). | Acute HBV infection |
| Multiple sex partners, IDU, infants born to infected mothers are risk groups for which hepatitis virus | HBV |
| This is an enveloped, double stranded DNA virus w/ ss-break; transmitted by infective body fluids. | HBV |
| This asymptomatic man has hep serology profile of HBsAg (-), Anti-HBs (+), Anti-HBc IgG (+), Anti-HBc IgM (-). | Resolved hepatitis B |
| This man has jaundice and is HBsAg (+) > 6 months, Anti-HBs (-), HBeAg (+), Anti-HBc IgG (+), HBV DNA > 20,000 IU/ml | Chronic active hepatitis B |
| This man has jaundice and is HBsAg (+) > 6 months, HBeAg (+) and evidence of necroinflammation. He should receive | Peg-IFN␣ 2a + lamivudine (or cidofovir) |
| his man has no jaundice, but HBsAg (+) >6 months, Anti-HBs (-), Anti-HBc IgG (+), HBeAg (-), persistently normal ALT. | Inactive HBsAg carrier |
| This man, at the time of annual physical exam, reveals Anti-HBs (+) and other markers are (-) | HBV immunized |
| Virologic confirmation of chronic jaundice in a HBV-immunized pt w/ IDU or hemodialysis is based on | HCV RNA > HCV IgG |
| More chronicity of HCV (than HBV) is due to immune-evasive quasispecies generated during replication (in blood) of | error-prone HCV RNA virus |
| Fulminant hepatitis in a patient, who has multiple sexual partners and is HBsAg (+); HBcIgM (-), can be fatal due to what? | HDV superinfection. |
| Cause of acute onset of jaundice, nausea, right-upper quadrant pain, hepatomegaly in pregnant women in India | HEV |
| Fever, arthralgia, carditis, polyarthritis, chorea, erythema marginatum; elevated WBCs or ESR/CRP. Clinical Dx is confirmed by | Rising ASO titer |
| Type II hypersensitivity due to molecular mimicry in a immunological sequel of streptococcal pharyngitis causes | Acute rheumatic fever (ARF) |
| Type II hypersensitivity due to molecular mimicry in a immunological sequel of streptococcal pharyngitis causes | Acute rheumatic fever |
| Acute rheumatic fever diagnosed and treated with | Anti-streptolysin O (ASO) titer and benzathine penG |
| A man with IDU has flu-like symptoms; 1-3 minor peripheral signs: conjunctival hemorrhage, Janeway lesions, Osler nodes, Roth spots, plus vegetation in tricuspid valve. Blood Culture should yield | S. aureus |
| A pt w/ hx of extraction of impacted tooth 3 weeks ago now has subacute (native, mitral-valve) endocardits. Blood culture should yield | Viridans streptococci |
| A pt with AIDS and recent hx of UTI has now subacute, native mitral-valve endocarditis. Culure? | Enterococcus faecalis (or faecium) |
| DOC of acute endocarditis in patient with IDU due to sensitive S. aureus (MSSA) | Nafcillin +gentamicin |
| DOC of acute endocarditis in patient with IDU due to resistant S. aureus (MRSA) | Vancomycin + rifampin |
| DOC of subacute, native mitral-valve endocarditits due to viridans streptococci | PenG +/- gentamicin |
| DOC of subacute, prosthetic-valve endocarditis due to Staphylococcus epidermidis | Vancomycin + gentamicin |
| DOC of subacute, native mitral-valve endocardits due to Enterococcus faecalis (or faecium) | High-dose ampicillin + gentamicin |
| Patient with enterococcal bacteremia fails to respond to vancomycin. Resistance mechanism? | D-Ala-D-Ala is changed to D- Ala-D-lac |
| Hx of catheter-related endocarditis, involving prosthetic or native valves. BCx (+) for budding yeast. Pt does not respond to AmphoB or fluconazole; should receive | Caspofungin |
| Patient with colon cancer has bacteremia due to | Streptococcus bovis |
| Cause of febrile, malaise, arthralgia, dyspnea, edema, palpitations. ST/T wave change, heart block, dysrhythmias; CXR: cardiomegaly | Coxsackievirus > echovirus > Trypanosoma cruzi (Chagas) |
| hinoviruses and enteroviruses belong to picornavirus family, but the rhinoviruses differ from enteroviruses on | Growth at 22oC/noninvasive |
| Rhinovirus receptor in the nasal passages and upper tracheobronchial tree is | ICAM-1 |
| Rhinovirus, influenza, parainfluenza, coronavirus, RSV, metapneumovirus, and adenovirus all cause | Upper-respiratory infections (URIs) |
| Sinusitis, otitis, laryngitis, exacerbations of bronchitis and asthma are mostly secondary to | Viral URIs |
| In HEENT, Streptococcus pneumoniae, non-typable Haemophilus influenzae, Moraxella catarrhalis all cause | Acute otitis media (AOM) & sinusitis |
| Acute otitis media and sinusitis are empirically treated with amoxicillin + clavulanate. Why use clavulanate? | Haemophilus and Moraxella are ␣-lactamase producers |
| Cause of pharyngeal pain, dysphagia, fever; red throat + purulent exudate that responds to penicillin | Streptococcus pyogenes -Group A hemolytic |
| Group-A Beta-hemolytic Streptococcus from Group A by | Bacitracin sensitivity |
| Common mode of acquisition of URI due to Streptococcus pyogenes? | Infective droplets |
| Major virulence factor with anti-phagocytic function of Streptococcus pyogenes | M-protein fibrils |
| Damage in posterior pharynx and tonsils due to Streptococcus pyogenes is associated with what host response? | Pyogenic inflammation |
| DOC of acute bacterial pharyngitis in a pt w/ Pen allergy | Erythromycin > clindamycin |
| Pyogenic complication of streptococcal pharyngitis | Tonsillar abscess |
| Toxigenic complication of streptococcal pharyngitis | Scarlet fever >> TSS (rare) |
| Immunologic complication of streptococcal pharyngitis | Acute rheumatic fever |
| Cause of fever, red throat + purulent exudate - pseudomembrane with lymphadenopathy, in a pt w/ questionable immunization | Corynebacterium diphtheriae |
| Gram/special stain of Corynebacterium diphtheriae should show | Gram(+) rods in palisade arrangements/metachromatic granules |
| Virulence genotype of Corynebacterium diphtheriae is acquired by | Transduction (phage mediated transfer of exotoxin gene) |
| Isolate on tellurite agar culture of throat swab for a cause of diphtheria is confirmed by | Immunodiffusion (ELEK) assay for toxin |
| Mechanism of action of exotoxin of Corynebacterium diphtheriae | ADP ribosylation of EF-2 (inhibits protein synthesis) |
| Damage to pharynx and cardiac myosites due to Corynebacterium diphtheriae is mediated by | Cytotoxicity of A-B toxin |
| Virologic Dx of URI symptoms, fever; red throat + purulent exudate; hepato-splenomegaly, lymphadenopathy, in a teenager, is confirmed by | heterophile antibody (+) |
| Host cells preferentially infected by EBV are | B cells |
| EBV is biologically similar to what class of viruses? | herpes viruses |
| Host immune system controls the EBV infection, mediated by | CD8+ T lymphocytes |
| Rash occurs following which antibiotic(s) to treat infectious mononucleosis? | amoxicillin |
| Burkitt's lymphoma in some African population is a B-cell tumor due to oncogenesis by | EBV |
| Nasopharyngeal carcinoma, a B-cell tumor that is common in the Oriental population that consumes preserved fish, is due to oncogenesis by | EBV |
| Heterophile-negative infectious mononucleosis syndrome is due to ? | CMV |
| Gram-positive bacteria that cause acute otitis media | Streptococcus pneumoniae |
| Gram-negative diplococci bacteria that cause acute otitis media | Moraxellar catarrhalis |
| Gram-negative coccobacilli bacteria that cause | Haemophilus influenzae |
| Week + of of nasal obstruction, rhinorrhea; purulent nasal drainage + frontal pain/tenderness is treated with | Amoxicillin & Clavulanate |
| DOC for acute mastoiditis in a young child is amoxicillin & clavulanate; why? | Same etiology as acute otitis media |
| Cause of “seal-like barking” cough + episodic aphonia w/ symptoms of URI in a child | parainfluenza virus |
| Gram-stain-nonreactive organism that causes redness; purulent discharge at lid margin/eye corners, in a newborn | Chlamydia trachomatis |
| Most common cause of redness; tenderess; hyperpurulent d/c; eye stuck shut in AM, lid edema. Gram stain shows | Staphylococcus aureus |
| Cause of pharyngitis, conjunctivitis, fever with rhinitis, and cervical adenitis in a child. | Adenovirus |
| ause of burning, gritty feeling in eyes; diffuse conjunctival injection & profuse tearing + preauricular LN. | Adenovirus |
| Cause of foreign body sensation, lacrimation, photophobia, conjunctival hyperemia, and ulceration | HSV-2>>1 |
| ause of severe pain and skin lesions in dermatomal pattern involving the ophthalmic division of the trigeminal nerve. | VZV |
| Cause of painful, swollen, red eyes, with conjunctival hemorrhaging and excessive tearing in an outbreak | Enterovirus |
| Cause of chorioretinitis in AIDS, but CMV antigen (-) | Toxoplasma gondii |
| Cause of painful keratitis, chronic corneal ulcers in contact lens users, unresponsive to antibiotics | Acanthamoeba spp. |
| In an infant w/ questionable immunization, 2 wks of paroxysmal coughs, inspiratory "whoop" + post-tussive emesis | Bordetella pertussis |
| Pertussis toxin inhibits chemotaxis via downregulation of C3a/C5a receptor, resulting in? | lymphocytic leukocytosis in CBC |
| Three major virulence factors of “whooping cough” pathogen? | ADP-ribosylating toxin; tracheal cytotoxin; hemolysin |
| Three major virulence factors of “whooping cough” pathogen? | ADP-ribosylating toxin; tracheal cytotoxin; hemolysin |
| Cause of fever + drooling, stridor, dyspnea in a child w/ ?immunization (pt appears septic) | Haemophilus influenzae b |
| Major virulence factor of Haemophilus influenzae associated with pneumonia and meningitis | Capsular polysaccharide (antiphagocytic and anti-C3b) |
| Since, absent spleen places host at increased risk for invasive H. influenzae infection, pre-exposure prophylaxis prior to elective splenectomy is ? | Hib immunization |
| Major virulence factor of Haemophilus influenzae associated with pneumonia and meningitis | Capsular polysaccharide (antiphagocytic and anti-C3b) |
| Cause of acute exacerbation (cough, purulent sputum) in pt with chronic bronchitis (COPD); CXR: R/O pneumonia; Lab: sputum reveals Gram-negative coccobacilli. | Haemophilus influenzae (non capsular types) |
| Most common cause of lower-respiratory infections in neonates (babies < 4 wk)? | Streptococcus agalactiae (aka: group B streptococcus) |
| Since, absent spleen places host at increased risk for invasive H. influenzae infection, pre-exposure prophylaxis prior to elective splenectomy is ? | Hib immunization |
| Cause of acute exacerbation (cough, purulent sputum) in pt with chronic bronchitis (COPD); CXR: R/O pneumonia; Lab: sputum reveals Gram-negative coccobacilli. | Haemophilus influenzae (non capsular types) |
| Most common cause of lower-respiratory infections in neonates (babies < 4 wk)? | Streptococcus agalactiae (aka: group B streptococcus) |
| Cause of acute exacerbation (cough, purulent sputum) in pt with chronic bronchitis (COPD); CXR: R/O pneumonia; Lab: sputum reveals Gram-negative coccobacilli. | Haemophilus influenzae (non capsular types) |
| Most common cause of lower-respiratory infections in neonates (babies < 4 wk)? | Streptococcus agalactiae (aka: group B streptococcus) |
| Complicated illness in a newborn of a GBS-colonized mother is | Sepsis or meningitis |
| Complicated illness in a newborn of a GBS-colonized mother is | Sepsis or meningitis |
| A mother colonized (recto-vaginally) w/ GBS is at risk for preterm baby or premature membrane rupture. She should receive | Ampicillin |
| A mother colonized (recto-vaginally) w/ GBS is at risk for preterm baby or premature membrane rupture. She should receive | Ampicillin |
| n elderly comes up with an abrupt-onset fever, myalgia, headache, malaise, dry cough, sore throat and rhinitis, in winter. Illness could have been prevented w/ ? | annual influenza vaccine |
| Annual influenza vaccine protects at-risk subpopulation w/ 60% immune protection, and is composed of what 3 viruses? | A:H1N1 + A:H3N2 + B |
| Secondary spread of influenza occurs in a crowded setting (within 6 feet of infected person) via | respiratory droplets |
| A mother colonized (recto-vaginally) w/ GBS is at risk for preterm baby or premature membrane rupture. She should receive | Ampicillin |
| n elderly comes up with an abrupt-onset fever, myalgia, headache, malaise, dry cough, sore throat and rhinitis, in winter. Illness could have been prevented w/ ? | annual influenza vaccine |
| Annual influenza vaccine protects at-risk subpopulation w/ 60% immune protection, and is composed of what 3 viruses? | A:H1N1 + A:H3N2 + B |
| n elderly comes up with an abrupt-onset fever, myalgia, headache, malaise, dry cough, sore throat and rhinitis, in winter. Illness could have been prevented w/ ? | annual influenza vaccine |
| Occasionally serious pandemic of influenza occurs due to antigenic shift. This occurs due to what genetic mechanism? | Reassortment of 8 genomic segments |
| Annual vaccine to prevent influenza is needed due to antigenic drift. This occurs due to what genetic mechanism? | Mutation |
| Annual influenza vaccine protects at-risk subpopulation w/ 60% immune protection, and is composed of what 3 viruses? | A:H1N1 + A:H3N2 + B |
| Occasionally serious pandemic of influenza occurs due to antigenic shift. This occurs due to what genetic mechanism? | Reassortment of 8 genomic segments |
| Bacterial superinfection, causing pneumonia, after influenza occurs in elderly in nursing home? | S. pneumoniae > S. aureus |
| DOC of pts with influenza <48 hours is | Oseltamivir |
| Secondary spread of influenza occurs in a crowded setting (within 6 feet of infected person) via | respiratory droplets |
| Bacterial superinfection, causing pneumonia, after influenza occurs in elderly in nursing home? | S. pneumoniae > S. aureus |
| Annual vaccine to prevent influenza is needed due to antigenic drift. This occurs due to what genetic mechanism? | Mutation |
| A seriously ill young adult w/ necrotizing pneumonia, poorly responding to vancomycin, should get | Linezolid |
| Occasionally serious pandemic of influenza occurs due to antigenic shift. This occurs due to what genetic mechanism? | Reassortment of 8 genomic segments |
| DOC of pts with influenza <48 hours is | Oseltamivir |
| Bacterial superinfection, causing pneumonia, after influenza occurs in elderly in nursing home? | S. pneumoniae > S. aureus |
| RSV causes seasonal, nosocomial pneumonia outbreaks in the pediatric units via | Contact spread |
| A seriously ill young adult w/ necrotizing pneumonia, poorly responding to vancomycin, should get | Linezolid |
| Cause of febrile illness + bronchiolitis in an infant; BAL viral culture (+). | Respiratory syncytial virus (RSV) |
| Pathophysiology of asthmatic Sx + Sn in bronchioles in high-risk infants due to RSV involves | type III hypersensitivity |
| RSV causes seasonal, nosocomial pneumonia outbreaks in the pediatric units via | Contact spread |
| Pathophysiology of asthmatic Sx + Sn in bronchioles in high-risk infants due to RSV involves | type III hypersensitivity |
| Inhaled anti-viral drug used in the sickest infants with bronchiolitis is | Ribavirin |
| Inhaled anti-viral drug used in the sickest infants with bronchiolitis is | Ribavirin |
| Insidious onset of fever, dry cough, malaise and sore throat in young adults. CBC: anemia; CXR: diffuse infiltrates | Mycoplasma pneumoniae |
| Dx of “walking pneumonia” in older children and young adults, while waiting for serology, is supported by | cold agglutinin (IgM Ab against RBCs) titer ␣1:32 |
| Insidious onset of fever, dry cough, malaise and sore throat in young adults. CBC: anemia; CXR: diffuse infiltrates | Mycoplasma pneumoniae |
| B-lactam abx is ineffective for Tx of mycoplasma pneumonia because | Wall-less bacteria |
| A male child with mycoplasma pneumonia now has systemic rash, covering 10% of his body | erythema multiforme (SJS) |
| Cause of upper respiratory Sx, slow onset of cough (laryngitis) >2wks + CXR: patchy infiltrate, viral serology (+) | Chlamydophila pneumoniae |
| The most common cause of community-acquired pneumonia is? | Streptococcus pneumoniae |
| A male child with mycoplasma pneumonia now has systemic rash, covering 10% of his body | erythema multiforme (SJS) |
| Cause of rapid onset of high fever, cough, & sputum, dyspnea; tachypnea in an elderly; CXR: lobar infiltrate; CBC: pronounced neutrophilic leukocytosis with left shift, is | Streptococcus pneumoniae |
| Cause of upper respiratory Sx, slow onset of cough (laryngitis) >2wks + CXR: patchy infiltrate, viral serology (+) | Chlamydophila pneumoniae |
| The most common cause of community-acquired pneumonia is? | Streptococcus pneumoniae |
| Gram-positive diplococci from sputum from a patient with lobar pneumonia yield ␣-hemolytic colonies and are confirmed by | Capsular swelling (Quelling rxn) |
| alpha-hemolytic colonies of Streptococcus pneumoniae is differentiated from viridans streptococci definitively confirmed by | Optochin sensitivity |
| Cause of rapid onset of high fever, cough, & sputum, dyspnea; tachypnea in an elderly; CXR: lobar infiltrate; CBC: pronounced neutrophilic leukocytosis with left shift, is | Streptococcus pneumoniae |
| Cause of upper respiratory Sx, slow onset of cough (laryngitis) >2wks + CXR: patchy infiltrate, viral serology (+) | Chlamydophila pneumoniae |
| The most common cause of community-acquired pneumonia is? | Streptococcus pneumoniae |
| Population w/ incidence of pneumococcal pneumonia is | AIDS |
| Gram-positive diplococci from sputum from a patient with lobar pneumonia yield ␣-hemolytic colonies and are confirmed by | Capsular swelling (Quelling rxn) |
| incidence of colonization of what organism is seen in very young and elderly, crowding, following viral URI ( increase in PAF receptors), fall/winter season? | Streptococcus pneumoniae |
| Streptococcus pneumoniae is transmitted by | Respiratory droplets |
| Nasopharyngeal mucosal colonization is facilitated by | IgA protease |
| Streptococcus pneumoniae reaches lungs after nasopharyngeal colonization via | aspiration |
| Major virulence factor, facilitating invasion and dissemination of Streptococcus pneumoniae is | Polysaccharide capsule |
| Pneumococcal cell wall peptidoglycans, teichoic acid elicit | Inflammation |
| Increased Lung cell injury in pneumococcal pneumonia is caused by virulence factor? | Pneumolysin (␣alpha-hemolysin) |
| Multiple myeloma, C3 deficiency, asplenia - Hg SS, COPD, diabetes, alcoholism, smokers are risk factors for mortality due to | pneumococcal pneumonia |
| Streptococcus pneumoniae is transmitted by | Respiratory droplets |
| Nasopharyngeal mucosal colonization is facilitated by | IgA protease |
| Streptococcus pneumoniae is transmitted by | Respiratory droplets |
| Streptococcus pneumoniae reaches lungs after nasopharyngeal colonization via | aspiration |
| Major virulence factor, facilitating invasion and dissemination of Streptococcus pneumoniae is | Polysaccharide capsule |
| Pneumococcal cell wall peptidoglycans, teichoic acid elicit | Inflammation |
| Increased Lung cell injury in pneumococcal pneumonia is caused by virulence factor? | Pneumolysin (␣alpha-hemolysin) |
| Major virulence factor, facilitating invasion and dissemination of Streptococcus pneumoniae is | Polysaccharide capsule |
| Multiple myeloma, C3 deficiency, asplenia - Hg SS, COPD, diabetes, alcoholism, smokers are risk factors for mortality due to | pneumococcal pneumonia |
| Hematologic marker for poor prognosis of pneumococcal pneumonia is | Leukopenia |
| Hematologic marker for poor prognosis of pneumococcal pneumonia is | Leukopenia |
| Emipiric DOC of community acquired in pts at risk or w/ comorbidity is | Azithromycin (or levofloxacin) + ceftriaxone |
| Increased Lung cell injury in pneumococcal pneumonia is caused by virulence factor? | Pneumolysin (␣alpha-hemolysin) |
| Pneumonia due to highly penicillin-resistant Streptococcus pneumoniae (Pen MIC >8) should receive | moxifloxacin or vancomycin |
| Pneumonia due to highly penicillin-resistant Streptococcus pneumoniae (Pen MIC >8) should receive | moxifloxacin or vancomycin |
| Mechanism of penicillin resistance in Streptococcus pneumoniae is | PBP alteration by mutation |
| Emipiric DOC of community acquired in pts at risk or w/ comorbidity is | Azithromycin (or levofloxacin) + ceftriaxone |
| Pt w/ agammaglobulinemia or asplenia or sick-cell anemia or decreased C3 should be vaccinated with | Pneumococcal polysaccharide vaccine (PPSV: 23-valent) |
| Mechanism of penicillin resistance in Streptococcus pneumoniae is | PBP alteration by mutation |
| Cause of necrotizing pneumonia >72 hrs after hospitalization of complicated viral illness | Staphylococcus aureus (assume MRSA) |
| Hx of a patient w/ seizure illness has fever, cough evolving over 2-4 wks; CXR infiltrate | Aspiration pneumonia |
| Community-acquired respiratory pathogens that cause aspiration pneumonia | Streptococcus pneumoniae > Anaerobes |
| Pt w/ agammaglobulinemia or asplenia or sick-cell anemia or decreased C3 should be vaccinated with | Pneumococcal polysaccharide vaccine (PPSV: 23-valent) |
| Mechanism of penicillin resistance in Streptococcus pneumoniae is | PBP alteration by mutation |
| 183. Hx: a patient w/ serious CAD now on a ventilator, acquires bronchopneumonia >72 hrs after hospitalization | Pseudomonas aeruginosa (VAP) |
| Hospital-acquired respiratory pathogens that cause aspiration pneumonia | Gram-negative bacilli > S. aureus +/- anaerobes |
| Cause of necrotizing pneumonia >72 hrs after hospitalization of complicated viral illness | Staphylococcus aureus (assume MRSA) |
| linical Dx of sudden dyspnea +/- cyanosis, fever, wheezing, often ARDS-like picture is | acid-related pneumonia |
| Pt w/ agammaglobulinemia or asplenia or sick-cell anemia or decreased C3 should be vaccinated with | Pneumococcal polysaccharide vaccine (PPSV: 23-valent) |
| Hx: a patient w/ serious CAD now on a ventilator, acquires bronchopneumonia >72 hrs after hospitalization | Pseudomonas aeruginosa (VAP) |
| Hx of a patient w/ seizure illness has fever, cough evolving over 2-4 wks; CXR infiltrate | Aspiration pneumonia |
| Community-acquired respiratory pathogens that cause aspiration pneumonia | Streptococcus pneumoniae > Anaerobes |
| Community-acquired respiratory pathogens that cause aspiration pneumonia | Streptococcus pneumoniae > Anaerobes |
| Hospital-acquired respiratory pathogens that cause aspiration pneumonia | Gram-negative bacilli > S. aureus +/- anaerobes |
| linical Dx of sudden dyspnea +/- cyanosis, fever, wheezing, often ARDS-like picture is | acid-related pneumonia |
| Hospital-acquired respiratory pathogens that cause aspiration pneumonia | Gram-negative bacilli > S. aureus +/- anaerobes |
| Empiric DOC of necrotizing pneumonia in a patient with seizure illness | clindamycin + levofloxacin |
| Pneumonia in homeless/alcoholics; Gram-positive diplococci in sputum Gram smear. | Streptococcus pneumoniae |
| linical Dx of sudden dyspnea +/- cyanosis, fever, wheezing, often ARDS-like picture is | acid-related pneumonia |
| Targeted Abx for anaerobic aspiration pneumonia is | clindamycin |
| Pneumonia in homeless/alcoholics; Gram-negative rods in sputum smear | Klebsiella pneumoniae |
| Pneumonia in homeless/alcoholics; Gram-positive diplococci in sputum Gram smear. | Streptococcus pneumoniae |
| Common cause of pneumonia in pts with CF | Pseudomonas aeruginosa |
| Sputum of a patient with hospital-acquired pneumonia yields a Gram-negative rod that is oxidase (+) | Pseudomonas aeruginosa |
| Common cause of external otitis due to hot tub use is | Pseudomonas aeruginosa |
| A patient with diabetes has osteomyelitis after penetrating foot injury. | Pseudomonas aeruginosa |
| Pneumonia in homeless/alcoholics; Gram-negative rods in sputum smear | Klebsiella pneumoniae |
| The most widely used anti-pseudomonal penicillin | Piperacillin > imipenem |
| The most widely used anti-pseudomonal aminoglycoside | Tobramicin > gentamicin |
| This pt >50 years, smoking hx, dec CMI␣ has pneumonia; diarrhea, renal failure. Urine antigen (+) for pathogen. Pt responds to azithromycin. | Legionella penumophila |
| Penicillin is ineffective against Legionnaire’s because | Intracellular organism |
| Cause of pulmonary embolism in a pt with IVDU | Staphylococcus aureus |
| Asymptomatic patient with PPD (+) | Latent tuberculosis infection |
| Cough > 2 wks, fever, night sweats, weight loss, hemoptysis, SOB; CXR: upper lobe infiltrate. | Active Mycobacterium tuberculosis infection |
| Pyridoxine is added to 4-drug therapy for TB to prevent | neuropathy (due to INH) |
| Pt w/ TB fails to respond to 4-drug regimen w/ INH+RIF resistance because | Multiply drug-resistant (MDR) TB |
| Common cause of pneumonia in pts with CF | Pseudomonas aeruginosa |
| Cause of TB-like Dz that does not respond to 1o TB Tx regimen, in a pt. w/ AIDS | MAC |
| Sputum of a patient with hospital-acquired pneumonia yields a Gram-negative rod that is oxidase (+) | Pseudomonas aeruginosa |
| Hx of chronic pneumonia w/ lung bpsy histopathology (+) for hyphae 2-4μm wide, septate, acute- angle branching. | Aspergillus fumigatus |
| Common cause of external otitis due to hot tub use is | Pseudomonas aeruginosa |
| Cause of TB-like LRI in a pt with outdoor activity (Giemsa stain of bronchoscopy specimen: (+) for 2-5 micro meter yeasts) is | Histoplasma capsulatum |
| A patient with diabetes has osteomyelitis after penetrating foot injury. | Pseudomonas aeruginosa |
| The most widely used anti-pseudomonal penicillin | Piperacillin > imipenem |
| TB-like Dz w/ ulcerative skin lesions. lung bpsy histopathology (+) for large yeast w/ broad-based bud. Rx? | Intraconazole |
| Hx of acute onset of cough, fever, infiltrate in a black male with dec CMI␣; histopathology of lung (+) for a large sac of endospores. DOC? | Fluconazole (indefinite) |
| Common cause of external otitis due to hot tub use is | Pseudomonas aeruginosa |
| The most widely used anti-pseudomonal aminoglycoside | Tobramicin > gentamicin |
| Granular specimen from draining fistulae from a pt with LRI on anaerobic culture should yield | Actinomyces israelii |
| A patient with diabetes has osteomyelitis after penetrating foot injury. | Pseudomonas aeruginosa |
| The most widely used anti-pseudomonal penicillin | Piperacillin > imipenem |
| This pt >50 years, smoking hx, dec CMI␣ has pneumonia; diarrhea, renal failure. Urine antigen (+) for pathogen. Pt responds to azithromycin. | Legionella penumophila |
| Pt with AIDS or organ transplant has indolent pneumonia, w/ or w/o CNS abscess or granuloma. | Nocardiosis |
| rganism w/ characterization of Gram-positive branching, beaded, filamentous rod, weakly acid fast is | Nocardia asteroids |
| Penicillin is ineffective against Legionnaire’s because | Intracellular organism |
| This pt >50 years, smoking hx, dec CMI␣ has pneumonia; diarrhea, renal failure. Urine antigen (+) for pathogen. Pt responds to azithromycin. | Legionella penumophila |
| Asymptomatic patient with PPD (+) | Latent tuberculosis infection |
| DOC of pneumocystis pneumonia (PCP) | TMP-SMX |
| Cough > 2 wks, fever, night sweats, weight loss, hemoptysis, SOB; CXR: upper lobe infiltrate. | Active Mycobacterium tuberculosis infection |
| Pt has urinary urgency, frequency, dysuria; lab: pyuria (+) or nitrite (+) | Cystitis due to E. coli |
| Pyridoxine is added to 4-drug therapy for TB to prevent | neuropathy (due to INH) |
| Microbial (structure) factor favoring bacterial persistence /colonization and UTI is | bacterial binding via fimbriae |
| Pt w/ TB fails to respond to 4-drug regimen w/ INH+RIF resistance because | Multiply drug-resistant (MDR) TB |
| Factor favoring bacterial persistence/colonization and UTI despite high osmolarity and urea concentrations and low pH is | high bacterial growth rates |
| Pt w/ TB fails to respond to 4-drug regimen w/ INH+RIF resistance because | Multiply drug-resistant (MDR) TB |
| Cause of TB-like Dz that does not respond to 1o TB Tx regimen, in a pt. w/ AIDS | MAC |
| Host factor favoring bacterial persistence/colonization and UTI is | Urinary stasis |
| ause of chronic pneumonia in a patient with cancer, receiving cytotoxic chemotherapy; lung-CT: halo/crescent sign (+)? | Aspergillus fumigatus |
| ause of chronic pneumonia in a patient with cancer, receiving cytotoxic chemotherapy; lung-CT: halo/crescent sign (+)? | Aspergillus fumigatus |
| Host factor favoring bacterial persistence/colonization and UTI despite frequent voiding and high urinary flow is | Absence of bactericidal effects of secreted proteins |
| Hx of chronic pneumonia w/ lung bpsy histopathology (+) for hyphae 2-4μm wide, septate, acute- angle branching. | Aspergillus fumigatus |
| Pyogenic inflammation in complicated UTI due to Gram- negative bacteria is due to | Lipopolysaccharide (LPS) |
| Pt with AIDS has blood culture (+) for histoplasmosis. DOC has effects on | Ergosterol in fungal cell membrane |
| TB-like Dz w/ ulcerative skin lesions. lung bpsy histopathology (+) for large yeast w/ broad-based bud. Rx? | Intraconazole |
| Hx of acute onset of cough, fever, infiltrate in a black male with dec CMI␣; histopathology of lung (+) for a large sac of endospores. DOC? | Fluconazole (indefinite) |
| Cause of TB-like LRI in a pt with outdoor activity (Giemsa stain of bronchoscopy specimen: (+) for 2-5 micro meter yeasts) is | Histoplasma capsulatum |
| Pt w/ aspiration pneumonia with cervico-facial lesion should respond to | Penicillin G |
| Pt with AIDS has blood culture (+) for histoplasmosis. DOC has effects on | Ergosterol in fungal cell membrane |
| Pt with AIDS or organ transplant has indolent pneumonia, w/ or w/o CNS abscess or granuloma. | Nocardiosis |
| TB-like Dz w/ ulcerative skin lesions. lung bpsy histopathology (+) for large yeast w/ broad-based bud. Rx? | Intraconazole |
| rganism w/ characterization of Gram-positive branching, beaded, filamentous rod, weakly acid fast is | Nocardia asteroids |
| Hx of acute onset of cough, fever, infiltrate in a black male with dec CMI␣; histopathology of lung (+) for a large sac of endospores. DOC? | Fluconazole (indefinite) |
| Hx of non-productive cough, fever and dyspnea evolving over 2-4 wks. CXR (+): bilateral interstitial infiltrates, hypoxemia; ␣LDH, CD4 count <200/mm | Pneumocystis pneumonia |
| Pt w/ aspiration pneumonia with cervico-facial lesion should respond to | Penicillin G |
| DOC of pneumocystis pneumonia (PCP) | TMP-SMX |
| Granular specimen from draining fistulae from a pt with LRI on anaerobic culture should yield | Actinomyces israelii |
| Microbial (structure) factor favoring bacterial persistence /colonization and UTI is | bacterial binding via fimbriae |
| Pt with AIDS or organ transplant has indolent pneumonia, w/ or w/o CNS abscess or granuloma. | Nocardiosis |
| Factor favoring bacterial persistence/colonization and UTI despite high osmolarity and urea concentrations and low pH is | high bacterial growth rates |
| Host factor favoring bacterial persistence/colonization and UTI is | Urinary stasis |
| Host factor favoring bacterial persistence/colonization and UTI despite frequent voiding and high urinary flow is | Absence of bactericidal effects of secreted proteins |
| rganism w/ characterization of Gram-positive branching, beaded, filamentous rod, weakly acid fast is | Nocardia asteroids |
| Pyogenic inflammation in complicated UTI due to Gram- negative bacteria is due to | Lipopolysaccharide (LPS) |
| Hx of non-productive cough, fever and dyspnea evolving over 2-4 wks. CXR (+): bilateral interstitial infiltrates, hypoxemia; ␣LDH, CD4 count <200/mm | Pneumocystis pneumonia |
| DOC of pneumocystis pneumonia (PCP) | TMP-SMX |
| Pt has urinary urgency, frequency, dysuria; lab: pyuria (+) or nitrite (+) | Cystitis due to E. coli |
| Microbial (structure) factor favoring bacterial persistence /colonization and UTI is | bacterial binding via fimbriae |
| Factor favoring bacterial persistence/colonization and UTI despite high osmolarity and urea concentrations and low pH is | high bacterial growth rates |
| Host factor favoring bacterial persistence/colonization and UTI is | Urinary stasis |
| Host factor favoring bacterial persistence/colonization and UTI despite frequent voiding and high urinary flow is | Absence of bactericidal effects of secreted proteins |
| Pyogenic inflammation in complicated UTI due to Gram- negative bacteria is due to | Lipopolysaccharide (LPS) |
| Empiric DOC to treat community-acquired UTI in adults is | ciprofloxacin |
| DOC to treat UTI in pregnant women is | Nitrofurantoin |
| Gram-positive bacteria that cause uncomplicated UTI in sexually active, young women are | Staphylococcus saprophyticus |
| Differentiation of Staphylococcus saprophyticus from S. epidermidis (both coagulase negative) is based on | novobiocin resistance |
| An elderly or pt with risks of urinary stasis, fever, chills, flank pain, and CVA tenderness; Lab: pyuria, casts, nitrite+. | Pyelonephritis due to E. coli |
| What causes at UTI that is a gram negative rod, encapsulated and has intrinsic ampicillin resistance? | Klebsiella pneumoniae |
| What causes at UTI that is a gram negative rod, slow fermenter, red pigment? | Serretia marcescens |
| What causes at UTI that is a gram negative rod, mobile, and slow fermenter ? | Proteus mirabilis |
| What causes at UTI that is a non-fermenter, blue pigment especially older woman in nursing home? | Pseudomonas aeurginosa |
| What causes at UTI that is a gram positive chain, catalase negative, grows in salt and penicillin resistant? | Enterococcus faecalis |
| If UTI is not improving with therapy, what test next? | Renal ultrasound to look for obostruction |
| Endotoxin that mounts pro-inflammatory cytokines responsible for endotoxic shock is | Lipid A of LPS |
| Genital chancre starts as a papule, ulcerates to form a single, painless and clean based ulcer is what? | Primary Syphilis (Treponema pallidum) |
| What drug can be given for syphilis if the patient is penn allergic? | Doxycycline |
| A woman presents with painful clustered vesicles with a red base and urinary retention | HSV-2 |
| Giemsa stain of fluid from herpetic lesion reveals | Multinucleated giant cells |
| If a patient does not respond to acyclovir for genital herpes, what is the problem | thymidine kinase deficient HSV |
| What is the cause of painful genital ulcers that have pus, grey base with painful inguinal adenitis | Haemophilus ducreyi (fastidious organism localized with neutrophils and fibrin in chancroid) |
| Most common cause of mucopurulent endocervical exudate in a young woman is? | Chlamydia trachomatis |
| What is the treatment for non-gonococcal urethritis | Azythromycin |
| A rare cause of genital ulcers, inguinal lymphadenopathy is | Chlamydia trachomatis |
| What infection can cause cervical motion tenderness in a woman with a tubo-ovarian abcess | PID |
| What is a gram-negative diplococci, PMNs in a man with mucopurulent urethritis | Neisseria gonorrhoeae |
| Immune evasion of neisseria gonorrhoeae | Antigenic variation of pili |
| Auxotrophic strains of N. gonorrhoeae can cause what type of infection? | Septic arthritis |
| What is the most frequent complication of gonococcal infection in men? | Epididymitis |
| Why is urethritis treated with ceftriaxone and azithromycin? | Concurrent gonococcus and chlamydia |
| Koilocytes in endocervical biopsy is | HPV 6 and 11 |
| Atypcial squamous cells on pap smear with no infection | HPV 16 and 18 |
| Strawberry cervix | motile tissue flagellate |
| Vaginal discharge with fishy odor, normal cervix | Gardnerella vaginalis |
| Bacterial vaginosis of anaerobic mobiluncus species and what other bug? | Gardnerella vaginalis |
| What is the treatment for bacterial vaginosis | metronidazole |
| curdy discharge from pregnant woman? | budding yeasts with pseudohyphae |
| What is a fungus normal commensal of the skin, GI, GU tract? | candida albicans |
| What is the mechanism on drugs for vulvovaginal candidiasis | blocks C14alpha-lanosterol demethylase |
| A young man present with a mono-like illness, ALT elevations and maculopapular rash. Monospot negative, what is it? | Acute retroviral syndrome (Less than 10,000 copies/ml=viral load) |
| What is the time from infection acquisition to acute seroconversion? | 6-12 weeks |
| In what gene is the homozygous deletion that confers resistance to infection and protection against progression | CCR5 |
| Host cells that trap HIV and mediate efficient transinfection of CD4+ cells are | Dendritic cells |
| What is the CD4+ count with chronic diarrhea, oral thrush, toxo encephalitis | less than 50 cells/ml |
| What is the most common cause of HIV associated peripheral and mucosal ulcers? | HSV-1 |
| What is the most common cause of HIC- associated nodules? | HHV-8 |
| AIDs patient with fatigue, abdominal pain, diarrhea, constitutional symptoms, dry cough with SOB? | MAC |
| What causes retinitis, viral pneumonitis and esophagitis in AIDs? | CMV |
| What is the CD4+ count for CMV? | Less than 50 |
| Ring enhancing lesions in AIDs patient other than toxo? | JC virus. Causes hemiparesis, visual problems, ataxia, aphasia, CN deficit. |
| Objective of HAART is to reduce viremia to what genomic level of RNA? | less than 50 copies |
| What is the initial HAART drugs? | Emtricitabine, tenofovir, efavirenz |
| What drug binds gp41 and prevents constitutional change required for viral fusion into cells? | enfuvirtide |
| What HIV drug inhibits integrase? | raltegravir |
| What antibiotic is needed with a CD4 count less than 200? | TMP-SMX for PCP |
| What is the treatment for toxo and PCP in AIDs | Bactrim |
| CD4 less than 100 with PPD+, treatment? | INH + pyridoxine |
| What is the antibacterial prophylaxis for MAC? | Azithromycin |
| What bug for an AIDs patient with a cat scratch, HSM, adenopathy? | Bartonella henselae |
| What is the cause of chorioretinitis in a neonate after mom had a mono-like illness post undercooked beef or pork? | Toxoplasma gondii |
| Neonate has deafness, cataracts, heart defects? | congenital rubella syndrome |
| Microcephaly, seizures, sensorineural hearing loss, feeding difficulties, petechial rash, HSM is what? | CMV |
| What virus that establishes life-long latency is a ds-DNA beta-herpesvirus | CMV |
| What Rx should HIV(+) women get before giving birth? | Nevirapine |
| Neonate with cutaneous lesions, jaundice, saddle nose, saber shins, Hutchinson teeth, CN VIII deafness? | tertiary syphilis |
| Neonatal septicemia or meningits when mom had a flu-like sickness after eating cheese? | Listeria monocytogenes |
| What causes a maculopapular rash, off white lesions on buccal mucosa that MMR prevents? | Measles |
| Maculopapular rash starting on face and moving to foot, MMR prevents | Rubella |
| Vesicular rash with moderate pain in kids | VZV |
| Sclarlet fever is what bug | Group A strep |
| Maculopapular slapped face rash in kid? | Parvovirus B19 |
| Maculopapular rash and systemic disease in ICH? | HHV-6 |
| Rubella virus is what kind of virus? | RNA togavirus |
| What affects scalp and beard resulting in scaly and crusted plaques | Dermatophytes (KOH shows hyphae and spores) |
| Most common cause of cutaneous mycoses | Trichophyton |
| Cutaneous mycosis assoc with animal contact? | microsporum |
| Drug for cutaneous mycoses? | itraconazole |
| Topical drug for cutaneous mycoses | terbinafine |
| Subcutaneous lesions with slow spread in a gardener or from rose-thorn injury? | Sporotrichosis (Sporothrix schenckii) |
| What is a dimorphic fungus that grows as a cigar shaped yeast at 37 and produces septate hyphae and conidia at 25 in flowers? | Sporothrix schenckii |
| Drug used for Sporotrichosis? | Itraconazole |
| What bug causes a curbuncle (subq lesion) | Staph aureus |
| superficial pustules-> erosions covered by honey colored crusts in kids are what bug? | Staph aureus>>Strep pyogenes |
| Bullae that rupture covered by light brown crusts is what diagnosis? | Bullous impetigo |
| mecA gene that encodes PBP2a, has low affinity for beta-lactams = resistance to what drug | Nafcillin |
| What causes Erysipelas, a butterfly wing rash on the face? | Strep pyogenes |
| What is a common cause of cellulitis? | Strep pyogenes |
| What microbial factor promotes degradation of C3b by binding to factor H | M protein |
| Cellulitis caused by a cat bite? | Pasteurella multocida |
| Cellulitis caused by salt water exposure? | Vibrio vulnificus |
| Cellulitis caused by fresh water exposure? | Aeromonas hydrophilia |
| Cellulitis when the patient is neutropenic? | pseudomonas aeruginosa |
| Cellulitis caused by a human bite? | Eikenella corrodens |
| What is the most likely bug causing osteomyelitis (left shift) | Staph aureus (protein A is virulence factor) |
| How does staph aureus damage neutrophils? | Penton-Valentine leukocydin |
| What causes osteomyelitis and osteochondritis in ICH? | Pseudomonas aeruginosa |
| What causes osteomyelitis in a sickle cell patient | Salmonella typhimurium |
| If the blood culture is negative for chronic veretebral osteomyelitis what is the organism? | TB |
| Septic arthritis in sexually active person that responds to ceftriaxone? | Neisseria gonorrhoeae |
| Septic arthritis in a patient with Rheumatoid arthritis? | S. Aureus |
| Septic arthritis in a patient with IVDU? | Staph or pseudomonas |
| Septic arthritis with unpasteurized dairy products consumed? | Brucella |
| Septic arthritis in a diabetic patient? | S. agalactiae- group B step |
| Reactive arthritis sexually acquired? | C. trachomatis and gonorrhoeae |
| Reactive arthritis non-sexually acquired? | Campylobacter, Salmonella |
| Bacteremia in neutropenic patients with a central line? | Staphylococcus epidermidis |
| Intrabdominal abcess with putrid pus or anaerobic bacteremia in a patient with invasive adenocarcinoma? | Bacteriodes fragilis |
| What cause of toxic shock responds to Vanco and clindamycin? | MRSA |
| High fever, diffuse sunburn-like rash, desqumation of palms and soles, necrotizing faciiits is what? | Streptococcal toxic shock syndrome |
| Drugs for streptococcal toxic shock syndrome? | PenG+ Clindamycin |
| **A neutropenic patient has positive blood cultures for Beta-D-Glucan antigenemia, what drug do you prescribe? | Caspofungin |
| **A patient has a line -associated infection and a invasive adenocarcinoma. Positive blood culures for Beta-D-glucan antigenemia. What drug is used? | Fluconazole |
| What causes meningoencephalitis post URI in the SW united states | Coccidioides immitis |
| What will CSF show in a patient with fever, cognitive deficits, focal neurological signs and temporal lobe involvement | CSF PCR (+) HSV2 |
| What typically causes fever, cognitive deficits, focal signs, seizures, abnormal mental status with ataxia, hemi-paresis in an AIDS patient? | JC virus |
| Fever, cognitive deficits, focal signs, seizures, changes in mental status with ataxia possible hemiparesis in adult during outdoor activity? | West Nile |
| A patient with a CD4+ count of less than 50 shows cognitive deficits, focal signs, seizures and ring enhancing lesions in the basal ganglia | Toxoplasma encephalitis |
| What long term medications should an HIV patient infected with Toxoplasma encephalitis | pyrimethamine + leucovorin + sulfadiazine |
| Folinic acid (leucovorin) prevents bone marrow suppression effect of what drug | pyrimethamine |
| An ICH presents with confusion, stiff neck, irritability over weeks to months. MRI shows multifocal lesions in the midbrain, brainstem and cerebellum. Wet mount of CSF shows motile macrophage-like organisms. What species is it? | Acanthamorba |
| What is the cause of severe headache, meningeal signs, fever, vomiting, focal signs that progress to a coma in a young child in the summer? | Naegleria fowleri |
| What can cause seizures, chronic headache, hydrocephalus in immigrants that responds to praziquantel and diazepam? | Taenia solium |
| A patient from Africa has a history of fever, lymphadenopathy, chancre and pruritis weeks ago and now has headaches, somnolence and neurological signs. He responds to pentamidine isothionate or sumarin. What is it? | Trypanosoma brucei |
| An infant has a umbilical stump infection, history of rigidity, muscle spasm and autonomic dysfunction. The infant cannot open their mouth due to masseter spasm. Neurotixin interferes with what? | GABA and glycine |
| A patient that is an IVDU has afebrile illness with diplopia, dysarthria, dysphoria, dysphagia. Neurotoxin blocks the release of | Acetylcholine |
| What do you treat an infant with constipation, weak cry, drooling, hypotonia, cranial neuropathy after ingestion of home-processed honey | Equine immune globin (infant botulism) |
| Coagulase positive | Staph Aureus |
| E Coli, Klebsiella, Proteus and Enterobacter are all | gram negative bacilli that are enteric lactose fermenters |
| Pseudomonas is a gream negative rod that | does not ferment lactose |
| B. Fragilis is | an anerobic gram negative rod |
| Septic abortion involves what type of organisms | Septic abortion commonly involves anaerobes, possibly including clostridia |
| What virus cough, coryza, conjunctivitis and Koplik’s spots | Measles |
| Dengue is what type of virus? | arbovirus infections |
| Genetic “shifts” are major reassortments of | influenza genome |
| The “Tzanck” test detects | multinucleated giant cells (herpes viruses) |
| What two malaria species have liver involvement? | Vivax and Ovale |
| A patient returns from Nantucket, blood smear shows ring forms. What predisposed him to this illness? | Asplenia. Developed heavy parasite load secondary to babesia infection. |
| A 16 year old present with fever, sore throat and lymphadenopathy and atypical lymphocytes. What do you treat himwith? | No treatment for Mono (EBV) |
| gram-neg (pink) diplococci that are biscuit or kidney shaped are typical of? | meningococci and gonococci |
| A man visits central America and returns with headache, petechial rash, muscle and joint pain. What can this progress to? | Hemorrhagic shock. This is Dengue Fever, spread by mosquito vector |
| Fibrocaseous cavitary lesion in the upper lobe of lung is what? | Secondary (re-activation or reinfection) TB |
| Enlarged hilar nodes, Ghon focus in lower lobe is | Primary TB |
| What causes Osteomyelits in Diabetics and IVDU? | Pseudomonas aeruginosa |
| What is the cause of Osteomyelitis if you are given little identifying information? | Staph aureus |
| Leukocyte esterase positive uncomplicated UTI that shows metallic sheen on EMB agar is what? | E. Coli |
| UTI with nitrite positive in sexually active otherwise healthy woman? | Staphlyococcus saprophyticus |
| UTI with urease positive, large mucoid capsule and viscous colonies is what? | Klebsiella pneumoniae |
| What strain of UTI produces a red pigment, nosocomial and drug resistant? | Serratia marcescens |
| What UTI bug is often nosocomial and drug resistant? | Enterobacter mirabilis |
| What UTI is associated with a woman in a nursing home, blue green pigment and fruity odor on culture and drug resistant? | Pseudomonas aeruginosa |
| An infant has chorioretinitis, hydrocephalus and intracranial calcifications, what is the bug? | Toxoplasma gondii from cat feces. Mom is not ICH. |
| Infant has a PDA or pulmonary artery hypoplasia, cataracts and deafness. What is the bug? | Rubella. Mom had rash, lymphadenopathy and arthritis |
| Infant has hearing loss, seizures, petechial rash, what is the bug? | CMV. Mom contracted sexually or via organ transplant |
| What does an infant with vertically transmitted HIV present with? | Recurrent infections and chronic diarrhea |
| What are the neonatal manifestations of herpes simplex-2? | Temporal encephalitis and herpetic lesions (same as adults) |
| What congenital infection usually results in stillbirth or hydrops fetalis? | Syphilis |
| Notched teeth, saber shins, saddle nose, short maxilla and CN VIII deafness is what? | Congenital syphilis (infant has survived) |
| Brain cysts, seizues is what parasite? | Taenia solium (cysticerosis) |
| Liver cysts is what parasite? | Echinococcus granulosus |
| B12 deficiency is associated with what parasite? | Diphyllobothrium latum |
| Bilary tract disease and cholangiocarcinoma is what parasite? | Clonorchis sinensis |
| Hemoptysis = what parasite? | Paragonimus westermani |
| Portal hypertension = what parasite? | Schistosoma mansoni |
| Squamous cell carcinoma of the bladder, hematuria =what parasite? | Schistosoma haematobium |
| Microcytic anemia is what parasite(s)? | Ancylostoma and Necator |
| Perianal itching = what parasite? | Enterobius |
| Antigens from cysts can cause anaphylaxis if released? | Echinococcus granulosus |
| Pus, empyema and abcess, think of | Staph aureus |
| Pediatric infection, think of | Haemophilus influenzae (including epiglottitis) |
| Pneumonia in CF, burn infection | Pseudomonas aeruginosa |
| Branching rods in oral infection with sulfer granules | Actinomyces israelii |
| Traumatic open wound, what bug? | Clostridium perfringens |
| Surgical wound is usually what bug? | S aureus |
| Dog or cat bite is what bug? | Pasteurella multocida |
| Current jelly sputum | Klebsiella |
| Positive PAS stain | Tropheryma whippelii (Whipple's disease) |
| Sepsis and meningitis is a newborn | Group B strep |
| Health care proiver acquires infection | HBV from needle stick |
| Fungal infection in diabetic | Mucor or Rhizopus species |
| Asplenic patient (3) | S. Pneumoniae, H influenzae B, N meningitidis |
| Chronic granulomatous disease | Catalase positive microbes |
| Neutopenic patients | Candida albicans (systemic), Aspergillus, Pseudomonas |
| Bilateral Bell's Palsy | Borrelia burgdorferi |
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