Micro 07
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| Ixodes tick - arthropod! | Lyme disease, Borrelia burgdorferi, spirochete, motile via axial filaments.
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| How to prevent Lyme disease? | regular tick checks because it takes greater than 24 hrs of the tick attachment for transfer of the organism
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| White-footed mouse, white-tailed deer, Northern U.S. | Lyme disease, Borrelia burgdorferi
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| erythema chronicum migrans | Lyme disease, Borrelia burgdorferi. Painless skin lesion at site of tick bite. Target lesion.
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| high fevers and photophobia | Leptospira, leptospiremic phase
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| Where is Leptospira found? | urine of animals (dogs, rats, livestock, etc), swimming in contaminated water
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| swimming in bad water, renal failure, jaundice, mental status changes | Leptospira, Weil's disease, organisms can be found in patient's urine in the second phase of the illness.
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| What kind of necrosis does M. TB cause in the lungs? | Caseous necrosis, surrounded by macrophages, multinucleated giant cells, fibroblasts, etc ==>calcifies. M.TB stays alive in these granulomas.
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| What part of the lungs are affected by M TB? | middle and lower lung zones - the parts with the highest airflow
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| Ghon focus | TB: calcified tubercle in middle or lower lung zones. Tubercles: granulomas that house the M. TB bug.
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| What is the most common site of reactivation TB? | Lungs - apical areas around the clavicles
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| Patient with productive cough with blood in it -- hx of exposure to HIV patients | M. TB - reactivation TB
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| Scrofula | TB in the lymph nodes -- most common manifestation of TB outside the lungs
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| Sterile pyuria | TB in the kidney, but only see WBC's and RBC's in the urine -- no organisms
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| Pott's disease | TB in the thoracic and lumbar spine -- destroy the intervertebral discs and adjacent vertebral bodies
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| Chronic arthritis of 1 joint | TB
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| Chronic arthritis of 1or 2 of the large peripheral joints (knee) - more than 1 year | Late stage lyme disease (Borrelia burgdorferi)
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| In a patient suspected of TB, if the acid-fast stain or culture FROM THE SPUTUM is positive, what does it tell you about the disease? | Active pulmonary infection
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| Infection with Mycobacterium avium-intracellulare (MAI) or MAC | AIDS pts, harbinger of death because it only strikes hen the T-helper count is virtually nonexistent
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| Where does Mycobacterium leprae like to grow? | Cooler areas of the body, close to the skin surface
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| Which is more severe? Lepromatous leprosy or Tuberculoid leprosy? | Lepromatous (leonine facies, saddlenose deformily, negative lepromin skin test because can't mount cell-mediated immune response)
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| What is special about mycoplasma? | tiniest free-living organisms capable of self-replication; no peptidoglycan wall, cell membrane packed with sterols
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| Name the two mycoplasma organisms we're interested in | Mycoplasma pneumoniae and Ureaplasma urealyticum
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| What is the number one cause of bacterial bronchitis and pneumonia in teenagers and young adults? | Mycoplasma pneumoniae
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| cold agglutinins | RBC antigens similar to antigens of Mycoplasma pneumoniae. Abs against Mycoplasma pneumoniae attach to RBC's at 4 degrees Celcius
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| Complement fixation test | antigens from Mycoplasma pneumoniae. Mix patient's serum with the antigens. 4x rise in antibody titer between acute and convalescent samples is diagnotic of a recent infection.
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| How to ID Ureaplasma urealyticum? | metabolizes urea into ammonia and CO2
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| What must your media have if you want to grow mycoplasma? | cholesterol and nucleic acids/urea
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| What do aminoglycosides cover? | G-, AEROBIC, enterics, Pseudomonas (Mean negative Guy with boxing gloves, does aerobics to stay in shape, jump around a lot so jostles stuff in the intestines and has blue/green sheen uniform)
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| Name drugs that are aminoglycosides | Mean GNATS canNOT kill anaerobes (because it requires O2 for uptake into the cell). Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin. NOT: Nephrotoxic (with cephalosporins), Ototoxic (with loop diurectics), Teratogenic
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| What is neomycin used for? | bowel surgery
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| Name two common aminoglycosides | Streptomycin (oldest one, many bugs resistant to it), Gentamicin (given in conjunction with penicillins to give it access through the outer membranes)
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| What is the mechanism of aminoglycosides? | 1. Stops the initiation complex in translation, 2. misreads the code, 3. polysome --> monosome. A 30-yo boxer (30S ribosomal unit) so he's really cheesy and stupid: STOP in the name of love (stops the initiation complex) & he can't read very well (misrea
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| What is the mechanism of resistance to aminoglycosides? | bacterial transferases modify the AG's
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| Adverse effects of AG's | 1. Mean guy -- 8th round boxing: 8th nerve toxicity - causes vertigo and hearing loss (irreversible) in his opponent!, 2. Left hook to kidney - renal toxicity (reversible), 3. KO - complete neuromuscular blockade
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| Spectinomycin | Sounds like AG, hits the 30S and is given IV, but not in the AG group!
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| What do you use spectinomycin for? | N gonorrhea that is resistant to both penicillin and tetracyclin
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| Name the anti-TB drugs | INH-SPIRE. INH used alone for TB prophylaxis. Streptomycin Pyrazinamide INH Rifampin Ethambutol used in combo for TB Treatment. All are hepatotoxic
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| What is the mechanism of Isoniazid in treating TB? | INH - interferes with biosynthesis of mycolic acid in cell wall of Mycobacteria
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| Why shouldn't you drink alcohol while on INH? | Alcohol induces CYP450 system --> increases metabolism of INH --> inc risk of developing hepatitis AND decreases INH therapeutic effect
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| Why should you prescribe Vit B6 with INH? | INH increases urinary excretion of B6 (needed for proper nerve function) --> decreased B6 in body --> pellagra (neurotoxicity)
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| Rifampin | 4 R's of Rifampin: RNA polymerase inhibitor, revs up CYP450, red/orange body fluids, rapid resistance if used alone
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| What drug turns your body fluids red? | Rifampin (anti-TB)
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| What is the mechanism of rifampin? | inhibits DNA-dependent RNA polymerase of M TB
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| What does Rifampin do to the CYP450 system? | Induces it --> increases metabolism of other drugs such as warfarin/coumadin, OCPs, anticonvulsants (can lead to seizures)
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| What drug used for MAI/MAC? | Rifabutin (like rifampin)
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| What is ethambutol and why is it not used in children? | anti-TB drug, causes loss of central and color vision. Not used in children because they can't report visual deterioration.
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| Deaf neonate, mom with hx of N gonorrhea infection | Used streptomycin while pregnant (causes ototoxicity and nephrotoxicity)
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| What is the first line drug for leprosy? | Dapsone
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| What is clofazimine? | Anti-leprosy drug. Clown climbs DNA -- binds to the DNA of Mycobacterium Leprae.
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| What is a side effect of clofazimine? | Turns skin and conjunctiva red (because it's a red-colored compound)
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| Leprosy drug reactions | Type 1: borderline pts, delayed hypersensitivity (type 4), Type 2: borderline lepromatous and lepromatous, immune complex mediated reaction (type 3)
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| What is the only use of thalidomide that is condoned in the U.S.? | To treat Type 2 reaction from taking leprosy drugs (because thalidomide is a teratogen)
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| What are flouroquinolones? | "-floxacin" (flocks of sinners), inhibit DNA gyrase (topoisomerase II) --> break bacterial DNA --> bactericidal
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| What is the mechanism of bacterial resistance to flouroquinolones? | point mutation in bacterial GNA gyrase --> flouroquinolones can't inhibit the enzyme anymore
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| How is ciprofloxacin different from 3rd and 4th generation flouroquinolones? | inhibits GABA --> can cause seizures
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| What do flouroquinolones cover? | G- (of urinary and GI tracts) including P aeruginosa and enterics (E coli, Salmonella, Shigella, Campylobacter)
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| Adverse effects of flouroquinolones | GI irritability (flox of sinners party so much you throw up), damage cartilage (flox of sinners like to eat chicken wings -- cartilage), Tendonitis/rupture (FlouroquinoLONES hurt attachment to your BONES.
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| Levofloxacin | Flouroquinolone with G- coverage PLUS improved G+ coverage -- good for community acquired pneumonia
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| What does vancomycin cover? | All G+, even MRSA!
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| Red man syndrome | IV administration of vancomycin too fast --> release of histamine --> rash of the torso and itching skin
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| What is the mechanism of vancomycin? | inhibits biosynthesis of G+ peptidoglycan production: complexes with D-ala D ala to inhibit transpeptidation
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| Vancomycin | Comes down IV tube (given IV) in Red Cross van (G+) --> going NOT so fast (nephrotoxicity, ototoxicity, thrombophlebitis) --> driven by a Red Man Indian --> wheels latch on to d-ala-d-ala and that brings it in to destroy the peptidoglycan wall
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| Mechanism of Trimethoprim and Sulfamethoxazole | Bacteria --(PABA)--> TH4 (humans don't make this; we get it as a vitamin) --> purines + dihydrofolate --(dihydrofolate reductase)--> TH4. Sulfameth looks like PABA and inhibits there, while Trim looks like DHFR. Block folate synthesis --> can't make hem
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| What does Sulfamethoxazole cover? | NO anaerobics, but G- and G+, Nocardia, Chlamydia, simple UTI.
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| What do Trimethoprim and Sulfamethoxazole cover? | recurrent UTI's, PCP, Shigella, Salmonella. TMP/SMX UPSS
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| Adverse effect of sulfamethoxazole | SULTAN can't pee (tobulointerstitial nephritis), has yellow eyes (kernicterus), and hold albumin in his hands (displace other drugs from albumin -- like warfarin)
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| Adverse effect of trimethoprim | TMP Treats Marrow Poorly: megaloblastic anemia, leukopenia, granulocytopenia (may alleviate with supplemental folinic acid)
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