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First Aid Microbiology

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.
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Question
Answer
What Structure gives rigid support and protects agains osmotic pressure   Peptidoglycan  
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Peptidoglycan - composition   Sugar backbone with cross-linked peptide side chains  
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Peptidoglycan - function   Gives rigid support, protects against osmotic pressure  
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Cell wall/Cell membrane found in which type of bacteria?   gram positive  
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Major surface antigen of gram positive bacteria   Cell Wall/Cell membrane (Teichoic acid induces TNF and IL-1)  
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Teichoic acid is found   in cell wall/cell membrane of gram positive bacteria - is major surface antigen, and induces TNF and IL-1  
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Outer membrane found in which type of bacteria?   Gram negative  
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Major surface antigen of gram negative   Outer membrane - contains the endotoxin (lipopolysaccharide). Lipid A induces TNF and IL-1  
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Composition of endotoxin   Lipopolysaccharide  
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Site of oxidative and transport enzymes in bacteria   Plasma membrane  
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Site of protein synthesis in bacteria   Ribosome (50S and 30S)  
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Periplasm   the space between the cytoplasmic membrane and outer membrane in gram-negative bacteria  
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Where are beta-lactamases in bacteria?   In periplasm of gram negative bacteria  
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What bacterial structure protects agains phagocytosis?   Capsule  
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What are bacterial capsules composed of?   Polysaccharide (except for Bacillus anthracis, which contains D-glutamase)  
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The function of the pilus/fimbrai in bacteria   mediates adherence of bacteria to cell surface. sex pilus forms attachment between 2 bacteria during conjugation.  
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Composition of bacterial pilus/fimbria   Glycoprotein  
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Function of Flagellum in bacteria   motility  
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Composition of bacterial flagellum   protein  
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Significance of bacterial spores   Provide resistance to dehydration, heat, and chemicals. Contain dipicolinic acid  
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What gives bacteria resistance to dehydration, heat, and chemicals   the keratin-like coat, containing dipicolinic acid of SPORES  
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Contains a variety of genes for antibiotic resistance, enzymes, and toxins   Bacterial Plasmid (made of DNA)  
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Glycocalyx - function   mediates adherence to surfaces, especially foreign surfaces (eg: indwelling catheters)  
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Glycocalyx - composition   polysaccharide  
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IgA proteases - function   Allow some organisms to colonize mucosal surfaces (S.pneumo, N.meningitidis, N.gonorrhoeae, H.influenza)  
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Organisms that contain IgA proteases   S. pneumo, N. meningitidis, N. gonorrhoeae, H. influenza  
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The only test that allows visualization of organisms in a sample from a patient:   Direct Flourescant Antibody  
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Indirect Fluorescant Antibody Test   Used to see if patient has antibodies agains a certain pathogen  
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Direct Fluorescant Antibody Test   Used to directly see if an organism is present within a patient  
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Structures within bacterial cell walls that are common to both gram positive and gram negative bacteria   Flagellum, Pilus, Capsule, Peptidoglycan, Cytoplasmic membrane  
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Structures in cell wall unique to gram positive organisms   Teichoic acid, Cell wall  
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Structures in cell wall unique to gram negative organisms   Endotoxin/LPS (outer membrane), Periplasm  
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Mnemonic to remember bugs that do not gram stain well   These Rascals May Microscopically Lack Color (Treponema, Rickettsia, Mycobacteria, Mycoplasma, Legionella pneumophila, Chlamydia)  
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Stain for Treponema   Is too thin to be visualized using traditional gram stain. Use darkfield microscopy and fluorescent antibody staining  
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Stain for Rickettsia   Is an Intracellular parasite - so does NOT stain well.  
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Stain for Mycobacteria   B/c wall has a high lipid content - it requires Acid-Fast stain  
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Stain for mycoplasma   Does not have a cell wall so does NOT gram stain well  
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Stain for Legionell pneumophilia   Is primarily intracellular so does NOT gram stain well. Need silver stain  
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Stain for Chlamydia   Is an intracellular parasite so does NOT gram stain well. Also Lacks muramic acid in cell wall  
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Bacteria that lacks muramic acid in cell wall   Chlamydia  
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During the Lag phase of bacterial growth curve   There is metabolic activity without division  
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Phases of Bacterial growth curve   Lag phase, Log phase, Stationary phase, Death phase  
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During the Log phase of the bacterial growth curve   there is Rapid cell division  
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During the Stationary phase of the bacterial growth curve   Nutrient depletion slows growth  
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During the Death phase of the bacterial growth curve   Prolonged nutrient depletion and buildup of waste products lead to death  
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Exotoxins - source   Certain species of some gram-positive and gram-negative bacteria  
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Endotoxins - source   cell wall of most gram-negative bacteria  
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Are exotoxins secreted from cell? Endotoxins?   Exotoxins = Yes. Endotoxins = No.  
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Chemical composition of exotoxins   Polypeptides  
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Composition of endotoxins   Lipopolysaccharide  
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Location of genes for exotoxins   Plasmid or bacteriophage  
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Location of genes for endotoxins   Bacterial chromosome  
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The toxicity of exotoxins is high or low?   High (fatal dose is on the order of 1 mcg)  
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The toxicity of endotoxins is high or low?   Low (compared to exotoxins) - fatal dose is on order of hundreds of mcg  
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General clinical effects of endotoxins   Fever and shock  
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General mode of action of endotoxins   TNF and IL-1  
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Antigenicity of exotoxins   Induces high-titer antibodies called antitoxins  
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Antigenicity of endotoxins   Poorly antigenic  
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What types of vaccines are used to protect agains exotoxins?   Toxoids  
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What types of vaccines are used to protect against endotoxins?   NO vaccine available! No toxoids formed  
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Heat stability of exotoxins   Destroyed rapidly at 60C (except staphylococcal enterotoxin)  
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Heat stability of endotoxins   Stable at 100C for 1 hour  
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Typical diseases caused by exotoxins   Tetanus, Botulism, Diphtheria  
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Typical diseases caused by endotoxins   Meningococcemia, sepsis by gram negative rods  
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Mnemonic to remember Bugs that secrete exotoxins   Some Stinking Bugs Are Very Deadly Because They Secrete PolyPeptide Exotoxins (S.aureus, S.pyogenes, B.pertussis, Anthracis, Vibrio cholerae, Diphtheriae, Botulinum, Tetani, Shigella, Perfringens, Pseudomonas, E.coli)  
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Bugs that make superantigens   S.aureus, and S.pyogenes  
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TSST-1   From S.aureus. Causes toxic shock syndrome. Causes fever, rash, and shock.  
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Enterotoxins   S.aureus. Causes food poisoning.  
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Scarlet-fever erythrogenic toxin   S.pyogenes. Is a Toxic-Shock-Like toxin (fever, rash, shock)  
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Bind directly to MHC II and T-cell receptor, activating large number of T cells to stimulate release of IFN-gamma, and IL-2.   Superantigens (S.aureus, S.pyogenes)  
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AB Toxins -   Are ADP ribosylating toxins that interfere with host cell function. B is binding component. A is active component which alters protein function. (Diptheria, Vibrio cholera, E.coli, Bordetella pertussis)  
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What does B component of AB toxin do?   B = Binding. Binds to a receptor on the surface of host cell enabling endocytosis (ADP ribosylating toxins)  
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What does the A component of AB toxin do?   A = Active. Component attaches an ADP-ribosyl to a host cell protein (ADP ribosylation) altering protein function.  
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ADP ribosylating Toxins - Organisms (5)   Corynebacterium diphtheriae, Vibrio cholerae, E.coli, Pseudomonas, Bordetella pertussis  
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Toxins that inactivate EF-2   Corynebacterium diphtheriae, Pseudomonas (exotoxin A)  
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Inactivates elongation facto (EF-2) causing pharyngitis and "pseudomembrane" in throat   Corynebacterium diphtheriae  
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ADP ribosylation of G protein stimulates adenylyl cyclase; increasing pumping of Cl- H20 into gut   Vibrio cholerae  
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Mechanism of rice-water stools   Vibrio cholerae: ADP ribosylation of G protein stimulates adenylyl cyclase increaseing the pumping of Cl- and H20 into the gut  
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Heat-labile vs. Heat-stabile toxin   E.coli. Heat labile toxin stimulates Adenylate Cyclase. Heat-stable toxin stimulates guanylate cyclase. "Labile like the air, Stable like the ground."  
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Mechanism of Bordetella pertussis   Stimulates adenylate cyclase; causes whooping cough; inhibits chemokine receptor causing lymphocytosis  
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Alpha Toxin   Clostridium perfringens. Causes gas gangrene; gets double zone of hemolysis on blood agar  
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C. tetani inhibits?   inhibitory neurotransmitter glycine. causes lockjaw  
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C.botulinum inhibits?   Acetylcholine, causing anticholinergic symptoms and CNS paralysis  
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Floppy baby   C. botulinum toxin. Found in canned food and honey.  
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Shiga toxin   Produced by Shigella and also E.coli O157:H7. Cleaves host cell rRNA and enhances cytokine release causing HUS.  
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Streptolysin O   A hemolysin made by S.pyogenes  
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ASO antibody   Rheumatic fever (against streptolysin O)  
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Lipopolysaccharide found in cell wall of gram negative bacteria   Endotoxins  
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Are endotoxins heat stabile or labile?   Stabile  
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Endotoxins mode of Action   Activate macrophages (IL-1, TNF, NO), Activate Complement (C3a, C5a), Activate Hageman factor (causing coagulation cascade which can lead to DIC)  
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Fermentation Patterns of Neisseria   MeninGococci ferment Maltose and Glucose, Gonocci ferment Glucos  
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Pigment producing bacteria   S.aureus (yellow), Pseudomonas aeruginosa (blue-green), Serratia marcescens (Red)  
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Gram +, Cocci, Clusters, Catalase +, Coagulase +   S.aureus  
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Gram +, Cocci, Clusters, Catalase +, Coagulase -, Novobiocin Sensitive   S.epidermidis (SEnsitive = S.Epidermis)  
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Gram +, Cocci, Clusters, Catalase +, Coagulase -, Novobiocin resistant   S.saprophyticus (Resistant = Strong = Saphrophyticus)  
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Gram +, Cocci, Chains, Catalase -, Alpha (green) hemolysis, Capsule, Optochin sensitive, Bile soluble   S.pneumoniae  
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Gram +, Cocci, Chains, Catalase -, Alpha (green) hemolysis, No capsule, Optochin resistant, Not bile soluble   Viridans streptococci (S.mutans)  
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Alpha (green) hemolytic streptococci   S. pneumoniae, or S. mutans (viridans)  
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How to tell between Alpha (green) hemolytic streptococci   Capsule, +Quelling, Optochin sensitive, Bile soluble = S. pneumo. No capsule, Optochin resistant, not bile soluble = S.mutans  
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Gram +, Cocci, Chains, Catalase -, Beta (clear) hemolysis, Bacitracin sensitive   Group A Strep (S.pyogenes)  
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Gram +, Cocci, Chains, Catalase -, Beta (clear) hemolysis, Bacitracin resistant   Group B Strep (S.agalactiae)  
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How to tell between different Beta (clear) hemolytic streptococci   Bacitracin sensitive = Group A Strep (S.pyogenes). Bacitracin resistant = Group B Strep (S.agalactiae)  
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Gram +, Cocci, Chains, Catalase -, Gamma (no) hemolysis   Enterococcus (E.faecalis and Peptostreptococcus)  
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Gram -, Cocci, Maltose fermenter   N.meningitidis  
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Gram -, Cocci, Maltose non-fermenter   N.gonorrhoeae  
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Gram -, "Coccoid" rods   H.influenza, Pasteurella, Brucella, Bordetella  
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Gram +, Bacilli, Spore Forming, ANerobic   Clostridium (Tetani, Botulinum, Difficile, Perfringens)  
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How to distinguish between Clostridium species   All are Catalse and Dismutase -. C.tetani = motile. C perfringens has two zones of hemolysis, and non-motile.  
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Gram +, Bacilli, Spore Forming, Aerobic   Bacillus spp. (Anthracis, and Cereus)  
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Gram +, Bacilli, Non-spore forming, Anaerobic   Actinomyces, Propionibacterium, Lactobacillus, and Bifidobacterium  
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Gram +, Bacilli, Non-spore forming, Aerobic   Corynebacterium diptheriae, Listeria monocytogenes, Tropheryma whipplei, Erysipelothrix rhusiopathiae  
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Gram +, Cocci, Chains, Catalase -, Strict Anaerobe   Peptostreptococcus  
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Gram -, Bacilli, Lactose fermenter, Fast fermenter   Klebsiella, E.coli, Enterobacter  
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Gram -, Bacilli, Lactose fermenter, Slow fermenter   Citrobacter, Serratia  
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Gram -, Bacilli, Lactos Non-fermenter, Oxidase -   Shigella, Salmonella, Proteus  
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Gram -, Bacilli, Lactose non-fermenter, Oxidase +   Pseudomonas  
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Chocolate agar with factors V (NAD) and X (hematin)   H.influenza  
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Thayer-Martin media   N.gonorrhoeae  
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Bordet-Gengou (potato) agar   B. pertussis  
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Tellurite plate   C.diphtheriae  
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Loffler's medium   C.diptheriae  
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Blood agar   C.diptheriae  
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Lowenstein-Jensen agar   M.tuberculosis  
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Pink colonies on MacConkey's agar   Lactose-fermenting enterics  
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CHarcoal yeast extract agar buffered with increased iron and cysteine   Legionella  
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Sabouraud's agar   Fungi  
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Congo red   Amyloid; apple-green birefringence in polarized light (b/c of Beta-pleated sheets)  
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Giemsa stain   Borrelia, Plasmodium, Trypanosomes, Chlamydia  
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PAS stain   Stains glycogen, mucopolysaccharides. Is used to diagnose Whipple's disease  
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Ziehl-Neelsen   Acid fast bacteria  
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India ink   Cryptococcus neoformans  
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Silver stain   Fungi, PCP, Legionella  
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Bacterial Genetics: Direct cell-to-cell transfer   Conjugation  
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What type of DNA is transferred during conjugation   Chromosomal or plasmid  
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Bacterial genetics: Phage-mediated cell to cell DNA transfer   Transduction  
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Transduction   Phage-mediated cell to cell DNA transfer  
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What type of DNA is transferred in Transduction   Any gene in generalized transduction. Only certain genes in specialized transduction  
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Bacterial Genetics: Purified DNA taken up by a cell   Transformation  
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Transformation is?   When purified DNA is taken up by a cell. Can occur in prokaryotic or eukaryotic cells.  
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What type of DNA is transferred in Transformation   Any DNA  
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Bacterial Genetics: DNA transfer to same or another chromosome or plasmid within a cell   Transposition  
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Transposition is?   DNA transfer to same or another chromosome or plasmid within a cell. Can occur in prokaryotes or eukaryotes  
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Nature of DNA transferred in Transposition   DNA sequences "jumping genes"  
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What types of transfer procedure can eukaryotes undergo?   Transformation or Transposition  
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What type of transfer procedure (bacterial genetics) can prokaryotes undergo?   Conjugation, Transduction, Transformation, and Transposition.  
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Which bacteria have the genetic code for their toxin encoded in a lysogenic phage?   Lysogeny: Botulinum toxin, Cholera toxin, Diphtheria toxin, Erythrogenic toxin of Strepcococcus pyogenes  
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Mnemonic to remember obligate aerobes   Nagging Pests Must Breathe (Nocardia, Pseudomonas, Mycobacterium tb, Bacillus)  
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Which bacteria use an O2 dependent system to generate ATP?   Obligate Aerobes (Nocardia, Pseudomonas, Mycobacterium TB, Bacillus)  
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What part of lungs is Mycobacterium TB found?   Apices of the lung (b/c it is an obligate aerobe, and the apices of the lung have the highest PO2)  
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Obligate anerobe organisms   Clostridium, Bacteriodes, Peptostreptococcus, Actinomyces  
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How do Obligate aerobes work?   Use an O2-dependent system to generate ATP  
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Which organisms lack catalase and/or superoxide dismutase?   Obligate anaerobes. The lack of catalase and/or superoxide dismutase makes them susceptible to oxidative damage  
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Characteristics of Obligate anaerobes   Generally foul smelling (short-chain fatty acids), are difficult to culture, and produce gas in tissue (CO2, and H2O). Are generally normal flora in GI tract  
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Mnemonic to remember Obligate Intracellular bugs   stay inside (cells) when it is Really Cold (Rickettsia, Chlamydia)  
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What is important about Obligate Intracellular bugs?   They cannot make their own ATP (Rickettsia, Chlamydia)  
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Mnemonic to remember Facultative Intracellular bugs   Some Nasty Bugs May Live FacultativeLY (Salmonella, Neisseria, Brucella, Mycobacterium, Listeria, Francisella, Legionella, Yersinia)  
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Encapsulated Bacterial Organisms   Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, and Klebsiella pneumonia. "Some Have Nice Kapsule"  
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Quelling reaction   positive in bacteria who have capsules. Qwelling = Swelling  
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Bacterial capsule component   Made of Polysaccharide.  
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Function of Bacterial Capsule   An antiphagocytic virulence factor  
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What do Pneumovax, HiB, and Meningococcal vaccines have in common?   All are encapsulated bacteria. Capsule serves as antigen in vaccines.  
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Who forms spores?   Only certain gram-positive organisms form spores when nutrients are limited  
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Spore-forming organisms   Aerobic: Bacillus anthracis, B.cereus. Anaerobic: Clostridium spp.  
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Do spores have metabolic activity?   NO  
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Special component of spores   Dipicolinic acid in core. Helps protect against destruction by heat and chemicals  
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How kill spores?   Autoclave  
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Alpha-hemolytic bacteria   1. Streptococcus pneumoniae (catalase -, optochin sensitive) 2. Viridans streptococci (catalse -, optochin resistant)  
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Beta-hemolytic bacteria   1. Staphylococcus aureus (catalase/coagulase +) 2.Streptococcus pyogenes (catalase -, bacitracin sensitive) 3.Steptococcus agalactiae (catalase -, bacitracin resistant) 4.Listeria monocytogenes (tumbling motility, meningitis newborns, unpasteurized milk)  
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Only gram positive organism with endotoxin   Listeria monocytogenes (found in soft cheese, deli meats, refrigerated). Tumbling motility  
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Function of catalase   Degrades H202, an antimicrobial product of PMNs. H202 is a substrate for myeloperoxidase.  
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Protein A   Staph aureus. Protein A is a virulence factor. It binds Fc-IgG, inhibiting complement fixation and phagocytosis  
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What type of immune response is elicited to TSST?   TSST is a super antigen that binds MHC II and T-cell receptor, resulting in polyclonal T-cell activation. Will have a HIGH level of T cell cytokines.  
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Food poisoning from S.aureus   Is due to ingestion of preformed enterotoxin. Is rapid-onset food poisoning.  
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Scalded skin syndrome   Due to exfoliative toxin (s.aureus)  
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Acute bacterial endocarditis   Staph aureus (IV drug user)  
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Streptococcus pyogenes causes:   1. PYOGENIC: pharyngitis, cellulitis, impetigo. 2. TOXIGENIC: scarlet fever, toxic shock syndrome. 3. IMMUNOLOGIC: rheumatic fever, acute glomerulonephritis.  
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Consequences of untreated Strep pyogenes   PHaryngitis gives you rheumatic PHever and glomerulonePHritis  
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Jones Criteria for Rheumatic Fever   No "RHEUM for SPECCulation" (Subcutaneous nodules, Polyarthritis, Erythema marginatum, Chorea, Carditis)  
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How increase host defenses against Step pyogenes?   Antibody to M protein enhances host defenses against S.pyogenes  
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How detect recet S.pyogenes infection?   ASO titer  
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Strep pneumo is the most common cause of?   MOPS - Meningitis, Otitis Media, Pneumonia, Sinusitis  
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Sepsis in sickle cell anemia or post splenectomy   Streptococcus pneumoniae  
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Rusty sputum pneumonia   Streptococcus pneumonia  
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How does strep pneumo protect itself?   It is encapsulated. Acts by inactivating complement to protect itself from opsonization.  
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What helps prevent bacteria from being immediately shed from mucosal surfaces?   IgA protease. Found on Strep pneumo, H.influenza, N.meningitidis, N.gonorrhoeae  
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Group B streptococci   Strep agalactiae (bacitracin resistant, Beta-hemolytic)  
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Pneumonia, meningitis, and sepsis in babies   Streptococcus agalactiae  
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Enterococci   Enterococcus faecalis, and E.faecium  
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Common cause of UTI and subacute endocarditis   Enterococci (Enterococcus faecalis and E.faecium)  
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Lancefield grouping of enterococci is based on?   C carbohydrate on the bacterial cell wall  
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Commonly affects prosthetic devices and catheters   Staphylococcus epidermidis  
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Commonly contaminates blood cultures   Staphylococcus epidermidis  
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How do biofilms form?   By altering the surface tension of liquids (staph epidermidis)  
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Common cause of dental caries   Strep mutans (viridans)  
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Common cause of subacte bacterial endocarditis   Strep sanguis (viridans)  
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How remember optochin differentiation b/t alpha-hemolytic strep   S.pneumon is optochin sensitive. Viridans strep "live in the mouth becase they are not afraid OF-THE-CHIN" (optochin resistant)  
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Clostridia categorization   Gram-positive, spore-forming, obligate anaerobic bacilli that make exotoxins  
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Blocks glycine release from Renshaw cells in the spinal cord   Tetanus toxin  
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Flaccid paralysis   From Botulinum toxin blocking ACh release  
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Lecithinase   Alpha-toxin of Clostridium perfringens  
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Cytotoxin   An exotoxin that kills enterocytes. C.difficile. Commonly secondary to clindamycin or ampicillin use  
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ABCDEFG of Corynebacterium diptheriae   ADP ribosylation, Beta-prophage, Corynebacterium, Diptheriae, Elongation Factor 2, Granules (metachromic)  
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Pseudomembranous pharyngitis   Corynebacterium diphtheriae  
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Beta-prophage exotoxin   Corynebacterium diptheriae. Exotoxin inhibits protein synthesis via ADP ribosylation of EF-2.  
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Looks like chinese letters on culture   Corynebacterium diptheriae  
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The only bacterium with a protein capsule   Bacillus anthracis  
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If come in contact with Anthrax   Get Malignant pustule (painless ulcer); can progress to bacteremia and death  
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If inhale Anthrax   Get flulike symptoms that rapidly progress to fever, pulmonary hemorrhage, and shock.  
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Wollsorter's disease   Inhalation of Anthrax spores from contaminated wool  
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Black skin lesions   Bacillus anthracis - vesicular papules covered by black eschar  
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Anthrax toxin   1) Lethal factor (releases TNF-beta, and IL-1). 2) Edema factor  
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Bacterial Rods forming long branching filaments resembling fungi   Actinomyces and Nocardia  
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Gram + aerobe that causes oral/facial abscesses with "sulfur granules" that may drain through sinus tracts in skin   Actinomyces  
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Gram-positive, weakly acid fast aerobe in soil causing pulmonary infection in ICH   Nocardia asteroides  
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Txt for Nocardia vs. Txt for Actinomyces   SNAP: Sulfa for Nocardia, Actinomyces use Penicillin  
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Facial abscesses draining through sinus tracts after bar brawl   Actinomyces  
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Mycetoma in ICH   Nocardia (mycetoma = brain and kidney abscesses)  
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Why are gram-negative bugs resistant to penicillin?   Gram-negative outer membrane layer inhibits entry of penicillin G and vancomycin. Gram-negatives are susceptible to penicillin derivatives such as ampicillin  
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Lipooligosaccharide endotoxin   N.meningitidis  
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N.gonorrhea vs. N.meningitidis   GONOCOCCI (No polysaccharide capsule, No maltose fermentation, No vaccine). MENINGOCOCCI (Yes polysaccharide capsule, Yes maltose fermentation, Yes vaccine)  
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Causes gonorrhea, septic arthritis, neonatal conjunctivitis, PID   N.gonorrhoeae  
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Causes meningococcemia and meningitis. Waterhouse-Friderichsen syndrome   N.meningitidis  
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Mnemonic to remember clinical manifestations of Haemophilus influenza   HaEMOP - Epiglottitis, Meningitis, Otitis media, and Pneumonia  
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Culture medium for H.influenza   Chocolate agar with factors V (NAD) and X (hematin). Mnemonic: When a child has "flu," mom goes to five (V) and dime (X) store to buy some chocolate  
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Most invasive type of H.influnza   Capsular type B (Vaccine contains type B capsular polysaccharide conjugated to diphtheria toxoid or other protein)  
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DOC of H.influenza meningitis   Ceftriaxone. Use Rifampin prophylaxis in close contacts.  
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H.influenza vaccine   Given between 2 and 18 months. Contains type B polysaccharide conjugated to diptheria toxoid or other protein  
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Mnemonic to remember the Enterobacteriaceae   "Citizens Eat Kitkats Every Seventh daY. Some People May Prefer Salad." (Citrobacter, E.coli, Klebsiella, Enterobacter, Serratia, Yersinia, Shigella, Proteus, Morganella, Providencia, Salmonella)  
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Mnemonic to remember characteristics of Enterobacteriaceae   "COFFEE" (Capsular, O antigen/Oxidase -, Flagellar antigen, Ferment glucose, Electron reducers of nitrate-nitrite, Enterobacteriaceae)  
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Somatic O antigen   Polysaccharide of endotoxin, found in enterobacteriaceae  
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Virulence of Enterobacteriaceae   the capsular K antigen is related to the virulence of the bug  
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Presents as pneumonia in alcoholics and diabetics. Red currant jelly sputum   Klebsiella. Note it also is a common cause of nosocomia UTIs  
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The 3A's of Klebsiella   Aspiration pneumonia, Abscess in lungs, Alcoholics  
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Pink colonies on MacConkey's agar   Lactose-fermenting enteric bacteria  
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Mnemonic to remember which enterobacteriaceae ferment lactose   "laCtose is KEE" (Klebsiella, E.coli, Enterobacter, and Citrobacter)  
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Salmonella vs. Shigella   Both are non-lactose fermenters, both invade intestinal mucosa and cause dysentery. Salmonella is motile (Salmon swim) and has animal reservoir. Shigella is non motile and is transferred via Food, Fingers, Feces, and Flies. Shigella is much more virulent.  
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Symptoms of what bacterium can be prolonged with antibiotic txt   Salmonella  
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What bacterium is commonly transmitted from pet feces (puppies), contaminated milk, or pork?   Yersinia enterocolitica. (outbreaks are very common in day-care centers)  
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What bacterium can mimic Crohn's disease or appendicitis?   Yersinia enterocolitica  
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Food poisoning from seafood   Vibrio parahaemolyticus and Vibrio vulnificus  
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Food poisoning from reheated rice   Bacillus cereus  
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Food poisoning from meats, mayonnaise, custard   Staph aureus  
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Food poisoning from reheated meat dishes   Clostridium perfringens  
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Food poising due to improperly canned foods (bulging cans)   Clostridium botulinum  
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Food poisoning from undercooked meat (cheeseburger)   E.coli 0157:H7  
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Food poisoning from poultry, meat, and eggs.   Salmonella  
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What organisms cause bloody diarrhea?   Campylobacter, Salmonella, Shigella, Enterohemorrhagic E.coli, Enteroinvasive E.coli, Yersinia enterocolitica, C.difficile, Entamoeba histolytica  
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Bloody diarrhea from a comma- or S-shaped organism growing at 42C and oxidase positive   Campylobacter  
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Bloody diarrhea from gram -, motile, lactose negative bacteria   Salmonella  
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Gram -, non-motile, lactose negative, low ID50 organism causing bloody diarrhea   Shigella  
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Shiga-like toxin   Enterohemorrhagic E.coli (bloody diarrhea)  
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Organism causing bloody diarrhea. Picked up at daycare. Presents as pseudoappendicitis   Yersinia enterocolitica  
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Bloody diarrhea after clindamycin administration   C.difficile (pseudomembranous colitis)  
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Causes of Watery Diarrhea   Enterotoxigenic E.coli, Vibrio cholerae, C.perfringens, Protozoa (Giardia, Cryptosporidium), Viruses (Rota, Adeno, Norwalk)  
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Classic traveler's diarrhea   Enterotoxigenic E.coli (no preformed toxin)  
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Rice-water diarrhea   Vibrio cholerae (comma shaped organism)  
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cAMP inducing bacteria   Vibrio cholera, Pertussis, E.coli, Bacillus antracis  
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Mechanism of Vibrio cholera toxin   Is a cAMP inducer. It permanently activates Gs. "turns the 'on' on."  
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Mechanism of Pertussis toxin   A cAMP inducer. Permanently disables Gi. "turns the 'off' off.  
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Mechanism of E.coli heat labile toxin   A cAMP inducer. Ribosylates Gs protein to permanently activate AC thus increasing cAMP.  
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Mechanism of Bacillus anthracis toxin   The edema factor is a cAMP inducer. Acts as a bacterial Adenylate cyclase increasing cAMP.  
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Culture for Legionella pneumophila   Charcoal yeast extract culture with iron and cysteine. (Think of a French leegionnaire (soldier) with his silver helmet, sitting around a campfire (charcoal) with his iron dagger - he is no sissy (cysteine)  
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Stain for Legionella pneumophilia   Silver stain. (Think of a French leegionnaire (soldier) with his silver helmet, sitting around a campfire (charcoal) with his iron dagger - he is no sissy (cysteine)  
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DOC for Legionnaires' disease   Erythromycin  
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Transmission of Legionella   Aerosol transmission from environmental water source habitat  
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Mnemonic to remember clinical manifestations of Pseudomonas   PSEUDOmonas: Pneumonia (especially in CF), Sepsis (black lesions on skin), External otitis (swimmer's ear), UTI, Drug use and Diabetic Osteomyelitis. Also associated with wound and burn infections and hot tub folliculitis.  
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Aerobic gram-negative rod. Non-lactose fermenting. Oxidase +   Pseudomonas aeruginosa  
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Pyocyanin   A blue-green pigment produced by Pseudomonas aeruginosa.  
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Produces both an endotoxin and exotoxin A.   Pseudomonas. Endotoxin (fever, shock). Exotoxin A (inactivates EF-2)  
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Txt of Pseudomonas aeruginosa   Aminoglycoside plus extended-spectrum penicillin (eg: piperacillin and ticarcillin)  
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Common cause of gastritis and up to 90% of duodenal ulcers   Helicobacter pylori  
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Urease positive organisms   H.pylori and Proteus  
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Gram negative curved-rod with polar flagella. Urease positive   H.pylori  
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Does H.pylori cause an acidic or alkaline environment?   Alkaline  
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Txt of H.pylori   Triple therapy: 1) bismuth, metronidazole, and either tetracycline or amoxicillin. or 2) (more expensive) metronidazole, omeprazole, and clarithromycin  
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Mnemonic to remember Zoonotic bacteria   "Bad Bugs From Your Pet" (Borrelia burgdorferi, Brucella spp, Francisella tularensis, Yersinia pestis, Pasteurella multocida)  
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Undulant fever   Brucella spp. "Unpasteurized dairy products give you Undulant fever"  
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Prarie dog vector   Yersinia pestis (also caused by flea bites, or rodents)  
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Cellulitis post animal bite   Pasteurella multocida  
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What could give one fever, chills, malaise, and an ulceroglandular (eschar)   A rabbit bite. Francisella tularensis. Remember b/c St. Francis loved rabbits.  
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Infection as site of tongue piercing   Fusobacterium spp  
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Positive whiff test   Gardnerella vaginalis  
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Greenish vaginal discharge with fishy smell   Gardnerella vaginalis  
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DOC for Gardnerella vaginalis   Metronidazole  
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If suspect Pasteurella multocida, what do you do with the wound?   Make sure to NOT suture.  
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A pleomorphic, gram-variable rod causing vaginosis   Gardnerella vaginalis  
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Clue cells   Gardnerella vaginalis  
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Positive PPD   Current TB infection, Past exposure to TB, BCG vaccination  
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Negative PPD   No TB infection, or immunocompromised (steroids, malnutrition, AIDS)  
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Primary TB localizes where   Ghon complex focus usually in lower lobes. Also affects the hilar nodes  
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Possible results of Primary TB infection   1) Heals by fibrosis - have immunity and hypersensitivity. 2) Progressive lung disease - HIV and malnuorished pts. 3) Severe bacteremia - miliary tb. 4) Preallergic lymphatic or hematogenous dissemination - dorman tb bacilli in several organs - 2ndary TB  
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Secondary TB infection location   Usually in apex of lung. Causes a fibrocaseous cavitary lesion. Caused by reinfection.  
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What are the signs of extrapulmonary TB?   CNS (parenchymal tb or meningitis), VERTEBRAL BODY (Pott's dz). LYMPHADENITIS, RENAL, GI  
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What is a Ghon complex?   Primary TB. Lobar and perihilar lymph node involvement  
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Types of Mycobacteria   1) Mycobacteria TB 2) Myocobacteria kansasii 3) M.scrofulaceum 4) M.avium-intracellulare 5) M.leprae 6) M.marinum  
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PPD is what type of hypersensitivity   Type IV  
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Acid-fast organism causing disseminated disease in HIV   Mycobacteria avium-intracellulare  
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Hot-tub lung   Mycobacterium avium-intracellulare  
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Armadillo reservoir   Mycobacterium leprae (Leprosy)  
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Classic TB sx   Night sweats, weight loss, hemoptysis  
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Which type of Hansen's disease is worse?   Two types of Leprosy: Lepromatous and Tuberculoid. Lepromatous is worse  
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Why is lepromatous leprosy worse than tuberculoid leprosy   Lepromatous has failed cell-mediated immunity. Tuberculoid is self-limited  
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Chronic disease with hypopigmented skin and loss of sensation that prefers cooler areas of skin   Hanson's dz (leprosy)  
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Txt for Leprosy   Dapsone, Rifampin, Clofazamine  
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Toxicity of dapsone   Hemolysis and methemoglobinemia  
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Leonine facies   Lepromatous leprosy (LEpromatous = LEthal)  
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Gram -, obligate intracellular organisms that infect vascular endothelium   Rickettsiae  
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Classic Triad of Rickettsiae   Headache, fever, rash  
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Transmission of Rickettsiae   All except Coxiella are transmitted by an arthropod vector and cause headache, fever, and rash. Coxiella is an atypical rickettsia because it is transmitted by aerosol and causes penumonia.  
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DOC for Rickettsial infections   Tetracycline  
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Rat flea vector   Endemic typhus (R.typhi)  
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Centrifugal rash (outward)   Endemic typhus (R.typhi) - "TyPHus has centriPHugal rash"  
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Centripetal rash (inward)   Rocky mountain spotted fever (R.rickettsii). "sPotted fever is centriPetal"  
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Human body louse   Epidemic typhus (R.prowazekii)  
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Positive Weil-Felix   Rickettsial diseases (except Q fever)  
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Rash on palms and soles migrating to wrists, ankles, and trunk. Headache and fever.   Rocky Mountain spotted fever (R.rickettsii)  
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Palm and Sole Rash   Rocky Mountain spotted fever, Syphilis, and Coxsackievirus A infection  
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Reaction that assays for antirickettsial antibodies which cross react with Proteus antigen   Weil-Felix reaction (negative for Q fever)  
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Insidious onset of headache, non-productive cough, with X-ray showing diffuse interstitial infiltrate   Mycoplasma pneumoniae  
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Eaton's agar   Mycoplasma pneumoniae  
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Only bacterial membrane containing cholesterol   Mycoplasma pneumoniae (no cell wall)  
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DOC for mycoplasma pneumoniae   Tetracycline or erythromycin (bugs are penicillin resistant because they have to cell wall)  
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Small, non-motile, obligate intracellular (need ATP/NAD from host) bacteria/parasites that cause mucosal infections   Chlamydiae  
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Two forms of Chlamydiae   1. Elementary body (small and dense) which Enters cell via Endocytosis. 2) Initial or Reticulate body, which Replicates in cell by fusion  
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Reactive arthritis, conjunctivitis, and nongonococcal urethritis   Chlamydia trachomatis  
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Peptidoglycan wall that lacks muramic acid   Chlamydia  
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Parrot fever   Chlamydia psittaci  
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Atypical pneumonia with positive Giemsa   Chlamydia pneumonia or C.psittaci  
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What type of hypersensitivity is caused by Chlamydia salpingitis?   Type IV hypersensitivity (TH1 lymphocyte response)  
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Types A, B, C of Chlamydia trachomatis   ABC = Africa/Blindness/Chronic infection (common cause of blindness in Africa)  
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Types D-K of Chlamydia trachomatis   Urethritis/PID, ectopic pregnancy, neonatal pneumonia, or neonatal conjunctivitis. (remember that ABC causes African Blindess/Chronic infections, and L causes Lymphogranuloma venereum. D-K causes everything else)  
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Types L1, L2, and L3 of Chlamydia Trachomatis   Lymphogranuloma venereum (L=L)  
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How txt neonatal chlamydial conjunctivitis   Erythromycin eye drops  
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Positive Frei test   Lymphogranuloma venereum (acute lymphadenitis) of Chlamydia trachomatic (type L)  
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Bacterial BLT   Spirochetes (BLT = Borrelia, Leptospira, and Treponema)  
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Dark-field microscopy   Treponema  
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Looks like ice-hooks on electron microscopy   Leptospira interrogans (a spirochete)  
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Rat-bite fever   Streptobacillus monilliformis (erythematous rash with discrete 1-4mm macules on extremities (including palms, soles and face)  
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bull's eye rash   Borrelia burgdoferi (Lyme dz)  
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3 stages of Lyme dz   1) Erythema chronicum migrans, flulike sx. 2) Neurologic and cardia manifestations. 3) autoimmune migratory polyarthritis  
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Erythema chronicum migrans   Lyme disease  
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Mnemonic for manifestations of Lyme dz   BAKE a key Lyme pie: Bell's palsy, Arthritis, Kardiac block, Erythema chronicum migrans  
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DOC for lyme disease   Tetracycline, Doxycycline, or penicillins  
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Painless bumps on arm of tropical population   Yaws = Treponema pertenue  
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Primary syphilis   Presents with painless chancre  
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Secondary syphilis   Disseminated disease with constituitional symptoms, maculopapular rash (palms and soles), condylomata lata  
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Tertiary syphilis   Gummas, aortitis, neurosyphilis (tabes dorsalis), Argyll Robertson pupil  
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Broad based ataxia, positive Romberg, Charcot joints, stroke w/o hypertension   Neurosyphilis (tabes dorsalis)  
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Saber shins, saddle nose, deafness   Congenital syphilis  
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FTA-ABS vs. VDRL   FTA-ABS: more specific, earliest positive, remains positive the longest. VDRL: cheapest, titer will fall late in disease  
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Nonspecific antibody that reacts with beef cardiolipin   VDRL  
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Mnemonic to remember false positives of VDRL   VDRL: Viruses (mono, hepatitis), Drugs, Rheumatic fever and rheumatic arthritis, Lupus and leprosy  
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Eukaryotes with cell wall   Fungi  
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Budding yeast with pseudohyphae in culture at 20C; germ tube formation at 37C   Candida albicans  
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DOC for Candida albicans   Nystatin for superficial infections. Amphotericin B for serious systemic infection  
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Systemic mycoses from Southwestern United States, California   Coccidioidomycosis  
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Only systemic myocosis w/no yeast form   Coccidiodes immitis (forms mold and spherules  
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Rounded spherules filled with endospores   Coccidiodes immitis  
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Found in sand of arid environment. Dust storms   Coccidiodes immitis  
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Systemic mycosis found in Mississippi and Ohio river valleys   Histoplasmosis  
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Systemic mycosis found east of Mississippi River and Central America   Blastomycoses  
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Systemic mycosis transmitted by bird or bat droppings   Histoplasmosis  
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Tiny yeast inside macrophages. "Captain's wheel" appearance   Histoplasmosis  
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Broad-based, budding yeast   Blastomycosis  
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Characterizations of dimorphic fungi   Mold in soil at lower temperatures. Yeast in tissue at higher temperatures (except coccidiomycosis which is a spherule in tissue)  
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DOC for Systemic mycoses   Local infection: Ketoconazole or Fluconazole. Systemic: Amphotericin B  
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Sabouraud's agar   Fungi  
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Cutaneous mycoses   Tinea versicolor, Tinea nigra, Tinea pedis/cruris/corporis/capitis.  
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Hypopigmented skin lesions in hot, humid weather   Malassezia furfur (tinea versicolor)  
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DOC for Tinea versicolor (Malassezia furfur)   Topical miconazole, selenium sulfide  
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Brownish spot infecting keratinized layer of skin   Cladosporium werneckii (Tinea nigra)  
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DOC for Tinea nigra (Cladosporium werneckii)   Salicylic acid  
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Dermatophytes   Microsporum, Trichophyton, and Epidermophyton  
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Epidermophyton   Infects skin and nails  
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Microsporum   Infects hair and skin  
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Trichophyton   Infects hair, skin, and nails  
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Mnemonic to remember types of Ringworm   "3C's at the PUB" (Cruris, Corporis, Capitis, Pedis, Unguium, Barbae)  
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Characteristics of Ringworm   Itchy, red, raised, scaly patches that may blister and ooze. Patches have sharply defined edges. Are often redder around the outside with normal skin tone in the center creating the appearance of a ring.  
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How diagnose Ringworm   KOH, Sabouraud's agar, Wood's lamp  
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Germ tubes at 37C   Candida  
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45 degree angle branching septate hyphae   Aspergillus  
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Rare fruiting bodies   Aspergillus  
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5-10 um yeasts with wide capsular halo   Cryptococcus  
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Narrow-based unequal budding   Crytococcus  
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Irregular broad (empty-looking) nonseptate hyphae, wide-angle branching   Mucor  
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Opportunistic fungal infections   Candida albicans, Aspergillus funigatus, Cryptococcus neoformans, Mucor and Rhizopus  
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Mold with irregular nonseptate hyphae branching at wide angles (>90)   Mucor and Rhizopus  
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Frontal lobe abscess in ketoacidotic diabetic   Mucormycosis  
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Causes pneumonia in ICH due to over-replication of type II pneumocytes and over-production of surfactant   Pneumocystis carinii  
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Diffuse interstitial pneumonia in AIDS patients   PCP  
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Is PCP a protozoa or yeast?   Yeast  
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Cysts and intracystic bodies on methenamine silver stain of lung tissue   PCP  
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DOC of PCP   TMP-SMX, Pentamidine, Dapsone  
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When start prophylaxis for PCP in AIDS pt?   When CD4 drops <200 cells/mL  
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Manifestations of Aspergillus infection   1) Allergic bronchopulmonary mucus plugs 2) Fungus balls (aspergilloma) 3) Invasive Aspergillosis  
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Urease positive, pigment production on niger seed agar   Cryptococcus neoformans  
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Latex agglutination test detects polysaccharide capsular antigen   Cryptococcus neoformans.  
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A heavily encapsulated, non-dimorphic yeast found in soil and pigeon droppings   Cryptococcus neoformans  
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India Ink   Cryptococcus neoformans  
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Subcutaneous fungal infections   Sporothrix schenckii and Pseudallescheria boydii  
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Dimorphic fungus that lives on vegetation and is traumatically introduced into skin, typically by a thorn   Sporothrix schenckii (rose gardener's disease)  
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Local pustule or ulcer with nodules along draining lymphatics (ascending lymphangitis)   Sporothrix schenckii  
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Cigar-shapped budding yeast   Sporothrix schenckii  
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DOC for Sporothrix schenckii   Itraconazole or Potassium iodide  
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Clinical manifestations of Entamoeba histolytica   Amebiasis: bloody diarrhea (dysentery), liver abscess, RUQ pain  
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DOC for Entamoeba Histolytica   Metronidazole and Iodoquinol  
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How is entamoeba histolytica transmitted   Fecal-oral (or anal-oral sexual contact). Cysts in water  
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How do you diagnose Entamoeba histolytica   Serology and/or trophozoites or cysts in stool  
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Bloating, flatulence, and foul-smelling diarrhea after a camping/hiking trip   Giardia lamblia  
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How is Giardia lamblia transitted?   Cysts in water  
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How do you diagnose Giardia lamblia?   Look for the Trophozoites or cysts in the stool  
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What will a colonic biopsy of a patient with Entamoeba histolytica show?   Ulcers in the colon w/o inflammatory response. Flask-like ulcers in the submucosa.  
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DOC in Giardia lamblia   Metronidazole  
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Severe diarrhea in AIDS pts. Mild watery diarrhea in non-HIV pts.   Cryptosporidium  
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How do you diagnose Cryptosporidium   Cysts on acid-fast stain  
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How is Cryptosporidium transmitted?   Cysts in water (fecal oral)  
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Presents with prolonged realapsing watery diarrhea, abdominal cramps, and fever after eating rasberries   Cyclospora cayetanensis  
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Commonly contaminates berries (rasberries, and strawberries)   Cyclospora cayetanensis  
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How do you diagnose Cyclospora cayetanensis   Acid fast cysts in stool (not as acid fast as Cryptosporidium parvum). Also it causes UV epifluorescence.  
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How txt Cryptosporidium?   No txt  
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Commonly causes brain abscesses in HIV patients   Toxoplasma (ring enhancing brain lesions)  
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How is toxoplasma transmitted?   Oocysts in cat feces, or tissue cysts in undercooked meat. Also transplacentally  
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What is DOC for toxoplasma   TMP-SMX  
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What is the vector for malaria?   the Anopheles mosquito  
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What are the types of Malaria?   Plasmodium Vivax, P.ovale, P.malariae, P.falciparum  
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Classic presentation of malaria   Cyclic fever, headache, anemia, splenomegaly  
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Which type of malaria can cause severe cerebral infection?   Plasmodium falciparum  
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How is relapse of malaria prevented?   Primaquine (relapse occurs in P.vivax, and P.ovale)  
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What is recrudescence?   Relapse of malaria, but not from liver. Seen in P.falciparum  
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Which type of malaria requires Duffy factor?   P.vivax  
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Which type of malari infects reticulocytes?   P.vivax and P.ovale. Falciparum infects RBCs in all stages of maturation. Malariae infects only mature RBCs  
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Which type of malaria infects mature RBCs?   P.malariae  
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Which type of malaria infects RBCs in all stages of maturation?   P.falciparum  
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In malaria life cycle: Mosquitos inject what type of cells into blood?   Sporozoites  
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Hypnozoites are present in which types of malaria?   P.vivax, P.ovale  
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Which type of malaria cells are released from the liver?   Merozoites  
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Schizonts are present in what part of the malaria life cycle?   Schizonts are part of the erythrocyte cycle. Merozoites are released from liver into blood. Schizonts are in RBCs - cause RBC rupture releasing gametocytes which are taken up by another mosquito.  
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Gametocytes of malaria are matured and fertilized into sporozoites where?   Maturation and fertilization occur in the mosquito. Released sporozoites migrate to the salivary gland of the mosquito.  
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Foul-smelling, greenish vaginal discharge, causing itching and burning   Trichomonas vaginalis.  
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How diagnose Trichomonas vaginalis?   Trophozoites (motile) on wet mount. Vaginal discharge pH > 4.5  
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Risks of Trichomonas vaginalis   Increases risk of preterm birth and HIV infection  
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"Strawberry cervix"   Trichomonas vaginalis.  
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How txt Trichomonas vaginalis?   Metronidazole  
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Vector is the Reduviid bug (kissing bug)   Trpanosoma cruzi (Chagas' disease)  
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Characteristics of Chagas' disease   Dilated cardiomyopathy, megacolon, megaesophagus  
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Romano's sign   Periorbital edema in Chagas' disease  
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How diagnose Chagas' disease?   Trypomastigotes in smooth muscle, GI tract, and blood smear  
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How does Trypansoma cruzi avoid immunity?   Antigenic variation (VSG - variant surface glycoprotein) surface Ag  
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Tsete fly   Vector of Trypanosoma gambiense and T.rhodesiense (African Sleeping Sickness)  
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DOC in Trypanosoma cruzi   Nifurtimox  
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Winterbottom's sign   Posterior cervical adenopathy in Afrcan Sleeping Sickness  
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DOC in treating Typanosoma gambiense or T.rhodesiense   Suramin for blood born disease or Melarsopro for CNS penetration  
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Sandfly   Vector for Leishmania donovani (Visceral leishmaniasis or kala-azar)  
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Where do the promastigotes of Leishmaniasis reproduce?   Macrophages (this is how diagnose - look for amastigotes in the macrophages)  
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Kala-azar   Visceral Leishmaniasis: fever, pancytopenia, hepatosplenomegaly  
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How diagnoses Leishmaniasis   Look for macrophages containing amastigotes  
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What is DOC for Leishmaniasis?   Sodium stibogluconate  
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Iodes nymph   vector for Lyme disease and Babesia microti  
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Babesiosis   Fever and anemia  
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Maltese cross of blood smear   Babesiosis  
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How txt Babesia?   Quinine, clindamycin  
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Rapidly fatal meningoencephalitis common acquired through the cribriform plate when diving into a freshwater lake   Naegleria  
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How diagnose Naegleria?   Amebas in spinal fluid  
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Sudden onset of sever fatal Praimary Amebic Meningoencephalitis (PAM)   Naegleria fowleri  
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How txt Naegleria fowleri?   No txt  
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Cestodes   Tapeworms (have long flattened body, proglottid body segments (self-contained hermaphroditic reporduction units), no gut  
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Species of tapeworms (cestodes)   Taenia saginata, Diphyllobothrium latum, Taenia solium, Echinococcus granulosus  
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Undercooked pork tapeworm; larvae cause mass lesion in the brain, cysticercosis   Taenia solium  
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Calcified cysticerci on CT or MRI   Taenia solium  
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Beef tapeworm   Taenia saginata  
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Txt of choice for Taenia solium   Praziquantel/niclosamide. Albendazole for cysticercosis  
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Hydatid cysts   "Cysts w/in cysts" - common in Echinococcus granulosus  
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Cystic rupture causing anaphylaxis   Echinococcus granulosus  
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Shepard with multiple cysts   Echinococcus granulosis  
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Dog/sheep life cycle.   Echinococcus granulosis  
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Treatment of choice for Echinococcus granulosus   Albendazole  
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In treating echinococcus granulosus cysts, is aspiration a good method?   Aspiration contraindicated because of risk of cystic rupture  
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Trematodes   Flukes. Have a blind alimentary canal, and dorsal and ventral suckers  
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Species of Trematodes (Flukes)   Schistosoma, Clonorchis sinensis  
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Diphyllobothrium latum   Fish tapeworm  
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Helminth cause of Vit B12 deficiency   Diphyllobothrium latum (b/c fish tapeworm eats it in jejunum)  
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Host of schistosoma spp   Snails in water  
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How is schistosoma transmitted   Through skin of humans  
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Intense pruritic rash at entry site followed by granulomas, fibrosis, and inflammation of the liver and spleen   Schistosoma spp  
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Common cause of bladder cancer in Japan   Schistosoma spp  
🗑
DOC for Schistosoma   Praziquantel  
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Chinese liver fluke   Clonorchis sinensis  
🗑
Cholangitis leading to cholangiocarcinoma   Clonorchis sinensis  
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Transmission of clonorchis sinensis   Eating undercooked fish  
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DOC in Clonorchis sinensis   Praziquantel  
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Transmitted by undercooked crab meat   Paragonimus wetermani (Lung fluke)  
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Lung Fluke   Paragonimus westermani  
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Trematode mimicking TB   Paragonimus westermani (lung mass - leading to 2ndary bacterial infection)  
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Treatment of choice for Paragonismus westermani   Praziquantel  
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Nematodes   Roundworms (wormlike, tubular alimentary tracts)  
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Hookworm   Necator americanus and Ancylostoma duodenale  
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Ancylostoma duodenale   Hookworm  
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Transmission of Ancylostoma duodenale   Commonly known as Hookworm. Larvae penetrate skin of feet.  
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Clinical manifestations of Ancylostoma duodenale   Commonly known as hookworm. Intestinal infections can cause anemia (in intestine)  
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DOC in Ancylostoma duodenale   Mebendazole/pyrantel pamoate  
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Giant Nematode (roundworm)   Ascaris lumbricoides  
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Most common helminth in the world   Ascaris lumbricoides  
🗑
Nematode presenting with distended abdomen, or intestinal obstruction   Ascaris lumbricoides  
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DOC in Ascaris lumbricoides   Mebendazole/pyrantel pamoate  
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Pinworm   Enterobius Vermicularis  
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Enterobius vermicularis   Pinworm  
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Nocturnal pruritic ani/vulvae   Pinworm (Enterobius vermicularis)  
🗑
DOC in Enterobius vermicularis   Mebendazole/pyrantel pamoate  
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What is only Nematode that has larvae present in feces?   Strongyloides stercoralis (allows for autoinfection)  
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How are Strongyloides stercoralis transmitted   Larvae in soil penetrate the skin  
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Clinical manifestations of Strongyloides stercoralis   Cause intestinal infection. Red, raised, serpiginous lesions on buttock and lower back. Can cause hyperinfection (entercolitis, and widespread dissemination)  
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DOC in treating Strongyloides stercoralis   Ivermectin/thiabendazole  
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Helminth infection resulting in periorbital edema, muscle pain and weakness   Trichinella spiralis  
🗑
DOC in Trichinella spiralis   Thiabendazole  
🗑
How diagnose Trichinella spiralis?   Muscle biopsy  
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Roundworm (nematode) found in drinking water causing skin inflammation and ulceration   Dracunculus medinensis  
🗑
DOC in Dracunculus medinensis   Niridazole  
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Deer (crysops) fly   Vector for Loa Loa  
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Also known as Eye worm (b/c can see worm crawling in conjunctiva)   Loa loa  
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DOC in Loa loa   Diethylcarbamazine  
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Female blackfly   Vector of Onchocerca volvulus (African River blindness)  
🗑
River Blindness   Onchocerca volvulus  
🗑
DOC in Onchocerca volvulus   Ivermectin (I=Eye)  
🗑
Night-biting female mosquito   Wuchereria bancrofti (Elephantiasis)  
🗑
Elephatiasis   Wuchereria bancrofti  
🗑
Causes blockage of lymphatic vessels resulting in lymph node scarring   Wucheria bancrofti (Elephantiasis)  
🗑
Causes rectal prolapse   Trichuris trichiura (Whipworm)  
🗑
Visceral larva migrans   Toxocara canis (eggs passed in dog feces)  
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Ocular larva migrans   Toxocara canis (granulomas - if in retina = blindness)  
🗑
DOC in Toxocara canis   Diethylcarbamazine  
🗑
DOC in Wuchereria bancrofti   Diethylcarbamazine  
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Parasite Hints: Brain cysts, seizures   Taenia solium (cysticercosis)  
🗑
Parasite Hints: Liver cysts   Echinococcus granulosus  
🗑
Parasite Hints: B12 deficiency   Diphyllobothrium latum  
🗑
Parasite Hints: Biliary tract disease   Clonorchis sinesis  
🗑
Parasite Hints: Hemoptysis   Paragonismus westermani  
🗑
Parasite Hints: Portal hypertension   Schistosoma mansoni  
🗑
Parasite Hints: Hematuria, bladder cancer   Schistosoma haematobium  
🗑
Parasite Hints: Microcytic anemia   Ancylostoma, Necator  
🗑
Parasite Hints: Perianal pruritis   Enterobius  
🗑
Only single-stranded DNA virus   Parvoviridae (Parvovirus B19)  
🗑
All DNA viruses are linear except:   Papovavirus (HPV, JC, BK), and Hepadnaviruses (HepB) - both are circular  
🗑
Only RNA virus that is double-stranded   Reoviridae (Rotavirus). "Repeatovirus = Reovirus"  
🗑
Naked (non-enveloped) DNA viruses   "PAP" (as in you have to be naked for a PAP smear): Parvoviridae (remember ssDNA), Adenovridae, and Papovaoviridae (BK, JC, HPV)  
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Enveloped DNA viruses   HPH: Hepadnaviridae (HepB), Poxviridae, and Herpesviridae  
🗑
Naked viral genome infectivity: Infectious naked viruses   Nake nucleic acids of most dsDNA (except Poxviruses and HBV) and (+) sense ssRNA viruses are infectious  
🗑
Naked viral genome infectivity: Non infectious naked viruses   Naked nucleic acids of (-) strand ssRNA and dsRNA viruses are not infectious  
🗑
How do viruses acquire their envelope?   Generally, enveloped viruses acquire their envelopes from plasma membrane when they exit from cell. Exceptions are herpesviruses, which acquire envelopes from nuclear membrane  
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Virus ploidy: All viruses are:   Haploid (1 copy of DNA or RNA). Exception are retroviruses which have 2 identical ssRNA molecules (diploid)  
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Only diploid virus   Retroviruses (HIV) - have 2 identical ssRNA molecules  
🗑
All DNA viruses replicate where?   In the nucleus (except poxvirus - replicates in cytoplasm)  
🗑
All RNA viruse replicate where?   In the cytoplasm (except influenza virus and retroviruses (nucleus)  
🗑
Mnemonic to remember DNA viruses   HHAPPPy viruses: Hepadna, Herpes, Adeno, Pox, Parvo, Papova  
🗑
All DNA viruses are icosahedral except:   Pox viridae (complex - brick shaped). "Pox in a Box"  
🗑
All DNA viruses replicated in the nucleus except:   Pox viridae (carries its own DNA-dependent RNA polymerase)  
🗑
Categorization of Hepadnavirus   Enveloped, dsDNA, partial circular  
🗑
Medical importance of Hepadnavirus   Hepatitis B: can be acute or chronic hepatitis, there is a vaccine available, is not a retrovirus but does have a reverse transcriptase.  
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Categorization of Herpesviruses   dsDNA, linear, enveloped (note: only enveloped viruse to acquire envelope from nuclear membrane - remember, most get from plasma membrane)  
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Types of Herpesviruses   HSV1 (oral lesions, keratoconjunctivitis), HSV2 (genital lesions), VZV (chickenpox, zoster, shingles), EBV (mono, burkitt), CMV (ICH, congenital dfts), HHV6 (roseola - exanthem subitum), HHV8 (kaposi's sarcoma)  
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Which type of Herpesvirus generally presents with oral lesions?   HHV-1 usually is the culprit of cold-sores. HSV1 can sometimes also cause genital lesions. HSV2 generally presents as genital lesions (with some oral lesions)  
🗑
Which Herpesvirus presents with genital lesions?   HSV2 (sometimes also causes oral lesions). HSV1 is usally oral (and some genital) lesions  
🗑
A herpetic lesion on nurses finger   Herpetic whitlow (from physical exam of person's mouth with herpes)  
🗑
What is most common type of congenital herpes?   HSV2 (75%)  
🗑
Categorization of Adenovirus   dsDNA virus, linear, naked (part of PAP - other nakeds are Parvo and Papova)  
🗑
Common clinical manifestations of Adenovirus   Febrile pharyngitis (sore throat), Pneumonia, Conjunctivitis - "pink eye"  
🗑
What causes "pink eye"?   Adenovirus  
🗑
Categorization of Parvovirus   ssDNA (the only one!), linear, negative sense, naked  
🗑
Why does a physician have to closely monitor a fetus of a mom exposed to Parvovirus B19?   Can cause hydrops fetalis!  
🗑
Can cause an aplastic crises in patients with sickle cell disease   Parvovirus B19  
🗑
"Slapped cheek"   Parvovirus B19  
🗑
Parvovirus B19 is aka?   Erythema infectiosum (fifth disease)  
🗑
Categorization of Papovavirus   dsDNA, circular, naked  
🗑
Types of Papovavirus   HPV, JC, BK  
🗑
Which types of HPV can lead to cancer?   HPV 16, 18, 31, 45 can predispose to cervical, penile, and anal cancer  
🗑
How is HPV transmitted?   Direct contact (sexual and non-sexual, minor trauma, and maternal-fetal  
🗑
Condyloma acuminata from?   HPV 6-11. most common viral STD.  
🗑
What regulatory genes does HPV inactivate?   Rb, and p53  
🗑
Progressive multifocal leukoencephalopathy is caused by?   JC virus (a Papovavirus). Presents as demyelination of CNS, hemiparesis, cognitive problems, visual field defects.  
🗑
How does PML present?   Demyelination of CNS, hemiparesis, cognitive problems, and visual field defects in ICH. Is a subcortical lesion that doesn't enhance with contrast on MRI  
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How does BK virus present   Asymptomatic in immunocompetent hosts. In ICH can have hemorrhagic cystitis, and renal transplant rejection  
🗑
What is the smallest DNA virus?   Parvovirus (also is ssDNA!)  
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What is the largest DNA virus?   Poxvirus  
🗑
Categorization of Poxvirus   dsDNA, linear, brick-shaped, enveloped  
🗑
Types of Poxvirus   Smallpox, Vaccinia, Molluscum contagiosum  
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What is the only DNA virus that replicated in the cytoplasm?   Poxvirus  
🗑
How tell between smallpox and chicken pox?   SMALLPOX: prodrome fever 2-4 day b/f rash, all pocks at same stage, pocks are deep seated, firm pustules, lesions on face, palms, and soles. CHICKENPOX: no prodrome, pocks at different stages, "dew drops on rose petal", mostly on trunk (few palms/soles)  
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Molluscum Contagiosum   A pox viruse. Have umbilicated skin lesions with eosinophilic cytoplasmic inclusion bodies  
🗑
Positive vs. Negative Sense   Positive sense RNA produces a negative sense intermeidate to produce a genomic duplictate. Negative sense RNA produces a positive sense intermediate to produce a genomic duplicate  
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Categorization of Picornaviruses   non-enveloped, ssRNA, positive sense, linear, icosahedral  
🗑
Which RNA viruses are naked?   Reoviruses, Picornaviruses, Calciviruses, Herpeviridae. "Rachel Plays Her Clarinet naked"  
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What is the only double-stranded RNA virus   Reovirus - of which Rotavirus is most famous  
🗑
Salk/Sabin vaccines   for Polio virus (a Picornavirus)  
🗑
Echovirus can cause?   Aseptic meningitis  
🗑
Types of Picornaviruses   Poliovirus, Echovirus, Rhinovirus, Coxsackievirus, Hepatitis A virus (PERCH)  
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Most common cause of the common cold   Rhinovirus (a Picronavirus - ssRNA, +, linear, icosahedral)  
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Coxsackie A16   Hand, foot, and mouth disease  
🗑
Coxsackie B   myocarditis  
🗑
Common cause of summer meningitis   Coxsackie virus (aseptic)  
🗑
Sudden onset of RUQ pain, fever, dark urine, and light stool after an international trip   Hepatitis A (picornaviridae, ssRNA non-enveloped)  
🗑
Causes of Chronic Hepatitis   HBV, HCV, HDV  
🗑
Categorization of Calciviruses   Non-enveloped, ssRNA, +, linear, Icosahedral  
🗑
Star of David appearance on EM   Norwalk virus (a Calcivirus) - common cause of gastroenteritis  
🗑
Outbreak on cruise ship   Norwalk viruse (a Calcivirus - ssRNA, naked) - found on any type of food (common on shellfish). very infectious  
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Categorization of Reovirus   Non-enveloped, dsRNA, linear segmented, double icosahedral (only dsRNA virus!)  
🗑
Colorado Tick Fever   A Reovirus (dsRNA), presents similar to Rocky Mountain spotted fever  
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#1 cause of fatal diarrhea in children   Rotavirus (a Reovirus - dsDNA).  
🗑
How diagnose Rotavirus?   Look for VP6 antigen in stool. Also know that is dsRNA  
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How remember enveloped, ssRNA, + sense viruses?   "Cons Rob From Tourists" (Coronaviruses, Retroviruses, Flaviviruses, Togaviruses)  
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Categorization of Flaviviruses   Enveloped, ssRNA, + sense, linear  
🗑
Types of Flaviviruses   HCV, Yellow fever, Dengue fever, St. Louis encephalitis, West Nile Virus  
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Fever with jaundice   Yellow fever (flavivirus). Transmitted by aedis aegypti mosquito  
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Break bone fever   Dengue fever (a flavivirus)  
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Dengue virus has tropism for which type of cells?   Striated muscle - causing break bone fever  
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Culex mosquito/Birds in life cycle   St. Louis encephalitis, and West Nile virus  
🗑
Older individual bitten by a mosquito causing encephalitis   West Nile virus  
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Categorization of Togaviruses   Enveloped, ssRNA, positive sense, linear (part of 'Cons Rob From Tourists')  
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Types of Togavirus   Rubella (German measles), Eastern equine encephalitis, Western equine encephalitis  
🗑
What is the only Togavirus that is not transmitted via arthropod?   Rubella (German measles)  
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Which is more severe WEE or EEE?   EEE is more severe (mortality approx 30% in those who develop encephalitis). Both are Togaviruses  
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Congenital Rubella   Purpura (blueberry muffin rash), Deafness, Cataracts, Heart defects (PDA), Retardation, Retinopathy  
🗑
Latino pregnant women comes in with 3 day rash that began at her face and descended. What do you worry about?   Rubella (German measles) - can cause congenital rubella!!!  
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Categorization of Retroviruses   Enveloped, ssRNA, positive sense, linear. Have reverse transcriptase (HIV)  
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Categorization of Coronaviruses   Enveloped, ssRNA, positive sense, linear. Have Helical capsid (all others in this group of Cons Rob From Tourists are Icosahedral)  
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Types of Coronaviruses   SARS and Common cold  
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SARS   Triphasic course. 1) Fever, myalgia 2) Cough, dyspnea 3) Recurrent fever, progressive infiltrates  
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How to remember the Enveloped, ssRNA, negative sense viruses   Real Foes Are Better Paralyzed Or Dead (Rhabdoviruses, Filoviruses, Arenaviruses, Bunyaviruses, Paramyxoviruses, Orthomyxoviruses, Deltavirus)  
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Categorization of Orthomyxoviruses   Enveloped, ssRNA, negative sense  
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Only clinically important Orthomyxoviruses   Influenza virus  
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Influenza virus   An orthomyxovirus (ssRNA, -, enveloped)  
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What are the major antigens of the influenza virus?   H and N  
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How does influnza virus evade the immune system?   1) Antigenic drift (gradual alteration of H and/or N w/in subtype which occurs in both A and B viruses). 2) Antigenic shift (appearance in human population of new subtype of A virus from animal reservoir like swine)  
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Antigenic drift   Gradual alteration (point mutations) of H and/or N w/in subtype which occurs in both A and B viruses  
🗑
Antigenic shift   Appearance in human population of new subtype of A virus (from animal reservoir like swine)  
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Categorization of Parmyxoviruses   Enveloped, ssRNA, negative sense, linear.  
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Types of Paramyxoviruses   PaRaMyxovirus: Parainfluenza, RSV, Measles, Mumps  
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Parainfluenza virus   A Paramyxovirus (ssRNA, enveloped, negative sense). Commonly causes croup (PIV1). PIV3 is second leading cause of bronchiolitis and pneumonia in infancy. PIV4 is asymptomatic or mild cold.  
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Croup   Parainfluenza virus 1 (a Paramyxovirus). Presents with a barking cough, and respiratory stridor  
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How does Parainfluenza virus type 3 present?   Second leading cause of bronchiolitis and pneumonia in infancy  
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Bronchiolitis in babies   RSV  
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DOC for RSV   Ribavirin  
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Which Paramyxovirus carries an RNA dependent RNA polymerase?   RSV  
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Antigeninc derterminants of RSV   F (fusion), G (attachment)  
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Measles   A Paramyxovirus (ssRNA, enveloped, negative sense, linear). Aka: Rubeola. 3C's: Cough, Coryza, Conjunctivitis. Also Koplick spots. Maculopapular rash which starts head, and spreads downward  
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Cough, Coryza, Conjunctivitis   Measles  
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Rash that spreads like a paintcan poured on someone   Measles  
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Slowly progressive central nervous system disease with mental deterioration and incoordination many years after measles   SSPE (Subacute Sclerosing Panencephalitis)  
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Parotid gland swelling   Mumps  
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Orchitis   Mumps  
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Categorization of Rhabdoviruses   Enveloped, ssRNA, negative sense, linear. Only one is Rabies  
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Rabies   Rhabdovirus (ssRNA, enveloped, negative sense)  
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Negri bodies   Rabies  
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Bullet-shaped, linear genome   Rabies (ssRNA, negative sense, Rhabdovirus)  
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Virus begins in striated muscle, ascends neurons to CNS where it spreads peripherally from CNS along neurons   Rabies  
🗑
Concentrates in salivary glands   Rabies  
🗑
How does Rabies present?   1) FURIOUS: hydrophobia, hallucinations, agitation, biting. 2) DUMB: ascending flaccid paralysis  
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What is mortality of Rabies?   100% (if not treated)  
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How treat Rabies?   Rabies immunoglobulin and vaccine within 48-72 hours  
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Categorization of Filoviruses   Enveloped, ssRNA, negative sense, linear. (part of Real Foes Are Better Paralyzed Or Dead)  
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Types of Filoviruses   Ebola virus, Marburg virus  
🗑
Hemorrhagic fevers resulting in DIC and Death   Ebola and Marburg virus (Filoviruses)  
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Categorization of Arenaviruses   Enveloped, ssRNA, negative sense, circular.  
🗑
Types of Arenaviruses   LCV (lymphocytic choriomeningitis), Lassa Virus  
🗑
Lymphocytic Choriomeningitis Virus   Arenavirus. Has "sand" granuels due to ribosomes. Causes meningitis from aerosolization of murine feces/urine.  
🗑
Lassa Virus   Arenavirus. Has "sand" granuels due to ribosomes. Classic presentation is bleeding, neck/face swelling, and shock  
🗑
How is Lassa virus transmitted   Rodent to human or human to human.  
🗑
Meningitis spread by mice   LCV (Arena virus)  
🗑
Categorization of Bunyaviruses   Enveloped, ssRNA, negative sense, circular.  
🗑
Types of Bunyaviruses   California encephalitis, Sandfly/Rift Valley Fevers, Crimean-Congo hemorrhagic fever, Hantavirus  
🗑
Pulmonary syndrome after exposure to deer mouse   Hanta virus  
🗑
Hepatitis D virus   Deltavirus. Enveloped, ssRNA, negative sense, circular.  
🗑
Live attenuated vaccines induce what type of immunity?   Humoral and cell-mediated immunity  
🗑
Killed vaccines induces what type of immunity?   Humoral  
🗑
What vaccines are Live attenuated?   Measles, Mumps, Rubella. Sabin, VZV, Yellow Fever, Smallpox, Adenovirus  
🗑
What vaccines are killed   Rabies, Influenza, Salk (polio), and HAV. Mnemonic: RIP Always. SalK=Killed  
🗑
Egg based vaccines   Flu, MMR, Yellow fever (FRY an egg)  
🗑
Recombinant vaccines   HBV (antige = recombinant HBsAg)  
🗑
What is Recombination   Exchange of genes between 2 chromosomes by crossing over within regions of significant base sequence homology  
🗑
Exchange of genes between 2 chromosomes by crossing over within regions of significant base sequence homology   Recombination  
🗑
What is Reassortment?   When viruses with segmented genomes (eg influenza virus) exchange segments. High frequency recombination. Cause of worldwide pandemics.  
🗑
When viruses with segmented genomes (eg: influenza virus) exchange segments. High frequency recombination. Cause of worldwide pandemics.   Reassortment  
🗑
What is Complementation?   When 1 of 2 viruses that infect the cell has a mutation that results in a nonfunctional protein. The nonmutated virus "complements" the mutated one by making a functional protein that serves both viruses  
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When 1 of 2 viruses that infect the cell has a mutation that results in a nonfunctional protein. The nonmutated virus makes a functional protein that serves both viruses.   Complementation  
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What is Phenotypic mixing?   Genome of virus A can be coated with surface proteins of virus B. Type B protein coat determines the infectivity of the phenotypically mixed virus. However, the progency from this infection has a type A coat and is encoded by its type A genetic material.  
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Genome of virus A can be coated with surface proteins of virus B. Type B protein coat determines the infectivity of the phenotypically mixed virus. However, the progeny form this infection has a type A coat and is encoded by its type A genetic material.   Phenotypic mixing  
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Negative stranded viruses   Rhabdovirus, Filovirus, Arenavirus, Bunyavirus, Paramyxovirus, Orthomyxovirus, Deltavirus. "Real Foes Are Better Paralyzed Or Dead"  
🗑
Segmented viruses   Bunyavirus, Orthomyxovirus, Arenavirus, Reovirus. "BOAR"  
🗑
Picornavirus types   Poliovirus, Echovirus, Rhinovirus, Coxsackievirus, HAV. "PEARCH on a peak"  
🗑
Are Picornaviruses large or small?   Small. PicoRNAvirus = small RNA virus  
🗑
How are Picornaviruses manufactured?   RNA is translated into 1 large polypeptide that is cleaved by proteases into functional viral proteins  
🗑
Important facts about Rhinovirus   Nonenveloped RNA virus (Picornavirus). Cause of common cold. >100 serotypes  
🗑
Most important cause of infantile gastroenteritis   Rotavirus (segmented dsRNA virus)  
🗑
Major cause of acute diarrhea in the US during winter   Rotavirus (segmented dsRNA)  
🗑
Virus causing villous destruction with atrophy leading to decreased absorption of Na+ and water   Rotavirus (dsRNA, segmented, Reovirus)  
🗑
Mnemonic to remember clinical consequences of Mumps   Mumps makes your parotid glands and testes as big as POM-poms. (P=parotitis, O=orchitis, M=meningitis)  
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Virus containing hemagglutinin and neuraminidase antigens   Influenza virus  
🗑
What type of vaccine is the influenza vaccine?   Killed  
🗑
Genetic shift   (Pandemic) Reassortment of viral genome (such as when human flu A virus recombines with swine flu A virus)  
🗑
Genetic drift   (Epidemic) Minor changes based on random mutation  
🗑
Which is more deadly Genetic shift, or Genetic drift?   Sudden Shift is more deadly than graDual Drift  
🗑
Txt of choice for Influenza virus   Amantadine and Remantadine useful for influenza A. Zanamivir and Oseltamivir are useful for both influenza A and B  
🗑
How does Rubella cause deafness?   Deafness is due to failure of cochlea and spiral ganglion to develop  
🗑
Travels to the CNS by migrating in a retrograde fashion up nerve axons   Rabies virus  
🗑
Arboviruses   Viruses transmitted by ARthropods. Flavivirus, Togavirus, and Bunyavirus. "Fever Transmitted by Bites"  
🗑
What is the reservoir for Yellow Fever?   Monkey or human reservoir  
🗑
High fever, black vomitus, and jaundice   Yellow fever  
🗑
Councilman bodies in the liver   Yellow fever  
🗑
Mnemonic to remember the types of Herpes   Get herpes in a CHEVrolet: CMV, HSV, EBV, VZV  
🗑
Clinical manifestations of HSV-1   Gingivostomatitis, keratoconjunctivits, temporal lobe encephalitis, herpes labialis  
🗑
How is HSV-1 transmitted?   Respiratory secretions, saliva  
🗑
Clinical manifestations of HSV-2   Herpes genitalis, neomatal herpes  
🗑
How is HSV-2 transmitted?   Sexual contact, perinatal  
🗑
Clinical manifestations of VZV   Varicella-zoster (shingles), encephalitis, pneumonia  
🗑
How is VZV transmitted?   Respiratory secretions  
🗑
What are the clinical manifestations of EBV?   Infectious mononucleosis, Burkitt's lymphoma  
🗑
How is EBV transmitted?   Respiratory secretions, saliva  
🗑
What are the clinical manifestations of CMV?   Congenital infection, mononucleosis (negative monospot), pneumonia  
🗑
How is CMV transmitted?   Congenital, transfusion, sexual contact, saliva, urine, transplant  
🗑
What are the clinical manifestations of HHV-8   Kaposi's sarcoma in HIV patients  
🗑
How is HHV-8 transmitted?   Sexual contact  
🗑
Monospot test   heterophile antibodies detected by agglutination of sheep RBCs  
🗑
Abnormal circulating cytotoxic T cells (atypical lymphocytes). Reacting against infected B cells   Mononucleosis  
🗑
A smear of an opened skin vesicle to detect multinucleated giant cells   Tzank test (looking for HSV1,HSV2, and VZV). "Tzanck heavens I do not have herpes"  
🗑
HAV   (RNA picornavirus) transmitted primarily by fecal oral route. Short incubation (3 weeks). No carriers  
🗑
Mnemonic to remember Hep A   Hep A: Asymptomatic (usually), Acute, Alone (no carriers, and naked ssRNA)  
🗑
HBV   DNA hepadnavirus. Transmitted primarily by parenteral, sexual, and maternal-fetal routes. Long incubation (3 months). Carriers. Reverse transcription occurs, however, the virion enzyme is a DNA-dependent DNA polymerase  
🗑
Which Hepatitis virus can undergo reverse transcription?   HBV (however, the virion enzyme is a DNA-dependent DNA polymerase)  
🗑
HCV   RNA flavivirus. Transmitted primarily via blood and resembles HBV in its course and severity. Carriers. Common cause if IV drug use hepatitis in the US.  
🗑
Common cause of IV drug use Hepatitis in the US   HCV (RNA flavivirus)  
🗑
Mnemonic to remember importance of Hep C   Hep C: Chronic, Carriers, Cirrhosis, Carcinoma.  
🗑
HDV   Deltavirus. A defective virus that requires HBsAG as its envelope. Carriers  
🗑
HEV   (RNA Calcivirus). Transmitted enterically and causes water-borne epidemics. High mortality rate in pregnant women.  
🗑
Hepatitis to worry about in pregnant women   HEV (high mortality!)  
🗑
Which hepatitis viruses are transmitted fecal-orally?   A and E. "The vowels hit your bowels"  
🗑
Mnemonic to remember importance of Hep D   Hep D: Defective, Dependent on HBV  
🗑
Mnemonic to remember importance of Hep E   Hep E: Enteric, Expectant mothers, Epidemics.  
🗑
Which hepatitis viruses predispose a patient to chronic active hepatitis, cirrhosis, and hepatocellular carcinoma?   HBV and HCV  
🗑
Best test to detect active hepatitis A?   IgM HAVAb. (IgM antibody to HAV)  
🗑
Antigen found on surface of HBV   HBsAg (continued presence of antigen indicates carrier state)  
🗑
The presence of this antigen indicates continued carrier state of Hepatitis B   HBsAg  
🗑
Which antibody indicates immunity to Hepatitis B   HBsAb (antibody to HBsAg)  
🗑
Antigen associated with core of HBV   HBcAg  
🗑
Hepatitis B test that is positive during window period   HBcAb (antibody to Hepatitis B core antigen)  
🗑
IgM HBcAb is indicative of what?   an indicator of recent disease  
🗑
What is an important indicator of HBV transmissibility?   HBeAg. "BEware"  
🗑
What indicates low HBV transmissibility?   HBeAb  
🗑
HBeAb   Indicates low transmissibility of HBV  
🗑
HBeAg   Indicates high transmissibility of HBV  
🗑
HBcAb   Antibody to HBcAg. indicates during window period.  
🗑
HBsAb   Indicates immunity to HBV  
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HBsAg   indicates carrier state of HBV, or early incubation period of HBV.  
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During the incubation period of HBV what will be positive?   HBsAg  
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During the Prodrome, or Acute disease phase of HBV what will be positive?   HBsAg, HBcAb  
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What is only serologic marker during window period?   HBcAb  
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What serologic markers indicate complete recovery from HBV   HBsAb, HBcAb (IgG)  
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What serologic markers indicate acute HBV?   HBsAg, HBcAb (IgM)  
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What serologic markers indicate the chronic carrier state of HBV?   HBcAb (IgG), HBsAg  
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What does the gp41 protein do in HIV?   It is an envelope protein (other is gp120). More specifically it acts during fusion of the viral envelope and cell membrane  
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What does gp120 protein do in HIV?   It is an envelope protein (other is gp41). More specifically it is the envelope protein which binds to CD4.  
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What does the p24 protein do in HIV?   is a rectangular neuclocapsid protein  
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Is the HIV genome haploid or diploid?   Diploid (2 molecules of RNA)  
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What does the p17 protein do in HIV?   It is a matrix protein  
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An RNA dependent DNA polymerase   HIV  
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Presumptive diagnosis of HIV is made with?   ELISA (sensitive, high false-positive rate, and low threshold) - can RULE out test. Positive results are then confirmed with Western blot assay (specific, high false-negative rate and high threshold) - Rule IN diagnosis  
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Which test has a high sensitivity for HIV?   ELISA (can rule out) - usually is inital test  
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Which test has a high specificity for HIV?   Western blot assay (can rule in HIV) - usually used to confirm a positive ELISA  
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What tests allow physicians to monitor the viral load of HIV?   HIV PCR  
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AIDS diagnosis   = < 200 CD4+, HIV positive with AIDS indicatior contition (eg: PCP), or CD4/CD8 ratio <1.5  
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CCR5 mutation   If homozygous allows immunity to HIV. If heterozygous, have a slower HIV course. (1% Americans homozygous, 20% heterozygous)  
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CXCR1 mutation   Rapid progression in AIDS  
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Reservoirs of HIV during latent phase of infection   Follicular dendritic cells in germinal centers of lymph nodes  
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Serologic markers of Acute HIV infection   Virus p24 antigen, High CD4 cells, Increasing number of Anti-p24, and Anti-gp120 antibodies  
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Serologic markers of latent HIV infection   Anti-p24 antibodies, Anti-gp120 antibodies, Still have high number of CD4 cells  
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Serologic markers of Progressive HIV infection   Decreasing number of CD4 lymphocytes, Decreasing amt of anti-p24 antibodies, and anti-gp120 antibodies, increasing amount of viral p24 antigen  
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What are opportunistic infections of the Brain in AIDS?   Cryptococcal meningitis, toxoplasmosis, CMV encephalopathy, AIDS dementia, PML (JC virus)  
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Opportunistic infections affecting the eyes of AIDS patients   CMV retinitis  
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Opportunistic infections affect the mouth and throat of AIDS patients   Thrush, HSV, SMV, oral hariy leukoplakia (EBV)  
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Opportunistic infections affecting the Lungs of AIDS patients   PCP, TB, Histoplasmosis  
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Opportunistic infections affecting the GI tract of AIDS patients   Cryptosporidiosis, MAC complex, CMV colitis, non-Hodgkin's lymphoma (EVB)  
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Opportunistic infections affecting the Skin of AIDS patients   Shingles (VZV), Kaposi's sarcoma (HHV-8)  
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Opportunistic infections affecting the Genitals of AIDS patients   Genital herpes, warts, and cervical cancer (HPV)  
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Primary CNS lymphoma   An intermediate to hight grade B cell lymphoma associated with EBV affecting AIDS patients. Presents with seizures, HA, cranial nerve deficits, and multicentric lesions sometimes involving the meninges.  
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Infectious agents that do not contain RNA or DNA   Prions (consist only of proteins)  
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Spongiform encephalopathy   Prion disease  
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Types of Prion disease   Creutzfeldt-Jakob disease, Kuru, Scrapie, and Mad Cow disease  
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Conformation of prions   Normal prions have alpha-helix conformation. Pathologic prions (like CJC) are beta-pleated sheets  
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Dominant normal flora of the Skin   Staphylococcus epidermidis  
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Dominant normal flora of the Nose   Staphylococcus aureus  
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Dominant normal flora of the Oropharynx   Viridans streptococci  
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Dominant normal flora of a dental plaque   Streptococcus mutans  
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Dominant normal flora of the colon   Bacteriodes fragilis > E.coli  
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Dominant normal flora of the vagina   Lactobacillus, colinized by E.coli and group B strep  
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Common causes of pneumonia in Children 6wks - 18 yrs   Viruses (RSV), Mycoplasma, Chlamydia pneumoniae, Strep pneumoniae  
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Common causes of pneumonia in Adults (18-40yrs)   Mycoplasm, Chlamydia pneumoniae, Strep pneumo  
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Common causes of pneumonia in Adults (40-65yrs)   S.pneumo, H.influenza, Anaerobes, Viruses, Mycoplasma  
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Common causes of pneumonia in Elderly   S.pneumo, Viruses, Anaerobes, H.influenza, Gram-negative rods  
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Pneumonia (hospital acquired)   Staphylococcus, gram-negative rods  
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Pneumonia in immunocompromised   Staphylococcus, gram-negative rods, fungi, viruses  
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Aspiration pneumonia   Anaerobes  
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Pneumonia in alcoholic/IV drug user   S.pneumoniae, Klebsiella, Staphylococcus  
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Post-viral pneumonia   Staphylococcus, H.influenza  
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Neonatal pneumonia   Group B streptococci, E.coli  
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Atypical pneumonias   Mycoplasma, Legionella, Chlamydia  
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MCC meningitis newborns   Group B streptococci  
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MCC meningitis Children (6mo-6yrs)   Streptococcus pneumoniae  
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MCC meningitis Adults (6yrs-60yrs)   N.meningitidis  
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MCC meningitis Elderly (60+)   S.pneumoniae  
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Causes of meningitis in HIV positive individuals   Cryptococcus, CMV, toxoplasmosis, JC virus  
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What type of meningitis has Increased opening pressure, Increased PMNs, Increased protein, and Decreased glucose   Bacterial  
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What type of meningitis has Increased opening pressure, Increased lymphocytes, Increased protein, and decreased glucose   Fungal/TB  
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What type of meningitis has Normal to Increased opening pressure, Increased number of lymphocytes, Normal protein, and Normal glucose   Viral  
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Bacterial Meningitis CSF findings   Increased opening pressure, Increased number of PMNs, Increased amt of protein, Decreased glucose  
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Fungal/TB meningitis CSF findings   Increased opening pressure, Increased number of lymphocytes, Increased amt of Protein, Decreased glucose  
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Viral meningitis CSF findings   Normal or increased opening pressure, Increased number of lymphocytes, Normal amt of protein, Normal glucose  
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MCC of Osteomyelitis   S.aureus  
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Osteomyelitis in sexually active individual   N.gonorrhoeae (rare), septic arthritis is more common  
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Osteomyelitis in diabetics and drug addicts   Pseudomonas aeruginosa  
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Osteomyelitis in Sickle cell disease   Salmonella  
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Osteomyelitis in persons with prosthetic replacement   S.aureus and S.epidermidis  
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Vertebral Osteomyelitis   Mycobacterium tuberculosis (Pott's disease)  
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UTIs in ambulatory pts   E.coli (50-80%), S.saprophyticus (10-30%), Klebsiella (8-10%)  
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UTIs in hospital pts   E.coli, Proteus, Klebsiella, Serratia, Pseudomonas  
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Predisposing factors to UTIs   Flow obstruction, kidney surgery, catherterization, gynecologic abnormalities, diabetes, pregnancy  
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Fever, chills, flank pain, and CVA tenderness   Pyelonephritis  
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Dysuria, frequency, urgency, suprapubic pain   Urinary tract infection  
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UTI bug producing a red pigment. Is often nosocomial and drug resistant   Serratia marcescens  
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UTI bug is 2nd leading cause of community-acquired UTI in sexually active women   Staphylococcus saprophyticus  
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UTI bug showing metallic sheen on EMB agar   E.coli (is the leading cause of UTI)  
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UTI bug that is often nosocomial and drug resistant   Enterobacter cloacae  
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UTI bug that has a large mucoid capsule and viscous colonies   Klebsiella pneumoniae  
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UTI bug that is motile, causing "swarming" on agar. also produces urease and is associated with struvite stones   Proteus mirabilis  
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UTI bug producing a blue green pigment and fruity odor. is usually nosocomial and drug resistant   Pseudomonas aeruginosa  
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Mnemonic to remember UTI bugs   SSEEKPP (Serratia marcescens, S.saprophyticus, E.coli, Enterobacet cloacae, Klebsiella, Proteus, Psedomonas)  
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Leukocyte esterase positive   Indicates bacterial  
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Nitrite test positive   Indicated gram-negative  
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Urethritis, cervicitis, PID, prostatitis, epididymitis, arthritis, creamy purulent discharge   N.gonnorrhoeae  
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Painless chancre   primary syphilis  
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Fever, lymphadenopathy, skin rashes, codylomata lata   secondary syphilis  
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Gummas, tabes dorsalis, general paresis, aortitis, argyll robertson pupil   tertiary syphilis  
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Painful penile, vulvar, or cervical ulcers   Genital herpes (HSV2)  
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Urethritis, cervicitis, conjunctivitis, Reiter's syndrome, PID   Chlamydia Trachomatis (D-K)  
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Ulcers, lympadenopathy, rectal strictures   Lymphogranuloma venereum (Chlamydia trachomatis L1-L3)  
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Vaginitis, strawberry-colored mucosa   Trichomonas vaginalis  
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Genital warts, koilocytes   Condylomata acuminata (HPV 6 and 11)  
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Painful genital ulcer, inguinal adenopathy   Chancroid (Haemophilus ducreyi)  
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Noninflammatory, malodorous vaginal discharge (fishy smell), positive whiff test, clue cells   Bacterial vaginosis (Gardnerella vaginalis)  
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Chandelier sign   Cervical motion tenderness in Pelvic inflammatory disease  
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Top causes of PID   Chlamydia trachomatis (subacute, often undiagnosed), Neisseria gonorrhoeae (acute, high fever)  
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Cervical motion tenderness, purulent cervical discharge   PID  
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Salpingitis is a risk factor for:   Ectopic pregnancy, infertility, chronic pelvic pain, and adhesions  
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Nosocomial infections: Newborn nursery   CMV, RSV  
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Nosocomial infections: Urinary catherterization   E.coli, Proteus mirabilis  
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Nosocomial infections: Respiratory therapy equipment   Pseudomonas aeruginosa  
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Nosocomial infections: Work in renal dialysis unit   HBV  
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Nosocomial infections: Hyperalimentation   Candida albicans  
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Nosocomial infections: Water aerosols   Legionella  
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Highest yield hints: Pus, empyema, abscess   S.aureus  
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Highest yield hints: Pediatric infection   H.influenza (including epiglottitis)  
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Highest yield hints: Pneumonia in cystic fibrosis, burn infection   Pseudomonas  
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Highest yield hints: Branching rods in oral infection   Actinomyces israelii  
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Highest yield hints: Traumatic open wound   Clostridium perfringens  
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Highest yield hints: Surgical wound   S.aureus  
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Highest yield hints: Dog or cat bite   Pasteurella multocida  
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Highest yield hints: Currant jelly sputum   Klebsiella  
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Highest yield hints: Sepsis/meningitis in newborm   Group B strep  
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