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253 Cards in this Set
- Front
- Back
what is the "Help me" MHC? "Kill Me"
|
MHC II-- Help me
MHC I- Kill me |
|
What factors will differentiate a cell towards TH1 and TH2 respectively?
|
TH1: INF Gamma and IL12
TH2: IL4 |
|
TH1 vs TH2:
Kills intracellular virus, fungus, bacteria |
TH1
|
|
TH1 vs TH2:
humoral response, making b-cells and killing extracellualr antigens |
TH2
|
|
TH1 vs TH2:
will lead to the formation of Plasma cells |
TH2
will make B cells (Abs, that become plasma cells when they reach their target tissue) |
|
TH1 vs TH2:
will lead to macrophage activation, CD8 cells, and NK cells |
TH1
|
|
what factor is responsible for differentiating TH1 cells into macrophages?
|
IFN gamma
|
|
What type of virus has a decoy molecule that allows it to escape from normal immune response? How is it destroyed?
|
CMV
ADCC (macrophage+NK+eosinophils) |
|
What virus has nuclear membranes and is immunologically invisible (has no MHC)
|
herpes
|
|
TH1 vs TH2:
leads to abscess formation leads to granuloma |
TH1: granuloma (from intrinsic things being walled off by macrophages)
TH2: abscess (from extrinsic things getting engulfed) |
|
Bottom line, what must a vaccine have in it in order to provide adequate immune response?
|
PROTEIN
this leads to B and T cell co-operation T cells only see protein B cells can only see things that fit their receptors Ex: H. influenza was bound to diptheria because it was known that diptheria could be bound by B cells B cells take up the combo bug and start cleaving it up to present to T-cells T cell then gets to see the H. Influenza protein and can start forming memory |
|
What is the defect in Chronic Granulomatous Disease? Sx?
|
Failure of ability to make NADPH oxidase--> cant make myeloperoxidase to kill foreign substances
sx: recurrent infections with CATALSE POSITIVE BACTERIA and fungi * Staphylococcus aureus. * Serratia marcescens. * Salmonella species. * Klebsiella species. * Pseudomonas cepacia, a.k.a. Burkholderia cepacia. * Nocardia. |
|
mother brings in her child with the 4th infection in a rather short period of time. The child appears to have a portion of the umbilical cord stump still present. What does this kid have? Cause?
|
Leukocyte adhesion deficiency
Absence of CD18--common B chain of leukocyte integrins |
|
pt has recurrent infections such as pneumonia, abscesses, and bacteremia with staph. What additional finding would tell you that this was NOT CGD but instead G6PD deficiency?
|
ANEMIA
otherwise presents the same |
|
pt presents with recurrent bacterial infections and has absent NK activity and partial Albinism. What is this?
|
Chediak Higashi syndrome
|
|
what is the molecular defect in Bruton X linked hypogamma globulinemia?
what type of cells will you/wont you see? |
Deficiency of tyrosine kinase
LOW IGs of ALL CLASSES b- cell maturation in bone marrow stopped at PRE-B stage |
|
what is the molecular defect in X-linked hyper IgM syndrome?
|
Deficiency of CD40 on activated T cells
high serum IgM without others |
|
pt presents with repeated sinopulmonary and GI infections. What is a likely cause?
|
Selective IgA deficiency
on places where IgA is used |
|
what will lead to recurrent meningococcal and gonococcal infections?
|
Deficiency of the MAC
C5, C6, C7, C8 |
|
pt presents with allergy like symptoms but no rise in IgE, what is likely going on?
|
Overuse of C1, C4, or C2 at mucosal surfaces
|
|
Embryo defect in DiGeorge?
|
failure of formation of the 3rd and 4th pharyngeal pouches
CATCH 22 |
|
pt has recurrent viral infections with low CD8 cells, CD4 are normal...what is going on?
|
Failure of TAP1 molecules to transport peptides to ER
this is MHC Class I deficiency |
|
What cells will be decreased in MHC II deficiency?
|
CD4 T cells (HELP ME!)
|
|
What is seen in Wiskott-Aldrich syndrome?
|
defected response to bacterial infection
loss of humoral and cellular responses Thrmobocytopenia and ECZEMA |
|
pt comes in with ataxia telangiectasia, what will be deficient?
|
IgA and IgE
|
|
early AIDs infection uses what receptor?
late? |
early: CCR5
Late: CXCR4 |
|
in AIDS reverse transcriptase is very error prone due to lack of proofreading, so each viron has a different appearance. The immune response tries to change to kill it, but this simply clones the viral DNA perpetuating the disease...this is an example of what?
|
Antigenic Drift
|
|
An individual who is homozygous for this receptor cannot be infected with HIV
|
CCR5
|
|
what is diagnostic of AIDs early in its course?
|
Ab to p24
|
|
what shows how symptomatic an AIDS pt is?
|
Viral load
|
|
At what CD4 count is there total collapse of the immune response?
|
less than 200
pt will get all sorts of infections they would have never gotten normally note: sx will start ~600 |
|
What is your normal CD4:8 ratio? What is like when an AIDS pt becomes symptomatic? what about when they are getting serious ass infections
|
normal: 2:1
Sx: 1:1 full blow AIDS: 1:2 |
|
how does HIV destroy both cell mediated and humoral immune resopnse
|
kills undifferentiated TH cells
|
|
What type of HS RXN is the following characteristic of?
IgE |
Type I
|
|
What type of HS RXN is the following characteristic of?
Mast cells cause injury |
Type I
|
|
What type of HS RXN is the following characteristic of?
Igm and IgG |
Type II
|
|
What type of HS RXN is the following characteristic of?
Opsonazation and phagocytocis of cells |
Type II
|
|
What type of HS RXN is the following characteristic of?
Immune Complexes |
Type III
|
|
What type of HS RXN is the following characteristic of?
CD4 + TH1 cells |
Type IV
|
|
What type of HS RXN is the following characteristic of?
Delayed |
Type IV
|
|
What type of HS RXN is the following characteristic of?
Macrophage activation and granuloma formation |
Type IV
|
|
Typical vs Atypical pneumonia:
lobar (localize infiltrate) |
Typical
|
|
Typical vs Atypical pneumonia:
Granuloma (is this TH1 or TH2) |
Atypical
TH1 |
|
Typical vs Atypical pneumonia:
abscess (is this TH1 or TH2?) |
Typical
TH2 |
|
Typical vs Atypical pneumonia:
homogenous infiltrate on x ray |
atypical
|
|
What type of HS RXN is the following characteristic of?
CD8 cell mediated cytolysis |
Type IV
|
|
What type of HS RXN is the following characteristic of?
minutes of the rexposure to anigen |
Type I
Immediate |
|
What type of HS RXN is the following characteristic of?
Autoimmune hemolytic anemia |
Type II
|
|
What type of HS RXN is the following characteristic of?
Rh incompatibility |
Type II
|
|
What type of HS RXN is the following characteristic of?
Acute Rheumatic fever |
type II
Target antigen: streptococcal cell wall Clinical manifestation: Myocarditis and arthritis |
|
What type of HS RXN is the following characteristic of?
Goodpastures |
Type II
will attack Type IV collagen |
|
What type of HS RXN is the following characteristic of?
MG and Graves Dz |
Type II
autoimmune tend to be II (not SLE or RA though) |
|
Describe Rh incompatibility. What type HS rxn was this?
|
fetal Rh blood cells enter maternal circulation (of a Rh negative mom) at birth mounting a T-cell response and memory
Subsequent birth with Rh+ will cause maternal IgG to cross placenta and attack the baby's RBCs hit mom up with RhoGAM after first pregnancy |
|
What type of HS RXN is the following characteristic of?
tends to be systemic |
Type III
|
|
What type of HS RXN is the following characteristic of?
SLE What antigen is involved? |
Type III
dsDNA |
|
What type of HS RXN is the following characteristic of?
Rheumatoid arthritis |
Type IV
|
|
What type of HS RXN is the following characteristic of?
Post strep glomerulonephritis deposits? |
Type III
lumpy bumpy |
|
What type of HS RXN is the following characteristic of?
soreness following tetanus booster what is this called? |
Type III
Arthus rxn |
|
What type of HS RXN is the following characteristic of?
Tuberculin test |
Type IV
|
|
What type of HS RXN is the following characteristic of?
contact dermatitis |
Type IV
(nickel, poison ivy) |
|
What type of HS RXN is the following characteristic of?
Multiple Slcerosis |
Type IV
|
|
What type of HS RXN is the following characteristic of?
Hashimoto thyroiditis |
Type IV
|
|
Please list the HLA allele associate with the following:
RA |
DR4
|
|
Please list the HLA allele associate with the following:
Insulin dependent diabetes mellitus |
DR3/4
|
|
Please list the HLA allele associate with the following:
Multiple sclerosis, goodpastures |
DR 2
|
|
Please list the HLA allele associate with the following:
SLE |
DR2/3
|
|
Please list the HLA allele associate with the following:
Ankylosing spondylitis |
B27
|
|
Please list the HLA allele associate with the following:
Psoriasis |
B27
|
|
Please list the HLA allele associate with the following:
Reiters |
B27
|
|
HLA assoc with
Celiac Dz |
DQ 2 or DQ8
|
|
Please list the HLA allele associate with the following:
Graves |
B8
|
|
what is the target for penicillin and cephalosporins for breakdown of bacteria
|
Peptidoglycan cell wall
|
|
What is the membrane of fungi made of?
cell wall? |
membrane: ergosterol
wall: chitin |
|
what is the cell wall of parasites made of?
membrane? |
NO CELL WALL
sterols |
|
what bacteria have sterols in their cellular membrane?
|
Mycoplasma
|
|
What are the encapsulated bacteria?
|
Strep pnuemo
Klebsiella pneumonaie Haemophalius influenzae Pseudomonas aerguinosa Neisseria meningitidis Cryptococcus neoformans Some Killers Have Pretty Nice Capsules |
|
What bacteria have IgA proteases (which leads to destruction of mucosal IgA)
|
Neisseria
Haemophilus S. pneumoniae |
|
What to bacteria are able to survive intracellularly by evading phagocytes
|
M. tuberculosis
Listeria (escapes phagosome into cytoplasm before phagosome-lysosome fusion) |
|
What type of bacteria have ENDOTOXIN?
*** |
Gram negative
=Lipopolysaccharide=LPS part of the outer membrane normally not released until death of the cell |
|
LPS activates what cells, leading to release of TNF alpha, IL1 and IL6?
|
remember LPS=Endotoxin
they activate macrophages |
|
How can G- bacteria lead to shock?
|
LPS/Endotoxin can lead to damage of the endothelium from brady-kinin induced vasodialation
SHOCK |
|
most EXOTOXINS are on what type of bacteria
|
Gram +
|
|
what is the major exotoxin from corneybacterium diptheriae?
MOA? |
Diptheria Toxin
ADP ribosyl transferase inactivates eEF-2 targets heart/nerves/epithelium |
|
what is the major exotoxin from Clostridium botulinum?
MOA? |
Botulinum toxin
Blocks release of ACh--FLACCID PARALYSIS |
|
what is the major exotoxin from clostridium tetani?
MOA? |
tetanus toxin
blocks release of the inhibitory transmitters |
|
what is the major exotoxin from Staph aureus?
MOA? role in dz? |
TSST
Super antigen role in dz: fever, increased susceptibility to LPS, rash, shock, capilary leakage (CYTOKINE STORM) |
|
what is the major exotoxin from Strep pyogenes?
MOA? role in dz? |
Exotoxin A (aka erythrogenic or pyrogenic form)
Super Antigen (similar to staph a TSS1) role in dz: fever, increased susceptibility to LPS, rash, shock, capilary leakage (CYTOKINE STORM) |
|
what is the major exotoxin from Enterotoxogenic E. Coli?
MOA? role in dz? |
Heat labile toxin (LT)
Stimualtes an adenylate cyclase by ADP ribosylation of GTP binding protein role in dz: promote secretion of fluit and electrolytes from intestinal epithelium |
|
what is the major exotoxin from Vibrio cholerae?
MOA? role in dz? |
Cholera Toxin
Stimualtes an adenylate cyclase by ADP ribosylation of GTP binding protein (similar to E. Coli LT/heat labile) role in dz: profuse watery diarrhea |
|
what is the major exotoxin from clostridium perferingens?
MOA? role in dz? |
Alpha Toxin
MOA: lecithinase role: damages cell membranes note: staph a also has an Alpha toxin that causes pores in cell membranes leading to leakiness |
|
Teichoic acids are found on what kind of bacteria?
|
Gram + only
|
|
which bacteria, gram -/+/both have and outer membrane
|
Gram negative only
|
|
what plays a role in the rigid support of bacteria
|
Cell wall=peptidoglycan
|
|
Bacillus and Clostridium are endospores, what are their mechanism of resistance?
|
New enzymes (dipicolinic acid synthetase, heat resistant catalase
|
|
you have an anaerobic bacteria that you want to grow in culture. What do you use?
|
Thioglycolate
|
|
What do you grow dyptheria on?
|
Tellurite agar
grows black colonies |
|
Pt comes in with severe watery diarrheam you suspect vibreo cholera. What will this grow on? what type of medium is this?
|
lies ALKALINE growth medium
TCBS |
|
What does legionella grow on?
|
Charcoal-yeast extract agar (CYE)
|
|
A young college student presents to your office with mailase and stiff neck. based on this alone you know what you will grow your suspected agent on...
|
Chocolate agar
this is likely Neisseria meningococcus chocolate agar will grow meisseria from normally sterile sites (like the CSF) and Haemophilus |
|
What do you grow Neisseria that comes from sites with normal flora on?
|
Thayer-Martin selective medium
|
|
What bugs require Cysteine for growth?
|
Francisella
Brucella Legionella Pasteurella the four sisters "Ella" worship in the "Cysteine" Chapel |
|
A person comes in with a bacterial infection that requires culturing. You are told that the bug used a CO2 incubator to grow. What 2 bugs could this be?
|
Campylobacter
Helicobacter -both require low but not full oxygen tension |
|
what type of bugs stain purple on a gram stain?
|
Gram Positive
Positive = Purple |
|
What type of bugs stain red/pink on a gram stain/
|
Gram Negative
|
|
With the exception of Neisseria, Moraxella, and Veilllonella, all cocci are gram...
|
Positive
|
|
All spore formers are gram...
|
Positive
|
|
What bug is Acid fast?
|
Mycobacterium
|
|
Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):
Staphlyococcus |
Gram +
Cocci |
|
Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):
Streptococcus |
Gram +
Cocci |
|
Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):
Corynebacterium |
Gram +
Rod Aerobic or facultative anaerobic |
|
Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):
Mycobacterium |
Gram Positive
Rod aerobic or facultative anaerobic note: mycobacterium does not stain well with the gram stain due to its waxy cell wall, but it is considered gram positive |
|
Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):
Clostridium |
Gram +
Rod Anaerobic |
|
Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):
Mycoplasma |
Trick question! this is a non gram staining bacteria!
|
|
Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):
Neisseria |
Gram -
Cocci Aerobic |
|
Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):
Bordetella |
Gram -
Rod Aerobic |
|
Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):
Escherichia |
Gram -
Rod Facultative anaerobic rod note: this is considered an enterobacteriaceae |
|
Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):
Salmonella |
Gram -
Rod Facultative anaerobic rod note: this is considered an enterobacteriaceae |
|
Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):
Yersinia |
Gram -
Rod Facultative anaerobe note: this is considered an enterobacteriaceae |
|
Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):
Haemophilus |
Gram -
Pasteurellaceae |
|
Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):
Treponema |
Gram -
Spirochete |
|
Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):
Rickettsia |
Gram -
note: they don't really stain because they are so thin, but they have G- walls |
|
Please list if the following is G+/-, its shape, and if it is aerobic or anaerobic (if applicable):
Chlamydia |
G-
note: so thin that the color of the gram stain cannot be seen, but has G- wall |
|
how can you distinguish Staph from Strep considering they are both Gram + cocci? (2)
What type of hemolysis do each undergo? |
Staphylococcus: Catalase positive, Coagulase Positive, Beta hemolysis
Streptococcus: Catalase Negative, Coagulase negative, B hemolysis you can spell cat out of staphylococcus |
|
What bug is commonly the cause of acute infective endocarditis?
give catalase, coagulase, and hemolysis |
Staph Aureus
Catalase + Coagulase + B hemolysis Note: pt will have been fine and suddenly feels so bad they are in the hospital |
|
What bug is commonly the cause of Endocarditis in IV drug users?
distinguishing feature of this bug |
Staph epidermidis
Novobiocin ok, i don't know where I got this card from, but I would go with staph a.... |
|
Honeymoon cystitis =
|
Staph saprophytic us
|
|
This bug is responsible for pharyngitis, scarlet fever, pyodermia, RF, and acute glomerulonephritis
|
strep progenies (group A)
remember this is B hemolytic |
|
this bug causes neonatal septicemia and meningitis...what hemolysis does it undergo?
|
Strep agalactiae (group B)
undergoes Beta hemolysis |
|
what type of hemolysis does strep pneumonia undergo?
|
alpha
|
|
what type of hemolysis does strep viridans undergo
|
alpha
|
|
What bug is commonly seen with dental caries? what hemolysis does it undergo?
|
s. viridans
alpha |
|
List a distinguishing factor for the following (plus another name for them)
Group A strep Group B strep Group D strep Strep pneumococcus |
Group A (pyogenes): Bacitracin
Group B (agalactia): CAMP test Group D (Enterococcus): Esculin agar Pneumococcus=Optochin |
|
Salty foods and custards can lead to infections with what bacteria? Why?
|
Staph a.
Ferments mannitol |
|
Coagulase -
Gram + cocci Novobiocin sensitive Infections of catheters what bug |
S. Epidermidis
|
|
Gastroenteritis 2-6 hour onset after salty food at a picnic. What would coagulase look like?
|
Coagulase +
this is Staph a. |
|
#1 cause of osteomyelits unless HbS is mentioned
|
Staph a
|
|
causes toxic shock syndrome: desquamatizing rash, fever, hypotension
|
staph a
|
|
cause of impetigo bullous
|
staph a
|
|
Osteomylitis in a sickle cell pt is caused by what?
|
Salmonella
|
|
2 toxins found in staph a
|
Enterotoxins (A-E-->food poisoning
Toxic shock syndrome toxin 1 (TSST1): superantigen |
|
DOC for tx of staph a?
|
Naficillin/oxacillin
Vancomycin for MRSA |
|
this bug is B-hemolytic, bacitracin sensitive, and pyrrolidony arylamidase (PYR) positive
|
Strep progenies (group A strep)
|
|
what are 2 of the major pathogenic factors for strep pyogenes?
|
Hyaluronic acid
M-protein: antiphagocytic, M12 strains associated with acute glomerulonephritis |
|
pt presents with abrupt onset of sore throat, fever, malaise, and headache. Furthermore they have tonsillar abscesses and tender anterior cervical lymph nodes. What would a catalase test show
|
this would be a group a strep infection
so Catalase negative |
|
pt presents with sore throat, enlarged cervical lymph nodes, and a blanching sandpaper rash with a strawberry tongue. What hemolysis does the causative agent undergo and what is it?
|
B- hemolysis
this is group a strep |
|
pt presents with honey-crusted lesions. What is the cause and what is this called?
|
strep pyogenes
Impetigo |
|
pt recently had strep pharyngitis, and you are worried about what possibly developing? What would be elevated in this?
|
Rheumatic fever (auto antibodies to the heart, especially valves)
elevated ASO |
|
the following are distinguishing features of what:
beta hemolysis Bacitracin resistant hydrolyze hippurate CAMP test positive |
Strep agalactiae (group B strep)
|
|
person comes in with suspected pneumonia. They spit up salmon colored sputum. Cause?
|
Staph a
|
|
The following are distinguishing features of what?
alpha hemolytic optochin sensitive lancet shaped diplocci lysed by bile |
Strep pneumonia
|
|
Most common cause of pneumonia with blood-tinged rusty sputum...what type of hemolysis?
|
strep pneumo
alpha |
|
Most common cause of adult meningitis
|
strep pneumo
look for lots of PMNs, decreased glucose, increase protein in CSF |
|
most common cause of otitis media and sinusitis in children
|
strep pneumo
|
|
Pneumonia buzzword quiz:
Rust colored sputum: Current jelly sputum: Salmon colored sputum: Elderly smoker with none of the above clues: |
Rust colored sputum: s. pneumo
Current jelly sputum: kleb Salmon colored sputum: s. aureus Elderly smoker with none of the above clues: Legionella pneumophilus |
|
this type of pneumonia causes lobar pneumonia with productive cough
|
typical (Pneumococcus)
|
|
what bugs cause typical pneumonia and atypical respectively
|
typical:
s. pneumo k. pneumonia h. influenzae s. aureus atypical: legionella pneumophilia mycoplasma pneumonia chylamidia pneumonia |
|
pt presents with malaise, fatigue, anorexia, night sweats, weight loss, and splitter hemorrhages. In his history you see that he had his mitral valve replaced 2 years prior. You suspect what? In questioning the pt, what procedure would he have likely undergone recently that led to this? what bug is responsible
|
Subacute infective endocarditis
due to viridans streptococci prostatic heart valve + dental work without prophylactic ABX or really bad oral hygiene |
|
tx for strep viridans subacute endocarditis
|
pen G with Aminoglycosides for endocarditis
|
|
the following are distinguishing features of what?
PRY test positive catalase negative hydrolyze esculin |
Enterococcus faecalis/faecium
|
|
Elderly man presents with subacute bacterial endocarditis after a GI/GU surgery. What bug was the likely the cause
|
Enterococcus faecalis/faecium
|
|
what are 2 spore forming G+ rods
|
Bacillus
Clostridium |
|
what 2 gram positive rods are facultative intracellular bugs that affect immunocompromised hosts?
|
Listeria
Mycobacterium |
|
the following are distinguishing factors for what bug:
large boxcar like G+ spore forming rod what is a potential use of this? |
Bacillus anthracis
BIOWARFARE |
|
a man comes to your office with a black eschar. He says that he works as a leather worker, in which he takes raw hides and makes leather belts and whatnot. What bug are you worried about
|
bacillus anthracis
|
|
a mail worker comes into your office with a life threatening pneumonia with cough fever, dyspnea and medicastinal hemorrhagic lymphadenitis...what bug? tx?
|
Bacillus anthracis
mediastinal widening! TX: Ciprofloxacin or doxycycline |
|
man comes in with rapid onset of gastroenteritis after eating fried rice at the China Buffet. What toxin was responsible from what bug
|
Bacillus cereus
emetic toxin: preformed fast (1-6 hours) |
|
a man is brought in by his wife with a dirty puncture wound. He is very rigid and having difficulty moving. Was the bug gram positive or negative? what was it?
|
large gram positive spore forming rod
Clostridium tetani RIGID PARALYSIS from tetanus toxin: blocks release of inhibitory mediators (glycine and GABA) at spinal synapses |
|
pt comes in with a dirty crusted wound. You see dirt and saliva in the wound and the pt says it has been longer than 6 hours since the wound was obtained from blunt trauma. What should you do to tx this pt?
|
This is a tetanus prone wound (blunt/missle, burn, frostbit, 1 cm deep; devialized tissue present + contaminants (dirt/saliva); any wound greater than 6 hours old)
must give Vaccine AND TIG (hyperimmune human globulin) |
|
mother brings her child in because she is terrified he fell and is permanently paralyized. The mother says she didn't see the fall but insists that is what must have happened. In the history you mark that the child is often given food that was home canned or vacuum packed. What are some of the distinguishing features of the responsible bug
|
this is clostridium botulinum
anaerobic, gram + spore forming rod |
|
how does clostridium cause flaccid paraylsis? what is a food product you must consider as a cause?
|
absorbed by gut and carried to peripheral nerve synapses
blocks release of ACh-->flaccid paralysis Foods: HONEY, home canned vegetables, vacuum packaged food |
|
what bug is identified by Nagler reactions and is a cause of gas gangrene after contamination of a wound with soil or feces?
|
Clostridium perferenges
|
|
Reheated meat dishes can lead to food poisoning from what bug? what toxin does this bug have
|
Clostridium perfringens
Alpha toxin (lecithinase, disrupts membranes and damages all sorts of stuff) |
|
You are on your IM rotation and have been visiting a pt who has been in the hospital for a few weeks now being treated with ABX. He now complains of massive diarrhea and GI irritation. What does he have? Classic cause?
|
pseudomembranous colitis due to infection with clostridium diff
due to abx tx with clindamycin (also cephalosporins, amoxicillin, etc) you will find yellow plaques on the colon |
|
pt comes in with diarrhea after eating only deli foods for a week. Where does the bug that caused this reside?
|
Inside macrophages
facultative intracellular LISTERIA could also be from unpasteurized milk |
|
What is the most common cause of meningitis in renal transplant pts and adults with cancer?
|
Listeria meningitis
|
|
Mother brings in her boy claiming he is having difficulty breathing. She is upset because they had to leave in the middle of their religious service, one you have never heard of. You look in the boys mouth and see dirty gray pseudomembranes. What will happen if you try to knock them loose? What is the cause of this?
|
They will bleed like crazy
Corynebacterium diphtheria Elek test will document toxin production tx with erythromycin |
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what genus of bug is anaerobic, gram positive branching rods that are non acid fast?
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Actinomyces
|
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pt presents with a lesion on the jaw line that drains with sulfur granules...what is the cause? What is another way you can get this?
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Actinomyces Israelii
Spread from IUD |
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this bacterial genus is unique in that it has a high conc of lipids, is an obligate aerobe, and is acid fast
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Mycobacterium
|
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Pt presents with a chronic cough and weight loss. You obtain an x ray and see a diffuse pattern not localized to any one lobe. You culture the bug and see that it produces Niacin. What bug is this?
|
Mycobacterium tuberculosis
THIS IS THE ONLY BUG THAT PRODUCES NIACIN acid fast |
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What are the 4 virulence factors of m. TB?
********** |
1. Facultative intracellular organism (lives in macrophage)
2. sulfatides (inhibit phagosome-lysosome fusion, allowing intracellular survival 3. Cord factor (causes serpentine growth and inhibits leukocyte migration, messes up mitochondrial OXPHOS) 4. Tuberculin (delayed hypersensitivity and cell mediated immunity) |
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What is a Ghon complex? what is it seen in?
|
macrophages transport bacilli to a regional lymph node
this is seen in primary pulmonary TB |
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what CD will macrophages have on them in TB?
based on what you know about TH1 responses, what is commonly seen in TB? |
CD14
caseating Granuloma |
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what do the following have in common:
atypical mycobacteria m. leprae Nocardia cryptosporidium isospora |
ACID FAST
I left TB off this list so you wouldn't just recognize that one |
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What is a positive PPD skin test in the following pts:
HIV: High risk (poor, IV drug abuser, immigration from TB area) low risk: |
HIV: >5mm zone of induration at 48-72 hrs
High risk (poor, IV drug abuser, immigration from TB area): >10mm low risk: >15mm |
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a man comes into your office saying that he has sensory loss in his extremities. He recently immigrated from mexico. How can you distinguish tuberculoid from lepromatous leprosy?
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Tuberculioid:
TH1 + lepromin test Granuloma formation Lepromatous: TH2 - Lepromin test |
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What is the key virulence factor in neisseria meningitides?
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Endotoxin (LPS): fever, septic shock, overproduction of outer membrane
|
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A college student shows up to your office with stiff neck and fever. What do you expect to see in the CSF?
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Gram - diploccous
Neisseria Meningitis signs of endotoxin meningococcemia: fever, chills, malaise, prostration, and a rash that is petecihal note: can also lead to adrenal bleed out (Waterhouse Frederichsen syndrome) |
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A young sexually active pt comes to your office with vaginal discharge. She also complaints of joint pain in her knee, and it is a bit swollen. What are 3 important virulence factors of what she has? what is it? tx?
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She has Neisseria Gonorrhoeae infection
1. Pili (attachment) 2. IgA protease 3. Invades mucosal surfaces to cause inflammation tx: ceftriaxone |
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gram negative diplocci in PMNs from urtheral smear from a male suggests N. Gonorrhea. Is this sufficient for females? Why/why not? What should you use?
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NO
They have similar normal flora in the vag Thayer-Martin medium kills normal flora to confirm diagnosis |
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pt is in the burn unit. They end up getting a blue green pus that leads to septicemia. The wound smells fruity. What was the cause? Where does this bug normally target?
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Pseudomonas (g- rod, oxidase +, aerobe)
Liver If you see water think pseudomonas |
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Pt with cystic fibrosis is highly susceptible to infection with what?
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Pseudomonas
|
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this bug causes atypical pneumonia and is associate with air conditioning systems or shower facilities...What type of people are commonly affected?
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Legionella pneumophilia
elder smokers, heavy drinkers, immunocompromised |
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a man comes into your office with atypical pneumonia after a long rabbit hunting trip. .
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tularemia
Francisella tularensis |
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a pt brings in her child with a paroxysmal cough. You look in the chart and see no history of vaccination due to religious objectioin. What is the bug and what are 3 toxins it has?
|
Bordetella pertussis
1. adenylate cyclase toxin (impairs leukocyte chemotaxis) 2. Tracheal cytotoxin (kills cilia) 3. Pertussis toxin (ADP ribosylation of Gi, inhibiting negative regulator of adenylate cyclase) |
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What are the 3 stages of whooping cough? sx? amount of bacteria on culture?
|
Catarrhal: Rhinorrhea, malaise, sneezing anorexia; HIGH
Paroxysmal: Cough/Whoop; Downward decline Convalescent: diminished cough, development of 2ndary complications (pneumonia, seizure, encephalopathy); low |
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this is the number 1 cause of bacterial diarrhea and is highly associated with poultry, what does it look like on gram stain?
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this is Campylobacter Jejuni
Gram-negative curved rods with polar lamella ("gulls wings") |
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Guillain-Barre syndrome is associated with what bacteria? What is interesting about its growth?
|
Campylobacter jejuni
grows at 42 degrees |
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What bugs are urease positive?
|
PUNCH
Proteus Ureaplasma Nocardia Cryptococcus Helicobacter |
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this bug is urease positive, diagnosed by the breath test, and is CLASSIFIED AS A TYPE I CARCINOGEN. What bacteria is this? What cancer can it lead to?
* |
Helicobacter pylori
Stomach cancer |
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This bug is commonly responsible for gastritis and duodenal ulcers.
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H. Pylori
Type B cause |
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A natural disaster hits New York city causing damage to the water treatment plant. Suddenly patents start coming in with massive rice water stool. What is the pathogenesis of this bug?
|
This is vibrio cholera
Cholera enterotoxin (similar to E coli LT): ADP ribosylates activating adenylate cyclase--> INCREASED cAMP--> EFFLUX OF Cl AND H2O Tremendous fluid loss give them fluid |
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how can you separate shigella from salmonella by lab considering they are both non-lactose fermenters?
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Shigella: nonmotile non-H2S producer
Salmonella: Motile, H2S producer Shigella does nothing but shit! (note: yersina is simialar to shigella in this way, while proteus is similar to salmonella) |
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What are 2 important lactose fermenters?
|
Escherichia
Klebsiella |
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Most common cause of UTI?
|
E. Coli
due to motility |
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group B strep is normally the cause of neonatal septicemia, but this is the second most common cause due to a capsule that has K1 serotype endotoxins
|
E. Coli
|
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What 2 toxins make ETEC so bad?
|
this is travelers' diarrhea
LT: heat labile toxin: increases cAMP, leads to dump of Cl and H2O ST: Heat stable toxin, stimulates guanylate cyclase |
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person goes to mexico and comes back with terrible diarrhea...cause?
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Enterotoxic ecoli (ETEC)
travelers |
|
second most common cause of infantile diarrhea due to adherence to M cells, leaing to effacement of brush border
|
EPEC
ecoli |
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pt comes in with bloody diarrhea. They have no fever, no PMNs, but report having eaten hamburgers at a picnic. What are 2 names for this bug?
|
Enterohemorrhagic Ecoli (EHEC)
O157 can also be from cow feces, or petting zoos |
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Elderly homeless alcoholic man with typical pneumonia and currant jelly sputum
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Klebsiella pneumonia
distinguishing feature: MAJOR CAPSULE (large polysaccharide) |
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Pt comes in with acute blood diarrhea. ON culture you have a gram negative bacilli that does not produce H2S. Is it motile or not? What is it? If we are in the US what is it specifically?
|
Nonmotile
Shigella (sit and shit) Shigella Sonnei |
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this bug has a toxin that lets it invade M cells and polymerize actin jet trails to go laterally without going back out into the extracellular milieu. It produces blood diarrhea
|
Shiga toxin
from Shigella dysenteriae |
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pt presents with high fever, swelling of the lymph nodes (buboes) conjunctivitis and pneumonia. What was the bug? what are 2 important virulence factors?
|
Yersinia Pestis (this is bubonic plague!!)
Endotoxin Envelope antigen (F1) inhibits phagocytosis |
|
yersinia enterocolitica likes to grow in what type of environment
|
cold
|
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pt has a UTI but the pain he has is really bad. You get an X-ray and see that he has a stag horn renal calculi. What bug caused this? What virulence factor allowed for this to happen?
|
Proteus (mirabilis/vulgaris)
Urease positive raises urine pH to cause struvite stones (stag horn) |
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pt presents with fever headache abdominal pain and bloody diarrhea. Widal test is positive in the pts serum and the bug is shown to produce H2S gas. What is it? Where does this infection begin? What could you see on the abdomen?
|
this is Salmonella (typhi)
starts in the ileocecal region then moses to mesenteric lymph nodes and blood on the abdomen you can see ROSE SPOTS: red spots on the belly reservoir is chickens and turtles |
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What bug causes osteomylitis in pts who are HbS?
|
Salmonella
normally it is caused by staph a! |
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pt presents with high fever, swelling of the lymph nodes (buboes) conjunctivitis and pneumonia. What was the bug? what are 2 important virulence factors?
|
Yersinia Pestis (this is bubonic plague!!)
Endotoxin Envelope antigen (F1) inhibits phagocytosis |
|
yersinia enterocolitica likes to grow in what type of environment
|
cold
|
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pt has a UTI but the pain he has is really bad. You get an X-ray and see that he has a stag horn renal calculi. What bug caused this? What virulence factor allowed for this to happen?
|
Proteus (mirabilis/vulgaris)
Urease positive raises urine pH to cause struvite stones (stag horn) |
|
pt presents with fever headache abdominal pain and bloody diarrhea. Widal test is positive in the pts serum and the bug is shown to produce H2S gas. What is it? Where does this infection begin? What could you see on the abdomen?
|
this is Salmonella (typhi)
starts in the ileocecal region then moses to mesenteric lymph nodes and blood on the abdomen you can see ROSE SPOTS: red spots on the belly reservoir is chickens and turtles |
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What bug causes osteomylitis in pts who are HbS?
|
Salmonella
normally it is caused by staph a! |
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3 mo-2 y unvaccinated child with meningitis
|
Haemophilus influenzae
|
|
what are the 2 virulence factors of H infuenzae?
|
polysaccharide capsule (type b capsule is polyribitol phosphate)
IgA protease (mucosal colonizing factor) |
|
besides meningitis, what can H. influenzae cause in unvaccinated kids? (2)
|
Otitis media
Epiglottitis (croup) |
|
What 3 drugs have IgA protease?
|
Strep pneumo
Haemophilus Neisseria (men/gon) |
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pt presents with a soft painful chancre on their genitals. what was the cause?
|
Haemophilus ducreyi
DO CRY open lesions can lead to increased likelihood of HIV infection |
|
woman comes in with thin gray vaginal discharge. What might you see in culture? What test could you do to give you a hint about what this was? What is it?
|
Clue cells
Whiff test: fishy amine odor ugh. |
|
What do you have to worry about with cat bites?
|
Pasteurella multocida
|
|
in the colon, this is the predominant anaerobe
|
Bacteroides Fragilis
|
|
describe the 3 types of Syphillis?
cause of all of them? |
primary: non tender painless chancre
Secondary: maculopapular rash (hits soles), condylomata lata (wart like lesions in perianal area) Tertiary: Gummas in CNS and CV system cause: Treponema pallidum (spirochete) |
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nontreponemal antibody is a screening test for syphilis, but it is not confirmatory. What is?
|
FTA-ABS
specific test for treponemal antibody |
|
Tx for syphillis?
|
Pen G
|
|
What is the screen for HIV? Confirmatory?
|
Screen: ELISA
Confirm: Western Blot (protein) |
|
What drug screens TB? confirm?
|
Screen: auramine rhodamine
Confirm: acid fast |
|
pt presents with influenza-like sx and erythema migrans. What was the cause?
|
Borrelia burgdorferi
Ixodes (deer) tick Lyme Dz |
|
what is the major pathogenesis of Lyme dz? what causes it? what is the rash you get?
|
invades skin, spreads via blood to involve primarily the heart, joints, and CNS
Borrelia burgdorferi Erythema migrans |
|
pt presents with Bells palsy, meningitis, arrhythmia, and mycarditis. Cause?
|
lyme dz
Borrelia burgdorferi |
|
triathalon swimmers in Lake Utah all come down with flu like symptoms. two of them have their gallbladders taken out.
|
Leptrospira interrogans
this can also be in hawaii in animal whizz |
|
Compare Rickettsiaceae and Chlamydiaceae in the following ways
Obligate intracellular parasite? Make ATP? Peoptidoglycan layer in cell envelope? |
Obligate intracellular parasite?
Rick: Yes Chlam: Yes Make ATP? Rick: Limited ATP Chlam: NO ATP Peoptidoglycan layer in cell envelope? Rick: Normal peoptidoglycan Chlam: modified peptidoglycan (lacks muramic acid and is considered by some as modified, others say it is absent) |
|
what are the two forms of chlamydia trachomatis? what are they each doing?
|
Reticulate: cells are metabolically active, replicating
Elementary body: infective form, inactive, and extracellular |
|
what is a key to diagnose to Chlamydia trachomatis?
|
Cytoplasmic inclusion bodies in scrapings
|
|
What serotype causes STDs with chlamydia?
|
D-K
Most common bacterial STD in US! can cause urethritis, cervicitis and conjunctivitis |
|
What bug, and of what serotypes lead to trachoma, a cause of blindness?
|
chlamydia A, B, Ba, and C
THIS IS THE LEADING CAUSE OF PREVENTABLE INFECTIOUS BLINDNESS note: serotypes L1,2,3 cause lymphogranuloma venereum |
|
Tx for chlamydia?
|
doxycycline or azithromycin
|
|
What bug is associated with bird handlers? (parrots, turkeys, etc)
|
chlamydophila psittaci
|
|
what bug will cause atypical "walking" pneumonia, that affects a single lobe with dry cough and hoarseness.
|
Chlamydia pneumonia
|
|
A man from North Carolina comes in with a rash on his ankles. You give him some cream and tell him to come back in if it is still there. He comes back in a few days later and the rash has spread to his trunk, soles, and face. What was the vector for this dz?
|
Dermacentor (tick)
this is Rickettsia rickettsii--Rocky Mountain Spotted Fever confirmed by Weil-Felix test |
|
this bug causes leukopenia, with low platelets and morulae (mulberry like structures inside infected cells)
|
Ehrlichia Phagocytophila
|
|
Young adult presents with atypical pneumonia and a positive cold agglutins test. What type of drugs can you NOT use in the tx of this?
|
this guy has Mycoplasma pneumonia
It does not have a cell wall, so you cannot use cephalosporins or penicillins! Must use a Macrolide (erythromycin) |
|
what is the only extracelluar bug that causes atypical pneumonia? what are 2 virulence factors?
|
Mycoplasma pneumonia
1. Inhibits ciliary action 2. Produces hydrogen peroxide (damages respiratory epithelium, leading to hacking cough) |
|
Positive cold agglutins will give you the diagnosis of what? what will it show on an RBC?
|
mycoplasma pneumonia
IgM Abs on RBC |