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***usmle 2609-2809 micro 3

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Babesia: How is it transmitted?
Ixodes tick
Babesia: How is it diagnosed?
Blood smear, no RBC pigment, apears as "maltese cross"
Babesia: How it is treated?
Quinine, clindamycin
Naegleria: What disease(s) does it cause?
Rapidly fatal meningoencephalitis
Naegleria: How is it transmitted?
Swimming in fresh water lakes
Naegleria: How is it diagnosed?
Amebas in spinal fluid
Naegleria: How it is treated?
Naegleria: AUTHOR
Nomi Levy
Medically important helminths: Which Cestode (tapeworm) can cause brain cysts and seizures?
Taenia solium
Medically important helminths: Echinococcus granulosus (a cestode) can cause cysts in the ____when ingested in dog feces; and _____ if antigens are released from cysts
liver, anaphylaxis
Medically important helminths: What is the standard treatment for trematodes (flukes)?
Praziquantel
Medically important helminths: Which fluke penetrates human skin, forming granulomas, fibrosis, and inflammation of the spleen & liver?
Schistosoma
Medically important helminths: Larvae of the nematode (roundworm) ___ are known to penetrate skin of feet & cause anemia if infect intestine.
Ancylostoma duodenale (hookworm)
Medically important helminths: Echinococcus granulosus (a cestode) can cause cysts in the ____when ingested in dog feces; and _____ if antigens are released from cysts.
liver, anaphylaxis
Medically important helminths: Which nematode causes anal pruritis?
Enterobius vermicularis (pinworm)
Medically important helminths: Lavae of the nematode ___ are found in the soil, penetrate the skin, and cause intestinal infection.
Strongyloides stercoralis
Medically important helminths: Trichinella spiralis (a nematode) is usually found in what food?
undercooked meat, usually pork
Medically important helminths: Which nematode can be seen crawling in the conjunctiva?
Loa loa
Medically important helminths: Treatment for river blindness, caused by onchocerca volvulus, is ___
Ivermectin
Medically important helminths: Wuchereria bancrofti cause blockage of lymphatic vessels in a condition known as:
elephantiasis
Medically important helminths: Three nematodes treated with Diethylcarbamazine:
Loa loa, Toxocara canis, and Wucheria bancrofti
Parasite hints: Perianal pruritis caused by:
Enterobius
Parasite hints: Microcytic anemia a result of infection with
Ancylostoma, Necator
Parasite hints: Schistosoma mansoni is known to result in
portal hypertension
Parasite hints: Schistosoma haematobium can cause ___ cancer and hematuria
bladder
Parasite hints: A trematode that causes hemoptysis is:
Paragonimus westernani
Parasite hints: Clonorchis sinensis causes disease in the:
biliary tract
Virology: All DNA viruses are dsDNA except:
parvoviridae
Virology: All DNA viruses are linear except these two:
papoviruses, hepadnavirus (circular)
Virology: All RNA viruses are ssRNA except
Reoviridae ("repeato-virus" (reovirus) is dsRNA)
Virology: Do hepadnavirus, herpesviruses, and poxvirus have an envelope?
Yes
Virology: Which virus is often responsible for "pink eye" (conjunctivitis)?
adenovirus
Virology: Which SS-linear(-) DNA virus is responsible for "slapped cheeks" rash?
Parvovirus
Virology: Which is the smallest DNA virus?
Parvovirus
Virology: Which DNA virus can cause aplastic crises in sickle cell disease?
Parvovirus (B19 virus)
Virology: Name 3 "naked" DNA virsuses (no envelope)
Parvo, Adeno, and Papovirus (you have to be naked for a PAP smear⬦)
Virology: The largest DNA virus, one which can cause "milkmaid's blisters" or molluscum contagiosum (and could be used in germ warfare), is:
poxvirus
DNA virus characteristics: Papovirus is not linear, but rather ____
circular, supercoiled
DNA virus characteristics: The only DNA virus that is not icosahedral is
Pox (complex)
DNA virus characteristics: All DNA viruses replicate in the nuclear except
Pox (carries own DNA-dependent RNA polymerase)
RNA viruses: Poliovirus, Echovirus,Rhinovirus, Coxsackievirus, and HAV are all members of which viral family?
Picornaviruses ("PERCH")
RNA viruses: Picorna-, Calci-, Flavi-, Toga-, Retro-, and Coronaviruses all share which RNA structure?
SS + linear
RNA viruses: Which SS-linear, nonsegmented RNA virus family is responsible for measles, mumps, and croup?
PaRaMyxovirus (Parainfluenza-croups; RSV-bronchiolitis in babies; Measles, Mumps)
RNA viruses: Hantavirus, Sanfly/Rift Valley fevers, and California encephalitis are all part of this SS-circular RNA viral family.
Bunyaviruses
RNA viruses: Orthomyxoviruses include which ubiquitous virus?
Influenza virus
RNA viruses: HIV and HTLV are both ____ with ____capsid symmetry.
retroviruses; icosahedral
RNA viruses: What is the #1 cause of fatal diarrhea in children?
Rotavirus (a reovirus)
RNA viruses: Rabies is caused by this viral family.
Rhabdoviruses
RNA viruses: Virus family credited with the "common cold"
Coronaviruses
RNA viruses: Ebola/Marburg hemorrhagic fever are caused by which viral family?
Filoviruses
More virology: Three naked (nonenveloped) RNA viruses are:
Calcivirus, Picornavirus, Reovirus (Naked CPR)
More virology: From where to herpesviruses aquire their envelopes?
nuclear membrane
More virology: From where do enveloped viruses usually acquire their envelopes?
plasma membranes
More virology: This is the only virus that is not haploid:
retrovirus (which has 2 identical ssRNA molecules, so considered diploid)
More virology: The only DNA viruses that does not replicate in the nucleus is:
poxvirus
More virology: The two RNA viruses which do not replicate in the cytoplasm are:
Influenza virus and retroviruses
Viral Vaccines: Live attenuated vaccines induce humoral and cell-mediated immunity, while killed viruses induce only ____ immunity.
humoral
Viral Vaccines: Are MMR (measles, mumps, rubella) vaccines live or killed?
Live attenuated
Viral Vaccines: Rabies, influenza, HAV, and Salk polio vaccines are of which type (live or killed)?
Killed (SalK=killed)
Viral Vaccines: A recombinant viral vaccine exists for which virus?
HBV (antigen=HBsAg)
Viral Vaccines: Worldwide pandemics of influenza virus are in part attributable to which type of viral genetics?
Reassortment (viruses with segmented genomes exchange segments)
Viral Pathogens: What structural similarity is shared by herpesviruses, HBV, and smallpox virus?
They are DNA enveloped viruses.
Viral Pathogens: RNA nucleocapsid enteroviruses include which pathogens?
poliovirus, coxsackievirus, echovirus, HAV
Viral Pathogens: The viral pathogens adenovirus, papillomaviruses, and parvoviruses are all what type of viral pathogens?
DNA nucleocapsid viruses
Viral Pathogens: Bunyaviruses, Orthomyxoviruses (influenza viruses), Arenaviruses, and Reoviruses are all what type of RNA virus?
segmented (BOAR)
Viral Pathogens: Aseptic (viral) meningitis can be caused by which small RNA viruses?
poliovirus, coxsackievirus, echovirus (and not by two other picoRNAviruses, rhinovirus and HIV)
Viral Pathogens: Reovirus considered the most important global cause of infantile gastroenteritis
Rotavirus (ROTA=Right Out The Anus)
Viral Pathogens: All paramyxoviruses have 1 serotype with this exception:
parainfluenza virus (4 serotypes)
Viral Pathogens: Parotitis can be caused by this paramyxovirus:
mumps virus ("mumps gives you bumps")
Viral Pathogens: Triad of mumps symptoms are:
asceptic Meningitis, Orchitis, and Parotitis (MOP)
Viral Pathogens: AUTHOR
Connie Chang
Measles virus: What virus type causes measles?
paramyxovirus
Measles virus: What bluish-gray spots on the buccal mucosa are diagnostic of measles
Koplik spots
Measles virus: 3 Cs of measles
Cough, Coryza, Conjunctivitis
Measles virus: 3 possible sequellae
SSPE, encephalitis, giant cell pneumonia. SSPE = subacute sclerosing panencephalitis
Influenza viruses: Five facts about Influenza: enveloped/nonenveloped, nuclear material, antigens, infection --> what risk?, protection.
1. Enveloped 2. ssRNA with segmented genome 3. Hemagglutinin and neuraminidase antigens 4. Risk of fatal bacterial superinfection 5. Protection = killed viral vaccine
Influenza viruses: Treatment for influenza A?
Amantadine, rimantadine, zanamivir, and oseltamivir
Influenza viruses: Treatment for influenza B?
Zanavir and oseltamivir (neuraminidase inhibitors)
Rabies virus: Rabies -- _______ (cytoplasmic inclusion) in _______(cell type)
Negri bodies in neurons
Rabies virus: Rabies -- incubation period
weeks to 3 months
Rabies virus: Rabies -- most common sources in US
bat, raccoon, skunk (>dog)
Rabies virus: Rabies travels to the CNS by⬦
retrograde migration up nerve axons
Rabies virus: Rabies - Si/Sx
hydrophobia and fatal encephalitis with seizures
Arboviruses: Arbovirus -- mode of transmission
Transmitted by arthropods (mosquitoes, ticks)
Arboviruses: Arbovirus -- classic illnesses
Dengue fever (in SE Asia = hemorrhagic shock syndrome) and yellow fever
Arboviruses: Arbovirus -- members of the family
flavivirus, togavirus, bunyavirus
Yellow fever: Yellow fever is transmitted by ____________
the Aedes mosquito (flavivirus)
Yellow fever: Symptoms of yellow fever
high fever, black vomitus, and jaundice.
Yellow fever: Yellow fever -- histology
Liver: councilman bodies (acidophilic inclusions)
Name the diseases caused by the following Herpesviridae:: HSV-1
Gingivostomatitis, keratoconjunctivitis, temporal lobe encephalitis, herpes labialitis
Name the diseases caused by the following Herpesviridae:: HSV-2
Herpes genitalis, neonatal herpes
Name the diseases caused by the following Herpesviridae:: VSV
Varicella-zoster (shingles), encephalitis, pneumonia
Name the diseases caused by the following Herpesviridae:: EBV
Infecious mononuelosis, Burkitt's lymphoma
Name the diseases caused by the following Herpesviridae:: CMV
Cogenital infection, mononucleosis, pneumonia
Name the diseases caused by the following Herpesviridae:: HHV-8
Karposi's sarcoma
Name the routes of transmission for the following Herpesviridae:: HSV-1
respiratory secretions and saliva
Name the routes of transmission for the following Herpesviridae:: HSV-2
sexual contact, perinatal
Name the routes of transmission for the following Herpesviridae:: VSV
respiratory secretions
Name the routes of transmission for the following Herpesviridae:: EBV
respiratory secretions, saliva
Name the routes of transmission for the following Herpesviridae:: CMV
congenital, transfusion, sexual contact, saliva, urine, transplant
Name the routes of transmission for the following Herpesviridae:: HHV-8
sexual contact
Mononucleosis: Mononucleosis is caused by _______
EBV
Mononucleosis: symptoms of mono
fever, hepatosplenomegaly, pharyngitis, and lymphadenopathy (esp posterior auricular nodes)
Mononucleosis: how do you test for mono?
heterophil antibody test
Mononucleosis: what do you see in the peripheral blood (mono)?
atypical lymphocytes (cytotoxic T cells)
Tzank test: What's a Tzanck test?
A smear of an opened skin vesicle to detect multinucleated giant cells (seen in HSV-1, HSV-2, VSV)
Hepatitis transmission: Name the type of nucleic acid and the virus type for the following hepatitis viruses:
0
Hepatitis transmission: Name the type of nucleic acid and the virus type for the following hepatitis viruses: Hepatitis A
RNA picornavirus
Hepatitis transmission: Name the type of nucleic acid and the virus type for the following hepatitis viruses: Hepatitis B
DNA hepadnavirus
Hepatitis transmission: Name the type of nucleic acid and the virus type for the following hepatitis viruses: Hepatitis C
RNA flavivirus
Hepatitis transmission: Name the type of nucleic acid and the virus type for the following hepatitis viruses: Hepatitis D
deta agent -- requires HBsAG as its envelope (coinfection only)
Hepatitis transmission: Name the type of nucleic acid and the virus type for the following hepatitis viruses: Hepatitis E
RNA calcivirus
Hepatitis transmission: Name the mode of transmission for the following hepatitis viruses
0
Hepatitis transmission: Mode of transmission: Hepatitis A
fecal-oral
Hepatitis transmission: Mode of transmission: Hepatitis B
parenteral, sexual, maternal-fetal
Hepatitis transmission: Mode of transmission: Hepatitis C
blood (IV drug users)
Hepatitis transmission: Mode of transmission: Hepatitis D
coinfection with HBV!
Hepatitis transmission: Mode of transmission: Hepatitis E
enterically; water-borne epidemics
Hepatitis transmission: which Hepatitis virus causes a high mortality rate in pregnant women?
E
Hepatitis transmission: which hepatitis virus has a short incubation period?
A (3 weeks)
Hepatitis transmission: which Hep virus has a long incubation period?
B (3 months)
Hepatitis transmission: which Hep virus has a DNA-dependent DNA polymerase?
B; reverse transcription also occurs
Hepatitis transmission: which pairs of viruses are similar in course, severity, and incubation?
HAV & HEV; HBV & HCV
Hepatitis transmission: Which virus type infection leads to chronic-carrier-status?
B, C, and D
Hepatitis serologic markers: If I got a Hepatitis B vaccine (no infection), for what Ab would I have a positive serology?
HBsAb
Hepatitis serologic markers: If I recently had a Hepatitis B infection, for what Ab would I have a positive serology
HBsAb and HBcAb (positive during window period)
Hepatitis serologic markers: What test tells you either that I have a current infection or that I am a chronic Hep B carrier?
HBsAg
Hepatitis serologic markers: What test demands that you(the doctor) to tell me to stop having sex with my spouse lest I give them Hep B?
HBeAg
Hepatitis serologic markers: What test tells you(the doctor) that I can resume sex with my spouse because I'm not likely to give them Hep B?
HBeAb (indicates low transmissibility)
Hepatitis serologic markers: What is the "window period"?
after the actue infection is cleared and before the humoral response produces lots and lots of Ab (HBsAg AND anti-HBs negative; HBcAb positive)
Hepatitis serologic markers: How big is the Hep B virus
42 nm
Hepatitis serologic markers: When can I detect HBV particles by DNA polymerase?
during the incubation period and the acute disease period
Hepatitis serologic markers: How can I distniguish between complete recovery from Hep B infection and the chronic carrier state?
Complete recovery: HBsAg-neg, HBsAb-pos; Chronic carrier: HBsAb-neg. HBsAb-pos; HBcAb is positive in BOTH states
HIV: HIV has a ________ genome with __<#>__ molecules of __<nucleic acid>____
HIV has a diploid genome with 2 molecules of RNA
HIV: name the "rectangular nucleocapsid protein": HIV: name the envelope proteins
gp41 and gp 120
HIV: name the matrix protein: HIV: what other important protein hangs out inside the nucleocapsid?
reverse transcriptase
HIV: name the matrix protein: Does HIV integrate into the host genome?
YES. HIV syntehsizes dsDNA from RNA and integrates the dsDNA into the host genome
HIV diagnosis: How do I make a diagnosis of HIV?
ELISA --> confirmed by Western blot
HIV diagnosis: T or F: HIV testing is always positive 1-2 weeks after infection
FALSE. ELISA/Western blot look for viral PROTEINS and can be falsely negative for the first 1-2 months of HIV infection
HIV diagnosis: How can I monitor the effect of HIV drug therapy?
HIV PCR/viral load
HIV immunity: Who is immune to HIV?
homozygous for CCR5 mutation
HIV immunity: What % of US caucasians have a slower course of HIV infection because of heterozygosity for the above allele?
0.2
HIV immunity: Persons with ______________ have a rapid progression to AIDS
CXCR1 mutation
Time course of HIV infection: HIV become symptomatic _____ after infection
3-10 years
Time course of HIV infection: Anti-p 24 and anti-gp120 increase between _______ after initial infection; after the onset of immunodeficiency, they ___________(increase or decrease)
1-2 months; decrease
Name the opportunistic infections seen in the following categories: (for AIDS patients): bacterial
TB, Mycobacterium avium-intercellulare complex
Name the opportunistic infections seen in the following categories: (for AIDS patients): viral
HSV, VAV, CMV, PML (JC virus)
Name the opportunistic infections seen in the following categories: (for AIDS patients): fungal
Thrush (Candida albicans), cryptococcosis (cryptococcal meningitis), histoplasmosis, Pneumocystis pneumonia
Name the opportunistic infections seen in the following categories: (for AIDS patients): protozoan
toxoplasmosis, cryptosporidiosis
Prions: Multiple choice: Prions are -- 1) infectious proteins ONLY 2) infectious RNA 3) infectious DNA 4) infectious proteins occasionally mixed with nucleic acids
1) infectious proteins
Prions: Name examples of prion diseases
CJD, kuru, scrapie, "mad cow"
Prions: Jeopardy style: pathologic prions take on this conformation
What is beta-pleated sheet
Prions: Prions are associated with ___________ encephalopathy
spongiform
Name the dominant normal flora in each of these areas:: skin
Staph epidermidis
Name the dominant normal flora in each of these areas:: nose
Staph aureus
Name the dominant normal flora in each of these areas:: oropharynx
Strep viridans
Name the dominant normal flora in each of these areas:: dental plaque
Strep mutans
Name the dominant normal flora in each of these areas:: colon
Bacteroides fragilis > E. coli
Name the dominant normal flora in each of these areas:: vagina
Lactobacillus, colonized by E. coli and group B strep
Common causes of pneumonia: Name the common causes of pneumonia in the following age groups:
0
Common causes of pneumonia: Name the common causes of pneumonia in the following age groups: Children (6 weeks to 18 yrs)
Virus (RSV), Mycoplasma, Chlamydia pneumoniae, Strep pneumoniae
Common causes of pneumonia: Name the common causes of pneumonia in the following age groups: Adults (18-40 yrs)
Mycoplasma, Chlamydia pneumoniae, Strep pneumoniae
Common causes of pneumonia: Name the common causes of pneumonia in the following age groups: Adults (40-65 yrs)
Strep pneumoniae, H. influenze, Anaerobes, Viruses, Mycoplasma
Common causes of pneumonia: Name the common causes of pneumonia in the following age groups: Elderly
Strep pneumoniae, viruses, anerobes, H. Influenzae, Gram-negative rods
Common causes of pneumonia: An AIDS patient comes into your office with symptoms of pneumonia. What organisms are you considering?
Staphylococcus, gram-negative rods, fungi, viruses, Pneumocystis carinii
Common causes of pneumonia: A patient in the CCU gets pneumonia. What organisms are you thinking?
Nosocomial infections are usually Staphylococcus and gram-negative rods
Common causes of pneumonia: The same patient also aspirated some peas prior to getting sick. What organisms do you add to your list?
Anaerobes
Common causes of pneumonia: His domineering wife of this same patient is mad because he also had a viral infection last week. What infectious agents would you now consider?
add H. influenzae; another common postviral pneumonia bug is Staph
Common causes of pneumonia: The wife is so distressed she goes into labor and gives birth to a 10 lb baby girl, who also gets pneumonia. Does she have the same bug as her dad in the CCU?
Neonatal pneumonia is usually due to Group B streptococci or E. coli -- the dad could have the latter.
Common causes of pneumonia: Of course, the wife get sick too, but her pneumonia is classified as "atypical." What might she have?
Mycoplasma, Legionella, Chlamydia
Name the causes of meningitis in the following age groups:: Newborn (0-6 months)
Group B strep, E. coli, Listeria
Name the causes of meningitis in the following age groups:: Children (6 mo to 6 years)
Strep pneumoniae, Neisseria meningitidis, Haemophilus influenze type B, Enteroviruses
Name the causes of meningitis in the following age groups:: 6-60 years
N. meningitidis, Enteroviruses, S. pneumoniae, HSV
Name the causes of meningitis in the following age groups:: 60+ years
Gram-negative rods, Listeria
Name the causes of meningitis in the following age groups:: An AIDS patient comes to you with high fevers, stiff neck, and mental status changes. What organisms might be causing his meningitis?
Cryptococcus, CMV, toxoplasmosis (brain abscess), JC virus (PML)
CSF findings in meningitis: You do a spinal tap on your patient. The CSF pressure appears to be increased. What type of infectious agent have you eliminated?
none. It could be bacterial, TB, fungal, or viral (in viral, CSF pressure is normal to increased)
CSF findings in meningitis: You do a quick smear of the spinal tap under the microscope and see increased polys. What type of infectious agent does this suggest?
bacterial. In fungal, TB, and viral, you see increased lymphocytes.
CSF findings in meningitis: The lab tests show an increase in protein and a decrease in sugar in the CSF. Does that confirm your previous guess or confuse you?
Confirms. These findings are seen in bacterial, fungal, and TB infections. In viral infections the protein and sugar concentrations of the CSF are normal.
Osteomyelitis: What population is most likely to get osteomyelitis?
children
Osteomyelitis: What lab test is elevated in osteomyelitis?
ESR
For each of the following groups of persons, name the organism that is most likely to cause osteomyelitis: Most people (nonspecific)
S aureus -- assume S aureus if no other information
For each of the following groups of persons, name the organism that is most likely to cause osteomyelitis: sexually active
Neisseria gonorrhea (rare -- septic arthritis is more common)
For each of the following groups of persons, name the organism that is most likely to cause osteomyelitis: drug addicts
Pseudomonas aeruginosa
For each of the following groups of persons, name the organism that is most likely to cause osteomyelitis: Sickle cell Px
Salmonella
For each of the following groups of persons, name the organism that is most likely to cause osteomyelitis: Prosthetic replacement
S. aureus and S. epidermidis
For each of the following groups of persons, name the organism that is most likely to cause osteomyelitis: Vertebral
Mycobacterium tuberculosis
Urinary tract infections: What 2 groups of males are likely to get UTIs?
old men with enlarged prostates and baby boys with congenital defects
Urinary tract infections: What are symptoms of pyelonephritis?
fever, chills, flank pain, CVA tenderness
Urinary tract infections: What are symptoms of a UTI?
dysuria, frequency, urgency, suprapubic pain
Urinary tract infections: The 2nd most common cause of UTI in young, ambulatory women is __________________
Staphylococcus saprophyticus
Urinary tract infections: Your patient gets a UTI while in the hospital. What organisms do you want to make sure his antibiotics cover while his urine culture is growing?
E. coli, Proteus, Klebsiella, Serratia, Pseudomonas
Urinary tract infections: What are predisposing factors for UTIs?
female gender (10:1; short urethra colonized by fecal flora), flow obstruction, kidney surgery, catheterization, gynecologic abnormalities, diabetes, pregnancy
Urinary tract infections: AUTHOR
Sharyn Miskovitz
UTI Bugs: Has a blue-green pigment and fruity odor
Pseudomonas aeruginosa
UTI Bugs: Two UTI bugs that are nosocomial and drug resistant
Pseudomonas aeruginosa and Serratia marcescens
UTI Bugs: Leading cause of UTIs
Escherichia coli
UTI Bugs: What does Proteus mirabilis produce?
Urease
UTI Bugs: Serratia marcescens produce what color pigment?
red
UTI Bugs: Large mucoid capsule and viscous colonies
Klebsiella pneumoniae
UTI Bugs: What do E. coli colonies show on EMB agar?
metallic sheen
UTI Bugs: 2nd leading cause of UTIs in sexually active women
Staphylococcus saprophyticus
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