Term
| In which group is herpes simplex encephalitis most common? |
|
Definition
| neonates < 6 weeks of age |
|
|
Term
| What are the 3 predominant bacteria you think about in children < 3 months when thinking meningitis? |
|
Definition
| Group B strep/ E.coli/ Listeria |
|
|
Term
| What is the typical CSF/serum glucose ratio? |
|
Definition
| 1/2 to 3/4 (if higher- hyperglycemia, if lower- infection) |
|
|
Term
| Why do we give steroids in addition to praziquantel when treating neurocysticercosis? |
|
Definition
| the steroids prevent a strong inflammatory response to the praziquantel |
|
|
Term
| What organism is being discussed?- gram (+) rod, obligate anaerobe, found in soil/water, majority of food intoxication outbreaks |
|
Definition
|
|
Term
| What's the mortality rate for C. botulinum intoxication? |
|
Definition
|
|
Term
| What's the treatment for C. botulinum poisoning? |
|
Definition
| use emetics/gastric lavage, HBAT (anti serotype toxin; IgG); supportive therapy |
|
|
Term
| How does C. botulinum LC get released into the motor neuron? |
|
Definition
| via vesicle acidification |
|
|
Term
| What's the most effective way to prevent infant botulinism? |
|
Definition
| do not give honey to children < 1 year |
|
|
Term
| What's the common standard of treatment for infant botulinism? |
|
Definition
| BIG-IV botulinum human immune globulin |
|
|
Term
| What is the difference between the BoNT/A and BoNT/E forms? |
|
Definition
| the Latter works for weeks, while the former works for months |
|
|
Term
| In addition to BoNT/A's cosmetic effects, what else has it been commonly used for? |
|
Definition
| as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy |
|
|
Term
| What's the typical incubation period and first common presenting symptom for someone poisoned with C. tetanus? |
|
Definition
| 8 days/ often notice stiffening of the jaw muscles and severe, painful spasms of voluntary muscles |
|
|
Term
| What the three main applications of engineered NT's? |
|
Definition
| study brain function, treat pain/epilepsy, treat diseases involving secretion |
|
|
Term
| What trait of BoNT makes it useful for delivery of medications? |
|
Definition
| It can be used for oral delivery since it translocates the gut epithelium |
|
|
Term
| Name the six agents that are considered Category A agents in their risk to national security? |
|
Definition
| Bacillus anthracis,variola major, clostridium botulinum, yersinia pestis, francisella tularensis, and hemorrhagic fever viruses |
|
|
Term
| On a CXR, what feature is unique to inhalational anthrax? |
|
Definition
|
|
Term
| What type of lymphadenopathy do we find in anthrax typically? |
|
Definition
| mediastinal & hilar lymphadenopathy |
|
|
Term
| What's the recommended course for possible exposure? |
|
Definition
| PO ciprofloxacin or doxycycline for 60 days (IV if sure) |
|
|
Term
| What's the case fatality rate for smallpox? |
|
Definition
|
|
Term
| What's the primary route of transmission of small pox? |
|
Definition
| spreads by aerosol or droplet nuclei from oropharynx |
|
|
Term
| What's the typical incubation period for the small pox disease? |
|
Definition
|
|
Term
| What's unique about the way the lesions develop in small pox? |
|
Definition
| they develop synchronously |
|
|
Term
| How does the rash in small pox evolve over time? |
|
Definition
| it initially is a maculopapular rash manifesting around the mouth area/pharynx which then rapidly becomes vesicular and then pustular (deep and tense) |
|
|
Term
| What's a potential complication of the smallpox rash? |
|
Definition
| It's followed by secondary bacterial infection of the eylids/cornea, potentially causing blindness |
|
|
Term
| What substance is used to cleanse potentially small-pox contaminated surfaces? |
|
Definition
|
|
Term
| What are the rules to giving smallpox vaccines? |
|
Definition
| If within 3 days of the exposure, give just the vaccine. If more than 3 days afterward, give the vaccine and vaccine immune globulin |
|
|
Term
| If we know a person has the plague, what's the typical treatment? |
|
Definition
| streptomycin or gentamicin |
|
|
Term
| What are the limitations of the smallpox vaccine? |
|
Definition
| It produces a limited vaccinia infection at the site of injection and does not produce life-long immunity (lasts 5-10 years) |
|
|
Term
| What unique quality of the smallpox vaccine makes it potentially effective? |
|
Definition
| if given <3 days post-exposure, it has such an immunogenic effect that it produces Ab during the incubation period, and those Ab's overwhelm and control the viral replication |
|
|
Term
| What bioterrorism agent produces characteristic bipolar staining (darker at 2 ends and lighter in the middle)? |
|
Definition
|
|
Term
| In yersinia pestis, what's the typical site of bubos (inflammed lymphadenopathy) |
|
Definition
|
|
Term
| Septicemic course of yersinia pestis can rp;douce what manifestations? |
|
Definition
| hemorrhage and necrosis of the digits/ ecchymosis and hemorrhage of the skin |
|
|
Term
| While the manifestations for tularemia are similar to the plague, what major difference exists between the two pathogens? |
|
Definition
| tularemia is not transmissible human-to-human |
|
|
Term
| What's the drug of choice and the 2nd option for tularemia? |
|
Definition
| IM streptomycin; IV gentamicin used alternatively |
|
|
Term
| For any unknown pneumonia, what management step is necessary? |
|
Definition
|
|
Term
| What's the primary way we diagnose tularemia? |
|
Definition
|
|
Term
| What's the DOC for both streptococcus pneumoniae and neisseria meningitidis (meningitis)? |
|
Definition
|
|
Term
| Ampicllin is used to treat which species that causes bacterial meningitis? |
|
Definition
|
|
Term
| For either mycoplasma pneumoniae or legionella pneumoniae, what drug is commonly used? |
|
Definition
|
|
Term
| Ceftriaxone is used to treat which species causing community-acquired pneumonia? |
|
Definition
|
|
Term
| For coagulase negative staphylococci or an IV line infection, what agent is commonly used? |
|
Definition
|
|
Term
| Ampicillin + gentamicin is the combination used to treat what species causing endocarditis? |
|
Definition
| enterococcus endocarditis |
|
|
Term
| For streptococcal infective endocarditis, what agent is used? |
|
Definition
|
|
Term
| For toxic shock syndrome and/or necrotizing fasciitis caused by streptococcal pygones, what agents do we turn to? |
|
Definition
| clindamycin + penicillin G |
|
|
Term
| How does the drug of choice for syphillis change over the course of the disease? |
|
Definition
| Initially benzathine penicillin IM; Aqueous Pen G if neurosyphilis |
|
|
Term
| For an outpatient case of cellulitis (likely S. aurues or GAS), what drug do we turn to? |
|
Definition
| cephalexin, if not that then dicloxacillin, clindamycin |
|
|
Term
| IV Vancomycin is used to treat what kind of cellulitis? |
|
Definition
|
|
Term
| Vancomycin + ceftriaxone + metronidazole is the common combination for what disease? |
|
Definition
| diabetic lower extremity, mixed infections |
|
|
Term
| Elevation of liver enzymes is a real concern for what class of antibiotics? |
|
Definition
|
|
Term
| What are the common side effects of synercid? |
|
Definition
| (quinupristin/dalfopristin)--. increased LFT's, myalgias, arthralgias |
|
|
Term
| What are the common adverse effects for linezolid? |
|
Definition
| low WBC, low platelets, lactic acidosis, retinopathy |
|
|
Term
| How does babesia microfti survive in the winter? |
|
Definition
| It survives within the deer tick (Ixodes tick), and then is transmitted to rodents in the spring |
|
|
Term
| What are the 2 parameters for droplet spread? |
|
Definition
| distance only up to 1 meter, diameter > 5 microns |
|
|
Term
| Which organism is known to be associated with droplet nuclei transmission? |
|
Definition
| coxiella burnetti, causing Q fever |
|
|
Term
| What diseases predominantly have lice as vectors? |
|
Definition
| epidemic typhus, relapsing fever, and trench fever |
|
|
Term
| In what sort of environment does leptospira proliferate and cause disease? |
|
Definition
| rainy season-significant runoff from farms into rafting rivers |
|
|
Term
| What three pathologies are commonly associated with leptospira? |
|
Definition
| high fever, conjunctival infection, and kidney failure |
|
|
Term
| For the plague, how does the spread from sylvatic to urban foci occur? |
|
Definition
| via the development of alternate primary reservoirs (domesticated animals) |
|
|
Term
| What is the primary reservoir of yellow fever, and how does it spread w/in the primary reservoir? |
|
Definition
| the tree-top monkey/ spreads with the help of forest mosquitoes |
|
|
Term
| What two major diseases feature humans as primary resrevoirs? |
|
Definition
| yellow fever and the plague |
|
|
Term
| What is the key epidemiologic factor in Q fever? |
|
Definition
| birthing animals (the coxiella burnetti heavily concentrated within the placental tissue)/ outbreaks occur downwind of the farm because of aerosolization |
|
|
Term
| Abattoir workers are at increased risk of contracting what disease? |
|
Definition
|
|
Term
| What are the 3 common pathological spirochetes that exist? |
|
Definition
| leptospira, borrelia, and treponema |
|
|
Term
| What's the difference between borrelia hermsii and recurrentis in terms of how they're transmitted? |
|
Definition
| in hermsii, rodents are the primary reservoir, and transmission occurs via tick bites (humans are inadvertent hosts); in recurrentis, humans are the primary reservoir, and transmission is person-to-person via fleas/lice |
|
|
Term
| What is a common marker of an intracellular pathogen (like african tick typhus-rickettsial species)? |
|
Definition
|
|
Term
| What is the main hallmark of african tick typhus? |
|
Definition
|
|
Term
| How do we typically confirm the clinical diagnosis of African tick typhus? |
|
Definition
|
|
Term
| What's the primary disorder in Viral hemorrhagic fever? |
|
Definition
|
|
Term
| what's the most effective treatment against Congo-Crimean hemorrhagic fever? |
|
Definition
|
|
Term
| What's the typical incubation period of rabies? |
|
Definition
| 10 days in animals, 2 months in humans |
|
|
Term
| In Africa, Asia, and South America, what's the most likely reservoir of rabies? |
|
Definition
|
|
Term
| What are the 2 possible manifestations of rabies? |
|
Definition
agitated- hypersensitivity to all stimuli due to complete collapse and breakdown of the synaptic pathways
dumb- mute, non-responsive, not moving |
|
|
Term
| What disease also is known as "break bone fever"--> manifesting as severe arthralgias/myalgias? |
|
Definition
|
|
Term
| What's the treatment of choice for yersinia pestis? |
|
Definition
| gentamicin or streptomycin |
|
|
Term
| What's the treatment of choice for Tularemia? |
|
Definition
| gentamicin or streptomycin (same as for yersinia pestis) |
|
|
Term
| What type of lymphadenopathy is found in oculoglandular syndrome (tularemia)? |
|
Definition
| pre-auricular lymphadenopathy |
|
|
Term
| deficiency in lower-numbered complement proteins is typically associated with what? |
|
Definition
|
|
Term
| What is the most common humoral defect in the general population? |
|
Definition
|
|
Term
| Which bacteria are more likely going to be involved with CMI defects? |
|
Definition
| mycobacteria, listeria, salmonella, nocardia, and legionella |
|
|
Term
| What two bacteria are post-splenectomy patients are more susceptible to getting? |
|
Definition
| streptococcus pneumoniae and haemophilus influenze |
|
|
Term
| What's the morphology of Pasturella? |
|
Definition
|
|
Term
| Describe the culture requirements of pasturella? |
|
Definition
| grows on blood agar in the presence of CO2 |
|
|
Term
| What's the DOC for Pasturella trans. by dog/cat bite? |
|
Definition
|
|
Term
| Characterize the morphology and culture requirements of francisella tularensis? |
|
Definition
| facultative anaerobe, Gram (-) bacillus, small, fastidious- requiring cysteine for growth |
|
|
Term
| How is typhoidal tularemia typically acquired? |
|
Definition
| eating/drinking contaminated water/food (group of beavers contaminating a stream) |
|
|
Term
| What species of Bartonella is associated with trench fever? |
|
Definition
|
|
Term
| What's the most common cause of chronic, benign lymphadenopathy in young adults? |
|
Definition
|
|
Term
| What's the typical way we diagnose Bartonella and how do we treat it? |
|
Definition
| serology/ treatment via azithromycin or erythromycin (macrolides) |
|
|
Term
| Describe the genome of borrelia burgodferi. |
|
Definition
| small, linear chromosome with multiple linear and circular plasmids |
|
|
Term
| Name the preferred hosts for the tick in all stages of life? |
|
Definition
larvae- prefrs white-footed mouse
nymph- preferred hosts- humans
adult- preferred host- deer |
|
|
Term
| T or F. There is transovarial passage but not transstadial passage for the tick carrying Lyme disease |
|
Definition
| F- it's the other way around |
|
|
Term
| How does borrelia burgodoferi induce inflammation? |
|
Definition
| it has lipoproteins on the surface of the cell that induce inflammation (no endotoxins) |
|
|
Term
| What makes the Borrelia burgdoferi able to multiply within 2 different hosts? |
|
Definition
| The VIsE protein undergoes antigenic variation and so employs entirely different sets of genes/ are also highly motile that can penetrate highly viscous gel-type material (i.e. connective tissue) |
|
|
Term
| At stage 3 Lyme Disease, what's the typical presentation? |
|
Definition
| oligoarthritis + neurologic symptoms (like an autoimmune disease-treatment may be like for RA) |
|
|
Term
| What's the process of testing for Lyme Disease? |
|
Definition
| ELISA test, followed by Western Blot if ELISA is positive |
|
|
Term
| How does the treatment for Lyme Disease change over time? |
|
Definition
| In early stages- Doxycycline, later on it's ceftriaxone |
|
|
Term
| What vaccine exists for Lyme Disease? |
|
Definition
| One based on OspA antigens expressed in ticks, can produce Ab's only transiently provided the vaccin actually enters the tick gut to kill the spirochete |
|
|
Term
| What sort of tick transmits Erhlichia? Rickettsia? |
|
Definition
|
|
Term
| What cells are predominantly affected by Rickettsia rickettsii? |
|
Definition
| endothelial and Smooth muscle cells (most Spotted Fever members always produce a rash) |
|
|
Term
| What organism predominantly causes epidemic typhus? |
|
Definition
| Rickettsia prowazekii (endothelial cells predominantly affected, sometimes a rash is produced) |
|
|
Term
| For how long does the infected tick need to bite the host before transmitting the Rickettsial organism? |
|
Definition
| 4-6 hours (process of engorgement of the tick with blood) |
|
|
Term
| What are the 4 main hallmarks of rickettsial infections? |
|
Definition
| severe vasculitis, periheral petechial rashes (starting at wrists/ankles-->palms,soles-->up the extremities), thrombocytopenia, and hyponatremia |
|
|
Term
| What sort of Rickettsial-transmitting tick is more common along the East coast? |
|
Definition
|
|
Term
| How does the louse transmit epidemic typhus (rickettsia prowazekii)? |
|
Definition
| it takes a blood meal, defecates, producing irritation- subsequent scratching allows feces to enter the circulation |
|
|
Term
| What are the two primary animals that transmit the causative agents of endemic typhus fever? |
|
Definition
| flying squirrels and rat fleas |
|
|
Term
| What's the treatment of choice for Q fever? |
|
Definition
|
|
Term
| What are the general symptoms associated with erlichia and anaplasma? |
|
Definition
| fever, headache, elevation of Liver Enzymes, myalgia, leukopenia, and thrombocytopenia |
|
|
Term
| What's the causative agent of human granulocytic ehrlichiosis? |
|
Definition
| anaplasma phagocytophilum |
|
|
Term
| Where does the dengue fever virus replicate? |
|
Definition
| in the cytoplasm of monocytes and macrophages |
|
|
Term
| Describe the concept of antibody enhancement of infection? |
|
Definition
| body producing Ab's against 1 serotype of Dengue can bind other serotypes, promoting uptake into monocytes/macrophages and leading to enhanced viral replication/production of very severe diseases |
|
|
Term
| How does the West Nile Virus Virus primarily spread? |
|
Definition
| via the bite of the Culex mosquito/ birds are the amplifying hosts |
|
|
Term
| For senior citizens with WNV, which manifestation has the highest incidence? |
|
Definition
|
|
Term
| What's the primary agent of transmission of the Yellow Fever/Black Vomit Fever? |
|
Definition
| Aedes aegypti mosquito (i.e. the same as dengue) |
|
|
Term
| What are the primary symptoms of the toxic phase of Yellow Fever? |
|
Definition
| abdominal pain, jaundice, liver and kidney failure |
|
|
Term
| What are the primary reservoirs (i.e. amplifying hosts) of La Crosse Encephalitis? |
|
Definition
|
|
Term
| What type of mosquito is the primary transmission agent of bunyavirus? |
|
Definition
| Aedes triseriatus (heavily wooded areas) |
|
|
Term
| S. pneumo and N. meningitidis are located within what structure before they invade the CNS? |
|
Definition
| nasopharynx (pathology is partially to the host inflammatory response to the organisms) |
|
|
Term
| What are the usual signs of neisseria meningitidis meningococcemia? |
|
Definition
| Organisms producing endotoxin leading to emboli, purpuric rash of DIC, poor tissue perfusion, and even shock |
|
|
Term
| What virulence factor is essential for the survival of N. gonorrhoaea? |
|
Definition
|
|
Term
| At what temperature and in what environment is N. meningitidis best cultured? |
|
Definition
| Between 30-37 C, best in chocolate media/Thayer Martin media |
|
|
Term
| T or F. N. meningitidis has an oxidase which oxidizes glucose and maltose |
|
Definition
|
|
Term
| What's the main way that N. meningitidis binds to the epithelium and penetrate the vascular endothelial cells? |
|
Definition
| Via pili and Opa proteins (hte latter undergoes phase variation) |
|
|
Term
| What is the recommendation for treatment of N. meningitidis during outbreaks? |
|
Definition
| Ceftriaxone and vancomycin |
|
|
Term
| During outbreaks, what drugs are used as prophylactic measures? |
|
Definition
| rifampin, quinolone ABX, and ceftriaxone for those who are carriers |
|
|
Term
| What feature does L. monocytogenes have that allows it to move and penetrate adjacent cells? |
|
Definition
| ActA- actin-mediate proliferation, penetrate adjacent cells w/o traveling by bloodstream |
|
|
Term
| T or F- L. monocytogenes is oxidase positive |
|
Definition
| F- it's catalase positive (N. meningitidis is oxidase positive) |
|
|
Term
| Which protein in the rabies virus structure codes for a glycoprotein envelope? |
|
Definition
|
|
Term
| What's the function of the L protein in the rabies virus structure? |
|
Definition
| It serves as a RNA-dependent RNA polymerase |
|
|
Term
| What key difference is there in the life cycles of the polio and rabies viruses? |
|
Definition
| The latter is not a lytic life cycle, leaves the cell via budding/reverse endocytosis |
|
|
Term
| What is the most frequent cause of death precipitated by inhalational anthrax? |
|
Definition
| overhwelming septicemia and CV collapse |
|
|
Term
| If dealing with rabbits, what's the way we can get tularemia from them? |
|
Definition
| We actually have to touch the viscera, because touching the hair only is not a problem |
|
|
Term
| Describe the structure of the borrelia burgdoferi spirochete |
|
Definition
| large organism with multiple periplasmic flagella attached to the single end (between outer membrane and cell cylinder) |
|
|
Term
| Why is lyme disease more prevalent during the summer? |
|
Definition
| That's when the tick is typically in its nymphal stage |
|
|
Term
| What's the main virulence factor of borrelia burgdorferi? |
|
Definition
| lipopproteins on the cell surface (VIsE protein)- antigenic variation |
|
|
Term
| What's the most common manifestation of Stage II Lyme Disease? |
|
Definition
|
|
Term
| What can be given within 72 hours of tick bite to prevent development of Lyme Disease? |
|
Definition
|
|
Term
| What the drug of choice for RMSF? |
|
Definition
|
|
Term
| T or F- Tetracycline is the drug of choice for Q fever? |
|
Definition
|
|
Term
| How does coxiella burnetti replicate intracellularly? |
|
Definition
| It enters the cell via endocytosis, enters a vacuole that fuses with the lysosome to form phagolysosome; produce a low pH within the vacuole that stimulate Coxiella to multiply |
|
|
Term
| How does transmission of erhlichia chafeensis (causing Human Monocytic Erhlichiosis) primarily occur? |
|
Definition
| via the Lone star tick (prevalent in southern golf courses) |
|
|
Term
| The symptoms of Human Monocytic Erhlichiosis relate with what? |
|
Definition
| leukopenia and thrombocytopenia |
|
|
Term
| How do we diagnosis Human Granulocyte Erhlichiosis (i.e. Anaplasmosis)? |
|
Definition
| visualization of inclusion bodies (i.e. morulae bodies) in granulocytes |
|
|
Term
| What organ is particularly targeted by arbovirus, and as so how do patients typically present? |
|
Definition
| liver- patients are often jaundiced |
|
|
Term
| What is typically absent on the genome of the flavivirus? |
|
Definition
|
|
Term
| Describe the replication process of the flavivirus. |
|
Definition
| viral RNA translated into a large polyprotein--> first protein cleaved (act as protease) -->protease cleaves the polyprotein to generate capsid proteins and polymerase --> polymerase makes the (-) strand, which serves as the template for viral nucleic acids |
|
|
Term
| What's a common hemorrhagic manifestation of dengue fever? |
|
Definition
|
|
Term
| When is the highest incidence of WNV? |
|
Definition
|
|
Term
| Relatively healthy, younger people are more likely to exhibit what kind of manifestation of WNV? |
|
Definition
| acute flaccid paralysis (weakness in a single limb and/or headache) |
|
|
Term
| What are the most severe symptoms produced in Yellow Fever during the toxic phase? |
|
Definition
| severe jaundice, abdominal pain, hemorrhaging, liver and kidney failure |
|
|
Term
| How does the bunyavirus replicate? |
|
Definition
| It has 3 segments, 1 of which codes for replicase |
|
|
Term
| How does the bunyavirus escape the host cell? |
|
Definition
| via budding with plasma membrane lipids |
|
|
Term
| What type of transmission does bunyavirus undergo- transstadial or transovarial? |
|
Definition
|
|
Term
| Which demographic is more affected by LC encephalitis and when? |
|
Definition
| younger children- June to October (when the mosquitoes seeking their blood meal) |
|
|
Term
| What is important to check in any person with N.meningitidis infection? |
|
Definition
|
|
Term
| What's the major criteria for CVID? |
|
Definition
| 2/3 of the Ig's are deficient (some degree of CMI defect) |
|
|
Term
| What's the most important bacterium to know when dealing with CMI defects? |
|
Definition
|
|
Term
| Name three diseases associated with deficient Ig levels or function |
|
Definition
CLL-> abnormal lymphocytes only able to produce non-functional Ig
multiple myeloma--> abundant abnormal plasma cells only able to produce abnormal whole-body Ig |
|
|
Term
| When discussing CMI defect, what diseases are linked with subacute meningitis (3 weeks)? |
|
Definition
| TB, cryptococus, HSV/VZV/CMV |
|
|
Term
| What's the recommended treatment for CVID? |
|
Definition
| vaccinations (unlikely to work); montly IVIG infusions, corticosteroids |
|
|
Term
| What's the typical cause of death for someone with CVID? |
|
Definition
| recurrent severe pneumonias, bronchiectasis |
|
|
