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Immunity and Infection 2
Review for Immunity and Infection Exam 2
843
Medical
Professional
11/14/2015

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Cards

Term
How does the mucosal surface area compare to the skin epithelial surface area?
Definition
The mucosal surface area is larger.
Term
Through what surfaces do the vast majority of infectious agents invade?
Definition
Mucosal.
Term
What is the role of microorganisms in the development of mucosal lymphoid tissue?
Definition
The mucosal lymphoid tissue cannot develop without microorganisms being present. Mucosal microorganisms are essential to our health.
Term
Is an immune response to food desirable?
Definition
No. It would do more harm than good.
Term
List two types of NALT.
Definition
Tonsils and adenoids.
Term
List three types of GALT.
Definition
Peyer's patches, solitary lymphoid nodules, and appendix.
Term
List the three inductive sites in the mucosal immune system.
Definition
NALT, BALT, and GALT.
Term
What is the effect of a tonsillectomy on the immune response to the Polio vaccine?
Definition
Children without tonsils have a poorer immune response to the Polio vaccine.
Term
List the two inductive sites in the GALT.
Definition
Peyer's patches and solitary lymphoid follicles.
Term
List the two effector sites of the GALT.
Definition
Lamina propria and epithelium.
Term
What types of cells are present in the effector sites of the mucosal immune system?
Definition
Activated immune cells.
Term
What types of immune cells are present in the epithelium of the GALT?
Definition
CD8 T cells.
Term
What cells facilitate antigen uptake in the GALT?
Definition
M cells.
Term
Are M cells antigen-presenting cells?
Definition
No.
Term
Does the mucosal tissue have afferent lymphatics?
Definition
No.
Term
How does the number of specificities for intraepithelial lymphocytes compare to that of other lymphocytes?
Definition
Intraepithelial lymphocytes have limited use of the V region and limited specificities.
Term
What are the two types of intraepithelial lymphocytes?
Definition
Conventional CD8 aB
Non-conventional (gamma-delta TCR or aB CDR, CD8aa)
Term
Where do lymphocytes stimulated in the mucosal immune system traffic to?
Definition
Mucosal sites.
Term
What type of integrin begins to be expressed if a T cell or B cell is stimulated in a Peyer's patch?
Definition
a4B7.
Term
What type of integrin is expressed if a B cell or T cell is stimulated in a lymph node?
Definition
a4B1.
Term
What addressin interacts with a4B7?
Definition
MadCAM.
Term
How do mucosal macrophages compare to systemic macrophages?
Definition
Mucosal macrophages are programmed to be less inflammatory.
Term
What intracellular receptors in epithelial cells interact with bacteria?
Definition
TLR or NOD.
Term
What transcription factor is activated by TLR and NOD signaling in the mucosal immune system?
Definition
NFkB.
Term
What is the hallmark of effective immunization against enteric pathogens?
Definition
An IgA response.
Term
Do non-conventional T cells recognize antigens via MHC class I?
Definition
No.
Term
Do non-conventional T cells undergo thymic selection?
Definition
No. Many are self-reactive.
Term
What two molecules are elevated on epithelial cells during stress?
Definition
MICA and MICB.
Term
What receptor on intraepithelial T cells recognizes MICA and MICB on stressed epithelial cells?
Definition
NKG2D.
Term
Define oral tolerance.
Definition
The mucosal immune system does not attack food proteins and commensal bacteria.
Term
How do commensal bacteria prevent dendritic cell maturation?
Definition
They stimulate the epithelium to produce cytokines and other factors that prevent dendritic cell maturation.
Term
What is the important cytokine released by immature dendritic cells?
Definition
TGF-beta.
Term
What cells are induced by immature dendritic cells?
Definition
Treg.
Term
How does the strength and speed of a secondary immune response compare to that of a primary immune response?
Definition
A secondary immune response is stronger and faster than a primary immune response.
Term
List the two causes of memory.
Definition
Clones of long-lived T and B cells.
Constant exposure to low antigen levels.
Term
How long are antibody levels from the primary immune response maintained after the infection is defeated?
Definition
A few months.
Term
List three ways that antibody left over from the primary immune response can prevent subsequent infections.
Definition
Neutralization, opsonization, and complement.
Term
What type of immune response is produced if a person is exposed to the same cold one year later?
Definition
Secondary immune response, which depends on immunological memory.
Term
What type of cell do most activated T cells and B cells become in the primary immune response?
Definition
Short-lived effectors.
Term
How does the lag time to a measurable response in the secondary immune response compare to that in the primary immune response?
Definition
Much shorter.
Term
How does the number of memory lymphocytes compare with the number of naive lymphocytes that act in a secondary immune response?
Definition
There are more memory lymphocytes acting in a secondary immune response.
Term
How does the affinity of lymphocytes for the pathogen in the secondary immune response compare to that in the primary immune response?
Definition
Higher affinity in the secondary immune response.
Term
Why do memory B cells have higher affinity antigen receptors?
Definition
They have already undergone affinity maturation and isotype switching.
Term
What isotype of antibody is produced in the primary immune response, but not in the secondary immune response?
Definition
IgM.
Term
How does memory affect the speed with which an infection is cleared?
Definition
Faster.
Term
How does memory affect the severity of the disease after re-exposure to the same pathogen?
Definition
It results in mild or unnoticeable disease.
Term
List two evolutionary advantages of memory.
Definition
Re-infection mortality is low, and survivors can care for the sick.
Term
How long can memory last?
Definition
Life.
Term
How long can immunity from a vaccination last?
Definition
Lifetime.
Term
How was smallpox eradicated?
Definition
Vaccination.
Term
What B cells participate in the secondary immune response?
Definition
Only memory B cells.
Term
What is the effect of immune complexes on naive B cells and memory B cells?
Definition
Immune complexes are inhibitory for naive B cells, but not for memory B cells.
Term
What is the mechanism by which immune complexes are inhibitory for naive B cells, but not memory B cells?
Definition
Crosslinking of BCR and FcvRIIB.
Term
Why does hemolytic disease of the newborn occur in the second and subsequent pregnancies, but not in the first pregnancy?
Definition
In the first pregnancy, only a primary immune response with low-affinity IgM and some IgG is produced. In the second and subsequent pregnancy, a secondary immune response with high-affinity IgG is produced.
Term
How is hemolytic disease of the newborn prevented?
Definition
Infusion of Rh-specific IgG inhibits the naive B cells from mounting a primary immune response.
Term
Do memory T cells require a co-stimulatory (CD28) signal?
Definition
No.
Term
How does the number of antigenic specificities of naive T cells compare to that of memory B cells?
Definition
Naive T cells have about 100 times as many antigenic specificities.
Term
Define original antigenic sin.
Definition
With a pathogen that is highly mutable, the immunological memory and immune response will be gradually eroded.
Term
What do effector memory T cells do?
Definition
Quickly differentiate into a potent Th1, Th1, or Th17 cell making lots of cytokines, depending on the cytokine environment.
Term
What do central memory T cells do?
Definition
They are specialized towards entering T cell zones of secondary lymphoid tissue. They rapidly express CD40L and interact with B cells, and some differentiate into follicular helper cells.
Term
Does the maintenance of immunological memory depend on antigen?
Definition
No.
Term
How do FDCs help maintain immunological memory?
Definition
Antigens can be maintained for long periods on FDCs in the form of immune complexes.
Term
What receptors that contribute to memory are expressed at high levels on FDCs?
Definition
Fc and C3.
Term
What immune response to gamma:delta T cells contribute to?
Definition
Innate.
Term
Do gamma:delta T cells undergo positive and negative selection?
Definition
No.
Term
How does the diversity of gamma:delta T cells compare to that of aB T cells?
Definition
Limited diversity.
Term
What do Vgamma9:Vdelta2 T cells recognize?
Definition
Phosphoantigens.
Term
What do gamma:delta T cells circulate directly to?
Definition
Infected tissues.
Term
What does an activated gamma:delta T cell do?
Definition
It kills infected cells.
Term
Where are T cells that express the Vgamma:Vdelta1 TCR found?
Definition
Mainly in the gut.
Term
What do Vgamma:Vdelta1 T cells react with?
Definition
MIC.
Term
What does MIC activate?
Definition
Vgamma:delta1 T cells and NK cells.
Term
What causes hemophagocytic lymphohistiocytosis?
Definition
Activation of CD8 T cells, which release IFN-gamma to activate macrophages, which release TNF-alpha and IL-6. Activated macrophages attack the bone marrow, damage tissues, and induce inflammation.
Term
Do NK cells have activating receptors, inhibitory receptors, or both?
Definition
Both.
Term
What receptor is expressed by all NK cells?
Definition
NKG2D.
Term
What receptors do NK cells use to discriminate healthy from infected cells?
Definition
Receptor for MHC class I molecules.
Term
How does the amount of MHC class I expressed by infected and tumor cells compare to that expressed by healthy cells?
Definition
Less.
Term
Give an example of an inhibitory receptor that monitors the overall level of class I.
Definition
NKG2A/CD94.
Term
What molecules binds to the leader sequence of class I molecules and is a measure of the overall expression of HLA?
Definition
HLA-E.
Term
What receptor detects loss of expression of a particular HLA?
Definition
KIR.
Term
What is missing or defective in the missing self hypothesis?
Definition
MHC class I.
Term
What types of T cells protect against mycobacterial infection?
Definition
T cells recognizing lipid antigens.
Term
What are CD1a, CD1b, and CD1c?
Definition
MHC class I-like molecules that present lipid antigens.
Term
What cells express CD1d?
Definition
Epithelial cells.
Term
What does CD1d present to?
Definition
NKT cells, not conventional aB T cells.
Term
What receptors do NKT cells express?
Definition
a:B T cell receptors.
Term
Are NKT cells part of innate immunity or adaptive immunity?
Definition
Innate.
Term
What type of B cells play a role in bridging innate and adaptive immunity?
Definition
B1.
Term
What are viral vaccines made from?
Definition
Whole viruses or viral components.
Term
Are you preventing an individual receiving a vaccine from developing disease?
Definition
Yes.
Term
What are the three strategies in vaccine development?
Definition
Heat killed or inactivated.
Attenuated live vaccines.
Subunit vaccines.
Term
How are attenuated live vaccines produced?
Definition
By growing in a non-human host.
Term
Should attenuated live vaccines be given to immunocompromised patients?
Definition
No.
Term
Give an example of a subunit vaccine.
Definition
HbsAg.
Term
What is the DTaP vaccine made of?
Definition
Toxoids.
Term
What do adjuvants do?
Definition
They non-specifically enhance the immune response to a vaccine.
Term
What are the components of complete Freund's adjuvant?
Definition
Oil in water emulsion with heat-killed mycobacteria.
Term
What is MF59?
Definition
An emulsion of squalene, oil, and water used as an adjuvant in humans.
Term
What do ISCOMs do?
Definition
They are lipid carriers that load peptides or proteins into the cell cytoplasm and allow MHC class I responses and CD8 T cell activation.
Term
How does an attenuated vaccine cause disease in some cases?
Definition
Back mutation.
Term
How can you prevent a person from developing a disease as a result of a live, attenuated vaccination?
Definition
Give the killed vaccine first.
Term
Why does public resistance to vaccination go up as the disease incidence goes down?
Definition
Fear of side effects replaces fear of disease.
Term
List two chronic disease vaccine issues.
Definition
Pathogens are adept at evading the immune response.
Pathogens can live for years in the host.
Term
What opens up new avenues of vaccine design?
Definition
Genome sequences of human pathogens.
Term
What causes Aschoff nodules (a form of granuloma) to appear in rheumatic fever?
Definition
Macrophages come in and turn into giant cells. Nodules form because the immune system unsuccessfully tries to destroy the pathogen.
Term
How does binding of factor H by M proteins enhance the virulence of Group A Streptococci?
Definition
It causes less control of complement activation.
Term
Why is it difficult to make a vaccination against Streptococcus pyogenes?
Definition
S. pyogenes antigenically varies its capsule.
Term
How does aspirin work?
Definition
It inhibits prostaglandin synthesis.
Term
What causes erythema marginatum in rheumatic fever?
Definition
Complement activation.
Term
Why can about 5% of individuals control HIV?
Definition
T cell response.
Term
Does vaccine development face greater or less public scrutiny than drug development?
Definition
Greater.
Term
How does the size of the vaccine development business compare to the size of the drug development business?
Definition
The vaccine development business is smaller.
Term
What is the big success story of immunology because it has given a greater quality and quantity of life?
Definition
Vaccination.
Term
Do viruses provide their own ribosomes for protein synthesis and energy-producing systems for replication?
Definition
No (except arenaviruses).
Term
What is the only group of viruses that are not submicroscopic?
Definition
Poxviridae.
Term
Can viruses have both DNA and RNA for genetic material?
Definition
No.
Term
What is the symmetry of paramyxoviruses?
Definition
Helical.
Term
What is the symmetry of reoviruses?
Definition
Icosahedral.
Term
What is the symmetry of poxviruses?
Definition
Amorphous.
Term
What is the symmetry of togaviruses?
Definition
Icosahedral.
Term
What is the symmetry of herpesviruses?
Definition
Icosahedral.
Term
What is the symmetry of the poliovirus?
Definition
Icosahedral.
Term
What is the symmetry of adenovirus?
Definition
Icosahedral.
Term
What is the symmetry of tobacco mosaic virus?
Definition
Helical.
Term
What type of genome does a helical virus have?
Definition
RNA.
Term
Do herpetoviridae have an envelope?
Definition
Yes.
Term
Do togaviridae have an envelope?
Definition
Yes.
Term
Do orthomyxoviridae have an envelope?
Definition
Yes.
Term
Do rhabdoviridae have an envelope?
Definition
Yes.
Term
Viruses with what structural component cause rashes and autoimmune infections?
Definition
Envelope.
Term
Is hemagglutinin likely to be found in a viral core?
Definition
No.
Term
Why were embryonic eggs the model of choice for propagating poxviruses, influenza viruses, and herpesviruses?
Definition
They were sterile and had no monolayer.
Term
Why couldn't poliovirus grow in an embronated egg?
Definition
The receptors for poliovirus were not present.
Term
What is viropexis?
Definition
A term used to describe the phagocytosis of a virus.
Term
What is the receptor for rabies virus?
Definition
Acetylcholine receptor in the brain.
Term
What are the receptors for influenza?
Definition
Mucoprotein receptors.
Term
Posttranslational cleavage to produce viral structural and non-structural proteins occurs during infection of...
Definition
Picornaviruses (They have polycistronic RNA).
Term
What virus family is characterized as having virion-associated polymerases?
Definition
Rhabdoviridae.
Term
Where do DNA viruses (except poxviridae) replicate?
Definition
In the nucleus.
Term
What do poxviridae use for early transcription?
Definition
A virion-associated DNA-dependent RNA polymerase.
Term
What do all DNA viruses except poxviridae use for early transcription?
Definition
Cellular RNA polymerase II.
Term
Where do RNA viruses (except retroviridae and orthomyxoviridae) replicate?
Definition
Cytoplasm.
Term
What do retroviridae use for early transcription?
Definition
Reverse transcriptase.
Term
What do (-) polarity RNA viruses use for early transcription?
Definition
Virion-associated RNA-dependent RNA polymerase.
Term
What do rheoviridae (with a +/- RNA genome) use for early transcription?
Definition
Virion-associated RNA-dependent RNA polymerase.
Term
What do viruses with an infectious (+)-polarity RNA genome use for early transcription?
Definition
Their own genomes.
Term
List the family, symmetry, genome type, and presence/absence of an envelope for human parvovirus B19.
Definition
Parvoviridae
Icosahedral
SS linear DNA
Naked
Term
What virus causes erythema infectiosum?
Definition
Human parvovirus B19.
Term
List the family, symmetry, genome type, and presence/absence of an envelope for human papillomavirus.
Definition
Papovaviridae
Icosahedral
DS circular DNA
Naked
Term
List the family, symmetry, genome type, and presence/absence of an envelope for BK poliomavirus.
Definition
Papovaviridae
Icosahedral
DS circular DNA
Naked
Term
List the family, symmetry, genome type, and presence/absence of an envelope for JC poliomavirus.
Definition
Papovaviridae
Icosahedral
DS circular DNA
Naked
Term
List the family, symmetry, genome type, and presence/absence of an envelope for JC polyomavirus.
Definition
Papovaviridae
Icosahedral
DS circular DNA
Naked
Term
List the family, symmetry, genome type, and presence/absence of an envelope for Merkel cell polyomavirus.
Definition
Papovaviridae
Icosahedral
DS circular DNA
Naked
Term
List the family, symmetry, genome type, and presence/absence of an envelope for adenovirus.
Definition
Adenoviridae
Icosahedral
DS linear DNA
Naked
Term
What are the smallest DNA viruses?
Definition
Parvoviruses.
Term
What is a replication-defective parvovirus that could potentially be used as a gene therapy vector?
Definition
Adeno-associated virus.
Term
How is human parvovirus B19 transmitted?
Definition
Respiratory transmission.
Term
What virus is associated with a slapped cheek rash?
Definition
Parvovirus B19.
Term
What commonly occurs in adults infected with parvovirus B19?
Definition
Arthritis for 2-3 weeks.
Term
What virus is associated with hydrops fetalis (fetal edema) and spontaneous abortion?
Definition
Parvovirus B19.
Term
What does parvovirus B19 attack?
Definition
Erythroid progenitors.
Term
What virus causes aplastic crisis in sickle cell patients and chronic bone marrow suppression in immune compromised patients?
Definition
Parvovirus B19.
Term
How do papilloma viruses enter hosts?
Definition
They enter via mucosa or small breaks in keratinized skin.
Term
What viruses infect undifferentiated keratinocyte stem cells in the basal layer?
Definition
HPV.
Term
Where does HPV virus replication occur?
Definition
Differentiated outer layers.
Term
What types of HPV cause most skin warts?
Definition
2 and 4.
Term
What types of HPV cause plane warts?
Definition
3 and 10.
Term
What type of HPV causes plantar warts?
Definition
1.
Term
What type of HPV causes butcher's warts?
Definition
7.
Term
What types of HPV cause condyloma acuminatum (cauliflower-shaped warts)?
Definition
6 and 11.
Term
What types of HPV cause condyloma planum?
Definition
16 and 18.
Term
What types of HPV are associated with 70% of cervical cancers?
Definition
16 and 18.
Term
What virus causes focal epithelial hyperplasia?
Definition
HPV.
Term
What virus causes oral papillomas?
Definition
HPV.
Term
How are common skin warts transmitted?
Definition
Person-to-person by contact.
Term
How are plantar warts transmitted?
Definition
Public showers and swimming pools.
Term
How are genital and oral warts transmitted?
Definition
Sexual contact.
Term
What diseases do polyomaviruses cause in children?
Definition
Mild respiratory infections.
Term
What virus causes fatal multifocal leukoencephalopathy in immunocompromised patients?
Definition
JC polyomavirus.
Term
What virus causes kidney infections in immunocompromised patients?
Definition
BK polyomavirus.
Term
What virus causes Merkel cell carcinoma?
Definition
Merkel cell polyomavirus.
Term
What symptoms are caused by adenovirus?
Definition
Cough, sore throat, congestion, and fever (sometimes also conjunctivitis).
Term
How is adenovirus transmitted?
Definition
Close contact or fecal-oral, such as in swimming pools.
Term
What two cellular anti-oncoproteins are bound and inactivated by HPV proteins?
Definition
p53 and pRb.
Term
In most HPV-associated cancer cells, what is the configuration of the HPV genome?
Definition
Integrated into host DNA.
Term
List the family, symmetry, genome type, and presence/absence of an envelope for smallpox (variola).
Definition
Poxviridae
Complex
DS linear DNA
Enveloped
Term
List the family, symmetry, genome type, and presence/absence of an envelope for vaccinia virus.
Definition
Poxviridae
Complex
DS linear DNA
Enveloped
Term
List the family, symmetry, genome type, and presence/absence of an envelope for Molluscum contagiosum.
Definition
Poxviridae
Complex
DS linear DNA
Enveloped
Term
List the family, symmetry, genome type, and presence/absence of an envelope for herpes viruses.
Definition
Herpesviridae
Icosahedral
DS linear DNA
Enveloped
Term
List the family, symmetry, genome type, and presence/absence of an envelope for varicella-zoster virus.
Definition
Herpesviridae
Icosahedral
DS linear DNA
Enveloped
Term
List the family, symmetry, genome type, and presence/absence of an envelope for cytomegalovirus.
Definition
Herpesviridae
Icosahedral
DS linear DNA
Enveloped
Term
List the family, symmetry, genome type, and presence/absence of an envelope for Epstein-Barr virus.
Definition
Herpesviridae
Icosahedral
DS linear DNA
Enveloped
Term
List the family, symmetry, genome type, and presence/absence of an envelope for hepatitis B virus.
Definition
Hepadnaviridae
Icosahedral
SS/DS circular DNA
Enveloped
Term
What types of cell do HSV-1 and HSV-2 infect?
Definition
Neurons.
Term
What types of cells does varicella-zoster virus infect?
Definition
Neurons.
Term
What family of viruses has a tegument layer?
Definition
Herpesviridae.
Term
What is the tegument of herpes viruses made of?
Definition
Proteins.
Term
What type of replication cycle does herpes virus use?
Definition
Lytic (productive).
Term
What does the capsid of herpesvirus do?
Definition
It docks to nuclear pores and releases DNA.
Term
What cell type does herpes simplex latency occur in?
Definition
Neurons.
Term
Describe viral gene expression during latency of herpesvirus.
Definition
Restricted.
Term
What cells does EBV infect?
Definition
B cells.
Term
List the three alpha-herpesviruses.
Definition
HSV-1, HSV-2, and VZV.
Term
What type of herpes is caused by HSV-1?
Definition
Mostly oral.
Term
What type of herpes is caused by HSV-2?
Definition
Mostly genital.
Term
List two ways that HSV-2 is acquired.
Definition
Sexually or perinatally during birth.
Term
Where does local replication of HSV-1 and HSV-2 occur?
Definition
In epithelial cells at sites of infection.
Term
What is herpes Whitlow?
Definition
HSV infection of the fingers.
Term
Who is at risk for herpes Whitlow?
Definition
Healthcare workers.
Term
What is the primary ocular infection caused by HSV?
Definition
Keratoconjunctivitis.
Term
What is the recurrent ocular infection caused by HSV?
Definition
Keratitis.
Term
What is the leading infectious cause of blindness?
Definition
HSV.
Term
How is neonatal herpes prevented?
Definition
Acyclovir.
Term
What usually causes necrotizing herpes simplex encephalitis?
Definition
HSV-1 in children and adults; HSV-2 in newborns.
Term
What virus causes chickenpox as the primary infection?
Definition
VZV.
Term
Where does latency of VZV occur?
Definition
Dorsal root ganglia.
Term
What is zoster?
Definition
Shingles (recurrence of VZV).
Term
What type of vaccine is available for VZV?
Definition
Live.
Term
Bell's palsy follows what part of VZV?
Definition
Zoster.
Term
List the four beta-herpesviruses.
Definition
CMV
HHV6A
HHV6B
HHV7
Term
What is the most important pathogen in the beta-herpesvirus subgroup?
Definition
CMV.
Term
How is CMV shed?
Definition
Body fluids.
Term
What is the main mode of transmission of CMV?
Definition
Oral.
Term
What are the symptoms of a CMV infection in an immunocompetent patient?
Definition
Can be asymptomatic.
Mild cold-like illness (no rash).
Mononucleosis-like syndrome.
Term
What is the most common cause of mononucleosis?
Definition
EBV.
Term
Where does CMV latency occur?
Definition
Myeloid lineage cells.
Term
What is the most common cause of death in AIDS patients?
Definition
CMV reactivation at CD4 counts less than 50-100 cell/cc.
Term
What is the first line treatment for CMV?
Definition
Ganciclovir.
Term
What is the major infective cause of birth defects and congenital hearing loss?
Definition
CMV.
Term
In what group of fetuses is CMV most severe?
Definition
Children of seronegative mothers.
Term
What virus causes Roseola Infantum (aka exanthem subitum), which involves severe fever and rash in infants?
Definition
HHV-6B.
Term
What cells do HHV-6A, HHV-6B, and HHV-7 infect?
Definition
T cells. This is also where latency occurs.
Term
List the two gamma-herpesviruses.
Definition
EBV and KSHV.
Term
Where do EBV and KSHV begin replicating?
Definition
Oral epithelium.
Term
What is the effect of EBV and KSHV on latently infected B cells?
Definition
Immortalized.
Term
What is the primary infection of EBV?
Definition
Mononucleosis.
Term
What causes oral hairy leukoplakia in AIDS patients?
Definition
EBV.
Term
How is hepatitis B virus transmitted in developed countries?
Definition
Sexually or IV drug use.
Term
What makes up the HBV vaccine?
Definition
Recombinant protein.
Term
How is smallpox spread?
Definition
Aerosol.
Term
What virus causes firm papules and nodules with central depression (common in children)?
Definition
Molluscum contagiosum.
Term
List the family, symmetry, genome type, and presence/absence of an envelope for Poliovirus.
Definition
Picornaviridae
Icosahedral
SS nonsegmented (+) RNA
Naked
Term
List the family, symmetry, genome type, and presence/absence of an envelope for Coxsackie virus.
Definition
Picornaviridae
Icosahedral
SS nonsegmented (+) RNA
Naked.
Term
List the family, symmetry, genome type, and presence/absence of an envelope for ECHO virus.
Definition
Picornaviridae
Icosahedral
SS nonsegmented (+) RNA
Naked
Term
List the family, symmetry, genome type, and presence/absence of an envelope for Rhinovirus.
Definition
Picornaviridae
Icosahedral
SS non-segmented (+) RNA
Naked
Term
List the family, symmetry, genome type, and presence/absence of an envelope for enteroviruses.
Definition
Picornaviridae
Icosahedral
SS nonsegmented (+) RNA
Naked
Term
List the family, symmetry, genome type, and presence/absence of an envelope for hepatitis A virus.
Definition
Picornaviridae
Icosahedral
SS non-segmented (+) RNA
Naked
Term
List the family, symmetry, genome type, and presence/absence of an envelope for norovirus virus.
Definition
Caliciviridae
Icosahedral
SS non-segmented (+) RNA
Naked
Term
List the family, symmetry, genome type, and presence/absence of an envelope for Rubella virus.
Definition
Togaviridae
Icosahedral
SS non-segmented (+) RNA
Enveloped
Term
List the family, symmetry, genome type, and presence/absence of an envelope for Dengue virus.
Definition
Flaviviridae
Icosahedral
SS non-segmented (+) RNA
Enveloped
Term
List the family, symmetry, genome type, and presence/absence of an envelope for Japanese encephalitis.
Definition
Flaviviridae
Icosahedral
SS non-segmented (+) RNA
Enveloped
Term
List the family, symmetry, genome type, and presence/absence of an envelope for St. Louis encephalitis.
Definition
Flaviviridae
Icosahedral
SS non-segmented (+) RNA
Enveloped
Term
List the family, symmetry, genome type, and presence/absence of an envelope for tickborne encephalitis virus.
Definition
Flaviviridae
Icosahedral
SS non-segmented (+) RNA
Enveloped
Term
List the family, symmetry, genome type, and presence/absence of an envelope for West Nile virus.
Definition
Flaviviridae
Icosahedral
SS non-segmented (+) RNA
Enveloped
Term
List the family, symmetry, genome type, and presence/absence of an envelope for Yellow fever virus.
Definition
Flaviviridae
Icosahedral
SS non-segmented (+) RNA
Enveloped
Term
List the family, symmetry, genome type, and presence/absence of an envelope for hepatitis C virus.
Definition
Flaviviridae
Icosahedral
SS non-segmented (+) RNA
Enveloped
Term
List the family, symmetry, genome type, and presence/absence of an envelope for rabies virus.
Definition
Rhabdoviridae
Helical
SS nonsegmented (-) RNA
Enveloped
Term
List the family, symmetry, genome type, and presence/absence of an envelope for respiratory syncytial virus.
Definition
Paramyxoviridae
Helical
SS non-segmented (-) RNA
Enveloped
Term
List the family, symmetry, genome type, and presence/absence of an envelope for mumps.
Definition
Paramyxoviridae
Helical
SS non-segmented (-) RNA
Enveloped
Term
List the family, symmetry, genome type, and presence/absence of an envelope for measles.
Definition
Paramyxoviridae
Helical
SS non-segmented (-) RNA
Enveloped
Term
List the family, symmetry, genome type, and presence/absence of an envelope for Marburg virus.
Definition
Filoviridae
Helical
SS non-segmented (-) RNA
Enveloped
Term
List the family, symmetry, genome type, and presence/absence of an envelope for Ebola virus.
Definition
Filoviridae
Helical
SS non-segmented (-) RNA
Enveloped
Term
List the family, symmetry, genome type, and presence/absence of an envelope for influenza viruses.
Definition
Orthomyxoviridae
Helical
SS segmented (-) RNA
Enveloped
Term
List the family, symmetry, genome type, and presence/absence of an envelope for Coronavirus.
Definition
Coronaviridae
Helical
SS non-segmented (+) RNA
Enveloped
Term
How are enteroviruses transmitted?
Definition
Ingestion of contaminated food or water.
Term
Where do enteroviruses replicate?
Definition
GI tract.
Term
Where are enteroviruses shed?
Definition
Stool.
Term
What is the major cause of aseptic meningitis?
Definition
Enteroviruses.
Term
How is polio shed?
Definition
Stool.
Term
How does polio cause damage to the lower motor neurons of the spinal cord and the brainstem?
Definition
Direct damage (not immune-mediated).
Term
What is the Salk polio vaccine?
Definition
Killed.
Term
What is the effect of the Salk vaccine?
Definition
It prevents poliomyelitis by inducing IgG in the blood.
Term
Does the Salk vaccine prevent GI infection or shedding?
Definition
No.
Term
What is the Sabin polio vaccine?
Definition
Live, attenuated.
Term
What does the Sabin vaccine do?
Definition
It prevents poliomyelitis by inducing IgG in the blood and prevents infection of the GI tract via secretory IgA.
Term
What viruses are the primary cause of the common cold?
Definition
Rhinoviruses.
Term
Where do rhinoviruses replicate?
Definition
Nasal passages.
Term
How are rhinoviruses spread?
Definition
Respiratory droplets and hand-to-hand.
Term
How is hepatitis A transmitted?
Definition
Fecal-oral.
Term
Is a vaccine available for hepatitis A?
Definition
Yes.
Term
Does hepatitis A often progress to chronic hepatitis?
Definition
No.
Term
How is norovirus transmitted?
Definition
Fecal-oral.
Term
What is the major cause of gastroenteritis outbreaks?
Definition
Norovirus.
Term
What type of hepatitis causes chronic hepatitis, liver cirrhosis, and liver cancer?
Definition
Hepatitis C.
Term
How are alphaviruses transmitted?
Definition
Mosquitos.
Term
How is rubella transmitted?
Definition
Respiratory droplets.
Term
What congenital disease causes heart disease, cataracts, hepatitis, CNS damage, and deafness?
Definition
Congenital rubella.
Term
How are all flaviviridae except hepatitis C transmitted?
Definition
Mosquitos or ticks.
Term
What two Flaviviridae cause hemorrhagic fever?
Definition
Yellow fever and dengue.
Term
What does West Nile virus cause?
Definition
Encephalitis.
Term
How is hepatitis C spread?
Definition
Blood products, tattooing, needle sharing, sexual, mother to infant.
Term
What are the symptoms of coronaviruses?
Definition
Upper respiratory infections.
Term
What virus has a bullet shape?
Definition
Rabies.
Term
How is rabies transmitted?
Definition
Usually by animal bites, but can be inhaled.
Term
What disease is characterized by swelling of the parotid glands?
Definition
Mumps.
Term
What are the three C's of measles?
Definition
Cough, coryza (runny nose), and conjunctivitis.
Term
What disease is associated with Koplik's spots in the mouth?
Definition
Measles.
Term
What type of rash occurs in measles?
Definition
Macular.
Term
What pneumovirus is a major cause of respiratory infections in children?
Definition
Respiratory syncytial virus.
Term
How are pneumoviruses transmitted?
Definition
Respiratory droplets and hand-to-mouth transmission.
Term
Which influenza type has more diverse H and N antigens and has an animal reservoir?
Definition
A.
Term
How are orthomyxoviruses spread?
Definition
Respiratory droplets.
Term
Does the flu usually involve a fever?
Definition
Yes.
Term
Does the flu usually involve a runny nose?
Definition
No.
Term
What cells mediate the destruction of epithelial cells in the respiratory tract in influenza?
Definition
T cells (worse in people with stronger immune systems).
Term
How is LaCrosse virus spread?
Definition
Mosquito bites.
Term
What two conditions does LaCrosse virus cause?
Definition
Meningitis and encephalitis.
Term
How are arenaviridae transmitted?
Definition
Rodents.
Term
What is unique about the structure of rotaviruses?
Definition
They have an icosahedral capsid within an icosahedral capsid.
Term
Describe the genome of rotaviruses.
Definition
Segmented, double-stranded RNA genome.
Term
What is the family of rotavirus?
Definition
Reoviridae.
Term
How many pieces of double-stranded RNA are in rotaviruses?
Definition
Ten.
Term
Do kuru infections cause an increase in antibodies?
Definition
No.
Term
Does kuru have a genome?
Definition
No.
Term
What demonstrated the role of an infectious agent in the pathogenesis of kuru?
Definition
The disease was serially transmitted to experimental animals.
Term
What are prions?
Definition
Infectious proteins.
Term
What disease is caused by communal cannibalism in Papua New Guinea?
Definition
Kuru.
Term
What is the normal function of prion proteins?
Definition
Copper-binding.
Term
What causes spongiform encephalopathies?
Definition
Prions.
Term
Do prions elicit an immune response?
Definition
No.
Term
How does classic CJD differ from variant CJD?
Definition
Classic CJD is genetically transmitted, and variant CJD is transmitted from the environment (such as infected beef).
Term
List the 6 steps of the viral life cycle in vivo.
Definition
1. Entry.
2. Replication at primary sites of infection.
3. Dissemination.
4. Replication at secondary sites of infection.
5. Secondary dissemination to tertiary sites.
6. Shedding.
Term
What is the different between virulence and pathogenicity?
Definition
Virulence is quantitative. Pathogenicity is not.
Term
What is the role of HSV ICP34.5?
Definition
Neurotropism.
Term
What is the role of HSV glycoprotein D?
Definition
Dissemination to neurons.
Term
What is the role of rotavirus NSP4?
Definition
It causes diarrhea.
Term
What causes fever, fatigue, malaise, aches, and drowsiness during viral infections?
Definition
Cytokine effects on the brain.
Term
What is the effect of preexisting antibodies due to a previous infection on the risk of hemorrhagic fever from dengue virus?
Definition
Increase.
Term
What is the mechanism of action of nucleoside and nucleotide analogs that are used as anti-herpesviral agents?
Definition
The compete for the active site in herpesviral polymerase.
Term
What is acyclovir?
Definition
A nucleoside analog.
Term
What is valacyclovir?
Definition
An L-valine ester of acyclovir used to increase oral bioavailability.
Term
What is penciclovir?
Definition
A nucleoside analog used to treat herpesviral infections.
Term
What is ganciclovir?
Definition
A dGTP analog used to treat herpesviral infections.
Term
What is valgancilovir?
Definition
An L-valine ester of Ganciclovir.
Term
What is cidofofir?
Definition
A dCTP analog used to treat herpesviral infections.
Term
What performs the first phosphorylation of anti-herpesviral nucleoside analogs?
Definition
Viral kinases.
Term
What causes the neutropenia and anemia in some patients who use Ganciclovir/Valganciclovir?
Definition
Activity against host polymerase-alpha.
Term
What is the metabolism of the nucleoside and nucleotide analogs used to treat herpesvirus infections?
Definition
Renal.
Term
What is the mechanism of resistance to the nucleoside analogs that are used to treat herpesviral infections?
Definition
Mutation in the viral enzyme that performs the initial phosphorylation.
Term
What is the less common mechanism of resistance to nucleoside and nucleotide analogs used to treat herpesvirus infections?
Definition
Mutation in the active site of the herpesviral polymerase causes cross-resistance to all available polymerase inhibitors.
Term
What is the spectrum of activity of acyclovir?
Definition
Active against HSV 1 and 2 and at high doses against VZV, EBV, and herpes B virus.
Term
What is the spectrum of activity of ganciclovir, valganciclovir, and cidofovir?
Definition
CMV, HHV6, HHV8, HSV, VZV, and EBV.
Term
What is Cidofovir active against, besides herpesviruses?
Definition
Adenoviruses, papilloma viruses, and pox viruses.
Term
What are the side effects of Ganciclovir?
Definition
Anemia and neutropenia.
Term
How is the activity of Ganciclovir monitored?
Definition
Monitor CMV serum PCR for response.
Term
What are the side effects of Valganciclovir?
Definition
Anemia and neutropenia.
Term
What is the side effect of Cidofovir?
Definition
Renal toxicity.
Term
What is the mechanism of Foscarnet?
Definition
Pyrophosphate analog that binds the pyrophosphate site on the herpesvirus polymerase, blocking it.
Term
What is the metabolism of Foscarnet?
Definition
Renal excretion.
Term
What is the mechanism of resistance to Foscarnet?
Definition
Viral DNA polymerase mutation.
Term
What is the spectrum of Foscarnet?
Definition
Active against all human herpesviruses and HIV
Term
What is Simeprevir?
Definition
It is a NS3/4A protease inhibitor used to treat hepatitis C.
Term
What are the two side effects of Simeprevir?
Definition
Rash and photosensitivity.
Term
What is the metabolism of Simeprevir?
Definition
CYP3A4
Term
What is Sofosbuvir?
Definition
Sofosbuvir is a NS5B protease inhibitor used to treat hepatitis C.
Term
What are the two side effects of Sofosbuvir?
Definition
Fatigue and headache.
Term
What is the metabolism of Sofosbuvir?
Definition
Metabolism by p-glycoprotein.
Term
Are hepatitis B treatments active against hepatitis C?
Definition
No.
Term
What is Lamivudine?
Definition
It is a nucleoside analog with HIV activity that is primarily used to treat hepatitis B.
Term
What is Entecavir?
Definition
A nucleoside/nucleotide analog used to treat hepatitis B.
Term
Is Entecavir active against 3TC/FTC resistant hepatitis B?
Definition
Yes.
Term
What is Adefovir?
Definition
Adefovir is a nucleoside/nucleotide analog used to treat hepatitis B.
Term
What is Tenofovir?
Definition
Tenofovir is a nucleoside/nucleotide analog used to treat hepatitis B.
Term
Are Adefovir and Tenofovir active against 3TC/FTC resistant hepatitis B?
Definition
Yes.
Term
What is Telbivudine?
Definition
Telbivudine is a nucleoside/nucleotide analog used to treat hepatitis B.
Term
How long must hepatitis B treatment be continued?
Definition
Indefinitely to prevent flares.
Term
What is Zanamivir?
Definition
A neuraminidase inhibitor used to treat influenza A and B.
Term
What is the side effect of Zanamivir?
Definition
Bronchospasm in patients with asthma or bronchitis.
Term
What is Oseltamivir?
Definition
A neuraminidase inhibitor used to treat influenza A and B.
Term
What is the mechanism of Zanamivir and Oseltamivir?
Definition
They are neuraminidase inhibitors that cause aggregation of viral particles within the cell.
Term
What is the metabolism of Oseltamivir and Zanamivir?
Definition
Renal and fecal excretion (Oseltamivir is first carboxylated).
Term
What is the antigen depot effect?
Definition
Adjuvants can increase the time that antigen remains at the administration site.
Term
Are killed or antigenic components Th1 biased or Th2 biased?
Definition
Th2 biased.
Term
Are live, attenuated vaccines Th1 biased or Th2 biased?
Definition
Th1 biased.
Term
What type of vaccine is the hepatitis A vaccine?
Definition
Formalin inactivated whole virus.
Term
What type of vaccine is the influenza vaccine?
Definition
Inactivated whole virus.
Term
What type of vaccine is the Hib vaccine?
Definition
Conjugated polysaccharide.
Term
What type of vaccine is the S. pneumoniae vaccine?
Definition
Conjugated polysaccharide.
Term
What type of vaccine is the Neisseria meningitidis vaccine?
Definition
Conjugated polysaccharide.
Term
What type of vaccine is the HPV vaccine?
Definition
Virus-like particle made from capsid proteins.
Term
What type of vaccine is the varicella zoster vaccine?
Definition
Temperature sensitive virus.
Term
What type of vaccine is the MMR vaccine?
Definition
Attenuated.
Term
What are two ways that the pathogen can win?
Definition
Alteration of the pathogen or inherited or acquired immunodeficiencies.
Term
What do the changes in pathogen include?
Definition
Genetic variation - prevention of long-term immunity.
Term
How does S. pneumoniae prevent a memory response?
Definition
Different serotypes means primary response all over again.
Term
What is antigenic drift?
Definition
A slight change in the antigens that leads to some of the antibodies from a previous infection being ineffective.
Term
What is antigenic shift?
Definition
A major change in the antigens of a virus that leads to an almost completely new virus, which can cause a pandemic.
Term
Does vaccination results in any protection in cases of antigenic drift?
Definition
Partial.
Term
Does vaccination result in any protection in cases of antigenic shift?
Definition
No.
Term
Describe the pathogenesis of sleeping sickness.
Definition
Trypanosoma brucei undergoes gene rearrangements to change its surface glycoproteins, leading to problems with antigen/antibody complexes causing neurological damage.
Term
How do pathogens exploit phagocytic cells?
Definition
They can use phagocytic cells as a protective haven.
Term
How does Treponema pallidum evade the immune system?
Definition
It coats itself with serum proteins to make itself look like the host.
Term
What do superantigens do?
Definition
They stimulate a massive but ineffective immune response.
Term
What type of T cell is active in the highly localized form of leprosy?
Definition
Th1.
Term
What type of T cell is activated in the disseminated form of leprosy?
Definition
Th2.
Term
What cytokine is potentially helpful for directing an appropriate immune response to leprosy?
Definition
IFN-gamma.
Term
What cytokine causes hypergammaglobulinemia in lepromatous leprosy?
Definition
IL-4.
Term
What type of T cells differentiate in an environment rich in TGF-beta?
Definition
Regulatory T cells.
Term
What is the consequence of lacking FOXP3?
Definition
Increased autoimmunity due to decreased Treg activity.
Term
What combination of cytokines causes differentiation into Th17?
Definition
TGF-beta + IL-6.
Term
What transcription factor is used by Th1 cells?
Definition
T-bet.
Term
What transcription factor is used by Th2 cells?
Definition
Gata-3.
Term
What transcription factor is used by Th17 cells?
Definition
ROR-gamma-t.
Term
What cytokine can induce MHC class II expression on some cells?
Definition
IFN-gamma.
Term
What is the role of viral IL-10 homologs in immune evasion?
Definition
Increase the pH of endosomes to inhibit proteolysis and loading of peptides onto MHC class II.
Term
What activates Pkr?
Definition
Binding to dsRNA.
Term
What increases the levels of Pkr?
Definition
Interferons.
Term
What does activated Pkr do?
Definition
It phosphorylates the translation initiation factor eIF2a, which shuts down translation and stops viral replication.
Term
Describe the genome of HIV.
Definition
2 copies of ssRNA.
Term
Does HIV have an envelope?
Definition
Yes; it is cell-derived.
Term
What molecule does HIV initially bind to when infecting a cell?
Definition
CD4.
Term
List the two co-receptors that HIV can use to enter a cell.
Definition
CCR5 and CXCR4.
Term
Where does reverse transcriptase act?
Definition
In the cytosol.
Term
What enzyme combines HIV viral DNA with the host cell's DNA?
Definition
Integrase.
Term
What is the role of HIV protease?
Definition
It cuts protein chains into individual proteins that combine to form a working virus.
Term
What is GP41?
Definition
The stalk of the complex on the surface of HIV.
Term
What does HIV use for transcription?
Definition
Host cell mRNA polymerase.
Term
After exposure to HIV, how long is the delay before HIV actually infects a cell?
Definition
48 hours.
Term
When do anti-HIV viral antibodies begin to appear?
Definition
After about 4 weeks.
Term
What is gp120?
Definition
It is an HIV surface glycoprotein used for entry into cells.
Term
Why does LPS get into the blood of HIV patients?
Definition
Bacteria escape from the gut.
Term
What is the result of increasing LPS in HIV patients?
Definition
Activation of CD8 T cells and a hyperactive immune system.
Term
What is CD14?
Definition
A receptor that delivers LPS to toll-like receptors.
Term
What does a high sCD14 mean in an HIV patient?
Definition
High risk of mortality.
Term
sCD14 increases as a result of activation of what type of cell?
Definition
Monocytes.
Term
What causes HIV-associated pulmonary disease?
Definition
Macrophage activation.
Term
Why must post-exposure prophylaxis for HIV be given early?
Definition
It must happen before the HIV genome is inserted into the host DNA.
Term
What is D-dimer a marker of?
Definition
Coagulopathy.
Term
Are antivirals static or cidal?
Definition
Static.
Term
What is AZT?
Definition
A dTTP analog used to treat HIV.
Term
What is D4T?
Definition
A dTTP analog used to treat HIV.
Term
What is DDI?
Definition
A dATP analog used to treat HIV.
Term
What is tenofovir?
Definition
A dATP analog used to treat HIV.
Term
What is 3TC?
Definition
A dCTP analog used to treat HIV.
Term
What is FTC?
Definition
A dCTP analog used to treat HIV.
Term
What is abacavir?
Definition
A dGTP analog used to treat HIV.
Term
What phosphorylates nucleoside analogs that are used to treat HIV?
Definition
Host cell enzymes.
Term
How is tenofovir different from the other nukes used to treat HIV?
Definition
It already has a phosphate group and is a nucleotide analog.
Term
What is the metabolism of nukes?
Definition
Metabolized by non-P450-dependent processes and/or excreted in the urine.
Term
What is the mechanism of HIV resistance to nukes?
Definition
Mutations in reverse transcriptase.
Term
What is the most likely NRTI to fail first?
Definition
3TC.
Term
What is FTC active against?
Definition
HIV and hepatitis B.
Term
What is 3TC active against?
Definition
HIV and hepatitis B.
Term
What is Abacavir?
Definition
It is a nucleoside analog used to treat HIV.
Term
List three side effects of abacavir.
Definition
Hypersensitivity syndrome (fever, rash)
Abdominal pain and possible vomiting
Increased risk of cardiovascular disease
Term
A patient tests positive for HLA B57-01. What does this mean?
Definition
The patient is at risk for hypersensitivity syndrome caused by Abacavir.
Term
What is Truvada?
Definition
Tenofovir + Emtriva coformulated.
Term
What are the two side effects of Tenofovir?
Definition
Renal toxicity and phosphate wasting-osteopenia.
Term
A patient taking Tenofovir for HIV has a GFR less than 60. What should you do?
Definition
Decrease the dose.
Term
What is Tenofovir active against?
Definition
HIV and hepatitis B.
Term
What is the mechanism of non-nucleoside reverse transcriptase inhibitors (NNRTIs)?
Definition
They are noncompetitive inhibitors of reverse transcriptase.
Term
What is the spectrum of NNRTIs?
Definition
They are active against HIV-1only.
Term
What is the metabolism of NNRTIs?
Definition
They are metabolized by the liver, including P450 3A4 enzymes.
Term
What is the mechanism of resistance to NNRTIs?
Definition
Mutation of reverse transcriptase.
Term
What is Efavirenz?
Definition
It is an NNRTI used to treat HIV.
Term
What is the major side effect of Efavirenz?
Definition
CNS side effects in 50%.
Term
What is a contraindication for Efavirenz use?
Definition
Pregnancy (teratogenic).
Term
What is Rilpivirine?
Definition
An NNRTI used to treat HIV.
Term
What are two side effects of Rilpiverine?
Definition
Rash and hepatitis.
Term
What is Etravirine?
Definition
It is an NNRTI used to treat HIV.
Term
What are two side effects of Etravirine?
Definition
Rash and hepatitis.
Term
What is Atripla?
Definition
Efavirenz + Tenofovir + Emtriva.
Term
What is Complera?
Definition
Rilpivirine + Tenofovir + Emtriva.
Term
What is the mechanism of HIV protease inhibitors?
Definition
They mimic the aromatic peptide bonds that are targeted by HIV protease, thus inhibiting the cleavage of gag and gag-pol precursors.
Term
What is the metabolism of protease inhibitors?
Definition
Mostly due to P450 enzymes.
Term
Which protease inhibitor inhibits CYP3A4?
Definition
Ritonavir.
Term
What is the mechanism of resistance to protease inhibitors?
Definition
4-8 mutations in HIV protease.
Term
What is the most difficult HIV drug to become resistant to?
Definition
Darunavir.
Term
Which HIV protease inhibitor has a huge number of drug interactions?
Definition
Ritonavir.
Term
What is the main side effect of Atazanavir?
Definition
Increased Bilirubin.
Term
What protease inhibitor is also useful for PI resistant HIV?
Definition
Darunavir.
Term
What class of HIV drugs causes Lipodystrophy syndrome?
Definition
HIV protease inhibitors.
Term
What is Raltegravir?
Definition
Integrase inhibitor.
Term
What is Elvitegravir?
Definition
Integrase inhibitor.
Term
What is STRIBLD?
Definition
Elvitegravir, Cobicistat, Tenofovir, and Emtriva.
Term
What is Dolutegravir?
Definition
Integrase inhibitor.
Term
What is Trivacay?
Definition
Dolutegravir, Abacavir, and Lamivudine.
Term
What is Mariviroc?
Definition
An HIV entry inhibitor.
Term
What is the mechanism of Mariviroc?
Definition
It binds CCR5.
Term
What is the TROPHILE assay?
Definition
It determines whether the HIV uses only CCR5 and is, therefore, susceptible to Mariviroc.
Term
When is the viral burden the greatest during an HIV infection?
Definition
During acute HIV.
Term
What is more transmissible by blood, hepatitis or HIV?
Definition
Hepatitis B and C.
Term
What is the primary means of identifying chronic HIV infection?
Definition
Antibody testing.
Term
What test is used to confirm a diagnosis of chronic HIV after ELISA is performed?
Definition
Western blot.
Term
What is the primary means of diagnosing acute HIV infection?
Definition
Viral load testing.
Term
Is the HIV antibody test positive or negative during acute HIV?
Definition
Negative.
Term
What virus causes retinitis, which often leads to irreversible blindness in HIV patients?
Definition
CMV.
Term
Give an example of an inherited immune deficiency that is not very severe.
Definition
IgA deficiency.
Term
What type of pathogen is an individual with an antibody deficiency unable to fight effectively?
Definition
Extracellular bacteria.
Term
What is X-linked aggamaglobulinemia?
Definition
Deficiency of IgG.
Term
What is the treatment for antibody deficiencies?
Definition
Antibiotics and monthly injections of gamma globulins from healthy individuals (passive immunity).
Term
Besides B cell deficiencies, what else can cause diminished production of antibodies?
Definition
Defects in T-cell help.
Term
Give an example of a receptor on T cells whose absence leads to immunodeficiency.
Definition
CD40L.
Term
What causes X-linked hyper-IgM syndrome?
Definition
No class switching.
Term
What are two consequences of defects in complement components?
Definition
Impaired antibody respones and accumulation of immune complexes.
Term
What types of infections are people with complement deficiencies susceptible to?
Definition
Extracellular bacterial infections.
Term
What type of infection are people with defects in phagocytes susceptible to?
Definition
Bacterial.
Term
What causes leukocyte adhesion deficiency I?
Definition
Deficiency in CD18 , an integrin component, so that inflammatory cells do not migrate to sites of infection.
Term
What causes leukocyte adhesion deficiency II?
Definition
Deficiency in selectins.
Term
What condition results from defects in T cell function?
Definition
SCID.
Term
Give an example of a gene defect that results in SCID.
Definition
Common gamma chain deficiency. The common gamma chain is a cytokine receptor chain associated with many cytokines (IL-2, 4, 7, 9, 15, and 21).
Term
What cells fail to develop as a result of bare lymphocyte syndrome MHC class II?
Definition
CD4.
Term
What cells fail to develop in bare lymphocyte syndrome MHC class I?
Definition
CD8.
Term
What is used to correct genetic defects of the immune system?
Definition
Hematopoietic stem cell transplants.
Term
The success of bone marrow transplants is directly correlated with what?
Definition
Degree of HLA matching.
Term
What is prevented by matching the HLA of bone marrow donors and recipients?
Definition
Graft vs Host Disease.
Term
What must be true in a bone marrow transplant in order for SCID not to occur?
Definition
The donor must share at least one MHC class I and one MHC class II.
Term
What is an ectoparasite?
Definition
An ectoparasite lives on the surface of the body.
Term
What is an endoparasite?
Definition
An endoparasite lives within the host's body.
Term
To what division of protozoa does Plasmodium belong?
Definition
Sporozoa.
Term
Which division of protozoa includes intracellular parasites?
Definition
Sporozoa.
Term
To what division of protozoa does Trypanosoma belong?
Definition
Flagellates.
Term
To what division of protozoa does Balantidium belong?
Definition
Ciliates.
Term
What are trophozoites?
Definition
The feeding, dividing, vegetative stage that causes tissue damage.
Term
What are cysts?
Definition
Dormant, inactive stage that protects the organisms from the environment and can be an infective stage.
Term
To what division of protozoa does Giardia lamblia belong?
Definition
Flagellate.
Term
To what division of protozoa does Cryptosporidium parvum belong?
Definition
Sporozoan.
Term
What does Entamoeba histolytica cause?
Definition
Bloody diarrhea (amoebic dysentery).
Term
What are the stages in the life cycle of Entamoeba histolytica?
Definition
Ameba and cyst.
Term
How is Entamoeba histolytica acquired?
Definition
By drinking water or eating foods contaminated with cysts (infective stage).
Term
What is the first place that Entamoeba histolytica goes from the intestine?
Definition
Liver.
Term
How is Amebiasis diagnosed?
Definition
Cysts in feces.
Term
What does Giardia lamblia cause?
Definition
Diarrhea and fatty stool.
Term
What are the stages in the life cycle of Giardia lamblia?
Definition
Troph and cyst.
Term
What is the infective stage for Giardia lamblia?
Definition
Cyst.
Term
How is Giardia lamblia acquired?
Definition
Drinking or eating contaminated food or water.
Term
What parasitic disease is characterized by an inability to absorb fat-soluble vitamins?
Definition
Giardiasis.
Term
What does Cryptosporidium parvum cause?
Definition
Diarrhea.
Term
How is Cryptosporidium acquired?
Definition
From contaminated water and food or from animals (zoonosis).
Term
Describe the location of Cryptosporidium.
Definition
It is an intracellular parasite, but extracytoplasmic.
Term
What part of the body does Balantidium coli infect?
Definition
Large intestine.
Term
What are the stages in the life cycle of Balantidium coli?
Definition
Cyst and troph.
Term
What is the infective stage of Balantidium coli?
Definition
Cyst.
Term
How is Balantidium coli acquired?
Definition
By eating or drinking contaminated food or water.
Term
What does Balantidium coli cause?
Definition
Diarrhea or dysentery - intestinal ulcers.
Term
What does Trichomonas vaginalis use for locomotion?
Definition
Flagella.
Term
What are the stages of the life cycle of Trichomonas vaginalis?
Definition
Only a flagellate stage, no cyst.
Term
How is Trichomonas vaginalis transmitted?
Definition
Sexually.
Term
What does Plasmodium cause?
Definition
Malaria.
Term
List two blood and tissue protozoal infections that are not transmitted by an arthropod vector.
Definition
Toxoplasmosis and amebic encephalitis.
Term
What cells do Plasmodium species infect?
Definition
Red blood cells and liver cells.
Term
How is malaria transmitted?
Definition
Anopheles mosquito.
Term
Which species of Plasmodium is the most virulent?
Definition
Plasmodium falciparum.
Term
What infective form of Plasmodium is injected into the blood by mosquitos?
Definition
Sporozoites.
Term
Where does Plasmodium go first?
Definition
Liver.
Term
What form of Plasmodium is released from the liver to go to red blood cells?
Definition
Merozoites.
Term
How does malaria lead to renal failure?
Definition
Immune complexes.
Term
What disease causes knobs on red blood cells?
Definition
Malaria.
Term
How is malaria diagnosed?
Definition
Red blood cell smears.
Term
What is the result of a lack of Duffy antigen?
Definition
Resistance to P. vivax.
Term
What is the host of toxoplasmosis?
Definition
Cats.
Term
To what group of protozoa does Toxoplasma gondii belong?
Definition
Sporozoa.
Term
How is Toxoplasmosis acquired?
Definition
Infected cat feces or from improperly cooked meat.
Term
What does toxoplasmosis cause in immunocompetent individuals?
Definition
Flu-like illness. It is much more severe and can cause things like encephalitis, myocarditis, and hepatitis in immunocompromised patients.
Term
What is the infective form of Toxoplasma gondii?
Definition
Oocyst.
Term
Is Toxoplasma an intracellular or extracellular parasite?
Definition
Intracellular parasite in macrophages.
Term
What is the role of macrophages in toxoplasmosis?
Definition
They carry Toxoplasma to the liver and brain.
Term
Where does Toxoplasma become encysted and dormant in healthy people?
Definition
Muscles.
Term
What parasitic disease causes hydrocephaly in newborns?
Definition
Toxoplasmosis.
Term
How is Toxoplasmosis diagnosed?
Definition
Test sera of mother and infant for IgM and IgG.
Term
What family does Leishmania belong to?
Definition
Trypanosomatidae.
Term
What are the stages in the life cycle of Leishmania?
Definition
Promastigotes and amastigotes.
Term
What causes sleeping sickness?
Definition
Trypanosomes.
Term
What causes Chagas disease?
Definition
American trypanosomiasis.
Term
How is Leishmania acquired?
Definition
Sandfly.
Term
How is African Trypanosomiasis acquired?
Definition
Tsetse fly.
Term
What is the infective stage of Leishmania?
Definition
Promastigote.
Term
What cells are infected by Leishmania?
Definition
Macrophages.
Term
What does Leishmania tropica cause?
Definition
Cutaneous Leishmaniosis.
Term
What does Leishmania brasiliensis cause?
Definition
Mucocutaneous Leishmaniosis.
Term
What does Leishmania donovani cause?
Definition
Visceral Leishmaniasis.
Term
Which form of Leishmania has a flagellum?
Definition
Promastigote.
Term
What causes the disfiguring scars in Leishmaniasis?
Definition
Ulcers are secondarily infected with bacteria.
Term
How is Leishmaniasis diagnosed?
Definition
Microscopic identification of the parasites in stained films or culture of material taken from the margin of a lesion.
Term
What is kala azar?
Definition
A disease caused by Leishmania donovani which affects the cells of the reticuloendothelial system, causing hepatosplenomegaly.
Term
What cytokines cause the coma in sleeping sickness?
Definition
TNF and IL-1.
Term
What is the major organ affected by Trypanosoma cruzi?
Definition
Heart.
Term
To what division of protozoa does Naegleria fowleri belong?
Definition
Free-living amebae.
Term
To what division of protozoa does Acanthamoeba belong?
Definition
Free-living amebae.
Term
To what division of protozoa does Balamuthia mandrillaris belong?
Definition
Free-living amebae.
Term
What does Naegleria fowleri cause?
Definition
Primary amebic meningoencephalitis.
Term
What does Acanthamoeba cause?
Definition
Granulomatous amebic encephalitis and amebic keratitis.
Term
What does Balamuthia madrillaris cause?
Definition
Amebic encephalitis.
Term
What is the source of Naegleria?
Definition
Soil and fresh water.
Term
How is infection with Naegleria diagnosed?
Definition
By finding amebae in CSF.
Term
How is amebic keratitis transmitted?
Definition
Contacts.
Term
What is the infective stage of Acanthamoeba?
Definition
Trophozoite.
Term
Which free-living ameba discussed in class is an opportunistic pathogen?
Definition
Acanthamoeba.
Term
Which form of amebic encephalitis is chronic?
Definition
Granulomatous.
Term
How is Balamuthia mandrillaris acquired?
Definition
Soil.
Term
How is Babesiosis transmitted?
Definition
Ixodes tick.
Term
What does Babesiosis cause?
Definition
Anemia due to lysing of red blood cells.
Term
What parasite generates ring-like trophozoites?
Definition
Babesia microti.
Term
What is an allergen?
Definition
An innocuous substance that causes an IgE response.
Term
What antibody causes Type I hypersensitivity reactions?
Definition
IgE.
Term
What type of antigen causes Type I hypersensitivity reactions?
Definition
Soluble.
Term
What is the effector mechanism of Type I hypersensitivity reactions?
Definition
Mast-cell activation.
Term
What type of antibody causes Type II hypersensitivity reactions?
Definition
IgG.
Term
What type of antibody causes Type III hypersensitivity reactions?
Definition
IgG.
Term
Serum sickness and the Arthus reaction are examples of what type of hypersensitivity reaction?
Definition
Type III.
Term
What receptor does IgE bind to on mast cells, eosinophils, and basophils to produce antigen receptors?
Definition
Fc-epsilon-R1.
Term
Can the first exposure to an allergen cause an allergic reaction?
Definition
No. IgE must already be present.
Term
Is Type I hypersensitivity immediate or delayed?
Definition
Immediate.
Term
In what case can monoclonal IgE cause a Type I hypersensitivity reaction?
Definition
If the allergen has repetitive epitopes.
Term
Which cells (mast cells or basophils) are tissue-resident cells?
Definition
Mast cells.
Term
What protease is released by mucosal mast cells?
Definition
Tryptase.
Term
What protease is released by connective tissue mast cells?
Definition
Chymotryptase.
Term
What molecules contribute to the late-phase reaction in a Type I hypersensitivity reaction?
Definition
Newly formed lipids, cytokines, and chemokines.
Term
What cells release histamine?
Definition
Mast cells.
Term
What enzyme produces histamine?
Definition
Histidine decarboxylase.
Term
What histamine receptor is involved in allergic reactions?
Definition
H1.
Term
What is the result of histamine release from mast cells?
Definition
Smooth muscle contraction and mucus production.
Term
What is diphenhydramine?
Definition
Antihistamine.
Term
What is the precursor for prostaglandins and leukotrienes?
Definition
Arachidonic acid.
Term
Do prostaglandins and leukotrienes contribute to the late-phase reaction or early-phase reaction?
Definition
Late-phase.
Term
What cytokine, released by what cells, stimulates eosinophil production?
Definition
IL-5 released by Th2 cells.
Term
The presence of what cells is diagnostic for chronic allergic inflammation?
Definition
Eosinophils.
Term
What is the principle cause of airway damage that occurs in chronic asthma?
Definition
Eosinophils.
Term
What is the role of basophils in Type I hypersensitivity reactions?
Definition
Initiate Th2/IgE with IL-4 and IL-13.
Term
What type of response is elicited by a skin test or skin exposure to an allergen?
Definition
Immediate wheal and flare reaction at the site.
Term
Is there a correlation between total IgE and severity of Type I hypersensitivity reactions?
Definition
No.
Term
What is used to treat systemic anaphylaxis?
Definition
Epinephrine.
Term
What is rhinitis?
Definition
Mild allergies to inhaled antigens.
Term
Where do allergens that cause allergic rhinitis enter the body?
Definition
Nasal mucosa.
Term
What is the hygiene hypothesis?
Definition
Exposure of children to multiple infections reduces the likelihood of an allergy.
Term
What causes Type II hypersensitivity reactions?
Definition
Antibodies specific for altered components of human cells.
Term
What type of hypersensitivity reaction is Goodpasture's syndrome?
Definition
Type II.
Term
What type of hypersensitivity reaction results from the reaction of penicillin with proteins on human cells?
Definition
Type II.
Term
What type of hypersensitivity reaction is prevented by matching ABO antigens of blood donor and recipients?
Definition
Type II.
Term
What causes Type III hypersensitivity reactions?
Definition
Immune complexes formed from IgG and soluble antigens.
Term
What complexes cause the most problems with Type III hypersensitivity?
Definition
Small.
Term
What can result from the administration of large quantities of soluble antigens, like anti-venom?
Definition
Type III hypersensitivity.
Term
What are Type IV hypersensitivity reactions mediated by?
Definition
Antigen-specific effector T cells.
Term
What type of hypersensitivity is delayed-type hypersensitivity?
Definition
Type IV.
Term
What type of hypersensitivity is contact hypersensitivity?
Definition
Type IV.
Term
What type of hypersensitivity is celiac disease?
Definition
Type IV.
Term
Does the first contact with poison ivy cause a detectable reaction?
Definition
No.
Term
What causes celiac disease?
Definition
Hypersensitivity to common food proteins.
Term
What is Necator americanus?
Definition
Hookworm.
Term
What is Ascaris lumbricoides?
Definition
Giant roundworm.
Term
What is Enterobius vermicularis?
Definition
Pinworm.
Term
What is the most common nematode in the United States?
Definition
Enterobius vermicularis.
Term
What is the infective stage of Necator americanus?
Definition
Larvae.
Term
How is Necator americanus acquired?
Definition
Larvae in soil penetrate the skin.
Term
How is Necator americanus diagnosed?
Definition
Eggs in feces.
Term
Where do adult Necator americanus worms reside?
Definition
in the intestine.
Term
What does Necator go through to get to the intestines?
Definition
Skin, then blood and lungs.
Term
What does Necator americanus feed on, and what is the consequence of this?
Definition
Necator americanus feeds on red blood cells and causes anemia.
Term
What are three conditions caused by Necator americanus?
Definition
Pneumonitis, diarrhea, and severe anemia.
Term
What does Ascaris lumbricoides infect?
Definition
Intestines.
Term
What is the infective form of Ascaris lumbricoides?
Definition
Egg.
Term
What form of Ascaris lumbricoides is diagnostic?
Definition
Egg.
Term
What do Ascaris larvae migrate through?
Definition
Lungs.
Term
What does Ancylostoma caninum cause?
Definition
Cutaneous larva migrans.
Term
What does Toxocara canis cause?
Definition
Visceral larva migrans.
Term
How is Toxocara canis transmitted?
Definition
Ingestion of eggs.
Term
What form of Enterobius is infective and diagnostic?
Definition
Eggs.
Term
How is Enterobius infection acquired?
Definition
Ingestion of eggs.
Term
How does the cell membrane of fungi and dermatophytes differ from human cell membranes?
Definition
They have ergosterol/zymosterol.
Term
What are the two forms of fungi?
Definition
Yeast and mold.
Term
What is the difference between yeasts and molds?
Definition
Yeasts are single cells, and molds are made up of hyphae and mycelium.
Term
What does Malassezia furfur cause?
Definition
Pityriasis versicolor.
Term
What does Malassezia furfur infect?
Definition
Skin.
Term
What does Trichophyton tinea cause?
Definition
Ringworm.
Term
What is dermatophytosis?
Definition
Ringworm.
Term
Does dermatophytosis invade living tissue?
Definition
No.
Term
How is subcutaneous mycosis transmitted?
Definition
Trauma.
Term
What are the causative agents of subcutaneous mycosis?
Definition
Soil saprophytes.
Term
What is sporotrichosis?
Definition
Rose Gardeners Disease.
Term
What does Sporothrix schenckii cause?
Definition
Rose Gardeners Disease.
Term
How is Rose Gardeners Disease acquired?
Definition
Traumatic inoculation of spores or inhalation of spores.
Term
What does Histoplasma capsulatum cause?
Definition
Primary pulmonary disease.
Term
What does Blastomyces dermatitis cause?
Definition
Primary pulmonary disease.
Term
What does Coccidiodes immitis cause?
Definition
Respiratory disease.
Term
What is the morphology of Histoplasma?
Definition
Dimorphic - yeast in tissue, mold in soil.
Term
What happens to Histoplasma spores after they are inhaled?
Definition
They are engulfed by macrophages and develop into yeast forms to form granulomas in tissue.
Term
What activities is Blastomyces dermatitides associated with?
Definition
Outdoor.
Term
What animals are a harbinger of human disease caused by Blatomyces dermatitides?
Definition
Dogs.
Term
How is Blastomycosis diagnosed?
Definition
Broad based budding yeast in tissue, urinary antigen.
Term
How is Coccidiodes immitis transmitted?
Definition
Inhaled from cacti in the desert.
Term
What disease causes fungus balls in the lungs?
Definition
Coccidiomycosis.
Term
What disease is associated with "skin tumors"?
Definition
Coccidiomycosis.
Term
What type of pathogen is Candida albicans?
Definition
Opportunistic.
Term
What type of pathogen is Aspergillus fumigatus?
Definition
Opportunistic.
Term
What type of pathogen is P. jiroveci?
Definition
Opportunistic.
Term
What fungus, which is often part of the normal flora, causes thrush?
Definition
Candida albicans.
Term
What fungus is associated with denture stomatitis?
Definition
Candida albicans.
Term
What fungus is associated with endocarditis in IV drug users?
Definition
Candida albicans.
Term
What fungus causes oral infections in newborns due to an infection in the mother?
Definition
Candida albicans (oral candidiasis).
Term
How is Cryptococcus neoformans acquired?
Definition
Inhalation of spores, which become deposited in the pulmonary alveoli.
Term
What tissue does Cryptococcus neoformans have a predilection for?
Definition
Brain.
Term
Is C. neoformans encapsulated?
Definition
Yes.
Term
What disease is associated with pigeon droppings?
Definition
Cryptococcosis.
Term
What is the most common cause of meningitis in HIV patients?
Definition
Cryptococcosis.
Term
What disease are HIV patients treated for prophylactically once CD4 count falls below 100?
Definition
Cryptococcosis.
Term
How is Aspergillus fumigatus transmitted?
Definition
Inhalation of large numbers of spores.
Term
What fungus is linked to hepatocellular carcinoma due to aflatoxin?
Definition
Aspergillus fumigatus.
Term
Where is zygomycosis (mucormycosis) acquired?
Definition
Everywhere (it is ubiquitous in nature).
Term
What state are zygomycetes always in?
Definition
Mold state.
Term
What fungi have hyphae that branch at bizarre angles?
Definition
Zygomycetes.
Term
Who is at an increased risk for rhinocerebral infection from zygomycosis?
Definition
Poorly controlled diabetics.
Term
What is the mechanism of action of azole antifungals?
Definition
Interfere with ergosterol synthesis by inhibiting fungal cytochrome P450 enzyme.
Term
Which azoles (imidazoles or triazoles) can be used systemically?
Definition
Triazoles.
Term
List two contraindications for use of azole antifungals.
Definition
Heart failure and drugs that prolong the QT interval.
Term
What class of antifungals is generally well tolerated but can cause GI distress, elevated liver enzymes, and prolonged QT interval and torsades?
Definition
Azoles.
Term
Resistance is a major problem for which azole antifungal?
Definition
Fluconazole.
Term
Does Fluconazole distribute to the CSF?
Definition
Yes.
Term
What condition requires caution when using Fluconazole?
Definition
Renal impairment.
Term
What antifungal can cause dry mouth, alopecia, and muscle weakness?
Definition
Fluconazole.
Term
What are two indications for use of Fluconazole?
Definition
Candidiasis and cryptococcosis.
Term
Which has a broader spectrum, Fluconazole or Itraconazole?
Definition
Itraconazole.
Term
Does Itraconazole distribute to CSF?
Definition
No.
Term
How is Itraconaozole eliminated?
Definition
Hepatic metabolism.
Term
How is Itraconazole administered?
Definition
Oral.
Term
What is a contraindication for Itraconazole?
Definition
Liver disease.
Term
What antifungal interacts with PPIs, H2 receptor blockers, and antacids?
Definition
Itraconazole.
Term
Which antifungal causes the following side effects?

Typical of azoles plus:
-Peripheral neuropathy, visual disturbances, hearing loss, tinnitus (rare)
- Congestive heart failure (rare)
Definition
Itraconazole.
Term
Which antifungal is a potent P450 inhibitor?
Definition
Vorioconazole.
Term
What antifungal causes visual disturbances and photosensitivity?
Definition
Vorioconazole.
Term
How is Vorioconazole eliminated?
Definition
Metabolism by the liver.
Term
Does Posconazole distribute to CSF?
Definition
No.
Term
How does Posaconazole get eliminated?
Definition
Fecal elimination of unchanged drug and metabolites.
Term
What is the broadest spectrum antifungal, used for prophylaxis against candida and aspergillus in severely immunocompromised patients?
Definition
Posaconazole.
Term
What increases the absorption of Posaconazole?
Definition
High fat meal.
Term
What antifungal is a prodrug?
Definition
Isavuconazonium.
Term
How is Isovuconazonium administered?
Definition
Oral and IV.
Term
Does Isavuconazonium distribute to the brain?
Definition
Yes, but not to the CSF.
Term
Is the half-life of Isovuconazonium long or short?
Definition
Long.
Term
How is Isovuconazonium eliminated?
Definition
Hepatic metabolism followed by fecal/renal elimination.
Term
Does Isovuconazonium have many drug interactions?
Definition
Yes. It can interact with man drugs and grapefruit because it is a CYP3A4 substrate.
Term
What antifungal is used for invasive aspergillosis and mucormycosis?
Definition
Isovuconazonium.
Term
What is Clotrimazole?
Definition
An imidazole antifungal.
Term
How is Clotrimazole administered?
Definition
Topically and with oral lozenges.
Term
What is the main side-effect of Clotrimazole?
Definition
Local discomfort with intravaginal administration.
Term
What antifungal is used for vaginal candidiasis, superficial candidiasis, dermatophytic infections, and oral candidiasis
Definition
Clotrimazole.
Term
What class of drugs end in -fungin?
Definition
Echinocandins.
Term
What is the mechanism of action of echinocandins?
Definition
They inhibit the synthesis of 1,3-beta-D-glucan, a component of the fungal cell wall.
Term
How are echinocandins administered?
Definition
IV.
Term
How are echinocandins eliminated?
Definition
Redistribution and slow metabolism.
Term
In what case would you need to decrease the dose of echinocandins?
Definition
Hepatic impairment.
Term
What antifungals are used for Aspergillosis, severe Candida infections, and esophageal candidiasis
Definition
Echinocandins.
Term
Are echinocandins appropriate for use in pregnant women?
Definition
No. They are pregnancy category C.
Term
What is Amphotericin B?
Definition
A polyene antifungal.
Term
What form of polyene is less nephrotoxic?
Definition
Liposomal preps.
Term
What is the mechanism of action of polyenes?
Definition
Polyenes bind to ergosterol and permeability of fungi.
Term
How are polyenes administered?
Definition
IV.
Term
Do polyenes distribute to CSF?
Definition
No.
Term
How are polyenes eliminated?
Definition
Kidney.
Term
What is a contraindication for polyenes?
Definition
Renal impairment.
Term
What class of drugs has a synergistic interaction with flucytosine?
Definition
Polyenes.
Term
Are polyenes safe to use in pregnancy?
Definition
Yes.
Term
What class of antifungals is used for rapidly progressing, severe mycoses and nonresponsive infections?
Definition
Polyenes.
Term
What is the mechanism of action of metronidazole?
Definition
Production of reactive oxygen species leads to DNA damage.
Term
How is metronidazole administered to treat protozoal infection?
Definition
Orally.
Term
Does metronidazole distribute to CSF?
Definition
Yes.
Term
How is metronidazole eliminated?
Definition
Hepatic metabolism (may turn urine reddish brown).
Term
For whom is metronidazole contraindicated?
Definition
Women in the first trimester of pregnancy.
Term
What drug has an antabuse-like reaction with ethanol?
Definition
Metronidazole.
Term
Which antiparasitic has the following spectrum of activity?

Trichmonas
Amebiasis (+luminal amebicide)
Giardia,
Anaerobic bacterial infections
Gardnerella bacterial vaginosis
Rosacea
Definition
Metronidazole.
Term
What is the mechanism of action of pyrimethamine?
Definition
Disrupts folic acid synthesis in parasites by inhibiting DHFR.
Term
What anti-parasitic drug is synergistic with sulfonamides?
Definition
Pyrimethamine.
Term
What is Pyrimethamine used for?
Definition
Toxoplasmosis and malaria.
Term
What is the mechanism of action of chloroquine?
Definition
It accumulates in the parasitic food vacuole and prevents protozoal polymerization and detoxification of heme.
Term
What is chloroquine used for?
Definition
Malaria.
Term
What type of malaria is commonly resistant to chloroquine?
Definition
P. falciparum.
Term
What is Mefloquine used for?
Definition
Treatment and prophylaxis for chloroquine-resistant malaria.
Term
What is the mechanism of action of Mefloquine?
Definition
It prevents heme degradation in the parasite.
Term
What is the main toxicity of Mefloquine?
Definition
CNS.
Term
What is Atovaquone used for?
Definition
Treatment and prevention of chloroquine-resistant malaria strains.
Term
What is the mechanism of action of Atovaquone?
Definition
It interferes with electron transfer (energy production).
Term
What are three contraindications for using Atovaquone?
Definition
Small child, pregnant, severe renal impairment.
Term
What are Artemisins used for?
Definition
Treatment of a broad spectrum of malaria types.
Term
What is the mechanism of action of Artemisinins?
Definition
It is converted to an active drug that produces reactive oxygen species.
Term
What can't Artemisinins be used in monotherapy?
Definition
Short half-life.
Term
What is Primaquine used for?
Definition
Treatment of relapsing malaria after treating and eliminating the erythrocytic stage.
Term
What are two contraindications for use of Primaquine?
Definition
G6PD deficiency and pregnancy.
Term
What is Quinine used for?
Definition
Treatment of chloroquine-resistant strains of malaria (not prophylaxis).
Term
What should Quinine be combined with?
Definition
Antibiotic.
Term
What is the mechanism of action of Quinine?
Definition
It inhibits heme detoxification.
Term
Who is more likely to have an autoimmune disease, males or females?
Definition
Females.
Term
What disease results if an antibody against the insulin receptor acts as an antagonist?
Definition
Type 2 diabetes.
Term
What disease results of an antibody against the insulin receptor acts as an agonist?
Definition
Hypoglycemia.
Term
What type of hypersensitivity causes Type 1 diabetes?
Definition
Type IV.
Term
What type of hypersensitivity reaction is Goodpasture's syndrome?
Definition
Type II.
Term
What causes Goodpasture's syndrome?
Definition
Antibodies directed against Type IV collagen react with the basement membrane, resulting in immune complex deposition in the kidney.
Term
What causes Graves' Disease?
Definition
Antibodies against the TSH receptor cause release of thyroid hormone.
Term
What type of hypersensitivity reaction is Graves' Disease?
Definition
Type II.
Term
What is the significance of the transfer of Graves' Disease between hosts with serum?
Definition
This demonstrates a soluble mediator (antibodies).
Term
What causes Hashimoto's thyroiditis?
Definition
Destruction of thyroid tissue by both antibody and T cells.
Term
What disease is characterized by ectopic lymphoid tissue?
Definition
Hashimoto's thyroiditis.
Term
What disease causes a butterfly rash?
Definition
Systemic lupus erythematosus.
Term
What causes most SLE?
Definition
Antibodies against nucleic acids and nucleoproteins.
Term
What type of hypersensitivity reaction is SLE?
Definition
Type III.
Term
Does Anti Ig play a major role in the inflammatory process in rheumatoid arthritis?
Definition
No.
Term
What type of hypersensitivity reaction is rheumatoid arthritis?
Definition
Type IV.
Term
What is a treatment for rheumatoid arthritis?
Definition
Anti-TNF-alpha.
Term
Besides anti-TNF-alpha, what is another treatment for rheumatoid arthritis?
Definition
Anti-CD20 antibodies reduce B cell levels and improve symptoms.
Term
What causes multiple sclerosis?
Definition
Th1 cells activated against the myelin sheath.
Term
What causes Myasthenia gravis?
Definition
Antibodies to the acetyl choline receptors induce their degradation.
Term
Autoimmunity is a failure in what cells' tolerance?
Definition
T cells.
Term
What causes APECED?
Definition
Deficiency in the transcription factor AIRE.
Term
What receptor on T cells checks the activating stimulation via CD28/B7?
Definition
CTLA4.
Term
Given an example of an inhibitory cytokine released by Treg.
Definition
TGFB.
Term
What T cells are activated by CTLA4?
Definition
Treg.
Term
What transcription factor is required for Treg development?
Definition
FoxP3.
Term
What causes Immune Dysregulation Polyendocrinopathy Enteropathy X-linked?
Definition
Absence of FoxP3.
Term
Inflammatory diseases like rheumatoid arthritis and Crohn's disease are associated with increased levels of what kind of T cells?
Definition
Th17.
Term
What is the primary genetic factor determining susceptibility to autoimmune diseases?
Definition
HLA.
Term
Can a certain HLA allele guarantee disease?
Definition
No.
Term
How does HLA affect the susceptibility to autoimmune disease?
Definition
By presenting specific subsets of peptides.
Term
How does inflammation facilitate the development of autoimmunity?
Definition
IFN-gamma induces expression of MHC class II on cells that do not normally express class II, which increases the probability of activating an auto-reactive T cell.
Term
What is epitope spreading?
Definition
An immune response against an increasing number of epitopes causes progression of autoimmune disease.
Term
Give an example of a disease that illustrates the consequences of epitope spreading.
Definition
Pemphigus vulgaris is caused by anti-desmoglein Ig.
Term
What is solid organ rejection?
Definition
The host attacks and destroys the transplant.
Term
What is graft vs host disease?
Definition
The transplant attacks the host.
Term
Define alloreaction.
Definition
Response of one individual against antigens (proteins) which differ among members of the same species.
Term
What causes hyperacute rejection?
Definition
Pre-existing antibodies.
Term
What three situations induce anti-HLA?
Definition
Pregnancy, multiple blood transfusions, and previous organ transplants.
Term
What type of hypersensitivity is similar to hyperacute rejection?
Definition
Type II.
Term
What causes acute rejection?
Definition
Host has alloreactive T cells that recognize donor Class I/II.
Term
How long does it take for acute rejection to develop?
Definition
Several days.
Term
Is acute rejection mediated by a direct or indirect pathway of allorecognition?
Definition
Direct.
Term
What test is used to test for alloreactivity before transplantation of solid organs?
Definition
The mixed lymphocyte reaction. PBLs from recipient are mixed with irradiated PBLs from donor, and the proliferation and function of recipient T cells is measured.
Term
Acute rejection is analogous to what type of hypersensitivity?
Definition
Type IV.
Term
How long does it take for chronic rejection to occur?
Definition
Months to years.
Term
What is the cause of chronic rejection?
Definition
Antibody against HLA interacts with FcR on PMN and monocytes to initiate an inflammatory reaction.
Term
Does chronic rejection involve direct or indirect recognition?
Definition
Indirect.
Term
What are corticosteroids used for?
Definition
They are anti-inflammatory immunosuppressive drugs.
Term
In what class of drugs does Prednisone belong?
Definition
Corticosteroids.
Term
What is the mechanism of action of corticosteroids?
Definition
Interfere with NF-kB which activates transcription of pro-inflammatory cytokines.
Term
What is Azathioprene?
Definition
A cytotoxic immunosuppressive drug.
Term
What is the mechanism of action of Azathioprene?
Definition
Inhibits DNA synthesis.
Term
What is Cyclophosphamide?
Definition
A cytotoxic immunosuppressive drug.
Term
What is the mechanism of action of Cyclophosphamide?
Definition
It crosslinks DNA and blocks cell division.
Term
What is Methotrexate?
Definition
A cytotoxic immunosuppressive drug.
Term
What is the mechanism of action of Methotrexate?
Definition
It blocks DNA replication.
Term
What is Cyclosporin A?
Definition
An inhibitor of T cell activation that acts as an immunosuppressive drug.
Term
What is Tacrolimus?
Definition
An inhibitor of T cell activation.
Term
What is the mechanism of action of Cyclosporin A and Tacrolimus?
Definition
They interfere with calcineurin, which activates the transcription factor NFAT.
Term
What is the mechanism of action of Rapamycin?
Definition
Inhibits T cell activation by interfering with signal transduction via IL2R.
Term
What is the mechanism of action of Belatacept?
Definition
It is soluble CTLA4, which binds B7 and blocks delivery of signal 2 (CD28-B7).
Term
Why can the eye be transplanted across HLA differences?
Definition
The cornea lacks vasculature.
The aqueous humor contains immune response inhibitors like TGF-beta, which generate immature DCs. These DCs produce tolerance.
Term
Why can the liver be transplanted across HLA differences?
Definition
It has very low levels of HLA.
It is constantly exposed to foreign proteins from the GI tract, which leads to low inflammatory state.
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