Shared Flashcard Set

Details

Micro Spring 2013 Block I
n/a
331
Microbiology
Graduate
02/02/2013

Additional Microbiology Flashcards

 


 

Cards

Term
What pathogen is responsible for the majority of UTIs?
Definition
E. coli
Term
What can increase the risk of ascending infection of UTIs?
Definition
Use of a diaphragm and use of spermicides which increase vaginal colonization and adherence of E. coli and colonization of vagina with uropathogens
Term
What is cystitis?
Definition
Infection of the bladder wall
Term
What are the symptoms of Cystitis?
Definition
Frequency, urgency to urinate, dysuria, suprapubic tenderness, malodorous urine, bacteria and WBCs are common in urine
Term
What is pyelonephritis?
Definition
An infection of the kidney and renal pelvis, most commonly following a bladder infection
Term
What is present in the urine in cases of pyelonephritis?
Definition
WBCs, cellular casts, bacteria, and protein
Term
What is glomerulonephritis?
Definition
Inflammation of the glomeruli in the nephrons
Term
How is glomerulonephritis detected?
Definition
Glomerular capillary network becomes leaky allowing plasma protein and blood cells to be excreted in the urine
Term
Acute prostatitis is often an extension of what?
Definition
Bladder or urethra infection and often follows urethral instrumentation such as catheterization
Term
What are pathogenicity islands?
Definition
Genes for these virulence factors are linked together as multigene segments. Encodes for virulence protiens which are components of finbriae, pili, and outermembrane proteins
Term
What determines anatomical location of infection?
Definition
Adhesive properties of virulence factors
Term
Pathogenicity islands are absent in what?
Definition
Normal, fecal coliforms
Term
Pathogenicity islands are similar to plasmids in that they're what?
Definition
Mobile
Term
Describe the appearance of E. coli
Definition
Gram-negative rods
Term
What is the pathogenicity of E. coli?
Definition
Adhere to mucosa via pili, causes tissue damage, endotoxin (LPS) causes inflammation
Term
How is E. coli treated?
Definition
Penicillin or ciprofloxacin
Term
What is the function of the P-pilli for E. coli?
Definition
allows bacteria to bind to P blood group antigens on urinary tract cells, especially kidneys
Term
What is the function of Type I pilli for E. coli?
Definition
allows bacteria to bind to bladder, epithelium, and glycoproteins in various cells
Term
What is the function of the K1 antigen for E. coli?
Definition
Impedes phagocytosis
Term
Describe the appearance of Proteus vulgaris and mirabilis
Definition
Gram-negative rods
Term
What are the characteristics of Prtoeus vulgaris and mirabilis?
Definition
Opportunistic, transmitted via catheters, uerase positive and HIGHLY MOTILE, can swarm across agar
Term
What is the second most common cause of UTIs behind E. coli?
Definition
Proteus
Term
What is critical to the virulence of Proteus?
Definition
Swarming ability
Term
How does Proteus precipitate the formation of calculi?
Definition
Urease activity raises pH
Term
What anti-swarming agent can be used to inhibit the expression of virulence factors in Proteus?
Definition
Para-nitrophenyl glycerol (PNPG)
Term
What is used to treat Proteus causing UTIs?
Definition
Broad spectrum penicillins and cephalosporins
Term
Proteus shows resistance to what drugs?
Definition
Nitrofurantoin and tetracycline
Term
Describe the appearance of Stpahylococcus saprophyticus
Definition
Gram positive cocci
Term
What are the characteristics of Staphylococcus saprophyticus?
Definition
Nitrate and coagulase NEGATIVE
Catalase POSITIVE
Novobiocin RESISTANT
Nonhemolytic --> gamma-hemolysis
Term
Enterococcus faecalis can cause what types of maladies?
Definition
Endocarditis, cystitis, wound infections
Term
Enterococcus faecalis is grown on what media?
Definition
Blood agar (gamma hemolysis) and Bile-esculin agar (causes black discoloration)
Term
How is Enterococcus faecalis trated?
Definition
Amoxicillin, Ampicillin, Vancomycin
Term
Describe the appearance of Klebsiella
Definition
Gram negative rods, non-motile, forms large MUCOID colonies
Term
What protects Klebsiella from phagocytosis?
Definition
K antigen
Term
What is used to treat Klebsiella infections?
Definition
Cephalosporins
Term
What can increase the risk of Candida infections?
Definition
Broad-spectrum antibiotics, pregnancy, diabetes, AIDS, surgery, indwelling catheters
Term
What most often causes a Candida infection
Definition
Use of antibiotics that kill normal flora allow for infection
Term
What is used to treat Candida infections?
Definition
Topical nystatin or clotrimazole
Term
What is necessary for Candida virulence?
Definition
Germ tube formation which is induced by D-glucose and a pH of 7-8
Term
What is th emost common site of nosocomial infections?
Definition
Catheter associated UTIs
Term
The isolation of what pathogens would imply acquisition from an exogenous source due to their absence in normal GI flora?
Definition
Serratia marcescens and Pseudomonas cepacia
Term
The majority of catheter associated UTIs are due to what?
Definition
Endogenous bowel flora
Term
What might lead to precipitation of phosphatic salts, stone formation and eventual blockage due to growth on catheters?
Definition
Microorganisms such as Proteus mirabilis
Term
A UTI caused by Schistosoma haematobium can lead to what?
Definition
Renal failure due to obstructive uropathy, pyelonephritis, bladder carcinoma, may vacilitate the spread of STDs due to causative lesions
Term
How do you diagnose Schistosoma haematobium?
Definition
Identify and speciate eggs in the urine over a 24hr urine collection. Watch for hasting at room temp if necessary
Term
How do you treat Schistosoma haematobium?
Definition
Antihelmintics --> Praziquantel
Term
Dark brown to red urine suggests the possible presence of what?
Definition
Porphyrins
Term
Black-brown urine suggests the presence of what?
Definition
Melanins
Term
What is used to detect nitrites in urine?
Definition
Griess' Reaction
Term
What do nitrites in urine indicate?
Definition
Bacteriuria, though not all bacteria convert nitrate to nitrite, mostly gram-negatives
Term
The presence of leukocytes in urine indicates what?
Definition
Leykocyte esterase activity in WBCs
Term
Blood in the urine indicates what?
Definition
Pseudoperoxidase activity of hemoglobin
Term
How does yeast present in urine?
Definition
Does not come up in lab testing, requires microscopic evaluation
Term
Hyaline casts in urine indicate what?
Definition
Capillary membrane damage with proteinuria
Term
Most UTIs are treated with what?
Definition
Amoxicillin (TMP-SX) and levaquin (fluoroquinolone)
Term
How are UTI's caused by chlamydia and mycoplasma treated?
Definition
Tetracycline or doxycycline
Term
Nonsecreters are at higher risk for UTIs. How is secretion genetically determined?
Definition
Presence of secretor gene (Se) is inherited independent of ABO and H genes responsible for A, B, and H antigens that are secreted. However, the H-gene is a necessary precursor for ABO, so all seretors will have the H gene
Term
Type I hypersensitivity reactions are mediated by what?
Definition
IgE --> allergy, anaphylaxix, asthma, an immune response releases vasoactive and spasmogenic substances that act on vessels and smooth muscles
Term
Type II hypersensitivity reactions are mediated by what?
Definition
Antibodies, promotes cell phagocytosis or lysis and cellular injury by inducing inflammation
Term
What are the classic examples of Type II hypersensitivity?
Definition
Autoimmune hemolytic anemia and Goodpasture's syndrome
Term
How is Goodpasture's diagnosed?
Definition
Antibody targeting non-collagenous domain of type IV collagen
Term
Type II hypersensitivity reactions always present in what way?
Definition
Always localized, antigen is always fixed or bound to either cell, tissue, or ECM
Term
Type III hypersensitivity reactions are mediated by what?
Definition
Immune response, antigen is NOT fixed, binds antibodies and induces inflammation, recruites leukocytes, is almost NEVER localized
Term
What is the only type III hypersensitivity reaction that is localized?
Definition
Arthus reaction (Tetanus reaction)
Term
Type IV hypersensitivity reaction is mediated by what?
Definition
Cell-mediated immune disorder via sensitized T-lymphocutes, Th1 lymphocytes/CD4, etc. Ex. contact dermatitis, MULTIPLE SCLEROSIS, type I diabetes, transplant rejection, tuberculosis
Term
What are the 3 criteria of autoimmune dissorders?
Definition
Presence of autoimmune reaction
Evidence that it is not secondary to tissue damage
The absence of another well defined cause of the disease
Term
What is the dominant genetic factor that affects susceptibility to autoimmune disease/
Definition
HLA
Term
Reactive arthritis is associated with what gene?
Definition
HLA-B27
Term
What is central tolerance?
Definition
Development of tolerance to self-antigens when encountered in PRIMARY sites of maturation such as lymphoid organs
Term
What is the function of AIRE (autoimmune regulator gene) in central tolerance?
Definition
Encodes a transcription factor that normally induces hundreds of genes in the cells of peripheral tissues as well as the thymus which are recognized by T lymphocytes that then undergo NEGATIVE SELECTION, leaving only T-cells that do not recognize the self proteins
Term
A defective AIRE gene gives rise to what?
Definition
Inherited autoimmune polyglandular disease (APD)
or
autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED)
Term
What is peripheral tolerance?
Definition
Development of tolerance when mature lymphocytes encounte rself-antigens in peripheral tissues
Term
What is anergy?
Definition
Prolonged or irreversible functional inactivation of lymphocytes that encounter antigens in the periphery under specific conditions. A component of peripheral tolerance
Term
What is required for anergy?
Definition
In absence of a second signal (CD28/B7)
OR
Inhibitory signal mediated via CTLA4/B7 interaction
Term
Where do regulatory T cells develop?
Definition
In the thymus or in the periphery via recognition of self-antigens
Term
What mediates the development of regulatory T cells?
Definition
IL-10 or TGF-beta secretion
Term
What gene is required for the development of regulatory T cells?
Definition
Foxp3 gene
Term
A mutation in the Foxp3 gene causes what
Definition
IPEX = immune dysregulation, polyendocrinopathy, enteropathy, X-linked
Term
How do regulatory T cells suppress autoreactive T cells?
Definition
They recognize autoantigens presented in the context of MHC-II molecules
Term
What facilitates clonal deletion in peripheral tolerance?
Definition
Fas/GasL interaction expressed by activated T cells that recognize self antigens, leads to apoptosis
Term
Mutation of the Fas gene results in what?
Definition
ALPS = autoimmune lymphoproliferative syndrome
Term
What are the characteristics of ALPs?
Definition
Lacks Fas molecules, cannot control size of lymphocyte population or remove autoimmune cells, secondary lymphoid organs cell and autoimmune reactions occur
Term
What are immune privileged sites?
Definition
Tissues wher eantigens are hidden from the immune system due to lack of communication with blood and lymph.
e.g. testes, eye, brain
Term
How does sympathetic opthalmia occur?
Definition
Trauma to one eye results in release of intraocular protein antigens which are carried to lymph nodes and activate T cells. Effector T cells return and attack antigen in both eyes
Term
When immature B lymphocytes interact strongly wit self-antigens in the bone marrow, B cells are deleted via what process?
Definition
Clonal deletion induces apoptosis
Term
What is clonal anergy?
Definition
Autoreactive B cells in lymph nodes fail to receive T cell help or enter primary lymphoid follicles, are trapped in T cell zone and undergo apoptosis. When the migrate to periphery, they remain anergic, encounter T cell specific their autoantigens, and activates Fas/FasL to induce apoptosis
Term
As a rule, autoimmune diseases are never caused by what immunoglobulin complex?
Definition
IgE
Term
The formation and deposition of soluble immune complexes in autoimmune disease corresponds to what type of hypersensitivity?
Definition
Type III
Term
What causes complement activation leading to autoimmune hemolytic anemia?
Definition
IgG and IgM abs binding to components of erythrocyte surfaces
Term
What are the 3 different means of RBC destruction in autoimmune hemolytic anemia following IgG/IgM binding induced complement activation?
Definition
FcR+ cells in the spleen inducing phagocytosis
Complement activation and CR1+ cells in the spleen inducing phagocytosis
Complement activation and intravascylar hemolysis
Term
An uncommon autoimmune disease characterized by the presence of circulating autoantibodies targeting non-collagenous domains of the alpha-3 chain of type IV collagen is known as what?
Definition
Goodpasture Syndrome
Term
The autoantibody targeting the alpha-3 chain of type IV collagen seen in Goodpasture Syndrome intiates inflammatory destruction of what?
Definition
Basement membranes in renal glomeruli and lung alveoli
Term
How do you diagnose Goodpasture's syndrome?
Definition
Linear IgG deposition on glomerular basement membranes and alveolar membranes detected by immmunofluorescence and the presence of anti-basememt membrane antibodies in the serum
Term
Both Goodpasture's and SLE autoantibodies show up on immunoflourescence. How are they distinguished?
Definition
GPS is smooth, linear while SLE is lumpy/bumpy
Term
How is Goodpasture's treated?
Definition
Primarily via **plasmapheresis.
Also can prescribe *prednisone for immunosuppression of new Ab formation
Term
An autoimmune blistering disease that results from a loss of normal intracellular attachment integrity is known as what?
Definition
Pemphigus
Term
What is the most common typ eof pemphigus?
Definition
Pemphigus vulgaris
Term
How does pemphigus present?
Definition
Initialy as oral ulcers that progresses to skin involvement. Primary superficial vesicles and bullae that rupture easily and leave shallow erosions covered with crust
Term
What is the main complication of pemphigus?
Definition
Secondary bacterial infection and EXTREME loss of fluid**
Term
Which strain of pemphigus is wart-like and presents on the axilla, groin, and flexure surfaces?
Definition
Pemphigus vegetans
Term
Which strain of pemphigus is benign and shows up on the scalp, face, chest, and back with a lack of bullae due to fragility?
Definition
Pemphigus foliaceus
Term
Which strain of pemphigus is less severe and involves the malar area in lupus-like fashion?
Definition
Pemphigus erythematous
Term
Pemphigus involves acantholysis which is the loss of attachment of what?
Definition
Attachment between keratinocytes due to deposition of Abs against desmosomes**
Term
Pemphigus foliaceus deposits Abs that react with what?
Definition
Desmoglein-1 present in the superficial layers of the epidermis
Term
Pemphigus vulgaris, the most common cause of pemphigus, deposits Abs that react with what?
Definition
Desmoglein-3** present in deeper layers of the epidermis
Term
Rheumatic fever is a complication of what?
Definition
Infection by Streptococcal pharyngitis or Streptococcal pyogenes
Term
What is the Jone's criteria of diagnosis?
Definition
2 major or 1 major + 2 minor criteria to confirm rheumatic fever
Term
What are the major Jone's criteria?
Definition
Carditis, arthritis, chorea, subcutaneous nodules, arythema marginatum
Term
What are the minor Jone's criteria?
Definition
Fever, joint pain, evidence of electrical changes in the heart
Term
How do you treat Rheymatic fever?
Definition
10 day course of penicillin
Term
Rheumatic fever most commonly damages which valves?
Definition
Mitral (most common), aortic (2nd most common)
Term
A hyperthyroid state due to an autoimmune abs acting as agonists on TSH receptors is known as what?
Definition
Grave's disease
Term
Grave's disease is biased towards which thyroid response?
Definition
TH2
Term
Graves disease commonly has what secondary manifestation?
Definition
Hypertension
Term
Grave's disease is associated with what disease?
Definition
HLA-B6 and HLA-DR3
Term
Most patients with Grave's disease have what antibody in their plasma?
Definition
TSH:receptor ab
Term
What are the symptoms of Grave's disease?
Definition
Heat intolerance, nervouseness, irritability, weight loss, BULGING EYES, pretibial myxedema, tremor, enlarged thyroid
Term
What causes exophthalmous bulging eyes in Grave's disease?
Definition
Increased volume of retro-orbital connective tissue and extraocular muscle due to proteoglycan and HA accumulation
Term
Graves disease shows what labs?
Definition
Inc T3 and T4, dec TSH, increased TSH-r Ab and ANA levels w/o evidence of SLE
Term
How do you treat Grave's disease?
Definition
Propranolol (symptomatic), Methimazole and Propylthiouracil (thyourea drugs) or thyroidectomy/ablation
Term
What disease is characterized as an autoimmune reaction against thyroid cells causing thyroid destruction and a hypothyroid condition?
Definition
Hashimoto's Thyroiditis
Term
Hashimoto's Thyroiditis is notable in among thyroid disorders in that it is what?
Definition
Most common thyroid disorder in the US
Term
How does Hashimoto's Thyroioditis usually occur?
Definition
Infection or non-specific inflammation causes IGN-gamma to induce HLA II, a normally absent molecule, to be expressed on thyroid cells. Specific T cells induce an autoimmune response
Term
What are the symptoms of Hashimoto's Thyroiditis?
Definition
Enlarged thyroid, depression, fatigue, dry mouth, dry eyes, thyroid antibodies
Term
What thyroid antibodies can be seen in Hashimoto's thyroiditis?
Definition
Antithyroid peroxidase** (90%)
Antithyroidglobulin** (40%)
Term
How is Hashimoto's thyroiditis treated?
Definition
Synthetic thyroid
Term
Myasthenia Gravis is characterized by what?
Definition
Blockade of AcH receptor by autoantibodies resulting in progressive muscle weakness
Term
What are the symptoms of myasthenia gravis?
Definition
Dropy eyelids and double vision progressing to muscle weakness in the face to the trunk and extremities with possible breathing difficulty
Term
How is myasthenia gravis diagnosed?
Definition
AcH ab detection and edrophonium test
Term
Type III hypersensitivity (immune-complex) is most often associated with what diseases?
Definition
SLE and Hepatitis
Term
What is characteristic of SLE?
Definition
Autoimmune response directed at autoantigens present in almost every cell in the body, has characteristic IgG abs which initiate inflammation, tissue destruction, and the release of soluble immune complexes
Term
How does SLE present?
Definition
Butterfly shaped skin rash on face resembling a "wolf's head" due to deposition of immune complexes, may be provoked by sunlight
Term
What are the 2 most common symptoms of SLE?
Definition
Glomerulonephritis and arthritis
Term
How does SLE cause glomerulonephritis?
Definition
Hypercellularity due to proliferation of mesengial cells and endothelial cells in response to antigen-ab complex deposition
Term
How is SLE diagnosed?
Definition
40-60% have anti-DNA ab, 95% ANA-ab but this is NONSPECIFIC, 20-30% have anti-Sm (smith antigen), typically have HIGH IgG and LOW C3/C4
Term
What drugs can induce SLE-like responses?
Definition
Hydrallazin, Procainamide, D-peniccillamine, Isoniazid
Term
How does intermolecular epitope spreading of SLE occur?
Definition
Q-specific T-cell recognizes same epitope present by MHC-II on all 3 types of B cells (P, Q, R).
The reverse with B cells and P, Q, R T-cells canalso occur, helps recognize same epitope on different antigens
Term
How is SLE treated?
Definition
High dose of Prednisone
Term
How is Chronic Discoid SLE different from classic SLE?
Definition
Mimics skin manifestations by systemic manifestations are rare, anti-DNA ab is rarely present
Term
Skin biopsy shows deposition of what in pt with chronic discoid SLE?
Definition
IgG and C3 at dermoepidermal junction (same as classic SLE)
Term
How is subacute cutaneous lupus erythematosus differentiated from discoid lupus erythematosus?
Definition
Rashes are widespread, superficial, nonscarring, has mild systemic symptoms consistent with SLE, strong association with Abs to SS-A antigen with HLA-DR3 genotype
Term
Drug induced lupus has an extremely high frequency of what antibody?
Definition
Anti-histone antibody
Term
Drug induced lupus is associated with what gene?
Definition
HLA-DR4 allele
Term
What bacteria can cause acute glomerulonephritis?
Definition
A complication of S. pyogenes infection
Term
Which types of S. pyogenes is nephrogenic?
Definition
GAS type 12, 3, and 1*****
Identification done based on M protein typing
Term
What characterizes Polyarteritis Nodosa (PAN)?
Definition
Necrotizing inflammation of the walls of small/medium sized arteries (NO VEINS)
Term
Polyarteritis Nodosa is most likely associated with what diseases?
Definition
HepB and CMV
Term
How is Polyarteritis Nodosa distinguished from Wegener's?
Definition
Wegener's involves the lungs, PAN does not
Term
What are the important type IV hypersensitivity/autoimmunity (T-cell mediated) diseases?
Definition
Type I diabetes, rheumatoid arthrytis, myltiple sclerosis, celiac disease
Term
What is the cause of Type I diabetes?
Definition
Insulin an dglutamic acid decarboxylase (GAD) act as an antigen for T cell responses (type IV hypersensitivity)
Term
What viral pathogen may possibly increase the risk of type I diabetes?
Definition
Rubella
Term
How is type I diabetes treated?
Definition
Daily insulin injection
Term
What is the cause of multiple sclerosis?
Definition
Autoimmune response against the myelin sheath of nerve cells causes demyelination of neuronal tissues in the white matter of the CNS (type IV hypersensitivity), causes sclerotic plaques
Term
What are the causative antigens for multiple sclerosis?
Definition
All found in the myelin sheath:
Myelin basic protein
Proteolipid protein
Myelin oligodendrocyte glycoprotein
Term
Multiple sclerosis is associated with what gene?
Definition
HLADR2
Term
How is multiple sclerosis treated?
Definition
Initially with immunosuppressive drugs (corticosteroids) and injections of IFN-beta to prevent disease progression.
Later more aggressive immunosuppressives such as cyclophosphamides are added alongside corticosteroids
Term
What is the cause of rheumatoid arthritis?
Definition
A chronic systemic inflammatory disorder of unknown cause that principally attacks joints via inflammatory synovitis, causing permanent damage and ankylosis (bone fusion). A type IV hypersensitivity reaction
Term
What is rheumatoid factor?
Definition
Antiimmunoglobulin antibodies that are produced against the Fc portion of human IgG. Not diagnostic, though prevalent in rheumatoid arthritis
Term
What is the classical presentation of patietns with rheymatoid arthritis?
Definition
Affects proximal inter-phalangeal joints with polyarthritic fusiform swelling, is SYMMETRICAL, affects all hand and feet joints in chronic advanced stage
Term
What is the pathological hallmark of Rheumatoid arthritis?
Definition
Pannus formation: a mass of synovial stroma consisting of inflammatory cells growing over articular cartilage that causes bone and joint destruction
Term
What are the major agents involved in pannus formation seen in rheumatoid arthritis?
Definition
Cytokines IL-1 and TNF-alpha produced by macrophages and activated T cells induce inflammation
Term
What activates osteoclasts and promotes bone destruction in rheumatoid arthritis?
Definition
Activated T cells and synovial fibroblasts producing RANKL, contributes to pannus formation
Term
What are rheumatoid nodules?
Definition
Formations on the extensor surface of bone that are loosely affixed to underlying boney surface
Term
How is rheumatoid arthritis diagnosed?
Definition
4 out of 7 criteria:
Morning stiffness
Arthritis in 3+ joint areas
Arhtritis in typical hand joints
Symmetric arthritis
Rheumatoid nodules
Serum rh factor
Typical radiographic changes
Term
How is rheumatoid arthritis treated?
Definition
Anti-inflammatory drugs, immunosuppression, antibodies against TNF-alpha, and physiotherapy
Term
What causes celiac disease?
Definition
Specific lesions of small intestines due to abnormal immune responses to gluten protein present in wheat (type IV hypersensitivity)
Term
What genes are associated with celiac disease?
Definition
HLA-DQ2 and HLA-DQ8
Term
T cells in celiac disease have receptors directed against what?
Definition
Tissue transglutaminase complexes and proline-rich 33 amino-acid fragments, causes inflammation
Term
All patients with celiac disease have autoantibodies specific for what?
Definition
Tissue transglutaminase
Many also have anti-gliadin antibodies
Term
What are the symptoms of celiac disease?
Definition
Diarrhea, flatulence, weight loss, fatigue, malnutrition, some skin manifestations are possible, adults become anemic and depressive, prone to intestinal cancer, children fail to thrive
Term
How is celiac disease treated?
Definition
Gluten free diet
Term
What is the classic characteristic of Sjogrens syndrome
Definition
Dry eyes and dry mouth
Term
What causes Sjogrens Syndrome?
Definition
Lymphocitic infiltration of T cells and fibrosis of the lacrimal and salivary glands (type IV hypersensitivity reaction)
Term
What autoantibodies are present in Sjogrens?
Definition
Rh factor, ANAs, SS-A, and SS-B (not diagnostic, all are also present in SLE)
Term
What are the symptoms of Sjogrens?
Definition
Blurred vision, burning, itching, and accumulation of ocular secretions, cerostomia causes difficulty swallowing, reduced taste, enlarged parotid gland, dry mucosa, peripheral neuropathy
Term
How is Sjogrens treated?
Definition
Symptomatic care, supportive care, artificial tears, sipping water, cholinesterase inhibitors and Ach derivatives may improve xerostomia
Term
White lesions unlike oral candiasis that cannot be removed by rubbing are what?
Definition
Leukoplakia
Term
Leukoplakia with an erythematous component is known as what?
Definition
Erththroplakia
Term
Lacy leukoplakia that may be erosive which requires a biopsy for diagnosis is known as what?
Definition
Oral lichen planus
Term
Leukoplakia that eventually invades into the tongue mass is known as what?
Definition
Oral cancer
Term
What causes leukoplakias?
Definition
Chronic irritations from tobacco, dentures, excessive alcohol
Term
The majority of erythroplasias are either what?
Definition
Dysplasia or carcinoma
Term
How is oral lichen planus treated?
Definition
Corticosteroids, Cyclosporines, Retinoids
Term
What are some predisposing conditions for oral candidiasis?
Definition
Oral dentures, chronic debilitating disease, diabetes melitus, chronic anemia, chemotherapy, immunosuppression
Term
How is Candida albicans diagnosed?
Definition
Spore, non-septate hyphae, pseudo phyphae, and germ tube identification
Term
How is Candida albicans treated?
Definition
Locally via nystatin mouth rinse and systemically with fluconazole or itraconazole if fluconazole resistant
Term
What is glossitis?
Definition
Inflammation of the tongue with loss of filiform papillae leading to a red, smooth surfaced tongue
Term
Glossitis is usually secondary to what?
Definition
Nutritional deficiency, drug reaction to ACE inhibitors, dehydration, irritants, autoimmune reactions such as Sjogrens or psoriasis
Term
Acute Necrotizing Ulcerative Gingivitis (ANUG or Trench Mouth) is found among whom?
Definition
Young individuals under stressful conditions caused by mixed bacterial infections
Term
What are the characteristics of ANUG/Trench mouth?
Definition
Painful gingival inflammation and necrosis, bleeding, halitosis, fever, cervical lymphadenopathy
Term
Synergistic infections between what types of pathogens is typical of ANUG/Trench mouth?
Definition
Spirochetes and anaerobic bacteria such as Fusobacterium
Term
What causes ANUG/trench mouth?
Definition
Stress, malnutrition, or immunodeficiency. Not contagious
Term
Fusobacterium pathogenesis is mediated by what?
Definition
LPS
Term
How is ANUG/trench mouth treated?
Definition
Clinamycin and 3rd gen Cephalosporin
Term
Aphthous ulcers/cancer sores/ulcerative stomatitis is caused by what?
Definition
Uncertain, though association with HHV6 is suggested
Term
Where are cancer sores found?
Definition
Non-karatinized mucosa, buccal and labial mucosa, NOT on gingiva or palate
Term
What do cancer sores look like?
Definition
Painful ulcers with irregular margin and yellow-grey fibrinoid center surrounded by red halo**
Term
Cancer sores occur in relation to what?
Definition
Stress
Term
How are Aphthous ulcers/cancer sores/ulcerative stomatitis treated?
Definition
Nonspecific, topical corticosteroids, oral prednisolone, thalidomide if recurrent in HIV patients**
Term
What is noma, aka cancrum oris?
Definition
Severe gangrenous stomatitis progressing beyond the mucus membrane to involve soft tissue, skin, and ocasionaly bone
Term
What types of patients exhibit noma (cancrum oris)
Definition
Severely debilitates patietns and people with poor oral hygiene, immunocompromised, malnourished, sometimes precipitated by measles
Term
What are the etiologic agents of noma/cancrum oris?
Definition
Fusobacterium, Bacteroides, and P. aeruginosa
Term
What are the 3 clinical forms of oral herpes simplex?
Definition
Recurrent small blisters on the lips (aka herpes labialis, most common type)
Generalized oral infections (aka herpetic stomatitis)
Small ulcers found on the palatal mucosa
Term
What causes hand foot mouth disease in children under age 6?
Definition
Coxsackie virus type A16
Term
How do you treat herpetic stomatitis?
Definition
Acyclovir
Term
What causes pharyngitis?
Definition
An infection of the pharyngeal mucosa, most often viral (though bacterial is possible as well)
Term
Which viruses are most likely to case pharyngitis?
Definition
Rhinovirus, coronavirus, adenovirus, influenza, and EBV
Term
What findings suggest a viral cause of pharyngitis?
Definition
Mild pharyngeal symptoms with rhinorrhea, exudative pharyngitis, vesicular lesions and ulcers, conjunctival congestion, generalized rashes
Term
What symptoms indicate a streptococcal infection behind pharyngitis?
Definition
Fever, tender anterior cervical adenopathy, LACK OF COUGH, phayngeotonsillar exudate (3 or more to be likely)
Term
Sreptococcus pharyngitis has what morphology?
Definition
Gram positive oval cells growing in CHAINS, non-motile, lactic acid fermetator
Term
Streptococcus pharyngitis grows best on what medium?
Definition
Enriched blood agar
Term
The virulence of Streptococcus pyogenes is mediated by what?
Definition
Cell wall components, primarily M12 protein
Term
What test can you use to quickly verify a strep infection?
Definition
Rapid strep test or GAS rapid antigen detection test (RADT)
These are solid phase ELISA tests
Term
How is Streptococcus pharyngitis treated?
Definition
Penicillin is first line, amoxicillin plus clavulanate to avoid failure with penicillin, erythromycin and second gen cephalosporin if penicillin sensitive
Term
What causes diptheria?
Definition
Corynebacterium diphtheriae
Term
What is the morphology of C. diphtheria?
Definition
Gram positive rod, non motile, exhibits CHINESE LETTER PATTERN, catalase positive
Term
What is the most characteristic feature of diphtheria?
Definition
Greyish-white membrane on the tonsiles that adheres to the underlying tonsils and is not easily removed, is made up of clotted blood and epithelial cells of host mucus membrane
Term
The exotoxins of C. diphtheria are also found in what other pathogen?
Definition
Pseudomonas
Term
How is diphtheria diagnosed?
Definition
Clinical diagnosis
Definitive diagnosis via culturing on Tinsdale and Tellurite agar
Term
How is Diphtheria treated?
Definition
Diphtheria toxin anti-serum alongside penicillin or erythromycin. High mortality even with treatment
Term
Describe the pathogenesis of Rhinoviruses
Definition
Infects respiratory epithelium, causing them to lose their ciliary motion and slough off, injury causes inflammation, inducing acute symptoms. Inflammation eventually contains the infection
Term
How is rihnovirus treated?
Definition
Pleconaril is in trials, usually self limiting
Term
Describe the morphology of adenovirus
Definition
Non enveloped double stranded DNA virus that can remain infectious in environments for long periods but is easily inactivated by heat, chlorine, and disinfectants
Term
What are the symptoms of adenoviral pharyngitis?
Definition
Fever, runny nose, grey-white pus on pharynx and tonsils, enlarged cervical lymph nodes, conjunctivitis, and diarrhea
Term
What symptom is present in adenoviral pharyngitis that is absent in the common cold?
Definition
Enlarged cervical lymph nodes
Term
How is adenovirus diagnosed?
Definition
Lung biopsy and serologic testing
Term
How is adenovirus treated?
Definition
Self limiting
Term
Describe the morphology of coronavirus
Definition
Enveloped RNA virus with petal or club shaped spikes projecting from its surface giving it the appearance of a crown of thorns
Term
What are the 3 types of human coronavirus?
Definition
Etiologic agent for the common cold
Enteric infections in the intestines
Agent of severe acute respiratory distress syndrome (SARS)
Term
What is essential for the diagnosis of pharyngitis?
Definition
Pharyngeal pain and pain on swallowing (odynophagia)
Term
When should a lateral neck X-ray be performed when suspecting pharyngitis?
Definition
If pt has stridor or respiratory compromise to rule out laryngeal obstructions
Term
What are the characteristics of Kawasaki's disease?
Definition
Mucocutaneous lymph node syndrome most commonly affecting asian children younger than 5
Term
What are the disease characteristics of Kawasaki's disease
Definition
Fever and four of the following for at least 5 days: Mucous membrane changes (injected pharynx, erythema, or strawberry tongue) Peripheral extremity changes (edema, desquamination, erythema, induration) A polymorphous rash Cervical lymphadenopathy Bilateral nonexudative conjunctivitis
Term
When do you intervene with warfarin in cases of kawasaki's disease?
Definition
If an aneurysm larger than 8mm in diameter occurs
Term
What are the possible complications of bacterial pharyngitis?
Definition
Peritonsillar or retropharyngeal abscesses, jugular vein thrombosis, rheymatic heart disease, post-streptococcal GN, acute airway obstruction, myocarditis, neuritis
Term
What are some possible viral pharyngitis?
Definition
Secondary bacterial infection
Term
A peritonsillar or retrotonsillar abscess indicates what type of infection? Characteristics?
Definition
Bacterial, usually as a complication of tonsillitis
Tonsils should be ASYMMETRICAL, common ABOVE 5yo
There is a danger of rupture and aspiration pneumonia
Term
A retropharyngial or lateral pharyngeal abscess arises due to what?
Definition
A complication of bacterial pharyngitis or accidental perforation of the pharyngeal wall by a foreign body, characterized by pain, inability to swallow, phonation change, and extended neck w/widened space
Can rupture --> aspiration pneumonia, also osteomyelitis or acute mediastinitis
Seen UNDER 5yo
Term
What kind of x-ray finding do you see in a retropharyngeal/lateral pharyngeal abscess?
Definition
Widening of space between cervical spine and posterior pharyngeal wall
Term
What is first line in treatment of pharyngitis in children?
Definition
Oral penicillin or amoxicillin in
Term
What 2nd and 3rd line in treatment of pharyngitis in children?
Definition
Erythromycin, if penicillin allergic giv clarithromycin, azithromycin, or an oral cephalosporin
Term
What are the symptoms of rhinnitis?
Definition
**Headache**
Nasal congestion, post-nasal drainage (clear), Watery rhinorrhea, Sneezing
Scratchy throat, pharyngotonsilar irritation (from drainage), General malaise
Term
Why do sinus infections occur?
Definition
When blockage occurs due to upper respiratory infection or viral rhinitis, the bacteria cannot be removed and are able to grow in numbers and cause an infection
Term
The change from rhinitis to sinusitis is marked by what?
Definition
Change from clear and watery to mucoid (yelow/green) rhinorrhea, marks the growth of the first aerobic bacteria
Term
How often are cases of bacterial sinusitis polymicrobial?
Definition
1/3
Term
What fungal pathogens are possible (rare) causes of sinusitis?
Definition
Candida spp.
Aspergillus spp.
Mucor spp.
Rhizopus spp.
Absidia spp
Term
What are the symptoms of acute sinusitis?
Definition
Usually of bacterial origin (aerobes anaerobes)
More dental pain
Children rarely complain of headache or facial pain
Nasal discharge, congestion, facial pressure, postnasal drip, fever, cough, fatigue, ear pressure
Term
How is sinusitis linked to smoking?
Definition
H. influenza growth is stimulated by nicotine, thereby exacerbating infection in smokers
Term
What are risk factors for sinusitis?
Definition
Allergic rhinitis, Nasal trauma (including deviated septum), Immune compromised/diabetic, Smoking, Swimming/barotrauma, Nasal polyps, Cocaine abuse
Term
How might Pseudomonas aeruginosa give someone sinusitis in a hospital setting?
Definition
Common as a nosocomial infection from nasal tubes or catheters
Term
What pathogen most commonly infects nasal passage hair follicles during a sinus infection?
Definition
Staphylococcus aureus
Term
What is the potential complication of fungal sinusitis?
Definition
If invasive, will spread into CNS and eyes
Term
Which strains of fungi that cause sinusitis are invasive?
Definition
 Rhizopus spp., Mucor spp., Absidia spp.
Term
What is the most common complication of bacterial sinusitis?
Definition
Preorbital swelling
Term
What are some less common complications of bacterial sinusitis?
Definition
Orbital cellulitis
Subperiosteal abscess
Orbital abscess
Frontal and maxillary osteomyelitis
Subdural abscess
Cavernous sinus thrombosis
Meningitis
Brain abscess
Term
How is sinusitis diagnosed?
Definition
Clinical diagnosis. Cultures and x-rays are useless. MRI and CTscans may be useful in chronic or rare cases.
Only clear useful diagnostic is transilumination
Term
How do viral and bacterial cases of sinusitis differ?
Definition
Fungal infections may affect only one sinus.
Poor response to nasal decongestants (bacterial).
Term
What are the two sites of ear infection?
Definition
Otitis externa and Otitis media
Term
How are ear infections contracted?
Definition
Individual is exposed to environment that inhibits or removes cerumen and may also contain pathogens
Term
What causes ear infections?
Definition
98% of cases are bacterial
Pseudomonas aeruginosa (20-60%)
Staphylococcus aureus (10-70%)
Often polymicrobial
Term
What is the hallmark sign of acute otitis externa ("swimmer's ear")?
Definition
Tenderness of the tragus (when pushed), pinna (when pulled up and back), or both
Term
What are the symptoms of otitis externa ("swimmer's ear")?
Definition
Otalgia (70%), Itching (60%), fullness (22%), hearing loss (32%)
Term
What was furunculosis?
Definition
Infected hair follicle in outer third of ear canal, most commonly due to Staph aureus
Term
What is otomycosis?
Definition
Fungal infection of the ear canal, aka "tropical ear"
Common in humid or tropical environments
Causes: Aspergillus (60-90%), Candida spp. (10-40%)
Term
What are the symptoms of otomycosis?
Definition
Pruritis and thickened otorrhea (black, green, white)
Term
How do you distinguish otitis externa from otitis media?
Definition
Pneumatic otoscopy should show good tympanic membrane motion in AOE and absent or limited mobility in AOM
Yellow/green = acute otitis media
Term
What is malignant Otitis Externa?
Definition
A complication of acute otitis externa seen in elderly, diabetics, or immune compromised
Spreads to posterior cranial bone (osteomyelitis), soft tissue, middle ear, inner ear, and potentially the brai
Term
What is the most common cause of malignant Otitis Externa?
Definition
90% Pseudomonas aeruginosa
Term
How is malignant otitis externa diagnosed?
Definition
Raised ESR, and abnormal CT/MRI (bone erosion) are diagnostic.
Facial nerve paralysis may be an early symptom
Term
How does an acute otitis media infection progress?
Definition
Infection may spread from pharynx to middle ear (URT infection)
Abrupt onset otalgia, irritability, otorrhea, or fever
Infection is treated or pressure from bacterial growth bursts tympanic membrane
Term
Acute otitis media must be differentiated from what?
Definition
Otitis media with a clear effusion, a non-infectious condition of the middle ear
Term
When is the peak first incidence of acute otitis media?
Definition
6-9 months
Term
What are some risk factors for acute otitis media?
Definition
Bottle fed, Smoking parents, Attending daycare, Male
Term
How is acute otitis media diagnosed?
Definition
Rapid onset (48 hours*)
Presence of middle ear effusion
Signs and symptoms of middle ear inflammation
Term
What is Chronic Suppurative Otitis Media?
Definition
Chronic inflammation of the middle ear and mastoid mucosa in which the tympanic membrane is NOT intact and discharge (otorrhea) is present
Term
What causes Chronic Suppurative Otitis Media?
Definition
Untreated acute ototis media
Term
What causes Cholesteatoma?
Definition
Prolonged eustachian tube dysfunction, leading to negative pressure that draws the upper flaccid portion of the TM inward.
This creates a squamous epithlemium lined sac. When the opening becomes blocked/clogged this can lead to chronic infection
Term
Cholesteatoma usually leads to what complication?
Definition
Bone erosion
Term
How is Cholesteatoma diagnosed?
Definition
Physical examination reveals an epitympanic retraction pocket or perforation that exudes keratin debris
Term
What is a complication of cholesteatoma?
Definition
Osteomyelitis/ Mastoiditis
Meningitis
Brain Abscess
Dural Sinus Thrombosis (DST)
Otitic Hydrocephalus
Otitis Externa (most common)
Term
What is Labyrinthitis?
Definition
Acute onset of continuous, usually severe vertigo lasting several days to weeks, along with hearing loss and tinnitus
Cause is unknown but frequently follows upper respiratory tract infections
Term
What are some ear problems associated with multiple sclerosis?
Definition
Episodic vertigo and chronic imbalance. Hearing loss is usually unilateral with rapid onset that may abate spontaneously
Term
What causes "honeymoon cystitis"?
Definition
Staphylococcus saprophyticus
Term
Which HLA genes are associated with Addison’s disease, Graves’ disease and myasthenia gravis?
Definition
HLA-DR3
Term
A patient presents with complaint of coughing up of blood and blood in urine. Which of the following is the most likely mechanism of this autoimmune disease pathology?
Definition
Antibody deposition on both glomerular and alveolar basement membrane
Term
You order a CBC on a patient suspected to have urinary schistosomiasis. What should you be checking for?
Definition
eosinophilia
Term
The main reason Escherichia coli is the most common cause of UTIs is that it is what?
Definition
an enteric bacterium
Term
What are the effects of urease activity by proteus mirabilis?
Definition
Hydrolyzes urea, produces ammonia and carbon dioxide, raises pH precipitating the formation of calculi stones
Term
Enterococcus faecalis is strongly associated with what bacterial infection?
Definition
Endocarditis
Term
Enterococcus faecalis is grown on what?
Definition
Blood agar
Bile-esculin agar (black discoloration)
Term
Enterococcus faecalis acquires 25% of its genome through what means?
Definition
Lateral gene transfer between Staphylococcus and Streptococcus
Pathogenicity island located on genome produce toxin that forms holes in cell wall and allow for adherence
Term
Enterococcus faecalis has high antibiotic resistance due to what?
Definition
Ability to acquire mobile gene elements
Term
How is Enterococcus faecalis treated?
Definition
Amoxicillin
Ampicillin
Vancomycin
Term
UTI caused by Salmonella sp. is suspicion for what?
Definition
Urinary schistosomiasis
Term
What are the statistics associated with recurrent UTIs?
Definition
20% of women who contract a UTI will suffer another
Of these women, 30% will suffer additional UTIs
Term
What causes Sub-acute bacterial endocarditis?
Definition
Infection of the damaged valves by normal flora of mouth (Streptococcus viridans) and skin (Staphylococcus epidermidis)
Term
Graves Disease is associated with what genes?
Definition
HLA-B8 and HLA-DR3
Term
Thickening of basement membrane in SLE is due to what?
Definition
Immune-complex deposition on the basement membrane
The clinical correlate is proteinurea and microscopic hematuria
Term
The most common causes of death from SLE are what?
Definition
Renal failure and intercurrent infections
Term
Does P-ANCA or C-ANCA present in polyarteritis nodosa?
Definition
P-ANCA
Term
In 90% of MS patients, the sclerotic plaque contain plasma cells that secrete what?
Definition
Oligoclonal IgG into the CSF
Term
Rheumatoid arthritis is most often associated with what gene?
Definition
HLA-DRB1
Term
Patients with Sjogren syndrome have an approximately 40-fold increased risk of developing what?
Definition
Lymphoid malignancies
Term
Some patients with limited scleroderma develop a combination of symptoms referred to as CREST which stands for what?
Definition
Calcinosis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, & Telangiectasia
Term
Reiters syndrome (reactive arthritis) is a clinical tetrad of what symptoms?
Definition
Urethritis
Conjunctivitis (or less commonly uveitis)
Mucocutaneou lesions
Septic arthritis
Term
Reiters syndrome usually develops following what kind of infection?
Definition
Dysenteric infection (with Salmonella, Shigella, Yersinia, or Campylobacter) or a sexually transmitted infection (with Chlamydia trachomatis, or perhaps Ureaplasma urealyticum)
Term
What is the clinical presentation of Reiters (reactive arthritis)?
Definition
The arthritis is asymmetric and involves the major weight bearing joints
fever, weight loss
The mucocutaneous lesion include balanitis, stomatitis, keratoderma blennorhagicum
Most of the symptoms but arthritis subsides within weeks
Term
How is Reiter's treated?
Definition
Non-steroidal anti-inflammatory drugs are the main drugs used

Tetracycline in reactive arthritis with C. trachomatis reduce the duration of symptoms

Sulfasalazine and anti-TNF agents are tried in patients refractory to NSAID and tetracycline
Term
What are the most common forms of amyloid protein?
Definition
AL (amyloid light chain): is derived from plasma cells and contains immunoglobulin light chain
AA (amyloid-associated): is a unique non-immunoglobulin protein synstesized by the liver
Ab amyloid: found in the cerebral lesion of Alzheimer disease
Term
How do you differentiate Group A from Group B Strep?
Definition
Group A strep is bacitracin sensitive
Term
What is the pathological hallmark of Kawasaki’s Disease?
Definition
IgA plasma cell infiltration in the visceral organs, lungs, and coronary arteries
Term
What can be given for influenza post-exposure prophylaxis
Definition
Amantidine
Term
What causes Acute Laryngitis?
Definition
Infection of the larynx that results in an inflammatory reaction
Most often viral but can also be bacterial
Term
Lateral X-rays help exclude what when diagnosing acute laryngitis?
Definition
Acute bacterial epiglottitis
Bacterial tracheitis
Term
What should be performed when hoarseness persists longer than 2 weeks with acute laryngitis?
Definition
Direct laryngoscopy
Term
What causes Croup (Acute Laryngotracheitis)?
Definition
Subglottic inflammation and edema caused by a viral or bacterial infection of the larynx, trachea, and bronchi
Term
What is the most common cause of upper respiratory tract obstructionin children between the ages of 6 months to 6 years
Definition
Croup (Acute Laryngotracheitis)
Term
What is the most common cause of croup in children?
Definition
Parainfluenza virus type I and II
Influenza A or B
RSV
Term
What is the most common cause of croup in adults?
Definition
HSV
Influenza A or B
Term
What are the signs and symptoms of croup?
Definition
Hoarsness of voice
Brassy cough
Stridor, Fever, Rhinorrhea
Ronchi, crepitations or wheezing
Diminished breath sound
Term
Imaging shows what in patients with croup?
Definition
Narrowing of the air column
Term
How is Croup treated?
Definition
Cool air humidification
Racemic epinephrine
Dexamethasone
Intubation may be required if medical management fails
Antibacterial if bacterial
Term
What is Acute Epiglottitis?
Definition
Respiratory emergency
acute inflammation and edema of the epiglottis and can cause upper airway obstruction
More common among children between 2-6 years of age
Bacterial only
Term
What causes acute epiglottitis?
Definition
H. Influenzae type b
S. Aureus
S. Pneumoniae
S. pyogenes
Term
What are the symptoms of acute epiglottitis?
Definition
Short, rapidly progressing febrile illness
Sore throat (esp. in adults)
Dysphagia
Shortness of breath
Anxious looking and appears toxic
Forward leaning with neck extended posture
Drooling and muffled voice
May have a stridor
Term
What can aid in rapid diagnosis of acute epiglottitis?
Definition
Serum latex agglutination test for Hi type b
Term
What imaging sign do you see in acute epiglottitis?
Definition
Thumb sign
Term
Hemophilus influenzae grows best on what?
Definition
Chocolate agar media
Requires hematin (X factor) and NAD (nicotine adenamide diphosphate, V factor) for growth
Term
Describe the pathogenesis of Hemophilus influenzae
Definition
Pili and other adhesins bind to epithelial cells
Grows between the respiratory epithelial cells
The capsule inhibits opsonization and phagocytosis
Endotoxin is locally toxic, but does not cause endotoxemia
No exotoxins
Term
Coccobacillus growing on chocholate agar but not on blood agar strongly suggest what?
Definition
Hemophilus
Term
What kind of prophylaxis is available for Acute epiglottitis and pneumonia?
Definition
Rifampin
Infants are protected by maternal antibody up to 6 months of age
Antibody response to Hib PRP is poor in children less than 18 months of age
Supporting users have an ad free experience!