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2011-04-09 18:35:12
micro oneliners

micro oneliners
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  1. 1. Cause of nausea; vomiting (onset < 6 hr) after eating cold cuts; or potato salad; or mayonnaise; or custards implicated. TOW?
    Staphylococcus aureus
  2. 2. Staphylococcal food poisoning is mediated by what?
  3. 3. Tx of staphylococcal food poisoning
  4. 4. Cause of nausea and vomiting; +/- diarrhea (onset < 6 hr) after eating reheated rice. TOW?
    Bacillus cereus
  5. 5. What makes bacterial spores resistant to heat
    dipicolinic acid core
  6. 6. Cause of nausea; vomiting; watery diarrhea w/ rapid onset (6-12 hr) after eating reheated meat or gravy implicated. TOW?
    Clostridium perfringens
  7. 7. Persistent dyspepsia in those not receiving NSAIDs is tested for what?
    Helicobacter pylori
  8. 8. Increased risk of gastric adenocarcinoma and MALT lymphoma.
    H. pylori colonization
  9. 9. Indications to treat H. pylori-associated PUD
    Presence of organism
  10. 10. Standard first line treatment for PUD due to H. pylori is what?
    PPI + clarith + amox
  11. 11. Hx of acute onset of diarrhea with rice-water stools; vomiting; dehydration in a pt during travel to South America. TOW?
    Vibrio cholerae
  12. 12. Sx and Sn of cholera are due to what?
    A-B toxin causes ? cAMP
  13. 13. Cholera pathogen is isolated from stool by culture on thiosulfate-citarate-buffered sucrose (TCBS) agar. Why sucrose (and not glucose)?
    Differential fermentation (+) by V. cholerae on sucrose
  14. 14. The comma-shaped cholera organisms are microscopically similar to
  15. 15. Tx of cholera involves
    Rehydration (tet in severity)
  16. 16. Secretory diarrhea; fever and vomiting during travel are caused by
    Enterotoxic E. coli
  17. 17. Secretory diarrhea w/ fatty; foul-smelling stools in campers; hikers; also day-care outbreaks are caused by
    Giardia lamblia
  18. 18. Following ingestion of 15-25 cysts and excystation; trophozoites with flat ventral surface adhere at brush border of enterocytes and contribute to malabsorption. TOW?
  19. 19. Dx of giardiasis is confirmed by
    Stool antigen (+)
  20. 20. Specific Rx of giardiasis involves
  21. 21. Protracted; secretory diarrhea w/ large fluid loss in AIDS is caused by (clue: acid-fast organisms)
    Cryptosporidium >> Cyclospora > Isospora
  22. 22. Frank bloody diarrhea; after eating undercooked meats or drinking fruits drinks; is caused by prepared foods or water; contaminated w/
    E. coli O157:H7
  23. 23. Mechanism of blood loss in hemorrhagic enterocolitis involves
    Shiga toxin (a cytotoxin)
  24. 24. Complication of hemorrhagic enterocolitis in children
    hemolytic uremic syndrome
  25. 25. Profuse diarrhea; fever; vomiting; and dehydration in infants is caused by
  26. 26. Mechanism of rotaviral diarrhea involves
    Villus destruction
  27. 27. Infantile watery diarrhea and fever are caused by
    Adenovirus 40 and 41
  28. 28. Outbreak of nausea; vomiting; fever in adults is caused by
  29. 29. Cause of nausea/vomiting; abdominal cramps; diarrhea +/- bloody 8-48h after eating eggs or poultry or peanut butter?
    Non-typhoidal Salmonella
  30. 30. Primary gastroenteritis progressing to chronic carrier state of Salmonella in bile ducts is common due to
    Abx use
  31. 31. Abx used to treat septic phase salmonella gastroenteritis is
  32. 32. Cause of fevers (>103�) abdominal pain; headaches; little diarrhea; macular rose-colored spots (rash). PE: bradycardia; hepatosplenomegaly (+/-) in a pt with hx of travel (to tropics)?
    Salmonella typhi
  33. 33. Cause of occult-bloody diarrhea; abdominal cramping and fever; 2d after ingestion of salad from meat-contaminated cutting-boards?
    Campylobacter jejuni
  34. 34. Abx for campylobacter enteritis with prolonged; high fevers in pregnancy; and HIV is
  35. 35. Cause of dysentery-like illness with fever + abdominal cramps; tenesmus + blood & mucus in children?
    Shigella sonnei
  36. 36. Tx of dysentery due to Shigella flexneri or S. dysenteriae in elderly involves
  37. 37. Cause of dysentery-like illness in the northern region after eating cheese; pseudoappendicitis or pseudo-crohn syndrome?
    Yersinia enterocolitica
  38. 38. Cause of dysentery-like illness in a patient on broad-spectrum abx?
    Clostridium difficile
  39. 39. Diarrhea due to Clostridium difficile is mediated by
    Toxin A (enterotoxin) + toxin B (cytotoxin).
  40. 40. Clostridium difficile diarrhea is confirmed by
    EIA for stool toxins
  41. 41. Tx of Clostridium difficile diarrhea involves
    po vanco > metron + ORS
  42. 42. Health-care associated spread of Clostridium difficile diarrhea and protracted outbreak is due to
    Contact mode of transmission of spores
  43. 43. Cause of dysentery involving abdominal pain; tenesmus; stools with mucus + blood in a patient; who recently traveled to tropics; CBC: eosinophilia?
    Entamoeba histolytica
  44. 44. Positive stool test using microscopy for trophozoites w/ intracellular RBCs confirms
    Amebic dysentery
  45. 45. Rx of amebic dysentery involves
    Metronidazole + iodoquinol
  46. 46. Abscesses in liver or peritonitis in travelers w/ or w/o hx of amebic dysentery is confirmed by
    Serology for E. histolytica
  47. 47. Chronic abdominal pain; diarrhea; follows intestinal obstruction; cholangitis; liver abscess; in children in Southern States. Lab: O & P (+) for eggs (oval with a thick coarse shell). TOW?
    Ascaris lumbricides
  48. 48. Ova & Parasite test using microscopy for oval eggs (with a thick coarse shell) in stool confirms what?
  49. 49. A child has stomach ache; distended abdomen; poor appetite. �Pearl-colored earthworm�-like organisms in the stool. Major immune response against this infection?
  50. 50. DOC of ascariasis is
  51. 51. Vomiting; cramping; diarrhea; epigastric pain; weight loss in an immigrant from developing country is caused by
    Strongyloides stercoralis
  52. 52. DOC of strongyloidosis is
  53. 53. Pt w/ high dose steroids or HIV/AIDS develops pulmonary infiltrates (+ eosinophilia) and/or gram negative sepsis. TOW?
    Invasive strongyloidosis
  54. 54. Weakness; fatigue; lightheadedness; dyspnea; pruritis; pallor; iron-deficiency anemia. CBC: elevated eosinophils. TOW?
    Hookworm infection
  55. 55. Fever; periorbital edema; subconjunctival hemorrhages; muscle weakness; rash; after ingestion of undercooked meat (e.g.; pigs; wild game). Lab: ? CPK; LDH & eosinophilia. TOW?
  56. 56. Vague abdominal pain; bloating; altered appetite after ingestion of sushi. CBC: megaloblastic anemia (B12 deficiency); eosinophilia with mild leukocytosis. TOW?
    Diphyllobothriasis (fish tapeworm) **this one is ALWAYS on every comlex exam--olivia
  57. 57. Dx of tape worm infection is confirmed by
    proglottids in stool
  58. 58. Tx of tape worm infection involves
  59. 59. Fever; lymphadenopathy; hepatosplenomegaly in an immigrant from Africa or Orient; pt recalls an itch within a day of fresh water exposure. RUQ ultrasound (+); CBC: eosinophilia. TOW?
    Schistosoma mansoni (Africa) S. japonicum (Far East)
  60. 60. Stool in chronic stage of schistosomiasis yields
    large eggs with lateral spine.
  61. 61. Rx of chronic stage of schistosomiasis involves
  62. 62. Patient with acute jaundice is HAV IgM (+). What should the family contact receive for prophylaxis?
    Inactivated HAV vaccine
  63. 63. Patient with jaundice for < 1 week has HBsAg (+); Anti-HBc IgM (+). TOW?
    Acute HBV infection
  64. 64. Multiple sex partners; IDU; infants born to infected mothers are risk groups for which hepatitis virus
  65. 65. This is an enveloped; double stranded DNA virus w/a ss-break; transmitted by infective body fluids. TOW?
  66. 66. This asymptomatic man has hep serology: HBsAg (-); Anti-HBs (+); Anti-HBc IgG (+); Anti-HBc IgM (-). TOW?
    Resolved hepatitis B
  67. 67. This man has jaundice and HBsAg (+) > 6 months; Anti-HBs (-); HBeAg (+); Anti-HBc IgG (+); HBV DNA > 20;000 IU/ml. TOW?
    Chronic active hepatitis B
  68. 68. A pt w/ chronic active hepatitis with evidence of necroinflammation should receive
    Peg-IFN? 2a + lamivudine (or cidofovir)
  69. 69. This man has no jaundice; but HBsAg (+) >6 months; Anti-HBs (-); Anti-HBc IgG (+); HBeAg (-); persistently normal ALT. TOW?
    Inactive HBsAg carrier
  70. 70. This man; at the time of annual physical exam; reveals Anti-HBs (+) and other markers are (-). TOW?
    HBV vaccination:
  71. 71. Virologic confirmation of chronic jaundice in a pt w/ IDU or hemodialysis; vasculitis and glomerulonephritis is based on
  72. 72. Heterogeneous; immune-evasive quasispecies (mutants)generated during replication of hepatitis C virus in blood causes
    Chronicity in HCV
  73. 73. Fulminant hepatitis in a patient; who has multiple sexual partners and is HBsAg (+); HBcIgM (-); can be fatal due to what?
    HDV superinfection.
  74. 74. Acute onset of jaundice; nausea; right-upper quadrant pain; hepatomegaly in pregnant women in India. TOW?
    HEV infection
  75. 75. Fever; arthralgia; carditis; polyarthritis; chorea; erythema marginatum; elevated WBCs or ESR/CRP. Clinical Dx is confirmed by
    rising ASO titer
  76. 76. Type II hypersensitivity due to molecular mimicry is the mechanism of a immunological sequel of streptococcal infection; called
    Acute rheumatic fever
  77. 77. Tx of ARF includes
    Benzathine penG.
  78. 78. A man with IDU has flu-like symptoms;1-3 minor peripheral signs: (conjunctival hemorrhage; Janeway lesions; Osler nodes; Roth spots). vegetation in tricuspid valve) Blood Cx (BC) should yield
    S. aureus
  79. 79. A pt w/ hx of extraction of impacted tooth 3 weeks ago now has subacute (native; mitral-valve) endocardits. BC should yield
    viridans streptococci.
  80. 80. A pt w/ hx of St. Jude bypass 2 months ago has now subacute bacterial endocarditis. BC should yield
    Staphylococcus epidermidis
  81. 81. A pt with AIDS and recent hx of UTI has not subacute (native-mitral valve) endocarditis. BC should yield
    Enterococcus faecalis (or faecium)
  82. 82. Tx of acute endocarditis in patient with IDU due to S. aureus (MSSA).
    Nafcillin +gentamicin
  83. 83. Tx of acute endocarditis in patient with IDU due to S. aureus (MRSA).
    Vanco + rifampin
  84. 84. Tx of subacute (native; mitral-valve) endocarditits due to viridans streptococci.
    PenG + gentamicin
  85. 85. Tx of subacute (prosthetic-valve) endocarditis due to Staphylococcus epidermidis
  86. 86. Tx of subacute (native mitral-valve) endocardits due to Enterococcus faecalis (or faecium)
    Ampicillin (high dose) + gentamicin
  87. 87. Patient with enterococcal bacteremia fails to respond to vancomycin. MOR?
    D-Ala-D-Ala is changed to D-Ala-D-lac
  88. 88. Hx of catheter-related endocarditis; involving prosthetic & native valves. WBC >9;000. BC (+) for budding yeast. Pt does not respond to AmphoB or fluconazole. Tx now?
  89. 89. Patient with colon cancer has bacteremia due to what?
    Streptococcus bovis
  90. 90. Hx of febrile; malaise; arthralgia; dyspnea; edema; palpitations. ST/T wave change; heart block; dysrhythmias. Imaging studies: chest XR w/ cardiomegaly. TOW?
    Coxsackievirus > echovirus > Trypanosoma cruzi (Chagas)
  91. 91. Rhinorrhea; red throat; and nasal pus are caused by
  92. 92. Rhinoviruses and enteroviruses belong to picornavirus family; but the rhinoviruses differ from enteroviruses on
    Growth at 22oC/noninvasive
  93. 93. Rhinovirus receptor in the nasal passages and upper tracheobronchial tree is
  94. 94. Rhinovirus; influenza; parainfluenza; coronavirus; RSV; metapneumovirus; and adenovirus all cause
    Upper-respiratory infections
  95. 95. Sinusitis; otitis; laryngitis; exacerbations of bronchitis and asthma are mostly secondary to
    Viral URIs
  96. 96. In HEENT; Streptococcus pneumoniae; non-typable Haemophilus influenzae; Moraxella catarrhalis all cause
    Acute otitis media (AOM) & sinusitis
  97. 97. AOM and sinusitis are empirically treated with amoxicillin + clavulanate. Why use clavulanate?
    Haemophilus and Moraxella are ?-lactamase producers
  98. 98. Cause of pharyngeal pain; dysphagia; fever; red throat + purulent exudate that responds to penicillin
    Streptococcus pyogenes (aka: Group A Streptococcus)
  99. 99. GABHS is differentiated from GBBHS by what?
    Bacitracin sensitivity
  100. 100. Common mode of acquisition of URI due to Streptococcus pyogenes?
    Infective droplets
  101. 101. Major virulence factor (with anti-phagocytic function) of
    M protein fibrils
  102. 102. Damage in posterior pharynx and tonsils due to Streptococcus pyogenes is associated with what host reaction?
    Pyogenic inflammation
  103. 103. DOC of acute bacterial pharyngitis in a pt w/ Pen allergy
    Erythromycin > clindamycin
  104. 104. Pyogenic complication of streptococcal pharyngitis
    Tonsillar abscess
  105. 105. Toxigenic complication of streptococcal pharyngitis
    Scarlet fever >> TSS (rare)
  106. 106. Immunological complication of streptococcal pharyngitis
    Acute rheumatic fever
  107. 107. Cause of fever; red throat + purulent exudate -pseudomembrane with lymphadenopathy; in a pt from Russia
    Corynebacterium diphtheriae
  108. 108. Gram/special stain of Corynebacterium diphtheriae should reveal
    Gram(+) rods w/ metachromatic granules
  109. 109. Virulence genotype of Corynebacterium diphtheriae is acquired by
    Transduction (phage mediated transfer of exotoxin gene)
  110. 110. Isolate on tellurite agar culture of throat swab for a cause of diphtheria is confirmed by
    Immunodiffusion (ELEK) assay for toxin
  111. 111. Mechanism of action of exotoxin of Corynebacterium diphtheriae
    ADP ribosylation of EF-2 (protein synthesis block).
  112. 112. Damage to pharynx and cardiac myosites due to Corynebacterium diphtheriae is mediated by
    Cytotoxicity of A-B toxin
  113. 113. Virologic Dx of URI symptoms; fever; red throat + purulent exudate; hepato-splenomegaly; lymphadenopathy; in a teenager; is confirmed by
    heterophile antibody (+)
  114. 114. Host cells preferentially infected by EBV are
    B cells
  115. 115. EBV is biologically similar to what class of viruses?
    herpes viruses
  116. 116. Host immune system controls the EBV infection; mediated by
    CD8+ T lymphocytes
  117. 117. Rash occurs following which antibiotic(s) to treat infectious mononucleosis?
  118. 118. Burkitt's lymphoma in some African population is a B-cell tumor due to oncogenesis by
  119. 119. Nasopharyngeal carcinoma; a B-cell tumor that is common in the Oriental population that consumes preserved fish; is due to oncogenesis by
  120. 120. Heterophile-negative infectious mononucleosis syndrome is due to ?
  121. 121. Gram-positive bacteria that cause acute otitis media (AOM)
    Streptococcus pneumoniae
  122. 122. Gram-negative diplococci bacteria that cause AOM
    Moraxellar catarrhalis
  123. 123. Gram-negative coccobacilli bacteria that cause AOM
    Haemophilus influenzae
  124. 124. > 7 days of nasal obstruction; rhinorrhea; purulent nasal drainage + frontal pain/tenderness is treated with
    Amoxicillin & Clavulanate
  125. 125. DOC for acute mastoiditis in a young child is amoxicillin & clavulanate; why?
    Same etiology as AOM
  126. 126. Cause of �seal-like barking� cough + episodic aphonia w/ symptoms of URI in a child
    parainfluenza virus
  127. 127. Gram-stain-nonreactive organism that causes redness; purulent discharge at lid margin/eye corners; in a newborn
    Chlamydia trachomatis
  128. 128. Most common cause of redness; tenderess; hyperpurulent d/c; eye stuck shut in AM; lid edema. Gram stain (+)
    Staphylococcus aureus
  129. 129. Cause of fever; conjunctivitis; pharyngitis with rhinitis; cervical adenitis in a child.
  130. 130. Cause of burning; gritty feeling in eyes; diffuse conjunctival injection & profuse tearing + preauricular LN.
  131. 131. Cause of foreign body sensation; lacrimation; photophobia; conjunctival hyperemia; and ulceration
  132. 132. Cause of severe pain and skin lesions in dermatomal pattern involving the ophthalmic division of the trigeminal nerve.
  133. 133. Cause of painful; swollen; red eyes; with conjunctival hemorrhaging and excessive tearing in an outbreak
  134. 134. Cause of chorioretinitis in AIDS; but CMV antigen (-)
    Toxoplasma gondii
  135. 135. Cause of painful keratitis; chronic corneal ulcers in contact lens users; unresponsive to abx.
    Acanthamoeba spp.
  136. "136. In an infant w/ ?immunization; 2 wks of paroxysmal coughs; inspiratory ""whoop"" + post-tussive emesis. TOW?"
    Bordetella pertussis
  137. 137. Pertussis toxin inhibits chemotaxis via downregulation of C3a/C5a receptor; resulting in?
    lymphocytic leukocytosis in CBC
  138. 138. Three major virulence factors of �whooping cough� pathogen?
    ADP-ribosylating toxin; tracheal cytotoxin; hemolysin
  139. 139. Cause of fever + drooling; stridor; dyspnea in a child w/ ?immunization (pt appears septic)
    Haemophilus influenzae b
  140. 140. Major virulence factor of Haemophilus influenzae associated with pneumonia and meningitis
    Capsular polysaccharide (antiphagocytic and anti-C3b)
  141. 141. Since; absent spleen places host at increased risk for invasive H. influenzae infection; pre-exposure prophylaxis prior to elective splenectomy is ?
    Hib immunization
  142. 142. Acute exacerbation of chronic bronchitis (AECB) is caused by an organism that needs NAD + hematin for growth; ?-lactamase (+). DOC?
    Ceftriaxone (severe) >. Amoxicillin-clavulanate
  143. 143. Most common cause of lower-respiratory infections in neonates (babies < 4 wk)?
    Streptococcus agalactiae (aka: group B streptococcus)
  144. 144. Complicated illness in a newborn of a GBS-colonized mother is
    Sepsis or meningitis
  145. 145. A mother colonized (recto-vaginally) w/ GBS is at risk for preterm baby or premature membrane rupture. She should receive
  146. 146. An elderly comes up with an abrupt-onset fever; myalgia; headache; malaise; dry cough; sore throat and rhinitis; in winter. Illness could have been prevented w/ ?
    annual influenza vaccine
  147. 147. Annual influenza vaccine protects at-risk subpopulation w/ 60% immune protection; and is composed of what 3 viruses?
    A:H1N1 + A:H3N2 + B
  148. 148. Secondary spread of influenza occurs in a crowded setting (within 6 feet of infected person) via
    respiratory droplets
  149. 149. Annual vaccine to prevent influenza is needed due to antigenic drift. This occurs due to what genetic mechanism?
  150. 150. Occasionally serious pandemic of influenza occurs due to antigenic shift. This occurs due to what genetic mechanism?
    Reassortment of 8 genomic segments
  151. 151. Treat persons with influenza <48 hours with
  152. 152. Bacterial superinfection; causing pneumonia; after influenza occurs in elderly (in LTCF) due to what?
    S. pneumoniae > S. aureus
  153. 153. A seriously ill young adult w/ necrotizing pneumonia; poorly responding to vancomycin; should get
  154. 154. Cause of febrile illness + bronchiolitis in an infant; BAL viral culture (+).
    Respiratory syncytial virus
  155. 155. Major cause of seasonal pneumonia outbreaks in the pediatric units via contact spread (by HCWs) is
  156. 156. Mechanism of asthmatic Sx + Sn w/ pathology in bronchioles in high-risk infants due to RSV is
    type III hypersensitivity
  157. 157. Inhaled drug used in the sickest infants with bronchiolitis (yet questionable efficacy) is
  158. 158. Insidious onset of fever; dry cough; malaise and sore throat in young adults. CBC: anemia; CXR: diffuse infiltrates. TOW?
    Mycoplasma pneumoniae
  159. 159. Dx of �walking pneumonia� in older children and young adults; while waiting for serology; is supported by
    cold agglutinin (IgM Ab against RBCs) titer ?1:32
  160. 160. ?-lactam abx is ineffective for Tx of mycoplasma pneumonia because
    Wall-less bacteria
  161. 161. A male child with mycoplasma pneumonia now has systemic rash; covering 10% of his body. TOW?
    erythema multiforme (SJS)
  162. 162. Cause of upper respiratory Sx; slow onset of cough (laryngitis) >2wks + CXR: patchy infiltrate; viral serology (+). TOW?
    Chlamydophila pneumoniae
  163. 163. Hx of rapid onset of high fever; cough; & sputum; dyspnea; tachypnea in an elderly; CXR: lobar infiltrate; CBC: pronounced neutrophilic leukocytosis with left shift. TOW?
    Streptococcus pneumoniae
  164. 164. Gram-positive diplococci from sputum from a patient with lobar pneumonia yield ?-hemolytic colonies and are confirmed by what test?
    Capsular swelling (Quelling rxn)
  165. 165. ?-hemolytic colonies of Streptococcus pneumoniae is differentiated from viridans streptococci definitively confirmed by what test?
    Optochin sensitivity
  166. 166. Population w/ ?incidence of pneumococcal pneumonia
  167. 167. ? incidence of colonization of what organism is seen in very young and elderly; crowding; following viral URI (? PAF receptors); fall/winter season?
    Streptococcus pneumoniae
  168. 168. Streptococcus pneumoniae is transmitted person-to-person via what?
  169. 169. Nasopharyngeal mucosal colonization is facilitated by
    IgA protease
  170. 170. Streptococcus pneumoniae reaches lungs after nasopharyngeal colonization via
  171. 171. Major virulence factor; facilitating invasion and dissemination of Streptococcus pneumoniae bacteria
    Polysaccharide capsule
  172. 172. Pneumococcal cell wall peptidoglycans; teichoic acid elicit
  173. 173. ? lung cell injury; bacterial growth; and bacteremia are caused by
    Pneumolysin (?-hemolysin)
  174. 174. Multiple myeloma; C3 deficiency; agammaglobulinemia; asplenia - Hg SS; chronic diseases - COPD; cancer; diabetes; alcoholism; smokers are risk factors for mortality due to
    pneumococcal pneumonia
  175. 175. Risk factor for poor prognosis of pneumococcal pneumonia
  176. 176. Emipiric DOC of community-acquired pneumonia (CAP) in individuals w/ risk or comorbidity is
    Azithromycin or levofloxacin + ceftriaxone
  177. 177. Pneumonia due to highly penicillin-resistant Streptococcus pneumoniae (Pen MIC >8) should receive
    moxifloxacin or vancomycin
  178. 178. Mechanism of penicillin resistance in Streptococcus pneumoniae is
    PBP alteration by mutation
  179. 179. Pt w/ agammaglobulinemia or asplenia or sick-cell anemia or ?C3 should be vaccinated with
    Pneumococcal polysaccharide vaccine (PPSV: 23-valent)
  180. 180. Hx: a patient w/ serious CAD now on a ventilator; acquires bronchopneumonia >72 hrs after hospitalization. TOW?
    Pseudomonas aeruginosa (VAP)
  181. 181. Cause of necrotizing pneumonia >72 hrs after hospitalization of complicated viral illness
    Staphylococcus aureus (assume MRSA)
  182. 182. Hx of a patient w/ seizure illness has fever; cough evolving over 2-4 wks; CXR infiltrate (+). Gram stain: polymicrobic. TOW?
  183. 183. Empiric DOC of necrotizing pneumonia in a patient with seizure illness
    Clindamycin + levofloxacin
  184. 184. Pneumonia in homeless/alcoholics; Gram-positive diplococci in sputum Gram smear. TOW?
    Streptococcus pneumoniae
  185. 185. Pneumonia in homeless/alcoholics; Gram-negative rods in sputum smear. TOW?
    Klebsiella pneumoniae
  186. 186. Cause of pulmonary embolism in a pt with IVDU
    Staphylococcus aureus
  187. 187. Common cause of pneumonia in pts with CF
    Pseudomonas aeruginosa
  188. 188. Sputum of a patient with hospital-acquired pneumonia yields a Gram-negative rod that is oxidase (+)/ pyocyanin(+). TOW?
    Pseudomonas aeruginosa
  189. 189. Common cause of external otitis due to hot tub use is
    Pseudomonas aeruginosa
  190. 190. A patient with diabetes has osteomyelitis after penetrating foot injury. TOW?
    Pseudomonas aeruginosa
  191. 191. The most widely used anti-pseudomonal penicillin
    Piperacillin > imipenem
  192. 192. The most widely used anti-pseudomonal aminoglycoside
    Tobramicin > gentamicin
  193. 193. This pt >50 years; smoking hx; CMI? has pneumonia; diarrhea; renal failure. Urine antigen (+) for pathogen. Pt responds to azithromycin. TOW?
    Legionella penumophila
  194. 194. Penicillin is ineffective against Legionnaire�s dz because
    Intracellular organism
  195. 195. Individuals with defective CMI response has poor prognosis of Legionnaire�s dz because
    Intracellular organism
  196. 196. Asymptomatic patient with PPD (+)
    Latent tuberculosis infection
  197. 197. Cough > 2 wks; fever; night sweats; weight loss; hemoptysis; SOB; CXR: upper lobe infiltrate. TOW?
    Active infection due to Mycobacterium tuberculosis
  198. 198. Oral drug regimen of choice for treatment of active TB (aka: 1st line drugs) is
    INH+RIF+PZA+EMB (oral) + Vit B6
  199. 199. Pyridoxine is added to 4-drug therapy for TB because
    neuropathy (due to INH)
  200. 200. Pt w/ TB fails to respond to 4-drug regimen w/ INH+RIF resistance because
    Multiply drug-resistant (MDR) TB
  201. 201. Pt w/ MDR-TB fails to respond to INH +RIF+FQ+an injectable drug (amikacin; capreomycin; or kanamycin) because
    Extremely-drug resistant (XDR) TB
  202. 202. Cause of TB-like Dz that does not respond to 1o TB Tx regimen; in a pt. w/ AIDS
    Mycobacterium avium � intracellulare (aka: MAC)
  203. 203. Cause of chronic pneumonia in a patient with cancer; receiving cytotoxic chemotherapy; lung-CT: halo/crescent sign (+)?
    Aspergillus fumigatus
  204. 204. Hx of chronic pneumonia w/ lung bpsy histopathology (+) for hyphae 2-4?m wide; septate; acute- angle branching. TOW?
    Aspergillus fumigatus
  205. 205. Hx of TB-like LRI in a pt with outdoor activity; bronchoscopy: Giemsa (+) for 2-5 ?m yeasts. TOW?
    Histoplasma capsulatum
  206. 206. Pt with AIDS has blood culture (+) for histoplasmosis. DOC has effects on
    Ergosterol in cell membrane
  207. 207. TB-like Dz w/ ulcerative skin lesions. lung bpsy histopathology (+) for large yeast w/ broad-based bud. DOC?
  208. 208. Hx of acute onset of cough; fever; infiltrate in a black male with CMI?; histopathology of lung (+) for a large sac of endospores. DOC?
    Fluconazole (indefinite)
  209. 209. Pt w/ aspiration pneumonia with cervico-facial lesion should respond to
    Penicillin G
  210. 210. Granular specimen from draining fistulae from a pt with LRI on anaerobic culture should yield
    Actinomyces israelii
  211. 211. Pt with AIDS or organ transplant has indolent pneumonia; w/ or w/o CNS abscess or granuloma. TOW?
  212. 212. Organism w/ characterization of Gram-positive branching; beaded; filamentous rod; weakly acid fast is
    Nocardia asteroids
  213. 213. Hx of fever; cough; progressing to pulmonary hemorrhage in a pt who works at a wool-sorting factory; CXR: mediastinitis. TOW?
    Anthrax (Bacillus anthracis)
  214. 214. Hx of non-productive cough; fever and dyspnea evolving over 2-4 wks. CXR (+): bilateral interstitial infiltrates; hypoxemia; ?LDH; CD4 count <200/mm3 in a man who has sex with man (MSM). TOW?
    Pneumocystis pneumonia
  215. 215. DOC of pneumocystis pneumonia (PCP)
  216. 216. Pt has urinary urgency; frequency; dysuria; lab: pyuria (+) or nitrite (+). TOW?
    Cystitis due to E. coli
  217. 217. Significant UTI is confirmed by semiquantitative MSU culture based on the threshold of
    > 1;000 cfu/mL
  218. 218. Mode of acquisition of uropathogen is
  219. 219. Microbial (structure) factor favoring bacterial persistence /colonization and UTI is
    bacterial binding via fimbriae
  220. 220. Factor favoring bacterial persistence/colonization and UTI despite high osmolarity and urea concentrations and low pH is
    high bacterial growth rates
  221. 221. Host factor favoring bacterial persistence/colonization and UTI is
    Urinary stasis
  222. 222. Host factor favoring bacterial persistence/colonization and UTI despite frequent voiding and high urinary flow is
    Absence of bactericidal effects of secreted proteins
  223. 223. Pyogenic inflammation in complicated UTI due to Gram-negative bacteria is due to
  224. 224. Empiric DOC to treat community-acquired UTI in adults is
  225. 225. These drugs inhibit DNA topoisomerases (DNA gyrase and topoisomerase IV) by binding to DNA-enzyme complexes; thereby interfering with bacterial DNA replication. What?
  226. 226. Avoid fluoroquinolones for the empiric Tx of UTI in pregnant women; alternative is
  227. 227. Gram-positive bacteria that cause uncomplicated UTI in sexually active; young women are
    Staphylococcus saprophyticus
  228. 228. Differentiation of Staphylococcus saprophyticus from S. epidermidis (both coagulase negative) is based on
    novobiocin resistance
  229. 229. In elderly or pt with risks of urinary stasis; fever; chills; flank pain; and CVA tenderness; Lab: pyuria; casts; nitrite+. TOW?
    Pyelonephritis due to E. coli
  230. 230. Pt hospitalized > 72 h for comorbidity has urinary frequency; dysuria and foul-smelling urine; w/ flank pain; fever and chills; in the presence of a urinary catheter: Clue 1: GNR; fermenter; encapsulated; intrinsic ampicillin resistance Clue2: GNR; slow fermenter; red pigment; intrinsic drug resistance Clue 3: GNR; swarming growth [very motile]; slow fermenter; intrinsic drug resistance Clue 4: GNR; non fermenter; oxidase+; blue pigment; intrinsic drug resistance Clue 5: GPC in chains; catalase-neg; grows in high salt; penicillin resistance
    1. Klebsiella pneumoniae 2. Serretia marcescens 3.Proteus mirabilis 4. Pseudomonas aeurginosa 5. Enterococcus Faecalis
  231. 231. If a patient with complicated UTI is severely ill or not improving with therapy; do what rapid test next?
    renal ultrasound (to rule out urinary tract obstruction)
  232. 232. For a patient with complicated UTI; once culture and sensitivity available; switch to what?
    Narrow-spectrum abx
  233. 233. Genital chancre begins as a papule; ulcerates to form a single; painless; clean-based ulcer. TOW?
    1o syphilis
  234. 234. Cause of genital chancre; begining as a papule; ulcerating to form a single; painless; clean-based ulcer.
    Treponema pallidum
  235. "235. Hx of pen-allergy in a non-pregnant woman; who has fever; ""copper penny"" macular lesions on the palms and/or soles; RPR(+). DOC?"
  236. 236. Hx of pen-allergy in a pregnant woman; who is RPR(+) and has tabes dorsalis (10-20yrs); or iritis; uveitis; iridocyclitis; Argyll-Robertson pupils. Manage how?
  237. 237. Hx of painful clustered vesicles with an erythematous base; urinary retention in a promiscuous woman. TOW?
    HSV-2 >> 1
  238. 238. Giemsa stain of fluid from a herpetic lesion should reveal
    Multinucleated giant cells
  239. 239. Patient with genital herpes does not respond to acyclovir because pt is infected with
    thymidine kinase deficient HSV
  240. 240. A pregnant woman with 1o symptomatic HSV-2 infection is at risk of her baby developing
    neonatal (congenital) herpes
  241. 241. Cause of painful genital ulcers (no induration); purulent; dirty grey base; painful inguinal adenitis (bubos); in a man with multiple sexual partners
    Haemophilus ducreyi
  242. 242. Fastidious organism found within the granulocytic infiltrate of the penile ulcer and co-localized with neutrophils and fibrin; in a pt w/ chancroid is
    Haemophilus ducreyi
  243. 243. All sex partners of pt with chancroid; regardless of symptoms; should be examined and treated with
    Azythromycin > ceftriaxone
  244. 244. Most common cause of mucopurulent endocervical exudate (Gram stain non revealing) in a sexually promiscuous woman
    Chlamydia trachomatis D-K
  245. 245. Dx of mucopurulent urethral discharge; dysuria; penile pruritis is based on
    NAAT of urethral specimen or urine (+)
  246. 246. DOC of most frequent cause of nongonococcal urethritis
    Azythromycin > doxycycline
  247. 247. Cause of rare genital ulcers; inguinal lymphadenopathy [cytology(-) for multi-nucleated giant cells; RPR (-)] in men is
    Chlamydia trachomatis L1-L3
  248. 248. Hx of systemic Sx/Sn w/ cervical motion tenderness in a woman with turbo-ovarian abscess. TOW?
  249. 249. Cause of mucopurulent urethritis; dysuria; penile pruritis
    [Smear (+):Gram-negative diplococci co-populated w/ PMNs] is Neisseria gonorrhoeae
  250. 250. Hx of frequent gonorrhea and disseminated gonococcal infection in a woman is due to deficiency in serum factors?
    Terminal complements
  251. 251. Immune evasion of Neisseria gonorrhoeae in frequent mucosal infection is due to
    Antigenic variation of pili.
  252. 252. Auxotrophic strains of N. gonorrhoeae (needing arginine for growth) and also with serum (complements) resistance are likely to cause
    Septic arthritis (aka: DGI)
  253. 253. Most frequent complication of gonococcal (GC) infection in men
  254. "254. Cause of ""bull headed clap""; urethral stricture; prostatitis is"
    Neisseria gonorrhoeae
  255. 255. Urethritis is treated with ceftriaxone + azythromycin because
    Concurrent GC + Chlamydia
  256. 256. An older woman with PID and tubo-ovarian abscess receives ceftriaxone; azythromycin; and metronidazole because
    Polymicrobic (endogenous) infection
  257. 257. Cause of anogenital warts w/ histology (+): koilocytes is
    HPV 6 and 11
  258. 258. Cause of atypical squamous cells of undetermined significance (ASCUS) on pap smear w/ no clinical signs of infection is
    HPV 16 and 18
  259. 259. Cause of koilocytotic cells and possible progression to squamous cell carcinoma
    HPV 16 and 18
  260. 260. Next step to identify viral cause of ASCUS on pap smear w/ and further management in a woman of age > 29 years is
    Colposcopy > HPV DNA in bpsy
  261. "261. Wet prep of vaginal discharge from a sexually promiscuous woman w/ vaginal pruritis; ectocervical erythema (""strawberry cervix"") should reveal"
    motile tissue flagellate
  262. 262. Gram stain of vaginal discharge w/ fishy odor from a sexually promiscuous woman w/ vaginal pruritis but no erythema and normal cervix should reveal
    SECs stippled with Gram-variable organisms.
  263. 263. DOC of bacterial vaginosis (BV) is
  264. 264. Disruption of normal vaginal flora and depletion of lactobacilli in pt with BV cause overgrowth of anaerobic Mobiluncus species and
    Gardnerella vaginalis
  265. 265. Wet prep of curdy discharge (no odor); adhering to vaginal walls; from a pregnant woman w/ recent UTI; who now has severe vaginal pruritis; vulvovaginal area - erythematous should reveal
    budding yeasts with pseudohyphae
  266. 266. Normal commensal of skin; GI & GU tracts; endogenous overgrowth of budding yeast; capable of >10 diseases. TOW?
    Candida albicans
  267. 267. Mechanism of action of a po DOC of vulvovaginal candidiasis is
    blocks C14?-lanosterol demethylase
  268. 268. Hx of flu-like illness; lymphadenopathy; maculopapular rash in a bisexual man. Lab: lymphopenia and transaminase elevations; monospot/all serology (-). TOW?
    Acute retroviral syndrome
  269. 269. Time from infection (acquisition) to acute seroconversion detected by HIV serology (ELISA/ WBlot) is
    6-12 weeks.
  270. 270. Hx of mononucleosis-like illness and lymphadenopathy in a man with MSM. Serology (-). What is HIV viral load?
    >10;000 copies/ml
  271. 271. Host-cell receptor for HIV-1 infection
  272. 272. Homozygous for deletions in what gene renders resistance to infection and some protection against progression.
  273. 273. Host cells that trap HIV and mediate the efficient transinfection of CD4+ T cells are
    Dendritic cells
  274. 274. A man; who practices �sex with another man�; has antibodies to HIV (ELISA and WB) but asymptomatic. TOW?
    Clinical latency
  275. 275. What happens to HIV-1 virus when acute retroviral syndrome progresses to clinical latency?
    Virus continues to replicate low level.
  276. 276. A man who practices �sex with another man�; is now HIV-1 serology (+) and has dual symptomatic infections/cancer (any two from below). Expected CD4+ count is i. Candidiasis; esophageal; bronchi; trachea; or lungs ii. Cervical cancer; invasive iii. Coccidioidomycosis; extrapulmonary iv. Cryptococcosis; extrapulmonary v. Cryptosporidiosis; chronic intestinal vi. Cytomegalovirus retinitis (with vision loss).. f this.. you get the damn point.. i'm not finishing this shit
    CD4+ < 200/?L
  277. 277. A man with HIV infection has lymphadenopathy; chronic diarrhea; oral thrush + herpes lesions. Expected CD4+ count is
    50 cells/?L.
  278. 278. Most common cause of HIV- associated peripheral skin or mucosal ulcers
    HSV-1 (>> Histo > CMV > VZV > Syphilis)
  279. 279. Most common cause of HIV- associated nodules (neoplasia)?
    HHV-8 (aka KSHV)
  280. 280. Hx of fatigue; nausea; abdominal pain; diarrhea; fever; chills; night sweats; dry persistent cough w/ SOB and weight loss in a man with AIDS. Lab: PPD (-); blood culture (+) for AFB. TOW?
    Mycobacterium avium-intracellulare complex
  281. 281. Common cause of retinitis; viral pneumonitis or esophagitis in AIDS
  282. 282. Hx: progressive CNS dz in a pt w/ AIDS: hemiparesis; visual; ataxia; aphasia; cranial nerves; sensory. MRI: ring-enhancing lesions. Toxo antibody (-). TOW?
    JC virus
  283. 283. Definitive indication for initial HAART (CD4+ count?) is
    CD4+ 350/mm3.
  284. 284. Objective of ARV Tx is to reduce viremia to what level of genomic RNA/mL
    < 50 copies RNA/mL.
  285. 285. Initial regimen of anti-retroviral therapy is
    Emtricitabine + Tenofovir + Efavirenz
  286. 286. Abacavir; emtricitabine; lamivudine; zidovudine; tenofovir belong to what class of antiretrovirals?
  287. 287. Efavirenz; nevirapine belong to what class of antiretrovirals?
  288. 288. Atazanavir; Lopinavir; Saquinavir belong to what class of antiretrovirals?
    Protease inhibitors
  289. 289. This drug binds to gp41 and prevents conformational change required for viral fusion and entry into cells.
  290. 290. This drug inhibits integrase; responsible for insertion of HIV proviral DNA into the host genome.
  291. 291. A man has AIDS and CD4 <200cells/?L or thrush. Antibacterial prophylaxis needed besides HAART is
    TMP-SMX (for PCP)
  292. 292. A man has AIDS and CD4 <100 + pos toxo IgG. Chemoprophylaxis needed besides HAART is
    TMP-SMX (for Toxoplasma encephalitis)
  293. 293. A man has AIDS and CD4 <100 + PPD >5mm induration. Antibacterial prophylaxis needed besides HAART is
    INH + pyridoxine
  294. 294. A man has AIDS and CD4 <50. Antibacterial prophylaxis needed besides HAART is
    azithromycin (for MAC)
  295. 295. Hx of fever; a pustule at a cat scratch site; adenopathy; hepatosplenomegaly in a pt w/ AIDS. Warthin-Starry stain tissue (+). TOW (clue: bacillary angiomatosis)?
    Bartonella henselae
  296. 296. Mnemonic of the leading causes of congenital infections
    ToRCH3eS-List To = Toxoplasma gondii R = Rubella C = CMV H = HSV-2 H = HIV H = HBV S = Syphilis List = Listeria monocytogenes
  297. 297. Cause of chorioretinitis; intracraneal calcifications; and hydrocephalus in a neonate (mom at pregnancy had mono-like illness after eating raw meat) is
    Toxoplasma gondii
  298. 298. Hx of deafness; cataracts; heart defects; microcephaly; or mental retardation in a child (of a seronegative mom; exposed to �Blueberry muffin baby� in a very poor neighborhood). TOW?
    congenital rubella syndrome
  299. 299. Microcephaly; seizures; sensorineural hearing loss; feeding difficulties; petechial rash; hepatosplenomegaly; or jaundice in a neonate. PCR of urine should yield
  300. 300. Hepatosplenomegaly; neurologic abnormalities; frequent infections in a neonate w/ low CD4+ counts. Woman before birthing should have received
  301. 301. Cause of vesicular skin lesions + conjunctivitis in a child (asymptomatic at birth)
  302. 302. Hx of cutaneous lesions; hepatosplenomegaly; jaundice; saddle nose; saber shins. Hutchinson teeth; + CN VIII deafness in a neonate (mom is a prostitute). TOW?
    3o syphilis
  303. 303. Neonatal septicemia or meningitis (mom had flu-like Sx and ate imported cheese during pregnancy). TOW?
    Listeria monocytogenes
  304. 304. What are the SIX red rashes of childhood (acute; febrile exanthema illnesses)? Clue1: maculopapular rash; off-white lesions on buccal mucosa; vaccine preventable virus Clue2: maculopapular rash; vaccine preventable virus Clue3: scarlatina rash post pharyngitis Clue4: vesicular rash; moderate pain Clue5: maculopapular �slapped face� appearance Clue6: maculopapular rash and generalized sx/sn in an immunocompromised pt
    1. Measles 2. Rubella 3. Scarlet fever (GAS) 4. Chicken Pox (VZV) 5. Parvovirus B19 6. HHV-6
  305. 305. Cause of single or multiple scaly and/or crusted patches and/or plaques; affecting the scalp or beard area +/- inflammation.
  306. 306. KOH prep of scales from the scalp and plucked hairs from cutaneous mycoses may reveal?
    hyphae and spores
  307. 307. Most common cause of cutaneous mycoses
    Trichophyton spp.
  308. 308. Common cause of cutaneous mycosis with animal contact
    Microsporum spp.
  309. 309. Oral DOC of cutaneous mycoses
  310. 310. Topical DOC of cutaneous mycoses
  311. 311. Dz w/ subcutaenous lesions w/ slow spread by lymphatic system producing nodules in a gardener; or from rose-thorn injury.
    Sporotrichosis-- ALWAYS on comlex--olivia
  312. 312. Cause of subcutaenous lesions w/ slow spread by lymphatic system producing nodules in a gardener; or from rose-thorn injury.
    Sporothrix schenckii
  313. 313. Dimorphic fungus that grows at 37�C as cigar-shaped yeast; and produces septate hyphae and conidia (in daisy arrangement) at 25�C is
    Sporothrix schenckii
  314. 314. DOC of sporotrchosis
  315. 315. Cause of deeper and wider lesions with interconnecting subcutaneous abscesses arising from infection of several neighboring hair follicles; in young children.
    Staphylococcus aureus (Curbuncle)
  316. 316. Cause of single or multiple; isolated or coalescent; small; superficial pustules progressing to erosions covered by stuck-on; honey-colored crusts; surrounded by erythematous halo; in young children.
    Staphylococcus aureus >> Streptococcus pyogenes (non-bullous impetigo)
  317. 317. mecA (SCC) genes which encode PBP2a; w/ low affinity for ?-lactams; confers resistance in Staphylococcus aureus against what?
  318. 318. Dz characterized by bullae and denuded areas after the blisters rupture; covered by thin; varnish-like light brown crusts; regional lymphadenopathy; in children. DOC 1. if lab: gram stain and culture of pus or base of the lesions yields GPC in chains. DOC 2. if lab: gram stain and culture of pus or base of the lesions yields GPC in clusters.
    Bullous impetigo DOC 1--Penicillin G DOC 2--Nafcillin
  319. 319. Cause of spreading (butterfly-wing) erythema on the face that responds to empirical penicillin.
    Streptococcus pyogenes (Erysipelas)
  320. 320. Cause of severe pain on his knee w/ site of injury is tender and erythematous. Blood culture may yield?
    Streptococcus pyogenes. (Cellulitis)
  321. 321. What is the microbial factor that promotes degradation of C3b by binding to factor H; the serum ? globulin factor
    M protein
  322. 322. Other causes of cellulitis: Clue1: cat/dog bite. What? Clue2: Salt water exposure. What? Clue3: Fresh water exposure. What? Clue4: Neutropenia. What? Clue 5: Human bite?
    1. Pasteurella multocida / Capnocytophaga canimorous 2. Vibrio vulnificus 3. Aeromonas hydrophila 4. Pseudomonas aeruginosa 5. Eikenella corrodens
  323. 323. Most common cause of Dz characterized by fever/chills/ night sweats; localizing pain/tenderness or swelling/erythema; elevated ESR; CRP; elevated WBC and platelets. Radiology: periosteal elevation.
    Staphylococcus aureus (Osteomyelitis)
  324. 324. Major antiphagocytic virulence factor of drug-resistant organism that causes osteomyelitis is
    protein A
  325. 325. Major neutrophil-damaging virulence factor of drug-resistant organism that causes osteomyelitis is
    Penton-Valentine leukocydin
  326. 326. Cause of vertebral; sternoclavicular or pelvic bone infections (in pt w/ IVDU) or osteochondritis of foot (following penetrating injuries through tennis shoes)?
    Pseudomonas aeruginosa
  327. 327. Cause of osteomyelitis in pt w/ underlying sickle cell Dz; blood culture +)?
    Salmonella typhimurium
  328. 328. Cause of chronic; vertebral osteomyelitis (blood culture negative)?
    Mycobacterium tuberculosis
  329. 329. Cause of osteomyelitis in pt. w/ hx of cat bites; GNSR; fastidious growth of wound culture?
    Pasteurella multocida
  330. 330. Dz is characterized by fever; chills; malaise; joint pain;swelling. PE: tenderness; erythema; heat; swelling; decreased ROM. CBC: leukocytosis w/ neutrophils predominating; joint aspirate: no crystals; yields bacteria. TOW? Caused by? Clue1: sexually active; blood culture negative; responds to ceftriaxone Clue2: Rheumatoid arthritis? Clue3: IVDU? Clue4: Unpasteurized dairy products Clue5: Diabetes-Grp B strep.
    Septic arthritis --- 1. Neisseria gonorrhoeae 2. S. aureus 3. S aureus and P. aeurginosa 4. Brucella spp. 5. GBS
  331. 331. Dz is characterized by arthritis in up to 6 joints (especially knees; feet); low back pain/stiffness; irritable eyes w/ or w/o redness; conjunctivitis; iritis; malaise. TOW? Caused by: Clue1: sexually acquired Clue2: non-sexually acquired
    Reactive arthritis caused by--- sexually acquired--C. trachomatis; N. gonorrhoeae caused by non-sexually acquired Campylobacter; Salmonella
  332. 332. Cause of bacteremia in neutopenic pts with central line or pts with prosthetic devices and catheters; blood culture (+) coagulase-negative bacteria.
    Staphylococcus epidermidis
  333. 333. Cause of intraabdominal abscess w/ putrid pus; anaerobic bacteremia in pt with trauma or solid GI tumor?
    Bacteroides fragilis.
  334. 334. A woman with obstetric infection has fever > 102oF; SBP < 90; diffuse sunburn-like rash or desquamation of palms and soles; multisystem Sx/Sns; vomiting; and diarrhea; blood culture negative. TOW?
    Staphylococcal Toxic shock Syndrome
  335. 335. What is the toxin associated with staphylococcal toxic shock syndrome?
    TSST-1 (a superantigen)
  336. 336. Cause of severe; watery diarrhea in a woman with toxic shock syndrome?
    Enterotoxin (coregulated with TSST-1)
  337. 337. Cause of toxic shock syndrome; which responds to vancomycin and clindamycin?
  338. 338. Hx: in a man w/ necrotizing fasciitis or myositis or gangrene; fever > 38.9oC; SBP < 90 ; diffuse sunburn-like rash or desquamation of palms and soles.. Multisystem involvement. Blood culture positive. TOW?
    Streptococcal toxic shock syndrome
  339. 339. What is the toxin associated with streptococcal toxic shock syndrome?
    SpeA (superantigen)
  340. 340. DOC for streptococcal toxic shock syndrome
    PenG + clindamycin
  341. 341. Hx: Fever; chills; and hypotensive. Blood culture yields a GNR; oxidase (-); lactose fermenting organism on MacConkey agar. Immunological mediators of sepsis.
    IL-1 and TNF
  342. 342. DOC for a line-associated infection in a pt w/ GI tumor; lab: positive blood cultures and ?-D-glucan antigenemia?
  343. 343. DOC for a neutropenic pt w/ line-associated infection w/ immune suppression (hematologic malignancy; organ or hematopoietic stem cell transplantation; chemotherapy); w/ positive blood cultures and ?-D-glucan antigenemia?
  344. 344. Cause of mononucleosis-like dz with fever; myalgia/ arthralgia w/ lab: leukopenia; LFT abnls; in a pt w/ solid organ transplant?
  345. 345. Lung biopsy reveals large cells with nuclear inclusions (Cowdry owl's eyes inclusion bodies) in a pt with AIDS and interstitial pneumonia. TOW?
  346. 346. DOC for CMV antigenemia in a febrile pt with solid organ tansplant?
  347. 347. Cause of hematuria; hemorrhagic cystitis; or ureteric stenosis; or interstitial nephritis in a severly immunocompromised pt?
    BK virus
  348. 348. DOC for a pt w/ travel hx (back from the tropics); who has flu-like symptoms; splenomegaly; lab: CBC: anemia; thrombocytopenia; hypoglycemia. Blood smear: enlarged RBCs and Schuffner dots.
    mefloquine + primaquine
  349. 349. Which drug is contraindicated in specific Tx of liver form of malaria in pts w/ G6PD deficiency?
  350. Primaquine
  351. 350. DOC for a pt w/ travel hx (back from the tropics); who has flu-like symptoms (fever > 103oF); seizure; hyperparasitemia (>2.5% of RBC); pulmonary edema; or renal failure; or severe anemia?
    quinidine and doxycycline.
  352. 351. Cause of malaria-like illness in an immunosuppressed pt w/o travel hx; lab: blood smear has cross-over rings in the RBCs?
    Babesia spp.
  353. 352. A pt from S. America has a week-long fever; anorexia; lymphadenopathy; mild hepatosplenomegaly; and myocarditis; a nodular lesion on the arm. Blood smear should reveal motile species of what?
    Trypanosoma cruzi
  354. 353. Cause of a chronic-stage systemic dz w/ cardiomyopathy; megaesophagus; megacolon; and weight loss in a pt from S. America; who does not respond to nifurtimox.
    Trypanosoma cruzi
  355. 354. Cause of protracted fever and Crohn�s; celiac dz; ocular problems; and lymphadenopathy; duodenal biopsy demonstrating foamy macrophages in lamina propria?
    Tropheryma whipplei
  356. 355. What is the most common cause of bacteremia associated w/ foreign device (prostheses; intravenous cathether; or central lines) in co-morbid; hospitalized pts?
    Staphylococcus epidermidis
  357. 356. What is the cause of infections associated w/ ventilator support of respiration in co-morbid pts in the ICU?
    Pseudomonas aeruginosa
  358. 357a. Hx: fever; headache; neck stiffness; and altered mental status; Kernig's/Brudzinski's sign other focal neurologic findings; rash; headache; seizures + myalgia; CSF: WBC > 2000 or PMNs > 1200; glucose < 34; protein > 220
    Acute bacterial (pyogenic) meningitis (ABM).
  359. 357b. CSF gram stain of the most likely pathogen of ABM in a 6 mos-6yr old (or adults > 50 years) should reveal
    Gram-positive diplococcus
  360. 357c. CSF gram stain of the most likely pathogen of ABM in an older child or young adult should reveal
    Gram-negative diplococcus
  361. 358. Most common cause of sepsis/meningitis in newborns/neonates?
    Streptococcus agalactiae
  362. 359. Cause of fever; headache; photophobia; nausea/vomiting; rash; diarrhea; meningeal signs; in older children in the summer months; CSF with 10-<1;000 WBC typical; mostly monos; moderately elevated protein?
    Enteroviruses (aseptic meningitis)
  363. 360. Cause of aseptic meningitis in men with exposure to rodents?
    Leptospira interrogans
  364. 361. Cause of aseptic meningitis with hx of tick bite and erythema migrans?
    Borrelia burgdorferi
  365. 362. Cause of aseptic meningitis with hx of sex with multiple partners; CSF PCR(+)?
    HSV-2 > 1
  366. 363. Cause of fever; headache; photophobia; meningismus; in pts w/ solid organ transplant; malignancy; corticosteroid use. CSF glucose < 2/3 serum glucose; elevated protein; WBC > 5 with PMNs?
    Listeria monocyotgenes
  367. 364. How does Listeria monocytogenes differ from other ?-hemolytic bacteria?
    Gram-positive rods; tumbling motility
  368. 365. Cause of chronic meningoencephalitis in a pt; who uses infliximab or native from endemic region; PE: papilledema. CXR (+). Lab: elevated monocytes on differential; low CSF glucose?
    Mycobacterium tuberculosis
  369. 366. Test to confirm subacute mengoencephalitis in a; immunocompromised pt (CD4 <100); vesicular skin lesions [CSF profile: protein 30-150mg/dl; monos 10-100]?
    CSF India ink
  370. 367. Cause of meningoencephalitis after a hx of respiratory illness after travel to SW USA?
    Coccidioides immitis
  371. 368. Test to confirm CNS pathology with fever; cognitive deficits; focal neurologic signs; seizures; temporal lobe involvement on MRI. Lab: no papilledema; CT (no brain lesion)?
    CSF PCR (+)
  372. 369. Cause of fever; cognitive deficits; focal neurologic signs; seizures; abnormal mental status with ataxia; hemi-paresis; in a pt w/ AIDS?
    JC virus > HHV-6
  373. 370. Cause of fever; cognitive deficits; focal neurologic signs; seizures or abnormal mental status with ataxia in an adult during outdoor activity?
    West-Nile virus > SLE
  374. 371. Cause of fever; cognitive deficits; focal neurologic signs; seizures; in a pt w/ AIDS (CD4 < 100). Brain CT or MRI: multifocal (ring-enhancing) lesions; affecting basal ganglia; Pt receives pyrimethamine + leucovorin + sulfadiazine for life
    Toxoplasma gondii (TE)
  375. 372. Cause of confusion; stiff neck; irritability over wks to months; in immunocompromised pts; CT or MRI = multifocal lesions in midbrain; brain stem; & cerebellum; wet mount CSF = motile macrophage-like organisms.
    Acanthamoeba spp. (GAE)
  376. 373. Cause of severe headache and other meningeal signs; fever; vomiting; and focal neurologic deficits; frequently progressing to coma; in a healthy boy (summer diving activity)?
    Naegleria fowleri (PAM)-- ALWAYS on comlex--olivia
  377. 374. Cause of seizures; chronic headache; symptomatic hydrocephalus; in immigrants from Mexico; Central or S. America); pt. successfully responds to praziquantel + anti-convulsant drug?
    Taenia solium (neurocysticercosis)
  378. 375. Hx of fever; lymphadenopathy; chancre; and pruritus weeks ago; in a pt from Africa; progressing to headaches; somnolence; abnormal behavior; pt. responds slowly to pentamidine isothionate or suramin. TOW?
    Trypanosoma brucei (sleeping sickness)
  379. 376. Hx of rigidity; muscle spasm; and autonomic dysfunction. Trismus or lock jaw due to masseter spasm in an infant w/ umbilical stump infection (secondary to poor birth delivery hygiene). Clostridial toxin interferes w/
    GABA and glycine
  380. 377. Hx of foodborne (chili) afebrile illness w/ diplopia; dysarthria; dysphoria; dysphagia; alert; and descending flaccid paralysis in a pt w/ IDU skin poppers with black tar heroin. Clostridial toxin blocks the release of
  381. 378. Immediate treatment of a male infant w/ constipation; a weak cry; and drooling; hypotonea and cranial neuropathy; after ingestion of home-processed honey.
    Equine immune globulin (infant botulism)
  382. 379. Ingestion of a raw potato delivers a new vaccine protein to elicit an immune response. The immune structure to interact with the vaccine protein?
    Lamina propria mucosae
  383. 380. Inflammation and the resulting increase in vascular permeability permit leakage into damaged or infected sites are effected by
    Phagocytic cells and acute phase proteins
  384. 381. The serum of a pt; who has IgG and IgM deficiency; appears to fix complement in an assay for tetanus antibodies. What is the explanation?
    Activation of the alternate pathway
  385. 382. A 3-year-old boy with genetic C3 deficiency has recurrent ear and lung infections due to pyogenic bacteria. Deficiency of what?
    B lymphocytes
  386. 383. A very young child; w/ recurrent infections due to Staphylococcus aureus; now has numerous granulomas. TOW?
    Chronic granulomatous dz
  387. 384. Treatment with which protease enzyme causes decrease in avidity of IgG w/o changing the specificity of the antibody?
  388. 385. Cells activated by both ?-IFN and CD40 are
  389. 386. High-dose chemo has caused severe bone marrow suppression in a pt with hematologic malignancy. Reversal is plausible with what?
  390. 387. Function of the T-lymphocyte receptor (CD3) complex of transmembrane proteins?
    Signal transduction
  391. 388. The MHC class I pathway presents an antigen directly to what?
    CD8+ T lymphocytes
  392. 389. HSV infection can block the transfer of antigenic peptides from the cytoplasm to the ER of the infected cells. As a result of this; action of what cell type is compromised?
    CD8+ T cells
  393. 390. Infection of the thyroid gland can induce the expression of MHC II molecules. Which cell types would initiate an autoimmune response; leading to Hashimoto�s thyroiditis?
    CD4+ T cells.
  394. 391. PPD skin test (+) in a pt ; who was vaccinated against turberculosis in his native country; reflects response of what cell type?
    CD4+ T lymphocytes (Th1 response ? ?-IFN)
  395. 392. A man with hx of MI is given a morphine injection for a new episode of chest pain; 10 mins later; he has itching and urticaria. Mechanism of this reaction?
    mediators from sensitized mast cells
  396. 393. Loss of skin pigments; sense of touch; inability to feel objects and pain in a pt from Africa; whose skin scraping contains AFBs; is caused by
    Th1-mediated DTH reactions
  397. 394. A man with polycystic kidney dz; who receives a renal transplant and cyclosporine; develops a high temp and swelling and tenderness in the grafted kidney. TOW?
    Immunity to the donor MHC antigens.
  398. 395. A man who now has progressive stupor and laryngeal spasms for 3 days after pt was being attacked by a wild bat in a cave a month ago should have received
    Inactivated rabies virus vaccine
  399. 396. Alternative and lectin pathways of complements activated
    bacterial surfaces
  400. 397. Classic complement pathway is activated by antibody-antigen complexes involving antibody class type
    IgM >> IgG
  401. 398. Chemotactic and anaphylotoxic complements are
    C3a; C5a
  402. 399. successful opsonization of all non-encapsulated bacteria are by complement
  403. 400. Defects or deficiency which complements predisposes individuals to infections caused by Neisseria spp.; the causative agents of gonorrhea and meningitis
  404. 401. Antimicrobial (immune) response important for intracellular bacterial infections involves cell type
    Th1 CD4 T cells
  405. 402. Immune response important for viral infections involves cell type
    CD8 cytolytic T cells
  406. 403. Major antibody in secretions and plays a significant role in first-line defense at the mucosal level is
  407. 404. Main antibody in the initial �primary� immune response and allows good complement activation is
  408. 405. Fc region of this immunoglobulin binds to eosinophils; basophils and mast cells and is significant mediator of allergic (hypersensitivity) reactions
  409. 406. What on macrophages enables them to sense that the material is microbial in origin; and must therefore be eliminated quickly?
    Toll-like receptor
  410. 407. These oxygen-dependent enzymes: NADPH oxidase; superoxide dismutase; and myeloperoxidase are involved in killing of what?
    Gram-positive bacteria
  411. 408. These oxygen-independent enzymes/proteins: lysosome; lactoferrin; defensins and other cationic proteins are involved in killing of what?
    Gram-negative bacteria
  412. 409. Infections persist; because m? activation is defective; leading to chronic stimulation of CD4+ T cells in what dz?
    Chronic granulomatous Dz
  413. 410. Defective respiratory burst; predisposing chronic bacterial infection is associated with deficiency of what?
    Glucose-6-phosphate dehydrogenase (G6PD)
  414. 411. All nucleated cells express MHC I antigens
    HLA-A; B; C
  415. 412. Antigen-presenting cells express MHC II antigens
    HLA-DP; DQ; DR
  416. 413. Lymphocyte proliferation (T; B) and NK ? cytotoxicity are undertaken by what cytokine?
  417. 414. B-cell activation; IgE and IgG4 switch; ? TH1 cells/ M?; ? IFN-?; TH0 ? TH2 are all undertaken by what cytokine?
  418. 415. M? activation; elevated expression of MHC and FcRs molecules on B cells; IgG2 class switching; increased IL-4 and TH2 are all undertaken by what cytokine?
  419. 416. The Th1 response; driven primarily by IFN-? leads to the activation of
  420. 417. The Th2 response; driven primarily by IL-4 and IL-5; leads to the production of IgE and IgG4 and to the activation of
    mast cells and eosinophils.
  421. 418. Variable T and B cells in DiGeroge�s syndrome is associated with
    Thymic aplasia
  422. 419. No B cells and immunoglobulins in X-linked agammaglobulinemia (Bruton�s) is associated with
    Loss of Btk tyrosine kinase
  423. 420. Lack of anti-polysaccharide antibody and impaired T-cell activation causing Wiskott-Aldrich syndrome is associated with
    X-linked-defective WASP gene
  424. 421. Inability to control B cell growth in X-linked lympho-proliferative syndrome is associated with
    SH2D1A mutant
  425. 422. Glomerulonephritis; pulmonary hemorrhage in
    basement membrane collagen
  426. Goodpasture�s syndrome is caused by what autoantigen?
    type IV
  427. 423. Hyperthyroidism in Myasthenia gravis is caused by what autoantigen?
    Thyroid-stimulating hormone
  428. 424. Progressive muscle weakness in Grave�s Dz is caused by what autoantigen?
    Acetyl choline receptor
  429. 425. Brain degeneration; paralysis in Multiple sclerosis (MS) is caused by what autoantigen?
    Myelin basic protein; proteolipid protein
  430. 426. Localized allergies (e.g.; drug allergy; asthma; hay fever) and anaphylaxis (food; drug) w/ systemic inflammation throughout circulation are associated with reaction?
    Type I hypersensitivity
  431. 427. Autoimmune hemolytic anemia: Ab�s produced vs RBC membrane Ag�s; mismatched blood (transfusion rxn); and allergies to antibiotics (e.g.; penicillins; sulfa drugs) are associated with reaction?
    Type II hypersensitivity
  432. 428. Grave�s Disease; Myasthenia Gravis; Goodpasture�s syndrome are all associated with reaction?
    Type II hypersensitivity
  433. 429. Post-streptococcal glomerulonephritis; serum sickness to horse diphtheria anti-toxin; systemic lupus erythematosis (SLE); and rheumatoid arthritis are all associated with reaction?
    Type III hypersensitivity
  434. 430. Poison ivy; erythematous induration in tuberculin skin test; and transplantation/graft rejection are all associated with reaction?
    Type IV hypersensitivity