ID 2

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ID 2
2011-04-25 10:49:38
ID Lab Notes Exam4

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  1. What are the diagnostic tests for Syphilis?
    • Screening: VDRL/RPR
    • Diagnostic: FTS
  2. What kind of reaction is a gumma?
    Type IV hypersensitivity
  3. What's the clinical presentation of primary syphilis?
    • Single painless chancre on penis/scrotum/vulva/cervix
    • Produce central ulcer
    • Present 3 wks post infection; resolve in 3-6 wks
  4. What's the clinical presentation of secondary syphilis?
    • Widespread mucocutaneous lesions of oral cavity, palms, soles
    • Present 2-10 wks post chancre
  5. What's the histological presentation of primary syphilis?
    • plasma cells, macrophages, endothelial activation -> fibrosis
    • Spirochetes (silver stain/immunofluorescence)
  6. What's the histological presentation of secondary syphilis?
    • Plasma cell infiltrate and enarteritis
    • Less intense inflammation
  7. What's the presentation of tertiary syphilis?
    • Presentation after 5 yrs latency
    • Cardiovascular (aortitis/aprtic valve insufficency)
    • Neuro (tabes dorsalis)
    • Benign (gummas in bone, skin, mucosa, upper airway)
    • No STI
  8. What is the Jarisch Herkheimer Reaction?
    • High syphilis bacterial load
    • Bacterial treatment
    • Massive exotoxin release
    • Fever, Rigus, HOTN, leukopenia
  9. What's the histological pattern in syphilis?
    Perivascular infiltrlate (plasma cells) in dermis
  10. What's a diagnostic stain for fibrosis from gummas?
    Trichrome stain (tertiary syphilis)
  11. What are the stages of Lyme disease?
    • 1. Acute illness (lymphadenitis/targetoid rash)
    • 2. Dissemination (CNS/Cardiac)
    • 3. Chronic (Arthritis, neuropathy)
  12. What are clinical presentations of Clostriduium sp?
    • C. dificile - Pseudomembranous colitis
    • C. cellulitis
    • C. perfungens - gas gangrene
    • C. botulism
  13. What's the gross hallmark of pseudomembranous colitis?
    Abundant plaque like adhesions on mucosa; necrotic debris
  14. What's the mechanism of C. dificile damage to colon?
    • Toxin a/b -> cytokine production
    • Host Cell Apoptosis
  15. What oragnisms cause destruction of bowel mucosa?
    • Shigella (distal colon)
    • Salmonella (blunting/vascular conjestion)
    • Yersinnia, Cholerae, Jejuni
  16. What are severe complications of bacterial entercolitis?
    Who needs Tx?
    • Barier destruction, fluid loss, perforation
    • Elderly & young pts
  17. What's the process for determining skin/soft tissue infection?
    • 1. ID organism
    • 2. Urgency (depth/life/limb)
    • 3. Intervention
  18. What's the pathogenesis of C. perfringens?
    • a-toxin -> destroy cell membranes/matrix proteins
    • Sudden onset
    • Edema/Gas bubble
    • HOTN/renal failure/organ dysfunction
  19. What toxin is related to C. Tetani?
    • Tetanospasmin
    • Bblock release of GABA (spastic paralysis)
  20. What's the toxin related to C botulinum?
    • botulims toxin
    • prevent ACh release (flaccid paralysis)
  21. What's the characteristic rash pattern of RMSF?
    • Distal --> Central
    • Palms & soles
  22. If you have a pt with DIC what tests do you order?
    Fibrin split products and d-dimer
  23. What's the rickettsia triad?
    Fever, headache, rash
  24. What's the diagnostic test for RMSF?
    Indirect fluorescent antibody or skin biopsy with immune staining (7-10 days post disease onset)
  25. How is RMSF trasmitted?
    • Rickettsiapox - mite
    • Other rickettsia - ixodid tick
  26. What's the pathogenesis of RMSF?
    • Intracellular
    • Blood borne -> endothelial invasion
    • Increase permeability
    • HOTN, thrombocytopenia
  27. What are complications of RMSF?
    • Interstitial pneymona & myocarditis
    • Renal failure -> death
    • Brain microinfarcts, skin necrosis
  28. What's the clinical presentation of Ehrlichiosis?
    • Cytoplasmic inclusion appearing like mulberry
    • Abrupt headache, fever, malaise, rash
  29. What's the complication of Rickettsia prowazeki?
    • Typhus fever/nodule in brain
    • Focal microglial proliferation of Tcells and macrophages
    • Body Louse
  30. What types of patients are seen with Candida infection?
    Immunocompromised patients (prego, DM, HIV)
  31. What are clinical examples of candida infection?
    Vaginits, thrush, diaper rash
  32. What do you see histologically on Candida infection?
    Budding yeast /pseudohyphe
  33. What are hematogenous disease caused be Candida?
    Blood, heart, meninges, kidney, lung, spleen, joints
  34. What types of fungi cause pulmonary infections?
    • Histoplasma - ohio & mississippi
    • Coccidioides - southwest
    • Blasomycosis - southeastern
  35. What are diagnositc techniques for fungal infections (superficial, deep, disseminated)
    • Superficial - KOH
    • Deep - biopsy with silver/PAS
    • Disseminated - multiple cultures
  36. What organism produces the soap-bubble lesion?
    Cruptococcus neoformans
  37. What's the organ involvement of Asperfillus; what does it look like?
    • Angioinvasive
    • Wages of necrosis Lung, heart
    • Acute angle branching
  38. Which Hb types are protective against malaria?
    HbS, HbC
  39. What's special about the Negative Duffy Ag?
    Protective against Vivax
  40. What are complications of malaria?
    Hepatosplenomegally, Congestion/edema (pulmonary, renal, cerebral)
  41. What's characteristic of Babesia
    • Maltese Crosses in cells
    • Northeast exposure to ixoides tick
  42. What's the cause of overwhealming malaria parasitemia?
    • RBCs become sticky and adhere to endothelial surface
    • Microinfarcts
  43. What are the serotypes of chlamydia?
    • A-C: trachoma
    • D-K: urethritis
    • L1-3: LGV
  44. What are genital diseases caused by C. trachomatis?
    NGU, epididymitis, mucopurulent cervicitis, PID, proctitis
  45. What is Lymphogranuloma venereum?
    • Mixed granulomatous/PMN response to C. trachomatis
    • Chlamydia inclusions in cytoplasm
    • HSV confusion??
  46. What is trachoma? How's it transmitted?
    • Chronic conjunctivitis
    • Eye --> eye
  47. What is the Elementary/Reticulate body?
    • EB: Infectious
    • RB: Intracellular
  48. What's Reiter's disease?
    • C. trachomatis complication (HLA-B27)
    • Pee, see, knee