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How large must something be to cause immune response?

> 6000 Daltons Define the following terms: Antigen - Any definable moiety Hapten - < 6000 D Immunogen - > 6000D Only known Immunogenic lipid Cardiolipin #1 factor for immunogenicity Variability What is the carrier effect? Using a known immunogenic substance with an attached hapten in the hopes that the body will recognize the hapten Macrophages Process antigens by? Macrophages Engulf, Digest, and present haptens on the variable Beta chain of MHC II. When this happens the invariant chain is pushed out of the way and the macrophage begins making IL-1. What is the only cell that releases IL-1? What is IL-1's function? IL-1 is Responsible for? fever and all feelings of sickness. It starts the immune response by recruiting more macrophages and T-Cells. Hot to fight infection Detergent Impairs Adhesion Antiseptic # of Pathogens Disinfectant #of Pathogens Sterilization Kills Spores How to kill spores 121 Degree vaporized heat for 15 min. How do disinfectants & Antiseptics work? They kill pathogens by dissolving the cell membrane Humoral Response B-Cells PMN Cell Mediated Response T-Cells Macrophages Cell-Mediated vs- Humoral Bacteria Humoral response Everything else Cell medicated response

Name the macrophage Brain Microglia Lung Type I Pneumoncite Liver Kupfer Cells Spleen RES Kidney Messangial Cell Lymph Node Dendritic Cell Bone Osteoclasts Skin Langerhans CT Schistocyte Giant Cell, Epithelioid Timeline for all infections 1st 24hr - Swelling 24hr PMN show up PMNs peak at day 3 If bacterial PMN's remain If not, T-Cells/MO show up at day 4 & peak at day 7 Fibroblasts show up at day 7 & peak at one month Fibroblasts takes 3-6 months to finish scarring. Cell-Mediated order of Infx Virus - CMV, EBV Fungus Microbacterium Protozoa Parasite Neoplasm Nutrition affect which immunity? Cell mediated before Humoral MCC of death in all cancers Bacterial Infection except cervical cancer where MCC of death is RENAL FAILURE. % of Lukenias that are B-cell 98% MC T-Cell Immune diseases DiGeoges Prednisone Cyslsporine Wiscott Aldrich SCID HIV T-Cell Lukenia T-Cell Lymphoma Mucocutaneois Candidiasis MC B-Cell Immune diseases Brutons Wiscott-Aldrich SCID B-Cell Lukemia B-Cell Lymphoma JOB Selective IgA Def

Selective IgG2 Def Multiple Myeloma Heavy Chain Disease CVID MC PMN Immune diseases CGD Nutropenia MC M0 Immune diseases CGD Chediak-Higashi Two T-Cell Lympmonas Mycosis Fungoides Sezary blood Clue for T-Cell Lymphomas Crenated cells Clues for Hairy Cell Lukemia Sunburst appearance Fried Egg appearance TRAP positive Name the defect in DiGeorge Failure 3rd & 4th pharyngeal arches to develop Name the defect in Mucocutaneous Candidiasis Chronic infection with candida Name the defect in SCID Adenisine deaminase deficiency Name the defect in Wiscot-Aldridge Defect in Class switching Name the defect in JOB syn. Hyper IgE due to class switching problem Name the defect in CGD NADPH oxidase deficiency. Features of DiGeorge's Absent Thymus Absent Inferior Parathyroid Decreased Ca2+ Tx: Transplant Thymus Immunoprivaledged Sites (Due to no Lymphatic flow): Thymus Testes Brain Cornea Clues for Kleinfelters Tall man with small testes Clues for Fragile X Short man with large testes.

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What gene protects from HIV CCR5 MCC proteins found in HIV Gp120Attach to CD4 receptor Pol gene - Integrates HIV RNA Reverse Transcriptase - Transcribe RNA p17/p24 - Used for Assembly gp41 - Surface marker Fastest in HIV population Heterosexual black female Elderly Reason Men pass HIV easier HIV loves mucosa easier for men to transmit to women. Reason Harder for preadolescents HIV Decreased vaginal pH HIV enters body and attacks? Vessel Vasculitis/Kaposi Brain- HIV Dementia Testes - Testicular Lymphoma Describe Kaposi Sarcoma Violatious Nodules How HIV Attaches to Cervix Likes CD4 receptor Female cervix is rich in CD4 receptors Cells that HIV attacks T-Cells and Macrophages What happens to other Cells in HIV? B-Cells and neutrophils will undergo hyperplasia leading to increased B-Cells and hyper-gammaglobulins Normal CD4 count CD4 800-1200 When do you start HIV Rx CD4 count < 500 PCP presents at CD4 of? Less than 200 Treatment for PCP Trimethaprin/Sulfamethoxazole If allergic to sulfa drugs use Pentamidine (Aerosole) MAI presents at CD4 of ? Less than 100 Treat MAI with Clarithromycin.

Defect in SCID Deficient Adenosine Deaminase Defect in Wiscott-Aldridge Defect in Class switching (CD 40 cells - IL4 responsible) Clue for Wiscott-Aldridge Fair skin with xema and thrombocytopenia Mechanism of Cyclosporin Inhibits production of IL-2 by T-Cells which inhibits Calcinuria Defect in Bruton's B-cells present but 2nd messanger (Tyrosine Kinase) does not work Clues for JOB Syndrome Hyper IgE Red hair female Clues for Selective IgA Def. MCC of Anaphylaxis in transfusions Clues for Selective IgA Def. MC Subtype Infx from encapsulated organisms MCC of every "PENIA" Viral infection Drugs Defect in CGD NADPH Oxidase deficiency How do you test for CGD? You want a negative NBT test Defect in lazy leukocyte syndrome PMN slow and lethargic What does a WBC tell you? White Blood Count, which is a measure of Leukocytes Normal White cell count 4-12 K Explain Demargination WBC represents only 10% of white cells in circulation 90% are marginated against the vascular endothelium 95% of these marginated cells are mature (PMNs). Less than 5% are Blasts. You can call them back into circulation Called demargination.

Define Demargination Recruiting marginated white cells back into circulation What hormones cause demargination Stress Epinepherine Cortisol What must you see in CBC to call infection? Bands Incr. WBC with all PMN Stress demargination Incr. Blasts < 5% Leukemoid Rxn Extreme stress Incr. Blasts > 5% Leukemia Whenever you biopsy a lymphnode You are looking for cancer, specifically LYMPHOMA. What is a myelodisplastic Syndrome? The entire Bone Marrow is involved. Steps in Chemotaxis Pavementing Selectins - Select out of circulation Integrins ICAM1-Anchor to vascular endothelium Flattening Marginate Walking Diapedesis - looking for gap between cells Migrate WBC concentrations Never Neutrophils 60% Let Lymphocytes 30% Mom Monocytes 8% Eat Eosinophils 2% Beans Bands/Basophils <1% Steps in Gram Staining COME - Crystal Violet IN Iodine AND Alcohol STAIN Safrinin Crystal Violet stain? Stains Petidoglycan Gm (+) What does Iodine do? Seals in the Crystal Violet What is the function of Etoh? Washes excess Crystal Violet What is stained by Safrinin?

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Gram (-) are stained pink How is staining of acid fast organisms different from Gm The opposite to gram staining occurs, pathogens are stained PINK and others are stained BLUE. Acid Fast Organisms Mycobacterium Nocardia Cryptosporidium Gm(+) with Endotoxin Listeria Features of Gram Negative 1 Peptidoglycan layer Outer membrane Endotoxin (LPS) Where is O-Antigen located? In the Periplasmic Space Endotoxins Virulence Cuase by Lipid-A Most variable part of LPS Core Bugs with Exotoxin E. Coli Pseudomonas Vibrio Bordetella Pertussis BACTERIAL KILLING PMNs show up 24hr peak 3d PMNs bring Myeloperoxidase O2 + H2O H2O2 denatures proteins Primarily gm(+). Some bacteria have catalase which breaks down peroxide to water Free Radicals - High energy bonds, kill anything in site PMNs also bring in NADP -Oxidase (Oxygen burst - day 7) which make bleach: O2 + H2O O OH HOCl- H2O2 Super oxide dismutase breaks bleach into peroxide Catalase (+) Bacteria Staph Aureus Pseudomonas Most Infx become anaerobic at day ?

Most infections become anaerobic at day 7 due to oxygen burst Day 1-3 staph Aureus Day 4-7 Strep Left shift of CBC means Immature Cells Young PMNs are needed to Young PMN have greatest amount of Myeloperoxiase (BANDS) Calculate Absolute Neutrophil Count (ANC) (% PMN + % BANDS) * WBC Normal ANC < 2500 Neutropenic < 1500 Moderate Neutropenia < 1000 Severe Neutropenia Patients Susceptipble to staph and Psuedomonas Neutropenia Burn Diabetics Monocytes are precursors to Macrophages MCC of monocytosis S - Salmonella Typhi T - TB E - EBV L - Listeria Monocytogenes S - Syphilis Allergic Reactions Primary Response 1st time you come into contat with allergen IgE Secondary Response 2nd time you come into contact with allergen IgE (1 Fab and 1 Fc) buries Fc portion into mast cell and causes degranulation. Eosinophils moderate Mast cell response Released by Mast Cells Histamine SRS-A EOS chemotactic factor Released by EOS Histaminase Heparin Arylsulfatase Mechanism of Heparin Is the cofactor for ATIII which inhibits Thrombin and factors 9, 10, 11, and 12.

What is a therapeutic INR 2-3 times normal Monitor Heparin with PTT Causes of Eosinophilia N - Neoplasm A Astham/Allergies A - Addisons C Collagen vascular dz P Parasites Biopsy a looking for Lymphoma Clues for Hodgkins + Reed Steinberg Cells Young person Hodgkins Staging 1 - 1 group Lymph nodes 2 - 2 nodes same side 3 - 2 nodes different sides 4 - Metastasis A - Without Symptoms B - With Symptoms Hodgekins Lymphomas MC - Nodular Sclerosis Best - Lymph predominant Worst - Lymphocyte depleted Int- Histiocytic/Lymphocytic Rx for Hodgkins Lymphoma A - Adiamycin B - Bleomycin V - Vinblastine D - Dacarbazine Clues for Non-Hodgkins - Reed Steinberg Cells MCC in GI tract (ileum) AIDS - CNS and TESTES MC Non-Hodgkins Follicular Lymphoma (t 14/8) Most notorius Non-Hodgekin Burketts Where do US Patients Burketts? Ileum African Patients Burketts In Jaw associated with EBV With other cancer is ass with EBV? Nasopharyngeal Carcinoma

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Describe Non-Hodgkins Starry Sky appearance (t 8/4 BCL-2) Clues for Mycosis Fungoides Fungal rash with crenated Lymphocytes. Rules for Leukemias 98% - B-Cell Leukemic Line destroys others Increased WBC and increase BLASTS > 5% Acute - Bone Marrow Chronic - Periphery (Mature) Who is the precursor? Lymphoblast Lymphocytes (T and B Cells) Myeloblastic PMN Monocytes, Macrophages Men tend to get Cancer 0-30yo 50yo and older Women tend to get cancers Age 30-50 MCC Ages for Leukemias ALL 0-15yo AML 15-30yo CML 30-50yo CLL > 50yo Clues for ALL TDT - Lymphoblastic marker CALLA - good prognosis Ages 1-10 - good prognosis Treat with Prednisone Clues for AML Auer Rods - Stains with sudan black and leukocyte alk phos. Clues for CML When macrophages go, you increase this line Philadelphia Chr - t(9/22) Clue for CLL Old man with lymphadenopathy Clue for promyeloblastic Causes DIC Most important Stage M3

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Immune Response seen with Bacteria Humoral with B-Cells and PMN Pathogens on the skin Staph. Aureus Strep. Pyogenes. Strep. Epidermitis Propionobacterium Acne MCC of All skin Infections Staph Aureus. Which skin Infx is not Staph Lymphangitis Impetigo Necrotizing Fascitis Eryselalis Scarlet Fever What causes LINES? Strep. Pyogenes. Cellulites vs- Erysipelas Cellulite- flat and blanch Erysipelas-Raised/not blanched 3 features of Scarlet Fever? Sandpaper Rash Strawberry Tongue Rash on Palms and Soles. Bullus Impetigovs- Impetigo Impetigo Strep Bullous Impetidgo Staph Clue for Impetigo Honey crusted lesion Define the Following: Carbuncle - Boil (firm) Furuncle C + follicle Folliculitis - Pus at hair follicle Cellulitis - Area of redness Panniculitis Pannus Oompholitis - Belly button Mastitis Breast Infx caused by Staph Epi? Shunt infection Central Line infection MCC Acne? Proprionobacterion Acne Women & adolescents have more acne because ? Proprionic acid is stimulated by progesterone, which is high in women and adolescents

Rx for Proprionobacterion Expose to air OXY5/OXY10 Pads Antibiotic Retina - Isotretinoin Pathogens in Mouth S. Pyogens S. Pneumonia H. Influenza Neisseria Meningiococcus 3 with IgA protease S. Pneumonia H. Influenza Neisseria Meningiococcus Obligate Aerobic organisms: Must Breathe, Clean, Fresh air Must - Mycobacterium Breathe - Bacillis Clean C. diphtheria Fresh - Frenciella Moral Infx start after a viral infection because? Organisms live in the mouth and are normally innocuous because the cilia beat the organism up and they are swallowed. Viral infections paralyze the cilia and lead to infections by these organisms. Does skin or throat Strep cause PSGN? Either can cause PSGN Does skin or throat Strep cause Rheumatic Fever? Throat Strep Jones Criteria Polyarteritis Carditis Subcutaneous Nodules Erythema Migranata Syndenham Chorea Pathogens found under gum: Streptococcus Peptostreptococcus Actinomyces Fusobacterium Strep Veridans Strep Mutans Strep Sanguis Strep Salivarius Bug with "Sulfur Granules"? Actinomyces Israelii 2 Fusobacterium diasease? Vincent's Angina - Painful ulcer in the back of the throat & Trench Mouth

MCC SBE Strep Veridans What bacteria cause carries? Strep Mutans Septic Emboli from SBE Brain - Mycotic Aneurysm Retina - Roth Spots Fingertips - Oslers Spots Toes - Janeway Lesions Under nail beds - Splinter Hemorrhages 5 Urease (+) pathogens H. Influenza Proteus Pseudomonas Cryptococcus Ureoplasma Urolytica MCC found in Stomach H. Pylori 2 ulcers H.Pylori Causes Gastric - 70% Duodenal - 90% Most Abundant in sm Intestine? E.Coli 4 vit which E. Coli makes Biotin Folic Acid Panthothenic Acid Vit K Vit E. Coli helps absorb B12 Most abundant gas in the colon? Carbon dioxide Gases responsible for the smell in flatulence? Methane and sulfur Pathogens found in the terminal ileum/colon? Clostridia Dificile Clostridia Malanogocepticus Strep Bovis Bacteroides Fragilis E.Coli Proteus Serratia Marscescens Actinobacter Citrobacter Pseudomonas Klebsiella

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Pathogens causing colon cancer? Strep Bovis Melanogocepticus Most abundant organism in the colon? Bacteroides Fragilis Name the Pathogen: Red Pigment Serratia Multiple cerebral abscesses - Citrobacter Colonizes everyone after a 48hr stay in the hospital - Pseudomonas Seen in alcoholics - Klebsiella Normal Rectum Flora anGEL Group B Strep E. Coli Listeria Staph Aureus Enzymes Catalase -Lactamase Coagulase Staphylokinase Erythrodermotoxin Lipase Hyaluronidase Collagenase Staph Aureus toxins TSST - Fever, Shock, Red, Rash on Palms and Soles SSSS - (+) Nykolsky Exfolatoxin - Scalded skin Enterotoxin dairy products. 5 bugs and their colors Strep. Veridans - Green Staph. Aureus - Gold Pseudomonas - Blue-Green Serratia Mecansus - Red Staph. Epidermitis - White Infx caused by Staph Epi Central Line Infections Shunt Infections Infx by Saprophyticus? UTI in women 5-10 & 18-24 Antibiotic to Rx Epidermidis Vancomycin. Palms and Soles SSS- Staph Aureus Syphilis - Treponema Pallidum Scarlet Fever - Strep Pyogens TST - Strep Pyogenes RMSF Riketsia Ricketsia Kawasaki Coxsakie Hand/Foot/Mouth

Who gets Pneumovax? Greater than 65 yo Sickle Cell > 2yo Sickle Cell with end organ damage. Give the DOC for: Staph Epi. Vancomycin Pyogenes Apmicillin Agalactiaceae Ampicillin Nitrate Negative UTI? Enterococcus MMC of Meningitis by age 0-2mos GEL 2mos-10yr SHN 10yr -21yr Neissaria >60yrs Strep Pneumo Only Gm(+)diplococci Strep Pneumo Kidney bean Shaped Normal Flora in rectum Group B Strep E.Coli Neissaria Meningitidis MCC of PSGN Strain 12 - Group A Strep (Pyogenes) Differentiate Strep strains by Their M-Protein. Give the strep class Group A Pyogenes Group B Agalactiaceae Group D Enterocossus Pregnant womans rectum culture returns (+) for Group B Strep. Rx with? Ampicillin Infx caused by Group C Strep Pharyngitis Infx caused by Group D Strep SBE Spore formers Clostridium Bacillis 5 causing heart block Chaga's Disease Legionella Lymes Diptheria Salmonella Typhi

4 features of spores: Formed in harsh environment Not replicating -release toxin Do not like heat D-dipacolonic acid membrane Membrane of Bacillus has? Poly D-glutamic acid 3 factors in Bacillus Anthracis Protective factor Lethal Factor Edema factor Infx caused by B. Anthracis Cutaneous - malignant pustule Pulmonary - Wool sorter's disease Bacillus Cereus causes? Gastroenteritis associated with Chinese fried rice C. Dificile causes Pseudomembranous colitis associated with antibiotic use C. Botulinum Causes Botulism Children honey & molases Adults - Canned foods C. Tetani causes Lockjaw in association with dirty wounds. C. Perfringins causes Gas gangrene Best Rx for C.dif colitis Vancomycin Current Rx for C.Dif colitis Metronidazole Botulinum toxin works by Inhibiting presynaptic release of Ach. C.Tetanus work by? INH release of Gly from S.C. What works like C. Tetanus? Strychnine 1st step to treat dirty wound Tetanus Anti-toxin C. Perfringins Infection Gas Gangrene Treatment for Gas gangrene Immediate Amputation

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Air emboli hurt by Causing Ventricular Outlet Obstruction Treatment for VOO L. Lateral Decubitus Chest PT on Right Associated with Holiday Ham & Turkey? Clostridium Clostridium associated with colon cancer? Melanosepticus What bacteria Looks like Chinese letters? Coreynebacterium Most bacteria acquire their toxins through ? Transduction. ADP ribosylation of EF-2 Diptheria ADP ribosylation of Gi ADP ribosylation of Gs Only acid fast GM(+) NOCARDIA Cluses for Nocardia Attack Diabetics Sinuses & Lungs. Behaves like a fungus. Only Gm(+) with endotoxin Listeria Illness caused by listeria Gastroenteritis in adults Clues for Listeria Raw Cabbage Spoiled Milk Migrant workers 5 - cause monocytosis: Salmonella TB EBV Listeria monocytogenes Syphilis 3 bugs Caused illness in 8hrs Bacillus Staph aureus Clostridium Reason for illness in 8 hrs Preformed toxins

Immune response with parasites? Cell mediated response with Tcells and Macrophages. What part of the body do parasites like? They like the GI tract and they cause Gastroenteritis. List all the liver flukes 1. Schistosomiasis Mansoni 2. Schistosomiasis Hematobium 3. 5. Clinorchis Sinessis 4. Echinococcus 5. Toxacara Given the following, name the organism: 1. Walking barefoot in the swamp 2. Raw lamb 3. Cat or Dog larvae 4. Biliary tract infection 1. 2. 3. 4. Schistosomiasis Echinococcus Toxacara Clinorchus Sinesis (Opthorcus)

Enzyme which indicates biliary tract involvement? Alkaline Phosphatase Rx for liver flukes? Prazaquintel Most common hookworm in US Necatur Americanus Hookwork causing rectal prolapse Tricarius Tricharia Worm causing duodenal obstruction Ankylostoma Duodenale What drug is used to treat Strongyloides? Thiebendazole Which worm lives in the Cecum? Enterobius Vermicularis (Pinworm) What does the pinworm cause? Pruitis Ani (Itching) Treatment for Hookworms Mabendazole Stongyloides Thiabendazole Worm that travels from the cecum to the anus to lay eggs Enterobius Vermicularis List all the flatworms: D. Latum Taenia Sanginata Taenia Solium Trichinella Spiralis Name the worm flatworm B12 deficiency D. Latum Raw Beef Tniea Saginata Raw Pork Tinea Solium Bear Meet Trichinella Spiralis Infantile form, Raw Pork - Cistocercosis Masses in the brain, floater across visual field -Cistercircosis What is the treatment for flatworms? Hyclosamine &Niclosamine How do these agents work? They paralyze the worm's nervous system Protozoa causing skin infections? Leishmania Cause of Gulf War syndrome? Leishmania

Infection due to Toxacara penetrates the skin? Cutaneous Larvae Migrans Infection is due to Toxacara invasioning organs? Visceral Larvae Migrans Rx for parasitic infections? Prazaquintel Name the hookworms: Use the nemonic: NEATAS N - Necatur Americanus E - Enterobius Vermicularis A - Anklystoma Duodenale T - Trichurius Trichiura A - Ascaris Lumbricoides S Strongyloides Hookworms cause disease by? Hooking into the GI tract and cause decreased absorption leading to diarrhea. What syndrome is associated with Pulmonary Infiltrate with Eosinophilia? Loeffler Syndrome The PIE organisms Use the nemonic NASSA N - Necatur A - Anklystoma S - Strongyloides S - Schistosomiasis A Ascaris

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Protozoa causing skin & nose infections? Leischmaniais Danavini How is Leishmania transmitted? By Sandflies The organ infection caused by Leishmania is called Kala-Azaar What causes Kala-Azaar? Leischmaniais Rodiensis Protozoa associated with the GI System? Giardia Entamoeba Histolytica Microsporidia Cryptosporidia Name the organism: Fresh water/Well water - Giardia Multiple liver Abscesses Entamoeba Histolytica MC in AIDS patients - Microsporidia Watery diarrhea in AIDS Cryptosporidia Only acid fast protozoa? Cryptosporidia Organisms that cause Heart Block Chagas Legionella Lymes Disease Diptheria Salmonella Protozoa affecting the ling Pneumocistis Carinii What CD4 count causes concern for this organism? < 200 RX for PCP Trimethaprim/Sulfamethoxazole Rx For Patients Allergic to TMP/SULFA Pentamidine RX for Leishmania Stybogluconate Trypanosoma Cruzii cause disease by It likes to eat ganglia

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Disease caused by Trypanosoma Cruzii Chagas's disease Name the organism Cat Urine Toxoplasma Swimming in a swamp - Niglaria Fowlerii Tse Tse fly Topanosoma Rhodensis Contact lenses Acanthomeoba Dog saliva Erlichiosis Like malaria BabeosisAcanthomeoba Dog saliva Erlichiosis Acts Like malaria Babeosis What is the treatment for Toxoplasma Pyramethamine/Sulfamethoxazole Niglaria Fowlerii invade the body by? Entering through the cribiform plate. What is the treatment for Babeosis? Treat it like malaria What is the most common cause of death worldwide? Plasmodium Malaria What is the most common cause of hemolytic anemia? Plasmodium Malaria Malaria protocol for travelers? Once a week for two weeks before trip. Once a week for each week away Once a week for four weeks after return What is the fever profile for: 1. Plasmodium Malaria 2. Plasmodium Falciparum 3. Plasmodium Vivax 4. Plasmodium Ovale Fever every four (4) days: Plasmodium Malaria Fever Every three days: 1. Plasmodium Falciparum 2. Plasmodium Vivax 3. Plasmodium Ovalle Form of Plasmodium that is Most fatal Falciparum MC worldwide Malaria Likes Mature RBC's Falciparum Likes Reticulocytes Vivax Chronic disease Vivax &OvalleVivax What drugs are used to treat Malaria? Chloroquine Mefloroquine Primaquine Quinine

Malaria Rx work by Causing Oxidative stress to RBC's & causing them to lyse. Which Malaria Rxs have the best liver penetration? Chloroquine & Mefloroquine

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Immune response seen with fungi Cell Mediated Tcells & Macrophages What Environment do fungi like? Warm, Dry, Sugary How are fungi different from bacteria and human cells? They have a unique cholesterol (Ergosterol) Goal of treatment with antifungal? Target Ergosterol Topical(creams) antifungal work by? They bind to Ergosterol and destroy it (Poke holes in the membrane) Human molecule damaged Antifunfals Cholesterol What topical antifungal is parenteral? Amphotericin B Hyperkalemia + Amphotericin mean? Systemic Toxicity due to destruction of cholesterol in the cell membrane leading to leaking of K+ into cytoplasm. Hypokalemia + Amphotericin mean? Nephotoxicity due to destruction of the cholesterol in the kidney cells and K+ leaks out in urine. Side Effects of Amphotericin? Hypokalemia Hyperkalemia Renal Failure How do the IV/Oral antifungal work? By inhibiting the synthesis of Ergosterol P-450 dependant drugs Warfarin Estrogen Theophalin Phenytoin Digitalis One dose treatment for candidiasis? Fluconazole Imidazole that crosses (BBB)? Fluconazole Imidazole inhibits P450? Ketoconazole Why can you not use topical and IV/Oral antifungal in combination? Because IV/Oral antifungal inhibit the synthesis of ergosterol and topicals bind to

Ergosterol and destroy it. So if there is no Ergosterol, the creams cannot work. How does griseofulvin work? It inhibits microtubules leading to inhibition of fungal replication. How is Griseofulvin delivered to the infected site? Through the sweat Sporonox treats? Toxic side effect? Nail fungus, Liver toxicity Superficial fungal infections? Piedra Clue for Piedra Little black balls on the hair shaft Treatment for Piedra Cut the hair Name of the infection: Tinea Capitis - Flaky crust on scalp Tinea Corporus - Ring worm Tinea Barbae - Infection on chin Tinea Versicolor - Back Infx, Xmas tree Tinea Nigra - pigmentation in hand lines Tinea Interigo - Infection in the skin folds Tinea Pedis - Athletes foot Reddened, macerated infection between fingers 2 fungal infections Rx by Griseofulvin? Tinea Capitis and Tinea Versicolor What is a Karion? Skin infection superimposed on a tinea capitis infection. How is it treated? Tinea Capitis - Griseofulvin The Infection (Staph Aureus) - Antibiotics The Inflammatory infection - Steroids Why should you not scrape a tinea corporus infected site? The site has live organisms. Scraping will cause further infections. Fungal infection is seen in the nail bed? Tinea Unguum MCC vaginitis in women? Candida Rx with Fluconazole What are the deep fungal infections? Tinea Unguum and Candidiasis MCC causes of vaginitis Candidiasis

Gardnerella Trichomonas Name the Organism White curdy discharge - candita Fishy odor with clue cells - gardnerella Frothy green discharge - trichomonas Most likely to get Candidal infections? Immunocompromised individuals (Tcell Mediation) Where is the country are these found? Given the following location clues, give the fungal infection: Midwest - Histoplasmoss East coast - Blastomycosis Southwest - Coccidio South America/Puerto Rico - Paracoccidio Moldy Hay/Basement - Aspergillus Organisms from the Southwest Coccidiomycosis Hanta Virus Histoplasmosis Clues to Histoplasmosis Midwest Bat droppings Pigeons Clues for Actinomycosis Pigeons Broad based hyphae Cavitates Clues for coccidiomycosis Southwest Thin walled cavities in the lung Clues for Paracoccidio Southamerica Looks like ships wheel Clues for Aspergillus Cavities with fungal ball Persistent Severe Asthmatic symptoms with increased eosinophils and increased IgE. Clues to Sporothrix Rosebush stick Clues for Rhozor/Mucor Mucosis Growing out the nose of diabetics MCC pulmonary infiltrate with Eosinophilia (PIE)? Allergic Broncho pulmonary Aspergillosis Loeffler - Infiltrate in Lung from Parasite Churg Strauss - Idiopathic

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Rx for Syphilis: Primary - 1.2x10 6 in one Buttock Secondary - 2.4x10 6 2 in each Buttock Tertiary - 2.4x10 6 x 3 wks 2 each Buttock . Neonate - 50,000 Kg/day for x 7-10 days Treatment for ALL SPIROCHETES? PENICILLIN Rule of six (6) for Treponema Pallidum A Painless Chancre will appear. If no Rx wi 6 wks it will disappear Reappear 6 wks later Disappear 6 wks later Neurological symptoms 6 years later Where in the brain does Treponema Pallidum infect? The Edinger-Westfall Nucleus What part does it particularly attack? Tabes Dorsalis Result of attack on EW nucleus? Argyle Robertson Pupils. What is the clue for treponemal pain? Shooting, Lancinating, Stabbing Neonate Syphilitic infection Snuffles - Destroys sinuses Hutchinsons Teeth Sabre Shin anterior bowing Rhagades - Split from corner of mouth. PseudoParalysis - Bones hurt movement Most specific test for Syphilis #1 Dark-field Microscopy - Most Specific FTA TPI Which Syphilitic tests are most sensitive? RPR and VDRL Which test is used to test pregnant women for Syphilis? RPR - Blood test Which test is used for screening for Syphilis by testing the CSF? VDRL How long does RPR stay positive? One Year Why are RPR and VDRL not specific for Syphilis? Because it will also be positive with Rheumatoid Arthritis and SLE.

TORCH organisms Toxoplasma Syphilis Rubella CMV Herpes Clues for Toxoplasma Associated with Cat urine Clues for Rubella Hearing loss Cataracts PDA Autism Clues for Herpes Multiple ring enhancing lesions in parietal lobe. Clues for CMV Central calcifications (nonfunctional legs, but arms work), and eye problems. MCC congenital blindness? CMV If a pregnant woman has a herpetic outbreak wi two weeks of delivery? Deliver by C-Section Vector for LYMES Disease? The IXODES Tick What organism causes LYME'S Disease? Borrelia Bergudorfi 3 diseases carried by IXODES tick? Lymes Disease Babiosis Erlichiosis Clues for primary stage of LYME'S? Erythema Chronicum Migrans (Red rash migrating outward). Flu like Symptoms Only 60% Symptomatic Clue for secondary LYME'S Disease? Arthritis and Carditis (HEART BLOCK) Clue for tertiary stage of LYME'S? Neuropathies How is LYME'S Disease Diagnosed? History Lyme Titers (IgM and IgG to Borrelia). Rx for LYME'S disease? Penicillin First Line Tetracylcinis Fever Patterns Brucellosis Undulating Fever Malaria

Clues for BORRELIA RECURRENTIS? Fever Head Ache Nonspecific SSX qwk x 5-6wks BORRELIA RECURRENTIS likes to hide in? It escape detection by? Hides in Lymph nodes Escapes by going through variation. What disease is caused by LEPTOSPIRA ENTEROGANS? How is it transmitted? What organs are particularly affected. 1. Causes Fort Bragg Fever. 2. Is transmitted by Rat Urine 3. Likes the Liver and Kidney (Weils disease) => Hepatitis and Kidney disease. List the ATYPICALS? 1. Chlamydia Pneumonia 2. Ureoplasma 3. Legionella 4. Mycoplasma MCC atypical pneumonia 0-6 months? Chlamydia Pneumonia infiltrate seen in atypical Infections? Cell mediated Tcells and Macrophages. In addition to T-Cells and M0, what else is seen with chlamydia Infx? Why? Eosinophils. This is because Chlamydia is an obligate intracellular organism. What are the two bodies that appear in CHLAMYDIAL infections? What does each indicate? 1. Reticulate Body - Resting Stage 2. Elementary Body - Infective Stage Chlamydia associated with what 2 dz? Nerofibrillary tangles of Alzheimer's Atherosclerotic Plaques of Angina. MCC of neonatal blindness? Chlamydia Trichomatis MCC congenital blindness? CMV What are the deep corneal ulcerations caused by CHLAMYDIA called? Trochomas

Neonatal Conjunctivitis 1st 24hrs Chemical from silver nitrate 2-7days Opthalmia Neonatorum - GC More than 7 days Chlamydia MCC of STD, PID, CERVICITIS, & SALPINGITIS?

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Chlamydia Trichomatis % of aymptomatic Chlamydia Infx Ninety percent (90%) MCC of infertility in women? Chlamydia Trichomatis Chlamydia Psittacii is transmitted by? Parrots and Parakeets Urease positive organisms? P- Proteus P- Pseudomonas U- Ureoplasma Urolyticum N- Nocardia C- Cryptococcus H- Helicobacter Pylori Infections caused by Ureoplasma Urolytica? PID and Urethritis in men. Silver Stain in the lung? Legionella Pneumocystis Carinii Legionella grows on? Charcoal Yeast Extract Agar (CYE). MCC of atypical pneumonia > 40 yo Legionella Legionella Pneumphilia causes? Pontiac Fever - Fever with nonspecific Sx Legionaries Dz - Full illness + pneumonia 5 causes f cryoglobulinemia? Use the nemonic : I AM HE I - Influenza A - Adenovirus M - Mycoplasma H - Hepatitis B E - EBV (+) Antibody to Strep. Salivarius? Means you have cold agglutinins. How is Mycoplasma different from other pathogens? It has Mycolic acid just like Mycobacterium MCC of atypical pneumonia 10-30yo Mycoplasma Pneumonia (Walking Pneumonia) How is interstitial pneumonia described? Interstitial Pattern Ground Glass Appearance Reticulo-Nodular appearance 3 criteria for cold agglutinins? IgM only Nonbacterial Acute Inflammation only. Presentation for mycoplasma pneumonia

Interstitial Pattern of pneumonia Cold agglutinins Symptoms out of proportion to PE MCC of symptomatic STD? Gonorrhea MCC of STD? Chlamydia % symptomatic Chlamydia infections Ten percent (10%). What is a Chlamydiazyme? ELIZA Test for Chlamydia done at every PAP Smear for sexually active teens. Patients ged arthritis/vasculitis with the flu because? This is due to cold agglutinins. Mycoplasma HOMMINUS Causes? STD MCC of STD Chlamydia Gonorrhea Ureoplasma Urolytica Mycoplasma Homminus I infections associated with Reiter's Yersinia Chlamydia Shigella Inflammatory Bowel Disease.

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Immume response seen with viruses Cell mediated T-cells and M0 Main characteristics of RNA viruses SS Orthomyxovirus, Reovirus is segmented Cytoplasm Except Retro Cytoplasmic inclusions Assemble on cell membrane RNA dep. RNA polymerase Enveloped Main characteristics of DNA viruses dS Parvo, Hepadna virus is segmented Replicate in nucleus except Pox Nuclear inclusions Assemble on Nuclear Membrane Naked except Herpes Dtermine whether a virus is -/+ stranded Nnegative - Cause disease that take 1-3wks to show up. Because the virus must be converted to a positive stranded mRNA and then be transcribed. This takes about 13wks. Positive - Viruses will be able to replicate quickly and cause illness in a few days because they are already DNA Which is the only DNA Hep virus? Hep B Incubation period for Hep Viruses Hep A/E 2-6 weeks Hep B 2-6 mos Hep C 20-30 years Hep D Recovery from B Risk of chronic disease for Hep Viruses Hep A/E No Chronic Disease Hep B 10% Chronic Hep C 60% Chronic Risk of cancer with Hep Viruses Hep A/E No cancer Hep B Highest risk of cancer Hep C Not as high as B Hepatitis is associated with shell fish? Hepatitis A Hepatitis + pregnant women Hepatitis E Route of infection for Hep Viruses Hep A/E Fecal/Oral Hep B IV/Sex/Blood/Vertical Hep C Blood/IV/Sex How do most viruses enter the body? Through Mucosal surfaces.

MC route of viral spread? Contact Minimize viral invasion by Detergent - stops adhesion Disinfectant - Dissolves viral envelopes What causes viruses to attack of certain parts of the body? Tropism Cellular process allowing viruses to enter Endocytosis How does HIV get into the body? It injects its RNA Stages of viral infection: Invasion Adherence Penetration Uncoating Replication Assembly Lysogenesis Rx used to sop viral uncoating Ramantidine Amantidine How soon must Ramantidine & Amantadine must be given? Within seventy-two (72) hours of exposure Why do you profiles contacts of people with Influenza with Amantadine for two (2) weeks? Because IgM takes two (2) weeks to show up. SE of Ramantadine & Amantadine Anticholinergic Side effects Anticholinergic -vs- Sympathetic drugs? Anticholinergic drugs will not allow you to sweat, but Sympathetic drugs will. Why is Amantadine used in Parkinson disease? Amantadine promotes Dopamine release During what stage of viral infection do most anti-viral work? During Replication. Which Nucleotide is replaced by each of the following drugs? AZT - Thymidine (Pyrimidine) DDI - Adenine or Guanine (Purine) DDC, 3TC/4TC - Cytosine (Pyrimidine) 5-FU - Uracil (Pyrimidine) All "Cyclovir"s - Guanine (Purine)

Clues for each of the following drugs? AZT - Aplastic anemia DDI/DDC - Painful neuropathy & pancreatitis 5-FU - Inhibits Thymidine synthesis For what kind of cancer is 5-FU used? Colon Cancer Why is 5-FU a good drug choice for cancer? The "U" in 5-FU stands for Uracil. By taking the place Uracil, RNA synthesis in inhibited by stopping transcription. Also Uracil is needed to make Thymidine and with no Thymidine you inhibit DNA replication. 4 drugs you can use to treat Herpes? Pencyclovir - TID Acyclovir - Five (5) times a day Demcycovir - TID Vancyclovir - BID Rx for HSV causes Viral shedding Recurrence Symptomatic days Rx for CMV Gancyclovir Rx for Shingles Famcyclovir Rx for RSV Ribavarin Give the infection seen in AIDS patient with eye problem (retinitis) CMV retinitis MCC reactivation of Herpes Zoster? Stress What workup in needed in Zoster patients > 40 yo? HIV Gastrointestinal cancer MC location of Zoster? V1 - Forehead (Trigeminal) 2. T4 - Breast (Dermatome) What stages of viral infection are asymptomatic but have viremia? Invasion Adhesion Penetration

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What stages of viral infection are considered the eclipse period of viral infection? Uncoating Replication Assembly How is the virus detected during these stages? PCR can be used to detect the virus even when there is no viremia because PCR can detect any genetic material. What state of viral infection is both viremic and symptomatic? The lysogenic stage Ribavarin is used to treat what virus RSV MCC of encephalitis? Arbovirus Herpes What is the presentation of encephalitis caused by Arbovirus? The patient presents with Fever, Severe headache, Ataxia. Infection is transmitted by mosquito bite. Nothing should be done because it is self-limiting. MCC Macrosteatosis Alcohol MCC Microsteatosis Reyes Syndrome Pregnancy Acetaminophen Toxicity Herpes vs- Arbovirus Encephalitis Herpes encephalitis is Hemorrhagic and affects the temporal lobe MCC of the following? Gastroenteritis in children - Rotavirus Gastroenteritis in Adults - Adenovirus Conjunctivitis - Adenovirus MCC of common cold with Runny Nose Rhinovirus Runny nose + other Sx in Fall and winter Adenovirus Runny nose + other Sx in Spring & Summer Corona virus Name the Organism Gingival stomatitis - HSV Pneumatocoele Staph Aureus Barking cough & Stridor - Croup

Cough/Coryza/Conjunctivitis - Measels Slapped red cheeks Parvo B19 Dendritic spine on cornea - HSV Rash 24 hours after koplik spots - Measels Morbiliform rash Painful ulcer on throat - Coxsackie A Rash after fever is gone - Roseola Inflamed eyes and lips - Kawasaki Herald patch - Pityriasis Rosea Rash moves from head to feet - Measels Clues for Measels Cough Coryza Conjunctivitis Clues for Kawasaki Fever > 4 days Cervical Lymph Nodes Mucus involvement Palms and soles What is a complication of using steroids on a dendritic spine on the cornea caused by Herpes? The Spine will eat through the cornea causing blindness. What complication exists if a Influenza infection is treated with Aspirin (ASA)? Reyes Syndrome What is the Peak season for Influenza Flu? Nov, Dec, Jan, and part of Feb List the organisms that can cause croup: RSV Influenza Parainfluenza What organisms cause Bronchiolitis? Parainfluenza - 80% RSV - 15% Adenovirus Influenza What is Bronchiolitis? Asthma like symptoms in children less than two years of age. List the common childhood viral infections and the causative organism: 1. Measles - Rubeola 2. German Measles - Rubella 3. Chicken Pox - VZV 4. Parotitis - Mumps 5. Hand, Foot, and Mouth Disease Coxsackie A 6. Pityriasis Rosea - Herpes 7 7. Roseola - Herpes 6 8. Mucocutaneous Lymphnode - Kawasaki

What is the most common complication of measles? Why? Otitis media Pneumonia (Mucus plugs up eustachian tube and lung) Neonatal Rubella infection? Hearing loss Cataracts PDA Autism How long is a patient infectious with varicella? 2 days before rash & 3 days after the rash Clue for Vericella Come in crops 4 Stages of VZV infection Red Macule Clear Vesicle Pustule Scab When is a patient no longer infectious When the scab appears approximately one week after infection. MCC complications of VZV infection? Skin infection (from scratching) Varicella pneumonia Complications mumps infection? Orchitis Oophoritis Pancreatitis What virus causes aplastic anemia Parvo B19 Palms and sole rashes? Scalded Skin Syndrome Scarlet Fever Syphilis Toxic Shock Syndrome Rocky Mountain Spotted Fever Coxsackie - Hand, Foot, and Mouth disease Kawasaki MC complication of Hand/FootMouth dz Dehydration Infection caused by Herpes 7 Pityriasis Rosea Infection caused by Herpes 6 Roseola Describe the rash caused by Herpes 7? Looks like the patches of eczema, but it follows the skin lines.

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What is characteristic about the rash caused by Herpes 6? Rash breaks out after the fever is gone. 5 characteristics Kawasaki: Inflamed Mucus membranes Cutaneous rash on the palms and soles Cervical Lymph node involvement A temperature greater than 102 Illness lasts for > 3 - 5days What is the platelet count of most vasculitites? Low 2 vasculities without high platelet count? Kawasaki High PLT Henoch Schonlein Purpura - Normal PLT What is the protocol for monitoring a patient with Kawasaki disease? Echocardiogram q mos x 6mos Kawasaki predisposes to coronary aneurysm and 90% of those that get aneurysm get them in the first six months. What is the Nikolsky sign? The skin sloughs off with little contact. Tx Kawasaki patient with a coronary aneurysm > 8mm? Bypass surgery and treatment with immunoglobulins What does Hep B core antigen (Hb-C) represent? It represents an acute infection within the past two (2) months. Antigen/antibody profiles for Hep B Hb-C only - Acute Infx < 2 mos Hb-S only - Vaccination < 2 mos Hb-C and Hb-S only - not possible (must also have Anti-Hb-C) Anti-Hb-C only - Window period Anti-Hb-S only - Vaccination in the past Anti-Hb-C & Anti-Hb-S Infx now Imm Hb-S after six months - Chronic infection (carrier state) Hb-C antigen What is the DNA that is transmitted by Hepatitis B? HebBc Immune response seen with Rickettsial infection? Cell mediated (Tcells and Macrophage) Eosinophils What structure does Rickettsia like to attack? Blood vessels causing vasculitis

Name the Rickettsial Infection Tick - Rickettsia - RMSF Flea - Typhi - Endemic Typhus Louse - Prowzeki - Epidemic Typhus Mite - Akari - Rickettsial Pox Mite - Tsutsugamushi - Scrub Typhus Dust - Coxiella Burnetti - QFever Rash that starts peripherally and comes centrally and affects the palms ad soles Rocky mountain spotted fever Rash that starts centrally and moves peripherally

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