Bugs Life
A 25-year-old male presents to the clinic with a lower leg infection. Upon exam, it is noted that the wound is poorly demarcated, warm, and purulent. On culture, grape-like clusters are present. The physician notes the organism is equipped to resist opsonization by IgG. What organism and virulence factor is mentioned?
Staph aureus
Protein A
Timmy has a peanut allergy. He needs an EpiPen, but they are too expensive. So Timmy's friend James takes the magic school bus and goes into Timmy's body to fix timmy's allergy. What immunoglobulin in James going to alter to fix Timmy's issue, and what adrenergic receptors are affected by epinephrine?
IgE
Non-specific agonist
Low doses: more B1 and B2
Higher Doses A1 becomes more prominent
Describe why the PCV vaccine induces a stronger immune response than PPSV.
PCV is conjugated to a protein, leading to both IgM and IgG production with a more prolonged effect.
How do you differentiate E. coli, Klebsiella, and S. saprophyticus using culture characteristics?
E. coli- gram-negative, indole-positive, lactose-fermenting
Klebsiella- Gram-negative, indole-negative, ferments lactose
S. Saprophyticus- Gram-positive, indole-negative, novobiocin-resistant
A 35-year-old patient comes into the emergency room complaining of shortness of breath, productive cough, and pleuritic chest pain. On examination, the patient is febrile, with lungs showing dullness to percussion, and decreased breath sounds unilaterally. When looking at his medical records, it shows he is HIV+ and has not been to the hospital recently. What is the most likely diagnosis and causative organism?
Community aquired pnemonia
Strep pneumo
Young child presents to the clinic with a constellation of symptoms, including a high fever for over 5 days, conjunctivitis, erythema + edema of hands and feet, strawberry tongue, and adenopathy. What is the treatment for this condition and what is the key risk in this treatment plan.
IVIG and Aspirin
Reye Syndrome
What are two specific transplants that are susceptible to causing graft vs host disease, and why?
Bone marrow and Liver (less likely)
They have immunocompetent T cells that recognize and mount damage to host tissues.
What is the recommended screening test for HIV infection? (What does this test look for)
Fourth-generation antigen/antibody immunoassay
p24 antigen
A 60-year-old lady comes into the emergency room presenting with a fever that has lasted for over 2 weeks. Upon physical examination, you notice Osler nodes on the fingertips. It turns out the lady had a dental procedure about a month ago. Name 2 other symptoms that you may find in this disease process, and also name the likely pathogen's virulence factor that allows for this presentation.
FROM JANE
Fever, Roth Spots, Murmur, Janeway lesions, Anemia, Nail-bed hemorrhage, Sptic Emboli,
Strep viridins dextran production
A 35 year old HIV + patient comes into the clinic presenting with fever, fatigue, malaise, jaundice, and right upper quadrant pain. Upon labrotory testing the antibodies HBsAg and Anti-Hbc IgM are both present. What is the name and MOA of the typical treatment for this presentation?
Entecavir
NRTI
Give one example of each type of hypersensitivity reaction
Type 1 Allegic (Peanut)
Type 2 (AIHA, Grave's)
Type 3 (Polyarteritis nodosa)
Type 4 (Contact Dermatitis, SJS)
60-year-old patient presents in the hospital with watery diarrhea, lasting 5 days. The patient has a history of extended antibiotic use for a previous case of endocarditis. The doctor notes this is not the first time this patient has dealt with watery diarrhea after a course of antibiotics. What is one medication that could help prevent recurrance from this infection?
Bezlotoximab
A four-year-old child comes into the ER with 3 days of bloody diarrhea and a fever of 104°F. Upon arrival, the child begins to have febrile seizures. After empirical antibiotics and fluids have been given, you get the culture report back and it shows the organism is H2S negative. Name a virulence factor involved with this infection, and explain what was the largest cause of the bloody diarrhea.
Shiga toxin (Inhibit protein synthesis) Increases severity but not main cause of bloody diarrhea, unlike in O157:H7 E. coli.
Invasion into the enterocytes > Shiga Toxin
The patient comes into the primary care clinic presenting with dysuria and right knee pain. What would be the empirical treatment for this patient? Think about likelihood of confections.
Chlamydia- Doxycycline
Gonorrhea - Ceftriaxone
Patient comes into the primary care clinic with recurrent easy bruising. The patient has been on warfarin for the previous 4 years and had never had this problem. Looking into their chart, they had a visit to a urgent care for a UTI. Based on this information what is the mechanism of action of the prescripted drug and why did this new side effect occur?
Folate Reductase Inhibitor 2 different steps
Inhibited CYP2C9, which is a crucial enzyme in the metabolism of warfarin, leading to increased anticoagulant effect
Patient presents to the clinic with chills, nonproductive cough, dyspnea, and myalgias. They are also suffering GI symptoms such as diarrhea, nausea, and abdominal pain. Lab values show hyponatriema, and a CXR with patchy infiltrates. Based on the presentation, what agar do you think will grow this pathogen the best? What test could you run in the meantime to help solidify a diagnosis.
Buffered Charcoal Yeast Extract
Rapid Urine antigen for Legionella
A 5-year-old child presents to the emergency room with an erythematous maculopapular exanthem and a fever. During the history the parents explained the rash started on the scalp area of the head and moved downwards. Upon physical exam there was no prominent postauricular, suboccipital lymphadenopathy. However, there was conjunctivitis present. What other symptoms could be present to help solidify a diagnosis and what is one key lethal complication that could come from the likely diagnosis?
Coryza, cough, Koplik spots
Subacute Sclerosing Panencephalitis
Patient comes in with a rash that looks similar to erythema multiforme. However, it involves the oral mucosa. What antibacterial drug could have been the cause of this presentation, and what AIDS defining infections does it provide prophylaxis against?
TMP-SMX
Pneumocystis jiroveci
Toxoplasmosis
Explain the players involved in HIV entry into both macrophages and T cells. (Both HIV virus and our own Immune) Name a drug that inhibis this process as well.
HIV gp120 (attach), gp41 (fusion)
Macrophages CD4 and CCR5
Helper T cells CD4 and CXCR4
Miraviroc and Enfuvirtide
This organism can be seen with darkfield microscopy. List the different screening and diagnostic tests there are for this organism, and list one symptom from each stage of the disease process
Screening VDRL, RPR
Diagnostic FTA-ABS
Primary Painless genital chancre
Secondary Disseminated macular rash, condyloma Lata, lymphadenopathy
Tertiary Gummas, Cardiovascular involvement