Micro Block 10 Atchley – Flashcards
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| eight parts of the clinical lab |
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| routuine chemistry hematology immunology immunohematology endocrine theraputic drug monitoring toxicology urinalysis |
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| what are the 10 parts to a rotuine chemisty |
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| glucose HBA1C pre-albumin kidney function protein C-reactive protein electrolytes cardiac lipid liver function |
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| what are the two renal function tests |
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| BUN and creatinine |
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| what electrolytes are measured during rotuine chemistry |
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| Na, K, Cl, Ca, CO2 |
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| what are the three liver function tests, why |
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| albumin bilirubin prothrobin time the liver will not produce albumin or clotting factors when failing, it will not remove bilirubin from the blood if damaged |
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| what are the three liver damage tests, what type of damage do they indicate, which is the best |
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| ALT: hepatocyte damage (hepatitis), most sensitive and specific enzyme test for the liver AST: hepatocyte damage (hepatitis) ALP: aminotransferase alkalinephospherase. duct damage (stones) GGT: do if you have elevated ALP to determine where it is coming from. indicates duct damage |
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| what are the three cardiac function tests |
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| CK-MB, troponin, myglobin |
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| what do leukocytes and neutrophil levels indicate for, explain |
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| neutrophils indicate bacterial infection leukocytes indicate viral infection 50% of systemic infection has low leukocytes and neutrophils but the differential will have a high WBC count |
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| what is the most common lab and hematologytest |
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| Complete blood count (CBC) |
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| what is tested for in theraputic drug monitoring |
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| plasma levels of drugs |
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| what does IgM in a lab indicate |
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| recent of acute infection (dissipears later in infection) |
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| what does IgG in a lab indicate |
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| past or convalescent infection (replaces IgM) |
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| how is a titer done, how is it read |
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| a patient comes in and you do a titer and see IgM or the antigen and you know they have the disease right now if you dont see IgM or antigen but you see IgG you dont know if they came in contact in the past or still have it and production just switched over. do a titer today and obtain the dilution level do a titer later and if there is a 4x increase in IgG they have the disease now, if there isnt they have just been exposed to it before |
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| how is haeatitis diagnosed |
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| IgM positive or 4 fold change in IgG titer |
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| what would a blood test for hep B immunization look like |
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| hep B surface antigen antibody ONLY (anti-HBsAg) |
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| immunohematology two parts |
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| blood typing and matching blood component harvesting |
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| urinalysis two tests |
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| dip stick wet prep |
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| what is the best marker for diagnosis of a UTI, how did that marker get there |
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| leukocyte esterase leukocytes spill over |
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| what three things can be tested for on a urine wet prep |
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| trichomonas and yeast - cervix pregnacy testing |
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| finish the statement: if you have acuracy you have.... |
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| if you have acuracy you have percision you can have percision without acuracy |
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| define acuracy |
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| is it correct? are the arrows in the center of the target? |
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| define percision |
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| is it reproducable? are the arrows grouped? |
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| which is more important, accuracy or percision, why |
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| percision because the result can be corrected to become accurate if needed |
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| why is it bad to do lots of lab tests, give some numbers to qualify your answer |
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| the more tests the more chance the results will be wrong 1 test 5% chance 2 tests 10% 3 tests 14% 12 tests 46% |
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| define sensitivity |
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| those with the disease and need treatment how likley the test will detect a sick person |
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| how is sensitivity calculated |
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| TP/ (TP+TN) |
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| what are the two components to sensitivity, define them |
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| true positive: patient is sick and tests positive false negative: patient is sick and tests negative |
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| define specificity |
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| measure of those without the disease how likley does a negative test indicate no disease |
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| calculate specificity |
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| TN / (TN+FP) |
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| what are the two components of specificity, define them |
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| true negative: patient isnt sick and tests negative false positive: patient isnt sick and tests positive |
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| give four examples of wet preps and what they test for |
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| cervical swab with saline: trich (strawberry cervix), and candida (yeast) feces + iodine = fecal parasites like giardia intestinalis, giardia duodenalis feces + methylene blue = fecal leukocytes like in inflammatory condition (usually low) or INVASIVE condition like shigella KOH prep = dermatophyte fungi (dissolves all but hyphe) |
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| explain the process of a gram stain |
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| make smear and heat fix add crystal violet and sit 5-10s add iodine (fixing mortant) decolorize with alcohol gram positive cells will retain purple color counterstain with safranin red to stain non-gram postive cells |
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| what are some generalizations to remember which are gram positive |
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| all cocci except neisseria and morxella all sporeforms are gram positive rods |
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| what stuff does a giemsa (wright) stain test for (8) |
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| blood smear for WBC differential blood borne pathogens malaria thalciprum babesiosis parasitic worms filarial and trichinella giant cell multinucleated viruses |
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| malaria: worse kind, second worse, how does it live, how can it be identified |
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| thalciprum is worst plasmodium is second hides in RBC and liver trophozoites show rings |
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| thalciprum: what is it, what does it do to the body 3), what disease does it cause |
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| malaria strain lyses RBC, pee blood, life threatning black water fever |
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| babesois: where does it come from, how can it be identified |
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| mouse gets the disease, deer or black leg tick bites mouse, tick bites us maltease cross on RBC (different from malaria!) |
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| what does trichrome test for |
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| fecal parasites |
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| what does acid fast mostly test for |
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| mycobacterium |
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| what organisms are partially acid fast (4) |
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| nocardia legionella cryptosporidium isospora cysts (protozoa) |
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| explain how an acid fast stain is done, what are the two types |
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| make smear and fix then add carbolfuschin if doing siehl nelsen add heat, if doing kinyoun dont decolorize with acid alcohol and acid fast retain the dye counterstain everything else with methylene blue acid fast cells are "red snappers" |
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| what is another name for the acid fast fluorescent stain, what is the benifit, what does it look for, how does it work |
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| auramine-rhodamine 99% specific mostly for TB uses acid alcohol to decolorize all by mycolic acid uses rhodamine instead of carbofuschion |
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| how long does a culture take in general |
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| slow minimum 18 hours / overnight viral cultures take days because hospitals dont do them |
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| what are the challenges with cultures |
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| slow different requirements per microbe some stuff isnt culturable viruses are hard to culture positive culture is more meaningful than negative. |
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| what are the microbes that cannot be cultured 93) |
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| chyamydia, syphilis, leprosy |
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| why are viruses hard to culture |
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| require cells to live in diagnose with sigs and symptoms |
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| general purpuse agar: how does it work, what does it grow, 2 examples |
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| no inhibitors non-fastidious pathogens and flora tryptic soy and sheep blood |
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| enriched bacteria: how does it work, what does it grow, one example |
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| extra supplements for fastidious bacteria chocolate agar |
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| chocolate agar: what is it made of, what does it do, 2 examples |
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| selective agar made of charcoal, blood and antibiotics lysed blood gets rid of inhibitors of growth grows bordetella pertussis and bordetella parapertussis |
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| differential agar; how does it work, one example |
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| has visual indicators, often selective sheep agar for hemolysis (grows everything) |
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| differential selective agar: how does it work, two types |
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| inhibits with dyes, antibiotics, or salts MacConkey, Mannitol salt |
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| MacConkey: what does it grow, what does it inhibit |
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| grows gram negative rods inhibits gram positive cocci detects lactose fermentation in purple detects lactose fermentation in purple: klevisella pneumpnia, E. coli, enterobaccter colace |
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| what is the only gram negative lactose fermenter, what are the two other lactose fermenters that show up on MacConkey |
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| E. coli klebsiella pneumpnia, enterobacter cloace |
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| mannitol salt: what does it grow, what does it inhibit, how is it interperteted |
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| grows gram positive cocci inhibits gram negative rods mannitol fermentrs will turn agar yellow (staph aureus) coagulase negative staph make clear colonies (cannot ferment mannitol) |
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| how is MRSA diagnosed |
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| staph aureus turns Mannirol salt yellow then grows on oxicilin to proove resistance |
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| charcoal blood agar (regan lowe): what does it show, how is it interperted |
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| bordetella pertussia a: partial digestion b: total digestion gamma: no digestion, no hemolysis |
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| what rules are there for blood collection (6) |
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| clean with betadine or chlorhexidine) EtOH does nothing) collect from two sites three times collect before starting antibiotics never draw from ports or lines draw distal to port or line COLLECT BEFORE STARTING ANTIBIOTICS |
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| what is the most likley blood contaminant |
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| coagnegative staph (S. epidermiditis) |
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| what are the 5 most likley blood pathogens |
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| s. aureus, S. pneumoniae, E. coli, K. pneumonia, P. aeruginosa |
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| compare A and B hemolytic |
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| B is a pathogen A isnt except for strep pneumo |
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| optichin: use, interpertation |
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| used in cell culture strep pneumo is sensitive other viridans are resistant |
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| bacitracin: use, interpertation |
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| differentiate group A and B strep group a is susceptibe group b is resistant (kills babies) |
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| cAMp test: how is it interperted, what is the point |
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| distinguish between group a and b strep a is negative b is positive arrow head |
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| what organism is caralase positive, how can you tell |
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| staph converts H2O2 to water and O2 making bubbles |
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| what organisms are catalase negative |
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| strep |
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| what organisms are coagulase positive |
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| staph aureus |
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| what organisms are coagulase negative, where are they found |
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| non staph aureus staph Staph epi: common on skin and blood pathogen staph saprophyticus, UTI |
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| define MIC |
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| minimal inhibitor concentration lowest level that inhibits bacterial replication |
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| minimal bacteriacidal concentration: define, how is it done |
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| lowest level that kills bacteria (homocidial) take MIC, plate it, at lowest concentration no growth means min level of drug |
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| kirby bauer disk: how does it work |
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| measure diameter of zones of inhibition around antibiotic NEED KEY - zone diameter is dependant on dose etc not quantative, no sensitivity without key |
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| what WBC are granulocytes |
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| neutrophils eosinophils basophils |
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| what WBC are agranulocytes |
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| lymphocytes monocytes |
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| what is the nucleucs like in neutrophils, what are the the two common types of neutrophils |
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| multilobed polymorphic and segmented |
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| what are the functions of neutrophils |
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| phagocytosis of baceria, debris, bing things. then they die |
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| bandemia: aka, what does it mean, what does it suggest clinically |
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| aka: shift to the left immature neutrophils come into the blood because they die when they eat and the marrow has to replace them (its ok for 2-3% of them to be immature normally) sugests trauma, bactria, leukemia |
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| what does lots of segmented neutrophils suggest |
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| B12 or folate deficiency |
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| eosinophils: color of granules, functions (4) |
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| red granules increase allergies fight parasites (worms) induces histamine release minor phagocyosis |
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| basophils: granule color, function |
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| purple granules contain and release histamine |
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| lymphocytes: what types of cells, what do they do, when do you see more lymphocytes |
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| T cells: immune regulation and cytotoxic functions B cells: make antibodies null cells: cytotoxic cells increase in VIRAL infection |
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| monocytes: what do they do |
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| become macrophages |
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| what does more than 5 segs mean for the neutrophil, what does it mean clinically |
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| hypersegmented neutrophils megaloblastic anemia - B12 and folate deficiency |
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| what does a hematocrit represent |
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| percent packed RBC vomule |
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| what are the three RBC indices, explain them |
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| mean cell volume (MCV): average RBC size MCH MCHC - mean cell Hb concentration: abverage Hb concentration |
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| define leukocytosis, what is the most common cause |
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| increased WBC - commonly indicates infection neutrophilia is most commonly the cause |
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| define lymphocytosis, what does it suggest clinically |
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| increased lymphocytes points to viral infection |
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| define neutrophilia, what does it point to clinically |
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| increased neutrophils points to bacterial infection |
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| define leukopenia, what does it point to clinically |
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| decreased WBC commonly points to a big bacterial or viral infection moderate decrease: viral large decrease: bacterial (sepsis) or marrow supression lymphocytopenia, neutrophils |
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| define lymphocytopenia |
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| decreased lymphocytes |
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| define neutropenia, what will this end up leading to |
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| decreased neutrophils left shift will occur in the future |
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| how is total neutropil count determined |
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| add all the forms of neutropils together, no matter their level of maturation |
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| what is flow cytometry, how does it work, what does it look for |
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| flourescently tagged monoclonial antibodies attach to specific cell membrane proteins to sort, separate, and store them can stain surface markers to get good counts, especially CD4 for HIV |
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| when do we treat HIV, when is AIDS classified, whan does the risk for PCP infection ncrease |
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| treat at <350 CD4 <200 CD4 diagnosed with AIDs for life and INCREASED PCP RISK |
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| what lab tests are done for spinal fluid analysis |
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| CBC, urine culture (UTI can get to blood and brain), blood cultures, LP |
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| how is WBC in CSF interperted |
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| increased neutrophils: bactreial increased lymphocytes: viral eraly meningitis: strange levels of WBC |
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| how is glucose intereperted in CSF analysis |
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| bacterial infection: CSF glucose < 1/2BG viral: CSF glucose > 1/2BG |
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| protein interpertation in the CSF |
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| meningitis increases CSF protein bacterial will have extremely high protein slightly high in viral |
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| what is the general rule for the difference between viral and bacterial meningitis |
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| viral is more mild, lymphocytes increased |
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| where can ALT be found, what does it indicate |
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| specific to the liver, hepatocyte function |
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| where can AST be found, what does it tell us |
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| liver, muscle, heart tells liver function, heart attack marker, hepatocyte function |
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| what is GGT, what does it indicate, where is it found |
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| gamma-glutamyl transaminase, gives info about the duct liver ductal cells can indicate chronic alcoholism |
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| where is ALP found, what does it indicate |
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| bone, placenta, kidney, liver ductal damage |
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| what are the liver damage tests, why do they indicate damage |
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| ALT, AST, GGT, ALP because when the cell dies they are released |
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| what are the acute phase proteins |
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| C reactive protein, fibrinogen, mannan binding lectin (MBL) |
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| C reactive protein: what is it, what does it do |
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| phosphorylchiline binds abcterial surface opsonizes bacteria and activates complement |
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| fibrinogen: when does it appear, what does it do |
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| inflammation increases it and causes stickey RBC which increases ESR |
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| mannan binding lectin: what does it do |
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| binds to bacteria surface mannose and opsonizes them activates complement |
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| how are acute phase proteins made |
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| macrophages make IL-6 which acts on hepatocytes to make them |
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| direct test function |
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| target antigens |
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| indirect test function |
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| target antibodies |
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| titer Moa, how is it read |
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| patient comes in and you see IgG so you dont know if they have the disease in the past or just recently moved from IgM to IgG production acute sera: do a titer now and get dilution level convalescent sera: do titer later too. if there is a 4x increase then they currently have the disease if there isnt an increase they were just exposed to it before |
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| what are the two parts of a titer, explain them |
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| acute sera: titer taken at time of initial sytpms convalescent sera: titer taken on road to recovery |
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| what is the difference between IgM and IgG when thinking clinically, what is their relationship |
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| IgM shows recent or acute infections IgG shows past infection or vaccine (2-4 weeks later) 4 fold or more increase in IgG = 1 IgM |
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| viral window: define, what is the issue ir brings |
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| time between the appearnce of viremia and synthesis of IgM if you test at this time a positive patient could get a false negative |
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| what are the ways to declaire an acute infection |
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| finding of IgM or a 4 fold or more change in IgG |
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| what does ELISA stand for, what is the point |
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| enzyme linked immunosorbant assay detect or measure immunoglobins or antibodies |
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| how is an ELISA done |
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| enzyme or reporter molecule is linked to an antibody covalently antigen antibody binding occurs (immunosorbant part) bound reporter gives signal and produces assay |
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| what are the three uses of ELISA |
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| detect antigen (hormone, enzyme, microbe antigen drug) detect antibody (infectious agent of exposure, HIV) tests variety of fluids (blood, spinal fluid, urine, enivrionmental) |
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| what are the 3 types of ELISA |
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| direct, indirect, sandwhich |
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| direct ELISA: function |
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| probe for antigen with a single labeled antibody looks directly at the cause of the infection (antigen) |
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| indirect ELISA: function |
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| probe for antibodies to an antigen labeled antibody lebeled antibody binds to unlabeled antibody lookes at antibodies involved |
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| how is an indirect ELISA done |
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| plastic contains bound antigen we want to see if they have an antibody. so add patient serum to antigenic site (epitpoe) now we have this antibody bound to antigen but we can't see it. so we need to add anti-human antibodies with an enzyme or something on it that gives a color reaction (reporter enzyme) add a substrate that changes the color of only bound reporter enzymes |
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| sandwhich ELISA function |
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| antigen is sandwiched between two usually looking for antigens |
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| percipitatation curve general idea |
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| depending on the level of antibody in the solution the curve will shift |
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| three zones of the percipitation curve, explain each |
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| prosone: antibody excess, antibodies left over aftr formation of antigen antibody complexes. very high antibodies will produce a negative result equlivance: no free antigens or antibodies, remain in solution after certerfugation of antigen antibody compled (max percipitation) antigen excess: high levels of free antigen in solution after formation of anrigen antibody complex |
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| what zone of the percipitation curve shows max percipitation |
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| equlivance |
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| how is the percipitation curve interpertered |
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| if the screen is negative, dilute the serum down and retest if the pt seems clinically positive if it is popsitive the first test was false negative due to prozone!! |
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| western blot: how does it work, what does it test, |
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| multi target indirect elisa on nutricelluose paper protein detection HIV test conformation |
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| what antibodies will someone who has never been in contact with HebB will that have |
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| no hepB antibodies |
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| what antibodies will someone with HepB have |
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| surface antigen plus more parts of hep B antigens |
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| what are the three morphologies of gram positive cells |
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| diplococci, staphlococci, streptococci |
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| whiff test: how do you do it, what are the results, what do they tell you |
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| add KOH to cervical swab if there is a strong amine odor it is trich or more likley bacterial vaginosis (garderella vaginalis) |
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| what microbe is mixed up with malaria, what can help distinguish it |
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| babesia - maltease cross in RBC |
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| what is the relationship between MIC and MBC |
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| MBC >= MIC |
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| what are three situations where neutrophils are decreased |
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| viral infections, overwhelming bacterial infections, some leukemias |
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| what do north south and west blots test for |
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| west: protein north: RNA and mRNA south: DNA |
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| pyogenic bacterial meningitis: appearance of CSF, PMN amount, lymph amount, protein amount, glucose amount |
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| yellow turbid increased PMN slight increase or normal lymphs increased protein decreased glucose |
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| viral meningitis: appearance of CSF, PMN amount, lymph amount, protein amount, glucose amount |
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| clear CSF slight increase or normal PMN increased lymphs slight increase or normal protein normal glucose |
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| TB meningitis; appearance of CSF, PMN amount, lymph amount, protein amount, glucose amount |
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| yellowish and viscous CSF slight increase or normal PMN increased lymphs slight increase or normal protein decreased glucose |
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| fungal meningitis: appearance of CSF, PMN amount, lymph amount, protein amount, glucose amount |
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| yellow and viscous CSF slight increase or normal PMN increased lymphs slight increased or normal proteins normal or decreased glucose |
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| what is the normal amount of urine produced in adults per minute and per day. what is the estimated amounts |
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| 1.2 ml/min and 1700 ml/day 1 ml/min and 1440 ml/day |
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| what word describes no urine? what amount qualifies this? |
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| anuria <100 ml/day |
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| what word describes too little urine? what amount qualifies this? |
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| oliguria <500 ml/day |
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| what word describes too much urine? what amount qualifies this? |
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| polyuria >2,500 ml/day |
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| what does GFR stand for, what does it tell us |
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| glomerular filtration rate |
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| what two values reflect the GFR |
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| BUN/creatinine creatinine clearance |
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| what does kidney function loss do to the GFR and the two values that reflex GFR |
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| decreases GFR, increases blood BUN and creatinine |
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| define creatinine clearance |
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| plasma volume cleared of creatinine per minute |
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| how is creatinine clearance calculated, explain how this value then relates to renal function |
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| ((140-age) x kg x (0.85 if female)) / (72 x serum Cr) CrCl ~ % renal function |
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| how can creatinine clearance be estimated, why can't you use this all the time |
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| 100 / serum creatinine little old lady exception (because real formula uses age and weight and if it isnt a normal ratio it throws it off too much) |
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| calculate the CrCl of a 30 yo diabetic female at 80 kg and serum Cr 1.1 |
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| 94.4 |
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| calculate a 85 yo diabetic female CrCL at 60 kg and serum Cr 1.1 |
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| 35.4 |
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| what are the three types of genitourinary tract analysis |
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| macroscopic microscopic culture |
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| what are the two parts to the macroscopic urine exam |
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| color and appearance chemical analysis (dip stick) |
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| what are the 10 parts to a urine chemical analysis |
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| glucose bilirubin ketones specific gravity blood pH protein urobillinogen nitrate leukocyte esterase |
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| what are the 2 parts of a urine microscopic exam, what three things are they looking for |
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| high power and low power exam cells, casts, crystals |
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| what urine test show diabetes (all by itself), how |
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| hyperglycemia on the glucose test |
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| what urine test shows liver function |
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| bilirubin is the crude test for liver function |
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| what three things can ketones in the urine tell you |
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| ketonurie = prolonged fasting or low carb diet diabetic ketoacidosis |
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| how is diabetic ketoacidosis diagnosed from urine |
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| ketones, hyperglycemia, acidic urine |
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| what can specific gravity tell us |
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| high= dehydrated low= hydrated |
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| what can acidic urine tell us |
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| high protein diet, metabolic acidosis |
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| what is the normal pH of the urine |
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| 5-8 |
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| what are 3 causes of proteinuria in urine |
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| functional renal: glomerulonephritis post renal: cystitis |
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| what does urobilinogen in the urine indicate |
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| increased hepatic processing of bilirubin |
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| what do nitrites in the urine indicate |
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| infection. not all infections make nitrites but all E. coli does |
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| what factors of a urine dip stick can tell us about infection |
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| leukocyte eserase is the most sensitive indicator for UTI nitrates present when it is E. coli |
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| why is leukocyte esterase the most sensitivie indicator for UTI, what is the down fall |
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| you can have leukocytes without an infection but you cant have an infection without leukocytes WBC must always be lysed first to release leukocyte esterase so compare with microscopic exam and urine culture |
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| what is pyelonephritis |
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| kidnet infection |
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| what is found in the urine when someone has pyelonephritis |
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| leukocyte and granular casts (indicate kidney damage, Tamm horsfall casts are ok to have some) renal tubular cells indicate kidney damage (it is ok to have epithelial cells) |
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| what is the most common form of acute glomerulonephritis |
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| post strep glomerulonephritis in children comes after srep throat or skin strep infection (impetigo) |
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| what is the #1 cause of UTI |
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| E. coli |
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| what is the #2 cause of UTI |
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| schistosoma haematobium: parasite that infects bladder and causes hematuria |
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| what are 5 qualifications to be considered an uncomplicated UTI |
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| healthy (no acute illness either: fever, nausea, vomit, flank pain) adult (>12 yo) female non-pregnant structurally and functionally normal UT |
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| what is the diangosis process of an uncomplicated UTI |
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| dipstick or urinalysis, no culture or lab tests |
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| what type of infection does a uncomplicated UTI get, what is the duration |
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| simple cystitis 1-5 days |
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| what qualifies someone as a complicated UTI (11) |
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| structural or functionally abnormal UT foley cathater renal caliculi bacteriema cystitis of long deruation hemorrhagic cystitis pregnacy comorbidities all males urosepsis/hospitalization pyelonephritis |
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| how is a complitated UTI diagnosed (3) |
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| urinalysis, urine culture, labs |
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| what is pyelonephritis |
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| infection of the kidney |
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| what are the 4 symptoms of pyelonephritis, which are the hallmark ones |
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| fever and chills are hall mark vomiting, headache |
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| what is used to diagnose pyelonephritis (4) |
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| urinalysis, urine culture, CBC, chemistry |
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| what are the two complications of pyelonephritis |
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| renal abscess what wont respond to antibodies nephrolithiasis: stones with severe flank pain |
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| when should nephrolithiasis be suspected in a UTI patient |
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| severe flank pain |
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| when should renal abscess be suspected in a UTI patient |
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| pt not improving with antibiotics |
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| what organism can cause kidney stones, how is this organisms identified, how does it cause stones |
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| proteus mirabilis: makes urease and shifts the pH upward to percipitate Mg-Ammonium-phosphate and produce struvite stones |
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| what are symptoms of prostatitis (12) |
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| pain: perineum, lower abdomen, testicles, penis pain with ejaculation blood in semen bladder obstruction fever, chills, dysuria, malaise, myalgia |
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| how is prostatitis diagnosed (6) |
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| DRE: edematous tender prostate increased PST urinalysis urine culture two cup test |
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| how are lab results for clean catch interperted |
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| >10^5 cfu/mL is infected 5 cfu/mL could be contaminated more than one bacteria is probablly contaminated |
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| how are lab results for suprabubic or catheter interperted |
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| any bacteria is infection |
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| what are the 2 main bacteria that cause commonity acquired UTI |
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| E. coli coagulase negative staph saphrociticus |
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| what is the main cause of hospital acquired UTI, what is the concern here |
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| proteus mirabilis beware of resistance |
question
| how is proteus mirabilis diagnosed |
answer
| when grown on plate it swarms it and grows over the entire thing |
question
| what is schistoma hematoboium classified as, what does it cayse |
answer
| termatode parasite hematuria which appears in pyleonephritis and cystitis |
question
| what protozoa cause STIs (1) |
answer
| trichomoniasis |
question
| what fungi cause STIs (1) |
answer
| candidis |
question
| what types of HPV cause warts (2) |
answer
| 6, 11 |
question
| what types of HPV cause cancer |
answer
| 16, 18, 31, 45 |
question
| how are the drips categorized, why |
answer
| chlydmia cannot be cultured so there are gonorrhea and non gonococcal urethritis |
question
| what are the non-conococcal urethritis (2) |
answer
| chalmydia and mycoplasmas |
question
| what is the number one STI by incidence |
answer
| most new cases in a year HPV |
question
| what is the number one STI by prevelence |
answer
| most poeple with the disease: HPV |
question
| what is the number one bacterial cause of STI |
answer
| chlamydia |
question
| what is the rule for categorizing HPV |
answer
| all warts are caused by HPV, not all HPV causes warts. HPV that causes cancer does not cause warts |
question
| what is the most cause of an abnormal pap, why is this not a super huge concern |
answer
| HPV. most people come in contact with HPV and most will auctally clear it. so it is only life long in theory |
question
| what are the 3 signs of HPV |
answer
| asymptomatic - most common warts cancer: cervical, anal, penile |
question
| what types of HPV does gardisil protect against, what symptoms are you avoiding by that |
answer
| 16, 18: anogenital cancer 6, 11: anogenital warts 6, 16: oropharyngeal warts |
question
| what are the causes of nongonoccal urethritis and gonococcal urethritis (full names) |
answer
| chlamydia trachomatis genital mycoplasmas: ureaplasma, mycoplasma genitalium gonogoccal: neisseria gonorrhea |
question
| how is gonorrhea grown |
answer
| thayer margin agar: antibiotics and chocolate agar. inhibits normal flora, selects for gonorrhea (gram negative intracellular diplococci) |
question
| chlamydia: full name, symptoms in names (3), symptoms in females (4) |
answer
| chlamydia trachomatis males: watery discharge, painful urination, 50% asymptomatic!! females: vaginal discharge, burning, itching, 75% asymptomatic!! |
question
| what happens if you dont treat chlamydia (7) |
answer
| PID and infertility!! cervicitis urethritis venereum bubos and abscess on groin rectum pharynx |
question
| why does chlamydia cause infertility (3) |
answer
| causes PID, scars fallopian tube, inflammation |
question
| what are concerns for a pregnant mother with chlamydia (2) |
answer
| can give conjunctivitis or pneumonia to the baby |
question
| what is a sign on the physical exam for chylamidia in a female (2) |
answer
| mucopurulent cervicitis (friable cervix) |
question
| what are the signs of gonorrhea in man (3) and women (4) |
answer
| men: 50% asymptomatic, yellow pus, painful urination females: 80% asymptomatic, vaginal discharge, painful urination, PID |
question
| how do you test for gonorrhea (4) |
answer
| bacterial culture: men and women gram stain: men nucleic acid hybridization DNA amplification assay |
question
| why can only men be gram stained for diplococci, what does it look like |
answer
| gram negative intracellular diplococci is diagnostic for gonorrhea in males women have normal flora (neisseria lactima, neisseria other) intra and extracellularly |
question
| what can PID be secondary to (2) |
answer
| chalmydia or gonorrhea |
question
| what are the non-STI vaginal discharges (3), why are they called this |
answer
| could be STI but can come from other sources too trichomonis, candidiasis, bacterial vaginosis |
question
| trichomonis: is there an odor, is there vaginal tenderness, is there discharge, what does it look like |
answer
| sometimes there is an odor there is vaginal tenderness frothy yellow-green discharge |
question
| candidiasis: is there an odor, is there vaginal tenderness, is there discharge, what does it look like |
answer
| no odor vaginal tenderness white curdy discharge |
question
| bacterial vaginosis: is there an odor, is there vaginal tenderness, is there discharge, what does it look like |
answer
| fishy amine odor no vaginal tenderness homogenous gray discharge |
question
| trhciomonas: pH changes, epithelial cell changes, wep prep findings |
answer
| pH > 4.7 normal epithelial cells swimmers on wet prep |
question
| candidisis: pH changes, epithelial cell changes, wep prep findings |
answer
| pH <4.5 normal epithelial cells budding yeast on wet prep |
question
| bacterial vaginosis: pH changes, epithelial cell changes, wep prep findings |
answer
| pH > 4.7 clue cells: glittery bacilli sticking to epithelium |
question
| what is the whiff test, how is it done, what does it tell you |
answer
| add a drop of KOH to vaginal sample. strong fishy amine loke odor beans bacterial vaginosis 70% of the time and the rest is trich |
question
| what is the normal vaginal pH |
answer
| 3.9-4.5 |
question
| trichomonas: full name, appearance |
answer
| trichomonas vaginalis microscopic pear shaped flagellated ptotozoa |
question
| trichomonas symptoms (2) |
answer
| discharge: smelly, green-yellow, foamy itching |
question
| how does someone get secondary syphilis, when does it happen, how long does it last, what are the signs (3) |
answer
| systemic dissemination of sphirochetes 2-8 weeks after chancere, lasts 2-10 weeks lymphadenopathy, rash on palms and soles, mucous patches |
question
| how does someone get tertiary syphilis, what are the signs |
answer
| latency of 1-30 years paralytic dementia, aortic anrueysm, aortic insuffiency, tabes dorsalis, gummas |
question
| what is a gumma |
answer
| large internal and external sores seen in syphilis |
question
| syphilis: incubation time |
answer
| 3-90 days |
question
| what are the signs of primary syphilis (4), what is the concern in this time |
answer
| early: macule (visble) > papule (palpable) > ulcer later: painless indurated ulcer with smooth firm borders (VERY INFECTIOUS) |
question
| what are the symptoms of genital herpes (4) |
answer
| vesicles > painfil ulcers > crusting likley reoccurance |
question
| what type of herpes causes genital ulcers |
answer
| if you have HSV1 in genital region it is more mild and will likley only show up once than come back HSV2 is more common and more symptomatic |
question
| what type of herpes causes oral ulcers |
answer
| HSV2 is more mild and will likley only show up once than come back HSV1 is more symptomatic and reoccurs more |
question
| which HSV is more common |
answer
| HSV2 |
question
| what are the complications of herpes (3) |
answer
| neonatal transmission: to C section enhanced Hiv transmission: more spreading to others psychosocial issues |
question
| which STDs cause cancer (3) |
answer
| HPV, HepC, HepB |
question
| which STDs have a vaccine (2) |
answer
| HPV, HepB |
question
| which STDs can be prevented by a condomn |
answer
| all can be prevented but not eliminated |
question
| what are 6 things that can cause acquired immunodeficiency |
answer
| burns iatrogenic: corticosteroids, chemotherapy malignancies malnutrtion HIV |
question
| what parts does HIV need to attach to people, how does it work |
answer
| GP160 splits into GP41 and GP120 GP120 attaches to the CD4 receptor. GP41, CXR/CXCR stabilize and pull the virus in GP41 injects the virons in like a syringe |
question
| how do we identify HIV (2) |
answer
| we look for antibodies to P24 core capsid antigen find GP160 |
question
| what types of cells does HIV attach to(4) |
answer
| macrophages, monocytes, dendeitic cells and CD4 cells all have CD4 receptors or Fc gamma receptors that are very simillar |
question
| what is a provirus |
answer
| cell that can make viruses |
question
| when do we treat HIV |
answer
| CD4 <500 (350 still now) |
question
| what are the AIDS defining diseases we need to know |
answer
| candidiasis of the esophagus, bronchi, trachea, or lungs cryptococcus in the CNS Karposki's sarcoma pneymocystis juvoreci pneumonia (PCP) |
question
| what is the most common way for a male to get HIV |
answer
| homosexual contact |
question
| what is the most common way for a female to get HIV |
answer
| heterosexual contact |
question
| how can HIV get into the blood (4) |
answer
| open cuts breaks in skin breaks in mucous membranes direct injections |
question
| what are the three routes of transmission of HIV |
answer
| sexual contact, blood exopsure, perinatal |
question
| what are the sexual contact ways to get HIV (3) |
answer
| male to male male to female female to female |
question
| what are the three ways to het HIV through blood exposure |
answer
| sharing drug needles occupational exposure transfusion of blood products |
question
| how can HIV be transmitter perinatally (3) |
answer
| in utero during delivery breast milk |
question
| what has a higher risk of transmission through blood than HIV |
answer
| hepB |
question
| where is HIV found in the body (7) List from fluid with highest to fluid with lowest concentration |
answer
| blood, semen, vaginal secretions, amniotic fluid, saliva, urine, breast milk |
question
| what is the most common route of HIV transmission |
answer
| 80% through unprotected intercourse (vaginal, anal, oral, genital) |
question
| why is someone with HIV and STDs more HIV infective |
answer
| someone with STDs sheds more HIV (increased semen viral load) due to inflammation increasing CD4 count |
question
| what are the initial symptoms of HIV, when do they show up (14) |
answer
| brief flu like symptoms: fever, muscle ache, rash, loss of appetite, swollen nodes if more immune supressed: fever, night sweats, weight loss, chronic fatigue, bruising, headaches, cough, diarrhea, bloody stool |
question
| when do HIV antibodies show up |
answer
| 1-6 months |
question
| how long does it take HIV to turn into AIDs |
answer
| 8-11 years |
question
| what is the most common disease and cause of death in AIDs |
answer
| pneumonia |
question
| how is AIDs diagnosed |
answer
| positive HIV test + AIDs defining illness or CD4<200 |
question
| when do you begin to treat HIV/AIDs |
answer
| positive HIV test + one of these 1. AIDS defining illness 2. CD4 <200 3. CD4 200-350 offer treatment 4. viral load >100,000 offer treatment |
question
| what are 4 AIDs defining illnesses |
answer
| candidiasis of the esophagus, bronchi, trachea, or lungs cryptococcus, extrapulmonary karposi sarcoma pneumocystis jiroveci pneumonia |
question
| what is the M phase |
answer
| early time where macrophages are targeted |
question
| what is the viral window |
answer
| period of time where an infected person tests negative for the anti-HIV virus |
question
| what is the timline for getting acurate tests, avoiding the viral window (3) |
answer
| 10% test positive within 3-6mo of exposure!! 70% test positive within 3 weeks of exposure 90% test positive within 3 months of exposure |
question
| why does it take time for someone with HIV to test positive |
answer
| seroconversion takes time |
question
| what are the diagnostic parts of HIV (4) |
answer
| gp160 (needed) gp41 and gp120 OR p24 |
question
| what is the rapid HIV test, what kind of test is it |
answer
| ELISA - sandwhich |
question
| what is the conformation test for HIV (2), how are they read |
answer
| western blot: need one gp160 and either gp12-+41 or p24. no bands is negative, 1-2 bands is inderterminate (test again in 2-4 months) PCR is becoming the new standard, it can test smaller samples and you don't have to wait 2-4 months |
question
| you do a western blot and the pt has less than 3 bands but has one now what |
answer
| indeterminate, do a PCR or wait and do it later. probablly were in viral widow |
question
| what will replace western blot as gold standard for HIV test |
answer
| molecular assay |
question
| what is GP160 |
answer
| splits into GP120 and GP41 |
question
| what does GP120 do |
answer
| attaches to CD4 receptor and pullsHIV close to cell |
question
| what does GP41 do |
answer
| attaches to CD4 receptor and pullsHIV close to cell injects viral particles into the cell |
question
| what does CXR/CSCR do |
answer
| binds to gp120 and pulls it close to stabilize it |
question
| what is p42 |
answer
| core capsid antigen of HIV |
question
| wwhat three enzymes does HIV have what do they do |
answer
| reverse transcriptase: turns viral RNA into DNA integrase: puts viral DNA into host genome protease: fit and trim viron particles |
question
| what are the symptoms of HIV in immune supression (8) |
answer
| fever night sweats weight loss chronic fatigue bruising hedache coough diarrhea bloody stool |
question
| [image] |
answer
| trichomonas |
question
| [image] |
answer
| trich strawberry cervix |
question
| [image] |
answer
| trich fecal smear |
question
| [image] |
answer
| trich discharge |
question
| [image] |
answer
| smear gonorrhea |
question
| [image] |
answer
| schistoma hematobium |
question
| [image] |
answer
| syphillis |
question
| [image] |
answer
| syphillis rash |
question
| [image] |
answer
| gonorrhea |
question
| [image] |
answer
| chaldymia |
question
| [image] |
answer
| oral thrush |
question
| [image] |
answer
| koh prep showing hyphe |
question
| [image] |
answer
| rash from kaposkis sarcoma |
question
| [image] |
answer
| herpes |
question
| [image] |
answer
| meth blue fecal smear |
question
| [image] |
answer
| chalmydia effect on cervix |
question
| [image] |
answer
| babesia in RBC showing maltease cross |
