Radiant Notes – Microbiology – Dr

Hamza
https://www.youtube.com/watch?v=rZqM5BA2Kc4

https://www.youtube.com/watch?
v=agjIyjhj1Q0&list=PLhkR6GKDrsh1YDjjnbV7lR7Bhw99czvtt&index=78

Parasitic Anemia
348. Mcq → Person pale looking Hb low and constipation. Organism causing Microcytic
hypochromic anemia (Iron Deficiency Anemia) → Ancylostoma duodenale


– Known difference
 Microcytic anemia with eggs in stool → Ancylostoma duodenale (hook worm)
 Mn → cytic = cyclo

 Fisherman with Anemia + Raised MCV (Megaloblastic anemia) + B12 Def →

Diphyllobothrium latum
 Mn → Large quantity of L in megaloblastic causative


 Background
 Microcytic anemia

 Cause → Iron deficiency

 Iron absorption occurs in duodenum.

 Ancylostoma duodenale damages duodenum → leads to IDA.

 Megaloblastic anemia

 Diphyllobothrium latum absorbs dietary Vitamin B12 → B12 deficiency anemia.

– Now let's practice some paper MCQs

 Q – Fisherman with macrocytic anemia picture on smear + eggs in stool. Causative
organism is → Diphyllobothrium latum
 Q’ – Fisherman only eating rice and fish. On labs shows anemia MCV → 106 fL (Normal
MCV – 90 fL), some neuropathy signs, stool shows ova, cause is → Diphyllobothrium
Latum.
 Rx → MCV 106 = Megaloblastic + Neuropathy signs → Vit B12 deficiency anemia.
 Q – A child with worm infestation Ancylostoma duodenale came with complains of pallor.
Labs showed Iron deficiency anemia. Most likely peripheral smear picture will show →
Microcytic and hypochromic anemia.
 Rx → IDA is Microcytic + Hypochromic.
 Q’ – A patient developed Microcytic, hypochromic anemia. On microscopy of stool, eggs
were noticed. Which following is most likely responsible for this condition → Ancylostoma
duodenale.
 Q’’ – Person pale looking Hb low and constipation. Organism causing Microcytic
hypochromic anemia (Iron Deficiency Anemia) → Ancylostoma duodenale
 Liver Abscess Organisms
349. Mcq → Most common site for amoebic ulcer in gut is → Caecum


– Notes / HYPs


Hydatid Liver Pyogenic Liver Amoebic Liver

Disease Abscess Abscess
Intro  Hydatid =  Pus in Liver due to  Pus in liver due to
Cavitated cyst bacteria. complication of
 Cavitated cyst = Amoebiasis
Cysts have (intestinal parasite)
microcysts within  Parasite infiltrates
the main cyst. Liver from
 Cysts occur in liver. intestine.
Causative organism  Echinococcus  E. coli (most  Entamoeba
Granulosus – common) histolytica
Parasite  Other  Mn → Amoeba is
 Mn → High Chin  Streptococcus ENT surgeon
 High = Hydatid milleri  E. histolytica cause
 Chin = Echin  Strep. Faecalis →
 Bacteroides amoebiasis
/amoebic
dysentery
 Amoebiasis →
infection of
intestine leading to
dysentery (bloody
diarrhea)
 Complication of
Amoebiasis is →
Amoebic Liver
abscess
Pathophysiology  Can affect any  Ascending infection  Trophozoites invade
organ, due to biliary portal circulation
 Liver is most obstruction from small intestine.
common affected (ascending
(75 %) cholangitis), or
 Others spread from
 Lungs > Brain > empyema of gall
Bone bladder
Features  Cysts in Liver (75  Multiple abscesses  VV IMP
%) or other affected in Liver  Single abscess in
organs. right lobe (RUQ) +
bloody diarrhea
 Most commonly
involves caecum
(part of colon)
  Histology → Flask
shaped ulcer – mcq
Diagnosis /  CT scan →  US abdomen  Serology – mcq
Investigations investigation of  Alkaline
choice – mcq phosphatase – ALP
 Hemagglutination → raised
test to detect
antibodies → Most
accurate test – mcq.
Treatment  Albendazole → 400  *Ampicillin +  1st line of therapy →
mg 3 times daily for Ciprofloxacin + *Metronidazole
30 days Metronidazole  If metronidazole NOT
 Surgical treatment  If Penicillin allergic in options →
→ ERCP – mcq → Ciprofloxacin + Tinidazole +
Clindamycin Diloxanide furoate.

 * Rule 1 → antibiotics effective for both parasites + bacteria.

 Rule 2 →
 if infection below diaphragm → Metronidazole (M is below C)

 If above diaphragm → Clindamycin (C is above M)

ⱺ ∵ Liver lies below diaphragm → Metronidazole treatment of choice.

•

– Now let's practice some paper MCQs

– Hydatid Liver Disease
 Q – Causative organism for cyst in Liver → Taenia echinococcus
 Close family member of Echinococcus granulosus
 Q – Which of following infection is most likely related with cysts in Brain with daughter
cysts on a CT scan → Taenia echinococcus
 Daughter cysts mean → more cysts within the main cyst.
 Q – CT brain of patient shows cyst with multiple daughter cysts, which of the following is
responsible → Echinococcus granulosus
 If Echinococcus NOT in options chose → Taenia solium

 Q – In which of following is man an intermediate host → Hydatid cyst disease – VV IMP

– Pyogenic Liver Abscess
 Q – Most common organism causing Pyogenic liver abscess → E. coli
 Q – Regarding Pyogenic liver abscess, Predisposing factor → Ascending cholangitis ???
– Amoebic Liver Abscess
 Q – Causative organism of Amoebic liver abscess → Entamoeba histolytica
 Mn → Amoeba is ENT surgeon

 Q – Amoebic abscess involves which portion of GIT most commonly → Caecum

 Q – DOC for Amoebic Liver Abscess → Tinidazole (if Metronidazole NOT in options)
 Q – Amoebic Liver abscess investigation → Serology
 Q – Bloody diarrhea, RUQ pain, liver abscess, flask shaped ulcer, causative organisms →
Entamoeba histolytica
 Q – Patient comes with tender right hypochondrium, stool with occult blood on
colonoscopy, ascending colon was involved, showing ulcers while other parts of colon
 were spared. On histology / microscopy, what will be seen → Entamoeba Histolytica ??? –
Double A mcq 161
 Occult stool I guess is early stage of bloody diarrhea.
 Q – A patient with right hypochondrium pain was admitted. After admission he develops
lung abscess. Scenario of liver abscess later developing lung abscess answer → Direct
extension from Liver abscess.


Peritonitis Organisms
350. Mcq → Most common organism causing peritonitis after abdominal surgeries → Bacteroides


– Intro / Background – Peritonitis

 Peritonitis → inflammation of Peritoneum.

– Notes / HYPs
 Most common cause of Pyogenic peritonitis → Bacteroides
 Most common cause of peritonitis AFTER surgeries → also Bacteroides
 Most common cause of Subacute Bacterial Peritonitis / only peritonitis → E. coli
 Mn → Acute has word E in it.

 Puerperal sepsis → group B streptococci > Bacteroides


– MCQ
 Q – Which of following is characteristic of Bacteroides → Foul smelling discharge.
 Q – Most common organism causing peritonitis after abdominal surgeries → Bacteroides


Diarrhea Timelines
351. Mcq → A group of friends went to eat from a Chinese restaurant where they ordered fried rice,
chicken and vegetable. After 6 hours, presented with vomit, diarrhea and abdominal cramps.
Most likely causative agent is → Bacillus Cereus
 Fried rice → signature word for Bacillus cereus


– Note / High Yield Points

 Diarrhea within 1- 6 hours (Acute diarrhea) + vomiting predominant → Staph aureus
 Mn → Staph Aureus → Staff of restaurant was not good → Staff → Staph aureus

 Diarrhea within 1- 6 hours (Acute diarrhea) + reheated rice is question. → Bacillus

cereus
 Mn → Baasi rice → reheated rice
 Note

 ∵ both Staph aureus and Bacillus occurs in same time period → To differentiate

between them look for

 Bacillus → occurs with Reheated rice.

 S. aureus → occurs with Meats, mayonnaise, custard, preformed toxin

 Diarrhea within 12 - 48 hours (Late diarrhea) → Salmonella spp (Non Typhoidal), E. coli
(Abdominal cramps + nausea)
 Note → In Microbiology, spp means Specie.
 Salmonella specie cause diarrhea EXCEPT Salmonella typhi specie.
  Mn → Second in notes → SEC → Salmonella Spp + E. coli
 Diarrhea within 48–72 hrs → Shigella, Campylobacter
 Mn → Bacter homophone of bahatar (72)

 Diarrhea AFTER 7 days + NOT treated with antibiotics → Giardiasis, Amoebiasis

 Mn → Jee gaya
 Note

 Giardiasis caused by → Giardia lamblia

 Amebiasis caused by → Entamoeba histolytica

Mn → Amoeba is ENT surgeon

ⱺ

 Note 2

 Giardiasis → non bloody diarrhea

 Amebiasis → Bloody diarrhea

 Note 3
 Both are parasitic infections

Diarrhea Characters (Bloody / Watery)

352. Mcq → Child had eaten from restaurant, then has Bloody diarrhea, petechiae and facial
swelling. Peripheral blood picture showed schistocytes. What is diagnosis → HUS (Hemolytic
Uremic Syndrome)

– Background – Hemolytic Uremic Syndrome
 Def – Damage of small vessels of small intestine + renal system.
 Triad of
 Renal Insufficiency
 Microangiopathic Hemolytic anemia
 Thrombocytopenia
 Explanation of Triad
 Renal Insufficiency →

 Excess fluid in body → Leads to Facial Swelling

 Microangiopathic Hemolytic anemia → presents with Schistocytes

 Schistocytes are damaged RBCs → occur in Microangiopathic Hemolytic

anemia.
 Thrombocytopenia

 Impaired renal function → ↓ thrombopoietin (TPO) production –→ thrombocytopenia.

 Causative organism → E coli.

 Serotype → H70157

– Notes / HYPs –Diarrhea scenarios
Info also in First aid – book pg 176


 Watery + Non–bloody diarrhea → Heat stable & Heat Labile enterotoxin – E. coli
 Aka → Traveler’s diarrhea

 Only Bloody diarrhea (Dysentery) → Shiga toxin – Shigella OR Vero-toxin aka Shiga-like
toxin – E. coli
 Bloody diarrhea with Schistocytes → HUS – E.coli
 Food poisoning, causative organism → Heat stable enterotoxin / Staphylococcal
enterotoxin (Staph. Aureus).
 Rice–water diarrhea → Cholera toxin – Vibrio cholera
  Mn → Rice water diarrhea comes AS vibration – Vibrio
 Sudden & extreme Diarrhea episodes which has an appearance that resembles water in
which rice has been rinsed.
 Also

 Diarrhea with coma shaped organism → Vibrio cholera

 Diarrhea in HIV patients → Cryptosporidium (Donut shaped cyst) – is a parasite.

 Mn → if HIV patient eats too many donut → diarrhea → double O is causative

organism name.
 Diarrhea with history of travelling + donut shaped cyst → also Cryptosporidium
 Due to ingestion of contaminated water in public pools.

 Mn → During Travelling we come across creepy places.

 Diarrhea with crescent shaped protozoa on duodenoscopy → Giardiasis

 Caused by Giardia duodenales aka Giara lamblia (pear shaped protozoa)

 Mn → Giardiasis k patient ko din me taray dikh jatay hian.

 Watery diarrhea resolves spontaneously within 1 weeks → Rota virus (Double A)



– Past paper MCQS about Diarrhea

 Q – Shigella causes dysentery by mechanism of → Mucosal invasion.
 Q – Female patient presented with complaint of weight loss, sweating, palpitation and
diarrhea, on examination BP is normal, what could be probable diagnosis → Hyperthyroid
???
 Q – A traveller came from Thailand with torrential diarrhea for several weeks. Stool, R/E
shows donut shaped cysts. What is most likely cause → Cryptosporidium.
 Q – After feeding, a baby develops diarrhea. What is likely cause → Gastrocolic reflex
 Gastrocolic reflex → Infants have bowel movement (pass stool) immediately after
eating or even while eating.
 Note → Difference between Gastrocolic reflex vs Lactose intolerance in baby

 If diarrhea occurs immediately after feeding → Gastrocolic reflex

 If diarrhea occurs 6 to 8 hours after feeding → Lactose intolerance

Mn → L in Late – L in Lactose
ⱺ

 Q’ – A baby brought by mother with complains of diarrhea and flatulence on/off after
taking milk/ milk products. What is likely diagnosis → Lactose intolerance
 Q’’ – Most common carbohydrate malabsorption due to deficiency of enzyme → Lactase
 A 40-year male working as a taxi driver in Dubai presented with complain of fever, weight
loss, anorexia, and diarrhea. O/E he is emaciated, has jaundice, splenomegaly and
generalized lymphadenopathy. What is diagnosis → AIDS
 Q – A patient with prolonged diarrhea undergoes Oesophago–gastro–duodenoscopy
(OGD). Biopsy of small intestine shows numerous crescent-shaped protozoa adjacent
to epithelial brush border. Which is likely pathogen involved → Giardia Lamblia (aka →
Giardia duodenales)
 Mn → Giardiasis k patient ko din me taray dikh jatay hian.

 Note

 Both Giardia Lamblia & Plasmodium Spp → crescent shaped organism

 Both Giardia Lamblia & Plasmodium Spp → parasites

Giardia causes → diarrhea

ⱺ

Plasmodium Spp causes → Malarial fever.

ⱺ
  Q’ – A child developed diarrhea. Biopsy of intestine show villous atrophy and gluten
free diet doesn't improve his symptoms. What is probable diagnosis → Giardiasis
 Giardiasis cause villous atrophy
 Q’’ – Mother bring her child complaining of diarrhea and weight loss. Biopsy shows 2
nuclei organism which is pear shaped, diagnosis → Giardiasis

 Note 2
 Both Giardia Lamblia & Trichomonas vaginalis → pear shaped

 Both Giardia Lamblia & Trichomonas vaginalis → parasites

 Trichomonas cause Cervical infection.

 Q – Newborn baby anaemic for which she received exchanged transfusion. After 10 days
she developed diarrhea and a rash on arm spreading to body, diagnosis → Graft versus
host reaction ???
 Q’ – Man presents with diarrhea followed by vomiting, rapid dehydration, dry tongue BP
of 90/40. Microscopic examination shows coma shaped organism, diagnosis → Vibrio
cholera.
 Recall → Diarrhea with coma shape organism → Vibrio cholera

 Q’’ – Vibrio cholera causes diarrhea by which mechanism → Increase Cl– channel
opening.
 Q – Child had eaten from restaurant, then has Bloody diarrhea, petechiae and facial
swelling. Peripheral blood picture showed schistocytes. What is diagnosis → HUS
(Hemolytic Uremic Syndrome).



 The most characteristic signs and symptoms of clostridium botulinum → Flaccid paralysis
of respiratory muscles.


 Can see mcq 97 in Double A regarding E coli.



Syphilis
353. In Primary Syphilis, best specimen for diagnosis is → Genital sores


– Background of Syphilis
 Causative organism → Treponema pallidum – mcq
 Treponema pallidum enters body via → damage to epithelium
 Primary Syphilis → Painless ulcer at
 Genitals
 Rectum
 Mouth
 Ulcer in Primary Syphilis called chancre.

 Secondary Syphilis → Painless Ulcer + Localized Lymphadenopathy

 Condylomata lata (condyloma latum) → painless cutaneous manifestation of Secondary
Syphilis – mcq.
 Tertiary Syphilis → Gumma – painless bumps on skin (characteristic of Tertiary
Syphilis)
 Late Syphilis → Neurological disorders + cardiac disorders – unverified.

 Note 1
 In general in all stages of Syphilis → Ulcers are painless.

 Painful Ulcer causative organism (Mn → BCG)

 Bechet disease

 Chancroid – Hemophilus ducreyi (dukh rahi)

 Genital Herpes – HSV–2

 Note 2 – Condylomata acuminata vs Condylomata lata

 Condylomata acuminata → caused by HPV

 Mn → Accumulation of various viruses - HPV 6 – 11

 Condylomata lata (condyloma latum) → caused by Syphilis

 Mn → Late Teen bound to have Sip of alcohol.

ⱺ
 – Background 2
 Hutchinson teeth → occurs if Syphilis is transmitted by a mother to child in utero or at
birth.
 Called Congenital Syphilis.
 Causes Argyll Robertson Pupil.
 Discussed ahead.


– Syphilis MCQs
 Q – Hutchinson teeth is characteristic of → Congenital Syphilis
 Q – Congenital Syphilis (in infant) is best diagnosed by → VDRL.
 Q – Child with Hutchinson teeth, mulberry molars and gumma at palate most likely
suffering from → Syphilis
 Hutchinson Teeth → Peg shaped / notched Incisor.
 Q – 35 years male usually goes to Dubai and has h/o immoral sexual activities and
doesn't use any protection. He has problem in walking in dark and loses balance, absent
light reflexes, no pain sensation, most likely diagnosis → Tabes dorsalis (caused by
Syphilis i.e. STD)
 Tabes Dorsalis → complication of Late Syphilis infection (untreated Syphilis)

 Patho → damage to spinal cord and peripheral NS.

 Q – In Primary Syphilis, best specimen for diagnosis is → Genital sores

 Q – A man who is sexually active was diagnosed with Syphilis that he got from his sexual
activity. 3 weeks ago, serology was positive. What will be most probable finding → Penile
chancre
 Rx → In Primary Syphilis → sores develop at site of infection.
 Sore from Primary Syphilis disappear within 2 to 6 weeks. If left untreated, syphilis will
move into its second stage – NHS
 Q – A lady delivered a baby having Hutchinson teeth which is centrally notched teeth
found in which infection → Syphilis.
 Q – Gummatous necrosis occurs in → Syphilis
 Rx → Gumma – characteristic feature of Tertiary Syphilis.
 Q – A 65-year man presented with constricted pupil, non-reactive to light but reacts with
accommodation. Patient iris is depigmented in patches. He also gives history of suffering
from Syphilis. Condition that best describes his pupil is → Argyll Robertson Pupil
 Features of Argyll Robertson Pupil are in name

 A → Accommodation

 R → Reflex

 P → Present

Pupillary Reflex Absent

ⱺ

 Q – Maternal infection that is associated with recurrent abortions → Syphilis



Different Viruses
354. Mcq → Burkitt Lymphoma in AIDS → EBV
 Same info book page 164 – First Aid

– Very Important Oncogenic Microbes
 These all are DNA Viruses

Pathogen Features / Disease
Herpes Simplex Virus 1 –  Herpes Labialis, Keratoconjunctivitis
HSV 1  Mn 1 → 1 is top number → affects top located tissues.
 Mn 2 → Simple Virus → cause simple diseases.

Herpes Simplex Virus-2 –  Herpes Genitalis or Cervical Cancer

HSV 2  Mn 1 → 2 is lower → affects lower located tissues.
 For Cervical Cancer → HPV > HSV–2

Varicella-Zoster Virus (HHV-  Varicella Zoster (Chickenpox, Complication → Shingles)

3)
Epstein-Barr virus (HHV-4)  All diseases are in Immunocompromised individuals.
 Mn → only compromised people go to Bar.
 Diseases → Infectious Mononucleosis
 Dx
 Monospot test +ve > Sheep test
 Mn → compromised people go to bar to get positive

 Cancers – Mn → Hairy Nose HBL

 Hairy tongue Leukoplakia (aka Oral Hairy Leukoplakia)
 Nasopharyngeal Carcinoma
 Hodgkin Lymphoma (in HIV patient)
 Reed Steinberg cells (look like owl eyes)
 Burkitt Lymphoma
 Lymphoma in AIDS
Burkitt Lymphoma
 Translocation 8:14

 Mn → Burkat wala din 14 august

 Patho
 Infects B cells – mcq
 Mn → B in EBV
 Transmission
 Most commonly spread through saliva – Google
 Less common source of transmission → sexual contact,
blood transfusions, and organ transplantations –
Google .
 Note
 EBV causes 2 cancers in HIV patients
 Hairy tongue Leukoplakia (aka Oral Hairy
Leukoplakia)
 Burkitt Lymphoma
 Mn → EHOB

 Note 2
 2 characteristic features in any disease/cancer caused by
EBV
 “Atypical” Lymphocytosis → Lymphocytes are
larger (more cytoplasm) and have nucleoli in their
nuclei.
 Cervical Lymphadenopathy.

Cytomegalovirus CMV  Diseases

(HHV-5) Infects both Immunocompetent +
Immunocompromised + a TORCH infection
 Immunocompetent patients
 Mononucleosis
 –ve Monospot test

 Immunocompromised
 Infections
 Example
 Pneumonia in transplant

 Chorioretinitis in AIDS

 Congenital CMV
 Discussed ahead
 Appearance
 Infected cells have characteristic "owl eye" inclusions –
mcq
 Some describe it blue berry muffin.

HHV–6 & HHV–7  Roseola Infantum – mcq

HHV-8  Kaposi sarcoma

 Mn → K mountain series k 8 pahaar hian
 Def – Neoplasm of endothelial cells but also called skin
cancer. (since lesion spread to skin)
 Most common skin cancer in immunocompromised →
Kaposi Sarcoma – mcq
 Note → All are immunocompromised
 Neonates
 Steroids used
 Diabetics
 AIDS
 Transplant patients

Parvo Virus (aka → B19  Aplastic crises in Sickle cell disease

Virus)  "Slapped cheek" rash in children (erythema infectiosum,
or fifth disease – mcq
 Mn → Paro in Devdas got slapped.
 Note
 Parvo Virus → DNA Virus – mcq

HPV  Remember from papilla that it will affect skin.

 Diseases
 SCC in AIDS patients
 HPV serotype 6-11 → causes Cauli flower like anogenital
Warts (called Condylomata acuminata)
 Note → Condylomata lata warts caused by Syphilis.
Mn 1 → Accumulation of various viruses - HPV 6–


11
 Mn 2 → Late Teen bound to have Sip of Alcohol

 HPV serotype 16 & 18

 Cervical cancer
 HPV > HSV–2

 Oropharyngeal carcinoma
  Mn → Small number causes less severe disease –
Large number causes cancer.
 Warts management
Topical podophyllum or cryotherapy → first line
Topical imiquimod → second line

HTLV – Human T cell  T-cell leukemia

Leukemia Virus  Mn → T in both

RNA Virus Feature / Disease

Picorna Virus Family – Mn → PERCY

Polio Virus  Polio
Echo Virus  Aseptic Meningitis
Rhinovirus  Common cold
Coxsackievirus  Hand Foot & mouth Disease – mcq
 hearts Diseases (Mn → When a person is sacked – Heart
sinks)
 Myocarditis; pericarditis
 Aseptic meningitis; herpangina

Paramyxovirus Mn → Paramyxo is PM
Measles virus  Features
 Is a Paramyxovirus – mcq
 In urdu called khasra
 Koplik spots characteristic for Measles – mcq
 Histo → Warthin-Finkel Dey Giant cell – characteristic.
(fused lymphocytes) – mcq
 Complication → Subacute sclerosing panencephalitis (SSPE)
(re–activation of measles virus) – mcq
Mumps  –

Others
Influenza virus  Flu

– Background for EBV – Sketchy diagram

 Transmission → air droplets
 Spread inside body → Lymphadenopathy
 Characteristically infect cervical lymphadenopathy
– Now Let’s practice some past paper mcqs.
– EBV
 Q – Cause of Nasopharyngeal CA → EBV
 Mn → Hairy Nose HBL

 Q – Cause of Burkitt lymphoma → EBV

 Mn → Hairy Nose HBL

 Q – Causative agent of Lymphoma in AIDS patient → EBV

 Recall → EBV cause 2 cancers in AIDS patient (Mn → EHOB)

 Hairy tongue Leukoplakia (aka → Oral Hairy Leukoplakia)

 Burkitt Lymphoma

 Q – A patient suffering from AIDS. He is more likely to suffer from Lymphoma. Most
important virus responsible is → EBV
 Q – EBV associated test → +ve Monospot test.
 EBV → +ve Monospot test

 CMV → –ve Monospot test

 Mn → compromised people go to bar to become positive.

 Q – EBV associated Lymphoproliferative disease → Burkitt lymphoma

 Q – Which statement shows EBV has strong association with Burkitt lymphoma → Every
patient with Burkitt's lymphoma has elevated antibody titre against viral capsid
antigen.
 Q – An 8-year-old girl has facial pain and mass in mandible, cause → EBV
 Rx → Burkitt lymphoma caused by EBV via cervical lymph nodes
 Q – Scenario with sore throat and later Cervical lymphadenopathy, Biopsy showed
atypical lymphocytes cause → EBV
 Rx → 2 characteristic features in any disease / cancer caused by EBV
 “Atypical” Lymphocytosis

 Cervical Lymphadenopathy.

 Q – A Sailer man presented with fever rash on elbow and generalized cervical
lymphadenopathy with TLC of 7230 what is suitable diagnose → Infectious Mononucleosis
– Double A mcq ???
 Q – Scenario with Atypical lymphocytosis → EBV
 Rx → 2 characteristic features in any disease / cancer caused by EBV

 “Atypical” Lymphocytosis

 Cervical Lymphadenopathy.

Q – Atypical Lymphocytosis is seen in → Infectious Mononucleosis.

Q – Least transmitted by blood transfusion → EBV
 Rx
 Most commonly spread through saliva – Google

 Less common source of transmission → sexual contact, blood transfusions, and organ

transplantations – Google .
Q – Causative agent of Infectious mononucleosis → EBV
 Mn → compromised people go to bar to get positive
– HPV
Q – Squamous papilloma caused by → HPV
Q – A female with warty lesion on vulva, diagnosis is → Condyloma acuminata
 Rx → HPV causes cauliflower like anogenital warts called Condyloma acuminata

 Mn → Acuminata – Accumulation of various viruses.

 Warts caused by Syphilis → Condyloma Lata

 Mn → Late teens bound to have Sip of alcohol

Q – Condyloma acuminata causative agent → HPV 6–11

Q – Cauliflower lesion caused by which organism → HPV 6–11
Q – Oropharyngeal carcinoma caused by → HPV 16 &18
 Mn → Small number causes less severe disease – Large number causes cancer.
Q – A boy whose circumcision had not done, presented with glans laceration and rash.
Skin is fixed. Which organism is responsible → HPV
 Rx → Uncircumcised men are 10 times more likely to have HPV infection relative to
circumcised men – Google.
A tourist 2 weeks after returning from another country presents with fever, generalized
lymphadenopathy and a macular rash. Atypical lymphocytosis seen on peripheral smear.
Most probable diagnosis → HIV
 Man returns from trip abroad with maculopapular rash and flu like illness- think of HIV
seroconversion always
Q – What follows sequence of metaplasia to dysplasia to carcinoma in situ and then
Cervical intraepithelial neoplasia – CIN → HPV cervix.
Q – A 40 years old lady having mild dysplasia on PAP smear, most likely etiology → HPV
??
Q – Cervical cancer caused by → HPV 16 & 18
 HPV > HSV–2
Q – Cancer associated with HPV 16 → Cervical Cancer
 Mn → Small number causes less severe disease – Large number causes cancer.
Q – A lady with Cancer of cervix suspicion. Which investigation is 96 % specific and cost–
effective → PAP smear ???
Q – Pap smear cancer of cervix scenario, most common causative agent → HPV 16
– CMV
Q – Bronchogenic Carcinoma is caused by which Virus → CMV ???
Q – Patient with AML undergo bone marrow transplant, presented with pneumonia.
Histology shows large cell with intranuclear inclusion, cause is → CMV ???
Q – Post-transplant patient prone to infection → CMV
 Post-transplant → CMV
 Post transfusion commonest → CMV > HBV > HCV

– HSV
Q – Lady from a cold region going to Jeddah presented with Vesicles in oral mucosa.
Vesicles were filled with clear fluid. Diagnosis → HSV 1
 Recall → HSV – 1 affects oral – HSV – 2 affects cervical
Q – A female travelled from cold area to Jeddah having buccal mucosal eruption. organism
involved → HSV type 1
 Recall
 HSV-1 – herpes labialis, keratoconjunctivitis

 HSV-2 – herpes genitalis

Q – Vesicles on vulva are due to → HSV–2

 Vesicle = cyst
 Vulva = external female genital organs.
– Others
Q – A young previously healthy female died within 3 days of presentation of chest pain
and fever. On aspiration of pericardial fluid there were lymphocytes, what is causative
organism of pathology → Coxsackie B virus.
 Mn → when a person is sacked – Heart is affected.
Q – Child has papules, rash starting from behind ear and spread to whole body most likely
diagnose is → Measles
 Do not confuse with Mumps – Mumps has swelling on angle of mouth ( remember from
Brooklynn 99 + angle has a U)
Q’ – Complication of Measles → subacute sclerosing encephalitis.
Q’’ – Which of following is a late sequela of Measles → Subacute sclerosing
panencephalitis (SSPE)
Q – Meningoencephalitis caused by → Echo virus
Which cancer has virus carcinogen as cause → T cell Leukemia

 Infectious Mononucleosis
355. Mcq → A pt presents with fever and lymphadenopathy. Investigation shows atypical
lymphocytosis. Next investigation to reach diagnosis is Monospot test


 Recall 1 → disease caused by EBV in immunocompromised → Infectious Mononucleosis

 Recall 2 → diagnosis → +ve Mono post test
 Mn → Compromised people go to bar to get positive

 Recall 3 → Cervical Lymphadenopathy + Atypical Lymphocytosis is characteristic feature

of EBV.


– Remember

Pathogen Disease
EBV  Infectious Mononucleosis (Monospot test >> Heterophile
sheep Antibody test)
 Heterophile antibody test also known as Monospot test
and Paul Burnell Test
 Atypical lymphocytosis
 Type of cell affected → B-cells
 Atypical cells that proliferate in response → CD8 T-cells
 Hint → URTI + taken amoxicillin/ampicillin develops rash-
 diagnosis is of IM

– Now let's practice some paper MCQs

 Q – Following is caused by DNA virus → Infection mononucleosis
 Q – A 30-years old man gives history of a sore throat with fever followed by 6-weeks of
malaise. O/E he has tender generalized lymphadenopathy. A cervical lymph biopsy is
performed, and microscopic examination reveals prominent germinal centers in follicles
with a diffuse polyclonal hyperplasia composed of lymphocytes, plasma cells and
macrophages. What is most likely diagnosis → Infectious mononucleosis.
 Q – Diagnostic test for Infectious mononucleosis → Paul-Burnell test
 Q – Diagnostic test for infectious mononucleosis → Heterophile antibody
 Q – A pt presents with fever and lymphadenopathy. Investigation shows Atypical
lymphocytosis. Next investigation to reach diagnosis is → Monospot test.


Opportunistic Diseases in AIDS

356. Mcq → A known HIV patient is suffering from severe headache, photophobia and signs of
meningeal irritation. On microscopy organism has halo around it, organism is → Cryptococcus
Neoformans


HIV
Disease  AIDS

 Hallmark of HIV → proliferation of virus in T cells

Pathophysiology  Hallmark of AIDS → HIV destroys CD4+ T Helper cells
leading to Progressive Immune deficiency.
  Normal CD4 count → 500-1500 cells/mm3
Diagnosis  Patient infected with HIV is declared to have AIDS when
CD4 count → ≤ 200 CD4+ cells/mm3

 Best initial Presumptive test → ELISA

 Confirmatory test
 Adults → Western blot
 Mn → We confirm everything from west knowledge →
Diagnostic Tests
Western
 Neonates → Nucleic Acid PCR assay
 Mn → P for Paediatrics – P for PCR
 For Viral load → PCR
 Start antiretroviral therapy in HIV when CD4 count is <
Treatment
350 x 106/L

Congenital  HIV is a TORCH infections

Follow Up / Disease  CD4 count

Monitoring

Common Diseases of HIV Positive Adults

CD4+ Cell Count <
500/mm3
Fungal Infection
Candida albicans  Oral thrush
 Most common cause of Meningitis in HIV patients.
Cryptococcus Neoformans Mn → Neo Men
Tx → AMP–B – mcq
Viral Infection
 EBV causes 2 cancers in AIDS patients
 Oral Hairy Leukoplakia (aka → Hairy Tongue leukoplakia)
EBV
 Burkitt Lymphoma
 Mn → EHOB

 Kaposi Sarcoma
 Most common skin cancer in HIV patients (+ in all
HHV-8
immunocompromised) – mcq
 Mn → K series k 8 pahar hian.

 Remember from papilla that it will affect skin

 Squamous cell carcinoma
HPV
 HPV 6–11→ Condylomata acuminata Warts
 HPV 16 & 18 → Cervical cancer + Oropharyngeal Cancer

CD4+ Cell Count <

200/mm3
Pneumocystis jiroveci  Pneumocystis jiroveci
(formerly known as
  Most common opportunistic infection in AIDS patient.
 BUT most common infection in patients with HIV (&
AIDS NOT established) is TB – Dr Hamza
 Occurs when CD4+ cell count < 200/mm3
 Most characteristic feature → antibiotic resistance in HIV
 Mn → Jiroveci – JURRAT wala virus
 Disease
 Pneumonia
 Pneumonia is called complicated pneumonia since

NOT respond to antibiotics.

 Otitis Media
Pneumocystis carinii)
 Diagnosis → Broncho alveolar lavage (silver stain shows
PJ)
 Management
 Co-Trimoxazole (TMP) + SMX

 IV pentamidine in severe cases

 Steroids if hypoxic

 Features
 Boat shaped organism – mcq
 Mn → Boats have anchor in shape of J
 Bilateral interstitial pulmonary infiltrates "Ground-glass-
pulmonary infiltrates" opacities on CXR.

CD4+ Cell Count <

100/mm3
 Oral / Esophageal thrush in AIDS (+ all
Candida albicans
immunocompromised)
 Cause Aspergillosis (respiratory fungal infection) in AIDS (&
all immunocompromised patients)
 Haemoptysis → Cavitation/infiltrates on chest imaging
 Note
Aspergillus Fumigatus
 Aspergillus → Septate hyphae branch at acute angle
(45 o)
 Mucor & Rhizopus → Non–Septate hyphae branching
at wide angles.
CMV  Chorioretinitis in AIDS – mcq
 Most common opportunistic infection in HIV
Mycobacterium Tuberculosis  Most common opportunistic infection in AIDS patient →
Pneumocystis jiroveci
Mycobacterium Avium  Meningitis
 Brain abscess in AIDS patient
Toxoplasma gondii  On MRI visible as → Multiple rings enhancing lesions in
basal ganglia – mcq
 Most common cause of Diarrhea in HIV
Donut Shaped cyst
Cryptosporidium
 Mn → if HIV patient eats too many donut → diarrhea →
Double o in causative organism name.
 •

– Brain Lesions in AIDS

 Toxoplasmosis → Most common lesion
 Multiple rings enhancing lesions in basal ganglia

 Progressive multifocal leukoencephalopathy → caused by JC virus

 Multiple bilateral non enhancing lesions in white matter

 Primary CNS lymphoma → No fever, single large homogenous enhancing periventricular

lesion

– How to differentiate between Toxoplasmosis and Lymphoma
 Thallium SPECT test. +ve in Lymphoma and -ve in Toxoplasmosis.


– Now let's practice some paper MCQs

– General for AIDS
 Q – Hallmark of HIV disease → Proliferation of virus in T–Cells.
 Q – HIV virus kills which immune cells → CD4 +ve TH1 Lymphocytes
 HIV destroys CD4 T Helper cells
+

 EBV target B cells.

 Q – HIV patient disease monitoring done by → CD4 cell count

 Q – Which cell type decreases in HIV patient → CD4 +ve TH1
 HIV destroys CD4 T Helper cells
+

 Q – HIV positive patient with chest infection is prophylactically treated with → TMP-SMX
 Q – Lymph node biopsy in early stages of HIV disease will reveal → Follicular Hyperplasia
???
 Q – Transmission of AIDS can occur from → Mother to fetus
 Rx → HIV is a TORCH infection.
 Q – HIV infected mother, gave birth to a baby. Investigation to confirm HIV infection in
baby → PCR
 Mn → P for paediatrics – P for PCR.

 Q – Baby born to HIV mother. What test will you perform to confirm HIV in neonates →
PCR
 Q – Longest incubation period among following → HIV – imp mcq
 Rx → IDK

 Q – Which is longest phase of HIV without ANY symptoms → Latent phase

 Mn → Jisko HIV hjae → vo late hne wale hjate hian.
 Q – In OT procedure, alcohol was used for cleansing purpose BUT organism was resistant,
organisms is → HIV
 HIV patient – Disinfection Protocol

 Floor → 1 % Hypochlorite

 Instrument → 2 % Glutaraldehyde

ⱺMn → Floor hugged IG

 Q – Which one is used in HIV → Zidovudine
 Q – Patient HIV seropositive BUT NOT yet developed AIDS, suffer from otitis media ???
 Q– HIV associated nephropathy → Focal segmental glomerulosclerosis ???
– Diseases in HIV by Organisms
 Q – HIV positive but AIDS not proven, CD4 cell count is 800, got pyogenic SOM (serous
otitis media). Causative organism → Pneumocystitis jiroveci
 Pneumocystitis jiroveci cause
  Pneumonia
 Otitis media

 Q – Most common opportunistic infection in AIDS → Pneumocystitis carinii

 Q – Most common organism causing infection in patients with HIV → Pneumocytic carinii
 Q – Which skin carcinoma is associated with AIDS/HIV → Kaposi sarcoma
 HHV–8 causes Kaposi Sarcoma.

 Mn → K series k 8 pahar hian

 Q – AIDS defining cancer → Kaposi Sarcoma

 Q – Female having some sort of auto immune disease and lymphoma from 1 year. Now her
cervical lymph nodes are positive. What is most probable reason → AIDS
 Rx → EBV cause 2 cancers in AIDS patient
 Hairy tongue Leukoplakia (aka Oral Hairy Leukoplakia)

 Burkitt Lymphoma

ⱺMn → EHOB
 2 characteristic features in any disease/cancer caused by EBV
 “Atypical” Lymphocytosis

 Cervical Lymphadenopathy.

 Q – A 35–years old lady having cervical lymphadenopathy, is diagnosed as a case of

Malignant cell lymphoma. Which immunological disorder she is most likely to have →
AIDS ???
 Recall → in AIDS patient EBV cause 2 cancers & characteristic of EBV is cervical
lymphadenopathy.
 Q – A 30–years old male developed brain tumor. Histological examination revealed B-cell
lymphoma. Most useful investigation in this patient is antibody test for → EBV
 Rx → Hodgkins lymphoma is B cell Lymphoma.
 Q – A known Hodgkin lymphoma patient presents with high grade fever and vomiting.
O/E neck stiffness and Kernig sign was positive. CSF shows a fungal organism. Which
organism is most likely responsible for it → Cryptococcus neoformans
 Rx → most common cause of meningitis in HIV patient → Cryptococcus Neoformans
 Sx of meningitis
 Headache

 Photophobia

 Altered mental status

 Fever

 Kernig’s sign positive.

 Q – A 25-year-old male AIDS patient has a fever of 102oF and complains of severe
headaches during past week. Staining of his CSF with Indian ink reveals Cryptococcus
neoformans. Treatment should be → Amphotericin B ???
 Q – Chronic fungal infection with rhinosinusitis (sinusitis complicated name) causing
medial erosion and granulomas is by → Aspergillus
 Rx → Fungal rhinosinusitis = respiratory infection caused by Aspergillus Fumigatus in
HIV patients.
 Q – A farmer with SOB came to clinic. On CXR, physician found coin lesion. What could be
cause → Aspergillus – ratta
 A pt HIV positive for 10 years presents with abdominal obstruction and pain, scan shows
grey, white mass which is resected and shows infiltrating and invading tumor most likely
→ B cell lymphoma ??

 – BCQs
 Q – If patient is HIV seropositive what is best approach?
 Repeat tests with other methods → Answer
 Correlate with history
 Isolate him
 Declare AIDS

 Q – A young girl presented with generalized lymphadenopathy due to which of these →

HIV
 AIDS → Answer
 Sarcoidosis
 Leukemia
 Asbestosis

 Lymphadenopathy can be caused by any of these → HIV, mononucleosis caused by

EBV, CMV,


Diagnostic Tests in HIV

357. Mcq → Baby born to HIV mother. What test will you perform to confirm HIV in neonates → PCR
 Mn → P for paediatrics – P for PCR

– Know difference
 Presumptive test → ELISA
 Confirmatory test → Western blot assay
 Mn → When we have to confirm something we look at West

 For Viral load → PCR

 For Neonates → PCR
 Mn → P for paediatrics – P for PCR

 Follow Ups / Disease Monitoring → CD4 count.


– Now let's practice some paper MCQs
 The HIV confirmatory test in baby of a HIV positive mother is → HIV PCR
 Investigation that confirms HIV in adults → Western blot


358. Mcq → HIV patient, Surgery done. What agent commonly used to wash floors after surgery →
1 % hypochlorite .


– Post HIV patient – Disinfection Protocol

 Routine antiseptic for hand wash in OT → Chlorhexidine and alcohol
 For HIV
 Floor → 1 % Hypochlorite
 Instrument → 2 % Glutaraldehyde

 Mn → Floor hugged IG


– MCQs
 Q – Which of following is used as an antiseptic for surgical scrub and skin during and
after surgery → Chlorhexidine and Alcohol.
 Q – Which of following is used as an antiseptic for hand wash in OT → Chlorhexidine and
alcohol
  Q – In HIV patient surgery done, which antiseptic is used to clean floor after surgery → 1
% hypochlorite.


Typhoid Bacteria – Gram –ve Rod

359. Mcq → Diagnostic test for typhoid in 2nd week is → Blood culture and Widal test


– Background
 Causative bacteria for typhoid → Salmonella typhi
 Sx
 Rose spots on chest + fever & headache – mcq
 Triad of – mcq
 Sinus Bradycardia

 Absolute Neutropenia

 Hepatosplenomegaly.

 All Salmonella specie cause diarrhea EXCEPT Salmonella typhi specie which cause
typhoid.
 Salmonella are gram –ve rod.
 Mn → in alphabetical order R follows S

– Note 1
 1st week → Blood Culture
 2nd week → Antibody test (aka → Widal Stool Test)
 3rd week → Stool
 4th week → Urine Culture
 Mn → BASU

 Mn 2 → BWSU


– Note 2
 Widal test is also confirmatory – mcq
 if in option blood culture + Widal test is present in single option for 2nd week choose
this.

– Now Let's practice some paper MCQs
 Q – Carrier of Typhoid → Asymptomatic.
 Q – Few days after Typhoid, bacteria reside in → Peyer patches
 Q’ – In 2nd week of Typhoid, Bacilli reside in → Peyer patches
 After months, then resides in Gall bladder (chronic carrier)

 Q – Best Investigation in 1st week of typhoid → Blood culture

 Mn → BASU

 Q’ – Patient infected with Typhoid, and it has been a week. How to diagnose → Blood
culture
 Q – Neutropenia is associate with → Typhoid
 Recall → All bacterial infections → ↑ Neutrophils

 Mn → Banan flavoured pen – discussed ahead

 Q – Test of choice for Typhoid in 1st week is → Blood culture + typhoid antibodies (there
was no option of blood culture alone)

 Gram Positive Rods
360. Mcq → Death in Clostridium botulinum is due to → Paralysis of respiratory muscles.

Bacteria Disease

Clostridium tetani  Diseases

 Spastic paralysis
 Risus sardonicus (Evil smile)
 Lockjaw (Trismus).
 Patho
 Tetanospasmin toxin prevents release of inhibitory NTs
(GABA and glycine) from Renshaw cells (aka →
interneurons) in spinal cord.
 Spread via motor neurons → mcq
 Mn → Motorcycle drivers contact tetanus
 Recall → anterior spinal cord is motor – posterior
spinal cord is sensory (Mn → AM BS)
 Treatment
 Metronidazole
 All Clostridium species DOC → Metronidazole
 EXCEPT Clostridium perfringens

 Note
 Vaccine used for Tetanus → Inactivated Toxoid – mcq
Clostridium botulinum  Intro
 Classic Botulism
 CB Affects adults.
 Caused by preformed exotoxin
 Improperly canned food allows spores to germinate &
affects adults.
 Infant Botulism → Ingestion of spores in honey.
 Diseases
 Descending Flaccid paralysis
 Floppy baby syndrome
 Descending Flaccid paralysis in babies is called FBS
 Patho
 Botulinum Toxin prevents release of stimulatory NT (ACh)
signals at NMJ resulting in Flaccid paralysis.
 Treatment
 Metronidazole

Clostridium difficile  Normal GIT flora

 Disease
 Pseudomembranous Colitis secondary to antibiotic use
 Treatment
 Metronidazole (10-14 days)
 if no response then → Oral Vancomycin
 For life threating complications Oral Vancomycin + IV
Metronidazole
 If Vancomycin + Metronidazole in option prefer that.
 Clostridium perfringens  Features
 Clostridium perfringens old name → Clostridium welchi
 Mn → Waraich on perfume
 Toxin
 α toxin → a phospholipase enzyme
 Heat Labile enterotoxin
 Diseases
 Heat Labile Enterotoxin
 Clostridium perfringens is NOT completely destroyed by
ordinary cooking.
 α toxin
 Myonecrosis & Gas Gangrene
 Crepitus
 Def – popping sound under skin due to air/gas in

subcutaneous tissue.
 Characteristic feature of disease.

 Pathophysiology
 α toxin is a phospholipase enzyme
 Phospholipase of Clostridium perfringens called →
Lecithinase.
 Phospholipase → degradation of phospholipids →
myonecrosis ("gas gangrene") and hemolysis.
 Treatment
 Penicillin G
 All Clostridium species DOC → Metronidazole EXCEPT
Clostridium perfringens
 Mn → Cluster is seen in Metro

Note  Features of all Clostridium Species

 Produce Endospores (Spores)
 Strictly Anerobic
 Gram +ve rods


– Now Let's solve some paper MCQs

– Tetani
Q – Prophylaxis against tetanus to population → Toxoid.
 Vaccine used for Tetanus → Inactivated Toxoid

Q – Which organism spores are MOST resistant → Clostridium – ratta

Q – Horse rider fall and scratches some days ago. Presented with lock jaw and spasm due
to → Tetanus toxin decreases GABA.
Q – Tetanus toxin is → Neurotoxin.
Q – Spore forming bacteria causing Tetanus → Clostridium tetani
 Recall → All Clostridium species → spore forming.
– Botulinum
Q – Characteristics finding of Clostridium botulinum → Flaccid paralysis of respiratory
muscle (Mn → FB)
 Paralysis in Clostridium tetani is Spastic paralysis Mn → ST

Q – Death due Clostridium botulinum → Flaccid paralysis of respiratory muscles

Q – Characteristic feature of Clostridium botulinum ingestion → Respiratory Failure
 Respiratory failure → occur in both Clostridium tetani + Clostridium botulinum
 Q – Clostridium botulinum inhibits release of ACh at → Neuromuscular junction
 Note

 C. botulinum inhibit release of ACh at → Neuromuscular junction

 C. tetani inhibit release of GABA at → Interneuron in Spinal cord.

– Difficile
 Q – Pseudomembranous colitis caused by → Clostridium difficile
 Q’ – Treatment for Pseudomembranous colitis → IV Metronidazole + Oral Vancomycin
– Perfringens
 Q – MOA of gangrene caused by Clostridium perfringens → Phospholipase
 Q – Gas gangrene caused by → Clostridium welchi
 Mn → Waraich on perfume

 Q – Cause of death in by gas gangrene → Toxemia shock

 Q – Most common cause of gas gangrene lower limb → Clostridium welchi

 Gram Positive Rods 2
361. Mcq → 90 % of anthrax patient have which of following findings → Skin lesion

– Notes / HYPs


Bacteria Disease
Bacillus anthracis  Intro
 Gram +ve spore-forming rod
 Produces anthrax toxin (an exotoxin consisting of
protective antigen, lethal factor, and edema factor).
 Disease
 Include
 Cutaneous Anthrax → 90 %
 Pulmonary Anthrax
 Cutaneous Anthrax
 Anthrax literally means black scar.
 Ulcer with black eschar (painless, necrotic) on skin

Cutaneous Anthrax

 Pulmonary Anthrax
 Inhalation of spores, most commonly from

contaminated animals or animal products →

Example wool.
 Also known as wool sorter’s disease
 Flu-like symptoms that rapidly progress to fever,
 Pulmonary hemorrhage + mediastinitis, and shock
 Medium
 Grows in Blood agar.
 Treatment
 Ciprofloxacin → mcq
 Mn → ABC

– Now let's solve some paper MCQs

 Q – Pulmonary anthrax infection. Drug of choice is → Ciprofloxacin
 Q’ – Person with common cold along with mild chest pain and breathing problem.
Diagnosed with early stage of pulmonary anthrax infection. Drug of choice is →
Ciprofloxacin.
  Q – A farmer also looking after sheep presents with sore throat, fatigue and mild fever
since 1 week. O/E he has a black lesion on his arm. What is likely diagnosis →
Cutaneous Anthrax.
 Q – Anthrax, main differentiating feature is → Spore forming bacteria
ⱺ

Parasites & Associations 2

362. Mcq → Scenario on fisherman with anemia, which parasitic infection → Diphyllobothrium
Latum


– Notes – Parasites & Associations

 Spiking Fever + Hepatosplenomegaly + Anemia + Hx of bitten by fly → Kala Azar
 Kala Azar is caused by → Leishmania spp

 Migratory lesions + walking barefoot on contaminated beach / soil → Cutaneous larva

migrans
 Caused by Hookworm

 Mn → Remember Migratory lesions from MIGRAns

 Microcytic anemia + eggs in stool → Ancylostoma duodenale Hookworm (same hookworm

as in above)
 Fisherman + Anemia + Raised MCV (Megaloblastic anemia) + B12 Def → Diphyllobothrium
latum
 Mn → Large quantity of L in Megaloblastic causative

 Cholangiocarcinoma / Biliary tract disease → Clonorchis sinensis

 Infects Biliary tract

 Mn → Sinensis nonsense to infect biliary tract.

 Bladder cancer (squamous cell carcinoma of bladder) + haematuria → Schistosoma

Haematobium
 Mn → SC in Schistosoma Haematobium = Squamous cell

 River Blindness (aka Onchocerciasis) → Onchocerca volvulus

 Called River blindness because → People who get infected live or work in rural areas,
near rivers, where black flies breed.
 Characteristic features → triad of
 Severe itching

 Disfiguring black skin conditions

 Visual impairment → leading to permanent blindness.

 Imp Note
 Cause of Global Blindness
Disease → Cataract > Glaucoma
ⱺ

Organisms → Chlamydia trachomatis (serotype A–C) > Onchocerca

ⱺ

• Mn → in both C is the 1st cause

 Cause of Infectious Blindness

Trachoma
ⱺ

 Rectal prolapse → Trichuris – mcq

 Mn → Repeat – RPT

 Cysticercosis → Taenia solium

 Anal / perianal itching → Enterobius vermicularis
 Mn → Vermin parasites cause anal itching

 Parasite + Respiratory symptoms / Lung involved → Ascariasis

 Causative organism → Ascaris Lumbricoides

 Spread → ingestion of mud – mcq

 Infects

 Initially → intestines

 Complication / Late stage → Lungs

 Respiratory Sx pathophysiology → penetrate wall of small bowel and migrate via portal
circulation through liver to lungs.
 Helminth disease caused by mosquito bite → Filariasis
 Helminth means parasitic worm.

 Eating raw and uncooked meat → Tapeworm

 Tapeworm includes →
 Taenia solium (pork worm infestation)

 Diphyllobothrium latum

 Echinococcus granulosus


– Note 2 – Fungi & Associations
 Diabetic patient + DKA, died + Eye protrusion + skin redness → Mucormycosis
 Mucormycosis
 Def – Opportunistic fungal infection in immunocompromised

 Infects

Lungs
ⱺ

Brain
ⱺ

Skin
ⱺ

– Note 3 – Round worms

 Pinworms
 Mode of transmission → fecal – oral – mcq
 Hook worm
 Microscopic feature → Spectacle shaped bilobed nucleus


– Now Let's solve some paper MCQs

– Clonorchis Sinensis
 Q – Which parasite causes Cholangiocarcinoma → Clonorchis sinensis
 Q – Biliary tract parasitic infection → Clonorchis sinensis
– Schistosoma Haematobium
 Q – SCC of bladder by → Schistosoma haematobium
  Q’ – Organism associated with Bladder squamous cell carcinoma → Schistosoma
haematobium
 Q’’ – Urinary bladder cancer caused by which species → Schistosoma haematobium
 Q’’’ – Squamous cell carcinoma diagnosed in a person who came from Dubai and
presented with painless haematuria. Likely organism is → Schistosoma haematobium
– Onchocerca volvulus
 Q – Onchocerciasis causes which of following → Eye involvement & skin nodules
 Recall → Onchocerca volvulus causes River blindness.
 Q’ – A female after coming from foreign trip develops lesion/nodules on side of her face
and eye. Vision issue increasing gradually. Relates to which of following → Onchocerca
Volvulus
 Q’’ – A person living on river side develops blindness. Which organism is most likely to
be cause of blindness in this person → Onchocerca volvulus.
 Q’’’ – An African woman comes to you with swollen eyes and skin rash. O/E a small
filarial worm was noticed in eye. Organism involved likely is → Loa-Loa
 For Loa–Loa → word African must be present in question.
– Ascariasis
 Q – Parasite related to lung infection → Ascariasis
 Q’ – A child with history habit of eating mud. He also complains of worms of 6 cm coming
out from mouth → Ascaris Lumbricoides
 Note

 Eating mud → Ascariasis

 Eat raw meat → Tape worm

 Q’’ – Parasite, which is transmitted in human body, need human to complete their life
cycle, non-parasitic to human → Ascaris Lumbricoides
 Q’’’ – Patient have respiratory issue, which parasite is present → Ascaris Lumbricoides
 Q’’’’ – A young person presents with dyspepsia, pain epigastrium, constipation, and
perversion of taste sensations. Her stool exam shows eggs. Diagnosis → Ascaris
Lumbricoides ???
 Q – Patient after ingesting some eggs of worms now presents with respiratory
symptoms, organism most likely is → Ascaris
– Mucormycosis
 Q – A Hypertensive and diabetic patient presented to ICU in comatose state. He had
bleeding from nose and right eye, orbital invasion and cellulitis. Organism most likely
involved is → Mucormycosis
 Recall → Mucormycosis is opportunistic fungal infection in immunocompromised
(diabetics are one of Immunocompromised)
 Q’ – Patient with Diabetic ketoacidosis dies in hospital. He is found to have fungal
infection in kidney, brain and heart. Most likely organism will be → Mucormycosis
 Q’’ – Which of following fungi produce life threatening infection in patients with diabetic
ketoacidosis → Mucormycosis.
– Others
 Q – In diabetics, ulceration of foot occurs due to → Neuropathy followed by Vasculopathy.
???
 Q – A child presented with complain of pre rectal bleeding. On examination there is rectal
prolapse causative organism → Trichuris trichurid
 Rectal prolapse → Trichuris

 Q – Farmer presented with migrating linear lesion on foot → Cutaneous larva migrans.
  Mn → Remember Migratory lesions from MIGRAns
 Q – Which of following spreads by eating raw and uncooked meat → Tapeworm
 Note 1

 Eating mud → Ascaris

 Eating uncooked meat → Tapeworm

 Note 2
 Tapeworm includes

Taenia solium
ⱺ

Diphyllobothrium latum
ⱺ

Echinococcus granulosus
ⱺ

 Q – A young group of boys living in daycare service, All of them are having malaise and
weakness and restlessness during night, they can’t properly sleep due to perianal
itching. What is the cause of their symptoms → Enterobius vermicularis
 Mn → Vermin parasites cause anal itching

 Q – Cause of Cysticercosis → Taenia Solium (caused by ingesting eggs of Taenia

Solium)


Congenital Infections 1
363. Mcq → A pregnant woman presented with German measles at 6th week of pregnancy.
Which of following is her child most likely to develop → Congenital cataract


– Background on German Measles.

 Infection from Rubella virus is also called German Measles.
 Congenital Rubella → Mother infected with Rubella virus transmits infection to newborn
baby.
 Rubella is a TORCH infection.
 TORCH infection includes
 Toxoplasmosis gondii

 Others (→ Hepatitis B, Syphilis, HIV, Listeria) (Mn → Hub, Sip, HIV, Lust)

 Rubella (German Measles)

 Cytomegalovirus – CMV

 Herpes Simplex Virus – HSV

 The classic complications of Congenital Rubella → cataracts, deafness, and heart defects
(Patent Ductus Arteriosus)
 Congenital Rubella Complication in Fetus + mnemonic as per timeline
 Ik larkey ko mohabbat huwi → Dilruba → Rubella

 If infection within FIRST 7 weeks → aankhon mein parda → Cataract

 If infection AFTER 7 weeks → us k khiulaaf batein sunna bhi chordeen → Deafness

 If WITHIN 5 to 10 weeks → affects heart → Patent ductus arteriosus



– Notes / HYPs
 Most common congenital anomaly overall in Rubella → Deafness
 Most common before week 7 → Cataract
 Because lens of eye is in critical phase of development at that time

 Most common after 7 weeks → Deafness

 Commonest cardiac anomaly associated with Rubella → Patent Ductus Arteriosus

 – Now let's solve some paper MCQs
 Q – A child is born with cataract. Which of following would have affected his mother
during pregnancy → Rubella
 Q – How to prevent congenital Rubella → Anti-Rubella vaccine in reproductive age.
 Q – Rubella infection detected in mother. Doctor wants to decide abortion. What test will
support decision → IgM in mother.
 Mn → IgM & German Measles both have M
 Q – An expecting mother was infected with Rubella virus. Months later delivers a full-
term baby with no obvious signs of infection in child. Best test to diagnose acute
infection in neonate be a parasite specific ELISA for which isotype of immunoglobulin →
IgM
 Q – Congenital anomaly of heart associated with Rubella → PDA
 Q – A pregnant woman got German measles. She consulted her obstetrician worrying
about baby. Which is most likely complication baby might develop → Deafness
 Most common overall congenital anomaly by Rubella → Deafness.
 Q – A woman with 5 weeks of pregnancy contracted German measles. She consulted
her obstetrician worrying about baby. Which is most likely complication baby might
develops → Congenital cataract
 In options deafness might NOT be present
 Q – A young woman is infected with Rubella virus. AFTER 7th week of pregnancy,
offspring is likely to have → Congenital deafness
 Before 7 weeks → cataract

 After 7 weeks → deafness

 Q – Pregnant lady fetus developed congenital cataract most likely due to → Rubella


Congenital Infection x 2
364. Mcq → A baby with Hutchison teeth, 8th cranial palsy and interstitial keratitis. Diagnosis →
Congenital Syphilis


– Background
 The term TORCH includes
 Toxoplasmosis gondii
 Others (→ Hepatitis B, Syphilis, HIV, Listeria) (Mn → Hub, Sip, HIV, Lust)
 Rubella (German Measles)
 Cytomegalovirus – CMV
 Herpes Simplex Virus – HSV
 TORCH organisms vertically transmitted from mother to fetus
 Via placenta
 Via breast milk
 Via body fluids
 Infection during 1st trimester has most devastating consequences.


Pathogen Disease
Toxoplasmosis  Features
 Parasitic disease – mcq
 Caused by Toxoplasma gondii.
  Transmission
 Oocysts in cat faeces – pregnant patients should avoid
cats – mcq
 Diseases
 Congenital toxoplasmosis
 Classic triad of
 Hydrocephalus

 Intracranial calcifications

 Chorioretinitis.

ⱺ Mn → Toxic people → internally dmagh calcified

hta hia
ⱺ Un ko dekh kar ghussa chartha hia. + ankhein
laal hjati hian + BP high hjata hia
 Meningitis
 Toxoplasmosis cause meningitis in AIDS patients.

 ON MRI visible as → Multiple rings enhancing lesions

in basal ganglia – mcq
Others – Congenital Syphilis  Maculopapular rash, osteochondritis, chorioretinitis,
Done already Hutchinson teeth, Clutton joints
 Syphilis is only maternal infection that is associated with
recurrent abortions.
Congenital Rubella  Congenital rubella is a condition that occurs in an infant
Done already whose mother is infected with virus that causes German
measles
 The classic findings of cataracts, deafness, and heart
defects (PDA)
Congenital  Features in Congenital CMV infection
Cytomegalovirus CMV  Neurological
 Periventricular calcifications – mcq

 Mn → CMV PVC

 Microcephaly
 Sensorineural hearing loss
 Mental retardation
 Other
 Hepatomegaly
 Jaundice

Herpes Simplex  3 forms of disease have been described

 Isolated mucocutaneous lesions (skin, eye, and/or
mouth), including keratoconjunctivitis
 Encephalitis
 Disseminated disease involving multiple organs (lungs,
liver, often CNS)


– Now let's solve some paper MCQs

– Toxoplasmosis
 Q – Toxoplasmosis is → Parasitic infection
 Caused by Toxoplasmosis gondii

Q’ – Mother has infection of Toxoplasmosis in 1st trimester, She was treated. Her baby is
born now, to check infection in baby by ELISA method which antibody will be there → IgM
 + ve IgM → recent infection.

 +ve IgG → patient is immunised.

 +ve IgG + +ve IgM → active infection.

Q – Patient having Toxoplasmosis, is suffering from which type of antibodies sufficiently

→ IgM
Q – Pregnant lady, having cat as a pet, most likely infection → Toxoplasmosis
 Recall transmission of toxoplasmosis → via cat faeces
 Pregnant patients should avoid cats – mcq

Q – Pregnant lady having cat as pet is at risk of → Toxoplasmosis

– Others
Syphilis done above
– Rubella
Rubella done above
– CMV
Q – A 22-year-old primigravida has noted no fetal movement at 18 weeks. Fetal gestation.
Ultrasound examination shows marked hydrops fetalis and organomegaly. There is
extensive cerebral necrosis and periventricular calcification. Infection with which of
the following organisms is most likely to produce these findings → CMV
 Mn → CMV – PVC
– HSV
Q – 2 days baby developed rash over her extremities. Mother has untreated infection
during pregnancy. Which organism is transmitted via vaginally → HSV
 Rx → look for 1 of the TORCH organism in options.


Spleen Infections
365. Mcq → 4 years boy undergo splenectomy done due to Immune thrombocytopenic purpura
(ITP). Most likely organism that causes infection → Hemophilus influenza


– Notes / HYPs
 Most common cause of infections in Post Splenectomy patients – Mn → SHiN
 Streptococcus Pneumoniae > Haemophilus influenzae > Neisseria meningitidis


– Now Lets Solve Some Past Paper MCQs

 Q – Post splenectomy elderly male, cause of infection → Strep Pneumonia
 Q’ – Opportunistic organism after splenectomy → Streptococcus Pneumonia
 Q’’ – After splenectomy vaccination against which organism should be done →
Streptococcus Pneumoniae
 Q – Vaccine given to patient who has undergone splenectomy → Pneumococcal (NOT
Streptococcal)
 Rx → Pneumococcal disease → Disease caused by Streptococcus Pneumoniae
 Pneumococcal, Meningococcal, and Haemophilus influenzae (Hib) vaccinations given to
patients after splenectomy.

 Urinary Tract Infections
366. Commonest organism causing UTI → E. Coli


– Note in order of most common

 Most common cause of UTI → E coli
 Mn → UTI & E. Coli Rhyme
 Sexually active young females UTI, cause of infection → Staphylococcus saprophyticus
(E coli is still more common in this group).
 Mn → Ladies love sapera

 Sexually active young men, UTI, cause of infection → Chlamydia trachomatis / Neisseria
gonorrhoeae – coinfection
 Mn → Males are Calm + Narcissistic

 Watery discharge from penis + STD history, causative organism → Chlamydia

trachomatis / Neisseria gonorrhoeae – coinfection
 Urease positive organism causing UTI → Proteus mirabilis
 Other Features
 Urine has ammonia scent

 Proteus is Lactose non fermenter – mcq

 Proteus shows swarming motility.

ⱺ Mn → Mirab is positive she has ammonia smell.

 Important Urease positive organism to remember
 Proteus mirabilis

 Strep Epidermidis ???

 Note
 If scenario of young active male / female arrives then go for → Chlamydia / Neisseria in
men & Proteus in women.
 IF nothing is mentioned go for → E.coli.

– Background – Pyelonephritis
 When UTI ascends to kidney called → Pyelonephritis
 Pyelonephritis is classified as UTI / complication of UTI.
 2 types
 Acute
 Chronic
 Chronic occur in patients with urinary obstructions.
 Uropathogenic Escherichia coli → highly resistant to antibiotics – mcq – Google.

– Now lets solve some past papers MCQs
– UTI
 Q – Long scenario of newly wed female with fever and pain at adnexa and suprapubic
tenderness. Her labs showed raised lymphocytes (>15,000). Organism involved → E. coli
 Female is NOT sexually active → E. coli > Staphylococcus saprophyticus
 Q – Gram negative organism can cause septic shock after infection in which tract →
Urinary tract
 Rx → E.coli – gram negative rod.

 Q – UTI scenario, gram negative rod is identified. Cause is → E. coli

 Q – Most common organism causing UTI is → E. Coli.
  Q – The most common lactose fermenting gram negative organism causing UTI is → E
coli
 Q – Female sexually active having dysuria fever most likely involved organism is →
saprophyticus
 Q – 70–years man with frequent complains of UTI. Cause → Obstruction to urine flow ???
– Pyelonephritis
 Q – Common cause of Acute pyelonephritis → E. Coli
 Pyelonephritis is a UTI.
 UTI from E.coli can be acute / chronic
 Q – A 30–years old female presented with rigors and chills, High grade fever and not
responding to treatment for more than 2 weeks. USG shows renal parenchymal
changes. Diagnosis is → Acute pyelonephritis.
 Uropathogenic Escherichia coli highly resistant to antibiotics
 Q – A 20–years old female has fever and lumber pain. Urine R/E shows pus in urine and no
response to antibiotics. likely diagnosis is → Acute Pyelonephritis
 Uropathogenic Escherichia coli highly resistant to antibiotics

 Q – The most common infectious agent associated with chronic pyelonephritis is →

Escherichia coli


Bacteria Contd.
367. Mcq → Corynebacterium diphtheria produces → Exotoxins

Pathogen Toxin / Virulence Factor Manifestations
Gram +ve Rod
Corynebacterium  Diphtheria toxin  Disease
diphtheriae (exotoxin)  Pseudomembrane Pharyngitis
 Pseudomembrane → A thick Grey-
white coating that cover back of throat
 Severe lymphadenopathy (bull neck)

 Heart Diseases (endocarditis)

 Mn → D in Diphtheria – D in Dil.
 Patho
 Affects CD8 cells – mcq – ratta

Gram –ve Rod

Pseudomonas  Exotoxin–A → Common  Other Features
aeruginosa exotoxin  Green discharge (characteristic) – mcq
 Endotoxin → If causes  Mn → pseudo people sabz bagh →

fever / HTN. green discharge

 Fluorescent pigment – mcq
 Mn → sabz bagh dikhane wale
chamak re the hian
 Resistant to antibiotic – mcq
 Note
 Pseudomonas → resistant to

antibiotics
 Giardiasis → diarrhea resistant to

antibiotics.
 Pneumocystis jiroveci →

antibiotic resistance in HIV patient.

 Uropathogenic E. coli →

Resistant to antibiotics
 Fever, typical cause → IL–1
 In P. aeruginosa → Fever caused by
TNF
 Mn → Pseudo → sabz
Pathogen Toxin / Virulence Factor Manifestations
E. coli   Other deets discussed accordingly.

Gram +ve Cocci

Staphylococcus  Toxic shock syndrome  Structural components
aureus toxin (TSST-1)  Encapsulated bacteria
 Exfoliative toxin  Protein A
 Heat-stable Enterotoxin  Protein A prevents opsonization.
 Coagulase +ve + catalase +ve
 Mn → S. aureus major bacteria has all
powers
 Grape like colonies – mcq
 Diseases
 Exfoliative toxin
 Causes Scalded Skin Syndrome
(desquamation of skin) – mcq
 Heat Labile Enterotoxin
 Causes Watery diarrhea
 Acute diarrhea → 2 to 6 hours
 TSST1 toxin
 Toxic shock Syndrome toxin aka →
TSST1
 Toxic shock Syndrome toxin is a
super antigen → leads to shock.
 Osteomyelitis
 Most common cause of Osteomyelitis –
mcq
 In sickle cell anemia patients → most
common cause of osteomyelitis is
Salmonella (see pic of sketchy) – mcq
 Most common cause of pyogenic lung
abscess – mcq
 Other Features
 Secrete EFB (Extracellular fibrinogen
binding protein)
 Via EFB escape phagocytosis – mcq
Staphylococcus  Glycocalyx Slime Layer  Features
Epidermidis (aka Exo polysaccharide)  Native to skin as name suggest →
Epidermidis
 Slime Layer produces an adherent
biofilm that allows it to adhere to ANY
prosthetic devices
 Example
 IV catheters
 Artificial valves
 Artificial joints
 Catalase +ve BUT Coagulase –ve
 Diseases
 Most common organ targeted → Heart
Pathogen Toxin / Virulence Factor Manifestations
 Causes subacute bacterial
endocarditis.
 Especially infects heart in case of
prosthetic heart devices.

Streptococcus  Streptolysin-O (enzyme)  Disease

pyogenes –  Degrades cell membranes of RBCs
Group A Strep)  Contributes to β-hemolysis
 Host antibodies against toxin (ASO) used
to diagnose Rheumatic fever
 Exotoxin A (aka  Diseases
Erythrogenic toxin)  Toxic shock-like syndrome (shock due to
Exotoxin A similar to Staph aureus)
 Scarlet fever
 Scarlet Fever pentagon of
 Fever

 Pharyngitis

 Sandpaper like rash – mcq

 Strawberry tongue

 Cervical lymphadenopathy

 Erythrogenic toxin is also called →

Pyrogenic toxin – mcq.
 M protein (in cell wall)  Diseases
 Rheumatic Fever

Streptococcus  Disease
Agalactiae –  Causes 3 diseases in neonates
Group B Strep  Neonatal Pneumonia
 Neonatal Meningitis
 Neonatal Sepsis
 Mn → PMS

 CAMP test
 CAMP test is used to identify +
differentiate Streptococcus agalactiae
– Group B from Group–A Strep
 Strep B → (CAMP +ve)

 Strep A (CAMP –ve)

Mn → B positive
ⱺ

Gram –ve Comma Shaped

Vibrio cholerae  Cholera toxin  Disease
 "rice-water" diarrhea – mcq
 Shows shooting star motility – mcq
 Mechanism → ↑Cl– secretion in gut.
 Frequency of diarrhea → very high (15 to
20/day).
 If multiple members develop Sx of
diarrhea + Hx of common water source
 Pathogen Toxin / Virulence Factor Manifestations
Suspect → Vibrio
 Produce Yellow colonies in TCBS agar
(Thiosulfate Citrate Bile Salt Sucrose) –
mcq
 Other
 Gram negative bacteria – mcq
 Mn → Vibration in car is a negative
feature
 Mechanism
 Stimulates Gs coupled receptor → ↑
adenylate cyclase → ↑ cAMP → ↑ Cl-
& H2O secretion in gut – mcq

Clostridium  Tetanospasmin (Exotoxin)  Spastic paralysis, risus sardonicus, and

tetani "lockjaw". Toxin prevents release of
inhibitory (GABA and glycine)
neurotransmitters from Renshaw cells in
spinal cord Spread via motor neurons

Clostridium  Botulinum Toxin  Flaccid paralysis, Floppy baby syndrome

botulinum Toxin prevents release of stimulatory (ACh)
signals at neuromuscular junctions
resulting in flaccid paralysis

Clostridium  Alpha toxin  Phospholipase Degradation of

perfringens phospholipids → myonecrosis ("gas
gangrene") and hemolysis.

– Now lets practice some MCQs

– Strep Aureus
 Q – Virulence factor of Staph aureus → Protein A
 Note → Capsule is NOT virulence factor since disease is not caused by capsule.
 Q – Virulence of Staph aureus is measured by → Protein A.
 Q – Thorn prick abscess formation. Most likely organism → Staph aureus v imp mcq
 Q – A person was walking on grass accidently a thorn pick his foot and it was painful and
got swollen likely cause is → Staph aureus
 Q – Which of following causes food poisoning by release of exotoxin → Staph aureus
 Recall → Heat labile enterotoxin causes → acute watery diarrhea.

 Q – TSST gene carried by 10- 15 % by following bacteria → Staph aureus

 Toxic shock Syndrome toxin is a super antigen → leads to shock
 Q – A girl during menstruation develops high grade fever because she was using
tampons, organism responsible is → Staph aureus v imp mcq
 Q – A lady was using tampons, she had TSST syndrome, what's most important feature
in toxic shock syndrome → Skin desquamation. XXX
 Skin desquamation is via Exfoliative toxin

 Shock Syndrome is via → TSST1 toxin.

 Q – Patient complained of abdominal pain and persistent vomiting, cause is →

Enterotoxin
  Q – After extraction of molar, patient develops condition of acute osteomyelitis, caused by
→ Staph. Aureus.
– Streptococcus pyogenes – Group–A Strep
 Q – Boy developed fever, hypertension and erythematous rash on face & limbs within 24
hours, cause → Erythrogenic toxin.
 Rx → Erythrogenic toxin of Streptococcus pyogenes causes Scarlet Fever.

 Q – Streptococcal toxic shock syndrome is due to → Pyrogenic Toxin

 Pyrogenic exotoxin due to → Streptococcus A
 Pyogenic exotoxin due to → Staph aureus.

 Q – Which of following causes Rheumatic Fever → Group–A Strep

 Mn → MA in Rheumatic rhymes with A.

 RF caused by → M toxin.

 Q – Which toxin responsible for Scarlet fever → Erythrogenic

 Q – Most prominent toxin produced by Streptococcus pneumonia is → Streptolysin O
 Recall → Streptolysin O is also produced by Strep pyogenes

 Mn → both bacteria have letter ‘O’ in name.

– Corynebacterium Diphtheria
 Q – Pathogenesis of Diphtheria is due to → Exotoxin (repeated mcq)
 Q – Diphtheria exotoxin has major effect on → Heart
 Rx → causes Endocarditis.

 Mn → D in Diphtheria – D in Dil

 Q – Child dyspnea, pseudomembrane on throat, Cause is → Exotoxin of Diphtheria

 Q – Regarding Corynebacterium diphtheria, following is true → It acts by exotoxins
 Q – Diphtheria has following most likely feature → Exotoxin mediated damage
– Others
 Q – Pseudomonas scenario. Common cause of infection → Exotoxin-A
 Note – Infection by Pseudomonas

 Commonly by exotoxin → Exotoxin–A

 If causes fever / HTN → Endotoxin

 Q’ – Green vaginal discharge by which organism → Pseudomonas

 Q’’ – Regarding Pseudomonas → Resistant to Fluoroquinolones.
 Q – True regarding Vibrio cholera → Transmitted by water and uncooked food.
 Q – A drug which blocks adenylyl cyclase and inhibits cAMP can be used in treatment of
→ Vibrio cholera
 Recall mechanism of Vibrio cholera.

 Q – Most prominent toxin produced by Streptococcus pneumonia is → Capsule ???

 Q – Endotoxin released after → bacteria death
 Q’ – Most important action of endotoxin → Activation of complement system
 Q’’ – Endotoxin mediates its action by → Activating complement system


Malaria
368. Mcq → Malarial parasite is transferred into human blood in form of → Sporozoites

– Intro / Background
 Malaria disease → cyclic fever + headache + hemolytic anemia + splenomegaly.
 Caused by → Plasmodium specie which is a parasite
 All species are Giemsa stain positive.
  All species → unicellular amoeba – mcq
 Crescent shaped organism – mcq
 Both Giardia Lamblia & Plasmodium Spp → crescent shaped organism

 Both Giardia Lamblia & Plasmodium Spp → parasites

 Giardia causes → diarrhea

 Plasmodium Spp causes → Malarial fever.

 5 parasite species cause malaria in humans

 Most important as per Radiant Notes → Plasmodium Falciparum
 Others include
 Plasmodium Vivax

 Plasmodium Ovale

 Plasmodium Malariae.

 Plasmodium Knowlesi

 Stages of Malaria
 Dormant phase of malaria → Hypnozoite – mcq

 (Mn → Hypnosis makes brain dormant)

 Malaria enters into human body as → Sporozoite – mcq

 Mn → S for Swarm – S for Sporozoite

 Sporozoite divide in liver as – Merozoite

 Mn → Mere jigger k tukray karna

– Note / HYPs
– General
 Longest Pro-erythrocyte stage of which Plasmodium → Plasmodium Malariae
 Mn → Jab shadi hti hia lambi mala pehna jati hia → Long

 Shortest Pre–erythrocytic phase of which Plasmodium → Plasmodium Falciparum

 Mn → F for Fast
 Fever pattern
 Plasmodium Ovale / Vivax → causes benign malaria (less severe Sx)
 Most common in Asia (Pakistan)

 Tertian fever pattern – mcq

 Plasmodium Falciparum causes → Malignant malaria (Severe Sx + can be fatal)

 Tertian Fever pattern (Every 48 hours)

ⱺMn → Falsay 48 hours taza rehte hian

 Plasmodium Malariae
 Quartan fever (Fever every 72-hour cycle)

ⱺMn → Maltay 72 hours taza rehte hian

– Plasmodium Falciparum
 In which stage Malaria inactive (dormant) in body → Hypnozoite stage
 Cerebral malaria caused by → Plasmodium Falciparum
 Mn → C in Cerebral – C in Falciparum

 Black Water Fever (black colored urine/ cola colored urine) cause → Plasmodium
Falciparum
 Plasmodium Falciparum cause hemolysis of erythrocytes


– MCQs
  Q – A patient with abdominal pain, sudden headache, fever and chills. He is also having
splenomegaly and hepatomegaly organism responsible for this is Giemsa stain
positive. Which organism is most likely → Plasmodium Falciparum.
 Recall → All species are Giemsa stain positive.

 Q – Longest pro erythrocytic phase is → P. Malaria

 Shortest pre-erythrocytic phase is seen in - Plasmodium Falciparum.

 Mn → F for Fast

 Longest pre-erythrocytic phase is in- Plasmodium Malaria.

 Mn → Jab shadi hti hia lambi mala pehna jati hia → Long

369. Farmer with migratory lesion on foot → Cutaneous Larva MIGRAns

– Note the key word MIGRAtory lesion → Larva MIGRAns
 Mn → Remember Migratory lesions from MIGRAns


Burns
370. Mcq → Most common post burns nonbacterial organism → Candida


– Note / HYPs
 Most deficient protein → Albumin
 Metabolic derangements → Hyponatremia + ↑ ESR.
 Rx → Decrease albumin


Pneumonia
371. Mcq → Pneumonia in immunosuppressant → Pneumocystis Jiroveci


– Intro / Background
 Bacterial pneumonia often occurs following influenza infection.
 Flu aka → influenza, is infection of nose, throat and lungs caused by Influenza virus
 H influenza is → bacteria

 Influenza virus → Virus .


– Notes / HYPs
 Most common cause of Pneumonia → Strep pneumonia > H. influenza > Staph aureus.
 Mn → SHA
 Most common cause of community acquired pneumonia → Strep pneumonia
 Mn → community me rehta hia SP Police
 Pneumonia In Elders (65+) → Strep pneumonia
 Mn → Old people have link with SP
 Pneumonia in Post Splenectomy patients → Streptococcus Pneumoniae
 Rx – Most common infections in Post Splenectomy patients – Mn → SHiN
 Streptococcus Pneumoniae > Haemophilus Influenzae > Neisseria Meningitidis

 Most common cause of hospital acquired pneumonia → Staph aureus / Pseudomonas

aeruginosa
 Mn → Hospital staff – sabz bagh
 Pneumonia in Immunocompromised → Staph Aureus / Pneumocystis jiroveci
 In Alcoholics → Klebsiella pneumonia
  Mn → Alcoholics go to club
 Atypical Pneumonia → Mycoplasma Pneumonia
 Pneumonia in Smoker / COPD → H influenza

– Note 2
 Diagnosis of pneumonia is based on sputum
 Streptococcus pneumonia → Brown Rusty Sputum.

 Klebsiella pneumonia → Current jelly sputum

 Staph aureus → Yellow Sputum

 Pseudomonas aeruginosa → Green Sputum



 In neonates (<4 weeks) → Group B streptococcus, E coli

 In children → Viruses RSV, Mycoplasma, C pneumonia, C trachomatis
 In Adults → Mycoplasma, C pneumonia, S pneumoniae, influenza virus, Anaerobes
 In Elders → Strep pneumonia, influenza virus, anaerobes, H influenza and gram- ve rods
 In Immunosuppressants → Pneumocystis Jiroveci


Bacteria Disease
Clostridium tetani  Gram, spore-forming rod that produces anthrax toxin (an
exotoxin consisting of protective antigen, lethal factor,
and edema factor).
 Cutaneous Anthrax
 Ulcer with black eschar A (painless, necrotic)
 Pulmonary anthrax
 Inhalation of spores, most commonly from
contaminated animals or animal
 products
 Flu-like symptoms that rapidly progress to fever,
pulmonary hemorrhage. mediastinitis, and shock. Also
known as wool sorter’s disease.


Streptococcus Pneumonia  Common in elderly, alcoholics, post-splenectomy

 Features
 Sputum → Brown Rusty sputum
 Mn → SP Police kehte hian hamari wardi par dagh
nahi lagna chye)
 Shape → Lancet diplococci – mcq
 Diseases
 causes → MOPS
 Meningitis, Otitis media, Pneumonia, and Sinusitis +
Sickle Cell Anemia.
 Meningitis
 Most common cause of meningitis in adults of all

ages → Strep Pneumonia

 Otitis Media
 Most common of otitis media in children – mcq
  Pneumonia
 Most common cause of community acquired
pneumonia
 Mn → community me rehta hia SP Police – Police

ka nizam rusty.
 Most common cause of Lobar pneumonia
 Sickle Cell Anemia
 cause Infection in sickle cell anaemic asplenic
patients – mcq
 Patients with Sickle cell anemia – Spleen removed
(called asplenic)
 Spleen filter encapsulated organisms

 Asplenic patients → ↑ risk of severe infections from

encapsulated organisms.
Klebsiella pneumonia  Seen in → Alcoholics and Diabetics
 Mn → Alcoholics go to club
 Aka → Friedlander pneumonia – mcq
 Mn → Klub me banada fries bhi khata hia
 5 A's of Klebsiella
 Aspiration pneumonia
 Abscess in lungs and liver
 Curr-A-nt jelly sputum (blood colored)
 CJ sputum aka → mucoid sputum.

Staphylococcal aureus  Most common cause of nosocomial (hospital acquired)

pneumonia
 Mn → Staph = staff = hospital staff
 Most common cause of pneumonia post influenza
infection
 Association
 Intravenous drug users
 Patients with underlying disease, e.g. leukaemia,
lymphoma, cystic fibrosis (CF)
 Features
 Golden, yellow-colored colonies – mcq
 Yellow sputum (characteristic) – mcq
 Discharge also yellow colored
 Grape like colonies – mcq
Pseudomonas aeruginosa  Most common cause of nosocomial pneumonia.
 Most common pathogen in bronchiectasis and CF
 Most common cause of death due to pneumonia in
patients with cystic fibrosis.
 Features
 Green sputum
 Pneumonia results in Bronchiectasis
Mycoplasma pneumonia  Cause Atypical Pneumonia
 Typical pneumonia
 Caused by organism having a cell wall + respond to


β lactam drugs + Sx confined to lungs.

 Atypical pneumonia
 Caused by organism who lack cell wall + Sx are mild
& dispersed systemically.
 Note
 Cell wall → Present in all bacteria EXCEPT Mycoplasma
species
 Example → Mycoplasma pneumonia, ureaplasma
 Cold agglutinins may cause an autoimmune haemolytic
anaemia. ???
H. Influenza  Normal flora of respiratory tract – mcq
 Gram negative coccobacilli – mcq
 Cause Pneumonia in
 COPD
 Smokers
Pneumocystis Jiroveci  Features
 Most common opportunistic infection in patients with
acquired immunodeficiency syndrome (AIDS)
 Occurs when CD4+ cell count < 200/mm3
 Boat shaped organism – mcq
 Causes Pneumocystis jiroveci pneumonia (PJP)
 Others
 Most common bacterial cause of acute exacerbation of
COPD
 Most common organisms isolated from patients with
bronchiectasis.
Actinomyces Israeli  Features
 Yellow Sulfur containing granules (characteristic)
 Yellow Sulfur containing granules aka → talcum
powder granules.
 Mn → Israel has yellow sand

 Note → Stap aureus has golden yellow pigment

 Mn → Au is symbol of gold.

 Actively involved in IUCD implants – mcq

 Granuloma with abscess – mcq


– Now let's practice some paper MCQs

– Mycoplasma
 Q – Which bacteria have no cell wall → Mycoplasma specie.
 Q – Which bacteria has NO cell wall → Mycoplasma & Ureaplasma.
 Q – Atypical pneumonia is a feature of → Mycoplasma
– Klebsiella
 Q – Friedlander pneumonia caused by → Klebsiella pneumonia
 Q’ – A Diabetic patient with thick mucoid sputum jelly like. Organism involved is →
Klebsiella
 Klebsiella pneumonia → Current jelly sputum


 Staph aureus → Yellow Sputum

 Streptococcus pneumonia → Brown Rusty Sputum.

 Pseudomonas Aeruginosa → Green Sputum

– Strep Pneumonia
 Q – 9 months old child presented with fever & cough. He was negative for respiratory
syncytial virus. Other common cause could be → Strep pneumonia.
 Strep pneumonia is most common cause of community acquired pneumonia & lobar
pneumonia.
 Q’ – Patient suffering from lobar pneumonia. Causative organism → Streptococcus
pneumonia
 Q’’ – A 70 years old lady presented with fever, cough with rusty sputum, involvement of
lower lung lobes and was unable to recognize her family. Most likely cause is → Strep
pneumonia
 Most common cause of meningitis in adults of all ages → Strep Pneumonia

 Q’’’ – Most prominent toxin produced by Streptococcus pneumonia is → Streptolysin O

 Recall → Streptolysin O is also produced by Strep pyogenes

 Mn → both bacteria have letter ‘O’ in name.

 Q’’’’ – Streptococcal pneumonia infection in a person. Clearance of infection will occur via
→ H2O2
 Q – Infectivity of Streptococcus pneumoniae is due to → Streptolysin O
– Pseudomonas
 Q – Man on vent has Pneumonia, sputum showed greenish color. Diagnosis →
Pseudomonas
 Q’ – Patient with cystic fibrosis, patient will develop → Bronchiectasis ???
 Q’’ – A child diagnosed with cystic fibrosis, developed Bronchiectasis, causative agent →
Pseudomonas aeruginosa.
– Actinomycetes
 Q – 55 years old male, diabetic patient with abscess on angle of mouth discharging
sinus. Histology shows granuloma. Most likely involved organism would be →
Actinomycetes.
 Granuloma with discharge (with abscess) in → Actinomyces
 Caseating Granuloma in → TB
 Non caseating granuloma in → Sarcoidosis
 Q – Most characteristic feature of Actinomyces → Talcum Granules.
 Q – Patient presented with abdominal and pelvic pain. Upon taking history, Intrauterine
Contraceptive Disease – IUCD was implanted. What causative organism has caused this
complication → Actinomycetes
– Other
 Q – Pneumonia diagnostic test → Sputum culture
 Q – Abscess in both lungs is caused by → Stap aureus.
 Q – Most common complication of AIDS → Pneumocystis carinii



Extra Portion
 Meningitis
– Note

Newborn Children 6-60 yrs > 60 yrs #1 cause in In HIV

(0-6 Months) (6 Mo-6 yr) teens
 Group B  S  S  S  N  Cryptococcu
Streptococci. Pneumoniae pneumoniae pneumoniae meningitidis s
 E. coli  N  N  Mn → Teen neoformans.
 Listeria meningitidis meningitidis naughty
 H.
influenzae
Type B

 Mn → BELL SuNH – SuN – S

 BELL → Group B > E Coli > Listeria

 SUNH → Strep pneumonia > N. meningitidis > H influenza

 Sx of Meningitis
 Headache

 Photophobia

 Altered mental status

 Fever

 +ve Kernig sign.

 Gram –ve Diplococcus ???



– MCQs
 Q – A boy present with sign and symptoms of meningitis. On examination, organism found
is diplococci and α hemolysis seen. It is caused by → Strep pneumonia
 Most common cause of meningitis in aged 6 months to 6 years → Strep pneumonia

 Q – Portal of entry of meningococcal meningitis → Respiratory droplets

 Mode of transmission of Streptococcal pneumonia is respiratory droplets.

 Q – Cause of meningitis in a 3 year and gram-negative coccobacilli → H. influenza

 H influenza is gram –ve coccobacilli.

 SUNH → Strep pneumonia > N. meningitidis > H influenza

 Q – Meningitis with rash → Neisseria meningitidis – ???
 Q – An HIV positive patient with fever from 4 to 5 days, Vomiting from 1 day, CSF Glucose
80, BSR 110, CSF Protein 45 with no cell raised cause in HIV patient is → Herpes
Encephalitis


Cell ↑ in Infections
 Note 1
 Grand Mn → Banana flavoured Pen

 In Bacterial infections → Neutrophils ↑ (Neutrophil Leucocytosis)

 Exception → TB – ONLY bacterial infection where Lymphocytes ↑

 In Fungal + Viral infections → Lymphocytes ↑

 In Parasitic Infections → Eosinophils ↑

 Note 2
  All bacterial + fungal infections → protein ↑ glucose ↓
 All virus → glucose Normal

 EXCEPT → Herpetic encephalitis + Mumps → Glucose is ↓

 Note 3
 Infectious Mononucleosis → Atypical Lymphocytosis

– MCQs
 Q – Pus in abscess contains → Neutrophils.
 Q – Boy eat ice cream then he developed sore throat. Investigation shows increase
neutrophils & lymphocyte count is normal. Cause is → Bacterial infection
 Grand Mn → Banana flavoured Pen

 Q – 27 years old man presents with headache, fever, +ve Kernig’s sign. CSF analysis
shows increased lymphocytes, sugar = Normal, proteins 60mg/dl, likely diagnosis → Viral
meningitis.
 Q – A Patient presented with headache, Neck stiffness and photophobia. On LP, glucose
40, Protein 150 and Lymphocytes 20 % and Neutrophils 80 %. What is diagnose →
Bacterial Meningitis.
 Q – Increase Lymphocytes seen in → Viral Disease
 Mn → Banana Flavored Pen – discussed ahead.


Medium of Growth
– Different Medium in which organism grow
 H influenza → Chocolate agar
 Mn → in flu shararti bache chocolate khate hian

 Neisseria → Thayer martin medium

 Mn → Thar mathey

 Bacillus anthrax grows in → Blood agar

 Mn → Bacillus bara khatarnak – khoon ki holy khelta hia.
 Capsule of B. Anthrax stain with M'Fadyean stain.

 Mn → Bacillus bemari khatrank – sab maafi mangte hian

 B pertussis → Bordet Gengou agar – mcq

 C diphtheriae → Loffler medium – mcq
 Mn → Diphtheria is a loafer

 MTB → LJ medium
 E.coli → Pink color on MacConkey agar (E coli is a lactose fermenter)
 M pneumoniae - Eaton agar
 Brucella, Francisella, Legionella, Pasteurella → Charcoal yeast extract agar buffered with
cysteine and iron
 Fungi - Sabouraud agar – mcq
 Mn → for fun sub log hne chye

 Cryptococcus Neoformans → Indian Ink Stain



Misc Infections & MCQs

– Rocky Mountain Spotted Fever
 Causative organism → Rickettsia rickettsii
  Spread by → tick bites.
 Sx
 Headache
 Muscle ache
 Rash
 Pathophysiology
 Primarily attack endothelial cells of vessel.
 They enter, grow and replicate within cytoplasm of endothelial cells.


 Q – The target tissue in Rickettsial infection is → endothelium.

 Q – Weil Felix test is done for identification of → Rickettsia


– Vaginal Infections
 Trichomonas Vaginalis
 Pear-shaped triphosphate (Parasite) – mcq

 Causes → Trichomoniasis
 Sx
 Foul (fish) smelling, greenish discharge

 Strawberry cervix

 Dx
 Characteristic jerky and spinning movement in fluid specimens – mcq

 Tx
 Metronidazole

 Q – A female is infected by Trichomonas Vaginalis appropriate treatment is →

Metronidazole to both partners.
 Rx → Metronidazole treats both bacterial & parasitic infections.

 Q – In Trichomonas infection, which investigation is required to Diagnose → Wet Smear

of Vaginal Secretion.
 Q – A female has vaginal infection. An organism isolated with jerky movements it is →
Trichomonas

 Bacterial vaginosis
 No inflammation
 Thin, white discharge with fishy odour
 Lab findings - Clue cells pH > 4.5. KOH, Whiff test

 DOC → Metronidazole


 Candida vulvovaginitis
 Inflammation Thick, white, "cottage cheese" discharge
 Lab findings Pseudo hyphae pH normal (4.0-4.5)

 DOC → Azoles


– Naegleria fowleri
 Brain eating amoeba
 Cause fatal meningoencephalitis
 Enters CNS through olfactory nerve via cribriform plate
 Hx of bathing in pond / swimming pool.
  Mn → Niagara falls me nahaney gaye → water entered from nose to brain → organism
reside in brain sinuses → eats brain cells → brain atrophy

 Q – 20 years young boy presented with fever, headache vomiting. He is having neck
stiffness and Alter mental status with hallucination which among following is brain eating
→ Naegleria fowleri

– Brucellosis
 Brucellosis → fever
 Cause → Brucella species
 Mode of Transmission
 Contact with infected animals
 Eat or drink contaminated animal products, including meat or raw milk (unpasteurized
milk) – mcq
 Is a zoonosis → an infectious disease that has jumped from a non-human animal to
humans.
 Butchers and Slaughter–house workers are at highest risk of contracting zoonotic disease.


 Q – Brucellosis is transmitted by → Raw milk.


– Waterhouse-Friderichsen Syndrome
 Most common cause → Neisseria meningitidis

– Endotoxin
 Endotoxin → 3 parts
 Lipid A

 O antigen

 Core polysaccharide

 Lipid A – of endotoxin → antigenic

 Stimulates host immune response via
 TNF
 IL-1

 Endotoxin is not released – ∵ part of outer membrane.

 Endo toxin is released when gram –ve cell is lysed.


 Q – Endotoxin causes → TNF activation > IL –1

 Q – Fever and hypotension in gram – ve organism is due to → Endotoxin.


– Pelvic Inflammatory Disease

 Most common cause → Chlamydia > Gonorrhea.
 Both are STDs.
 PID affects female reproductive organs (DO NOT confuse with UTI which affects urinary
tract)
 Sx
 Pain around pelvis
 Supra pubic pain.


– Lyme Disease
  Organism → Borrelia burgdorferi – mcq
 Borelli is a spirochete.

– Droplet Infection
 Q – Droplet infection spread by
 A– 1-3 feet
 B – 1-3 Meter
 C – 3-6 feet
 D – 1-6 feet
 Droplet infection : 1-3 feet

 Airborne infection: 3-6 feet


–
– Strep Viridans
 Intro
 Streptococcus Viridans Group include

 Strep mutans

 Strep mitis

 Strep sanguinis

Mn → MMS
ⱺ

 All 3 Viridans part of normal oropharyngeal flora

 Virulence
 Unique ability of Strep viridans group to synthesize dextrans from glucose.

 Glucose Viridans Group Dextran

→
 Dextrans allow bacteria to adhere to areas of endothelial trauma.
 Bacteria Specially adhere to damaged heart valves.
 Recall → Staph Epidermidis adhere to prosthetics
 Diseases
 Bacterial endocarditis

 Most common manifestation of Strep Viridans

 Many Sx of bacterial endocarditis

Characteristic feature of bacterial endocarditis → splinter hemorrhages

ⱺ

 Splinter hemorrhages → dark lesions that run vertically underneath nail bed.
 Dental caries
 Strep mutans + Strep mitis cause dental caries.

 Lactobacillus less common cause of dental caries → mcq

 Worsening of Rheumatic Fever

 Def RF → Auto immune disease in which antibodies directed against body’s own

organs.
  Antibodies target following organs → Heart, Joint, Skin, Brain
• Mn → JONES

Joints
ⱺ

Heart (heart has hole)

ⱺ

Nodules → Subcutaneous nodules in Skin.

ⱺ

Erythema Marginatum (a rash with thick borders) – Skin

ⱺ

Sydenham’s Chorea (quick involuntary movements that most commonly affect face
ⱺ

and hands) – Brain

 Note
 1 – Since antibodies target heart in RF → heart at risk of infection with Strep viridans

group in Rheumatic Fever.

 2 – Since part of normal flora → during a dental procedure, bacteria enter

bloodstream → result in subacute carditis If patient preexisting valvular lesion.



 Q – A patient is having Mitral Valve disease now present with Fever, Malaise and
Petechia. On examination he was also having Splinter hemorrhages and
splenomegaly. What is the causative agent of such Illness → Strep viridans


– Mycobacterium Tuberculosis
 TB Dx Timelines
 Initial → Chest X ray

 Definitive Dx → Sputum Culture

 Diagnostic → PCR > AFB (Acid Fast Bacillus Stain)

 Microscopic → Caseous necrosis

 Histological → Epithelioid Cells with Caseating granuloma

 Hypersensitivity Reaction → Type–4 T Cell Mediated

 Margins → Undermined

 Antibodies → Cell Bound



– Kawasaki Disease
 Sx (Mn → Fever + KRASH)
 Fever > 5 days
 Conjunctivitis
 Rash
 Adenopathy (cervical lymphadenopathy)
 Strawberry tongue
 Hands & feet swelling (edema)


 Q – 4-year-old girl with a sick appearance has a 7-days lasting fever, bilateral
conjunctivitis, cracked lips, bilateral cervical lymphadenopathy and maculopapular skin
rash. What is the most likely diagnosis → Kawasaki Disease.

– Listeria Monocytogenes
 Affects
 Adults

 Pregnant women

 Neonates

 Adults → Flu like illness + Gastroenteritis.

  Pregnant women → Flu like illness
 Neonates →

 If acquired early → Granulomatous infantisepticia

 If acquired late → Neonatal Meningitis

 Features
 tumbling motility

 forms “rocket tails” via actin polymerization.

 Organism acquired by ingestion of

 Cold deli meats

 Unpasteurized dairy products

 Grows well at cool temperatures (4 – 10 o C)

 A TORCH organism


 Q – Gram +ve, coco-bacillus with Tumbling motility causes diarrhea in pregnant female
→ Listeria
 Mn → We start tumbling when list of result is here.


– Hepatitis
 HBV is present in all bodily secretions → Milk Sweat, Tears Lymph etc.
 Orofecal route - Hep. A > Hep. E
 Most lethal hepatitis - Hep. D
 Most common in pregnancy - Hep. A
 Most lethal/remote Area in pregnancy Hep E


 Q – Boy eat cholay from rerhi wala and develop which type of hepatitis → Hepatitis A


– Fungal Infections
  Candida
 Oral / Esophageal thrush in Immunocompromised
 Pseudo hyphae – mcq
 only Candida form pseudo–hyphae.

 All other forming true mycelia

 Aspergillus Fumigatus
 Disease
 Immunocompromised and neutrophilic dysfunction (CGD)

 Fungal Rhinosinusitis

 Features

 Hyphae → Septate hyphae branch at acute angle (45 )

o

Mn → A for acute – A for Aspergillus

ⱺ

 Coin Lesions

 Mucor and Rhizopus

 Diseases

 Diabetic (DKA) (Mn → Mithae & Diabetes)

 Neutropenic Leukemia

 Fungal Rhinosinusitis.

 Features
 Non septate hyphae branch at right angle

Mn → M for Muhammad – M for right.

ⱺ

 Invade blood vessel

 Cryptococcus Neoformans
 Disease
 Meningitis and Encephalitis in immunocompromised

 (Soap bubble lesion)

 Histoplasma
 Fungus which grows within macrophages.


 Q – Person with difficulty in swallowing, there was some white growth inside esophagus
with pseudo–hyphae likely reason is → Candidiasis
 Q – Patient is having rhinosinusitis and nasal polyp with the fungus invading lamina
papyracea, excessive endothelial damage and having non septate hyphae organism
involved is → Mucor
 Q – One of the following fungus acts by involvement of the Reticulo endothelial system →
Histoplasma


– Important MCQs from Past Paper

 Q – Person had an accident with fracture of mandible → intermaxillary wiring is done to
stabilize fracture. After some time, draining sinuses are seen, organism involved → Staph
aureus
 Q – Organism in boil of nose → Staphylococcus aureus
 Q – In parapneumonic pleural effusion which finding will be seem in Pleural fluid → Protein
more than 35 g / dl ???

– Important MCQs from Double AA
 Q – Gram negative differs from gram positive because of → Peri plasmic Space. ???
 Q – Dx of gonococcus is easily made by which of following → Gram Stain.
 Q – A patient whose biopsy taken from muscular area showing Langerhans cells and
multiple necrotic area cause is → Leprosy
 Q – Initial investigation of Leprosy → Nasal Scraping.
 Caused by Mycobacterium leprae

 Q – Regarding Mycobacterium Leprae → Intracellular AFB (Acid Fast Bacillus)

 Q – Homosexual male, HIV positive, has fever, dry cough for weeks. Atypical mycobacteria
shown cause is → Atypical Mycobacterial infections
 Atypical mycobacterial infections are infections caused by a species of
mycobacterium other than Mycobacterium tuberculosis and Mycobacterium leprae –
Google
 Q – Cell wall of gram–positive bacteria causes septic shock. Which component of cell wall
cause shock → Peptidoglycan
 Gram Positive cause Shock via Exotoxin and Peptidoglycan
 Gram Negative cause Shock via Endotoxin (LPS)

 Q – Antigenic property of bacteria is due to → Carbohydrate in cell wall.

 Q – Cells responsible for innate immunity are activated most commonly by →
Carbohydrate sequence in bacteria.
 Q – Person infected with rat fleas, presents with multiple lymphadenopathy, fever and
chills and eventually dies in epidemic. Organism identified was gram negative rod. What is
causative organism → Yersinia Pestis.
 Q – In 1918, H. influenza pandemic was worst pandemic and killed many people. Why was
it so lethal → Antigenic shift due to animal proteins – ratta
 Q – Fumigation is done in case of H1N1 – Influenza Infection.
 Q – Laryngotracheobronchitis is caused by → H influenza. – ratta
 Q – Acute laryngotracheobronchitis (Croup) is caused by → H influenza. – ratta
 Q – Disease caused by mosquito bite → Yellow fever.
 Q – Criteria for diagnosis of Sepsis → Positive Culture.
 Q – Q fever is caused by → Coxiella burnetii
 Q – Rod shaped bacteria which are slightly curved → Campylobacter jejuni
 Q – A lady with history of mild sore throat infection died. Autopsy shows bilateral adrenal
gland enlargement and critical hemorrhages. Organism involved? → Neisseria
meningitidis
 N. meningitidis can cause Sore throat and most commonly cause adrenal hemorrhage

 Q – Brodie’s abscess is seen in → Pyogenic Osteomyelitis.

 Q – Weil disease is caused by → Leptospira.
 Q – Chlamydia is cause of bacterial → Conjunctivitis
 Q – Rat bite cause fever by toxin → Streptobacillus moniliformis.
 Q – Function of lactoferrin → Prevent iron utilization by bacteria.
 Q – Formalin is used in pathology lab for samples because → It prevents autolysis.
 Q – Feature of acid-fast bacilli in TB → Mycolic acids.
 Q – Which viral agent cause bronchiectasis in child → RSV – Respiratory Syncytial virus.
 Q – Child at 6 years of age. Bowing of legs was noticed and history of diarrhea few weeks
back. Now paralysis of right leg. Parents give history of incomplete vaccination in
childhood previously → Polio
 Q – Regarding Poliomyelitis true is → Affects anterior horn cells
  Recall 1 → anterior spinal cord is motor – posterior spinal cord is sensory (Mn → AM
BS)
 Recall 2 → Tetanus spreads via motor neurons (Mn → Motorcycle drivers contact tetanus)

 Q – Corona virus was recently named → SARS Cov–2 (aka → SARS Covid–2)
 Q – Reinfection with what causes Fever and Hemorrhagic manifestations → Dengue
 Q – Most Common Opportunistic infection after kidney Transplant → Polyoma – ratta
 Q – Virus increase virulence by → Mutating DNA
 Q – Farmer present with red granules + draining abscess from foot organism responsible
is → Actinomadura ???
 Q – Parasite rate in blood is calculated in which age → Below 5 years – ratta
 Q’ – Parasite live in which system → Lymphatics
 Q – Cause of infection in contact lens wearer → Acanthamoeba – not confirm
 Q – Which cause malignancy of stomach → H. pylori
 Q – Sore throat, fever and lymphadenopathy, Monospot test positive. Type of cell affected
→ Activated B lymphocytes ???
 Q – Non–invasive fungal sinusitis is seen in → Immunocompetent.
 Q – 65 years old female wearing upper denture, white lesions appear on palate. On biopsy
you find hyphae, provisional diagnosis is → Candida albicans.


– Important BCQs from Double A

 Q – ICU infections prevented by
 Using face mask

 Multiple hand washing → answer

 Sterilizing reusable instruments
 By keeping ICU temperature at 20
 Q – Typical Feature of a virus is
 Self-replicative → Answer
 It has his own DNA and RNA
 Enveloped coated
 Has DNA