Microbiology & Immunology

237 Pages·1995·14.671 MB·English

by  Richard M. Hyde Ph.D. (auth.)

Basic Sciences Review for Medical Licensure
Developed at
The University of Oklahoma College of Medicine
Suitable Reviews for:
United States Medical Licensing Examination
(USMLE), Step 1
Microbiology
&
Immunology
Fourth Edition
Richard M. Hyde
Springer-Verlag
New York Berlin Heidelberg London Paris
Tokyo Hong Kong Barcelona Budapest
Richard M. Hyde. Ph.D.
Department of Microbiology and Immunology
College of Medicine
Health Sciences Center
The University of Oklahoma
Oklahoma City. OK 73190
USA
Library of Congress Cataloging-in-Publication Data
Hyde. Richard M.
Microbiology and immunology I Richard M. Hyde. - 4th ed.
p. cm. - (Oklahoma notes)
Rev. ed. of: Microbiology and immunology. 3rd ed. c1992.
Includes bibliographical references.
ISBN-13: 97W387-94392-3 e-ISBN-13: 978-1-4613-8439-7
00110.10071978-1-4613-8439-7
1. Medical microbiology-Outlines. syllabi. etc. 2. Medical
microbiology-Examinations. questions. etc. 3. Immunology
Outlines. syllabi. etc. 4. Immunology-Examinations. questions.
etc. I. Hyde. Richard M. Microbiology & immunology II. Title.
III. Series.
[DNLM: 1. Microbiology-examination questions. 2. Microbiology
outlines. 3. Allergy and Immunology-examination questions.
4. Allergy and Immunology-outlines. QW 18.2.H995m 1995]
QR46.H93 1995
616'.01-dc20
DNLMIDLC
for Library of Congress 95-2578
Printed on acid-free paper.
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987654321
Preface to the
()~~
In 1973, the University of Oklahoma College of Medicine instituted a requirement
for passage of the Part 1 National Boards for promotion to the third year. To assist
students in preparation for this examination, a two-week review of the basic
sciences was added to the curriculum in 1975. Ten review texts were written by
the faculty: four in anatomical sciences and one each in the other six basic sci
ences. Self-instructional quizzes were also developed by each discipline and ad
ministered during the review period.
The first year the course was instituted the Total Score performance on National
Boards Part I increased 60 points, with the relative standing of the school chang
ing from 56th to 9th in the nation. The performance of the class since then has
remained near the national candidate mean. This improvement in our own stu
dents' performance has been documented (Hyde et al: Performance on NBME
Part I examination in relation to policies regarding use of test J. Med. Educ. 60:
439-443, 1985).
A questionnaire was administered to one of the classes after they had completed
the Boards; 82% rated the review books as the most beneficial part of the course.
These texts were subsequently rewritten and made available for use by all stu
dents of medicine who were preparing for comprehensive examinations in the
Basic Medical Sciences. Since their introduction in 1987, over 300,000 copies
have been sold. Obviously these texts have proven to be of value. The main reason
is that they present a concise overview of each discipline, emphasizing the content
and concepts most appropriate to the task at hand, i.e., passage of a comprehen
sive examination covering the Basic Medical Sciences.
The recent changes in the licensure examination that have been made to create a
Step l/Step 2/Step 3 process have necessitated a complete revision of the Okla
homa Notes. This task was begun in the summer of 1991 and has been on-going
over the past 3 years. The book you are now holding is a product of that revision.
Besides bringing each book up to date, the authors have made every effort to make
the tests and review questions conform to the new format of the National Board
of Medical Examiners. Thus we have added numerous clinical vignettes and ex
tended match 'questions. A major revision in the review of the Anatomical Sci
ences has also been introduced. We have distilled the previous editions' content to
the details the authors believe to be of greatest importance and have combined the
four texts into a single volume. In addition a book about neurosciences has been
added to reflect the emphasis this interdisciplinary field is now receiving.
I hope you will find these review books valuable in your preparation for the
licensure exams. Good Luck!
Richard M. Hyde, Ph.D.
Executive Editor
Preface
The material in this text has been compiled to serve as a study guide for a review
of Microbiology and Immunology suitable for preparing for STEP 1 of the United
State Medical Licensing Examination (USMLE). I have assumed that you, the
reader, have already had a full fledged course covering this discipline. In-depth
presentation of material will not be found in this review. You are urged to consult
other study aids (lecture notes, textbooks, etc.) for detailed explanations of mate
rial that you find difficult to understand.
In general, the text of the book is on the left side of each page; questions, illustra
tions, summary sentences or phrases, and other study aids are on the right. This
format has the intent of getting you involved in the review process. Use a high
lighter, put boxes around key statements, answer the questions, and fill in the
blanks as you work through the book. Your reward will be proportional to your
effort (Le., no pain, no gain). As the format is a work book, you benefit most by
active participation. Write key words in the margins; add to the review statements
by writing out your own; use whatever study skills you have found help you in the
past.
The book is organized into three sections that reflect the balance of emphasis seen
in the STEP 1 examination. Each section has a set of Review Statements at the
end of the text portion; these are followed by Review Examinations which use
"extended match" and "clinical vignette" formats extensively to provide the reader
with practice in the test taking skills that will prove useful in the licensure exami
nation. In addition, a comprehensive examination will be found at the end of the
book. There are over 350 questions in these examinations which should provide
plenty of opportunity to review and reinforce the material presented in the text.
Some questions may deal with material not covered in the book; be sure that you
know the answer to these questions as well, since these will expand your knowl
edge base further.
The section on Pathogenic Microbiology has been revised significantly. The first
18 pages are devoted to a discussion of infectious diseases by systems, starting
with the Respiratory System, then progressing to Septicemia, and thence to Men
ingitides, much the way that pathogens invade the body. The Gastrointestinal
tract is also covered, as is the Genitourinary system (with emphasis on sexually
transmitted diseases). These presentations deal with the most common agents
encountered, the diseases they cause, their symptoms, diagnosis, and therapy.
Following these discussions the reader will find brief presentations of the major
points about the individual pathogens.
Contributions by the following individuals are gratefully acknowledged: Drs. J.J.
Ferretti, D.C. Graves, R.K. Tweten, and S.R. Hyde; Ms. Dawn H. Struthers (art-
viii Preface
work); and Dr. D.R. Billington (text format). The excellent secretarial assistance of
Ms. J.D. Reames is also acknowledged.
I would be sorely remiss if I did not acknowledge the enormous contributions to
this text made by my wife. Her patience, understanding, and support during my
hours (and days) of agony over content, illustrations, etc., were a true inspiration
to me. Thanks my love!
Richard M. Hyde
Contents
Preface to the Oklahoma Notes v
Preface ............................................................................................................. vii
Section I Review of Microbial Physiology and Genetics
Bacterial Structure 2
Bacterial Growth 7
Bacterial Metabolism 9
Chemotherapeutic Agents ........................................................................ . 11
Viral Structure ...................... '" .................................................................. . 24
Viral Classification ........................ ., .......................................................... . 25
Viral Replication ....................................................................................... . 28
Antiviral Agents ........................................................................................ . 32
Viral Immunotherapy and Prophylaxis .................................................... . 34
Review Statements ........................................................................................ . 35
Microbial Physiology Review Exam ........................................................... .. 37
Microbial Genetics
Mutations 43
Gene Transfer ............................................................................................. 48
Bacteriophages ... ......... ...... ........ ........ .............. ...... ...... ....... ..... ...... ...... ....... 50
Lysogeny ..................................................................................................... 51
Recombinant DNA Technologies ....... ......... .............. ...... .... ...... ....... ......... 56
Review Statements ......................................................................................... 60
Microbial Genetics Review Exam .................... ........... ............ ...... ................ 62
Section II Review of Immunology
Basic Immunology
Innate Immunity ........................................................................................ 67
Complement ............................................................................................... 70
Antibody Structure and Function .............................................................. 75
Immune Response ....... ...... ......... ...... ......... ...... ................... ..... ......... .......... 78
Immunosuppression ....... ....... .... ... ... ...... ...... ...... ......... ...... ............. ..... ....... 83
Serologic Reactions .................................................................................... 86
Clinical Immunology
Hypersensitivity Reactions ..... ......... ...... ...... ...... ........ .......... ......... ...... ....... 91
Autoimmunity............ ...... ...... ...... ... .... .... ........ ...... ...... ......... ... ......... ...... .... 96
Immune Deficiency Diseases ........ ...... ...... ............. ..... ......... ............ .......... 100
Transplantation Immunology......................... ...... ...... ..................... .......... 103
Tumor Immunity ....... ....... ............. ...... ...... ........ .......... ......... ...... ...... .......... 107
Review Statements ............ ............... ........ ...... ........ ....... ........ ...... ...... ............. 109
Immunology Review Exam 115
x Contents
Section III Review of Pathogenic Microbiology
Systems
Respiratory Tract Microbiology ................................................................ 130
Sepsis .......................................................................................................... 134
Purulent Meningitides ............................................................................... 136
Enteric Diseases . ...... ............ ........................ ... ................ ...... ..... ....... ...... ... 139
Sexually Transmitted Diseases .................... ................... ........................... 144
Specific Pathogens
Gram Stain .................................................................................................. 148
Properties of A-B Toxins ........................................................................... 150
Gram Positive Cocci ................................................................................... 151
Gram Negative Cocci ................................................................................. 155
Gram Positive Rods .................................................................................... 157
Gram Negative Rods .................................................................................. 162
Gram Negative Respiratory Pathogens ...................................................... 166
Generalized Gram Negative Pathogens ..................................................... 170
Spirochetes ............ ...... ...... ............. ................................. ........................... 172
Rickettsiae, Bacteria, Chlamydiae and Viruses ......................................... 174
Medical Mycology ...................................................................................... 178
Medical Parasitology ...... ......................................................................... ... 179
DNA Viruses
Herpes ........................................................................................................ 183
Adenoviruses .............................................................................................. 186
Papovaviruses ............................................................................................. 187
Poxviruses .................................................................................................. 188
RNA Viruses
Myxoviruses ........... ... ..... ................... ............ ...... ... ...... ... ...... ...... ...... ......... 189
Arthropod-Borne Viral Diseases ................................................................ 192
Rhabdoviruses ........... ...... ............ ...... ......... ...... ...... ...... ... ...... ......... ...... ...... 195
Picornaviruses ............................................................................................ 196
Rhinoviruses ............................................................................................... 198
Hepatitis Viruses ............................................................................................ 199
Slow Viruses .................................................................................................. 201
Oncogenic Viruses ......................................................................................... 202
Review Statements ........ ...... ...... ...... ...... ...... ...... ............ ......... ......... ............... 205
Pathogenic Microbiology Review Exam ....................................................... 210
Comprehensive Review Examination 219
The first portion of this section will deal with
bacteria and fungi, their structure, chemical
composition, and metabolism. This will be followed
by a discussion of chemotherapeutic agents that are
active against bacteria, fungi and animal parasites.
The second section will deal with Basic Virology
(viral structure, classification, replication and the
effects of antiviral agents of viral replication). The
last portion will deal with Microbial Genetics
(mutations, gene transfer, and recombinant DNA
technolo gies).
1
BACTERIAL STRUCTURE
W\CI'ERIAL MORmOLOGY
Cell Wall
'!he cell wall of bacteria protects the '!he figure below is a representation of
=
cell against osmotic lysis. Both the basic unit of peptidoglycan: NAM
Gram positive and Gram negative N-acetyl muramic acid, NAG = N-acetyl
bacteria have peptidoglycan glucosaminei the circles are the amino
(mucopeptide) as the innennost layer of acids where dlain cross-linking occurs,
the cell wall. '!hey differ in amount, between alanine and lysine in Gram
and in the nature of the surface layers. positive cocci or alanine and diamino
p:ilnelic acid (I:l7\PA) in other bacteria.
'!he cell wall of Gram positive bacteria
contains from 40-90% peptidoglycan, while
cell walls of Gram negative bacteria
contains only 5-10% peptidoglycan. In
Gram positives, the next. layer is c:arl::>o
hydrate, ~ of ribitol teichoic
acid, and the outennost layer of the cell
wall is ~ of two or three kinds of
protein. '!he lipoteichoic acids of group
A streptococcal cell walls are involved
in adherence to epithelial cells.
'!he cell walls of Gram negative
bacteria are ~ of an outer layer
of lipoprotein-lipopolysaccharide
(endotoxin) anchored to the peptidoglycan
layer (in the periplasmic space) through
protein and lipoprotein molecules.
'!he periplasmic space enables bacteria
to keep various proteins close to the
cell in a concentrated fonn (e. g. beta
lactamase, etc.). '!he cell membrane,
which is not a part of the cell wall,
appears as a double layered structure
immediately below the cell wall.
'Ihe basic unit of peptidoglycan is a
disaccharide-tetrapeptide containing N
acetylrnuramic acid, N-acetylglucosamine, '!he mucopeptidase, lysozyme, hydrolyzes
D-alanine, L-alanine, D-glutamic acid or the linkage between N-acetylrnuramic acid
its derivative, D-isoglutarnine, and a and N-acetyl glucosamine causing
basic amino acid, usually diarninop:ilnelic
acid. '!he basic units of mucopeptide are A. the peptidoglycan layer to dissolve.
cross-linked to each other to fonn a B. the cell to become osmotically
tight meshwork which surrounds and pro fragile.
tects the entire cell. C. Both
D. Neither
Lipopolysaccharides are composed of lipid
A, core and o-antigen. Lipid A is the (Answer on next page)
toxic moiety of endotoxin. '!he polysacch-
aride side dlains are the 0 antigen epitopes.
2