Sketchy Micro

Hepatitis B

Hep B Love, the hippie scene. *See pathoma p. 120 for better explanation of serologic markers of Hep. B.* Hippie Pad. Hepadna virus. He*pad*na. Hippies inside the dome and outside the dome. Replicates in the nucleus and in the cytoplasm. Kum ba yah circle of hippies. The circle is almost double, but it's not. Partially double stranded. Hippie reading reverso-transcriptum. Has a reverse transcriptase. Hippie holding sex, drugs and rock and roll sign with the baby wearing the red splattered dress. In front of torches. Hep. B is a large virus and does not cross the placenta during pregnancy, but can be transmitted during childbirth where there is a lot of blood. Woman with 10% of the cookie and her newborn with 90% of the cookie. Adults will progress to the chronic stage 10% of the time. Newborns infected with Hep. B will progress 90% of the time. Hippie lady who is beading. She represents the extrahepatic manifestations of Hep. B. Prodromal serum like sickness with rash and arthralgias. Glomerular nephritis and polyarteritis nodosa. See below. Beads that the hippie lady is holding up. Polyarteritis nodosa is a systemic vasculitis that affects small to medium sized vessels and the aneurysms it forms is said to have beads on a string appearance. PAD can affect the blood vessels going to the kidney. Would manifest as a reduced GFR and HTN. She is covered in henna. Knees have lightning bolts. Rash. Purpuric rash with nonblanching dark macules. Arthralgias. Two other kidney problems unrelated to PAD. Membranous glomerulonephritis and membranoproliferative glomerulonephritis. Knot above has two strings associated with it. Extra thick glomerular membrane look. Membranous glomerulonephritis. Three strings associated with it. Represents the deposits in the mesangium expanding into the glomerular basement membrane causing a tramtrack appearance. Viral hepatitis and hepatitis from alcohol cause an increase in liver enzymes so how do you tell the difference? Alcoholic, AST greater than ALT. Viral, ALT is usually greater. Hippie and son playing volleyball. Hippie has the volleyball labeled ALT in the air. In acute viral infection, ALT rises and then after symptomatic phase is over, ALT drops. Baby playing with a deflated ALT volleyball. Acute *early* neonatal infection can show normal ALT despite active replication of HBV. We are all one SPECIES. Serology. Focus on the colored ones. S. HBsAg. Surface antigen. Represents current infection. E. HBeAg. E antigen. Marker of infectivitity. Tire flat underneath S and E. This is when people would be symptomatic. Definition of window period. Antibodies towards the surface have been made and are binding surface antigens. Both may be undetectable. If one were to just look at the antibodies to surface or the surface antigens, it may give false reassurance that the patient is not infected. This is known as the window period. Thus, we must check antibodies to the core. For an infected individual, antibodies to the core will be positive during the window period. Second E. Antibody to E antigen. Second S. Antibody to surface antigen. Indicates recovery. If somebody has this then they are over the illness. Syringe wrapped around the blue line which corresponds to the second S, the blue S. Vaccines are given to the surface and that's what immunized people will have. How would one tell the difference between immunized people and those that have had the disease? Immunized would only have antibodies to S. Those that have had the disease would have antibodies to E antigen or Core antigen. Liver made out of a rock (or something hard or coral in other sketches). Liver cirrhosis or carcinoma. Father hippie with orange hippies sons. Hep. D. Orange because Hep. D is an RNA virus. Moon necklaces. Negative sense. Circular headbands. Circular genome. Stickers over their body. Hep. D requires the surface antigen of Hep. B to cause infection. Orange kid cooperating holding his dad's hand. There are two ways Hep. D can be infectious. Co-infection or Hep. D infection AFTER a Hep. B infection. Co-infection has better outcomes. Father hippie grimacing under the weight of his second orange child. Superior position of the kid represents superinfection, or Hep. D infection after a Hep. B infection already occured. This is associated with worse outcomes and why the father is grimacing. Who gets treatments? Acute cases will resolve, but you should treat pregnant women and those who have progressed to the chronic stage. Make peace, lamb, not war, elf queen with a nucleotide mace stomping on a book. Lamivudine as treatment. NRTIs as treatment. Antenna on the van. Interferon alpha. Baby with deflated volleyball holding IgG keys. If mother is Hep. B positive, you must give neonate vaccinations and IgG antibodies for both passive and active immunity. HBV behavior once inside cell (courtesy firecracker): Once inside hepatocytes, the partially dsDNA viral genome is completed via a viral DNA polymerase. Newly complete dsDNA generates mRNA transcripts that can be used to generate viral proteins or to make more partially dsDNA via a RNA-dependent DNA polymerase.

Ehrlichiosis vs. Anaplasmosis

MEGA berry for where the morulae (mulberry-like) inclusions are. Monocytes = Ehrlichiosis Granulocytes = Anaplasmosis

Strep pyogenes (Group A strep)

The Pie Genie's Bakery *Question you've gotten wrong a bunch: Acute RF is a type II HSR. PSGN is a type III HSR. Recall that nephritic syndromes are characterized by immune complex deposition.* The *H*ot *A*pple pie underneath the pie display and the red beta hemolytic light bulb = hyaluronic acid, encapsulated, and beta hemolytic The pyogenic infections: Honey crusted pie holding chef to represent impetigo (careful though as Staph aureus can also cause impetigo). Red necktie = strep pharyngitis. Big red hulk hand gloves = erythema of the skin as cellulitis and erysipela (erysipela is cellulitis with well-defined borders). The toxigenic infections: The chef putting a strawberry to his tongue, wearing a red necktie and red frosting a gingerbread man while being cognizant to skip the face. He represents Scarlet Fever (1. strawberry red tongue, 2. pharyngitis, 3. rash that spares the face). He is also wearing a red cape to represent toxic shock *like* syndrome, do no confuse with toxic shock syndrome of staph aureus. Lastly, he burnt one gingerbread cookie to represent necrotizing fascitis. The burnt gingerbread man has one leg off because it is sometimes necessary to amputate the affected leg. The gingerbread man has a B on it to represent that that toxin causes NF while the other toxins cause the other toxigenic infections of Strep pyogenes. Master chef wearing a miter hat and swatting away another chef who is trying to eat his Jones criteria cupcakes. The M also stands for M protein which is part of Strep and also found in our heart, which sometimes creates the molecular mimicry that is responsible for Rheumatic Fever. The J in joints is why it was called Rheumatic fever in the first place. The J cupcake is seen spilling frosting onto another chef's elbow for joints. N cupcake has gumdrop decorations on it for (cutaneous nodules). E cupcake has red squiggly lines on it for erythema marginatum. S cupcake is seen falling off for Sydenham's Chorea. Master chef (RF) and PSGN chef (post strep glomerular nephritis) both be precipitated by pharyngitis. However, PSGN chef has a honey crust crumbs on his face and a pencil. So, impetigo usually precedes PSGN and even though the PSGN chef has a pencil for penicillin, he still has PSGN. Another way of saying that is, penicillin can prevent RF during the pharyngitis stage, but cannot prevent PSGN. Chef handling the O-shaped jelly filled doughnuts with antibody tongs. Woman customer across from him counting the O-shaped jelly filled doughnuts with tongs = Anti-Streptolysin O (ASO) titer as a way to diagnose someone who just had a recent S. pyogenes infection. Basset hound seen munching on a pastry = Bacitracin sensitive. This is how you wound differentiate Group A strep from Group B strep. Recall in Group B strep, the galactic baby, that the basset hound is unable to lick the baby and thus, Group B strep is bacitracin resistant.

Adenovirus

A Den-O Lions where the den looks like tonsils - the virus first isolated from adenoids Blue cave. DNA virus. Red hues in the back of the cave. #1 cause of tonsilitis. Lions yawning. Most common cause of infection in the adenoids and tonsils. Could it also cause a pharyngitis? Naked David carved into the the cave wall. Drippings from the cave. Respiratory droplets. Lion poop. Fecal-oral. Those who are at risk: children who are gross, military recruits, and those who frequent public pools (fecal-oral) Kids in camo shirts observing the lions. Children commonly affected and military recruits. Kid drowning. Swimmers at public pools often affected. David peeing a pool of blood that a kid is drowning in. Causes hemorrhagic cystitis. Affects swimmers at public pools. Red eyes in the back. Common cause of viral conjunctivitis. Pink eye. Farting on pillow. Kid in camo shirt holding the vaccine. Vaccine available and only administered to military recruits because we do not want them to have pink eye and pee blood.

Strep viridans

Actually a group of strep species that include mutans and mitis (oropharynx species that cause dental caries) and sanguinis (species that infects damaged heart valves) The jester with the facial jaw armor in the alpha knight tournament (alpha hemolytic, alpha means partial hemolysis and green). Damaged miter hat. Dextrans (deck of cards) binds platelet aggregates on damaged heart valves and cause subacute bacterial endocarditis. Jester jaw mask. Optochin resistant (contrast Strep pneumoniae) A deck of cards. Dextrans binds platelet aggregates on damaged heart valves and cause subacute bacterial endocarditis. His donkey has green booties on and donkey teeth. Bile insoluble (contrast strep pneumoniae). Viridans are normal flora of the oropharynx and cause dental caries.

Bartonella henselae

Bart the leopard Cause of two diseases. Cat scratch disease and bacillary angiomatosis. Woman on the left with puffy sleeves. Cat scratch disease and axillary lymphadenitis (usually regional and unilateral). Man on right with cane and dots all over him represents bacillary angiomatosis. Raised red vascular lesions. Can be confused with Kaposi sarcoma, but differentiated base on the their infiltrates. Bartonella will have a neutrophilic infiltrate because its bacterial and HHV-8/Kaposi will have a lymphocytic infiltrate because it is viral. Not in FA: Starry night backdrop to represent the Warthin-Starry stain Red pillow. Gram negative. Bike tire in front. Doxy. Crow in the sky. Macrolides, ezithromycin.

Bordatella pertussis

Board and Care of disabled GI with a bowtie Disabled GI. Pertussis toxin disables Gi through ADP-ribosylation. Tractor in the midline. Tracheal (trachea midline) toxin damages respiratory epithelium. DTaP vaccine for children. Tdap for adolescents and adults. Also called whooping cough or 100-day cough.

Parvovirus

Bombs away playroom B19 bomber's mission to bomb the small town. Smallest DNA virus. B19 on a runway. Runways only have one lane. Single stranded DNA virus. This is unique. Statue of liberty and and a statue of David. TORCH infection and naked. Sketch is around parvovirus infection in 4 populations. Fetus to the left, child to the right, adult in the middle and sickle cell patients in the cupboard. Kid getting slapped. Slapped cheek fever a.k.a. fifth disease (also known as exanthem infectiosum). Fever for about a week and then a rash develops on their face. Similar to roseola except roseola has a rash that spares the face. Flame design on the plane. Flames start at the nose of the plane and moves downward. Rash starts at the face and moves downward. Adult who is kneeling on a lego. Joint pain, arthritis and edema in adults. Communist plane with a sickle and a bone underneath it. Aplastic anemia in sickle cell patients. Red balloon baby. Hydrops fetalis in those who contract parvovirus in the 1st or 2nd trimester. Recall CMV hydrops fetalis in those who contract CMV in the 2nd trimester.

Brucella

Bruce's farm Undulating hills in the back of Bruce's farm with cows and pigs. Causes undulant fever. Unpasteurized milk, direct contact with cows and pigs. Not in FA: Fish bones being fed to pig. Osteomyelitis. Tire looking windmill. Doxy. Rifle on Bruce's back. Rifampin as adjunctive *treatment* in addition to doxy. Do not confuse rifampin prophylaxis with rifampin treatment. In Neiserria and H. flu, the rifle was on a healthy person and that is to represent prophylaxis in close contacts.

Sporothrix schenckii

Cigar-smoking rose gardener who has potassium iodide pesticide (KI is one tx along with pine cone) Cigar. Sporothrix look like cigar shaped yeast under a microscope. Roses going up the walls and up her arms. Ascending lymphadenitis. Pinecones. Itraconazole is the drug of choice to treat lymphocutaneous sporotrichosis. Potassium iodide on her back. Saturated solution of potassium iodide may also be used to treat lymphocutaneous sporotrichosis. Do not confuse with KOH. KI is for treatment, KOH is for diagnosis of many other fungi, not including sporothrix.

State whether each of the following will cause blindness or deafness Congenital gonorrhea Congenital chlamydia Congenital syphilis

Congenital gonorrhea. Blindness. The mother quickly shielding the baby's eyes from the violinist dying. Congenital chlamydia. Blindness. The mermaid idol on the front of the pirate ship shielding the baby's eyes. Note that this neonatal conjunctivitis is later in time course than gonorrhea's. Congenital syphilis. Deafness. Kids in the cold with earmuffs on outside the Pallidum observatory.

Corynebacterium diphtheriae

Corazon de la corrida "Heart of the bullfight" *Gray cotton candy being eaten by the kids wrapped in wrappers. Gray pseudomembrane formation in the oropharynx.* Heart shaped matador cape. Heart problems. Diptheriae can lead to life threatening myocarditis, heart block and arrhythmias. Bull with large neck. Bull's neck lymphadenopathy Man with bowtie playing the accordian. ADP-ribosylation of elongation factor 2 (EF-2). Old guy shaking the maracas in the stand. Maracas represent club shaped, or V/Y shaped metachromatic granules. "Tele" labeled megatron. Cystine-tellurite agar in order to colonize for a diagnosis. FA says Black colonies on cystine-tellurite agar. Kid pointing and laughing in the stands. Loeffler's medium in order to colonize for a diagnosis. Bull tongue sticking out. Elek test to differentiate between toxic and non-toxic strains of diptheriae. Bull being stabbed by vaccines = TDaP vaccine.

Microsporum, Epidermophyton, Trichophyton

Dermatophytes Tinea tin man Tin man wearing a headband and toto. Athletes are a population at risk and pets are a source of these fungi. Crura is the structure that attaches the base of the penis to the ischiopubic rami. Tinea crura is jock itch. Woodlamps up with microsporum. Woodlamp used to diagnose microsporum. Tx: Pinecone. Azole. Wizard of Oz biting his nails. Terbinafine as treatment for nail dermatophytes. Wizard of Oz holding a grease can. Griseofulvin for most severe infections.

Francisella tularensis

Francis the rabbit eating radishes and scratching off ticks Ticks and a rabbit. Cause of tularemia, also known as rabbit fever. *Kaplan Qbank: begin as a rupturing pustule followed by an ulcer, with involvement of regional lymph nodes.* Not in FA: Radishes. Gram negative, coccobacilli Psis gardening tools. Streptomycin as treatment.

Giardia lambda

Giardia jungle ride with the metro. Kid sitting on a yellow stool. Steatorrhea. Kids with backpacks. Associated with campers and hikers who drink poorly purified water. Think about lakes and streams. Bubbles in the water. Transmitted by cysts. Decorative shields on the side of the boat. Distinct looking trophozoites. Monorail in the background. Metronidazole. Kid with OP shirt. Stool O and P is diagnostic. Boat called ELISA. ELISA for stool antigen also diagnostic.

Cryptosporidium

HIV man with a poncho in the crypt filtering the water for purple gems. Severe diarrhea in HIV patients. Cane. Old man. Poncho. HIV. Stains acid fast (only parasite to do so). Bubbles and amethyst crystals. Infectious cysts and purple circular things found underneath the microscope. Purple crystals are composed of 4 motile sporozoites. Sewage draining pipe that is narrow and without hofstra. Diarrhea and small intestine damage. Question stem: patient with diarrhea and oocytes with acid fast staining on stool O and P and asked how to treat it (or given picture). Knitted sock that is draining water. Nitazoxanide as treatment. Filtration can remove oocysts from infected water. Cryptosporidium is highly resistant to chlorination. Spirit crows. Spiramycin, a macrolide (does not follow the -thromycin rule in FA). Not FDA approved in the US.

HSV1 + HSV2

Hermes, the God of Herpes Cowhide robe. Intranuclear cowdry bodies. These are also present in CMV and VZV. Poxvirus has similar inclusions, but they are in the cytoplasm. The torch is he is carrying. Torch infection. Upper half of the body is HSV-1. Lower half is HSV-2. Inflammed mouth. You'll want to think cold sores when you think of HSV-1, but the first thing that happens is gingivostomatitis. Then cold sores ensue. The snakes wrapped around his torch. Serpiginous corneal ulcers on fluorescein slit lamp exam. Keratoconjunctivitis. Helmet with red wings on it. Temporal lobe encephalitis. Black helmet represents necrosis and red wings represent hemorrhage. Hemorrhage and necrosis of the inferior and medial temporal lobes. #1 cause of sporadic encephalitis in USA. Three gems on the side of his helmet. HSV-1 latent in the trigeminal ganglia. He is tripping only to show the dew drops have been dislodged from the rose petals. Herpes vesicles are said to have dew drops on a rose petal appearance. Also seen in VZV. Dew drops on his finger. Herpetic whitlow, more common in dentists. HSV-1 and 2. Hermes is a postal worker and has red stamps going up and down his arm. This occurs more often with HSV-1 and represents erythema multiform that may appear 1-2 weeks after infection. Tufting around the skirt. Painful inguinal lymphadenopathy with HSV-2. Metal cup in front of his genitals. HSV-2 lies dormant in sacral ganglia. Neck brace. HSV-2 a cause of aseptic meningitis in adults and adolescents. Keep straight which strain causes temporal lobe encephalitis and which strain causes aseptic meningitis. Tank with large multinucleated giant cells as the camouflage. Tzanck smear of a lanced ulcer shows large multinucleated giant cells (old way of doing it). Also seen in VZV. PCR of skin lesions or CSF PCR for herpes encephalitis. Violet trash can. Valacyclovir.

Staph aureus

Moses and the Golden Staff ("naf for staph") Purple robes. Gram positive. Coagulated red sea. Coagulase positive. Compare Staph epidermidis and sapro. Egyptian cat. Catalase positive. Tall man behind moses. Ability to ferment mannitol. Some agar. He is wearing yellow because mannitol fermenters turn the agar yellow. Beta hemolytic light bulb. Staff with the letter A at the end and the A binding the Fc region of the antibody. Protein A as the virulence factor binds Fc region of IgG, inhibiting complement and phagocytosis. Sphinx's nose. Colonizes the nares. Man coughing next to the camel with patchy quilts. Pneumonia and patchy infiltrates seen on X-ray. Icosahedron shaped balls dangling from the camels back. Icosahedron shape of viruses. Staph aureus usually causes a post-viral pneumonia when our immune system has been weakened. Man kneeling with camel and camel kneeling. Staph aureus is the most common cause of septic arthritis in adults. Large red mounds on the camels back. Large erythematous abscesses. Mortar and pestle with weird medication vials dangling from the side. IVDU. Woman clutching her chest and the camel getting spooked and sprinting towards the edge of the cliff. Hearts over the camel and three pyramids in the background. *Acute* bacterial endocarditis. Fish bones. Most common cause of osteomyelitis. Man roasting in the sun. Scalded skin syndrome. Mediated by exfoliative toxin, a protease. Cape on the man. Toxic shock syndrome. Gauze after a rhinoplasty or a tampon left in for too long. Woman looking like shes about to vomit with meats and a jar of mayonnaise. Rapid onset food poisoning that is most associated with vomiting instead of diarrhea. Ingestion of the preformed toxin. Meats and creams that have been left out for too long. Merciless pharoah and the anubis jackels. MRSA. MRSA comes about by altering it's cell wall. In history, it was slaves (PBCs) that built the pyramids (walls of the bacteria), but this pyramid is using altered humans to represent the altered PBCs that are now constructing the cell wall. Caravan. Vancomycin as treatment for MRSA. However, if the bug is found to be methicillin sensitive, nafcillin will kill better than vanocmycin. Naf for staph. MRSA = vancomycin

Paracoccidioidomycosis

Piratas del Sur "captain's wheel" South America map in the back. Geographic distribution. Red thing in front of the much bigger captain's wheel. Captain's wheel yeast that is much bigger than an RBC. Earrings. Cervical lymphadenopathy. Gold medallions. Potential for granulomas in the lung. Poor dentition. Mucocutaneous lesions.

Rickettsia rickettsii

Ricket's Rock Climbing Competition

Type III secretion system

Salmonella, Shigella, Pseudomonas, E. Coli. However, the turkey baster is not in Pseudomonas or E. coli's sketch.

Listeria monocytonegenes

Santa's List. Pregnant women in the doorway looking at at her space cadet baby as Santa Claus is looking over his list. Early term contraction can lead to abortion. Later term contraction can lead to newborn meningitis. 3rd most common cause after GBS and E. Coli. Christmas time = cold outside. Grows well at refrigeration temperatures like 4 - 10 degrees. Meat, cheese and milk left out for Santa. Unpasteurized dairy products and cold deli meats can be a source. Christmas tree decorations that are tumbling off the tree. Said to have tumbling motility outside of the cell. Toy rocket as a present on the ground, and also a toy rocket inside of Santa's bag. Listeria rapidly polymerizes actin inside of the cell to get from place to place. Said to look like a rocket or form 'rocket-tails.' Guitar and guitar amp as a present. Ampicillin as treatment.

S. dysenteriare, S. flexneri, S. boydii, S. sonnei

Shigella species in order of decreasing severity

Blastomycosis

The blast of the cannons (Civil War geographic location, Blasto is present around great lakes as well) Geographic difference from Histo. Blasto is around the lakes and the east coast. Cannonballs in the soldiers hands. Single, broad based budding as the method of replication. Cannonballs creating a lung pattern and smoking. CXR has a patchy alveolar infiltrate. Lesions or cavities may also be present on imaging. Statue of Robert E. Lee with ulcers and an exposed leg rod. Systemic disease affects the skin and bones. Yellow river. Rapid urine antigen testing. Itraconazole.

Strep pneumoniae

The encapsulated knight in the alpha knight tournament (alpha hemolytic, alpha means partial hemolysis and green). Heavily armored with a little bit of rust to represent encapsulated and the "rust-colored sputum" Carrying with him two lances, a flag with three axes on them, AND A SICKLE. Lancet shaped diplococci, ceftriaxone, and a cause of sepsis in patients with sickle cell disease and asplenic patients. Armor lacking chin protection = optochin sensitive (contrast strep viridans which has the large jester face jaw armor mask) The common *MOP*per next to the knight. MOPS mnemonic. Strep pneumoniae is the most common cause of meningitis, otitis *media* (in children), bacterial pneumonia, sinusitis. Knight's horse has mud on it's feet to represent bile soluble (contrast strep viridans which is bile insoluble) Marcolide crow *From Kaplan Q bank: IgA protease as virulence factor. Strep pneumo and Neiserria.*

Bacillus cereus

The guy reheating rice in King Anthra's (the Viking) Axe sketch. Causes reheated rice syndrome. No play-on words for B. cereus and rice.

Cytomegalovirus

The mega low prices you'd find at a supermarket. Woman proding the sleeping employee next to the toy shelf. Latent in mononuclear cells. The toys represent the different kinds of cells that mononuclear cells are. They are B and T cells and macrophages. Hermes messenger also on the toy shelf. Part of the the herpes family of viruses. CMV is HHV-5. Boy who drove his car into the the blueberry muffin stand. Congenital CMV. The most common fetal viral infection. #1 on the boys shirt. #1 cause of sensorineural hearing loss in children. #1 cause of mental retardation from a congential viral infection. Blueberry muffins. Petechial rash. Recall congenital rubella. Covering his ears and has a ventricle helmet. Sensorineural deafness and ventriculomegaly. Milk splashes that landed right around the ventricles. Periventricular calcifications. Intracranial calcifications. Recall toxoplasma also has intracranial calcifications. Man slipping on the spilled milk and in motion. Periventricular calcifications cause of the seizures in congenital CMV infections. Yellow cow with a liver and spleen spot. HSM and jaundice in congenital CMV. Congenital CMV all together: blueberry muffin petechial rash, sensorineural deafness, ventriculomegaly with periventricular calcifications, seizures, HSM and jaundice. 80-90% off sign. 80-90% of congenital CMV infections are asymptomatic and thus they are off the hook from all of those nasty symptoms. Red balloon baby. Hydrops fetalis. CMV infections in a pregnant mother can also be transmitted in utero and cause hydrops fetalis, leading to spontaneous abortion. Most common if mother is infected with CMV in the 2nd trimester. Butcher coughing. Pneumonia in organ transplant patients. Old man with cane checking out a frozen pizza that looks like a retina. CMV retinitis in AIDs patients. Described as a pizza pie retinopathy. Register check out reading 'Charity Drive 50 cents." CMV retinitis when CD <50. Conveyor belt that looks like an esophagus with linear marks on it. CMV esophagitis. Need to be able to differentiate from Herpes esophagitis. Singlular, deep, linear. Herpes is multiple and shallow. Pink groceries bags clumped together that are supposed to look like colonic hofstra. CMV colonitis. Red ulcers. Owl eye cereal. Owl eye inclusions in cells. Compare EBV. Green 'cans only' recycling bin. Specifically gancyclovir as treatment. Car with a net that the little boy is driving. 2nd line treatment is foscarnet UL97 on the car. Foscarnet is used when the virus has a mutation in the UL97 gene that makes it resistant to gancyclovir. The mom with the very red throat holding box that says 'no mo spots.' CMV infections in healthy individuals. CMV mononucleosis. Sore throat, lymphadenopathy and fatigue. Differentiate from EBV mononucleosis with the monospot test. CMV mononucleosis will have a negative monospot test. Sore throat differential: strep pharyngitis, EBV mononucleosis, CMV mononucleosis. Can differentiate with amoxicillin, ampicillin and the monospot test.

Staph epidermidis

The plumber in beauty and the plumber (he's navel sensitive and novobiocin sensitive). The beauty is staph sapro and she is not navel sensitive and thus novobiocin resistant. Think of the plumber as putting in prosthetic devices. Staph epidermidis is known as the bane of the orthopedist's existence. But also heart valves as represented by the rusted over heart under one sink!!! Both are coagulase negative and this is signified by the plumber and the beauty who have just put the gell *HYPHEN* o into the bowl. The hyphen in the gell-o is to represent coagulase negative (contrast staph aureus where Moses has parted the red sea and the red sea looks more solid and coagulated. This gell-o looks more liquid and thus, non-coagulated). Urease positive with the spray bottle and catalase positive with the cat. Van in the background = vancomycin as a treatment.

Epstein-Barr virus

Ye Olde Epstein Bar. Woman leaning in for a kiss. Kissing disease transmitted primarily through saliva. Knight tugging on the back of the guy's shirt. Tender lymphadenopathy. Knight reacting to having a drink spilled on him. Reactive CD8+ cells seen on blood smear. Also go by the name of Downey or atypical cells. Can also be natural killer cells. In response to the infection the T-cells proliferate which is why your lymph nodes and spleen become enlarged. Cow behind the bar with a spleen spot. Splenomegaly. Sleeping archer. When the virus encounters a new host, it targets the B lymphocytes. There it remains latent. Must B 21 to enter sign. EBV envelope glycoprotein binds CD21 to infect B cells. Guy being kissed drooling and with exudates coming out of mouth. Pharyngitis. Mono causes pharyngitis and this is often confused with strep pharyngitis. Strep pharyngitis more often seen in children and adolescents. Pharyngitis caused by mono is more likely to be asymptomatic at a young age. At older ages, mono more likely to be symptomatic. Person drawing a maculopapular rash on the sleeping archer. If mistakenly given ampicillin or amoxicillin, those infected with mono will break out into a rash. The picture of the stern owl amongst some reeds. Association with B cell lymphoma. B cell lymphomas can be divided into two main groups. Hodgkin's lymphoma and non-Hodgkin's lymphoma. Hodgkin's lymphomas are characterized by Reed-Sternberg cells that look like "owl's eyes." Associated with the mixed cellularity subtype. Bar kid dressed in African clothing eating crab puffing out his cheeks. African Burkitt lymphoma. A non-hodgkin lymphoma. Characterized by large jaw lesion and swelling. This is the endemic kind. In the non-endemic kind (less of an association with EBV), the lesion develops in the ileocecum and peritoneum. Crab pinching the Asian man's nose. Nasopharyngeal carcinoma associated with Asian EBV patients. Old hairy man sitting in the corner of the bar with a cane. Oral hairy leukoplakia in HIV patients. Characterized by white patches on the lateral aspects of the tongue. Can be confused with oral thrush of candida. Difference is that you can scrape off candida, but you cannot scrape off leukoplakia. Dart board with star shaped darts clumped on a red central target. Diagnosis of EBV through the monospot test. In the acute phase, EBV activates B cells to secrete heterophile anti-sheep red blood cell antibodies. These antibodies will clump or agglutinate sheep or horse red blood cells. IgM molecules that clump RBCs. No contact jousting in the bar. Treatment is supportive, but you must tell your patients no contact sports for risk of splenic rupture. Also known as HHV-4. Sore throat differential: strep pharyngitis, EBV mononucleosis, CMV mononucleosis. Can differentiate with amoxicillin, ampicillin and the monospot test.

Clostridium difficile

"Field trip to the chocolate factory" Two sides, two toxins. Toxin A for Apples. Apples being brushed. The toxin works on the brush border of gut. Toxin B for black licorice. Black licorice that looks like actin filaments twisted together. The licorice is eventually wrapped into a wrapper to represent toxin B causing pseudomembranous colitis. Clean handwashing sign, poor hand washing and clindamycin (C. diff infection secondary to antibiotic use) as a means of transmission. Little kid's green (green = toxin) shoe to represent that the toxin, NOT the organism, is found in the stool for diagnosis. Metro in the background = metronidazole. Van unloading in the back that has a ramp looking like a tongue = oral vancomycin.

Hep C

(a member of flavivirus, but it gets its own video); The Hep Sea - Hep C hippo is out at sea, Hep A hippo is stuck at the picornavirus zoo. *Hep. C hippo being discovered by explorers. Signs in front of it saying at what times it could be viewed.* Blood pool surrounding the hippo. Blood as major source of transmission. 1990s transfusion? Hep. C. Colorful tent on the right side of the sketch. Antigenic variation and reason for no vaccine. Misspelled "hippopotamus" on the sign that also says no viewing from 3-5. No proofreading capability on it's polymerase and the reason for the antigenic variation. Sign stating that 60-80% of chronically infected. 60-80% of those infected progress to a chronic state. Contrast Hep. B where 10% of infected adults progress and 90% of infected children progress. Warm hues, but snowflakes coming up on the sea-shore. Associated with cryglobulinemia. Ribs in the distance. Rib-vir as an anti Hep. C drug. See below. Interference on the woman's radio. Interferon alpha. See below. Man with his machete caught in a tree. Protease inhibitor. Simeprevir. See below. *Hep. C sketchy pharm* Plate of ribs in the corner with the wolf spider near the streamers. Ribavirin as a polymerase inhibitor and a teratogen. Man sleeping on the sofa near the streamers. Sofosbuvir as a polymerase inhibitor. Radio with interfered antenna. Interferon alpha. Recall interferon arcade and Pachtderm-man (a hippo man running away from a hairy ghost and a black ghost). The 'A' in Pachtderm is supposed to represent alpha. Treatment also for hairy cell leukemia, malignant melanoma, kaposi sarcoma, and condyloma accuminata. Also RCC with the crab in the kidney shaped claw game. Finishing out interferon arcade for completeness sake. Beta was Beta invaders, combating lesions through time and space for M.S. G was Gamma Ga and fighting the CGD asteroids. Man outside with put his machete in the tree as he is simmering a pot for dinner. Simeprevir as a protease inhibitor for Hep. C.

Reovirus

A race on the rio (Rotavirus, CO tick virus in the family) *Majority of sketch about rotavirus.* CO sign on the very left hand side, everything else about rotavirus. Warm hues. RNA. See below. No sun or moon in the sketch. DS RNA virus. Also reinforced with the floating divider in the race. *DS DNA dividers.* David carved into the mountain. Naked. 11 boats in the race. 10-12 segmented virus. One of the BOAR viruses. 3, 8, 2, 10-12. Propeller on the back of one of the contestants boats. Rotavirus. Do not confuse with the propeller on the back of the Cali-Sea-Cruise, although they both signify explosive diarrhea. Propeller says Nine SPeed 4 stroke and the boat says chlo-rider. NSP4 toxin increases chloride permeability. Snowcaps in the mountain off into the distance. Wintertime as a prime rotavirus season. Recall Coxsackie infections more prevalent in summertime. Child fan holding the number 1 sign. Rotavirus is the number one cause of severe diarrhea in young children. Waterbottle being held by the kid in the speedboat. Tx for rotavirus is oral rehydration. TV crew filming the race with the sign saying LIVE and the anchor holding up a syringe. He is holding up the syringe to his mouth, like you'd do with a microphone. Oral live attenuated rotavirus vaccine part of the vaccination schedule for children. Must know a few things about when to give them. Man next to the TV crew with a large telescope camera. The vaccine sometimes causes intussception, or telescoping of the bowels. The vaccines causes an increase in the size of peyer's patches which are thought to act as a lead point. Welcome to colorado sign and someone puking and with sweat droplets. CO tick virus causing myalgia, fever, vomiting and no rash. Can be differentiated by RMSF by the lack of rash.

Arenavirus

Arenavirus gladiators. Gladiators fighting inside of two circles. 2 segments. One of the BOAR viruses. 3, 8, 2, 10-12. Rodents on the floor of the arena. Transmitted by rodents. Spiral banners going up the arena columns. Helical. LCV roman numerals in the back for lymphocytic choriomeningitis. One of the fighters with a red shawl that covers his head and neck. Meningioencephalitis of LCV. Night-time fight. RNA negative sense.

Aspergillus fumigatus

Asparagus farm with a peanut plant (aflatoxins are a family of toxins found on peanut plants among others) that has acute angles and farmers that represent different diseases. Cat on the scarecrow. Catalase positive. Tracker with a crab on it, behind a cow with a liver spot. Aspergillus flavus (not fumigatus) in certain conditions can grow on peanuts and produce aflatoxins, a carcinogen that is strongly associated with hepatocellular carcinoma. Peanut plant is growing at 45 degree angles. Acute angle septations (contrast mucor, which is wide angle). The first two letters of aspergillus are A.S. which stand for acute septate. Within peanut plan are the yellow flowers (aspergillus's conidiophores) that look like an aspergillum, a device used to sprinkle holy water and where aspergillus gets its name. These bud off and then float through the air. Transmission by inhalation. Migratory worker sweating and with an inhaler. ABPA (allergic bronchopulmonary aspergillosis). Wheezing, fever, migratory pulmonary infiltrate. Associated with asthma, wheezing and CF patients. IgE written on the inhaler. Type I HSR. Worker coughing next to the TB cactus. Aspergillomas. Fungus balls in the lungs. People who are susceptible are those who already have cavitations in the lungs. TB. Worker with cane on the right next to the red sprinklers and the scarecrow showing what organs are affected. Angioinvasive aspergillosis affects immunocompromised patients (particularly chemotherapy patients who are neutropenic). Fever, cough and hemoptysis. Kidney spots for kidney failure. Heart spot for endocarditis. Straw protruding through the head with white rings around it. Ring enhancing brain lesions (recall toxo and recall JC virus with non-enhancing lesions). Scarecrow without a nose. May spread to paranasal sinuses and cause necrosis. Paranasal necrosis occurs in mucor as well. Question stem. Seizures, focal neuro deficits. Has a cough, symptoms of pneumonia and has a past of TB, you may want to jump to TB, but also keep aspergillosis in the the back of your mind and the way you'd differentiate is by seeing ring enhancing lesions on CT. Vortex. Voriconazole. Amphotericin B for angioinvasive aspergillosis.

Why should you suspect C. tetani infections after puncture wounds?

C. tetani spores found on rusty nails and puncture wounds will close off air. Clostridium species are obligate anaerobes.

(Norwalk) Calicivirus

Cali Sea Cruise Narwhal in the background. Norovirus. David sand statue. Naked. Man handing out long admission tickets. Cleavage of a long polypeptide. Cruise ship with a propeller that is kicking up mud. Explosive watery diarrhea. Viral gastroenteritis. Going onto the ship are day-care children and they are eating shellfish. Day-care children/close quarters are a risk factor. Shellfish are a source. Cruise ship and cruise-goers. Close quarters. Buffett. Anyone who is infected and touches food.

Toxoplasmosis gondii

Cat lady scene Three ways to transmit Toxo: oocysts in raw or undercooked meat, oocysts in shed animal feces, or through the placenta of an infected woman as a torch infection. Organization of the sketch: Statue of liberty torch cat overlooking classic triad plus one symptom of congenital toxo, and then gandi (HIV/AIDS), and Ben Franklin cat for prophylaxis (with certain parameters) in HIV/AIDS patients. Gandi cat with turban, needle through the turban and multiple lenses to his hipster glasses. Encephalitis, *biopsy to differentiate from CNS lymphoma (which also causes ring enhancement and can also happen in AIDS/immunocompromised patients)* Compare JC virus, which causes non enhancing lesions on CT. Gandi cat kicking over the bowl of meat in a hunger strike. Cysts in undercooked meat. When thinking about the classic triad plus one symptom of congenital toxo, it is important to recall that toxo is a CNS parasite. Classic triad: chorioretinitis, hydrocephalus, and intracranial calcifications. Added symptom: deafness. Camera that looks like a retina held by the pregnant lady. Chorioretinitis. Cat shaking with a fish bowl on his head. Hydrocephalus and seizures secondary to hydrocephalus and intracranial calcifications. Kitten drinking milk and getting it all over it's head. Intracranial calcifications. Compare congenital CMV that has periventricular calcifications. Beethoven cat. Deafness that is not part of the classic triad of congenital toxo, but a frequent finding. Dyed eggs with pyramids on them. Sulfadiazine and pyrimethamine for treatment. Ben Franklin cat with the positive sign kite and the IgG keys dangling from it. Ben Franklin cat is also holding a $100 bill. Egg next to Ben Franklin cat that does not have any dye or pyramids on it. In HIV patients with CD4 count <100 and who also are IgG positive for toxo, begin TMP-SMX prophylaxis.

taenia solium, taenia saginata, diphyllobothrium latum, echinococcus

Cestodes a.ka. tapeworms Cestode County Carnival. Tents. Taenia. Sun and Sold tent with the pig. Taenia solium. Sagging tent with cow. Taenia saginata. Hooks on the pigs tent. Proglottid heads of T. solium seen on O and P. Circus merry go round that flung off the girl with the cheese head next to the eggs in feces water. Ingestion of taenia eggs that leads to cysticercosis or neurocysticercosis. Brain said to have a swiss cheese appearance on CT. Seizure are a symptom. Important distinction. Ingestion of the cysts or larvae of the Taenia species will lead to taeniasis, which is usually asymptomatic, but could cause GI problems or malabsorption. Ingestion of eggs in feces contaminated water may cause neurocysticercosis. Pretzel stand. Treat taenia with praziquantel. Strong man bending a bar on the merry go round. If patient has neurocysticercosis, additional treatment with albendazole is necessary. Man throwing away his fish running to the bathroom. Bathroom sounds like bothrium. Diphyllobothrium latum, the fish tapeworm. Bathroom located next to the fireworks stand that says, "must B12 to buy fireworks." This tapeworm is associated with B12 deficiency and megaloblastic anemia. Cobalt firework going off in the background. Cobalamin is another name for B12. Man walking out of the bathroom with a long piece of toilet paper stuck to his foot. D. latum is the longest tapeworm (can grow up to 10 feet). Toilet paper segments in the brown puddle. Proglottid segments in stool as diagnostic for D. latum. Man with toilet paper stuck to foot eating a pretzel. Praziquantal for treatment of D. latum. Nickel donation thing on the front of the bathroom. Niclosamide for treatment of D. latum. Cockerspaniel winning first place. Liver spot and a ribbon on that liver spot. For winning first place he received a cracked egg in an egg cup. Echinococcus granulosus. Causes hyatid cysts in the liver. Eggshell calcification of the liver on CT. Flushed, red man removing the second place pin from the sheepdog. Anaphylaxis and an acute abdomen that results if the hyatid cysts rupture. Sheep are intermediate host and dogs are definitive host. Surgeons will inject the cells with ethanol or hypertonic saline to kill the cells before attempting to remove the cysts. If cysts were in the lungs, you'd see hooks in the patients sputum. Contrast how you would treat the liver abscesses of entamoeba histolytica with medicine. Cockerspaniel that pooped. Dog feces that contaminate human food or water.

Neisseria meningitidis

College kid in red spotted boxers who OD'ed on malt liquor and vaccines. MAC swabbing the malt liquor bottle and placing drug (vaccine) syringes underneath capsules. No capsule for B. This is to represent that N. meningitis ferments maltose (N. gonorrhoeae does not) and that the type B vaccine is not widely available and the reason for outbreaks. Burning envelopes to represent the envelopes of LOS proteins blebbing off and creating the inflammatory response (FA says Neisseria's LOS has strong endotoxin activity). 1st step of the pathogenesis. Sprinklers creating purple wet spots on the floor and the kid who overdosed with red spotted boxers to represent leaky capillaries (caused by LOS virulence factor) and consumption of platelets that cause hypovolemia and a petechial rash. Petechia can progress to purpura which can progress to DIC. Menigitis with a petechial rash? Think Neiserria. Sparked outlet to represent shock. Waterhouse in the background to represent Waterhouse-Friderichsen syndrome. Peripheral vasoconstriction goes to a maximum in order to preserve blood flow and as a result some organs become poorly perfused. Adrenals are one of them. Waterhouse-Friederichsen syndrome is characterized by adrenal insufficiency, fever, DIC, shock. Pathogenesis: encapsulated Neiserria transmitted by respiratory droplets, LOS proteins bleb off and cause a massive inflammatory response, leakage of capillaries and consumption of platelets. Petchial rash and shock. Waterhouse-Friderichsen syndrome. Mortality rate even with antibiotics is 15%. Treatment is ceftriaxone (firefighter with axe). Prophylaxis for anyone who was in contact with the individual is rifampin (FA also says ceftriaxone). Represented by the policeman with the rifle fencing off the crime scene to the college kids 'close contacts.' Recall the rifle tooting close contact is also in phyllis's chocolate covered cherries for H. flu meningitis.

Corona-virus

Crown = kingdom Kingdom of SARS King is coughing next to his helical kingdom. Cause of a common cold. Helical shaped. FA: Helical, SARS, MERS (middle eastern respiratory syndrome), common cold.

Trypanosoma cruzi

Cruzin' through Che's Gas (Che's gas = Chagas, for Chagas disease) Protozoa of the blood. Causes chagas disease. Colon gas line. Big red heart bag. Snake with giant throat. Megacolon, DCM, and megaesophagus. Che kissing his gf. Transmitted by the kissing bug, reduviidae insects that are vectors for the parasite. Blood leaking from the gasoline pump. Acute infections diagnosed on peripheral blood smear. Chronic infections diagnosed with serology. Red bug on the DCM heart bag. Reinforcement of bug name and trypanosomes seen within cardiac myocytes on heart biospy. Knee high, furry mocassins of Che's gf. Nifurtimox. This is for the acute infection. No treatment for chronic infection. Romana sign not in sketch. Romana sign is periorbital swelling.

Coxiella burnetii

Curly Q the Ram. Horn on the ram is in the shape of a Q. Cause of Q fever. White ram. No rash. Common to confuse Borrellia, Ricketsii and Coxiella, but you will not do this. This is the only one out of those without a rash. Walnuts and animal poop. Spores are in animal poop. Ram kicking up a dust cloud. Aerosol transmission (or amniotic fluid from a farmer delivering a baby sheep). Farmer knocking his head, sweating, coughing and standing in front of a cow. HA, fever, pneumonia and hepatitis. This could be confused with Brucella because both around farm animals, but with Brucella the undulating fever will be emphasized. Ram is inside the barn with a lock on. Obligate intracellular. Compare Chlamydia and Ricketsii species. (From sketchy pharm): Treatment is doxycycline.

Gardnerella vaginalis

Detective at the Fish Garden Graffiti all over the fish garden. Gram variable rod. Detective. Clue cells. Detective dog sniffing. Amine whiff test that enhances the fishy odor. Venus flytraps with gray white drool. Venus flytraps represent the imbalance in normal flora and the overgrowth that leads to bacterial vaginosis. If it's part of the normal flora, likely why it cannot be transmitted sexually. Metro in the background. Metronidazole. Price 4.5 and up. Changes pH to 4.5. *pH, microscope, D/C comparison of vaginal infections.* Gardnerella vaginalis. Grows at pH 4.5 and up. Plants at price 4.5 and up. Candida albicans. Grows at pH 4 (does NOT change pH. Canadian playground open until 4pm (does not go higher/past 4). Trichomonas vaginalis. Grows at pH 4.5 and up. Street art next to the magician on the green street corner sold at price 4.5 and up. Thus, pH of 4.5 can narrow it down to Trichomonas and Gardnerella. Under the microscope this is what each would show... Gardnerella vaginalis. Clue cells. Candida albicans. Pseudohyphae. Trichomonas vaginalis. The distinct looking trophozoite (but they may not be that obvious and in that case *motile* is the buzzword). Discharge of each... Chlamydia. Watery. Gonnorhea. Thicker than Chlamydia. Gardnerella vaginalis. Gray-White. Candida albicans. Vaginal thrush. Trichomonas vaginalis. Malodorous yellow green.

Klebsiella, Enterobacter, Serratia

Dinosaurs hovering around the hospitalized patient with a non-rebreather mask and a urinary catheter in to represent causes of nosocomial pneumonia and UTIs. Hospital setting and pills on the ground should clue you in to multi-drug resistance and use of a carbapenem when treating (because resistance isn't an issue with carbapenems). Pterodactyl and Triceratops are motile. Klebsiella is not motile because it knocked over the red currant jelly and has it's foot caught in it. 3 A's of Klebsiella on it's tail = alcoholics, aspiration, abscesses (abscesses also represented by the CXR in the back). FA A's of Klebsiella: aspiration pneumonia, abscesses in lungs and liver, alcoholics, di-A-betics, curr-A-nt jelly sputum. *X-ray = cavitary lesion to remind that it causes abscesses and that it may get confused with TB* *MacConkey caveat: serratia ferments at a slow rate. Can show up negative on a lactose fermentation test.*

E. coli

E. Cola's Soda Fountain and $1.57 Hamburger Joint Left = EHEC, middle = shared features, right = ETEC Hamburgers. EHEC found in undercooked hamburgers. $1.57 hamburgers to represent that the O157:H7 is the serotype strain that causes EHEC (and the most common serotype in the US). EHEC stands for Enterohemorrhagic E. coli. Soda fountain that uses milk in it's milkshakes. Lactose fermenter that would produce pink colonies on MacConkey agar. Only lactose fermenters are the dinosaurs and E. coli. Sorbitol-FREE glomerulus soda straw that is popping the red balloon of the kid with the She-gorilla toy. EHEC does not ferment sorbitol (contrast other strains of E. Coli) and E. coli produces Shiga-like toxin which produces HUS and schistocytes. Sorbitol is a new sweetener and this is an old-school Soda fountain. Ketchup over the burger to represent bloody stool. Gentlemen capping the cake with a K on it from the neonate with the space helmet on. K capsule as a virulence factor and K capsule being the virulence factor necessary for causing neonatal mengitis. E. coli also encapsulated. Girl with red bows in her hair. Fimbriae as a virulence factor. Fimbriae cause cystitis and pyelonephritis. #1 on a yellow drink with two straws facing outwards to represent that E. coli is the number 1 cause of UTIs. The strawberry milkshake with the strawberry atop the whipcream. Supposed to represent E. coli being the leading cause of gram negative sepsis. Virulence factor responsible for this is LPS. LPS not illustrated because LPS is a virulence factor for all gram negative bugs and not just E. coli. Green coasters underneath drinks on the bar counter. E. coli forms green colonies on EMG (Eosin-methylene blue) agar. Water guy delivering water from the company eL Agua de San Gabriel. Labile increases cAMP, stable increases cGMP. Water also a symbol that ETEC produces watery diarrhea (contrast EHEC which produces bloody diarrhea.

Cryptococcus neoformans

Egyptian crypt and the crypt cleaner with the tx hieroglyphics in the background (frog for amphotericin with the pharaoh playing the flute, for flucytosine, and then the pillar with the pinecone for fluconazole). Latex gloves. Latex agglutination of polysaccharide antigen. Coughing. Pneumonia. Neck brace. Meningitis. Red and silver color of the coffins. Mucicarmine (red) and methenamine silver stain. Methenamine silver stain is also used for diagnosis of pneumocystis jiroveci. Cleaning and soap bubbles. Soap bubble bronchopulmonary washing and soap bubble lesions on brain scan. Pigeons flying everywhere. Bird dropping as a source. Vat of black ink. India ink diagnosis. Frog and flute hieroglyphics and then a pine cone pillar. Tx for cryptococcal meningitis. Amphotericin B and flucytosine and then maintenance with a conazole.

Entamoeba histolytica

Entering the historical digsite for Queen Iodo's tomb. Pool with bubbles. Cysts are infectious. Man drinking water holding another mans hand. Associated with men who have sex with men. Anal-oral. Drinking contaminated water. Digging in the right lobe of the digsite. Right lobe of the liver most commonly affected (abscess formation). Anchovy truck in the background. Pus inside liver abscess described as having anchovy paste consistency. Colon sewage pipe with brown lesions. Causes intestinal amebiasis and ulcerations in the colon. Specifically, flask shaped lesions (intestinal biopsy would show flask shaped lesions). O and P written on the side of the sewage pipe. O and P as diagnostic test. Red cups floating around in the amoeba/trophozoite puddle. Endocytosed RBCs within a trophozoite. Metro in the sketch. Metronidazole. Pair of mice. Paramycin that is a luminal agent that works by eliminating cysts in the lumen of the intestine, a spot where some drugs have a hard time reaching. Queen iodo's dig site. Iodoquinol as another luminal agent. Important to know that you do not operate on these liver abscesses. Treat medically. Contrast to enchinococcus, surgeons inject hydatid cysts with ethanol or hypertonic saline before attempting to remove. Testmakers will give you a question stem about a liver mass and then make you determine if it is echinococcus or entamoeba. Recall echinococcus hydatid cysts, eggshell calcifications and risk of anaphylactic shock.

Strep bovis

FA only. Gram positive cocci, colonizes the gut. S. galloyticus (S. bovis biotype 1) can cause bacteremia and subacute endocarditis and is associated with colon cancer. Bovis in the blood = cancer in the colon.

(Pico) Poliovirus

Flamingo breeding pool (flamingos were chosen to represent polio because polio is said to result in asymmetric paralysis, the posture of the flamingo leg bent is supposed to represent that). Baby counterpart. Picornavirus. David statue. Naked. Toucan. Anterior horn cells. Yellow pool and flamingo standing. Acid stable. Sign reading Peyer's flamingo, caution, patches of eggs, breeding season 2-3 weeks. Peyer's patches in the gut is a site of replication. There are two sites of replication and the other is not represented. The other is the tonsils. Paralysis by disabling lower motor neuron cell bodies in the anterior horn of the spinal cord. Sulking teenager with the skull and cross vaccines shirt. Salk vaccine. Skull represents that this is the killed vaccine. Also called IPV, or inactivated polio vaccine. IgG response. Savin' a life donation next to the sulking teenager with the skull and cross vaccines shirt. Sabin vaccine. 'Life' on the donation post is meant to represent that this is the live vaccine. Also called OPV, or oral polio vaccine. Unique IgA response. Refer back to picornavirus overview.

Flavivirus

Flavor Packed Flavi, party along the Nile Hooded party-goers. Enveloped. Straw of the Hep. C is not bendy. Flaviviruses are non-segmented. Hep. C (play on High C drink). Man on a dinghy adrift with a brown white oar. Dinghy fever. Dengue fever. Also known as breakbone fever. Dinghy oar is in two pieces. Type 2 of dengue fever. Red tubes surrounding the kidney shaped dinghy. Compare dinghy with that in leptospirosis. Dengue fever is a type of hemorrhagic fever. Acute renal failure. Yellow waterbuffalo. Yellow fever. Do not mistake for general jaundice of Hep. C. This is it's own flavivirus. Waterbuffalo has mosquitoes buzzing around it. Liver spot and a hump on it's back. Aedes egypti. Jaundice. Backache. A man climbing on a red stool poking a vaccine into the yellow water buffaloes back. Yellow fever can cause red stool (can also cause bloody vomit) and a live attenuated vaccine. Swans floating in the river. Mosquitoes buzzing around them. Birds are the reservoir for West Nile virus. Mosquitoes are the vector. Culex mosquito. Turban, neck brace, and floppy neck of the swans. Encephalitis, meninigitis, flaccid paralysis.

Strep agalactiae

Galactic baby Mainly problematic in babies to mothers with vaginas infected by Group B strep. The baby is seen coughing and has a space cadet helmet to signify that this causes meningitis and pneumonia in babies. He is holding a stuffed hippo to represent hippurate positive (do not get confused with hepatitis). He is facing a basset hound who cannot lick him through his helmet (bacitracin resistant and this is how you will differentiate between Group A Strep). CAMP tents in the backgound with beta hemolytic light bulbs to signify CAMP factor production (not cyclic AMP, but named after those who discovered it). The spaceship that the baby arrives in: Has "35 wks." painted on the top half of it and then the bottom half looks like a vaginal canal and that canal is being stabbed by pencils. Screen pregnant women vagina and rectum at 35 weeks to see if colonized by Group B strep. If they are, patient is given intrapartum penicillin. The pencils stabbing the canal is to represent that the medication is given intrapartum, or during birth.

Neisseria gonorrhoeae

Gonzo's bar and the violinist's last clap (Fitz Hugh Curtis band) Trendy white cell looking chair with multiple white spots = PMN (polymorphonuclear cells also called granulocytes, FA has a picture of Neisseria facultative intracellular in a neutrophil). Broken glass on the ground at Gonzo's bar represents that N. gonorrhoeae does not have a capsule. Contrast N. meningitidis, which does have a capsule (recall the crime scene of the college kid where vaccines are put under capsules). Statue with the cracked knee that has crushed the violinist. Septic arthritis. Sexually active female who comes in with unilateral arthritis? N. gonorrhoeae Clam shell napkins on the table. Assumption of chlamydia co-infection in those with gonorrhoeae. Ceftriaxone for gonorrhoeae and doxy (bicycle tire wheel as a captain's wheel) or azithromycin (crow in the bird's nest of the pirate ship) for chlamydia. Mother quickly shielding her babies eyes to represent neonatal conjunctivitis. Gonorrhoeae conjunctivitis comes quicker than chlamydia conjunctivitis. Chandelier dropping hot wax onto the table. Neisseria gonorrhoeae discharge is thicker than Chlamydia's discharge. Difference in neonatal conjunctivitis with chlamydia and gonnorhea. *Timecourse* (gonnorhea earlier, recall quickly shielding eyes from the scene of the violinist's death) and presence of *pneumonia* (buzzword staccato cough, recall clam shell bra on the newborn in the mermaids arms).

Mycobacterium leprae

Good, Bad, Lion-cloth faced. Jail cell #1. Prisoner is behind bars and the deputy is pointing his rifle at him. TH1 response to the disease that is well contained a.k.a. tuberculoid. Dapsone and rifampin as treatment. Jail cell #2. Prisoner is escaping with the lion-cloth faced bandit while the deputy is being held at gunpoint and his rifle is by his side. TH2 response to the disease that is not well contained a.k.a. lepromatous. Clofazamine added to the dapsone/rifampin regimen. Cold setting. Infects skin and extremities due to lower temperature creating the glove and stocking loss of sensation. Armadillo. Armadillo are the reservoir in the US.

(Pico) Hepatitis A

Hippo exhibit USA Shellfish stand. Says three things on it. One month only. Limit one per customer. No carrying out of food. One month duration of infection. Self-limiting. No carrier/chronic state. Hippos on the rocks above the yellow pool. Acid stable. Person putting out their cigarette. Infected smokers have aversions to smoking. FA: No HCC risk. Monocyte infiltrate on biopsy. Council bodies (not specific?) Refer to picornavirus overview for general characteristics. Naked statue in the front of the Peak Animal Nursery. Long tickets for admission. Long polypeptide that is cleaved. Sun and warm hues. RNA positive sense.

Enterobius vermicularis, ancylostoma duodenale, necator americanus, ascaris lumbricoides, strongyloides stercoralis, trichinella spiralis

Intestinal nematodes, the "Super Worms!" scene Enterobius vermicularis (pin-worm), ancylostoma duodenale, necator americanus, ascaris lumbricoides, strongyloides stercoralis, trichinella spiralis. All intestinal nematodes in this scene can be treated by bendazoles. Vermin lady crawling out of a round hole. Pinworms lay eggs at the anus (round hole) at night. Fecal-oral. Vermin lady with a long tape cape. Scotch tape test. American dude with the neck and ankle brace swinging in from a hook (other side iron) kicking the vermin lady "PAM!" Hookworms found in rural southern United States. Suckers that feed on capillaries. Iron-deficiency anemia. Pyrantel pamoate for treatment of American dude and vermin lady. Red boots of american dude. Hookworm penetrate skin of soles of feet. Arrow on american dude. Circuitous route throughout the body to the intestines. Blood, lungs, intestines (goes to lungs, coughed up and swallowed and is then in the GI tract). American dudes grenades in the puddle. American dudes eggs in stool. Groot. Lumbercoides. Groot with rubble behind him. T-shirt design with the arrow and a tree. Intestinal obstruction as the main complication of ascaris. Respiratory symptoms. With albendazole (MT inhibitor), you run the risk of causing the worms to die and then obstruct as well. Also, do not give albendazoles to pregnant women. Strong guy. Red boots and circuitous T-shirt design. Strong guy kicking into the wall. Autoinfection. Strongyloides larvae hatch from eggs laid in intestinal wall, repentrate wall, enter blood stream. Larvae at the base of strong guy. Since the eggs are laid into the intestinal wall, they are not passed into the stool. This is important for diagnosis. Instead you will see larvae. No dumping, drains to the river sign next to strong guy. Ivermectin (or albendazole) for strong guy. Porky trickster with sweats, red glasses, and green drool. Standing in front of a striated brick wall. Fever, vomiting, periorbital edema, and myalgias. Pig because you can get it from eating undercooked pork. Red pipes. Larvae enter blood stream (ingestion of cysts in undercooked meat). Striated brick. Larvae travel to striated muscle. Fire behind him. Muscle inflammation.

Actinomyces Israeli

Israeli soldier The Israeli solider with a jaw bandage (to represent jaw trauma and association with dental caries) and the gas mask (anaerobic, contrast nocardia) who is writing a letter to his family with his pencil. The bandage around his face is purple. Banzai looking tree in the background. Purple jaw bandage + banzai looking tree = gram positive filamentous rod (one of two gram positive filamentous rods, the other is nocardia - actinomyces can be differentiated from nocardia based on the fact that actinomyces is anaerobic). Yellow rocks scattered about and a draining sewer tract represents the buzz phrase 'formation of sinus tracts that drain yellow sulfur pus.' Known as cervicofacial actinomyces. Google search of cervicofacial actinomyces shows the yellow pus in sinus tracts along the jawline and neck region. Pencil = penicillin G as treatment.

Polyomavirus JC and BK

Julius Caesar and the Senators (Brutus kills Julius Caesar with a knife) Takes place in a circular government room with a statue of David. DS, circular, naked DNA virus. Robe falling off JC. Reinforcing naked virus. Focus on Julius Caesar, the bust, senator count 200 and his cane for JC virus and the rest of the sketch belongs to BK virus. JC with a cane. HIV patients. Causes disease specifically in HIV patients with CD4+ count <200. 'PML' bust with the white roman crown. JC virus causes PML in HIV patients with CD4+ count <200. White crown is supposed to be non-enhancing brain lesions on CT. Contrast toxoplasma which causes ring enhancing brain lesions on CT. Senator count 200. JC virus causes PML in HIV patients with a CD4 count <200. Fountain of baby peeing bright red water. BK virus causes hemorrhagic cystitis. Also seen in adenovirus and cyclophosphamide sketch. Prevented in cyclophosphamide with co-administration of MESNA (2-mercaptoeethanesulfonate). Meats falling (should be on the left side of the sketch. The workbook is wrong). Baby peeing blood. BK virus causes hemorrhagic cystitis in transplant patients.

Bacillus anthracis

King Anthra's (the Viking) Axe. Entire sketch minus the bottom left corner represents Bacillus anthracis. The guy vomiting while holding rice represents Bacillus cereus and reheated rice syndrome. No play-on words for B. cereus and rice. King Anthra seen standing in a black circle with a fire around it holding his lung shaped bloody axe to represent cutaneous and pulmonary anthrax. Ulcer with black eschar. Pulmonary anthrax that causes hemorrhagic shock. Sheep being tended to by one of King Anthrax's soldier. Pulmonary anthrax also known as woolsorter's disease. All solider and kings representing B. anthracis are wearing armor with multiple belts with "D-shaped" buckles around their chest to represent polypeptide D-glutamate capsule. Walnuts in sketch = spore forming.

Pasteurella multicoida

Louis Pasteur's lab (lab = labrador retriever). Louis Pasteur is holding out a fishbone tempting his dog who has bitten him. Osteomyelitis. Cellulitis where his dog has bitten him and dog/animal bites as the mode of transmission. Not in FA: Cat. Catalase positive. Helps reinforce animal bites. Capsule over the swan neck flask (actual invention). Encapsulated. Blue ring. Oxidase positive. Sheep's blood. Grows on sheep blood agar. Safety pin on his lab coat. Bipolar staining. Recall Yersinia. Pencil. Penicillin as treatment.

Malassezia furfur

Malassezia's Italian Restaurant, Malassezia furfur causes tinea/pityriasis versicolor, entrance of the restaurant has a sun blue glass stain for "selsun blue" Chef sprinkling KOH onto the plate of spaghetti and meatballs. M. furfur resembles spaghetti and meatballs on KOH prep of skin scrapings. Heat lamps. Thrives in hot and humid conditions. Light and dark colored spots on the chefs back. Causes pityriasis versicolor, which manifests as hypo- and/or hyperpigmented patches. Merely a dermatological annoyance. Broken olive oil bottle. M. furfur produces melanocyte damaging acids via lipid degradation. Lasagna with a side of corn. M. furfur generally stays confined to the stratum corneum of the epithelium. Baby slurping up the spaghetti. NICU neonates recieving total parenteral nutrition are at risk of M. furfur fungemia due to lipophilicity of M. furfur. Stained glass window of a blue sun. Selsun blue as treatment a.k.a. selenium sulfide.

Mucormycosis and Rhizopus

Mu car auto shop "Rides R us" Old man with bread reaching his hand into a jar of candy. Immunocompromised people (specifically those with leukemia and neutropenia) and diabetics (the bug likes ketone bodies). Bread to represent rhizopus as a bread mold. Ketone auto parts. DKA is the most common predisposing factor to infection with this fungus. Red jumper cables. The fungus like to proliferate in blood vessel walls where there are high amounts of glucose and ketones. Tire irons on the wall and with the mechanic. Hyphae that are nonseptate and branch at wide angles. Oil pan with holes in it. After invasion into the blood vessels this fungi penetrates the cribiform plate. Recall Naegleria fowleri penetrates through the cribiform plate as well. Mechanic under the car with oil dripping onto his face. Rhinocerebral mucormycoses with frontal lobe abscesses. Necrosis of nasal and paranasal tissue also seen in aspergillosis. Car that looks like a frog. Amphotericin B as treatment. Don't forget surgical debridement.

Vibrio cholera

Mustache Colonel Cholera's baSe cAMP The colonel has a mustache. Comma shaped (Helicobacter, Campylobacter and Vibrio are all comma shaped, but Helicobacter and campylobacter and more helical/spiral shaped). baSe cAMP map. Activates Gs to increase cAMP. Soldier outhouse dumping into a river where rice-field workers are. Fecal-oral. Rice water diarrhea. Colonel drinking water and enjoying oysters and lemon. Oral rehydration and seafood as a source of parahaemolyticus and vulnificus.

Campylobacter jejuni

Mustache guy on the red stool and the bears around a campfire cooking a chicken. Guy and the bears. Guillan Barre. Guy has a mustache and a ring. Comma shaped (however, comma shaped is more of a buzzword for Vibrio. Helicobacter, Campylobacter and Cholera are all comma shaped, but Helicobacter and Campylobacter and slightly more helical/spiral) and oxidase positive. Red stool. Blood diarrhea. Campfire. Likes hot temperatures. Grows at 42 degrees celcius. Cooking the chicken. Uncooked chicken as a source. Guy slapping knee. Reactive arthritis. Also in Chlamydia with the pirate slapping his knee at the monkey who is falling off the tree. Reactive arthritis is also known as Reiter's syndrome. Represented by the monkeys in the chlamydia sketch. Can't see (uveitis), can't pee (urethritis), can't climb a tree (arthritis).

Naegleria fowleri

Naegleria Falls Protozoa of the CNS. Also called brain eating amoeba. Annie Edson Taylor. 63 year old woman during the civil war era who survived a drop in Niagara falls in a wooden barrel. Annie opening a bottle of champagne to celebrate. Champagne tap is a colloquial term that means not getting any blood in a spinal tap. *Amoebas seen in CSF on spinal tap.* Niagara falls setting. Transmission via swimming in fresh water lakes. Watersports. Cribs going down the falls. Parasite entrance via the cribiform plate. Turbans on the men a the bottom of the falls, one dead, one alive and with frogs crawling on him. Causes a rapidly fatal meningoencephalitis. Give amphotericin B to the survivors.

Nocardia

No card games for old men Gun fight in a bar. The gentleman shooting the gun hits a planted cactus. Soil spilling from the cactus pot represents that this bacteria is found in soil. The man on the right being shot has a cane (infections occur in the immunocompromised) and represents the 3 infections that nocardia can cause: CNS, pulmonary, and cutaneous. CNS and lung abscesses are represented by the bullets hitting his chest and cowboy hat. Cutaneous nocardia is represented by the redness around his cow-spots on his cow-hide outfit. The gentleman shooting also has on the acid fast mycolic garb and is sporting a fuschia colored pistol to represent that this bacteria stains acid fast (weakly). Above the bar is a picture of the actinomyces isreali desert banzai tree to represent that it is one of the two gram positive filamentous rods along with nocardia. We can differentiate this bacteria from nocardia based on the fact that nocardia is anaerobic (recall the gas mask in the actinomyces israeli scene). Air bellow on the counter of the bar to represent that nocardia is aerobic Jar of rotten eggs on the bar top represents TMP-SMX as a treatment for nocardia infections. Cat on the top of the bar counter = catalase positive. CGD.

Neisseria species overview

Noir TV series (the detective with red handcuffs). Starring Thayer-Martin as "MAC" the private eye. A Noir series is a dramatized hollywood crime show. Detective is eating a chocolate bar to represent growth on a chocolate agar. Vice City Private Nvestigator = VPN agar, which is vancomycin, polymyxin E (also known as colistin), nystatin. VPN agar has some chocolate in it's agar, but can be thought of as a special, selective type of chocolate agar. Starring Thayer Martin as MAC the Private Eye. Thayer Martin is another name for the VPN agar. Taken together, VPN, chocolate bar and Thayer-Martin represent the agars that Neisseria can be grown on. MAC the private eye to represent that people with MAC attack complex deficiency are more prone to Neisseria infections. (C5-C9, represented by the show's air time). Ace card in MAC's hat to represent IgA protease as Neisseria's virulence factor. IgA protease is what allows it to survive in mucousal surfaces (recall mucosal surfaces have IgA's secreted into them).

Zika virus

Not in sketchy, but in FA. A flavivirus. conjunctivitis, low-grade fever, itchy rash in 20%, congential microcephaly diagnose RT-PCR or with serology sexual and vertical transmission possible outbreaks more common in tropical/subtropical tx = supportive

HIV

One Cane to Rule them all (most powerful immunocompromised cane to rule them all) HIV wizard garb. Sundial around the hat. gp24 that acts as a capsid protein. Cap = a type of hat. Two dragon design on the wizard cap. Two RNA strands within the cap. These are positive sense RNA strands. Notice that HIV is in the RNA positive video folder of sketchy micro. Also notice that warm hues with the sun. Do not confuse with the dragons in the calicivirus sketch that was a GOT reference. Pipe in his mouth and robe pockets. Env gene (of env, gag, and pol) encodes for the proteins gp41 and 120 which sketchy decided to combine into 4/20 and his pipe. 41 and 120 pipes are associated with the env protein and so they are sticking out of his robe. Reading 4/20 left to right you will remember that 41 is the part closest to his mouth and 120 the part that is farthest away. 41 etched into the middle of one of his pipes. gp41 as the transmembrane protein and gp120 as the outer protein. Busting out of a cage with the carving CCR5. First infects macrophages through the CCR5 receptor. Casting a spell on squires with the banner CXCR4. Then infects CD4+ cells through the CXCR4 receptor. Following the spell follows the course of the disease. Primary infection includes flu-like, mono-like syndrome. Lymphadenopathy and fever. Fall 200 ft. to their death. CD4+ count less than 200 as the definition for AIDS. Caution. AIDS can also be defined when there is a count above 200 AND an AIDs defining illness. Archers congregated into a stronghold shooting at the giant crab. HIV can cause a large (large crab) diffuse, B-cell lymphoma (archers congregated into the stronghold). CCR5 banner holder blocking the bucking mare. Maraviroc as use in addition to HAART (NNRTIs, NRTIs) Elf with a shield that says ELISA in front of a wall markings that look like a Western blot. ELISA screen, Western blot to confirm diagnosis. Why you have to wait a few months before using an ELISA is that it test antibodies. *Neonate testing!* If you are wanting to know if the mother passed down HIV you should not use ELISA. HIV positive mother will pass down the antibodies to the baby and cause ELISA and western blot of the baby to read positive. You must use nucleic acid amplification for neonates.

Orthomyxovirus

Orthodontist Night Shift at the Orthodontist's (flu scene) Doktor Drift's Night Shift. Drift is a point mutation. Shift is recombination with another species like bird flu or swine flu. Drift cause of epidemics. Shift cause of pandemics. Octopus hoarding the RBCs. Hemagglutinin. Hemagglutinin (HA) envelope protein binds sialic acid on cells, facilitating endocytosis. Octopus with 8 legs. 8 segments. One of the four segmented viruses, BOAR. 3, 8, 2, 10-12. Octopus grabbing one of the nurse assistant's scalpels and using it to cut the lights from the diver's helmet. N and A of nurse assistant stand for neuraminidase and the scalpel cleaving the lights represents sialic acid being cleaved by NA to release virions. Diver's helmet and octopus babies inside to represent that orthomyxovirus is an exception to the rule that RNA viruses replicate in the cytoplasm. NA is a virulence factor that cleaves sialic acid to release virions from the cell (not necessarily the nucleus, which the diver's helmet is supposed to represent). Amantadine manatee with utensils looking for the baby octopus hiding in the shell that has M2 carved into the lip of the shell. Amantadine is an M2 inhibitor. M2 is a proton channel that is required to make the proper pH that is required for viral uncoating. Air bubbles going into the nose and a syringe stabbing the skeleton represent the two administration routes for vaccines. Live intranasal or killed intramuscular. Nurse assistant is named Tammy V. Osel*tamivir*. Tammy V capping the scalpels. NA inhibitor. Anamivir is the same as oseltamivir. Trade name tamiflu. Only works within the first 72 hours.

Pneumocystis jiroveci

PCP ping pong of the old man beating the young man 20 - 0 for <200 cell count (PCP = pneumocystis pneumonia). Old man versus the young kid. Symptoms are evident in immunocompromised individuals and infection is usually asymptomatic in healthy individuals. Cracked glass tables. Ground glass infiltrate on CXR. Player squirting a bottle of BAL into his mouth. PCP diagnosis can be confirmed with a bronchoalveolar lavage. Silver discs in the middle of the table. BAL sample is stained with methenamine silver to identify PCP that will look disc shaped yeast. Methenamine silver stain also in cryptococcus neoformans. ^biopsy would also reveal "spherical bodies with sharply outlined walls" Crushed ping pong balls. Ground glass appearance on PCP pneumonia X-ray can look like crushed ping pong balls. Backhand. Bactrim as prophylaxis once CD count is <200 and for treatment if the disease is contracted. Jar of ping pong balls that look like eggs. Sulfamethoxazole and trimethoprim are the components of bactrim. Pentagon shaped paddles. Pentamidine use for individuals allergic to sulfa drugs. Recall that Sketchy micro has prophylaxis for one other bug. Toxo. For toxoplasmosis, we begin prophylaxis when that patient was IgG positive for toxoplasma and had a CD count <100. We also give bactrim (recall this egg was not dyed and did not have any pyramids drawn on it). Sulfadiazine and pyrimethamine were for treatment of toxoplasma, not prophylaxis. *Pneumocystis is an atypical, extracellular fungi*

Paramyxovirus

Paranormal Mixer *Measles Weasles* Male weasle with 4 C's going down his tuxedo. Cough, Coryza, Conjuncitivis, Koplik spots. Woman weasle with a red latin flowy dress. Rubeola sounds more latin. Also known as rubeola. Do not confuse with roseola or rubella. Woman weasle with rubies that are going down her face. Rash that starts at the head and moves down. Compare rubella. Son weasle with a turban on and hands fused together. Standing next to a sign that says Tales of SSPEence. Fusion protein. Subacute sclerosing panencephalitis. Woman weasle next to octopus hors d'oeuvres and the weasle son with his hands fused together. Only HA and fusion protein as virulence factors for measles. Compare croup (3 wolves) and the mumps mummy (3 represented visually). *Mumps mummy.* Holding an orchid and a plate of octopus hors d'oeuvres with a scalpel. Orchiditis, haemagluttin (HA), and NA. Big cheeks on the mummy. Parotidis. Child mummy with hands fused together. Fusion protein in mumps. Scalpel, octopus, and fusion protein. Mumps has all 3 virulence factors. *RSV R.I.P. tombstone.* Little children and one really pale ghost. Palivizumab as prophylaxis for RSV premies. Ribs around the tombstone. Ribavirin for adults infected with RSV. *Seal howling at the steeple with the wolves* Seal-like bark. Croup. Also called parainfluenza. Seal wants to be part of the croup. Croup. Howling at the steeple. Steeple sign on X-ray. 3 wolves in his wolf pack to represent that parainfluenza has all 3 virulence factors as well. HA, NA, fusion protein. MMR live puppet show with one puppet defending the pregnant puppet. Live vaccine, do not give to pregnant women. Ghosts with envelopes. Enveloped.

Bunyavirus

Paul Bunyavirus in CA rift valley Paul Bunyan chopping down 3 trees. 3 segments. Part of the BOAR viruses that are segmented. 3, 8, 2, 10-12. Arbor in the background. Arbovirus. Most viruses in the bunyavirus family are arboviruses with the exception of Hantavirus. Hantavirus takes up 4 and a half minutes of the 6 minute sketch. Walking in front of him are haunted mice. Two of the mice have spirits leaving their bodies. Hantavirus. Hantavirus is NOT an arbovirus and is a robovirus (rodent transmitted virus). Hantavirus outbreak in yosemite from people who swept up rodent feces. Paul's sweaty shirt and renal shaped canteen represent the symptoms of Hantavirus. Capillary leak causing pulmonary edema and pre-renal azotemia. Paul's bloody axe. Hemorrhagic fever that can also occur in Hantavirus. Kids shaking and the teacher with a turban outside of the California Rift Valley Elementary. On the same side as the arbor. CA encephalitis and Rift Valley fever caused by an arbovirus of bunyavirus. Seizures and encephalitis.

Picornavirus Overview

Peak animal nursery. Volcano peak in the background. Exhibit A for hep. A Exhibit B for birds Exhibit C for cold Admission has a long ticket being ripped into many pieces. Long polypeptide that is cleaved. Statue of David. Naked Poop everywhere. Fecal-Oral. All animals have a baby animal next to them. Baby hippo, baby birds, baby rhino. Represents pico in picornavirus. Hippo with armband A exhibit on the left. Human head shaped bird cage in the middle that says ENTER aviary. Inside are flamingos, cockatoos, and birds that are echo-ing each other. Enteroviruses that include poliovirus, coxsackie, and echo virus. #1 cause of aseptic meningitis. Bird feed with no added sugar, no organisms and source of protein. CSF findings in viral meningitis. Rhino exhibit on the right. Mud on the nose. Not transmitted fecal orally.

Haemophilus influenzae

Phyllis's (HaemoPHYLLIS) Chocolate Covered Cherries. Chocolate covered cherries. Plated on chocolate agar (recall Neiserria) 5 cents. Factor V - nicotinamide or nickel-tin-amide. Factor added to chocolate agar. 10 cents. Factor X - hematin or hem-a-ten. Factor added to chocolate agar. Spraying pesticide on a bee hovering around a case of chocolate covered cherries. See below. $2.18 special on sugar DIPped items. Vaccine to H. flu given to children from 2-18 months and vaccine contains the the type b capsular polysaccharide conjugated to diptheria. Kids represent the diseases. One kid *screaming*, drooling, crying and with a cherry red epiglottis. Cherry red epiglottis. Drooling and inspiratory stridor are physical exam findings in epiglottitis. As far as STEP 1 is concerned, epiglottitis is caused by H. flu. Other kid is plugging his ears because the epiglottitis kid is screaming. Otitis *media.* Kid with space cadet helmet pointing at the capsule with the bee floating around it. H. flu only causes meningitis when it is the type B strain. Sickles with the two kids dressed as knights. Three axes also in their costume. Sickle cell patients because encapsulated. Ceftriaxone as a treatment for meningitis or systemic infection. Use augmentin for mucosal infections (not represented). Rifle tooting close contact of the kids in the store. Rifampin prophylaxis for close contacts. Recall Neiserria meningitis rifampin rifle on the police officer holding back the close contacts.

Papilloma virus

Pill-oma bugs (pill looking bugs) Blue table. Statue of David. Naked DNA virus. 6 people in the sketch ages 1, 4, 6, 11, 16, 18. Seperate warts and cancers. Kids outside holding up their fingers (1 and 4) to show how old they are. They are covered in skin bugs. Strains 1-4 cause verruca vulgaris the cutaneous common wart. *Can also think of the children being covered in multiple bugs to remember the high-yield fact that laryngeal papillomas in children are multiple as opposed to singular in adults.* 6 and 11 year old's eating one and then dropping it down his pants. Laryngeal papillomatosis a.k.a. recurrent respiratory papillomatosis. Condyloma acuminata a.k.a. anogential warts from HPV 6, 11. Teens with a 15 year promise sharing a crab dinner. The guy is about to sit on one of the bugs. HPV 16, 18, 31, 33 associated with anogenital cancers. Vaccine fence with the kids outside. Guardasil covers 6, 11, 16, 18. The 31 and 33 year old selfs of the teens are not within the fence. Fork with shrimp shaped like a 6. E6 targets p53. Root beer with a straw that is shaped like a seven. E7 targets RB. Blue sunny side up eggs next to the woman. HPV infected cells on pap smear are called koilocytes and look like blue sunny side up eggs. Ribbon on the woman. AIDS-defining illness. Invasive cervical/anal/penile cancers. Immunosuppression increases risk of HPV-related cancer. Casted leg and cane. Because she wasn't old enough to represent HIV/AIDS. Car keys. 16 year old. I voted sticker. 18 year old.

Chlamydia

Pirates of Chlam Island. Marooned on an island. Obligate intracellular. Think of the sand as being the limits of the cell. Other sketches depict obligate intracellular as an indoor theme. Obligate intracellular because chlamydia cannot make their own ATP. Ghostbusters sign with mermaid. Lack of muramic acid and thus why penicillins cannot be used to treat. Life cycle with pearls and clams. Pearls. Elementary form. Clam with two pearls inside of it. Reticular Form. Elementary form enters a cell and then replicates inside of the cell via binary fission. Release outside of the cell to become 2 elementary forms again. *Elementary = infectious, reticular = replicating* Treasure chest full of gems and knats flying around the chest. Diagnosis. Gems to represent giemsa stain (recall borrellia) 3 types of chlamydia - trachomatis, pneumoniae and psittaci. Parrot dropping on mermaid with clam shell bra - psittaci (parrot) and pneumoniae cause an atypical pneumonia. Think pet store workers for psittaci. 3 types of trachomatis. A-C: Blindness. D-K: STI. L1-L3: LGV. Hole through the side of the ship. Watery D/C. Recall candle wax (thicker) in gonnorhea. Difference in neonatal conjunctivitis with chlamydia and gonnorhea. *Timecourse* (gonnorhea earlier, recall quickly shielding eyes from the scene of the violinist's death) and presence of *pneumonia* (buzzword staccato cough, recall clam shell bra on the newborn in the mermaids arms). Mermaid with barnacles around her waist. Lymphogranuloma venereum. Small, painless ulcers on genitals that progress to swollen, painful inguinal lymph nodes that ulcerate. Treat with doxy. Captain with the shades on. Blindness and the representation of subtypes A-C (as in, you *SEE* with your eyes). He is the leader and this is the leading cause of blindness worldwide. His hand up to his world represents hand to eye contact as transmission. Pirate slapping his knee. Reactive arthritis. Reactive arthritis is also known as Reiter's syndrome. Represented by the monkeys in the chlamydia sketch. Can't see (uveitis), can't pee (urethritis), can't climb a tree (arthritis). This same syndrome can be seen in the Campylobacter sketch and Guillan Barre. Reither's syndrome is common to trachomatis. Crow in the birds nest. Marcolides, specially azithromycin. Topical macrolides not effective for treatment of neonatal conjunctivitis, you must give an oral macrolide. Bicycle wheel tire. Doxy. Captain with 'MAC the private eye's' hat. Frequently tested concept that you must treat as a co-infection with gonnorhea. Add ceftriaxone (3 axes in the logo for Gonzo's bar).

Proteus mirabilis

Poseidon god with a spray bottle throwing a stone at a urinal in a public restroom. Tentacles. Swarming motility. Spray bottle. Urease positive. Breakdown of urea to basic NH3 creates an alkaline environment that is conducive for formation of struvite stones. Fish and eggs on the ground. Fishy odor and sulfonamides as tx.

Poxvirus

Pox in a box (Poxvirus packs everything into itself when it infects, over-preparer into ever virion), the box shipping warehouse Employees making own envelopes. Only virus that makes it's own envelope. Boxes full of things. Poxvirus has everything it needs and is the only DNA virus that replicates in the cytoplasm. Guarnieri's shipping. Intracytoplasmic guarnieri inclusion bodies when looking at cells infected with poxvirus on biopsy. Because it has everything it needs and doesn't need to go into the nucleus we can derive that the inclusion bodies are intracytoplasmic. Dumbbells. Dumbbell shaped core. World's largest shipping center. Largest DNA virus. Smallboxes sign with same day shipping. Smallpox is a pox virus. Also called variola. Blisters look similar to varicella. Can be differentiated by the fact that varicella's blisters are in different stages of development. Smallpox's blisters are all in the same stage of development. Utter shaped styrofoam dispencing unit. Cowpox. Snail mail. Molluscum contagiosum. Umbilicated. Cannot be found on palms and soles. Typically on trunk of child. Black guy with a cane. Molluscum contagiosum typically presents as a single umbilicated lesion in adults, but if it spreads all over this would mean that the patient is immunocompromised.

Coccidioidomycosis

Presidio (rhythm and a Spanish military settlement) San Joaquin Earthquake/San Joaquin. Earthquake as a RF (inhalation of spores now aerosolized). Also called San Joaquin Valley Fever. Tumbleweed next to the red sombrero. Coccidiomycosis does not follow the addage mold in the cold, yeast in the heat. When in the heat, it is actually a spherule full of endospores, that is much larger than an RBC (represented by the red sombrero). Man kneeling coughing. In some healthy individuals it can present as a fever with pneumonia and arthalgias. Self-limiting and lasts a couple of weeks. Man with a neck brace sitting next to immunocompromised Junipero Sera. Menigoencephalitis. Junipero Sera has a ulcer in his skin, lungs and a rod exposed on his leg (bone). Can KOH prep, or use serology for all systemic mycoses.

Trypanosoma bruchei gambiense and rhodesiense

Prince bruce and sleeping beauty African Sleeping Sickness Gambia and rhodesiense (old name for zimbabwe) Coma, recurrent fevers, axillary and cervical lymphadenopathy. Goat next to a pricked, bloody finger. Trypomastigote on blood smear (goat is the symbol for anything ending in mastigote) Pink ribbon in the beauty's hair. Motile with a single flagella. Fly in the tea. Tsetse fly as a vector. Price Bruce with wine serum and a bar of soap. Suramin for peripheral blood infection (think serum for suramin) and melarsoprol for CNS infection.

Clostridium perfringens

Private Fringen's motorcycle accident. Motorcycle accidents actually a way of contracting C. perfringens (dirt and soil). Deep penetrating wounds from military combat actually a way of contracting C. perfringens (dirt and soil). Gas flowing up into the air. Gas gangrene called myonecrosis. Crash into a market where there is an alpha flag being hung up on a clothes-line with a series of clothes-pins. Alpha toxin is a lecithinase, a type of phospholipase. Crash into walnuts and tomatoes. Spores and hemolysis. Market lady with a pencil in hand. IV penicillin G as treatment. Double fine zone. Doubles the zone of hemolysis. Also knocked over a slow sign (food poisoning and the subsequent diarrhea is late onset).

Rickettii prowazekii

Pro Boot Camp in Rickett's Tire's Arena CoA giving the NAD+ to indoor athletes. Obligate intracellular because cannot produce CoA or NAD+ on it's own. Compare Chlamydia which cannot produce ATP on it's own and is thus obligate intracellular. Rickettsia prowazekii: The outbreak play with the football players with white gloves and feet catching a louse. Epidemic typhus. Being tackled. Myalgias and arthralgias. Pneumonia. Encephalitis with dizziness and confusion. Tire Arena. Doxy.

Enterococcus

Protest at the California caucus. 3 signs and a lined off police scene (they ran out of normal police tape and had to use tiger striped police tape). Faecium incredibly resistant to antibiotics. "Stop the FEES" = faecium as a species name and this protester is buffer and causes more serious infection. Buff guy resisting van = VRE. Linezolid and tigecycline as treatment. "Resist the 6.5%" = this bacteria can grow in 6.5% N. CA (N. California = NaCl) "Do U HEART TREES?" = urinary tract infections, subacute endocarditis, biliary tree/tract infections (bile resistant means it can be insoluble in bile and colonize our biliary tract). Buff guy holding the "Stop the FEES" sign resisting the billy club of the police officer to show that enterococci are bile resistant. Also wearing the same boots as the viridans joker. Setting at the CA caucus = faecalis as a species name. More people underneath the CA banner to show that this bug is more common (but causes less serious infection).

Rhabdovirus

Rabid Wrecking Yard Dog smoking a cigar. Initially infects nicotinic ACh receptors. Do not confuse as cigar shaped as like in sporothrix. Hoodie. Enveloped. Bullets on collar. Bullet shaped. Dumpster boat named integrity on a pile of cars. Cytoplasmic negri bodies as inclusion bodies. Seahorse on the boat. Hippocampal cells. Bungie cords hanging from the trees. Purkinje cells. Other animals in the sketch like foxes, bats, skunks, raccoons. Dogs not the only reservoir of rabies. If someone is known to have slept in the same room as bats and because bat bites can go unnoticed, you must administer IgG prophylaxis shot. Dog tethered to the motor of a car and her babies underneath the motor area of the car. After infecting the nAChR, the virus travels retrograde via dynein to the motor neurons. Replicates in motor neurons. Cola cans and a random power outlet. Reinforce nAChR receptors.

Clostridium tetani

Rhesus research revolution (evil grin monkey with a wrench and a saw for Renshaw cells). Evil grin called Risus sardonicus. Monkey with the wrench and the saw in the left half of the sketch. See below. Monkey with scissors cleaving the SNARE trap that the G and G gasmask researcher was in sending him back to the bottom of the cage that the monkeys are in. Tetanus toxin cleaves SNARE protein that prevents the release of GABA and glycine from renshaw cells located in the spinal cord. Causes a spastic paralysis (contrast C. botulinum, which produces a flaccid paralysis). One monkey writhing with an arched back (opisthotonos) One researcher that had the SNARE cleaved from under him has a needle to represent a toxoid vaccine (orange colored like the orange colored scissors that represent the toxin because it cleaves the SNARE). Treatment (courtesy firecracker): Treatment includes anti-tetanospasmin immunoglobulin, along with adjunctive antimicrobial therapy with metronidazole. Muscle spasms can be controlled with benzodiazepines or neuromuscular blockade.

(Pico) Rhinovirus

Rhino exhibit Baby rhino. Picornavirus. *Zoo-goer feeding a lemon. Acid-labile.* Zoo-goer shielding the rhino sneeze with his hands. Fomites on hand. Inhalation. Rhino underneath a colorful tent. Antigenic variation. Photographing. Rhinovirus enters cells by attaching to ICAM-1 Rhinos sleeping in the shade. Thrives in cooler environments, such as the nose where air is constantly coming in and out. Refer to picornavirus overview video for general characteristics.

Rickettsia prowazekii Rickettsia typhus Rickettsia rickettsii

Rickettsia prowazekii: The outbreak play with the football players with white gloves and feet catching a louse. Epidemic typhus and a description of the how the rash progresses. Rickettsia typhus: Cause of endemic typhus. Barely mentioned in the prowazekii sketch. Rickettsia rickettsii: RMSF.

Human Herpes virus 8

Ring around a Ka-posi, Kate's Posies (posy = a small bunch of flowers) An 8 with a hermes inside of it. Kate's logo. HHV-8. Old lady kate. Kaposi sarcoma in HIV/AIDS. Rose petals on Kate's nose and arm. Kaposi sarcoma causes violacious lesions on nose, extremities and mucous membranes. Guy with a red hose. Causes proliferation of vasculature. VEG-Fertilizer. Dysregulation of VEGF and reason for the proliferation of vasculature. Roof of greenhouse that looks like palate. Many roses on the roof. Kaposi's lesions most commonly occur on the hard palate. Row of plants with a hofstra looking cover over them. GI also a location to get Kaposi sarcoma. B rating of the store and a statue of an archer. HHV-8 can infect B cells and cause a B cell lymphoma known as a primary effusion lymphoma. Russian rhododendrons and African azaleas. Higher incidence in Russian men and African populations. Russians will have lower extremity lesions, Africans will have the palatal lesions and in children, it could be fatal. Bart on the outside of Kate's posies. Confusion with Bartonella's bacillary angiomatosis. Can be differentiated based on infiltrate. Not pictured. Transmission of HHV-8 is through sexual contact.

Human Herpes virus 6

Ro-six-ola. HHV-6. Exanthem subitum. Squire boy with 4 feathers and a 4 belt buckle. Infects CD4 cells. Can cause a state of immunosuppression. Hermes on the horses flank. Member of the herpes family of viruses. 4 suns on the knights banner that is in the picture. Fever that lasts for 4 days. Squire is trembling. High fevers that can cause seizures. Nun in laces who has her face exposed. Rash that has a lacy appearance and that spares the face. Baby in her arms. Affects children 6 months to 2 years. Baby covered in laces with the face exposed. Lacy rash that spares the face. Blue fire around the nun abberation who is dressed in laces that expose her face. Rash appears as the fever subsides. Blue flames = cooling. Contrast with measles that has a rash that does not spare the face and a rash that occurs at the same time as the fever. Contrast with parvovirus where parvovirus has a fever for about a week and then they get a rash on their face.

Shigella

She-Gorilla Circus All gorillas wearing green tutu's to represent the that Shigella produces green colonies on Hektoen agar (contrast Salmonella which forms BLACK colonies on Hektoen agar). 1st gorilla chained to the stool. Immotile. Contrast salmonella. 1st gorilla on a red stool surrounded by fire to represent inflammatory bloody diarrhea (leukocytes in the stool). Child circus ringleader cracking a nephron whip on the balloon of the first she gorilla. Represents HUS and schistocytes. Hemolytic uremic syndrome seen in children (typically under 10 years of age) who contract S. dysenteriae. HUS = triad of thrombocytopenia, anemia and acute renal failure. Produces schistocytes. Prodromal diarrhea and then one week later when things are just about to be looking up they develop acute renal failure? Think HUS and think Shigella or E. coli (E. coli = Shiga-like toxin). 2nd gorilla launching onto an M pad. Both invasion of M cells and use of actin filaments to propel itself into another cell. Facultative intracellular. 3rd gorilla tightwalking over a vat of acid. Acid stable. Needs far fewer organisms to cause disease. Contrast Salmonella which is acid labile. 60 second timer to the left of the 1st she gorilla to represent that the toxin acts on the 60S subunit.

Mycobacterium tuberculosis

Shootout at the TB Corral Lowenstein general store Acid fast cowboy Man coughing inside of an old buggy Yellow lasso on the cowboy with the mycolic acid garb. Serpentine cord factor (virulence factor). Cord factor activates TNF alpha, activates macrophages (firecracker says inhibits maturation of macrophages) and creates granulomas. TNF alpha prevents the bacteria from going anywhere, but now the bacteria can hide. However, TNF alpha still important for the immune system. If starting a patient on a TNF alpha inhibitor you first want to do a PPD screen to make sure you aren't putting them at risk for reactivation of TB. Clouds puffing up, but not coalescing next to yellow spurs on the cowboy with the mycolic acid garb. Sulfatide virulence factor that prevent phagosome formation and phagocytosis. After primary infection there are 3 outcomes 1. Healed latent infection 2. Systemic Infection (miliary TB) 3. Reactivation TB Gun complex and the TB lung cacti in front with gunshots in the middle lobe BCG needle in the pile of dirt. BCG vaccine can give a positive PPD test even if the patient has not been exposed to TB. TB usually heals, but when it doesn't it can seed almost any organ. Right side of the sketch shows the TB lung cacti and bullet holes in the upper lobe. Reactivated TB usually affects the upper lobes. Man coughing in the old buggy and the scene taking place at night. Reactivated TB usually has these characteristic features: cough, night sweats, hemoptysis. Stack of pots and man who is getting his cowboy hat shot at. Two common areas of reactivation. Potts disease in the vertebral column. CNS involvement (10-15% of the time). Recall that the same cowboy hat being shot at is also in the Nocardia sketch.

Filovirus

Soccer Field'O virus (Ebola = E-GOAL-a) Marburg as a last name on the jersey. Marberg hemorrhagic fever. Defender lying on the ground in a pool of blood. Hemorrhagic fever. Spirals around the goal post. Helical. Monkey medics. Can be a source of transmission. Both ebola and Marburg fever are hemorhaggic fevers. Takes place at night. Negative sense RNA. FA: Ebola: endothelial cells, hepatocytes, phagocytes, 21 day incubation period, flu, diarrhea, vomitting, high fever, myalgia, DIC, hemorrhage, shock, RT-PCR, high mortality, bodily fluids, dead bodies, bats, primates, noscomial.

Leptospirosis interrogans

The (Fresh?water) Surfer's Oasis Hawaiian surfer rubbing his eyes with red sunglasses on. Conjunctival suffusion (redness without exudate). Surfing stance. Myalgias that are classically of the calves. Riding a yellow wave. Animal urine. Whale in the background. The severe form of leptospirosis also known as icterohemorrhagic leptospirosis. Red inner tubes that are being thrown about. Spread hematogenously and seeds many organs. Two most imporant talked about in sketchy are the kidneys are the liver. Kidney shaped inner tube being launched into the air by the whale. Kidney dysfunction. Yellow suit of the surfer that was previously yellow in the sketch. Jaundice.

Pseudomonas aeruginosa

The 3 maids, 3 suitors and 1 dalmation of Pseudo Mona Blue ring. Oxidase positive. Cat. Catalase positive. Dead-giveaways: 1. blue-green around the red hot tub. pyocyanin/pyoverdin production and gram negative rod. 2. grapes. grape like odor Nurse maid pouring more chlorine into the hot tub. Nosocomial pneumonia and respiratory failure in CF patients (recall mutation in chloride channel). Urine pot next to the nurse maid. Nosocomial UTI. Maid caught on fire with an air bellow. Aerobic. Pseudomonas infection a feared complication of burn patients. Fish skeleton next to the encapsulated jar of candy and mortar and pestle. Cause of osteomyelitis in diabetics and IVDU. Pseudomonas is encapsulated. Maid listening to the suitors with an ear trumpet through the door. Otitis *externa* (swimmer's ear). Suitor in green with a bowtie playing an accordian = ADP-ribosylation (recall diphtheriae toxin works in a similar mechanism). Suitor with a psi kneeling holding out a flower = aminglycoside and fluoroquinole as tx. Fluoroquinolones are especially useful in pseudomonas UTIs. Suitor playing a PIPE (do not confuse with a flute. Flucytosine would also not make sense as pseudomonas is a bacteria). Piperacillin or Ticar. as a treatment because these are the antipseudomonal penicillins. Dalmation. Ecthyma gangrenosum.

Borrelia

The Bows and the Arrows Bows and arrows competition in the NE US. Robin of Ixodes shooting an arrow riding on a unicycle in lyme colored garb. Ixodes tick found on deer. Causes lyme disease. FYI rodent is the host of the larvae and deer the host of the adult tick. Doxy as tx. Going left to right are the stages of the disease. All have targets for arrows. Arrow hitting a bull's-eye target on the left. Erythema migrans. A heart and two bells on either side for the middle target. Heart block and bilateral bell's palsy. Straw 'burning man' guy who is supposed to be a moving target (most difficult) with an arrow in the knee and an arrow in the head on the right. Migratory polyarthritis and encephalopathy. Other two contestants in the competition are Sir Wright and Sir Giemsa. Giemsa and Wright stain for this spirochete. Recall Giemsa stain is used for Chlamydia and is represented by the treasure chest full of gems with buzzing knats around. Knats to represent that nucleic acid amplication a.k.a. PCR is now used more frequently.

Candida albicans

The Canadian playground with the 100lb. slide and the "play nyce" sign for nystatin 5 things it causes. Oral, vaginal, esophageal candidiasis, diaper rash, and candida infective endocarditis. 37 flavors snow cone stand. Candida forms germ tubes/true hyphae (mold) at 37 degrees celcius. Canadian shrubbery that is segmented and looks like pseudohyphae. Thermometer next to it. Stash of snowballs that look like yeast cells. Yeast form at 20 degrees celcius. Cat. Catalase positive. Baby in red swing. Causes diaper rash in characteristic distribution due to the heat and humidity within a baby's diaper. Old man with a cane and kid throwing a snowball. Oral candidiasis seen in immunocompromised patients or those using oral steroids. Oral steroid use must be followed by oral rinsing to avoid development of oral candidiasis. Adult scraping snow off the drive way. Oral candidiasis can be scraped off the oral mucosa. Leukoplakia cannot be scraped off. KOH right next to the woman scraping snow. KOH is used to prep oral scrapings when attempting to diagnose oral candidiasis. Max 100 lbs. CD4 <100 makes the patient susceptible to candida esophagitis. AIDS defining illness. Woman dropping her jar of candy, prescription pills (represent antibiotics) and birth control as she is pelted in the crotch with a snowball. Vaginal candidiasis and the things that predispose a woman to getting yeast infections. Playground open until 4pH. Candida infections do not change the pH. Three heart shaped pyramids. Candida often found in certain types of heroin. IVDU. Seeds the tricuspid valves. Pinecones. Minor candida infections. Diaper rash baby holding a pinecone. Azole for diaper rash. Frog ride next to the immunocompromised man. Amphotericin B for immunocompromised, disseminated infections. Cap on the old man. Capsofungin may be used for disseminated candidal infections resistant to amphotericin. "Play NYCE" sign next to the face and esophagus slide for candidal esophagitis.

Histoplasma capsulatum

The historian's cave. Ohio and MI river valley on the historian's map. Bird, bat, cave. Bird, bat droppings, and cave as method of transmission. Cave stalagmite legs that look like someone is peeing. Red bumps are also on these legs. Rapid urine antigen test. Erythema nodosum. Erythema nodosum also seen in cocci, and more associated with cocci. You will use geography to differentiate. Smaller red stalagmite. Rapid serum antigen test. Canary brought down in the cage. Small intracellular oval bodies within macrophages. Also means that they are much smaller than RBCs (size in relation to RBCs is important to know for systemic fungi). Open book with TB. Histoplasma may mimic TB in presentation. Cane in front of the cow. Dissemination in the immunocompromised can cause HSM.

Treponema pallidum

The Pallidum Observatory Spiral shaped galaxy off in the distance and spiral shaped staircase. Spiral shaped. Spirochete. Attic represents diagnosis and primary syphilis. Secondary syphilis takes place underneath the dome. Tertiary and congenital syphilis takes place outside. Congenital syphilis represented by the constellation of orion and his horse and the children down below. Monitor reading Darkfield Galaxy with a list underneath it and "*V*ideo *D*isplay *R*esearch *L*aboratory" underneath the monitor. VDRL stands for venereal disease research lab and is a non-treponemal screen. Has many false positives. Mono, RF, SLE, Leprosy, IVDU. Because of so many false positives, it is necessary to have a confirmatory test. Gigantic telescope reading *F*ield *T*elescope *A-Ab*. Confirmatory test FTA-ABS. Astronomer being poked from behind by the sundial and not noticing. Sundial supposed to be phallic and the astronomer not noticing is supposed to represent the painless chancre found on the penis in primary syphilis. Astronaut with red gloves and boots pointing to a planet with a lot of bumps. Rash on the palms and soles of the feet (only characteristic of secondary syphilis, RMSF a.k.a. Ricketsii ricketsii, and Coxsackie. RMSF's rash starts on the palms and soles and moves towards the trunk. Ricketsii prowazekii has a rash that spares the hands and feet). Lot of bumps = condyloma LATA. Note that this is note the same as gummas. Gummas are a characteristic of tertiary syphilis and are represented by the crater of the moon. Moon with craters. Gummas. Tree in the shape of an aorta. Aortitis and thoracic aneursym/vaso vasorum destruction. Columns in the back of the picture that are cracking. Destruction of the posterior columns of the spinal cord known as tabes dorsalis. Greeter in an argyle sweater that is accommodating, but not reacting to the kid shining the light in his eye. Arygll-robertson pupil. Orion in the constellation has a saber on his hip that goes down to his shin. Horse in the constellation has a saddle on his back for saddle nose deformity. Kids outside the observatory are cold. They have earmuffs on and they are chattering their teeth. Deafness, Hutchinson teeth (notched incisors) and mulberry molars. Jarisch Herxheimer comet viewing. Jarisch Herxheimer reaction (~1 hr.) when treating someone with penicillin. Antibiotic induced spirochete death and release of toxins. *This indicates that the treatment is working.*

Plasmodium

The Queens and Warlords of Plasmodium. Explanation of what is meant by 48 and 72 hour fever cycles. These fevers are 48 or 72 hours apart. For example, 72 hour fever would be fevers on the 1st and 4th day. 48 hour fevers would be fevers on the 1st and 3rd day. Not well-represented in the sketch. For drug sensitive malaria, give chloroquine. For drug resistant malaria, give mefloquinine or atovaqoine/proguanil. For life-threatening malaria, give artesunate and IV quinidine. For the hypnozoites (dormant form in liver of vivax/ovale), add primaquine. Malariae warlord has 4 buttons and the 1st and 4th are lit up. 72 hour fever cycle for P. malariae. Ax and oval cow-skin liver spot shield who is hypnotizing the color queen with a metronome that has 1st and 3rd and 5th dots lit up. 48 hour fever cycle of vivax and ovale. Primal queen coming to the rescue of color queen who is being hypnotized by vivax/ovale. Give primaquine to vivax/ovale. Vivax/ovale might be resistant to chloroquine? Falciparum warlord has a tattered skirt. Irregular fevers of falciparum.

Salmonella

The Salmon dinner for the chicken and the seagull. Flopping salmon tail (despite it being dead?) to represent that it is motile. Contrast with Shigella, which is not motile. Lemon next to the salmon to represent that these organisms are acid labile and thus, you only need a large amount of organisms to cause infection (because acid is degrading the majority of them, contrast with shigella, which has one of the She-gorillas in the She-gorilla circus balancing on a tight rope over a pool of acid. Thus, shigella only needs a few organisms to cause disease). Acid labile also means that you are more susceptible to acid labile organisms whenever you are producing less stomach acid (taking omeprazole, had pernicious anemia, etc.) Salmon on a black plate (Hektoen Enteric Agar a.k.a. HEK, HE, or HA) to show that it produces H2S and forms black colonies on plates. Contrast Shigella which does not. Wikipedia says the HEK agar is specifically used to discriminate between salmonella and shigella. All enteric bacteria that are H2S positive are also motile. Left represents salmonella species. Chicken Right represents S. typhi. The seagull with the typhoid Mary apron on (characteristic rose spots on the abdomen) and that chronic carriers of salmonella typhi harbor it in their gallbladder. "Pea soup" looking bird droppings underneath the seagull to represent "Pea soup" diarrhea in S. typhi. Flower on the seagull side to represent fluorquinolones as the treatment for S. typhi. Sickle and capsule to represent encapsulated organism and sickle cell patients. #1 cause of osteomyelitis in sickle cell patients. Vaccine poking the leg of the seagull to represent that a vaccine is available for S. typhi. Contrast S. enteriditis and shigella which do not have vaccines.

Babesia

The Vampire Babes. Protozoa of the blood. Robin of ixodes about to be fed on while his is tied up and sitting over a maltese cross. Ixodes tick is the vector. Maltese cross is formed by a tetrad of trophozoites. Don't forget about ring form. Also, due to ixodes tick, consider co-infection with lyme disease from borrelia. Stained windows are cracked. Hemolytic anemia. Atova, the vampire queen with a sickle and crows on her shoulders. Atovaqoine and azithromycin as treatment. Higher risk of severe disease in sickle cell patients or those with asplenia. Robin's clothes are tattered. Irregularly cycling fevers. Robin's clothes have a spleen shaped hole. Higher risk of severe disease in asplenia. Red carpet. Thick blood smear as diagnosis. Maltese cross a little off center and pointing to the northeast. NE geographic distribution.

Legionella

The WWI iron-made, charcoal powered S.S. Cysteine joins the legion. ^ to represent growth on charcoal medium with iron and cysteine. Silver being painted on the red iron. Gram negative but stains poorly so use of a silver stain is necessary. Red iron still yet to be painted is to remind of gram negative origin. The paint looks white, but should be silver and the red iron looks brown, but should thought of as red. Sailor with the salt wheelbarrow spilling into the ocean. Hyponatremia sometimes present. Sailor peeing. Urine antigen test. Legionella causes two diseases: pneumonia and pontiac fever. Old guy next to pontiac car smoking looking at blueprints of the ship's hull. Pontiac fever (mild flu like syndrome that is self limiting). Blueprints of the ships hull has a white unilateral opacity. Legionella pneumonia often has a unilateral lobar pneumonia. Common in smokers. Pneumonia with diarrhea and hyponatremia? Legionella Pneumonia with neurologic symptoms such as headache and confusion? Legionella.

Staph saprophyticus

The beauty in beauty and the plumber (she's not navel sensitive because she is in shape and thus novobiocin resistant). The beauty is seen drinking out of a martini glass with two straws facing outwards (ureters leading to a bladder). Staph sapro is the 2nd leading cause of a UTI after E. Coli. Both are coagulase negative and this is signified by the plumber and the beauty who have just put the gell *HYPHEN* o into the bowl. The hyphen in the gell-o is to represent coagulase negative (contrast staph aureus where Moses has parted the red sea and the red sea looks more solid and coagulated. This gell-o looks more liquid and thus, non-coagulated). Urease positive with the spray bottle and catalase positive with the cat. Van in the background = vancomycin as a treatment.

Helicobacter pylori

The mustache helicopter pilot cleaning his helicopter windshield with a spray bottle. Spray bottle. Urease positive and the urease breath test (called UBT) Blue ring on the pilot. Oxidase positive. All of the curved rods are oxidase positive (Helicobacter, Campylobacter, Cholera). Mustache. Comma shaped. Comma shaped (Helicobacter, Campylobacter and Vibrio are all comma shaped, but Helicobacter and campylobacter and more helical/spiral shaped). Proton bomb clogging the duodenum gas line for the helicopter. PPI as tx and H. pylori causing duodenal ulcers. An ammo box. Amoxicillin as treatment. Do no confuse amoxicillin ammo symbol with ampicillin (an amp, recall Listeria). Crows everywhere including a crow on the keep clear sign. Marcolides as treatment, specifically clarithromycin. Do not confuse 'keep clear' sign in this sketch with the 'keep clean' sign in the C. diff chocolate factory sketch. 'Keep clear' is to represent clarithromycin as a tx in H. pylori and the 'keep clean' sign in C. diff is supposed to represent clindamycin as a cause of C. difficile (recall that metronidazole and oral vancomycin are treatments for C. difficile). Dumpster with lots of tissues in it (tissues that he is using to clean the helicopter with) and cancer on the side of the helicopter. Two cancers that H.pylori can cause. lymphoma of the MALT (mucous associated lymphoid tissues) and gastric adenocarcinoma.

(Pico) Coxsackievirus

The two birds in two cages Left side is A, right side is B. Baby cockatoo in the sketch (on the right side) represents that Coxsackie A and B are picornaviruses (enteroviruses, recall ENTER aviary). Statue of David on the left having his hand, foot and mouth poked out by the cockatoos. Naked. Hand foot and mouth disease that causes rashes on the palms and soles. Compare and contrast the other diseases that cause rashes on the hands and foot. Secondary syphilis and RMSF cause a rash on the hands and feet. RMSF's rash moves inward. Ricketsii prowaseki's rash starts centrally and moves outward (outbreak) and then spares the hands and feet. On the right is a cockatoo with two red bird feed bags that look like hearts. Dilated cardiomyopathy. One of the cockatoos is being squeezed to represent devil's grip a.k.a. pleurodynia a.k.a. Bornholm disease. Little boy in a space cadet helmet to represent viral meningitis. Refer back to the picornavirus overview sketch for the CSF findings of viral meningitis. Little girl in a bathing suit. Coxsackie more common in summer months. Refer back to picornavirus overview.

Dracunculus medinensis, Onchocerca volvulus, Wuchereria bancrofti, Toxocara canis, Loa loa

Tissue Nematodes Screamatodes III: Return of the Flesh Eater *The horror movie set* Dracula actor. Dracunculus medinensis. Dracula actor drinking water. Transmission by water contaminated with copepods containing larvae. Untied shoes. Dracula worms, adult females, emerge from painful ulcer in skin (typically on lower extremities). Treatment is taking a match stick and slowly unraveling the worm out of the ulcer. Thought to be basis of the snake intertwined for the symbol for medicine. Fly man clutching his eye wearing a lab coat that has spots on it. Oncho. Hyper and hypo-pigmented spots that occur with onchodermatitis. Cause of river blindness. Transmission by the black fly. 2nd most common cause of infectious blindness after trachoma. Microfilariae in eye causes blindness. Microscope behind fly man. Microfilariae seen in skin biopsy under microscope. No dumping, drains to river sign behind fly man. Rivermectin as treatment. Witch that has ruffles and MC hammer pants and is coughing. Wuchereria that causes elephantiasis, a long-standing complication of lower extremity lympadenopathy. Coughing because microfilariae in lungs causing a hypersensitivity reaction. Witch reading diet and carb magazine. Diethylcarbamazine as treatment. Mosquitoes hovering around the witch. Blood smear on her hat. Mosquitoes are vector and blood smear for diagnosis. Wolfman with a poopbag and nightshades on sitting in a bended metal bar chair. Toxocara canis. Transmission by ingesting food contaminated with dog or cat feces. Larvae apparently never mature when they are inside of us and circulate on for year. Visceral larvae migrans. If the larvae gets to the eye, it is called ocular larvae migrans and can cause blindness. Treatment is albendazole. Creature from the black lagoon. Fish man who has conjunctivitis and local subcutaneous swellings all over his body. Loa loa, african eye worm. Local subQ swellings are known as calabar swellings. Blood smear across loa loa's face. Microfilariae seen on blood smear. Deer flies buzzing around the swamp man. Transmission by deer flies. Swamp man is reading diet and carb magazine. Diethylcarbamazine. Swamp man also sitting on a bent metal chair. Albendazole as another treatment to diethylcarbamazine.

Togavirus

Toga, toga, toga (arbovirus and rubella, NOT rubeola, rubeola is measles). Wearing togas. Enveloped. The turban wearing horse messenger knocking his head on the arbor. Arbovirus (short for arthropod virus, vector mosquito or ticks) as a cause of Western/Eastern/Venezuelan Equine encephalitis. Takes place in Rome to help remember roman aqueduct to help remember PDA in rubella. Child on throne represents childhood rubella. Aqueduct baby represents congenital rubella. Fanning adults represents rubella in adulthood. Toga child on the throne with rubies falling off and dangly neck pieces. Rash starts on the head and face and moves downward. Dangly neck pieces to represent postauricular/occipital lymphadenopathy. Congenital rubella represented by the yellow buddha baby on the *OPEN* aqueduct next to the torches. Holding hands over ears. Deafness. Blank eyes. Cataracts/blindness. Blue jewels. Blueberry petechial rash. Yellow. Jaundice. Open aqueduct sign. PDA. Adults. Lymphadenopathy and arthritis. Live puppet show to represent the MMR vaccination. One puppet is shown defending a pregnant lady. Do not give MMR vaccine, which is live, to a pregnant women. 200 tickets next to the puppet show. Should only be given to HIV positive patients when CD count is above 200. Same goes for the shingles vaccine (Max occupancy 200 for the senior seating). Tickets are also being ripped off into smaller pieces. Long polypeptide being cleaved. Also used in picornavirus and calicivirus sketches.

Schistosoma mansoni, S. japonicum, S. haematobium, Clonorchis sinensis, Paragonimus westermani

Trematodes a.k.a. flukes San Franschisto Ocean Park Portal into the fish. Portal system. Maturation occurs in the liver. School of blue fish going one way. Schistocytes going another way. All do it the hard way and migrate against portal blood flow. Merman in the portal with a fin on his back/side. S. mansoni with a large lateral spine. Japanese tourists and the circular fish. S. japonicum. Portal about to burst. All schistocytes acutely cause a swimmer's itch. Chronically, mansoni and japonicum cause portal hypertension and potential GI hemorrhage, cirrhosis and liver failure. Asian dad wearing a yellow coat. Jaundice. Swordfish piercing a bladder-shaped jellyfish and a crab. S. haematobium (no name hook) causes hematuria and bladder cancer. Pretzel in the tank. Praziquantel as treatment. Orca. Clonorchis sinensis. Seagull on pigmented stones. Pigmented gallstones. Seagull with the robe and the crab. Biliary fibrosis and potential for cholangiocarcinoma. Eggs with yamikas on them. Operculated eggs on O and P. Penguins with lung spots feasting on crab legs. Paragonimus westermani Lung fluke transmitted through consumption of raw or undercooked crab meat with larvae. Penguin eggs with yamika. Operculated eggs on O and P.

Trichomonas vaginalis

Tricks for money, the Seattle magician on the street corner Seattle to help remind of the wet mount necessary to visualize the distinct looking, motile trophozoite. Magician pulling a strawberry out of his cervix looking hat. Strawberry cervix as a buzzword and cervicitis. Green-yellow hues. Malodorous green-yellow discharge. Car splashing/Seattle. Diagnosis and visualization of the distinct looking, motile trophozoite on wet mount. Street corner artist selling inflamed vagina looking paintings for 4.5 and up. Grows in pH 4.5 and up (normal vaginal pH is 4). Vaginitis. *pH, microscope, D/C comparison of vaginal infections.* Gardnerella vaginalis. Grows at pH 4.5 and up. Plants at price 4.5 and up. Candida albicans. Grows at pH 4 (does NOT change pH. Canadian playground open until 4pm (does not go higher/past 4). Trichomonas vaginalis. Grows at pH 4.5 and up. Street art next to the magician on the green street corner sold at price 4.5 and up. Thus, pH of 4.5 can narrow it down to Trichomonas and Gardnerella. Under the microscope this is what each would show... Gardnerella vaginalis. Clue cells. Candida albicans. Pseudohyphae. Trichomonas vaginalis. The distinct looking trophozoite (but they may not be that obvious and in that case *motile* is the buzzword). Discharge of each... Chlamydia. Watery. Gonnorhea. Thicker than Chlamydia. Gardnerella vaginalis. Gray-White. Candida albicans. Vaginal thrush. Trichomonas vaginalis. Malodorous yellow green.

Varicella zoster virus

Varicella "Zeus"-ter virus, a greek tragedy about Zeus. Hermes toy above the stage. Part of the herpes family. VZV is HHV-3. Kids with squirt guns. Respiratory droplet transmission. All ages welcome. Blisters will be in all stages of development. This is in contrast to smallpox where the blisters will all be in the same stage of development. Live show sign in the shape of syringe above the 'all ages welcome' sign. Live attenuated vaccine for varicella. Kid playing with the tank that has multinucleated giant cell camo. Tzanck smear for diagnosis. Recall HSV-1 + 2 sketch. Adult on stage represents the infection in adults. Coughing with a cane and a turban. Pneumonia in adults and encephalitis in the immunosuppressed. Blue recycling bin. Acyclovir for treatment in children 12+, adults and immunosuppressed. Woman sleeping on the roots of the trees extending outwards. Latent in the dorsal root ganglia. Rose petals in a dermatomal distribution. Zoster/shingles. Rarely crosses the midline and when it does, it is a red flag that someone is immunocompromised. Zeus striking him with a lightning bolt. Extremely painful rash of shingles. Shirtless guy without a rash, but still a lightning bolt. Postherpetic neuralgia. Pain after rash subsides. Eye patch being worn by the man on stage. Herpes Zoster Opthalmicus. Live show sign in the shape of a syringe above the 'seniors only' sign. Live attenuated vaccine for shingles. Because it is live, do not give to patients who are pregnant or immunocompromised. Max occupancy 200. Can give the vaccine to HIV patients if their CD count is above 200. Same goes for the MMR vaccine (200 tickets for next to the puppet show in the Togavirus rubella sketch). Question stem: immunocompromised, vesicles on their forehead and blindness? Herpes Zoster Opthalmicus. Family wearing recycling shirts next to the roof top with roof shingles. Famcyclovir for shingles. Violet recycling bin next to the blue recycling bin. Valcyclovir for shingles. Keep straight the treatments for each: Acyclovir for varicella in childrens 12+, adults and immunocompromised. Famcyclovir and Valcyclovir in those who get shingles. Torches around the stage. Torch infection. Doll being victimized by chicken. Stubby arms and legs, stuffing ripped out in a dermatomal distribution and a missing eye. Congenital varicella syndrome. Limb hypoplasia, cutaneous dermatomal scarring, and blindness.

Mycoplasma pneumoniae

Walking on thin ice Don't eat on the ice. Eaton agar. IgG snowflakes that are clumping the RBC pucks. Cold agglutination test. Stormy weather but actually a good hockey game. Looks worse than the patient is on CXR. Hence, cause of a walking (pt. walking about) pneumonia (would typically keep a patient bedridden). Classical cause of a walking pneumonia, however, there are others. Recall non-trachomatis species of Chlamydia that produce atypical pneumonias. Hockey net has a cholesterol design in it. Only bacteria with cholesterol in it's membrane. Crow hanging on the hockey goal. Macrolides as tx. Hockey goalie wearing a military jersey with the number "<30" for high risk populations.

Yersinia enterocolitica

Yersin's Pets - Yersinia Enterocolitica represented by the English Terrier (meant to sound like Entercocolitica) licking the toddlers RLQ. Petis is the cause of the bubonic plaque and has 3 adult characters in the sketch. *Yersinia Enterocolitica* Toddler on a red stool, with milk in his hands, a safety pin and being licked by an English Terrier puppy. Toddlers who play with puppies are affected (transmission through puppy feces). Contaminated milk also a source (recall Listeria). Red stool for bloody diarrhea and the safety pin is meant to represent the bipolar colony growth on plates. Cold frost on the window of the store to represent cold resistance (recall Listeria was the same). Toddler with RLQ pain, fever, elevated white count and the stem mentions puppies, think Yersinia because of it's ability to cause pseudoappenditicis. Encapsulated rodent to represent that Yersinia species are encapsulated and that fleas on rodents were how Yersinia pestis was spread. Guy with a psi picking up puppy poop = aminoglycosides as treatment. *Under zoonotics in FA is Yersinia Pestis* Prarie dog/rodent underneath the capsule. Prarie dogs and rodents as the reservoir for fleas, which carry the disease. Flea sign on the door. Fleas Fleas, causes plague. Two most common post-infectious sequelae of yersiniosis: Reactive arthritis associated withe HLA-B27 expression and erythema nodosum

Leishmania donovani + baziliensis

Zombie in the desert Zombie in brazil robe with flies buzzing around him. Cutaneous form caused by the braziliensis strain. Vertebrates are host (humans), sandflies are the vector (think desert scene). Goats in cages. Amastigotes are the intracellular form, seen within macrophages. Promastigotes are what is seen in the vector. Amastigotes are what would be seen in hosts. Hyperpigmented spots on Donovan. Visceral leishmaniasis caused by the donovani strain. Black fever, or kala-azar caused by visceral leishmaniasis. Fever of donovan. Fever caused by visceral. Pan of meats. Pancytopenia in visceral. Cow with liver and spleen shaped spots. HSM in visceral. T-bone steak offering *for the zombie.* Stibogluconate for cutaneous leishmaniasis. Frogs. Amphotericin B for visceral leishmaniasis.

Difficult vocabulary words condyloma acuminatum condyloma lata opisthotonos risus sardonicus trismus coryza erythema marginatum erythema migrans erythema multiforme erythema nodosum erysipelas

condyloma acuminatum = genital warts caused by HPV (HPV pill bug sketch, interferon arcade - Pacht-derm man game) condyloma lata = genital warts caused by syphillis (the wart like planet being pointed at by the character representing secondary syphillis in the treponema pallidum space observatory sketch). opisthotonos = arched back spastic paralysis (C. tetani rhesus monkey research sketch) risus sardonicus = raised eyebrows and open grin (C. tetani rhesus monkey research sketch) trimus = lockjaw (C. tetani) coryza = rhinitis (not all-inclusive, measles weasles and board and care of the disabled Gi, the catarrhal phase) erythema marginatum erythema migrans erythema multiform. Many causes, but typically HSV-1. erythema nodosum. Histo or cocci. More associated with cocci. Indicates a robust immune response and generally only seen in healthy people. erysipelas

MacConkey agar

lactose fermenting enterics. Form pink colonies. Represented in sketches by the pink milk carton. Narrows it down to a few. E. coli The dinosaurs. Enterobacter (pterodactyl), Serratia (triceratops), and Klebsiella (club tail) Caveat: Serratia grows slowly on the culture. However, other ways to culture Serratia.

Clostridium botulinum

robotulism (children eating spores in the honey vs. eating preformed toxins, canned food and adults). A gas mask researcher (does not have G and G on his suit) uses orange scissors to cut the powerline from the ACh battery to the robots. One robot is seen trying to revive the floppy robot baby with honey. Also on the table and covered in honey are metal 'nuts.' Tetani and botulinum both cleave SNARE but in different places. Botulinum cleaves SNARE at the NMJ, while tetani cleaves SNARE in the renshaw cells of the spinal cord. Ingestion of spores (metal nuts = walnuts) in honey leads to floppy baby syndrome. Causes flaccid paralysis (contrast tetani, which causes spastic paralysis). Adults can handle the spores, but they can't handle the preformed toxins, which exist in canned food (why we are always told to heat canned food thoroughly and the oxygen-less atmosphere of the canned food is perfect for the survival of the obligate anaerobic clostridium species). Adult disease = ingestion of preformed toxins. Infant disease = ingestion of spores. Likely won't give canned food in the question stem, but will mention someone about a whole family experiencing neuro symptoms after eating dinner.