Oklahoma Notes Basic-Sciences Review for Medical Licensure Developed at The University of Oklahoma at Oklahoma City, College of Medicine Suitable Reviews for: National Board of Medical Examiners (NBME), Part I Medical Sciences Knowledge Profile (MSKP) Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS) Oklahoma Notes Microbiology & Immunology Richard M. Hyde Springer-Verlag New York Berlin Heidelberg London Paris Tokyo Richard M. Hyde, Ph.D. Department of Microbiology and Immunology Health Sciences Center The University of Oklahoma at Oklahoma City Oklahoma City, OK 73190 U.S.A. Library of Congress Cataloging in Publication Data Hyde, Richard M. Microbiology & immunology. (Oklahoma notes) 1. Medical microbiology-Examinations, questions, etc. 2. Immunology-Examinations, questions, etc. 3. Medical microbiology-Outlines, syllabi, etc. 4. Immunology-Outlines, syllabi, etc. I. Tide. II. Title: Microbiology and immunology. Ill. Series. [DNLM: 1. Allergy and Immunology. 2. Allergy and Immunology-examination questions. 3. Microbiology. 4. Microbiology-examination questions. QW 4 H995m] QR46.H93 1986 616'01 86-26119 ©1987 by Springer-Verlag New York Inc. All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Verlag, 175 Fifth Avenue, New York, New York 10010, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use of general descriptive names, trade names, trademarks, etc. in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the -authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or impiled, with respect to the material contained herein. 9 8 7 6 5 4 3 2 1 ISBN-13: 978-0-387-96336-5 e-ISBN-13: 978-1-4684-0288-9 DOl: 10.1007/978-1-4684-0288-9 Preface to the Oklahoma Notes In 1973, the University of Oklahoma College of Medicine instituted a requirement for passage of the Part I National Boards for promotion to the third year. To assist students in preparation for this examination, a two week review of the basic sciences was added to the curriculum in 1975. Ten review texts were written by the faculty: four in anatomical sciences and one each in the other six basic sciences. Self-instructional quizzes were also developed by each discipline and administered during the review period. The first year the course was instituted the Total Score performance on National Boards Part I increased 60 points, with the relative standing of the school changing from 56th to 9th in the nation. The performance of the class has remained near the national candidate mean (500) since then, with a mean over the 12 years of 502 and a range of 467 to 537. This improvement in our own students' performance has been documented (Hyde et al: Performance on NBME Part I examination in relation to policies regarding use of test. J. Med. Educ. 60:439-443, 1985). A questionnaire was administered to one of the classes after they had completed the boards; 82% rated the review books as the most beneficial part of the course. These texts have been recently updated and rewritten and are now available for use by all students of medicine who are preparing for comprehensive examinations in the Basic Medical Sciences. RICHARD M. HYDE, Ph.D. Executive Editor PREFACE The material in this text was compiled to serve as a study guide for a review of microbiology and immunology suitable for preparing for Part I of the National Board of Medical Examiners (NBME) exam. I have assumed that you, the reader, have had a comprehensive course covering this discipline. In-depth presentation of material will not be found in this review: You are urged to consult other study aids (lecture notes, textbooks, etc.) for detailed explana tions of material that you find troublesome. In general, the text of the book is on the left side of each page; questions, illustrations, summary sentences or phrases, and other study aids are on the right. This format has the intent of getting you involved in the review process. Use a highlighter, put boxes around key statements, answer the questions, and fill in the blanks as you work through the book. Your reward will be proportional to your effort (i.e., no pain, no gain). There are five proficiency examinations in this book, one for each major area of coverage. In addition, a comprehensive examination will be found at the end of the book. Performance data for each is given to help you evaluate your own preparedness. Some questions may cover material not detailed in the book: Be sure that you know the answer to these questions as well, since this is just another form of review. Contributions by the following individuals are gratefully acknow ledged: Drs. G. S. Bulmer, J. J. Ferretti, D. C. Graves, M. H. Ivey, M. P. Lerner, L. V. Scott, J. R. Sokatch, and C. Weeks, and Ms. Dawn H. Struthers (artwork). R.M.H. TABLE OF CONTENTS Section I Review of Microbial Physiology 1 Bacterial Morphology 2 Growth of Bacteria 7 Bacterial Metabolism 9 Chemotherapeutic Agents 11 Review Statements 24 Microbial Physiology Proficiency Test 29 Review of Microbial Genetics 35 Mutations 36 Gene Transfer 41 Extrachromosomal Genetics 45 Recombinant DNA 47 Bacteriophage 48 Review Statements 50 Microbial Genetics Proficiency Test 54 Section .II Review of Immunology 59 Innate Immunity 61 Antibody Structure and Function 64 Immune Response 68 Immune Suppression and Tolerance 72 Antigen:Antibody Reactions 75 Complement 80 Immediate Hypersensitivity 85 Delayed Hypersensitivity 88 Autoimmune Diseases 90 Immune Deficiency Diseases 94 Transplantation Immunology 97 Human Tumor Immunology 101 Review Statements 103 Immunology Proficiency Test 109 Section III Pathogenic Microbiology Review 119 Gram Stain 120 Gram Positive Cocci 124 Gram Negative Cocci 128 Gram Positive Rods: Sporeformers 130 Gram Positive Rods: Non-Sporeformers 132 Gram Negative Rods: Enterics 135 Gram Negative Respiratory Pathogens 139 Generalized Gram Negative Pathogens 143 Potent Bacterial Protein Exotoxins 145 Spirochetes 147 Rickettsiae and Chlamydiae 149 ca 1 Mycology 153 ~~edi Parasito logy 154 Review Statements 158 Pathogenic Microbiology Proficiency Test 165 Section IV Virology Review 175 Virus Structure 176 Virus Classfication 177 Viral Replication 180 Interference with Viral Replication 184 Viral Immunotherapy and Prophylaxis 186 DNA Viruses: Herpes 187 Adenoviruses 190 Papovaviruses 191 Poxviruses 192 RNA Viruses: Myxoviruses 193 Arthropod-Borne Viruses 196 Rhabdoviruses 199 Picornaviruses 200 Hepatitis Viruses 203 Slow Viruses 205 Oncogenic Viruses 206 Review Statements 209 Virology Proficiency Test 214 Comprehensive Examination 221 x REVIEW OF MICROBIAL PHYSIOLOGY Definitions Autotrophs - organisms which are able to use CO2 as the sole carbon source. Axial filament - proteinaceous organelles of spirochetal forms. Bacterial cell wall - barrier against osmotic lysis; composed of peptidoglycan inner layer and various surface layers which differ in the different bacteria. Capsule - usually carbohydrate layer outside the cell wall of many bacteria - anti-phagocytic function. Cell membrane - bilayered structure inside bacterial cell wall. Contains enzymes responsible for synthesis of cell wall, etc., as well as transport of solutes and oxidative phosphorylation. Enterochelins - iron chelating compounds found in enteric bacteria (e.g., E. coli, Salmonella) which are important in survival in vivo as they permit the organism to accumulate ferrous ions essential for growth-. -- Flagella - proteinaceous organelles of motility in rod-shaped bacteria. Heterotrophs - organisms that require the major portion of their carbon from organic sources. Metachromatic granules - polymetaphosphate inclusions found in many bacteria. Their presence is useful in identification of the diphtheria bacillus. Mesosomes - irregular convoluted invaginations of the cell membrane-functions include a role in DNA replication, and secretion. Pili - proteinaceous appendages on gram negative bacteria; function in conjugation and/or adherence to host cell membranes. BACTERIAL MORPHOLOGY Cell Wall Complete the table below: The cell wall of bacteria protects the Gram Negative Chemical cell against osmotic lysis. Cell walls Ce 11 Wa 11 Zone Component of Gram positive and Gram negative bacteria both have peptidoglycan Outer Membrane (mucopeptide) as the innermost layer of the cell wall. They differ in the nature of the surface layers. The cell wall of Gram positive bacteria contains from 40-90% peptidoglycan, while Middle Layer cell walls of Gram negative bacteria contains only 5-10% peptidoglycan. In Peptidoglycan Gram positives, the next layer is carbo hydrate, composed of ribitol teichoic Cytoplasmic acid, and the outermost layer of the cell membrane wall is composed of two or three kinds of protein. The lipoteichoic acids of group A streptococcal cell walls are involved in the organism's adherence to epithelial cell s. Cell walls of Gram negative enteric Porins are "holes" in the outer membrane bacteria are composed of an outer layer portion of the cell wall of Gram nega of lipoprotein-lipopolysaccharide tives which allow free diffusion of (endotoxin), a middle layer of protein, molecules less than 600 daltons through and an innermost layer of peptidoglycan. the membrane. They also serve as attach The cell membrane, which is not a part of ment sites for phage. the cell wall, appears as a double layered structure immediately below the cell wall. The basic unit of peptidoglycan is a The mucopeptidase, lysozyme, hydrolyzes disaccharide-tetrapeptide containing N the linkage between N-acetylmuramic acid acetylmuramic acid, N-acetylglucosamine, and N-acetyl glucosamine causing D-alanine, L-alanine, D-glutamic acid or its derivative, D-isoglutamine and a 1. the peptidoglycan layer to disappear. basic amino acid, usually diaminopimelic 2. the cell to become an osmotically acid. The basic units of mucopeptide are fragile. cross-linked to each other to form a 3. Both tight meshwork which surrounds and pro 4. Neither tects the entire cell. (Answer on next page) Lipopolysaccharides are composed of lipid A, core and O-antigen. Core is sub divided into inner core, or backbone, and outer core. 2