Orris

Make a cheat sheet of these questions that too in priority wise btw give the answers in text format and give the important ones first then if time permits we'll see remaining and Divide that priority wise list into paper I and 2

I'll read the PDF skill first, then extract both papers simultaneously.
Reading File
Now let me extract both PDFs simultaneously.
Running Command

cd /home/daytona/workspace && python3 -c " import pdfplumber papers = { 'paper1': '/home/daytona/workspace/attachments/efb08531-a113-4e12-9be0-848a9c132b7c/NTRUHS 2K23 MICROBIOLOGY PAPER-1 SUPER-50.pdf', 'paper2': '/home/daytona/workspace/attachments/efb08531-a113-4e12-9be0-848a9c132b7c/NTRUHS 2K23 MICROBIOLOGY PAPER-2 SUPER-50.pdf' } for name, path in papers.items(): print(f'=== {name.upper()} ===') with pdfplumber.open(path) as pdf: print(f'Pages: {len(pdf.pages)}') for i, page in enumerate(pdf.pages): text = page.extract_text() if text: print(f'--- Page {i+1} ---') print(text) print() "

I have all the questions. Now I'll read the medical library skill and search for key topics simultaneously while building the cheat sheet.Now I have everything I need. Let me build the complete cheat sheet from my medical knowledge, prioritized by exam importance (high-yield topics that are repeatedly tested, broad/long-answer type questions first, then short/medium, then rare topics last).

Give the answers again

Reading File

Give only paper 2 questions priority wise in text format

Here is the complete NTRUHS 2K23 Microbiology Paper 2 cheat sheet, priority-wise with answers in text format.

NTRUHS 2K23 MICROBIOLOGY - PAPER 2

PRIORITY-WISE CHEAT SHEET

🔴 PRIORITY 1 - HIGH YIELD (Do These First)

1. TUBERCULOSIS

Causative agent: Mycobacterium tuberculosis - acid fast bacillus, obligate aerobe, slow growing (18-24 hr doubling time), contains mycolic acid in cell wall.
Pathogenesis:
  • Droplet inhalation → alveolar macrophages phagocytose bacilli
  • Ghon focus = primary lesion in lower lobe
  • Ghon complex = Ghon focus + hilar lymph nodes
  • Cell-mediated immunity activates - CD4+ T cells → granuloma formation (caseous necrosis)
  • Reactivation TB: upper lobe (high O2 tension)
Clinical manifestations: Fever, night sweats, weight loss, haemoptysis, productive cough >3 weeks
Tuberculin Skin Test (Mantoux):
  • 0.1 ml of 5 TU PPD injected intradermally
  • Read at 48-72 hours
  • Induration ≥10 mm = positive (≥5 mm in HIV/immunocompromised)
  • False positive: BCG vaccination, NTM infection
  • False negative: Miliary TB, AIDS, malnutrition, sarcoidosis (anergy)
Lab Diagnosis:
  • ZN stain (Ziehl-Neelsen): red bacilli on blue background
  • Culture: Lowenstein-Jensen (LJ) medium - buff coloured, rough, dry colonies (eugonic) in 6-8 weeks
  • BACTEC (radiometric) - faster, 9-14 days
  • Auramine-rhodamine fluorescent stain
Molecular methods:
  • Gene Xpert MTB/RIF: detects TB + rifampicin resistance simultaneously, within 2 hours
  • Line Probe Assay (LPA/Hain test): detects MDR-TB (rpoB gene for RIF, katG and inhA for INH)
  • LAMP (Loop-mediated isothermal amplification)
  • PCR - detects specific DNA sequences
Treatment (DOTS):
  • Intensive phase: 2 months - HRZE (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol)
  • Continuation phase: 4 months - HR
  • MDR-TB: resistant to both INH and Rifampicin
  • XDR-TB: MDR + resistant to fluoroquinolones + injectable agents
Atypical Mycobacteria (NTM):
  • Runyon classification based on pigment and growth rate
  • Group I (Photochromogens): M. kansasii - yellow pigment in light
  • Group II (Scotochromogens): M. scrofulaceum - yellow even in dark
  • Group III (Non-chromogens): M. avium-intracellulare (MAI) - most common in AIDS
  • Group IV (Rapid growers): M. fortuitum, M. chelonae

2. BACTERIAL MENINGITIS

Common organisms:
  • Neonates: E. coli, Group B Streptococcus, Listeria
  • Children: Neisseria meningitidis, H. influenzae
  • Adults: Neisseria meningitidis, Streptococcus pneumoniae
  • Elderly: S. pneumoniae, Listeria
  • Post-neurosurgery: Staphylococcus, Pseudomonas
Meningococcal Meningitis (N. meningitidis):
  • Gram negative diplococcus (kidney-bean shaped)
  • Capsule - polysaccharide (serogroups A, B, C, W135, Y)
  • Virulence: endotoxin (lipid A), capsule, IgA protease
  • Waterhouse-Friderichsen syndrome: bilateral adrenal hemorrhage → shock → DIC
Tuberculous Meningitis:
  • CSF: lymphocytes, low glucose, high protein, cobweb clot
  • India ink stain negative (crypto positive)
  • ADA (Adenosine deaminase) elevated
Cryptococcal Meningitis:
  • Cryptococcus neoformans - encapsulated yeast
  • India ink stain: halo around yeast (capsule)
  • Latex agglutination for capsular antigen
  • Opportunistic in HIV (CD4 <100)
CSF Analysis - Summary:
ParameterNormalBacterialViralTBCrypto
Cells<5100-10,000 PMN100-1000 lymph100-500 lymphlymph
Glucose60-80Very lowNormalLowLow
Protein20-45Very highMildly highHighHigh
Lab Diagnosis of Meningitis:
  • Gram stain + culture (blood agar, chocolate agar)
  • India ink for Cryptococcus
  • ZN stain for TB
  • Bacterial antigen detection (latex agglutination)
  • CSF PCR

3. RABIES

Causative agent: Rhabdovirus - bullet shaped, single stranded (-) sense RNA, enveloped
Morphology: Bullet-shaped, 180x75 nm, helical nucleocapsid. Glycoprotein spikes (G protein) on surface - responsible for attachment to acetylcholine receptors and neutralizing antibodies.
Pathogenesis:
  • Bite of infected animal → virus in saliva
  • Replicates at bite site in muscle
  • Travels via peripheral nerve (retrograde axonal transport) to CNS
  • Spreads to brain → encephalitis
  • Then spreads centrifugally to salivary glands
  • Negri bodies = eosinophilic intracytoplasmic inclusions in hippocampal neurons (Ammon's horn) - pathognomonic
Clinical features:
  • Incubation: 1-3 months (can be 10 days to 1 year)
  • Prodrome: fever, pain/paresthesia at bite site
  • Furious (encephalitic) rabies: hydrophobia, aerophobia, hyperexcitability - 80%
  • Dumb (paralytic) rabies: ascending paralysis - 20%
  • Death within 7-10 days of onset
Lab Diagnosis:
  • Negri bodies in brain (Sellers stain - Negri bodies: magenta/red; neurons: blue)
  • Fluorescent antibody test (FAT) on brain tissue - gold standard
  • RT-PCR on saliva, CSF, skin biopsy (nape of neck)
  • Virus isolation in suckling mice
Post Exposure Prophylaxis (PEP):
  • Wound washing with soap and water for 15 min - most important first step
  • Category I (touching/feeding): No PEP needed
  • Category II (minor scratches): Wound treatment + vaccine only
  • Category III (transdermal bites, licks on broken skin): Wound treatment + RIG + vaccine
Rabies Immunoglobulin (RIG):
  • Human RIG (HRIG): 20 IU/kg - infiltrate at wound + remainder IM
  • Equine RIG (ERIG): 40 IU/kg
Vaccines:
  • HDCV (Human Diploid Cell Vaccine) - gold standard
  • Schedule: Days 0, 3, 7, 14, 28 (5 doses) - Essen protocol
  • Zagreb protocol: 2-1-1 (Day 0 two doses, day 7 one, day 21 one)
  • Pre-exposure: Days 0, 7, 21/28

4. NEISSERIA GONORRHOEAE (STI)

Morphology: Gram negative diplococcus (intracellular in PMN), kidney-bean shaped, non-motile, non-sporing, oxidase positive
Virulence factors: Pili (attachment), Opa proteins, LOS (lipooligosaccharide), IgA protease, porin proteins, beta-lactamase
Culture: Thayer-Martin medium (selective: chocolate agar + VCN antibiotics - Vancomycin, Colistin, Nystatin)
Pathogenesis:
  • Attaches to non-ciliated columnar epithelium
  • Produces endocytosis → submucosal spread
Clinical features (Male): Urethritis, purulent discharge, dysuria Clinical features (Female): Cervicitis (often asymptomatic), PID, Fitz-Hugh-Curtis syndrome (perihepatitis) Disseminated gonococcal infection (DGI): Arthritis-dermatitis syndrome
Lab Diagnosis:
  • Urethral smear: Gram stain - intracellular gram -ve diplococci in PMN (diagnostic in males)
  • Culture: Thayer-Martin medium, 5-10% CO2 (capnophilic), 35-37°C
  • NAAT (Nucleic Acid Amplification Test) - most sensitive
Other STI organisms:
  • Treponema pallidum (Syphilis)
  • Chlamydia trachomatis (NGU, LGV)
  • Haemophilus ducreyi (Chancroid)
  • HSV-2 (Genital herpes)
  • HPV (Genital warts)
  • Trichomonas vaginalis
  • HIV, HBV, HCV

5. SYPHILIS

Causative agent: Treponema pallidum - spirochete, cannot be cultured in vitro, visualized by dark-field microscopy
Stages:
  • Primary syphilis: Painless chancre (indurated, clean base) at site of inoculation, appears 3 weeks after exposure. Heals in 3-6 weeks.
  • Secondary syphilis: 6-8 weeks after chancre. Maculopapular rash (including palms and soles), condyloma lata, mucous patches, generalized lymphadenopathy, snail track ulcers. Highly infectious.
  • Latent syphilis: No symptoms, serology positive. Early latent (<1 year), Late latent (>1 year).
  • Tertiary syphilis: Gumma (granulomatous lesion anywhere), cardiovascular syphilis (aortitis, aortic regurgitation), neurosyphilis (tabes dorsalis, general paresis of insane - GPI)
  • Congenital syphilis: Hutchinson's triad (interstitial keratitis, deafness, Hutchinson's teeth), saddle nose, saber tibia, snuffles
Lab Diagnosis:
Non-treponemal tests (screening, become negative after treatment):
  • VDRL (Venereal Disease Research Laboratory) - flocculation test, cardiolipin antigen
  • RPR (Rapid Plasma Reagin)
  • Biological false positive: SLE, leprosy, malaria, pregnancy
Treponemal tests (confirmatory, remain positive lifelong):
  • TPHA (T. pallidum Hemagglutination Assay)
  • FTA-ABS (Fluorescent Treponemal Antibody-Absorbed) - most sensitive
  • TPPA, TPI (T. pallidum Immobilization test) - gold standard
RPR test: Antigen is carbon particles coated with cardiolipin-lecithin-cholesterol. Visible flocculation (no microscope needed). Used for screening and monitoring treatment.

6. CLOSTRIDIUM TETANI / TETANUS

Morphology: Gram positive rod, anaerobic, spore-forming (terminal spore = drumstick appearance), motile
Toxin:
  • Tetanospasmin (neurotoxin) - responsible for disease
  • Tetanolysin (hemolysin) - minor role
  • Tetanospasmin: spreads via motor nerves retrograde → brainstem and spinal cord → blocks inhibitory interneurons (glycine and GABA release blocked) → spastic paralysis
Clinical features:
  • Trismus (lockjaw) - first symptom
  • Risus sardonicus (sardonic smile)
  • Opisthotonos (arching of back)
  • Reflex spasms triggered by stimuli
  • Autonomic instability
Incubation period: 3-21 days (shorter = more severe)
Lab Diagnosis: Primarily clinical. Culture unnecessary. Gram stain of wound - drumstick bacilli.
Prevention:
  • Active immunization: Tetanus toxoid (TT) - alum precipitated
  • DPT vaccine: 6, 10, 14 weeks; booster at 18 months and 5 years
  • Passive immunization: TIG (Tetanus Immunoglobulin) 250-500 IU IM for wound prophylaxis
  • Wound management: debridement, metronidazole (antibiotic of choice)

7. STREPTOCOCCUS PYOGENES (Group A Streptococcus)

Morphology: Gram positive cocci in chains, catalase negative, beta-hemolytic, Lancefield Group A
Virulence factors:
  • M protein - antiphagocytic, typing antigen, >100 types
  • Hyaluronidase (spreading factor)
  • Streptokinase (fibrinolysin)
  • Streptolysin S (oxygen stable) and O (oxygen labile) - cause beta hemolysis
  • Erythrogenic toxin (causes rash in scarlet fever)
  • C5a peptidase
Diseases:
  • Throat: Pharyngitis/tonsillitis → scarlet fever
  • Skin: Impetigo, erysipelas, cellulitis, necrotizing fasciitis
  • Systemic: Septicemia
Post-Streptococcal Complications:
  • Rheumatic fever (pharyngitis only): Jones criteria - fever, carditis, polyarthritis, chorea, subcutaneous nodules, erythema marginatum. Mechanism: molecular mimicry
  • Post-streptococcal glomerulonephritis (skin or throat): haematuria, hypertension, oedema. Anti-streptolysin O (ASO) titre raised.
Lab Diagnosis:
  • Throat swab on blood agar - beta hemolysis
  • Bacitracin sensitivity (S. pyogenes sensitive, S. agalactiae resistant)
  • ASO titre: >200 Todd units = significant
  • Rapid antigen detection test

8. DIPHTHERIA

Causative agent: Corynebacterium diphtheriae - Gram positive rod, Club-shaped (one end broader), non-motile, non-sporing, aerobic
Special features:
  • Chinese letter/cuneiform arrangement in smears
  • Metachromatic granules (Babes-Ernst/volutin granules) - stain red/purple with Albert's/Pugh's stain when rest of bacillus stains green
  • Albert's stain: granules appear bluish-black (metachromatic)
Culture: Loeffler's serum slope (rapid growth, granules visible), Tellurite medium (selective): DTM (Downie's Tellurite Medium), CTBA - grey-black colonies
Toxin:
  • Diphtheria toxin - encoded by bacteriophage (beta-phage)
  • Mechanism: Fragment B (binds to receptor) → Fragment A enters → ADP-ribosylation of EF-2 (elongation factor 2) → inhibits protein synthesis → cell death
  • Affects heart (myocarditis), nerves (demyelination), kidney
Elek's gel precipitation test: Detects toxin production in vitro. Strip of filter paper soaked in antitoxin placed in agar, bacterial streak made perpendicular. Precipitation line at 45° = toxigenic.
Clinical features:
  • Pseudomembrane (grey-white, adherent, bleeds on removal) on tonsils/pharynx
  • Bull neck (lymphadenopathy)
  • Myocarditis (most common cause of death), heart block
  • Neurological: palatal palsy (first), then oculomotor palsy, diaphragm palsy
Treatment: Diphtheria Antitoxin (DAT) + Penicillin/Erythromycin
Prevention: DPT vaccine - alum precipitated toxoid

9. POLIO VIRUS (Picornavirus)

Classification: Enterovirus, Picornavirus family, (+) sense ssRNA, naked (non-enveloped), icosahedral, 3 serotypes (1,2,3) - type 1 most common (Mahoney strain)
Pathogenesis:
  • Fecal-oral route
  • Replicates in oropharynx and intestine
  • Spreads to regional lymph nodes → viremia → CNS
  • Attacks anterior horn motor neurons → flaccid paralysis
  • Bulbar polio: affects brainstem - most dangerous
Clinical features:
  • 90-95%: Inapparent/subclinical infection
  • 4-8%: Abortive poliomyelitis (minor illness - fever, headache)
  • 1-2%: Non-paralytic polio (aseptic meningitis)
  • <1%: Paralytic polio (asymmetric flaccid paralysis, loss of deep tendon reflexes, no sensory loss)
OPV vs IPV:
FeatureOPV (Oral, Sabin)IPV (Inactivated, Salk)
RouteOralInjection
TypeLive attenuatedKilled
ImmunityMucosal + humoralHumoral only
Herd immunityYesNo
VAPP riskYes (1/750,000)No
Cold chainRequiredRequired
CostCheapExpensive

10. INFLUENZA / SWINE FLU (H1N1)

Virus: Orthomyxovirus, (-) sense ssRNA, 8 segments (important for antigenic shift), enveloped
Surface antigens:
  • Hemagglutinin (HA): 18 types - attachment to sialic acid receptors, neutralizing antibody target
  • Neuraminidase (NA): 11 types - release of virus from cells, oseltamivir target
Antigenic Variation:
  • Antigenic drift: Minor mutations in HA/NA genes (within influenza A, B, C) → seasonal epidemics
  • Antigenic shift: Major reassortment of RNA segments (only influenza A, requires co-infection) → pandemics
H1N1 (Swine Flu):
  • Pandemic 2009 - triple reassortment (human + swine + avian)
  • Diagnosis: RT-PCR (nasal/throat swab) - gold standard
  • Rapid antigen detection test (less sensitive)
Treatment: Oseltamivir (Tamiflu) - 75 mg BD x 5 days. Zanamivir (inhaled)
Prevention: Annual influenza vaccine (killed, trivalent/quadrivalent), neuraminidase inhibitors for prophylaxis

11. ECHINOCOCCUS GRANULOSUS (Cestodes)

Classification of Cestodes:
  • Taeniidae: Taenia solium, T. saginata, Echinococcus
  • Diphyllobothridae: Diphyllobothrium latum (fish tapeworm)
  • Hymenolepididae: Hymenolepis nana (dwarf tapeworm)
Echinococcus granulosus (Hydatid disease):
  • Definitive host: Dog (adult tapeworm in intestine)
  • Intermediate host: Sheep, cattle, humans (accidental)
  • Infective stage to humans: Eggs (hexacanth embryo/oncosphere)
Life cycle:
  • Dog excretes eggs → Human ingests eggs → hexacanth embryo hatches → penetrates intestinal wall → carried via portal blood → lodges in liver (most common 60%) or lung (25%) → develops into hydatid cyst
Hydatid cyst structure:
  • Pericyst (outer, host-derived fibrous layer)
  • Ectocyst (outer germinal laminated membrane)
  • Endocyst (inner germinal layer - produces brood capsules, scolices, daughter cysts)
  • Hydatid sand = free scolices + brood capsules + daughter cysts
  • Daughter cysts within mother cyst = pathognomonic
Clinical features: Liver cyst (painless hepatomegaly), lung cyst (cough, hemoptysis), anaphylaxis if cyst ruptures
Lab Diagnosis:
  • Casoni's skin test (hypersensitivity)
  • Serology: IHA, ELISA
  • Imaging: USG, CT scan - pathognomonic (cyst within cyst)
  • Aspiration contraindicated (anaphylaxis risk)
Treatment: PAIR (Puncture, Aspiration, Injection of hypertonic saline, Re-aspiration) + Albendazole

12. URINARY TRACT INFECTIONS (UTI)

Common organisms:
  • Community acquired: E. coli (80%), Staphylococcus saprophyticus (young women), Klebsiella, Proteus
  • Hospital acquired: E. coli, Klebsiella, Pseudomonas, Enterococcus
Acute Pyelonephritis (APN):
  • Causative organisms: E. coli (most common), Klebsiella, Proteus, Pseudomonas
  • Pathogenesis of APN:
    • Ascending route (most common): periurethral bacteria → bladder → ureter → renal pelvis → parenchyma
    • Virulence factors: P-fimbriae (pyelonephritis-associated pili) bind to uroepithelium, type 1 fimbriae, hemolysin, aerobactin (iron acquisition), urease (Proteus)
    • Inflammatory infiltrate → neutrophil recruitment → renal cortex and medulla involvement
    • Risk factors: vesicoureteral reflux, urinary obstruction, pregnancy, diabetes, female sex
Lab Diagnosis of UTI:
  • Sample: Midstream clean catch urine (MSU)
  • Significant bacteriuria: ≥10^5 CFU/ml (symptomatic: ≥10^3 CFU/ml)
  • Microscopy: >10 WBC/mm3 = pyuria, bacteria on Gram stain
  • Culture: CLED medium (Cystine Lactose Electrolyte Deficient) - no swarming by Proteus; MacConkey, Blood agar
  • Dipstick: Nitrite test (gram negative bacteria), leucocyte esterase
  • Sensitivity testing (antibiogram)

13. COVID-19

Causative agent: SARS-CoV-2 - Coronavirus, (+) sense ssRNA, largest RNA virus, enveloped, club-shaped peplomers
Spike (S) protein: Binds to ACE-2 receptor (on respiratory epithelium, heart, kidney, intestine)
Pathogenesis:
  • Droplet/aerosol inhalation
  • S protein binds ACE-2 → enters via TMPRSS2-mediated priming → replicates in upper and lower respiratory tract
  • Cytokine storm: IL-6, TNF-alpha, IL-1 → massive inflammation → ARDS, multi-organ failure
  • Hypercoagulability → thrombosis
  • Immune evasion: inhibits interferon response
Clinical features:
  • Incubation: 2-14 days (median 5 days)
  • Fever, dry cough, anosmia/ageusia (pathognomonic), dyspnoea, myalgia
  • Severe: ARDS, cytokine storm, multi-organ dysfunction
Lab Diagnosis:
  • RT-PCR (nasopharyngeal/oropharyngeal swab) - gold standard
  • Rapid Antigen Test (RAT) - faster but less sensitive
  • Serology (antibody detection): not for acute diagnosis
  • CT chest: ground glass opacities (bilateral, peripheral)
Treatment: Remdesivir, Dexamethasone (for severe/critical), anticoagulation

14. ASPERGILLOSIS

Causative agent: Aspergillus fumigatus (most common), A. flavus, A. niger, A. terreus
Morphology: Septate hyphae with acute angle branching (45°), conidiophore with vesicle bearing phialides → conidia (Fruiting body = aspergillum)
Types:
  • Allergic bronchopulmonary aspergillosis (ABPA): asthmatics, eosinophilia, IgE elevated, fleeting infiltrates
  • Aspergilloma (fungus ball): pre-existing lung cavity (TB cavity), Monod sign on X-ray (crescent of air)
  • Invasive aspergillosis: immunocompromised (neutropenic), angioinvasion → halo sign on CT (ground glass opacity around nodule)
  • Otomycosis: A. niger (black) - ear canal
Lab Diagnosis:
  • KOH mount: septate hyphae
  • Culture: Czapek-Dox agar or Sabouraud's agar
  • Galactomannan antigen detection (ELISA) - for invasive aspergillosis
  • Beta-D-glucan
  • CT scan: halo sign (early), air crescent sign (late) in invasive
Treatment: Voriconazole (drug of choice for invasive), Amphotericin B, Itraconazole (ABPA)

15. PLAGUE (Yersinia pestis)

Morphology: Gram negative coccobacillus, bipolar staining (safety-pin appearance) with Wayson/Giemsa stain, non-motile at 37°C (motile at 22°C), encapsulated (F1 antigen)
Virulence factors: F1 capsular antigen (antiphagocytic), V and W antigens (intracellular survival), Pesticin, LPS endotoxin, Yersiniabactin (iron acquisition)
Clinical types:
  • Bubonic plague: Most common. Flea bite (Xenopsylla cheopis) → Bubo (painful enlarged lymph node - inguinal most common) → fever, hemorrhage, black necrosis ("Black Death")
  • Septicemic plague: Primary (no bubo) or secondary (from bubonic). DIC, purpuric rash.
  • Pneumonic plague: Most dangerous, airborne spread possible. Cough with bloody sputum. 100% fatal if untreated.
  • Pharyngeal plague: Rare
Lab Diagnosis:
  • Gram/Wayson stain: bipolar safety-pin appearance
  • Culture: Blood agar, MacConkey - small colonies at 24-48 hrs
  • F1 antigen detection
  • Serology: passive hemagglutination
Treatment: Streptomycin (drug of choice), Gentamicin, Doxycycline, Ciprofloxacin

🟡 PRIORITY 2 - IMPORTANT (Do After Priority 1)

16. SYPHILIS LAB - RPR TEST

RPR (Rapid Plasma Reagin):
  • Flocculation test using carbon particle-coated cardiolipin antigen
  • No microscope needed - visible black clumping = positive
  • Used for: screening, monitoring treatment response (titres fall with successful treatment)
  • Biological false positives: SLE, leprosy, malaria, antiphospholipid syndrome, pregnancy

17. CHANCROID

Causative agent: Haemophilus ducreyi - Gram negative coccobacillus, "school of fish" or "railroad track" arrangement
Features:
  • Painful genital ulcer (contrast with syphilis = painless)
  • Soft chancre (contrast with syphilis = hard/indurated)
  • Painful inguinal lymphadenopathy (bubo) may suppurate
  • Undermined edges, dirty grey base
Lab Diagnosis: Culture on chocolate agar + vancomycin (selective), Gram stain from ulcer base
Treatment: Azithromycin single dose, Ceftriaxone, Ciprofloxacin

18. LYMPHOGRANULOMA VENEREUM (LGV)

Causative agent: Chlamydia trachomatis serovars L1, L2, L3
Features:
  • Painless primary lesion (transient)
  • Secondary stage: painful inguinal lymphadenopathy (groove sign = bubo above and below inguinal ligament - Greenblatt's sign)
  • Tertiary: esthiomene (genital elephantiasis), rectal stricture
Lab Diagnosis: Frei's test (intradermal, now obsolete), TWAR antigen, serology (CFT), NAAT
Treatment: Doxycycline 21 days

19. NEUROCYSTICERCOSIS / TAENIA SOLIUM

Taenia solium (Pork tapeworm):
  • Definitive host: Human (adult worm - taeniasis)
  • Intermediate host: Pig (cysticerci in muscle)
  • Infective stage to human: Cysticercus cellulosae (eating undercooked pork) OR eggs (cysticercosis via fecal-oral)
Cysticercosis in Humans: When human ingests eggs → larvae hatch → penetrate gut → blood → lodge in muscles, brain, eye
Neurocysticercosis:
  • Cysticerci in brain → seizures (most common presentation), raised ICP, hydrocephalus
  • CT/MRI: cystic lesion with scolex (dot in cyst = pathognomonic "hole with dot" sign)
  • Serology: ELISA for cysticercal antigens
Treatment: Albendazole (+ dexamethasone to reduce inflammation), Praziquantel; anti-epileptic drugs

20. BRUCELLOSIS

Causative agents: B. melitensis (goats - most virulent), B. abortus (cattle), B. suis (pigs), B. canis (dogs)
Transmission: Unpasteurized milk/dairy, contact with infected animal products, inhalation (lab hazard - biosafety level 3)
Clinical features: Undulant fever (waves of fever every few weeks), night sweats, arthralgia, hepatosplenomegaly. Complications: orchitis, spondylitis, endocarditis, neurobrucellosis.
Lab Diagnosis:
  • Culture: blood culture (gold standard) - Castaneda bottle method, BACTEC; slow growing, BSL-3
  • Serology: SAT (Standard Agglutination Test) - titre ≥1:160 significant; Rose Bengal test (screening); 2-ME test (distinguishes IgM from IgG)
  • Brucellergen (skin test - not commonly used)
Treatment: Doxycycline + Rifampicin (6 weeks) or Doxycycline + Streptomycin

21. MYCOPLASMA PNEUMONIA (Atypical Pneumonia)

Organism: Mycoplasma pneumoniae - smallest free-living organism, no cell wall (resistant to penicillin), pleomorphic, "fried egg" colonies on PPLO agar
Clinical features:
  • Atypical pneumonia (walking pneumonia): gradual onset, dry cough, low-grade fever, chest X-ray worse than clinical picture
  • Extrapulmonary: cold agglutinins (haemolytic anaemia), Stevens-Johnson syndrome, Guillain-Barre syndrome
Lab Diagnosis:
  • Cold agglutinins (IgM against RBC antigen I) - titre ≥1:64 in 50% of cases
  • Culture: PPLO agar (Eaton's medium) - "fried egg" colonies
  • CFT (Complement Fixation Test)
  • PCR - most sensitive
Treatment: Macrolides (Azithromycin), Doxycycline, Fluoroquinolones (NOT penicillin - no cell wall)

22. PERTUSSIS (Whooping Cough)

Causative agent: Bordetella pertussis - Gram negative coccobacillus, strict aerobe
Toxins:
  • Pertussis toxin (PT) - ADP ribosylation of Gi → increased cAMP → lymphocytosis
  • Filamentous hemagglutinin (FHA) - attachment
  • Tracheal cytotoxin - ciliary destruction
  • Adenylate cyclase toxin
Stages:
  1. Catarrhal (1-2 weeks): rhinorrhoea, mild cough - most infectious
  2. Paroxysmal (2-4 weeks): inspiratory "whoop", post-tussive vomiting, cyanosis, lymphocytosis (WBC 20,000-50,000 with >70% lymphocytes)
  3. Convalescent (weeks): gradual improvement
Lab Diagnosis:
  • Culture: Bordet-Gengou medium (potato-blood-glycerol) or Regan-Lowe medium; pearl-like "mercury drop" colonies
  • Nasopharyngeal swab (per-nasal swab) - catarrhal stage
  • PCR - sensitive
  • DFA (Direct fluorescent antibody)
Treatment: Azithromycin (or Erythromycin) - shortens catarrhal stage; supportive in paroxysmal
Prevention: DTaP/DTP vaccine

23. MUMPS

Virus: Paramyxovirus, (-) sense ssRNA, enveloped, hemagglutinin-neuraminidase and F protein surface antigens
Clinical features:
  • Parotitis (bilateral) - pathognomonic
  • Orchitis (post-pubertal males) → may cause sterility
  • Oophoritis
  • Meningitis/Meningoencephalitis (most common CNS complication)
  • Pancreatitis
Lab Diagnosis:
  • Virus isolation from saliva, CSF, urine
  • Serology: CFT, ELISA (IgM) - diagnostic
  • PCR
Prevention: MMR vaccine (live attenuated) at 9-12 months and 15-18 months

24. TOXOPLASMA GONDII

Definitive host: Cat (sexual cycle in intestine - oocysts shed) Intermediate hosts: All warm-blooded animals including humans
Infective stages to humans:
  • Oocysts (in cat feces - ingestion)
  • Tissue cysts in undercooked meat
  • Tachyzoites (congenital transmission, blood transfusion)
Life cycle:
  • Ingested oocysts/tissue cysts → sporozoites/bradyzoites → tachyzoites (actively dividing in tissue) → bradyzoites (dormant in tissue cysts in brain, muscle, eye)
Clinical forms:
  • Immunocompetent: Asymptomatic or cervical lymphadenopathy (Piringer-Kuchinka lymphadenitis)
  • Immunocompromised (HIV CD4 <100): Toxoplasma encephalitis - ring-enhancing lesions in basal ganglia on MRI
  • Congenital toxoplasmosis: Chorioretinitis, hydrocephalus, intracranial calcifications, psychomotor retardation (classic tetrad)
  • Ocular: Chorioretinitis (most common cause of posterior uveitis worldwide)
Lab Diagnosis:
  • Serology: Sabin-Feldman dye test (gold standard - live tachyzoites + antibody → fail to take methylene blue dye), IFA, ELISA IgM/IgG
  • PCR (CSF for neurotoxoplasmosis)
  • Histology: tachyzoites/pseudocysts
Treatment: Pyrimethamine + Sulfadiazine + Folinic acid; Spiramycin (for pregnant women)

25. ONCOGENIC VIRUSES

RNA Oncogenic viruses:
  • HTLV-1: Adult T-cell leukemia/lymphoma
  • HCV: Hepatocellular carcinoma
  • HIV: Kaposi's sarcoma (indirect)
DNA Oncogenic viruses:
  • HPV (types 16, 18): Cervical carcinoma, oropharyngeal cancer - E6 (degrades p53), E7 (inactivates Rb)
  • HBV: Hepatocellular carcinoma - HBx protein
  • EBV: Burkitt's lymphoma (c-myc translocation), Nasopharyngeal carcinoma, Hodgkin's lymphoma, infectious mononucleosis, Post-transplant lymphoproliferative disorder
  • KSHV/HHV-8: Kaposi's sarcoma, primary effusion lymphoma
  • MCPyV (Merkel cell polyomavirus): Merkel cell carcinoma

26. VIRAL HEMORRHAGIC FEVERS (VHF)

Examples:
  • Dengue hemorrhagic fever (Flavivirus)
  • Yellow fever (Flavivirus) - Aedes aegypti; Councilman bodies in liver
  • Ebola/Marburg (Filovirus) - zoonosis from bats; person-to-person spread; BSL-4
  • Lassa fever (Arenavirus) - rodent reservoir
  • Crimean-Congo hemorrhagic fever (CCHF) - Nairovirus, tick-borne
  • Hantavirus - rodent reservoir, no person-to-person spread
  • Kyasanur Forest Disease (KFD) - Flavivirus, hard tick, India
Common features: Fever, hemorrhage (petechiae, ecchymosis, bleeding from orifices), thrombocytopenia, shock, high mortality
Lab: RT-PCR (gold standard), antigen detection, serology. BSL-3/4 required.

27. CONGENITAL RUBELLA SYNDROME

Virus: Rubivirus (Togavirus family), (+) sense ssRNA
Rubella in adults: Mild febrile illness, pink maculopapular rash (head to toe), post-auricular/suboccipital lymphadenopathy, polyarthralgia in women, Forchheimer spots (petechiae on soft palate)
Congenital Rubella Syndrome (CRS):
  • 1st trimester infection = highest risk (80%)
  • Classic triad: Sensorineural deafness (most common), Congenital heart defects (PDA, pulmonary artery stenosis), Cataracts/Ocular defects
  • Also: microcephaly, mental retardation, blueberry muffin rash, hepatosplenomegaly, thrombocytopenia
Lab Diagnosis:
  • IgM antibodies in neonate (indicates congenital infection)
  • Virus isolation from throat/urine/CSF
  • Hemagglutination inhibition (HI) test
Prevention: MMR vaccine (live attenuated) - contraindicated in pregnancy. Women of childbearing age vaccinated and advised to avoid pregnancy for 1 month.

28. SLOW VIRAL INFECTIONS / PRIONS

Slow Viral Infections:
  • Long incubation (months to years), progressive neurological disease, invariably fatal
  • Examples:
    • Subacute sclerosing panencephalitis (SSPE): caused by defective measles virus. Anti-measles antibodies in CSF. Periodic Ewing complexes on EEG.
    • Progressive multifocal leukoencephalopathy (PML): JC polyomavirus, HIV patients
    • HIV dementia
    • Kuru: prion disease
Prions:
  • Proteinaceous infectious particles - no nucleic acid
  • PrPc (normal cellular protein) → PrPsc (scrapie form - misfolded, beta-sheet conformation, protease resistant)
  • Diseases: Creutzfeldt-Jakob disease (CJD), variant CJD (vCJD - from BSE/mad cow disease), Fatal Familial Insomnia, Gerstmann-Straussler-Scheinker, Kuru, Scrapie (sheep)
  • Transmission: iatrogenic (contaminated neurosurgical instruments, corneal transplant, growth hormone), vCJD from eating infected beef
  • Histology: Spongiform encephalopathy (vacuolation), amyloid plaques, no inflammation
  • Resistant to autoclaving (need 134°C), formaldehyde, UV; inactivated by NaOH/bleach

29. NAEGLERIA FOWLERI

Primary Amoebic Meningoencephalitis (PAM):
  • Naegleria fowleri (thermophilic free-living amoeba) - same as Primary Amoebic Encephalitis
  • Transmission: swimming in warm fresh water → enters via cribriform plate → olfactory bulb → brain
  • Clinical: fulminant purulent meningitis, rapid deterioration, death in 3-7 days
  • CSF: neutrophilic pleocytosis, low glucose, trophozoites on wet mount
  • Treatment: Amphotericin B (drug of choice), Miltefosine; nearly always fatal

30. PNEUMOCYSTIS PNEUMONIA (PCP)

Causative agent: Pneumocystis jirovecii (previously P. carinii) - classified as fungus (based on rRNA), but behaves like protozoan
Opportunistic infection in AIDS (CD4 <200)
Clinical features: Subacute onset, dry cough, progressive dyspnoea, fever. CXR: bilateral diffuse ground-glass/interstitial infiltrates ("bat-wing" appearance).
Lab Diagnosis:
  • BAL (Bronchoalveolar lavage) or induced sputum
  • GMS stain (Gomori Methenamine Silver): cysts stain black, 4-6 cysts per cluster
  • Giemsa: trophozoites
  • Immunofluorescence - most sensitive
Treatment: Co-trimoxazole (TMP-SMX) - drug of choice; Pentamidine (alternative); Dapsone + Trimethoprim Prophylaxis: TMP-SMX when CD4 <200

🟢 PRIORITY 3 - MODERATE (Time Permitting)

31. HISTOPLASMOSIS

Causative agent: Histoplasma capsulatum (dimorphic fungus - mould in environment, yeast at 37°C in tissue)
Transmission: Inhalation of microconidia from soil contaminated with bird/bat droppings (Ohio/Mississippi River valley endemic)
Clinical features:
  • Asymptomatic (most)
  • Pulmonary histoplasmosis: flu-like, calcified granulomas
  • Progressive disseminated histoplasmosis: in AIDS (CD4 <150) - fever, weight loss, hepatosplenomegaly, mucosal ulcers
Micro: Small oval yeast (2-4 µm) inside macrophages (despite name, no capsule)
Lab Diagnosis: KOH mount and culture (Sabouraud's), urinary antigen test (most useful in disseminated), serology, skin test (histoplasmin)
Treatment: Mild: Itraconazole. Severe/disseminated: Amphotericin B → Itraconazole

32. ZYGOMYCOSIS / MUCORMYCOSIS

Causative agents: Rhizopus (most common), Mucor, Cunninghamella - Class Zygomycetes
Morphology: Non-septate (aseptate/coenocytic) hyphae with wide-angle (90°) branching - key difference from Aspergillus (septate, 45° branching)
Risk factors: Diabetic ketoacidosis (DKA) - most common, neutropenia, organ transplant, deferoxamine therapy
Clinical forms:
  • Rhinocerebral (most common): palatal necrosis (black eschar), proptosis, periorbital oedema → cavernous sinus thrombosis
  • Pulmonary
  • Cutaneous
  • Disseminated
Lab Diagnosis: KOH mount/histopathology: non-septate hyphae with right-angle branching; angioinvasion with thrombosis and infarction
Treatment: Amphotericin B (drug of choice) + surgical debridement; Posaconazole; treat underlying DKA

33. TRICHOMONAS VAGINALIS

Morphology: Pear-shaped, 4 anterior flagella + 1 posterior flagellum forming undulating membrane, axostyle, no cyst form
Transmission: Sexually transmitted only
Clinical features:
  • Females: frothy yellow-green vaginal discharge, "strawberry cervix" (colpitis macularis), dyspareunia, vaginal pH >4.5
  • Males: usually asymptomatic, mild urethritis
Lab Diagnosis:
  • Wet mount: motile trophozoites with rotary/tumbling motion - most practical
  • Culture: Feinberg-Whittington or Diamond's medium
  • NAAT (most sensitive)
Treatment: Metronidazole (treat both partners)

34. BORRELIA VINCENTI

Vincent's Angina (Trench mouth/Acute Necrotizing Ulcerative Gingivitis - ANUG):
  • Caused by Borrelia vincenti (spirochete) + Fusobacterium nucleatum (fusiform bacilli) - symbiotic pair
  • Clinical: painful necrotic ulcers of gums, foul smell, fever, lymphadenopathy
  • Lab: Smear from lesion - Gram stain shows gram-negative spirochetes + fusiform bacilli ("fusospirochetosis")
  • Treatment: Penicillin + Metronidazole, dental hygiene

35. JAPANESE B ENCEPHALITIS

Virus: Flavivirus, (+) sense ssRNA, enveloped
Vector: Culex mosquito (Culex tritaeniorhynchus) Reservoir/Amplifying host: Pigs and wading birds Transmission to humans: Accidental dead-end host
Clinical features: Most asymptomatic. Encephalitis: fever, headache, vomiting, altered consciousness, Parkinsonian features (tremors, mask-like face), seizures. Case fatality rate 20-30%.
Pathology: Neuronal necrosis with perivascular cuffing (lymphocytes) and glial nodules. Thalamus most affected (hemorrhagic).
Lab Diagnosis:
  • IgM in serum/CSF (ELISA) - diagnostic
  • RT-PCR
  • Virus isolation (suckling mice)
Prevention: SA 14-14-2 live attenuated vaccine (China), Inactivated mouse-brain derived vaccine (older), IXIARO (Vero cell inactivated vaccine). Mosquito control.

36. PARAGONIMIASIS

Causative agent: Paragonimus westermani (lung fluke)
Hosts:
  • Definitive host: Humans, cats, dogs
  • 1st intermediate host: Freshwater snail
  • 2nd intermediate host: Freshwater crab/crayfish
  • Infective stage: Metacercariae (in undercooked crab)
Life cycle: Metacercariae ingested → excyst in intestine → penetrate gut wall → peritoneum → diaphragm → pleura → lung parenchyma → adult worms in lung cysts
Clinical features: Chronic cough, rusty brown/blood-tinged sputum (golden-brown eggs in sputum), hemoptysis, pleural effusion. Cerebral paragonimiasis: seizures, visual disturbance.
Lab Diagnosis:
  • Microscopy: characteristic ova (golden brown, operculated with thickened rim opposite operculum) in sputum or stool
  • Serology: ELISA
Treatment: Praziquantel (drug of choice)

37. ANAEROBIC VAGINOSIS

Bacterial Vaginosis (BV):
  • Not true infection but dysbiosis - replacement of normal Lactobacillus flora by mixed anaerobes
  • Organisms: Gardnerella vaginalis (key), Mobiluncus, Prevotella, Mycoplasma hominis, Peptostreptococcus
Amsel's criteria (3 of 4):
  1. Homogeneous grey-white vaginal discharge
  2. Vaginal pH >4.5
  3. Positive whiff/amine test (10% KOH added → fishy amine odour)
  4. Clue cells (vaginal epithelial cells studded with bacteria) on wet mount
Treatment: Metronidazole (oral or intravaginal gel) or Clindamycin

38. SATELLITISM

Satellitism phenomenon:
  • Haemophilus influenzae requires both Factor X (hemin) and Factor V (NAD) for growth
  • Staphylococcus aureus produces Factor V (NAD) which it excretes extracellularly
  • When H. influenzae is streaked on blood agar (has Factor X but Factor V is destroyed by RBC phosphatases) and S. aureus is crossed:
    • H. influenzae grows only around S. aureus colonies = satellitism
  • Demonstration: streak S. aureus across blood agar, then H. influenzae across it → small colonies of H. influenzae only around S. aureus

39. ELEK'S GEL PRECIPITATION TEST

  • Tests toxigenicity of Corynebacterium diphtheriae in vitro
  • Method: Paper strip soaked in diphtheria antitoxin placed in center of special agar plate → test organism streaked at right angles to strip → toxin diffuses from organism, antitoxin diffuses from strip → precipitin line forms at 45° (line of identity) = positive for toxin production
  • Virulence test (alternative to guinea pig inoculation)

40. NON-GONOCOCCAL URETHRITIS (NGU)

Most common causes:
  • Chlamydia trachomatis (serovars D-K) - 50%
  • Mycoplasma genitalium - 20%
  • Ureaplasma urealyticum
  • Trichomonas vaginalis
Features: Mild urethral discharge (mucopurulent), dysuria. Gram stain: no intracellular diplococci
Complications: Epididymo-orchitis, pelvic inflammatory disease (in women), reactive arthritis (Reiter's syndrome: urethritis + conjunctivitis + arthritis)
Treatment: Doxycycline 100mg BD x 7 days or Azithromycin 1g single dose

41. TULAREMIA

Causative agent: Francisella tularensis - Gram negative coccobacillus, intracellular, BSL-3 agent, potential bioterrorism agent
Transmission: Tick bite (Dermacentor), handling infected rabbits/rodents (rabbit fever), inhalation, ingestion
Clinical types:
  • Ulceroglandular (most common): ulcer at inoculation site + regional lymphadenopathy
  • Glandular: lymphadenopathy without ulcer
  • Pneumonic: most severe, from inhalation
  • Oculoglandular: conjunctivitis + lymphadenopathy
  • Typhoidal: septicemia without local lesion
Treatment: Streptomycin or Gentamicin (first line); Doxycycline, Ciprofloxacin

42. INFECTION CONTROL

Standard Precautions (apply to ALL patients):
  • Hand hygiene (5 moments of WHO)
  • PPE (gloves, gown, mask, eye protection based on exposure)
  • Safe injection practices
  • Respiratory hygiene/cough etiquette
  • Safe handling of contaminated equipment
  • Environmental cleaning
Transmission-based precautions:
  • Contact precautions: MRSA, VRE, C. diff - gown + gloves
  • Droplet precautions: Influenza, meningococcal - surgical mask
  • Airborne precautions: TB, measles, chickenpox - N95 mask, negative pressure room

43. CEREBRAL MALARIA (see also Paper 1)

Causative agent: Plasmodium falciparum exclusively
Pathogenesis:
  • Infected RBCs express PfEMP1 (P. falciparum erythrocyte membrane protein) on surface
  • Cytoadherence to cerebral microvascular endothelium (ICAM-1, CD36 receptors)
  • Rosetting (infected RBCs bind uninfected RBCs) → microvascular obstruction
  • Sequestration in brain capillaries
  • Cytokines (TNF-alpha) → blood-brain barrier disruption
  • Hypoglycemia, lactic acidosis contribute
Clinical criteria (WHO): Unarousable coma with parasitaemia in absence of other cause
Treatment: IV Artesunate (drug of choice), IV Quinine (alternative); Dexamethasone - contraindicated (worsens outcome); treat complications (hypoglycemia, seizures, ARDS)

🔵 PRIORITY 4 - LOW YIELD / SHORT ANSWER (If Time Remains)

44. CONGENITAL RUBELLA SYNDROME - (covered in Priority 2 above)

45. ACUTE PYELONEPHRITIS - (covered under UTI in Priority 1)

46. RAPID PLASMA REAGIN (RPR) - (covered under Syphilis in Priority 1)

47. NEUROCYSTICERCOSIS - (covered in Priority 2 above)

48. YERSINIA PESTIS - same as Plague (covered in Priority 1)

49. BACILLUS ANTHRACIS / ANTHRAX

Morphology: Gram positive, large spore-forming bacillus (central/subterminal spore), capsule (poly-D-glutamic acid), non-motile, aerobic, "Medusa head" colonies on BA, "inverted fir tree" growth in gelatin stab
Virulence:
  • Capsule: antiphagocytic
  • Anthrax toxin = PA (Protective Antigen) + LF (Lethal Factor = Zn metalloprotease → MAPK pathway disruption) + EF (Edema Factor = adenylate cyclase → cAMP → edema)
Clinical types:
  • Cutaneous anthrax (most common - 95%): painless papule → vesicle → black eschar (malignant pustule). Malignant oedema around it. Mortality <1% with treatment.
  • Pulmonary/Inhalation anthrax (Woolsorter's disease): most lethal. Mediastinal widening on CXR. Hemorrhagic mediastinitis.
  • GI anthrax: ingestion of infected meat, haemorrhagic ascites
Treatment: Ciprofloxacin or Doxycycline (100% susceptible to penicillin naturally, but engineered resistance possible)

50. CRYPTOCOCCAL MENINGITIS (See under Bacterial Meningitis, Priority 1)

QUICK REFERENCE - IMPORTANT MNEMONICS & FACTS

Safety-pin staining organisms: Yersinia pestis, Burkholderia pseudomallei, Klebsiella rhinoscleromatis
Obligate intracellular parasites: Viruses, Chlamydia, Rickettsia, Coxiella, Plasmodium, Toxoplasma, Leishmania
Organisms with no cell wall: Mycoplasma, Ureaplasma, Chlamydia (intracellular), L-forms
Thermophilic organisms: Naegleria (free-living amoeba), Legionella (hot water systems)
Organisms with biphasic growth (dimorphic fungi): Histoplasma, Blastomyces, Coccidioides, Paracoccidioides, Sporothrix - "HBCPS" - mold at 25°C, yeast at 37°C (except Coccidioides = spherules)
Organisms diagnosed by India ink: Cryptococcus neoformans
Organisms with capsule: S. pneumoniae, N. meningitidis, K. pneumoniae, H. influenzae type b, Cryptococcus, Bacillus anthracis (poly-D-glutamic acid)
That is the complete Paper 2 cheat sheet, priority-wise. Summary of the structure:
  • Priority 1 (do first): TB, Bacterial Meningitis, Rabies, Gonorrhoea/STIs, Syphilis, Tetanus, Streptococcus pyogenes, Diphtheria, Polio, Influenza/H1N1, Echinococcus, UTI/Pyelonephritis, COVID-19, Aspergillosis, Plague
  • Priority 2 (important): RPR, Chancroid, LGV, Neurocysticercosis, Brucellosis, Mycoplasma pneumonia, Pertussis, Mumps, Toxoplasma, Oncogenic viruses, VHFs, Congenital Rubella, Slow viruses/Prions, Naegleria, PCP
  • Priority 3 (moderate): Histoplasmosis, Zygomycosis, Trichomonas, Borrelia Vincenti, JE, Paragonimiasis, BV, Satellitism, Elek's test, NGU, Tularemia, Infection Control, Cerebral Malaria
  • Priority 4 (short/low yield): Anthrax and remaining short topics
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