3: Resp ID 2

Question 1

Most common cause of bronchitis (general)

Answer 1

Mainly viral esp common cold viruses and flu. Bacterial 2* infections possible

Question 2

What is bronchiolitis? Most common cause?

Answer 2

Viral infection in infants. RSV.

Question 3

Most common cause of pertussis (general)

Answer 3

Bacterial infection, >90% B. pertussis

Question 4

Most common cause of pneumonia (general)

Answer 4

Various: viral (more common in children), bacterial, fungal.

Question 5

Presentation of bronchitis

Answer 5

Cough, fever, CP. Preceeding common cold signs.

Question 6

CXR of bronchitis

Answer 6

Usually no consolidations or infiltrates

Question 7

Etiology of bronchitis

Answer 7

Usually after viral URI that spreads down to trachea, bronchi and bronchioles (not alveoli) -> hacking cough, some sputum

Question 8

Bronchitis treatment

Answer 8

Usually self-limited. If >14 d w fever and purulent sputum, likely bacterial -> culture, abx (usually erythromycin or azithromycin)

Question 9

Classification of rhinovirus

Answer 9

Class IV: ssRNA+ nonsegmented, icosahedral, non-enveloped, picornaviridae family

Question 10

Classification of paramyxovirus (parainfluenza virus)

Answer 10

Class V: ssRNA- nonsegmented, helical, enveloped, paramyxoviridae family

Question 11

Classification of Mastadenovirus

Answer 11

Group 1: dsDNA, icosahedral, non-enveloped, adenoviridae family

Question 12

Staining of mycoplasma pneumoniae. What are mycoplasma?

Answer 12

Lack cell wall = not gram pos or neg.

Question 13

Classification of chlamydia pneumoniae (general)

Answer 13

Bacteria, does not gram stain (not + or -). Obligate intracellular parasite, replicate within inclusion bodies

Question 14

Most common causes of atypical pneumonia (4)

Answer 14

Mycoplasma, legionella, chlamydia, viruses

Question 15

Most common cause of pneumonia in adults 18-40

Answer 15

Mycoplasma, Chlamydia pneumoniae, S. pneumo

Question 16

Dx of bronchiolitis

Answer 16

Infant (narrow airways) Rule out pneumonia via CXR + clinical signs and symptoms, usually preceeding viral URI. Test for RSV antigen.

Question 17

Treatment of bronchiolitis

Answer 17

May need O2. In high risk patient (pre-mature, congenetic abnl): passive immunization with anti-RSV antibodies

Question 18

Most common cause of bronchiolitis (3)

Answer 18

Paramyxovirus (parainfluenza), RSV, Mastadenovirus

Question 19

Bronchiolitis is inflammation of the bronchial tree as low as ___

Answer 19

bronchioles (not alveolar involvement)

Question 20

Symptoms of Pertussis

Answer 20

2 distinct symptom phases + convalescent phase

Question 21

First stage of pertussis infection

Answer 21

Incubation 3-21d then catarrhal stage: cold sx esp rhinorrhea, 1-2 weeks

Question 22

Second stage of pertussis

Answer 22

Paroxysmal stage: severe, uncontrollable coughing -> burst blood vessels in eye, vomiting, seizures from small brain hemorrhages

Question 23

What is the pertussis toxin? What does it cause in the body?

Answer 23

AB toxin: B binds, A enters -> enzymatic act -> lots of cAMP ->mucus production -> cough. Tracheal cytotoxin (separate entity) kills ciliated cells.

Question 24

Classification of B. pertussis (gram and shape)

Answer 24

Gram - pleomorphic coccobacilli

Question 25

How is pertussis grown in the lab?

Answer 25

Bordet-Gengou Agar -> selective growth of Bordetella spp. Uses horse blood, beef extract, gelatin peptone, starch, charcoal, niacin

Question 26

Most common causes of meningitis in children 6 mo - 6 years (3)

Answer 26

S. pneumo, N. meningitidis, H. flu type B (dec w Hib vaccine)

Question 27

Most common cause of pneumonia in adults 40-65

Answer 27

S. pneumo, H. flu, Legionella

Question 28

Most common cause of pneumonia 65+

Answer 28

S. pneumo, gram neg rods, H. flu

Question 29

Most common cause of meningitis in 60+

Answer 29

S. pneumo, gram neg rods, Listeria

Question 30

How is the influenza virus' genome and replication conducive to its survival?

Answer 30

High error rate of polymerase -> many mutations + segment swapping in individuals infected with 2 strains at once

Question 31

How is hemaglutinin utilized by the influenza virus?

Answer 31

Hemaglutinin: viral surface protein that allows it to attach to the sialic acid on the host cell -> endocytosis

Question 32

How is neuraminidase utilized by the influenza virus?

Answer 32

Cleaves hemaglutinin bound to sialic acid allowing for viral spread

Question 33

What is antigenic shift?

Answer 33

Major changes in antigens occur due to gene reassortment in the influenza virus

Question 34

What is antigenic drift?

Answer 34

Minor changes in antigens occur due to gene mutation in influenza virus.

Question 35

What is the significance of influenza's ability to infect birds, pigs, and other animals?

Answer 35

E.g. infection of pig with human and bird version results in reassortant virus particle via mixing of segments -> attacks new hosts

Question 36

Why are new strains of influenza particularly concerning

Answer 36

Tend to have increased mortality rates due to lack of adaptive immune response

Question 37

What is influenza reassortment? What group is most susceptible?

Answer 37

Human, swine, and avian segments are swapped leading to new assortments that have not hit humans before -> inc mortality. Pregnant women.

Question 38

How is each season's flu vaccine produced

Answer 38

Worldwide surveillance for prevalent strains -> infect chicken eggs (rapid growth) -> inactivated. Made 6 mo ahead of season

Question 39

Classification of Respiratory syncytial virus

Answer 39

Class V: ssRNA-, helical, enveloped, paramyxoviridae family -pneumovirus group - RSV

Question 40

Most common cause of pneumonia in young children (2)

Answer 40

RSV, parainfluenza virus

Question 41

Most common causes of aseptic meningitis (3)

Answer 41

Coxsackievirus, echo, mumps virus

Question 42

Most common causes of palm and sole rash

Answer 42

Syphilis, RMSF, Coxsackie

Question 43

Most common causes of conjunctivitis

Answer 43

H. flu, Adenoviruses, S. pneumo

Question 44

What is the convalescent stage of pertussis?

Answer 44

bacteria decreasing -> no ongoing symptoms BUT cilia of epithelial cells are recovering weeks to months (suscept to 2* infection)

Question 45

Classification of s. pyogenes inc __ hemolytic and bacitracin ___.

Answer 45

Gram + cocci, catalase neg, beta hemolytic, bacitracin sensitive

Question 46

Classification of H. flu

Answer 46

gram neg coccobacilli (pleomorphic), X & V factors required

Question 47

S. pneumo classification including sensitivities

Answer 47

Gram + diplococci, catalase neg, alpha hemolytic, bile-esculin neg, optochin susceptible

Question 48

How does the neuraminidase receptor evade immune detection over time?

Answer 48

Constantly changes sequence of exposed regions where antibodies bind while keeping the binding sites at a low rate of mutation

Question 49

Classification of S. agalactiae including bacitracin sensitivity

Answer 49

= GBS. Gram pos cocci, catalase neg, beta hemolytic, bacitracin resistant.

Question 50

N. asteroides classification

Answer 50

Gram + beaded filaments, weakly acid fast, obligate aerobe

Question 51

2 clinically relevant acid-fast staining organisms

Answer 51

Nocardia and mycobacteria

Question 52

Which bacteria resemble fungi (2)? How can they be differentiated?

Answer 52

Nocardia, Actinomyces israelii. A. israelii forms sulfur granulus and is not acid-fast.

Question 53

Pneumonia with rust-colored or currant jelly sputum suggests ___

Answer 53

More invasive microorganism, Klebsiella or strep pneumo both capable. Klebsiella is more invasive.