ClinLab 3 Quizlet Flashcards
What is the standard for collecting blood cultures?
1 set= 1 aerobic, 1 anaerobic bottle, different sites/time, no more than 4 sets in 24 hrs
What kind of sample should be collected if there is suspected bacteremia, endocarditis, or sepsis?
Blood culture
A throat swab is primarily done to look for which organism?
Group A streptococcal pharyngitis
Neisseria Gonorrhoeae
A nasopharyngeal swab is primarily done to look for what organism?
MRSA
If you are culturing one of these organisms from respiratory swabs, you will need special media
Bordatella
Corynbacterium
Neisseria
Critical or Panic Values
Organisms in CSF or joint fluids, positive cryptococcal antigens, positive AFB smear, positive blood cultures, positive CSF cultures, isolation of M. tuberculosis, positive eye cultures P. aeruginosa or Bacillus, positive blood films for Plasmodium, or isolation of E. coli O157:H7
Diagnosis of viral respiratory infections, measles, C trachomatis pneumonia in infants, diphtheria, and pertussis are done by which collection method?
Nasopharyngeal aspirates, washings, and swab specimens
Suspected pneumonia is diagnosed by which sample collection methods?
Sputum and tracheal aspirates (first morning sputum is best)
What are the three main culprits for bacterial diarrhea?
Salmonella
Shigella
Campylobacter
What are the most prevalent drug resistant organisms?
Acinetobacter baumannii
Pseudomonas aeruginosa
MRSA
Which immunoglobulin will be present during a current infection (acute and convalescent) and a previous exposure, and can result due to having an infection or the vaccination?
IgG
A 4-fold increase in a titer indicates what?
Acute infection
If a day 5 titer reads 1:4 and then the day 12 titer reads 1:64, what does that indicate?
Primary response
Which type of Hepatitis is mostly chronic due to timing of catching the infection?
Hepatitis C
Which type of hepatitis is transmitted by the fecal-oral route, and is self-limiting so it does not result in chronic infection or liver disease?
Hepatitis A
What serum marker will turn negative in an acute Hep B infection with the development of Anti-HBs, but will remain consistently positive in a chronic infection?
HBsAg
What does the presence of Anti-HBs indicate?
HBV infection or vaccination
What serum marker comes from a portion of the viral core and shows the HBV is replicating actively and is infectious?
HBeAg
What does the presence of HBV DNA in the blood indicate and what is it used for?
Active infection (acute or chronic) used to monitor viral load
What serum marker for Hep B quickly degenerates in serum and is not measurably detectable?
HBcAg
What is the screening tool for Hep C?
EIA Assay
What is the confirmatory test for Hep C?
RIBA
What is the criteria for uncomplicated cystitis?
Healthy woman (over age 12), non-pregnant, no fever, nausea, vomiting, or flank pain and diagnosed by dipstick
What is the criteria for complicated cystitis?
Females w/ comorbidites
All males
Catheters/Hospitals
(May need urinalysis and culture)
What organism presents in urethritis with pyuria but no bacteria?
Chlamydia Trachomatis
Which results will be positive in a urinalysis when screening for a UTI?
Nitrite and Leukocyte (WBC) esterase
positive urine casts if there is kidney involvement
What are the two most common causes of UTIs in females? Males?
Females: E. Coli, Staph saprophyticus (young, sexually active females
Males: Enterobacteriaceae
S/Sx- sterile culture, discharge, dysuria, frequency
What are the most common pathogens for cystitis, prostatitis, and pyelonephritis?
E. Coli Staph saphrophyticus Proteus mirabilis Klebsiella Enterococcus
Which test can detect both Chlamydia and Gonorrhea simultaneously?
Nucleic acid amplification (PCR)
What are the most common pathogens for urethritis?
Chlamydia
Gonorrhea
What are some of the conditions that can result from untreated cervicitis?
Endometritis
PID
HIV
What causes for vulvovaginitis will present with a positive amine test?
Trichomoniasis
Vaginosis
An infection that presents with copious amounts of frothy green/yellow/gray discharge, a motile organism, increased vaginal pH, strawberry cervix, and vaginal soreness is indicative of which condition?
Trichomoniasis
An infection that presents with slightly malodorous gray white discharge, often asymptomatic, but have an increased vaginal pH of >4.5 and a positive amine test is indicative of which condition?
Bacterial vaginosis
What stage of syphilis presents with rashes on the palms and soles?
Secondary
What cause for vulvovaginitis presents with a normal pH?
Candidiasis
An infection presenting with intense perivaginal itching/burning, thick white cottage cheese texture that is odorless and adherent to vaginal walls, dysuria, and a normal vaginal pH is indicative of which condition?
Candidiasis
What stage of syphilis is asymptomatic and non-contagious?
Latent
What is a very sensitive and specific test for Herpes?
Viral PCR
Which disease is caused by a virus that presents as warts, can cause cervical cancer (Types 16, 18, 31, 33, 35), and is diagnosed by an “anogenital” PAP smear?
HPV
What test for syphilis uses RPR, is sensitive but not specific, and requires a titer determination?
Non-treponemal test (Screening)
Which disease is marked by painful ulcers in the genital region, tender inguinal lymphadenopathy, and a school of fish/railroad track smear morphology?
Haemophilus ducreyi
What is the proper criteria for testing HIV if there is a positive result?
Positive ELISA specimen: re-run Positive 2nd ELISA: notify individual (face to face) and submit second blood specimen for Western Blot
If positive: notify of confirmed HIV and status
If negative: request a third blood specimen
If 3rd specimen positive HIV is confirmed
What is the proper criteria for testing HIV if there is a positive result?
What is the typical culprit of endocarditis in healthy cardiac valves with a catheter?
MRSA
What testing is done when a patient is confirmed HIV positive?
Baseline viral load
CD4 level
Screen for TB, HBV, HCV
Splinter hemorrhages, Roth spots, Osler nodes, clubbing of the digits, and Janeway lesions on palms and soles, elevated WBCs on a CBC, elevated C Reactive protein, and elevated ESR values are all signs of which infection?
Endocarditis
What is HACEK?
A group of organisms that commonly infects pediatric patients with endocarditis (Haemophilus species, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella)
What is the causative agent for bacterial pharyngitis as well as scarlet and rheumatic fever?
Group A Strep
Which type of specimen is best for identifying B. pertussis?
Nasopharyngeal swab
What is the typical culprit of sub acute endocarditis in damaged cardiac valves?
Strep viridans
Which type of specimen is best for culturing viruses in URIs?
Nasopharyngeal wash
What is the recommended test for influenza?
PCR (Viral culture is gold standard for screening test and public health surveillance
Which organisms are most likely to cause bacterial pharyngitis (swollen uvula w/ white spots, gray furry tongue)?
Group A Strep
M. Pneumoniae
What is the typical culprit of prosthetic valve endocarditis?
Staph epidermidis
What are the diagnostic tests for Strep pyogenes (strep throat, scarlet fever, and rheumatic fever), which are GP cocci in chains?
Screening- Rapid antigen test takes 30 mins; Confirmatory- Throat culture is gold standard, follow up a negative rapid Ag test in children; Serology- Used to diagnose ARF
What are the diagnostic tests used to identify streptococcal pharyngitis?
Rapid antigen test (screening)
Throat culture (gold standard, confirm)
Serology (diagnose ARF)
What type of pharyngitis presents more in young adults with slow progression and what are the main causative agents?
Viral:
Epstein Barr
Adeno
Coxsackie A- vesicles
Which bacterial infection presents as an inflammatory disease that can affect the heart, joints, skin, and brain about 20 days after having strep throat or scarlet fever?
Rheumatic Fever
Which illness presents with dysphagia, drooling, and distress, muffled speech, “hot potato” voice, and is usually caused by Haemophilus influenzae type B?
Epiglottittis
Which illness presents as a thick, pseudo-membrane that covers tonsils, throat, and uvula with a sudden onset of malaise, sore throat, pharyngitis, and swollen lymph nodes that give a “bull-neck” appearance, and is diagnosed by nasopharyngeal swab?
Diptheria
Which illness presents with cold like symptoms and a “whooping” cough in severe bouts (paroxysms) and is diagnosed with nasopharyngeal swab?
Pertussis
What is the diagnostic screening test for strep pyogenes?
What is the gold standard test?
Rapid antigen test
Throat culture
Which illness is common in children (usually 3 months-5 years), caused by the parainfluenza virus, and presents with inspiratory stridor, barking cough, symptoms worse at night, and is diagnosed by a nasal wash?
Laryngotracheobronchitis (Croup)
What are the main culprits of swimmer’s ear?
P. aeruginosa
Aspergillus
A food borne that presents within 1 hour is usually indicative of what?
Ingestion of a chemical
What are the most common organisms responsible for pneumonia?
Children: RSV, parainfluenza, adenovirus
Young: M. Pneumoniae
Adult: S. pneumoniae
A food borne illness that presents within 1-6 hours is usually indicative of what?
Preformed toxin ingestion
B. Cereus, C. botulinum, C. Perfringens
A food borne that presents within 8-16 hours is usually indicative of what?
Clostridium perfringens
Enterotoxin-producing strains of Bacillus cereus
Which infectious type of diarrhea is characterized by watery, high volume, low frequency, small bowel, fecal leukocyte negative results, and is usually self-limited and caused by viral organisms, Giardia, Vibrio, or E coli?
Secretory diarrhea
Which type of infectious diarrhea is characterized by mucus and PMNs, positive for fecal leukocytes, low volume but high frequency, is in the large bowel, and has a longer duration?
Inflammatory diarrhea
Which type of infectious diarrhea is characterized by bloody stool, positive for fecal leukocytes, low volume but high frequency, is in the large bowel, usually is caused by E coli O157:H7, and has a longer duration with complications?
Hemorrhagic diarrhea
What are the main organisms that produce toxins and invade tissue in a gastrointestinal infection?
Vibrio parahemolyticus
Yersinia enterocolitica
What is fecal occult blood an indicator of?
Colon cancer
What test is used to determine inflammatory vs. noninflammatory diarrhea?
Fecal leukocytes
What are some of the conditions that you will see a large number of WBCs in the stool?
Chronic bacillary dysentery
Chronic ulcerative colitis
Colonic abscess
What disease shows monocytes on a fecal leukocyte test?
Typhoid fever
What is the protein released by neutrophils that is an indicator of intestinal inflammation?
Lactoferrin
Stool pH less than 5.5 indicative of:
Carbohydrate absorption abnormality
A high stool pH may be associated with:
Colorectal cancer
What is used to test stool pH?
Nitrazine paper
When is a stool culture warranted for diarrhea?
Bloody
>3 days
Prolonged w/ History of travel
What are the organisms that are tested for on the extended stool culture?
Vibrio cholerae
Yersinia enterocolytica
E. Coli
What are the top 3 parasitic infections for the GI tract?
Giardia
Cryptosporidium
Entamoeba
What assay is performed for all cases of bloody diarrhea?
Shiga toxin
What test is performed for organisms that may be difficult or slow to culture?
PCR
What organism would you suspect in a patient with diarrhea after eating rice/Chinese restaraunt?
Bacillus cereus
Which bacterial infection of infancy is associated with ingestion of honey?
Clostridium botulinum
Presents w/ flaccid paralysis and intoxication
Which bacterial infection is associated with traveler’s diarrhea?
ETEC
Which bacterial infection is associated with hemolytic uremic syndrome?
EHEC
What bacterial is commonly associated with ingestion of undercooked poultry and unpasteurized milk?
Campylobacter jejuni
What bacteria is associated with flu-like symptoms and meningitis from unpasteurized cheese or lunch meat?
Listeria monocytogenes
What parasite is associated with bulky diarrhea, fatty, yellow stools?
Giardia lamblia
What parasite is associated with dysentery, liver abscess, and intestinal blockage and shows trophozoite ingested RBCs on O&P?
Entamoeba histolytica
What type of arthritis is purulent and typically a collection of pus inside the joint of wrist, fingers, ankles and toes?
Non-gonococcal
What organisms are mainly associated with artificial joint arthritis?
Staph aureus
Staph epidermidis
Which type of osteomyelitis is caused by S. Aureus or streptococcus?
Acute
Which type of osteomyelitis is caused by Enterobacteriaceae (usually in diabetic ulcers)?
Chronic
What is the lab work up to diagnose osteomyelitis?
Blood cultures, bone biopsy, CBC, CRP, ESR, and needle aspiration of affected area
Multinucleated giant cells with a Wright or Giemsa stain on a Tzanck smear are a sign of which condition?
Herpes infection
What lab test is used to diagnose a viral agent by using wright or gives a stain?
Tzanck Smear
What is the syndrome caused by S. Pyogenes that causes superficial cellulitis with shiny, raised, indurated and tender plaque-like lesions with distinct margins?
Erysipelas
What are the causative agents for impetigo?
S aureus
MRSA
S pyogenes
What is a bacterial invasion into the subcutaneous tissue with rapid spread through superficial and deep fascial planes aided by toxins and enzymes causing necrosis, caused by S pyogenes or S aureus?
Necrotizing fasciitis
Which condition infects the superficial layers of the skin, is nonfollicular, progresses to a honey colored crusted vesicle, and is caused by S aureus (bullous), MRSA, or S pyogenes (non-bullous)?
Impetigo
What is the gram stain characteristic of clostridial infection?
GPR and NO PMNs
What is characterized by scabs/vesicles/pustules on the trunk that are contagious before they appear?
Varicella Zoster
Which condition is characterized by rash, Koplik spots, red eyes, and photophobia, fever greater than 101, lasts for at least 3 days or long, is spread by contact with droplets and can be isolated from the throat, urine, and nasal specimens?
Rubeola (Measles)
Which condition is characterized by a fever greater than 99 degrees, headache, runny nose before the rash appears but lasts 3 days or less, and is a severe congenital infection that can be isolated from the nose, throat, urine, CSF, and blood?
Rubella (German measles)
Which infection usually affects children by the age of 2 that is caused by HHV6 or HHV7, is characterized by a high fever followed by a pink/rose-colored rash, swollen lymph nodes, and is diagnosed by serology?
Roseola
What are the three major causes of bacterial meningitis?
Strep pneumoniae
Neisseria meningitidis
Haemophilus Influenzae
What kind of meningitis do you see 200-20,000 PMNs, low glucose, high protein in CSF?
Bacterial
Which type of meningitis is usually mild/self-limiting, presents with lymphocytes, normal glucose, and high protein in the CSF?
Viral meningitis
Which type of meningitis has a gradual onset, will have lymphocytes (100-1000), low glucose, and high protein in the CSF, and is usually found in immunocompromised patients?
Fungal meningitis
What microorganism causes aseptic meningitis?
Enterovirus
Which type of meningitis will have a CSF analysis with 100-1000 eosinophils, normal-low glucose, and high protein?
Parasitic meningitis
What is the primary cause of parasitic meningitis?
What are the other two causes?
Naegleria fowleri- warm fresh water causing Primary Amebic Encephalitis
Taenia Solium- seizures and Ca lesions
Toxoplasma gondi- abscess and encephalitis
Which type of meningitis is characterized by hydrocephalus, non-specific signs and symptoms, and is caused by slow-growing organisms?
Chronic
Which condition is brain swelling characterized by confusion, personality changes, altered mental status, seizures, and is caused by a virus that triggers the inflammation?
Encephalitis
Which organism lives in lung tissue and is reactivated during times of immunosuppression, is transmitted by respiratory droplets, and causes TB meningitis in children and AIDS patients?
Mycobacterium tuberculosis
What standard tests are performed on the tubes for CSF analysis?
Tube 1: glucose and protein
Tube 2: cryptococcal antigen, gram stain, cultures
Tube 3: hematology, cell count and diff
Tube 4: immunology, serology
What is very high in bacterial meningitis CSF sample?
Protein
What is the gold standard for bacterial meningitis diagnosis?
Culture
What organism uses a capsule, fimbriae, and IgA protease transmitted through respiratory droplets in close quarters to cause meningitis?
Neisseria meningitidis
What organism is characterized by intracellular survival in phagocytic cells and especially affects the pregnant and immunosuppressed?
Listeria monocytogenes
Which organism is transmitted through exposure to deer ticks, changes the outer surface proteins, and causes facial palsy?
Borrelia burgdorferi
Which fungi affects primarily AIDS patients (considered an AIDS defining illness), and causes meningitis?
Cryptococcus neoformans
What can result in a patient with an untreated treponema pallium infection?
Neurosyphilis
Which organism is found in cat feces and raw meat that often affects pregnant mothers or newborns or AIDS patients, and causes encephalitis and abscesses?
Toxoplasma gondii
If TB is suspected, which test should be performed?
Obtain early morning sputum specimens for 3 consecutive days for smear and culture
Results in 6-8wks
Which tests are used to detect latent TB infections?
TST
IGRA
What test for TB can give false positives for BCG vaccinated patients and environmental non-tuberculosis mycobacteria?
TST
What is usually negative in Active TB in a late HIV infection?
Tuberculin skin test
What type of malaria is most common?
Most deadly?
P vivax
P falciparum- cerebral malaria
What are the two most important pieces of information to account for in a malaria infection?
Travel history
Periodicity of fevers spikes
Continual fevers with irregular spikes in a 36 hr cycle, CNS changes, respiratory distress, bleeding, circulatory collapse, fatigue, malaise, and possible hepatic involvement are all signs of what?
P. Falciparum malaria
What is the gold standard for parasite detection for malaria?
What is the gold standard for speciation for malaria?
Thick blood smear
Thin blood smear
Both best taken AFTER fever spike
When testing for malaria does a single set of negatives rule out malaria?
No, additional specimens 12hr intervals for 36hrs
What is the organism responsible for “wool sorter’s disease”
Bacillus antracis
What is characterized by a black scab (eschar), blister or ulcer, or a widened mediastinum, depending on the type?
Anthrax
Which disease is also known as Rabbit fever, caused by direct contact through a break in the skin with an infected animal, and causes ulcers, chills, fever, joint stiffness, and requires a blood culture to diagnose?
Tularemia
What diseases shows flu-like symptoms with undulant fever?
Brucellosis
Bang’s Dz
Malta fever
Which organisms are included in a toxin assay?
Shiga toxin (Shigella), C diff, and Botulinum toxin
What is the most common cause of meningitis in AIDS patients?
Cryptococcus neoformans
What are the most common causative agent of subacute infectious endocarditis?
Strep viridans
What is the most common causative agent of acute infectious endocarditis?
MRSA
What respiratory pathogen presents with spherules in tissue, mold with arthroconidia, flulike illness with pneumonia?
Coccidiodes immitis
What respiratory pathogen presents as encapsulated round yeast and pneumonia that precedes meningitis?
Cryptococcus neoformans
What respiratory pathogen presents as pneumonia with clusters of 4-6um cysts in tissue and secretions, effecting immunocompromised individuals?
Pneumocystis jiroveci
What parasite is associated with watery diarrhea, dehydration, weight loss and stomach cramps from a contaminated water source and shows with an acid fast cell wall?
Crypto parvum
What kind of infection in pediatric patients causes a/febrile with non-bloody diarrhea?
Viral
What kind of infection in pediatric patients causes afebrile with bloody diarrhea?
Bacterial w/ complications
What kind of infection in pediatric patients causes febrile with bloody diarrhea?
Bacterial
What samples need to be refrigerated if their delivery to the lab is delayed?
Respiratory specimens
Urine
Sputum
Stool
What samples need to be maintained at room temps if their delivery to the lab is delayed?
Body fluids
Blood cultures
CSF
What special transport medias are used for viruses, stool and stool parasites?
Virus- viral transport media
Stool- Cary-Blair media
Parasites- Formalin and Polyvinyl Alcohol
What are the criteria for the labs to reject samples?
What is the exception?
Improper labels
Wrong specimen container
Leakage or unsuitable specimen
Duplicates- exception for blood cultures for endocarditis
What facial infection can kids get from oral transmission?
Herpes Whitlow
Impetigo
Roseola
When treating gonnorhea, what else is always treated?
Chlamydia
What 3 findings will be seen on a UTI PE?
+ CVA pyelonephritis
urethral discharge
tender prostate
All PTs w/ confirmed/suspected urethritis are tested for G/C but also ?
HIV
S/Sx of Vaginosis
ASx or abd pain White/gray d/c pH >4.5 \+ amine test Clue cells/neg KOH
S/Sx of Trichomoniasis
Sore, dysparenia Green/yellow/frothy pH 5-6 Amine + Trichomonads/neg KOH
S/Sx of Candidiasis
Pruritis, sore, dysparunia Clumpy adherent d/c pH 4-4.5 No amine test Pseudohyphae
What is normally seen on a saline wet prep in a normal vaginal smear?
Lactobacilli
What are the stages of syphilis and what occurs in each stage?
Primary- contagious, painless chancre
Secondary- contagious, wks/mons after primary w/ rash
Latent- ASx, not contagious, + serology
Late/Tertiary- Sx, no contagious AKA benign tertiary sysphilis, cardiovascular syphilis or neurosyphilis, tabes dorsalis
What are the syphilis screenings?
Non-treponemal
RPR, VDRL
What are the syphilis confirmations?
Treponemal tests
FTA-ABS
MHA-TP
TP-PA
What is the triad of screenings, confirmation and interpretations of syphilis testing?
+ screen + confirm= active
+ screen - confirm= false pos
- screen + confirm= spirochete or previous infection
4x decline of titer in syphilis treatment = ?
4x increase = ?
Response to therapy
Treatment failure
What are the low/high sensitivity tests for HSV?
Low- direct detection= Tzanck, rapid Ag
High- semi-direct= DFA
Culture- gold standard
When is Herpes viral PCR best used?
CSF testing of neonate w/ encephalitis
What are the stages of LGV?
Chlamydia Trachomatis in S America
1- lesion, papule or ulcer
2- lymphadenopathy w/ “groove sign”
Characteristics of Donovanosis
Granuloma Inguinale Klebsiella Tropics, rare in US Painless beefy granulomatus ulcer Mononuclear cells w/ cytoplasmic vacuoles packed w/ bacteria- Donovan Bodies
What medication is approved by FDA for HPV treatment?
Gardasil
What makes up the Dx of PID?
Endometriosis Salpingitis Tuboovarian abscess Pelvic peritonitis Usually as a complication of cervicitis
What is the confirmatory test for HIV 1 and HIV 2
1= Western Blot 2= Bio-Rad multispot
What tests are Western Blots good for confirmatory results?
HIV EIA
HCV for RIBA
Burgdorferii
Characteristics of Acute Infectious Endocarditis
Acute ABE rapid- septicemic episode on healthy cardiac valves(catheter) from Staph A (MRSA)
IVDU- MRSA in tricuspid valve
Characteristics of Subacute Infectious Endocarditis
Gradual infection in damaged valves with congenital, sclerotic or RF damage from Strep V group or intestinal flora S Bovis which suggests intestine CA or from Staph A
How do you tell if an endocarditis positive blood culture is significant
Correlates to organism Coag neg staph are significant in artificial valves Multiple cultures + for same organism Shorter incubation Degree of severity
What organisms are most commonly isolated from endocarditis blood cultures?
Acute- Staph A Sub acute- Strep Viridan Prosthetic- Staph Epidermis Gram Neg Bacilli Enterococci
What are the common organisms that cause endocarditis but are culture negative?
Aspergillus Brucella Coxiella Burnetti Chlamydia HACEK
What is the most common place for infectious agents to gain access to the body?
Respiratory tract
What microbes cross over into warmer/summer months?
Rhino Enterovirus Adeno PIV 2 3 MPV
What 3 viruses make up the common cold?
What is unique about this triad?
Rhino
Corona
Adeno
Most frequent human Dz from contact w/ infected mucoids
S/Sx of URI vs Influenza
URI- hacking cough, rare HA
Flu- Dry cough, HA, fever, malaise, myalgia
S/Sx of allergies that are different from URIs and Influenza
Itchy watery eyes
Sneezing
Never fever
Never myalgia
What type of pharyngitis needs to be evaluated and what kind needs to stay home
Bacterial- to clinic
Viral- stay home and gargle salt water
S/Sx of non-bacterial/viral pharyngitis
S/Sx of bacterial?
Red swollen tonsil
Red throat
Swollen uvula
Gray furry tongue
White spots on tonsils
S/Sx of Strep Pyogenes
Scarlet fever
Strawberry tongue
How do you tell a Mycoplasma Pneumoniae pharyngitis from GAS infection?
Cough
What are the 3 stages of pertussis?
Catarrhal- most infectious, common cold-like
Paroxysmal- whooping and mucus
Convalescent- reduced paroxysms and secondary complication
Otitis media is always accompanied by ?
Viral URI
What agents cause otitis media?
Strep Pnemo Pseudomonas Aeur. H. Influenza Moraxella Catarrhalis RSV Picornavirus
What micrboes cause furunculosis in otitis externa?
GAS
What type of bacterial pneumonia occurs in epidemics?
Staph A
What type of bacterial pneumonia affects alcoholic, DM and nosocomial infections?
Klebsiella
What type of bacterial pneumonia affects CF or ventilated PTs?
Pseudo. Aeurginosa
What type of bacterial pneumonia affects young adults in summer or fall?
Mycoplasma pneumonia
What type of bacterial pneumonia affects AIDS ans suppressive therapy PTs?
Pneumocystitis jiroveci
Lab work ups for pneumonia include gram stain and UA for ? microbes?
Strep pneumo
Legionella
What does rust color, currant jelly and foul smelling sputum mean?
Rust- S Pneumo
Currant- Klebsiella
Foul- anaerobic infection
Fungal infection of bats and birds
Histoplasmosis
Fungal infection of wood and soil
Bastomycosis
Fungal infection of SW US, desert soil and rodent burrows?
Coccidioidomycosis
What opportunistics infection can pass through milk, urine and feces?
Q fever
What respiratory bacteria causes pharyngitis?
What bacteria causes epiglottitis
Strep Pyogenes
Haemophilus influenza
What respiratory bacteria impacts adults, compromised and smokers?
Legionella
What respiratory bacteria causes walking pneumonia
Mycoplasma
What respiratory bacteria causes pharyngitis and conjunctivitis
N. Gonorrhea
What respiratory bacteria causes ventilator pneumonia
Stenotropho Malto
Pseudo Aeruginosa
What microbe is #1 for CAP
Strep pneumo
What respiratory fungus is an invasive form of pneumonia
Aspergilloma
What respiratory fungus causes meningitis in adults w/ cell mediated immunity defects like HIV?
Cryptococcus neoform
What respiratory fungi causes invasive pneumonia in diabetics and neutropenic PTs?
Rhizopus
Mucor
What respiratory parasite causes empyema and lung abscesses
Entamoeba histolytica
What respiratory parasite causes hemoptysis and chronic bronchitis
Lung fluke
Paragonimus westermani
What respiratory parasite causes wheezing, coughing pneumonia in compromised PTs?
Strongyloids Stercoralis from Rhabdo larva
What respiratory virus causes conjunctivitis
Adeno virus
What respiratory virus causespneumonia in compromised PTs?
Cytomega virus
What respiratory virus causes ARDS
Hanta virus
What respiratory virus causes Shifts and Drifts
Influenza
What respiratory virus causes croup
Parainfluenza
What respiratory virus causesbronchiolitis
Respiratory syncitial virus
What are the most commonly encountered infections of primary care?
GI infections
Characteristics of Secretory Diarrhea
Watery
No leukocytes
High vol, low freq
In small bowel of Viral origin, Giardia, Vibrio, ETEC
Characteristics of Inflammatory Diarrhea
Mucus and PMNs
+ leukocytes
Low volume, high freq
Large bowel from Slamonella, shigella or Campylobacter
Characteristics of hemorrhagic diarrhea?
Bloody w/ leukocytes
Low vol, high freq
In large bowel from H7
What are dysenteric Sx of diarrhea?
Fever
Tenesmus
Blood/pus
What can cause falst pos Guaiac tests?
What can cause false negatives?
Gum/GI bleeds
Foods
Vitamin C
Where does Staph Aureus food poisoning come from?
Casserole/mayo/food handler
What kind of foods cause poisoning from Clostridium Perfringens
High protein, gravy, meat dishes
What kind of food causes salmonella poisoning?
Raw/undercooked meat, poultry or eggs (including reptile eggs)
S/Sx of Salmonella Typhi
Diarrhea/constipation High fever Rose spots Mental confusion Bradycardia Hepatosplenomegaly
What microbe causes pseudoappendicitis
Yersinia enterocolitica
What microbe can cause an “ammonia cloud”?
H Pylori
What bug made Milwaukee famous?
Crytpo Parvum
What microbe is the Winter Vomit Dz and where does it come from?
Rotavirus- day care and diapers
Who is primarily affected by hematogenous osteomyelitis
Children at metaphysis
If in adult- spine
All lesions w/ ? characteristic need to be deeply excised for evaluation?
Pigmented
What type of sample is used to dx fungal and scabie infections of the skin?
Skin scraping
What instrument is used to Dx dermatological dz?
Woods lamp Capitis- blue green Corpis- faint green Erythrasma- coral red Vittiligo- milky white
Define Diascopy
Test of blanchability to determine lesion type
Inflammatory= no blanching
Pink then brown/scaly sing patched are caused by?
Erythrasma
Corynebacterium
Impetigo bollous = ?
Impetigo non-bollous =
Staph A
Staph P
What skin issue feels like a water filled balloon?
Carbuncles= multiple furuncles from Staph A
What is Risus Sardonicus and what causes it
Grinning muscle spasms
Clostridium
Define Intertrigo
Inflammation rash of body folds from Candidiasis
Define Malassezia Furfur and what causes it
Tan/brown/white scaly patches from Tinea Versicolor
What type of derm issue is acquired from inhaling decaying vegetation?
Blastomycosis- painless sores that look like warts or ulcers
Dx w/ culture showing broad based budding
What is Rose Handler’s Dz
Sporotrichosis- poorly healing skin lesions w/ secondary lesion on lymph vessels
What form of herpes are nurses likely to get?
What form are wrestlers likely to get?
Whitlow
Gladiatorum
What causes Slappped Cheek appearance?
5th Dz
Parvovirus B19
What is 6th Dz?
Roseola
HHV6 or 7
What causes ‘creeping eruption’?
Cutaneous larvae:
Ancylostoma duodenal
Necator americanus
What disease does the Phlebotomine Sandfly carry?
L Donovani
Cutaneous sores w/ volcanic appearance
Visceral form- Kala Azar
What causes Swimmer’s Itch?
Austrobilharzia Vargilandis- cercariae
Cercarial Dermatitis- Schistosome
What is Myiasis
Derm. Hominis
Cordylobia anthropophaga
Botfly larva in skin
Define Pleocytosis
Inc amount of CSF cells
What microbes are most likely to cause bacterial meningitis across ages?
Elder- S. pneumo, E coli
Adult- S pneumo, N meningitis
Kids- S pneumo, N miningitis
Neonate- GBS, E coli
Who and when does aseptic meningitis mostly affect?
Enterovirus in summer and fall in infants and kids
Someone who raises pigeons may suffer from what form of meningitis?
Fungal
What discovery is pathognomic for rabies?
Negri bodies
What serologic Ab titer results indicates syphilis treatment?
1: 256 prior to treatment
1: 4 after
What virus causes projectile vomit in kids?
Norovirus
What type of media is used for stool sample transport for suspected OandP?
What is used for culture, EIA or virus?
Formalin and PVA
Cary-Blair
Viral- VTM
What test for TB is not affected by BCG vaccine and results are available in 24-48hrs after one visit?
IGRA
What two vulvovaginitis tests produce a positive amine test?
Trichomoniasis
Vaginitis
PT presents w/ mucus/bloody diarrhea after 15 days of ABX treatment. What test would be best to ID the source of his infection?
EIA for Toxin A and B
PT complains of watery, stinky diarrhea x 2wks after drinking untreated water while hiking. What test can ID the cause?
O and P
Malaria fever cycles become highly synched causing which form to be difficult to Dx?
Falciparum
S/Sx of pulmonary TB
Productive cough
Chest pain
Hemoptysis
F/C/Ns
What is a more specific screening method for TB?
Interferon Gamma Release Assay
Define Syndemic and what are the two?
Convergence of two or more diseases that act syngergistically to magnify the Dz burden
HIV is driver of TB infection and alters transmission dynamics
What malarias synchronize at what time frames?
ViVae, Ovale- 48
Faciparum- 36-48hrs
Malariae- 72hrs
What are the 3 phases of malarial paroxysms?
Cold 15-60min
Hot 2-6hrs
Sweat 2-4hrs
What causes Blackwater Fever?
Hepatic malaria
Hyperbillirubinemia
Acute Hepatitis panel will show?
IgM anti-HAV
IgM anti HBc
HBsAg
anti-HCV
Most common form of anthrax?
Cutaneous
How is a plague case in the SW US Dx’d?
Lymph node aspirate
What are the categories of Tularemia
Ulceroglandular- most common Glandular Oropharyngeal Pneumonic Typhoidal
Slaughter house workers, farmer and vets are at increased risk of contracting?
Brucellosis
B Melitensis is most virulent but most preventable
How is Brucellosis dx’d?
Culture of blood, clean catch urine, CSF and marrow
What does Arenaviruses cause?
Lassa Junin Machupo Guanarito Sabia
What does Filovirus cause
Ebola
Marburg
What does Bunyaviruses cause
Crimean congo Uukuniemi Hanta LaCrosse Rift Valley
What does Flaviviruses cause?
Dengue
Yellow fever
What is the skin test for HSV and VZV?
Tzanck smear
How is pyelonephritis Dx’d?
UA
CBC
Culture
Chemistry
How is prostatitis and urethritis diagnosed?
UA
Culture
Pyuria but no bacteria= chlamydia
N. Gonorrhea has what samples sent for Dx?
D/c for stain, culture and PCR
What issue requires a sterile culture?
Male urethritis
When is a culture for a UTI necessary?
Pyelonephritis or Complicated Cystitis- Culture for ABX
Quantitaive- 10^5 general rule
Culture for Urethritis/Cervicitis has what amount of specificity and specifically for what microbe?
100%
Inc resistance of N Gonorrhoeae
How is chancroid Dx?
Clinical and Culture
What is the gold standard for HSV ID?
Viral culture
How is PID Dx?
Clinically
Confirmed w/ nucleic acid test
What is the difference of effect on the heart between endocarditis and staph a?
Endocarditis- Mitral and Aortic
Staph A/MRSA- tricuspid/right sided from IV drugs
What are the Susceptibility tests?
Kirby Bauer- disc diffusion
Broth/agar- minimum inhib concentration
What type of HPV is in Types 6 and 11
Condyloma Acuminatum
What suspicions need lab alerts?
Dimorphic fungi
Epiglottitis
Diphtheria
Pertussis
What microbes require extended stool cultures?
TCBS- Vibrio Cholerae
CIN- Yersinia Enterocolitica
MAC- E Coli EHEC
How is Typhoid Fever diagnosed?
Stool culture- monocytes
Agglutination assay- Vi Ag
What are the 3 stages of HIV CD4 counts?
1= +500 2= 200-499 3= <200 4= unknown
