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LOWER RESPIRATORY Flashcards

1
Q

SOURCES OF LOWER RESPIRATORY TRACT SAMPLES

A

Expectorated sputum
Induced sputum
Endotracheal aspirate
Bronchial washings
BALs
Bronchial brushings

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2
Q

Ideal sputum specimen collection occurs

A

first thing in the morning, with no food ingestion for 1–2
hours prior.

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3
Q

Rinsing the mouth with water before collection and collecting directly into a sterile
specimen container aid in

A

avoiding contaminating the sample with saliva

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4
Q

Sputum is collected
through the following methods:

A

Expectorated sputum
Induced sputum
Endotracheal aspirate

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5
Q

Expectorated sputum is expelled by

A

a deep cough of the patient

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6
Q

Induced sputum collection uses

A

an aerosol spray that reaches the lungs, inducing a deep
cough

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7
Q

Endotracheal aspirate samples are

A

collected via mechanical suction from patients with a
tracheostomy tube.

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8
Q

Bronchoscopy procedures visualize

A

the lungs by passing a tube with a light source and camera
down a patient’s throat and into the lungs.

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9
Q

Bronchoscopes are used for collection of the following
lower respiratory tract specimens

A

Bronchial washings
Bronchial brushings
BALs

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10
Q

Bronchial washings are collected from

A

the bronchial tube

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11
Q

A measured amount of sterile
saline is passed through (washings)

A

the scope, and then it is gently suctioned back out

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12
Q

For washing The suctioned
saline is placed into

A

a sterile container because it contains the cells and fluids needed for
analysis.

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13
Q

Bronchoalveolar lavage samples are collected from

A

the smaller bronchoalveolar pathways
via the same process as bronchial washings. Multiple lavage samples may be collected from
several sites during one procedure

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14
Q

Bronchial brushings are collected by

A

passing a brush through the bronchoscope and
gently abrading the surface of the airway mucosa and bronchial lesions to collect cells for
analysis

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15
Q

Quantitative and semiquantitative results from Gram stains of lower respiratory tract specimens
are used to

A

evaluate the quality of samples before culture and aid in the diagnostic and treatment
process for patients suspected of lower respiratory tract infections

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16
Q

Expectorated and induced
sputum samples must

A

meet specific Gram stain criteria to be considered acceptable for culture

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17
Q

For sputum, Observed in 10–20 fields under low power, the following criteria indicate an acceptable specimen

A

<10 squamous epithelial cells and ≥10 WBCs per field. Regardless of the number of white cells
present, samples with more than 25 epithelial cells per low-power field will be rejected.

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18
Q

For sputum, unacceptable samples indicate

A

that a sample did not originate in the lower respiratory tract and is contaminated
by saliva and oral flora

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19
Q

Physicians interpret semiquantitative results for bacteria in
conjunction with quantitative WBC and epithelial cell results to determine the following:

A

presence or absence of infection, the presumptive cause of infection, and the severity of infection

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20
Q

ORAL FLORA GPCs

A

S. aureus
S. epidermidis
S. pneumo
S. pyogenes
S. mitis
S. salivarius
S. mutans
E. faecalis

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21
Q

ORAL FLORA GPRs

A

Corynebacterium
Actinomycetes
Lactobacillus

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22
Q

ORAL FLORA Gram-positive buds, hyphae, or pseudohyphae

A

Candida species

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23
Q

ORAL FLORA GNC

A

Neisseria species

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24
Q

ORAL FLORA GNRs

A

H. influenzae
E. coli

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25
S. aureus colony morphology
soft, opaque or pale gold, and circular
26
S. epidermidits colony morphology
opaque, gray, smooth, raised, with no hemolysis
27
S. pneumoniae colony morphology
alpha-hemolytic, convex, mucoid or “water drop”
28
S. pyogenes colony morphology
grayish-white, transparent to translucent, matte or glossy, large zone of hemolysis
29
S. mitis colony morphology
alpha-hemolytic, broken glass appearance
30
S. salivaris colony morphology
small, colorless, smooth or rough, nonhemolytic or weakly alpha- hemolytic
31
S. mutans colony morphology
small white to gray, rough, nonhemolytic or alpha-hemolytic
32
E. faecalis colony morphology
circular, smooth, nonhemolytic
33
Corynebacterium colony morphology:
small to medium, gray, white, or yellow, nonhemolytic
34
Actinomycetes colony morphology:
white, rough, crumbly texture, occasionally pigmented red
35
Lactobacillus colony morphology:
small to medium, gray, alpha-hemolytic
36
Candida colony morphology:
creamy, white, dull, grows upward with foot-like projections
37
Neisseria colony morphology:
small, white to gray-brown, smooth, butter-like, translucent, possible green hue underneath
38
H. influenzae: on chocolate agar colony morphology:
❖ Unencapsulated strain — small, smooth, and translucent ❖ Encapsulated strain — larger, mucoid, with a mouse nest odor
39
E. coli colony morphology:
circular, dull gray, smooth, convex
40
COMMON LOWER RESPIRATORY TRACT PATHOGENS
S. aureus S. pneumo H. influenzae K. pneumo Legionella Candida Mycoplasma pneumoniae Mycobacterium tuberculosis
41
GPCs in lower resp tract:
Staphylococcus ❖ S. aureus: soft, opaque or pale gold, and circular ❖ S. epidermidis: opaque, gray, smooth, raised, with no hemolysis
42
GNRs in lower respiratory tract
o H. influenzae: on chocolate agar ❖ Unencapsulated strain — small, smooth, and translucent ❖ Encapsulated strain — larger, mucoid, with a mouse nest odor o K. pneumoniae: small to medium, grayish-white, translucent or opaque. circular, dome shaped, mucoid, nonhemolytic o Legionella: green or iridescent pink, circular with entire edge, convex, glistening, with a ground-glass appearance on buffered charcoal yeast extract agar
43
Mycoplasma pneumoniae in lower respiratory tract
o Organisms do not stain well due to the lack of a rigid cell wall. o Pinpoint, granular, “fried egg” appearance on media enriched with cholesterol and fatty acids.
44
Mycobacterium tuberculosis in lower respiratory tract
o Mycolic acid in the cell wall resists Gram stain. Appear as slim rods, gram variable or bright red using an acid-fast stain. o Off-white to buff, dry, rough, raised, and wrinkled on Löwenstein–Jensen medium.
45
Fungi in lower respiratory tract
o Yeasts: Gram-positive buds, hyphae, or pseudohyphae ❖ Candida: creamy, white, dull, grows upward with foot-like projections o Other fungi: fluorescent white buds, hyphae, or pseudohyphae with KOH reagent and calcofluor-white stain ❖ Variable growth on Sabouraud’s dextrose agar for up to 6 weeks after inoculation.
46
Legionnaires’ disease and Pontiac pneumonia are lower respiratory infections caused by
Legionella bacteria
47
Legionella bacteria’s natural habitat is
freshwater lakes and ponds, and it becomes pathogenic when it is able to grow in human-made water systems such as air conditioners, shower heads, hot water heaters, and large plumbing systems.
48
Legionella in lower respiratory tract
* Heat shock protein 60: aids in invasion * Outer membrane protein: prevents phagocytosis * Type IV pili: entry into macrophages for spread and survival.
49
Primary infections caused by M. tuberculosis take place in
the lungs causing pneumonia-like symptoms
50
If left untreated, tuberculosis can
become disseminated and spread to other organ systems in the body
51
M. tuberculosis in lower respiratory tract
* No endotoxins or exotoxins, toxic effects on cells from lipids and phosphatides * Cord factor: destroys cell mitochondria, inhibits leukocyte migration * Waxy layer and mycolic acid cell wall: delay hypersensitivity, induce multidrug-resistant variants
52
Opportunistic fungi such as Aspergillus and Cryptococcus species aspirated into the lungs can cause
pneumonia and lead to sepsis in immunocompromised patients.
53
Bacterial lung abscesses are commonly a
polymicrobial infection predominantly comprised of anaerobic oropharyngeal or gastric normal flora aspirated into the lungs
54
DIRECT AND MOLECULAR TECHNIQUES FOR DETECTING RESPIRATORY PATHOGENS
immunochromatographic or immunofluorescent assays Direct-fluorescent antibody testing real-time PCR Multiplex PCR isothermal loop-mediated amplification
55
S. pyogenes, or group A Streptococcus, is the respiratory pathogen responsible for
upper respiratory infections including strep throat and pharyngitis
56
B. pertussis is responsible for
whooping cough
57
immunochromatographic or immunofluorescent assays
Rapid test kits have been created for the detection of S. pyogenes Positive results are enough evidence to diagnose infection, whereas negative results need to be confirmed with a throat culture
58
Direct-fluorescent antibody testing
serologic test for the presence of IgG antibodies to B. pertussis. Although helpful in diagnosing an infection of B. pertussis, a diagnosis will be delayed because this method is best when a patient is tested between 2 and 8 weeks of symptom onset Traditional culture or molecular methods allow for a timelier diagnosis for B. pertussis than antibody testing
59
The most common molecular method used to detect S. pyogenes and B. pertussis is
real-time PCR
60
Multiplex PCR methods are also used to detect
B. pertussis, along with multiple other respiratory pathogens.
61
highly specific isothermal loop-mediated amplification method can also be used in
detecting B. pertussis infections between 0 and 3 weeks of symptom onset
62
COMMON PNEUMONIA-CAUSING PATHOGENS
S. aureus S. pneumo H. influenzae K. pneumo M. pneumo
63
Lower respiratory tract infections can manifest into
various disease states including tracheitis, acute or chronic bronchitis, and community- or hospital-acquired pneumonia.
64
The mode of transmission for these pathogens is through
the inhalation of respiratory droplets from an infected person.
65
S. aureus in pneumonia
o Exotoxins: hemolysins, leukocidins, spreading factor by coagulase and hyaluronidase, nuclease, protease, and lipase o Beta-lactamase: penicillin resistance, MRSA: methicillin resistance
66
S. pneumo in pneumonia
o Pneumolysin: antiphagocytic capsular protein o Several adhesion factors and immunogenic cell wall membrane
67
H. influenzae in pneumonia
o Encapsulated strains: resistant to phagocytosis and complement-mediated lysis
68
K. pneumo in pneumonia
o Encapsulated to inhibit phagocytosis and complement-mediated lysis o Lipopolysaccharide endotoxin causing inflammation o Fimbriae for adhesion and siderophores that acquire host iron for organism survival
69
M. pneumoniae in pneumonia
o P1 membrane protein: acts as a cytohesin to ciliated epithelial cells o Community-acquired respiratory distress syndrome toxin: damages respiratory epithelium and ciliary activity by releasing cytokines and inflammatory mediators.

ASCP M Mometrix (18 decks)

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