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ASCP M Mometrix > LOWER RESPIRATORY > Flashcards

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
Q

S. aureus colony morphology

A

soft, opaque or pale gold, and circular

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26
Q

S. epidermidits colony morphology

A

opaque, gray, smooth, raised, with no hemolysis

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27
Q

S. pneumoniae colony morphology

A

alpha-hemolytic, convex, mucoid or “water drop”

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28
Q

S. pyogenes colony morphology

A

grayish-white, transparent to translucent, matte or glossy, large zone of
hemolysis

29
Q

S. mitis colony morphology

A

alpha-hemolytic, broken glass appearance

30
Q

S. salivaris colony morphology

A

small, colorless, smooth or rough, nonhemolytic or weakly alpha-
hemolytic

31
Q

S. mutans colony morphology

A

small white to gray, rough, nonhemolytic or alpha-hemolytic

32
Q

E. faecalis colony morphology

A

circular, smooth, nonhemolytic

33
Q

Corynebacterium colony morphology:

A

small to medium, gray, white, or yellow, nonhemolytic

34
Q

Actinomycetes colony morphology:

A

white, rough, crumbly texture, occasionally pigmented red

35
Q

Lactobacillus colony morphology:

A

small to medium, gray, alpha-hemolytic

36
Q

Candida colony morphology:

A

creamy, white, dull, grows upward with foot-like projections

37
Q

Neisseria colony morphology:

A

small, white to gray-brown, smooth, butter-like, translucent, possible green
hue underneath

38
Q

H. influenzae: on chocolate agar colony morphology:

A

❖ Unencapsulated strain — small, smooth, and translucent
❖ Encapsulated strain — larger, mucoid, with a mouse nest odor

39
Q

E. coli colony morphology:

A

circular, dull gray, smooth, convex

40
Q

COMMON LOWER RESPIRATORY TRACT PATHOGENS

A

S. aureus
S. pneumo
H. influenzae
K. pneumo
Legionella
Candida
Mycoplasma pneumoniae
Mycobacterium tuberculosis

41
Q

GPCs in lower resp tract:

A

Staphylococcus
❖ S. aureus: soft, opaque or pale gold, and circular
❖ S. epidermidis: opaque, gray, smooth, raised, with no hemolysis

42
Q

GNRs in lower respiratory tract

A

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
Q

Mycoplasma pneumoniae in lower respiratory tract

A

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
Q

Mycobacterium tuberculosis in lower respiratory tract

A

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
Q

Fungi in lower respiratory tract

A

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
Q

Legionnaires’ disease and Pontiac pneumonia are lower respiratory infections caused by

A

Legionella bacteria

47
Q

Legionella bacteria’s natural habitat is

A

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
Q

Legionella in lower respiratory tract

A
  • Heat shock protein 60: aids in invasion
  • Outer membrane protein: prevents phagocytosis
  • Type IV pili: entry into macrophages for spread and survival.
49
Q

Primary infections caused by M. tuberculosis take place in

A

the lungs causing pneumonia-like
symptoms

50
Q

If left untreated, tuberculosis can

A

become disseminated and spread to other organ
systems in the body

51
Q

M. tuberculosis in lower respiratory tract

A
  • 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
Q

Opportunistic fungi such as Aspergillus and Cryptococcus species aspirated into the lungs can cause

A

pneumonia and lead to sepsis in immunocompromised patients.

53
Q

Bacterial lung abscesses are
commonly a

A

polymicrobial infection predominantly comprised of anaerobic oropharyngeal or
gastric normal flora aspirated into the lungs

54
Q

DIRECT AND MOLECULAR TECHNIQUES FOR DETECTING RESPIRATORY PATHOGENS

A

immunochromatographic
or immunofluorescent assays
Direct-fluorescent antibody
testing
real-time PCR
Multiplex PCR
isothermal loop-mediated amplification

55
Q

S. pyogenes, or group A Streptococcus, is the respiratory pathogen responsible for

A

upper respiratory
infections including strep throat and pharyngitis

56
Q

B. pertussis is responsible for

A

whooping cough

57
Q

immunochromatographic
or immunofluorescent assays

A

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
Q

Direct-fluorescent antibody
testing

A

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
Q

The most common molecular method used to detect S. pyogenes and B. pertussis is

A

real-time PCR

60
Q

Multiplex PCR methods are
also used to detect

A

B. pertussis, along with multiple other respiratory pathogens.

61
Q

highly specific isothermal loop-mediated amplification method can also be used in

A

detecting B. pertussis
infections between 0 and 3 weeks of symptom onset

62
Q

COMMON PNEUMONIA-CAUSING PATHOGENS

A

S. aureus
S. pneumo
H. influenzae
K. pneumo
M. pneumo

63
Q

Lower respiratory tract infections can manifest into

A

various disease states including tracheitis,
acute or chronic bronchitis, and community- or hospital-acquired pneumonia.

64
Q

The mode of
transmission for these pathogens is through

A

the inhalation of respiratory droplets from an infected
person.

65
Q

S. aureus in pneumonia

A

o Exotoxins: hemolysins, leukocidins, spreading factor by coagulase and hyaluronidase,
nuclease, protease, and lipase
o Beta-lactamase: penicillin resistance, MRSA: methicillin resistance

66
Q

S. pneumo in pneumonia

A

o Pneumolysin: antiphagocytic capsular protein
o Several adhesion factors and immunogenic cell wall membrane

67
Q

H. influenzae in pneumonia

A

o Encapsulated strains: resistant to phagocytosis and complement-mediated lysis

68
Q

K. pneumo in pneumonia

A

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
Q

M. pneumoniae in pneumonia

A

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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