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micro 1 Flashcards

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1
Q

what immune system is the mucocillary elevator?

A

innate immune system

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2
Q

3 parts of URT

A

nasal cavity
pharynx
larynx

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3
Q

3 parts of LRT

A

trachea
bronchi
lungs

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4
Q

3 types of immunity in the lung

A

mechanical
chemical
immune cells

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5
Q

% of particles removed from bronchioles to trachea?

A

90%

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6
Q

components of mucocillary elevator?

A

ciliated epithelial cells
secretory cells (mucus)
periciliary liquid (PCL)
mucus layer

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7
Q

Main component of mucocillary elevator?

A

mucins

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8
Q

What allows cilia to beat?

A

mucus floating on the PCL

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9
Q

What do secretory cells prosuce?

A

mucus

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10
Q

How is depth maintained in mucociliary elevator?

A

by pumping Cl ions into PCL which attracts water

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11
Q

Which respiratory tract infection is mostly acute?

A

Upper RTI

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12
Q

Are URTIs MOSTLY viral or bacterial?

A

viral

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13
Q

bronchitis

A

inflammation of the bronchi

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14
Q

bronchiolitis

A

inflammation of the bronchioles

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15
Q

pneumonia

A

inflammation of the alveoli

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16
Q

Does influenza affect URT or LRT?

A

both

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17
Q

How are respiratory infections transmitted?

A

droplets

contact

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18
Q

How many virus particles per sneeze/cough in influenza?

A

> 0.5 million

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19
Q

How long does influenza survive for?

A

24 hrs

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20
Q

How long does TB survive for?

A

6 months

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21
Q

Common species that cause COPD exacerbation?

A

H influenzae
S pneumoniae
M catarrhalis

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22
Q

Most common species that causes COPD exacerbation in ADVANCED idease?

A

P aeruginosa

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23
Q

What happens to lungs in pneumonia?

A

inflammation of the lung

alveoli fill with fluid

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24
Q

3 types of pneumonia?

A

community
hospital
ventilator

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25
Q

What is hospital pneumonia?

A

acquired > 48hrs after hospital admission

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26
Q

typical microorganisms that cause community pneumonia?

A

S. pneumonia
Group A Streptococcus
H. influenza
M. catarrhalis

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27
Q

microorganisms that cause hospital/ventilator pneumonia?

A

G neg bailli - E coli, P. aeruginosa

G pos cocci - MRSA

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28
Q

another name for group A streptococcus?

A

Streptococcus pyogenes

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29
Q

Describe group A streptococcus?

A

Gram positive
grows in chains
beta haemolytic
has a group specific polysaccharide - Lancefield antigen

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30
Q

What can group A streptococcus cause?

A

strep throat

tonsilitis

31
Q

How many serotypes are there of group A streptococcus?

A

> 100

32
Q

How are group A streptococcus serotypes categorised?

A

by M-protein antigen

33
Q

Where is the M-protein antigen on group A streptococcus serotypes?

A

on cell surface and fimbriae

34
Q

How is group A streptococcus identified now (M protein has gone over time)?

A

PCR/sequencing of the EMM gene

35
Q

How many genotypes are there of the EMM gene?

A

> 200

36
Q

What is attachment/invasion mediated by in group A streptococcus?

A

M proteins
pili F proteins
hyaluronic acid capsule

37
Q

How does the body react when group A streptococcus is detected?

A

pro inflammatory response
cytokines released - IL6, TNF
recruits macrophages and neutrophils

38
Q

How does group A streptococcus evade the immune system?

A
  • hyaluronic acid capsule
  • M protein
    (both protect from phagocytosis)
  • secretes enzymes
39
Q

What enzymes does GAS secrete?

A
  • streptolysin O and S
  • proteinase
  • streptokinase
  • C5a peptidase
40
Q

What does secreted proteinase from GAS do?

A

cleaves IL-8

interferes with neutrophil recruitment

41
Q

What does streptokinase in GAS do?

A

dissolves fibrin clots

42
Q

What does C5a peptidase in GAS do?

A

cleaves C5a

stops complement from working

43
Q

What is the cause of TB?

A

mycobacterium tuberculosis

44
Q

What other species can also cause TB?

A

M bovis
M africanum
M canetti
M microti

45
Q

When is TB transmitted?

A

obligate pathogen:

disease transmitted during active infections

46
Q

What % of TB involves the lungs?

A

90%

47
Q

What type of bacteria is TB?

A

aerobic bacillus
rod
G+ or G-

48
Q

What is in the cell wall of TB?

A

lipids

mycolic acid

49
Q

How long does TB take to divide?

A

15 - 20 hours

50
Q

How long to culture TB in lab?

A

3 - 4 weeks

51
Q

obligate pathogen?

A

has to cause disease to be transmitted

52
Q

TB cycle in the body?

A

1) TB inhaled
2) bacteria ingested by macrophages, survives,
3) cemokines surround the infected cell, chemokines recruit lymphocytes
4) lymphocytes kill the infected macrophages, necrotic zone in the middle of granuloma - latent TB (no symptoms, years)
5) active TB - granuloma disintegrates, spreads to other parts of the body, coughing spreads it

53
Q

old TB diagnosis test?

A

Heaf test

54
Q

What is the Heaf test?

A

6 needles injected tuberculin PPD into wrist
left for 2-7 days
scale of negative to 4

55
Q

What replaced the TB Heaf test in 2005?

A

Mantoux test

56
Q

What does the Mantoux test do?

A

single needle injection of PPD tuberculin
looks for red bump - immune reaction to tuberculin
diagnoses latent TB
graded on bump size (pos = > 5mm)

57
Q

False positives for Mantoux TB test?

A

allergy to tuberculin
previous infection with non-tuberculous mycobacterium
BCG vaccination

58
Q

False negatives for Mantoux TB test?

A

recent TB infection (<10 weeks ago)

immuno compromised

59
Q

2 other diagnostics for TB?

A

sputum microscopy and culturing

60
Q

What 3 sputum samples?

A

deep cough
induced sputum
bronchoscopy and lavage
preferably one from early morning

61
Q

What stain is used for microscopy of sputum samples?

A

Ziehl Neelson stain

62
Q

problem with sputum microscopy?

A
  • need a lot of bacteria (5000 bacteria/ml)
  • can’t tell the difference between mycobacteria
  • difficult for some patients
  • contains different microbes
  • doesn’t account for
    viruses
63
Q

Problem with culturing for TB diagnosis?

A

long turn around time (> 16 days)

longer if waiting for drug sensitivity

64
Q

2 other diagnostics for TB? (2nd)

A
  1. radiography

2. interferon gamma release assay

65
Q

2 types of radiography used?

A

chest x-ray

thorax CT

66
Q

problems with radiography

A

hard to distinguish between active and cured TB because of scarring

67
Q

How does interferon gamma release assay work?

A

uses blood samples
looks for T lymphocyte release of IFN - gamma
not affected by BCG status (different antigens)
diagnoses latent TB

68
Q

1 line TB treatment

A

isoniazid and rifampicin for 6 months

pyrazinamide and ethambutol for 1st 2 months

69
Q

2 resistant forms of TB

A

MDR -TB (multi drug resistant, to isoniazid and rifampicin)

XDR -TB (extremely drug resistant, ison, rif, 1/3 injectable 2nd line drugs)

70
Q

What is the TB vaccine?

A

BCG:

Bacillus Calmette Guerin vaccine

71
Q

What is BCG vaccine made from?

A

live attenuated vaccine made from M. bovis

72
Q

% effectiveness of BCG for severe forms (TB meningitis)?

A

70 - 80%

73
Q

What groups are offered BCG vaccine? (4)

A
  • children <5 in high TB area
  • people with parents/grandparents born in countries with high TB
  • living in country > 3 months with high TB rate
  • close contact for long time with someone who has pulmonary TB
74
Q

What are streptolysin O and S (secreted from GAS)?

A

hemeloytic exotoxins

microbiology (4 decks)

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