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respiratory system > Micro > Flashcards

Micro Flashcards

1
Q

What is the season for influenza

A

Late November to late march

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2
Q

Which type of influenza mainly affects the lower respiratory tract??

A

H5N1 ( avian influenza);it is a severe disease but it is not effectively transmitted between humans.

Note : influenza mainly affects the upper respiratory tract.

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3
Q

Myxoviruses are divided into:

A

1) Orthomyxoviruses

2) Paramyxoviruses

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4
Q

The differences between ortho and para myxoviruses

A

Ortho:smaller, RNA is fragmented into 8 segments,it is liable to agic variation

Para: larger,not fragmented,not liable to agic variation

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5
Q

Which virus is the most common cause of bronchiolitis

A

Respiratory syncytial virus

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6
Q

Characteristics of influenza viruses

A

Hemagllutinin
Neuraminidase
RNA SEGMENTS +nucleocapsid= a nucleocapsid with helical symmetry

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7
Q

The most common serotype of influenza viruses

A

Type A; and it is the most severe

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8
Q

Hemoagglutinin binds to what type of receptor on mucus secreting cells

A

To sialic acid

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9
Q

True or false

Type B influenza viruses affect humans and animals

A

False, type A affects humans and animals

Type B and C affect humans only.

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10
Q

Order thetypes of influenza from the most stable antigenically to the least stable

A

C(only antigenic drift) THEN B(only antigenic drift) then A(antigenic shift+ antigenic drift)

Note: If we order them according to severity then A is the most severe followed by B Then C

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11
Q

True or false

Type C influenza only has 7 segments

A

True, it lacks neuroaminidase

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12
Q

What is the target of neutralising antibodies for influenza

A

Haemagglutinin

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13
Q

Antigenic shift occurs in influenza A due to

A

Wide host range

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14
Q

True or false

Ifluenza causes viremia

A

False, but it causes systematic symptoms due to cytokines production.

Note common cold doesn’t cause systemic symptoms

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15
Q

True or false

More severe infections are usually associated with influenza due to damaged airways

A

True, example pneumonia

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16
Q

The most common cause of superimposed infection pneumonia post influenza ( secondary bacterial pneumonia)is?

A

Staphylococcus aureus

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17
Q

Which drugs are contradicted with influenza virus in children

A

Salicylic drugs such as aspirine

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18
Q

True or false nucleoprotein( NP) doesn’t change in influenza viruses

A

True

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19
Q

Which influenza pandemic caused the highest number id deaths

A

Spanish flu

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20
Q

What are the 3 types of influenza vaccines

A

1) whole virus vaccine: inactivated forms of the virus with predicted HA are grown in embyonated eggs
2) subunit vaccine: uses both NA an HA subunits which were extracted from recombinant virus form
3) split virus vaccines:purified HA

Note: there is a live attenuated vaccine( LAIV)

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21
Q

Inactivated vs live attenuated vaccine of influenza?

A
  • Both have a tri and quadra valent forms
  • both are given annually
  • Inactivated form is given intramuscularlly( flu shots) while live attenuated forms are given intranasally( FLUMIST)
  • live attenuated form is contradicted in pregnancy and in people allergic to egg proteins
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22
Q

Which antivirals are used for influenza

A

Oseltamivir and zanamivir ,they are neuraminidase inhibitors

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23
Q

what is the reservoir for type A influenza virus

A

wild birds especially migratory waterfowl(ducks and geese’s).

note :domestic poultry like chickens and turkey are not natural reservoirs

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24
Q

the main route of transmission of avian virus is?

A

through their feces

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25
Q

compare H1N1 and H5N1

A

H1N1 spreads fast , it affects the upper respiratory tract but it is rarely fatal, while H5N1 spreads slowly , it affects the lower respiratory tract(more severe), often fatal.

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26
Q

characteristics of streptococcus

A

oval in shape
arranged in chains or pairs
catalase negative
contain superoxide dismutase (that’s why they can tolerate ROS)

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27
Q

why does the alpha hemolysis in streptococcus result in a green haze color

A

because of the incomplete lysis which will result in an interaction between hydrogen peroxide in the bacteria and hemoglobin (it will get oxidized to form biliverdin).

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28
Q

B hemolysis is due to the production of hemolysins known as

A

1)streptolysin O 2)streptolysin S

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29
Q

according to Lancefield grouping which streptococcus are human pathogens

A

A,B,C,F,G

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30
Q

which bacteria is the main cause of neonatal sepsis and neonatal meningitis ?

A

S.agalactiae

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31
Q

what specific biochemical tests do we use to test for S.pyogene and S.pneumonia

A

S.pyogene we use bacitracin

S.pneumonia we use optochin

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32
Q

how do we determine that the streptococcus we are looking for is E.faecalis?(using biochemical reactions)

A

first we use an Bile-esculin agar (if a characteristic black discoloration appears then it is either E.faecalis or S.bovis). then we add the sample to 6.5% NaCl if growth occurs then its E.faecalis .

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33
Q

what are the suppurative infections caused by S.pyogenes?

A

1) respiratory tract—>causes pharyngitis which could progress to mastoiditis or even meningitis
2) skin—> erysipelas, impetigo(honey crust) , cellulitis, fasciitis, necrotizing fasciitis.
3) soft tissue life threatening infections and toxic associated infections.
4) serious hallmark post infective immunologic reactions ( Rheumatic fever, acute glomerulonephritis)
* note: it can also cause scarlet fever, otitis media, sinusitis, peritonsillar and retropharyngeal abscess(which can develop to retropharyngeal pharyngitis ).

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34
Q

examples on exotoxins secreted by S.pyogene?

A

1) streptolysin O
2) hyaluronidase
3) streptokinase
* note: if these are found in the strain of S. pyogene then scarlet fever will definitely occur.

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35
Q

the most important virulence factors in S. pyogene is??

A

M protein, if it is found then S. pyogene is virulent if it is not found then it is not virulent(avirulent). it causes the immunogenic reaction

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36
Q

for adhesion which factors are important ?

A

bronectin on the eukaryotic cells and F protein , T protein and M protein on the virus.

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37
Q

what is the difference between S. pyogenes vs S. pneumonia

A

the capsule of S.pyogene is not immunogenic while the capsule for S. pneumonia is immunogenic and used for Dx

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38
Q

which hemolysin is used for the diagnosis of S. pyogene (Rheumatic fever, acute glomerulonephritis)

A

1) Streptolysin O because it is immunogenic
* note :streptolysin S is not immunogenic so it can’t be used
* note: Streptolysin O is Oxygen labile, Streptolysin S is serum soluble.

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39
Q

what are the escape factors for S.pyogene

A

1) hyaluronidase
2) streptokinase
3) DNase( immunogenic so can be used for DX in gas skin infections)

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40
Q

**what is the most common cause of pharyngitis?

A

viral(such as influenza)

while the most common BACTERIAL cause is S.pyogene(its causes odynophagia not dysphagia).

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41
Q

Some clues that indicate bacterial infection:

A
  • Tonsils enlarged more in bacterial
  • Enlarged uvula
  • White-yellow exudate (may not be present)
  • Gray fairy tongue
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42
Q

another streptococcus which can cause pharyngitis?

A

streptococcus equisimilis

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43
Q

what are the pathognomonic characteristics of scarlet fever

A

1) strawberry tongue

2) sand paper like rash

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44
Q

what is the difference between staphylococcus and streptococcus toxic shock syndrome?

A

streptococcus TSS has a recognizable site of pyogenic inflammation and it has a positive blood culture , while staf TSS has neither

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45
Q

true or false

acute glomerulonephritis occurs more commonly following skin infections rather than pharyngitis

A

true

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46
Q

which viruses replicate in the nucleus??

A

influenza viruses and retro viruses(like HIV). only these viruses have their replication occurring in the nucleus

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47
Q

acute glomerulonephritis usually follows?

A

skin infection not pharyngitis

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48
Q

clinical features related to AGN

A

1) hypertension( it is very weird in children)
2) edema of the face and ankles
3) Smokey urine

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49
Q

what type of hypersensitivity reactions causes AGN

A

type 3

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50
Q

what type of hypersensitivity reactions causes acute rheumatologic fever

A

type 2

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51
Q

criteria of RF

A

JONES criteria

1) joints(migratory polyarthritis)
2) cardiac (endocarditis which can lead to damaging of the valves so leading to valve vegetations.
3) nodules
4) erythema marginatum
5) Sydenham’s chorea

52
Q

RF occurs after ?

A

pharyngitis not skin infections

note in RF : ASO and ESR are elevated.

53
Q

what is the effect of reinfection on both AGN and RF

A

reinfection wont exacerbate AGN but it will exacerbate RF (so long term prophylaxis is required )

54
Q

what is the common age group for RF?

A

between the age 5-15 (in children because this is the age where they are usually infected by GAS and causes pharyngitis) .

55
Q

the golden standard for the diagnosis of GAS is ?

A

culture , however it takes almost 18 hours( too long) so we use rapid tests(if negative and there is a high clinical suspicion of GAS then we use culturing ).

56
Q

the only vaccine available for streptococcus is for ?

A

streptococcus pneumonia

57
Q

what is the shape of strep .pneumonia

A

lancet shape and they are arranged as diplococci or in chains

58
Q

what causes the release of pneumolysin

A

the release of pneumolysin is stimulated by the release of autolysin

59
Q

what are the virulence factors for strep . pneumonia

A

1) capsular polysaccharide
2) lipoteichoic acid ( responsible for inflammatory cytokines and for septic shock syndrome)
3) pneumolysin (which recruits RBC and WBC, thus forming consolidation )
4) IgA protease

60
Q

true or false pneumonia is an exogenous disease ( communicable )

A

false, it is an endogenous disease( it is considered as non communicable

61
Q

what are the diseases caused by strep. pneumonia?

A

1) community acquired pneumonia (most common BACTERIAL cause)
2) bacteremia (the leading cause of sepsis in patients without a functional spleen)
3) meningitis (most common cause)
4) otitis media, sinusitis, Mastoiditis(most common cause)
5) Conjunctivitis
6) empyema
7) pericarditis

62
Q

main difference between viral and bacterial pneumonia?

A

in viral pneumonia : both lungs are affected while in bacterial pneumonia :only a lobe or a segment of a lobe is affected

63
Q

the most common lobes affected by strep. pneumonia are ?

A

middle right lobe and the lower left lobe.

64
Q

what are the clinical characteristics of pneumonia ?

A

1) high fever and chills
2) pleuritic pain
3) productive cough with a rusty sputum(due to RBC)

65
Q

at which age does meningitis caused by strep. pneumonia occur ?

A

it is bimodal ,it affects children younger than 3 and it affects adults older than 45

66
Q

how can we detect the presence of strep. pneumonia on a serum

A

we use quelling reaction( we use an omnivalent serum containing antibodies targeting more than 90 capsular serotypes with methylene blue ).

67
Q

treatment of pneumococci?

A
  • mainly penicillin G for severely ill patients , for less severely ill patients we can use penicillin V.
  • erythromycin or azithromycin can be used for penicillin sensitive patients.
  • vancomycin can be used for penicillin resistant patients
  • ceftriaxone and levofloxacin (fluoroquinolone) can be used for less severely ill patients
68
Q

13 vs 23 valent pneumococcal vaccines?

A

13 valent pneumococcal vaccine ( Prevnar 13 ): used for immunocompromised patients and children younger than 5 years old, it is conjugated to a carrier protein (diphtheria toxoid). a booster dose is given every 5 years.

23 valent pneumococcal vaccine (Pneumovax 13 ): it is unconjugated, given for healthy adults above the age of 50, a booster dose is given at the age of 65 .

69
Q

how many serotypes of H. influenza is there?

A

6 serotypes , type B is the most serious one(composed of polyribitol phosphate, which promotes anti-phagocytosis and invasiveness)

70
Q

H. influenza can cause

A

1) meningitis (3rd most common cause in children )
2) sinusitis (2nd only to pneumonia)
3) otitis media(2nd only to pneumonia)
4) epiglottitis
5) sepsis (especially in asplenic patients)
6) septic arthritis (especially in asplenic patients)
7) cellulitis (especially in asplenic patients)

71
Q

what factors are required for the growth of H. influenza on a laboratory media

A

factors X (Heme) and V (NAD)

72
Q

true or false
pneumococcus , meningococcus and H .influenza cause pyogenic infections with no EXOTOXINS ( ONLY EDNOTOXINS and the capsule)

A

true

73
Q

epiglottitis characteristics ??

A

1) cherry red epiglottis
2) drooling
3) stridor
4) comfort upon sitting up (Tripod position )
5) almost exclusively caused by H influenza in young children
6) thumb print sign

74
Q

characteristics of Corynebacterium diphtheriae

A

1) gram positive ,rod shaped ,have beads on their end to store energy in the form of phosphate
2) palisade or v shaped
3) stain metachromatically
4) non spore forming, non motile
5) non-invasive

75
Q

true or false

in Corynebacterium diphtheriae the systematic effects are due to the bacteria reaching the blood

A

false, there is no sepsis in Corynebacterium diphtheriae , the systematic effects are due to the toxoid.

76
Q

what is the function of diphtheria toxin

A

it inhibits the protein synthesis by the ADP-ribosylation of elongation factor 2

77
Q

what are the complications of Corynebacterium diphtheriae

A

1) pseudomembrane which can cause airway obstruction if it reaches the larynx
2) myocarditis( endocarditis, pancarditis) and it can lead to arrhythmias and circulatory collapse
3) nerve weakening or even paralysis , especially in the cranial nerves . note: paralysis of the muscles of the soft palate and the muscles of the pharynx can lead to regurgitation of the fluids through the nose. it can also lead to PERIPHERAL NEURITIS
4) can affect the skin causing gray patches on top of ulcers.
5) nonspecific symptoms: fever, sore throat, cervical adenopathy

78
Q

true or false

For diphtheria the presence of the organism is not enough, we need to find the toxin

A

true, due to the presence of atoxigenic strains

79
Q

which mediums are used to test Corynebacterium diphtheriae ?

A

1) Loeffler’s medium
2) tellurite plate (black colonies which is characteristic for Corynebacterium diphtheriae).
3) blood agar

note: this is not enough we need to test for the toxin , we can use Elek test or PCR.

80
Q

true or false

• Immunization consists of three doses given at 2 ,4 , and 6 months of age , with boosters at 1 and 6 years of age.

A

true, note a booster dose is given every 10 years.

81
Q

which of the following microorganisms is unencapsulated

1) strep. pneumonia
2) H .influenza
3) Corynebacterium diphtheria
4) Bordetella pertussis

A

the answer is 3

REMEMBER : Bordetella pertussis is encapsulated

82
Q

true ore false

most gram NEGATIVE bacteria are responsible for pathogenesis by the release of exotoxin.

A

false, gram positive bacteria usually release exotoxins while gram negative bacteria have LPS

note: an exception is Bordetella pertussis which depends on an exotoxin for its pathogenesis

83
Q

what are the virulent factors for Bordetella pertussis

A

1) Filamentous hemagglutinin
2) pertussis toxin
3) adenyl cyclase
4) tracheal cytotoxin

84
Q

why does lymphocytosis occur in Bordetella pertussis infection ?

A

due to the inhibition of the transduction of the chemokine signals therefore, the lymphocyte remains in the blood they do not enter the lymph nodes .

85
Q

true or false

in Bordetella pertussis infection death is mainly due to pneumonia

A

true

86
Q

medium used for culturing of bordetella pertussis

A

Bordet-Gengou medium

note : we can use difluorescence antigen testing or PCR to test for antigens

87
Q

micobacterium tuberculosis complex is composed of 11 types of microbacterium which are :

A

1)Mycobacterium tuberculosis
2)Mycobacterium bovis
3)Mycobacterium africanum
4)Mycobacterium caprea
5)Mycobacterium oryx
6)Mycobacterium dassie
7)Mycobacterium mungi
8)Mycobacterium canetti
9) Mycobacterium suricatte
10micobacterium pinnipedii
11)Mycobacterium microti

88
Q

the stain retained in mycobacterium after acid fast staining is ?

A

Carbon fuschin

89
Q

mycobacterium tuberculosis characteristics

A

1) obligate aerobes
2) facultative intracellular
3) non-spore forming
4) waxy ; more than 60% of the bacterial weight is lipid

90
Q

what are the culture media for Mtb ?

A

1) Löwenstein- Jensen (Inspissated egg media and malachite green)
2) Middlebrook 7H10 and 7H11 (semi-synthetic AGAR medium , it appears creamy , white , fuzzy )
3) BROTH media (Middlebrook 7H9 and 7H12 ), less sensitive and specific than agar but it is faster.

91
Q

virulence factors of Mtb

A

1) LAM (Lipoarabinomannan)

2) cord factor (trehalose dimycolates )

92
Q

what is the single most killer infecting agent in humans ?

A

Mtb

93
Q

define scrofula and pott disease?

A

scrofula: TB in the lymph nodes

pott disease: TB in the spine

94
Q

true or false
primary TB occurs in the middle and lower lobes while
in the reactivation of TB the apex of the lung is affected.

A

true

95
Q

what are the indefinitive and the definitive tests for TB

A

2 indefinitive tests

1) X ray : Ghori complex Hilar lymph node and miliary tb can be seen
2) complete blood count: rise in WBC

Defenitive test :culture

also 2 screening tests: tuberculin skin test, interferon gamma release assay.

96
Q

drug used in the treatment of TB

A

isoniazid
rifampin
ethambutol or streptomycin
pyrazinamide

note: there is a method used in some countries known as directly observed treatment (DOT)

secondary drugs: fluoroquinolones and injectable anti-TB drugs
for latent TB we can use isoniazid (IPT)

97
Q

the only available vaccine for TB is ?

A

BCG vaccine ;for TB bovis

98
Q

NTM are divided into

A

fast growers (<7) and slow grower (>7), an each one is divided into photochromogens, scotochromogens ,non-chromogens

99
Q

name the NTM which are slow growers ?

A

1) M. Kansasii (pulmonary disease )
2) M. marinum ( aquatic granuloma )
3) M. ulcerans (skin and soft tissue infection )
4) M. avium complex (in aids patients )
5) M. scrofulaceum (causes lymph node inflammation, it is a Scotochromogen)

100
Q

name the NTM which are fast growers ?

A

M. fortuitum complex (causes pulmonary infection)

M. chelonae-abscessus (causes skin infection)

101
Q

the most common cause of viral pneumonia and pharyngitis

A

adenovirus

102
Q

the most causative agent of mononucleosis is ??

A

Epstein-Barr virus

103
Q

laryngitis is strongly associated with which virus ?

bronchiolitis is associated with ?

A

parainfluenza virus

Respiratory syncytial virus

104
Q

viral pneumonia is caused by ?

A

adenovirus, influenza …

105
Q

difference between typical and a typical pneumonia

A

in atypical pneumonia :low to middle grade fever and DRY cough are present
in typical pneumonia :high grade fever and productive cough are present

106
Q

true or false

mycoplasma, Chlamydia and legionella are opportunistic bacteria

A

true,

107
Q

true or false mycoplasma is identified as an intracellular infections

A

false, it is an extracellular infection

108
Q

true or false

chlamydia is facultative intracellular

A

false, its is an OBLIGATE intracellular

109
Q

**trachoma is caused by ??

A

chlamydia trachomatis , it is one of the most common causes of PREVENTABLE BLINDENESS

110
Q

what is the biphasic morphology of chlamydia ?

A

1) elementary bodies

2) reticulate bodies

111
Q

true or false

chlamydia pneumonia tends to affect adults

A

false, it tends to affect children

112
Q

the gold standard test for chlamydia pneumonia is ?

A

MIF (microimmunofluorescence ),

we can also use many other tests , one of them is MaCoy cell culture

113
Q

treatment for mycoplasma an chlamydia is ?

A

azithromycin and fluoroquinolones such as levofloxacin

114
Q

psittacosis (ornithosis ) is caused by

A

C . psittaci , it is a zoonotic disease, transmission is from birds to humans , NOT through air droplets and there is no documented person to person transmission

115
Q

legionella pneumonphila can cause 2 infection :

A

1) Pontiac fever
2) legionnaires, includes atypical pneumonia and GI side effects.

note : legionella is facultative anaerobe and it is naturally found in aquatic bodies and wet soil , its main route of transmission is through water droplets (a vey common route is through the AC )

116
Q

true or false

there is no vaccine for mycoplasma , chlamydia and legionella

A

true

117
Q

Cryptococcus neoformans ?

A

it causes cryptococcosis ,it is encapsulated , after affecting the lungs it affects the CNS ( neurotropic ) , the reservoir is birds( pigeons) , transmission is through feces of pigeons. it can can meningitis which can lead to death. microscopically we can use India INK , for culture we can use bird seed agar, we can also use PCR

118
Q

Aspergillosis?

A

airborne soil fungus , it leads to the formation of fungal balls (aspergilloma), which can only be removed surgically . aspergillosis can occur in the lungs and it can lead bronchopulmonary allergy (simplest form ). invasive aspergillosis can lead necrotizing pneumonia, infection of the brain and the heart.
treatment : surgery, amphotericin B ,nystatin

119
Q

zygomycosis (mucormycosis ) ?

A

it is abundant in nature, it is known to affect immunocompromised patients , diabetes (especially ), malnutrition patients . it causes sever destruction of the areas.
very bad prognosis in immunocompromised patients

120
Q

PNEUMOCYSTIS

A

Pneumocystis jirovecii causes lethal pneumonia in immunocompromised patients, specifically in AIDS patients
treatment by : TMP/SMX

121
Q

which fungus cannot be cultured ?

A

pneumocystis juveretcii , we diagnose it by BAL

122
Q

endemic mycosis is caused by ?

A

thermally dimorphic fungus

123
Q

true or false

histoplasmosis is encapsulated

A

false , it is not

124
Q

histoplasmosis ?

A

not encapsulated , its intracellular inside immune cells of reticuloendothelial system. infection by inhalation of microconidia or macroconidia . we can use histoplasmosis skin test to test for it .

125
Q

coccidioidomycosis& Blastomycosis

A

they cause primary infection in the lung , Blastomycosis can cause morbidity or even mortality while Coccidioidomycosis causes only acute infections. mode of infection is by inhalation of microconidia.
skin test is not significant due to false positive.
we can use direct microscopy (c. immitis had a unique characteristics).
for culturing use SDA agar

126
Q

Paracoccidioidomycosis is caused by ?

A

Paracoccidioides brasiliensis

note: it has a similar presentation to Coccidioides immitis

respiratory system (4 decks)

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