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Ash's Certification Study > Micro Basics, Lab Testing and Dx, and Antimicrobial Resistance > Flashcards

Micro Basics, Lab Testing and Dx, and Antimicrobial Resistance Flashcards

1
Q

What bacteria can transform into endospores?

A
  1. Bacillus anthracis
  2. Clostridium tetani
  3. Clostridioides difficile
  4. Clostridium perfringens
  5. Clostridium botulinum
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2
Q

Exam of fresh clinical specimens

A

wet mount

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3
Q

The following conditions may be dx’d with what method?
Actinomycosis
Chlamydia
cytomegalovirus
Genital herpes
giardiasis
Histoplasmosis
Leprosy
Lymphogranuloma venerium
Rubeola

A

Histology and Cytology

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4
Q

Examples of organisms that can be diagnosed with wet mount: sputum

A

Sputum for fungi

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5
Q

Examples of simple stains

A

Calcifour white, and india ink

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6
Q

Types of antigen detection test

A

-agglutination
- immunofluorescence
- enzyme linked immunosobent assay (ELISA)

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7
Q

When infection suspected in sterile body fluid, total protein, cell counts with differential, body fluid glucose, gram stain, culture.

Most compare with normal value for fluid.

A

Body fluid analysis

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8
Q

Presence of large number of white blood cells in any body fluid is an indication of..

A

Infection or inflammation

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9
Q

When is CSF assessed and what do they look for?

A

When meningitis suspected.
Color and clarity
Protein
Glucose
Wbc and differential

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10
Q

antibodies that cause clumping or glutination of type o red blood cells and cold temperatures test is used to detect antibodies that result from mycoplasma pneumoniae infection, viral pneumonia, or atypical pneumo

A

Cold agglutination

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11
Q

Shows current inflammatory process, sometimes used in the diagnosis of meningitis, pneumococcal pneumonia, sepsis, tuberculosis, and urinary tract infections

A

C reactive protein

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12
Q

Measure injury and damage to liver.

A

Liver function test

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13
Q

Measure gas exchange, shows resp failure due to pneumo, important for HAI pneumo and ventilator pneumo

A

Arterial blood test

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14
Q

General health assessment, white blood cells count and differential most useful for infection

Interpretation

A

Complete blood count

Increased WBC indicative of infection or inflammation

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15
Q

Reduced white blood cells counts

A

Leukopenia

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16
Q

WBC for Phagocytosis

A

Neutrophil

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17
Q

Increase in number if immature neutrophils

A

Left Shift

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18
Q

What is left shift indicative of?

A

Bacterial infection

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19
Q

What are increased lymphocytes indicative of?

A

Pertussis, syphilis, and toxoplasmosis

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20
Q

Lymphocytes with frothy cytoplasm (atypical or reactive lymphs) are indicative of

A

Viral infections like cytomegalovirus, or mononucleosis

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21
Q

Changes to this type of WBC is indicative of the following conditions:
EBV
TB
subacute bacterial endocarditis
syphilis
protozoan and rickettsial infections

A

Monocytes

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22
Q

Increase in eosinophils

A

Allergic reactions
parasitic infections

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23
Q

Dx test for the following conditions:
Rickettsial Diseases (RMSF, Q fever, epidemic typhus, rickettsial pox)

A

Weil-Felix agglutination

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24
Q

Indicators in Urinalysis

A

Color and clarity
Proteins
glucose
ketones
blood nitrate
leukocyte esterase

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25
Q

What do dipsticks test for?

A

Leukocyte esterase (WBC in urine) and nitrates (bacteria in urine)

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26
Q

Describe gram positive cell wall

A

Many layers of peptidoglycan forming a thick rigid structure

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27
Q

Describe gram negative cell wall

A

It’s an outer membrane composed of lipoproteins, lipopolysaccharides, and phospholipids.

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28
Q

What benefits do the gram negative cell wall provide?

A

the outer membrane evades phagocytosis
provides a barrier to certain antibiotics
confers properties of virulence (endotoxins)

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29
Q

What are the methods to identifying fungus?

A

Skin scraping and culture

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30
Q

Common examples of yeasts

A
  1. Candida spp.
  2. Cryptococcus neoformans
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31
Q

Common example of molds

A
  1. Aspergillus app
  2. Mucormycosis agents (rhizopus and mucor)
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32
Q

Example of dimorphic fungi

A

Pneumocystis jirovechii

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33
Q

How are most parasites diagnosed?

A

Microscopy* (direct exam of stool, urine, vag, or duodenal secretions

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34
Q

How is giardiasis dx?

A

Direct antigen detection

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35
Q

How are amebiasis, schistosomiasis, cysticercosis, echinicoccosis, and malaria diagnosed?

A

serology

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36
Q

Describe viruses

A

Obligate intracellular parasites (can only grow and reproduce in cells)

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37
Q

How to dx viruses

A
  1. Direct detection- microscope, ELISA, PCR
  2. Antibody assay
  3. Viral culture
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38
Q

This antimicrobial susceptibility test measures the zone of inhibition

A

Disk diffusion/ Kirby bauer

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39
Q

This antimicrobial susceptibility test measures the minimum inhibitory concentration of antibiotics

A

broth dilution or e-test

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40
Q

Basics for specimen collection and transport

A
  • collect aseptically and place in sterile container
  • some specimens may go directly into culture media for example blood specimens and nasal swabs
  • prompt delivery to the lab
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41
Q

When should routine environmental testing occur?

A
  • biologic monitoring of sterilization processes
  • monthly cultures/endotoxin testing of water and dialysate in hemodialysis units
  • short-term evaluation of ip measures or changes in IP protocols
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42
Q

What are two examples of when special environmental testing may be indicated?

A
  1. Fungal spores
  2. Legionella and water
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43
Q

Describe quality systems for lab

A

All policies procedures and processes are required to achieve quality and reliable testing

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44
Q

Closeness of the result of obtained to the true value and it’s measured by sensitivity and specificity

A

Accuracy

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45
Q

Lab personal expertise and Quality assessment (pre-analytical through post analytical)

A

Quality systems

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46
Q

Repeatability (same results on same sample when repeated)

A

Precision

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47
Q

External evaluation of the quality of laboratories performance

A

Proficiency testing program

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48
Q

Ability of a test to identify the presence of disease or illness correctly, absence of false negatives

A

Sensitivity

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49
Q

Equation for sensitivity

A

True positives / (true positives + false negatives)

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50
Q

The ability of a test to identify the absence of a disease or illness correctly, absence of false positives

A

Specificity

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51
Q

Equation for specificity

A

True negatives /( true negatives + false positives)

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52
Q

Microscopic of tissues, useful when agents difficult or impossible to culture

A

histology

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53
Q

study of cells

A

cytology

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54
Q

Study of bacteria, fungi, protozoa, viruses, and algae

A

Microbiology

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55
Q

What are the shapes of fungi?

A

Mycelial
Stalked
Budded

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56
Q

What bacteria have long chain fatty acids?

A

Fastidious, acid fast bacteria

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57
Q

How to stain fungi

A

Calcifour white, makes the fungi flourescent

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58
Q

When a DNA in the environment, possibly from dead bacteria, enters another bacterium

A

Transformation

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59
Q

Occurs when all or part of a plasmid is transferred from a donor to a recipient cell. The cell must be in direct contact and transfer occurs via the sex pills. Can occur between widely separated species, leaving to rapid dissemination of genetic information

A

Conjugation

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60
Q

Occurs when bacterial DNA is transferred from a donor cell to a recipient cell via virus capable of infecting bacteria

A

Transduction

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61
Q

Term meaning must reproduce within living cells, cannot live outside of another cell

A

Obligate intracellular parasite

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62
Q

Example of an obligate intracellular parasite

A

Virus

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63
Q

Type of microscope used to look at viruses

A

Electron scanning microscope

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64
Q

What is a virus called when it is outside of the host cell

A

Virion, metabolically inert and it does not grow or multiply until it enters a host cell

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65
Q

Three major methods to diagnose viral infections

A
  1. Direct detection in a clinical specimen
  2. Specific antibody assay to detect viral antibodies in the serum
  3. Viral culture
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66
Q

Aston based test that produces a reflection change for detection of influenza virus

A

OIA (optical immunoassay)

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67
Q

Late microscopy cell scrapings from infected sites that can detect cowdry type A inclusion bodies to detect what virus?

A

Herpes simplex virus

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68
Q

Test for HPV

A

paniculaoi (pap) smear

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69
Q

What are negri bodies used to diagnose?

A

Rabies

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70
Q

General test for viruses

A
  1. Microscopy
  2. EliSA
  3. PCR
  4. DNA probes
  5. Latex agglutination
  6. Virus culture
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71
Q

When should wet mount examination occur?

A

ASAP after collection

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72
Q

Describe nutrient agar

A

Support growth of wide variety of bacteria

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73
Q

Example of nutrient agar

A

tryptic soy agar with 5 percent sheep’s blood

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74
Q

Enrichment medium

A

Special nutrients necessary for growth of fastidious bacteria

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75
Q

Example of enrichment medium

A

chocolate agar for Neisseria meningitidis

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76
Q

Selective media

A

Contains chemicals or antibiotics designed to inhibit normal commensal bacteria

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77
Q

Example selective media

A

bismuth sulfate agar for the isolation of salmonella

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78
Q

Differential media

A

Stains colonies of specific organisms, while inhibiting the growth of others

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79
Q

Example differential media

A

acetate agar to differentiate between e coli and shigella

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80
Q

Chocolate agar used to id

A

Neisseria meningitidis

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81
Q

Bismuth sulfate agar used to isolate

A

Salmonella

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82
Q

Acetate agar used to..

A

Differentiate between e coli and shigella

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83
Q

Mackconkeys agar

A

Selective media

84
Q

Examples of how to decrease HAI risk regarding environment

A
  • cleaning high touch surfaces and routine environment
  • Washing from clean to less clean areas
85
Q

Example of how to decrease HAI risk regarding surgery

A
  • Preoperative showering using antimicrobial soap
  • treatment of remote site infections prior to surgery
86
Q

Examples of how to decrease HAI risk regarding surveillance

A
  • Active surveillance culturing for epi sig organisms based on facility’s epi
87
Q

Examples of how to decrease HAI risk regarding personal hygiene

A
  • maintaining good oral hygiene and caring for the mouth
  • encouraging good genital/ perineal area cleansing
88
Q

True or false: Never cohort patients with a common exposure to a disease

A

False - patients can be cohorted if exposed as long as individual private rooms are not available and patients are not immunocompromised

89
Q

What cells release cytokines? What is the trigger?

A

T-Cells, part of cell mediated immune response triggered when dendritic cells displace antigens to T-Cells

90
Q

What does the release of cytokines activate?

A

Macrophages that will kill the microbe

91
Q

Methods to reduce microbial exposure for Immunocompromised patients regarding standard practices

A

isolation
HH

92
Q

Methods to reduce microbial exposure for Immunocompromised patients regarding antibiotics

A

Prophylactic antibiotics

93
Q

Methods to reduce microbial exposure for Immunocompromised patients regarding reservoirs

A

no plants/ flowers
no pets
IP for food and water

94
Q

True or false: the presence of microbes in a clinical specimen indicates the presence of infection

A

False, could be colonized

95
Q

Bacteria that can form endospores

A

Bacillus anthracis
Clostridium tetani
Clostridium difficile
Clostridium perfringens
Clostridium botulinum

96
Q

Shapes of bacteria: round

A

Coccus
diplococcus
streptococcus
Staphylococcus

97
Q

Shapes of bacteria - spiral

A

spirochete
vibrio
spiral

98
Q

Shapes of bacteria- rods

A

Rod (Bacilli)
Diplobacillis
Streptobacillis
coco-baciliius

99
Q

Process gram stain

A

crystal violet
iodine
decolorize alcohol
safranin (red)

100
Q

single-celled human parasites

A

Protozoa

101
Q

types of parasitic worms

A

flukes
tapeworms
roundworms

102
Q

Types of ecotoparasites

A

Lice
Scabies

103
Q

What is critical to a proper culture?

A

Choice of nutrients in Petri dish
Incubation time
temperature

104
Q

What is the concern for improperly selected/ collected/ transported specimens?

A

-can generate misleading clinical data and lead to wrong treatment

105
Q

How do labs assist in the id of an outbreak?

A
  • confirm organism identity
  • recognize unusual organism clusters
  • detect unusual organisms
  • detect unusual resistance patterns
106
Q

Type of testing used to identify disease processes without signs or symptoms

A

Screening

107
Q

Generally what are the sensitivity and specificity for screening tests?

A

High sensitivity, low specificity (require confirmation)

108
Q

3 types of testing

A

Screening
Confirmation
Dx

109
Q

Evaluation of someone suspected have a certain disease state/ characteristic

A

diagnostic testing

110
Q

most common stain procedure to examine a specimen for bacteria or fungi

A

Gram stain

111
Q

Exam of fresh clinical specimens under direct examination

A

Wet mount

112
Q

Diagnostic testing that generally detects with the use of immunologic or serologic procedures

A

Antigen detection

113
Q

What are the sources for antigen detection?

A

Serum
Body fluids
other clinical specimens

114
Q

Diagnostic test that assesses host response- often referred to as serology

A

antibody detection

115
Q

Most widely used dx test

A

PCR

116
Q

Which type of bacteria have o-antigens?

A

Gram-negative

117
Q

Which type of bacteria have Lipid A

A

Gram-negative

118
Q

Which type of bacteria have teichoic acid?

A

Gram-positive

119
Q

What is teichoic acid important for?

A

Antigenic - so helps with serological testing of gram + bacteria

120
Q

What organism has cell walls with long chains of fatty acids?

A

acid-fast bacteria

121
Q

Traits of acid-fast bacteria cell wall

A

contain mycolic acid= cord factor (VLCFA)

122
Q

Impact of acid-fast bacteria on staining process

A

waxy surface that is impervious to chemicals or dyes

123
Q

Important pathogens associated with mycobacteria

A

TB
Leprosy
Opportunistic Wound Infections

124
Q

What cells can mycobacteria grow in?

A

macrophages

125
Q

Acid fast stain process

A

stain with carbolfuschin
heat
decolorize with alcohol
counterstain methylene blue

126
Q

special fluorescent stain that binds to chitin in cell walls of fungi

A

calcoflour white

127
Q

what kind of microscope is necessary for calcoflour white stain?

A

flourescent microscope

128
Q

What happens if a bacteria acquires an R plasmid?

A

renders that bacterium and it’s descendants immediately resistant to antibiotics if resistance genes are encoded on the plasmids

129
Q

type of microscope for virus

A

Electron microscope

130
Q

Part of virus outside of the host cell - metabolically inert (does not grow or multiply) until it enters a host cell

A

Virion

131
Q

Light microscopy cell scrapings from infected sites can detect ____ inclusion bodies from herpes simplex virus

A

Cowdry type A inclusion bodies

132
Q

What is the optical immunoassay used to test for?

A

influenza

133
Q

when to examine a direct wet mount

A

ASAP after collection

134
Q

Example of trophozite examined in stool under wet mount

A

Giardia lamblia

135
Q

Example of organism examined on a wet mount in vaginal discharge or urine sediment

A

Trichomonas vaginalis

136
Q

Example of an organism examined on a wet mount from liver abscess aspirate

A

Entamoeba histolytica

137
Q

What does the choice of media depend on?

A
  • Site being cultured
    -growth requirements of common suspected pathogens
    -liklihood of normal flora
138
Q

Only aerobic growth- oxygen required

A

Obligate aerobe

139
Q

Both aerobic and anaerobic growth, greater growth in presence of oxygen

A

Facultative anaerobe

140
Q

Only anaerobic growth, ceases to grow in presence of oxygen

A

Obligate anaerobes

141
Q

Only anaerobic growth, but continues in presence of oxygen- oxygen has no effect

A

aerotolerant anaerobes

142
Q

Only aerobic growth, oxygen required in low concentration

A

microaerophiles

143
Q
A
144
Q
A
145
Q

Gram negative diplococci

A

Neisseria meningitidis

146
Q

Part of bacteria for sex

A

Pili

147
Q

Part of bacteria to adhere to surfaces

A

fimbrae

148
Q

Part of bacteria for motility

A

Flagella

149
Q

When do bacteria form endospores?

A

when nutrients are depleted and environmental conditions are too harsh to grow and multiply

150
Q

What antibiotics are mycobacteria resistant to?

A

beta-lactam antibiotics

151
Q

bacteria that lacks cell wall and is resistant to antibiotics that attack the cell wall

A

mycoplasma

152
Q

What do catalase test differentiate?

A

strep and staph

153
Q

What is coagulase used to differentiate?

A

Staph aureus- positive from other staph like staph epidermidis

154
Q

True or false: gram-positive organisms are generally tested for their ability to ferment the nutrient sugar named lactose

A

False- gram negative

155
Q

True or false- Pseudomonas spp. and Proteus spp. are non-lactose fermenting gram-positive organisms

A

False- gram negative

156
Q

CSF analysis- what to look for

A

viral and bacterial infections
tumors/ cancers of nervous system
bleeding/ hemorhaging from spinal cord

157
Q

4 basic components of CSF

A

1) color and clarity
2) protein
3) glucose
4) WBC

158
Q

How to tell a bacterial infection in CSF from viral or fungal

A

Cloudy
Increased WBC
Decrease Glucose
Increase neutrophils
increased neutrophils and cloudy

159
Q

Precautions for immunocompromised patient suspected of having cryptococcal meningitis

A

Standard precautions

160
Q

Who should get PEP if they had unprotected exposure to infected N. meningititidis patients in healthcare?

A

encotrachel intubation
airway suctioning
oxygen admin

161
Q

Mode of transmission N. meningitidis

A

droplet to close contacts
- household members
- Childcare center personnel
- persons directly exposed to the patient’s oral secretions

162
Q

Main selective pressure responsible for the increasing drug resistance seen in hospitals

A

antimicrobial resistance

163
Q

Alter permeability of fungal membrane, inhibit membrane biosynthesis or DNA synthesis

A

antifungals

164
Q

Inhibit formation of DNA precursors, DNA polymerase, and HIV reverse transcription.

A

Antivirals

165
Q

Interfere with cell wall biosynthesis, inhibit bacterial ribosomes, interfere with DNA replication or RNA transcription, or inhibit metabolic pathways

A

antibacterial

166
Q

bactericidal activity by inhibiting cell wall synthesis

A

Beta-lactam drug

167
Q

Examples of beta lactam drugs

A

Penicillin
Cephalosporin
Monobactam
Carbapenem

168
Q

Inhibit bacterial enzymes - important in DNA replication

A

Fluoroquinolones

169
Q

example fluoroqunionlone

A

ciprofloxacin

170
Q

Inhibit protein synthesis, mostly bacteriostatic therefore used for less serious infection

A

Macrolides

171
Q

Example of macrolide

A

Azithromycin

172
Q

Act at site of bacterial ribosomes and are used for combination therapy for serious or multi-drug resistant infection

A

aminoglycoside

173
Q

Example of aminoglycoside

A

gentamicin

174
Q

in this susceptibility testing, bacteria is spread in law fashion onto Mueller-Hinton agar, paper disks impregnated with a standard amount of antibiotic are placed onto the agar surface, the agar plate is incubated overnight, organism growth is either inhibited by the concentration of the antibiotic in the agar or not

A

Disk Diffusion - Kirby Bauer Method

175
Q

Area in which the concentration of antibiotic prohibits the growth of the organism

A

Zone of inhibition

176
Q
A
177
Q

What is cold agglutination used to dx?

A

Atypical pneumonia- mycoplasma (no cell wall) and viral

178
Q

Obligate intracellular parasites

A

Chlamydia
Rickettsia
Coxiella
Some Mycobacterium
Apicomplexans (plasmodium, toxoplasma gondii, crypto)
typanosomatids (Leismania and trypanosoma cruzi
some fungi- penumocystis jerovichi

179
Q

CSF timeframe for transport

A

1 hour

180
Q

Specimen collection and transport: site of collection

A

Collect from site where agent most likely to be found

181
Q

Specimen collection and transport: time

A

Collect at optimum time (ie sputum early in the morning)
Collect before antibiotics

182
Q

Specimen collection and transport: volume

A

Collect adequate volume

183
Q

Specimen collection and transport: contamination

A

Collect aseptically to minimize or eliminate from contamination from indigenous floro

184
Q

Specimen collection and transport: collection equipment

A

Use appropriate collection devices, transport media, and sterile, leak-proof containers

185
Q

Specimen collection and transport: label

A

clearly label specimens including site of collection
ID specimen source/ site of collection

186
Q

Specimen collection and transport: skin collection

A

If collected through intact skin, cleanse the skin with 70% alcohol and iodine solution first or CHG.

187
Q

Specimen collection and transport: patient collecting their own specimen

A

provide clear instructions (ie clean catch urine or stool) to obtain best quality and allay fears

188
Q

Specimen collection and transport: delivery to lab

A

Delivery pro,ptly to lab

189
Q

Specimen collection and transport: protection for HCP

A

Wear proper gloves and PPE
Use safety devices

190
Q
A
191
Q

When to use cold agglutination

A

Mycoplasma pneumonia
Mononucleosis
Viral pneumonia

192
Q

Difference in cerebrospinal fluid analysis between bacteria viruses and fungi

A

1) Bacteria are cloudy while viruses and fungi are clear or hazy

2) Bacteria have an increase in neutrophils while viruses and fungi have a decrease in neutrophils

3) Bacteria have a decrease in lymphocytes and monocytes while viruses and fungi have normal to increase lymphocytes and monocytes

193
Q

What does c-reactive protein show

A

Liver inflammation

194
Q

What is leukocytosis

A

White blood cell count is greater than 10,000

195
Q

What is leukopenia and when do you see leukopenia

A

White blood cell count is less than 4,000 and see an overwhelming infection with aids, viral hepatitis, mononucleosis, and legionnaires disease

196
Q

What type of agents increases the number of neutrophils?

A

Bacteria

197
Q

What is weil Felix agglutination used for

A

Rickettsial agents

198
Q

What is the high cold aglutinin test usually indicative of

A

Mycoplasma pneumonia, viral pneumonia, or atypical pneumonia

199
Q

Absolute neutrophil count

A

Total number of neutrals in blood

200
Q

When does the sedimentation rate increase?

A

With severe acute infection and inflammation

201
Q

What test identifies exotoxins?

A

Eia

202
Q

What test identifies gram-negative lipid a endotoxin?

A

Limitless amoebocyte lysate test

203
Q

Examples of organisms that release exotoxins

A

Clostridium tetani
Corynebacterium diphtheriae
C diff
S aureus

204
Q

Examples of organisms that release endotoxins

A

E coli
Salmonella
Shigella
Pseudomonas
Neisseria
H influenza
Bordetella pertussis
Vibrio cholera

205
Q

What wbc count is indicative of pyuria j. Urinalysis?

A

> 10 WBC / mm^3

Ash's Certification Study (22 decks)

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