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Resp II > Micro review > Flashcards

Micro review Flashcards

1
Q

Bordetella purtusis

A

aka whooping cough
highly contagious
gram neg aerobic coccobacillys capsulate
humans only known reservoir

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2
Q

Bordetella purtusis phases

A

catarrhal
paroxysmal
convalescent

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3
Q

catarrhal phase

A

rhinorrhea
lacrimation
conjunctival injection
low grade fever for days

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4
Q

paroxysmal phase

A

uncontrollable expirations, followed by gasping inhalation (whoop)
post cough cyanosis, gagging, vomiting
last up to 4 weeks

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5
Q

convalescent phase

A

reduction in frequency and severity of cough, can last from weeks to months

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6
Q

Bordetella purtusis Tx

A

supportive
azithromyocin
chemoprophylaxis to control outbreaks

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7
Q

klebsiella pneumonia

A

gram negative, non-motile, capsulate rods

facultative anaerobe

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8
Q

klebsiella infections

A 
UTI
soft tissue
endocarditis
CNS
severe bronchopneumnia
CAP and HAP (cavitary lung lesions)
currant jelly sputum
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9
Q

M. cartarrhalis

A 
gram neg bacteria
chocolate agar
diplococci
catalase +
oxidase +
penumonia, especially in elderly
otitis media
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10
Q

N. meningitidis

A 
aerobic gram neg kidney shaped diplococci, capsule
oxidase +
ferments maltose and glucose
thayer martin and chocolate agar
commensal of URT
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11
Q

clinical manifestation of N. meningitidis

A 
meningitis
septicemia
pneumonia 
septic arthritis, pericarditis, chronic bacteremia
conjunctivitis
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12
Q

N. meningitidis Tx

A

penicillin

3rd generation cephalosporins

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13
Q

Pseudomonas

A

aerobic gram neg rod
pyocyanin
primarily nosocomial
in hospital can colonize moist surfaces

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14
Q

Pseudomonas infections

A 
HAP, VAP
community aquired infections associated w/hot tubs, whirpools, swimming pools, extended contact lenses
otitis externa
puncture wounds thru shoes
endopthalmitis
endocarditis
UT
skin infections, burns, ecthyma gangreosum
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15
Q

pseudo bacterial factors

A 
exo and endotoxins
type III secreted toxins
pili
flagella
proteases
phospholipids
iron binding proteins
exopolysaccharides
biofilms
pyocyanin
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16
Q

pseudo Tx

A

extended spectrum penicllin and aminoglycoside combination

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17
Q

Chlamydophilla psittaci

A

gram neg obligate intracellylar bacteria

macrophages principal host cell

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18
Q

Chlamydophilla psittaci diseases

A

psittacosis
atypical pneumonia
febrile illness

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19
Q

Chlamydophilla psittaci transmission

A

aerosolized bird secretions, dust

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20
Q

Chlamydophilla psittaci Tx

A

tetracyclines
macrolides
FQs

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21
Q

Chlamydophilla pneumoniae

A

80% of adults seropositive
common in kids <5
atypical penumonia

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22
Q

Chlamydophilla pneumoniae atypical pneumonia

A

incubation several wks
non productive cough
preceded by nasal congestion, sore throat, and hoarseness
HA

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23
Q

Chlamydophilla pneumoniae labs

A

normal white count

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24
Q

Chlamydophilla pneumoniae Tx

A

tetracyclines
macrolides
FQs

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25
Q

Coxiella burnetti

A

gram neg that infects hosts monocytes
incompletely eliminated after acute infection
will continue to multiply in immunocompromised and endocarditis patients despite high Abs
infects mammals, birds, ticks

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26
Q

Coxiella burnetti spread

A

animal feces, urine, milk, birth products
survives in environment and can be spread by wind
major outbreaks associated w/sheep and goats during lambing season

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27
Q

Q-fever

A 
Coxiella burnetti
60% seroconvert w/o disease
38% self limited
2% require diagnostic evaluation
prolonged fever
pneumonia
hepatitis
rash
meningitis, encephalitis, menigioencephalitis, peripheral neuropathy
pericarditis, myocarditis
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28
Q

Coxiella burnetti prego

A

uterine infections and spontaneous abortions

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29
Q

Q fever endocarditis

A

intermittent fever
vegetations frequently absent
cerebral emboli, renal insufficiency, splenomegaly, hepatomegaly

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30
Q

Coxiella burnetti Tx

A

Doxy

Doxy + hydroxychloroquine for 18-36 months for endocarditis

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31
Q

Francisella tularensis

A

infectious zoonosis
small aerobic pleomorphic gram neg bacillius
rabbits, squirrels, muskrats
direct contact, ingestion of water or meat, bite of infected tick or fly, aerosol, NOT human -> human

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32
Q

Francisella tularensis clinical

A 
ulceroglandular
glandular
oculoglandular
typhoidal
oropharyngela
pneumonic
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33
Q

Francisella tularensis ulcerolglandular

A 
fever and constitutional symptoms
swollen lymph nodes that drain an inoculation
ulcer formation
sore throat
patchy infiltrates on CXR
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34
Q

Francisella tularensis glandular

A

fever
constitutional symptoms
lymphadenopathy

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35
Q

Francisella tularensis typhoidal

A

fever of unknown cause

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36
Q

Francisella tularensis oropharyngeal disease

A

uncommon in US
mucous membranes of mouth and pharynx are portal of entry
contaminated water or food
painful exudative pharyngitis and tonsillitis
pharyngeal ulcers
swollen retropharyngeal and cervical lymph nodes

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37
Q

Francisella tularensis pneumonic disease

A

inhalation exposure
fever, malaise, dry cough, substernal discomfort, pleural effusion, dyspnea, sore throat,
CXR- peribronchial infiltrates to bronchopenumomia w/effusion
hilar adenopathy

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38
Q

Francisella tularensis Tx

A

gentamicin or streptomycin
doxy
cipro

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39
Q

bacillus anthracis

A 
spore forming gram pos non motle rod
aerobic or facultatively anaerobic
catalase +
hemolysis neg
sheep agar
zoonotic (goats, sheep, cattle, antelope, kudu, pigs, horses, zebu)
soil contaminated w/spores
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40
Q

bacillus anthracis inhalation:

A

mediastinal adenopathy and widening, pleural effusions, rapidly fatal if not treated w/multiple abx and pleural drainage

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41
Q

bacillus anthracis cutaneous

A

most common

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42
Q

bacillus anthracis GI

A

oropharyngeal

intestinal

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43
Q

bacillus anthracis menigeal

A

nearly always fatal, can occur as complication of inhalation, cutaneous, or GI

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44
Q

bacillus anthracis Tx

A

multi-drug regimen

pleural drainage

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45
Q

Yersinia pestis

A

gram neg coccobacillus, microaerophilic, nonmotile, and non-spore forming
rodents and fleas as vectors
prairie dogs

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46
Q

clinical manifestation of plauge

A

bubonic
septicemic
pneumonic

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47
Q

bubonic plague

A

swollen tender lymph nodes (boboes) closest to site of initial infection
fever, chills, myalgia, arthralgia, HA, malaise, prostration
untreated- tachycardic, agitation, confusion, delirium, convulsions

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48
Q

septicemic plague

A

nausea, vomiting, diarrhea, ab pain
DIC
hypotension, renal failure, obtundation
ARDS

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49
Q

pneumonic plague

A

fever, cough, chest discomfort, tachycardia, dyspnea, bacteria laden sputum, chills, HA, myalgias, weakness, dizziness
respiratory distress, hemoptysis, cardiopulmonary insufficiency, circulatory collapse
death w/in 24hours

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50
Q

Yersinia pestis Tx

A

streptomycin for penumonic
tetracyclines for bubonic
chloramphenicol for meningitis

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51
Q

leptospirosis

A

spirochete w/terminal hook
dark field microscopy or silver stain
obligate aerobe
weils disease, pulmonary hemorrhage syndrome

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52
Q

leptospirosis resevoir

A

persistent renal carriage from rodents, dogs, pigs, cattle, and sheep
colonize renal tubules, excreted in urine, and survives for wks to months in enviroment

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53
Q

leptospirosis transmission

A

penetrates skin or mucous membranes during contact w/contaminated water, soil, vegetations

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54
Q

leptospirosis early phase

A 
3-7 days
fever, myalgia, ab pain, diarrhea, cough, photophobia
mm tenderness
rash
conjunctival suffusion
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55
Q

leptospirosis late phase

A 
aka weils disease
jaundice
acute hemorrhage
renal failure
severe thrombocytopenia
GI bleeding
pulmonary hemorrhage
myocarditis
aseptic menigitis
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56
Q

lepto diagnosis

A

agglutination test

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57
Q

leptospirosis Tx

A

doxy

penicillin

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58
Q

H. influenza

A 
encapsulated gram neg pleomorphic rod
aerobic or facultative aanaerobe
chocolate agar
nasopharyx of adults and kids
type B was most common cause of meningitis before vaccines
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59
Q

H. influenza menigitis

A

children <5f and adults w/skull trauma or CSF leaks
Type B
diagnosis by detecting PRP capsular Ags in CSF

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60
Q

H. influenza epiglottis

A

life threatening infection in kids thumb print

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61
Q

H. influenza Pneumonia

A

fever, cough, lobar consolidation
parapneumonic effusion and empyema
smoking risk factor

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62
Q

other presentations of H. influenza

A

bronchitis (COPD)
acute sinusitis
otitis media

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63
Q

H. influenza Tx

A

3rd generation cephalosporin

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64
Q

C. diptheriae

A

gram + bacillus, club shaped
non-spore forming
aerobic
reservoir- throat and pharynx

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65
Q

respiratory diptheriae

A

incubation of 1-7 days
sore throat, malaise, fever
pharyngeal erythema followed by tonsillar exudate -> grayish membrane tightly adhered and bleeds on attempted removal

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66
Q

C. diptheriae clinical presentation

A

cervical adenopathy- bull neck
stridor
extension of membrane - airway obstruction
myocarditis, recurrent laryngeal n palsy, and peripheral neuritis

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67
Q

C. diptheriae Tx

A

erythromycin

antitoxin

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68
Q

legionellas

A

weakly gram - pelomorphic rod
facultative intracellular
requires cysteine and iron (charcoal yeast extract)
water organism, amebae, air-conditioners

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69
Q

legionellas risk factors

A

smokers
55+
high alcohol intake
immunosupression

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70
Q

legionaires disease

A

-fevers, malaise, cough, chills, dyspnea,
-myalgias, HA, chest pain, diarrhea distinguish from other penumonias
mental confusion

71
Q

pontiac fever

A

fever sore throat mylagia, HA, extreme fatigue
short duration, lasting on average 3 days
legionellas

72
Q

Tx of legionella

A

FQ
azithromycin
erythromycin +rifampin in immunocompromised
dug must penetrate human cells

73
Q

M. pneumonia

A 
smallest free-living bacteria
no cell wall (therefore beta lactams have no effect)
sterol containing membrane
requires cholesterol for culture
military, dorms
highest incidence 5-20
74
Q

M. pneumonia respiratory infection

A 
2-3 wks incubation
fevers, malaise, HA, and cough
5-10% progress to pneumonia
cough usually non-productive
'walking pneumonia'
can also cause Bullous myringitis
75
Q

M. pneumonia Dx

A

primary clinical

positive cold agglutinins in 65%

76
Q

M. pneumonia Tx

A

macrolides

tetracyclines

77
Q

S. pneumonia

A 
gram + diplococcus
lancet shaped
blood agar
alpha hemolytic
optochin sensitive
lysed by bile
polysaccharide capsule
78
Q

S. pneumonia risk factors

A 
influenzae infection
COPD
CHF
alcoholics
asplenia
79
Q

S. pneumonia typical pneumonia

A

most common causative agent

shaking chills, high fever, rigors, lobar consolidation, rusty (blood tinged) sputum

80
Q

other manifestations of S. pneumonia

A

Adult meningitis most common causative agent

otitis media and sinusitis most common causative agent in kids

81
Q

S. pneumonia pneumonia Tx

A

beta lactams
macrolides
FQs

82
Q

Tx of S. pneumonia T meningitis

A

3rd generation cephalosporin

vancomicin if penicillin reisistant

83
Q

SARS

A

coronavirus (second most common cause of common cold)
reservoir- birds and small mammals
virus also found in urine, sweat, and feces

84
Q

clincial manifestation of SARS

A 
fever >100.4
flu-like illness
dry cough
dypsnea
progressive hypoxia
85
Q

SARS Dx

A

clinical Hx and travel Hx (far east or Toronto)

86
Q

SARS Tx

A

supportive

50% mortality in elderly

87
Q

Varicella-Zoster virus

A

infects epi cells and lymphocytes in oropharynx and URT
infected lymphocytes disseminate
virus enters skin thru endo cells in blood vessels and spreads to epi -> rash
virus remains dormant in CN ganglia and DRGs reactivation -> herpes Zoster

88
Q

Varicella-Zoster virus Tx

A

shingles- acyclovir PO
immunocompromised w/shingles- IV acyclovir
aspirin CI due to Ryes syndrome

89
Q

Varicella-Zoster virus vaccine

A

CI in:
hematologic malignant neoplasms
AIDS/HIV w/CD4 < 200
people receiving high dose immunosupressive therapy or anti-tumor necrosis factor

90
Q

S. aureus

A 
gram + cocci in clusters
catalase +
coagulase +
beta hemolytic
small yellow colonies on blood agar
ferments mannitol
91
Q

S. aureus transmission

A

hands, sneezing, surgical wounds

foods: custards, potato salad, canned meats

92
Q

S. aureus pathogenesis

A

adhesions, toxins, enzymes, surface binding proteins, capsule
tissue invasion and toxin mediation

93
Q

S. aureus toxin mediated disease

A

food poising
toxic shock syndrome
scalded skin syndrome

94
Q

staph aureus clinical manifestations

A 
skin
bacteremia
endocarditis
pericarditis
osteromyelitis 
septic arthritis, infected prothetic joints
penumonia
95
Q

S. aureus skin maifestations

A 
impetigo
folliculitis
furuncle
abscess
erysipelas
cellulits
mastitis
necrotizing fasciitis
wound infections
96
Q

S. aureus endocarditis

A

roth spts
oslers nodes (ICs)
janeway lesions (septic emboli)
petichiae

97
Q

S. aureus pneumonia

A

nosocomial pneumonia

salmon colored sputum

98
Q

Staphylococcal food poisoning

A

S. aureus
enterotoxins A-E
2-6 hours after eating nausea, vomiting, diarrhea, ab pain
self limited

99
Q

Toxic shock syndrom

A

S. aureus
TSST-1 (super Ag)
fever, erythoderma, hypotension, 3+organ systems, deequamation of palms and soles

100
Q

scalded skin syndrome

A

S. aureus

exfoliative toxin A or B

101
Q

S. aureus Tx

A

gastroenteritis is self limiting
Nafcillin/oxacillin
MRSA-vancomicin

102
Q

Pneumocystis jirovecii

A

fungus
obligate extracellular parasite
silver stain
opportunistic infection in HIV patients w/CD4 count less then 200

103
Q

PCP

A

fever
nonproductive cough
shortness of breath
CXR- patchy infiltrate, ground glass, lower lobe and periphery may be sparred

104
Q

PCP Dx

A

silver staining cysts in bronchial alveolar lavage fluids or biopsy

105
Q

PCP Tx

A

sulfamethaxazole/trimethoprim

or dapsone

106
Q

PCP prophylaxis

A

when CD4 count <200

107
Q

Histo

A

dimorphic fungus
facultative intracellular parasite
soil, caves, abandoned buildings w/bats or birds

108
Q

Histo transmission

A

disruption of soil, cleaning attics, bridges, barns, tearing down old structures, spelunking
endemic to Mississippi and Ohio river valleys

109
Q

Histo acute

A

most asymptomatic

several weeks after exposure fever, chills, fatigue, non-productive cough, anterior chest discomfort, myalgias

110
Q

Histo chronic

A

progressive often fatal

elderly immunocompromised and COPD patients at risk

111
Q

Histo x-ray acute

A

patchy lobar or multilobar infiltrate

112
Q

Histo x-ray chronic

A

upper lobe infiltrates. multiple cavities, fibrosis of lower lobes (mimics TB)

113
Q

Histo Tx

A 
itraconazole
Amphotericin B (IV)
114
Q

Blasto

A

thermally dimorphic fungus
broad based budding yeast
associated w/soil and decaying vegetation, especially near rivers and lakes

115
Q

blasto endemic

A

north central, south central, great lakes, and SE sea board

116
Q

blasto acute

A

asymptomatic or thought to have community acquired pneumonia
fever, malaise, non-productive cough
skin lesions

117
Q

Blasto acute CXR

A

lobar, multilobar, or nodular

118
Q

Blasto chronic

A 
fever
night sweats
fatigue
weight loss
cough
hemoptysis
dyspnea
119
Q

Blasto chronic CXR

A

cavitary, nodular, fibrosis, mass like

120
Q

Blasto Tx

A

all patients should be treated
Itraconazole if mild
amphotericin B if severe

121
Q

Coccidiodes

A

dimorphic fungi
inhaled anthroconidia -> spherules -> internal septation -> endospores
endemic to SW desserts

122
Q

coccidiodes clinical

A 
most asymptomatic
5-11 days post exposure
fever, weight loss, fatigue, dry cough, peluritic chest pain
arthralgias
erythema nodosum
123
Q

coccidiodes CXR

A

pulmonary infiltrates
hilar adenopahty
peripneumonic effusion
pulmonar nodule-> cavitary

124
Q

coccidiodes disseminated

A

immunocompromised
3rd trimester of pregnancy,
skin, joints, bones

125
Q

coccidiodes Tx

A

itraconazole

amphortericin B

126
Q

Paramyxoviruses traits

A

enveloped
helical neuclocapsid
negative sense ssRNA

127
Q

paramyxoviruses

A

parainfluenza
measles
mumps
RSV

128
Q

parainfluenza

A

person-person contact

most children exposed by elementary school

129
Q

parainfluenza clinical

A

Coryza, rhinorrhea, pharyngitis w/o lymphadenopathy and low grade fever
symptoms for 3-5 days
CROUP

130
Q

Croup

A

raspy barking cough w/indpiratory stridor, dyspnea, and respiratory distress
symptoms result from subglottic inflammation and edema

131
Q

parainfluenza bronchiolitis or pneumonia

A

cough, rales, wheezing, hypoxia

132
Q

cold

A

reinfection of adults w/parainfluenza typically caused cold symptoms in normal adults and kids

133
Q

measles

A 
rubeola
highly contagious
3 Cs- cough, coryza, conjunctivits
generalized maculopapular rash
fever
134
Q

measles contagious

A

4days before and after onset of rash

135
Q

measles clincial

A

incubation 8-12 days
prodrome of fever, Cs, koplik spots
malaise, myalgia, HA
rash 2-6 days after catarrhal symptoms head-> trunk-> extremities

136
Q

measles complications

A

diarrhea, otitis media, pneumonia
post infectious encephalomyelitis
subacute sclerosing panencephalitis

137
Q

subacute sclerosing panencephalitis

A

degenerative demylinatng disease due to chronic infection

occurs years after acute measles infection and is universally fatal

138
Q

measles Tx

A

supportive

prevention w/vaccine

139
Q

Mumps clinical

A

parotitis
aseptic meningitis- common and usually mild
encephalitis rare and severe
orchitis

140
Q

mumps Tx

A

supportive and prevention w/vaccine

141
Q

RSV

A

epidemics late fall in souther states peaking in feb-march in colder climates

142
Q

RSV clinical

A

infants
conjunctival injection, mucopurulent discharge, cough, low grade fever
otitis media
less common- wheezing, tachypnea, cyanosis
expiratory wheezing and rales

143
Q

RSV CXR

A

hyperinflation and diffuse interstitial pneumonitis

144
Q

RSV Tx

A

ribavarin

no vaccine

145
Q

strongyloides stercoralis

A

endemic in warm climates
contact w/larvae in soil
enter circulation -> rupture in alveolar spaces-> coughed -> swallowed

146
Q

stongyloides pulmonary

A

can be sever in immunocompromised

resembles ARDS w/acute onset of dyspnea, productive cough, and hemoptysis accompanied by fever, tachypnea, hypoxemia

147
Q

stongyloides Tx

A

ivermectin

148
Q

aspergillosis

A

ubiquitous organisms in foil, decaying matter, air
spore like conidia-> reach tissue forming invasice hyphae
basements, crawl spaces, bedding, humidifiers, ventilation ducts, potted plants, dust, condiments, marijuana

149
Q

invasive aspergillosis

A 
immunocompromised
fever
pulmonary inflitrates
nodules
wedge-shaped densities resembling infarcts
sinusitis
150
Q

aspergillosis extrapulmonary

A

CNS absesses, endophthalmitis, MI, GI, renal, osteomyelitis, endocarditis

151
Q

aspergillosis Dx

A

BAL, needle aspiration, thoracoscopic biopsy, open lung biopsy

152
Q

Tx aspergillosis

A

Antifungal- voriconazole or liposomal amphotericin B
reversal of immunosupression
surgical resection of infected lesions

153
Q

aspergilloma

A

ball in cavity
debris in preformed cavity from TB, histo, or fibrocystic sarcoidosis
Tx- intraconazole or voriconazole

154
Q

allergic bronchopulmonary aspergillosis (ABPA)

A

history of chronic asthma, or cystic fibrosis
airway obstruction, fever, eosinophillia, postive sputum cultures, mucous plugs containing Hyphae, brown flecks in sputum, upper lobe contraction,
elevated IgE

155
Q

ABPA Tx

A

corticosteroids and itraconazole

156
Q

Cryptococcosis

A

immunosupressed- HIV
meningitis is most common in clinical manifestation
pulmonary and other organ involvement can occur

157
Q

cryptococcus neoformans

A

yeasts
environment and tissues
polysaccharide capsule is major virulence factor

158
Q

cryptococcus CNS

A 
meningioencephalitis
HAs over several weeks
nuchal rigidity 
lethargy 
personality changes
confusion
visual abnormalities 
nausea and vomiting
159
Q

cryptococcus pulmonary

A

risk factors: COPD, corticosteroid use, solid organ transplant
fever, cough, dyspnea
treated w/antifungals

160
Q

other organs affected by cryptococcus

A 
skin
prostate
osteoarticular surfaces
breast
eye
larynx
161
Q

cryptococcus Dx

A

yeast grown in culture from CSF, blood, sputum, skin lesions, other body fluids
india ink stain
latex agglutination

162
Q

cryptococcus CNS Tx non-aids

A

amphotericin B and flucytosine for 6 weeks

163
Q

cryptococcus CNS Tx aids

A

amphortericin B and flucytososine for 2 wks followed by fluconazole

164
Q

HACEK organisms

A 
Heamophilus spp
actinobacillus actinomycetemcomitans
cardiobacterium hominis
Eikenella corrodens
Kingella
165
Q

HACEK

A

5% of endocarditis
normal flora
common cause of endocarditis in IV drug users
difficult to diagnosis

166
Q

CMV

A 
member of herpes family
double stranded DNA genome
latent infections
most clinical disease due to reactivation of latent infection in immunocompromised 
owl eye
167
Q

CMV vertical spread

A

in utero during vaginal delivery

breast milk

168
Q

CMV horizontal spread

A

saliva
genital
urine

169
Q

CMV congenital and neonatal

A

microcephaly, intracerebral calcification, hepatosplenomegaly, and rash
mental retardation and hearing loss
mother w/primary infection during pregnancy

170
Q

CMV immunocompetent

A

most asymptomatic

few w/mono like illness

171
Q

CMV transplant recipients

A

fever, neutropenia, atypical lymphocytes, and hepatosplenomegaly
hepatits- transplanted liver
penumonia
colitis- diarrhea

172
Q

CMV AIDS

A

CD4 <50
retinitis
colitis

173
Q

CMV Tx

A

antivirals

Resp II (15 decks)

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