PBL: Case 2 Part 1

Question 1

What is the order of the anatomical areas of the respiratory tract?

Answer 1

Upper: Nasal, sinus, nasopharynx, oropharynx, epiglottis, larynx
Lower: Trachea, bronchi, alveoli (last two are in the lungs)

Question 2

• Methods for collecting a throat specimen

- sterile or not?

Answer 2

• swab, avoid the tongue

- not sterile

Question 3

• Methods for collecting a sinus infection specimen

- Sterile or not

Answer 3

• aspiration?
• Expectorated Sputum
• Induced Sputum

Question 4

• Method for collecting tracheostomy specimen

- Sterile or not

Answer 4

• Not a good specimen

Question 5

Method for collecting endotrachiostomy

- Sterile or not

Answer 5

• go down through the throat

- not a good specimen

Question 6

• Method for collecting transtrachiostomy

- Sterile or not

Answer 6

• Go in through trachea;

- the best because its a sterile

Question 7

• Method for Bronch washing

- sterile or not?

Answer 7

take a tube down into the the lung and then such back up (same as BAL) you use a branch brush to bring up cells

Question 8

• Method for BAL

- sterile or not?

Answer 8

depends on the lab if its sterile or not

Question 9

• Method for Fine needle aspirate

- sterile or not

Answer 9

sterile

Question 10

Which specimens avoid exposure to the usual flora of the upper respiratory tract?

Answer 10

Transtracheal, BAL, fine needle, open biopsy, others depend if double lumen

Question 11

Most common bacterial pathogens:

- Throat

Answer 11

• Group A strep- strep pyogenes (only for a strep screen would we look for this - treat with penicillin)
• Other beta strep

Question 12

Most common bacterial pathogens:

- Upper respiratory

Answer 12

• ## Archanobacterium (looks like beta strep group A; causes sore throat, GPR THOUGH; just do a gram stain)

Question 13

Most common bacterial pathogens:

- Thrush

Answer 13

Candida (yeast)

Question 14

Most common bacterial pathogens:

- community acquired

Answer 14

• strep pneumonea

- others (group B in babies)

Question 15

Most common bacterial pathogens:

- hospital acquired

Answer 15

Legionella and GNRs (especially drug resistant)

Question 16

Most common bacterial pathogens:

- aspiration pneumonia

Answer 16

• anaerobes

- mixed

Question 17

Most common bacterial pathogens:

- pertussis

Answer 17

Bordetella pertussis (parapertussis)

Question 18

Most common bacterial pathogens:

- diphtheria

Answer 18

C. diphtheria

Question 19

Most common bacterial pathogens:

- Cystic fibrosis

Answer 19

• Start off with staph aureus or Haemophilus
• Later progresses to pseudomonas (more resistant)
• Later progresses to Burkholdaria cepacia

Question 20

Most common bacterial pathogens:

- Walking pneumonia

Answer 20

mycoplasma pneumonia

Question 21

Most common bacterial pathogens:

- Tuberculosis

Answer 21

• mycobacterium tuberculosis

- M. avium

Question 22

Most common bacterial pathogens:

- Immunocompromised

Answer 22

• fungi
• Nocardia
  (avoid normal flora)

Question 23

Most common bacterial pathogens:

- Epiglottis

Answer 23

• H. influenza type b (not seen as much due to vaccine)

- M. catarahralis (in kids causing ear and sinus infections)

Question 24

Most common bacterial pathogens:

- Otitis media

Answer 24

• strep pneumo

- H. flu

Question 25

Most common bacterial pathogens:

- Pharyngitis

Answer 25

Group A strep

Question 26

What organisms are most commonly found as “usual flora”in the upper respiratory tract specimen?

Answer 26

• *Mouth Flora:
  1. Alpha and gamma steptococci
  2. Corynebacterium spp.
  3. CoNS
  4. non-pathogenic Neisseria spp.
  5. Prevotella melaninogenica
  6. Prevotella spp.
  7. Porphyromonas spp.

Question 27

What are 5 Upper respiratory infections?

Answer 27

1. Pharyngitis
2. Sinus infection
3. Otitis Media
4. Epiglottitis
5. Pertussis

Question 28

What are 2 lower respiratory infections?

Answer 28

1. Acute Bronchitis/Bronchiolitis

2. Phenumonia (acute or chronic)