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Pulmonology > Pulm Micro > Flashcards

Pulm Micro Flashcards

1
Q

An example of a serious pathogen converted from an avirulent organism to a virulent organism by LYSOGENIC CONVERSION in

A

Corynebacterium Diptheriae

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2
Q

What is lysogenic conversion in the context of diptheriae

A

Strains lacking the diptheriae toxin (carried on the TOX gene on a Lysogenic bacteriophage) can be converted to toxigenic by by lysogenization

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3
Q

A+B Toxin model

A

B subunit is an adhesin that binds while the A subunit is toxic.

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4
Q

Where does corynebacterium diptheriae live?

A

Pharynx

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5
Q

Why is it particularly important to do a throat swab carefully when testing for diptheriae

A

If you rupture the epithelial layer on the back of the pharynx, you allow quick systemic access.

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6
Q

Symptoms of Diptheriae

A

SORE THROAT, Neck Swelling in severe cases, Skin lesions in cutaneous diptheriae

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7
Q

What is required to establish a diagnosis of corynebacterium diptheriae infection

A

The isolation of cornebacterium diptheriae in culture media….YOU MUST DO THIS or find some diptheria toxin

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8
Q

Diptheriae Differential

A

Think things like pharyngiitis, mono, epiglottitis, etc..

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9
Q

Treatment for Diptheriae

A 
Diptheriae antitoxoin (neutralizes the circulating toxin) if used early can help, but it cannot work against toxin that has already bound to body tissue.
Cutaneous diptheriae usually just requires antibiotics
AB= Erythromycin or Penicillin
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10
Q

If you hear gram positive aerobic spore former you think

A

Anthrax Bacillus

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11
Q

What are the 3 Category A agents of bioterrorism that we’re discussing

A

Anthrax, Plague, Tularemia (high mortality rate for these three)

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12
Q

Two Anthrax Virulence Factors

A

1) Antiphagocytic non-antigenic capsule
2) A+B toxin: B is the binding part and it is called the Protective antigen. A has 2 subunits which makes ANthrax unique, one is the Edema factor and one is the Lethal Factor that disrupts the hosts immune response

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13
Q

Two types of disease caused by BA

A

Cutaneous Anthrax and Inhalational Anthrax

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14
Q

Inhalational Anthraxhas two phases

A

1) Flu like–> fever, aches, chest pain, Short of Breath, Rhinorrhea
2) Fever, SEVERE SHortness of Breath, Chest pain

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15
Q

What characterizes cutaneous anthrax?

A

Swelling, non-painful…..THE INTENSE SWELLING IS WHAT SHOULD MAKE YOU THINK ANTHRAX

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16
Q

What is Phase 2 of Anthrax infection generally characterized as?

A

Hemorrhagic Mediastinitis with Pleural Effusion.

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17
Q

Key signs and symptoms of inhalational anthrax?

A

Infection of hilar/mediastinal Lymph nodes DIFFERENTIATES IT FROM PNEUMONIA.
Mediastinal widening on x-ray

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18
Q

In ANthrax, the spores are the infectious form. THey enter the body, are phagocytosed by macrophages, germinate, become encapsulated, disseminate through the bloodstream, ALL OF THIS CAN TAKE 6 weeks

A

Thats why if you’ve been exposed, you must take CIPRO for 40 days

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19
Q

Diagnosis procedure for Anthrax

A

Flu test to rule it out, blood culture (look for large boxcar chains of Gram positive rods),

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20
Q

Treatment

A

Ciprofloxacin IV or Doxy IV and Ampicillin

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21
Q

Lancet shaped diplococcus

A

Strep Pneumo

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22
Q

Most significant virulence factor for strep pneumo

A

Antiphagocytic polysaccharaide capsule

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23
Q

Pneumolysin virulence factor

A

Pore forming toxin, recruits neutrophils and T and B cells which contributes to inflammation. It breaks down hemoglobin into a green pigment. Its why pneumococcal colonies are surrounded by a green zone on blood agar plates. Picture a drill.

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24
Q

Strep Pneumo Hyaluronidase viirulence factor

A

Aids in bacterial spread through hyaluronic acid containing tissues

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25
Q

Neuraminidase

A

Strep pneumo vrulence factor that clips N-acetylneuramic acid from cell surface glycoproteins, this either causes direct damage or unmasks binding sites for pneumococci bacteria. This process occurs when pneumococci move along the eustachian tube toward the middle ear.

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26
Q

Pili

A

Strep Pneumo virulence factor that aids in adhesion to epithelium

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27
Q

Lipoproteins

A

Iron Uptake….strep pneumo virulence factors

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28
Q

Peptidoglycan and Teichoic Acid

A

Strep Pneumo virulence factors….

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29
Q

Choline Binding Proteins

A

Strep Pneumo virulence factor…Most are hydrolytic enzymes that stimulate inflammation

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30
Q

Competence protein

A

Strep Pneumo virulence…allows pneumococci to acquire DNA from the environment

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31
Q

Autolysin

A

Disrupt cell wall…release inflammatory contents…Strep Pneumo virulence

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32
Q

Where does strep Pneumo colonize?

A

Nasal cavity. Cause infection in the middle ear, sinuses, trachea, bronchi and lungs….can also cause infection elsewhere by hematogenous spread

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33
Q

Major symptoms of CAP caused by Strep Pneumo

A

Cough, fatigue, shaking, chills, sweats, SOB
GRAYISH ANXIOUS APPEARANCE
Diminished breath sounds, increased fremitus, crackles, RUST COLORED SPUTUM

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34
Q

Cause of death for CAP by strep pneumo

A

accumulation of fluid in alveoli leads to suffucation

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35
Q

Meningitis by strep pneumo, symptoms

A

Occurs when strep pneumo gets in CSF
Headache, stiff neck, photophobia
Babies may have a bulge ver the fontanelle
Progressive disease may lead to seizures, drowsiness, loss of consciousnes

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36
Q

Most common age range for CAP

A

UNder 2 and over 65

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37
Q

Risk factors for developing Strep Pneumo Infection

A

NO SPLEEN (spleen clears unopsonized pneumonia), defects in Ab formation, defects in complement system, diabetes, chronic disease, alcohol abuse, sickle cell, influenza

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38
Q

Diagnosis of Strep Pneumo infection

A

Sputum sample with only a small amt of saliva and thus very few squamous epithelial cells.
Alpha hemolysis, Catalase negativity,
Susceptibility to optochin, solubility in bile salts
CHEST X RAY

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39
Q

Treat strep pneumo with

A

A macrolide, doxycycline, amoxicilin

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40
Q

Strep pneumo meningitis treatment

A

penicillin or ceftriaxone

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41
Q

When you hear Nocardia Asteroides think

A

Normal soil microflora, assoc with water. Gram positive bacili with branching head
Pulmonary disease of immunocompromised host

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42
Q

How does Nocardia Asteroides differ from mycobacteria (TB)

A

Shorter chained mycolic acids.

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43
Q

Nocardia Virulence Factors

A

catalase and superoxide dismutase protect against Neutrophil/macrophage damage
Cord Factor prevents fusion of phagosome and lysosome

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44
Q

Nocardiosis is an opportunistic pathogen thatmost commonly presents as

A

Pulmonary Disease

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45
Q

The majority of pts with clinically recognized nocardiosis have?

A

Underlyng debilitating factors such as:

LUNG DISEASE

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46
Q

Can Nocardial infections be transported from person-person

A

NO

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47
Q

Diagnosis of Nocardiosis

A

Evaluate smears and stains for gram positive branching filaments

48
Q

Treatment of Nacardiosis

A

SUlfas, in well ppl for no less than 6 mths, In immunocompromised ppl for 12 mths

49
Q

Actinomyces Israeli is very similar to

A

Nocardia

50
Q

Actinomyces are normal flora of

A

Mouth

51
Q

Are Actinomyces Isrealii very virulent

A

No…mostly opportunist attacks when mucosa is disrupted such as dental plaque present, large peridontal pockets, trauma, etc…

52
Q

I say dental procedure you say

A

Actinomycetes

53
Q

Diseases that actinomycetes causes

A

Pulmonary Infection, Facial actinomycosis, Jaw actinomycosis, GI infections

54
Q

Symptoms of pulmonary infection

A

Cough with phlegm, chest pain, night sweats, wt loss

55
Q

Characteristic pathogenesis of actinomycetes

A

Abcess of hard yellow sulfur granules

56
Q

Treatment of actinomycosis

A

IV penicillin for 4-6 weeks, oral penicillin after that

57
Q

Diagnosis of actinomycosis

A

biopsy of aspiration material containing sulphur granules

58
Q

Chlamydia have a biphasic life cycle

A

True. Elementary Body enters the cell by endocytosis. The EB, now within an endosome (or phagosome) inhibits phagolysosomal fusion and organizes into a Reticulate body. This forms doughter EBs by binary fission

59
Q

Chlamydial virulence factors

A

Type Three secretion systems that secrete proteins into the cell cytosol and interfere with host response pathways.

60
Q

Legionella virulence factors

A

avoids phagosome lysosome fusion, injects bacterial proteins into the host cells and alters the activity of host factors involved in vesical traffic

61
Q

Chlamydia trachomatis infects what type of cells?

A

squamocolumnar

62
Q

What is the worlds leading preventable cause of blindness?

A

Trachoma

63
Q

Neonatal pneumonia and neonatal inclusion conjunctivitis are caused by?

A

Immunotypes D-K of Chlamydia trachomatis…it can be prevented with erythromycin eye drops at birth.

64
Q

Chlamydia is the most prevalent STI in the developed world

A

The problem is that 50-70% of the infections are silent in men and women so they never get treated.

65
Q

Pontiac Fever

A

Milder illness caused by L. Pneumophila. Causes flu-like symptoms and passes in 2-5 days.

66
Q

Important symptoms of chlamydia pneumonia

A

relatively mild respiratory illness, symptoms of bronchitis, cough with little sputum, HOARSENSS, headache. (headache and hoarseness are both unique findings) SINUS PERCUSSION TENDERNESS

67
Q

Legionella symptoms

A

high fever, chills, cough, muscle aches, headaches

68
Q

Mycoplasma

A

fever, malaise, dry cough, headache, chills,scratchy sore throat

69
Q

When do you get legionella

A

When you breathe in the contaminated mist or water vapor that has been contaminated with bacteria…Hot tub

70
Q

Are legionella spread from person to person

A

NO

71
Q

Chlamydia treatment

A

Doxycycline

72
Q

Legionella treatment of choice

A

Respiratory quinolones

73
Q

Whats the significance of the Rhinovirus not having an envelope

A

It can survive on surfaces for long periods of time

74
Q

Rhinovirus grows in what kind of environment

A

Limited tempertaure range (33-35) and non-acidic environments which is why it can basically only live in the nasopharynx

75
Q

Upon virus entry and uncoating, what happens

A

The positive sense RNA genome is released into the cell cytoplasm and serves as messenger RNA for translation of polyprotein

76
Q

What is unique about Rhinovirus proteases>

A

They cleave the “cap-binding complex” of eukaryotic cells that are required for translation initiation of host mRNAs. This shuts off protein synthesis but rhinovirus translation continues since it occurs in a CAP independent manner due to the presence of VPG and IRES.

77
Q

Does direct viral damage contribute to the disease symptoms of a cold?

A

No. Its the local inflammatory response

78
Q

I say ICAM-1, LDL-R. Sialoprotein Receptors you say

A

Rhinovirus receptors that help determine serotype

79
Q

Adenovirus causes what type of infections

A

Respiratory, Eye, GI

80
Q

Military recruits with acute respiratory disease

A

May be adenovirus

81
Q

Eye infection from swimming pool

A

Adenovirus

82
Q

Contaminated opthalmic medicine

A

keratoconjunctivitis

83
Q

Pharyngoconjunctival fever =

A

combo of pharyngitis and ocular infection

84
Q

H. Capsulatum

A

Histoplasmosis agent

85
Q

In tissues, what form does H Capsulatum take on

A

Yeast…this form resists macrophage killing

86
Q

What form does Blastomyces take on in the body

A

yeast…but it doesnt survive in macrophages

87
Q

Coccidioides immitis takes on what form in tissue

A

spherule

88
Q

Aspergillus are rapid growing molds with BRANCHING SEPTATE HYPHAE

A

true….recognize branching septate hyphae

89
Q

I say tornadoes and fuingi you say

A

murcomycosis

90
Q

The vast majority of Histoplasmosis infections are…

A

asymptomatic

91
Q

A minority of them lead to

A

chronic and relapsing pneumonia that resembles TB.

92
Q

The hallmark of acute pneumonia from blastomyces is purulent brown and bloody sputum

A

true

93
Q

Chronic lung infections from Blastomycosis can mimic lung cancer because of the formation of mass like lesions

A

truth

94
Q

Blastomyces infections disseminate where>

A

Skin (warty lesions), bone, genitourinary tract, prostate

95
Q

Coccidimycosis is also knows as

A

Valley FeverDevelops in 40% of infections and is characterized by feer, arthralgia, rash,

96
Q

ABPA

A

allergic bronchopulmonary aspergillosis seen in asthma and CF patients

97
Q

Pts with an underlying pulmonary conditions may form a —– ball

A

fungal ball…this can cause life threatening hemoptysis

98
Q

Invasive aspergillosis can spread beyond the lungs and into the central nervous system

A

true

99
Q

I say fungal infection in acidotic diabetic on corticosteroid treatment, you say

A

Mucormycosis

100
Q

Mucormycosis can cause death in as little as two weeks how>

A

Rhinocerebral mucormycosis

101
Q

Pneumocystis presesnts as

A

diffuse interstitial pneumonia. Lung infiltrates develop and lead to reduced oxygen saturation

102
Q

Ohio and Mississippi river valleys

A

histoplasmosis

103
Q

How do you diagnose fungal infections

A

Treat culture or tissue specimens with KOH to remove all structures except fungal walls.

104
Q

First line treatment for fungal infections

A

Azoles. If infection still persists: Ampho B

105
Q

At first suspicion of aspergillus, start

A

Ampho B

106
Q

Mucormycosis

A

Ampho B

107
Q

See fungal-protozoan structure think

A

Pneumocystosis

108
Q

Treat pneumocystosis with

A

trimethroprim sulfamethoxazole

109
Q

Koryne= club, Bacter= Little Rod

A

diptheria name and shape

110
Q

Diptheria’s main cause of harm

A

Throat

111
Q

Chubby gram negative rods, safety pin

A

yersinia pestis

112
Q

F1 virulence factor in Yp

A

paralyzes phagocytes

113
Q

Unpasteurized dairy product consumption

A

Brucellosis

114
Q

Keys to plague diagnosis

A

History (exposure to groud rodents, travel to Southwest US, large painful lymph nodes, resistance to B-lactams and macrolides

115
Q

Lower respiratory tract infections in infants

A

RSV, hpMV1 and pPIV

116
Q

Sand in eye

A

Adenovirus

117
Q

Capsid Penton Protein

A

Adenovirus

Pulmonology (41 decks)

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