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IDIS > PULM: RTIs - I, II, III > Flashcards

PULM: RTIs - I, II, III Flashcards

1
Q

discuss strep pyogenes in terms of

  • hemolysis
  • resistance/sensitivities
  • virulence factors
A

graim +, cocci chains

  • beta hemolytic
  • bacitracin (A-disc) sensitive
  • virulence factor: M-proteins
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2
Q

what is the most common cause of a LRT infection?

A

pneumonia

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3
Q

what are the most important immune cell in the LRT and what does it do?

A

alveolar macrophage

  • prevent infections: phagocytize microbes before they can act
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4
Q

what are the two main modes of transmission of respiratory tract infections?

A

inhalation

aspiration

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5
Q

characterize the parts of the respiratory tract in terms of whether they are most commonly infected by

  • viruses
  • bacteria
A

bacterial:

  • epiglottis: epiglottitis/croup
  • trachea- pertussis/whooping cough

viral:

  • larynx - laryngitis
  • trachea- croup
  • bronchi - bronchitis
  • Bronchioles- bronchiolitis
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6
Q

common cold

  • occurs during what time of year
  • pathogenesis?
  • what are the main etiological agents & the differences between them
A
  • occurs during the winter
  • contamination by aerosols/repsiratory droplets. etiological agents bind to their receptors & cause cells to slough off
  • etiological agents:
    1. rhinovirus (m/c) - naked RNA
  • pathogenesis - binds to ICAM-1 receptor
  • presentation - NO fever
  1. SARS-Cov-2 - naked RNA
  • pathogensis - binds to ACE-2 receptor with its “spike” protein
  • presentation - FEVER, plus:
    • loss ot taste/smell
    • shortness of breath
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7
Q

summer grippe

  • is prevalent during what time of the year?
  • pathogenesis?
  • etiological agents?
  • what presentation?
A
  • seen during the summer
  • agents/pathogenesis:
  • virus (enteroviruses - entero, echo, cocksackie) ingested via fecal-oral route
    • infect epithelial cells of GI tract
      • cause HIGH fever, malaise, GI disruption/nausea
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8
Q

complication of the common cold?

A

rhino, SARs-CoV-2

  • exntension of infection to LRT
  • blockage of eustachian tubes
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9
Q

what is the best way to prevent summer grippe?

A

avoid food and water sources contaminated with feces

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10
Q

contrast the common cold and summer grippe based on

  • prevalent season
  • means of spread
  • m/c agents
  • presentation
  • prevention
A

common cold:

  • winter
  • spread via respiratory droplets
  • rhinovirus (ICAM), SARS-covid (ACE-2)
  • presentation: none / moderate fever
    • SARS: loss of taste / smell, shortness of breath
  • prevention - sanitization

summer grippe:

  • summer
  • spread via fecal-oral
  • echovirus, enterovirus, cocksackie
  • prsentation: HIGH fever + GI issues (N&V)
  • prevention - dont drink suspect water
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11
Q

what is rhinosinusitis?

A

inflammation of nasal cavity (rhinitis) + at least one paranasal sinus (sinusitis)

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12
Q

viral vs bacterial rhinosinusitis

  • which is more common
  • which is more severe
  • what are the m/c agents of each?
A
  • acute viral rhinosinusitis - more common
    • rhino, adeno, parainfluenza, RSV
  • acute bacterial rhinosinusitis - more severe / longer lasting
    • commonunity aquired - S, pneumo, H. flu,** **M. catarrhalis
    • nosocmial: gram -
    • post-dental: anaerobic
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13
Q

pathogenesis of rhinosinusitis

A
  • typicaly triggered by a viral URI (rhino, adeno, RSV)
    • etiological agent causes inflammation
    • sinus secretion cant drain
    • pressure builds –> facial pain, aural fullness, ocular issues
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14
Q

major manifestations of rhinosinusitis

A
  • Aural fullness
  • Facial pain
  • Fever
  • Myalgias
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15
Q

what are the major diagnostic indicators (seen in physical exam) of rhinosinusitis?

A

both: unilateral facial swelling / facial pain / aural fullness

  • adults (> 7 days): TOOTH PAIN
  • children (10-14 days): HIGH FEVER
  • other: ocular (diplopia, infraorbital hypothesia), altered mental status
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16
Q

rhinocerebral mucormycosis - most common etiological agents?

A
  • rhizopus/rhizomucor (most common)
  • asperilliguis
  • fursarium
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17
Q

rhinocerebral mucormycosis is seen in what patients?

A

almost exclusively immunocomporised patients

  • diabetetics (with DKA)
  • transplant recipients
  • cancer - lymphoma/leukemia
  • chronic use of glucocoritcoid/deferoxamine
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18
Q

pathogenesis of rhinocerebral mucormyocisis

A
  • fungal spores (likely rhizopurus) are inhaled
  • spores germinate –> form hyphae –> hyphae invade nasal cavity/sinuses –> get into blood veseels –> cause necrosis
19
Q

clinical presentation of rhinocerebral mucormycosis

A
  • start of with rhinosinusitis symptoms
  • bloody nasal discharge develops
  • then:
    • dusky/necrotic nasal turbinates
    • black eschar on palate (hemipalatal necrosis)
    • ocular problems
20
Q

prevention and therapy for rhinosinusitis

A
  • prevention
    • correct septal deviations
    • plug nose when jump in pool
    • control allergic rhinitis, proper dental management
  • treatment -
    • viral - manage symptoms
    • bacterial - give antibiotics
21
Q

prevention and treatment of rhinocerebral mucormycosis

A
  • prevention: encourage diabetics to maintain good control over their serum glucose
  • treatment: URGENT
    • aggressive surgical debridement
    • high dose antifungal (amphotericin B)
22
Q

Which of the following is considered a severe symptom of acute rhinosinusitis?

  1. Coughing
  2. Tooth pain
  3. Purulent nasal discharge
  4. Nasal congestion
  5. Temperature= 37o C
A

tooth pain

23
Q

A diabetic patient complains of fascial pain over his right maxillary sinus. Examination reveals a discolored palate and dusky turbinates. Most likely cause?

  1. Candida
  2. Aspergillus
  3. Fusarium
  4. Trichophyton
  5. Rhizopus
A

rhizopus

24
Q

pharyngitis - most common etiological causes?

list characteritics of agents

A
  • viruses > bacteria
    • if bacteria s. pyogenes, n. gonorrhea
      • strep pyogenes: common
        • A-disc (Group A Strep) sensitive, B-hemolytic, bacitracin sensitive, PYR +
      • neisseria gonorrhea: rare
        • diploccocus, oxidase +, grows on Thayer Martin plates
25
Q

list the identifiers of strep pyogenes

A
  • B-hemolytic
  • A-disc (Bacitracin) sensitive (Group A strep)
  • PYR positive
  • CAMP negative
26
Q

list the identifers for neisseria gonorrhea

A
  • gram - diploccous
  • oxidase positive
  • Thayer-Martin plate growth
27
Q

what symptoms indicate viral pharyngitis?

A
  • CCC: conjunctivitis, cough, coryza
  • hoarseness
  • diarrhea
  • anterior stomatitis (discrete ulcerative lesions on mouth)
28
Q

what syptoms are indicative of strep throat (s. pyogenes pharyngitis0

A
  • Sudden onset
  • fever with severe pain
  • nausea/vomitting
  • SCARLITINIFORM RASH
29
Q

symptoms of viral vs strep pharyngitis

A
  • viral
    • cough, coryza, conjuncivitis (CCC)
    • diarrhea
    • anterior stomatis/mouth ulcers
  • s. pyogenes
    • fever with severe pain
    • nausea/vomitting
    • scarlitiniform rash*
30
Q

what manifestation is specific for strep pharyngitis?

A

scarlitiform rash

31
Q

what are the possible manifestations of strep pharyngitis?

A

scarlett fever -scarlett rash, strawberry tongue, desquation, pastias lines

rhuematic fever

glomerulonephritis

supperative complications: peritonsillar absesses, cervical lymphadenitis, mastoiditis

32
Q

is strep A more prevalent in adults or chidlren?

A

children

33
Q

what patients need testing for Group A Strep and how is it done?

A
  • dont need testing - if pharyngitis looks viral (CCC, oral ulcers, diarrhea)
  • testing indicated - if pharyngitis looks bacterial

throat is swabbed and tested for GAS with RADT

34
Q

Which of the following is the most common cause of pharyngitis?

  1. Bacteria
  2. Viruses
  3. Fungi
  4. Parasites
A

viruses

35
Q

what are s. pyogenes virulence factors?

A
  • M-proteins
  • hyaluronic acid capsule
36
Q

lemierre’s disease

  • etiological agent
  • presentation
A
  • agent - fusobacterium necrophorum (gram - rod)
  • presentation:
    • sore throat –> neck swelling –> thrombophlebitis (clot) –> sepsis
    • infection spreads to lungs, mediastinum
37
Q

diphtheria

  • etiological agent
  • presentation
  • treatment
A
  • agent - cornyebacterium diptheria
  • presentation:
    • think unimmunized patients
    • psuedomembrane
    • (bull neck - regional lymphadenopathy
    • palatine palsy - numb room of mouth
  • treatment:
    • give anti-toxoid antibody (DTaP vaccine works by injecting inactive toxoid to induce Ab production)
38
Q

identify, note important characteristics

A

fusarium (fungus)

canoe-shaped macroconidia with septate hyphae

grow on SDA

39
Q

identify, note important characteristics

A

aspergillus (fungus)

septate hyphae at 90 degrees

grows black & fuzzy under wood lamp

40
Q

identify

what disease does this agent cause?

A

fusobacterium necrophorum (gram - rod)

causes lemierre’s disease

41
Q

what is the most common cause of death in in diptheria patients?

A

myocarditis

42
Q

which of the following is due to bacteria? what are the others due to?

  1. Common cold
  2. Summer grippe
  3. Acute rhinosinusitis
  4. Pharyngitis
  5. Diphtheria
A
  1. Common cold – rhino, SARS-Cov-2
  2. Summer grippe – entero, echo, cocksackie virus
  3. Acute rhinosinusitis – adeno, rhino, RSV
  4. Pharyngitis – viruses > s. pyogenes
  5. Diphtheria – c. diptheria
43
Q

A patient presents with pharyngitis, runny nose, itchy eyes and cough. Which is the most likely cause of this patient’s current condition?

  1. Bacteria
  2. Viruses
  3. Fungi
  4. Parasites
  5. Prions
A

1.Bacteria

2.Viruses - cough, coryza, conjunctivitis

  1. Fungi
  2. Parasites
  3. Prions

IDIS (12 decks)

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