Pulmonary infections Flashcards
1
Q
Pneumonia is an infection of what?
A
Lung parenchyma
2
Q
What are risk factors for bacterial pneumonia?
A
Chronic diseases, immune deficiencies, and splenectomy
3
Q
How is lobular pneumonia grossly defined?
A
Consolidation of an entire lobular region
4
Q
how is Bronco pneumonia grossly defined?
A
Multi focal patch distribution with inflammatory infiltrates
5
Q
The congestion phase of lobular pneumonia occurs one to two days after initial exposure. What are the histologic findings of this stage?
A
Red purple consolidation of the parencyma;
6
Q
congestion phase evolves into red hepatitis after three to 4 days; What histologic changes can be seen during this stage?
A
Red Brown consolidation with Fibrin And leukocytosis
7
Q
After five to seven days the Red Brown consolidation evolves to a uniform gray; What are other characteristics of the gray hepatization phase?
A
lysed red blood cells
8
Q
what happens after eight days from initial exposure?
A
Enzymatic digestion of exudate by macrophages
9
Q
What are common complications of Bronco pneumonia?
A
Necrosis abscess formations, emphysema organization of Exudate to solid tissue, Bacteremia Induced Pericarditis
10
Q
Describe the morphology of viral pneumonia.
A
Second alveolar septa With intra alveolar inflammatory Infiltration; Infected areas are generally red blue In color
11
Q
What are common complications of viral pneumonia?
A
Tonsillitis, hyperplasia of lymphatic tissue within the wallier ring, Sinusitis, nasal congestion, secondary superiorative bacterial infections
12
Q
What are distinct histologic characteristics of adenovirus?
A
Necrosis with cellular debris in Alveolar spaces; Dark circular viral inclusions
13
Q
What are distinct histologic characteristics of cytomegalovirus?
A
Cytomegaly with multiple basophilic inclusions in the cytoplasm and nucleus
14
Q
Hemoglutin plays what role in influenza pneumonia?
A
Viral attachment
15
Q
neuroaminidase plays what role and influence on pneumonia?
A
promotes release of newly formed virons
16
Q
describe different mechanisms of influenza type a resistance
A
Antigenic drift: mutations of hemoagglutinin and neuroaminidase; Antigenic shift: Genes for hemagglutinin and neuroaminidase Are replaced in recombination of rna segments associated with other strains of influenza A
17
Q
What are common clinical presentations of influenza type a pneumonia?
A
ARDS, Overproduction of Mucus, Bacterial Super infections, red lungs
18
Q
What are Histologic characteristics of influenza type a pneumonia?
A
Thickened alveolar walls with deposition of hyaline membranes
19
Q
Methicillin resistant staph aureus Is associated with what type of pneumonia?
A
Bronco pneumonia
20
Q
Patients with cystic fibrosis and emphysema are at increased risk of what hospital acquired pneumonia
A
Pseudomonas Aeruginosa
21
Q
What are the histologic characteristics Of pseudomonas aeruginosa?
A
Thick blue areas of neutrophilic debris surrounding large vessels
22
Q
Define aspiration pneumonia?
A
Aspiration of oropharyngeal gastric contents causing pulmonary infection
23
Q
What is seen microscopically with aspiration pneumonia?
A
Inflammatory infiltration with PMNs and eosinophils
24
Q
What is the most common cause of lung abscesses?
A
Aspiration pneumonia; pneumonia; brochiectasis
25
What are other causes of lung abscesses?
Neoplasia, septic embolism, infective endocarditis, chest trauma,
26
what kind of inflammation would you expect to see for TB Pneumonia?
Granulomatis
27
What are the most common fungal pneumonia infections?
Histoplasmosis; blastomycosis; coccidioidomycosis
28
Histoplasmosis is commonly found in what regions of North America?
Ohio and Mississippi River Regions; also prevalent in the Caribbean
29
blastomycosis is commonly found in which region of the United States?
Southwestern United States
30
Coccidioidomycosis Is commonly found in which regions of North America?
Southwestern United States and Mexico
31
What are histologic characteristics of TB pneumonia?
Hilar lymphadenopathy associated with GHON complexes; giant cells With cuffed margins; elongated epithelioid histocytes
32
where are the GHON complexes generally found?
Sub plural layer of the upper lobes
33
Describe the mechanism of TB induced inflammation
The Th1 response: Activates macrophages to kill mycobacteria however this results in granuloma formation and necrosis leading to tissue destruction
34
What would you expect to see on dissection of lungs from a patient with a history of chronic reactivation of TB?
bronchiectasis With extensive Pulmonary fibrosis
35
What does a histoplasmosis infection look like under the microscope?
pear shaped budding yeast
36
How is histoplasmosis pneumonia acquired?
Inhalation of dust particles contaminated with bird and bat droppings
37
How is blastomycosis acquired?
Direct inoculation of the organism into the skin
38
how is coccidioidomycosis Acquired?
Skin penetration
39
what would you Suspect to find under the microscope of C imitus infection?
Spherical structures filled with small endoscores
40
For hiv patients what would indicate a bacterial or TB pneumonia?
more than 200 cells per millimeter of CD 4
41
for hiv patients what would indicate pneumonocytiss?
A CD4 count less than 200
42
Cmv impossible fungal infection is suspected in hiv patients when CD 4 count reaches less than what?
less than 50 cells per millimeter
43
Pulmonary infiltrates are not always infectious in etiology. what malignancies can be mistaken as infectious pulmonary infiltrates?
kaposi sarcoma, not Hodgkin's lymphoma, lung cancer
44
Pneumonia cytos is an extracellular pathogen That infects what kind of cells?
plasma cells
45
What is a unique histological characteristic of CMV?
Purple intra nuclear inclusions surrounded by a clear halo also referred to as owl eyes
46
For suspected cryptococcus neoformans pneumonia what would you expect to see under the microscope?
Clear capsule surrounding a pale blue nucleus
47
What is the most common cause of death for HIV patients Living?
Tuberculosis
48
Describe TB morphology and microbial characteristics
aerobic Double quote intracellular; positive acid fast stain associated with mycolic acid; Sulfur tides Inhibit vaginal lice system fusion; sulfatides inhibit phagolysomsome fusion Activates macrophages and induces release of tumor necrotic factor
49
GHON complexes undergo fibrosis calcify and form what.
Rinky complexes
50
List all of the systemic extra pulmonary diseases that are caused by T B Tab
Lymphedinitis; plural effusion; infections of the upper airway; uti's; Pots disease; meningitis; tuberculoma; gastroenteritis; infective pericarditis
51
How is miliary TV clinically defined?
Homogerous spread of TB throughout the body; almost all cases arise from Primary infection or reactivation of a latent infection; Opacity of the lung parenchyma; looks like millet seeds on x-ray
52
TB of the kidney can cause what
Nephritis
53
What is interferon gamma release essay Typically used for?
Preferred for patients that have received ABCG vaccine; more specific than the traditional tb skin test
54
What is the gold standard for diagnosis of mycobacteria?
Culture
55
What are common post TB complications?
chronic pulmonary disability; bronchiactus; Pulmonary fibrosis; Aspergerilloma;
56
enteroviruses and rhinoviruses are part of what viral group?
Pike coronavirus
57
what are the general characteristics of picornaviruses
non enveloped, - single stranded rna genome
58
What is the primary sight of rhinovirus infection
Nasal epithelium
59
Kasaki viruses peek around which time of year
August through October
60
What are common associations with cocksaki virus
Harpangia, rash, hand foot and mouth disease mainly caused by typeA
61
What is the best preventative treatment for cocksaki virus
Hand washing after every visit to the restroom
62
Are coronaviruses positive or negative single stranded rna
Positive sense
63
The spike protein binds to what receptors on the host cell
ace 2 receptors; found in respiratory and gi epithelium
64
Serologic testing for COVID 19 is primarily done for what purposes
To assess possible protective agent against reinfection and if the plasma of these patients can be used to treat critically ill patients
65
What are common characteristics of Adenovirus
Double stranded dna genome
66
Adenoviruses enter host cells via endocytosis; Both cocksaki and Adenovirus attach to what receptor
CAR
67
How does adenoviruses inhibit apoptosis
Suppression of IFN Alpha and MHC one
68
How are adenoviruses typically transmitted
fomites: preventative measures can be taken with careful hand washing and disinfection of surfaces
69
Is influenza a negative or positive sense
Negative single stranded RNA
70
The H protein of influenza plays a role in what part of the host cell infection process
host cell membrane
71
the N protein plays what role in the host cell infection process
cleavage of salic acid for virus exit from the cell
72
Define antigenic drift
Spontaneous mutations within the viral genome
73
defined antigenic shift
Reassortment of viral dna when a host cell is infected by two or more viruses; this process creates a new virus
74
Influenza is thought to no longer be contagious after after how many hours from the termination of fever
twenty four hours after the Fever has subsided
75
RSV is positive or negative since
negative sense RNA genome
76
What populations are at The most risk for RSV infection
elderly And pediatric patients;
77
What is a distinct clinical syndrome of RSV
IgE mediated hypersensitivity correlated with bronchiolitis
78
What is the major distinction Between strep and strap
All strep bacteria are catalase negative
79
How would streptococcus pneumonia Appear on a gram stain?
Gram positive diplococci in pairs
80
What are virulent factors associated with streptococcus pneumonia?
IgA & pneumolysin
81
Streptococcus pneumonia Strep B is most prevalent in what age group
Young to middle aged adults
82
What are susceptible patient populations for streptococcus Pneumonia Strep B?
Alcoholics and cancer patients
83
When performing a disk sensitivity test for suspected streptococcus how will you differerieate b/t Strep A. and Strep B.
So streptococcus pneumonia Strep B. is optochin sensitive and alpha hemolytic; Strep A: beta-hemolytic & bacitracin sensitive
84
What are virulent factors for streptococcus pneumonia caused by strep a strains?
hyaluronic acid and M protein
85
Unlike Strep B how would strep a cells appear on a gram stain
Rather than being arranged in pairs the cocci are arranged in chains
86
Strep a streptococcus pneumonia is most frequently seen in what age groups
Pediatric patients
87
What is the mechanism of strep a induced scarlet fever
Conjugation: transfer of pyrogenic toxin
88
Mycoplasma pneumonia is most prevalent in what age groups
Teenagers & adolescents
89
What is the gold standard for diagnosis of mycoplasma pneumonia
ELISA is gold standard; also reacts with cold hemagglutinins
90
what are Secondary complications of mycoplasma pneumonia
erythema multiform and And hemolytic anemia
91
What are the gram negative pathogens associated with pneumonia you need to know
Bordetella pertusis; haemophilus influenzae; klebsiella; pseudopneumonia argenosisa; legionella; coxilla burnetti
92
A patient with a history of severe immunocombined deficiency Presents to your clinic with symptoms of pneumonia; A gram stain and culture is ordered; gram stain reveals gram positive bacteria Arranged in Hyphae like structures. What is the pathogen
nocardia
93
A 65 year old male presents to your clinic with symptoms of pneumonia; A gram stain reveals gram negative bacteria that grow well on chocolate agar. what is the pathogen?
H. influenzae
94
What are virulent factors associated with H. influenzae?
IgA protease & Polyribitol phosphase
95
This pathogen is also referred to as the whooping cough and will only grow on a special type of media. what is the name of the pathogen?
Bordetella pertussis
96
What are virulent factors of klebsiella pneumonia?
Endotoxin (LPS) & capsule
97
Klebsila will grow on what type of aggars?
Blood and MacConkey agar
98
A patient With a history of cystic fibrosis presents to your clinic with symptoms of pneumonia; the culture is ordered And appears blue green the next day; Additional testing also showed that the pathogen is oxidase positive; What is the pathogen?
Pseudopneumonia Argenosa
99
What kind of agar will lesionella Grow on And positive with what type of stain?
BCYE Agar; + silver stain
100
What are susceptible populations for klebsiella pneumonia?
alcoholics, diabetics, Cancer, and immunocompromised
101
How is klebsiella introduced inside the body?
entero bacteria
102
A GIEMSA stain is + for an intracellular pathogen; Graham stain revealed Graham negative bacteria arranged in spore like structures. What is the name of the pathogen, what are associated complications, and in what occupations Our high risk?
Coxila Burnetti; Assoc. w/ Q fever; acquired by direct interaction with livestock
103
What are extra pulmonary symptoms of nocardia
Brain Abscesses and nodular skin lesions
104
What are virulent factors of nocardia?
Chord factor, mycolic acid, treyhalose
105
What would you see under the microscope for a biopsy of tuberculosis Infected lung tissue?
Granulomas with numerous langhan cells
106
What culture would you order for suspected tuberculosis?
Lowenstein/Jensen agar
107
Compare and contrast the differences between primary and secondary tuberculosis
Regional:
P: middel And lower lobes
S: upper lobes
Immunity Responses:
P: The humoral response
S: T cell mediated
108
How does tuberculosis evade the immune system?
blocks acidification process within the phagosome
109
What regions in north america have the highest # of coccidioidomycosis cases?
Mexico and Southwestern United States
110
How is coccidioides infection transmitted?
Inhalation of atheroscores in soil
111
Coccidioidomycosis is assoc. w/ what immune response?
T cell mediated Th-1; IL-2 & IFN gamma
112
what are virulent factors assoc. w/ coccidioidomycosis?
resistant to killing by phagocytes; Secretive proteinases break down collagen, elastin, hemoglobin IGG and IGA
113
What are Clinical presentations of coccidioidomycosis?
Arthralgia; Erythema nodosum (Inflammation of fat cells under the skin);
114
What antifungal agents are used to treat coccidioidomycosis?
1st line: Amphotericin B; fluconazole & itraconazole
115
Cave disease is most prevalent in what regions of the United States?
Ohio & mississippi valley regions
116
How is histoplasmosis transmitted?
contaminated Bird and bat droppings: yeast Disperses into soil and gets deposited in dust cells
117
How is histoplasmosis treated?
Amphotericin B for disseminated; Ketaconazole & itraconazole for self-limited infections
118
Describe the virulent factors of histoplasmosis
Yeast cells absorb iron and calcium from host cells; survival inside macrophages due to elevation of ph
119
blastomycosis is more frequent in what region of the United States?
Midwest and eastern United States; more so in rural areas of these regions
120
How is blastomycosis transmitted?
Occupational contact with contaminated soil
121
how does blastomycosis evade the immune system?
Sheds its surface antigens After entering host
122
How is Blastomycosis treated?
Amphotericin B for severe cases; itraconazole or fluconazole for less severe cases
123
Paracocccidiodomycosis is most prevalent in which regions of North America?
Central and South America
124
What are susceptible populations for paracoccidiodomycosis?
older men that are either farmers or rural laborers
125
How is paracoccidiodomycosis treated?
1st line: sulfa drugs then itraconazole w/ amphotericin B
126
How is mucormycosis transmitted?
exposure to airborne spores
127
What are risk factors for mucormycosis?
neutropenia; hematologic malignancy; stem cell or organ transplantation; glucocorticoid treatment; elevated free iron in serum supports fungal growth; Diabetic patients with ketoacidosis due to dissociation of iron firms sequestering proteins in the serum
128
List the different clinical manifestations of mucromycosis.
rhino orbital cerebral disease; progression to blurry vision and conjunctival suffusion; out flares spread to Sinuses, orbit, palate, and facial soft tissue; black necrotic eshar; GI complications
129
What is the 1st line treatment for mucromycosis?
amphotericin B
130
talaromyces marneffei is primarily found in what regions of the world?
Southeast Asia
131
What fungal pneumonias are associated with granulomas?
Histoplasmosis And Blastomycosis
132
What fungal pneumonia forms spores in sputum?
coccidioidomycosis
133
A tissue biopsy of histoplasmosis would reveal what Under the microscope?
yeast cells inside macrophages
134
Light microscopy from a lung biopsy taken out of pneumonia patient reveals the following morphological features:
thick walled multinucleated spherical yeast cells.
What is the pathogen?
bastomycosis
135
You are an epidemiologist investigating a new outbreak of fungal pneumonia Amongst COVID 19 patients That has never been seen before. Light microscopy reveals broad hyphae, non-septated branches arranged orthogonally. What is this new fungal infection called?
mucromycosis
136
A patient presents to your clinic with symptoms of pneumonia. Your clinic is located in the Mississippi Valley region. After ruling out the most likely pathogens, You suspect histoplasmosis but serology test performed on a sputum was negative for presence of histoplasmosis antigens; You decide to Cx the sputum specimen and send it to the CDC for further analysis; Light microscopy revealed a lack of budding and secretion of an unknown red pigment at room temp; The epidemiologists at the CDC calls you And tells you to inquire about the patient's whereabouts in the past year. The patient says four months ago she And her husband went on a vacation to Thailand. what is the most likely pathogen?
Talaromyces Marneffei
137
A patient with a history of hiv presents to your clinic with symptoms of pneumonia. microscopic analysis reveals budding yeast positive for sugar fermentation and germ tubes. What is the most likely pathogen?
Mucocutaneous Candidiasis
138
What are long term complications of chronic muco cutaneous candidiasis?
Intertrigo-Erythematous irritation in the skin folds; multi organ involvement
139
Aspergillus fungi are not part of the normal human flora; What are distinctive characteristics That can be observed under the microscope?
V-shpaed branches of septate hyphae & spores that form radiating chains
140
A patient with a history of leukemia who recently had a stem cell transplant Is presenting to your clinic today With abrupt onset of fever, chest pain, cough hemoptysis, and shortness of breath. Sputum is very thick and contains hyphae casts; Serum labs reveal elevated IgE and eosinophilia. What is the pathogen and treatment plan?
Aspergillosis
Treatment:
voriconazole or amphotericin B
141
Cryptococcosis is transmitted how?
inhalation of contaminated pigeon feces
142
Describe the morphology of cryptococcosis.
oval budding yeast w/ large polysaccharide capsules
143
chronic cryptococcosis can lead to what?
meningitis assoc. w/ vision & sensory deficits
144
How is cryptooccosis treated?
meningitis: amphotericin B & flucytosine
pneumonia: fluconazole
145
Pneumoncystis is unique in that it is localized to what layer of the lungs?
Surfactant extracellular layer
146
Pneumoncystis s is treated with what?
TMP_SMX & pentamidine
147
MRSA stands for what?
oxacillin and methicillin resistant
148
List different methods that are performed to detect MRSA.
altered mecAgene expression w/ cefoxitin disk screen test; latex aggluination; Mueller-Hinton agar; PCR
149
Identification of C. diff requires what?
anaerobic culture for spore-forming rods
150
How is MDR gonorrhea treated?
IV ceftriaxone + oral azithromycin
151
List the 3 strains of carbapenem-resistant enterobacteriaccae.
KPC, NDM, VIM
152
What are last resort treatment for CREs?
polymyxins & fosfomycin
153
List the 5 Virulent factors of pertussis
pertosis toxin; adenolate cyclase toxin; dermodecrotic toxin; trichial cytotoxin; hemolysin
154
Although cholera is rare in the United States, how is it typically transmitted and what special agar does it grow on?
marine water & fecal matter in bodies of water; TCBS agar
155
How is cholera treated?
electrolyte replacement
156
List the clinical manifestations of measles.
dense rash on face, trunk, arms, & legs; red eyes; photosensitivity; Koplik spots: red spots with bluish white centers in mouth
157
What medications are used to treat measles?
acetaminophen or ibuprofen for fever; no anti-viral for this virus so management is mostly supportive
158
what are common presentations of mumps?
swollen parotid glands; salivary gland hypertrophy
159
What are lab indications of mumps infection?
anti-mumps IgM; 4-fold rise in IgG
160
monkeyPox is endemic to which regions?
central & western Africa
161
Dengue fever is transmitted by what carrier?
aedes aehypti
162
What is the virulent factor of african hemorrhagic fevers induced by filoviruses?
BSL 4
163
What do you need to know about Hantavirus pulmonary syndrome?
reservoir: deer mice; Unique symptoms: progressive pulmonary edema w/o hemorrhaging; Ribavirin offers some benefit
164
What is the reservoir for SARS-CoV-2?
bats
165
List the different treatments for COVID.
dexamethasone, remdesivir, paxlovid, molnupiravir; Prophylaxis: evushield
166
What masks are recommended by the CDC for COVID?
N95 or surgical; not cloth
167
What is the most predominant COVID strain in the US currently?
Omicron; more infectious than delta due to mutated spike proteins
168
Delta is most prevalent in which contry?
India
169
What was first COVID varient?
Alpha first discovered in England but subsided w/ more aggressive delta variant
170
Influenze spike protein H does what?
binds to host cell membrane
171
Influenza spike protein N does what?
cleaves sialic acid for viron exit from the cell
172
Compare & contrast the difference b/t antigenic drift & antigenic shift.
drift: spontaneous mutations
shift: re-assortment in host infected infected by more than one kind of virus
173
How long after initializing mechanical ventilation are pts. at increased risk of contracting nosocomial pneumonia?
48 hrs.
174
What is the primary route of infection for hospital acquired pneumonia?
oropharyngeal tract
175
Overgrowth of Virulent organisms is associated with what
Prolonged antibiotic use; inadequate hand washing; comorbid illnesses; frequent or prolonged hospitalizations
176
What Can impair host defense Mechanisms in a hospital setting
Sedation; impaired mental status; lying supine; endotracheal tubes; and nasogastric tubes
177
moraxella is a Normal flora of the respiratory tract. What test can you do to distinguish this from other pneumonia infections
these bacteria are oxidase positive
178
what is the main test utilized to discern strep from staph
Coagulase
all strep are coagulase negative
all staff are coagulase positive
179
What is the main virulent factor involved in H influenza pneumonia
IgA protease
180
What is the main virulent factor involved with staff aureus pneumonia
protein A
181
H influenza grows well on what type of agar
Chocolate
182
Staph. Aureus is a fermenter of what substance
ferments Mannitol that turns the agar yellow
183
MRSA Is what type of Resistance mechanism
Penicillin binding proteins
184
pseudomonas aeruginosa Is a gram negative motile bacillus; it thrives in moist environments like the oropharyngeal track And produces an odor that smells like what
grape
185
What is the main virulent factor involved in E coli induced pneumonia
K capsule Antigen
186
These two bacteria Are both gram negative and lactose fermenters and are part of the intestinal flora
e coli and klebsiella
187
List Out the ABCDE acronym for Klebsiella risk factors.
Aspiration pneumonia
Abscess
currant jelly sputum
Diabetes mellitus
ETOHO reuse
188
S. Aureus is positive for which tests?
coagulase and catalase
189
List the Triple C buzzwords for Staphylorius
CCC:
Clusters
catalase positive
coagulates positive
190
What are morphological differences between strip A and strip b
Strip B. appears in pairs of diplococci While strip a appears in chains
191
Pathology of aspiration pneumonia usually is isolated to which region of the lungs
Right lower lobe
192
Although less common, Anaerobe infections of the lungs Can slowly build up and evolve over time in cases of aspiration pneumonia. list the most common anaerobes associated with this particular pneumonia
Purple flowers prefer blooming
Peptostreptococcus
fusobacterium
Prevotella
Bacteroides
193
List the clinical presentations of pneumonia
Mnemonic
PNEUMONIA - Productive cough, Noise on auscultation (Rales), Elevated tactile fremitus, Unpleasant sputum (mucopurulent), Malaise (from fever & chills), Oxygen saturation low (Hypoxemia), dyspNea, Impaired percussion (Dullness), Agony from chest (Pleuritic pain).
194
Describe the many few none acronym
MDR: many Antibiotics are effective
XDR: extensively drug resistant; a few antibiotics Are effective
PDR: No Antibiotic Is effective
195
what are 1st line antibiotics that are effective against MRSA?
vancomycin and linezolid
196
What are our first line antibiotics Effective against pseudomonas?
piperacillin tazobactam combo; cefepime
197
What are first line antibiotics for the treatment of anaerobic induced aspiration pneumonia
Clindamycin; Amoxicillin w/ clavulanate combo; Metronidazole & beta lactam combo
198
What are preventative measures that can be taken to reduce incidences of hospital acquired pneumonia
Elevate head of the bed; strict hand washing; Minimization of tubing an antibiotic treatment; avoid intubation and sedation if possible
199
Describe type one isolation protocol
prevention of transmission from patient to healthcare worker
200
Describe type 2 isolation protocol
prevention of transmission from the healthcare worker to the patient
201
Standard precautions are Implicated for every hospitalized patient; however these additional precautions are applied when the patient has a known infection
transmission based precautions
202
What are common pathogens transmitted through droplet contacts
B. pertussis, N. Meningitidis, influenza virus
203
What are common pathogens transmitted through airborne contact
TB, measles, chicken pox, small pox
204
What are common pathogens transmitted through fomites
MRSA & VRE; C. diff
205
What are main precautions taken to prevent transmission of fomites
Gloves, gowns, segregated bathrooms
206
What are main precautions taken to prevent transmission of droplet contact
No special air handling necessary; regular surgical mask is sufficient enough; respiratory isolation
207
What special air handling precautions are taken to reduce transmission of airborne pathogens
N95 mask at the very least and perhaps higher; Negative pressure filtration initiated And respiratory isolation
208
What is the most common virulent factor of intestinal C. diff infections?
Toxin A: enterotoxin that attracts neutrophils and cytokine secretion
Toxin B: cytotoxin that causes necrosis
209
What irtrogenic devices does staph aureus thrive on
prosthetic devices
210
What cell wall antigens makeup group d streptococci
teichoic acid
211
What is the most common hospital acquired in enterococcus spp. infection
E. faecium; more MDR than E. faecalis; inhibited by ampicillin but not killed
212
E coli are lactose fermenters; How would the colonies appear on EBM and MAC agar?
EMB: black
MAC: green
213
How are E coli differentiated from other lactose fermenting gram negative rods?
E. Coli: indol positive and uriase negative
Klebsieela: indol negative in uriase positive
Enterobacter: indoor negative and uriase negative
214
What is characteristic of all PSUEDOMONAS species
ALL are enterobacteriaceae, gram -, Oxidase positive, Aerobic and non fermenting, thrive thrive in many moist environments; produce blue green on agar with grape odor; all our resistant to commonly used antibiotics
215
Cystic fibrosis patients Are more likely to have a chronic infection of pseudomonas Isolated to which region of the lungs
lower respiratory tract
216
K. pneumoniae In most cases is isolated to what Region of the respiratory tract
upper lobes
217
What strain of klebsiella in ICU-admitted premature neonates susceptible to
K. oxytoca
218
What population is more susceptible to opportunistic Infection by acinetobacter baumannii?
military wound victims
219
Organs with high fluid content are more susceptible to colonization of an HAI. What are most frequently colonized regions and what kind of infections are they implicated in
Respiratory tract, cerebral spinal fluid, peritoneal fluid, urinary tract
implicated in meningitis, sepsis, UTI, and necrotizing fasciitis
220
Hospital acquired pneumonia Caused by impaired host defense of the cough reflux and the swallow mechanism is typically associated with what conditions
cns depression and neuromuscular disorders
221
Aspiration pneumonia Is most commonly induced by what impairment of Host offenses
Gastric acidity
222
Under what conditions do pathogens of the normal flora cause pneumonia
Introduction of foreign bodies such as intra tracheal and nasogastric tubes
223
Hospital acquired pneumonia due to impaired mucosillary clearance is most commonly caused by what conditions
smoking, alcohol, genetics ciliary defects
224
What conditions can impair host defense mechanisms of alveolar macrophages and cause hospital acquired pneumonia
Smoking, 02 intoxication, anoxia
225
What is the most common virus involved for the common cold
Rhinovirus
226
What are the most common etiologies associated with viral sinusitis
Rhinovirus and coronavirus And influenza
227
What are the most common etiologies of bacterial sinusitis
S pneumonia and H influenza
228
What are our first line drug classes for treatment and management of sinusitis
Antihistamines and nasal steroids
229
What are the most common secondary complications associated with sinusitis
Osteomolitis, meningitis, epidural and cerebral abscesses
230
What is the most common etiology of acute pharyngitis
Rhinovirus and coronavirus
231
bacterial acute pharyngitis is associated with what secondary complications
rheumatic heart disease, acute glomerulonephritis, peritonsillar abscesses
232
What is the most common bacterial etiology of acute pharyngitis
Strip a
233
Fusobacterium is assoc. w/ what disease?
Lemierre's disease: pharyngitis followed by thrombosis of internal jugular vein & septicemia
234
What are the most common clinical presentations of laryngitis
Aphonia and acute hoarseness
235
What is the most common viral etiology of Laryngitis
Para influenza virus
236
What is the most common etiology of epiglottitis
H Influenza type b
237
Describe the pathophysiology of pneumonia
Overwhelmed alveolar macrophages:
Secretion of inflammatory mediators (specifically IL 1 and tumor necrosis factor Alpha)
increased vascular permeability of the alveolar capillaries leads to capillary leak into alveolar sex
the above subsequently causes decreased error exchange hypoxemia dyspnea rails consolidation
238
What age groups are the most susceptible to community acquired pneumonia
Less than four years of age and greater than 60 years of age
239
What are the most common pathogens that cause bronchiectasis?
P. aeruginosa, S. aureus
240
Lung abessces are most commonly caused by what pathogens
MRSA, Tb, And atypical mycobacteria
241
What CAP pathogens are most commonly associated with neurologic deficits
oral anaerobes
242
what's ca pathogens are most commonly associated with alcoholism
S. pneumoniae, oral anaerobes, K. pneumoniae, acinetobacter spp. TB
243
What CAP pathogens are most commonly associated with COPD and smoking
Age influenza, P. aeruginosa, Legionella, chlamydia
244
Travel to Ohio and Mississippi River Valley Regions Is commonly associated with what CAP
Histoplasma capsulatum
245
What's CAP's are most prevalent and endemic to the southwestern regions of the United States
Hantavirus, coccidioides
246
Staying in a hotel or a cruise ship for two weeks is most commonly associated with what CAP
lesionella
247
what are the most commonly local acquired CAP's
influenza virus, S pneumonia, and S aureus
248
what is a common CAP associated with recent exposure to exotic birds
Chlamydia
249
Rabbit hunting is commonly associated with what CAP
Francisella tularensis
250
exposure to sheep and goats is most commonly associated with what ca
Coxiella burnetiid (AKA Q fever)
251
What serology test would you order for suspected mycoplasma atypical pneumonia
cold agglutination
252
What are the most commonly used antibiotics for treatment and management of CAP
If pt. does not have comorbidities: amoxicillin clavulanate combo
cephalosporin
macrolide
quinolone
If pt. has comorbidities:
all of the above + MRSA and pseudomonas coverage
253
Compare and contrast the differences between typical and atypical c ap
Typical Vs. Atypical
Acute versus slow
productive cough and chest pain versus dry cough and myalgia
Clear consolidation versus opaque consolidation
