Respiratory and Wound Care

Question 1

Normal flora of the upper respiratory tract

Answer 1

Streptococcus, Corynebacterium, Coag Neg Staph, Staph aureus, Neisseria

Question 2

What organism is the most common cause of epiglottitis.

Answer 2

Haemophilus influenzae

Question 3

List the organism of major concern in cystic fibrosis patients

Answer 3

Pseudomonas aeruginosa

Question 4

What specimen should be collected for the possible ID of Bordetella pertussis and then placed on what media?

Answer 4

Nasopharyngeal/sputum. Use Dacron not cotton swab. Put on Regan-Lowe medium or Bordet-Gengou medium

Question 5

What organism is implicated in Vincent stomatitis or trench mouth?

Answer 5

Treponema pallidum

Question 6

Discuss the importance of numerating the squamous epithelial cells and PMN per low power field on a sputum smear.

Answer 6

> 25 lpf epithelial cells you reject

Question 7

What organism is the most common cause of lobar pneumonia in an adult?

Answer 7

Streptococcus pneumoniae

Question 8

What two organisms are the most common cause of lobar pneumonia in a child?

Answer 8

Mycoplasma pneumonia, Chlamydia pneumoniae

Question 9

What is the causative agent for atypical pneumonia or walking pneumonia and can we culture it?

Answer 9

Mycoplasma pneumonia, can’t grow on plates

Question 10

You have a gram stain of sputum from an alcoholic patient with aspiration pneumonia. The gram stain shows rare gram positive cocci, 4+ gram negative diplococci, moderate PMNs. What organism should you be concerned with isolation from this patient.

Answer 10

Moraxella catarrhalis

Question 11

A sputum sample has >25 epithelial cells. What do you report?

Answer 11

Reject sample.

Question 12

You have an alpha hemolytic organism on a sputum culture that has a large zone of inhibition around the optochin disk. What do these results indicate?

Answer 12

Strep pneumoniae

Question 13

3+ gram neg diplococci in sputum culture

Answer 13

Moraxella catarrhalis

Question 14

4+ gram pos cocci in chains and clusters

4+ gram pos rods in sputum

Answer 14

Normal flora

Question 15

4+ gram pos diplococci in sputum

Answer 15

Strep pneumoniae

Question 16

3+ tiny gram neg rods in sputum

Answer 16

Haemophilus influenzae

Question 17

How do you identify Moraxella catarrhalis morphology or biochemically?

Answer 17

Large kidney bean shaped colony, moves on plate like hockey puck. Oxidase, catalase, DNAse, nitrate reduction and butyterate esterase positive.

Question 18

Interpret the pathogenicity and disease state of Moraxella catarrhalis

Answer 18

Upper respiratory tract infections, middle ear and eye infection

Question 19

What specifically are you looking for on a blood agar plate when you are screening for Group A Beta Strep and how do you confirm an isolate as being this organism?

Answer 19

Zone of beta hemolysis. Large zone = Strep pyogenes Narrow zone = Strep agalactiae you confirm this with Latex pos

Question 20

What are you screening for on a choc plate in a sputum culture?

Answer 20

Fastidious organisms

Question 21

What are you screening for on a BAP plate in a sputum culture?

Answer 21

hemolysis and colony morphology

Question 22

What are you screening for on the MAC plate in a sputum culture? What is the most common neg rod isolated from a patient with pneumoniae?

Answer 22

Gram neg. LF or non LF

Pseudomonas aeruginosa, Klebsiella, Acinetobacter

Question 23

What must be done if the EIA screen from group A Beta Strep is neg?

Answer 23

Throat culture and a work up

Question 24

When will H. influenzae grow on a blood agar plate?

Answer 24

It requires factor X (hemin) and V (NAD) Bap only has factor X

Question 25

What is the best specimen for the culture of Bordetella pertussis and N. meningitidis?

Answer 25

Nasopharyngeal swabs

Question 26

What are the symptoms of Corynebacterium diphtheriae in Respiratory and Cutaneous forms?

Answer 26

Respiratory - Pharyngitis w/ development of exudative membrane Cutaneous - Non healing ulcers and membrane formation

Question 27

Review which media a suspected Corynebacterium diphtheriae specimen should be transported on, as well as where should the specimen be taken from?

Answer 27

Cystine-tellurite, modified tinsdale, Loeffler media | Taken from throat

Question 28

How is Corynebacterium diphtheriae identified?

Answer 28

Look for toxigenic C bacteria, Nitrate reduction pos

Question 29

Review the importance of identifying H. influenzae in respiratory cultures

Answer 29

Cause of pneumonia possibly COPD

Question 30

Testing and treatment of Neisseria gonorrhoeae

Answer 30

Testing: Gram stain, Oxidase pos, glucose pos, DNase neg, Gen probe, API, guadFERM, rapid agglutination kit Treatment: ceftriaxone

Question 31

List the agents of STDs published by WHO

Answer 31

``` Neisseria gonorrhoeae Gardnerella vaginalis Haemophilus ducreyi Chlamydia trachomatis Treponema pallidum subsp. pallidum Herpes simplex virus ```

Question 32

Testing and treatment of Chlamydia trachomatis

Answer 32

Testing: EIA or DFA technique Treatment: Azithromycin or doxycycline

Question 33

Testing and treatment of Gardnerella vaginalis

Answer 33

Testing: Beta hemolytic gram variable pleomorphic rods on human blood agar, rapid ID commercial system Treatment: metronidazole

Question 34

Testing and treatment of Treponema pallidum

Answer 34

Testing: RPR pos, FTA-ABS pos, VDRL Treatment: Penicillin

Question 35

Testing and treatment of Haemophilus ducreyi

Answer 35

Testing: Gram stain: school of fish or chains of gram neg coccobacilli, special media such as GC agar with Hgb, 5-10% CO₂. After 48-72 hrs they are Ox +, Nitrate +, Catalase neg Treatment: azithromycin

Question 36

Testing and treatment for herpes simplex virus

Answer 36

Testing: CPE Treatment: Famvir, Zovirax, Valtrex

Question 37

Discuss the organisms most frequently isolated from wounds and abscesses

Answer 37

Staphylococcus aureus or Streptococcus pyogenes

Question 38

What organisms are considered normal flora on the skin?

Answer 38

``` Staph epidermidis Candida Propionibacterium Corynebacterium Other Coag neg staphs Occasionally - Staph aureus ```

Question 39

List five bacteria that are most frequently isolated from acute bacterial conjunctivitis

Answer 39

``` Staph aureus Haemophilus influenzar subsp. ducreyi Chlamydia trachomatis Strep pneumoniae Enterobacteriaceae N. gonorrhoeae ```

Question 40

What bacteria is prophylactively treated with penicillin drops in the eyes of newborns?

Answer 40

Neisseria gonorrhoeae

Question 41

What bacteria are the most frequent cause of otitis media. What two cause over 50% of infections?

Answer 41

``` ~50% strep pneumoniae strep pyogenes staph aureus ~50% Haemophilus influenzae Moraxella catarrhalis ```

Question 42

Limitations of a Beta Strep test

Answer 42

5 out of 100 patients will be missed. Must confirm with culture.

Question 43

What bacteria is the most common isolate from swimmers ear?

Answer 43

Pseudomonas aeruginosa

Question 44

Organisms most frequently isolated from spinal fluids by age.

Answer 44

Premature: GNR Infants: Strep pneumoniae, Group B Strep, Haemophilus, Neisseria, E. coli Children: Neisseria meningitis, Strep Pneumoniae Elderly: Strep pneumoniae, GNR, Neisseria, Listeria

Question 45

What are clue cells?

Answer 45

Epithelial cells of the vagina that get their distinctive stippled appearance by being covered with bacteria

Question 46

Impetigo organism and population

Answer 46

Organism: nonbullous - Strep pyogenes bullous - Staph aureus. Population: children in daycares

Question 47

Erysipelas organism and population

Answer 47

Organism: Strep pyogenes Population: Overweight, diabetic, elderly

Question 48

Cellulitis organism and population

Answer 48

Organism: Staph aureus Population: Overweight, diabetic, elderly

Question 49

Folliculitis organism and population

Answer 49

Organism: Staph aureus Population: Multiple, bikini waxers

Question 50

Furuncle organism and population

Answer 50

Organism: Staph aureus Population: Obese people

Question 51

Carbuncle organism and population

Answer 51

Organism: Staph aureus Population: Obese people

Question 52

Paronychia organism and population

Answer 52

Organism: Staph aureus, fungal Population: baker, bartender and dishwasher

Question 53

Define myonecrosis and the organism associated with the condition.

Answer 53

The destruction or killing of the muscle tissue. Clostridium perfringens

Question 54

Identify the organism most often associated with bacterial vaginosis

Answer 54

Gardnerella vaginalis Mobiluncus Mycoplasma hominis Prevotella

Question 55

RPR and VDRL test

Answer 55

Nontreponemal antibody test-nonspecific

Question 56

Discuss necrotizing faciitis and the causative organism that is isolated most frequently.

Answer 56

flesh-eating disease, is an infection that results in the death of parts of the body's soft tissue. group A Streptococcus or MRSA

Question 57

FTA-ABS

Answer 57

Treponemal antibody test-specific

Question 58

CSF reporting to physician

Answer 58

Any organism is a critical value