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S3B1 IDIS > Respiratory Infection I > Flashcards

Respiratory Infection I Flashcards

1
Q

What structures exist within the nasal cavity to help rid the body of particles & pathogens?

A
  • hairs (filter large particles)
  • turbinate bones
    • air swirls as it passes & forces particles to contact mucous
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2
Q

After the nasal cavity, what structures of the respiratory tract help rid the system of particles & pathogens?

A
  • Change in air-flow direction after nasal cavity
    • particles impinge in back of throat
  • adenoids & tonsils
    • lymphoid organ that help with immune response
  • mucosal surfaces
    • trap particles & pathogens
  • Cilia
    • drive mucus upwards to back of throat
  • Sneeze & cough reflex
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3
Q

What are the 2 main functions of the microbiota of the respiratory tract?

A
  1. compete with pathogenic organisms for potential attachment sites
  2. produce substances that are bactericidal & prevent infections by pathogens
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4
Q

What is the most important means of eliminating pathogenic organisms that enter the lungs?

A

alveolar macrophages

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5
Q

List the location & most common pathogens the cause the following disease:

Common cold (nonspecific URI)

A

Nasal passage

Rhinovirus

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6
Q

What pathogen is the most common cause of summer grippe?

A

various enteroviruses

Enterovirus, Coxsackievirus, Echovirus

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7
Q

What characteristics can help you differentiate between the common cold & summer grippe?

A

Colds usually do not cause a fever & are most common in the winter

Summer grippe usually results in a fever & is most common in summer months

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8
Q

Identify the diagnosis based on the following symptoms

general malaise, lacrimation, sore throat, no fever, anosmia/hypoasmia, ageusia/hypogeusia, anorexia

winter month

cough & substernal discomfort

A

common cold

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9
Q

SARS-CoV2 infection can cause what additional symptoms to the common cold?

A

fever, anosmia, ageusia & is not limitd to the winter months

GI discomfort

common all year long

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10
Q

Identify the diagnosis based on the following symptoms:

fever, malaise, headace, possible uper respiratory symptoms, possible nausea & vomiting

summer month

lasts 3-4 days

A

Summer Grippe

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11
Q

Describe the general transmission of the viruses tha cause the Common Cold, Summer Grippe & SARS-CoV-2

A
  • Common Cold: person to person, usually hand-to-hand contact
  • SARS-CoV-2: droplets, aerosols & contact with contaminated objects
  • Summer grippe: fecal oral means
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12
Q

What is the receptor

A
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13
Q

What is the receptor that SARS-CoV-2 is able to attach to on the host cell?

A

ACE-2

angiotensin converting enzyme-2

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14
Q

How long does it take the common cold to reach its pathological peak?

A

2 - 4 days

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15
Q

What illness fits the following pathogenesis?

Days 1-2: runny nose, clear mucoid nasal secretions

Day 2: Secondary bacterial infection from respiratory microbiota & secretions become purulent

A

Common cold

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16
Q

The common cold can cause what complications?

A

blockage of the sinus ostia / eustacian tube, leading to acute rhinosusitis or otitis media

compilcations are usually related to bronchitis

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17
Q

What is the treatment for Summer Grippe & the Common Cold?

A

supportive thearpy to ease discomfort

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18
Q

What are the 4 preventative measures to avoid infection by SARS-CoV-2?

A
  1. vaccine
  2. social distancing
  3. masks
  4. handwashing
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19
Q

What measures can be taken to avoid the common cold in children and in adults?

A
  • Children:
    • probiotics
    • vitamin C
    • zinc sulfate
    • nasal saline irrigation
  • Adults:
    • garlic
    • vitamin C
  • Both
    • handwashing & disinfecting?
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20
Q

What is the definintion of rhinosinusitis?

A

inflammation or infection of the mucosa of the nasal passages and at least one of the paranasal sinuses that lasts no longer than 4 weeks

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21
Q

What are the most common etiological causes of rhinosinusitis?

A

Respiratory viruses:

  1. rhinovirus
  2. parainfluenza virus
  3. respiratory syncytial virus
  4. adenovirus
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22
Q

How does acute bacterial rhinosinusitis usually occur?

Most common etiological causes?

A

as a complication of acute viral rhinosinusitis

  1. Streptococcus pneumoniae
  2. Haemophilus influenzae
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23
Q

What is Rhinocerebral mucormycosis?

Most common etiological agents?

A

invasive, life-threatening fungal infection

Rhizopus, Rhizomucor

(less commonly) Aspergillus & Fusarium

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24
Q

Identify the diagnosis based on the following symptoms:

sneezing, rhinorrhea, nasal congestion, post nasal drip, aural fullness, facial pressure & headache, sore throat, cough & fever and myalgias

less than 4 weeks duration

A

acute rhinosinusitis

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25
Q

What is a complication of advanced frontal rhinosinustis?

A

Pott’s puffy tumor

soft tissue swelling & pitting edema over frontal bone from superiostal abscess

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26
Q

Identify the diagnosis based on the following symptoms:

upper respiratory tract infection, blood nasal discharge, dusky or necrotic turbinates, changes in metal state, black eschar of the palate

A

rhinocerebral mucormycosis

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27
Q

At what time of year is rhinosinusitis most commonly occur?

A

winter months

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28
Q

What type of patients are most susceptible to rhinocerebral mucormycosis?

A

immunocompromised

diabetic w/ ketoacidosis, transplant recipient, patients w/ hematologic malignancies & patients on chronic glucocorticoid or deferoxamine therapy

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29
Q

What virulence factor allows Streptococcus pneumoniae to cause bacterial acute bacterial rhinosinusitis?

A

capsule

protects it from phagocytosis

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30
Q

What virulence factor allows Haemophilus influenzae to cause bacterial acute bacterial rhinosinusitis?

A

LOS

helps it to bind to host nonciliated epithelial cells

causes an increase in mucin production by host cells

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31
Q

What symptoms would help you differentiate between bacterial & viral acute rhinosinusitis?

A

bacterial is more likely when persists beyond 7 days or severe symptoms of any duration

persistent fever, altered mental status, diplopia (double vision), infraorbital hypesthesia (diminished physical sensatio)

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32
Q

What are treatment options for patients with acute rhinosinusitis?

A

increase oral hydration, nasal saline & steam

antipyretics, analgesics, decongestants & mucolytics

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33
Q

What are the 3 major factors for successful cerebral mucormycosis?

A
  1. Reversal of underlying predisposition
  2. Aggressive surgical debridement
    • removal of all dead tissues & severely compromised tissue
  3. Aggressive antifungal therapy
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34
Q

What are strategies to prevent acute viral or bacterial rhinosinusitis?

A
  • Good management of allergies
  • Not getting flu or common cold
  • Avoid jumping in water without plugging the nose
  • Have septal deviation corrected & polyps or foreign bodies surgically removed
  • Practice proper dental management
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35
Q

What is a strategy to prevent rhinocerebral mucormycosis?

A

encouraging diabetic patients to maintain good control over serum glucose levels

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36
Q

What is pharyngitis?

A

sore throat

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37
Q

Most common etiological causes of bacterial pharyngitis?

A
  • S. pyogenes* (B-hemolytic group A Streptococcus)
  • Neisseria gonorrhoea* (following oral sex)
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38
Q

Identify the diagnosis based on the following symptoms:

fever, sore throat, edema, hyperemia of tonsils and pharyngeal walls

A

pharyngitis

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39
Q

What symptoms suggest a viral rather than bacterial agent causing pharyngitis?

A

conjunctivitis, cough, coryza, hoarseness, anosmia, ageusia & diarrhea

anterior stomatitis and discrete ulcerative lesions & viral exanthem

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40
Q

What finding is specific for S. pyogenes pharyngitis?

A

scarlet fever rash

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41
Q

What are complications that can develop from untreated S. pyogenes pharyngitis?

A
  • Suppurative: peritonsillar abscess, cervical lymphadenitis & mastoiditis
  • Nonsuppurative: acute glomerulonephritis & rheumatic fever
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42
Q

What is acute glomerulonephritis?

A

sudden onset of hematuria, proteinuria & red blood cell casts

hypertension, edema & impaired renal function

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43
Q

What are the most common causes of acute pharyngitis?

A

viruses

  • rhinovirus
  • COVID
  • adenovirus (military & boarding schools)
  • HSV
  • Parainfluenza (children)
  • Influenza
  • Coxsackievirus
  • RSV (children)
  • Epstein-Barr (adolescents)
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44
Q

What virulence factors allow S. pyogenes to cause bacterial pharyngitis?

A

M-protein (prevents phagocytosis)

lipoteichoic acid

fibronectin-binding protein (protein F)

capsule with hyaluronic acid

protease & hyaluronidase

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45
Q

Why can S. pyogenes cause damage to renal & heart tissue?

A

M protein shares antigenic epitopes with heart & renal tissue

antibody made to certain type sof M protein can cross reaction with heart tissue causing carditis

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46
Q

What bacteria is B-hemolytic, catalase-negative, gram-positive cocci & sensitive to bacitracin?

A

S. pyogenes

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47
Q

How should the diagnosis of Group A Strep pharyngitis established?

A
  1. Testing by rapid antigen detection tests (RADT)
    • in children, (-) RADT should be backed up by throat culture
  2. Back up cultures of (-) RADT is not necessary for adults b/c risk rheumatic fever is v. low
  3. Anti-streptococcal antibody titer non recommended (reflect past events)
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48
Q

Who should & shouldn’t be tested for GAS pharyngitis?

A
  • Shouldn’t
    • if strongly suggest viral etiology
    • under 3 yrs old
    • follow-up post treatment
    • asymptomatic household contacts of patients with GAS pharyngitis
  • Should
    • under 3 w/ older sibling with GAS infection
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49
Q

What is the general treatment for acute pharyngitis?

A

antipyretics, analgesics & supportive care

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50
Q

There is an adenovirus vaccine available for what demographic of people?

A

military

not recommended for general public

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51
Q

What is the treatment for S. pyogenes pharyngitis?

A

antipyretics, analgesics & supportive care

antimicrobials

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52
Q

What is Lemierre’s Disease?

A

anaerobic infection Fusobacterium necrophorum

starts as sore throat

neck pain, swelling & stiffness

sepsis 3-10 days after sore throat

postanginal septicemia

53
Q

What bacteria causes Diptheria?

Shape? Gram stain?

How does the vaccine agains this bacteria work?

A

Corynebacterium diptheriae with toxin-producing lysogenic bacteriophage (B-phage)

irregularly staining gram-positive, rod-shaped

induces antibody production to inhibit diptheria toxin

54
Q

Identify the diagnosis based on the following presentation:

pharyngeal pain, pseudomembrane on tonsils & back of oropharynx, regional lymphadenopathy (“bull neck”), edema of surrounding tissue, fetid breath, low-grade fever, and cough

can cause tachypnea, stridor, and cyanosis

can cause neurologic abnormalities & myocarditis

A

Diptheria

55
Q

How is C. diptheriae transmitted?

A

respiratory droplets & skin contact

56
Q

How does diptheria toxin damage the pharynx?

A

kills the mucosal cells by adenosine diphosphate ribosylateion of elongation factor II and terminating protein synthesis

57
Q

What are important symptoms to diagnose Diptheria?

A

pseudomembrane that bleeds upon removal & cervical lymph adenopathy

Neurologic abnormalities (palatine palsy, difficulty swallowing, etc.)

58
Q

What is the treatment for Diptheria?

A

hospitalization, placed in isolation, immediately treated with antiserum & antimicrobial treatment

59
Q

What pathologies are involved with “the croup” ?

A

acute laryngitis, laryngotracheobronchitis (viral croup), epiglottitis (bacterial croup)

60
Q

Why are respiratory diseases particular concerning for young children?

A

their airways are narrower than older children / adults

61
Q

What is the most common etiological cause of viral croup?

A

Parainfluenza virus type II

62
Q

What are the most common causes of epitglotitis?

A

(1) Haemophilus influenzae type b
(2) S. pyogenes

63
Q

Identify the diagnosis based on the following presentation:

upper respiratory infection, followed by dysphonia and reduced vocal pitch

odynophonia, dysphagia, odynophagia, sore throat, congestion, fatigue & malaise

A

acute laryngitis

64
Q

Identify the diagnosis based on the following presentation:

fever (38-39), upper respiratory infection with coryza, nasal congestion, sore throat & cough (2-3 days)

hoarsness with harsh, brassy “bark-lke” cough, air hunger and restlessness, waking up at night

usually resolves 4-7 days

A

Viral Croup

65
Q

Children with severe croup have what predominant stridor?

A

inspiratory stridor

66
Q

Identify the daignosis based on the following presentation:

acute onset fever, sore throat, and hoarseness

Retraction of suprasternal notch & stridor with every breath

throat & epiglottis are swollen

A

Epiglottitis

67
Q

How serious is epglottitis & what are the 4 signs to be watchful for?

A

medical emergency

dysphagia, dysphonia, drooling, and distress

68
Q

What age group is most susceptible to viral croup?

A

6 months - 3 yrs (boys)

69
Q

Acute laryngitis occurs most common in what age group?

A

18-40

70
Q

Why has the incidence of epiglottitis drastically decreased?

A

Haemophilus influenzae type b (Hib) vaccine

71
Q

What pathogenesis is responsible for the inspiratory stridor heard in viral croup?

A

narrowing of the subglottic trachea

72
Q

What virulence factor that allows H. influenzae to cause epiglottitis?

A

type b capsule prevents phagocytosis

73
Q

What treatments work on viral croup but not bacterial cropu?

A

racemic epinephrine or water-saturated air (steam)

74
Q

What is the characteristic radiographic finding for viral croup?

A

steeple sign

in anteroposterior neck radiograph

75
Q

What is the “epiglotitis triad”

A
  1. Severe sore throat (usually rapid onset)
  2. Hoarse voice
  3. Pyrexia, generally unwell, dehydrated
76
Q
A
77
Q

What is the most important component of treating epiglottitis?

A

securing the patient’s airway by intubation & antibiotic therapy

78
Q

What is acute bronchitis?

It most commonly affects what age group?

A

inflammation of the trachea & bronchi but NOT the alveoli

young & older persons

79
Q

What are the most common etiological causes of acute bronchitis?

A

Viruses:

  • Respiratory Viruses
    • Flu A & B, Parainfluenza birus, adenovirus, RSV, HSV, Rhinovirus, Coxsackievirus A & B, echovirus
  • Mycoplasma pneumoniae
  • Chlamydophila pneumoniae
80
Q

How can you differentiate bronchitis from pneumonia on an X-ray?

A

Pneumonia shows consolidations or infiltrates

these are NOT seen in bronchitis

81
Q

Identify the diagnosis based on the following presentation:

malaise, headache, coryza & sore throat

cough (from non-purulent to mucopurulent), substernal pain, fever (38.3-38.9), infected pharynx

rhonchi & crackles on auscultation

7-10 days

A

Acute bronchitis

82
Q

What are predisposing factors in children for developing acute bronchitis?

A

poor nutrition, allegy, deficiencies in IgG2, IgG3, IgG4, and rickets

83
Q

What treatments are abailable for bronchitis?

A

supportive therapy with analgesics, antipyretics, antitussives & expectorants

if greater then 14 days, antimicrobials may be needed

84
Q

What is bronchiolitis?

It most commonly affects what age group?

A

inflammation of the bronchial tree as low as the bronchiles but does NOT involve the alveoli

infalnts younger than 1 year

85
Q

What is the most common etiological causes of bronchiolitis?

A

RSV

human metapneumovirus, parainfluenza virus, adenovirus

86
Q

What diagnosis can be made based on the following presentation?

mild rhinorrhea, cough, low-grade fever

paroxysmal cough & dyspnea

tachypnea, tachycardia, diffuse expiratory wheezing, inspiratory crackles, nasal flaring, intercostal retractions

A

bronchiolitis

87
Q

What are risk factors for contracting RSV bronchiolitis?

A

age younger than 6 months, bottle feeding, prematurity (before 37 weeks), exposure to cigarette smoke, crowded living conditions

88
Q

How is a diagnosis of bronchiolitis made?

A

patients symptoms

chest radiograph (AP & Lateral views: hyperinflation, & patchy infiltrates, air trapping, focal atelectasis, flattened diaphragm, peribronchial cuffing)

antigen test of nasal washings for RSV

89
Q

What is the general treatment for bronchiolitis?

A

supplememntal oxygen & replacement of electrolytes

90
Q

What drug can be given for prophylaxis in patients with hig-risk for bronchiolitis?

A

palivizumab (humanized monoclonal antibody reactive with rsv)

91
Q

Influenza can lead to fatal complication in what demographics of people?

A

very young

elderly

underlying cardiovascular & pulmonary diseases

3rd trimester pregnancy

92
Q

Idenfity the diagnosis based on the following presentation:

abrupt onset fever (38.9 - 40), chills, rigors, headache, congested conjunctiva, extreme prostation with myalgia in back & limbs, nonproductive cough

fever lasts 3-4 days

recovery usually complete in 7 days

A

Influenza

93
Q

What is a symptom of influenza that is mostly unique to children?

A

diarrhea and vomiting

94
Q

What are the etiological agents mostly likely to cause a secondary bacterial pneumonia after an initial influenza infection?

A

Staphylococcus aureus

  • Haemophilus influenzae*
  • Streptococcus pneumoniae*
  • Streptococcus pyogenes*
95
Q

What type of flu cause epidemics?

A

types A and B can cause epidemics

96
Q

What is the cause of Avian influenza?

A

influenza A H5N1

97
Q

What are the H antigen and N antigen and why are they imporant for the influenza virus?

A

H: hemagglutinins - required for binding the virus to the cell

N: neuraminidases - helps mature virus escape from the cell

98
Q

Describe the difference between influenza shift & drift

A
  • shift: major changes in H or N types
  • drift: mutation in the H or N antigens that result in slight change
99
Q

What is one way to differentiate between atypical pneumonia and influenza pneumonia?

A

atypical pneumonia is usually insidious

influenza pneumonia is rapid onset

100
Q

What persons are recommended to receive influenza vaccination?

A

all persons over 6 months of age

101
Q

What is the treatment for healthy persons who contract influenza virus?

A

supportive care

antipyretics and analgesics

antiviral drugs can be effective if given in the first 2 days of symptoms

102
Q

What is the coloquial name for petussis?

What is the etiological cause of pertussis?

A

Whooping cough

Bordatella pertussis

103
Q

What are the phases invloved in a pertussis infection?

A
  • incubation period (7-10 days)
  • catarrhal phase (1-2 weeks)
    • upper respiratory phase
    • coryza, sneezing, low-grade fever, occasional cough
  • paroxysmal phase (2-4 weeks)
    • episodic, sudden coughing, paroxysm of numerous rapid coughs
    • inspiratory stridor causing “whoop”
    • vomiting & exhaustion
104
Q

What sign in pathognomonic for Pertussis?

A

high-pitched whoop at the end of a paroxysm of numerous, rapid coughs

105
Q

What are the most important virulence factors of B. pertussis?

How does it work?

A
  • pertussis toxin
    • enzyme that ribosylates guanine-nucleotide-binding protein with ADP, which affects regulatory mechanism in the ciliated cells of the host’s trachea
  • cytotoxin
    • kills the cells that line the trachea
  • filamentous hemagglutinin
    • important in the attachment to ciliated cells
106
Q

What step can be taken to prevent pertussis among young infants?

A

Tdap vaccine durign pregnancy

107
Q

What lab test provides a uniqe finding for children wtih pertussis?

A

elevated WBC with lymphocytosis

(unusual for bacterial infection)

108
Q

What is the treatment for pertussis?

A

Antibiotics (erythromycin) if given before paroxysmal stage

Supportive care to preven hypoxia & pulmonary complications

109
Q

What is the best method to prevent pertussis?

A

vaccination

DTap (given to children 6mo - 6 yrs)

110
Q

What is the name for infections that cause diseases in the lower respiratory tract?

A

pneumonia

111
Q

Identify the diagnosis based on the following presentation:

cough, dyspnea, sputum production, tachycardia, fever, abnormal breath sounds, dullness to percussion, wheezes, and crackles

A

pneumonia

112
Q

Under what condition will pnemonia present without fever?

A

neonate with afebrile Chlamydia trachomatis pneumonia

113
Q

What is the usual onset for typical pneumonia?

A

24-48 hrs

114
Q

What is the usual onset for interstitial pneumonia?

A

several days to 1 week

115
Q

What is the timeline for symptoms to fully develop with chronic pneumonia?

A

several weeks to a month

116
Q

Identify the diagnosis based on the following presentation:

night sweats, low-grade fever, significant weight loss, productive cough with purulent sputum production, dyspnea

A

chronic pneumonia

117
Q

What symptoms are uniqe to aspiration pneumonia?

A

recurrent chills rather than shaking chills

consolidations int he dependent lung segments

1/4 will produce foul smelling sputum

118
Q

What is the etiological cause of Legionnaire’s disease?

What unique features are associated wtih Legionnaire’s disease opposed to other types of pneumonia?

A

Legionella sp.

  • relative bradycardia
  • abdominal pain
  • vomiting
  • diarrhea
  • hematuria
  • mental confusion
  • abnormal liver/renal functional tests
  • increases in serum creatinine phosphokinase
119
Q

What is the etiological cause of Psittacosis?

What unique features are associated with Psittacosis opposed to other types of pneumonia?

A

Chlamydophila psittaci

  • relative bradycardia
  • epistaxis
  • Horder spots
  • splenomegaly
  • normal - low leukocyte counts
  • people who take care of psittacine birds
120
Q

What is the etiological cause of Q fever?

What unique features are associated with Q fever opposed to other types of pneumonia?

A

Coxiella burnettii

  • relative bradycardia
  • tender hepatomegalyendocarditis
  • abnormal liver function tests
  • farmers who have recently birthed livestock
121
Q

What etiological causes of pneumonia also cause erythema nodosum and hilar adenopathy?

A

Funal causes

  • Histolasma capsulatum* (Ohio and Mississippi river valleys)
  • Coccidiodes immitis* (San Joaquin valley)
  • Coccidiodes posadasii* (Southwest US)
122
Q

What is the most common fungal cause of pneumonia?

What symptoms are unique to this type of pneumoina?

Where is this fungus endemic?

A

Blastomyces dermatitidis

endemic in Southeast US

rough verrucous skin lesions

123
Q

What unique features are associated with pneumonia caused by COVID-19?

A
  • higehr fever (102 - 104)
  • loss of taste and/or smell
  • ground glass appearance of lungs on CT
  • lymphopenia
  • elevated lactate dehydrogenase & ferritin levels
124
Q

What are the most common means of acquiring pneumonia?

A

Inhalation & aspiration

125
Q

What time of year & in what age group is pneumonia most common?

A

winter

over 65

126
Q

What conditions predispose persons to aspiration pneumonia?

A
  • altered level of consciousness
  • alcoholism
  • seizures, anesthesia
  • central nervous system disorder
  • trauma
  • dysphagia
  • esophageal disorders
  • nasogastric tubes
127
Q

What are the 3 major ways that organisms are able to survive in the alveoli?

A
  1. Capsule : prevents phagocytosis by alveolar macrophages
    • S. pneumoniae, H. influenza, K. pneumoniae
  2. Viruses & Chlamydia invade host cells before alveolar macrophages can phagocytize them
  3. M. tuberculosis can survive in alveolar macrophages after being phagocytized
128
Q

What is a “consolidation” as described on a chest x-ray?

A

acumulation of microorganisms, immune cells & serum components taht caue the alveolit ot fill and spread to othe ralveoli that are in close proximity

129
Q
A

S3B1 IDIS (2 decks)

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