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WISE > streptococcal & staphylococcal infection/ Neisseria Meningitidis > Flashcards

streptococcal & staphylococcal infection/ Neisseria Meningitidis Flashcards

1
Q

most common cause of pyogenic infection of the skin

and soft tissues

A

Staphylococcus aureus

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2
Q

bacteremia associated with s.aureus

A 
osteomyelitis, 
suppurative arthritis, 
pyomyositis, 
deep abscesses, 
pneumonia, 
empyema, 
endocarditis, 
pericarditis and 
rarely meningitis
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3
Q

Toxin-mediated diseases of s.aureus

A

food poisoning,
staphylococcal scarlet fever,
scalded skin syndrome,
and toxic shock syndrome (TSS)

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4
Q

interfere with opsonophagocytosis.

A

slime layer

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5
Q

differentiates S. aureus from coagulase-negative staphylococci

A

clumping factor and/or coagulase

Clumping factor interacts with fibrinogen to cause large clumps of organisms, interfering with effective phagocytosis

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6
Q

causes plasma to clot by interacting with fibrinogen and this may have an important role in localization of infection (abscess formation).

A

coagulase

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7
Q

Present in most strains of S. aureus but not coagulase-negative staphylococci and reacts specifically with immunoglobulin G (IgG1, IgG2, and IgG4).

A

Protein A

located on the outermost coat of the cell wall and can absorb serum immunoglobulins, preventing antibacterial antibodies from acting as opsonins and thus inhibiting phagocytosis

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8
Q

inactivates hydrogen peroxide, promoting

intracellular survival

A

catalaase

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9
Q

inactivatespenicillin at the molecular level

A

penicillinase or B lactamase

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10
Q

enzyme associate with skin infection

A

lipase

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11
Q

protein that S. aureus combines with phospholipid in the leukocytic cell membrane, producing increased permeability and eventual death of the cell

A

Panton-Valentine leukocidin

Strains of S. aureus that produce Panton-Valentine leukocidin are associated with more-severe and invasive skin disease, pneumonia, and osteomyelitis.

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12
Q

serologically distinct proteins that produce localized (bullous impetigo) or generalized (scalded skin syndrome, staphylococcal scarlet fever) dermatologic manifestations

A

Exfoliatin A & B

Exfoliatins produce skin separation by splitting the desmosome and altering the intracellular matrix in the stratum granulosum.

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13
Q

superantigen that induces production of interleukin-1 and tumor necrosis factor, resulting in hypotension, fever, and multisystem involvement

A

Toxic shock syndrome toxin-1 (TSST-1)

associated with TSS related to menstruation and focal staphylococcal infection

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14
Q

mediates adhesion to mucosal cells proteins that promote adhesion to fibrinogen,
fibronectin, collagen, and other human proteins

A

teichoic acid

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15
Q

responsible for the methicillin resistance of MRSA isolates

A

altered PBP-2A

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16
Q

risk factor for the development of infection

A

disruption of intact skin, including breaches from wounds,
skin disease such as eczema, epidermolysis bullosa or burns,
ventriculoperitoneal
shunts, and indwelling intravascular or intrathecal catheters

malnutrition
corticosteroid
azotemia

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17
Q

congenital defects that increase risk for staph infection

A

Congenital defects in chemotaxis (Job syndrome, Chédiak-Higashisyndrome, Wiskott-Aldrich syndrome)

and defective phagocytosis and killing (neutropenia, chronic granulomatous disease)

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18
Q

skin infection caused by staph

A

impetigo contagiosa, ecthyma, bullous impetigo, folliculitis, hydradenitis, furuncles (boils), carbuncles (multiple coalesced boils), paronychia, staphylococcal scalded skin syndrome, and staphylococcal scarlet fever,

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19
Q

respiratory manifestation of staph

A

otitis media, sinusitis
membranous tracheitis
high fever, leukocytosis and evidence of severe upper airway obstruction

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20
Q

direct laryngoscopy or bronchoscopy of staph

A

normal epiglottis with subglottic narrowing and thick, purulent secretions within the trachea

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21
Q

necrotizing pneumonitis may be associated with

A

early development of empyema, pneumatocele, pyopneumothorax and bronchopleural fistula

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22
Q

characteristic of disseminated s.aureus disease

A

fever, persistent bacteremia despite antibiotics, and focal involvement of 2 or more separate tissue sites (skin, bone, joint, kidney, lung, liver, heart).

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23
Q

Localized staphylococcal abscesses in muscle sometimes without septicemia

A

pyomyositis

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24
Q

most common cause of osteomyelitis and suppurative

arthritis in children

A

s.aureus

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25
Q

true or false:

Meningitis caused by s.aureus is common

A

false

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26
Q

CNS infection caused by s.aureus is associated with

A

penetrating cranial trauma and neurosurgical procedures (craniotomy, cerebrospinal fluid [CSF] shunt placement), and
less frequently with endocarditis, parameningeal foci (epidural or brain abscess), diabetes mellitus, or malignancy

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27
Q

common cause of acute endocarditis on native valves, and results in high rates of morbidity and mortality

A

s. aureus

Perforation of heart valves, myocardial abscesses, heart failure, conduction disturbances, acute hemopericardium, purulent pericarditis, and sudden death may ensue

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28
Q

true or false

Pyelonephritis and cystitis
caused by S. aureus are unusual

A

true

common cause of renal and perinephric abscess usually of hematogenous origin

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29
Q

fever, shock &/ scarlet fever like rash

A

toxic shock syndrome

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30
Q

rarely follows overgrowth of normal bowel flora by S. aureus, which can occur as a result of broad-spectrum oral antibiotic therapy

A

staphylococcal enterocolitis

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31
Q

in staphylococcal food poisoning, how long will severe vomiting begin?

A

approx 2-7hrs after ingestion of toxin.

Watery diarrhea may develop, but fever is
absent or low. Symptoms rarely persist longer than 12-24 hr. Rarely,
shock and death may occur.

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32
Q

best culture material

A

Tissue samples or fluid aspirates in a syringe

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33
Q

Initial treatment for serious infections thought to be caused by methicillin-susceptible S. aureus

A

semisynthetic penicillin (e.g., nafcillin) or a first-generation cephalosporin (e.g., cefazolin)

34
Q

true or false

Antistaphylococcal penicillins and cephalosporins provide activity against MRSA

A

false

35
Q

initial treatment for drug penicillin-allergic individuals and those with
suspected serious infections caused by MRSA

A

vancomycin (10-20 μg/mL)

36
Q

true or false

Clindamycin is bacteriostatic and should be used to treat endocarditis, brain abscess, or meningitis caused by S. aureus.

A

false

37
Q

acute and potentiallysevere illness characterized by fever, hypotension, erythematous rash with subsequent desquamation on the hands and feet, and multisystem involvement, including vomiting, diarrhea, myalgias, nonfocal neurologic abnormalities, conjunctival hyperemia, and strawberry tongue

A

Toxic Shock Syndrome

38
Q

pathogenesis of TSS

A

toxins act as a superantigens, which trigger cytokine release causing massive loss of fluid from the intravascular space and end-organ cellular injury

39
Q

complication of TSS

A

acute respiratory distress syndrome, myocardial dysfunction, and renal failure

40
Q

recovery of TSS associated with desquamation happens on what day?

A

7-10days

41
Q

Diagnostic criteria of TSS

A

MAJOR CRITERIA (ALL REQUIRED)

  1. Acute fever; temperature >38.8°C (101.8°F)
  2. Hypotension (orthostatic, shock; blood pressure below age appropriate norms)
  3. Rash (erythroderma with convalescent desquamation)

MINOR CRITERIA (ANY 3 OR MORE)
1. Mucous membrane inflammation (vaginal, oropharyngeal or
conjunctival hyperemia, strawberry tongue)
2. Vomiting, diarrhea
3. Liver abnormalities (bilirubin or transaminase greater than twice upper limit of normal)
4. Renal abnormalities (urea nitrogen or creatinine greater than twice upper limit of normal, or greater than 5 white blood cells per
high-power field)
5. Muscle abnormalities (myalgia or creatinine phosphokinase greater
than twice upper limit of normal)
6. Central nervous system abnormalities (alteration in consciousness without focal neurologic signs)
7. Thrombocytopenia (100,000/mm3 or less)

EXCLUSIONARY CRITERIA
1. Absence of another explanation
2. Negative blood cultures (except occasionally for Staphylococcus
aureus)

42
Q

hair loss in TSS is observed how many months after toxin infltration

A

1-2 months

43
Q

most common and persistent species, representing

65-90% of staphylococci present on the skin and mucous membranes

A

s.epidermidis

44
Q

pathogenesis of CONS

A

CoNS produce an exopolysaccharide protective biofilm, or slime
layer, that surrounds the organism and may enhance adhesion to foreign surfaces, resist phagocytosis, and impair penetration of antibiotics.

45
Q

manifestation of CONS bacteremia

A

apnea, bradycardia, temperature instability,

abdominal distention, hematochezia, meningitis in the absence of CSF pleocytosis, and cutaneous abscesses.

46
Q

common cause of prosthetic valve endocarditis,

presumably a result of inoculation at the time of surgery

A

CONS

47
Q

true or false

Central venous catheters become infected through the exit site and
subcutaneous tunnel, which provide a direct path to the bloodstream

A

true

48
Q

manifestation of line sepsis

A

fever, leukocytosis, tenderness, erythema

49
Q

Most (70-80%) infections
occur within __ mo of the operation and are manifested by signs of
meningeal irritation, fever, increased intracranial pressure (headache),
or peritonitis from the intraabdominal position of the distal end of the shunt tubing.

A

2 months

50
Q

common cause of primary urinary tract infections

in sexually active females

A

S. saprophyticus

51
Q

DOC for methicillin resistant stain

A

vancomycin

52
Q

Which of the following is not true regarding N. meningitides?

A. Smoking and influenza virus are asscoiated with increase carriage and disease.
B. Highest rate of meningococcal disease occurs in infants < 1 year old.
C. Carriage peaks in early childhood and is unusual in adolescence and young adulthood.
D. MSM, binge drinking, bar patronage increase disease risk.

A

C. Carriage peaks in early childhood and is unusual in adolescence and young adulthood.

Carriage is unusual in early childhood, and peaks in adolescence and young adulthoood.

53
Q 
The following are all common features in severe septicemia, EXCEPT:
A. Hypoglycemia
B. Acidosis
C. Hyperglycemia
D. Hypophosphatemia
E. Hypokalemia
A

C. Hyperglycemia

Hypoglycemia is a common feature

54
Q

The most common form of menigococcal infection is:
A. Meningococcal meningitis
B. Occult bacteremia
C. Meningococcal septicemia with or without meningitis
D. Asymptomatic carriage in the nasopharynx

A

Asymptomatic carriage in the nasopharynx

55
Q

Which of the following statements is not true about meningococcemia?
A. Chronic meningococcemia does not spontaneously resolve and meningitis surely develops in untreated cases.
B. Seizures and focal neurologic signs occur less frequently than in patients with meningitis caused by H. Influenza and S. pneumonia.
C. Focal infections in bone, eye, peritoneum, sinuses and amiddle ear are well recognized.
D. As the disease progreses, nonblanching or petechial rash will develop in 80% of cases.

A

A. Chronic meningococcemia does not spontaneously resolve and meningitis surely develops in untreated cases.

Chronic meningococcemia may spontaneously resolve but meningitis may develop in untreated cases

56
Q

The following statements are true, EXCEPT:
A. Meningococci may be indentified in a Gram stain preparatin and/or culture of petechial purpuric skin lesions
B. Isolation of organism from the nasopharynx is diagnostic of invasive disease.
C. CSF culture results may be positive in patients with meningococcemia in the absence of CSF pleocytosis.
D. CSF specimens that are gram positive are sometimes culture negative.

A

B. Isolation of organism from the nasopharynx is diagnostic of invasive disease.

Isolation of organism form the nasopharynx is not diagnostic of invasive disease because the organism is a common commensal

57
Q

]recommended treatment for invasive N. meningitides in neonates:

A

Cefotaxime 200-300mg/kg/day

58
Q

most frequent neurologic sequelae of meningitis, occurring in 5-10% of children is

A

deafness

59
Q

The presence of the ff indicate rapid, fulminant progression and poorer prognosis, EXCEPT:
A. purpura fulminans
B. low or normal ESR
C. petechiae less than 12hrs before admission
D. absence of meningitis

A

purpura fulminans

60
Q 
Which among these drugs is not routinely used as prophylaxis for Meningococemia
1/1
A. Rifampicin
B. Ciprofloxacin
C. Azithromycin
D. Ampicillin
A

D. Ampicillin

together with PenG are not used because it does not eradicate nasopharyngeal carriage

61
Q

The ff are true regarding administration of secondary protection among those at risk for Meningococcemia after exposure except:
A. Those who frequently slept in same dwelling as index patient during 7 days before onset of illness.
B. Passengers seated directly next to index case during airline flights lasting >10hrs
C. household contact, especially children < 2yo
D. mouth to mouth resuscitation, unprotected contact during ET intubation during 7 days before onset of illness.

A

B. Passengers seated directly next to index case during airline flights lasting >10hrs

62
Q

Which of the following statement is false regarding Staphylococcus?
1/1
a. PBP-2A is responsible for the methicillin and cephalosporin resistance of MRSA isolates.
b. Ingestion of preformed enterotoxin, particularly types A and B can result in food poisoning with S. aureus
c. The staphylococcal coagulase inactivates hydrogen peroxide, promoting intracellular survival.

d. Most staphylococci produce biofilm which may interfere with opsonophagocytosis.

A

c. The staphylococcal coagulase inactivates hydrogen peroxide, promoting intracellular survival.

The staphylococcal catalase inactivates hydrogen peroxide, promoting intracellular survival

63
Q

The most significant risk factor for the development of infection of Staphylococcal infection is

A

Disruption of intact skin

64
Q

Which of the ff is true regarding treatment of Staphylococcal infection:
A. Penicillin and ampicillin are appropriate empiric therapy for MSSA.
B. B-lactamase inhibitors when added to a penicillin-based drug confers activity against MRSA
C. Clindamycin is used to treat TSS due to its action as a cell wall inhibitor 3
D. Carbapenems have activity on both MRSA and MSSA
E. All of the statements are not true

A

E. All of the statements are not true

65
Q 
Which of the ff is may be an adjunctive agent to B-lactam or vancomycin in infections like endocarditis specifically involving prosthetic valve?
1/1
A. Oxacillin
B. Ceftaroline
C. Colistin
D. Rifampicin
A

D. Rifampicin

66
Q

The most effective measure to preventing spread of staphylococci from between individuals is?
1/1
A. isolation of affected staphylococcal patients
B. strict hand hygiene practices
C. decolonization
D. Constant surveillance of staphylococcal infections within hospitals

A

B. strict hand hygiene practices

67
Q 
Initial empiric treatment for non-life threatening infection without signs with low likelihood of MRSA suspected is?
A. Cotrimoxazole
B. Clindamycin
C. Cefazolin
D.Oxacillin
A

C. Cefazolin

68
Q

Food poisoning caused by staphylococci is described as follows except:
A. Severe vomiting could be present as early as 8 hrs after ingestion of the toxin1
B. Fever is absent or low.
C. Symptoms rarely persist >48 hrs (symptoms rarely persist >12-24 hrs
D. Shock and death are rare

A

C. Symptoms rarely persist >48 hrs (symptoms rarely persist >12-24 hrs

69
Q 
Major criteria for Staphylococcal Toxic Shock Syndrome include the ff except:
A. rash with convalescent desquamation
B. acute fever >38.8
C. thrombocytopenia
D. Hypotension
A

C. thrombocytopenia (minor criteria)

70
Q

The most common cause of nosocomial bacteremia usually associated with CVC is

A

staph epidermidis

71
Q

The ff. differentiates CONS bacteremia from contamination, EXCEPT:
A. > 1 blood culture is positive with the samw CONS strain
B. Symptoms compatible with CONS sepsis resolve with appropriate antibiotics
C. Blood culture grow rapidly within 48 hrs
D. Centeal and peripheral cultures are positive

A

C. Blood culture grow rapidly within 48 hrs

72
Q 
The following describe Streptococcus pneumonia bacteria, EXCEPT:
1/1
A. Optochin +
B. Bile soluble
C. Encapsulated
D. Catalase positive
A

D. Catalase positive

73
Q

The ff. statements are true about Strep pneumonia, EXCEPT:
A. Polysaccharide pneumococcal vaccine is effective for children less than 2 yo
B. Rates of pneumococcal carriage peak during the first 2 yrs of life
C. Males are more frequently infected than females
D. Patients with cochlear implants are at increased risk.

A

A. Polysaccharide pneumococcal vaccine is effective for children less than 2 yo

Children <2 yrs have decreased ability to produce antibody against T-cell independent polysaccharide antigen hence the decreased effectiveness of pokysaccharide vaccine

74
Q

This test should be performed to determine whether clindamycin resistance can be induced by erythromycin resistance

A

D-test

75
Q 
Which of the ff. is not part of the clinical criteria for defining streptococcal Toxic Shock Syndrome ?
A. Hepatic involvemenr
B. Hypotension
C. Gastrointestinal manifestations
D. Coagulopathy
A

C. Gastrointestinal manifestations

76
Q

Which of the ff. is not true about Grouo A Strep pharyngitis?
1/1
A. Resistant strains against Penicillin and Cephalosporins have never been encountered
B. Recommended duration of treatment is 7 days.
C. Post treatment throat cultures are indicated only in certain situations.
D. Acute RF only follows an infection of the upper respiratory tract.

A

B. Recommended duration of treatment is 7 days.

77
Q

The ff. statements are true about Poststreptococcal reactive arthritis (PSRA), EXCEPT:
1/1
A. Arthritis is nonmigratory
B. Arthritis responds dramatically with aspirin
C. May involve axial skeleton
D. Latent period between antecedent GAS pharyngitis and PRSA is shorter than in RF

A

B. Arthritis responds dramatically with aspirin

78
Q

Which of the ff. statements is true about Rheumatic Fever?
A. Diagnosis of recurrent acute RF can be made only in high risk population by presence of 2 minor with evidence of preceding GAS infection.
B. Arthritis as one of the major criteria refers only to polyarthritis in low-risk areas but also monoarthritis and polyarthritis in high-risk areas.
C. Acute RF typically develops 10-28 days after an acute GAS infection.
D. Patients with carditis and/or congestive heart failure should not receive steroids

A

B. Arthritis as one of the major criteria refers only to polyarthritis in low-risk areas but also monoarthritis and polyarthritis in high-risk areas.

79
Q

Which is the treatment of choice in maternal chemoprophylaxis against GBs infection?

A

Pen G

80
Q 
The following are alpha-hemolytic Streptococci, EXCEPT:
A. Group C Strep
B. Streptococcus mitis
C. Streptococcus viridans
D. Streptococcus bovis
A

A. Group C Strep

81
Q

The ff. statements are true regarding GBS infection, EXCEPT:
A. Administration of maternal chemophrophylaxis before onset of labor is an effective means of eradicating maternal GBS colonization and consequently preventing neonatal GBS infection.
B. Vaginorectal GBS screening cultures must be performed for all pregnant women at 35-37 weeks.
C. UNcomplicated meningitis is treated for 14 days.
D. Late-onset neonatal GBS infection presents at > /= 7 days of life.

A

A. Administration of maternal chemophrophylaxis before onset of labor is an effective means of eradicating maternal GBS colonization and consequently preventing neonatal GBS infection.

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