Test 3: Wk11: 4 Cystic Fibrosis and Tuberculosis - Yu

Question 1

— activate M1 macrophages

Answer 1

microbial TLR-ligands

IFN-gamma

Question 2

activated M1 macrophage releases

Answer 2

ROS, NO, lysosomal enzymes

Question 3

— activate M2 macrophage

Answer 3

IL-13

IL-4

Question 4

Activated M2 macrophages release

Answer 4

IL-10

TGF-Beta

Question 5

M1 macrophage actions

Answer 5

microbicidal actions

Question 6

M2 macrophage actions

Answer 6

anti-inflammatory, wound repair, fibrosis

Question 7

3 Functions of M1 Macrophages

Answer 7

1. produce ROS, NO, lysosomal enzymes
2. Cytokine Secretion
3. Increased expression of B7 MHC molecules

Question 8

— are antigen presenting cells and activate —

Answer 8

macrophages, T cells

Question 9

Lobar pneumonia is characterized by — and is caused by what organism

Answer 9

Inflammatory infiltrates in alveolus

Streptococcus pneumonia

Question 10

Lobar pneumonia color

Answer 10

red/gray hepatization and resolution

Question 11

Bronchopneumonia is characterized by — and infiltrates in —
caused by what organism

Answer 11

patchy inflammation; inflammatory infiltrates in small airways

Staphylococcus aureus,

Question 12

Interstitial pneumonia is an atypical ammonia with inflammatory infiltrates —. What organisms cause it? Why is it atypical

Answer 12

on alveolar walls only.

Legionella pneumophila, Mycoplasma pneumoniae and Chlamydia pneumonia.

caused by virus and bacteria

Question 13

Causes of Pneumonia Neonates < 4 weeks (2)

Answer 13

Group B strep, E. coli

Question 14

Causes of Pneumonia Children - 4 weeks to 18 yrs (3)

Answer 14

) Mycoplasma, Chlamydia, Strep pneumoniae

Question 15

Causes of Pneumonia Adults

Answer 15

Strep pneumoniae
Haemophilus influenza
Atypical pneumonia bacteria

Question 16

most common cause of pneumonia in adults

Answer 16

Strep pneumoniae

Question 17

Causes of Pneumonia

Adults (hospital-acquired)

Answer 17

Gram-negative rods, Klebisella, E. coli, Pseudomonas, in VAP, ICU

S. aureus

Anaerobes

Question 18

Gene for CF

Answer 18

CFTR gene chromosome 7

Question 19

Most common CF mutation

Answer 19

F508 deletion of 3 bases, missing one aa (F) resulting in abnormal protein trafficking

Question 20

what kind of channel is CFTR

Answer 20

chloride

Question 21

CFTR Channel function

Answer 21

Chloride channel uses ATP to pump Cl-out of cells.

Increased Cl ion inside the cells, increased Na ion reabsorption

Question 22

CFTR mutation causes

Answer 22

The mucus on top of the airway, small intestine (meconium ileus), and pancreatic duct become dehydrated and sticky.

Question 23

Loss of CFTR in sweat glands results in

Answer 23

Na pump is called ENaC. Loss of CFTR makes both Na and Cl levels increased extracellularly (hypertonic luminal fluid on apical surface).

Question 24

Bronchoalveolar lavage (BAL) fluid from a patient with CF

Answer 24

see slide 13

Question 25

CF microbiology (6)

Answer 25

– S. aureus including MRSA (childhood) Haemophilus influenzae (no capsule) P. aeruginosa including MDR-PA (adult) Burkholderia cepacia Achromobacter Stenotrophomonas maltophilia

Question 26

--- is a poor prognosticator for lung transplant with a low 5 year survival rate.

Answer 26

B. cepacia

Question 27

--- is a poor prognosticator for lung transplant with a low 5 year survival rate.

Answer 27

B. cepacia

Question 28

CF antibacterial therapy

Answer 28

Anti-Pseudomonas penicillins 4th gen cephalosporins Combination therapy Inhaled tobramycin Monobactams (Aztreonam) or Carbapenems (Meropenem)

Question 29

Anti-Pseudomonas penicillins (2) they have greater

Answer 29

Piperacillin and Ticarcillin; greater porin penetration

Question 30

add --- to Piperacillin and Ticarcillin

Answer 30

β-lactamase inhibitors. e.g, Zosyn and Timentin.

Question 31

4thgen cephalosporins

Answer 31

cefepime

Question 32

CF Combination therapy

Answer 32

Intravenous administration of ticarcillin or piperacillin, plus an aminoglycoside

Question 33

--- is resistant to many antibiotics (MDR).

Answer 33

P. aeruginosa

Question 34

Major mechanism of antibiotic resistance in Gram-negative pathogens

Answer 34

β-Lactamases

Question 35

It is synthesized in cytoplasm and secreted to in periplasm

Answer 35

β-Lactamases

Question 36

Gram-positives synthesize --- in cytoplasm which is then secreted extracellularly.

Answer 36

β-lactamases

Question 37

Three types of β-lactamases

Answer 37

1. Penicillinases inactivate penicillins 2. “Extended-spectrum β-lactamases” 3. Carbapenemases

Question 38

agents inhibit bacterial growth while the agent is present. Rely on the immune system (of an immunocompetent person) to aid the bacteriostatic agent and clear the infection.

Answer 38

Bacteriostatic

Question 39

agents kill bacteria but are bacteriostatic under some conditions

Answer 39

Bactericidal

Question 40

Tuberculosis is caused by inhalation of

Answer 40

aerosolized Mycobacterium spp including M. tuberculosis

Question 41

Mycobacterium are --- aerobes

Answer 41

Obligate aerobes

Question 42

Primary tuberculosis --- intracellular, and infects ---

Answer 42

Facultative macrophages

Question 43

Primary tuberculosis culture

Answer 43

Difficult to culture, slow growing, doesn’t stain well with Gram stain. Acid fast

Question 44

Primary tuberculosis develops in

Answer 44

Develops 2 to 4 weeks after exposure

Question 45

Primary tuberculosis Initial exposure causes

Answer 45

the formation of focal caseating necrosis in the lower lobe of lung and hilar lymph nodes

Question 46

Cell mediated immune response controls TB

Answer 46

TH1 response, CD4+ T cells, interferon-γsecretion, macrophage activation

Question 47

Secondary TB due to the reactivation of what 2 major risk factors

Answer 47

HIV and aging

Question 48

-- inhibitors is a risk factor for Secondary TB

Answer 48

TNF alpha Etanercept, Infliximab

Question 49

is diabetes a risk factor for reactivation of TB

Answer 49

yes

Question 50

Secondary TB due to the reactivation Occurs --- and can spread to any tissue

Answer 50

at the apex of lung

Question 51

Secondary TB due to the reactivation forms what in the lung

Answer 51

cavitary foci of caseous necrosis

Question 52

Secondary TB due to the reactivation symptoms

Answer 52

fever and night sweats cough with hemotypsis wt loss

Question 53

biopsy of TB granuloma will show

Answer 53

AFBpositive bacilli

Question 54

Two subtypes of granuloma

Answer 54

Noncaseating granuloma Necrotizing or caseating granuloma see image on slide 24

Question 55

Caseating granulomas Bacteria:

Answer 55

Mycobacterium tuberculosis Treponema pallidum Listeria monocytogenes

Question 56

Caseating granulomas Fungi:

Answer 56

``` Aspergillus Blastomyces Coccidioides Cryptococcus Candida Histoplasma ```

Question 57

Caseating granulomas Helminthic infection

Answer 57

Schistosoma mansoni S. japonicum the liver granulomas form around the parasite eggs.

Question 58

Noncaseating granulomas are a reaction to what and caused by (5)

Answer 58

Reaction to foreign materials Sarcoidosis Beryllium exposure Crohn disease Cat scratch disease Mycobacterium leprae

Question 59

TB diagnosis

Answer 59

tuberculin skin test (TST), PPD vitro IFN-γrelease assays

Question 60

TB diagnosis microscopy

Answer 60

Acid fast bacilli

Question 61

gold standard of TB dx

Answer 61

Culture, takes 3-4 wks

Question 62

TB treatment first 2 months

Answer 62

RIF, INH, PZA, EMB

Question 63

2 drug TB treatment 4 months

Answer 63

INH and RIF

Question 64

--- is important to ensure adherence and resistance in TB Tx

Answer 64

Direct observed therapy

Question 65

For LTBI --- is used for ---

Answer 65

INH | 9 months