UPPER RESPIRATORY

Question 1

Upper respiratory tract samples collected with a swab require a

Answer 1

plastic shaft flocked swab and the
appropriate transport media for the potential pathogens, whether aerobic, anaerobic, or viral

Question 2

Specimens collected to evaluate for such infections include the following

Answer 2

throat
nasal
nasopharyngeal
sinus
middle ear

Question 3

Throat swabs are placed in the

Answer 3

back of the throat, and the tonsillar area is vigorously
swabbed in patients suspected of strep throat infections.

Question 4

Nasal swab collection consists of a

Answer 4

swab inserted at least a half inch into the nostril, firmly
rotated, and left in place for 10–15 seconds. Repeat the process in the other nostril using the
same swab

Question 5

Nasopharyngeal swab collection requires a

Answer 5

thin, flexible swab that is more easily inserted
into the nasopharyngeal passage. The patient’s head should be tilted back slightly at a 70°
angle to straighten the passage from the nares to the nasopharynx. Gently insert the swab
through the nose, to the posterior nares, rotate it several times, and remove

Question 6

Sinus exudate samples are collected via

Answer 6

direct needle aspirate of the sinus or with a swab
during surgical procedures of the sinuses

Question 7

Middle ear samples are collected with a

Answer 7

swab or needle aspirate. If the patient’s eardrum
has ruptured, the fluid released into the outer ear can be collected by inserting a sterile
swab into the ear using an auditory speculum. Neonates, the elderly, or patients with
persistent, chronic, or recurrent otitis media may have middle ear fluid collected via
tympanocentesis, requiring a sterile needle puncture through the tympanic membrane to
aspirate the middle ear fluid.

Question 8

MAJOR PATHOGENS OF UPPER RESPIRATORY TRACT

Answer 8

S. pyogenes
S. pneumo
C. diphtheriae
B. pertussis
H. influenzae
P aeruginosa

Question 9

S. pyogenes in URT

Answer 9

grayish-white, transparent to translucent, matte or glossy, large zone of
hemolysis

Question 10

S. pneumo in URT

Answer 10

alpha-hemolytic, convex, mucoid or “water drop”

Question 11

C. diphtheriae in URT

Answer 11

Gram-positive bacilli in a “Chinese letter” formation
small, circular, convex, white to gray

Question 12

B. pertussis in URT

Answer 12

small, round, shiny, silver colored, becoming whitish gray with age on
charcoal blood agar

Question 13

H. influenzae: on chocolate agar in URT

Answer 13

❖ Unencapsulated strain — small, smooth, and translucent
❖ Encapsulated strain — larger, mucoid, with a mouse nest odor

Question 14

P. aeruginosa in URT

Answer 14

grayish-white, translucent to opaque, circular with irregular edges

Question 15

COMMON THROAT, OROPHARYNX, AND EAR PATHOGENS

Answer 15

S. pyogenes, C. diphtheriae, B. pertussis, and H. influenzae

Question 16

S. pyogenes in throat

Answer 16

o O2-stable streptolysin S, O2-labile streptolysin O
o Erythrogenic toxin: causes scarlet fever rash
o Streptococcal pyrogenic exotoxin B: inhibits immunoglobulins, cytokines, and
complement actions
o M protein: prevents phagocytosis
o Hyaluronidase: bacterial spreading factor

Question 17

C. diphtheriae in throat

Answer 17

o Diphtheria toxin: inhibits protein synthesis, leading to the death of host cells, and is
carried in the bloodstream to other organs causing paralysis and CHF
o Pili structures and proteins for adherence and colonization
❖ SpaA, B, and C: selective to pharyngeal epithelial cells
❖ SpaD and H: selective for lung and laryngeal epithelial cells

Question 18

B. pertussis in throat

Answer 18

o Adhesion and colonization factors
❖ Filamentous hemagglutinin
❖ Pertussis toxin: specific to tracheal endothelium; S2 adheres to ciliated epithelial
cells and S3 adheres to phagocytes
o Lipopolysaccharide endotoxin
o Invasive adenylate cyclase: reduces local phagocytic activity
o Lethal toxin: localized inflammation, issue necrosis
o Tracheal cytotoxin: kills ciliated respiratory epithelium

Question 19

P. aeruginosa
cause

Answer 19

swimmer’s ear, developing from moisture in or damage to the ear canal.

Question 20

Middle ear
infections, otitis media, occur along with or following other upper respiratory symptoms caused by

Answer 20

S. pneumoniae or H. influenzae