Week 2 Flashcards
What makes up the triad of infectious disease?
Host
Environment
Pathogen
True or false, you need a chest radiograph in order to diagnose pneumonia
True
What is pneumonia?
Inflammation of one or both of the lungs. Usually due to infection
What are the four different types of pneumonia?
Typical
Atypical
Viral
Aspirational
Typical acute pneumonia is usually CAP. What does this mean?
Typical acute pneumonia is usually community acquired pneumonia
How long do symptoms of typical acute pneumonia usually last?
Hours to days
Describe the signs and symptoms of pneumonia
Onset with chills, fever, and wet cough
Lobar consolidation or segmental or sub-segmental bronchopneumonia
Pleura often involved giving chest pain with inspiration
Micro-aspiration of upper respiratory tract colonizing bacteria (can be as far up as the oral cavity!)
What bacterial species is the most common cause of typical acute pneumonia?
Streptococcus pneumoniae
Pneumococcus
What is the second most common bacteria to cause pneumonia? (Yet this species has largely disappeared)
Haemophilus influenzae
True or false.. gram negative species are the most common types of bacteria to cause pneumonia
False. Gram positive are the most common
Viral pneumonia is most often seen in ____ and during ____ epidemics
Children
Influenza
What is the most common bacterial species to cause atypical (walking) pneumonia?
Legionella species
What is lung hepatization?
When the the lobes of the lung get so condensed with neutrophils due to inflammation that it is solid-like. Like the liver
Bacterial infection in the pleural space is called ____
Empyema
Acute, atypical pneumonia that is environmentally acquired is likely to be caused by what three species?
Legionella pneumophilia
Coxiella burnetii
Chlamydophila psittaci
What two bacterial species are the most likely causes for acute atypical pneumonia (walking pneumonia)?
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Treatment for atypical acute pneumonia requires ____ antibiotics such as ____, ____, and _____.
Non-beta-lactam
Macrolides
Fluroquinolones
Tetracyclines
Describe aspiration pneumonia
What kind of bacteria cause this?
This is when you inhale bacteria due to stupor, coma, or seizures. Focal infiltrates.
Oropharyngeal bacteria aspired into lung. Coughing prevents this.
Due to gram + cocci (CAP)
Due to gram negatives (S. Aureus) (micro of hospital-acquired)
What does asthenic mean?
Skinny, chronically ill-appearing
What are sulfur granules?
Bacterial colonies in vivo
True or false.. the immune system keeps everything sterile below the vocal cords
True
Name some viruses responsible for viral pneumonia
Human respiratory viruses (influenza, parainfluenza, RSV, adenovirus..(common in children, rare in adults)
Hantavirus
Coronavirus
Bacterial pneumonia with or in the wake of influenza
True or false… lung tissue affected by necrotizing pneumonitis can be revived
False
How long does chronic pneumonia usually last?
Weeks to months. Not days like acute
True or false… chronic pneumonia is always caused by an infection of some sort
False. There are many non-infectious diseases such as neoplasia, chemical/drug exposure, radiation, etc.
What is the empiric treatment for chronic pneumonia?
There is none
True or false.. TB replicates relentlessly and spreads to lymph nodes and then systemic circulation
True
What is the difference between an antibiotic and an antimicrobial?
An antimicrobial is the umbrella term. It is any substance of natural, semisynthetic, or synthetic organ that kills or inhibits the growth of microorganisms. Antibiotics, on the other hand, are more specific in that they are antimicrobial products actually produced by a microorganism.
What is the difference between bacterostatic and bacterocidal?
Bacterostatic - slow or stop growth
Bacterocidal - actually kill microorganisms
What is the difference between 1, 2, and 3 patterns of activity for antimicrobials?
Type 1 - deals with concentration
Type 2 - deals with duration of exposure
Type 3 - deals with long term affects after drug has been removed
What is the difference between a drug’s spectrum of action and the therapeutic range?
Spectrum of action - how many different types of bacteria does it affect?
Therapeutic range - how big is the difference between the minimum therapeutic dose and toxic dose?
Are tetracyclines broad spectrum or narrow spectrum? What about isoniazid?
Tetracycline - broad spectrum
Isoniazid - narrow spectrum (only one against one genus)
True or false… some antimicrobials are effective against all microbes
False
What should you do before giving a patient antimicrobials?
Culture and test the infection to see what is the best antimicrobial to give the patient
With an AIDS patient, should you give them bactericidals or bacterostatics?
Bactericidals
If the infection is very serious, what should you do?
Always take specimens and culture. But since this takes a while to get the results, make an educated guess and give the patients antimicrobials. Or do a shotgun approach and give them a ton of antimicrobials at once
What is MIC?
The minimum concentration of antimicrobial that will inhibit the growth of a bacterial strain
Name in order or smallest to largest, which will have the largest halos in a disc diffusion test. Intermediately susceptible, moderately susceptible, susceptible, and resistant
Resistant
Intermediate
Moderate
Susceptible
In a disc diffusion test, is the plate covered in bacteria first, or are the discs placed first?
The bacteria is covered first
The broth dilution test determines both the ___ and the ____
MIC
MBC
(Minimum bactericidal concentration)
Describe the relationship of MIC and MBC with bactericidals vs bacteristatics
Bactericidal - antibiotics usually have very similar MIC and MBC
Bacteristatic - antibiotics have much higher MBC than MIC
What is the difference between prophylactic and definitive antimicrobial treatment?
In definitive, you have successful identification of the infectious agent. In prophylactic, you do not.
In pharmacokinetics, it involves the relationship of the ___ on the ____
Body on the drug
Although MIC is compared to ____ concentrations, these concentrations may or may not reflect drug concentration at the _____
Plasma
Site of infection
True or false….antimicrobial doses should provide “overkill” without causing toxicity to the host
True
What are the two goals of antimicrobial dosing?
Goal one: achieve a bacterocidal concentration at the site
Goal 2: discourage resistance of bacteria
Which phase of growth is most sensitive to antimicrobial intervention?
The log phase
Describe the persistent post antibiotic affect
These drugs providesuppression of bacterial growth following antibiotic exposure
Name 5 key rules for treating serious infections
Begin treatment asap
Use the safest effective drug
Use the largest reasonable dose
Monitor the plasma concentration of antibiotic if it is needed to guide the dose
Must continue treatment at least two days after apparent cure, but some infections take much longer
When drug selectivity is ____, the risk of adverse effects are reduced
High
The ideal
AMT is defined by….
Itspecificity of action in host vs pathogen
Many, but not all,adverse effects are ___ - dependent
Dose
The _____ the therapeutic range the safer the antibiotic
Wider/higher
True or false…. the adverse effects of the AMT is analogous to the antimicrobial action
False. Some are analogous, some are independent (such as allergies)
Name four mechanisms of actions of antimicrobial drugs
Inhibition of….
Cell wall synthesis/permeability
Protein synthesis by inhibiton the 50s or 30s ribosome subunits
Nucleic acid synthesis (DNA or RNA)
Why use combination therapy?
Treatment of mixed infections
Improve efficacy (synergism)
For initial empiric therapy of uncharacterized serious infection
To lower drug concentration
To delay emergence of resistance
What is a super infection and what causes them?
The over growth of pathogen due to the use of antimicrobials. This can be caused by…
Use of broad spectrum antimicrobial agent (destroying normal flora)
Use of a higher than normal concentration of even a narrow spectrum antimicrobial drug
Upper Respiratory infections are also known as ____
Colds
Name 5 upper respiratory infection syndromes. Out of these 5, which one is different from the others? Why?
Bronchitis Otitis Sinusitis Pharyngitis Epiglottitis
Epiglottitis is different than the others because it is due to a bacterial infection and is a medical emergency
The three most important etiologies of URI are what? Name some other etiologies.
Rhinoviruses
Coxsackie virus A (enteroviruses)
Coronavirus
Influenza and RSV (most severe in children)
Adenovirus Echovirus EBV Parainfluenza HSV
Nearly all upper respiratory infections are ____ infections. True or false, these are spread mostly by direct contact by our hands.
Viral
True
How long do most colds (URI) last? When do most people go to the doctor?
7-10 days (although coughs with colds can take a month or longer to recover)
Since colds are 3 days in, 3 days of, and 3 days out, many people will go to the doctor on the 4th or 5th day of the sickness
What is pharyngitis? What causes it most of the time?
Sore throat
Most of the time is due to virus
What is group A strep? What causes it?
Strep throat caused by bacteria. (Note that it occurs in kids more than adults)
Streptococcus pyogenes, diphtheria, pertussis, gonococcus, archanobacteria, tularemia, chlamydia, anaerobic bacteria (anaerobic cause tonsillitis)
What is the main chracteristic of group A pharyngitis that sets it apart from viral pharyngitis? What are some other features of group A?
Sudden onset
Fever, headache, pharyngeal inflammation, discrete exudate Tender cervical nodes Most likely in winter-spring Most likely ages 5-15 NOT cough, congestion, conjunctivitis
True or false… nearly all cases of otitis (ear infections) are viral infections
False. Half are viral half are bacterial
What are some bacterial species that can cause otitis?
Pneumo, H. Flu, moraxella
Name some features of otitis
Follows URIs Ear pain/pulling 60% no fever Antibiotics little value (Virus closes the eustacian tube, trapping the bacteria. The bacteria then can replicate more than they're supposed to)
Name some features of sinusitis
More common in adults
Follows URIs
Most viral, but same bacteria as otitis
Symptoms include facial pain, head ache, upper teeth pain, opacity by transillumination
X-rays not specific
Antibiotics little value
Epiglottitis is a bacterial infection most likely due to _____. Its symptoms are….
Haemophilis influenzae
Dysphagia, drooling, stridor (difficulty breathing)
You can diagnosis this by a lateral neck X-ray
It is best to not treat all of the URIs besides two. You can treat with antibiotics for these two. What are these two?
Group A strep
Epiglottitis
What is the difference between live attenuated vaccines and inactivated vaccines?
Live attenuated vaccines - made from weakened viruses or bacteria. Must replicate to work. Replication mimics natural infection, stimulates immune response. (You should not give these to pregnant women or immunocompromised pts)
Inactivated vaccines - made from various fractions of viruses or bacteria (subversions, subunits, polysaccharides, toxoids). These do not replicate because they are killed
How are live attenuated or inactivated vaccines administered?
Live attenuated vaccines - subcutaneously
Inactivated vaccines - intramuscularly
Note that inactivated vaccines result in less side effects
Name four other ways in which live attenuated vaccines and inactivated vaccines differ
Storage requirements (live is more difficult to store)
Duration of protection (live last much longer)
Adverse effects (live might have more adverse effects)
Contraindications/precautions
True or false… you should ALWAYS follow ACIP recommendations
True
True or false… if you go too long between the vaccine doses, you do not need to restart the series
True
True or false.. if live vaccines are not administered simultaneously, you must wait four weeks for the next immunization
True
Patients must be offered a ____ with every immunization
Vaccine information statement
You should report adverse reactions to vaccines to ____
Vaccine adverse event reporting system (VAERS)
Technique is critical to vaccine administration. Name four techniques to keep in mind when administering the vaccine
IM vs SC
Diluents
Shaking vaccines
Storage
How long is the incubation time for influenza. (During this time the patient remains asymptomatic). Then, the virus continues to shed ___ days after symptoms begin
1-2 days
5-10 days
True or false.. about 20% of influenza cases are asymptomatic
True
Match each of the following bacteria to their types, either G+ cocci, G+ bacilli, G- cocci, or G- bacilli. Peptostreptococcus Actinomyces Veillonella Prevotella Eubacterium Leptotrichia Fusobacterium Porphyromonas
G+ cocci: peptostreptococcus
G+ bacilli: Actinomyces, eubacterium, leptotrichia
G- cocci: veillonella
G- bacilli: fusobacterium, prevotella, porphyromonas
Is actinomyces aerobic or anaerobic?
Anaerobic
Viral pneumonia is ___ children and ____ in adults
Common
Rare
How do you treat empyema?
Drainage of pleural space
Which is more common, bronchopneumonia or lobar pneumonia?
Bronchopneumonia is more common
If you have a case of lobar pneumonia, what two bacteria are the most likely cause?
Strep. Pneumoniae or klebsiella. These can also cause bronchopneumonia
Name some symptoms of anaphylaxis
Increased itchiness Erythema Urticaria (hives) Angioedema (swelling of lips, face, throat) Severe bronchospasm Shock
What are the signs and symptoms of influenza?
Fever, chills, cough, sore throat, fatigue, body aches, headache, runny nose, sometimes nausea
All enterics are gram ___, oxidase ____, ____ glucose, do not grow on CNA,
Negative bacilli
Negative
Ferment
Streptococcus pneumoniae is gram ___, catalase ____, and is bile ____
Positive
Negative
Soluble
Haemoplilus influenzae is gram ___’ and only grows on ____ agar, meaning that…
Negative, pleomorphic
Chocolate
It requires X and v factors
Pseudomonas is gram ____, _____ glucose, smells like corn chips, oxidase ____, and produces _____.
Negative bacilli
Does not ferment
Positive pyocyanin
Legionella is gram ____, grows on ___ agar,
Negative bacilli
Byce
True or false… enteric species grow on macconkeys and are lactose fermenters (meaning that the media turns pink)
True
True or false… enterics can grow on SBA and chocolate agar
True
True or false… pseudomonas can grow on SBA, chocolate agar, and MacConkey’s agar. Pseudomonas is a lactose fermenter
The first statement is true, the second is false. (Pseudomonas will cause MacConkey’s agar to turn yellowish)
True or false… pseudomonas prefers to grow at warmer temperatures, 42 degrees Celsius
True
True or false… legionella pneumophila grows on SBA and MacConkeys agar
False
BCYE is used to grow legionella because it contains ___ which is required for its growth
L-cysteine
