Buxton 9-21-07

Front 1

Types of Respiratory Syndromes
URTIs

Back 1

Colds
Sinusitis/Otitis
Pharyngitis
Diphtheria
Laryngitis
Tracheitis

Front 2

Types of Respiratory Syndromes
LRTIs

Back 2

Pertussis
Bronchitis
Bronchiolitis
Pneumonia

Front 3

Viral Groups Associated With Respiratory Disease

Back 3

Rhinoviruses
Coronaviruses
Adenoviruses
Paramyxoviruses
Enteroviruses
Influenza viruses
Herpesviruses
Others

Front 4

Bacteria Associated With Respiratory Disease

Back 4

Streptococcus pneumoniae
Group A Strep (S. pyogenes)
Haemophilus influenzae
Moraxella catarrhalis
Corynebacterium diphtheriae
Neiserria gonorrhoeae
Bordetella pertussis
Legionella pneumophilia
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Mycobacterium tuberculosis
Staphylococcus aureus
Klebsiella pneumoniae
Pseudomonas aeruginosa
Enteric gram-negative rods
Anaerobes

Front 5

Fungi Associated With Respiratory Disease

Back 5

Blastomyces dermatitidis
Coccidioides immitis
Histoplasma capsulatum
Aspergillus sp.
Pneumocystis jiroveci

Front 6

Common Colds most common cause

Back 6

Rhinovirus

Front 7

Rhinovirus receptor is ubiquitous molecule _____

Back 7

ICAM-1

Front 8

Why is rhinovirus only working in the nose?

Back 8

temperature

Front 9

Common cold symptoms

Back 9

Sore throat, nasal congestion, watery nasal discharge changing to purulent discharge
+/- cough
Fever more common in children

Front 10

Complications of Common Colds

Back 10

Otitis media
Sinusitis
Apnea in neonates
Bronchospasm and asthma exacerbation

Front 11

Rhinovirus is what type of virus?

Back 11

Picornaviridae; RNA viruses

Front 12

Second most frequent cause of common colds

Back 12

Coronaviruses

Front 13

cause of SARS

Back 13

Novel Coronavirus

Front 14

Enterovirus Disease Associations (Picornaviridae)

Back 14

Respiratory
Common colds
Skin/Mucous Membrane
Herpangina, hand, foot and mouth disease, summer rash
Eye infections
Acute hemorrhagic conjunctivitis
Muscle
Pleurodynia, myocarditis, pericarditis
Nervous System
Meningitis, encephalitis, polio
Hepatitis
HAV

Front 15

predisposing factor causing children to get otitis media

Back 15

Short and horizontal Eustachian tube
Supine position while bottle feeding allows reflux of pharyngeal contents into Eustachian tube

Front 16

Viral and bacterial causes of otitis media

Back 16

Most are viral in etiology
Rhinovirus
RSV
Others
Bacterial causes:
Streptococcus pneumoniae
Non-typeable Haemophilus influenzae
Moraxella catarrhalis

Front 17

major virulence factor Pneumococcal Infections

Back 17

Capsule

Front 18

cytotoxin secreted by Streptococcus pneumoniae. Kills cells ie, phagocytes, ciliated epithelial cells

Back 18

Pneumolysin

Front 19

Most of tissue damage in setting of S. pneumonia infection is caused by ____

Back 19

host inflammatory response

Front 20

Disease associations of S. pneumonia

Back 20

otitis media, sinusitis, pneumonia, sepsis, meningitis

Front 21

agar used to culture Strep pneumo

Back 21

blood agar

Front 22

Test to help differentiate Sterp pneumo from others

Back 22

optocin- disk - inhibs growth

Bile solubility test-isolated colony dissolves when exposed to drop of bile-

Front 23

DOC for Strep pneumo

Back 23

susceptible strains: penicillin group (penicillin, amoxicillin, ampicillin)

DOC for high-level DRSP (MIC>2ug/ml) is vancomycin

Front 24

Vaccine for strep pneumo

Back 24

Conjugate vaccine for children

Polysaccharide vaccine for adults:

Front 25

Haemophilus influenzae gm stain and shape

Back 25

Gram-negative, pleomorphic rods

Front 26

Haemophilus influenzae causes what problems?

Back 26

Causes epiglottitis, meningitis, pneumonia, otitis media, sinusitis, bacteremia, cellulitis

Front 27

Major virulence factor for Type B H. influenzae is

Back 27

anti-phagocytic capsule containing polyribitol phosphate

Front 28

agar for diagnostic culture of Haemophilus influenzae

Back 28

chocolate agar

Front 29

Forms satellite colonies around what bacteria on blood agar?

Back 29

S. aureus


why? b/c aureua lyses RBCs

Front 30

Haemophilus influenzae treatment

Back 30

Treatment
Amoxicillin/clavulanate
2nd generation cephalosporin

Front 31

prevention of Haemophilus influenzae

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Prevention
Vaccine 4 doses given @2, 4, 6 and 12-15 mo. age

Front 32

Moraxella catarrhalis
breathing, gm-stain, shape, oxidase or not?

Back 32

Aerobic, oxidase-positive, gram-negative diplococci

Front 33

Moraxella catarrhalis Disease associations

Back 33

Disease associations: otitis media, sinusitis, bronchitis, pneumonia

Front 34

Is Moraxella catarrhalis hemolytic on blood agar?

Back 34

Non-hemolytic on blood agar

Front 35

Treat Moraxella catarrhalis with penicillin?

Back 35

Most isolates produce b-lactamases, resistant to penicillins

Front 36

Moraxella catarrhalis DOC

Back 36

DOC is amoxicillin-clavulanate; alternatively cephalosporins or fluoroquinolones

Front 37

Treatment plan of otitis media

Back 37

"wait to treat approach" except in < 6mo.

Treat symptomatically. If no improvement in 2-4 days, then treat with antibiotics
Amoxicillin in most cases
Amoxicillin plus clavulanate for b-lactamase producing H. influenzae or M. catarrhalis

Front 38

Most common etiology of acute sinusitis

Back 38

URT viruses

Front 39

Treatment of Acute sinusitis

Back 39

Antibiotics are not immediately prescribed
Treat symptomatically for 7-10 days
If symptoms persist or worsen or fever >102 treat with antibiotics to cover H. influenzae, S. pneumoniae and M. catarrhalis
Amoxicillin, TMP/SMX

Front 40

Common Viral Causes of Pharyngitis

Back 40

Adenoviruses
Coxsackieviruses
Parainfluenza viruses
Rhinoviruses
Coronaviruses
Influenza
EBV
HSV-1

Front 41

Common Bacterial Causes of Pharyngitis

Back 41

Group A Streptococci (Streptococcus pyogenes)
- 5-10% adults
- 15-30% children
Group C and G Streptococci
Neisseria gonorhoeae
Corynebacterium diphtheriae
Hemophilus influenzae
Borrelia vincenti

Front 42

If symptoms of GAS paryngitis:

Give quick strep test --> if negative, then what?

Back 42

culture the child/adolescent

treat adult symptomatically

Front 43

Over 70% of acute pharyngitis is caused by ____ (all age groups)

Back 43

viruses

so don't think antibiotics first

Front 44

Can fever, exudate on tonsils, cervical lymphadenopathy occur in both viral and bacterial pharyngitis ?

Back 44

yes

Front 45

What (in culture) distinguishes GAS from other strep?

Back 45

Disk= bacitracin;

Front 46

Treatment of GAS pharyngitis

Back 46

Penicillins
Oral penicillin V for adults
Ampicillin for children;
Amoxicillin-clavulanate for frequent infections

Front 47

Serious complications of GAS pharyngitis

Back 47

Scarlet fever
Rheumatic fever
Post-streptococcal glomerulonephritis

Front 48

Signs of Scarlet fever

Back 48

Diffuse erythematous rash 1-2 days after onset of pharyngitis
“Strawberry tongue”
Desquamation 7 days following onset of rash
Pastia’s lines- red
coloration under arms
and groin

Front 49

Major manifestations of ARF

Back 49

Polyarthritis (75%)
Carditis (40-50%)
Chorea (15%)
Subcutaneous nodules
Erythema marginatum

Front 50

What's the problem?

Hematuria, proteinuria following strep pharyngitis or skin infection
Due to Type III hypersensitivity reaction
Associated with certain strain of S. pyogenes (nephritogenic strains: 12, 4, 1, 3, 25, 49)
Strains differentiated on by M protein differences –what is the function of M proteins?

Back 50

Post-streptococcal glomerulonephritis

Front 51

Viral causes of acute pharyngitis

Back 51

Adenoviruses (Acute pharyngitis)
Rhinoviruses, Coronaviruses (Common cold)
Parainfluenza (Colds)
Influenza (Fever,malaise, myalgia, arthralgia)

Front 52

Neisseria gonorrhoeae diagnostic agar

Back 52

Thayer Martin Agar

Front 53

viral cause of pharyngeal conjunctival fever

Back 53

adenovirus

Front 54

Respiratory Syndromes Caused by Adenoviruses

Back 54

Acute febrile pharyngitis
Pharyngeal-conjunctival fever
Flu-like illness
Pneumonia
Common cold

Front 55

Outbreaks of adenovirus associated with _____

Back 55

under-chlorinated swimming pools

Front 56

What is heterophil antibody assoc with?

Back 56

infectious mononucleosis (IM)

Front 57

Does negative heterophil antibody test rule out EBV cuase of IM?

Back 57

no

Front 58

Causes of heterophil-negative mononucleosis

Back 58

EBV
CMV
HIV
Toxoplasma

Front 59

Corynebacterium diphtheriae
Epidemiology:

Back 59

asymptomatic carriage by immune individuals
Spread by respiratory droplets

Front 60

Corynebacterium diphtheriae:

Toxin-induced cell damage induces thick exudate called _________ tightly adhered to underlying submucosa.

Back 60

“pseudomembrane”

Front 61

diagnostic characteristic of
Corynebacterium diphtheriae

Back 61

Dislodging membrane causes bleeding


Diagnosis: culture taken from nasopharynx and throat; cultured on cysteine-tellurite agar or serum tellurite agar

Front 62

Corynebacterium diphtheriae:

Toxin in blood stream can cause damage to cardiac myocytes -->_______
Organisms can also cause skin ulcers

Back 62

myocarditis

Front 63

Clinical Manifestations of Corynebacterium diphtheriae

Back 63

Sudden onset pf exudative pharyngitis,
Low grade fever, malaise
Development of pseudomembrane
In severe cases, breathing obstruction
Skin ulcers can occur especially with poor hygiene; primarily tropical areas

Front 64

Treatment of Corynebacterium diphtheriae:

Back 64

diphtheria antitoxin; erythromycin or penicillin

Front 65

Control of Diphtheria

Back 65

vaccine (toxoid)

Front 66

What's the problem?

Primarily affects children 2-4 yr age
Most often due to spread of H. influenzae b from nasopharynx to epiglottis
Induces intense inflammation
Epiglottis swells and can obstruct airflow
Medical emergency!

Back 66

Acute Epiglottitis