Crrab 2: Froberg Lung Path

Front 1

Pneumonia often secondary to COPD

Back 1

Bronchial (Insidious onset and mixed bacteria, but esp gram -)

Front 2

Pneumonia histology showing Alveolar infiltrates (NOT patchy)

Back 2

Lobar (Pneumococcus)

Front 3

Alveolar influx of serum & RBCs (what's it called and what's it associated with?)

Back 3

Red hepatization: Lobar Pneumonia

Front 4

Alveolar influx of WBCs(what's it called and what's it associated with?)

Back 4

Gray hepatization: Lobar pneumonia

Front 5

Pneumonia distribution assoc with rapid dissemination

Back 5

Lobar

Front 6

Distribution of Pneumonia MC in HAP, HCAP

Back 6

Bronchial

Front 7

Patchy alveolar involvement (What distribution of pneumonia?

Back 7

Bronchial

Front 8

Pneumonia classically assoc with a dry cough?

Back 8

Interstitial/Atypical

Front 9

CXR will show "fluffy, patch distribution" because it is centered around airways

Back 9

Bronchial Pneumonia

Front 10

CXR may appear lacy, but only in severe cases

Back 10

Interstitial/Atypical Pneumonia

Front 11

Transmission: air-conditioning units and contaminated water (chlorine resistant)

Back 11

Legionella Pneumophila

Front 12

Fibrinopurulent pneumonia predominated by mononuclear phagocytes (leukocytoclasis)

Back 12

Legionella Pneumophila

Front 13

Gram - rod that stains with Dieterle's Silver stain

Back 13

Legionella Pneumophila

Front 14

Where does Legionella Pneumophila replicate and how?

Back 14

Intracellular replication in Macs:
prevent acidification of phagosome
block phagosome-lysosome fusion

Front 15

What will the CXR normally show with Legionella Pneumophila?

Back 15

Lobar pattern

Front 16

Nucleorrhexis of infected phagocytes (leukocyctoclasis)

Back 16

Legionnaire's Disease

Front 17

What does the Exotoxin A of Pseudomonas do?

Back 17

Blocks protein synthesis (similar to diptheria toxin)

Front 18

What does phospholipase C of Pseudomonas do?

Back 18

Lyses RBCs and degrades surfactant

Front 19

**Name 3 risk factors for a Pseudomonas infection

Back 19

CF, neutropenia, severe burns

Front 20

Leading cause of HAP

Back 20

Pseudomonas

Front 21

Blue vasculitis of denuded BV wall

Back 21

Pseudomonas

Front 22

Attaches to respiratory mucosal cilia and kills cell by cytotoxin (block signal transduction)

Back 22

B. Pertussis

Front 23

organisms grow on surface ***WBC = lymphocytosis

Back 23

B. Pertussis

Front 24

Toxin causes myocardial fiber necrosis and peripheral nerve damage

Back 24

C. Diptheriae

Front 25

What forms the pseudomembrane assoc with C. Diptheriae?

Back 25

Dead epithelial and inflammatory cells + fibrin rich exudate coalesce

Front 26

Is there invasion with C. Diptheria?

Back 26

NO!! Grows on surface of colonized larynx and trachea

Front 27

***What's the big deal about H. Influenzae's polysaccharide capsule (b)? (i.e., what does it do?)

Back 27

important for colonization of URT, ability to invade & disseminate, avoid phagocytosis & complement mediated destruction

Front 28

**What is H. Influenzae's capsule is a polymer of?

Back 28

polyribitol phosphate (PRP) (Vaccine is produced from this)

Front 29

What does the unencapsulated form of H. Influenzae cause?

Back 29

Local pharyngitis
Otitis media

Front 30

When is the PRP conjugated protein vaccine for H. Influenzae effective and what is it conjugated with?

Back 30

at 2 months (protein conjugated using Corynebacterium diphtheria or Neisseria meningiditis) --> 99% reduction in meningitis

Front 31

mononuclear cells (lymphs & Macs) largely confined to interstitium

Back 31

Interstitial pneumonitis (Atypical Pneumonia)

Front 32

cold agglutinins (IgM)

Back 32

Mycoplamsa Pneumoniae
(MyCOLDplasma)

Front 33

Pneumonia common in teens

Back 33

Mycoplasma Pneumoniae (usually subclinical)

Front 34

Severe Interstitial Pneumonitis may cause this

Back 34

Diffuse Alveolar Damage (DAD) which presents clinically as ARDS

Front 35

Chronic inflammationis confined largely to what in Interstitial Pneumonitis?

Back 35

Septum

Front 36

Interstitial Pneumonitis is composed mainly of what cells?

Back 36

Monocytes and lymphocytes

Front 37

What does DAD do?

Back 37

Cap damage leads to fibrin rich hyaline membranes that line the alveoli

Front 38

Help Influenza release virus from cell

Back 38

NA

Front 39

Point mutations in Influenza

Back 39

Antigenic Drift

Front 40

RNA recombination in Influenza

Back 40

Antigenic Shift

Front 41

What will cause a major epidemic/pandemic with Influenza?

Back 41

Major antigenic shifts  new strain circulates into animal or avian reservoirs  readapt to very susceptible human population

Front 42

What cells will swell and slough in Influenzal Pneumonia?

Back 42

Type I alveolar epithelial cells

Front 43

What will you find in the intersitium of Influenzal Pneumonia?

Back 43

cap dilation, leakage and edema; mononuclear infiltration

Front 44

What will you find in the alveoli of Influenzal Pneumonia?

Back 44

lumen protein "membrane" against wall; Type II alveolar cell proliferation

Front 45

What is the ultimate complication of Influenzal Pneumonia that may result in death?

Back 45

Secondary bacterial infection

Front 46

**MC resp infection in infants and young children

Back 46

RSV (SS - RNA)

Front 47

**Comment on the transmission of RSV

Back 47

very contagious (secretions) but most adults are immune

Front 48

Mucosal necrosis--> sloughing & polykaryons

Back 48

RSV

Front 49

**> in pediatric wards, especially winter months; If concurrent other major illness can be fatal

Back 49

RSV

Front 50

**What is the fatality rate for RSV? For pts with chemo/congenital heart or lung disease?

Back 50

0.5-1% normally; 15% for pts on chemo/congenital heart or lung disease

Front 51

Syncytial cells

Back 51

RSV

Front 52

Cowdry Type A inclusions, eosinophilic with halo

Back 52

Adenovirus (Naked, DNA)

Front 53

Scant inflammation

Back 53

Hantavirus

Front 54

What is the vector for Hantavirus?

Back 54

Deer mouse

Front 55

**Hantavirus has a 50% mortality rate due to what?

Back 55

Rapid pulmonary edema

Front 56

Animal reservoirs are civet cat and bats

Back 56

SARS-CoV (Env + ss RNA)

Front 57

Characteristics of Measles (Rubeola) --> Paramyxovirus

Back 57

Env ss RNA

Front 58

What 2 proteins of Measles (Rubeola) bind the virus to resp epithelium and aid cell entry

Back 58

H protein (HA) and F protein (Fusion)

Front 59

Koplik spots (oral) and rash (vasculitis), infrequently brain

Back 59

Measles (Rubeola)

Front 60

**(Warthin-Finkeldey cells) with nuclear and cytoplasmic inclusions

Back 60

Measles (Rubeola)

Front 61

**What will you see in the lungs with measles (Rubeola)?

Back 61

Interstitial pneumonia; polykaryons prominent (Like RSV)

Front 62

Subacute sclerosing panencephalitis (months later) is possible

Back 62

Measles (Rubeola)

Front 63

huge nuclear enlargement with large, dark inclusion with halo (cytopathic effect); Owl's Eye Inclusion

Back 63

CMV (Env, linear DNA)

Front 64

**CMV in a person with normal immune system

Back 64

No or minimal change

Front 65

Who is CMV most dangerous in?

Back 65

Neonates and the IC

Front 66

Most common life-threatening complication in transplantation

Back 66

CMV

Front 67

TORCH

Back 67

TOxo, Rubella, CMV and Herpes (Sever diseases of newborns)

Front 68

What activates T cells and Macs in TB?

Back 68

IL-12

Front 69

What do CD4 cells produce that activate Macs in TB?

Back 69

IFN-y

Front 70

**In secondary TB, (reinfection/reactivation), what do you often see in the apex?

Back 70

caseous necrosis + fibrosis -->granuloma

Front 71

How does miliary TB often spread?

Back 71

via pulmonary vein

Front 72

Rx Aminoguanidine to mice infected with TB results in what and why?

Back 72

Death in primary TB or Reactivation of Latent TB; AG inhibits NOS which is nec for killing

Front 73

Pott's Disease

Back 73

When Extrapulmonary TB involves the vertebra

Front 74

When EP TB involves neck nodes; from what bug?

Back 74

Scrofula from M. bovis

Front 75

small intracellular yeast with NO capsule

Back 75

Histoplasma capsulatum

Front 76

Mississippi Valley from inhaling soil enriched with bat or bird droppings

Back 76

Histoplasma capsulatum

Front 77

What sort of dissemination may you see with Histoplasma capsulatum?

Back 77

hepatosplenomegaly, anemia, thrombocytopenia, Addison’s

Front 78

"Laminated Granuloma"

Back 78

Histoplasma capsulatum

Front 79

Yeast forms are present in macs

Back 79

Histoplasma capsulatum

Front 80

Southern California: Valley fever, inhale arthrospores from sand

Back 80

Coccidiodomycosis

Front 81

Form "spherules" in lungs

Back 81

Coccidiodomycosis

Front 82

Name 3 dimorphic fungi

Back 82

Coccidiodes, Histoplasma, Blastomyces

Front 83

large free yeast, double refractile wall, broad-based buds

Back 83

Blastomyces dermatidis

Front 84

Rural, Ohio River Valley, local --> Namekagon fever

Back 84

Blastomyces dermatidis

Front 85

Dimorphic fungi with possible skin ulcers

Back 85

Blastomyces dermatidis

Front 86

BV invasion may produce "Target lesions"

Back 86

Aspergillosis

Front 87

***Fungus with Diffuse or patchy pneumonia, foamy alveolar exudate, Macs

Back 87

P. jirroveci/carinii

Front 88

MC AIDS defining infection

Back 88

P. jirroveci (CD4 < 200)

Front 89

Charcot-Leyden crystals & eosinophils

Back 89

Aspergilliosis & Asthma (Basically an allergic response)

Front 90

Ability to adhere to mucosa, cause local damage, resist host defenses. Give some ex.

Back 90

Primary Pathogens
Ex)rhinoviruses, influenza, Streptococcus pneumoniae, Bordetella pertussis, C. diphtheriae

Front 91

Follow viral infection, chronic resp disease (cystic fibrosis), impaired defenses (age, alcohol, smoking, HIV, etc.). Give some ex.

Back 91

Secondary Pathogens (opportunistic)
Ex) CMV, S. aureus, P. aeruginosa

Front 92

Name some common normal flora of the URT

Back 92

oral streptococci, corynebacteria (NOT diptheria), Bacteroides, Candida albicans, Streptococcus mutans, Haemophilus influenza (NONencapsulated)

Front 93

> in the normal flora of what 3 bugs may follow antibiotic therapy?

Back 93

C. albicans, Psudomonas, E. coli

Front 94

Why do some pts get a gram - (Pseudomonas) bug following hospitalization instead of a gram + cocci?

Back 94

< fibronectin (usually aids colonization of gram + cocci)

Front 95

Name 3 bacterial causes of Acute Pharyngitis

Back 95

1. S. pyogenes
2. H. influenzae
3. C. diptheriae

(Didn't talk about N. gonorrheae)

Front 96

Hemolysis of Strep pyogenes

Back 96

Beta hemolytic (complete)

Front 97

**Gram positive cocci, grow in chains, most facultative anaerobes, Beta-hemolytic, catalase negative, non spore-forming

Back 97

Group A strep (pyogenes)

Front 98

**Most common cause of bacterial tonsillopharyngitis (70% are viral)

Back 98

Group A strep (pyogenes)

Front 99

Complications may include sinusitis, otitis media, *meningitis, Scarletina (scarlet fever), Erysipelas & cellulitis

Back 99

Group A strep (pyogenes)
> cause of meningitis as H.influenzae is no longer a big player

Front 100

Strep throat + erythematous skin rash + red beefy tongue

Back 100

Scarlet fever (Group A strep)

Front 101

Erysipelas

Back 101

Complication of Group A strep (acute skin infection on face)

Front 102

Capsule (hyaluronic acid), M protein and hemolysins

Back 102

Group A strep (hemolysins: streptolysin O and S)

Front 103

Coat fimbriae and enhance binding and antigenicity in Strep pyogenes

Back 103

M protein

Front 104

What causes fever and toxic shock with a strep pyogenes infection?

Back 104

Strep pyrogenic exotoxins

Front 105

Antibodies against what in group A strep infection react with heart valves?

Back 105

carbohydrates

Front 106

Aschoff bodies

Back 106

Rheumatic carditis via strep pyogenes infection

Front 107

What is helpful in Dx of group A strep?

Back 107

presence of serum antibodies vs. Streptolysin O

Front 108

Tx of Group A strep

Back 108

Penicillin or Erythromycin if allergic

Front 109

Strawberry Tongue

Back 109

Scarlet fever (Strep pyogenes)

Front 110

What is a negative about Rapid Strep An test?

Back 110

misses 5% or more, so culture on blood agar to look for beta hemolysis too!

Front 111

**Small, non-motile, gram negative, coccobacilli or pleomorphic bacilli ; faculative anaerobe

Back 111

H. influenza

Front 112

**Common colonizer of URT

Back 112

H. influenza (about 50%)

Front 113

Type of H. flu that can cause pharyngitis and otitis media

Back 113

H. influenza

Front 114

Type of H. flue that can cause meningitis and epiglottis

Back 114

Encapsulated type B strain

Front 115

Polysaccharide capsule, (polymer of PRP), IgA protease and endotoxin (LPS)

Back 115

H. influenza virulence factors

Front 116

-Sudden onset - fever, sore throat, hoarseness, stridor
-Epiglottis is swollen and cherry-red

Back 116

H. influenza

Front 117

Requires X & V factors for growth: X = hemin, V = nicotinamide adeninedinucleotide (NAD)

Back 117

H. influenza

Front 118

Chocolate agar

Back 118

H. influenza

Front 119

When is the peak incidence of infection for H. influenza?

Back 119

6-18 months

Front 120

Gram +, catalase positive, aerobic (or facultative anaerobic) non spore-forming rod; club shaped

Back 120

C. diptheriae

Front 121

C. diptheriae, catalase what?

Back 121

+ (also gram +)

Front 122

Non-encapsulated, non-motile, pleomorphic, club-shaped, slender rod

Back 122

C. diptheriae

Front 123

What are the only reservoirs for C. diptheria?

Back 123

Humans (transmission is primarily through resp droplets, fomites and infected milk)

Front 124

What produces the gene encoding for tox+ in C. diptheria?

Back 124

lysogenic bacteriophage gene

Front 125

Prevents interaction of mRNA and tRNA, halting further addition of amino acids to polypeptide chains

Back 125

Inactivation of EF2 by the A fragment of C. diptheria

Front 126

Toxin-mediated: largely affects heart and CNS

Back 126

C. diptheria

Front 127

Name 3 bugs and 1 fungi that can cause sinusitis

Back 127

1. Strep pneumoniae
2. H. influenzae
3. Moraxella catarrhalis
4. Aspergillus

Front 128

Gram +, lancet-shaped diplococci, catalase negative, alpha hemolysis

Back 128

Strep pneumoniae (pathogenic strains are encapsulated)

Front 129

Phosphorylcholine (cell wall component that binds plt activating factor receptor on resp epithelial cells) - what bug?

Back 129

S. pneumoniae

Front 130

Polysaccharide capsule, pneumolysin, IgA protease, Phosphorylcholine

Back 130

S. pneumoniae

Front 131

Gram - diplococci, aerobic and oxidase + (Like Neisseria and Pseudomonas)

Back 131

Moraxella catarrhalis

Front 132

Otitis media is usually preceded by what?

Back 132

URT viral infection

Front 133

MC cause of otitis externa?

Back 133

Pseudomonas species

Front 134

Gram negative, pleomorphic coccobacilli, strict aerobes

Back 134

Bordetella pertussis

Front 135

In what set of pts may you see malignant otitis externa?

Back 135

pts with diabetes or who are IC (pseudomonas MC)

Front 136

MOA of B. pertussis A-B toxin

Back 136

ADP-ribosylates a G protein inhibitory to adenylate cyclase leading to > cAMP

Front 137

Lymphocytosis on CBC and a strong clinical suspicion to Dx

Back 137

Bortetella pertussis

Front 138

Tracheobronchitis --> paroxysms of cough --> emesis or seizure

Back 138

Bortetella pertussis (Whooping cough)

Front 139

Normal oropharyngeal flora in 40-70% of pts, binds to fibronectin

Back 139

Strep pneumoniae

Front 140

Causes lobar pneumonia in infants, elderly, IC pts, sickle cell pts and chronic alcoholics

Back 140

Strep pneumoniae

Front 141

Self-infection secondary to aspiration of organisms from oropharynx (< epiglottal reflexes, stroke, drugs and alcohol, cold/virus infection)

Back 141

Strep pneumoniae

Front 142

Most important virulence factor of Strep pneumoniae?

Back 142

Capsule (inhibits phagocytosis; likely to cause pneumonia)

Front 143

Produces H2O2 and neruaminidase (facilitates attachment to ciliated epithelium)

Back 143

Strep pneumoniae

Front 144

What is an important test to preform in a pt with severe strep pneumoniae?

Back 144

Culture looking for bacteremia

Front 145

Risk factors include COPD, HIV infection, nursing home residents, influenza

Back 145

H. influenzae

Front 146

Non-motile, gram-negative, rod with polysaccharide capsule

Back 146

Klebsiella pneumoniae (CAP or nosocomial infection)

Front 147

Risk factors: elderly (CAP), alcoholism (2/3 of cases), diabetes, and COPD

Back 147

Klebsiella pneumoniae

Front 148

Produces mucoid “currant jelly” sputum

Back 148

Klebsiella pneumoniae

Front 149

2 bacteria that may cause a necrotizing pneumonia

Back 149

Klebsiella pneumoniae and staph auerus

Front 150

Lactose fermenter like Escherichia coli. Colonies turn red when grown on MacConkey agar & are urease-positive.

Back 150

Klebsiella pneumoniae

Front 151

Gram-positive cocci, grow in clusters, B-hemolytic, catalse +, coagulase +, able to clot plasma

Back 151

S. aureus

Front 152

May cause CAP, HAP (hospital-associated pneumonia), VAP (ventilator-associated pneumonia), or HCAP (health care-associated pneumonia)

Back 152

S. aureus (The whole spectrum!)

Front 153

Definition of HAP or VAP

Back 153

occurring after 48 hours after hospital admission or tracheal intubation

Front 154

TSST-1 (superantigen), Protein A (anti-phagocytic: binds fc portion of IG), Coagulase (fibrin and abscess), Cytolytic toxins, Teichoic acid (tissue binding)

Back 154

S. aureus

Front 155

Gram-negative, aerobic, oxidase +, motile rod

Back 155

Pseudomonas aeruginosa

Front 156

Human contact via swimming pools, hot tubs, contact lens solutions, respirators, dialysis fluid, aqueous solutions, wet surfaces, soil, veggies.

Back 156

Pseudomonas aeruginosa

Front 157

Most common cause of nosocomial pneumonia

Back 157

Pseudomonas aeruginosa

Front 158

Exotoxin A & exoenzyme S (like diptheria toxin; invasins), Pyocanin, Alginate (defensin that forms biofilm)

Back 158

Pseudomonas aeruginosa

Front 159

Bronchopneumonia pattern with abscess formation (bronchocentric) or hemorrhagic necrosis (vasocentric)

Back 159

Psudomonas aeruginosa

Front 160

Oxidase status of P. aeruginosa

Back 160

+

Front 161

Smallest free-living bacteria that are capable of causing human disease

Back 161

Mycoplasma pneumoniae (lack a cell wall)

Front 162

Outbreaks may occur at schools, universities and military training camps (young adults)

Back 162

Mycoplasma

Front 163

Complications: bronchiolitis obliterans, CNS involvement, interstitial fibrosis, ARDS, Stevens-Johnson syndrome

Back 163

Mycoplasma

Front 164

Are obligate intracellular parasites

Back 164

Chlamydia (Rickettsia too!)

Front 165

Infectious form is the elementary body (EB)

Back 165

Chlamydia

Front 166

Elementary body in chlamydia is activated to form this

Back 166

Reticulate body (causes cell to burst and release new infectious EB)

Front 167

Causes neonatal pneumonia , transmission from mother during delivery through birth canal

Back 167

Chlaymydia trachomatis

Front 168

zoonotic infection spread largely from parrots to humans

Back 168

Chlamydia psittaci "Parrot fever"

Front 169

Fastidious pleomorphic gram-negative rods that live within fresh water amoebae

Back 169

Legionella pneumophila:

Front 170

Most specific test to dx Legionella?

Back 170

Urine antigen test

Front 171

Organisms are rod-shaped and most organisms contain vacuoles.

Back 171

Legionella

Front 172

Zoonotic disease caused by Coxiella burnetti: a rickettsial-like organism

Back 172

Q fever; difference is that infection occurs by inhalation (most rickettsia are tick-borne!)

Front 173

Primary reserviors of Coxiella burnetti (Q fever)

Back 173

sheep, cattle, goats

Front 174

Ring granuloma seen in the bone marrow of 53 YO hobby farmer with three weeks of FUO

Back 174

Q fever (Coxiella burnetti)

Front 175

Gram +, large, spore-forming, nonmotile, aerobic rod, ubiquitous; causes anthrax

Back 175

Bacillus anthracis

Front 176

Characteristics of Bacillus Anthracis

Back 176

Gram +, large, spore-forming, nonmotile, aerobic rod; zoonotic

Front 177

grey-glass, raised, with irregular borders (medusa head)

Back 177

Bacillus Anthracis

Front 178

bamboo or boxcar rods

Back 178

Bacillus Anthracis

Front 179

Cutaneous (95%) - direct invasion of spores through small abrasions, form eschar (burn-like)- usually self-limited

Back 179

Bacillus Anthracis

Front 180

Toxins: protective antigen (PA) binds to cell surface, transports edema factor (EF) and lethal factor (LF) to cytosol

Back 180

Bacillus Anthracis

Front 181

Pathology of Bacillus Anthracis

Back 181

Widened mediastinum, hemorrhage and edema of involved sites

Front 182

ANAEROBIC gram-positive filamentous rod. Mycelial-like colonies.

Back 182

Actinomyces israeli (rarely causes pneumonia)

Front 183

Sulfur granule = nidus of radial filamentous bacteria

Back 183

Actinomyces israeli

Front 184

Other acid fast bug (NOT M. TB)

Back 184

Nocardia (form red-orange colonies)

Front 185

Zoonotic disease from contact with infected beavers, muskrats, rabbits, voles, or bites of ticks, deer or black flies

Back 185

Francisella tularensis

Front 186

Francisella tularensis, gram what?

Back 186

-

Front 187

MC form of francisella tularensis

Back 187

Ulceroglandular

Also: typhoidal and pneumonic (highest mortality)

Front 188

+ Quelling Rxn

Back 188

Encapsulated bacteria (S. pneumonia, H. influenzae, N. meningitidis, Klebsiella pneumoniae)

Front 189

Obligate aerobes

Back 189

Nocardia, P. AERuginosa, M. TB and Bacillus (Nagging Pests Must Breathe)

Front 190

Obligate anaerobes

Back 190

Actinomyces, Bacteroides, Clostridium (ABC)

Front 191

Form a green ring around colonies on blood agar (type of hemolysis) and what bugs?

Back 191

Alpha (S. pneumonia and S. viridans) Tell them apart based on optochin sensitivity. (S. pneumonia is optochin sensitive)

Front 192

Form a clear are of hemolysis on blood agar (type of hemolysis) and what bugs?

Back 192

Beta, Staph aureus, Strep pyogenes (bacitracin sensitive), Strep agalactiae, Listeria

Front 193

Gram + rods with metachromatic granules

Back 193

C. Diptheriae

Front 194

The only bacterium with a protein capsule

Back 194

Bacillus anthracis

Front 195

3 A's of Klebsiella

Back 195

Aspiration pneumonia
Abscess in lungs
Alcoholics

Front 196

Grow on charcoal yeast; extract culture with Fe and cysteine

Back 196

Legionella pneumophila

Front 197

Klebsiella (Enterobacteriacae) and P. aeruginosa oxidase status?

Back 197

Klebsiella is oxidase -
P. aeruginosa is oxidase +

Front 198

Name 2 bacteria that produce exotoxin A (inactivates EF-2)

Back 198

P. aeruginosa and C. Diptheria

Front 199

Yersinia pestis, gram what?

Back 199

- (Some cases in the US associated with ground squirrels_

Front 200

acute onset dyspnea with wheezing, often have putrid expectorant with foul breath

Back 200

Aspiration pneumonia

Front 201

If CAP/aspiration, most likely etiology:

Back 201

Strep. pneumoniae

Front 202

If HAP/aspiration in intubated pt, most likely etiology:

Back 202

Pseudomonas aeuginosa

Front 203

Characteristics of Group B strep

Back 203

Bet hemolytic, gram + cocci (Tends to colonize the female GI tract and vagina, important to give antibiotics to Group B+ women during labor!)

Front 204

A slender, slightly curved, aerobic, acid-fast rod

Back 204

Mycobacterium TB

Front 205

What is a new test for TB?

Back 205

Quantiferon (blood test for > IFN-y). Supposed to be more sensitive, but it's $$

Front 206

How do you tell the difference between MAC/MAI and M. TB?

Back 206

MAC/MAI does NOT produce niacin/reduce nitrate as M. TB does

Front 207

In tissue Bx see large numbers of intracellular acid-fast bacilli

Back 207

MAI (NOT contagious); TB shows scant numbers of extracellular orgs

Front 208

Causes “swimming pool granuloma”

Back 208

M. marinum (Causes cutaneous skin lesions generally limited to extremities)

Front 209

Def of dimorphic fungi

Back 209

Can grow as a single cell yeast at warmer temps (in the body) and a mold with hyphae that produce spores (conidia or arthrospores) at colder ones.
YEAst in HEAt
MOLD in COLD

Front 210

Transmitted by inhalation of conidia when soil is disturbed (logging, tilling, etc.)

Back 210

Blastomycosis

Front 211

In tissue produce spherules containing endospores

Back 211

Coccidiodomycosis

Front 212

Pneumonia in neutropenic pts (transplant or leukemic pts), or pts with CF; also cause allergic pneumonitis

Back 212

Aspergillosis

Front 213

A common, monomorphic, ubiquitous, filamentous fungus

Back 213

Aspergillosis

Front 214

Name 3 gram -, Aerobic rods.

Back 214

Bordetella, Legionella (weakly gram -, stains better with silver stain) and Pseudomonas (Not a complete list!)

Front 215

Technique used to visualize acid-fast bacilli using fluorescence microscopy, notably species in the Mycobacterium genus

Back 215

Auramine or Rhodamine

Front 216

What kind of staining technique is the capsule stain?

Back 216

NEGATIVE

Front 217

media used as differential for lactose fermentation

Back 217

MacConkey agar (e-coli, Klebsiella)

Front 218

Agar to isolate and differentiate Enterobacteriaceae

Back 218

MacConkey agar

Front 219

Lactose fermentation leads to what on MacConkey agar?

Back 219

pink or red colonies

Front 220

Name 2 oxidase + bugs

Back 220

Neisseria and Pseudomonas

Front 221

The laboratory obtains a surgical wound swab from a 56 year old male four days after undergoing a colectomy for colon cancer. The isolate is gram +, catalase +, coagulase + and  hemolytic. It is most likely

Back 221

staph auerus

Front 222

The initial data necessary to adequately identify a bacterial unknown are its

Back 222

Morphology and gram staining

Front 223

Streptococcus viridans and pneumoniae are both B hemolytic, catalase -, gram + cocci. Which test may readily distinguish them?

Back 223

Resistance to optochin

Front 224

What is the most common bug to cause recurrent infection in pts with CF after 10 years of age?

Back 224

P aeruginosa (responsible for death)

Front 225

What two respiratory sequela often develops in pts with CF?

Back 225

COPD (90%!) and Bronchiectasis

Front 226

1st and most common mutation in CF

Back 226

Delta F508

Front 227

What is the pathology of the defect of the CFTR gene in deltaF508?

Back 227

CFTR is not glycosylated causing a folding defect in the protein which is retained in the ER

Front 228

Class II CF mutation

Back 228

Abnormal trafficking, folding and protein is degraded before reaching the apical membrane (deltaF508)

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What leads to the mucus plugging in CF?

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Defective CFTR--> < Cl- transport to ASL--> >Na and H2O reabsorption--> dehydrated mucus--> pluggin --> bacteria can colonize!

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The mutant CFTR leads to < internalization of what bug?

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P. aeruginosa (WT CFTR binds to LPS, internalizes and clears bacteria) Thus, it explains why P. aeruginosa causes problems in these pts!