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252 Cards in this Set
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Group of microorgs that cause disease when host defenses are impaired
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Secondary
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Group of microorgs that can successfully infect the healthy respiratory tract by unique properties which allow them to evade host defenses
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Professional
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Name 3 common systemic bugs
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Parainfluenza, H. influenzae and influenza virus
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Microbial adhesion of Influenza A and measels virus
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Hemogglutinin
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Microbial adhesion of rhinovirus
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Capsid protein
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Microbial adhesion of Cox A
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Capsid protein
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Microbial adhesion of of Parainfluenza Type 1 and RSV
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Envelope protein
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Microbial adhesion of mycoplasma pneumoniae
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Mycoplasmal molecule or "foot"
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Microbial adhesion of H. influenzae, Strep. pneumonia, Klebsiella pneumoniae
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Surface molecule
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Name 2 bugs that synthesize a glycan that forms a matrix between cells to develop dental plaques
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Strep mutans and Lactobacillus
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What produces dental caries?
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Plaque bateria secrete lactic acid. (Strep mutans and lactobacillus)
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Name 2 anerobic bugs that contribute to peridontal disease
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Actinomyces and Bacteroides
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Why do rhinoviruses usually only affect the URT?
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They like to grow at 33 degrees C, not 37. Thus, they flourishin the URT, not the LRT where it is warmer
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Bug that causes Herpangina
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Cox A
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Vesicular enathem of the tonsis and soft palate affecting children 6 months-10 years in summer and fall
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Herpangina (Cox A)
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Bug of Hand, foot and mouth disease
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Cox A
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Demographics of Hand, foot and mouth
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Enathem in the spring and summer in kids < 5
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Vesicular lesions and ulcerations, tender cervical lymphadenopathy, high fever, irritability and swollen gingiva
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HS Gingivostomatitis
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Bugs of a cold
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Rhinoviruses and secondarily Coronaviruses
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Attachment Mech: Penton fiber binds to cell receptor
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Adenovirus
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Attachment Mech: G protein on virus binds to glycoside on cell
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RSV
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Most common causes of pharyngitis
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Strep Pyogenes and Unknown
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Causes disease in summer and fall, multiply in tonsils and can spread to other parts of the body including the meninges resulting in a meningitis (2 bugs)
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Cox and ECHO
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VP4 mediates binding to host cell and determines trophism
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Cox and ECHO
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A toxin activity associated with their pentons
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Adenovirus
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Fever, sore throat, very enlarged cervical lymph nodes and may produce pharygealconjuctival fever. If you have a sore throat and eye involvement, think what bug?
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Adenovirus
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Creamy exudate on the tonsils, widespread lympahdenoapathy, systemic disease. What bug?
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EBV
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Linked to late effect cancers Burkitt's Lymphoma and Nasopharyngeal Carcinoma
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EBV
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Usually generate Heterophile Ab that will produce a + Monospot
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EBV (Cytolomegalovirus will be Monospot -)
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In what demographic do most severe middle RTI occur?
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infants or very young children (epiflottitis, laryngitis, croup and bronchitis/tracheobronchitis are all middle RTIs)
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Characteristics of Strep mutans (and note hemolysis type)
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Gram + cocci that grow in chains; of the group Strep Viridans; alpha hemolytic
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Tx for Strep mutans?
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Penicillin G
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Attributes of Pathogenesis of Strep mutans?
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Cell associated carb capsule
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How do you differentiate between pharyngeal thrush and Candida lesions?
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Candida lesions will be painless
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Fungi causing Stomatitis
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Candida
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Viruses causing Stomatitis
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HSV and COX A
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Dimporphic fungus: yeast form on mucosal surface as normal flora, but hyphae and pseudohypae in tissues
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Candida albicans (Opportunistic)
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Yeast form produces proteases and phosholipase that assist tissue invasion
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Candida albicans
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Characteristics of HSV
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Enveloped viron w/ linear dsDNA
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Cowdry type A acidophilic nuclear inclusion bodies
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HSV
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Initial infection and replication in mucoepithelial cells and establish latent infections of sensory neurons
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HSV
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Gingivostomatitis in kids
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HSV Type 1
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Gingivostomatitis in young adults
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HSV Type 2
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Causes herpes labialis (cold sores)
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HSV Type 1
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Dx by cytopathogenic effects in Tzanck test
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HSV
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Tx of HSV? Resistant bugs?
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Acyclovir, famiciclovir and valacyclovir. For resistant bugs, Foscarnet and Cidofovir.
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Dendritic ulcers in keratoconjuctiitis
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HSV
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Characteristics of COX
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Naked, icosahedral viron with ss + sense RNA
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Tx of COX?
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Supportive
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Common cold virus most common in adults
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Rhinovirus
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Common cold viruses predominant in kids
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Coronavirus and Parainfluenza virus
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Characteristics of Rhinovirus
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Naked icosahedral viron with ss + sense RNA
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Secretor IgA and interferon important for controlling the spread of this infection
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Rhinovirus
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Treatment with Pleconaril is possible, but usually not done for this virus
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Rhinovirus
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Characteristics of Coronavirus
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Enveloped virus with helical nucleocapsid containing ss + sense RNA
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Causes the common cold in kids and perviously SARS
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Coronavirus
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Characteristics of HPIV?
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Enveloped virus with helical nucleocapsid containing ss - sense RNA
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Tx of HPIV?
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Supportive, no vaccine
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May cause croup (barking cough with inspiratory stridor), Bronchiolitis (fever and expiratory wheezing) and Pneumonia
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HPIV
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Clinical presentation often consists ofexudates, palatal petechiae, follicles, scarlet fever-like rash and tender cervical adenitis
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Strep Pyogenes (Group A)
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Which virus will give you an exudate? (Most viruses lack exudates)
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EBV
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Characteristics of Strep Pyogenes (Group A); Catalase?
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gram + cocci that grow in chains; Catalase -
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Cell associated M protein and hyaluronic capsule; extracellular products
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Strep Pyogenes
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Hemolysis of Strep Pyogenes (Group A)
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Beta hemolysis
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Tx of strep pyogenes
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Penicillin G
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Honey crusted lesions on face and trunk
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Impetigo; Strep Pyogenes
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Characteristics of C. diphtheria
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Gramp + club-shaped rod
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Extracellular A-B type exotoxin that inhibits protein synthesis by inactivation of elongation factor
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C. Diphtheria
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Black colonies on tellurite agar (Loeffler medium) is Dx
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C. Diphtheria
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Virulence factor that inhibits the activation of complement and protects the org from phagocytosis
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M protein of Strep Pyogenes
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May produce pyrogenic exotoxins that stimulate T cells to pour out inflammatory cytokines (superantigen) and induce TSS
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Strep Pyogenes (So can staph auerus)
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Colonizes in the pharynx forming a pseudomembrane composed of fibrin, leukocytes, necrotic epithelial cells
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C. Diphtheriae
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Multinucleated giant syncytial cells with intranuclear inclusion bodies
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HSV
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Has at least 17 adhesion moelcules including fibronectin and collagen binding proteins
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Strep. Pyogenes
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What proteins create antibodies that crossreact with cardiac myosin and sacrolemmal membrane to cause rheymatic fever? What bug?
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M protein in Strep Pyogenes
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Toxins and antibodies of this bug can lead to GN and streptococcal TSS
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Strep Pyogenes
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Name 2 things Strep Pyogenes has to inhibit host defenses
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M proteins and polysaccharide capsule
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"Bull-neck" appearance due to swelling of lymph nodes
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C. Diptheria
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A/B toxin coded for by lysogenic beta phage is the major pathogenic factor
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C. Diptheria
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What sort of vaccine is the Diptheria vaccine?
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Formalin inactivated toxoid
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What does the B fragment of the Ditheria toxin do?
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B = Binds
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Causes an acute epiglottis due to swelling of supraglottic tissue; usually in kids 2-4
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H. influenzae
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What protects H. influenzae from phagocytosis?
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Antiphagocytic capsule
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Prevention of H. influenzae?
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Hib vaccine: consists of type b capsular material conjugated to diptheria toxoid
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What age group is H. influenzae most prevalent in?
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Kids 2-4
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The usual cause of laryngitis
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Parainfluenza Virus
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Causes croup (a laryngotracheobronchitis) that affects kids in the fall and winter
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Parainfluenza Virus
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Parainfluenza Virus binds to epithelial cells of tracheobronchal tree via what?
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Hemagglutin/neuraminidase protein
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Causes Whooping cough
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Bordetella pertussis
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How do Bordetella pertussis attach to epithelial cells?
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Hemagglutinin and fimbria
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This bug can survive in phagocytic cells and secrete pertussis toxin, adenylate cyclase toxin, tracheal cytotoxin and an endotoxin
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Bordetella pertussis
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Tx of Whooping cough via Bordetella pertussis
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Erythromycin
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Prevention of Bordetella pertussis?
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Acellular pertussis vaccine
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Causes 75% of bronchiolitis infections
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RSV
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Demo of RSV
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children 2 or less in the late winter or early spring
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Dangerous pediatric nosocomial infection
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RSV
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Type of influenza most frequently involved in yearly epidemics
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A
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What part of influenza is responsible for the molecular biology of antigenic drift and shift in yearly epidemics?
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Hemeagglutinin and neuraminidase
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Forms an ion channel in endosome which permits the influx of ions and that releases the core that travels to the nucleus for replication of the s.s. virion RNA
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M2 matrix protein of influenza
(Without M2, influenza cannot replicate) |
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What determines the binding that can occur in influenza?
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Hemagglutinin
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Protein sequence of HA changes. (Point mutations in that segment that codes of HA of the influenza virus).
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Antigenic drift (Yearly)
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Take two different influenza viruses with different types of HA and NA and combine them... Exchange of RNA segments between two viruses.
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Antigenic shift causing major pandemics
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Antiviral drugs which inhibit viral neuraminidase
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Zanamivir and Oseltamivir
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What mediates lobar pneumonia?
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Bacteria
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What mediates interstitial pneumonia?
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Virus
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How are acute pneumonias classified?
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Community-acquired (CAP) and Hospital-acquired (HAP)
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What general group of bugs cause children's pneumonias?
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Viruses (Only cause 10-20% of adult pneumonias)
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Major bacterial causes of CAP
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Strep pneumonia, H. influenza and Moraxella catarrhalis
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Characteristics of Bordetella pertussis?
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Gram - coccobacilli with fastidious growth requirements
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Bordetella pertussis, Oxidase + or -?
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Oxidase +
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Name 2 bugs with an A-B type exotoxin
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Bordetella pertussis and C. Diphtheriae
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Growth on Bordet-Gengou or blood charcoal agar
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Bordetella pertussis
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Tx of Bordetella pertussis?
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Whole cell inactivated vaccine part of DPT and two acellular pertussis vaccines as part of D TaP, Or Erythromycin if neccessary
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Human Metapneumovirus (HMPV) may cause what?
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Bronchitis/Bronchiolitis
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Wheezing on expiration can be correlated with what according to the bug table?
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RSV in bronchiolitis
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Characteristics of RSV
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Enveloped virus with helical nucleocapsid containing ss negative sense RNA
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Tx of RSV
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Supportive or Ribavirin in severe peds cases
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May use palivizumab as a preventative measure for this virus
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RSV
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Why do viruses with HA glycoproteins cause heme-agglutination when mixed with RBCs?
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HA attaches to host sialic acid receptors which are present on the surface of erythrocytes (also present on the cells of the URT)
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What allows the influenza virus to attach to the URT cell membranes?
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HA attaches to host cell sialic acid receptors (present in URT and RBC)
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What is the function of Nueraminidase (NA) in the influenza virus?
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Breaks down Neruaminic acid in the mucin and exposes sialic acid receptors for HA to bind
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What is the mechanism of Zanamivir and oseltamivir?
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Inhibit NA in influenza
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Name two viruses with Fusion (F) protein that causes the infected host cells to fuse together into multinucleated giant cells
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PIV and RSV
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Can cause Reyes syndrome in kids
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Influenza
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Characteristics of Influenza virus
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enveloped with 8 helical nucleocapsids each containing a different ss negative sense RNA
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What types of influenza can undergo antigenic DRIFT?
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A and B
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What type of influenza can undergo antigenic SHIFT?
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A
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What is the mechanism of Amantadine and Rimantadine in the tx of influenza?
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inactivate M2 proton channel necessary for replication of the virus
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Define acute and chronic Pneumonias
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Acute = sx 1-3 days following infection
Chronic = sx progress over three weeks or longer |
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When bacteria is leaked into the pleural space during a pneumonia
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Empyema
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A causual fungi of a typical CAP in an immunosuppressed individual
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Pneumocystis jiroveci
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A pneumonia in an AIDS pt is probably caused by what?
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Pneumocystis jiroveci
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A pneumonia in a pt with cystic fibrosis is probably caused by what?
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P. aeruginosa
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Name the common pathogens of a CAP in pts < 50
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Strep pneumonia, mycoplasma pneumonia and chlamydophila pneumonia and resp viruses
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Name the common pathogens of a CAP in pts > 50
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Strep pneumonia, H. influenza, Moraxella catarrhalis, Legionella and other resp viruses
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neonatal pneumonia is frequently observed in infants born to infected mothers with what?
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Chlamydophilia trachomatis
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Atypical pneumonias are NOT caused by what?
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Strep pneumonia or H. influenza
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Characteristics of Strep pneumonia
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Gram + cocci that are seen in PAIRS rather than chains like other Strep
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How do you differentiate between Strep viridans and Strep pneumonia since they are both alpha hemolytic?
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Strep pneumonia is Optichin sensitive (will stop growing) while Strep viridans is Optichin resistant
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Extracellular products IgA protease and pneumolysin
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Strep pneumonia
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Hemolysis of Strep pneumonia?
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alpha hemolytic
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+ Quelling Rxn
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Strep pneumonia and H. influenza
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Tx of Strep pneumonia
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Polysaccharide capsular vaccine; Penicillin G; Cephalosporin and Vanco for Pen resistant strains
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Characteristics of H. influenza
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Gram - faculative coccobacilli with fastidious growth requirements (Like Bordetella pertussis)
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H. influenza, Catalase what?
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Catalase -
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Requires factor X (hemin) and factor V (NAD) for growth
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H. influenza
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Growth on chocolage agar supplemented with growth factors X and V
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H. influenza
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Prevention of H. influenza
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Hib conjugate vaccine containing type b capsule
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Which polysaccharide capsule of H. influenza usually causes disease in kids and is bad?
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b (b=bad)
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What specific type of H. influenza will cause ottitis media in kids?
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nonencapsulated strains as they lack the virulent invasiveness of the capsulated ones and can thus only cause localized infection
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What pathogenesis does H. influenza cause?
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Epiglottis and meningitis in kids and pneumonia in the elderly
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What is the significance of Filamentous hemagglutinin (FHA)?
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Allows Bordetella pertussis to bind to ciliated epithelial cells. (Note: remember Bordetella pertussis does NOT actually invade they body. It releases exotoxins from the surface of the ciliated epithelial cell it binds to)
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The AB subunits of Pertussis toxin activate what?
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G protein --> adenylate cylase --> > cAMP --> protein kinase
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Exotoxin of Bordetella pertussis that impair the generation of H2O2 and superoxide
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Extra cytoplasmic adenylate cyclase
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Exotoxin of Bordetella pertussis that destroys ciliated epithelial cells resulting in impaired clearance of mucus
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Tracheal cytotoxin
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This type of CAP develops more slowly and have less severe, more systemic complaints (besides a non-productive cough)
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Atypical pneumonia
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What are the major bacterial causes of Atypical pneumonia?
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Legionella and Mycoplasma pneumonia
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What are the Chlamydia causes of an Atypical Pneumonia
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Chlamydophila pneumonia and psittaci
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A possible viral cause of an atypical pneumonia in a kid
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RSV (Although
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Unique bacteria that lack a peptidoglycan cell wall
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Mycoplasma
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Atypical pneumonias will show up as what on a CXR
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Interstitial pattern (Which is usually associated with viruses, but bacteria such as mycoplasma pneumonia can also produce this pattern)
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Require sterols for growth
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Mycoplasma pneumonia (All mycoplasma require sterols due to lack of cell wall)
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Adhesion virulence factor of Mycoplasma pneumonia
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protein P1
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May cause a Walking Pneumonia
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Mycoplasma pneumonia
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Tx for Mycoplasma pneumonia
|
Erythromycin and Tetracycline
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IgM "cold agglutinins" are Dx
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Mycoplasma pneumonia
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2nd most common nosocomial infection
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Nosocomial pneumonia (UTIs are the first)
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Endotracheal intubation increases the risk for this infection
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Nosocomial Pneumonia
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How do you determine if a pt acquired a nosocomial pneumonia or if it was just incubating?
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If they develop the disease after being hospitalized for > 5 days = Nosocomial
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Name 3 opportunistic orgs
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CMV, Aspergillis fumigatis, and Pneumocystis jiroveci
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Name the most common orgs to cause a nosocomial pneumonia
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Gram negative rods (E. coli, Klebsiella pneumonia, P. aeruginosa) and Staph aureus
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Many pts with this show evidence of peridontal disease and 3/4 of the cases occur in pts > 65
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Aspiration pneumonia
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Most common cause of Aspiration pneumonia
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Anerobic strep (Peptostreptoccocus species)
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unique cell wall components prevent destruction in the lysosomes
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Mycobacteria TB
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Bacteria causes of Chronic CAP
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Mycobacterium TB and avium, and Nocardia
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Fungi causes of Chronic CAP
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Histoplasma capsulatum, Coccidiodes immitis, Blastomyces dermatitidis, Cryptococcus neoformans, and Sporothrix scheneckii)
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Fungal causes of Chronic Opportunistic Pulmonary Mycosis
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Aspergillus fumigatus and flavia
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Prevalent fungi around the Mississippi river areas
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Histoplasma and Blastomyces
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Fungi prevalent in the southwest that causes systemic infections
|
Coccidioides immitis
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Name the 3 dimorphic fungi that can cause systemic infections
|
Histoplasma capsulatum, Coccidoides immitis, Blastomyces dermatitidis
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NONencapsulated (despite name) and found in bat and bird poop
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Histoplasma capsulatum
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Fungi are isolated form soil and rotten wood and environmental form is mold
|
Blastomyces dermatitis
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Tx of Histoplasma capsulatum infection
|
Non-disseminated: Intraconazole
Disseminated: Amphotericin B |
|
Mold form lives in desert sand
|
Coccidiodes immitis
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Tx of Coccidiodes infection
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Non-disseminated: Fluconazole
Disseminated: Amphotericin B |
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Tx of Blastomyces dermatitidis
|
Non-disseminated: Azoles
Disseminated: Amphotericin B |
|
Encapsulated yeast cells often found in pigeon droppings
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Cryptococcus Neoformans
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Tx of Cryptococcus Neoformans
|
Fluconazole
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India Ink stain shows yeast cells with surrounding halo
|
Cryptococcus neoformans (Common infection in AIDS pts)
|
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Filamentous fungus ubiquitous in the environment
|
Aspergillus
|
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Fungus that causes a Type I HS (Elevated IgE)
|
Aspergillus
|
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Tx of Aspergillus
|
Surgical removal of aspergilloma or Amphotericin B
|
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Pathology associated with periodontal disease, chest pain, anemai and putrid breath
|
Lung Abcess
|
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Bacteria cause of Lung Abcess
|
Anaerobic bacteria
|
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Bacteria that cause Otitis Media & Acute Sinusitis
|
Strep pnumonia, H. influenza and Moraxella catharralis
|
|
Causes chronic sinusitis, particularly in AIDS pts
|
P. aeruginosa
|
|
produce only lactic acid from sugars
|
Lactobacillus
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Characteristics of lactobacillus
|
Gram-positive facultative anaerobic or microaerophilic rod-shaped bacteria
|
|
Causal org of epiglottitis in kids? In adults?
|
H. influenza in kids, Strep pyogenes in adults
|
|
Viruses that can cause a pharyngotonsillitis
|
Adenovirus, Cox A, EBV and Enterovirus
|
|
Tx of adenovirus
|
supportive
|
|
Characteristics of Adenovirus
|
Naked viron with linear ds DNA
|
|
Infects human B cells and is associated with Burkitt's Lymphoma
|
EBV
|
|
Heterophile Ab resulting in a + Monospot
|
EBV
|
|
Characteristics of EBV
|
Enveloped viron with linear ds DNA
|
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Tx of EBV
|
supportive
|
|
Downey cells in blood smear
|
EBV
|
|
organisms are engulfed by alveolar macrophages and replicate within them since the unique cell wall components prevent destruction in the lysosomes
|
Mycobacterium tuberculosis
|
|
healed primary lesions of Primary TB that have become calcifies are called
|
Ghon complexes
|
|
Prevention of Primary TB
|
a live attenuated vaccine is available
|
|
TB that occurs at other sites including the CNS and GU tract and results from the hemeatogenous spread of the bacteria
|
Miliary (extrapulmonary) TB
|
|
hospital-acquired lung abcesses are the result of which usual hospital-acquired infections?
|
K. pneumonia, P. aeruginosa
|
|
IV drug users are prone to lung abcesses from which bug?
|
S. aureus
|
|
inhaled from deer mouse feces invade pulmonary capillary endothelium resuling in large increases in fluid in the lungs and hyptension and cardiogenic shock
|
Sin Nombre hantavirus
|
|
Name some parasites that can cause lung infections
|
Ascaris and hookworms and Schistosome larvae, Echinococcus granulosus larvae and Paragonimus westermanii
|
|
Characteristics of Mycobacteria TB
|
Acid fast aerobic rod
|
|
Unique cell wall containing mycolic acids and cord factor
|
Mycobacteria TB
|
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Unique cell wall prevents killing by macrophage lysosomes; intracellular parasites
|
Mycobacteria TB
|
|
Prophylactic tx for Mycobacteria TB
|
Isoniazid
|
|
Faculative intracellular growth: can survive and multiply in macrophages
|
Mycobacteria TB
|
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Nonmotile, no capsule, no attachment pili and No exotoxins or endotoxins. DOES ahve lipolysaccharide
|
Mycobacteria TB
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Polysaccharide capsule yeast
|
Cryptococus neoformans
|
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Branching (45 degree angles) septated hyphae
|
Aspergillus
|
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Wheezing pt and CXR with fleeting infiltrates
|
Aspergillus
|
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Pneumonia lesions can calcify, looking similar to TB on a CXR ("Coin lesion")
|
Histoplasma capsulatum
|
|
Yeast forms present in macs
|
Histoplasma Capsulatum
|
|
Cysts and trophozoites present; cysts attach to type I pneumocytes
|
Pneumocystis jiroveci
|
|
Diffuse "flying saucer" cysts
|
Pneumocystis jiroveci
|
|
Hyphae with distinctive tuberculate macroconidia
|
Histoplasma capsulatum
|
|
Big, broad, budding yeasts
|
Blastomyces dermatitidis
|
|
Athroconidia found in the desert sand
|
Coccidiodomycosis
|
|
Lancet shaped diplococcus
|
Strep pneumoniae
|
|
Colonizes with help of protein adhesins and an IgA protease; produces hydrogen peroxide
|
Strep pneumoniae
|
|
What does Strep pneumoniae have that reduces the efectiveness of complement and Ab, < phagocytic uptake
|
polysaccharide capsule
|
|
Hyaluronic acid capsule inhibits phagocytic uptake
|
Strep Pyogenes
|
|
Has a toxin that is a potent ADP ribosyl transferase
|
C. diphtheriae
|
|
Adheres through filamentous HA, pertactin and pili
|
B. pertussis
|
|
Tozin that has an ADp ribosyl transferase that > cAMP
|
B. pertussis
|
|
Tracheal cytoxin that kills ciliated resp cells
|
B. pertussis
|
|
Often causes resp disease in adolescents and young adults
|
Mycoplasma pneumoniae (Walking pneumoniae)
|
|
attaches to UR and bronchial epithelial cells via P1 protein
|
Mycoplasma pneumoniae
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Fried egg appearing colonies on culture
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Mycoplasma pneumoniae
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Pneumonia associated with ventilators and postinfluenza infections
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S. auerus
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Gram negative rod, lactose-fermenter with capsule
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Klebsiella pneumoniae
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Pneumonia associated with ventilator, alcoholism (although pneumoccocus is still more common) and aspiration
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Klebsiella pneumoniae
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Current jelly sputum
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Klebsiella pneumoniae (nonmotile)
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Gram -, nonfermenting rod, motile
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P. aeruginosa
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Burn, CF, severly neutropenic patients, respirator associated pneumonia
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P. aeruginosa
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production of copious extracellular slime
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P. aeruginosa
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gram - NONstaining, pleomorphic rod with no peptidoglycan
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Chlamydia pneumoniae (Atypical Pneumonia)
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|
Poorly gram - staining rod which is a faculative intracellular pathogen of human macs
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Legionella pneumophila
|
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Found in contaminated water, air-conditioners, etc.
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Legionella pneumophila (NOT contagious from person to person)
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