Micro 1-Liners Lower Respiratory

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137. In an infant w/ ?immunization, 2 wks of paroxysmal coughs, inspiratory "whoop" + post-tussive emesis. TOW?

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Bordetella pertussis

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138. Pertussis toxin inhibits chemotaxis via downregulation of C3a/C5a receptor, resulting in?

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lymphocytic leukocytosis in CBC

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139. Three major virulence factors of “whooping cough” pathogen?

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ADP-ribosylating toxin; tracheal cytotoxin; hemolysin

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140. Cause of fever + drooling, stridor, dyspnea in a child w/ ?immunization (pt appears septic)

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Haemophilus influenzae b

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141. Major virulence factor of Haemophilus influenzae associated with pneumonia and meningitis

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Capsular polysaccharide (antiphagocytic and anti-C3b)

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142. Since, absent spleen places host at increased risk for invasive H. influenzae infection, pre-exposure prophylaxis prior to elective splenectomy is ?

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Hib immunization

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143. Cause of acute exacerbation (cough, purulent sputum) in pt with chronic bronchitis (COPD); CXR: R/O pneumonia; Lab: sputum reveals Gram-negative coccobacilli.

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Haemophilus influenzae (non capsular types)

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144. Tx of AECB, caused by an organism that needs NAD + hematin for growth; β-lactamase (+), is

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Ceftriaxone (severe) >. Amoxicillin-clavulanate (mild)

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145. Most common cause of lower-respiratory infections in neonates (babies < 4 wk)?

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Streptococcus agalactiae (aka: group B streptococcus)

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146. Complicated illness in a newborn of a GBS-colonized mother is

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Sepsis or meningitis

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147. A mother colonized (recto-vaginally) w/ GBS is at risk for preterm baby or premature membrane rupture. She should receive

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Ampicillin

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148. An elderly comes up with an abrupt-onset fever, myalgia, headache, malaise, dry cough, sore throat and rhinitis, in winter. Illness could have been prevented w/ ?

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annual influenza vaccine

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149. Annual influenza vaccine protects at-risk subpopulation w/ 60% immune protection, and is composed of what 3 viruses?

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A:H1N1 + A:H3N2 + B

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150. Secondary spread of influenza occurs in a crowded setting (within 6 feet of infected person) via

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respiratory droplets

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151. Annual vaccine to prevent influenza is needed due to antigenic drift. This occurs due to what genetic mechanism?

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Mutation

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152. Occasionally serious pandemic of influenza occurs due to antigenic shift. This occurs due to what genetic mechanism?

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Reassortment of 8 genomic segments

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153. DOC of pts with influenza <48 hours is

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Oseltamivir

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154. Bacterial superinfection, causing pneumonia, after influenza occurs in elderly (in LTCF) due to what?

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S. pneumoniae > S. aureus

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155. A seriously ill young adult w/ necrotizing pneumonia, poorly responding to vancomycin, should get

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Linezolid

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156. Cause of febrile illness + bronchiolitis in an infant; BAL viral culture (+).

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Respiratory syncytial virus (RSV)

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157. RSV causes seasonal, nosocomial pneumonia outbreaks in the pediatric units via

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Contact spread

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158. Pathophysiology of asthmatic Sx + Sn in bronchioles in high-risk infants due to RSV involves

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type III hypersensitivity

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159. Inhaled anti-viral drug used in the sickest infants with bronchiolitis is

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Ribavirin

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160. Insidious onset of fever, dry cough, malaise and sore throat in young adults. CBC: anemia; CXR: diffuse infiltrates. TOW?

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Mycoplasma pneumoniae

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161. Dx of “walking pneumonia” in older children and young adults, while waiting for serology, is supported by

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cold agglutinin (IgM Ab against RBCs) titer ≥1:32

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162. β-lactam abx is ineffective for Tx of mycoplasma pneumonia because

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Wall-less bacteria

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163. A male child with mycoplasma pneumonia now has systemic rash, covering 10% of his body. TOW?

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erythema multiforme (SJS)

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164. Cause of upper respiratory Sx, slow onset of cough (laryngitis) >2wks + CXR: patchy infiltrate, viral serology (+)

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Chlamydophila pneumoniae

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165. The most common cause of community-acquired pneumonia (CAP) is

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Streptococcus pneumoniae

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166. Cause of rapid onset of high fever, cough, & sputum, dyspnea; tachypnea in an elderly; CXR: lobar infiltrate; CBC: pronounced neutrophilic leukocytosis with left shift, is

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Streptococcus pneumoniae

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167. Gram-positive diplococci from sputum from a patient with lobar pneumonia yield α-hemolytic colonies and are confirmed by

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Capsular swelling (Quelling rxn)

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168. α-hemolytic colonies of Streptococcus pneumoniae is differentiated from viridans streptococci definitively confirmed by

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Optochin sensitivity

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169. Population w/ ↑incidence of pneumococcal pneumonia is

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AIDS

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170. ↑ incidence of colonization of what organism is seen in very young and elderly, crowding, following viral URI (↑PAF receptors), fall/winter season?

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Streptococcus pneumoniae

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171. Streptococcus pneumoniae is transmitted P2P by

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Respiratory droplets

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172. Nasopharyngeal mucosal colonization is facilitated by

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IgA protease

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173. Streptococcus pneumoniae reaches lungs after nasopharyngeal colonization via

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aspiration

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174. Major virulence factor, facilitating invasion and dissemination of Streptococcus pneumoniae is

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Polysaccharide capsule

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175. Pneumococcal cell wall peptidoglycans, teichoic acid elicit

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Inflammation

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176. ↑ Lung cell injury in pneumococcal pneumonia is caused by virulence factor?

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Pneumolysin (α-hemolysin)

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177. Multiple myeloma, C3 deficiency, asplenia - Hg SS, COPD, diabetes, alcoholism, smokers are risk factors for mortality due to

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pneumococcal pneumonia

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178. Hematologic marker for poor prognosis of pneumococcal pneumonia is

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Leukopenia

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179. Emipiric DOC of CAP in pts at risk or w/ comorbidity is

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Azithromycin (or levofloxacin) + ceftriaxone

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180. Pneumonia due to highly penicillin-resistant Streptococcus pneumoniae (Pen MIC >8) should receive

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moxifloxacin or vancomycin

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181. Mechanism of penicillin resistance in Streptococcus pneumoniae is

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PBP alteration by mutation

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182. Pt w/ agammaglobulinemia or asplenia or sick-cell anemia or ↓C3 should be vaccinated with

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Pneumococcal polysaccharide vaccine (PPSV: 23-valent)

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183. Hx: a patient w/ serious CAD now on a ventilator, acquires bronchopneumonia >72 hrs after hospitalization. TOW?

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Pseudomonas aeruginosa (VAP)

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184. Cause of necrotizing pneumonia >72 hrs after hospitalization of complicated viral illness

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Staphylococcus aureus (assume MRSA)

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185. Patients that are aspiration prone have hx of

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dysphagia, decreased consciousness

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186. Hx of a patient w/ seizure illness has fever, cough evolving over 2-4 wks; CXR infiltrate (+).TOW?

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Aspiration pneumonia

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187. Community-acquired respiratory pathogens that cause aspiration pneumonia

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Streptococcus pneumoniae > Anaerobes

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188. Hospital-acquired respiratory pathogens that cause aspiration pneumonia

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Gram-negative bacilli > S. aureus +/- anaerobes

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189. Clinical Dx of sudden dyspnea +/- cyanosis, fever, wheezing, often ARDS-like picture is

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acid-related pneumonia

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190. Bacterial etiology and Tx of aspiration pneumonia are determined by

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Gram stain (polymicrobic) and culture of sputum

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191. Empiric DOC of necrotizing pneumonia in a patient with seizure illness

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clindamycin + levofloxacin

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192. Targeted Abx for anaerobic aspiration pneumonia is

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clindamycin

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193. Pneumonia in homeless/alcoholics; Gram-positive diplococci in sputum Gram smear. TOW?

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Streptococcus pneumoniae

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194. Pneumonia in homeless/alcoholics; Gram-negative rods in sputum smear. TOW?

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Klebsiella pneumoniae

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195. Cause of pulmonary embolism in a pt with IVDU

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Staphylococcus aureus

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196. Common cause of pneumonia in pts with CF

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Pseudomonas aeruginosa

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197. Sputum of a patient with hospital-acquired pneumonia yields a Gram-negative rod that is oxidase (+). TOW?

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Pseudomonas aeruginosa

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198. Common cause of external otitis due to hot tub use is

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Pseudomonas aeruginosa

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199. A patient with diabetes has osteomyelitis after penetrating foot injury. TOW?

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Pseudomonas aeruginosa

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200. The most widely used anti-pseudomonal penicillin

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Piperacillin > imipenem

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201. The most widely used anti-pseudomonal aminoglycoside

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Tobramicin > gentamicin

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202. This pt >50 years, smoking hx, CMI↓ has pneumonia; diarrhea, renal failure. Urine antigen (+) for pathogen. Pt responds to azithromycin. TOW?

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Legionella penumophila

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203. Penicillin is ineffective against Legionnaire’s dz because

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Intracellular organism

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204. Individuals with defective CMI response has poor prognosis of Legionnaire’s dz because

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Intracellular organism

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205. Asymptomatic patient with PPD (+)

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Latent tuberculosis infection (LTBI)

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206. Cough > 2 wks, fever, night sweats, weight loss, hemoptysis, SOB; CXR: upper lobe infiltrate. TOW?

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Active Mycobacterium tuberculosis infection

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207. Oral drug regimen of choice for treatment of active TB (aka: 1st line drugs) is

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INH+RIF+PZA+EMB (oral) + Vit B6

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208. Pyridoxine is added to 4-drug therapy for TB to prevent

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neuropathy (due to INH)

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209. Pt w/ TB fails to respond to 4-drug regimen w/ INH+RIF resistance because

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Multiply drug-resistant (MDR) TB

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210. Pt w/ MDR-TB fails to respond to INH +RIF+FQ+an injectable drug (amikacin, capreomycin, or kanamycin) because

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Extremely-drug resistant (XDR) TB

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211. Cause of TB-like Dz that does not respond to 1o TB Tx regimen, in a pt. w/ AIDS

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Mycobacterium avium – intracellulare (aka: MAC)

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212. Cause of chronic pneumonia in a patient with cancer, receiving cytotoxic chemotherapy; lung-CT: halo/crescent sign (+)?

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Aspergillus fumigatus

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213. Hx of chronic pneumonia w/ lung bpsy histopathology (+) for hyphae 2-4μm wide, septate, acute- angle branching. TOW?

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Aspergillus fumigatus

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214. Cause of TB-like LRI in a pt with outdoor activity (Giemsa stain of bronchoscopy specimen: (+) for 2-5 μm yeasts) is

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Histoplasma capsulatum

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215. Pt with AIDS has blood culture (+) for histoplasmosis. DOC has effects on

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Ergosterol in fungal cell membrane

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216. TB-like Dz w/ ulcerative skin lesions. lung bpsy histopathology (+) for large yeast w/ broad-based bud. DOC?

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Intraconazole

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217. Hx of acute onset of cough, fever, infiltrate in a black male with CMI↓; histopathology of lung (+) for a large sac of endospores. DOC?

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Fluconazole (indefinite)

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218. Pt w/ aspiration pneumonia with cervico-facial lesion should respond to

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Penicillin G

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219. Granular specimen from draining fistulae from a pt with LRI on anaerobic culture should yield

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Actinomyces israelii

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220. Pt with AIDS or organ transplant has indolent pneumonia, w/ or w/o CNS abscess or granuloma. TOW?

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Nocardiosis

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221. Organism w/ characterization of Gram-positive branching, beaded, filamentous rod, weakly acid fast is

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Nocardia asteroids

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222. Hx of non-productive cough, fever and dyspnea evolving over 2-4 wks. CXR (+): bilateral interstitial infiltrates, hypoxemia; ↑LDH, CD4 count <200/mm3 in a MSM. TOW?

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Pneumocystis pneumonia

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223. DOC of pneumocystis pneumonia (PCP)

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TMP-SMX