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64 Cards in this Set

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what are sinuses
we have cavities in the front of our face, like maxillary, ethmoid, frontal, sphenoid
what are s n s of sinusitis
-thick colored post nasal drainage
-headache
-fever
-congested nasal passages
-facial pain, tenderness,swelling
-cough
-loss of breath
-halitosis
-ear stuffiness
what are the s n s of otitis media
-fever
-irritanility
-""otalgia""
-anorexia
-vomitting
-bulging tympanic membrane
-middle ear effusion
what do sinusitis and otitis media uaually follow
Upper respiratory infections
what is the general cause of both sinusitis and otitis media
PMN infiltrate the sinuses and ear canal
what is the epidemiology of Otitis media
-most common infection in kids
-50% will have it by their by 1sr bday and 80% before 3rd
-most common reason to prescribe antibacs
what is the clinical disease seen with Otitis media
-constant complain about an ear ache
-nausea
-hearing loss
-accompanied by URIm the congestion spreads to eustahsisn tube leading to ""Stasis"", effusion and multiplication of bacteria
-spontaneous resolution with drainage or perforation of tymapnic membrane
-tympanic membrane may be erythmatous and bulge
what are the most common pathogens associated with sinusitis and Otitis media
-haemophillus influenza
-strp pneumoniae
-moraxella catarrhalis
w/c species out of the 3 listed has been controlled by HIB virus
-haemophillus influenza
-strp pneumoniae
-moraxella catarrhalis
haemophillus
what are signs symptoms associated with haemophillus influenza
-sinusitis
-otitis media
-epiglottitis
-bronchitis
-pneumonia
what are the characteristics of haemophillus influenza
-g-
-coccobacilli
-facultative anaerobe
-blood loving so it require hematin to grow
-requires hematin x and nad+ V growth factor
-part of the normal flora and is found in the human repiratory tract
-requires chocolate agar
chocolate agar
haemophillus influenza
otalgia and stasis
otitis media
are there multiple serotypes to haemophillus influenza and what does the HIB protect against
there are multiple strains and the HIB vaccine protects only against type B strain
what is the most virulent strain haemophillus influenza
type B strain
what determines if the bacteria is serotypeable or not
whether its pathogenic or not and only time it's pathogenic is when it has the capsule, non capsulated strains are part of the normal flora
what are the virulence factors associated with haemophillus influenza
-PRP capsule renders the influenza resistant to phagocytosis by PMN
-IgA protease
-pili
-beta lactamase
w/c strain of haemophillus influenza causes meningitis and epiglottitis
strain B
what else does strain B of haemophillus influenza causes
-primary case of meningits
-otitis media
-LRT, seen in CF patients and pneumonia in older patients
-epiglottitis
what is epiglottitis and what causes it
it is a medical emergency and it causes the obstruction of airways post infection with haemophillus influenza type b
-children b/t 2-4 yrs
-adults 20-40 yrs
-fever
-drooling
-""dysphagia""
-""stridor"" respiratory distress
dysphagia
stridor
drool
medical emergency
begining w/inflammation and ending with complete obstruction of airways
epiglottitis caused by haemophillus influenza
what are some of the lab tests associated with haemophillus influenza
- culture on the chocolate agar
-g strain to make sure
-""rapid PRP antigen for haemophillus influenza"
what are some of the treatments associated with haemophillus influenza
-amox/calvlinic acid combo
-sulfa (antimetbolite)
-broad spectrum cephalosporin
what are the preventions and controls against haemophillus influenza
-HIB vaccine
-rifampin as a chemproflaxis to high risk groups (inhibits Nucleic Acid synthesis)
what do we congugate the Hib vaccine with
usually an immunogenic protein in the case of PRP-d vaccine it was congugated with bacterial toxoid
what is caused by moraxella catarrhalis
otitis media, sinusitis
how do you know that the infection is causes by the moraxella
usually g- cocci would be attaching to or releasing within PMN in sputum specimen
what are some of the virulence factors of moraxella catarrhalis
-oxidase positive
-DNASE
-beta lactamase +
-penicillin resistant
moraxella catarrhalis
- g-
-obligate parasite of the mucosal mebranes
-3rd most common cause of otitis media
-beta lactamase +
-penicillin resistant
-normal pharyngeal flora in kids
what happens with patients that are immunocompromied and are infected with moraxella catarrhalis
-brinchitis
-pneumonia
-meningitis
-bacterimia
-endocarditis
what is the treatment and prevention for moraxella catarrhalis
-pencillin resistant
-SMX/TMP (antimetbolites)
-amp/calvulanate
what are the treatments for
1)otitis media w/bulging tympanic membrane
2)otitis media w/out bulging tympanic membrabe
1)immediately treat w/high dose of amoxicllin 80-100 mg
2)delayed antibiotic strategy, start with tylenol and prescribe amox w/instructions to take it if fever or otalgia (ear pain)
what is caused by corynebacterium diptheriae
diptheria
what is significant about diptheria
it is the most serious obstruction of airways after pharyngitis
what is characteristic presentation of corynebacterium diptheriae
it is called Chinese alphabets but mostly looks like snapping characters
what are some of the characteristics of corynebacterium diptheriae
-g+
-coryneform (irregular shaped or club shaped)
-normal flora residing in the naso pharynx of humans
-usually asymptomatic
what are the virulence factors of corynebacterium diptheriae
-diptheria toxin
-AB toxin
inhibits prtoein synthesis by ADP ribosyltaion of EF-2 transcription factor
-lysogenized corynebacteriophage B
-regulation via DTxR (iron dependent repressor protein)
what do we launch an immune response/antibiotic against in AB toxins
B, b/c the goal should be to inhibit the binding of the bacterium
as far as the iron is concerned, what is required to + the repressor of of the corynebacterium diptheriae phage
high leve of iron is needed to repress the toxin gene but if iron is low then repressor is inhibited and the toxin gene is activated
what does diptheria toxin require to be effective
it requires a diptheria receptor, once bound it releases a unit called furin, w/c with the help of V-atpase cause acidification and that would lead to the inhibition of E2F factor via ribosylation
how is diptheria spread
person -person
what do asymptomatic carriers carry
they are the carriers of the lysogenized phage
what is DRAP 27
it is diptheria toxin receptor associated protein
what is clinical respiratory diptheria
-2-6 day incubation
-clolonize in the epthelial cells of the pharynx
-will lead to formation of ""pseudomembrane"" or ""pathgnomonic""
-exudate filled with neutrophills, necrotic epithelial cells, erythrocytes and bacteria in fibrous mesh
covers tonsils and uvula
-difficult to detach wothout damaging underlying skin
what is nasal diptheria
mild w/one sided nasal discharge
what id cutaneous diptheria
-skin contact acquisition
-more common than resp form
-chronic non healing ulcer
what are some of the complications with all of diptheria associated diseases
breathing obstruction
-myocrditis
-cardia arrythmias
-neuritis, peripheral neuropathy
-coma
-death
what are some of diptheria signs
gross swelling and congestion of the whole pharyngeal and tonsillar area, with dirty white exudate that covers the area
-bull neck or periglandular edema
-perforation of the soft palate as a late effect of the
disease
how is lab diagnosis made against corynebacterium diptheriae
-microscopy = yields false results
-must see club shaped g+
-also metallic shiny grnuales that are filled with inorganic polyphosphates
-potassium tellurite will inhibts normal growth flora and only pathogenic diptheriae will grow aqnd for black colonies w/in 24-48 hours
-
what kind of testing is performed against toxin
elek test, immunodiffusion assay
- 3 streaks if toxin present you'll see streaks or spurs, if not no streaks
what is the treatment against corynebacterium diptheriae
-early administration of diptheria antitoxin
-penicillin or erythromycin
-respiratory support
how can an infection w/corynebacterium diptheriae be prevented
-DPT toxoid vaccine series followed by boosters
-any contact to known case should receive a booster
what is the main symptom caused by bordetella pertussis
-whooping cough
what are some of the characteristics of bordetella pertussis
- G -
-coccabacillus
-reservoir human only
-sensitive to drying
-aerosol transmission /direct contact
-endemic even though there is a vaccine for it
-immunity in adults is waning
what are the virulence factors associated with bordetella pertussis
-filamentuous hemaglutinin
-peractin
-pertussis toxin
what do FHA and pertacin have that allows bordetella pertussis to bind
they a RGd sequence that binds to integrins
what are some of the toxins associated with bordetella pertussis
AB type = pertussis toxin type x S1 or A subunit is ADP ribosyl transferase
-lethal or dermonecrotic toxin= heat labile
-tracheal cytotoxin = PG subunit, interferes w/DNA synthesis, kills ciliated respiratory cells, increase IL-1, + fever
what are pertussis AB toxin properties
1 A subunit
5 B subunti
S2 attaches to the host by binding to lactisylceramide
SI (enz )contains disulfide bonds, and are reduced to release active enzymes
-reductions occurs inside the host cell membrane
what is the overall effect of pertussis toxin
it increases the cAMP levels b/c the ribosyl transferase transfers to the G regulatory subunit and that causs it to be inhibited and the adenylate cyclase cannot be inhibited and you have continuous production of cAMP
what are the clinical symptoms associated with bordetella pertussis
-whooping cough
-7-10 days incubation
-3 stages
1) cattrahl (1-2 wks)= common cold, profuse rhinorrhea, sneezing and low grade fever
2)paroxysmal (2-4 wks)= destruction of ciliated epithelium, impairment of mucous clearing, characteristic inspirational whoop w/cough
-vomitting
-leukocytosis
3)convalescent = 2ndry complications, seizures, pneumonia, encephalopathy
what is lab diagnosis for bordetella pertussis
-FA on aspirated apecimens
-CCBA culture-charcoal-cephalexin blood agar
-molecular= PCR, bordet-gengou, regan-lowe
-serolog= sp. antiserum agglutination
titers against pertussis toxin and hemagglutinin using acute and convalescent toxin
what is the treatment for bordetella pertussis
supportive, in less than 1% of the cases hydration and oxygenation, steroids for babies, elderly
how can bordetella pertussis infections be prevented
-DPT vaccine whole cell inactivation 80-85% effective
-DaPT vaccine= multivalent acellular
-erythromycin =prophylaxis
where is whooping cough endemic
it is endemic in school children of UK despite being immunized