Micro Nath Lower Respiratory Infections

Front 1

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

Back 1

Bordetella pertussis

Front 2

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

Back 2

lymphocytic leukocytosis in
CBC

Front 3

Three major virulence factors of “whooping cough”
pathogen?

Back 3

ADP-ribosylating toxin; tracheal cytotoxin; hemolysin

Front 4

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

Back 4

Haemophilus influenzae b

Front 5

Major virulence factor of Haemophilus influenzae
associated with pneumonia and meningitis

Back 5

Capsular polysaccharide
(antiphagocytic and anti-C3b)

Front 6

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

Back 6

Hib immunization

Front 7

Acute exacerbation of chronic bronchitis (AECB) is caused
by an organism that needs NAD + hematin for growth; #-lactamase (+). DOC?

Back 7

Ceftriaxone (severe) >.
Amoxicillin-clavulanate

Front 8

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

Back 8

Streptococcus agalactiae
(aka: group B streptococcus)

Front 9

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

Back 9

Sepsis or meningitis

Front 10

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

Back 10

Ampicillin

Front 11

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/?

Back 11

annual influenza vaccine

Front 12

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

Back 12

A:H1N1 + A:H3N2 + B

Front 13

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

Back 13

respiratory droplets

Front 14

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

Back 14

Mutation

Front 15

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

Back 15

Reassortment of 8 genomic
segments

Front 16

Treat persons with influenza <48 hours with

Back 16

Oseltamivir

Front 17

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

Back 17

S. pneumoniae > S. aureus

Front 18

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

Back 18

Linezolid

Front 19

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

Back 19

Respiratory syncytial virus

Front 20

Major cause of seasonal pneumonia outbreaks in the
pediatric units via contact spread (by HCWs) is

Back 20

RSV

Front 21

Mechanism of asthmatic Sx + Sn w/ pathology in
bronchioles in high-risk infants due to RSV is

Back 21

type III hypersensitivity

Front 22

Inhaled drug used in the sickest infants with bronchiolitis (yet questionable efficacy) is

Back 22

Ribavirin

Front 23

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

Back 23

Mycoplasma pneumoniae

Front 24

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

Back 24

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

Front 25

Beta-lactam abx is ineffective for Tx of mycoplasma
pneumonia because

Back 25

Wall-less bacteria

Front 26

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

Back 26

erythema multiforme (SJS)

Front 27

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

Back 27

Chlamydophila pneumoniae

Front 28

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

Back 28

Streptococcus pneumoniae

Front 29

Gram-positive diplococci from sputum from a patient with
lobar pneumonia yield "-hemolytic colonies and are confirmed by
what test?

Back 29

Capsular swelling (Quelling
rxn)

Front 30

alpha-hemolytic colonies of Streptococcus pneumoniae is
differentiated from viridans streptococci definitively confirmed by
what test?

Back 30

Optochin sensitivity

Front 31

Population w/ increase incidence of pneumococcal pneumonia

Back 31

AIDS

Front 32

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

Back 32

Streptococcus pneumoniae

Front 33

Streptococcus pneumoniae is transmitted person-to-person
via what?

Back 33

droplets

Front 34

Nasopharyngeal mucosal colonization is facilitated by

Back 34

IgA protease

Front 35

Streptococcus pneumoniae reaches lungs after
nasopharyngeal colonization via

Back 35

aspiration

Front 36

Major virulence factor, facilitating invasion and
dissemination of Streptococcus pneumoniae bacteria

Back 36

Polysaccharide capsule

Front 37

Pneumococcal cell wall peptidoglycans, teichoic acid elicit

Back 37

Inflammation

Front 38

Increase lung cell injury, bacterial growth, and bacteremia are
caused by

Back 38

Pneumolysin (alpha-hemolysin)

Front 39

Multiple myeloma, C3 deficiency, agammaglobulinemia,
asplenia - Hg SS, chronic diseases - COPD, cancer, diabetes,
alcoholism, smokers are risk factors for mortality due to

Back 39

pneumococcal pneumonia

Front 40

Risk factor for poor prognosis of pneumococcal pneumonia

Back 40

Leukopenia

Front 41

Emipiric DOC of community-acquired pneumonia (CAP) in
individuals w/ risk or comorbidity is

Back 41

Azithromycin or levofloxacin
+ ceftriaxone

Front 42

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

Back 42

moxifloxacin or vancomycin

Front 43

Mechanism of penicillin resistance in Streptococcus
pneumoniae is

Back 43

PBP alteration by mutation

Front 44

Pt w/ agammaglobulinemia or asplenia or sick-cell anemia
or decrease C3 should be vaccinated with

Back 44

Pneumococcal polysaccharide
vaccine (PPSV: 23-valent)

Front 45

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

Back 45

Pseudomonas aeruginosa
(VAP)

Front 46

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

Back 46

Staphylococcus aureus
(assume MRSA)

Front 47

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

Back 47

Anaerobes

Front 48

Empiric DOC of necrotizing pneumonia in a patient with
seizure illness

Back 48

Clindamycin + levofloxacin

Front 49

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

Back 49

Streptococcus pneumoniae

Front 50

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

Back 50

Klebsiella pneumoniae

Front 51

Cause of pulmonary embolism in a pt with IVDU

Back 51

Staphylococcus aureus

Front 52

Common cause of pneumonia in pts with CF

Back 52

Pseudomonas aeruginosa

Front 53

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

Back 53

Pseudomonas aeruginosa

Front 54

Common cause of external otitis due to hot tub use is

Back 54

Pseudomonas aeruginosa

Front 55

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

Back 55

Pseudomonas aeruginosa

Front 56

The most widely used anti-pseudomonal penicillin

Back 56

Piperacillin > imipenem

Front 57

The most widely used anti-pseudomonal aminoglycoside

Back 57

Tobramicin > gentamicin

Front 58

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

Back 58

Legionella penumophila

Front 59

Penicillin is ineffective against Legionnaire’s dz because

Back 59

Intracellular organism

Front 60

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

Back 60

Intracellular organism

Front 61

Asymptomatic patient with PPD (+)

Back 61

Latent tuberculosis infection

Front 62

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

Back 62

Active infection due to
Mycobacterium tuberculosis

Front 63

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

Back 63

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

Front 64

Pyridoxine is added to 4-drug therapy for TB because

Back 64

neuropathy (due to INH)

Front 65

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

Back 65

Multiply drug-resistant
(MDR) TB

Front 66

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

Back 66

Extremely-drug resistant (XDR) TB

Front 67

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

Back 67

Mycobacterium avium –
intracellulare (aka: MAC)

Front 68

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

Back 68

Aspergillus fumigatus

Front 69

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

Back 69

Aspergillus fumigatus

Front 70

Hx of TB-like LRI in a pt with outdoor activity;
bronchoscopy: Giemsa (+) for 2-5 um yeasts. TOW?

Back 70

Histoplasma capsulatum

Front 71

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

Back 71

Ergosterol in cell membrane

Front 72

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

Back 72

intraconazole

Front 73

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

Back 73

Fluconazole (indefinite)

Front 74

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

Back 74

Penicillin G

Front 75

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

Back 75

Actinomyces israelii

Front 76

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

Back 76

Nocardiosis

Front 77

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

Back 77

Nocardia asteroids

Front 78

Hx of fever, cough, progressing to pulmonary hemorrhage in a pt who works at a wool-sorting factory; CXR: mediastinitis.
TOW?

Back 78

Anthrax (Bacillus anthracis)

Front 79

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

Back 79

Pneumocystis pneumonia

Front 80

DOC of pneumocystis pneumonia (PCP)

Back 80

TMP-SMX