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80 Cards in this Set
- Front
- Back
In an infant w/ ?immunization, 2 wks of paroxysmal |
Bordetella pertussis
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Pertussis toxin inhibits chemotaxis via downregulation of C3a/C5a receptor, resulting in?
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lymphocytic leukocytosis in
CBC |
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Three major virulence factors of “whooping cough”
pathogen? |
ADP-ribosylating toxin; tracheal cytotoxin; hemolysin
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Cause of fever + drooling, stridor, dyspnea in a child w/
?immunization (pt appears septic) |
Haemophilus influenzae b
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Major virulence factor of Haemophilus influenzae
associated with pneumonia and meningitis |
Capsular polysaccharide
(antiphagocytic and anti-C3b) |
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Since, absent spleen places host at increased risk for
invasive H. influenzae infection, pre-exposure prophylaxis prior to elective splenectomy is? |
Hib immunization
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|
Acute exacerbation of chronic bronchitis (AECB) is caused
by an organism that needs NAD + hematin for growth; #-lactamase (+). DOC? |
Ceftriaxone (severe) >.
Amoxicillin-clavulanate |
|
Most common cause of lower-respiratory infections in
neonates (babies < 4 wk)? |
Streptococcus agalactiae
(aka: group B streptococcus) |
|
Complicated illness in a newborn of a GBS-colonized
mother is |
Sepsis or meningitis
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A mother colonized (recto-vaginally) w/ GBS is at risk for
preterm baby or premature membrane rupture. She should receive |
Ampicillin
|
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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/? |
annual influenza vaccine
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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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Secondary spread of influenza occurs in a crowded setting
(within 6 feet of infected person) via |
respiratory droplets
|
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Annual vaccine to prevent influenza is needed due to
antigenic drift. This occurs due to what genetic mechanism? |
Mutation
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Occasionally serious pandemic of influenza occurs due to antigenic shift. This occurs due to what genetic mechanism?
|
Reassortment of 8 genomic
segments |
|
Treat persons with influenza <48 hours with
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Oseltamivir
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Bacterial superinfection, causing pneumonia, after influenza occurs in elderly (in LTCF) due to what?
|
S. pneumoniae > S. aureus
|
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A seriously ill young adult w/ necrotizing pneumonia,
poorly responding to vancomycin, should get |
Linezolid
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Cause of febrile illness + bronchiolitis in an infant; BAL
viral culture (+). |
Respiratory syncytial virus
|
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Major cause of seasonal pneumonia outbreaks in the
pediatric units via contact spread (by HCWs) is |
RSV
|
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Mechanism of asthmatic Sx + Sn w/ pathology in
bronchioles in high-risk infants due to RSV is |
type III hypersensitivity
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Inhaled drug used in the sickest infants with bronchiolitis (yet questionable efficacy) is
|
Ribavirin
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Insidious onset of fever, dry cough, malaise and sore throat
in young adults. CBC: anemia; CXR: diffuse infiltrates. TOW? |
Mycoplasma pneumoniae
|
|
Dx of “walking pneumonia” in older children and young
adults, while waiting for serology, is supported by |
cold agglutinin (IgM Ab
against RBCs) titer $1:32 |
|
Beta-lactam abx is ineffective for Tx of mycoplasma
pneumonia because |
Wall-less bacteria
|
|
A male child with mycoplasma pneumonia now has
systemic rash, covering 10% of his body. TOW? |
erythema multiforme (SJS)
|
|
Cause of upper respiratory Sx, slow onset of cough
(laryngitis) >2wks + CXR: patchy infiltrate, viral serology (+). TOW? |
Chlamydophila pneumoniae
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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? |
Streptococcus pneumoniae
|
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Gram-positive diplococci from sputum from a patient with
lobar pneumonia yield "-hemolytic colonies and are confirmed by what test? |
Capsular swelling (Quelling
rxn) |
|
alpha-hemolytic colonies of Streptococcus pneumoniae is
differentiated from viridans streptococci definitively confirmed by what test? |
Optochin sensitivity
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Population w/ increase incidence of pneumococcal pneumonia
|
AIDS
|
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Increase incidence of colonization of what organism is seen in very
young and elderly, crowding, following viral URI (% PAF receptors), fall/winter season? |
Streptococcus pneumoniae
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Streptococcus pneumoniae is transmitted person-to-person
via what? |
droplets
|
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Nasopharyngeal mucosal colonization is facilitated by
|
IgA protease
|
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Streptococcus pneumoniae reaches lungs after
nasopharyngeal colonization via |
aspiration
|
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Major virulence factor, facilitating invasion and
dissemination of Streptococcus pneumoniae bacteria |
Polysaccharide capsule
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Pneumococcal cell wall peptidoglycans, teichoic acid elicit
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Inflammation
|
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Increase lung cell injury, bacterial growth, and bacteremia are
caused by |
Pneumolysin (alpha-hemolysin)
|
|
Multiple myeloma, C3 deficiency, agammaglobulinemia,
asplenia - Hg SS, chronic diseases - COPD, cancer, diabetes, alcoholism, smokers are risk factors for mortality due to |
pneumococcal pneumonia
|
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Risk factor for poor prognosis of pneumococcal pneumonia
|
Leukopenia
|
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Emipiric DOC of community-acquired pneumonia (CAP) in
individuals w/ risk or comorbidity is |
Azithromycin or levofloxacin
+ ceftriaxone |
|
Pneumonia due to highly penicillin-resistant Streptococcus
pneumoniae (Pen MIC >8) should receive |
moxifloxacin or vancomycin
|
|
Mechanism of penicillin resistance in Streptococcus
pneumoniae is |
PBP alteration by mutation
|
|
Pt w/ agammaglobulinemia or asplenia or sick-cell anemia
or decrease C3 should be vaccinated with |
Pneumococcal polysaccharide
vaccine (PPSV: 23-valent) |
|
Hx: a patient w/ serious CAD now on a ventilator, acquires
bronchopneumonia >72 hrs after hospitalization. TOW? |
Pseudomonas aeruginosa
(VAP) |
|
Cause of necrotizing pneumonia >72 hrs after
hospitalization of complicated viral illness |
Staphylococcus aureus
(assume MRSA) |
|
Hx of a patient w/ seizure illness has fever, cough evolving
over 2-4 wks; CXR infiltrate (+). Gram stain: polymicrobic. TOW? |
Anaerobes
|
|
Empiric DOC of necrotizing pneumonia in a patient with
seizure illness |
Clindamycin + levofloxacin
|
|
Pneumonia in homeless/alcoholics; Gram-positive
diplococci in sputum Gram smear. TOW? |
Streptococcus pneumoniae
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Pneumonia in homeless/alcoholics; Gram-negative rods in
sputum smear. TOW? |
Klebsiella pneumoniae
|
|
Cause of pulmonary embolism in a pt with IVDU
|
Staphylococcus aureus
|
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Common cause of pneumonia in pts with CF
|
Pseudomonas aeruginosa
|
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Sputum of a patient with hospital-acquired pneumonia
yields a Gram-negative rod that is oxidase (+)/ pyocyanin(+). TOW? |
Pseudomonas aeruginosa
|
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Common cause of external otitis due to hot tub use is
|
Pseudomonas aeruginosa
|
|
A patient with diabetes has osteomyelitis after penetrating
foot injury. TOW? |
Pseudomonas aeruginosa
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The most widely used anti-pseudomonal penicillin
|
Piperacillin > imipenem
|
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The most widely used anti-pseudomonal aminoglycoside
|
Tobramicin > gentamicin
|
|
This pt >50 years, smoking hx, CMI# has pneumonia;
diarrhea, renal failure. Urine antigen (+) for pathogen. Pt responds to azithromycin. TOW? |
Legionella penumophila
|
|
Penicillin is ineffective against Legionnaire’s dz because
|
Intracellular organism
|
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Individuals with defective CMI response has poor prognosis
of Legionnaire’s dz because |
Intracellular organism
|
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Asymptomatic patient with PPD (+)
|
Latent tuberculosis infection
|
|
Cough > 2 wks, fever, night sweats, weight loss,
hemoptysis, SOB; CXR: upper lobe infiltrate. TOW? |
Active infection due to
Mycobacterium tuberculosis |
|
Oral drug regimen of choice for treatment of active TB
(aka: 1st line drugs) is |
INH+RIF+PZA+EMB (oral)
+ Vit B6 |
|
Pyridoxine is added to 4-drug therapy for TB because
|
neuropathy (due to INH)
|
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Pt w/ TB fails to respond to 4-drug regimen w/ INH+RIF
resistance because |
Multiply drug-resistant
(MDR) TB |
|
Pt w/ MDR-TB fails to respond to INH +RIF+FQ+an
injectable drug (amikacin, capreomycin, or kanamycin) because |
Extremely-drug resistant (XDR) TB
|
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Cause of TB-like Dz that does not respond to 1o TB Tx
regimen, in a pt. w/ AIDS |
Mycobacterium avium –
intracellulare (aka: MAC) |
|
Cause of chronic pneumonia in a patient with cancer,
receiving cytotoxic chemotherapy; lung-CT: halo/crescent sign (+)? |
Aspergillus fumigatus
|
|
Hx of chronic pneumonia w/ lung bpsy histopathology (+)
for hyphae 2-4µm wide, septate, acute- angle branching. TOW? |
Aspergillus fumigatus
|
|
Hx of TB-like LRI in a pt with outdoor activity;
bronchoscopy: Giemsa (+) for 2-5 um yeasts. TOW? |
Histoplasma capsulatum
|
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Pt with AIDS has blood culture (+) for histoplasmosis.
DOC has effects on |
Ergosterol in cell membrane
|
|
TB-like Dz w/ ulcerative skin lesions. lung bpsy
histopathology (+) for large yeast w/ broad-based bud. DOC? |
intraconazole
|
|
Hx of acute onset of cough, fever, infiltrate in a black male
with CMI#; histopathology of lung (+) for a large sac of endospores. DOC? |
Fluconazole (indefinite)
|
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Pt w/ aspiration pneumonia with cervico-facial lesion
should respond to |
Penicillin G
|
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Granular specimen from draining fistulae from a pt with
LRI on anaerobic culture should yield |
Actinomyces israelii
|
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Pt with AIDS or organ transplant has indolent pneumonia, w/ or w/o CNS abscess or granuloma. TOW?
|
Nocardiosis
|
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Organism w/ characterization of Gram-positive branching,
beaded, filamentous rod, weakly acid fast is |
Nocardia asteroids
|
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Hx of fever, cough, progressing to pulmonary hemorrhage in a pt who works at a wool-sorting factory; CXR: mediastinitis.
TOW? |
Anthrax (Bacillus anthracis)
|
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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? |
Pneumocystis pneumonia
|
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DOC of pneumocystis pneumonia (PCP)
|
TMP-SMX
|