Micro One Liners, Part 2

Front 1

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

Back 1

Bordetella pertussis

Front 2

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

Back 2

Lymphocytic leukocytosis in CBC

Front 3

140. Three major virulence factors of "whooping cough" pathogen?

Back 3

ADP–ribosylating toxin; tracheal cytotoxin; hemolysin

Front 4

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

Back 4

Haemophilus influenzae b

Front 5

142. Major virulence factor of Haemophilus influenzaeassociated with pneumonia and meningitis

Back 5

Capsular polysaccharide(antiphagocytic and anti–C3b)

Front 6

143. 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

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

Back 7

Haemophilus influenzae (non capsular types)

Front 8

145. Tx of AECB, caused by an organism that needs NAD +hematin for growth; –lactamase (+), is

Back 8

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

Front 9

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

Back 9

Streptococcus agalactiae(aka: group B streptococcus)

Front 10

147. Complicated illness in a newborn of a GBS–colonized mother is

Back 10

Sepsis or meningitis

Front 11

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

Back 11

Ampicillin

Front 12

149. 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 12

annual influenza vaccine

Front 13

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

Back 13

A:H1N1 + A:H3N2 + B

Front 14

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

Back 14

respiratory droplets

Front 15

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

Back 15

Mutation

Front 16

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

Back 16

Reassortment of 8 genomic segments

Front 17

154. DOC of pts with influenza <48 hours is

Back 17

Oseltamivir

Front 18

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

Back 18

S. pneumoniae > S. aureus(common) (severe)

Front 19

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

Back 19

Linezolid

Front 20

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

Back 20

Respiratory syncytial virus(RSV)

Front 21

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

Back 21

Contact spread

Front 22

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

Back 22

type III hypersensitivity

Front 23

160. Inhaled anti–viral drug used in the sickest infants with bronchiolitis is

Back 23

Ribavirin

Front 24

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

Back 24

Mycoplasma pneumoniae

Front 25

162. Dx of “walking pneumonia” in older children and youngadults, while waiting for serology, is supported by

Back 25

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

Front 26

163. Mycoplasma spp. is an atypical bacterial pathogen and is hard to grow because of fragility due to lack of

Back 26

Cell wall

Front 27

164. Beta–lactam abx is ineffective for Tx of mycoplasma pneumonia because

Back 27

Wall–less bacteria

Front 28

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

Back 28

erythema multiforme (SJS)

Front 29

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

Back 29

Chlamydophila pneumoniae

Front 30

167. The most common cause of community–acquired pneumonia (CAP) is

Back 30

Streptococcus pneumoniae

Front 31

168. 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

Back 31

Streptococcus pneumoniae

Front 32

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

Back 32

Capsular swelling (Quelling rxn)

Front 33

170. α–hemolytic colonies of Streptococcus pneumoniae is differentiated from viridans streptococci definitively confirmed by

Back 33

Optochin sensitivity

Front 34

171. Population w/ increased incidence of pneumococcal pneumonia is

Back 34

AIDS

Front 35

172. increased incidence of colonization of what organism is seen in very young and elderly, crowding, following viral URI (increased PAFreceptors), fall/winter season?

Back 35

Streptococcus pneumoniae

Front 36

173. Streptococcus pneumoniae is transmitted P2P by

Back 36

Respiratory droplets

Front 37

174. Nasopharyngeal mucosal colonization is facilitated by

Back 37

IgA protease

Front 38

175. Streptococcus pneumoniae reaches lungs after nasopharyngeal colonization via

Back 38

aspiration

Front 39

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

Back 39

Polysaccharide capsule

Front 40

177. Pneumococcal cell wall peptidoglycans, teichoic acid elicit

Back 40

Inflammation

Front 41

178. Increased Lung cell injury in pneumococcal pneumonia is caused by virulence factor?

Back 41

Pneumolysin (alpha–hemolysin)

Front 42

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

Back 42

pneumococcal pneumonia

Front 43

180. Hematologic marker for poor prognosis of pneumococcal pneumonia is

Back 43

Leukopenia

Front 44

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

Back 44

Azithromycin (or levofloxacin) + ceftriaxone

Front 45

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

Back 45

moxifloxacin or vancomycin

Front 46

183. Mechanism of penicillin resistance in Streptococcus pneumoniae is

Back 46

PBP alteration by mutation

Front 47

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

Back 47

Pneumococcal polysaccharide vaccine (PPSV: 23–valent)

Front 48

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

Back 48

Pseudomonas aeruginosa(VAP)

Front 49

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

Back 49

Staphylococcus aureus(assume MRSA)

Front 50

187. Patients that are aspiration prone have hx of

Back 50

dysphagia, decreased consciousness

Front 51

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

Back 51

Aspiration pneumonia

Front 52

189. Community–acquired respiratory pathogens that cause aspiration pneumonia

Back 52

Streptococcus pneumoniae > Anaerobes

Front 53

190. Hospital–acquired respiratory pathogens that cause aspiration pneumonia

Back 53

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

Front 54

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

Back 54

acid–related pneumonia

Front 55

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

Back 55

Gram stain (polymicrobic)and culture of sputum

Front 56

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

Back 56

clindamycin + levofloxacin

Front 57

194. Targeted Abx for anaerobic aspiration pneumonia is

Back 57

clindamycin

Front 58

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

Back 58

Streptococcus pneumoniae

Front 59

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

Back 59

Klebsiella pneumoniae

Front 60

197. Cause of pulmonary embolism in a pt with IVDU

Back 60

Staphylococcus aureus

Front 61

198. Common cause of pneumonia in pts with CF

Back 61

Pseudomonas aeruginosa

Front 62

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

Back 62

Pseudomonas aeruginosa

Front 63

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

Back 63

Pseudomonas aeruginosa

Front 64

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

Back 64

Pseudomonas aeruginosa

Front 65

202. The most widely used anti–pseudomonal penicillin

Back 65

Piperacillin > imipenem

Front 66

203. The most widely used anti–pseudomonal aminoglycoside

Back 66

Tobramicin > gentamicin

Front 67

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

Back 67

Legionella penumophila

Front 68

205. Penicillin is ineffective against Legionnaire’s dz because

Back 68

Intracellular organism

Front 69

206. Individuals with defective CMI response has poor prognosisof Legionnaire’s dz because

Back 69

Intracellular organism

Front 70

207. Asymptomatic patient with PPD (+)

Back 70

Latent tuberculosis infection(LTBI)

Front 71

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

Back 71

Active Mycobacterium Tuberculosisinfection

Front 72

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

Back 72

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

Front 73

210. Pyridoxine is added to 4–drug therapy for TB to prevent

Back 73

neuropathy (due to INH)

Front 74

211. Pt w/ TB fails to respond to 4–drug regimen w/ INH+RIFresistance because

Back 74

Multiply drug–resistant(MDR) TB

Front 75

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

Back 75

Extremely–drug resistant(XDR) TB

Front 76

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

Back 76

Mycobacterium avium –intracellulare (aka: MAC)

Front 77

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

Back 77

Aspergillus fumigatus

Front 78

215. Microscopic observation of Aspergillus fumigatus in tissue biopsy sections depends on staining by

Back 78

Silver stain

Front 79

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

Back 79

Aspergillus fumigatus

Front 80

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

Back 80

Histoplasma capsulatum

Front 81

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

Back 81

Ergosterol in fungal cell membrane

Front 82

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

Back 82

Intraconazole

Front 83

220. 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 83

Fluconazole (indefinite)

Front 84

221. Pt w/ aspiration pneumonia with cervico–facial lesion should respond to

Back 84

Penicillin G

Front 85

222. Granular specimen from draining fistulae from a pt withLRI on anaerobic culture should yield

Back 85

Actinomyces israelii

Front 86

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

Back 86

Nocardiosis

Front 87

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

Back 87

Nocardia asteroids

Front 88

225. 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?

Back 88

Pneumocystis pneumonia

Front 89

226. DOC of pneumocystis pneumonia (PCP)

Back 89

TMP–SMX

Front 90

227. Pt has urinary urgency, frequency, dysuria; lab: pyuria (+)or nitrite (+). TOW?

Back 90

Cystitis due to E. coli

Front 91

228. Significant UTI is confirmed by semiquantitative MSUculture based on the threshold of

Back 91

> 105 cfu/mL

Front 92

229. Mode of acquisition of uropathogen is

Back 92

Endogenous

Front 93

230. Microbial (structure) factor favoring bacterial persistence/colonization and UTI is

Back 93

bacterial binding via fimbriae

Front 94

231. Factor favoring bacterial persistence/colonization and UTIdespite high osmolarity and urea concentrations and low pH is

Back 94

high bacterial growth rates

Front 95

232. Host factor favoring bacterial persistence/colonization andUTI is

Back 95

Urinary stasis

Front 96

233. Bacterial persistence/colonization and UTI despite frequent voiding and high urinary flow is favored by

Back 96

lack of Tamm–Horsfall proteins

Front 97

234. Pyogenic inflammation in complicated UTI due to Gram– negative bacteria is due to

Back 97

Lipopolysaccharide (LPS)

Front 98

235. Empiric DOC to treat community–acquired UTI in adults is

Back 98

ciprofloxacin

Front 99

236. The abx class that inhibits DNA gyrase or topoisomerase IVand blocks with bacterial DNA replication is

Back 99

Fluoroquinolones

Front 100

237. DOC to treat UTI in pregnant women is

Back 100

Nitrofurantoin

Front 101

238. Gram–positive bacteria that cause uncomplicated UTI in sexually active, young women are

Back 101

Staphylococcus saprophyticus

Front 102

239. Differentiation of Staphylococcus saprophyticus from S. epidermidis (both coagulase negative) is based on

Back 102

novobiocin resistance

Front 103

240. In elderly or pt with risks of urinary stasis, fever, chills, flank pain, and CVA tenderness; Lab: pyuria, casts, nitrite+. TOW?

Back 103

Pyelonephritis due to E. coli

Front 104

241. Pt hospitalized > 72 h for comorbidity has urinaryfrequency, dysuria and foul–smelling urine; w/ flank pain, fever and chills, in the presence of a urinary catheter:Clue: GNR; fermenter; encapsulated; intrinsic ampicillin resistance) Clue: GNR; slow fermenter; red pigment; intrinsic drug resistance) Clue: GNR; swarming growth [very motile]; slow fermenter; intrinsic drug resistance)Clue: GNR; non fermenter; oxidase+, blue pigment; intrinsic drug resistance)Clue: GPC in chains; catalase–neg; grows in high salt; penicillin resistance)

Back 104

Klebsiella pneumoniae

Serretia marcescens

Proteus mirabilis

Pseudomonas aeruginosa

Enterococcus faecalis

Front 105

242. If a patient with complicated UTI is severely ill or notimproving with therapy, do what rapid test next?

Back 105

renal ultrasound (to rule outurinary tract obstruction)

Front 106

243. For a patient with complicated UTI, once culture andsensitivity available, switch to what?

Back 106

Narrow–spectrum abx

Front 107

244. 2 or more of the following: fever (T>38°C) or hypothermia(T< 36°C), tachycardia (HR>90), tachypnea (RR>20), leukocytosis(WBC>12,000 or differential w/ >10% bands). TOW?

Back 107

SIRS

Front 108

245. SIRS + infection (e.g., positive blood culture) is

Back 108

Sepsis

Front 109

246. Sepsis + organ failure, decreased perfusion (lactic acidosis,oliguria, altered mental status) or low BP. TOW?

Back 109

Severe Sepsis

Front 110

247. Severe sepsis + hypotension despite fluids + lactic acidosis,oliguria, altered mental status.

Back 110

Septic Shock

Front 111

248. Septic shock due to Gram–negative bacteria (e.g., E. coli,Klebsiella spp., or Pseudomonas aeruginosa) is

Back 111

Endotoxic Shock

Front 112

249. Endotoxin that mounts pro–inflammatory cytokines,responsible for endotoxic shock, is

Back 112

Lipid A of LPS