Respiratory Exam Ii

Front 1

Most common cause of acute bronchitis

Back 1

Viral

Front 2

Bacterial causes of acute bronchitis

Back 2

S. pneumoniae
H.influenzae
C.pneumoniae
M.pneumoniae
B.pertussis

Front 3

Bacterial agents of chronic bronchitis

Back 3

S.pneumoniae
H.influenzae
M. catarrhalis

Front 4

_ can exacerbate symptoms of chronic bronchitis

Back 4

Viruses

Front 5

Necrotizing pneumonia with cavitation and destruction of lung parenchyma

Back 5

Lung abscess

Front 6

Involves invasion of lung interstitium

Typical of viral pneumonia

Back 6

Interstitial pneumonia

Front 7

More diffuse patchy consolidation - what type of pneumonia

Back 7

Bronchopneumonia

Front 8

Involvement of distinct region of lung - type of pneumonia

Back 8

Lobar

Front 9

This type of pneumonia produced by pyogenic bacteria living in nasopharynx

Which bacteria most commonly caused it?

Back 9

Typical

S.pneumoniae

Front 10

Type of pneumonia that is caused by organisms inhaled from environment not apparent on gram stain

Which organism most common?

Back 10

Atypical

Mycoplasma pneumoniae

Front 11

Patient presents with dyspnea, pleuritic chest pain, purulent cough, fever and shaking chills, he produces RUSTY SPUTUM - what type of pneumonia

Back 11

Typical pneumonia

Front 12

Patient presents with pneumonia, has less abrupt onset, cough is unproductive, no pleuritic pain, had flu like symptoms for past 2 weeks - what type of pneumonia

Back 12

Atypical pneumonia

Front 13

Which organisms usually cause aspiration pneumonia

Back 13

ANAEROBIC

Front 14

Which type of pneumonia is characterized by foul smell

Back 14

Aspiration (anaerobic) pneumonia

Front 15

#1 cause of community acquired pneumonia

#2?

#3 ?

Back 15

STREP PNEUMONIA

Mycoplasma pneumonia

Chlamydia pneumonia

Front 16

Which organisms are common causes of pneumonia following influenza

Back 16

S pneumonia

S aureus

H influenza

Front 17

Nosocomial infections occur _ after hospitalization

Back 17

72 hours

Front 18

People who are at high risk (ICU, ventillation) usually caused pneumonia by _

Back 18

Pseudomonas aeruginosa

Multidrug resistant gram negative rods

Front 19

What type of pneumonia is caused by Strep Pneumonia

Back 19

Typical pneumonia

Lobar pneumonia

Front 20

Which patients are at higher risk for Strep Pneumonia caused pneumonia

Back 20

SICKLE CELL PATIENTS

Asplenic

Alcoholics

Poverty

Debilitated health

Front 21

Main virulence factor of Strep Pneumonia

Back 21

CAPSULE

Front 22

_ vaccine recommended for elderly against Strep Pneumonia, against 23 most common serotypes

Back 22

Polysaccharide vaccine

Front 23

_ vaccine recommended for ages 2 months to 23 months, against 7 serotypes, reduces incidence of invasive pneumococcal disease, pneumonia and otitis media

24-59 months targeted to children at risk

Back 23

Conjugate vaccine

Front 24

Patient presents with symptoms of rapid onset, she had single episode of rigor, she complains of chills, fever, dyspnea and cough productive of rusty sputum - chest x ray shows lobar pneumonia - which organism responsible

Back 24

Streptococcus pneumonia

Front 25

Describe stages of pneumonia

Back 25

1st stage - lung alveoli fill with fluid

2nd stage - early consolidation, PMN's

3d stage- late consolidation

4th stage- resolution

Front 26

Alpha hemolytic

Optochin sensitive

Bile soluble

Quellung reaction

Back 26

Strep Pneumonia

Front 27

What is the treatment of Strep Pneumonia

Back 27

DOC was penicillin but now 1/3 resistant

Multiple drug resistance developing

Need multi drug therapy

Front 28

Other than pneumonia, S pneumonia causes _

Back 28

Acute sinusitis

Otitis media

Bacteremia

Often follows viral infections

Front 29

Gram negative rod

Oxidase negative

Lactose fermenter

Causes pneumonia

Back 29

Klebsiella Pneumonia

Front 30

65 year old male, alcoholic with positive history for pulmonary deficits has pneumonia, x ray shows cavitary necrotic destruction. He produces current jelly sputum

Whats the organism

Back 30

Klebsiella Pneumonia

Front 31

Nonfermenter

Gram negative rod

Oxidase positive

Back 31

Pseudomonas Aeruginosa

Front 32

Who is at risk for getting pseudomonas pneumonia

Back 32

CYSTIC FIBROSIS

Chronic lung disease

Neutropenia

Front 33

Microabscess formation and tissue necrosis

Diffuse bilateral bronchopneumonia

Organism?

Back 33

Pseudomonas family

Front 34

Hospitalized patient is found to have bilateral bronchopneumonia often with radioluscencies

Back 34

Pseudomonas Aeruginosa

Front 35

This organism causes nosocomial infection, normal patients spread it to cystic fibrosis patients, has long pili to bind to mucous of CF patients, CF patients become ill - very serious infection

Organism?

Back 35

Burkholderia cepacia

Front 36

Third most frequently isolated non-fermenter gram negative rod

Found in contaminated disinfectant solution, respiratory therapy equipment and ice machines

Organism?

Treatment?

Back 36

Stenotrophomonas maltophilia

Treatment - TMP SXT

Front 37

Slender pleomorphic gram negative rod

Stain poorly with grams stain, use silver stain

Fastidiuous grow on buffered charcoal yeast agar, require cysteine in media

Back 37

Legionella pneumonia

Front 38

This organism can tolerate high temperatures, requires hyper chlorination to eradicate, can be a facultative intracellular parasite for Acanthomoeba, Naegleria, acquired from environment

Back 38

Legionella pneumonia

Front 39

Where is Legionella most commonly found

Back 39

WATER DISTRIBUTION SYSTEMS

Front 40

Who is at most risk for Legionella

Back 40

Elderly alcoholics, smokers

IMMUNOCOMPROMISED

Dialysis patients

Chronic underlying disease

Front 41

How do you acquire Legionella

Back 41

Inhale infectious particles

Binds complement on surface of monocytes and macrophages

ENDOCYTOSED

Prevents phagolysosomal fusion

Front 42

How do you diagnose Legionella

Back 42

Silver stain

Front 43

Can cause CAP or nosocomial pneumonia

Causes atypical pneumonia

Onset less explosive than pneumococcal pneumonia

Sputum production less than pneumococal

Organism?

Back 43

Legionella

Front 44

65 year old male presents with fever, headache, cough was nonproductive initially, now patient has CNS and GI abnormalities - he has change in mental status, also nausea, vomitting and abdominal pain, he also has BRADYCARDIA - what disease

Back 44

Legionnaires disease

Front 45

Patient has multi lobar pneumonia with micro abscesses in lungs, he also has multi organ disease and more monocytes than PMN's - what disease

Back 45

Legionnaries

Front 46

How do you make diagnosis for Legionnaries

Back 46

Gram stain - moderate number of PMN's

Buffered charcoarl yeast extract for isolation

Antigen detection in urine

Direct fluorescent antibody

Front 47

2nd most common cause of Legionella pneumonia, weakly acid fast, mostly nosocomial, MAY PRESENT AS ACUTE PE, common in transplant recipients, hematologic malignancies and steroid use

Back 47

Legionella micdadei

Front 48

Most common cause of walking pneumonia, can also cause pharyngitis, non purulent otitis media and tracheobronchitis

Back 48

Mycoplasma pneumonia

Front 49

This is the smallest free living bacteria, it LACKS CELL WALL, it requires sterols for growth

Name bacteria and virulence factor

Back 49

Mycoplasma pneumonia

P1 adhesin - binds cilia on epithelial cells, cilistatic, results in PERSISTENT COUGH

Front 50

How is mycoplasma pneumonia transmitted

Back 50

Inhalation of droplets - spreads within groups/families

Front 51

25 year old female presents with ear pain, bullous myringitis and persistent nonproductive "hacking" cough

Which organism? Treatment?

Back 51

Mycoplasma pneumonia

Erythromycin, tetracycline, fluoroquinolones

Front 52

Patient presents with pneumonia - culture of bronchial washings shows strict aerobe, however it is not seen on gram stain but can see many PMN's, organism was isolated on special media with sterols, serology positive for cold agglutinins

Back 52

Mycoplasma pneumonia

Front 53

Obligate intracellular bacterium, cannot generate own ATP, lacks oxidative enzymes - cant see on gram stain, many PMN's

Back 53

Chlamydia pneumonia

Front 54

This organism causes pneumonia in elderly, debilitated patients, but also found in helathy individuals, transmission through droplets, associated with atherosclerosis, Alzheimers and asthma

Back 54

Chlamydia Pneumonia

Front 55

Patient presents with mild pneumonia, he has hoarseness and fever, respiratory symptoms followed few days later, he also has severe pharyngitis

Back 55

Chlamydia pneumonia

Front 56

Treatment of chlamydia pneumonia

Back 56

Macrolides

Tetracycline

Levofloxacin

Front 57

Organism responsible for parrot fever

Back 57

Chlamydophila psittaci

Front 58

This organism is shed in aerosoles, feces and feathers of birds, has abrupt onset, humans inhale aerosols, systemic infection develops, mucous plugs may form (can cut down on airway but not fatal)

Back 58

Chlamydia psittaci

Front 59

Treatment of psittacosis

Back 59

Tetracycline and macrolides

Treat the birds with tetracycline too

Front 60

This organism can cause fatal septicemia - droplets are inhaled from infected individual, carried from lungs by macrophages to lymphatic system, within 24 hours causes pulmonary necrosis, septicemia

Disease

Back 60

Pulmonary anthrax

Front 61

Patient presents with dyspnea, cyanosis, severe pyrexia, he is disoriented, within hours he develops circulatory failure, shock, goes into coma and dies

Disease?

Back 61

Anthrax

Front 62

Virulence factors of anthrax

Back 62

Capsule

Edema toxin

Lethal toxin

2 plasmid requirement

Front 63

Military person presents with edema and widened mediastinum on x ray, gram positive rod with spores is isolated

Back 63

Bacillus anthracis

Front 64

Causative agent of pneumonic plague

Back 64

Yersinia pestis

Front 65

How is Yersinia pestis transmitted

Back 65

Aerosols

Front 66

Patient is 45 year old farmer, develops septicemia and pulmonary hemorrhagic necrosis

Disease, organism

Back 66

Tularemia - francisella tularensis

Front 67

Obligate intracellular parasite, causes Q fever, member of riccketsia family, endemic to Nova Scotia, rare or underreported in US

Back 67

Coxiella burnetti

Front 68

This bug is a member of riccketsia family but doesnt cause rash

Back 68

Coxiella burnettie

Front 69

How do you get Q fever

Back 69

Cattle, sheep and goats are primary reservoir

Inhale from aerosols of feces or genital secretion of infected domestic animals

May reactivate years later - especially during pregnancy

Front 70

34 year old female presents with systemic illness after visit to a farm 20 days ago. She has rigors, fever, headache, myalgia and nonproductive cough, she also has maculopapular rash, she is also diagnosed with hepatitis, x ray shows patchy infiltrate

Diagnosis

Back 70

Q fever

Front 71

What can occur in chronic Q fever

Back 71

ENDOCARDITIS (especially if previous valvular disease, transplant recipients and immunosuppressed)

Children - bone and joint involvement

Front 72

Cell wall of mycobacteria is 60% _

Back 72

Lipid (mycolic acid)

Front 73

Who is at risk for TB

Back 73

Minorities

HIV

Homeless

Recent immigrants

IVDU

Front 74

47 year old male presents with fatigue, weight loss, fever, night sweats and productive cough. He complains of blood stinged sputum and pleuritic chest pain

Diagnosis

Back 74

TB

Front 75

How is TB spread

Back 75

Droplet spread

Front 76

Which cells pick up TB

Back 76

Macrophages

Front 77

How long for immune response to take place after infection with TB

Back 77

3 weeks

Front 78

What is the evidence for TB infections

Back 78

Positive PPD

Ghon complex on x ray

Front 79

Organized collection of epitheloid cells surrounded by lymphocytes and capillaries

Back 79

Granuloma

Front 80

What is TB test

Back 80

Purified protein derivative

Front 81

If patient is at no known risk what should be reaction to PPD

Back 81

< or equal to 15 mm

Front 82

If patient is at intermediate risk what should be reaction to PPD

Back 82

< or equal to 10 mm

Front 83

If patient is at high risk what should be reaction to PPD

Back 83

5 mm

Front 84

What can give you false positive TB test

Back 84

Infected with atypical mycobacteria

BCG vaccination

Front 85

HIV patients - what should be reaction to PPD

Back 85

Less than 5 mm

Front 86

Close contact of person with active TB - what should be PPD

Back 86

Less than 5 mm

Front 87

Patient has chest x ray suggestive of previous inactive TB - what should be PPD

Back 87

Less than 5 mm

Front 88

HIV negative IV drug user - what should be PPD

Back 88

Less than 10

Front 89

Immigrant from Asia - what should be PPD

Back 89

Less than 10

Front 90

Resident of nursing home/correction facility - what should be PPD

Back 90

Less than 10

Front 91

Locally identified high prevalence group - what should be PPD

Back 91

Less than 10

Front 92

Immunosuppressive disease (not HIV) - what should be PPD

Back 92

Less than 10

Front 93

If person on TB drug is non compliant - what do you need to do?

Back 93

DOT - direct observation therapy

Front 94

What do you need to have before removing patient with TB from isolation room

Back 94

3 negative AFB sputum smears prior to removal

Front 95

Which bacteria are part of MAC complex

Back 95

M. avium

M. paratuberculosis

M intracellulare

M leprae

Front 96

TB that causes osteomyelitis is called_

Back 96

Potts disease

Front 97

Positive HIV patient has productive cough, fever, weight loss, GI symptoms, night sweats but no pneumonia. He has disseminated infection with fever and wasting. PE shows enlargement of liver, spleen, intrabdominal and mediastinal lymph nodes. He has history of chronic diarrhea and abdominal pain

Diagnosis?

Back 97

MAC complex infection

Front 98

What is MAC treatment

Back 98

Clarithromycin

Ethambutol

Rifabutin

Front 99

This organism is second to MAC, has highest incidence in midwest and southwest, common in miners, welders and sandblasters, looks like TB

Back 99

Mycobacterium kansasii

Front 100

Gram positive rod with true branching, STRICT AEROBE, weakly acid fast, opportunistic pathogen

Back 100

Nocardia

Front 101

Who is at risk for nocardia

Back 101

Lymphoma

Leukemia

Solid tumors

Organ tumors

Organ transplants

AIDS

Children with CGD

Front 102

Patient presents with confluent necrotizing bronchopneumonia, CAVITIES ARE PRODUCED. He complains of cough, dyspnea and fever

Organism?

Back 102

Nocardia

Front 103

Current or recent pneumonia with cavities on x ray - what should you think first

Back 103

Nocardia

Front 104

Organism was grown on charcoal buffered yeast extract, gram stain shows gram positive rod with branching

Organism?

Back 104

Nocardia

Front 105

Looks like star on blood agar

Back 105

N asteroides

Front 106

How do you treat Nocardia infections

Back 106

Sulfonamides

Front 107

This organism is aerobic actinomycete, it is similar to Nocardia and is an opportunistic pathogen

ASSOCIATED WITH SEVERELY IMMUNOCOMPROMISED PEOPLE ESPECIALLY IF EXPOSED TO HORSES

Back 107

Rhodococcus

Front 108

Alcohol and smoking inhibit this protective mechanism of upper respiratory tract

Back 108

Mucociliary elevator

Front 109

2 most common URT infections in adults

Back 109

Sinus infections

Chronic sinusitis

Front 110

2 most common URT infections in kids

Back 110

Pharyngitis

Acute otitis media

Front 111

ONLY pharyngiits that requires treatment

Back 111

Strep pyogenes

Front 112

This type of pharyngitis occurs in winter, early spring, in children, has abrupt onset, fever, sore throat with exudate and petechiae on palate

Back 112

Streptococcal

Front 113

This type of pharyngitis occurs all year long, at all ages, patient has cold like symptoms, absence of fever, mild sore throat

Back 113

Viral