Ch5: URT Chaussee Flashcards Preview

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Flashcards in Ch5: URT Chaussee Deck (104):
1

What does upper respiratory mean?

Above larynx

2

How does number of microbes change throughout lung?

Very high in the mouth
Decreases as you move down the respiratory tract
None in lungs

3

Where does RT become aseptic?

Alveolar bronchiole

4

Normal flora has what role in RT?

Protects by competing with harmful microbes

5

What bacteria are in middle ear and sinuses?

None, sterile

6

Normal flora of URT? (50% of people or more)

1. Corynebacteria
2. Candida albicans
3. Alpha-hemolytic strep
4. Strep mutants
5. Haemophilus influenzae
6. Neisseria
7. Non staph aureus staph

7

Host defenses in URT?

1. Orthogonal structure
2. Saliva
3. Mucin and mucus
4. TLR's

8

the orthagonal structure of URT has what effect?

Traps microbes

9

What does saliva contain? 2

Lysozyme
Secretory IgA

10

What does mucus do?

Traps microbes from entering LRT.

11

What sweeps mucus up and out and into stomach?

Ciliated epithelial cells

12

Ciliated epithelial cells + Mucus = ?

Mucocilliary escalator

13

50-70% of sore throats are caused by what in children?

Viruses

14

What symptoms suggest a viral sore throat?

Conjunctivitis
Coryza
Ulcerative lesions
Viral exanthema
Diarrhea

15

What percentage of adult sore throats are viral?

0%

16

Bacterial causes of pharyngitis?

1. Group A strep:
2. Group C and G strep
3. Anaerobes (bacterioides, fusobacterium, spirochetes
4. Corynebacterium diptherae
5. Neisseria gonorrhoea

17

Which bacterial causes of pharyngitis are common?
Infrequent?

Group A strep = common

Group C and G strep = infrequent
Neisseria gonorrhea = infrequent

18

GAS caused pharyngitis has what associations? 3

Tonsilitis, scarlet fever, sequelae

19

What are spirochetes that cause pharyngitis?
What else are they associated with?

Borrelia and treponema

Trench mouth

20

In terms of GAS strep throat
Onset?
Symptoms? (3)

1. Severe pain
2. Difficulting swallowing
3. Flu-like

21

Suppurative sequelae of GAS? 4

1. Peritonsillar abscess
2. Otitis media, sinusitis, mastoiditis
3. Scarlet fever
4. Streptococcal Toxic Shock Syndrome

22

Scarlet fever encompasses what?

Peripheral rash (Maybe strawberry tongue) caused by SPE's

23

What is STSS due to?

Production of Spe's that act as superantigens

24

What happens if GAS is in the blood?

Bacteremia and toxigenic disease

25

Non-suppurative/post infection sequelae to GAS pharyngitis?

Acute rheumatic fever: Due to autoimmune

26

Why does acute rheumatic fever occur?
How long does it take to develop?
What percent of kids get it?

M protein mimics cardiac myosin
3 weeks
3%

27

Clinical diagnosis of ARF is based on what?

Jones criteria

28

ARF typically follows what type of GAS infection?

Pharyngeal

29

What is the Jones criteria requirements for GAS?

Evidence of previous GAS infection
2 major or 1 major + 2 minor

30

Major manifestations of ARF? 5

1. Joints
2. Heart inflammed
3. Nodules subcutaneous
4. Erythema marginatum
5. Sydenham's Chorea

31

Minor manifestations of ARF? 4

1. Previous ARF
2. Fever
3. Joints
4. Acute phase reaction

32

Laboratory obtained evidnece of previous GAS infection?

Anti-streptolysin O test

33

Besides ARF, what else is a non-suppurative post infection sequlae of GAS?

Pediatric Autoimmune Neuropsychiatric Disorders Associated WIth Strep Infections (PANDAS)

34

What causes PANDAS?

Cross reactivity between GAS antigens and neuro tissue

35

GAS may be responsible for what neuro disorders?

1. OCD
2. Tourettes

36

Lab diagnosis of GAS? (7)

1. Rapid diagnostic test (Ab's to GAS carb)
2. Culture throat swab
3. Beta-hemolytic
4. Gram positive
5. Catalase negative
6. Bacitracin sensitive
7. Positive PYR test

37

Treatment of all GAS children should be what?
What about adults?

Antibiotics
Not so much since usually due to virus

38

Main drugs for GAS sore throat? (2)

1. Penicillin
2. Erythromycin for kids with allergies

39

Group C and G strep is what type of hemolytic?
Gram positive?

Beta-hemolytic
Gram positive

40

Habitat of Group C and G strep?

1. Mucosal surfaces like nasopharynx

41

Transmission of Group C and G?

Droplets or direct contact

42

Do GCS and GGS have M protein?

Yes

43

What is the one suppurative of GCS/GGS infection?
What are the two non-suppuratives

Pharyngitis

GLomerulonephritis: Group C
ARF: Group C and G

44

Laboratory diagnosis of GCS and GGS?

1. Rapid diagnostic
2. Beta hemolytic
3. Gram + cocci in chains
4. Catalase negative
5. Bacitracin resistant
6. PYR Negative

45

Treatment of GCS and GGS? 2

Penicillin or macrolides

46

Neisseria gonorrhoeae is what in gram stain?

Gram-negative

47

Habitat of neisseria gonorrhoeae?

Humans

48

Transmission of N. gonorrhoeae?

Sexual contact

49

Lab diagnosis of N. gonorrhoeae is on what medium? 2

Chocolate agar or Thayer-Martin agar

50

What is Thayer-martin agar?

Chocolate agar + antibiotics for most bacteria and fungi

51

Treatment of N. gonorrhoeae? 2

1. Intramuscular Ceftriaxone
2. Oral azithromycin or doxycycline

52

What is N. gonorrhoeae resistant to?

Penicillin and Tetra

53

Acute otitis media is what?

Inflammation of mucosa in tympanic cavity

54

What starts AOM?

Obstruction or blockage of the Eustachian tube or opening to sinuses

55

Result of obstruction in Eustachian tube or sinuses?

Microbial products accumulate --> Inflammation

56

AOM diseases are treated with what?

Amoxicillin or cephalosporins

57

Infants and children are susceptible to otitis media why?

Eustachian tube is shorter and more linear.

58

Why are infants more susceptible to otitis media?

Eustachian tube is shorter and more linear

59

What percentage of otitis media is caused by viruses?

50%

60

Common bacterial causes of otitis media?4

Haemophilus INfluenzae
Strep Pneuoniae
Moraxella catarrhalis
Strep pyogenes/Staph aureus

61

What is unique of the bacterial causes of otitis media?

They are all normal flora of URT

62

Hemophilus influenzae is gram what?
Shape? (2)
Respiration?
Divided into serotypes based on what?
Which is most virulent?

Gram -
Rods or coccobacilli
Facultative anaerobe
6 capsular anaerobes
Type B

63

Habitat of H. influenzae?

Humans in throat and skin

64

What type of H. influenzae do people get at birth?

Non-encapsulated H. influenzae

65

Transmission of H. influenzae?

Respiratory droplets or direct contact

66

VIrulence factors of H. influenzae?

Polysaccharide capsule

67

Type B H. influenzae capsule has what important component?

Polyribitol phosphate (PRP) that Ab's attack

68

Infections caused by H. influenzae? 4

AOM, meningitis, pneumoniae, acute epiglottis

69

Vaccine against H. influenzae?

Yes, protein conjugate virus of PRP linked to a protein like tetanus toxoid or meningococcal outer membrane protein

70

Strep pneumoniae is in what form?
Gram stain?
Hemolytic?
Shape?

Encapsulated
Gram +
Alpha hemolytic
Lancet shape in diplococci

71

Habitat of Strep pneumoniae?

Human URT

72

Transmission of Strep pneumoniae?

Droplets or direct contact

73

Virulence factors of Strep pneumoniae?

Polysaccharide capsule

74

Clinical infections of Strep pneumoniae?

AOM, meningitis, pneumonia

75

Vaccine for Strep pneumoniae in adults?
In children?

Pneumovac23
Prenavar 13 (PCV 13)

76

Moraxella catarrhalis is gram what?
Metabolism?
Habitat?

Negative diplococci
Aerobic
human urt

77

Clinical infections of moraxalla catarhallis

Otitis media
Other itis's

78

Diagnosis of AOM in moraxalla catarhallis?

1. Otoscope --> Bulging tympanic membrane
2. Puff of air on tympanic membrane to see if it can vibrate
3. Tympanometry: measure tone off membrane

79

Treatment of AOM?

Hold off on antibiotics, aren't as helpful

80

COmplications of AOM?

1. Permanent damage --> Hearing loss
2. Mastoiditis
3. Invasive disease

81

Main antibiotic for AOM?

Amoxicillin

82

Otitis externa is known as what?

Swimmer's ear, infection of ear canal

83

Main causes of otitis externa?

Staph aureus
Candida albicans
Gram-negatives

84

Acute sinusitis goes for the most amount of time at what?

4 weeks

85

Bacterial causes of acute sinusitis? 4

S. pneumoniae, H. influenzae, Staph aureus, S. pyogenes

86

Diagnosis of acute sinusitis? 4

Prolonged rhinitis
Maxillary toothache
Don't respond to decongestants
Headache/Fever

87

Treatment for acute sinusitis?

Amoxicillin

88

What is acute epiglottitis?

Cellulitis and swelling of supraglottic tissue

89

Is acute epiglottitis serious?

Life threatening --> Can block trachea

90

Main bacterial causes of acute epiglottitis?

H. influenzae = Most in children
S. pneumoniae, GAS, s. aureus

91

Diagnosing acute epiglottis? (2)

1. Scope
2. X-ray

92

Treatment of acute epiglottitis? 4

Intubation
Broad spectrum Antibiotics
3rd generation cephalosporin
Steroids

93

Oral candidiasis is caused by what?

Candida albicans: Fungus that stains gram positive

94

Habitat of Candida albicans?

Humans (mouths of 25-50%) of healthy people
100% of rectums

95

Transmission of Candida albicans?

Endogenous: Opportunistic fungal infection

96

Where does Candida albicans cause disease?

All organs possibly

97

Treatment of Candida albicans? (2)

1. Flucanazole: Attack ergosterol
2. Nystatin: Insert into fungi membrane

98

Caries is caused by what?

Strep mutants

99

What percentage of people have strep mutans?

80-90

100

Three components in development of caries?

1. Strep mutans
2. Sucrose
3. Susceptible tooth enamel

101

Sucrose is used by strep mutans to form what?
What does this allow for?

Glucose polymer
Bacteria can adhere to enamel

102

What else does strep mutans ferment?
Result

Sucrose to lactic acid
Demineralize the tooth enamel --> Cavities

103

Periodontal disease includes what species?

Actinomyces viscosus, actinobacillus, bacteroides

104

What type of bacteria colonize space between teeth and gingiva?

Anaerobes, gram - and LPS