session 3

Question 1

SIRS is defined as 2 or more of the following:

Answer 1

fever ＞38 C Respiratory
HR ＞ 90 beat/min
rate ＞20/min
PaCO2 < 32mmHg
Abnormal
WBCs count ＞ 12000/mm3

Question 2

The prevalence of sepsis is on the rise, factors could be many such as

Answer 2

ageing population
- immune suppression
evolving of multidrug resistant pathogens
increased number of low birth weight newborns

Question 3

Severe sepsis inculde

Answer 3

It include :
 Organ dysfunction (renal failure, respiratory failure, delirium)
 Hypoperfusion (lactic acidosis)
 Hypotension (absolute systolic blood pressure below 90 mmHg or greater than 40 mmHg below the patient baseline systolic blood pressure)

Question 4

the TFN AND IL1 ARE PROINFLAMMATORY OR ANTI-INFLAMMATORY

Answer 4

Proinflammatory mediators

Question 5

LI4 AND LI10 ?

Answer 5

ANTI-inflammatory factors

Question 6

‘purpura fulminans

Answer 6

a blood clot forms and block these small vessels.

Question 7

antibiotics for neisseria meningitidis

Answer 7

cefotaxime or ceftriaxone

Question 8

prophylatic drugs for meningitis

Answer 8

the rifampin, ciprofloxacin and ceftriaxone

Question 9

Role of the immune system

Answer 9

Pathogen recognition= Cell surface and soluble receptor
▪ Contain/eliminate the infection = killing and clearance mechanism
▪ Regulating itself= Minimum damage to the host (resolution)
▪ Remembering Pathogen = Preventing the disease from recurring

Question 10

Chemical barriers

Answer 10

Low PH Chemical barriers
▪ Skin 5.5 ▪ Stomach 1-3 ▪ Vagina 4.4
▪ Antimicrobial molecules ▪ IgA (tear, saliva, mucous membrane )
▪ Lysozyme (sebum, perspiration, urine)
▪ mucous (mucous membrane )
▪ β-defensins (epithelium) ▪ Gastric acid + pepsin

Question 11

Examples of normal flora that inhabit… • The skin

Answer 11

Staphylococcus aureus (week 1, case 1) ▪ Staphylococcus epidermidis ▪ Streptococcus pyogenes ▪ Candida albicans ▪ Clostridium perfringens

Question 12

The nasopharynx flora

Answer 12

▪ Streptococcus pneumoniae (week 3, case 2) ▪ Neisseria meningitides (week 3, lecture case) ▪ Haemophilus species

Question 13

❖Normal flora

Answer 13

=>Serious infections in high-risk patients • Asplenic (and hyposplenic) patients • Patients with damaged or prosthetic valves • Patients with previous infective endocarditis

Question 14

Oxygen dependent (respiratory burst in kiling bacteria

Answer 14

Hydrogen peroxide • Hydroxyl radical • Nitric oxide • Singlet oxygen • hypochlorite

Question 15

Oxygen independent

Answer 15

Lysozyme • Acid hydrolases • Lactoferrin • Cationic proteins • Neutral proteases • Lysosomal contents

Question 16

➢ Cytokines/Chemokines

Answer 16

▪ Chemoattraction ▪ Phagocyte activation ▪ Inflammation

Question 17

Anti-microbial actions of macrophage-derived TNFα/IL-1/IL-6

Answer 17

Liver (opsonins) • CRP • MBL (-> complement activation)
• Bone marrow • Neutrophil mobilization
• Inflammatory actions • Vasodilation • Vascular permeability • Adhesion molecules -> attraction of neutrophils
• Hypothalamus • Increased body temperature

Question 18

First lines of defense is responsible for Limit entry and growth of pathogens at portals of entry

Answer 18

Limit entry and growth of pathogens at portals of entry

Question 19

Second lines of defenses are responsible for

Answer 19

Contain and eliminate the infection

Question 20

Decrease spleen function

Answer 20

• Asplenic patients • Hyposplenic patients

Question 21

Decrease neutrophil number (1.8 x109/l)

Answer 21

• Cancer chemotherapy • Certain drugs (phenytoin) • Leukemia and lymphoma

Question 22

phenytoin decrease ——–cells

Answer 22

neutrophilis

Question 23

Decrease neutrophil function

Answer 23

Chronic granulomatous disease (No respiratory burst)

• Chediak-Higashi syndrome (no phagolysosomes formation)

Question 24

who peaples at risk of meningitis by neissiria meningiidis

Answer 24

1-persons with functional or surgical asplenia.
2-persons with complement deficiencies.
3-travelers to highly endemic areas (eg, sub-Saharan Africa).
4-“closed populations” such as: a- students living in dormitories
b- the military recruits
c- religious pilgrims
5-populations experiencing a community outbreak.
6-clinical laboratory workers (microbiologists

Question 25

N meningitidis growth in

Answer 25

chocolate agar and Thayer – Martin agar

Question 26

N. Meningitidis cause

Answer 26

``` Meningitis Arthritis Pericarditis Pneumonia Urethritis septicemia ```

Question 27

vaccinations recommended for-risk groups?

Answer 27

1-persons with functional or surgical asplenia. 2-persons with complement deficiencies. 3-travelers to highly endemic areas (eg, sub-Saharan Africa). 4-“closed populations” 5-populations experiencing a community outbreak. 6-clinical laboratory workers (microbiologists).

Question 28

Physiological barriers

Answer 28

``` ▪ Diarrhea •Food poisoning ▪ Vomiting • Food poisoning ، • Hepatitis • Meningitis ▪ Cough • Pneumonia ▪ Sneezing •Sinusitis ```