Test 3 Week 1

Question 1

What are the 4 “centor” criteria for pharyngitis diagnosis?

Answer 1

Fever
Tonsillar Exudate
Tender enlarged anterior cervical lymph nodes
Absence of Cough

Question 2

What are 2 common bacterial pathogens that cause pharyngitis?

Answer 2

B-hemolytic strep (gas)

Mycoplasma

Question 3

What can EBV cause? (which then causes pharyngitis)

Answer 3

Infectious mononucleosis

Question 4

Difference between sensitivity and specificity of testing?

Answer 4

Sensitive: % of patients with disease tests positive
Specificity: % of patients withOUT disease tests negative

Question 5

What test is used to detect “heterophile antibodies” in EBV?

Answer 5

Monospot

Question 6

Why is CA (community acquired) pneumonia better than HCAP (hospital care acquired) pneumonia?

Answer 6

Because it’s more treatable with less resistance

Question 7

What do you tell if a sputum bit is acceptable?

Answer 7

If there’s less 10 squamous epithelial cells. (means it’s lower respiratory not upper)

Question 8

What two pathogens would you use urine antigen test for?

Answer 8

Strep pneumo (except for kids)
Legionella (only type 1 pneumophila)

Question 9

What is empyema?

Answer 9

Bacterial organisms seen in pleural fluid on gram stain or PUS aspirated from the pleural space (requires chest tube drainage)

Question 10

What is thorocentesis?

Answer 10

needle in the lung pleura for fluid culture

Question 11

What’s an “uncomplicated parapneumonic effusion? pleura

Answer 11

exudate, increased neutrophils, resolve with treatment of pneumonia

Question 12

What’s a “complicated parapneumonic effusion”? pleura

Answer 12

Exudate, bacterial invasion of pleural fluid, low pH, low Glucose, cultures negative

Question 13

What is a sputum culture used for?

Answer 13

Bacterial diagnostics

Question 14

What is a bronchoalveolar lavage used for?

Answer 14

Viral diagnostics (lower tract)

Question 15

What is a nasopharyngeal swab used for?

Answer 15

Viral diagnostics (upper tract)

Question 16

What are the two different parts of the Flu virus that distinguish it?

Answer 16

HA

NA

Question 17

Difference in Flu A vs Flu B?

Answer 17

Flu A: birds, pigs, humans, seasonal (H and N, Antigenic Drift or Shift)
Flu B: sporadic all year

Question 18

What are two medications to give flu patients?

Answer 18

Oseltamivir (48hours)

Zanamivir

Question 19

What is RSV?

Answer 19

Respiratory Synctial Virus

Question 20

What would RSV look like in the lungs?

Answer 20

Giant cells (they glom together)

Question 21

What are risk factors for Strep pneumo?

Answer 21

Asplenia
HIV
Smokers
Diabetics
Alcohol

Question 22

What is the triad of infectious diseases?

Answer 22

Host (how well can we fight it off)
Pathogen (what kind is it)
Environment (where did you pick it up from)

Question 23

What’s acute pneumonia? Typical pneumonia

Answer 23

CAP or HCAP
Hours to days
Fever and cough
Lobar consolidation
Pleuritis
URT colonizing bacteria
Strep Pneumo

Question 24

What drug is used for “atypical” pneumonia? legionella, mycoplasma, chlamydia.

Answer 24

Azythromycin

Question 25

What drug is used for Bacterial pneumonia?

Answer 25

Ceftriaxone (B-lactam)

Question 26

What gram stain is Klebsiella pneumonia?

Answer 26

Gram negative

Question 27

How do people get aspiration pneumonia?

Answer 27

They accidentally aspirate bacteria from the oropharynx down into the lungs

Question 28

What gram stain are CAP pneumonias usually?

Answer 28

Gram pos

Question 29

What gram stain are HCAP pneumonias usually?

Answer 29

Gram Neg

Question 30

What group is viral pneumonia most common in?

Answer 30

Children

Question 31

What is a chronic pneumonia like?

Answer 31

weeks to months (not days) | Non-infectious diseases cause it

Question 32

What's the trick behind the mucosal immunity?

Answer 32

It has to make immune responses to the right things, and not the good things it's exposed to (like food)

Question 33

Where's the repository of most lymphocytes in the body?

Answer 33

within the mucosal linings (not the secondary lymphoid tissues)

Question 34

Where does 60-70% of the lymphocytes reside?

Answer 34

MALT- (mucosal associated lymphoid tissues)

Question 35

What do M-cells do in the peyers patch?

Answer 35

It helps pull in the antigens into the Peyers Patch.

Question 36

Where are B cells taught to make IgA?

Answer 36

Peyers patches

Question 37

What can increase mucous production in the mucus linings?

Answer 37

Inflammatory cytokines

Question 38

What do paneth cells produce?

Answer 38

Defensins: natural antibodies

Question 39

What does the Mcell lack that the surrounding epithelial cells have?

Answer 39

Glycocalyx | Mucous

Question 40

How do M-cells get used by disease organisms?

Answer 40

The diseases trick the M-cells into letting them into the cell.

Question 41

Which TCR cells have limited diversity?

Answer 41

Intraepithelial lymphocytes

Question 42

Where do Gamma Delta Tcells flock to?

Answer 42

inflammation (not the lymph nodes)

Question 43

What's the major job of gamma delta Tcells?

Answer 43

secrete cytokines when stimulated

Question 44

What's the difference in Effector DC's (CD11b) and Regulatory DC's (CD103)??

Answer 44

Effector: stimulate Effector Tcells. can migrate to MLN Regulatory: stimulate Treg cells to suppress immunity.

Question 45

What do CCR9 and a4B7 cytokines do?

Answer 45

They attract tcells to the gut

Question 46

What does RA (retinoic acid) do? by DC's

Answer 46

holds the Tcells in a anti-inflammatory state, induces Treg cell differentiation

Question 47

Why are TLR's polarized in the epithelium of the gut?

Answer 47

They perform different functions (activate or inactivate) based on which side of the cell the TLR gets ligated.

Question 48

How does a mucosa activated lymphocyte find its way back to the gut?

Answer 48

Gut homing integrins and chemokines

Question 49

What is the main Immunoglobulin formed in the gut?

Answer 49

IgA (it sticks to the mucus)

Question 50

Why is the IgA (and it's secretory part) important in the gut?

Answer 50

Because the epithelial and Mcells are able to transport IgA back and forth pretty easily.

Question 51

What is the major role of IgA?

Answer 51

block adherence of bacteria to epithelial cell surface

Question 52

What are the 3 C's of measles? (early)

Answer 52

cough Coryza Conjunctivitis (late: Rash, koplik)

Question 53

What antibiotic always works for Group A strep pharyngitis?

Answer 53

Penicillin

Question 54

How is EBV and spleen enlargement connected?

Answer 54

Massive bcell involvement, mono is likely

Question 55

What's important about Urine antigen test with Strep Pneumo?

Answer 55

It doesn't work with children

Question 56

What is RSV? what does it do? what are symptoms?

Answer 56

Respiratory synctial virus | fever, cough, cold symptoms