Fundamentals Test II Flashcards

Terms Definitions
Legionella Pneumophila
Fastidious
Catalase-negative
Facultatively intracellular
Gram-negative bacillus
Nonfermentative
Stains poorly w/ safranin
Multiple serogroups
Community acquired pneumonia
Echocardiogram checks what?
Pressures
Staphylococcus saprophyticus
Catalase positive
Coagulase negative
Novobicin resistant
Rarely cultured from genitourinary tracts of asymptomatic women
UTI symptoms present in 90% of women from whom S. saprophyticus cultured
Honeymoon cystitis
Nocardia
Filamentous gram positive bacilli
Lipid in cell wall- produce partial acid fast-- retain stain under less rigorous conditions than complete acid fast
Culture is slow-grows on TB media
Can ID w/ PCR
Ubiquitous in environment- acquired by inhalation, cutaneous inoculation
Pathogenesis: Cord factor prevents phagolysosome fusion & intracellular killing in phagocytes
Facultative intracellular parasites--can be chronic
Produce: catalase & superoxide dismutase
Disease: mostly immunocompromised- see pneumonia, lung abscesses, brain abscess/meningitis
Others: cellulitis/ulcerations, mycetomas
Common: respiratory manifestations
Influenza Virus
Host: Respiratory Epithelium
Attachment site: Neuraminic acid
Pathogenic Treponemas
Diseases caused
SYPHILIS
Developing nations, esp SE Asia- yaws
N. Africa: T. pallidum endemicum- endemic syphilis
Pinta
Mycoplasma pneumoniae
Host: respiratory epithelium
Attachment site: neuraminic acid
Smallest free-livign org.; agent of walking pneumonia
Lack cell wall
Specialized lipid-containing cell membrane
Pleiomorphic
Related to gram positive
Extracellular pathogen that reside in mucosal surfaces
Susceptible to drying & freezing
Person to Person transmission
Disease: community acquired pneumonia
Tracheobronchitis
Role in asthma, causes wheezing
Hematoma definition
full of blood
SCUD:
Sequential compression device-dilate certain amounts of pressure-changes where the air is, constantly changing where pressure is to try and prevent clots
C. jeikeium
Corynebacteria
Bacteremia in bone marrow transplant patients
Multiple antibiotic resistance
Susceptible: vancomycin, tetracycline
Erisipelothrix rhusopathiae
Gram positive bacillus
Zooontic infection-common in animals
Transmission: skin wounds
Occupational hazard: working w/ animals
Self-limiting skin lesions w/ erythema & eruption
Susceptible to antibiotics
Can spread to bloodstream
Bordatella pertussis
Encapsulated, gram negative coccobacillus bacteria
Fastidious, slow growing- difficult to culture
Strict aerobe
Uses amino acids NOT carbs
Vaccine: almost eradicated disease
Older vaccine: whole killed organisms-wears off
Aka: whooping cough- caused by irritation produced in upper resp. tract by bacteria & necrosis from toxins
Stages: catarrhal stage (cough, sneeze), paroxysmal, convalescent
Recovery confers immunity
Pathogenesis: Attach to ciliated resp. epithelium w/ adhesins, filamentous hemagglutinin (FHA), Pertussis toxin (PTx), kills resp. cells
Releases factors that interfere w/ neutrophil chemotaxis
Exotoxins Damage Tissues
C. urealyticum
Corynebacteria
Causes UTIs and stones
Bacteria splits urea, releases ammonia, raises urine pH - calcium & magnesium to precipitate out (stones)
Difficult to treat b/c antibiotics cannot reach bacteria due to stones
M. leprae
Hansen\'s disease
Humans & armadillos
Transmission: inhalation or skin contact w/ contaminated resp. secretions of lepromatous patients
Incubation: 3 mo. to 3 yrs.
Dx: does not grow in artificial media
Grows in nude, immunocompromised, mice or armadillo
AFB stain of nasal secretions
Leprominin test- skin test
Tx: dapsone & rifampcin (at least 1 yr. treatment)
Prevention: isolation of leper, vaccines in development
Ehrlichia
Part of Rickettsial family
Targets WBC
Hallmarks: some rash, fever, headache, neutropenia & thrombocytopenia
Dx: serology
Tx: Doxycyline
M. fortuitum
Rapid grower
Skin infections
Pulmonary diseases
Esp. CF & lung transplants
Francisella tularensis
Causes: tularemia (rabbit fever)
Tick-bourne
Midwest
Enters skin
Causes ulcer
Vaccine: use is rare
Staphylococcus
Family: Micrococcaceae
Others in fam: Stomatococcus & Micrococcus
Carrier state: colonizes newborn- nares, umbilical stump, perineal area = warm, moist
Adult: some colonization goes away; varies amongst individuals
Characteristics: Gram positive; round colonies, nonmotile, no endospore; beta hemolytic beige; catalase positive; facultative anaerobes; heat & salt tolerant
Enterobacter cloacae
E. aerogenes
Lactose positive
Nonmotile
UTI- nosocomial
Cephalosporinase- ampC: ampicillin & cephalothin resistant
Neisseria gonorrhoeae
Host: Uretheral epithelium
Attachment: carbohydrate on host cells
arthroscerosis
excessive build up of plague
Classic Actinomycosis
\"lumpy jaw\"
Face is asymmetric, swollen on one side
Also can see (in specific patient), an abscess tooth (bone & root are degraded)
See sulfur granules
When crushed, reveals thin, branching, gram positive rods
Note: sulfur granules can be caused by some fungi too
Clostridia perfringens
Rectangular, gram positive rods
Makes spores (within cell, do not bulge)
Double zone beta hemolysis (toxins destroy membranes but other toxins don\'t completely hemolyze, so double zone)
Nagler test: Egg yolk agar; One side w/ antitoxin, the other w/ no toxin--place bacteria, see if toxin is neutralized
Causes: gas gangrene (myonecrosis)
Tx: requires debridement
Also causes: soft tissue infections (cellulitis, myonecrosis), food poisoning, necrotizing enteritis
Various types, each associated w/ different toxins
All types have alpha toxin phospholipase C- chews up membranes
Destroys tissue & turns it into hydrogen & CO2
Form gas pockets in skin
Can be lethal
Clostridia diseases
C. botulinum- botulism
C. tetani- tetanus
C. difficile- antibiotic-associated diarrhea
C. septicum
Anaerobe chamber
Very extreme
Filled w/ hydrogen gas
Air lock
Catalyst takes care of any oxygen
Everything must be done inside chamber
Giardia Lamblia
Host: Duodenum & jejunum
Attachment: Mannose-6-phosphate
Syphilis: Dx
CANNOT be cultured
Serological test used
Two stage testing strategy used to eliminate false positives
Serology of untreated syphilis: height of titer usually corresponds w/ disease; important in treating & managing patients
Tx: Penicillin, still has not developed resistance
Escherichia coli
Normal flora: O157:H7- causes disease
Host: Intestinal epithelium, urinary tract, epithelium
Attachment: D-mannose
Coliform: measures fecal content in water
Salmonella (general)
Salmonella typhi is most common
Salmonella enterica has 2400 main species
Syndromes:
Enteric Fever (typhoid)
Enterocolitis (food poisoning, self-limiting)
Bacteremia (complication of enterocolitis)
Labs: lactose negative; H2S positive
Anaerobic containers
Hydrogen generators w/ catalyst
Add plates, water & catalyst turn hydrogen and any oxygen into water
Cholera toxin
ADP-ribosylation of host regulatory protein. Leads to massive fluid loss.
Type: A-B
Capnophilic bacteria
Require Co2
Ex: fastidious bacteria like Neisseria gonorrhea & Haemophilus influenza
Mycobacterium tuberculosis
Origin of Koch\'s postulates
Humans are only natural host
TB does NOT transmit easily; requires high degree of contact
High prevalence: Zambia & Namibia (also high rates of AIDS)
Transmission: respiratory droplets (infectious load: 5-200 droplets)
Pathogenesis: inhaled, go to middle lung, phagocytosed by macrophage, set up tubercle & infect
Process: latent disease- inhaled, middle lobe of lung, hilar & peribronchiolar lymph nodes, lymphohematogenous dissemination, finally immune system kicks off
Forms tubercles, walls off infection, as granuloma grows, caseous necrosis occurs and eventual dystrophic calcification (Ghon complex)
Coagulase Negative Staphylococci
Non-hemolytic white colonies
Some species more pathogenic than others: S. epidermidis, S. saprophyticus, S. lugdenensis, S. schleiferi
Usually multi-resistant
Common infections: bacteremia (endocarditis), UTI, endopthalmitis, infections w/ prosthetics (IV catheters, prosthetic joints, vascular grafts, CSF shunts)
Legionella Detection
Silver staining of histopath. specimens of lung biopsy
Direct fluorescent antibody (poor sensitivity)
Urine polysaccharide antigen-- will ONLY pick up Legionella pneumonia
Serotology (IFA)-paired sera required; retrospective dx
PCR- currently evolving
Strep D
Ex: S. bovis
Can cause endocarditis
Ask about GI malignancy
Tropheryma whippeli
Actinomycete etiologic agent of Whipple\'s Disease
CANNOT be cultured except in tissue culture
Dx: histopathology & PCR
Aerobic actinomyces
Large group: mycobacteria & corynebacteria
Separated by presence or absence of mycolic acids in cell wall
Corynebacteria & Nocaridea are most important
Gram positive rods
Catalase positive
Haemophilus Detection
Detection: fastidious organism; grows on chocolate agar
Chocolate agar: lysed RBC- releases factor X (hemin) and factor V (NAD)
Satellitism test: Blood agar plate w/ haemophilus, streak S. aureus in middle; S. aureus hemolyzes RBCs so haemophilus will grow near S. aureus streak
Old school test: haemophilus on agar w/ added paper strips w/ factor X, V or both- grows near both strip
Specific for haemophilus influenza, not others
Holman's Sign
dorsiflex foot, if call hurts--positive, if it is positive it suggests that has a patient has a DVT
Moraxella catarrhalis
Common cause of community acquired resp. infections
Otisis media, sinusitis, bronchitis, pneumonia
Carried in upper resp. tract of healthy children
Most strains: produce beta lactamase-- main virulence factor
Gram negative coccus
Other Haemophilus
H. ducreyi- painful genital ulcers
H. aegyptius- purulent conjunctivits
Dacryocystitis
Prior to or w/o Hib vaccine, Haemophilus influenza B infection would occur in peds around eye but caused by Actinomyces
Sulfur granules clog tear ducts- once removed, infection disappears
Shigella
Related to E. coli; four types
All lactose negative (must lose lac operon to be virulent)
Nonmotile
Fermentative, no gas produced from glucose
Bacillary dysentary-- oral inoculation, infects upper GI, moves from watery diarrhea to bloody-mucoid stool as organism moves from upper GI to lower colon
Treatment: supportive; should give antibiotics for public health
S. pneumniae, pneumococcus
Cause: resp. tract infections
Kids: sinus or ear infections, pneumonia
Pneumonia: can lead to bacteremia = meningitis, bone & joint infections
Osler\'s Triad: S. pneumoniae pneumonia, endocarditis, meningitis
Gram positive cocci in pairs or short chains
Alpha hemolytic
Optochin (P disk) susceptible
Bile soluble- autolyses in bile
Quellung rxn
Pathology; can aspirate from upper airway to lower = pneumonia
Virulence factor: capsule
Vaccine: adult-23 valent polysacch- prevent invasive pneumococcus, not pneumonia
Child: 7 valent conjugate vaccine (w/ diphtheria toxin)
Proteus mirabilis
P. vulgaris
Urease positive
Highly motile, swarm on plate
H2S positive
Infections: UTI (community acquired), wound infections, pneumonia, septicemia
Resistance: tetracycline, ampicillin, cephalosporin
Quantiferon- Gold Standard
IFN-gamma release assay
Three tubes: No antigen, TB antigen, Mitogen
Blood collected & put in tubes
Mitogen releases all IFN-gamma = measure of possible rxn
Antigens used are not in BCG vaccine- can differentiate b/t vaccine & actual TB
E. coli Opportunistic Infections
Peritonitis from ruptured gut
Septicemia secondary to UTI or pneumonia
Wound infection
Risk factors for hypertension
African American (genetics), overweight, inactiveness, pregnancy, alcohol, elderly men, high salt intake
What should nurses inspect the chest for?
symmetry
Staphylococcal Scalded Skin Syndrome
Mostly children
Systemic symptoms = RITTER\'s disease
Skin lesions due to toxins produced, not bacteria
Diagnosis of RMSF
Lab: normal or decreased WBC, increased bands (immature cells), anemia, thrombocytopenia
Natural history: left untreated, can die in 1-2 wks and death is 3-4 times more likely without antibiotics
Dx: Serological tests- IFA, agglutination test, Weil-Felix test (outdated) but relies on Ab production
Lab: Immunofluorescence or immunoperoxidase staining of biopsy specimen (fresh or formaldehyde fixed), sensitive not that great & decreases w/ antibiotic therapy but specificity is 100%
Facultative bacteri
Have enzymes that can produce energy in absence or presence of oxygen
Have machinery to use oxygen and will use O2 first b/c more ATP is made
Klebsiella pneumoniae
Lab: gram negative rods w/ capsules that exclude stain
Lactose positive
Nonmotile
Large Capsule
B-lactamase: ampicillin & carbenicillin resistant
Sensitive to: Cephalosporins
Predisposition: Nosocomial, respirator, age, aspiration of oral secretions, alcoholism, diabetes, chronic bronchopulm. disease
Disease: pneumonia (non-purulent bloody sputum, necrosis & abscess), septicemia, UTI, meningitis
Diagnosis of Tuberculosis
AFB smear- negative or positive reported in 24 hrs. (use fluorescent stain)
TB smear: shows red organisms in stain
Skin test: Mantoux test, can show exposure to other mycobacteria
Larger the swelling around area of test, more positive dx of TB
Chest radiograph
AFB culture
Culture prep: digest sputum w/ mycolytic agent (eg NaOH), decontaminant w/ 2-3% NaOH; concentrate, acid fast stain, cultivate in solid (egg or agar) or liquid (automated) media, wait 8 weeks
If TB grown, MUST send off for susceptibilities
Salmonella Enterocolitis
Vomiting & profuse diarrhea 8-48 hrs. after infection
Resolves in 3-7 days
Source of Infection: water, meat, dairy, eggs, humans
Non spore-forming Gram positive Bacilli
Ex: Actinomyces
Actinomyces israelii is most common
Slow growing
Difficult to grow
Cross tissue planes
Have sulfur granules: microcolonies of organism encased in host material, visible to eye, Seen in draining sinuses, Typically yellow
Cause oral, respiratory, and female genital tract infections
Mycoplasmas (in addition to pneumoniae)
Genital Mycoplasmas:
M. hominis
M. genitalium
Ureaplasma species
Found in lower urogenital tract
Cause opportunistic infections
Disease:
Nongonococcal urethritis: ureaplasma & M. genitalium
Urinary calculi: ureaplasma (b/c splits urea)
Pelvic inflammatory disease/cervicitis: M. genitalium & M. hominis
Premature delivery: ureaplasma infection; causes oxygen damage in lung due to incr. oxygen demand, spontaneous abortion, postpartum fever
Septic arthritis in Ab deficient: ureaplasma
Cell Wall/ Other Toxins
Function: inflammation & necrosis
Type of Toxin: Bacterial products
Pathogenesis of Mycoplasma
Attaches to resp. epithelium w/ P1
Testing looks for Abs to P1
Danamages tissue w/ peroxide & hemolysin
Affects beating of cilia
Stimulates cytokine cascade
Self-limited, NO acute fever or chills
No vaccine b/c changes its antigen
Exotoxin recently described similar to pertussis ADP ribosyl transferase that causes vacuolation & ciliostatis of epith.
Arterial Clot vs. DVT clot temperature
cool vs. hot
Where would edemas present?
feet, sacral area, periobrital (around the eye)
Risks for cardiovascular disease
age, gender, inheritance, smoking (most modifiable), hypertension (25% of adults), stress, high cholesterol, obesity, lack of exercise, and diabetes
What does a bruit indicate?
Narrowing of the carotoid
Sickle Cell Anemia
ischemia throughout the entire body, extremely painful
Environmental Resistance of M. tuberculosis
Survives drying
Resistant to many disinfectants like alcohol
Susceptible to: UV irradiation (does not penetrate plastic), chlorine & phenols, pasteurization, High Efficiency Particulate Air Filters
TB Risk Factors
AIDS w/ CD4 less than 400
Iatrogenic immunosuppression (eg TNF-alpha inhibitors, steroids)
Age
Pregnancy
Alcoholism/malnutrition
Diabetes
Genetics
Pitting edema
Push thumb down for 10-15 seconds and let go. If print is still there when you remove your thumb then pitting edema is present.
Where is the apical HR?
Mitral valve, 5th intercostal, midclavicular line
DVT Nursing care
Do NOT massage, warm (heat may dilate), do not want to cause vasoconstriction (encourage to change position often, can not cross their legs! Increase pressure, constricts blood flow), elevative, but never so that their knees are bent
Salmonella enteric fever (typhoid fever)
Humans are only hosts
Resistance is common
Pathogenesis: Ingest organisms; go through gastric acid barrier & attach to Peyer\'s patches; go through mesenteric lymph nodes, cause bacteremia
Live in macrophages of liver, spleen, gallbladder, bone marrow
7-14 days later: secondary bactermia, responsible for symptoms
Vaccine: Killed whole S. typhi with LPS = localized side effects
Live vacine: Ty21a-- chemically mutagenized strain
4 Normal Solutions for edema
elevate edema above heart, measure circumfrence of limb or abdomen, where we have edema, might have to drain abdomen, may give diuretics
What does exercise do (physiologically speaking)
makes platelets less sticky, prevents thrombosis, increases HDL, increase muscle build-up
Arterial Clot vs. DVT clot pain differences
intermittent claudication vs. cramping-constant ahce
Arterial Clot vs. DVT clotpulse
decreased or absent below the clot vs. no change (we don't feel pulses in veins)
Pitting edema measurements
2 mm= +1 edema4 mm= +2 edema6 mm= +3 edema8 mm= +4 edema
ECG is used for what kind of diagnosis?
for electrical problems in heart
Ineffective Tissue Perfusion- what does it look like?
Depends on what part of the body it is in.
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Term:
Definition:
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