Chapter 21 - Respiratory System Infections

Enlargement of which of the following structures may contribute to ear infections by interfering with normal drainage from Eustachian tubes? A. Nasal chamber B. Nasal conchae C. Adenoids D. Epiglottis E. Parotid glands

C. Adenoids

Which of the following are common signs and symptoms of bacterial pneumonia? A. Fever B. Cough C. Rash D. Chest pain E. Sputum production F. Diarrhea G. Vomiting

A, B, D, E??

Which statement regarding common colds and adenoviral respiratory tract infections is TRUE? A. Fever is a sign of adenoviral respiratory tract infections, but is not a sign for the common cold. B. The incubation period for adenoviral respiratory tract infections is 1-2 days, while that for common colds is 5-10 days. C. Cold viruses are non-enveloped, double-stranded DNA viruses while adenoviruses are non-enveloped single-stranded RNA viruses. D. Cold viruses may cause infections other than respiratory infections while adenoviruses only cause upper respiratory tract infections. E. Adenoviral respiratory tract infections may also be caused by bacteria while the common cold is always caused by a virus of some kind.

A. Fever is a sign of adenoviral respiratory tract infections, but is not a sign for the common cold.

The disease that closely resembles "strep throat" but is of viral origin is A. adenoviral pharyngitis B. otitis media C. the common cold D. tonsilitis E. bronchitis

A. adenoviral pharyngitis

Why is Legionella pneumophila detected using immunofluorescence? A. It is a virus B. It stains poorly with conventional dyes C. It is Gram-non-reactive D. It is an acid-fast bacterium E. It lacks a peptidoglycan cell wall

B. It stains poorly with conventional dyes

Superantigen exotoxins that cause a cytokine storm may be produced by which of the following? A. Mycobacterium tuberculosis B. Legionella pneumophila C. Corynebacterium diphtheriae D. Streptococcus pyogenes E. Streptococcus pneumoniae

D. Streptococcus pyogenes

The pneumococcal vaccine is directed against the A. flagella B. pili C. cilia D. capsule E. A-B toxin

D. capsule

Two relatively widespread North American lung mycoses are A. candidiasis and coccidioidomycosis B. candidiasis and aspergillosis C. aspergillosis and Reyes syndrome D. coccidioidomycosis and histoplasmosis E. None of the choices is correct

D. coccidioidomycosis and histoplasmosis

Diphtheria toxin works on A. lysosomes B. mitochondria C. chloroplasts D. elongation factor 2 E. messenger RNA

D. elongation factor 2

Put the following events in the pathogenesis of tuberculosis in order. 1. Airborne Mycobacterium tuberculosis are inhaled from respiratory droplets most often spread when an infected person coughs. 2. If the bacteria enter the bloodstream, they spread throughout the body to locations such as the kidney, brain, and lymph nodes. 3. An inflammatory reaction occurs, leading to recruitment of macrophage and lymphocytes to the site, forming a granuloma called a tubercle. Growth of bacteria ceases in latent cases of TB. 4. Alveolar macrophages engulf the bacteria but the bacteria survive and even multiply within the macrophages. 5. In active cases of TB, the inflammatory response cannot contain the growth of M. tuberculosis. The tubercules rupture, releasing the bacteria and the organisms spread throughout the lungs and are released through coughing.

1, 4, 3, 5, 2

Match the statements to the infection being described in order to test your understanding of the distinctive characteristics of respiratory syncytial virus infection and hantavirus pulmonary syndrome. 1. Hantavirus Pulmonary Syndrome 2. Respiratory Syncytial Virus (RSV) Infection

1. -Symptoms include muscle aches, vomiting, and diarrhea. -This respiratory disease is spread from animals (zoonosis) and is not generally spread from person to person. -The incubation period of this disease ranges from 3 days to 6 weeks. 2. -Symptoms include runny nose and cough. Patients may also develop a dusky color due to lack of oxygen. -This respiratory disease is spread from person to person, often from adults and children with mild symptoms. -The incubation period of this disease is short, lasting 1 to 4 days.

Place the steps of the disease pathway in the correct order to test your understanding of the pathogenesis of diphtheria. Not all labels are used.

1. Corynebacterium diphtheriae enters by inhalation. 2. Bacteria establish an infection in the nasal cavity and/or throat. 3. Bacteria release toxin; pseudomembrane forms. Pseudomembrane may come loose and obstruct breathing. 4. Toxin causes paralysis, damages heart muscles, kidneys, nerves. 5. Bacteria exit the body by respiratory secretions.

Place the steps of the disease pathway in the correct order to test your understanding of the pathogenesis of influenza. Not all labels are used.

1. Influenze virus is inhaled and carried to the lungs. Viral HA attaches to ciliated epithelial cell receptors and virus enters the cell by endocytosis. 2. New virions are synthesized and bud from host cells; they infect ciliated epithelium, mucus-secreting cells, and alveolar cells. 3. Infected cells ultimately die and slough off; mucociliary escalator is damaged. 4. Secondary bacterial infection of lungs, ears, and sinuses may occur. 5. Virus exits by coughing.

Place the steps of the disease pathway in the correct order to test your understanding of the pathogenesis of tuberculosis. Not all labels are used.

1. M. tuberculosis cells are inhaled. Bacteria are phagocytized by lung macrophages and multiply within them. 2. Infected macrophages are carried to kidneys, brain, and lymph nodes; bacteria may be released, causing delayed-type hypersensitivity. 3. Bacteria in lungs are surrounded by macrophages and lymphocytes, forming granulomas (tubercles); bacterial growth stops. 4. Intense inflammatory reaction and release of enzymes causes necrosis and cavity formation in lungs. 5. Bacteria exit the body through the mouth with coughing.

Match the statement to the correct type of pneumonia being described to test your understanding of the distinction between pneumococcal, Klebsiella, and mycoplasmal pneumonia.

1. Mycoplasmal Pneumonia: -This type of pneumonia is caused by a bacterium with no cell wall -This type of pneumonia has an incubation period of 2 to 3 weeks 2. Klebsiella Pneumonia: -This type of pneumonia causes repeated chills -Patients with this type of pneumonia will produce thick, bloody, gelatinous sputum -This type of pneumonia is caused by a Gram-negative rod 3. Pneumococcal Pneumonia: -60% of adults with pneumonia who require hospitalization have this type of pneumonia -This type of pneumonia is caused by a Gram-positive coccus -This type of pneumonia can be prevented with a vaccine

Complete the sentences with the terms provided in order to test your understanding of the pathogenesis of histoplasmosis. 1. Histoplasmosis or " ____________ disease" begins when Histoplasma capsulatum, a ____________ enters the lung. 2. Once in the lung, the organisms replicate inside the ____________ . 3. Granulomas form and eventually are replaced by scar tissue. They may calcify, leading to a visible spot seen on an ____________ . 4. In ____________ individuals, the disease may spread throughout the body.

1. Spelunker's; fungus 2. macrophages 3. X ray 4. immunocompromised

Please place the statements about strep throat and diphtheria into the correct columns. 1. Some strains of causative agent extremely invasive. 2. Caused by C. diphtheriae. 3. Caused by S. pyogenes. 4. Disease characteristics caused in part by A-B toxin. 5. Disease characteristics caused in part by destructive enzymes. 6. Causative agent may cause sequelae such as rheumatic fever. 7. Causative agent may cause chronic skin ulcers. 8. Causative agent with little invasive ability. 9. Treated with antibiotics. 10. Treated with antibiotics and antiserum.

1. Strep throat 2. Diphtheria 3. Strep throat 4. Diphtheria 5. Strep throat 6. Strep throat 7. Diphtheria 8. Diphtheria 9. Strep throat 10. Diphtheria

Which of the following are signs and symptoms associated with adenoviral respiratory infections? A. Sore throat B. Cough C. Enlarged lymph nodes D. Rash E. Chest pain F. Fever G. Conjunctivitis H. Vomiting

A, B, C, E, F, G

Please select all the TRUE statements about the pathogenesis of histoplasmosis. A. H. capsulatum microconidia found in bird and bat droppings are inhaled. B. Inhaled microconidia are engulfed by alveolar macrophages. C. Microconidia escape the alveolar macrophages and enter the bloodstream. D. Granulomas resembling those of TB develop in affected areas of the lung. E. The mold phase of H. capsulatum multiplies within the alveolar macrophages. F. The yeast phase of H. capsulatum multiplies within the alveolar macrophages.

A, B, D, F

Which parts of the respiratory system have no normal microbiota? Check all that apply. A. Lungs B. Trachea C. Nasal cavity D. Pharynx E. Alveoli F. Bronchioles

A, B, E, F

Which of the following protects the upper respiratory tract? A. Mucociliary escalator B. Eustachian tubes C. Tonsils D. Adenoids E. Nasolacrimal duct F. Mastoid air cells

A, C, D

Which of the following are virulence factors of Streptococcus pyogenes? A. M protein B. Attachment pili C. Hyaluronic acid capsule D. A-B exotoxin E. Proteins F and G F. Streptolysins

A, C, E, F

In which disease are monoclonal antibodies against PA protein used as treatment? A. Inhalation anthrax B. Legionellosis C. Pertussis D. Pneumococcal pneumonia E. Influenza

A. Inhalation anthrax

An 80-year-old woman in a nursing home develops fever and chills, a productive cough with bloody, gelatinous sputum (resembling red currant jelly), and chest pain. She is given a combination of antibiotics, including a carbapenem, but fails to respond to the treatment. Within a few days, she dies. Given this information, you can conclude that the woman likely died from A. Klebsiella pneumonia B. Influenza C. Viral pneumonia D. Hantavirus pulmonary syndrome E. Mycoplasmal pneumonia F. Pneumococcal pneumonia

A. Klebsiella pneumonia

The conjuctivae A. have few resident bacteria B. are often covered with bacteria C. are populated with S. aureus D. are populated with S. pyogenes E. are protected by IgE

A. have few resident bacteria

All of the following are ways to avoid catching a cold EXCEPT A. receiving a rhinovirus vaccine. B. frequent hand washing. C. avoiding touching the face. D. avoiding crowds and crowded areas. E. These are all ways to avoid catching a cold.

A. receiving a rhinovirus vaccine.

Most colds are probably caused by A. rhinovirus B. S. aureus C. Pseudomonas sp D. E. coli E. varicella

A. rhinovirus

Please select all of the infections that are frequently caused by Streptococcus pneumoniae and Haemophilus influenzae to test your understanding of the parts of the upper respiratory system commonly infected by these organisms. A. Influenza B. Sinus infections C. Earache D. Strep throat E. Pinkeye

B, C, E

Why must new influenza vaccines be developed annually? Check all that apply. A. Avian and swine influenza viruses frequently combine B. The genes coding for HA and NA antigens mutate frequently C. Genetic reassortment occurs annually D. Every year some avian influenza strains acquire the ability to infect humans E. Antigenic shift frequently occurs F. Antigenic drift frequently occurs

B, F

Are people infected with Mycobacterium tuberculosis always highly infectious to those around them? A. Yes—as the causative agent is transmitted by direct contact, everything the infected person touches can get contaminated with it. B. No—in the early stages of the disease, people with TB do not have a cough, which is how M. tuberculosis is usually transmitted. C. No—they are only infectious in the early stages of disease, when they have many bacteria in their lungs. D. Yes—people infected with this bacterium constantly shed high numbers of organisms into the environment around them. E. Yes—the infectious dose of M. tuberculosis is so low people infected with it are always contagious.

B. No—in the early stages of the disease, people with TB do not have a cough, which is how M. tuberculosis is usually transmitted.

Which disease is characterized by paroxysmal coughing, caused by mucous production in conjunction with decreased mucociliary action? A. Klebsiella pneumonia B. Pertussis C. Tuberculosis D. Legionellosis E. Mycoplasmal pneumonia

B. Pertussis

Which of the following causative agents of pneumonia is a eukaryote? A. Mycoplasma pneumoniae B. Pneumocystis jirovecii C. Klebsiella pneumoniae D. Legionella pneumophila E. Streptococcus pneumoniae F. P. jirovecci AND M. pneumoniae

B. Pneumocystis jirovecii

A child is sent home from class after complaining of feeling unwell. His symptoms include a severe sore throat with pus on his tonsils, swollen lymph nodes, and a mild cough. He also has conjunctivitis and diarrhea. His parents take him to the doctor, who prescribes a course of penicillin. Three days later the child has shown little improvement, and his parents bring him back to the doctor who tells them to give the child analgesics for his pain. Within a week, the child begins to recover and after three weeks he is completely well. Based on this information, it is likely that the child had A. a common cold B. adenoviral respiratory tract infection C. pneumonia D. streptococcal pharyngitis E. tuberculosis

B. adenoviral respiratory tract infection

The destructive nature of tuberculosis can be characterized as a(n) A. endotoxin pyrogenic response B. delayed-type cell-mediated hypersensitivity reaction C. immune complex reaction D. inflammatory response E. inflammatory pyogenic response

B. delayed-type cell-mediated hypersensitivity reaction

Both S. pneumoniae and K. pneumoniae use this as a virulence factor. A. Pili B. Flagella C. Capsules D. Cilia E. Toxins

C. Capsules

Choose the statement that best describes the normal microbiota of the upper respiratory tract. A. Limited to several types of Gram-negative bacteria. B. No normal microbiota in the upper respiratory tract. C. Contains a variety of microbes including some that can cause serious disease. D. Limited to a few types of Gram-positive bacteria. E. Contains a variety of microbes but not any that can cause serious disease.

C. Contains a variety of microbes including some that can cause serious disease.

The Mantoux test can help to identify people infected with A. Bordetella pertussis B. Streptococcus pneumoniae C. Mycobacterium tuberculosis D. Klebsiella pneumoniae E. Corynebacterium diphtheriae

C. Mycobacterium tuberculosis

Which step(s) of phagocytosis are avoided by Streptococcus pyogenes? A. Recruitment of phagocytes AND phagolysosome formation B. Phototaxis AND recognition and attachment C. Recruitment of phagocytes AND recognition and attachment D. Phagolysosome formation E. Phagolysosome formation AND lysis

C. Recruitment of phagocytes AND recognition and attachment

Which of the following does NOT explain why a patient with Klebsiella pneumonia is more likely to die than one with pneumococcal pneumonia? A. Treatment options for Klebsiella pneumonia are limited because the causative agent is resistant to many antibiotics. Pneumococcal pneumonia can be treated with antibiotics such as penicillin. B. The causative agent of Klebsiella pneumonia is Gram-negative and may cause septic shock. Streptococcus pneumoniae is a Gram-positive bacterium so does not have endotoxin. C. The most severe types of Pneumococcal pneumonia can be prevented with the PPSV23 vaccine. There is no vaccine that protects against Klebsiella pneumonia. D. Klebsiella pneumoniae causes lung abscesses which may result in the death of the patient. Pneumococcal pneumonia does not result in permanent lung damage. E. All of these statements explain why Klebsiella pneumonia is more frequently fatal than pneumococcal pneumonia.

C. The most severe types of Pneumococcal pneumonia can be prevented with the PPSV23 vaccine. There is no vaccine that protects against Klebsiella pneumonia.

Smokers are at higher risk of respiratory infections because A. chemicals in cigarette smoke increases the replication rate of most pathogens. B. cigarette smoke is carcinogenic and pathogens can invade cancer cells. C. chemicals in cigarette smoke can impair the mucociliary escalator. D. they produce excess mucus that traps viruses and bacteria in their lungs. E. people who touch cigarettes are exposed to viruses that are transferred from their hands to their lungs.

C. chemicals in cigarette smoke can impair the mucociliary escalator.

Developing a vaccine to protect people from the common cold has not been possible because: A. cold viruses mutate frequently, changing their surface antigens. B. the causative agent of colds is unknown. C. colds are caused by a large number of immunologically different viruses. D. vaccines cannot be developed for viral diseases. E. it is difficult to culture rhinoviruses for creating a vaccine.

C. colds are caused by a large number of immunologically different viruses.

TB disease may occur in those with latent tuberculosis infection (LTBI) when A. the microbes used in the BCG vaccine revert to virulence. B. alveolar macrophages that have engulfed M. tuberculosis become activated. C. the person's immune system is impaired by stress, advanced age, or disease such as AIDS. D. the generation time of M. tuberculosis is reduced from 16 hours to 20 minutes. E. M. tuberculosis bacteria enter the bloodstream and become systemic.

C. the person's immune system is impaired by stress, advanced age, or disease such as AIDS.

Antibiotics prevent the transmission of diphtheria, but are insufficient for treating the disease. Which of the following statements explains this? A. Diphtheria is caused by a bacterium that is completely resistant to all antibiotics B. Diphtheria is caused by a virus, on which antibiotics have no effect C. The causative agent of diphtheria enters a latent stage, during which time antibiotics are ineffective D. The signs and symptoms of diphtheria are toxin-mediated; antibiotics have no effect on the toxin

D. The signs and symptoms of diphtheria are toxin-mediated; antibiotics have no effect on the toxin

Why are there currently no vaccines against Streptococcus pyogenes? A. There are many antigenic types in the M protein of this organism. A vaccine against one type might not protect against another. B. There is great variation in the polysaccharide capsule of this organism. A vaccine against one type might not protect against another. C. Antibodies to streptococcal M protein may also recognize and bind to myosin in the heart, causing autoimmunity and leading to rheumatic fever. D. There is great variation in the M protein of this organism. A vaccine against one M type might not protect against another AND antibodies to streptococcal M protein may also recognize and bind to myosin in the heart, causing autoimmunity and leading to rheumatic fever. E. There is great variation in the polysaccharide capsule of this organism. A vaccine against one type might not protect against another AND antibodies to streptococcal M protein may also recognize and bind to myosin in the heart, causing autoimmunity and leading to rheumatic fever.

D. There is great variation in the M protein of this organism. A vaccine against one M type might not protect against another AND antibodies to streptococcal M protein may also recognize and bind to myosin in the heart, causing autoimmunity and leading to rheumatic fever.

Virulence factors used by S. pyogenes include all of the following EXCEPT A. protein F B. M protein C. a capsule D. lipopolysaccharide E. protein G

D. lipopolysaccharide

The signs and symptoms of adenovirus respiratory tract infections may be confused with those of A. pneumonia AND tuberculosis B. tuberculosis AND diphtheria C. pertussis AND pneumonia D. strep throat AND pneumonia E. strep throat AND pertussis

D. strep throat AND pneumonia

Adenoviral pharyngitis is effectively treated with A. antibiotics B. lysozyme C. proteases D. nucleotide analogs E. None of the choices is correct

E. None of the choices is correct

Colds are effectively treated with A. antibiotics B. aspirin and acetaminophen C. proteases D. nucleotide analogs E. None of the choices is correct

E. None of the choices is correct

Strep throat (streptococcal pharyngitis) is caused by A. S. pneumoniae B. M. pneumoniae C. H. capsulatum D. S. aureus E. S. pyogenes group A

E. S. pyogenes group A

Which is/are true of the causative agents of coccidioidomycosis and histoplasmosis? A. They are both photosynthetic soil fungi. B. They are both dimorphic parasitic fungi. C. They both cause life-threatening illnesses. D. They both cause diseases that may be treated with antibiotics. E. They are both dimorphic soil fungi.

E. They are both dimorphic soil fungi.

Legionella pneumophila is acquired A. by direct contact with an infected person. B. by ingestion of contaminated meat products. C. by touching contaminated fomites and surfaces. D. by inhalation of humid air in tropical forests. E. by inhaling water droplets contaminated with the organism.

E. by inhaling water droplets contaminated with the organism.

Rhinoviruses need to be grown A. in living cells AND at 39°C B. in synthetic media AND at 39°C C. on blood agar AND at 33°C D. in live animals or plants E. in living cells AND at 33°C

E. in living cells AND at 33°C

Mycoplasmal pneumonia is different from pneumococcal pneumonia in that A. mycoplasmal pneumonia is caused by a virus while pneumococcal pneumonia is caused by a bacterium. B. mycoplasmal pneumonia always requires hospitalization. C. the causative agent of mycoplasmal pneumonia cannot be cultured in the lab, so Koch's postulates cannot be proved. D. the causative agent of mycoplasmal pneumonia is unknown. E. mycoplasmal pneumonia cannot be treated with penicillin.

E. mycoplasmal pneumonia cannot be treated with penicillin.

Please determine whether the following statement is true or false: "The influenza virus is able to decrease the effectiveness of the host immune response by a mechanism called antigenic drift, which involves the reassortment of gene strands with other influenza viruses."

False

True/False: Corynebacterium diphtheriae is an invasive, toxin-producing, pleomorphic spore-forming bacterium that aggressively enters tissues and the bloodstream.

False

True/False: Ear infections caused by Haemophilus influenzae cannot be treated with antibiotics such as amoxicillin because this causative agent is a virus.

False

True/False: Influenza viruses that have undergone antigenic drift are more problematic than those that have undergone antigenic shift because antigenic drift leads to annual influenza epidemics.

False

True/False: Mycoplasma is effectively treated with cell wall inhibiting antibiotics.

False

True/False: People with latent TB infection develop tuberculous lung cavities that cause permanent tissue damage.

False

Match the statements to the disease that they are describing in order to test your understanding of strep throat and diphtheria. 1. Sequelae can include paralysis, and both heart and kidney failure. 2. Symptoms begin with a mild sore throat and extreme fatigue and malaise. 3. Disease presents as a sore throat accompanied with difficulty with swallowing 4. Sequelae can include glomerulonephritis and rheumatic fever.

Strep throat - 3, 4 Diphtheria - 1, 2

True/False: A vaccine is available for protection from pneumococcal pneumonia.

True

True/False: Histoplasmosis may mimic tuberculosis.

True

True/False: S. pneumoniae can cause infections of both the upper respiratory tract and the lower respiratory tract.

True

True/False: The lipids of foamy macrophages are thought to facilitate M. tuberculosis survival in the host cell.

True

True/False: The main virulence factor of both K. pneumoniae and S. pneumoniae is a capsule.

True

Please assign the diseases to either the upper or the lower respiratory tract on the figure. Not all labels are used.

Upper respiratory system: -Adenoviral pharyngitis -Common cold -Diphtheria -Otitis media -Strep throat Lower respiratory system: -Pneumonia -Legionellosis -RSV infections -Tuberculosis -Influenza -Histoplasmosis -Coccidiomycosis -Hantavirus pulmonary syndrome -Pertussis