Biol 2420 CH 19 HW
Select all of the statements that apply to healthcare-associated or nosocomial pneumonia to test your understanding of the differences between healthcare-associated and community-acquired pneumonia.
- Often are polymicrobial in origin - Bacteria enter lower respiratory tract due to abnormal breathing - Bacteria enter lower respiratory tract due to mechanical ventilation - Can be caused by coliform bacteria
Based upon the patient history information, the patient appears to be in which stage of disease?
- Paroxysmal
Choose the statement that best describes second-line (secondary) immune defenses of the respiratory tract.
- Phagocytic cells inhabit the alveoli and tonsils.
Culturing of many respiratory pathogens is time consuming. What additional diagnostic test could be performed on the specimen to provide genotypic information on the pathogen in a rapid manner?
- Polymerase chain reaction
Which of the following is INCORRECT regarding the vestibular and vocal folds?
- They are found in the nasal cavity
Which hypothesis could explain the recent outbreaks of pertussis in Australia and California?
- all of these
Based upon these results, the pathogen appears to be a:
- bacterium
The trachea is an airway that is kept open by rings of:
- cartilage
Label the image to examine the process of antigenic shift exhibited by influenza viruses.
- duck influenza virus - H RNA (top) - Human influenza virus - N RNA (above) - hybrid virus
The respiratory system is protected from invading microorganisms by only first-line (innate) immune defenses.
- false
True or False: The patient in the case should have been adequately protected from infection with Bordetella pertussis from the vaccinations she had already received.
- false
True or False: The patient must present the "whooping" sound during coughing to be positively diagnosed with pertussis.
- false
Based upon the staining results, the pathogen appears to be a(n):
- gram-negative coccobacillus
As air enters the nasal cavity
- it is cleaned before entering the rest of the respiratory system
The patient likely has pneumonia and respiratory specimens are sent to the lab to confirm this initial diagnosis. In educating the patient about the diagnosis, which organism does the RN state is the primary cause of community-acquired pneumonia?
- pneumococcus
In educating the patient about the prevention of community-acquired pneumonia, all of the following are emphasized by the RN as effective methods except:
- prophylactic antibiotics
Choose the answer that best completes the blanks of this sentence in the correct order. The influenza virus is able to evade the immune response by two mechanisms: antigenic _______, which is the swapping out of one of the gene strands with a gene strand from a different influenza virus, and antigenic ________, in which the antigens gradually change their amino acid composition.
- shift; drift
Which vaccine may a 35-year-old man who will become a father in the next 6 months be advised to receive?
- tdap
To reduce the threat to public health, patients with MDR-TB are treated with directly observed therapy.
- true
Based upon all of the information obtained through specimen testing, along with the patient's symptoms, the pathogen is most likely: A. Mycobacterium tuberculosis. B. Influenza A. C. Streptococcus pyogenes. D. Bordetella pertussis.
-D. Bordetella pertussis.
Based upon this identification, what was the most likely mode of transmission of this pathogen?
-Droplet contact
What is the most appropriate type of isolation for this patient while awaiting the results of the bacterial and viral studies?
-Respiratory precautions (droplet mask, gown, and gloves)
This image depicts an acid-fast stained sputum sample showing red bacilli. What might be a preliminary diagnosis for this patient?
-Tuberculosis
Based upon this diagnosis, what disease is the patient suffering from?
-Whooping cough
Which of the following anatomical structures is a part of the lower respiratory tract?
-bronchus
In order for proper gas exchange to occur, alveoli are surrounded by pulmonary:
-capillaries
All of the following are potential differential diagnoses that the RN may anticipate for this patient except:
-otitis media
Based upon Figure 1, how many states had a TB rate greater than the national average?
10
Drag the images to their correct category to test your knowledge of statistical information related to the transmission, pathogenesis, and treatment of microbes affecting the respiratory system.
15% - percentage of population carrying S pyogenes as normal biota 33% - mortality rate for hantavirus pulmonary syndrome 40% - percentage of CAP cases caused by Strepto pneumoniae 95% - mortality rate for epidemic forms of scarlet fever
Based upon Figure 2, in which year did the number of TB cases among foreign-born persons eclipse the number of TB cases among US-born persons?
2001
During June, the graph indicates less than ___% are positive by antigen detection.
5
By law, all states must submit reports from confirmed TB cases, which include the patient's self-identified race, ethnicity, treatment formation, and, whenever available, drug-susceptibility test results to the ____.
CDC
Match the virulence factors with the causative agents to demonstrate your understanding of the agents that cause pneumonia.
Capsule - Streptococcus pneumoniae Adhesins - mycoplasma pneumoniae Induces inflammatory response - Hantavirus Survival in phagocytes - Histoplasma capsulatum
Match the statement to the disease it best describes to test your understanding of microorganisms that cause upper and lower respiratory infections.
Caused by Bordetella; called "whooping cough" - pertussis Viral infection characterized by giant multinucleated cells - RSV Infection Viral infection causing chills, body aches, headache, and fever - Influenza
Match the pathogen to the disease it causes to test your understanding microorganisms that cause upper respiratory tract diseases.
otitis media - streptococcus pneumoniae pharyngitis - streptococcus pyogenes common old - rhinovirus diphtheria - corynebacterium diphtheriae
Label the image to assess your knowledge of respiratory system anatomy.
outside: - Upper respiratory tract - sphenoid sinus - Nostril - Pharynx - Epiglottis - Larynx - Lower respiratory tract inside: - frontal sinus - Nasal cavity - oral cavity - Trachea - Bronchus - Bronchioles Image - alveoli
How is pertussis different from RSV infection?
pertussis is caused by bacterium
The vast majority of pneumonia caused by ______ occur in AIDS patients.
pneumocystis jirovecii
Which of the following is true regarding the tuberculin skin test?
reaction involved T cell action
Which form of clinical tuberculosis has a nearly 60% mortality rate and leads to the most severe symptoms in patients?
secondary or reactivation tuberculosis
The laboratory findings are discussed with the medical team. Culturing on specialized media will be required for definitive identification of the microbe. Which medium will the technicians use to culture this suspected medium?
tellurite medium
In the case study, the patient was placed on respiratory isolation precautions because:
the infectious agent is transmitted in an airborne maner
To reduce the threat to public health, patients with MDR-TB are treated with directly observed therapy.
true
Viruses originally thought to produce cold symptoms have now been determined to cause pneumonia and death, illustrating the mutability of such viruses.
true
This image depicts an acid-fast stained sputum sample showing red bacilli. What might be a preliminary diagnosis for this patients?
tuberculosis
RSV is an infection of the ____ respiratory tract.
upper and lower
RSV is a ______.
virus
RSV infections are a the highest rate during the ____ months.
winter
The degree of scarring in the lungs as seen on the chest X ray film surprised clinicians due to the patient's:
young age
The nurse assesses the patient's medical history and notes that she has not received routine medical screening and treatment in the past 15 years. The patient could have avoided this preventable disease by staying current with which vaccination?
Td
Which of these microbes has an unusual waxy, wall structure that contributes to its virulence?
mycobacterium tuberculosis
Suspecting the patient with influenza, the nurse prepares to obtain which of the following specimens for rapid testing at an external laboratory?
nasal swab
What conclusion can you draw from the data presented in these graphs?
both respiratory diseases appear to have higher rates during times of the year when the temperatures tend to be colder
Choose the fungi that cause pneumonia to test your understanding of microorganisms that cause lower respiratory tract diseases.
- Histoplasma capsulatum - Pneumocystis jiroveci
Select all of the statements that apply to the disease diphtheria to test your understanding of upper respiratory diseases caused by microorganisms.
- A characteristic pseudomembrane forms on the tonsils and in the pharynx - Disease can be prevented by use of a toxoid containing vaccine - Toxin can enter bloodstream and cause myocarditis and neuritis
The lab calls to notify the RN that the 12-hour growth on the respiratory bacterial culture is negative. Based upon this result, which of the following is the most likely causative organism in this otherwise healthy 5-month-old child?
- A virus
Based on the initial assessment, what is the RN's priority intervention for this patient?
- Administration of supplemental oxygen
Which form of treatment should be administered to the patient at this time? A. Rifampin B. Erythromycin C. Supportive care as needed, including breathing support from a ventilator and IV fluids D. Amphotericin B
- B. Azithromycin
What antibiotic does the RN expect to be ordered for this patient?
- Cefotaxime
The viral antigen studies come back positive for respiratory syncytial virus (RSV). The parents are anxious that their older children (ages 10 years and 12 years) may have been exposed. Which of the following statements by the RN is most appropriate regarding the susceptibility of the other children?
- Children younger than 2 years of age are the most susceptible to serious disease from RSV
Choose the statement that best describes the normal biota of the upper respiratory tract.
- Contains a variety of microbes including some that can cause serious disease
Select all of the statements that are factors affecting a person's susceptibility to TB to test your understanding of the epidemiology of tuberculosis infection.
- Inadequate nutrition - Poor access to medical care - Crowded living conditions - Compromised immune system
Conducting additional research as necessary, drag the labels to complete each of the sentences discussing the damage caused by smoking that leads to upper and lower respiratory tract infections. Then, rearrange the sentences to create a logical paragraph.
1) Normal defenses of the respiratory tract include CILIATED epithelium that line the TRACHEA. The delicate cilia constantly beat upward the mucus that traps potentially PATHOGENIC bacteria, eliminating them from the respiratory system. 2) The toxins in cigarette smoke initially PARALYZE the cilia and over time destroy the epithelial cells, replacing them with more resilient SQUAMOUS cell epithelia. 3) Without the constant beating action of the cilia, mucus gathers in the lower respiratory tract which must be forced upward by COUGHING. The abundance of mucous and the inability to expel pathogens results in a warm, nutrient-rich environment for the organisms to REPRODUCE 4) A persistent smoker's cough can lead to chronic BRONCHITIS and greater susceptibility to infection, since the immune system is constantly challenged. This allows OPPORTUNISTIC pathogens to multiply and cause sinusitis and pneumonia.
Based upon the table in the report, which racial/ethnic population had the most TB cases in 2014?
Asians
Place the relevant descriptions into the correct boxes to compare and contrast these 2 respiratory diseases.
Both influenza & the common cold: - involves respiratory symptoms, including runny nose and cough - can leave patients vulnerable to secondary infections - can be transmitted through droplets and fomites - immune response contributes to the signs and symptoms of disease Common cold: - usually affects people more than once per year - treatment is limited to over-the-counter meds and rest Influenza: - can get more than once due to antigenetic shift and drift - caused by orthomyxoviruses - a vaccine exists to prevent infection - often presents with systemic effects such as fever, body aches and fatigue - causative agents also infect swine and birds
Match the statement to the disease it best describes to test your understanding of microorganisms that cause upper respiratory infections.
Caused by Corynebacterium diphtheriae which eventually results in pseudo-membrane formation on the tonsils or pharynx - Diptheria Most common cause is Streptococcus pneumoniae and results in a sensation of fullness or pain in the ear - Otitis Media Streptococcus pyogenes infection that results in a sore throat with reddened mucosa, swollen tonsils, and pus nodules - Bacterial Pharyngitis Caused by hundreds of viruses and results in sneezing, scratchy throat, and runny nose - common cold Caused by a number of bacteria and results in nasal congestion, pressure above the nose or in the forehead, and headache - sinusitis
What age group is the most susceptible to serious RSV infection?
Children under 6 months
Move the correct terms into the empty boxes to complete the concept map
Community-acquired pneumonia (top) - Bacteria -- S. pneumoniae - Viruses - Fungi -- H. capsulatum, P. jiroveci
Examination of the throat swab specimen reveals distinct gram-positive club-shaped bacilli. The laboratory technician immediately contacts the medical team and begins the process of submitting specimens for PCR testing to the CDC. The suspected pathogen is:
Corynebacterium diphtheriae
What is the mechanism of pathogenicity for this disease and how does it lead to the manifestations?
Corynebacterium diphtheriae produces a cytotoxin that destroys tissue in the throat and attracts immune cells
Order the following structures of the upper respiratory tract, going from the uppermost structure to the lowest structure in the tract, to test your understanding of respiratory anatomy.
Larynx - 4 Nasal cavity - 1 Epiglottis - 3 Pharynx - 2
Move the correct terms into their corresponding empty boxes within the figure to complete the concept map.
Left side: - S. pneumoniae middle: - viruses Right side: - fungi - P. jiroveci
Label this figure to examine various aspects of the two major forms of pneumonia. Use the pop-up hints to help you complete the concept map correctly.
Left: - Community acquired: -Bacterial: S. pneumoniae, Legionella sp., Mycoplasma pneumoniae - Viral: Hantavirus, SARS - Fungal: Histoplasma capsulatum, pneumocystis jiroveci Right: - Healthcare-associated - polymicrobial infections - transmitted through aspiration in patient - prevention through proper patient positioning - treatment with multiple antibiotics is advised
Label the image to assess your overall knowledge of disease-causing microbes of the respiratory system.
Left: - sinusitis:Various bacteria and fungi - rhinitis: over 200 viruses - Diphtheria: corynebacterium diphtheriae -influenza: A,B,and C viruses - pneumonia: S. pneumoniae, Pseudomonas, Hantavirus, Histoplasma Pneumocystis Right: - Otitis media: S.pneumoniae and other bacteria -pharyngitis: S.pyogens, Fusobacterium, and viruses - whooping cough: Bordetella pertussis -Respiratory Syncytial Virus : RSV - tuberculosis: Mycobacterium tuberculosis
In the case study, all new employees at the hospital were required to have which test to rule our tuberculosis?
Mantuox skin test
Based on what you know about rhinovirus infection, do you think the data in the left graph is an accurate presentation of the total number of common colds in Colorado in 2016?
No, the common cold is caused by more than rhinoviruses, and most patients do not get tested in the laboratory for this infection
The laboratory findings report that the child is infected with influenza B virus. Which of the following medications would the nurse expect to be ordered for this child?
Oseltamivir
Drag the statements or images to their correct category to examine the spectrum of diseases caused by microorganisms affecting both the upper and lower respiratory tracts.
Pertussis: - whooping cough - caused by bordetella pertussis, transmitted by droplet contact which uses many toxins for virulence - DTaP acellular vaccine used for prevention RSV Disease: - caused by a paramyxovirus that causes giant multinucleated cells called syncitia in the respiratory tract. - passive antibody preparation used for prevention in high-risk children since no vaccine is yet available Influenza: - H and N spikes image - caused by one of three;,A,B,Corthomyxoviruses; Types A, B, or C - Virulence of the causative agent due to its ability to alter envelope glycoprotein spikes - seasonal vaccines exist for this disease, though new pandemic strains have prompted the development of additional vaccines
Drag the labels to the correct category to demonstrate your understanding of streptococcal infections.
Phenotypic characteristics: - gram positive coccus - capsule, M protein, slime layer, streptolysins produced - does not form catalase Diseases caused: - pharyngitis - rheumatic fever - scarlet fever Culture & Diagnosis: - rapid antigen tests - beta hemolysis - sensitivity to bacitracin Treatment: - penicillin - cephalexin
Complete this table with the correct information to demonstrate your understanding of RSV infection.
Respiratory Syncytial virus: - droplet & fomite contact - syncytia formation Direct Antigen Testing: - passive antibody preparation - antiviral drugs in serious cases - !% mortality in US general population
Match the statement to the sequelae (complication) to the correct description to show your understanding of Streptococcus pyogenes infection .
Results from a Streptococcus pyogenes strain that is infected with a toxin-coding bacteriophage and is characterized by a sandpaper-like rash - Scarlet Fever Due to an immunological cross reaction between the streptococcal M protein and heart muscle - Rheumatic Fever Results from streptococcal proteins forming immune complexes which are deposited on the basement membranes of the kidney - Glomerulonephritis Streptococcal toxins that act as superantigens and cause skin issues - psoriasis
Drag the statements or images to their correct category to examine the spectrum of upper respiratory tract diseases caused by microorganisms.
Rhintis: - the common cold, caused by 200+ viruses transmittedby indirect or droplet contact - symptoms due to the localzed inflammatory reaction mounted against the virus, similar to those of inhalant allergies Sinusitis: - Often caused by mixed bacterial infections including S. pyogens, S. Pneumoniae, and H. influenzae, which are then treated wth broad-spectrum antibiotics - Inflammation of the sinuses caused by allergies, bacterial and/or fungal (less common) infections, or structural problems Diphtheria: - Pseudomembrane forms on the tonsils or pharynx - caused by corynebacterium diphtheriae, which produces an exotoxin: prevention by DTaP vaccination Pharyngitis: - Viral forms of this disease are typically less severe but are associated with hoarseness - S. pyogenes causes an often severe form of disease, due to its generation of surface antigens, toxins, and enzymes Otitis media: - Can be associated with a viral infection, or caused by a bacterial infection in the normally sterile middle ear - Routine use of broad-spectrum antibiotics for treatment has lead to resistance; "watchful waiting" is now recommended
Based on what you know about influenza and the data presented in the right graph, when would be the best time to receive an influenza vaccination?
September
If the journalist was susceptible to this disease, why did she note develop it in the United States?
She was protected by herd immunity; those around her received the vaccination in childhood
Drag the labels to the correct categories to demonstrate your understanding of tuberculosis. Use the pop-up hints to help you complete this concept map correctly.
Top: Tuberculosis Middle: -M. tuberculosis -M. Avium -- MAC Left: - 3 forms of disease: - primary - secondary - extrapulmonary Middle: - diagnosis w/direct or indirect tests - Tuberculin test -acid-fast staining - Antimicrobial sensitivity testing - chest x-rays Right: - long-term drug treatment - noncompliance leads to resistant strains - MDR-TB -XDR-TB
Mycobacterium tuberculosis is a(n):
bacterium
The patient's clinical condition deteriorates rapidly. Even without laboratory confirmation of the pathogen, the provider orders which course of treatment?
administration of antitoxin to treat the patient's suspected diphtheria
RSV infection is prevented with _______ immunity in high-risk groups like premature infants.
artificial, passive
In this case, Micheal likely contracted RSV from his ______.
day care or siblings
What disease is the journalist likely to have and why was she not immune?
diphtheria - not vaccinated as a child
RSV is most commonly diagnosed with ___.
direct antigen testing
Which of the following organisms is most problematic with respect to the resistance to antibiotics?
mycobacterium tuberculosis
These two graphs cannot be compared because they are different types of graphs and do not depict the same kind of data.
false
True or false: the diagnosis of tuberculosis was confirmed by the clinical findings consistent with this disease in the patient's chest X ray.
false
True or false: the patient in the case study was treated by directly observed therapy.
false
What other disease (s) affect both upper and lower respiratory tracts?
influenza & pertussis
The rapid microbial analysis is negative for group A Strep and reveals the presence of only normal biota in the patient specimen. Based upon this information, all of the following microbes can be ruled out in the diagnosis except ______.
influenza A
The RN educates the patient about diphtheria. In explaining the role of exotoxin in the pathogenesis of the disease, the nurse correctly states that the exotoxin:
is the major virulence factor of the disease and is released in the blood causing system effects
In the case study, the patients had a great deal of scarring in his lungs. Such scarring along with the formation of tubercles is often seen in TB patients due to the action of:
mononuclear cells