PBL: Case 2 Part2

Question 1

Media and specimen type recommended for the setup of the following:
- Strep Screen

Answer 1

• Looking for Group A strep
• blood agar plate only; anaerobically, looking for organisms that produce streptolysin S
• (or stab plate)
• or SXT on agar to get rid of normal flora

Question 2

Media and specimen type recommended for the setup of the following:
- Archanobacterium and Group A strep?

Answer 2

Gram stain

Question 3

Media and specimen type recommended for the setup of the following:
- Sputum and other non sterile specimen

Answer 3

• SBA, CHOC, MAC, CNA
• ANA BAP
• ANA PEA (prevent swarming of proteus)

Question 4

Media and specimen type recommended for the setup of the following:
- Legonella Culture

Answer 4

BCYE (Buffer Charcoal Yeast Extract)

Question 5

Media and specimen type recommended for the setup of the following:
- Purtussis

Answer 5

• Bordet Gengou
• Reagan Lowe
• Charcoal Cephalexin Blood Agar
• nasophargeal swab

Question 6

Media and specimen type recommended for the setup of the following:
- Diphtheria

Answer 6

• Tinsdale or KTEL (brown or black halo)
• potassium telurate
• lofalers?

Question 7

Media and specimen type recommended for the setup of the following:
- Cystic Fibrosis patients

Answer 7

• Mannitol Salt agar
• PC agar
• BC agar (burkholderia)

Question 8

What is the significance, sensitivity, and specificity of rapid antigen testing in diagnosis of strep throat?

Answer 8

Rapid strep screen: 
- rapid
- not sensitive 
- very specific 
(pos it definitive but negative needs a culture)

Question 9

Significance (pathogenicity, organism identification) of polysaccharide capsules and intracellular growth for respiratory pathogens

Answer 9

• Polysaccharide capsules: more pathogenic, less easly phagosatized
• Encapsulated: strep pneuma, Kleb. Pneumo, hemophilus Influenza
• Intracellular pathogens: myco tb, legionella, significance?: pathogenicity, not as easily killed

Question 10

what is the reasoning for quantitation of organisms in respiratory tract specimens?

Answer 10

1) tells doc how overwhelming severity of pathogen and usual flora
2) tells them if it’s a good specimen or not .
* *Usual flora is quantitated in one big group

Question 11

What is the role of anaerobes in the cause of respiratory infections?

Answer 11

• significant in aspiration pneumonia

- *do not collect a sputum, more sterile?

Question 12

Relationship of positive blood cultures and pneumonia

Answer 12

***pos blood + positive for pneumonae = Strep pneumonea???

Question 13

Evaluate adequacy of sputum specimens basted on microscopic evaluations

Answer 13

• Normally found in upper respiratory: squamous epithelium cells
• Normally found in Lower Respiratory specimen: ciliated epithelium, WBCs, Macrophages (dust phagocytes)

Question 14

At what magnification do we evaluate specimen quality?

Answer 14

10X objective

Question 15

When do we reject a sputum?

Answer 15

when greater than 25 epithelium

Question 16

What organisms do we see in the sputum BUT we don’t see them on a gram stain?

Answer 16

anaerobic specimen, because we are not culturing for anaerobes

Question 17

Lower respiratory Specimen should match up with the organisms found in the _____ _____

Answer 17

gram stain

Question 18

What vaccines are available for prevention of pneumonia

Answer 18

• HIB
• DTAP or TDAP (pertussis diphtheria…
• Strep pneumo vaccine (for very young and very old)
• Niseria miningitidis vaccine

Question 19

Resistance issues

Answer 19

MRSA
VRE
CRE
ESBL 
Burkholdaria (more infections more resistance very quickly)

Question 20

Agents of bioterrorism

Answer 20

• Pulmonary Anthrax
• Bubonic plague
• Tularemia