Id Rotation - Exam Flashcards 5 (Pgs 231-297)

Front 1

How does a Campylobacter infection present?

Back 1

1. Prodrome of fever, headache, myalgias and malaise 12-24 h before
2. Acute enteritis with fever, abdominal pain, and loose, watery or bloody stools

Front 2

What is the current mainstay of therapy for Campylobacter infections?

Back 2

Macrolides

Front 3

How is HIV confirmed in the laboratory?

Back 3

1. Serum ELISA test
2. Positive ELISA repeated
3. After 2 positive ELISA tests, confirmatory Western blot is done

Front 4

When should HIV patients be encouraged to take antiretroviral drugs?

Back 4

When CD4 count is less than 350/mm3

Front 5

What three types of drugs are used in HAART therapy?

Back 5

1. Nonnucleoside reverse transcriptase inhibitors (NNRTIs)
2. Nucleoside reverse transcriptase inhibitors (NRTIs)
3. Protease inhibitors

Front 6

HAART: NNRTI MOA

Back 6

Blocks HIV replication cycle at the point of RNA-dependent DNA synthesis by binding to it and altering the position of amino acids = alteration of viral structure

Front 7

HAART: NRTI MOA

Back 7

Acts as a competitive inhibitor of HIV reverse transcriptase and a chain terminator of viral DNA synthesis

Front 8

HAART: PI MOA

Back 8

Inhibits protease of HIV, preventing cleavage of viral poly-proteins resulting in immature virus formation

Front 9

What is the leading source of bacteremia in the ICU?

Back 9

Central lines

Front 10

What are the 2 major pathways of line infections?

Back 10

1. Extraluminal: colonization of the intravascular part of the catheter from the skin
2. Endoluminal: resulting from contamination of catheter hub during manipulation

Front 11

Common central line contaminants resulting in infection

Back 11

Gram + cocci (esp. coag neg staph) and candida

Front 12

Name three recommendations to reduce the risk of blood infections from central venous catheters.

Back 12

1. Use sterile barrier precautions during insertions
2. Prep skin with 2% chlorhexidine during CVC insertion
3. Use antimicrobial or antiseptic impregnated CVC in patients expected to have catheter > 5 days
4. Use CVC with minimum number of ports or lumens
5. Use subclavian site rather than jugular or femoral sites

Front 13

Define nosocomial FUO

Back 13

Fever that started > 72 hours after admission to an acute care hospital that persists w/o obvious source of infection

Front 14

When eosinophilia is found in a patient with nosocomial FUO, what could this be an indicator of?

Back 14

Drug fever

Front 15

What tests should be run routinely in FUO?

Back 15

CBC, BMP, blood cx, line cx, U/A w/ cx, CXR and/or CT, stool cx

Front 16

What are generally the most common Gram neg pathogens in nosocomial PN?

Back 16

Pseudomonas, Enterobacter, and Acinetobacter

Front 17

Nine reasons for fever in the ICU

Back 17

POP RUNS DC
Post-op abscess
Occult ischemia
Phlebitis
Respiratory - PE/atelectasis
Unknown
Nosocomial infxn (UTI, PN, wound, catheter)
Sinusitis/OM
Drugs
Central fever - after CVA

Front 18

Appropriate therapy for gram neg bacteremias in neutropenic patients

Back 18

Zosyn monotherapy

Front 19

What is the typical duration of IV antibiotic treatment for osteomyelitis?

Back 19

4-6 weeks

Front 20

How is a prosthetic joint infection treated?

Back 20

Two stage procedure:
1. Surgical debridement and removal of infected hardware - abx impregnated spacer is placed
2. After 4-6 wks of IV abx, new prostheses are implanted

Front 21

When can osteomyelitis be treated orally?

Back 21

Hematogenous osteomyelitis in children and Enterobacteriaceae osteomyelitis in adults

Front 22

How is septic arthritis usually acquired? What is the most common pathogen?

Back 22

Usually hematogenous spread - S. aureus is most common

Front 23

T/F: Viral septic arthritis is commonly monoarticular.

Back 23

FALSE - polyarticular; bacterial is generally monoarticular

Front 24

What is the most common joint to present with septic arthritis?

Back 24

Knee

Front 25

Acute vs. chronic osteomyelitis

Back 25

Acute: fever, bone pain, drainage, often after bacteremia
Chronic: subclinical, drainage of infected bone, presence of sequestra (dead bone patches)

Front 26

Osteomyelitis most commonly occurs as a result of contiguous/hematogenous spread.

Back 26

Contiguous (in adults)
Hematogenous (in pediatrics)

Front 27

How much of the bone has to be affected before osteomyelitis is apparent on an x-ray?

Back 27

40-50% (10-30 days of infection)

Front 28

What is the most common infecting organism in prosthetic joint infections?

Back 28

S. epidermidis

Front 29

What is the common duration of IV abx treatment for prosthetic joint infections?

Back 29

6 weeks

Front 30

What is the classic symptom triad in Reiter's syndrome?

Back 30

1. arthritis
2. nongonococcal uretheritis
3. conjunctivitis

Front 31

Treatment for Reiter's Syndrome (reactive arthritis)

Back 31

NSAIDs, steroids, anti-rheumatic drugs; abx not helpful

Front 32

Definition of postpartum fever

Back 32

Temp > 100.4 (38C) on any 2 of first 10 days postpartum (excluding first 24 hours - unless high temp and evidence of infection)

Front 33

What is the most common infection associated with postpartum fever?

Back 33

Uterine infection (endometritis)

Front 34

Empiric tx for endometritis

Back 34

Clinda + gent or Amp + gent or tobra

Front 35

Treatment for mastitis

Back 35

Dicloxacillin

Front 36

28 yo female presents 6 days postpartum with fever, tachycardia, rope-like tender abdominal mass. Has h/o PID and recent pelvic surgery. Dx is likely...

Back 36

Septic Pelvic Thrombophlebitis

Front 37

Tx for septic pelvic thrombophlebitis

Back 37

Broad spectrum abx, anticoagulation with heparin, surgery if necessary

Front 38

54 yo male with long h/o alcohol abuse presents with productive cough, fever, SOB and CXR shows ULL pneumonia with cavitary lesions. Infecting organism is likely to be...

Back 38

Klebsiella

Front 39

What pathogen is responsible for PN that has concurrent GI sx (N/V/D, anorexia) >50% of the time?

Back 39

Legionella

Front 40

Name the likely PN-causing organisms:
1. bloody or rust colored sputum accompanied by rigors
2. HA, malaise, N/V/D
3. Foul smelling sputum
4. Green sputum
5. Currant jelly sputum
6. Cavitation + pleural effusions

Back 40

1. Pneumococcus
2. Legionella
3. Anaerobic infection
4. Pseudomonas or Haemophilus
5. Klebsiella and Pneumococcus
6. TB

Front 41

MAC includes what two infecting organisms?

Back 41

M. avium and M. intercellulare

Front 42

Lung infections: CT shows "halo sign" and "air crescent" sign.

Back 42

Aspergillosis

Front 43

What is the leading cause of CAP?

Back 43

S. pneumoniae (also leading cause of meningitis and AOM)