Id Therapeutics Exam 1 Set 8

Front 1

how would you treat coag neg staph catheter infection?

Back 1

remove catheter and treat x 5-7 days with IV antibiotics, if catheter retained treat with IV antibiotics for 10-14 days plus antibiotic lock

Front 2

how would you treat staph aureus related catheter infection?

Back 2

remove catheter and treat 7-14 days with IV antibiotics

Front 3

how would you treat enterococcus related catheter related infection

Back 3

remove catheter and treat 7-14 days with IV antibiotics

Front 4

how would you treat gram - bacilli related catheter infectiond?

Back 4

remove catheter and treat 7-14 days with IV antibiotics

Front 5

how would you treat candida species related catheter infections?

Back 5

remove catheter and treat with antifungal for 14 days after first negative culture

Front 6

how would you treat a complicated catheter infection?

Back 6

remove catheter and treat for 4-6 weeks (IV antibiotics)

Front 7

MSSA (complicated catheter infection)
1. preferred therapy (2)
2. alternative therapy (2)

Back 7

1. nafcillin, oxacillin
2. cefazolin, vancomycin

**penicillinase-resistant Pen or cephalosporin are preferred to vancomycin

Front 8

MRSA (complicated catheter infection)
1. preferred therapy (1)
2. alternative therapy (1)

Back 8

1. vancomycin
2. daptomycin 6-8 mg/kg/day

**linezolid not recommended for empiric therapy (static drug-poor outcome)

Front 9

CoNS (Meth Susceptible) (complicated catheter infection)
1. preferred therapy (2)
2. alternative therapy (1)

Back 9

1. nafcillin, oxacillin
2. vancomycin

**some do not use naf or ox in this case and will use vanco regardless of susceptiblity due to heteroresistance

Front 10

CoNS (Meth resistant) (complicated catheter infection)
1. preferred therapy (1)
2. alternative therapy (1)

Back 10

1. vancomycin
2. daptomycin

Front 11

Enterococcus (complicated catheter infection) non amp resistant
1. preferred therapy (1)
2. alternative therapy (1)

Back 11

1. ampicillin with or without gentamicin
2. vancomycin

Front 12

Enterococcus (complicated catheter infection) amp resistant
1. preferred therapy (1)
2. alternative therapy (1)

Back 12

1. vancomycin with or without gentamicin
2. daptomycin

Front 13

VRE (complicated catheter infection)
1. preferred therapy (1)
2. alternative therapy (2)

Back 13

1. daptomycin
2. linezolid, synercid (quinupristin/dalfopristin)

Front 14

risk factors for developing infective endocarditis (IE) (8)

Back 14

1. structural heart disease (congenital or acquired)
2. rheumatic heart disease
3. prosthetic valve
4. mitral valve prolapse with regurgitation
5. ateriovenous fistulae
6. intravascular devices
7. pacemakers
8. IV drug use

Front 15

microorganisms that adhere to NBTE (endothelium and valves) more avidly then others (5)

Back 15

1. enterococci
2. viridans streptococci
3. s. aureus
4. s. epidermis
5. p. aeruginosa

Front 16

how to antibiotics prevent IE? (2)

Back 16

1. kill bacteria
2. inhibit adhesion

Front 17

gram - bacilli are usually isolated in endocarditis in which patients (4)

Back 17

1. IVDAs
2. hospitalized patients
3. individuals with prosthetic valves (less than 1 year following surgery)
4. patients with cirrhosis

Front 18

commonly isolated gram - bacilli from NBTE (6)

Back 18

1. salmonella
2. ecoli
3. serratia marcescens
4. pseudomonas aeruginosa
5. burkholderia cepacia
6. HACEK microorganisms (haemophilus parainfluenzae, h. influenzae, actinobacillus actinomycetemcomittans, cardiobacterium hominis, ekenella corrodens, kingella kingae)

Front 19

how long is the incubation period generally for patients with IE

Back 19

less than 2 weeks

Front 20

sx of IE (15)

Back 20

1. fever (80%)
2. night sweats 25
3. weight loss 25
4. heart murmur 85% (new 3-5%; changing murmur 5-10%)
5. embolic pneumonia 50+%
6. stroke
7. skin lesions
8. chills
9. anorexia
10. malaise
11. weakness
12. myalgia and arthralgia
13. splenomegaly
14. dyspnea
15. back pain

Front 21

small painful nodular lesions found on the pads of the fingers or toes. disappears within hours (10-23%)

Back 21

osler nodes

Front 22

red/brown streaks found in the nails (15%)

Back 22

splinter hemorrhages

Front 23

initially red, nonblanching lesions found in the conjuctivae, buccal mucosa, palate, and extremeties (20-40%)

Back 23

pectechiae

Front 24

hemorrhagic, macular, painless lesions found on the palms and soles. persists for days (less than 10%)

Back 24

Janeway lesions

Front 25

oval, pale, retinal lesions surrounded by hemorrhage (10%)

Back 25

roth spots

Front 26

factors associated with increased mortality with IE (5)

Back 26

1. CHF
2. culture negative endocarditis
3. endocarditis caused by resistant organisms (fungi or gram - bacteria)
4. left sided endocarditis caused by s. aureus
5. prosthetic valve endocarditis

Front 27

indications for surgical interventions in IE patients (6)

Back 27

1. patient develops CHF
2. valvular obstruction
3. local suppurative complications due to myocaridal abscess
4. endocarditis caused by resistant microorganism (fungi or gram-)
5. early prosthetic valve endocarditis
6. perisistent bacteremia or other evidence of failure or appropriate medical therapy

Front 28

which high risk patients should receive prophylaxis against IE (4)

Back 28

1. patients with prosthetic valves
2. patients with hx of IE
3. most patients with congenital heart disease
4. cardiac transplantation recipients who develop cardiac valvulopathy