Jungkind- Lab Diagnosis, Test Procedure

Front 1

Testing for congenital infection:
1. what, when do you check

2. expected result for + and -

Back 1

1. AB titer, at birth, 3-4 months
2. neg: no IgM, IgG↓ at 50%/month ( eg. 1:16 titer drop to 1:8)
positive: IgM present, IgG↑

Front 2

Three characters of third generation immunoassays

Back 2

1. sensitivity/ specificity ok
2. single tests - easy to detect, solid or membrane based
3. convenient

Front 3

4th gen asssays detect how many things

Back 3

detect 2 things and use novel technology.

1. either AG/AB or multiple AG
2. superior reagnets : monoclonal AB or recombinant AG

3. new improved technology

Front 4

First molecular nucleic acid amplification method

Back 4

target amplication with PCR

Front 5

purpose of microarrays, an emerging diagnostic tech

Back 5

ID & type microbial, detect host response, unique- run multiple tests on a single specimen

Front 6

name two types of arrays

Back 6

microbe & host oriented ( predict worse outcome, problem with Rx : eg HIV pt with certain gt have hypersensitivity to abacavir)

Front 7

results of culture vs. chemical test

Back 7

culture: + or - ( ie grow or not grow)
chemical (molecular tests or immunoassays): shades of grey- end pt= color with various intensity, multiple run with various end pts, bell curves in +/- patients.

Front 8

true or false: prevalence can affect predictive values

Back 8

true: 98% specificity and sesitivity with 1% prevalence with have 1TP, 2 FP: PPV will be low- 67% will be FP and 33% TP

Front 9

2 things u should be aware about technology as a clinician

Back 9

help pts be aware that FDA approve certain % FP, FN

test can be for: screening or confirmation - 1 tests can't do all, don't rely on 1 test, repeat.

Front 10

specimens beyond salvage

Back 10

mis ID, in fixative, dried, insufficient quantity

Front 11

organisms that require prompt culture

Back 11

Haemophilus decreyi
anaerobes in reg tube
n. gonorrhoeae in joint fluid

Front 12

two types of contaminated specimens

Back 12

expected ( has normal flora) vs. unexpected contamination ( sterile specimen with itroduced bacteria- inadequate cleaning, "talkers" while csf collection)

Front 13

how many sets blood should you collect for continuous/ intermittent bacteremia

Back 13

2-3 sets /episode
continuous ( 1 aerobic/ 1anaerobic)

intermittent- collect before antibiotics

draw from new site ( 2 sticks /set?)

Front 14

things to avoid before blood collection

Back 14

don't just use alcohole ( iodophore for 2 min)

don't collect 5+ sets, 1 set

don't collect 1 bottle per set (collect aerobic/ anaerobic)

don't collect all sets from 1 needle( don't collect from femoral vein, venous catheters)

Front 15

T ot F : postmortem blood rarely useful

Back 15

true

Front 16

2 things to do to prevent csf contamination

Back 16

wear mask, and gram stain from cell count tube- contaminants contain g negative and are not on the streak line)

Front 17

best sample for pneumonia

Back 17

1. lung tissue bx from OR
2. saliva free sputum from bronchoscopy ( low in epithelical cells)
3. cough sputum ( low epithelial)

Front 18

this must be avoid when collecting cough sputum for culture

Back 18

saliva ( has squamous cells and wbc - pus cells)

Front 19

how soon should you refrigerate urine , how fast do bacteria double in it

Back 19

refrigerate with 1hr, org doble every 30 min.

Front 20

urine collection criteria

Back 20

clean catch, morning, refrigerate or in preservative tube.

Front 21

urine preservative chemical characteristic

made of, toxicity, what initiate growth
cost, duration of effect

Back 21

boric acid based
toxic
dilution initiates growth
$2/sample, effective for 8-24 at 20C

Front 22

unsuitable samples for detecting UTI

Back 22

from catheter tip, bag,
unsupervised female with no extensive instruction
left out for 2hrs

Front 23

describe community acquired diarrhea: up to when, cause

Back 23

occur before 3 days in hospital
cause: parasite, bacterial, viral

Front 24

3 bacterias that cause community acquire diarrhea

Back 24

salmonella, shigella, campylobacter

"sashi camp"
(sashi=dog)

Front 25

cause diarrhea in patients hospitalized for more than 3 days. Those with recent antibiotic and chemotherapy.

Back 25

C. Difficile toxin

Front 26

2 don'ts for contaminated surface wounds

Back 26

don't swab superficial layers
don't use surgical techniques to take superficial specimen with surface contamination.

( to go deep, don't use swab, use surgical/ bx)

Front 27

can't culture anaerobes in these

Back 27

contaminated with fecal
midstream, from cath
expectorated sputa
throat, nose, oropharyngeal swabs
gastric contents
vaginal and cervical swabs ( normale anaerobic flora?)
superficial material from skin
( wound, eschar, ulcers, sinus tracts)

Front 28

minimum antibiotic concentration that inhibits growth

con of this

Back 28

MIC

(costly to measure, multiple tubes required)

Front 29

other name for kirkby bauer test

what variables are measured

Back 29

disk diffusion test

measure "SIR ( out-->in) " (susceptible, inhibition, resistant)

Front 30

cons of Bauer Kirkby Disk test

Back 30

O/N incubation
Average accuracy 92%
Bug/Drug specific contraindications

Front 31

E test use what instead of paper disk?\

Measures what?

Back 31

Strip

MIC

Front 32

Beta Lactamase confer resistance to
which drugs? of which bacterial form?

what makes it so challanging?

Back 32

Penicillin, cephalosporins in certain g- rods

The resistance is insidious: dev slowly and often missed in the susceptibility test (not economical)

Front 33

species with inducible B- Lactamase

Back 33

PE CAKE

( pseudomonas, enterobacter, citrobacter, aeromonas, klebsiella, ecoli)

Front 34

how to report possibility of inducible B-lactamase?

Back 34

lab report to alert but lab test can't reliably detect it.
( doc should be aware of B-lacamase when treating with B-lactam antibiotics)

monitor carefully.

Front 35

inducible B- lactamase that just became ready for limited routine testing. in what micro- organism?

Back 35

Amp C in enterobacteriaceae.

Front 36

downside of KPC producer detection

Back 36

some show low level carbapenem resistance- may not be detected on automated system.

other words: hard to detect low resistance.

Front 37

when do you suspect KPC producer

KPC= klebsiella, pneumoniae carbapenemase

Back 37

in enterobacteriaceae- especially klebsiella pneumoniae resistant to cephalosporins.

Front 38

true or false-
acute infection must be treated after the lab results come out

Back 38

false-
for acute infection, often treatment given before specific lab results are available.