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Pathophys II > Infectious disorders > Flashcards

Infectious disorders Flashcards

1
Q

Antibiotic resistance is

A

bacteria that have become resistant to the antibiotics designed to kill them
* it does not mean that the body is becoming resistant to antibiotics

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2
Q

________ are responsible for an increasing number of hospital acquired infections

A

multi-drug resistant organisms

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3
Q

The antibiotic class that causes the most allergic reactions is

A

the Beta lactams (includes penicillin)

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4
Q

The types of penicillin include

A 
penicillin G (must be given IV) destroyed by stomach acid
Penicillin V (given by mouth) semi-synthetic
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5
Q

There is a crossover allergy between

A

penicillin & cephalosporins

cephalosporins contain benzylpenicillin causing the side chain reaction

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6
Q

Patients with penicillin allergies should

A

avoid 1st generation cephalosporines (cefazolin & cephalexin)

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7
Q

Surgical site infection statistics:

A

2 to 5% for extra-abdominal surgeries
20% for intraabdominal surgeries
15% of all nosocomial (hospital acquired) infections
Occur within 30 days of surgery or within 1 year of a prosthetic implant or organ

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8
Q

Prevention of SSI includes:

A

preoperative antibiotics- timed so that concentration is established in the serum and tissues when incision is made
glycemic control <200 mg/dL
maintain normothermia
optimize oxygenation
shower/bath prior to surgery with antimicrobial soap
intraoperative skin prep with an alcohol-based antiseptic agent

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9
Q

Blood stream infections are most likely due to

A

central venous catheters

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10
Q

Catheter associated BSI is defined as

A

bacteremia or fungemia in a patient with an intravascular catheter and at least one positive blood culture obtained from a peripheral vein

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11
Q

Central line insertion bundles include

A 
clean skin with CHG
avoid femoral site if possible
wash hands
full barrier precautions
sterility when access ports
remove as soon as no longer needed
avoid parental dextrose/nutrition when no longer needed
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12
Q

Clostridium difficile is a

A

spore-forming bacterium

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13
Q

C diff produces

A

antibiotic associated diarrhea and pseudomembranous colitis due to production of toxins A & B

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14
Q

C diff may lead to the need for

A

subtotal colectomy and ileostomy

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15
Q

Treatment of C diff is

A

removal of causative antibiotic and oral antibiotics (metronidazole or vancomycin)

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16
Q

Intraoperative considerations for the C diff patient include

A

hemodynamic instability is likely
contact and isolation precautions are essential
must use handwashing to remove spores
must use bleach germicidal wipes on equipment/room

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17
Q

The mortality of necrotizing soft tissue infections is

A

75%

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18
Q

Necrotizing soft tissue infections include

A

gas gangrene, toxic shock syndrome, severe cellulitis, flesh-eating infection, Fournier’s gangrene- genital/perineal area

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19
Q

The presentation of necrotizing soft tissue infections is

A

general infection, AMS, pain

infection begins in deep tissue planes

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20
Q

Anesthetic management of the patient with necrotizing soft tissue infections includes

A

do not delay surgical tx.
resuscitation often necessary d/t septic & fluid shifts
hemodynamic instability- release of cytokines, good IV access, a-line, +/- CVC, blood product availability
at risk for multiorgan failure–> ICU

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21
Q

Tetanus is caused by

A

the neurotoxin tetanospasmin which is produced by Clostridium tetani organisms
leads to the clinical manifestations of tetanus

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22
Q

Tetanus suppresses the

A

inhibitory neurons in the spinal cord–> generalized skeletal muscle contractions

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23
Q

Early signs of tetanus are

A

Trismus and neck rigidity

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24
Q

The treatment of tetanus is to

A

control skeletal muscle spams (benzodiazepines, muscle relaxants)

  • neutralize exotoxin- human anti-tetanus immunoglobulin
  • penicillin
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25
Q

Tetanus affects

A

disadvantaged areas and communities and the disease is transmitted when children are born in unhygienic conditions
non-sterile materials are used to cut the umbilical cord

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26
Q

The main challenges to eliminate tetanus are

A

a lack of access to communities because of insecurity, cultural barriers, competing priorities, and inadequate funding

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27
Q

Types of pneumonia include

A

community acquired, aspiration, postoperative, and ventilator- associated

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28
Q

Communicated acquired pneumonia is most often due to

A

streptococcus pneumoniae

other organisms can be viral (RSV, SARS, influenza) or fungal (pneumocystis, cyptococcus)

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29
Q

Aspiration pneumonia clinical manifestations

A

depend on the nature and volume of aspirated material and can include fulminating arterial hypoxemia, airway obstruction, atelectasis, and pneumonia

30
Q

The presentation of pneumonia includes

A

fever, chest pain, dyspnea, fatigue, rigors, cough, & sputum production
chest radiograph, + cultures, increased WBCs
patient history (travel, cave exploration, diving, contact with birds/sheep, immunocompromise)

31
Q

Prevention of pneumonia includes

A

PPSV23 for adults >65 and for adults 19-64 who smoke or have certain health conditions

32
Q

For patients with pneumonia who must undergo anesthesia

A

delay surgery if possible, during acute pneumonia
avoid fluid overload
suctioning
maintain abx/antiviral/antifungal schedule
LPV, often PEEP dependent- consider same ventilator settings as ICU, lowest inspired Oxygen possible

33
Q

S/S of SARS include

A

nonspecific (fever, headache, diarrhea, respiratory distress, hemoptysis)

34
Q

SARS is highly

A

virulent with high mortality

7 coronavirus strains that can infect people, also includes “bird flu” H5N1

35
Q

For viral transmission, an increase in

A

viral load with peak is when you are infectious

36
Q

Viral infections treatment includes

A

prevention of spread
vaccines when available
neuraminidase inhibitors decrease severity when given in first 48 hours of symptoms
mostly supportive care

37
Q

Anesthesia management of SARS include

A

LPV and symptom management
barrier precautions- full body disposable over suits, double glove, goggles, air purifying respirators, filters, N95
filters placed on both limbs of breathing circuit- protect patient and ventilator
clean the room with alcohol
if possible, wait 48 hours until another case

38
Q

Personal protective equipment for the SARS patient includes

A

negative pressure rooms

& provider precautions

39
Q

Provider precautions for SARS include

A

goggles, face shields, gowns, gloves, masks, and shoe covers

40
Q

Operating rooms are considered to be

A

positive pressure rooms

41
Q

Ultraviolet germicidal irradiation is used

A

against multiple organisms (Ebola, coronavirus, bacteria)

42
Q

Ultraviolet germicidal irradiation uses

A

different types of wavelengths- hospitals use UV-C (vs. UV-A, UV-B)- germicidal UV

43
Q

Ultraviolet germicidal irradiation can be

A

installed in HVAC systems
needs direct line of sight to the surface
Blind spots: underside of a table won’t be exposed

44
Q

Ultraviolet germicidal irradiation can cause

A

burns

45
Q

HEPA filters are

A

high-efficiency particular air filters that can theoretically mechanically remove dust, pollen, mold, bacteria, and any airborne particles with a size of 0.3 microns

46
Q

HEPA filters are used in

A

HVAC systems for isolation rooms
available for AGM breathing circuits-expiratory and inspiratory limbs
portable- filters the air in a room when it is not an isolation room- useful in ORs which are positive pressure rooms

47
Q

HMEF are

A

heat & moisture exchange medium together with an electrostatic filter medium
*add dead space & resistance

48
Q

Tuberculosis is the result of

A

mycobacterium tuberculosis- an obligate aerobe responsible for TB which survives most successfully in tissues with high oxygen concentrations
-pulmonary and extrapulmonary

49
Q

Most cases of TB come from

A

Asia & Africa-TB more likely in HIV infected than HIV negative individual

50
Q

Signs and symptoms of TBB include

A

cough, anorexia, weight loss, night sweats, chest pain
chest radiographs show apical or subapical infiltrates or bilateral upper lobe infiltration with the presence of cavitation
TB vertebral osteomyelitis (Pott’s disease) is a common manifestation of extrapulmonary TB

51
Q

The most common test for TB is

A

tuberculin skin (Mantoux’s) test

52
Q

TB treatment includes

A

Can be resistant to second-line therapeutic agents (fluoroquinolones and at least one of three injectable (amikacin, kanamycin, or capreomycin)
chemotherapy with isoniazid

53
Q

Anesthetic considerations for TB include

A

delay case until treatment if possible, negative pressure rooms, patients and staff should wear N95 face masks, HEPA filter, caution to avoid spine injury during airway manipulation

54
Q

Acquired immunodeficiency syndrome is an

A

acute seroconversion illness occurs with a high viral load soon after infection

55
Q

_______ does not usually occur until the CD4 count is less than 200 cells/mL

A

Pneumocystis pneumonia

56
Q

Gradual involution of lymph nodes occurs with

A

a decrease in T help lymphocytes (CD4 T cells) and an increase in viral load as onset of AIDs occurs

57
Q

The diagnosis of AIDs in HIV positive patients is established

A

When one of the AIDs defining diagnoses is present

58
Q

The most specific and sensitive test for HIV is

A

nucleic acid testing of HIV RNA

59
Q

Anesthesia considerations for the for the AIDs patient includes

A

patients are subject to long-term metabolic complications including lipid abnormalities and glucose intolerance which may result in the development of DM, CAD, and CVD

60
Q

Anesthesia that should be avoided with AIDs patients includes

A

focal neurologic lesions may increase intracerebral pressure, precluding neuraxial anesthesia
neurologic involvement may make the use of succinylcholine hazardous

61
Q

Appropriate labs to draw for patients with AIDs include

A

CBC, metabolic panel, renal function studies, liver function tests, coagulation studies
Chest XR, ECG

62
Q

Antiretroviral treatment includes

A

six major classes of antiretroviral agents in which at least 3 are used

63
Q

When an accidental exposure occurs,

A

students must call the Duke employee occupational health and wellness safety hotline

64
Q

Prions are

A

proteinaceous infective particles that are infectious proteins without known nucleic acid genomes

65
Q

Prions preferentially target

A

neurologic tissue, cause spongiform encephalopathies

66
Q

Types of prions include

A

Creutzfeldt Jakob disease, Mad cow disease

these neurodegenerative diseases are universally lethal

67
Q

Prions (contagious)

A

are not contagious unless you have direct inoculation of the brain or nervous system with infective tissue
-standard precautions are used

68
Q

Standard precautions apply to

A

the care of all patients, regardless of suspected or confirmed infection or colonization status
hand hygiene, safe injection practices, respiratory hygiene and cough etiquette, environmental cleaning and disinfection, and reprocessing of reusable medical equipment

69
Q

Contact precautions are used for

A

known or suspected infections that represent an increased risk for contact transmission
intended to prevent transmission of infectious agents, like MDROs
use of gown & gloves, dedicated equipment, private room when possible
e.g. norovirus, C. diff. MRSA

70
Q

Enhanced barrier precautions are used to

A

expand the use of PPE beyond situations in which exposure to blood and body fluids is anticipated
care activities requiring gown and glove- toilet, airway care, wound care

71
Q

Droplet precautions are used for

A

pathogens transmitted by respiratory droplets that are generated by a patient who is coughing, sneezing, or talking
E.g. meningitis, TB, rash petechial with fever, RSV, adenovirus, flu, SARS, avian flu

72
Q

Airborne precautions are used for

A

known or suspected to bbe infected with pathogens transmitted by the airborne route (e.g. TB, measles, chickenpox, herpes zoster, herpes simplex, smallpox, rubeola

Pathophys II (43 decks)

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