Chap 36-BOOK (Part 2)

Question 1

One of the most important cultures for rapid, accurate results.

Answer 1

Blood culture

Question 2

To cleanse the skin we must use

Answer 2

70% to 95% ethanol or isopropyl followed by 2% tincture of iodine or chlorhexidine

Question 3

For patients who have IV lines through which they are getting fluids and/or medications, blood must be drawn

Answer 3

Below the line because blood drawn above the line will be diluted with the fluid being transfused

Question 4

The optimal ratio of blood to culture

Answer 4

1 : 5 to 1 : 10

Question 5

In cases in which a 1 : 5 dilution cannot be achieved, this can be added to the bottle

Answer 5

0.025% to 0.050% of SPS

Question 6

The ratio of blood to broth

Answer 6

1 : 5 to 1 : 10

Question 7

Organisms are immediately cleared from the peripheral system by the reticuloendothelial system.

Answer 7

Transient bacteremia

Question 8

Recommended that blood culture specimens be collected before an anticipated temperature rise to ensure maximum recovery.

Answer 8

Intermittent bacteremia

Question 9

Constantly released into the bloodstream and therefore are likely to be isolated whenever the blood culture specimen is taken

Answer 9

Continuous bacteremia

Question 10

Standard recommended procedure for blood cultures

Answer 10

Inoculation of separate aerobic and anaerobic bottles

Question 11

he typical aerobic culture bottle contains media that is nutritionally enriched, such as

Answer 11

Soybean casein digest broth, peptone broth, tryptic or trypticase soy broth, brain-heart infusion, Brucella broth, or Columbia broth base

Question 12

May be added to permit the growth of certain thiol-requiring organ-sms, and the media may be prereduced to decrease the oxidation- reduction potential to help support the growth of anaerobes.

Answer 12

0.5% cysteine

Question 13

a resin that nonspecifically absorbs any antimicrobial agent present in the patient’s blood,

Answer 13

Antimicrobial removal device (ARD)

Question 14

SPS inhibits the growth of certain organisms, notably

Answer 14

Peptostreptococcus anaerobius, N. gonor- rhoeae, N. meningitidis, and Gardnerella vaginalis

Question 15

Is a structural relative of SPS that is less effective in neutralizing serum bactericidal activity and is inhibitory to Klebsiella pneumoniae.

Answer 15

Sodium amylosulfate (SAS)

Question 16

An anticoagulant, is inhibitory to some gram-positive cocci.

Answer 16

Sodium citrate (0.5% to 1.0%)

Question 17

Sometimes used as an osmotic stabilizer.

Answer 17

Sucrose (10% to 30%)

Question 18

blood culture bottles are typically incubated at

Answer 18

35° C ± 2° C for 5 days

Question 19

was designed from the original biphasic (solid agar and broth combination) blood culture medium called the

Answer 19

Casteneda culture bottle

Question 20

Most organisms will grow within

Answer 20

48 hours of inoculation

Question 21

Manual blood culture system in which blood is inoculated into a bottle containing a liquid medium that will support the growth of aerobes, anaerobes, and microaerophiles

Answer 21

Oxoid Signal system

Question 22

Provide optimal recovery of unusual fastidious bacteria such as Bartonella, yeasts, and dimorphic fungi mycobacteria

Answer 22

Lysis centrifugation method

Question 23

These are noninvasive, continuous- monitoring blood culture instruments that use fluorescence to detect CO2

Answer 23

Bactec 9000 series and BD FX

Question 24

it detects the consumption or production of multiple gases (CO2, H2, and O2) by organisms growing in the culture medium.

Answer 24

VersaTREK

Question 25

Fully automated, nonradiomet- ric blood culture system, the BacT/ALERT 3D System, consists of aerobic and anaerobic bottles with pH-sensitive membranes placed in the bottom of the bottles.

Answer 25

BacT/ALERT 3D System

Question 26

causative agent of tularemia, is best recovered from a liquid blood culture medium to which L-cysteine and glucose have been added.

Answer 26

F. tularensis

Question 27

Best recovered early in the disease before onset of symptoms. Uses Fletcher's media

Answer 27

Leptospira spp.

Question 28

Conventional, manual blood culture medium (Ruiz Castañeda) should be held for up to 6 weeks at 35° C ± 2° C

Answer 28

Brucella

Question 29

Adequately recovered using standard broth culture bottles because of the vitamin B6 present in human blood

Answer 29

Abiotrophia and Granulicatella

Question 30

performed with a confluent growth of the test organism on a blood agar plate.

Answer 30

staphylococci streak test

Question 31

subcultured onto selective media or enriched media such as CHOC and incubated in a microaerophilic environment at 42°C for 48 hours

Answer 31

Camplobacter spp. (C. jejuni)

Question 32

subcultured onto selective media or enriched media such as CHOC and incubated in a microaerophilic environment at 42°C for 48 hours

Answer 32

Camplobacter spp. (C. jejuni)

Question 33

most common fastidious bacterium reported in the literature as causing endocarditis.

Answer 33

Coxiella burnetii

Question 34

best isolated using lysis centrifugation and plating the concentrated blood onto freshly prepared media containing 5% horse or rabbit blood

Answer 34

Bartonella spp.

Question 35

known causes of endocarditis and will grow in blood culture bottles within 5 days. Extended incubation

Answer 35

HACEK

Question 36

Media in the bottles contains a lysing agent and enrichment (Middlebrook-based) designed for long incubation periods, up to 6 weeks

Answer 36

Mycobacterium spp.

Question 37

The presence of fungi in the blood is termed

Answer 37

Fungemia

Question 38

presence of viruses in the blood

Answer 38

Viremia

Question 39

Has been demonstrated to be occasionally contaminated with Burkholderia cepacia and Enterobacter spp.

Answer 39

Benzalkonium chloride

Question 40

Contamination of certain iodine solutions, such as povidone-iodine, with

Answer 40

B. cepacia has also been reported. Con- tamination with Serratia marcescens and Moraxella spp

Question 41

This test can be used to determine whether gram-positive cocci in clusters growing in a blood culture are S. aureus (coagulase-positive) or CoNS.

Answer 41

Direct Tube Coagulase.

Question 42

Uses an oligonucleotide or peptide nucleic acid probe with a fluorescent label. Although this is a molecular method, there is no amplification of

Answer 42

Fluorescence in situ Hybridization

Question 43

Methods using nucleic acid amplification, such as the polymerase chain reaction assay, which can identify microorganisms growing in a blood culture, are increasingly available.

Answer 43

Nucleic Acid Amplification Methods

Question 44

Most common cause of admissions and death in intensive care units and rates are increasing.

Answer 44

Sepsis

Question 45

considered the “gold standard”, they are positive in only about one-third of sepsis cases and generally require 3 to 5 days for a positive result

Answer 45

Blood culture

Question 46

classic indicators of sepsis

Answer 46

elevated white blood cell count, fever, elevated C-reactive protein, and hypotension,

Question 47

defined as an objectively measured characteristic that indicates a normal biologic or pathogenic process, or pharmacologic response to therapy

Answer 47

Biomarker

Question 48

defined as an objectively measured characteristic that indicates a normal biologic or pathogenic process, or pharmacologic response to therapy

Answer 48

Biomarker

Question 49

a peptide released in response to proinflammatory stimuli, is regarded as a potential biomarker for sepsis.

Answer 49

Procalcitonin

Question 50

Has been found to be helpful in indicating severe sepsis, particularly when used with C-reactive protein or procal- citonin levels

Answer 50

serum lactate (lactic acid)

Question 51

mainstay of treatment of bacteremia

Answer 51

Antimicrobial agents

Question 52

Are frequently used for initial empiric therapy, and a combination of agents may be used to ensure coverage of several possible pathogens.

Answer 52

Broad-spectrum antimicrobial agents

Question 53

Is a fundamental method for management of the septic patient.

Answer 53

Resuscitation with IV fluids to maintain tissue perfusion

Question 54

shown in clinical trials to decrease mortality in patients with septic shock

Answer 54

drotrecogin alfa, also known as activated protein C

Question 55

Drotrecogin alfa inhibits factors

Answer 55

Va and VIIIa

Question 56

potent antiinflammatory action; interest in the treatment of sepsis

Answer 56

glucocorticoids

Question 57

Aimed at blocking the action of tumor necrosis factor and other cytokine mediators of sepsis have been studied in the treatment of sepsis.

Answer 57

Anticytokine Therapies