Circulatory, RES, & Lymphatics

Question 1

bacteria in the blood

Answer 1

bacteremia

Question 2

a broad term that includes bacterial toxins or fungi

Answer 2

septicemia

Question 3

Most common sources of bacteremia

Answer 3

UTI, respiratory tract infection, infections of skin or soft tissues

Question 4

Sepsis=

Answer 4

SIRS + suspicion or proof of an infectious cause

Question 5

Sources of SIRS other than infection

Answer 5

pancreatitis, burns, trauma, PE, myocardial infarction, anaphylaxis and drug overdose

Question 6

SIRS required two or more of the following

Answer 6

temperature elevated or decreased, increased HR, increased RR, significantly elevated or decreased WBCs OR 10% immature neutrophils

Question 7

immature neutrophils

Answer 7

bands

Question 8

sepsis assoc. w/ organ hypoperfusion

Answer 8

severe sepsis

Question 9

indicators of organ hypoperfusion

Answer 9

reduction in urine output, mental status changes, systemic acidosis and/or hypoxemia

Question 10

hypotension not responsive to fluid and pharmacologic treatment

Answer 10

refractory septic shock

Question 11

sepsis+ hypotension (systolic pressure < 90 mm Hg)

Answer 11

septic shock

Question 12

throwing clots in many different parts of the body

Answer 12

disseminated intravascular coagualation

Question 13

death from septic shock is usually caused by

Answer 13

multi-organ failure

Question 14

fatality rate of septic shock

Answer 14

40-60%

Question 15

septic shock is classically induced by

Answer 15

gram - bacteria in the bloodstream-LPS

Question 16

Gram + bacteremia causes septic shock via

Answer 16

peptidoglycan or exotoxins

Question 17

release of vasoactive substance such as histamine can cause

Answer 17

arterial hypotension

Question 18

TNF can affect cardiac muscle via

Answer 18

depression of cardiac muscle contractility-decreases organ perfusion

Question 19

cell function is affected rather than organ destruction

Answer 19

cellular stasis

Question 20

Tx septic shock-hypotension:

Answer 20

IV fluids (1-2L of normal saline over 1-2 h)

Question 21

Tx septic shock-hypoxia:

Answer 21

ventilator therapy

Question 22

Tx septic shock-DIC:

Answer 22

transfusion of fresh-frozen plasma and platelets to stop bleeding OR heparin to prevent thrombi formation

Question 23

Tx septic shock-bacterial infection:

Answer 23

antibiotics

Question 24

In septic shock patients what was the major determinant of outcome?

Answer 24

the interval between the onset of hypotension and the administration of antibiotics

Question 25

What happens when you run out of clotting components during DIC

Answer 25

start to hemorrhage-need to give plasma/platelets

Question 26

Early in DIC Tx

Answer 26

Heparin to prevent thrombi formation

Question 27

Septic shock Tx for unknown bacterium

Answer 27

Vancomycin and gentamicin to cover both gram-positive, and gram-negative infections

Question 28

Septic shock with generalized erythroderma

Answer 28

toxic shock syndrome-Staph. aureus, Strep. pyogenes

Question 29

Septic shock with petechiae in skin

Answer 29

Neisseria meningitidis

Question 30

Septick shock with petechial skin lesions in person who has been bitten by a tick in an endemic area

Answer 30

Rocky Mountain spotted fever

Question 31

Septic shock with hemorrhagic skin lesions with history of consuming raw oysters

Answer 31

Vibrio vulnificus

Question 32

Main method of diagnosing sepsis

Answer 32

blood cultures

Question 33

% of infective endocarditis yielding + blood cultures

Answer 33

95%

Question 34

When do you not do a blood culture for diagnosing sepsis

Answer 34

if the patient is already on antibiotic therapy

Question 35

most common cause of septic shock

Answer 35

bacteria (gram +/ gram -)

Question 36

Predisposing factors to pericarditis

Answer 36

pericardial effusion, immunosuppression, chronic diseases, cardiac surgery, chest trauma

Question 37

common causes of pericarditis

Answer 37

streptococci, staphylococci, gram-negative rods, anaerobic bacteria, haemophilus influenzae, early complication of lyme disease (borrelia burgdorferi)

Question 38

Tx of pericarditis

Answer 38

surgical drainage, systemic antibiotics

Question 39

Dx: of pericarditis

Answer 39

very high fever, WBC count, and cardiac tamponade | may test pericardial fluid

Question 40

fatality rate: pericarditis

Answer 40

untreated: fatal, treated: 40% mortality

Question 41

Dx: mycobacterial pericarditis

Answer 41

bacilli observed in pericardial fluid or a biopsy of the site

Question 42

acute infectious myocarditis should be suspected in patients with

Answer 42

dynamically evolving changes in ECG, echocardiography, and serum creatine kinase levels

Question 43

infectious myocarditis most commonly associated with

Answer 43

non-bacterial pathogens (viruses-coxsackie B, trypanosoma cruzi protozoa, endomyocardial fibrosis-parasite)

Question 44

bacterial causes of myocarditis

Answer 44

borrelia burgdorferi, orientia tsutsugamushi, rickettsia rickettsii, coxiella burnetii, mycoplasma pneumoniae, chlamydia pneumoniae, corynebacterium diphtheriae

Question 45

high fever (103-104F), acutely ill, rapid damage to cardiac structures

Answer 45

acute bacterial endocarditis

Question 46

acute bacterial endocarditis if untreated

Answer 46

progresses to death within weeks

Question 47

mycotic aneurysm may result from

Answer 47

acute bacterial endocarditis

Question 48

subacute bacterial endocarditis presentation

Answer 48

low-grade fever, night sweats, weight loss, vague constitutional complaints, indolent course (slow damage to the heart)

Question 49

bacterial causes of acute bacterial endocarditis (ABE)

Answer 49

staph. aureus, beta-hemolytic streptococci, pneumococci

Question 50

subacute bacterial endocarditis-bacterial causes

Answer 50

viridans streptococci, enterococci, coagulase-negative staph, HACEK group (normal oropharyngeal flora)

Question 51

native valve endocarditis bacterial agents

Answer 51

staph. aureus, viridans streptococci, group D streptococci, enterococci, HACEK

Question 52

injection drug users-endocarditis bacterial agents

Answer 52

staph. aureus, enterococci and streptococci

Question 53

Prosthetic valve endocarditis early infections (within 2 months of implant) caused by

Answer 53

staphylococci, gram - organisms, fungi

Question 54

Prosthetic valve endocarditis late infections caused by

Answer 54

mainly streptococci, but staphylococci also

Question 55

transvenous pacemaker or implanted defribrillator-associated endocarditis causes

Answer 55

nosocomial, staph. aureus or coagulase- staph.

Question 56

Most common causes of endocarditis

Answer 56

STAPH AUREUS!

Question 57

clinical manifestations of endocarditis

Answer 57

fever, valve destruction, peripheral purpura, embolisms

Question 58

nontender erythematous macules on palms or soles usually seen in ABE

Answer 58

Janeway lesions

Question 59

painful, purplish nodules of the fingers, toes or feet usually seen in SBE

Answer 59

Osler nodes

Question 60

dark, linear discolorations under the nails usually seen in SBE

Answer 60

Splinter hemorrhages

Question 61

Embolisms in the heart and brain may result in

Answer 61

infarctions

Question 62

predisposing factors to endocarditis

Answer 62

degenerative valve disease, prosthetic heart valves, IV drug abuse, and intracardiac devices

Question 63

present in 50% of endocarditis cases

Answer 63

disease of the heart valves

Question 64

how does disease of heart valves predispose to endocarditis

Answer 64

alters blood flow-disrupts endothelial surface-provides a focus for direct attachment and colonization of the bacterium

Question 65

Common sources of bacteria causing endocarditis

Answer 65

transient bacteremia from dental, upper respiratory, urologic, and lower gastrointestinal diagnostic and surgical procedures

Question 66

continuous bacteremia with endocarditis is caused by

Answer 66

continuous shedding of bacteria from vegetations

Question 67

vegetation is composed of

Answer 67

platelets, fibrin, microcolonies of bacteria and inflammatory cells

Question 68

Dx: of bacterial endocarditis

Answer 68

fever, positive blood cultures, peripheral emboli, visualization of vegetative growth on echocardiography

Question 69

Tx of bacterial endocarditis

Answer 69

b/f blood culture results: vancomycin and gentamicin (covers staph, strep, enterococci) prolonged therapy (> 4 weeks), surgical vegetectomy and valve replacement in some cases