Exam #1: Infectious Disease Flashcards Preview

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Flashcards in Exam #1: Infectious Disease Deck (37):
1

What is the difference between morbidity & mortality?

Morbidity= Illness
Mortality= Death

2

What is immune senescence?

Decline in immune response with age

3

What are the main features of immune senescence?

1) Depressed T-cell response & depressed T-cell macrophage interaction

2) Decreased B-cell affinity

4

How do co-morbid diseases complicate infections?

Physiologic "frailty" predisposes to worse infections & damped immune response

5

What is the impact of nutritional status on immune function?

Malnutrition impairs immune function

6

What are the long-term care considerations for infectious diseases?

1) Residence in LTC facility puts older adult at risk
2) Widespread ABX use increased likelihood of resistant infection
3) Resistance in impaired by factors of age & residency
4) Maintaining UTD immunizations is critical

7

How is fever redefined in nursing-home residents?

- Temp. >2 F of baseline
- Oral temp. >99
- Recatal temp. >99.5

*****Note that fever may be absent in 30-50% of older frail adults w/ serious infections

8

What is the most common cause of iatrogenesis in the elderly?

Medication management

9

How are antibiotics dosed in the elderly population?

Renal function

*****Also, note that there are many antibiotic interactions with commonly prescribed medications for older adults

10

What is the minimum criteria for ABX initiation for UTI without catheter?

- Fever AND one of the following:
1) New or worsening urgency
2) Frequency
3) Suprapubic pain
4) Gross hematuria
5) CVA tenderness
6) Incontinence

11

What is the minimum criteria for ABX initiation for UTI with catheter?

Fever OR one of the following:
1) New CVA tenderness
2) Rigors
3) New-onset delerium

12

What is the minimum criteria for ABX initiation for skin & soft tissue infection?

Fever OR one of the following:
1) Redness
2) Tenderness
3) Warmth
4) New or increasing swelling of affected site

13

What is the minimum criteria for ABX initiation for respiratory infection?

- Fever > 102 AND RR >25, or productive cough
- Fever >100 but 25 + Pulse >100
- Afebrile w/ COPD AND new or increased cough w/ purulent sputum
- New or increased cough AND RR> 25 or new-onset delerium

14

What is the minimum criteria for ABX initiation for fever without source of infection?

New-onset delirium or rigors (chills)

****Note that the patient should be fully underessed to look for a source of infection first

15

What is the most common cause of bacterial pneumonia in older adults?

Streptococcus pneumoniae

16

What is the first line antibiotic therapy for community acquired pneumonia?

- Beta-lactam/ Beta-lactamase combination (PCN or cephalosporin)
given with or without macrolide
- OR newer fluoroquinolones with enhanced activity against S. pneumoniae

17

What is the first line antibiotic therapy for hospital acquired pneumonia?

Generally, initial regimens should be broadly inclusive & then narrow
- IF MRSA is suspected--vancomycin or linezolid

18

How can the risk of penumonia reduced?

1) Immunization
2) Smoking cessation
3) Aggressive treatment of comorbidities
4) System changes in the LTC facility

19

What is the recommendation for flu vaccination in the geriatric population?

Annual flu vaccination recommended for ALL adults

20

How does UTI in geriatrics differ from young adults?

Geriatric= resistant isolates e.g. Pseudomonas aeruginosa

21

Is treatment recommended for asymptomatic bacteruria?

No

22

What antibiotics are recommended for Lower UTI in women?

Fluoroquinolones (vs. bactrim)

****Only culture if first round therapy is ineffective

23

How does management of Upper UTI differ from lower UIT?

Much more serious
- IV abx
- Longer course of therapy
- More constitutional symptoms d

24

What is the most common cause of UTI in older men?

Prostatic Disease

25

How does treatment of UTI differ in men & women?

Longer treatment course in men: ~14 days

26

What is the most common cause of TB in older adults?

Reactivation

27

What are the recommendations for a "positive" PPD?

>15mm= universally positive

>10mm= positive in:
- nursing home
- recent converters
- immigrants

>5mm= positive in HIV

28

How is TB treated?

Isoniazid for 9 months

29

What is infective endocarditis? What is it associated with and now is it treated?

Infection of the endocardial surface of the heart
- Associated with degenerative valvular disorders '
- Treat with 4-6 weeks of abx

30

What is the most common cause of septic arthritis? How is it treated?

- S. aureus
- Aggressive antibiotic with serial arthrocentesis
- Surgical drainage if conservative strategy fails

31

What is the most common cause of osteomyelitis in old age? Why is this more common in the elderly?

- S. aureus
- Pressure ulcers that go down to the bone

32

When should you consider meningitis as part of your differential?

Fever + mental status change

33

What is the optimal treatment for neurosyphilis?

PCN G

34

When is Herpes Zoster vaccine recommended?

> 60 years-old

35

What are three infectious diseases that are associated with Bell's Palsy?

1) Herpes Simplex
2) Varicella zoster (shingles)
3) Lymes

36

When should you get a surgical consult on an elderly patient with abdominal pain?

Abdomianl pain + fever= surgical consult

37

What are the fist line treatments for C.diff?

- Metronidazole for mild to moderate cases
- Vancomycin