Exam 5 - Infections in Immunocompromised Pts Wrin

Question 1

4 risk factors for infection (broad)

Answer 1

-neutropenia
-immune system defects
-destruction of protective barriers
-environmental contamination/alteration of microbial flora

Question 2

neutropenia is ANC less than ______

a. 5000
b. 2000
c. 1000
d. 500

Answer 2

c. 1000

Question 3

ANC equation

Answer 3

ANC = WBC * (%polys + %bands)

Question 4

risk factors for infection-
high risk: ANC < _____
highest risk: ANC < _____
highest risk with severe neutropenia > ___-___ days

Answer 4

< 500
< 100
7-10 days

Question 5

common fungi that cause infections in immunocompromised patients (3)

Answer 5

candida spp.
aspergillus
zygomycetes (mucor, rhizopus)

Question 6

common viruses that cause infections in immunocompromised patients (3)

Answer 6

HSV
VZV
CMV

Question 7

common bacteria that cause infections in immunocompromised patients (6)

Answer 7

s. aureus
s. epidermis
streptococci
enterococcus spp.
enterobacterales
p. aeruginosa

Question 8

cell-mediated immunity is primary defense against _______ pathogens

a. intracellular
b. extracellular

Answer 8

a. intracellular

Question 9

humoral immunity is primary defense against _______ pathogens

a. intracellular
b. extracellular

Answer 9

b. extracellular

Question 10

destruction of protective barriers: skin - common pathogens (3)

Answer 10

s. aureus
s. epidermis
candida spp.

Question 11

which of the following is NOT a common pathogen found in destruction of skin?

a. s. aureus
b. s. epidermis
c. p. aeruginosa
d. candida

Answer 11

c. p. aeruginosa

Question 12

destruction of protective barriers: mucous membranes - common bacterial pathogens (6)

Answer 12

s. aureus
s. epidermis
streptococci
enterobacterales
p. aeruginosa
bacteroides spp.

Question 13

which of the following is NOT a common pathogen found in surgery patients?

a. s. aureus
b. s. epidermis
c. streptococci
d. enterobacterales
e. p. aeruginosa
f. bacteroides spp.

Answer 13

c. streptococci

Question 14

oropharyngeal flora rapidly change to primarily _____ _____ _____ in hospitalized pts

a. gram positive cocci
b. gram positive bacilli
c. gram negative cocci
d. gram negative bacilli

Answer 14

d. gram negative bacilli

Question 15

_______ is leading cause of death in neutropenic cancer patients

Answer 15

infection

Question 16

45-75% of bacteremic episodes in cancer pts are due to _____ _____ _____

a. gram positive cocci
b. gram positive bacilli
c. gram negative cocci
d. gram negative bacilli

Answer 16

a. gram positive cocci

Question 17

etiology of bacterial infections: mucositis (slide 15)

a. staphylococci
b. viridans streptococci
c. enterobacterales
d. p. aeruginosa

Answer 17

b. viridans streptococci

Question 18

heme and HCST (hematopoietic stem cell transplantation) pts are more at risk for _______ infection due to _______ _______

Answer 18

aspergillus;
prolonged neutropenia

Question 19

PJP and toxoplasma gondii

a. bacteria
b. fungus
c. protozoa
d. virus

Answer 19

c. protozoa

Question 20

PJP infection typically manifests as

a. severe lung infection
b. lung, brain, and eye disease
c. UTI
d. skin rash

Answer 20

a. severe lung infection

Question 21

toxoplasma gondii typically manifests as

a. severe lung infection
b. lung, brain, and eye disease
c. UTI
d. skin rash

Answer 21

b. lung, brain, and eye disease

Question 22

most important finding, may be only clinical finding

Answer 22

fever

Question 23

how often should blood cultures, CBC, and BMP/CMP be taken for neutropenic cancer pts?

Answer 23

daily

Question 24

empiric antimicrobial tx for febrile neutropenia should include ________ coverage

Answer 24

antipseudomonal

Question 25

beta-lactam monotherapy for management of febrile neutropenia (5 drugs; no doses)

Answer 25

cefepime ceftazidime piperacillin/tazobactam imipenem meropenem

Question 26

T or F: vancomycin is recommended as part of initial empiric regimen for management of febrile neutropenia

Answer 26

F (not recommended initially, can be added on)

Question 27

management of febrile neutropenia in pts with PCN allergy (3 drug regimen)

Answer 27

cipro + aztreonam + vanc

Question 28

target therapy for febrile neutropenia: what is the median time to defervescence for pts? (range)

Answer 28

5-7 days

Question 29

how long should antifungal therapy be continued in absence of s/sx of invasive fungal infections?

Answer 29

2 weeks (often continued for duration of neutropenia)

Question 30

tx options for HSV/VZV in febrile neutropenia (2)

Answer 30

acyclovir, valacyclovir

Question 31

tx options for CMV in febrile neutropenia (2)

Answer 31

ganciclovir, valganciclovir

Question 32

2 most common pathogens for catheter-related bloodstream infections

Answer 32

s. aureus s. epidermis

Question 33

most important determinant in pt outcomes

Answer 33

resolution of neutropenia

Question 34

infection control: laminar air flow rooms decreased risk of airborne pathogens, such as ? (slide 32)

Answer 34

aspergillus

Question 35

which of the following is TRUE about FQ prophylaxis in management of febrile neutropenia? a. use ciprofloxacin or delafloxacin b. inc risk of fever and death c. cipro has poor activity against gram-positive d. FQs are used in empiric tx

Answer 35

c. cipro has poor activity against gram-positive (a. is cipro or levo; b. is dec; d. is NOT used)

Question 36

antiviral prophylaxis for febrile neutropenia: should we give an activated or inactivated influenza vaccine for all pts?

Answer 36

inactivated

Question 37

HSV seropositive patients undergoing allogeneic HSCT or leukemia induction therapy: what drug should they receive for antiviral prophylaxis?

Answer 37

acyclovir