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[1L] QUIZ 2: Exercise 7 to 16 > EXERCISE 9 > Flashcards

EXERCISE 9 Flashcards

1
Q

The collection time is best when the [?] the suspected agent is greatest.

A

likelihood of recovering

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2
Q

If the patient is for antimicrobial therapy, samples must be collected [?] is administered

A

before the antimicrobial agent

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3
Q

This is for the recovery of organisms that are usually highly susceptible to antibiotics like:

  • beta-hemolytic Streptococcus from a
  • Neisseria gonorrhoeae from
  • Haemophilus influenzae or Neisseria meningitidis from
A
  • throat swab
  • genitourinary samples
  • CSF
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4
Q

The administration of antibiotics does not necessarily preclude the recovery of other microorganisms from clinical samples. Therefore, one should always attempt to [?], although the result must be interpreted accordingly or qualified in the written report.

A

culture

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5
Q

Recovery of suspected agents is also greatest during the [?] phase of the illness. In the case of viral infection, it is best to collect the sample from 2 to 3 days of infection.

A

acute (early)

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6
Q

In many cases, specimen collection should also be based on the [?] of infectious disease.

A

history and pathophysiology

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7
Q

In suspected cases of typhoid fever, a [1] is preferred during the first week of infection and [2] during the second and third weeks of infection.

A

blood sample

urine or feces

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8
Q

The collection site is from an [?] with minimum contamination from adjacent tissues, organs, or secretions.

A

actual infection site

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9
Q

Specimen containers for microbiologic processing must be [3 answers]. However, for stool samples [2 answers] container is acceptable.

A

sterile, sealable, and leak-proof

clean, and leakproof

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10
Q

Samples must be transported within sealable, leak proof, plastic bags with a separate section for paperwork; marked with a [?].

A

biohazard label

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11
Q

Specimen volume should be [?] to perform the microbiologic studies requested

A

adequate

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12
Q

As a general rule, at least [?] of material should be received for routine bacterial culture, and more is necessary for additional studies.

A

0.5 ml or 0.5 g

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13
Q

If the sample is insufficient, notify the nurse/ doctor. If possible collect additional samples. If an additional sample is not possible and scientific, ask the doctor to [?] the test.

A

prioritize

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14
Q

[?] are inferior in the collection of most specimens since it does not provide sufficient quantity, are easily contaminated, and can become dried out, leading to a loss of organisms.

A

Swabs

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15
Q

Swabs are appropriate when a [?] of sample is not necessary like samples from the oropharyngeal, upper respiratory tract, external ear, eye, and genital tract.

A

large volume

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16
Q

A swab from wound swab is acceptable only when the organism load is [?]

A

high

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17
Q

[?] is recommended.

A

Polyester tipped on a plastic shaft

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18
Q

should be avoided for viral culture (inactivate HSV). It may emit toxic products that may inhibit fastidious bacteria.

A

calcium alginate

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19
Q

tends to have excessive fatty acid which may be toxic to certain bacteria like Neisseria gonorrhoeae

A

cotton-tipped swab

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20
Q

is toxic to Chlamydia trachomatis

A

wooden shaft

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21
Q

Organism recovery from swabs may be enhanced by placing the swab in [?] and vertexing for 20 seconds before inoculation

A

0.5 to 1.0 mL of saline or tryptic soy broth

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22
Q

use of [?] are encouraged

A

aspiration needles and catheters

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23
Q

maintain the sample as near its original state as possible with minimum deterioration and to minimize hazards to specimen handlers by using [?] that are confined within proper protective containers

A

tightly fitting collection devices

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24
Q

[?] between the collection of specimens and inoculation of media to a minimum

A

reduce the time delay

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25
Q

– material should be inoculated directly onto MAC or GN broth

A

Shigella species from a patient with bacillary dysentery

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26
Q
  • inoculated directly onto CAM or selective media
A

Neisseria gonorrhoeae from urethral or cervical secretion

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27
Q
  • inoculated directly onto fresh Bordet-Gengou agar
A

Bordetella pertussis from respiratory specimen

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28
Q

are also especially sensitive to ambient condition

A

Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, and anaerobes

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29
Q

Samples must be transported to the laboratory within [?] (ideal) from collection because many microorganisms are susceptible to environmental conditions

A

30 minutes to 2 hours

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30
Q

• presence of oxygen (O2) -

A

anaerobes

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31
Q

• changes in temperature

A

Neisseria meningitides

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32
Q

• changes in pH

A

Shigella

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33
Q

Small volumes of fluid (<1 ml) or tissue (<1 cm3) should be submitted within [?] to avoid evaporation, drying, and exposure to ambient conditions. A few drops of no bacteriostatic saline may be added for hydration

A

15 to 30 min

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34
Q

Larger volumes and those specimens in the holding medium may be stored for as long as

A

24 h

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35
Q

▪ Samples must be placed in a

A

biohazard bag

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36
Q

transport containers for anaerobic specimen

A
  1. Syringe and needle for aspiration
  2. Tube or vial
  3. Swab/ plastic jacket system
  4. Bio-bag or plastic pouch
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37
Q

[?] or liquid specimens can be transported to the laboratory after bubbles are carefully expelled from the syringe and the tip of the needle is inserted into a sterile stopper.

A

Fresh exudate

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38
Q

Syringe and needle for aspiration procedure is valid only if the specimen can be transported to the laboratory without [?]. This practice is under question because of the chance of HIV transmission from a needlestick injury.

A

delay

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39
Q

Tube or vial contains semisolid holding medium, an atmosphere of [?], a reducing agent, and [?]indicator to give visual indication of anaerobiosis.

A

5% CO2; reazurin

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40
Q

The tube is used primarily for the insertion of [?]; the vial is used for inoculation of the [?]

A

swab specimen; liquid specimen

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41
Q

is fitted with a swab and contain either Cary-Blair, Amies transport, or prereduced (PRAS) medium.

A

A plastic tube or jacket

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42
Q

The [?] also includes a vial or chamber separated by a membrane that contains chemicals resulting in the generation of CO2 catalysts and desiccants to “scavenger” any reduced O2 that may get into the system.

A

culturette system

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43
Q

[?] containing a CO2-generating system, palladium catalyst cups, and an anaerobic indicator.

A

Transport plastic bag

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44
Q

The bag is sufficiently large to enclose an inoculated petri dish containing prereduced media, or a biochemical identification microtube tray such as for performing [?].

A

Minitek tests

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45
Q

Bag or pouch is sealed after inoculated plates have been inserted and the CO2-generating systems is that the plates can be directly observed through the thin, clear [?] of the bag for visualization of early growth of colonies.

A

plastic

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46
Q

governed by guidelines

A

Shipping of infectious material

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47
Q

▪ goal of Shipping of infectious material: safeguard [?] in the transportation industry and the [?]

A

employees; general public

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48
Q

patient specimens and culture isolates must be [?] before being shipped

A

triple packaged

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49
Q

the primary [?] that must be watertight

A

receptacle

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50
Q

the [?] material is placed around the primary receptacle

A

absorbent

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51
Q

the secondary receptacle is also

A

watertight

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52
Q

patient specimens and culture isolates must be [?] before being shipped

A

triple packaged

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53
Q

the primary [?] that must be watertight

A

receptacle

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54
Q

the [?] material is placed around the primary receptacle

A

absorbent

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55
Q

the secondary receptacle is also [?]; sealed

A

watertight

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56
Q

sturdy outer container constructed of

A

fibreboard

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57
Q

specific instructions must be followed for labeling the container as

A

“Hazardous Material”

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58
Q

Shipping carton containing dry ice (hazardous material) as a refrigerant for a specimen must be marked [?] and package must allow the escape of carbon dioxide gas to prevent the build-up of pressure that can rupture the container.

A

“Dry Ice Frozen Medical Specimen”

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59
Q

The dry ice should be placed outside the [?] along with a shock-absorbent material in such a manner that the second container does not become loose inside the outer container as the dry ice sublimates.

A

secondary container

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60
Q

sputum samples for recovery of mycobacteria and fungi – without further treatment if collected in a

A

sterile propylene or polyethylene container

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61
Q

maintain appropriate colony count.

A

Specimen preservatives

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62
Q

maintain accurate urine colony counts

A

boric acid

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63
Q

essentially a solution of buffers with [3 answers] and growth factors excluded

A

carbohydrates, peptones, and other nutrients

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64
Q

maintain the [?] of microorganisms present in a specimen without supporting the growth of any other organisms

A

viability

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65
Q

absorb fatty acids present in the specimen that could kill fastidious organisms such as Neisseria gonorrhoeae or Bordetella pertussis

A

charcoal

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66
Q

Direct inoculation to culture media at the time of

specimen collection is optimal for the isolation of certain pathogens

A

(bedside inoculation)

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67
Q

provides semi-solid consistency to prevent oxygenation and spillage

A

a small amount of agar

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68
Q

recommended as a preservative for specimens suspected of containing mycobacteria (distant transport)

A

sodium borate solution

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69
Q

transport buffered medium for recovery of viruses

A

sucrose-phosphate-glutamate

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70
Q

o blood, synovial fluids, and peritoneal fluids into a

A

blood broth culture

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71
Q

o specimens for N. gonorrhoeae can be

placed directly onto a [?] such as JEMBEC system

A

commercial transport system

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72
Q

o nasopharyngeal swabs for isolation of Bordetella pertussis onto

A

selective medium

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73
Q

o eye, especially [?] should be inoculated directly on an appropriate medium

A

cornea scrapings

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74
Q

used to prevent clotting of specimens such as blood, bone marrow, and synovial fluid because microorganisms will otherwise be bound up in the clot

A

Anticoagulants

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75
Q

higher concentration destroys Neisseria and other anaerobic bacteria

A

0.025% (w/v) Sodium polyethanol sulfonate (SPS)

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76
Q

to ensure the ratio of the specimen to SPS it is necessary to have both [?] available

A

large (adult size) and small (pediatric size) tubes

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77
Q

commonly used in viral culture and isolation of Mycobacterium spp. in the blood; inhibit the growth of gram-positive bacteria and yeast

A

Heparin

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78
Q

should not be used because efficacy has not been demonstrated for a majority of organisms

A

Citrate, EDTA (ethylenediaminetetraacetic acid)

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79
Q

Becton, Dickinson and Company yellow tap may contain either

A

SPS or ACD (trisodium citrate/citric acid/dextrose – not for microbiology use)

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80
Q

Specimen storage is dependent on the

A

type of transport media (if applicable) and the etiologic agent sought

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81
Q

unpreserved urine &stool, swabs, outer ear, sputum and other respiratory specimens, a specimen for detecting Chlamydia trachomatis or viruses, and foreign devices such as catheters

A

refrigerate (4ºC)

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82
Q

prevent overgrowth of NF

A

refrigerate (4ºC)

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83
Q

refrigeration adversely affects the recovery of potential pathogens (anaerobes)

A

room (ambient) temperature (22 ºC)

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84
Q

other body fluids, blood, inner ear, preserved urine & stool, genital, nasal, nasopharynx, throat, tissue and specimens collected for recovery of Neisseria gonorrhoeae

A

room (ambient) temperature (22 ºC)

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85
Q

Specimen labeling

▪ labeled at a very least with

A

o patient’s name, identifying number (hospital number)
o age or birthday
o source (special culture media can be selected if required)
o date and time of collection (ensure that the specimen is processed within an acceptable length of time)
o physician (consultation or early reporting of the result if required)

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86
Q

freezer temperature (either -20ºC or -70ºC)

serum for serologic studies

A

-20ºC

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87
Q

freezer temperature (either -20ºC or -70ºC)

tissues or specimen for long-term storage (more than 4 days)

A

-70ºC

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88
Q

enough information should be provided on the specimen label so that the specimen can be matched up with the [?] when it is received in the laboratory

A

requisition

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89
Q

the order form that is sent to the laboratory along with the specimen

A

Specimen requisition form

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90
Q

Specimen requisition form should include:

A

patient’s name, hospital number, age or date of birth, sex, collection date and time, ordering physician, exact nature and source of specimen, diagnosis, immunization history, current antimicrobial therapy

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91
Q

specimens require prompt processing after arrival in the laboratory

A

Specimen priority

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92
Q

level of specimen prioritization

A

level 1: critical/invasive
level 2: unpreserved
level 3: quantitation required
level 4: preserved

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93
Q

represent a potentially life-threatening illness and are from an invasive source

A

level 1: critical/invasive

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94
Q

require immediate processing

A

level 1: critical/invasive

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95
Q

amniotic fluid, blood, brain, cerebrospinal fluid, heart valves, pericardial fluid

A

level 1: critical/invasive

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96
Q

unprotected and may quickly degrade or have an overgrowth of contaminating flora

A

level 2: unpreserved

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97
Q

• provide an optimum growth environment for the fastidious organisms that may be found in the specimen

A

level 2: unpreserved

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98
Q

• body fluid not listed in level 1, bone, drainage from wound, feces, sputum, tissues

A

level 2: unpreserved

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99
Q

those that arrived in the laboratory in holding and transport media

A

level 4: preserved

100
Q

• catheter tip, urine, tissue

A

level 3: quantitation required

101
Q

those that arrived in the laboratory in holding and transport media

A

level 4: preserved

102
Q

the special area designated for receipt of specimen

A

. Specimen receipt

103
Q

personnel should wear protective clothing as appropriate – laboratory coats, rubber gloves, in some instances surgical masks to prevent

A

LAI

104
Q

processing of specimen includes:

o the [?] into a logbook or computer terminal

o [?] or determination of whether all criteria for acceptance were met

o for certain specimens, microscopic examination of direct mounts or stained smears to establish a [?]

A
  • entry of essential data
  • visual examination
  • presumptive diagnosis
105
Q

Information on the label does not match the information on the requisition form

A

Rejection of unacceptable specimen

106
Q

Specimen is leaking

A

Rejection of unacceptable specimen

107
Q

Quantity of specimen is insufficient for testing

A

quantity not sufficient (QNS)

108
Q

Specimen is leaking

A

Rejection of unacceptable specimen

109
Q

Rejection of unacceptable specimen

Specimen transport time exceeded [?] without proper preservation

A

2 hours

110
Q

Specimen received in a [?], which, in essence, kills any microorganisms present

A

fixative (formalin)

111
Q

Exception: large specimens in which the time exposure to preservative is [?] – tissue should be bisected with sterile knife or scissors and an innermost portion sampled for culture

A

short (less than 1 hour)

112
Q

Specimen received for [?] from a site known to have anaerobes as part of the normal flora (vagina, mouth)

A

anaerobic culture

113
Q

Specimen is dried up

A

Rejection of unacceptable specimen

114
Q

24-hour sputum collection

A

Rejection of unacceptable specimen

115
Q

It is difficult to prevent contamination, and an individual collection containing a high concentration of microorganisms will be diluted out by subsequent less concentrated samples

A

Rejection of unacceptable specimen: 24-hour sputum collection

116
Q

Smears of secretions from the uterine cervix, vaginal canal or anus for Gram’s stain detection of

A

Neisseria gonorrhoeae

117
Q

Contaminated with barium, chemical dyes, or oily chemicals

A

Rejection of unacceptable specimen

118
Q

(processing the specimen would produce information of questionable medical value)

A

From Foley catheter

119
Q

Duplicate specimen (except blood culture) received in

A

24 hours

120
Q

Transport time exceeds [?] post-collection and the specimen is not preserved

A

2 hours

121
Q

Rejected for anaerobic culture: gastric washings, midstream urine, prostatic secretion collected transurethrally, feces (except for recovery of Clostridium species associated with the [?] – C. difficile, C. perfringens, C. septicum), ileostomy or colostomy swab, throat, nose or other oropharyngeal specimens (except for deep tissue samples obtained during [?]), superficial skin and environmental specimens.

A

gastrointestinal disease; surgical procedures

122
Q

Regardless of the reason for rejection, it may be more politically correct to state that the specimen cannot be accepted due to the inability to [?], rather than to use the word “rejected”.

A

correctly interpret the results

123
Q

It may be necessary to do the best possible job on a less than optimum specimen if it would be impossible to collect the specimen again because

A

o the patient is taking antibiotics
o the tissues were collected at surgery
o the patient would have to undergo a second invasive procedure (bone marrow or spinal tap)

124
Q

A notation regarding improper collection should be added to the [?] in this instance because only the primary caregiver can determine the validity of the result

A

final report

125
Q

chosen before skin disinfection

A

Site

126
Q

with existing IV line: blood is drawn before the existing IV line (blood [?] IV line is diluted)

A

above

127
Q

less desirable to draw blood through [?] (prosthetic devices are difficult to decontaminate completely)

A

vascular shunt or catheter

128
Q

preferred antiseptic agent

A

70% alcohol and antiseptic

129
Q

kill surface and subsurface bacteria

A

iodine

130
Q

fewer than [?] of blood were commonly found in patients with clinically significant bacteremia

A

30 cfu/mL

131
Q

of blood per culture – strongly recommended

A

10 mL (absolute minimum) to 20 mL

132
Q

volume is directly proportional to

A

yield

133
Q

is enough for children

A

1 to 5 mL

134
Q

of bacteria results to serious disease in children

A

10cfu/mL

135
Q

is enough for children

A

1 to 5 mL

136
Q

Number of blood culture:

dependent on the characteristic of the disease; if blood volume is adequate, usually [?] blood cultures are sufficient to achieve optimum blood culture sensitivity

A

2 or 3

137
Q

it is generally accepted that [?] blood cultures be spaced an hour apart

A

2 to 3

138
Q

if immediate therapy is needed: [?] at one time, 20 mL from each of two separate venipuncture sites, using 2 separate needles and syringes before patient is given antimicrobial therapy

A

40 mL

139
Q

a delay beyond [?] can delay the detection of positive cultures

A

2 hours

140
Q

inhibit numerous organisms and not recommended for use

A

Heparin, citrate, EDTA

141
Q

best anticoagulant for blood; anticomplementary, antiphagocytic

A

0.025% to 0.03% (w/v) SPS

142
Q

interferes with the activity of some antimicrobial agents

A

aminoglycoside

143
Q

inhibit the growth of few microorganisms - —

addition of [?] counteract inhibitory actions of SPS (but recovery may be decreased)

A

1.2% gelatin

144
Q

of blood to unmodified medium has been found to be adequate in conventional blood culture

A

1:5 ratio

145
Q

blood culture bottle contents:

A
  • trypticase soy broth
  • brain-heart infusion broth
  • supplemented peptone
  • thioglycolate broth
146
Q

specialized broth bases:

A

Columbia or Brucella broth

147
Q

enhance recovery of staphylococci,

particularly when patients receive bacteriostatic drugs

A

resin-containing medium

148
Q

examples of Osmotic stabilizers

A

• sucrose, mannitol, sorbose

149
Q

enhance recovery of staphylococci,

particularly when patients receive bacteriostatic drugs

A

resin-containing medium

150
Q

examples of resin-containing medium

A

BACTEC system (Becton-Dickinson), BacT/ALERT

151
Q

significantly increases yield of microorganisms over standard blood culture media

A

Activated charcoal particles

152
Q

examples of Activated charcoal particles

A

BacT/ALERT

153
Q

one of the least clinically relevant specimens — contaminated with saliva

A

Expectorated Sputum

154
Q

. Lower Respiratory Tract Specimens

A
  1. Sputum
  2. Bronchial washings or aspirate
  3. Bronchoalveolar lavage (BAL) samples
  4. Protected bronchial brush samples
  5. Transtracheal aspirates
  6. Other invasive procedures (thoracentesis, needle aspiration of material from the involved area of the lung, open lung biopsy)
155
Q

Upper Respiratory Tract Specimens

A
  1. Throat swab

2. Nasopharyngeal swab

156
Q

Urine Specimens

A
  1. Clean-catch midstream urine
  2. Suprapubic bladder aspirate
  3. Straight (Single )catheterized urine
  4. Indwelling catheter
157
Q

Lower genital tract

A
  1. Urethral discharge

2. Cervical/Vaginal

158
Q

deep-coughed specimen

A

Expectorated Sputum

159
Q

patient preparation
• should not have been ingested food for 1 to 2 hrs before expectorating
• patent with dentures should remove dentures first
• mouth rinsed with saline or water just before expectoration
• expectorate with the aid of a deep cough directly into a sterile container

A

Expectorated Sputum

160
Q

deep-coughed specimen

A

Expectorated Sputum

161
Q

single Expectorated Sputum specimen is adequate for detection of

A

bacterial lower respiratory tract infection

162
Q

three separate early morning Expectorated Sputum specimens (collected on successive days) are appropriate for

A

fungal and mycobacterial infection

163
Q

— stimulate acceptable sputum

A

postural drainage and thoracic percussion

164
Q

collected by allowing the patient to breathe aerosolized droplets of a solution containing 15% sodium chloride and [?] for 10 minutes, or until a strong cough reflex is initiated

A

10% glycerine

165
Q

watery, resembling saliva, although they often contain material directly from alveolar spaces

A

Induced Sputum

166
Q

used to obtain sputum specimen. It is placed in-line between the vacuum circuit and the suction catheter.

A

ndotracheal or tracheostomy suction specimen

Lukens trap (“sputum trap”):

167
Q

Bronchial washings or aspirate is collected through

A

broncoscopy

168
Q

obtained by instilling a small amount of [?] into the bronchial tree and withdrawing the fluid when purulent secretions are not visualized

A

sterile physiologic saline

169
Q

may still be contaminated with URT flora such as

A

viridians streptococci and Neisseria spp.

170
Q

Bronchoalveolar lavage (BAL) samples is collected through

A

broncoscopy

171
Q

high volume of saline [?} is infused into a lung segment through the bronchoscope to obtain cells and proteins of the pulmonary interstitium and alveolar spaces

A

(100 to 300 mL)

172
Q

safe and practical method for diagnosing [?] in immunesuppressed patients

A

opportunistic pulmonary infections

173
Q 
Bronchoalveolar lavage (BAL) samples
 is suitable for detecting [?]
A

Pneumocystis cyst and fungal elements

174
Q

obtained via a [?] as part of broncoscopy examination

A

protected catheter bronchial brush

175
Q

obtained by inserting a small plastic catheter into the trachea via a needle previously inserted through the skin and [?]

A

cricothyroid membrane

176
Q

used to isolate anaerobes

A

Transtracheal aspirates

177
Q

Transtracheal aspirates

indicated when:

A

o the patient is debilitated and cannot spontaneously expectorate a sputum sample
o routine sputum samples have failed to recover a causative organism in the face of clinical bacterial pneumonia
o an anaerobic pulmonary infection is suspected

178
Q

thoracentesis is obtained from patient with

A

pleural empyema

179
Q

excellent specimen that accurately reflects the bacteriology of an associated [?]

A

pneumonia

180
Q

may be performed percutaneously

A

needle aspiration of material from the involved area of the lung

181
Q

if no material is withdrawn into the syringe after the first try, approximately [?] can be injected and then withdrawn into the syringe

A

3 mL of sterile saline

182
Q

with several side effects; frequently use in [?]

A

children

183
Q

most invasive procedure of collecting respiratory secretion; performed by surgeon

A

open lung biopsy

184
Q

used to procure a

A

wedge of lung tissue

185
Q

open lung biopsy is used for the diagnosis of severe

A

viral infections

186
Q

are suitable for collecting most URT microorganisms

A

cotton-, dacron-, or calcium alginate-tipped swabs

187
Q

Use only sterile swabs with

A

plastic or metal shafts.

188
Q

Options for Nasopharyngeal swab include

A

flocked, foam, spun polyester (e.g., dacron), and spun rayon tipped swabs.

189
Q

DO NOT [?], as they may contain substances that inactivate some viruses and/or interfere with
some molecular assays.

A

use cotton, calcium alginate swabs or swabs with wooden sticks

190
Q

collected by aseptically inserting a needle into the subarachnoid space, usually at the level of the lumbar spine

A

Cerebrospinal Fluid

191
Q

▪ puncture site for CSF collection

A
  • 3rd or 4th lumbar interspace (or lower) in
    adults
  • 4th or 5th interspace in children

vary if an infection is present at the preferred site

192
Q

avoid locally infected site:

A

prevent

introduction of infection into the CNS

193
Q

procedure: performed aseptically

a. Thorough cleanse of the patient’s skin and apply of a [?]
b. The spinal needle is advanced into the [?], and often a pop is heard on penetration of the dura mater.
c. Immediately after the dura mater has been entered and before any CSF had been removed, the physician takes the initial or [?] of the CSF using a manometer that attached to the spinal needle.
d. If CSF pressure is normal, ? can be removed safely.
e. After the CSF has been removed and before the spinal needle has been withdrawn, the physician takes the [?]
f. Both CSF pressure and values and the amount of CSF removed are recorded in the [?]

A
  • local anesthesia.
  • lumbar interspace
  • “opening” pressure
  • 20 mL CSF
  • “closing” CSF pressure
  • patient’s chart.
194
Q
  • normal CSF pressure for an adult in a lateral recumbent position range from
  • slightly higher in a
A

50 to 180 mm Hg; sitting position

195
Q
  • If CSF pressure is abnormal only [?] should be removed

* Infant and children: remove proportionately

A

1 to 2 mL; smaller volumes of CSF

196
Q

CSF collected is dispensed into 3 or more sequentially labelled [?]

A

sterile collection tubes

197
Q

1st tube

A

chemical and immunologic testing

198
Q

2nd tube

A

microbial testing

199
Q

3rd tube

A

reserved for the microscopic examination of cellular components (rbc and wbc counts and cytologic studies)

200
Q

any minimal blood contamination resulting from [?] during the initial tap normally does not affect results

A

vessel injury

201
Q

▪ If only small amount of CSF is obtained
o use [?]
o ordering physician [?] the test desired
o microbiology laboratory receives the specimen first to ensure [?] of a sterile specimen, followed by cell counts, chemical and immunologic testing

A
  • single collection tube
  • prioritizes
  • culturing
202
Q

delay can cause inaccurate results

falsely [?] caused by lysis of wbc

A

low cell counts

203
Q

delay can cause inaccurate results

falsely [?] caused by glycolysis

A

high lactate levels

204
Q

delay can cause inaccurate results

[?] of viable microbial organisms

A

jeopardized recovery

205
Q

chemical and immunologic testing (tube 1)

A

frozen (-15º to -30 °C)

206
Q

microbiologic studies (tube 2)

A

room temperature (19° to 26 °C)

207
Q

cell counts and cytologic studies (tube 3)

A

refrigerated (2° to 8°C)

208
Q

must be frozen and saved for possible future chemical or immunologic studies

A

excess CSF

209
Q

least invasive procedure

A

Clean-catch midstream urine

210
Q

Clean-catch midstream urine

first morning specimen is preferred because it provides a

A

more concentrated sample

211
Q

must be performed carefully for optimum results, especially in females

A

Clean-catch midstream urine

212
Q

procedure
• patient should clean [?] area well with a mild soap to avoid contamination and rinse well to remove soap (bacteriostatic)
• retract the [?], begin to void, and then collect a midstream urine sample

A

periurethral

labia folds or glans penis

213
Q

washes contaminants from the urethra

A

first portion of urine

214
Q

is more representative of that in the bladder

A

midstream portion

215
Q

advantages of Clean-catch midstream urine

A

it is neither invasive nor uncomfortable
it is simple and inexpensive
it can be performed in almost any clinical setting
there is no risk of introducing bacteria into the bladder by catheterization
there is no risk of complications

216
Q

Colony counts from urine specimens collected by this method correlate reasonably well with those of specimens collected via

A

suprapubic aspiration or straight catheterization.

217
Q

Greater than 100,000 colonies/ml represents urinary tract infection. For counts between 10,000 and 100,000, the culutre is .

A

indeterminate

218
Q

disadvantages of Clean-catch midstream urine

A
  • urine sample passes through the distal urethra and can become contaminated with commensal bacteria. - There may be difficulties with proper collection of samples from elderly patients, as well as from those
    patients who have physical or other types of impairments, which adds to the importance of collecting specimens properly to avoid contamination.
219
Q

Suprapubic bladder aspirate

urine is withdrawn directly into a syringe through a [?], thereby ensuring a contamination-free specimen

A

percutaneously inserted needle

220
Q

Suprapubic bladder aspirate

is punctured using a needle and syringe and sampled following proper skin preparation

A

full bladder

221
Q

best method to avoid contamination of

specimens with bacteria in the distal urethra

A

Suprapubic bladder aspirate

222
Q

disadvantages of Suprapubic bladder aspirate

A

used infrequently because it is not indicated clinically (except in rare circumstances)
it is invasive and uncomfortable
it requires too much time and too many resources to be practical

223
Q

allows collection of bladder urine with less urethral contamination; slightly invasive

A

Straight (Single )catheterized urine

224
Q

next-best technique for obtaining urine specimens with minimal contamination, but, again, it is not indicated clinically for most patients because it is too labor intensive and costly for routine use and it is invasive

A

Straight (Single )catheterized urine

225
Q

disadvantages of Straight (Single )catheterized urine

A

the process of inserting a catheter through the urethra can introduce bacteria into the bladder (and thereby cause UTI), and rare complications have been reported

226
Q

should be clamped off above the port to allow collection of freshly voided urine

A

catheter tubing

227
Q

should then be cleaned vigorously with 70% ethanol and urine aspirated via a needle and syringe

A

catheter port or wall of the tubing

228
Q

(cotton or rayon treated with charcoal to absorb material toxic to gonococci and wrapped tightly over one end of a thin wire shaft)

A

use urogenital swab

229
Q

swabs are generally more toxic for HSV, gonococci, chlamydiae, and mycoplasmas than are treated cotton\ swabs

A

calcium alginate

230
Q

(least toxic): recommended for viral specimens; also

acceptable for chlamydiae and genital mycoplasmas

A

Dacron swabs

231
Q

swab is inserted approximately[?] into the urethra and rotated gently before withdrawing

A

2 cm

232
Q

in case of [?] is not needed collect the discharge

A

profuse discharge (male) swab

233
Q

mucus is removed by gently rubbing the area with cotton ball

A

Cervical/Vaginal

234
Q

swab is inserted into the cervical canal and rotated and moved from side to side for [?] then gently before withdrawing

A

30 seconds

235
Q

collected in clean (not necessarily sterile), wide mouthed containers that can be covered with a [?]

A

tight-fitting lid

236
Q

containers must be free of preservatives, detergents, or metal ions

A

Fecal Specimen

237
Q

preserves viability of intestinal bacterial pathogens (Campylobacter and Vibrio)

A

0.5% to 0.16% Cary-Blair

238
Q

equal parts of glycerol and [?] supports viability of Shigella better than Cary-Blair

A

0.033 M phosphate buffer (pH 7.0)

239
Q

useful in newborns or in severely debilitated adults

A

Rectal swab

240
Q

more effective in recovering Shigella, Clostridium difficile

A

Rectal swab

241
Q

clean area with alcohol; collected from advancing margin of the lesion and should be collected by needle aspiration rather than by swab

A

Wound discharge

242
Q

aspirated material should be placed in a sterile tube or transport vial and not [?] onto a swab

A

“squirted”

243
Q

It is the [?] responsibility to provide clinicians with a collection manual or instruction cards listing optimal specimen collection techniques and transport information

A

microbiologist’s

244
Q

Specimen collection instruction to clinicians and nurses

A

a. safety considerations
b. selection of appropriate anatomic site
c. collection instructions including type of swab or transport medium
d. transport instructions including time and temperature
e. labeling instructions including minimum patient demographic information (minimum of two patient identifiers)
f. special instructions such as patient preparation
g. sterile versus nonsterile collection devices
h. minimum acceptable quality

245
Q

Instructions must be written at the same time instructed in a concise set of

A

verbal instructions

[1L] QUIZ 2: Exercise 7 to 16 (6 decks)

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