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SUMGERI > GERI-INFX > Flashcards

GERI-INFX Flashcards

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1
Q

What is the norovirus?

A

Nonenveloped single strand RNA virus. *The most common cause of gastroenteritis in the US. MCC is GII.4

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2
Q

Where are norovirus outbreaks common?

A

Cruise ships and in long-term care facilities-winter

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3
Q

What can greatly reduce the length of a gastroenteritis illness?

A

Probiotics!

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4
Q

What are the symptoms of norovirus?

A

N/V, nonbloody and watery diarrhea, and abdominal cramping.

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5
Q

How is norovirus transmitted?

A 
**CONTAGIOUS. 
contaminated surfaces, 
vomit-aerosolized, f
ood or water, or 
P2P.
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6
Q

What is the definition of a norovirus outbreak?

A

2 or more similar illnesses resulting from a common exposure that is either suspected or laboratory-confirmed to be norovirus.

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7
Q

In what population group is hepatitis C most common?

A

The baby boomer population. (1 in 30-unknowingly infected!)

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8
Q

What is the source of transmission of hepatitis A?

A

Food sources, aka fecal-oral.

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9
Q

What is the source of transmission of Hepatitis B?

A

Blood!

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10
Q

What is the most common complication of Hepatitis C?

A

Hepatocellular carcinoma.

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11
Q

Who is most at risk for Hepatitis C?

A
  • IV drug users
  • Received blood/organs before 1987-1992.
  • hemodialysis.
  • Medical workers needle sticks.
  • Children of HCV+ women.
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12
Q

Who is at a moderate risk of developing Hep C?

A
  • Transplant recipients after 1992. - Cocaine abusers - Tattoos - Multiple sexual partners - Long-term steady sexual partners of HCV+ persons. - HIV+ persons
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13
Q

What are the symptoms of Hepatitis C?

A

MC-ASYMPTOMATIC. +/- fever, fatigue, n/v, dark urine, and jaundice.

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14
Q

If symptoms of an acute hepatitis infection, how long ago exposed? Are they contagious during this time?

A

6-8 weeks ago. YES they are contagious even if asymptomatic.

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15
Q

What are common symptoms of a chronic hepatitis C infection?

A

Arthritis, itching, and numbness.

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16
Q

If a patients comes in c/o icterus and itching, what 2 labs must you draw?

A

CMP, LFTs and hepatitis panel.

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17
Q

Can Hepatitis C be cured?

A

YES! New antiviral medications -Epclusa 12 week $$

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18
Q

In the management of Hep C, what lab test is done in order to watch out for development of hepatocellular carcinoma?

A

Alphafetaprotein (AFP) q3 months x2, then q6 months.

If spikes —> get liver ULS evaluation for lesions.

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19
Q

What is C Diff?

A

A bacterial infection that causes mild to severe diarrhea. Contaminated surfaces, then touching nose or mouth.

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20
Q

What are the symptoms of C Diff?

A

Diarrhea -3 watery,yellow, and very foul smelling stool daily for 2+ days,
fever,
nausea, and abdominal pain.

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21
Q

What are the potential complications of C Diff?

Study These Flashcards
A
  • Colitis - Sepsis - Death
22
Q

What patients are most at risk for developing C Diff? At what facilities are outbreaks most common?

Study These Flashcards
A

elderly, ill, and IMC hospitalized patients, SNFs, community care facilities.

23
Q

Recent use of what medication predisposes you to C Diff?

Study These Flashcards
A

ALL Antibiotics!

  • *Ampicillin
  • Amoxicillin
  • Cephalosporin
  • Fluoroquinolones
24
Q

If a C Diff infection occurs in a facility you are working, what must you do to decrease the spread?

Study These Flashcards
A

exposure protocol.
- Strict hand WASHING-
Gloves and disposable gowns. -
Disciplined toilet/incontinent cleanliness procedures.

25
What is the treatment for C Diff?
Vancomycin 125mg PO 4x daily x10-14 days. **Must be oral.
26
What does it mean to have a complicated C Diff infection?
C Diff + hypotension, shock, ileum, or megacolon.
27
How do you treat severe, complicated C Diff?
Vancomycin 500mg 4x daily PO or IV AND metronidazole 500mg 3x daily IV. Consider a vancomycin enema.
28
If a patient with C Diff does not show improvement by day 4-6 of vancomycin treatment, what can you add to the treatment regimen?
Rifampin 10mg/kg/dose.
29
If a patient with C Diff still does not show improvement by day 4-6 of vancomycin and rifampin treatment, what should you do?
Consult GI, infectious disease, and/or surgery. Increase to high dose vancomycin and consider donor stool transplant.
30
If a patient with C Diff has a suspected ileus (i.e. vomiting, abdominal pain, distention) or a toxic megacolon (vomiting, Abdominal pain, distention, fever, tachycardia, and hypotension), how should you treat?
1. Obtain a GI, infectious disease, or surgery consult! 2. Metronidazole 7.5mg/kg/dose IV q6 hours x10 days. 3. Consider intracolonic vancomycin.
31
If a patient has a second relapse of C Diff within 1 year or if a patient worsens significantly after treatment is discontinued, what should you do?
Either: 1. Vancomycin taper x6 weeks. OR 2. Vancomycin pulse therapy (dose every 2-3 days) x3 weeks.
32
What is MRSA?
Methicillin-resistant staph aureus
33
What medications can NOT be used to treat Staph?
- Methicillin - Amoxicillin - Oxacillin - Cephalosporins (Keflex)
34
Where do we find Staph bacteria?
On our population! 30% of the population carry Staph in the nose or on the skin.
35
Where in the community do patients usually acquire MRSA?
- Schools - Athletic centers - Correctional facilities
36
Where in the hospital do patients usually acquire MRSA?
- Surgeries - IV tubing - Artificial joints
37
Who is at a high risk for developing a MRSA infection?
- comorbidities, frail, debilitated, or malnourished. - Prior antibiotic use - Body implants (i.e. hip and knee replacements or pacemakers) - Prior hospital or nursing home admission
38
How is transmission of MRSA prevented within the health care setting?
- Hand hygiene - Gloving - Mouth, nose, and eye protection - Gowning - Cleaning patient equipment (beds/rails, wheelchairs, gurneys)
39
What is the treatment for a MRSA skin infection?
**1st line: Doxycycline 100mg PO BID x10 days. OR Bactrim DS: 1 tablet PO BID x10 days + Keflex.
40
What is TX for more serious MRSA infection?
clindamycin 150-300mg OR 300-450mg severe. orally q6 hours.
41
What is sepsis?
Life-threatening organ dysfunction caused by a dysregulated host response to infection. Bacteria! But can be from fungi, viruses, or parasites.
42
What is the risk of death with sepsis?
>30%. Severe sepsis-50%, a septic shock- 80%.
43
Where are the MC primary sources of infection resulting in sepsis?
Lungs, abdomen urinary tract.
44
The criteria was changed from SIRS to the qSOFA score in 2016. What is different about this criteria?
*SIRS may or may not progress to sepsis/shock.
45
What is the criteria for diagnosis of sepsis?
``` Quick Sequential (Sepsis Related) Organ Failure Assessment Score Suspected/documented infection + 2 on the qSOFA: - Hypotension with SBP <100 (1 point) - Altered mental status (1 point) - Tachypnea (RR>/=22) (1 point) ```
46
What is the SIRS criteria?
At least 2 of the 4 criteria must be present: - Temp >100.4F or <96.9F - HR >90bpm - RR > 20 breaths/min or PaCO2 <32 mmHg - WBC count >12,000/mm2, <4000/mm3, or >10% bands/immature forms.
47
What lab value is diagnostic of sepsis?
Lactate -if patient with an infection meets only 1 of the qSOFA criteria in the ED,
48
what should be done within the first hour of triage?
- Lactate, labs, and blood cultures drawn. - Fluid bolus started. - Antibiotics -Beta-lactam).
49
What is the full lab workup for a septic patient?
- CBC - CMP - Blood culture - VBG * - Lactate - Urinalysis/culture - Chest x-ray - Lipase - Coags INR
50
What is procalcitonin?
improvement measure marker of sepsis

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