IDs

Question 1

True or false. guidance recommends that every person entering an emergency department should be asked if they have traveled internationally in the last 21 days

Answer 1

True

Question 2

define immunocomprimised person

Answer 2

one or more defects in the body’s normal defense mechanisms that predispose him or her to infections

Question 3

the number and type of immunocomprimised hosts are increasing for what reasons

Answer 3

the aging of certain populations around the globe; medical advances that have kept persons alive who previously would have died of their underlying disease; pandemic infection by the human immunodeficiency (HIV), hepatitis B (HBV), and hepatitis C (HCV) viruses; homelessness and the resultant lack of basic hygiene and good nutrition; the obesity epidemic; tobacco and recreational drug abuse; diminishing access to primary care with resultant late diagnosis of diseases; and immigration of persons from developing parts of the world where exotic and potentially immunocompromising infectious agents are endemic

Question 4

what are 7 host defects that affect state of immunosupression

Answer 4

-defects in the cutaenous barrier
-defects in mucous membrane
-obstructions to a natural body passage
-abnormal number or function of granulocytes
-abnoramlities of cell mediated immunity
-abnormalities of humoral immunity
-factors that affect immunity in multiple ways

Question 5

define true pathogens

Answer 5

those able to cause infection and idsease

Question 6

define opportunistic organissm

Answer 6

organisms that become pathogenic only when an individual has some level of immunosupression

Question 7

define public health

Answer 7

the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals

Question 8

what are direct examination testing methods?

Answer 8

-staining
-histology/cytology
-wet mount

Question 9

describe acid fast staining

Answer 9

This uses heat or detergents to force dye into the cell, after which the cell cannot be colorized with acid-alcohol, hence the term acid-fast.

Question 10

what are the 2 type of acid fast staining?

Answer 10

1. fluroescent (DFA,, IFA)
2. Non fluoresent stain (Kinyoun stain)

Question 11

describe avidity

Answer 11

Some organisms absorb an increased amount of the stains and are said to have a strong avidity, whereas others are weakly stained and present a pale appearance (low avidity).

Gram-negative enteric pathogens (e.g., E. coli) have a strong avidity to the safranin stain and are bright red.

Pseudomonads are less avid and uptake only a moderate amount of safranin.

Question 12

what is histology?

Answer 12

microscopic structure of tissues

useful for diagnosing infections with agents taht are impossible to culture. Infectious agents may be seen directly or indirectly as cell damage.

Question 13

what is cytology?

Answer 13

the study of the formation, structure, and function of cells

Question 14

what may histology or cytology be use to diagnose?

Answer 14

-actinomycosis
-chlamydia
-genital herpes
-cytomegalovirus
-giardiasis
-histoplasmosis
-leprosy
-rubeola

Question 15

what is a wet mount?

Answer 15

microscopic examination of fresh clinical sepcimens

Question 16

what can you test for with a wet mount?

Answer 16

sputum viewed for fungal elements; stool examined for larvae, adult worms, ova, cysts, or parasites; cerebral spinal fluid for Cryptococcus neoformans; vaginal secretions for Trichomonas vaginalis; and urine sediment for white blood cells (WBCs), bacteria, yeast, and parasites (e.g., T. vaginalis)

Question 17

what are some stains used for wet mounts?

Answer 17

Lactophenol cotton blue, calcofluor-white, India ink, Loeffler’s methylene blue

Question 18

what are the 2 classes of tests used to detect immunological response?

Answer 18

-antigen and antibody detection

Question 19

when are antigen tests helpful?

Answer 19

helpful in early diagnosis, when cultures are not yet positive or are not possible or practical

Question 20

what are some available antigen tests?

Answer 20

adenovirus, bacterial meningitis (Haemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitidis, group B streptococcus), Brucella spp., Cryptococcus spp., hepatitis B, hepatitis D, HIV, influenza virus, Legionella spp., parainfluenza virus, Cryptosporidium spp., Giardia lamblia, Entamoeba histolytica, Plasmodium spp., Wuchereria bancrofti, T. vaginalis, and RSV

Question 21

what are some examples of antibody tests?

Answer 21

agglutination tests, complement fixation, indirect immunofluorescent-antibody (IFA), immunoblot, indirect hemagglutination (IHA), bentonite flocculation (BF), and radioimmunoassay (RIA). Serum

Question 22

what are some things that can be tested for by antibody?

Answer 22

chlaymida
adenovirus
cocksackievirus
encephalitis viruses
lyme disease
mumps
polio
psitttcosis
syphillis
toxoplasma

Question 23

describe body fluid analysis

Answer 23

When infection is suspected in a sterile body fluid (e.g., pleural, peritoneal, synovial), a sample of the fluid is obtained using sterile techniques for analysis of its various components and for the detection of the presence of abnormal constituents that may indicate infection.

analysis usually includes total protein, specific gravity, cell count (red and white blood cells) with differential (types of WBCs present), body fluid glucose, Gram stain, and culture. Microscopic examination for crystals also may be requested.

In general, large # of WBC indicates infection

Question 24

describe cold agglutinins

Answer 24

Cold agglutinins are antibodies that cause clumping or agglutination of type O red blood cells at cold temperatures. The cold agglutinins test is used to detect antibodies that result from Mycoplasma pneumoniae infection or infectious mononucleosis.

In combination with acute respiratory symptoms, a high cold agglutinin titer usually indicates M. pneumoniae infection, viral pneumonia, or primary atypical pneumonia.

Question 25

what specimens go directly on culture media?

Answer 25

blood and genital

Question 26

If the specimen is collected through intact skin, cleanse the skin first with 70% alcohol and iodine solution (e.g., povidone-iodine) or a chlorhexidine/alcohol combination. If iodine is used, remove excess after the specimen has been collected.

Answer 26

true

Question 27

what are some transport mediums?

Answer 27

stuart aimes carey-blair

Question 28

define infection

Answer 28

the entry into and multiplication of an infectious agent in the tissues of the host and tissue damage resulting in apparent or unapparent changes in the host

Question 29

what are the 2 types of infections?

Answer 29

Unapparent, asymptomatic, or subclinical infections run a course similar to that of clinical disease but below the threshold of discernible clinical symptoms. Apparent, clinical, or symptomatic infections result in clinical signs and symptoms of a recognizable disease process.

Question 30

define incubation period

Answer 30

period of time from exposure to some infectious source to the development of signs and symptoms

Question 31

define latent period

Answer 31

the time from exposure to the beginning of the infectious period. This usually applies to chronic types of infections (such as tuberculosis) that are dormant for an extended period of time (months or even years) before signs and symptoms appear.

Question 32

define colonization pressure

Answer 32

the proportion of other patients colonized within a defined population or area. A rise in colonization pressure may result in the creation of a major reservoir for infection and transmission. Colonization pressure may result in decreased efficacy of methods of preventing infections.

Question 33

define contamination

Answer 33

the presence of a potentially infectious agent on a surface, on a material, or in a laboratory specimen

Question 34

what are pseudo outbreaks frequently attributed to?

Answer 34

lab errors or contaminated specimen collection

Question 35

what are the 3 relationships between the human host and normal flora?

Answer 35

Commensal, in which flora neither harm nor benefit the host, such as microbes on the skin. Common commensals rarely cause infection, although infection may occur if there is damage to skin or mucosal barriers or for individuals who are immunocompromised. Mutual, in which both the flora and the host benefit. Pathogenic, in which the flora harm the host, leading to infections and disease.

Question 36

what are components of the cell mediated immune system?

Answer 36

T lymphocytes and mononuclear phagocytes

Question 37

what is the innate immune system?

Answer 37

primary spontaenous and reactive portion

Question 38

what are the 5 types of leukocytes in order of frequency (CMI)

Answer 38

1. neutrophils 2. lymphocytes 3. monocytes 4. esonphils 5. basophils

Question 39

the initial response to acute bacterial infection (such as appendicitis) may result in immature neutrophils (called band or stab cells) entering the system. This is referred to as

Answer 39

left shift

Question 40

describe what increased lymphocytes are associated with and how these infections present

Answer 40

pertussis, syphilis, and toxoplasmosis; lymphocytes with a characteristic frothy cytoplasm (“atypical” or “reactive” lymphs) are associated with a number of viral infections, such as infectious mononucleosis.

Question 41

what infections are increased monocytes associated with?

Answer 41

Epstein-Barr virus, tuberculosis, subacute bacterial endocarditis, syphilis, and other illnesses

Question 42

what is an increase in esonophils associated with?

Answer 42

allergic reactions but can be increased due to parasitic infections and occasionally tuberculosis, systemic fungal infections, and scarlet fever, among other infections

Question 43

what is an increase in basophils associated with?

Answer 43

various food and drug allergies, variola and varicella infections, and ulcerative colitis.

Question 44

humoral immune system is AKA

Answer 44

adaptive immune system

Question 45

humoral immunity is expressed by

Answer 45

antibodies. These are found principally in the bloodstream, but secretory antibodies are also present in oral secretions, tears, intestinal contents, breast milk, prostate, and, to a small degree, urine. Antibodies are also secreted from mucosal surfaces of the female reproductive tract.

Question 46

True or false. All antibody molecules possess multiple structural sites referred to as Fab (fragment, antigen-binding), which react with specific antigens, and one other structural site called Fc (fragment, crystallizable), which can be used to categorize antibodies into groups (immunoglobulins)

Answer 46

true

Question 47

what are the most important and common host defenses?

Answer 47

-sin and mucous membranes -normal flora

Question 48

Chemical substances that surround cells are known as

Answer 48

glycollax

Question 49

If the glycocalyx is organized and firmly attached to the cell wall, it is referred to as a

Answer 49

capsule

Question 50

If the glycocalyx is unorganized and only loosely attached to the cell wall, it is called a

Answer 50

slime layer

Question 51

When essential nutrients are depleted, certain Gram-positive bacteria form structures known as

Answer 51

endospores

Question 52

which species commonly produce biofilms?

Answer 52

E. coli klebsiella pneumoniae enterococcus faecils pseudomonas

Question 53

True or false. Biofilms occur naturally in the human body, such as in the mouth or the bladder

Answer 53

true

Question 54

enzyme production can be

Answer 54

Catalase, which catalyzes the decomposition of hydrogen peroxide to water and oxygen. Coagulase, which causes blood to coagulate.

Question 55

what is the taxonomy of viruses based on?

Answer 55

Whether the virus contains DNA or RNA Whether the virus is single- or double-stranded Size and shape of the virus Structure of the protein coat Presence or absence of an envelope Mode of replication

Question 56

what is a prion?

Answer 56

infectious particles of abnormally folded proteins that do not contain DNA or RNA (i.e., spongiform encephalopathies)

Question 57

how many fungi cause disease?

Answer 57

less than 500 (less than 50 in healthy persons)

Question 58

define mycosis

Answer 58

infections or diseases caused by fungi.

Question 59

wha are the 4 mycosis categories?

Answer 59

Superficial or cutaneous. Infections or diseases that involve hair, skin, or nails without direct invasion of deeper tissues. This category includes infections caused by dermatophytes, a group of three genera of fungi, Epidermophyton, Trichophyton, and Microsporum, that commonly cause skin disease in people or animals. Subcutaneous. Infections or diseases (chromoblastomycosis and mycetoma) that involve cutaneous and subcutaneous tissues. Systemic. Infections or diseases that affect a specific body system, usually the lungs, although any organ system may be involved. This category includes infections caused by Blastomyces, Coccidioides, Histoplasma, Paracoccidioides species, and Penicillium marneffei. Opportunistic. Systemic mycoses that occur primarily in individuals whose immune status is altered either by underlying disease or use of immunosuppressive agents. This category includes infections caused by Aspergillus, Candida, and Cryptococcus.

Question 60

what are the 4 categories of parasites?

Answer 60

1. protozoa 2. helminths 3. microfilaria (microscopic worms transmitted by mosquitos) 4. arthropods (ticks, fleas, mosquitos)

Question 61

describe the role nurses play in antimicrobial stewardship

Answer 61

Early recognition of sepsis. Timely administration of medication. Monitoring for side effects associated with medication. Obtaining samples to determine therapeutic levels. Accurate surgical prophylaxis. Transitioning from IV to oral therapy. Appropriate resource use. Assessing for allergy labelin

Question 62

what does SBAR stand for?

Answer 62

situation background assessment recommendation used for communicating among HCP about a patients conditions

Question 63

describe the 4 parts of an SBAR form

Answer 63

Situation (S). After identifying who you are, the patient (or other issue) in question, and other identifying information such as unit and room number, use this area to indicate the nature of the issue, when it started or occurred, and its severity. Background (B). Here you identify any important background information about the patient (or other issue) that is critical for the recipient’s understanding. This can include date of admission, prior diagnoses, current medications, IV fluids, most recent vital signs, code status, and other clinical or patient information such as allergies or current and prior lab results. Assessment (A). Here the sender (e.g., a nurse) provides their personal assessment of the situation, which could be one or more potential diagnoses. Recommendation (R). Here the sender indicates recommended next steps such as specific diagnostic tests, transferring the patient to another care setting, or the need for a change in the physician’s orders

Question 64

what are some examples of penicillins plus B lactamase inhibitors

Answer 64

Amoxicillin-clavulanate (Augmentin) Ampicillin-sulbactam (Unasyn) Piperacillin-tazobactam (Zosyn) Ticarcillin-clavulanate (Trimentin)

Question 65

describe cephlasporin spectrum activity

Answer 65

higher class (4 and 5) are more broad spectrum

Question 66

how are antimicrobials classified?

Answer 66

-cell wall -cell memraben -ribosome -nucleid acid synthesis -metabolic pathways

Question 67

what is an example of a cell membrane antimicrobial?

Answer 67

daptomycin and fluconazole

Question 68

what are some cell wall antimicrobials?

Answer 68

penicillin, vancomycin, echinocandin

Question 69

what are some metabolic pathway inhibitors?

Answer 69

ethambutol and bactrim

Question 70

how does acylovir kill?

Answer 70

nucleid acid synthesis

Question 71

what are the two major antimicrobial side effects?

Answer 71

allergies and GI reactions

Question 72

surgical prophylaxis is commonly aiemd at

Answer 72

staph and strep

Question 73

what are the 5 major factors that contribute to sucessful antimicrobial therapy?

Answer 73

Prompt institution of an appropriate antimicrobial The “bug” factor: the virulence and susceptibility of the infecting organism The “drug” factor: the activity of the antimicrobial at a particular site of infection The “host” factor: the underlying condition and immunocompetence of the patient The “site” factor: related to the fact that infections at certain body sites (e.g., meninges, heart valves) are inherently more difficult to treat for a variety of reasons

Question 74

what are some mechanisms of antimicrobial resistance?

Answer 74

drug inactivation, alteration in target site, decreased permeability or efflux, and bypass of a metabolic pathway

Question 75

what are some examples of antimicrobial misuse?

Answer 75

Prolonged empiric antimicrobial therapy without clear evidence of infection Treating a positive clinical culture in the absence of infection Failure to narrow the antimicrobial therapy after a causative pathogen is identified Prolonged prophylaxis Excessive use of certain antimicrobials (For example, widespread use of fluoroquinolones has led to the fluoroquinolone-resistant strain of C. difficile.)

Question 76

what are some examples of patient misuse of antimicrobials?

Answer 76

Stopping use of an antibiotic once they feel better. Using antibiotics left over from a previous illness. Pressuring providers into writing prescriptions for them. Sharing prescriptions with others.

Question 77

what are some examples of antimicrobial misuse interventions?

Answer 77

Interventions prior to or at the time of prescription: Clinician education Patient and public education Institution-specific guidelines for the management of common infections Cumulative antibiograms Prior authorization of restricted antimicrobials De-labeling of spurious antibiotic allergies Interventions after prescription: Prospective audit and feedback Self-directed antibiotic reassessments by prescribing clinicians (antibiotic timeouts) Antibiotic dose optimization Antibiotic duration

Question 78

what are the symptoms of sepsis?

Answer 78

Symptoms include high heart rate or weak pulse; fever, shivering, or feeling very cold; confusion or disorientation; shortness of breath; extreme pain or discomfort; and clammy or sweaty skin