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SF quizzes > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

What does antibiotic misuse mean?

A

Prescribed without indication (colnoization, fever, bacteriuria)
Too broad/too narrow
Wrong dose
Wrong duration

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2
Q

What does abx misuse contribute to? (2)

A 
Resistance 
adverse events (c difficile)
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3
Q

What is the most common exposure in patients with CDI ?

A

abx

c difficile infection

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4
Q

What is the antimicrobial stewardship program (ASP)? 4

A
  • improve abx prescribing practises
  • limit emergence of abx rsistance
  • enable more cost effective usage
  • decrease CDI
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5
Q

What procedures require abx prophylaxis? to prevent catastrophic

A
  • prosthesis (vascular surgery, orthopaedic)
  • intra abdominal surgery + most urologic procedures
  • spinal surgery
  • invasive ophthalmic sx
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6
Q

When should you decide what abx you order?

A

“As soon as possible” before OR

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7
Q

How do you kno what abx to order, what specific issue to identify?

A

Allergies,

especially to G+ve (penicillins)

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8
Q

Whose responsibility is it to prescribe abx prophylaxis?

A

The surgeon’s

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9
Q

How do you dose ancef abx?

A

1g IV less than 60kg

2g IV more than 60kg

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10
Q

Which abx cannot be giving within 1 hour of incision?

A

Vanco (needs drip, and cannot be bolused)

Cipro

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11
Q

For a patient already on abx, do you give the prophylactic dose anyway?

A

Yes, it can be considered *** as 1 dose pre-op is not problematic

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12
Q

When do you redose cefazoline?

A
  • 3-4 hours after first dose given, or last dose given

- When there is excessive blood loss (>1/3rd blood volume)

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13
Q

When do you discontinue prophy abx?

A

Within 24 hours

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14
Q

What is the cross reactivity between penicillins and cefazolin?

A

No more than 10%

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15
Q

What allergies to penicillin preclude its use?

A
  • Anaphylaxis, resp disterss,
  • urticaria (hives, not just rash)
  • Steven Johnson’s syndrome
  • Abx renal or liver dysfunction
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16
Q

What percent of clindaymycin resistance exists, from staph auerus, at TOH?

A

25 %

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17
Q

What cefazolin timing decreases SSI rate the most ?

A

Within 15 minutes of surgical incision

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18
Q

What % abx are inappropriately prescribed at TOH?

A

10 to 60% of the time

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19
Q

Klebsiella pneumonia skin and urine

A

-

20
Q

What is hospital acquired pneumonia?

A

> 72 hr = HAP, not CAP

-resp flora, more likely to be colonized by s aureus, g-ves

21
Q

Management of HAP (early)?

A
  • Early (less than 5days) and no abx in prior 90 days

- - ceftriaxone or levofloxacine

22
Q

Management of HAP (late)?

A

Late (> 5 days), abx in prior 90 days, im-suppresive disease or tx
-anti-pseudomonal coverage (ceftazidime, or piptazo +/or vanco)

23
Q

Bacteruria?

A
  • unless symptomatic rarely important
  • do NOT tx urine without evidence of infection
  • do NOT culture urine based on appearance or odour alone
24
Q

When is a U/A sensitive for ruling out a UTI?

A

BOTH WBC and nitries negative

25
Q

What are the only bacteria that creates nitrites?

A

“PUNCH-K”

proteus, ureoplasma, nocardia, cryptococcus, Hpylori, klebsiella

26
Q

Pleural effusion grows CoNS, susceptible to vanco only, do you add vanco?

A
  • No. CoNS (coag negative staph) is not typically a resp pathogen, therefore not tx indicated
  • common contaminant
27
Q

DDx for abnormal looking wound, ex post op THR ? (3)

A
  • dehiscence without infection
  • cellulitis (superficial infection)
  • abscess (superficial or deep)
28
Q

How do you assess possible abscess?

A

Ultrasound

29
Q

SSI account for what pecent of HAI ?

A

second most common

30
Q

Pathogenesis of SSI?

A

1-outside in (introduce organisms via skin at time of sgx)
or
2- from inside out (intra-abdo sx)

31
Q

Therapy of SSI?

A

Cover skin organism

  • cefazolin (staph or strep) or cloxacillin (staph)
  • clinda if allergies - NB rates of clinda (25% MSSA)
  • Vanco if MRSA
32
Q

Cdiff tx?

A
  • PO flagyl 500 q8h
  • PO vanco 125mg q6h (not IV !)
  • if ileus, consider PR vanco and or IV flagyl
  • reassess all PPI use
33
Q

what are the encapsulated organisms?

A

Strep pneumoniae
H Influenza
N Meningitidis
-need humoral immunity (B cels)

34
Q

Degree of immunosuppression in an HIV pt depends on what?Degree of infectivity?

A

Immunosuppression - CD4 count

Infectivity - viral load

35
Q

True or False, early (non-transplant related) post op infections same as in non-SOT (solid organ transplant) patients?

A

True

36
Q

Asplenia can be anatomic or functional, which organisms do you worry about?

A

Encapsulated organisms, and parasites (malaria, babesiosis)

37
Q

What is is OPSI?

A

Overwhelming post-splenectomy infection –> sepsis/death

38
Q

Elective splenectomy, when do you vaccinate?

A

ideally 10 wks, but minimum 2 weeks before OR

39
Q

EMERGENT splenectomy, when do you vaccinate?

A

2 weeks POST OR, or at discharge

40
Q

TOH SPelenectomy guidelines suggest Rx of what else?

A

-amox-clav 875 mg PO BID x 7 days
or, -moxifloxacin 400mg PO Daily x7D (if pen allergy)
-Take if fever, unwell etc.
-medicalert bracelet

41
Q

Which surgical resident level is most at risk of a needle stick injury?

A

PGY1

But your risk accumulates by the end of your training

42
Q

Infection risk with Hep B from needlestick (in a patient WITH the disease)?

A

0% if vx responder

43
Q

Infection risk with Hep C from needlestick (in a patient WITH the disease)?

A
  • Risk is 1.8% from needlestick or cut

- unknown (but low) from splash to eye, nose or mouth

44
Q

Infection risk with HIV from needlestick (in a patient WITH the disease)?

A
  1. 3% from needlestick or cut

0. 1% from splash to eye, nose, mouth, non-intact skin

45
Q

Post-exposure follow-up, if patient is positive?

A
  • PEP x 4 weeks
  • Followup x 6 months
  • Discontinue if negative, no follow-up

SF quizzes (9 decks)

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