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Pathophys II > Infectious disorders > Flashcards

Infectious disorders Flashcards

1
Q

Antibiotic resistance is

A

bacteria that have become resistant to the antibiotics designed to kill them
* it does not mean that the body is becoming resistant to antibiotics

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2
Q

________ are responsible for an increasing number of hospital acquired infections

A

multi-drug resistant organisms

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3
Q

The antibiotic class that causes the most allergic reactions is

A

the Beta lactams (includes penicillin)

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4
Q

The types of penicillin include

A 
penicillin G (must be given IV) destroyed by stomach acid
Penicillin V (given by mouth) semi-synthetic
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5
Q

There is a crossover allergy between

A

penicillin & cephalosporins

cephalosporins contain benzylpenicillin causing the side chain reaction

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6
Q

Patients with penicillin allergies should

A

avoid 1st generation cephalosporines (cefazolin & cephalexin)

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7
Q

Surgical site infection statistics:

A

2 to 5% for extra-abdominal surgeries
20% for intraabdominal surgeries
15% of all nosocomial (hospital acquired) infections
Occur within 30 days of surgery or within 1 year of a prosthetic implant or organ

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8
Q

Prevention of SSI includes:

A

preoperative antibiotics- timed so that concentration is established in the serum and tissues when incision is made
glycemic control <200 mg/dL
maintain normothermia
optimize oxygenation
shower/bath prior to surgery with antimicrobial soap
intraoperative skin prep with an alcohol-based antiseptic agent

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9
Q

Blood stream infections are most likely due to

A

central venous catheters

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10
Q

Catheter associated BSI is defined as

A

bacteremia or fungemia in a patient with an intravascular catheter and at least one positive blood culture obtained from a peripheral vein

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11
Q

Central line insertion bundles include

A 
clean skin with CHG
avoid femoral site if possible
wash hands
full barrier precautions
sterility when access ports
remove as soon as no longer needed
avoid parental dextrose/nutrition when no longer needed
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12
Q

Clostridium difficile is a

A

spore-forming bacterium

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13
Q

C diff produces

A

antibiotic associated diarrhea and pseudomembranous colitis due to production of toxins A & B

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14
Q

C diff may lead to the need for

A

subtotal colectomy and ileostomy

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15
Q

Treatment of C diff is

A

removal of causative antibiotic and oral antibiotics (metronidazole or vancomycin)

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16
Q

Intraoperative considerations for the C diff patient include

A

hemodynamic instability is likely
contact and isolation precautions are essential
must use handwashing to remove spores
must use bleach germicidal wipes on equipment/room

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17
Q

The mortality of necrotizing soft tissue infections is

A

75%

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18
Q

Necrotizing soft tissue infections include

A

gas gangrene, toxic shock syndrome, severe cellulitis, flesh-eating infection, Fournier’s gangrene- genital/perineal area

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19
Q

The presentation of necrotizing soft tissue infections is

A

general infection, AMS, pain

infection begins in deep tissue planes

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20
Q

Anesthetic management of the patient with necrotizing soft tissue infections includes

A

do not delay surgical tx.
resuscitation often necessary d/t septic & fluid shifts
hemodynamic instability- release of cytokines, good IV access, a-line, +/- CVC, blood product availability
at risk for multiorgan failure–> ICU

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21
Q

Tetanus is caused by

A

the neurotoxin tetanospasmin which is produced by Clostridium tetani organisms
leads to the clinical manifestations of tetanus

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22
Q

Tetanus suppresses the

A

inhibitory neurons in the spinal cord–> generalized skeletal muscle contractions

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23
Q

Early signs of tetanus are

A

Trismus and neck rigidity

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24
Q

The treatment of tetanus is to

A

control skeletal muscle spams (benzodiazepines, muscle relaxants)

  • neutralize exotoxin- human anti-tetanus immunoglobulin
  • penicillin
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25
Tetanus affects
disadvantaged areas and communities and the disease is transmitted when children are born in unhygienic conditions non-sterile materials are used to cut the umbilical cord
26
The main challenges to eliminate tetanus are
a lack of access to communities because of insecurity, cultural barriers, competing priorities, and inadequate funding
27
Types of pneumonia include
community acquired, aspiration, postoperative, and ventilator- associated
28
Communicated acquired pneumonia is most often due to
streptococcus pneumoniae | other organisms can be viral (RSV, SARS, influenza) or fungal (pneumocystis, cyptococcus)
29
Aspiration pneumonia clinical manifestations
depend on the nature and volume of aspirated material and can include fulminating arterial hypoxemia, airway obstruction, atelectasis, and pneumonia
30
The presentation of pneumonia includes
fever, chest pain, dyspnea, fatigue, rigors, cough, & sputum production chest radiograph, + cultures, increased WBCs patient history (travel, cave exploration, diving, contact with birds/sheep, immunocompromise)
31
Prevention of pneumonia includes
PPSV23 for adults >65 and for adults 19-64 who smoke or have certain health conditions
32
For patients with pneumonia who must undergo anesthesia
delay surgery if possible, during acute pneumonia avoid fluid overload suctioning maintain abx/antiviral/antifungal schedule LPV, often PEEP dependent- consider same ventilator settings as ICU, lowest inspired Oxygen possible
33
S/S of SARS include
nonspecific (fever, headache, diarrhea, respiratory distress, hemoptysis)
34
SARS is highly
virulent with high mortality | 7 coronavirus strains that can infect people, also includes "bird flu" H5N1
35
For viral transmission, an increase in
viral load with peak is when you are infectious
36
Viral infections treatment includes
prevention of spread vaccines when available neuraminidase inhibitors decrease severity when given in first 48 hours of symptoms mostly supportive care
37
Anesthesia management of SARS include
LPV and symptom management barrier precautions- full body disposable over suits, double glove, goggles, air purifying respirators, filters, N95 filters placed on both limbs of breathing circuit- protect patient and ventilator clean the room with alcohol if possible, wait 48 hours until another case
38
Personal protective equipment for the SARS patient includes
negative pressure rooms | & provider precautions
39
Provider precautions for SARS include
goggles, face shields, gowns, gloves, masks, and shoe covers
40
Operating rooms are considered to be
positive pressure rooms
41
Ultraviolet germicidal irradiation is used
against multiple organisms (Ebola, coronavirus, bacteria)
42
Ultraviolet germicidal irradiation uses
different types of wavelengths- hospitals use UV-C (vs. UV-A, UV-B)- germicidal UV
43
Ultraviolet germicidal irradiation can be
installed in HVAC systems needs direct line of sight to the surface Blind spots: underside of a table won't be exposed
44
Ultraviolet germicidal irradiation can cause
burns
45
HEPA filters are
high-efficiency particular air filters that can theoretically mechanically remove dust, pollen, mold, bacteria, and any airborne particles with a size of 0.3 microns
46
HEPA filters are used in
HVAC systems for isolation rooms available for AGM breathing circuits-expiratory and inspiratory limbs portable- filters the air in a room when it is not an isolation room- useful in ORs which are positive pressure rooms
47
HMEF are
heat & moisture exchange medium together with an electrostatic filter medium *add dead space & resistance
48
Tuberculosis is the result of
mycobacterium tuberculosis- an obligate aerobe responsible for TB which survives most successfully in tissues with high oxygen concentrations -pulmonary and extrapulmonary
49
Most cases of TB come from
Asia & Africa-TB more likely in HIV infected than HIV negative individual
50
Signs and symptoms of TBB include
cough, anorexia, weight loss, night sweats, chest pain chest radiographs show apical or subapical infiltrates or bilateral upper lobe infiltration with the presence of cavitation TB vertebral osteomyelitis (Pott's disease) is a common manifestation of extrapulmonary TB
51
The most common test for TB is
tuberculin skin (Mantoux's) test
52
TB treatment includes
Can be resistant to second-line therapeutic agents (fluoroquinolones and at least one of three injectable (amikacin, kanamycin, or capreomycin) chemotherapy with isoniazid
53
Anesthetic considerations for TB include
delay case until treatment if possible, negative pressure rooms, patients and staff should wear N95 face masks, HEPA filter, caution to avoid spine injury during airway manipulation
54
Acquired immunodeficiency syndrome is an
acute seroconversion illness occurs with a high viral load soon after infection
55
_______ does not usually occur until the CD4 count is less than 200 cells/mL
Pneumocystis pneumonia
56
Gradual involution of lymph nodes occurs with
a decrease in T help lymphocytes (CD4 T cells) and an increase in viral load as onset of AIDs occurs
57
The diagnosis of AIDs in HIV positive patients is established
When one of the AIDs defining diagnoses is present
58
The most specific and sensitive test for HIV is
nucleic acid testing of HIV RNA
59
Anesthesia considerations for the for the AIDs patient includes
patients are subject to long-term metabolic complications including lipid abnormalities and glucose intolerance which may result in the development of DM, CAD, and CVD
60
Anesthesia that should be avoided with AIDs patients includes
focal neurologic lesions may increase intracerebral pressure, precluding neuraxial anesthesia neurologic involvement may make the use of succinylcholine hazardous
61
Appropriate labs to draw for patients with AIDs include
CBC, metabolic panel, renal function studies, liver function tests, coagulation studies Chest XR, ECG
62
Antiretroviral treatment includes
six major classes of antiretroviral agents in which at least 3 are used
63
When an accidental exposure occurs,
students must call the Duke employee occupational health and wellness safety hotline
64
Prions are
proteinaceous infective particles that are infectious proteins without known nucleic acid genomes
65
Prions preferentially target
neurologic tissue, cause spongiform encephalopathies
66
Types of prions include
Creutzfeldt Jakob disease, Mad cow disease | these neurodegenerative diseases are universally lethal
67
Prions (contagious)
are not contagious unless you have direct inoculation of the brain or nervous system with infective tissue -standard precautions are used
68
Standard precautions apply to
the care of all patients, regardless of suspected or confirmed infection or colonization status hand hygiene, safe injection practices, respiratory hygiene and cough etiquette, environmental cleaning and disinfection, and reprocessing of reusable medical equipment
69
Contact precautions are used for
known or suspected infections that represent an increased risk for contact transmission intended to prevent transmission of infectious agents, like MDROs use of gown & gloves, dedicated equipment, private room when possible e.g. norovirus, C. diff. MRSA
70
Enhanced barrier precautions are used to
expand the use of PPE beyond situations in which exposure to blood and body fluids is anticipated care activities requiring gown and glove- toilet, airway care, wound care
71
Droplet precautions are used for
pathogens transmitted by respiratory droplets that are generated by a patient who is coughing, sneezing, or talking E.g. meningitis, TB, rash petechial with fever, RSV, adenovirus, flu, SARS, avian flu
72
Airborne precautions are used for
known or suspected to bbe infected with pathogens transmitted by the airborne route (e.g. TB, measles, chickenpox, herpes zoster, herpes simplex, smallpox, rubeola

Pathophys II (43 decks)

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