Main powerpoint bacteria, Emerg data, all screenings, some lab testing Flashcards

Question

Acute sinusitis MC and RI

Answer 1

viral -Secondary bacterial infections: S. pneumoniae S. aureus H. influenzae M. catarrhalis Risk Factors: Allergic rhinitis Structural abnormalities Nasal polyps

Answer 2

S. pneumoniae

Answer 3

determine if a person with pneumonia should get inpatient treatment: Confusion (+1) BUN 20+ (+1) RR. 30+ (+1) SBP less than 90, DBP 60 or less (+1) Age 65 or more. (+1) 3+ points mean inpatient 2 points means consider inpatient or out w/ close f/u 1 point means outpatient treatment

Answer 4

PSI/PORT Score: Pneumonia Severity Index for CAP Estimates mortality for adult patients with community-acquired pneumonia. **MUST HAVE LABWORK FOR THIS**

Answer 5

Doxycycline associated with reduced infection in C. Diff versus Azithromycin

Answer 6

Pneumovax is for all adults 65 and older, anyone ages 2-64 with (DM, LungD,HD,cirrhosis, SC), immunocompromised, anyone 19-64 who smokes, has asthma, resident of a nursing home.

Answer 7

All kids ages 2, 4, 6, 12-15 mo. All adults 65+ who have never gotten Prevnar 13. Do we need to know whats on the next slide?

Answer 8

Group B strep baby S. pneumoniae toddler to school age Neisseria meningitidis teenager S. aureus (more common with penetrating head trauma) H. influenzae (Rare in US after HIB vaccine, still seen outside US)

Answer 9

Adults S. pneumoniae S. aureus N. meningitidis (less common here) Elderly S. pneumoniae S. aureus Listeria monocytogenes

Answer 10

Pseudomonas, Listeria, and Gram -

Answer 11

E. faecalis E. faecium

Answer 12

Endocarditis ampicillin + gentamicin Skin/wound/UTI infections Mild - ampicillin or vancomycin Complicated - ampicillin or vancomycin Resistance VRE - Vancomycin Resistant -Enterococcus Recommended treatment: linezolid daptomycin

Answer 13

Encapsulated, toxin producing bacteria Naturally transmitted via contact with infected animals or their products. Bioterrorism agent CDC Tier 1 Toxins (spores) can be weaponized as a fine powder

Answer 14

Produces toxins, causes diarrhea and emesis

Answer 15

Most infections in neonates, the elderly, and immunocompromised persons Great risk during pregnancy Spontaneous abortion Neonatal meningitis Transmitted via ingestion of contaminated foods Dairy / Queso Fresco cheese Raw vegetables Meat (presentation is bacteremia, meningitis, dermatitis, oculoglandular)

Answer 16

Active immunization with diphtheria toxoid is part of routine childhood immunizations with appropriate booster injections Susceptible persons exposed to diphtheria should receive a booster dose of diphtheria toxoid as well as a course of PCN or erythromycin (&treat contacts of infected with erythromycin)

Answer 17

Opportunistic infections in hospitalized, critically ill and immunocompromised Can affect any organ system resp MC, infect tracheostomy sites, suppurative infections, bacteremia Can survive on dry surfaces for up to a month

Answer 18

Acute otitis media (AOM) Acute and chronic sinusitis COPD exacerbations

Answer 19

Characteristics Human reservoir 40% of adults are carriers Spread via person to person Outbreaks occur in close communities Military camps College Dorms Schools and Daycare Outbreaks more common in winter and spring b/c cooped up more More common in children, adolescents, and young adults Previous infection or vaccination confers immunity

Answer 20

Prevention Meningococcal Vaccine (a vaccine that covers strains A,C,Y, and W, as well as a vaccine that covers strain B - CDC recommends vaccination of all children starting at age 11-12 with booster at 16 New Emerging Prevention Penbraya - covers strains A,C,Y,W, and B Approved by FDA

Answer 21

Evidence from this analysis supports the Centers for Disease Control and Prevention’s recommendation that vaginal swabs are the optimal sample type for women being tested for chlamydia, gonorrhea, and/or trichomoniasis (over urine) FDA grants approval for first time to a home test for chlamydia and gonorrhea

Answer 22

Most common: Pseudomonas aeruginosa Gram - rod Primarily found in water and soil Causes opportunistic infections Healthy individuals otitis externa, UTIs, dermatitis Immunocompromised hosts, ex) burn patients; CF; VAP UTIs, pneumonia, bacteremia, sepsis

Answer 23

Most common first symptom is a fever #1 pathogen Otitis externa Corneal ulcers from bacterial keratitis in contact lens wearers ICU-related pneumonia Osteochondritis after puncture through tennis shoe #2 pathogen Gram - organism in nosocomial pneumonia #3 pathogen Hospital-acquired UTIs Folliculitis “hot-tub folliculitis” urticarial plaques, papules/pustules pruritus 7-10 day duration

Answer 24

UTI and Pneumonia

Answer 25

Sinusitis, OM, bronchitis, Epiglottitis, Pneumonia, Cellulitis, Meningitis, Endocarditis

Answer 26

Haemophilus sp colonize the upper respiratory tract in patients with COPD and frequently cause purulent bronchitis. Common cause of sinusitis, otitis, or respiratory tract infection. Empiric antibiotic treatment depending on area of infection

Answer 27

More common in immunocompromised persons, smokers, and those with chronic lung disease

Answer 28

Normal intestinal flora Typically, only causes disease in immunocompromised persons Alcoholics Diabetics HIV Klebsiella can also cause UTIs

Answer 29

E. coli (tenesmus, 4-5 loose watery stools, fever)

Answer 30

Campylobacter Jejuni

Answer 31

Enteric fever - the best example of which is typhoid fever,Caused by Salmonella typhi / enterica (Typhoid Fever). Serotypes other than typhi typically do not cause invasive disease. 10/10/10 Has a prodromal stage of the flu, sore throat, abd pain, and then worsens.. rose spots and bloody pea soup. 2% mortality. Elderly do poorly. Relapses 15% of cases. Acute enterocolitis - caused by S.typhimurium and S.enteritidis, among others Infection transmitted by consumption of contaminated food or drink. The incubation period is 5–14 days

Answer 32

Modes of transmission Ingestion of infected foods Eggs, poultry/chicken Raw milk Meat Direct contact with infected animals Pet turtles and reptiles inflammatory diarrhea

Answer 33

Most caused by Escherichia coli (E coli). Also, Klebsiella, Proteus mirabilis, Enterobacter

Answer 34

its making a reoccurance in navajo, kenya, china, oregon, madagascar

Answer 35

Caused by Francisella tularensis History of contact with rabbits, rodents, and ticks in endemic areas Spreads easily by aerosol; highly virulent CDC category A eschar on thumb

Answer 36

Fever >38.3 degrees C (101.9 degrees F) on several occasions taken with an oral thermometer Failure to make diagnosis despite 1 week of inpatient investigation >3 weeks duration

Answer 37

Lab Studies CBC with diff Peripheral blood smear CMP - along w/ Hepatitis A,B,C w/ any abnormal liver studies ESR or SED rate UA and Cx Blood cultures - at least 3 sets from different sites drawn several hours apart HIV serology TB serology CXR

Answer 38

Defined as 2 or more of the following: Fever >38C (100.4F) or less than 36C (96.8F) Heart rate >90 bpm Resp rate >20 bpm or arterial carbon dioxide tension (PaCO2)<32 mmHg Abnormal WBC >12,000 or <4,000 or >10% bands

Answer 39

Bacteria in the bloodstream which may multiply and produce systemic signs and symptoms >200,000 deaths / yr. 20-35% with severe sepsis / 40-60% septic shock die w/in 30 days Respiratory infection most common cause Highest among those patients ≥ 65 y/o Incidence greatest in winter months with resp infection Gram + bacteria most prevalent, with Gram - and fungal increasing

Answer 40

Usually coincides with the infectious source Example: cough with dyspnea = pneumonia Hypotension Systolic BP <90 Elevated temperature (>38 degrees Celsius) or hypothermia (<35-36 degrees Celsius) Heart rate >90 bpm Tachypnea, with respirations >20 breaths/min (producing resp alk with PaCO² <32) Signs of end organ perfusion Warm, flushed skin ↓ cap refill, cyanosis, mottling Altered mental status Absent bowel sounds

Answer 41

Identification of early sepsis via Sequential Organ Failure Assessment score (SOFA) – must act quick after 2 or more A qSofa score of ≥2 is associated with poor outcomes due to sepsis: Resp rate ≥22 / min Altered mentation Systolic BP ≤100 mmHg If above meets criteria, do full SOFA score

Answer 42

Leukocytosis (WBC >12,000) or leukopenia (<4,000) Normal WBC with >10 immature forms Hyperglycemia w/o diabetes >140 C-reactive protein (CRP) >2 SD above normal Arterial hypoxemia Acute oliguria <0.5 mL/kg/hr for at least 2 hours despite fluid resuscitation Coagulation abnormalities INR >1.5 or aPTT >60 sec Thrombocytopenia Platelets <100,000 Hyperbilirubinemia Tot bili >4 mg/dL Adrenal insufficiency Hyponatremia Hyperkalemia Hyperlactatemia Serum lactate >2 mmol/L Plasma procalcitonin (PCT) >2 SD above normal Specific to bacteria infection

Answer 43

Nosocomial pathogens - higher mortality rate than community-acquired pathogens Early administration of appropriate antibiotics = beneficial impact UTI - lowest mortality Ischemic bowel - highest mortality Mortality 50-55% when source of infection unknown (which is why we do empiric abx)

Answer 44

Centor Criteria History of Fever, Tonsillar exuhate, tender anterior cervical adenopathy, abscence of a cough = +1 14 and younger = +1 45 and up = -1 1 point = not at all 2-3 = cx. if pos, treat with abx 4+ = just give abx don't give to kids 3 yrs old and younger unless they are at risk (outbreak at a daycare, contact w strep +, clinical findings) don't do routine strep throat screening of asymptomatic people.

Answer 45

pathogens unknown, suspected mixed pathogens known resistance severe infection infection is not responding to 1st line

Answer 46

1 to 2 days after cx results.

Answer 47

gram negative bacteria

Answer 48

L3-L4 or L4-L5

Answer 49

Supraspinous, Interspinous, Ligamentum Flavum "pop", epidural space "pop", dura mater, subarachnoid space

Answer 50

4 total Cell count and differential Glucose and protein levels Gram stain, C&S other (lactic acid, LDH, CRP) - only order if other tests abnormal

Answer 51

Pleural effusion is exudative (*cloudy inflam from protein being high in the ECM) if ONE of these exists: Pleural fluid **protein: serum** **protein** *greater* than **1:2** Pleural fluid **LDF:serum LDH** *greater* than **0.6** Pleural fluid LDH is greater than 0.6, or greater than 2/3 times the normal upper limit for serum LDH

Answer 52

Lactate Dehydrogenase elevated in bacterial infections and leukemia

Answer 53

elevated in bacterial or fungal infections

Answer 54

Glucose, Lactate levels, amylase, TG (triglycerides), Tumor markers

Answer 55

lymphatic system involvement

Answer 56

increases with pancreatitis, esophageal rupture, or malignancy

Answer 57

Infection. If down more, malignancy

Answer 58

septic arthritis

Answer 59

inflammation

Answer 60

fresh or old blood

Answer 61

inflammatory, infectious

Answer 62

CT utilizes radiation to produce images quickly, bone detail good, contrast can be added IV, PO or **PR** MRI uses magnetic fields and radio freq. pulses to produce a more detailed image of soft tissue. Req long time and contrast can be added PO or IV

Answer 63

100,000 of a SINGLE bacteria

Answer 64

Atypical bacteria, mycobacterium (TB), and fungal infections. TB can be diagnosed with Acid Fast Testing and culture specific for TB. this requires 3 seperate sputum samples and 12 weeks for a definitive diagnosis. Fungal infections often require serum testing or biopsy.

Answer 65

Strep bovis (endocarditis)

Answer 66

Strep viridans (endocarditis)

Answer 67

The number of babies born with syphilis is surging 9/10 were preventable

Answer 68

If they have comorbiditis, that includes smoking. If they had abx in the last three months, that counts. If that had COPD, that counts as well. That qualifies them for Levofloxacin or either IP or OP treatment. ## Footnote Rocephin + Z pack

Answer 69

If you do doxycycline for CAP it will lower risk of C diff versus zithromax

Answer 70

Whooping cough is rising in some countries and boosters may be needed

Answer 71

Extensively drug resistant shigelloisis is on the rise in the US

Answer 72

Multple cases of vibrio cholera recently

Answer 73

Missouri man dies after eating raw oysters from contracting this.