Zeynep Tekin Tas

Question 1

Standard Precautions

Answer 1

 Hand hygiene  Use of personal protective equipment (PPE)  Respiratory hygiene  Environmental controls (cleaning and disinfection);  Waste management  Packing and transporting of patient-care equipment, linen and laundry, and waste from
isolation areas  Prevention of needle-stick or sharps injuries

Question 2

Hands are not visibly soiled ->

Answer 2

using an alcohol-based hand rub, or by
washing hands with soap and water, and drying them using a single-use
towel

Question 3

Hands are visibly dirty or soiled with blood or other body fluids 

Answer 3

washed thoroughly with soap and water

Question 4

5 moments for hand hygiene

Answer 4

1-before touching a patient
2-before clean/aseptic procedure
3-after body fluid exposure risk
4-after touching a patient
5-after touching patient surrounding

Question 5

Putting on PPE

Answer 5

Ö M G E
-ÖNLÜK
-MASK
-GÖZLÜK YADA YÜZ KORUYUCU
-eldiven

Question 6

Remove PPE

Answer 6

E G Ö M
-eldiven
-gözlük
-önlük
-maske

Question 7

DROPLET PRECAUTIONS

Answer 7

Droplet precautions are appropriate for protection against droplets larger than 5 μm in size,
which are spread through close respiratory or mucous membrane contact with respiratory
secretions
**• SARS-CoV
• Bordetella pertussisa
• Influenza virus
• Adenovirus
• Rhinovirus
• Mycoplasma pneumoniae
• Group A Streptococcus
• Neisseria meningitidis
• Haemophilus influenzae
• Corynebacterium diphtheriae
• Mumps virüs
• Parvovirus B19

Question 8

Gastroenteritis

Answer 8

the inflammation of the mucus membranes of the gastrointestinal tract and
is characterized by diarrhea or vomiting

Question 9

**Which pathogens cause most of infectious gastroenteritis cases
And give example

Answer 9

Viral like:rotavirus(the most in young children ), norovirus(most common cause of medically attended), adenovirus, and astroviruses

Question 10

**Which pathogen is responsible for severe cases of infectious diarrhea?

Answer 10

Bacterial :
Nontyphoidal Salmonella, Campylobacter, and Shigella

Question 11

Which organism associated with poultry and common cause of travelers diarrhea in asia with postinfectois arthritis and Guillain -barre syndrome

Answer 11

Campylobacter jejuni

Question 12

Most common cause of travelers diarrhea

Answer 12

E.coli

Question 13

Most common cause of dysentery

Answer 13

Shigella spp.

Question 14

**Which organism is more presents persistent or cronic diarrehea

Answer 14

Parasitic:Giardia, cryptosporidium, and E. Histolytica

Question 15

Diarrhea of small bowel origin

Answer 15

typically w ate ry, of large volume, and associated with abdominal cramping, bloating, and
gas.

Question 16

 Diarrhea of large intestinal origin

Answer 16

requent, regular, small volume, and often painful bowel movements. Fever and bloody
or mucoid stools are common, and red blood cells and inflammatory cells can be seen routinely on stool microscopy

Question 17

bacterial causes of visibly bloody diarrhea

Answer 17

shigella, campylobacter, and
salmonella species.
E.coli

Question 18

Stool test

Answer 18

-Antigen testing
-Enzyme immunoassay
-Polymerase chain reaction (PCR) of stool (multipathogen molecular panels )
-Fecal lactoferrin

Question 19

**Red flags of diarrhea

Answer 19

Severe volume depletion/dehydration  Abnormal electrolytes or renal function  Bloody stool/rectal bleeding  Weight loss  Severe abdominal pain  Prolonged symptoms (more than one week)  Hospitalization or antibiotic use in the past three to six months  Age 65 or older  Comorbidities (eg, diabetes mellitus, immunocompromised)  Pregnancy

Question 20

**empiric antibiotic therapy

Answer 20

 Acute, nonbloody diarrhea (non-travel-associated), not administering empiric antibiotic therapy
 Severe illness (fever ≥38.5°C [101.3°F], hypovolemia, ≥6 unformed stools per 24 hours, severe
abdominal pain)
 Features of inflammatory diarrhea (bloody diarrhea, small volume mucous stools, fever)
 High-risk host features (age ≥70 years, cardiac disease, immunocompromising condition, inflammatory
bowel disease, pregnancy)

Question 21

** HIV can be transmitted by:

Answer 21

-sexual contact
-sharing needles
-mother to baby

Question 22

**HIV not transmitted by

Answer 22

-air or water
-saliva,sweat,tears,or closed mouth kissing
-insects or pets
-sharing toilets,food,drinks

Question 23

Chronic HIV infection

Answer 23

– Chronic infection, without AIDS – AIDS, characterized by a CD4 cell count <200 cells/microL or the presence of any
AIDS-defining condition – Advanced HIV infection, characterized by a CD4 cell count <50 cells/microL

Question 24

Symptomatic acute HIV infection is
characterized by

Answer 24

fever, lymphadenopathy, sore
throat, rash, myalgia/arthralgia, diarrhea, and
headache (often described as a
mononucleosis-like illness)

Diagnosis :
 Anti-HIV is negative  p24 antigen test is positive (from day 14)  If infection is strongly suspected and the p24 antigen test is negative, quantitative
HIV RNA should be measured by PCR (from day 10)  Treatment should be started immediately; with treatment prognosis is better as a
consequence of increased number of CD4 cells and decreased viral load

Question 25

NON-AIDS DEFINING DISEASES IN THE EARLY STAGE OF SYMPTOMATIC HIV INFECTION

Answer 25

 Constitutional symptoms> 1 month fever or diarrhea  Oral aphthae  Vaginal candidiasis, persistent, frequent and difficult to manage  Oral hairy leukoplakia  Herpes zoster, two episodes or> 1 dermatome  Peripheral neuropathy  Bacillary angiomatosis (bartonella)  Cervical dysplasia  Cervical carcinoma in situ  Idiopathic thrombocytopenic purpura  Unexplained fever, weight loss, malasise, headache  Recurrent or persistent oropharyngeal or vulvovaginal candidiasis and oral hairy leukoplakia  Seborrheic dermatitis  Bacterial folliculitis, particularly due to Staphylococcus aureus, is also common

Question 26

Dermatological findings in HIV infection

Answer 26

-Acute Retroviral Syndrome -Seborrheic Dermatitis -Staphylococcal folliculitis -kaposi's sarcoma -herpes zoster -viral warts -tinea pefis and onychomycosis

Question 27

**Vaccination in HIV

Answer 27

 Hepatitis A and B vaccines  Influenza vaccine  Pneumococcal vaccine (conjugated and polysaccharide)  HPV vaccine  Meningococcal vaccines  Diphtheria, tetanus, pertussis vaccine  Polio vaccine  Measles, rubella, mumps and chickenpox vaccine  Zoster vaccine: VZV IgG positive elderly

Question 28

Laboratory Testing In HIV

Answer 28

Renal function Hepatic function Glucose and lipid profile Urine pregnancy test Childbearing potential patiernts Bone mineral density testing

Question 29

 The primary targets of the HIV

Answer 29

dendritic cells in the mucosa of the genital tract The dendritic cells then transport HIV into lymph nodes, where the virus infects lymphocytes  The receptors of the virus are the CD4 molecules on the surface of T lymphocytes  HIV destroys these CD4 cells, weakening a person’s immunity

Question 30

-Vaccination is indicated for those without evidence of immunity, unless the patient has evidence of severe immunosuppression (a CD4 count <200 cells/microL) -Prophylactic antibiotics for primary prevention of opportunistic infections should be given to patients with CD4 cell counts <200 cells/microL

Question 31

POST EXPOSURE PROPHYLAXİS (PEP) is required

Answer 31

Parenteral or mucosal contact with infected body fluids (blood, body fluids containing blood, genital secretions, CSF, amniotic fluid, peritoneal, synovial, pericardial and pleural fluid)

Question 32

POST EXPOSURE PROPHYLAXİS (PEP) is not required:

Answer 32

Contact with body fluids that are not at risk of transmission (tears, saliva without blood, urine and sweat)

Question 33

Airborne transmission

Answer 33

occurs when particles are created from desiccation of suspended droplets (<5 μm in size) and disseminated as airborne droplet nuclei

Question 34

**what are airborne precautions organisms

Answer 34

• M tuberculosis • Rubeola (measles) • Variola (smallpox) • Middle East respiratory syndrome (MERS) • VZV, primary or disseminated

Question 35

CONTACT PRECAUTIONS

Answer 35

Contact precautions are intended to prevent transmission of infectious agents spread by direct or indirect contact with patients or their environments

Question 36

Contact precautions Or MDRO

Answer 36

• Methicillin-resistant S aureus • Vancomycin-intermediate S aureus • Vancomycin-resistant S aureus • Vancomycin-resistant Enterococcus • Extended-spectrum β-lactamase–producing organisms • Carbapenem-resistant Enterobacteriaceae • Multidrug-resistant S pneumoniae • C difficile • SARS-CoV • Herpes simplex virus (HSV), VZV • RSV • Acute viral conjunctivitis • Rotavirus • Scabies • Parainfluenza

Question 37

Antibiotic prophylaxis (AP) refers to:

Answer 37

the prevention of infection complications using antimicrobial therapy -primarily (initial) -secondary (recurrence) -prevent inf by eliminating a colonizing organism

Question 38

What is the most common indication for anti microbial use

Answer 38

Surgical

Question 39

Antimicrobial prophylaxis is justified for most clean-contaminated procedures **The use of antimicrobial agents for dirty procedures or established infection is not classified as prophylaxis; rather, it represents treatment for presumed infection

Question 40

What are skin flora organisms

Answer 40

streptococcal species, Staphylococcus aureus, and coagulase-negative staphylococci

Question 41

Clean-contaminated procedures

Answer 41

predominant organisms include gram-negative rods and enterococci in addition to skin flora

Question 42

General Principles Of Surgical Antimicrobial Prophylaxis

Answer 42

-bactericidal, nontoxic, and inexpensive and have in vitro activity against the common organisms that cause postoperative wound infection after a specific surgical procedure -bactericidal, nontoxic, and inexpensive and have in vitro activity against the common organisms that cause postoperative wound infection after a specific surgical procedure -Vancomycin and fluoroquinolone infusions should be started 90 to 120 minutes before surgical incision because these require at least 1 hour to infuse -The duration of AP for most procedures should not exceed 24 hours, with the exception of cardiac surgeries, in which antibiotics may be continued for up to 48 hours -The majority of preoperative prophylactic antibiotics are administered intravenously (IV)

Question 43

........is used most often for surgical prophylaxis in patients with no history of beta-lactam allergy or of MRSA infection

Answer 43

(Cefazolin) -In patients requiring only cefazolin for preoperative surgical prophylaxis, (clindamycin or vancomycin )are often used as alternatives for those with significant allergies to the medication -Redosing antibiotics due to significant blood loss or dilution during surgery are other considerations being studied at this time

Question 44

Surgical prophylaxis

Answer 44

Cefazolin Ciprofloxacin Clindamycin Metronidazole Vancomycin

Question 45

**Rheumatic Fever

Answer 45

is associated with tonsillopharyngitis caused by the group A β- hemolytic streptococci, may result in carditis with or without valvulopathy **Preferred: -Penicillin G benzathine (1.2 million U IM every 4 week) -Penicillin V(Preferred)(250 mgr orally twice daily) • Macrolides (Erythromycin/Clarithromycin (250 mgr orally twice Daily) /Azithromycin) (who are allergic to penicillin)

Question 46

Primary AP for Rheumatic Fever

Answer 46

appropriate treatment of group A streptococcal tonsillopharyngitis

Question 47

Secondary AP ofRF

Answer 47

prevents recurrent episodes of RF

Question 48

RECURRENT CELLULITIS

Answer 48

• Patients with lymphedema or severe venous insufficiency of their extremities are at increased risk of recurring β-streptococcal cellulitis • Typically, more than 2 or 3 episodes per year should occur before AP is initiated -Recurrent pyogenic skin infections caused by Staphylococcus aureus, including methicillin-resistant S aureus (MRSA), may be managed by encouraging good -penicillin G&V

Question 49

MENINGOCOCCAL DISEASE

Answer 49

• Antimicrobial prophylaxis for meningococcal diseases should be offered to close contacts of sporadic cases of Neisseria meningitidis infection (headaches,altered mental status,photophobia,phonophobia,stiffness,high fever) Tx:Rifampin 600 mg orally every 12 h for 2 day or, • Ciprofloxacin 500 mg orally for 1 dose (adults) or, • Ceftriaxone 250 mg IM once

Question 50

Urinary Tract Infection

Answer 50

• Non-pregnant women with recurrent (≥3 per year),uncomplicated urinary tract infections • Other patients who may be considered for prophylaxis of frequent UTIs • Pregnant women • Persons with spinal cord injuries • Persons with neurogenic bladders, • Renal transplant recipients, • Men with chronic bacterial prostatitis Tx:trimethoprim

Question 51

SPONTANEOUS BACTERIAL PERITONITIS

Answer 51

• Ampirical oral or parenteral antimicrobial treatment of patients with cirrhosis and upper gastrointestinal (UGI) bleeding reduced the incidence of bacterial infections and was associated with shortened hospital stays and reduced rates of overall mortality, mortality from bacterial infections, and rebleeding • Aerobic gram-negative organisms and streptococci are the most frequent causes of this infection Tx(ascites and UGI bleeding) :ceftriaxone

Question 52

BITE WOUND INFECTION

Answer 52

• These infections can lead to septic arthritis, tenosynovitis, severe soft tissue infection, or sepsis • The microbiology of dog and cat bite infections is typically polymicrobial and includes Pasteurella species as the most common isolate, followed by staphylococci, streptococci, and anaerobes Tx:Amoxicillin-clavulanate 875 mg orally twice daily for 3-5 day

Question 53

PERTUSSIS

Answer 53

Pertussis (whooping cough), an upper respiratory tract infection caused by Bordetella pertussis, is associated with prolonged bouts of coughing that may last 1 to 6 weeks *tx:Azithromycin 500 mg orally day 1, then 250 mg per day on days 2-5

Question 54

***Crimean-Congo Haemorrhagic Fever

Answer 54

-causes severe viral haemorrhagic fever outbreaks. -The virus is primarily transmitted to people from ticks and livestock animals. Human-to-human transmission can occur resulting from close contact with the blood, secretions, organs or other bodily fluids of infected persons. • In high risk contacts • Percutaneous injury • Mucosal/impaired skin contact with infected body fluids • < 1m contact without any precaution • In prophylaxis, Ribavirin 4 x 500 mg/day for 7 days , po is recommended