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GI DRx > 03a: Infectious > Flashcards

03a: Infectious Flashcards

1
Q

Anaerobes are characterized by their ability to grow only in an atmosphere containing (X)% oxygen.

A

X = under 10

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2
Q

Anaerobes are isolated in (X)% of all clinical infections.

A

X = 5-10

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3
Q

Anaerobic bacteria are a component of the normal flora of:

A
  1. Skin
  2. Mouth
  3. GI tract
  4. F genital tract
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4
Q

List Gram-negative anaerobes commonly identified in clinical practice.

A
  1. Fusobacterium
  2. Bacteriodes group (B. fragilis, Prevotella, etc)
  3. Veillonella
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5
Q

List Gram-positive anaerobes commonly identified in clinical practice. Star the cocci.

A
  1. Peptostreptococcus*
  2. Clostridia
  3. Proprionobacterium
  4. Actinomyces
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6
Q

T/F: Frequently, anaerobes are a component of polymicrobial (mixed) infections.

A

True

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7
Q

T/F: Anaerobic infections commonly associated with gas in tissue and positive routine culture.

A

False in that it’s usually negative on routine culture

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8
Q

Which type of bacteria associated with post-bite infections and (X) granules?

A

Anaerobes

X = sulfur

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9
Q

T/F: most anaerobes will die once in contact with oxygen.

A

False - most are aerotolerant (not strict anaerobes)

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10
Q

Obligate aerobes require (X)% oxygen to grow.

A

X = 15-21

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11
Q

Which locations on normal person have highest anaerobes:aerobe ratio?

A
  1. Gingival surface
  2. Colon

Ratio is 1000:1

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12
Q

Anaerobic infections generally arise from (X). List some exceptions.

A

X = endogenous flora

  1. Food poisoning from C. perfringens
  2. C. tetani infections
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13
Q

Many anaerobic bacteria have (slow/fast) growth rates, making β-lactam antibiotics (more/less) effective.

A

Slow; less

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14
Q

T/F: Anaerobes seldom involved in acute/chronic sinusitis and otitis media.

A

False - seldom in acute, but frequent in chronic

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15
Q

T/F: Anaerobes seldom involved in meningitis.

A

True

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16
Q

List some GI infections in which anaerobes seldom play a role.

A
  1. Acute cholecystitis
  2. Spontaneous peritonitis
  3. Cystitis
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17
Q

T/F: Your diabetic patient has a foot ulcer that is now infected. The culprit is likely anaerobic.

A

True

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18
Q

Between your patient with UTI/pyelonephritis and another with appendicitis, which is likely infected with anaerobe?

A

Appendicitis

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19
Q

What are key things to keep in mind when collecting and processing anaerobic bacteria?

A
  1. Aspirate using needle and syringe
  2. Expulsion of air and sealing of syringe
  3. Prompt processing (under 2-3h)
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20
Q

How could a swab be used to collect sample for anaerobe culture?

A

Place swab in Stuarts Transport Medium during 1-2h transport

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21
Q

T/F: Room T is more conducive for anaerobe survival than refrigeration.

A

True

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22
Q

While waiting for gram stain, which findings in bacterial specimen leads to suspicion of anaerobes?

A
  1. Foul odor
  2. Gas
  3. Necrotic tissue
  4. “Sulfur” granules
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23
Q

Above diaphragm treatment for anaerobes typically involves:

A

Beta-lactam/beta-lactamase inhibitor combos

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24
Q

Below diaphragm treatment for anaerobes typically involves:

A

Metronidazole

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25
Which antibiotics have proven active against both "arms" (above and below diaphragm) of anaerobic infections?
New beta-lactams (ex: piperacillin/tozobactam) and tigecycline
26
Most common reasons for failure of therapy in anaerobic infections:
1. Undrained pus | 2. Insufficient duration of antibiotics
27
Gut anaerobes (commensals) are important in (X) metabolism.
X = CHO, vitamin K, bile acids, and some drugs
28
What are the most common anaerobes involved in infectious states (immuno-competent host).
1. Peptostreptococcus 2. Prevotella 3. Bacteriodes 4. Fusobacterium
29
(X) species are the most | commonly isolated microorganisms in intra-abdominal infections.
X = E. coli (aerobic) and Bacteriodes (anaerobic)
30
Two major causes of visceral pain in GI.
1. Distension (stool, fluid, gas) | 2. Obstruction
31
T/F: GI viscera are relatively insensible to most stimuli, so pain is fairly indicative of tissue damage.
False - despite being relatively insensible, pain in GI viscera will occur even in absence of tissue damage
32
(X) is a GI disorder characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause.
X = IBS (irritable bowel syndrome)
33
Patients with IBS have changes in (X), which is what causes their Sx.
X = neurologic processing of bowel sensation and motor function
34
List the three characteristics of IBS pathophysiology.
1. Altered GI motility (increased reactivity to meals, stress, distention, CCK) 2. Altered visceral sensation (hypersensitivity) 3. CNS-Enteric NS dysregulation
35
IBS patients have an (absent/exaggerated) gastrocolic response, so (X) immediately causes (Y).
Exaggerated; X = gastric distention after meals Y = fecal urgency and diarrhea
36
(X) is the primary NT of the GI tract, released from (Y).
``` X = serotonin (5-HT) Y = ECC (enterochromaffin cells) ``` 95% of serotonin in body found in GI tract!
37
Serotonin role in GI tract.
Initiates peristaltic, secretory, vasodilatory, vagal, and nociceptive reflexes
38
T/F: Serotonin regulates nausea/vomiting in CNS.
True
39
Which NT receptors in GI tract are implicated in pathophysiology of IBS? Therapeutic agents target these receptors for (activation/inactivation).
Serotonin (5-HT3 and 5-HT4) Inactivation (antagonizing)
40
Rome IV Criteria is for diagnosing (X).
X = IBS
41
Rome IV Critera: 3 months of (X) at least (1/3/5) days per week and associated with 2 or more of following:
X = abdominal pain (recurrent) 1 day/week 1. Defacation 2. Change in stool frequency 3. Change in stool appearance/form
42
IBS Subtypes:
1. IBS with constipation 2. IBS with diarrhea 3. Mixed IBS 4. Unsubtyped IBS (doesn't meet criteria for other subtypes)
43
Patient meets criteria for IBS diagnosis and reports that over 50% of her stools are watery and she never has hard/lumpy stools. Which subtype would you place her in?
IBS with diarrhea (over 25% are loose/watery and under 25% are hard)
44
Patient meets criteria for IBS diagnosis and reports that he never has normal stools - they're always either hard/lumpy or watery. He reports the ratio is about 1:1. Which subtype would you place him in?
Mixed IBS (over 25% are loose and over 25% are hard)
45
Most recent estimates yield IBS rates around (X)% with F:M ratio of (Y).
``` X = 10 Y = 3:1 ```
46
First IBS presentation typically occurs around ages (X) and prevalence decrease after age (Y).
``` X = 30-50 Y = 60 ```
47
T/F: A diagnosis of IBS is life-long.
True - chronic disease, though symptoms wax and wane
48
Diagnosis of IBS made when which 3 criteria are met?
1. Rome criteria fulfilled 2. No "alarm symptoms" 3. Negative screening studies
49
Patient may meet Rome criteria for IBS, but presence of "alarm symptom" such as (X) would prompt additional workup.
X = weight loss, blood in stool, nocturnal Sx, abnormal PE, FHx of colon cancer
50
Patient presents with IBS-like symptoms, but he has cousin with Crohn's. Which screening test(s) could you do to rule out IBD?
ESR and CRP
51
Patient presents with IBS-like symptoms. You run a TTG serology to screen/exclude (X) etiology.
X = Celiac
52
T/F: Workup for diagnosing IBS includes screening for infectious pathogens.
True - stool for ova/parasites
53
List the three symptom groups of IBS.
1. Abdominal pain/bloating 2. Diarrhea 3. Constipation
54
Abdominal pain/bloating Rx for IBS includes which agents?
1. Anticholinergic | 2. 5-HT3 R antagonism (SSRIs commonly used instead)
55
T/F: Opioids are commonly prescribed to relieve abdominal pain/bloating in IBS.
False - prescribed for diarrheal symptoms
56
List two opioids used in IBS when (X) is the predominant symptom.
X = diarrhea 1. Loperamide 2. Diphenoxylate
57
Aside from opioids, (X) drug has been shown to improve (Y) symptom in IBS. What's the likely mechanism?
``` X = rifaximin (antibiotic) Y = diarrhea ``` Likely alters gut flora composition
58
First line therapy for severe IBS constipation is (X), which is effective in (minority/majority) of cases.
X = fiber supplementation Minority
59
What could you try next if fiber supplementation, for treating (X) symptom of IBS, fails? What's the mechanism behind this?
X = constipation Surfactants (docusate Na) - impair small intestinal water absorption
60
Your patient with IBS-constipation is relieved to find that OTC senna (a stimulant laxative) has significantly helped her symptoms. What advice do you give her?
Stimulant laxatives not recommended for chronic use - you can prescribe osmotic laxatives and other effective therapies
61
Most effective therapies for severe IBD constipation:
1. Osmotic laxatives (Mg salts, lactulose, sorbitol) 2. Miralax (polyethylene glycol) 3. Bowel retraining
62
Prostaglandin analogues are being used to treat (X) symptom of IBS.
X = constipation
63
A new drug, (X), is used for (diarrhea/constipation) IBD and mimics which bacterial toxin?
X = linaclotide Constipation ETEC (diarrhea-induction via cGMP production and increased fluid/electrolyte secretion)
64
IBS patient with (X) symptoms is candidate for tricyclic antidepressant therapy.
X = diarrhea, nausea, abdominal pain

GI DRx (11 decks)

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