5. Infection

Question 1

MC colon anaerobe and aerobe

Answer 1

b. fragilis (anaerobe), e. coli (aerobe)

Question 2

Fever source

Answer 2

< 48h: atelectasis
2-5 days: UTI
>5 days: wound infection
7-10 days: abscess

Question 3

GN Sepsis

Answer 3

Mech: usually e.coli; endotoxin triggers TNFa
- lipopolysacharide A is MC endotoxin
Px: hyperglycemia, then sepsis

Question 4

G+ vs. G- toxin

Answer 4

G+ make exotoxins

G- make endotoxins

Question 5

C. Diff Colitis

Answer 5

Mech: c. diff releases toxin A
Px: foul smelling DRH
Dx: ELISA for toxin A
Tx:
- mild: oral metro
- severe/preg: oral vanc
- no response: oral/rectal vanc + IV metro
- fulminant: total colectomy w/ ileostomy

Question 6

Wound types (infection rate)

Answer 6

1. Clean: 2% - hernia
2. Clean contaminated: 3-5% - elective colectomy
3. Contaminated: 5-10% - GSW to colon
4. Gross contaminated: 30% - abscess

Question 7

Staph aureus

Answer 7

Aerobic, G+ cocci, C+

Question 8

Steph epi

Answer 8

Aerobin, G+ cocci, C-

Question 9

Exoslime

Answer 9

Exo polysaccharide matrix

Released by staph species

Question 10

E. coli

Answer 10

Aerobic, G- rod

Question 11

B. fragilis

Answer 11

Anaerobic, G-

Question 12

MC infection in surgery pt

Answer 12

UTI 2/2 e. coli

Question 13

MC infectious death after surgery

Answer 13

nosocomial PNM

Question 14

MC organisms causing ICU PNM

Answer 14

1. S. aureus
2. Pseudomonas
3. E. coli

Question 15

MC CO line infection

Answer 15

s. epi > s. aureus > yeast

Question 16

Nectrotizing infections

Answer 16

Mech: beta-hemolytic strep, c. perf, MRSA

Question 17

C. perfringens infection

Answer 17

Mech: alpha toxin decreases redox potential
Tx: early debridement, penicillin, clindamycin

Question 18

Actinomyces

Answer 18

Px: Pulmonary sxs, Tortuous abscess
Dx: Yellow sulfer granules
Tx: penicillin g

Question 19

Nocardia

Answer 19

Px: Pulmonary + CNS sxs
Tx: sulfonamide

Question 20

Candida

Answer 20

MC fungemia
Tx: fluconazole, anidulafungin (severe)
- candiduria: remove foley. No anti-fungal needed

Question 21

Aspergillosis

Answer 21

Mech: oma in pre-existing cavity (sarcoid, TB)
Px: air in non-dep position
Tx: Voriconazole

Question 22

Histoplasmosis

Answer 22

Px: Mississippi and Ohio River Valley
- Pulmonary sxs
Tx: Amphotericin

Question 23

Cryptococcus

Answer 23

Px: CNS sxs in AIDS pt
Tx: Amphotericine

Question 24

Coccidiomycosis

Answer 24

Px: Pulmonary sxs; southwest
Tx: Amphotericin

Question 25

Spontaneous Bacterial Peritonitis

Answer 25

Mech: E. coli, strep, klebsiella 2/2 decreased host defense (not transmural migration)
Dx: Peritoneal fluid w/ PMN > 250
Tx: Ceftriaxone, weekly flourquinolone for ppx

Question 26

Exposure risk for HIV

Answer 26

1. Blood trx
2. Infant to mom
3. Needle stick

Question 27

Tx for HIV exposure

Answer 27

AZT (reverse transcriptase inhibitor) and Ritonavir (protease inhibitor)

Question 28

Aspiration PNM

Answer 28

Mech: Strep pneumo is MC and anaerobes
Px: Superior segment of R lower lobe

Question 29

Acute septic arthritis

Answer 29

Mech: Gonococcus, staph
Tx: drainage, 3g cephalosporin and vanc

Question 30

MC bugs in a human bite

Answer 30

1. Strep

2. Staph

Question 31

Eikenella

Answer 31

Found in human bites

Tx: Augmentin

Question 32

Pastuerella multocida

Answer 32

Founds in cat and dog bites

Tx: Augmentin

Question 33

How to prevent SSI

Answer 33

Use clipper instead of razor
Keep glucose 80-120
Keep O2 elevated
Keep patient warm
Chlorhexidine prep with iodine drapes