581 Midterm

Question 1

Gram + bacteria characteristics

Answer 1

thick peptidoglycan layer that stains purple violet; allows bacteria to survive unfavorable conditions in “suspended animation.” Allows you to determine how to treat certain diseases and/or what kind of treatment

Question 2

Clostridium difficile

Answer 2

gram + spore forming bacillus that causes GI disease. It lives naturally in gut flora. Due to factors that disturb the gut flora environment, this opportunistic organism grows at rates causing diarrhea & abdominal pain.

Question 3

Risk factors for c.diff

Answer 3

abx use: fluoroquinolone (cipro, levofloxacin) and clindamycin
age
gastric aid suppression
GI surgery
Long length of stay in hospital
serious underlying illness

Question 4

C.diff microbiology

Answer 4

Gram + anaerobic spore forming bacteria that produces:

• Enterotoxin A
• Cytotoxin B

Question 5

C.diff Toxin A

Answer 5

Enterotoxin that destroys tight cell junctions = INC permeability of the intestinal wall = diarrhea; nonvirulent

Question 6

C.diff Toxin B

Answer 6

Cytotoxin that targets actin and destroys cellular cytoskeletons; essential for virulence

Question 7

What does c.diff do to the gut?

Answer 7

• colonocyte death
• loss of intestinal barrier function
• neutrophillic colitis
• inflammation and fluid buildup
• inflamed cells burst & die
• spores leave colon via diarrhea

Question 8

C.diff disease presentation

Answer 8

Watery diarrhea
Low abdominal pain, cramping
low grade fever
nausea 
elevated WBC

Question 9

Diseases caused by c.diff

Answer 9

psudomembranous colitis PMC
toxic megacolon
perforations of the colon
sepsis
death

Question 10

C.diff diagnosis

Answer 10

toxin detection in feces; no way to distinguish active infection v carrier state
Use this test for patients in-hospital who are having symptoms

Question 11

C.diff Treatment

Answer 11

stop taking abx
place in isolation precautions
oral vancomycin or fidaxomicin; if one fails try the other
fecal transplant if recurrent

Question 12

C.diff prevention and control

Answer 12

contact precautions: single patient room, use of gloves/gown by those that come in
wash hands
Clean rooms with sporicidal antiseptics
Use disposable equipment

Question 13

5 steps to drug research

Answer 13

1. discovery & development
2. preclinical research
3. clinical research
4. FDA review
5. post market monitoring

Question 14

4 clinical trial phases

Answer 14

1. assess drug safety/dosage; 20-100 healthy volunteers with the disease/condition; 70% move forward
2. efficacy and side effects; 100s of people; 33%
3. compare new and current treatment; 100s-1000s of volunteers; 25-30%
4. safety and efficacy: several thousand volunteers

Question 15

Genetically engineered monoclonal antibodies

Answer 15

specifically bind to a substance
Bezlotoxumab binds to c.diff toxin B
Actoxumab binds to c.diff toxin A

Question 16

Hospitalist

Answer 16

in-patient PCP; first specialty based on patient location and not organ system

Question 17

Hospitalist team

Answer 17

hospitalist, consulting MDs, advanced care practitioners, nurses, case managers, social workers, pharmacists

Question 18

patient centered care

Answer 18

providing care that is respectful and responsive to individual preferences, needs & values

Question 19

patient experience

Answer 19

sum of all interactions that influence patient perceptions across a continuum of care

Question 20

patient engagement

Answer 20

actions taken by individuals to obtain the greatest benefit from the healthcare services available to them

Question 21

Healthcare value should include

Answer 21

cost, outcomes (quality of care) and patient experience

Question 22

Value v Cost

Answer 22

High cost + high value= MRI epidural abcess
High cost + low value = routine MRI LBP
Low cost + high value = universal HIV screening
Low cost + low value = preoperative testing prior to low risk sx

Question 23

cost

Answer 23

actual numerical dollar value of interventions + unintended consequences like side effects or pain; INC by improving quality of care at lower cost or by reducing total cost & maintaining quality

Question 24

Triple aim for healthcare improvement

Answer 24

improve the experience of care, improve the health of populations, reduce per capita cost of healthcare

Question 25

To Err is Human

Answer 25

research report concluding a high number of patients dying each year due to medical error, blaming the healthcare system as a whole and brought focus to patient safety

Question 26

IOM report

Answer 26

how we deliver care is just as important as what care is delivered; we need interprofessional approaches = patent centered care, timelier, more efficient

Question 27

competency

Answer 27

ability or skill needed to perform a particular role, knowledge in a particular domain, or a value that can be expressed

Question 28

4 competency domains

Answer 28

1. values/ethics
2. roles/responsibilities
3. communication
4. teams/teamwork