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PBD II > AMBLER CIS - SRS > Flashcards

AMBLER CIS - SRS Flashcards

1
Q

What are the three mechanisms of antibiotic resistance we covered?

A
  1. Decreased penetration to target
  2. Alteration of target site
  3. Inactivation by enzyme
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2
Q

What is an example of how organisms alter antibiotic target sites?

A

•change in PBP by strep and staph so it is not recognized

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3
Q

What are some examples of inactivation of antibiotics by bacterial enzyme?

A

•enzyme eats abx renderning ineffective. ‘ase’. ie penicillinase, carbapenimase

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4
Q

How are Antibiotic resistance characteristics transferred?

A

a. chromosomal - ie inducible by Enterobacter
b. plasmid – can be a moving target as non chromosomal
c. transposon – non chromosomal like plasmid. ‘jumping genes’

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5
Q

What are five types of beta-lactam resistances we encounter?

A
  1. •Penicillinase
  2. •Cephalosporinase
  3. •ESBL (Extended Spectrim Beta-lactamase)
  4. •AMP-C
  5. •Carbapenemase. ‘CRE’ has been in the news a lot recently.
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6
Q

What are the tests shown here?

What are they for?

A

•Kirby Bauer
–abx discs and read zone of clearing; CLSI has breakpoints for S, I or R
•e-Test
–graduated concentration of abx and read point

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7
Q

What does leukocyte esterase detect?

What is it diagnostic for?

A

–Leukocyte esterase great at detecting very small WBC’s so despite decent sens/spec:75-96%/94-98%,

it is not diagnostic and does not inform how many white cells present.

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8
Q

What are the ways we identify (attempt to anyway) UTI?

A

–1) symptoms.
–2) pyuria (increase in wbc’s)
–3) bacteria suggestive of infection. ie Staph epi = no.

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9
Q

What are the 7 clinical pearls related to blood culturing that we were given?

A
  1. –always try 2 separate sites of draw
  2. –if rigors/chills. Get 2 sets stat as rigors signify clearing of the bacteremia
  3. –if fever then q 15 min is fine
  4. –if thinking endocarditis or persistant bacteremia, showing persistence over time necessary.
  5. –Newer blood culture machines are better at culturing the ‘fastidious- (ie HACEK group).
  6. –Not many instances for holding blood cultures >5 days. Propionibacterium is one common exception
  7. –Fungal blood cultures very low yield except candida which grows on normal culture stuff.
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10
Q

What is BSA agar? What is it good for?

A

Blood sheep agar

•routine. most things GP, GN and candida grow here

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11
Q

What organisms do we use MacConkey agar for?

A

•For Gram negatives/enterics (bile tolerant).

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12
Q

Name this agar, and tell us what it is made of/used for!

A

–Chocolate
•lysed red cell media to release nutrients for picky (fastidious) organisms

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13
Q

What do you suppose this agar is?

What is it for?

A

–Sabouraud
•for dermatophytes and other fungi

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14
Q

What is a key component in obtaining a sputum specimin?

A

Must attempt to avoid oral contamination as the sample is removed. This is difficult due to the high load of organisms (particularly anaerobics).

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15
Q

It is thought that a minimum of how many organisms must be present for a gram stain procedure to work?

What does this mean for us?

A

10^4 to 10^5 organisms.

Means that staining a simple sputum specimen may be insufficient, and you may have to wait for culture growth.

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16
Q

See if you can rattle off 8 encapsulated bacteria.

A
  1. •Typeable Haemophilus influenzae (ie type B)
  2. •Strep pneumo
  3. •Neisseria meningiditis
  4. •Strep agalactiae (group B)
  5. •Klebsiella
  6. •Salmonella
  7. •Capnocytophaga
  8. •Crytptococcus
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17
Q

Who are encapsulated organisms particularly bad for?

A

Asplenic patients

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18
Q

In order from most to least common, what are the top three organisms that cause 85% of bacterial cases of community aquired pneumonia?

A

–Strep pneumoniae
–Haemophilus influenzae
–Moraxella catarrhalis

19
Q

What agar is best for growing H. influenza?

A

Chocolate, since this organism needs factors “V” and “X”.

20
Q

H. influenza type B and non-typable strains have capsules. Who are these infections common in?

A

–common in smoker/copd patients

21
Q

The arrow is indicating the patient’s enlarged epiglottis. The patient presents with fever, sore throat, and is leaning forward with their mouth open and drooling.

What is the infection?

What must you be aware of in this situation?

What is the best approach to managing this infection?

A

H. influenza type B

In kids especially life threatening since the can lose their airway rapidly due to the epiglottitis

As usual the best approach is prevention, vaccinations are available against this.

22
Q

Mycoplasma pneumoniae is a cause of what kind of pneumonia?

A

Atypical, “walking pneumonia”

23
Q

What is a somewhat unique way of testing for M. pneumoniae?

A

Cold agglutinins

24
Q

What are some of the extrapulmonary consequences of an M. pneumoniae infection?

A

–Hemolysis, usually mild
–skin: maculopapular rash or vesicular to SJS.
–CNS: 0.1% of all pts and 7% hospitalized pts. aseptic menigitis, peripheral neuropathy, cranial nerve palsy, cerebellar ataxia, ADEM and transverse myelitis
–cardiac: one of the more common presentations with rhythm abnormality, CHF
–Rheum: raynauds, polyarthralgias and mylagias from immune-medicated mechanism but has been cultured from synovial fluid.
–rare Glomeruloneprhitis
–rare hepatitis and pancreatitis
–Otitis media and bullous myrigitis

25
Q

Legionella pneumophila is another atypical pneumonia. What are 8 common presentations associated with this?

A
  1. syndrome of fever with temp/HR dissociation,
  2. Head ache
  3. , myalgia,
  4. confusion,
  5. diarrhea,
  6. cough,
  7. inc LFT’s.
  8. Hyponatremia
26
Q

What is Legionella pneumophila resistant to?

A

Cephalosporins

27
Q

What are the most common causative agents of endocarditis, and what type are they involved in?

A
  1. Streptococcus viridans: Sub acute endocarditis
  2. Staphylococcus aureus: Acute endocarditis
  3. S. Epidermidis: foreing body
28
Q

The HACEK group is associated with endocarditis. What are the organisms of the HACEK group?

A

–Haemophilus aphrophilus
–Actinobacillus actinomycetemcomitans
–Cardiobacterium hominis
–Eikenella corrodens
–Kingella kingae

29
Q

How does one get Eikenella corrodens?

A

Human bites

30
Q

Neutropenic fever is particularly concerning d/t the lack of an intact immune system. Describe the management of a patient like this.

A
  1. Obtain cultures including blood, sputum if able, urine.
  2. start empiric anti-pseudomonal abx
  3. begin Gram positive coverage if line suggested as possible source. (cover MRSA/MRSE)
  4. obtain imaging as needed
  5. if after 4-7 days with fever, without source, add antifungal
31
Q

What are the diagnostic criteria for a “fever of unknown origin”

A

Outpatient -Three weeks fever without diagnosis

Inpatient - Three days fever without diagnosis

32
Q

See if you can articulate the minimum workup for a FOUO.

A

–blood cultures, erythrocyte sedimentation rate or C-reactive protein, serum lactate dehydrogenase, HIV antibody test and viral load, rheumatoid factor, heterophile antibody test, creatine phosphokinase, antinuclear antibodies, tuberculin skin test or interferon-gamma release assay, serum protein electrophoresis, and computed tomography scan of abdomen and chest, LP, Bone marrow biopsy.

33
Q

What organism is associated with cat and to a lesser degree dog bites. That is also a small GNCB?

A

Pasteurella multocida

34
Q

What does pasteurella multocida produce that impacts antimicrobials?

What does it lead to sometimes?

A

Beta-lactamase producer

Tenosynovitis as well as joint and bone infections

35
Q

What is the causative agent of “cat scratch disease”?

A

Bartonella henselae

36
Q

What is bartonella henselae easily be mistaken for?

A

Often occurs in children as they tend to get scratched by cats more frequently… 1-3 weeks later the child will have enlarged, tender lymph nodes. This can freak out parents, and will make them think their child has lymphoma

37
Q

In aids, what does bartonella henselae cause?

A

Bacillary Angiomatosis

38
Q

In aids patients B. henselae can cause bacillary angiomatosis which can be a few to hundreds of lesions which are papules or nodules that are red, globular, and non-blanching with a vascular appearance.

There can also be purplish nodules that are similar to what other common thing seen in AIDs patients?

A

Kaposi’s sarcoma

39
Q

Which is more numerous in the GI tract? Aerobes or anaerobes?

A

Anaerobes, 1000:1

40
Q

What is the largest bacterial group in the GI tract?

A

Bacteriodes fragilis

41
Q

What are the two special conditions of anaerobic infections?

A

Ludwigs angina

Lemiere’s Syndrome

42
Q

What leads to Ludwigs angina? What is it?

A
  • starts with dental infection 50-90% of the time
  • infection of sublingual and submandibular spaces especially with base of tongue swelling
43
Q

What organism causes Lemiere’s syndrome?

A

•Fusobacterium necrophorum

44
Q

What is Lemiere’s syndrome?

A

•post compartment of lateral pharyngeal space with suppurative thrombophlebitis of IJ vein. shows right sided septic emboli to lung (septic emboli due to infectious origin of embolus)

PBD II (18 decks)

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