Exam #1: Infectious Disease

Question 1

What is the difference between morbidity & mortality?

Answer 1

Morbidity= Illness
Mortality= Death

Question 2

What is immune senescence?

Answer 2

Decline in immune response with age

Question 3

What are the main features of immune senescence?

Answer 3

1) Depressed T-cell response & depressed T-cell macrophage interaction
2) Decreased B-cell affinity

Question 4

How do co-morbid diseases complicate infections?

Answer 4

Physiologic “frailty” predisposes to worse infections & damped immune response

Question 5

What is the impact of nutritional status on immune function?

Answer 5

Malnutrition impairs immune function

Question 6

What are the long-term care considerations for infectious diseases?

Answer 6

1) Residence in LTC facility puts older adult at risk
2) Widespread ABX use increased likelihood of resistant infection
3) Resistance in impaired by factors of age & residency
4) Maintaining UTD immunizations is critical

Question 7

How is fever redefined in nursing-home residents?

Answer 7

• Temp. >2 F of baseline
• Oral temp. >99
• Recatal temp. >99.5

*****Note that fever may be absent in 30-50% of older frail adults w/ serious infections

Question 8

What is the most common cause of iatrogenesis in the elderly?

Answer 8

Medication management

Question 9

How are antibiotics dosed in the elderly population?

Answer 9

Renal function

*****Also, note that there are many antibiotic interactions with commonly prescribed medications for older adults

Question 10

What is the minimum criteria for ABX initiation for UTI without catheter?

Answer 10

• Fever AND one of the following:
  1) New or worsening urgency
  2) Frequency
  3) Suprapubic pain
  4) Gross hematuria
  5) CVA tenderness
  6) Incontinence

Question 11

What is the minimum criteria for ABX initiation for UTI with catheter?

Answer 11

Fever OR one of the following:

1) New CVA tenderness
2) Rigors
3) New-onset delerium

Question 12

What is the minimum criteria for ABX initiation for skin & soft tissue infection?

Answer 12

Fever OR one of the following:

1) Redness
2) Tenderness
3) Warmth
4) New or increasing swelling of affected site

Question 13

What is the minimum criteria for ABX initiation for respiratory infection?

Answer 13

• Fever > 102 AND RR >25, or productive cough
• Fever >100 but 25 + Pulse >100
• Afebrile w/ COPD AND new or increased cough w/ purulent sputum
• New or increased cough AND RR> 25 or new-onset delerium

Question 14

What is the minimum criteria for ABX initiation for fever without source of infection?

Answer 14

New-onset delirium or rigors (chills)

**Note that the patient should be fully underessed to look for a source of infection first

Question 15

What is the most common cause of bacterial pneumonia in older adults?

Answer 15

Streptococcus pneumoniae

Question 16

What is the first line antibiotic therapy for community acquired pneumonia?

Answer 16

• Beta-lactam/ Beta-lactamase combination (PCN or cephalosporin)
  given with or without macrolide
• OR newer fluoroquinolones with enhanced activity against S. pneumoniae

Question 17

What is the first line antibiotic therapy for hospital acquired pneumonia?

Answer 17

Generally, initial regimens should be broadly inclusive & then narrow
- IF MRSA is suspected–vancomycin or linezolid

Question 18

How can the risk of penumonia reduced?

Answer 18

1) Immunization
2) Smoking cessation
3) Aggressive treatment of comorbidities
4) System changes in the LTC facility

Question 19

What is the recommendation for flu vaccination in the geriatric population?

Answer 19

Annual flu vaccination recommended for ALL adults

Question 20

How does UTI in geriatrics differ from young adults?

Answer 20

Geriatric= resistant isolates e.g. Pseudomonas aeruginosa

Question 21

Is treatment recommended for asymptomatic bacteruria?

Answer 21

No

Question 22

What antibiotics are recommended for Lower UTI in women?

Answer 22

Fluoroquinolones (vs. bactrim)

**Only culture if first round therapy is ineffective

Question 23

How does management of Upper UTI differ from lower UIT?

Answer 23

Much more serious

• IV abx
• Longer course of therapy
• More constitutional symptoms d

Question 24

What is the most common cause of UTI in older men?

Answer 24

Prostatic Disease

Question 25

How does treatment of UTI differ in men & women?

Answer 25

Longer treatment course in men: ~14 days

Question 26

What is the most common cause of TB in older adults?

Answer 26

Reactivation

Question 27

What are the recommendations for a “positive” PPD?

Answer 27

> 15mm= universally positive

> 10mm= positive in:

• nursing home
• recent converters
• immigrants

> 5mm= positive in HIV

Question 28

How is TB treated?

Answer 28

Isoniazid for 9 months

Question 29

What is infective endocarditis? What is it associated with and now is it treated?

Answer 29

Infection of the endocardial surface of the heart

• Associated with degenerative valvular disorders ‘
• Treat with 4-6 weeks of abx

Question 30

What is the most common cause of septic arthritis? How is it treated?

Answer 30

• S. aureus
• Aggressive antibiotic with serial arthrocentesis
• Surgical drainage if conservative strategy fails

Question 31

What is the most common cause of osteomyelitis in old age? Why is this more common in the elderly?

Answer 31

• S. aureus

- Pressure ulcers that go down to the bone

Question 32

When should you consider meningitis as part of your differential?

Answer 32

Fever + mental status change

Question 33

What is the optimal treatment for neurosyphilis?

Answer 33

PCN G

Question 34

When is Herpes Zoster vaccine recommended?

Answer 34

> 60 years-old

Question 35

What are three infectious diseases that are associated with Bell’s Palsy?

Answer 35

1) Herpes Simplex
2) Varicella zoster (shingles)
3) Lymes

Question 36

When should you get a surgical consult on an elderly patient with abdominal pain?

Answer 36

Abdomianl pain + fever= surgical consult

Question 37

What are the fist line treatments for C.diff?

Answer 37

• Metronidazole for mild to moderate cases

- Vancomycin