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ABSITE Studying > Fiser Chapter 5: Infection > Flashcards

Fiser Chapter 5: Infection Flashcards

1
Q

Most common immune deficiency leading to infection.

A

Malnutrition

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2
Q

Microflora in:

Stomach; proximal small bowel; distal small bowel; colon

A

Stomach: sterile, some GPC, some yeast
Proximal small bowel: GPC (10^5)
Distal small bowel: GPC, GPR, GNR (10^7)
Colon: 10^11 (anaerobes; some GNR, GPC)

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3
Q

Most common anaerobe in the colon

A

Bacteroides fragilis

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4
Q

Most common aerobic bacteria in the colon

A

E. coli

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5
Q

Which are more common organisms in the GI tract: aerobic or anaerobes?

A

Anaerobes

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6
Q

Anerobes lack these enzymes making them vulnerable to oxygen radicals.

A

Superoxide dismutase

Catalase

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7
Q

Most common organism that causes GN sepsis

A

E. coli

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8
Q

Pathophysiology of GN sepsis

A

Endotoxin (Lipopolysaccharide lipid A) is released; triggers release of TNF-alpha; released from macrophages, triggers inflammation, activates complement, actives coagulation cascade

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9
Q

Describe hyperglycemia in early vs. late GN sepsis

A

Early: Decreased insulin; impaired utilization
Late: insulin resistance

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10
Q

T/F Hyperglycemia occurs just before the patients becomes clinically septic.

A

True

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11
Q

Optimal glucose level in a septic patient

A

80-120

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12
Q

Diagnostic test for C. diff

A

ELISA for Toxin A

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13
Q

What do you use to treat C. diff in pregnancy?

A

PO Vanc

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14
Q

Treatment for fulminant C. diff colitis?

A

Total colectomy with end ileostomy

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15
Q

What percentage of abdominal abscesses have anaerobes?

A

90%

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16
Q

What percentage of abdominal abscesses have both anaerobes and aerobes?

A

80%

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17
Q

When do intra-abdominal abscesses usually occur?

A

7-10 days post-op

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18
Q

When are antibiotics indicated for intra-abdominal abscesses?

A

Diabetes, cellulitis, sepsis, fever, prosthetic hardware

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19
Q

4 classes of surgical operation

A

Clean: hernia (2%)
Clean-contaminated: elective colon-resection with prepped bowel (3-5%)
Contaminated: GSW colon with repair (5-10%)
Gross contaminated: abscess (30%)

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20
Q

Most common SSI organism

A

Staph aureus (coag-positive)

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21
Q

Is staph epi coag positive or negative?

A

Negative

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22
Q

What is the exoslime released by staph species?

A

Exo-polysaccharide matrix

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23
Q

Most common GNR in surgical wounds?

A

E. coli

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24
Q

Most common anerobe in surgical wound infection?

A

B. fragilis

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25
Q

What does recovery of B. fragilis from surgical wound infection indicate?

A

Necrosis, abscess, gut translocation

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26
Q

How many bacteria required for SSI?

A

10^5 (less if foreign body)

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27
Q

Risk factors for wound infection

A

Long operation; hematoma or seroma formation; advanced age; chronic disease (COPD, ESRD, liver failure, DM), malnutrition, IS drugs

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28
Q

Most common infection in surgery patients

A

UTI; biggest risk factor is urinary catheter; most commonly E. coli (GNR)

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29
Q

Leading cause of infectious death after surgery; most common organisms

A

Nosocomial pneumonia

  • Related to length of ventilation, aspiration
  • S. aureus, Pseudomonas, E. coli
  • GNR #1 cause in ICU patients
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30
Q

3 most common line infections

A
  1. S. epi
  2. S. aureus
  3. Yeast
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31
Q

What % of infected lines can be salvaged?

A

50%

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32
Q

2 most common causes of necrotizing soft tissue infections

A

GAS; MRSA (exotoxins); C. perf

Or mixed

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33
Q

Risk factors for necrotizing soft tissue infections

A

DM, poor Q, immunocompromised

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34
Q

Signs/symptoms of necrotizing soft tissue infection

A

Pain out of proportion to skin, mental status changes, WBC >20, thin gray drainage, blistering/necrosis, induration/edema, crepitus, soft tissue gas on X-ray

35
Q

T/F Nec fasc spreads along fascial planes

36
Q

Which necrotizing organism has alpha toxin?

37
Q

Where does Fournier’s gangrene occur anatomically?

A

Perineal, scrotal

38
Q

Most common anatomic location of aspiration pneumonia? Most common organism?

A

RLL (sup seg); S. pneumonia MC organism

39
Q

Test with highest sensitivity for OM?

40
Q

Treatment for brown recluse spider bite?

A

Oral dapson; avoid early surgery

41
Q

Treatment for acute septic arthritis? Most common organisms?

A

Drainage, CTX + Vanc

- Gonococcus, staph, H. flu, strep

42
Q

Most common cause of cat/dog/human bite?

A

S. pyogenes

43
Q

What bacteria is found in human bites?

A

Eikenella; can cause joint damage

44
Q

What bacteria can be found in cat/dog bites

A

Pasturella multocida

45
Q

Treatment for cat, dog, human bites?

46
Q

Most common cause of impetigo, erysipelas, cellulitis, folliculitis

A

Staph (MC), strep

47
Q

Diffrerence beteween furuncle and carbuncle

A

Furuncle: boil (S. epi/S. aureus)
Carbuncle: Multi-loculated furunce

48
Q

Symptoms of PD catheter infection

A

Cloudy fluid, abdominal pain, fever (monobacterial)

49
Q

MCC PD catheter infections

A

S. epi (#1), S. aureus, Pseudomonas; fungal difficult to treat

50
Q

Treatment PD catheter infection

A

IP Vanc/Gent; increased dwell time, IP heparin; IV ABX not as helpful

51
Q

When do you remove PD catheter for infection?

A

After 4-5 days of infection

52
Q

What about fecal peritonitis in PD catheter infection?

A

Ex lap to find perforation

53
Q

Which infections require removal of PD catheter infections

A

Pseudomonas, fungal, tuberculous

54
Q

Treatment of sinusitis

A

BS ABXB; rare to have to tap sinus for systemic illness

55
Q

Best prevention strategy for nosocomial infections

A

Hand washing

56
Q

Highest risk patients for nosocmial infections

A

Burn patients

57
Q

Best practices to prevent surgical site infections

A 
Clippers pre-op (over razor)
Glucose 80-120
PaO2 -- 100% FiO2
Patiente warm
Chlorhexidine prep with iodine-impregnated drapes
58
Q

Yellow sulfer granules on Gram stain; symptoms, treatment

A

Actinomyces; pulm symptoms

- Drainage and PCN G

59
Q

Treatment of Nocardia

A

Drainage and Bactrim

60
Q

MCC fungemia

A

Candida

Tx: Fluconazome

61
Q

Treatment for Candiduria

A

Remove foley catheter

62
Q

Treatment for aspergillosis

A

Voriconazole

63
Q

Treatment of Histoplasmosis (MS and Ohio River Valleys)

64
Q

Treatment for Cryptococcus

65
Q

Treatment of Coccidiomycosis

66
Q

MCC SBP

A

E coli, Strep, Klebsiella

67
Q

How many PMN’s needed for diagnosis of SBP?

68
Q

Treatment SBP?

69
Q

Polymicrobial SBP?

A

R/O intra-abdominal source

70
Q

PPX SBP

A

q weekly flouroquinolones

71
Q

T/F HIV is an RNA virus with reverse transcriptase

72
Q

T/F HIV anti-virals should be given within 1 hour of exposure

73
Q

Most common indication for laparotomy in HIV patients

A

CMV; second most common is lymphoma

74
Q

Most common intestinal manifestation of AIDS

A

CMV colitis; pain, bleeding, perforation

75
Q

Most common neoplasm in AIDS

A

Kaposi’s sarcoma

76
Q

Most common location of lymphoma in HIV patients

A

Stomach, then rectum

- NHL (B; cell)

77
Q

UGI vs. LGI bleed in AIDS patients

A

UGI: Kaposi, lymphoma
LGI: CMV, bacterial, HSV

78
Q

CMV is transmitted by (this cell)

A

Leukocytes

79
Q

Most common infection in transplant patients?

80
Q

Most common manifestation of CMV infection

A

Febrile mononucleosis

81
Q

Most common deadly form of CMV

A

CMV pneumonititis

82
Q

CMV biopsy

A

Cellular inclusion bodies; CMV serology

83
Q

Treatment of CMV

A

Ganciclovir; CMV immune globulin (neg patient receive positive organ)

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