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SUMGERI > GERI-INFX > Flashcards

GERI-INFX Flashcards

1
Q

What is the norovirus?

A

Nonenveloped single strand RNA virus. *The most common cause of gastroenteritis in the US. MCC is GII.4

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2
Q

Where are norovirus outbreaks common?

A

Cruise ships and in long-term care facilities-winter

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3
Q

What can greatly reduce the length of a gastroenteritis illness?

A

Probiotics!

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4
Q

What are the symptoms of norovirus?

A

N/V, nonbloody and watery diarrhea, and abdominal cramping.

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5
Q

How is norovirus transmitted?

A 
**CONTAGIOUS. 
contaminated surfaces, 
vomit-aerosolized, f
ood or water, or 
P2P.
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6
Q

What is the definition of a norovirus outbreak?

A

2 or more similar illnesses resulting from a common exposure that is either suspected or laboratory-confirmed to be norovirus.

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7
Q

In what population group is hepatitis C most common?

A

The baby boomer population. (1 in 30-unknowingly infected!)

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8
Q

What is the source of transmission of hepatitis A?

A

Food sources, aka fecal-oral.

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9
Q

What is the source of transmission of Hepatitis B?

A

Blood!

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10
Q

What is the most common complication of Hepatitis C?

A

Hepatocellular carcinoma.

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11
Q

Who is most at risk for Hepatitis C?

A
  • IV drug users
  • Received blood/organs before 1987-1992.
  • hemodialysis.
  • Medical workers needle sticks.
  • Children of HCV+ women.
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12
Q

Who is at a moderate risk of developing Hep C?

A
  • Transplant recipients after 1992. - Cocaine abusers - Tattoos - Multiple sexual partners - Long-term steady sexual partners of HCV+ persons. - HIV+ persons
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13
Q

What are the symptoms of Hepatitis C?

A

MC-ASYMPTOMATIC. +/- fever, fatigue, n/v, dark urine, and jaundice.

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14
Q

If symptoms of an acute hepatitis infection, how long ago exposed? Are they contagious during this time?

A

6-8 weeks ago. YES they are contagious even if asymptomatic.

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15
Q

What are common symptoms of a chronic hepatitis C infection?

A

Arthritis, itching, and numbness.

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16
Q

If a patients comes in c/o icterus and itching, what 2 labs must you draw?

A

CMP, LFTs and hepatitis panel.

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17
Q

Can Hepatitis C be cured?

A

YES! New antiviral medications -Epclusa 12 week $$

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18
Q

In the management of Hep C, what lab test is done in order to watch out for development of hepatocellular carcinoma?

A

Alphafetaprotein (AFP) q3 months x2, then q6 months.

If spikes —> get liver ULS evaluation for lesions.

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19
Q

What is C Diff?

A

A bacterial infection that causes mild to severe diarrhea. Contaminated surfaces, then touching nose or mouth.

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20
Q

What are the symptoms of C Diff?

A

Diarrhea -3 watery,yellow, and very foul smelling stool daily for 2+ days,
fever,
nausea, and abdominal pain.

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21
Q

What are the potential complications of C Diff?

A
  • Colitis - Sepsis - Death
22
Q

What patients are most at risk for developing C Diff? At what facilities are outbreaks most common?

A

elderly, ill, and IMC hospitalized patients, SNFs, community care facilities.

23
Q

Recent use of what medication predisposes you to C Diff?

A

ALL Antibiotics!

  • *Ampicillin
  • Amoxicillin
  • Cephalosporin
  • Fluoroquinolones
24
Q

If a C Diff infection occurs in a facility you are working, what must you do to decrease the spread?

A

exposure protocol.
- Strict hand WASHING-
Gloves and disposable gowns. -
Disciplined toilet/incontinent cleanliness procedures.

25
Q

What is the treatment for C Diff?

A

Vancomycin 125mg PO 4x daily x10-14 days. **Must be oral.

26
Q

What does it mean to have a complicated C Diff infection?

A

C Diff + hypotension, shock, ileum, or megacolon.

27
Q

How do you treat severe, complicated C Diff?

A

Vancomycin 500mg 4x daily PO or IV AND metronidazole 500mg 3x daily IV. Consider a vancomycin enema.

28
Q

If a patient with C Diff does not show improvement by day 4-6 of vancomycin treatment, what can you add to the treatment regimen?

A

Rifampin 10mg/kg/dose.

29
Q

If a patient with C Diff still does not show improvement by day 4-6 of vancomycin and rifampin treatment, what should you do?

A

Consult GI, infectious disease, and/or surgery. Increase to high dose vancomycin and consider donor stool transplant.

30
Q

If a patient with C Diff has a suspected ileus (i.e. vomiting, abdominal pain, distention) or a toxic megacolon (vomiting, Abdominal pain, distention, fever, tachycardia, and hypotension), how should you treat?

A
  1. Obtain a GI, infectious disease, or surgery consult!
  2. Metronidazole 7.5mg/kg/dose IV q6 hours x10 days.
  3. Consider intracolonic vancomycin.
31
Q

If a patient has a second relapse of C Diff within 1 year or if a patient worsens significantly after treatment is discontinued, what should you do?

A

Either: 1. Vancomycin taper x6 weeks. OR 2. Vancomycin pulse therapy (dose every 2-3 days) x3 weeks.

32
Q

What is MRSA?

A

Methicillin-resistant staph aureus

33
Q

What medications can NOT be used to treat Staph?

A
  • Methicillin
  • Amoxicillin
  • Oxacillin
  • Cephalosporins (Keflex)
34
Q

Where do we find Staph bacteria?

A

On our population! 30% of the population carry Staph in the nose or on the skin.

35
Q

Where in the community do patients usually acquire MRSA?

A
  • Schools
  • Athletic centers
  • Correctional facilities
36
Q

Where in the hospital do patients usually acquire MRSA?

A
  • Surgeries
  • IV tubing -
    Artificial joints
37
Q

Who is at a high risk for developing a MRSA infection?

A
  • comorbidities, frail, debilitated, or malnourished.
  • Prior antibiotic use -
    Body implants (i.e. hip and knee replacements or pacemakers)
  • Prior hospital or nursing home admission
38
Q

How is transmission of MRSA prevented within the health care setting?

A
  • Hand hygiene
  • Gloving
  • Mouth, nose, and eye protection
  • Gowning
  • Cleaning patient equipment (beds/rails, wheelchairs, gurneys)
39
Q

What is the treatment for a MRSA skin infection?

A

**1st line: Doxycycline 100mg PO BID x10 days. OR Bactrim DS: 1 tablet PO BID x10 days + Keflex.

40
Q

What is TX for more serious MRSA infection?

A

clindamycin 150-300mg OR 300-450mg severe. orally q6 hours.

41
Q

What is sepsis?

A

Life-threatening organ dysfunction caused by a dysregulated host response to infection.
Bacteria!
But can be from fungi, viruses, or parasites.

42
Q

What is the risk of death with sepsis?

A

> 30%.
Severe sepsis-50%, a
septic shock- 80%.

43
Q

Where are the MC primary sources of infection resulting in sepsis?

A

Lungs,
abdomen
urinary tract.

44
Q

The criteria was changed from SIRS to the qSOFA score in 2016. What is different about this criteria?

A

*SIRS may or may not progress to sepsis/shock.

45
Q

What is the criteria for diagnosis of sepsis?

A 
Quick Sequential (Sepsis Related) Organ Failure Assessment Score
Suspected/documented infection + 2 on the qSOFA: - Hypotension with SBP <100 (1 point)
- Altered mental status (1 point) 
- Tachypnea (RR>/=22) (1 point)
46
Q

What is the SIRS criteria?

A

At least 2 of the 4 criteria must be present:

  • Temp >100.4F or <96.9F
  • HR >90bpm
  • RR > 20 breaths/min or PaCO2 <32 mmHg
  • WBC count >12,000/mm2, <4000/mm3, or >10% bands/immature forms.
47
Q

What lab value is diagnostic of sepsis?

A

Lactate -if patient with an infection meets only 1 of the qSOFA criteria in the ED,

48
Q

what should be done within the first hour of triage?

A
  • Lactate, labs, and blood cultures drawn.
  • Fluid bolus started.
  • Antibiotics -Beta-lactam).
49
Q

What is the full lab workup for a septic patient?

A
  • CBC
  • CMP -
    Blood culture
  • VBG
    • Lactate
  • Urinalysis/culture
  • Chest x-ray
  • Lipase
  • Coags INR
50
Q

What is procalcitonin?

A

improvement measure marker of sepsis

SUMGERI (14 decks)

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