Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

UC > IBS > Flashcards

IBS Flashcards

1
Q

What is IBS?

A

Is a functional gastrointestinal disorder involving disturbance in bowel function affecting the sensorimotor function of the gut.

A syndrome with a diagnosis made of cluster of x in the absence of structural abnormalities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is fecal calproctectin?

A

A non- invasive market of mucosal inflammation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Treatment decision made on disease is based on what?

A

Severity and and location rather than strictly by diagnosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Diagnosis for IBD are..

A 
Patient history
Various tests including blood tests. Stool tests (esp fecal calprotectin), 
Endoscopy
Biopsies
Imaging studies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In suspected IBD tests should aimed at what?

A

Differentiating IBD from infectious gastrointeritis and coeliac dse.

Ix also helps in defining dse activity and severity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Lab test Ix should include blood and stool to rule out what?

A

Other causes of diarrhea and inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Blood tests are not specific for IBD but may be done to detect and evaluate what?

A

Severity of inflammation
Anemia
Vitamin or mineral deficiency associated with IBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

FBC can reveal what?

A

Anemia - low mean corpuscular volume (MCV)

High MCV suggesting B12 or folate deficiency or seen in patients on immunomodulators such as thioprines

Normal MCV with high red cell distribution width (RDW) indicating iron and folate def or folate and vit B 12

WCC elevation - evidence of inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Low Albumin

A

Inflammation and malnutrition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Raise creatinine and urea

A

Evidence of dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Electrolyte disturbances

A

Low magnesium, selenium, potassium, zinc

Rrlated to poor diet and long standing diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Low ferritin

A

Iron def < 100 microgram

Elevated serum ferritin can be a marker of inflammationesp in liver rrlated inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Non-celiac features includes

A

Fistulas
Perianal dse
Bloody stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Fecal calprotectin is widely used neutrophil derived protien biomarker in Australia.

Highly sensitive, non invasive marker of intestinal inflammation therefore is useful in the ff settings.

What are they?

A

Differentiating people with or without lower gut inflammation bet people with IBS and IBD

Monitoring people on therapy to check disease activity or response to tx

Assess mucosal heal is achieved where colonoscopy is not practicable due to cost, access, patient comorbidities and Pt’s refusal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Stool testing with suspected IBD is valuable tool to determine enteric infections such as what?

A

Clostridium difficile (common in elderly, immunocompromised and on antibiotic therapy)

Tx of IBD w/ immunosuppression without addressing infectious pathogens can be dangerous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

FOBT testing can reveal what?

A

Traces of blood that cannot be seen with the naked eye

A screening tests for colorectal ca and should not be used as a diagnosis for IBD

Other stool culture for patients who travelled abroad to check infectious diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Endoscopy and colonoscopy with histology and radiology are used for what?

A

Diagnosis of IBD to assess it’s extent and severity

To prevent young Pt’s from unnecessary exposure to radiation by using MRI over CT if possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

First line procedure to establish diagnosis and extent of IBD

A

Colonoscopy with ileoscopy with multiple biopsy specimens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Endoscopy is used for

A

Visual exam of the the entire lining of large intestine

Examine ulcers, inflammation, bleeding, stenosis
Multiple biopsies from the colon to TI
Lack of response to tx
Assess CMV infections - testing on biopsies, PCR. Pt’s on chronic use of immunosuppressants or w/ C diff infection appearances suggests pseudomembranes

Colonoscopy for dysplasia surveillance

Upper GI endoscopy is ised for upper GI sx such as nausea, vomitting, epi pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Capsule endoscopy is used for what?

A

To assess presence, extent and severity of small bowel involvement in Crohn’s dse

Stricturing Crohn’s dse is a contraindication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Plain abdo xray is used for?

A

Wether colitis is present and its extent in some cases of UC

Exclude toxic megacolon with acute severe colitis

Give impression of mass on RIF or show dilatation or obstructions on CD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Barium double contrast enema
Is rarely used and is replaced by colonoscopy.

When is it helphlful?

A

In rare circumstances when colonoscopy is incomplete or to delineate the lenght of a colonic stricture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When is USS and MRI used?

A

To determine the extent and severity of the disease to assess for perforating complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Intestinal USS permits a real time assessment of disease activity including what are they??

A

Quantifying inflammatory burden that assist in determining the inflammatory and fibrotic components of a stricture

Determine sx are due to active diseases or due to functional issues such as faecal loading.

It is non- invasive, don in an unprepped bowel

Relatively safe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Dual emission Xray absorptiometry

A

To assess bone mineral density

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

CXR

A

Exclude TB

Look for free air under fiaphragm in case of perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Referral to specialist should not be delayed for high risk patients due to poor outcome and prevent avoidable bowel resection

Who are those people at risk?

A 
Weight loss >5 kg at presentation
Poor appetite, < oral intake
Unable to manage usual activities
Need steriods at ist presentation
Hospital admission at 1st present
Long term reliance on opioids for chronic pain
Mood disorder on antidepressants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Treatment decisions on IBD have been based on a step up approach.

What are those

A

At diagnosis, mild anti inflammatory therapy if these tx fail,

Immunomodulating agents are offered. If dse persist

Biologic agents are added

If all of these measures fail, surgery is the last resort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

6 main categories treatment to control inflammation to allow GIT opportunity to heal

A

Aminosalicylates (5 ASA)
Corticosteriods
Immunomodulators (azathioprine, 6MP, methotrexate)
Biologic agents (infliximab, adalimumab, vedolizumab, ustekinumab)
Antibiotics ( metronidazole, ciproflixacin,)
Exclusive enteral nutrition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Mesalazine 5 ASA is the first line tx and is also used to treat mild to moderate sx of active colonic IBD.

Is more useful to treat UC than CD
True or false

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How do 5 ASA works?

A

Main use for long term maintenance of remission

Act topically on the colonic mucosa to suppress production of pro inflammatiry mediators and control inflammation

Effective in colonic dse than in small bowel

Can be given orally or rectally

Topical therapy act on the mucosal level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the 5 ASA preparation in Australia?

A

Sulfasalazine
Olsalazine
Balsalazide
Other mesalazine preparations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Those available for rectal use include

A

Mesalazine enemas )liquid or foam)

Suppositories

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Patients must be treated first with sulfasalazine unless allergic to sulfur containing meds

True or false

A

True

Patients will be offered mesalamine containing 5 ASA which do not have sulfamoity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Combination of oral steriods and 5 ASA may be used in more severe cases

True or false

A

True

A combination of topical and oral 5 ASA bring Pt’s into remission more quickly that oral tx alone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

When is corticosteroids use for?

A

Are used for moderate to severe active IBD

Use for Pt’s who are not responding to 5ASA tx

Prednisone is considered

Not effective for maintenance therapy

Expect signs of improvement in 3-5 days

Hospital admission is necessary if not responding to steriods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Steriods shoulds be given with what medications?

A

Immunomodulators such as azathioprine, 6 MP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Corticosteriods side effects includes

A 
Weight gain
Susceptibility to infections
Acne
Facial hair
Hypertension
Glucose intolerance
Diabetes
Sleep and mood disturbances
Dyspepsia
Prolonged use >12wks include cataracts,
Osteoporosis and myopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Budesonide (oral steriods) are used for what?

A

Mild ileal or ileocolonic Crohn’s dse

Matrix encased budesonide (cortiment) for mild to moderate colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the standard of care for the maintenance of remission in both CD and UC?

A

Long term maintenance therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is immunomodulators?

A

Drugs that modulate or suppress the immune system ( esp azathioprine, 6MP and methotrexate)

Prevent or reduce corticosteriods dependence in IBD

Slow onset of action not ideal for induction of remission (2-3/12 for optimal response)
6 MO (8-12/52 full dose efficacy)
Methotrexate (commence s/c weekly dosing min 6/52 full dose efficacy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

In IBD, what are the first line immunomodulating therapy?

A

Thiopurines (6MP or azathiprine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

When is immunimodulator started?

A

Disease assessed endoscopically is clinically severe at onset

Steroid dependence

Second course of steriods for a relapse is needed

Patients avoiding steroids due to obesity, osteoporosis, diabetes steroid induce menta illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Cycloporins or tacrolimis

A

Reserved for rescue therapy when there is a severe episode and not responding to high dose IV steroids in hospital

Used as a last resort and prior to colorectal surgical consultation is recommended

Surgery is the next step mgt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Twhat is the aim for immunomodulator therapy?

A

To achieve and maintain steroid free remission and heal the mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Immunomodulators side effects

A

Vomitting
Diarrhea
Associated complications include pancreatitis (thiopurines), hepatitis, reduced wbc count, increased risk of onfection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Biologic treatments is used for what?

A

Patients with moderate to severe IBD where standard medical tx has been insufficiently effective.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are the 2 anti tumour necrosis factor (TNF) antibidies available on PBS tx for IBD

A

Infliximab(Remicade)

Adalimumab (Humira)

Both are effective in patients with UC and CD.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Infliximab is used in hospitalized pations with UC with severe acute colitis and fail to respond adequately to IV cortecosteroids

Itolerance to and inefficacy from aminosalicylates, thiopurines and a course of cortecosteroids.

True or false

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Adalimimab is used for what?

A

Chronically active moderate to severe UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How is infliximab and adalimumab given?

A

Infliximab is IV infusions

Adalimumab is S/C

These agents blocks immune syatem’s production of TNF, a pro inflammatory cutokine implicated in IBD.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Where is Vedolizumab used?

A

Approved by PBS for both induction and maintenance therapy for moderate to severe CD and UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Ustekinumab is used for what

A

For the management of plaque paoriasis for those who developed psoriatic dse while on anti TNF therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Biologic therapy shown highly effective as first line for the tx of IBD

True or false

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Biologics adverse effects

A 
Infection
Malignancy
Immunoganicity
Infusion reaction
Opportunistic infections
Reactivation of viral infections
Reactivation of or primary infection with tuberculosis
Psorias and other paradoxical immune related disorders
Worsening of congestive heart failure
Demyelinating disorders
Malignancy and lymphoma
56
Q

What is Exclusive Enteral Nutrition?

A

Administratiin of a liquid nutrition formula to meet all nutritional requirements, replacing normal diet either orally or nasoenteric tine.

57
Q

When is antibiotics (metronidazole, ciprofloxacin, rifaximin) used?

A

Effective for the tx of CD complications (perianal dse, fistulas, inflammatory mass, bacterial overgrowth in setting of strictures)

It is used for the tx of pouchitis in UC following proctocolectomy.

58
Q

What antibiotic has an increased risk of C. Difficile infection?

A

Broad spectrum antibiitic especially fluoroquinolones such as ciprofloxacin

59
Q

When is surgey indicated?

A

When sx no longer controlled and mechanical complications such as strictures, obstructions, perforations, abscess or refractory bleeding.

Resection is not a cure typically will recur post surgery therefore recommend to detect recurrence early is post op surveillance

Metronidazole recommend for 12 wks, thiopurine therapy for those at risk and ideally where available an anti TNF agent for thise at highest recurrent risk

Colonoscopy at 6-12 mos to see if step up in theraphy is warranted to intervene early before the 2 nd resection.

60
Q

What is TNF?

A

TNF inhibitors are antibodies made in a lab from human or animal tissue. (Your body makes antibodies to fight off infections.) Once they’re put into your blood, they cause a reaction in your immune system that blocks inflammation.

Your immune system makes a substance called tumor necrosis factor (TNF). Usually, your body keeps your TNF levels steady. But if you have an autoimmune disease like RA, something goes wrong. You start making too much TNF, and that leads to inflammation.

61
Q

What is IBD?

A

It is thought to atise from disregulation bet the immune system, host genetics and the complex ecology of the gut.

62
Q

What is microbiome?

A

The gut is thought to harbour trillions of bacteria.

Alterations and reduced diversity of microbiome in Pt’s with IBD is DYSBIOSIS

63
Q

What is the management for recurrent C.Diff?

A

FMT (faecal microbiota transplantation)

64
Q

What are the goals for IBD therapy?

A

Symptoms control and mucosal healing

Assessed either endoscopically or non- invasively with fecal calprotectin and or intestinal ultrasound

A lifelong dse like IBD requires therapeutic drug monitoring for anti TNF and thiopurines in therapies particular.

65
Q

6 TGN levels above 235 pmol x 10 RBC have been associated with increased likelihood of clinical remission.

However, if it exceeds 5,700 pmolx10RBC it can be associated with what?

A

Hepatotoxicity.

Therefore, when using with therapeutic 6 TGN while avoiding higher 6 MMP levels where possible

66
Q

How does Anti TNF and Thiopurines work?

A

Inactive prodrugs that are metabolised to produce the active nucleotide metabolites 6 thioguanine nucleotides (6TGN) and also 6 methylmercaptopurine (6mmp) which do not confer efficacy.

67
Q

Maintenance care for established IBD patients not on immunosuppression, what monitoring should be done?

A

Annual FBE
Biochemistry along with checking weight and asking about general health
If symptomatic preceeding year tx is indicated and prompt fecal calprotectin for active dse

If Pt’s on steroids or had a low bone density, bone monitoring density should be considered

All pt’s should have at least an annual r/v

68
Q

Recommendation for patients with UC extending proximal to the sigmoid colon or patients with Crohn’s colitis affecting more than one third of the colon and with one or more ff risks factors:

Active dse
PSC
Fhx of CRC in 1st deg relative < 50 y/o
Colonic strictures, multiple inflammatory polyps shortened colon
Previous dysplasia
A

Annual colonoscopy surveillance

69
Q

Recommendation for surveillance for patients with:

Inactive colitis extending prox to sigmoid colon without risks factors from annual surveillance category

Patient’s with crohn’s colitis affecting more than 1/3 of the colon without other risk factors

IBD patients with family hx of CRC in a 1st deg relative > 50 y/o

A

3 yearly colonoscopies

70
Q

Recommendation for patients with prev colonoscopies were histology were normal.

A

5 yearly colonoscopies

71
Q

ECCo guidelines for surveillance should take into acct the what?

A

Risk for dysplasia to progress to CRC between 2 surveillance interventions.

Disease extent should be taken from most extensively histologically confirmed inflammation from all prev colonoscopies

72
Q

What should be screened for patients with known significant small intestinal Crohn’s dse and how often it should be done?

A

A yearly screen for malabsorption in cluding iron studies, vitaminD, B12 and folate to avoid complications from malnutrition.

73
Q

Strategies in managing IBD

A

Maintaining remission, anticipating problems and thereby preventing complications

74
Q

Recommendation for surveillance for cancer risk 8 years after the onset of extensive colitis should be?

A

2-3 years colonoscopy surveillance with biopsies for dysplasia.

75
Q

What to assess in patients on long term steroid use and weight loss?

A

DXA dual energy xray absorptiometry to assess bone mineral density

76
Q

What to check on patients on immune modifiers

A

Regular weekly or forthnightly blood tests (EUC, FBC, LFTs) while adjusting the dose and regular 3 monthly monitoring while patient on stable therapy.

77
Q

If patients are not in remission,

What to do?

A

Prompt referral to specialist- routine bloods and fecal calprotectin yearly useful tool for annual assessment

78
Q

What is the common complications of IBD?

A

Anemia is caused by iron def and also by chronic inflammation

79
Q

Ehat is the most common nutritional problem in IBD?

A

Iron def that leads to unexplained fatigue/lethargy

80
Q

Ehat other factors in IBD patients that leads to development of anemia?

A

Blood loss
Inadequate nutrient intake or absorption
Inflammation on the bone marrow and iron handling/transport.

81
Q

What is the induction therapy in Crohn’s dse among children?

A

Exclusive enteral nutritional therapy

Avoidance of prolonged use of steroids given the direct impact on growth and pubertal development

82
Q

6 monthly height and weight in patients with IBD is recommended among children.
True or false

A

True

83
Q

Gast, colon, entero, and radial eus can be used to how many hours?

A

72 hrs after last processing provided recent microbiological surveillance cultures have been negative.

84
Q

EUS, DUO and Bronchoscope can be used up to how many hrs?

A

12 hours after last reprocessing

85
Q

Rmergency endoscopes eg intibating bronchoscopes that are not sterile and wrapped should be reprocessed how many hours?

A

72 hes even if not used.this is to ensure that in a time critical emergency they are ready to use.

86
Q

Endoscopes that are stored horizontally there should be alarm monitored continuous air flow through each channel
True or false

A

True

Storage cupboards ahould be tall enough to allow endoscopes to hang without touching the floor and are well ventilated

87
Q

Duo, liear, bronchoscopes and AFER should be tested how often?

A

Monthly for microbial growth

88
Q

All other endoscopes and those stored in a wrapped state should be tested how often?

A

Three monthly for microbial growth.

89
Q

Water supply filtered to 0.2 microns for manual rinsing should be tested how often?

A

3 monthly or

Monthly if the water is not filtered.

90
Q

What is ISO 15883?

A

AFER design and principles has been updated

91
Q

A number of chemical germicides are capable of achieving sterilization if used for prolonged periods for eg aldehydebased products a contact time exceeding 3 hours may be required
True or false?

A

True

92
Q

Disinfection is not sterilization what is it?

A

It involves of removing or killing the vast majority but not all microorganisms.

High disinfection is considered adequate for reprocessing of endoscopes because it removes or kill microorganisms regarded likely to cause disease.

93
Q

High level disinfection processes need to kill all forms of bacteria(gram+ and gram-ve), viruses inc HIV and resitant viruses like polio, fungi (candida), protozoa(giardia)

Hig level chemical alone can kill the more reistant form of bacterial spores and cyst only with prolonged contact time usually 3 hours

Heat alone is alo effective disinfectant for eg temp 70 deg for 100 min are used for pasturisation

True or false

A

True

94
Q

What are the factors that warrants the disfrctant to kill all microorganisms?

A

Adequate removal of biological material through pre-cleaning.

Initial number of microorganisms present- a reduction of microorganisms can be achieved by scrupulous cleaning alone.

Temperature
Recommended temperature is provided on the disinfectant product label glutaraldehyde 25-35 deg, OPA 20-25 deg

Concentration
Chemical concentration should be checked using test strips

Contact time
Minimal time required for biocidal activity based on manufacturers instructions and based on adequately cleaned beforehand

Other factors
Disinfectant ph and relative resistance of the microorganism involved

95
Q

What are the practical barriers to chemical sterilization?

A 
Staff errors
Mechanical endoscope defects
Design flaws in AFER
Potential for inadequate cleaning
Contaminated rinse water
96
Q

When is bronchoscopes used?

A

Are feequently used to take samples (BAL) for diagnosis of lung conditions inc culture for bacteria, mycobacteria and fungi.

97
Q

What is pseudo outbreaks?

A

Repeated positive results for the same microorganisms from BAL fluid from different patients

98
Q

Bacteria (salmonella)

A

Most commonly transmitted by endoscopy.

99
Q

Mycobacterium tuberbulosis

A

Relatively resistant to most chemical agents including aldehydes

Non tuberculosis (atypical) mycobacteria are even more resistant to glutaraldehyde.

100
Q

Cdiff spores are more susceptible to a variety of chemical disinfectants than test spores

Exposure to 10 minutes to 2 percent glutaraldehyde has been shown to inactivate Cdiff spores.

True or false

A

True

101
Q

What bacterial species are extremely difficult to remove from the plumbing, AFER and damaged endoscope channels?

A

Pseudomonas aeruginosa

Is a common hospital oathogen and endoscope and accessories contamination(most likely acquired from the hospital than from prev patients)

102
Q

No agent can be effective against microorganisms it cannot reach.
True or false

A

True.

Therefore inadequate cleaning can compromise even prolonged contact time in excess of 60 minutes is unlikely to kill pathogenic microorganisms present on or in the endoscope.

Inadequate cleaning caused disinfection process failed.

103
Q

What is the most important process of endoscope decontamination?

A

Scrupulous manual cleaning prior to disinfection.

104
Q

What is meant by manual cleaning?

A

Refers to physical tasks performed by hand of removing biological material from the scope with appropriate brush, cloths, detergents and water.

105
Q

Lightguide plug

A

Connects into light source.
The air/water and suction channels have ports in light guide plug.

The terminals of it is not waterproof and must be covered with soaking cap supplied prior to cleaning.

Periodical checks should be made to ascertain continuing water tightness of these caps.

106
Q

Umbilical cable/universal cord

A

Connects the light guide plug to the body of the scope.

107
Q

Control head

A

Contains angulation control handles which allows the operator to flex the instrument, suction and air/water valves for control of air and water flow from the distal too.

108
Q

Insertion tube

A

Enters the patient’s body and is grossly contaminated during the procedure.

The distal tip houses the microchip in video scopes, openings for suctions, air/water and jet washing channels and the lens covering the flexible fibre optic light guides.

Bending section is adjacent to insertion tube.
Covering is made up of soft flexible material that is Vulnerable to damage

109
Q

Cables allow the tip of scope to flex.

A negative leakage test does not exclude damage to internal scooe structures.

True or false

A

True

110
Q

What equipment are useful to clean grooved control handles and to brush the distal tip and biopsy ports?

A

Soft toothbrushes

111
Q

What does enzymes do?

A

Digest biological material enhancing removal by brushing and flushing

These products reduce microorganisms load by up to 3 folds.

112
Q

Enzymatic detergents should used at the correct temperature and concentration. Optimim efficacy when products are used in warm water 35 deg

True or false

A

True

Conversely, use of hot water >60 deg denature protiens and inactivate enzymes

113
Q

Many bacteria exists in a planktonic state (free suspension).
What do you call this bacteria?

A

Biofilm is formed when bacteria adhere to a surface and secrete large amount of polysaccharides to form a protective mattix or film around themselves.

Pseudomonas species, legionella and atypical mycobacteria have the ability to exist either in a planktonic state or to form biofilms.

Biofilms protect the bacteria against brushing, fluid flow and chemical (disinfectant) making microorganisms more difficult to remove.

114
Q

Biofilms developed in scopes and AFER not detectable by the surveillance culture should be sampled for microbiological surveillance how many hours after disinfection?

A

12 hrs. As bacteria from superficial layers have been destroyed but within the deeper layers have not.

115
Q

The final rinse for bronchoscope and duo should be bacteria free and other endoscope should also be of high wuality and free of bacterialnown to cause invadive clinical dse including pseudomonas species.
The water used after manual cleaning and before disinfection does not need to be bacteria free
True or false

A

True

116
Q

The filterbanks often in a 3-4 stage filter size arrangement from 10 micron to 0.2 micron absolute final filter.

Where should filter banks be placed?

A

At the beginning of water delivery and an access point immediately prior to the entry into the AFER.

117
Q

Disinfectant for use in scooes reprocessing are regulated by who?

A

TGA

Peracetic acid are used in machine systems in Australia and New Zealand

118
Q

The recommended contact time will differ if the disinfectant temperature and concentration is higher.

At room temp 20deg how many minutes is the soaking time?

A

10-20 minutes for glutaraldehyde and OPA in manual systems are usual.

119
Q

Before leak testing performed what needs to be done to assist in detectingminor leaks arising from cracks in a channel.

A

Removal of buttons.

120
Q

Flexing distal tip whilst instrument is pressured will assist in detecting leaks from where?

A

A rubber of the bending section.

Function of angulation cables should be checked.

Check lens and outer sheath for signs of cracking or damage

121
Q

As per AS 4187, what is the minimum air exchanges ler hr is required in processing area?

A

10

122
Q

Manual cleaning steps following a procedure.

A

Pre-cleaning

Leak testing

Cleaning- buttons are clean in ultrasonic cleaner

Rinsing

AFER

Dry

Store

123
Q

TGA advised reprocessing of scopes in the new cleaner disinfector AFER mist be commenced within 1 hour of the procedure. Scopes should never be left soaking for long periods eg overnight.

True or false

A

True

124
Q

AFER used as a complete reprocessing machine which performs what?

A

Leak testing, cleaning, disinfection, alcohol perfusion and drying.

Time after use is critical and must not exceed an hour

125
Q

Extended storage is only permitted if microbiological results had shown negative.
How long for to store?

A

Within 12 mos

126
Q

How often emergency scopes should be routinely reprocessed?

A

72 hrs to ensure they are ready to be used anytime

127
Q

If recent cultures have been positive or inadequate storage facilities not available, endoscope should be disinfected if storage time has been longer than 12 hrs

True or false

A

True

128
Q

Microbiological surveillance for loan scope should be done within how many hrs?

A

72 hrs of the receipt of scope

129
Q

Chemical indicator

A

Demonstrates that scopes have been subjected to sterilisation process

130
Q

Surveillance culture of AFER amd scopes as a quality control measure has been recommended by who?

A

GESA & GENCA since 1995 and endoscopes surveillance by New Zealand expert Committee in 2002

131
Q

What is quality control marker used in endoscopes and AFER?

A

Surveillance culture to check the adequacy and completeness of cleaning and disinfection process and structural integrity of the scope.

132
Q

How often surveillance culture for AFER, duo, linear and bronchoscopes be done?

A

4 week or every month

All other scopes incl radial should be done every 3 mos

133
Q

Endoscope that have been reprocessed through a sterilisation cycle and stored in a wrapped state shoul be monitored every how often?

A

3 mos

134
Q

Water used for manual rinsing of endoscopes should be monitored every month If filter banks not in use

How often if water is filtered to 0.2 microns?

A

Every 3 months

135
Q

Endoscopes on loan to be tested within when?

A

73 hrs of receipt of the instrument

136
Q

Microbiological testing should be done after usual processing and following storage of up to 12 hours to allow detection of microorganism arising from a biofilms

True or false

A

True

UC (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions