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CIC Exam > IDs > Flashcards

IDs Flashcards

1
Q

True or false. guidance recommends that every person entering an emergency department should be asked if they have traveled internationally in the last 21 days

A

True

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2
Q

define immunocomprimised person

A

one or more defects in the body’s normal defense mechanisms that predispose him or her to infections

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3
Q

the number and type of immunocomprimised hosts are increasing for what reasons

A

the aging of certain populations around the globe; medical advances that have kept persons alive who previously would have died of their underlying disease; pandemic infection by the human immunodeficiency (HIV), hepatitis B (HBV), and hepatitis C (HCV) viruses; homelessness and the resultant lack of basic hygiene and good nutrition; the obesity epidemic; tobacco and recreational drug abuse; diminishing access to primary care with resultant late diagnosis of diseases; and immigration of persons from developing parts of the world where exotic and potentially immunocompromising infectious agents are endemic

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4
Q

what are 7 host defects that affect state of immunosupression

A

-defects in the cutaenous barrier
-defects in mucous membrane
-obstructions to a natural body passage
-abnormal number or function of granulocytes
-abnoramlities of cell mediated immunity
-abnormalities of humoral immunity
-factors that affect immunity in multiple ways

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5
Q

define true pathogens

A

those able to cause infection and idsease

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6
Q

define opportunistic organissm

A

organisms that become pathogenic only when an individual has some level of immunosupression

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7
Q

define public health

A

the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals

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8
Q

what are direct examination testing methods?

A

-staining
-histology/cytology
-wet mount

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9
Q

describe acid fast staining

A

This uses heat or detergents to force dye into the cell, after which the cell cannot be colorized with acid-alcohol, hence the term acid-fast.

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10
Q

what are the 2 type of acid fast staining?

A
  1. fluroescent (DFA,, IFA)
  2. Non fluoresent stain (Kinyoun stain)
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11
Q

describe avidity

A

Some organisms absorb an increased amount of the stains and are said to have a strong avidity, whereas others are weakly stained and present a pale appearance (low avidity).

Gram-negative enteric pathogens (e.g., E. coli) have a strong avidity to the safranin stain and are bright red.

Pseudomonads are less avid and uptake only a moderate amount of safranin.

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12
Q

what is histology?

A

microscopic structure of tissues

useful for diagnosing infections with agents taht are impossible to culture. Infectious agents may be seen directly or indirectly as cell damage.

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13
Q

what is cytology?

A

the study of the formation, structure, and function of cells

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14
Q

what may histology or cytology be use to diagnose?

A

-actinomycosis
-chlamydia
-genital herpes
-cytomegalovirus
-giardiasis
-histoplasmosis
-leprosy
-rubeola

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15
Q

what is a wet mount?

A

microscopic examination of fresh clinical sepcimens

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16
Q

what can you test for with a wet mount?

A

sputum viewed for fungal elements; stool examined for larvae, adult worms, ova, cysts, or parasites; cerebral spinal fluid for Cryptococcus neoformans; vaginal secretions for Trichomonas vaginalis; and urine sediment for white blood cells (WBCs), bacteria, yeast, and parasites (e.g., T. vaginalis)

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17
Q

what are some stains used for wet mounts?

A

Lactophenol cotton blue, calcofluor-white, India ink, Loeffler’s methylene blue

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18
Q

what are the 2 classes of tests used to detect immunological response?

A

-antigen and antibody detection

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19
Q

when are antigen tests helpful?

A

helpful in early diagnosis, when cultures are not yet positive or are not possible or practical

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20
Q

what are some available antigen tests?

A

adenovirus, bacterial meningitis (Haemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitidis, group B streptococcus), Brucella spp., Cryptococcus spp., hepatitis B, hepatitis D, HIV, influenza virus, Legionella spp., parainfluenza virus, Cryptosporidium spp., Giardia lamblia, Entamoeba histolytica, Plasmodium spp., Wuchereria bancrofti, T. vaginalis, and RSV

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21
Q

what are some examples of antibody tests?

A

agglutination tests, complement fixation, indirect immunofluorescent-antibody (IFA), immunoblot, indirect hemagglutination (IHA), bentonite flocculation (BF), and radioimmunoassay (RIA). Serum

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22
Q

what are some things that can be tested for by antibody?

A

chlaymida
adenovirus
cocksackievirus
encephalitis viruses
lyme disease
mumps
polio
psitttcosis
syphillis
toxoplasma

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23
Q

describe body fluid analysis

A

When infection is suspected in a sterile body fluid (e.g., pleural, peritoneal, synovial), a sample of the fluid is obtained using sterile techniques for analysis of its various components and for the detection of the presence of abnormal constituents that may indicate infection.

analysis usually includes total protein, specific gravity, cell count (red and white blood cells) with differential (types of WBCs present), body fluid glucose, Gram stain, and culture. Microscopic examination for crystals also may be requested.

In general, large # of WBC indicates infection

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24
Q

describe cold agglutinins

A

Cold agglutinins are antibodies that cause clumping or agglutination of type O red blood cells at cold temperatures. The cold agglutinins test is used to detect antibodies that result from Mycoplasma pneumoniae infection or infectious mononucleosis.

In combination with acute respiratory symptoms, a high cold agglutinin titer usually indicates M. pneumoniae infection, viral pneumonia, or primary atypical pneumonia.

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25
Q

what specimens go directly on culture media?

A

blood and genital

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26
Q

If the specimen is collected through intact skin, cleanse the skin first with 70% alcohol and iodine solution (e.g., povidone-iodine) or a chlorhexidine/alcohol combination. If iodine is used, remove excess after the specimen has been collected.

A

true

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27
Q

what are some transport mediums?

A

stuart
aimes
carey-blair

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28
Q

define infection

A

the entry into and multiplication of an infectious agent in the tissues of the host and tissue damage resulting in apparent or unapparent changes in the host

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29
Q

what are the 2 types of infections?

A

Unapparent, asymptomatic, or subclinical infections run a course similar to that of clinical disease but below the threshold of discernible clinical symptoms.

Apparent, clinical, or symptomatic infections result in clinical signs and symptoms of a recognizable disease process.

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30
Q

define incubation period

A

period of time from exposure to some infectious source to the development of signs and symptoms

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31
Q

define latent period

A

the time from exposure to the beginning of the infectious period. This usually applies to chronic types of infections (such as tuberculosis) that are dormant for an extended period of time (months or even years) before signs and symptoms appear.

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32
Q

define colonization pressure

A

the proportion of other patients colonized within a defined population or area. A rise in colonization pressure may result in the creation of a major reservoir for infection and transmission. Colonization pressure may result in decreased efficacy of methods of preventing infections.

33
Q

define contamination

A

the presence of a potentially infectious agent on a surface, on a material, or in a laboratory specimen

34
Q

what are pseudo outbreaks frequently attributed to?

A

lab errors or contaminated specimen collection

35
Q

what are the 3 relationships between the human host and normal flora?

A

Commensal, in which flora neither harm nor benefit the host, such as microbes on the skin. Common commensals rarely cause infection, although infection may occur if there is damage to skin or mucosal barriers or for individuals who are immunocompromised.

Mutual, in which both the flora and the host benefit.

Pathogenic, in which the flora harm the host, leading to infections and disease.

36
Q

what are components of the cell mediated immune system?

A

T lymphocytes and mononuclear phagocytes

37
Q

what is the innate immune system?

A

primary spontaenous and reactive portion

38
Q

what are the 5 types of leukocytes in order of frequency (CMI)

A
  1. neutrophils
  2. lymphocytes
  3. monocytes
  4. esonphils
  5. basophils
39
Q

the initial response to acute bacterial infection (such as appendicitis) may result in immature neutrophils (called band or stab cells) entering the system. This is referred to as

A

left shift

40
Q

describe what increased lymphocytes are associated with and how these infections present

A

pertussis, syphilis, and toxoplasmosis; lymphocytes with a characteristic frothy cytoplasm (“atypical” or “reactive” lymphs) are associated with a number of viral infections, such as infectious mononucleosis.

41
Q

what infections are increased monocytes associated with?

A

Epstein-Barr virus, tuberculosis, subacute bacterial endocarditis, syphilis, and other illnesses

42
Q

what is an increase in esonophils associated with?

A

allergic reactions but can be increased due to parasitic infections and occasionally tuberculosis, systemic fungal infections, and scarlet fever, among other infections

43
Q

what is an increase in basophils associated with?

A

various food and drug allergies, variola and varicella infections, and ulcerative colitis.

44
Q

humoral immune system is AKA

A

adaptive immune system

45
Q

humoral immunity is expressed by

A

antibodies.

These are found principally in the bloodstream, but secretory antibodies are also present in oral secretions, tears, intestinal contents, breast milk, prostate, and, to a small degree, urine. Antibodies are also secreted from mucosal surfaces of the female reproductive tract.

46
Q

True or false. All antibody molecules possess multiple structural sites referred to as Fab (fragment, antigen-binding), which react with specific antigens, and one other structural site called Fc (fragment, crystallizable), which can be used to categorize antibodies into groups (immunoglobulins)

A

true

47
Q

what are the most important and common host defenses?

A

-sin and mucous membranes
-normal flora

48
Q

Chemical substances that surround cells are known as

A

glycollax

49
Q

If the glycocalyx is organized and firmly attached to the cell wall, it is referred to as a

A

capsule

50
Q

If the glycocalyx is unorganized and only loosely attached to the cell wall, it is called a

A

slime layer

51
Q

When essential nutrients are depleted, certain Gram-positive bacteria form structures known as

A

endospores

52
Q

which species commonly produce biofilms?

A

E. coli
klebsiella pneumoniae
enterococcus faecils
pseudomonas

53
Q

True or false. Biofilms occur naturally in the human body, such as in the mouth or the bladder

A

true

54
Q

enzyme production can be

A

Catalase, which catalyzes the decomposition of hydrogen peroxide to water and oxygen.

Coagulase, which causes blood to coagulate.

55
Q

what is the taxonomy of viruses based on?

A

Whether the virus contains DNA or RNA

Whether the virus is single- or double-stranded

Size and shape of the virus

Structure of the protein coat

Presence or absence of an envelope

Mode of replication

56
Q

what is a prion?

A

infectious particles of abnormally folded proteins that do not contain DNA or RNA (i.e., spongiform encephalopathies)

57
Q

how many fungi cause disease?

A

less than 500 (less than 50 in healthy persons)

58
Q

define mycosis

A

infections or diseases caused by fungi.

59
Q

wha are the 4 mycosis categories?

A

Superficial or cutaneous. Infections or diseases that involve hair, skin, or nails without direct invasion of deeper tissues. This category includes infections caused by dermatophytes, a group of three genera of fungi, Epidermophyton, Trichophyton, and Microsporum, that commonly cause skin disease in people or animals.

Subcutaneous. Infections or diseases (chromoblastomycosis and mycetoma) that involve cutaneous and subcutaneous tissues.

Systemic. Infections or diseases that affect a specific body system, usually the lungs, although any organ system may be involved. This category includes infections caused by Blastomyces, Coccidioides, Histoplasma, Paracoccidioides species, and Penicillium marneffei.

Opportunistic. Systemic mycoses that occur primarily in individuals whose immune status is altered either by underlying disease or use of immunosuppressive agents. This category includes infections caused by Aspergillus, Candida, and Cryptococcus.

60
Q

what are the 4 categories of parasites?

A
  1. protozoa
  2. helminths
  3. microfilaria (microscopic worms transmitted by mosquitos)
  4. arthropods (ticks, fleas, mosquitos)
61
Q

describe the role nurses play in antimicrobial stewardship

A

Early recognition of sepsis.

Timely administration of medication.

Monitoring for side effects associated with medication.

Obtaining samples to determine therapeutic levels.

Accurate surgical prophylaxis.

Transitioning from IV to oral therapy.

Appropriate resource use.

Assessing for allergy labelin

62
Q

what does SBAR stand for?

A

situation background assessment recommendation

used for communicating among HCP about a patients conditions

63
Q

describe the 4 parts of an SBAR form

A

Situation (S). After identifying who you are, the patient (or other issue) in question, and other identifying information such as unit and room number, use this area to indicate the nature of the issue, when it started or occurred, and its severity.

Background (B). Here you identify any important background information about the patient (or other issue) that is critical for the recipient’s understanding. This can include date of admission, prior diagnoses, current medications, IV fluids, most recent vital signs, code status, and other clinical or patient information such as allergies or current and prior lab results.

Assessment (A). Here the sender (e.g., a nurse) provides their personal assessment of the situation, which could be one or more potential diagnoses.

Recommendation (R). Here the sender indicates recommended next steps such as specific diagnostic tests, transferring the patient to another care setting, or the need for a change in the physician’s orders

64
Q

what are some examples of penicillins plus B lactamase inhibitors

A

Amoxicillin-clavulanate (Augmentin)

Ampicillin-sulbactam (Unasyn)

Piperacillin-tazobactam (Zosyn)

Ticarcillin-clavulanate (Trimentin)

65
Q

describe cephlasporin spectrum activity

A

higher class (4 and 5) are more broad spectrum

66
Q

how are antimicrobials classified?

A

-cell wall
-cell memraben
-ribosome
-nucleid acid synthesis
-metabolic pathways

67
Q

what is an example of a cell membrane antimicrobial?

A

daptomycin and fluconazole

68
Q

what are some cell wall antimicrobials?

A

penicillin, vancomycin, echinocandin

69
Q

what are some metabolic pathway inhibitors?

A

ethambutol and bactrim

70
Q

how does acylovir kill?

A

nucleid acid synthesis

71
Q

what are the two major antimicrobial side effects?

A

allergies and GI reactions

72
Q

surgical prophylaxis is commonly aiemd at

A

staph and strep

73
Q

what are the 5 major factors that contribute to sucessful antimicrobial therapy?

A

Prompt institution of an appropriate antimicrobial

The “bug” factor: the virulence and susceptibility of the infecting organism

The “drug” factor: the activity of the antimicrobial at a particular site of infection

The “host” factor: the underlying condition and immunocompetence of the patient

The “site” factor: related to the fact that infections at certain body sites (e.g., meninges, heart valves) are inherently more difficult to treat for a variety of reasons

74
Q

what are some mechanisms of antimicrobial resistance?

A

drug inactivation, alteration in target site, decreased permeability or efflux, and bypass of a metabolic pathway

75
Q

what are some examples of antimicrobial misuse?

A

Prolonged empiric antimicrobial therapy without clear evidence of infection

Treating a positive clinical culture in the absence of infection

Failure to narrow the antimicrobial therapy after a causative pathogen is identified

Prolonged prophylaxis

Excessive use of certain antimicrobials (For example, widespread use of fluoroquinolones has led to the fluoroquinolone-resistant strain of C. difficile.)

76
Q

what are some examples of patient misuse of antimicrobials?

A

Stopping use of an antibiotic once they feel better.

Using antibiotics left over from a previous illness.

Pressuring providers into writing prescriptions for them.

Sharing prescriptions with others.

77
Q

what are some examples of antimicrobial misuse interventions?

A

Interventions prior to or at the time of prescription:

Clinician education

Patient and public education

Institution-specific guidelines for the management of common infections

Cumulative antibiograms

Prior authorization of restricted antimicrobials

De-labeling of spurious antibiotic allergies

Interventions after prescription:

Prospective audit and feedback

Self-directed antibiotic reassessments by prescribing clinicians (antibiotic timeouts)

Antibiotic dose optimization

Antibiotic duration

78
Q

what are the symptoms of sepsis?

A

Symptoms include high heart rate or weak pulse; fever, shivering, or feeling very cold; confusion or disorientation; shortness of breath; extreme pain or discomfort; and clammy or sweaty skin

CIC Exam (9 decks)

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