Infection

Question 1

most common cause of death

Answer 1

nosocomial infection

Question 2

Top 3 differential for AIDS pt with diffuse CXR infiltrates

Answer 2

Toxo
Pneumocystis (PCP)
Mycobacterium Avium (MAC)

Question 3

Pt with AIDS who has diffuse pulm infiltrates and fever. Most likely dx? Initial tx?

Answer 3

Pneumocystis (PCP)

Start Bactrim

Question 4

4 combos for empiric abx coverage in a diabetic with a foot ulcer and possible sepsis? surgical intervention?

Answer 4

1. vanc + meropenem
2. vanc + imipenem
3. vanc + pip/tazo
4. vanc + aztreonam + metronidazole
   * surgical debridement early, may need revascularization or amputation

Question 5

how to diagnose a catheter associated UTI (CAUTI)

Answer 5

symptomatic +

1. urine cx with 100,000 colonies
2. urine cx with 1000 colonies and pyuria on UA (leukocytes, nitrites, etc.)

Question 6

Fever classification in Celsius

Answer 6

38.3

if post-op –> 38.5

Question 7

5 common causes of fever of unknown origin

Answer 7

1. infection
2. autoimmune or inflammatory
3. neoplastic
4. drug induced (abx > anticonvulsants)
5. no diagnosis

Question 8

most likely cause of central line infection? abx coverage?

Answer 8

Staph (gram +)

Vanco

Question 9

Single broad spectrum empiric abx choice

Answer 9

Carbapenems best (not ertapenem b/c it doesn’t cover pseudomonas)

Question 10

Ertapenem doesn’t cover what bug?

Answer 10

Pseudomonas

Question 11

5 reasons to use vanco

Answer 11

1. culture proven infection
2. sxs of infection due to resistant pathogen (MRSA/pneumococcas)
3. pt on quinolone prophylaxis and sxs of infection
4. pt on intensive chemo w severe mucositis
5. hypotension or other cardiac compromise

Question 12

how does temp vary with time of day

Answer 12

lower in AM

Question 13

define fever of unknown origin

Answer 13

prolonged fever (greater than 3 wks) without an obvious etiology despite workup

Question 14

most common infectious cause of fever of unknown origin

Answer 14

Tb (usually extrapulm or miliary with negative PPD and sputum + –> dx via bone marrow bx or lymph node bx)

Question 15

predisposing factors to occult abscess

Answer 15

steroids, DM, immunosuppressed, valvular disease

Question 16

dx in pt with arthritis and fever > 39. (103) for more than 6 weeks

Answer 16

JRA/Stills dz

Question 17

pt > 50 y/o with HA, rapid vision loss, anemia, inc ESR, and polymyalgia rheumatica

Answer 17

Giant cell arteritis

Question 18

localizing sx for pt with giant cell arteritis

Answer 18

jaw claudication

Question 19

localizing sx for pt with granulomatous meningitis

Answer 19

subtle changes in behavior

Question 20

causes of post-op fever

Answer 20

inflammation secondary to surgery
surgical site infection
nosocomial/ventilator associated pneumonia
CLABSI (catheter related)
CAUTI
blood products
drug fever
c diff, etc.

Question 21

hyper-acute surgical site infection likely due to

Answer 21

clostridium perfringens or group a strep (pyogenes)

Question 22

risk factors for nosocomial (hospital acquired)/ventilator associated pneumonia

Answer 22

aspiration

NG tube

Question 23

which is higher - rectal or oral temps?

Answer 23

rectal temps are 1F or 0.6C higher b/c of mouth breathing

Question 24

onset of staph aureus vs epidermidis

Answer 24

early - s aureus

late - s epidermidis

Question 25

septic patient with superficial fasciitis 2/2 s pyogenes who is s/p debridement. what type of precautions?

Answer 25

contact precautions for lg wound with drainage if minor, then standard precautions ok

Question 26

pt with full thickness pressure ulcer w eschar. debridement or wound vac?

Answer 26

need to debride necrotic tissue before considering wound vac

Question 27

csf sample with gram + diplococci in pairs. tx?

Answer 27

ceftriaxone and vanco

Question 28

tx for status epilepticus?

Answer 28

IV benzo

Question 29

IV drug user has acute onset b/l LE paralysis, compressive cord lesion and osteo. Surgical decompression or abx first?

Answer 29

Surgery!?