Infection

Question 1

Enterotoxigenic bacteroides fragilis, think of what other disease?

Answer 1

Colon cancer

e. faecalis too

Question 2

Mechanism of action of vancomycin?

How does resistance develop?

Answer 2

Inhibits cell wall synthesis in gram (+) bacteria. Cross-linking is interrupted

Resistance as a result of structural changes to the cell wall that prevents vancomycin action

Question 3

How does resistance to fluoroquinolones?

Answer 3

DNA gyrase conformational changes prevent quinolones from working.

Also decreased cell wall penetration.

But if you give it a while the enzyme changes go back to being susceptible

Question 4

Role of vasopressin in non-septic pts?

Answer 4

No role for non-septic pts.

Question 5

Most effective method of preventing surgical site infection?

Answer 5

Prevent hypothermia

Question 6

Antibiotics needs to be given in what timeframe before the incision?

Answer 6

60 minutes before the incision

Question 7

GI prophylaxis with proton pump inhibitor has what effect to nosocomial pneumonia rate? Why?

Answer 7

Increases rate of pneumonia. Because the pH is increased so much that the bugs survive now

PPI is not superior to sucralfate for barrier protection

Question 8

What is the worry with using clarithromycin in renally impaired pts?

Answer 8

Increased risk of qt prolongation. You have to adjust the dose

Question 9

Most common organism for emphysematous GB?

Answer 9

Clostridium species

Question 10

What is the most common side effect of zosyn?

Answer 10

Diarrhea

Question 11

Tetanus immune globulin vs toxoid. When to give?

Answer 11

Immune globulin: tetanus prone wound, >6 hrs, >5 yrs or unknown immunization

Toxoid: >5 yrs or unknown immunization

Question 12

Pts taking amphotericin B are at a risk for what electrolyes abnormality?

What does it do to sodium? Potassium? Magnesium?

Answer 12

Hypokalemia

Hypomagnesemia

No effect on sodium

Question 13

What is the rate of transmission after exposure to hep C?

What is the postexposure prophylaxis?

Answer 13

0.1 - 1.8%

Postexposure prophylaxis generally not recommended due to low chance of exposure. Treatment only if an infection is proven

Question 14

What is the mechanism of how bacteria develop resistance to bactrim?

Answer 14

Trimethoprim-sulfamethoxazone.. develop resistance by ability to use preformed folic acid

Question 15

How does bacteria develop resistance to gentamicin?

Answer 15

Genetic mutation for production of modifying enzymes

Question 16

What’s in the surviving sepsis guideline’s 1hr bundle?

Answer 16

Blood culture then start abx

30cc/kg crystalloid

Apply pressors to keep MAP > 65

Measure lactate and repeat if >2

Question 17

What is the scoring system in SOFA score?

Answer 17

Sequential organ failure assessment

Respiratory rate > 22
GCS < 15
SBP < 100

Question 18

What’s included in the surgical site infection bundle?

Answer 18

1) abx 1hr prior to incision
2) clipping of hair (not shaving)
3) perioperative glucose control <200
4) perioperative normothermia

Question 19

What is the most common organism in CAUTI? 2nd most common?

What is the #2 most common organism isolated from UTI in general?

Answer 19

1: e. Coli
2: enterococcus

Klebsiella

Question 20

What is BI/NAP 1/027?

Answer 20

Especially virulent c. Diff strain. Produces both toxin A and toxin B

Question 21

Evidence based intraoperative interventions to decrease SSI

Answer 21

Perioperative glucose control with goal < 200
Normothermia
Alcohol based prep unless otherwise contraindicated
Post-op abx not needed for 24hr post-op

Antibiotic wound irrigation and abx powders do not improve SSI

Question 22

What are the 3 types of nec fasc?

Only type II benefits from what therapy?

Answer 22

Type I: polymicrobial
Type II: Group A strep/MRSA (IVDU)
Type III: Clostridium species/vibrio (marine exposure)
Type IV: fungal (immunocompromised)

Only type II group A strep benefits from IVIG. Actually has mortality benefit. Type I and III do not

Question 23

Most common organism causing severe soft tissue infection? (SSTI)

Answer 23

Mrsa

Question 24

Side effect of linezolid to be concerned for in someone with depression?

Answer 24

Serotonin syndrome

Question 25

Pts after splenectomy are more susceptible to encapsulated organism infection because spleen is the primary location of storage for what?

Answer 25

For macrophages

Question 26

Most up to date guideline for perioperative antibiotics

• when to give it
• when do you need to redose?
• post-op abx?

Answer 26

• IV and 1 hr prior to incision
• Redose when the operation time is twice the half life of the drug or if there is a lot of blood loss and transfusion
• no need for post-op abx 24 hrs beyond first dose

Question 27

What are the triad of symptoms from fungal infection that pose an ominous prognosis?

Answer 27

Muscle pain, rash, fever

Question 28

Most common organisms causing cholangitis (4)

Answer 28

E coli

Klebsiella pneumoniae
Enterococcus
B fragilis

Question 29

Most common organism for central venous Catheter infection?

Most common organism for suppurativa thrombophlebitis?

Most common organism in lactating breast abscess?

Answer 29

CVC: staph epi

Suppurative thrombo: staph aureus

Lactating breast abscess: staph aureus

Question 30

Which of the following has the highest transmission rate from blood transfusions?

• hep B
• hep C
• HIV
• EBV

Answer 30

Hep B: 1 in 200,000

Hep C and HIV: 1 in 2,000,000

Question 31

Emphysematous cholecystitis. Aerobe or anaerobe? Gram positive or negative? Rods or cocci?

Answer 31

Anaerobic gram positive rods.

Question 32

perforated appy. does irrigation reduce abscesses? increase abscesses? solution to pollution is dilution?

Answer 32

irrigation vs. no irrigation -> there is no difference

Question 33

Lap ccy. You spill stones and purulent bile. Wound class?

What is the wound class for gangrenous cholecystitis?

Answer 33

Purulent bile and stone: contaminated

Gangrenous ccy: dirty