Infection control Flashcards
You see Mrs A, a 68-year-old NZ European woman who was admitted to Lower Hutt hospital 4 days previously. Mrs A’s husband had brought her in to ED because he was concerned that she had recently become quite confused. On examination in ED she was disorientated with a respiratory rate of 34/min, a BP of 85/60, and crackles were heard over the left lower lobe during inspiration. Once she was admitted she was put on Ceftriaxone and Azithromycin for her suspected pneumonia. On her 3rd day of admission Mrs A developed abdominal pain and passed approximately 15 watery stools a day. Which of the following statements is NOT true in regards to the most likely cause of her diarrhoea?
Question 1Select one:
The Ceftriaxone she is taking for her pneumonia is a risk factor
Toxic megacolon is a rare complication from the cause of her diarrhoea
A stool culture will be diagnostic of the cause
She may require treatment with oral metronidazole
Her gender, ethnicity, and age are associated with a higher incidence of this infection
False - A stool culture will be diagnostic of the cause
She has C. diff (in hospital, on abx)
Requires toxin A/B immunoassay not a stool culture
You are a trainee intern doing a long day in the Emergency Department. You are the first to see Ms. Myers who was discharged from hospital 10 days ago after having an abdominal hysterectomy. She feels unwell, has a fever and abdominal pain. The wound looks healthy without surrounding erythema. A CT scan shows a pelvic collection. What organisms are likely to cause Ms. Myers’ surgical site infection?
Question 3Select one:
Gram negative rods, enterococci, Group B strep, anaerobes
Gram negative rods
Gram negative rods, streptococci, anaerobes
S. aureus, Coagulase negative staphylococcus
S. aureus, Coagulase negative staphylococcus, streptococci, gram negative rods
Obstetric/gynecologic HAI:
Gram Negative Rods, Enterococci, Group B strep, anerobes
Mrs V, a 78-year-old Pakeha woman, has come to hospital by ambulance. She was found on Saturday when her son visited her at her rest home, and she was lying in bed delirious and incoherent, febrile and smelling of urine. She did not have a catheter in at this time. After fluid resuscitation on the way to hospital she perked up a bit. A urine dipstick was done in ED which showed leukocytes +++, blood cells +, and nitrites positive. Urine was sent for culture, blood cultures were also taken and empiric IV cefuroxime was started. You meet her on the third day of her admission on the ward round. She has been having diarrhoea, but says she otherwise feels much better than when she came in, and is looking forward to heading home in a day or two. Blood culture results from admission show a heavy growth of Escherichia coli. You come in to see her with her discharge paperwork on the 5th day, and find she is doing worse again. She is febrile and is delirious, hypotensive and has soiled herself. She has erythema around her peripheral IV line. You look at her drug chart and see that on Monday she was changed to oral ciprofloxacin. Wondering what’s going on, you take some further blood cultures and change her antibiotics. The next morning the lab calls to advise that yesterday’s blood cultures have grown gram positive cocci. What is the most likely cause of Mrs V’s decline on Day 5?
Question 6Select one:
She has developed hospital-acquired pneumonia.
Her peripheral IV cannula has become colonised and lead to Staphylococcal sepsis.
She has developed enterococcal meningitis from an infectious colitis.
Switch to ciprofloxacin was incorrect for treatment of urinary tract infection.
Cefuroxime was an inappropriate choice for empiric treatment.
Her peripheral IV cannula has become colonised and lead to Staphylococcal sepsis.
Before seeing a patient, you as a 5th year medical student are asked by the infectious diseases consultant to describe the risk factors for contracting a C. difficile infection. Which of the following would you not include in your list of risk factors?
Question 12Select one:
Being elderly
Excessive ciprofloxacin antibiotic use
Lack of handwashing by medical staff
Immune-suppressive treatment for inflammatory bowel disease
Uncontrolled GORD
False answer = Uncontrolled GORD
Interestingly, PPIs increases C diff rates!
Raymond is a 56-year-old male from Upper Hutt who is in theatre for an open cholecystectomy. RaymondÕs notes say that he has a long history of excess alcohol consumption, a 30 pack-year smoking history and a background of severe rheumatoid arthritis for which he takes long-term steroids as part of his treatment. Prior to surgery his hairy belly was trimmed and he was given a single dose of cefuroxime. It was a hectic afternoon for the surgical staff and there were lots of nurses, medical students and doctors coming and going from the theatre while the operation was in progress. The surgery was successful with no complications and Raymond was stitched up.There are several risk factors for surgical site infections (SSIs) in the stem above.Which of the following options is NOT a risk factor for SSIs in Raymond’s case:
Question 14Select one:
30-pack-year smoking history
Single dose of cefuroxime
Long-term/continued steroids for his RA
Busy theatre (lots of people coming and going)
Hair trimmed with clippers
Hair trimmed with clippers
Actually allows good skin prep. Better than razor which can cause microabrasians.
Cephazolin and metronidazole should have been used for his prophylaxis instead!
Which antibiotics to use in clean contaminated (GI) procedures?
Cephazolin + metronidazole
Alex, a 19 year old male, presents to ED with gradually worsening abdominal pain. It started two days ago as a tummy ache and has since localised to his right iliac fossa. He says he’s never experience pain like this before. Alex has no significant past medical history and is not taking any medications. He has smoked a pack a day since he was 14 (5 pack years). On examination, Alex is very tender over McBurney’s point, and has a positive Rovsing’s sign. He has a temperature of 38.5 and his bloods came back with a WBC at 14.The surgeons decide that Alex needs to be taken straight to theatre. Prior to / during the surgery the team does the following:
I. Prepares Alex by shaving off the body hair around the surgical site so they can clean the site appropriately prior to incision.
II. Administers one dose of cefuroxime as antibiotic prophylaxis.
III. Performs a surgical washout (Lavarge) during the procedure to decrease contamination
Which of the three steps above are appropriate management for reducing Alex’s risk of surgical site infections?
Question 16Select one:
I + III
I + II
I + II + III
II + III
III
III
You are a TI working in Wellington who has been asked to review Mr Wilson a 58 year old man who is day 4 post partial colectomy for colorectal carcinoma. The nurse has called you because he is still spiking fevers and you notice his CRP remains elevated. On examination you see he has erythema around his laparotomy wound and a small amount of purulent discharge on the dressing. Which of the following is NOT a risk factor for developing a surgical site infection.
Question 17Select one:
Obesity
Staph aureus colonisation
Use of razor for hair removal
Concurrent steroid use
Washouts and drainage of the surgical site
Washouts and drainage of the surgical site
Mr X is in Ward 7 North and the nurse takes his routine obs for the morning. He has recently had a bowel resection. He is febrile with a temp of 38.5, hypotensive, and a little tachycardic and tachypnoeic. He has inflammation at the IV canula site.He has no abdo pain or distension. His stoma site looks clear and faeces in the colostomy bag show no signs of blood. Blood cultures show the patient has a bacteraemia. Which of the following statements is INCORRECT?
Question 21Select one:
The infection most likely started from contamination at the surgical site and the patient has a pocket abscess from a poorly formed anastamoses site, with leaking bowel matter.
Treatment likely involves commencement of appropriate antibiotics, fluid resus and repeat bloods at 48 hours with monitoring
There is a chance it could colonise heart valves, or disseminate and cause other focal areas of infections such as meningitis, osteomyelitis etc.
Staph aureus is the most common cause of hospital acquired blood stream infection.
The infection most likely started from contamination at the surgical site and the patient has a pocket abscess from a poorly formed anastamoses site, with leaking bowel matter.
You are asked about Mrs Wilson, has been in hospital for several weeks receiving clindamycin for a lower limb cellulitis. You are asked by the pharmacist to consider changing her to flucloxacillin by the ward pharmacist as that is standard for cellulitis. Mrs W has also had 3 days of fever, severe abdominal pain and diarrhoea with new-onset delirium. A blood culture has grown Staphylococcus epidermidis and white cells are significantly raised. Which of the following is MOST accurate in this situation?
Question 22Select one:
Stool PCR and testing for bacterial toxins is most likely to yield a positive result in this case, but should not delay empiric treatment given that Margaret has severe colitis.
Margaret requires urgent treatment due to the risk of C. difficile infection, and should receive fluid resuscitation followed by IV vancomycin
IV Flucloxacillin is not an appropriate first-line antibiotic in this situation due to increasing resistance in S. epidermidis
Margaret’s blood culture is benign, S.epidermidis is a frequent contaminant and other worrying causes of her symptoms can be excluded on the basis of a negative blood culture. The doctor should initiate contact precautions for norovirus given Mrs W is in hospital.
The blood culture indicates that Mrs W is most likely suffering from infective endocarditis given her history of cellulitis and comorbidity, and her atypical symptoms are due to age. She should be given IV flucloxacillin + gentamicin
Stool PCR and testing for bacterial toxins is most likely to yield a positive result in this case, but should not delay empiric treatment given that Margaret has severe colitis.
Have to treat with oral not IV vancomycin
