Infection CPC

Question 1

What is in keeping with pneumocystis jiroveci?

Answer 1

Ground glass changes on x Ray

Start in co trimoxazole, side fx of rash

Question 2

What should you test for with PCP?

Answer 2

HIV.
Didn’t do it when patient first came in, made assumption that he wouldn’t have it.
Hypoxia is hallmark for PCP
Second line treatment for PCP? Clinda and primiquine

Question 3

What is given for candiadisis?

Answer 3

Fluconazole

Question 4

What is PCP classified as?

Answer 4

Fungus

Question 5

What tests do you do for PCP?

Answer 5

Histo staining

Immunofluroscence

Question 6

In descending order of cd4 count what conditions are likely with HIV?

Answer 6

Bacterial skin infection, herpes simplex, fungal infection 
Kaposi sarcoma
Hairy leukoplakia, TB 
PCP, cryptococcus, toxoplasmosis
Cmv, lymphoma

Question 7

How can patients who are immunocompromised differ from normal patients?

Answer 7

Type of infectious agent
Speed of progression
Atypical presentation

Question 8

What are the causes of immunodeficiency?

Answer 8

Inherited
Acquired- iatrogenic, steroid, chemo, radiotherapy
HIV
Chronic illness- diabetes group b strep, cancer
Malnutrition

Question 9

What type of infection would you get with T cell defect?

Answer 9

Sepsis
CMV, EBV, VZV, resp and intestinal
Candida, PCP
Aggressive, opportunistic

Question 10

What type of infection would you get with B cell defect?

Answer 10

Strep, staph, haemophilus
Enteroviral encephalitis
Giardia
Recurrent sinopulmonary infections

Question 11

What type of infection would you get with neutrophil defect?

Answer 11

Staph, pseudo

Candida, nocardia, aspergilus

Question 12

What type of infection would you get with complement defect?

Answer 12

Neisserial, childhood

Question 13

What organism is typically associated with alcoholic?

Answer 13

Actinomyces
Slow growing, lung abscess, discharge
Long course of tx, 1 year, specific growth media
Basophilic granules, long gram positive rods

Question 14

Why is rifampcin given along with fluclox for deep seated s aureus infection?

Answer 14

Activity against biofilm formation, useful with prosthesis

Question 15

Why could the same bacteria be present with the same sensitivity?

Answer 15

Inadequate debridement, tried to keep ankle function

Question 16

What are the most important factors in recovery of prosthetic joint infection?

Answer 16

Removal of prosthesis
Adequate debridement and drainage of abscess
Abx play a role
Damaged bone prone to infection, or walled off abscess, fibrous capsule. Not well vascularised, low ph inactivated abx like gentamicin.

Question 17

What can central line insertion predispose to?

Answer 17

Endocarditis

Question 18

What abx given for chronic leg ulcer?

Answer 18

Vanco- mrsa
Cefuroxime- allergic to penicillin, for staph and strep
Metro- chronic nature of ulcer
Cipro- antipseudo

Question 19

What can be done to remove c diff spores from hand?

Answer 19

Chlorine

Hand wash to remove spores, not gel

Question 20

What is the c diff severity score? 1 for each of the following

Answer 20

Temp more than 38.5
Hr more than 90
WBC more than 15
Rising creatinine
Clinical signs of severe colitis/radiology mega colon, ileus no diarrhoea
Failure to respond to therapy at 72 hours

Question 21

Why should vanco be given orally in c diff?

Answer 21

Too big to get into colon via iv. Not absorbed orally, so if you give oral their is high intra colonic levels

Question 22

What type of c diff is severe, has outbreaks in Quebec and U.S.?

Answer 22

Ribotype 027 
Produces 16 times more toxin a and 23 times more toxin b 
Quebec- fluoroquinolones were found to be the class of antimicrobials most prone to induce c diff associated diarrhoea. Traditionally its clindamycin and cephalosporins

Question 23

Pathogenesis for pseudomembranous colitis.

Answer 23

Destruction of Tight junction in epithelium
Neutrophil inflammatory response
Cytotoxic effect on cells

Question 24

What is given to severe CAP?

Answer 24

Co amoxiclav and clarithromycin