Infectious Flashcards
1
Q
Penicillin is what type of an antibiotic?
A
Beta-lactam
2
Q
What is the true penicillin allergy %, and cross-over % between penicillin and cephalosporins?
A
<1% true allergy
10% cross-over allergy between pcn and cephalosporins
3
Q
What is it about cephalosporins that cause the crossover allergy with pcn?
A
they contain benzylpenicillin
4
Q
How do beta-lactam atbx work?
A
inhibit the cross-linking of peptidoglycan [inhibit cell wall synthesis]
3-carbon, 1-nitrogen ring is highly reactive
5
Q
What 5 types of antibiotics are beta-lactams?
A
- penicillins
- cephalosporins
- Carbapenems
- Monobactams
- Beta-lactamase inhibitors
6
Q
What is the timeframe for SSI?
A
w/n 30d of surgery, or 1 year of prosthetic implant or organ
7
Q
What are the 6 mechanisms of SSI prevention?
A
- Preop atbx (so concentration is established by INCISION)
- Glycemic control <200mg/dL
- Normothermia
- optimize oxygenation
- antimicrobial soap before surgery
- alcohol-based skin prep (antiseptic agent)
8
Q
What is a catheter-associated BSI?
A
bacteremia or fungemia in pt with CVC and AT LEAST ONE positive blood culture obtained from a peripheral vein
9
Q
Length of R subclavian CVC?
A
14cm
10
Q
Length of R IJ CVC?
A
15cm
11
Q
Length of L IJ CVC?
A
18cm
12
Q
Length of L subclavian CVC?
A
17cm
13
Q
Clostridium Difficicle
A
spore-forming bacterium
toxins A & B create diarrhea & pseudomembranous coliits
may need subtotal colectomy & ileostomy
14
Q
What 2 antibiotics can cause Cdiff?
A
vancomycin
metronidazole
15
Q
What is the mortality of necrotizing soft tissue infections?
A
up to 75%
16
Q
5 infections included in necrotizing soft tissue infections
A
- gas gangrene
- toxic shock syndrome
- Fournier’s gangrene [genital/perineal area]
- severe cellulitis
- flesh-eating infection
17
Q
Anesthesia management of necrotizing infections
A
- resuscitation d/t hemodynamic instability
- release of cytokines
- good IV/A-line/CVC
- blood product availability - do not delay surgical treatment
AT RISK OF MULTIORGAN FAILIURE → ICU
18
Q
Tetanus neurotoxin & what does it do?
A
tetanospasmin;
suppresses inhibitory neurons in the spinal cord = generalized skeletal muscle contractions
19
Q
Tetanospasmin is produced by what?
A
vegetative forms of Clostridium tetani
20
Q
What does tetanospasmin do?
A
trismus (75%) = jaw tightness
neck rigidity
21
Q
What is the treatment of tetanus?
A
benzodiazepines
muscle relaxants
- neutralize exotoxin; human anti-tetanus immunoglobin; pcn
22
Q
How do infants get tetanus?
A
non-sterile materials used to cut the umbilical cords
23
Q
What are the 4 types of pneumonia?
A
- community-acquired (streptococcus pneumoniae = most common)
- Aspiration (s/s can include fulminating arterial hypoxemia, airway obstruction, atelectasis, penumonia)
- postoperative
- ventilator-associated
24
Q
What is included in the presentation of pneumonia?
A
fever, chest pain, dyspnea, fatigue, rigors, cough, sputum
pt history (travel, caves, diving, birds/sheep, immunocompromised)
chest xray, + cultures, ↑ WBC
25
What is the prevention of pneumonia for adults 65 & older?
PPSV23 for pneumococcal pneumonia
& for those 19-65 who smoke cigarettes or suffer from other health conditions
26
Anesthesia management in pneumonia
- delay if possible
- avoid fluid overload
- LPV [pts are PEEP dependent]; use lowest FiO2 possible, same vent settings as in ICU
- suctioning pt
- maintain antibiotics/viral/fungal schedule
27
Severe acute respiratory viral illness
highly virulent & high mortality
H5N1 = Influenza A = bird flu
COVID strains, MERS-CoV, SARS-CoV
28
S/s of severe acute respiratory viral illess
nonspecific
| fever, headache, diarrhea, respiratory distress, hemoptysis
29
Treatment of viral respiratory infections
- prevention
- vaccines
- NEURAMINIDASE INHIBITORS; zanamirvir, peramivir, oseltamivir (tamiflu), baloxavir marboxil)
* *only give in the first 48 hours of symptoms
- supportive care
30
Anesthesia management of viral illnesses
1. LPV / symptom management
2. barrier precautions
3. filters on both sides of breathing circuit (protect pt & ventilator)
4. clean room with EPA approved hospital disinfectant
5. prioritize procedures if possible
31
Who should intubate pts with active viral illnesses?
most experienced anesthesia professions available
- wear PPE
32
What PPE should be worn when manipulating the airway of an active viral infection?
mask, gown, gloves, face-shield
| N95 or PAPR
33
What kind of intubation should be avoided in patients with active viral illness?
AVOID awake fiberoptic intubation;
standard can be avoided
[RSI is preferred to avoid manual ventilation & aerosolization of particles]
34
What type of tidal volumes should be used when manually ventilating a patient with an active viral illness?
small, to limit aerosolization of particles
35
What is a negative pressure room / recommendations?
minimum of 15 air exchanges per hour with a minimum of 3 air changes of outdoor air per hour
anteroom is needed
**OPERATING ROOMS ARE POSITIVE PRESSURE**
36
What type of ultraviolet rays are used by hospitals?
UV-C
37
What is a HEPA filter?
High-efficiency particulate air (HEPA)
- theoretically mechanically removes 99.97% of pollen, dust, mold, bacteria, and any AIRBOURNE particles with size 0.3microns
38
What are HMEFs?
Heat & Moisture Exchange medium with ELECTROSTATIC FILTER
- protects pts from cross infx. Filter uses an ELECTROSTATIC medium of permanently charged bipolar rectangular split fibers to capture airborne particles
39
What are bacterial/viral filters?
prevent transmission of bacteria & viruses and cross-infection;
filter medium is constructed of permanently charged bipolar rectangular split fibers that are able to capture airborne particles
40
Where are air filters available?
1. HVAC systems for isolation rooms
2. AGM breathing circuits
3. Exp & Insp limbs
4. Portable [filters air when it is not an isolation room] ** useful in positive pressure ORs
41
What aerobe causes tuberculosis?
mycobacterium tuberculosis
*an obligate aerobe
42
What are the s/s of tuberculosis?
cough, anorexia, weight loss, night sweats, chest pain
apical or subapical infiltrates, bilateral upper lobe infiltration with the presence of cavitation
43
What is Pott's disease?
tuberculous vertebral osteomyelitis; common manifestation of extrapulmonary TB
44
What is Mantoux's test?
most common test for TB = tuberculin skin test
45
Treatment of TB
- can be resistant to 2nd line treatment
- chemo with isoniazid
- DELAY case
- negative pressure room
- N95 / HEPA filters
**Caution** to avoid spine injury during airway manipulation
46
What skin lesions are related to heroin use?
abscesses, celluliitis, ulcerations, scaring, thrombosed veins
47
Four leading drugs of abuse
prescription pain killers
heroin
fentanyl
carfentanil
48
Pulmonary disease related to drugs of abuse
```
edema
septic embolism
lung abscess
opportunistic infections
foreign body granulomas from talc
```
49
Infections related to drugs of abuse
skin & SQ tissue
heart valves
liver
lungs
*ENDOCARDITIS; right side heart valves [esp tricuspid], d/t contaminated needles - most by staphylococcus aureus
50
Acquired Immunodeficiency Syndrome
infx by human immunodeficiency virus;
destroys CD4+ T-cells & leads to profound immunodeficiency
51
The timeline of HIV infection
- acute seroconversion upon infection (high viral load)
- decrease in viremia after several months d/t pt immune response.
involution of lymph nodes & concomitant DECREASE in T-HELPER LYMPHOCYTES (CD4 T cells) & increase in viral load
- Pneumocystis pneumonia does not usually occur until the CD4 count is less than 200 cells /mL
52
3 phases of HIV
1. Acute phase
2. Chronic phase
3. AIDS
53
Seroconversion of HIV occurs when?
within 3-7 weeks of exposure
54
When is the "latent" HIV infection?
chronic phase; eventual decline in CD4 T-cells
55
AIDS development from HIV
progressive loss of CD4+T cells leading to PROFOUND IMMUNE DEFICIENCY
- high incidence of opportunistic infections
- progressive ENCEPHALOPATHY
56
Do HEPA filters provide humidification?
NO!
| only mechanical filtration of particles
57
Are HEMF filters mechanical or electrostatic?
electrostatic
58
What happens during the acute phase of HIV infection?
virus enters through the mucosa.
infects & destroys CD4+ T cells
→ seroconversion usually within 3-7 weeks of exposure
systemic s/s resembling other infection
59
What happens during the chronic phase of HIV infection?
virus replicates in SECONDARY lymphoid organs
s/s are "latent"
→ eventual decline in CD4+ T cells
60
What happens during the AIDS phase of HIV infection?
[the continued loss of CD4+ T cells leads to eventual] profound immune deficiency
→ high incidence of opportunistic infections
→ progressive ENCEPHALOPATHY
61
What is the most sensitive test for HIV?
nucleic acid testing of HIV RNA
62
How is AIDS diagnosed in HIV+ patients?
one of the AIDS-defining diagnoses is present
63
What does the treatment for HIV/AIDS look like?
combination of antiviral drugs
→ highly active antiretroviral therapy [HAART]
*virus is NOT eradicated
64
What are the side effects of HAART?
↑ lipids
insulin resistance
peripheral neuropathy
premature cardio/renal/liver disease
→ INCREASED RISK of cancer & cardiovascular disease when on HAART therapy....... unknown why this happens..
65
Anesthetic considerations of HIV/AIDS
patients are subjected to LONG TERM METABOLIC COMPLICATIONS
- ↑ lipids
- glucose intolerance → can result in DM, CAD, CV dz
66
What pre-op labs should be checked when a patient has HIV/AIDS?
```
CBC
metabolic panel
renal function
LFTs
Coags
Chest x-ray
ECG
```
?CD4+ count & viral load won't likely change anesthesia management
67
What can cause neuraxial anesthesia to be precluded in HIV/AIDS patients?
focal neurological lesions = increased ICP
**neurological involvement may make SUCCINYLCHOLINE HAZARDOUS
68
Who must be notified if a student experiences a biological or chemical exposure in clinical?
* Duke Employee Occupational Health & Wellness (EOHW) safety hotline
↓ notify IN WRITING
* Director [Dr. Simmons]
* Clinical Education Coordinator [Dr. Pitman]
* Advisor
* Clinical Site Coordinator or chief CRNA
69
Who must be notified if a critical incident occurs?
ie. dental damage, CODE, intraop death, corneal abrasions, etc
↓ notify IN WRITING
* Director [Dr. Simmons]
* Clinical Education Coordinator [Dr. Pitman]
* Advisor
* Clinical Site Coordinator
70
Who must be notified of events involving students' physical or mental health or safety?
ie. syncope, illness in the OR, falls, accidents, etc
must report to
* Program Director [Dr. Simmons] and Clinical Education *Coordinator [Dr. Pitman]
* Clinical Site Coordinator or chief CRNA
71
Standard precautions applies to who?
All patients. regardless of suspected or confirmed infection or colonization status
72
What is included in standard precautions?
- hand hygiene
- safe injection practices
- respiratory hygiene & cough etiquette
- environmental cleaning & disinfection
- reprocessing of reusable medical equipment
73
What is included in contact precautions?
- gown
- gloves
- dedicated equipment (stethoscope, BP cuff)
- private room or shared room with same pathogen
74
What are 5 pathogens that require contact isolation?
1. Norovirus
2. C.diff
3. scabies
4. MSSA
5. MRSA
75
What are enhanced barrier precautions?
expand the use of PPE beyond situations in which exposure to blood & body fluids is anticipated
76
What care activities require enhanced barrier precautions?
- toilet
- airway care
- wound care
77
Droplets are spread by:
coughing, sneezing, talking
78
What are 8 pathogens that require droplet precautions?
1. meningitis
2. TB
3. Rash petechial w/ fever
4. RSV
5. adenovirus
6. influenza
7. SARS-CoV
8. avian influenza
79
What patients require airborne precautions?
known or suspected to be infected with pathogens transmitted by the airborne route
80
What are 7 pathogens transmitted via an airborne route?
1. tuberculosis
2. measles (rubeola)
3. chickenpox
4. disseminated herpes zoster
5. varicella-zoster
6. herpes simplex
7. variola (smallpox)
