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N935 Advanced Pathophysiology > Infectious > Flashcards

Infectious Flashcards

1
Q

Penicillin is what type of an antibiotic?

A

Beta-lactam

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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

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3
Q

What is it about cephalosporins that cause the crossover allergy with pcn?

A

they contain benzylpenicillin

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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

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5
Q

What 5 types of antibiotics are beta-lactams?

A
  1. penicillins
  2. cephalosporins
  3. Carbapenems
  4. Monobactams
  5. Beta-lactamase inhibitors
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6
Q

What is the timeframe for SSI?

A

w/n 30d of surgery, or 1 year of prosthetic implant or organ

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7
Q

What are the 6 mechanisms of SSI prevention?

A
  1. Preop atbx (so concentration is established by INCISION)
  2. Glycemic control <200mg/dL
  3. Normothermia
  4. optimize oxygenation
  5. antimicrobial soap before surgery
  6. alcohol-based skin prep (antiseptic agent)
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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

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9
Q

Length of R subclavian CVC?

A

14cm

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10
Q

Length of R IJ CVC?

A

15cm

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11
Q

Length of L IJ CVC?

A

18cm

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12
Q

Length of L subclavian CVC?

A

17cm

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13
Q

Clostridium Difficicle

A

spore-forming bacterium

toxins A & B create diarrhea & pseudomembranous coliits

may need subtotal colectomy & ileostomy

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14
Q

What 2 antibiotics can cause Cdiff?

A

vancomycin

metronidazole

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15
Q

What is the mortality of necrotizing soft tissue infections?

A

up to 75%

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16
Q

5 infections included in necrotizing soft tissue infections

A
  1. gas gangrene
  2. toxic shock syndrome
  3. Fournier’s gangrene [genital/perineal area]
  4. severe cellulitis
  5. flesh-eating infection
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17
Q

Anesthesia management of necrotizing infections

A
  1. resuscitation d/t hemodynamic instability
    - release of cytokines
    - good IV/A-line/CVC
    - blood product availability
  2. do not delay surgical treatment

AT RISK OF MULTIORGAN FAILIURE → ICU

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18
Q

Tetanus neurotoxin & what does it do?

A

tetanospasmin;

suppresses inhibitory neurons in the spinal cord = generalized skeletal muscle contractions

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19
Q

Tetanospasmin is produced by what?

A

vegetative forms of Clostridium tetani

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20
Q

What does tetanospasmin do?

A

trismus (75%) = jaw tightness

neck rigidity

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21
Q

What is the treatment of tetanus?

A

benzodiazepines
muscle relaxants
- neutralize exotoxin; human anti-tetanus immunoglobin; pcn

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22
Q

How do infants get tetanus?

A

non-sterile materials used to cut the umbilical cords

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23
Q

What are the 4 types of pneumonia?

A
  1. community-acquired (streptococcus pneumoniae = most common)
  2. Aspiration (s/s can include fulminating arterial hypoxemia, airway obstruction, atelectasis, penumonia)
  3. postoperative
  4. ventilator-associated
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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

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25
Q

What is the prevention of pneumonia for adults 65 & older?

A

PPSV23 for pneumococcal pneumonia

& for those 19-65 who smoke cigarettes or suffer from other health conditions

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26
Q

Anesthesia management in pneumonia

A
  • 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
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27
Q

Severe acute respiratory viral illness

A

highly virulent & high mortality
H5N1 = Influenza A = bird flu
COVID strains, MERS-CoV, SARS-CoV

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28
Q

S/s of severe acute respiratory viral illess

A

nonspecific

fever, headache, diarrhea, respiratory distress, hemoptysis

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29
Q

Treatment of viral respiratory infections

A
  • prevention
  • vaccines
  • NEURAMINIDASE INHIBITORS; zanamirvir, peramivir, oseltamivir (tamiflu), baloxavir marboxil)
    * *only give in the first 48 hours of symptoms
  • supportive care
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30
Q

Anesthesia management of viral illnesses

A
  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
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31
Q

Who should intubate pts with active viral illnesses?

A

most experienced anesthesia professions available

  • wear PPE
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32
Q

What PPE should be worn when manipulating the airway of an active viral infection?

A

mask, gown, gloves, face-shield

N95 or PAPR

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33
Q

What kind of intubation should be avoided in patients with active viral illness?

A

AVOID awake fiberoptic intubation;

standard can be avoided

[RSI is preferred to avoid manual ventilation & aerosolization of particles]

34
Q

What type of tidal volumes should be used when manually ventilating a patient with an active viral illness?

A

small, to limit aerosolization of particles

35
Q

What is a negative pressure room / recommendations?

A

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
Q

What type of ultraviolet rays are used by hospitals?

A

UV-C

37
Q

What is a HEPA filter?

A

High-efficiency particulate air (HEPA)
- theoretically mechanically removes 99.97% of pollen, dust, mold, bacteria, and any AIRBOURNE particles with size 0.3microns

38
Q

What are HMEFs?

A

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
Q

What are bacterial/viral filters?

A

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
Q

Where are air filters available?

A
  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
Q

What aerobe causes tuberculosis?

A

mycobacterium tuberculosis

*an obligate aerobe

42
Q

What are the s/s of tuberculosis?

A

cough, anorexia, weight loss, night sweats, chest pain

apical or subapical infiltrates, bilateral upper lobe infiltration with the presence of cavitation

43
Q

What is Pott’s disease?

A

tuberculous vertebral osteomyelitis; common manifestation of extrapulmonary TB

44
Q

What is Mantoux’s test?

A

most common test for TB = tuberculin skin test

45
Q

Treatment of TB

A
  • 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
Q

What skin lesions are related to heroin use?

A

abscesses, celluliitis, ulcerations, scaring, thrombosed veins

47
Q

Four leading drugs of abuse

A

prescription pain killers
heroin
fentanyl
carfentanil

48
Q

Pulmonary disease related to drugs of abuse

A 
edema
septic embolism
lung abscess
opportunistic infections
foreign body granulomas from talc
49
Q

Infections related to drugs of abuse

A

skin & SQ tissue
heart valves
liver
lungs

   *ENDOCARDITIS; right side heart valves [esp tricuspid], d/t contaminated needles - most by staphylococcus aureus
50
Q

Acquired Immunodeficiency Syndrome

A

infx by human immunodeficiency virus;

destroys CD4+ T-cells & leads to profound immunodeficiency

51
Q

The timeline of HIV infection

A
  • 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
Q

3 phases of HIV

A
  1. Acute phase
  2. Chronic phase
  3. AIDS
53
Q

Seroconversion of HIV occurs when?

A

within 3-7 weeks of exposure

54
Q

When is the “latent” HIV infection?

A

chronic phase; eventual decline in CD4 T-cells

55
Q

AIDS development from HIV

A

progressive loss of CD4+T cells leading to PROFOUND IMMUNE DEFICIENCY

  • high incidence of opportunistic infections
  • progressive ENCEPHALOPATHY
56
Q

Do HEPA filters provide humidification?

A

NO!

only mechanical filtration of particles

57
Q

Are HEMF filters mechanical or electrostatic?

A

electrostatic

58
Q

What happens during the acute phase of HIV infection?

A

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
Q

What happens during the chronic phase of HIV infection?

A

virus replicates in SECONDARY lymphoid organs

s/s are “latent”
→ eventual decline in CD4+ T cells

60
Q

What happens during the AIDS phase of HIV infection?

A

[the continued loss of CD4+ T cells leads to eventual] profound immune deficiency

→ high incidence of opportunistic infections
→ progressive ENCEPHALOPATHY

61
Q

What is the most sensitive test for HIV?

A

nucleic acid testing of HIV RNA

62
Q

How is AIDS diagnosed in HIV+ patients?

A

one of the AIDS-defining diagnoses is present

63
Q

What does the treatment for HIV/AIDS look like?

A

combination of antiviral drugs

→ highly active antiretroviral therapy [HAART]

*virus is NOT eradicated

64
Q

What are the side effects of HAART?

A

↑ 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
Q

Anesthetic considerations of HIV/AIDS

A

patients are subjected to LONG TERM METABOLIC COMPLICATIONS

   - ↑ lipids
   - glucose intolerance → can result in DM, CAD, CV dz
66
Q

What pre-op labs should be checked when a patient has HIV/AIDS?

A 
CBC
metabolic panel
renal function
LFTs
Coags
Chest x-ray
ECG

?CD4+ count & viral load won’t likely change anesthesia management

67
Q

What can cause neuraxial anesthesia to be precluded in HIV/AIDS patients?

A

focal neurological lesions = increased ICP

**neurological involvement may make SUCCINYLCHOLINE HAZARDOUS

68
Q

Who must be notified if a student experiences a biological or chemical exposure in clinical?

A
  • 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
Q

Who must be notified if a critical incident occurs?

ie. dental damage, CODE, intraop death, corneal abrasions, etc

A

↓ notify IN WRITING

  • Director [Dr. Simmons]
  • Clinical Education Coordinator [Dr. Pitman]
  • Advisor
  • Clinical Site Coordinator
70
Q

Who must be notified of events involving students’ physical or mental health or safety?

ie. syncope, illness in the OR, falls, accidents, etc

A

must report to

  • Program Director [Dr. Simmons] and Clinical Education *Coordinator [Dr. Pitman]
  • Clinical Site Coordinator or chief CRNA
71
Q

Standard precautions applies to who?

A

All patients. regardless of suspected or confirmed infection or colonization status

72
Q

What is included in standard precautions?

A
  • hand hygiene
  • safe injection practices
  • respiratory hygiene & cough etiquette
  • environmental cleaning & disinfection
  • reprocessing of reusable medical equipment
73
Q

What is included in contact precautions?

A
  • gown
  • gloves
  • dedicated equipment (stethoscope, BP cuff)
  • private room or shared room with same pathogen
74
Q

What are 5 pathogens that require contact isolation?

A
  1. Norovirus
  2. C.diff
  3. scabies
  4. MSSA
  5. MRSA
75
Q

What are enhanced barrier precautions?

A

expand the use of PPE beyond situations in which exposure to blood & body fluids is anticipated

76
Q

What care activities require enhanced barrier precautions?

A
  • toilet
  • airway care
  • wound care
77
Q

Droplets are spread by:

A

coughing, sneezing, talking

78
Q

What are 8 pathogens that require droplet precautions?

A
  1. meningitis
  2. TB
  3. Rash petechial w/ fever
  4. RSV
  5. adenovirus
  6. influenza
  7. SARS-CoV
  8. avian influenza
79
Q

What patients require airborne precautions?

A

known or suspected to be infected with pathogens transmitted by the airborne route

80
Q

What are 7 pathogens transmitted via an airborne route?

A
  1. tuberculosis
  2. measles (rubeola)
  3. chickenpox
  4. disseminated herpes zoster
  5. varicella-zoster
  6. herpes simplex
  7. variola (smallpox)

N935 Advanced Pathophysiology (9 decks)

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