infectious disaeases

Question 1

where is crp synthesized

Answer 1

liver

Question 2

crp production is controlled by

Answer 2

il-6

Question 3

what is hs CRP?

Answer 3

A high-sensitivity CRP (hs-CRP) test measures low levels of CRP using laser nephelometry. The test gives results in 25 minutes with a sensitivity of 0.04 mg/L.

(Page 1348).

Question 4

Where is procalcitonuiin synthesized during normal conditions

Answer 4

thyroid parafollicular c cells
In bacterial infection, PCT is ubiquitously synthesized in multiple extrathyroidal tissues.

(Page 1348).

Question 5

in which infewctious conditions an increase in pct is seen

Answer 5

increase in pct is seen in bacteriaemia ,gram negative more than gram positive , less in fungaemia and viral and intra cellular infections

Question 6

half life o0f pct

Answer 6

less than 24 hours

Question 7

pct falsae positives

Answer 7

steroids. PCT can be elevated in renal impairment, severe trauma and surgery or in patients after cardiac shock, acute graft-versus-host disease, immunotherapy, autoimmune diseases, and paraneoplastic syndromes.

(Page 1349).

Question 8

what are positive aand negative acute phase reactants ?

Answer 8

in reaction to infection and release of cytokines the liuver up regulate the synthersis of certain proteins ( poisitive acute phase reactants ) and downregulatews the synthesia of some ( negative acute phase reactants )

Question 9

give the names of positive and negative acute phase reactants

Answer 9

positive C-reactive protein, mannose-binding protein,[2] complement factors, ferritin, ceruloplasmin, serum amyloid A and haptoglobin

negative : albumin,[8] transferrin,[8] transthyretin,[8] retinol-binding protein, antithrombin, transcortin.

Question 10

is the mortality for hiv patients in the icu more ?

Answer 10

NO, N OWADAYS HIV INFECTED AND NON INFECTEF PATIENTS HAVE SIMILAR MORTALITY AND the prognosis is more related to the acute illness leading to admission

Question 11

most commom reason for icu admission for hiv patients

Answer 11

The most common cause overall for admission to intensive care remains respiratory failure. Previously the predominant cause for this was PJP, but bacterial pneumonia and non-HIV-related respiratory illnesses such as chronic obstructive pulmonary disease (COPD) and asthma are increasing in prevalence.

(Page 710).

Question 12

what is window period in hiv detection ?

Answer 12

It may take a number of weeks for HIV antibody to become positive during seroconversion.

(Page 711). Most patients who develop HIV will have positive antibodies by 3 months after their exposure to the virus; after this time, absence of HIV antibodies excludes HIV infection in almost all cases.

(Page 711).

Question 13

what is IRIS ?

Answer 13

IRIS is a complication related to the commencement of antiretroviral therapy and the subsequent reconstitution of the immune system. The syndrome can lead to a worsening of treated opportunistic infections or even unmask untreated infections.

(Page 712).

Question 14

IN Which patients is IRIS comkmon ?

Answer 14

infections. IRIS is more common in those patients with a history of cytomegalovirus retinitis, cryptococcal meningitis and tuberculosis,

(Page 712).

Question 15

treatment of IRIS

Answer 15

infection. ART is usually continued if mild IRIS develops. Corticosteroids, other immunosuppressive agents and even cessation of ART may be considered for the management of severe IRIS.11–13

(Page 712).

Question 16

should ART be continued in the icu

Answer 16

tes if possible

Question 17

name some common art drug interactions

Answer 17

efavirenz and protease inhibitors are potent enz inhibitors of the cyt p 450 enzyme system.

Question 18

in case of AIDS related opportunistic infections should art therapy be instituted in the icu ?

Answer 18

in case of mjost opportunistic infections therapy started vin the icu itself leads to0 better outcomes.
exceptions are cjmv meni9ngitis and tubercul;ar meningitis where the iris reactions may be particularly stro9ng.

Question 19

critical finding in pneumocystis pneumoniua

Answer 19

hypoxia

Question 20

definitive diagnosis of pneumocyustis pneumonia

Answer 20

A definitive diagnosis is made by demonstrating Pneumocystis cysts in an induced sputum specimen, bronchoalveolar lavage fluid or a transbronchial biopsy.

(Page 713).

Question 21

treatment of severe pneumocystosis pneumonia

Answer 21

iv cotrimoxazole

steroids if p/f ratio less than 140 or alveolar arterial gradient greater than 35

Question 22

what is to be done hypersensitivity reactions to cotrimoxazole

Answer 22

the drug is to be continued in case ofg
mild hypersensitivity reactions
only in severe reactions iv pentamidine is to be used

Question 23

which patients should receive pneumocystis prophylkaxis?

Answer 23

cd4 count vless than 200

Question 24

Most common comp-licaqtion assosciated with pneumopcystis

Answer 24

pneumothorax, low tidal volume ventlation

Question 25

most cmmon cryptococcal infec tion in hiv

Answer 25

cryptocovval meningitis

Question 26

peculiar featires of cryptococcal meningitis found in hiv

Answer 26

minimal inflammation and neck rigidity | also minimal signs of csf inflammation

Question 27

how is cryptococcal meningitis diagnpo0sed

Answer 27

detection of cryptococcal antifen in serum an d csf

Question 28

how to treat cryptococcal meningitis

Answer 28

iv amphotericin and 5 fc ...followed by fluconaziole top prevent relapses

Question 29

how to diagnosetoxoplasma encep[halitis

Answer 29

Toxoplasmosis can be diagnosed by ring enhancing lesion found on the CT scan or by serological evidence of toxoplasmosis. to differentiate with cns malignaanmncies Toxoplasmosis can be diagnosed by ring enhancing lesion found on the CT scan or by serological evidence of toxoplasmosis to differentiate to differentiate with us brain biopsy may be used

Question 30

What is the treatment of toxoplasmosis

Answer 30

Treatment is oral pyrimethamine, together with either intravenous sulfadiazine or clindamycin. Hypersensitivity reactions to sulfadiazine and clindamycin are common, and an alternative drug regimen may be necessary. (Page 714).

Question 31

what is The most common site for reactivation of CMV infection (Page 714).

Answer 31

retina

Question 32

in which pastients does cmv occur

Answer 32

CMV disease most often occurs in patients with very severe immunodeficiency (CD4 T-cell count <50/mL). (Page 714).

Question 33

when to remove 1. bloodc t5ransfusion sets | 2. pressure transducers 3. propofol lines 4. all other lines

Answer 33

1. 24 hrs 2.96 hrs 3. 12 hrs 4. 2 to 4 daysew

Question 34

what is the order of colonization in the icu

Answer 34

MV; the oropharynx is the first site to be colonized by pathogens (36 hours), followed by the stomach (36-60 hours), the lower respiratory tract (60-84 hours), and the ETT thereafter (60-96 hours). (Page 612).

Question 35

when is the risk of developing vap more early or late during the icu stay?

Answer 35

MV; the oropharynx is the first site to be colonized by pathogens (36 hours), followed by the stomach (36-60 hours), the lower respiratory tract (60-84 hours), and the ETT thereafter (60-96 hours). (Page 612).

Question 36

most common viral etiology of vaP

Answer 36

HSV 1

Question 37

ROLE OF CUFF MATERIAL IN PREVENTING VAP

Answer 37

In particular, the polyurethane cuff has a thickness of 5 to 10 µm, in comparison to 50 µm for PVC cuffs. Hence, upon inflation, smaller folds form with polyurethane cuffs, and aspiration of secretions above the cuff can be prevented or reduced. Some investigators have attempted to prevent aspiration by modifying the shape of the cuff.161 In comparison to standard cuffs with cylindrical shapes, cuffs designed with a smooth, tapering shape allow elimination of folds for a full circumference of the trachea or cuff contact zone, irrespective of the cuff material. (Page 615).

Question 38

roloe of ventilatory settings

Answer 38

effects of 5 to 8 cm H2O PEEP in normoxemic ventilated patients and showed a reduction in the rate of VAP. (Page 615).

Question 39

role of specialloy treated ett

Answer 39

In conclusion, ETT coated with antimicrobial agents could reduce the incidence of VAP, but the evidence supporting its use comes only from one study, with significant limitations.180 (Page 615). (Page 615).

Question 40

has closded tracheal suctioning found to have any advantage

Answer 40

no

Question 41

is there any advantage ofd hme or heated humidifiers in vap prevention ? how soon should they be changed ?

Answer 41

no role of hme or heated humidifiers in vap prevention anmd changing them frequentrly has no role in vaop prevention they should be changed in 72 hours for humidiofication efficacy

Question 42

role of chlorhexidine oral decontamination

Answer 42

oral decontamination with chlorhexidine should be routinely used, specifically in cardiothoracic patients. In other ICU populations, the use of higher chlorhexidine concentrations could be a promising option. Alternatively, some investigators recently tested once-daily bathing of all patients with disposable cloths impregnated with 2% chlorhexidine as a preemptive strategy for nosocomial infections, but they did not find any significant benefit with this approach.233 (Page 616).