Infectious Disease

Question 1

What is CURB:65 scoring?

Answer 1

Confusion
Urea greater or equal to 20 mg/dL
Respiratory rate greater than 30
Systolic bp less than 90, diastolic bp less than 60
Age equal to or greater than 65

Question 2

What score on curb 65 constitutes an inpatient setting?

What score on the curb 65 constitutes ICU?

Answer 2

Two or higher

Four or higher

Question 3

What are the three types of nocosomial pneumonia, and what are the differences?

Answer 3

Hospital acquired pneumonia, ventilator associated pneumonia, healthcare associated pneumonia.

Hospital acquired happens two days after admission without intubation.
Ventilator is more than 48 to 72 hours after endotracheal intubation.
Healthcare associated happens after discharge from the hospital stay for two or more days with in 90 days of the infection, or resided in nursing home or long-term care facility, Or who received a recent IV antibiotics, chemotherapy, or wound care with in the past 30 days of the current infection, or who attended a hospital or hemodialysis clinic.

Question 4

What are some risk factors for nocosomial pneumonia? Name at least five.

Answer 4

Intubation and mechanical ventilation, supine patient position, enteral feeding, oral pharyngeal colonization, stress leading prophylaxis, blood transfusion, Hyperglycemia, immunosuppression/corticosteroids, surgical procedures: thoracic, abdominal, immobilization, nasogastric tubes, previous antibiotic therapy, admission to the ICU, elderly, underlying chronic disease.

Question 5

What are the most common bugs in the community acquired pneumonia?

Answer 5

Mycoplasma pneumoniae, streptococcus pneumoniae, haemophilus influenzae, chlamydia pneumoniae, Legionella pneumophila

Question 6

What are common pneumonia bugs in alcoholics, nursing home, COPD, post influenza, exposure to water, poor oral hygiene, and HIV infection?

Answer 6

Alcoholics: strep pneumoniae, Oral anaerobes, gram-negative bacilli
Nursing home: strep pneumoniae, H influenzae, gram-negative bacilli, S aureus
COPD: S pneumoniae, H influenzae, M catarrhalis
Post influenza: H influenzae, S aureus, S pneumoniae
Exposure to water: Legionella
Poor oral hygiene: oral anaerobes
HIV infection: pneumocystis jirovechi, S pneumoniae, M pneumoniae, Mycobacterium

Question 7

What common bugs are in hospital acquired pneumonia?

Answer 7

S aureus, pseudomonas aeruginosa, enterobacter

Less common: K pneumonia, Candida spp, acinobacter, Serratia marcescens, E. coli, S pneumonia

Question 8

Which hospital acquired pneumonia bugs tend to be transmitted by healthcare workers hands?

Answer 8

Pseudomonas, S aureus

Question 9

Which hospital acquired pneumonia bugs are transmitted by respiratory equipment?

Answer 9

Pseudomonas, Enterobacteriaceae

Question 10

1) In pneumonia, what is empiric treatment of non-hospitalized patients, without comorbidities, previously healthy and no antibiotics in the past three months?

Answer 10

A) A macrolide: specifically clarithromycin or Azithromycin if H. influenzae is suspected

OR

B) Doxycycline

Question 11

In community acquired pneumonia or, what is in. Treatment of a non-hospitalized patient with comorbidities or recent antibiotic therapy in the past three months?

Answer 11

A)Respiratory Fluoroqinolone (mixing, gemi, levo 750)

OR

B) Macrolide (or Doxycycline) with high-dose amoxicillin, or Augmentin 2 g b.i.d., or a cephalosporin (Ceftriaxone, cefuroxime, or cefpodoxime)

Question 12

In community acquired pneumonia, what is empiric treatment of hospitalized patients with moderately severe pneumonia?

Answer 12

A) respiratory fluoroquinolone (moxifloxacin, Gemifloxacillin (oral), or levofloxacin 750 mg)

OR

B) ampicillin, ceftriaxone, or cefotaxime (ertapenem in select patients), Plus a macrolide (or doxycycline)

Question 13

And community acquired pneumonia and what is empiric treatment of hospitalized patients with severe pneumonia requiring ICU treatment (may need to add antibiotics to cover pseudomonas or MRSA)

Answer 13

A) ampicillin/sulbactam OR

B) Ceftriaxone OR

C) Cefotaxime

PLUS

A respiratory fluoroquinolone or azithromycin

Question 14

How long should a person with community acquired pneumonia be treated for?

Answer 14

At least five days with 2 to 3 days afebrile and no more than one sign of clinical instability (S I RS): (elevatedtemperature, heart rate, respiratory rate, decreased systolic blood pressure, or arterial oxygen saturation)

Question 15

If hospital acquired pneumonia is less than five days and the patient has no risk factors for multi drug-resistant organisms, how do you empirically treat?

Answer 15

A)Third generation cephalosporin (ceftriaxone), B)Fluroquinolone (levofloxacin, moxifloxacin, ciprofloxacin)
C)ampicillin/sulbactam
D) ertapenem

Question 16

If hospital acquired pneumonia starts after five days or longer, Or patient has risk factors for multi drug-resistant organisms (Pseudomonas, Klebsiella(ES BL), acinobacter, MRSA, legionella)?

Answer 16

A)Ceftazidime, or cefepime OR
B) Imipenem, meropenem, or doripenem OR
C)pip/tazo OR

PLUS aminoglycoside or fluoroquinolone (Cipro, Levo)

(Vanco or linezolid only MRSA risk factors (History of M RSA a infection, recent hospitalization or antibiotic use, presence of invasive healthcare devices) or high incidence locally greater than 10 to 15%.

Question 17

What is the treatment duration for hospital acquired pneumonia?

Answer 17

Seven or eight days. 14 days for pseudomonas or acinobacter

Question 18

In pneumonia, what are five risk factors for multi drug resistant organisms?

Answer 18

Antibiotics in past 90 days
Hospitalization of five days or more
High resistance and community or hospital unit
Risk factors for healthcare associated pneumonia
Immunosuppressive disease or therapy

Question 19

What are differences between cold and influenza?

Answer 19

Colds are gradual onset, hacking cough, stuffy nose, sneezing, sore throat

Flu is sudden, high temperature for 3 to 4 days, headache, myalgia, exhaustion, Dry cough

Question 20

Which patients have a higher risk of influenza complications

Answer 20

Patients younger than two or 65 and older, patients with chronic disease, immunosuppressed patients, pregnant women, patients younger than 19 on long-term aspirin, Native Americans,residents of nursing homes

Question 21

When mistreatment for the flu occur?

Answer 21

Within 48 hours

Question 22

What are the brand and generic name of adamantane flu drugs?

How do they work?

Answer 22

amantadine (Symmetrel), rimantadine (Flumedine)

The inhibit viral and coding and release of viral nucleic acid by inhibiting m2 protein.

Only works for flu A virus and not recommended for treatment due to high resistance.

Question 23

What are examples of neuraminidase inhibitors and what do they do?

Who shouldn’t use them, what is regular and renal dosing?

When should they be given if someone has high risk the flu?

Answer 23

oseltamivir (Tamiflu), zanamivir (Relenza)

The inhibits neuraminidase. Side effects include nausea vomiting for Tamiflu, andbronchospasm or cough in relenza. Do not use Relenza in asthma or COPD patients.

Tamiflu is 75 mg orally b.i.d. for five days. Renal dosing is 75 mg a day (CrCl

Question 24

What is the difference between PPSV23 and PCV13?

Answer 24

Strep Pneumoniae Vaccine:
PCV13 contains a carrier protein, and is not for children. PCV 13 is for patients with CSF leaks and cochlear implants. Give this one first, wait 8 weeks and then the other.

PPSV 23 is for those over 65 OR those between 2-64 with certain diseases OR those between 2–64 living in nursing homes.

Only revaccinate PPSV 23 patients who received the vaccine more than five years ago when they were under 65. Also 2-64yo patients who are immunocompromised (they should also get PCV 13), or patients with asplenia (they should also get PCV 13)

Question 25

What are the different types of flu vaccine products and what are the differences between them

Answer 25

And activated trivalent, intranasal quadrivalent, high-dose trivalent, and inactivated quadrivalent, Intradermal and activated trivalent, and activated trivalent cell culture based, Recomment inactivated trivalent.

The intradermal and cell culture and recombinant vaccines are 18 and over. Cap is 49 yo for the recombinant, and 64 years for the intradermal. The recombinant is see for patients with egg allergies. The high dose is 465 and older, and the FluMist is 42 249 years old without underlying illnesses. Both the inactivated trivalent and quadrivalent for six months and older.

Question 26

What is first-line therapy for bacterial sinusitis and what is second line therapy?
What is duration of therapy

Answer 26

First-line therapy is Augmentin 2 g twice a day in adults or 90 mg per kilogram per day divided twice daily and kids.

Second line therapy is a respiratory Fluoroqinolone
OR
Doxycycline
OR
Cefixime or cefpodoxime with clindamycin (non tye1 allergy to PCN)
Intranasal saline and intranasal corticosteroids PRN

Adults 5 to 7 days children 10 to 14 days

Question 27

What are the most common bugs for community/nocosomial acquired UTIs?

Answer 27

Community:
E. coli, Staphylococcus, saprophyticus, Proteus

Nocosomial: E. coli, Pseudomonas, other gram-negative bacilli, Klebsiella, fungal

Question 28

What are characteristics of community acquired pneumonia? Acute infection of the pulmonary parenchyma, accompanied by the presence of an acute infiltrate consistent with pneumonia on chest radiograph or auscultatory findings. Patients must also not have any of the following characteristics:

Answer 28

1. Hospitalization two days or more in the past 90 days
2. Residence in a long term care facility
3. Receipt of intravenous antibiotic therapy
4. Chemotherapy
5. Wound care in the past 30 days
6. Attendance at a hospital for hemodialysis clinic