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monster management > infectious disease > Flashcards

infectious disease Flashcards

1
Q

clean surgical wound

A

no break techiniqueno inflammationclean areas: cardiac, vascular, neuro, ortho, ophtha

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2
Q

clean contaminated wound

A

POTENTIALLY colonized hollow viscus disrupted (head, neck, oral, abd, gym surg)minor break in procedure

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3
Q

contaminated wound

A

** penetrating trauma lt 4 hours old **inflammation already, MAJOR break in technique, major hollow organ spill

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4
Q

dirty wound

A

frank purulent drainage, abscess ** penetrating trauma gt 4 hours old **

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5
Q

clean areas of wounds

A

cardiac, vascular, neuro, ortho, ophtha

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6
Q

MRSA + central line relationship

A

87% bacteremic pts18-55% endocarditis ptshad central line

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7
Q

common MRSA sites

A

wounds, nares, trachea, perinum

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8
Q

MRSA - how resistance works

A

produce beta lactamasealtered penicillin-binding proteins (PBP) - rx efficacy needs high affinity between drug & PBP

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9
Q
  • MRSA: at risk pops
A

aged / debilitatedmales/p surgery + lengthy hospymultiple invasive proceduresICU, trauma, burnindwelling cath, intravasc device, ET tube, ventprev hospyprior prolonged abx txpresence/size of wound

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10
Q

MRSA resistant to these meds

A

methicillinaminoglycosides: gentamicinerythromycintetracyclinescephalosporinsquinolones: cipro, floxin

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11
Q

what counts as epidemic

A

greater than 4 cases over baseline per month

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12
Q

MRSA + surgical pt care approach highlights

A
  • tx remote infection prior to surgery (urine C&S + nasal swabs)- good control of glucose levels (150 ok, higher = increased infx risk)- special bathing protocol (air dry + chlorhexidine)- universal precautions always
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13
Q

MRSA + infected/colonized pt care highlights

A

CONTACT ISOLATION- gloves + hand wash most important- colonized + asymp + no surgical + no pna risk = NO NEED TO TREAT

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14
Q

MRSA: don’t need to treat who

A

pts who are… colonized + symp + no surgery + no pna risk

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15
Q

** MRSA TREATMENT ** x4

A

vanc (IV) 15 - 20 mg/kg/dose Q8-12 hrs- bacteremia - vanc or dapto 2 wk- infective endocarditis: vanc 6 wk- CAP (one of the following)– vanc IV 7-21 – linezolid (zyvox) PO/IV – clindamycin IV

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16
Q

vanc-resistant enterococcus

A

4th leading cause HAI in ICUintrinsic & acquired resistance possiblepoor prognosis w high mort rate

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17
Q

VRE key risk factors

A
  • broad spectrum cephalosporins- parenteral vancomycin
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18
Q

** VRE TX OPTIONS **

A

newer abx: zyvoxcombo tx: pcn + vanc + gent

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19
Q

vanc resis r/t heavy use 3rd gen cephalosporins

A

klebsiella pneumoniae

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20
Q

** skin infection tx **

A

ORAL- clindamycin- bactrim (sulfa-tmp)- tetracycline- linezolid (zyvox)

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21
Q

** cellulitis organisms ** common / less (x3 each)

A

BOOYEAH: gram pos cocci- beta hemolytic strep (A, B, C, G, F)- staph aureus- MRSAEHHH?- gram neggies- h flu- non-spore forming anaerobes

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22
Q

cellulitis at risk pops

A

diabeteselderlypedal edemavenous or lymphatic compromiseobese: abdominal wall cellulitis

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23
Q

cellulitis s/s** + intensification + toxic

A

** erythema w irregular borders but “spreading” **tenderness, warmth, pain, edemalymphadenopathyno vesicles or bullaeINTENSIFY RAPIDLY (edema, eryth spread 6-36 hours)TOXIC: tachy(cardic/pneic), hypotensive, septicemia

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24
Q

spread of cellulitis s/s

A

INTENSIFY RAPIDLYeryth + ede 6 - 36 hours spread

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25
Q

important ddx for cellulitis

A

VTE nec fasc (appears toxic - HAS BULLAE and cellulitis don’t)

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26
Q

nec fasc s/s

A

skin necrosisbullaecrepitusanesthesia over skinrhabdomyolysisTOXIC!

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27
Q

** cellulitis w purulent drainage tx **

A

empirically for MRSA!!- clinda- bactrim- tetracycline (doxy)- linezolid (zyvox)

28
Q

** non-purulent, no comorb cellulitis **

A

dicloxacillin 500 mg QIDcephalexin (keflex) 500 mg QIDclindamycin 300-450 mg q6 - 8 hrs ← pcn / cepha allergy

29
Q

** acutely ill patient w cellulitis tx **

A

IV abxnafcillin (unipen or nafcil) 1-2 g IV q4hrscefazolin (ancef) 2 g IV q6hrsoxacillin 2gm IV q4hrsclindamycin 600-900 mg IV q8hr

30
Q

cellulitis follow up

A

s/s resolved (typi within 24-48 hours)visible may take 72 hourslook for worsening

31
Q

** recurrent cellulitis tx **

A

pcn 250-500 BID

32
Q

tb transmission mode

A

airborne

33
Q

primary TB

A
  • infected but effective immune response not yet mounted- clinically & radiographically silent
34
Q

progressive primary TB

A

5% infected, unable to contain organisms

35
Q

** LATENT TB **

A

no active disease, cannot transmit10% progressive primary w/in 2 yearsactive tb will develop if immunocompromised or impaired (ex: prednisone)- pos ppd- neg CXR- no sx active tb

36
Q

active TB

A

cough - at least 3 wks (dry to productive)fatigueweight lossanorexianight sweats***fever (low grade)blood streaked sputum (significant hemoptysis rare)bronchial breath soundsdullness to percussionRales, cracklesappears chronically ill, malnourished

37
Q

gold standard tb diagnosis

A

CULTURE!!!!

38
Q

tb dx

A

exposure hx, predisposing factors, s/sppd CXR: infiltrates, nodular densities in apical region of upper lobes3 early morning sputum specimens- acid-fast bacilli on smear- positive sputum culture bronchoscopy (bronchoalveolar lavage)gastric morning aspirate (after an overnight fast) - culture only, can’t smear

39
Q

may have diminished reaction to PPD testing x4

A

malnourishedimmunosuppressedunderlying bacterial/viral infection

40
Q

HIV patients + tb

A

anergistic

41
Q

considered PPD conversion

A

wheal increases 10 mm+ within 2 years - needs follow up

42
Q

** tb test interp: high

A

greater than 5HIV/AIDSclose contact tb positiveCXR = “old” healed tb

43
Q

** tb test interp: moderate

A

greater than 10persons from high incidence country (asia, africa, latin america)IVDUunderserved, low incomeinsititutionalizedgastrectomy, jejunoileal bypass10% under IBWCKD, DMcorticosteroids or immunosuppressantleukemia, lymphoma, other cancers

44
Q

** tb test interp: low

A

greater than 15everyone else

45
Q

** CDC TB TX RECS **

A

4 rx = prevent resistance development- INH- rifampin- PZA- ethambutolmonitor liver & renal fxn- weekly culture + sputum smear x6 weeks then mo- mo f/u s/s AE

46
Q

tb rx AE

A

INH, rifampin, PZA - hepatotoxicPZA - ↑ uric acid levelsethambutol - optic neuritis

47
Q

ethambutol monitoring

A

visual acuity & red/green color perception (causes optic nerve damage)

48
Q

protease inhibitor and rifampin

A

CONTRAINDICATEDalt: rifabutin

49
Q

FUO criteria

A

illness - 3 wks durationgt 100.4 F / 38.3 C several occasions undx after 3 office visits / 3 days in hospital3x s/s severe enough to require evaluation

50
Q

hospital associated FUO

A

over 38.3 C (several occasions)admission cultures negativeundx after 3 days

51
Q

neutropenic FUO

A

THINK CHEMOover 38.3 Cneutrophils less than 500neg culturesundx after 3 daysdifferentials: fungal, occult bacterial infx

52
Q

HIV-associatied FUO

A

over 38.3 C- 4 wk outpt- 3 days inptwill see CMV, fungal infection, pneumocystis pneumonia

53
Q

common causes of FUO

A

tuberculosisendocarditis (recent dental work? murmur?)gallbladder diseaseHIV (primary or opportunistic infection)systemic infection: tb, endocarditis, CMV, Epstein Barrinfection: 25-40% cancer: 25-40% (lymphoma, leukemia)undx: 10-15%

54
Q

common abscess sites/sources

A

liver, spleen, kidney, brain, bonegall bladder (cholecystitis)UTIdental abscess paranasal sinuses

55
Q

big tx no no with FUO

A

NO STEROIDSmasks fever, exacerbates infectious process

56
Q

anion gap + FUO

A

Na - (CO2 + Cl)normal: 10 - 1216+ – losing bicarb or retaining H

57
Q

fever 101+ tx

A

NSAID: naproxen 250 mg BIDget blood cultures first - remember, can take 3 to 5 days to grow

58
Q

when to admit FO

A
  1. appears “toxic”2. declining rapidly with / without weight loss3. neutropenic (chemo)4. s/p transplant within 6 mo
59
Q

PIs, NNRTIs - interactions

A

metabolized by Cyp450 system, can be inhibitor, inducer, and substrate

60
Q

Ritonavir, Cobicistat - interactions

A

avidly bind Cyp34A enzyme & can yield very high levels of competing compounds

61
Q

HIV drugs: key drugs resulting in interactions

A 
Versed
Statins
Cafergot
Rhythmol
Viagra
Rifampin
Fluticasone
62
Q

viral load & CD4 count: goals & use

A

viral load

  • monitor this value!
  • goal: undetectable @ under 20 - 75 copies/mL

CD4 count

  • AIDS defining: under 200/uL (level at which ↑ risk opportunistic infection)
  • reference range: 500 - 2000 cells/uL
63
Q

HIV: ELISA

A

enzyme-linked immunosorbent assay - rapid test

most commonly used screening method

64
Q

HIV: western blot

A

most widely accepted confirmatory assay for detection of ab to HIV retrovirus

65
Q

kernig’s sign

A

straighten bent leg = pain

sign of meningitis

66
Q

brudzinski sign

A

flex neck = flex knee

sign of meningitis

monster management (29 decks)

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