POS Infections + Antibiotics Flashcards
A 60-year patient has bacteremia associated with a red, tender intravenous site. After removal of the cannula, and treatment with antibiotics, the area of redness and bacteremia persists. The next best step is:
A. Removal of the affected vein
B. Incision and drainage of the area of redness
C. Change antibiotics
D. Anti-coagulation
E. Placement of port-a-cath for long term antibiotics
A. Removal of the affected vein
What is the most sensitive marker of fascial infection?
1. Grey dish water appearance
2. Redness and swelling
3. Quick spreading with fever
4. Purulent discharge
- Grey dish water appearance
What is the most common cause of toxic shock syndrome?
- Staph aureus
- Strep pyogenes
- Staph aureus exotoxin (enterotoxin type B)
- Strep pyogenes exotoxin (also a cause)
- Staph aureus exotoxin (enterotoxin type B)
A 55 year old female with a history of a mechanical aortic valve replacement 5 years ago is undergoing an abdominal hysterectomy for symptomatic fibroids causing discomfort and significant menorrhagia. What would be the most appropriate antimicrobial prophylaxis?
A. IV penicillin and gentamycin
B. IV Ampicillin and Tobramycin
C. IV Clindamycin
D. IV Vancomycin
B. IV Ampicillin and Tobramycin
Which of the following patients will require prophylactic antibiotics prior to the specified procedure?
A. A 65 year old man undergoing cholecystectomy
B. A 25 year old woman undergoing an emergency caesarian section
C. A 35 year old woman undergoing a splenectomy for ITP
D. A 60 year old man undergoing a colonoscopy
B. A 25 year old woman undergoing an emergency caesarian section
Which of the following cardiac conditions is NOT associated with a high risk of adverse outcome from infective endocarditis and thereby does NOT necessitate peri-operative antibiotic prophylaxis?
A. Prosthetic Cardiac Valve
B. History of infective endocarditis
C. Cardiac transplant patient
D. Unrepaired congenital cyanotic heart disease
E. Repaired Congenital heart disease with residual defect adjacent to prosthetic patch
C. Cardiac transplant patient
What’s the most common risk factor for infective endocarditis?
A. Mitral valve prolapse without regurgitation
B. Isolated atrial defect
C. Prosthetic heart valve
C. Prosthetic heart valve
Dirty wound irrigated and closed, what stitch?
A. Nylon
B. PDS
A. Nylon
Acute empyema
A. Chest tube + abx
B. Thoracentesis
A. Chest tube + abx
What to redose antibiotics during surgery?
A. 3 hours
B. One half life of Abx
C. 2 half lives of Abx
D. Right before end of OR
C. 2 half lives of Abx
You’ve sustained a needlestick injury by an HIV positive patient, when is the best time to test?
A. 1 week
B. 4 weeks
C. 2 months
D. 4 months
B. 4 weeks
Which of the following organisms is associated with anal squamous cell carcinoma?
A. Herpes Simplex Virus
B. Human T-cell lymphotropic virus
C. Human papiloma virus
D. Human immunodeficiency virus
C. Human papiloma virus
Which of the following is a risk factor for developing a candida infection?
A. Prolonged antibiotics
B. Steroid Use
A. Prolonged antibiotics
A patient returns post knee surgery with erythema and swelling at the wound. Which of the following is most likely pathogen?
A. GPC
B. GNC
C. GPR
D. GNR
A. GPC
Which of the following is the most common causative agent of central line infections?
A. Coag-neg staph
B. Candida
C. E Coli
A. Coag-neg staph
Something about blood transfusion, which is true?
A. HIV transmission is less than 1/20,000
B. Viral transmission is mroe common than bacterial transmission
B. Viral transmission is mroe common than bacterial transmission
True animal vs. human bite
A. Animal bites have more anerobic
B. Human bites have greater beta lactamase bacteria
C. Eikenella higher in animal bites
D. Pasturella higher in human bites
B. Human bites have greater beta lactamase bacteria
All are true regarding gas gangrene (clostridium) except:
A. Caused by C. prefering es
B. Can follow minor trauma
C. Gas in X-ray pathognomonic
D. Tx by pencillin
E. Need aggressive surgical debridement
C. Gas in X-ray pathognomonic
All of the following influence risk of transmission of HIV except:
A. Hollow vs solid needle
B. Depth of the needle stick
C. Degree of contamination
D. Strain of virus
D. Strain of virus
Most common cause of UTI in catheterized patient:
A. Proteus
B. Klebsiella
C. E.Coli
D. Pseudomonas
E. Staph
C. E.Coli
40 gets appendectomy, 2 weeks later, RLQ abscess drained. Fistula present. Fluid contains sulfur granules (Actinomyces). Management:
A. Parenteral 3rd gen cephalosporins for 1-2 weeks
B. IV gentamycin for 2 weeks
C. Oral clinday or flagyl 3-6 months
D. High dose IV penicillin, followed by oral penicillin for 6-12 months
D. High dose IV penicillin, followed by oral penicillin for 6-12 months
Which of the following cannot be used to treat pseudomonas:
A. Amikacin
B. Cefoxitin
C. Tobramycin
D. Piperacillin
E. Ticarcilin
B. Cefoxitin
Risk factors for the development of surgical site infections include all of the following except:
A. Presence of a chronic inflammatory process in the patient
B. Hyperthermia during the surgical procedure
C. Patient receving a blood transfusion
B. Hyperthermia during the surgical procedure
You are asked to evaluate a patient on the ward who requires a post op blood transfusion. The patient is concerned about blood borne disease transmission risk. The most common blood born risk would be:
A. HIV
B. HBV
C. HCV
D. CMV
C. HCV
An incision and drainage of a localized perianal abcess without systemic infection is performed in the operating room. Postoperative care for this patient should include:
A. 5 days of Keflex
B. BID wound packing
C. Ceftriaxone for 48 hours
D. None of the above
Evidence based interventions to reduce nosocomial postoperative infections include:
A. Appropriate targeted antibiotics for 48 hours after surgery
B. Incentive spirometry
C. OR room cooling after induction of anesthesia
D. Avoidance of urinary catheter insertion
A. Appropriate targeted antibiotics for 48 hours after surgery
Where is C. Diff most prevalent?
A. Surgical Ward
B. ICU
C. Medical Ward
D. ER
C. Medical Ward
What is the most common cause of infection after splenectomy?
A. Strep Pneumo
B.Staph Aureus
C. Klebsiella
D. Nisseria
Which of the following is true regarding the surgical site infections (SSI):
A. The use of drains has clearly been shown to reduce SSI in clean and clean-contaminated surgery.
B. Chronic Obstructive pulmonary disease is an independent risk factor for the development of a SSI.
C. Hypothermia is definitely associated with an increased incidence of SSI.
D. The duration of a procedure has no impact on the risk of a SSI.
C. Hypothermia is definitely associated with an increased incidence of SSI.
Which of the following locations in the human body generally does not possess resident microflora (microbes) in healthy individuals:
A. Skin
B. Biliary Tract
C. Oropharynx
D. Distal Colon
B. Biliary Tract
Which of the following antimicrobials agents has very limited activity (ie. Significant rate of resistance) against Pseudomonas Aeruginosa:
A. Ceftazidime
B. Tobramycin
C. Levofloxacin
D. Vancomycin
D. Vancomycin
Based on the summary of Surviving Sepsis campaign guidelines which of the following is true:
A. Transfusion of red blood cells should occur when the hemoglobin drops below 90 (<9.0g/dl)
B. Source control should always occur before starting empiric antibiotics
C. Intravenous hydrocortisone should be initiated once aggressive fluid resuscitation fails
D. The first line choice for a vasopressor is norepinephrine
D. The first line choice for a vasopressor is norepinephrine
Which of the following is associated with the highest risk of being transmitted from a blood transfusion in North America:
A. HAV
B. HIV
C. HBV
D. HCV
D. HCV
Prophylactic antibiotics are recommended to decrease the incidence of wound ifnection after surgical procedures. Which of the following statement is TRUE:
A. IV Vancomycin is recommended for an elective neurosurgery
B. IV cefazolin is recommended for an elective aortic valve replacement
C. IV metronidazole is recommended for an urgent obstructed small intestine surgery
D. IV vancomycin is recommended for urgent vascular surgery
E. IV ciprofloxacin is recommended for elective hernia repair
B. IV cefazolin is recommended for an elective aortic valve replacement
A 65 year old, male type-two diabetic had an elective laparotomy and right-hemicolectomoy for colon cancer one day ago. You are called to assess the patient because of a fever of 39.1 degrees celsius, tachycardia of 120 bpm. Blood pressure and other vital signs remain normal. To determine the source if this infection, initial steps should include:
A. Blood and urine cultures
B. Would evaluation and possible exploration
C. Chest x-ray
D. CT scan of the abdomen and pelvis
C. Chest x-ray
Which of the following is true with regard to the prophylaxis of surgical site infections (SSI’s):
A. Poor glycemic control, hypothermia and hypoxia are associated with higher rates of SSI’s.
B. A first generation Cephalosporin would be considered an appropriate antibiotic for the prophylaxis of SSI prior to a laparoscopic appendectomy for uncomplicated appendicitis.
C. A patient with a documented allergy to cephalosporins is undergoing a masectomy. An appropriate alternative prophylactic antibiotic to cefazolin would be ciprofloxacin.
D. An elective laparoscopic cholecystectomy does not require prophylactic antibioitcs unless indicated by other patient factors.
A. Poor glycemic control, hypothermia and hypoxia are associated with higher rates of SSI’s.
Empiric therapy for intra-abdominal sepsis secondary to an anastamotic leak should be continued until:
A. The patient is otherwise ready for discharge.
B. 14 days of total antibiotic therapy have been given.
C. White blood cell count has normalized, bands are absent on peripheral blood smear, and fevers have resolved.
D. Until cross-sectional imaging shows complete resolution of any non-drainable collections.
C. White blood cell count has normalized, bands are absent on peripheral blood smear, and fevers have resolved.
To improve the survival of sepsis, guidelines recommend all but which of the following:
A. Early initiation of antibiotic therapy.
B. Initial bolus of 1000ml of crystalloid followed by further resuscitation with colloid (preferably albumin) if necessary.
C. Source control measures immediately after initial resuscitation.
D. The consideration of the use of steroids if poor response to fluids and vasopressors.
A. Early initiation of antibiotic therapy.
The diagnosis of a nosocomial urinary tract infection should be based on:
A. The presence of bacteria of a urine dip.
B. Demonstrating a combination of white blood cells, bacteria or positive leukocyte esterase on a urinalysis.
C. Symptoms of dysuria, fever or incomplete voiding.
D. Cloudy or foul smelling urine in a patient with a history of recent catheterization.
B. Demonstrating a combination of white blood cells, bacteria or positive leukocyte esterase on a urinalysis.
Which of the following blood-borne pathogens has by far the highest transmission rate to health care worker in hospital derived needle-stick injuries:
A. HIV
B. HBC
C. HCV
D. EBV
E. CMV
B. HBC
A 55kg adult female patient is undergoing elective knee arthroplasty due to chronic complications associated with juvenile arthiritis. The most appropriate antibiotic prophylaxis order is:
A. Cefazolin 2g IV within 60 minutes prior to skin incision
B. Cefazolin 1g IV within 30 minutes prior to skin incision
C. Cefazolin 2g IV within 20 minutes prior to skin incision
D. Cefazolin 1g IV within 90 minutes prior to skin incision
A. Cefazolin 2g IV within 60 minutes prior to skin incision
Confirmation of the preoperative administration of prophylactic antibioitics must be reviewed during which phase of the surgical safety checklist:
A. In patient preparation unit
B. Prior to induction of anesthesia
C. Prior to skin incision
D. During procedure debrief
C. Prior to skin incision
American risk index for infection include all except:
A. OR duration
B. ASA
C. Pre-op abx
D. Class of wound
B. ASA
Risk factor for SSI:
A. Prolonged hospital stay
B. Local anesthesia
C. Multiple IV instrumentation
D. Distant history of smoking
A. Prolonged hospital stay
Which is a risk factor SSI:
A. Prior radiation on another site
B. Controlled HTN
C. Controlled DM
D. BMI of 24
C. Controlled DM
What is the most common nosocomial infection?
A. SSI
B. Pneumonia
C. UTI
D. Sepsis
C. UTI
Which of the following antibiotic provide a broad coverage of anaerobes?
A. Penicillin
B. Levofloxacin
C. Ceftazidime
D. Gentamycin
B. Levofloxacin
C. Ceftazidime
B Vs C
64 Male had a carpal tunnel release four days ago, he has diabetes, presents now with swollen hand, redness, and white discharge (pus) from the wound. Hemodynamically stable. Which of the following would you do prior to administering antibiotics?
A. Open the wound sutures and irrigate
B. CT scan of the hand
C. X-ray of the hand
D. Sterile dressing
A. Open the wound sutures and irrigate
Patient undergoing inguinal hernia repair, had a reaction to penicillin in the past with hives and difficulty breathing with laryngeal edema- penicillin allergy (anaphylactic type reaction), what antibiotic should he get?
A. Ancef
B. Clindamycin
C. Flagyl
D. Meropenem
B. Clindamycin
Patient with preforated appendictis, post op developed wound infection, what is the most likely organism causing SSI?
A. Staphylococcus Aureus
B. Streptococcus Pyogenes
C. E.Coli
D. Clostridium Perfringens
C. E.Coli
Male patient presents after a dog bite injury to the hand. Your management will consist of?
A. Irrigate and debride, close the wound and close follow up
B. Irrigate and debride, oral antibiotics, close the wound and close follow up
C. Irrigate and debride, oral antibiotics, leave wound open and close up
D. Irrigate and debride, admite or IV antibiotics
C. Irrigate and debride, oral antibiotics, leave wound open and close up
Which is the best skin prep?
A. Chlorhexidine with alcohol
B. Chlorhexidine with water
C. Proviodine
D. NaCl
A. Chlorhexidine with alcohol
Burn patient 2 days later develops hypoxia. What is the most likely cause?
A. Pulmonary edema
B. Bronchopulmonary Pneumonia
C. ARDS
D. CO Poisoning
B. Bronchopulmonary Pneumonia
Patient with necrotizing fasciitis. Beside wide surgical resection, what will provide the most benefit to the patient?
A. Broad spectrum antibiotics
B. MRI of the lower extrimities
C. CT of the lower extremities
A. Broad spectrum antibiotics
Using which of the following antibiotics would result in achiles tendon rupture?
A. Ciprofloxacin
B. Flagyl
C. Ancef
D. Clindamycin
A. Ciprofloxacin
Which of the following is a sign of hypomagnesemia?
A. Hyperreflexia
B. Lethargy
C. Severe abdominal Pain
A. Hyperreflexia
Which electrolyte abnormality would result in difficulty correcting hypokalemia?
A. Hypomagnesmia
B. Hypocalcemia
C. Hyponatremia
A. Hypomagnesmia
What is true about inflammatory markers?
A. They are not reliable with hepatic insufficiency
B. ESR decrease in response to inflammatory process
C. Can be measured b y serum protein electrophoresis
A. They are not reliable with hepatic insufficiency
How to confirm the diagnosis of C. Diff?
A. Sigmoidoscopy to see plaques
B. CT scan to see thin colon wall
A. Sigmoidoscopy to see plaques
(PCR is the best)
What is the most common organism found in infected IV lines?
A. Staph aureus
B. Strep epidermidis
C. Pseudomonas
D. E. coli
A. Staph aureus
What is the risk of transmission of Hepatitis B in a blood transfusion?
A. 1 in 150,000
B. 1 in 750,000
C. 1 in 1.1 million
D. 1 in 3 million
C. 1 in 1.1 million
For sepsis secondary to encapsulated organisms in patients post-splenectomy, which of the following statements is true?
A. Vaccination should be delayed for 2 months
B. Children are more prone to OPSI than adults
C. Adult should receive continous antibiotic prophylaxis
D. Infections are usually indolent with slow onset
B. Children are more prone to OPSI than adults
In Leukocyte depleted blood all of the following are true except:
A. CMV transmission not affected
B. Decreases wbc count by 99%
C. Reduces hla 1 mediated reaction
D. Reduces febrile neutropenia
A. CMV transmission not affected
Patient to undergo an inguinal hernia repair but has a lot of hair at surgical site. When and what is the best time to remove the hair?
A. At home the week before
B. At the preop center 1 day before
C. At home the day before
D. Immediately Pre-op
D. Immediately Pre-op
