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Clin Med II - Exam 1 > Schoenwald > Flashcards

Schoenwald Flashcards

1
Q

what are the 2 main symptoms of neutropenic fever

A
  1. fever (earliest symptom)
  2. sores along mucous membranes of the GI tract
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2
Q

what does a microbiologically documented infxn mean

A

culture positive

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3
Q

what does a clinically documented infxn mean

A

ex cellulitis

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4
Q

what is an unexplained fever

A

no clinical focus or culture positive material

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5
Q

what are important hx factors to take into account w. neutropenic fever (3)

A
  1. GI risk factors
  2. previous infxn → what organism?
  3. non-infectious causes
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6
Q

what are 2 non infectious causes of neutropenic fever

A
  1. blood transfusion
  2. comorbidities
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7
Q

what exam should you AVOID w. neutropenic fever

A

DRE!!

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8
Q

what are some common sites of infxn w. neutropenic fever

A
  1. lungs
  2. indwelling ports/IV catheters
  3. skin and mucous membranes
  4. perianal → but avoid DRE!
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9
Q

what is the definition of neutropenia relative to ANC count

A

absolute neutrophil count (ANC) < 500 cell/microL

OR

an ANC expected to decrease to at least 500 cell/microL w.in 48 hr

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10
Q

what is the equation for ANC

A

total WBC x (%PMNs + %bands)

ex. total WBC = 1,000

PMNs = 30%

bands = 10%

→ 1,000 x 40%

ANC = 400

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11
Q

how many blood cultures do you need to dx neutropenic fever

A

2

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12
Q

what 2 sites do you need blood cultures from to dx neutropenic fever

A
  1. one from periphery
  2. one from port or line
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13
Q

what needs to be done prior to initiation of antimicrobial therapy in neutropenic fever

A

2 blood cultures

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14
Q

how can you tell if an infxn is a line infxn

A

there is at least a 2 min delay btw line and culture positives and line was first

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15
Q

besides cultures, what are other lab tests for neutropenic fever (6)

A

CBC

CMP

UA w. culture

sputum culture

stool culture w. C.diff

LP/CSF if HA

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16
Q

should you delay antimicrobial therapy for neutropenic fever to wait for labs other than blood cultures?

A

no

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17
Q

what imaging should you order for low risk neutropenic fever pt

A

CXR

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18
Q

what imaging should you order for high risk neutropenic fever pt

A

chest CT

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19
Q

what is the definition of neutropenic fever

A

fever in setting of ca and active chemo receiving cytotoxic antineoplastic therapy

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20
Q

what are the fever parameters for neutropenic fever

A

single temp measured at 38.3 C (101F)

OR

38.0 C (100.4F) sustained over 1 hr

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21
Q

what pathogens are associated w. neutropenic fever

A

colonizing bacteria or yeast of GI tract

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22
Q

what pathogen is most commonly associated w. neutropenic fever

A

pseudomonas → high mortality

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23
Q

what is the most common gram positive organism associated with neutropenic fever

A

staph epidermidis

(MRSA becoming more common in setting of MDRO)

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24
Q

what is the two most common fungal pathogens associated with neutropenic fever

A

candida

Aspergillus

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25
Q

__ and

__ pathogens are associated w. high mortality in neutropenic fever

A

pseudomonas

fungal

26
Q

fungal pathogens are are more commonly associated with __ patients in neutropenic fever

A

high risk

27
Q

what are the most common viral pathogens in neutropenic fever

A
  1. herpes simplex
  2. shingles reactivation
28
Q

what is the definition of a low risk pt in neutropenic fever (3)

A
  1. expect to be neutropenic <7 days
  2. no comorbidities
  3. most solid tumor regimens
29
Q

what is the definition of high risk neutropenic fever (3)

A
  1. expect neutropenia >7 days
  2. ongoing comorbidities
  3. hematologic cancers (esp leukemias; also lymphomas etc)
30
Q

what is used for antiviral prophylaxis for neutropenic fever

A

Acyclovair 400-800 mg po

31
Q

what 2 patient populations are given Acyclovair prophylaxis for neutropenic fever

A
  1. leukemics starting therapy
  2. HSCT (bone marrow transplant pt’s)
32
Q

what drug is given for aspergillus prophylaxis in neutropenic fever

A

posaconazole → 13 yo and older and undergoing intense chemo for AML/MDS (myelodysplastic syndromes)

33
Q

what drug is given for candida prophylaxis in neutropenic fever

A

fluconazole

34
Q

what 2 patient populations are given fluconazole prophylaxis for neutropenic fever

A
  1. leukemics starting tx
  2. HSCT (bone marrow transplants)
35
Q

what prophylactic drug is given for expected prolonged neutropenia w. ANC < 100

A

fluoroquinolones

36
Q

are pt w. solid tumors given prophylaxis for neutropenic fever?

A

no! → they are low risk

37
Q

what pt population is given hematopoietic growth factor for neutropenic fever

A

consider in pt w. anticipated risk of fever, and neutropenia is 20% or higher

38
Q

hematopoietic growth factor is not recommended for

A

pt w. established febrile neutropenia

39
Q

in terms of tx initiation, neutropenic fever is considered a

A

medical emergency

40
Q

1st step in tx of neutropenic fever

A

empiric abx asap w.in 1 hr!

41
Q

tx for neutropenic fever is considered delayed if it is given in

A

1 hour

42
Q

abx for neutropenic fever focus on __ pathogens,

but __ pathogens should be considered for more complicated pt

A

gram negative

gram positive

43
Q

what is the tx for low risk neutropenic fever pt’s

A

oral abx → Fluoroquinolones (Cipro or Levo) PLUS Amoxicillin Clauv 500/125 mg po tid

44
Q

what is the tx for high risk pt’s for neutropenic fever

A

require hospitalization and IV abx:

  1. Cefepime 2 gm IV q 12 hr (BID)
  2. Piperacillin/Tazobactam (Zosyn) 4-5 g IV q 6 hr (TID)
  3. Imipenem OR Meropenem for more resistant organisms
  4. Vancomycin only if MRSA is suspected
45
Q

what is the abx duration for neutropenic fever

A

until neutropenia is resolved → ANC > 500

46
Q

what is the MASCC risk score?

A
47
Q

what is the “low risk” score for MASCC

A

21 or higher

48
Q

a MASCC score of 5 indicates

A

no/mild sx

49
Q

a MASCC score of 3 indicates

A

moderate sx

50
Q

a MASCC score of 0 indicates

A

severe sx/moribund

51
Q

what is functional neutropenia

A

suppressed immune system in the setting of adequate neutrophil count

52
Q

what 2 PE exam findings would make you suspect osteomyelitis

A
  1. bone can be probed w. a swab from the wound site
  2. a wound is present > 6 weeks duration
53
Q

what imaging is used to dx osteomyelitis

A

plain film xray

54
Q

what imaging is used to evaluate osteomyelitis if the initial xray is negative, but you have a high suspicion for osteo

A

MRI

55
Q

what are the 2 main symptoms of osteomyelitis

A
  1. fever
  2. bone or joint tenderness/pain
56
Q

what do labs show in osteomyelitis

A

elevated acute phase reactants

57
Q

what are 5 RF for osteomyelitis

A
  1. bone fx
  2. weakened immune system (DM, AIDS)
  3. kidney failure
  4. IV drug use
  5. joint replacement/hardware
  6. peripheral neuropathy
58
Q

osteomyelitis is __ or

__ infxn of bone

A

bacterial

fungal

59
Q

what are the 3 infectious sources of osteomyelitis

A
  1. hematogenous
  2. invasion from a contiguous focus of infxn → DM foot ulcer
  3. skin breakdown → vascular insufficiency or trauma
60
Q

what 3 sources of bacteremia is hematogenous osteomyelitis associated with

A
  1. sickle cell anemia
  2. elderly
  3. IV drug users
61
Q

what bacteria do you think of when you see sickle cell anemia and osteomyelitis

A

salmonella

62
Q

what bacteria do you think of when you see sickle cell anemia, elderly, and IV drug users

A

staph aureus

Clin Med II - Exam 1 (7 decks)

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