sepsis etc... (4)

Question 1

infection

Answer 1

inflammatory response to the presence of microorganisms or invasion of normally sterile site or host tissue by those organisms

Question 2

bacteremia

Answer 2

presence of viable bacteria in the blood

Question 3

what is SIRS

Answer 3

systemic inflammatory response syndrome

widespread inflammatory response

presence of 2 or more of:

1. temp >38.5 or 90 bpm
2. RR > 20 or PaCO2

Question 4

what is sepsis

Answer 4

SIRS + clinical/definitive EVIDENCE OF INFECTION (presumed or confirmed)

severe sepsis is when its associated with organ dysfunction or hypoperfusion

Question 5

what is septic shock

Answer 5

sepsis with HYPOTENSION despite adequate fluid resuscitation along with PERFUSION ABNORMALITIES (i.e lactic acidosis, oliguria or acute alteration of mental status)

patients requiring inotropic or vasopressor therapy despite adequate fluid resuscitation are in septic shock

“refractory hypotension”

Question 6

etiologic agents of septicemia/sepsis

Answer 6

E. coli = most common organism causing septic shock (22%)

second most common is S. aureus

gram +s = more cause of sepsis than gram -s

E. coli, S. aureus, S. pneumo, Klebsiella

Question 7

clinical presentation of sepsis

Answer 7

look for:

1. confusion
2. leukocytosis
3. tachycardia
4. tachypnea
5. hypotension
6. organ dysfunction

Question 8

management of sepsis

Answer 8

1. fluid rescusitation
2. appropriate cultures
3. source control
4. vasopressors/inotropes when fluid fixed
5. early institution of appropriate Ab therapy–> HIT HARD AND HIT EARLY

Question 9

clinical presentation of septic shock

Answer 9

1. hemodynamic alterations–> hyper or hypodynamic
2. myocardial depression
3. altered vasculature
4. altered organ perfusion
5. imbalance O2 delivery
6. lactic acidosis

Question 10

what is “warm shock”

Answer 10

assoc w severe sepsis/septic shock

hyperdynamic state–> elevated cardia output, tachycardia, decreased systemic vascular resistance

Question 11

what is “cold shock”

Answer 11

assoc with severe sepsis/septic shock

hypodyamic state–> decreased cardiac output

Question 12

what is infective endocarditis

Answer 12

infection of the endocardial surface of the heart

usually heart valves but may occur on septal defects or mural endocardium

Question 13

what are the 4 types of infective endocarditis

Answer 13

1. native valve
2. prosthetic
3. IV drug abuse
4. nosocomial

Question 14

what percent of infective endocarditis is native valve?

Answer 14

55-75% (underlying abnormality)

Question 15

what is the median age of infective endocarditis

Answer 15

47-69

Question 16

who is given infective endocarditis prophylaxis

Answer 16

given to high risk patients (i.e with prosthetic heart valves, previous IE, cardiac transplant, congenital heart defect, and high risk procedures)

Question 17

what causes acute infective endocarditis

Answer 17

S. aureus
S. pyogenes (GAS)
S. pneumoniae

(strep more likely than staph in native valve endocarditis)
(in prosthetic valve coagulase - staph is more likely than strep is more likely than staph)

Question 18

what causes chronic/subacute infective endocarditis

Answer 18

viridans group strep

Question 19

how does infective endocarditis occur

Answer 19

turbulent blood flow makes the endocardium “sticky”–> bacteremia delivers organism to the endocardial surface–> adherence of organism–> eventual invasion of valvular leaflets

Question 20

how does infective endocarditis present clinically

Answer 20

1. febrile illness (85%)
2. persistent bacteremia
3. lesions on heart
4. vegetation (variable in size)
5. heart murmur (85%)
6. peripheral signs–> Osler’s nodes, splinter hemorrhage, Janeway lesions, subconjunctival lesions
7. Roth spots (embolic lesions)
8. spenomegaly (30%)

Question 21

Tx for native valve endocarditis

Answer 21

acute: vancomycin + ceftriaxone

subacute–await culture

Question 22

Tx for prosthetic valve endocarditis

Answer 22

if its early onset (

Question 23

risk factors for prosthetic joint infections

Answer 23

1. primary–> rheumatoid arthritis, diabetes mellitus, poor nutritional status, obesity
2. revision–> prior joint surgery, prolonged OR time, preoperation infection (skin, teeth, UTI)

uncommon infection–less than 2% of joint replacements

Question 24

etiologic agents in prosthetic joint infections

Answer 24

S. aureus and coagulase - staph

Question 25

what are some examples of coagulase negative staph species

Answer 25

Staph epidermis
Staph haemolyticus
Staph saprophyticus

Question 26

Tx of prosthetic joint infections

Answer 26

empiric therapy is not recommended

treat based on culture and sensitivity and treat for at least 6 weeks

remove prosthesis if joint age is more than 30 days and symptoms persist for more than 3 weeks

Question 27

what is febrile neutropenia

Answer 27

development of fever, often with other signs of infection, in a patients with neutropenia

Question 28

what is neutropenia

Answer 28

an abnormally love number of neutrophil granulocytes in the blood

Question 29

what type of patients get febrile neutropenia

Answer 29

immunocompromised people

Question 30

what causes febrile neutropenia

Answer 30

gram -s like pseudomonas

can also be cause by gram +s, fungal superinfection if the neutropenia is prolonged

Question 31

what is the clinical presentation of febrile neutropenia

Answer 31

fever for longer than 1 hour and ANC less than 0.5 but trending down