SIRS/Sepsis Flashcards
1
Q
How do viruses proliferate
A
invade host cells and take over cells’ machinery (can’t reproduce)
2
Q
Virus consists of
A
DNA OR RNA, surrounding protein coat (capsid), opt: lipoprotein envelope
3
Q
A viruses 3 methods of affecting cell
A
lyse host cells to spread, remain latent incorporated in host genome, cause oncogenic change
4
Q
4 facts about viruses that make them hard to kill
A
- intracellular: evade humoral immune system
- easily mutate (new strands, body w/o immunity)
- disguise themselves (take part host cell memb camo)
- target our own immune cells for destruction
5
Q
Describe prion’s and their effects
A
No genome, produce progressive wasting disease of CNS, replicate and add up w/in neuron
6
Q
What happens to body in Prion disease, S/S
A
progressive non-inflamm neuron degeneration, leads to ataxia, dementia, death, no treatment
7
Q
What typically causes GU disease and atypical pneumonia
A
mycoplasma (bacteria)
8
Q
Describe mycoplasma
A
no cell wall, bacteria causes disease w/o cellular invasion
9
Q
What 3 ABX categories is mycoplasma sensitive to
A
E-mycins, tetracycline, quinolone ABX
10
Q
How do you see spirochetes
A
dark field microscopy
11
Q
Spriochetes: Gram result?, can they move?, shape?
A
GNR (gram neg rods), motile, corkscrew shape
12
Q
What causes syphilis (Treponema)
A
spirochetes
13
Q
what causes GI disease (H. pylori)
A
spirochetes
14
Q
what causes lyme disease (Borrelia)
A
spirochetes
15
Q
What 2 diseases does mycoplasma cause
A
GU disease and atypical pneumonia
16
Q
describe chlamydiae
A
obligate intracellular parasite, obtain energy from host cell
17
Q
what does chlamydiae cause
A
GU infection, atypical pneumonia
18
Q
3 ABX to treat chlamydiae
A
tetracyclines, macrolides, some quinolone ABX
19
Q
Describe Rickettsiae
A
intracellular parasites, usually spread by insect vector
20
Q
What does Rickettsiae cause
A
vascular cell infection/vasculitits
21
Q
What ABX use for Rickettsiae
A
tetracyclines
22
Q
Mycobacteria: description, how to see, where in body
A
GPR (weakly), acid fast-retain dye after alcohol wash, slow growing intracellular parasites of macrophages
23
Q
what 3 diseases does mycobacteria cause
A
TB, MAC, leprosy
24
Q
Nocardia/Actinomyces description
A
weakly GP filament bacteria, slow growing; work well in pts with T-cell immune dysfunction
25
What does Nocardia/Actinomyces cause
severe infection/abscess (require long term treatment)
26
Pts with T-cell immune dysfunction should watch out for what bacteria
Nocardia/Actinomyces
27
What bacteria is intracellular parasite of macrophages
mycobacteria
28
list 3 gram positive rods
Uncommon: Diptheria, Corynebacteria, Listeria
29
List 3 gram positive cocci
Enterococcus (including VRE), staphylococcus (epidermidis and aureus)
30
what is grouped by carbohydrate capsules A-D
streptococci
31
What hemolysis blood agar: alpha incomplete, beta complete, gamma none
streptococci
32
Skin colonizer and potential pathogen (bacteria)
Staphylococcus
33
Gram status and description of staphylococcus epidermidis
gram positive cocci
34
patients with DM, IVDA, or HD patients might have what colonized in their nares
Staphylococcus aureus
35
What has abscesses with low intenral pH and has enzymes to retard body's defense mech
staphylococcus aureus
36
What produces enterotoxins (scalded skin syndrome and TSS)
staphylococcus aureus
37
what is increasingly becoming resistant to all beta-lactams
staph
38
Features of gram negative bacteria
cell wall with lipopolysaccharide to strongly induce cytokines (like TNF)
39
List some GN bacteria
haemophilus species, klebsiella species, pseudomonas species, eschherichia coli, enterobacter, Moraxella, serratia, slamonella, shiegella, proteus, neisseria
40
2 ways anaerobes cause infection
contaminate of sterile sites with heavy load of anaerobes (aspiration pneumonia), infection of tissues with poor vascular supply and low tissue oxygen concentration (diabetic ulcers)
41
What pathogen infection generally implies a polymicrobial infection
anaerobic infection
42
2 examples of anaerobes
clostridium species, bacteroides fragilis
43
3 clues for presence of anaerobic infection
foul odor, presence of gas (x-ray or crepitus), mixed GN and GP cultures, esp on aerobic culture
44
6 common fungi
Candida, Histoplasma, Coccidiomycosis, Cryptococcus, aspergillus, pneumocystis jiroveci
45
Fungi found in mouth, skin, blood (fungemia)
Candida
46
fungi found in cavitary lung or systemic dz, endemic to ohio river valley
Histoplasma
47
endemic to desert SW, cause pneumonia, meingitis
Coccidiomycosis
48
insidious meningitis, space occupying lesions or pulm disease (fungi)
Cryptococcus
49
fungi found in lungs, sinuses
aspergillus
50
opportunistic infection in pts with t-cell immunodef (fungi)
Pneumocystis jiroveci
51
What 2 components do both innate and adaptive immunity have
humoral immunity and cellular immunity
52
5 innate defenses of immune system
mucociliary clearance, skin/epithelium, phagocytic cells (neutrophils), toll-like receptors (transmemb receptors recognize diff compon of microbes), complement (protein activated by immune complex or surf proteins, enhances opsonization, phagocytosis, lysis)
53
Upon activing complement cascade what are the 4 steps that happen
Deposite complement on microbial surface, local inflammation/leaky capillaries, drill pores in surface cause cell lysis, recruit WBC
54
What type of immunity is complement
Humoral
55
relationship of mnocytes and macrophages
start as monocytes and differentiate into macrophages
56
3 roles of monocytes/macrophages
phagocytosis and presentation of ingested antigens to lymphocytes; secretion of proteolytic enzymes, oxygen radiacals, and cytokines (further inflame and call attn. to site of inf); debris clean-up
57
3 examples of graunlocytes
Polymorphonuclear cells (PMN)/neutrophils, eosinophils, basophils
58
what cell releases cytoplasmic graunles containg proteolytic enzymes (also actively phagocytic cell)
PMN or netuorphils
59
3 roles of lymphocytes
destroy cells identified by antibodies, defend against viral pathogens, recognize and kill tumor cells/abn cells/cells inf w/ intracellular pathogens (like viruses)
60
list 3 types of lymphocytes
Natural killer cells, B lymp, T lymph
61
Difference between T and B lymph
T matures in thymus, B matures in bone marrow
62
what type of cell secretes cytokines (like IL and TNF) to be general activator of inflammation and immune response
Lymphocytes
63
Role of central lymphoid tissues, bone marrow and thymus
finishing school for B and T lymphocytes, they must mature appropriately in order to leave the organ (otherwise destroyed)
64
Role of B lymphocyte
circulate in body to find antigens, if recognized then cell proliferates and ramps up immunoglobulin production (humoral immun)
65
Role of T lymphocytes
recognize protein antigens on MHC so if foreign antigens are identified T lymp seeks out and kills invader or cell infected by pathogen (cellular immun)
66
List the 5 types of immunoglobulins secreted by B lymph specific to each invader
IgA, IgG, IgM, IgD, and IgE
67
What stimulates humoral immunity
complement cascade
68
3 things antibodies (immunoglobulins) do
recognize and bind microbe to inactivate it, binding to microbe and facilitate phagocytosis, recognize foreign proteins and kill it
69
principal antibody molec for infectious agents, smaller remains elevated longer (Antibody)
IgG
70
large antibody, elevates quickly in acute infection, macroglobulin (Antibody)
IgM
71
increased in allergic individuals (Antibody)
IgE
72
antibody for things we inhale or eat
IgA
73
antibody found on cell memb of b lymph
IgD
74
2 types of T-lymp and what they do (general)
CD4 and CD8: kill body's own cels that were invaded
75
What adaptive defense component is vital in organizing immune system
CD4 T-lymphocytes
76
Helper T cell vs cytotoxic t cell
Helper: help B lymph and phagocytic cells make antibodies and lyse
Cytotoxic: kill lyse intracellular microbes
77
Humoral Innate Immunity
pattern receptors, complement, enzymes, cytokines
78
Cellular innat eimmunity
phagocytes, NK cells (all must be tagged)
79
Humoral adaptive immunity
antibodies, cytokines
80
Cellular adaptive immunity
T and B cells
81
adaptive immunity lag time for proliferation of lymphocytes to respond to antigen
>1 week
82
5 parts of peripheral lymphoid tissues
spleen, lymph nodes, tonsils, appendiz, MALT/GALT (mucosa-assoc lymphoid tissues of gut, lung, reproductive systems)
83
Areas that function as localized meeting places to expose antigens to immune cells and promote cell-cell interactions
peripheral lymphoid tissues
84
Direction that lymph enters the nodes
afferent channel
85
What do t-cells do to B cells in lymph nodes
t cells present antigens to b cells after phagocytosis and b cells pump out antibodies into efferent lymph flow
86
maturation site of b lymphocytesq
bone marrow
87
areas to provide "first look" and are active in humoral immunity
MALT, appendix, tonsils
88
antibodies of newborn process
```
maternal antibodies (most IgG) cross placenta stored in fetal tissues, first few months of life
exception: preemies, chronic viral disease
```
89
What contains IgA and what does it help with
colostrum and breast milk, decreases diarrheal illness in newborn
90
Hypersensitivity Rxns (4)
Type 1: anaphylactic, II: cytotoxic, III: immune complex, IV: delayed hypersensitivity or cell-mediate dhypersensitivty
91
if someone has autoimmune hemolytic anemia, RH hemolytic disease, or glomerulonephritis what hypersensitivity rxn they might have
cytotoxic (type II): antibodies bind to cell or tissue antigens (causes complement mediated lysis of cell)
92
rheumatoid arthritis, lupus, glomerulonephritis could cause this hypersensitivity rxn
type 3: immune complex (complex deposited in tissues, causes tissue damage)
93
TB skin test, fungal an dparasitic infections, contact dermitits might cause which hypersensitivity rxn
type 4: delayed hypersensitivyt, t-lymph are sensitized, lymphokines cause inflammation and activat emacrophages
94
4 types of drugs for immune suppression
cytotoxic drugs (heavy), anti-metabolite drugs (mod), corticosteroids, immune globulins
95
at risk for what if defect in humoral immunity
encapsulated organisms (Neisseriak, H flu, pneumococcus0
96
at risk for what if defect in neutrophil #/func
bacterial and fungal infetion
97
at risk for what if defect in t cell immunity
pathogens that replicate w/in host cells
98
3 agents for inflammation and the 4 s/s
physical (temp), chemical, microbiologic
| calor, dolor, rubor (redness), tumor (swelling)
99
3 effects of infalmmation
capillary dilation, increased capillary permeability, attraction of leukocytes
100
When and where are C-reactive protein and ferritin produced
The acute inflammatory process in the liver (these are acute phase reactants)
101
Negative effect of inflammation/acute inflammatory process
pus, tissue destruction, fibrous tissue (scar)
102
essential to making immune response happen, type of regulatory proteins
cytokines
103
what molecule activates or inhibits actions of lcal cells in immune system (large enough quantiies can mediate systemic response)
cytokines
104
Where is systemic response first typically found
in lungs (b/c get 100% of blood)
105
Systemic inflammatory response syndrome (SIRS) defeintino
response by body to insults, can cause dysfunction, organ failure, death
106
HR and RR requirement for SIRS to be met
HR >90, RR>20 or pCO2< 32
107
Temp and WBC requriemtn for SIRS to be met
Temp>100.4 (38C) or <96.8 (36C); WBC>12k or <4k or >10% immature bands
108
4 categories of shock
distributive, cardiogenic, hypovolemic, obstructive
109
If someone has sepsis what type of shock are you worried about
distributive shock
110
stages of shock
preshock (compensated: sweaty, inc HR, RR, BP), shock (can't compensate, organ dysfunc s/s: tachycardia, dyspnea), end stage shock (end0organ dysfunc, pt death)
111
shock s/s
tachycardda, dyspnea, restlessness, diaphoresis, etabolic acidosis, oliguria, cool clammy skin
112
s/s of end stage shock
anuria/acute renal failure, academia decrease cardiac output, restlessness becomes agitation, obtundation and coma
113
infection with altered organ function is
sepsis
114
most common cause of ICU death
septic shock
115
3 steps in sepsis pathogenesis
Endotoxin or cell wall products
1) induce pro-inflam cytokines (IL-1 and TNF-alpha)
which activate neutorphils and endothelial cells
2) damaging endothelium and making it leaky
systemic inflame activates
3) coagulation pathways causing widespread microthrombi, tissue ischemia, depletionof natural anitocauglants
116
cardiac and lung status during sepsis
cardiac: func sub-optimal, vasodilates, BP falls - end organ hypoperfusion
lungs: ARDS due to cytokine induced increaesin pulm cap perm
117
what does gram neg sepsis often produce
coagulopathy
118
hematologic result of sepsis
thrombocytopenia, leukocytosis, leukopenia (alcoholics, elderly), coagulopathy (gram neg sepsis), 10% DIC
119
3 other manifestations of sepsis
renal dysfunction, GI bleeding (b/c coagulopathy and thrombocytopenia), hypoglycemia (cause AMS, Sz)
120
studies for sepsis
full physical exam, CBC, chemistries, blood, urine, sputum culture, wound culture, CSF exam, radiology
121
What is the MOST IMPORTANT thing you can do for sepsis (and other things)
choose appropriate empiric antimicrobial (other things: fluids, O2, glucose control, steroid therapy)
122
what is the strongest predictor of mortality in spesis
time to initaitno of appropriate antimicrobial therapy
123
Empiric ABX therapy for sepsis if Pseudomonas not a consideration
vancomycin with: cephalosporin 3-4 gen, beta-lactam/beta-lactamase inhibitor, carbapenem
124
Empiric ABX therapy for sepsis if Pseudomonas IS a consideration
vancomycin with: antipseduomonal cephalosporin, anti-pseudomonal carbapenem, anti-pseudomonal beta-lactam/beta-lcamase inhibor, fluorquinolone, aminoglycoside, monobactam
125
alcoholism predisposed to what 2 micro-organisms
klebsiella, strep pneumo
126
Diabetes predisposed to what 2 micro-organisms
Pseduomonas, strep pneumo
127
Splenic dysfunction predisposed to what 3 micro-organisms
Strep pneumo, H. flu, Neisseria meningitis
128
Neutropenia predisposed to what 2 micro-organisms
GNR from gut, Pseudomonas
129
diseases found on skin
staph, strep
130
diseases found on DM ulcers
staph, strep, gram neg, pos, anaerboes
131
diseases found on burns
strep, staph, pseudomonas (love burns!!)
132
diseases found on urine
enteroic gram neg (e coli), gramp pos (enterococcus)
133
diseases found on lungs CAP
typical: strep pneumo, h flu, staph aureus
atypical: microplasma, legionella, clamidia
134
diseases found on lungs HAP/VAP
all CAP typical and pseudomans and other gram neg
135
diseases found on lines
gramp pos: staph, strep
136
diseases found on heart
strep, staph (stpah=#1)
137
diseases found on abdomen
gram neg, anerobe
138
Albumin/Hetastarch/dextran
plasma expanders w/ high MW that increase plasma oncotic pressure
139
first choice treatment in distributive shock like sepsis
levophed/norepinephrine
140
treatment for cardiogenic shock
dobutamine
141
useful adjunct in severe septic shock, 2nd line
vasopressin
142
when to intubate
RR>30, mental status changes, hemodynarmic nistabiilty
143
what is bedside echocardigoraphy used for
assess myocardial function during sepsis
144
Defintion TPN
IV feeding of critically ill pt
145
ANC value for neutropenic
<1500
146
Febrile Neutorpenia requirements
fever, ANC<1500
147
what is neutropeniac pt at HIGH risk for
fungal and bacterial infection (common sites: skin, perirectal, genital mucosa)
148
when is febrile neutropenia seen
following CTX, XRT, cancer, aplastic anemic, toxins, drugs
149
s/s febrile neutorpnia
not typical inf symp b/c not enough neutrophils to cause symp
150
work-up for febrile neutropenia to search for infection
CXR, pan-culture, and additional studies guided by PE findings
151
work-up for febrile neutropenia (5)
blood cultures (10-15 min apart), urinalysis w/ culture and sensitivity, culture of wound or catheter discharge (if wet), sputum (gram stain and culture), stool for clostridium difficile
152
treatment and precautions for febrile neutropenia (general)
skin and oral care, avoid rectal manipulation, start bowel regimen; gowns/glvoes/mask, no flowers, diet restriction (no raw)
153
treatment (pharm) for febrile neutropenia
Broad sprectum ABX (start w/in 1 hr of culture)
If fever fails to improve w/in 4-5 days add empiric anti-fungal
Filgrastim (Neupogen) or Pegfilgrastim (Neulasta): granulocyte colony0stiulaitng factors (improve cytotoxicity of neutrophils) (use only in some pts)
154
what is febrile neutropenia prognosis dependent on
recovery of adequate neutrophil numbers: rapid initaiton of appropriate empiric ABX: moratlity 4-30%
155
What 3 diseases do spirochetes cause
syphilis (treponema), GI disease (H. pylori), lyme disease (Borrelia)
