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D&D Infectious Disease Midterm > Therapeutics - General Principles PT1 > Flashcards

Therapeutics - General Principles PT1 Flashcards

1
Q

name the 3 types of antimicrobial therapy

A

-prophylactic

-empiric

-definitive

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2
Q

name2 particular populations that get prophylactic antimicrobial therapy

A

high riskk patients, like HIV patients with CD4 count less than 200, OR for surgical prophylaxis

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3
Q

when giving prophylactic antibiotics to surgical patients, around how long before surgery do they take it

A

around 1 hour prior because that’s when the concentration of AB will be highest at incision time

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4
Q

explain what empiric therapy is

A

there’s a suspected or proven infection, but the specific pathogen hasn’t been identified yet

we give broad spectrum as a best guess to what we think the potential pathogens are -want to cover all potential pathogens it may be

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5
Q

when is definitive therapy given

A

AFTER the culture and susceptibilities results come back – we give a more targeted antibiotic for that specific pathogen identified (based on its suceptibility)

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6
Q

what are the 3 things in the “triangle” approach to antimicrobial therapy

A

patient, drug, bug

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7
Q

confirming the infection is which of the 3 things in the “triangle” approach to antimicrobial therapy

A

patient

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8
Q

normal range of WBC count

A

4-10,000 cells/mm cubed

BUT can vary based on age, gender, comorbidities and also based on different labs where it’s done

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9
Q

what is normal body temp (oral)

what about rectal and axillary

A

98-98.6

rectal – 1 degree fahrenheit over

axillary - 1 degree farhenheit lower

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10
Q

what temp does the CDC define a fever as

A

100.4 degrees farhenheit (38 celsius)

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11
Q

is a fever a specific or nonspecific marker

A

NONSPECIFIC

just because someone has a fever doesn’t mean they have an infection

could be related to an autoimmune disease, malignancy, drug-induced….etc

therefore, diagnosing an infection is a diagnosis of exclusion - must rule out EVERYTHING ELSE FIRST

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12
Q

WBC’s are also known as ________

A

leukocytes

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13
Q

leukocytosis

A

term for elevated WBC’s

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14
Q

is leukocytosis specific for infection or nonspecific

A

NONSPECIFIC - may be due to many other things like stress, malignancy, corticosteroid side effect, etc

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15
Q

leukocytosis may be absent in what patients that actually do have an infection

A

the elderly, ppl with severe sepsis

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16
Q

a patient has elevated WBC and high fever

is it a fever

A

cant say for sure

both of these could be due to other factors, but could very well also be a fever

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17
Q

which particular WBC are high in a patient with a BACTERIAL infection

A

neutrophils

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18
Q

in the case of a bacterial infection, a CBC with differential will usually have neutrophils greater than _____%

A

80%

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19
Q

what will the neutrophil bands be like in a patient with a bacterial infection

A

greater than 10% (immature)

making neutrophils so quickly to fight the infection

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20
Q

which WBC are high in parasitic infections and allergic reactions

A

eosinophils

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21
Q

which WBC are typically high in viral or fungal infections

A

lymphocytes

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22
Q

which WBC are typically high in chronic infections

A

monocytes

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23
Q

what are “segs and bands”

A

segs = mature neutrophils
bands = immature neutrophils (will be greater than 10% in bacterial infection)

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24
Q

name 2 biomarkers of infection that are nonspecific markers of inflammation

they are not used to ____, but used to ____

A

CRP and ESR

not used to confirm infection, but for monitoring (ie - osteomyelitis)
for ex, monitoring if the patient is responding to the antibiotic – want to make sure pt is improving and inflammation going down

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25
Q

normal CRP

A

less than 10ng/mL

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26
Q

normal ESR for men vs women

A

men - less than 22mm/hr
women less than 29

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27
Q

what biomarker is a marker for sepsis and what is norm value

A

LACTATE

0.5-1mmol/L

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28
Q

what is a marker of inflammation what is more specific for bacterial infections

it is a tool used to ____________

A

procalcitonin

tool used to discontinue antibiotics

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29
Q

how is lactate a marker for sepsis

A

bc high in impaired tissue oxygenation – happens when pt is septic

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30
Q

important consideration when using markers

A

NEVER used as sole evidence to diagnose infection

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31
Q

tissue or fluid samples can be used to see the presence of _________________

which particular fluids can be tested

A

WBC and bacteria

sputum, urine, spinal or joint fluid – pretty much anything can be cultured

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32
Q

how are X-rays, CT scans, MRIs, and echos used in diagnosing infection

A

for signs of inflammation like infiltrate and fluid

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33
Q

name 3 things that can be looked at to find out the SEVERITY of the infection

A

hemodynamic changes like change in heart rate and blood pressure

respiratory changes like SOB, rapid breathing

neurologic issues like lethargy, altered mental status, confusion

34
Q

as mentioned, hemodynamic changes such as blood pressure can be used to estimate the severity of the infection

a low blood pressure could indicate what

A

sepsis

35
Q

pt has dysuria, flankpain, and abnormal urinalysis

where is infection

A

urinary tract

36
Q

pt has headache, altered mental status, +LP

A

CNS infection (meningitis)

+LP means positive lumbar culture

37
Q

pt has cough, chest pain sputum, +CXR

A

lung infection

+CXR = infiltrates in chest XRAY

38
Q

pt has fever, heart murmer, +blood cultures and + TTE

A

+TTE = trans thoracic echo

heart infection (endocarditis)

+ blood cultures means bacteremic!!!!

39
Q

pt has pain at IV site, swelling, and erythema and + cultures

A

IV site infection

40
Q

why is it important to know where the infection is

A

may need more than just antibiotics to treat

for EX if IV line infection - need AB and need to take the line out

also if endocardidits, may need surgery to remove the vegitation – antibiotics alone isnt gonna work

41
Q

“non lactose fermenting, gram negative rods”

suggests what bacteria??

A

pseudomonas aeruginosa

42
Q

is e coli gram positive or negative??
lactose fermenting or non lactose fermenting

A

negative
lactose fermenting

43
Q

staph aureus and strep pneumoniae are gram positive or negative

A

positive

44
Q

“gram positive cocci in clusters”

suggests what bacteria

A

staph species (staph aureus or epidermidis)

45
Q

differentiate between the pathogenecity of staph aureus vs staph epidermidis

A

staph aureus is always a true pathogen

staph epidermidis may not always be a true pathogen – its normally all over skin

46
Q

how do streptococcus species grow

A

in chains or pairs

NOT clusters like staph

47
Q

name the 4 nonsterile specimen types, meaning that it’s normal for them to contain bacteria and the presence of bacteria does not indicate an infection

A

stool
throat swab
wound swab
genital swab

may not be reliable

48
Q

is sputum considered a sterile specimen

A

only deep sputum

49
Q

explain when and how blood cultures should be collected

A

2 sets and from 2 different body sites
each set has aerobic and anaerobic bottle

collect when pt is acutely ill bc the yield is higher, and incubate 5-7 days (may be longer for fungus)

MUST BE STERILE

50
Q

explain how sputum cultures should be obtained

A

first rinse mouth with water

pt should breathe deep and cough several times to get DEEP SPECIMEN - more reliable - into a dry sterile container

51
Q

if a pt is unable to give a high quality sputum sample, what can be done?

A

get induced sputum

52
Q

explain how urine cultures should be obtained

A

catch midstream!! or straight catherization if pt cant pee

do NOT collect urine from the bag of an indwelling catheter - not reliable. use a needle to aspirate directly from the tubing instead

53
Q

difference between urine dipstick and urinalysis

A

urine dipstick is rapid screening - shows leukocytes, nitrites, blood, etc

urinalysis w microscopy shows appearance, bacteria, WBC, epithelial cells, and RBC

54
Q

why do urine dipsticks detect nitrites

A

some bacteria (like e. coli) convert nitrate (normally in urine) to NITRITE - therefore, can be marker of bacterial infection

55
Q

bacterial specimen is treated with crystal violet and then iodine

when the iodine is washed off, what will the difference be between gram (+) vs gram (-) bacteria

A

in gram positive, the color will remain and the counter stain won’t do anything - it will still be purple BC OF THICK CELL WALL

in gram negative, the color will WASH OFF and the counter stain (safranin) will make it pink - bc peptidoglycan layer is covered by outer membrane and the cell wall is very thin

56
Q

what is the first clue to determine the type of organism involved in causing the infection

A

gram stain with microscopy

can see if (+) or (-), can show number of organisms, and the type of cells present (ie: WBC, epithelial cells)

57
Q

gram positive cocci that grows in chains and pairs

name 2 potential bacteria

A

enterococci and streptococci

58
Q

gram positive bacilli that grow in rods

name 2 potential bacteria

A

listeria
corynebacterium

59
Q

why do we care if there are epithelial cells in our sample of urine

A

poor quality sample - not catching good midstream void

60
Q

sputum or blood culture has a lot of epithelial cells

good or bad sample

A

bad

61
Q

staph epi can be called coagulase __________. why?

A

coagulase negative

it can sometimes be a contaminant

62
Q

true or false

corynebacterium and listeria are anaerobic gram positive rods

A

FALSE

all true but they’re AEROBES

63
Q

are strep and staph aerobic or anaerobic

A

aerobic

64
Q

gram positive cocci anerobes

A

peptococcus and peptostreptococcus (NOT STAPH - THEY’RE AEROBES)

65
Q

anaerobic gram positive bacilli (rods)

A

clostridium

(NOT corynebacterium or listeria - they’re aerobic)

66
Q

gram negative aerobes that grow in rods and are lactose fermenting

A

e. coli
enterobacter
klebsiella

67
Q

gram negative bacilli (rods) aerobes that are non lactose fermenting

A

THINK NOSOCOMIAL

pseudomonas and acinetobacter

68
Q

aerobic gram negative cocci

A

neisseria
N. gonorrhoeae
h. influenzae

69
Q

gram negative anaerobes that grow in rods are typically part of……

name 3 of them

A

our gut!

bacteroides
fusobacterium
prevotella

70
Q

name 3 ATYPICAL bacteria that are not gram (+) or (-)

they are common in what infection

A

common in CAP

mycoplasma
legionella
chlamydophila

71
Q

fungi infections are typically common in which type of patients

A

immunocompromised

72
Q

gram positive cocci that grow in clusters

A

STAPH

73
Q

gram positive cocci that grow in chains or pairs

A

streptococci, enterococci

74
Q

gram negative rods, lactose fermenting

A

e. coli
enterbocater
klebsiella

75
Q

gram negative rods, NON lactose fermenting

A

THINK NOSOCOMIAL

pseudomonas aeruginosa, acinetobacter

76
Q

differentiate between a contaminate, colonizer, and pathogen

A

contaminate - introduced from external source due to poor technique or poor sample

colonizer - normal flora that does not cause harm

pathogen - damages the tissue and elicits a host response

77
Q

“1/2 sets of blood cultures reveals gram positive cocci in clusters, coagulase negative”

A

this is staph epidermidis!!!

coagulase negative is the giveaway

must be a contaminent - repeat the sample. only grew in 1/2 and staph epi is normally on the skin

78
Q

staph epi loves to grow on….

A

medical devices

79
Q

give an example of a risk factor that may make a person prone to a real staph epi infection

A

IV drug use

80
Q

which covers pseudomonas
pipercillin-tazobactam
vancomycin

A

pipercillin-tazobactam

81
Q

name 2 of the most common antibiotics used in practice to cover pseudomonas

A

pipercillin-tazobactam and cefepime (3rd gen cephalosporin)

82
Q
A

D&D Infectious Disease Midterm (26 decks)

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