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Immunology/Infection

Immunology/Infection. The most common acquired hospital infection is: A. Pneumonia B. Blood stream infection C. Urinary tract infection D. Colitis. The most common acquired hospital infection is: A. Pneumonia B. Blood stream infection C. Urinary tract infection D. Colitis

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Immunology/Infection

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  1. Immunology/Infection

  2. The most common acquired hospital infection is: • A. Pneumonia • B. Blood stream infection • C. Urinary tract infection • D. Colitis

  3. The most common acquired hospital infection is: • A. Pneumonia • B. Blood stream infection • C. Urinary tract infection • D. Colitis • Most common acquired hospital infection is UTI • This is often related to placement of urinary catheters • The best treatment of a UTI is removal of the catheter

  4. The most common cause of bloodstream infection: • A. UTI • B. Pneumonia • C. Colitis • D. Central line sepsis

  5. The most common cause of bloodstream infection: • A. UTI • B. Pneumonia • C. Colitis • D. Central line sepsis • The most common cause of blood stream infection is central line sepsis. When a pt. spikes a fever send off blood, urine, and sputum Cx, Check the wound and a CXR, send a CBC.

  6. The mechanism of aminoglycoside resistance is: • A. Plasmids for beta-lactamase • B. Changes in cell wall binding protein • C. Decreased active transport due to modifying enzymes • D. Enhanced metabolism of the bacteria

  7. The mechanism of aminoglycoside resistance is: • A. Plasmids for beta-lactamase • B. Changes in cell wall binding protein • C. Decreased active transport due to modifying enzymes • D. Enhanced metabolism of the bacteria • Active transport of aminoglycosides is decreased by modification of the transport proteins by enzymes

  8. The mechanism of penicillin resistance is: • A. Plasmids for beta-lactamase • B. Changes in cell wall binding protein • C. Decreased active transport due to modifying enzymes • D. Enhanced metabolism of the bacteria

  9. The mechanism of penicillin resistance is: • A. Plasmids for beta-lactamase • B. Changes in cell wall binding protein • C. Decreased active transport due to modifying enzymes • D. Enhanced metabolism of the bacteria • The usual mechanism of PCN resistance is by plasmids coding for beta-lactamase • The mechanism of vancomycin resistance is changes in cell wall binding protein

  10. Appropriate vancomycin peak and trough values are: • A. Peak 20-40, trough 5-10 • B. Peak 5-10, trough <1 • C. Peak 40-80, trough 20-40 • D. Peak <1, trough 5-10

  11. Appropriate vancomycin peak and trough values are: • A. Peak 20-40, trough 5-10 • B. Peak 5-10, trough <1 • C. Peak 40-80, trough 20-40 • D. Peak <1, trough 5-10 • The appropriate peak (20-40) and trough (5-10) values for vancomycin are important in pts. With renal failure

  12. Appropriate gentamicin peak and trough values are: • A. Peak 20-40, trough 5-10 • B. Peak 5-10, trough <1 • C. Peak 40-80, trough 20-40 • D. Peak <1, trough 5-10

  13. Appropriate gentamicin peak and trough values are: • A. Peak 20-40, trough 5-10 • B. Peak 5-10, trough <1 • C. Peak 40-80, trough 20-40 • D. Peak <1, trough 5-10 • The appropriate peak (5-10) and trough (<1) values for gentamicin are important in pts. with renal failure

  14. A pt. on gentamicin has a peak level of 80 and a trough of <1. The most appropriate management is: • A. Continue current dosing • B. Decrease dose but maintain frequency • C. Decrease dose and decrease frequency • D. Maintain dose and decrease frequency

  15. A pt. on gentamicin has a peak level of 80 and a trough of <1. The most appropriate management is: • A. Continue current dosing • B. Decrease dose but maintain frequency • C. Decrease dose and decrease frequency • D. Maintain dose and decrease frequency • To decrease the peak level of a drug, decrease the dose of the drug (peak level is taken 1 hour after dosing) • To decrease the trough of a drug, decrease the frequency or longer time b/t doses

  16. A pt. w/ an enterococcal blood stream infection is best treated by which of the following antibiotics: • A. Cefazolin • B. Ceftriaxone • C. Bactrim • D. Ampicillin

  17. A pt. w/ an enterococcal blood stream infection is best treated by which of the following antibiotics: • A. Cefazolin • B. Ceftriaxone • C. Bactrim • D. Ampicillin • Ampicillin was specifically designed to treat enterococcus, although this will not pick up VRE • 1st, 2nd, 3rd generation cephalosporins and Bactrim does not cover enterococci

  18. Sludging in the gallbladder and cholestatic jaundice is characteristic of which of the following antibiotics: • A. Quinolones • B. Bactrim • C. Erythromycin • D. Ceftriaxone

  19. Sludging in the gallbladder and cholestatic jaundice is characteristic of which of the following antibiotics: • A. Quinolones • B. Bactrim • C. Erythromycin • D. Ceftriaxone • Sludging in the gallbladder and cholestatic jaundice are complications of ceftriaxone

  20. Match each immunoglobulin with its appropriate statement • IgA Binds mast cells • IgG Major antibody of the secondary immune response • IgM Most prevalent serum immunoglobulin • IgD May bind complement • IgE Found particularly in secretions Function unknown Mediates type I hypersensitivity reactions

  21. Which of the following statements regarding phagocytosis are true? • A. Neutrophils are the major phagocytic cell w/in tissue • B. Lysosomal granules require oxygen to destroy foreign particles • C. Chronic granulomatous disease results from a flaw in production of superoxide anions and eventually hydrogen peroxide in neutrophils • D. Once a monocyte migrates to tissue to become a macrophage it loses all function except phagocytosis

  22. Which of the following statements regarding phagocytosis are true? • A. Neutrophils are the major phagocytic cell w/in tissue TRUE • B. Lysosomal granules require oxygen to destroy foreign particles • C. Chronic granulomatous disease results from a flaw in production of superoxide anions and eventually hydrogen peroxide in neutrophils • D. Once a monocyte migrates to tissue to become a macrophage it loses all function except phagocytosis

  23. Which of the following statements regarding phagocytosis are true? • A. Neutrophils are the major phagocytic cell w/in tissue TRUE • B. Lysosomal granules require oxygen to destroy foreign particles FALSE • C. Chronic granulomatous disease results from a flaw in production of superoxide anions and eventually hydrogen peroxide in neutrophils • D. Once a monocyte migrates to tissue to become a macrophage it loses all function except phagocytosis

  24. Which of the following statements regarding phagocytosis are true? • A. Neutrophils are the major phagocytic cell w/in tissue TRUE • B. Lysosomal granules require oxygen to destroy foreign particles FALSE • C. Chronic granulomatous disease results from a flaw in production of superoxide anions and eventually hydrogen peroxide in neutrophils • TRUE • D. Once a monocyte migrates to tissue to become a macrophage it loses all function except phagocytosis

  25. Which of the following statements regarding phagocytosis are true? • A. Neutrophils are the major phagocytic cell w/in tissue TRUE • B. Lysosomal granules require oxygen to destroy foreign particles FALSE • C. Chronic granulomatous disease results from a flaw in production of superoxide anions and eventually hydrogen peroxide in neutrophils • TRUE • D. Once a monocyte migrates to tissue to become a macrophage it loses all function except phagocytosis FALSE

  26. 2 groups of phagocytic cells: mononuclear and polymorphonuclear • Neutrophils are polymorphonuclear and are the major phagocytic cell within the tissue • Lysosomes destroy foreign particles w/ oxygen dependent and oxygen independent mechanisms • In granulomatous disease there is a flaw in the production of superoxide anions and hydrogen peroxide • Macrophages break down and process antigen to T/B lymphocytes, secrete factors to facilitate clonal expansion, produce cytokines

  27. Which of the following statements is false? • A. NK cells are large granular lymphocytes that do not express the T- or B- phenotype • B. NK cells require previous exposure to antigen to express cytotoxicity • C. NK activity is not restricted by the MHC • D. Interferon augments the activity of NK cells and macrophages

  28. Which of the following statements is false? • A. NK cells are large granular lymphocytes that do not express the T- or B- phenotype • B. NK cells require previous exposure to antigen to express cytotoxicity • C. NK activity is not restricted by the MHC • D. Interferon augments the activity of NK cells and macrophages • NK cells are large granular lymphocytes that do not express T/B phenotypes, do not need previous exposure to mediate cytotoxicity to various targets, not restricted by MHC, and their activity is increased by interferon

  29. Endocarditis prophylaxis is recommended for which of the following patients? A. A pt. w/ mitral valve prolapse w/o murmur undergoing rigid bronchoscopy B. A pt. w/ a h/o rheumatic fever w/ normal cardiac valves undergoing prostatic Bx C. A pt. w/ a prosthetic aortic valve undergoing ERCP for biliary obsruction D. A pt. w/ severe hypertrophic cardiomyopathy undergoing tympanostomy tube placement E. A pt. Previously treated for streptococcal endocarditis undergoing tonsillectomy

  30. Endocarditis prophylaxis is recommended for which of the following patients? A. A pt. w/ mitral valve prolapse w/o murmur undergoing rigid bronchoscopy B. A pt. w/ a h/o rheumatic fever w/ normal cardiac valves undergoing prostatic Bx C. A pt. w/ a prosthetic aortic valve undergoing ERCP for biliary obsruction D. A pt. w/ severe hypertrophic cardiomyopathy undergoing tympanostomy tube placement E. A pt. Previously treated for streptococcal endocarditis undergoing tonsillectomy

  31. The overall risk of endocarditis is determined by type of cardiac lesion and type of procedure known to be associated w/ significant bacteremia Individuals at highest risk are those w/ prosthetic heart valves, previous h/o endocarditis, or complex cyanotic heart disease Moderate risk includes hypertrophic cardiomyopathy, mitral valve prolapse w/ mitral insufficiency, and valvular disease from rheumatic fever Pts. at moderate to high risk undergoing bacteremia producing procedures (ERCP, sclerotherapy for esophageal varices, esophageal dilatation, tonsillectomy, bronchoscopy w/ rigid scope, prostate surgery, cystoscopy) probably benefit from abx prophylaxis Abx not indicated for endotracheal intubation, typanostomy tubes, or urethral catheterization

  32. Which of the following statements regarding interleukins is/are true? • A. All interleukins will only up-regulate the immune system • B. Interleukin-8 (IL-8) is a neutrophil chemotactic factor • C. Interleukins are produced only by leukocytes • D. Interleukin-3(IL-3) functions as a general hematopoietic growth factor

  33. Which of the following statements regarding interleukins is/are true? • A. All interleukins will only up-regulate the immune system • B. Interleukin-8 (IL-8) is a neutrophil chemotactic factor • C. Interleukins are produced only by leukocytes • D. Interleukin-3(IL-3) functions as a general hematopoietic growth factor • Interleukins up and down regulate the immune system • IL 3 is a hematopoietic grwoth factor • IL 4 (macrophage cytokine secretion), IL 6 (TNF), IL 10 (monocyte/macrophage) have inhibitory functions • IL 8 attracts neutrophils to the site of inflammation • IL made by macrocytes/monophages, T/B lymphocytes, mast cells, thymus/bonemarrow, fibroblasts, epithelial cells, and endothelial cells

  34. Match each type of hypersensitivity reaction with the appropriate item • Type I ABO incompatibility • Type II Contact Dermatitis • Type III IgE bound to mast cells and basophils • Type IV Serum Sickness • Anaphylaxis • IgG or IgM antibody reaction with cell bound antigen • Tuberculin skin test

  35. Type I (immediate hypersensitivity) initiated by antigens that react with IgE. Binding of antigen to IgE and to mast cells/basophils causes release of histamine, slow reacting substance of anaphylaxis, serotonin, prostaglandins, and bradykinin • Type II (cytotoxic reaction) result from reaction of IgG or IgM antibodies to cell bound antigen. Examples include Rh/ABO incompatibility, myasthenia gravis, Graves disease, and ITP • Type III (immune complex mediated) deposition of antibody-antigen complex from circulation. Examples include serum sickness, Rheumatoid arthritis, and SLE • Type IV (delayed type hypersensitivity) results from antigen stimulation of previously sensitized T cells (primarily CD4+). Clinical examples include TB skin test and contact dermatitis.

  36. Pt. w/ recurrent duodenal ulcer presents w/ recurrent abdominal pain for the last 2 years. 15 months ago, an upper endoscopy showed a duodenal ulcer. He was treated with pepcid and his condition improved, but his symptoms recurred. Before considering surgery, an upper endoscopy was repeated and a CLO test result was positive. He was then treated w/ abx and PPI for 2 weeks. Which of the following tests to assess eradication of H. pylori should be performed after treatment? • A. Urea breath test • B. CLO test • C. Biopsy and culture • D. Serum antibody (by ELISA) • E. Stool antibody test

  37. Pt. w/ recurrent duodenal ulcer presents w/ recurrent abdominal pain for the last 2 years. 15 months ago, an upper endoscopy showed a duodenal ulcer. He was treated with pepcid and his condition improved, but his symptoms recurred. Before considering surgery, an upper endoscopy was repeated and a CLO test result was positive. He was then treated w/ abx and PPI for 2 weeks. Which of the following tests to assess eradication of H. pylori should be performed after treatment? • A. Urea breath test • B. CLO test • C. Biopsy and culture • D. Serum antibody (by ELISA) • E. Stool antibody test

  38. Surgery is indicated in the treatment of peptic ulcers for intractable hemorrhage, perforation, and obstruction, failure of medical management • Length of treatment varies b/t 2-4 weeks (amoxicillin, clarithromycin, flagyl, PPI, bismuth) • Bx and CLO test require endoscopy • The serologic test for H. pylori is of limited value in determining the success of therapy (may remain + after successful treatment) • No stool antibody test (only antigen)

  39. Which of the following statements regarding the collection of blood cultures is true? A. Optimal timing for drawing a blood culture is approximately 1 hr b/f onset of fever B. Blood collected via intravascular devices for culture should be paired w/ blood obtained by peripheral venipuncture C. At least two sets of blood cultures should be obtained for any pt. w/ suspected bacteremia D. A minimum of 10 cc of blood should be collected for each set of cultures E. All are correct

  40. Which of the following statements regarding the collection of blood cultures is true? A. Optimal timing for drawing a blood culture is approximately 1 hr b/f onset of fever B. Blood collected via intravascular devices for culture should be paired w/ blood obtained by peripheral venipuncture C. At least two sets of blood cultures should be obtained for any pt. w/ suspected bacteremia D. A minimum of 10 cc of blood should be collected for each set of cultures E. All are correct

  41. Early studies demonstrated that rigors and fever often follow bacteremia by 30-90 minutes Good data documents that 2 or 3 sets of blood cultures containing at least 10 mL of blood per set demonstrates most episodes of bacteremia/fungemia CVC blood draws should be paired w/ peripheral blood draw to aid in the interpretation of a positive test result

  42. Which of the following statements regarding methicillin-resistant S. aureus is/are true? A. MRSA is a common nosocomial pathogen, but it can also be detected in the community B. The treatment of choice is vancomycin C. MRSA is more virulent than methicillin-sensitive S. aureus D. Hospitalized pts. Colonized w/ MRSA require contact isolation E. Treatment of surgical pts. W/ intranasal mupirocin decreases wound infection rates due to this bacteria

  43. Which of the following statements regarding methicillin-resistant S. aureus is/are true? A. MRSA is a common nosocomial pathogen, but it can also be detected in the community B. The treatment of choice is vancomycin C. MRSA is more virulent than methicillin-sensitive S. aureus D. Hospitalized pts. Colonized w/ MRSA require contact isolation E. Treatment of surgical pts. W/ intranasal mupirocin decreases wound infection rates due to this bacteria

  44. Carriage of MRSA into the community has increased Vancomycin (treatment of choice) or linezolid can be used to treat MRSA Some studies suggest that there is a significant increase in mortality from infections caused by MRSA vs. MSSA, but increased death rate most likely due to comorbidities and not differences in virulence Pts. colonized w/ MRSA require contact isolation to avoid spread of bacteria to other pts. Intranasal mupirocin does not significantly reduce S. aureus SSI but does significantly reduce rate of all nosocomial S. aureus infections amoung pts. who are S. aureus carriers

  45. Which of the following statements regarding tetanus prophylaxis is/are true? A. Pt. w/ a minor clean wound. His second tetanus shot was 4 yrs. ago. He requires a dose of tetanus toxoid. Antitetanus immunoglobulin is not required. B. Pt. who has never received tetanus vaccine has a minor clean wound. He requires both toxoid and antitetanus immunoglobulin C. Pt. who completed 3 tetanus shots when he was a child, but has not had a booster in 20 yrs. has a dirty wound. He is immune and does not require toxoid or immunoglobulin D. Pt. / a dirty wound who does not remember when and how many tetanus shots he received in the past. He requires a toxoid dose and antitetanus immunoglobulin

  46. Which of the following statements regarding tetanus prophylaxis is/are true? A. Pt. w/ a minor clean wound. His second tetanus shot was 4 yrs. ago. He requires a dose of tetanus toxoid. Antitetanus immunoglobulin is not required. B. Pt. who has never received tetanus vaccine has a minor clean wound. He requires both toxoid and antitetanus immunoglobulin C. Pt. who completed 3 tetanus shots when he was a child, but has not had a booster in 20 yrs. has a dirty wound. He is immune and does not require toxoid or immunoglobulin D. Pt. / a dirty wound who does not remember when and how many tetanus shots he received in the past. He requires a toxoid dose and antitetanus immunoglobulin

  47. The majority of tetanus cases occur in older adults (age>60 yrs) who have waning immunity Tetanus toxoid and immunoglobulin are indicated for pts. w/ dirty wounds who have received < 3 doses of toxoid in the past or whose immunization status is unknown Only toxoid is indicated for pts. w/ dirty wounds who have received 3 doses of toxoid > 10 yrs. ago and have not had a booster w/in 5 yrs. of the injury Pts. w/ clean minor wounds require toxoid if they have received <3 doses of toxoid less than 10 years ago and have not received a booster or the pts. immune status is unknown

  48. Match each agent w/ 1 or more mechanisms of antimicrobial action Carbapenems Aminoglycosides Quinolones Cephalosporins Vancomycin Impairment of bacterial DNA synthesis Inhibition of cell wall synthesis Disruption of ribosomal protein synthesis Disruption of cell wall cation homeostasis

  49. Carbapenems, aminoglycosides, quinolones, cephalosporins, and vancomycin are bacteriocidal; bacteriostatic agents include tetracyclines, chloramphenicol, erythromycin, clindamycin, and linezolid Carbapenems and cephalosporins are B-lactam abx and interfere w/ enzymes w/in bacterial cytoplasmic membrane responsible for peptide cross linking which interferes w/ cell wall synthesis, eventually resulting in cell lysis Vancomycin is a glycopeptide that also inhibits bacterial cell wall synthesis and assembly by complexing to cell wall precursors, preventing elongation and cross-linkage, making the cell susceptible to lysis (limited to gram +) Aminoglycosides bind irreversibly to 30S bacterial ribosome and interfere w/ protein synthesis; unlike other abx that inhibit protein synthesis aminoglycosides are bacteriocidal b/c they have a disruptive effect of calcium and magnesium homeostasis w/in the cell wall Quinolones inhibit topoisomerase II (DNA gyrase) and topoisomerase IV, impairing DNA synthesis in bacteria

  50. For which of the following are perioperative antibiotics indicated? • Perforated appendix • Open fracture of the humerus • Mastectomy • Traumatic colon perforation • Elective cholecystectomy

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