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CBIC Section 1

Identification of Infectious Disease Processes

Virulence The ability to grow and multiply
Infectivity The ability to enter tissue
Pathogenicity The ability to cause disease
Duration of exposure The length of time the person is exposed to organism
Size of inoculum The number of organisms needed to cause disease.
Patient w/ the same airborne disease may share a room if there is no clinical contraindication. T or F True
Cohorting of patients infected or colonized with a common organism by room or personnel assignments can reduce the risk of transmission of infectious agents to other noninfectious patients. True
Increased HAI rates have been associated with the use of nonpermanent staff True
The IP wants to calculate the surgeon-specific rate of infections associated with spinal fusion surgeries in the facility. Which one of the following data elements will he need? Number of spinal fusion surgeries performed by each surgeon within the designated time frame Number of spinal fusion infections for each surgeon within the designated time frame.
Colonization Occurs when microorganism inhabit a specific body site (such as the skin) but don't cause S/S.
What is the difference between signs and symptoms? Signs: Quantitative data (temp, BP etc) Symptoms: Subjective(how a pt is feeling)
Infection Clinical signs of illness or inflammation (i.e. localized pain/tenderness, redness, warmth, swelling, pus, fever) due to tissue damage caused by the microorganism's invasion
IgM Early Immune recognition & response first reacting immunoglobulin
IgD Functions in later immune responses
IgG Late-occurring immunoglobulin in an immune response & is the longest lived.
IgE Principle allergy-inducing immunoglobulin
IgA Effective in preventing virus infections of the respiratory tract and intestinal mucosa
The most immediate postoperative surgical site infections, beginning in less than 24 hours from incision are caused by: a) Staphylococcus aureus b) Streptococcus pneumoniae c) Streptococcus pyogenes d) Escherichia coli c) Streptococcus pyogenes
What bacterial factor/structure facilitates bacteria implanting on plastic devices? a) Cell wall b) Exotoxins c) Endotoxins d) Glycocalyx d) Glycocalyx-also on skin
Which immune marker represents past exposure to disease? a) IgM b) IgE c) IgA d) IgG IgG antibodies are the antibodies that provide long- term resistance to infections after immunizations.
10 M is admitted w/ a 3-day hx of temp, abd pain, D/V. Just returned from a week camping expedition in the mountains that included trips to the seashore. A STC is reported w/ many lactose-negative colonies. What is the most probable causing organism? Yersinia enterocolitica
The IP is reviewing the chart of a patient with a sputum culture positive for pathogens. Which of the following findings indicates that the specimen had been properly collected from a patient with a possible bacterial pneumonia? Numerous neutrophils and few if any epithelial cells
A 14 M from rural Maryland was seen in the emergency room with fever, fatigue, chills, headache and a large annular lesion on his left thigh which the patient described as burning and itching. What is the most probable vector of this child’s illness? Tick
What is the time frame it takes for the Erythema migrans to appear after being bitten by a tick? A. 1-7 Days B. 3-14 Days C. 3-30 Days D. 7-30 Days C. 3-30 Days
True or False: The tick must be attached for 36 to 48 hours or more before the Lyme disease bacterium can be transmitted True
A pt who is extremely immunocompromised. While reviewing the labs for this pt, you discover a sputum examination for AFB, which is smear +. The Dr is aware but states isolation is not necessary. What is a reason that the pt does not need isolation? His regular sputum culture is growing Nocardia spp.
A 38-F being tx for CA has a WBC of 2.3. This is an improvement during the past 2 wks. Her Dr has been aggressive in tx every potential infection. Pt is on an ABX for a BSI from S. epidermidis. Now has a fever of 100.4. What action should be taken? More blood cultures because she may be developing fungal septicemia
Which of the following virulent factors associated with the Enterobacteriaceae are associated with septic shock and DIC? A. Flagellar H antigens B. Capsule K antigens C. Pathogenic islands D. LPS-polysaccharides and Lipid A endotoxin LPS-polysaccharides and Lipid A endotoxin
Some bacteria can transform into endospores Bacillus anthracis • Clostridium tetani • Clostridium difficile • Clostridium perfringens • Clostridium botulinum
In a Gram stain procedure, Gram-positive bacteria stain purple because: They have a thick peptidoglycan cell wall that retains the primary stain during the alcohol decolorization
You have isolated a bacterium from your skin. Chemical analysis shows that it contains proteins, peptidoglycan, lipids, DNA, and teichoic acid. What sort of bacteria is this? Gram-positive
A microbe that can grow in the absence of oxygen but is also able to utilize oxygen for growth is a/an: A. Aerobe B. Obligate anaerobe C. Facultative anaerobe D. Microaerophilic anaerobe C. Facultative anaerobe
Fastidious organisms require _____ media, and __________ media is used to inhibit normal commensals. 1. Differential 2. Enriched 3. Selective 4. Nutrient broth 5. Synthetic sheep blood agar A. 1,3 B. 2,3 C. 5,1 D. 3,4
Fastidious organisms require Enrichment media. Which media is used to inhibit normal commensals? A. Differential B. Enrichment C. Selective D. Synthetic sheep blood agar
An example of a selective media that inhibits Gram-positive bacteria is: A. Sabouraud agar B. Chocolate agar C. Trypticase Soy agar D. MacConkey’s agar
The Director of the Operating Room (OR) requests that the OR surfaces be routinely environmentally cultured. The IPs best response should be: Routine culturing should not be considered unless an epidemiologic investigation is being conducted
Important considerations regarding BC specimens include: 1. Collect prior to the initiation of antimicrobial therapy 2. Collect from a central venous catheter whenever possible 3. Ensure that the volume of the specimen collected is sufficient 4. Cultu
You receive a call from a man who thinks he was exposed to HIV. His baseline HIV test (ELISA) was negative. At what time period after exposure would we be most likely to detect HIV antibodies? A. 1 to 3 months B. 3 weeks C. 6 months D. 12 months
A Dr orders a culture, O & P specimen on a 10 M admitted w/ diarrhea. A liquid stool specimen is collected from the patient at 9pm. The specimen is refrigerated until 9am the next day when the Dr calls and requests that the lab look for amoebic tropho Perform a trichrome stain on the original specimen B. Request a fresh specimen C. Perform a concentration on the original stool specimen D. Perform a saline wet mount on the original specimen
Pts w/ cell-mediated immunity dysfunction are susceptible to infections attributed to pathogenic intracellular bacteria. is. I.e of these organisms include: 1. Salmonella typhi 2. Bacteroides fragilis 3. Listeria monocytogenes 4. Staphylococcus aureus A. 3,4 B. 1,2 C. 1,3 D. 2,3
An example of an obligate intracellular parasitic bacterium would be an organism responsible for: 1. Hepatitis 2. Q fever 3. Malaria 4. Chlamydia A. 2,3 B. 2,4 C. 3,4 D. 1,2
Which of the following specimens can remain at room temperature after collection if transport to the lab will be delayed? A. Sputum B. Urine C. Stool D. Cerebral spinal fluid
Which factor is commonly associated with Clostridium difficile infections (CDIs)? Prophylactic antibiotics or antibiotic to treat a primary bacterial infection
What is/are the highest risk antimicrobial(s) associated with causing CDI? Third-generation cephalosporins B. Fluoroquinolones C. Clindamycin and Vancomycin D. Metronidazole Third-generation cephalosporins Third-generation cephalosporins have supplanted clindamycin as the highest risk antimicrobials associated with CDI
What class of antibiotics do cephalosporins belong to? A. Fluoroquinolones B. Beta-lactam drugs C. Macrolides D. Aminoglycosides Fluoroquinolones
What is considered the “gold standard” for CDI diagnostic testing? A. Stool culture B. Cell Cytotoxic Assay C. Enzyme Immunoassay for Toxins A and B D. PCR A. Stool culture
50 percent of infants through about 1 year of age harbor the organism and its toxin without any gastrointestinal tract symptoms. T/F True
60 percent of hospitalized patients of all ages asymptomatically carry toxigenic and nontoxigenic strains of C. difficile in their stool False
Which of the following treatments has been shown to significantly improve the prevention of recurrence of Clostridium difficile infection? A. Fecal transplants B. Subtotal colectomy C. Colon cleansing D. Antimicrobial therapy
A pt was recently diagnosed with C. Diff of the colon. You are called to institute Contact Precautions & do all of the following EXCEPT: D. The patient is moved to a negative pressure room to avoid airborne fomite exposure
The optimal time to collect a sputum specimen for an acid- fast bacilli (AFB) testing to rule out TB would be: A. First thing in the morning B. After respiratory treatment C. Prior to the patient going to bed D. Prior to a respiratory treatment
When a patient with AIDS is admitted with possible pneumonia, the physician, who is a general practitioner, orders airborne isolation. What is the correct response? A. A TST skin test should be placed to determine if patient may have TB B. A sputum specimen should be collected for AFB daily x 3, if TB is suspected D. PCP is not transmitted person-to-person and does not require isolation
Which of the following statements is false regarding influenza viruses? B.Influenza A strains have been the predominant cause of worldwide epidemics (pandemics) C.Influenza A and B strains have been named according to the city, or state and year of their initial isolation
A pt w/ rust-colored sputum, malaise, weight loss & fatigue is admitted from a LTC. The Dr orders sputum for AFB smear & culture, fungal & bacterial cultures. A chest xray shows RUL infiltrates. The pt has a -PPD, & 1 sputum specimen is smear -.
The validity of a culture report is dependent on the quality of the specimen sent. To determine if an expectorated specimen was sputum and not saliva, the Gram stain should show: A.>10 epithelial cells per low-power field & abundant P. aeruginosa in pure culture B.> 10 epithelial cells per low-power field & mod to abundant polys C. Many WBCs and organisms on low-power field D. Fewer than 10 epithelial cells per low-power field
TRUE or FALSE: Enterobacteriaceae are Gram-positive organisms False
Enterobacteriaceae are naturalinhabitants of A. Lung B. Urinary Tract C. Gastrointestinal tract D. Skin C. Gastrointestinal tract
What is the single most important means to effectively reduce the transmission and horizontal spread of Enterobacteriaceae and other microorganisms in allhealthcare settings? Hand Hygiene
Enterobacteriaceae are associated most often with which of the following HAI: 1. Pneumonias 2. Surgical site infections 3. Bacteremia 4. Urinary Tract Infections A. 1, 2 and 3 B. 1, 3, and 4 C. 3 and 4 D. 1,2,3 and 4
APACHE SCORE Acute Physiology and Chronic Health Evaluation II Score
The most common organism associated with pneumonia in school aged children Mycoplasma pneumoniae
Bacterial Meningitis 1) Opening Pressure 2) Glucose 3) Predominate inflammatory 4) WBC counts 5) Total protein 6) Staining 1) Elevated 2) normal to decreased 3) Neutrophils 4) >1000 5) Elevated 6) gram +/- cocci or gram -rods
Viral Meningitis 1) Opening Pressure 2) Glucose 3) Predominate inflammatory 4) WBC counts 5) Total protein 6) Staining 1) Normal 2) Normal 3) Lymphocyte 4) < 100 per m3 5) normal to elevated 6) Gram -
Fungi Meningitis 1) Opening Pressure 2) Glucose 3) Predominate inflammatory 4) WBC counts 5) Total protein 6) Staining 1) Variable 2) low 3) Lymphocyte 4) variable 5) Elevated 6) India ink +
TB Meningitis 1) Opening Pressure 2) Glucose 3) Predominate inflammatory 4) WBC counts 5) Total protein 6) Staining 1) Variable 2) low 3) Lymphocyte 4) variable 5) Elevated 6) AFB +
An example of pneumonia generally acquired from an environmental source is: Legionella
When reviewing a gram stain you see gram negative bacilli which organism will this mostly likely represent? 1) E. Coli 2) S. aureus 3) Enterococcus faecium 4) Clostridim perfringens 1) E. Coli
Wound swabs for culture should be obtained from which of the following: 1) skin surface adjacent to the wound 2) purulent material from the dressing 3) wound surface before cleaning 4) drainage after cleaning wound surface 4) Drainage after cleaning wound surface
Environment that increases risk of TB Overcrowded prisons
Administrative control Screening of HCW at risk
Environmental control Keeping infected pts isolated
Agent for TB Mycobacterium tuberculosis
Engineering Control Portable HEPA unit
At high risk for TB Immunocompromised pts
Pathogenicity Ability to cause disease
Invasive Ability to enter & grow in host
Infectious Dose Number of organisms needed for infection to occur
REservoir The habitat where an infectious disease lives, multiplies & grows.
Influenza Virus A causative agent of illness/disease
Droplet; direct/indirect contact mode of transmission
Infected person Reservior
Respiratory tract portal of entry and/or exit
non-vaccinated people & those in high risk gropus susceptible hosts
Wound Swabs for culture should be obtained how? Drainage after cleaning wound surface
Normal Flora Microbes that are normally present in a particular environment & are found in most people, most of the time.
Pathogen an organism that is causing disease
Colonization when a microbe is present but no disease
Contaminant Microorganism is present due to poor handling or poor specimen acquisition.
Specificity Test characteristic which is the true negative rate
Gram stain results are either Positive or negative
Cocci or Bacilli are Types of bacterial shapes
Colonization Presence of organism doesn't necessarily indicate disease
Most common nucleic acid amplification test PCR
Cerebral spinal fluid w/ a predominance of neutrophils, elevated protein, & decreased glucose is usually indicative of meningitis caused by which class of organism? Bacterial
Many people carry this in their nares MRSA
Heads the list of most common pathogens causing CLABSI Coagulase negative Staph
Slime AKA Bio film
MRSA strains that develop resistance to this are Super Bugs Vancomycin
Rapidly becomes colonized by microorganisms embedded in bio film IV catheters
GPC found in enteric tract but are the 3rd most common causes of BSI's Enterococcus species
Can be the cause of antibiotic resistance in E. coli & Klebsiella ESBL
Grows in shampoo in your shower & contaminants medication vials Serratia
Normal flora in GI tract E. Coli, Proteus, Enterobacter
Normal flora in the GI tract but most common cause of UTI’s E. Coli
Acinetobacter Organism which is resistant to many drugs
Scary cause of severe meningitis Neisseria meningitides
genus containing species TB, kansaii & gordonae Mycobacterium
does not jump nor fly Head louse or bed bugs
Infectious particle w/ no DNA or RNA present Prion
Mold associated w/ construction Aspergillus
virus which remains dormant in nerve cells Varicella
One way to detect scabies skin scraping
When reviewing the gram stain of a person w/ a wound infection, the IP sees gram + organisms in clusters. Which organism would this most likely represent? Staphylococcus
What precautions do we use with every patient Standard Precautions
Which precautions require a special negative air pressure room? Airborne Precautions
Disease transmitted by airborne particles should use what preactions? Airborne
Disease transmitted by droplets should use what precations? Droplet
Uncontained body fluids should use what precautions? Contact
All pt's/residents should use what preacutions? Standard
A gram + coccus resistant to methicillin MRSA
Also known as CRE Carbapenem resistant enterobactericae
Prudent use of antibiotics Antibiotic Stewardship
Normally lives in the intestinal tract but is resistant to Vancomycin VRE
Negative pressure room Airborne infection isolation Room (ALL room)
Used to prevent inhalation of airborne disease N95/PAPR
Tuberculin skin tests TST
Infected with TB w/o any symptoms Latent TB
By 2020 the % of HCWs expected to receive influenza vaccine 90%
Precautions that are required to prevent transmission of influenza Droplet precautions
Adults may be contagious for X days prior to flu symptoms One day
Respiratory etiquette includes: Cover your cough
How chickenpox is transmitted Airborne & Contact
How Shingles is contracted From reactivation of Herpes Zoster
Disseminated Shingles requires Contact & this precaution Airborne
Localized shingles requires this precaution Standard
Created by: JRWeidenaar
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