Exam #1: Infectious Disease Flashcards Preview

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Flashcards in Exam #1: Infectious Disease Deck (37)
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1
Q

What is the difference between morbidity & mortality?

A
Morbidity= Illness
Mortality= Death
2
Q

What is immune senescence?

A

Decline in immune response with age

3
Q

What are the main features of immune senescence?

A

1) Depressed T-cell response & depressed T-cell macrophage interaction
2) Decreased B-cell affinity

4
Q

How do co-morbid diseases complicate infections?

A

Physiologic “frailty” predisposes to worse infections & damped immune response

5
Q

What is the impact of nutritional status on immune function?

A

Malnutrition impairs immune function

6
Q

What are the long-term care considerations for infectious diseases?

A

1) Residence in LTC facility puts older adult at risk
2) Widespread ABX use increased likelihood of resistant infection
3) Resistance in impaired by factors of age & residency
4) Maintaining UTD immunizations is critical

7
Q

How is fever redefined in nursing-home residents?

A
  • Temp. >2 F of baseline
  • Oral temp. >99
  • Recatal temp. >99.5

*****Note that fever may be absent in 30-50% of older frail adults w/ serious infections

8
Q

What is the most common cause of iatrogenesis in the elderly?

A

Medication management

9
Q

How are antibiotics dosed in the elderly population?

A

Renal function

*****Also, note that there are many antibiotic interactions with commonly prescribed medications for older adults

10
Q

What is the minimum criteria for ABX initiation for UTI without catheter?

A
  • Fever AND one of the following:
    1) New or worsening urgency
    2) Frequency
    3) Suprapubic pain
    4) Gross hematuria
    5) CVA tenderness
    6) Incontinence
11
Q

What is the minimum criteria for ABX initiation for UTI with catheter?

A

Fever OR one of the following:

1) New CVA tenderness
2) Rigors
3) New-onset delerium

12
Q

What is the minimum criteria for ABX initiation for skin & soft tissue infection?

A

Fever OR one of the following:

1) Redness
2) Tenderness
3) Warmth
4) New or increasing swelling of affected site

13
Q

What is the minimum criteria for ABX initiation for respiratory infection?

A
  • Fever > 102 AND RR >25, or productive cough
  • Fever >100 but 25 + Pulse >100
  • Afebrile w/ COPD AND new or increased cough w/ purulent sputum
  • New or increased cough AND RR> 25 or new-onset delerium
14
Q

What is the minimum criteria for ABX initiation for fever without source of infection?

A

New-onset delirium or rigors (chills)

**Note that the patient should be fully underessed to look for a source of infection first

15
Q

What is the most common cause of bacterial pneumonia in older adults?

A

Streptococcus pneumoniae

16
Q

What is the first line antibiotic therapy for community acquired pneumonia?

A
  • Beta-lactam/ Beta-lactamase combination (PCN or cephalosporin)
    given with or without macrolide
  • OR newer fluoroquinolones with enhanced activity against S. pneumoniae
17
Q

What is the first line antibiotic therapy for hospital acquired pneumonia?

A

Generally, initial regimens should be broadly inclusive & then narrow
- IF MRSA is suspected–vancomycin or linezolid

18
Q

How can the risk of penumonia reduced?

A

1) Immunization
2) Smoking cessation
3) Aggressive treatment of comorbidities
4) System changes in the LTC facility

19
Q

What is the recommendation for flu vaccination in the geriatric population?

A

Annual flu vaccination recommended for ALL adults

20
Q

How does UTI in geriatrics differ from young adults?

A

Geriatric= resistant isolates e.g. Pseudomonas aeruginosa

21
Q

Is treatment recommended for asymptomatic bacteruria?

A

No

22
Q

What antibiotics are recommended for Lower UTI in women?

A

Fluoroquinolones (vs. bactrim)

**Only culture if first round therapy is ineffective

23
Q

How does management of Upper UTI differ from lower UIT?

A

Much more serious

  • IV abx
  • Longer course of therapy
  • More constitutional symptoms d
24
Q

What is the most common cause of UTI in older men?

A

Prostatic Disease

25
Q

How does treatment of UTI differ in men & women?

A

Longer treatment course in men: ~14 days

26
Q

What is the most common cause of TB in older adults?

A

Reactivation

27
Q

What are the recommendations for a “positive” PPD?

A

> 15mm= universally positive

> 10mm= positive in:

  • nursing home
  • recent converters
  • immigrants

> 5mm= positive in HIV

28
Q

How is TB treated?

A

Isoniazid for 9 months

29
Q

What is infective endocarditis? What is it associated with and now is it treated?

A

Infection of the endocardial surface of the heart

  • Associated with degenerative valvular disorders ‘
  • Treat with 4-6 weeks of abx
30
Q

What is the most common cause of septic arthritis? How is it treated?

A
  • S. aureus
  • Aggressive antibiotic with serial arthrocentesis
  • Surgical drainage if conservative strategy fails
31
Q

What is the most common cause of osteomyelitis in old age? Why is this more common in the elderly?

A
  • S. aureus

- Pressure ulcers that go down to the bone

32
Q

When should you consider meningitis as part of your differential?

A

Fever + mental status change

33
Q

What is the optimal treatment for neurosyphilis?

A

PCN G

34
Q

When is Herpes Zoster vaccine recommended?

A

> 60 years-old

35
Q

What are three infectious diseases that are associated with Bell’s Palsy?

A

1) Herpes Simplex
2) Varicella zoster (shingles)
3) Lymes

36
Q

When should you get a surgical consult on an elderly patient with abdominal pain?

A

Abdomianl pain + fever= surgical consult

37
Q

What are the fist line treatments for C.diff?

A
  • Metronidazole for mild to moderate cases

- Vancomycin