BCCCP-Infectious Disease I
Exam Questions and Correct
Answers the Latest Update
Graded A+
QUESTIONS AND ANSWERS
QUESTIONS ANSWERS
Individual risk factors for VAP Chronic lung disease or acute lung
injury
trauma (chest trauma or TBI)/
Burns
Re-intubation
aspiration
coma
How long after intubation does VAP happen? >48hrs after endotracheal
intubation.
VAP is caused by monomicrobial or polymicrobial Both, rarely viral or fungal.
pathogens?
Risk factors for MDROs Causing VAP?!?! Prior IV ABX in preceding 90 days
Acute Renal Replac Therapy (RRT) before VAP 5 or more days of
onset hospitalization prior to onset of
VAP
Increased sputum production. Septic Shock at time of VAP
ARDS preceding VAP. How to prevent VAP
1.Avoid or limit duration of ET Intubation Clinical Signs and Symptoms of
pneumonia include?
2. Minimize duration & deep level of sedation ( to
promote assessment of readiness to extubate)
,3. Maintain/improve physical conditioning while
on MV
4. Minimize pooling of secretions above ET tube
cuff.
5. Elevate head of bed at least 30 degrees.
6. Maintain integrity of MV circuit.
new or changing infiltrate on chest X-ray AND 2 Elevated WBC
or more of the following....
Fever (>100.4*F/38*C) Macroscopic purulent sputum
production
Impaired or worsening oxygenation Non-invasive techniques for
obtaining resp. tract cultures for
VAP are...
Obtained from what part of lung?
What kind of results does is yield?
Tracheal aspirate from ET or Tracheostomy tube Invasive Techniques for obtaining
resp. tract cultures in VAP are?
obtained sample from upper airway secretions
obtained from where?
Yields semi-quantitative results.
What king of results does it yield
Blind Catheter-directed/Bronchoscopic BAL Diagnostic Strategy for VAP
distal sample of lung lobe/segment (uses saline includes what?
lavage) yields significant QUANTITATIVE
results. (if <10,000 CFU/mL = d/c ABX)
Bronchoscopic protected specimen Brush (PSB):
Distal sampling of specific bronchial segment
significant QUANTITATIVE growth. <1,000
CFU/mL= d/c ABX
Clinical Suspicion + NON-INVASIVE sampling = ALL patients with suspected VAP
SEMI-quantitative results should receive a ABX against what
organisms.
, and not invasive sampling which yields
quantitative results.
MSSA and P.Aeruginosa At least give one agent for each
in all pts.
Vanc + Cefepime In patients with VAP, when do you
need to have double pseudomonal
coverage (with different MOA)?
MDRO risk factors When should you include MRSA
coverage for VAP?
ICU antibiogram with >10% gram(-) isolates
resistant to agent used as monotherapy
ICU ABX susceptibility is unavailable.
MDRO risk factors When treating VAP patients
ICU MRSA prevalence is >10-20% S. Aureus
Prevalence of MRSA is not know.
WITHOUT MDRO risk factors SINGLE-Antipseudomonal agent
with 90% or more activity
MRSA prevalence is < 10-20%. What is the most likely pathogen
and
What is the treatment? P. Aeruginosa
S. Pneumoniae Haemophilus Influenzae
A/B-hemolytic Strep MSSA
Gram Neg Bacilli (GNB, like E.coli, Klebs, Give:
Enterobacter, Proteus, serratia)
Cefepime, Imi/meropenem, Levofloxacin, Zosyn Ceftriaxone is a reasonable agent
for empiric manage-
Exam Questions and Correct
Answers the Latest Update
Graded A+
QUESTIONS AND ANSWERS
QUESTIONS ANSWERS
Individual risk factors for VAP Chronic lung disease or acute lung
injury
trauma (chest trauma or TBI)/
Burns
Re-intubation
aspiration
coma
How long after intubation does VAP happen? >48hrs after endotracheal
intubation.
VAP is caused by monomicrobial or polymicrobial Both, rarely viral or fungal.
pathogens?
Risk factors for MDROs Causing VAP?!?! Prior IV ABX in preceding 90 days
Acute Renal Replac Therapy (RRT) before VAP 5 or more days of
onset hospitalization prior to onset of
VAP
Increased sputum production. Septic Shock at time of VAP
ARDS preceding VAP. How to prevent VAP
1.Avoid or limit duration of ET Intubation Clinical Signs and Symptoms of
pneumonia include?
2. Minimize duration & deep level of sedation ( to
promote assessment of readiness to extubate)
,3. Maintain/improve physical conditioning while
on MV
4. Minimize pooling of secretions above ET tube
cuff.
5. Elevate head of bed at least 30 degrees.
6. Maintain integrity of MV circuit.
new or changing infiltrate on chest X-ray AND 2 Elevated WBC
or more of the following....
Fever (>100.4*F/38*C) Macroscopic purulent sputum
production
Impaired or worsening oxygenation Non-invasive techniques for
obtaining resp. tract cultures for
VAP are...
Obtained from what part of lung?
What kind of results does is yield?
Tracheal aspirate from ET or Tracheostomy tube Invasive Techniques for obtaining
resp. tract cultures in VAP are?
obtained sample from upper airway secretions
obtained from where?
Yields semi-quantitative results.
What king of results does it yield
Blind Catheter-directed/Bronchoscopic BAL Diagnostic Strategy for VAP
distal sample of lung lobe/segment (uses saline includes what?
lavage) yields significant QUANTITATIVE
results. (if <10,000 CFU/mL = d/c ABX)
Bronchoscopic protected specimen Brush (PSB):
Distal sampling of specific bronchial segment
significant QUANTITATIVE growth. <1,000
CFU/mL= d/c ABX
Clinical Suspicion + NON-INVASIVE sampling = ALL patients with suspected VAP
SEMI-quantitative results should receive a ABX against what
organisms.
, and not invasive sampling which yields
quantitative results.
MSSA and P.Aeruginosa At least give one agent for each
in all pts.
Vanc + Cefepime In patients with VAP, when do you
need to have double pseudomonal
coverage (with different MOA)?
MDRO risk factors When should you include MRSA
coverage for VAP?
ICU antibiogram with >10% gram(-) isolates
resistant to agent used as monotherapy
ICU ABX susceptibility is unavailable.
MDRO risk factors When treating VAP patients
ICU MRSA prevalence is >10-20% S. Aureus
Prevalence of MRSA is not know.
WITHOUT MDRO risk factors SINGLE-Antipseudomonal agent
with 90% or more activity
MRSA prevalence is < 10-20%. What is the most likely pathogen
and
What is the treatment? P. Aeruginosa
S. Pneumoniae Haemophilus Influenzae
A/B-hemolytic Strep MSSA
Gram Neg Bacilli (GNB, like E.coli, Klebs, Give:
Enterobacter, Proteus, serratia)
Cefepime, Imi/meropenem, Levofloxacin, Zosyn Ceftriaxone is a reasonable agent
for empiric manage-
