Misc

Question 1

HBV HCW PEP

Answer 1

• Source HBsAg+
  
  • unvaccinated or known nonresponder HCW: HBIG x1 + HB vaccine
  • known vaccine responder: none required
• Source HBsAg-
  
  • unvaccinate: HB series
  • known responder or nonresponder: none

Question 2

Work restrictions for HCW w/ measles

Answer 2

• active: exclude from duty 4 days after rash appears
• postexposure: exclude 5 days after 1st exposure through 21 days after last exposure (and/or 4 days after rash appears)

Question 3

Near drowning/submersion injuries

abx?

what orgs?

Answer 3

• ppx abx not indicated unless water grossly contaminated
• PSAR, proteus, aeromonas

Question 4

Drugs linked to eosinophilic PNA

Answer 4

• dapto
• nitrofurantoin
• amiodarone
• ACEi

Question 5

IHI VAP Bundle Components

Answer 5

• HOB 45
• daily awakening trials/assessment for extubation readiness
• chlorhexidine oral care
• stress ulcer and DVT ppx

Question 6

Common causes of hypothermia (<35C)

Answer 6

• BB
• Alpha-blockers
• Opioids
• EtOH
• Antidepressants
• Antipsychotics
• ASA
• Oral hypoglycemics

Question 7

acute onset (w/in 24hrs of new rx/dose change)

hyperreflexia (>bradyreflexia)

N/V/D, tremors –> shivering

Flush skin

• Dx:
• Common etiologic agents:
• Treatment:

Answer 7

Serotonin syndrome

Classic = linezolid (MAOi) + SSRIs

Antiemetics

TCAs (amitriptyline)

Tx: dc rx. Benzos

Question 8

mental status change w/ dysautonomia

catatonia, stupor, coma

mutism

labs: rhabdo, myoglobinemia

1-3 days (up to 2 weeks) post exposure

• Dx:
• Common agents:
• Mgmt:

Answer 8

NMS

Cause: Frequent = haloperidol

any neuroleptic (antipsychotic), metoclopramide, w/d of antiparkinson rx

Tx: Dantrole (up to 10 days)

Dopamine agents (bromocriptine)

Question 9

muscle contraction (masseter spasm). “lead pipe rigidity”

CV instability

steep rise in CO2 (despite being on vent = high met rate)

labs: severe hypercarbia, rhabdo

• dx:
• triggers:

Answer 9

malignant hyperthermia

• usually <1hr (but up to 10hrs) after trigger
• Classic: halothane (inhaled), succinylcholine

Question 10

asx distinctive target lesions - often w/ febrile prodrome

a/w oral, ocular, genital mucosal lesions

• Dx:
• Causes:

Answer 10

Erythema multiforme

Causes: infections > drugs

• HSV, mycoplasma, etc

Question 11

when does DRESS usually occur?

Which rx a/w?

Answer 11

• 1-3wks (up to 6wks) after rx exposure
• aromatic AEDs (highest lamotragine), vanc, raltegravir, dapsone, sulfas

Question 12

rash (often morbiliform) + facial edema + eosinophilia

Answer 12

DRESS

Question 13

HCW exposure to…

• N meningitidis
• VZV
• TB

Answer 13

Question 14

HCW Exposure to…

• HAV
• Parvo
• Pertussis

Answer 14

Question 15

HCW exposure to…

• HIV
• HCV
• HBV

Answer 15

Question 16

PPD >5mm positive in:

Answer 16

• close contacts of pts w/ active TB
• HIV
• persons w/ CXR w/ fibrotic lesion c/w healed TB
• organ transplant recipients
• persons on pred (>15mg/day for >1mo)
• persons on TNFa inhibitors

Question 17

PPD >10mm positive in:

Answer 17

• recent ppd converters
• persons with medical RF (DM, silicosis, CKD, gastrectomy, J-I bypass, malnutrition, IS therapy)
• foreign-born persons from high prevalence countries
• IVDU/EtOH
• LTC residents
• HCW

Question 18

outbreaks a/w yellow pigment, powdered infant formula

Answer 18

cronobacter (formerly enterobacter) sakazakii

Question 19

contaminated iodophors

Answer 19

think Burkholderia cepacia

Question 20

Cat A BT Agents Infection Control

1. Smallpox
2. Plague
3. VHF
4. Anthrax
5. Botulism
6. Tularemia

Answer 20

1. SP - airborne/contact (+lab)
2. Plague - airborne or droplet (+lab)
3. VHF - airborne/contact (+lab)
4. Anthrax - no P2P spread (standard, no lab containment req)
5. Botulism - standard (no lab cont req)
6. Tularemia - standard (+lab)

Question 21

Indications for Airborne precautions

Answer 21

• TB
• measles
• chickenpox (diss VZV)

“Opportunistic” Airborne (i.e. w/ aerosol generating procedures): SARS, MERS-CoV, ebola, some BT agents