Medical Terminology and Concepts, Exams of Advanced Education

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Correct Answers 2023

Medical intervention factors that affect risk of infection - Correct Answer-indwelling devices, staffing ratio, lengths of stay, duration of invasive procedures, medications, # of exams by providers, type of institution, and knowledge/experience of providers environmental intervention factors that affect risk of infection - Correct Answer- disinfectant type used, contact with animals, hand hygiene anatomical/phys factors that affect risk of infection - Correct Answer-preexisting diseases, trauma, malignancies, age, gender, and nutritional status DMAIC - Correct Answer-D=define customers, project boundaries, and processes M=measure performance A=analyze data to identify causes of variation, gaps in performance, and prioritize actions I=improve the process C=control the process to prevent reverting What should an effective surveillance program be able to provide? - Correct Answer- Detection of infections and injuries, identify trends, identify risk factors associated with infections and other AEs detect outbreaks and clusters, assess the overall effectiveness of the infection control and prevention program and demonstrate changes in proactive and processes that lead to better outcomes Define point prevalence - Correct Answer-number of persons ill on the date divided by the population on that date. Define attack rate - Correct Answer-Number of people at risk in whom a certain illness develops / (divided by) / Total number of people at risk Define prevalence - Correct Answer-fraction of a population having a specific disease at a given time Define incidence - Correct Answer-number of new cases of a disease divided by the number of persons at risk for the disease. Type of specimen for C. diff - Correct Answer-liquid stool is required When to suspect C. diff infection? - Correct Answer-when 3 or more unformed/watery stool in 24 hrs occurs

Relative Risk (RR) - Correct Answer-Used in cohort studies to determine how strongly a risk factor is associated with an outcome. 1 is the null= no significance of the association between exposure and adverse event P(X infection or exposed)/P(Y infection or unexposed) = RR Details of control chart - Correct Answer-central line = the ave of data pts x axis = time y axis = rate/count may be upper control/lower control limit lines and +/- 3 SD lines Directly observed therapy (DOT) - Correct Answer-requires that a health care provider directly observe the patient swallowing the pills, whether it is in the hospital, office, or home care setting the best method for TB regimen, intermittent therapy, MDRO, high risk for noncompliance (drug abusers/homeless) Hill's Criteria of Causality - Correct Answer-1) strength of association- relationship between casual factor and disease outcome

2. consistency of finding- associations are repeated
3. specificity of association- very specific cause
4. temporality- cause must be before the effect
5. biological gradient- dose and response relationship, more exposure causes higher risk
6. biologic or theoretical plausibility- has to make biological sense
7. coherence with the established knowledge- established knowledge should not conflict with findings True or False: The thoroughness of the cleaning is more important than the duration of the disinfection - Correct Answer-true Steps of systemic review and meta-analyisis - Correct Answer-1. Research question

2. develop methodology
3. Literature search/selecting studies
4. Analysis of data/interpretation 4 stages of prevention - Correct Answer-1. preventing altogether ie vaccine
5. early identification/tx ie cessation or dx testing
6. providing optimal health to prevent further disease progression
7. preventing healthcare associated complications Volume limit for alcohol-based hand dispensers - Correct Answer-1.2 L in rooms, hallways/areas open to hallways 2L in suites

What is the primary limitation of qualitative research? - Correct Answer-lack of generalizability a positive is the patients' point of view chain of infection - Correct Answer-infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host Passive/indirect transmission - Correct Answer-occurs when an organism is present and does not replicate within the source such as hepA (hepA does not replicate in the food) Crude mortality rate - Correct Answer-Number of deaths ÷ population total x 1,000 = _____ per 1, Reusing single-use devices - Correct Answer-must have written policy and procedures and plan for reprocessing (often done by a third party) high-level disinfection - Correct Answer-heat-automated pasteurization and liquid immersion time needed = 10-90 minutes destroys all microorganisms except for high levels of spores required for heat sensitive semi-critical items Division of Healthcare Quality Promotion (DHQP) - Correct Answer-Division of the CDC responsible for monitoring HAIs and maintaining the NHSN Responsible for prevention of dialysis-associated disease and guidance for sterilization and disinfection social cognitive theory - Correct Answer-views prejudice as an attitude acquired through direct instruction, modeling, and other social influences when a critical mass of persons act a certain way the environment changes and others are more likely to carry out similar behaviors The Agency for Healthcare Research and Quality (AHRQ) mission - Correct Answer-to improve the quality of medical care through outcomes research and development of clinical guidelines Aims to make healthcare safer and more accessible and affordable HRSA (Health Resources and Services Administration) - Correct Answer-the primary federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable CMS (Centers for Medicare and Medicaid Services) - Correct Answer-Federal agency in the Department of Health and Human Services that runs Medicare, Medicaid, clinical

laboratories, and other government health programs; responsible for enforcing all HIPAA standards other than the privacy and security standards Surveillance criteria - Correct Answer-should be considered exactly as defined without consideration of diagnosis Standardized Infection Ratio (SIR) - Correct Answer-formula = observed/predicted the 3 most common causes of HAIs - Correct Answer-contamination or defects on medical products/devices lapses in infection prevention practices colonization or infection of healthcare personnel case definition - Correct Answer-A method of determining criteria for cases that should be included in a registry What is the method of surveillance that is likely to provide the most useful information? - Correct Answer-combined whole house and targeted as targeted alone, although the NHSN system focuses on this, may miss small outbreaks or breaches in non-targeted areas IOM - Correct Answer-Institute of Medicine: primary aim is patient-centered/safety dependent variable - Correct Answer-The outcome factor: occurs in result of something else independent variable - Correct Answer-the cause or the influence of the dependent variable ordinal scale - Correct Answer-a scale of data measurement that involves ordered categorical responses (stages of cancer) nominal scale - Correct Answer-measurement in which numbers are assigned to objects or classes of objects solely for the purpose of identification (male/female; gay/straight..) interval scale of measurement - Correct Answer-Numerical distances between intervals ie temperature Most appropriate graphic display for continuous data - Correct Answer-histogram, freq polygon, ogive (line chart) cross-sectional study - Correct Answer-A study in which a representative cross section of the population is tested or surveyed at one specific time best to assess outcomes and potential risk factors in a group at one point in time

used to determine prevalence, but not incidence cohort study - Correct Answer-A type of epidemiologic study where a group of exposed individuals (individuals who have been exposed to the potential risk factor) and a group of non-exposed individuals are followed over time to determine the incidence of disease clinical trials - Correct Answer-experiments that study the effectiveness of medical treatments on actual patients Case-control study - Correct Answer-A type of epidemiological study where a group of individuals with the diseases, referred to as cases, are compared to individuals without the disease, referred to as controls What is the most common organism associated with osteomyelitis? - Correct Answer-S. aureus- also associated with empyema, endocarditis, septic arthritis, septicemia, sinusitis, and cellulitis what is Klebsiella sp. most commonly associated with? - Correct Answer-septicemia and UTIs What is psuedomonas sp. most commonly associated with? - Correct Answer-HA- pneuomia and coagulase-negative staph CSF in bacterial meningitis - Correct Answer-↓ Glucose; ↑ Protein; ↑ Neutrophils; ↑ Pressure; cloudy CSF in viral meningitis - Correct Answer-Normal/increased pressure; Increased lymphocytes Normal/increased protein; Normal sugar; clear to hazy CSF in fungal meningitis - Correct Answer-↑pressure, ↑lymphocytes, ↑protein, ↓sugar; clear to hazy Immunocompromised patient at risk of p. jiroveci infection should receive ab ppx with what? - Correct Answer-TMP-SMX for the duration of risk If cannot tolerate, use oral dapsone or atovaquone or inhaled pentamidine Dietary restrictions for neutropenic patients - Correct Answer-Avoid raw rasp and strwb use only pasteurized dairy products reheat deli meat to steaming hot before eating What happens when administering piper/tazo and an aminoglycoside in the same IV? - Correct Answer-inactivates both agents the CDC recommended method of hand washing is now using alcohol based hand rubs EXCEPT - Correct Answer-when hands are visibly soiled or come into contact with B. anthracis, C. diff, or norovirus- then hand washing with soap and water is required

Sterilization - Correct Answer-The process that completely destroys all microbial life, including spores. Sterilization methods - Correct Answer--steam -dry heat -filtration -gas -ionizing radiation steam sterilization - Correct Answer-1. Minimum sterilization parameters 250'F with 15 to 20 lbs per square inch (psi) for 30 mins.

2. Corrodes non-stainless (carbon) steel instruments
3. Dulls instruments and burs
4. Ok for SOME plastics; cotton rolls/gauze (cloth goods)
5. Paper packets come out wet and tear.
6. Spore Test= Geobacillus stearothermophilus dry heat sterilization - Correct Answer-kills by oxidation; takes 1-6 hours HCP with long nails should be advised that the nails could harbor..? - Correct Answer- gram - and fungal organisms In order to prevent BSIs in the NICU, the CDC recommends skin antisepsis for vascular access with? - Correct Answer->0.5% chlorhexidine gluconate with alcohol (often 2% with 70%) why is povidine iodine not safe for neonates/premature infants but can be used on mature infants? - Correct Answer-be it may be absorbed resulting in thyroid dysfunction cath lab requirements - Correct Answer-max humidity of 60% min floor space of 400 sq ft temp 70-75 F/20-24 C 15 air exchanges/hr (3 = fresh air) all material = nonporous A pregnant HCW should be routinely screened for what? - Correct Answer-HIV unless otherwise identified Immunizations and pregnant HCWs - Correct Answer-recommended: flu (inactivated) and Tdap not recommended: HPV contraindicated: LAIV flu, MMR, varicella, and herpes zoster What is the incubation period for salmonella spp.? - Correct Answer-1-3 days infection persists for 4-7 days True or false: abs are usually contraindicated for S. typhi or S. paratyphi? - Correct Answer-True

When using alcohol-based surgical hand scrub products for surgical hand antisepsis, the first step is to? - Correct Answer-prewash hands and forearms with non- antimicrobial soap and water and dry then the scrub is applied and massaged thoroughly into the hands for duration per the manufacturer- the scrub should air dry which maternal host facts increase the risk of healthcare-associated perinatal infection in both infant and mother? - Correct Answer-immunocompromised with corticosteroids low economic status ruptured membranes BMI under 19 or over 30 uncontrolled DM ASA score of 3 or < smoking preterm labor extended hosp stay colonization: HIV, GBS, HSV, chlamydia, gonorrhea, syphilis WHO phases of pandemic (6) - Correct Answer-1. low risk of cases in humans

2. higher risk of cases in humans
3. human-to human transmission is nonexistent to low
4. some human-to-human transmission is evident
5. sig human-to-human transmission is occurring
6. efficient/sustained human-to-human transmission is occurring What is the purpose of BioWatch? - Correct Answer-to collect air samples to test for aerosolized biological agents (coordinated with CDC, EPA, and Homeland Security) BioSense - Correct Answer-Syndromic surveillance system CDC national web-based program Disease detection, monitoring and situational awareness Reporting emergency room data DOD, VA, civilian hospitals Data clearinghouse: stored, searched & analyzed by multiple parties What are the 4 phases of disaster with mass casualties? - Correct Answer- preparedness, impact, response, recovery Nonbullous impetigo is typically associated with what organism? - Correct Answer- group A strep bollous impetigo is related to what disease and bacteria - Correct Answer-s. aureus What is the most effective prevent for c. diff spores? - Correct Answer-glove use/barrier protection- better than hand washing practice

Enterococcus spp. - Correct Answer-facultative gram positive cocci, grow in short chains Enterococci that causes majority of infections of the spp? - Correct Answer-E. faecalis Enterococci that demonstrates high vancomycin resistance of the spp? - Correct Answer-E. faecium what bac sp is most commonly associated with SSIs (~20%)? - Correct Answer-s. aureus Surgical wound classification - Correct Answer-Clean (uninfected), clean-contaminated (controlled entry without unusual contamination), contaminated (accidental/surgical wound), dirty (pre-existing infxn) A comparison of the incidence of lung cx in a pop of smokers compared with the incidence of a nonsmoking pop defines what stat term? - Correct Answer-relative risk what % of nosocomial infections are believed to be caused by bac contamination carried by hands of caregivers/HCW? - Correct Answer-15% most likely mode of transmission for organism appears to be non-acid-fact - Correct Answer-contact "Decide-Announce-Defend Model" - Correct Answer-a top-down, minimally participatory method of public management. category A specimen - Correct Answer-when exposure occurs is capable of causing permanent disability or life-threatening or fatal disease in otherwise healthy humans or animals requires triple packaging: double-layer waterproof packaging, absorbent material should break occur, appropriate documentation enclosed by outer packaging infectivity risks from transmission of HIV from pts to HCWs..? - Correct Answer-are highest with encounters involving needles and sharps are often associated with asymptomatic carriers of HIV HIV seroconversion rate = 0.5% vs HBV = 25% C. tetani appearance - Correct Answer-tennis racket anthrax gram stain - Correct Answer-gram positive nonmotile rods prototypical arboviral infection - Correct Answer-malaria- spread by vector transmission by the Plasmodium falciparum mosquito sp.

Dengue and yellow fever virus - Correct Answer-flavivirus- vector is Aedes aegypti mosquito when should close contacts of rabies infection pt receive PEP? - Correct Answer-when they have had close mucous membrane exposure serology for immunized Hep B - Correct Answer-+HbsAB

• HbeAG
• HbsAG +HbsAG indicates? - Correct Answer-potentially infectious carrier state may be detected at any time +HbeAG indicates? - Correct Answer-high degree of potential infectivity serology for chronic active state of HepB - Correct Answer-+HbsAG +HbcAB What does dx of chronic hepatitis require? - Correct Answer-sero markers, elevated liver enzymes, bx, and other ancillary studies incubation period for vector - Correct Answer-vector invasion by the microbe to the next step in vector transmission ie bite What is the T-point system? - Correct Answer-a method of assessing an institution's variation in average time length of surgical procedures compared with the databases of the NHSN ie T-point = 2 for hernia repair means 75% of herniorrhaphies in the database were completed within 2 hours The 0- to 3- point scoring system using the NNIS Risk Index: - Correct Answer-assigns 1 point for preoperative ASA scores of 3 to 5 The American Society Anesthesiologists (ASA) - Correct Answer-Originally oped the ASA Classifications to determine modifications necessary to provide general anesthetic to patients during surgical procedures. Agents and methods used to sterilize or disinfect are segregated into 3 tiers. Which of the following statements are not true and which are true? low-level agents, iodophors, kill most bacteria and fungi, but not viruses alcohol is an intermediate disinfectant that does not kill/inactivate spores H2O2 is an example of a high level disinfectant high level disinfectants may not eradicate high concentrations of bac spores - Correct Answer-F T T

T

OSHA regs to prevent illness spread by blood borne paths are what level agents? - Correct Answer-intermediate, particularly in critical areas: ED, surg suites, and labs Iodophors - Correct Answer-Complex of iodine and alcohol Have replaced free iodine solutions in medical antisepsis low-level tier agents: kill most bac but may not kill certain strains of fungi or viruses intermediate agents - Correct Answer-alcohol and bleach (sodium hypochlorite) kills veg bac such as MTb, viruses and fungi proportion of spinal cord pts that develop decbiti - Correct Answer-1/ surgical environment air exchanges - Correct Answer-at least 15/hr, 3 being of fresh air In order to comply with the Safe Medical Devices Act of 1990: - Correct Answer-facilities that use medical devices associated with death or injury must file semiannual and annual medical device reporting (mdr) The Shewhart cycle refers to: - Correct Answer-a quality management tool for problem- solving Plan, Do, Check, Act What does the Joint Commission do? - Correct Answer-Provides accreditation programs for various healthcare facilities (ambulatory, behavioral health, acute care, critical care hospitals, labs, etc). requires drug testing and background checking pre-employment