USMLE Forum Archives - USMLE Step 3 - Case 1 (ID)
Case 1 (ID)
meduploader - 05-03-09 11:57
You admit a 65-year-old female to your local hospital
for treatment of a stroke. She presents about 12 hours
after the onset of symptoms. She has left-sided hemiparesis
and left-sided neglect. She has hypertension
but no other significant medical history. Her only
medications on admission are hydrochlorothiazide and
atenolol. She does not smoke. She is mildly dysarthric
with left-sided weakness, and she is unable to ambulate.
CT scan of her head shows no acute hemorrhage.
She is evaluated by physical, occupational, and speech
therapists and you plan to consult your local neurologist.
She has intravenous fluids running.
What is the most common source of bacterial
infection of intravenous catheters?
A) Hematogenous seeding of the catheter from
remote sites of infection.
B) Failure to properly sterilize fluid during the manufacturing
process.
C) Contamination of medications delivered intravenously.
D) Contamination at the site where the catheter enters
the skin during insertion or with manipulation.
E) Insufficient use of antibiotic ointment around
insertion sites.
meduploader - 05-03-09 11:57
You admit a 65-year-old female to your local hospital
for treatment of a stroke. She presents about 12 hours
after the onset of symptoms. She has left-sided hemiparesis
and left-sided neglect. She has hypertension
but no other significant medical history. Her only
medications on admission are hydrochlorothiazide and
atenolol. She does not smoke. She is mildly dysarthric
with left-sided weakness, and she is unable to ambulate.
CT scan of her head shows no acute hemorrhage.
She is evaluated by physical, occupational, and speech
therapists and you plan to consult your local neurologist.
She has intravenous fluids running.
What is the most common source of bacterial
infection of intravenous catheters?
A) Hematogenous seeding of the catheter from
remote sites of infection.
B) Failure to properly sterilize fluid during the manufacturing
process.
C) Contamination of medications delivered intravenously.
D) Contamination at the site where the catheter enters
the skin during insertion or with manipulation.
E) Insufficient use of antibiotic ointment around
insertion sites.
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#1
Re: Case 1 (ID) bingousmle - 05-03-09 12:42 D) Contamination at the site where the catheter enters the skin during insertion or with manipulation.
#2
Re: Case 1 (ID) InSitu - 05-03-09 13:07 Hello Meduploader..thanks for the question. Please use the new multiple choice feature for better interaction.
D
#4
Re: Case 1 (ID)
meduploader - 05-03-09 13:45 The correct answer is D. Most infections around intravenous
sites or venous infections from IV catheters
occur during insertion or manipulation of the catheter.
IV sites should be changed about every 3 days toreduce the rate of infections, and a semi-sterile technique
(thorough skin cleansing with alcohol, use of
sterile instruments, and wearing gloves) should be
used. It would be rare for IV catheter site infections to
arise from hematogenous spread or contaminated IV
fluids or medications. Answer E is incorrect as the use
of antibiotic ointments does not seem to significantly
affect the rate of IV catheter site infections.
#5
Re: Case 1 (ID) meduploader - 05-03-09 13:46 Your patient is concerned about getting sicker in the
hospital. You assume that she is talking about a nosocomial
infection. You reassure her that your hospital
does a better-than-average job of following hand
hygiene recommendations (unfortunately, the average
is only 40% compliance).
Which of the following statements regarding
hand hygiene accurately reflects the Centers
for Disease Control and Prevention (CDC)
guidelines?
A) In clinical settings, hand washing with soap and
water is preferred to using alcohol-based rub.
B) If latex gloves are worn during patient care, further
hand hygiene is not necessary.
C) Hands should be rubbed with an alcohol-based
lotion if they are visibly dirty or contaminated
with blood or other bodily fluids.
D) Hands should be washed or cleansed with an
alcohol-based rub before and after entering a
patient’s room, even if you have touched nothing.
E) None of the above.
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