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Clinical Medicine: Infectious Disease (Part 1) > Bacterial Infections > Flashcards

Bacterial Infections Flashcards

1
Q

What is a potential complication of Group A Strep pharyngitis?

A

Scarlet Fever

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2
Q

Describe the rash of scarlet fever.

A

Resembles a Sunburn
Sandpaper Consistency
Most intense in groin and axillary
Enlarged Red Papillae (Strawberry Tongue)

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3
Q

What is a complication of scarlet fever?

A

Rheumatic Fever

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4
Q

What must be met for a Positive JONES Criteria?

A

Two Major Criteria
OR
One Major + Two Minor Criteria

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5
Q

What are the Major Criteria of JONES?

A

Joint - Polyarthritis
Oh My Heart - Carditis
Nodules - Subcutaneous Nodules
Erythema Marginatum
Sydenham’s Chorea

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6
Q

What are the Minor Criteria of JONES?

A

Fever
Arthralgia
Inflammatory Markers
ProlongedPR interval

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7
Q

What drugs do you use to treat Rheumatic Fever?

A

Penicillin G
Aspirin
NSAIDs

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8
Q

Patients who have had rheumatic fever should be treated with a continuous course of antimicrobial prophylaxis for how long?

A

5 years

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9
Q

What are the drugs of choice for rheumatic fever prophylaxis?

A

Penicillin V (oral)
Erythromycin (oral)
Pencilling G (IM)

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10
Q

What percentage of people are asymptomatic carriers of Staphylococcus aureus?

A

25%

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11
Q

A purulent skin and soft tissue infection with possibly an abscess would lead to a high suspicion of what pathogen? Typically causes abscess, furuncle, carbuncles, and cellulitis with purulence.

A

Staphylococcus Aureus

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12
Q

What is the treatment for an SSTI caused by Staph. Aureus?

A

Incision and Drainage (PRIMARY)
Antibiotics

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13
Q

What antibiotics should be used when treating S. aureus orally?

A

Dicloxacillin or Clindamycin
MRSA - Clindamycin, Bactrim, or Doxycycline

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14
Q

What antibiotics should be used when treating S. aureus via IV medications?

A

Nafcillin or Cefazolin
MRSA - Vancomycin or Daptomycin

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15
Q

A non purulent skin and soft tissue infection that commonly causes cellulitis and erysipelas would lead to a high suspicion of what pathogen?

A

Beta-hemolytic streptococci (Group A Strep.)

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16
Q

What antibiotics should be used when treating Beta-hemolytic streptococci orally?

A

Amoxicillin
Cephalexin or Clindamycin

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17
Q

What antibiotics should be used when treating Beta-hemolytic streptococci via IV medications?

A

Nafcillin or Cefazolin
Vancomycin or Daptomycin

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18
Q

What pathogen causes approximately 60% of all cases of osteomyelitis?

A

Staph. aureus

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19
Q

What are the most common sites of osteomyelitis?

A

Long bones
Vertebrae

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20
Q

What is a common complication to be mindful of with vertebral osteomyelitis?

A

Epidural Abscess

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21
Q

What are the common signs of epidural abscess?

A

Fever
Severe Back Pain
Neck Pain
Radicular Pain (pinched nerve in a dermatome)
Spinal Cord Compression

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22
Q

What are the three causes of osteomyelitis?

A

Hematogenous Spread (through the blood)
Contiguous Focus of Infection (Open Fracture & Surgery)
Vascular Insufficiency

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23
Q

What is Hematogenous Osteomyelitis commonly associated with?

A

Sickle Cell Disease
IV Drug Use
Diabetes
Old Age

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24
Q

How do patients with hematogenous osteomyelitis present?

A

Sudden High Fever
Chills
Pain and Tenderness

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25
Q

What is Contiguous Focus of Infection Osteomyelitis usually caused by?

A

Prosthetic Joint Replacement or Orthopedic Surgery
Neurosurgery
Trauma

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26
Q

What pathogens most commonly cause Contiguous Focus of Infection Osteomyelitis?

A

Staph. aureus
Staph. epidermis

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27
Q

What are the signs of Contiguous Focus of Infection Osteomyelitis?

A

Localized Inflammation
- High fever and other toxic signs are absent

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28
Q

What is the most common site of osteomyelitis due to vascular insufficiency?

A

Foot
Ankle

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29
Q

What are the best bedside clues to the presence of osteomyelitis due to vascular insufficiency?

A

easy advancement of probe to bone through skin ulcer
Ulcer Area greater than 2cm x 2cm

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30
Q

How is the diagnosis of osteomyelitis made?

A

Isolation of Organism from:
- blood
- bone
- contiguous focus

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31
Q

What is usually elevated and can be useful to follow the course of during the treatment of osteomyelitis?

A

ESR and CRP (Inflammatory Markers)

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32
Q

List the steps of imaging used to detect and diagnose bone infections.

A
  1. X-Ray
  2. CT Scan
  3. Bone Scan or Gallium Scan
  4. Bone Biopsy (diagnostic)
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33
Q

What suspicion would prompt you to order an MRI when assessing for osteomyelitis?

A

Epidural Abscess

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34
Q

How long do you need to treat osteomyelitis for?

A

4 - 6 weeks (possibly longer)

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35
Q

What antibiotics do you use to treat osteomyelitis?

A

Cefazolin (IV)
Nafcillin or Oxacillin (IV)

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36
Q

What antibiotics do you use to treat osteomyelitis caused by MRSA?

A

Vancomycin (IV)
Daptomycin (IV)

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37
Q

When Staphylococcus aureus enters the blood (staph. bacteremia) what three things should you consider?

A

Endocarditis
Osteomyelitis
Deep Infections

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38
Q

How do you rule out infective endocarditis?

A

Trans-esophogeal Echocardiogram

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39
Q

How do you treat staphylococcal bacteremia?

A

Vancomycin or Daptomycin (IV)
(4 - 6 weeks)

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40
Q

Characterized by an abrupt onset of high fever, vomiting, and watery diarrhea due to the toxins of staphylococcus aureus.

A

Toxic Shock Syndrome

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41
Q

What are two common signs of toxic shock syndrome?

A

Macular Erythematous Rash
Non-purulent Conjunctivitis

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42
Q

Why are blood cultures negative when looking for evidence of a pathogen with Toxic Shock Syndrome?

A

Symptoms are from the TOXIN
(not systemic infection)

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43
Q

How do you treat toxic shock syndrome?

A

REMOVE SOURCE OF TOXIN
Clindamycin (IV)

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44
Q

Common causes of infections by coagulase-negative staphylococci

A

Intravascular Devices
Prosthetic Devices
Wound Infection following Cardiothoracic Surgery

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45
Q

What are the signs and symptoms of a coagulase-negative staphylococci infection?

A

Purulent or Serosanguineous Drainage
Erythema
Pain or Tenderness
- at site of foreign body or device
Joint Instability and Pain of Prosthetic Joint

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46
Q

How do you treat infections caused by coagulase-negative staphylococci?

A

Remove Device or Foreign Body (if possible)
Vancomycin (IV)
- if normal kidney function

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47
Q

What causes Tetanus?

A

neurotoxin tetanospasmin
(clostridium tetani)

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48
Q

What are the risk factors for tetanus?

A

Unvaccinated
Older Adults
Migrant Workers
Newborns
IV Drug Users

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49
Q

What are the early signs of tetanus?

A

Jaw and Neck Stiffness
Dysphagia
Irritability

50
Q

What are the late signs of tetanus?

A

Spasms of the Jaw muscles (Trismus)
Painful tonic convulsions from minor stimuli
Spasms of the glottis and respiratory muscles
- causes asphyxia and apnea

51
Q

What is the most common cause of death as a result of tetanus?

A

Respiratory failure

52
Q

What is the immunization schedule of Tetanus, Diphtheria, and Pertusis for children and what vaccine would they be receiving?

A

DTaP
2 months
4 months
6 months
15-18 months
4 - 6 years

53
Q

When should women receive their Tdap vaccine while pregnant?

A

27-36 weeks

54
Q

How do you treat someone with symptoms of Tetanus?

A

Tetanus Immune Globulin (500 units IM)
Debride Wound
Metronidazole (IV or PO)
Bed Rest and Limit Stimuli

55
Q

A paralytic disease caused by a toxin that has been classified by the CDC asa high-priority agent due to potential concern for bioterrorism

A

Botulism
(clostridium botulinum)

56
Q

What are the three forms of naturally occurring botulism?

A

Food-borne: canned, smoked, or vacuum packed
Infant: Honey
Wound: IV Drug Use

57
Q

How long after ingestion of the botulism toxin do signs and symptoms appear?

A

12 - 36 hours

58
Q

Symmetric descending flaccid paralysis progressing to respiratory failure and death may occur unless mechanical assistance is provided. What is the disease?

A

Botulism

59
Q

How do you treat botulism?

A

Equine Serum Heptavalent Botulism Antitoxin
- given within 24 hours of symptom onset
Intubation and Mechanical Ventilation
Parenteral fluids
Contact the CDC

60
Q

Disease that causes tenacious gray membrane that covers that tonsils and pharynx and may lead to upper airway and bronchial obstruction.

A

Diphtheria
(corynebacterium diphtheria)

61
Q

Why should a presumptive diagnosis of diphtheria should be made on clinical grounds without waiting for laboratory verification?

A

Emergency treatment is needed.

62
Q

Susceptible people exposed to diphtheria (not with an active case) should receive what treatments?

A

Diphtheria Toxoid Booster
- complete series if unimmunized
Penicillin G or Erythromycin x7 days

63
Q

What is the treatment for people with active diphtheria?

A

Removal of membrane
Antitoxin (from horse serum)
PCN G or Erythromycin x14 days.

64
Q

This disease may be sporadic or come from outbreaks and is associated with eating contaminated foods such as: unpasteurized dairy, hot dogs, deli meats, cantaloupe, and soft cheeses.

A

Listeriosis
(listeria monocytogenes)

65
Q

Infection of listeriosis usually occurs in the last trimester of pregnancy and may result in what?

A

Spontaneous Abortion or Stillbirth
(surviving infants at risk for neonatal listeriosis)

66
Q

A neonatal infection acquired in utero that results from listeriosis and has a high mortality rate

A

Granulomatous infantisepticum

67
Q

Listeriosis in the blood that occurs in neonates or immunocompromised adults and is considered a febrile illness without a recognized source.

A

Bacteriemia (listeriosis)

68
Q

Listeriosis that affects infants less than two months old as well as older adults.

A

Meningitis (listeriosis)

69
Q

In a patient with meningitis caused by listeriosis, what would you find in the cerebrospinal fluid?

A

Lymphocytic Pleocytosis
- with variable protein and glucose

70
Q

How do you diagnose listeriosis?

A

Lumbar Puncture
- neutrophil elevation and increased protein
Culture from Biological Sample
- stool
- blood
- cerebrospinal fluid
- amniocentesis

71
Q

What is the treatment of choice for listeriosis?

A

Ampicillin (IV)

72
Q

Acute infection of the respiratory tract where adults are often the reservoir of the disease.

A

Pertussis (Whooping Cough)
(Bordetella pertussis)

73
Q

Bursts of rapid, consecutive coughs followed by deep, high pitched inspiration (whoop).

A

Paroxysmal Stage

74
Q

How do you diagnose pertussis?

A

Isolating organism from nasopharyngeal culture
- require special agar

75
Q

How can you prevent pertussis?

A

Vaccination (DtaP)
Erythromycin (prophylaxis)

76
Q

What is the treatment for pertussis?

A

Azithromycin
Clarithromycin
Bactrim

76
Q

Infection that may cause sinusitis, otitis, and epiglottitis?

A

Haemophilus Infuenzae Type B

77
Q

What are the treatment options for Haemophilus?

A

Augmentin

78
Q

How do you treat more seriously ill patients with haemophilus that have toxic clinical features with multi-lobe pneumonia?

A

Ceftriaxone (IV)
Fluoroquinalone (IV)

79
Q

Abrupt onset of high fever, drooling, and inability to handle secretions. Severe sore throat despite unimpressive exemption of the pharynx. Stridor and respiratory distress from obstruction.

A

Epiglottitis

80
Q

How do you diagnose epiglottitis?

A

Direct visualization
- performed in ICU with intubation ready

81
Q

What is the drug of choice for epiglottitis?

A

Ceftriaxone (IV)
PCN Allergy: Fluoroquinalone (IV)

82
Q

Infection that is transmitted by the ingestion of the organism, usually from tainted food or drink (CHICKEN)

A

Salmonellosis
(salmonella enterica)

83
Q

Clinical syndrome characterized by GI symptoms as well as constitutional symptoms such as fever, malaise, headache, cough, and sore throat. Progressive infection evolves with delirium.

A

Typhoid Fever

84
Q

How long is it until Typhoid Fever reaches a plateau and the patient is much more ill?

A

7-10 days

85
Q

What type of diarrhea is seen with Typhoid Fever?

A

Pea Soup diarrhea

86
Q

Physical examination findings of someone with Typhoid fever.

A

Hepatosplenomegaly
Bradycardia (Relative)
Meningismus
Rose Spots (faint pink or salmon colored)

87
Q

How do you treat Typhoid Fever?

A

Azithromycin
Ceftriaxone

88
Q

How do you treat chronic carriers of Typhoid fever?

A

Cholecystectomy

89
Q

What is the most common form of salmonellosis?

A

Salmonella Gastroenteritis

90
Q

What are the signs and symptoms of Salmonella Gastroenteritis?

A

Fever
Nausea and Vomiting
Cramping Abdominal Pain
Diarrhea
- bloody
- 4 to 7 days

91
Q

How do you diagnose Salmonella Gastroenteritis?

A

Stool Culture

92
Q

How do you treat Salmonella Gastroenteritis in patients who are severely ill, have sickle cell disease, or are immunocompromised?

A

Ciprofloxacin
Levofloxacin
(3-14 days)

93
Q

Prolonged or recurrent fears accompanied by bacteremia and local infection. May result in mycotic aortic aneurysm.

A

Salmonella Bacteremia

94
Q

Usually abrupt onset of bloody diarrhea, lower abdominal cramps, and tenesmus (cramping rectal pain).

A

Shigellosis

95
Q

What are the laboratory findings in a patient with Shigella?

A

Stool shows many leukocytes and red cells.

96
Q

How do you treat uncomplicated Shigellosis?

A

Treat dehydration and hypotension

97
Q

What antibiotics should be used for severe cases of shigellosis and immunocompromised patients?

A

Fluroquinalones
Ceftriaxone

98
Q

Acute diarrheal illness that is toxin mediated. Causes hyper secretion of water and chloride ions and massive diarrhea (up to 1L per hour). Death results from profound hypovolemia.

A

Cholera
(vibrio cholera)

99
Q

How does the stool of cholera appear?

A

Gray and turbid
No odor
No blood or pus

100
Q

How do you treat Cholera?

A

Lactated Ringers (IV)

101
Q

Outbreaks of this have been associated with the consumption of raw milk. Dairy cattle and poultry an important reservoir.

A

Campylobacter jejuni

102
Q

C. jejuni toxins cause inflammation which causes what?

A

Toxic Megacolon

103
Q

How do you treat uncomplicated Campylobacter jejuni?

A

Hydration and Electrolyte Balancing

104
Q

How do you treat severe campylobacter jejuni?

A

Azithromycin

105
Q

Zoonotic infection carried by wild rodents that then transmit fleas that bite humans and spread the disease. Extremely virulent.

A

Plague
(Yersinia pestis)

106
Q

A sign of the plague that develops when the organisms spread through the lymphatics to the lymph node.

A

Buboes

107
Q

What are the signs and symptoms of the Plague?

A

Sudden onset of high fever
Purpuric spots (black plague)

108
Q

How do you treat the Plague?

A

Fluroquinalones
Amino-glycosides
Doxycycline

109
Q

How do you diagnose urethritis and cervicitis? (Gonorrhea)

A

Nucleic Acid Amplification Test (mucosal sites)
First Catch in the Morning (Men)

110
Q

What is the treatment for Gonorrhea?

A

Ceftriaxone (IM)

111
Q

What is treatment for Chlamydia?

A

Doxycycline (non-pregnant)
Azithromycin 1g (pregnant)

112
Q

Vesicopustule that breaks down to form a painful, soft ulcer with a necrotic base, surrounding erythema, and undermined edges.

A

Chancroid
(Haemophilus ducreyi)

113
Q

What is the treatment for Chancroids?

A

Azithromycin 1g (oral)
Ceftriaxone 250mg (IM)

114
Q

Acute infection of children and young adults that is transmitted from cats to humans as the result of a scratch or bite. Most commonly presents as regional lymphadenitis.

A

Cat Scratch Disease
(Bartonella henselae)

115
Q

How do you diagnose Cat Scratch Disease

A

Clinical Diagnosis

116
Q

What is the treatment for Cat Scratch Disease?

A

Self Limited
Azithromycin 500mg x1 w/ 250mg x4 days (Z-Pak)
- lymphadenitis

117
Q

Acute and chronic STI caused by Chlamydia trachomatis serotypes L1-L3. Initial papular or ulcerative lesion (usually on external genitalia) is evanescent and often goes unnoticed.

A

Lymphogranuloma Venereum

118
Q

What is the most common presentation of lymphogranuloma venereum?

A

Proctocolitis

119
Q

What appears 1-4 weeks after exposure to lymphagranuloma venereum?

A

Inguinal or Femoral Buboes

120
Q

What is the preferred diagnosis of lymphogranuloma venereum?

A

Nucleic amplification test for chlaymida trachomatis

121
Q

Who should be actively screened for Chlamydia?

A

Sexually active women 25 or younger
Women 26+ with risk factors for STI
Pregnant Women
HIV Patients
Men with risk factors for STIs

Clinical Medicine: Infectious Disease (Part 1) (3 decks)

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