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bacterial infections I - G+ & G- Flashcards

1
Q

what is the most pathogenic staphylococcus

A

s. aureus

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2
Q

what staphylococcus is most common on skin and hospital acquired infections

A

s. epidermidis

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3
Q

what stapholococcus is common in UTIs

A

s. saprophyticus

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4
Q

what staphylococcus is common in foreign body/prosthetic device infections

A

s. lugdunensis

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5
Q

what is the difference between coagulase positive and negative species?

A

positive - able to clot
negative - cannot

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6
Q

what type of staphylococcus species is most virulent

A

coagulase positive species
resistance is increasing = MRSA

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7
Q

what staphlyococcus are coagulase positive and coagulase negative?

A

positive - S. aureus
negative - S. epidermidis, S. saprophyticus, S. lugdunensis

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8
Q

what is the most common mode of transmission of staphylococcus

A

direct tissue invasion
- skin/soft tissue infectios
- osteomyelitis
- septic arthritis
- pneumonia
- endocarditis

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9
Q

severe local staphylococcus infection can lead to ?

A

bacteremia

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10
Q

how do staphylococcal skin infections most commonly present?

A

erythema
purulent drainage

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11
Q

steps in treating staphylococcal skin infections?

A
  1. drain abscess
  2. empiric abx
  3. alter tx after cx results
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12
Q

what abx do you use for a staph skin infection with a low risk of MRSA

A
  1. cephalexin (keflex)
  2. dicloxacillin
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13
Q

what abx do you use for a staph skin infection with a high risk of MRSA

A
  1. clinda
  2. sulfamethoxazole/trimethoprim (bactrim)
  3. doxy/minocycline
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14
Q

what is the first line inpatient tx for a staph skin infection

A

vancomycin

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15
Q

most of osteomyelitis is caused by ?

A

s. aureus

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16
Q

how do you confirm osteomyelitis?

A

x-ray
bone scan most sensitive

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17
Q

tx for staph osteomyelitis

A
  1. culture!
  2. x-ray
  3. empiric coverage (no first line tx) - vancomycin + 3/4 gen cephalo
  4. prolonged therapy for 4-6 weeks
  5. surgery (sometimes)
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18
Q

if a pt presents with a MSSA osteomyelitis, what is the abx?

A

nafcillin (IV) / oxacillin / cefazolin

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19
Q

if a pt presents with a MRSA osteomyelitis, what is the abx?

A

vancomycin IV

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20
Q

what is the disease that is caused by a toxin produced by S. aureus, commonly seen from tampon use and nasopharynx packing?

A

Toxic shock snydrome (TSS)

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21
Q

common presentation for TSS

A
  1. erythematous rash on palms and soles that desquamates*
  2. sudden onset fever*
  3. hypotension
  4. N/V/D
  5. myalgia

can cause hepatic damage, thrombocytopenia, confusion*

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22
Q

tx for TSS

A
  1. supportive
    - antipyretics
    - IV fluids
    - monitor hepatic and renal functions
  2. debride/decontaminate*
  3. empiric - vancomycin + clinda + (pip/taz)/cefepime/carbapenem *
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23
Q

scalded skin syndrome is most common in?

A

infants, younger children

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24
Q

scalded skin syndrome is transmitted via ?

A

birth canal
hands of adult carriers

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25
Q

symptoms of scalded skin syndrome

A
  1. bullae with sloughing
  2. fever, malaise

can lead to sepsis and electrolyte abnormalities

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26
Q

what causes scalded skin syndrome?

A

s. aureus toxins

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27
Q

tx for scalded skin syndrome

A
  1. biopsy
  2. fluid management
  3. skin care - tx as burns*
  4. abx
    - MSSA - nafcillin / oxacillin
    - MRSA - vancomycin
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28
Q

staph food poisoning is caused by ?

A

ingestion of exotoxin

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29
Q

symptoms of staph food poisoning

A

quick onset - 2-8hrs after ingestion
self limiting within 12hrs

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30
Q

characteristics of coagulase negative staph infections? Main tx?

A
  1. humans are natural carriers
  2. typically hospital acquired
  3. resistant to most beta-lactams
  4. tx: vancomycin*
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31
Q

what streptococcus is the most common cause of pharyngitis and skin infections

A

S. pyogenes (group A) (GABHS)

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32
Q

what streptococcus can cause septic abortion and illness in neonates

A

S. agalactiae (group B)

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33
Q

what steptococcus can cause endocarditis esp. prosthetic valve

A

S. bovis (group D)

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34
Q

pharyngitis is most common in ?

A

ages between 5 - 15

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35
Q

common presentations of pharyngitis

A
  1. beefy red uvula*
  2. palatal petechiae*
  3. tender ant. cervical lympadenopathy
  4. tonsillar exudate possible
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36
Q

how do you diagnose pharyngitis

A

diagnosis made by presentation THEN rapid strep test

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37
Q

3 tx for pharyngitis - strep pyogenes (GABHS)

A
  1. benzathine PCN G
  2. PCN VK
  3. amoxicillin (better for kids)
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38
Q

what is the tx for pharyngitis if there is a PCN allergy?

A

cephalo

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39
Q

what is the tx for pharyngitis if there is a PCN and cephalo allergy?

A

Azithromycin (Zpack)

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40
Q

presentation of scarlet fever

A
  1. erythematous rash resembling a sunburn with superimposed fine red papules (sandpaper rash)
    -fine desquamatino
  2. strawberry tongue
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41
Q

a focal, vasicular, pustular lesions with a thick, honey-colored crust with a “stuck-on” appearance

A

impetigo

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42
Q

what is the main bacteria that causes impetigo

A

Strep
S. aureus can cause too

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43
Q

3 tx for impetigo MSSA

A
  1. topical mupirocin*
  2. cephalexin* (1st) (keflex)
  3. dicloxacillin
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44
Q

tx for impetigo MRSA

A
  1. sufanethoxazole/trimethoprim (bactrim)*
  2. clinda*
  3. doxycycline
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45
Q

what is the main cause of erysipelas

A

strep
s. aureus can cause too

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46
Q

a painful superficial cellulitis with derma lymphatic involvement that frequently involves the face

A

erysipelas

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47
Q

outpatient tx for erysipelas

A
  1. PCN VK*
  2. amoxicillin*
  3. dicloxacillin
  4. cephalexin* (PCN allergy)
  5. clinda/erthyromycin
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48
Q

inpatient abx for erysipelas

A
  1. vanco
  2. cefazolin (1st)
  3. ceftriaxone (3rd)
  4. clinda
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49
Q

cellulitis is most caused by either ___ or ___

A

GABHS
S. aureus

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50
Q

how is strep agalactiae (group B strep) important in pregnancy

A
  • must have routine screening during pregnancy at 35th week
  • can lead to neonatal sepsis if no prenatal care done
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51
Q

if a pregnant pt is positive for group B strep, what do you give? (3)

A

treatment prophylaxis - intrapartum
1. PCN G or ampicillin
2. cefazolin (1st)
3. clinda or vanco

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52
Q

what strep is most common cause of CAP

A

s. pneumoniae

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53
Q

what streptococcus commonly causes upper & lower rsp tract and meninges

A

s. pneumoniae

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54
Q

what streptococcus is seen in endocarditis in the native valve

A

s. viridans

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55
Q

3 organisms that cause acute OM

A
  1. s. pneumoniae
  2. m. catarrhalis
  3. h. influenzae
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56
Q

otitis media is most common in?

A

children between 2-14

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57
Q

signs of otitis media (3)

A
  1. bulging TM
  2. absence/displacement of light reflex, poor mobility
  3. otorrhea with TM rupture
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58
Q

acute sinusitis most commonly starts as ?

A

viral

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59
Q

first line tx for acute sinusitis? 2nd?

A
  1. amoxicillin / clavulanic acid (augmentin)
  2. doxy
  3. clinda
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60
Q

s/s of pneumococcal pneumonia

A
  1. early onset rigors*
  2. productive cough - rust colored*
  3. SOB
  4. pleuritic chest pain
  5. crackles and riles heard in affected lobe*
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61
Q

What is the difference between diagnosing outpatient vs inpatient/comorbidities of pneumococcal pneumonia

A

outpatient - NO sputum culture
inpatient/with comorbidities - DO sputum culture

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62
Q

first line tx for pneumococcal pneumonia? 2nd?

A
  1. amoxicillin
    then
  2. doxy
  3. azithromycin (zpack) - only in areas w/ <25% resistance
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63
Q

what 2 abx is given with an OUTPATIENT pt with COPD/comorbidities or with recent abx tx for pneumonia with the LAST 3 MONTHS

A
  1. levofloxacin (levaquin)
  2. combo:
    - amoxicillin/clavulanate (augmentin)/cephalosporin + macrolide/doxy
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64
Q

2 tx for inpatient pneumococcal pneumonia

A
  1. levofloxacin (levaquin)
    OR
  2. macrolide + beta-lactam (amoxicillin or can use ceftriaxone)
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65
Q

how do you determine the severity of pneumococcal pneumonia?

A

pneumonia severity index (PSI)

66
Q

prevention for pneumococcal pneumonia

A
  1. pneumococcal vaccine

recommended for:
1. ALL adults +65 y/o
2. chronic health problems
3. immunocompromised
4. 19-64 y/o:
- who smokes or have asthma
- residents of nursing homes/long-term care facilities

67
Q

causative organisms for meningitis in children and young adults

A
  1. group B strep - 1 - 3 m/o
  2. s. pneumoniae - 3m - 10 y/o
  3. Neisseria meningitidis - 10 - 19 y/o
68
Q

causative organism for meningitis in adults and elderly

A

s. pneumoniae

69
Q

what is the tx for endocarditis (enterococcus)

A

ampicillin + gentamicin

70
Q

tx for both mild and complicated skin/wound/UTI infection (enterococcus)

A

ampicillin or vancomycin

71
Q

tx for VRE enterococcus

A

linezolid
daptomycin

72
Q

a encapsulated, toxin producing bacteria that is a bioterrorism agent

A

bacillus anthracis

73
Q

modes of transmission of bacillus anthracis

A
  1. direct contact
  2. ingestion - inadequately cooked meat of infected animals
  3. inhalation - most fatal
74
Q

if a pt presents with a painless black eschar, it is most likely from?

A

bacillus anthracis

75
Q

ingesting spores from bacillus anthracis can cause ?

A

lesions and bleeding in GI tract

76
Q

inhalation of b. anthracis can present with?

A
  1. insidious onset of flu-like symptoms
  2. chest pain and severe rsp distress - hypoxia, shock
77
Q

if a b. anthracis exposure is suspected, what do you start with?

A

cipro prophylaxis
7-10 days (cutaneous)
60 days (inhalation)

78
Q

what is the alternative of cipro for B. anthracis

79
Q

what organism is present in foods, esp rice and left overs, that can cause quick onset of N/V/D within 1-10 hrs of exposure

A

bacillus cereus
self-limiting
supportive tx

80
Q

what infection presents a greater risk during pregnancy by ingesting contaminated foods such as dairy, raw veggies, and meat

A

listeriosis

81
Q

how do you diagnose and tx listeriosis

A

diagnose:
1. culture
- blood
- CSF
tx:
- ampicillin + gentamicin
- amoxicillin (outpatient)

82
Q

what causes an adherent dense, grey cover on the tonsils and pharynx

A

(pharyngeal diphtheria)
corynebacterium diphtheriae
followed by toxemia and prostration

83
Q

tx for corynebacterium dipheriae (3)

A
  1. diphtheria equine antitoxin - must get from CDC
  2. PCN
  3. erythromycin
84
Q

ppl in contact with corynebacterium diphtheriae, what abx do they get

A

erythromycin

85
Q

what is the prevention for corynebacterium diphtheriae?

A
  1. immunization
  2. susceptible persons = booster + PCN or erythromycin
86
Q

characteristics of acinetobacter infections

A
  1. opportunistic infections
  2. can affect any organ system
  3. survive on dry surfaces for up to a month
87
Q

moraxella catarrhalis is the common cause of ___ infections

A
  • rsp tract
    1. acute OM
    2. acute and chronic sinusitis
    3. COPD exacerabtions
88
Q

neisseria can cause …

A

meningococcal
meningitis
gonorrhea

89
Q

characteristics of meningococcal meningitis

A
  1. human reservoir
  2. outbreaks occur in close communities
90
Q

clinical presentation of meningococcal meningitis

A
  1. stiff neck*
  2. maculopapular rash, petechiae*
  3. kernig and brudzinski signs*
  4. Fever, HA
  5. N/V, photophobia, lethargy
91
Q

how do you diagnose meningococcal meningitis

A

gram stain and culture
- lumbar puncture with CSF analysis
- blood

92
Q

tx for meningococcal meningitis

A
  1. ceftriaxone (start)
  2. PCN G - if known meningococcal susceptible to PCN
93
Q

close contacts of meningococcal meningitis receive?

A

prophylactic abx

94
Q

meningococcal vaccine covers what strain?

A

B
starting at age 11-12 with booster at 16

95
Q

diagnosis with yellow-green purulent discharge and erythematous cervix

96
Q

disease states of neisseria gonorrhoeae

A
  1. cervicitis, urethritis
  2. prostatitis
  3. PID
  4. conjunctivitis
97
Q

conjunctivitis from n. gonorrhoeae is especially seen in?

98
Q

tx for gonorrhea

A

ceftriaxone - single dose
must report to local health department

99
Q

pseudomonas is the #1 pathogen of: (3)

A
  1. otitis externa
  2. corneal ulcers
  3. osteochondritis after puncture through tennis shoe
100
Q

pseudomonas is the #2 pathogen of:

A

nosocomial pneumonia

101
Q

pseudomonas is the #3 pathogen of:

A

hospital-aquired UTI

102
Q

folliculitis also known as “hot-tub folliculitis” is caused by what organism

A

pseudomonas

103
Q

what is the most common first symptom from pseudomonas

104
Q

outpatient/oral tx options for pseudomonas

A
  1. ciprofloxacin
  2. levofloxacin
105
Q

why avoid ciprofloxacin and levofloxacin in children when treating pseudomonas

A

can have cartilage effects

106
Q

what is the inpatient beta-lactam tx for pseudonomas (5)

A
  1. pip/taz
  2. ceftazidime (3rd)
  3. cefepime (4th)
  4. meropenem
  5. aztreonam
107
Q

what organism causes whooping cough

A

b. pertussis

108
Q

4 rsp tract infections caused by H. flu

A
  1. pneumonia
  2. bronchitis
  3. OM
  4. sinusitis
109
Q

what rsp infection is transmitted via aerosolized droplets that affects mostly children and presents with coughing fit w/ gasps for breath that could continue for months

A

whooping cough

110
Q

what abx can be given for whooping cough? alternative?

A
  • azithromycin
  • bactrim
111
Q

epiglottitis is commonly caused by what organism

112
Q

what organism colonize the upper rsp tract in COPD pts and frequently cause purulent bronchitis

113
Q

legionnaires disease is more common in ? (3)

A

immunocompromised
smokers
chronic lung disease

114
Q

outbreaks of legionnaires disease have been associated with ?

A

contaminated water sources

115
Q

presentation of legionnaires disease

A

scant sputum*
pleuritic chest pain
fever
toxic appearance
focal patchy infiltrates or consolidation in CXR

116
Q

how do you confirm legionnaires disease?

A

antigen detection

117
Q

tx for legionnaires disease

A
  1. macrolides
  2. fluoroquinolone

10-14 days/21 day course for immunocompromised

118
Q

typically, klebsiella pneumoniae only causes disease in: (4)

A
  1. immunocompromised
  2. alcoholics
  3. DM
  4. HIV
    normal intestinal flora
119
Q

red, currant-jelly sputum is commonly seen in ?

A

klebsiella pneumoniae

120
Q

tx for klebsiella pneumoniae

A

empiric - rsp fluoroquinolone, carbapenem

121
Q

gastrointestinal illnesses causing organisms (g- rods)

A
  1. E. coli
  2. campylobacter
  3. salmonella
  4. shigella
  5. vibrio
122
Q

pt presenting with who recently went on a trip
1. increased freq, volume, and weight of stool
2. freq loose stools
3. tenesmus
4. N/V

A

E coli - traveler’s diarrhea

123
Q

if traveler’s diarrhea is not resolving, what do you give?

A
  1. antimotility agents/antididiarrheals
  2. bismuth subsalicylate (pepto)
  3. cipro
124
Q

antimotility agents/antididiarrheals are not recommended for ?

A

infants or ppl with fever or bloody stool

125
Q

bismuth subsalicylate is not recommended for ?

A

children
pregnant women

126
Q

what is one of the main causes of bacterial foodbourne illness that produces inflammatory, sometimes blood, diarrhea

A

campylobacter jejuni

127
Q

abx for campylobacter jejuni

A

ciprofloxacin
azithromycin

128
Q

what infection causes diarrhea, often with blood and mucus, with WBC in stools

A

shigellosis

129
Q

tx for shigellosis

A

ciprofloxacin (cipro)
TMP-SMX DS (bactrim)

130
Q

a pt complains of liquid, gray, non-odor stool what do they most likely have?

A

cholera - vibro cholerae

131
Q

4 tx for cholera - vibrio cholerae (DNA/protein synthesis ABX)

A
  1. tetracycline/doxy
  2. TMP-SMZ- DS
  3. azithromycin
  4. quinolones - cipro
132
Q

vibrio parahaemolyticus infections are from ?

A

ingestion of shellfish or contaminated seawater, usually occurs in Japan and coastal US

133
Q

tx for non-cholerae vibrio infections

A

doxy or ciprofloxacin

134
Q

two main clinical patterns of salmonella infection:

A
  1. enteric fever (typhoid fever)
  2. acute enterocolitis
135
Q

prodomal stage of typhoid fever presents with:

A

typhoid/enteric fever
1. blood “pea” soup
2. rose spots
3. malaise
4. N/V
5. abd pain

136
Q

3 tx for typhoid fever

A
  1. ciprofloxacin/levofloxacin
  2. ceftriaxone
  3. azithromycin
137
Q

presentation of enterocolitis (salmonella)? how do you get it?

A
  1. diarrhea - inflammatory
  2. Nausea, abd pain
  3. fever

from ingesting infected food or direct contact with infected animals (turtles and reptiles)

138
Q

tx for enterocolitis (salmonella)

A
  1. Supportive
  2. SEVERE!! do not treat in uncomplicated cases
    - cipro
    - ceftriaxone
    - azithromycin
    - TMP-SMX
139
Q

most UTI/pyelonephritis is caused by ?

A

E. coli
also klebsiella, proteus mirabilis , enterobacter

140
Q

most UTIs involve what part of the bladder?

A

lower urinary tract - bladder, urethra

141
Q

an infection in any part of the urinary system

142
Q

untreated UTI spread to kidneys and can cause permanent kidney damage

A

pyelonephritis

143
Q

5 tx for UTI (uncomplicated)

A
  1. TMP-SMZ DS
  2. nitrofurantoin
  3. fosfoycin
  4. cephalos - cephalexin/cefdinir
  5. ciprofloxacin
144
Q

what would you use in children for uncomplicated UTIs

A

cephalosporins - cephalexin/cefdinir WITH Bactrim

145
Q

tx for pyelonephritis

A
  1. ciprofloxacin
  2. levofloxacin
  3. ceftriaxone PLUS bactrim/augmentin/omnicef (cefdinir)
146
Q

what is transmitted among rodents and to humans by bites of fleas or from contact with infected animals

A

bubonic plague by yersinia pestis

147
Q

presentation of bubonic plague

A
  1. bubo (enlarged, painful LNs)
  2. purpuric spots
  3. blood-tinged sputum
  4. cyanosis with pneumonia
  5. sudden onset of fever, malaise
148
Q

tx for bubonic plague? what is the prophylactic tx

A
  1. streptomycin
  2. gentamyicin
  3. doxy
  4. fluoroquinolones

prophylactic therpay for any contacts with doxy AND ciprofloxacin

149
Q

a pt who has been in recent contact with rabbits/rodents/ticks that presents with an ulcer at site of being bitten is dx with ?

150
Q

tx for tularemia

A
  1. streptomycin
  2. gentamicin
  3. doxy
  4. fluoroquinolone
151
Q

What temp is considered a fever

A

+38C or +100.4F

152
Q

shaking chills seen with a fever is more likely what type of etiology?

A

infectious
usually s. pneumoniae

153
Q

tx for FUO

A
  1. no empiric
  2. treatment directed toward etiology once determined
  3. referral if cannot be determined
154
Q

SIRS is defined as 2+ of the following:

A
  1. fever (+38C/100.4F) or <36C (96.8F)
  2. +90bpm
  3. rsp +20 bpm, <32 mmHg (PaCO2)
  4. Abnormal WBC
    - >12k
    - <4k
    - >10% bands
155
Q

when bacteria is in the bloodstream and can multiply and produce systemic s/s

A

bacteremia

156
Q

what is the most common cause of bacteremia

A

respiratory infection
highest among +65 y/o
G+ most prevalent

157
Q

8 risk factors of sepsis

A
  1. ICU admission
  2. bacteremia
  3. +65 y/o
  4. immunosuppressed
  5. DM and cancer
  6. CAP
  7. previous hospitalization
  8. genetic factors
158
Q

common s/s of sepsis

A
  1. hypotension
  2. elevated temp or hypothermia
  3. +90 bpm
  4. tachynpea
  5. signs of organ perfusion
    - warm flushed skin
    - altered mental status
    - absent bowel sounds
159
Q

what is the scoring system in identifying sepsis

A
  1. qSOFA score of +2 findings
    - rsp rate +22 bpm
    - altered mental status
    - <100 mmHg BP
  2. do full SOFA score
160
Q

tx for sepsis

A
  1. abx within 1 hr of suspected dx
  2. empiric abx used to depend on source of infection
  3. IV fluids
  4. vasopressors
  5. central lines
161
Q

prognosis of sepsis

A
  1. nosocomial pathogens > community-acquired
  2. UTI (lowest mortality)
  3. ischemic bowel (highest mortality)

Infectious disease (15 decks)

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