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Clinical Medicine I > Bacterial infectious diseases > Flashcards

Bacterial infectious diseases Flashcards

1
Q

What are key features of scarlet fever?

A

rash resembling sunburn most commonly in groin and axillary, strawberry tongue, fine red papules, blanches, petechial, circumoral pallor

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2
Q

What is associated with scarlet fever and treatment should be tailored as such?

A

Pharyngitis -> penicillin

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3
Q

What criteria is key for diagnosing acute rheumatic fever?

A

Jones criteria
Major - polyarthritis, carditis, chorea, rash (subq nodules, erythema marginatum)
Minor - fever, arthralgia, inflammatory markers, PR segment prolongation

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4
Q

What is the Jones criteria?

A

two major criteria or one major and two minor criteria for acute rhuematic fever

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5
Q

What helps diagnose acute rheumatic fever in patient history?

A

recent GAS infection; strep

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6
Q

What helps diagnose acute rheumatic fever?

A

bacterial culture, rapid strep, elevated anti-strep antibodies

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7
Q

How do you treat acute rheumatic fever?

A

penicillin

Consider prevention of continuous course of antimicrobial prophylaxis - penicillin, erythromycin, or IM penicillin G benziathine

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8
Q

When should you add antibiotics (orally) for skin and soft tissue infections?

A
  • severe or extensive disease
  • symptoms/signs of systemic illness
  • purulent cellulitis/wound
  • comorbidities or age extreme (young/old)
  • abscess in difficult area to drain
  • associated septic phlebitis
  • lack of response to I&D
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9
Q

How do you treat skin and soft tissue purulent infections (first line)?

A

I&D

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10
Q

What antibiotics do you add for skin/soft tissue infections in “special situations”?

A

dicloxacillin or clindamycin

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11
Q

What antibiotics do you use for skin/soft tissue infections for MRSA?

A

clindamycin, bactrim, doxycycline

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12
Q

What antibiotics do you use for skin/soft tissue infections for sepsis?

A

IV nafcillin, cefazolin
MRSA - vancomycin or daptomycin

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13
Q

How do you treat skin and soft tissue non-purulent infections?

A

amoxicillin, cephalexin, clindamycin

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14
Q

How do you treat severe skin/soft tissue non-purulent infections?

A

IV nafcillin, cefazolin, vancomycin, daptomycin

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15
Q

What is hematogenous osteomyelitis?

A

sudden onset of high fever, chills, pain, tenderness of involved bone

Older patients may have low grade fever, worsening bone pain, neurologic abnormalities

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16
Q

What should you consider to help diagnose osteomyelitis?

A

isolation of organism, blood cultures, bone biopsy and culture indicated if blood cultures are negative

Imaging - x-ray for soft tissue swelling, deminerilization –> CT to locate abscesses –> bone scan for bone infection –> US to diagnose effusion

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17
Q

What should you always check for with the following symptoms: fever, severe back/neck pain, radicular pain, spinal cord compression + vertebral osteomyelitis?

A

epidural abscess

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18
Q

What’s your test of choice when epidural abscess is suspected?

A

MRI

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19
Q

what makes hematogenous osteomyelitis more likely in a patient?

A

If they are/have: DM, IV catheters, indwelling urinary catheters, IV drug users, sickle cell anemia, old age

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20
Q

How can you differentiate contiguous osteomyelitis?

A

high fever, localized signs of inflammation
with all other signs of toxicity absent

Generally from surgery, trauma, joint replacement

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21
Q

How can you differentiate vascular insufficiency osteomyelitis?

A

commonly on foot or ankle; hip/sacrum; bone pain often absent or muted by neuropathy

also NO FEVER
think - stasis dermatitis

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22
Q

What’s the best bedside clue of vascular insufficiency osteomyelitis?

A

ability to advance a sterile probe to bone through a skin ulcer

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23
Q

How do you treat osteomyelitis (first line)?

A

IV cefazolin, nafcillin, oxacillin
MRSA: IV vancomycin or daptomycin

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24
Q

How can you shorten IV therapy with osteomyelitis?

A

oral levofloxacin/ciprofloxacin + rifampin after 2 weeks of IV

MRSA = bactrim, doxycycline, clindamycin

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25
When is surgery indicated for osteomyelitis?
staphylococcal osteomyelitis w/ epidural abscess/spinal cord compression, other abscesses, extensive disease, recurrent/persistent infection
26
What should you think with staphylococcal bacteremia?
endocarditis, osteomyelitis, other deep infection
27
What do you need to rule out infective endocarditis?
transesophageal ecg; maybe transthoracic if lower risk
28
How does toxic shock syndrome present?
abrupt onset of high fever, vomiting, watery diarrhea, sore throat, myalgias, headache - can have diffuse macular erythematous rash, nonpurulent conjunctivitis, desquamation of palms/soles
29
What's weird about TSS in blood cultures?
cultures will be negative! It's not systemic.
30
How can you treat TSS?
rapid rehydration, anti-staph therapy, manage organ failure, remove toxin source IV clindamycin to inhibit toxin production, maybe IV immune globulin
31
What is a coagulase-negative staph infection?
presenting with purulent or serasanguineous drainage, erythema, pain, tenderness at site, and joint instability/pain, commonly following surgery
32
How do you treat a coagulase-negative staph infection?
remove device! IV vancomycin (for normal kidney function) If valve endocarditis (MRSA) = vanc+rifampin+gentamicin
33
How does tetanus present?
early - pain/tingling at site, spasticity of muscles, jaw/neck stiffness, dysphagia, irritability late - hyperreflexia, trismus, rigidity, spasm, convulsions, spasms death
34
Who are at risk for tetanus?
unvaccinated, older adults, migrant workers, newborns, IV drug users
35
How do you prevent tetanus?
active immunization; booster Tdap every 10 years (and given with each pregnancy) If >5 years after dose you need a booster in a risk situation
36
How are unvaccinated individuals treated when dealing with tetanus?
passive immunization (250) AND active tetanus toxoid as well
37
How do you treat tetanus (vaccinated)?
human tetanus 500 immune globin IM within 24 hours + debride wound, metronidazole IV or PO abx; optional penicillin IV **Keep muscles relaxed, sedation often needed to prevent contraction**
38
What are common symptoms of botulism?
visual disturbances, dry mouth, dysphagia, dysphonia, nausea, vomiting Symmetric descending paralysis
39
How can you manage botulism?
contact state! Equine serum heptavalent botulism antitoxin within 24 hrs and establish airway - intubation, mechanical ventilation, fluids
40
What is diptheria?
can be nasal (discharge), laryngeal (upper airway/bronchial obstruction) or pharyngeal (MC) = mild sore throat, fever, malaise --> toxemia, prostration; patches on the back of throat
41
How can you diagnose diptheria?
**DO NOT WAIT -- EMERGENCY** but can culture, PCR
42
How can you manage diptheria?
antitoxin, removal of membrane, isolate All contacts should recieve booster or complete series + PCN/erythromycin
43
What is listeriosis?
illness from contaminated dairy * can cause miscarriage in pregnancy and if not miscarriage, neonatal listeriosis: * neonatal infection, high mortality rate --> bacteremia, meningitis LOTS of complications
44
How do you diagnose listeriosis?
lumbar puncture Stool, blood, meningitis, transplacental infection MRI if focal brain abscess CT/US if liver abscess suspected
45
How do you manage listeriosis?
Prevent exposure!!! Ampicillin IV can + gentamicin IV PCN allergy = trimethoprim/sulfamethoxazole IV
46
What is the presentation of pertussis?
catarrhal stage of insidious onset lacrimation, sneezing, hacking cough, anorexia, malaise --> paroxysmal stage - rapid, consecutive coughs with high-pitch inspiration --> convalescent stage of decreasing severity
47
How to diagnose pertussis (whooping cough)?
elevated WBC, other labs are normal Diagnosis = isolating organism from nasopharyngeal culture
48
How do you treat pertussis?
azithromycin, clarithromycin, bactrim also for contacts to active case exposed
49
How can you prevent pertussis?
vaccine, with significant exposure = prophylaxis + macrolide (erythromycin) vaccination of adults to stop reservoir
50
What should you consider with otitis, sinusitis, and meningitis?
haemophilus
51
What is haemophilus?
otitis, sinusitis, epiglottitis, meningitis causer
52
How do you treat haemophilus?
amoxicillin, augmentin, cefuroxime, fluoroquinolones, azithromycin IV ceftriaxone or fluoroquinolones
53
What is typhoid fever?
* malaise * headache * cough * sore throat * abdominal pain, constipation, "pea soup" diarrhea * --> plateau and exhaustion
54
How can you recognize a complication from typhoid fever?
high HR
55
How do you handle carriers of typhoid fever?
ciprofloxacin and cholecystectomy
56
How can you diagnose typhoid fever?
splenomegaly, abdominal distention/tenderness, bradycardia, meningismus Rash = rose spots **Best diagnosed by blood culture, low WBC**
57
How do you treat typhoid fever?
azithromycin or ceftriaxone If visited Pakistan = meropenem Hospitalized = combo of ceftriaxone/meropenem + azithro critical = dexamethasone
58
What should you watch for in salmonella gastroenteritis even when it's self-limited?
observe for bacteremia in joints/bones
59
What is salmonella bacteremia?
prolonged or recurrent fevers w/ bacteremia and local infection (complication of salmonella gastroenteritis), common in immunocompromised **May have mycotic aortic aneurysms**
60
How do you treat salmonella bacteremia?
systemic antimicrobial therapy + drainage of abscesses -> ciprofloxacin or levofloxacin OR ceftriaxone, trimethoprim-sulfamethoxazole, amoxicillin, azithromycin
61
What is shigellosis?
abrupt onset of diarrhea, lower abdominal cramps, tenesmus (rectal urge) **stool = blood and mucus** systemic = fever, chills, anorexia, malaise, headache
62
How can you diagnose shigellosis?
tender abdomen, sigmoidoscopy = inflamed, engorged mucosa with punctate and large areas of ulceration Stool culture = many leukocytes + red cells
63
How do you treat shigellosis?
no treatment for mild disease! - treat dehydration/hypotension abx for severe cases/immunocompromised: fluoroquinolones (ciprofloxacin or levofloxacin) or ceftriaxone
64
What is cholera?
acute onset of severe, frequent and watery diarrhea "gray, turbid, watery, rice water" - deadly from dehydration and hypotension
65
How can you diagnose cholera?
stool culture, rapid antigen + PCR testing
66
How can you treat cholera?
oral rehydration IV fluids for severe severely ill - tetracyclines, macrolides, fluoroquinolones
67
What is campylobacter jejuni?
fever, muscle pain, malaise, headache --> crampy abdominal pain, diarrhea (watery, bad-smelling, bloody) can cause a toxic megacolon!
68
How do you treat campylobacter jejuni?
hydration and correction; self-limited severe = azithromycin, ciprofloxacin/levofloxacin
69
What are the plague presenting symptoms?
sudden onset high fever, malaise, **tachycardia, intense headache, delirium**, myalgia pneumonia can form with tachypnea, productive cough, bloody sputum, cyanosis
70
What can help you diagnose the plague?
axillary, inguinal, cervical nodes "buboes" Hematogenous spread = purpuric spots Buboe spreads Cultures, CSF, sputum
71
What is the treatment for anyone with risks of plague?
doxycycline, ciprofloxacin, levofloxacin, moxifloxacin
72
What is the treatment of the plague?
fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin) OR aminoglycosides (streptomycin, gentamycin) OR doxycycline
73
What is urethritis?
dysuria, serous/milky discharge with urethral pain, discharge (yellow, creamy, profuse) -- can regress or progress to involve more anatomy with painful inflammation (consider
74
What is urethritis usually caused by?
gonorrhea
75
How can you diagnose urethritis?
nucleic acid amplification tests; first catch AM urine
76
How can you treat urethritis/cervicitis?
IM ceftriaxone (daily for arthritis/dermatitis syndromes) Co-treat with doxycycline (non-pregnant) and azithromycin (pregnant) PCN allergic = gentamicin + azithromycin
77
How do you manage a hospital-complicated infection of urethritis/cervicitis?
IV ceftriaxone + doxycycline + metronidazole Outpatients = ceftriaxone IV, cefoxitin IM + doxycycline & metronidazole
78
What are the symptoms of cervicitis?
dysuria, urinary frequency, urgency, purulent discharge, inflammation of bartholin glands...may be asymptomatic Inflamed cervix with discharge
79
What is the triad of disseminated disease of gonorrhea?
rash, tenosynovitis (hands, wrists, feet, ankles) and polyarthralgia
80
What is chancroid?
vesicopustule develops -- painful, soft ulcer with necrotic base, surrounding erythema associated lymphadenopathy with overlying erythema fever, chills, malaise
81
How do you treat chancroid?
azithromycin PO or ceftriaxone IM
82
What is cat scratch disease?
regional lymphadenitis, papule/ulcer at inoculation site then fever, headache, malaise with regional lymphadenopathy **Do they have a history of a bite/scratch?**
83
How do you treat cat scratch disease?
z-pak! azithromycin
84
What is lymphogranuloma venereum?
initial papular/ulcerative lesion on external genitalia --> inguinal or femoral buboes post exposure breakdown of draining sinuses, extensive scarring
85
How can you diagnose lymphogranuloma venereum?
positive nucleic amplification test! LGC-specific molecular tests (but take awhile)
86
How can you treat lymphogranuloma venereum?
doxycycline, erythromycin, azithromycin
87
How can you differentiate between chlamydia and gonorrhea?
chlamydia is less painful, purulent, and more watery often no symptoms!
88
When should you screen for chlamydia?
sexually active <25 women Women >25 with risk for STIs pregnant women people with HIV men with risk of STIs
89
How do you treat chlamydia?
doxycycline, azithromycin or levofloxacin (pregnancy) presumptive gonoccocal therapy!

Clinical Medicine I (33 decks)

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