Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

IPT: ID > Block 2 - CNS, SSTI, DFI > Flashcards

Block 2 - CNS, SSTI, DFI Flashcards

1
Q

What AB have good penetration to CNS?

A

Penicillins such as aq. Pen G, Nafcillin, and Ampicillin

Ceph such as ceftriaxone, ceftazidime, and cefepime

Carbapenems

Others such as Bactrim, Vanco, Oxazolidinones, cipro, and moxi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Risk factors of CA meningitis?

A

Lack of vaccinations/Immunocompromised

Asplenic

Dental procedures

Endocarditis

Unpasteurized dairy

CVC or shunts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

CA Meningitis Patho?

A

Nasopharyngeal colonization

Transports to blood

Organisms avoid phagocytosis

Infects choroid plexus and bacteria is in CSF

**If in infants, its related to birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Symptoms of CA meningits?

A

Nuchal rigidity

AMS

Photophobia

N/V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Signs of CA meningitis?

A

Kernig and Brudzinski’s sign

Fever

Skin lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Kernig’s sign?

A

Cant fully extend leg when hips are flexed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is Brudzinski’s sign?

A

When neck is passively flexed, hips and knees are flexed as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Besides blood cultures, what else do you need to diagnose meningitis?

A

Lumbar puncture (risk of hernication)

Strep and Listeria antigen tests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some CSF findings for CA meningitis?

A

WBC 100-1000s

Serum glucose ≤0.4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the common pathogens found in CA meningitis?

A

1 month to >50yrs old = N. meningitidis + S. pneumonniae

L. mono is found in the extremes only (<1 month and >50 yrs)

Group B strep + E. coli is found on the younger sides (<2 yrs old)

1-23 months have H. influenzae

<1 month have Klebsiella spp.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CA meningitis Tx for adults

Empiric AB

A

Vanco

LD 25-30mg/kg x1

MD 15-20mg/kg q8-12hr

Ceftriaxone 2g q12h

+/- Ampicillin 12g continuous for <1 month or >50yrs old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Adjunctive agents for CA meningitis Tx for adults?

A

Decadron 0.15mg/kg q6h for 2-4 days before 1st dose of AB

**Only for pneumococcal meningitis in adults or haemophilus in pediatrics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

H. influenzae, beta-lactamase negative CA meningitis.

Tx?

A

Ampicillin x7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

H. influenzae, beta-lactamase positive CA meningitis.

Tx?

A

3rd Gen ceph x7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

L. mono CA meningitis.

Tx?

A

Ampicillin ≥21 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

N meningitidis CA meningitis

Tx?

A

Depends on MIC

Penicillin or ampicillin x7 days

3rd gen ceph x7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

S. pneumoniae CA meningitis

Tx?

A

Depends on MIC

Penicillin or ampicillin x14 days

3rd gen ceph x14 days

Vanco x14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Monitoring parameters for CA meningitis?

A

WBC xday

CSF at baseline and x2-3 days

Vanco - measure UOP daily

Ceftriaxone - dont mix with LR + measure LFTs

Ampicillin - watch for fluid overload

Decadron - measure BP and BG daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

PCV13 vs PCV23

Which one should children get?

A

PCV13

Adults w/ risk factors or anyone ≥65yo can get it too

PCV23 excludes the kids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Who needs the ACWY vaccine?

A

Childhood vaccine, adults with risk factors for N. meningitidis

B = lab personnel or outbreak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which vaccines are needed to prevent CA meningitidis?

A

S. pneumoniae (PCV13/23)

N. meningitidis (ACWY, B)

H. influenzae B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

CA vs HA meningitidis

No instrumentation or trauma

A

CA meningitidis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How does the CDC define HA meningitidis?

A

One of the following from each group:

{fever/headache, meningeal or cranial signs}

+

{CSF, blood cultures, titer (positive findings)}

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Risk factors of HA meningitidis?

A

Catheterization for >5 days

Perioperative steroids

Trauma

d/c of device

CSF shunts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

CA vs HA meningitidis

Some patients will not present with any signs or symptoms and some will have a very mild, non-specific appearance (new fever and increased wbc)

A

HA meningitidis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the pathogens found in HA meningitidis?

A

Staph, P. acnes

E. coli, enterobacter, citrobacter, P. aeruginosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Empiric AB therapy for HA meningitidis?

A

Vanco for G+ (Staph and p. acnes)

+ Ceftazidime, cefepime, Merrem**

(**can replace with aztreonem or cipro if allergic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

MSSA/MSSE HA meningitidis

Tx?

A

Nafcillin or Oxacillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

MRSA/MRSE HA meningitidis

Tx?

A

Vanco + Rifampin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

MRSA w/ >1 MIC HA meningitidis

Tx?

A

Zyvox, dapto, or bactrim

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

P. acnes HA meningitidis

Tx?

A

Pen G

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

P. aeruginosa HA meningitidis

Tx?

A

Cefepime, ceftazidime, Merrem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Carbapenem-resistant enterobacteriaceae HA meningitidis

Tx?

A

Colistin or polymyxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

When should you put in a new device once CSF cultures are negative?

A

Not for at least 10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are some common pathogens for encephalitis?

A

HSV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Risk factors for encephaltis?

A

STDs

Geographically, travel history

Insects or animals

Vaccination history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are some diagnostic tests you can do for encephalitis?

A

Blood, CSF

Wound if vesicles are found (HSV, VZV)

Biopsy

IgG, IgM testing

MRI (sensitive and specific), can do CT if MRI is nonexistent

Temporal lobe enhancement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Encephalitis Tx?

A

Acyclovir 10mg/kg (IBW) q8h x 14-21 days

Give with fluids to reduce nephrotoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Risk factors for DFI?

A

Ulcers >30 days

+ probe to bone test

Uncontrolled DM

Renal insufficiency

Loss of sensation

PVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Risk factors for amputation (related to DFI)?

A

Male, smoker

Previous osteomyelitis, retinopathy

PAD

WBC>11

Isolation of G- organism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What do you need to diagnose DFI?

A

MRI (preferred) over X-ray

Microbiology data BEFORE

Deep wound cultures AFTER debridement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

ISDA severity and DFI?

A

Uninfected - no signs (outpatient)

Infection limited to 0.5-2cm w/ no SIRS - mild (outpatient)

> 2cm w/ no SIRS - moderate (out/inpatient)

w/ SIRS - severe (inpatient)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

When would you consider moving a patient with moderate DFI to inpatient side?

A

Severe PAD or lack of home support

44
Q

Mild DFI, what are the bugs?

A

Staph and strep

45
Q

Moderate DFI, what are the bugs?

A

P. aeruginosa, MSSA, MRSA

46
Q

Severe DFI, what are the bugs?

A

Polymicrobial, MRSA, P. aeruginosa, Enterobacteriaceae, anaerobes

47
Q

Risk factors of CA MRSA + DFI?

A

History of MRSA

Mild: > 50% local MRSA

Moderate: > 30% local MRSA

48
Q

Risk factors of P. aeruginosa + DFI?

A

Warm climates

Soaking feet

Failed non-Pseudomonal therapy

49
Q

Mild, moderate, severe DFI

What routes should the Rx go through?

A

Mild = PO

Moderate = IV, then PO

Severe = IV

50
Q

What are the treatments for uninfected DFI?

A

Wound care constantly

51
Q

What are the treatments for mild DFI with no MRSA risk factors?

A

Amoxicillin- clavulanate

Cephalexin

x1-2 wks

52
Q

What are the treatments for mild DFI with MRSA risk factors?

A

Bactrim

Clinda

Doxy

x1-2 wks

53
Q

What are the treatments for moderate DFI?

A

Ampicillin-sulbactam
Ceftriaxone
Ertapenem

Piperacillin-tazobactam
(Levo or Cipro) + Clindamycin

x1-3wks

54
Q

What are the treatments for severe DFI?

A

Anti-pseudo + anti-MRSA Rx

2-4 wks if NO bone involvement

55
Q

What is the goal of wound care?

A

“create a moist wound environment to promote granulation, autolytic processes, angiogenesis, and more rapid migration of epidermal cells across the wound base”

Dry = hydrate

Draining = absorb

Necrotic = debride

56
Q

What bugs cause contiguous brain abscess?

A

Strep, Staph

Polymicrobial

Anaerobes

57
Q

What bugs cause neurosurgical procedures and/or head trauma-related brain abscess?

A

S. aureus and epidermidis

GNR

58
Q

Abscess pathophysiology?

A

Bacteria enters brain through 3 routes

  • Contiguous (50%)
  • Hematogenous (33%)
  • Unknown (~20%)

Necrosis, edema of white matter, and capsule formation (fibroblasts and neovascularization)

59
Q

What bugs cause hematogenous brain abscess?

A

Staph and strep only

60
Q

S/Sx of brain abscess?

A

Cranial-nerve palsy, gait disorder, hydrocephalus

Seizures (~25%)

61
Q

Empiric Abx for brain abscess are..?

A

Vanco LD, then MD

Ceftriaxone 2g q12h

Flagyl 500mg q8h

62
Q

CA Meningitis
HA Meningitis
Encephalitis
Brain Abscess

Which one does not use CSF cultures typically?

A

Brain abscess

63
Q

What is qSOFA?

A

Identifies sepsis

Must meet 2 of 3 criteria

SBP≤100

Altered mental status (Glasgow coma scale <15)

Respiratory rate ≥ 22

64
Q

Infection depth of Folliculitis, furuncles, carbuncles?

A

Hair follicles only

65
Q

Infection depth of Impetigo?

A

Epidermis

66
Q

Infection depth of Cellulitis & abscesses?

A

Epidermis, dermis, and/or hypodermis

67
Q

Infection depth of Necrotizing fasciitis?

A

Hypodermis

68
Q

What are the nonpurulent severity cases?

A

Mild = Typical cellulitis/erysipelas

Moderate = Mild + systemic signs of infection

Severe = Ppl who failed incision and drainage + oral Abx OR ppl with systemic signs of infection OR they are immunocompromised OR someone with deeper infections

69
Q

What are the purulent severity cases?

A

Pretty much the same as nonpurulent, but severe criteria doesnt include the deeper signs of infection part

70
Q

What are the nonpurulent skin conditions?

A

Necrotizing

Cellulitis

Erysipelas

71
Q

What are the purulent skin conditions?

A

Furuncles

Carbuncles

Abscess

72
Q

Mild nonpurulent Tx options?

A

Pen VK

Cephalosporin

Dicloxacillin

Clindamycin

x5 days

73
Q

Moderate nonpurulent Tx options?

A

Penicillin

Ceftriaxone

Cefazolin

Clindamycin

x5 days

74
Q

Severe nonpurulent Tx options?

A

Empiric = Vanco + Zosyn or merrem or imi/cilastatin

x5 days

75
Q

Mild purulent Tx options?

A

Incision and drainage

76
Q

Moderate purulent Tx options?

A

Incision and drainage; culture and sensitivity

Empiric: Bactrim or Doxy

Targeted

MRSA: Bactrim

MSSA: Cephalexin or Dicloxacillin

x5 days

77
Q

Severe purulent Tx options?

A

Incision and drainage; culture and sensitivity

Empiric: Vanco, dapto, zyvox, telavancin, ceftaroline

MRSA = Empiric

MSSA = Nafcillin, cefazolin, clindamycin

x5 days

78
Q

What are the systemic signs of infection?

A

> 38 degree celsius

> 24 breaths per min

<400 or >12K WBC count

79
Q

Impetigo general information

A

Affects epidermis

Contagious and affects children

Nonbullous and bullous forms

S. pyogenes and S. aureus

80
Q

When should you use oral therapy on impetigo?

A

If it involves the face

81
Q

Empiric therapy on impetigo (non oral)?

A

Topical mupirocin or retapamulin if mild (5 days)

82
Q

Empiric therapy on impetigo (oral)?

A

Non-bullous = dicloxacillin or cephalexin

Bullous = something that covers MSSA and MRSA

x 7 days

83
Q

Targeted therapy on impetigo?

A

Strep? Penicillin

Strep + MSSA? dicloxacillin or cephalexin

MRSA? Clinda, Doxy, Bactrim

x 7-10 days

84
Q

What is Ecthyma?

A

Deep impetigo, treat the same way as impetigo

85
Q

What is Erysipelas

A

Form of cellulitis that has red burning pain lesions caused by S. pyogenes

86
Q

How do you treat Erysipelas?

A

Mild/Moderate = Pen G IM or Pen VK, or clinda

Severe = aq Pen G IV followed by PO PCN

x7-10 days

87
Q

What is the dose for dapto for MRSA?

A

6 mg/kg IV once daily x 5 days

88
Q

Non-Pharm for Cellulitis?

A

Elevation and immobilization of involved area to decrease local swelling

COLD compress, follow with moist heat

89
Q

What causes type 1 NF?

A

Strep, enterobacteria, anaerobes

Trauma/surgery, IVDU

90
Q

What causes type 2 NF?

A

S. pyogenes

Blunt trauma, muscle strain, now more in younger people

91
Q

What causes type 3 NF?

A

C. perfringens

Trauma/surgery

92
Q

How do you treat type 1 NF?

A

Vanco + Zosyn

93
Q

How do you treat type 2 NF?

A

Pen + Clinda

94
Q

How do you treat type 3 NF?

A

Pen + Clinda

95
Q

Which NF spreads the fastest? Slowest?

A

Fastest = 3 (hours)

Slowest = 1 (3-5 days)

96
Q

Non pharm treatment of NF?

A

Surgical debridement on all types

97
Q

Why is penicillin and clindamycin given for type 2 and 3 NF?

A

Clindamycin: Suppresses streptococcal toxins and cytokine production

PCN: Added in case of bacterial resistance to clindamycin

98
Q

What is folliculitis, furuncle, and carbuncle?

A

Folliculitis = looks like severe acne, superficial, affect epidermis only

Furuncle = affects hair shaft to SQ area, generally develop in areas of friction and
perspiration

Carbuncle = furuncles that combine into one, usually on the back of neck and in diabetics

99
Q

What causes folliculitis, furuncle, and carbuncle?

A

Usually S. aureus

100
Q

How do you treat folliculitis?

A

Warm compress

Clindamycin, erythromycin, mupirocin, or benzoyl peroxide; 2-4 times daily for 7 days

101
Q

How do you treat furuncle, and carbuncle?

A

Moist heat

Bactrim, doxy, or mino for 5-10 days

102
Q

Human bite bugs?

A 
Viridans 
Streptococci
Anaerobes
Eikenella corrodons
Staphylococcus spp.
103
Q

Dog/Cat bite bugs?

A 
Viridans 
Streptococci, 
Anaerobes
Pasteurella multocida (esp. cat) 
Staphylococcus spp
104
Q

DOC for bites?

A

Augmentin

105
Q

(T/F)

Wound closure is expected for bites?

A

False

Except for the face, just irrigate, cautious debridement, and use preemptive antibiotics

106
Q

Treatments for bites with PCN allergy

A

Moxi or doxy

Bactrim or Levo or Cipro AND Flagyl or Clinda

107
Q

Treatments for bites with someone who is pregnant?

A

Augmentin

2nd or 3rd Gen ceph + Flagyl or Clinda

Ertapenem

Bactrim (2nd trimester only) + Clinda

IPT: ID (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions