Brainscape's Knowledge GenomeTM

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


See full index

Internal Medicine - MTW - Fischer > Ch_5 - Infectious Disease > Flashcards

Ch_5 - Infectious Disease Flashcards

1
Q

Below what temp is NOT a fever?

A

<38C (100.4F) is NOT a fever

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

T/F Persistent fever is more dangerous than a single elevation

A

True

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

Normal Rectal Temp can be __C (__F) (higher/lower) than oral temp

A

Normal Rectal Temp can be 0.5C (~1F) HIGER than oral temp

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

Fever + Hypotension/Tachycardia = ?

A

SIRS (danger)

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

Fever + Hypotension/Tachycardia + acidosis + confusion = ?

A

Likely Sepsis (worse danger)

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

Fever + Hypotension/Tachycardia + acidosis + confusion + AKI + lung failure = ??

A

Severe Sepsis (death is knocking)

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

Do not send a culture (except blood culture) without what?

A

evidence of infection

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

If a sputum culture grows Staph in a patient with pneumonia, what are the reasons for growing the Staph in the sputum culture?

A
  1. Contaminant from sloppy sample collection
  2. Colonization of mouth
  3. Colonization from endotracheal or tracheostomy tube.
  4. Possible PNA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

If patient gets sepsis (fever + hypotension/tachycardia + confusion or metabolic acidosis, what should the patient get?

A

FLUIDS! – 500-1000 mL of NS
Blood cultures
and IV Antibiotics STAT!

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

Everyone with Unexplained fever needs (3)

A

Blood cultures (2 sets from different sites)
CXR
U/A

“Blood, lungs, and Urine”

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

If a patient presents with an obvious skin infection from cellulitis causing fever, does the pt need a UA?

A

No

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

Which cultures should you not do because they are useless or could be dangerous?

A
  1. No UCx unless UA shows WBCs
  2. No sputum Cx without a new infiltrate on CXR and pt produces no sputum.
  3. Do not swab a skin ulcer and send for Cx. Any ulcer will grow something, and they may not have caused the infection.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When NOT to do a Urine culture?

A

When UA shows no evidence of infection (eg, WBCs)

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

When not to do a sputum cx?

A

If there’s no infiltrate on CXR and pt doesn’t produce sputum

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

Should skin ulcer surfaces be swabbed and sent for culture?

A

No

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

What are the possible adverse consequences of unnecessary cultures?

A
  1. prolonged hospital stay
  2. giving antibiotics that have no benefits (but can harm)
  3. C. diff colitis diarrhea
  4. Resistant organisms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

T/F Wound or Urine “colonization” should be treated with antibiotics

A

False, should not!

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

an elevated WBC count (leukocytosis) should be evaluated the same way as ???

A

Fever

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

A pt presents with an elevated white count. Now what?

A

1) look for/ask about a clear cause of infection (Urine, lung, skin are MC)
2) 2 blood Cx, UA, CXR
3) No UCx unless WBCs are in UA
4) No sputum Cx unless new infiltrate on CXR and sputum is produced

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

What about “pan-culture”

A

Don’t do it! The only thing you need for fever/high WBC is a blood culture (2). Do UCx only if UA is + for WBCs and no sputum culture unless indicated.

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

Urine culture done and shows E. coli and/or fungi. Now what?

A

if there’s no evidence of infection (eg, no WBCs on U/A) then don’t treat (exception is pregnant women).

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

E. coli growing from urine w/o WBCs or dysuria can be from?

A
  1. Colonization of Foley
  2. Contamination on urine collection
  3. “Clean catch” urine can be very hard to obtain in bedbound pts, esp women, demented.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

blood cx can be contaminated with _____ from inadequate prep

A

skin bacteria (flora)

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

If blood cx grows an organism you have to make sure it’s…?

A

…a true infection and not a contaminant.

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

If blood cx grows an organism you have to make sure it’s a true infection and not a contaminant. How can one tell whether it’s a true infection (or limit the result to be of a contaminant?)

A

if same organism is grown from multiple sites (thus, taking at least 2 blood cx from MULTIPLE sites is key!)

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

the only routine culture in a febrile patient is…

A

a blood culture.

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

When should you suspect sepsis?

A
  1. Fever + hypotension + tachycardia
  2. Metabolic acidosis (pH < 7.2) w/ low HCO3
  3. Incr anion gap
  4. Resp alkalosis (compens) PCO2 <35
  5. high/low WBC (less important than acidosis and hypotension)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What should you order for a pt with sepsis?

A

blood cx
UA
CXR
Abx NOW! – don’t wait for lab results (can’t wait 1-2 days for blood cx results if pt is septic.

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

in addition to sepsis signs, what sx/sy would make you believe a pt is in severe sepsis?

A

organ dysfunction – renal, hepatic, CNS disturbance

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

Treatment of sepsis is ..

A

empiric (prior to culture results)

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

Is there one single treatment for all sepsis?

A

No

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

How do you generally empirically treat sepsis?

A

Vancomycin + 1 of the following

  1. Zosyn (pipercillin/tazobactam) or Timentin (Ticarcillin/Clavulanic acid)
  2. Carbapenem (DIM - Doripenem, Imipenem, Meropenem)
  3. Cefepime or Ceftazidime
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How do you generally treat severe sepsis?

A

Tx of sepsis (eg, Vanc + Zosyn) + a second gram-negative agent:

  1. FQ
  2. Monobactam (Aztreonam)
  3. Aminoglycoside (Gentamicin, Amikacin, Tobramycin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Name the commonly used FQs [4]

A
  1. Ciprofloxacin
  2. Levofloxacin
  3. Moxifloxacin
  4. Gemifloxacin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

T/F Ciprofloxacin covers pneumococcus

A

False

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

Name the group of Abx that cover Gram-neg rods

A

FQs, some Penicillins, Cephalosporins, AGs, Monobactem (Aztreonam) and Carbapenems

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

Which 2 penicillin agents cover gram-neg rods?

A

Pipercillin, Ticarcillin

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

What must the 2 penicillin agents be combined with to cover for gram-neg rods?

A

a beta-lactamase inhibitor
Pipercillin - tazobactam
Ticarcillin - Clavulonate

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

What are the 4 commonly used Cephalosporins against gram-neg rods?

A

Ceftriaxone
Cefotaxime
Cefepime
Ceftazidime

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

What is considered the #1 Cephalosporin agent against pneumococcus?

A

Ceftriaxone

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

What are the 3 common aminoglycosides (AGs) used against gram-neg rods?

A

GTA

Gentamicin, Tobramicin, Amikacin

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

Should aminoglycosides be used as single agents against gram-neg rods?

A

No!

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

What is the common monobactem that is used against gram-neg rods?

A

Aztreonam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Which beta-lactam does not have cross-reaction with penicillin?

A

Aztreonam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are the 4 carbapenems commonly used against gram-neg rods?

A

DIME

Doripenem, Imipenem, Meropenem, Ertapenem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Which carbapenem does not cover Pseudomonas?

A

Ertapenem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Pt has PCN allergy (rash only), can Ceph’s be used

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Staph and Strep commonly cause which diseases (organs)?

A

Bone/heart/skin/joint infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are the IV meds used against Staph aureus and Strep pyogenes?

A

IV Oxacillin, IV Nafcillin, IV Cefazolin (1st gen Ceph)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are the Oral meds used against S. aureus and Strep pyogenes?

A

PO Dicloxacillin, PO Cephalexin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Oxacillin route of administration?

A

IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Dicloxacillin route of administration?

A

PO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Nafcillin route of administration?

A

IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Cefazolin route of administration?

A

IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Cephalexin route of administration?

A

PO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What are the common gram-neg rods?

A

E.coli, Enterobacter, Pseudomonas, Citrobacter, Klebsiella, Proteus, Serratia, Morganella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Gram-neg rods often cause what diseases (organs)?

A

GI/UTI/Liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Anaerobes often cause what diseases (organs)?

A

Abdominal/Lung, Abscesses

59
Q

GI diseases 2/2 anaerobes are often tx w/ what meds?

A

Flagyl (Metronidazole)
Carbapenems
B-lactam/lactamase

60
Q

Respiratory diseases 2/2 anaerobes are often tx w/ what meds?

A

Clindamycin

B-lactam/lactamase

61
Q

Tigecycline covers ___ and ___

A

MRSA and G(-) rods

62
Q

MRSA infection can be divided into 2 types…

A

Severe infections and minor localized infection

63
Q

‘Severe’ MRSA = ??

A

Lung, Heart, CNS, Bacteremia

64
Q

‘Minor localized’ MRSA = ??

A

Skin

65
Q

Severe MRSA drug options

A
  1. Vancomycin
  2. Linezolid
  3. Daptomycin
  4. Tigecycline
  5. Ceftaroline
66
Q

Minor localized MRSA drug options

A
  1. Bactrim (TMP/SMX)
  2. Clindamycin
  3. Doxycycline
  4. Linezolid
67
Q

Common dangerous adverse effect of Linezolid?

A

Thrombocytopenia

68
Q

Common dangerous adverse effect of Daptomycin?

A

CPK elevation

69
Q

T/F Daptomycin is not effective in the lungs

A

True

70
Q

Which cephalosporin covers MRSA?

A

Ceftaroline

71
Q

What are the 4 commonly used Beta-lactam/Beta-lactamase antibiotics?

A
  1. Unasyn (Ampicillin/Sulbactam)
  2. Augmentin (Amoxacillin/Clavulonate)
  3. Zosyn (Piperacillin/Tazobactam)
  4. Timentin (Ticarcillin/Clavulonate)
72
Q

What is the generic name for Unasyn?

A

Ampicillin/Sulbactam

73
Q

What is the generic name for Augmentin?

A

Amoxacillin/clavulanate

74
Q

What is the generic name for Zosyn?

A

Piperacillin/Tazobactam

75
Q

What is the generic name for Timentin?

A

Ticarcillin/Clavulante

76
Q

The beta-lactam/beta-lactamase meds all cover what?

A
  1. Streptococcus
  2. Anaerobes
  3. Most gram-(-) rods
    - -Piperacillin and Ticarcillin also cover Pseudomonas
77
Q

What does the beta-lactamase inhibitor do? Why add it to the beta-lactam?

A

Adds Staph coverage

Expands gram-neg rod coverage

78
Q

Which Abx are safe in pregos?

A
  1. Penicillins (ALL of them)
  2. Cephs (ALL)
  3. Aztreonam
  4. Carbapenems
  5. Nitrofurantoin (eg, UTI)
  6. Metronidazole
  7. Azithromycin
79
Q

Flagyl + EtOH –>??

A

Disulfuram-like reaction –> Nausea + Vomiting

80
Q

Flagyl adverse effects?

A

Metal taste

CNS disturbance

81
Q

Imipenem adverse effect?

A

Seizures

82
Q

Quinolones adverse effects?

A
  1. Bone/tendon growth abnormality
  2. Avoid in pregnancy/children
  3. Rare QT prolongation
83
Q

All UTIs present with?

A

Dysuria

84
Q

What is dysuria?

A

“F U Bitch”
Frequency
Urgency
Burning

85
Q

What is urinary frequency?

A

urge to urinate often, without much urine coming out

86
Q

what question can you ask to assess for urinary urgency?

A

“When you feel you have to go, do you feel you have to RUN to the bathroom?”

87
Q

Frequency vs Polyuria

A 
Frequency = going often, may or may not pee a lot
Polyuria = increased volume of urine (eg, DM, DI)
88
Q

What clinical presentation do you expect in a pt with Cystitis?

A

look for Dysuria (FUB) + Suprapubic/bladder pain + Afebrile + UA > 5-10 WBCs

89
Q

Patient presents with dysuria, suprapubic pain + U/A 6 WBCs. T* 37.3*C. Next best step in therapy?

A

start treatment with Abx (Nitrofurantoin, Fosfomycin, or Bactrim). Do not wait for results of urine culture.

90
Q

What are the drugs to use for Cystitis?

A

Nitrofurantoin
Fosfomycin
Bactrim

91
Q

What dose of Nitrofurantoin may you use to tx Cystitis?

A

Nitro 100 mg BID x 5 days

92
Q

What dose of Fosfomycin may you use to tx Cystitis?

A

Fosfo 3 g single dose

93
Q

What dose of Bactrim (TMP/SMX) may you use to tx Cystitis?

A

Bactrim DS 1 bid x 3 days

DS = double strength

94
Q

What would you do if the cystitis is “complicated”?

A

extend length of Abx

95
Q

Who is treated longer for cystitis, males or females?

A

Males b/c of longer UT and likely anatomical defect.

96
Q

Male presents with UTI. Next step after empiric treatment?

A

Renal/Urinary tract imaging with U/S or CT.

97
Q

Complicated UTIs need at least how many days of therapy?

A

7 days.

98
Q

What is usually the case when a patient has a complicated UTI?

A

obstruction or foreign body 2/2

  1. stone
  2. stricture
  3. tumor, obstruction, neurogenic bladder
  4. Pregnancy
  5. catheters
  6. diabetes
99
Q

what is the clinical presentation of Pyelonephritis?

A

Dysuria + UA w/ WBC (more than in cystitis)

  1. Flank or CVA tenderness and pain
  2. FEVER!!!
  3. More “sick” than cystitis
100
Q

What do you need to do diagnostically in someone with dysuria + WBC on UA + CVA tenderness + fever?

A

Get U/S or CT to determine CAUSE of UTI.

eg, to look for stone, stricture, obstruction

101
Q

If patient gets recurrent UTIs, what may be the underlying cause?

A

anatomic problem causing the pyelo that is not detected on US or CT.

102
Q

Outpatient Tx of Pyelo?

A

PO Ciprofloxacin 750 mg bid for 10-14 days.

103
Q

What is the clinical significance b/w PO and IV Cipro

A

PO Cipro at higher dose (750 mg bid) has a similar “area under the curve” as IV cipro (ie, bioavailability).

104
Q

Inpt tx of pyelo?

A

Ceftriaxone 1 g q 24 hours
Ciprofloxacin
Ampicillin and Gentamicin
Meropenem, b-l/b-lase (severe, complicated cases)

105
Q

If a pt has a resistant organism causing pyelonephritis, what can they develop?

A

Perinephric abscess

106
Q

T/F A pt with pyelonephritis will not improve after 5-7 days of treatment.

A

True, especially if they have a resistant organism causing a perinephric abscess

107
Q

Pt with a perinephric abscess would show what on CT?

A

CT of kidneys will show a collection under the capsule.

108
Q

What is required in the management of a perinephric abscess?

A

CT-guided biopsy/aspiration. Appropriate therapy has to be tailored to what is found in the culture.

109
Q

How are skin infections diagnosed?

A

By physical exam (appearance). There’s, generally, no specific diagnostic test.

110
Q

Why are there, generally, no specific, useful diagnostic tests for skin infections?

A

Swab cultures are worse than useless and aspirations yield little.

111
Q

How many skin infections cause bacteremia?

A

<5%.

112
Q

What is cellulitis?

A

deep tissue infection in the subcutaneous tissues and dermis.

113
Q

Is drainage common in cellulitis?

A

no

114
Q

What is the MC organism that causes cellulitis?

A

S. aureus

115
Q

What is another common cause of cellulitis?

A

Group A beta hemolytic Strep pyogenes (less common than S. aureus).

116
Q

List the following skin infections from superficial to deep.

Erysipelas, Impetigo, Cellulitis

A

Superficial –> Deep

Impetigo –> Erysipelas –> Cellulitis

117
Q

Bright red and warm/hot skin ‘rash’
somewhat deep
culture shows GAS
Who am I?

A

Erysipelas

118
Q

T/F Erysipelas is easier to determine by appearance

A

False

119
Q

Superficial skin infection

“weeping, crusting, oozing lesion that may look like honey

A

Impetigo

120
Q

IV treatment for skin infections (eg, cellulitis)

A

IV Oxacillin, Nafcillin
IV Cefazolin (Ancef)
IV Vancomycin if no response after 2-3 days or anaphylaxis to Penicillin

121
Q

Dose of IV oxacillin or nafcillin for skin infection (eg, Cellulitis)

A

1-2 grams q 4 hrs

122
Q

Dose of IV Cefazolin for skin infection

A

1-2 grams q 8 hrs

123
Q

Dose of IV Vancomycin for skin infection

A

1 gram q 12 hours

124
Q

Is Cefazolin safe when patient has rash allergy to penicillin?

A

yes

125
Q

Topical meds for skin infection caused by staph or strep?

A

Mupirocin (Bactroban)
or
Retapamulin

126
Q

What is muporocin used for?

A

It’s a topical antibiotic used against staph/strep skin infections

127
Q

What is Retapamulin used for?

A

It’s a topical antibiotic used against staph/strep skin infections

128
Q

Oral meds against staph/strep skin infections?

A

PO Dicloxacillin or Cloxacillin
PO Cephalexin (Keflex)
anti-MRSA (local) abx (Bactrim, Clindamycin, Doxycycline, Linezolid)

129
Q

How much of dicloxacillin or cloxacillin should be used for staph/strep skin infections?

A

PO, 500 mg 4x/day

130
Q

How much of cephalexin (Keflex) should be used for staph/strep skin infections?

A

PO, 500 mg 4x/day

131
Q

Endocarditis - look for what in the patient?

A

fever

new murmur or change in a murmur

132
Q

Risks of endocarditis

A

injection drug use

prosthetic valves

133
Q

Rare manifestations of endocarditis

A

embolic events (splinter hemorrhage, Roth spots in eye, Janeway/Osler’s in hands/feet).

134
Q

T/F Persistent bacteremia may be a feature of endocarditis

A

true

135
Q

patient is an IV drug user, fever, new murmur.

  • MLDx?
  • first best test?
A 
Endocarditis
Blood cultures (3) to rule out ec.
136
Q

What is a strong clinical indicator of endocarditis?

A

sustained or persistent bacteremia

137
Q

patient is an IV drug user, fever, new murmur.

  • MLDx?
  • first best test?
  • first test is +, next best diagnostic step?
A
  • endocarditis
  • blood cultures (+)*
  • ECHO (TTE first)

*if suspicion for ec is high, start empiric Abx tx

138
Q

When would you do a TEE for endocarditis?

A

If TTE is negative and there is persistent bacteremia.

TEE is 95% Sn and Sp.

139
Q

What would you expect to see on ECHO for endocarditis?

A

vegetations

murmurs

140
Q

When should treatment for endocarditis be started if suspicion is high?

A

as soon as 3 blood cx are obtained.

141
Q

Empiric antibiotic therapy for endocarditis?

A

Vancomycin + Gentamicin

142
Q

When should antibiotics be changed for endocarditis?

A

once blood cx grow and the specific organism and sensitivity is known, switch abx

143
Q

Pt with suspected endocarditis has positive blood culture of an organism that is sensitive to PCN. The patient had been on vanc + gent. Next best step?

A

Switch from Vanc –> PCN b/c of more efficacy!

Internal Medicine - MTW - Fischer (11 decks)

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