Clinical Flashcards
With what can you treat Streptococcus pneumoniae meningitis?
- Penicillin G or Ampicillin (pen susceptible)
- Cefotaxime or Ceftriaxone IV
With what can you treat Neisseria meningitidis?
- Penicillin G or Ampicillin (pen susceptible)
- Cefotaxime or Ceftriaxone IV
With what can you treat Haemophilus influenzae (type B) meningitis?
- Cefotaxime or Ceftriaxone IV
- Ampicillin (if susceptible)
With what can you treat Group B streptococcus meningitis and Listeria monocytogenes meningitis?
Beta lactam IV
+
aminoglycoside IV
What other therapy is recommended to treat meningitis?
Steroids to prevent neurological damage (especially to hearing) due to inflammatory and cytokine influx
- Altered mental status ranging from subtle deficits to complete unresponsiveness
- Seizures
- Focal neurological signs: hemiparesis, cranial nerve palsies
- Behavioral/personality changes
- Fever
- Meningeal irritation eg nuchal rigidity usually absent
WHAT DO YOU SUSPECT?
Encephalitis
What is the empiric treatment of herpes simplex encephalitis?
Acyclovir 500 mg/m2/dose iv q 8 h (20 mg/kg/dose in neonates) x 21 days
What are the 3 types of meningitis that you have to declare to public health and investigate the source?
- N. meningitidis
- H. influenzae
- L. monocytogenes
What is the classic meningitis triad?
- fever
- nuchal rigidity
- altered mental status
What are the causes of meningitis in neonates?
- Group B streptococcus
- Gram negative enteric rods
- Listeria monocytogenes
What are the causes of meningitis in infants (1-3 months)?
- Group B streptococcus
- Gram negative enteric rods
- Listeria monocytogenes
- Streptococcus pneumoniae
What are the causes of meningitis in children?
- Streptococcus pneumoniae
- Neisseria meningitidis
- Haemophilus influenzae (type B)
What are the causes of meningitis on adults?
- Streptococcus pneumoniae
- Neisseria meningitidis
- Listeria monocytogenes
What are the causes of Healthcare-Associated Bacterial Meningitis?
- Pseudomonas aeruginosa (aerobic gram-negative bacilli)
- Staphylococcus
- Propionibacterium acnes
How do you treat a neonate with meningitis?
Ampicillin IV + Cefotaxime IV (3rd generation of cephaloporin)
How do you treat an infant with meningitis?
Ampicillin IV + Vancomycin IV
+
Cefotaxime or Ceftriaxone IV
How do you treat a child with meningitis?
Cefotaxime or Ceftriaxone IV
+
Vancomycin IV
How do you treat an adult with meningitis?
Ampicillin IV + Vancomycin IV
+
Cefotaxime or Ceftriaxone IV
How do you treat Healthcare-Associated Bacterial Meningitis?
Vancomycin and Ceftazidime
or
Vancomycin and Cefepime
or
Vancomycin and Meropenem
- Fever
- Poor feeding
- Vomiting
- Lethargy
- Irritability
- Bulging fontanelle (late finding)
- Seizures
- Headache with photophobia
- Neck stiffness
- Altered mental status
- Brudzinski’s and Kernig’s signs (specific) and Jolt accentuation
- Rash
WHAT DO YOU SUSPECT?
Meningitis (DUH)
What is the treatment of pharyngitis?
FOR GAS: Penicillin, amoxicillin, 1st generation cephalosporins
Treat for 10 days to prevent complications
What are the causes of pneumonia in infants and young children?
– Gr B strep
– RSV, parainfluenza, influenza
– S. pneumonia and H. influenza type B (now less frequent since vaccines)
What are the causes of pneumonia in young adults?
– Mycoplasma, chlamydophyla (“atypicals”)
– Influenza
What are the causes of pneumonia in older adults?
– S. pneumo, H. influenza, S. aureus, gram negatives
– TB
A COPD patients has a pneumonia, what organism do you suspect?
- H. influenza
- S. pneumonia
- Moraxella
- Legionella
An hospitalized patient develops pneumonia, what organism do you suspect?
G(-) pathogens
Pneumonia post-influenza, what organism do you suspect?
- Staphylococcus
- S. pneumonia
- H. influenza
Alcoholic patient with pneumonia, what organism do you suspect?
- S. pneumonia
- H. influenza
- Klebsiella
- anaerobes
- TB
What is the gold standard diagnosis tool of pneumonia?
radiology: CXR
What is the treatment of Acute Pharyngitis?
Penicillin, amoxicillin, 1st generation cephalosporins
For penicillin-allergic: clindamycin, macrolides
In a patient in palliative care with fungal infection, what is the contraindication?
Never give systemic oral anti-fungal if they take midazolam or triazolam as a sedative agent = TOXIC LEVELS
Standard treatment of active TB?
- Isoniazid
- Rifampin
- Pyrazinamide
- Ethambutol
At least for 24 weeks
Standard treatment for latent TB?
Rifampin for 4 months (better than Isoniazid for 9 months)
What is the most common pathogen of Hematogenous osteomyelitis?
Staphylococcus aureus
How do we work up an osteomyelitis?
- Vitals
- Stick an instrument in the hole (lol)
- Bone biopsy (gold standard)
- Imaging: MRI
- Systemic: CBC, CRP, blood culture
What is the most common pathogen of hematogenous mono-mibrobial NATIVE joint infection?
- S. aureus
- N. gonorrhoeae
How do you investigate a joint infection?
- Synovial fluid aspiration (gold standard)
- U/S: confirm effusion/guide aspirate
- Systemic: CBC
What is the most common pathogen of prosthetic joint infection?
S. aureus
Staphylococci:
1) Coagulase-negative
2) S. aureus
Do you recap a needle after you used it?
NEVER FOR FUCK’S SAKE
What workers are at risk of work related infectious diseases?
- Healthcare workers that manipulate needles and touch people
- Soldiers can be at risk of tropical disease
- People who work around water (E Coli, Salmonella, Gardia, enteroviruses)
- People who work with animals (farmers)
- People who work indoors in a building with mould
- Pregnant worker (Parvovirus, varicella, rubella, measles)
- Public safety and emergency response workers (bloodborne pathogens)
- Workers who travel (tropical diseases)
What percentage of people exposed to TB will develop TB during their lifetime?
10% (HIGH YIELD)
Someone has meningitis and is allergic to Penicillin. What do you give?
Trimethoprim-sulfamethoxazole (Septra) IV
Febrile neutropenic patient: what must you absolutely cover?
- Gut organisms (including anaerobes)
- Pseudomonas aeruginosa
- Staphylococcus aureus
- Respiratory organisms
Humoral Immunity Dysfunction: sucpeptible to which pathogens?
- S. pneumoniae
- H. influenzae
- Mycoplasma spp
- Moraxella catarrhalis
Cellular Immunity Dysfunction: suceptible to which organism?
- Intracellular organisms (Salmonella spp, Listeria monocytogenes, Mycobacterium spp)
- Fungi (including Pneumocystis jiroveci), viruses, parasites (Toxoplasma gondii)
Complement Immunity Dysfunction: suceptible to which pathogen?
Neisseria meningitidis
Neutropenia (not due to chemotherapy): suceptible to which pathogen?
COMMUNITY ORGANISMS
- S. pneumoniae
- S. aureus
- Mycoplasma spp
- UTI
- Respiratory viruses
- N. meningitidis
Hyper IgE (Job) syndrome: suceptible to which pathogen?
S. aureus (skin and severe invasive disease)
Chronic granulomatous disease: suceptible to which pathogen?
CATALASE positive organisms: S.aureus, Aspergillus spp
Asplenia or splenic dysfunction: suceptible to which organisms (ex. Sickle cell disease)?
Encapsulated organisms
- S. pneumoniae
- H. influenzae
- N. meningitidis
- Salmonella
What are the predisposing factors of infective endocarditis?
- Native Valve problem (the valves with which you are born)
- Rheumatic heart disease
- Congenital heart disease (some but not all)
- Degenerative heart disease
- Mitral valve prolapse: uncontrolled bacteremia and/or history of prior endocarditis
- Prosthetic valve
- Endovascular device utilization
- IVDU
What valve is the most affected by infective endocarditis?
Mitral valve
What are the major criteria of infective endocarditis?
- Blood culture positive
- Evidence of endocardial involvement
What are the minor criteria of infective endocarditis?
- Predisposition
- Fever
- Vascular phenomenon (spleen, lung, liver, CNS)
- Immunologic phenomenon
- Microbiological evidence
What is the work-up steps of infective endocarditis?
- Blood culture (MOST IMPORTANT DX TEST; 3 sets of 2 bottles in 24 hours)
- Trans-thoracic electrocardiogram (TTE): rare false negative
- Trans-oesophageal electrocardiogram (TEE): some false negative so cannot exclude if negative
- Clinical criteria: 2 major OR 1 major and 3 minor OR 5 minor
This Classic Triad is a sign of wath in a newborn:
- Hydrocephaly
- Diffuse intracranial calcifications
- Chorioretinitis
Toxoplasma infection
What is the #1 determinant of severity of fetal congenital infection?
The time on onet during gestation
What are the treatable fetal congenital infection you CANNOT MISS?
- Toxoplasma
- Syphilis
- HSV
- HIV
- Hepatitis B
- CMV
Baby presents with hearing loss at 2-3 weeks of age. What do you suspect?
CMV
What is the most common CAUSE of UTI?Ob
Obstruction via catheter
What are the most common pathogens causing Otitis externa (swimmer’s ear)?
- Pseudomonas aeruginosa
- Staphylococcus aureus
What are the most common pathogen of fungi otitis?
- Aspergillus
- Candida
What are the most common pathogen of otitis media?
- Streptococcus pneumoniae
- Haemophilus influenzae
What is the first line of treatment of otitis media (HIGH YEILD QUESTION)?
amoxicillin IS FIRST LINE OF TREATMENT or macrolides IF ALLERGIC TO PENICILINI
What is the most common pathogen causing Parotitis?
S. Aureus
What is the most common pathigen causing chronic sinusitis?
Pseudomonas
What is the most common pathogen causing impetigo and folliculitis?
S. aureus
What is the most common pathogen that causes cellulitis and nec fasc?
GAS
What causes scarlet fever?
GAS
This triad is a sign of what?
1) polyarthralgia/arthritis
2) dermatitis
3) tenosynovitis
Disseminated Gonnococcal infection
What are the causes of BLOODY diarrhea?
SSCYE
»Shigella spp
»Salmonella spp
»Campylobacter jejuni
»Yersinia enterocolitica
»Escherichia coli O157
Someone presents with Urethritis/ cervicitis, what’s you differentials?
- Neisseria gonorrhoeae
- Chlamydia trachomatis
- Trichomonas vaginalis
Someone presents with Genital ulcer disease, what are your differentials?
- Herpes Simplex Virus
- Treponema pallidum
- Chlamydia trachomatis: LGV
Genital warts is a sign of what?
Human Papilloma Virus
What do those values mean?
- Temperature > 38 or < 36
- HR > 90
- RR > 20 or PaCO2 < 32
- WBC < 12 000 or < 4000
SEPSIS
What is the line of treatment of otitis media with a perforation?
fluoroquinolone (HIGH YEILD)
