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Boc G - Infections > Clinical > Flashcards

Clinical Flashcards

1
Q

With what can you treat Streptococcus pneumoniae meningitis?

A
  • Penicillin G or Ampicillin (pen susceptible)
  • Cefotaxime or Ceftriaxone IV
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2
Q

With what can you treat Neisseria meningitidis?

A
  • Penicillin G or Ampicillin (pen susceptible)
  • Cefotaxime or Ceftriaxone IV
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3
Q

With what can you treat Haemophilus influenzae (type B) meningitis?

A
  • Cefotaxime or Ceftriaxone IV
  • Ampicillin (if susceptible)
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4
Q

With what can you treat Group B streptococcus meningitis and Listeria monocytogenes meningitis?

A

Beta lactam IV

+

aminoglycoside IV

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5
Q

What other therapy is recommended to treat meningitis?

A

Steroids to prevent neurological damage (especially to hearing) due to inflammatory and cytokine influx

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6
Q
  • 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?

A

Encephalitis

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7
Q

What is the empiric treatment of herpes simplex encephalitis?

A

Acyclovir 500 mg/m2/dose iv q 8 h (20 mg/kg/dose in neonates) x 21 days

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8
Q

What are the 3 types of meningitis that you have to declare to public health and investigate the source?

A
  1. N. meningitidis
  2. H. influenzae
  3. L. monocytogenes
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9
Q

What is the classic meningitis triad?

A
  1. fever
  2. nuchal rigidity
  3. altered mental status
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10
Q

What are the causes of meningitis in neonates?

A
  1. Group B streptococcus
  2. Gram negative enteric rods
  3. Listeria monocytogenes
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11
Q

What are the causes of meningitis in infants (1-3 months)?

A
  1. Group B streptococcus
  2. Gram negative enteric rods
  3. Listeria monocytogenes
  4. Streptococcus pneumoniae
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12
Q

What are the causes of meningitis in children?

A
  1. Streptococcus pneumoniae
  2. Neisseria meningitidis
  3. Haemophilus influenzae (type B)
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13
Q

What are the causes of meningitis on adults?

A
  1. Streptococcus pneumoniae
  2. Neisseria meningitidis
  3. Listeria monocytogenes
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14
Q

What are the causes of Healthcare-Associated Bacterial Meningitis?

A
  1. Pseudomonas aeruginosa (aerobic gram-negative bacilli)
  2. Staphylococcus
  3. Propionibacterium acnes
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15
Q

How do you treat a neonate with meningitis?

A

Ampicillin IV + Cefotaxime IV (3rd generation of cephaloporin)

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16
Q

How do you treat an infant with meningitis?

A

Ampicillin IV + Vancomycin IV

+

Cefotaxime or Ceftriaxone IV

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17
Q

How do you treat a child with meningitis?

A

Cefotaxime or Ceftriaxone IV

+

Vancomycin IV

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18
Q

How do you treat an adult with meningitis?

A

Ampicillin IV + Vancomycin IV

+

Cefotaxime or Ceftriaxone IV

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19
Q

How do you treat Healthcare-Associated Bacterial Meningitis?

A

Vancomycin and Ceftazidime

or

Vancomycin and Cefepime

or

Vancomycin and Meropenem

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20
Q
  • 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?

A

Meningitis (DUH)

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21
Q

What is the treatment of pharyngitis?

A

FOR GAS: Penicillin, amoxicillin, 1st generation cephalosporins

Treat for 10 days to prevent complications

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22
Q

What are the causes of pneumonia in infants and young children?

A

– Gr B strep

– RSV, parainfluenza, influenza

– S. pneumonia and H. influenza type B (now less frequent since vaccines)

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23
Q

What are the causes of pneumonia in young adults?

A

– Mycoplasma, chlamydophyla (“atypicals”)

– Influenza

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24
Q

What are the causes of pneumonia in older adults?

A

– S. pneumo, H. influenza, S. aureus, gram negatives

– TB

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25
Q

A COPD patients has a pneumonia, what organism do you suspect?

A
  • H. influenza
  • S. pneumonia
  • Moraxella
  • Legionella
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26
Q

An hospitalized patient develops pneumonia, what organism do you suspect?

A

G(-) pathogens

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27
Q

Pneumonia post-influenza, what organism do you suspect?

A
  • Staphylococcus
  • S. pneumonia
  • H. influenza
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28
Q

Alcoholic patient with pneumonia, what organism do you suspect?

A
  • S. pneumonia
  • H. influenza
  • Klebsiella
  • anaerobes
  • TB
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29
Q

What is the gold standard diagnosis tool of pneumonia?

A

radiology: CXR

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30
Q

What is the treatment of Acute Pharyngitis?

A

Penicillin, amoxicillin, 1st generation cephalosporins

For penicillin-allergic: clindamycin, macrolides

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31
Q

In a patient in palliative care with fungal infection, what is the contraindication?

A

Never give systemic oral anti-fungal if they take midazolam or triazolam as a sedative agent = TOXIC LEVELS

32
Q

Standard treatment of active TB?

A
  1. Isoniazid
  2. Rifampin
  3. Pyrazinamide
  4. Ethambutol

At least for 24 weeks

33
Q

Standard treatment for latent TB?

A

Rifampin for 4 months (better than Isoniazid for 9 months)

34
Q

What is the most common pathogen of Hematogenous osteomyelitis?

A

Staphylococcus aureus

35
Q

How do we work up an osteomyelitis?

A
  1. Vitals
  2. Stick an instrument in the hole (lol)
  3. Bone biopsy (gold standard)
  4. Imaging: MRI
  5. Systemic: CBC, CRP, blood culture
36
Q

What is the most common pathogen of hematogenous mono-mibrobial NATIVE joint infection?

A
  1. S. aureus
  2. N. gonorrhoeae
37
Q

How do you investigate a joint infection?

A
  1. Synovial fluid aspiration (gold standard)
  2. U/S: confirm effusion/guide aspirate
  3. Systemic: CBC
38
Q

What is the most common pathogen of prosthetic joint infection?

A

S. aureus

Staphylococci:

1) Coagulase-negative
2) S. aureus

39
Q

Do you recap a needle after you used it?

A

NEVER FOR FUCK’S SAKE

40
Q

What workers are at risk of work related infectious diseases?

A
  • 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)
41
Q

What percentage of people exposed to TB will develop TB during their lifetime?

A

10% (HIGH YIELD)

42
Q

Someone has meningitis and is allergic to Penicillin. What do you give?

A

Trimethoprim-sulfamethoxazole (Septra) IV

43
Q

Febrile neutropenic patient: what must you absolutely cover?

A
  • Gut organisms (including anaerobes)
  • Pseudomonas aeruginosa
  • Staphylococcus aureus
  • Respiratory organisms
44
Q

Humoral Immunity Dysfunction: sucpeptible to which pathogens?

A
  • S. pneumoniae
  • H. influenzae
  • Mycoplasma spp
  • Moraxella catarrhalis
45
Q

Cellular Immunity Dysfunction: suceptible to which organism?

A
  • Intracellular organisms (Salmonella spp, Listeria monocytogenes, Mycobacterium spp)
  • Fungi (including Pneumocystis jiroveci), viruses, parasites (Toxoplasma gondii)
46
Q

Complement Immunity Dysfunction: suceptible to which pathogen?

A

Neisseria meningitidis

47
Q

Neutropenia (not due to chemotherapy): suceptible to which pathogen?

A

COMMUNITY ORGANISMS

  • S. pneumoniae
  • S. aureus
  • Mycoplasma spp
  • UTI
  • Respiratory viruses
  • N. meningitidis
48
Q

Hyper IgE (Job) syndrome: suceptible to which pathogen?

A

S. aureus (skin and severe invasive disease)

49
Q

Chronic granulomatous disease: suceptible to which pathogen?

A

CATALASE positive organisms: S.aureus, Aspergillus spp

50
Q

Asplenia or splenic dysfunction: suceptible to which organisms (ex. Sickle cell disease)?

A

Encapsulated organisms

  • S. pneumoniae
  • H. influenzae
  • N. meningitidis
  • Salmonella
51
Q

What are the predisposing factors of infective endocarditis?

A
  • Native Valve problem (the valves with which you are born)
  1. Rheumatic heart disease
  2. Congenital heart disease (some but not all)
  3. Degenerative heart disease
  4. Mitral valve prolapse: uncontrolled bacteremia and/or history of prior endocarditis
  • Prosthetic valve
  • Endovascular device utilization
  • IVDU
52
Q

What valve is the most affected by infective endocarditis?

A

Mitral valve

53
Q

What are the major criteria of infective endocarditis?

A
  1. Blood culture positive
  2. Evidence of endocardial involvement
54
Q

What are the minor criteria of infective endocarditis?

A
  1. Predisposition
  2. Fever
  3. Vascular phenomenon (spleen, lung, liver, CNS)
  4. Immunologic phenomenon
  5. Microbiological evidence
55
Q

What is the work-up steps of infective endocarditis?

A
  1. Blood culture (MOST IMPORTANT DX TEST; 3 sets of 2 bottles in 24 hours)
  2. Trans-thoracic electrocardiogram (TTE): rare false negative
  3. Trans-oesophageal electrocardiogram (TEE): some false negative so cannot exclude if negative
  4. Clinical criteria: 2 major OR 1 major and 3 minor OR 5 minor
56
Q

This Classic Triad is a sign of wath in a newborn:

  1. Hydrocephaly
  2. Diffuse intracranial calcifications
  3. Chorioretinitis
A

Toxoplasma infection

57
Q

What is the #1 determinant of severity of fetal congenital infection?

A

The time on onet during gestation

58
Q

What are the treatable fetal congenital infection you CANNOT MISS?

A
  • Toxoplasma
  • Syphilis
  • HSV
  • HIV
  • Hepatitis B
  • CMV
59
Q

Baby presents with hearing loss at 2-3 weeks of age. What do you suspect?

A

CMV

60
Q

What is the most common CAUSE of UTI?Ob

A

Obstruction via catheter

61
Q

What are the most common pathogens causing Otitis externa (swimmer’s ear)?

A
  1. Pseudomonas aeruginosa
  2. Staphylococcus aureus
62
Q

What are the most common pathogen of fungi otitis?

A
  1. Aspergillus
  2. Candida
63
Q

What are the most common pathogen of otitis media?

A
  1. Streptococcus pneumoniae
  2. Haemophilus influenzae
64
Q

What is the first line of treatment of otitis media (HIGH YEILD QUESTION)?

A

amoxicillin IS FIRST LINE OF TREATMENT or macrolides IF ALLERGIC TO PENICILINI

65
Q

What is the most common pathogen causing Parotitis?

A

S. Aureus

66
Q

What is the most common pathigen causing chronic sinusitis?

A

Pseudomonas

67
Q

What is the most common pathogen causing impetigo and folliculitis?

A

S. aureus

68
Q

What is the most common pathogen that causes cellulitis and nec fasc?

A

GAS

69
Q

What causes scarlet fever?

A

GAS

70
Q

This triad is a sign of what?

1) polyarthralgia/arthritis
2) dermatitis
3) tenosynovitis

A

Disseminated Gonnococcal infection

71
Q

What are the causes of BLOODY diarrhea?

A

SSCYE

»Shigella spp

»Salmonella spp

»Campylobacter jejuni

»Yersinia enterocolitica

»Escherichia coli O157

72
Q

Someone presents with Urethritis/ cervicitis, what’s you differentials?

A
  1. Neisseria gonorrhoeae
  2. Chlamydia trachomatis
  3. Trichomonas vaginalis
73
Q

Someone presents with Genital ulcer disease, what are your differentials?

A
  1. Herpes Simplex Virus
  2. Treponema pallidum
  3. Chlamydia trachomatis: LGV
74
Q

Genital warts is a sign of what?

A

Human Papilloma Virus

75
Q

What do those values mean?

  • Temperature > 38 or < 36
  • HR > 90
  • RR > 20 or PaCO2 < 32
  • WBC < 12 000 or < 4000
A

SEPSIS

76
Q

What is the line of treatment of otitis media with a perforation?

A

fluoroquinolone (HIGH YEILD)

Boc G - Infections (7 decks)

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