Clinical Questions - Infectious Disease Flashcards

1
Q

What is the empiric treatment for osteomyelitis

A

IV Vancomycin
Fluoroquinolone - good bone penetration - cipro or levaquin
3rd gen cephalosporine - ceftazidine
4th gen cefepime

Surgical debridement
Hyperbaric O2
Negative pressure wound therapy

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2
Q

septic arthritis - presentation and steps to diagnosis

A

Risk factors: Hx of IV drug use, multiple sexual partners

Presentation: painful joint, fever
Labs: elevated WBC and ESR

Arthrocentesis with joint fluid analysis

  • WBC count >50K
  • GS and Cx
  • Histology
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3
Q

Exam findings of bacterial endocarditis and treatment

A
Fever
New murmur
Osler's nodes
Janeqay lesions
Splinter hemorrhages (non specific)
Roth Spots on fundoscopy - hemorrhages

Tx:
Empiric Abx - IV vans 4-6 weeks
Valve replacement

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4
Q

Recommended pix for infective endocarditis prior to dental procedures

A
Criteria:
Prosthetic cardiac valve
Prior infectious endocarditis
Congenital heart disease
- Unrepaired cyanotic congenital heart defect
-Palliative shunts/conduits
-repaired with prosthetic material
Cardiac transplant with valvulopathy

Abx: 2g amok x1 30-60 min prior to procedure

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5
Q

Testing for syphilis

A
screening: RPR, VDRL
Confirm with FTA-Abs, MHA-TP
Spirochete identification:
Dark field microscopy of chancre
Fluorescent Ab testing of lesions
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6
Q

Malaria prophylaxis

A

Many areas show drug resistance to chloroquine, use primaquine except in G6PD patients

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7
Q

Lyme disease - presentation and treatment

A

Classic presenting symptom is target lesion - erythema migrant

Tx:
Doxy
Amox
Ceftriaxone

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8
Q

Treatment of choice for rocky mountain spotted fever (RMSF)

A

Doxycycline

However in pregnant patients give chloramphenicol (toxicity -> gray baby sn)

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9
Q

Neutropenic fever

A

Typically seen in chemotherapy patients

Definition:
ANC less than 500
Temp of 101 F (38.3) or 100.4 (38) for longer than 1 hr

Start broad spectrum antibiotics

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10
Q

Criteria for ppx and agents used in HIV pt for Cryptococcus neoformans meningitis

A

No pix - treat with IV amphotericin and flucytosine

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11
Q

Criteria for ppx and agents used in HIV pt for Histoplasma capsulatum

A

CD4 less than 150 - itraconazole

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12
Q

Criteria for ppx and agents used in HIV pt for Mycobacterium avid complex

A

CD4 less than 50 - azithromycin

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13
Q

Criteria for ppx and agents used in HIV pt for PJP

A

CD4 less than 200 - bactrim or dapsone, pentamidine

No bactrim or dapsone in G6PD deficiency

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14
Q

Criteria for ppx and agents used in HIV pt for toxoplasma gondii

A

CD4 less than 100 - bactrim

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15
Q

Criteria for ppx and agents used in HIV pt for candida albicans

A

no ppx, tx with fluconazole or nystatin

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