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Abim 2014 > Deck 2 > Flashcards

Deck 2 Flashcards

1
Q

Antimicrobial stewadship

A

If appropriate narrow spectrum antibiotic found on S/S - change from initial empiric broad spectrum

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2
Q

Vibrio vulnificus

A

eating raw shellfish or trauma associated with contaminated seawater - hemorrhagic bullae, necrotizing fascitis, worse with liver dz/hemochromatosis (inc iron, inc growth),

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3
Q

Babesia

A

deer tick (Iox), NE/mE US, flu like sx, intraerythrocytic parasite, maltese cross, no rash, splenic rupture

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4
Q

Capnocytophagia

A

dog or cat bite - GNR

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5
Q

Rickettsia

A

RMSF - rash - palm, soles, wrists/ankles first

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6
Q

Smallpox exposure

A

smallpox vacccine w/in 3 days - buccal/pharyngeal rash - same stage crops, respiratory spread - widespread outbreak - can tx with cidofovir

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7
Q

Tacrolimus toxicity

A

tacrolimus levels increased by macrolide drugs/azole agents - inc cr, BUN

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8
Q

West Nile Virus

A

Myelitis - asymmetric flaccid paralysis, weakness

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9
Q

Middle aged woman, chronic cough, MAC on culture, no pre-existing lung dz, no systemic sx, neg acid fast smear

A

repeat acid fast smear - need to confirm dx as don’t want to treat colonization

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10
Q

Cryptococcal Meningitis - HIV immune reconstitution syndrome

A

Meningitis after initial HIV therapy - dramatic inflammatory response after immune system comes back - cryptococcus likely, +crypto Ag in CSF, - amphot B + fluconazole (oral)

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11
Q

CMV meningitis

A

only if CD4<100

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12
Q

Toxoplasmosis

A

multiple ring enhancing lesions on MRI, CD4<100

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13
Q

Histoplasmosis

A

Ohio/Missippi River valley - acute pulmonary dz +- CNS

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14
Q

HSV 2 Aseptic Meningitis

A

fever, vomiting, h/a, photosensitivity, normal CSF glucose, CSF gram stain neg

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15
Q

Bechets

A

painful oral/apthous ulcers/gential ulcers, uveitis

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16
Q

Erythema Migrans

A

if no cardiac or neuro sx then oral doxycycline - don’t test for lyme with EM rash

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17
Q

Benign recurrent lymphocytic Meningitis/ Mollaret Meningitis

A

CSF PCR for HSV-2 - have 2-10 episodes of meningitis - recover without tx, h/a, fever, neck stiffness, lymphocytes on CSF analysis - transient neuro sx (sz, halluc, diplopia)

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18
Q

Cryptococcal Meningitis

A

conventional amphotericin B + flucytocine - skin lesions present - decreased leukocytes, +crypto titers - can also tx with amphotericin B + fluconazole, fluconaz + flucytocine - DO NOT tx with caspofungin - lipid form of amphotericin if CRI/AKI

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19
Q

PID - outpt

A

ceftriaxone single dose + doxy x 14 days - cervicitis + signs of PID - (cervical motion tenderness, adnexal tenderness, uterine tenderness) - if systemic then clinda + gentamycin

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20
Q

Genital Herpes simplex

A

Dx - PCR of fissure/lesion - recurrent genital itching, burning,

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21
Q

Lymphogranuluma Verenum (LGV)

A

genital ulcer with lymphadenopathy + fever/malise - PAINLESS ulcer - check Chlymdia serology L1,L2,L3

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22
Q

Candial vulvovaginitis

A

KOH Wetmount

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23
Q

Syphillus Cancre

A

PAINLESS - single nodule - raised border - homosexuals, - check RPR, darkfield,

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24
Q

Chancroid

A

single or multiple PAINFUL lesions, ragged border, purulent exudate

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25
Q

DGI - disseminated gonnococcal infection

A

PCR for neisseria gonnorrhea - arthrtisis-dermatitis syndrome - assymetric joint involvement

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26
Q

Pulmonary histoplasmosis

A

mild PNA - no tx with healthy host - Ohio/Mississippi river valley - non-prod cough/fever - if needed use itraconazole, if severe amphotericin B (lipid)

27
Q

Catheter associated UTI

A

maintain bag below level of bladder - prevent backflow/stagnation - DO NOT NEED cleaning, tx of asyptomatic bactiuria or antibx coated catheters, or routine changing of catheter

28
Q

Dx of UTI (catheter associated)

A

> 10^3 CFU, signs/sx UTI (new onset fever, dysuria, lethargy, malaise)

29
Q

newly dx HIV

A

Start HAART without sx if CD4<500 -

30
Q

CAP outpt

A

young pt with no risk factor for drug resistent S Pneumo - tx with azithro (macrolide)

31
Q

Coccoidiomycosis

A

SW US - pulm dz and erythema nodosum - elev ESR - hilar lymphadenopathy

32
Q

Blastomycosis

A

Ohio/Mississippi River valley - PNA+erythema nodosum - itraconazole

33
Q

Histoplasmosis

A

Ohio/Mississippi River valley - PNA only itraconazole

34
Q

Acute, uncomplicated cystitis

A

nitrofurantoin or bactrim (if no sulfa allergic)

35
Q

Tuberculous Pericarditis

A

Pericardiocentesis - 4 drug regimen and PREDNISONE

36
Q

Prevent hospital acquired infections

A

hand hygene

37
Q

Osteomyelitis

A

can’t get MRI 2/2 ICD - use CT scan if not 3 phase bone scan

38
Q

Malaria P. Falciparum

A

most deadly form - only immature ring forms inside RBCs

39
Q

P. Ovale/Vivax

A

Should see all forms (trophoids, schiffer dots and immature forms) in RBCs

40
Q

P. Malariae

A

fever q72hr, + band form (trophozoite)

41
Q

Active TB - pt d/c’d meds

A

if d/c’d >2 wks start tx all over

42
Q

Extrapulm Blastomycosis (ie skin, genital lesions)

A

Itraconazole - see yeast/buds in microscopy

43
Q

Influenza tx

A

only if started 2 days into sx - oseltamavir, zanamavir (DO NOT USE amantadine or rimandatine - resistance high)

44
Q

Pyrazinamide side effects

A

acute gout - hyperuricemia - inhibit excretion of uric acid

45
Q

Isonazid side effects

A

hepatitis, rash, peripheral neuropathy, lupus like syndrome

46
Q

Rifampin

A

orange body fluids, hepatitis, rash, GI upset

47
Q

Drug resistant Pseudomonas

A

Colistin IV - GN bacteria

48
Q

Hospitalized patient with bacteremic pneumococcal PNA

A

d/c on 7 day oral abx after swithing to oral - no need to observe if stable already

49
Q

Anthrax

A

bacillus anthracis - flu like syndrome, widened mediastinum - rapid septic state - mediastinal LN get infected from inhalational anthrax - hemorrhage - shows widended mediastinum

50
Q

Asymptomatic patient with blasto in stool

A

diarrhea resolved w/in 24 hrs no further tx needed

51
Q

Sporadic Creutzfeldt-Jakob Disease

A

prionosis - rapid dementia, myoclonus, bland CSF, nondx MRI, spongiform biopsy brain, period sharp wave on EEG, 14-3-3 protein on CSF

52
Q

CA-MRSA PNA

A

no risk factors for HCAP (so no zosyn) - tx CAP + treat for MRSA (vanc) - see cavitary lesions - after flu - superinfxn - improved then suddenly worse

53
Q

Botulism

A

Triad - symmetric descending paralysis, bulbar palsy (diplopia, dysarthria, dysphonia, dysphagia), normal temp, clear sensorium - ingestion of canned food with toxin or wound contamination

54
Q

Guillain-Barre

A

antecedant infection - ocular palsy, ASCENDING paralysis, parathesia

55
Q

Tick Paralysis

A

ASCENDING paralysis - large muscles,

56
Q

paralytic shellfish poisoning

A

parathesia digits hands/feet, loss of control arms/legs

57
Q

Oral candidiasis with esophageal involvement

A

oral fluconazole - can’t use just swish and swallow nystatin

58
Q

DM associated osteomyelitis

A

Pseudomonas (foul smelling) - vanc/meropenum (MRSA/pseudomonas)

59
Q

HIV in pregnancy

A

DON’T use efavirenz (teratogenic) - use zidovudine, lamivudine, lopinavir-rotinavir to prevent vertical transmission

60
Q

Dengue Fever

A

mosquito bite - fever with chills, severe h/a, retroorbital pain, MSK pain, non specific rash sparing palms/soles - SE Asia, tropics, abn LFTs,

61
Q

Leptospirosis

A

contact with animal urine or tissues (rodents/small mammals) - high fever, myalgia, abd pain

62
Q

CA-MRSA soft tissue infxn

A

Bactrim,

63
Q

TB Skin testing

A

> 5mm - contact with active TB, HIV, old fibrosis on cxr,

>10mm - IVDA, from endemic countries, employee/resident NH, prison, mycobacterial lab workers, pt with r/o TB (DM, CKD)

64
Q

Post Tx infection (kidney)

A

CMV - fever, cytopenia, hepatitis, low plt, seropositive donor
EBV - would have LAD
Poly BK Virus - decoy(inclusion cells) in urine

Abim 2014 (14 decks)

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