Deck 2 Flashcards
Antimicrobial stewadship
If appropriate narrow spectrum antibiotic found on S/S - change from initial empiric broad spectrum
Vibrio vulnificus
eating raw shellfish or trauma associated with contaminated seawater - hemorrhagic bullae, necrotizing fascitis, worse with liver dz/hemochromatosis (inc iron, inc growth),
Babesia
deer tick (Iox), NE/mE US, flu like sx, intraerythrocytic parasite, maltese cross, no rash, splenic rupture
Capnocytophagia
dog or cat bite - GNR
Rickettsia
RMSF - rash - palm, soles, wrists/ankles first
Smallpox exposure
smallpox vacccine w/in 3 days - buccal/pharyngeal rash - same stage crops, respiratory spread - widespread outbreak - can tx with cidofovir
Tacrolimus toxicity
tacrolimus levels increased by macrolide drugs/azole agents - inc cr, BUN
West Nile Virus
Myelitis - asymmetric flaccid paralysis, weakness
Middle aged woman, chronic cough, MAC on culture, no pre-existing lung dz, no systemic sx, neg acid fast smear
repeat acid fast smear - need to confirm dx as don’t want to treat colonization
Cryptococcal Meningitis - HIV immune reconstitution syndrome
Meningitis after initial HIV therapy - dramatic inflammatory response after immune system comes back - cryptococcus likely, +crypto Ag in CSF, - amphot B + fluconazole (oral)
CMV meningitis
only if CD4<100
Toxoplasmosis
multiple ring enhancing lesions on MRI, CD4<100
Histoplasmosis
Ohio/Missippi River valley - acute pulmonary dz +- CNS
HSV 2 Aseptic Meningitis
fever, vomiting, h/a, photosensitivity, normal CSF glucose, CSF gram stain neg
Bechets
painful oral/apthous ulcers/gential ulcers, uveitis
Erythema Migrans
if no cardiac or neuro sx then oral doxycycline - don’t test for lyme with EM rash
Benign recurrent lymphocytic Meningitis/ Mollaret Meningitis
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)
Cryptococcal Meningitis
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
PID - outpt
ceftriaxone single dose + doxy x 14 days - cervicitis + signs of PID - (cervical motion tenderness, adnexal tenderness, uterine tenderness) - if systemic then clinda + gentamycin
Genital Herpes simplex
Dx - PCR of fissure/lesion - recurrent genital itching, burning,
Lymphogranuluma Verenum (LGV)
genital ulcer with lymphadenopathy + fever/malise - PAINLESS ulcer - check Chlymdia serology L1,L2,L3
Candial vulvovaginitis
KOH Wetmount
Syphillus Cancre
PAINLESS - single nodule - raised border - homosexuals, - check RPR, darkfield,
Chancroid
single or multiple PAINFUL lesions, ragged border, purulent exudate
DGI - disseminated gonnococcal infection
PCR for neisseria gonnorrhea - arthrtisis-dermatitis syndrome - assymetric joint involvement
Pulmonary histoplasmosis
mild PNA - no tx with healthy host - Ohio/Mississippi river valley - non-prod cough/fever - if needed use itraconazole, if severe amphotericin B (lipid)
Catheter associated UTI
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
Dx of UTI (catheter associated)
> 10^3 CFU, signs/sx UTI (new onset fever, dysuria, lethargy, malaise)
newly dx HIV
Start HAART without sx if CD4<500 -
CAP outpt
young pt with no risk factor for drug resistent S Pneumo - tx with azithro (macrolide)
Coccoidiomycosis
SW US - pulm dz and erythema nodosum - elev ESR - hilar lymphadenopathy
Blastomycosis
Ohio/Mississippi River valley - PNA+erythema nodosum - itraconazole
Histoplasmosis
Ohio/Mississippi River valley - PNA only itraconazole
Acute, uncomplicated cystitis
nitrofurantoin or bactrim (if no sulfa allergic)
Tuberculous Pericarditis
Pericardiocentesis - 4 drug regimen and PREDNISONE
Prevent hospital acquired infections
hand hygene
Osteomyelitis
can’t get MRI 2/2 ICD - use CT scan if not 3 phase bone scan
Malaria P. Falciparum
most deadly form - only immature ring forms inside RBCs
P. Ovale/Vivax
Should see all forms (trophoids, schiffer dots and immature forms) in RBCs
P. Malariae
fever q72hr, + band form (trophozoite)
Active TB - pt d/c’d meds
if d/c’d >2 wks start tx all over
Extrapulm Blastomycosis (ie skin, genital lesions)
Itraconazole - see yeast/buds in microscopy
Influenza tx
only if started 2 days into sx - oseltamavir, zanamavir (DO NOT USE amantadine or rimandatine - resistance high)
Pyrazinamide side effects
acute gout - hyperuricemia - inhibit excretion of uric acid
Isonazid side effects
hepatitis, rash, peripheral neuropathy, lupus like syndrome
Rifampin
orange body fluids, hepatitis, rash, GI upset
Drug resistant Pseudomonas
Colistin IV - GN bacteria
Hospitalized patient with bacteremic pneumococcal PNA
d/c on 7 day oral abx after swithing to oral - no need to observe if stable already
Anthrax
bacillus anthracis - flu like syndrome, widened mediastinum - rapid septic state - mediastinal LN get infected from inhalational anthrax - hemorrhage - shows widended mediastinum
Asymptomatic patient with blasto in stool
diarrhea resolved w/in 24 hrs no further tx needed
Sporadic Creutzfeldt-Jakob Disease
prionosis - rapid dementia, myoclonus, bland CSF, nondx MRI, spongiform biopsy brain, period sharp wave on EEG, 14-3-3 protein on CSF
CA-MRSA PNA
no risk factors for HCAP (so no zosyn) - tx CAP + treat for MRSA (vanc) - see cavitary lesions - after flu - superinfxn - improved then suddenly worse
Botulism
Triad - symmetric descending paralysis, bulbar palsy (diplopia, dysarthria, dysphonia, dysphagia), normal temp, clear sensorium - ingestion of canned food with toxin or wound contamination
Guillain-Barre
antecedant infection - ocular palsy, ASCENDING paralysis, parathesia
Tick Paralysis
ASCENDING paralysis - large muscles,
paralytic shellfish poisoning
parathesia digits hands/feet, loss of control arms/legs
Oral candidiasis with esophageal involvement
oral fluconazole - can’t use just swish and swallow nystatin
DM associated osteomyelitis
Pseudomonas (foul smelling) - vanc/meropenum (MRSA/pseudomonas)
HIV in pregnancy
DON’T use efavirenz (teratogenic) - use zidovudine, lamivudine, lopinavir-rotinavir to prevent vertical transmission
Dengue Fever
mosquito bite - fever with chills, severe h/a, retroorbital pain, MSK pain, non specific rash sparing palms/soles - SE Asia, tropics, abn LFTs,
Leptospirosis
contact with animal urine or tissues (rodents/small mammals) - high fever, myalgia, abd pain
CA-MRSA soft tissue infxn
Bactrim,
TB Skin testing
> 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)
Post Tx infection (kidney)
CMV - fever, cytopenia, hepatitis, low plt, seropositive donor
EBV - would have LAD
Poly BK Virus - decoy(inclusion cells) in urine