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Infectious Disease > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

cryptococcus diagnosis

A

india ink stain, antigen test

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2
Q

fungal pneumonia in immunocompromised patients

A

pneumocystis jirovecii or cryptococcus

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3
Q

pneumocystis diagnosis

A

special stains, PCR

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4
Q

pneumocystis chest xray

A

diffuse bilateral ground glass opacities

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5
Q

when to initiate pneumocystis prophylaxis

A

CD4<200

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6
Q

dermatophytes

A

cluster of superficial skin fungi that cause tinea infections

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7
Q

dermatophytes colonize ____

A

keratinized stratum corneum

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8
Q

how long to take meds for onychomycosis

A

3 months

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9
Q

non-dermatophyte cutaneous mold

A

malassezia furfur

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10
Q

tinea versicolor causative agent

A

malassezia furfur

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11
Q

tinea versicolor diagnosis

A

“spaghetti and meatballs” on KOH prep

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12
Q

subcutaneous mold

A

sporotrichosis

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13
Q

sporotrichosis causative agent

A

sporothrix schenckii

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14
Q

sporotrichosis mechanism

A

found in soil, follows traumatic implantation

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15
Q

sporotrichosis presentation

A

chronic, localized skin infection - nodular ulcerated lesions

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16
Q

what is associated with “fungus ball” in sinuses

A

rhizopus, mucor

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17
Q

where can zygomycosis manifest

A

rhino/facial/cranial, lungs, GI tract

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18
Q

complications of zygomycosis

A

emboli, tissue necrosis

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19
Q

aspergillus aka

A

black mold

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20
Q

aspergillus sites

A

body cavities, ear canal, invasive lung disease

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21
Q

dimorphic fungi

A

blastomyces, histoplasma, coccidioides

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22
Q

where is blastomyces endemic

A

mississippi and Ohio river valleys, great lakes region

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23
Q

extrapulmonary manifestations of blastomyces

A

skin, osteomyelitis, CNS, GU tract

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24
Q

where is histoplasma endemic

A

southeastern US, mid-Atlantic states

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25
Q

extrapulmonary manifestations of histoplasma

A

bone marrow, blood, CNS, lymph nodes

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26
Q

coccidioides endemic

A

Southwestern US

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27
Q

extrapulmonary manifestations of coccidioides

A

erythema nodosum/multiforme, meningitis, bone, arthralgia, fatigue, fever, myalgia, headache, night sweats, weight loss

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28
Q

culture of coccidioides

A

white fuzzy growth on blood auger - don’t open the plate

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29
Q

pulmonary manifestations of coccidioides

A

chronic cough, dyspnea, hemoptysis, pleuritic chest pain

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30
Q

coccidioides aka

A

valley fever

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31
Q

coccidioides diagnosis consideration

A

TB mimic

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32
Q

fungal infection chest x-ray appearance

A

multiple small nodules

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33
Q

fungal infection diagnosis considerations

A

require selective culture media for 21 days, special stains, special testing

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34
Q

special testing for aspergillus

A

EIA test

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35
Q

special testing for endemic mycoses

A

immunodiffusion

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36
Q

immunodiffusion

A

IgM antibodies to endemic mycoses

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37
Q

other special test for fungi

A

complement fixation

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38
Q

non-systemic fungal treatment

A

Imidazoles

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39
Q

imidazoles examples

A

ketoconazole, miconazole, clotrimazole

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40
Q

systemic fungal treatment

A

triazoles

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41
Q

triazoles examples

A

fluconazole, itraconazole, voriconazole, posaconazole

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42
Q

which triazoles are PO only

A

itraconazole, posaconazole

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43
Q

which triazoles are IV/PO

A

fluconazole, voriconazole

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44
Q

which triazoles are for candida

A

fluconazole

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45
Q

which triazoles are for aspergillus

A

itraconazole, voriconazole

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46
Q

which triazoles are for dimorphic fungi

A

fluconazole

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47
Q

what is posaconazole used for

A

other invasive molds

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48
Q

cryptococcus treatment

A

amphotericin IV plus flucytosine PO

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49
Q

yeasts on skin/mouth treatment

A

nystatin

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50
Q

dermatophyte treatments 2nd line

A

terbinafine topical, griseofulvan PO

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51
Q

pneumocystis treatment

A

PO Bactrim

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52
Q

terbinafine tx considerations

A

monitor LFTs, lengthy course of treatment

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53
Q

antifungals are metabolized by ___

A

liver

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54
Q

which antifungal has black box warning for cardiomyopathy

A

itraconazole

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55
Q

how to avoid some amphotericin side effects

A

premedicate with antihistamines

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56
Q

normal skin flora

A

staph aureus, staph epidermitis, strep pyogenes, p. acnes, candida albicans

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57
Q

normal nasopharynx flora

A

strep pneumonia, h. influenzae, moraxella catarrhalis

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58
Q

normal mouth flora

A

strep viridans, actinomyces, candida albicans

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59
Q

normal pharynx flora

A

strep pyogenes, kingella kingae (peds)

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60
Q

normal GI flora

A

enterobacteriacea (e coli, klebsiella, enterobacter), enterococcus, candida

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61
Q

normal vaginal flora

A

strep agalactiae, actinomyces, gardnerella vaginalis, candida albicans

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62
Q

mutualism

A

both the host and microbe benefit

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63
Q

commensalism

A

one partner of relationship benefits (usually microbe) and the other partner (usually the host) is neither harmed nor benefitted

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64
Q

parasitic relationship

A

the microbe benefits at the expense of the host

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65
Q

pathogenic relationship

A

the microbe causes damage to the host

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66
Q

opportunistic pathogens definition

A

only cause disease in those with a compromised immune defense

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67
Q

opportunistic pathogens due to T-cell immune compromise

A

pneumocystis pneumonia, cytomegalovirus colitis

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68
Q

opportunistic pathogen due to patients receiving broad-spectrum abx

A

c diff colitis

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69
Q

opportunistic pathogen in patients with intravenous catheters

A

staph epidermidis bacteremia

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70
Q

frank pathogens definition

A

always associated with disease

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71
Q

examples of frank pathogens

A

neisseria, shigella, HIV

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72
Q

facultative pathogens definition

A

can be either normal flora or pathogenic

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73
Q

majority of organisms that cause disease are ___

A

facultative

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74
Q

examples of facultative pathogens

A

staph aureus, e coli

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75
Q

gram positive are usually what morphology

A

cocci or bacillus

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76
Q

obligate aerobes

A

mycoplasma tuberculosis, pseudomonas, nocardia, bacillus

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77
Q

obligate anaerobes

A

bacteriodes fragilis, fusobacterium, clostridia, actinomyces, peptostreptococcus

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78
Q

gram positive bacteria characteristics

A

thick peptidoglycan layer that holds the crystal violet stain

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79
Q

gram negative bacteria characteristics

A

thin peptidoglycan layer that decolorizes and then holds the safranin (counterstain)

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80
Q

common causes of neonatal meningitis

A

e coli, group B strep, listeria

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81
Q

common causes of infant/toddler meningitis

A

strep pneumo, neisseria, hib, group B strep, e coli

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82
Q

common causes of teen/young adult meningitis

A

neisseria, strep pneumo

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83
Q

common causes of adults >50 meningitis

A

strep pneumo, neisseria, Hib, group B strep, listeria

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84
Q

treatment for neonatal meningitis

A

ceftriaxone, ampicillin

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85
Q

treatment for infant/pediatric meningitis

A

ceftriaxone, vanc

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86
Q

treatment for older adults meningitis

A

ceftriaxone, vanc, ampicillin

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87
Q

bacteria not characterized by gram stain

A

mycobacteria, nocardia, mycoplasma, chlamydia, rickettsia, treponema

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88
Q

why can’t mycobacteria/nocardia be characterized by gram stain

A

mycolic acids and lipids in cell wall don’t allow stain to penetrate completely

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89
Q

why can’t mycoplasma be characterized by gram stain

A

no cell wall

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90
Q

why can’t chlamydia/rickettsia be characterized by gram stain

A

obligate intracellular organisms

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91
Q

why can’t treponema be characterized by gram stain

A

too small

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92
Q

what mechanisms are used by extracellular bacteria to evade an immune response

A

formation of biofilms, blockade of opsonization/phagocytosis by binding proteins, production of toxins to escape phagosomes, prevention of phagosome-lysosome fusion, induced uptake by non-phagocytic cells

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93
Q

gram negative rods lactose fermenters

A

e coli, klebsiella enterobacter

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94
Q

gram negative rods non-lactose fermenter

A

pseudomonas, e. coli, proteus, salmonella, shigella

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95
Q

gram positive cocci catalase positive

A

staph aureus, coagulase-negative staph

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96
Q

gram positive cocci catalase negative beta hemolytic

A

strep pyogenes, strep agalactiae

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97
Q

gram positive cocci catalase negative alpha/non hemolytic

A

strep pneumo, strep viridans, enterococcus

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98
Q

test for mycobacteria

A

acid fast

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99
Q

test for nocardia

A

modified acid fast

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100
Q

test for chlamydia

A

PCR

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101
Q

test for rickettsia

A

antibody titer

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102
Q

test for treponema

A

dark-field microscopy

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103
Q

bronchitis is usually due to ____

A

respiratory viruses

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104
Q

bronchiolitis pathogen

A

RSV

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105
Q

bronchiolitis diagnosis

A

rapid antigen or PCR testing of nasopharyngeal swab

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106
Q

bronchiolitis risk factors

A

infants, especially premature, age 6 months or younger. And children with congenital heart or chronic lung disease

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107
Q

bronchiolitis recommended therapy

A

maintain nutrition, hydration, and oxygen saturation over 90%

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108
Q

croup pathogen

A

parainfluenza virus

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109
Q

croup ssx

A

barking cough, stridor, labored/noisy breathing

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110
Q

croup prognosis

A

self-limiting in 3-5 days

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111
Q

croup treatment

A

keep child calm, using humidified or cool air. Signle dexamethasone shot can be given. Racemic epi only given in severe cases.

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112
Q

organisms causing acute pneumonia

A

strep pneumo, haemophilus influenzae, moraxella catarrhalis, legionalla

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113
Q

organisms causing atypical pneumonia

A

mycoplasma pneumoniae, chlamydia pneumoniae, SARS-COVID19, flu A/B, adenovirus, RSV, rhinovirus

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114
Q

legionella morphology

A

gram negative bacilli

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115
Q

legionnaires infectivity

A

doesn’t spread person to person, but spreads through mist, usually associated with community outbreaks

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116
Q

risk factors for legionnaires

A

> 50, weak immune systems, chronic lung disease, heavy tobacco use

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117
Q

legionnaires presentation

A

may be asymptomatic or cough/fever/chills, SOB, myalgias, headaches, diarrhea

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118
Q

most common pathogen for aseptic meningitis

A

enterovirus

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119
Q

3 forms of fungi

A

yeasts, molds, dimorphic

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120
Q

most common yeast species

A

candida albicans

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121
Q

candida albicans diagnosis

A

budding yeast with pseudohyphae visible on gram stain

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122
Q

candida albicans skin infection ssx

A

deep red itchy rash with satellite lesions

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123
Q

“notable yeasts”

A

candida albicans, cryptococcus, pneumocystis

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124
Q

which yeast causes pneumonia and meningitis in immunocompromised patients

A

cryptococcus

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125
Q

cryptococcus yeast characteristics

A

encapsulated budding yeast visible with india ink stain

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126
Q

cutaneous molds

A

dermatophytes, malassezia furfur

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127
Q

types of dermatophytes

A

trycophytan, microsporum, epidermophytan

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128
Q

malassezia furfur causes what conditions

A

tinea versicolor, seborrheic dermatitis

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129
Q

tinea versicolor ssx

A

hypo or hyperpigmentation of skin

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130
Q

what are the invasive molds

A

rhizopus, mucor, aspergillus

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131
Q

causative agents of zygomycosis

A

rhizopus, mucor

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132
Q

which mold causes emboli and necrosis of tissue

A

zygomycosis

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133
Q

where does zygomycosis invade

A

rhino-facial-cranial area, lungs, GI tract

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134
Q

black mold

A

aspergillus

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135
Q

where does aspergillus colonize

A

body cavities, ear canal, lungs

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136
Q

ingestion of aspergillus

A

can contaminate foods and form toxins

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137
Q

side effects of triazoles

A

GI intolerance, hepatotoxicity due to effects on CYP450, rash, QT prolongation

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138
Q

side effects of amphotericin B

A

rigors, fever, chills, hypoxia, dyspnea, local phlebitis, nephrotoxicity, muscle/joint pain

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139
Q

mycoplasma pneumoniae aka

A

“walking pneumonia”

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140
Q

mycoplasma pneumoniae diagnosis consideration

A

bacterium is very small and cannot be gram stained or grown with traditional cultures - can use cold agglutinin

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141
Q

2nd most common cause of CAP

A

mycoplasma pneumoniae

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142
Q

mycoplasma pneumoniae presentation

A

mild ssx, persistent cough for weeks to months

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143
Q

who does mycoplasma pneumoniae usually affect

A

people under 40 and those in crowded settings

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144
Q

mycoplasma pneumoniae transmission

A

spreads via droplets

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145
Q

mycoplasma pneumoniae chest x ray

A

may be normal

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146
Q

mycoplasma pneumoniae treatment

A

normally self-limiting but may use azithromycin or doxy

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147
Q

chlamydia pneumoniae type of bacterium

A

obligate intracellular

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148
Q

chlamydia pneumoniae transmission

A

respiratory droplets

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149
Q

chlamydia pneumoniae ssx

A

similar to m. pneumoniae mild with gradual onset and prolonged cough of 2-6 weeks

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150
Q

chlamydia pneumoniae diagnosis

A

PCR (usually not performed), CXR may be normal

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151
Q

chlamydia pneumoniae treatment

A

usually self-limiting but may use azithromycin or doxy

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152
Q

general ssx of atypical pneumonias

A

`subacute presentation with milder ssx, moderate sputum production, no consolidation

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153
Q

chest x-ray atypical pneumonia

A

may be normal or may see diffuse interstitial infiltrates

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154
Q

atypical pneumonia wbc

A

moderate elevation

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155
Q

nosocomial pneumonia pathogens

A

MRSA, pseudomonas, enterobacteriaceae (e coli, acinetobacter)

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156
Q

aspiration pneumonia pathogens

A

peptostreptococcus, fusobacterium, klebsiella

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157
Q

pathogen associated with secondary bacterial pneumonia after influenza infection

A

staph aureus

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158
Q

pathogens associated with lung abscess and necrotizing pneumonia

A

oral anaerobes, staph aureus, strep pneumo, klebsiella

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159
Q

pathogens associated with chronic pneumonia

A

nocardia, actinomyces, TB, non-TB mycobacteria, endemic mycoses

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160
Q

causes of neonatal pneumonia

A

group B strep, e.coli

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161
Q

causes of pneumonia specific to elderly

A

gram negative bacilli

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162
Q

what does rust-colored sputum suggest

A

strep pneumo

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163
Q

antivirals for pneumonia due to influenza

A

oseltamivir, zanamivir

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164
Q

abx for pneumococcal pneumonia

A

amoxicillin or augmentin, azithromycin, doxycycline, levofloxacin

165
Q

abx for atypical pneumonia

A

azithromycin, doxycycline, levofloxacin

166
Q

abx for pneumoncystis pneumonia

A

trimethoprim/sulfamethoxazole

167
Q

new antiviral for influenza

A

baloxavir marboxil (Xofluza)

168
Q

when to initiate antivirals for flu

A

within 48 hours of ssx onset

169
Q

mycobacteria culture considerations

A

require 4-6 weeks to grow, requires 3 consecutive morning sputum samples - PCR testing is sometimes available

170
Q

mycobacteria characterization

A

acid-fast bacilli

171
Q

when does primary TB infection occur

A

after inhalation of bacilli

172
Q

CXR latent TB

A

can be normal, can see granulomas/cavitary lesions

173
Q

are patients contagious with latent TB

A

no, as long as ssx are not present

174
Q

what is latent TB

A

bacteria live in the body without making Pt sick

175
Q

latent TB sputum culture

A

will be negative

176
Q

how to diagnose latent TB

A

tuberculin test or IFN-gamma release assay

177
Q

what percept of latent TB will become active

A

5-10%

178
Q

active TB ssx

A

gradual onset of fever, weight loss, fatigue, hemoptysis

179
Q

active TB transmission

A

airborne

180
Q

active TB complication

A

inflammatory response can result in necrosis and structural collapse of lung

181
Q

active TB CXR

A

hilar lymphadenopathy, apical lobes affected

182
Q

when/how to read TB skin test

A

measure induration (not erythema) at 48-72 hours

183
Q

5 mm is positive TB test for what groups

A

HIV, close contacts of active TB, organ transplants, abnormal CXR

184
Q

10 mm is positive TB test for what groups

A

recent arrivals from high-prevalence countries, IV drug users, residents of long-term care facilities, healthcare workers, comorbid conditions (including leukemia/lymphoma), children under 5

185
Q

15 mm is positive TB test for what groups

A

everyone

186
Q

active TB treatment

A

rifampin, INH, pyrazinamide, ethambutol

187
Q

rifampin side effects

A

reddish-orange secretions

188
Q

INH side effects

A

peripheral neuropathy, fulminant hepatitis

189
Q

how to prevent neuropathy with INH

A

administer with vitamin B6

190
Q

pyrazinamide side effects

A

photosensitivity

191
Q

ethambutol side effects

A

blurred/changed vision, other eye effects

192
Q

latent TB treatment

A

9 months of INH

193
Q

biofilm treatment principles

A

remove infected device, surgical debridement, systemic dual abx therapy with one of them being rifampin

194
Q

some infections creating biofilms

A

endocarditis, osteomyelitis, chronic wounds/infections, bronchitis from CF, periodontal disease, bacterial prostatitis

195
Q

why are bacteria in biofilms more resistant to bacteria

A

decreased metabolic rate of bacteria, increased expression of drug resistant genes, abx may not penetrate biofilm

196
Q

which organisms account for 80% of infective endocarditis

A

streptococci (viridans, enterococcus), staphylococci (staph aureus and coagulase negative)

197
Q

vascular phenomena of infective endocarditis

A

emboli, hemorrhages (splinter, intracranial, conjunctival), painless Janeway lesions

198
Q

immunologic phenomena of infective endocarditis

A

glomerulonephritis, painful osler nodes, roth spots, rheumatoid factor

199
Q

criteria for infective endocarditis

A

Duke criteria: 2 major OR 1 major + 3 minor OR 5 minor

200
Q

predisposing conditions for infective endocarditis

A

dental procedures, IV drug use, prosthetic heart valves, rheumatic heart disease

201
Q

right-sided endocarditis predisposing factor

A

IV drug use

202
Q

most common organism associated with right-sided endocarditis

A

staph aureus

203
Q

most commonly affective valve in right-sided endocarditis

A

tricuspid

204
Q

acuity and vascular involvement for right-sided endocarditis

A

acute, pulmonary vascular involvement

205
Q

left -sided endocarditis predisposing factors

A

acquired valvular disease, congenital heart disease

206
Q

most common organisms associated with left-sided endocarditis

A

strep viridans, staph aureus

207
Q

most commonly affective valve in right-sided endocarditis

A

mitral

208
Q

acuity and vascular involvement for left-sided endocarditis

A

acute or subacute, systemic vascular involvement

209
Q

CV physical exam/echo findings for infective endocarditis

A

new regurgitant murmur, vegetations on valves

210
Q

frequent contaminants of blood cultures

A

staph epidermidis, bacillus, diphtheroids

211
Q

causes of false positive blood cultures

A

poor skin antisepsis, poor technique, blood came from central line, only one set collected

212
Q

causes of false negative blood cultures

A

abx initiated prior to collection, slow-growing organism or one that is difficult to culture, not enough blood

213
Q

organisms that are difficult to culture

A

legionella, bartonella, coxiella, rickettsia, chlamydia

214
Q

when to collect blood cultures

A

when fever spikes

215
Q

how much blood to collect for cultures

A

at least 10 mL per bottle

216
Q

what does a set of blood cultures consist of

A

bottles for aerobic and anaerobic cultures

217
Q

how to collect blood cultures

A

2 sets each from different venipuncture sites

218
Q

categories of risk factors for bacteremia

A

immune dysfunction, disruption of epithelium, obstruction of drainage conduit or abscess

219
Q

causes of immune dysfunction as risk for bacteremia

A

neutropenia, age, immunosuppressive meds, genetics

220
Q

causes of disruption of epithelium as risk for bacteremia

A

trauma, surgery, bites, central venous catheters

221
Q

causes of obstruction of drainage conduit/abscess as risk for bacteremia

A

choledocolithiasis, nephrolithiasis, diverticulitis, hepatic abscess

222
Q

examples of bloodstream infections

A

primary bacteremia, infective endocarditis, central line associated, bacteremia secondary to focal infections

223
Q

mortality rate for sepsis

A

14-37%

224
Q

sepsis criteria for inpatient

A

SOFA acute change of at least 2 points

225
Q

major elements of SOFA criteria

A

respiration, coagulation, bilirubin, BP, GCS, creatinine

226
Q

sepsis definition

A

life threatening organ dysfunction caused by a dysregulated host response to infection

227
Q

septic shock definition

A

sepsis and vasopressor therapy needed to increase MAP to at least 65 and lactate over 2 despite adequate fluid resuscitation

228
Q

indicators of sepsis

A

temp over 38 or under 36, HR over 90, tachypnea, WBC over 12 or under 4, SBP under 90, lactate over 1

229
Q

what is a hordeolum/stye

A

impacted eyelash follicle/gland

230
Q

hordeolum/stye pathogen

A

staph aureus

231
Q

hordeolum/stye treatment

A

warm compresses (abx drops usually aren’t useful)

232
Q

what is a chalazion

A

impacted gland on the back of the eyelid

233
Q

chalazion pathogen

A

staph aureus

234
Q

chalazion tx

A

abx drops

235
Q

most common conjunctivitis etiology

A

adenovirus

236
Q

when to use abx for conjunctivitis

A

if no URI ssx and in one eye only

237
Q

bacterial keratitis

A

corneal abrasion from contacts

238
Q

bacterial keratitis pathogen

A

MSSA, strep pneumo, pseudomonas

239
Q

herpes keratitis appearance on exam

A

dendritic lesion

240
Q

herpes keratitis tx

A

oral or topical acyclovir plus topical steroid drops and emergent specialist referral

241
Q

preseptal cellulitis cause

A

scratch or peri-ocular skin infection

242
Q

preseptal cellulitis ssx

A

swollen, erythematous eyelid

243
Q

preseptal cellulitis pathogens

A

staph aureus or strep pyogenes

244
Q

preseptal cellulitis tx

A

keflex

245
Q

what is orbital cellulitis

A

infection in the connective tissue posterior to orbital septum

246
Q

orbital cellulitis cause

A

contiguous spread from sinus cavity

247
Q

orbital cellulitis ssx

A

swollen, eryhtematous eyelid plus proptosis, abnormal EOM, double vision, pain with eye movement

248
Q

orbital cellulitis pathogens

A

strep pneumo, haemophilus, moraxella

249
Q

orbital cellulitis tx

A

emergent referral for IV abx and drainage of abscess

250
Q

most common pathogen of otitis media

A

strep pneumo

251
Q

why is otitis media more common in peds

A

flat position of eustachian tubes

252
Q

otitis media presentation on exam

A

bulging and eryhtematous tympanic membrane

253
Q

initial treatment of otitis media

A

amoxicillin or cephalosporin

254
Q

what is serous otitis media

A

often viral with dull, injected, or possibly retracted tympanic membrane

255
Q

what is mastoiditis

A

spread of otitis media to mastoid cells of temporal bone

256
Q

causes of otitis externa

A

pseudomonas, aspergillus

257
Q

swimmers ear pathogen and ssx

A

pseudomonas, green mucoid discharge

258
Q

otitis externa tx

A

abx ear drops

259
Q

most common etiology of pharyngitis in adults

A

adenovirus

260
Q

bacterial etiology of pharyngitis

A

strep pyogenes (group A strep), arcanobacterium

261
Q

tx of bacterial pharyngitis

A

penicillin/amoxicillin

262
Q

tonsillitis/peritonsillar abscess ssx

A

unilateral tonsil enlargement, displaced uvula, drooling, hot potato voice

263
Q

tonsillitis/peritonsillar abscess tx

A

PCN/amoxicillin, abscess drainage, prednisone

264
Q

epiglottitis ssx

A

mild stridor, drooling, trouble swallowing - palliation on sitting up or leaning forward

265
Q

epiglottitis imaging

A

thumb sign on soft tissue neck x-ray

266
Q

epiglottitis tx consideration

A

evaluate in monitored environment due to airway issues

267
Q

most common pathogen in retropharyngeal abscess

A

strep pyogenes (group A strep)

268
Q

retropharyngeal abscess presentation

A

similar to epiglottitis plus trismus

269
Q

retropharyngeal abscess tx

A

medical emergency: IV abx and surgical drainage

270
Q

what is ludwig’s angina

A

infection of the bilateral submandibular space

271
Q

when is ludwigs angina seen

A

in HIV patients

272
Q

Ludwigs angina tx

A

medical emergency - airway management, IV abx and surgical drainage

273
Q

what is parotitis

A

inflammation/infection of parotid gland that can be viral or bacterial

274
Q

most common viral parotitis

A

mumps (can also be EBV, HIV)

275
Q

most common bacterial parotitis pathogens

A

staph aureus, strep viridans, anaerobic oral flora (peptostreptococcus/fusobacterium)

276
Q

what is sialadenitis

A

infection/inflammation of any salivary gland that is usually bacterial with same organisms causing parotitis

277
Q

what does sialadenitis usually occur

A

due to salivary gland blockage

278
Q

tx of parotitis and sialadenitis

A

beta lactamase inhibitor like augmentin or clindamycin. Also need sialogogues to stimulate saliva formation and gentle massage of gland

279
Q

mumps ssx

A

asymptomatic, swollen/painful salivary glands, fever, HA, fatigue, anorexia

280
Q

mumps tx

A

2 weeks of symptom relief

281
Q

mumps complications

A

orchitis, hearing loss, meningitis/enchephalitis

282
Q

mumps diagnosis

A

viral culture of buccal mucosa, PCR testing

283
Q

methods of spread of organisms to CNS

A

hematogenous, contiguous, direct inoculation, neuronal

284
Q

most common route for organisms to spread to CNS

A

hematogenous

285
Q

what organisms transmit to CNS via neuronal route

A

herpes, rabies

286
Q

differences in CNS infections

A

blood brain barrier, no lymphatics, little complement: Difficult for infections to get in and difficult to treat them

287
Q

meningitis main ssx

A

meningismus (headache, nuchal rigidity, photophobia)

288
Q

acute meningitis is usually

A

bacterial

289
Q

subacute meningitis is usually

A

viral but may be bacterial

290
Q

chronic meningitis is usually

A

mycobacterial or fungal

291
Q

main ssx of encephalitis

A

altered mental status, +/- focal deficits

292
Q

most common causative pathogens of encephalitis are ___

A

viruses

293
Q

brudzinksi’s sign

A

involuntary flexion of knees and hips following passive flexion of neck while supine

294
Q

kernig’s sign

A

while the thigh is flexed at hip and knee at 90 degree angles, extension of knee is painful

295
Q

diagnosis of meningitis without signs of ICP is via

A

Lumbar puncture

296
Q

contraindications to LP

A

increased ICP, focal deficits, significant coagulopathy, lumbar soft tissue infection

297
Q

standard LP tests

A

cell count with diff, glucose, protein, gram stain, bacterial culture

298
Q

CSF nucleated cells in bacterial meningitis

A

> 1000

299
Q

%PMNs in bacterial meningitis

A

> 50%

300
Q

glucose in bacterial meningitis

A

<40

301
Q

protein in bacterial meningitis CSF

A

> 200

302
Q

CSF nucleated cells in viral meningitis

A

<1000

303
Q

%PMNs in viral meningitis

A

PMNs then lymphocytes

304
Q

glucose in CSF viral meningitis

A

WNL

305
Q

protein in CSF in viral meningitis

A

50-100

306
Q

CSF nucleated cells in TB/fungal meningitis

A

100-500

307
Q

%PMNs in TB/fungal meningitis

A

PMNs then lymphocytes

308
Q

CSF glucose in TB/fungal meningitis

A

less than 40

309
Q

protein in fungal meningitis

A

50-100

310
Q

protein in TB meningitis

A

> 200

311
Q

first-line treatment for pediatric and adult meningitis

A

ceftriaxone and vancomycin

312
Q

treatment for neonatal meningitis

A

ceftriaxone and ampicillin

313
Q

treatment for geriatric meningitis

A

ceftriaxone, vancomycin, ampicillin

314
Q

pathogens in neonatal meningitis

A

e coli, group B strep, listeria

315
Q

what pathogens for meningitis are common to all age groups (except neonates)

A

strep pneumo, neisseria

316
Q

what pathogen causes meningococcal meningitis

A

neisseria meningitidis

317
Q

transmission of meningococcal meningitis

A

respiratory droplets

318
Q

complications of meningococcal meningitis

A

neurological deficits, hearing loss, limb loss, sepsis

319
Q

treatment for meningococcal meningitis

A

IM ceftriaxone +/- rifampin or cipro

320
Q

vaccine for meningococcal meningitis age given

A

1st dose age 11-12, booster age 16-18

321
Q

prophylaxis for meningococcal meningitis exposures

A

2 days of ceftriaxone/rifampin or single dose of cipro

322
Q

treatment for strep pneumo meningitis

A

dexamethasone and then vancomycin plus 3rd generation cephalosporin

323
Q

preventive vaccines for meningitis

A

Hib, strep pneumo, neisseria

324
Q

when to do droplet precautions after initiation of abx for meningitis

A

first 24 hours

325
Q

most common cause of aseptic meningitis

A

enteroviruses

326
Q

most common season for viral meningitis

A

late summer

327
Q

causes of viral meningitis

A

varicella zoster, HSV, enteroviruses (coxsackie, echo), CMV

328
Q

treatment for varicella zoster and HSV meningitis

A

acyclovir

329
Q

treatment for CMV meningitis

A

gancyclovir

330
Q

treatment for meningitis due to enteroviruses

A

supportive care

331
Q

what is required for control of HSV infection

A

cell-mediated immunity

332
Q

encephalitis implies involvement of the ____

A

brain parenchyma

333
Q

encephalitis ssx

A

headache, abnormal behavior, seizures, +/- fever/meningismus

334
Q

viral causes of encephalitis

A

HSV, rabies, arboviruses, West Nile

335
Q

JC virus causes what complication in patients taking monoclonal antibodies

A

progressive multifocal leukoencephalopathy

336
Q

ssx of brain abscess

A

fever, headache, focal deficit, vomiting, seizures, mental status changes

337
Q

bacterial causes of brain abscess

A

mixed anaerobes, staph aureus, nocardia

338
Q

other causes of brain abscesses

A

toxoplasma, cryptococcoma, tuberculoma

339
Q

methods of pathogen spread to brain to cause brain abscess

A

hematogenous, contiguous, post-trauma

340
Q

methods of pathogen spread to spinal cord to cause spinal epidural abscess

A

hematogenous or contiguous

341
Q

what conditions may be associated with spinal epidural abscess

A

discitis, vertebral osteomyelitis, psoas abscess

342
Q

spinal epidural abscess diagnosis

A

MRI, needle biopsy for cultures, PPD, fungal serology, etc

343
Q

causative pathogens in spinal epidural abscess

A

staph aureus, gram negative rods, streps, TB, fungi

344
Q

clinical features of simple cellulitis

A

poorly demarcated erythema, edema, warmth, tenderness

345
Q

clinical features of erysipelas

A

well demarcated erythema, edema, warmth, tenderness, spreads through lymphatics

346
Q

clinical features of necrotizing fasciitis

A

pain out of proportion to exam, edema, skin necrosis, bullae, cutaneous numbness, fever, crepitus

347
Q

clinical features of abscess

A

erythema, edema, warmth, tenderness, fluctuance

348
Q

clinical features of impetigo

A

superficial, intra-epidermal vesicles, “honey-crusted”

349
Q

simple cellulitis pathogens

A

staph aureus, group A strep (pyogenes)

350
Q

erysipelas pathogen

A

group A strep

351
Q

necrotizing fasciitis pathogens

A

strep pyogenes, staph aureus, clostridium perfringens, enteric bacteria, polymicrobial

352
Q

fournier’s gangrene site pathogens

A

GU, polymicrobial

353
Q

abscess pathogens

A

staph aureus, anaerobes (pilonidal abscess)

354
Q

impetigo pathogens

A

group A strep, staph aureus

355
Q

hot tub folliculitis pathogen

A

pseudomonas

356
Q

cellulitis is a ___ diagnosis

A

clinical

357
Q

characteristics of mild SSTI

A

local symptoms only

358
Q

characteristics of moderate SSTI

A

<2 signs of systemic infection

359
Q

characteristics of severe SSTI

A

failed PO abx and/or have systemic signs of infection, and/or immunocompromised, and/or ssx of deeper infection

360
Q

initial treatment for all purulent SSTIs

A

I&D

361
Q

when to C&S purulent SSTIs

A

moderate/severe

362
Q

empiric abx for moderate purulent SSTI

A

TMP/SMX or doxycycline

363
Q

treatment for moderate purulent SSTI MRSA

A

TMP/SMX

364
Q

treatment for purulent moderate SSTI MSSA

A

dicloxacillin or cephalexin

365
Q

empiric tx for severe purulent SSTI

A

Vancomycin or ceftaroline etc

366
Q

treatment for severe purulent SSTI MRSA

A

vancomycin or ceftaroline etc

367
Q

treatment for severe purulent SSTI MSSA

A

nafcillin or cefazolin or clindamycin

368
Q

tx for mild nonpurulent SSTI

A

oral abx: PCN, cephalosporin, clindamycin

369
Q

tx for moderate nonpurulent SSTI

A

IV PCN, ceftriaxone, clindamycin

370
Q

tx for severe nonpurulent SSTI

A

emergency surgical consult plus empiric tx of vanc plus pip/taz

371
Q

nonpurulent SSTIs include

A

necrotizing, cellulitis, erysipelas

372
Q

purulent SSTIs include

A

furuncle/carbuncle/abscess

373
Q

SSTI staph/strep abx

A

cephalexin/ceftriaxone

374
Q

SSTI with MSSA

A

dicloxacillin

375
Q

simple cellulitis abx

A

doxycycline

376
Q

tx for impetigo

A

bactroban/mupirocin ointment

377
Q

SSTI with MRSA

A

bactrim

378
Q

SSTI abx if reactions to other meds

A

clindamycin

379
Q

severe SSTI abx

A

pip/taz and vanc (covers pseudomonas)

PCN+clinda : covers GAS and clostridium for nec fasc

380
Q

most animal bites are from a ___

A

dog

381
Q

pathogen in human bites

A

eikenella

382
Q

pathogen in cat bites

A

pasteurella

383
Q

pathogen in dog bites

A

capnocytophaga

384
Q

bite wound treatment

A

copious irrigation with exploration for foreign bodies and bone/tendon involvement, leave open when possible or loosely suture

385
Q

wounds that become infected within 24 hours of bite are often _____

A

pasteurella

386
Q

first-line bite prophylaxis

A

augmentin

387
Q

when to initiate tetanus prophylaxis after a bite

A

if it is has been more than 5 years since last immunized

388
Q

characteristics of nec fasc

A

rapid spread, brawny edema of site, wooden feeling to tissue, crepitus with worsening perfusion and later anesthesia, sepsis

389
Q

initial empiric treatment for nec fasc

A

vancomycin and pip/taz

390
Q

defined treatment for nec fasc if due to GAS

A

penicillin and clinda

391
Q

toxic shock syndrome pathogens

A

staph aureus, GAS

392
Q

characteristics of toxic shock syndrome

A

fever, hypotension, ARDS, coagulopathy, sunburn-like rash, renal/liver failure, necrosis

393
Q

toxic shock syndrome initial treatment

A

IV PCN and clindamycin, surgical debridement, IV immunoglobulin

394
Q

common organisms in hematogenous osteomyelitis

A

staph aureus, GAS, mycobacterium, staph epidermidis, Hib

395
Q

vertebral organisms in hematogenous osteomyelitis

A

staph aureus, staph epidermidis, mycobacterium, GNR, candida

396
Q

diagnosis of osteomyelitis

A

bone biopsy/aspiration, blood cultures, PPD/AFB culture

397
Q

treatment of osteomyelitis

A

cover for MSSA/GAS and add coverage for MRSA if septic or previous history. Treat with IV abx for minimum 6 weeks

398
Q

organisms in local infection non-hematogenous osteomyelitis

A

staph aureus, GNR, anaerobes

399
Q

Organisms in puncture wounds becoming non-hematogenous osteomyelitis

A

staph aureus, GAS, polymicrobial, pseudomonas

400
Q

what pathogen associated with foot puncture wound in diabetic neuropathy

A

polymicrobial

401
Q

what pathogen associated with puncture through a tennis shoe

A

pseudomonas

402
Q

septic arthritis usually affects how many joints

A

one

403
Q

pathogens in septic arthritis

A

staph aureus, GAS, gonorrhea, salmonella

404
Q

diagnosis of septic arthritis

A

bacterial culture of joint aspirate, fluid cell cout/diff, glucose, total protein, blood cultures, STI testing

405
Q

post-infectious reactive arthritis presentation

A

polyarticular in larger joints of lower extremities 4-6 weeks after infection

406
Q

respiratory organisms leading to reactive arthritis

A

GAS, neisseria meningitides, viruses

407
Q

GU organisms leading to reactive arthritis

A

gonorrhea, chlamydia

408
Q

GI organisms leading to reactive arthritis

A

salmonella, shigella, campylobacter, yersinia

409
Q

treatment of reactive arthritis

A

prednisone

Infectious Disease (5 decks)

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