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ABIM Critical Care > Extra-Pulmonary Infections > Flashcards

Extra-Pulmonary Infections Flashcards

1
Q

Seizures in meningitis should prompt investigation for what two pathogens?

A

Listeria or HSV

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2
Q

Indications for head CT prior to LP

A
  1. Immunosuppression.
  2. Hx CNS disease
  3. New seizures within 1 week
  4. Papilledema
  5. Focal neuro deficits
  6. Altered mentation
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3
Q

Empiric antibiotics for bacterial meningitis in routine patient?

A

Vanc + Ceftriaxone

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4
Q

Empiric antibiotics for bacterial meningitis in >50yo or pregnant?

A

Vanc + Ceftriaxone.
Add ampicillin for Listeria.

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5
Q

Empiric antibiotics for bacterial meningitis in immunosuppressed patient?

A

Vanc + Ceftriaxone/Merrem + Ampicillin

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6
Q

Empiric antibiotics for bacterial meningitis in post-neurosurgical patient?

A

Vanc + Cefepime/Ceftazidime/Merrem

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7
Q

Indications for steroids in bacterial meningitis?

A

Give empirically. Continue if hearing loss, FND, S Pneumo (mortality benefit).

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8
Q

Difference in symptoms between aseptic meningitis vs viral encephalitis?

A

Viral encepalitis has altered mentation. Aseptic meningitis has fever but normal mentation.

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9
Q

Which lobe is classically hit by HSV encephalitis?

A

Temporal lobe with edema or hemorrhage.

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10
Q

Dx HSV Meningitis?

A

HSV PCR in CSF

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11
Q

Tx (HSV Meningitis)?

A

Acyclovir x 2-3 weeks IV (no PO)

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12
Q

Patient population sensitive to West Nile encephalitis?

A

> 50yo or immunosuppressed

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13
Q

Sx WNV Encephaliits?

A

fever, occular disease, encephalitis

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14
Q

Dx (WNV Encephalitis)?

A

CXR / Serum WNV IgM. PCR is not any good.

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15
Q

Presentation of WNV Encephalitis that is unique to WNV?

A

Acute Flaccid Paralysis

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16
Q

Most common bugs causing brain abscess?

A

staph, strep, anaerobes

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17
Q

Immunosuppressed patient with brain abscess. What bacteria?

A

Toxo, listeria, nocardia, aspergillus, fungi

18
Q

Empiric antibitoics for brain abscess?

A

vanc + flagyl + ceftriaxone/cefepime/cefotaxime.
Cefepime if recent CNS procedures or hematogenous spread from GI/Liver abscess

19
Q

Imaging modality of choice for brain abscess?

A

MRI. Look at T1.

20
Q

Worse potential spaces to have head/neck infections?

A

danger space, prevertebral space.

21
Q

An infection in which potential space in the head/neck causes Ludwig’s Angina?

A

Submandibular space

22
Q

Woody induration of a protruding tongue is suspicious for what disease?

A

Submandibular space infection, AKA Ludwig’s Angina.

23
Q

Infection of what space causes Lemierre’s syndrome?

A

Para-pharyngeal space or Lateral-pharyngeal space

24
Q

Septic thrombophlebitis of the jugular vein causes infection of what space in the head/neck?

A

Para-pharyngeal space or lateral-pharyngeal space. Lemierre’s Syndrome.

25
Q

Most common bacteria causing Lemierre’s Syndrome?

A

Fusiform Necrophorum. Infection of Para-pharyngeal space or lateral-pharyngeal space.

26
Q

Most common mechanism of retropharyngeal space / danger space infection?

A

penetrating trauma (chicken bone, instrumentation, tooth infection).

27
Q

Retropharyngeal / danger space infections spread where?

A

pleural or pericardial spaces (Descending necrotizing mediastinitis)

28
Q

Treatment of retropharyngeal / danger space infection in immunocompotent?

A

Augmentin / Rocephin+Flagyl / Clinda+Levaquin. Add vanco or linezolid if MRSA needed.

29
Q

Treatment of retropharyngeal / danger space infection in immunosuppressed?

A

Cefepime+Flagyl / Merrem / Zosyn. Add vanco or linezolid if MRSA needed.

30
Q

LRINEC score for what disease?

A

Laboratory Risk Indicator for NECROTIZING FASCIITIS.

31
Q

Usual etiology of Staph Toxic Shock Syndrome?

A

Women with nasal packing or tampons.

32
Q

Usual etiology of Strep Toxic Shock Syndrome?

A

Men=Women. Trauma, NSAIDs, post-partum.

33
Q

Desquamation of palms & soles, 1-2 weeks after infection with Toxic Shock Syndrome. What is the bacteria?

A

Staph

34
Q

Treatment of Staph Toxic Shock Syndrome?

A

Remove foreigh body. Clinda. Vanc or nafcillin. No controlled trials of IVIG.

35
Q

Treatment of Strep Toxic Shock Syndrome?

A

Surgical debridement. PCN-G + Clinda. IVIG based on limited data.

36
Q

Antibitoics for gas gangrene?

A

PCN-G + Clindamycin

37
Q

Bacteria causing gas gangrene?

A

Clostridium Perfringes or Clostridium Septicum.

38
Q

Clostridium Septicum bacteria coming from what other disease?

A

Colon cancer.

39
Q

Symptoms of wound botulism?

A

Diplopia, ptosis, descending paralysis, respiratory failure.

40
Q

Difference in symptoms between wound botulism vs myasthenia gravis?

A

Wound botulism has dilated pupils & no fluctuating muscle weakness or fatiguability.

41
Q

Treatment of wound botulism?

A

Antitoxin. Debridement. PCN-G (Flagyl 2nd line). Avoid aminoglycosides; it can worsen neuromuscular blockade.

ABIM Critical Care (37 decks)

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