High Yield Microbiology And Antibiotics

Question 1

Describe the appearance of a patient presenting with meningitis

Answer 1

ACUTE onset of
Fever, neck stiffness, and altered mental status
Remember, as soon as you suspect this and draw cultures, give appropriate antibiotics

Question 2

What are the causative organisms of meningitis

Answer 2

TYPICAL:
Streptococcus pneumonia
Neisseria Meningitis
Haemophilus Influenza

ATYPICAL (older, alcohol, immunocompromised, pregnancy)
Listeria monocytogenes

Question 3

What are the causative organisms of meningitis?

Answer 3

TYPICAL:
Streptococcus pneumonia
Neisseria Meningitis
Haemophilus Influenza

ATYPICAL (older, alcohol, immunocompromised, pregnancy)
Listeria monocytogenes

Question 4

A patient presents with fever of 38.2, confusion, neck stiffness. What is your management?

Answer 4

Draw blood cultures, CSF. Treat after draws, not after results
Dexamethasone + Ceftriaxone + Vancomycin +Ampicilin

dex improves outcomes by reducing inflammation
ceftriaxone for typicals
vancomycin for resistant strep
ampicillin for atypicals

Question 5

What is on your differential of a patient presenting with dysuria

Answer 5

Cystitis
Pyleonephritis
STI
Vaginitis
Nephrolithiasis
Other

Question 6

If someone is presenting with dysuria, urgency, frequency what organisms may be responsible.

Answer 6

KEEPS
Klebsiella pneumoniae
E.coli (MOST COMMON)
Enterococcus species
Proteus mirabella
Staphylococcus saprophyticus

Question 7

A 47yo woman (hcG neg) has positive UA and E.Coli on culture. What is your management

Answer 7

NO TREATMENT FOR ASYMPTOMATIC
ONLY TX PREGNANT

Question 8

What characterizes complicated vs uncomplicated cystitis or pyleonephriti s. What are the implications of this for management

Answer 8

Uncomplicated cases are young non-pregnant, healthy women. Anyone else (men, instrumentation, pregnant, older are complicated
Complicated means more resistant organisms (different ABx and longer regimen)

Question 9

Describe the clinical presentation and physical exam findings of someone presenting with cystitis and someone with pyelonephritis. How might investugations change if you suspect pyleonephritis?

Answer 9

Cystitis: H: dysuria. urgency, frequency.
Pyelonephritis: Nausea/vomiting, headache, dysuria, frequency, urgency. CVA tenderness, fever.

Draw blood cultures for pyleonephritis

Question 10

Describe the treatment of Cystitis, Pyelo

Answer 10

Cystitis: Nitrofurantoin, TMP-SMX
Pyleo (inpatient): ceftriaxone (+/- ampicilin) OR gentamycin (+/- ampicilin) OR fluoroquinolone (+/- ampicilin)
Pyleo (outpt): TMP-SMX 7-14 , fluoroquinolone 7, amox-clav 10-14

NEVER GIVE MOXIFLOXACIN bc it never reaches the bladder

Question 11

Warm red skin differential

Answer 11

Erysipelas
Deep tissue infection
Drug eruption
Disrupted flow of lymph or blood (eg. DVT, venous stasis, lymphedema)
Malignancy (carcinoma erysipeloides, radiation recall reaction)

Question 12

What organisms are responsible for cellulitis and how would you treat?

Answer 12

Non purulent: Streptococcuus (GAS) Tx: Cephalexin or cephazolin 5-7 d
Purulent: S.aureus or MRSA Tx: I&D, cephalosporin 7d

Question 13

What are predictors of atypical cellulitis organisms

Answer 13

Bites
Water exposure
IVDU
Handling meat, animals, fish, hides

Question 14

What are risk factors for

List risk factors for diabetic foot ulcer. What presentation would make you think of an infection

Answer 14

Risk: Diabetic neuropathy, PVD, Poor glycemic control
Infection: redness, warmth, tenderness, swelling, loss of function
systemic symptoms, fluctuance

Ulcer may then become infected with polymicrobial bugs

Question 15

Describe the presentation of osteomyelitis

Answer 15

2cmx2xm or >3mm deep
visible bone
ulcer over prominence
ESR CRP
Xray, CT findings

Question 16

What are the organisms responsible for DSI

diabetic skin infection

Answer 16

MOST COMMOIN: S aureus, Steptococcus

Enterobacteriaciae
Pseudomonas aeruginosa

TAKE CULTURE BEFORE ABX

Question 17

How do you treat mild DFI vs severe/chronic

Answer 17

ABX
cefazolin
cefriazone +metronidazole
piptazo+ vancomycin
OTHER
wound care, debridement, revascularization, glycemic control, offloading pressure

Question 18

How would you explore a CC of diarrhea using Hx and Ix

Answer 18

H: Associated symptoms eg. N/V, abdo pain, SOB
Medical Hx
Medications
Travel
Immune state
FHx
Diet
I: electrolytes, stool culture, O+P, C diff, CT, blood culture, endoscopy, stool AFB

Question 19

How do you manage Cdiff

Answer 19

ABC
stop unnecessary meds like abx that copntributed
antimicrobials- Vancomycin +/- Metronidazole`
reassessment of response
HYDRATE, ISOLATE

Question 20

Describe the presentations of pneumonia and the common organisms

Answer 20

1. fever, sob, cough
2. cough (young with walking pneumo)
   changes to breath sounds
   typical- LOBAR
   staph pneumo
   h influenza
   atypical DIFFUSE
   legionella
   TB
   other
   PCP if immunocompromised eg. HIV

Question 21

How do you treat CAP Pneumonias

Answer 21

Outpatient: amoxicillin

Inpatient: Amox-clav OR ceftraixone

ICU: ceftriaxone +/- azithromycin

MRSA: vanco
beta lactam allergy: levofloxacin

Question 22

What is the CURB 65 and how is it used

Answer 22

Score to determine disposition- outpt (<2), admission (2+), ICU (3+)
confusion
urea>7
RR>30
BP<90/60
age>65

Question 23

What are 5 reasons for non-resolving infection

Answer 23