ID Flashcards
1
Q
tx for toxoplasmosis
A
pyrimethamine (+leucovorin i.e. folic acid) + sulfadiazine
2
Q
dengue fever
A
breakbone fever (arthralgia, myalgia), retroorbital pain, thrombocytopenia, rash with a white macular appearance.
DANG MY EYE HURTS and BONES BREAK
3
Q
etec treatment
A
Ciprofloxacin
Azithromycin
Rifaximin
Might have diarrhea in the CAR when abroad
4
Q
mgmt of candidemia
A
- Echinocandin = Caspofungin, Micafungin or Anidulafungin
- removal of intravascular catheter
- opthalmo eval for endopthalmitis in all pt
5
Q
Centor criteria
A
Fever (subjective)
Tender anterior cervical LN
Tonsillar exudate
Absence of cough
0-1: No test
2-3: Rapid strep test
4: empiric amoxicillin/penicillin
6
Q
When do u treat asx candiduria?
A
In neutropenic pt or those undergoing urologic procedure only
7
Q
Mgmt of acute bacterial meningitis
A
Early empiric abx + dexamethasone + acyclovir. Those who need CT scan (AMS, FND, hx CNS dz, papilledema, seizure) prior to LP should get tx right after cultures without waiting for LP
8
Q
Minimum induration for positive PPD
A
5mm (HIV pt, recent contact with +TB pt, CXR shows fibrotic changes from prior TB, organ transplant/immunosuppressed)
10-15mm for other individuals
CXR for positive PPD only
9
Q
Increased opening pressure definition
A
> 200 mm H20
10
Q
meningitis in patient with AIDS
A
cryptococcal (usually at CD4 <100)
11
Q
Management of meningitis in AIDS patient, opening pressure elevated (>200)
A
CRYPTOCOCCAL
Induction: Amphotericin B + Flucytosine (2 weeks)
Maintenance: Fluconazole daily (until 3 months of CD4>100, usually a year)
Increased ICP: Serial lumbar puncture (not steroids/mannitol)
12
Q
ring enhancing lesion in HIV
A
Toxoplasmosis: multiple small lesions. CD4 <100. + mass effect. basal ganglia esp.
Primary CNS lymphoma: solitary lesion, large (>4cm). CD4 <50. EBV virus. +mass effect, also B sxs
- PMFL no mass effect, enhancement or edema
- CMV encephalitis is periventricular, no mass effect
13
Q
T/F: Right sided IE patients typically present with new cardiac murmur and septic pulmonary emboli
A
False, usually no heart murmur in right sided IE. Will have bilateral cavitary lesions in lungs from septic emboli
14
Q
Most common bug right sided IE
A
Staph Aureus
15
Q
Tx of neurocysticercosis
A
Albendazole (antiparasitics) and/or corticosteroids
16
Q
Specific abx in bacterial meningitis treatment
A
Vanc: STREP PNEUMO (covers cephalo-resistant), **Staph aureus and coag neg staph (staph after head trauma, nsx, nsx device)
Cefepime: NEISSERIA (gnr) **pseudomonas (head trauma, nsx, nsx device, immunocompromise)
Ampiciliin: LISTERIA (also tx by penicillin G)
17
Q
T/F: Patients with suspected IE and no acutee sxs/good CV f(x), empiric therapy not always necessary
A
True. can be defeeerred until blood culture results available
18
Q
Main bugs to cover with empiric native valve IE coverage
A
Staph, Strep, Enterococci
Use VANCOMYCIN
- *If penicillin allergy: Cefazolin. If cx turn strep pneumo, can do ceftriaxone
- ** Vanc MIC >1 and MRSA: Use Daptomycin (unless MRSA pna)
Alt: Unasyn + gentamicin (gent is not gentle on kidneys)
19
Q
HAV post exposure prophylaxis
A
Either HAV vaccine OR IG.
Prefer HAV vaccine usually. Kids or immunocompromise get IG. All household/sexual contacts.
20
Q
HBV post exposure prophylaxis
A
HBV vaccine PLUS HBIG
includes sexual/household contacts for patients with HBV and those with needle stick injury
21
Q
T/F: Latent TB does not need tx if negative CXR
A
False. Latent TB = positive PPD but no sxs and negative CXR.
Tx options:
- Rifampin for 4 mo
- INH + rifapentene 3 mo
- INH 6-9 mo (watch for hepatitis and peripheral neuropathy)
22
Q
Tx for chronic schisto infx
A
Praziquantel
23
Q
Mucormycosis vs aspergillus: branching/septations
A
both affect immunocompromised.
mucor: Hyphae with irregular branching, No septations
aSpergillus: Hyphae with regular branching and many septations
24
Q
Alternatives to penicillin for syphillis
A
Primary and secondary: can use doxycycline or tetracycline
Neurosyphillis: can use IV ceftriaxone for mild pen allergy, otherwise desensitize and admin
25
chikugunya sxs
unremitting high fever + severe polyarthralgia
26
T/F: Patients can transmit genital HSV while asymptomatic
very true, viral shedding. consider daily valcyclovir or acyclovir to reduce partner transmission
27
Pulmonary surfactant inhibits efficacy of this MRSA drug against pna
Daptomycin. use for skin/soft tissue infxs.
Use Vanc or Linezolid for MRSA pna/VAP
28
When do you add listeria in empiric meningitis coverage?
Age >50 and immunocompromised
29
post-influenza secondary. bacterial pna empiric tx
Patients with influenza transiently improve and then more severe sxs. Usually Strep and Staph.
Ceftriaxone, Azithro + Vanc
30
Tx for Aspergillosis
For invasive (i.e. halo sign on CT): Voriconazole
For ABPA (asthma/CF pt with difficult to control sxs): Steroids + itraconazole
31
Clues for aspergillosis
- Halo sign (invasive asp): nodules surrounded by ground glass infiltrates
- asthma/CF (ABPA) with difficulty controlling sxs, hemoptysis
- fever unresponsive to abx
- hemoptysis in neutropenic patient
- EELISA on serum or BAL shows galactomannan antigen
32
T/F: FTA-AT test (flurorescent treponemal antibody) remains positive for life
True, so retesting this later doesn't make much sense
33
How much should titer for Syphilis decrease to say its a good tx response/
4 fold in 6-12 mo.
- If tx failure, LP to eval for neurosyphilis + retreatment
- serofast state (baseline titer positive forever after 4 fold decrease): repeat VDRL testing and check HIV status, no tx needed
34
Tx for MAC
Clarithromycin (or azithro)
Rifampin
Ethambutol
MACCRE (MAC-RAY)
35
Disseminated endemic mycosis
Blasto: bone, skin (primary skin lesion), genitourinary. "Blasto blasts bones, balls and skin"
Histo: LN, pancytopenia, hepatosplenomegaly
Cocci: erythema nodosum or multiforme, meningitis
36
Empiric tx for febrile neutropenia (ANC <500)
Cover pseudomonas: zosyn or cefepime.
Don't need vanc unless hemo unstable, pna, catheter related infx, skin/soft tissue infx
37
How do you treat Lyme disease?
Early disease: Doxycycline (14-21 days)
**alternatives: Amoxicillin, Cefuroxime
Late arthritis and facial nerve palsy: Doxycycline
Late carditis or neurologic disease: IV Penicillin or IV Ceftriaxone (28 days)
NO DOXY IN PREGNANCY (amoxicillin or cefuroxime)
38
Most common persistent manifestation of untreated Lyme dz
Arthritis/arthralgia.
Don't forget that in secondary stage can have meningitis, facial nerve palsy, arthritis
39
Management of recurrent HSV 1
- minimal sxs: supportive care w/o antiviral therapy
- recurrent pain/discomfort: oral antiviral at prodrome onset
- >4 episodes/year or complications like meningitis: chronic suppressive therapy (daily acyclovir or valcyclovir)
40
Tx of herpes sequelae
Primary herpes keratoconjunctivitis: vidarabine, acyclovir or trifluorothymidine + opthalmo referral
Herpes encephalitis: IV acyclovir
Bells palsy: steroids
41
conjunctival suffusion
redness in conjunctiva w/o inflammatory exudates
LeptospiROsis
Red Ocular phenom.
42
When do you give antiviral tx for influenza
Oseltamavir within 48 hours of sxs. Anyone with severe disease/hospitalization should also get it regardless of sx duration
43
T/F: Rapid influenza antigen test is highly sensitive
False, its a shitty test. Go off of clinical suspicion even if its negative. Hx of immunization also should not deter you.
44
Sxs of tacrolimus toxicity
Acute nephrotoxicity, hypertension, neurotoxicity (i.e. tremor), metabolic disturbance (i.e. glucose intolerance)
45
common post-transplant infection
First 4 weeks: candida, mold (fusarium)
```
After first month:
**CMV most common**
BK virus ("bad kidney")
EBV (in all patients with lymphoproliferation)
HBV, HCV, HSV reactivation
```
46
Gram positive rods
Bacillus
Clostridium
Listeria
Nocardia, Actinomyces
47
leading cause of dilated cardiomyopathy in central/south america
Chagas disease from Trypanosoma cruzi. Patients will have LV APICAL ANEURYSM (pathognomonic)
48
Acute rheumatic fever
```
J- joints (migratory arthritis)
O - carditis
N - subq nodules
E - erythema marginatum
S - sydenham chorea
```
occurs 2-4 weeks after GAS pharyngeal infx
49
Nocardia vs Actinomyces
Nocardia: Lung (nodules, consolidation abscess) and Brain (abscess) infection, some skin cellulitis etc. Acid-fast branching rods, aerobic. Bactrim
Actin: affects face (after dental work/infection/trauma) and abdominal. anaerobic gram positive rod part of normal oral flora. sulfur granules. penicllin
50
Neck pain/swelling and fever with recent hx of pharyngitis
Suspect Lemierre syndrome - from anaerobic fusobacterium necrophorum.
it is septic thrombophlebitis of internal jugular vein. develops despite appropriate pharyngitis antibiotic tx. may see PE on chest imaging
51
sore throat with gray and white tonsillar exudates, cervical LN
Corynebacterium diptheria
52
Posterior cervical LN + sore throat
mono
53
When do you add empiric abx after abscess I/D?
```
Abscess >2cm
extensive cellulitis
systemic signs
multiple abscess
neutropenia
```
Use Bactrim or Doxy
54
HIV PrEP (pre)
2 drug regimen: Tenofovir + Emtricitabine. Give them 3 month supply to ensure good f/u and counseling
-need HIV and HBV testing/vaccination status to qualify
55
When do you DC PJP prophy in HIV patient?
CD4>200 for 3 months
56
most common cause pneumothorax in AIDS pt
PJP. They can have cystic lesions (thin-walled cavitary lesions) that rupture
57
elevated LDH in HIV patient
PJP. Dx using silver stain or IF monoclonal antibody stain
most will have LDH >50...LDH>450 is predictive of PJP
58
Tx for PJP
Mild: PO Bactrim
Mod-Severe: IV Bactrim
**If sulfa allergy: IV pentamidine or IV Clindamycin + primaquine
+Steroids: If A-a>35 or arteral PO2 < 70
59
Disseminated gonococcal infection
Purulent arthritis w/o skin lesions OR
| triad: migratory asymmetric polyarthralgias, tenosynovitis, painless pustular skin lesions
60
T/F: Wait for Lyme serology in suspected lyme before tx
false, can start empiric doxy. antibodies to borrelia usually negative in early dz
61
Anti malarial in pregnancy
Chloroquine or Mefloquine
62
how do you treat leptospirosis?
Lepto has conjunctival suffusion (redness), diffuse myalgia, liver dz, gi sxs seen in tropical areas
Tx with Doxycycline or Penicillin
63
3 stages of syphilis
Primary: ulcer (chancre). 3 weeks post inoculation, painless
Secondary: Skin (any type of rash, often palmar/plantar involvement), painless LN, HA/stiff neck/AMS, condylomata lata (wart-like lesions on intertriginous surfaces). 2-8 weeks after primary. widespread hematogenous spread
Latent (tertiary): +RPR/FTA-ABS serology but no sxs. Can manifest years later with AORTITIS, Aortic insufficiency, ascending aorta calcifications, Tabes Dorsalis (posterior columns, sensory ataxia, argyll robertson pupils), stroke in a young patient
64
T/F: FTA-ABS will remain positive indefinitely in syphillis patient
true
65
Tx of Syphillis
Primary, Secondary: Penicillin G IM x 1 dose (or doxy x 14 days)
Latent/Tertiary: Penicillin G IM weekly x 3 weeks (doxy 28 days)
Neurosyphillis: Pen G IV x 10-14 days (Ceftriaxone 14 days)
Failure of serology to decrease fourfold in 6-12 months = treatment failure or reacquisition
66
college kid with severe myalgias, rash
Neisseria meninigitidis
67
empiric meningitis coverage in these patients require cefepime instead of ceftriaxone
Immunocompromised
Neurosurgery/penetrating skull trauma
Note: Ampicillin for age >50 and immunocompromised
68
why is dexamethasone added to empiric meninigits coverage?
to cover pneumococcal meningitis and reduce neurological sequelae (hearing loss, mortality). it should be DC'ed if CDF gram stain/any cultures indicate nonpneumococcal organism
69
T/F: All patients empirically covered for meningitis should get acyclovir
False. Give it if suspect herpes encephalitis/meningitis. Most cases accompanied by genital lesions, absence of nuchal rigidity and hypotension
70
Risk factors for ESBL
- length of hospital/ICU stay
- catheters: foley, central/arterial, feeding tube
- ventilator
- nursing home
Tx with carbapenems (meropenem, iminopenem)
71
Presentation of babesia
High fever
hemolytic anemia
thrombocytopenia
jaundice
blood smear shows parasitized rbc: intraerythrocytic parasites in tetrads = maltese cross (BB 4)
can use atovaquone + azithro if needed
72
presentation of ehrlichiosis
```
severe/prolonged fever
LEUKOPENIA
thrombocytopenia
elevated LFTs
myalgia, AMS, LN
sometimes rash
```
peripheral smear shows moruale: intracytoplasmic inclusions in neutrophils
73
T/F: LP Is contraindicated in presence of brain abscess
True...potential increased ICP and herniation.
Drain/excise any >2.5cm
74
Recurrent cellulitis
tx risk factors, such as lymphedema, tinea pedis, chronic venous insufficiency
75
infection plus hemorrhagic bullae in patient with cirrhosis
vibrio
76
New diabetic foot infection
ABI and foot imaging for all
77
CURB-65
```
Confusion
Uremia
RR
BP low
Age >65
```
0-1 outpatient
2 admit
78
T/F: Never treat asx bacteruria
False, treat it in pregnant women and those getting urologic procedure
79
Patient with TB starting on treatment with RIPE. special testing?
All need HIV if not already
Pyrazinamide: uric acid levels
Ethambutol: visual acuity/color vision testing
80
T/F: Candidemia occurs most frequently when indwelling catheter
true
81
T/F: Candida in sputum and blood usually contaminant
False...
In sputum: usually contaminant
In blood: never a contaminant
Don't tx asx candiduria (unless neutropenic, uro procedure) or candida in sputum of vented pt
82
recurrent disseminated gonococcal infection (arthritis-dermatitis syndrome with migration or purulent monoarthritis)
consider terminal complement deficiency (c5, c6, c7, c8)...membrane attack complex MAC
screen with CH50 assay
83
Tx chlamydia/gonorrhea
C: Azithro or Doxy
G: Ceftriaxone
GC CAD
84
drug induced fever
Anticonvulsants (phenytoin, carbamazepine)
Antibiotics (b-lactam, sulfonamides, nitrofurantoin)
allopurinol
85
```
Diplopia
Dysphonia
Dysarthria
Dysphagia
Descending paralysis
```
Botulism (clostridium botulinum)
86
Toxic shock syndrome
- no steroids
| - MRSA: vanc + clinda/linezolid
87
X marks the spot for lyme
doxycycline
amoxicillin
cefuroxime
88
Babesia, Ehrlichiosis, Rocky
Babesia: hemolytic anemia, parasites in rbc = maltese cross
Ehlichiosis: morulae = clumps of organism in wbc, leukopenia and thrombocytopenia
Rocky: rash starts at ankles/wrists and includes palms/soles
89
UTI abx in pregnant women
Augmentin
Nitrofurantoin
Cefixime/Cefpodoxime
get a urine culture after treatment
90
TB false neg or false pos
NAAAAAT
91
who gets MAC?
- middle age/old male smoker w/ lung dz
- old thin white healthy ladies
- xray shows nodular bronchiectatic dz
- similar presentation to TB
Tx: Macrolide, ethambutol, Rifampin
*clarithromycin susceptibility testing is routinely recommended
*can also get it from nonsterile water (hot tub, cosmetic procedures, tattooing, pedicures, trauama, surgery)
92
T/F: serial galactomannan enzyme assay can be followed serially to assess response to therapy for aspergillosis
true
93
How do you tx pulmonary aspergillus?
ABPA: Steroids
Aspergilloma: Surgical resection. If asx and stable cxr no therapy needed
Invasive (halo sign, GGO , hemmorhage): Voriconazole
94
when to tx asx candiduria?
neutropenic patient
| invasive urologic procedure
95
biggest risk for candidemia
intravascular catheter
96
CD4 count for cryptococcal meningitis and MAC
<100, <50 (MAC)
97
how long do you do fluconazole for maintenance in cryptococcal meningitis?
so this is after amphotericin and flucytosine
maintenance for 3 months after CD4>100 and viral load suppressed
98
Tx of endemic mycoses
Pick itraconazole (except for coccidi is fluconazole)
99
T/F: Use gram stain to dx gonorrheal cervicitis
false, use NAAT testing
100
Most common cause of recurrent erythema multiforme
HSV recurrences (it triggers the hypersensitivity rxn)
101
T/F: Recurrent oral HSV infection is generally not treated
true
102
osteomyelitis after dog/cat bite
pasteurella
103
T/F: Pseudomonas common following foot puncture wound
true (through rubber sole of a shoe)
104
Imaging of choice for osteomyelitis if MRI is contraindicated
nuclear bone scan
105
most common drug induced fever (FUO)
anticonvulsants
antibiotics (sulfonamides, beta lactam, nitro)
allopurinol
106
deficiency of which Ig = increased risk for transfusion rxns?
IgA def (they develop anti IgA ab). most patients with selective IgA def don't need tx
*don't give standard IVIg to patients with isolated IgA def (may have IgG or IgE ab directed against transfused IgA)
107
most common immunodeficiency
CVID (may have giardia diarrhea, bronchiectasis, encapsulated bacteria i.e. pneumococcus/haemophilus)
Tx with IVIg
108
What should you screen all patients with recurrent neiserria (meningococcal or disseminated gonnorhea) infections with?
CH50 assay and f/u with individual component measures. this looks for complement def
109
med of choice for anthrax
cipro. give them the vaccine as well. if its bad or inhalational, cipro + 2 abx
110
T/F: Cryptococcal associated with increased opening pressure
true
111
Test this in young patients presenting with herpes zoster
HIV
112
T/F: Morbiliform rash in mono patients after ampicillin is an allergic rxn
False, patients can subsequently use ampicillin without rash recurrence
113
Maculopapular rash that turns petechial. Low sodium, high LFTs
rocky mountain spotted fever. tx with doxy. in pregnant, choose chloramphenicol.
114
severe hemolytic anemia, jaundice, kidney failure, tick born
babesia (maltese cross)
115
T/F: Anthrax is a gram positive bacilli has widened mediastinum
true
116
T/F: Yersinia gram negative coccobacilli from fleas that causes bubonic plague
true. tx with streptomycin and gentamicin.
"Safety pin shape gets streptomycin or gentamicin"
117
tx babesia with
atovaquone + azithromyin
118
T/F: Transfusions and asplenia = risk factors for babesia
true
