ID Flashcards
Treatment for gonorrhea/chlamydia
Gon - ctx
Chlam- azithro or doxy (not if preg)
Tx for genital hsv
Valacyclovir
If resistant (via cx), foscarnet
Initial test for syphilis
Darkfield microscopy (more sens than vdrl or rpr)
But use rpr and fta for secondary or tertiary
Best initial test for OM
X-ray, then mri if negative but high suspicion
Esr to monitor response to tx
Skin infxns
- impetigo - most superficial, strep pyog or staph, tx topical mupirocin etc, oral diclox or cephalexin if severe
- erysipelas - GAS (pyog), oral diclox or keflex, dermis
- cellulitis - diclox, keflex, augmenting or oxacillin/nafcillin/unasyn if severe
- infxn hair follicle: folliculitis <furuncle<carbuncle<boil - tx is same as cellulitis
- fungal - topical unless scalp or nail, then oral terbinafine, itraconazole
UTI tx
If uncomplicated: fosfomycin, nitrofur, bactrim 3d, quinolone if ecoli resistance or severe
Complicated (stone etc) - bactrim or cipro 7d
Best initial dx test for prostatitis
UA
Tx cipro or bactrim for at least two weeks
Endocarditis criteria
Duke - 2 major, 1 major 3 minor or 5 minor
Major: 2 pos bcx and abnormal echo
Minor: fever, risk fx, vascular findings (eg janeway, infarcts, emboli), immuno findings (Roth, osler, glomeruloneph), pos bcx with diff org or only 1
Fever and murmur, think…
IE. Get blood cx, then echo (tte, then tee if tte neg)
IE tx
Vanc and gent 4-6 wks to cover most common orgs (strep viridans, staph aureus, mrsa)
Nocardia dx and tx
Dx - initial is cxr, then culture
Tx - bactrim or imipenem
Actinomyces
Oral flora so get through dental or face trauma
Tx is pcn
Histo vs blasto vs coccidio
Histo - initial is lung, viral like sx, don’t need to treat; dissem goes to marrow —> pancytopenia, dx with urine and serum ag and tx with amphotericin then itraconazole
Blasto - SE, bone and skin lesions, tx antifúngica
Coccidio - dry areas like az, joint pain and erythema nodosum, dx with sputum cx and serology, tx flucon or ampho if severe
ABPA
Asthma and CF
Brown mucus plugs
Tx oral pred
Tx for Candida auris
Echinocandins
Ehrlichia/anaplasma sx and tx
Sx - elevated Alt and ast, thrombocytopenia, leukopenia
Tx - doxy
Complications of mucor vs actinomycosis
M- cerebral venous thrombosis
A- fistulous tracrs, abscesses etc
CSF analysis for meng
Bacterial - glucose low, protein high, wbc>1000; tx ctx and vanc, add amp for listeria in older pt
Viral - glucose nml (40-70), protein low, wbc 10-500
Gbs - high protein, low wbc
Cryptococcus - high opening pressure, low gluc, high protein, low wbc with mostly lymphs, usu in aids, may have lesions that look like molluscum, tx ampho B and flucytosine for two or more weeks until sx abate and CSF sterilized, then high dose flucon for 8 weeks, then low dose flucon for a yr to prevent recurrence, dc thereafter if cd4>100 and vl undetectable for three mo
Acute rheumatic fever tx
Monthly pcn
Sx migratory poly arthritis after pharyngitis
Pna tx
Cap, outpt - amox, cefurox
Hap - ctx, add vanc and azithro if severe
Atypical - azithro
Beta lactamase inhib adds coverage for
Staph (not mrsa) and gram neg rods
Treatments for infection in CF
Mild - macrolide, bactrim, cipro
Pseudomonas or staph - vanc (mrsa) plus tobramycin/amikacin (psa) or ceftaz/cefe for psa
Resistant - inhaled tobra
Tick paralysis
Neurotoxins in tick saliva —> fatigue prodrome, then ataxia and ascending paralysis over hours and absent dtr’s
Tx: remove the tick
How to dx and tx schistosomiasis
Eggs in urine sed
Praziquantel
Tx for zoster
If within 72hrs of rash, valacyclovir x7-10d (have to dose acyclovir too frequently)
If more than 72 hrs, supportive
Biopsy lymph nodes after EBV if they fail to resolve after…
3-4 weeks
Diphtheria dx and tx
Dx - culture respiratory secretions or toxin assay; presents with fever, Malas, sore throat and gray pseudo membrane, complications, include myocarditis, neuritis, kidney disease
Tx - erythromycin or pcn, antitoxin if severe
Hep B lab results
Acute infection: sAg, eAg (contagious) rise with igm anti-core
Then antic sticks around and igg antic develops with antis and antie in recovery phase
If vax, have antis
If recovered, have antic and antis igg
Chronic carriers have sAg and igg antic
Acute bacterial rhinosinusitis aka sinus infxn tx
Amox clav x5-7d
Alt is doxy or fluoroquin
PEP for meningitis
Assume neisseria meng and give close contacts rifampin, ctx or cipro
When does Giardia present?
Weeks after exposure
Most common cause of rhinosinusitis
Viral!
Why do we not give abx for bloody diarrhea if child looks well?
Likely bacterial but abx increase risk of hus if stec
Treatment of PCP
Bactrim, po if o2>70, otherwise iv + steroids
Hip effusion - positioning?
Keep hip flexed and externally rotated, eg synovitis or septic arthritis
Elevated adenosine deaminase, think…
TB
