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Medicine Clerkship > ID > Flashcards

ID Flashcards

1
Q

4 main types of lung/respiratory infections

A

PNA
Lung abcess
TB
Influenze

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2
Q

Bugs cause
typical CAP
atypical CAP
HCAP

A

typical CAP = Strep pneumo (#1), H. influenzae (#2), aerobic GNR

atypical: Mycoplasma (#1), Chlamydia, Legionella

HCAP: Staph aureus (#1), Pseudomonas, aerobic GNR

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3
Q

PNA × alcoholics, bug?

A

klebsiella

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4
Q

PNA + immigrant, bug?

A

TB

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5
Q

PNA + nursing home, bug?

A

HCAP (Staph aureus (#1), Pseudomonas, aerobic GNR)

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6
Q

PNA + AIDS, bug?

A

Pneumocystis carinii (PCP), TB

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7
Q

complications of PNA

A

pleural effusions, empyema, acute respiratory failure

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8
Q

presentation of typical PNA vs atypical PNA

A

Typical CAP: sudden-onset fever/chills, productive cough, pleuritic chest pain

Atypical CAP: insidious-onset sore throat, headache, nonproductive cough, dyspnea

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9
Q

Special Dx test when suspect…
TB…
legionella
HIV

A

suspect TB → acid-fast stain
suspect Legionella → urinary ag
HIV+ → silver stain (fungi, PCP)

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10
Q

When do you admit a person with PNA?

A 
2/5 of CURB-65 – 
Confusion
Uremia,
RR ≥30, 
BP <90/60
age ≥65
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11
Q

outpateint tx of PNA vs inpt tx of PNA

A

outpatient → Tx azithromycin (<60 y/o), ceftriaxone (≥60 y/o)

inpatient → Tx azithromycin + either ceftriaxone or fluoroquinolone

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12
Q

who gets pneumovax?

A

> /= 65

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13
Q

aspiration → cough w/ foul-smelling sputum, SOB, fever/chills

how to make Dx?
tx?

A

lung abcess

Dx CXR (cavitation w/ air-fluid levels, most commonly in right lower lobe)

Tx IV abx

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14
Q

what bugs cause lung abcess?

A

oral anaerobes (Prevotella, Peptostreptococcus, Fusobacterium, Bacteroides)

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15
Q

1/1 vs 2/2 TB smx

A

1° TB: granulomatous inflammation in lower lobes → infx contained → usually asx

2° TB: reactivation in upper lobes → fever/chills, night sweats, weight loss, cough w/ hemoptysis

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16
Q

how to dx TB?

A

Dx
- screen w/ tuberculin skin test (≥15 mm, ≥10 mm if high-risk, ≥5 mm if HIV+ or CXR+)

  • confirm w/ CXR (cavitation in upper lobe)
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17
Q

Treatment for active vs latent TB

A

active TB →
2 mos of RIPES (rifampin, INH, pyrazinamide, ethambutol, streptomyin then
4 mos of INH + rifampin

latent TB → INH only

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18
Q

tamiflu is

A

oseltamivir

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19
Q

triad of fever, nuchal rigidity, ∆MS

tx? tx?

A

Dx head CT to check for ↑ICP, then lumbar puncture + CSF analysis

Tx IV abx

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20
Q

Kerning sing vs brudzinski sing

A

Kerning sign: inability to fully extend knees when lying supine w/ hips flexed

Brudzinski sign: flexion of head causes flexion of hips/knees when lying supine

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21
Q

meningitis, purpura fulminans, bilateral adrenal hemorrhage (W-F syndrome) =

A

disseminated miningococcal infx

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22
Q

bugs that cause..

Meningitis × neonates:
Meningitis × kids:
Meningitis × adults:
Meningitis × elderly:

A

Meningitis × neonates: GBS > E. coli > Listeria

Meningitis × kids: MC > Strep pneumo > H. influenzae

Meningitis × adults: Strep pneumo > MC > H. influenzae

Meningitis × elderly: Strep pneumo > MC > Listeria

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23
Q

∆MS, focal neuro sx, s/sx of meningitis

dx?
tx?

A

encephalitis

*meningitis = triad of fever, nuchal rigidity, ∆MS

Dx head CT to check for ↑ICP, then lumbar puncture + CSF PCR

Tx admit + ACV (for HSV), GCV (for CMV)

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24
Q

bugs that cause encephalitis

A
  • viruses: HSV-1 in temporal lobe, arbovirus, enterovirus
  • toxoplasmosis
  • aspergillosis
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25
Q

headache, ∆MS, seizures,
nausea/vomiting, focal neuro sx

dx?
tx?

A

brain abcess

Dx head CT or MRI

Tx IV abx, surgical drainage, ±steroids

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26
Q

bugs that cause brain abcesses

A

Staph, Strep, anaerobes

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27
Q

Abscess × AIDS: bugs?

Abscess × DKA: bugs?

A

Abscess × AIDS: toxo, fungi

Abscess × DKA: zygomycosis

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28
Q

Tx for pyelo

A

uncomplicated → Tx Bactrim or Cipro

complicated → Tx admit + IV amp/gent

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29
Q

fever/chills, dysuria, frequency, urgency, low back pain + boggy, tender prostate

dx? tx?

A

Dx DRE (boggy tender prostate) + UA/UCx

Tx Bactrim or Cipro

** Chronic prostatitis: usually asx Dx prostatic secretion analysis (↑WBC) and Tx long-term Cipro

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30
Q

usually asx, jaundice, dark-colored urine, RUQ pain, n/v, daycare, travel

bug? ow to dx? tx?

A

HAV

Dx HAV IgM = acute infx
HAV IgG = previous infx or immunity

Tx supportive care

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31
Q

jaundice, dark-colored urine, RUQ pain, n/v, polyarteritis nodosa, MGN

tx?

A

HBV

Tx IFN-α

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32
Q

Dx HBsAg = ?
Dx HBsAb = ?
Dx HBeAg = ?
Dx HBcAb IgM = ?

A

Dx HBsAg = acute/chronic infx
Dx HBsAb = previous infx or immunity
Dx HBeAg = infectivity
Dx HBcAb IgM = window period

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33
Q

jaundice, dark-colored urine, RUQ
Cryoglobulinemia, Chronic infx,
Cirrhosis, Carcinoma, Carriers, IVDA, MPGN

Dx? Tx?

A

HCV

Dx HCV RNA

Tx IFN-α + ribavarin, liver txp if severe

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34
Q

jaundice, dark-colored urine, RUQ, Deadly, HBV co-infection

dx? tx?

A

HDV

Dx HDV Ab
Tx IFN-α

35
Q

jaundice, dark-colored urine, RUQ, cruise ships, fatal in pregnancy

dx?
tx?

A

HEV

  • Dx HEV Ab
  • Tx supportive care
36
Q

viral hep strains that are

  1. sexually transmitted
  2. parentally transmitted
  3. fecal oral route
A

sex: B and D
parental: B, C, D

fecal-oral: A and E

37
Q

symmetric, descending flaccid paralysis + canned food or wound infx

A

C botulism

38
Q

how to dx and tx botulism

A

Dx toxin assay

Tx admit + antitoxin

39
Q 
Diarrhea × n/v: viral 
Diarrhea × fever/blood:
Diarrhea × mayonnaise:
Diarrhea × raw chicken:
Diarrhea × raw seafood:
Diarrhea × abx: 
Diarrhea × travel: 
Diarrhea × daycare: 
Diarrhea × AIDS:
A

Diarrhea × n/v: viral gastroenteritis or food poisoning

Diarrhea × fever/blood: Shigella, Salmonella, Campy, EHEC

Diarrhea × mayonnaise: Staph aureus (

40
Q

Tx for bacterial gastroenteritis

A

Tx ciprofloxacin x5 days

C. diff → Tx Flagyl or PO vancomycin

41
Q

Cellulitis × fight bite:

A

Eikenella

42
Q

tx for cellulitis

A

Tx Keflex or Bactrim, consult ophtho if orbital involvement

43
Q

“fiery red”, painful skin lesion on face or extremities

Dx? bug? tx?

A

Erysipelas

Strep pyogenes

Tx w. PCN or erythromycin

44
Q

bugs that caise nec fasc

A

strep pyogeneis and C perfringens

tx id debriedment + broad specturm abx

45
Q

infx of LN → tender LN w/ local cellulitis

bug? dx? tx?

A

lymphadenitis

skin forlar/strp pyogenes, staph aureus

Tx Keflex or Bactrim, warm compresses

46
Q

trismus (lockjaw), opisthotonos (spastic back), risus sardonicus (spastic smile)

bug? pathophys? tx?

A

Tetanus

c. tetani exotoxin = blocks GABA and glycine relase
tx: Tx tetanus antitoxin (TIG) in one site, Td immunization in a different site

47
Q 
OM × IV catheter: 
OM × prosthetic joint: 
OM × diabetic foot:
OM × nosocomial:
OM × IVDA: 
OM × sickle cell:
OM × vertebra: 
OM × cat/dog bite:
A

OM × IV catheter: Staph aureus

OM × prosthetic joint: coagneg Staph epidermidis

OM × diabetic foot: polymicrobial

OM × nosocomial: Pseudomonas

OM × IVDA: Pseudomonas

OM × sickle cell: Salmonella

OM × vertebra: TB (Pott dz)

OM × cat/dog bite: Pasturella multocida

48
Q

how to monitor for resolution of osteomyelitis

A

serial ESR/CRP

49
Q

Arthritis × sexually-active young adults:
Arthritis × IVDA:
Arthritis × sickle cell:

A

Arthritis × sexually-active young adults: N. gonorrhoeae
Arthritis × IVDA: Pseudomonas
Arthritis × sickle cell: Salmonella

50
Q

erythema chronicum migrans

A

target shaped lesion in lyme dz

51
Q

how to dx lyme dz

A

Dx screen w/ ELISA, confirm w/ WB

Tx doxycycline

52
Q

triad of HA + fever + rash (vasculitis that starts on extremities and comes inward)

tx?

A

RMSF

doxy

53
Q

cyclic fever/chills, headache, anemia, splenomegaly

how to dx? tx?

A

blood smear w/ giemsa stain

cholorquine (mefloquine if resistent) +/- primaquine for p. vivax/ovale hypnozoites

54
Q

pain at bite location → fever, malaise →
agitation, photophobia, hydrophobia
(foaming) → paralysis, coma → death

how to dx? tx?

A

Dx viral cx, Negri bodies on Purkinje cell bx

Tx emergent passive + active immunization

55
Q

Plasmodium falciparum (24h),
P. vivax and ovale (48h),
P. malariae (72h) via

A

malaria

56
Q

vector for malaria

A

Anopheles mosquito

57
Q

vector for RMSF

A

tick

58
Q

vector for lymes disease

A

ixodes tick

59
Q

Rickettsia rickettsii

A

RMDF

60
Q

pseudohyphae

A

candidia

61
Q

air-crescent sign on CXR

+ hemoptysis

A

aspergillosis

62
Q

tx for…

aspergilloma vs invasive aspergillosis

A

lung lobectomy (aspergilloma)

IV ampho B (invasiveaspergillosis)

63
Q

need what to get aspergilloma

A

prior lung caviation

64
Q

meningitis/encephalitis in HIV+ pts

A

cryptococcus

65
Q

vector for crytococcus

A

via pigeon droppings

66
Q

vector for histo

A

bat/bird droppings in caves

67
Q

how does histo present?

tx?

A

usually asx, mild respiratory virus

itraconazole

68
Q

tx for cryptococcis

A

IV amp B + flucytosine

69
Q

inflammatory lung dz, granulomatous
nodules in skin and bone

tx?

A

Blastomycosis

itraconazole

70
Q

gardener local ulcer + ascending LN-opathy

tx?

A

Sporotrichosis (“rose gardener disease”)

itraconazole or potassium iodide

71
Q

usually asx, mild respiratory sx after earthquakes in SW US

tx?

A

Coccidioidomycosis

itraconazole

72
Q
  • huge spherule w/ endospores
  • Broad Based Buds
  • macrophage-filled spores
  • India ink stain (thick capsules)
  • cigar-shaped yeasts
A

huge spherule w/ endospores = Coccidioidomycosis

Broad Based Buds = Blastomycosis

macrophage-filled spores = Histoplasmosis

India ink stain (thick capsules) = Cryptococcosis

cigar-shaped yeasts = Sporotrichosis

73
Q

bloating, flatulence, foul-smelling fatty diarrhea?

bug? dx? tx?

A

Giardia lambii
• Dx stool sample
• Tx metronidazole

74
Q

flask-shaped ulcers in ascending colon → bloody diarrhea; “anchovy paste” abscess in liver → RUQ pain

bug? dx? tx?

A

Entamoeba histolytica

  • Dx stool sample
  • Tx metronidazole (for diarrhea and abscess)
75
Q

usually asx, can cause bowel obstruction

bug? dx? tx?

A

Ascaris lumbricoides
• Dx stool sample
• Tx mebendazole

76
Q

mild diarrhea, severe diarrhea in HIV+ pts

bug? dx? tx?

A

Cryptosporidium parvum
• Dx acid-fast stain
• (no tx exists

77
Q

hooks onto bowel walls and sucks blood → iron-deficiency anemia

bug? dx? tx?

A

Ancylostoma duodenale (old),
Necator americanus (new)
• Dx stool sample
• Tx mebendazole

78
Q

perianal pruritus, worse at night

bug? dx? tx?

A

Enterobius vermicularis

scotch tape test
mebendazole

79
Q

usually asx `→ macrocytic anemia

bug?

A 
Taenia saginata (beef),
Taenia solium (pork),
Diphyllobothrium latum (fish)

eats vitamin B12 → macrocytic anemia

stool sample
praziquantel

80
Q

cause fibrosis of liver and spleen

bug? tx?

A

Schistosomiasis = S. mansoni/japonicum

praziquantel

81
Q

causes bladder infx → dysuria, bladder SCC

A

Schistosomiasis = S. haematobium

82
Q

bugs that cause catheter related sepsis (when left in > __ days)

A

> 3 days
Staph aureus (#1),
coag-neg Staph epidermidis (#2)

83
Q

fever/chills, sore throat, malaise, myalgias, severe cervical LN-opathy

dx? tx?

A

mono

EBV, CMV

monospot test (heterophile agglutination) test

supportive care + avoid contact sports to prevent splenic rupture

Medicine Clerkship (20 decks)

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