ID 4 Flashcards
Found in Shellfish, patients present with Diarrhea and Bullous skin lesions. It can cause potentially fatal infection in patient with Chronic Liver Disease and Cirrhosis?
Vibrio Vulnificus.
When is ppx for Lyme disease indicated?
When the tick has been attached for > 36hrs and medications needs to be started within 72 hrs (3 days)
Management of Candidemia?
Removal and Catheter and Start IV Caspofungin
Next step in management in a patient diagnosed with influenza, feels better then gets sick again?
This is Secondary Bacterial Pneumonia. Give
Ceftriaxone + Azithromycin (CAP Treatment )+ Vancomycin (Cover for MRSA PNA)
Pt with Poor Oral hygiene or Recent Dental Work presents with swelling over the mandible for 3 months. The sinus tract extending into skin shows purulent and blood-tinge drainage. Next Step in management?
Actinomycoses
IV PCN for 6 weeks then Oral PCN for 6-12 months
This occurs in Pts who are severely immunocompromised (Blood Cancer Patients on Induction Chemo, Bone Marrow Transplant Patients) They develop Refractory Fevers, Skin lesions and Pulmonary disease.
Inoculation occurs through breaks in the skin from soil or Tap water. Dx? Rx?
Fusariosis.
Amp. B +/- High Dose Vorioconazole.
They need to AVOID SOIL and TAP Water.
What is the most sensitive way to Diagnosis Typhoid Fever (Fever, Relative Bradycardia, Bacteremia Abdominal pain, Rash, Contaminated food in Developed Country)?
Bone Marrow Cultures.
Rather than bodily cultures.
Bone Marrow Cultures remain positive several days after Abx has been started.
- Fever, Headache, Retro-Oribital Pain, Rash, and Body aches, leukopenia, thrombocytopenia and Elevated LFTs. Dx?
- Fever, Myalgia, Headache, Abdominal Pain + Conjunctival injection. Dx?
- Fever, Chills, Headache, Abdominal Pain, N/V, Splenomegaly, Hyperbili and Anemia and Thrombocytopenia?
- Fever, Abdominal pain, N/V, Jaundice and Hepatomegaly. LFTs> 1000 U/L. Dx?
- Dengue Fever
- Leptospirosis.
- Malaria
- Acute Viral Hepatitis
Next Step in management for a patient who was exposed to TB but TST remains negative?
Do a repeat TST in 8-12 weeks due to Window Period.
Name the vomiting predominate Organisms (Pre-Formed Toxin)?
- Staph (Potato Salad) 2. Bacillus (Fried Rice) 3. Norovirus (Cruise Ship)
Common CD4 counts for these opportunistic infections:
- TB
- PCP
- Histoplasmosis
- Toxo
- Mycobacterium Avium
- Any CD4 count
- CD4< 200
- CD4 < 150
- CD4 < 100
- CD4 < 50
Which abx are appropriate to help prevent Travelers diarrhea in a patient seeking travel?
Azithromycin, Fluoroquinolones, Rifixamin. They can self medicate at the onset of diarrhea.
Away For Relaxation
Which patients require CT scan before LP? Name the steps in Management ?
AMS, Immunocompromised, CNS disease (Stroke,), Seizure, Papilledema or Focal Neurologic Deficit.
- Get Blood Cultures.
- Abx and Steroids PRIOR to CT
- CT
- LP
- Acute febrile illness (Fever, Myalgia, Rash Progression) following syphilis treatment with Penicillin G.
- What is the recommended treatment for a patient with confirmed syphilis in the latent phase or unknown duration?
- Jarisch-Herxheimer Reaction. Give Acetaminophen or NSAIDs. Usually resolves within 48 hrs.
- Pen G weekly for 3 weeks. Doxy for Severe PCN Allergy. All other get single dose of PCN G.
Treatment for Hospital Acquired Meningitis?
Cefepime/Ceftazidime/Meropenem. Work against Gram negative Organism and have good CNS penetration.
- Contact with infected animals (Rabbits). Pts present with Ulceroglandular disease with a single Erythematous papular skin ulcer, Central Eschar and Tender local lymphadenopathy.
- Bites and Scratches from Domestic Pets (Cats.) Pt have localized cellulitis and regional lymphadenopathy
- Travel to Texas with Rat exposure. Ot presents with Fever and Regional Lymphadenitis (Swollen/Painful !!!Nodules.) Dx?
- Francisella Tularensis (Tularemia)
- Pasteurella Multocida. Amoxicillin/Clavulanate
- Yersinia Pestis ( Bubonic Plague- Bubo)
Which medication is important to give in addition to abx in patients with suspected Acute Bacterial Meningitis caused my Strept Pneumoniae ?
Dexamethasone. If CSF or Blood Cultures show NONpenumoccoal organism than you can stop steroid.
Recommended prophylatic treatment for people EXPOSED to Neisseria Meningititis ?
Rifampin, Ciprofloxacin or Ceftriaxone.
- Common nocosomial infections in Transplant patients within the first month of surgery?
- When does CMV occur?
- When does PCP occur?
- VRE, MRSA, Candida and Pseudomonas (colonizes hospital equipment (Mechanical Ventilation.)
- 1-6 months ( Place on Valganciclovir ppx)
- 3-4 months ( place on Bactrim PPx)
Give symptom of each stage:
- Early localized Lyme disease
- Early disseminated Lyme disease
- Late Lyme Disease
- Erythema migrans
- CN palsy and/or Meningitis
- Arthritis
Pt with DM and multiple Admissions for Ketoacidiosis presents with Purulent Nasal Discharge, Congestion and Right Sided Periorbital Swelling and Tenderness. Dx? Test? Rx?
Mucormycosis
Biopsy
Surgical Debridement + IV Ampicillin.
Presents in Asplenic Patients, Age > 50 or Immunocompromised. After travel to Endemic area and Can Occur after Receiving a Blood Transfusion. Dx? Test? Rx?
Babesiosis
Peripheral Smear
Azithromycin + Atovaquone
Seen in patients who Garden/Landscape. Pt present with reddish nodules that later ulcerates and other nodules with ulcerations appear in area. Dx? Test? Rx?
Sporotrichosis
Culture
Itraconazole
