ID Flashcards
Who should get HAV vaccine?
MSM
HBV, HCV pts
IVDU
What vaccines should HIV pt get?
PCV 13 then PPSV23 8 wks later and every 5y
Live vaccines only if cd4>200 and no AIDS defining illness
Hep a
Corynebacterium diphtheriae causes what
It releases diphtheria toxin which is life threatening and causes URI symp
If high suspicion then give diphtheria antitoxin (horse serum) to avoid myocarditis, neuritis, and nephreitis but risk of anaphylaxis in 10%
Severe pain, erythema fever, hypotension after wood splinter may be due to which organism/disease?
Gp a strep/nec fasciitis
Most common organism in bloodstream inf is
Staph epidermidis
Nec fasciitis treatment involves
Broad abx - zosyn, vanc, clinda and urgent surgical debridement before imaging
Tx of giardia or amoeba infection
Flagyl
Also the inf is not assoc w eosinophilia
Tx of parasitic inf like roundworm, hookworm etc. NOT amoeba
Albendazole or mebendazole
Rubella vs rubeola vs roseola
Rubella - 3 day german measles - maculopap rash that begins in face and spreads caudually and disapears in 5 days, may have cough, co
May be assoc w arthritis. quick progression.
Roseola - high fever that resolves and followed by rosy nonpruritic rash on trunk spreading to extremities
Rubeola - is measles - 3 c’s cough coryza conjunctivitis, koplik spots and sick appearing
When do u start steroids for PCP? What a-a gradient and what pao2?
A-a gradient 35
Pao2 70
Which types of abx incr risk for seiZures?
Pcns, cephalosporins, IMIPENEM, fluoroquinolonrs
hydroPhobia, f/drool, dysphagia, ataxia!! Started one week ago with throat pain and hx of caves exploring
Rabies!!!! Vs epiglottitis is more acute and have stridor
Hydrophobia bc water triggers pharyngeal spasms
Once pt develops symptoms death is common… Only tx is palliative
Do u give zoster vaccine to those who have had zoster?
Yes if >60. 5% chance reactivation
Iris - immune reconstitution syndrome treatment
Worsening of hiv symp after starting haart due to rapid immune response. Since it is self limited there is no treatment and just continue haart. Unless there is severe organ dysfunction
What is considered severe c diff?
Wbc>15, cr >1.5x baseline, high fever and can consider oral vanco as first tx
If severe an high wbc>20 and lactic acidosis and ileus than may need colectomy
frequent relapses- consider fidaxomicin and fecal transplant
Progressive neuro deficits in someone w aids whohas brain bx of oligodendrocytes with intranuclear inclusions, demyelination, astrogliosis is due to? Tx?
pmL - progressive multifocal leukoencephalopthy due to jc virus 4% aids. Tx is HAART.
Wo tx majority of ppl will die in 3-6mo
Who is supposed to get abx ppx for meningococcal meningitis exposure? Intubator? Ambulance driver? Coworker? Child care center worker? Family in home?
What is tx?
Anyone with close contact with secretions- intubator, family, child care
Not coworker, not ambulance driver, not coworker
Rifampin q12h for 4 doses. Could also use one time dose of cipro and ceft
Ppd cutoffs for 5, 10, 15 mm?
Tx for latent tb?
5 - hiv or immunocomp or recent contact w active tb
10 - healthcare, recent immigrant, ivdu
15 no risk factors
Tx with 9 mo inh or 4 mo rifampin
What is gold standard to diagnose active tb?
Sputum studies - 3 specimens 8-24 hrs apart with at least a morning specimen. For those who cant give sample then sputum induction with aerosolized hypertonic saline
If they have three neg sputums but still have high suspicion then get BAL
3 negative afbs even with symptoms of tb mean
Noninfectious but should still tx them bc afb sputum has low sensitivity
Immunocomp pt wih cough, cp, fever, and headache with nasal bleeding!!!
Invasive aspergillosos!! Will also see pulm lobe infitrate!!
Tropical travel and come back wih fever, myagia, headache, LAD, pharyngeal edema, hemorrhagic tendoncies like petechiae after tournequet and elevated liver enz
Dengue fever
Bc of incr capillary permeability, incr risk of circulatory collapse, pleural eff, ascites
If you are exposed to someone w tb and get ppd and its neg, what is next step?
Get ppd in 3 mo
What type of contact precautions needed for herpes zoster?
Airbone and contact until lesions are crusted over
What is best screening test for hiv?
Hiv p24 ag and ab screen
not hiv rna
Hiv pt w dysphagia/n/v/epigastric pain and also eye involvement and pain w white lesions in eye into vitreous
Tx?
Candidiasis disseminated causing candida endopthalmitis
Tx w vitrectomy and amphotericin b
Note that ketoconazole isnt strong enough
What is best indicator of pts current immune status? Of their prognosis?
Cd4. Prognosis by viral load
Pt w recent abx for uti now w neck pain and stiffness and csf w high protein, low glc, leukocytes in CSF w high neutrophils but neg gram stain and cx has
Bacterial meningitis!! Gram stain has lower yield if recent abx
Not aseptic viral meningitis
Hiv pt cd4 600 and low viral load is prego. On haart. Anychanges to haart if they are prego?
No change bc current regimen working
And pt can get vaginal delivery unless vira load >1000 and they should get csection
Rabies exposure but got rabies vaccine a year ago. Next step
Give rabies vaccineX 2 days
If no vaccine before give both rabies ivig and vaccine (x 4)
Hiv pt w painful swallowing a egd shows biopsy w giant ulcer and NO viruses
Next tx is
Steroids!!!
Aphthous ulcer
If cmv or hsv would see virus!!
Hiv pt w syphillis and neuro complaints has csf neg for neurosyphillis, how much duration tx should he get?
Penicillin g qweek for 3 wks bc he has latent syphillis - likely >12 months infected
If less than 12 mo, then just one time dose
Syphillis pt receives pcn and within 24 hrs has fever, mailase, headache, what is this and hoe to prevent?
Jarish hercheimer rxn and due to rapid spirochete lysis and cannot prevent
Teenage boy w hx of multiple ona and sbo comes in a pna/green sputum. What does he have an what tx?
Cf and pna likely pseudomonas and staph
Need to cover two pseudomonal ie cefepime and amikacin it zosyn or penem
Guy w urethritis gram stain shows many neutrophils (diagnostic) but no organisms!! Means which organism?
Chlam!!!! If gonorrhea would see dipplococci
Tx w doxy it azithro
If pt had gonorrhea need to tx ceft and cover for chlam too
In those who dont get better tx w flagyl bc trichomonas can also cause
Healthcare worker exposed to someone w tb. When to check ppd?
Now for baseline and then in 3 mo
Pt w mono w rash after abx. Txv
Just supportive
No steroid!
If seborrheic dermatitis throughout face, body, chest next test is
Hiv test !!!! See in severe sevorhejc dermatitis
Dont do fungal cx of skin scraping
