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ID Flashcards

1
Q

Who is at highest risk for osteomyelitis?

A

IV drug users
sickle cell pts
immunosuppressed

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2
Q

when do you give rabies PEP after animal bite?

A

High risk wild animal (bat, raccoon, skunk): start PEP unless animal is available, then euthanize and examine brain
Low risk wild (squirrel, chipmunk, rabbit, mouse): No PEP
Pet: If available for testing, observe for 10 days and don’t start PEP unless you see signs. If not available start PEP

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3
Q

CSF findings in bacterial meningitis (OP, wbc, protein, glu)

A

Increased Openining Pressure
Increased wbc
Increased Protein
Decreased Glucose

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4
Q

Tx for bacterial meningitis

A

Ceftriaxone, Vanc, and Dexamethasone

if >50 or immunocomp, Add Ampicillin (listeria)

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5
Q

Causes of diarrhea in AIDS patients

A

CD4:
<200: Cryptosporidium (+ low fever)
<100: Microsporidium (no fever)
<50: MAC (+ high fever) or CMV (bloody + abd. pain)

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6
Q

Intrahepatic cysts with exposure = living with dogs for several years

A

Hydatid cysts caused by Echinococcus granulosus (a tapeworm)

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7
Q

Febrile wasting disorder in HIV pt with pulmonary (crackles/cough), mucocutanous (nodules/ulcers), and reticuloendothelial (hepatosplenomegaly, lymphadenopathy) + Panycytopenia and elevated transaminases

A

Histoplasmosis

  • ->Urine/Serum Histo Ag test
  • ->Itraconazole/Amphotericin B
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8
Q

What causes cystericosis and how does it present?

A

Taenia Solium tapeworm. Affects the brain (seizures) or cerebral ventricular system (intracranial HTN). Usually no liver involvement (vs echinococcus hydatid cyst)

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9
Q

Cardiac manifestations of endocarditis

A

New murmur…usually Mitral Regurg with MVP

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10
Q

T/F: Aspiration pneumonia and TB both infect the upper lobes

A

False. Aspiration = lower lobes. TB = apices/upper lobes

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11
Q

Dx test of choice for vertebral osteomyelitis (exquisite tenderness to touch over lumbar vertebrate typically)

A

MRI (not bone scan)

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12
Q

tx for endocarditis in IV drug user

A

assume MRSA/strep/enterococci

–>Give Vancomycin as first line

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13
Q

What do you do when someone steps on a rusty nail?

A

A. If received the 3 childhood toxoid vaccines: only give Tdap if haven’t received booster in last 5 years
B. Didn’t get all 3 in childhood/vaccine status unknown: Tdap + Tetanus IG

Also give TIG for symptomatic tetanus

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14
Q

When do you give Tetanus Immunoglobulin but not Tdap vaccine?

A

Never.

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15
Q

Kaposi sarcoma vs bacillary angiomatosis

A

Bacillary: ass. with fevers and systemic sxs, may involve mucosa/visceral organs. friable plaques and papules

Kaposi: begin as papules and morph into plaques, have color change, seen on legs/face/mouth/GI

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16
Q

Who gets HAV vaccine?

A
  • Chronic liver dz (Hep B/Hep C)
  • IV drug users
  • MSM
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17
Q

T/F: You start PEP for HIV exposure if serology of affected person comes back positive i.e. following needlestick

A

False. Get serology but start 3 drug tx right away

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18
Q

Empiric antibiotics if you suspect meningitis (while waiting for LP)

A

Cephalosporin + Vancomycin. If immunocompromised/>50, add Ampicillin

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19
Q

Myalgia, fever, headache, rigors after tx of Syphilis with IM Penicillin

A

Jarisch-Heixmer rxn. occurs w/in 12 hours tx, resolves within 48 hours on its own.

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20
Q

In organ transplant patients, what do you give for prophylaxis against opportunistic infections?

A

Bactrim: covers PCP.

Can also worry about CMV (Ganciclovir)

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21
Q

Sxs of Parvo virus infection in adults

A
  • typically asx
  • most commonly in people with close contact with children (school teachers etc)
  • get an acute onset Rheumatoid-like arthritis
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22
Q

Bloody diarrhea, RUQ pain, liver abscess, travel to mexico

A

Entamoeba Histolytica….tx with oral metronidazole

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23
Q

In a patient positive for Neisseria Gonnorrhea, what co-infections should be tested for?

A
  • Chlamydia trachomatis
  • HIV
  • Syphilis
  • Hep B
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24
Q

Strep bovis infection

A

Endocarditis and Colon Cancer. Get colonsocopy

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25
Q

Does negative heterophile test r/o mono?

A

Nope, it can usually be negative in early infection. Don’t be a peasant!

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26
Q

Rash after amoxicillin

A

EBV

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27
Q

Someone comes in with Influenza infection i.e. the flu. Mgmt?

A

If <65 and without major risk factors (chronic medical problems/pregnancy): No dx’ic studies necessary, just do symptomatic tx

Only give Oseltamavir if >65/risk factors or those w/o risk factors who present within 48 hours of onset

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28
Q

Post-influenza bacterial pneumonia

A

> 65: MSSA

Young adults: MRSA

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29
Q

Human bite wound empiric AB’s

A

usually polymicrobial infection of strep/staph/eikenella/h flu/anaerobics

–>Give Amoxicillin/Clavulanate (augmentin)

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30
Q

What reduces risk of Toxoplasmosis infection?

A

Bactrim

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31
Q

which pneumococcal vaccine do you give to liver dz patients ?

A

23 now, and then 13 + 23 when >65

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32
Q

Tx of mucormycosis (DM pt with nasal congestion/necrosis)

A

Surgical debridgement + Amphotericin

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33
Q

What is trichinosis and how does it present?

A

Intestinal roundworm from undercooked meat (usually mexico/china/thailand)
Fever, vomiting, nausea, periorbital edema, myalgia.
Tx with Bendazoles

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34
Q

Who gets Pneumococcal 13 vs 23

A

13, then 23 for >65
13, then 23 for <65 with high risk conditions: CSF leak, SICKLE CELL, Asplenia, Chronic Renal Failure, cochlear impalnts
23 alone for <65 with chronic conditions: DIABETES, SMOKING, Alcoholic, Liver dz, Heart dz, Lung dz

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35
Q

Td vs Tdap for adults

A

All adults should get a one time Tdap dose, followed by Td q10 years. If their vaccination hx is unknown, hit em with the Tdap

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36
Q

When do you give Prednisone with bactrim for PCP?

A

PaO2 <70 or A-a >35

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37
Q

Tx of Legionella

A

Fluoroquinolone or Macrolide

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38
Q

T/F: All patients, regardless of hx or sxs, should get one-time HIV screening between ages 15-65

A

True.

HIV p24 antigen and antibody testing

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39
Q

Who gets annual HIV screening?

A

IVDU + sex partners

MSM

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40
Q

How does Babesiosis present and who gets it?

A

Fever + Hemolytic anemia

increased risk = Splenectomy/Asplenia, immunocompromised

Ixodes tick in northeast US

Dx with blood smear (maltese cross), Tx = Atovaquone + Azithromycin

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41
Q

Unvaccinated health care worker exposed to Hep B patients blood. Mgmt?

A

Give Hep B Vaccine

Give HB IG

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42
Q

Tx for chronic hep b/c

A

Chronic HBV: IFN-alpha, alternatively lamivudine (nucleoside analog)
Chronic HCV: IFN-alpha + Ribavirin

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43
Q

T/F: + Anti-HCV = vaccination

A

False, = HCV infection.

–>There is no vaccine

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44
Q

Neuropathy + CSF findings of Elevated protein but normal cell count/glucose

A

GBS

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45
Q

Tx for GBS

A

IVIG or PLEX.

Don’t give steroids.

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46
Q

HIV patient with bloody diarrhea

A

Probs CMV colitis…need colonoscopy. If +, need ocular exam also to r/o retinitis.

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47
Q

How do you make the dx of HCV?

A

Need 2 steps:

    • serologic test for Anti-HCV
    • molecular test for HCV RNA

–>need these 2 before anti-viral agents

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48
Q

Infectious esophagitis in HIV

A

If +oral thrush or dysphagia: Candida
none of these, +odynophagia: CMV
dysphagia = DIFFICULT swallowing
odynophagia = PAINFUL swallowing

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49
Q

Prophylaxis against MAC (fever/night sweats/diarrhea/abdominal pain/weight loss) in HIV CD4<50

A

Azithromycin

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50
Q

Pt with uncomplicated pyelo tx

A

2 days IV ceftriaxone

If better, DC with oral AB (what theyre sensitive too…even including Bactrim)

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51
Q

T/F: C-section is always indicated if mom is HIV+

A

False. If viral load is low (<1000 copies) and CD4>500, not needed.

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52
Q

Sxs of Toxo in HIV pt

A

Sxs of mass lesion + encephalitis (HA, Fever, AMS, Focal deficits)

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53
Q

Meningitis in HIV

A

Crypto

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54
Q

Who gets toxo encephalitis?

A

HIV

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55
Q

Tx for bacterial meningitis

A

Ceftriaxone + Vancomycin + Dexamethasone. If immunocompromised or >50, + Ampicillin (Listeria)

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56
Q

Who else gets PCP other than HIV?

A

Chronic steroids (think autoimmune dz like SLE)

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57
Q

Tx for PCP

A

Bactrim. Dapsone. Atovaquone. Pentamadine. all are options. Start at front.

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58
Q

Immunosuppressed (steroids) or compromised (HIV) patient with cough, hypoxia, SOB, and increased LDH

A

PCP has increased LDH!

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59
Q

organisms implicated in ventilator-associated pneumonia

A

Nocosomial (HCAP) so Pseudomonas (also, E coli and Klebsiella are other G-), MRSA (also Strep). Need lower resp tract sampling/gram stain and culture. about 48 hours after intubation

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60
Q

Who gets mycoplasma pneumoniae (headache, malaise, persistent cough, CXR bad like pleural effusion. can have pharyngitis and rash)

A

Young healthy patients!!! <30 usually

–>especially military recruits/prison/dorm

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61
Q

What clues make you think Legionella pneumonia?

A

GI SYMPTOMS!!! also systemic (headache/confusion). Slow onset cough and high grade fever

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62
Q

CXR reveals increased interstitial markings. In a patient with cough and fever, what does this indicate?

A

Interstitial Pneumonia (as in NOT LOBAR CONSOLIDATION NOT STREP). I.e. atypical pneumonia

63
Q

Pneumonia in a person with recent viral illness

A

Staph aureus.
If <65, MRSA = necrotizing pneumonia (multilobar cavity infiltrates, high fever, hemoptysis…so don’t get fucked up and pick TB for post-viral pneumonia in a young patient)

64
Q

Anesthetic, hypopigmented lesions (no sensation on rash) with painful nerves and glove/stocking loss of sensation/neuropathy. Dx: Full thickness bx of skin lesion. Tx with Dapsone and Rifampin

A

Leprosy

65
Q

Who gets diarrhea from C perfringens?

A

Consumer of undercooked or unrefrigerated food. Brief watery diarrhea, fever and cramps

66
Q

common watery diarrhea that turns bloody

A

EHEC

67
Q

Bloody diarrhea

A

Ecoli
Shigella
Campylobacter

68
Q

Tx for early syphillis in patient w/ hx of anaphylaxis to penicillin

A

ORAL DOXYCYCLINE JIGNESH

69
Q

Tx of syphillis

A

No allergy:

  • Primary/Secondary: IM Pencillin x1
  • Latent: IM Pencillin x 3
  • Tertiary: IV IV IV IV Penicillin x 14 days

Anaphylaxis:

  • Primary/Secondary: Oral Doxycycline x 14 days
  • Latent: Oral Doxycyline x 28 days
  • Tertiary: Desensitization and then IV Pen. alt = Ceftriaxone 14 days
70
Q

How does disseminated gonoccocal infection present?

A

Septic arthritis picture. Purulent monoarthritis or triad of tenosynovitis, papules/pustules on body, and asymmetric polyarthralgias
–>blood cultures of NG often negative due to fastidious growth req, need NAAT. do synovial fluid analysis (gram stain still +)

71
Q

T/F: As soon as CD4 count <200, should give HIV patients MMR, zoster and varicella vaccines if they haven’t already

A

False, these are all live vaccines and contraindicated <200

72
Q

who gets HAV vaccine?

A

Chronic liver dz (including HBV and HCV), Gay men, IVDU

73
Q

Who gets meningococcal vaccine?

A

Patients 11-18; college student/military recruits; asplenic

74
Q

Vaccines in HIV additional to normal ones

A
  • Hep B unless they have + Anti-HBs
  • Strep pneumo with PCV13 followed by 23 valent few months later; again in 5 years; again at age 65
  • Varicella
75
Q

T/F: Reactivation TB is common in HIV and substance abuse

A

true

76
Q

Tx Pulmonary nodules that grow acid fast rods and do not gram stain vs partially acid fast gram positive

A

No gram stain: TB, RIPE

G+: Nocardia, Bactrim

77
Q

types of neonatal conjunctivtis

A
  1. Chemical: <24 hrs, mild, needs lubricant
  2. Gonococcal: 2-5 days, most severe of the 3. eyelid swelling can lead to blindness. Prophylaxis against with Erythromycin eye drop in first hour of birth. If infected, tx with IM Ceftriaxone. Can be purulent or mucupurelen
  3. Chlamydia: 5-14 days: mild. serousanguinous or mucopurulent discharge. PO macrolide if infected.
78
Q

How do you differentiate orbital from preseptal cellulitis?

A

Orbital hurts, can have vision impairment, and can have eye bulging (proptosis). Very severe complications (vs preseptal is not bad)

79
Q

how to diff measles, varicella and rubella (all maculopapular rashes starting at head and moving down

A

Varicella: VESICLES (pruritic) = HSV = VESICLES
Measles: Cough/Coryza(rhinitis)/Conjunctiva/Koplik spot
Rubella: desquamating trunk rash, postauricular lymphadenpathy

80
Q

vitamin A reduces morbidity/mortality in this childhood exanthem

A

Measles

81
Q

Cystic fibrosis and respiratory infection (cause)

A

<20 years old aka peds: STAPH AUREUS

>20 years old: Pseudomonas

82
Q

Pertussis tx/post-exposure prophylaxis

A

Macrolides! must be given to all house-hold contacts regardless of age/immunization status

83
Q

Kid is exposed to another kid that has chickenpox. How do you manage?

A

If prior infection/vaccine (2 doses): Observe/reassure
No: Immunocompetent = VACCINE ONLY
Immunocompromised (including pregnant) = VZ IG ONLY

84
Q

mastoiditis and facial nerve palsy are potential complications (in kids) of:

A

AOM

85
Q

Mumps complication

A

Aseptic meningitis, Orchitis

86
Q

specific sxs that differentiate kawasaki from scarlet fever (both can have lymphadenopathy, changes to buccal mucosa like circumoral pallor/strawberry tongue, rash/fever)

A

Kawasaki would have bilateral conjunctival injection and/or changes to peripheral extremities. Sandpaper like rash usually used to describe Scarlet fever.

87
Q

what sxs in a patient with pharyngitis of unknown etiology would make you think viral pharyngitis?

A

cough, rhinorhhea, nasal congestion conjunvtivitis, oral ulcers

88
Q

Kid walks in with sore throat, dysphagia, tonsillar erythema, palatal petechiae, anterior cervical LN, white exudates on tonsils. next step?

A 
Rapid Antigen (Strep) Test! If +, its strep throat and you treat with oral penicillin/amoxicillin. 
If negative, get a throat culture. If still negative its viral and just supportive tx
89
Q

What additional features does adolescent/adult with Rubella have (in addition to maculopapular blanching rash spreading head down)?

A

Arthralgias/Arthritis!!! Wrist and fingers etc hurt

90
Q

Sensorineural hearing loss, cataracts, PDA

A

Congenital rubella

91
Q

Measles vs Rubella

A

Measles: really HIGH fevers >104; lymphadenopathy = cervical. no arthritis

Rubella: more mild fevers; lymph = posterior auricular/suboccipital; adults get arthritis/arthralgais

92
Q

describe the fever in rocky mountain spotted fever

A

erythematous macular rash starts at wrists/ankles and spreads centrally

93
Q

Tx of cryptococcal meningitis

A

First: Amphotericin B with Flucytosine
then: Fluconazole

94
Q

HIV patient with meningitis or signs of intracranial process but negative MRI

A

Cryptococcus

95
Q

what would you expect in HSV encephalitis?

A

personality changes, FND, seizures…due to temporal lobe involvement

96
Q

T/F: Negative heterophile antibody test i.e. monospot test rules out EBV

A

False, 25% false negative rate in first week of infection

97
Q

sore throat/malaise/myalgia + lymphocytosis with variant lymphocytes with a large, vacuolated cytoplasm

A

EBV!! These are “atypical lymphocytes”

98
Q

Atypical lymphocytes =

A

EBV

99
Q

Clindamycin is effective against (general):

A

G+ and anaerobes (so not best for broad spectrum coverage)

100
Q

Amoxicillin-clavulanate (Augmentin) is effective against (general)

A

G+, G-, and beta-lactamase producing anaeraboes, so great for empiric coverage

101
Q

Ixodes tick dz presents with no rash, thrombocytopenia, leukopenia, and elevated LFTs. Dz, Dx, Tx.

A

Ehrlichosis. Peripheral blood smear: inclusion bodies in wbc (morule). Doxycyline

102
Q

Ixodes tick dz presents with hemolytic anemia, is severe in asplenic patients

A

Babesiosis. Peripheral blood smear: rings in rbcs. can also do PCR. Atovaquone and Azithromycin.

–>Babes without spleens destroy rbcs because the rings inside Crow AT them.

103
Q

Ixodes tick dz with rash, AV node block, Bells Palsy, late joint involvement. Dz, Dx, Tx

A

Lyme Dz. Get Serology (IgM, IgG, Elisa, PCR, etc). Doxycyline or Amoxicillin. For Brain or Heart involvemen: IV Ceftriaxone.

104
Q

Tx of Bacillary angiomatosis aka bartonellae henslae

A

Doxycycline, erythromycin or HAART

105
Q

how does bx differentiate kaposi (HHV8) from Bacillary angiomatosis (bartonellae henslae)

A

Kaposi: lymphocytes
Bartonella: neutrophils

106
Q

Tx of legionella

A

Fluoroquinoles (Levofloxacin) or Macrolides

107
Q

Tx for patient with fever, malaise, atypical lymphocytes, no splenomegaly, is homosexual

A

CMV mononucleosis: self-resolves.

108
Q

Lobar pneumonia, arthralgias, erythema nodosum in a patient traveled to southwest

A

Coccidioides (only immunosuprressed need keto/fluconazole. self resolves in healthY)

109
Q

inadequate oral hygiene leading to mandibular molar infections and cellulitis of submandibular space

A

Ludwig angina

110
Q

colitis (bloody/diarrhea, abdominal pain), liver abscess (RUQ pain, fever), ALT and AST = 100, solitary cystic lesion seen on liver. Dx and Tx

A 
Entamoeba histolytica (protozoa from travel to endemic areas)
Metronidazole 
(note: HAV = vomiting, RUQ pain, jaundice, LFTs 1000)
111
Q

What is erysipelas?

A

Group A Strep infection leading to high fever, lymphadenopathy, and warm, tender erythematous rash with raised sharp borders. typically on face, may involve external ear.

112
Q

HIV patient with CMV. What screening test is necessary?

A

Ocular exam to r/o CMV retinitis

113
Q

Bloody diarrhea in HIV patient with CD4 <50

A

CMV!!!! COLITIS!!! not cryptosporidium (severe watery, low fever, CD4<200), Microsporidium (watery, abdominal pain, CD4<100), MAC (watery, high fever, CD4<50)

114
Q

Puncture wounds +/- osteomyelitis bacteria

A

Staph aureus and Pseudomonas!

115
Q

T/F: Cryptosporidium is only seen in AIDS patients

A

False, causes mild watery diarrhea in immunocompetent also

116
Q

Hydatid cysts (eggshell calcifcations around cystic hepatic lesion) in a patient with close contact to dogs

A

Echinococcus granulosis (tapeworm). Tx w/albendazole

117
Q

Ulcer:: LN + Tx
No pain: No Pain
Pain: +/-
No Pain: Pain

A

-/- Syphillis. Penicillin (or doxy)
+/? H ducreyi. Azithromycin or Cipro
-/+ LGV. Doxycycline

118
Q

T/F: For primary syphillis, may be too early for serology so you have to do Darkfield Microscopy

A

True

119
Q

What do you use to dx endocarditis (fever + new murmur)?

A

BLOOD CULTURES + ECHO (transesophageal)

  • ->for Acute (staph/strep pneumo): watch until BCx-, start ABx right away. Won’t see the rheum sxs yet
  • ->for Subacute (bovis/viridans/HACEK): watch until BCx+, then start ABx. Will have rheum sxs
120
Q

HACEK organisms (subacute endocarditis)

A 
H flu 
Actinobacillus 
Cardiobacterium
Eikenella
Kingella
121
Q

back bone of endocarditis tx

A

VANCOMYCIN and GENTAMICIN

  • ->if native (normal) valve, just Vanco
  • ->mostly going to add CEFTRIAXONE for most people (if >1 yo). For babies, give cefepime instead.

–>Can’t use Vanc? Use daptomycin instead

122
Q

Bacterial associations for endocarditis

A

Staph: Prosthetic valves, IVDU, catheters
Staph Epi: Pros valve, catheter
Strep Viridans: Dentist

Enterococci: UTI (nocosomial)!!!

123
Q

Who needs prophylaxis against endocarditis and what do you use?

A

Bad valve
(Congenital heart dz, prostethic, hx of endocarditis)
+ Mouth/throat
(having dental proecdure or bronch/bx of airway)
= AMOXICILLIN (ceftaz if pen allergy)

124
Q

What prophy meds do you give HIV patients?

A

<200: PCP –>BACTRIM BABY
(DAPSONE if cant bactrim. ATOVAQUONE if G6PDef)

<100: Toxo –>Bactrim

<50: MAC –>Azithromycin

125
Q

how is vertical transmission of HIV prevented (med)

A

Only Zidovudine

126
Q

Pre and post exposure prophy drugs for HIV

A

Emtricitabine + tenofovir. +/- Realtegravir

127
Q

Opportunistic infxs cd4 <50 and tx

A

MAC (disseminated). Proph: Azithro. Tx: Clarithromycin + Ethambutol

CMV Retinitis: Valacyclovir, Foscarnet

128
Q

Patient comes in with Fever and HA. What’s the broad ddx?

A

Meningitis (+neck stiffness)
Abscess/Cancer (+FND)
Encephalitis (+confusion)–>HSV!!! WNV (flaccid)

129
Q

Patient comes in with Fever and HA. How do you decide if you need non-con CT before LP?

A 
if any of the FAILS +, need non-con CT before LP!
FND
AMS
Immunodeficiency
Lesion
Seizure
130
Q

Fever and HA patient, LP is safe to do before non-con CT (- for all FAILS). Management?

A

Lots of PMNS –> Vancomycin, Ceftriaxone and Steroids
–> add Ampicillin if immunosuppressed

Lymphocytes –> HSV!!!!!will have bloody tap. Acyclovir

Otherwise, look for Crypto, RMSF, Lyme, TB, Syphillis

131
Q

Fever and HA patient, LP not safe (FAILS). Managment

A

Give antibiotics now and do non-con CT:

  • if CT -, do LP
  • if CT+ and HIV + –> Tx toxo and rescan in 6 weeks
  • if CT-, HIV- –>BIOPSY –> Cancer gets chemo/rad; abscess/infx gets Antiobiotics/drainage
132
Q

HIV patient with mass lesion/fever and HA and FND/ and CD4<200

A

Toxoplasmosis

if they have meningitis on the other hand i.e. no FND and instead neck stiffness, its Crypto

133
Q

hemorrhagic/bloody tap (LP), patient has encephalitis/fever and HA

A

HSV Encephalitis (temporal lobes)

134
Q

T/F: TB lumbar puncture/csf findings are consistent with a fungal organism, not bacterial

A

True to be careful (TB is a bacteria obvi).

Low glucose, increased protein, predom lymphocytes. Tx with RIPE

135
Q

Rocky mountain spotted fever presents with fever, headache, and rash that starts on wrists/peripherally and moves centrally to trunk. How do you tx?

A

Doxycycline (or Ceftriaxone)

136
Q

T/F: Osteomyelitis is dx with bone scan

A

FALSE.
First do Xray, if neg do MRI
Best test: Biopsy . Follow with ESR and CRP as you treat with antibiotics for 4-6 weeks

137
Q

Pain out of proportion

A

Abdominal: Mesenteric Ischemia

Skin infection/cellulitis: Necrotizing fasciitis

138
Q

Crepitus, rapidly progressive cellulitis and sicka s shit, Blue Gray Discoloration, Pain Out Of Proportion

A

Necrotizing fasciitis

139
Q

Skin infection with crepitus

A
  1. Gas gangrene (c perfringens)…penetrating wound gets contaminated. Debridement and PCN + Clindamycin
  2. Nec Fas: staph and strep. pain out of proportion, blue grey discoloration. Debride and antibiotics…ampicillin, clinda, idk everything
140
Q

location of: Primary TB; Reactivation TB

A

Primary: LOWER lobes and middle. “Lobar pneumonia/cavitation/caseating granuloma/ghon complex”
Reactivation: Apex. hemotysis/night sweats/wt loss

141
Q

+PPD, - CXR Tx

+PPD, + CXR Tx

A

-CXR: Exposure only (not infected)…INHx9mo (w/B6)

+CXR: Get AFB Smear. + = Active TB = RIPE. -= Latent = INH x9mo + B6

142
Q

Patient has sxs of TB/acute ill, how do you manage?

A

Can’t wait for PPD
1. Get a CXR and AFB
+CXR, +AFB: Active TB = RIPE
+CXR, -AFB: Latent TB = INH + B6
-CXR, -AFB: Something else. can do NAAT and PCR to 100% ruled out if they ask.
Note: -CXR but 6 weeks later +AFB culture = MAC

143
Q

RIPE side effects

A

Rifampin: red urine
INH: Neuropathy (give B6)
Pyrazinamide: GOUT (hyperuricemia)
Ethambutol (optic neuritis/red green color blindness)

ALL are HEPATOtoxic

144
Q

Tachy tachy white hot

A 
SIRS
Tachycardia >90
Tachypnea >20 
Wbc>12
T>38
145
Q

Ambulatory pneumonia is basically acute bronchitis (fever, cough, -CXR, +sputum) or “atypical pneumonia” (+bilateral infiltrates on cxr). How do we tx these?

A

Azithromycin (alt: doxy, moxifloxacin)

146
Q

subacute pneumonia, CXR shows bilateral fluffy infiltrates, LDH is elevated, dx is made on Silver Stain. Dz and Tx?

A 
PCP pneumonia (HIV pt)
IV Bactrim. If hypoxemic, add Steroids
147
Q

bugs of pneumonia

A 
Strep pneumo: #1
H flu: COPD/SMOKER
Legionella: GI + CNS sx. get Urine Ag
Klebsiella: EtOH
Chlamydia: Placenta/sheep. Serum AB
148
Q

Ambulatory (outpatient aka acute bronchitis) Pnemonia tx vs Inpatient CAP vs Inpatient HCAP

A

Ambulatory: Azithromycin (alt: doxy, moxi)

In CAP: Ceftriaxone + Azithromycin
In HCAP: Vancomycin + Pip/Tazo

PCP (Bactrim and steroids) and Influenza (Oseltamavir)

149
Q

Fever + Cough ddx (broad)

A

Bronchitis (-CXR. not as sick. PO/home tx)
Pneumonia (+CXR more sick. IV/hospital tx)
Abscess (Cavitations. IV/hospital)
(viral flu is technically on the ddx also. +myalgia)

150
Q

Healthcare associated pneumonia bugs and def

A

Pseudomonas and MRSA: Tx with Pip/Tazo + Vanc

<90 days from health exposure; >48 hr post admit

151
Q

Tx of community acquired pneumonia

A

Ceftriaxone + Azithromycin
OR
Moxifloxacin

152
Q

Tx of acute bronchitis/ambulatory pneumonia

A

Azithromycin only (CAP = Ceftriaxone also)

153
Q

How do you treat abscess in lung? i.e. Fever and cough, +CXR for cavitation, foul breath etc

A

Ceftriaxone and Clindamycin. do NOT drain lung abscess

Step 2 UWORLD (17 decks)

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