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1
Q

What is the treatment options for resistant TB

A

2 months of RIP (rifampin, INH, Pyrazinamide)

Then Pass on to 4 months of INH and rifampin

Or
Just start with 6-9 months of INH AND rifampin

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2
Q

What are manifestations of extra pulmonary TB

A

Meningitis
Adenitis
Pleuritis
Disseminated (miliary dz)

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3
Q

What is the treatment for TB meningitis

A

2 months of RIP AND streptomycin

Then RI for another 10 months

PLUS - steroids

Can stop streptomycin after isolating the strain and confirming sensitivity to INH

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4
Q

Buzzword for XRAY findings in PCP pna

A

Ground glass appearance

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5
Q

Antibiotic choice for tx of neutropenia fever

A

Zosyn + an aminoglycoside

Or

Ceftazidime

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6
Q

Organism causing diarrhea in pt that has been in swimming pool or municipal water

A

Cryptosporidium

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7
Q

Organism causing diarrhea in pt that has been near farm livestock or petting zoos

A

Cryptosporidium, e. Coli

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8
Q

Organism causing diarrhea in pt that is immunocompromised

A

Cryptosporidium

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9
Q

Organism causing diarrhea in pt that has consumed apple juice, cider or undercooked ground beef

A

E. Coli

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10
Q

Organism causing diarrhea from pt eating chitterlings or pork

A

Yersinia

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11
Q

Organism causing diarrhea in pt that has eaten improperly cooked poultry, untreated water or dairy farms

A

Campylobacter

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12
Q

Organism causing diarrhea in pt that has eaten unpasteurized milk

A

Campylobacter, e. Coli

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13
Q

What are first generation cephalosporins effective towards

A

Gram positive cocci

Not good for methicillin resistant organisms, listeria or enterococcus. They do not penetrate CSF.

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14
Q

What organisms do second generation cephalosporin cover

A

Beta lactamase producing gram negatives

Enterobacteriaceae, H. Flu, Moraxella Catarrhalis

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15
Q

What do 4th gen cephalosporins cover

A

Pseudomonas

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16
Q

When is rifampin used as prophylaxis

A

For meningococcal or Hib exposure

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17
Q

What organisms spread through airborne

A

Aspergillosis, TB, measles, varicella, disseminated zoster

*special handling units are needed to prevent spread as these remain airborne for prolonged periods of time

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18
Q

Bacteria that causes infections in asplenic pts (sickle cell)

A

Strep pneumonia, neissereia, h. Flu (encapsulated organisms)

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19
Q

Bacteria that cause infections in immunocompromised pts

A

Gram negative bacilli (pseudomonas, e. Coli, klebsiella) and staph

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20
Q

Dermatological manifestation for pseudomonas

A

Ecthyma gangrenosum; large pustules on an indurated, inflamed base

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21
Q

Dermatological manifestation for salmonella thyphi

A

Rose spots

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22
Q

Buzz words for chlamydia pna

A

Afebrile, staccato cough

Intracyroplasmic inclusion bodies

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23
Q

Tx for chlamydia trachomatis

A

1g of azithro or 7 days of doxy

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24
Q

How does Rocky Mountain spotted fever present

A

Petechial rash in wrist, ankle, palms and soles that then spreads centrally. Pt will also have a headache and may have fever and myalgia.

If no rash will present with hyponatremia and depression of one or all 3 cell lines in CBC

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25
How do you test for RMSF during the acute phase
Direct immuniflurescense of skin biopsy
26
How do you distinguish ehrlichiosis from RMSF
Both have hyponatremia and theombocytopenia but ehrlichiosis will also have leukopenia and elevated liver enzymes
27
Who should receive chemoprophylaxis following h. Flu type b exposure
Everyone in household if - Someone younger than 12 months who has not received the primary series of Jin vaccine Someone younger than 4 incompletely immunized If immunocompromised child present If there are 2 or more cases occurring within 60 days and unimmunized or incompletely immunized children attend a childcare or preschool then prophylaxis is indicated for all attendees at the school
28
How does treatment impact pertussis based on the stage of when it is started
If during catarrhal stage will shorten this stage If during paroxysmal stage will decrease the period of communicability but does not shorten the coughing stage
29
Turtles, snakes and hedgehogs - petting and then diarrhea. What organism?
Salmonella
30
How can shigella present
Fever with diarrhea. Bloody diarrhea after fever subsides. Increased bands on WBC Seizures
31
Tx for pseudomonas
Piperacillin/tazobactam, gent Imipenem/meropenem, ceftazidime Cipro/levofloxacine
32
Fever and malaise in a pt with exposure to cattle, sheep or goats
Brucellosis
33
Tx for brucellosis
Tetracycline or bactrim
34
I&D only is appropriate for abscesses of which size
Smaller than 5cm
35
What's the mechanism of action for adult botulism
Preformed toxin from poorly canned goods is ingested
36
Mechanism of action for infantile botulism
Spores are ingested and they germinate. The toxin is then produced and absorbed. Toxin blocks release of acetylcholine.
37
How do you diagnose infantile botulism
Toxin or organism in feces
38
Primary stage of syphilis
Chancre (painless) 3 wks after exposure and resolves in a few weeks
39
Secondary stage of syphilis
1-2 months after first stage Rash( palms and soles), mucocutaneous lesions, lymphadenopathy Resolves spontaneously 3-12 wks
40
Tertiary syphilis
15-30 yrs after initial infection Gumma formation, cardiovascular, neurosyphilis
41
Screening tests for syphilis
Rpr and vdrl
42
Diagnostic tests for syphilis
FTA-ABS Spirochete on microscopic dark field examination or direct fluorecent antibody
43
When do you need to tread a newborn for syphilis
- if mom was tx within a month of the pregnancy (not if tx bf) - if mom tx with erythromycin as it doesn't cross the placenta - if baby titers are higher than mom's
44
Presentation of congenital syphilis
Snuffles, bullous lesions, osteochondritis, pseudoparalysis, poor feeding. Lymphadenopathy, mucocutaneous lesions, pna, edema, thrombocytopenia, heoatosplenomegaly, hemolytic anemia, jaundice
45
How does untreated congenital syphilis present
Develop symptoms after 2 yrs of age Hutchinson triad - Interstitial keratitis 8th cranial nerve deafness Hutchinson teeth (peg shaped central incisor)
46
Common infections associated with kingella kingae
Suppurative arthritis, osteo, bacteremia
47
Serogroups that cause meningitis
C, Y, W-135
48
Who should receive meningococcal chemophrophylaxis
- household contacts - childcare contacts 7 days prior to onset of illness - secretions shared 7 days prior to onset - mouth to mouth or endotracheal intubation 7 days prior to onset - slept in same dwelling 7 days prior to onset - passages directly next to pt on flights longer than 8 hours
49
Which bacteria causes abdominal pain that mimics appendicitis or intussuception
Campylobacter Yersinia enterocolitica also mimics appi
50
Yersinia pestis causes what
Bubonic plague | Swollen painful lymph nodes
51
When is treatment for cat scratch disease indicated?
Hepatosplenomegaly, large painful adenopathy, immunocompromised pts
52
If an infant is infected with rubella during the first trimester how would they commonly present and what's the percentage likelihood
Cataracts and PDA 50%
53
When is measles most contagious
4 days before to 4 days after the rash appears
54
What are the stages of measles (rubeloa)
- incubation 8-12 days - pristine first 2 days - koplik spots - rash around day 5 - rash is worse after a week and resolves around day 10
55
Post exposure management of measles
- within 6 days of exposure immune globulin should be given - measles vaccines to those not completely immunized. If given within 3 days of exposure might help prevent onset of disease
56
Complications of mumps
``` M- eningitis U- nderwear (orchitis) - not infertility M- uscle aches P- ancreatitis S - welling if parotid gland ```
57
What virus causes hydrops fetalis and aplastic crisis in sickle cell patients
Parvovirus b19
58
When do you test during HIV exposure
At time of exposure, 6wks, 12 wks and 6 months. If someone is going to seroconvert will do so in first 6 months
59
When is the mmr vaccine contraindicated in pts with HIV
When the cd4 count is less than 15 percent of normal for age
60
When is a newborn given VZIG for varicella exposure
If mother developed chicken pox 5 days before or 2 days after
61
Pt with conjunctivitis, pharyngitis, and otitis media during the summer. What organism.
Adenovirus
62
Pt with diarrhea who was in cruise ship. Organism.
Norovirus Rapid onset and quick resolution
63
What animals would you think of for rabies
Bat, raccoon, skunk, coyote, bobcat
64
When do you treat with oral acyclovir or valacyclovir in healthy children with varicella
Unvaccinated older than 12 yrs Chronic cutaneous or pulmonary disorder Ppl receiving long term salicylate tx Kids receiving short, intermittent, or aerosolized courses of corticosteroids
65
When do you give varicella IG or IGIV for post exposure prophylaxis
Immunocompromised or pregnant without immunity. Newborn that mom had chicken pox 5 days before or 2 days after Hospitalized preterm >28 wks without maternal immunity or less than 28 wks regardless
66
Whose at risk for infection with entamoeba histolytica
Immigrants or long term visitors of endemic areas Institutionalized people Men who have sex with men
67
Presentation of amebic dysentery from entamoeba hystolytica
Belly pain, diarrhea (watery, bloody and mucous), tenesmus (painful but ineffectual urge to defecate)
68
What's the clinical course of entamoeba
Ashmptomatic to severe GI to abscesses in the liver and brain or lung disease
69
Treatment for asymptomatic pts with entamoeba
Oidoquinol, paromyocin or diloxanide
70
Treatment for symptomatic pts with entamoeba
Metronidazole or tinidazole Plus... Iodoquinol or paromycin
71
Presentation of pts with giardia intestinalis
Acute watery diarrhea, foul smelling stool, fluctuance, anorexia, wt loss, anemia
72
When is tx for toxo given and what is it
Pyrimethamine, sulfadiazine, foilinic acid (leucovorin) All congenital infections Or acquired with chorioretinitis, severe organ damage, immunocompromised
73
What clues indicate ascaris lumbricoides infection
Obstruction or abdominal pain symptoms AND Travel or immigration from a tropical region
74
How does toxocara canis present (toxocariasis, visceral larva migrans)
GI symptoms (HEPATOMEGALY, abdominal pain) AND Respiratory symptoms (wheezing) * exposure to cats and dogs * preschooler eating dirt * eosinophilia
75
How do you diagnose visceral larval migrans
ELISA
76
Tx for visceral larval migrans
Abendazole or thiabendazole
77
Where is coccidiodomycosis seen
CAT: California, Arizona, Texas
78
How does coccidioidomycosis present
Influenza like symptoms with fever, night sweat, headache, chest pain and muscle aches Tx amphoterecin b, fluconazole or ketoconazole
79
Presentation for aspergillosis
Asthmatic with worsening symptoms despite tx Increased eosinophils and infiltrates noted on Cxr
80
How do you diagnose aspergillosis
Positive serum galactomannan
81
Where do you see histoplasmosis
Ohio, Missouri, Mississippi River valleys
82
Presentation of histoplasmosis
Flu like symptoms AND hepatosplenomegaly From bird droppings like crypto Flu like as coccidiomycosis
83
How does cryptococcosis present
Pulmonary disease as well as meningitis (headache)
84
Which organism is associated with rose spots
Salmonella which can cause thyphoid
85
Which organism gives you a normal WBC but bandemia
Shigella
86
Tx for campylobacter
Azithromycin and erythromycin which shorten duration of illness and excretion of organism Most common cause of bacterial gastro in developed world Bloody diarrhea!!!!! Fever and abdominal pain
87
How does yersinia enterocolitica present
Bloody diarrhea! RLQ pain, high WBC
88
What pts do you commonly see yersinia enterocolitica in
Sickle cell and thalassemia because it loves iron!
89
When do you treat yersinia?
Less than 3 months are at increased risk for bacteremia and those who have sickle cell and thalassemia due to excessive iron stores Tx Bactrim
90
Tx for kingella kingae
Penicillin agents Resistant to clinda and Bactrim
91
What organisms cause osteoporosis
``` Staph aureus (most common) Strep pneumonia, group a strep ``` Salmonella (in sickle cell) Group B strep (neonates)
92
When can a mother provide expressed breast milk but not breastfeed
Varicella 5d before or 2 days after Untreated active TB until RD for a minimum of 2 wks HSV lesions until they have resolved
93
Contraindications to breast feeding
Brucellosis, HIV, HTLV 1 or 2

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