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1
Q

Honey colored crusts

A

Impetigo

  1. Topical Mupirocin
  2. Keflex
    * *Bactrim/Doxy for MRSA
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2
Q

Painful erythematous facial rash, clear margins

A

Erysipelas (B-hemolytic strep > staph)

1. PCN or Keflex

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3
Q

Cellulitis (Bugs)

  • Common
  • DM
A
  1. Staph or Strep pyogenes

2. Pseudomonas

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4
Q

Human Bite

A

Eikenella

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5
Q

Animal Bite

A

Pasteurella (Cats)

Capnocytophaga (Dogs)

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6
Q

Type 1 Nec Fasc

A

Polymicrobial (Anaerobes + GNRs)

DM, Immunosuppressed, IV Drugs, Peripheral vascular disease

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7
Q

Type 2 Nec Fasc

A

B-hemolytic Strep or Staph

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8
Q

A complication of necrotizing fasciitis is ***

A

Compartment Syndrome

Muscle weakness, paresthesias

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9
Q

Presence of gas in soft tissue on a CT or MRI indicates __________.

A

Necrotizing Fasciitis

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10
Q

Nec Fasc treatment

A

Group A Strep - PCN +/- Clinda (toxins
Mixed - Vanc/Zosyn
Surgical consult for debridement

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11
Q

Both orbital and pre-orbital cellultits present with erythema and eye pain - what symptoms are seen in orbital cellulitis alone?

A 
Oculomotor dysfunction
Proptosis
Chemosis
Pain w/ movement 
Decreased visual acuity
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12
Q

Complications associated with orbital cellulitis

A

Blindness
Meningitis
Cavernous Sinus Thrombosis

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13
Q

If concerned for orbital cellulitis what test confirms this

A

CT of the orbits
Blood cultures
CBC

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14
Q

Orbital Cellulitis Rx

A

Cover GNRs - IV Ceftriaxone or Amp/Sulbactam
Cover MRSA - Vanc
++Surgical Consult

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15
Q

In osteomyelitis ESR And CRP are usually _________ and blood cultures are _________.

A

Elevated

Negative

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16
Q

How to diagnose osteomyelitis

A
  1. CBC, ERR/CRP, cultures
  2. Plain films (may be nml if infection < 2 weeks)
  3. MRI (bone scan if CI)
  4. Bone biopsy if MRI/bone scan are abnormal
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17
Q

Osteomyelitis Treatment

A

Unless pt is septic delay antimicrobial therapy until specimen obtained through surgical debridement.

Broad spec if septic

4-6 weeks of directed therapy

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18
Q

Patients with sickle cell get OM from what organism

A

Salmonella

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19
Q

What patients are at risk for Pseudomonas OM

A

Diabetics
IV Drug use
Lower extremity ulcers

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20
Q

Which cases of OM can resolve with antibiotics alone (i.e. no surgical debridement)?

A

Axial skeleton

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21
Q

Risk Factors for Septic Arthritis

A 
Instrumentation - Injection, arthroscopy, etc
Joint damage - OA, RA, trauma
Prosthetic Joint (staph epi)
Gonococcal infection
Bacteremia
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22
Q

Fluid for Septic Arthritis

A

> 50K WBC ++ Neutrophils

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23
Q

Septic Arthitis Treatment

A

Surgical washout

4-6 weeks of antibiotics

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24
Q

Fever, chills, N/V, abdominal pain, +/- palpable mass

A

Diverticulitis - clinical diagnosis often made on CT

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25
Q

Diverticulitis treatment

Diverticulitis + Abscess

A

Antibiotics (GNR and anaerobes)
Cipro and Metronidazole

Surgical drainage + Abx

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26
Q

The leading cause of encephalitis is _______.

A

HSV - IV Acyclovir

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27
Q

Encephalitis symptoms

A

Fever/malaise (viral prodrome)
Confusion, seizures, focal neuro deficits
Headaches, photophobia, +/- meningeal signs

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28
Q

Patient presenting w/ bizarre behavior, speech disorder, gustatory/olfactory hallucinations, or acute hearing impairment.

A

HSV Encephalitis
MRI - bilateral temporal lobe
LP - HSV PCR and culture

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29
Q

Fever and AMS in late spring, summer early autumn

A

West Nile Encephalitis

30
Q

West Nile can also present with symptoms of transverse myelitis _________

A

Spinal cord inflammation

Extrapyramidal symptoms or flaccid paralysis

31
Q

Treatment for West Nile Encephalitis

A

Supportive

32
Q

Common causes of meningitis in neonates

A

Group B strep, E. coli, Listeria

33
Q

Common causes of meningitis in infants

A

Strep pneumo, N. meningitidis, H flu

34
Q

Common causes of meningitis in age 2-50

A

Strep pneumo, N. meningitidis

35
Q

Common causes of meningitis in elderly (> 50 yo)

A

Strep pneumo, N. meningitidis, Listeria

36
Q

Meningitis Broad Spec Coverage

A

Vanc
Ceftriaxone
Ampicillin - Bactrim if allergic
+/- IV Acyclovir

37
Q

For meningitis begin empiric therapy _______ blood cultures and _______ LP.

A

Immediately after getting blood cultures

**Don’t wait for LP

38
Q

If Strep Pneumo meningitis is suspected give ____________ prior to antibiotics

A

Dexamethasone - decreases mortality

39
Q

Strep pneumo meningitis

A

GS: GP cocci in pairs and short chains

Vanc + Ceftriaxone + Dexamethasone

40
Q

N meningitidis meningitis

A

GN diplococci

Ampicillin or Ceftriaxone

41
Q

Listeria monocytogenes meningitis

A

GP rods

Ampicillin

42
Q

Strep agalactiae (Group B Strep)

A

GP cocci in pairs and short chains

Ampicillin

43
Q

H flu B

A

GN coccobacilli
unvaccinated patients
Ceftriaxone

44
Q

Most common causes of acute sinusitis

A
  1. Viruses
  2. Bacteria - Strep pneumo, Hflu Moraxella
    * *Mucor in diabetics
45
Q

When to give antibiotics for sinusitis

A

Augmentin vs Doxy
> 10 days
Improve then worsen

46
Q

Treatment of otitis externa

A

Oxfloxacin + steroids

- usually pseudomonas, sometimes Staph aureus

47
Q

Pharyngitis is typically due to ____________.

A

Viral causes: Rhinovirus, Adenovirus, EBV

Group A strep (25%)

48
Q

Scoring for Strep Infection

A 
Anterior cervical LAD
Tonsillar exudate
History of Fever
Absence of cough
2-3 pts test
4 points treat
49
Q

Treatment for Group A Strep

A 
Penicillin (Macrolide if allergic)
Chronic carriers (+culture, asymptomatic) - Clinda
50
Q

Rheumatic Fever

A

Fever, arthritis, carditis, chorea, rash

51
Q

Which patients should you consider urine Legionella and S pneumo

A 
ICU admission
Fail outpatient therapy
Alcohol use disorder
\+Pleural effusion
Asplenic or chronic liver disease
52
Q

Typical Pneumonia pathogens

A

Strep pneumo
H Flu
Staph aureus (in setting of flu)

53
Q

Atypical pneumonia pathogens

A 
Mycoplasma
Chlamydia
Moraxella
Legionella
**Azithromycin**
54
Q

CURB-65

A 
Confusion
Urea > 19
RR > 30
BP < 90/60
Age > 65
55
Q

Treatment duration for PNA

A

CAP - 5 days
HCAP 7-8 days
MRSA/Pseudomonas 14 days

56
Q

Who is at risk for PJP PNA

A

CD4 < 200

57
Q

Findings in PJP PNA

A

Ground glass infiltrates
Elevated LDH
Bronch for pneumocystis

58
Q

PJP Treatment

A

IV Bactrim for 3 weeks (IV Pentamidine)

59
Q

Treatment for active TB

A

RIPE
Rifampin, INH, Pyrazinamide Ethambutol - 8 weeks
Rifampin, INH - 16 weeks

60
Q

Treatment for latent TB

A

INH 6-9 months

61
Q

Rifampin side effects

A

Red/orange body fluids

Hepatitis

62
Q

INH SE

A

Peripheral Neuropathy (Give pyridoxine, B6)
Hepatitis
SLE-like syndrome

63
Q

Pyrazinamide SE

A

Hepatitis

Hyperuricemia

64
Q

Ethambutol

A

Optic Neuritis

65
Q

True/False: Diagnose prostatitis by obtaining urine cultures before and after prostate massage.

A

True

66
Q

Treat acute bacterial prostatitis with (3 options)

A

Fluoroquinolone, or IV piperacillin/tazobactam

or Ceftriaxone 2 weeks

67
Q

Chronic bacterial prostatitis

A

Bactrim or fluoroquinolone for 4-6 weeks

68
Q

Rashes that affect the palms and soles (9)

A 
Coxsackie - hand/foot/mouth
Rocky Mountain Spotted Fever
Neiserria meningococcemia
2˚Syphilis
Janeway Lesions (bacterial endocarditis)
Kawasaki Disease - vasculitis
Measles
Toxic Shock
Reactive Arthritis
69
Q

How to diagnose 1˚ Syphilis

A

Specific treponemal test - FTA-ABS, MHA-TP, darkfield shows spirochetes.
Nontreponemal to confirm RPR or VDRL

70
Q

Who gets an LP for syphilis

A

If they’ve had the disease for > 1 year
Neuro/Ophthalmic signs
VDRL ≥ 1:32

71
Q

Rx for genital herpes

A

Acyclovir for 7-10 days during first infection

Repeat can get acyclovir or valcyclovir x5 days

72
Q

T/F: Treat chlamydia with a single po dose of Azithromycin and gonorrhea with single IM dose of Ceftriaxone.

A

True - always treat both and always treat partners

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