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STEP 2 AG > ID > Flashcards

ID Flashcards

1
Q

Positive TB skin test

A

> 5mm HIV, known contact
10 risk factors (hosp worker, prison)
15

Get CXR —> latent TB (R x4 OR isoniazid x6), active TB (RIPE x 2mo, IR x4)

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2
Q

Endocarditis w UTI

A

Enterococcus

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3
Q

Osteomyelitis foot

A

Pseudomonas

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4
Q

Hep C

A

dx anti-hC ab PLUS confirmatory PCR (some ppl clear have only Ab test x2)
Pregnancy: Give hep A+B vaccines, Csection not protective, BF ok unless bleeding

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5
Q

MC causes of esophagitis in HIV

A

CD4<100
Candida tx fluconazole
Viral PAIN HSV (round ulcers), CMV (linear ulcers)
Rx esophagitis NSAID bisphosphonates, tetracyclines, K supplements

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6
Q

Post op fever

A

Hrs - normal infl, malignant hyperthermia, nonhemolytic transfusion rxtn (cytokines in stored blood)
<1 week - nosocomial UTI PNA
>1 week - infx/abscess of IV catheter, surgical site, PE, drug fever

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7
Q

Kaposi sarcoma

A

Viollaceous

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8
Q

Septic PE

A

IVDU, staph tricuspid OFTEN NO MURMUR

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9
Q

MC cause of sepsis in sickle cell

A

Strep pneumo (SHiN) blood, meningitis, pneumonia, osteo=staph a + salmonella

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10
Q

Central line —> bacteremia

A

Staph epidermidis/aureus, 10% candida

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11
Q

Acute HIV infx sx

A 
MR GU
Mono sx (LAD, arthralgias)
Rash
GI
Ulcers (oropharyngeal)
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12
Q

Tetanus ppx

A

If 3x vaccine give another dose if >10y ago or if severe injury >5y
If unsure hx AND severe give IG also

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13
Q

Meningitis

A 
<1 mo GBS, E. coli, HSV, listeria
1 mo-10y strep pneumo, neisseria
>10y neisseria
IC GIVE AMP
Bruzig/Kernig signs-->knee ext + hip flexion, neck flexion
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14
Q

CMV sx (immunocomp)

A

Pneumonitis, bloody diarrhea

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15
Q

HIV lung stuff

A

TB

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16
Q

PCP treatment

A

TMP-smx, steroids if PaO2<70 or Aa gradient>35

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17
Q

Bloody diarrhea

A

Ecoli, shigella, campy

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18
Q

Ehrlichosis

A

Rocky mt spotted fever w o the spots, lone star tick, s central/SE us, thrombocytopenia, leukopenia, ^AST ALT, LDH, tx doxy

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19
Q

HSV pregnancy

A

Treat w acyclovir 36 w, if active lesions c section

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20
Q

Babesiosis

A

Same tick as Lyme, intravascular hemolytic anemia/thrombocytopenia, dx smear

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21
Q

Oral ulcers/vesicles

A

HSV-1 oral mucosa/lips, anterior

Coxsackie A herpangina posterior, oropharynx, grey ulcers, late summer/early fall

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22
Q

Mono

A

Cervical LAD, SORE THROAT, autoimmune hemolytic anemia/thrombocytopenia, splenomegaly, abnormal lymphocytes

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23
Q

Neutropenic fever, no focal infx

A

Pseudomonas

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24
Q

Anti-pseudomonal abx

A

(CCMP) Cefepime, cipro, meropenem, pip-tazo

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25
Q

Impetigo

A

Topical abx mupirocin if local skin infx, PO cefalexin if widespread, PSGN

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26
Q

Nocardia

A

Acid-fast, branching filamentous rod, gram pos
IC pt, systemic sx (TB-like) + lung nodules + brain
Tx TMP-smx x6-12 mo

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27
Q

Abx for cervicitis vs PID

A

CTX + azithromycin, PID + metro

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28
Q

Neonatal conjunctivitis

A

Ppx topical erithromycin, gon more purulent

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29
Q

Epididymitis

A

<35 gon/chlamydia, >35 E. coli

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30
Q

Syphillis tx

A

PenG, if allergic doxy

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31
Q

HIV screening

A

Anyone 15-65 once, p24 antigen + Ab for early detection, then confirmatory testing

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32
Q

Post op surgical site infx

A

Urgent debridement esp if gray dishwater exudate

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33
Q

Pyelonephritis tx

A

IV CTX, if improvement 48 h, can switch to PO TMP-smx (check sensitivities)

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34
Q

STD no organisms seen

A

Chlamydia

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35
Q

MC risk factor for bacterial sinusitis

A

URI

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36
Q

HACEK

A

3% IE, haemophilus aphrophilus, aggregatobacter actinomy….who cares??, cardiobacterium hominis, eikenella corrogens, kingella kingae
Gram neg, dental procedures

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37
Q

Prevent catheter-associated UTI

A

CLean intermittent catheterization

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38
Q

Probe to bone

A

Bone biopsy for osteo

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39
Q

Malaria ppx

A

Mefloquine, atovaquone, doxy 2 w prior-4 w after

40
Q

Rubella lymph nodes

A

Post auricular and occipital lymphadenopathy

41
Q

Blastomycosis

A

Can affect immunocompetent, Mississippi valley, violaceous skin lesions, well circumscribed, heaped-up

42
Q

UTI in pregnancy tx

A

You CAN use, cephalexin, amox-clav, NF (bactrim 2nd tri)

43
Q

Hep C derm sx

A

Porphyria cutanea tarda=painful blisters on sun-exposed skin (photosens)

44
Q

Bacillus cereus

A

Rice, preformed exotoxin

45
Q

Trichinella

A

1w GI, 2-4w myositis, periorbital edema, eos>20%

46
Q

Ludwig angina

A

Submandibular cellulitis, oral flora, tooth infx

47
Q

Gonococcal pharyngitis

A

Fever + pharyngitis + lower abd pain

48
Q

Prosthetic joint infection bugs

A

<3 mo staph aureus, 3-12 mo staph epi (no fever), >12 mo staph a

49
Q

Measles vaccine

A

Can have mild sx 1-3 weeks after, vaccine at ages 1 and 4

50
Q

Rabies PEP

A

Vaccine + IgG, give if can’t confirm animal, otherwise wait 10 day quarantine or euthanize and brain bx

51
Q

Congenital toxo

A

DIFFUSE intracranial calc (periventricular CMV)

52
Q

Actinomyces tx

A

Penicillin (PO, IV +- surgery if severe=fistula)

53
Q

Pneumococcal vaccine

A

> =65 OR <65 w IC, asplenia, CKD —> 13 x1, then 23 8w, 5y, age 65
<65 w/ DM, heart/lung/liver probs, smoker —> 23

54
Q

Tdap Td schedule

A

Tdap once (+ every pregnancy), then Td q10y

55
Q

When to give azithro for MAC ppx in HIV

A

CD4<50

56
Q

Zoster vacc

A

60, maybe 50, <50 NO

57
Q

Indications for meningococcal vacc

A

11-12, BOOSTER 16-21

Asplenia/complement def, sub Saharan Africa, dorm/military

57
Q

Live vaccines

A 
Varicella
Influenza (intranasal)
MMR
Yellow fever
Rotavirus

Can give CD4>200

58
Q

Management of infective endocarditis

A

BLOOD CLX x3, if stable vitals can wait for result before abx

59
Q

Sickle cell osteo

A

Salmonella 2/3 staph a 1/4, vanc + CTX

60
Q

Human bite abx

A

Amox-clav

61
Q

Rhinosinusitis MC bugs

A

Moraxella, strep pneumo, h flu nontypable, tx amox-clav

62
Q

Erysipelas

A

Superficial dermal layer (cellulitis is deeper), well demarcated borders, often involves external ear, strep pyo, IV CTX or PO Amox if no systemic sx

63
Q

Syphillis s/s

A

EPITROCHLEAR NODES
Primary chancre, tertiary CNS + gummas, secondary everything else (Rash palms/soles truncal—> spreads outward to extremities, gray stuff in oropharynx, gray papules on genitals Condyloma lata, Hepatitis, Flu-like sx)

64
Q

CMV

A

Transmission Bodily fluids, renal transplant pts, colonic ulcers, abnormal leukocytes, bloody diarrhea (other diarrhea in pts w HIV not bloody)

65
Q

Cryptococcus

A

Increased ICP, indolent course, no mass lesion on CT, India ink, sabouraud, tx Ampho B + flucytosine + fluconazole

66
Q

Vertebral osteomyelitis

A

IVDU, exquisite pt tenderness, not imp w rest, may not have a white count, w/u XR (may not show < 3w), blood clx/ESR/CRP –> MRI, bone bx to confirm

67
Q

Histoplasmosis

A

Mimics sarcoidosis, hilar LAD, pt from Mississippi gets way worse w steroids, HIV disseminated tx AmphoB x2w, itraconazole x1y

68
Q

Varicella PEP

A

Vacc ages 1 and 4, give vacc if not immune, immunosuppressed give IG, if <1yo don’t need PEP

69
Q

Lyme dz

A

AV block!! Spirochete

70
Q

PCP pneumonia

A

Can’t be cultured, need sputum or BAL

71
Q

Aspergillosis

A

In HIV nd bx and clx to confirm

72
Q

Influenza virus

A

Primary=diffuse opacities, PT >65

Secondary bacterial=lobar, high fever

73
Q

Ecthyma gangrenosum

A

Skin lesions in chemo/immunosuppressed pts, start as non painful pustules—>gangrenous ulcers, usually pseudomonas infiltrates blood vessels

NOT PYODERMA GANGRENOSUM=IBD painful*

74
Q

Vaccinate for hep A?

A

YES

75
Q

Meningitis bact vs viral vs fungal

A

(nl = glu 40-70, pro <40)
Bact —> glucose<40, protein>250, PNMs
Fungal —> looks like bact (glu<40, pro>250) BUT lymphs
Viral —> nl glucose 40-70, nl-slightly high protein <150, lymphs

***dirty tap = 500-1,000 RBCs/1 WBC

76
Q

Anaerobic coverage abx

A

CAMA Clindamycin, Amox-clav, Meropenem, ampicillin** PLUS SULBACTAM

77
Q

HIV in a baby

A

lots of diarrhea, PJP

78
Q

MC congenital valve dz, most highly a/w IE

A

Mitral prolapse/regurg

79
Q

septic arthritis in a baby

A

staph, also GBS and pseudomonas < 3 mo old, baby will hold hip in a weird position

81
Q

abx ppx for ortho surg

A

cefazolin (2nd line vanc or clinda), bugs s aureus, epi, only if foreign body implantation

82
Q

Laryngeal papilloma

A

HPV vertical transmission kids, finger-shaped lesions on vocal chords, irreg, exophytic punctate, surg

83
Q

Roseola infantum

A

Fever 3-5d VERY HIGH, then blanching macular rash HHV-6

84
Q

Toxic shock syndrome

A

STAPH A, macular rash palms + soles, tx clinda +/- vanc (MRSA)

85
Q

Acute otitis media (vs serous)

A

> 3 in 6mo, >4 in 1y consider tympanoplasty, serous no s/s infx common in HIV

86
Q

Epiglottitis

A

Attempt intubation ONCE, cricothyrotomy, CTX (Hib strep pneumo) + vanc (staph a)

87
Q

Cavernous sinus thrombosis

A

Infx, 2d later HA/inc ICP, periorbital edema, u/l facial nerve probs—>b/l, dx MRV, tx IV abx, check for herniation

88
Q

Aminoglycosides

A

SN hearing loss

89
Q

Entamoeba histolytica

A

Travel bloody diarrhea liver lesion, tx metro + paromomycin

90
Q

IS MALASSEZIA A DERMATOPHYTE

A

No fucking, NO. Selenium sulfide ketoconazole

91
Q

Hep B screen

A

Sex, finger stick

92
Q

Hep C screen

A

Transfusion <1992

93
Q

Mumps

A

Non-specific prodrome –> PAROTITIS, orchitis

94
Q

Afebrile no WBCs watery stools

A

ETEC

95
Q

Meningococcemia

A

pt in close quarters w/ others (camp, military, college), sore throat URI sx fever, RASH

96
Q

Cutaneous larva migrans AKA

A

HOOKWORM

97
Q

Infective endocarditis complications

A

ABSCESS (brain, kidney), can have elev ESR

STEP 2 AG (16 decks)

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