ID Flashcards
Positive TB skin test
> 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)
Endocarditis w UTI
Enterococcus
Osteomyelitis foot
Pseudomonas
Hep C
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
MC causes of esophagitis in HIV
CD4<100
Candida tx fluconazole
Viral PAIN HSV (round ulcers), CMV (linear ulcers)
Rx esophagitis NSAID bisphosphonates, tetracyclines, K supplements
Post op fever
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
Kaposi sarcoma
Viollaceous
Septic PE
IVDU, staph tricuspid OFTEN NO MURMUR
MC cause of sepsis in sickle cell
Strep pneumo (SHiN) blood, meningitis, pneumonia, osteo=staph a + salmonella
Central line —> bacteremia
Staph epidermidis/aureus, 10% candida
Acute HIV infx sx
MR GU Mono sx (LAD, arthralgias) Rash GI Ulcers (oropharyngeal)
Tetanus ppx
If 3x vaccine give another dose if >10y ago or if severe injury >5y
If unsure hx AND severe give IG also
Meningitis
<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
CMV sx (immunocomp)
Pneumonitis, bloody diarrhea
HIV lung stuff
TB
PCP treatment
TMP-smx, steroids if PaO2<70 or Aa gradient>35
Bloody diarrhea
Ecoli, shigella, campy
Ehrlichosis
Rocky mt spotted fever w o the spots, lone star tick, s central/SE us, thrombocytopenia, leukopenia, ^AST ALT, LDH, tx doxy
HSV pregnancy
Treat w acyclovir 36 w, if active lesions c section
Babesiosis
Same tick as Lyme, intravascular hemolytic anemia/thrombocytopenia, dx smear
Oral ulcers/vesicles
HSV-1 oral mucosa/lips, anterior
Coxsackie A herpangina posterior, oropharynx, grey ulcers, late summer/early fall
Mono
Cervical LAD, SORE THROAT, autoimmune hemolytic anemia/thrombocytopenia, splenomegaly, abnormal lymphocytes
Neutropenic fever, no focal infx
Pseudomonas
Anti-pseudomonal abx
(CCMP) Cefepime, cipro, meropenem, pip-tazo
Impetigo
Topical abx mupirocin if local skin infx, PO cefalexin if widespread, PSGN
Nocardia
Acid-fast, branching filamentous rod, gram pos
IC pt, systemic sx (TB-like) + lung nodules + brain
Tx TMP-smx x6-12 mo
Abx for cervicitis vs PID
CTX + azithromycin, PID + metro
Neonatal conjunctivitis
Ppx topical erithromycin, gon more purulent
Epididymitis
<35 gon/chlamydia, >35 E. coli
Syphillis tx
PenG, if allergic doxy
HIV screening
Anyone 15-65 once, p24 antigen + Ab for early detection, then confirmatory testing
Post op surgical site infx
Urgent debridement esp if gray dishwater exudate
Pyelonephritis tx
IV CTX, if improvement 48 h, can switch to PO TMP-smx (check sensitivities)
STD no organisms seen
Chlamydia
MC risk factor for bacterial sinusitis
URI
HACEK
3% IE, haemophilus aphrophilus, aggregatobacter actinomy….who cares??, cardiobacterium hominis, eikenella corrogens, kingella kingae
Gram neg, dental procedures
Prevent catheter-associated UTI
CLean intermittent catheterization
Probe to bone
Bone biopsy for osteo
Malaria ppx
Mefloquine, atovaquone, doxy 2 w prior-4 w after
Rubella lymph nodes
Post auricular and occipital lymphadenopathy
Blastomycosis
Can affect immunocompetent, Mississippi valley, violaceous skin lesions, well circumscribed, heaped-up
UTI in pregnancy tx
You CAN use, cephalexin, amox-clav, NF (bactrim 2nd tri)
Hep C derm sx
Porphyria cutanea tarda=painful blisters on sun-exposed skin (photosens)
Bacillus cereus
Rice, preformed exotoxin
Trichinella
1w GI, 2-4w myositis, periorbital edema, eos>20%
Ludwig angina
Submandibular cellulitis, oral flora, tooth infx
Gonococcal pharyngitis
Fever + pharyngitis + lower abd pain
Prosthetic joint infection bugs
<3 mo staph aureus, 3-12 mo staph epi (no fever), >12 mo staph a
Measles vaccine
Can have mild sx 1-3 weeks after, vaccine at ages 1 and 4
Rabies PEP
Vaccine + IgG, give if can’t confirm animal, otherwise wait 10 day quarantine or euthanize and brain bx
Congenital toxo
DIFFUSE intracranial calc (periventricular CMV)
Actinomyces tx
Penicillin (PO, IV +- surgery if severe=fistula)
Pneumococcal vaccine
> =65 OR <65 w IC, asplenia, CKD —> 13 x1, then 23 8w, 5y, age 65
<65 w/ DM, heart/lung/liver probs, smoker —> 23
Tdap Td schedule
Tdap once (+ every pregnancy), then Td q10y
When to give azithro for MAC ppx in HIV
CD4<50
Zoster vacc
60, maybe 50, <50 NO
Indications for meningococcal vacc
11-12, BOOSTER 16-21
Asplenia/complement def, sub Saharan Africa, dorm/military
Live vaccines
Varicella Influenza (intranasal) MMR Yellow fever Rotavirus
Can give CD4>200
Management of infective endocarditis
BLOOD CLX x3, if stable vitals can wait for result before abx
Sickle cell osteo
Salmonella 2/3 staph a 1/4, vanc + CTX
Human bite abx
Amox-clav
Rhinosinusitis MC bugs
Moraxella, strep pneumo, h flu nontypable, tx amox-clav
Erysipelas
Superficial dermal layer (cellulitis is deeper), well demarcated borders, often involves external ear, strep pyo, IV CTX or PO Amox if no systemic sx
Syphillis s/s
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)
CMV
Transmission Bodily fluids, renal transplant pts, colonic ulcers, abnormal leukocytes, bloody diarrhea (other diarrhea in pts w HIV not bloody)
Cryptococcus
Increased ICP, indolent course, no mass lesion on CT, India ink, sabouraud, tx Ampho B + flucytosine + fluconazole
Vertebral osteomyelitis
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
Histoplasmosis
Mimics sarcoidosis, hilar LAD, pt from Mississippi gets way worse w steroids, HIV disseminated tx AmphoB x2w, itraconazole x1y
Varicella PEP
Vacc ages 1 and 4, give vacc if not immune, immunosuppressed give IG, if <1yo don’t need PEP
Lyme dz
AV block!! Spirochete
PCP pneumonia
Can’t be cultured, need sputum or BAL
Aspergillosis
In HIV nd bx and clx to confirm
Influenza virus
Primary=diffuse opacities, PT >65
Secondary bacterial=lobar, high fever
Ecthyma gangrenosum
Skin lesions in chemo/immunosuppressed pts, start as non painful pustules—>gangrenous ulcers, usually pseudomonas infiltrates blood vessels
NOT PYODERMA GANGRENOSUM=IBD painful*
Vaccinate for hep A?
YES
Meningitis bact vs viral vs fungal
(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
Anaerobic coverage abx
CAMA Clindamycin, Amox-clav, Meropenem, ampicillin** PLUS SULBACTAM
HIV in a baby
lots of diarrhea, PJP
MC congenital valve dz, most highly a/w IE
Mitral prolapse/regurg
septic arthritis in a baby
staph, also GBS and pseudomonas < 3 mo old, baby will hold hip in a weird position
abx ppx for ortho surg
cefazolin (2nd line vanc or clinda), bugs s aureus, epi, only if foreign body implantation
Laryngeal papilloma
HPV vertical transmission kids, finger-shaped lesions on vocal chords, irreg, exophytic punctate, surg
Roseola infantum
Fever 3-5d VERY HIGH, then blanching macular rash HHV-6
Toxic shock syndrome
STAPH A, macular rash palms + soles, tx clinda +/- vanc (MRSA)
Acute otitis media (vs serous)
> 3 in 6mo, >4 in 1y consider tympanoplasty, serous no s/s infx common in HIV
Epiglottitis
Attempt intubation ONCE, cricothyrotomy, CTX (Hib strep pneumo) + vanc (staph a)
Cavernous sinus thrombosis
Infx, 2d later HA/inc ICP, periorbital edema, u/l facial nerve probs—>b/l, dx MRV, tx IV abx, check for herniation
Aminoglycosides
SN hearing loss
Entamoeba histolytica
Travel bloody diarrhea liver lesion, tx metro + paromomycin
IS MALASSEZIA A DERMATOPHYTE
No fucking, NO. Selenium sulfide ketoconazole
Hep B screen
Sex, finger stick
Hep C screen
Transfusion <1992
Mumps
Non-specific prodrome –> PAROTITIS, orchitis
Afebrile no WBCs watery stools
ETEC
Meningococcemia
pt in close quarters w/ others (camp, military, college), sore throat URI sx fever, RASH
Cutaneous larva migrans AKA
HOOKWORM
Infective endocarditis complications
ABSCESS (brain, kidney), can have elev ESR