ID Flashcards
clindamycin covers
most gram positive, some MRSA coverage
antibiotics that cover enterococcus
vancomycin, linezolid, ampicillin, rifampin and quinolones
first generation cephalosporin antibiotics
cephalexin (keflex), Cefazolin (acne)
first generation cephalosporins coverage
staph and strep, no MRSA, some gram negative (proteus, E. coli, Klebsiella)
2nd generation cephalopsorin antibiotics
cefaclor, cefuroxime, cefotetan, cefoxitin
2nd generation cephalosporin coverage
no gram positive but better gram negative (h. flu, enterobacter, Neisseria, proteus, E. coli, klebsiella)
3rd generation cephalosporin antibiotics
ceftriaxone, cefotaxime, ceftazidime, cefpodoxime
3rd generation cephalosporin coverage
good for hospital acquired gram negative infections and meningitis, ceftazidime is good for pseudomonas
4th generation cephalosporin antibiotic
cefepime
macrolides side effect
increased GI motility
carbapenems used for
ESBL producing organisms such as Enterobacter
metronidazole used for
GET BCG
Giardia, Entamoeaba, Trichomonas, Bacteroides, Clostridium, Gardnerella
treatment for enterococcus faecalis
vancomycin, linezolid, ampicillin, rifampin or quinolone
enterococcus faecalis is a
G+ diplococcus
listeria monocytogenes is a
G+ diphtheroid (rod)
listeria monocytogenes treatment
ampicillin
clostridium tetani treatment
tetanus immunoglobulin + metronidazole OR penicillin
corynebacterium diphtheria treatment
erythromycin or penicillin G
alpha hemolytic strep species
strep viridans and strep pneumoniae
beta hemolytic strep species
strep agalactiae and strep pyogenes
strep agalactiae causes
GBS
strep progenies causes
GAS skin infection
rheumatic fever is caused by
strep pharyngitis only
post infectious glomerulonephritis is caused by
strep pharyngitis OR strep skin infection
peritonsillar abscess treatment
IV clindamycin or Unasyn, once drained PO augmenting
most common organism causing peritonsillar abscess
grp A strep (but also cover for anaerobes)
retropharyngeal abscess presents most commonly in
younger kids (<6 years) with fever, LAD, hyperextension of neck and drooling
most common organism causing retropharyngeal abscess
grp A strep
xray of retropharyngeal abscess
widening of retropharyngeal space
scarlet fever is due to what organism
grp A strep
scarlet fever rash description
rash in the creases that is initially sandpaper but then more erythematous. pink or red lines near creases called pasties lines. strawberry or white tongue. rash does not hurt
most common organism that causes occult bacteremia
strep pneumoniae (don’t treat if no symptoms/found incidentally)
most common cause of pneumonia in kids
strep pneumo
most common cause of pneumonia in kids with CF
staph aureus or pseudomonas aeruginosa
early onset GBS timeline
within first 6 days of life
most common cause of early onset GBS
pnuemonia
late onset GBS timeline
after 6 days and up to the first 90 days of life
most common infections in late onset GBS
usually focal (meningitis, cellulitis, osteomyelitis)
confirmed GBS treatment
penicillin G
band:neutrophil count ratio suggestive of infectio
> 0.2
rectovaginal GBS screening at
36 to 37 6/7 weeks
intrapartum antibiotic prophylaxis must be given how low before delivery to be considered adequate
at least 4 hours prior
early onset GBS meningitis treatment
ampicillin, gentamicin and cefotaxime
early onset GBS bacteremia, sepsis or pneumonia treatment
ampicillin and gentamicin
late onset GBS bacteremia treatment
ampicillin and gentamicin (or vancomycin and cefotaxime)
late onset GBS meningitis treatment
ampicillin, gentamicin and cefotaxime
late onset GBS cellulitis treatment
nafcillin and gentamicin (or vancomycin and cefotaxime)
late onset GBS septic arthritis or osteomyelitis treatment
nafcillin and cefotaxime (or vancomycin and cefotaxime)
gram positive organism in clusters on gram stain
staph aureus
treatment for coagulase negative staph
vancomycin
rash presentation of Rocky Mountain spotted fever
starts on palms, wrists and soles, then spreads to trunk within hours
RMSF treatment
doxycycline
enterobacter
hospital acquired gram negative urinary or respiratory infection, often ESBL requiring carbapenem but if not can use cephalosporin
citrobacter freundii
brain abscess
small nontender papule or ulcer that resolves then a tender lymph node appears that ruptures and drains for months but relieves the pain
lymphogranuloma venereum (chlamydia trachomatis)
chlamydia trachomatis STD treatment
azithromycin x1 or doxycycline x 7 days
chlamydia conjunctivitis treatment
PO erythromycin (to eradicate nasopharyngeal colonization that can lead to pneumonia)
lymphogranuloma venereum
small nontender papule or ulcer initially that resolves and then a tender lymph node forms, pain resolves once it drains and it can drain for months
lymphogranuloma venereum treatment
doxycycline or erythromycin
common phrase for chlamydia
intracytoplasmic inclusions (its an intracellular organism)
most common bacterial STD
chlamydia
most common STD overall
HPV
most common reported STD
chalmydia
first line treatment for chlamydia pneumonia
macrolide (azithromycin or erythromycin) no matter age
risk of macrolide in infant <2 weeks
risk of infantile hypertrophic pyloric stenosis with erythromycin and azithromycin but still use in chlamydia pneumonia bc benefits outweigh risks
bird exposure plus atypical pneumonia
chlamydia psittasci pneumonia
chlamydia psittasci pneumonia treatment
doxycycline or macrolides
tachypnea, staccato cough +/- eye discharge in child less than 2 months
chlamydia pneumonia
infections caused by mycoplasma pneumonia
atypical pneumonia or bulls myringitis (some get near symptoms after infection)
mycoplasma pneumonia diagnosis
PCR or serum IgM titers
mycoplasma pneumonia treatment
macrolide
gram stain description of h. flu organism
pleomorphic organism
h. flu treatment
ceftriaxone
CBC w/ pertussis
lymphocytosis (WBC <20K)
diagnosis of pertussis
PCR w/ nasopharyngeal swab
treatment of pertussis
erythromycin, azithromycin or clarithromycin (if <1 month azithromycin) bactrim alternative if <1 month
use of antibiotics in pertussis
shorten early URI catarrhal stage, does not shorten whooping/paroxysmal stage
anti-psuedomonal antibiotics
ceftazidime, cefepime, ticaricillin, carbenicillin, piperacillin, gentamycin, tobramycin, ciprofloxacin, levofloxacin
rash of lyme shows up how long after bite
1 to 2 weeks (titers often still negative at this time)
treatment of lyme is oral if
acute arthritis, disseminated erythema migrans or bells palsy (doxycycline if >8, amoxicillin if <8)
treatment of lyme is IV if
carditis, neuritis or recurrent arthritis (penicillin or ceftriaxone)
common location of arthritis in lyme
large joints ex: knees
if lyme antibody titers are positive confirm with
western blot
bells palsy aka
unilateral facial nerve (CN 7) palsy)
jarisch-herxheimer reaction
fever, chills, hypotension, headache, myalgia and exacerbation of skin lesions during antibiotic treatment of a bacterial disease (usually spirochetes) due to large quantities of toxins released into b ody
leptospirosis is spread via
urine of animals
leptospirosis diagnosis
blood cultures if during first week, urine if after first week
leptospirosis treatment
penicillin
conjunctiva suffusion diagnosis
leptospirosis
leptospirosis presentation
multisystem complaints including nonexudative conjunctivitis (conjunctival suffusion), abdominal pain, headache, transient rash, liver/renal failure
unstable ICU patient with sepsis due to fungemia should be treated with
amphotericin B (liposomal amphotericin if there is renal disease)
types of infections associated with cryptococcus
pneumonia and meningitis
areas associated with cryptococcus
northwest US
animal associated with cryptococcus
birds (pigeon droppings)
diagnose cryptococcus via
india ink staining
treatment of cryptococcus
for meningitis or disseminated - amphotericin first, then fluconazole
broad based budding yeast
blastomyces
location blastomyces is often found
near water
illness blastomyces causes
pneumonia or flu like illness, skin lesions
blastomyces treatment
azole (itraconazole is first line)
illness caused by coccidioidmycosis
pneumonia or flu-like illness
areas associated with coccidioidmycosis
west - california, Arizona, texas
treatment for coccidioidmycosis
amphotericin or azole(fluconazole, ketoconazole
type of illness caused by histoplasmosis
flu like illness
area associated with histoplasmosis
Ohio and mississippi
xray findings with histoplasmosis
hilar calcifications that look like TB or pulmonary fibrosis
histoplasmosis associated with what exposure
bird droppings
histplasmosis treatment
amphotericin or azole (fluconazole, ketoconazole)
aspergillus in an immunocompetent patient
hypersensitivity reaction - allergic bronchopulmonary aspergillosis (ABPA) - especially asthmatics and CF
allergic bronchopulmonary aspergillosis treatment
itraconazole and steroids
diagnosis of allergic bronchopulmonary aspergillosis
increased eosinophilia and lung infiltrates
chronic eosinophilia pneumonia
caused by aspergillum in immunocompromised, causes peripheral infiltrates on CXR
treatment of invasive aspergillus
voriconazole or isavuconazole, long term steroids, negative pressure room
mycobacterium TB diagnosis
acid fast staining
positive PPD if no risk factors
> 15 mm
positive PPD if xray findings
> 5 mm
treatment for TB if +PPD but no xray findings
INH x9 months
treatment for TB if +xray
rifampin, isoniazid, pyrazinamide (may get ethambutol x2 months)
PPD check in newborns of mom with +PPD neg CXR
every 3 months
treatment for kid with neg PPD and CXR but close +TB contact
INH prophylaxis x12 weeks
treatment for kid with + PPD, neg CXR and + TB close contact
INH prophylaxis x 9 months
treatment for kid with + PPD, +CXR and +TB close contact
triple or quadruple therapy
treatment for kid with TB meningitis
triple or quadruple therapy plus steroids plus streptomycin
R supraclavicular node drains what
mediastinum and lungs (more likely to show adenopathy with lung infection)
L smupraclavicular node drains what
thorax and abdomen (more likely to be lymphoma)
which lesions usually appear first in hand, foot mouth
mouth lesions (coxsackie = enterovirus)
HHV 6 aka
roseola
high fever and then a rash develops a few days after the fever subsides
HHV 6 (roseola)
EEG with HSV meningitis
PLEDs (periodic lateralizing epileptiform discharges)
CT scan with HSV meningitis
temporal lobe lesions
rash of varicella zoster
comes in crops at different times, goes to the trunk and then the face and extremities, lasts 7 to 10 days. leaves minimal scars
rash of small pox (variola)
lesions all appear at the same time and limited to the face/extremities, lasts 3-4 weeks and leaves a lot of scars
things that require negative pressure rooms
Measles, Mycobacterium Tuberculosis, Varicella, Aspergillus
pregnant women with HIV treatment
zidovudine or nevirapine
testing of babies at high risk of HIV (mom not treated)
DNA PCR at birth and 2 weeks, start zidovudine within 72 hours and continue for 6 weeks
testing of lower risk babies of HIV (Mom treated during pregnancy)
DNA PCR starting at 2 weeks
HIV antibodies in newborns
maternal antibodies can last u to 18 months, test at 12-18 months to ensure they have cleared, if positive do a genetic material test
prophylaxis once diagnosed with HIV
bactrim for PCP prophylaxis immediately
cough, conjunctivitis, coryza
measles aka rubeola (also koplik spots)
last symptoms of measles to appear
rash (starts at the head/hairline and progresses down), resolves after ~5 days
major cause of death in measles
pneumonia
time you are contagious with measles
4 days prior to onset of rash until 4 days after rash appears
measles post exposure prophylaxis for someone <6 months
IGIM if <6 days since exposure
measles post exposure prophylaxis for 6 to 11 month old
MMR if 3 days or less since exposure, IGIM if 4-6 days since exposure
how long do you have to wait to give MMR after giving IGIM
5 months
German measles aka
rubella virus
rash of rubella
maculopapular. starts on the face and spreads to the trunk and extremities within 24 hours. face rash disappears as the body rash starts. rash resolves within 3 days.
who should not get MMR vaccine
pregnant women (live)
zika virus is transmitted by
aedes mosquito
diffuse ring enhancing lesions on head CT
toxoplasma gondii
periventricular lesions on head CT
CMV
oral rehydration solution contents
2% glucose and 90 mEq NaCl
only diarrhea that can have loperamide
traveler’s diarrhea (enterotoxigenic E. coli)
diarrhea in older child associated with raw seafood
norwalk
diarrhea that can cause HUS
shiga toxin producing e coli (STEC)
enterotoxigenic E. coli description
travelers diarrhea - non bloody diarrhea with cramps abdominal pain, sometimes fever and vomiting. treat with azithromycin if lasting >1 week, ok to use loperamide
high fever, bloody diarrhea, tenesmus, seizures and rectal prolapse caused by
shigella infections (gram negative)
CBC in shigella infection
high neutrophils and bandemia (blood and WBC in stool)
shigella treatment
azithromycin or ceftriaxone if ill
diseases that cause tenesmus
shigella and entamoeba histolytica
green malodorous diarrhea after eating at a picnic (especially eggs) or playing with an iguana is caused by
salmonella non-typhi
treatment of salmonella typhii
ceftriaxone or cefotaxime
treatment of campylobacter jejuni
erythromycin
crampy abdominal pain, fever and inflammatory diarrhea caused by
campylobacter jejune (or shigella)
diarrhea that starts within 8 hours is caused by
staph aureus or bacillus cereus
fever and diarrhea after eating raw pork or unpasteurized milk is due to
yersinia enterocolitica
yersinia enterocoliti results in
fever and diarrhea, pseudo appendicitis, erythema nodosum and reactive arthritis
non bloody diarrhea ~10 hours after eating raw turkey or raw beef is from
clostridium perfringens (preformed toxins)
antibiotics that cause c. diff
clindamycin, beta lactam, cephalosporins
treatment of c. diff
oral metronidazole or oral vancomycin
bloody diarrhea causes
salmonella, shigella, campylobacter, EHEC, EIEC, clostridioides difficle
most common treatment for acute diarrhea
ceftriaxone, followed by azithromycin
giardia diagnosis
string test + ELISA
diardia treatment
metronidazole
undigested food in poop
toddlers diarrhea
toddlers diarrhea treatment
decrease carb intake/juice, increase fat and fiber intake
diarrhea, emesis and malabsorption while on formula but not clears
food protein induced enteropathy
food protein induced enteropathy treatment
if breastfeeding have mom stop drinking milk, if formula fed change to hydroxylate or amino acid derived formula, usually resolves once GI strict matures
food protein induced enteropathy diagnosis
clinical - usually apparent after switching from breastfeeding to formula. not IgE mediated.
food protein induced proctitis/colitis presentation
blood in stools but otherwise well (-itis of lower GI tract) more common in breastfed infants from cows milk in mom’s diet
lactase deficiency diagnosis
hydrogen breath test (Eat carb load, if no lactase to digest then bacteria digest carbs and release hydrogen in breath - also diagnoses bacterial overgrowth)
lactase deficiency treatment
soy milk (has sucrose instead of lactose)
protein losing enteropathy with steatorrhea, low serum protein, low serum gamma globulin level, edema and possible lymphopenia
intestinal lymphangiectasia
francisella tularensis gram stain
pleomorphic gram negative organism
fever, HSM, LAD, ulcers, exposure to deer or rabbits
tularemia from francisella tularensis (tick-borne illness)
francisella tularensis treatment
streptomycin + tetracycline
atypical mycobacterium diagnosis/treatment
freely movable node, painless LAD, with some induration with PPD but not enough for TB, surgical excision is curative, no antibiotics
brucellosis treatment
bactrim + rifampin if <8, doxycycline + rifampin, streptomycin or gentamicin if >8
yersinia pestis treatment
streptomycin
fever, painful and swollen LAD of inguinal and axillary region, in southwest US woods hunting
yersinia pestis
sporotrichosis aka
rose pickers disease
single painless movable nodular lesion that enlarges and then ulcerates, then other movable nodules appear along lymphatic chain
sporotrichosis from sporothrix schenckii
sporotrichosis treatment
itraconazole or amphotericin B
excision node biopsy findings of Hodgkins lymphoma
reed sternberg cells
encapsulated organisms
Strep pneumo, Neisseria meningitidis, klebsiella pneumonia, h. flu, salmonella type, cryptococcus neoformans, pseudomonas aeruginosa
(some nasty killers have some capsule protection)
