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ID - kap Flashcards

1
Q

What vaccinations are recommended for a HIV pt?

A 
HAV
HBV
HPV (if under 26)
Influenza (IM only)
Meningococcus (age 11-18, or asplenic)
Pneumococcus (PCV13, once in life)
Tdap (or Td every 10 years)
Only give MMR, zoster, varicella if the CD4+ is 200+ (live vax)
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2
Q

A pt with confirmed Strep Bovis should also be screened for?

A

Colon cancer

Order Colonoscopy

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3
Q

A pt with pyelonephritis, basic (pH>8) urine most likely has?

A

Urease producing bacteria
Proteus mirabilis, Klebsiella pneumoniae
High urine pH increases the risk for struvite stones (magnesium ammonia phosphate)

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4
Q

When do you suspect ventilator-associated pneumonia

A

48+ hours post intubation
Fever, purulent sputum, ABN CXR
Work up - Sputum/lavage gram stain & culture + empiric Abx

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5
Q

Which systemic fungus presents with well circumscribed nodules (wart like) and plaques in a immunocompetent pt?

A

Blastomycosis

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6
Q

When should a pt be screened for HIV

A

Recommended for all 15-65 regardless of RF

MSM, IVDU, unprotected sex, Hx of other STD’s

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7
Q

Which TB drug causes neuropathy?

A

Isoniazid

Add pyridoxine, especially if they are malnourished, pregnant, or other comorbidities

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8
Q

Immunoguppressed pt with pulm syx and acid fast filamentous rods?

A

Nocardia

Tx - Tm-Sx

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9
Q

How do you Dx Babesiosis?

A

Blood Smear (reveals Maltese cross)

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10
Q

Pt presents with fever, malaise, exudate on the tonsils, and lymphadenopathy. Dx?

A

Mono (Ebstein-Barr virus)

Can have autoimmune hemolytic anemia 2-3 weeks after syx (IgM cold agglutination Ab)

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11
Q

Painful penile pustule that ulcerates with inguinal lymphadenopathy

A 
Haemophilus ducreyi (chancroid)
GNR
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12
Q

Diagnosis of chronic HCV is a two step process, what are they?

A
  1. Serology of HCV Ab

2. PCR for HCV

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13
Q

What is Ludwig angina?

A

Progressive cellulitis of the submandibular and sublingual space that is caused by an infected mandibular molar.
Tx - IV abx to prevent airway compromise
Polymicrobial

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14
Q

HIV pt with meningitis syx suspect?

A

Cryptococcus

Dx - CSF + india ink

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15
Q

Abx for anaerobic infections?

A

Metronidazole + amoxicillin
Amoxicillin-clavulanate
Clindamycin

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16
Q

What is the vaccination schedule for pneumonoccocus 23 alone?

A

Adults 65+ or those with high risk comorbidity (Health lung or liver dz, DM smokers, alcoholics)

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17
Q

When is sequential PCV 13 followed by PPSV23 recommended?

A

Adults 65+
Adults under 65 with VERY high risk comorbidity (CSF leak, sickle cell, cochlear implant, asplenia, immunocompromised, chronic renal failure)

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18
Q

Liver U/S reveals smooth, round cysts with daughter cysts inside. Dx?

A

Echinococcus

Think dogs owners and sheep farmers

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19
Q

URI with white sputum and no tonsillar exudate. Dx?

A

Viral bronchitis

Self limiting

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20
Q

Concerning organisims in a febril pt with neutropenia?

A

Pseudomonas - ceftazidime
MRSA - vanco
Aspergillus - voriconazole

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21
Q

Tx for acute pyelo

A

IV quinolones (cipro)

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22
Q

Fever, retro-orbital pain, rash, URI, myalgias. Dx?

A

Dengue fever

Hemorrhagic form - dehydration, hemoconcentration, thrombocytopenia, spontaneous bleeding, and hemorrhage

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23
Q

Tx for Staph aureus penumonia?

A

IV vanco or linezolid

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24
Q

Pt has seizure after a URI. Dx?

A

Brain abscess

Usually alpha-hemolytic strep and mixed anaerobes

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25
Q

Pt with VP shunt presents with meningitis. Organism?

A

Staph epi
Colonizes skin
Tx - naf

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26
Q

College student with meningtitis and petichial rash

A

Neisseria meningitidis

Most common cause of meningitis w/ a petichial rash

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27
Q

Gradual onset of pneumonia and malaise. CXR b/l chest infiltrate

A

Mycoplasma pneumoniae
Atypical pneumonia due to gradual onset, absence on high fever and rigors, non productive cough
“Walking pneumonia”

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28
Q

TB on RIPE has dark urine. Why?

A

Rifampin:
Increases hepatic clearance of drugs (CYP450 inducer)
Turns urine and tears orange
Chemical hepatitis (hepatogmeagly)

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29
Q

HAP grows acinetobacter baumanii. Tx?

A

Imipenem

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30
Q

Tx for GNR UTI?

A

Bactrim (TMP-SMX)

po quinolone 2nd choice

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31
Q

HIV pt has a single ring enhancing lesion on CT. Tx?

A

Treat for toxo first (usually multiple rings)
Tx - Pyrimethamine + sulfadiazine
If fails, bx for lymphoma (usualy a single ring)

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32
Q

Presence of blood on a CSF in the absence of a traumatic tap

A

Herpes encephalitis

Gold standard - PCR

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33
Q

College student has a week of malaise, fever, and enlarged posterior cervical LN, gray-green tonsillar exudate

A

EBV
Positive heterophile test
Increased risk of splenic rupture (no contact sports for a while)

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34
Q

Painful, swollen salivary glands + orchitis

A

Mumps
Orchitis develops 7-10 days after the parotitis
Infertility is rare
Tx = NSAIDs, bed rest, cool the testes

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35
Q

How do you manage uncomplicated pyelo?

A

admit and give IV abx

Once stable, discharge and put on 14day course of abx. No follow up needed

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36
Q

Empiric treatment of bacterial meningitis in adult >50

A

Ceftriaxone, vanco, ampicillin

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37
Q

Empiric tx of bacterial meningitis in 1-49 y/o’s

A

Vanco + 3rd gen cephalosporing

38
Q

Drug of choice in aspiration PNA

A

Clindamycin

Best drug for ALL anaerobic infections about the diaphragm

39
Q

Most common cause of meningitis in an adult

A

Strep pneumo

40
Q

Post needlestick while drawing on a HIV + pt. Management?

A

Draw blood for HIV serology and start antiretroviral 3 drug therapy x 4 weeks
recommended for a high risk exposure to blood or body fluids of an infected individual
Start therapy w/in hours
Repeat serology at 6 wks, 3mo, and 6 mo

41
Q

HIV + w/ dysphagia
EGD - large, irregular, linear ulcers in dystal esophagus
bx - intranuclear and intracytoplasmic inclusions

A

CMV

Tx - Ganciclovir

42
Q

HIV w/ dysphagia

EGD - vesicles and round/ovoid ulcers

A

HSV

Tx - acyclovir

43
Q

post transplant pt with acute respiratory failure

A

Pneumocystis pneumonia
dx w/ bronchoalveolar lavage
Also has elevated LDH and XRS w/ b/l diffuse interstitial infiltrates

44
Q

Sex worker

Fever, tenosynovitis, polyarthralgia, pustular lesions on trunk and extremities

A

Disseminated gonorrhea
Tx - IV ceftriaxone + azitrhro or doxy
STD + septic arthritis = gonorrhea
DX - swab for PCR

45
Q

Atypical PNA syx + GI and neuro syx

A

Legionella
Dx - Urine Ag
Labs - hyponatremia and mild hepatitis
Tx - macrolide or fluoroquinolone

46
Q

Immigrant
Hypopigmented patch
Numbness/tingling

A

Leprosy
Dx - skin bx from edge of the lesion
Tx - minimal lesions -> dapsone + rifampin, if extensive lesions add clofazimine
May take months to years to completely heal

47
Q

chronic HCV pt has vesicular rash on dorsum of hand

A

Porphyria cutanea tarda (PCT)
Fragile, photosensitive skin that develops vesicles and bullae w/ trauma or sun exposre
All PCT pts should be screened for HCV
Tx - serial phlebotomy or hydroxychloroquine

48
Q

Tx for mycoplasma pneumo

A 
po azithromycin (macrolides)
Can present with hemolytic anemia d/t cold agllutinins
CXR - interstitial infiltrates
49
Q

Immunocompromised
Seizures
Lung nodules on CT
Bronchoalveolar lavage - partially acid-fast, gram +, branching rods

A 
Nocardia
Tx - trimethoprim-sulfamethoxazole
Carbapenem is added when there is brain involvement
Drain abscesses when possible
duration of therapy = 6-12m
50
Q

Fever, back pain, FOCAL spine tenderness

A

suspect vertebral osteomyelitis
Get blood culture, inflammatory markers (ESR, CRP)
Dx with MRI
Bx - CT guided

51
Q

When would you CT a pyelo pt?

A

If they do not improve after 72 hours on abx

52
Q

How does B. cereus cause food poisoning?

A

Igenstion of enterotxin

Primary syx if vomiting

53
Q

Tx for endocarditis caused by strep mutans

A

IV Penicillin G or
IV ceftriaxone
x 4wks

54
Q

Sailor gets a cut and later develops nec fasc w/ hemorrhagic bullous and septic shock

A

Vibrio vulnificus
Marine bacteria, food borne illness and food infections
Look for hx of liver dz (cirrhosis, viral hepatitis, hereditary hemachromatosis)

55
Q

Meningitis in immunocompromised

A

Cryptococcus
Tx - amphotericin B + flucytosine, followed by fluconazole
May need serial LP’s to reduce pressure

56
Q

HIV + pt with bright red firm friable exophytic nodules

A

Bacillary angiomatosis (Bartonella)
Caused by Bartonella, GNR
Tx - po erythromycin

57
Q

HIV + pt with skin plaques/nodules that change colors from light brown -> pink -> dark violet

A

Kaposi sarcoma

Usually on the trunk face or extremities

58
Q

Travelers diarrhea that is prolonged, profuse, and watery

A

Think parasite
Cryptosporidium parvum, cyclospora, Giardia
Transiently sev ere but typically self-limited (10-14 days)
Immunocompromised are at increased risk of infection

59
Q

Intracellular protozoan transmitted via contimaniated water. Penetrate intestinal epithelial cells alternating the villous architecture.

A

Cryptosporidium parvum

Fecal lab tests + for specialized stains

60
Q

When should you screen for HIV or HBV?

A

Hx of high risk sex (unprotected; msm)

61
Q

Who should be screened for HCV?

A

IVDU
High risk of needle exposure
Blood transfussion before 1992

62
Q

Most common cause of secondary bacterial PNA after influenza

A

young patient - MRSA

Older folks - strep pneumo

63
Q

Best way to prevent UTI in a pt with neurogenic bladder

A

Clean intermittent catheterization
Avoids unnecessary cath use, minimize duration of cath
Insertion and removal q4-6h

64
Q

Pt has tick on them. How do you remove?

A

Remove tick w/ small forceps

Abx prophylaxis for Lyme dz is not required if tick is attached for < 36 hours

65
Q

Rheumatic fever + dental work -> infective endocarditis

A

Veridians streptococci (Strep mutans)

66
Q

Diabetic foot infections and OM are caused by?

A

Polymicrobial (GN, GP, anaerobic) through contigious spread from a DM foot ulcer

67
Q

HIV guy is up to date on all childhood vaccines, TdaP, HBV, Meningococcal. What else does he need?

A

HAV
MSM are high risk
Not a part of routine childhood vaccines until 2006

68
Q

PNA s/t influenza most likeley caused by?

A

Strep pneumo
Staph
Staph aureus PNA tends to have rapid onset, severe, necrotizing w/ high risk of mortality

69
Q

PPD is + when the size of induration is?

A

> 15mm

70
Q

HIV with CD4 count <200
PNA
CXR - b/l interstitial infiltrates

A

Pneumocystis pneumonia (PCP)
Tx - Bactrim
Add corticosteroids if PaO2<70 or A-a gradient >35 on RA

71
Q

Tx for lyme in a preggo or lactating mom?

A

Amoxicillin

Rash = erythema migrans

72
Q

You suspect syphilis but VDRL is negative. What next?

A

Fluorescent treponemal Ab absorption

Painless ulcer

73
Q

Pt has infective carditis and grows Eikenella corrodens. Where did that come from?

A

Poor dentition, periodontal infection, dental procedure
anaerobe in nL human flora
(HACEK group of organisms; haemophilus, aggregatibacter, cardiobacterium, Eikenella, Kingella kingae)

74
Q

Slutty guy
Systemic syx (fevel, malaies)
System lymphadenopathy
Diffuse maculopapular rash beginning on the trunk and extending to extremities

A

Secondary syphillis
Dx - Treponoma studies
Tx - IM penicillin

75
Q

Superficial skin infection
Systemic f/c
Regional lymphadenitis
Warm, tender, erythematous rash with raised sharply demarcated borders

A

Erysipelas
Infection of the upper dermis and superficial lymphatic system
Caused by GAS

76
Q

Mono syx, but no pharyngeal exudate

A 
CMV
Less likely to cause pharyngitis
Atypical lymphocytes on Blood smear
Negative heterophile test
\+ CMV IgM serology
77
Q

Puncture wound through footwear, 2 wks later pt has osteomyelitis. Etiology?

A

Pseudomonas

Staph aureus

78
Q

Symmetric arthritis of the hands, knees and ankles x 10 days
worse in the morning
skin rash, diarrhea

A

Parvo
Confirm with B19 IgM testing
Tx - self limitied

79
Q

CAP + arthralgias, erythema nodosum, erythema multiforme

Recent travel to Arizona

A 
Coccidioides
Endemic mycosis of the desert
Syx for wks - months
Healthy pts do not need antifungals
Immunocompromised - need keotconazole or fluconazle to prevent dissemination
80
Q

Pt with syphilis has anaphylaxis to penicillin. Tx?

A

po doxycyclin

81
Q

Chronic fever, weight loss, fatigue, pulm syx
recent incarciration
CXR - diffuse reticulonodular pattern

A

Miliary TB

RF - substance abuse, incarciration

82
Q

Most effect prophylaxis for malaria?

A

Mefloquine chemoprophylaxis until 4 weeks after return

83
Q

Cause of cutaneous larva migrans?

A

Dog or cat hookworm larvae (ancylostoma)
Obtained from walking barefoot in the sand or soil
Syx - pruritic papular lesion at the portal of entry. Intensly pruritic, migrating, sepiginous reddish brown tracks
tx - Ivermectin

84
Q

IVDU increases risk for which type of IE?

A

R sided
Tx for native valve endoarditis is geared toward MRSA, strep, enterococci
Tx - Vanco

85
Q

Pt develops IE days after a cystoscopy. Be suspicious for?

A

Enterococcus faecalis

Endocarditis d/t nosocomial UTI’s

86
Q

HIV pt with CD4 count <50 needs prophylaxis against?

A

Pneumocystis PNA - Trimethoprim-sulfamethoxazole (<200)
Mycobacterium avium - azithromycin (<50)
HSV - only recommended in pt has recurrent infection
Candida - no prophylaxis indicated

87
Q

Slutty guy
mucopurulent urethral discharge
No bacteria on gram stain

A

Chlamydial urethritis

PCR confirms dx

88
Q

What tetanus prophylaxis should be given to pts with puncture wounds

A

Td/Tdap

Tetanus IG is reserved for those with significant or dirty wounds that have not received at least 3 doses of td vax

89
Q

fatigue, weakness x weeks
Joint pain, dark urine, pain in fingertips
PE - swelling of finger bads
UA 2+ blood, 1+ protein

A

infective endocarditis

90
Q

Gi syx followed by triad of: periorbital edema, myositis, eosinophilia

A

Trichinellosis

Can also have fever, subungual splinter hemorrhages, conjunctival or retinal hemorrhages

91
Q

Epididymitis not related to STD. etiology?

A

E. coli
Unilateral testicular pain, swelling
Bacturia from bladder outlet obstruction

92
Q

Tx for toxo

A

Sulfadizine and pyrimethamine

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