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MKSAP: Key Points > ID key points > Flashcards

ID key points Flashcards

1
Q

3 MCCs of viral meningitis?

A
  1. Enterovirus
  2. HSV 2
  3. Arboviruses
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2
Q

Viral meningitis + parotitis or orchitis is a clue to what bug?

A

Mumps

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3
Q

Viral meningitis + rash is a clue to which two bugs?

A

Enterovirus, HIV

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4
Q

Viral meningitis + pharyngitis is a clue to which bug?

A

HIV

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5
Q

Viral meningitis + genital lesions is a clue to which bug?

A

HSV2

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6
Q

General management of viral meningitis? When can you stop empiric anti-microbials?

A

Supportive, can stop once CSF Cx r/o bacterial meningitis

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7
Q

5 MCCs of bacterial meningitis?

A
  1. Strep pneumo
  2. N. meningitidis
  3. GBS
  4. H flu
  5. Listeria monocytogenes
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8
Q

When should you start empiric antimicrobial therapy in suspected bacterial meningitis?

A

Immediately

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9
Q

What non-antimicrobial drug should be started as adjunctive therapy in all cases of bacterial meningitis in developed countries?

A

Dexamethasone

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10
Q

When should you start empiric antimicrobial therapy in suspected brain abscess?

A

Immediately

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11
Q

Successful Tx of a brain abscess typically consists of what 2 therapeutic modalities?

A
  1. Anti-microbial therapy

2. Surgical drainage

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12
Q

Name 2 places that spinal epidural abscesses commonly arise from

A

Infected vertebral discs

Inected intervertebral body disc spaces

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13
Q

RFs for spinal epidural abscesses? (9)

A
  1. Prolonged epidural catheter placement
  2. Steroid or analgesic injections
  3. DM
  4. HIV
  5. Trauma
  6. IVDU
  7. Tattooing
  8. Alcoholism
  9. Accupuncture
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14
Q

How many sets of BCx should you get for a spinal epidural abscess?

A

2

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15
Q

Cranial subdural empyemas typically arise as a complication of which processes? (3)

A

Sinusitis
OM
Mastoiditis

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16
Q

Cranial subdural empyemas are a medical emergency. In addition to immediately evaluating the patient, which consult should you call?

A

Neurosurgery

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17
Q

Characteristic imaging findings of HSV encephalitis?

A

Unilateral or bilateral localized infection of the temporal lobes

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18
Q

CSF findings in HSV encephalitis?

A

Lymphocytic pleocytosis +/- rbcs (if necrosis is extensive)

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19
Q

What test is highly sensitive and specific for diagnosis of HSV encephalitis?

A

HSV PCR of the CSF

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20
Q

All patients suspected of having encephalitis should get what anti-viral drug empirically?

A

IV ACV

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21
Q

VZV encephalitis is MC in which 2 patient populations?

A

HIV/AIDS

Defects in cellular immunity

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22
Q

Dx of VZV CNS infection?

A

VZV PCR of the CSF

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23
Q

Tx of VZV encephalitis?

A

Parenteral ACV

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24
Q

Tx of VZV vasculopathy?

A

Parenteral ACV

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25
Q

What percent of patients with West Nile virus develop neuroinvasive disease?

A

Less than 1%

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26
Q

3 general presentations of West Nile neuroinvasive disease?

A

Meningitis, encephalitis, or myelitis. Note it can present with just one or with an overlap syndrome.

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27
Q

Dx of West Nile neuroinvasive disease?

A

CSF serology

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28
Q

When do most patients with West Nile neuroinvasive disease develop detectable IgM antibody to West Nile?

A

Within 1st week of Sx

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29
Q

Name 4 presenting features of anti-NDMA receptor encephalitis

A
  1. Choreoathetosis
  2. Psych Sx
  3. Seizures
  4. ANS instability
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30
Q

Anti-NDMA receptor encephalitis is associated with what underlying condition in over 50% of patients?

A

Ovarian teratoma

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31
Q

Dx of anti-NDMA receptor encephalitis?

A

Detection of anti-NDMAR antibody in serum

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32
Q

Tx of anti-NDMA receptor encephalitis?

A

Remove teratoma + immunosuppression with either steroids or IVIG

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33
Q

MC form of prion disease in humans?

A

CJD

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34
Q

Which form of CJD is most common?

A

Sporadic

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35
Q

2 major causes of iatrogenic CJD transmission?

A
  1. Use of growth hormone prepared from cadaveric pituitaries

2. Contaminated cavaderic dura mater allografts

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36
Q

2 major causes of variant CJD transmission?

A
  1. Eating contaminated beef

2. Blood/blood products from vCJD-infected donors

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37
Q

MCC of cellulitis w/ purulent drainage or exudates?

A

MRSA

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38
Q

MCC of non-purulent cellulitis?

A

Beta-hemolytic strep

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39
Q

Skin infections are typically diagnosed clinically. What are 3 circumstances when radiography would be considered?

A
  1. Dx is uncertain
  2. Nec fasc is suspected
  3. Concern for associated abscess or foreign body
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40
Q

Primary Tx of CA-MRSA cutaneous abscess?

A

I&D

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41
Q

When are antibiotics indicated for CA-MRSA cutaneous abscess? (8)

A
  1. If I&D is ineffective
  2. Extensive disease
  3. Rapidly progressive disease w/ associated cellulitis
  4. Presence of immunodeficiencies or other CMx
  5. Very young or very old patient
  6. Clinical signs of systemic illness
  7. Involved area is difficult to drain
  8. Presence of septic phlebitis
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42
Q

Clues to an underlying necrotizing SSTI? (3)

A
  1. Systemic toxicity w/ fever, chills, AMS, hypoTN
  2. Pain out of proportion to exam
  3. Loss of sensation
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43
Q

Why can loss of sensation occur in nec fasc?

A

Destruction of cutaneous nerves

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44
Q

Gold standard for Dx and Tx of nec fasc?

A

Early surgical exploration

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45
Q

3 components of early management of toxic shock syndrome?

A
  1. Adequate resuscitation to maintain tissue perfusion
  2. Identification of the cause and focus of infection
  3. Source control
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46
Q

When managing toxic shock syndrome, what does source control typically involve?

A

Surgical debridement

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47
Q

3 ways to decrease the risk of infection in animal bites?

A
  1. Prompt wound irrigation w/ NS
  2. Removal of any foreign bodies
  3. Debridement of necrotic tissue
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48
Q

All patients with animal bites should be assessed for need for prophylaxis against which 2 infections?

A

Tetanus and rabies

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49
Q

Which animal bite patients require prophylactic amox-clavulanate? (5)

A
  1. Immunosuppressed
  2. Moderate-to-severe wounds, esp on face or hands
  3. Wounds near a joint or bone
  4. Wounds associated with significant crush injury
  5. Wounds associated with significant edema
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50
Q

Which human bite wounds require Abx Ppx, and which Abx is used?

A

All require ppx w/ amox-clavulanate

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51
Q

3 components of wound care for diabetic foot infections?

A
  1. Wound cleansing
  2. Debridement
  3. Off-loading of foot pressure
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52
Q

Which patients with new diabetic foot wounds get imaging?

A

All of them!

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53
Q

Which age group is more likely to get CAP?

A

Older adults

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54
Q

MCC of CAP?

A

Strep pneumo

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55
Q

2 MC respiratory viruses contributing to development of CAP?

A

Influenza A and B

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56
Q

MRSA as a cause of CAP is MC w/ nosocomial exposures. What are some other risk factors? (3)

A
  1. Hemodialysis
  2. SNF exposure
  3. Exposure to people with SSTI
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57
Q

5 clinical symptoms of CAP?

A
  1. Fever
  2. Cough
  3. Dyspnea
  4. Sputum production
  5. Pleuritic chest pain
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58
Q

What radiographic finding is required for a Dx of PNA?

A

Pulmonary infiltrate on CXR

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59
Q

Indications for microbiologic testing w/ sputum Cx and BCx in CAP? (8)

A

Hospitalized patients with one or more of the following:

  1. ICU admission
  2. Cpx like pleural effusion or cavitary lesion
  3. Underlying lung disease
  4. Active EtOH abuse
  5. Asplenia
  6. Liver disease
  7. Leukopenia
  8. Unsuccessful outpatient anti-microbial therapy
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60
Q

Empiric outpatient therapy for CAP in patients w/o CMx or recent antimicrobial use? (2 options)

A
  1. Macrolide

2. Doxy

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61
Q

Empiric outpatient therapy for CAP in patients w/ CMx, recent antimicrobial use, or living in an area with highly prevalent macrolide-resistant strep pneumo? (2 options)

A
  1. Respiratory FQ

2. Combo therapy w/ beta-lactam + macrolide (alternate to macrolide is doxy)

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62
Q

When can hospitalized CAP patients be switched from parenteral Abx to PO?

A

When clinically stable

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63
Q

Does it improve outcomes to continue inpatient monitoring of CAP patients who have been switched from parenteral to PO Abx?

A

Nope

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64
Q

Pts w/ PNA who are treated with the appropriate Abx typically show clinical improvement when?

A

Within 2-3 days

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65
Q

What are RFs for unsuccessful Tx of CAP?

A
  1. Multilobar PNA
  2. MRSA
  3. Legionella
  4. Gram-neg bacilli
  5. PNA severity index of 90 or more
  6. Initial Tx w/ an anti-microbial regimen to which the causative pathogen was not susceptible
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66
Q

Tx courses for CAP longer than _________ have not shown to have a clinical benefit

A

5 days

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67
Q

Why shouldn’t you routinely use follow-up CXR s/p CAP?

A

CXR findings may linger beyond clinical improvement and symptom resolution

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68
Q

When do Lyme disease Sx typically first appear?

A

1-4 weeks s/p infection

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69
Q

Characteristic initial Sx of Lyme?

A

Erythema migrans (single target lesion)

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70
Q

What percent of Lyme patients will develop erythema migrans?

A

60-80%

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71
Q

Dx of early Lyme disease if erythema migrans is present?

A

Documentation of erythema migrans + compatible epidemiologic history

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72
Q

Why isn’t serologic testing indicated in early Lyme?

A

Antibodies may not be present yet, leadign to false negative testing in early localized disease

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73
Q

Are antibodies typically present during disseminated Lyme?

A

Yup

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74
Q

Dx of disseminated Lyme?

A

2 step serologic testing: ELISA followed by confirmatory Western blot

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75
Q

Mx of post-lyme disease syndrome?

A

Treat the symptoms. No Abx bc they’re no longer infected!

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76
Q

STARI is clinically indistinguishable from what other infectious disease?

A

Localized Lyme

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77
Q

Tx of STARI?

A

Oral antibiotic active against localized Lyme disease (bc impossible to tell if it’s Lyme vs STARI). Thus doxy is best, amoxicillin if can’t take doxy (young kids, pregnant women)

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78
Q

Describe typical presentation of babesiosis

A

Either ASx or mild febrile illness w/ myalgias, HA, fatigue

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79
Q

What are 4 potential features of severe babesiosis?

A
  1. Acute respiratory failure
  2. AKI
  3. DIC
  4. Splenic rupture
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80
Q

What’s the most sensitive test for diagnosis of mild babesiosis?

A

PCR bc these patients typically have low parasite counts

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81
Q

Sensitivity of microscopy of Giemsa or Wright-stained blood smears in the diagnosis of babesiosis depends on what?

A

Level of parasitemia

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82
Q

Tx of choice for mild-moderate babesiosis?

A

Atovaquone + azithro

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83
Q

Tx of choice for severe babesiosis?

A

Clinda + quinine

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84
Q

Human monocytic ehrlichiosis and human granulocytic anaplasmosis typically present as non-specific febrile illnesses accompanied by what 4 Sx?

A
  1. HA
  2. Myalgia
  3. Arthralgia
  4. Meningismus
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85
Q

What test is extremely sensitive for ehrlichiosis and anaplasmosis if done before initiation of Abx?

A

Whole blood PCR

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86
Q

What drug should be given empirically when considering ehrlichiosis or anaplasmosis? Why?

A

Doxy- delay in therapy is a/w adverse clinical outcomes

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87
Q

What diagnosis should be considered in any patient presenting w/ fever and possible tick exposure?

A

RSMF

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88
Q

Describe utility of serologic testing during acute illness w/ RSMF

A

Limited utility

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89
Q

DOC for all spotter fever group rickettsioses? Alternate in pregnancy?

A

Doxy. Alt is chloramphenicol

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90
Q

RF for MDR UTI? (6)

A
  1. Current or recent hospitalization
  2. Immunocompromise
  3. Presence of underlying structural abnormalities of the urinary tract
  4. Previous UTI
  5. Kidney Tpx
  6. Recent anti-microbial therapy
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91
Q

3 major reasons for the increasing frequency of anti-microbial resistance among urinary pathogens in the community and hospitals?

A
  1. Abx overuse
  2. Inappropriate Tx of ASx bactiuria
  3. Local differences in Abx use
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92
Q

5 indications for a culture of midstream, clean-void urine in the Dx of UTI?

A
  1. Suspected pyelo
  2. Complicated UTI
  3. Recurrent UTI
  4. Multiple anti-microbial allergies
  5. Suspect resistant bug
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93
Q

Describe utility of UA/UCx as part of routine health surveillance in ASx patients

A

Not indicated

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94
Q

In women with acute uncomplicated cystitis, why are TMP-SMX or nitrofurantoin better options than fosfomycin?

A

Fosfomycin has lower efficacy and is more expensive

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95
Q

Acute uncomplicated pyelo: DOC and duration of treatment?

A

FQ for 5-7 days

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96
Q

Duration of Tx for acute complicated pyelo?

A

14 days

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97
Q

When can hospitalized patients w/ pyelonephritis be switched from IV to PO Abx?

A

Once can take PO and have clinical improvement

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98
Q

2 best options for PO Tx of acute pyelo?

A

TMP-SMX or FQ

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99
Q

What 2 drugs are options for Ppx in women with recurrent cystitis?

A

TMP-SMX or nitrofurantoin

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100
Q

While once-daily dosing of TMP-SMX or nitrofurantoin reduces episodes of cystitis in women w/ recurrent cystitis, what is the downside of using Abx Ppx?

A

ADEs are common

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101
Q

What is an option for Ppx of UTI in women with recurrent UTIs linked to sexual activity?

A

Abx Ppx with single dose given after sex. Options include nitrofurantoin or TMP-SMX

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102
Q

DOC for acute uncomplicated prostatitis? Duration?

A

PO FQ (levo or cipro) for 4-6 wk

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103
Q

After completing Tx for acute uncomplicated prostatitis, how can you check for response?

A

Repeat Cx

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104
Q

What percent of cases of TB in the US are in foreign-born people?

A

65%

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105
Q

What percent of HIV-associated deaths occur 2/2 TB (worldwide)?

A

20%

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106
Q

Immunocompromise is obviously a RF for development of TB. Name specific groups to be worried about? (8)

A
  1. Immunosuppression 2/2 meds
  2. HIV
  3. Malignancy
  4. DM
  5. CKD
  6. IVDU
  7. Smokers
  8. Malnutrition
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107
Q

What percent of active TB is pulmonary?

A

70%

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108
Q

9 s/s of pulmonary TB?

A
  1. Fever
  2. Chronic cough
  3. Purulent or blood-streaked sputum
  4. Chest pain
  5. Malaise
  6. Wt loss
  7. Night sweats
  8. Anorexia
  9. Fatigue
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109
Q

What is latent TB?

A

ASx patient w/o clinical evidence of active TB is diagnosed w/ positive PPD or interferon gamma release assay

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110
Q

4 causes of false negative TB PPD

A
  1. Very old
  2. Very young
  3. Immunosuppressed
  4. Overwhelming active TB
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111
Q

2 reasons for false positive TB PPD?

A
  1. Infection w/ atypical mycobacteria

2. Hx of bCG vaccine or chemo

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112
Q

What test is preferred for diagnosis of TB in patients who for the bCG vaccine or in those who are unlikely to return to have their skin test read?

A

interferon gamma release assay

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113
Q

For otherwise healthy adults, what is an alternative to the standard 9 months of INH for latent TB?

A

12 wk of once weekly INH/RIF

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114
Q

First line treatment plan for active TB?

A

8 wk of RIPE followed by 4-7 months of RI

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115
Q

How often should patients RTC for clinical evaluations during TB treatment?

A

At least monthly

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116
Q

Which patients getting TB treatment should get routine labs?

A

Those w/ baseline abnormalities or with increased risk of ADE

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117
Q

What vaccine is used in endemic countries to prevent disseminated TB and TB meningitis in kids?

A

bCG vaccine

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118
Q

What further identification do you need to do after documenting a mycobacterial infection?

A

Species-level identification

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119
Q

Specific DNA probes exist for which two non-TB mycobacteria? What species-level identification technique can identify the remaining mycobacteria?

A

Mycobacterium kansasii and MAC

HPLC can ID the other species

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120
Q

MC manifestation of non-TB mycobacterial infection?

A

Pulmonary disease

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121
Q

MC non-TB mycobacterial species causing infection?

A

MAC

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122
Q

Which AIDS patients are at risk of disseminated MAC?

A

Those with CD4 under 50 who aren’t getting MAC Ppx

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123
Q

How does mycobacterium kansasii typically present?

A

With a lung infection mimicking TB w/ cough, fever, weight loss, and cavitary lung disease

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124
Q

Name 3 rapidly growing mycobacteria that are becoming increasingly relevant as a cause of disseminated disease in immunosuppressed patients

A

M. abscessus
M. fortuitum
M. chelonae

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125
Q

Name 4 scenarios associated with SSTI 2/2 mycobacterium abscessus, fortuitum, and chelonae

A
  1. Trauma
  2. Surgery (esp w/ implanted prosthetics)
  3. Catheter insertion
  4. Cosmetic procedures (tattoos, piercing, pedi)
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126
Q

Name 4 common focal infections in systemic candidiasis

A
  1. UTI
  2. CNS infection
  3. Bone and joint infection
  4. Peritonitis
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127
Q

Typical DOC for most patients w/ candidemia?

A

An echinocandin

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128
Q

Candidemia patients with which 3 types of infection shouldn’t get an echinocandin bc of poor tissue penetration?

A
  1. UTI
  2. Endophthalmitis
  3. Meningitis
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129
Q

2 aspects of therapy in non-neutropenic patients w/ candidemia?

A

Antifungal therapy + intravascular catheter removal

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130
Q

2 indications for Tx of ASx candiduria?

A
  1. Neutropenia

2. About to undergo a urologic procedure

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131
Q

4 potential manifestations of aspergillus pulmonary disease?

A
  1. Colonization
  2. ABPA
  3. Aspergilloma (fungus ball)
  4. Invasive aspergillosis
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132
Q

Definitive diagnosis of invasive aspergillosis? What’s a helpful serologic diagnostic method?

A

Definitive: tissue Bx
Sero: Galactmannan antigen immunoassay

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133
Q

MC presentation of mucormycosis?

A

Rapidly fatal rhinocerebral infection

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134
Q

5 main s/s of rhinocerebral mucormycosis?

A

HA, epistaxis, proptosis, periorbital edema, decreased vision

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135
Q

MC site of disseminated cryptococcus?

A

CNS

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136
Q

Latex agglutination assay is highly sens/spec for Dx of cryptococcal meningitis in what group of patients?

A

Symptomatic pts w/ AIDS

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137
Q

How long do you continue maintenance therapy for pts w/ AIDS + cryptococcal meningitis?

A

Until both of the following:

  1. they’ve responded to anti-retroviral therapy (with CD4 above 100 for at least 3 months
  2. They’ve been getting anti-fungal therapy for at least 1 yr
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138
Q

1st and 2nd MC sites hit by blastomycosis? Name 3 other sites it commonly affects

A

1: Lungs
2: Skin
Other: bones, joints, prostate

139
Q

Although histo is typically Asx, it has numerous symptomatic manifestations. Name 6

A
  1. Pulmonary disease (acute or chronic)
  2. Disseminated disease (acute or chronic)
  3. Pulmonary nodules (histoplasmomas)
  4. Granulomatous mediastinitis
  5. Fibrosing mediastinitis
  6. Broncholithiasis
140
Q

How does primary coccidioidomycosis typically present? How long after initial exposure?

A

CAP, 1-3 wk s/p exposure

141
Q

Preferred method of Dx for primary coccidioidal infection? How else can it be used

A

Serologic testing

It can also be sued to monitor course of therapy. Repeat testing can help improve sensitivity if needed.

142
Q

DOC for cutaneous sporotrichosis? Osteoarticular?

A

Itraconazole for both

143
Q

Describe USPSTF recommendations for chlamydia screening

A

Sexually active women 24 and under: at least yearly
Older women: screen if have RFs
MSM: at least annually

144
Q

Best test for Dx of chlamydia?

145
Q

NAAT for Dx of chlamydia: name 2 preferred specimen sites for men and 2 for women

A

Men: first void urine or urethral swab
Women: vaginal or endocervical sample

146
Q

Describe USPSTF recommendations for gonorrhea screening

A

Sexually active women with one or more of the following:

  1. Hx of gonorrhea
  2. Another STI
  3. New or multiple partners
  4. Inconsistent condom use
  5. History of exchanging sex for money or drugs
147
Q

The USPSTF doesn’t recommend screening men for gonorrhea, but what does the CDC suggest?

A

Annual screening for MSM

148
Q

Best test for Dx of gonorrhea?

149
Q

Upon diagnosis of epididymitis, what further testing should you do? (4)

A

NAAT for GC/CT, UA/UCx

150
Q

Upon diagnosis of PID, what further testing should you do? (5)

A
  1. CT NAAT
  2. GC NAAT
  3. HIV screen
  4. Syphilis serology
  5. Pregnancy test
151
Q

3 types of tenderness a/w PID?

A
  1. Cervical motion tenderness
  2. Adnexal tenderness
  3. Uterine tenderness
152
Q

Name 4 findings that increase the specificity of the Dx of PID

A
  1. Fever
  2. Mucopurulent cervical discharge
  3. Elevated inflammatory markers
  4. Leukocytes on a wet mount of vaginal fluid
153
Q

Presentation of epididymitis?

A

Pain and swelling of the ipsilateral testis and spermatic cord

154
Q

Recommended dosage of ceftriaxone for gonorrhea?

155
Q

When is PO cefixime appropriate for treatment of gonorrhea?

A

If parenteral ceftriaxone isn’t available

156
Q

What are 2 possible drugs that can be added to ceftriaxone in order to increase chance of eradication of GC?

A

Azithro or doxy

157
Q

Describe the lesions of genital HSV

A

Painful vesicles that progress to ulcers on an erythematous base

158
Q

Name 5 s/s of a primary genital HSV outbreak

A
  1. Multiple genital lesions
  2. Regional LAD
  3. Fever
  4. Myalgia
  5. Malaise
159
Q

Most sensitive modality for Dx for HSV?

160
Q

Describe the lesion of primary syphilis

A

Painless ulcer at the site of inoculation w/ a firm raised border and clean base

161
Q

Describe the rash of secondary syphilis

A

Generalized maculopapular rash involving the trunk and extremities, including palms and soles

162
Q

Which stage of syphilis involves the CV system and has gummas?

163
Q

DOC for all stages of syphilis?

164
Q

Mx of sexual partners of pts diagnosed w/ syphilis?

A

Partners should be referred for eval. If exposed w/in the 90 days preceding diagnoses, they should get treated regardless of serologic results.

165
Q

2 main Sx of chancroid?

A
  1. Painful genital ulcer

2. Tender inguinal LAD, often suppurative

166
Q

Describe presentation of LGV

A

Starts w/ genital papule or ulcer followed by a tender unilateral inguinal LAD

167
Q

Describe genital warts

A

Painless, flesh-colored, exophytic lesions

168
Q

Will Tx of genital warts prevent HPV transmission?

169
Q

MC isolated cause of hematogenous osteomyelitis?

170
Q

Which group of people would you worry about getting salmonella osteomyelitis?

A

Sickle cell

171
Q

People with which high risk behavior are at higher risk of Pseudomonas osteomyelitis?

172
Q

What physical exam finding is pathognomonic for chronic osteomyelitis?

A

Draining sinus tract

173
Q

How are xrays in the diagnosis of osteomyelitis?

A

Lack sens/spex

174
Q

Best imaging technique for Dx osteomyelitis? Name 2 reasons why

A

MRI:

  1. High sensitivity for bone infection
  2. Superior at delineating bone anatomy and giving excellent resolution of surrounding soft tissue
175
Q

Role of follow-up MRI in management of osteomyelitis?

A

Only for patients who don’t clinically improve w/ therapy

176
Q

Which cases of suspected osteomyelitis should get BCx?

A

All of them

177
Q

Why should all cases of suspected osteomyelitis get BCx?

A

A positive BCx could avery more invasive testing

178
Q

Gold standard for Dx of osteomyelitis?

179
Q

In suspected osteomyelitis, how do culture samples from soft tissue or sinus tracts correlate w/ deep Cx from bone?

180
Q

3 components of successful Tx of osteomyelitis?

A
  1. Prolonged Abx
  2. Surgical debridement
  3. Removal of orthopedic hardware, if present
181
Q

Is it ever okay to treat chronic osteomyelitis with PO Abx alone?

A

Apparently yes, in some cases

182
Q

Findings that predict contiguous osteomyelitis in patients with diabetic foot ulcers? (5)

A
  1. Ulcers that have been present for 2 wk or longer
  2. Ulcer size greater than 2 cm
  3. Grossly visible bone
  4. Ability to probe to bone
  5. ESR greater than 70
183
Q

Best way to ID the offending bug in DM-associated osteomyelitis?

A

Debridement and culture of the sample before initiation of Abx

184
Q

In DM-associated osteomyelitis, how long should you continue Abx s/p surgical debridement?

185
Q

What are some red flags that should prompt you to consider vertebral osteomyelitis? (6)

A
  1. Worsening back or neck pain w/o an alternate explanation
  2. Local tenderness
  3. Sensory changes
  4. Radicular pain
  5. Motor weakness
  6. Neurologic deficits
186
Q

Approx what percent of patients w/ vertebral osteomyelitis have a fever at presentation?

187
Q

Approx what percent of patients w/ vertebral osteomyelitis will have positive BCx? Why is this important?

A

More than 50%

Important bc they can help guide therapy and limit unnecessary testing

188
Q

General duration of Abx therapy for vertebral osteomyelitis?

189
Q

3 major classes of causes of FUO?

A
  1. Infection
  2. Malignancy
  3. Connective tissue disease
190
Q

The longer a FUO persists w/o diagnosis, the less likely is is to be 2/2 ________? (Which one of the 3 major causes of FUO)

191
Q

Although people with selective IgA deficiency can be ASx, they can also present with which two types of recurrent infections?

A
  1. Sinopulmonary

2. GI

192
Q

People with selective IgA deficiency have an increased risk of what 2 specific diseases and what 2 classes of disease?

A
  1. IBD
  2. Celiac disease
  3. Allergic disorders
  4. Autoimmune disorders
193
Q

CVID typically manifests with what lab finding?

A

Hypogammaglobulinemia

194
Q

CVID typically presents with involvement of what two organ systems? How does each manifest?

A
  1. Respiratory: recurrent infections

2. GI: chronic diarrhea or malabsorption

195
Q

2 findings that confirm CVID Dx?

A
  1. Low levels of total IgG and IgA or IgM

2. Poor antibody response to vaccines

196
Q

People with recurrent bloodstream infections with encapsulated bugs or invasive meningococcal or gonococcal disease should be screened for what immunodeficiency? What is the proper screening test?

A

Complement deficiency

Assay for total hemolytic complement (CH50) activity

197
Q

What larger issue should you suspect if you have a patient with inhalational anthrax?

A

Deliberate bioterrorism-related spread

198
Q

7 potential Sx of inhalational anthrax?

A
  1. Low-grade fever
  2. Malaise
  3. Myalgia
  4. HA
  5. Cough
  6. Dyspnea
  7. Chest pain
199
Q

2 potential agents for post-exposure prophylaxis for inhalational anthrax?

A

Doxy or cipro

200
Q

Why should a single case of suspected or confirmed smallpox cause concern for bioterrorism?

A

It has been eradicated worldwide

201
Q

5 s/s of smallpox?

A
  1. High fever
  2. HA
  3. Vomiting
  4. Backache
  5. Rash
202
Q

Describe the rash of smallpox (both spread of lesions and progression of lesion characteristics)

A

Spread: start on buccal and pharyngeal mucosa, followed by cutaneous spread to the hands and face, then to arms, legs and feet.
Lesions: evolve synchronously from macules to papules to vesicles to pustules, then finally crust over.

203
Q

4 presenting features of pneumonic plague?

A
  1. Sudden high fever
  2. Pleuritic chest discomfort
  3. Productive cough
  4. Hemoptysis
204
Q

When do Sx of botulism typically occur after toxin exposure?

A

Within 24 to 72 hr

205
Q

Classic triad of botulism presentation?

A
  1. Symmetric descending paralysis w/ prominent bulbar signs
  2. Absence of fever
  3. Normal mental status
206
Q

Bug causing tularemia?

A

Francisella tularensis

207
Q

Tularemia presents with abrupt onset of (? 4 Sx) followed by what other type of Sx?

A

Starts with: fever, chills, myalgia, and anorexia

Followed by: respiratory Sx

208
Q

3 methods useful in diagnosis of tularemia?

A
  1. PCR
  2. Direct fluorescent stains of clinical specimens
  3. IHC stains of clinical specimens
209
Q

7 features of viral hemorrhagic fever presentation?

A
  1. High febrile prodrome
  2. Variable degrees of myalgia and prostration
  3. Conjunctival injection
  4. Petechial hemorrhages
  5. Easy bruising
  6. Flushing
  7. Mild hypoTN
210
Q

6 MC Sx of malaria?

A
  1. Fever
  2. HA
  3. Myalgia
  4. n/v
  5. Abdominal pain
  6. Diarrhea
211
Q

Which type of malaria should be suspected in a pt w/ history of travel to Africa and a peripheral smear showing high levels of parasitemia w/ typical morphologic features?

A

Plasmodium falciparum

212
Q

Incubation period of typhoid fever?

213
Q

6 presenting features of typhoid fever?

A
  1. Fever
  2. HA
  3. Arthralgia
  4. Pharyngitis
  5. Anorexia
  6. Abdominal pain/tenderness
214
Q

3 preferred Abx for typhoid fever?

A
  1. Ceftriaxone
  2. FQs
  3. Azithro
215
Q

Name 3 groups of people in whom Abx Ppx for travelers diarrhea should be considered?

A
  1. IBD
  2. Immunocompromised states
  3. CMx that would be adversely affected by significant dehydration
216
Q

Mainstay of Tx of travelers’ diarrhea?

A

Fluid replacement

217
Q

Effects of Abx on Tx of travelers’ diarrhea, and when are they indicated?

A

Reduce duration of diarrhea by 1-2 days. Recommended only in severe dz

218
Q

Dengue fever presents as an acute febrile illness potentially accompanied by a combo of what 5 features?

A
  1. Frontal HA
  2. Retro-orbital pain
  3. Myalgia
  4. Arthralgia
  5. Minor spontaneous bleeding manifestations
219
Q

Timing of hep A vaccine for travelers to endemic areas?

A

Give the initial vaccine one month before travel. Then give the booster 6-12 months later.

220
Q

What option exists for travelers requiring HBV vaccinations but who have less than 6 months (recommended dosing schedule) before they leave?

A

Accelerated vaccination schedule

221
Q

Rickettsial infection often presents with what 4 features?

A
  1. Fever
  2. HA
  3. Malaise
  4. Rash (maculopapular, vesicular, or petechial)
222
Q

7 s/s of brucellosis?

A
  1. Fever
  2. Myalgia
  3. Arthralgias
  4. Fatigue
  5. HA
  6. Night sweats
  7. Depression
223
Q

Describe the natural progression of most cases of infectious diarrhea

A

Self-limited, resolving without directed intervention

224
Q

General management of otherwise healthy patients with mild diarrhea who present w/ less than 72 hr of Sx?

A

Supportive Tx w/ no additional diagnostic evaluation or Abx

225
Q

3 types of patients with acute diarrhea who require diagnostic testing (including stool Cx)?

A
  1. Immunocompromised
  2. Sick enough to require admission
  3. Inflammatory diarrhea
226
Q

If campylobacter is isolated in the stool of a patient with diarrhea, what further testing should you do?

A

In vitro susceptibility testing to guide Abx choices

227
Q

If choosing to empirically treat a patient with suspected campylobacter diarrhea (controversial choice btw), what is the preferred antibiotic?

228
Q

Empiric Tx of Shigella infection should be considered for which 2 groups of patients? Which patients should always get Tx for Shigella diarrhea?

A

Consider for: pts w/ compatible epidemiologic history or those w/ severe S
Always for those w/ positive stool Cx

229
Q

Why should patients with culture-proven shigella diarrhea get Abx?

A

Reduces risk of secondary transmission

230
Q

Name 2 reasons you shouldn’t give Abx to otherwise healthy patients w/ mild symptoms of Salmonella diarrhea?

A
  1. Doesn’t hasten recovery

2. May cause prolonged ASx shedding of salmonella bacteria

231
Q

Name 3 features that, if present in a patient w/ salmonella diarrhea, constitute severe salmonellosis

A
  1. High fever
  2. Sepsis
  3. Hemodynamic instability
232
Q

Benefits of Abx in patients w/ severe salmonellosis? (2)

A
  1. Shorter duration of Sx

2. Decreases risk of extraintestinal spread

233
Q

2 classes of medications that have been associated with increased risk of HUS when given to patients w/ Shiga toxin-producing E coli infection?

A
  1. Abx

2. Anti-motility meds

234
Q

What tissue is Yersinia trophic for? This can cause it to mimic what condition?

A

GI lymphoid tissue; appendicitis

235
Q

A combo of which 2 risk factors puts patients at risk of severe Vibrio disease, specifically at risk of bloodstream infection with sepsis (which has a fatality rate close to 30%)?

A

Hepatic dysfxn + heavy EtOH use

236
Q

Although enzyme immunoassays for C diff have good specificity, their sensitivity using a single stool sample is only _____?

237
Q

What test for C diff is being used more and more often because it’s more sensitive than enzyme immunoassay?

A

PCR for toxins A and B

238
Q

What 2 drugs are equally effective in Tx of mild-moderate C diff? Which one is preferred and why?

A

Flagyl and PO vanc

Flagyl is preferred bc it’s cheaper

239
Q

What drug is preferred for first-line Tx of severe C diff?

240
Q

What non-pharmacolgic treatment is effective in managing multiple relapses of C diff?

A

Fecal microbiota transplant

241
Q

Describe effects of a fecal microbiota transplant on prevention of C diff in patients on Abx

A

It reduces risk for infection

242
Q

Describe utility of documenting clearance of C diff via multiple stool samples?

A

Not useful

243
Q

Most likely source of norovirus AGE?

A

Ingestion of contaminated food or water

244
Q

Testing for parasites is not recommended for diarrhea lasting less than ______ or for patients who develop diarrhea more than ______ into a hospital stay

A

7 days; 3 days

245
Q

Treatment of giardia with flagyl is curative in what percent of patients?

A

More than 85%

246
Q

What is more sensitive for diagnosis of amebiasis: OPE or stool antigen testing?

A

Stool antigen testing

247
Q

What group of patients is particularly susceptible to Cryptosporidium infection, which can lead to prolonged diarrhea, dehydration, and weight loss?

A

Immunocompromised patients, esp those w/ HIV/AIDS

248
Q

DOC for symptomatic Cyclospoa infection?

249
Q

Treatment for symptomatic Cyclospoa infection in patients w/ a sulfa allergy?

250
Q

In transplant patients, risk of specific infection varies ~predictably based on what 5 things?

A
  1. Type of transplant
  2. Donor and patient characteristics
  3. Immunosuppressive regimen
  4. Time since transplant
  5. Post-transplant complications
251
Q

Post-Tpx CMV infections can present in a lot of ways. Name 6

A
  1. Non-specific febrile illness
  2. Cytopenias, specifically thrombocytopenia and leukopenia
  3. Pneumonitis
  4. Hepatitis
  5. Colitis
  6. Esophagitis
252
Q

What is the most significant consequence of EBV infection in a transplant patient?

A

Post-transplant lymphoproliferative disease

253
Q

Proliferation of what cell line leads to post-transplant lymphoproliferative disease?

254
Q

2 reasons that bacterial infections are common s/p solid-organ transplant? 1 reason they’re common s/p HSCT?

A

Solid organ: surgical and nosocomial infections

HSCT: neutropenia

255
Q

Early-phase fungal disease in transplant patients is MC due to which two bugs?

A
  1. Candida

2. Aspergillus

256
Q

When is cryptococcus neoformans meningitis MC in transplant patients?

A

Later period

257
Q

When is PCP MC in transplant patients?

A

Middle or late period

258
Q

Infection prevention s/p transplant mainly relies on what 2 things?

A
  1. Prophylactic antimicrobials

2. Immunizations

259
Q

What type of immunization is typically CI in patients getting immunosuppression?

A

Live vaccines

260
Q

Describe vaccine requirements in HSCT patients

A

They require revaccination with the complete series after immune system reconstitution, but live vaccines are CI

261
Q

What percent of catheter-associated bloodstream infections and UTIs are thought to be preventable?

262
Q

What percent of VAP and surgical site infections are thought to be preventable?

263
Q

What is the cornerstone of preventing hospital-acquired infection?

A

Handwashing

264
Q

Should you perform routine UA/UCx in patients w/ indwelling urinary catheters w/o s/s of UTI?

265
Q

Which bug is MCC of surgical site infections?

A

Staph aureus

266
Q

When you suspect a surgical site infection, what are 3 options of specimens to send for Cx?

A
  1. Wound drainage material
  2. Purulent fluid
  3. Infected tissue
267
Q

Treatment of deep incisional and organ or deep space surgical site infections generally requires a combination of what 2 things?

A

Specific antimicrobial therapy + surgical debridement

268
Q

Describe benefit of continuing prophylactic antimicrobial agents post-op in preventing surgical site infections

A

No benefit

269
Q

What should you suspect in patients w/ bacteremia and a central line with no obvious source of bacteremia (i.e. no infections at other sites)?

270
Q

First two steps in treating a CLABSI?

A

First, remove infected central line. Next, start appropriate antibiotics

271
Q

How often should you assess hospitalized patients with central lines to decide if the line can be removed?

272
Q

First-line treatment for MSSA bacteremia? (2 options)

A
  1. Nafcillin

2. 1st gen cephalosporin, like cefazolin

273
Q

First-line treatment for MRSA bacteremia? (2 options)

A
  1. Vanc

2. Dapto

274
Q

Median time to clearance of MRSA bacteremia?

275
Q

Most significant RF for hospital acquired PNA?

A

Intubation and mechanical ventilation

276
Q

4 clinical findings of VAP

A
  1. Temp greater than 38.0 C
  2. Leukocytosis or leukopenia
  3. Purulent sputum
  4. Decrease in arterial oxygen saturation
277
Q

Is there evidence for double-covering pseudomonas HAP/VAP?

278
Q

If you have a patient with suspected HAP or VAP who doesn’t improve w/ 72 hr of appropriate antimicrobial therapy, what are 3 things you should evaluate for?

A
  1. Infectious complications
  2. Alternate diagnosis
  3. Another site of infection
279
Q

Avoiding intubation is a great way to decrease the risk of HAP. What’s a solid alternative to use, if feasible?

A

Non-invasive positive pressure ventilation

280
Q

What are the 3 best ways to limit transmission of antimicrobial-resistant bugs in healthcare settings?

A
  1. Full compliance with hand-washing protocols and contact precautions
  2. Cleaning and disinfecting the environment and patient care equipment before it’s used for another patient
  3. Judicious use of antimicrobials
281
Q

3 main ways HIV is transmitted?

A

Sexually, exposure to infected blood, perinatally

282
Q

Dx of acute HIV infection requires detecting the virus by one of which two methods?

A
  1. RNA PCR

2. p24 antigen testing

283
Q

What two scenarios would cause you to diagnose an HIV patient as having AIDS?

A
  1. Development of an AIDS-defining illness

2. CD4 drops below 200

284
Q

Who should be screening for HIV?

A

Everyone from 13-65 yo

285
Q

What is 4th gen HIV testing? How do you follow up a positive result?

A

Combo of HIV antibody immunoassay and a test for p24 antigen. If positive, follow with HIV-1/HIV-2 antibody differentiation immunoassay.

286
Q

What are 2 important baseline studies to do in HIV patients to help guide initiation of therapy and to assess therapy response down the line?

A
  1. Quant HIV RNA (viral load)

2. CD4 count

287
Q

When can you stop monitoring T-cell subsets in HIV patients?

A

If they have persistently undetectable viral load, a normalized CD4 count, and if their therapy is stable.

288
Q

How do risks of strep pneumo infection change in HIV patients, and what should you do about it?

A

They’re at risk of invasive strep pneumo infections. Help by vaccinating with both the 13- and 23-valent pneumococcal vaccines.

289
Q

In HIV/AIDS patients with a positive TB skin test or positive IFN-gamma release assay, what much you check before treating for latent TB or prophylaxing for MAC? What else do you also have to check if their CD4 is less than 50?

A

Must r/o active TB infection in all. If CD4 less than 50, also must r/o active MAC infection.

290
Q

What are 3 metabolic complications associated with HIV infection and management?

A
  1. DM
  2. Hyperlipidemia
  3. Glc intolerance
291
Q

Why should all HIV patients be evaluated for active hep B and C?

A

Because co-infection is associated with increased risk of progression and worse prognosis

292
Q

Interrupting HIV therapy is associated with what 2 major complications?

A
  1. Increased CV events and death

2. Increased infectious complications

293
Q

When does IRIS develop in HIV/AIDS patients (in relation to beginning anti-retroviral therapy), and what is it?

A

Develops in the first few months of initiating therapy. It occurs because the patient’s reconstituted immune system has an intense inflammatory response to a preexisting infection (known or ASx)

294
Q

In patients w/ untreated HIV, when do opportunistic infections usually start?

A

Once CD4 is less than 200

295
Q

What is usually required for Dx of PCP?

A

Stains of BAL fluid

296
Q

5 MC manifestations of CMV in AIDS?

A
  1. Retinitis
  2. Esophagitis
  3. Colitis
  4. Polyradiculitis
  5. Encephalitis
297
Q

Describe the lesions of Kaposi sarcoma in AIDS patients

A

Color varies from red to purple to brown. Potential morphology includes macules, papules, plaques, or nodules.

298
Q

Which HIV patients get anti-retrovirals?

A

Whoever is ready to start, regardless of CD4

299
Q

What is the most important principle in treatment of HIV?

A

The ARV regimen must fully suppress viral replication to prevent the development of viral drug resistance

300
Q

How does viral load change with initiation of effective ARV treatment?

A

Viral load drops quickly and progressively within the first few wks of Tx, reaches undetectable levels within a few months, and remains undetectable as therapy continues,

301
Q

Name two booster drugs used in HIV treatment. What is the point of a booster drug?

A

Cobicistat and ritonavir. Booster drugs inhibit the metabolism of other anti-retrovirals, leading to improved therapeutic drug levels and allowing less frequent dosing.

302
Q

Describe the general recommendations for choosing an initial anti-retroviral treatment regimen.

A

Start with 3 drugs from 2 different classes, most commonly 2 NRTIs + either a protease inhibitor or an integrase inhibitor.

303
Q

When should you do resistance testing as a part of HIV/AIDS management? (2)

A

When ARV therapy is initiated and when treatment failures occur

304
Q

If performing resistance testing because of treatment failure in an HIV patient, when should you do it?

A

While the patient is still on the ineffective regimen

305
Q

Which pregnant women should be tested for HIV?

A

All of them

306
Q

Which HIV positive pregnant women should be given anti-retrovirals?

A

All of them- gotta reduce perinatal transmission

307
Q

Post-exposure prophylaxis for HIV- when should you start it (in relation to exposure), how many drugs, and how long should you continue it?

A

Start ASAP, 3 drugs, treat for 4 wk

308
Q

What is the FDA-approved regimen for HIV pre-exposure prophylaxis?

A

Once-daily combo pill of tenofovir-emtricitabine

309
Q

Seasonal flu disproportionately affects what age group?

A

65 and older

310
Q

4 groups of people predisposed to more severe flu infections?

A
  1. Very old
  2. Very young
  3. Chronic medical conditions
  4. Pregnant women
311
Q

2 MC complications of the flu?

A

Primary influenza pneumonia and secondary bacterial pneumonia

312
Q

During a confirmed local flu outbreak, how can you diagnose infection? Who should get confirmatory testing?

A

Diagnose on clinical criteria. Save confirmatory testing for pts at high risk of complications

313
Q

Who should get the flu vaccine?

A

Everyone 6 months old or older

314
Q

What are two drug options recommended for pts w/ confirmed or highly suspected flu who are at increased risk for complications?

A

Oseltamivir or zanamivir

315
Q

Most effective intervention for preventing the flu?

A

Annual flu vaccine

316
Q

What group of viruses causes SARS and MERS?

A

Novel RNA-containing coronaviruses

317
Q

2 MC manifestations of primary HSV-1 infection?

A

Gingivostomatitis and pharyngitis

318
Q

What virus is a very common cause of genital ulcer disease worldwide?

319
Q

3 drugs that are effective for treating episodic HSV infections and suppressing recurrent infections?

A
  1. ACV
  2. Val-ACV
  3. Famciclovir
320
Q

Name 4 benefits of starting either ACV, val-ACV or famciclovir within 72 hours of onset of VZV rash

A
  1. Accelerate lesion resolution
  2. Decrease new lesion formation
  3. Decrease viral shedding
  4. Lessen severity of acute zoster pain
321
Q

What age group should get the zoster vaccine in order to reduce the incidence and severity of zoster and post-herpetic neuralgia?

A

Immunocompetent people 60 and older

322
Q

MCC of infectious mono?

323
Q

3 main clinical features of mono?

A
  1. Exudative pharyngitis
  2. Fever
  3. LAD
324
Q

Which patients with EBV need steroids?

A

Only those with complications of EBV like compromised airway or auto-immune hemolytic anemia. Regular old mono doesn’t need steroids.

325
Q

Most cases of CMV are ASx. When primary infection is symptomatic, how does it typically present?

A

As a mono-like syndrome

326
Q

DOC in treatment of CMV reactivation in immunocompromised patients?

A

Ganciclovir

327
Q

3 primary indications for daptomycin?

A
  1. Gram positive complicated SSTI
  2. Staph aureus bacteremia
  3. Right-sided endocarditis
328
Q

2 primary indications for telavancin?

A
  1. Complicated SSTI caused by aerobic gram positive bugs (including MRSA)
  2. Staph aureus HAP
329
Q

What are two newly approved antibiotics for treatment of acute bacterial SSTI which can be dosed once weekly?

A
  1. Dalbavancin

2. Oritavancin

330
Q

Compare tedizolid (a new oxazolidinone) to linezolid? (3)

A
  1. More potent
  2. Active against linezolid-resistant staph aureus
  3. Lower risk for thrombocytopenia
331
Q

Name 3 highly resistant bugs that ceftaroline is active against.

A
  1. MRSA
  2. MDR Strep pneumo
  3. Vanc-intermediate, linezolid-resistant, daptomycin-nonsusceptible strains of staph aureus
332
Q

How does ceftaroline’s gram negative activity compare to that of ceftriaxone?

A

About the same

333
Q

Name 2 highly resistant bugs that ceftolozane-tazobactam is active against.

A
  1. MDR pseudomonas

2. ESBL E. coli

334
Q

When should you use tigecycline?

A

Only when alternate treatments aren’t available

335
Q

Describe spectrum of TMP-SMX

A

Broad aerobic, gram-positive, and gram negative activity

336
Q

Is TMP-SMX active against CA MRSA?

337
Q

What do you need to monitor in patients on colistin?

A

Renal function (it has dose-dependent nephrotoxicity)

338
Q

Describe main usefulness of fosfomycin. What are two types of infections you should definitely not use it for?

A

Major use is in treatment of lower UTIs caused by VRE faecium and other MDR uropathogens. Don’t use it for bacteremia or pyelonephritis.

339
Q

You must monitor aminoglycoside serum levels to avoid which two dose-dependent toxicities?

A

Oto and nephrotoxicity

340
Q

What style of aminoglycoside dosing creates less nephrotoxicity?

A

Extended-interval dosing

341
Q

What is the most commonly used rifamycin?

342
Q

Why isn’t rifampin used as monotherapy?

A

Development of resistance

343
Q

Describe bioavailability of rifampin

A

Excellent! It distributes widely through body tissues and fluids, even CSF

344
Q

4 big negative effects of suboptimal use of anti-microbials?

A
  1. Resistance
  2. Poor outcomes
  3. Increased costs
  4. Increased ADE

MKSAP: Key Points (6 decks)

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