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IDS Flashcards

1
Q

In the assessment of acutely ill patients Fever may be absent on which patients

A 
Elderly patients
Immunocompromised hosts 
uremic
Cirrhotic
on GC's or NSAIDS
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2
Q

Diagnostic work up for patients with severe infection

A

Blood For various exams ( Culture, Chem, CBC)- at the time Iv is placed and before giving antibiotics
For I E:3 sets of Blood cs
If Asplenic: Blood some dr: flowell - Jolly bodies
Buffy coat exam. Presence oF bacteria(> 10 to the 6 th us10 to the 4th in patients with intact spleen)
Blood smears: pX s at risk of parasitic infection: malaria, Babesiosis
LP For possible meningitis( before antibiotic and in the absence of pocst neurologic deficits)
Focal Abscesses: CT /MRI
Other Diagnostics: wound cultures etc.

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3
Q

Infections requiring urgent surgical attention

A

subdural em pyema, spinal epidural abscess, otolarhyngologic surgery for possible mucormycosis cardiothoracic Surgery ffor critically ill patients with acute endocarditis

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4
Q

Infections that require rapid intervention before other therapeutics /diagnostics

A

necrotizing Fasciitis

clostridial myonecrosis

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5
Q

possible Etiologies for Septic stock

A

pseudomonas, gram negative enteric bacilli, Staph, Strep

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6
Q

purpura fulminans

A

N. meningitidis

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7
Q

meningococcemia treatment

A

penicillin/ceftriaxone

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8
Q

Toxic Shock Syndrome is caused by

A

GABHS, Staph Aureus

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9
Q

Treatment For Acute Bacterial Endocarditis

A

Ceftriaxone+ vancomycin

covering For the Following: S. aureus, HACEK, B -hemolytic Strep, Neisseria sp, S, pneumonia

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10
Q

Septic shock patients at risk of adverse outcomes

A

elderly patients with co - morbid, concurrent malignancy and neutropenia, recent surgery/ hospitalization

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11
Q

septic shock patients that may present with hypotension and moDs

A

Gram negative bacteremia ( P. aeruginosa, E. coli)

Gram positive infection ( Staph /Strep)

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12
Q

what is the role Of CRP and Procalcitonin in septic Shock patients

A

NOT For Dx but can Facilitate de - escalation of therapy

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13
Q

pink, blanching, maculapapular(trunk and ext) becoming hemorrhagic, forming petechiae

A

meningococcemia

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14
Q

Cutaneous manifestation of DIC

A

purpura Fulminans

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15
Q

E cthyma Gangrenosum

A

P. aeruginosa/ Aeromonas hydrophila

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16
Q

Focal skin lesions and overwhelming sepsis seen in patients with liver disease is usually caused by

A

vibrio vulnificus

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17
Q

causes septic shock in asplenic patients with infection Following a dog bite

A

Capnocytophagia caninormus

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18
Q

Sunburn - type rash s usually diffuse, on face, trunk and extremities seen on TSS patients

A

Erythroderma

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19
Q

Risk factors For Necrotising Fasciitis

A

bm, PVD, iv drug use

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20
Q

Bacterial meningitis is most commonly associated with

A

S. pneumonia, N. meningitidis

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21
Q

Predisposing risk factors For Listeria monocytogenes meningitis

A

cell mediated immune deficiency

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22
Q

Poor prognostic Findings For Bacterial meningitis patients:

A 
coma, 
hypotension, 
meningitis due to S. pneumonia, 
respiratory distress, 
CSF glucose < l0mg/ dL, 
CSF protein> 2.5 
WBC 5000, 
Na< 135
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23
Q

Cerebral malaria is caused by

A

Plasmodium Falciparum

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24
Q

Jugular septic thrombophiliabitis caused by Fusobacterium necrophorum

A

Lemierre’s disease

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25
Q

Vaccines contraindicated For pregnant, Immunocompromised, HIV with CD4<200

A

MMR, varicella, zoster

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26
Q

HPV vaccine given to

a) Male b) Female

A

Males HPV 4

Females: HPV 2 and HPV 4

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27
Q

Zoster vaccination

A

single dose: for adults >/=60 years old regardless of prior episode of Herpes Zoster

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28
Q

Indications to Hib vaccine

A

Anatomical or Functional asplenia
sickle cell disease
undergoing Elective splenectomy( 14 or more days before)

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29
Q

Fever> 38.3 on at least 2 occasions > /= 3 weeks no known immunocompromised state and dx remains uncertain after a thorough investigation

A

Fever of Unknown Origin

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30
Q

More common non infectious causes of FUO

A 
Large vessel vasculitis
Polymyalgia rheumatica
Sarcoidosis
Familial mediterranean fever
Adult onset Still's disease
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31
Q

Schnitzler’s syndrome

A

FUO+ Urticaria
Bone pain
Monoclonal gammopathy

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32
Q

Most common cancer cause of FUO

A

Malignant Lymphoma

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33
Q

Miscellaneous cause of FUO

A

Exercise induced hyperthermia

Drug induced fever

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34
Q

Causes of drug induced fever

A

Allopurinol, carbamazepine, lamotrigine, phenytoin, sulfasalazine, furosemide, anti microbials, nevirapine

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35
Q

Exercise induced hyperthermia

A

Increase body temp associated with moderate-strenous exercise lasting 30mins to several hours not associated with inc in ESR, CRP

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36
Q

Most common infectious cause of FUO

A

Tuberculosis

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37
Q

Established imaging procedure in FUO

A

FDG-PET

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38
Q

For FUO pxs with TST positive or with anergy bit with granulomatous disease therapeutic trial with anti TB is indicated for how long

A

6 weeks

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39
Q

Recombinant IL 1 receptor antagonist given to FUO patients

A

Anakinra

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40
Q

Most common mode of entry of microbial pathogens into the alveolar level

A

Aspiration from oropharynx

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41
Q

Roles of alveolar macrophages in hosts defense

A

Phagocytic (innate)
antigen presenting cell to T cells (acquired)
produce many cytokines and mediators

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42
Q

Fever in pneumonia is due to

A

IL-1 and TNF

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43
Q

Peripheral leukocytosis and purulent secretions in pneumonia is due to

A

IL-8 and G-CSF

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44
Q

Capillary leak in pneumonia

A

Caused by inflammatory mediators released by alveolar macrophages and newly recruited neutrophils

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45
Q

Hypoxemia in pneumonia is due to

A

Alveolar filling

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46
Q

Causes of dyspnea in pneumonia

A

Decreased compliance due to capillary leak, hypoxemia, inc respiratory drive, secretions and interferon related bronchospasm

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47
Q

4 stages of lobar pneumonia

A
  1. Edema/congestion
  2. Red hepatization
  3. Gray hepatization
  4. Resolution
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48
Q

Predominant cells in gray hepatization

A

Neutrophils

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49
Q

Predominant cells in Resolution stage of Lobar pneumonia

A

Macrophages

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50
Q

Most common pattern in nosocomial pneumonia

A

Bronchopneumonia

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51
Q

Lobar pneumonia pattern is seen in

A

Bacterial CAP

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52
Q

VAP has what type of pneumonia pattern

A

Respiratory bronchiolitis

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53
Q

Typical bacterial pathogens in pneumonia

A

H. Influenza, s. Pneumonia, s. Aureus, klebsiella pneumonia, pseudomonas aeruginosa

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54
Q

Atypical bacterial pathogens in pneumonia

A

Mycoplasma, chlamydophila, legionella, Resp virus (influenza, adeno, human metapneumo, RSV)

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55
Q

Complications of anaerobic pneumonia

A

Abscess, empyema, effusions

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56
Q

Serious consequence of MRSA pneumonia

A

Necrotizing pneumonia

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57
Q

Risk factors for pseudomonas infection

A

Recent hosp/antibiotic therapy
Structural lung disease (bronchiectasis)
heart/renal failure
Alcoholism

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58
Q

Risk factors for Legionella infection

A 
Recent hotel stay/cruise ship
Male
Smoking
Renal disease
Immunocompromised (malignancy, HIV)
DM
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59
Q

Adequate sputum specimen for culture

A

> 25 pmns and <10 squamous cells per LPF

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60
Q

Indications for Blood culture for CAP

A

High risk patients (neutropenia, asplenia, complement deficiency)
chronic liver disease

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61
Q

CURB 65

A 
Confusion
Urea >7
RR >30
BP <90/60
65 age more than

Score
0= Opd
1= ward
2= ICU

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62
Q

Sensitivity classification of pneumococcal strains

A

MIC
= 2 SUSCEPTIBLE
= 2-4 INTERMEDIATE
= 8 RESISTANT

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63
Q

Risk factors for penicillin resistant pneumococcal infection

A 
Recent antimicrobial therapy
Age <2 or >65
Attendance at daycare centers
Recent hospitalization
HIV infection
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64
Q

Microbial infection resulting to necrosis and cavitation of the pulmonary parenchyma

A

Lung abscess

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65
Q

Primary lung abscess is due to

A

Aspiration of anaerobic bacteria or occur in the absence of an underlying pulmonary or systemic condition

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66
Q

Classification of lung abscess based on duration

A

Acute <4-6wks

Chronic >6wks (40%)

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67
Q

Most common location of primary lung abscess

A

Posterior upper and superior lower

R>L

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68
Q

Most common cause of secondary lung abscess

A

Pseudomonas, gram negative rods

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69
Q

Preferred imaging for lung abscess

A

CT

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70
Q

Treatment for primary lung abscess

A

Clindamycin 600mg iv tid then with fever lysis and clinical improvement 300mg po qid
Iv beta lactamase followed by co amox
Tx ranging from 3-4wks to 14wks until clearance/regression

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71
Q

Indication for surgical intervention in lung abscess

A

Failure of antibiotic tx

>8cm size

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72
Q

Etiologic agents in community acquired native valve endocarditis

A 
Oral cavity: viridans strep
Skin: staph
URT: HACEK
GIT: strep bovis/gallolyticus
GUT: Enterococci
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73
Q

Health care associated NVE

A

Staph aureus, CoNS, enterococci

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74
Q

Prosthetic valve endocarditis

A

Within 2 mos: s aureus, CoNS, gram neg bacilli, diph, fungi
2-12mos: CoNS
>12mos: community assoc NVE

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75
Q

Endocarditis among IV drug users

A

MRSA affecting tricuspid valve (right sided)

polymicrobial (left sided)

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76
Q

Pathogenesis in IE

A

Endothelial injury leading to direct infection by virulent organisms and development of platelet-fibrin thrombus (NBTE- non bacterial thrombotic endocarditis)

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77
Q

Nonsuppurative peripheral manifestation of subacute endocarditis and related to prolonged infection

A

Janeway lesions

78
Q

Septic embolization seen in s. Aureus endocarditis

A

Osler’s nodes

79
Q

Focal dilations of arteries occuring at points in the artery wall that have been weakened by infection in the vasa vasorum or where septic emboli have lodged

A

Mycotic aneurysms

80
Q

Diagnosis of IE based on DUKE’S CRITERIA

A

Definite: 2 major or 1 major 3 minor or 5 minor
Possible: 1 major and 1 minor or 3 minor

81
Q

Hand foot and mouth disease

A

Coxsackie virus A16

82
Q

Staphylococcal scalded skin syndrome

83
Q

Gas gangrene

A

Clostridium

84
Q

Bullous impetigo

A

Staph aureus

85
Q

Impetigo contagiosa

A

Strep pyogenes

86
Q

Hot tub folliculitis

A

Pseudomonas

87
Q

Swimmers itch

A

Schistosoma

88
Q

Erysipelas

A

Strep pyogenes

89
Q

Most common causes of infectious arthritis

A

S. Aureus, neisseria gonorrhea

90
Q

Most common route of entry into the joints

A

Hematogenous

91
Q

Common joint infection among patients with RA

A

Polyarticular

92
Q

Periods of greatest risk to develop gonococcal arthritis among women

A

Menses and pregnancy

93
Q

Culture results of patients with true gonococcal septic arthritis
Synovial fluid and blood

A

SF: positive in < 40%
Blood: negative

94
Q

Treatment for true gonococcal septic arthritis

A

Ceftriaxone once local and systemic signs are clearly resolving the 7 day course may be completed with cefixime or ciprofloxacin or if penicillin susceptible, amox

95
Q

Reiter’s syndrome

A 
Urethritis
Conjunctivitis
Uveitis
Oral ulcers
Rash
96
Q

Most commonly affected bone with osteomyelitis in adults

97
Q

Acute osteomyelitis is managed with

A

Antibiotics only

98
Q

Gold standard for diagnosis of osteomyelitis

99
Q

Most commonly associated with primary (spontaneous) bacterial peritonitis

A

Liver cirrhosis

100
Q

Most common presentation of patients with primary peritonitis

101
Q

Diagnostic finding of ascitic fluid of SBP patients

102
Q

Most common bacterial isolate in SBP

A

E. Coli or other gram neg

Typically single organism

102
Q

Most common bacterial isolate in SBP

A

E. Coli or other gram neg

Typically single organism

103
Q

Antimicrobial treatment for Primary (spont) bacterial peritonitis

A

3rd gen ceph (ceftriaxone, cefotaxime)
piptaz
Coverage: gram neg aerobic bacilli, gram positive cocci

104
Q

Bacterial contamination of the peritoneum as a result of spillage from an intraab viscus

A

Secondary peritonitis

105
Q

Diagnostics for secondary peritonitis

A

Abdominal tap RARELY indicated, ONLY done in trauma patients
Stable: abdominal CT
Unstable: surgery prior to imaging

106
Q

Antimicrobial treatment for secondary peritonitis

A

Ticarcillin/clavulanate
Cefoxitin
Levox
Ceftri + metro

ICU pxs: imipenem, merop, ampi+metro+cipro

Coverage: gram neg aerobic bacilli and anaerobes

107
Q

Most common bacteria associated with CAPD peritonitis

A

Staphylococcus

108
Q

Most common anaerobic isolate in intraabdominal abscess

A

Bacteroides fragilis

109
Q

Most common cause of intraabdominal abscess

A

Fecal spillage from a colonic source

110
Q

Highest diagnostic yield for intraabdominal abscesses

A

Abdominal CT

111
Q

Most common source of liver abscess

A

Disease of the biliary tract

112
Q

Most common presenting sign of liver abscess

113
Q

Single most reliable laboratory finding in liver abscess

A

Increased alkaline phosphatase (70%)

114
Q

Most common pathogens isolated in liver abscess

A

If arising from biliary tree: gram negative aerobic bacilli
Pelvic and other intraabdominal source: mixed but mostly b. Fragilis
Hematogenous: staph, strep
Patients on chemo: candida
Amoebic: serologic test with positive result >90%

115
Q

Management for liver abscess

A

Mainstay: drainage percutaneous or surgical
~ SURGICAL : presence of multiple, sizable abscesses, viscous abscess, asso dse req surgery or lack of response to percutaneous drainage (4-7days)

Medical: same as intraab sepsis and sec peritonitis

116
Q

More common cause of splenic abscess

A

Hematogenous

117
Q

Most common infection associated with splenic abscess

A

Bacterial endocarditis

118
Q

Predisposing risks for splenic abscess

A

immunosuppressive therapy, hemoglobinopathies, other hematologic disorders( sickle cell)

119
Q

Most sensitive diagnostic tool for splenic abscess

A

CT scan of the abdomen

120
Q

Most common isolate for splenic abscess

A

Streptococci

St aph aureus( 2nd most common)

121
Q

Standard management and best approach to patients with complex, multi localbr, multiple splenic abscess

A

Splenectomy with antibiotics ( adjunct)

122
Q

Preferred approach to patients with high surgical risk and single<3cm splenic abscess

A

Percutaneous drainage

123
Q

Portal of entry for perinephric and renal abscess

A

UTI( 75 %)

124
Q

Most important risk factor for Renal Abscess

A

Nephronthiasis obstructing urinary flow

125
Q

Most common isolates in Renal Abscess

A

E .coli, Proteus, klebsiella

126
Q

Most useful diagnostic modalities for Renal Abscess

A

Renal UTZ and Abdominal CT

127
Q

Treatment for Psoas Abscess

A

Surgical drainage and administration of an antibiotic regimen directed at the inciting organism
IF associated with pott’s: m.TB
others: Staph, mixed organisms

128
Q

Mechanisms of Gastrointestinal Pathogens Cansing diarrhea

A

Non Inflammatory (enterotoxin)
Inflammatory ( invasion or cytotoxin)
Penetrating

129
Q

Non inflammatory diarrhea usually presents with usterry diarrhea and affects what part of the colon

A

Proximal Small bowel

130
Q

Enteric fever has what mechanisms of diarrhea affecting the distal colon

A

Penetrating

131
Q

Cause watery diarrhea by acting directly on secretory mechanisms in the intestinal mucosa

A

Enterotoxin

132
Q

Causes destruction of mucosal cells and produce dysentery syndrome, with bloody Stools containing Inflammqtory Cells

133
Q

Cytotoxin producing enteric pathogens:

A

Shigella dysenteriae type 1( hemorrhagic colitis)
v. parahaemolYticus
Clostridium difficille
Shigq toxin_ producing strains of E .co li ( HUS)

134
Q

Predominant cause of Nosocomial diarrhea in adults

A

C. Difficile

135
Q

Considered if with history and stool exam indicating a non inflammatory etiology of diarrhea and there is evidence Of a common - outbreak

A

Bacterial food Poisoning

136
Q

Associated with contaminated fried rice due to germination of Spore when cooked rice is not refrigerated

A

Emetic form of Bacillus cereus

137
Q

Diarrhea with slightly longer duration( 8-14 H) results from the survival of heat resistant spores in inadequately cooked meat, poultry or legumes

A

Clostridium perfringens

138
Q

Culture media For cholera

139
Q

culture media For Shigella and Salmonella

A

Mac (onkey agar

140
Q

Inexpensive agent for prophylaxis of travelers diarrhea

A

Bismuth subsalicylate

141
Q

Resistance of TB bacilli to at least Rifampicin and Isoniazid

142
Q

Resistance to INH -R- FQ+ One Iv aminoglycoside

143
Q

most common mode or transmission of TB

A

Aerosolized droplet

144
Q

Most likely to transmit PTB

A

(+) Sputum AFB by microscopy
cavitary PTB
laryngeal PTB

145
Q

Non infectiouS TB

A

culture negative TB and extrapulmonary TB

146
Q

Encodes for catalase/ peroxidase enzyme to protect against Oxidative stress required nor isoniazid activation and subsequent bactericidal activity

147
Q

Encodes a key step in gly oxy late shunt that Facilitates bacterial growth on fatty acid substrate I required for Long term persistence of m. T B

A

Isocitrate lyase gene, icl1

148
Q

control of r R NA transcription required for replication and persistence of the host all

A

car D gene

149
Q

determine susceptibility to TB

A

NRAMP1(at chromosome 2q)

150
Q

Delayed type hypersensitivity ( DTH) reaction to various bacillary antigens, can destroy un activated macrophages that contain multiplying bacilli and cause caseons necrosis

A

Tissue damaging response

151
Q

T. cell- mediated phenomenon resulting in activation of macrophages that are capable of killing and digesting tubercle bacilli

A

macrophage activating response

152
Q

Lymphocytes and activated macrophages evolve to epithelioid and giant cell

A

Granulomatous lesions ( tubercles)

153
Q

Bacilli remain active forming biofilms in necrotic areas where they temporarily hide

154
Q

Healed lesions in lung parenchyma and hilar Lymph nodes may Later undergo calcification

A

Ranke complex

155
Q

confers partial immunity against m. tuberculosis

A

Cell- mediated immunity

156
Q

complication characterized by rupture of dilated vessel in a cavity leading to massive hemoptysis

A

Rasmussen’s aneurysm

157
Q

most common presentation of extrapulmonary TB

A

TB lymphadenitis

158
Q

Gold standard for Diagnosis OfTB meningitis

A

CSF culture

159
Q

uncommon manifestation of TB, presents as One or more SOL and usually causes seizure and focal signs

A

Tuberculoma

160
Q

Most common sites affected by GI TB

A

terminal ileum and cecum

161
Q

Pathognomonic of military TB

A

choroidal tubercles( 30 % 0f cases)

162
Q

chronic pulmonary Aspergillosis as a complication of PTB is treated with

A

Itraconazole 6 months

163
Q

Measure of variability, number AFBin skin scrapings that stain uniformly bright in leprosy patients

A

morphologic Index

164
Q

A logarithmic scaled measure of the density of M. leprae in the dermis

A

Bacteriologic Index

4+ to 6+ in untreated patients and decreases with effective therapy

165
Q

Relapse or drug resistance in Leprosy patients is indicated by

A

Increasing Bacteriologic ald morphologic index

166
Q

key component in the cell membrane of M. leprae

A

Lipoarabinomannan

167
Q

Less severe end of the spectrum Of leprosy with symptoms usually confined to the skin and peripheral nerves
may present with out nerve trunk involvement with no skin lesions ( neural leprosy)
Lepromin test positive

A

Tuberculoid leprosy

168
Q

More severe end Of the Leprosy spectrum
characteristic Leonine facies
Negative Lepromin test

A

Lepromatons leprosy

169
Q

Most commonly affected nerve trunk in Leprosy

A

Ulnar nerve
NOTE: median nerve: impairs thumb opposition and grasp
radial nerve: Rare in leprosy leads to wrist drop

170
Q

Partial or complete Footdrop in leprosy

A

peroneal Nerve palsy

171
Q

Treatment for Leprosy

A

CRD
clofazimine
Rifampin
Dapsone

Rifampin is the only bactericidal
Dapsone ( Folate antagonist) Sulfones: mainstay therapy
> causes severe he momsis in G 6 P D deficient individuals
Clofaziomine causes red black skin discoloration

172
Q

Classification of leprosy based on number of Skin lesions ( WHO)

A

Paucibacillary < 5 lesions

multibacillary >/= 5 lesions

173
Q

Classification of leprosy based on number of Skin lesions ( WHO)

A

Paucibacillary < 5 lesions

multibacillary >/= 5 lesions

174
Q

Associated with aspirin given to patients with influenza b infection

A

Reye’s syndrome

175
Q

Treatment for refractory arthritis in Chikungunya

A

Chloroquine

176
Q

Characteristic pathologic CNS finding in rabies

A

Cytoplasmic inclusions - Negri bodies

177
Q

Two acute neurologic forms of rabies in humans

A
  1. Encephalitic (80%)

2. Paralytic (20%)

178
Q

Six genus of plasmodium causing malarial infections in humans

A 
P. Malaria
P. Falciparum
P. Vivax
P. Ovale (2 morphologically identical sympatric species)
P. Knowlesi
179
Q

Pathogenesis of malaria

A

Due to direct effects of rbc invasion and destruction by the asexual parasite and the hosts reaction

180
Q

In patient infected with malaria when do symptoms occur

A

When merozoites are released into the bloodstream reaching densities of 50/ul of blood (100M parasites in the blood of an adult)

181
Q

Responsible for relapses in p. Vivax and ovale

A

Hypnozoites

Remains dormant in the liver for 3 weeks to a year

182
Q

When merozoites invade rbcs the become

A

Trophozoites multiplying 6-20 fold every 48-72H

183
Q

At the end of the intraerythrocytic stage the trophozoite nearly consumes 2/3 of the rbcs hgb and has grown to occupy thw cell

184
Q

Schizogony/merogony

A

Mult nuclear divisions, rbc ruptures to release 6-30 daughter merozoites capable of invading new rbcs to repeat the cycle

185
Q

Transmission of malaria

A

Parasites develop morphologically distinct, longer lived SEXUAL forms (gametocytes) that can transmit malaria

186
Q

Sporogony in malaria

A

When a biting female anopheline mosquito ingests a gametocyte and forms a zygote in its midgut which will later mature and produce sporozoites

187
Q

Most common measure of malaria transmission rate

A

Entomologic inoculation rate

188
Q

Fever spike patterns in malaria

A

Tertian every 2 days

Quartan every 3 days

189
Q

Genetic disorder that confers protection against death from falciparum malaria

A 
Sickle cell disease
Hemoglobin  C and E
Hereditary ovalocytosis
Thalassemia
G6PD

Harri 's Quick peak (10 decks)

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